Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Diagnostic Dilemma in Spindle Cell Lesions of Breast- A Case Report K Khowsalya Subrajaa, S Preethi, S Balamurugan, S Manjani Spindle cell lesions of breast pose diverse morphological patterns which can turn out to be reactive, benign and malignant tumours with overlapping features. Differential diagnosis are wide. It is challenging to the pathologist due to its rarity. The origin of spindle cell lesions of the breast is highly variable and represents multiple lineages. Hereby authors report a case of a 56-year-old female presented to the Outpatient Department with left breast swelling. Mammogram showed hypoechoic ill-defined irregular lesion. On imaging findings, evolving abcess and neoplastic were considered as probable diagnosis. On histopathological examination, the lesion showed bland spindle cells arranged in short fascicles and and in diffuse pattern. The lesion was diagnosed as spindle cell lesion. Immunohistochemistry confirmed the diagnosis of fibromatosis. The standard treatment of wide local excision with adequate safety margins was done. Postoperative period was uneventful. On two years follow-up, the patient had no recurrence. While being very rare at this site, the lesion has locally aggressive behaviour with high recurrence rate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ED01-ED03&id=16680 https://doi.org/10.7860/JCDR/2022/58130.16680 Dual Origin of Left Vertebral Artery- A Case Report of an Uncommon Vascular Variant Chandra Sekhar Patil, S Sushmitha Reddy, Raja Kollu, KS Prashanth Kumar Vertebral artery duplication is relatively an uncommon vascular variant. It is a developmental anomaly with a dual origin and has different levels of fusion in the neck. It is usually an incidental finding found during workup of other clinical conditions. Due to its anatomical similarity with arterial dissection, it is often misinterpreted on vascular imaging, so a thorough understanding of this vascular variant is necessary to avoid diagnostic and therapeutic complications during endovascular interventions. A 43-year-old male presented with complaints of pain and discolouration of fingers of left hand since two days. Computed Tomography (CT) angiography of upper limb was done which revealed short segment near complete to complete occlusion/thrombosis of proximal left subclavian artery which was seen 8 mm from its origin with distal reformation by the collaterals. There was an evidence of hypoplastic V1 segment of native left vertebral artery, a small artery was seen arising from the aortic arch in the middle of common carotid and left subclavian artery origins, which was found to be duplicated vertebral artery with dual origin from both the subclavian artery and aorta with fusion of both the limbs at C4-C5 levels https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=TD01-TD02&id=16705 https://doi.org/10.7860/JCDR/2022/56325.16705 Paratyphi Pneumonia- Does What You Eat Matter? VK Vineeth, P Senthur Nambi, Jagadeesh Chandrasekaran, Aarthee Asokan Most common signs and symptoms of typhoid are localised to gastrointestinal system. Less commonly, extraintestinal infectious complications occur with enteric fever. This case report is about a 29-year-old female, without risk factors, who presented with fever, loose stools and cough of five days duration. The patient was diagnosed to have paratyphi A bacteraemia, with clinical and radiological features of pneumonia. Her sputum cultures were sterile, and hence paratyphi A pneumonia was diagnosed. She received 14 days of antimicrobial therapy and recovered. Vi-based monovalent vaccines do not offer protection against most paratyphoid fever, because only <i>Salmonella serovars Typhi</i>, and paratyphi C carry the Vi antigen. Further studies are needed on bivalent and polyvalent typhoid vaccines covering all serovars. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OD01-OD03&id=16698 https://doi.org/10.7860/JCDR/2022/55235.16698 Malignant Hypertension Leading to Non Arteritis Anterior Ischaemic Optic Neuropathy-Unilateral Involvement an Exigency Ruchita Kabra, Sourya Acharya, Sachin Daigavane, Avi Sharma, Sunil Kumar Non arteritis Anterior Ischaemic Optic Neuropathy (NAION) is mentioned as loss of blood supply to the optic nerve further causing sudden onset and painless vision loss in eye. Exact mechanism, leading to reduced or loss of flow of blood to an optic nerve in NAION, is unknown but there are certain risk factors responsible for NAION like diabetes, malignant hypertension, Hypercholesterolaemia, platelet polymorphism, phosphodiesterase inhibitors, hyperhomocysteinemia, nocturnal hypotension, sleep apnea, contribute to it. This case report is about a 40-year-old patient who presented with a complaint of sudden onset vision loss in one eye which was further diagnosed as NAION on fundus examination. This shows association of malignant hypertension and NAION. Early diagnosis of the condition led to complete recovery of vision loss. Early management of blood pressure and timely management of NAION using antihypertensives and steroids in this patient found to be fruitful and patient regained his vision back. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OD04-OD06&id=16716 https://doi.org/10.7860/JCDR/2022/55673.16716 Recurrent Hypokalaemic Paresis in Secondary Sjögren’s Syndrome Vignessh Raveekumaran, Dhruvi Reddy Sanikommu, Sivashankar Hypokalaemia has a wide scale of causes. The most common ones include potassium loss from urinary tract, gastrointestinal system and loss through sweating. This is report is about a young 24-year-old Indian female who presented with sudden onset weakness of all four limbs which was found to be secondary to hypokalaemia. Refractory hypokalaemia and severe metabolic acidosis in this patient led to further work-up, which revealed positive Anti-SSA (anti-Sj&#246;gren&#8217;s-syndrome-related antigen A autoantibodies), Anti-SSB Anti-Sj&#246;gren&#8217;s syndrome type B and Anti-snRNP (Small nuclear ribonucleoprotein), strongly suggestive of secondary Sj&#246;gren&#8217;s syndrome. Renal involvement with distal Renal Tubular Acidosis (RTA) causing hypokalaemia is seen in 10% of cases with Sj&#246;gren&#8217;s syndrome. Thus, this report highlights the unusual initial presentation of hypokalaemic paresis in a patient with Sj&#246;gren&#8217;s syndrome, and to emphasise that an autoimmune disorder should be considered in such presentations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OD07-OD09&id=16722 https://doi.org/10.7860/JCDR/2022/56588.16722 Coexistent Ovarian Tuberculosis with Borderline Serous Cyst Adenoma in an Infertile Young Female: A Case Report Shweta Verma, Preeti Agarwal, Mithilesh, Nancy Gupta, Vandana Solanki Genital tuberculosis involving the ovary in young non-immunocompromised females is rare, and its coexistence with serous neoplasm makes it even rare and diagnostically challenging. A 32-years-old female patient, presented with primary infertility and abdominal pain. Menstrual history was unremarkable; her ultrasound (USG) abdomen revealed an anechoic cyst in left ovary with normal right ovary, uterus, and cervix. Serum Carbohydrate Antigen (CA)-125 was 226 IU/mL. Laparotomy with cystectomy was performed, and gross examination revealed a cystic lesion with a small papillaroid growth. Microscopic examination predominantly displayed large coalescing epithelioid granuloma, multinucleate giant cells, and dense inflammation. On careful examination, the sections further revealed areas of irregular glands lined by single layer of cuboidal columnar cells with homogenous chromatin and moderate eosinophilia cytoplasm. These glands were seen infiltrating the ovarian parenchyma. However, the total depth of invasion was not more than 3 mm in any area. Morphological differentials of granulomatous lesion with borderline ovarian tumour or any metastatic adenocarcinoma was made. Further immunohistochemical work-up was done and the tumour cells showed strong nuclear positivity for Wilms&#8217; Tumor suppressor gene1 (WT1) and Paired-box gene 8 (PAX8), confirming the presence of serous ovarian lesion. As the total depth of invasion was upto 3 mm according to World Health Organisation (WHO) 2020 the lesion was classified as borderline serous neoplasm with microinvasion over shadowed by the tubercular component in the same ovary. Interestingly, both may result infertility in a young female. Above case emphasises on the importance of careful morphological assessment in delineating two different pathologies occurring in same organ which is clinically relevant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ED04-ED06&id=16735 https://doi.org/10.7860/JCDR/2022/56988.16735 Minimalistic Intervention of White Spot Lesions and Dental Fluorosis with Resin Infiltration Technique- A Report of Two Cases Raji Viola Solomon, Shanti Priya, Mohammed Abdul Wahed, Priyanka Gopishetty, Mallarapu Sathyanvesh The advances in scientific developments in dentistry have led to the emergence of innovative technologies for early diagnosis, prevention, interception, and therapeutic strategies for the preservation of tooth structure loss due to carious destruction or tooth decay arresting the carious lesions in order to preserve the tooth structure loss. Minimal intervention techniques to replace, repair, and remove as little tissue as possible is gaining significant importance over traditional techniques, as the emphasis is given on the preservation of the original tooth structure. White spot lesions are a form of enamel demineralisation which usually occurs due to dental fluorosis or postorthodontic treatment, compromising the aesthetics and self-esteem of the patient. The resin infiltration technique is a reliable treatment option advocated for the treatment of white spot lesions and non cavitated carious lesions. It is a microinvasive intervention performed without drilling or sacrificing the healthy tooth structure aiming at reinforcing the demineralised enamel by filling with visible light curing resin. The rationale for the use of resin infiltration is to allow the light-activated resin to permeate into the enamel porosities by virtue of capillary action, into the treated surface of the tooth. The infiltrated resin occludes the enamel microporosities and prevents the lesion progression further as it blocks the various pathways of ingress created by the acid penetration and dissolved materials in the enamel matrix. The first case presentation highlights the successful management of white spots visible in the maxillary anterior region of a female patient of age 25 years. The second case represents the use of the resin infiltration technique to treat and eliminate yellow-brownish stains in the maxillary anterior teeth of a female patient of age 23 years. Both the patients expressed concerns about the non uniform colour and appearance of their teeth and wanted solutions to rectify the same, without any drilling or removal of the tooth surface. This article highlights the concept of resin infiltration as a minimally invasive treatment option for the management of white spot lesions as a viable solution to suit patient specific needs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZD01-ZD04&id=16737 https://doi.org/10.7860/JCDR/2022/56182.16737 Long-standing Renal Hydatid Cyst Mimicking an Angiomyolipoma: A Rare Case Report Ellerhea Shalom Fernandes, Deepak Madhukar Kamle Primary hydatid cyst of the kidney is very rare and accounts for 1-4% of all hydatid disease. Authors hereby reports an unusual case of an isolated, long-standing renal hydatid cyst, mimicking an angiomyolipoma on imaging. A 72-year-old female, from a rural area, presented with pain in the right flank since two years. She also complained of mild fever off and on, since one year. A 10&#215;10 cm, non tender lump was palpated in the right flank. Ultrasonography and computerised tomography showed a large right-sided renal mass measuring 10 cms and a diagnosis of angiomyolipoma was rendered. A right-sided open/simple nephrectomy was done. The kidney was large, cystic, firm and was sent for histopathological examination. On gross examination, a large, unilocular, thick-walled, cystic lesion was seen. Cut-surface showed heterogeneous, creamy coloured necrotic contents, with few nodular gelatinous masses. On microscopy, characteristic acellular, laminated structure of the ectocyst of <i>Echinococcus granulosus</i> was seen. Extensive calcification and ossification of the cyst wall with bone marrow production was also seen. Contents of the cyst were necrotic and no daughter cysts were seen. Adipose tissue of the bone marrow was mistaken on imaging for the lipomatous component of an angiomyolipoma. Isolated renal hydatid cyst is very uncommon and though active hydatid cysts do have characteristic radiological findings, they can be misdiagnosed as a benign renal tumours, renal cysts or abscesses. Old cases show degenerative changes as well as calcification and are difficult to diagnose preoperatively. Surgical treatment of renal hydatid cyst depends on the size, number of cysts, exact intrarenal location and residual renal function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=PD01-PD02&id=16745 https://doi.org/10.7860/JCDR/2022/55766.16745 Osteosarcoma of Jaw Masquerading as Calcifying Epithelial Odontogenic Tumour- A Diagnostic Dilemma Neha Sethi, Nimisha Devpura, Nitin Khutenta, ML Yadav, Maneesh Vijaywargia Osteogenic osteosarcoma is the most widely recognised primary malignant bone tumour involving particularly the appendicular skeleton. Osteosarcoma of jaw including maxillary and mandibular osteosarcoma accounts for about 7% of cases. The variants of osteosarcoma involving jaw include- osteosarcoma, Not Otherwise Specified (NOS) Low grade central osteosarcoma; chondroblastic osteosarcoma; parosteal osteosarcoma; periosteal Osteosarcoma. The present case was a 27-year-old male who came to the dental Outpatient Department (OPD) with the complaints of swelling in the upper vestibule and loosening of upper alveolar teeth and was reported as Calcifying Epithelial Odontogenic Tumour (CEOT) on histopathological examination and excision of the lesion was done. After two months the patient again presented with a recurrent lytic and sclerotic lesion involving the left maxillary bone with soft tissue extension in the maxillary sinus. Provisional diagnosis was made as malignant transformation of CEOT and immunohistochemistry was performed for the confirmation of the diagnosis. This case represented the challenges in the diagnosis of osteosarcoma of jaw which can be due to difficult biopsy procedure; limited imaging and challenges in legitimate resection because of the proximity to essential structures and the challenges are being faced to get the optimal treatment of jaw osteosarcoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ED07-ED09&id=16747 https://doi.org/10.7860/JCDR/2022/55035.16747 Unusual Presentation of Aplastic Anaemia: Evolving into Myelodysplastic Syndrome with Excess Blasts 1 and Type III Paroxysmal Nocturnal Haemoglobinuria Clone Shilpi More, Saroj Rajput, Geetika Sharma, Nimisha Sharma, Tathagata Chatterjee Aplastic Anaemia (AA) is an immune mediated, primary haematopoietic disorder characterised by pancytopenia with significant morbidity and mortality. Allogeneic Haematopoietic Stem Cell Transplant (HSCT) is the treatment of choice in younger patients whenever Human Leucocyte Antigen (HLA) matched donor is available. For older patients and those in whom matched donor is not available, immunosuppressive therapy is the frontline treatment. With the long survivals of AA patients, clonal evolution into Myelodysplastic Syndrome (MDS) and clinically evident Paraoxysmal Nocturnal Haemoglobinuria (PNH) is frequently seen over a period of 5-10 years. The prognosis and overall survival of post AA, MDS is poor and the only treatment of choice is Allogeneic HSCT. The overall survival of post AA, MDS is however comparable to de novo MDS post-transplant. The authors hereby discuss a case of 26-year-old male patient, known case of AA who evolved into MDS with Excess Blasts 1 (MDS-EB-1) and type III PNH clone over a period of six years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ED10-ED12&id=16749 https://doi.org/10.7860/JCDR/2022/56765.16749 Non Spontaneous Cerebrospinal Fluid Rhinorrhoea and Subsequent Bacterial Meningitis: A Case Report G Vaishnavadevi, Dayanandan Yoganandan Cerebrospinal Fluid (CSF) protects brain and maintains intracranial pressure which is secreted by choroid plexus. After severe Craniomaxillofacial (CMF) trauma, disruption of meningeal structure leads to CSF leak. About 80-90% of CSF leak in adults is due to head injuries. CSF rhinorrhoea can be classified into spontaneous and non spontaneous. Meningitis is seen in 19% of persistent CSF leakage with 10% of mortality due to delayed and longer duration of the CSF leakage. Post-traumatic CSF leaks are commonly seen in 1-3% of adults among all head injuries. Traumatic CSF leak is reported to be approximately 10-30% of the skull base fractures in adults. Common pathogens of meningitis are <i>Haemophilus influenzae (H. influenzae)</i> and <i>Streptococcus pneumoniae (S. pneumoniae)</i>. Present case was of non spontaneous CSF rhinorrhoea and subsequent bacterial meningitis in a 33-year-old male patient, with fever and chills, headache, vomiting, neck stiffness. Kernig sign&#8217;s was present. Patient had past history of road traffic accident and found to have CMF injury. Neurosurgery opinion was sought and found to be persistent CSF rhinorrhoea. Haematological and chemical analysis of cerebrospinal fluid was abnormal. CSF and blood sample sent for culture and sensitivity. <i>H. influenzae</i> grown in both culture. <i>H. influenzae</i> is an uncommon cause of adult bacterial meningitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DD01-DD02&id=16774 https://doi.org/10.7860/JCDR/2022/57360.16774 Anaesthetic Management of a Peripartum Cardiomyopathy Patient undergoing Caesarean Section Monika Sharma, Sanjot Ninave, Aruna Chandak, Vijay Chandak Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the last month of pregnancy or upto five months after delivery. In this condition, the heart chamber enlarges and the muscle weakens. This case report is about a 30-year-old primigravida, with oligohydramnios, at 32.3 weeks of gestation. She visited for a caesarean section, and was diagnosed with PPCM on the basis of clinical findings of growing fatigability, troubled breathing and severe dyspnoea and on echocardiography ejection fraction of 64% with mild mitral regurgitation, moderate dilated left ventricle, tricuspid regurgitation was found. These patients require vigilant anaesthetic intervention for management of painless labour and/or either vaginal or operative delivery. The basic haemodynamic goals should always be kept in mind for favorable maternal as well as foetal outcome while selecting the drug dose and mode of anaesthesia. Various studies showed that both general and regional anaesthesia can be used with comparable outcomes in PPCM patients undergoing caesarean section. The index patient, who needed a caesarean section, was managed with Combined Spinal-Epidural (CSE) anaesthesia, weighing the risk of increase mortality due to general anaesthesia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UD01-UD03&id=16775 https://doi.org/10.7860/JCDR/2022/57272.16775 Co-existence of Head and Neck Squamous Cell Carcinoma with Sinonasal Mucormycosis: Therapeutical Challenges Nitin Sharma, Dushyant Mandlik, Purvi Patel, Aditya Joshipura, Kaustubh Patel Pandemic was new experience for entire humanity. Medical fraternity was no exception. The cases of mucormycosis were on the rise during the second wave of the pandemic. Presented here are two cases which were combination of two diseases, one of which was squamous cell carcinoma of head and neck region (49-year-old male) and other one was sinonasal mucormycosis (56-year-old male). Both patients were diabetics and had history of Coronavirus Disease-2019 (COVID-19) infection in past. Our literature search doesn&#8217;t reveal any previously reported cases of this rare combination. There were certain challenges in management. Both diseases were lethal and treatment of one cannot be prioritised over other. Challenges in managing those cases were, reconstruction planning, perioperative management and postsurgery adjuvant therapy. In absence of previous experience to treat this combination or any literature available new treatment protocol were formulated. Cases were discussed in multidisciplinary team meetings and treatment plans were formulated. Mucormycosis and oral squamous cell carcinoma both were operated and reconstructed in same sitting. In one patient revision endoscopic debridement had to be done. Amphotericin B was started once diagnosis was confirmed. Patients were followed-up on weekly basis during first month and imaging was done every 15 days. Both patients had satisfactory recovery without any sign of progression of mucormycosis. Adjuvant radiation was given in both cases at appropriate time. At follow-up both patients were free from disease for six months. From these unique experiences it can be recommended that combination of sinonasal mucormycosis and squamous cell carcinoma of head and neck is very rare. Both diseases can be treated simultaneously. excision and reconstruction can be done in single sitting. There is no need to delay or avoid adjuvant radiation. Multidisciplinary team approach is the key for treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=XD01-XD04&id=16776 https://doi.org/10.7860/JCDR/2022/53093.16776 An Interesting Case of Bell’s Palsy in Pregnancy Associated with COVID-19 Infection Disket Dolkar, Vinika Nimodia Recent studies have reported that Coronavirus Disease 2019 (COVID-19) can be the cause of peripheral facial paralysis and neurological symptoms may be the only manifestation of the disease. Hereby, the authors report an interesting case of a pregnant COVID-19 positive female with Bell&#8217;s palsy, in third trimester of pregnancy. A 33-year-old female, G3P0L0A2, presented with left-side deviation of angle of mouth, excessive lacrimation and redness of right eye for the past three days. She had involuntary drooling on right and left side labial commissural deviation, absence of forehead frowning, inability to close her right eye (positive Bell&#8217;s phenomena), and ipsilateral lagophthalmos. No lesions were seen on the external ear and otoscopy was normal. She was confirmed to have right-sided facial nerve palsy. She had an uneventful course of pregnancy till term and underwent caesarean section at 40 weeks, in view of foetal distress. Pregnancy and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, both are immunocompromised state, and hence could be a risk factor for Bell&#8217;s palsy. But larger studies with more cases are required to prove the causal association. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=QD04-QD05&id=16782 https://doi.org/10.7860/JCDR/2022/57812.16782 Pulmonary Arteriovenous Malformations in a 18-months-old Child: A Case Report Hesham Mohamad Fayad, Fatema Chowdhury, Godfred Antony Menezes, Shria Sadhu, Samiha Anjum Hossain Pulmonary Arteriovenous Malformation (PAVM) is a cardiovascular anomaly in which an anatomic communication between the pulmonary artery and pulmonary vein is formed, resulting in an additional cardiac shunt from the right to left side. PAVM is a rare disease, reported more in females, but in newborns comparatively higher in males. Cases can vary from asymptomatic to symptomatic such as having dyspnoea, hypoxia, cyanosis, neurological symptoms. They are mostly congenital having association with Hereditary Haemorrhagic Telangiectasia (HHT). Herby, author present a case of 18-months-old female was admitted with peripheral cyanosis in the Paediatric Department. Her saturation was 76%, after admission she received three doses of salbutamol nebulisation and was kept on 3 litre oxygen until her saturation increased to around 90%. On auscultation, a murmur of grade 2/6 heard in the left axilla with clear lung fields. Chest X-ray detected a prominent lobulated opacity in the left sided lung adjacent to the heart border. An echocardiogram was done which turned out normal. Thoracic Computed Tomography (CT) scan with contrast showed a vascular malformation in the apical region of the left lower lobe. Pulmonary angiography showed multiple vascular lesions in the peripheries which was consistent with arteriovenous malformation. The child was diagnosed with PAVM. A transcatheter embolisation and coil closure of AVM was performed and postprocedure the child was stable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=SD01-SD03&id=16772 https://doi.org/10.7860/JCDR/2022/55333.16772 An Emerging Neglected Co-infection: <i>Aspergillus fumigatus</i> and <i>Mycobacterium gordonae</i> Co-infection in an Immunocompromised Patient Rani Kumaravel, Priyadarshini Shanmugam, R Alice Peace Selvabai Non Tuberculous Mycobacteria (NTM) commonly affect the immunocompromised patients afflicted with chronic pulmonary disease and other opportunistic infections such as <i>Aspergillus</i> species. Although the symptoms and signs are similar for both, early laboratory diagnosis and treatment would reduce the duration of hospitalisation and unnecessary exposure to antimicrobials. Since NTM and <i>Aspergillus</i> species co-infection is an emerging trend, and delay in diagnosis and treatment can cause major complications, it is essential to clinically suspect the same, and this will help in early diagnosis of the infection, keeping in mind the delayed growth of NTM and <i>Aspergillus</i> species in culture and the time taken to identify the infecting organism. Here, an interesting case of an immunocompromised 63-year-old male patient with Chronic Obstructive Pulmonary Disease (COPD) on frequent treatment who had symptoms of cough with expectoration, breathlessness on exertion, malaise, loss of weight and apetite for three months is reported. The patient was conscious, oriented and cachectic with complaints of breathing difficulty at the time of admission. Considering the positive report of sputum for Acid Fast Bacilli (AFB) and negative GeneXpert report, the patient sample was tested by Polymerase Chain Reaction (PCR) for NTM which was positive. The patient was diagnosed with <i>Mycobacterium gordonae (M. gordonae)</i> and <i>Aspergillus fumigatus</i> co-infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DD03-DD05&id=16790 https://doi.org/10.7860/JCDR/2022/57351.16790 Pedicled Forehead Flap for Reconstruction of Cheek Defect: A Novel Surgical Case Report Senthil Kumar, Rinku George, Davidson Rajiah, Deepak Chandrasekaran, Pradeep Oral cancers are considered slow killer disease. Every year 3,00,000 cases are diagnosed worldwide. Public awareness has been a great challenge to educate people to avoid harmful oral habits to prevent oral cancer. People are not aware about life threatening complications such as death due to oral cancer. Oral cancer is the eighth most common malignancy in India and third most common malignancy in South East Asia. Buccal mucosa carcinoma spreads rapidly and invades deeply to underlying tissues and has high recurrence rate. Surgical resection is more challenging if the tumour invade adjacent anatomical structures and reconstruction should be planned according to extent of tumour resection. Regional flaps are used for oral cavity after tumour resection such as radial forearm flap, deltopectoral flap, pectoralis major flap, latissimus dorsi flap, transverse rectus abdominis myocutaneous flap, trapezius flap. In this case report of a 46-year-old female, folded forehead pedicle flap was used to provide both inner and outer linings of the cheek defect following buccal mucosa tumour resection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZD05-ZD08&id=16796 https://doi.org/10.7860/JCDR/2022/50171.16796 Oral Fibrolipoma Arising from Maxillary Alveolus: A Rare Case Entity Shreyas N Shah, Garima S Jain, Uday Patel, Arpan Shah Lipoma is a non malignant tumour of adipocytes. Lipomas are most commonly seen during 4<sup>th</sup> to 6<sup>th</sup> decades of life. About 20% lipomas are seen in head and neck region of which only 1-4% have been reported in oral cavity. Most common site of occurrence in oral cavity is buccal mucosa and tongue (50%). Various histological variants of lipoma have been identified, which include fibrolipoma, angiolipoma, infiltrating (intramuscular) lipoma, pleomorphic lipoma, osteolipoma, sialolipoma, chondrolipoma, myxolipoma and spindle cell lipoma. Fibrolipoma is a rare histological variant and occurrence on alveolus is even rare. This case reports a case of fibrolipoma of size 2&#215;2 cm arising from maxillary alveolus in a 42-year-old female patient with a long standing history of four years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZD09-ZD11&id=16797 https://doi.org/10.7860/JCDR/2022/58028.16797 Nipple Papilloma with Dysplasia: A Case Report Pratiksha Yadav, Yevvari Sameera, Vanshita Gupta, Varsha Rangankar, Tushar Kambale Nipple papilloma is an uncommon benign breast tumour. Polypoid lesions arising from the surface of the nipple include nipple papilloma, fibroepithelial stromal polyp of the nipple. These must be differentiated from malignant lesions involving the nipple, like Paget&#8217;s disease of the nipple, and malignant breast lesion with nipple involvement. Detailed clinical examination, and to a great extent, imaging helps to differentiate these lesions. Hereby, authors report a case of 46-year-old female presented with abnormal growth arising from the right nipple. On full field digital mammography, bilateral breasts revealed scattered fibroglandular breast parenchyma {American College of Radiology (ACR) type B). An irregular hyperdense mass with lobulated margins is seen superior to right nipple which measured approximately 16&#215;14 mm. The case was managed by local curative excision under local anaesthesia. On gross histopathology, the lesion showed squamous epithelium consisting of variable levels of acanthosis and hyperkeratosis, and focal parakeratosis which also shows focal ulceration and moderate to severe dysplasia and mixed inflammation consistent with papilloma. Histopathological examination has a role in differentiating the benign lesions like nipple papilloma from fibroepithelial stromal polyp of nipple and also helps in determining the presence of atypical hyperplasia, dysplasia or carcinoma in-situ. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=TD03-TD05&id=16799 https://doi.org/10.7860/JCDR/2022/51905.16799 An Ectopic Intrathoracic Kidney in an Adult Female: A Case Report Tharun Ganapathy Chitrambalam, Nidhi Mariam George, Ramyasree Paladugu, Sundeep Selvamuthukumaran, Lokesh Reddy The kidney is an organ prone to congenital anomalies owing to its complex and sequential development. Ectopia of the kidney is a rare entity with intrathoracic ectopia being an exceptionally uncommon occurrence. Intrathoracic kidneys represent less than 5% of all renal ectopias with a prevalence rate of less than 0.01%. The concurrent association of an intrathoracic kidney with a Bochdalek hernia is extremely infrequent with an incidence of 0.25%. Most of the patients are asymptomatic and have an uneventful clinical course. It is often incidentally detected simulating a posterior mediastinal mass. Thoracic kidney is a condition that shows male predominance. Here, authors present a case of a 43-year-old female patient who presented to the Institution with breathlessness and associated chest pain. Computed Tomography (CT) scan revealed left-sided Bochdalek hernia with the left kidney, adrenal gland, transverse colon, splenic flexure and proximal descending colon within the thorax. The patient underwent elective diagnostic laparoscopy followed by reduction of the contents and mesh repair of the diaphragmatic defect. The patient was discharged and remained asymptomatic on a periodic follow-up of over a year. Awareness regarding this rare entity can obviate the need for a battery of unnecessary investigations and operative procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=PD03-PD04&id=16800 https://doi.org/10.7860/JCDR/2022/56659.16800 Massive Traumatic Postpartum Haemorrhage with Co-incidental Atypical Eclampsia and Abdominal Koch’s- A Maternal Near Miss Ruby Bhatia, Kartika Pandey, Sukhbir Pal Kaur, Karishma Singh Obstetric haemorrhage is related with augmented risk of maternal morbidity and mortality and continues to be the second greatest direct cause of near miss and maternal death. Postpartum Haemorrhage (PPH) is the most common form of obstetric haemorrhage, atonic PPH being responsible for 80% cases. Traumatic PPH with massive vulval haematoma, an infrequent but possibly fatal condition if left undiagnosed and untreated. Hence, prompt recognition and management with simultaneous resuscitation and operative procedure is vital to save life of mother. A 24-year-old P1L1 female with traumatic haemorrhage with the formation of massive vulval haematoma, periurethral tears, extensive cervical and vaginal wall tears with hypovolaemic shock with severe anaemia admitted to the tertiary care hospital. Immediate resuscitation measures were taken followed by vaginal exploration for the vulvovaginal haematoma and a multispeciality approach for the better outcome. However, postvaginal exploration after 24 hours, there was progression in vulvo vaginal haematoma size, with haemodynamic instability. Re-exploration under anaesthesia via abdominal approach was performed. The patient required a longer hospital stay. Thus, early diagnosis and treatment of puerperal haematomas can prevent significant complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=QD06-QD08&id=16801 https://doi.org/10.7860/JCDR/2022/54920.16801 A Peculiar Three-way Connection: Colo-urachal-vesical Fistula with Cutaneous Extension Ankit Vyas, Alhad Mulkalwar, Kamlesh Singh, Bhushan Patil Urachal anomalies are quite a rare phenomenon in adults. This report is about a patient of a colo-urachal-vesical fistula with cutaneous extension. A 68-year-old diabetic male patient presented with purulent umbilical discharge since 15 days. Investigations revealed a colo-urachal-vesical fistula communicating with the umbilicus. He underwent a colo-urachal fistula excision with sigmoid-colectomy and bladder-cuff-excision. A thorough literature search revealed only nine reported cases so-far. While the most common symptom was faeculent umbilical discharge, this patient had a slightly varied-presentation of purulent-discharge. This is also the first study to conclusively demonstrate a vesical connection along with colo-urachal and cutaneous extensions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=PD05-PD06&id=16808 https://doi.org/10.7860/JCDR/2022/56764.16808 Cutaneous Tuberculosis- One Diagnosis, a Plethora of Differentials NR Vignesh, Sivaramakrishnan Sangaiah, Ashok N Kumar, Arisha Salam Cutaneous Tuberculosis (TB) is a chronic bacterial infection. It is difficult to diagnose these lesions since they mimic various other dermatological conditions. Cutaneous tuberculosis has a wide range of variations in morphology, histopathology, immunology and treatment response and a diagnosis of cutaneous tuberculosis is very much common in developing countries like India. Cutaneous tuberculosis can be exogenous; endogenous: caused by contiguity or autoinoculation and by haematogenous spread; induced by the Calmette-Gu&#233;rin bacillus and manifest as a tuberculoid. The diagnosis of the infection is supported through the direct test, culture, histopathology, tuberculin skin test, polymerase chain reaction, interferon-gamma release assay, and genotyping. Drugs used for treatment comprises of isoniazid, rifampicin, pyrazinamide and ethambutol. The authors hereby present a case series of various types of lupus vulgaris and scrofuloderma that came to Dermatology Outpatient Department with similar findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=WR01-WR05&id=16740 https://doi.org/10.7860/JCDR/2022/56272.16740 Incidentally Detected Anomalous Renal Arteries during Angiogram- A Case Series Phani Chakravarty Mutnuru, Rammurti Susarla, Rahul Devraj Modern medical society is witnessing increased surgeries for various renal pathologies like renal transplantation and vascular abnormalities. Anomalous origin of renal vasculature might interfere with surgical procedures and outcomes. Hence, accurate roadmap of renal vasculature is necessary for surgeons. Non invasive or minimally invasive imaging techniques help in accurate demonstration of renal vasculature and aid in minimising trauma during surgeries. Preoperative assessment of live renal donor by conventional angiography is a protocol in the institute. A retrospective analysis of anomalous renal arteries was done in a total of 381 cases that were being done in Digital Subtraction Angiography (DSA) suite in Radio Diagnosis Department from 2015 to 2021. In this case series of four patients, different types of anomalous renal arteries have been presented that were incidentally detected during angiograms. Single accessory renal artery was the most common finding in our study followed by multiple accessory renal arteries. Supra coeliac origin of right renal artery was noted in one case which was a rare finding with very few similar case reports in literature. In addition, there was an extremely rare case presentation showing bilateral lower polar accessory renal arteries. They had one common origin, arising from abdominal aorta at the level of aortic bifurcation. No similar case reports have been found in literature and probably the present one is first one of this kind. Knowledge of various anomalies is of utmost importance for the awareness of clinicians and for surgical success. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=TR01-TR03&id=16699 https://doi.org/10.7860/JCDR/2022/57252.16699 A Harrowing Experience of Pinna Lacerations RB Namasivaya Navin, S Prabakaran, S Rajasekaran, PN Aswin Vaishali, R Karthika Otological injuries are not rare presentations to the Emergency Department but they may sometimes be harrowing. These injuries can sometimes lead to haematoma and perichondritis which may lead to cosmetic disfigurement. Hence, opportune and prudent intervention is required to prevent the complications. The present study was conducted to examine the wide range of pinna lacerations, various methods of repair to obtain best cosmetic results and outcome, prevention of development of complications. This case series is about 27 patients with pinna laceration and its management in patients who attended the Emergency Department at a tertiary care hospital. All lacerations of pinna due to any cause were included in the study except chemical and thermal burns. Detailed history was recorded. These patients were managed with wound debridement, suturing and were followed-up regularly to monitor the development of complications. Out of 27 patients, 21 patients had a complete wound healing without any complications. Two patients developed wound gapping and underwent resuturing under local anaesthesia. Perichondritis of pinna has occurred in three patients. Timely intervention is very important for healing and prevention of complications. Normal anatomical contour and good cosmetic results is achieved by adequate wound debridement, maximum tissue restoration, meticulous suturing and wide antibiotic coverage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=MR01-MR03&id=16689 https://doi.org/10.7860/JCDR/2022/53691.16689 Sodium Hypochlorite Accident Associated with Endodontic Treatment of Maxillary First Molar Varun Kumar, Ruchi Juneja, Sneha Priya https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZJ01-ZJ03&id=16725 https://doi.org/10.7860/JCDR/2022/56496.16725 Double Walker of an Infected Dental Follicle Santana Natarajan, Elamparithi Bujabalan, Pavana Basker, Sathish Kumar Jayagopal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZJ04-ZJ05&id=16764 https://doi.org/10.7860/JCDR/2022/56459.16764 A Rare Case of Atrial Fibrillation due to Anaphylaxis to Sugammadex Soundararajan Veluchamy, Stephanie Pauling https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UL01-UL02&id=16781 https://doi.org/10.7860/JCDR/2022/55727.16781 Referral Pattern of Inpatients to Psychiatry Department and the Diagnostic Concordance between the Referral Departments and Psychiatry Team- A Retrospective Study Iniyan Selvamani, Aswin Sasidharan, B Haritha Sree, B Minu Rekha, Sumedha Dondapati <b>Introduction:</b> The referral of inpatients to psychiatry team is more in India due to the increase in the morbidity rates of people. The referrals to Psychiatric Department with a specific psychiatric diagnosis are considerably very low. Most often, the diagnosis made by the clinicians does not match with that of the psychiatrist. Physical illness is shown to have a strong association with psychiatric co-morbidity. Such association complicates the course and outcome of both the conditions. <b>Aim:</b> To evaluate the pattern of inpatient referral to the Psychiatric Department and to estimate the diagnostic concordance between the referral and psychiatric team. <b>Materials and Methods:</b> This retrospective study, with prior permission from the Department of Psychiatry, included all the inpatient referrals (n=310) to Psychiatry Department by other departments from January 2019 to December 2019. Data collection was done from March 2020 to August 2020 and data analysis from September 2020 to November 2020, in Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India.Data was obtained from a psychiatry referral register and was statistically analysed using Microsoft Excel (MS Office 2013) for percentage, mean and Standard Deviation (SD) for descriptive variables. Diagnostic concordance to assess the reason for referral and diagnostic accuracy in terms of reason of referral and psychiatric diagnosis was analysed using kappa statistics. <b>Results:</b> The most common psychiatric disorder for referral was alcohol dependence syndrome 102 (32.9%) followed by depression 38 (12.3%) and adjustment disorders 34 (10.9%). Concordance was good for intellectual disorder (&#954;=1.00), depression (&#954;=0.969) and alcohol dependence syndrome (&#954;=0.963). Very low concordance was observed in diagnosing acute confusional state (&#954;=0.195) and panic disorder (&#954;=0). <b>Conclusion:</b> Alcohol withdrawal syndrome, adjustment disorder and depression were the most common reasons in referring inpatients to psychiatry. Lower concordance for psychiatric disorders like acute confusional state and panic disorder could be explained by inadequate psychiatry exposure and hence be improved by better undergraduate psychiatry training. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=VC06-VC09&id=16809 https://doi.org/10.7860/JCDR/2022/55526.16809 Micronucleus Scoring in Fine Needle Aspiration Cytology of Breast Lesions- A Retrospective Analytical Study Ramya Katta, Kakumanu Nageswara Rao, Badugu Krishna Murthy, Shaik Raja Husne Kalam <b>Introduction:</b> Micronuclei and other nuclear abnormalities are biological indicators of genotoxicity and chromosomal instabilities. Breast lesions are frequently encountered in routine clinical practice and Fine Needle Aspiration Cytology (FNAC) is used as a routine diagnostic modality. <b>Aim:</b> To identify the utility of micronucleus scoring in classifying and diagnosing palpable breast lesions with FNAC. <b>Materials and Methods:</b> The present study was a two year retrospective analysis in the Department of Pathology of Guntur Medical College and Government General Hospital, Guntur, Andhra Pradesh. Case records and FNAC smears of breast lesions in the period from March 2018 to February 2020 were retrieved from the departmental archives. Data was analysed in the month of September 2020. A total of 108 cases were included in the study. Micronucleus scoring was done on the FNAC smears independently by two institutional pathologists who were blinded to clinical data and final diagnosis and mean micronuclear scores were obtained. Statistical analysis was done using Chi-square test on Statistical Package of the Social Sciences (SPSS) software (version 14) to determine the significance of micronuclear score in differentiating benign and malignant lesions, and in grading the malignant tumours. <b>Results:</b> All the cases were classified into four categories: benign, atypical favouring benign, suspicious of malignancy, invasive breast carcinoma on cytology. In the present study it was found that micronucleus scoring was effective in differentiating various benign and malignant breast lesions (p-value=0.0001) and also in grading of malignant tumours (p-value=0.05). The results obtained showed that there exists a significant level of correlation with other well established standard grading systems (Pearson correlation coefficient=0.94). <b>Conclusion:</b> The present study revealed that micronucleus scoring is indeed a useful and reliable method for diagnosing breast lesions and can be used as an adjunct in classifying difficult and borderline cases on cytology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC52-EC55&id=16810 https://doi.org/10.7860/JCDR/2022/49784.16810 Comparison of Rate of Tooth Movement, Root Resorption and Pulp Vitality during En masse Anterior Retraction with Micro-osteoperforation and Low Level Laser Therapy: A Randomised Clinical Trial Allen Joseph, GS Prashantha, Sharanya Sabrish, Roshan Sagarkar, Silju Mathew <b>Introduction:</b> Micro-osteoperforation (MOP) and Low Level Laser Therapy (LLLT) are rapidly gaining popularity in clinical practice due their proven success in accelerating tooth movement and acceptable patient compliance. However, literature shows an inconsistent and variable evidence of their iatrogenic effects on the root and pulp due to biological variations of the samples chosen by the previously studies. <b>Aim:</b> To evaluate and compare the rate of tooth movement, changes in amount of external root resorption and pulp vitality in teeth during en masse anterior retraction associated with MOP and LLLT using split mouth technique. <b>Materials and Methods:</b> This was a double blinded, single center split mouth randomised clinical trial conducted at Faculty of Dental Sciences, MS Ramaiah University of Applied Sciences, Bangalore, Karnataka, India from March 2019 to October 2019. Total of 11 patients with bimaxillary dentoalveolar protrusion which required all four first premolar extractions were included in the study. Nickel Titanium (NiTi) closed coil springs were used for en masse retraction in upper and lower arches with force of 150g per side. Root resorption of all anterior teeth was evaluated using Cone Beam Computed Tomography systems (CBCT) and pulp vitality was checked using cold test after 4 months. The data was entered in Microsoft excel and the Statistical Package for Social Sciences software (SPSS) version 18.5 (SPSS Inc, Chicago) software was used for data entry and statistical analysis. A p-value of less than 0.05 was considered as statistically significant. <b>Results:</b> Total of 11 patients in which 9 were females and 2 males aged between 18-30 years with mean age 19&#177;4.21 year, participated in this trial. LLLT (4 mm) and MOP (4.05 mm) showed similar performance in acceleration of tooth compared to each other. The overall root resorption was more in the experimental groups (LLLT- 2.60 mm, MOP- 2.84 mm) compared to the allotted controls. However, the canine showed less root resorption in both the experimental groups compared to the control. The overall root resorption was similar in both the experimental groups. The canine in LLLT group (0.30 mm) showed less root resorption compared to canine in MOP group (0.59 mm). There was no change in the pulp vitality status in both the experimental groups and the control groups. <b>Conclusion:</b> The overall root resorption in a given quadrant increases with increased rate of tooth movement. The tooth which was subjected to acceleratory orthodontic technique showed less root resorption compared to control. The tooth subjected to LLLT showed less root resorption as compared to the tooth subjected to MOP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC31-ZC36&id=16802 https://doi.org/10.7860/JCDR/2022/55298.16802 Correlation between Degree of Desaturation and Severity of Obstructive Sleep Apnoea: A Cross-sectional Study Rashmi Soori, Giridhar Belur Hosmane, Ivor D’sa, <b>Introduction:</b> Obstructive Sleep Apnoea (OSA) is major Non Communicable Disease (NCD) which is becoming very common worldwide. The OSA results in day time hypersomnolence, nocturnal hypoxia and snoring. Repeated desaturation events during sleep results in aerobic metabolism at tissue level changing to anaerobic metabolism, which results in cellular inflammation and insulin resistance further complicating metabolic syndrome. <b>Aim:</b> To study correlation between degree of desaturation and severity of obstructive sleep apnoea. <b>Materials and Methods:</b> This cross-sectional study was conducted in Department of Pulmonary medicine at KS Hegde Medical Academy (tertiary care hospital), Mangaluru, Karnataka, India, from March 2018 to February 2021. Total 54 patients who underwent overnight polysomnography and diagnosed to have OSA were included in the study. The minimum recorded oxygen saturation (SpO<sub>2</sub>) defined as maximum desaturation was noted. Relative desaturation was defined as drop in saturation by 3% or more from the pre-event baseline. Correlation between total number of relative desaturation and Apnoea Hypopnea Index (AHI) was analysed. The correlation between two variables were analysed by Pearson&#8217;s correlation and the coefficient was calculated. The p-value was calculated by regression analysis and Analysis of Variance (ANOVA). <b>Results:</b> Total of 54 patients was included in the study. Out of which, 22 were mild, 14 moderate and 18 severe OSA, respectively. Number of relative desaturations recorded was from 0-636. The correlation between AHI and mean SpO<sub>2</sub> in sleep was r-value=-0.4542 (p-value=0.001) and the correlation between AHI and minimum SpO<sub>2</sub> was r-value=-0.45577 (p-value=0.001), respectively. Correlation between mean SpO<sub>2</sub> and minimum SpO<sub>2</sub> was r-value=0.747266 (p-value <0.001) and the correlation between AHI and relative desaturation was r-value=0.876698 (p-value=0.001). <b>Conclusion:</b> As the severity of the obstructive sleep apnoea worsened, there was greater degree of desaturation in sleep and the lowest SpO<sub>2</sub> was also observed during severe obstructive sleep apnoea. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC37-OC40&id=16803 https://doi.org/10.7860/JCDR/2022/55114.16803 Association between Preoperative RBC Parameters with Serum VEGF in Women Diagnosed with Breast Carcinoma: A Case-control Study Apoorva P Gowda, TS Rekha, MVSST Subbarao, Venugopal R Bovilla <b>Introduction:</b> The complete blood count is the first investigation to be done in every patient with breast carcinoma before surgery. Vascular Endothelial Growth Factor (VEGF) plays a major role in angiogenesis, metastasis and progression of tumours. <b>Aim:</b> To assess Red Blood Cell (RBC) parameters in breast carcinoma patients and controls, and to evaluate its relation with serum VEGF. <b>Materials and Methods:</b> The present study was a case-control study, conducted in Department of Pathology of JSS Medical College and Hospital, Mysuru, Karnataka, India from November 2019 to April 2021. Preoperative venous blood samples were collected and run in an automated analyser Mindray CAL-6000 for all haematological parameters. Preoperative serum samples were collected and serum VEGF was estimated using the Enzyme Linked Immunosorbent Assay (ELISA) method. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) version 22.0 to evaluate the association between RBC parameters and serum VEGF using Mann-Whitney U test. <b>Results:</b> A total of 80 samples were evaluated, which included 40 preoperatively diagnosed breast cancer cases and 40 age and sex matched controls. RBC parameters such as RBC, Haemoglobin (Hb), Haematocrit (Hct), red cell indices Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), reticulocytes, Red cell Distribution Width (RDW) and nucleated RBCs (nRBCs) were measured. The nRBCs and serum VEGF of cases were significantly higher than controls. A statistically significant association between patients with low Hb and high serum VEGF was found. <b>Conclusion:</b> A higher percentage of breast carcinoma cases with anaemia in the present study was significantly associated with high serum VEGF, reflecting anaemia induced hypoxia may trigger the tumour cells to secrete VEGF. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC47-EC51&id=16806 https://doi.org/10.7860/JCDR/2022/57026.16806 Oncological Outcomes of Primary Renal Malignancies other than Clear Cell Renal Carcinoma: A Retrospective Study from a Tertiary Centre in Southern India Ramanitharan Manikandan, Ketan Mehra, Lalgudi Narayanan Dorairajan <b>Introduction:</b> A lot of research is available about clear cell Renal Carcinomas (ccRCC). But there are lesser known facts about other subtypes of renal malignancies. With advances in immunohistochemical and cytogenetic techniques, new variants of renal tumours are being increasingly reported. The treatment and prognosis of such rare malignancies is still an enigma. <b>Aim:</b> To analyse the incidence, clinicopathological features, surgical treatment, and survival of non clear cell RCC at the tertiary care centre. <b>Materials and Methods:</b> The present study was a retrospective study in which histopathological reports of 77 nephrectomy specimens, who underwent surgical treatment for suspected renal tumours from 2013-2018 were reviewed. Out of which, 19 (24%) patients had documented uncommon histologic variants of RCC. The clinical, demographic, and histologic characteristics of these patients were analysed, and survival was evaluated. The characteristic light microscopy and immunohistochemical features of these lesions were documented. <b>Results:</b> The mean age of the study participants was 45 years (21-67 years). Out of 19 patients, 14 (73.6%) were males, and 5 (26.4%) were females. Mean tumour size was 8.8 cm (range 6-36) in the largest dimension. About 17 (22%) patients underwent radical nephrectomy, and 2 (2.5%) were treated with partial nephrectomy. Patients with collecting duct, synovial sarcoma, and Primitive Neuroectodermal Tumour (PNET) had associated inferior vena caval thrombus and underwent venous thrombectomy. Adjuvant treatment in the form of chemotherapy was instituted in collecting duct, adult Wilm&#8217;s and pure sarcomas. There was no mortality in the papillary carcinoma, and the worst prognosis was encountered in collecting duct carcinoma. <b>Conclusion:</b> Papillary variant had a good outcome as compared to other non clear cell carcinomas. RCC with sarcomatoid variant has a poor prognosis. Variants like renal sarcomas are rare but can be managed by nephron sparing surgeries with adjuvant therapies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=XC08-XC11&id=16807 https://doi.org/10.7860/JCDR/2022/55492.16807 Quarantine of Travellers during the Initial Phase of the COVID-19 Pandemic- Experience from a Rural Setting in Kerala, India Carol Pinheiro, Lakshmi Rajeev Thuruthiyath, Sairu Philip, Anuja Munduvadackal Viswabhadran, Amrutha Mudikunnath Sivadasan <b>Introduction:</b> Quarantine of travellers was one of the major public health strategies enforced by the state to curb the transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the initial phases. Proper quarantine requires commitment from the person, support, and monitoring from the public health system. <b>Aim:</b> To understand the process, practices, perceptions, and difficulties of quarantined persons during the initial phase of the Coronavirus Disease-2019 (COVID-19) in a panchayat in Alappuzha, Kerala, India. <b>Materials and Methods:</b> A cross-sectional study was conducted from May to September 2020 using a semi-structured questionnaire through telephonic interview among quarantined individuals in a panchayat in Alappuzha, Kerala. Quarantine practices, the process of quarantine, perceptions, and difficulties faced were explored to understand their viewpoint. The perceptions of the healthcare providers were also enquired qualitatively. The data collected was entered in Microsoft Excel and statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 27 (SPSS Inc, Chicago, USA). <b>Results:</b> Out of the 182 quarantined individuals, 152 were in home quarantine of which 89 (58.6%) observed strict room quarantine and 132 (72.5%) had a quarantine period of more than 14 days which was the guideline then. Majority were contacted by the health staff during the period; however, 28% were not satisfied with the information that was conveyed to them. Majority adhered to infection control guidelines during quarantine. Almost half (46.7%) of them reported emotional problems during quarantine of which the major issues were loneliness and lack of social contact. Almost one-third of them had experienced stigma and rejection from people in the neighbourhood. <b>Conclusion:</b> Quarantine to be used effectively as a public health measure requires that the concerns and problems should also be taken care of. Adequate information regarding the need and process of quarantine should be provided and there should be a system to cater to the emotional concerns of the persons. Awareness regarding the purpose and role of quarantine among the general public will enable quarantine to be used as a powerful tool for disease control in the future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LC27-LC31&id=16793 https://doi.org/10.7860/JCDR/2022/57784.16793 Comparative Assessment of WBC Scattergram, Histogram and Platelet Indices in COVID-19 and Non COVID-19 Patients: A Cross-sectional Study Nikhil, Subhashish Das, Raju Kalyani <b>Introduction:</b> Coronavirus Disease-2019 (COVID-19) is an extremely transmissible infectious disease. Detection of coronavirus by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) requires expert skills and moreover, it is not widely available in all the laboratories. <b>Aim:</b> To evaluate Red Blood Cell (RBC), platelet histogram and White Blood Cell (WBC) scattergram graphic patterns and interpretation of corresponding parameters along with peripheral smear in 500 COVID-19 RT-PCR positive study cases (COVID-19) and to compare them with normal study controls (non COVID-19). <b>Materials and Methods:</b> This was a laboratory-based cross-sectional observational study, conducted at a fully accredited National Accreditation Board for testing and calibration Laboratories&#8217;s (NABL) Central Diagnostic Research Laboratory, RL Jalappa Hospital Tamaka, Kolar, Karnataka, India from September 2020 to April 2021. RBC, platelet histogram, WBC scattergram graphic patterns with corresponding parameters were noted in RT-PCR COVID-19 positive patients and compared with controls using (Automated Haematology Analyser XN11500). Cases were further subcategorised into moderate and severe categories. For statistical analysis, Chi-square test or Fisher&#8217;s-Exact test, Independent t-test was used for assessing qualitative and quantitative data, respectively. Mean and standard deviation were depicted in box plots. Receiver Operating Characteristic (ROC) curve was used for predicting severity. A p-value <0.05 was considered statistically significant. <b>Results:</b> Among 500 subjects, males were 359 and females 141 with the mean age 50.5 years. Present study showed a characteristic finding of &#8220;sandglass&#8221; effect in WBC scattergram which is described as discontinuous cluster of plasmacytoid lymphocytes. RBC histogram and parameters did not show any significant changes. In severe COVID-19 cases, among WBC, parameters most common finding was neutrophilia. Platelet Lymphocyte Ratio (PLR), Platelet Monocyte Ratio (PMR), Platelet Neutrophil Ratio (PNR) were statistically significant in severe COVID-19 cases (p-value <0.001) corresponding ROC curve for WBC and platelet showed WBC count and PLR as the significant parameter in severe COVID-19 positive cases. <b>Conclusion:</b> Current study reported a specific and unique sandglass effect in WBC scattergram in severe COVID-19 subjects which can help the physicians for predicting the severity of disease and to prevent further progression of disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC41-EC46&id=16794 https://doi.org/10.7860/JCDR/2022/56018.16794 Para-Adnexal Cysts- A Clinicopathological Study Shwetha Basavaraj, Sumitha Maniyan Prakash, Nalini Modepalli, Jyothi Ananth Raj, Devayani Chaudhuri, Ravi Saini <b>Introduction:</b> Para-adnexal cysts (paraovarian and paratubal) constitutes a homogenous group of cystic lesions originating from mesosalphinx or broad ligament, located in proximity of the fallopian tube and ovary. As with the lesions of the adnexa, paraovarian and paratubal cysts can be neoplastic but are often misinterpreted as true functional cysts. A correct radiological and clinical diagnosis would be useful in order to render necessary treatment. <b>Aim:</b> To highlight the histomorphologic spectrum of the para-adnexal cysts and correlate with clinical findings. <b>Materials and Methods:</b> The present study was a retrospective study conducted in the Department of Pathology, Rajarajeswari Medical College, Bengaluru, Karnataka, India, from January 2017 to June 2019. All specimens including salpingo-ophorectomy specimens which harboured paratubal or paraovarain cysts, or paratubal/paraovarian cysts diagnosed on radiology and resected and sent separately for histopathologic evaluation were sampled and included in the study. All surgically and radiologically proven paratubal and paraovarian cystic lesions were included and solid lesions were excluded. The results were analysed using descriptive statistics. <b>Results:</b> Present study analysed 114 cases and found that 28 of the cases showed neoplastic cysts, one of them showing a serous borderline tumour, which have the potential to turn malignant. The mean age of diagnosis was 40.1 years and menstrual abnormalities was the most common presentation. Of the neoplastic cysts, paraovarian cysts (78.6%) were more common than paratubal cysts (21.4%). About 75.4 % were non neoplastic cysts and 24.6% were neoplastic. <b>Conclusion:</b> Para-adnexal cysts are often misdiagnosed or not sampled as they are thought of as functional cysts. Histopathologic evaluation of these lesions would help in understanding the different histological types that would arise in para-adnexal sites which in turn helps in better management of these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC37-EC40&id=16791 https://doi.org/10.7860/JCDR/2022/57373.16791 Pattern of Follow-up among Patients Attending the Department of Psychiatry: A Prospective Study Harsimran Kaur, Pir Dutt Bansal, Arvind Sharma, Akshara Mishra, Bhavneesh Saini, Rakesh Kumar, Priyanka Bansal, Kavita Moria <b>Introduction:</b> Adherence to drug regimen is a very important factor for improvement. Dropping out may affect the treatment outcome and also is as indication of poor clinical performance. Patient who left the treatment in between can lead to a deterioration in clinical condition, resulting in the need for more intensive therapy that significantly incurs higher social and economic loss. Therefore, improving medication compliance potentially reduces morbidity and suffering of patients and their families, and the cost of rehospitalisation. <b>Aim:</b> To study the pattern of follow-up among patients of various psychiatric disorders and also to study the therapist factors contributing in adherence to treatment and the socio-demographic profile of patients who drop out from study. <b>Materials and Methods:</b> This was a prospective analytical study conducted in the Department of Psychiatry, GGSMCH Faridkot, Punjab, India over one year. A total of 500 psychiatric patients were selected by the convenient non probability sampling technique in the age group between 18-45 years who met the inclusion criteria. These patients were evaluated for illness related variables using psychiatric proforma and Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS) was applied. After this all the patients were assessed for a period of one year, the factors affecting the pattern of follow-up, relating to the treatment and its side effects, disease progression as well as therapist-related factors using a semi-structured questionnaire. The data, thus generated, was subjected to appropriate statistical analysis. <b>Results:</b> In the socio-demographic profile among drop out education status, occupation, and duration of illness, statistically significant difference was found among different disorders (p<0.05). CPOSS scale was applied among three follow-up groups in which highest mean was 53.03&#177;10.05 in regular follow-up group followed by 49.49&#177;9.06 in intermittent and 44.80&#177;10.70 in drop out follow-up group. Total CPOSS mean was 49.19&#177;10.66. Overall results were statistically significant (p=0.0001). Also in the medication, disease and physician related factors among follow-up groups, statistically significant results were found (p<0.05). <b>Conclusion:</b> The study showed that various socio-demographic factors, medication, disease and physician related factors affect the follow-up patterns. So, it is very important to diagnose all these factors to improve adherence among various psychiatric patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=VC01-VC05&id=16773 https://doi.org/10.7860/JCDR/2022/50233.16773 Knowledge of Hand Hygiene among Ophthalmologists in Northern India: A Cross-sectional Survey Renu Dhasmana, Hennaav Kaur Dhillon, Prasansha Narnoli, Darshika Rawat <b>Introduction:</b> Hands of healthcare workers act as the most common vehicle for the transmission of healthcare associated infections (HCAI). A good practice of hand hygiene reduces the incidence of these nosocomial infections. There is a dearth of precise data about the awareness of hand hygiene practice amongst Ophthalmologists in India. <b>Aim:</b> To assess the knowledge of hand hygiene amongst the Ophthalmologists and trainees in Uttarakhand and surrounding regions of Northern India. <b>Materials and Methods:</b> This cross-sectional study was conducted by Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India amongst Ophthalmologists attending a three days long annual ophthalmology conference in Uttarakhand in October 2019, after taking due approval from the Ethics Committee of the Institute. All the 150 participants who were included in the study filled the World Health Organisation (WHO) hand hygiene questionnaire, comprising of 10 multiple-choice questions. The respondents were asked to tick the most appropriate choices and scores were given out of a maximum score of 25. Mann-Whitney test was used for statistical analysis in the study. <b>Results:</b> A total of 150 subjects participated in the survey, among which 70 were females and 80 were males. Of all, 90 (60%) of the participants were practicing surgeons, while 60 (40%) were postgraduate students. About 126 (84%) reported having received a formal training on hand hygiene. Hands of the healthcare workers were reported to be the commonest route of cross transmission of germs between the patients and healthcare facilities. The average total score of the participants in the survey was 16 (64%) and there was no significant difference between the scores of participants based on gender and training. <b>Conclusion:</b> The study shows that majority of the Ophthalmologists have formal training and fair knowledge on the basics of hand hygiene, but lacked an in-depth knowledge, which needs to be addressed in order to reduce the incidence of hospital acquired infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=NC05-NC08&id=16765 https://doi.org/10.7860/JCDR/2022/53022.16765 Efficacy of Open versus Closed Kinetic Chain Exercises on Dynamic Balance and Health Status in Individuals with Osteoarthritis of Knee Joint: A Quasi-experimental Study Roopa Rajendra Desai, Ashwini Ravindranath Damsam, Tushar Jaikrishna Palekar <b>Introduction:</b> Osteoarthritis is an inflammatory disorder characterised by changes in the biomechanics, biochemistry and genetic background of joint cartilage and subchondral bone. When distal parts move freely throughout exercises in a weight-bearing position, the phrase open kinetic exercises is employed. Closed kinetic exercises are employed in a weight-bearing position when the body travels through a hard and quick distal phase. <b>Aim:</b> To compare the efficacy of Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) exercises on dynamic balance and health status in individuals with osteoarthritis of knee joint. <b>Materials and Method:</b> A single-blinded experimental study was conducted from April 2020 to May 2021 at Dr D.Y. Patil college of Physiotherapy, Pimpri-Chinchwad area, Pune, Maharashtra, India. A sample of 30 subjects with unilateral osteoarthritis of knee joint, between the age of 40-60 years of both genders, were recruited. They were divided into open kinetic group (Group A) and closed kinetic group (Group B) using convenient sampling method. Y-balance and Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) (Pune CRD version) were used as outcome measures-preintervention, post two weeks and post four weeks of intervention. Data normality was tested by Shapiro-wilk test. Significance was tested using paired t-test within the groups for WOMAC and Y-balance test. Unpaired t-test was used between the groups. <b>Results:</b> Among 30 subjects, 17 were males and 13 females. There was a significant improvement in dynamic balance (p-value=0.001) and WOMAC (p-value=0.001) in both the groups. In group A, preintervention mean values for WOMAC was 41.2&#177;10.53, and post four weeks of intervention it was 34.53&#177;10.12 (p-value=0.001). Preintervention mean for Y-balance test was 0.554&#177;14.6 and after four weeks of intervention mean was 0.586&#177;13.8 (p-value <0.001). In group B, preintervention mean for WOMAC was 40.87&#177;8.33, and after four weeks of intervention, mean was 30.47&#177;7.22 (p-value=0.001); while preintervention mean for Y-balance test was 0.583&#177;7.8 and after four weeks of intervention, mean was 0.645&#177;7.0 (p-value=0.001).Between groups, analysis showed p-value=0.051 for both groups post four weeks of intervention. <b>Conclusion:</b> The study concluded that CKC exercises are more effective than OKC exercises in improving dynamic balance and decrease in pain, stiffness, and improving physical function in knee osteoarthritis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=YC05-YC09&id=16766 https://doi.org/10.7860/JCDR/2022/51079.16766 Pattern of Bacterial Infections among Children with Sickle Cell Disease in a Tertiary Care Hospital of Nagpur, Maharashtra, India Jacinta Lalhmunsangi, Swati Manohar Bhise, Vyantekesh Katkar, Rajendra Surpam, Swagnik Roy <b>Introduction:</b> In India Sickle Cell Disease (SCD) is associated with significant morbidity and represents a major health problem in central India. Patients with SCD are susceptible to a variety of bacterial infections, which are major cause of morbidity and mortality. The burden of disease caused by bacterial infections in patients with SCD is less studied and have long been neglected. Therefore there is scarcity of data for the association between SCD and invasive bacterial diseases. So it becomes necessary to have knowledge of distribution of these pathogens and their susceptibility to antibiotics. <b>Aim:</b> To identify the most common bacterial infections among children with SCD and to check antibiotic susceptibility patterns of all the clinical isolates. <b>Materials and Methods:</b> Present study was a descriptive observational study which was conducted in Department of Microbiology, Govt Medical College and Hospital Nagpur, Maharashtra, India, for two years from October 2013 to October 2015. Paediatric patients of age &#8804;12 years diagnosed as SCD and admitted in paediatric wards of tertiary care hospital, having body temperature &#8805;38.5&#176;C were enrolled in the study. Clinical specimen i.e. blood, urine, pus, and body fluids such as Cerebrospinal Fluid (CSF), pleural fluids were collected aseptically and the bacteria causing infections were isolated and identified conventionally in accordance with the standard operative procedures. Antimicrobial susceptibility testing was performed as per the Clinical and Laboratory Standards Institute (CLSI) guidelines 2013 by modified Kirby-Bauer method. Data was presented as numbers and percentages. <b>Results:</b> A total of 824 samples including blood, urine, CSF, pus and pleural fluid were collected from 412 SCD patients. Prevalence of bacterial infections among patients with SCD was 17.35%. Bacteraemia was the most common infection among febrile children with SCD 84 (20.38%) followed by Urinary Tract Infection (UTI) 55 (15.02%), Osteomyelitis 2 (13.34%), and Meningitis 1 (5.56%). Total 143 organisms were isolated from different samples and gram negative bacilli 106 (74.12%) were found to be the commonest cause of bacterial infections among children with SCD. Imipenem was the best antibiotic for infections with multidrug resistant gram negative bacilli. <b>Conclusion:</b> To identify children with SCD and prevent bacterial infections in them should be a priority target for health research as these infections make a large contribution to the morbidity and mortality among children with SCD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC64-DC69&id=16767 https://doi.org/10.7860/JCDR/2022/56049.16767 Comparison of Efficacy and Safety of Lupin’s Pegfilgrastim with Neulastim<sup>®</sup> as an Adjunct to Chemotherapy in Patients with Non Myeloid Malignancies: A Randomised Phase III Clinical Study Minish Jain, Sharad Desai, Rajnish Nagarkar, Rakesh Neve, Unmesh Takalkar, Dhananjay Bakhle, Chirag Shah <b>Introduction:</b> Pegfilgrastim is indicated in patients receiving myelosuppressive anticancer drugs to reduce the Duration of Severe Neutropenia (DSN) and incidence of Febrile Neutropenia (FN). The efficacy and safety of a proposed Pegfilgrastim biosimilar should be compared with an approved biologic drug to establish therapeutic equivalence. <b>Aim:</b> To compare the efficacy of Lupin&#8217;s biosimilar Pegfilgrastim versus Neulastim<sup>&#174;</sup> (Amgen Inc.) as an adjunct to chemotherapy in patients with non-myeloid malignancies. <b>Materials and Methods:</b> The present prospective, open-label, randomised phase lll clinical study was conducted on a total of 170 patients with histologically or cytologically confirmed non-myeloid malignancies eligible to receive a myelosuppressive chemotherapy regimen. The participants were administered Lupin&#8217;s Pegfilgrastim (n=86) or Neulastim<sup>&#174;</sup> (n=84) 6 mg by subcutaneous injection, once in each chemotherapy cycle for a maximum of three cycles. Patients were chemotherapy naive or had not received myelosuppressive chemotherapy within last 12 months of screening. The primary efficacy endpoint was DSN (number of days on which absolute neutrophil count <0.5&#215;109/L) in cycle 1 of chemotherapy. Equivalence was confirmed, if 95% Confidence Intervals (CI) were within the equivalence margin of &#177;1 day. Safety evaluation included assessment of Adverse Events (AEs), rate of discontinuation due to AEs, vital signs, and laboratory parameters. Statistical analysis were done using SAS Enterprise guide 9.4 (SAS Institute Inc., Cary, 2000). <b>Results:</b> Of the 170 patients balanced for demographic characteristics, 161 patients completed cycle 1, 151 patients completed cycle 2, and 142 patients completed cycle 3. The mean&#177;Standard Deviation (SD) DSN in cycle 1 was 0.127&#177;0.5533 days with Pegfilgrastim (n=63) and 0.197&#177;0.6615 days with Neulastim<sup>&#174;</sup> (n=66) in the Per Protocol (PP) assessment; and 0.174&#177;0.636 days with Pegfilgrastim and 0.193&#177;0.671 days with Neulastim<sup>&#174;</sup> in the modified Intent-to-Treat (mITT) assessment. The mean DSN between the groups did not differ significantly (PP: p=0.5167, mITT: p=0.8554). The 95% CI of difference in mean DSN in PP (-0.2796 to 0.1481) and mITT (-0.2103 to 0.1889) assessments was contained within the predefined equivalence margin of &#177;1 day. Secondary outcomes and safety profiles were also comparable between the two groups. <b>Conclusion:</b> The present study establishes Lupin&#8217;s Pegfilgrastim as a therapeutically equivalent biosimilar alternative to Neulastim<sup>&#174;</sup> in patients with non-myeloid malignancies receiving myelosuppressive chemotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=XC01-XC07&id=16768 https://doi.org/10.7860/JCDR/2022/57833.16768 Spectrum of Haemoglobinopathies Detected on Antenatal Screening and Diagnostic Work-up in an Urban Healthcare Set-up: A Retrospective Study Susan Cherian, Parul Singh, Soniya Patil, Prashant Bhandarkar, Vaishali R Jadhav <b>Introduction:</b> Haemoglobinopathies are inherited disorders of haemoglobin (Hb) and consist of Thalassemias and many other structurally variant haemoglobins. Out of these, beta-thalassemia major and clinically significant sickle cell disorders are of great public health importance in India. Lack of awareness regarding their prevalence and knowledge about diagnostic methods, has resulted in failure of community control of birth of these otherwise totally preventable genetic disorders in India. <b>Aim:</b> To study the spectrum of haemoglobinopathies in the study population and to assess the effectiveness of the antenatal screening program, in identifying the couples at-risk and providing prenatal intervention. <b>Materials and Methods:</b> This retrospective cohort study was performed at a community healthcare set-up in Mumbai. from August 2021 to October 2021 on medical records of 10,025 patients including women who were part of antenatal screening, patients investigated for anemia and who underwent haemoglobin electrophoresis over 12 years (October 2007 to October 2019). Alkaline Electrophoresis test was performed using the InterlabGenios analyser on cellulose acetate and the findings were interpreted along with haemogram parameters. Finding of various conditions were presented in terms of prevalence rates and mean values of relevant blood count parameters were presented as mean&#177;SD. <b>Results:</b> An abnormal haemoglobin pattern was seen in 544 (5.42%) of the 10,025 cases with age group ranged from 1 year to 84 years. Most common haemoglobinopathies detected were beta (?) thalassemia trait 378 (3.77%) followed by sickle cell trait (0.9%), Hb D trait (0.26%), HbE trait (0.24%) and others. Carriers of haemoglobinopathies were detected in 186(3.74%) of 4968 women, on antenatal screening. A total of 18 couples-at-risk were identified. One child with thalassemia major and another with sickle cell disease were born in this population over 12 years. <b>Conclusion:</b> The ?-Thalassemia trait and HbS trait are the commonest haemoglobinopathies detected. Antenatal screening programme and timely intervention is an effective strategy to control clinically significant major hemoglobinopathies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC21-EC25&id=16769 https://doi.org/10.7860/JCDR/2022/53015.16769 Comparison of Serum C-reactive Protein, Parathyroid Hormone, and Calcitonin Levels between Pregnant and Non Pregnant Women from Rural North Gujarat: A Case-control Study Viral Gopalbhai Solanki, Kinjal Prahaladbhai Patel, Sandip Sanabhai Sendhav, Harshili Rameshbhai Tale, Vinay Patke, Chirag Kanubhai Pandya, Prasad Vitthalrao Khodke <b>Introduction:</b> Pregnancy requires women to provide calcium to foetus in amounts that may exceed their daily intake. C-reactive protein (CRP) is a susceptible marker of systemic inflammation. Parathyroid hormone (PTH) regulates foeto-placental mineral homeostasis and skeletal development and stimulates placental calcium transfer. The increase in calcitonin and calcitriol levels are significant in the transport of maternal calcium to the fetus and in the anticipation, and revival of maternal bone loss. These changes have direct implications on calcium metabolism and cause decreased albumin level, inflammation, increase in extracellular fluid volume, increase in renal function, and placental calcium transfer. <b>Aim:</b> To assess the serum levels of CRP, calcitonin, and PTH in the first, second, and third trimester of pregnancy and also to compare these parameters with non pregnant women. <b>Materials and Methods:</b> The present case-control study was conducted in the Department of Biochemistry of Nootan Medical College and Research Centre, Visnagar, Gujarat, from June 2021 to October 2021. A total of 150 subjects (75 age-and sex-matched apparently healthy well-nourished non pregnant females, and 75 pregnant females) were included. CRP, PTH, and calcitonin were measured. Statistical analysis was performed using Independent t-test, and Pearson&#8217;s correlation coefficient (r). <b>Results:</b> Mean age of participants in case group was 32.16&#177;10.97 (mean&#177;SD). The mean age of control was 30.54&#177;6.63. Serum CRP level of cases was significantly higher 3.2&#177;2.2 than the level in controls 2.3&#177;1.8 (p=0.003). Serum PTH level of cases 31.6&#177;10.4 was significantly lower (p=0.0012) than the level in controls 45.9&#177;9.8. Serum calcitonin level of cases 281&#177;143 was significantly higher (p<0.001) than the level in controls 103&#177;46. <b>Conclusion:</b> There was a significant increase in serum CRP level and serum calcitonin level in cases as compared with controls while there is decrease in serum PTH levels between these two groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC24-BC27&id=16770 https://doi.org/10.7860/JCDR/2022/56115.16770 Prevalence and Risk Factors of Dry Eye Disease at a Tertiary Care Centre in Haryana, India: A Cross-sectional Study Anshul Garg, Sonia Bhargav, Tarun Arora, Ashok Garg <b>Introduction:</b> Dry Eye Disease (DED) is a multifactorial disease which causes ocular discomfort and visual disturbances. It is one of the major causes of patients&#8217; visit to the clinic. The prevalence of DED has increased in recent times due to increased time spent on computers and mobile phones, ageing population and highly stressful social environment. Various studies done in past on DED prevalence have given the variable results. <b>Aim:</b> To determine the prevalence of DED and analyse the associated risk factors in a tertiary care centre in Sonepat, Haryana, India. <b>Materials and Methods:</b> Present study was a cross-sectional observational study done in Outpatient Department of Ophthalmology at Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana, India, from April 2021 to December 2021. Total 820 patients, aged >18 years were administered Ocular Surface Disease Index (OSDI) questionnaire. Patients with OSDI score >12 and positive one or both of the dry eye objective tests of Schirmer&#8217;s and Tear film Break Up Time (TBUT) below cut-off value were labelled as DED and were evaluated for association with various risk factors. Data were statistically analysed by Chi-square test, Wilcoxon-Mann-Whitney U test and Fischers-exact test. <b>Results:</b> The mean age of patients were 39.65&#177;15.52 years ranging between 18-79 years. DED was found to be more prevalent in females 120 (56.1%) compared to males 94 (43.9%). The prevalence of DED was 26.1% (214/820). Maximum prevalence was found in the age group 18-40 years (43.9%). Out of the 214 DED patients, 113 (52.8%) had mild, 95 (44.4%) had moderate and 6 (2.8%) had severe dry eye. The risk factors significantly associated (p<0.05) with DED were: more than 3.71 hours of Visual Display Terminal (VDT) use, occupational VDT users, homemakers, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, Chronic Obstructive Pulmonary Disease (COPD), alcohol intake and mask use. <b>Conclusion:</b> The DED is a significant cause of ocular morbidity, affecting more than quarter (26.1%) of the study population. Awareness and identification of risk factors for dry eye which are occupational VDT users, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, COPD, alcohol intake and mask use is important for effective prevention and management of DED. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=NC09-NC12&id=16777 https://doi.org/10.7860/JCDR/2022/58419.16777 Clinicolaboratory Profile and Outcome of Serologically Confirmed Scrub Typhus among Children from Sub Himalayan Tribal District of India: A Hospital-based Cross-sectional Study Raj Kumar Soorya, Mangla Sood, Deepika Dhiman <b>Introduction:</b> Scrub typhus is transmitted by the bite of the larva (chigger) of a microscopic trombiculidae mite (<i>Leptotrombidium</i>) found in moist areas and vegetation, which serves as both vector and reservoir. Scrub typhus is an often neglected and misdiagnosed febrile illness; clinical suspicion is the only key to diagnosis. <b>Aim:</b> To study clinicolaboratory profile and outcome of serologically confirmed scrub typhus in children from sub Himalayan tribal district of India. <b>Materials and Methods:</b> This cross-sectional observational study was conducted in Department of Paediatrics at Government District Hospital, Chamba, Himachal Pradesh, India, from May 2019 to April 2020. Children upto 18 years admitted with positive Immunoglobulin M (IgM) antibodies for scrub typhus were enrolled. The observational data including detail history and examination, relevant laboratory investigation and treatment was analysed by Statistical Package for Social Sciences (SPSS) software version 18.0 and Chi-square test with p-value <0.05 was considered statistically significant. <b>Results:</b> There were total 55 patients with scrub typhus, mean age was 9.2 years, most common age group was 7-12 years, 51% were male. Fever was most common complaint, followed by vomiting (27.3%), abdomen pain (25.4%), respiratory (1.8%), and rash (9%). Clinical examination findings were generalised lymphadenopathy in 46 (83.6%) patients and splenomegaly in 29 (52.7%). Eight patients presented with respiratory signs and tachypnea at the time of admission. Eschar was present in only 3 (5.5%) patients. Sign of meningeal irritation was present in 4 (7.3% cases and low GCS score (below 9) was observed in 7 (12.7%) patients. Eight patients required mechanical ventilatory support. Nineteen patients were prescribed doxycycline alone; while 34 were given both azithromycin and doxycycline. There were total five deaths; on multivariate logistic regression, respiratory complaint, need for mechanical ventilation, pain abdomen with liver damage, history of seizures and duration of fever more than four days before presentation to hospital were associated with adverse outcome. <b>Conclusion:</b> The prevalence of scrub typhus is considerably high during rainy season, and should be considered as a differential diagnosis of fever among children in this period regardless of the presence of an eschar. Immediate medical care, treatment with doxycycline with early defervescence of fever reduce mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=SC15-SC19&id=16778 https://doi.org/10.7860/JCDR/2022/57061.16778 Does Cementing Influence CRP and ESR Levels after Total Hip Replacement in Early Postoperative Period? A Prospective Interventional Study Anant Krishna, Vivek Vijayakumar, Tungish Bansal, Sudhir Kumar Garg, Sandeep Gupta, Gunjar Jain <b>Introduction:</b> The role of C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) in diagnosing delayed (>6 weeks) periprosthetic joint infection prior to performing a revision joint arthroplasty is well established. <b>Aim:</b> To evaluate the effect of bone cement on C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) in the first 3 weeks after Total Hip Replacement (THR). <b>Materials and Methods:</b> This prospective interventional study was conducted in Department of Orthopaedics at Government Medical College, Chandigarh, India, between June 2014 to December 2017. Sixteen patients who underwent an uncemented THR and 15 patients who underwent a hybrid THR were included in the study. Serum CRP and ESR were measured on the day before surgery and postoperatively on days 1, 2, 3, 7, 12, and at 3 weeks. Comparison of ESR and CRP values between the groups were performed using a Student&#8217;s t-test. A p-value <0.05 was considered statistically significant. <b>Results:</b> There was no significant difference between the two groups with respect to age, gender, indication of surgery, co-morbidities, operative time and blood loss. CRP showed a peak at day two with a mean value of 203.74&#177;46.15 mg/L in the uncemented group and a mean of 206.10&#177;46.78 mg/L in the hybrid group, with normalisation by 3 weeks. ESR values showed a peak on day three with a mean of 94.28&#177;5.97 mm/hour in the uncemented group and 92.15&#177;6.86 mm/hour in the hybrid group and remained elevated even at 3 weeks. Statistically, no significant difference was observed in CRP and ESR values after the usage of cement in total hip arthroplasty (p-value >0.05 in all cases). <b>Conclusion:</b> Bone cement does not affect CRP or ESR values significantly in the early phase after uncomplicated total hip arthroplasty. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=RC17-RC20&id=16779 https://doi.org/10.7860/JCDR/2022/55984.16779 Study of ER, PR and VEGF Expression in Endometrial Epithelial Neoplasms and its Association with Histological Stage and Grade of Endometrial Carcinoma SK Samim Rahaman, Rathin Hazra, Nirmalya Chakrabarti, Prasenjit Kumar Bar <b>Introduction:</b> Exogenous or endogenous estrogen induces hyperplastic endometrium which presents with abnormal uterine bleeding. Atypical endometrial hyperplasia is the precursor for endometrial carcinoma. In case of invasive carcinoma, Rstrogen Receptor (ER) and Progesterone Receptor (PR) expressions are commonly diminished but their expressions are generally increased in high grade and high stage endometrial carcinomas. Vascular Endothelial Growth Factor (VEGF), a crucial promoter of angiogenesis in endometrial carcinogenesis, is associated with poor prognosis. This study is needed for assessment of biological behaviour of endometrial epithelial neoplasms and application of targeted antiangiogenic therapy. <b>Aim:</b> 1. Immunohistochemical expression of ER, PR, and VEGF in normal endometrium, hyperplastic endometrium and endometrial carcinoma. 2. Association of the changes in immunohistochemical expression with grade and stage of endometrial carcinoma. <b>Materials and Methods:</b> The present cross-sectional, non interventional, retrospective study was conducted in the Department of Pathology along with Department of Obstetrics and Gynaecology of N R S Medical College, Kolkata, from 1<sup>st</sup> January 2018 to 30<sup>th</sup> June 2019 comprising of 51 cases. In the present study, histopathological diagnosis was made for each endometrial lesion with grading and staging of endometrial carcinoma followed by immunohistochemical evaluation, performed on the representative sections using monoclonal antibody. Chi-square test and Z-test were used to observe the association of different study variables and to see the significant difference between two proportions. The p value of<0.05 was taken as statistically significant. <b>Results:</b> Out of 51endometrial samples, eight cases had proliferative endometrium, 14 cases had endometrial hyperplasia without atypia, five cases had atypical endometrial hyperplasia and 24 cases had endometrial carcinoma. ER and PR expression was seen less in endometrial hyperplasia and endometrial carcinoma than in benign proliferative endometrium and there was statistically significant association present between PR expression and histopathological diagnosis. All cases of grade-1 endometrial carcinoma showed ER and PR positivity and decreasing expression in higher grades-2 and 3, but were not statistically significant. Expression of VEGF in the groups of endometrial carcinoma (91.7%) and atypical hyperplasia (80%) was significantly increased in comparison with the groups of normal proliferative endometrium (37.5%) showing a significant statistical association. VEGF expression had no statistical association with grade and stage of endometrial carcinoma. <b>Conclusion:</b> ER, PR and VEGF were effectively associated with prognosis in patients with endometrial carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC26-EC30&id=16783 https://doi.org/10.7860/JCDR/2022/55445.16783 Study of Nitric Oxide and Lipid Peroxidation in Preterm Labour: A Case-control Study Monika Nandkumar Chavan, Jayashree Ganu, Sangita Jadkar, Arvind Yadav, Anup N Nillawar <b>Introduction:</b> Preterm Labour (PTL) is a major obstetric health problem. It contributes to 75% of neonatal mortality worldwide. According to a World Health Organisation (WHO) report, 15 million preterm birth occur every year. Nitric Oxide (NO), synthesised by three isoforms of NO Synthase (NOS) play physiological role in uterine muscle relaxation and prevention of preterm labour contractions. NO is also demonstrated to react with Reactive Oxygen Species (ROS). <b>Aim:</b> To assess the level of serum NO, Malondialdehyde (MDA) (end product of lipid peroxidation), total protein, albumin, calcium, and inorganic phosphorus in PTL and also to compare these parameters with full-term labour. <b>Materials and Methods:</b> A case-control study was conducted in the Department of Biochemistry and Obstetrics and Gynaecology, Government Medical College, Miraj, Maharashtra, India, during the period of November 2014 to May 2015. Study included 60 women with age ranged between 21-31 years and gestational age between 28 to 37 weeks. Out of total 60 women, 30 were full-term labour, served as control and 30 women who had regular uterine contraction before 37 weeks were selected as cases. Estimation of NO (as nitrite) and MDA, Total Protein (TP), albumin, calcium and inorganic phosphorus was done. Data were analysed by applying a Student&#8217;s t-test and Pearson correlation test. <b>Results:</b> The mean maternal age was 26.53&#177;3.42 years for cases and for control 27.63&#177;2.51 years. The mean gestational age in cases were 31.1&#177;2.795 weeks, whereas in controls was 37.26&#177;0.520 weeks. A highly significant decrease in NO (7.1967&#177;1.236 &#956;mol/L and 15.900&#177;3.897 &#956;mol/L in PTL and control group), TP (4.996&#177;0.509 g/dL and 6.906&#177;0.480 g/dL in PTL and control group), Albumin (3.460&#177;0.440 g/dL and 4.406&#177;0.390 g/dL in PTL and control group), calcium (8.240&#177;0.431 mg/dL and 8.950&#177;0.486 mg/dL in PTL and control group) and inorganic phosphorus (2.006&#177;0.532 mg/dL and 3.786&#177;0.537 mg/dL in PTL and control group) concentration was observed in PTL as compared to the controls. Lipid peroxidation (MDA) (10.590&#177;0.8715 mg/dL and 5.6500&#177;0.4725 mg/dL in PTL and control group) was found to be significantly increased in PTL as compared to controls. <b>Conclusion:</b> There was significant drop in the NO and increase in ROS reflected by increase in serum MDA levels in PTL group as compared to normal full-term labour. These parameters may have role in the diagnosis and prevention of PTL after appropriate larger cohort studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC28-BC31&id=16784 https://doi.org/10.7860/JCDR/2022/56584.16784 Peritumoural Mast Cell Density in Invasive Breast Carcinoma: Possible Antitumourigenic Effect with Potential Role for Immunotherapy CD Anand, S Muthu, JJ John, G Shivashekar, A Sundaram, SM Tamaskar <b>Introduction:</b> The interaction of cancer cells and the host within the tumour microenvironment plays a major role in determining the outcome of cancers. Mast cells are part of the innate immune system that interact with tumour cells and known to have pro-tumourigenic and antitumourigenic action through their mediators. Their role in the outcome of invasive breast cancer is still not clear with studies showing both a beneficial role as well as a role in tumour progression. <b>Aim:</b> To assess Mast Cell Density (MCD) in tissues of invasive carcinoma of breast and compare with clinicopathological parameters to infer their biological significance. <b>Materials and Methods:</b> The study was a retrospective cross- sectional study carried out in the Department of Pathology at SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, India on 51 cases of invasive carcinoma of breast received between January 2011 to July 2013 and the study conducted between August 2013 to November 2013. Clinical parameters and histopathological findings were recorded. Mast cells were clearly demonstrated in tissue using Toluidine Blue stain at pH 2.3. The MCD within primary malignant breast tumour tissue (mastectomy specimens, n=51) was assessed using an eyepiece grid and expressed as number of cells/per sq. mm. Statistical analysis of all parameters was performed using Statistical Package for the Social Science (SPSS) software (version 17.0) to analyse association of MCD with clinicopathological parameters. <b>Results:</b> The MCD was significantly higher in malignant breast tissue compared to non neoplastic breast tissue (p-value <0.0001). No significant difference in MCD was observed between tumour size groups (T1, T2, and T3) (p-value=0.696). No statistically significant difference in MCD was observed between the four histological types observed (p-value=0.892). The majority of the tumours were of grade 2 category (n=37), followed by grade 3 (n=11) and grade 1 (n=3). No significant difference in MCD was observed between the three histological grades (p-value=0.785). The MCD was significantly higher in patients without lymphnode metastasis compared to the group with lymphnode metastasis (p-value=0.0023). The MCD in invasive carcinoma of breast, postchemotherapy group was significantly higher than that in invasive carcinoma of breast pre-chemotherapy group (p-value=0.0064). <b>Conclusion:</b> The current study shows significantly increased MCD at the periphery of the carcinoma breast tissue in patients without lymphnode metastasis compared to those with lymphnode metastasis. Hence, a potential antitumourigenic and beneficial role of mast cells in invasive primary breast carcinoma could be inferred and may serve as one of the prognostic indicators for patient stratification for various treatment options including immunotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC31-EC36&id=16785 https://doi.org/10.7860/JCDR/2022/56975.16785 Prescription Practices of Antifungal Agents at Gynaecology and Oncology Departments of a Tertiary Hospital in Mwanza, Tanzania: A Retrospective Study Kayo Hamasaki, Zaomba Hussein, Bernard Okamo, Stanley Mwita, Deogratius Katabaro, Stephen E Mshana, Martha F Mushi <b>Introduction:</b> Irrational antifungals prescription results in inappropriate use of antifungals, leading to emergence of antifungal resistance. <b>Aim:</b> To determine the prescription patterns of antifungal agents in Gynaecology and Oncology Departments of the tertiary hospital in Tanzania. <b>Materials and Methods:</b> This was a retrospective hospital-based study involving files of patients who attended Gynaecology and Oncology Department of Bugando Medical Centre between January 2017 to December 2017. All files of patients with fungal infections were analysed. The analysis of the data was done from January 2018 to August 2018. Checklist was used to collect information such as clinical diagnosis, age, name of antifungal, number of antifungals, dosage form and dose frequency. Descriptive analysis was done using STATA version 13.0. <b>Results:</b> A total of 1,070 files of patients who attended Gynaecology and Oncology Departments in the year 2017 were retrieved, of which 860 (80.4%) were from patients who attended Gynaecology Department. A total of 156 (14.6%) files out of 1,070 were of patients with fungal infections. Of the patients from gynaecology 116 (n=860, 13.48%) had fungal infection. While of the patients from oncology 40 (n=210, 19.1%) had fungal infection. The most common fungal infection diagnosed were vaginal candidiasis 112 (96.6%) and oral candidiasis 33 (82.5%) from gynaecology and oncology department, respectively. Common antifungal prescribed were azoles (clotrimazole 56.9% in gynaecology and fluconazole 30% in oncology). The prevalence of irrational antifungal prescription in gynaecology and oncology departments was 22.4% (26/116) and 20% (8/40), respectively. <b>Conclusion:</b> About one in five antifungal prescriptions for vaginal candidiasis in gynaecology and oral candidiasis in oncology are irrational as evidenced in standard treatment guideline. Clinicians should adhere to the national standard treatment guidelines in order to reduce irrational prescriptions of antifungal agents. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=QC06-QC10&id=16786 https://doi.org/10.7860/JCDR/2022/55087.16786 Adverse Outcomes in Pregnancy with Chronic Hypertension with and without Superimposed Preeclampsia in Urban South Indian Population: A Prospective Observational Study Niharika Reddy Kallu, Geeta Kolar, Saritha Redishetty, Pradeep Kumar Reddy Kistampally <b>Introduction:</b> Pregnant women with chronic hypertension and who developed superimposed Preeclampsia (PE) had a higher rate of adverse maternal and perinatal outcomes. Prospective data on the outcome of pregnancies with chronic hypertension are sparse. <b>Aim:</b> To evaluate the maternal and perinatal outcomes in pregnancies complicated by chronic hypertension with and without superimposed PE in South Indian population. <b>Materials and Methods:</b> A two group, parallel, prospective observational study was carried out in 270 women with singleton pregnancy and chronic hypertension, with and without superimposed PE, also who received antenatal care and delivered in the Department of Obstetrics and Gynaecology at Fernandez Hospital, Hyderabad, Telangana, India from March 2019 to February 2020. A total of 180 women had chronic hypertension without superimposed PE and 90 had superimposed PE (group A, 180 cases; group B, 90 cases). The medical records were reviewed with specific reference to the treatment, development of Foetal Growth Restriction (FGR), maternal and perinatal outcomes. FGR was considered as the primary outcome variable. Secondary variables were stillbirth rate, low birth weight, Neonatal Intensive Care Unit (NICU) admissions, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) at 5 minutes, gestational age at delivery, caesarean section rate and maternal complications. Categorical variables were assessed by Pearson&#8217;s Chi-square test. Continuous variables were assessed by unpaired Student t-test. <b>Results:</b> The mean maternal age in group A was 32&#177;5 years and in group B was 30&#177;4 years. Adverse maternal outcomes like abruption, Haemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome, and pulmonary oedema were all low in women without superimposed PE than those with superimposed PE (1.6% vs 12.2%, p-value <0.001). There were no maternal deaths in either group. Compared to group A, group B showed higher FGR rate (15.5% vs 51.1%, p-value <0.001), preterm deliveries (<37 weeks) (50.5% vs 80% p-value <0.001), stillbirths (0 vs 13.3%), low APGAR at 5 minutes (1.1% vs 16.6%, p-value <0.001), low birth weight (21.2% vs 71.1%, p-value <0.001), NICU admissions (14.4% vs 43.3%, p-value <0.001). There was no significant difference in the caeserean section rate between the groups (69.4% vs 74.4%, p-value=0.39). <b>Conclusion:</b> Maternal and perinatal morbidity was higher in women having chronic hypertension with superimposed PE. They need vigilant maternal and foetal surveillance and should be counseled about all the possible adverse outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=QC11-QC14&id=16787 https://doi.org/10.7860/JCDR/2022/55451.16787 Dynamic Compression Plate versus Locking Compression Plate Fixation in Adult Forearm Fractures: A Prospective Interventional Study Ishan Shevate, Gaurav Lalasaheb Patil, Rahul Salunkhe, Ashwin Deshmukh, Ashwinkumar Vasant Khandge, Siddharth Yadav, Sayooj Sukrethan <b>Introduction:</b> Injuries resulting from traffic accidents, industrial accidents, natural disasters and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. <b>Aim:</b> To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. <b>Materials and Methods:</b> A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a LCP (n=15) or a DCP (n=15) at the Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. <b>Results:</b> Out of total, 13 (86.7%) patients each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although, it was statistically insignificant (p-value=0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). <b>Conclusion:</b> In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=RC21-RC25&id=16788 https://doi.org/10.7860/JCDR/2022/56969.16788 Blood Lead Levels in Children Living near Lead Smelting Zone: A Pilot Field Study Kakali Roy, Surupa Basu, Nabendu Murmu, Jyotirmoy Adhikari, Sumantra Adhikari, Ritabrata Kundu, Apurba Ghosh <b>Introduction:</b> Children are most susceptible to Lead (Pb) toxicity. Exposure to lead in the environment still exists in various pockets of urban cities due to continued practices of using lead in jewellery making, paints, battery smelting and in cosmetics. <b>Aim:</b> To evaluate Blood Lead Level (BLL) and its association with haemoglobin, Red Blood Corpuscle (RBC) indices and bone parameters (vitamin D, parathyroid hormone, calcium, phosphorus, and Alkaline Phosphatase (ALP) in children residing near lead battery smelting units of Kolkata. <b>Materials and Methods:</b> This was a cross-sectional field-based pilot study carried out by Institute of Child Health, Kolkata, West Bengal, India. A camp was organised in the month of August 2015, at a known major cluster of secondary lead smelting area ward no. 66 in the Kolkata metropolitan district. A total of 45 camp attending children were enrolled. BLL was measured using graphite furnace atomic absorption spectrometry, and association with haematological and bone parameters were evaluated. <b>Results:</b> Mean age of the participants was 5.6&#177;3.3 years, and mean BLL was 3.7&#177;1.9 &#956;g/dL (range:1.3-8.2). About 35 children were found to have low BLL <5 &#956;g/dL (LBLL, 2.88&#177;1.08) while 10 had elevated BLL &#8805;5 &#956;g/dL (EBLL, 6.59&#177;0.95) (p<0.0001). Red Cell Distribution Width (RDW) was high (p=0.03) and Mean Corpuscular Volume (MCV) was low (p=0.05) in EBLL group; but there was no significant difference in haemoglobin level, compared to LBLL group. The mean vitamin D level was 15.2&#177;8.7 ng/mL, while 23 (51%) were severely deficient without concomitant rise in parathyroid hormone (mean, 37.9&#177;0.7 pg/mL). Calcium, phosphorous and ALP were within normal reference range. None of the bone parameters showed any correlation with BLL. <b>Conclusion:</b> Overall, 22% children of the cohort had elevated BLL, beyond the permissible safety limit of 5 &#956;g/dL but within 10 &#956; &#956;g/dL. Mildly elevated BLL relate to iron deficient haematopoiesis (increased RDW and low MCV) without any apparent affection of bone metabolism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=SC20-SC23&id=16789 https://doi.org/10.7860/JCDR/2022/53738.16789 Role of Corticosteroids in Tubercular Pleural Effusion: A Prospective Interventional Study from a Tertiary Care Teaching Hospital, Telangana, India Sunitha Dubba, Suresh Babu Sayana, Mounika Vadithya,M Sravan Kumar, I Sridhar, Meela Ranjith Kumar <b>Introduction:</b> Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. <b>Aim:</b> To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of Tubercular Pleural Effusion (TPE). Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. <b>Materials and Methods:</b> This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for two weeks there after tapering of the dose done every second weekly in next four weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24<sup>th</sup> week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chi-square test. The p-values <0.05 was considered as statistically significant. <b>Results:</b> There was early initiation of symptomatic relief in patients treated with steroid group as compared to non steroid group (p-value <0.001). Average duration for symptomatic relief in steroid group was 3.42 days (range 1-7 days) and in non steroid group 8.3 days (range 1-42 days). There was significant difference between two groups in duration taken for symptomatic relief (p-value <0.001). <b>Conclusion:</b> Results of the present study suggest that corticosteroids still play some role in the treatment of TPE. Addition of the corticosteroids to the standard ATT exerts more rapid relief of clinical symptoms. The rapidity in pleural fluid absorption is not influenced significantly by adding corticosteroids to the ATT. There was no recurrence of pleural effusion after addition of corticosteroids to ATT. The incidence of pleural thickening was not influenced by steroids. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC25-OC28&id=16726 https://doi.org/10.7860/JCDR/2022/57821.16726 Sleep Hygiene Intervention and its Effectiveness in Reduction of Insomnia and Obesity among Undergraduate Medical Students E Suganya, A Arvinth, DR Vedapriya <b>Introduction:</b> Adequate amount and quality of sleep is the basic need for any human. Children and adolescents requires at least eight to nine hours of sleep per night. Insomnia results in both mental and physical health consequences, diminished productivity, accident proneness, increased medical utilisation and elevated risk of psychiatric disorders. Sleep hygiene intervention is a behavioral intervention to improve sleep quality. <b>Aim:</b> To determine the effectiveness of sleep hygiene intervention programme in reduction of insomnia and obesity among undergraduate medical students. <b>Materials and Methods:</b> This interventional study was conducted at Tagore Medical College and Hospital, Chennai, India, January 2019 to May 2019, among 602 undergraduate medical students. Study was conducted in two phases, in phase 1, participants were surveyed for Insomnia Severity Index (ISI) scoring and BMI. Those with ISI scores between 8-21 and BMI &#8805;30 kg/m<sup>2</sup> were eligible for phase 2. In phase 2 using, stratified random sampling total 100 subjects, 50 each for control and intervention group were selected. Periodical sleep hygiene intervention was given for intervention group, insisting to follow 10 simple non pharmacological behavioral measures. Follow-up assessment of weight (kg) and ISI scoring was done. Paired t-test, repeated measures Analysis of Variance (ANOVA) and Bonferine Post-hoc test was done to identify the statistical significance using Statistical Package for Social Sciences (SPSS) version 20.0. <b>Results: </b>Among the 100 participants in phase II, 29 were female in both control and intervention group. The prevalence of Subthreshold insomnia 289 (48%) was higher. Over 4 month period comparison, intervention group had better reduction in weight {(62.48&#177;10.62 kg to 51.48&#177;6.88 kg) vs (61.58&#177;10.35 kg to 62.48&#177;10.66 kg)} and insomnia severity (13.70&#177;3.62 to 10.34&#177;2.43) vs (12.56&#177;3.78 to 13.50&#177;3.63) than control group. <b>Conclusion: </b>Simple non pharmacological intervention seems to have greater benefits in improving sleep hygiene and reducing obesity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LC18-LC21&id=16727 https://doi.org/10.7860/JCDR/2022/55304.16727 Evaluation of Alveolar Bony Trabecular Pattern in Subjects with Crossbite Malocclusion using Intraoral Periapical Radiographs: A Cross-sectional Study Rama Raji Sankaranarayanan, Ravindra Kumar Jain, Nivethigaa Balakrishnan <b>Introduction:</b> Trajectories of force determines the trabecular pattern of bone. In transverse malocclusions, force trajectories are altered which can affect the trabecular pattern. Hence, it is important to study the trabecular pattern associated with transverse malocclusions. <b>Aim:</b> Assessment of trabecular pattern changes on Intraoral Periapical Radiographs (IOPA) in subjects with dental crossbites using fractal analysis. <b>Materials and Methods:</b> This cross-sectional study was conducted in Department of Orthodontics at Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India, from October 2021 to December 2021. The study involved 30 IOPAs in 15 patients with unilateral first mandibular molar teeth in crossbite. The sample was divided into two groups. Group A has 15 IOPAs of mandibular molars in crossbite side, group B has 15 IOPAs of mandibular molars not in crossbite. A Region of Interest (ROI) of 256&#215;256 pixels were selected between the roots of the premolar and mandibular molars and converted into an 8-bit image with image J software. Fractal dimensional analysis with box counting was used to assess trabecular perimeter and the trabecular number. Normality of the data was assessed by Shapiro-Wilk test and an Independent t-test was carried out to find intergroup differences. <b>Results:</b> The IOPAs of 15 subjects (9 males and 6 females) were included in the study with mean age of 27&#177;8 years with unilateral mandibular first molar in crossbite. Shapiro-Wilk tests p-values was not significant (p-value >0.05) for both groups ensuring normality of data. The mean fractal dimensions measured were 0.867 (group A) and 1.213 (group B). The mean trabecular perimeter in group A was 86.37&#177;29.31 whereas in group B it was 194.62&#177;43.26 and the intergroup difference was significant (p-value <0.001). <b>Conclusion:</b> Fractal analysis of IOPAs revealed that the alveolar bone surrounding the teeth in crossbite presented with significant reduction in the trabecular perimeter and number when compared with teeth not in crossbite. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC12-ZC15&id=16728 https://doi.org/10.7860/JCDR/2022/53493.16728 Assessment of Normal Intracranial Parameters of the Sellar Region in Healthy Subjects of South Indian Population: A Retrospective Study Deepa Rebecca Korula, Sabari S Ramesh, Senthil Kumar Aiyappan, S Vinayagam, Vamsi Krishna Maddineni, Aishwarya Athani <b>Introduction:</b> There is a significant degree of anatomical variation at the level of the sphenoid sinus and sella turcica and a wide range of these values have been reported in literature and ethnic variation has also been found to contribute to this. Thus preoperative imaging of the central skull base with a knowledge of the normal anatomy and measurements in a specific population is imperative to identify these variations and prevent avoidable intraoperative complications. <b>Aim:</b> To assess the normal intracranial measurements of the intercarotid distance, pituitary fossa width, optic chiasm height, optic chiasm width and the pituitary to optic chiasm distance in healthy subjects of the South Indian population aged between 10 to 80 years and to establish normal reference ranges across the various age groups. <b>Materials and Methods:</b> This retrospective study was conducted in the Radiology Department at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from July 2021 to December 2021. The study included normal Magnetic Resonance Imaging (MRI) brains of 700 healthy subjects (378 males and 322 females) in the age range of 10 to 80 years. Subjects were divided into seven groups of 100 subjects for each decade. The variables that were measured included the intercarotid distance, pituitary fossa width, optic chiasm height, optic chiasm width and the pituitary to optic chiasm distance. RStudio version 1.2.1093 was used for statistical analysis and p-value <0.05 was considered statistically significant. Association between age and outcome variables were assessed by Pearson&#8217;s correlation coefficient at 95% confidence interval. <b>Results:</b> The overall mean age was 45.4 years. The overall mean intercarotid distance was 16.2&#177;3.7 mm, optic chiasm width was 13.1&#177;1.6 mm, optic chiasm height was 2.18&#177;2.7 mm, pituitary width was 12.1&#177;2.3 mm, pituitary to optic chiasm distance was 5.7&#177;1.84 mm. The overall pituitary fossa width and pituitary to optic chiasm distance was found to be higher in males (p-value <0.001; p-value=0.03, respectively) than females while there was no significant difference between genders in the rest of the parameters. A low and positive correlation was found between age and the pituitary width, age (r-value=0.175, p-value <0.001) and the pituitary to optic chiasm distance (r-value=0.342, p-value <0.001) and pituitary width and optic chiasm width (r-value=0.236, p-value <0.001). A strong and positive correlation was found between the pituitary width and the intercarotid distance (r-value=0.736, p-value <0.001). <b>Conclusion:</b> Establishment of normal reference values across various age groups of the South Indian population may prove useful for future reference and improving diagnostic accuracy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=TC01-TC05&id=16729 https://doi.org/10.7860/JCDR/2022/55466.16729 Clinical Features and Predisposing Factors Influencing the Outcome of COVID-19 in First and Second Wave at Nanded, Maharashtra- A Retrospective Study Supriya Madhavrao Emekar, Sanjaykumar Rajaram More, Rohit Sinha, Raghavendra Swamy <b>Introduction:</b> It is crucial to determine possible factors associated with exacerbation of the disease due to the alarming global spread, morbidity and mortality associated with Coronavirus Disease-2019 (COVID-19). It is important to determine the co-morbidities associated with this disease which will help in better treatment of patients in time and to make amendments to management policy. <b>Aim:</b> To compare the clinical features and predisposing factors (socio-demographic factors and co-morbidities) influencing the outcome in COVID-19 infected patients admitted in a tertiary care centre in the first and second wave of COVID-19 pandemic. <b>Materials and Methods:</b> The retrospective study was conducted at the Department of Microbiology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India. The data was collected from the electronic resource which was maintained by the Institute Integrated Disease Surveillance Program (IDSP) health record reporting database for the duration of June 2020 to August 2021. This data included patient&#8217;s demographic details (age, sex, address, contact number), other details (history of close contacts, international travel) clinical history, different types of symptoms Indian Council of Medical Research (ICMR patient category), co-morbidities, number of patients requiring Intensive Care Unit (ICU) admission, type of sample, the outcome in terms of death and discharge, cause of death. The analysis was done for the complete data and then for two separate durations of the first and second wave which were compared later with Chi-square test (Bivariate analysis). <b>Results:</b> A total of 8841 patients were involved and the majority of patients in the study were between the age group of 30-75 years, there was a predominance of males in first and second waves with 2226 (66.21%) and 3569 (65.13%) respectively. The paediatric patients had a mortality rate of 7 (100%) found in the second wave. Fever (39%) and dyspnea (22%) were found as the commonest presentation in both waves. Gastrointestinal manifestations were observed relatively more in the second wave. The serious patients on ventilator were found to have (>91%) the highest mortality. It appeared that the highest attributable risk to severity and mortality (8-10 times increased) was due to hypertension, diabetes and other co-morbidities. Pregnancy did not predisposed to be as a risk factor. <b>Conclusion:</b> Prompt management and preventive care are needed for patients with co-morbidities to avoid the exacerbation of COVID-19 as well as drug cross interactions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC33-DC38&id=16730 https://doi.org/10.7860/JCDR/2022/56227.16730 Anorectal Manometry Profile among Patients with Chronic Constipation and Faecal Incontinence in Western India: A Retrospective Study Shankar Lal Jat, Pratibha Maan, Utkarsh Sharma, Vivek Mohan Sharma, Amit Mathur, Urvashi Vijay, Nidhi V Shihora <b>Introduction:</b> About 50% of patients referred to tertiary care centre for constipation in the western countries have faecal evacuation disorder. A diagnosis of faecal evacuation disorder requires specialised investigations such as anorectal manometry. Anorectal manometry is a method to measure pressure exerted by the muscles in anus and rectum. <b>Aim:</b> To evaluate the characteristics of anorectal pressure in a cohort of western Indian patients with chronic constipation and faecal incontinence. Also, to evaluate the types of faecal evacuation disorders in patients with chronic constipation. <b>Materials and Methods:</b> The present retrospective study was conducted from January 2020 to May 2022 at Department of Gastroenterology, National Institute of Medical College and Research, Jaipur, Rajasthan. Total of 115 patients presented with chronic constipation and faecal incontinence, were included in the study. Sigmoidoscopy or full-length colonoscopy, Balloon Expulsion Test (BET) and anorectal manometry test were done in all the patients. Mean resting and squeeze pressure were measured by anorectal manometry. Continuous variables were summarised using means and standard deviations for normally distributed data. Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS) version 20.0 (IBM Corp, Armonk, NY, USA). <b>Results:</b> Among 115, 62 were (53.9%) males and 53 (46.1%) females with mean age 51.9&#177;16.2 years. In High Resolution Anorectal Manometry (HRAM), the mean resting anal pressure was 67.2&#177;34.24 mmHg (range 14-183 mmHg) and mean squeeze pressure was 113.4&#177;60.9 mmHg (range 30-290 mmHg). In present study type I dyssynergic defecations was most common with 20 (17.4%) patients. <b>Conclusion:</b> The present study showed that almost half of the patients had defecation disorders and type I dyssynergic defecations was most common, followed by type IV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC29-OC32&id=16731 https://doi.org/10.7860/JCDR/2022/58112.16731 Pre-emptive Analgesic Efficacy of Low Dose Ketamine versus Magnesium Sulfate in Patients undergoing Major Abdominal Surgeries under General Anaesthesia: A Randomised Clinical Study Kavita Jain, Surendra Kumar Sethi, Sourabh Bagra, Veena Patodi <b>Introduction:</b> Pre-emptive analgesia has been proposed to result in better pain management, reduced analgesic consumption, and improved patient satisfaction. <b>Aim:</b> To evaluate pre-emptive analgesic efficacy of intravenous ketamine and intravenous magnesium sulfate in patients undergoing major abdominal surgeries under general anaesthesia by administering it 10 minutes before the incision. <b>Materials and Methods:</b> This randomised, double-blind, clinical study, was conducted in JLN Medical College, Ajmer, Rajasthan, India, from November 2019 to November 2020. The study included 100 patients, aged 18-60 years of American Society of Anaesthesiologist (ASA) physical status I and II were randomly allocated into two groups. Group K (n=50) received intravenous (i.v.) ketamine infusion 0.3 mg/kg in 100 mL normal saline over 10 minutes. Group M (n=50) received i.v. magnesium sulfate (MgSO<sup>4</sup>) infusion 30 mg/kg in 100 mL normal saline over 10 minutes. The duration of analgesia, total amount of rescue analgesic consumed in 24 hours, haemodynamics, and side-effects were noted. The quantitative data was presented as mean&#177;standard deviation and were compared by student&#8217;s t-test. <b>Results:</b> Duration of analgesia was significantly prolonged in group K (67.96&#177;9.20 min) as compared to group M (30.60&#177;6.44 min) (p-value <0.001). The total dose of rescue analgesic consumption in 24 hours was lesser in group K (1180&#177;388.09) as compared to group M (1280&#177;453.56) (p-value=0.236). Haemodynamics and side-effect profile were comparable in the two groups. <b>Conclusion:</b> In major abdominal surgeries under general anaesthesia, patients getting ketamine had longer duration of analgesia compared to magnesium sulfate, had an improved quality of recovery after surgery and less serious adverse events in the Postanaesthesia Care Unit (PACU). Ketamine reduces the need for intraoperative opioids and could suppress the pressure response to endotracheal intubation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UC14-UC17&id=16732 https://doi.org/10.7860/JCDR/2022/56110.16732 Physical Fitness Index of Medical Students in Thrissur, Kerala, India: A Cross-sectional Study Arsha Krishnan, Gokul Suresh Revathy <b>Introduction:</b> Physical activity forms an important component of a healthy lifestyle. Inadequate physical activity is a major risk factor for non communicable diseases. It is necessary to identify the status of physical fitness of medical students who are the future professionals of healthcare. There are various parameters available to assess the physical fitness of an individual. Modified Harvard step test is a tool used for assessing cardiopulmonary fitness, which is employed in this study. <b>Aim:</b> To compare the physical fitness of medical students who were regular basketball players, with sedentary medical students, using cardiovascular parameters. <b>Materials and Methods:</b> The cross-sectional study was conducted in the Department of Physiology, Government Medical College, Thrissur, Kerala, India, from April 2017 to April 2018. Total 60 medical students of both gender, in the age group 18-25 years, out of which 30 were athletes and 30 non athletes, were selected by simple random sampling. Physical fitness index was measured after the subjects performed modified Harvard step test. The duration of exercise and the recovery heart rates were considered. Statistical analysis was done using Chi-square test, correlation and regression tests, Independent t-test and Paired t-test, for which, p-value <0.05 was significant. <b>Results:</b> The mean age of the athletes was 20.97&#177;1.69 years and non athletes was 21.40&#177;1.42 years. Lower Body Mass Index (BMI), resting pulse rate and after exercise recovery pulse rates were found in athletes which were statistically significant (p-value <0.05). The duration of exercise and Physical Fitness Index (PFI) were found to be higher in athletes than non athletes and was statistically significant (p-value <0.001). Physical fitness was thus found to be higher in athletes compared to non athletes. <b>Conclusion:</b> The study indicated that students who had routine physical training had better fitness levels than sedentary students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=CC12-CC16&id=16733 https://doi.org/10.7860/JCDR/2022/57596.16733 Effects of Casting Methods over the Composition Stability of the Dental Casting Alloy Shubha Joshi, Pronob Kumar Sanyal, Jyotsna Arun Patil <b>Introduction:</b> Alloys with high nickel content have been increasingly used for dental prostheses. The dental casting machines are regularly used to make dental restorations. The effects of the casting of the base metal alloys using actylene-oxygen flame casting machine and induction casting machine has not much been studied. <b>Aim:</b> To estimate nickel, chromium, cobalt, and molybdenum metals from as-received dental casting alloy of three different brands and to estimate metals from these alloys after fabrication of crown using actylene-oxygen flame casting machine and induction casting machine. <b>Materials and Methods:</b> This in-vitro comparative study was conducted in the Department of Prosthodontics at School of Dental Sciences, KIMSDU, Karad, Maharashtra, India. Total of 15 crowns were fabricated using actylene-oxygen flame casting machine and 15 crowns by induction casting machine from three different brands of Dental Casting Alloys (DCA) by lost wax technique. Elemental estimation was done for the as-received pellets and for the crowns fabricated by both methods using X-ray Florescence spectrometry (XRF). Unpaired t-test was used for data analysis. <b>Results:</b> Nickel (Ni), chromium (Cr) and molybdenum (Mo) levels in crowns fabricated by both actylene-oxygen flame casting and Induction casting technique were significantly decreased (Ni: -2.01% to -5.14%, Cr:-7.35% to -29.51% and Mo: -15.70% to -95.94%) in all brands of dental casting alloys. Cobalt level was not detected in all three brands of fabricated crowns by XRF by either of the casting methods. <b>Conclusion:</b> These observations indicate that the elemental composition of the fabricated crowns is decreased as compared to that of As-received crowns, which could be due to the burnout of some amount of elements during casting. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC16-ZC21&id=16734 https://doi.org/10.7860/JCDR/2022/56300.16734 Effect of Ionic Calcium and Vitamin D3 in Lumbar Spine Bone Mineral Density of Paediatric Epileptic Patients on Antiepileptic Drugs Rahim Sheeja Ajmal, Ghanshyam Singh Sengar, Gogra Keerti <b>Introduction:</b> Epilepsy is one of the most common neurologic conditions occurring in persons under 21 years of age. Vitamin D deficiency is highly prevalent among children with epilepsy. Antiepileptic drugs (AEDs) are associated with decreased Bone Mineral Density (BMD) as AEDs increase catabolism of 25-hydroxy vitamin D by induction of the hepatic P 450 enzyme system, which leads to relative hypocalcaemia, increased levels of parathyroid hormone (PTH) and subsequently low BMD. <b>Aim:</b> To evaluate the association of ionic calcium and vitamin D3 in paediatric epileptic patients who were on AEDs with BMD. <b>Materials and Methods:</b> This was an observational cross-sectional study carried out at Department of Paediatrics, SPMC, Bikaner, Rajasthan, India from December 2020 to November 2021. A total of 150 epileptic patients aged 5 to 15 years who were on AED therapy for more than six months and a comparable group of 130 age and gender matched healthy individuals participated in this study. Serum vitamin D3, Alkaline Phosphatase (ALP), ionic calcium and phosphorous levels were assessed and compared between both the groups. Using OSTEOPRO DEXA BMD at the lumbar spine was calculated. Mann-Whitney test and t-test were used to compare quantitative data whereas Chi-square test was used to compare qualitative data in two groups. Non parametric tests (Spearman Correlation) were used to explore the correlation between the two variables. The p-value of <0.05 was considered to be statistically significant. <b>Results:</b> The mean age of study group and control group were 9.94&#177;2.61 years and 10.09&#177;2.53 years respectively. Mean serum ionic calcium (1.09&#177;0.13 mmol/L) was significantly lower in study group as compared to controls (1.15&#177;0.13 mmol/L) with p-value <0.001. Mean serum phosphorous and serum ALP levels were not significantly different in study and control group. The mean Vitamin D3 level (16.70&#177;5.35 ng/mL) was lower in children receiving AEDs as compared to controls (19.08&#177;5.39 ng/mL) with p-value <0.001. Serum levels of ionic calcium and Vitamin D3 were found to be significantly lower in groups with polytherapy and enzyme inducer group of AEDs (p<0.05) whereas only statistically significant difference in vitamin D3 was found in subjects with more than two years of AED therapy. The mean Lumbar Spine Bone Mineral Apparent Density (LSBMAD) of the study and control group were 0.47&#177;0.14 g/cm<sup>2</sup> and 0.61&#177;0.12 g/cm<sup>2</sup> respectively. <b>Conclusion:</b> Epileptic children receiving multiple drugs for longer duration showed more decline in calcium and serum 25 hydroxy vitamin D compared to those with single drug for shorter duration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=SC05-SC08&id=16738 https://doi.org/10.7860/JCDR/2022/56688.16738 Comparison of Antegrade Percutaneous Intramedullary K-wire Fixation and Transverse Pinning for Treatment of Unstable Displaced Metacarpal Neck and Shaft Fractures: A Prospective Interventional Study Ansari Emad Yaqub, Navneet Singh, Punit Tiwari, Sandeep Singh Jaura, Bhupinder Singh Brar <b>Introduction:</b> Metacarpal fractures account for upto 10% of all body fractures and 36% of all hand fractures in adolescents, young adults, and active adults. Among metacarpal fractures, fracture of the metacarpal shaft and neck are most common after direct trauma, roadside accidents, or sports injuries. The ratio of the shaft to the neck is 1:2. Closed reduction and plaster of paris cast can be used to treat the majority of these fractures conservatively. Unstable and comminuted fractures necessitate surgery. <b>Aim:</b> To compare the clinical, functional and radiological outcomes in antegrade intramedullary fixation and transverse pinning of metacarpal fractures in patients of unstable and displaced metacarpal shaft and neck fractures. <b>Materials and Methods:</b> A single-institutional prospective interventional study identified 60 cases of metacarpal fractures between November 2019 to August 2021 in the Maharishi Markandeshwar Medical college and Hospital, Kumarhatti, Himachal Pradesh, India. Each of the cases met the inclusion criteria for closed extra-articular fractures, displaced and unstable fractures of the metacarpal bone. The patients were divided into two groups having 30 subjects each, randomly allotted to two groups (Antegrade intramedullary K-wiring and Transverse Pinning). Outcomes were compared for range of movement by the American Society of Hand Surgeons Total Active Motion score (ASSH TAM), Visual Analog Scale (VAS), and radiological parameters (Angulation). Patients were followed-up for 12 weeks. Complications were listed in terms of pin site infection. <b>Results:</b> Most of the patients were found to be in the third decade of life. The fracture union was achieved at 8&#177;2 weeks. Clinical evaluation done by VAS score which was found to be statistically insignificant between two groups (p-value=0.243). Radiological assessment evaluated by measuring postoperative angulation between two groups was found to be statistically insignificant (p-value=0.248). Difference in functional evaluation between the two groups done by ASSH TAM was found to statistically significant between the groups (p-value=0.036). <b>Conclusion:</b> Both antegrade intramedullary K-wiring and transverse pinning demonstrate good and comparable results for extra-articular neck and shaft metacarpal fractures. However, the former is superior in terms of final range of motion as per ASSH TAM score. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=RC06-RC10&id=16739 https://doi.org/10.7860/JCDR/2022/56686.16739 Clinical and Radiological Profile in Non Hypertensive Intracerebral Haemorrhage- A Prospective Observational Study Siddaganga, Bharat L Konin, Swathi Bhat <b>Introduction:</b> Intracerebral Haemorrhage (ICH) is less frequent than ischemic stroke, but has higher mortality and morbidity, it being one of the first causes of severe disability. Hypertension is the most common cause of ICH but Non Hypertensive Intracerebral Haemorrhages (NHICH) are not rare. Hence, the importance of recognizing these conditions and need for urgent specific therapy which may play a vital role in therapeutic planning and prevention of ICH. Hence this study was performed to study. <b>Aim:</b> To study the clinical and radiological profile in NHICH, to identify risk factors, and to determine whether clinical/neuronradiological parameters would predict the prognosis of ICH. <b>Materials and Methods:</b> The present prospective observational study was conducted in the Department of General Medicine Mahadevappa Rampure Medical College Gulbarga, Karnataka, India, from January 2016-January 2017. It involved 50 subjects with NHICH. Demographic details, clinical and radiological data were collected in patients presenting with signs and symptoms of stroke and confirmed by Computed Tomography (CT) scan/Magnetic Resonance Imaging (MRI) brain as ICH, who were non hypertensive and with age more than 18 years. Clinical outcome of the patients was measured based on Glasgow Coma Scale (GCS), site and volume of haemorrhage. Descriptive statistics of the explanatory and outcome variables were calculated by mean, Standard Deviation (SD) and Chi-square test was applied for qualitative variables. <b>Results:</b> In the present study 31 (62%) were males, and 19 (38%) were females. The age of patients ranged from 18-85 years. The most common risk factor associated with intracerebral haemorrhage was alcohol consumption 16 (32.0%), followed by smoking 13 (26%), and anticoagulant intake 13 (26%). Most common clinical presentation were hemiplegia/hemiparesis, speech defect, vomiting, convulsion, pupillary defect and cranial nerve involvement, in decreasing frequency. High ICH score and low GCS were poor prognostic factors for outcome of intracerebral haemorrhage patient in the present study. In hospital mortality rate was 28%. During 30 days follow-up, there was 22.2% mortality among the discharged patient. <b>Conclusion:</b> Although hypertension remains as a most common risk factor for intracerebral bleed, other risk factors such as significant alcohol consumption, coagulopathy should also be kept in mind especially in young. Non hypertensive haemorrhage usually occurs at sites not typical for hypertensive bleed. All efforts should be directed to establish the aetiological factors for intracerebral bleed, so that appropriate timely therapy can be provided to prevent further morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC33-OC36&id=16736 https://doi.org/10.7860/JCDR/2022/55362.16736 Estrogen Receptor, Progesterone Receptor Profile in Association with CK 5/6 Immunohistochemical Status in Proliferative, Preinvasive and Malignant Epithelial Neoplasms of Breast Sneha, Tushar Kanti Das <b>Introduction:</b> Breast carcinomas have shown increasing incidence across the world over the recent few years. The different epithelial cells play a role in the pathogenesis of different breast lesions consistent with the varying cytokeratin (CK) expression profiles. The luminal cells express CK 8 and 18 while myoepithelial cells show CK 5/6 and CK 17 expression. Triple Negative Breast Cancers (TNBC) (hormonal receptors and Human Epidermal growth factor Receptor 2 (HER2)/neu negative) express basal cytokeratins and histopathologically show metaplastic to medullary features while luminal breast cancers with glandular differentiation show hormonal receptor or HER2 expression. Also basal cells are characteristic of benign lesions like epithelial hyperplasia, fibroadenoma etc. while being absent in atypical hyperplasia and preinvasive lesions. <b>Aim:</b> To study cytokeratin 5/6 and Estrogen Receptor/Progesterone Receptor (ER/PR) expression pattern in proliferative, preinvasive and malignant lesions of breast. <b>Materials and Methods:</b> An observational cross-sectional study was undertaken in the Department of Pathology in a tertiary care hospital in East India, from January 2019 to June 2020. A total of 41 samples diagnosed as proliferative (Usual Ductal Hyperplasia (UDH)/Atypical Ductal Hyperplasia (ADH), preinvasive Ductal carcinoma in Situ (DCIS) and invasive breast carcinomas were selected by systematic random sampling. Immunohistochemical examination was done using monoclonal antibodies against Cytokeratin 5/6 and ER/PR/HER2 after obtaining thin sections from formalin fixed paraffin embedded blocks and retrieval of antigen. The data was interpreted by light microscopy using a semi-quantitative method with respect to prefixed parameters and statistical analysis was done by Chi-square test and Fischers-exact test using Statistical Package for the Social Science (SPSS) version 25.0. <b>Results:</b> Of the 41 cases, three were of proliferative lesions (UDH+ADH), 1 (33%) (UDH) showed positive CK 5/6 expression and 2 (66.7%) (ADH) showed negative CK 5/6 expression. Of two preinvasive lesions (DCIS), 100% of them showed negative CK 5/6 expression. On categorisation of carcinoma cases into molecular subgroups as indicated by surrogate immunohistochemical expression, it was found that majority of the cases (20) exhibited Luminal-A Like molecular profile constituting 55.6% of total. This was followed by an equal incidence of HER2/neu enriched (non luminal) and triple negative phenotypes. Both Luminal B-like (HER2-positive) and Luminal B-like (HER2-negative) were three in number contributing to 8.3% of total each. Out of 36 malignant cases, 5 (13.9%) showed positive CK 5/6 expression while 31 (86.1%) showed negative CK 5/6 expression. All these five cases showing positive CK 5/6 expression belonged to triple negative molecular subtype and this association between the molecular subtypes and CK 5/6 expression pattern was statistically significant p-value=0.0034. Of total five TNBC cases, 2 (40%) were reported to have weak positive CK 5/6 immunostaining, while 3 (60%) of the cases had moderate intensity. Still none of these cases exhibited strong immunostaining. The single UDH case reported in present study, exhibited strong positive immunostaining with CK 5/6. <b>Conclusion:</b> The proliferative lesions consisting of both luminal and myoepithelial cells like UDH showed strong membranous and cytoplasmic expression while ADH, DCIS, and invasive breast carcinoma comprising primarily of luminal epithelial cells were negative for basal cytokeratin 5/6 expression. These group of breast carcinomas belonged to other immunophenotype categories apart from TNBC. However, a special immunophenotype TNBC group, negative for ER/PR and HER2/neu was strikingly positive for CK 5/6 and a statistically significant association was found. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC12-EC16&id=16723 https://doi.org/10.7860/JCDR/2022/55331.16723 Real World Experience using Cidofovir in BK Polyomavirus Haemorrhagic Cystitis following Stem Cell Transplantation- Are Generics Equally Efficacious? Sharon Lionel, Sushil Selvarajan, Uday Kulkarni, Aby Abraham, Vikram Mathews, Kavitha M Lakshmi, Asha Mary Abraham, Biju George <b>Introduction:</b> BK Polyomavirus induced Haemorrhagic Cystitis (BKPyV-HC), a well-recognised complication following Haematopoietic Cell Transplantation (HCT), is associated with increased organ dysfunction and mortality. The treatment is a multipronged strategy which includes manipulating immunosuppression and antiviral therapy along with newer advances of virus specific cellular therapy. Cidofovir is a nucleotide analogue of Cytosine that is effective against many Deoxyribonucleic Acid (DNA) viruses and its use has been limited in the past because of cost and toxicity. <b>Aim:</b> To capture real world data on the use of cidofovir in BKPyV-HC, post HCT especially with regard to dosage, efficacy, toxicity and predictors of response to therapy. The study compared the efficacy and safety of the innovator molecule of cidofovir with Generic versions. <b>Materials and Methods:</b> This study was a retrospective cohort of 67 patients, who were diagnosed with BKPyV-HC post haematopoietic stem cell transplant, and were treated with cidofovir. The study was conducted at a tertiary care centre at Vellore, Tamil Nadu, India, between 2015 and 2021. BKPyV Polymerase Chain Reaction (PCR) was checked in urine routinely in alternate donor transplants, and if there were typical lower urinary tract symptoms or haematuria in any other transplant setting. Treatment with cidofovir (initially innovator an subsequently generic) was as per physician&#8217;s discretion. <b>Results:</b> 985 patients underwent Allogeneic HCT during the study period, of which 67 had BKPyV-HC and were treated with cidofovir (47 with Innovator molecule, 20 with Generic molecule). There was clinical resolution in 47 (70.1%) and mortality in 32 (47.8%) of the cohort. On univariate analysis, risk factors associated with mortality were an absence of clinical resolution (p<0.001), treatment initiation at a higher grade of HC (p=0.032), CD34 cell dose >9x10<sup>6</sup>/Kg (p=0.029), partial remission of malignancy at the time of transplant (p=0.001), &#8804;3 doses of cidofovir used (p=0.036), BK log value >log 7 at the time of stopping cidofovir (p=0.021) and toxicity with cidofovir (p=0.036). However, only the absence of clinical resolution was significantly associated (p<0.001) with mortality risk on multivariate analysis. There was no significant difference between the two comparator molecules of cidofovir. <b>Conclusion:</b> Cidofovir is an effective and safe therapeutic option to treat BKPyV-HC with no significant differences seen between the innovator and Generic molecule of Cidofovir in this small series of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC20-OC24&id=16724 https://doi.org/10.7860/JCDR/2022/55240.16724 Evaluation of Bulk Fill Composite Roughness Polished with Spiral Rubber Discs: An In-vitro Study Glaucia Danielle Ferreira da Silva, Marlon Ferreira Dias, Cláudio Eufrásio Medeiros Lins, Eric Roberto Soares Xavier de Siqueira, Amina Kadja Martins Cahu, Natália Gomes de Oliveira, Re <b>Introduction:</b> Restorations with high surface roughness directly influences restorative procedure longevity. When used correctly, polishing systems optimises the quality, aesthetics and longevity of composite resins. <b>Aim:</b> To evaluate the influence of three two-step polishing systems of spiral rubber discs on surface roughness of three different bulks fill composite resins. <b>Materials and Methods:</b> This in-vitro study was conducted from May 2021 to January 2022, at the Universidade Estadual de Pernambuco, School of Dentistry, Recife, Pernambuco, Brazil. Total 20 specimens of each resin {three Bulk Fill resins: Filtek One Bulk Fill (3M-ESPE), Aura Ultra Universal Restorative Bulk Fill (SDI) and Opus Bulk Fill (FGM)} were randomly divided into four groups (n=5 each). The three groups include test polishing systems {Sof-Lex Diamond Polishing System (3M/ESPE, Saint Paul, Minnesota, USA), Decamp Plus Twist Spiral EVE (Odontomega, Ribera Prato, SP, Brazil), Spiral Swivel (Jota, Ruth, Kanton St. Gallen, Switzerland)} and one control group include no polishing system. To assess surface roughness, before and after polishing, specimens were evaluated on a digital rugosimeter. Data was subjected to the Shapiro-Wilk test to assess normality, followed by Analysis of Variance (ANOVA) to compare the mean between the different types of resins and types of polishers. <b>Results:</b> For the composite resins studied, significant differences were observed only when polished with Sof-lex Spiral (p-value=0.013). All polishing system caused a significant improvement in the roughness of composite resins compared to the control group. The mean roughness reduction comparison test between the types of polisher was significant (p-value <0.001), there was a significantly greater reduction in the roughness of EVE Decamp Plus Twist Spiral and Swivel Spiral polish system, compared to polish system from Sof-Lex Diamond Polishing System and control group. No statistically significant differences were found between EVE Diacomp Plus Spiral and Spiral Swivel polishing system. <b>Conclusion:</b> The spiral rubber polishers evaluated were effective in reducing the roughness of bulk fill composites. However, EVE Decamp Plus Spiral and Spiral Swivel polishers showed better results than Sof-Lex Spiral. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC01-ZC05&id=16688 https://doi.org/10.7860/JCDR/2022/56321.16688 A Clinical Study of Patients with Erythroderma Attending a Tertiary Care Hospital in Eastern India Prerna Raj Gupta, Suchibrata Das, Alok KR Roy <b>Introduction:</b> Erythroderma is characterised by erythema and scaling over more than 90% of the body surface, a morphological reaction pattern of skin having innumerable underlying causes. Morbidity related to erythroderma is considerably high. The importance of finding the etiology with special emphasis on histopathology allow early and appropriate intervention for each case. <b>Aim:</b> To observe etiological factors of erythroderma through appropriate haematological and biochemical investigations and histopathological examination. <b>Materials and Methods:</b> An observational cross-sectional clinical study was done in the , Department of Dermatology and Venereology, NRS Medical College, Kolkata, West Bengal, India, from March 2016 to February 2017 on 37 successive admitted erythrodermic patients. Detailed clinical history recording with laboratory tests were performed. Clinical and laboratory data was analysed by percentage using MedCalc version 7.0.0.2 software. Chi-square test was used for data analysis and p-value <0.05 was considered as statistically significant. <b>Results:</b> Of the 37 erythrodermic patients, commonest age group was 40 to 60 years, 16 (43.24%), Male:Female (M:F) ratio 2.1:1, duration of illness in majority from one to six months 20 (54.05%). Chronic dermatitis was the commonest cause of erythroderma, followed by Drug Induced erythroderma, Idiopathic and Malignancy in descending order. Psoriasis was the most common etiology 12 (32.43%). Combination of clinical and histopathological evaluation, diagnosed 31 (83.78%) cases. <b>Conclusion:</b> Erythroderma has high morbidity with low mortality rate. Combination of good clinical history with histopathological evaluation confirms majority of cases and guide for proper management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=WC07-WC12&id=16715 https://doi.org/10.7860/JCDR/2022/53305.16715 Burden of Congenital Haemolytic Anaemias among the Rural Paediatric Population of Central India Manal Ashraf Ali, Minhajuddin Ahmed, Nitesh Upadhyay <b>Introduction:</b> Childhood anaemia may be caused due to many factors, including malnutrition, chronic infections, deficiency of iron and vitamins, parasitic infections. On haematological work up the most common finding is microcytic hypochromic anaemia. Inherited defects in Red Blood Cell (RBC) and haemoglobin structure and metabolism result in congenital haemolytic anaemia. About 4.2% of all paediatric microcytic anaemias are diagnosed with haemoglobinopathies. Thalessaemia and other haemoglobinopathies have a large representation in the Indian subcontinent. A study of the extent of these hereditary anaemias will help in formulating a targeted approach of spreading awareness and educating couples in target population, who are planning conception. <b>Aim:</b> To comprehend the incidence of congenital haemolytic anaemias in the paediatric population of central India, and to evaluate their clinico-haematological status. <b>Materials and Methods:</b> This cross-sectional observational study was conducted in the Paediatric Anaemia Clinic at Chirayu Medical College and Hospital (teaching, tertiary care hospital), Bhopal, Madhya Pradesh, India, from January to December 2021. All relevant details regarding clinical history, consanguinity, family history of the patients were recorded. Investigations done included-complete blood count, reticulocyte count, sickling test, Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) and High Performance Liquid Chromatography (HPLC). All the relevant data collected was entered into Microsoft excel and frequency, distribution, standard deviation were analysed and calculated. <b>Results:</b> Amongst the total 1080 cases of microcytic hypochromic anaemia in the Paediatric Anaemia Clinic, there were 55 cases of congenital haemolytic anaemias. Of these 55 cases of congenital haemolytic anaemias, there were 41 (74.54%) cases of thalassaemia (four major and 37 minor thalassaemia), 11 (20%) cases of sickle cell anaemia, 1 (1.81%) case of Hereditary Persistence of Foetal Haemoglobin (HPFH) and 2 (3.63%) cases of Haemoglobin J variant (HbJ). The haemoglobin values were the lowest in the &#946;-thalassaemia major patients, followed by sickle cell disease. Foetal Hb (HbF) was highest in &#946;-thalassaemia major at and the HPFH case had foetal haemoglobin of 35%. <b>Conclusion:</b> In the current study, 5.09% of the paediatric population presenting to the clinic were diagnosed with congenital haemolytic anaemias, with major representation of &#946;-thalassaemia, followed by sickle cell trait. This lifelong burden of haemolytic anaemias on the children and their families may be reduced by active counseling and awareness programs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC17-EC20&id=16743 https://doi.org/10.7860/JCDR/2022/57388.16743 Correlation of Lipid Profile with Inflammatory Markers among COVID-19 Positive Patients: A Retrospective Study Asha Kumari, Yuthika Agarwal, Sangeeta Bhattacharya Singh, Shikhaa Mahajan, Vivek Sharma <b>Introduction:</b> Lipids are fundamental biomolecules of the body. Infections like Coronavirus Disease-2019 (COVID-19) with intricate immune response in some patient&#8217;s leads to acute complications by affecting metabolic pathways at multiple levels. Metabolism of cholesterol, triglyceride and High Density Lipoprotein-Cholesterol (HDL-C) is deranged by cytokines and multiple inflammatory mediators. The sex differences in lipid metabolism may contribute in susceptibility, severity and outcome COVID-19. Performing lipid profile in COVID-19 patient may help in assessing severity and prognosis of disease. <b>Aim:</b> To assess the relationship between lipid profile and inflammatory markers in COVID-19 patients and also to evaluate the gender-wise differences in lipid parameters and their correlations with inflammatory markers. <b>Materials and Methods:</b> This retrospective study was conducted in Department of Biochemistry at SHKM, GMC, Mewat, Haryana, India (tertiary care health centre) on COVID-19 positive patients attending Outpatient Department (OPD) and Inpatient Department (IPD), from October 2020 to December 2020. The data of 85 patients with COVID-19 positive, confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and who were prescribed for lipid profile along with C-Reactive Protein (CRP) and serum ferritin were included in the study. Serum total cholesterol, triglyceride, HDL-C, CRP and ferritin were measured in the subjects. Data was statistically analysed using Student&#8217;s t-test and Pearson&#8217;s correlation coefficient. <b>Results:</b> Total 85 (46 males and 39 females) COVID-19 patients were included in the study. Mean age in male and female patients were 43.02&#177;15.52 years and 42.02&#177;15.25 years, respectively with a range of 5-82 years. Mean value of Serum triglycerides, HDL-C and total cholesterol was 204.94&#177;141.27 mg/dL, 42.97&#177;13.38 mg/dL and 187.058&#177;45.75 mg/dL, respectively. Serum triglycerides were statistically significantly higher in males than females (p-value=0.0413). The HDL-C, however, was significantly higher in females than males (p-value=0.0006). In male patients, r-value between cholesterol and CRP was -0.3538, and p-value was 0.016. Ferritin had a significant negative correlation with HDL-C (r-value=-0.3578, p-value=0.00079). Weakly positive correlation was noted between triglyceride and ferritin (r-value=0.2285, p-value=0.035). <b>Conclusion:</b> High levels of serum triglycerides, low total cholesterol, and low HDL-C correlates with inflammatory markers like CRP and ferritin in COVID-19 patients. Lipid profile may be used as a potential marker in all COVID-19 patients in assessing prognosis of disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC19-BC23&id=16744 https://doi.org/10.7860/JCDR/2022/55477.16744 Non Invasive Assessment of Fibrosis in Non Alcoholic Fatty Liver Disease by Shear Wave Elastography and NAFLD Fibrosis Score: A Cross-sectional Study BN Vinyasa, Vikram Patil <b>Introduction:</b> The major consequence of Non Alcoholic Fatty Liver Disease (NAFLD) is the inflammation and fibrosis of hepatic tissue resulting in cirrhosis, portal hypertension, and eventually hepatocellular carcinoma. Presently, the distinction between simple steatosis, steatohepatitis, and cirrhosis stages of NAFLD is largely dependent on liver biopsy. Since, liver biopsy is invasive, it is not suitable for screening purposes. To overcome this limitation, elastography and NAFLD fibrosis score have been studied as non invasive objective substitutes for liver biopsy. <b>Aim:</b> To evaluate the diagnostic accuracy of Shear Wave Elastography (SWE) as a method to diagnose significant-advanced fibrosis in patients with NAFLD by using NAFLD fibrosis score as a reference standard. <b>Materials and Methods:</b> This hospital based cross-sectional study was conducted at JSS Hospital, Mysuru, Karnataka, India over a period of 18 months from September 2018 to November 2019.Total 154 participants underwent ultrasound abdomen to assess the presence and grade the degree of steatosis. All patients underwent 2D shear wave elastography and the values were compared with NAFLD fibrosis scores. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) statistics version 23.0. <b>Results:</b> The age of this study group ranged from 20-76 years, mean age was 42.8&#177;10.8 years including 51 (33.1%) females and 103 (66.9%) males. The level of agreement for assessment of fibrosis between SWE and NAFLD fibrosis score was good (score of 0.71). Using a predictive shear stiffness threshold of 6.1 kPa, shear stiffness distinguished low (fibrosis stage 0-2) from high (fibrosis stage 3-4) fibrosis stages with a sensitivity of 83% and a specificity of 92.5% (area under the curve of 0.879). <b>Conclusion:</b> Two-dimensional shear wave elastography showed a good diagnostic performance for detection of fibrosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=TC06-TC10&id=16748 https://doi.org/10.7860/JCDR/2022/50642.16748 Effect of <i>Moringa oleifera</i> Leaf Powder Supplementation in Children with Severe Acute Malnutrition in Gwalior District of Central India: A Randomised Controlled Trial Hemant Yadav, Ajay Gaur, Satvik Chaitanya Bansal <b>Introduction:</b> Child malnutrition is a major public health problem with a significant impact on child survival. In order to tackle this it is important to improve the nutritional quality of complementary and supplementary food while making it inexpensive and easily available. <i>Moringa oleifera</i> is a commonly grown local plant, with high nutritional and medicinal value, can be used as supplement. <b>Aim:</b> To assess the effect of <i>Moringa oleifera</i> leaf powder supplementation on children with Severe Acute Malnutrition (SAM) during facility-based care and home-based care. <b>Materials and Methods:</b> This randomised controlled trial was conducted in the Severe Malnutrition Treatment Unit (SMTU) of Kamla Raja Hospital, Madhya Pradesh, India. A total of 100 children in the age group of 7-59 months admitted between November 2019 to October 2020, who fulfilled the World Health Organisation (WHO) recommended criteria for identification of severe acute malnutrition were included in the study. The children were randomised to routine supplementation alone (control group) and routine supplementation with <i>Moringa</i> leaf powder (intervention group). The anthropometric data was collected at the time of admission to the SMTU, at the time of discharge and every 15 days post discharge for two months. unpaired t-test, Chi-square test and Fischers-exact were used for statistical analysis. <b>Results:</b> There was significant weight gain (p=0.012) in the intervention group as compared to the control group. Similarly the number of children with severe wasting were significantly less (p=0.032) in the intervention group at the end of two months follow-up. There was no significant difference in height, Head Circumference (HC), Chest Circumference (CC), Mid Upper Arm Circumference (MUAC), Subcutaneous Fat Assessment (SCFA), complications observed between both the groups and duration of hospital stay. <b>Conclusion:</b> The use of <i>Moringa oleifera</i> leaf powder supplementation resulted in improved weight gain and reduction in severe wasting at the end of two months. It has the potential to link both facility-based and home-based care of malnourished children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=SC09-SC14&id=16746 https://doi.org/10.7860/JCDR/2022/55126.16746 Seroprevalence and Clinicoepidemiological Profile of Leptospirosis in Acute Febrile Illness Cases at a Medical College in Amritsar, Punjab, India Prabhjot Kaur, Kanwardeep Singh, Loveena Oberoi, Shailpreet Kaur Sidhu, Amandeep Singh <b>Introduction:</b> Leptospirosis is an anthropozoonotic disease; it occurs worldwide but is most common in tropical and subtropical countries. It is usually underreported due to a lack of awareness, atypical presentations and lack of diagnostic facilities, especially in a resource-limited setting like India. Knowing the local prevalence of such infections is of utmost importance for appropriate control and management. <b>Aim:</b> To estimate the seroprevalence of leptospirosis among suspected Acute Febrile Illness (AFI) cases and to assess the clinicoepidemiological profile of leptospirosis cases presented at Government Medical College, Amritsar, Punjab, India. <b>Materials and Methods:</b> This hospital-based cross-sectional study was conducted at Government Medical College, Amritsar, Punjab, India from 1<sup>st</sup> January 2020 to 30<sup>th</sup> June 2021. A total of 360 clinically suspected AFI cases were enrolled in the study. The demographic and clinical profile of the cases were taken on a semi-structured predesigned proforma. Blood sample was collected from the patients, and an Immunoglobulin M (IgM) Enzyme-linked Immunosorbent Assay (ELISA) was done for diagnosis. Data analysis was done using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistical package for windows. <b>Results:</b> Out of 360 AFI cases suspected of leptospirosis, 62 (17.2%) were positive for leptospirosis IgM ELISA. The majority of AFI cases and leptospirosis cases belonged to the 21-40 years age group followed by the 41-60 years age group. Seroprevalence was found to be higher in males (20.8%) as compared to females (12.7%). Maximum seroprevalence (20.1%) was seen during the monsoon season followed by the autumn, summer and winter season. The association between risk exposure to risk factors and leptospirosis seroprevalence was found to be statistically significant (p-value=0.034). Fever, myalgia, headache, nausea/vomiting, icterus and hepatomegaly were common clinical features observed in leptospirosis cases. <b>Conclusion:</b> Leptospirosis has rapidly emerged to become the major cause of AFI in many parts of India. High seroprevalence of leptospirosis was reported among undifferentiated AFI cases in the present study. A programmatic approach towards the prevention, control and management of these emerging diseases in Punjab is highly recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC39-DC43&id=16750 https://doi.org/10.7860/JCDR/2022/56636.16750 Effect of Tamsulosin and URSL on Renal Function and Stone Free Rate in Unilateral Solitary Ureteric Stone: A Prospective Interventional Study Soumya Mondal, Eeshansh Khare, MurariMohan Mandal, Dilip Kumar Pal <b>Introduction:</b> Stones are common cause of obstructive uropathy which may lead to decrease in renal function. Though endourological procedure like Ureteroscopic Lithotripsy (URSL) is commonly done, yet, Medical Expulsive Therapy (MET) is often offered as a first line therapy for mid and distal ureteric stones of size less than one cm. <b>Aim:</b> To compare the effect of Tamsulosin and URSL on renal function and stone free rate for solitary mid and distal ureteric stone. <b>Materials and Methods:</b> This prospective interventional study was done in IPGME&R and SSKM Hospital, Kolkata, West Bengal, India, from May 2020 to October 2020, on the total study population of 50 patients with 26 patients in MET and 24 patients in URSL group. Parameters measured and compared were changes in Glomerular Filtration Rate (GFR) and stone free rate after six weeks of intervention. Numerical variables and categorical variables were compared between two groups using independent t-test and Chi-square test respectively. <b>Results:</b> The mean age of patients in MET (n=26) and URSL group (n=24) was 37.12 years and 33.63 years, respectively. GFR was significantly increased after completion of treatment in individual groups (p-value=0.01) and in final study population but change in GFR was not significant, when compared between the groups (p-value=0.372). Difference in stone clearance rate between two groups was also insignificant (p-value=0.902) whereas, within the groups was significant (p-value <0.05). <b>Conclusion:</b> Tamsulosin for six weeks does not result in significant functional loss in the affected kidney and proved as effective as URSL for mid and distal solitary ureteric stone upto one cm in size with similar stone free rate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=PC08-PC11&id=16751 https://doi.org/10.7860/JCDR/2022/53359.16751 Evaluation of Antifungal Effectiveness of a Novel Probiotic Toothpaste: An In-vitro Study Pavita Kataria, Harpreet Singh <b>Introduction:</b> There is increasing public interest in probiotic healthcare products since their discovery by Élie Metchnikoff in the early 20<sup>th</sup> century. This trend is not only visible in supermarkets and dental practices, but also in the scientific world. An increasing number of clinical trials and laboratory investigations are being conducted to validate the claims made about these products with regards to their antifungal properties. <b>Aim:</b> To evaluate the antifungal properties of commercially available probiotic, anticaries toothpaste, Purexa, against <i>Candida albicans</i> in-vitro. <b>Materials and Methods:</b> An in-vitro study was carried out for a period of three months from December 2021 to February 2022 in the Department of Microbiology, Baba Jaswant Singh Dental College and Research Institute, Patiala, Punjab, India. Two wells were prepared in each blood agar plate containing lawn cultures of Candida albicans. The plates were incubated at 37°C for 24 hours. Purexa toothpaste was poured into one well as test material. The second well was filled with distilled water to act as control. A total of 10 sample plates were made. Antifungal activity was assessed by measuring the Zone of Inhibition (ZOI) in millimeters (mm) using a digital vernier caliper after 24, 48 and 72 hours, and then after one week. Increasing width of zones of inhibition indicated definite antifungal activity of Purexa toothpaste. A p-value <0.05 was considered to be statistically significant. <b>Results:</b> All the sample plates showed definite zones of inhibition at 24 hours, 48 hours, 72 hours and one week intervals around the wells containing the test material, which indicated antifungal efficacy of Purexa probiotic toothpaste. No inhibition zones were seen around the wells containing distilled water. The mean width, if ZOI was the highest at day 7 (28.71 mm), followed by day 2 (26.66 mm), day 3 (26.36 mm) and least on day 1 (25.25 mm). <b>Conclusion:</b> The preliminary data obtained from the present study indicates the prospective use of Purexa probiotic toothpaste in cases, where antifungal activity of toothpaste is desirable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC22-ZC26&id=16752 https://doi.org/10.7860/JCDR/2022/55875.16752 Relationship between Autonomic Functional Status and Maximal Aerobic Capacity Ravi Saini, Sudhanshu Kacker, Reshu Gupta <b>Introduction:</b> Modern autonomic function tests can assess the degree and spread of autonomic dysfunction non invasively. Cardiovagal, pseudomotor and adrenergic autonomic functions could be assessed in standard laboratory tests. Cardio-respiratory Fitness (CRF) also known as aerobic fitness or maximal aerobic power is typically reported as VO<sub>2</sub> max. <b>Aim:</b> To find the relationship between autonomic functional status and maximal aerobic capacity (VO<sub>2</sub> max). <b>Materials and Methods:</b> This observational study was conducted in the Research laboratory of Department of Physiology at RUHS College of Medical Sciences, Jaipur Rajasthan, India, from December 2020 to May 2021. The study included 100 apparently healthy students between 18-25 years of age and not practicing any form of exhaustive physical training (cycling, aerobic, skating, scuba diving, professional sports, track and field, water jogging, walking at 5 mph, competitive gymnasium). Autonomic functional status was assessed by various parasympathetic and sympathetic tests. VO<sub>2</sub> max was assessed by treadmill test using Graded exercise protocol. To found a correlation between VO<sub>2</sub> max and autonomic function test parameters, Pearson&#8217;s Pearson correlation test was done. <b>Results:</b> The subjects had a mean age of 21.03&#177;2.45 years, mean height of 1.64&#177;0.08 m, mean weight of 59.66&#177;11.15 kg and mean Body Mass Index (BMI) of 22.08&#177;3.75 kg/m<sup>2</sup>. Mean height was 1.69&#177;0.06 metre for male subjects and 1.58&#177;0.06 metre for female subjects; mean weight was 62.52&#177;9.52 kg for male subjects and 56.80&#177;11.64 kg for female subjects. Mean BMI was 21.57&#177;3.06 kg/m<sup>2</sup> for male subjects and 22.59&#177;4.3 kg/m<sup>2</sup> for female subjects. Weak positive correlations were found between VO<sub>2</sub> max and autonomic function test parameters, such as Valsalva ratio and hand grip blood pressure response, whereas weak negative correlations were found between VO<sub>2</sub> max and Expiration/Inspiration (E/I) ratio ratio. VO<sub>2</sub> max had a weak positive association (r-value=0.024) with Valsalva ratio and Blood pressure response to hand grip test (r-value=0.111), but a weak negative correlation (r-value=-0.019) with E/I ratio in males. <b>Conclusion:</b> Regular aerobic exercise appears to be associated with decrease in sympathetic responses and increase in parasympathetic responses. The present study indicated the existence of gender differences in autonomic function tests in young adults of 18-25 years of age due to difference. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=CC17-CC21&id=16753 https://doi.org/10.7860/JCDR/2022/56005.16753 Effectiveness of Yoga on Quality of Life among Patients with Depression: A Randomised Controlled Trial Nitu Kumari, Anuradha Yadav, Namit Garg, Kavita Yadav, Manisha Sankhla, Sai Sailesh Kumar Goothy, Anita Choudhary <b>Introduction:</b> Depression is the overriding reason for disability and its global prevalence has been increasing in recent decades. Depression is a substantial contributor to the global disease burden and a crucial determinant of quality of life and survival. <b>Aim:</b> To determine the quality of life of patients with depression who received yoga intervention and compare it to patients who received conventional antidepressant medication (without yoga intervention) in terms of various domains. <b>Materials and Methods:</b> This randomised controlled trial was conducted in Department of Physiology with the collaboration of the Department of Psychiatry at Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from November 2018 to February 2020. The study involved clinically diagnosed 60 patients with mild to moderate depression between the age groups of 18 to 45 years. The participants were split into two groups. The participants were split into two groups: interventional and control. The interventional group received a set of yoga exercises for three months in addition to conventional antidepressant treatment, while the control group received only conventional antidepressant treatment for the same duration. The World Health Organisation Quality of Life-BREF (WHOQOL-BREF) scale was used to assess the quality of life in both study groups at baseline, and after one month and three months. The unpaired Student&#8217;s t-test and repeated measures Analysis of Variance (ANOVA) were applied for two and more groups respectively. A p-value <0.05 was considered as statistically significant. <b>Results:</b> The present study included 60 patients with depression; out of them 39 were male and 21 were females. A statistically significant difference was observed in WHOQOL-BREF scores between the interventional and control group in the physical (p-value<0.001) and psychological health (p-value<0.001) domain after three months of follow-up, but it was more improved among the interventional group. A significant difference was observed after one month in the interventional group in overall quality of life (p-value=0.004), physical (p-value<0.001), and psychological health domain (p-value=0.009) of quality of life. While in the control group, physical (p-value<0.001) and psychological health domain (p-value<0.001), as well as social relationships domain (p-value=0.015) significantly improved after three months of antidepressant treatment. <b>Conclusion:</b> Three month of yoga practice improved the overall quality of life and all domains of quality of life. Whereas, three months of conventional antidepressant treatment improved only physical, psychological health and social relationship. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=CC22-CC27&id=16754 https://doi.org/10.7860/JCDR/2022/56068.16754 Utilisation of Antenatal Care Services and its Determinants among Pregnant Women Attending Tertiary Care Hospital in Western India: A Cross-sectional Study Nitin Lodha <b>Introduction:</b> Good quality Antenatal Care (ANC) is not uniformly distributed in the community. A better ANC coverage not only ensures a safer outcome from pregnancy but also provides a platform for improving the health status of mother and baby. <b>Aim:</b> To assess the utilisation of ANC services among the pregnant women and to study the associated factors related to utilisation of ANC. <b>Materials and Methods:</b> This was a hospital-based cross-sectional study conducted among 250 full term pregnant women in tertiary care hospital in Vadnagar, Gujarat, India from June 2021 to August 2021. Systemic random sampling technique was adapted to select required participants. Women were interviewed, using predesigned and pretested semi-structured proforma, to assess the ANC received by them. Categorical variables were expressed as frequency and proportions, continuous variables as mean and standard deviation. Chi-square test was used to found association between comprehensive ANC and various determinants affecting it and logistic regressions were applied to find out the predictors. <b>Results:</b> Mean age of the participants were 25.31&#177;4.09 years. A total of 205 (82%) of participants were literate and 210 (84%) pregnant women were from rural area. About 69.2% participants belonged to joint family and 92.4% were housewife. Majority of the participants were from class IV (63.6%) and V (16%) socio-economic class. About 66% participants were multigravida. All study participants were registered. A 87.2% women had early registration of pregnancy (within 12 weeks), 93.6% had atleast four ANC visits, 98.4% had taken two doses or one booster dose of Tetnus Toxoid (TT) injections and 71.2% women had taken minimum 100 iron and folic acid tablets. Total 69.2% of the mothers had received the full ANC. Significant relation was found between utilisation of full ANC with age of women, residence area, education, socio-economic class and parity. <b>Conclusion:</b> Full ANC utilisation was inadequate. Most of the indicators seemed better, only Iron Folic Acid (IFA) tablets consumption was poor. There is a need for intensified and targeted awareness programs for pregnant women on the importance of antenatal visits and utilisation of various services. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LC22-LC26&id=16755 https://doi.org/10.7860/JCDR/2022/58290.16755 Efficacy of Intranasal Dexmedetomidine with Lidocaine versus Intranasal Lidocaine alone in Awake Fiberoptic Nasotracheal Intubation- A Randomised Clinical Study Mandeep Kaur, Parmod Kumar, Balwinder Kaur Rekhi, K Priyaa Cathrine <b>Introduction:</b> Awake Fiberoptic Intubation (AFOI) is considered as the gold standard technique in patients with predicted and unpredicted difficult airway. It is best performed with the patient awake to maintain spontaneous ventilation. Dexmedetomidine has been successful in several clinical settings including AFOI due to its diverse actions like sedation, analgesia, anxiolysis, cardiovascular stabilising effect and preservation of respiratory function. <b>Aim:</b> To assess the efficacy of using dexmedetomidine intranasally with lidocaine in AFOI in comparison to using lidocaine alone in terms of haemodynamic stability, sedation, ease of intubation, patient&#8217;s satisfaction with the procedure and reduction in intraoperative propofol requirement. <b>Materials and Methods:</b> This randomised clinical study was conducted on 100 patients of either gender aged between 18 to 60 years with American Society of Anesthesiologists (ASA) physical status I or II scheduled for elective surgeries under general anaesthesia at Government Medical College and Rajindra Hospital, Patiala, India from February 2021 to November 2021. The patients were randomly divided into two groups of 50 each namely group D (intranasal dexmedetomidine 2 mcg/kg+lidocaine 10%) and group L (intranasal lidocaine 10% alone). Maximum dose of 10% lidocaine was <5 mg/kg body weight in both groups.The various parameters were recorded in both the groups during AFOI and the data was analysed using Statistical Package for Social Sciences (SPSS) software version 22.0 and Microsoft excel. Descriptive statistics was done for all data and were reported in terms of mean, standard deviation and percentages. <b>Results:</b> Among 100 patients, group D and group L comprises of 50 each. The mean heart rate during AFOI was 70.16&#177;8.02 in group D, and 95.62&#177;11.04 in group L. The Mean Arterial Pressure (MAP) during AFOI was 81.42&#177;5.55 in group D and 101.78&#177;6.22 in group L. There was statistically highly significant (p-value <0.001) decrease in mean heart rate and MAP (within normal clinical range) in group D as compared to group L. The mean Ramsay Sedation Scale (RSS) in group D was 3.66&#177;0.48 and in group L was 2.32&#177;0.55 (p-value <0.001). There was a significant difference (p-value <0.001) in patient tolerance, time to intubation, propofol requirement, patient satisfaction and anaesthesiologist satisfaction between the two groups. There was no significant decrease in Saturation of Peripheral Oxygen (SpO<sub>2</sub>) or respiratory depression in both groups (p-value=0.221). <b>Conclusion:</b> Intranasal dexmedetomidine with lidocaine provides better haemodynamic stability and improves the quality of intubation, reduces propofol requirement, provides good patient and anaesthesiologist satisfaction and maintains oxygen saturation during AFOI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UC18-UC22&id=16756 https://doi.org/10.7860/JCDR/2022/55878.16756 Determination of Incidence of Soft Tissue Reactions after Total Hip Replacement using Elastography and Role of Elastography in Screening of Periprosthetic Soft Tissue: A Prospective Observational Study Ruchit Khera, Parvinder Singh Sandhu, Hardas Singh Sandhu, Atul Kapoor <b>Introduction:</b> Adverse local tissue reactions after Total Hip Replacement (THR) have been widely described in literature recently as a course of aseptic loosening. Evaluation for any adverse soft tissue reactions is challenging with traditional imaging techniques like Magnetic Resonance Imaging (MRI), and are limited, due to production of metallic artifact. Ultrasound, specifically its refined form elastography, has emerged recently as a useful tool for assessing the soft tissues. <b>Aim:</b> To determine the incidence of soft tissue reactions in cases of THR and to evaluate role of elastography in assessment of periprosthetic soft tissue. <b>Materials and Methods:</b> This prospective observational study was conducted in the Department of Orthopaedics at Dr. Hardas Singh Orthopaedic Hospital, Amritsar, Punjab, India, from May 2013 to April 2014. Study comprises of consecutively followed-up 66 hips which were evaluated and assessed clinically and radiologically using ultrasound elastography for periprosthetic soft tissue and degree of fibrosis. The MRI was done in patients with positive findings only. Diagnosis was then confirmed with biopsy in patients who underwent revision surgery. Incidence of clinical symptoms, implant loosening, stability of implant, various types of soft tissue reactions, pseudotumour formation and synovial hypertrophy were determined and association between clinical and radiological findings was done. Chi-square test was determined to see the statistical significance. <b>Results:</b> Total of 66 hips were studied in 60 patients with mean age of 56.08&#177;16.55 years (26-95 years). The incidence of soft tissue reactions observed in the study was 55 (83.3%), of all 66 hips 36 were symptomatic, implant loosening was seen in 29 hips, pseudotumours were detected in 3 (4.5%) hips, cystic nodules in 2 (3.0%) hips, enlarged lymphnodes in one (1.5%) hip, fibrogranuloma in 2 (3%) hips and synovial thickening was seen in 12 hips. Association of Harris Hip Score with capsular thickness, implant stability, acetabular loosening, joint congruency and degree of peritrochanteric fibrosis was found to be statistically significant. <b>Conclusion:</b> The study shows a substantially higher incidence of soft tissue reaction and capsular hypertrophy following THR. Ultrasound elastography is a good screening tool to detect early soft tissue changes in periprosthetic tissue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=RC11-RC16&id=16757 https://doi.org/10.7860/JCDR/2022/56366.16757 Neutralising Antibodies in Healthcare Workers after Two Doses of Covishield Vaccine at Three Months and Six Months: A Single-centre Observational Study J Naveena, MP Nandhini, K Kavitha, CN Manjunath, Amulya Cherukumudi, N Prapulla <b>Introduction:</b> The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) as a pandemic has put the global population at risk for its infection. It has also led to an accelerated effort to develop vaccines that can mitigate progression to severe infections at a minimum. The ambiguity about existence of antibodies in the human serum poses problem in formulating public health policies like suitable interval between doses of vaccines, appropriate time for vaccinating population, post natural infection, necessity of booster doses along with single dose. <b>Aim:</b> To estimate neutralising antibody level following Covishield vaccination of Healthcare Workers (HCWs) after three months and six months, respectively. <b>Materials and Methods:</b> This was a prospective observational study performed in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India after Institutional Ethics Committee (IEC) approval from January 2021 to February 2022. The study was conducted in 304 HCWs in the institute who had received two doses of Recombinant ChAdOx1 nCoV-19 Coronavirus Vaccine (Covishield). Forty one HCWs who were naturally infected with SARS-CoV-2 either before or after vaccination were also included. These participants were then subjected to IgG neutralising antibody titre estimation at three months and six months, postvaccination. The data was entered in MS excel spreadsheet 2016 and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0. <b>Results:</b> The study included 304 eligible HCWs. Majority of the participants belonged to the age group of 31-40 years (35.9%). Majority of the study participants were females (51%). Of the 304 participants, 263 were uninfected and 41 participants had been infected before and after vaccination. At the six month follow-up, it was observed that all except one HCW had seroconverted with majority of the participants showing more than 60% antibody level. Participants in the age group of 31-40 years showed the highest level and this observation was found to be statistically significant. <b>Conclusion:</b> Neutralising antibody response in HCWs is a key indicator of the efficacy of the vaccination program for Coronavirus Disease-2019 (COVID-19) in India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC44-DC47&id=16758 https://doi.org/10.7860/JCDR/2022/56189.16758 Assessment of Factors Influencing the Positivity of Blood Culture by BacT/ALERT®3D Microbial Detection System: A Cross-sectional Observational Study Riddhi Patel, Naimikaben Patel, Rupal Patel <b>Introduction:</b> Bloodstream Infections (BSI) are defined as the presence of living microorganisms in the blood. It is a systemic condition that can result in life-threatening sepsis, thus leading to high morbidity and mortality. Blood cultures have become critically important. Positive blood culture results can help a clinician&#8217;s early diagnosis and start empirical antimicrobial at the correct time. Today many laboratories use modern, automated, continuous-monitoring blood culture systems for the detection of bacterial growth for blood culture. At our hospital, blood culture is done by using automated detection in BacT/Alert instrument (Biomerieux, France). <b>Aim:</b> To determine the effect of number of blood cultures and volume of blood on positivity rates, contamination rate in blood cultures, and rate of false-positive blood cultures. <b>Materials and Methods:</b> The present study was a cross-sectional observational study conducted from 1st May 2019 to 31st July 2019. Blood culture requests of all patients were included in the study. All blood culture bottles were processed as per standard laboratory protocols. The effect of number of blood cultures and amount of blood volume on positivity rate, contamination rate, and false-positive blood cultures were studied in detail. The patient&#8217;s details and microbiological result parameters were extracted from Laboratory Information System (LIS). All the data was analysed in Microsoft Excel 2010. <b>Results:</b> A total of 761 blood culture bottles were received at the Microbiology laboratory from 604 patients. Maximum (30%) blood cultures were received from 0-10 years of age group. A total of 31% (236/761) of blood cultures were positive. The true pathogen positivity rate was 41.1% and the contamination rate was 58.9%. Single (74.4%) blood culture requests were more than two (25.3%) or three (0.3%) blood cultures. True pathogens were isolated in 9% (41/449) of single blood cultures and in 18% (56/306) of two blood cultures. Overall, 42% of blood cultures had adequate volume and 58% of blood cultures had inadequate volume. However, the true pathogen positivity rate was 14% (61/444) from bottles with inadequate volume and 11% (36/317) from bottles with adequate volume. Out of 236 positive blood cultures, 139 (59%) were identified as contaminants. A total of 5/761 (0.7%) blood cultures were identified as false positive blood cultures. <b>Conclusion:</b> Based on the study findings, a step should be taken to discourage single blood culture and to encourage multiple blood cultures for the diagnosis and better patient care. Although, volume of blood is important, inadequate volume did not affect true pathogen positivity rate in present study. Contamination rate of blood cultures is a major concern and regular training of the concerned staff regarding strict asepsis should be implemented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC48-DC52&id=16759 https://doi.org/10.7860/JCDR/2022/56676.16759 Protective Action of Phosphorus 6CH in SARS-CoV-2 Spike Protein Induced Pathogenecity in <i>Gallus-gallus</i> Embryo Debasmita Chatterjee, Krishnendu Paira, Pritam Goswami, Sayak Ghosh, Dharitri Choudhuri, Satadal Das <b>Introduction:</b> In the search of effective medicines against Coronavirus Disease-2019 (COVID-19) besides the conventional mode of treatment many medicines belonging to alternative therapeutics claimed to be effective in this disease. In homeopathy- a branch of alternative medicine, some medicines are claimed to be effective in COVID-19 after human trials. <b>Aim:</b> To study whether ultradiluted preparation of Phosphorus 6CH (centesimal (C) dilutions, using Hanhemann&#8217;s (H) dilution method) can protect damaging action of Delta Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) spike protein Receptor Binding Domain (RBD) in <i>Gallus gallus</i> embryo in relation to their gross appearances, histopathological changes and cytokine changes. <b>Materials and Methods:</b> The present in-vivo study was an experimental analysis carried out at the Genetic Research Laboratory of Heritage Institute of Technology, Kolkata, West Bengal, India. The whole experimental study was on 20,000 subjects in a time period of November 2021 to January 2022 and the data collected were analysed using statistical software Minitab. About 14 days old <i>Gallus gallus</i> embryonated eggs were inoculated with the antigen along with the vehicle alcohol controls. The Phosphorus 6CH was used to see whether it can prevent or cure the damaging action of the spike protein in the embryo in different experimental sets. <b>Results:</b> The notable finding in this experiment is the remarkable elevated expression of Interleukin (IL)-10 gene in the curative, preventive sets as well as in the medicine control sets in comparison to antigen and alcohol control sets. In case of Transforming Growth Factor, (TGF) &#946;1 there was enhanced expression of TGF &#946;1 gene in the alcohol 6C set and antigen set which gets ameliorated with Phosphorus 6CH. The morbid anatomy of the embryo and the histopathological picture of the liver of the embryo also reflected similar findings in these two experimental sets. After statistical analysis it was found that there was significant correlation in between Interferon (IF) &#947; and IL-10 in these experimental results which appears very important. <b>Conclusion:</b> The homeopathic medicine phosphorus 6CH is capable of maintaining cytokine balance in Delta SARS-CoV-2 spike protein RBD induced pathogenecity in <i>Gallus gallus</i> embryo. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC53-DC57&id=16760 https://doi.org/10.7860/JCDR/2022/56788.16760 Cross-cultural Adaptation and Psychometric Properties of the Gujarati Version of Rapid Assessment of Physical Activity Dharti Shah, Subhash Khatri <b>Introduction:</b> Physical activity is an important factor for healthy ageing and inactivity can lead to various disorders. The Rapid Assessment of Physical Activity (RAPA) is an established method for assessing physical activity in adults aged over 50 years. <b>Aim:</b> To compare the cross-cultural adaptation and translation of English RAPA into Gujarati language and to identify the psychometric properties of the Gujarati RAPA. <b>Materials and Methods:</b> This cross-sectional study was carried out from October 2021 to February 2022 with the original author&#8217;s permission and the study was completed in three phases (i) Translation and cross-cultural adaptation (ii) Face and content validity (iii) Test-retest reliability. The author&#8217;s suggested procedure was undertaken for translation and the consensus method was used for face and content validity. Total nine experts from different fields examined each item of the Gujarati RAPA. Total 108 participants were included in the study and to find test-retest reliability, one week interval was used. <b>Results:</b> Total 108 participants with mean age of 61.6&#177;7.82 years were studied. The Content Validity Ratio (CVR) for item 1 was 0.88 and for all other items, the value was 1. Item-Content Validity Index (I-CVI) value of all the items of Gujarati RAPA was >0.79%. Test-retest reliability measured by weighted kappa k (for RAPA1: 0.82 and RAPA2: 0.73) was very good. <b>Conclusion:</b> Gujarati RAPA had good face and content validity and very good test-retest reliability. Hence, it is a useful tool for the assessment of physical activity in Gujarati speaking population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=YC01-YC04&id=16761 https://doi.org/10.7860/JCDR/2022/58115.16761 Qualitative Assessment of Different Face Masks using Povidone-Iodine in Comparison to Standard Saccharin Method Amogh Ratnaparkhi, Sapna Malik <b>Introduction:</b> The World Health Organisation (WHO) recommends that N95 masks should be used by healthcare workers and patients. Given the shortage, extended use and reuse of masks, it becomes imperative to test the filtration efficacy. Surgical masks and cloth covers should also be assessed for their protection factor, since their use is more prevalent among the general population, and these masks are not certified by National Institute for Occupational Safety and Health (NIOSH). Occupational Safety and Health Administration (OSHA) is the authority for the standard testing and certification of Filtering Face Pieces (FFPs) in the USA; its equivalent in India is the Bureau of Indian Standards (BIS). The BIS recently relaxed the certification guidelines for both N95 and Surgical Masks; thus, even certified masks may prove to be inefficient. <b>Aim:</b> To assess different face masks using povidone-iodine in comparison to standard saccharin method. <b>Materials and Methods:</b> A cross-sectional study was carried out in a tertiary care hospital in western India from August 2021 to October 2021. A novel, qualitative (and semi-quantitative) function test using an aerosol of iodine solution and detector strips of starch-iodide paper was studied to prove for efficacy of masks by 15 volunteers and various masks of different types (surgical, N95, cloth) over three months. This method provides a rapid, simple and cost-effective assessment of respirator efficacy. <b>Results:</b> Thirty five masks (N95, Surgical, Cloth and Silver nanoparticle) were tested, of which N95 - 90% pass the test. A 2 out of 5 trials of the double layered cloth mask + surgical mask combination passed both the iodine and saccharin tests. The sensitivity and specificity of proposed iodine test in comparison to standard saccharin test were (10/10, 100%) and (22/25, 88%). <b>Conclusion:</b> Povidone-iodine method is a qualitative assessment which is a crude indicator of mask function as the masks that fail both tests will provide some degree of protection from airborne particles, and concentrations of many respiratory organisms. The N95 masks along with the double masks (surgical and cloth) passed the tests proving their efficacy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC58-DC63&id=16762 https://doi.org/10.7860/JCDR/2022/54944.16762 Perception and Attitude of Students and Teaching Faculty on Continuous Cumulative Evaluation System in Dental Education Rashmi Venkatesh, Seema Bargale, Monali Shah <b>Introduction:</b> Continuous Cumulative Evaluation System (CCES) is an innovative formative evaluation system practiced in Sumandeep Vidyapeeth which is located in Gujarat, India. The CCES is carried out during the conduct of course and every undergraduate student is evaluated for his/her performance in theory lectures and/or in clinical and/or practical classes daily. The cumulative marks secured by the student for entire academic year is calculated and part of it goes as internal assessment marks which will be added to their summative evaluation. <b>Aim:</b> To evaluate the perception and attitude of dental students and teaching faculty regarding CCES. <b>Materials and Methods:</b> In this cross-sectional study, self-prepared validated questionnaires were distributed amongst dental students and teaching faculty of K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Total 42 faculty questionnaire and 300 student questionnaires were distributed. Questionnaire for teaching faculty consisted of eight questions while questionnaire for students consisted of six questions. Collected data from filled questionnaires were subjected to descriptive statistics and the significance of differences among responses depending on seniority of faculty in faculty group and by year of study in student group was determined by Chi-square test. <b>Results:</b> The response rate of the study questionnaire was 83.33% (n=35) and 92% (n=276) for faculty and students respectively. Both students (100%) and the faculty (91.42%) were open to implementation of newer evidence-based evaluation methodologies in curriculum. The junior faculty felt (n=14, 82.35%) difficulty in adapting to CCES system. Both faculty (n=24, 68.57%) and students (n=257, 93.11%) agreed that CCES in every lecture has increased the students attentiveness in theory class. <b>Conclusion:</b> The CCES as an innovative evaluation system is well accepted by teaching faculty and students of K M Shah Dental college and Hospital, Sumandeep Vidyapeeth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC27-ZC30&id=16763 https://doi.org/10.7860/JCDR/2022/56643.16763 Effect of Stress on Heart Rate Variability in Medical Students: A Cross-sectional Study Vijaya Y Vageesh, T Bharath <b>Introduction:</b> Medical education can impose significant psychological stress on undergraduate students. A considerable degree of psychological morbidity has been reported among medical students ranging from stress, interpersonal problems, and suicidal ideation to psychiatric disorders and they tend to have greater psychological distress than the general population. Stress is one of the factors known to cause variation in heart rate variability. Heart Rate Variability (HRV) is a proven reliable non invasive marker of cardiovascular health and has been used in cardiovascular risk stratification. <b>Aim:</b> To study the effect of stress on heart rate variability in medical students. <b>Materials and Methods:</b> The cross-sectional study was conducted in the Department of Physiology at JSS Medical College, Mysuru, Karnataka, India, from December 2017 to February 2018. Total 58 healthy first-year MBBS medical students aged between 18-25 years with normal Body Mass Index (BMI) were included in the study. The Medical Student Stressor Questionnaire (MSSQ), a validated instrument to identify sources of stress in medical students was used to assess the level of stress. AD Instruments PowerLab (Data Acquisition System) was used to record the frequency and time domain analysis of HRV from the limb leads. Kruskal-Wallis test was applied to assess the association between stress domains and HRV domains, using Statistical Package for Social Sciences (SPSS) version 23.0. <b>Results:</b> Most of the medical students had mild to moderate degrees of stress in all the domains of the MSSQ. There was no statistically significant (p-value>0.05) association found between domains of stress with the time and frequency domains of the HRV. <b>Conclusion:</b> Though it was found that medical students were exposed to significant stressors during their medical training, the stress was of mild to a moderate degree which had no significant effect on HRV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=CC01-CC04&id=16678 https://doi.org/10.7860/JCDR/2022/53713.16678 Evaluation of Self-directed Learning Readiness among Students of Medicine and Allied Branches in South Kashmir, India Mehak Mufti, Shaugfa Aara, Haneen Beg, Mudasir Dar, Mohsina Mukhtar <b>Introduction:</b> The aim of Self-directed Learning (SDL) is to motivate the undergraduate student to become a lifelong learner who plays an active role in the acquisition of knowledge and skills. With the implementation of competency based medical education (CBME) in 2019, SDL has become an integral part of the curriculum hence it is important to know whether our students are ready for it or not. <b>Aim:</b> To assess the readiness of the students of Medical College and college of Nursing and Paramedical sciences, Government medical college, Anantnag for SDL. <b>Materials and Methods:</b> An institution based cross-sectional study was conducted on 295 undergraduate medical and paramedical students of Government medical college, Anantnag, Jammu and Kashmir, India. Williamson&#8217;s SDL readiness scale (SDLRS) was provided to the students who were instructed to describe themselves by indicating on the Likert scale, the extent to which the item best described their personal attitude. The score ranges from 60 to 300. Data was calculated in form of frequency (n) and percentages (%) and was analysed by using Pearson Chi-square test. <b>Results:</b> Out of the 295 students (150 were boys and 145 were girls, 195 medical and 100 paramedical students), mean age 19.07&#177;0.762 years, who took part in the study, 40% (N=118) had high readiness scores, 52.88% (N=156) had moderate score and 7.12% (N=21) had low score. A total of 45.52 % (N=66) of girls had high readiness as compared to 34.66% (N=52) boys. Nursing and paramedical students appeared to be more ready for SDL than Bachelor of Medicine and Bachelor of Surgery (MBBS) students as 52% (N=52) of nursing and paramedical students had a high score whereas only 33.85 % (N=66) of medical students had a high score and this difference was statistically significant (p-value <0.001). <b>Conclusion:</b> Most of the medical and paramedical students seem to be ready for self-directed learning and paramedics are more ready for SDL than medical students. Female students seem to be more receptive for SDL as compared to male students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=CC05-CC07&id=16679 https://doi.org/10.7860/JCDR/2022/57749.16679 Knowledge, Attitude and Practices Regarding Tuberculosis among Outpatients of a Rural Field Practice Area: A Cross-sectional Study in Uttar Pradesh, India Neha Agrawal, Ashok Kumar, Nawazish Ali, Sandeep Kumar Uppadhaya, Hemant Kumar Singh <b>Introduction:</b> Tuberculosis (TB) is a significant cause of morbidity worldwide, especially in the low and middle-income countries like India and is found to be more common in the rural areas. Delays in diagnosis and initiation of treatment along with lower treatment adherence and completion rates have increased the morbidity and mortality of TB in the rural areas. The collation of information accumulated through the assessment of people&#8217;s Knowledge, Attitude, and Practices (KAP) towards TB, helps in charting new health programs for the public, identifying lacunae, and devising interventions based on these lacunae which in turn will help us to achieve the vision of a &#8220;TB free India&#8221; by 2025. <b>Aim:</b> To find out KAP and any association amongst them regarding TB among the study subjects. <b>Materials and Methods:</b> This was a cross-sectional study conducted on patients attending Outpatient Department (OPD) at the Rural Health Training Centre (RHTC) attached to NCR Institute of Medical Sciences, Meerut, Uttar Pradesh, India, during January 2021 to April 2021. From a sample of 106 patients data of KAP regarding TB was collected via a structured questionnaire which was predesigned and pretested. Pearson&#8217;s Chi-square test was used to ascertain the association between subjects&#8217; KAP about TB. A p-value <0.05 was taken as the predictor of statistical significance. <b>Results:</b> Out of 106 patients, 72 (67.92%), 80 (75.47%) and 52 (49.06%) had adequate KAP respectively. Participants having adequate knowledge showed positive attitude and good practices and this association was found to be statistically significant. <b>Conclusion:</b> The study results reflect that having adequate knowledge of the disease transforms into good practices and a positive attitude towards a person suffering from the said disease as well as helps the people to have a positive frame of mind in case they themselves contract the disease. Health education and behaviour change communication hence needs to be scaled up in rural communities to prevent, detect and treat tuberculosis in order to achieve a TB free India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LC06-LC11&id=16691 https://doi.org/10.7860/JCDR/2022/57590.16691 Lymphovascular Invasion and Ductal In-situ Components in Operable Infiltrating Duct Carcinoma of Breast- A Single Centre Experience Shyama Sasidharan, Ravindran Chirukandath, Sharath Krishnan, Rinza Nazrin, MS Meera, PB Veeshma <b>Introduction:</b> Lymphovascular Invasion (LVI) in carcinoma breast is a significant prognostic factor in invasive breast cancer, with respect to local and distant recurrence and poor survival. Infiltrating duct carcinoma with accompanying ductal carcinoma in-situ has shown significantly different expression patterns of Her2/neu, progesterone receptors and Ki67 than infiltrating duct carcinoma. <b>Aim:</b> To associate the significance of LVI and concomitant in-situ component with the receptor status and clinicopathological characteristics of infiltrative duct carcinoma. <b>Materials and Methods:</b> This retrospective study was conducted in a single unit in the Department Of General Surgery, Government Medical College, Thrissur, Kerala, India, for two months between June 2021 and July 2021 and data was analysed in August 2021. This study was conducted in a systematic manner to review all the operated infiltrative duct carcinoma patients from a single cohort in 100 patients based on surgical intervention. The collected data were entered in Microsoft Excel worksheet and the results were analysed statistically using Statistical Package of the Social Sciences (SPSS)-16. Chi-square test was used, considering p-value &#8804;0.05 as a significant. <b>Results:</b> The mean age of the study population was 55.6&#177;15 years with maximum number of patients above 60 years. In total 64% of the patients had tumour size of 2-5 cm (pT2) and 59% of the cases had no lymph nodal metastasis (pN0). 28 cases (28%) showed concomitant in-situ component and 37 cases showed lymphovascular invasion (37%). The presence of lymphovascular invasion, was found to be significantly associated with Her2 positivity (p=0.045). Concomitant in-situ component also seemed to increase the likelihood of lymphovascular invasion (p=0.0320). There was significant positive correlation observed between LVI and Her2 (r=0.238, p=0.045) and in-situ component (0.214; p=0.032). However, no significant association was observed between LVI and other clinicopathological variables. <b>Conclusion:</b> The LVI is a significant prognostic factor in invasive breast cancer associated with poor survival and definitely carries a significant association with Her2 Status and also reflected on the concomitant in-situ carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=PC01-PC04&id=16692 https://doi.org/10.7860/JCDR/2022/51608.16692 Retinal Vessel Parameters and Choroidal Thickness using Optical Coherence Tomography and OCT Angiogram in Normal Children: A Cross-sectional Study Florida Selus, Saban Horo, Thomas Kuriakose, Mahasampath Gowri, Deepa John <b>Introduction:</b> Optical Coherence Tomography (OCT) and OCT Angiogram (OCT-A) are non invasive techniques for imaging the microvasculature of retina and choroid. OCT is a method of analysing the in-vivo retinal architecture. OCT uses low coherence interferometry to create a cross-sectional map of the retina with a resolution of 10-15 &#956;m. Swept Source OCT utilises light source of 1050 nm wavelength and can reproducibly measure choroidal thickness. OCT-A uses the principle of motion contrast, where the moving red blood cells are traced to depict vessels through different segments of the retina. The same tissue area is imaged repeatedly and differences are analysed between scans to detect area with high flow rates, low flow and no flow at all. Only a few studies have been reported on baseline choroidal thickness and retinal vessel parameters in children. This study was conducted to measure these parameters using Swept source OCT in normal children. <b>Aim:</b> To measure retinal vasculature parameters and choroidal thickness using OCT and OCT-A in normal children. <b>Materials and Methods:</b> A cross-sectional study was conducted on 68 children between 5-15 years of age in Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India between February to July 2018, after obtaining the ethical clearance from the Institutional Review Board. The children were divided into two groups, 5-10 years and >10-15 years. Children with Best Corrected Visual Acuity (BCVA) <6/6, axial length <20/>25 mm, any systemic disease or ocular pathology were excluded. All underwent comprehensive ophthalmic examination along with fundus photography, OCT and OCTA imaging. Retinal artery and vein calibre at the disc margin and Subfoveal Choroidal Thickness (SFCT) were measured. Measurement of Foveal Avascular Zone (FAZ) both superficial and deep, Vascular Density (VD) of perifoveal, papillary and peripapillary area were obtained from OCT-A. T-test was used to compare the parameters with p-value <0.05 considered as significant. <b>Results:</b> A total of 136 eyes were included. Mean retinal artery measured at superior and inferior disc margin was 176.84&#177;43.88 &#956;m and 177.78&#177;41.69 &#956;m respectively. Mean retinal vein measured at superior and inferior disc margin was 218.90&#177;46.36 &#956;m and 235.37&#177;48.07 &#956;m respectively. Perifoveal images were clear and vessel densities could be anlaysed but papillary and peripapillary vessel densities were not analysed due to poor image quality in many subjects. The mean retinal artery caliber in the age group 5-10 years was 179.85&#177;45.62 &#956;m and 174.00&#177;42.30 &#956;m in the age group >10-15 years at the superior disc margin with p-value of (0.4403). There was no statistical difference retinal vessel caliber between the two groups. The mean SFCT in the 5-10 years group was 344.42&#177;86.77 &#956;m and 343.40&#177; 93.56 &#956;m in the other with a p value 0.9474. The mean superficial FAZ (SFAZ) was 189.79&#177;117.11 &#956;m<sup>2</sup> in the first group and 264.88&#177;169.91 &#956;m<sup>2</sup> in the second group, (p=0.0034). There was no statistical difference among these parameters between the two groups except SFAZ. <b>Conclusion:</b> Present study describes the normative data on retinal vasculature parameters and choroidal thickness in Indian paediatric population aged 5-15 years using OCT and OCT-A. The study findings will further help in screening and monitoring the subjects in this age group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=NC01-NC04&id=16693 https://doi.org/10.7860/JCDR/2022/56707.16693 Hybrid Immunity in SARS-CoV-2: Are Antibody Responses Similar in all Infected and AZD1222 Vaccinated Persons? Sajitha Musthafa, James Chithra, R Sajithkumar, Kummannoor Venugopal, MS Suma <b>Introduction:</b> There is a diversity in population regarding the number and doses of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines and past infection status and the antibody titres may be different across various groups. The antibody titres determined in the same time-frame after the immune evoking event may give clues regarding the prioritisation for boosters and factors causing variability in titres. <b>Aim:</b> To compare and assess the Immunoglobulin G (IgG) anti-spike (S) antibody titres among the Healthcare Workers (HCWs) with history of Adenovirus vector based vaccine AZD1222 (Covishield) and infections, in different orders. <b>Materials and Methods:</b> An observational cross-sectional cohort study was conducted in a tertiary care centre during November 2021 to December 2021. The antibody titres of a healthy cohort of HCWs (n=178) who were either double-vaccinated with no history of SARS-CoV-2 infection or vaccinated but along with a history of SARS-CoV-2 infection were determined six weeks after the last event (infection/vaccination). They were grouped based on the order of vaccination (V) and infection (I). <b>Results:</b> The major groups were group 1 (V+V), group 2 (I+V+V), group 3 (V+ V+ I) and group 4 (V+I+V). The highest titres of Anti-S IgG antibody observed in vaccinated with breakthrough infection group 3-V+V+I (n=71) {20662(10853-34744)}. The group with double vaccination but with no history of infection {group 1-V+V (N=49)} had the lowest titres - {2395(844.4-7443)}. The hybrid immunity group (those who had infection which was followed by vaccination) group 2 (I+V+V) had titres 4241 (2220-7373) and group 4 (V+I+V) had titres 6542 (3772-11700) which were lower than those with breakthrough infection. <b>Conclusion:</b> Anti-S antibody titres are highest among vaccinated with breakthrough infections and lowest in those with two doses of vaccines but no history of previous confirmed infections and booster doses may be prioritised for the second group. The timing of previous infection can also be a criterion for further booster doses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC01-OC04&id=16694 https://doi.org/10.7860/JCDR/2022/57766.16694 Clinical, Dermoscopic and Histopathologic Features of Cicatricial Alopecia- A Prospective Cohort Study Priyadharsini Jeyaprakash, Priyavathani Annie Malathy, Samuel Jeyaraj Daniel <b>Introduction:</b> Cicatricial Alopecia (CA) is a scarring form that arises due to permanent hair follicle destruction. It can either primarily affect the follicles or by an external process leads to secondary alopecia causing scarring and considerable disfigurement of the scalp. Hence initial diagnosis, aetiology of the contributing factors and earlier intervention are vital. <b>Aim:</b> To identify the diagnostic features of CA based on clinical, dermoscopic and histopathological (HP) findings and the underlying aetiological causes. <b>Materials and Methods:</b> This prospective cohort study was conducted in a tertiary care centre of Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India from November 2016 to September 2017. Total 50 clinically diagnosed CA cases were randomly selected and case history, related skin findings, predisposing factors and other findings associated with scarring were documented. Dermatological examination and Hair pull test was done. Trichoscopic examination was done using a non polarised dermoscopy with specific emphasis on the follicular ostia and morphological patterns. Scalp biopsy was done. The collected data were analysed in terms of frequency and percentage and Chi-square test was also performed with p-value <0.05 as statistically significant. <b>Results:</b> Out of total 50 patients, 22 (44%) were males, and 28 (56%) females with the mean age of 35.46&#177;15.03 years. Total 29 (58%) patients had multiple lesions and 21 (42%) had localised involvement of alopecia in the scalp. Focal type was noted in 86%, and diffuse type in 14%. In this study, 80% of CA were of primary causes with only 20% secondary causes. Lichen Plano Pilaris (LPP) and trauma were the most common primary and secondary causes. The dermoscopic features of absent follicular orifice, arborising thicker blood vessel and pustule formation were statistically significant (p-value <0.001) for the diagnosis of CA. The most common histopathological feature was basal cell vacuolization (54%), followed by hyperkeratosis (52%), and follicular plugging (46%). <b>Conclusion:</b> The clinical, dermoscopic and histopathological findings of this study were consistent for diagnosis and differentiating primary CA. Histopathology is the final confirmatory diagnostic tool when characteristic clinical and dermoscopic features are absent. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=WC01-WC06&id=16695 https://doi.org/10.7860/JCDR/2022/55269.16695 Ultrasound Evaluation of the Rotator Cuff after Osteosynthesis of Humeral Shaft Fractures with Interlocking Intramedullary Nail- A Prospective Interventional Study MS Shashikumar, Gaurav Kishore Shetty, MU Abhishek, Daivik Taranath Shetty <b>Introduction:</b> Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. However, shoulder impairment remains an important complication of intramedullary nailing. The procedure involving the splitting of supraspinatus tendon to expose humeral head for nail insertion has been attributed for it, even though it is followed by the repair of the tendon. <b>Aim:</b> To evaluate rotator cuff integrity with Ultrasonography (USG) in patients who underwent humeral fracture fixation with an intramedullary interlocking nail and to evaluate the clinical outcome of the shoulder joint in patients with and without rupture of the rotator cuff using Constant-Murley and QuickDASH scores. <b>Materials and Methods:</b> This prospective interventional study was conducted in the Department of Orthopaedics of AJ Institute of Medical Sciences, Mangaluru, India, from August 2018 to September 2020 in which 20 adult patients with acute humeral shaft fractures were treated with closed intramedullary nailing in antegrade manner. Patients were followed-up for six months clinically and radiologically. The USG evaluation of rotator cuff was done at six months follow-up, along with clinical evaluation using Constant-Murley and QuickDASH scores. Association between variables was analysed by using Chi-square test for categorical variables. Unpaired t-test was used to compare the mean of quantitative variables. The level of significance was set at 0.05. Data were entered into Microsoft Excel (Windows 7; Version 2007) and analyses were done using the Statistical Package for the Social Sciences (SPSS) for Windows software (version 22.0; SPSS Inc, Chicago). <b>Results:</b> At six months follow-up, patients were evaluated by USG showing ruptured supraspinatus tendon in 3 (15%) of the study patients. The results by Constant-Murley score were 76.50&#177;12.61 for the entire series, 77.82&#177;12.75 for patients without rotator cuff rupture, and 69&#177;10.53 for patients with partial rupture of the rotator cuff, with no statistical difference (p=0.275). QuickDASH scores were 9.90&#177;7.69 for the entire series, better in the group without rupture of the rotator cuff (9.41&#177;7.92 versus 12.70&#177;6.84) but without statistically significant difference (p=0.510). <b>Conclusion:</b> The functional outcome of the shoulder joint was satisfactory and was not influenced by the presence or absence of a rotator cuff tear following the procedure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=RC01-RC05&id=16696 https://doi.org/10.7860/JCDR/2022/57007.16696 Prognostic Value of Long Corrected QT Interval on Electrocardiogram in Acute Organophosphate Poisoning: A Cohort Study Jayshree Gamit, Archana Gandhi <b>Introduction:</b> According to data available from National Poison Information Centre India, suicidal poisoning with household agents (organophosphates, carbamates etc.) is the most common modality of poisoning. There are reports suggesting relationship between prolonged corrected QT interval and the severity of Organophosphate (OP) poisoning. Corrected QT (QTc) interval is measured in 12 lead electrocardiograms taken on admission. <b>Aim:</b> To assess prognosis of acute organophosphate poisoning patients by studying association of corrected QT interval with its complications and mortality. <b>Materials and Methods:</b> The cohort study was conducted at Medicine Department of Medical College, Baroda and Sir Sayaji General Hospital, Vadodara, Gujarat, India, from December 2017 to November 2018. The study included 60 patients with a history of OP poisoning. The QTc interval in electrocardiogram was determined by using the Bazett formula. Prognostic importance of QTc interval was assessed by correlating it with Paradeniya Organophosphorus Poisoning Scale score, hospital stay, atropine requirement, requirement of ventilatory support and mortality. Data was analysed by using descriptive statistics and Chi-square test. <b>Results:</b> The organophosphate poisoning was seen more in younger age group, between 18-29 years (68.4%). The QTc prolongation was seen in 12, 80% of patients in moderate grade of Paradeniya Organophosphorus Poisoning Scale and in 9 (20%) patients among mild grade of Paradeniya Organophosphorus Poisoning Scale (p-value=0.0001). Amongst patients who needed hospital stay for more than 7 days, QTc prolongation was seen in 43% of patients, and in patients who needed hospital stay for less than 7 days QTc prolongation was seen in 9% of patients (p-value=0.0223). Statistically significant association was seen between atropine ampule requirement and QTc prolongation. Total 29 (48.3%) patients developed respiratory depression, and amongst them 19 (65.5%) had QTc prongation (p-value <0.0001). Thirteen (22%) patients died and amongst them 12 (92.31%) had QTc prolngation. In those who survived (47,78%) only 9 (19.15%) had QTc prolongation (p-value <0.0001). <b>Conclusion:</b> Prolonged QTc interval in electrocardiogram is a good prognostic indicator in patients with organophosphorus poisoning. Early identification of prolonged QTc interval and subsequent timely shifting of patients to Intensive Care Unit (ICU) and subsequent intensive management in a patient of OP poisoning would be of profound value at any level of health care setting for favourable outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC05-OC08&id=16697 https://doi.org/10.7860/JCDR/2022/53737.16697 Role of Lipoprotein Associated Phospholipase A2 in Diagnosis of Coronary Artery Disease V Veena, M Ganesh, Santhi Silambanan <b>Introduction:</b> Cardiovascular Diseases (CVD) are a major cause of significant morbidity and mortality in industrialised countries, of which Coronary Artery Disease (CAD) is the most common. The diagnostic workup of CAD has improved over the years starting from conventional investigations like Electrocardiography (ECG) to invasive procedures like coronary angiogram. Moving forward, numerous novel inflammatory biomarkers are coming up to diagnose CAD. <b>Aim:</b> To assess the role of Lipoprotein associated Phospholipase A2 (LpPLA2) as an independent predictor of CAD. <b>Materials and Methods:</b> This case-control study was conducted in the Inpatient Department of Cardiology at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from September 2014 to November 2014. Participants without significant blockage in the coronary arteries and without detectable atheroma served as controls and those with detectable atheroma and significant blockage in coronary arteries served as cases. Peripheral blood samples of 80 male patients aged over 40 years undergoing Coronary Angiography were processed for LpPLA2 levels. Mean and Standard deviation was calculated for the parameters included in the study. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 15.0. <b>Results:</b> Mean age of the participants in the control group was 51.75&#177;8.74 years and that of the case group was 59.15&#177;11.31 years. The mean LpPLA2 level in the cases was found to be higher than that in the controls and the difference was statistically significant (p-value <0.05). No correlation was noted between the age and Body Mass Index (BMI) of both the groups with their respective LpPLA2 levels. <b>Conclusion:</b> The current study showed that LpPLA2 can be used as a potential independent predictor of CAD, thus minimising the usage of invasive investigations and favouring the psychosocial and economic welfare of the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC01-BC05&id=16681 https://doi.org/10.7860/JCDR/2022/55726.16681 Effect of Preoperative Oral Melatonin on Postoperative Sedation and Analgesia among Patients undergoing Elective Surgery under General Anaesthesia: A Randomised Controlled Study Monika Gandhi, Shrutika Singh, Kishore Kumar Arora, Ravi Barde <b>Introduction:</b> Postoperative pain is one of the major causes of dissatisfaction and prolonged hospital stay in patients undergoing surgery under general anaesthesia. Melatonin has been used for sleep regulation and Intensive Care Unit (ICU) sedation but there is limited knowledge regarding its effect postoperative analgesia and sedation. <b>Aim:</b> To evaluate the effects of preoperative melatonin on postoperative sedation and analgesia. <b>Materials and Methods:</b> This randomised controlled study was conducted from June 2020 to June 2021, at Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India. Total 100 patients belonging to American Society of Anaesthesiologists (ASA) grade I and II of either gender, of age 18-60 years who were planned for elective surgery under general anaesthesia were randomly divided into two groups. Group M (n=50) was given 6 mg oral melatonin (two capsules of 3 mg each), and group C (n=50) was given multivitamin capsules, 90 minutes before induction of anaesthesia. General anaesthesia was induced using standard method for both the groups. Sedation score was assessed in preoperative period as well as after giving drugs and till four hours postoperatively by using Ramsay Sedation score. Pain was evaluated by Visual Analogue Scale (VAS) score till 8 hours postoperatively. Time of request of first rescue analgesia was noted and compared to that of control group. <b>Results:</b> At preoperative time sedation score was comparable between both the groups. At postoperative time, sedation score 4 was seen in significantly higher number of patients of group M in comparison to group C, while at all the other time intervals, sedation scores were comparable between the two groups. Mean VAS score was found to be significantly higher in group C (3.2&#177;0.4) in comparison to group M (3.02&#177;0.14), four hours postoperatively. The mean time to request for first rescue analgesia in group M was 7.27&#177;1.01 hours and in group C was 5.40&#177;0.78 hour (p-value=0.001). <b>Conclusion:</b> Preoperative oral melatonin can be used to effectively reduce the postoperative pain without producing undue sedation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UC01-UC04&id=16682 https://doi.org/10.7860/JCDR/2022/56679.16682 Assessment of Bacteriological Quality of Drinking Water in a Rural Tertiary Healthcare Institute of Haryana: A Record-based Descriptive Study Jai Pal Majra, Ramesh Kumar Verma, Surinder Kumar <b>Introduction:</b> Of all natural resources, water is one of the most essential and precious resources. It forms 70% of our body weight and acts as a necessary vehicle for all metabolic processes in the body. Water is exposed to various contaminants animal wastes, human wastes, etc. which affect the biological quality of water. So, water quality monitoring becomes an essential component for formulating measures and addressing the issues to safeguard public health. <b>Aim:</b> To assess the bacteriological quality of drinking water in a rural tertiary healthcare institute in Haryana <b>Materials and Methods:</b> This descriptive, record-based, study was conducted in Bhagat Phool Singh Government Medical College for Women Khanpur, Kalan, Sonepat, Haryana, India (rural tertiary healthcare institute), from 1<sup>st</sup> January 2016 to 31<sup>st</sup> December 2018. The water samples were collected, transported, and analysed according to the World Health Organisation (WHO) guidelines for drinking water quality assessment and the Indian Council Medical Research (ICMR). Incomplete records with respect to inadequate samples and reporting issue were excluded from the study. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. <b>Results:</b> Out of a total of 422 tested water samples 244 (58%) were found satisfactory while 178 (42%) unsatisfactory i.e. unfit for human consumption. From March to mid-June (summer season) 56 (31%) and from mid-June to mid-September (rainy season), 74 (42%) of water samples were found unsatisfactory while, 63 (26%) water samples were observed fit for human consumption in mid-September to mid-December (postmonsoon season) and 76 (31%) in mid-December to February season (winter season). Seasonal variations were recorded for water quality reporting. <b>Conclusion:</b> Comprehensive planning and feasible approach are to be followed prior to hot weather and rainy season for the provision of safe and potable drinking water. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LC01-LC05&id=16683 https://doi.org/10.7860/JCDR/2022/58033.16683 Unmasking the Mask Issues among Healthcare Workers in COVID-19 Era Neha Gupta, Renu Gur, Shalini Dewan Duggal, Deepak Dhamnetiya, Ravi Prakash Jha <b>Introduction:</b> Recent pandemic have showed importance of adequate availability of Personal Protective Equipment (PPE) most importantly the face mask and training of Healthcare Workers (HCWs) for its proper usage for protection from various infections to maintain smooth functioning of healthcare facility. <b>Aim:</b> To examine practices and barriers to compliance regarding face mask usage among HCWs. <b>Materials and Methods:</b> The present study was a cross-sectional observational analytical study which was conducted at Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, India, from 30<sup>th</sup> June, 2020 to 24<sup>th</sup> July, 2020 during Coronavirus Disease-2019 (COVID-19) pandemic. Data was collected through semi-structured bilingual online questionnaire using Google form based on recommendations for mask use by World Health Organisation (WHO) and Centers for Disease Control and Prevention (CDC). Data was recorded in MS Excel and Statistical Package for the Social Sciences (SPSS) 16.0 software was used for statistical analysis. Qualitative data was expressed in percentages and continuous data was summarised in mean&#177;Standard Deviation (SD). Chi-square test was used to check the association between the categorical variables. <b>Results:</b> Total 362 HCWs submitted responses, of which 44.7% respondents wore N95 masks to protect themselves from COVID-19. Only 34.2% were satisfied with availability of masks in healthcare facility. Itching and sweating on part inside mask was major problem faced by 52.8% of respondents. Only 58% followed proper hand hygiene precautions while handling mask whereas, 62.7% took proper measures while doffing. <b>Conclusion:</b> There appears to be a lack of awareness about proper hand hygiene while handling mask, appropriate precautions for reuse and doffing. Availability of mask also needs to be addressed. Regular trainings are needed to increase awareness, improve behaviour and practices regarding mask usage for prevention of occupational spread of infection among HCWs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC01-DC06&id=16684 https://doi.org/10.7860/JCDR/2022/55258.16684 Efficacy of Counselling in Improving LATCH Score and Successful Breastfeeding: A Hospital-based Prospective Cohort Study R Divya, Amar Taksande, M Karthik Balaji, C Sweetline <b>Introduction:</b> The World Health Organisation (WHO) recommends exclusive breast feeding for six months, and thereafter until two years. Breast milk is the ideal food for the new born babies. It provides them with adequate nutrition, promotes growth and prevents the occurrence of infectious diseases. A timely intervention to mothers helps in improving the effectiveness of breast feeding. LATCH score assessment tool has been used in developed countries to identify mothers who need breastfeeding support to sustain lactation. <b>Aim:</b> To study the efficacy of counselling new mothers in improving the LATCH score and successful breastfeeding. <b>Materials and Methods:</b> This hospital-based prospective cohort study was carried out in the Department of Paediatrics at a tertiary care hospital Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe, Wardha, Maharashtra, India. In total 160 mother-infant dyads born between July 2020 and January 2021, born of both vaginal and caesarean delivery, with gestational age &#8805;37 weeks and singleton births were included in the study. Preintervention data on LATCH score was collected immediately postpartum. These postpartum mothers were given breastfeeding education in the form of video assisted teaching as an intervention. Postintervention data was collected at six weeks postpartum. Data entry was done in MS excel and analysed in Statistical Package for the Social Science (SPSS) software. <b>Results:</b> The mean age of the mothers was 26.74&#177;4.20 years. Overall 84 (52.50%) of mothers had completed their higher secondary education, majority 54 (33.75%) of the mothers belonged to lower middle class, 102 (63.75%) were multi-gravida, while 112 (70%) belonged to a joint family. The difference between preintervention mean LATCH score (7.31&#177;0.84) and postintervention mean LATCH score (8.9&#177;0.73) was found to be statistically significant (p<0.05). <b>Conclusion:</b> The LATCH score is a simple, easy, economical tool which can be easily used by the health workers as a breastfeeding assessment tool. Intervention using video assisted teaching helped in the better understanding of the mothers regarding breastfeeding. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=SC01-SC04&id=16685 https://doi.org/10.7860/JCDR/2022/56968.16685 Comparison of the Efficacy of Ultrasound-guided Pectoral versus Erector Spinae Plane Blocks for Postoperative Analgesia in Patients undergoing Modified Radical Mastectomy: A Randomised Controlled Trial V Bhavani, Sangeeta Dhanger, Namrata Gupta, I Joseph Raajesh, Saravanan Pandian <b>Introduction:</b> Postmastectomy pain is more common following carcinoma breast surgery. Preventive analgesia for breast carcinoma includes administration of local infiltration or regional anaesthesia in the form of a paravertebral block, epidural, pectoral nerve block or intercostal block. Interfascial blocks, such as ultrasound guided pectoral nerve (PECS II) and Erector Spinae Plane (ESP) block have been shown to provide effective analgesia for mastectomy surgeries. <b>Aim:</b> To compare the postoperative analgesic efficacy of PECSII block and ESP block following mastectomy surgeries. <b>Materials and Methods:</b> The present study was a double-blinded randomised controlled study. Patients scheduled for an elective unilateral modified radical mastectomy surgery of age 18-70 years, American Society of Anaesthesiologists (ASA) physical status I-II, were endrolled in the study. Sixty patients (ASA I-II) were divided into two groups. (30 in the PECS II group and 30 in the ESP group). The patients received respective blocks under ultrasound guidance after general anaesthesia. The primary outcome measured was the time of first request analgesia between groups. The secondary outcomes were postoperative Numeric Rating Scale (NRS) at eight different time-points (0.5, 1<sup>st</sup>, 2<sup>nd</sup>, 4<sup>th</sup>, 6<sup>th</sup>, 8<sup>th</sup> 12<sup>th</sup> and 24<sup>th</sup> hour) and intraoperative fentanyl requirement and haemodynamics (heart rate and mean arterial pressure). Total postoperative intravenous paracetamol consumption and rescue analgesic requirement in the first 24 hours postoperatively were noted. Statistical analysis was conducted by using Statistical Package for the Social Sciences (SPSS) version 20.0. Pearson&#8217;s Chi-square test was performed to compare ratios, and categorical variables were compared using Fisher&#8217;s exact test. A p-value value <0.05 was taken as statistically significant. <b>Results:</b> The time of first request analgesia was prolonged and significant in ESP block (255.5&#177;48.76 minutes) than PEC II (197.5&#177;31.35 minutes) (p=0.000347). In the postoperative ward, NRS scores at the 30<sup>th</sup> min, first and second hour were significantly lower in ESP block than PECS II group (2.3&#177;0.4 vs. 5.2&#177;0.8; 3.2&#177;0.4 vs. 4.4&#177;0.3, 3.7&#177;0.4 vs. 5.2&#177;0.4); p=0.041 p=0.047, p=0.037 respectively. From the second postoperative hour to the end of the observation period, there were no significant changes in NRS scores among groups. Postoperative paracetamol consumption was significantly higher in PECS II than ESPB (1.25&#177;0.5 grams vs 2.33&#177;1.2 grams, p<0.043824).There was no change in intraoperative fentanyl consumption and haemodynamics between groups. <b>Conclusion:</b> ESP block had better pain control, reduced postoperative pain scores and rescue analgesia than PECS II when given as preventive analgesia in mastectomy surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UC05-UC08&id=16686 https://doi.org/10.7860/JCDR/2022/55835.16686 Assessment of Clinical Profiles of the Obstetric Patients Admitted to ICU in a Tertiary Care Hospital, Madhya Pradesh, India: A Longitudinal Study Priyadarshini Tiwari, Seema Diwar <b>Introduction:</b> Management of critically ill obstetric population admitted to Intensive Care Unit (ICU) remains a significant hurdle in developing countries. <b>Aim:</b> To examine demographic characteristics, diagnoses, clinical outcomes, and performance of modified Sequential Organ Failure Assessment (SOFA) score between survivors and non survivors in all obstetric admissions to the ICU. <b>Materials and Methods:</b> This was a longitudinal study conducted in a 12-bedded obstetric ICU at 850 bedded Netaji Subhash Chandra Bose Medical College, Madhya Pradesh, India from March 2016 to August 2017. Clinical profile and outcomes of ICU patients were analysed for total 367 obstetric ICU admission. To determine mortality outcomes of the study population, a modified SOFA score was used to take into account physiological changes in pregnancy. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 15.0 (Inc., Chicago, Illinois, USA). Receiver Operating Characteristics (ROC) curve analyses of SOFA score as a predictor of mortality, and optimum cut-off point value was determined. <b>Results:</b> The mean age of the study population was 24.7&#177;4.0 years. Eclampsia (35.7%) and preeclampsia (13.62%) were the leading indications of admission. The survival of patients was associated significantly with low SOFA scores with mean SOFA score of 6.48&#177;2.804 among survivors and 10.42&#177;3.579 among non survivors (p-value=0.001). <b>Conclusion:</b> Eclampsia and preeclampsia were the leading cause of ICU admission, that can be preventable. Higher SOFA score was related to higher mortality in the obstetric patients requiring ICU. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=QC01-QC05&id=16700 https://doi.org/10.7860/JCDR/2022/55836.16700 COVID-19 Vaccination Status among Patients with Chronic Respiratory Diseases: A Cross-sectional Study from a Tertiary Care Centre in Southern India Anil Kumar Kodavala, Surekha Tadisetti, MD Badusha, Prasannapurna Kuruganti <b>Introduction:</b> Pre-existing respiratory diseases were recognised as risk factors for COVID-19 associated morbidity and mortality. One year after the launch of vaccines against COVID-19, vaccination status in specific population was not clear. Vaccination of population at risk is crucial for COVID-19 control. <b>Aim:</b> To estimate the COVID-19 vaccination status and to detect the reasons for vaccine hesitancy among people with chronic respiratory diseases. <b>Materials and Methods:</b> This cross-sectional observational study was conducted in Respiratory Medicine Department at Narayana Medical College, Nellore, Andhra Pradesh, India, from January 2022 and February 2022. All the patients above 18 years of age, who presented with chronic respiratory diseases, were included in the study. After taking informed consent, their responses were noted using a validated questionnaire containing data like demographic data and details of vaccination against COVID-19 and reasons for refusal/hesitancy. <b>Results:</b> Out of total 755 subjects, 44.50% were of Chronic Obstructive Pulmonary Disease (COPD), 42.38% were of asthma, 9.40% were of Post-tuberculosis lung disease, 2.52% were of bronchiectasis, and 1.72% were of Interstitial Lung Disease (ILD). Mean age of study population was 51.37&#177;15.30 years, 58% were male and 42% were female. Overall, 75% subjects received atleast single dose of COVID-19 vaccine. Higher vaccine acceptance was noted among 31-42 years age group, males, residents of rural area, graduates, subjects with income more than one lac per month and smokers. Vaccine hesitancy was 25%. Intake of a native medicine (72.87%) was the most common cause for vaccine refusal among these subjects. Other reasons for vaccine hesitancy were, worries about side-effects (63.3%), associated multiple co-morbidities (44.15%), lack of confidence in vaccines (15.96%) and fear of injection (14.89%). <b>Conclusion:</b> Vaccine acceptance against COVID-19 is nearly 75% among people with chronic respiratory diseases in India. Nonetheless, some people were still hesitant to receive vaccine. Continuous health education at every level is needed to achieve vaccination targets. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC09-OC13&id=16701 https://doi.org/10.7860/JCDR/2022/56474.16701 Role of Vitamin D and Haemoglobin Levels in Prediabetic Patients- A Retrospective Study Deepa K Nair, B Shanthi, Giridhar Bupesh <b>Introduction:</b> The 25-hydroxy (OH)D3 (Vitamin D, Cholecalciferol) and Haemoglobin (Hb) level have a significant role in the regulation of immune response. A decrease in Vitamin D and haemoglobin concentrations is a common risk factor for diabetes. The link between Vitamin D and insulin resistance has been studied more thoroughly in patients with diabetes mellitus, although data from people with prediabetes is scarce. <b>Aim:</b> To study the association of Vitamin D and Hb levels in prediabetes patients. <b>Materials and Methods:</b> This retrospective study was conducted in the Sree Balaji Medical College and Hospital, Chennai from July 2020 to December 2020. Total 100 subjects with prediabetes conditions were included and their Vitamin D and Hb levels were measured. The patients who gave written informed consent for prediabetes screening according to ADA-2020 recommendations for prediabetes were included and their Vitamin D and Hb level done as part of the routine check-up were collected. Data were statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. <b>Results:</b> Data of total 100 patients was analysed, including 68 female patients and 32 male patients. Out of 100 patients, 84 were aged between 25-50 years and 16 were aged between 51-65 years. The difference between male and female were statistically significant with p-value <0.01 (for Hb) and p value 0.05 (Vit-D), respectively. A significant difference in mean Hb level when compared among Vitamin D deficient (0.0-19.99 IU/mL) level, insufficient (20-29.99 IU/mL) and sufficient (30-99.99 IU/mL) subjects (p=0.008) was observed. <b>Conclusion:</b> Low levels of Vitamin D is significantly associated with low Hb level. The patients with deficient Vitamin D level showed a significantly low mean Hb level compared to insufficient and sufficient Vitamin D level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC06-BC08&id=16702 https://doi.org/10.7860/JCDR/2022/55626.16702 Correlation of Heart Rate Variability and Inflammatory Markers in Patients with Depression: A Cross-sectional Study Deepti Jangpangi, Sunita Mondal, Rajiv Bandhu, Dinesh Kataria, Jayashree Bhattacharjee <b>Introduction:</b> Depression has been found to be associated with cardiovascular morbidity and mortality. Autonomic dysregulation and inflammation have been implicated as the possible mechanisms. A cross-talk between the autonomic nervous system and inflammatory pathways has been observed in different clinical studies. <b>Aim: </b>To examine the inter-relationship between Heart Rate Variability (HRV), a measure of autonomic function, and inflammatory biomarkers measured by high sensitivity C-Reactive Protein (hsCRP) and Interleukin-6 (IL-6) in patients with depression, without any comorbid conditions. <b>Materials and Methods:</b> This cross-sectional study was conducted in Department of Physiology, in collaboration with the Department of Psychiatry and Biochemistry, Lady Hardinge Medical College, New Delhi, India, from November 2010 to March 2012. Total 30 drug naive cases (without any co-morbid diseases) diagnosed with depression (mild, moderate and severe depression) as per International classification of diseases-10 (ICD-10) guidelines, in the age group of 20-45 years old were included in the study. Heart rate variability measures were recorded and analysed, frequency domain measures Low Frequency (LF), High Frequency (HF) and time domain measures like Standard Deviation of all NN interval (SDNN) and Root Mean Square of Successive differences of NN intervals (RMSSD). The IL-6 and hsCRP levels were also measured and severity of depression by Hamilton Depression Rating Scale (HDRS) was also assessed and correlated. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 16.0. Normality of data was assessed using the Shapiro-Wilk test. <b>Results:</b> The mean age of the cases was 30.33±6.97 years. There were 14 males and 16 females. There was no significant correlation found between the HRV measures and inflammatory biomarkers (LF vs hsCRP: p-value=0.781, HF vs hsCRP: p-value=0.713, SDNN vs hsCRP: p-value=0.262, RMSSD vs hsCRP: p-value=0.50, LF vs IL-6: p-value=0.477, HF vs IL-6: p-value=0.425, SDNN vs IL-6: p-value=0.137, RMSSD vs IL-6: p-value=0.328). Correlation of HDRS with HRV measures or inflammatory markers was not found to be significant. <b>Conclusion:</b> Future studies with larger sample size and wide array of inflammatory biomarkers besides IL-6 and hsCRP is warranted. No significant correlation was observed between HRV and inflammatory markers in depression patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=CC08-CC11&id=16703 https://doi.org/10.7860/JCDR/2022/56183.16703 COVID-19 Pandemic Effect on Psychological Status and Perception towards the Medical Profession among Haryana’s First Year MBBS Students: A Cross-sectional Study Himanshu Madaan, Meenakshi Puri, Vaneet Kaur, Sumit Dokwal, Savita Chahal <b>Introduction:</b> The Coronavirus Disease-2019 (COVID-19) pandemic has emerged as a major health crisis throughout the world. In order to control the spread of disease in India, the Central Government imposed a nationwide lockdown. The ongoing spread of the pandemic, strict lockdown measures and delay in the opening of educational institutions in the country are expected to affect the mental health of medical college students too. In order to help and guide the students, we should first be aware of the magnitude of the problem faced by medical students due to the pandemic. For this purpose, this study was conducted online. <b>Aim:</b> To assess the effect of the pandemic on the psychological status of the students and their perception towards medical profession. <b>Materials and Methods:</b> A questionnaire-based cross-sectional study was conducted by the Department of Biochemistry of Kalpana Chawla Government Medical College, Haryana, India from 22nd May 2020 to 5th June 2020, among 538 first year Bachelor of Medicine, Bachelor of Surgery (MBBS) students from several Government and Government aided medical schools in the state of Haryana after obtaining ethical clearance. The detailed questionnaire, a study consisting of sections on the current status in relation to the COVID-19 pandemic, perception towards medical profession and psychological status. It was posted online on social media platforms and the responses were collected within 15 days of posting. The psychological status was assessed based on a 21 item Depression, Anxiety, and Stress Scale (DASS-21). Statistical analysis was done by Chi-square test, using Statistical Package for Social Sciences (SPSS) version 20.0 software. <b>Results:</b> Out of 538 student&#8217;s responses, it shows that 19.1% (n=103) of students experienced moderate stress, probably because of the COVID-19 outbreak and the effect it had on the social and academic aspects of their lives. About 11.5% (n=62) of students had a moderate level of anxiety, and 16.9% (n=91) had experienced moderate depression during the ongoing pandemic. <b>Conclusion:</b> The study demonstrates various factors, like interruptions in regular studies, social distancing, fear of infection, fear of losing a loved one, and worry about the completion of the syllabus and examinations, all cause stress and anxiety in students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC09-BC13&id=16704 https://doi.org/10.7860/JCDR/2022/57776.16704 Diagnostic Characterisation of Various Phenotypic Methods for Class-A Extended Spectrum of β-Lactamase among Multidrug Resistant <i>Pseudomonas aeruginosa</i> Isolated from Diabetic Patients Bhavana Gupta, Rajni Sharma, Kapil Garg <b>Introduction:</b> <i>Pseudomonas aeruginosa</i> often causes nosocomial infection, especially in high risk group patients like diabetics. It shows a high degree of resistance to broad spectrum of antibiotics due to its high adoptability in hospital settings, so their infections are difficult to treat. Extended Spectrum &#946;-Lactamase (ESBL) enzymes confer resistance to most of the &#946;-lactam antibiotics, including penicillin, cephalosporins and monobactams. <b>Aim:</b> To identify ESBL producing strains among Multidrug Resistant (MDR) <i>Pseudomonas aeruginosa</i> isolated from diabetes patients using various phenotypic methods with their performance characteristics. <b>Materials and Methods:</b> An observational descriptive cross-sectional study was conducted in the Department of Microbiology at Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from April 2017 to March 2019. Various clinical samples received from diabetic patients were cultured and <i>P. aeruginosa</i> were identified as per standard protocol. Antimicrobial susceptibility testing was done according to Clinical and Laboratory Standards Institute (CLSI) guidelines. ESBL producing MDR <i>P. aeruginosa</i> was detected by using standard Epsilometer test (E test), Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Double Disc Synergy Test (DDST). Test characteristics sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy were calculated. Kappa coefficient was used to show diagnostic agreement between the tests. <b>Results:</b> A total 430 clinical samples were received from diabetic patients, out of 430 samples, 72 (16.7%) <i>P. aeruginosa</i> were recovered. Multidrug resistance was exhibited by 34 isolates out of 72 <i>P. aeruginosa</i> strains. Out of 34 MDR strains, 10 (29.4%) were found ESBL producers by PCDDT, 9 (26.5%) by DDST while 10 (29.4%) were found positive by E test. Sensitivity, specificity and accuracy for PCDDT was found 90%, 95.8% and 94.1% respectively and &#8216;almost perfect agreement&#8217; was observed with E test. <b>Conclusion:</b> Magnitude of multidrug resistant strains was found 47.22% among <i>P. aeruginosa</i> isolated from diabetic patients which is an alarming sign. The ESBLs were found in 29.4% isolates. So, screening of ESBLs with the use of simple test like PCDDT in <i>Pseudomonas aeruginosa</i> will direct us for treatment option of suitable antibiotic regimens in diabetic patients and to prevent the spread of drug resistant organisms in hospitals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC28-DC32&id=16717 https://doi.org/10.7860/JCDR/2022/55865.16717 Six Sigma Metrics: An Evolving Indicator of Quality Assurance for Clinical Biochemistry Devi Prasad Pradhan, Debasish Pandit, Sibasish Sahoo, Roma Rattan, Sucharita Mohanty <b>Introduction:</b> The analytical phase of the total testing process is the one in which the clinical biochemist can directly intervene to improve the quality of tests reporting. The sigma metrics and Operational Process Specification (OPSpec) chart can specify to which category the laboratory belongs. <b>Aim:</b> To apply sigma metrics to analytical process of testing, do the root cause analysis and apply the corrective measures according to Westgard Rules to improve laboratory performance towards the quality assurances. <b>Materials and Methods:</b> This was a retrospective-prospective study carried out in a clinical laboratory of MKCG Medical College and Hospital, Berhampur, Odisha, India, from July 2020 to March 2021. A retrospective secondary data analysis of six months duration was carried out in a clinical chemistry laboratory with a follow-up prospective study for three months. During this period, 16 analytes were tabulated to analyse the Internal Quality Control (IQC). External Quality Control (EQC) for the same analytes were obtained on monthly basis and the sigma metrics was calculated for each analytes. For analytes with sigma value <3, appropriate measures were taken according to Westgard rules to improvise the quality of laboratory investigations. The statistical analysis of sigma metrics was performed in &#8220;R&#8221; v-3.6.3. <b>Results:</b> Out of total 16 analytes, three analytes at level 1 and two analytes at level 2 Quality control (QC) showed a world class performance whereas four analytes showed a poor performance at both the QC levels with sigma metrics value <3. From Quality Goal Index (QGI) and root cause analysis, the source of error was detected and corrected. <b>Conclusion:</b> The inaccuracy and imprecision of different parameters in the analytical phase of the testing process can be addressed by calculating the sigma metrics and do the root cause analysis. Application of corrective measures according to Westgard rule can improve the laboratory performance towards the quality assurance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BC14-BC18&id=16718 https://doi.org/10.7860/JCDR/2022/56691.16718 Adverse Drug Reactions to a Daily Fixed-dose Combination Based Antituberculosis Treatment Regime in India’s National Tuberculosis Elimination Programme: A Prospective Cohort Study Kapil Mate, Gyanshankar Mishra, Radha Munje <b>Introduction:</b> In India, the daily weight-based, Fixed Dose Combination (FDC) Antituberculosis Treatment (ATT) regime under the National Tuberculosis Elimination Programme (NTEP) was introduced, replacing the previous intermittent regime with the aim of improving compliance, decreasing Adverse Drug Reactions (ADRs) and thus ultimately translating to improved treatment outcomes. The ADRs are an important factor that can adversely impact the treatment compliance and outcomes of an ATT regime. There is currently a paucity of studies reflecting the development of ADRs in the Indian population to the new ATT regime. <b>Aim:</b> To study the ADRs of daily FDC-based first-line ATT regime under NTEP. <b>Materials and Methods:</b> A prospective cohort analysis was conducted in the Department of Respiratory Medicine at Indira Gandhi Government Medical College (tertiary care centre), Nagpur, Maharashtra, India, from January 2019 to September 2020. Total 750 People With Tuberculosis (PWTB) were enrolled in the study. They were administered a standardised daily FDC first-line ATT regime under NTEP comprising of initial two months of intensive phase with Isoniazid (INH or H), Rifampicin (R), Ethambutol (E), and Pyrazinamide (Z) followed by a continuation phase of four months with INH, rifampicin, and ethambutol (2EHRZ/4HRE). Clinical evaluation and/or laboratory investigations were used at baseline and when clinically indicated during therapy to identify treatment-related adverse events. <b>Results:</b> Among the 750 PWTB, 402 (53.60%) were females, and 348 (46.40%) were males. The mean age of PWTB was 36.46&#177;15.6 years. The ADR to ATT was present in 271 (36.13%) PWTB, 217 (80.07%) were managed on an Outpatient Department (OPD) basis and 54 (19.93%) patients required hospitalisation. Causality assessment revealed that most ADRs were probable (81.18%), followed by possible (18.82%). Regarding the severity of ADRs, 87.08% were mild, 11.44% were moderate, 1.48% were severe, and none of the ADRs was life-threatening. In 67.9% of PWTB, gastrointestinal ADRs were seen, followed by joint pain (37.64%) and cutaneous drug reactions (16.60%). Female PWTB, People Living with Human Immunodeficiency Virus & Tuberculosis (PLHIV-TB), and PWTB with systemic co-morbidities, especially diabetes and systemic hypertension, were at a higher risk of developing ADRs. The risk of ADRs was unaltered with age distribution, body mass index distribution, type of diet, the type of tuberculosis, or the pill burden. Addiction to alcohol and tobacco did not significantly alter the risk of ADRs. <b>Conclusion:</b> The ADRs caused by daily FDC-based ATT are common, but most are mild and can be managed on an OPD basis. Gastrointestinal ADRs, arthralgia, and cutaneous drug reactions are the most common ADRs of the daily FDC-based ATT regime. Female PWTB, PLHIV-TB, and PWTB with systemic co-morbidities, especially diabetes and systemic hypertension, being at a high risk of developing ADRs, need to be actively screened for ADRs during treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=OC14-OC19&id=16719 https://doi.org/10.7860/JCDR/2022/57878.16719 Association between Anxiety, COVID-19 Status and Symptoms of Patients attending Fever Clinic of a Tertiary Level COVID-19 Hospital, West Bengal, India: A Cross-sectional Study Mousumi Datta, Pushpak Das, Abhishek Reja <b>Introduction:</b> The Coronavirus Disease-2019 (COVID-19) pandemic has caused considerable panic and anguish among the world&#8217;s population, including India. So, besides physical health, COVID-19 has considerably left its mark on mental health. <b>Aim:</b> To describe the study population according to their clinico-social, demographic profile, the level of anxiety prior to COVID-19 rapid antigen testing, and to explore the determinants of anxiety among COVID-19 suspected patients. <b>Materials and Methods:</b> A cross-sectional survey was conducted in June, 2021-August, 2021 with a sample of 197 adult participants attending the fever clinic of Medical College, Kolkata, West Bengal , India. The data collection tool used was a predesigned, pretested structured schedule where the level of anxiety was measured with the Generalised Anxiety Disorder-7 (GAD-7) self-administered questionnaire. Relevant frequencies, percentages, central tendencies, and dispersions were calculated. <b>Results:</b> Total of 197 responses were analysed, the mean age of respondents was 44.43&#177; 16.54 years with 58.4% male. Among the patients, 64.5% were vaccinated and around 50.3% of total patients were partially or fully vaccinated by Covishield. Of the 197 respondents included in the study, 11.7% had anxiety (GAD score &#8805;10) before Rapid Antigen Testing (RAT) and among the participants who tested positive (70 patients), 10 patients (14.3%) had anxiety. Education, occupation, number of the symptoms and the symptoms of sore throat, myalgia and joint pain were significantly associated with the anxiety level. Number of symptoms, joint pain, fatigue, weakness and current fever status was significantly associated with RAT positivity. <b>Conclusion:</b> One out of every 10 patients attending fever clinic with suspected COVID-19 suffered from significant anxiety before the RAT test. These findings mandates linking counselling services with RAT testing facility at the fever clinic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LC12-LC17&id=16720 https://doi.org/10.7860/JCDR/2022/55403.16720 Assessment of Changes in Birefringence and Orientation of Collagen Fibres in Different Grades of Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma using Picrosirius Red and Polarising Microscopy Ashwini Chikkanayakanahalli Prabhakar, HC Girish, Varsha Vimal Kumar, Umapathy Thimmegowda, Praveen Mallavalli Nagaraj Shetty <b>Introduction:</b> Oral Submucous Fibrosis (OSMF) is a potentially malignant disease with a prevalence of 7-13%. It is characterised by the fibroelastic changes due to excessive deposition of collagen which results in dense fibrous bands and epithelial changes. About 90-95% of oral cancers are Oral Squamous Cell Carcinoma (OSCC). Stroma produced by the invading neoplastic cells are rich in collagen fibres. These collagen fibers have been the main focus of study to understand the pathogenesis of these lesions. Hence, these fibres have been evaluated under polarised microscopy following staining with picrosirius red stain. <b>Aim:</b> To evaluate changes in birefringence, thickness and orientation of collagen fibres in different histopathological stages of OSMF and OSCC. <b>Materials and Methods:</b> This observational study involved sections of clinically and histopathologically confirmed cases of OSCC and OSMF from Department of Oral Pathology and Microbiology, Rajarajeswari Dental College and Hospital, Bangalore, India. The study was conducted for a duration of one year from April 2017 to March 2018. The study included total 60 cases among which 20 for each normal mucosa, OSCC and OSMF. Tissue sections were stained with picrosirius red stain and collagen fibres were analysed for colour, thickness and orientation under polarised microscope. Chi-square test was used for statistical analysis. Significance was set at p-value <0.05. <b>Results:</b> Comparison of birefringence of collagen fibres between OSMF, OSCC and normal mucosa was not statistically significant (p-value=0.37). Orientation of collagen fibres between OSMF, OSCC and normal mucosa was statistically significant with (p-value=0.02). <b>Conclusion:</b> This study showed a change in colour from yellow orange to orange red in advanced OSMF cases which indicated progression of disease and tightly packing of collagen fibres, suggestive of presence of thick fibres in the extracellular matrix. In OSCC, the colour change from yellow orange to orange red and haphazardly arranged collagen fibres was indicative of transformation of preneoplastic to carcinoma stage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZC06-ZC11&id=16721 https://doi.org/10.7860/JCDR/2022/53504.16721 Clinicopathological Concordance of Paediatric Laparoscopic Cholecystectomy at a Single Centre in India Shagufta Tahir Mufti, Bharti Parashar <b>Introduction:</b> The overall incidence of cholecystitis in children appears to be increasing although the exact frequency of acute and chronic cholecystitis among children in India or worldwide remains unknown. The frequency of paediatric cholecystitis has proportionally increased with the childhood obesity and intake of habitual fatty food. <b>Aim:</b> To present the histopathological concordance of Laparoscopic Cholecystectomy (LC) performed among children for a clinical diagnosis of Gallbladder (GB) disease. <b>Materials and Methods:</b> A single centre retrospective study was performed including histopathological and relevant clinical data of all paediatric LC performed at Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India, between January 2019 to January 2022. Paediatric patients who had undergone LC in the designated time period for a clinical diagnosis of cholelithiasis and/or inflammatory GB disease with classical signs of inflammation were included. Study population with LC procedure submitted for histological evaluation were identified by performing an electronic search through the archives of Department of Pathology, Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India, followed by a manual review of GB specimens, histopathology slides and reports. <b>Results:</b> Among 265 patients who underwent LC during this period, there were 62 (23.4%) children. The average age of presentation was 13 years (range 5-18 years), 49 (79%) were girls and 13 (21%) were boys. The clinical diagnosis for which paediatric LCs were performed were cholelithiasis among 51% and cholecystitis among 48%. On histopathological concordance these turned out to be chronic cholecystitis among 98.4% children among which 51% were associated with cholelithiasis. Calculous cholecystitis was more frequent than acalculous cholecystitis. Chronic cholecystitis with cholelithiasis and cholesterolosis was more frequent among adolescent girls. <b>Conclusion:</b> This study suggests that chronic cholecystitis accounts for the majority of inflammatory diseases among children undergoing LC for a GB disease and may or may not be associated with cholelithiasis. Chronic cholecystitis with cholelithiasis and cholesterolosis seem more frequent among adolescent girls. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC01-EC05&id=16706 https://doi.org/10.7860/JCDR/2022/57706.16706 Clinical Manifestations and Sequelae of COVID-19 in First and Second Wave among Nursing Officers of a Tertiary Care Centre, New Delhi, India Suman R Kashyap, Suman Luthra, Nishat Hussain Ahmed <b>Introduction:</b> There are lot of challenges involved in studying the multiorgan manifestations and sequelae of acute Coronavirus Disease 2019 (COVID-19), that too in face of fighting the pandemic, which has led to fall short of resources and restriction in activities for prevention of transmission. The literature on persisting manifestations and sequelae of COVID-19 in the patients recovered in the first and second waves is scarce. <b>Aim:</b> To study the presenting and persistent manifestations after acute COVID-19 illness in first and second wave among Nursing Officers (NOs) of a tertiary care Medical Institute. <b>Materials and Methods:</b> This was a cross-sectional study conducted in Dr. Rajendra Prasad Centre for Ophthalmic Sciences at All India Institute of Medical Sciences, New Delhi, India, from 15<sup>th</sup> May 2021 to 31<sup>st</sup> October 2021. Total 103 nurses, who had recovered after testing positive for COVID-19 in the first and second wave were followed-up for persisting symptoms. Statistical analysis was done using Pearson Chi-square test. <b>Results:</b> Total of 103 subjects were recruited in the study, 36 in the first wave and 67 in the second. Fever (72.82%), bodyache (67.96%) and fatigue (66.99%) were found to be the most common presenting manifestations in the study subjects having mild to moderate COVID-19 infection. Bodyache (p-value=0.048), headache (p-value=0.044) and fatigue (p-value=0.025) were seen in significantly more subjects in second wave as compared to first wave. Persistence of symptoms for more than four weeks was seen in 45.63% subjects. There was no statistically significant difference between persisting symptoms in the two waves, except sleep disturbances which were found to be persisting in significantly more subjects in second wave than those in first wave. <b>Conclusion:</b> The data of current study will add to the literature of presenting signs and sequelae of coronavirus, and pave the way for more elaborate and multispecialty studies for enhanced understanding of the disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC07-DC11&id=16707 https://doi.org/10.7860/JCDR/2022/56024.16707 Mephentermine vs. Phenylephrine for Prevention and Management of Maternal Hypotension during Caesarean Section under Spinal Anaesthesia and their Effects on Foetal Outcome- A Randomised Control Trial Srinivasan Divyabharathi, Sinam Neetu Devi, Jonan Puni Kay, Rakesh Nongthombam, Balusamy Devanathan, Lakshminarayanan Sowrirajan, Adeenpa Chara, Navaneethapriya Nandinie <b>Introduction:</b> For the best maternal and foetal outcome during caesarean section under spinal anaesthesia, maintaining Systolic Blood Pressure (SBP) at 100% of the baseline is necessary. Mephentermine and Phenylephrine are both sympathomimetic drugs used for timely correction of maternal hypotension. <b>Aim:</b> To compare the effect of intravenous bolus administration of mephentermine and phenylephrine for prevention and management of maternal hypotension and to evaluate the foetal outcome. <b>Materials and Methods:</b> In this randomised double-blinded controlled trial, a total of 150 American Society of Anaesthesiologist (ASA) II scheduled for elective Lower Segment Caeserean Section (LSCS) were randomly allocated into three groups to receive the study drugs: group A received mephentermine 6 mg in 2 mL Normal Saline (NS), group B received phenylephrine 100 mcg in 2 mL NS, and group C received 2 mL NS immediately following sub-arachnoid block. Whenever hypotension occurred (Systolic Blood Pressure (SBP) <90 mm Hg) rescue boluses were given. Maternal haemodynamic parameters, umbilical cord blood gases, and complications were recorded from the time of sub-arachnoid block till the end of surgery. <b>Results:</b> There was no significant difference in the maternal haemodynamics and neonatal outcome among the three groups. It was observed that phenylephrine had quick peak effect, higher foetal umbilical pH and better neonatal outcome though statistically insignificant. Incidence of significant bradycardia (16%) and absence of intraoperative nausea and vomiting were also reported among group B. None of the neonate had APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score <7 and the umbilical pH was comparable in all the three groups (p >0.05). The time of first rescue vasopressor and the total volume of requirement was earlier and higher in group C with the mean timing of 5.87&#177;4.37 min and mean volume of 2.68&#177;1.58 mL, respectively. <b>Conclusion:</b> There was a significant improvement of arterial blood pressures and better neonatal outcome observed when phenylephrine (100 mcg) and mephentermine (6 mg) are given as a prophylactic intravenous (i.v.) bolus dose immediately after subarachnoid block; especially in the initial time period between skin incision and delivery of the baby. When given as a prophylactic i.v. bolus, it had the advantage of lesser total dose requirement of the vasopressor used and better haemodynamic maintenance till the delivery of the baby. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UC09-UC13&id=16708 https://doi.org/10.7860/JCDR/2022/55818.16708 Urethral Sounding: Experience from Two Tertiary Care Centres in Northern India Mohd Mubashir Ali Khan, Gyanendra Singh, Mukesh Kumar, Apul Goel <b>Introduction:</b> Foreign bodies have been removed from urethra and bladder of young females since time immemorial. Various explanations have been offered by the patients but the variety, multiplicity and large sizes indicate masturbation as the major cause. <b>Aim:</b> To study the characteristics and find out the actual motive of urethral sounding at two tertiary care centres in Uttar Pradesh, India. <b>Materials and Methods:</b> This was a retrospective study conducted between January 2021 to December 2021 analysing the records of all patients who presented to urology emergency of King George&#8217;s Medical University, Lucknow and Uttar Pradesh University of Medical Sciences, Saifai, Etawah between June 2006 and June 2020 with foreign bodies in the urethra or urinary bladder. Data regarding the age, marital status of patient, type of foreign body and its location in the lower urinary tract, presence of any psychiatric illness, method of removal of the foreign body and possible cause of insertion of the foreign body from the records were collected. Data was segregated, coded and recorded in the Microsoft&#174; Excel spreadsheet. Descriptive data were presented as percentages and analysed using Statistical Package for the Social Sciences (SPSS) version 24.0 by IBM USA. <b>Results: </b>A total of 21 patients presented to the urology emergency with foreign body in the lower urinary tract between June 2006 and June 2020. None of the patients had any known psychiatric illness and all of them were adult males with age ranging from 18 to 45 years. Eight patients were managed by removal of foreign body with the help of artery forceps while 12 patients underwent cystoscopic removal of foreign body. One patient who had knotted electric wire in urinary bladder required laser fragmentation. Thirteen of the patients confessed to urethral masturbation while the rest offered vague explanations like accidental insertion or simply inquisitiveness. <b>Conclusion: </b>The results of this retrospective study indicate that urethral masturbation using foreign body exists in the healthy adult males. It generally does not come into notice until the patient ends up with impaction of the foreign body. More studies need to be done to see whether this could be a possible cause of urethral stricture in patients with inadequate history. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=PC05-PC07&id=16709 https://doi.org/10.7860/JCDR/2022/57881.16709 Immunohistochemical Analysis of TP53 and PTEN Expression in Glioblastoma Multiforme Patients of Western Rajasthan, India: An Observational Study Garima, Sharad Thanvi, Poonam Elhence, Kishore Khatri, Roshan Verma, Vijay Verma, Hanuman Prasad Toshniwal, Shailendra Sharma <b>Introduction:</b> Glioblastoma Multiforme (GBM) is the most aggressive brain tumour with a dismal prognosis. Very few studies on its diagnosis, prognosis and therapeutics have been attempted in the past on Indian population. Standard treatment of this highly aggressive tumour yields little survival benefit; hence, greater attention is now being paid to personalised treatment and, correspondingly, to the expression of specific molecular markers with the goal of assessing their possible therapeutic as well as prognostic significance. <b>Aim:</b> To estimate the proportion of Tumour Protein 53 (TP53) and PTEN (Phosphatase and Tensin Homolog) expression in GBM patients of Western Rajasthan, India. <b>Materials and Methods:</b> This study was a ambispective, single institutional observational study done on 35 brain tissue biopsies of histopathologically diagnosed and confirmed cases of GBM based on the World Health Organisation (WHO) classification, 2007 received in Department of Pathology, Dr. Sampurnanand Medical College (Dr. SNMC), Jodhpur, Rajasthan, India, from January 2015 to December 2020 (January 2015 to September 2018:Retrospective and October 2018 to December 2020:Prospective) after applying inclusion and exclusion criteria. Immunohistochemical (IHC) analysis was done for TP53 and PTEN markers in all cases of GBM. The results were then applied for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 22.0 software package (SPSS Inc., Chicago, IL, USA). The association between age and gender with TP53 and PTEN positive cases, respectively, was analysed by using Fisher&#8217;s-exact test and the results of the same were compiled. <b>Results:</b> The TP53 expression was seen in 32 cases (91.4%). The mean age of presentation of TP53 positivity was 50.3 years. Most of the TP53 cases occurred in the 41 to 50 and 61 to 70 years of age groups. In TP53 mutated cases, males were found more commonly affected as compared to females. Overall, the majority of cases (eight cases) occurred in the temporal region of the brain (25%). The relationship between age and gender with TP53 expression was found to be insignificant. PTEN expression was found absent (mutation positive) in 11 cases (32.4%). Mean age of these patients was 52.5 years. The male to female ratio was found to be 1.8:1. Regarding tumour location in the brain, most of the cases occurred unilaterally, with 45.4% (n=5) of cases occurring in the temporal region. The association between PTEN mutation with age and gender was not found to be significant. <b>Conclusion:</b> The higher prevalence of TP53 expression in the population suggests distinct genetic pathways that need to be studied in detail to have a better understanding of this highly aggressive tumour. The PTEN mutation was discovered to be prevalent in the population of Western Rajasthan and needs to be studied further on a large scale. The simultaneous presence of molecular markers in GBM cases would need to be considered before initiating any gene therapy for its improved effectiveness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=EC06-EC11&id=16710 https://doi.org/10.7860/JCDR/2022/57495.16710 Effect of Interleukin 28B SNP rs12979860 Genotype on Viral Load in Hepatitis C Virus in Kolar Population, Karnataka, India Devinder Kaur, Prabhakar Kamarthy, Subhashis Das <b>Introduction:</b> The natural course of Hepatitis C Virus (HCV) infection is influenced by a number of host and viral variables. Interleukin 28B (IL28B) is a kind of interleukin. A Single Nucleotide Polymorphism (SNP) designated as rs12979860 was reported to predict viral clearance with and without treatment. Subjects with the GG (favourable) IL28B rs12979860 genotype were more likely to clear the infection spontaneously and respond well to therapy. These findings imply that people who have the &#8220;favourable&#8221; GG genotype have a lower viral burden than those who have the &#8220;unfavourable&#8221; AA genotype. <b>Aim:</b> To determine the effect of IL28B SNP rs12979860 genotype on HCV viral load in Kolar population, Karnataka, India. <b>Materials and Methods:</b> The present study was a case-control study which was carried out in Department of Microbiology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Subjects were enrolled from Department of Medicine of R. L. Jalapa Hospital and Research centre, teaching hospital of Sri Devaraj Urs Medical College between November 2020 to March 2021. A total of 248 were taken of which 124 were HCV antibody-positive and 124 were controls. The effect of IL28B rs12979860 SNP on HCV viral load and clearance among HCV-infected patients were examined. Detection and quantification of HCV-RNA was determined by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). IL28B rs12979860 genotyping was performed using PCR and Restriction Fragment Length Polymorphism (RFLP) technique and specific primers. Statistical analysis was done by using open epi tool. The frequency, percentage and Chi-square test were used to analyse categorical variable. A p-value <0.05 was considered as significant. <b>Results:</b> In this study the frequency of G/G genotype was considerably high 83 (67%) compared to G/A 17 (13.7%) and A/A 24 (19.3%) and in group 2 the frequency of G/G genotype 84 (67.7%), G/A genotype 34 (27.4%) and A/A genotype 6 (4.9%). There was a statistically significant difference in both the HCV infected and healthy controls groups (p=0.002). The average (&#177;SEM) HCV viral load was 4.6&#177;3.6&#215;10<sup>7</sup>, 9.4&#177;7.7&#215;10<sup>7</sup> and 5.5&#177;5.2&#215;10<sup>7</sup> IU/mL in patients with the IL28B rs12979860 GG, GA and AA respectively. Also there was a significance between the viral load and IL28B rs 12979860 (p-value <0.05). <b>onclusion:</b> Thus, present study results indicate that the IL28B rs12979860 genotype has an effect on viral load in untreated HCV patients. These findings highlight the importance of viral-host interactions in influencing the outcome of HCV infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC12-DC15&id=16711 https://doi.org/10.7860/JCDR/2022/56858.16711 Intensive Case Finding of Tuberculosis and Diabetes Mellitus-Bidirectional Screening of Patients Attending a Tertiary Teaching Hospital in Rural Telangana, India Kiranmai Sannithi, Tashita Singh, Neelima Angali, Raghuram Prasad, Rajive Kumar Sureka <b>Introduction:</b> Tuberculosis (TB) is a communicable disease of global public health threat. Poor and vulnerable populations are mainly affected with it. In association with Diabetes Mellitus (DM), TB may get worsen as increased relapse rates, delayed sputum culture conversion, increase in the case fatality rates etc. Conversely, TB may increase the incidence of DM, and worsen glycaemic control in diabetes patients. <b>Aim:</b> To study the effectiveness of bidirectional screening for TB and DM in rural hospital. <b>Materials and Methods:</b> A cross-sectional cohort study conducted at Medicine and Pulmonology department of MediCiti Institute of Medical Sciences (MIMS) for a period of nine months in June 2019-February 2020. All TB patients were screened for DM and vice versa. All TB patients were followed-up for treatment outcome of TB and all DM patients were followed-up for glycaemic control. Relative risk was calculated using incidence of outcome or control of disease in TB with DM patients to TB patients and DM with TB patients to DM patients. <b>Results:</b> Of 256 TB patients, 38 (14.8%) were TB with DM cases. All 256 patients were followed-up for TB treatment outcome, 100% TB patients without DM had recovery, whereas 97.3% TB patients with DM had recovery after two months of therapy. Relative risk of DM on TB outcome was 0.97. Of 256 DM patients screened, 9 (3.5%) had been newly diagnosed with TB. All 256 people were followed-up for impact on glycaemic control. Relative risk of TB on glycemic control was 1.87. <b>Conclusion:</b> Bidirectional screening would potentially improve care and prevention of TB and DM.` https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC16-DC21&id=16712 https://doi.org/10.7860/JCDR/2022/55850.16712 In-vitro Antimicrobial Activity of Green Synthesised Silver Nanoparticles of Leaf Extract of <i>Rhinacanthus nasutus</i> against Bacterial Food Borne Pathogens V Nagasinduja, S Shahitha <b>Introduction:</b> Green synthesis of nanoparticles plays a major role in the control of virulent pathogens due to their ecofriendly, depreciated cost and naive nature. This peculiarity of plant based nanoparticle synthesis accomplishes them as fleeting development in nanobiotechnology. <i>Rhinacanthus nasutus</i> is one such plant, which is generally known as snake jasmine has prodigious medicinal properties to explore. <b>Aim:</b> The present intent of this study was to harmonise silver nanoparticles (AgNPs) from leaves extract of <i>Rhinacanthus nasutus</i> (Snake jasmine) and interrogate its vitality against virulent bacteria secluded from food. <b>Materials and Methods:</b> The in-vitro study was conducted in Department of Microbiology at Muthayammal College of Arts and Science, Namakkal, Tamil Nadu, India, during November 2018 to November 2020. Nanoparticles were harmonised using 2 mM silver nitrate with leaves extract of <i>Rhinacanthus nasutus</i> which was then characterised by ultraviolet-visible spectroscopy, Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM) with Energy Dispersive X-ray (EDX) analysis and Transmission Electron Microscopy (TEM) imaging and Energy Dispersive X-ray (EDX) analysis. Followed with this the antibacterial activity of silver nanoparticles was evaluated by agar well diffusion method against virulent bacteria isolated from food samples. Furthermore AgNPs was subjected to antibiofilm activity. Origin tool and Microsoft word 2010 were used for statistical analysis. <b>Results:</b> In this present study, 13 food samples were used from which 56 different isolates of various pathogens were isolated. The green synthesis of silver nanoparticles possessed antibacterial activity against antibiotic resistant, biofilm and beta-lactamase producing <i>Escherichia coli</i>, <i>Enterococcus spp</i>, <i>Klebsiella spp</i>, <i>Pseudomonas spp</i>, <i>Proteus spp</i>, <i>Staphylococcus spp</i>, <i>Salmonella spp</i> and <i>Shigella spp.</i> Together with this the amalgamated AgNPs also exhibited antibiofilm activity in all the isolates. The better results of antibiofilm activity was observed against <i>Salmonella species</i> (74.1%). <b>Conclusion:</b> This study divulges the presence of substantial antibacterial activity of green synthesis of silver nanoparticles of <i>Rhinacanthus nasutus</i> leaves extract against virulent bacterial species. Hence, it can be explored and exploited for the formulation of new antimicrobial against biofilm and betalactamase producing bacterial isolates due to its modest and ecofriendly nature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DC22-DC27&id=16713 https://doi.org/10.7860/JCDR/2022/56581.16713 Ropivacaine: A Review on the Pharmacological Features, Therapeutic Efficacy and Side-effects When used for Caudal Epidural Analgesia Shilpa Shankar, Vivek Chakole Inadequate post operative pain treatment can lead to clinical and psychological changes, as well as increased morbidity, mortality, and financial burden, all of which can influence quality of life. A review of the pharmacological characteristics, therapeutic efficacy in delivering postoperative analgesia, and side-effects of Ropivacaine is presented in this article. Motor blockade is an unwanted effect during the post operative period. The fear of side-effects and hemodynamic instability caused by the most of the analgesic drugs are the challenges faced in providing effective post operative analgesia in children. Ropivacaine has lesser cardiotoxic effects, lesser motor blockade and minimal side-effects as compared to bupivacaine. These properties make it a promising drug for pediatric caudal analgesia and forms a cost-effective method by decreasing the requirement of systemic analgesics, morbidity and improving the life quality postoperatively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=UE01-UE04&id=16687 https://doi.org/10.7860/JCDR/2022/56478.16687 Effectiveness of Tetracycline Drugs in the Non Surgical Treatment of Peri-implantitis: A Systematic Review and Meta-analysis Raghavendra S Medikeri, Ashwini Anil Sutar, Marisca A Pereira, Ajay R Bandal, Manjushri Waingade <b>Introduction:</b> Peri-implantitis is a significant factor affecting the success rate of oral reconstruction. Hence, it is vital to prevent it. To control peri-implant disease, non surgical treatment is the first line of defense. While peri-implant mucositis can be entirely treated, there are unforeseen repercussions for the treatment of peri-implantitis, according to many studies using non invasive approaches. <b>Aim:</b> To investigate the clinical effects of the tetracycline group of medications in the treatment of non surgical peri-implantitis. <b>Materials and Methods:</b> Electronic bibliographic databases PubMed (MEDLINE), EBSCO, Cochrane database, Clinical trial registry, DOAJ, Google Scholar, and Manual reference searches were performed for articles published January 2010 to August 2021. Total five Randomised Controlled Trials (RCTs) were selected. Three reviewers independently performed the data extraction using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting. The risk of bias was assessed with the ROB-2 tool and the quality of evidence was determined with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. A quantitative meta-analysis was performed to compare the reduction in Bleeding On Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). <b>Results:</b> In the overall analysis, BOP and PPD, was statistically reduced in the tetracycline drugs compared to the tetracycline groups. When comparing experimental and control groups, the mean reduction in BOP was -9.71 mm, (95% CI: -11.74 to -7.68), The random-effects model showed a statistically significant difference Z=9.40 (p-value <0.00001). The mean PPD was reduced by -1.18 mm in the experimental groups compared to the control groups (95% CI: -2.35 to -0.02). The CAL gain was -0.98 mm from 3.23 to 1.28 mm in the experimental group which was statistically non significant. The minocycline revealed statistically significant mean difference in BOP (mean difference was -0.72 (95% CI: -6.84, -3.24 mm but non significant difference reduction in PPD (p-value >0.05). High heterogenicity was reported in all analyses. <b>Conclusion:</b> The non surgical treatment with the tetracycline medication group resulted in a significant clinical reduction in BOP and PPD without a significant change in CAL when compared to other non surgical therapies. The minocycline has resulted in clinical decreases in BOP except PPD. Long-term randomised controlled trials are needed to assess the efficacy of treatments that do not prevent further bone loss, implant survival rates and oral health-related quality of life standards. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZE01-ZE07&id=16690 https://doi.org/10.7860/JCDR/2022/55407.16690 Exudative Benign Cementoblastoma with Radiographic Rarities- A Case Report with Review of Literature CJ Sanjay, Karthikeya Patil, D Saikrishna, Nagabhushana Doggalli, A Shiny Cementoblastoma is a rare benign odontogenic neoplasm of mesenchymal origin. The benign cementoblastoma was previously classified as one of the cementoma neoplasias by the World Health Organisation&#8217;s (WHO) classification of odontogenic tumours. The benign cementoblastoma in 2005 has been added to the list of odontogenic tumours that involve &#8220;mesenchyme and/or odontogenic ectomesenchyme, with or without odontogenic epithelium&#8221;. It accounts for around 0.69-8% of all odontogenic tumours. The lesion usually is asymptomatic and slow growing causing cortical plate expansion of both buccal and lingual plates. Cementoblastoma has male predilection, commonly seen involving mandibular first molar diagnosed in early age. There are very few incidents of an infected cementoblastoma in the literature. Radiological examinations can reveal a blend of radiolucent and radiopaque mass presenting a wheel spoke pattern. The histopathological results for both cementoblastoma and osteoblastoma are comparable. The relationship of the lesion with the tooth is the distinguishing element. Hereby, authors present a case of infected cementoblastoma in a 51-year-old female patient involving impacted mandibular second molar, clinically aggressive with unique radiologic features. Cementoblastoma is usually an incidental finding while the present case was associated with an impacted tooth and was symptomatic with infection. The uniqueness of the present case was the complete involvement of the root structure and the cyst like expansion of the lesion instead of the usual thin radiolucent rim. Also, the lesion was infected with no dental caries associated with the tooth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZE08-ZE12&id=16741 https://doi.org/10.7860/JCDR/2022/56579.16741 Public and Private Healthcare System in Terms of both Quality and Cost: A Review Saad AL Kaabi, Betsy Varughese, Rajvir Singh A public healthcare system is one in which the Government governs and controls all healthcare services. It offers high-quality medical care to all citizens, regardless of their ability to pay. The benefits of public healthcare against the private healthcare system showed that the former reduces overall healthcare and administrative costs. It helps in standardising the services and creates a healthier workforce, prevents future costs, and guides the population to make better choices. In contrast, private healthcare maintains a business-driven culture and creates unfair competition for non profit organisations. It considers healthcare as a commodity rather than a right of every citizen and may use its considerable economic power to exert undue influence on healthcare policies. Countries with the best healthcare in the world provide free or universal healthcare. These countries regard healthcare as a social good rather than an economic good and provide universal care, which means that healthcare must be affordable and accessible to all the citizens. Considering the ethical issues in the for-profit healthcare system, as well as the drawback of private health insurers, it is advocated that health insurance must be administered by non profit healthcare providers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=IR01-IR08&id=16742 https://doi.org/10.7860/JCDR/2022/55387.16742 Enhanced Periodontal Debridement with Periodontal Endoscopy (Perioscopy) for Diagnosis and Treatment in Periodontal Therapy Aishwarya Deepaksingh Rathod, Priyanka Ganesh Jaiswal, Deepika Ajit Masurkar The perioscope, which was only recently introduced, has greatly improved the removal of subgingval calculus during periodontal therapy. A fibre-optic periodontal endoscope was created to aid in the imaging of subgingival tissues and to improve periodontal disease diagnosis and treatment. Scaling and root planing have the goal of completely removing plaque and calculus from root surfaces. While this is unachievable, the agreed end-point during periodontal instrumentation is a smooth, glassy root surface. This has frequently led in over instrumentation and excessive cementum removal. Cement removal has been judged unnecessary in most cases. The removal of plaque, calculus, and endotoxin adhered to the root surface is critical. The easiest way to clean root surfaces is to use powered instruments sparingly. Due to a lack of visibility, excessive cementum removal occurs during hand instrumentation. The ability to visibly debride roots using endoscopic technology can improve success rates in a more conservative and minimally invasive manner. The perioscopy device was created to visualise the subgingival region for diagnosis, but it has since been altered to help with periodontitis therapy. The perioscope is a small camera that is encased in a sleeve and inserted under the gingival sulcus or pocket for subgingivally visualisation and instrumentation. This technique gives the greatest conservative approach to non surgical and surgical periodontal care because it enables superb magnified visualisation of the root surface and ensures the total or near complete elimination of the bacterial infection. The aim of this brief review was to provide knowledge about periodontal endoscopy, its implementation in day today practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=ZE13-ZE16&id=16795 https://doi.org/10.7860/JCDR/2022/56120.16795 Metagenomic Characterisation of Microorganisms in the Dental Plaque- A Pilot Study Ashok Veni Baskaran, Aishwarya Dhanalakshmi Jayaraj, Thangam Menon <b>Introduction:</b> Progression of dental plaque gives rise to periodontal disease. The oral cavity has a diverse flora of microorganisms and caries is often caused by members of the oral microbiome. Metagenomic techniques and next-generation sequencing technology have been used to analyse microbiomes. <b>Aim:</b> To analyse the components of the dental plaque by culture and metagenomics techniques. <b>Materials and Methods:</b> The present study was a pilot study in which analysis of the components of the dental plaque by bacteriological culture, 16s ribosomal Ribonucleic acid (rRNA) Polymerase Chain Reaction (PCR) with region specific primers and sequencing of V3-V4 regions, using the Illumina platform was performed. <b>Results:</b> Ten different phyla were identified (Firmicutes, Bacteroidetes, Proteobacteria, Fusobacteria, Actinobacteria, TM7, Spirochaetes, Tenericutes, SR1, GN02). Bacteriodetes was the most abundant phylum in the plaque samples. Firmicutes was less abundant in the plaque samples, when compared to the control. <i>Streptococci</i> were more abundant in the control (57.93%) when compared to plaque samples (10.7%, 19.3%). Routine culture grew only Viridans group <i>streptococci</i> (VGS). <b>Conclusion:</b> The 16S rRNA gene sequencing is a useful method for studying the bacterial composition of the dental plaque. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=DM01-DM03&id=16792 https://doi.org/10.7860/JCDR/2022/57882.16792 Response to an Outbreak of COVID-19 Infection among Undergraduate Medical Students in Mumbai, Maharashtra Anuradha Kunal Shah, Kosturi Dakshit, Gajanan Dattatray Velhal <b>Introduction:</b> Coronavirus Disease-2019 (COVID-19) is an infectious disease. The most effective way to slow down the transmission is by social distancing and following all the preventive protocols. <b>Aim:</b> To describe the outbreak of COVID-19 in Undergraduate (UG) medical students of a medical college in Mumbai and steps taken to control the spread as well as to break the chain of transmission of COVID-19 infection. <b>Materials and Methods:</b> The institutional contact tracing team contacted the positive case and identified contacts as soon as they were notified between 28<sup>th</sup> September, 2021 to 7<sup>th</sup> October, 2021 at Seth GSMC and KEMH, Mumbai, Maharashtra, India. A total of 40 students were isolated due to the contraction of COVID infection. History was taken by telephonic calls. Meetings were held among the institute and hostel authorities to prevent the spread. All the contacts of positive cases were separated in a quarantine facility. COVID appropriate behaviour (CAB) was implemented strictly and swab of symptomatic students were taken for Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Non academic leisure activities were suspended temporarily. Academic lectures were shifted to an online platform. <b>Results:</b> This outbreak lasted over a period of 10 days, a total of 40 students were isolated and 89 students were quarantined. Most of the students who were infected were residing in the hostels, 27 (67.5%) and had come in contact with other positive students during the college&#8217;s cultural fest. Majority of positive cases had received both doses of COVID vaccination. Mild symptoms were present in 87.5% students and rest were asymptomatic. Cases were detected from the same cluster of students and follow-up was done for the next two weeks. <b>Conclusion:</b> Strategies like scheduled testing for in-campus students, strict implementation of CAB and temporary withdrawal of activities which causes gathering helped effectively to control the spread. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=LM01-LM04&id=16714 https://doi.org/10.7860/JCDR/2022/56016.16714 Bisalbuminemia: An Uncommon Finding on Serum Electrophoresis Archana Dhavale, Deepak Bokankar, Sarika Argade, Bhagwat Kale Bisalbuminemia is a rare finding, characterised by the presence of two albumin fraction on serum protein electrophoresis. The disorder can either be inherited in autosomal dominant pattern or acquired. Acquired bisalbuminemia have discovered in various pathological conditions like diabetes mellitus, multiple myeloma, alzheimer&#8217;s disorder, sarcoidosis, nephrotic syndrome, chronic kidney disease, pancreatic pseudocyst and in patient receiving high doses of penicillin. Hereby, authors reports an uncommon case of a 55-years-old male, who presented with symptoms of lower back pain since 4 month. X-ray skull shows multiple lytic lesions. Bone marrow aspirate was hypercellular and showed 60% plasma cells. Patient was diagnosed with multiple myeloma and was sent for further biochemical investigations. Serum protein electrophoresis showed two distinct bands in the albumin region and a prominent M peak in gamma globulin region. The band may be mistaken as an abnormal globulin peak specifically while screening suspected or confirmed cases of monoclonal gammopathies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=BD01-BD02&id=16798 https://doi.org/10.7860/JCDR/2022/57377.16798 Hereditary Spherocytosis in Pregnancy- A Case Report Neethu Mathew, Vinitha Wills, NS Sreedevi Hereditary Spherocytosis (HS) is the most common inherited red cell membrane disorder included under intracorpuscular defect. The HS has both autosomal dominant and autosomal recessive inheritance. The disease may be mild, moderate or severe and requires a multidisciplinary approach for its management during pregnancy. Hereby, authors present a case of a 30-year-old female G2P1L1 at 34 weeks+4 days presented with anaemia not responding to iron therapy since first trimester. Peripheral blood smear revealed red blood cell&#8217;s were normocytic and normochromic. Spherocytes were seen with mild polychromatophilia and diagnosed as a case of HS and its management was done with haematological support. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=August&volume=16&issue=8&page=QD01-QD03&id=16780 https://doi.org/10.7860/JCDR/2022/56223.16780