Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Xanthoma of Fallopian Tube in Young Female- An Uncommon Entity Hima Sree Edupuganti, PV Nikhil, Jessica Minal, Archana Shetty, Kanna Sandhyarani Xanthomas or xanthelasmas are rare benign tumours characterised by localised lipid deposits within an organ system which can be an important sign of systemic disease. These tumours have a predilection for skin and subcutaneous tissue, the most common visceral site being the Gastrointestinal (GI) tract. Xanthoma in female genital tract is a rare finding and should be considered as a differential diagnosis for abdominal pain in a reproductive age group. This is an unusual case of xanthoma of fallopian tube in a 27-year-old female presenting with lower abdominal pain. Ultrasonography (USG) revealed right hydrosalpinx. The histopathological examination of fallopian tube showed sheets of foamy macrophages with peripherally placed nucleus and abundant vacuolated cytoplasm in the lamina propria which was positive for Cluster of Differentiation 68 (CD68) and negative for Cytokeratins (CK). A final diagnosis of xanthoma of right fallopian tube was made. Fallopian tube xanthomas must be distinguished from xanthogranulomatous salpingitis, which is associated with an inflammatory cell infiltrate, often including giant cells and plasma cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ED01-ED02&id=16146 https://doi.org/10.7860/JCDR/2022/52435.16146 Unilateral Double Subscapular Artery: A Case Report Jailenne I Quiñones-Rodríguez, Valeria Lozada-Miranda, Natalia del Mazo-Arbona, Martin G Rosario Variations in the Subscapular Artery (SA) are among the most common variations in the Axillary Artery (AA) and its branches. However, the occurrence of a common trunk from the third division is unusual. Hereby, authors report an atypical variation in the distal division of the axillary artery found during routine dissection of an elderly female cadaver. In this donor, the third portion of the AA gave rise to an SA, a common trunk, and the anterior circumflex humeral artery. In addition, the common trunk gave rise to a second SA, the posterior circumflex humeral artery, the scapular circumflex artery, and the thoracodorsal artery. Both SA branches appeared to irrigate the subscapularis muscles. Comprehension of the diverse anatomical variations of the subscapular artery is critically important in surgical procedures and therapeutic interventions for the upper limb. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=AD01-AD03&id=16183 https://doi.org/10.7860/JCDR/2022/52633.16183 <i>Chryseobacterium gleum</i>: A Rare Pathogen from Respiratory Tract Infections- A Case Report Mohammad Mukhit Abdul Gaffar Kazi, Gayatri S Gurav, Chinmay K Saraf, Mangesh G Bolegave, Sonam D Shinde It is well known that Hospital Acquired Infections (HAIs) are a major concern in the field of medicine. The newer pathogens have been implicated as one of the causative agents in these infections. Recently our laboratory had reported a rare pathogen from a postoperative case admitted in the tertiary care hospital. The causative agent was a Gram negative bacillus, which was identified as <i>Chryseobacterium gleum</i> by automation method (VITEK 2 Biomeriux). This is a rare bacterium that was isolated from a respiratory specimen of a 32-year-old male who was involved in a road traffic accident. Repetitive culture was done followed by Gram stain and biochemical reactions and identified as <i>Chryseobacterium gleum</i> by automated system. It is interesting to study this bacterium for its virulence, habitat and source of infections. This is the second case report which has been reported as a causative agent in HAI as per our knowledge from India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=DD01-DD02&id=16184 https://doi.org/10.7860/JCDR/2022/53010.16184 Bilateral Xanthogranulomatous Oophoritis Mimicking Malignancy- A Rare Case Report Hardik Kabra, Prajna Das, Devika Chauhan, Sarojini Raman, Urmila Senapati Xanthogranulomatous Oophoritis is an uncommon form of chronic inflammation of genitourinary system. The exact aetiology of this entity is unknown, but it shares similar histopathological findings to those occurring in various other organs, including the gallbladder and kidney. It is often mistaken for ovarian malignancy clinically and radiologically. A vigilant histopathological evaluation is important to diagnose the disease. The current case is of 38-year-old, premenopausal female who presented with fever and lower abdominal pain. The case was suspected as bilateral malignant adnexal mass by imaging and tumor marker studies. Final diagnosis of bilateral xanthogranulomatous oophoritis was established after histopathological examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ED06-ED07&id=16191 https://doi.org/10.7860/JCDR/2022/51966.16191 Dilated Cardiomyopathy with Congestive Hepatopathy in Post COVID-19 Patient- A Case Report Mustaq Ahmed, Siva Ranganathan Green, Divya Sundar In the current situation of pandemic, Coronavirus Disease 2019 (COVID-19), main organ involvement is of respiratory system ranging from mild symptoms to acute severe respiratory distress syndrome. Some studies are showing an increasing number of patients being hospitalised for COVID-19 with acute heart failure and multi-system inflammatory state. A 17-year-old male, with no known co-morbidities, presented with breathlessness and jaundice. He was diagnosed as a case of Dilated Cardiomyopathy (DCM) with congestive hepatopathy. He was treated with diuretics and supportive medications for which he showed symptomatic improvement, and there was a significant improvement in his ejection fraction during the course of treatment. The patient had Coronavirus Disease 2019 (COVID-19) infection 15 days prior to the onset of the above symptoms. The progression of COVID-19 complications seems potentially life-threatening, if associated with cardiac and hepatic manifestations. The present case illustrates the probable course of the ailment that has led to DCM. There was liver involvement too which was monitored and treated meticulously. These patients have high chances of deterioration even in simple situations of fever or pain, due to an increase in metabolic demands. It is a unique case which shows a strong association between COVID-19, acute heart failure, and congestive hepatopathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OD04-OD07&id=16179 https://doi.org/10.7860/JCDR/2022/53273.16179 Lipoma Arborescens of Hip Joint in a Case of Ankylosing Spondylitis Nikita Jindal, Ranjana Gupta, Puneet Mittal, Venkata Raviteja Reddy Gayam, Sanjay Singh Lipoma arborescens is a rare synovial pathology that is most commonly seen in the knee joint. Only a few cases of this condition have been reported in the hip joint. Here the authors present a case of a 35-year-old female patient who presented with active bilateral sarcroiliitis who was a known case of Human Leukocyte Antigen B27 (HLA-B27) positive ankylosing spondylitis for the past four years. The Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings suggestive of Lipoma arborescens of the hip joint in association with ankylosing spondylitis is reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TD01-TD02&id=16162 https://doi.org/10.7860/JCDR/2022/53664.16162 Rare Case of Severe Post Adenoidectomy Secondary Haemorrhage Gaurang Singhal, Pradeepti Nayak, Nishi Sharma Tonsillectomy and adenoidectomy are amongst the most common surgeries performed in children. Haemorrhage, after and during these procedures, is a major and known complication. Most commonly, the haemorrhage presents intraoperatively or in the immediate postoperative period and is self-limiting. However, secondary haemorrhage presenting after adenoidectomy where adenoidectomy alone was performed have been reported in very few patients. In this case, a 10-year-old male presented with history of upper airway obstruction including sleep apnoea, adenoid facies, and bilateral moderate conductive hearing loss since four years. He had no co-morbidities, history of bleeding diathesis. The preoperative evaluation of the adenoids (clinically and radiologically) revealed no abnormal vasculature or anatomical variations. Conventional adenoidectomy and bilateral grommet insertion was performed under General Anaesthesia (GA). The postoperative period was entirely uneventful, and the patient was discharged on postoperative day 3. Despite having no risk factors, he presented with profuse posterior epistaxis after conventional adenoidectomy on postoperative day 5. Immediate management was done by posterior nasal packing and intravenous amoxicillin-clavulanate. Definitive treatment was done by re-exploration and debridement of the remnant adenoid tissue using a microdebrider under GA the next day. The patients had no complaints postoperatively or at 6 months follow-up. The rarity of complications makes adenoidectomy a fairly safe procedure. However, despite being uncommon, secondary complications of adenoidectomy should be anticipated by surgeons to avoid dire consequences for the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=MD01-MD03&id=16207 https://doi.org/10.7860/JCDR/2022/53480.16207 Tubercular Meningitis Presenting as Multiple Cranial Nerve Palsy Upesh Shivkumar Parati, Ponvijaya Muthuswamy Yadav, Vijayashree S Gokhale, Keyuri Mehta, Chirag Gurbani Tubercular Meningitis (TBM) is caused due to the seeding of meninges with <i>Mycobacterium tuberculosis</i> and about one-third of the world&#8217;s population is infected with it. The risk of contracting the infection increases in immunocompromised states which includes diabetes mellitus, chronic use of steroids, chronic alcoholism and Human Immunodeficiency Virus (HIV) co-infection. Here, a case of 47-year-old female has been presented, who reported to the Department of Medicine with complaints of weakness over the left side of the face associated with diminished hearing and tinnitus in the left ear and subjective vertigo since 20 days. Initially, all the above involvement was attributed to bell&#8217;s palsy but no improvement was seen with its treatment. Incidentally, she was found to be HIV positive and lumbar puncture was done and eventually, she was diagnosed as a case of TBM. The patient was successfully treated with antitubercular medications and supportive measures and she responded well. She was discharged with antitubercular medications with regular follow-up in view of starting antiretroviral therapy after 6 weeks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OD08-OD09&id=16211 https://doi.org/10.7860/JCDR/2022/55069.16211 An Unusual Case of Post-traumatic Bilateral Anterior Shoulder Dislocation Ashwinkumar Vasant Khandge, Gaurav Lalasaheb Patil, Rahul Salunkhe, Sayooj Sukrethan, Siddharth Bilateral anterior shoulder dislocation is a rare entity. It is uncommon for bilateral shoulder dislocations to occur simultaneously and they almost always occur in the posterior direction. On the other hand, only a few cases of anterior shoulder have been reported. A 46-year-old male reported to the Emergency Orthopaedic Department after an automobile accident with complaints of pain and swelling over bilateral shoulders. The patient presented with severe ecchymosis over the anterior aspect of both shoulder joints. There was a bilateral anterior flattening of shoulder contour and anterior fullness. Plain radiographs revealed anterior dislocation of both the shoulder joints. The reduction was done by Kocher&#8217;s manoeuvre. Radiographs were repeated after the treatment and showed a considerable reduction. Both the shoulder joints were immobilised in arm chest bandaging. Both traumatic and atraumatic causes can lead to bilateral anterior shoulder dislocation. Such dislocations occurring simultaneously are rare. The aetiology behind dislocations should not conflict the emergency physicians or orthopaedic surgeons regarding the diagnosis. Fracture, neurovascular injuries, rotator cuff tear may be associated with such dislocations. Diagnosis can easily be made by clinical and radiological examinations. An early reduction, proper follow-up and adequate physiotherapy can regain a full range of movements. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=RD01-RD03&id=16204 https://doi.org/10.7860/JCDR/2022/51792.16204 Acute Necrotising Pancreatitis in a Patient with Situs Inversus Totalis- A Rare Case Report Rohith Muddasetty, Kolandasamy Chinnusamy, Prabhakaran Raju, Sugumar Chidambaranathan, Naganathbabu Obla Lakshmanamoorthy Situs inversus totalis is a rare congenital anomaly occurring in one per 4000-20000 live births. It can present in early life due to gut rotation abnormality, however majority of them are asymptomatic and identified later in life when they undergo imaging for other reasons. Although acute pancreatitis is a common disease in young adults, presence of situs inversus alters the approach for necrosectomy when it is necessary. Here, author reports a 29-year-old male patient who had acute necrotising pancreatitis and incidentally found to have situs inversus totalis. Since the patient required drainage of necrotic collection there was a change in approach to right flank region rather than the routine left flank. This case was reported to emphasise on identification of situs anomalies and need to alter surgical approach. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PD01-PD02&id=16217 https://doi.org/10.7860/JCDR/2022/51532.16217 Radical Surgery for Successful Management of Axillary Hidradenitis Suppurativa Complicated by Mycobacterial Infections Srinjoy Saha Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to localised immunosuppression. Sometimes, it causes superadded Non tuberculous mycobacterial infections that require radical surgeries. After an extensive literature search, no Indian case report on this rare topic could be found, and this case report aims to fill up the void. A 28-year-old female presented with recurrent ulcers over her left axilla, which were refractory to medical treatments and surgeries for the last five years. Earlier, she had received a six month course of antitubercular drugs after Acid-Fast Bacilli (AFB) were found on pus examination. When the ulcers recurred afterward, she was empirically diagnosed as Non tuberculous mycobacterial infection in Thailand and treated with appropriate antibiotics for three months. However, multiple ulcers in new areas recurred over her axilla about a month after her treatment schedule was completed. To achieve complete surgical cure, radical excision of all the tracts, fistulae, and sinuses over her axilla was performed under ultrasound guidance. Wide excision resulted in a significant axillary defect that was reconstructed with large advancement flaps aided by progressive tension sutures. Postoperatively, a seven year follow-up period of the patient was disease-free with the patient taking all necessary precautions. After seven years, the affected axilla appeared near-normal with some areas of stretched scars that did not bother the patient. To conclude, HS with Non tuberculous mycobacteria is rare, and a proper antimicrobial therapy with early en bloc excision under ultrasound guidance produced a complete cure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PD03-PD05&id=16228 https://doi.org/10.7860/JCDR/2022/53802.16228 Congenital Partial Bronchial Atresia of Right Middle Lobe- A Rare Cause of Dyspnoea J Mohanakrishnan, AS Aravind Raj, L Koushik, M Yasar Arafat Congenital Bronchial Atresia (CBA) is a rare congenital condition with features of focal obliteration of a proximal segment of a bronchus. Left upper lobe is the most commonly involved lobe. Authors hereby, present a case report of a 17-year-old male who presented with exertional dyspnoea, cough and chest pain. High Resolution Computed Tomography (HRCT) chest showed hyperventilated lung parenchyma with paucity of bronchovascular pattern in right middle lobe. Bronchoscopy revealed right middle lobe bronchial segmental atresia with rudimentary bronchus above that segment. The patient was treated with bronchodilators, steroids and improved symptomatically and advised surgical management. Patient was not willing for the same and hence managed conservatively. Though definite management for CBA is done surgically, medical management can be preferred for patients with mild symptoms and without recurrent infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OD10-OD11&id=16229 https://doi.org/10.7860/JCDR/2022/53402.16229 Inflammatory Subcutaneous Pseudotumour due to Migrating Foreign Body through Concealed Colonic Perforation: A Case Report Vikas Jadhav, Varsha Rangankar, Anmol Singh, Purnachandra Lamghare, Merry Francis Kallely Foreign body ingestion though a common occurrence, rarely leads to bowel perforation. Thus, foreign body migration presents a diagnostic challenge. The author presents a case report of a 75-year-old female with a inflammatory subcutaneous pseudotumour due to migrating foreign body through a concealed colonic perforation. The patient presented with insidious abdominal pain and fever since two months, with local tenderness and palpable lumbar in right lumbar region on examination. The diagnosis was initially made on ultrasound and confirmed on Computed Tomography (CT). Surgical removal of the foreign body was done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TD03-TD05&id=16238 https://doi.org/10.7860/JCDR/2022/52461.16238 A Case Report on Management of Recurrent Ectopic Pregnancy- A Medical Success Shyma Thondalil Seeni, Vinitha Wills, NS Sreedevi Recurrent ectopic cases have been on the rise as there is increase in Artificial Reproductive Techniques (ART) recently. Earlier patient presentation and more precise diagnosis by proper clinical examination and with proper interpretation of serial &#946;-human Chorionic Gonadotropin (&#946;-hCG) allows identification of an ectopic pregnancy before ruptures and differentiates from other common conditions like infection, miscarriage, degenerating leiomyomas or pain around ligament. Various studies have been conducted over time to set a discriminatory zone for &#946;-hCG. Initially, the cut-off for &#946;-hCG was taken to be 1000-2000 mIU/mL. But now the cut-off has been increased to 3510 mIU/mL. Methotrexate has been used as first line drug in medical management of ectopic pregnancy for a long time. But methotrexate has been used with caution when laboratory values show a high &#946;-hCG. Here, authors report a case of a 29-year-old female with recurrent ectopic pregnancy which was successfully managed with methotrexate therapy despite the initial high &#946;-hCG values thus avoiding a surgical intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QD01-QD02&id=16249 https://doi.org/10.7860/JCDR/2022/52914.16249 Left Gastric Artery Pseudoaneurysm within a Pancreatic Pseudocyst: A Case Report Budumuri Gautam V Kumar, Prasanna Kumar Beeram, Udit Chauhan, Itish Patnaik, Rohit Gupta Left gastric artery Pseudoaneurysm (PSA) is a rare vascular complication of Acute Pancreatitis (AP), resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst. The splenic artery is the commonest artery involved, followed by the gastroduodenal artery and pancreaticoduodenal arteries. The occurrence of left gastric artery PSA within a Pancreatic Pseudocyst as sequelae of AP is rare but a significant life-threatening complication. Only a few cases have been reported on left gastric PSA causing haemorrhagic pseudocyst. The authors report a case of AP in a 57-year-old male with history of significant alcohol consumption who presented with pain in abdomen of pancreatic origin. On evaluation, he had a pseudocyst in the pancreatic head. After transpapillary drainage of the pseudocyst, it started draining bloody contents. An abdominal computed tomography was obtained, which showed a small left gastric artery PSA. The patient underwent successful angiographic coil embolisation of the PSA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OD12-OD13&id=16255 https://doi.org/10.7860/JCDR/2022/50664.16255 Multiple, Eruptive and Generalised Lobular Capillary Haemangiomas- A Rare Morphological Variant Samuel Jeyaraj Danie, Suresh Kumar Ramalingam, R Karpagavalli, S Anitha Christy, P Deepavarshini Lobular Capillary Haemangioma or Pyogenic Granuloma (PG) is a common benign, vascular proliferative lesion, usually occurring at sites of preceding trauma. It is known to occur more commonly in children and young females. The most common presentation is a solitary lesion. Multiple, eruptive PG have been reported after antecedent burns, trauma and following retinoid therapy and as satellite lesions after treatment of a primary lesion. A 14-year-old female, without any co-morbidities presented with spontaneous onset of multiple, eruptive and generalised skin coloured papules and nodules over face, neck, upper chest and upper back. The lesions were eruptive in nature, involved the back, face and upper trunk over duration of four months. There was intermittent bleeding from the lesions after trivial trauma. Clinical diagnosis of lobular capillary haemangioma was confirmed by histopathology which showed lobules of variably dilated network of blood filled capillaries in the papillary dermis surrounded by typical epithelial collarette. The lesions were removed by Radiofrequency (RF) in subsequent sittings. The present case report features an interesting and unusual morphological presentation of generalised eruptive lobular capillary haemangioma, which occurred de novo in a young female without any associated skin or systemic disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=WD01-WD02&id=16263 https://doi.org/10.7860/JCDR/2022/53101.16263 Pedunculated Intraperitoneal Lipoma Presenting as Ovarian Torsion: A Case Report Vijayalakshmi Kandasamy, J Jennifer Britto, S Renuka, Priya Murugan Lipoma is a very common (prevalence 39%) benign soft tissue tumour that is composed of mature fat. Lipomas, though common on external surface of body, also have been reported in mediastinum, chest wall, thorax, retroperitoneal areas and pelvis. In Gastrointestinal Tract (GIT), lipomas are mainly found in the submucosa and subserosa of the small and large intestine. An eight-year-old female child presented with a feature suggesting torsion of the dermoid ovarian cyst. The clinical features included sudden abdominal pain, vomiting and other symptoms suggesting a differential diagnosis of appendicitis or an ovarian cause. Serum markers for carcinoma were normal. The Contrast Enhanced Computed Tomography (CECT) showed a right iliac fossa fat density with few internal septations and Magnetic Resonance Imaging (MRI) confirmed the torsion of the pedunculated mass and histopathological examination showed the mass as lipoma. The site of the lipoma, presented in this case, is rare. Though the presentation of intraperitoneal lipoma is rare, this should be considered as differentials in young patients presenting with features of ovarian torsion. The presentation of intraperitoneal lipoma especially in young patient is rare which is mostly an incidental finding in a laparotomy and mostly present as a case of obstruction or abdominal pain. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QD03-QD04&id=16265 https://doi.org/10.7860/JCDR/2022/52733.16265 Mini-Crush Technique in Left Main Coronary Bifurcation: A Case Report Sanjat Chiwane Percutaneous coronary intervention of Left Main (LM) coronary artery bifurcation disease remains technically challenging. Despite the plethora of techniques in current practice and guidelines advocating provisional strategy (one-stent or main branch-stent only), controversy still persists regarding the two-stent techniques.Moreover, there is improved mindfulness towards various factors affecting LM treatment such as patient selection, stent characteristics, risk stratification, optimum imaging, as well as vessel preparation. The latest generation stent with ultra-thin struts have been safe and efficient in the treatment of LM bifurcation lesions, as they have upgraded designs that aid in the expansion of their diameters to larger extent. Additionally, being ultra-thin leads to lower metal load at the carina, thus improving the long-term outcomes. The authors here present with the case of a 42-year-old patient with LM bifurcation disease who was successfully managed with mini-crush technique using ultra-thin Tetriflex Sirolimus-Eluting Stents (SES). The case depicts that optimum amalgamation of ultrathin strut stents implantation and mini-crush technique would provide very favourable results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OD14-OD15&id=16283 https://doi.org/10.7860/JCDR/2022/52212.16283 Giant Groin Lipoma Deluding as Hernia: A Case Report Divish Saxena, Siddharth Pramod Dubhashi Diagnosis of a soft tissue tumour in groin region is rather misleading owing to the fact of similarity in complaints of pain and swelling, especially in cases of irreducible groin hernias. Strategic selection of investigations and treatment option plays an enormous role in preoperative management of these patients. Authors present a case of a 36-year-old female with a previous history of two caesarean sections through Pfannenstiel incision with a soft tissue irreducible swelling in left inguinal region. Computed Tomography (CT) abdomen revealed a groin lipomatous lesion. Groin lipomas should be included in the differential diagnosis of irreducible groin swellings. A history of previous caesarean section in this patient prompted us to have a provisional diagnosis of incisional hernia. Meticulous planning of specific treatment strategy is essential for an effective outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PD06-PD07&id=16285 https://doi.org/10.7860/JCDR/2022/53458.16285 Role of Palliative Duodenojejunostomy in Advanced Pancreatic Carcinoma- A Case Series N Indumathi, A Murugan, KV Rajan Pancreatic cancer is a common gastrointestinal malignancies associated with poor prognosis. Most of the patients present only in late stage with metastasis or locally advanced disease during the time of diagnosis, requiring palliative surgery. At the time of diagnosis, patients usually have a few months of survival. The surgical palliation for such patients is a less explored area; so, here authors present a series of three patients, who presented with symptoms suggestive of Gastric Outlet Obstruction (GOO) or duodenal obstruction. On further work-up, they found to have pancreatic growth infiltrating the duodenum or Duodenojejunal Flexure (DJF). All three patients underwent palliative duodenojejunal bypass with relief of symptoms and improvement in quality of life in postoperative period. Hence, duodenojejunal bypass is an effective surgical procedure for palliation of obstructive symptom for advanced pancreatic cancer involving duodenum to improve the quality of life of the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PR01-PR03&id=16280 https://doi.org/10.7860/JCDR/2022/54930.16280 COVID-19 Associated Guillain-Barré Syndrome- A Case Series Pankaj Kumar Saini, Rahul Gupta, Gaurav Kumar Gupta The outbreak of Coronavirus Disease-2019 (COVID-19) infection with associated Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) caused modified and compromised immune system that gave rise to various immune mediated disease. Various studies on both central and peripheral nervous system involvement has been reported. The common syndromes reported are meningoencephalitis, myelitis and Guillain-Barr&#233; Syndrome (GBS) etc. This case series reports four cases (41-years-old male, 35-years-old female, 50-years-old male and 65-years-old male patients) presenting with the duration from onset of viral illness to neurologic manifestations ranging from 4-60 days. One patient had a typical course of viral symptoms preceding GBS findings and two patient presented with GBS later. A patient was found to be IgG seropositive for SARS-CoV-2 and presented 2 months later of recovery from infection while one case had onset of weakness while having respiratory symptoms. These cases had Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) who presented with acute flaccid paralysis two to three weeks following COVID-19 infection. All the patients received Intravenous Immunoglobulin (IVIG) as treatment and showed significant improvement. It can be concluded that COVID-19 viral infection is probably related as a causal factor for immune mediated illness like GBS and early identification and treatment has good recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OR04-OR07&id=16281 https://doi.org/10.7860/JCDR/2022/56035.16281 High Resolution Ultrasound in Entrapment Neuropathies of Ulnar Nerve- A Case Series Ramakrishna Narayanan, Anu Kapoor, Vigneshwar Dagam Ulnar nerve is one of the terminal branches of the medial cord of brachial plexus. Owing to its superficial location and unprotected course ulnar nerve is susceptible to physical impingement at specific sites. Although clinical and electrophysiological assessment can diagnose ulnar neuropathy and site of compression, they do not provide aetiological information which is important for management. High Resolution Ultrasonography (HRUS) is a non invasive imaging tool that has been used widely to evaluate peripheral nerves. In this case series, HRUS imaging findings in seven distinct cases of entrapment of ulnar nerve or its branches are presented. In cases 1, 2, 3 and 4, ulnar nerve was entrapped at the elbow; by synovial thickening due to degeneration, claw osteophyte arising from ulna, synovial cyst and epineural ganglion cyst respectively. In cases 5 and 6, ulnar nerve was entrapped at the wrist by a pisotriquetral ganglion cyst and an ulnar artery pseudoaneurysm respectively. In case 7 the Dorsal Cutaneous Branch (DCB) of ulnar nerve was entrapped over the Extensor Carpi Ulnaris (ECU) tendon. In all the aforementioned cases, HRUS accurately identified the site of entrapment, the status of ulnar nerve and the underlying cause of entrapment, which was subsequently confirmed surgically. The non invasive, inexpensive and accurate qualities make HRUS a potential first line imaging tool in the evaluation of entrapment neuropathies of superficial nerves. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TR01-TR04&id=16239 https://doi.org/10.7860/JCDR/2022/52738.16239 Attachment Retained Tooth Supported Overdentures: A Case Series Shruti Potdukhe, Janani Iyer, Mithilesh Uikey, Jyoti Nadgere Present case series describes the three different types of attachments use for tooth supported overdenture for prosthetic rehabilitation. Loss of teeth causes continuous resorption of the bone leading to a compromised treatment. Retaining two or more natural teeth can be used as an abutment for prosthetic rehabilitation of partial edentulism arches. Preventive prosthodontics includes tooth supported overdentures which preserves natural teeth, roots and maintains propioception. Depending upon the interarch distance available various types of attachments can be used to enhance the retentive factors. The first case (71-year-old female patient) describes the use of telescopic attachment overdenture on 33, 43 with available interarch space of 15 mm in mandibular arch. The second case (62-year-old female patient) describes the use of ball attachments overdenture on 34 and 35 with available interarch space of 13 mm in mandibular arch. The third case (60-year-old female patient) is about equator attachment overdenture on 33, 43 with available interarch space of 12 mm in mandibular arch. Use of telescopic, ball and equator attachments for tooth supported overdentures has enhanced the retention, stability, function and aesthetic outcome of the removable prosthesis in mandibular arch. The natural teeth provide additional support, stability and retention of the overdenture than the edentulous ridges alone which is particularly advantageous for mandibular arch. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZR01-ZR04&id=16235 https://doi.org/10.7860/JCDR/2022/52599.16235 Anaesthetic Management and Literature Review of Syndromic Craniosynostosis in Infants-A Case Series Smriti Sinha , Reena R Kadni , Joel Chakravarthy , Varghese K Zachariah Craniosynostosis is a rare congenital defect. This group of patients is heterogeneous, presenting as a single suture defect in otherwise well child to Syndromic Craniosynostosis (SC) affecting multiple sutures as cranial defect associated with extracranial defects. Syndromic Craniosynostosis is found to be associated with Apert, Crouzon, Pfeiffer, Muenke and Saethre-Chotzen syndrome. These cases are generally associated with raised Intracranial Pressure (ICP), difficult airway and congenital multiple organ involvement. The case series describes the successful anaesthetic management of three and half-month-old male infant with Crouzon syndrome presented with raised ICP and difficult airway, planned for third ventriculostomy and seven-month-old male infant with Apert syndrome with syndactyly for correction surgery. A literature review about anaesthetic concerns related to SC is also described. The literature search was performed in the PubMed database with terms SC and anaesthetic management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=UR05-UR07&id=16236 https://doi.org/10.7860/JCDR/2022/50287.16236 Diagnostic Challenges of Soft Tissue Sarcomas with Special Emphasis on Immunohistochemical Profile- A Case Series Vandana Maroo, Sanghamitra Mukherjee, Gopinath Barui, Manisha Mahata Soft tissue tumours arise from the mesenchymal tissues of different origin like adipocytic, smooth muscles, skeletal muscle, fibroblastic/myofibroblastic, fibrohistiocytic, pericytic, vascular, osteo-cartilagineous or even unknown. Its diagnosis depends on the age of the patient and site of presentation but sometimes they may present at unusual sites. Some of the tumours have overlapping histomorphological features which results in a list of differential diagnosis. Therefore, immunohistochemistry and molecular genetics play an important role for definite diagnosis. French Federation of Cancer Centres Sarcoma Group System (FNCLCC) based on necrosis, tumour grading and tumour differentiation is commonly used for grading of the sarcomas to assess the treatment response and prognosis of the patient. Hereby, authors present a series of nine cases of soft issue tumours, comprising five cases of synovial sarcomas and one each of dedifferentiated liposarcoma, rhabdomyosarcoma, epithelioid angiosarcoma and Well Differentiated Liposarcoma (WDLS). Few cases are located at unusual anatomical sites; hence, they should be kept in mind as differential diagnosis. Immunohistochemistry has played an important role for confirmation of diagnosis of synovial sarcomas and angiosarcoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ER01-ER04&id=16180 https://doi.org/10.7860/JCDR/2022/53215.16180 Utility of p63 in Giant Cell Lesions of Bone- A Case Series Shima Kannadas, Sily Sreedharan, Chris Thomas, MK Ravindran, MM Aneesh Giant cell lesions of bone include a relatively large group of biologically and morphologically diverse bone lesions which shows presence of numerous multinucleate osteoclast like giant cells. Recently, p63 has been found to be a sensitive marker in the diagnosis of giant cell tumour. The aim of this case series is to assess the role of p63 in diagnostically difficult giant cell lesions of bone. The authors here present four cases with giant cell rich lesions of bone as seen in Hematoxylin and Eosin (H&E) staining, in which an accurate diagnosis was not possible with the available clinical and radiological data were included in this study. The tissue was stained with hematoxylin and eosin and Immunohistochemical staining (IHC) with p63 was done. Though the specificity of the marker was found to be less, it was concluded that, p63 can be used as an ancillary aid along with histomorphological and radiological data in arriving at a diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ER05-ER07&id=16181 https://doi.org/10.7860/JCDR/2022/55478.16181 Joint Manifestations Following COVID-19 Infection- A Case Series of Six Patients Jyothi Visalakshy, Thomas George, Sekhar V Easwar A rare subset of Coronavirus Disease-2019 (COVID-19) positive patients has musculoskeletal manifestations including arthritis, arthralgia, myalgia and non specific bodyaches. Moreover, postviral Reactive Arthritis (ReA) has been reported following COVID-19 infection. This article reports the characteristic joint manifestations of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection in 6 out of 211 consecutive patients with laboratory-confirmed diagnosis of COVID-19 and treated at dedicated hospital. One 49-year-old female patient developed arthritis while having active COVID-19 infection, one 54-year-old male had post COVID-19 ReA, and one 48-year-old female was found to have undifferentiated arthritis. One 58-year-old female patient was initially thought to have ReA the diagnosis was reconsidered later when her symptoms resolved without any disease modifying agents. Two patients 37-year-old male and 63-year-old female, developed arthralgia following COVID-19 infection. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and steroids were found to be beneficial in the series of patients. The key point to be noted is that not all arthritis or arthralgia following COVID-19 is ReA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OR01-OR03&id=16192 https://doi.org/10.7860/JCDR/2022/51552.16192 The Trident in the Brain- A Case of Osmotic Demyelination Syndrome Secondary to Alcohol Withdrawal Nipun Bawiskar, Sourya Acharya, Sunil Kumar Osmotic Demyelination Syndrome (ODS) is characterised by demyelination of pons and is also called as central pontine myelinolysis. It has been observed in patients with alcohol dependence, although hyponatraemia remains the most common cause. It should be suspected in chronic alcoholics and especially in those with protracted delirium tremens. Magnetic Resonance Imaging (MRI) is the modality of choice to diagnose this condition with a trident or pig snout appearance of pons being the characteristic finding. This publication discusses the case of a 27-year-old male who reported to the casualty ward in a delirious state following an episode of tonic clonic seizures and was diagnosed with alcohol withdrawal with pontine myelinolysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OJ01-OJ02&id=16151 https://doi.org/10.7860/JCDR/2022/51657.16151 Imaging of Intra Medullary Spinal Cord Lesions on MRI Bhanupriya Singh, Gaurav Raj, Dewansh Mishra Lesions originating from parenchyma of the spinal cord present with a myriad of symptoms and signs more commonly via direct compression, followed by infiltration into the spinal parenchyma. Pain can be radicular, posterior midline, dull and aching. Rare presentations include paravertebral tightness/stiffness, and syringomyelia. Deficits were most commonly motor, followed by, sensory or bladder dysfunction <a href=#fr1 name=ft1>(1)</a>. Astrocytomas are second most common intramedullary tumours, and most common among paediatric age group. They are neoplasms of astrocytic origin and infiltrate into the surrounding spinal cord tissue, ill-defined margins, lack well defined capsule or cleavage plane, making them prone for incomplete resection and recurrence. They present with long multi-segment, eccentric and holocord involvement. They are associated with neurofibromatosis and cyst formation. Tumoural cysts are usually intra substance and reflect necrosis, haemorrhage, or degeneration that shows in-homogeneous signal intensity and peripheral contrast enhancement on MRI <a href=tableview.asp?id=16278&img_src=16278_1.jpg target=_blank>(Table/Fig 1)</a>(a-e),<a href=tableview.asp?id=16278&img_src=16278_2.jpg target=_blank>(Table/Fig 2)</a>(a-e). Canal widening with kyphoscoliosis is more frequently encountered in paediatric age group. On Magnetic Resonance Imaging (MRI), they appear to expand the cord and are hypo to isointense on T1 weighted images, hyper intense on T2 and Short Tau Inversion Recovery (STIR) images, with varying degrees of patchy enhancement <a href=#fr1 name=ft1>(1)</a>,<a href=#fr2 name=ft2>(2)</a>. Ependymomas are most common intramedullary tumours in adults, with predilection in cervico-thoracic segments. However, myxopapillary variant of ependymomas tends to occur more commonly in filumterminale and conusmedullaris. They are known to arise from ependymal lining of cord with central location, and extend peripherally as they grow. Rare variant of extramedullary ependymoma can initially be intramedullary and become eventually exophytic, growing out of the medulla. Ependymomas have well defined margins, and compress the cord <a href=#fr1 name=ft1>(1)</a>,<a href=#fr2 name=ft2>(2)</a>. Traversing vessels at the junction,get stretched and eventually bleed; giving the &#8220;cap sign&#8221; <a href=tableview.asp?id=16278&img_src=16278_3.jpg target=_blank>(Table/Fig 3)</a>(a-e),<a href=tableview.asp?id=16278&img_src=16278_4.jpg target=_blank>(Table/Fig 4)</a>(a-e). Non enhancing non tumoural (polar) cysts are commonly associated with ependymoma, and show Cerebrospinal Fluid (CSF) signal extends beyond the cranial or caudal pole of the neoplasm. Presence of syringohydromyeliais seen more consistently with ependymoma, than astrocytoma. Most of the ependymomas were T1 iso to hypointense, with hyperintensity on T2 and STIR images, and homogenous intense enhancement with persistent hypointense &#8220;cap sign&#8221;. Ependymomas tend to occur commonly in association with Neurofibromatosis 2 <a href=#fr2 name=ft2>(2)</a>,<a href=#fr3 name=ft3>(3)</a>. Haemangioblastomas are benign tumours of vascular origin, and show short segment involvement with prominent flow voids, usually extending along pial surface <a href=tableview.asp?id=16278&img_src=16278_5.jpg target=_blank>(Table/Fig 5)</a>. They have cystic component with enhancing highly vascular nodular component. They have surrounding oedema, syrinx and association with Van HippelLindau disease. Enlarged spinal arteries may be seen, and they should be differentiated from vascular malformation <a href=#fr4 name=ft4>(4)</a>. Intramedullary spinal cord metastases are comparatively rare, especially in absence of known primary malignancy. Drop metastasis with CSF dissemination through the spinal cord, central canal or contiguous spread from carcinomatous meningitis <a href=tableview.asp?id=16278&img_src=16278_6.jpg target=_blank>(Table/Fig 6)</a>(a-d),<a href=tableview.asp?id=16278&img_src=16278_7.jpg target=_blank>(Table/Fig 7)</a>(a-e). Most common route of spread through haematogenous dissemination leading to arterial embolisation (most common primaries include carcinoma lung). Other routes include retrograde spread through Batson&#8217;s spinal venous plexus; metastatic perineural spread to the spinal cord, CSF dissemination through drop metastasis or intraspinal through perineural sheaths. Cystic change/haemorrhage are seen rarely. They show postcontrast enhancement with extensive disproportionate oedema (extensive T2 hyper intensity, which can be on average multifold larger than that of the enhancing portion of the lesion) <a href=#fr3 name=ft3>(3)</a>. Postcontrast complete or partial rim enhancement along margins is noted.Another rarer proposed route of spread is via penetrating vessels within the Virchow-Robin spaces penetration of the spinal cord parenchyma. Rare subtype of exophytic ependymoma <a href=tableview.asp?id=16278&img_src=16278_8.jpg target=_blank>(Table/Fig 8)</a>(a-d) has similar features as ependymoma, with additional exophytic soft tissue component. Infective granulomas present with fusiform cord swelling with ill-defined iso to hyperintensity on T1WI <a href=tableview.asp?id=16278&img_src=16278_9.jpg target=_blank>(Table/Fig 9)</a>(a-d). Surrounding oedema maybe present with T2 hypointense area. Adjacent disc, soft tissue may show enhancement, depending on involvement.Varying amount of caseous necrosis and liquefaction present as central hyperintensities. An iso-hypointense rim, showing enhancement was seen surrounding a hyperintense centre <a href=#fr4 name=ft4>(4)</a>. <a href=tableview.asp?id=16278&img_src=16278_10.jpg target=_blank>(Table/Fig 10)</a> describes the radiological findings of all the nine cases. Malignant intramedullary spinal tumours may escape early diagnosis, as patients bearing these lesions may be initially asymptomatic. With use of MRI; T1, T2 and STIR weighted images should be accessed, in atleast two different imaging planes with large field-of-view, to allow visualisation of the entire cord, and demarcate location and extent of these tumours. Haemorrhagic components should be assessed on Gradient echo images. Postcontrast images demonstrate solid enhancing tumour components and helps in differentiating tumour cysts from peritumoural cysts <a href=#fr5 name=ft5>(5)</a>. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TJ01-TJ04&id=16278 https://doi.org/10.7860/JCDR/2022/52029.16278 Comparative Evaluation of the Border Morphology Produced by Three Different Border Molding Materials: An In-vivo Study Ruttonji Zarir, Ajaykumar Nayak, Shruti Gundewar, Preethi Kusugal, Preeti Astagi, Chithra Melavanki Introduction: Different materials and technique exist to record the functional and physiologic border of the denture. There is a need to determine which among the various materials available would accurately record the borders width and height as compared to tissue conditioner. Aim: To compare and evaluate the morphology of the denture borders produced by three different commercially available border molding materials. Materials and Methods: This in-vivo study was conducted at KAHER&#8217;s KLE VK Institute of Dental Science, Belagavi, Karnataka, India, from November 2012 to June 2013. The study included 20 patients with previous dentures. The labial flange of 20 patients with the existing maxillary denture was trimmed 2 mm short of the sulcus and border molding was done with tissue conditioner. The patients were instructed to perform routine activity with the denture and asked to report after first day. Three custom trays were fabricated without spacer, 2 mm short of the labial border. Border molding was carried out with low fusing compound, putty addition silicone and pattern resin. The trays were beaded at 2 mm from the depth of the vestibule and were poured with die stone. Casts were obtained and with the standardised method, the cast were sectioned into six sections. Border morphology of the sulcus was viewed under stereomicroscope and under image analyser. The statistical analysis carried out was using Statistical Package for the Social Sciences (SPSS) software version 19.0 Inc. Chicago, IL, USA. The level of significance was 95% confidence with p-value <0.05 was considered. Analysis of Variance (ANOVA) test and Bonferroni multiple posts-hoc test was used to analyse the data. Results: The descriptive analysis showed that the mean area of tissue conditioner (111590.95 &#956;m<sup>2</sup>) was least, next being pattern resin (131253.30 &#956;m<sup>2</sup>) followed by Low fusing impression compound (154854.20 &#956;m<sup>2</sup>) and addition silicone (190968.55 &#956;m<sup>2</sup>) (p-value <0.001). Conclusion: The result of the study showed that tissue conditioner was the best material that could be used for border molding followed by pattern resin and low fusing compound. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC55-ZC58&id=16291 https://doi.org/10.7860/JCDR/2022/52190.16291 Antibody Response following Exposure to SARS-CoV-2: Is It a Reliable Marker of Immunity? Mona Dhakal, Om Prakash Dhakal, Dhurba Bhandari <b>Introduction:</b> Infection and vaccination with the viral vector vaccine Covishield are both expected to produce immunity in the body against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Production of neutralising antibodies as a result of the humoral immune response plays a key role in defending against this deadly infection. A lack of virus-specific antibodies in the serum does not always imply a lack of immunological memory. The immune response mediated by T cells is also important. <b>Aim:</b> To check for the humoral immune response after exposure to the SARS-CoV-2 virus. <b>Materials and Methods:</b> This cross-sectional observational study was carried out at Central Referral Hospital (CRH), a tertiary care hospital in Gangtok, Sikkim, India, from May to June 2021. A total of 90 participants were divided into three equal groups; unvaccinated with a history of infection with SARS-CoV-2 in the recent past, vaccinated but no infection and history of vaccination and infection both, respectively. The test was performed with COVISCREEN. It&#8217;s a double antigen sandwich immunoassay that can detect total antibodies (IgM+IgG+IgA) simultaneously to the SARS-CoV-2 virus. The Statistical Package for the Social Sciences (SPSS), version 16.0 for Windows, was used to analyse the data. <b>Results:</b> Overall, 30 (33.3%) participants showed positive antibody tests out of total 90. Participants with prior infection exhibited more antibody responses irrespective of the vaccination status as compared to vaccinated participants with no prior infection, this difference was statistically insignificant (p=0.165). <b>Conclusion:</b> Both B cell, as well as T cell immune responses following infection and vaccination, need to be evaluated to predict long term immunological memory and protective immunity against future infections with SARS-CoV-2. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC36-OC39&id=16284 https://doi.org/10.7860/JCDR/2022/52654.16284 Immunohistochemical Expression of CDX2 in Gastroesophageal Junction Biopsies: An Emerging Marker for Early Intestinal Differentiation of Barrett’s Metaplasia Twisha Adhikari, Vidya Monappa <b>Introduction:</b> Histological diagnosis of Barrett&#8217;s oesophagus (BE) in mucosal biopsies is challenging and affected by multiple factors. Goblet Cells (GCs) are not distributed uniformly in BE and is dependent on sampling probabilities. Furthermore, GC Mimickers (GCM) are potential pitfalls in the diagnosis of Intestinal Metaplasia (IM). Alcian Blue (AB) stain has been extensively used in detection of GC&#8217;s although it has the limitation of low specificity with positive staining for GCM. Recently, CDX2 Immunohistochemistry (IHC) is reported to be highly sensitive and specific marker which has shown to identify early intestinal phenotype even in absence of diagnostic GCs and especially pertaining to conditions where characteristic morphological changes are not apparent. <b>Aim:</b> To study the histomorphology of non neoplastic and neoplastic lesions of the Gastroesophageal Junction (GEJ) in reflux patients and evaluate the diagnostic role of CDX2 IHC versus AB stain in detecting IM. <b>Materials and Methods:</b> This retrospective study was conducted in Department of Pathology at Kasturba Medical College, Manipal, Karnataka, India, on 55 patients with clinical features of reflux and adequate records of GEJ biopsies, diagnosed over 6 years from January 2012 to August 2018. Clinical presentation, endoscopic findings and histomorphology (18 parameters) were recorded. AB stain and CDX2 (IHC) were performed and evaluated in all cases. A detailed histological evaluation was done for all cases and subsequently, sensitivity, specificity, positive predictive value and negative predictive value of CDX2 IHC to identify early intestinal differentiation was calculated. <b>Results:</b> Of 55 cases, 28 were BE, 19-Reflux oesophagitis (RE) and 8-adenocarcinoma. Heart burn and chest pain were the most common clinical presentations of BE. Endoscopy of BE predominantly showed hiatus hernia with tongue like projections of the gastric mucosa. Histologically, intraepithelial eosinophils and spongiosis were more common features in RE. Barrett&#8217;s oesophagus showed columnar epithelium with multilayering, presence of IM with GC (1-20/crypt) along with sub-squamous buried epithelium and splitting of muscularis mucosa. By IHC, as compared to AB; CDX2 IHC was more sensitive (100% vs 78.2%) and specific (96.5% vs 82.6%) for detecting an intestinal phenotype. The five cases (22%) of BE contained only GCM in the biopsy, were CDX2 negative but showed a false positivity for AB. In BE, CDX2 additionally highlighted positivity in non GC columnar cells which were AB negative. The CDX2 showed diffuse positivity in dysplasia with focal strong to absent expression in adenocarcinoma. <b>Conclusion:</b> The CDX2 efficiently differentiated between GC and pseudo GC. Its presence in the absence of AB in non GC columnar cells suggests that it effectively detects intestinal phenotypic features even before morphological features are evident. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC17-EC22&id=16286 https://doi.org/10.7860/JCDR/2022/55446.16286 Predictive Value of Brückner Test in Detecting Refractive Errors among Children Neha Nitin Kotwal, Varsha Kulkarni, Tejaswini Khandgave <b>Introduction:</b> Uncorrected refractive errors form a major ocular morbidity in children. They often go unnoticed and affect child development. The prevalence of refractive error in Indian children is 10.8%. They are known to affect the overall development of children. However, if the error is high it could lead to amblyopia or strabismus. Snellen&#8217;s visual acuity along with cycloplegic refraction is an accepted method to detect refractive errors, but in children, it needs special skill, patience and understanding. The Br&#252;ckner test is useful for early detection of refractive errors especially in children. <b>Aim:</b> To re-evaluate the results of Br&#252;ckner test in the form of sensitivity, specificity and provide data about a simpler, easy, ergonomic technique for mass screening of refractive errors. <b>Materials and Methods:</b> This cross-sectional study was conducted at Bharati Hospital (tertiary care hospital), Pune, Maharashtra, India, among 532 children (1064 eyes) in the age group of 2-15 years visiting the Ophthalmology Outpatient Department from October 2018 to September 2020. Position and size of pupillary crescent was recorded among children with direct ophthalmoscope. Children were classified according to errors of refraction as Emmetropia (no crescent), Myopia {inferior crescent (mild (<1/3), moderate (1/3-2/3), high (>2/3)}, Hypermetropia {superior crescent (mild (<1/3), moderate (1/3-2/3), high (>2/3)}. Subsequently, cycloplegic refraction was performed using auto-refractometer. Sensitivity, specificity, positive predictive value and negative predictive value of the test for emmetropia, myopia and hypermetropia were calculated. Subjective refraction was prescribed to children diagnosed with refractive errors during the course of this study. <b>Results:</b> Total 275 females and 257 males (mean age 8.3 years) were included in this study, out of which, the study found 354 Emmetropic eyes, 326 Myopic eyes and 384 Hypermetropic eyes. Sensitivity of Br&#252;ckner for emmetropia was 86.4%, specificity was 95.2%. Whereas for myopia, sensitivity was 95.1% and specificity was 94.6%. Also for hyperopia sensitivity was 95.3% and specificity was 98.8%. The crescent size was found to be significant (p-value<0.001) in diagnosing grades of myopia and hypermetropia as divided. <b>Conclusion:</b> The Br&#252;ckner test has good sensitivity, specificity, positive and negative predictive value. It is a useful, accurate, and simple screening test. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=NC05-NC08&id=16287 https://doi.org/10.7860/JCDR/2022/52334.16287 Comparison of Long-term Efficacy of Intravitreal Ranibizumab in Diabetic Retinopathy following Monthly vs Pro Re Nata vs Treat and Extend Protocol Avik Dey Sarkar, Sanjay Kumar Daulat Thakur, Rupam Roy, Ajoy Dey Sarkar <b>Introduction:</b> Diabetic Retinopathy (DR) is a major complication of Diabetes Mellitus (DM), which remains a leading cause of visual loss in working age populations. The most common cause of vision loss in patients with DR is Diabetic Macular Oedema (DME). Intravitreal administration of anti-Vascular Endothelial Growth Factor (anti-VEGF) agents is currently the mainstay of therapy for both early and advanced stages of DR. <b>Aim:</b> To compare long-term change in Central Macular Thickness (CMT) and Best Corrected Visual Acuity (BCVA) in patients with Non Proliferative Diabetic Retinopathy (NPDR) with Clinically Significant Macular Oedema (CSME) after receiving Intravitreal Ranibizumab (IVR) following monthly, Pro Re Nata (PRN) protocol and Treat and Extend (T&E) protocol. <b>Materials and Methods:</b> This is a hospital based longitudinal prospective cohort study conducted on patients attending the Out Patient Department (OPD) of the Opthalmology Department at Midnapore Medical College and Hospital, West Bengal, India. from October 2018 to February 2021. Institutional Ethical clearance was obtained prior to the initiation of the study. Among 93 patients, 31 were chosen each for IVR PRN Monthly (Group A), (Group B) and T&E protocol (Group C) over a period of nine months. CMT and BCVA were measured at baseline and followed-up monthly for 12 months after last injection using Spectral Domain Optical Coherence Tomography (SD-OCT), while Glycated Haemoglobin (HbA1c) level was maintained below 7.4. Statistical analyses were performed using Statistical Package of Social Sciences (SPSS) statistics version 20 software. Chi-square test was used to find out the association between categorical variables. Pre and post comparisons were done using Wilcoxon sign rank test. A p-value less than 0.05 were considered as statistically significant. <b>Results:</b> There was significant decrease in CMT and betterment of BCVA in all groups at the end of treatment compared to baseline. At six months and one year of last injection there was no significant change in CMT in group A and C while group B at one year (p=0.0487) showed significant increase. There was no significant worsening of BCVA in group A and group C while group B (p=0.01) showed significant worsening at one year long-term follow-up. <b>Conclusion:</b> Thus, the present study concludes that, even though monthly protocol T&E protocol are equally good compared to PRN protocol on the basis of long-term beneficial effect, T&E protocol needed comparatively fewer doses of IVR compared to monthly protocol making it the choice of protocol for long-term control in NPDR with DME patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=NC09-NC12&id=16288 https://doi.org/10.7860/JCDR/2022/52668.16288 Impact of COVID-19 Pandemic on Paediatric Appendicitis at a Tertiary Care Paediatric Hospital in New Delhi- A Retrospective Study Mamta Sengar, Chhabi R Gupta, Pritesh Maheshwari, Niyaz Khan, Shefalika Sharma <b>Introduction:</b> Across the globe the healthcare system was severely affected by Coronavirus Disease-19 (COVID-19) pandemic. Measures taken to curtail the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus have severely affected the paediatric patients presenting with Acute Appendicitis (AA). <b>Aim:</b> To assess the impact of COVID-19 on paediatric Acute Appendicities patients at tertiary care center in New Delhi. <b>Materials and Methods:</b> This retrospective study was conducted at Chacha Nehru Bal Chikitsalaya, New Delhi. Patient demographics, symptomatology including delay in presentation to hospital, haematological, intraoperative findings and complications of all paediatric AA patients who underwent appendectomy from 23rd March 2020 to 22nd July 2020 (Pandemic Group- PG group) were recorded. Patients presenting in corresponding time period in the year 2019 was also compared {Non Pandemic Group (NPG) group}. Group comparisons for continuously distributed data were made using Independent sample t-test. For non normally distributed data, non parametric tests in the form of Wilcoxon test was used. Chi-squared test was used for group comparisons for categorical data. <b>Results:</b> A total of 72 patients were included with 39 in NPG and 33 in PG group, respectively. There were no significant differences between the two groups in terms of age (p-value=0.759) and sex distribution (p-value=0.93). Patients in PG group had higher leukocyte counts as compared to NPG group (16748.48&#177;7744.08 vs 12510.26&#177;7736.58, p-value <0.007). There was no significant difference in delay in presentation, symptomatology, duration of hospital stay and postoperative complications rate between the two groups. <b>Conclusion:</b> There has been no significant change in the number of patients presenting with AA and the symptomatology during COVID-19 pandemic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PC21-PC23&id=16289 https://doi.org/10.7860/JCDR/2022/52235.16289 Predictors of Mortality in Spontaneous Intracerebral Haemorrhage: A Prospective Interventional Study from a Tertiary Care Centre, Kerala, India Shameej Koloth Vayalipath, Rajeev Mandakaparambil, Prakasan Kannoth, Jaleel Padinhareyiel, Shinihas Vattaparambil, Binu Areekal <b>Introduction:</b> Spontaneous Intracerebral Haemorrhage (SICH) is a potentially life-threatening condition associated with a high mortality and morbidity. Early assessment of outcome is important to optimise the therapeutic efforts. This study helps in the prediction of outcomes in SICH based on clinical and radiological predictors, so as to effectively utilise the treatment resources. <b>Aim:</b> To assess clinical and radiological predictors of mortality and morbidity in patients with SICH at a Tertiary Care Centre, Kerala, India. <b>Materials and Methods:</b> This prospective interventional study included 100 patients admitted with SICH at Government Medical college, Kozhikode, Kerala, India, from 1st May 2019 to 30th January 2020. The assessed variables include age, sex, mean Glasgow Coma Scale (GCS) score on admission, Intracerebral Haemorrhage (ICH) volume, ICH site, ICH score and treatment provided (conservative/surgery). The dependent variable was 30 day mortality. Univariate analysis was performed to determine the association between the mortality and independent variables. A binary logistic regression was also performed. Statistical analysis performed using Statistical Package for the Social Sciences (SPSS) software version 22.0. The p-value <0.05 was considered significant. <b>Results:</b> Among the total of 100 SICH patients, males were 52% and females were 48%; the mean age was 67&#177;11 years. The medical history of SICH patients predominantly showed hypertension (90%), diabetes (45%) and alcohol abuse (33%). Out of total, 70% cases were managed conservatively, and 30% cases were managed surgically. The short-term outcome of 30 day mortality was 40% and the survival rate was 60%. Univariate analysis inferred that the location of bleed (p-value=0.0002), volume of ICH (p-value <0.001), ICH score (p-value 0.003) and type of management (p-value <0.001) were statistically significant predictors for 30 day mortality in SICH patients. <b>Conclusion:</b> The location of bleed, volume of ICH, ICH score and type of management were statistically significant predictors for 30 day mortality in SICH patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PC16-PC20&id=16275 https://doi.org/10.7860/JCDR/2022/53246.16275 Forgotten Needs of Patients with Systemic Lupus Erythematosus: A Qualitative Study in Iran Mansour Dianati, Mohsen Taghadosi, Batol Zamani, Fereshteh Mazhariazad <b>Introduction:</b> Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease which affects different body systems and different aspects of health. It has an irreversible course. Identifying the needs of SLE afflicted patients is the first step to help them manage and cope with their illness. Qualitative research among patients with SLE can identify aspects of the disease relevant to clinical research and practice. <b>Aim:</b> To explore the forgotten needs of patients with SLE. <b>Materials and Methods:</b> This qualitative study was conducted in Iran from April 2020 to March 2021 using conventional content analysis. All participants were patients with definite diagnosis of SLE purposefully selected from Iranian Lupus Association and Rheumatology Clinics in Kashan, Kerman and Bandarabbas, Iran. Data were collected with deep, semi-structured, and face-to-face interviews, which are focused on patients&#8217; experiences of needs. Data collection continued until saturation was reached. Finally, 17 patients with SLE participated in this study. Data collection and data analysis were conducted concurrently. Data were analysed with conventional content analysis, and managed with the MAXQDA software 2020. <b>Results:</b> The forgotten needs of patients with SLE came into three main categories, namely social needs (with three subcategories), economic needs (with two subcategories), and need for self-control (with two subcategories). The seven subcategories of these three categories were the need for family support, the need for professional support by healthcare providers, the need for social support, the need for financial support by family members, the need for financial support by the government, the need for gaining autonomy, and the need for effective role performance. <b>Conclusion:</b> Patients with SLE have many forgotten psychological and socio-economic needs. Patient education, referrals to mental health professionals, and support organisations are important supplements to medical treatment. The findings can be used to develop strategies for providing quality care to patients with SLE and other chronic disabling conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC42-LC46&id=16276 https://doi.org/10.7860/JCDR/2022/52712.16276 Comparison of the Lever Sign Test, Anterior Drawer Test and Lachman Test in Cases of Anterior Cruciate Ligament Tear: A Prospective Cohort Study Gagandeep Singh, Manish Singh, Pallav Gupta <b>Introduction:</b> The Anterior Cruciate Ligament (ACL) is a very commonly injured ligament of knee. Several physical examination tests are performed for evaluating ACL stability. The Lachman, pivot-shift, and anterior drawer tests are commonly performed for evaluating the knee laxity. <b>Aim:</b> To compare Lever sign test with anterior drawer test and Lachman test in case of ACL tear, and to assess preanaesthesia and postanaesthesia variability in tests results. <b>Materials and Methods:</b> This prospective cohort study was conducted at Government Medical College, Kathua, Jammu, India, from October 2018 till September 2019. Total 50 patients were included (age group 18-60 years) with symptomatic ACL tear requiring diagnostic arthroscopy or repair. Three test included Lever sign test, anterior drawer test and Lachman test were performed preanaesthesia and postanaesthesia and findings were recorded. Sensitivity and specificity was calculated preanaesthesia and postanaesthesia. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. The p-value &#8804;0.05 was considered statistically significant. <b>Results:</b> Total 50 patients were evaluated and analysed including 60% males (n=30) and 40% females (n=20). The mean age of the patients was 34.5&#177;2.6 years. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Values (NPV) and diagnostic accuracy of anterior drawer test preanaesthesia were 83%, 87%, 97%, 50%, and 84%, respectively, and postanaesthesia were 88%, 87%, 97%, 58%, and 88%; for Lachman test preanaesthesia were 88%, 87%, 97%, 58%, and 88%, respectively, and postanaesthesia were 90%, 87%, 97%, 63%, and 90%; and for Lever sign test preanaesthesia were 85%, 88%, 100%, 57%, and 88%, and postanaesthesia were 88%, 100%, 100%, 61%, and 90%, respectively. There was no significant difference in the diagnostic accuracy of the three tests while comparing for preanaesthesia and postanaesthesia or for individual tests (p>0.05). <b>Conclusion:</b> The lever test showed high specificity, but comparable diagnostic accuracy in the detection of ACL tears in comparison to anterior drawer test and Lachman test. All the tests hold equal importance for diagnosing ACL tears before and after anaesthesia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=RC15-RC19&id=16277 https://doi.org/10.7860/JCDR/2022/51898.16277 Relationship between Physical Activity Status and Physiological Parameters among Adolescents and Young Children Jerusha Jetty, Srujana Dampetla, Indira Veeranki, Vijay Sam Nethala <b>Introduction:</b> Childhood obesity is strongly associated with elevated Blood Pressure (BP) and elevated cholesterol levels, progressing over time to adult premature Cardiovascular Disease (CVD). Physical Activity (PA) is protective against various diseases like hypertension and CVD. <b>Aim:</b> To assess the relationship between PA status and physiological parameters among adolescents and young children. <b>Materials and Methods:</b> An interventional study was conducted in the Department of Physiology at Siddhartha Medical College, Vijayawada, Andhra Pradesh, India from October 2019 to December 2019. A PA intervention was given to 30 participants in the study group (one hour of PA, three times a week for three months) and compared with 30 participants in the control group. The anthropometric and physiological parameters were compared between the groups. The coGuide statistical software was used for data analysis. <b>Results:</b> A total of 30 participants in each group were studied. The mean age was 14.28&#177;3.1 years in the study group and 13.6&#177;2.8 years in the control group. The mean duration of PA was 47.8&#177;6.3 minutes. No statistical significance was observed between groups for Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and body temperature postintervention. There was a statistically significant difference between the two groups in heart rate (beats/min) and respiratory rate (breaths/min) postintervention (p-value <0.05). <b>Conclusion:</b> The findings shed light on the need of different PA intervention programs for school going children to improve their physiological parameters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=KC01-KC04&id=16264 https://doi.org/10.7860/JCDR/2022/51630.16264 A Cross-sectional Study of the Patterns and Impact of Socio-demographic Factors in Anxious and Depressed Alcohol Dependent Patients Puneet Mathur, Sunil Kumar Pawar, Nabanita Sengupta, Rahul Bhargava <b>Introduction:</b> Socio-demographic factors may play a pivotal role in anxious and depressed alcohol dependent patients. Identifying the patterns and impact of these factors may be important in the successful management of Alcohol Use Disorders (AUDs). <b>Aim:</b> To assess the patterns and impact of socio-demographic factors in anxious and depressed alcohol dependent patients. <b>Materials and Methods:</b> This cross-sectional study was conducted at Rama Medical College Hospital and Research Centre Hapur, Uttar Pradesh, India, from August 2018 to January 2020. Patients with history of substance dependence, gross brain damage, severe medical complications, or evidence of drinking during the hospital stay were excluded. Severity of Alcohol Dependence Questionnaire (SADQ) was used to rate the extent of alcohol dependence and Hamilton Depression Rating Scale (HAM-D or HDRS) to rate depression. Socio-demographic data was recorded in each patient which included age, gender, background, education level, employment status, occupation, marital status, and family type. The severity of anxiety symptoms was measured on Hamilton Anxiety Rating Scale (HAM-A). Independent t-tests, Chi-square tests, one-way Analysis of Variance (ANOVA) and Pearson&#8217;s correlation analysis were used for statistical analysis. A p-value <0.05 was considered statistically significant. <b>Results:</b> The total of 90 alcohol dependent patients with mean age of 37.6&#177;9.3 years and mean HDRS score was 8.5&#177;4.3. The overall prevalence of depression cohort was 40%. Out of these 30 (33.3%) had mild and 6 (6.7%) had moderate depression, respectively. The mean Hamilton anxiety scale score was 18.6&#177;5.2. Patients who had a lower Socio-economic Status (SES) (p-value=0.049 and 0.004), were maritally separated (p-value <0.001 and 0.027), living in a nuclear family (p-value=0.005 and <0.001) and were unemployed (p-value <0.001 and p-value <0.001) had significantly higher depression and anxiety scores, respectively. <b>Conclusion:</b> In anxious and depressed alcohol dependent patients, lower SES, marital separation, living as a single family and unemployment significantly influenced depression and anxiety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=VC01-VC05&id=16250 https://doi.org/10.7860/JCDR/2022/53044.16250 Computerised Photometric Analysis of Photodynamic Therapy versus Triamcinolone Acetonide for Treatment of Erosive Lichen Planus- A Prospective Interventional Study Abhik Sikdar, Smriti Pramod Kumar, Jugajyoti Pathi, Sangamesh Ningappa Chinnannavar, Dhirendra Kumar Singh, Snehjyoti Jha <b>Introduction:</b> Lichen planus is a mucocutaneous disease of unknown aetiology. Topical corticosteroid has been widely used for the treatment purpose so far. In order to overcome the side-effects of corticosteroid, Photodynamic Therapy (PDT) has been proposed, but very few studies have been done to evaluate the effect of PDT and corticosteroid on lichen planus using computerised photometric analysis. <b>Aim:</b> To compare the efficacy, using computerised photometric analysis and Red Green Blue (RGB) scoring, of triamcinolone acetonide and PDT in the treatment of erosive lichen planus. <b>Materials and Methods:</b> This prospective interventional study was done in the Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India, from January 2021 to February 2021. There were 10 patients of erosive lichen planus who were divided into two groups. Patients of group A were treated with triamcinolone acetonide, and group B patients were treated with PDT, for four weeks. Visual Analogue Score (VAS), Reticular Erosive Ulcerative (REU) Score, Oral Mucositis Index (OMI), photometric analysis using RGB scoring were recorded at baseline, after two weeks and four weeks of treatment. Mann-Whitney U test was used for intergroup comparison, and paired t-test for intragroup comparison. <b>Results:</b> In the study, there was no significant difference (p-value=1.00) in age among the patients of two groups. At baseline, VAS mean score of group A patients (5.20&#177;0.837), group B patients (6.40&#177;1.140) and the p-value was 0.101; REU mean score of group A patients (5.90&#177;1.245), group B patients (9.00&#177;2.00) and p-value was significant (0.028); OMI mean score of group A patients (1.20&#177;0.447), group B patients (1.60&#177;0.548) and p-value was 0.221; RGB mean score for group A (110.80&#177;1.212) and group B (116.52&#177;1.194). After four weeks of treatment, VAS mean score of group A patients was (0.80&#177;0.84), group B patients was 0, with p-value=0.05; REU mean score in group A (2.70&#177;1.04), group B (1.00&#177;0.71), p-value=0.031; OMI mean score of both group A and B was 0; RGB mean score for group A (113.22&#177;1.89), group B (121.58&#177;0.96), p-value=0.009. <b>Conclusion:</b> It was found that PDT was better in treating erosive lichen planus and it can be used as an alternative to the standard treatment modalities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC40-ZC44&id=16252 https://doi.org/10.7860/JCDR/2022/52380.16252 Effect of Glycated Haemoglobin Deviations on Glomerular Filtration Rate and Electrolyte Homeostasis among Paediatric Patients with Type I Diabetes Mellitus Kavita M Sudersanadas, Maha AL Turki, Atheer Zaid Abuthyab, Razan Salim Almutairi, Ohud Dakhil Alharbi, Salini Scaria Joy, Mohammed AL Mutairi <b>Introduction:</b> Hyperglycaemia-induced electrolytic imbalance is a major contributing factor for the onset of complications observed in diabetes and other endocrine disorders. Children with Type I Diabetes Mellitus (T1DM) often exhibit electrolyte disturbances which contribute early onset of diabetic complications. Hyperglycaemia-induced electrolytic imbalance is a major contributing factor for the onset of complications observed in diabetes and other endocrine disorders. <b>Aim:</b> To assess the effect of glycated haemoglobin deviations on estimated Glomerular Filtration Rate (eGFR) and electrolytes (sodium, potassium, calcium, and magnesium) in paediatric subjects with T1DM. <b>Materials and Methods:</b> This retrospective study was conducted at King Abdullah Specialised Children&#8217;s Hospital (KASCH)/NGHA, Riyadh, Saudi Arabia, a tertiary care teaching hospital. Total 78 paediatric T1DM patients with diabetes for a duration of five years registered at the hospital for medical and nutritional care from January 2013 to December 2013, formed the study population. Data related to demography (age, gender, Body Mass Index [BMI]) and biochemical variables {Haemoglobin A1C (HbA1c), total cholesterol, Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL), Triglycerides (TG), urea, and serum creatinine, data related to electrolytes such as sodium, potassium, magnesium, calcium, and vitamin D} were extracted from the hospital information system. Frequencies, percentages, mean, standard deviation, student&#8217;s t-test, tertiles with percentages, analysis of variance and Pearson correlation coefficient were used to analyse the data by statistical software Statistical Package for the Social Sciences (SPSS) (version 22.0). <b>Results:</b> A total of 31 males and 47 females between ages 6-14 years were included in this study. eGFR (p-value=0.004) and sodium (p-value=0.013) were independently associated with HbA1c in T1DM even after adjusting the confounding factors such as age, BMI, and LDL. Whereas, other electrolytes (potassium, magnesium) and vitamin D showed an inverse relation with HbA1c but were not significant after adjusting for confounding factors (p-value <0.05). Serum creatinine (r-value=0.313, p-value=0.005) indicated a significant positive correlation with HbA1c while, eGFR (r-value=-0.344, p-value=0.002) and sodium (r-value=-0.236, p-value=0.040) showed a significant negative correlation with HbA1c. <b>Conclusion:</b> Maintaining a balance between glycaemic control and nutritional therapy is essential to avoid the progressive development of diabetic complications in T1DM. In addition, early diagnosis, proper medications, including adequate insulin therapy and dietary supplements are needed to prevent diabetic complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=SC01-SC05&id=16253 https://doi.org/10.7860/JCDR/2022/55018.16253 Assessment of Preoperative Anxiety among Patients Attending a Preanaesthetic Check-up Clinic at a Tertiary Care Hospital, Odisha: A Cross-sectional Study Partha Sarathi Mohapatra, Krishna Mishra, IPSA Mohapatra, Amit Kumar <b>Introduction:</b> Anxiety during the preoperative period predisposes to postoperative complications such as increase in postoperative pain, delay of healing and prolonged hospital stay.Further, patients with a high level of preoperative anxiety require higher doses of anaesthetic agents and recover poorly. Due to these factors, each tertiary care hospital should have an idea about the prevalence of preoperative anxiety in their setting, so that appropriate preventive measures can be planned. <b>Aim:</b> To assess the prevalence of preoperative anxiety in patients attending the Preanaesthetic Check-up (PAC) clinic for elective surgeries and to find out the factors associated with anxiety among them. <b>Materials and Methods:</b> This hospital-based, cross-sectional study was conducted in the PAC Clinic at Kalinga Institute of Medical Sciences (tertiary care hospital), Bhubaneswar, Odisha, India, from May to July 2018. The study included 100 patients, using convenient sampling technique, undergoing preanaesthetic check-up, before the proposed elective surgeries. A researcher made study tool, using Hamilton-A (HAM-A) scale, for assessing preoperative anxiety was used. Data was analysed using Epi Info software. A p-value <0.05 was considered as statistically significant. <b>Results:</b> Among the sampled 100 study participants, preoperative anxiety was found to be present in 97, 72 of the study participants had mild anxiety, 14 had mild to moderate and 11 moderate to severe anxiety. Of the 97 participants who had preoperative anxiety, 7 (14.89%) of the females had moderate to severe anxiety as compared to 4 (8%) of males. The age group of 60-69 years and Christianity religion were found to be statistically significant factors associated with anxiety in the study population. <b>Conclusion:</b> The prevalence of preoperative anxiety among the study participants was found to be high. Preventive measures like counselling sessions to address their apprehensions should be planned to decrease the anxiety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=UC10-UC13&id=16254 https://doi.org/10.7860/JCDR/2022/52737.16254 Comparison of NS1 Antigen Detection by RDT and ELISA and its Concordance with RT-PCR for the Early Diagnosis of Dengue in Ananthapuramu District, Andhra Pradesh, India Adireddi Paradesi Naidu, Chitralekha Saikumar, G Swarnalatha, Sardar Sulthana, Sailaja Meeniga <b>Introduction:</b> Early detection of dengue fever is important for effective clinical care and vector control. For the detection of dengue viral antigen and antibodies, several serological techniques based on the concept of immunochromatography and Enzyme-Linked Immunosorbent Assays (ELISA) are routinely utilised. The performance of these tests depends on the sensitivity and specificity. <b>Aim:</b> To compare Non Structural protein-1 (NS1) antigen detection by Rapid Diagnostic Tests (RDTs) and ELISA and its association with Real-Time Polymerase Chain Reaction (RT-PCR). <b>Materials and Methods:</b> This diagnostic cross-sectional study was done on 100 clinically suspected cases of Dengue between July-November 2021 at a tertiary care hospital in Ananthapuramu, Andhra Pradesh, India. All the sera samples were collected and subjected to NS1 antigen detection test by rapid test, NS1 ELISA, and RT-PCR, and also serotypes DENV-1, 2, 3, 4 were detected from serum sample by RT-PCR test. The results of rapid and ELISA tests were compared with RT-PCR. Data was analysed by Statistical Package for the Social Sciences (SPSS) version 16.0. <b>Results:</b> Out of total 100 samples, 29 samples were tested positive by NS1 rapid test, 30 samples were tested positive by NS1 ELISA, and 32 samples were tested positive by RT-PCR. The sensitivity, specificity of dengue NS1 antigen rapid test were 87.50% and 98.52%, respectively when compared to RT-PCR whereas that of NS1 ELISA were 93.75% and 100% when compared to RT-PCR. Out of 32 samples tested positive by RT-PCR, two samples were positive for DENV-1, 26 samples were positive for DENV-2, and four samples were positive were DENV-3. <b>Conclusion:</b> The NS1 ELISA test requires extra procedures and time. RDTs need a one-step operation that takes roughly 15-30 minutes. Despite the fact that RT-PCR and ELISA have better performance than RDTs, RDTs are more effective for early diagnosis and therapy of dengue fever in countries with limited infrastructure and in remote places. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=DC15-DC17&id=16257 https://doi.org/10.7860/JCDR/2022/55640.16257 Carba M Test for Rapid Detection and Simultaneous Differentiation of Carbapenemases among Clinical Isolates of Gram Negative Bacteria Shoorashetty Manohar Rudresh, Basavaraj, MV Naik Kusuma, Giriyapura Siddappa Ravi <b>Introduction:</b> Carbapenemase production is the most common mechanism of carbapenem resistance. The carbapenemases belongs to class A, class B and class D of Ambler&#8217;s molecular classification. Various tests have been designed for screening and confirmation of these enzymes. The acidimetric based Carba NP (Nordmann Poirel) test is simple and detects carbapenemases within two hours. The test could not differentiate between the serine carbapenemases from Metallo &#946;-Lactamase (MBL). Differentiation of these two classes of enzymes will help in choosing the newer carbapenemase inhibitors like avibactam which selectively act on serine carbapenemases. <b>Aim:</b> To design a test that can simultaneously confirm and differentiate Amblers class A and D from class B carbapenemase enzymes among clinical strains of the Gram-Negative Bacteria (GNB). <b>Materials and Methods:</b> An experimental cross-sectional study was conducted between January-December 2018 on 195 strains of carbapenem resistant and 40 strains of carbapenem sensitive GNB. The carbapenemase genes were detected among all the bacteria by multiplex Polymerase Chain Reaction (PCR). The Carba M test was designed and evaluated for the detection and differentiation of class A and D from class B carbapenemases among the study isolates. <b>Results:</b> The Carba M test had 100% sensitivity and specificity for identification of New Delhi Metallo-&#946;-lactamase (NDM) and Verona Integron-encoded Metallo-&#946;-lactamase (VIM) enzymes. The strains which co-produced two MBL enzymes were detected with 100% sensitivity. The test had 42.85% sensitivity for the detection of Oxacillinase (OXA)-48-like enzymes. <b>Conclusion:</b> The Carba M test is useful in detection and simultaneous differentiation of carbapenemase content of the GNB and will help to choose appropriate carbapenemase inhibitors judiciously. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=DC18-DC22&id=16258 https://doi.org/10.7860/JCDR/2022/55467.16258 Utility of Intraoperative Imprint Cytology in Diagnosis and Grading of Glioma: A Cross-sectional Study Shivam Chakraborty, Chhanda Das, Sayantan De, Mamata Guha Mallick Sinha <b>Introduction:</b> Gliomas are most common primary Central Nervous System (CNS) neoplasm in adult population. Gliomas predominantly arise from brain parenchyma. Invasion of adjacent normal parenchyma is a prominent feature. <b>Aim:</b> To study the epidemiological incidence of glial tumours and the viability and accuracy of intraoperative cytology in diagnosis and grading glial tumours. <b>Materials and Methods:</b> A cross-sectional study was done on 30 patients who underwent excision surgery at Department of Neurosurgery at Institute of Postgraduate Medical Education and Research IPGMER and SSKM, Kolkata, West Bengal, India. Clinically, radiologically confirmed cases of Space Occupying Lesion (SOL) of brain with a history of neurosurgical intervention were included. Patients medically unfit for surgery or without radiological evidence of SOL in the brain were excluded from the study. Intraoperative imprint touch cytology of the specimens was done. Part of the tissue was kept for Formalin Fixation and Paraffin Embedding (FFPE) and subsequent histopathological examination were done. Results of intraoperative imprint cytology were compared with final histopathology report and grading. Matthews correlation coefficient t-test, Kohen&#8217;s Kappa (&#954;), Chi-square test (&#967;<sup>2</sup>) were used for the statistical analysis. A p-value of p<0.5 was considered statistically significant. <b>Results:</b> About 10 (33.3%) of the patients presented with frontal lobe lesion. Out of 30 cases 29 (96.6%) were histologically confirmed to be of glial origin, 1 (3.3%) was metastasis from other tumour. These 29 cases were diagnosed as different glial neoplasm on intraoperative imprint cytology and were confirmed by histology. According to histological subtype 12 (41.37%) were glioblastoma, 10 (34.48%) were diffuse astrocytoma, 3 (10.34%) were pilocytic astrocytoma, 3 (10.34%) was ependymoma. Intraoperative impression cytology diagnosis was compared with confirmatory histological diagnosis. Sensitivity and specificity was found to be 93% and 50%, respectively, Positive Predictive Values (PPV) 96%, Negative Predictive Values (NPV) 33%, diagnostic accuracy 89.65% and p<0.5 was statistically significant. <b>Conclusion:</b> In the present study, confirmatory histopathology report showed a significant association with imprint cytology report. Hence, it can be concluded that intraoperative imprint cytology is a fairly accurate, rapid and inexpensive method of diagnosis and grading of gliomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC41-EC43&id=16259 https://doi.org/10.7860/JCDR/2022/53269.16259 Asymptomatic COVID-19 Infection among Healthcare Workers in Dedicated Tertiary Care Facility of Kolkata, India Debarup Das, Kaushik Basu, Lekha Biswas, Sidhartha Bhattacharya, Punnag Sarkar, Niharika Pant, Rishav Sanghai, Amarnath Thakur <b>Introduction:</b> In view of the present Coronavirus Disease 2019 (COVID-19) pandemic it is of utmost importance to look out for the &#8216;trojan horse&#8217; that is the asymptomatic population who are potential for spreading the disease. Healthcare Workers (HCWs) are the most vulnerable group. The possibility of having the infection does not always correlate well with the symptoms. It urges the need for development of certain special plans beyond continuous surveillance and symptom monitoring. <b>Aim:</b> To explore asymptomatic COVID-19 infection among HCWs as a potential source of transmission.Materials and Methods: This hospital-based cross-sectional study was conducted at Medical College and Hospital, Kolkata, West Bengal, India, from June 2020 to September 2020. The data were collected from 714 HCWs over a period of three months of study period, with the help of a standard questionnaire and blood sample was analysed by serological assessment of Immunoglobulin G (IgG) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by EUROIMMUN Kit, Enzyme-Linked Immunosorbent Assay (ELISA). Epi info software 7, available from the World Health Organisation (WHO) site was used to manage and analyse the data. <b>Results:</b> The mean age was 35.30&#177;11.79 years. Out of 714 people, 54.8% (391/714) were male and 45.2% (323/714) were female. In this survey, 9.16% of HCWs in COVID-19 designated duties were IgG positive; whereas 21.89% of HCWs designated in other parts of area were detected to be IgG positive. Seroprevalence was least amongst nursing staffs with 5.41% (8/148); among doctor&#8217;s it was 9.62% (41/426). Most interestingly among ward boys and cleaners this prevalence was found to be 29.90% (29/97) being the highest. Overall seroprevalence for IgG against SARS-CoV-2 was found to be 12.75% (91/714). <b>Conclusion:</b> This serosurvey at this tertiary COVID-19 care facility is a unique venture to look for the possible sources of super-spread. The high rate of sero-positivity among ward boys and cleaners might be due to their lack of knowledge and training regarding steps to prevent a droplet borne pandemic. This study also points out that if adequate precautions are taken, infectivity is not to an alarming extent, even in a full-fledged COVID-19 care hospital. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC28-OC31&id=16260 https://doi.org/10.7860/JCDR/2022/52612.16260 Effects of Efavirenz for the Treatment of HIV on the Basis of Genetic Polymorphisms Brighty Elizabeth Kurian, Swamy Miryala, Srikrishna Raghavendra Boddu <b>Introduction:</b> The CYP2B6 is a liver enzyme that is involved in the metabolism of several drugs including Efavirenz, which is one of the mainstay treatments for Acquired Immunodeficiency Syndrome (AIDS), caused by the Human Immunodeficiency Virus (HIV). Polymorphisms in the CYP2B6 gene determines the rate of enzyme activity. One such polymorphism, rs3745274, where there is a change from G to T at codon 516 results in an amino acid change from glutamine to histidine at position 172. The Food and Drug Administration (FDA) USA has recommended this molecular marker as a companion diagnostic test for Efavirenz. <b>Aim:</b> To evaluate the effect of Efavirenz in the treatment of HIV on the basis of genetic polymorphisms, to determine the CYP2B6 genotype of healthy individuals and those with HIV before starting the antiretroviral therapy, to review the reported cases of genetic polymorphisms and document drug toxicity in the selected population. <b>Materials and Methods:</b> A prospective clinical observational study was done at Kamineni Hospital, Hyderabad, Telangana, India, from September 2017 to August 2020 with an inclusion criterion of participants above the age of 18 years who were HIV positive diagnosed by Enzyme Linked Immunosorbent Assay (ELISA) test, reporting to the Outpatient Department (OPD) or getting admitted for treatment with Efavirenz with a sample size of 369 based on the prevalence of CYP2B6 polymorphism in Southern India. <b>Results:</b> Out of the study population, 276 HIV patients and 93 controls were genotyped by Polymerase Chain Reaction (PCR) and subjected to Restriction Fragment Length Polymorphism (RFLP) technique to establish CYP2B6-516 G>T polymorphism. About 69% were of GT genotype, 18% were of TT genotype and 13% is of GG genotype. Patients with GT genotype were intermediate metabolisers of the drug, those with TT genotype were poor metabolisers of the drug, and GG genotype was an extensive metaboliser of the drug. Individuals with the 516T allele had low enzyme activity and were poor metabolisers of the drug, causing delayed clearance leading to Adverse Drug Reactions (ADR) causing neurological deficits and cardiac complications. <b>Conclusion:</b> This observation helps the clinician adjust the dose of Efavirenz by studying the genetic polymorphism of the patient. Based on this study, we recommend that all HIV diagnosed patients should undergo CYP2B6 genotyping before starting an Efavirenz based regimen to decrease the adverse drug reactions and promote effective Highly Active Antiretroviral Therapy (HAART) therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC32-OC35&id=16261 https://doi.org/10.7860/JCDR/2022/52614.16261 Evaluation of Incidence, Risk Factors, Diagnosis and Management of Gestational Trophoblastic Neoplasia: A Retrospective Study Anjali Muralidas, Shilpa Ann Baby <b>Introduction:</b> Detection of any definite established pattern in aetiological factors can help identify high risk groups among vesicular mole patients, so that the development of Gestational Trophoblastic Neoplasia (GTN) can be anticipated to avoid delay in management of this disease with almost 100% cure rate. <b>Aim:</b> To determine the incidence of GTN, various factors associated with the condition, and any difference in risk factors between low risk and high risk disease and to evaluate the efficacy of the different treatment protocols used. <b>Materials and Methods:</b> A retrospective descriptive study done in the Department of Obstetrics and Gynaecology in a tertiary level hospital in South India which included 100 cases of GTN who were registered in the Gestational Trophoblastic Disease (GTD) clinic for a period of 10 years from January 2002 to December 2011. Data analysis was done from January 2020 to August 2020 The hospital incidence of GTN and proportion of GTN among vesicular mole was calculated. The different socio-demographic factors, clinical features and hormonal profile of all cases of GTN were studied in detail. <b>Results:</b> The incidence of GTN was 0.76 per 1000 deliveries. The proportion of GTN among molar pregnancy was 10.7%. Uterine size greater than period of amenorrhoea, bilateral theca leutin cysts especially with size >6 cm and pre-evacuation human Chorionic Gonadotropin (hCG) >100,000 mIU/mL was associated with development of GTN. GTN was found more in those with complete mole and that was around 71%. Around 81% had low risk GTN and 19% had high risk GTN. Major indication for starting chemotherapy was rising &#946;-hCG (72%). Presence of theca lutein cysts and uterine size greater than period of amenorrhoea were statistically significant risk factors for high risk GTN (p=0.022 and p<0.001, respectively). <b>Conclusion:</b> Identification of risk factors helps in early recognition of GTN and improves the overall outcome. The choice of chemotherapy depends on risk categorisation based on International Federation of Gynaecology and Obstetrics (FIGO) scoring system. Single agent for low risk and combination chemotherapy for high risk group is often sufficient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QC14-QC18&id=16262 https://doi.org/10.7860/JCDR/2022/52824.16262 Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Permanent Mandibular Molars: An In-vitro Study Nandini T Niranjan, Jwaalaa Rajkumar <b>Introduction:</b> Minimal invasive endodontics in the form of conservative access designs and minimal root canal taper preparation have been devised to preserve tooth structure and increase fracture resistance. <b>Aim:</b> To assess the influence of two different access cavity designs and two different final preparation tapers on fracture resistance of mandibular molars. <b>Materials and Methods:</b> In this in-vitro study, performed over a period of two months, a total of 54 extracted human permanent mandibular first and second molar teeth with completely formed apices were selected and for infection control, the teeth were stored in 10% buffered formalin solution for two weeks before the experiment. The teeth were then randomly allocated into three groups, Group C where no tooth preparation was carried out, Group TAC in which Traditional Access Cavity design was performed and Group TREC where Truss Access Cavity was performed. The groups TAC and TREC were further subdivided into subgroup A and B with two different tapers 0.04 and 0.06 taper preparations. Mesial canals of the teeth were chosen for testing the minimal root canal taper preparations. After apical gauging the distal canals, obturation and postendodontic restoration was carried out in all teeth of both the test groups. The teeth in all three groups were subjected to fracture testing in a universal testing machine. The data were recorded. One-way Analysis of Variance (ANOVA) and Tukey&#8217;s Post-hoc test were used for statistical analysis. <b>Results:</b> The fracture resistance between group C and groups TAC and TREC and their subgroups were found to be statistically significant (p<0.05). However, there was no statistically significant difference (p>0.05) observed between the two test groups TAC and TREC and their subgroups. <b>Conclusion:</b> The conservative truss access design in combination with a reduced root canal taper preparation has shown to have produced better fracture resistance values in comparison to other groups and their subgroups although the results were not statistically significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC45-ZC50&id=16267 https://doi.org/10.7860/JCDR/2022/52143.16267 Tobacco Smoking and Alcohol Drinking among Youth in Duhok, Iraq: A Cross-sectional Study Bakhtiyar Ahmed Rasheed Baba Hajee, Saad Younis Agha <b>Introduction:</b> Tobacco smoking and alcohol drinking are among the high risk health behaviours that determine individual and community health, increasing risk of chronic diseases like cardiovascular diseases and cancer, and of early mortality. <b>Aim:</b> To determine the prevalence and pattern of tobacco and alcohol use among youths in Duhok Province, Kurdistan Region of Iraq. <b>Materials and Methods:</b> This community based cross-sectional study conducted from September 2020-January 2021 in Duhok Province, Iraq. Systematic random sampling was used to interview 729 youths (15-24 years) (366 males and 363 females), who visited the Premarital Screening and Counselling Health Clinic in Duhok city, Iraq. Data collection was done using questionnaire based on the World Health Organisation (WHO) STEPwise approach to Non Communicable Diseases (NCD) surveillance. Data were analysed by Statistical Package for the Social Sciences (SPSS) version 26.0, and association between variables was calculated using the Chi-squared test and logistic regression. <b>Results:</b> Prevalence of tobacco smoking among youth was 20.3%, (25.4% in males and 15.2% in females). Males were 2.2 times more likely to smoke tobacco (OR: 2.2). Nargila/waterpipes was the most commonly used tobacco product (19.5%) followed by cigarettes (14.1%). Prevalence of alcohol drinking was 4.0%, (7.1% in males and 0.8% in females). <b>Conclusion:</b> Tobacco smoking among youth in Duhok was high, especially among females, with more use of Nargila/waterpipes. Exposure to second hand smoking was very high. Alcohol drinking was higher than WHO estimate for Iraq. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC35-LC41&id=16268 https://doi.org/10.7860/JCDR/2022/52701.16268 Efficacy of Biosilicate Glass-Ceramic and Gluma in the Treatment of Cervical Dentin Hypersensitivity: An Interim Results of Randomised Control Trial Maria Luiza Lima Santana, Ana Isis Cesário, Danilo Rocha Dias, Edgar Dutra Zanotto, Oscar Peitl Filho, Carlos Estrela, Virgílio Moreira Roriz <b>Introduction:</b> Dentin Hypersensitivity (DH) is known to be a relatively common condition that affects a considerable portion of the population, and manifests itself in the form of acute pain, due to the exposure of dentin and open dentinal tubules, after the removal of enamel or root cement. It has a multifactorial aetiology. <b>Aim:</b> To compare the efficacy in DH treatment using Biosilicate and Gluma Desensitiser. <b>Materials and Methods:</b> This randomised clinical trial pilot study with a split-mouth design included seven participants. Two teeth presenting Gingival Recession (GR)-related DH were selected in each participant and allocated to treatment groups by simple randomisation. Gluma® desensitiser (GD) and Biosilicate® (BIO) were applied once a week for four weeks. The pain intensity under a volatile stimulus was measured using a Visual Analogue Scale (VAS) at baseline and after treatment, at 15 days and 6 months follow-up. Data analysis were performed by means of descriptive statistics, Paired t-test for inter-group comparison and Friedman test for intra-group comparison (p-value <0.05). <b>Results:</b> The mean age of seven participants were 19.9 years, from which five were women (71.4%). The GD and BIO groups presented initial mean VAS values of 4.86&#177;2.55 and 6.14&#177;1.57, respectively. Fifteen days after treatment, both groups showed a significant improvement (GD group p-value=0.03 and BIO group p-value=0.02, Wilcoxon test) in pain intensity, with 71.4% teeth without sensitivity (VAS=0). <b>Conclusion:</b> Both treatments resulted in a reduction in painful sensitivity under volatile stimuli 15 days after treatment. BIO group presented a better outcome regarding reduction in DH, without recurrence at the 6th month evaluation, when compared to GD group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC51-ZC54&id=16269 https://doi.org/10.7860/JCDR/2022/52874.16269 Comparison of Sodium and Potassium Levels among COVID-19 Patients on Arterial Blood Gas Analysers and Clinical Chemistry Autoanalysers Mukesh Udevir Singh, Rakhi Negi, Pratibha Misra, Ashwini Kumar, Bhasker Mukherjee, MK Sibin <b>Introduction:</b> The electrolytes and Arterial Blood Gas (ABG) analysis are the crucial part of the evaluation in Coronavirus Disease 2019 (COVID-19) patients. Hyponatraemia and hypokalaemia are the electrolyte imbalance, commonly seen in COVID-19 and hence, patients require serial monitoring of electrolytes. Variations of sodium and potassium levels between arterial and venous blood are known, however as per existing literature, there are no previous studies on the comparison of electrolytes in COVID-19 patients, when analysed in arterial and venous blood, by different methods and its significance in clinical practice. <b>Aim:</b> To determine whether the sodium and potassium levels of COVID-19 patients are comparable when simultaneously analysed in arterial whole blood and venous serum sample, by ABG analyser and chemistry Autoanalyser (AA) respectively. <b>Materials and Methods:</b> This prospective observational study was conducted among COVID-19 positive patients admitted in Medical Intensive Care Unit at a Tertiary Care Super-specialty Hospital, Pune, Maharashtra, India, from February 2021 to June 2021. A total of 100 arterial and 100 venous blood samples of COVID-19 patients were analysed for sodium and potassium levels on Gem Premier 3000 Blood Gas Analyser and Auto-Quant 400i chemistry AA. The statistical analysis was done by the Bland Altman method to assess the agreement between the method of measurement for sodium and potassium levels in arterial and venous samples. Shapiro-Wilk&#8217;s test was applied to check normal distribution and statistical variables in sodium and potassium values measured by two methods. <b>Results:</b> The mean values for sodium in arterial blood were 135.91&#177;8.36 mmol/L and in serum was 140.26&#177;8.49 mmol/L. The mean value of potassium in arterial blood was 4.12&#177;0.76 mmol/L and in serum 4.41&#177;0.67 mmol/L. Coefficients of variation for arterial and venous sample sodium level was 4.21 mmol/L and for potassium was 0.28, with bias (95% limits of agreement) of 4.96-3.46 mmol/L and 0.35-0.21 mmol/L, respectively. <b>Conclusion:</b> The present study found a significant difference in electrolyte levels when compared between arterial whole blood in ABG analyser and venous serum sample in chemistry autoanalyser in COVID-19 patients. So, the clinicians must be aware of these variations and the same has to be kept in mind, while interpreting the results in COVID-19. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=BC13-BC16&id=16270 https://doi.org/10.7860/JCDR/2022/52960.16270 Fixation Versus No Fixation of Prolene Mesh in Lichtenstein Mesh Hernioplasty for Inguinal Hernia: A Short-term Follow-up Study Heet Jitendra Amlani, Jitendra Kumar Mangtani, Neelkamal Gupta <b>Introduction:</b> Lichtenstein tension free repair is the most commonly used anterior technique in which mesh is used for inguinal hernia. <b>Aim:</b> To compare fixation vs no fixation of prolene mesh in Lichtenstein mesh hernioplasty for inguinal hernia. <b>Materials and Methods:</b> This prospective interventional study was conducted in the Department of General Surgery at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, between December 2019 and May 2021. Patient of either sex aged 18-70 years who had reducible inguinal hernia were divided into two groups (group A: no mesh fixation and group B: mesh fixation by Lichtenstein mesh hernioplasty). Operative procedure time, postoperative pain (using visual analogue pain scale), postoperative haematoma/seroma, wound infection and rate of early recurrence were assessed. Operative procedure time and postoperative pain in both group was compared in both group using student&#8217;s unpaired t-test with unequal variance while postoperative haematoma, postoperative recurrence and mesh migration were compared in both group using Fischer&#8217;s-exact test. <b>Results:</b> A total of 89 patients were enrolled (group A has 48 patients and group B has 41 patient). Operative procedure time was less in group A in comparison to group B which was statistically significant (p-value=0.00221). Postoperative mean pain score was lower in group A at 12 (5.85 vs 6.97), and 24 hours (5.79 vs 7.19), and at day 2 (5.12 vs 6.61), day 4 (4.33 vs 5.1), day 7 (3.67 vs 4.56) and at 1 month (3.1vs 3.58). Postoperative haematoma/seroma was found less in group A but was not significant. Recurrence and mesh migration were seen in one patient in group A. <b>Conclusion:</b> No prolene mesh fixation technique in Lichtenstein mesh hernioplasty had decreased postoperative pain with an added benefit of lesser in operative time. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PC12-PC15&id=16271 https://doi.org/10.7860/JCDR/2022/55207.16271 Maternal and Foetal Outcomes in Early and Late Intrahepatic Cholestasis of Pregnancy and their Association with Maternal Serum Bile Acid Levels: A Prospective Cohort Study Sangeeta Gupta, Shreya Bhattarai, Taru Gupta, Sarika Arora <b>Introduction:</b> Intrahepatic Cholestasis of Pregnancy (IHCP) also known as recurrent jaundice of pregnancy is a pregnancy specific benign liver disease presenting in the second and third trimester of pregnancy and is associated with increased perinatal morbidity and mortality. <b>Aim:</b> To study and compare the maternal and foetal outcomes in early and late IHCP and to evaluate the Serum Bile Acid (SBA) levels and its association with adverse maternal and foetal outcomes at a tertiary care hospital in New Delhi. <b>Materials and Methods:</b> This was an observational, prospective cohort study, conducted during September 2018 to March 2020 in the Department of Obstetrics and Gynaecology, ESI PGIMSR, Basaidarapur, New Delhi, India. A total of 196 antenatal women with clinical signs and symptoms suggestive of IHCP with deranged liver function tests were grouped on the basis of period of gestation as early IHCP ( diagnosed &#8804;32 weeks) comprising of 40 women, and late IHCP (diagnosed >32 weeks), comprising of 156 women. They were further divided into four groups A, B, C, D on the basis of the maternal Serum Bile Acid (SBA) levels between 10-19 mmol/L, 20-29 mmol/L, 30-39 mmol/L and &#8805;40 mmol/L, respectively. Maternal outcomes such as caesarean rates, instrumental delivery, postpartum haemorrhage, blood transfusion, hospital stay and foetal outcomes such as preterm birth, birth weight, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, Neonatal Intensive Care Unit (NICU) admission, intrauterine foetal demise and neonatal death were noted and association was found by Pearson&#8217;s Chi-square test or Fisher&#8217;s-exact test. <b>Results:</b> A total of 196 women (mean age 25.64&#177;3.8 years, 40 in Early IHCP and 156 in late IHCP) were analysed for foetomaternal outcomes and were further divided into group A (n=138), group B (n=27), group C (n=13), and group D (n=18) on basis of maternal SBA. Adverse maternal outcomes such as high caesarean rates, instrumental delivery, postpartum haemorrhage, blood transfusion, prolonged hospital stay and adverse foetal outcomes such as preterm birth, low birth weight, low APGAR score, NICU admission, intrauterine foetal demise and neonatal death was more common in early IHCP in comparison to late IHCP (p<0.05). It was also observed that risk of adverse foetomaternal outcomes increased with increasing maternal SBA levels with maximum adverse outcomes seen in women with SBA &#8805;30 mmol/L i.e., Group C and D (p<0.05). <b>Conclusion:</b> Women diagnosed with IHCP at an earlier gestation &#8804;32 weeks have more propensity towards adverse foetomaternal outcomes and significantly higher rate of adverse outcome was observed in patients with SBA level &#8805;30 mmol/L. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QC19-QC23&id=16272 https://doi.org/10.7860/JCDR/2022/52069.16272 Histomorphological Features of Ovarian Neoplasms and Expression of p53 and WT1 in Surface Epithelial Tumours: A Cross-sectional Study Nupur Kaushik, Deepa Rani, Shikha Prakash, Richa Singh, Lalit Kumar <b>Introduction:</b> Ovary is the most common site of neoplastic and non neoplastic lesion, can present in childhood to postmenopausal age group and remain the most lethal of all gynaecological malignancies. Tumour Protein (p53) gene mutations or deletions are most common in ovarian carcinoma. However, Wilms’ Tumour gene1 (WT1) and p16 expression are also seen in serous ovarian carcinoma. These Immunohistochemistry (IHC) markers are useful in the differential diagnosis of serous ovarian carcinomas. <b>Aim:</b> To study histomorphology of ovarian neoplasm along with expression of p53 and WT1 in surface epithelial tumours and to assess the prevalence of various ovarian neoplasms in different age groups. <b>Materials and Methods:</b> This cross-sectional study was conducted in Department of Pathology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years (from September 2018-September 2020). A total of 78 ovarian specimen received in histology laboratory was studied for gross and microscopic features. The p53 and WT1 IHC expression pattern was studied in surface epithelial tumours. Statistical significance was calculated in relation to p53 and WT1 expression with histological type and grade of tumour using Chi-square test. <b>Results:</b> A total of 78 cases were studied, out of which benign tumours were the most common 40 (51.3%) cases, followed by malignant tumours 32 (41.0%) cases and borderline malignancy 6 (7.7%) cases. The most common benign lesions were mucinous cystadenoma 20 (50%) cases. Serous carcinomas were most common malignant tumours 19 (59.3%) cases followed by Germ Cell Tumours (GCT) 5 (15.6%) cases. All benign and borderline epithelial ovarian tumours were found p53 and WT1 negative. Out of 22 cases of malignant surface epithelial tumour, 14 (63.6%) and 12 (54.4%) were positive for p53 and WT1 respectively and all were serous carcinomas. <b>Conclusion: </b>Ovarian lesions present with wide spectrum of histomorphological features. The p53 and WT1 show different rates of expression and staining pattern in various epithelial ovarian carcinomas. Hence routine gross, proper histological examination and correct IHC interpretation is required for specific diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC01-EC06&id=16153 https://doi.org/10.7860/JCDR/2022/52010.16153 Expression of Melan-A (MART-1) in Various Pigmented Melanocytic Nevi and Close Mimickers R Shubha Sangeetha, Prakhar Garg, Nikita Jaju, YA Manjunatha <b>Introduction:</b> Melanocytic nevi are neoplasms resulting from the proliferation of melanocytes. Diagnosis of melanocytic tumours can be tricky, considering two factors, diagnosis of origin and determination of its benign or malignant nature. Visualisation of melanin or other pigments are non specific with Hematoxylin and Eosin (H&E) staining and specific with Melan-A Immunohistochemistry (IHC). Intensity and pattern of these reactions shows marked variability in different melanocytic lesions. <b>Aim:</b> To study the intensity and pattern of Melan-A expression in various pigmented melanocytic nevi and to understand its utility to differentiate close mimickers. <b>Materials and Methods:</b> A cross-sectional study of 50 lesions (45 cases and 5 controls) was conducted in the Department of Pathology of Dr. B.R. Ambedkar Medical College (tertiary hospital), Bengaluru, Karnataka, India, between September 2020 to October 2021. The skin biopsies received were fixed in formalin and paraffin embedded. Sections were stained with H&E and Melan-A IHC marker, using A103 antibody and a high temperature antigen retrieval was performed. Pattern and intensity of Melan-A expression were studied and its evaluation was done with normal skin (control). <b>Results:</b> Melan-A showed varied intensity (+ weak; ++ moderate; +++ strong), pattern (patchy, diffuse), distribution and on various pigmented melanocytic lesions and mimickers were analysed. Dermal nevi (18) showed +++ intensity, diffuse pattern in dermis and two cases showed ++ intensity and patchy staining. Five cases of Compound nevi showed ++ intensity, diffuse pattern in Dermoepidermal Junction (DEJ) and dermis, Deep penetrating nevi (in one case) +++ intensity and diffuse pattern in DEJ, dermis. Two cases of pigmented Basal Cell Carcinoma (BCC) showed + intensity and no definitive pattern in dermis. Four cases in fibrohistiocytic lesions and Malignant Peripheral Nerve Sheath Tumour (MPNST) shows negative Melan-A. In control melanocytes show dendritic pattern of staining and melanophages were negative. <b>Conclusion:</b> Melan-A is specific melanocytic marker as it stains only melanocytic lineage and no other cell types in background thus it is a marker of histogenesis instead of malignancy indicator. It highlights important architectural features and confirms the origin of lesions thus aiding the pathologist towards accurate diagnosis and differentiates from close mimickers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC07-EC12&id=16154 https://doi.org/10.7860/JCDR/2022/53438.16154 Clinical Profile and Outcomes of COVID-19 Patients with Malignancy- A Cross-sectional Study Chaitra Rao, M Parvathi, K Ravi <b>Introduction:</b> Patients with history of past or active malignancy are at increased risk of contracting the virus and developing Coronavirus Disease-2019 (COVID-19) related complications. With the global prevalence of cancer and the high transmissibility of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), an understanding of the disease course of COVID-19 and factors influencing clinical outcomes in patients with cancer is necessary and is largely unknown. <b>Aim:</b> To study the laboratory characteristics of patients with malignancy and COVID-19 infection and to evaluate the outcomes in terms of clinical features, severity of infection and mortality of patients with malignancy and COVID-19 infection. <b>Materials and Methods:</b> The present study was a cross-sectional study conducted at Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India, involving 72 subjects with COVID-19 infection. The duration of the study was from April 2020 to November 2020. Demographic details and data were collected in patients with active or previous malignancy and COVID-19 illness based on Indian Council of Medical Research (ICMR) criteria. Clinical outcome of the patients was measured based on need for Intensive Care Unit (ICU) admission, oxygen therapy and mortality. Descriptive statistics of the explanatory and outcome variables were calculated as mean, Standard Deviation (SD), median and Interquartile Range (IQR) for quantitative variables, frequency and proportions for qualitative variables. Inferential statistics like Chi-square test was applied for qualitative variables. <b>Results:</b> The mean age of the subjects was 52.10&#177;14.512 years with 29 males and 43 females. Among 72 patients with malignancy, patients were classified as mild (23), moderate (22) and severe (27) according to ICMR case type, respectively. Among the total patients, 21 (29.2%) were asymptomatic and 51 (70.8%) were symptomatic with 26 (36.1%) symptomatic patients having severe disease. Also, 30 (41.7%) had requirement of Oxygen (O<sub>2</sub>) and 28 (38.9%) were admitted to ICU. Most common was solid organ malignancy (66), lung carcinoma (13), breast (10), compared to haematological malignancies (6). A total of 22 (30.6%) patients had mortality with most common complication being Acute Respiratory Distress Syndrome (ARDS) (20.8%) followed by sepsis (4.2%). <b>Conclusion:</b> The results of present study revealed higher mortality and increased inflammatory markers in patients with severe COVID-19 infection and malignancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC01-OC04&id=16185 https://doi.org/10.7860/JCDR/2022/54947.16185 Spatial and Space-time Clustering of Diarrhoeal Cases among Under-Five Children in Karkala, Karnataka: A Geospatial Analysis Mackwin Kenwood Dmello, Sanjeev Badiger, Sudeep Kumar, Nanjesh Kumar, Neevan Dsousa <b>Introduction:</b> Globally, India tops by contributing the maximum number of diarrhoeal fatality. Forecasting the path and spread of diarrhoeal disease is critical due to its multifactorial cause, which needs robust spatial analysis and experiential investigations of communicable disease. <b>Aim:</b> To investigate purely spatial, purely temporal, and space-time clusters of diarrhoea among under-five children using a Geographic Information System (GIS) in Karkala taluk of the Udupi district of Karnataka, India. <b>Materials and Methods:</b> A retrospective longitudinal study was conducted involving all the primary health centres of Karkala taluk by the investigators, from the Department of Public Health, KS Hegde Medical Academy, Nitte (DU), Mangalore, Karnataka, India. The data on diarrhoea among under-five children was collected for three years, i.e., from 1st April 2015 to 31st March 2018, at the Udupi district health office. The data from 49 villages were obtained, and 3894 under-five childhood diarrhoea were reported during the study period. The annual incidence of childhood diarrhoea at the taluk level was calculated using excel. The spatial, temporal and space-time diarrhoeal clusters were identified using Kulldorff SaTScan software. Geographic Information System, QGIS 3.20.2 software was used to plot the maps. <b>Results:</b> The analysis of the spatial cluster using SaTScan software for three years in the study area identified eight high-risk areas (p-value <0.0001), covering 17 villages. The most likely spatiotemporal cluster region was located at the northern Karkala, and the most-at-risk period was 1<sup>st</sup> April 2016 to 30<sup>th</sup> September 2017 {Log Likelihood Ratio (LLR)=114.67 and p-value <0.00001}. The analysis of purely temporal cluster showed that one most likely cluster happened in all villages (LLR=73.89, p-value <0.001) from 1<sup>st</sup> April 2017 to 3<sup>rd</sup> March 2018. <b>Conclusion:</b> The diarrhoea among under-five children at Karkala taluk was not randomly distributed over space and time. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC01-LC05&id=16186 https://doi.org/10.7860/JCDR/2022/55604.16186 Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: A Retrospective Study of Mid and Long-term Outcomes V Manjunath, Deep Kumar Jain, M Shwethashree, Anupam Choudhary <b>Introduction:</b> Dorsal onlay urethroplasty with Buccal Mucosal Graft (BMG) is the single stage procedure and is most commonly used to treat long segment anterior urethral strictures. Unilateral mobilisation of the urethra prevents both chordee and ischaemia. <b>Aim:</b> To evaluate the feasibility, medium-term and long-term outcomes of dorsal onlay BMGs when used to treat long anterior segment penile urethral stricture with unilateral mobilisation of the urethra. <b>Materials and Methods:</b> A retrospective study was conducted in Kasturba Hospital, Manipal, Karnataka, India, from January 2008-December 2018. A total of 56 patients with long anterior segment penile urethral strictures underwent BMG substitution for urethroplasty, with a follow-up period ranging from 1.2-10 years. The outcome of the procedure was assessed through clinical history and physical examination, uroflowmetry, retrograde and voiding cystourethrography and urethroscopy {6 French gauge (Fr)}. Statistical analysis was performed using the mean and median. <b>Results:</b> The mean age of 56 patients was 51.8&#177;9.9 years, with a mean&#177;Standard Deviation (SD) Maximum Flow Rate (MFR) of 20.1&#177;5.3 mL at one month and 18.1&#177;4.3 mL at three and 18.7&#177;3.7 mL six months, 17.3&#177;5.1 mL, 19.3&#177;4.3 mL and 18.6&#177;3.7 mL at one year, 2-5 years and 10 years postoperative respectively. Postvoid Residual urine (PVR) volume was higher till one year follow-up (i.e., first month it was 38.6&#177;23.6 mL in 47 patients, third month it was 45.8&#177;22.4 mL in 12 patients, sixth month it was 49.0&#177;28.8 mL in 14 patients and one year follow-up it was 43.9&#177;30.8 mL in 24 patients). Minimal complications were noted over 5-10 years follow-up. <b>Conclusion:</b> For long segment anterior penile urethral strictures, unilateral mobilisation in BMG urethroplasty had shown success over both medium and long-term periods. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC05-OC07&id=16187 https://doi.org/10.7860/JCDR/2022/51648.16187 Functional Outcome of Monorail Fixator as a Primary and Definitive Mode of Fixation in Open Fractures of Tibia- An Interventional Study Kuldip Singh Sandhu, Dharm Pal, Arvind Kumar, Jaspreet Singh, Ashok Kumar Sharma, Kanwarjit Singh Sandhu <b>Introduction:</b> Open fractures of the tibia are associated with massive soft tissue injury and bone loss with high rates of infection and non union resulting in poor treatment outcome. The treatment goals include prevention of infection, soft tissue coverage, and fracture stabilisation with simultaneous mobilisation of nearby joints, enabling early return to function. The management in open fractures continues to be a topic of debate in orthopaedic traumatology with various treatment options, having their own set of complications. <b>Aim:</b> To assess the functional outcome of open tibial fractures with a monorail fixator using Radiographic Union Scale in Tibial fracture (RUST) score and modified Johner and Wruh&#8217;s criteria. <b>Materials and Methods:</b> This prospective interventional study of 30 cases was conducted from November 2018-October 2020 in Government Medical College, Patiala, Punjab, India. The 30 patients of open tibial fractures of type 2, type 3A, 3B (male=27, female=3) as classified by Gustilo-Anderson were included in this study. Patients were operated for monorail system to assess the stability of monorail fixator, total time taken in fracture union and compliance with range of motion of joints. On follow-up patients were also assessed for pin track infection and postoperative surgical site infection by taking swab for culture and antibiotic sensitivity. Statistical analysis was performed using the statistical software Statistical Package for the Social Sciences (SPSS) 25.0. In this study, quantitative data was expressed as mean values with Standard Deviation (SD) and categorical data were expressed as frequencies with percentages. <b>Results:</b> Present study had shown excellent to good results in 27 cases (90%) with minimum surgery time of 52.17&#177;14.24 minutes. Full weight bearing with fixator was allowed in 5.37 days and fracture union occurred at 31.8&#177;5.8 weeks. RUST score of 2 was seen in 33.33% and score 3 in 63.33% of patients respectively. Only one patient (3.33%) had shown score 1, which was treated with removal of fixator, debridement, sequestrectromy and fracture fixation with ring fixator and bone grafting. The bacteriology positivity was seen in six cases (n=2 was positive for <i>Escherichia coli</i> and n=4 was positive for <i>Staphylococcus aureus</i>). <b>Conclusion:</b> Present study demonstrated the benefits of monorail fixator as a primary and definitive mode of fixation in open tibial fractures with early full weight bearing over a stable construct and minimal complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=RC01-RC05&id=16188 https://doi.org/10.7860/JCDR/2022/52697.16188 Surgical Outcomes of Trabeculectomy Alone versus Trabeculectomy with Manual Small Incision Cataract Surgery Following Acute Angle Closure Glaucoma: A Comparative Study Soumya Ray, Soumen Chakraborty <b>Introduction:</b> Acute Angle Closure Glaucoma (AACG) is an ophthalmic emergency and is managed medically. Therapeutic options for the management of the post congestive phase are varied and no procedure has a documented therapeutic superiority over the other. Two established procedures were therefore chosen and compared to determine their therapeutic efficacy. <b>Aim:</b> To compare the surgical results of combined manual Small Incision Cataract Surgery (SICS) and trabeculectomy with standalone trabeculectomy in patients following an attack of AACG, with a final aim to decide which would be the better therapeutic approach in such a situation. <b>Materials and Methods:</b> This was a prospective observational comparative study done in Bankura Sammilani Medical College located in West Bengal, India. Sixteen patients presenting with AACG in a 19 months study period from October 2019-April 2021 and having 50% or more synechial angle closure on indentation gonioscopy were selected for this study after obtaining necessary ethical clearance. Eight of them underwent trabeculectomy alone (Group A) and the rest underwent a combined procedure of trabeculectomy and SICS (Group B). They were followed-up for a six-months period and compared on the basis of Intraocular Pressure (IOP) control, Anterior Chamber (AC) depth and the requirement for further surgery. <b>Results:</b> Mean IOP following surgery at the end of six weeks in Group A was 15.98&#177;1.56 mmHg whereas in Group B it was 12.01&#177;1.18 mmHg. Results were compared by unpaired t-test, and the difference was statistically significant (p<0.001). Three out of eight patients (37%) in Group A developed cataract which caused a reduction in visual acuity and needed cataract surgery within the six months follow-up period but none of the patients in Group B needed any additional surgery. One patient in Group A needed additional medications due to uncontrolled IOP after surgery but no such event was noted in Group B. Seventy five percent patients in Group A had Grade 2 angles whereas 87% patients in Group B had Grade 4 angles as estimated by Van Herrick&#8217;s method. <b>Conclusion:</b> Combined trabeculectomy and SICS offers a better level of postoperative IOP control than trabeculectomy alone, and perhaps offers a better therapeutic option following AACG. Also, the chances of postoperative cataract formation and associated visual debility are eliminated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=NC01-NC04&id=16189 https://doi.org/10.7860/JCDR/2022/55272.16189 Predictive Accuracy of Conventional Clinico-radiological Indicators in Foreign Body Aspirations among Children: A Retrospective Study Shinaz Sadiq, MK Binu, CS Aravind, SV Beena <b>Introduction:</b> Foreign Body Aspiration (FBA) is a common and serious paediatric emergency condition. A Suspected Foreign Body Aspiration (SFBA) is based on Clinical History (CH), Physical Findings (PF), and Chest Radiograph (RAD/CXR). The predictive accuracy of these factors as indicators of FBA and to perform Rigid Bronchoscopy (RB) based on these factors has been debated. <b>Aim:</b> To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of clinical history, physical findings and radiology in SFBA. <b>Materials and Methods:</b> A retrospective analysis was conducted on paediatric patients with suspicion of foreign body aspiration, admitted in the Department of Paediatric Surgery at Government Medical College, Thiruvananthapuram, Kerala, India, between January 2006 and December 2020. Factors in CH, PF, and RAD were subjected to univariate and multivariate analysis to evaluate the predictive accuracy of these factors as indicators for bronchoscopy. Sensitivity, specificity, positive and NPV were calculated for the clinico-radiological indicators in predicting FBA. The association between evidence of FBA and clinico-radiological indicators was evaluated by Pearson Chi-square test; and p-values <0.05 were considered to be statistically significant. <b>Results:</b> A total of 458 children (263 males and 195 females) were admitted with SFBA having mean age of 29.49&#177;24.92 months, 389 had confirmed FBA (Group A), and 69 had no FBA (Group B). The age group of 1-2 years was found to be a statistically significant factor for FBA (p-value=0.03). Foreign Body aspiration Witnessing Event (FBEW) (p-value <0.0001, sensitivity=91%, specificity=31%), choking spell (p-value <0.0001, sensitivity=95%, specificity=25%), acute cough (p-value <0.0001, sensitivity=87%, specificity=46%), tachypnea (p-value <0.0167, sensitivity=89%, specificity=20%), decreased breath sound (p-value <0.0001, sensitivity=92%, specificity=35%), abnormal CXR (p-value <0.0001, sensitivity=94%, specificity=37%) and hyperinflation (p-value <0.0001, sensitivity=95%, specificity=31%) were found to be independent statistically significant factors in FBA. Multivariate analysis showed a PPV of 97% when the aspiration event was witnessed along with abnormal physical and radiological findings. <b>Conclusion:</b> It was observed that assessment of clinico-radiological parameters is valuable in predicting FBA. The indications of RB in SFBA can be safely based on these clinico-radiological parameters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PC01-PC06&id=16190 https://doi.org/10.7860/JCDR/2022/53732.16190 Considerations for Testing of COVID-19 in Travellers under Quarantine- A Retrospective Study from Palakkad district, Kerala, South India C Sreedevi, N Divyamol, Shilu Mariam Zachariah, MG Deepak <b>Introduction:</b> Until sufficient herd immunity is generated in the population, contact tracing, testing, and quarantining should be continued as key interventions in breaking the chain of transmission of Coronavirus Disease 2019 (COVID-19). <b>Aim:</b> To identify appropriate strategies for testing of the travellers, who were coming from high-risk areas by analysing patterns of testing among COVID-19 positive returnees. <b>Materials and Methods:</b> A retrospective cohort study was conducted in Community Medicine Department, Government Medical College, Palakkad, Kerala, India, during 25th September 2020 to 15th October 2020, using the secondary data available from the database of COVID-19 Contact Tracing Cell (CCTC) to determine the testing pattern among the laboratory confirmed cases of COVID-19 positive returnees in Palakkad district. Only COVID-19 positive travellers returning to Palakkad district in May 2020 were included in the study, thus the sample size obtained was 122. Data regarding age, gender, co-morbidity, presence of symptom and time of its onset, time of swab collection and reporting of results which were collected by CCTC were analysed. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyse the data collected by CCTC. Quantitative variables were summarised as means with standard deviations and median with interquartile ranges. Qualitative variables were summarised as percentages. <b>Results:</b> Between arrival and swab collection there was mean duration of 6.9&#177;3.8 days and a median duration of seven days among the total positive returnees. Among the asymptomatic cases, the mean duration was found to be 7.4&#177;3.6 days for the same. Between day 10 and day 12 of quarantine, 79%-91% of the cases have given swabs for Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing. This had yielded 90% positive reporting within 14 days of quarantining. Total 10 cases were diagnosed after 14 days of quarantine due to late swab collection while in quarantine. Mean duration between symptom onset and swab collection among 22 symptomatic cases was 1.9&#177;1.6 days (median=2 days). <b>Conclusion:</b> Testing of asymptomatic returnees from high risk area may be initiated (swab collection) by day 10 as swabs collected around 10<sup>th</sup> day of quarantine capture maximum number of positive cases. A delayed initiation for testing may prolong the time taken for diagnosis. Those who have tested negative during 14 days of quarantine should self-monitor for symptoms and reduce contact with high risk persons for one more week. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC06-LC09&id=16193 https://doi.org/10.7860/JCDR/2022/55065.16193 Survival Analysis of Infiltrating Ductal Breast Cancer Patients with Cure Rate Regression Model- A Retrospective Cohort Study from a Tertiary Care Hospital in Central Kerala Rejani Parassery Parameswaran, Shehna Abdul Khader, Paduthol Godan Sankaran, Rajagopalan Pillai Mahadevan, Krishnan Nair Lalithamma Jayakumar <b>Introduction:</b> Breast cancer is a leading cause of morbidity among women all around the world. Monitoring the survival pattern and identifying the prognostic factors on survival are always great concerns in cancer researches. Cure rate regression model is a useful statistical tool to predict the cure rate of cancer diseases and to determine the factors associated with survival of patients. <b>Aim:</b> To estimate the cured proportion and to make out the factors associated with survival time of infiltrating ductal breast carcinoma patients in a tertiary care hospital of central Kerala. <b>Materials and Methods:</b> The retrospective cohort study was conducted in the Department of Radiotherapy of a major tertiary care hospital of central part of Kerala, India. A total of 313 female patients diagnosed with infiltrating ductal breast cancer during January 2012 to December 2015 were considered for the study. The impact of the covariates, age at diagnosis of disease, grade of cancer, stage of disease, tumour stage, status of regional lymph node, distant metastasis, and triple-negative status on survival of patients were studied. The parametric mixture cure rate regression model was used for estimation and inferential procedures. The cure rate with respect to each study variable and their role on long term survival of patients were investigated. <b>Results:</b> Mean age of patients was 51.95&#177;10.91 years. The minimum cure rate found out (29.8%) among the patients presented with distant metastasis. The bivariate analysis showed the factors, stage of cancer (T-stage), status of regional lymph node and distant metastasis status influence significantly on incidence of death due to breast cancer in long run period and grade of cancer determines the survival of patients at shorter duration of time. The presence of regional lymph node and distant metastasis status were found out to be two important indicators that determine cure rate of infiltrating ductal breast cancer patients in multivariate analysis. The hazard of patients living with higher grade cancer was seen 1.48 times more than that of others (Hazard Ratio=1.48, p-value <0.001). <b>Conclusion:</b> The cure rate of patients estimated between 29.8% and 69.6% with respect to various factors under study. The status of regional lymph node and distant metastasis status were found to be associated with cure rate of patients. The study results showed that the grade of cancer is one significant factor that determines survival of patients. The study recommends cure rate regression model as a useful tool to analyse breast cancer survival data in the presence of cured proportion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=YC01-YC05&id=16194 https://doi.org/10.7860/JCDR/2022/51739.16194 Role of Sonography and Sonoelastography in Characterisation of Cervical Lymphadenopathy with Pathological Association: A Cohort Study Sumit Kaushik, Madhu Sharma, Lal Bahadur Sharma, Ankur Malhotra, Deepti Arora, Anshul Jain <b>Introduction:</b> Identification of the nature of lymph nodes is one of the most important parameters for diagnosis in any oncological setting. The lymph nodes help in staging and this directly affects the prognostic outcome and treatment decision. Ultrasound is the preferred imaging method for distinguishing between benign and malignant superficial lymph nodes given ease of availability and its low cost. However, there is no reliable and definitive sonographic criterion in ultrasound to categorise lymph nodes as benign or malignant. <b>Aim:</b> To evaluate the role of sonography and sonoelastography in characterisation of cervical lymphadenopathy and to associate the imaging findings with cytopathology. <b>Materials and Methods:</b> This was a prospective cohort study, conducted over a period of one year in Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India, constituting a total of 60 patients with enlarged cervical lymph nodes and evaluated on B-mode ultrasound and elastography in the present study. The ultrasonography was performed using either Acuson S3000 ultrasound system (Siemens Medical Solutions, Mountain View, CA) with a 4 to 9 MHz linear transducer for conventional sonography and Acoustic Radiation Force Impulse (ARFI) imaging. Results of radiological findings were tabulated, evaluated and collated with pathological findings. <b>Results:</b> ARFI imaging displayed a sensitivity and specificity of 80% and 97.5% respectively with a Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 94.1% and 90.7% respectively in distinguishing malignant from benign cervical lymphadenopathy with the diagnostic accuracy being 91.67%. Using Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of 0.925, a cut-off value for shear wave velocity of 2.98 m/s was obtained. <b>Conclusion:</b> ARFI is a novel technique which can be used to characterise the nature of cervical lymph nodes. Present study demonstrated high diagnostic accuracy (91.67%) in comparison with histopathological findings, ARFI elastography may help in distinction of benign from malignant nodes in adjunct to the gray scale. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TC01-TC05&id=16195 https://doi.org/10.7860/JCDR/2022/50832.16195 Identification of Effective Model for Prediction of Ovarian Malignancy Risk using Models like Risk of Malignancy Index, Logistic Regression, International Ovarian Tumour Analysis- Simple Rules SR Ramya <b>Introduction:</b> Ovarian tumour is not a single entity it is a spectrum of neoplasm involving variety of histological tissues. Use of mathematical formula as malignancy index which is based on logistic model, menopausal status, serum levels of Cancer Antigen 125 (CA-125) and ultrasound findings in a score system is not so popular which can be a useful predictor for diagnosing and monitoring the progression of ovarian malignancy. <b>Aim:</b> To determine the effectiveness of the three models i.e., Risk of Malignancy Index (RMI-1,2,3 and 4), Logistic Regression 2 (LR-2), International Ovarian Tumour Analysis (IOTA) - simple rules in predicting ovarian malignancy. <b>Materials and Methods:</b> This prospective cohort observational study was conducted in Department of Obstetrics and Gynaecology at Saveetha Medical College and Hospital, Tamil Nadu, India, from June 2017 to July 2018. The study included a total of 70 female subjects with ovarian mass. Information obtained by investigations, ultrasound was used to predict the risk of malignancy by using the three models {Risk of Malignancy Index (RMI-1, 2, 3 and 4), Logistic Regression 2 (LR-2), International Ovarian Tumour Analysis (IOTA)- simple rules}. CA-125 level was considered as primary outcome variable. Study group histopathology impression (malignant vs benign) was considered as primary explanatory variable. The result from the above models was compared with the postoperative histopathological report. The sensitivity and specificity of each model was also identified. <b>Results:</b> Majority of the study participants 49 (70%) were in premenopausal status and only 21 (30%) were in menopausal status. The mean CA-125 level was 108.82&#177;233.13 in the study population (95% CI: 53.23-164.41). Among the 70 study subjects, 53 (75.70%) patients were RMI-1 benign and only 17 (24.30%) were RMI-1 malignant. Majority of the study participants 44 (60%) were IOTA impression benign and only 23 (40%) were IOTA malignant. The difference in the proportion of IOTA-simple rules between histopathology impression was statistically significant (p-value <0.001). The sensitivity of IOTA-simple rules in predicting malignant histopathology was 92%, specificity was 90.48%, diagnostic accuracy was 91.04%. <b>Conclusion:</b> For early risk stratification of adnexal masses, IOTA-simple rules can be used as a screening tool due to its high sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QC01-QC05&id=16196 https://doi.org/10.7860/JCDR/2022/53286.16196 Reference Interval, Biological Variations and Distribution of Creatinine Level in Fasting Urine: A Cross-sectional Study Hasnamol Pila Thottathil, Sindu Padinjareveedu Chandran, Jose Jacob <b>Introduction:</b> Serum creatinine, urine creatinine, and rate of urine formation are components of creatinine clearance and are under multiple influences. Of these, urine creatinine has the widest variability, especially in the tropical region. Reference intervals, biological variations, and distributions of urine creatinine in the reference individuals are related and important for clinical interpretations of kidney functions. <b>Aim:</b> To establish the reference intervals, biological variations, and distributions of creatinine in urine formed during morning fasting state from reference individuals in a tropical location. <b>Materials and Methods:</b> This observational cross-sectional study of the sample population was done from January 2017-November 2021 for the establishment of reference interval. Reference individuals, defined by inclusion and exclusion criteria, were from the population at near sea levels plains, in Thrissur district, Kerala, avoiding the mountainous Western Ghats. Morning fasting, third sample of urine was collected to ensure that the urine collected was formed in the morning (n=156). A second set of 44 urine samples, collected from 10 reference individuals consecutively for 4-5 days, was used for estimating the analytical Coefficient of Variation (CV<sub>A</sub>), within-subject (CV<sub>I</sub>), and between-subject (CV<sub>G</sub>) components of biological variation. Outliers in the creatinine data were identified and removed by the Box-Whisker plot to exclude the subclinical influences that affected the urine creatinine, followed by Box-Cox transformation to bring the distribution to Gaussian and reference interval calculations of fasting urine creatinine. <b>Results:</b> As the total sample number was >120, non parametric percentile method was used to calculate the reference interval of 17.14-325.89 mg/dL. As the female sample number was between 40 and 120, double-sided, 95% reference interval, based on normal distribution was calculated as 12.41-328.71 mg/dL. As the male sample was <50, method of robust calculation was used to define the reference interval of 21.91-379.12 mg/dL. The reference interval and biological variation data showed gender differences in the distribution, CV<sub>I</sub>, and CV<sub>G</sub> due to lower concentration of fasting urine creatinine in females resulting from lower muscle mass. <b>Conclusion:</b> Reference intervals of creatinine in fasting urine formed in the morning were established. Gender differences were observed in the distribution of data, CV<sub>I</sub>, and CV<sub>G</sub>. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=BC01-BC07&id=16197 https://doi.org/10.7860/JCDR/2022/53649.16197 Immunohistochemical Evaluation of Myxoid Sarcomas- A Tertiary Care Hospital Experience Karthik Sigamani, Karkuzhali Ponnuswamy <b>Introduction:</b> Myxoid sarcomas are a rare and heterogeneous group of tumours exhibiting overlapping histomorphological features with varied biological behaviour. Hence, additional ancillary techniques like Immunohistochemistry (IHC) are necessary for definite diagnosis and categorisation of the myxoid sarcomas. <b>Aim:</b> To identify the distribution of myxoid sarcomas among patients and also to evaluate the utility of basic IHC in the diagnosis of myxoid sarcomas. <b>Materials and Methods:</b> This was six years retrospective observational cross-sectional study carried out in the Department of Pathology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, during the period of January 2008-December 2013. Relevant pathological data of all the myxoid sarcomas reported during the study period were retrieved from the medical records. Corresponding Haematoxylin and Eosin (H&E) stained slides were reviewed and IHC was done using a panel of markers for confirmation. <b>Results:</b> Among the 57 myxoid sarcomas, 46% occurred in the age group of 41-60 years with a striking male preponderance (74%). Myxofibrosarcoma was the most common histological type (33.33%). All cases of myxofibrosarcoma were positive for vimentin while two cases showed focal Smooth Muscle Actin (SMA) positivity and one case showed focal CD34 positivity. Low grade fibromyxoid sarcomas were positive for only vimentin. Myxoid liposarcomas and extra-skeletal myxoid chondrosarcomas showed vimentin and S100 positivity. Myxoid Dermato Fibrosarcoma Protuberans (DFSP) was positive for vimentin and CD34 while synovial sarcoma with myxoid change was positive for vimentin and Pancytokeratin (Pan CK). Myxoid Malignant Peripheral Nerve Sheath Tumour (MPNST) showed 100% vimentin and S100 positivity while CD34 was positive in 12.5% of cases. Leiomyosarcoma with myxoid change was positive for vimentin, SMA, desmin and Pan CK. <b>Conclusion:</b> The IHC is a valuable adjunct to light microscopy for the diagnosis of myxoid sarcomas and can provide as a judicious tool for diagnosis of this uncommon and challenging group of malignant soft tissue tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC13-EC16&id=16198 https://doi.org/10.7860/JCDR/2022/55509.16198 Dentinal Microcrack Formation by Different Rotary Endodontic File Systems: An In-vitro Study Ruchika Gupta, Suvarna Patil, Pramod Mohite, Divya Gupta, Divya Dudulwar <b>Introduction:</b> During endodontic treatment, biomechanical preparation of the root canals constitutes one of the prime steps to enable bacterial eradication, irrigant percolation and three dimensional obturation of the canal space. Currently used rotary endodontic instruments generate stresses in the dentinal walls as microcracks and craze lines which can eventually precipitate vertical root fractures. This endangers the prognosis of an endodontically treated tooth or can even lead to tooth extractions. <b>Aim:</b> To compare dentinal microcrack formation during biomechanical preparation by different Nickel-Titanium rotary endodontic instruments, Reciprocating single file system and Self-Adjusting File (SAF) using a stereomicroscope. <b>Materials and Methods:</b> The study was a randomised controlled trial conducted for a total duration of two months. A total of 80 extracted human mandibular molars with intact mesial roots were selected. Endodontic access was achieved. Hyflex CM file (Coltene), One Shape file (Micromega), Twisted File (TF; SybronEndo, Orange, CA), One endo file (Nano endo), ProTaper Next file (Dentsply Maillefer), Reciproc file (VDW) and SAFs were used to prepare the samples, leaving ten teeth unprepared which served as control. Sectioning of the prepared samples were carried out perpendicular to their long axes at 9, 6 and 3 mm. Under 40X magnification of a stereomicroscope, digital images of each section were recorded with the aid of a digital camera. Examination of each specimen was carried out by two operators to verify the presence of dentinal defects/microcracks. The statistical analysis was done by Chi-square test. <b>Results:</b> Except the control group, all the remaining groups recorded the presence of dentinal defects. The incidence of cracks was highest in One Endo (40%) followed by One Shape, Twisted (30%), Protaper Next (23.33%), Reciproc (10%), Hyflex (6.67%), SAF (3.33%) and control (0%). A significant difference was found for the cracks in coronal section between the file systems (p=0.0001). <b>Conclusion:</b> Usage of nickel titanium rotary instruments leads to the formation of microcracks or craze lines in root dentine. Instruments which have Metallurgical (M) wire or Controlled Memory (CM) wire in their metallurgy result in fewer formations of microcracks. When compared to multiple rotary files system, a reciprocating file led to the induction of lesser number of radicular cracks. SAF creates minimal cracks as compared to other file systems. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC01-ZC06&id=16199 https://doi.org/10.7860/JCDR/2022/52863.16199 Benefits of Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure with Reduced Ejection Fraction: A Longitudinal Study Dharmendra Jain, Umesh Kumar Pandey, Suyash Tripathi, Abhishek Kaushley, Bhupendra Verma, Soumik Ghosh, Krishna Vemuri Santosh, Rajpal Prajapati <b>Introduction:</b> Combination of Angiotensin Receptor and Neprilysin Inhibitors (ARNI) has become the mainstay drug in treatment of Heart Failure (HF) with reduced Ejection Fraction (HFrEF). However, there are very few studies to evaluate the extent and spectrum of benefit of ARNI therapy in Indian HFrEF patients. <b>Aim:</b> To observe the benefits of sacubitril/valsartan (ARNI) therapy on left ventricle function, parameters of cardiac remodelling, N terminal pro Brain-natriuretic peptide (NT-proBNP), rate of rehospitalisation for HF and detailed subgroup analysis in symptomatic HFrEF patients who are already receiving optimal medical therapy. <b>Materials and Methods:</b> This longitudinal study was conducted at Cardiology Department of Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from September 2018 to August 2020. Total 200 patients of HFrEF with previous echocardiographic records of past six months, who did not show any further improvement in left ventricle dysfunction or cardiac dimensions were included in the study out of these 200 patients, 174 (87%) completed the one year follow-up. Patients were started on ARNI initially from 100 mg/day and up titrated to 400 mg/day. At each follow-up (6 weeks, 4 months, 6 months, 9 months and 1 year) clinical examination, New York Heart Association (NYHA) functional class, 2D Echocardiography and NT-ProBNP were done. Echocardiographic parameters of Cardiac Reverse Remodelling (CRR) i.e., Left Ventricular Ejection Fraction (LVEF), Left Ventricular End Diastolic Diameter (LVEDD), Left Ventricle End-Systolic Diameter (LVESD) were recorded at each follow-up. All categorical variables were shown in the form of frequency, mean with standard deviation and percentage.Intergroup comparison between different time periods was done by one-way Analysis of Variance (ANOVA) and paired t-test. A p-value <0.05 was considered statistically significant. <b>Results:</b> Mean age of study population was 58.61&#177;11.95 years, of whom 104 (59.77%) were males, and 70 (40.22%) were females. Mean LVEF increased from 30.42% at baseline to 45.98%, after 1 year (p-value <0.05). There was reduction in mean LVEDD of 4.5 mm (p<0.05) and LVESD of 3.86 mm (p-value <0.05) at 1 year. These benefits of CRR were observed in all the subgroups of study population (including diabetics, hypertensive, tobacco users, age, gender). Reduction in NT-ProBNP from 1097.65&#177;769.7 pg/mL at baseline to 127.28 pg/mL after 1 year with mean reduction of 970.37&#177;731.33 pg/mL (p-value <0.05). Rate of rehospitalisation for HF was 13.2% (N=23). A positive although weak correlation was seen between change in NT-ProBNP level and change in LVEF, LVEDD, LVESD as per Spearman&#8217;s rank correlation coefficient. <b>Conclusion:</b> The ARNI was well tolerated in this Indian population as 72% achieved maximum dose of 400 mg. There was significant improvement in LV systolic function and cardiac dimensions and benefits extended to different subgroups of HFrEF patients along with positive although weak correlation between fall in NT-ProBNP level and improvement in LV function and cardiac dimensions over and above optimal medical therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC08-OC13&id=16200 https://doi.org/10.7860/JCDR/2022/54929.16200 Prevalence of Oral Lesions among HIV Positive Patients Attending Antiretroviral Therapy Centre in Rural Area of Western Maharashtra Anita D Munde, Sunil S Mishra, Ravindra R Karle, Anuja A Deshpande, Ruchira V Sawade, Hemant Pawar <b>Introduction:</b> The Oral Manifestations (OM) of Human Immunodeficiency Virus (HIV) is indication of compromised immune status and disease progression. These Oral Lesions (OL) cause morbidity and affect quality of life of the patients. <b>Aim:</b> To evaluate the association between OM in patients with HIV infection and their level of Cluster of Differentiation 4 (CD4) count. <b>Materials and Methods:</b> The study was designed as a descriptive, cross-sectional study for a duration of two years which included a total of 565 known HIV-positive individuals visiting the regional Antiretroviral Therapy (ART) centre for counseling and/or on Highly Active Antiretroviral Therapy (HAART) were selected irrespective of age and sex. The OL were diagnosed using the presumptive criteria given by by the European Committee (EC) Clearinghouse, 1993. Oral and systemic manifestations were recorded and associated with CD4 counts. The data collected was subjected to statistical analysis using Statistical Package of Social Science (SPSS) 8.0 software and p-value was considered significant at a level of 0.05. <b>Results:</b> The male-to-female ratio was almost equal and 95.04% of the patients had reported heterosexual contact as the transmission route. The peak age of occurrence of HIV infection was during 31-40 years with the mean age of males and females 39.26 years and 34.46 years, respectively. Pulmonary tuberculosis (16.11%) and herpes zoster (16.81%) were the most common systemic manifestations. The prevalence of OM reported was 86.01% and was higher in females than in males. Intraoral melanotic pigmentation (50.08%) was the most common finding, followed by periodontitis (36.46%), linear gingival erythema (14.51%), Necrotising Ulcerative Gingivitis (NUG) (4.42%), candidiasis (8.67%), oral ulcers, herpes zoster (5.13%), herpes simplex virus infection (1.17%) and salivary gland disease (SGD) (0.7%). There was a significant association (p=0.0110) between OL and reduced CD4 count. <b>Conclusion:</b> The OL occur commonly in HIV infection. The decrease in CD4 count is associated with a wide range of OM. The result from this study can be used as predictive marker for oral manifestations in Acquired Immunodeficiency Syndrome (AIDS) based on the level of immune suppression and help in improving their quality of life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC07-ZC12&id=16201 https://doi.org/10.7860/JCDR/2022/48575.16201 Vascular Calcification in Chronic Kidney Disease Patients- A Cross-sectional Study M Bagavad Geetha, R Logesh, M Jayakumar, S Santhosh, Santhi Silambanan, Viji Devanand <b>Introduction:</b> Vascular Calcification (VC) is considered as a cardiovascular risk marker in Chronic Kidney Disease (CKD) patients. VC is a process characterised by thickening and loss of elasticity of muscular arteries walls. The three pathological forms of cardiovascular disease in CKD are cardiac geometry, atherosclerosis and arteriosclerosis of the large vessels (carotid artery or aorta). <b>Aim:</b> To evaluate VC as a cardiovascular risk marker in CKD patients. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Nephrology Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from November 2019-December 2020. The study included 27 CKD patients who were on maintenance haemodialysis. The participants were 20-70 years of age, and of both genders. The Intima Media Thickness (IMT) was assessed by ultrasonography. Peak Systolic Velocity (PSV) measurement was done using doppler ultrasonography. Both the measurements were done on Common Carotid Artery (CCA), and Internal Carotid Artery (ICA) on both sides of the neck. Student&#8217;s t-test and Chi-square test was used in this study. Data were expressed as mean&#177;SD. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Out of 27 study participants, 20 (74%) were male and females were 7 (26%), with mean age of 48 years.<b></b> There was significant increase in IMT of the ICA on the right side of the neck compared to left side (p-value=0.01). Also, there was significant increase in PSV of ICA on the right side compared to left side of the neck (p-value=0.04). There were no statistically significant differences in IMT and PSV when CCA on the right side was compared to that of the left side of the neck. <b>Conclusion:</b> The IMT was increased in ICA and CCA. But there was statistically significant difference only in ICA, where it was more prominent on the right side compared to left side. CKD patients on haemodialysis management could have the risk factors in the form of increased IMT predisposing them to early mortality from cardiovascular complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=CC01-CC03&id=16182 https://doi.org/10.7860/JCDR/2022/52601.16182 Evaluation of Doses to Target Volume and Organs at Risk by Conventional versus RTOG Contouring Based 3D Conformal Plans in Breast Cancer: A Prospective Study Prabha Verma, Madhup Rastogi, Ajeet Kumar Gandhi, Rohini Khurana, Anoop Kumar Srivastava, Avinav Bharati, Rahat Hadi, Niraj Agarwal <b>Introduction:</b> In radiotherapy, conventional field borders have often little anatomical correlation with the draining lymphatics. So, with the availability of more conformal techniques and delineation guidelines, an evident need exists to optimise our treatment plans with more focus on planning and dosimetric aspects. <b>Aim:</b> To evaluate the differences in dosimetric parameters to the Organs at Risk and target volumes in patients treated with conventional plans vis-&#224;-vis Radiation Therapy Oncology Group contour guided treatment plans. <b>Materials and Methods:</b> A prospective interventional study was conducted in which 30 patients of histopathologically proven Infiltrating Ductal Carcinoma (IDC) breast, with age range of 18 to 80 years were enrolled. Patients were treated with 50 Gray in 25 fractions of radiation with additional 10 Gray in 5 fractions boost in Breast Conserving Surgery (BCS) patients by conventional treatment plans. Radiation Therapy Oncology Group (RTOG) guidelines were used for breast/Chest Wall (CW), axillary nodes, Supraclavicular Fossa (SCF), and Internal Mammary Node (IMN) delineation. Organs At Risk (OARs) included heart, Ipsilateral (I/L) lung, Contralateral (C/L) breast, oesophagus and spinal cord. Dose-Volume Histograms (DVHs) for these contours were generated from conventional treatment plans. Further, new treatment plans were generated to cover >90% of Planning Target Volume (PTV) by 90% isodose line. DVH parameters of these two plans were compared using paired t-test. A p-value of <0.05 was considered statistically significant. <b>Results:</b> Of the total 30 cases, the mean volume of breast/CW PTV covered by 90% isodose line (V90) was better in RTOG plan as compared to Conventional plan (93.39 vs 90.39, p-value=0.001). Similarly, mean V90 for total axilla (97.44 vs 90.39, p-value=0.0001) and combined PTV (92.60 vs 88.81, p-value=0.0001) was better with RTOG plan. For OARs, conventional vs RTOG plans; Dmean for heart was 2.56 vs 2.60Gy, p-value=0.63), I/L lung V20Gy was 28.77 vs 28.94%, p-value=0.71) and V5Gy for C/L breast was 0.48 vs 0.54%, p-value=0.47), respectively. In cases where IMN was irradiated, mean doses to the heart, I/L lung V20Gy, and contralateral breast V5Gy increased significantly. <b>Conclusion:</b> The present study showed that RTOG target volumes had inadequate coverage in conventional plans. On the contrary, plans directed at RTOG contours provided statistically better coverage for target volumes without increase in the doses to the OARs. In patients with IMN irradiation, the doses to some OARs were increased in RTOG as compared to conventional plans. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=XC01-XC05&id=16137 https://doi.org/10.7860/JCDR/2022/52508.16137 Prognostic Importance of Red Cell Distribution Width, Mean Platelet Volume and Neutrophil Lymphocyte Ratio among Sepsis Patients at a Tertiary Setting in Kolar, South India Minni Meka, A Raveesha, R Kalyani <b>Introduction:</b> Complete Blood Count (CBC) analysis contain several parameters that are routinely investigated during admission. Of these parameters, Red-Cell Distribution Width (RDW), Mean Platelet Volume (MPV), Neutrophil-Lymphocyte Ratio (NLR) have been observed as independent risk factors for various systemic diseases. <b>Aim:</b> To compare the prognostic value of RDW, MPV, NLR with Sequential Organ Failure Assessment (SOFA) score among sepsis survivors and non survivors. <b>Materials and Methods:</b> A prospective observational study was conducted among 120 sepsis patients admitted in department of General Medicine and Intensive Care Unit (ICU) at a tertiary care and research center in Kolar, South India, for 18 months from January 2018 to July 2019. Patients information regarding age, gender, SOFA scores, and parameters like RDW, MPV, NLR were recorded from the blood sample. The SOFA score, RDW, NLR, and MPV levels were considered explanatory variables for sepsis patients&#8217; mortality. To test significance, independent t-test and Chi-square test were used. Correlation analysis was performed with the pearson correlation coefficient. The SOFA score, RDW, MPV, and NLR were further analysed using the receiver operating characteristic (ROC). The level of significance was set at &#8804;0.05. coGuide software, V.1. was used for data analysis. <b>Results:</b> All 120 subjects were divided into two groups. Survivor&#8217;s group had 79 (65.8%) subjects, and 41 (34%) were in non-survivor&#8217;s groups. Most of the survivors were in the age group 60-79 years which were 29 (36.71%), whereas non survivors were 40-59 years which were 17 (41.46%). Maximum were males in both the groups. Fever was the most common presenting symptom in survivors, 62 (78.48%) and non survivors 31 (75.61%). The calculated Area Under Curve (AUC) for RDW was 0.973 with 90.24% sensitivity and 97.47% specificity. The AUC for MPV was 0.966 with 92.68% sensitivity and 97.47% specificity, and for NLR, it was 0.984 with 100% sensitivity and 89.87% specificity. The yielded AUC for SOFA score was 0.772 with 56.10% sensitivity and 89.87% specificity. Ventilator and ionotropic support were strongly associated between groups (p-value <0.001). There was a significant difference among survivors and non survivors for SOFA score (p-value <0.001), systolic and diastolic blood pressure, pulse rate, GCS, and investigations like RDW, NLR, and MPV (p-value <0.001). <b>Conclusion:</b> This study demonstrated a strong correlation between increased levels of RDW, NLR, MPV and mortality among sepsis patients and can be used as prognostic markers for mortality prediction in adult sepsis patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC23-EC27&id=16203 https://doi.org/10.7860/JCDR/2022/52240.16203 Histopathological and Clinical Evaluation of Non Neoplastic Intestinal Lesions: A Cross-sectional Prospective Study in a Quaternary Care Centre, Gujarat, India Nanda Nikunj Jagrit, Rajul R Shah, Dhara J Modi, Killol Nathubhai Desai <b>Introduction:</b> Small and large intestines are major portion of gastrointestinal tract. So many benign, malignant and congenital disorders arise from there. Benign causes, mainly include inflammatory and infectious disorders. Colon is the most common site for gastrointestinal neoplasia in western populations. <b>Aim:</b> To find out the pattern, frequency and site of non neoplastic lesions affecting intestine with intention that clinicians of this region can be responsive of its incidence. <b>Materials and Methods:</b> A prospective cross-sectional study was done at a quaternary care centre from June 2017-October 2019. Total 150 cases were studied, out of those 125 were benign and 25 were malignant cases. Patients of all ages were included with sign and symptoms of intestinal lesions. <b>Results:</b> Majority of specimens were bowel resection 130 (86.7%) and remaining were endoscopic biopsy 20 (13.3%). Majority of lesions were inflammatory lesions (73.34%) followed by malignant lesions (16.66%). Congenital and benign lesions were less common (6% and 4%). Non neoplastic lesions 125 (83.33%) were more common than neoplastic lesions 25 (16.67%). 65.33% lesions were in small intestine and cecum and 34.67% were in colon and rectum. Non specific inflammation was most common type (47.90%). Hirsprung&#8217;s Disease and Ulcerative Colitis lesions were least common (1.69% and 3.36%) in present study. <b>Conclusion:</b> Accurate macroscopic and microscopic examination of specimens which are associated with clinical data helps to reach at definite goal and can improve quality of life of the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC32-EC35&id=16237 https://doi.org/10.7860/JCDR/2022/55852.16237 Evaluation of Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Retrospective Study Pallav Gupta, Manish Singh, Gagandeep Singh <b>Introduction:</b> Osteoarthritis (OA) of the knee is a debilitating old age disease causing pain and restriction in movement. Proximal Fibular Osteotomy (PFO) can be a novel surgical technique which may provide an increase in the joint space and balance the load bearing of the knee joint. The present study was conducted to determine the outcomes of this surgical technique in patients with OA of the knee. The findings may motivate many practicing orthopaedicians to undertake this surgical technique and thereby, impart better quality of life to such patients. <b>Aim:</b> To assess the outcome in terms of medial joint space, lateral joint space, tibiofemoral angle and range of movement of medial compartment decompression by fibular osteotomy in medial compartment knee OA. <b>Materials and Methods:</b> This retrospective study was conducted in the Postgraduate Department of Orthopaedics, Government Medical College, Jammu, India, from November 2018 to October 2019, on 30 adult patients (both genders) aged 40-60 years who had moderate to severe symptomatic medial compartment knee OA. Patients who had rheumatoid arthritis, post-traumatic arthritis, congenital lower extremities defects, infections in joints, presence of ligament/meniscus injury, and those with abnormality in the lateral compartment were excluded. Preoperatively and postoperatively, medial joint space, lateral joint space, tibiofemoral angle and range of movement were assessed and compared. The p-value <0.05 was taken as statistically significant. <b>Results:</b> A total of 30 patients were enrolled in the study, 18 (60%) were males, and 12 (40%) were females. Compared to preoperative values, postoperatively there was a significant increase in medial joint space (1.3&#177;0.7 vs 5.2&#177;0.9 mm, p-value <0.01), significant decrease in lateral joint space (6.9&#177;0.3 mm vs 5.7&#177;0.2 mm, p-value <0.01), significant decrease in tibiofemoral angle (180.7&#177;1.02 vs 178.13&#177;0.97, p-value <0.01) and significant increase in range of movement (135.36&#177;1.06 degrees vs 137.6&#177;1.02 degrees postoperatively, p-value <0.01). The median duration of follow-up for the patients were six months. <b>Conclusion:</b> Proximal fibular osteotomy can be suitably applied in the clinical practice for OA of the knee joint and it can give prolonged beneficial outcomes for the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=RC06-RC09&id=16220 https://doi.org/10.7860/JCDR/2022/51884.16220 Effects of COVID-19 Lockdown on Clinical Practice among Undergraduate Dental Students in Tamil Nadu- A Survey Abirami Vetriselvan, S Elakiya, Srivatsa Kengasubbiah <b>Introduction:</b> The Coronavirus Disease-2019 (COVID-19) pandemic had not only developed as a key challenge to public health all around the world but also instigated physical and mental constraints on the healthcare professionals especially on the education of dental students with the sudden switch from traditional teaching methods to e-learning platforms thereby shutting all means of clinical experiences. <b>Aim:</b> To assess the effects of lockdown on clinical practice among undergraduate dental students in Tamil Nadu, India. <b>Materials and Methods:</b> A cross-sectional observational study was done among undergraduate dental students in Tamil Nadu, India, from June 1, 2021 to July 1, 2021, using convenience sampling method to yield a total of 510 responses for a self-administered online questionnaire that aimed at evaluating the consequence of lockdown on clinical practice. Statistical Package for the Social Sciences (SPSS) version 19.0 was used to analyse the data. <b>Results:</b> A total of 510 responses (mean age: 21.72&#177;2.2827 years; 323 female and 187 male) were analysed in the present study. Majority of the students felt that COVID-19 lockdown had a negative impact on clinical exposure. Inspite of following infection control measures, only 35.1% of students felt imperative to practice during pandemic. With over 82.7% of patient flow reduced due to fear of disease spread. 85.1% revealed being stressed in completing clinical quota in a short duration. Further questions on prospects in improvising their clinical knowledge; showed 45% recommending e-workshops, 29.4% opting for video demonstration followed by 22.2% on exposure to Objective Structured Clinical Examination (OSCE) to compensate for the loss of clinical practice. <b>Conclusion:</b> New teaching protocols have to be adopted taking into account the changing aspects of the pandemic to improve their wellbeing, overcome mental stress and to enhance the sustainability of dental education. Focus on video demonstrations, lectures provoking their clinical reasoning, simulations on phantom heads and conducting workshops enhancing preclinical skills as well as following appropriate safety protocols must be implemented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC28-ZC34&id=16230 https://doi.org/10.7860/JCDR/2022/52893.16230 A Cohort Study to Decode the Application of Peritoneal Carcinomatosis Index in Predicting the Prognosis of Advanced Ovarian Malignancies Athul Damodaran, Gopinathan Kathir Velu, Devimeenal Jagannathan <b>Introduction:</b> Peritoneal Carcinomatosis Index (PCI) is used to assess the extent of peritoneal cancer by dividing the peritoneal cavity into 13 well-defined regions and assessing the size of the largest tumour nodule in each region. <b>Aim:</b> To evaluate the imaging features of peritoneal carcinomatosis using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) and correlate it with diagnostic laparotomy. Also to determine the prognostic significance of peritoneal carcinomatosis index calculated radiologically, in predicting the outcome of advanced ovarian malignancies. <b>Materials and Methods:</b> This was a prospective cohort study conducted in Kilpauk Medical College, Chennai, Tamil Nadu, India, from July 2019 to December 2020. Total of 50 females between 18-80 years of age with advanced ovarian malignancies with peritoneal deposits underwent CT and MRI to calculate initial PCI. Then these patients underwent cytoreductive debulking after which final response was assessed. Followed-up for a period of 1 year to assess the treatment response and to look for any complications. IBM Statistical Package for the Social Sciences (SPSS) version 22.0 software was used for statistical analysis. Descriptive analysis was carried out using mean and standard deviation for quantitative variables. <b>Results:</b> Fifty females were included with a mean age of 53.4 years. PCI calculated using CT and MRI showed strong correlation with laparoscopic PCI with correlation coefficient (r) of 0.984 and 0.988 respectively with a statistically significant p-value <0.001. Initial radiological PCI and cytoreduction showed strong correlation when analysed using ROC curve (Receiver Operating Characteristic curve) with an AUC (Area under the ROC Curve) of 0.933. With Youden index, a cut-off value of 11 was derived under which patients had optimal cytoreduction and a better outcome. Radiological PCI showed good sensitivity (82.35%) and specificity (88.78) for predicting complications and it was found that patients with PCI >15 were at a higher risk for developing various complications. <b>Conclusion:</b> Radiological PCI strongly correlate with laparoscopic PCI and is a very strong predictor of disease outcome in advanced ovarian malignancies. It was found that patients with high PCI values had poor response to cytoreductive surgery and chemotherapy. So, high initial PCI values above 11 was indicative of poor patient prognosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TC06-TC10&id=16232 https://doi.org/10.7860/JCDR/2022/52609.16232 Papillary Lesions of Breast- A Retrospective Analysis of Cytomorphological Features with Histopathology Concordance KR Anila, Nileena Nayak, Nair P Sindhu, P Mony Rari, K Jayasree <b>Introduction:</b> Papillary lesions of the breast include a spectrum of entities ranging from benign papilloma to malignant papillary carcinoma. The overlapping morphological features in benign and malignant lesions make their accurate sub categorisation difficult. Definitive surgical management decisions on papillary lesions of breast based on fine needle aspiration cytology report alone is a matter of concern. <b>Aim:</b> To evaluate the cytomorphological features of papillary lesions of breast and its concordance with histopathology. <b>Materials and Methods:</b> This retrospective study was conducted in Department of Pathology at Regional Cancer Centre, Thiruvananthapuram, Kerala, India (tertiary cancer centre) from January 2017 to June 2017. Total 28 cases diagnosed as papillary lesions/neoplasm on nipple discharge/fine needle aspiration cytology (FNAC) from January 2014 to December 2016 were reviewed and concordance with histopathology where ever available was analysed. Cytomorphological features that were analysed included cellularity, complex folded and branching epithelial sheets, stromal bare nuclei, cyst macrophages, single cells and atypia. <b>Results:</b> Total 28 cases of papillary lesions diagnosed by cytology were identified with mean age of 51 years. Out of 28, 22 cases had histopathology concordance. Most common diagnosis in cytology was papillary neoplasm, accurate categorisation into benign or malignant could not be done in cytology in most of the cases. Most common diagnosis in histopathology was carcinoma, in-situ and invasive. Of total 22 cases,16 cases showed true papillae. Majority of the cytomorphological features assessed were statistically insignificant in differentiating benign and malignant lesions. Fifteen cases out of the total 22 cases turned out to be malignant in final histopathology. Out of the total 22 cases wherein histopathology correlation was available, cytology could give a conclusive diagnosis of malignancy in two cases and could give a suggestion of malignancy in seven cases. Out of these nine cases where cytology favoured malignancy, one case turned out to be benign in histopathology while the rest eight cases were malignant. In five cases cytology gave benign diagnosis, one of these turned out to be malignant in histopathology, rest four cases histopathological diagnosis was in concordance with cytology. In eight cases cytology gave an equivocal diagnosis of papillary neoplasm, where further categorisation into benign and malignant category was not possible. Out of these equivocal cases, six turned out to be malignant in histopathology and two were benign. <b>Conclusion:</b> Cytomorphological features of papillary lesions of the breast are not unique and are inadequate for consistent categorisation into benign and malignant lesions. Excision biopsy with adequate sampling and immunostaining with myoepithelial markers and Oestrogen and Progesterone Receptors (ER and PR) are essential for accurate categorisation of papillary neoplasms of breast. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC28-EC31&id=16233 https://doi.org/10.7860/JCDR/2022/53488.16233 Assessment of Routine Preoperative Laboratory Testing Practice among Elective Surgical Patients at a Tertiary Care Institution, Addis Ababa, Ethiopia: A Retrospective Study Berhanetsehay Teklewold Teklemariam, Migbar Desalegn, Mekdim Tadese, Maru Gama <b>Introduction:</b> There are over 90,000 major elective surgeries performed each year in Ethiopia. Obtaining routine or baseline preoperative laboratory tests increases healthcare costs. Preoperative testing should be based on clear guiding principles. Hence, tests should be done only if results are likely to affect patient management and postoperative outcome. <b>Aim:</b> To assess routine preoperative laboratory testing practice in patients who underwent elective surgery in a resource-limited setup at a tertiary care institution, Addis Ababa, Ethiopia. <b>Materials and Methods:</b> The study was conducted at St. Paul&#8217;s Hospital Millennium Medical College (SPHMMC), which is located in Addis Ababa, Ethiopia. A retrospective observational study of medical records was done with proportional sampling among preoperative elective surgical patients of different disciplines from March 2019 to May 2019 to assess the practice of preoperative laboratory testing, appropriateness of use and implied extra cost in comparison with the National Institute for Health and Clinical Excellence (NICE) guidelines. <b>Results:</b> Total 353 patients were subjected to a 1567 test. About 643 (41%) of all tests were not indicated and 27 (4.2%) of these had unexpected abnormal results. The change in decision rate from unindicated tests were 29.6%. The total deviation rate from National Institute for Health and Care Excellence (NICE) Guideline was 26.5%. The proportion of tests done which conformed to the guidelines (58.9%) were significantly lower than the proportion of test not done but conformed (p-value <0.001). The extra cost incurred was 71.5% of the total cost for the tests. <b>Conclusion:</b> The proportions of tests with expected abnormal results, unexpected abnormal results, and subsequent changes in the decision was low, which underlines the essence of a guideline that takes into account population characteristics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=PC07-PC11&id=16234 https://doi.org/10.7860/JCDR/2022/51768.16234 Diagnostic Performance of O-RADS MRI Scoring System for the Assessment of Adnexal Masses in Routine Clinical Radiology Practice- A Single Tertiary Centre Prospective Cohort Study Aniruddha Basu, Mukheswar Pame, Rupak Bhuyan, Deep Kumar Roy, Vivek Mathew James <b>Introduction:</b> In 2019-20, the American College of Radiology (ACR) introduced Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI). Application of the O-RADS MRI in routine clinical practice can increase lesion characterisation accuracy, promote better interdisciplinary communication, and help in personalised patient management of adnexal masses. <b>Aim:</b> To assess the diagnostic performance of the ACR O-RADS MRI scoring system for the predicting malignancy in adnexal mass in routine clinical radiology practice by using histology/imaging findings during a minimum 4 month follow-up as the reference standard. <b>Materials and Methods:</b> This single-center prospective cohort study was conducted in Jorhat Medical College, Assam, on 42 patients with 46 adnexal masses who underwent MRI between April 2020 to June 2021 were assessed. The ACR O-RADS Magnetic Resonance (MR) scores were assigned using the MRI protocol with a dynamic study. Sensitivity, specificity, positive and negative predictive values along with the area under the Receiver Operating Characteristic (ROC) curve was calculated (cut-off score &#8805;4 was considered malignancy,). Histopathologic diagnosis or >4 months follow-up imaging findings were the reference standard used. Logistic regression analysis of MRI parameters used in identifying malignant masses were assessed. Statistical analysis was done using 95% Confidence Intervals (CI). The p-values <0.05 was considered statistically significant. <b>Results:</b> The mean age of subjects in the study was 35.9 (range 10-75 years), and 39 (84.8%) of adnexal masses were premenopausal. Malignancy was more common in postmenopausal patients (57.1%). Of 46 lesions, 13 (28.3%) were malignant. The ACR O-RADS-MR scoring system, using a dynamic MRI protocol, showed 92.3% sensitivity and 87.8% specificity in malignancy prediction. The area under the Receiver Operator Characteristic (ROC) curve for predicting malignancy was 0.962. The positive and negative predictive values were 75% and 89.1%, respectively. <b>Conclusion:</b> In a teaching hospital in Assam, the O-RADS MRI scoring system, based on a dynamic MRI protocol demonstrated good sensitivity, specificity and area under the ROC curve in identifying malignant adnexal masses. The ACR O-RADS MRI system enables standardised MRI reporting with uniform lexicon and interpretation guide on adnexal masses. This will help to improve communication between radiologists and referring physician and in patient management, particularly in indeterminate masses on ultrasound. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=TC11-TC16&id=16240 https://doi.org/10.7860/JCDR/2022/54998.16240 Clinicopathological Study of Breast Lesions with Special Reference to the Role of CD34 Immunostaining in Diagnosis- A Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India Ambika Prasad Chakraborty, Debasis Mukhopadhyay, Arnab Mandal, Aparajita Samaddar, Swapan Pathak <b>Introduction:</b> Breast carcinoma is the most common cancer among women and leading cause of mortality. Prognosis of breast carcinoma primarily depends on early detection. The changes in molecular and antigenic expression in stromal micro-environment surrounding the tumour cells was noted earlier in tumours of skin and gastrointestinal tract which showed loss of Cluster of Differentiation 34 (CD34) expression in stromal cell of malignant tumours. <b>Aim:</b> To evaluate the intensity of CD34 staining in benign, borderline and malignant lesions of breast and to find out whether it can help to differentiate benign and malignant lesions from borderline and in-situ carcinomas. <b>Materials and Methods:</b> This was a cross-sectional prospective study done over a period of 18 months in a tertiary care hospital of Bankura, West Bengal, India. Total 78 specimens of breast lesions obtained by lumpectomy and Modified Radical Mastectomy (MRM) were first evaluated on routine histology and classified as benign, borderline or malignant accordingly. Subsequent immunohistochemical staining was performed for CD34 and intensity of expression in stromal cells was graded from 0 to 3+. Then comparison of CD34 expression in different lesions was done and level of significance was assessed by using Student&#8217;s t-test. <b>Results:</b> Out of total 78 cases evaluated, 50 (64.1%) were categorised as benign and rest 28 (35.9%) were either premalignant or malignant lesions. Intensity of CD34 expression was found to be significantly higher in benign and in-situ lesions compared to malignant epithelial lesions of breast (p<0.05) whereas those between borderline and malignant phyllodes found to be statistically non significant (p-value 0.342). <b>Conclusion:</b> CD34 immunostaining can help to differentiate benign and in-situ carcinomas from invasive carcinomas, however, its role in differentiating borderline from malignant phyllodes tumour is limited. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EC36-EC40&id=16241 https://doi.org/10.7860/JCDR/2022/55414.16241 Predictive Role of Chest Radiograph in COVID-19 Hospitalised Patients- A Retrospective Analysis Judah Nijas Arul, Mohan Kumar, Swathy Moorthy, Rajkumar Mani <b>Introduction:</b> The portable Chest Radiograph (CXR) has an indispensable role in large scale screening and diagnosis of Coronavirus Disease-2019 (COVID-19), especially in developing countries with limited resources. It can help in predicting the severity of lung involvement in the patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, especially in areas where the Computed Tomography (CT) is unavailable. <b>Aim:</b> To determine the prognostic value of CXR at clinical presentation in assessing the disease severity and its correlation with inflammatory markers in COVID-19 hospitalised patients. <b>Materials and Methods:</b> This was a single-centre retrospective study, conducted at Sri Ramachandra Institute of Higher Education and Research, from October 2020 to December 2020, on hospitalised COVID-19 patients. Clinically, the patients were categorised as mild, moderate and severe, based on their peripheral oxygen saturation- more than or equal to 94%, between 90-93%, and less than or equal to 89%, respectively. Blood samples, drawn at presentation to the hospital tested for various inflammatory markers proven to be predictive of disease severity, were documented for the analysis purpose. The CXRs done at the presentation, were scored based on the number of zones involved and type of abnormality present (ground glassing, consolidation and septal thickening). The CXRs were scored a minimum &#8216;0&#8217; to a maximum of &#8216;9&#8217;. Correlation between the radiograph score and inflammatory markers were further analysed. <b>Results:</b> Among the 456 study patients, 71.9% had mild, 15.1% had moderate and 13% had severe COVID-19 infection. The mean CXR score in each category was 1, 3 and 4, respectively (p-value <0.001). The study groups were grouped as mild and non mild (included the moderate and severe categories). A criterion CXR score of 2 was able to differentiate mild and non mild cases (sensitivity was 78.29%, specificity was 77.98%, positive predictive values was 58.38%, negative predictive values was 90.11%), with an accuracy of 78.1%. The inflammatory markers like Neutrophil Lymphocyte Ratio (NLR), Absolute Lymphocyte Counts (ALC), eosinophil%, D-dimer, Lactate Dehydrogenas (LDH), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and ferritin showed statistically significant difference between the two groups (p-value<0.001). <b>Conclusion:</b> The CXR can be used as a screening and predictive tool for disease severity in developing countries where access to Computed Tomography (CT) is limited. Given the possibility of subsequent waves of the COVID-19 pandemic and the risk of excessive radiation exposure from CT, CXR may be used as a reliable alternative. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC24-OC27&id=16242 https://doi.org/10.7860/JCDR/2022/53224.16242 Assessment of Drug Sensitivity of Different Urinary Isolates to Nitrofurantoin and its Comparison with Other Drugs- A Retrospective Study Aditi Goyal, Kiranjeet Kaur <b>Introduction:</b> Uncomplicated Urinary Tract Infection (UTI) is one of the most common indications for antibiotic use in the community. However, gram negative organisms that are predominant cause of UTI are becoming increasingly resistant to commonly used antibiotics. Consequently, empiric therapy is likely to fail resulting in increasing number of patients with uncomplicated UTI requiring hospitalisation for intravenous antibiotics as there are no oral treatment options left. <b>Aim:</b> To assess the susceptibility trends of urinary isolates to panel of antibiotics with particular reference to nitrofurantoin. <b>Materials and Methods:</b> The present retrospective study was conducted at Adesh Hospital Bathinda, Punjab, India, for a period of one year from April 2020 to April 2021. Kass criteria was followed for interpretation of significant bacteriuria according to which significant growth is considered if number of colony is more than 10<sup>5</sup> Colony Forming Unit (CFU)/mL. Culture positive were analysed by gram staining and on the basis of colony characteristics, gram staining, final identification was done using Vitek 2 compact system. Statistical analysis was done using Chi-square test. <b>Results:</b> A total of 392 urinary isolates were identified during the study period. Out of the 392 isolates, 316 (80.6%) were gram negative isolates and 76 (19.4%) were gram positive isolates. Maximum sensitivity was shown to nitrofurantoin, 88% in case of gram negative isolates and 76% in case of gram positive isolates. <b>Conclusion:</b> Nitrofurantoin is an effective therapeutic agent in the treatment of UTI. It has been used for a long time, but the emergence of antibiotic resistance and the decline in newly developed antibiotics has increased interest in the treatment of bacterial UTI with this antibiotic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=DC06-DC08&id=16243 https://doi.org/10.7860/JCDR/2022/51845.16243 Impact of Body Mass Index and Height on Hypertensive Disorders in Pregnancy Shubham Prasad, Harsha S Gaikwad, Himanshu Shekhar, Nishi Choudhary <b>Introduction:</b> Hypertension is common cause of morbidity and mortality in pregnant females. Hence, prevention and management of preeclampsia is necessity. Maternal Body Mass Index (BMI) and preeclampsia are inter-related. South Asian females are prone to obesity. <b>Aim:</b> To find relation among maternal BMI, height and gestational hypertension or preeclampsia, and to assess the severity of hypertensive disorders during pregnancy and maternal and foetal outcomes. <b>Materials and Methods:</b> This prospective observational cohort study was conducted in Department of Obstetrics and Gynaecology in Vardhman Mahavir Medical College and Safdarjung Hospital (tertiary care hospital), Delhi, India, from September 2013 to December 2014. The study involved pregnant women with gestational age less than 14 weeks. After registration, body weight and height of all the subjects were measured during the first prenatal visit and recorded. Blood pressure was measured at every antenatal visit. The subjects were followed-up once monthly till 32 weeks, every 15 days till 36 weeks and weekly thereafter till delivery. To compare the baseline parameters between the two groups of patients, Chi-square test was used for categorical variables. A two-sided p-value <0.05 was statistically significant. To find out the correlation between BMI and height with pregnancy Pearson correlation coefficient test was used. <b>Results:</b> Total 375 consecutive pregnant women, 44 were lost to follow-up, hence, 331 were followed-up. Obese group constituted 21.8%, majority (38.1%) had normal BMI. Overweight/obese women suffered hypertensive complications more than normal and underweight women (p-value=0.001). Short height (<150 cm) pregnant females were more prone to develop hypertensive complications (p-value=0.03). The BMI (as continuous variable) was positively correlated with Pregnancy Induced Hypertension (PIH) (r=0.351; p-value <0.0001). As BMI increases, the PIH severity increases (p-value <0.0001). However, height (as continuous variable) of the patients was negatively correlated with PIH severity (r=-0.170; p-value=0.002) and as the height of patient decreases, risk of PIH severity increases. <b>Conclusion:</b> Short stature and high BMI pregnant females are more prone to develop hypertensive disorders and preeclampsia. Preconception prior counselling regarding weight optimisation is must. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QC09-QC13&id=16244 https://doi.org/10.7860/JCDR/2022/51516.16244 Trends in Hospital Outpatient Department Registrations and Admissions during COVID-19 Pandemic in a Super Speciality Hospital, Delhi, India Amit Aggarwal, Harish Chander Sharma, Rakesh Yadav <b>Introduction:</b> Delhi, India&#8217;s capital, witnessed the first Coronavirus Disease-2019 (COVID-19) case on February 10, 2020, and subsequently three waves of the pandemic due to which the government had to impose lockdown starting March 25. It led to a decrease in patients seeking health care services for non emergency problems. Janakpuri Super Speciality Hospital (JSSH), a three hundred bedded autonomous institute under Delhi Government, also encountered a decrease in patient footfall. <b>Aim:</b> To identify the changes in trend in Outpatient Department (OPD) registrations and Inpatient Department (IPD) admissions during one year (January 1, 2020 to December 31, 2020) of COVID-19 pandemic in comparison to 2019 and also to analyse the collected data with the publicly available data on daily COVID-19 incidence in Delhi. <b>Materials and Methods:</b> A retrospective study was done by collecting data from the Janakpuri Super Speciality Hospital, Delhi, India, Medical Record Department from 1<sup>st</sup> January 2019 to 31<sup>st</sup> December 2020, for daily OPD visits and IPD admissions. The collected data was analysed with the publicly available data on daily COVID-19 incidence in Delhi. Statistical analysis was performed using Microsoft excel 2017. The non parametric exponential smoothening technique (dampening factor=0.9) was applied over the dot plot graphs. <b>Results:</b> In 2020, compared to 2019, the daily OPD visits decreased by 37%. After an initial fall with March lockdown, there was a gradual increase in daily load. The OPD load peaked near middle of August 2020, The second big fall in OPD footfall occurred near second wave in September 2020, After that, OPD volume remained low till the 31<sup>st</sup> December 2020. Similarly, IPD admission volume peaked near the first wave in June 2020. The 2020 IPD admission volume also witnessed a massive decrease of 40.67% compared to 2019 and was maximum in gastroenterology admissions (65.63%). <b>Conclusion:</b> The study&#8217;s findings suggest that temporal associations between COVID-19 pandemic and hospital OPD and IPD admissions during 2020. The possibility of increased morbidity and mortality amongst non COVID-19 patients due to the unavailability of timely health care cannot be ruled out. The government should do capacity building to guide patients to identify the best doctor, clinic and hospital nearest to them in case of future pandemics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=IC01-IC04&id=16245 https://doi.org/10.7860/JCDR/2022/53199.16245 Functional Outcome of Anterior Cruciate Ligament Reconstruction by Tibial Attachment Preserving versus Sacrificing Hamstring Graft Technique- A Prospective Interventional Study Avinash Singh, Atul Agrawal, Ruchit Khera, Faiz Akbar Siddiqui <b>Introduction:</b> Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft&#8211; tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. <b>Aim:</b> To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. <b>Materials and Methods:</b> A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student&#8217;s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value <0.05 was considered to be significant. <b>Results:</b> The mean age of patients in group A was 30.73&#177;10.02 years whereas in group B it was 29.54&#177;9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23&#177;8.37, at 12 week score was 86.85&#177;5.93 and at 24 week score was 95.58&#177;4.91. For group B, mean Lysholm score at 6 weeks was 74.15&#177;5.82, at 12 weeks score was 87.46&#177;5.95 and at 24 weeks score was 96.92&#177;3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p<0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. <b>Conclusion:</b> The ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=RC10-RC14&id=16246 https://doi.org/10.7860/JCDR/2022/52515.16246 Efficacy of Extract Derived from Desiccated Carrot (<i>Daucus carota subsp.sativus</i>) against Oral Microflora: An In-vitro Study Preethi Rajamanickam, Sumathi Felicita <b>Introduction:</b> Fixed orthodontic appliances with its various components cause inaccessible areas for plaque and make tooth cleaning difficult. Several chemical formulations have been used for mechanical cleaning, but due to their unpleasant side-effects researchers now concentrate on herbal drugs. <b>Aim:</b> To determine the antibacterial effect of carrot extract on <i>Lactobacillus</i>, <i>Aggregatibacter actinomycetemcomitans</i> and <i>Streptococcus mutans</i>. <b>Materials and Methods:</b> This was an in-vitro study conducted to determine the antibacterial activity of <i>Daucus carota</i> subsp. sativus (carrot) extract against <i>Lactobacillus</i>, <i>Aggregatibacter actinomycetemcomitans</i> and <i>Streptococcus mutans</i>. A 500 grams of healthy and mature carrots were cleaned, washed and peeled then dried in a hot air oven at 40&#176;C for 5 days and then ground. Ground powder was mixed with distilled water and ethanol to obtain the aqueous and ethanolic extract respectively. The antimicrobial activity of these extracts was studied using well diffusion methods in culture plates under three different concentrations. Antimicrobial activity was studied by measuring the area of inhibition. Cytotoxic activity of the samples was also assessed. Kruskal-Wallis test was performed to compare antimicrobial activity of aqueous and ethanolic extract mouthwash. <b>Results:</b> Aqueous mouthwash showed moderate antimicrobial activity without statistically significant difference against <i>S.mutans</i> (p-value=0.06), <i>Lactobacillus</i> sp. (p-value=0.7), or <i>A. Actinomycetemcomitans</i> (p-value=0.16) microbes, at three different concentrations. Ethanolic extract had moderate antimicrobial activity against all the three microorganisms, but more significant at 100 microlitre concentrations with a p-value of 0.03 against S. mutans. The cytotoxic effects of the ethanolic and aqueous mouthwashes were less cytotoxic at minimal concentrations. <b>Conclusion:</b> Extract derived from <i>Daucus carota</i> was proven to possess antimicrobial activity against <i>S.mutans</i>, <i>A.actinomycetemcomitans</i> and <i>Lactobacillus</i>. Further research is required to advocate its efficacy at lower concentrations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC35-ZC39&id=16247 https://doi.org/10.7860/JCDR/2022/52632.16247 Isolation, Identification and Antifungal Susceptibility Testing of <i>Candida</i> Species: A Cross-sectional Study from Manipur, India Urvashi Chongtham, Debina Chanu Athokpam, Rajkumar Manojkumar Singh <b>Introduction:</b> Candidiasis is an opportunistic infection which occurs due to indiscriminate and prolonged use of broad-spectrum antimicrobials, corticosteroids, immunosuppressive agents, diabetes mellitus, Human Immunodeficiency Virus (HIV), chronic renal failure, haemodialysis, renal transplantation or indwelling urinary catheter. Recently, Non-<i>albicans Candida</i> (NAC) species have replaced <i>Candida albicans</i> and emerged as an important opportunistic pathogens exhibiting decreased susceptibility to commonly used antifungal agents. Early speciation of <i>Candida</i> isolates along with their antifungal susceptibility testing not only will restrict the empirical use of antifungal agent but also greatly influence the treatment options for the clinicians. <b>Aim:</b> To speciate <i>Candida</i> isolates from various clinical specimens and to determine their antifungal susceptibility pattern. <b>Materials and Methods:</b> This study was a cross-sectional study carried out in the Mycology Section, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, from September 2016 to August 2018. <i>Candida</i> isolates were identified using standard microbiological procedures and speciation was done following conventional and HiCrome differential media. Antifungal susceptibility testing was determined by using Clinical and Laboratory Standards Institute (CLSI) disk diffusion method. Data analysis was done using descriptive statistics and Chi-square test. <b>Results:</b> A total of 100 isolates were identified from different clinical specimens, which included 43 (43%) from sputum, 34 (34%) from urine, in majority. Highest age was 92 years and lowest age was one year from whom the isolates were detected and females (57%) outnumbered males (43%) patients. Predominant <i>Candida</i> isolates were <i>Candida albicans</i> (44%), <i>Candida tropicalis</i> (32%). Among the azoles, the most sensitive agent was voriconazole (86%) and least was ketoconazole (56%), 81% of the total isolates were found sensitive to amphotericin B. <b>Conclusion:</b> The present study demonstrated that NAC spp. have surpassed <i>Candida albicans</i> and there is an increase in the resistance of the <i>Candida</i> isolates to commonly used antifungal agents. Therefore, this study highlights the need for speciation of <i>Candida</i> isolates upto species level and to determine the antifungal susceptibility pattern to decrease the morbidity and mortality of the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=DC09-DC14&id=16248 https://doi.org/10.7860/JCDR/2022/55695.16248 Double Jeopardy in Malaria Infected Children with Common Haemoglobinopathies: A Cross-sectional Study in Malaria Mesoendemic Districts of Ghana Raymond Charles Ehiem, Bernard Walter L Lawson, John Asiedu Larbi <b>Introduction:</b> Malaria and conditions associated with common haemoglobinopathies constitute a health threat to young children in sub-Saharan Africa. Malaria is known to exert some influence on common haemoglobin variants while haemoglobinopathies also exacerbate malarial infection especially in children as a result of anaemia and other conditions. <b>Aim:</b> To assess the views of parents/guardians on malaria and haemoglobinopathies and to determine the extent to which common haemoglobin variants influence malaria parasitaemia among children in the acute stage of the infection. <b>Materials and Methods:</b> This cross-sectional study was conducted in seven districts in the forest zone of Ghana between June 2018 to July 2018 and involved 342 malaria-parasitaemic subjects aged 5 years and below. Questionnaires were administered to elicit responses on malaria prevention and sickle cell knowledge from the parents/guardians/caretakers accompanying the children to seek healthcare. Follow-up responses on medication and treatment outcome were collected during and after treatment. Venous blood samples were collected for malaria test, sickle cell investigations and identification of common haemoglobinopathies. After treatment, malaria tests were conducted using microscopy. The Chi-square test was used to compare categorical data between groups, and the Independent t-test used to compare means between groups. <b>Results:</b> Out of total 342 subjects, 220 respondents (64.3%) identified fever as the most classical symptom of malaria, whilst 167 (48.8%) consistently used Insecticide Treated Nets (ITNs). More so, 146 respondents (42.7%) strongly agreed that Sickle Cell Disease (SCD) is a curse, and 182 respondents (53.2%) strongly agreed that SCD is inherited with 225 (65.8%) strongly agreeing that SCD children die before their teen ages. Common haemoglobin variants identified were Haemoglobin A and C bands (HbAC) 17 (5%), Normal Foetal Haemoglobin (HbAF) 7 (2%), Haemoglobin A and S bands (HbAS) 86 (25.1%), Haemoglobin S and C bands (HbSC) 4 (1.2%) and Haemoglobin S (homozygous) band (HbSS) 9 (2.6%). One month post-treatment, 10 (58.8%) of HbAC subjects, all 9 (100%) of HbSS and all 4 (100%) of HbSC subjects were still parasitaemic but with significantly low mean parasite density (495&#177;1744). <b>Conclusion:</b> Knowledge on malaria among the parents/guardians/caretakers was satisfactory, but usage of bed nets was poor, warranting the need for targeted health education of the rural folk. Though parasite densities had significant reductions, all subjects with HbSC and HbSS phenotypes remained parasitaemic after 4 weeks of treatment, suggesting a double jeopardy for individuals with SCD. Routine newborn screening in all healthcare facilities in Ghana could be a proactive step in malaria case management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC27-LC34&id=16218 https://doi.org/10.7860/JCDR/2022/52416.16218 Diurnal Variation in the Mortality of Patients with COVID-19 Pneumonia: A Retrospective Study Jenita Baruah, Anshul Shakya, Mukul Sarma, Giriraj Kusre <b>Introduction:</b> Coronavirus Disease 2019 (COVID-19), the new contagious novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), pandemic in 2020-21 has had a devastating impact on human race. The most common cause of death among hospitalised patient was COVID-19 pneumonia or lung injury. Various studies have shown diurnal variation in human mortality due to all causes with or without intervention. <b>Aim:</b> To identify existence of diurnal variations for mortality among the hospitalised patients with COVID-19 pneumonia. <b>Materials and Methods:</b> This hospital-record based, retrospective study was conducted in a tertiary referral centre of north-east India (Assam Medical College, Dibrugarh, Assam, India) which was a dedicated COVID-19 hospital during the pandemic. The study was conducted from September 2021 to December 2021 and the data was collected and recorded from the Cadaver slips issued to families of patient dying of COVID-19 pneumonia during the period January 2021 to August 2021. The data were generated by plotting the number of deaths of COVID-19 cases for each two hour interval as a percent of the mean number of deaths per two-hour interval and as a percentage of cumulative deaths per two-hour interval on a 24 hour scale. The deaths were sub grouped according to gender, age, and reported co-morbid causes of death along with pneumonia. Comparisons of data i.e., mean deaths/2 hour interval (mean&#177;SD) were performed by one-way Analysis of Variance (ANOVA), followed by Bartlett&#8217;s test for equal variances. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Total 743 deaths, with 537 males and 206 females were included in the study. Mean age of the deaths was 56.01 years. There was rise of deaths during 4 PM-6 PM (16:00-18:00) interval for all deaths due to COVID-19 pneumonia. The increase in deaths during this period mainly accounted for males equal or above 65 years and females below age 65 years. However, the deaths of females equal or above the age of 65 years did not show significant diurnal variation. Only 26.51% (n=197) of pneumonia deaths were without co-morbidity. <b>Conclusion:</b> There exists a diurnal variation in mortality among COVID-19 pneumonia patients with evening rise of deaths. Diurnal variation is significantly more among males rather than females above 65 years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC10-LC15&id=16205 https://doi.org/10.7860/JCDR/2022/54837.16205 Assessment of the Impact of Prosthodontic Intervention on the Oral Health Related Quality of Life among Post COVID-19 Mucormycosis Affected Individuals in Central India Vinay Dutta, Arun Khalikar, Sattyam Wankhede, Suryakant Deogade, Archit Kapadia, Pradyumna Doibale <b>Introduction:</b> The currently prevalent Coronavirus Disease 2019 (COVID-19) pandemic has amounted to various co-morbid conditions amongst patients and mucormycosis has been one among them. A globally emerging disease, this requires aggressive surgical treatment that necessitates due prosthetic rehabilitation. <b>Aim:</b> To assess the impact of prosthodontic intervention on the Oral Health Related Quality of Life (OHRQoL) through Oral Health Impact Profile 14 (OHIP-14) questionnaire in post COVID-19 mucormycosis affected individuals. <b>Materials and Methods:</b> The following study was a questionnaire-based prospective interventional study. The study population included post COVID-19 mucormycosis affected individuals who sought prosthodontic therapy for rehabilitation from the month of April 2021 to October 2021. The study instituted the questionnaire amongst 48 consenting participants. The OHIP-14 questionnaire was validated in their native languages and data was collected before and one month after prosthodontic intervention. Data was statistically analysed by the Wilcoxon signed-rank test. <b>Results:</b> For all the individual questions, OHRQoL impact showed a significant decrease following prosthetic intervention (p-value <0.05). Total OHIP score also showed a significant decrease post-treatment (p-value=0.001). <b>Conclusion:</b> Percentage improvement of OHRQoL ranging from 34.79-59.86% post prosthodontic intervention was observed. Thus, the impact of prosthodontic therapy among post COVID-19 mucormycosis affected individuals on the OHRQoL of the patient is positively significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC13-ZC17&id=16206 https://doi.org/10.7860/JCDR/2022/52592.16206 Safety and Efficacy of Ketamine-Dexmedetomidine versus Ketamine-Propofol Combination for Short-term Sedation in Postoperative Obstetric Patients on Mechanical Ventilation: A Randomised Clinical Trial Anchal Raj, Vipin Kumar Singh, Tanmay Tiwari, Sandeep Sahu <b>Introduction:</b> Prolonged mechanical ventilation in postoperative obstetric patients is an important cause of morbidity and mortality. Choosing intravenous sedation for these patients is challenging, as many of these drugs have unique benefits and adverse effects.There are several options are available like benzodiazepines, propofol, alfa-2 agonist, opioids and ketamine. Usually, a combination of sedatives are used to avoid dose dependent adverse effects. <b>Aim:</b> To evaluate the combination of Ketamine-Dexmedetomidine (KD) and ketamine-propofol for sedation in mechanically ventilated obstetric patients to compare haemodynamic changes. Secondary objectives to assess adverse effects if any, additional opioid (fentanyl) requirement and total length of intensive care unit stay. <b>Materials and Methods:</b> This randomised clinical study was conducted at King George&#8217;s Medical University, Lucknow, Uttar Pradesh, India, from May 2018 to August 2019. Total 67 obstetric patients, between 18-45 years of age, requiring postoperative ventilatory support, were included in the study. For sedation, 33 patient received ketamine-dexmedetomidine (group I) combination and 34 patients received ketamine-propofol (group II) combination upto 12 hours of ventilatory support. Target of sedation was to obtain Ramsay sedation scoring between 3-4. Mean Arterial Pressure (MAP) was measured at 0.5 hour, one hour, two hours, four hours, and at every two hourly till 12 hours. Pain was assessed using adult non verbal pain score. Adverse effects (tachyarrhythmia, agitation and hypersalivation) were noted. Total length of Intensive Care Unit (ICU) stay was also recorded. <b>Results:</b> Age of patients enrolled in the study ranged from 20 to 37 years, the mean age being 27.09&#177;4.61 years. At baseline mean arterial pressure of patients of group I (103.82&#177;19.26 mmHg) was higher than that of group II (96.74&#177;13.49 mmHg) (p-value=0.085). For the rest of the periods of observation, from 0.5 hour to 14 hour,the MAP of group I remained higher as compared to group II. On intragroup comparison, group II had more fluctuation in MAP than group I. Additional requirement of fentanyl was significantly high in Group II, as compared to group I (32.4% vs 12.1%). Mean duration of ICU stay was higher in group II, as compared to group I (30.44&#177;7.26 hours vs 22.91&#177;4.03 hours). <b>Conclusion:</b> Ketamine-dexmedetomidine is a better combination for sedation in postoperated obstetric patients on mechanical ventilation than ketamine-propofol as it provides stable haemodynamics, significantly lesser opioid requirement and total length of ICU stay. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=UC01-UC04&id=16222 https://doi.org/10.7860/JCDR/2022/53272.16222 Evaluation of Lipid Profile and Antioxidant Status in Hypertensive Smokers: A Case-control Study Syed Sadath Ulla, Vivian D’Souza, Bhagyajyothi M Bhat <b>Introduction:</b> Hypertension and smoking are two independent risk factors for oxidative stress and dyslipidaemia, thereby development of cardio and cerebrovascular diseases are common. The effect of smoking on oxidants, antioxidants and lipid profile in hypertensive individuals is the matter of concern. <b>Aim:</b> To compare fasting serum lipid profile, Glutathione (GSH) and Thiobarbituric Acid Reactive Substances (TBARS) of hypertensive smokers and hypertensive non smokers. <b>Materials and Methods:</b> This case-control study was conducted in the Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India, between September 2021 to December 2021. The study population consisted of 58 hypertensive smokers and 58 hypertensive non smokers visiting the Department of Internal Medicine, tertiary care hospital. Height, weight, smoking intensity, family history of hypertension was recorded, fasting serum lipid profile, GSH and TBARS were estimated. Smoking intensity was expressed as pack-years. Body Mass Index (BMI) was calculated using the measured height and weight. The data were analysed using Chi-square test, independent sample t-test and Pearson&#8217;s correlation. <b>Results:</b> The mean age of cases were 40.38&#177;14.96 years whereas among controls, it was 45.98&#177;14.96 years. Among cases, 50 were males and eight were females, whereas among the controls, 47 were males and 11 were females. Out of total 58 subjects in each group, 43 in cases and 45 in controls had a family history of hypertension. A significant increase in the levels of serum TC, TAG, LDL-C, TBARS and a significant decrease in GSH, BMI in cases compared to the control (p<0.001) was observed. Total Cholesterol (TC), Triacylglycerol (TAG), Low Density Lipoprotein- Cholesterol (LDL-C) and TBARS exhibited a significant positive correlation whereas, BMI, HDL-C and GSH showed a negative correlation with pack-years. <b>Conclusion:</b> Smoking was found to be significantly associated with dyslipidaemia and oxidative stress in hypertensive individuals. It was observed that the dyslipidaemia and oxidative damage was correlated with the pack-years in hypertensive smokers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=BC08-BC12&id=16223 https://doi.org/10.7860/JCDR/2022/55196.16223 From Bench to Bedside: A Retrospective Study on the Utility of Rapid Antigen Testing for Coronavirus Disease from Firozabad, Uttar Pradesh, India Lekha Tuli, Rohit Patawa <b>Introduction:</b> Ever since the Coronavirus Disease-2019 (COVID-19) pandemic hit, there have been constant efforts to develop rapid, sensitive and specific diagnostic methods to detect the virus in order to curb the further spread of the disease. There is an array of tests available for the detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Time being a very crucial factor and Rapid Antigen Testing (RAT) is very helpful in detecting the virus. <b>Aim:</b> To discuss the importance of rapid antigen testing among symptomatic and asymptomatic cases in different age groups and gender with association to infection. <b>Materials and Methods:</b> This retrospective study was conducted in Department of Microbiology, Autonomous State Medical College and SNM Hospital, Firozabad, Uttar Pradesh, India, from April 2020 to August 2021. A total of 16,258 samples were collected from symptomatic patients having Influenza Like Illness (ILI), Severe Acute Respiratory Illness (SARI), those seeking hospitalisation, contacts (symptomatic and asymptomatic) and travellers were subjected to antigen detection by the Standard Q COVID-19 antigen kit following proper precautions. The cases were divided into Group A of patients who presented with symptoms &#8804;7 days, Group B of patients who presented with signs and symptoms >7 days and group C comprised of asymptomatic patients. The Chi-square test was done to test the statistical significance of association of symptomatic patients with outcome of the antigen test. <b>Results:</b> Of the total 16,258 samples tested, the maximum number of positive cases were found in the age group 30-39 years followed by 20-29 years. The least number of positive cases were found in extreme age group, i.e., six cases in >90 years and no case was found in below 9 years. No significant impact was found on the positivity rates on the basis of gender. The percentage positivity as detected by rapid antigen was 2.1% and maximum patients were found in the group having symptoms &#8804;7 days (p<0.05). <b>Conclusion:</b> Rapid Antigen Detection Test (RADT) for SARS-CoV-2 is a simple, portable, fast and easy to perform test. It could be easily used in rural areas as it does not require special laboratory setup. It could be used for mass testing and helped as a good epidemiological tool. However, few symptomatic cases which could not be detected by rapid testing had to be cross checked with Real Time-Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Thus, when used in conjunction with molecular methods, the sensitivity of the test increased. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=DC01-DC05&id=16224 https://doi.org/10.7860/JCDR/2022/55224.16224 A Cross-sectional Survey on Dentist’s Knowledge and Perception towards the Application of Arnica Montana in Dental Practice Hani Mawardi, Lena Elbadawi <b>Introduction:</b> Postsurgical oedema (PSE) is a common complication encountered in the dental field following different surgical procedures including wisdom teeth extraction and other periodontal and implant surgeries. Arnica Montana (AM) is a homeopathic agent which may represent as a safe, effective and an alternative agent for Non Steroidal Anti-Inflammatory (NSAID) medications to prevent or decrease the risk of PSE. <b>Aim:</b> To evaluate the knowledge of practicing dentists and their experiences using AM supplements in their daily practice for management of PSE. <b>Materials and Methods:</b> This was an observational, cross-sectional self reported electronic based study to survey practicing dentists on the application of AM in daily dental practice conducted from January to September 2021. The electronic survey included 13 questions on: 1) dentist&#8217;s demographics and educational backgrounds; 2) knowledge related to AM supplement; and 3) previous experience, if any, with AM use for management of PSE. The survey was distributed to potential subjects and descriptive statistics was used to summarise the data, and presented as percentages and frequencies using Microsoft Excel for mac (Version 16.40). <b>Results:</b> A total of 84 subjects participated in the survey, out of which 23 (27.3%) were familiar with AM use in dentistry. Overall, 15 participants (65.2%) indicated preventions or reduction of PSE risk and pain and seven participants reported prevention and reduction of postsurgical discolouration and bleeding (30.4%) as potential indications for AM use. In total, eight participants (34.7%) have prescribed AM to patients before, mainly for external and internal sinus grafting (4/8; 50% for both) and surgical extraction of impacted teeth (2/8; 25%). Out of all, five participants (5/8; 62.5%) reported significant benefit with using AM following a surgical procedure and four participants (50%) reported numbness of the lips, altered taste sensation and increased bleeding as associated toxicities. <b>Conclusion:</b> From the present study the uses and user based experienced of the material AM in the field of dentistry can be well understood and analysed.<b></b> This was the first survey to discuss the knowledge and application of AM among dentists from various specialties. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC23-ZC27&id=16225 https://doi.org/10.7860/JCDR/2022/52518.16225 Comparative Study of the Efficacy and Safety of Ultrasound-guided and Landmark-based Paravertebral Block Technique in Patients undergoing Elective Unilateral Breast Surgery Akhil Goel, Navdeep Sethi, Kaminder Bir Kaur, Debashish Paul, Deepak Dwivedi, Arijit Ray <b>Introduction:</b> Identifying the Paravertebral Space (PVS) by its anatomical landmarks is associated with high failure rates and complications. With the advent of Ultrasonography (USG), failure rate has decreased leading to an increased interest in performing USG-guided Thoracic Paravertebral Block (TPVB). <b>Aim:</b> To assess the efficacy and safety of ultrasound guided TPVB and its comparison with the landmark-based technique, in patients undergoing elective unilateral breast surgery. <b>Materials and Methods:</b> This cross-sectional study was carried out at Command Hospital, Pune from July 2014 to December 2015, on females between 18-70 years, accepted in American Society of Anaesthesiology (ASA) I-III for unilateral breast surgeries. Patients were divided into two groups with 40 subjects in each group. Group A subjects were treated with anatomical landmark technique and group B subjects with Ultrasound-guided (USG-guided) technique. The p-value <0.05 was considered to be statistically significant. <b>Results:</b> Demographic parameters (age, height, weight and Body Mass Index (BMI) and the scheduled surgery were comparable in between the groups. In group A, success rate of the block was 82.5%, compared to 95% in group B (p-value >0.05 using Fisher&#8217;s-Exact test). Mean (SD) time taken for performing the block in group A was 371.10 (10.37) seconds while it was 613.73 (37.15) seconds in group B (p-value <0.05 by two independent sample t-tests). No statistically significant difference was seen in haemodynamic parameters, except for the Heart Rate (HR) at 70, 80, 90 minutes after administering the block and at the end of surgery. Correlation analysis for quantitative variables with PVS depth (dependent variable), measured sonologically, showed very good linear correlation of PVS depth with weight (Pearson&#8217;s correlation coefficient, r=0.819, p-value <0.001). BMI (r=0.884; p-value <0.001). <b>Conclusion:</b> The success rate is higher with ultrasound-guided TPVB compared to the landmark technique, though statistically insignificant. But it is recommended to use ultrasound-guided TPVB for advantages such as lesser requirement of opioid supplementation, real time visualisation of the spread of drugs in PVS with lesser complication rates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=UC05-UC09&id=16226 https://doi.org/10.7860/JCDR/2022/50267.16226 Effect of Visual Cue Training on Gait and Walking Velocity in Chronic Stroke Patients- A Quasi-experimental Study Shreya Upadhyay, Neha Verma <b>Introduction:</b> Stroke is the major cause of disability and death in the world. More than 80% of stroke survivors face walking impairment due to muscle weakness, incoordination and spasticity. For physical rehabilitation of patients with neurological conditions combination of approaches are used. Visual cuing techniques are useful approaches for rehabilitation but the effect of visual cue training for gait and walking velocity is less explored for a patient with chronic stroke. <b>Aim:</b> To determine the effect of visual cue training on gait and walking velocity in subjects with chronic stroke. <b>Materials and Methods:</b> This was a quasi-experimental study in which 38 patients of chronic stroke were selected from various physiotherapy Outpatient Departments (OPD), of Surat, Gujarat from January 2019 to August 2020. Samples were randomly allocated into two groups, group A and group B; conventional and experimental group respectively. Group A was given conventional training and group B was given visual cue training along with conventional training for three days a week, 20 minutes/session. Both groups received conventional training five days a week, for four weeks. Dynamic Gait Index (DGI) and walking velocity were taken as an outcome measure and checked before intervention and after the end of four weeks of intervention. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) version 16.0. Paired t-test was carried out for within group comparison. <b>Results:</b> The results of the study indicates that there was significant difference in DGI and walking speed preintervention and postintervention in both the groups (p<0.001). The mean difference of DGI in group A and B was 1.94&#177;0.002 and 3. 26&#177;0.41, respectively (p<0.001). The result of the study suggests that there is greater improvement in visual cue training group. Conclusion: The present study results conclude that visual cue training along with conventional training shows greater improvements in gait and walking velocity than the conventional training alone. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=YC06-YC10&id=16227 https://doi.org/10.7860/JCDR/2022/50349.16227 Role of Concurrent use of Thoracic Ultrasonography with 2D Echocardiography among Patients with Commonly Diagnosed Respiratory Illnesses- A Cross-sectional Study Amrutha Peter, Jitendra Kishor Bhargava, Amit Kinare, Rekha Agrawal, Brahma Prakash <b>Introduction:</b> Respiratory diseases may affect the functioning of the heart, lung and heart work synchronously. Clinical assessment and work-up of patients with pulmonary problems may need an extension to cardiac disease. Thoracic Ultrasonography (TUS) is a diagnostic modality being used to assess respiratory conditions as it carries the inherent advantages of ultrasonography such as being reliable, inexpensive, safe, reproducible, and having no radiation hazard. <b>Aim:</b> To assess the usefulness of performing Thoracic Ultrasound (TUS) and 2D Echocardiography in the same sitting, so as to confirm the respiratory diagnosis and to early identify various cardiac dysfunctions in patients with respiratory illnesses. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Outpatient Department (OPD) of Respiratory Medicine at Netaji Subhash Chandra Bose Medical College (tertiary care hospital), Jabalpur, Madhya Pradesh, India, from January 2019 to March 2020. Patients hospitalised with clinico-radiological diagnosis of pleural effusion, pneumonia, pulmonary fibrosis of interstitial lung disease, pulmonary oedema and Chronic Obstructive Pulmonary Disease (COPD) were subjected to TUS and echocardiography. Sonological findings and cardiac abnormalities were recorded. Data was analysed by applying descriptive statistics, t-test, and Chi-square test. A p-value <0.05 was considered as statistically significant. <b>Results:</b> A total of 133 patients were enrolled with diagnosis of pleural effusion (n=46), COPD (n=33), pneumonia (n=22), pulmonary fibrosis (n=18) and pulmonary oedema (n=14). Out of total 46 patients, 36 patients with pleural effusion had cardiac findings. The presence of pleural effusion showed a significant association with cor-pulmonale (p-value=0.012), dilated Right Ventricle (RV) (p-value=0.012), septal deviation (p-value=0.012), Pulmonary Hypertension (PH) (p-value=0.0002), Left Ventricular (LV) dysfunction (p-value=0.02) and Left Ventricular Ejection Fractions (LVEF) (p-value=0.006). The focal B-lines were seen in patients with pneumonia. Patients with Pulmonary fibrosis had scattered B-Lines, and patients with pulmonary oedema had bilateral diffuse B-lines. Among patients with pulmonary fibrosis, 11 (61.1%) had cor-pulmonale and dilated RV, whereas 10 (55.5%) had septal deviation. Patients with scattered B-lines more commonly had PH. In patients with COPD, cor-pulmonale was detected in 21 (63.6%), LV dysfunction in 5 (15.1%), mild PH in 14 (42.4%), moderate PH in 7 (21.2%), and severe PH in 5 (15.1%) using echocardiography. <b>Conclusion:</b> This study reveals the importance of performing a combination of TUS with 2D Echocardiography and suggests its usefulness in early diagnosis of cardiac dysfunctions in patients with various respiratory illnesses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC14-OC18&id=16212 https://doi.org/10.7860/JCDR/2022/53489.16212 Prevalence of Domestic Violence among Pregnant Women: A Cross-sectional Study from a Tertiary Care Centre, Puducherry, India Sunita Samal, Sagana Poornesh <b>Introduction:</b> Domestic Violence (DV) during pregnancy is a serious public health issue which threatens maternal and foetal health outcomes. Routine antenatal care provides an opportunity for identifying women experiencing violence during pregnancy. <b>Aim:</b> To evaluate the prevalence of DV among pregnant women so that foetal complications can be prevented and adequate measures can be taken to protect mothers from DV. <b>Materials and Methods:</b> This cross-sectional study was conducted from 1<sup>st</sup> October 2016 to 30<sup>th</sup> November 2016 at the Outpatient Department (OPD) of Obstetrics and Gynaecology of Mahatma Gandhi Medical College and Research Institute, Puducherry, India. A validated modified version of Abuse Assessment Screen questionnaire was given to 200 pregnant women at their first hospital visit. A statistical analysis was conducted using Chi-square test and Fisher&#8217;s-exact test in MS Excel 2007, version 12.0. A p-value of less than 0.05 was considered significant. <b>Results:</b> A total of 200 consecutive pregnant women at the first visit to hospital were enrolled in the study. Prevalence of DV was reported to be 6.5%. Out of which, maximum (3%) reported verbal abuse. There was no reporting of sexual abuse. Educational status showed influence on DV. Economic status too had great influence on DV which was more prevalent among proverty strucken people (19.4%). There were 7.9% incidences for DV in the age group <25 year (p-value=0.3). Prevalence was slightly more in rural areas (8.7%) than in urban areas (4.2%) (p-value=0.198). With respect to education, women with high school and above had lower incidence of DV (4.8%). <b>Conclusion:</b> The pregnant woman should be continually provided with a non judgemental, sensitive and supportive service during their pregnancies. The study establishes that women in the present environment experience DV during pregnancy and more in younger age group. This is also more common in women with lower literacy and with lower socio-economic status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=QC06-QC08&id=16213 https://doi.org/10.7860/JCDR/2022/50428.16213 Comparative Evaluation of Instrumentation Time and Quality of Obturation between Different File Systems in Primary Molars: A Randomised Clinical Trial Manisha Kaushik, Updesh Masih, Sushma Gojanur, Methili Singhal, Vishakha Mittal <b>Introduction:</b> Pulpectomy has been a treatment of choice in all necrotic primary teeth. With the advancement of technology, the rotary system is developed to reduce skill and enhance the quality of pulpectomy therapy. In paediatric dentistry, new technologies should be leveraged to improve treatment protocols. <b>Aim:</b> To evaluate and compare the instrumentation time and quality of obturation between the different file systems (Hyflex Controlled Memory (CM), Flexicon X7 and Hedstrom files). <b>Materials and Methods:</b> In the present randomised clinical trial, a total number of 60 primary molar were selected of healthy children of both sexes from 5-9 years of age attending Department of Pedodontics and Preventive Dentistry at KD Dental College and Hospital, Mathura, Uttar Pradesh during the study period from January 2017 to March 2018. The samples were divided into three groups. Instrumentation was done by using Hedstrom files (H-files) in Group 1; Flexicon X7 in Group 2; Hyflex CM in Group 3; and instrumentation time was recorded in seconds. The quality of obturation was categorised as underfill, optimal fill, and overfill. Statistical analysis was done by using the Chi-square test, ANOVA, and Post-hoc Tukey test with significance level at p<0.05. <b>Results:</b> In the present study including 60 healthy children, 26 were females and 34 males. Each group consisted of 20 participants each. No significant difference was found with regard to the quality of obturation between the three groups (p=0.519). Flexicon X7 had significantly lesser instrumentation time when compared to that of Hyflex CM and H-file (p<0.001). <b>Conclusion:</b> The application of the rotary file system in the primary molar significantly reduces the instrumentation time although there was no significant difference noted in the quality of obturation between the different file systems https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZC18-ZC22&id=16214 https://doi.org/10.7860/JCDR/2022/52311.16214 Prediction of Reperfusion Outcome using Platelet Indices in Primary Percutaneous Coronary Intervention- A Prospective Cohort Study Thomas Varghese Attumalil, Sam Jacob Chirame, VV Radhakrishnan, K Sunitha Viswanathan, Alummoottil George Koshy, Nini Prabha Gupta <b>Introduction:</b> Platelets play a vital role in systemic inflammation and thrombus formation in ST Elevation Myocardial Infarction (STEMI). Understanding its role has diagnostic and prognostic implications in developing therapeutic strategies. <b>Aim:</b> To estimate the prognostic accuracy of platelet indices- Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and MPV/Platelet Count (PC) ratio (MPV/PC ratio) on reperfusion outcome in STEMI patients. <b>Materials and Methods:</b> This prospective cohort study enrolled 262 subjects, who presented with acute chest pain within a window period of 12 hours, and an Electrocardiogram (ECG) suggestive of STEMI. Blood samples collected on admission were measured for MPV and PDW. The major endpoints studied were angiographic thrombus burden and in-hospital Major Adverse Cardiovascular Events (MACE). Data was summarised by mean and Standard Deviation (SD) for continuous variables, frequency and percentage for categorical variables. <b>Results:</b> This study demonstrated that Acute Coronary Syndrome- STEMI (ACS-STEMI) patients with larger PDW had Larger Thrombus Burden (LTB). PDW of more than 13 fL was the best cut-off for predicting LTB with a sensitivity of 67.01% and a specificity of 53.23%. There was no significant difference between the means of MPV in LTB and small thrombus burden. The total in-hospital MACE at the end of one week was 20.99% (n=55/262 patients). The maximum MACE was contributed by acute heart failure (12.6%), followed by cardiac death (6.1%) and stent thrombosis (1.5%). There was a significant association between increased PDW and in-hospital MACE, mortality and acute heart failure (p-value=0.024, p-value=0.03, p-value=0.02, respectively). The best cut-off PDW value for prediction of the composite MACE endpoint was 14.7 fL with sensitivity of 75.6% and specificity of 51.4% and the area under the Receiver Operating Characteristic (ROC) curve was 0.63 (95% CI, 0.57 to 0.69). <b>Conclusion:</b> The study emphasised on the use of platelet indices, especially PDW, as a predictor of poorer reperfusion outcomes in primary Percutaneous Coronary Intervention (PCI) as evidenced by higher MACE rates in patients with higher PDW. Hence, PDW can help in predicting the thrombus burden even before doing the angiogram and such high-risk patients could benefit from early initiation of stronger antiplatelets, Glycoprotein (Gp) IIb/IIIa antagonist drugs and thrombus aspiration techniques. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OC19-OC23&id=16215 https://doi.org/10.7860/JCDR/2022/52851.16215 Clinicoepidemiological Profile of Otorhinolaryngological Diseases among Patients Aged 5-15 Years- A Retrospective Study Mohan Kumar Mili, Asha Saikia, Monikuntal Sarmah, Jyotirmoy Phookan, Naba Jyoti Saikia <b>Introduction:</b> Ear, nose and throat diseases are some of the common causes of absenteeism among the school going children and can contribute to various co-morbidities. The most common among the Ear, Nose, Throat (ENT) diseases in school going children is hearing impairment due to ear wax or different types of otitis media which can be prevented with early detection and intervention. Upper respiratory tract infections also predispose a child to complications such as tonsillitis, sinusitis along with otitis media that can lead to morbidities like hearing impairment and learning disability. <b>Aim:</b> To determine the prevalence of ear, nose and throat diseases among the school going children and their clinico-epidemiological profile. <b>Materials and Methods:</b> This retrospective study was carried out in a tertiary care centre, Assam Medical College and Hospital, Dibrugarh, Upper Assam, India during the period of January 2019 to December 2019. Study included all the 1525 children within age group of 5-15 years attending the ENT Outpatient Department (OPD). Data was obtained from the outdoor register and the history sheets. Data collected was age, sex, religion and distribution of diseases according to site. Number of children having ear, nose, throat or neck diseases were calculated using Microsoft Excel software 2013, version 15.0. <b>Results:</b> Majority of the cases studied were found to be in the age group of 5-10 years (54.1%). ENT diseases were more common in boys (54.2%) than in girls (45.8%). Diseases of the ear (55.9%) were most common, followed by oral cavity and throat (19.3%), nose and Paranasal Sinus (PNS) (18.2%) and neck (6.6%). The most common diseases in ear were Chronic Suppurative Otitis Media (CSOM) and presence of earwax, while sinusitis and allergic rhinitis were more prevalent in diseases of nose and PNS. Pharyngitis and tonsillitis were more commonly found among the diseases of oral cavity and throat. <b>Conclusion:</b> These diseases are a major burden in the school going children resulting in their absence from school, low academic and extracurricular performance and other outdoor activities. Keeping an eye on this aspect, a structured and systematic school health program can be designed in collaboration with state health system, so that it can be properly followed-up and needed treatment can be initiated with the help of state government cost. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=MC01-MC03&id=16216 https://doi.org/10.7860/JCDR/2022/47916.16216 Looking Beyond Knowledge and Accessibility- Exploring Barriers and Facilitators for Cervical Cancer Screening Services among Tribal Women in Tea Gardens of Darjeeling, West Bengal Shashi Kala, Alapan Bandyopadhyay, Sharmistha Bhattacherjee, Abhijit Mukherjee, Samir Dasgupta <b>Introduction:</b> Despite efforts to motivate all reproductive age women to avail cervical cancer screening services, many still do not utilise them. Most researchers have universally identified barriers like the lack of knowledge and lack of accessibility as the reason for not availing services. However, additional barriers also prevent women from making use of these screening services. <b>Aim:</b> To explore the barriers and facilitating factors for cervical cancer screening beyond the lack of knowledge and accessibility of services. <b>Materials and Methods:</b> This qualitative research was conducted among tribal women residing in the Kiranchandra Tea Estate and Atal Tea Estate (two tea gardens in the rural Naxalbari Block) West Bengal, India, from July 2018 to February 2019. Women aged 30-59 years, living in the garden for atleast the last five years, not suffering from obstetrics/gynaecological disease during last two years and willing to participate in the study were included, based on a purposive sampling method. Information Education Campaign (IEC) on cervical cancer and screening were undertaken and screening services arranged in the gardens on garden holidays for two consecutive weeks. Eight Focus Group Discussion (FGDs), four in each garden were conducted, with each FGD consisting of 5-8 participants (N=49). Data obtained was recorded and logged with the participants&#8217; permission and consent. A manifest content analysis was used to explore the perceived barriers and facilitators of cervical screening. <b>Results:</b> The major barriers identified were lack of support, burden of responsibility and the lack of felt need. The facilitators found most frequently were provision of information, social motivation, easy accessibility and affordability of screening services. <b>Conclusion:</b> The present study revealed that, there are various actual and perceived barriers to cervical cancer screening among tribal women in tea garden areas. Even after imparting knowledge and increasing availability and accessibility of a free program, familial support, burden of responsibility and lack of felt need, hinder increased uptake of the services. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC16-LC20&id=16208 https://doi.org/10.7860/JCDR/2022/52280.16208 Awareness and Skills of Modern Telemedicine Practice among Doctors in Kerala- A Cross-sectional Study Anil Bindu Sukumaran, Manju Leela, Kannan Suresh, Himiki Selvin, Regi Jose, Shilpa Prakash, Divija Vijith, PV Benny <b>Introduction:</b> In this modern era of technology, Information and Communication Technology (ICT) has made a very big revolution. Telemedicine is an emerging concept in healthcare services in Kerala, its implementation has not been satisfactory and successful. It is cost effective and provides easy access to healthcare services for people anywhere and especially during pandemic situations like this. A study is required in the domain of awareness and skill of doctors to facilitate its adoption and implementation. There was an urgent need to devise means for patients to consult doctors during Coronavirus Disease 2019 (COVID-19) pandemic. <b>Aim:</b> To assess the level of awareness and skill among doctors practicing modern medicine during COVID-19 pandemic. <b>Materials and Methods:</b> A cross-sectional study was conducted among 535 modern medicine doctors of Kerala from June 2020 to May 2021, using a structured self-administered questionnaire designed for the study. The total scores of awareness and skill calculated and categorised as poor, moderate, and good. Data was analysed by Statistical Package for the Social Sciences (SPSS) version 20.0 software by IBM. The Chi-square test/ Fisher&#8217;s-Exact test was used as test of significance. <b>Results:</b> Mean age of the study participants was 40.44&#177;10.66 years, with majority 326 (60.94%) being females. Among the 535 doctors participated, 68.22% had moderate skill, 27.85% had good skill and only 3.92% had poor skill. Years of experience of doctors ranged from 1 to 48 years, with mean of 13.47&#177;10.46 years. In majority, 431 (80.56%) of the participants, had moderate awareness and 15.89% had good awareness, about the telemedicine practice. Poor awareness was present in 19 (3.55%) doctors. About 46.54% believed that specific software training is required for practicing telemedicine. <b>Conclusion:</b> Even though, awareness and skill of doctors practicing modern medicine are favourable, more webinars or workshops are needed to improve their knowledge. Telemedicine is an emerging technology in the health sector in India, so it requires study to know health professional&#8217;s awareness and skills towards telemedicine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=LC21-LC26&id=16209 https://doi.org/10.7860/JCDR/2022/51754.16209 Association of Age and Sex with Different Status of Serum Vitamin D Level among Different Grades of Diabetic Retinopathy: A Cross-sectional Study Rajarshi As, Pinaki Das, Sunita Das, Bosumita Sinha <b>Introduction:</b> Diabetes Mellitus (DM) is rapidly escalating globally as well as in India, affecting all age and sex groups. One of the dreaded microvascular complications of DM is Diabetic Retinopathy (DR). In parallel to increase in prevalence of DM and its complications, several reports of serum 25 hydroxy (OH) Vitamin D deficiencies have been documented in India. <b>Aim:</b> To establish the relation of different age and sex groups with different status of serum 25 (OH) Vitamin D level among different grading of Diabetic Retinopathy in patients of Type 2 Diabetes Mellitus. <b>Materials and Methods:</b> This cross-sectional and observational study was conducted in Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, from May 2019 to May 2020. Total 107 type 2 DM patients aged 40 years and above including both males and females were taken. Direct ophthalmoscopy was done for examination of retina and venous blood was taken for Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS), Glycated Haemoglobin (HbA1c) and serum 25 (OH) Vitamin D level estimation aseptically. Number of patients and percentage of patients were compared across the groups using Fisher&#8217;s-exact test/Pearson&#8217;s Chi-square test for independence of attributes as appropriate. Mean, median and standard deviation were compared across the groups using Mann-Whitney&#8217;s U-Test/Kruskal-Wallis&#8217;s Test as appropriate. Spearman&#8217;s test was applied for assessing the correlation between age of diabetic patients and vitamin D levels. The p-value <0.05 was considered as statistically significant. <b>Results:</b> In this study, most of the participants were under the age group of 50-59 years. No significant relationship between the age and Vitamin D levels of the subjects was observed. The association between different status of serum Vitamin D level and different age groups among different grading of Diabetic Retinopathy is statistically significant out of entire sample size, not in individual grading. The association between different sex groups and different vitamin D status among different grading of DR was not statistically significant. There was no significant difference between serum Vitamin D level in males and females with DR. Correlation between serum Vitamin D level and age was linear and positive; but strength was low and p-value was not significant (correlation coefficient=0.100 , p-value=0.306). <b>Conclusion:</b> This present study showed that maximum subjects were under the age group of 6<sup>th</sup> decade. There was a significant association between different status of serum Vitamin D level and different age groups out of whole study population, but not in individual grading of DR. No association was observed between different sex groups and different Vitamin D status among different grading or severity of DR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=CC04-CC09&id=16210 https://doi.org/10.7860/JCDR/2022/54908.16210 Characterisation of Clinicopathological and Molecular Features of Leukoplakia not Associated with Tobacco- A Scoping Review Kalpa Pandya, Sivakumar Pradeep, GVV Giri, Malathi Narasimhan Tobacco has been implicated as the strongest risk factor for oral malignancies and common potentially malignant disorders. Recent trend shows an increase in the prevalence of these lesions in non tobacco population. Studies suggest that clinicopathological features of leukoplakia differ in tobacco users and non users. Also, leukoplakia without known risk factors is at a higher risk of malignant transformation. Preliminary studies on carcinogenesis of non tobacco-associated head and neck cancers have identified a difference in the key genes involved in the pathogenesis of cancers associated with and without tobacco. While the genetic characterisation of non tobacco oral cancers is gaining focus in the literature, there is a paucity of studies on non tobacco leukoplakia. An understanding of the non tobacco leukoplakia, possibly a distinct subgroup, may provide an insight into the inception of non tobacco oral cancers, leading to avenues for prevention, early diagnosis and precision medicine-led treatment approaches. Through this narrative review, authors revisit and summarise the existing literature on leukoplakia among non tobacco population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=XE01-XE04&id=16219 https://doi.org/10.7860/JCDR/2022/52294.16219 Journey of Natural Killer Cells and their Role in Liver Diseases Archana Buch, Rohan S Kulkarni, Saagar S Kulkarni, Parul Bhandari Natural Killer (NK) cells are the key lymphocyte subset of the natural immune system that arbitrates antiviral and anticancer responses. In the human body NK cells inhabit in the bone marrow, lymph nodes, tonsils, skin, liver, gut, and lungs. This bibliographic study covers the origins and evolution of these cells. This review of NK cells includes synopsis of their well-known and evolving themes including their development, functions of cytokine production, anticancer cytotoxicity, clearing of viral infections and exhaustion.Within the liver, NK cells are enhanced in lymphocytes and possess distinctive phenotypic characters and useful properties, which contain tumour cytotoxicity and explicit cytokine profiles. NK cells while providing innate immunity in the liver, play important roles in providing protection versus pathogens and tumours utilising their cytotoxicity and cytokine production. Accruing substantiation from the last few decades proposes that NK cells perform a vital role in regulating viral hepatitis and liver tumours. In addition, they contribute to the pathogenesis of liver damage including its inflammation. Understanding the description of hepatic NK cell functions has aided us in better understanding the pathogenesis of diseases of the liver and consequently divulging novel therapeutic goals for treating these illnesses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=EE01-EE05&id=16221 https://doi.org/10.7860/JCDR/2022/52276.16221 End of Life Care in Terminal Head and Neck Cancer- An Amalgamated Approach Karthikeya Patil, Nagabhushana Doggalli, VG Mahima, CJ Sanjay, Romali Panda Oral cancer is among the leading causes of cancer morbidity and mortality worldwide, and palliative care is a critical requirement for cancer patients. It is a multidisciplinary strategy that involves professionals from a variety of medical specialities. Yet, a stomatologist&#8217;s presence in the palliative care group is unavoidable. Although oral care is considered one of the most fundamental nursing practices, it might be affected in cancer patients due to the disease or various treatment regimens. The present review focuses on combined approach, starting with breaking down news to the family and progressing to palliative care measures for Head and Neck Cancer (HNC) patients. This includes pain management, aftereffects of chemoradiation therapy, outcome of cytoreduction, management of external fungating lesion, postradiotherapy dysgeusia management, postmalignancy therapy trismus management and xerostomia management. Furthermore, this also includes special interest topics like results of altered anatomy, cancer cachexia and Euthanasia legalisation in Indian scenario. Prioritising cure along with prolonging survival of the patient with minimal suffering is the basic goal of palliative care. As a result, a respectable death is one that is painless, serene, and honourable, occurring in the presence of loved ones and without the need for unnecessary brave interventions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZE20-ZE24&id=16155 https://doi.org/10.7860/JCDR/2022/52188.16155 Association between Oral Probiotic <i>Streptococcus</i> Supplements and Salivary <i>Streptococcus Mutans</i> Count in Human Study: A Systematic Review Saravanan Poorni, MS Nivedhitha, Manali Ramakrishnan Srinivasan, B Arthi <b>Introduction:</b> Probiotics in caries prevention is a subject of growing interest due to their specific activities and inhibitory effects on the cariogenic organisms. Though numerous reviews have evaluated the effect of probiotics in caries prevention, very few have focussed on the probiotic streptococcus strains, none of them have emphasised on the effect of probiotic Streptococcus strains on the salivary <i>Streptococcus mutans (S. mutans)</i> count. <b>Aim:</b> To evaluate the current literature on the association between oral probiotic Streptococcus supplements on the <i>S. mutans</i> level. <b>Materials and Methods:</b> In the present systematic review a focused PICO question was formulated. Comprehensive literature searches were independently performed by two reviewers in various electronic databases. Randomised control trials in humans in which oral probiotic Streptococcus supplements were used to alter the salivary <i>S. mutans</i> count were included. Risk of bias and data extraction of the included articles was performed. <b>Results:</b> Five studies were included in the qualitative synthesis. The quality of the included studies was quite low as only one among the five studies had moderate risk of bias while all others had a high risk of bias. <b>Conclusion:</b> Within the limitations of the available data, it can be concluded that probiotic Streptococcus supplements have a positive effect on reducing the <i>S. mutans</i> levels as long as they are being used. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZE01-ZE05&id=16148 https://doi.org/10.7860/JCDR/2022/54977.16148 The 100 Most Cited Publications on Dental Ceramics between 1980 To 2020: A Bibliometric Analysis Naisargi Shah, Praveen Badwaik, Prakruti Shah, Sheetal Jadhav, Vishrut Bhatnagar, Arshad Idrisi <b>Introduction:</b> Evidence-based dentistry provides clinically oriented decisions with the help of available scientific data and literature. The significance of an article is reflected by its citation count, the impact it has on clinical practice. This is where bibliometric studies play an important role by providing an overview of research and scientific activity by calculating bibliometric indicators that give information about the quantity of published research in a specific field. The citation index is considered an important parameter for measuring relevance in a specific field. Articles that are heavily cited are considered important in the field of dental ceramics as they can provide basic information, recent advances, and the areas that are extensively researched. <b>Aim:</b> To perform a bibliometric analysis of the 100 most cited publications in the field of dental ceramics, in the past 40 years from 1980-2020. <b>Materials and Methods:</b> The Scopus database was used to retrieve all publications with titles containing the term &#8220;Dental Ceramics&#8221;. Thereafter, the data obtained was arranged in a descending order and a list of the 100 most cited publications were prepared. The data was analysed for the number of citations, the journals in which they were published, its impact factor, the work of the author, country in which it was published, document type retrieved, university affiliation, funding sponsors, area of subject in study, and the number of articles published per year. Prediction of future growth trend was also analysed using data gathered in Microsoft Excel software. <b>Results:</b> Out of the retrieved data, 3815 was the highest number of citations recorded. Two of the articles received more than 1000 citations and 32 articles were cited less than 100 times. These 100 publications were documented from the year 1986-2018. Largest number of publications were made in the Journal of Dental Materials (n=31), followed by the Journal of Prosthetic Dentistry (n=12) and Journal of Dental Research (n=10). 85 of the total documents were original articles, 12 were reviews, two cited publications were books and one was a conference paper. <b>Conclusion:</b> The bibliometric analysis of the 100 most cited articles revealed a marked change in the trends and progress that has taken place in the field of dental ceramics amongst the researchers, clinicians and technicians. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZE06-ZE13&id=16149 https://doi.org/10.7860/JCDR/2022/51342.16149 Effectiveness of Ozone against Common Dental Problems: A Literature Review Surabhi Durgapal, Mamatha Shetty Oral disease represents a major concern among all populations. Despite great efforts that have been made in the past few decades to overcome these diseases; a large part of the world population still suffers from oral diseases which are considered a major reason for the loss of a tooth. Different bacterial species colonises the oral cavity, some of the bacteria are found to be associated with the cause of one of the most common disease called periodontitis. The infectious nature of periodontopathogens has been studied extensively. Currently, treatment of various oral diseases includes supragingival as well as subgingival debridement, root canal treatment and in severe cases, extraction along with antibiotic therapy to help achieve a pathogen-free environment. Continued research and development in the field of dentistry have brought new approaches in treatment modalities. The use of ozone is one of the latest therapies that has gained the interest of researchers in the past few decades. Ozone is a pale blue colour gas and is the natural constituent of the atmospheric layer of Earth. It is a modern pharmacological approach that is biocompatible and has shown its effectiveness against bacteria (gram-positive and gram-negative bacteria), viruses, and fungi. The beneficial biological effect of ozone has made its usage at all stages of disease propitious. The explication of the mechanism of ozone at the molecular level has proved to be beneficial in different medical and dental treatments. The use of ozone in clinical practice can be advantageous to the patient in terms of pain relief and treatment time. Therefore, the present article briefly reviews the chemical nature of ozone, its therapeutic uses, and the benefits it can provide in the treatment of various oral diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZE14-ZE19&id=16150 https://doi.org/10.7860/JCDR/2022/52741.16150 Postural Control in Diabetic Peripheral Neuropathy: A Narrative Review Urvi Bhatt, Megha Mehta, G Palani Kumar Diabetes mellitus is a metabolic disease of chronic hyperglycaemia which leads to neurological complications such as Diabetic Peripheral Neuropathy (DPN). When compared to healthy persons, those with DPN are more likely to fall, especially in geriatric population. Present review aims to provide an insight to the pathophysiology, outcome measures, and physiotherapy treatment of impaired postural control in DPN. Searches for relevant articles were conducted using Google Scholar, PubMed, Ovid, Springerlink, Science Direct (SD), Seniorcare Ageing Growth Engine (SAGE), Elton B. Stephens Company (EBSCO) Discovery Service and Web of Science. Keywords used were diabetes, DPN, diabetic foot, postural control, balance, postural sway, physiotherapy intervention. Irrespective of their year of publication, studies and reports published in English, that provide data of postural control in individuals with DPN and its physiotherapy management were included in the study. The included publications were reviewed and a narrative review was formulated. A total of 35 studies were included in this review. All studies suggest that there is postural instability in people with DPN which increases with age and duration of diabetes. Multidirectional postural sway was observed in most of the studies with medio-lateral instability encountered in more cases. Significant improvement in timed up and go test, single leg stance test, Berg balance scale, and other outcome measures post physiotherapy intervention were reported. Literature suggests that multidirectional postural instability is present in DPN patients. Physiotherapy, offloading devices and diabetic foot care education improve postural stability in individuals with DPN. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=YE06-YE14&id=16273 https://doi.org/10.7860/JCDR/2022/52191.16273 Challenges and Issues in the Treatment of Reproductive Cancer in India: A Behavioural Science Perspective Padmaja Gadiraju, Punam Singh, C Vanlalhruaii, Ranjit Kumar Dehury There has been a transition of diseases among the Indian masses seen over the last two decades. Of late, noncommunicable diseases and diseases due to environmental factors have increased manifold. Among them, cancer is a concern with every passing day across regions of India. Among them, reproductive cancers are conditions that occur in the reproductive organs contributing to the increased burden of diseases. These are cancers in the breast, cervix, uterus, vulva, endometrium and ovaries, which affect across demographics and geographies of India. Reproductive cancers can also be found in men, like prostate cancer, testicular cancer, and penile cancer. Reproductive cancers have a significant impact on the lives of men and women worldwide.Given the seriousness of the problem, this review discusses the various determinants of reproductive cancer care in India. Further, this review examines the access to cancer care among Indian men and women. The paper gathered existing evidence through a literature search about facts, figures, and narratives of reproductive cancer in India. According to the basic objective, a literature review was done to assess various factors affecting reproductive cancer in the Indian population. The issues of reproductive cancer were assessed at different levels like socio-cultural, concerns of cancer and access to cancer care. The search sites like PubMed, Scopus, Web of Science, and Journal Storage (JSTOR) were used to unravel the issues of reproductive cancer among men and women. The article brings out many concerns about the control of reproductive cancer in India. In India, the screening, diagnosis, and modern cancer care procedures are insufficient, especially reproductive cancer care. There is also a lack of access to reproductive cancer care in most parts of the country, especially in the rural areas. The infrastructure, workforce, and supply chain of medications for cancer care are very worrisome, which needs to be augmented for primary cancer care. Overall, the public health system has to be augmented by considering the systems thinking approach by including all the stakeholders. The complex issues need simplified solutions. Hence, there is a need for training and capacity building to enhance reproductive cancer care among individuals, families, and communities at large. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=IE01-IE07&id=16251 https://doi.org/10.7860/JCDR/2022/52714.16251 Therapeutic Drug Review on Romosozumab: The First Sclerostin Inhibitor Vijay Kumar Jain, Karthikeyan P Iyengar, Arvind Nune, Gaurav Kumar Upadhyaya Osteoporosis is a progressive skeletal disorder which is characterised by low bone mass, normal mineralisation and abnormal bone microarchitecture. This disruption of bone microarchitecture causes subsequent increase in bone fragility and raises risk of fractures. Osteoporosis is a growing public health problem and affects approximately over 200 million people worldwide. In the United Kingdom, it is estimated that around 3 million people have osteoporosis. Since the evolution of drug therapy for osteoporosis in the 1940&#8217;s with oestrogen therapy several approaches to developing novel therapeutics for osteoporosis in animal studies and clinical observations (e.g., oestrogen, calcitonin, and teriparatide) or opportunistic repurposing of existing compounds (e.g., bisphosphonates) to one driven by advances in fundamental bone biology (e.g., denosumab). The advent of biologic agents has provided a more specific and targeted approach to the treatment of osteoporosis. Sclerostin is a glycoprotein secreted by osteocytes and regulates bone metabolism by inhibiting activation of osteoblast function and bone formation. By inhibiting sclerostin, targeted therapeutic pharmacological agents are being developed to address severe osteoporosis and patients who do not respond well to primary line of medical management of osteoporosis. Romosozumab is humanised as a monoclonal antibody designed to target sclerostin. This review assesses the mechanism and current role of romosozumab in osteoporosis treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=RE01-RE03&id=16256 https://doi.org/10.7860/JCDR/2022/50084.16256 Physical Therapy in Hemiplegic Shoulder Pain: A Systematic Review Roshan Lal Meena, Tarun Kumar, Sandeep Singh <b>Introduction:</b> Shoulder joint pain in hemiplegic patients is a common complication which interferes with the therapeutic exercises, influences activities of daily living, social participation and delays the recovery process. Various treatment methods have been given to prevent and manage the Hemiplegic Shoulder Pain (HSP). The purpose of present systematic review was to find the study which is most effective in HSP. <b>Aim:</b> To determine the most effective method used in physical therapy for the management of HSP. <b>Materials and Methods:</b> In the present systematic review, a search of PubMed, Physiotherapy Evidence Database (PEDro), CINHAL, Scopus database, Google Scholar, Cochrane Library Register of control trials and bibliography was conducted from January 2016 to March 2020. Randomised clinical trials were included in the review. The methodological quality of the identified Randomised Controlled Trials (RCTs) was assessed using the McMaster Critical Appraisal Tool. The RCTs which scored less than 9 out of 15 or below 64.2% on McMaster Critical Appraisal Tool were not included into the systematic review. <b>Results:</b> A total of 1337 citations were identified, however, only six RCTs matched the eligibility criteria and were included in the review. The identified studies were similar in design. Investigated diverse physical therapy modalities that were applied for dissimilar periods, and outcome measures assessed at different periods which shown inconsistent results. <b>Conclusion:</b> This systematic review found evidence for improvement in HSP in those treated with Kinesiotaping (KT) and Electromyography (EMG) triggered Neuromuscular Electrical Stimulaton (NMES) with bilateral arm training. However, more number of RCTs needed to substantiate the results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=YE01-YE05&id=16266 https://doi.org/10.7860/JCDR/2022/52483.16266 Effectiveness of Respiratory and Abdominal Strength Exercises in Postoperative Patients with Abdominal Surgeries: A Narrative Review Anjan R Desai, VP Hathila Abdominal surgeries are performed to diagnose and/or to treat different medical conditions by opening the abdominal cavity through large incision in the abdominal wall. Weakness of abdominal muscles, pulmonary complications and incisional pain are more common after abdominal surgeries. There has been significant research on managing such complications by using variety of physiotherapy interventions. This review intended to narrate the available literature on the effects of respiratory exercise and abdominal muscle strength training on pain and abdominal muscle strength after major abdominal surgeries. A systematic search of online databases was conducted and based on the reference lists of selected articles, further studies were identified. Twelve articles that met the inclusion criteria were analysed. Many of the previous studies concluded that respiratory exercise and abdominal muscle strength training after open abdominal surgeries improve abdominal muscle strength and decrease pain. Respiratory functions were also reported to be improved. But recent evidence regarding such effectiveness is insufficient and these aspects need to be explored in future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=YE15-YE21&id=16290 https://doi.org/10.7860/JCDR/2022/52574.16290 Photobiomodulation and its Effect on Stability of Orthodontic Mini-implants: A Systematic Review and Meta-analysis of Randomised Controlled Trials Reshma Mohan, Ravindra Kumar Jain, Arthi Balasubramaniam <b>Introduction:</b> The influence of Photobiomodulation (PBM) on the field of orthodontics has been of recent interest. The PBM has a promising effect on acceleration of tooth movement, alleviation of pain during orthodontic treatment and Mini-Implant (MI) stability. <b>Aim:</b> To systematically report on the effectiveness of PBM on the stability of orthodontic MI. <b>Materials and Methods:</b> This systematic review was conducted during January 2021 and February 2021. Literature search was conducted in five electronic databases for human trials published between January 2000 to February 2021 on the effectiveness of PBM therapy for stability of orthodontic MI. Cochrane review manager software (Revman version 5.4) and Cochrane Risk Of Bias (ROB) 2 tool were used for bias assessment. The primary outcome measured was the stability of MI using Resonance Frequency Analysis (RFA) or Periotest Value (PTV). The secondary outcomes measured were pain and inflammation around the peri-implant area. Also, Interleukin-1&#946; (IL-1&#946;) was also measured in gingival crevicular fluid. <b>Results:</b> A total of six Randomised Controlled Trials (RCTs) were included in the review. Out of the six studies, two showed low Risk Of Bias (ROB) whereas three showed some concerns and one showed high ROB. Quantitative analysis was done for four studies with a random effects model to assess the MI stability measured by periotest at 30 days and 60 days. A significant mean difference of -3.31 (95% Confidence Interval [CI]-5.15, -1.47) between PBM and controls for mini-implant stability at 30 days and a significant mean difference of -3.47 (95% CI-4.58, -2.36) between PBM and controls at 60 days with low heterogeneity was obtained. Three studies reported on the pain response after PBM and both groups showed no significant difference. A decrease in gingival inflammation was reported in one study whereas other study showed no significant change in IL-1&#946; in gingival crevicular fluid. <b>Conclusion:</b> Majority of the studies included in this review reported improved secondary stability with PBM. The low heterogeneous nature of the quantitative studies also supports the data obtained. However, the results should be concluded with caution. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZE25-ZE30&id=16282 https://doi.org/10.7860/JCDR/2022/53306.16282 Pyroptosis- What We Know and the Road Ahead! Anitha Krishnan Pandarathodiyil, Srinivas Prasad Vijayan, Roopa S Rao, Anil Sukumaran Pyroptosis, a type of cell death, initiated by proinflammatory signals, is classically associated with inflammation. It was thought to occur mainly in macrophages and leukocytes during inflammatory conditions and involves the activation of caspase 1 {Interleukin-1beta (IL-1&#946;)-converting enzyme} followed by the production of proinflammatory cytokines such as IL-1&#946;. The process takes place within dendritic cells and macrophages, although there have been few reports of caspase-1 activity within other cells. Induction of pyroptosis involves the caspase-1 activity, however, how its downstream substrates bring about cell death is not well understood. And recently, there has been an addition to the gasdermin family, namely, Gasdermin-D (GSDMD) protein, which plays an important role during pyroptosis. Pyroptosis has been found to have a significant role in tumourigenesis, as it extrudes inflammatory mediators which are vital for tumour development. It is also well known that the activity of proto-oncogenes and antioncogenes, the microenvironment of the immune system, chronic inflammation, and oxidative stress, could determine tumourigenesis and hence the link to pyroptosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ZM01-ZM03&id=16274 https://doi.org/10.7860/JCDR/2022/55236.16274 Intracholecystic Papillary Neoplasm with Low-grade Intraepithelial Neoplasia: A Rare Entity Vertika Gupta, Sarita Devdhar, Rashmi Gautam, Arun Chaudhary, Bhuvan Adhlakha Intracholecystic Papillary Neoplasm (ICPN) is a recently described, rare, mass forming, epithelial neoplasm originating in the mucosa of the gall bladder. It usually protrudes in the lumen and is generally non invasive, but may show dysplastic changes which may be low-grade or high-grade or may be associated with invasive carcinoma. Authors, hereby, describe a case of ICPN in a 57-year-old female patient who reported to Surgery Outpatient Department (OPD) with the chief complaint of pain in abdomen since last five days. On ultrasonography, gall stones were detected for which she underwent cholecystectomy. Histopathological Examination (HPE) revealed a papillary growth in the body of gall bladder measuring 1.0 cm in diameter. Sections from the growth showed back-to-back arranged glands exhibiting a papillary pattern. The glands were lined by columnar epithelium with basally located nuclei. Pyloric metaplasia was noted focally. No foci of invasion were seen. Papillary hyperplasia was noted in adjacent areas along with features consistent with chronic cholecystitis. Thus, a diagnosis of ICPN with low-grade intraepithelial neoplasia was made. The patient recovered well postsurgery and is on regular follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=ED03-ED05&id=16147 https://doi.org/10.7860/JCDR/2022/52489.16147 A Case Report on Spontaneous Coronary Artery Dissection in a Patient with Churg-Strauss Syndrome Neel Kanth Issar, Jayachandra Amarapalli, Prabhat Sharma, Ajay Shankar Prasad, Narendra Pachehra Spontaneous Coronary Artery Dissection (SCAD) is a rare but of one the important causes of sudden cardiac arrest and Acute Coronary Syndrome (ACS). It is complex and often under diagnosed. It has multifactorial aetiologies. It is predominantly seen in young women presenting with ACS, with no pre-existing history of Coronary Artery Disease (CAD) and is commonly diagnosed via coronary angiography. It may be associated with autoimmune disease, connective tissue disorder, collagen vascular disease, Marfan syndrome, intense physical exercise and during peripartum period. The various treatment modalities for SCAD are conservative medical treatment, Percutaneous Coronary Intervention (PCI), and surgery. Here, authors describe a case of 33-year-old women who presented with ACS, with no pre-existing history of CAD. Patient responded well with medical management. This condition has grave prognosis, if not detected and treated promptly. So it is very important to keep SCAD as differential diagnosis in ACS among young patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=OD01-OD03&id=16171 https://doi.org/10.7860/JCDR/2022/50801.16171 KISS- Keep it Simple Yet Safe: A Dependable Option in Anticipated Difficult Airways Milon Vasant Mitragotri, Roopa Sachidananda, Triveni Bedradi Venugopal, Priti Sherikar Difficult airway guidelines provide an algorithmic approach as suggested by many international societies and journals. These guidelines have always been made with an earnest conviction at securing an airway with utmost safety and they provide a framework in times of difficulty. These guidelines are likely to add complexity with technological advances and gadgets available at hand like video laryngoscopes, fibreoptic bronchoscope etc., that may confuse the anaesthesiologist and hinder the decision making process. KISS- Keep it Simple, Stupid!- A concept well known, was first used in aviation which advices the pilot to keep things simple. We applied the same principle to our airway management protocol by modifying it into &#8216;Keep it simple yet safe&#8217;. The current case series describes 10 subjects which seemed to have a difficult access to airway and intubation. These patients were difficult to ventilate or difficult to intubate. Cases were successfully managed by applying this KISS technique. Due care was taken to keep our difficult airway cart ready as an alternative option. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=April&volume=16&issue=4&page=UR01-UR04&id=16202 https://doi.org/10.7860/JCDR/2022/51131.16202