Journal of clinical and diagnostic research

Central Nervous System Tuberculosis Presenting as Ventriculitis in an Immunocompetent Patient: A Diagnostic Challenge

Cherisha Selvaraj, O Johnson, C Kailash, Iqbal Nayyar

Although tuberculosis is commonly identified as a respiratory disease, its extrapulmonary manifestations, particularly in the Central Nervous System (CNS), pose significant diagnostic and treatment challenges. This report discusses a 73-year-old woman who presented with a month-long fever and two days of altered sensorium associated with lethargy and inappropriate verbal response. Magnetic resonance Imaging of her brain revealed disproportionate dilatation of ventricles suggestive of ventriculitis. Despite a negative Cerebrospinal Fluid Cartridge-based Nucleic Acid Amplification Test (CSF CB-NAAT), findings such as elevated protein, low glucose, lymphocytic pleocytosis, and raised adenosine deaminase suggested CNS Tuberculosis (CNS TB). She received high-dose intravenous steroids, anti-epileptics, and Anti-Tubercular Therapy (ATT). After 21 days of hospitalisation, she was discharged with significant improvement. A year later, she was symptom-free, with no relapse. This case report elaborates on a clinical variant of TB infection and the diagnostic challenges posed.

Troponin I Assay Interference Due to Paraproteinaemia: A Diagnostic Challenge in Multiple Myeloma: A Case Report

G Shankavi, V Vidvath, Miryala Srinivas Jayanth, TA Vidya

Cardiac troponins are among the most reliable biomarkers for diagnosing acute myocardial infarction. However, in certain clinical situations, analytical interferences can result in misleading or uninterpretable results, creating confusion in diagnosis and management. One such rare cause of interference is paraproteinaemia associated with plasma cell disorders such as multiple myeloma. A 60-year-old man with no known comorbidities presented with exertional retrosternal chest pain and heartburn of three months’ duration. Clinical evaluation revealed pallor and biochemical findings of anaemia, renal dysfunction, and hyperproteinaemia. Electrocardiography showed ischaemic changes, but serial Troponin I assays repeatedly displayed “error” messages, raising the suspicion of assay interference. Further investigations demonstrated a monoclonal spike on serum protein electrophoresis, and bone marrow examination confirmed multiple myeloma. Despite aggressive multidisciplinary management, the patient developed septic shock, disseminated intravascular coagulation, and multiorgan failure and succumbed during the hospital stay. This case highlights a rare but important cause of analytical interference in Troponin I estimation due to paraproteinaemia. It emphasises the need for clinicians to interpret laboratory results in correlation with the clinical picture and to maintain close coordination with laboratory teams whenever results appear inconsistent. Early recognition of such assay interferences can help avoid misdiagnosis and unnecessary interventions in critically ill patients.

CT Unveils a Striking Case of Hydranencephaly: A Case Report

Komal Rathod, Ramesh Chaple, Ajay Chavan, Saraswathula Bharadwaj

A rare congenital brain condition known as hydranencephaly is characterised by the near-total loss of the cerebral hemispheres, which are replaced by cerebrospinal fluid, although the brainstem and cerebellum are left intact. It is usually diagnosed in infancy; however, uncommon presentations can also occur. We describe a child who experienced frequent Generalised Tonic-Clonic Seizures (GTCS), drowsiness, and dyspnoea across four days, as well as a history of steady weight loss since birth. Clinical examination revealed an underlying neurological condition, and non-contrast Computed Tomography (CT) of the brain showed almost complete bilateral loss of cerebral parenchyma, except for the retained falx cerebri, thalami, brainstem, and cerebellum, confirming the diagnosis of hydranencephaly. This case emphasises the necessity of looking for hydranencephaly in neonates with unexplained seizures and developmental failure, as well as the critical role of radiological imaging, particularly CT and Magnetic Resonance Imaging (MRI), in attaining timely diagnosis, parental counselling, and appropriate care.

Inguinal Canal Metastasis in a Case of Cholangiocarcinoma: A Case Report

In adults, inguinal hernias are commonly encountered, and in rare instances, metastatic masses may develop within the hernia sac. Here, the authors report the case of a 75-year-old male who presented with a two-month history of jaundice, pruritus, and dark urine, along with a one-month history of right inguinal swelling. He had a prior history of bilateral inguinal hernioplasty performed 15 years earlier. On examination, the patient had abdominal distension with ascites and a 3×3 cm non-reducible right inguinal swelling without a cough impulse. Contrast-Enhanced Computed Tomography (CECT) of the abdomen revealed ill-defined, minimally enhancing lesions involving the Common Bile Duct (CBD) and Common Hepatic Duct (CHD), resulting in Intrahepatic Biliary Radical Dilatation (IHBRD) and metastatic lymphadenopathy, suggestive of Type IV cholangiocarcinoma. Additionally, an irregular, thick-walled, heterogeneously enhancing lesion measuring 3×3 cm was noted within the hernia sac, suggestive of a metastatic deposit. Imaging and histopathological evaluation of the hernia sac lesion were performed to establish the diagnosis and guide management. The patient was subsequently managed with palliative chemotherapy; however, the prognosis remained poor due to advanced metastatic cholangiocarcinoma. The present case is noteworthy as it represents a rare presentation of cholangiocarcinoma metastasising to the inguinal canal through a hernia sac-a phenomenon scarcely documented in medical literature. It highlights the importance of maintaining a high index of suspicion and performing histopathological evaluation of atypical hernia sac contents, particularly in patients with underlying malignancy.

A Case of Postpartum Psychosis Associated with Typhoid and Urinary Tract Infection: A Complex Clinical Presentation

Althea Sukhato Wotsa, Tatonginla Jamir

Postpartum psychosis (PPP) is a rare but severe psychiatric disorder occurring shortly after childbirth. The present report describes a 37-year-old female who, three weeks after an uncomplicated vaginal delivery, developed acute psychosis coinciding with systemic infections - typhoid fever and Urinary Tract Infection (UTI). She initially presented with low mood, social withdrawal, disturbed sleep and auditory hallucinations. She was prescribed Sertraline 50 mg/day and Olanzapine 5 mg/day for 14 days, but she discontinued the medication due to poor insight. The day after her psychiatric consultation, she presented to the Emergency Department with high-grade fever, vomiting and decreased responsiveness. Blood culture grew Salmonella typhi and urine culture grew Escherichia coli. Initial antibiotic therapy with ceftriaxone and nitrofurantoin was started but later escalated to meropenem due to clinical deterioration. With combined psychiatric and antimicrobial management, the patient gradually improved. At discharge on day 21, she was psychiatrically stable, afebrile and laboratory parameters had normalised. At three-month follow-up, she remained in remission with continued adherence to medication. The present case underscores the diagnostic challenge of distinguishing PPP from infection-associated delirium and highlights the importance of multidisciplinary care and medication adherence.

Management of Residual Post-traumatic Palatal Defect Resulting in Palatal Fistula: A Case Report

The typical skeletal framework that directs anatomical reductions after fixing is absent from pan facial fractures, which have a complicated pattern and are often associated with post traumatic deformities of face. Management of such conditions like depressed forehead, temporal hollowing, nasal deviation, telecanthus, loss of facial width, palatal fistulas, malocclusion is crucial when they involve functional abnormalities. Palatal fistulas following trauma, benign or malignant pathologies are debilitating conditions rendering patients difficulty in swallowing and speech impairment. This case report mainly emphasises on the management of one such defect, post traumatic residual palatal fistula. Here, a case of 43 year old male patient who was operated for facial bone fractures along with the neurosurgery team, developed a postoperative palatal fistula. Later after a month, second surgery was done, under General Anaesthesia (GA), fistula repair with palatal pedicle advancement flap was done. Postoperative outcome was satisfactory for both patient and the surgeon. Palatal pedicle advancement flap provides a robust, well vascularised, local tissue cover that allows tension free, single stage closure of the defects with good tissue match and minimal donor site morbidity.

Navigating and Managing Eight Canals in a Maxillary First Molar: A Case Report

Understanding the existence of an additional root and atypical root canal anatomy is essential because it impacts the manner in which endodontic therapy occurs. For endodontic procedures to be performed successfully, a thorough knowledge of the basic anatomy of root canals and their possible variations is essential. The anatomical features of permanent maxillary molars are characterised by three roots and canals consisting of one palatal and two buccal roots and root canals. The most frequently encountered kind of root canal is the second Mesiobuccal (MB) root canal. The outcome of treatment for maxillary first molars is significantly affected by the frequent occurrence of root canal variations. It may be easy to avoid iatrogenic errors and guarantee success by having an in-depth knowledge of root canal morphology and being able to anticipate any potential morphological changes with the help of Cone Beam Computed Tomography (CBCT) and Dental Operating Microscope (DOM). This case report documents the successful endodontic treatment of a maxillary 1st molar with three roots and eight root canals under a dental operating microscope. The root canal anatomy was confirmed using CBCT analysis.

‘From Broken Bones to Broken Brain’ – Unveiling Cerebral Fat Embolism in a Healthy 21-Year-Old Female

Yatrik Vasavada, Akhilesh Singh, Aditya Pundkar

Cerebral Fat Embolism (CFE) is an uncommon but deadly complication that can occur following long bone fractures, particularly those of the femur. It is distinguished by a variety of neurological symptoms and may resemble other acute neurological disorders. Early detection along with therapeutic care are critical to better results. We present the example of a 21-year-old girl who suffered a catastrophic injury to her right thigh in a car accident. A first radiographic examination revealed a closed fracture of the right femoral shaft. Within 18 hours following the injury, the patient experienced altered mental state and respiratory discomfort. On diffusion-weighted imaging, brain Magnetic Resonance Imaging (MRI) revealed several hyperintense lesions, which were suggested to be CFE. Other possible explanations were ruled out by laboratory and radiological examinations. Supportive care, such as oxygen therapy and frequent monitoring, was implemented. The patient’s neurological condition gradually improved over the next few days. CFE should be evaluated in individuals with long bone fractures who report with unexplained neurological decline. Prompt diagnosis by imaging and supportive treatment are critical for successful results. This example demonstrates the significance of clinical vigilance in trauma patients, especially those with femoral fractures.

IgA Nephropathy with ANCA Vasculitis: A Case with Diagnostic and Therapeutic Challenges

The co-existence of IgA nephropathy (IgAN) and Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis (AAV) is rare but presents a distinct diagnostic and therapeutic challenge. IgAN is the common glomerulonephritis characterised by mesangial IgA deposition, while AAV typically involves small-vessel vasculitis associated with Myeloperoxidase (MPO)-ANCA or PR3-ANCA positivity. Although these are classically considered separate entities, emerging evidence suggests that ANCA positivity can be seen in a subset of IgAN patients, often associated with more aggressive renal involvement and a broader systemic inflammatory response. We describe three cases of biopsy-proven IgA nephropathy with AAV. All patients had histological features consistent with both mesangial IgA deposition and crescentic glomerulonephritis, along with elevated ANCA titers. Presentations varied from constitutional symptoms to a severe pulmonary-renal syndrome. All patients received immunosuppressive therapy including corticosteroids and cyclophosphamide, followed by maintenance with mycophenolate mofetil. Two patients showed improvement in renal function, while one progressed to end-stage kidney disease requiring dialysis. This case series underscores the importance of considering ANCA testing in IgA nephropathy with atypical or rapidly progressive features and supports a combined immunosuppressive treatment approach in such overlapping pathologies.

A Case of Appendicular Adenocarcinoma Presenting as Acute Appendicitis

R Kavin Shanmugavel, D Balaji, P Harshwanth Chandar, J Sowmiya, Teena Eugene

Primary adenocarcinoma of the appendix is a rare malignancy, accounting for less than 1% of gastrointestinal neoplasms. The clinical presentation of appendiceal tumours is variable and non specific. Acute appendicitis from luminal obstruction is the most common presentation. Hereby, the authors present a case of 60-year-old female presented with chief complaint (c/o) of abdominal pain for duration of two months, exhibiting clinical findings of tenderness in right iliac fossa. She was diagnosed with acute appendicitis based on clinical and radiological evidence. A laparoscopic appendicectomy was done and specimen sent for Histopathological Examination (HPE), which showed features of adenocarcinoma. As part of evaluation, Contrast-enhanced Computed Tomography (CECT) was taken and tumour markers were sent, showed no abnormal findings. Patient subsequently underwent right hemicolectomy, which is the standard protocol for adenocarcinoma of the appendix. Very minimal cases are reported till now. The present case report will discuss the management and presentation of appendicular adenocarcinoma.

Excision of a Calcaneal Osteochondroma via Medial Approach: A Case Report

Abdulmalik B Albaker

Osteochondromas are the most common benign bone tumours, typically arising from the metaphyses of long bones, while involvement of the calcaneus is rare. When present in the hindfoot, these lesions may become symptomatic due to mechanical irritation or proximity to Neurovascular (NV) structures, posing both diagnostic and surgical challenges. Hereby, the authors report the case of a 30-year-old male patient who presented with a one-year history of progressive medial heel pain and a palpable bony mass. Radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) demonstrated a pedunculated osteochondroma arising from the medial aspect of the calcaneus with continuity of the medullary canal and a thin cartilage cap. Due to persistent symptoms and concern for NV compression, surgical excision was performed using a medial approach. The lesion was removed en bloc with complete excision of the cartilage cap while preserving adjacent NV structures. Histopathological examination confirmed a benign osteochondroma. The patient experienced complete resolution of symptoms and returned to normal activities, with no recurrence at 12-month follow-up. The present case highlights the importance of considering calcaneal osteochondroma in patients with persistent heel pain and demonstrates that a medial surgical approach offers safe exposure, effective NV protection and favourable functional outcomes when anatomically feasible.

Avascular Necrosis of the Femoral Head Managed with Total Hip Arthroplasty in a Patient with Lymphatic Filariasis: A Case Report

Lymphatic filariasis is one of the major issues in public health in endemic regions. This tropical disease is caused by mosquito-borne parasites such as Wuchereria bancrofti, Brugia malayi, and Brugia timori and predominantly targets the lymphatic system, causing limb dysfunction and other complications. It is clinically noted as lymphoedema, swelling, pain and fever. This is a case of a 52-year-old male farmer from an endemic region with chronic lymphoedema and progressive right hip pain. He presented to the Outpatient Department with complaints of pain in right hip and swelling in left lower limb. Initially, the patient experienced a dull, aching pain in the right hip. The pain was persistent throughout the day, relieved with rest and exacerbated on walking and weight-bearing activities. The pain progressively worsened, eventually leading to significant difficulty in moving the left lower limb. Radiological evaluation revealed avascular necrosis of the femoral head of the right hip, for which the patient subsequently underwent right-sided-total hip arthroplasty. The diagnosis of lymphatic filariasis involving the left lower limb was confirmed by serological testing, and appropriate medical management was initiated. This case highlights an unusual orthopaedic manifestation of lymphatic filariasis requiring hip arthroplasty, rarely reported in literature.

Clinical Conundrum: Unveiling a Rare Case of Morquio Syndrome with Rheumatic Heart Disease

Krupa Bhanushali, Keta Vagha, Ashish Varma, Amar Taksande

A genetic lysosomal storage condition called Mucopolysaccharidosis (MPS) causes a variety of enzyme deficits that result in the build-up of specific glycosaminoglycans in the tissues. These deposits impact several systems, resulting in chronic morbidity, and create a variety of physical abnormalities that give characteristic looks and findings. This is a case study of a male patient who was diagnosed with Rheumatic Heart Disease (RHD) after presenting with cardiac problems. After testing and research, he was found to have Type 4, a very uncommon form of MPS, often known as Morquio syndrome. The child underwent surgical correction for mitral regurgitation, specifically mitral valve replacement This case highlights the need for increased margin of suspicion for RHD in a child with mucopolysaccharidoses and takes timely corrective measures. Morquio syndrome is a type 4 MPS with characteristic features and has multisystemic involvement. Although cardiovascular system inolvement is one of the known involvements in the disease spectrum, the presence of RHD in a child with Morquio is not a frequent occurrence. This case highlights the need to consider and thoroughly examine a child with MPS for cardiac involvement and take necessary corrections in a timely fashion.

Oesophageal Perforation during Chemoradiation for Ewing’s Sarcoma: A Case Report

VK Gopi, KT Muralikrishnan, Nafiya, A Rahul Dev, Bini B Nambiar

Oesophageal Perforation (EP) is a rare condition, mostly iatrogenic, commonly caused by endoscopic procedures. Non-iatrogenic EP associated with chemoradiotherapy for non-oesophagal malignancies is exceedingly rare. We report a case of oesophageal perforation in an eight-year-old girl undergoing adjuvant chemoradiotherapy for posterior fossa Ewing’s sarcoma. During intensive chemotherapy, the patient developed acute chest pain, recurrent vomiting and abdominal pain. Diagnostic evaluation via gastrografin swallow X-ray confirmed an oesophageal perforation. The child was initially managed with a gastrostomy tube for enteral feeding, followed by posterolateral thoracotomy and repair of EP. The patient had an uneventful postoperative recovery. This case highlights the need for high clinical vigilance in paediatric oncology patients undergoing intensive chemotherapeutic regimens, where atypical presentations of gastrointestinal complications may arise. Early recognition and multidisciplinary interventions are essential to mitigate the risks of EP and optimise outcomes in this vulnerable population.

Thoracic Occupation of All Abdominal Organs in a Neonate: Intraoperative Surprise of Diaphragmatic Eventration

Somya Goel, Thavendra Dihare, Raju K Shinde, Khusbu Vaidya, Ashish Jivani

Congenital Diaphragmatic Hernia (CDH) is commonly diagnosed at birth or in the early days of life. It is commonly observed on the left side, with a male predominance. It can be diagnosed during prenatal scans using common diagnostic modalities such as ultrasound. Diaphragmatic eventration is an abnormal elevation of the diaphragm caused by muscle paralysis, thinning, and/or weakness without any disruption or continuity in the diaphragm. Severe congenital diaphragmatic eventration can mimic CDH and present a diagnostic challenge. Foetal Magnetic Resonance Imaging (MRI) can help differentiate congenital diaphragmatic eventration from CDH. This is a case of a nine-day-old male neonate, presented to the emergency department with respiratory distress, and was subjected to radiological investigations, which showed left-sided CDH, Bochdalek type. Intraoperatively, a large diaphragmatic eventration was found. The neonate underwent a successful Bochdalek congenital diaphragmatic repair and was discharged on postoperative day 30. A follow-up at 1.5 months showed the infant recovering well postoperatively with no new complications. This case highlights the imaging-operative discordance. This neonate with acute respiratory distress, imaging suggestive of Bochdalek CDH, and an intraoperative finding of extensive eventration (rather than a full-thickness posterolateral defect) is rarely detailed. The successful management of this case was evident by an uneventful postoperative recovery.

Managing Severe Foetal Anaemia Due to Rh Alloimmunisation: A Report of Two Cases of Successful Intrauterine Blood Transfusion

B Megala, A Ashwin, R Krishnamoorthy, R Niranj Rathan, M Sampat Kumar

Intrauterine Transfusion (IUT) remains a critical intervention in managing severe foetal anaemia, particularly due to Red Blood Cell (RBC) alloimmunisation. Without timely treatment, foetal anaemia can lead to hydrops foetalis, heart failure, or even intrauterine death. The decision to perform IUT is guided by key clinical indicators such as raised Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV), decreased foetal haemoglobin, and high maternal antibody titres. Although IUT has significantly improved foetal and neonatal outcomes, it requires precise timing, well-coordinated teamwork, and careful preparation of compatible donor blood to minimise complications. In the present report, both cases involved Rh-negative women with known alloimmunisation who presented in the third trimester with rising antibody levels and ultrasound findings suggestive of foetal anaemia. The transfusions were performed under ultrasound guidance via umbilical vein puncture. Blood prepared for Intrauterine Transfusion (IUT) was group O RhD-negative, leukocyte-depleted, irradiated, and crossmatch-compatible with the maternal sample. Foetal haemoglobin and haematocrit levels were assessed before, during, and after the transfusion, with close monitoring maintained until delivery and throughout the neonatal period. In the first case, two well-timed transfusions improved foetal haemoglobin and normalised MCA-PSV, resulting in the birth of a stable neonate who later required exchange transfusion and phototherapy but recovered fully. The second mother received one IUT but declined further treatment despite worsening MCA-PSV. Due to foetal distress, an emergency caesarean section was performed. The preterm infant responded well to a double-volume exchange transfusion and phototherapy. Both babies remained stable during follow-up, with one requiring a top-up transfusion for delayed haemolysis.

Combined Hepatocellular-Cholangiocarcinoma (cHCC-CCA): A Rare Case of Biphenotypic Primary Liver Carcinoma in a Post-Hemicolectomy Patient

Devika Venugopal, Veena Raja

Combined Hepatocellular-Cholangiocarcinoma (cHCC-CCA) is a rare primary liver malignancy characterised by the presence of both hepatocytic and biliary epithelial differentiation within the same tumour and is associated with a poorer prognosis compared to Hepatocellular Carcinoma (HCC) or intrahepatic Cholangiocarcinoma (iCCA) alone. Accurate diagnosis is challenging, particularly in patients with a prior history of extrahepatic malignancy, where metastatic disease must be carefully excluded. We report the case of a 65-year-old male with a history of colonic adenocarcinoma treated by hemicolectomy and adjuvant chemotherapy in 2007, who remained disease-free for 18 years. In 2025, he presented with abdominal pain, and imaging revealed a solitary hepatic lesion in segment VI. Serum tumour markers demonstrated markedly elevated Alpha-Fetoprotein (AFP; 951 ng/mL), while Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen 19-9 (CA19-9) levels were within normal limits. Given the prior history of Colorectal Carcinoma (CRC), metastatic disease was initially considered. Histopathological examination revealed a poorly differentiated malignant neoplasm with biphasic morphology. Immunohistochemical analysis showed hepatocytic differentiation with positivity for HepPar-1 and arginase-1, alongside cholangiocytic differentiation demonstrated by CK7 and CK19 expression. Markers associated with colorectal origin (CK20, CDX2, SATB2) were negative, effectively excluding metastatic CRC. Based on these findings, a final diagnosis of poorly differentiated classical combined hepatocellular–cholangiocarcinoma was rendered. This case underscores the critical role of comprehensive histopathological evaluation and targeted immunohistochemistry in establishing the diagnosis of cHCC-CCA. Early and accurate distinction from metastatic disease and other primary liver tumours is essential due to its distinct biology, aggressive behaviour, and adverse prognostic implications.

Gastric Immature Teratoma in a Newborn with Very High AFP (Alpha-Fetoprotein) Level: A Case Report

M Ramsheena, K Subitha, Letha Vilasiniyamma

Gastric teratomas are exceptionally rare germ-cell tumours of infancy, representing <1% of all teratomas and showing a strong predominance in male infants. These tumours typically originate from the posterior wall of the stomach and most often present with abdominal distension or features of gastric outlet obstruction. While the majority are mature lesions, pure immature teratomas are exceedingly uncommon and are distinguished by the presence of primitive neuroectodermal components. Preoperative imaging using ultrasound/CT reveals a heterogeneous mass composed of solid and cystic elements, characteristic of teratomas. We report a case of two-day-old male neonate presented with abdominal distension and respiratory distress, with prenatal imaging suggesting an intra-abdominal teratoma. Laboratory tests revealed markedly elevated Alpha-Fetoprotein (AFP) levels (73000 ng/mL). Imaging confirmed a large, multiloculated cystic mass in the abdomen, which was surgically excised and found to arise from the posterior aspect of the stomach. Histopathological examination revealed a Grade 3 immature teratoma, showing components from all three germ layers, including immature neuroectodermal tissue, cartilage, bone, glial tissue, and various epithelial linings. Immunohistochemistry (IHC) demonstrated AFP positivity in the immature tissue and gastric epithelium. Despite the high AFP level, no yolk sac elements were identified, confirming a diagnosis of immature teratoma. This case highlights the diagnostic complexity posed by elevated AFP levels in the absence of other malignant Germ Cell Tumour (GCT) components. Early detection, accurate histopathological evaluation, and awareness of such rare presentations are crucial for appropriate management. This case contributes to the limited literature on pure immature gastric teratomas with markedly elevated AFP in neonates.

Apocrine Carcinoma of the External Auditory Canal: A Rare Case Report

Shehla Basheer Kollathodi, Shahin Hameed, TP Sajith Babu

Apocrine carcinoma of the External Auditory Canal (EAC) is an extremely rare malignant neoplasm arising from modified apocrine (ceruminous) glands. We report a 41-year-old man with a long-standing recurrent EAC mass, previously excised multiple times and reported as papillary apocrine cystadenoma and ceruminous adenoma. He presented with progressive conductive hearing loss and a firm swelling occluding the EAC with extension into the temporal region. Imaging showed a large soft-tissue mass filling the canal and involving the temporal soft-tissue and mastoid air cells. Wide excision revealed an invasive tubulopapillary neoplasm with abundant eosinophilic cytoplasm, apocrine snouts, nuclear pleomorphism, mitoses and necrosis. Immunohistochemistry showed diffuse positivity for androgen receptor, GATA-3 and GCDFP-15 with a high Ki-67 proliferative index, confirming apocrine carcinoma. Re-excision with wider margins and selective neck dissection revealed lymph node metastasis and lymphovascular invasion. The patient subsequently received adjuvant radiotherapy. At the time of writing this report, he remains on regular follow-up with no evidence of local recurrence or metastatic disease. This case is notable for its unusual site, occurrence in a relatively young patient and progression from previously benign-reported ceruminous lesions. It highlights the malignant potential of recurrent ceruminous gland tumours and underscores the need for complete excision, thorough histopathological evaluation and long-term surveillance to detect early transformation or recurrence.

Breast and Axillary Metastases from High-grade Serous Ovarian Carcinoma: A Rare Case Report Highlighting Diagnostic Challenges and Pitfalls

Alka Yadav, Ankita Singh, Ram Nawal Rao

High-grade Serous Ovarian Carcinoma (HGSOC) is an aggressive malignancy that commonly metastasizes to peritoneum, omentum, pelvic and para-aortic lymph nodes, serosal surfaces of bowel and mesentery. Metastases to the breast and axillary lymph nodes is extremely rare and can closely mimic primary breast malignancy, making diagnosis extremely difficult, especially if it occurs after a prolonged disease-free interval. A 35-year-old nulligravid woman presented with a painless right breast lump of two months’ duration along with bilateral axillary lymphadenopathy. She had already been diagnosed with HGSOC six years prior, for which she received neoadjuvant chemotherapy, optimum cytoreductive surgery, and several lines of chemotherapy. On radiological assessment, a suspicious right breast lesion with bilateral axillary lymph node enlargement and pleural effusion was discovered during the current presentation. Core biopsies from the right breast lesion and axillary lymph nodes showed a high-grade malignant epithelial tumour arranged in papillary pattern. Metastatic HGSOC was confirmed by immunohistochemistry, which showed positive expression for PAX8, WT1, CK7 with aberrant p53 and negative for breast-specific immunohistochemistry markers ER, PR, HER2, and GATA3. Given the chemoresistant disease and symptomatic breast lesion, the patient was treated with palliative local radiation, after which she experienced symptomatic relief and stable disease at short-term follow-up. The case highlights the importance of careful histopathological examination supported by an appropriate immunohistochemistry panel in making the correct diagnoses at unusual metastatic sites with long latency periods which can cause diagnostic confusion with primary breast carcinoma and prompted this case presentation.

Dengue Fever with Transient Mobitz Type 1 Heart Block: A Rare Paediatric Case Report

Manoj Kumar, Shailaja Mane, DS Darshana, Owais Ali Khan, Ganesh Kumar

Dengue fever is a mosquito-borne viral illness caused by the dengue virus, primarily transmitted by Aedes aegypti mosquitoes. It remains a major public health concern in tropical and subtropical regions worldwide. Clinical presentations range from mild febrile illness to severe complications such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). In recent years, atypical manifestations, including cardiac involvement, have been recognised. The present case report focuses on a nine-year-old male child from a dengue-endemic area who presented with a high-grade fever, myalgia, abdominal pain, and vomiting. Laboratory findings revealed thrombocytopenia and elevated haematocrit levels, meeting the criteria for dengue with warning signs. During the course of the illness, the child was found to have Mobitz type 1 Atrioventricular (AV) block (Wenckebach phenomenon) on an Electrocardiogram (ECG). This cardiac conduction abnormality, though rare in the paediatric population, was transient and resolved spontaneously without the need for intervention. The patient was managed conservatively with close monitoring, fluid management, and supportive care, ultimately making a full recovery. A repeat ECG showed normalisation of the cardiac rhythm. The present case underscores the importance of recognising cardiac complications in dengue fever, even in children, as they may be self-limiting yet clinically significant. Early detection and vigilant monitoring of warning signs, including electrocardiographic changes, can aid in preventing potential morbidity. Clinicians should maintain a high index of suspicion for such atypical manifestations in dengue cases, especially during outbreaks.

Arteriovenous Malformation of Lower Lip in Familial Cerebral Cavernous Malformation Syndrome: A Case Report

Riya Anand Goyal, Nitin Dharampal Bhola, Sanjana Wadewale, Rajanikanth Kambala

Familial Cerebral Cavernous Malformations (FCCM) is a genetic condition marked by the presence of numerous vascular abnormalities within the brain and spinal cord. These lesions are composed of closely packed, thin-walled vascular spaces lined by endothelium, varying in size from a few millimetres to several centimetres. Despite the potential manifestations, approximately half of those with FCCM may never experience any related symptoms throughout their lives. We present a rare case of a middle-aged female with FCCM syndrome who was diagnosed with an Arteriovenous Malformation (AVM) of the lower lip. It is characterised by the presence of a bluish, compressible and pulsatile swelling. Symptoms often appear between the second and fifth decades of life and may include seizures, neurological deficits, headaches, or haemorrhages, though many individuals remain asymptomatic. Diagnosis is based on imaging findings and genetic testing while treatment focuses on managing symptoms and surgically addressing problematic lesions when necessary. This report highlights the coexistence of these vascular anomalies, emphasising the congenital, clinical and therapeutic considerations involved in managing such patients.

Anaesthesia in a Child With 9q13-q21 Deletion Syndrome: Tailored Perioperative Management in a Rare Genetic Disorder

C Harshitha, Chaitali Shashikant Patil, Rochana Girish Bakhshi

Rare genetic disorders may present unique challenges in the treatment of anaesthesia due to their variable clinical presentations and potential for unexpected complications, necessitating a highly customised approach to perioperative management. The 9q13-q21 microdeletion syndrome is an exceptionally rare chromosomal disorder with limited literature documentation. This case report describes the successful perioperative anaesthetic management of a 12-month-old male child with heterozygous microdeletion in chromosome 9q13-q21.33 who presented for orchidopexy. The patient exhibited developmental delay, profound hypotonia, and distinctive craniofacial dysmorphic features including microcephaly, midfacial flattening, hypertelorism, and blepharophimosis, alongside undescended testis, severe congenital ptosis, and suspected congenital myasthenic syndrome. Significant cardiac and thyroid abnormalities were ruled out by a thorough preoperative evaluation, and underlying muscle dysfunction was ruled out by electromyography. The primary anaesthetic challenge involved management of a potentially difficult airway due to syndromic features and developmental status. Given the patient’s age, hypotonia, and the potential of problems from traditional anaesthesia, a carefully planned anaesthetic technique was adopted utilising ProSeal Laryngeal Mask Airway (LMA) and Total Intravenous Anaesthesia (TIVA) with propofol infusion was titrated to maintain spontaneous ventilation, accompanied by caudal block using 0.2% bupivacaine for analgesia. The 90-minute surgery was uneventful with steady haemodynamics and complete recovery of patient’s protective airway reflexes. This case highlights the necessity of rigorous preoperative screening, anticipation of many anaesthetic problems, and tailored perioperative management techniques in attaining optimal outcomes in children with uncommon genetic diseases.

Follicular Variant Papillary Thyroid Carcinoma with Rare Oral and Sternal Metastases: A Case Report

Metastatic spread of Differentiated Thyroid Carcinoma (DTC), including its Follicular Variant of Papillary Thyroid Carcinoma (FV-PTC), to the oral cavity is extremely rare, with the hard palate being an exceptionally uncommon site. A 65-year-old female with a history of total thyroidectomy for FV-PTC presented with a painful, progressively enlarging swelling in the left posterior maxilla and sternum. The patient had undergone total thyroidectomy six years prior to the current presentation. Examination showed a diffuse, firm palatal mass with submandibular lymphadenopathy and restricted mouth opening. Imaging revealed an extensive destructive lesions of the skull base and sternum with vascularity and calcification. Cytology from the sternum confirmed metastatic PTC, whereas the initial maxillary biopsy showed granulomatous changes, highlighting the diagnostic challenge. The patient was started on lenvatinib 4 mg daily, later escalated to 8 mg daily, resulting in a marked and sustained regression of both palatal and sternal lesions over twelve months without significant toxicity. This case highlights the importance of repeat biopsy in atypical oral lesions, the need for meticulous clinicopathological correlation, and the therapeutic value of targeted agents in advanced thyroid carcinoma.

Magnetic Resonance Imaging Features and Management of a Large Symptomatic Rathke Cleft Cyst: A Case Report

Kattula Leela Krishna, Sanjot Ninave, Amol Bele

The Rathke pouch is a permanent remnant of the embryonic buccal cavity that, in normal conditions, disappears following the establishment of the anterior pituitary. Pathogenesis of cystic sellar and suprasellar lesions, referred to as pars intermedia or Rathke cleft cysts, results from failure of pars intermedia closure. The cysts are usually small, symptomless, and incidentally discovered, with diagnosis strongly dependent on magnetic resonance imaging. We report a case of a 51-year-old postmenopausal female patient with a six-day history of headache, weakness, and progressive worsening of vision for two years. She developed leukocytosis on laboratory findings, while endocrine parameters were normal. Magnetic resonance imaging showed a massive extra-axial non-enhancing cystic lesion in the sellar, suprasellar, and parasellar region that was hypointense on T1-weighted images and hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences with mass effect upon the optic chiasm, hypothalamus, and thalamus. On these radiological findings, Rathke cleft cyst was diagnosed. The patient was admitted for left pterional craniotomy with complete surgical excision of the cyst. Post-operative course was uneventful, and she was discharged on the fourth day on a regimen of regular follow-up. This case emphasises the clinical importance of detecting symptomatic Rathke cleft cysts, which, while rare, can produce progressive loss of vision and neurological findings, if considerable. It emphasises the importance of thorough radiological evaluation in diagnosis, defines surgical treatment as the therapy of choice for symptomatic lesions, and illustrates a favourable outcome after prompt intervention.

Orthodontic Correction of Vertical Maxillary Excess using Mini-implants: A Case Report

KS Renjini, Mohamad Shaloob, Mohammad Nayaz, VP Shahana Mol, K Hasanath

Vertical Maxillary Excess (VME) is a complex skeletal anomaly frequently linked with long-face syndrome and characterised by excessive incisor visibility, lip incompetence, and aesthetic disharmony. This case report outlines the successful orthodontic management of a 14-year-old male presenting with skeletal Class II malocclusion, vertical maxillary excess, and bimaxillary protrusion. The treatment strategy integrated mini-implant-supported intrusion and en-masse retraction following the extraction of all first premolars. Three titanium mini-implants were employed—one midline and two inter-radicular mini-implants in the molar region—for effective anterior intrusion and posterior retraction using absolute anchorage, minimising patient compliance requirements. Cephalometric analysis revealed notable skeletal and dental improvements, including a 3° reduction in Sella-Nasion to Point A angle (SNA), normalisation of the A point-Nasion-B point angle (ANB) to 2°, a decrease in the upper incisor to nasal floor distance (U1-NF) from 36 mm to 33 mm, and a 4° reduction in the Frankfort Mandibular Plane Angle (FMA), indicating favourable mandibular autorotation. These changes contributed to improved smile aesthetics, profile balance, and incisor display. The treatment was concluded with Hawley’s retainers. This case highlights the efficacy of mini-implants in addressing VME with minimal invasiveness, offering predictable results and high patient satisfaction.

Triple Maxillary Labial Frenal Attachment: A Rare Case Report

Labial frenum is a dynamic, often variable structure which is subject to variation in shape, size and position during the stages of growth and development. The maxillary labial frenum gives support to the upper lip and any discrepancy can lead to various consequences such as diastema, improper position of the maxillary central incisors, orthodontic treatment relapse and periodontal problems including gingival recession, bone loss caused by the muscle pull, food impaction, dental caries, aesthetic problems and restriction in lip mobility during speech and smile. Early identification and understanding of morphologic variations in the maxillary labial frenum, as well as distinguishing them from pathology, are essential for effective treatment and prevention of dental complications. The present case report describes a rare case involving a 26-year-old male who presented with deposits on both upper and lower teeth and was found to have three maxillary labial frenal attachments, which were attached to the gingiva at different levels, respectively. The case highlights the unique and uncommon presentation of labial frenal attachment. The triple labial frenum attachment did not affect the patient’s daily activities; therefore, the patient declined treatment. In the advanced digital era of dentistry, there is a great scope of overwhelming outcomes, including the field of periodontal surgery. Treatment options depend on the severity and type of the abnormality, like classical frenectomy, Miller’s technique, Z-plasty, V-Y plasty, electrosurgery and laser surgery. Oral health education is important for raising awareness of these variations, which may be asymptomatic but can have long-term negative effects.

Benign Recurrent Intrahepatic Cholestasis: A Rare Diagnostic Challenge

Benign Recurrent Intrahepatic Cholestasis (BRIC) is a rare liver disorder that occurs sporadically or via autosomal recessive inheritance. It is characterised by recurrent episodes of cholestasis with pruritus and jaundice in the absence of chronic liver disease. It typically first presents in childhood or adolescence; however, adult-onset forms may occur and can be difficult to diagnose. The present case report involves a 23-year-old male who presented with recurrent episodes of jaundice, pruritus and pale stools. A thorough evaluation, including autoimmune, infectious and metabolic workup, was negative. Imaging studies showed no evidence of extrahepatic biliary obstruction, and liver biopsy indicated a cholestatic pattern consistent with intrahepatic cholestasis. Whole-exome sequencing, a form of genetic testing, identified a mutation in the ATP8B1 gene, confirming the diagnosis of BRIC. Whole-exome sequencing revealed a pathogenic mutation in ATP8B1, which encodes the Familial Intrahepatic Cholestasis 1 (FIC1) protein responsible for bile salt homeostasis. Mutations in ATP8B1 are associated with BRIC type 1 and are essential to confirm the diagnosis, particularly in atypical or late-onset presentations. The patient was managed conservatively, with resolution of symptoms, and experienced no further attacks during follow-up. The present case illustrates the need to consider BRIC in the differential diagnosis of recurrent cholestatic jaundice in young adults when other common aetiologies have been excluded. Timely recognition allows appropriate supportive management and reduces the burden of unnecessary investigations.

Effect of High-intensity Laser Therapy on Shear-wave Elastography Parameters in Achilles Tendinopathy: A Case Report

Muskan Bathla, Manu Goyal, Chhaya, Ritika Kashyap, Kanu Goyal

Achilles tendinopathy is a common musculoskeletal occurrence primarily affecting athletes, but the general population is also prone to develop this pathology. Shear-wave elastography serves as a complement to traditional ultrasound imaging in assessing tendon properties in patients with Achilles tendinopathy. High Intensity Laser therapy (HILT) is a non-invasive and painless treatment option, exhibiting anti-inflammatory, analgesic, and bio-stimulant characteristics. However, limited evidence exists on the effectiveness of high-intensity laser therapy on shear-wave elastography parameters in patients with Achilles tendinopathy. This case study examines the case of a 22-year-old male with a complaint of pain in the Achilles region. He reported stiffness in the morning and difficulty with weight-bearing activities. To assess patient numeric pain rating scale, range of motion (using goniometer) and shear-wave elastography were used. High-intensity laser therapy was administered to the patient for three sessions alternately. Outcome measures were assessed at baseline and after the commencement of treatment. HILT demonstrated positive effects in reducing pain and improving tissue elasticity in patients with Achilles tendinopathy, as observed through shear-wave elastography. These results indicate that HILT may serve as a valuable complement in the conservative treatment of Achilles tendinopathy.

Physiotherapy Management of Kager’s Fat Pad Irritation Associated with a Multi-ligament Ankle Sprain and Tendinopathy in a 35-Year-Old Male Patient: A Case Report

Swapnil U Ramteke, Chaitali S Vikhe

Kager’s fat pad irritation is an under-recognised source of posterior ankle pain, especially when occurring alongside multiligament ankle sprains and tendinopathy. This case report describes the rehabilitation of a 35-year-old male who presented with chronic right ankle pain and instability, attributed to long-term barefoot walking for religious purposes and repeated, untreated ankle sprains. Magnetic Resonance Imaging (MRI) revealed irritation of the Kager’s fat pad, sprains of the Anterior Talofibular Ligament (ATFL), Calcaneofibular Ligament (CFL), Posterior Talofibular Ligament (PTFL), and tenosynovitis of the posterior tibialis and flexor digitorum longus tendons. The patient underwent a physiotherapy programme focused on pain relief, proprioceptive retraining, strengthening, and functional restoration. Over the course of rehabilitation, the patient demonstrated marked improvements in pain, stability, and balance, with the Numeric Pain Rating Scale (NPRS) decreasing from 6 to 0, Balance Error Scoring System (BESS) errors reducing from 21 to 8, and the Foot and Ankle Ability Measure – Activities of Daily Living (FAAM-ADL) score improving from 61% to 92%. This case emphasises the effectiveness of conservative physiotherapy in complex ankle pathologies and the need to consider cultural factors like habitual barefoot walking in clinical decision-making.

Laboratory Detection of Pseudohyperkalaemia in a Trauma Patient: A Case Report

MS Sudharshan, P Renuka, A Raja Mydeen, Kothai Gnanamoorthy, VM Vinodhini

Pseudohyperkalaemia refers to a spuriously elevated serum potassium concentration resulting from laboratory artefacts and frequently poses a diagnostic and therapeutic challenge in routine clinical practice. Its significance is heightened in acute care settings, where timely and appropriate clinical decisions are critical. The present report describes the case of a 53-year-old male who developed pseudohyperkalaemia following polytrauma with extensive lower limb injuries, including a crush injury to the left foot. Initial potassium levels were within the normal range; however, subsequent elevations were observed in the absence of Electrocardiographic (ECG) changes or clinical features suggestive of true hyperkalaemia. Further evaluation revealed thrombocytosis, a recognised cause of pseudohyperkalaemia due to potassium release from activated platelets during clot formation. The present case is notable because the diagnostic dilemma occurred in a critically injured trauma patient, where differentiating true hyperkalaemia from pseudohyperkalaemia had significant therapeutic implications. Prompt recognition prevented unnecessary administration of potassium-lowering therapy, which could have resulted in iatrogenic hypokalaemia. Correlation of laboratory findings with clinical assessment, along with the use of plasma rather than serum samples, aided in confirming the diagnosis. The present report highlights the importance of maintaining a high index of suspicion for pseudohyperkalaemia in patients with thrombocytosis or leukocytosis, particularly in trauma and critical care settings. Awareness of this phenomenon can prevent mismanagement, enhance patient safety, and guide rational treatment decisions.

Vocal Cord Amyloidosis in a Middle-aged Female: A Rare Clinical Entity

Pragati Shikha, Sagar Gaurkar, Prasad Deshmukh, Jasleen Kaur, Anjori Raut

Primary laryngeal amyloidosis is a rare disorder, accounting for approximately 1% of all benign laryngeal lesions. The authors, here, report the case of a 55-year-old female who presented to the Otorhinolaryngology Department with complaints of change in voice for the past 2-3 years. The patient described a gradual onset of hoarseness, strained quality, and fatigue of voice. Additionally, she experienced quivering, effortful phonation, and a relatively high pitch. Video-directed laryngoscopy revealed a polypoid or polypoid-like, reddish growth over the true vocal cords. A Contrast-Enhanced Computed Tomography (CECT) scan of the neck showed features suggestive of glottic and subglottic stenosis. The patient subsequently underwent microlaryngoscopy under general anaesthesia, and a unilateral excisional biopsy was taken from the lesion. Histopathological examination of a 20× section demonstrated Congo red positivity under polarised light, confirming the presence of amyloid deposits. A corresponding Haematoxylin and Eosin (H&E)-stained section (20×) showed proliferation of fibroblasts arranged in fascicles with areas of hyaline degeneration. Postoperatively, the patient was advised speech therapy, and at three weeks of follow-up, significant improvement in voice quality was noted. The present case highlights the rarity of primary laryngeal amyloidosis and underscores the importance of considering this diagnosis in patients presenting with long-standing hoarseness of voice. A multidisciplinary approach, including surgical excision, postoperative speech therapy, and long-term follow-up, is essential for achieving favourable outcomes and reducing recurrence rates.

Acute Hepatitis A Virus-induced Cutaneous Necrotising Vasculitis: A Case Report with Literature Review

Harsh Babariya, Sourya Acharya, Sunil Kumar, Shilpa Bawankule, Ankit Girepunje

Cutaneous Necrotising Vasculitis (CNV), a rare dermatological condition, is characterised by inflammation and necrosis of small blood vessels, often presenting as palpable purpura. While viral aetiologies have been identified, Hepatitis A Virus (HAV)-induced CNV is seldom reported. A 41-year-old male presented with palpable papular rash involving both upper and lower limbs, abdomen and back region over the past 15 days. The rash was associated with high-grade fever, diarrhoea and pain in both knee and ankle joints. He had a recent history of consuming outside food and drinks. Total leukocyte count, C-Reactive Protein (CRP) levels, total anti-HAV antibody titres, and anti-HAV IgM were elevated. Liver function test was slightly deranged with raised alkaline phosphatase (104 U/L), aspartate aminotransferase (34 U/L) and alanine aminotransferase (77 U/L) and normal serum bilirubin levels. Skin biopsy demonstrated necrotising vasculitis with fibrinoid necrosis of the vessel wall. The patient was treated with systemic steroids, antihistaminic agents and topical lotion. On four weeks follow-up, rash disappeared spontaneously. Thus, viral aetiologies should be considered in patients presenting with cutaneous vasculitis to facilitate timely diagnosis and management.

Impact of Swiss Ball Stabilisation Training Combined with Strength Training in a Five-Year-Old Child with Spastic Diplegic Cerebral Palsy: A Case Report

Shrikrishna Gangadhar Shinde, Mohd Irshad Qureshi

Spastic Diplegic Cerebral Palsy (SDCP) is a common form of cerebral palsy that predominantly affects the lower limbs, often resulting in stiffness, spasticity, and functional limitations. Conventional rehabilitation typically emphasises mobility and strengthening exercises; however, recent evidence suggests that incorporating core stabilisation strategies has been shown to enhance outcomes. This case report describes a five-year-old child with SDCP, classified as Gross Motor Function Classification System (GMFCS) Level III. The child underwent a 6-week physiotherapy programme, consisting of three sessions per week that combined Swiss ball–based stabilisation training with hip and knee extensor strengthening. The primary outcome measures were the Paediatric Balance Scale (PBS), Gross Motor Function Measure-88 (GMFM-88), and Cerebral Palsy Quality of Life Questionnaire (CP-QOL). Following intervention, the PBS improved from 25 to 32, GMFM-88 from 58% to 74%, and CP-QOL from 20 to 38, reflecting notable gains in balance, gross motor abilities, and quality of life. These findings suggest that the integration of Swiss ball stabilisation and strength training can positively influence motor performance and participation in children with SDCP. This report highlights the potential value of incorporating stabilisation techniques into paediatric rehabilitation and supports further research into their clinical applicability.

Outcomes of Haploidentical Haematopoietic Stem Cell Transplantation in Acute Leukaemia Patients: A Report of Two Paediatric Cases

Lakshmi N Nair, A Ashwin, R Krishnamoorthy, Niranj Rathan, Sampat Kumar

Leukaemias are the most common malignancies in children. Allogeneic Haematopoietic Stem Cell Transplantation (HSCT) is the most effective treatment option for haematological malignancies in children. Haploidentical HSCT (haplo-HSCT) has become a broadly accepted alternative for patients without 100% Human Leucocyte Antigen (HLA)-matched donors. Here, we share a report of two cases of acute leukaemia among the paediatric age group. Both patients with high-risk Acute Myeloid Leukaemia (AML) lacking fully HLA-matched donors underwent haploidentical peripheral blood SCT from paternal donors following myeloablative conditioning. Both patients received adequate CD34+ cell doses with post-transplant cyclophosphamide-based Graft-Versus-Host Disease (GVHD) prophylaxis and achieved successful engraftment, with neutrophil recovery and platelet recovery and demonstrated complete donor chimerism. No acute GVHD or significant transplant-related complications were observed during the early post-transplant period. Here, we highlight the effectiveness and outcome of haplo-HSCT in paediatric leukaemia.

Physiotherapeutic Assessment and Management of a Rare Case of Eosinophilic Granulomatosis with Polyangiitis: A Case Report

Savio Joseph, Gopika Anilkumar, Saumya Srivastava

Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a type of necrotising vasculitis mainly involving small and medium-sized vessels. In this condition, eosinophils accumulate within affected tissues and lead to organ damage through ischaemia and tissue infiltration. The present case report presents the case of a 72-year-old female patient with eosinophilic granulomatosis with polyangiitis with reduced muscle strength, balance, functional independence and this report aims to evaluate the result of a tailor-made physiotherapy treatment protocol. The patient’s muscle strength was assessed using Medical Research Council (MRC) grading system and Concern of falling was assessed using Falls Efficacy Scale (FES). The patient had issues with balance which was assessed using Berg Balance Scale and functional independence was evaluated using Barthel Index. The patient underwent a six-week tailor-made rehabilitation programme consisting of 45-minute sessions, six days per week for six weeks. The treatment protocol included graded exercises for upper and lower-limb strengthening, core stabilisation, balance training and functional training like stair climbing with progressions. There were definite improvements in the patient’s outcomes post-treatment. The Falls Efficacy Scale score reduced from 61/64 to 26/64, indicating marked reduction in concern of falling. The Berg Balance Scale score improved from 10/56 to 42/56, demonstrating a significant improvement in balance control. Functional independence of the patient also improved which was shown by Barthel Index score from 60/100 to 95/100. The tailor-made physiotherapy treatment protocol for six weeks including strengthening exercises, balance training and functional training had shown effectiveness in a patient with EGPA.

Cross-cerebellar Diaschisis in a 38-year-old Male with Rasmussen Encephalitis: A Case Report

Rasmussen Encephalitis (RE) is a rare chronic inflammatory neurodegenerative disease that affects just one hemisphere of the brain, resulting in seizures, hemiparesis and cognitive deterioration. RE’s pathophysiology is complex and while it frequently presents with unilateral cortical atrophy and epileptic activity, concomitant symptoms such as Cross-cerebellar Diaschisis (CCD) are seldom reported. CCD is characterised by functional depression in the contralateral cerebellum, resulting from a lesion in one of the brain's hemispheres, which is often detected via neuroimaging. The authors hereby, report a 38-year-old male with a long-standing history of Generalised Tonic-Clonic Seizures (GTCS) that began at the age of five years. Due to ignorance, his condition deteriorated over time, resulting in hemiparesis and cognitive impairment. A Magnetic Resonance Imaging (MRI) of the brain was performed to evaluate the situation. The present report presents a rare case of RE complicated by CCD, as evidenced by MRI findings.

Rare Compound Heterozygous HbE-β Thalassaemia Diagnosed using HPLC and Familial History: A Case Report

Ruchi Agarwal, Hemlata Kamra, Parul, Kulwant Singh, Swaran Kaur

Haemoglobin E-beta thalassaemia (HbE/βT) is a compound heterozygous haemoglobinopathy caused by a mutation in the β-globin chain (glutamic acid ? lysine at position 26) and co-inheritance of a β-thalassaemia allele. Diagnosis is difficult because to its wide range of phenotypic heterogeneity, which includes severe thalassaemia major-like disease and transfusion independence. An 11-year-old female presented with pallor, growing weakening and history of single blood transfusion. Anisopoikilocytosis revealing target cells and microcytic hypochromic red cells was observed in the peripheral smear. Significantly increased HbA2 (29.7%) and HbF (11.3%) were detected by High Performance Liquid Chromatography (HPLC). Homozygous HbE and HbE/βT were considered as differential diagnosis on the basis of various investigations carried out.The diagnosis of HbE/βT in the patient was supported by family HPLC investigations, which showed the mother was HbE heterozygous, the younger brother had thalassaemia trait and elder brother had HbE/βT. After three months, repeat HPLC or molecular testing was advised for confirmation. This case emphasises how crucial family studies are for clearing up diagnostic ambiguity, especially when recent history of blood transfusions can cloud laboratory test results. It underlines the importance of maintaining a high index of suspicion for compound heterozygous states and encourages a thorough diagnostic workup, including family study using HPLC. Through this report, we hope to contribute for improved awareness and earlier detection of this challenging and often misdiagnosed condition.

Rare Presentation of Metastatic Dedifferentiated Liposarcoma of Paratesticular Origin to the Colon Mimicking Gastrointestinal Mesenchymal Tumours: A Case Report

Mesenchymal tumours of the Gastrointestinal (GI) tract are relatively uncommon, with Gastrointestinal Stromal Tumours (GISTs) representing the most frequent subtype. Other mesenchymal neoplasms of the GI tract are far rarer and encompass a heterogeneous group of lesions that resemble their soft-tissue counterparts in other anatomical sites. These include lipoma, liposarcoma, leiomyoma, leiomyosarcoma, desmoid tumours, schwannoma, inflammatory fibroid polyps, and fibromatosis. Because of overlapping clinical and morphological features, distinguishing these tumours can be challenging. We report the case of a 67-year-old male who presented with an abdominal mass and diarrhoea. Imaging studies demonstrated retroperitoneal lesions with extension to the colon. A right hemicolectomy revealed two serosal-based tumours. Histopathological evaluation showed a spindle-cell neoplasm exhibiting marked atypia, brisk mitotic activity, and occasional lipoblasts. Given the broad differential diagnosis- including GIST and other spindle-cell sarcomas- immunohistochemistry was crucial. The tumour showed strong nuclear positivity for MDM2, confirming the diagnosis of metastatic Dedifferentiated Liposarcoma (DDLPS). Correlation with previous medical history revealed an earlier diagnosis of paratesticular DDLPS, establishing these colonic lesions as metastatic deposits. The DDLPS is a rare, high-grade mesenchymal tumour, and its occurrence in the paratesticular region is particularly uncommon. Metastasis to the colon is exceedingly rare, with only isolated cases described in the literature. This case underscores the importance of comprehensive histopathological analysis, clinical correlation, and the use of immunohistochemical markers such as MDM2 in reaching an accurate diagnosis. Awareness of these rare metastatic patterns is essential to avoid misinterpretation as more common GI mesenchymal tumours and to guide appropriate therapeutic management.

Obstructed Inguinal Hernia with Maldescended Testis in an Infant: A Case Report

Aniruddha Patel, Imran Khan, Aditya Sriharsha

An inguinal hernia is a common congenital condition that can affect babies in their first year of life. This condition occurs when a segment of the intestines, omentum, or reproductive organs enters the scrotum or labia via an incompletely closed processus vaginalis. The main components of a hernia are typically the intestines and the ovaries or testicles. Immediate surgery is necessary for patients displaying an immobile dilated bowel loop (a potential indicator of strangulation) or reduced blood flow to the testicles/ovaries. Here the authors present a case of a five-month-old male infant who presented with abdominal distension with painful swelling in the left groin, which was irreducible. The swelling was globular, smooth, firm, tender, and irreducible, with an elevated local temperature. The left testis could not be palpated in the left hemiscrotum. Ultrasound revealed an obstructed inguinal hernia in the left inguinoscrotal region, with aperistaltic intestinal loops, mild fluid collection, and an absent left testis. The patient was scheduled for urgent surgery. A 5 cm oblique incision was made; an 8×4 cm sac containing ileum was opened, and the viable bowel was reduced. The sac was then ligated and excised, and a herniotomy was performed. The left testis was found to be viable and repositioned into the scrotum, followed by orchidopexy. Inguinal hernia in an infant can rapidly progress to strangulation; hence, early recognition and prompt surgical management are crucial to prevent life-threatening complications and preserve gonadal viability.

Day Care Surgical Management of Post FNAC Breast Abscess: A Case Report

Samina Ruquaya, K Vivekananda Subramania Nathan, M Reegan Jose, Najeem Fazil

Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, and widely used diagnostic tech-nique for evaluating breast lesions. It is generally considered a safe procedure with a low complication rate. However, on rare occasions, unexpected adverse events such as abscess formation can occur. Here, the authors report the case of a 67-year-old woman who developed a retroareolar abscess following FNAC of the breast. The patient developed pain, redness, and swelling at the aspiration site a few days after the procedure. The clinical examination confirmed a tender, fluctuant swelling suggestive of an abscess. She was managed successfully with Incision and Drainage (I&D) under local anaesthesia in a day care set-ting, which allowed rapid treatment and recovery without the need for hospital admission. Pus obtained during drainage was sent for culture and sensitivity testing, which grew Staphylococcus aureus. Based on these findings, the patient was treated with an appropriate course of oral antibiotics. She showed excellent clinical improvement, with complete resolution of the infection and satisfactory wound healing on follow-up. The present case highlights that, although FNAC is generally safe, clinicians should remain aware of potential but uncommon complications such as abscess formation. Prompt recogni-tion and early intervention are essential for favourable outcomes. The current case also demonstrates that such infections can be effectively managed with simple day care surgical procedures, minimising patient discomfort, hospital stay, and cost. Awareness of these rare complications ensures timely man-agement and reinforces patient safety in routine diagnostic practice.

Giant Fibroadenomas of the Left Breast in an Adolescent Female: A Case Report

Ashwini Jasani, Amit Patil, Tushar Jadhav

Giant fibroadenomas are rare benign lesions usually seen in juvenile to adolescent females. Present case describes an 18-year-old adolescent female presenting with multiple bilateral fibroadenomas, including giant fibroadenomas in the left breast. Diagnosis was confirmed through clinical examination, ultrasonography, and histopathological evaluation. Due to the large size of the lesions in the left breast causing breast disfigurement, surgical excision was performed in a staged manner using a periareolar incision to ensure optimal cosmetic outcomes. Postoperative recovery was uneventful, with no recurrence or complications. This case highlights the importance of a comprehensive diagnostic approach and individualised surgical management in patients with multiple and giant fibroadenomas to achieve both therapeutic and aesthetic goals.

Torsion of a Solitary Ovary Associated with a Paraovarian Cyst: A Rare Presentation with Spontaneous Detorsion

Shirish Vaidhya, Saraswathula Bharadwaj

Ovarian torsion is a prevalent gynaecological emergency in the juvenile population that necessitates immediate surgical intervention to preserve ovarian viability, while spontaneous detorsion is a rare and little-reported phenomenon. An unusual case of an 11-year-old girl presenting with acute pelvic pain and generalised weakness is reported. Initial pelvic ultrasonography revealed a solitary ovary with imaging features suggestive of ovarian torsion, which was subsequently confirmed on abdominal MRI at a higher centre. The patient was scheduled for emergency surgical exploration; however, intraoperatively, the afflicted ovary was discovered to have undergone spontaneous detorsion, resulting in normal morphology and vascularity. This case emphasises the necessity of early imaging in suspected ovarian torsion, the uncommon likelihood of spontaneous detorsion, and the possible role of conservative, ovary-preserving surgical techniques in juvenile patients when ovarian viability is maintained.

Multimodality Imaging and Endovascular Management of Intralobar Pulmonary Sequestration in a Young Female: A Case Report

Arnav Vivek Ramteke, Kajal Mitra, Prashant Onkar, Suresh Phatak, Ashish Ambhore

Pulmonary sequestration is an uncommon congenital lung anomaly in which non-functioning lung tissue lacks communication with the tracheobronchial tree and receives blood supply from an abnormal systemic artery. Intralobar sequestration, though less frequent, often presents with recurrent respiratory infections in children and adolescents. This case report describes a young female with a long history of recurrent fever and pneumonia who was evaluated using multimodality imaging. Imaging revealed cavitary lesions in the left lower lung. CT angiography demonstrated an aberrant artery arising from the abdominal aorta, findings consistent with intralobar pulmonary sequestration The patient was initially managed with drainage and antibiotics, followed by endovascular coil embolisation of the anomalous artery. This reduced the risk of bleeding and facilitated a safe, planned surgical removal of the sequestered lung tissue. This case demonstrates the value of combining modern imaging and minimally invasive embolisation with surgery to achieve safe and effective management of pulmonary sequestration.

A Rare Triad of Osteomyelitis, Thrombophlebitis and Septic Pulmonary Embolism caused by Enterococcus in an Adolescent: A Case Report

Acute febrile illnesses in Indian subcontinent commonly occur in monsoon season and presents with fever, bodyache, rash, headache, myalgia and sometimes with complications like acute respiratory distress, renal failure, bleeding tendencies. Herein, authors report an unusual case of 13-year-old boy presenting with fever and respiratory distress preceded by history of trivial trauma to his left arm. On subsequent investigations, including Magnetic Resonance Imaging (MRI) of left arm, CT-Pulmonary Angiography (CTPA), High Resolution Computed Tomography (HRCT) thorax and blood culture, he was found to have Septic Pulmonary Embolism (SPE) secondary to acute osteomyelitis induced deep vein thrombophlebitis. Blood culture grew Enterococcus species which is a rare finding. Patient required invasive ventilation, anticoagulant and higher antibiotics for six weeks, following which his condition gradually improved and did not require surgical intervention. A trivial trauma to left arm resulting into enterococcal acute osteomyelitis leading to deep vein thrombophlebitis and SPE. The triad of acute osteomyelitis, deep vein thrombophlebitis and SPE may lead to life threatening complications, if not diagnosed early.

Zellweger Syndrome with Novel PEX1 Variants and Unusual Periventricular Leukomalacia in a Term Infant: A Case Report

Zellweger syndrome is a rare disorder due to mutations in PEX genes, resulting in defective peroxisome biogenesis and multi-systemic features. This is a case of a male infant born at term via caesarean section due to breech presentation, who experienced perinatal asphyxia and demonstrated the characteristic features of the syndrome such as facial dysmorphism, hypotonia, renal cysts and hepatic dysfunction along with a novel finding of Periventricular Leukomalacia (PVL). Despite intensive supportive care, the infant’s condition progressively worsened, with complications such as aspiration pneumonia and sepsis leading to death at five months. Genetic testing revealed two previously unreported heterozygous variants in the PEX1 gene: a splice site variant within intron 13 and a frameshift mutation in exon 5, both predicted to significantly impair protein function. The PVL, which is rarely seen in a term infant with Zellweger syndrome, is caused by oxidative stress, mitochondrial dysfunction, and defective myelination. This case highlights the importance of genetic testing for diagnosis as well as genotype-phenotype correlation, thereby adding to the existing mutation database. There is no cure and life expectancy is short, but early diagnosis and supportive care can improve quality of life.

Ayurvedic Management of Avascular Necrosis Through Panchakarma and Oral Medication: A Case Report

Kashmira Nikhil Bhaidkar, Punam Sawarkar, Vedangi Wargantiwar

Osteonecrosis is a degenerative bone condition characterised by the death of cellular components of the bone secondary to an interruption of the subchondral blood supply, also, known as Avascular Necrosis (AVN), it typically affects the epiphysis of long bones at weight-bearing joints. According to Ayurveda, AVN can be correlated with Asthimajjagata Vata. A 22-year-old female patient came to the Outpa-tient Department (OPD) with complaints of pain in bilateral hip joint, restricted and painful movement of the lower limbs and difficulty in walking. Her Magnetic Resonance Imaging (MRI) reports suggested AVN of Bilateral femoral head and neck, Grade 2 on right and Grade 3 on left (Ficat and Arlet classifica-tion) along with marrow oedema. The condition was addressed with a combination of various traditional ayurvedic medicines like Aarogyavardhini Vati, Maharasnadi Kwath, Punarnavadi Guggulu, Yograj Guggu-lu, Rasapachak Vati and Panchakarma like Sthanik Snehan (local oleation), Patra Pot-tali Swedana (fomentation), and Basti (medicated enema). Panchakarma was done for a period of 16 days and oral medication was continued for a period of three months. Significant relief in pain as per Visual Analogue Scale (VAS) reduced stiffness and increased range of motion was noted along with improvement in Harris Hip Score and Quality of Life (QoL) score. The current case underscores the effectiveness of Ayurvedic Panchakarma treatment in achieving positive outcomes for AVN.

A Case Report on Successful Ayurvedic Management of Vicharchika (Eczema)

Sadhana Durgaprasad Misar, Kaustubh Vilasrao Kharche, Ketki Rajesh Wajpeyi

Vicharchika is one of the skin disorders explained in the Kushtha Chikitsa Adhyaya. It can be correlated with eczema in modern science due to its similar manifestations. In Ayurveda, Shodhana (purification) and Shamana (palliative) therapy are described for Vicharchika. A 55-year-old male patient reported to the Kayachikitsa Outpatient Department with the chief complaints of severe itching, pus discharge, painful skin cracks, and scaly patches on the dorsum of both hands and the scalp, persisting for the past two years. He was treated using Shodhana Chikitsa with Vaman (therapeutic emesis) and Raktamokshana (bloodletting) along with Shamana Chikitsa with Aarogyavardhini Vati, Panchatikta Ghrita Guggulu, Brihatmanjishthadi Kwath, and local application of Karanj Taila. All formulations used in this case have properties like Kushthaghna (anti-leprosy), Kandughna (anti-pruritic), and Krimighna (antibacterial), which help in breaking the pathogenesis and reducing the symptoms. Ayurvedic Shodhana and Shamana Chikitsa are use-ful in the treatment of Vicharchika.

Erythema Elevatum Diutinum: An Underdiagnosed Entity- A Case Report

G Sukanya, S Gayathri, NR Vignesh, M Yogalakshmi

Erythema Elevatum Diutinum (EED), an uncommon form of chronic leukocytoclastic vasculitis presents as reddish-brown plaques and papulonodules primarily affecting the extensor surface. It mimics various cutaneous disorders and hence poses diagnostic difficulties. EED is predominantly seen in middle-aged individuals between fourth and sixth decade. EED can also have various extracutaneous manifestations such as arthralgia, scleritis, panuveitis, ulcerative keratitis and neuropathy indicating circulating immune complexes deposition in several organs. Thereby thorough clinical and systemic examination for early diagnosis and comprehensive management of both skin and extracutaneous findings are essential to prevent complications and further progression. The authors hereby report a case of 47-year-old female with long standing diabetes mellitus presenting with asymptomatic papulonodular lesions over the extensor surface with sensory abnormalities, highlighting the diagnostic dilemma and emphasising the importance of histopathological correlation in arriving at appropriate diagnosis.

Ayurvedic Management of Abnormal Uterine Bleeding in a Patient with a Septate Uterus: A Case Report

Manjiri Thakre, Punam Sawarkar, Gaurav Sawarkar, Mahima Dubey, Shubham Kalode

Abnormal Uterine Bleeding (AUB) refers to bleeding that is irregular in volume, duration, or timing, often without identifiable structural pathology. Menstrual and reproductive problems can result from a congenital uterine anomaly known as a septate uterus. Ayurveda provides holistic management by balancing doshas and promoting reproductive health, even if surgery is frequently used. A 42-year-old female presented with heavy, irregular menstrual bleeding and was diagnosed with a septate uterus via ultrasonography. Ayurvedic diagnosis correlated the condition with Asrigdara and Yonivyapad. Treatment was focused on the purification process and hormonal balance. There was a significant reduction in bleeding duration and volume after two treatment cycles. Ayurvedic interventions show promising results in managing AUB associated with congenital uterine anomalies like the septate uterus.

Combining Mineral Trioxide Aggregate, Titanium-prepared Platelet-rich Fibrin and Hydroxyapatite Bone Graft in Apicoectomy as a Regenerative Strategy in Endodontic Surgery: A Case Report

An apicoectomy is a microsurgical endodontic procedure performed to manage persistent periapical pathologies in teeth that have previously undergone root canal therapy. The technique involves a precise osteotomy to gain access to the periapical region, excision of the pathological tissue, resection of the apical portion of the root, and retrograde preparation and filling of the root-end cavity. Advances in regenerative endodontic surgery have focused on combining bioactive materials with autologous platelet concentrates and bone grafts to promote predictable healing. Mineral Trioxide Aggregate (MTA) offers excellent sealing ability and biocompatibility, while Titanium-prepared Platelet-rich Fibrin (T-PRF) and Hydroxyapatite (HA) bone grafts support tissue regeneration. In the present report, a 35-year-old male patient presented with discolouration of the left maxillary central incisor. A microsurgical apicoectomy was performed using MTA for retrograde filling, a T-PRF membrane, and an HA bone graft. The outcome demonstrated uneventful healing with radiographic evidence of bone regeneration at three months.

Multimodal Management of Mandibular Parasymphysis Fracture in a Growing Child: A Case Report with 6-month Follow-up

SB Meghana, Somya Sinha, N Aishwarya

Mandibular fractures in paediatric patients are relatively uncommon due to key anatomical and developmental differences from adults, such as greater bone elasticity, the presence of developing tooth buds, and a smaller facial skeleton. Among these, parasymphysis fractures are particularly rare in young children and present distinct diagnostic and management challenges. Paediatric mandibular fractures necessitate customised treatment approaches to avoid disrupting facial growth and dental development. In this report, the authors present a five-year-old male child with a mandibular parasymphysis fracture managed using a multimodal approach involving cap splint stabilisation combined with selective fixation. Over a 6-month follow-up period, the patient achieved satisfactory healing, restoration of occlusion and function, and no apparent disruption to underlying tooth development or mandibular growth. This case underscores the critical importance of individualised planning in paediatric facial trauma, balancing conservative methods with surgical support when indicated. The findings suggest that a hybrid strategy can yield favourable outcomes while minimising long-term risks in young patients.

Effect of Modified Constraint Induced Movement Therapy in Chronic Seizure Disorder and Infantile Hemiparesis: A Case Report

Himanshu Sharma, Shamama Athar, Ravish Yadav, Mohd Asif, Kapila Jain

Epileptic seizures in children have the highest rate in infants. The incidence rate reported from India ranges from 0.42 per year in West Bengal to 0.49 per year in rural areas and 0.27 per 1000 per year in urban areas. Intraventricular haemorrhage of a newborn, Transient Ischaemic Attack (TIA), congenital or perinatal injuries to the brain may lead to infantile hemiparesis. A seven-year-and-four-month-old female presented with difficulty eating with her right hand, an inability to maintain her grip on a pen for prolonged periods, and impaired gait. She was classified as Gross Motor Function Classification System (GMFCS) level II, Manual Ability Classification System (MACS) level III, and had a Quality of Upper Extremity Skills Test (QUEST) score of 29.30%. She was diagnosed with a chronic seizure disorder and right-sided hemiparesis. She was administered modified Constraint Induced Movement Therapy (mCIMT) for hand function three days a week for eight weeks. The constraint time of the left hand was two hours and 30 minutes per session. During the session, she went through intensive exercises for the right hand, like handling spherical and cylindrical objects, manipulating different shapes, and using a pegboard, etc. Within eight weeks, a significant change was seen in handling and manipulating objects. The MACS score improved to II, and the QUEST score increased to 47.95 ~ 48. While dissociated movement and grasp showed significant improvement, the tripod grasp remained unexecuted. The study concludes that mCIMT for upper limb function can significantly improve the quality of life for children with hemiparesis.

Heterotopic Ossification (HO) in Caecal Adenocarcinoma: A Case Report

The Heterotopic Ossification (HO) or Osseous Metaplasia (OM), is a rare condition that presents as benign bone formation at non-skeletal locations, often incidentally identified during histopathological evaluation but not typically radiologically detected. HO within colorectal adenocarcinoma occurs rarely; only a few cases have been reported in the literature, which demonstrate how unique cases expand our knowledge of this unusual entity and its diagnostic implications. Author presents a case of a 47-year-old female patient who had a history of three months of abdominal pain with a 5 kg weight loss over the past month. She was found to have a 3×3 cm hard immobile mass in the right iliac fossa on physical examination, which CT imaging showed to be an irregular circumferential thickening with a malignant-appearance involving the caecum, terminal ileum, lower ascending colon and proximal appendix. Interestingly, there was no sign of ossification on CT scan. A right hemicolectomy was done and the resected specimen was sent for histopathological examination. Histology confirmed an infiltrative malignant neoplasm consistent with a moderately differentiated adenocarcinoma. Importantly, benign bone tissue was seen within the fibrous stroma of the tumour. In this case, we emphasise the significance of histopathological evaluation for correct diagnosis when primary ossifying soft-tissue neoplasms or carcinosarcomas are suspected because these have a worse prognosis than HO. Although HO in colorectal carcinoma is rare, it does not appear to directly affect the patient’s prognosis; however, further study of this entity is crucial as cases continue to increase.

Sub-internal Limiting Membrane Haemorrhage following High Intensity Laser Exposure: A Case Report

Laser-induced maculopathy is an increasingly recognised clinical entity, particularly among adolescents and young adults who have easy access to high-powered handheld or entertainment laser devices. Retinal damage may occur through photothermal, photochemical, or photomechanical mechanisms, depending on the wavelength, power, and duration of exposure. Although regulatory limits exist for safe laser use, inadvertent or prolonged exposure can result in significant and sometimes irreversible visual impairment. Here, the present case of acute vision loss following prolonged exposure to multicoloured laser light during a pilgrimage walk is reported. A young adult presented to the Outpatient Department with sudden, painless diminution of vision in the right eye for one week. The patient reported continuous exposure to laser beams for approximately one hour. Ocular history was otherwise unremarkable. On examination, the anterior segment of both eyes was within normal limits, with no signs of intraocular inflammation. Fundus examination of the right eye revealed a large, coin-shaped sub-Internal Limiting Membrane (ILM) haemorrhage centred at the macula. Spectral-Domain Optical Coherence Tomography (SD-OCT) demonstrated focal disruption of the ellipsoid zone and outer retinal layers, confirming structural retinal injury. The patient was advised an intravitreal Sulphur Hexafluoride (SF6) gas injection to facilitate displacement of the haemorrhage. The present case underscores the potential retinal hazards associated with laser devices, the importance of thorough retinal imaging for diagnosis, and the value of prompt intervention to optimise visual outcomes. Furthermore, it highlights the growing public health concern regarding unsupervised laser use and reinforces the need for public education on safe handling practices.

Segmental Caroli’s Disease in Autosomal Dominant Polycystic Kidney Disease: A Rare Association

Praveen Thirumal, Ramakrishna Narayanan

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a common disorder characterised by progressive renal cyst formation and other extrarenal manifestations, while Caroli’s disease is a rare autosomal recessive disorder involving intrahepatic bile duct dilatation with its segmental variant being exceptionally uncommon. We report a 40-year-old man with known ADPKD who, during MRI-based renal volumetry, was incidentally found to have segmental Caroli’s disease involving hepatic segments V and VI, demonstrated by localised biliary dilatations and the characteristic “central dot sign.” Laboratory tests revealed mildly impaired renal function but normal liver parameters. This case highlights a rare phenotypic overlap between distinct ciliopathy disorders, underscoring the need for further research into shared genetic or modifying factors influencing bile duct morphogenesis in ADPKD.

Oral Squamous Cell Carcinoma arising from Pre-existing Actinic Cheilitis: A Case Report

Vandana Sekizhar, Nandini Vellmurugan

Oral Squamous Cell Carcinoma (OSCC) is considered one of the most prevalent cancers globally. A significant number of OSCC cases arise from pre-existing potentially malignant disorders, among which Actinic Cheilitis (AC) is uncommon. AC occurs most commonly on the lower lip with symptoms ranging from pale, dry and scaly lips to ulcerations, burning sensation and crusting. Due to the malignant potential, AC necessitates immediate evaluation and treatment. The present case report discusses a 70-year-old female patient who presented with a painful ulcer on the lower lip of one month’s duration. A provisional diagnosis of AC was made and an incisional biopsy was recommended. However, the patient did not show willingness for the biopsy and reported four months later with a non healing ulcer. A provisional diagnosis of OSCC of the lower lip was established. Histopathological analysis revealed hyperparakeratinised stratified squamous epithelium exhibiting significant dysplasia. Surgical excision of the lesion was performed and follow-up after two weeks showed satisfactory healing. This paper highlights the critical importance of timely diagnosis and management of AC to prevent its progression into malignancy thereby emphasising the importance of early diagnosis and timely intervention.

Solitary Osteoma in the Angle of the Mandible: A Case Report

Riya Anand Goyal, Nitin Dharampal Bhola, Sanjana Wadewale, Rajanikanth Kambala

Although osteomas are relatively common in craniofacial bones, the occurrence of a solitary osteoma is relatively more common in the mandible and is rare in the maxilla. Hereby, the authors highlight the clinical, radiological, and histopathological features of a solitary osteoma in the left angle of the mandible of a 60-year-old male patient, followed by surgical management and a review of the literature. The purpose of present article was to present the clinical, radiographic, and surgical features of a solitary peripheral mandibular osteoma in a 60-year-old male patient and to contribute to the evidence of their prevalence.

Unprecedented Encounter of Dual Ipsilateral Mandibular Impacted Teeth: A Case Report

Riya Anand Goyal, Sanjana Wadewale, Nitin Dharampal Bhola, Rajanikanth Kambala

An impacted tooth is defined as a tooth which fails to erupt partially or completely into its correct position in the dental arch, and its eruption potential has been lost. Impaction of teeth is a common dental issue, but the simultaneous impaction of two teeth on the same side is relatively uncommon, particularly when involving different tooth types are involved. Hereby, the authors present a case report of a 21-year-old female patient with a rare occurrence of dual ipsilateral mandibular tooth impactions involving a premolar and a canine. Both the impacted premolar and canine were surgically exposed, followed by extraction of one to allow for proper orthodontic alignment and correction of the patient’s occlusion. The report highlights the successful diagnosis and surgical management of complex dental impactions through radiographic analysis and a minimally traumatic extraction techniques in managing complex dental impactions. The patient showed favourable recovery and alignment, post-treatment underscore the value of a multidisciplinary approach integrating surgical and orthodontic planning.

Oncocytic Form of Papillary Renal Cell Carcinoma: A Rare Morphological Variant

Yaminy P Ingale, Sushama P Gurwale, Sonam M Dabaria, Snigdha Saikia

Oncocytic Papillary Renal Cell Carcinoma (OPRCC) is a rare variant of Papillary Renal Cell Carcinoma (PRCC), characterised by distinct morphological and immunophenotypic features. Present report is of a 75-year-old hypertensive female who presented with constipation and abdominal bloating for four months. Imaging revealed an exophytic lesion in the lower pole of the right kidney, measuring 6.1×5.8×5.4 cm, without perinephric or sinus invasion. Laboratory studies demonstrated mild haematuria, elevated Lactate Dehydrogenase (LDH), and hypercalcaemia. The patient subsequently underwent radical nephrectomy. Gross examination revealed a 6.5 cm brown-yellow tumour with haemorrhagic areas, confined to the kidney. Histopathology showed papillary structures lined predominantly by oncocytic cells with abundant granular eosinophilic cytoplasm, vesicular nuclei, and prominent nucleoli. Focal pseudostratification, nuclear atypia, haemosiderin deposition, foamy macrophages, and focal necrosis were present, with no capsular, vascular, or nodal involvement. Immunohistochemistry (IHC) demonstrated diffuse positivity for Alpha-Methylacyl-CoA Racemase (AMACR), vimentin, and CD10, with negativity for CK7, CD117, and Ki-67, confirming the diagnosis of OPRCC. Postoperative recovery was uneventful, and a structured surveillance plan was initiated. Recognition of OPRCC is crucial to prevent misdiagnosis with benign oncocytoma or more aggressive RCC subtypes, enabling appropriate prognostication and management.

Role of Thoracic Epidural Analgesia in Retroperitoneal Rhabdomyosarcoma Surgery in an Adult: A Case Report

Dilip Venkata Naga Sai Krishna Sanka, Nikhil Bhalerao, Vinit Sunil Dhanure

Rhabdomyosarcoma is an adult soft tissue sarcoma of mesenchymal origin. Retroperitoneal rhabdomyosarcomas can reach gigantic size before the development of clinical symptoms and necessitate extensive resection, making anaesthetic management daunting. The following is a case presentation of a 58-year-old male patient with a four-month history of progressively worsening abdominal swelling due to a gigantic poorly differentiated retroperitoneal rhabdomyosarcoma. Preoperative anaemia was diagnosed and adequately treated, and normal organ function tests were obtained. Patient optimisation was followed by tumour resection under the cover of an association of thoracic epidural analgesia with General Anaesthesia (GA). An epidural catheter was placed at T10, and intraoperative analgesia was achieved by infusion of local anaesthetic, with low opioid requirement and haemodynamic stability being achieved. Induction was with etomidate, fentanyl, and vecuronium, and smooth tracheal intubation was performed to prevent dental trauma. Intraoperatively, the patient developed Supraventricular Tachycardia (SVT). Arterial blood gas analysis revealed hypokalaemia as the etiology, with a potassium level of 2.8 mmol/L. Intravenous (i.v.) potassium replacement was initiated, which restored normal rhythm stability as the potassium level normalised to 3.9 mmol/L. The operation was uneventful, following which reversal of neuromuscular blockade was achieved with sugammadex, and extubation was smooth. 0.125% bupivacaine at 7 mL/hr was infused through the epidural catheter postoperatively for 48 hours with satisfactory recovery and pain control. The case indicates the need for proper preoperative assessment, anticipating a difficult airway, cautious use of a thoracic epidural for perioperative pain management, and cautious observation for metabolic derangement like hypokalaemia, which causes intraoperative arrhythmias for successful anaesthesia management.

Anaesthetic Management of an Adult with Acquired Tracheoesophageal Fistula: A Case Report

Gummalla Abhigna, Vivek Chakole

Tracheoesophageal Fistula (TEF) is a life-threatening condition in adults, acquired through prolonged mechanical ventilation, malignancy, trauma, or iatrogenic injury. Diagnosis of TEF is delayed because symptoms such as dysphagia, repeated aspiration, chronic cough, or recurrent chest infections are nonspecific. Prompt diagnosis is dependent on clinical suspicion and established by a combination of imaging scans, Gastrointestinal (GI) endoscopy, and Fibreoptic Bronchoscopy (FOB). Anaesthetic management of TEF is challenging due to the shared airway between the surgical and anaesthesia teams, the risk of aspiration or gastric insufflation, and the potential for air leak through the fistula. The primary objective is to achieve adequate ventilation without insufflation due to the fistula and maintain airway protection. Tube selection must be undertaken carefully and with proper placement distal to the point of the defect. We report a case of a 34-year-old male with a history of prolonged ventilatory support, who developed a mid-tracheal TEF presenting with worsening dysphagia and projectile vomiting. Diagnosis was confirmed by upper GI endoscopy, chest X-ray, and FOB. During surgery, a microlaryngeal tracheal tube was used with distal cuff placement below the fistula. Confirmation of correct placement was ensured through bronchoscopy. Intraoperative course was uneventful under sevoflurane-based anaesthesia with stable haemodynamics and no respiratory distress. This case highlights the importance of individualised anaesthetic plans and multidisciplinary collaboration in the successful management of TEF. Successful anaesthetic and surgical outcomes can be achieved with proper preoperative assessment and airway planning, even in cases with complicated fistula presentations.

Thoracic Segmental Spinal Anaesthesia for Modified Radical Mastectomy: A Case Report

Shyamolima Bhuyan, Deepjit Bhuyan, Kartik Chandraker

Thoracic Segmental Spinal Anaesthesia (TSSA) serves as a safe and effective alternative to general anaesthesia in high-risk patients with respiratory comorbidities such as Chronic Obstructive Pulmonary Disease (COPD). By avoiding airway instrumentation, the respiratory complications of general anaesthesia, TSSA can be a viable alternative to general anaesthesia in patients undergoing surgeries like modified radical mastectomy. This case report describes a 72-year-old female with very severe COPD posted for modified radical mastectomy for infiltrating ductal carcinoma. Breast surgeries are usually conducted under general anaesthesia. However, general anaesthesia comes with various complications which include higher stress response, nausea and vomiting, inadequate analgesia, postoperative cognitive dysfunction and delirium, and increased length of hospitalisation. In critically ill patients, these complications can prove difficult to handle. An appropriate choice of regional anaesthesia technique can help alleviate some of these issues. One of these techniques includes TSSA. Due to her American Society of Anaesthesiologists (ASA) III status and high risk for pulmonary complications under general anaesthesia, TSSA was chosen. This is because it provides better clinical outcome especially in elderly and frail patients. As we were faced with a high-risk patient who was prone for multiple postoperative complications, an innovative mode of regional anaesthesia was used to overcome complications associated with general anaesthesia. The surgery was uneventful and completed without respiratory or haemodynamic compromise. Postoperative period was uneventful and patient was discharged on postoperative day 5. TSSA proved a safe, effective alternative to general anaesthesia, avoiding airway instrumentation and mitigating major perioperative risks in this high-risk patient.

Rubinstein-Taybi Syndrome in a Toddler with Refractory Seizures and Congenital Heart Disease: A Case Report

Rubinstein-Taybi Syndrome (RTS) is a rare congenital genetic disorder characterised by distinctive facial dysmorphism, broad thumbs and halluces, postnatal growth retardation, intellectual disability, and variable multisystem involvement. It is most commonly caused by pathogenic variants in the CREB-Binding Protein (CREBBP) gene and less frequently by mutations in the EP300 (E1A-binding protein p300) gene. Owing to marked phenotypic variability and overlap with other syndromic conditions, diagnosis is often delayed, particularly in early childhood. Neurological manifestations such as seizures, although relatively uncommon, are clinically significant and may be severe. The present case report describes an 18-month-old male child who presented with fever, respiratory symptoms, and refractory generalised tonic-clonic seizures. The patient had a history of recurrent pneumonia and had previously undergone surgical correction for Congenital Heart Disease (CHD), including ventricular septal defect and patent ductus arteriosus. Developmental evaluation revealed global developmental delay with growth retardation. Physical examination showed microcephaly, characteristic facial dysmorphism, broad thumbs and halluces, and bilateral cryptorchidism. Neuroimaging demonstrated ventriculomegaly with a periventricular granulomatous lesion. Cerebrospinal fluid culture grew Candida species. Whole-exome sequencing later identified a pathogenic CREBBP gene variant, confirming RTS type 1. The present case highlights the importance of recognising the characteristic clinical constellation of RTS in children presenting with seizures and CHD. Early diagnosis facilitates appropriate multidisciplinary management, anticipatory guidance, and genetic counselling. Reporting the current case adds to the limited literature on severe neurological presentations of RTS and underscores the need for heightened clinical awareness.

Aplasia Cutis Congenita and Cutis Marmorata in a Neonate with Down Syndrome: A Rare Case Report

Ketki Giradkar, Sham Lohiya

The rare congenital skin malformation known as Aplasia Cutis Congenita (ACC) can be identified by a localised lack of skin. Cutis marmorata, characterised by a transient, net-like, violaceous mottling of the skin, is often seen in preterm or low birth weight infants due to immature vascular responses to cold or stress. Down Syndrome (DS) is linked to uncommon dermatological conditions and has a higher incidence of some common dermatoses. This case presents a rare combination of cutis marmorata and ACC in a neonate diagnosed with DS. The management primarily focused on supportive care, including maintaining a thermoneutral environment, ensuring the baby remained warm, and close monitoring of vital signs. Stabilisation of respiration was achieved through appropriate oxygen support based on the degree of respiratory distress and oxygen requirement, along with prevention and management of potential infections. By doing so, the neonate can be prevented from going into shock, and the need for prolonged ventilation can be avoided. The presence of both cutis marmorata and ACC in this infant may not be coincidental. These skin findings could reflect overlapping effects of an underlying chromosomal abnormality. The favourable outcome reinforces the role of timely diagnosis, tailored supportive therapy, and multidisciplinary coordination, particularly when dealing with multiple congenital anomalies.

Perioperative Anaesthetic Management of Severe Aortic Stenosis with Anticipated Difficult Airway in Geriatric Hip Fracture Surgery: A Case Report

Anand Kuppusamy, Lakshme Sanjana Karthik

Aortic Stenosis (AS) is a high-risk valvular condition associated with significant perioperative morbidity during non-cardiac surgery, especially in elderly patients. Anaesthetic management is quite difficult due to fixed cardiac output, dependence on preload, and intolerance to tachycardia or hypotension. The presence of multiple comorbidities and difficult airway further increases perioperative risk. We report the anaesthetic management of a 73-year-old male with severe AS (aortic valve area 0.8 cm², mean gradient 40 mmHg), diabetes mellitus, hypertension, and anticipated difficult airway, who underwent elective proximal femoral nailing for intertrochanteric fracture. Preoperative evaluation revealed preserved left ventricular systolic function with electrocardiographic ischaemic changes. A properly planned general anaesthesia technique was adopted using etomidate-based induction, invasive haemodynamic monitoring, controlled airway management using video laryngoscopy, and regional analgesia via ultrasound-guided fascia iliaca block. Intraoperative haemodynamics were maintained within normal limits with judicious fluid therapy, opioid supplementation, and beta-blocker titration. The postoperative period presented with transient delirium, which was managed successfully with dexmedetomidine infusion. The patient had an uneventful recovery and was discharged on postoperative day five. This case study underlines the significance of meticulous anaesthetic planning after thorough assessment and perioperative cardiovascular monitoring for elderly individuals with multiple comorbidities undergoing non-cardiac procedures, especially when complicated by difficult airway.

Multidisciplinary Rehabilitation of Discoloured and Calcified Maxillary Incisors using MTA, EndoGuide-Assisted Canal Negotiation, and Aesthetic Restoration: A Case Report

Managing calcified root canals and discoloured anterior teeth remains a clinical challenge due to diagnostic complexity and the risk of procedural complications. This case report presents a multidisciplinary approach for the rehabilitation of maxillary incisors affected by pulp canal obliteration, apical pathology and aesthetic concerns. A 28-year-old male patient reported with discolouration of the maxillary right central incisor, while the adjacent lateral incisor exhibited complete canal calcification. Tooth 11 was treated through surgical endodontic intervention involving apicectomy and retrograde Mineral Trioxide Aggregate (MTA) obturation, supplemented with Platelet-Rich Fibrin (PRF) membrane and collagen plug placement to promote periapical healing, followed by non-vital bleaching. Tooth 12 was successfully managed using static guided endodontics, enabling safe negotiation of the obliterated canal and subsequent obturation. The combined use of Cone-Beam Computed Tomography (CBCT)-guided planning, surgical intervention, and aesthetic rehabilitation resulted in favourable functional and aesthetic outcomes at the six-month follow-up. This report underscores the clinical value of guided endodontics and a multidisciplinary treatment strategy in managing complex anterior endodontic cases.

Co-existing Carotid-Cavernous Fistula and Central Retinal Vein Occlusion Presenting as Unilateral Vision Loss in a 30-Year-Old Male: A Case Report

Kunal Bhat, Sachin Daigavane

Carotid-Cavernous Fistulas (CCFs) are aberrant arteriovenous connections between the carotid arteries and the cavernous sinus. Although uncommon, they might manifest with subtle or deceptive symptoms, especially in young individuals with no past medical history. This case study describes the clinical appearance, diagnosis, and treatment of a direct CCF in a 30-year-old male. The patient had a history of trauma three months prior to presentation followed by chief complaints of diminution of vision and swelling in the right eye. There was sudden increase in pain and swelling since 2 weeks prior to presentation. Patient underwent CT scan, ocular examination, fundus evaluation which revealed the presence of a direct carotid cavernous fistula along with Central Retinal Vein Occlusion (CRVO), following which surgical intervention was done. The patient had successful endovascular embolisation. Following surgery, ocular symptoms and proptosis along with visual acuity improved significantly. Early detection of CCFs is crucial for avoiding vision-threatening consequences. Clinicians should be cautious of young patients who have unexplained red eye, proptosis, as well as visual impairment, particularly after trauma. Prompt diagnosis using appropriate imaging and swift intervention can result in positive outcomes.

Phacolytic Glaucoma Secondary to Mature Senile Cataract in an Elderly Female: A Case Report

Suyash Singh, Sachin Daigavane

Phacolytic glaucoma is a rare type of secondary open-angle glaucoma caused by leakage of high-molecular-weight lens proteins through an intact capsule of a mature/hypermature cataract. It is most frequently seen in elderly patients who defer cataract surgery and, if not recognised and managed promptly, can lead to permanent visual impairment. A 61-year-old woman presented with severe ocular pain and redness in the left eye for 20 days, along with progressive visual decline over the past 1.5 years. Detailed slit-lamp and fundus examinations revealed phacolytic glaucoma associated with a mature senile cataract in the left eye, while the right eye showed pseudophakia with Posterior Capsular Opacification (PCO). Initial management focused on controlling Intraocular Pressure (IOP) and inflammation using topical along with systemic antiglaucoma medications. Definitive treatment was achieved through cataract extraction with Posterior Chamber Intraocular Lens (PCIOL) implantation, following which the IOP normalised and ocular pain resolved. However, the final visual outcome remained guarded due to prolonged period of raised IOP prior to intervention. This case highlights diagnostic and therapeutic challenges of phacolytic glaucoma, particularly in developing regions where delayed cataract surgery is common. Early diagnosis, prompt medical stabilisation, and timely surgical removal of cataract are essential to prevent irreversible optic nerve damage.

Central Diabetes Insipidus Unmasked: A Rare Presentation of Lymphocytic Infundibuloneurohypophysitis

Lymphocytic Infundibulo-Neurohypophysitis (LINH) is a rare autoimmune inflammatory disorder selectively involving the posterior pituitary and stalk, commonly presenting as Central Diabetes Insipidus (CDI). Due to its non-specific clinical and radiologic features, it remains underdiagnosed and is frequently misclassified as idiopathic CDI. We report a 21-year-old female who presented with polyuria (8-10 L/day) and polydipsia (10-12 L/day) over one month, associated with weight gain and headache. Laboratory evaluation revealed normal glycaemia, serum sodium of 139 mEq/L, urine specific gravity of 1.005, and serum osmolality of 287 mOsm/kg. Water deprivation testing demonstrated a rise in serum sodium to 147 mEq/L, serum osmolality to 305 mOsm/kg, and 3 kg weight loss with inadequate urinary concentration, confirming CDI. MRI pituitary showed posterior pituitary T1/T2 hypointense lesion measuring 7.3×4.3×7.0 mm with stalk thickening (5 mm) and absent posterior pituitary bright spot. Differential diagnoses including tuberculosis, IgG4-related hypophysitis, lymphoma, and infiltrative disorders were considered. Biopsy and anti-rabphilin-3A antibody testing were deferred due to financial constraints. A diagnosis of CDI secondary to LINH was made based on clinicoradiologic correlation. The patient was treated with desmopressin and oral glucocorticoids with marked symptomatic and radiologic improvement on follow-up. This case highlights the role of non-invasive diagnostic strategies and conservative management in LINH in resource-limited settings.

A Case of Recurrent Conjunctival Vascular Lesion in a Young Adult: A Clinicopathological Challenge

Hetaj Sheth, Kshama Popat

Conjunctival vascular tumours are rare in adults and often pose diagnostic challenges due to overlapping features between haemangioma and lymphangioma. A 22-year-old male presented with painless, slowly enlarging mass in the left lower lid for five years. The lesion was excised in July 2021, and histopathology revealed conjunctival haemangioma. However, a residual mass remained and gradually increased in size, reaching 2.5×1 cm. A second excision was performed in July 2025, and histopathological examination demonstrated dilated vascular and lymphatic channels consistent with conjunctival lymphangioma. Postoperative course so far is uneventful and the patient remains recurrence free on three months follow-up. This case illustrates the diagnostic dilemma of conjunctival vascular tumours, especially when histopathological features vary between excisions. Recurrence may be related to incomplete excision or the co-existence of vascular and lymphatic components. Careful excision, histopathological confirmation, and long-term follow-up are essential as conjunctival vascular tumours are known for their recurrences. Recurrent conjunctival vascular lesions in adults require thorough evaluation, as haemangioma and lymphangioma may co-exist or mimic one another.

Synergistic Effects of Manual Therapy, Neuromuscular Training and Virtual Reality in Cervical Radiculopathy: A Case Report

Shreya Tonpe, Deeba Shaikh, Rishikesh Maheshwari, Renu Choudhari

Cervical radiculopathy is a common condition that typically occurs as a result of nerve root or roots compression and inflammation in the region of the neural foramen. The encroachment normally causes neck and radiating arm pain or paresthesias, sensory impairment, or motor dysfunction in the upper extremities and neck. Hereby, the authors present a case report of a 37-year-old female with cervical radiculopathy. She complains of neck and shoulder joint pain, radiating down to left arm till elbow joint. On observation she had forward head posture and on examination reduced mobility of cervical region and shoulder joint with reduced strength of scapular muscle. This comprehensive rehabilitation strategy incorporates multiple evidence-based technique ues, including Mulligan mobilisation, neural tissue mobilisation, Scapular mobilisation, Sahrmann Exercise and virtual reality. Range of motion, Pain, and Muscle strength were the primary outcome measures. Neck Disability Index (NDI) was also assessed. The four week rehabilitation protocol has shown positive outcomes that highlight reduction in pain, improved mobility, increased muscle strength, correction of faulty posture, restored functions, and enhanced overall well-being. However, further clinical studies are necessary to evaluate the combined efficacy of these interventions and to establish standardised protocols for their implementation.

Individualised Anaesthetic Strategies for High-risk Cardiac Parturient: A Case Series

Rochana G Bakhshi, Mona S Jadhav, Sakshi Khatri, Meghana Chowdhary

Cardiac disease in pregnancy is a significant contributor to maternal morbidity and mortality worldwide. Physiological changes of pregnancy including increased cardiac output, expanded blood volume, tachycardia, and decreased Systemic Vascular Resistance (SVR) place additional stress on the cardiovascular system. These changes may unmask previously asymptomatic cardiac abnormalities or worsen pre-existing disease. The management of pregnant women with underlying cardiac conditions poses a unique perioperative and obstetric challenge, requiring multidisciplinary coordination to maintain maternal and foetal stability. Here, the authors, present a series of four clinically distinct and rare cardiac conditions encountered during pregnancy, each demonstrating different mechanisms of haemodynamic compromise. The first case involved rheumatic mitral stenosis of a 26-year-old gravida, where increased circulatory demand precipitated pulmonary congestion and heightened risk of decompensated heart failure. The second case in a 32-year-old gravida, featured Partial Anomalous Pulmonary Venous Connection (PAPVC) with sinus venosus defect, a congenital anomaly infrequently detected during pregnancy due to its subtle symptom profile. The third case in 36-year-old primigravida was unique due to the coexistence of Coronavirus Disease 2019 (COVID-19) infection and acute myocardial infarction during the second trimester - a rare combination associated with a three to four-fold increased risk of infarction in pregnancy. The fourth case in a 38-year-old gravida 2, involved an Atrial Septal Defect (ASD) complicated by anaemia and beta-thalassaemia trait, where the additive effects of hypervolaemia and reduced oxygen-carrying capacity intensified right-sided volume overload. Each case required individualised management emphasising pharmacological optimisation, vigilant haemodynamic monitoring, and careful peripartum planning. The present case series highlights the importance of early recognition, risk stratification, and multidisciplinary care for achieving favourable maternal and foetal outcomes in pregnant patients with complex cardiac disease.

Role of Norepinephrine and Vasopressin in Persistent Pulmonary Hypertension of the Newborn with Shock: A Case Series from a Tertiary Care Centre in Northern India

Aayushi Joshi, Naini Puri, Syed Moiz Ahmed, Divya Mishra, Shantanu Shubham

Persistent Pulmonary Hypertension of the Newborn (PPHN) complicated by shock presents significant therapeutic challenges, particularly in resource-limited settings without access to inhaled Nitric Oxide (iNO) and Extracorporeal Membrane Oxygenation (ECMO). Conventional inotropic agents may worsen pulmonary pressures, making their use potentially detrimental. Norepinephrine and vasopressin, with their selective vasoconstrictive effects, may simultaneously improve systemic perfusion and pulmonary haemodynamics. This case series included five term and late-preterm neonates admitted to a tertiary Neonatal Intensive Care Unit (NICU) in North India between December 2023 and January 2025 with echocardiographically confirmed PPHN and systemic hypotension despite preserved cardiac function. All infants received intravenous sildenafil. Norepinephrine was initiated at 0.2 μg/kg/min and escalated up to 0.5 μg/kg/min as the first-line vasopressor. In cases with inadequate response, vasopressin was added, starting at 0.1 mU/kg/min and increased up to 0.2 mU/kg/min. All neonates developed hypotensive shock within the first 20–28 hours of life. Three infants showed clinical improvement in perfusion and oxygenation following norepinephrine alone while two required adjunctive vasopressin for persistent hypotension, with both demonstrating rapid stabilisation marked by improved mean arterial pressure, lactate clearance, and oxygenation indices. This dual-agent vasopressor strategy appears to be both feasible and beneficial in improving outcomes in such critical cases. However, larger prospective studies are warranted to validate these results and assess long-term safety and efficacy.

Hypothalamic Hamartoma Presenting with Gelastic Seizure and Precocious Puberty: Successful Management with GnRH Agonists

Precocious Puberty (PP) is defined as an onset of puberty occurring more than 2.5 standard deviations earlier than the population mean age. Central Precocious Puberty (CPP) results from early activation of the hypothalamic-pituitary-gonadal axis. CPP in boys and very young girls is usually due to an organic lesion. Hypothalamic Hamartoma (HH) is the most common organic cause of CPP. HH are rare developmental, non-progressive, non-neoplastic, heterotopic lesions located at the base of the hypothalamus, arising from the tuber cinereum and the floor of the third ventricle, with an estimated prevalence of 1 in 100,000-200,000. HH presents with PP, gelastic seizures, and/or behavioural abnormalities. PP due to HH occurs particularly at age of 2-3 years. CPP can be treated with Gonadotropin Releasing Hormone (GnRH) agonist. Treatment options for seizures include antiepileptic drugs and surgical interventions. We hereby describe a series of four cases of HH from India. All patients presented with CPP and gelastic seizures before the age of three years and Magnetic Resonance Imaging (MRI) revealed HH. Following treatment with GnRH agonist, their pubertal changes regressed and the frequency of gelastic seizures decreased without any antiepileptic drugs and no significant changes in the size of HH. Therefore, GnRH agonist can be effectively used in patients with HH presenting as CPP and gelastic seizure with the regression of pubertal changes and a decrease in the frequency of seizures and surgical interventions are rarely required in case of refractory seizures and compressive symptoms.

Total Laparoscopic Hysterectomy in Bicornuate Uterus: A Case Series with 10 Surgical Steps

Venus Bansal, Arshdeep Kaur

Total Laparoscopic Hysterectomy (TLH) is a minimally invasive and safe procedure commonly performed today for various gynaecological conditions. Mullerian anomalies include a wide range of congenital malformations that arise from changes occurring in the embryogenesis of Müllerian ducts, which alter the morphology of the uterus, cervix, fallopian tubes, and vagina. This case series emphasises the difficulties encountered during TLH in patients with a bicornuate uterus and the approach to overcome those difficulties. Our first case was a 46-year-old female P3L2 with previous two c-sections, who presented with a complaint of heavy menstrual bleeding for 2 months. Her ultrasound showed bicornuate/septate uterus with a subserosal fibroid of 60*53*45 mm and a complex left ovarian cyst of 44*40 mm. Intraoperatively, the bladder could be pushed down with difficulty due to a tough band connecting the bicornuate uterus in the midline and the previous two c-sections. The second patient was a 52-year-old female P3L3 with previous three vaginal deliveries and presented with abdominal pain. Her ultrasound showed a bicornuate uterus with endometrial hyperplasia. Endometrial biopsy suggested endometrial hyperplasia without atypia. She was taken up for TLH with bilateral salpingo-oophorectomy. The third patient was a 16-year-old girl who presented to the Outpatient Department (OPD) with primary amenorrhoea and recurrent episodes of abdominal pain, not relieved even by injectable pain killers, for 6 months. Clinical and radiological findings suggested a diagnosis of uterus didelphys bicollis with unilateral left haematometra with left haematosalpingx with left ovarian endometriotic cyst and right rudimentary uterine horn. Diagnostic laparoscopy was done and followed by drainage of the left haematosalpinx and left ovarian endometriotic cystectomy. Laproscopic hysterectomy of such cases is challenging at each step. Most commonly faced difficulties were inserting the uterine manipulator and specimen retrieval. Delineating the anatomy carefully during the surgery in patients with Müllerian anomalies and meticulous dissection are key to the prevention of urinary tract or Gastrointestinal (GI) injuries.

Retained and Knotted Guidewires during Central Venous Catheterisation: A Case Series on Anaesthetic Management, Endovascular Retrieval, and Preventive Strategies

Kriti Bhandari, Bharat Choudhary, Abhinav Singh, Devaram, K Kavya

Retained or knotted guidewires during Central Venous Catheterisation (CVC) are rare but entirely preventable complications that may result in serious cardiovascular and vascular consequences, including arrhythmias, embolisation and vascular injury. Despite widespread adoption of ultrasound-guided techniques, guidewire-related events continue to occur, particularly in high-pressure clinical environments. Present case series is of three patients who developed guidewire-related complications following right subclavian vein cannulation. Two patients experienced complete guidewire retention with distal migration extending from the superior vena cava to the ipsilateral iliac vein, while one patient developed intravascular knotting at the subclavian–brachiocephalic junction following resistance during insertion. All patients were haemodynamically stable at presentation, with one reporting intermittent palpitations. Endovascular retrieval was performed in a hybrid operating theatre using a femoral venous approach with a 7 French sheath and a 5 French vascular snare under fluoroscopic guidance. All procedures were conducted under Monitored Anaesthesia Care (MAC) using midazolam, fentanyl and dexmedetomidine, which provided cooperative sedation, preserved spontaneous ventilation, and haemodynamic stability throughout the intervention. Retrieval was successful in all three cases without vascular injury, arrhythmias, or procedure-related complications. Postprocedure imaging confirmed complete removal of the guidewire without residual fragments. This case series is unique in emphasising the anaesthetic considerations during endovascular retrieval of retained and knotted guidewires, an aspect that is infrequently described in existing literature. It underscores the importance of early recognition, multidisciplinary coordination, and vigilant anaesthetic management, while reinforcing strict adherence to guidewire handling techniques to prevent these potentially catastrophic yet avoidable complications.

Paediatric Scrub Typhus Complicated by Myocarditis and Acute Respiratory Distress Syndrome: A Series of Four Cases

Lily Singh, Shalini Verma, Poulomi Roy, Abhinav Agarwal, Shrish Bhatnagar

Scrub typhus is an emerging zoonotic infection in Southeast Asia that can cause severe complications in children, including myocarditis and Acute Respiratory Distress Syndrome (ARDS). A case series of paediatric patients presenting with fever, respiratory distress, and cardiovascular compromise requiring intensive care is described here. In all the cases, laboratory evaluation revealed thrombocytopenia, elevated inflammatory markers, and positive Orientia tsutsugamushi IgM ELISA. Echocardiography confirmed myocarditis with reduced Left Ventricular Ejection Fraction (LVEF), while ARDS was diagnosed on clinical and radiographic grounds. Cases were managed with doxycycline, Intravenous Immunoglobulin (IVIG), ionotropic support, and ventilatory measures. While three patients improved with timely intervention, one child succumbed to illness, which reflects the potential severity of scrub typhus in paediatric age groups. This series emphasises the importance of early recognition and prompt management in endemic regions to prevent life-threatening complications and reduce morbidity and mortality. Clinicians in endemic regions should maintain a high index of suspicion for scrub typhus in children presenting with acute febrile illness and cardiorespiratory compromise, as early diagnosis and targeted therapy can be lifesaving.

Mercedes-Benz Sign Shaped Glasswool Tripod Foreign Body Impaction in the Eye: A Rare Clinical Case Series

Debajyoti Nanda, Manisha Sarkar, Abhisek Lohia

Superficial ocular foreign body is the commonest form of ocular trauma and one of the leading causes of ocular morbidity. A foreign body that lands on the anterior part of the eye may cause abrasions on the cornea. We present ten cases of very rare ocular Foreign Bodies (FB) that were missed on routine eye examination. Patients presented with complaints of foreign body sensation and diminution of vision in some cases due to corneal abrasion in the affected eyes. Some patients were diagnosed with conjunctivitis initially as conjunctival congestion was a prominent sign. However, symptoms particularly foreign body sensation did not improve after giving ocular antibiotic drops, hence suspicion of a foreign body in palpebral conjunctiva or in the cornea was strong. Slit-lamp biomicroscopy examination was done in all 10 cases and fluorescein staining of the affected eye was done in five cases. The cornea showed large epithelial defect in one case under slit-lamp and linear corneal abrasions in two cases under fluorescein dye staining. After eyelid eversion, meticulous examination indicated tripod-shaped glassy FB embedded within conjunctiva or in cornea. We present these cases of such unusual glassy type of tripod FB which mimics the Mercedes-Benz sign. This type of foreign body may go undetected even on slit lamp examination and fluorescein staining may aid in the early diagnosis which can prevent corneal ulcer.

Unravelling the Aggressive Nature of Renal Cell Carcinoma Subtype with Rhabdoid Differentiation: A Series of Six Cases

Sowmiya Jayachandran, Supriya Verma, Kalaivani Amitkumar, Muthu Sudalaimuthu

Rhabdoid differentiation has been described in various carcinomas involving different organs and is recognised as a marker of aggressive tumour behaviour. In Renal Cell Carcinoma (RCC), the current grading system of the International Society of Urologic Pathology (ISUP) has given the highest grade IV to renal cell carcinoma with rhabdoid differentiation, signifying the worst prognosis. This article delineates 6 cases of clear cell RCC with rhabdoid differentiation over four years. All patients were male with a median age of 57.5 years. Microscopically, the tumour showed clear cell areas with rhabdoid differentiation occupying 10 to 45% of tumour volume. One of the six cases showed metastasis to the small bowel at the time of presentation, highlighting the aggressive clinical course. Immunohistochemical evaluation of Ki67 labelling index ranging from 25 to 50%. Our study highlights the significance of rhabdoid differentiation in clear cell renal carcinoma, which is seen rarely but indicates aggressive behaviour.

Role of Colour Doppler Ultrasound in Planning Pedicled Perforator Flaps for Lower Limb Reconstruction: A Case Series

Coverage of lower limb defects is a common challenge in reconstructive surgery. Flaps are often required, and perforator flaps are widely used. Preoperative mapping of perforators and donor site morbidity are key concerns. Traditional modalities used to locate perforators include computed tomographic angiography, magnetic resonance imaging and angiography, and handheld Doppler devices. With advancements in duplex ultrasound, minute details of the arterial system and its perforators can now be assessed preoperatively and utilised in surgical planning for lower limb reconstruction. A total of 17 patients with lower limb defects were reconstructed using pedicled perforator flaps guided by Colour Doppler Ultrasound (CDU). Fourteen patients were male and three were female. The mean age was 36±12.4 years (range: 13-57 years), and the mean follow-up period was six months. All defects were due to trauma. The average defect size was 33.6 cm² (range: 12-200 cm²). The choice of perforator flap was based on the best adjacent perforator identified using colour Doppler ultrasound. The mean perforator diameter was 1.4±0.2 mm (range: 1.1-1.8 mm), and the mean peak systolic blood flow velocity was 24.8±8.08 cm/s (range: 12-37 cm/s). The procedure was successful in 16 patients (94%). Colour Doppler ultrasound is a useful tool for identifying perforators for pedicled perforator flaps in lower limb reconstruction. Further studies with larger sample sizes are needed to establish linear correlations.

Navigating the Grey Zone: A Series of Three Cases on Mixed-phenotype Acute Leukaemia

Mixed-phenotype Acute leukaemia (MPAL) may consist of a single population of abnormal progenitors (morphological blasts) expressing antigens from two or more lineages. MPAL remains one of the most diagnostically challenging groups of acute leukaemias because of its intrinsic biological heterogeneity and overlap with both Acute Myeloid Leukaemia (AML) and Acute Lymphoblastic Leukaemia (ALL). Lineage assignment is best performed by Flow Cytometric Immunophenotyping (FCM IPT) in order to correlate the patterns of antigen expression on one or more cell populations. Authors present three cases of mixed phenotype acute leukaemia to highlight the breadth of MPAL presentations across age groups, ranging from neonates to elderly adults. Case 1 was of a 62-year-old male diagnosed with B/Myeloid MPAL whose molecular analysis revealed IDH2, SRSF2, and CUX1 mutations with del(7q), suggesting evolution from a myeloid clonal background. The high VAF of CUX1 (77.39%) in the context of del(7q) likely indicates Loss Of Heterozygosity (LOH). Case 2 (64-year-old male) presented with Central Nervous System (CNS) infiltration. In Case 3, 85-day-old male infant with B/T MPAL presented with extreme hyperleukocytosis and rapid clinical deterioration. This series underscores the marked biological and clinical heterogeneity of MPAL across age groups and disease subtypes, reinforces the critical role of multiparameter flow cytometry in objective lineage assignment, and highlights the importance of integrating immunophenotypic, cytogenetic, and molecular data to establish an accurate diagnosis. The varied clinical courses observed also reflect the prognostic unpredictability of MPAL and the practical challenges of managing this rare entity, particularly in resource-limited settings, emphasising the need for early recognition and comprehensive diagnostic evaluation to guide optimal therapy.

Clinical and Pathological Variants of Ameloblastoma of the Mandible: A Series of 5 Cases

AV Akhilesh, S Amrutha, Patil Shashank Avinash

Odontogenic in origin, ameloblastoma is a benign tumour, characterised by its locally aggressive behaviour and high tendency for recurrence, which necessitates early recognition and meticulous management. The tumour is primarily categorised into three variants, with conventional ameloblastoma being the most common, followed by less frequently encountered forms such as unicystic and peripheral ameloblastomas and the rare entity, adenoid ameloblastoma. These different subtypes present distinct clinical, radiographic and histopathological characteristics, which can pose challenges in diagnosis and management. The present case series (3 males, 2 females) documents multiple variants of ameloblastoma, including the rare entity adenoid ameloblastoma, which was treated with no signs of recurrence on periodic follow-up. The present case series thereby illustrates the diversity of presentations, as each variant exhibits different biological behaviour, surgical considerations and recurrence potential. The present series further emphasises the importance of integrating clinical and radiological findings with histopathological confirmation to establish an accurate diagnosis. The range of treatment options outlined in the literature spans from simple bone curettage to segmental resection with staged reconstruction, thus balancing the need to minimise surgical morbidity, while ensuring a low recurrence rate. The present case series reinforces the significance of comprehensive evaluation and highlights the need for curating individualised treatment strategies to optimise patient outcomes since both conservative and radical surgical approaches have variant-specific implications. Long-term follow-up remains indispensable to monitor for recurrence, which is a persistent concern regardless of the surgical modality.

A Frightening Encounter that Ended in a Smile: Professional Growth through Fearful Encounter with Patient in Clinical Set-up

Anjali Giridhar Bhoyar

I had recently joined a private dental institute as a lecturer in the Department of Prosthodontics. One morning, during my OPD duty, I was seated beside the dental chair, examining a patient, when I noticed an unusual stir among the staff. From a distance, I could see my colleagues hurriedly retreating into the inner section of the department, whispering nervously, their heads down, as if something or someone had unsettled them.

Images in Medicine of Davener’s Dermatosis: Frictional Hyperpigmentation of the Spine

Narala Sai Akankssha, Sree Divya Mohan, Ramya Ramanathan

Friction-induced dermatoses are a distinct group of skin conditions resulting from chronic mechanical pressure or repetitive trauma over bony prominences. Among these, Davener’s dermatosis is an under-recognised entity that presents as benign, midline hyperpigmentation secondary to prolonged friction and posture-related stress (1).

Unveiling the Beaver Tail Liver: A Hepatic Variant with Diagnostic Significance

Nitika Senger, Sourabh Deshmukh, Mahima Dubey

A 26-year-old woman presented to the Outpatient Department (OPD) with the complaints of persistent fatigue, progressive dyspnoea on exertion, generalised weakness, and recent worsening of vision. She had a known history of dimorphic anaemia {Haemoglobin (Hb) 10.3 gm/dL} and poorly controlled type 2 diabetes mellitus {Glycosylated Haemoglobin (HbA1c) - 7.3}. On physical examination, she appeared pale, with bilateral pedal oedema and mild hepatomegaly. Her random blood glucose was markedly elevated, and fundoscopic examination revealed early signs of diabetic retinopathy.

Erythema Dyschromicum Perstans with Islands of Sparing: A Case Report

A 46-year-old female presented with a six-month history of gradually progressive asymptomatic dark coloured skin lesion over back of the neck. She did not reveal any history of topical application prior to onset of lesions, usage of hair cosmetics or chronic mechanical irritation at the site. The patient did not report any preceding redness, induration, history of trauma or any other previous skin lesions at that particular site. She denied history of similar lesions anywhere else in the body. There was no history of fever, abdominal pain, altered bowel habits or significant weight loss and antecedent drug intake. Past history and family history was insignificant. She was a paddy field worker and used to have chronic exposure to sunlight and pesticides. On general examination, the patient was conscious and oriented. Her vital signs showed a blood pressure of 120/80 mmHg, a pulse rate of 78/min, and she was afebrile.

Squamous Cell Carcinoma of the Breast: A Rare Diagnostic Challenge

Kashmira Bhaidkar, Vinod Ade, Punam Sawarkar

Squamous Cell Carcinoma (SCC) of the breast is rare and aggressive. The prevalence of SCC of the breast is extremely low, accounting for less than 0.1% of all primary invasive breast cancers. Squamous cells are not normally present in the breast, which explains the rarity of this malignancy in the breast (1).

Uncommon Cutaneous Spread of Oral Cavity Cancer: A Clinical Image

Ram Pukar Bharat, Jagrati Yadhav, Kanchan Dasharth Devde, Amol Shankar Dongre

A 55-year-old man presented with a non-healing ulcer on the left mandibular region, which had gradually enlarged over six months from a pea-sized lesion to approximately 3×2 cm, with associated extraoral fungation. He reported sticky, thick saliva and hypersalivation for one month, along with restricted mouth opening of 15 mm. The patient had a history of chronic kharra chewing for approximately 10 years, consuming it three to four times daily, but had recently discontinued this habit. There was no history of smoking and alcohol consumption. The patient had no known medical comorbidities such as diabetes mellitus, hypertension, cardiac disease, or pulmonary tuberculosis. Mastication had been difficult for three months; however, there was no history of pain, dysphagia, or burning sensation. On intraoral examination, a 4×3 cm deep ulcer was noted arising from the left gingivobuccal sulcus, extending from tooth 34 to 38. Teeth 12 and 13 exhibited grade I mobility, while tongue, palate, uvula, and floor of mouth were free of tumour involvement. Contrast-enhanced computed tomography demonstrated a 3×2×2.6 cm soft-tissue mass involving the buccal mucosa and Retromolar Trigone (RMT), with infiltration into the overlying skin and masticator muscles. Multiple cervical lymph nodes were noted, the largest measuring 2×1 cm at level IB 1 (Table/Fig 1).

Theism Leading to Late Presentation of an Unusually Large Antrochoanal Polyp

Sanskriti, Ishita Guglani, Ashish Anjankar

A six-year-old boy was brought to the Otorhinolaryngology department of a tertiary hospital in rural central India by his parents with chief complaints of a mass hanging in the mouth, disrupted speech, and congestion of the nose for six months. There were also complaints of difficulty in swallowing solids and decreased sense of smell for the last two months. There was no significant past history. Family history was also insignificant. Local examination was done which revealed a bluish-grey cystic swelling in the left nasal cavity (Table/Fig 1) and a large reddish mass hanging in the oropharynx (Table/Fig 2). The mass also extended into the oropharynx and was seen abutting the epiglottis.

Coal Worker’s Pneumoconiosis Presenting as Miliary Opacities: A Diagnostic Dilemma

Poonam Avinash Patil, Amit Nitin Toshniwal

A 54-year-old male, with a smoking history of 10 pack-years and employed as a coal mine worker for 16 years, presented with complaints of intermittent cough for three years, dyspnoea on exertion Modified Medical Research Council (mMRC) score of II to III since one year, and a history of loss of appetite and weight loss around 10 kilograms over a period of six months. The patient denied any history of systemic co-morbidities. On general examination, the patient was conscious and oriented to time place and person and was vitally stable. On systemic examination, palpation findings within normal limits, percussion revealed resonant notes over all lung fields, and auscultation demonstrated reduced breath sounds in the right infraclavicular region.

Rising Tide of Vitamin D Deficiency among Middle-aged Population in Chennai, Tamil Nadu, India, Post-COVID: A Call for Public Health Action

Mary Chandrika Anton

Dear Editor, The Coronavirus Disease 2019 (COVID-19) pandemic has indelibly reshaped the landscape of global health, but one of its more insidious legacies has emerged quietly in its aftermath—an alarming rise in Vitamin D deficiency, especially among the middle-aged population (defined as individuals aged 40 to 65 years) in urban regions such as Chennai (1). This growing nutritional concern has significant implications for public health, given the vital role Vitamin D plays in musculoskeletal integrity, immune regulation, and chronic disease prevention.

Evaluation of Rational Drug Use in Outpatients with Urinary Tract Infection at a Rural Indian Hospital: A Cross-sectional Study

Samiksha Shelar, Vijaykumar Pawar, Nitin Gawari, Bipin Shelar, Seema Bhalerao

Introduction: Urinary Tract Infections (UTIs) in outpatients are frequently treated empirically with antibiotics. It is essential to assess prescribing patterns to address irrational drug use and prevent the development of antimicrobial resistance. Aim: To evaluate rational drug use in outpatients with UTIs. Materials and Methods: The present cross-sectional study was conducted in the Medicine Outpatient Department (OPD) at Swami Ramanand Tirth Rural Government Medical College, Ambajogai, Maharashtra, India. A total of 1,000 prescriptions from patients diagnosed with UTIs between December 2018 and June 2020 were evaluated for demographic characteristics, co-morbidities, and medication profiles. The World Health Organisation (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology was used to assess prescriptions using metrics such as Prescribed Daily Dose (PDD), DDD, PDD:DDD ratio, and DDD per 1,000 Inhabitants per Day (DID). Rationality was evaluated using WHO prescribing indicators and the Index of Rational Drug Prescribing (IRDP). Categorical data were analysed using the Chi-square test and Pearson’s correlation. Results: The UTIs were more common in females, 682 (68.2%), than in males, 318 (31.8%). The most frequent co-morbidities were diabetes mellitus 360 (36%), urolithiasis 190 (19%), and Benign Prostatic Hypertrophy (BPH) 104 (10.4%). A total of 2,550 drugs were prescribed, most commonly nitrofurantoin 256 (25.6%), paracetamol 280 (28.0%), norfloxacin 113 (11.3%), pantoprazole 149 (14.9%), levofloxacin 118 (11.8%), amoxicillin 55 (5.5%), cefpodoxime 29 (2.9%), and disodium hydrogen citrate 1,000 (100%). The mean PDD was 675.71±607.29 mg, mean DDD was 0.92±1.03 mg, the PDD:DDD ratio was 1.0±0.5, and DID was 0.0492±0.0452. The average number of drugs per encounter was 2.55. Of all drugs prescribed, 42.03% were written by generic name and 53.05% were from the Essential Medicines List (EML). Antibiotics were prescribed in all encounters; no injections or Fixed-Dose Combinations (FDCs) were used. The overall IRDP index was 2.03. Conclusion: Low DID values indicate limited antibiotic utilisation. Minimal polypharmacy and the absence of injections or Fixed-Dose Combinations (FDCs) demonstrate rational prescribing practices. However, universal antibiotic prescribing and a low IRDP index suggest considerable scope for improvement.

Serum IgE as a Biomarker of Severity and Short-term Treatment Response in Steroid-naïve Children with Asthma: A Hospital-based Prospective Study

Introduction: Paediatric asthma is a growing public health challenge in Low- and Middle-Income Countries (LMICs), with increasing prevalence and substantial morbidity. Immunoglobulin E (IgE), a key mediator in type 2 airway inflammation, is often elevated in allergic asthma; however, its role as a severity biomarker and its responsiveness to treatment remain unclear in LMIC settings. Aim: To evaluate the role of serum IgE as a biomarker for baseline asthma severity and to assess its trends in relation to spirometric parameters following guideline-directed Inhaled Corticosteroid (ICS) therapy in steroid-naïve children with asthma. Materials and Methods: This hospital-based, prospective interventional study was conducted at the Department of Paediatrics, SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India, over 14 months from October 2023 to December 2024. Children aged 5-14 years with newly diagnosed asthma were enrolled, excluding those on prior corticosteroid or anti-allergic therapy. Baseline and three-month post-treatment serum IgE levels were measured using Enzyme-linked Immunosorbent Assay (ELISA), and spirometry was performed following American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. ICSs were administered per Global Initiative for Asthma (GINA) 2023 recommendations. Correlation and Receiver Operating Characteristic (ROC) curve analysis were performed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: Among 101 children, the mean age was 103.9±28.3 months, with a male predominance (64.4%). A stepwise increase in baseline IgE levels was observed with rising asthma severity. The ROC analysis demonstrated good diagnostic performance of serum IgE in identifying moderate to severe asthma, with an optimal cut-off of 362 IU/mL (sensitivity 80.4%, specificity 79.6%). Post-treatment IgE levels demonstrated a non-significant downward trend (p=0.1746) Although children with atopic dermatitis had higher mean serum IgE levels, the association was not statistically significant (p=0.6188), while spirometric improvement was consistent among all the children in the sample. Conclusion: Serum IgE correlates with baseline asthma severity and may serve as a low-cost, accessible biomarker for initial risk stratification in paediatric asthma Short-term ICS therapy did not result in a statistically significant change in serum IgE levels, indicating limited short-term biomarker responsiveness.

Impact of Antimicrobial Photodynamic Therapy Combined with Mechanical Debridement on Clinical Parameters and Peri-implant Microbiota in Patients with Peri-implantitis: A Prospective Clinical Study

Mohamed Thaha, Arvina Rajasekar

Introduction: Peri-implantitis is an inflammatory condition affecting tissues around dental implants, often leading to implant failure. Mechanical debridement is the standard non surgical treatment, but adjunctive therapies like antimicrobial Photodynamic Therapy (aPDT) may enhance clinical outcomes and reduce peri-implant pathogens. Aim: To evaluate the adjunctive effect of aPDT combined with mechanical debridement on clinical parameters and peri-implant microbiota in patients with peri-implantitis. Materials and Methods: A prospective clinical study was conducted at the Department of Periodontology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, from November 2024 to March 2025, with 50 peri-implantitis patients aged 25–60 years, randomly allocated to control (Group-1) (mechanical debridement only, n=25) or test (Group-2) (mechanical debridement+aPDT, n=25) groups. Clinical parameters including Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded at baseline and three months. Subgingival plaque samples were collected for Tannerella forsythia quantification via Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Data were analysed using independent and paired t-tests with significance set at p<0.05. Results: Group-1 (32.56±5.77 years) included 12 males and 13 females, while Group-2 (33.39±4.94 years) comprised 13 males and 12 females. No significant intergroup differences in age or gender were noted (p>0.05). Both groups showed significant improvements from baseline to three months in PI, GI, PD, CAL and T. forsythia levels (p<0.001). The test group demonstrated significantly greater reductions in all parameters compared to controls at three months (p<0.05). Conclusion: aPDT significantly enhances clinical and microbiological outcomes in non surgical peri-implantitis management compared to mechanical debridement alone.

Task-based Online Module in Medical Education Technology for Postgraduate Residents: A Mixed-methods Educational Intervention Study

Introduction: Competency-based Medical Education (CBME) mandates postgraduate residents to acquire pedagogic competencies such as teaching skills, assessment literacy, reflective practice, and leadership. Structured, task-based Medical Education Technology (MET) modules delivered through digital platforms may enhance motivation and applied educational skills; however, evidence from Indian postgraduate settings remains limited. Aim: To design, implement and evaluate a structured online MET module for postgraduate residents and assess its feasibility, engagement, motivational impact and development of selected pedagogic skills. Materials and Methods: This mixed-method, descriptive educational intervention study was conducted at Burdawan Medical College and Hospital, West Bengal, India, from March 2025 to August 2025. The MET module was developed by six faculty members trained in medical education, representing the Departments of Physiology, Community Medicine, and the Medical Education Unit. To facilitate feasibility of intervention and interaction, participants were divided into three groups (Group A: 43, Group B: 44, Group C: 43) to facilitate moderated discussions. A one-month asynchronous MET module comprising four threads and eight tasks was implemented for postgraduate residents across clinical and non clinical departments. Of 145 enrolled residents, 130 completed the module (clinical: 94; non clinical: 36). Quantitative data were collected using a structured, pre- and post intervention motivation scale, task completion records and punctuality metrics, while qualitative data were obtained from reflective submissions and Focus Group Discussions (FGD). Quantitative data were analysed using paired t-tests, with p-value <0.05 considered statistically significant. Qualitative data underwent thematic analysis. Results: Of the 145 residents enrolled, 130 (89%) completed all assigned tasks, and among these, 118 (91%) submitted their work within the stipulated timelines. Participation remained consistent across all four weeks, with slightly higher engagement among non clinical residents. Optional face-to-face Objective Structured Clinical Examination/Objective Structured Practical Examination (OSCE/OSPE) sessions were attended by 98/130 participants (75%). Critical reflection beyond descriptive levels was demonstrated by >90% of submissions, while 109/130 (84%) of OSCE/OSPE stations were competency-aligned. Mean motivation scores showed a statistically significant improvement across all domains, including CBME awareness, reflective practice, assessment confidence and self-directed learning (p-value <0.001). Conclusion: The structured online MET module demonstrated high feasibility, engagement, and significant improvement in motivation and applied pedagogic competencies among postgraduate residents. This task-based, asynchronous model offers a scalable and replicable framework for strengthening CBME implementation in postgraduate medical education.

Emergency Clinical Treatment Protocols for Alleviating Pain in Patients with Symptomatic Irreversible Pulpitis of Permanent Teeth: Systematic Review and Meta-analysis

Rohit Pradeep Magar, Sumanthini V Margasahayam, Anuradha Patil, Divya Naik

Introduction: Symptomatic Irreversible Pulpitis (SIP) is a frequent cause of dental emergencies, often presenting with severe and persistent pain. Multiple emergency treatment options have been suggested, but the relative effectiveness of these approaches remains uncertain. Aim: To evaluate the effectiveness of various emergency clinical treatment protocols in reducing pain among patients with SIP in permanent teeth. Materials and Methods: A comprehensive literature search was conducted using Medical Subject Headings (MeSH) terms and Boolean operators across databases including PubMed, Medline, ClinicalKey, ProQuest, and EBSCOhost. Grey literature sources were also searched for English-language articles published up to August 31, 2023. Following PRISMA guidelines, 19 Randomised Controlled Trials (RCTs) were selected based on inclusion and exclusion criteria, and the review was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Results: Preoperatively, pharmacological strategies such as Non steroidal Anti-inflammatory Drugs (NSAIDs) and Novafen enhanced anaesthesia effectiveness and reduced baseline pain. Intraoperatively, pulpotomy–often with Calcium-enriched Mixture (CEM) or Mineral Trioxide Aggregate (MTA)–consistently relieved pain and was favoured for its simplicity. Occlusal reduction showed mixed results, with some studies reporting benefit. Adjuncts like cryotherapy, laser, and acupuncture demonstrated variable but promising outcomes. meta-analysis indicated that occlusal reduction significantly decreases pain at 12 hours (SMD=-0.32), and cryotherapy irrigation during root canal treatment leads to reduced postoperative discomfort (SMD-1.10), with Calcium Hydroxide {Ca(OH)2} pulpotomy showing substantial pain reduction (SMD-3.27). Conclusion: This review underscores the efficacy of diverse preoperative, intraoperative and postoperative strategies, in managing endodontic pain in permanent teeth, with pulpectomy and full pulpotomy offering the most consistent pain reduction. Incorporating these evidence-based interventions into clinical practice can enhance patient outcomes and optimise pain management in endodontic emergencies.

Cuttlebone-derived Hydroxyapatite in Bone Tissue Engineering: A Systematic Review

Introduction: Bone tissue engineering seeks to overcome limitations of conventional grafts in treating craniofacial and orthopaedic defects. Hydroxyapatite (HA) is a widely used substitute, but synthetic forms lack bioactive ions and remodeling capacity. Marine-derived biomaterials, especially Cuttlebone (CB), offer a natural architecture and trace elements that enhance osteogenesis. Aim: To evaluate the regenerative potential of Cuttlebone-derived Hydroxyapatite (CB-HA) in preclinical in-vitro and in-vivo models. Materials and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic search of PubMed, Scopus, Web of Science, and EBSCO was performed for studies published between 2005 and 2025. Eligible articles investigated CB-HA or its composites in bone regeneration. Data were extracted using the PICO framework, and quality was assessed with the modified SYRCLE tool. Results: The present systematic review included 18 studies. In-vitro experiments demonstrated that CB-HA promoted osteoblast proliferation, alkaline phosphatase activity, mineral deposition, and osteogenic gene expression compared with controls. In-vivo studies in rat and rabbit models confirmed greater new bone volume, mineralisation, and vascularisation. Composites incorporating polymers or ion substitutions (Si, Sr, Mg, Mn) further improved bioactivity and mechanical performance. No adverse local or systemic effects were reported. Conclusion: CB-HA shows superior osteogenic potential over conventional substitutes, attributed to its biomimetic architecture, porosity, and favourable surface chemistry. With standardised fabrication and long-term animal studies, CB-HA holds promise for future clinical translation in orthopaedic, craniofacial, and dental applications.

Impact of Diabetes Duration on Stage of Retinopathy and Visual Outcome Post-laser Photocoagulation: A Prospective Interventional Study

Hetaj Sheth, Kshama Popat

Introduction: The chronicity of Diabetes Mellitus (DM) plays a pivotal role in the onset and progression of Diabetic Retinopathy (DR). Early intervention can mitigate vision loss, but clinical outcomes post-treatment often vary with the duration of diabetes. Aim: To evaluate the association between duration of diabetes and severity of DR, and to assess its influence on visual outcomes following Pan-retinal Photocoagulation (PRP). Materials and Methods: A prospective interventional study was conducted at the Department of Ophthalmology, GT Sheth Ophthalmological Hospital, P.D.U. Government Medical College, Rajkot, Gujarat, India from November 2012 to September 2014 on 80 eyes of 44 diabetic patients who underwent PRP. Patients were categorised based on diabetes duration: Group A- <5 years, Group B- 6-10 years, and Group C- >10 years. DR was classified per Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines, and all patients underwent PRP. Best Corrected Visual Acuity (BCVA) was assessed at baseline and over a 6-month follow-up. Chi-square was applied to find the association between the duration of DM and severity of DR. Paired t-test and Analysis of Variance (ANOVA) test were applied to compare visual improvement post-laser PRP with severity of DR. Results: Severity of DR increased with diabetic duration (p-value=0.0247). Proliferative Diabetic Retinopathy (PDR) was observed in 47.1% (16/34 eyes) of patients with <5 years’ duration, 59.1% (26/44 eyes) in 6-10 years, and 100% (2/2 eyes) in >10 years. Visual improvement post-PRP was seen in 28 eyes (82.3%), 35 eyes (79.5%) and 1 eye (50%) of patients across the three groups, respectively. Visual deterioration was observed only in patients with diabetes duration of ≥6 years. Conclusion: Duration of diabetes is directly related to disease severity and inversely related to improvement in vision after laser treatment. Early screening and timely PRP can significantly enhance the prognosis for patients with DR.

Morphometric Evaluation of the Iliac Crest in Dry Human Hip Bones: A Cross-sectional Study

Introduction: The human bony skeleton comprises the appendicular and axial skeletons. The hip bone is a part of the appendicular skeleton. This massive bone is formed by the fusion of three individual bones: the ilium, ischium, and pubis. These three parts unite at the acetabulum to form the hip joint. The need for present study lies in its potential to aid clinicians in reconstructive surgeries and bone graft procedures, particularly in the treatment of osteonecrosis of the femoral head. Aim: To evaluate detailed morphometric parameters of the iliac crest along with important bony distances related to the iliac crest. Materials and Methods: The present cross-sectional study was conducted on 50 dry adult hip bones (25 right and 25 left) of unknown sex, obtained from the Department of Anatomy, SGT Medical College, SGT University, Gurugram, Haryana. The thickness of the iliac crest was measured at three distinct points: the most anterior point, the midpoint, and the most posterior point. These measurements were recorded for both right and left hip bones to ensure a comprehensive morphometric analysis. The range and mean with standard deviation of all parameters were calculated and presented in tabulated form. Observations were recorded separately for the right and left sides, along with t-values. Statistical significance was determined using a p-value of less than 0.05. Results: At the most anterior point, the right side showed a mean±SD (Standard Deviation) thickness of 10.2±6 mm, while the left side showed a mean of 8.3±4.2 mm (p=0.06). At the midpoint, the right side had a mean of 7.6±6.2 mm and the left side had a mean of 7.8±4.4 mm (p=0.08). At the most posterior point, the right side showed a mean of 10±6.3 mm and the left side had a mean of 12±3.1 mm (p=0.2). Conclusion: The present study examined morphometric parameters of the iliac crest, including various critical bony distances, to provide an accurate and detailed anatomical description of both sides of the hip bone in the North Indian population. These findings may be beneficial for clinicians and reconstructive surgeons, particularly during bone graft procurement, which is commonly utilised in the treatment of osteonecrosis of the femoral head.

Correlation of Emotional Intelligence and Coping Styles for Academic Stress with the Academic Performance of Medical Undergraduates: A Cross-sectional Study in Western Maharashtra, India

Priyanka Mourya, Milind Sharad Chitale

Introduction: Undergraduate medical students often experience considerable academic stress. Emotional Intelligence (EI) and coping strategies are key factors in stress management. Given that Academic Performance (AP) is a primary source of stress for these students, it is crucial to explore how psychological resources such as EI and coping mechanisms affect their AP. However, this relationship has not been thoroughly investigated in the context of Indian medical education. Aim: To investigate the correlation between EI and coping styles for academic stress in relation to AP as well as to explore the interrelationship between EI and coping styles among undergraduate medical students. Materials and Methods: This cross-sectional analytical study was conducted at SMBT Institute of Medical Sciences and Research Centre, Nandi Hills, Dhamangaon, Igatpuri, Nashik, Maharashtra, India, from October 2024 to July 2025. The study involved 178 undergraduate of Bachelor of Medicine and Bachelor of Surgery (MBBS) students from all four years. EI and broad coping styles were assessed using the Schutte Self-Report Emotional Intelligence Test (SSEIT) and the Brief-COPE inventory, respectively. AP was defined as the percentage score obtained in the most recent university theory examinations. Spearman’s correlation was used to measure the strength of the association between EI, coping styles and AP. Statistical significance was set at p-value <0.05. Results: The mean age of the study population was 20.79±1.4 years. 51.12% of participants were female and the rest were male. The Mean±Standard Deviation (SD) of the EI score was 124.11±10.84. No significant correlation was observed between AP and EI (r-value=-0.034, p-value=0.648) or any broad coping style. However, EI was significantly correlated with problem-focused coping (r-value=0.489, p-value <0.001). The mediation analysis indicated that coping strategies did not mediate the relationship between EI and students’ AP. Conclusion: No significant correlation was found between EI, coping strategies and AP. However, the correlation between EI and problem-focused coping highlights the role of EI in developing adaptive stress management strategies. These findings suggest the potential value of integrating EI and coping skills training into medical education to enhance students’ psychological resilience.

Prescription Patterns and Medication Adherence among Heart Failure Patients at a Tertiary Care Hospital in Southern India: A Cross-sectional Study

MB Sasmi, Sreelakshmi Menon, VJ Ambika Abhishake, C Ushabhayi

Introduction: Heart failure bears a significant health burden globally, particularly in India, where its prevalence is on the rise. There are striking regional variations in the prescription pattern for heart failure. Prescription pattern monitoring will help to understand the trends in drug use, compliance with regional, state or national guidelines and provide feedback information to prescribers. Being a chronic disease, medication adherence also plays a major role in improving clinical outcomes. Aim: To analyse the prescription patterns of heart failure drugs as well as the medication adherence among heart failure patients admitted to a tertiary care hospital. Materials and Methods: A hospitalbased, cross-sectional, observational study was conducted in the inpatient department (IPD) of Medicine in a tertiary care teaching hospital, over a period of six months from August 2024 to January 2025. A total of 204 prescriptions of heart failure patients were analysed using a prestructured proforma. The patients were asked about cardiac rehabilitation practices, and their responses were recorded by using 5-point Likert scale ranging from never to always. Medication adherence was assessed by using a pre-validated questionnaire containing nine questions, and patients were categorised to have low, moderate or high adherence based on their scores. The collected data were analysed by descriptive statistics. Results: Males (61.3%) outnumbered females (38.7%). Most patients were aged 51-60 years, with a mean age of 63.2±12.14 years. Hypertension (60.8%), ischaemic heart disease (60.3%) and diabetes (58.3%) were the most common co-morbidities. Combination therapy was preferred with diuretics (92.7%), beta blockers (57.4%) and vasodilators (44.6%) being the most commonly prescribed drugs. Mineralocorticoid Receptor Antagonist (MRA), sodium-glucose cotransporter-2 (SGLT-2) inhibitors and angiotensin receptor neprilysin inhibitors (ARNI) were also prescribed. Cardiac rehabilitation uptake was poor, only 29% adhered to dietary modifications and 7.3% engaged in regular physical activity. Medication adherence assessment showed that 47.6% of patients had high adherence, while 25.5% had moderate and 27% had low adherence levels. Conclusion: Most of the recommended drugs, including the newer drugs like SGLT-2 inhibitors and ARNI, were observed in the prescriptions. Cardiac rehabilitation and medication adherence were inadequate, highlighting the need for structured and targeted adherence improvement strategies and cardiac rehabilitation programmes.

Comparison of Intrathecal Hyperbaric Bupivacaine and Levobupivacaine in Lower Limb Orthopaedic Surgeries: A Prospective Interventional Study

Jino Raju, MC Vipin, KP Biji, KR Radha

Introduction: Subarachnoid block was widely used for lower limb orthopaedic surgeries. Hyperbaric bupivacaine provides reliable anaesthesia but is associated with higher neurological and cardiac toxicity. Levobupivacaine, the S-enantiomer of bupivacaine, was developed to offer comparable anaesthesia with improved safety and haemodynamic stability. Aim: To compare the effects of intrathecal administration of hyperbaric bupivacaine and levobupivacaine in lower limb orthopaedic surgeries. Materials and Methods: A prospective interventional study was conducted in the Department of Anaesthesiology at Government Medical College, Kozhikode Tertiary Care Hospital, Kerala, India, from January 2023 to December 2023. Total of 120 American Society of Anaesthesiologists-Physical Status (ASA-PS) grade I-II patients aged 18-65 years undergoing unilateral lower limb surgeries, who were divided into two equal groups of 60 each based on whichever drug the treating anaesthesiologist selected in routine practice: Group B (hyperbaric bupivacaine 0.5% 2.0 mL+60 mcg buprenorphine) and Group L (hyperbaric levobupivacaine 0.5% 2.0 mL+60 mcg buprenorphine). Motor and sensory block characteristics, duration of effective analgesia and incidence of side-effects were compared. Data were analysed using an Independent samples t-test and a Chi-square test. Results: Both groups L and B were demographically comparable in terms of age, gender, and ASA grading. Group L achieved a significantly faster onset of sensory block (2.99±0.62 vs 4.23±0.83 min, p-value=0.001) and motor block (5.71±1.28 vs 6.43±1.08 min, p-value=0.001). Group B attained a higher sensory level (T6 vs T8, p-value=0.008) and showed longer duration of analgesia (157.3±14.3 vs 150.2±12.3 min; p-value=0.004). Motor regression was faster in group L (198.7±18.8 vs 207.2±14.4 min; p-value=0.006). Incidence of hypotension was significantly higher with bupivacaine (41.7% vs 13.3%; p-value=0.001). Heart Rate (HR) and Mean Arterial Pressure (MAP) trends were comparable between the groups. Conclusion: Compared to intrathecal hyperbaric bupivacaine, hyperbaric levobupivacaine offers faster onset, quicker motor recovery and better haemodynamic stability with reduced hypotension. Bupivacaine provides longer analgesia but at the cost of higher sympathetic blockade. Levobupivacaine was observed to be a safer alternative for lower limb orthopaedic surgeries.

Comparison of Cisatracurium and Atracurium on Intubating Conditions and Haemodynamic Responses during Laryngoscopy in Patients Undergoing General Anaesthesia: A Randomised Double-blind Clinical Study

Introduction: General anaesthesia is commonly facilitated by endotracheal intubation, for which Neuromuscular Blocking Agents (NMBA) are used to achieve optimal intubating conditions and haemodynamic stability. Atracurium and cisatracurium are benzylisoquinolinium neuromuscular blockers with distinct pharmacokinetic and pharmacodynamic profiles, which may influence intubation quality and cardiovascular responses. Aim: To compare Cisatracurium and Atracurium in patients requiring general anaesthesia and undergoing elective surgery with respect to intubating conditions and haemodynamic responses during laryngoscopy. Materials and Methods: This randomised double-blinded clinical study was conducted at the Department of Anaesthesiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India, from August 2023 to September 2024. A total of 74 American Society of Anaesthesiologists (ASA) physical status grade I-II patients scheduled for elective surgery under General Anaesthesia (GA) were enrolled and randomly assigned to two equal groups of 37 each. Participants in Group A received Atracurium 0.5 mg/kg intravenously, while those in Group C received Cisatracurium 0.2 mg/kg intravenously. Intubation conditions, cardiovascular stability, duration of action, and cost parameters were evaluated for both groups. Continuous variables were expressed as mean±SD and compared using an Independent t-tests or Mann-Whitney U test, while categorical variables were analysed using Chi-square or Fisher’s-exact tests. Results: The mean age of participants was 37.9 years, with group A averaging 37.9±10.9 years and group C averaging 38.0±12.2 years. Diastolic Blood Pressure (DBP) differed significantly between groups immediately after induction (70.51±14.49) and at 2 (69.68±16.53), 4 (82.00±17.41), and 6 (79.86±10.56) minutes (p<0.001). Mean Arterial Pressure (MAP) also showed significant variation at 2 minutes (70.32±8.07) and 4 minutes (83.86±16.61) (p-value <0.001), whereas Heart Rate (HR) and Oxygen Saturation (SpO2) remained comparable. Maintenance dose duration was shorter in Group A (38.3±7.5 min) than in Group C (64.9±20.8 min; p<0.001). Conclusion: Cisatracurium and atracurium are intermediate-acting muscle relaxants; however, cisatracurium releases less histamine, ensuring steadier haemodynamics. The present study inferred that cisatracurium offers favourable haemodynamics, superior intubating conditions, and longer duration of action, although it may be slightly expensive, suggesting that cisatracurium may offer clinical advantages in selected settings.

Clinicopathological and Immunohistochemical Profile of Neuroendocrine Neoplasm of Breast: A Cross-sectional Study

Pranjal Shah, Sunil Vitthalrao Jagtap

Introduction: Breast cancers exhibiting Neuroendocrine (NE) features are notably diverse, encompassing tumours resembling Neuroendocrine Tumours (NET) found elsewhere in the body, Invasive Breast Carcinomas of No Special Type (IBCNST), and other distinctive subtypes showing NE morphology or expressing NE markers. Aim: To study IBC in surgically excised specimen of breast. Materials and Methods: The present cross-sectional study was conducted in Department of Pathology of Krishna institute of Medical Sciences, Karad, Maharashtra, India for two years from May 2022 to April 2024. Total 160 cases of breast carcinoma from modified radical mastectomy or lumpectomy were studied. The tissues were stained using Haematoxylin and Eosin (H&E) staining, and Immunohistochemistry (IHC) for Synaptophysin and Chromogranin A was performed.The parameters studied during the study include patient’s age, duration, laterality of the breast lump, side, location in breast quadrant, size of the tumour, skin changes, lymph node status, BIRADS score, histopathological impression, histological grading, Estrogen Receptor(ER)/Progesterone Receptor (PR)/Her2Neu status, synaptophysin and chromogranin results. Results: A total of 160 cases of IBC were studied, out of which 32 cases showed NE morphology on histology. Of these, 22 cases were positive for the NE markers synaptophysin and chromogranin A. Possible reasons for this are discussed in the discussion section. The mean age of patients with NETs was 54.57 years. Among the 22 positive cases, seven were positive for both markers, 16 were positive for synaptophysin, and 13 were positive for chromogranin A. Based on the histological subtypes of the 22 cases studied two cases were classified as Neuroendocrine Carcinoma (NEC) (showing >90% NE features) 15 cases were diagnosed as mixed IBC with NE differentiation (10-90% NE features), and five cases were IBC with focal NE features (<10% NE features). Conclusion: Primary Neuroendocrine Neoplasms (NEN) of the breast are rare and distinct subtype of IBC, characterised by specific histopathological features and NE markers. Accurate diagnosis requires a combination of morphological evaluation and immunohistochemical staining, particularly for markers such as Synaptophysin and Chromogranin A. Understanding its clinicopathological and immunohistochemical profile is essential for appropriate classification, prognostication, and management.

Development and Validation of a Questionnaire to Assess Clinicians’ Preferences for Flexible Dentures: A Cross-sectional Study

Introduction: The 1950’s saw the introduction of thermoplastic resin dentures, frequently referred to as flexible dentures. Nevertheless, up to this point, methyl methacrylate has been the most widely utilised denture base material. A number of denture-base materials made of thermoplastic resin that have higher physical properties and better clinical performance have been available since 2007. In addition to being more aesthetically pleasing than cast partial dentures, these materials are also more economical. Flexible dentures are becoming more and more popular among dentists and dental technicians, despite the fact that thermoplastic resin partial dentures are typically not covered in depth in the dental school undergraduate course curriculum. Aim: To develop and validate a questionnaire to assess the preferences of clinicians regarding the use of thermoplastic resin made removable dentures over conventional dentures to rehabilitate partially edentulous patients. Materials and Methods: In this cross-sectional study, conducted in the Department of Prosthodontics and Crown and Bridge, in Guru Nanak Institute of Dental Sciences and Research, Kolkata, private dental College and Hospital, West Bengal, India from January 2024 to September 2024, the initial draft questionnaire was constructed from the earlier studies available through literature review. The draft questionnaires were evaluated for three rounds by a committee of eight subject matter experts. The final questionnaire contains 12 items, assigned to one of the three domains. The validity, reliability and repeatability of the questionnaire were assessed thereafter. Results: Content validity was estimated by Content Validity Index (CVI) and Cronbach’s alpha was used to assess internal consistency. Scale level CVI/ average (S-CVI/Ave) and Scale level CVI based on Universal Agreement (S-CVI/UA) S-CVI/Ave and S-CVI/UA of the final questionnaire was estimated 0.97 and 0.75. Minimum Item-CVI (I-CVI) of all the items was more than 0.88. To assess reliability, responses from 120 participants (1:10 item-participants ratio) were considered. The calculated Cronbach’s alpha was 0.7708. There was no significant difference between average domain scores and overall scores of two sets of responses given by a same cluster of participants at an interval of 30 days. Conclusion: The developed questionnaire was a validated reliable tool, which can be employed for a larger population. Clinician’s preference can be calculated from domain scores (clinician’s preference=positive concerns+applicability- negative concerns) and its range is from -20 to +28.

Comparative Evaluation of Antifungal Efficacy of Ozonated Water Against Candida albicans in Heat Cure Acrylic Resin: An In-vitro Study

Introduction: Ozonated water has been therapeutically used in different fields of Dentistry. Ozone usage has become more extensive because of its antimicrobial action, especially against Candida albicans. The anticandidal efficacy of ozonated water generated by commercially available portable machines that are used commonly in household is not investigated. The purpose of the study was to evaluate the effectiveness of ozonated water as a denture cleanser generated by portable ozonator which is easily accessible and affordable to patient. Aim: To evaluate the effect of ozonated water on Candida albicans adhered to heat cure acrylic resin at different time intervals. Materials and Methods: The present in-vitro comparative study was conducted in Central Research Laboratory, Maratha Mandal’s Nathajirao G Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India from January to June 2017. A total of 120 (N=12 in each group) heat cure acrylic resin disc specimens were inoculated with Candida albicans American Type Culture Collection (ATCC) 2091 for 24 hours and were subjected to flowing (Group A), immersion (Group B), and ultrasonication (Group C), in 0.5 mg/L ozonated water and commercially available denture cleanser (Efferdent- Group D) for different time intervals. Distilled water and 50 mg of nystatin 1:20 dilution (Group E) was used as negative and positive control, respectively. The Colony Forming Units (CFU) of Candida albicans of each group were evaluated under Scanning Electron Microscopy (SEM). Data were analysed by One-way ANOVA and Post-hoc Bonferroni test and the p-value <0.05 was considered as statistically significant. Results: One-way ANOVA test showed that there was a significant difference with a p-value <0.001 between the groups overall. The antifungal effect of ozonated water at a concentration of 0.5 mg/L for 15 minutes immersion showed the maximum reduction of microbial counts of Candida albicans with mean value of CFU 5.26±1.62 whereas flowing ozonated water for one minute revealed the least reduction of CFU showing the mean score of 29.65±4.16 when compared to all the other groups. Post-hoc Bonferroni test showed significant differences in mean CFU counts were found with respect to various groups (p<0.001). Conclusion: Ozone is found to be a potent denture cleanser. Ozonated water shows better antifungal activity against Candida albicans in heat cure acrylic resin than commercially available denture cleanser. Ozonated water could be used in denture cleaning protocol effectively in candidiasis patients at lower concentrations.

Assessment of Glycaemic Control and its Association with Quality of Life in Patients of Diabetes Mellitus: A Cross-sectional Study

Mohammad Junaid Pasha, Priyank Rastogi

Introduction: Incidence of Diabetes Mellitus (DM) is rising in India. Uncontrolled diabetes is a harbinger of potential life-threatening complications. In recent years, focus has shifted to achieving adequate glycaemic control in order to prevent the complications of Diabetes. Adequate glycaemic control significantly reduces diabetes-related complications. Good glycaemic control should therefore lead to better Quality of Life (QoL) in Diabetes patients. Aim: To assess whether glycaemic control has any relationship with QoL as assessed by the World Health Organisation (WHO) Quality of Life Brief Version (WHOQoL-BREF) Questionnaire. Materials and Methods: This cross-sectional study was conducted at the Department of Medicine, ESI Postgraduate Institute of Medical Sciences and Research, Basaidarapur, New Delhi, India, from July 2022 to December 2023, in which 140 subjects satisfying inclusion and exclusion criteria were recruited. Patients were subjected to Serum HbA1c estimation and based on HbA1c values, the subjects were divided into good glycaemic control group (satisfying ADA glycaemic goal of HbA1c <7%, n=55) and poor glycaemic control group (not satisfying ADA glycaemic goal and HbA1c ≥7%, n=85). The patients were then administered QoL questionnaire devised by WHOQoL-BREF evaluating four key domains of life i.e., physical, psychological, social relationships and environmental and the QoL scores for each domain were calculated for each patient. Thereafter, the QoL scores in all four domains of both good and poor glycaemic control were compared and correlation was assessed using Pearson’s correlation coefficient. Results: A total of 140 patients were enrolled in the study with a mean age of 55.32±5.9 years. The proportion of male patients was slightly less as compared to female patients of Diabetes Mellitus (46.4% vis a vis 53.6%). The QoL of good glycaemic control group was significantly higher in all four domains viz., p-values was <0.001 for physical, and for psychological, social and environmental domain it was p-value ≤0.001 as compared to the poor glycaemic control group. QoL scores in all four domains showed a statistically significant negative correlation with HbA1c (all p-value<0.05), with correlation coefficients ranging from -0.181 to -0.417. Conclusion: In the present study, majority of the diabetic patients had poorly controlled diabetes. The level of glycaemic control has a weak to moderate negative correlation with QoL and good glycaemic control is associated with better QoL as compared to poor glycaemic control group.

Prevalence of Posterior Condylar Canal in Adult Human Skulls of the Indian Population: A Cross-sectional Study

Introduction: The Posterior Condylar Canal (PCC) is the largest emissary foramen that transmits the Posterior Condylar Vein (PCV). Emissary veins connect extracranial veins with intracranial veins. This anatomical channel also provides a potential route for the spread of infection. Aim: To determine the prevalence of the PCC in adult human skulls. Materials and Methods: A descriptive, cross-sectional osteological study was conducted in the Department of Anatomy, MS Ramaiah Medical College, Bengaluru, Karnataka, India from March 2020 to March 2022. A total of 150 dry adult skulls of Indian origin, with unknown age and gender were collected from the medical and dental students. Fully ossified skulls with intact occipital bone and preserved condylar region were included in the study. The base of skulls was observed for the presence and absence of PCC on both sides. The laterality of the PCC (unilateral or bilateral) was also noted. The presence and absence of the posterior condylar foramen were recorded in percentage. Chi-square test was used to compare the presence and absence of PCC between the right and left sides using Statistical Package for Social Sciences (SPSS) software version 22.0. Results: The PCC was present in 201/300 (67%), out of which 98 (65.3%) were present on the left side and 103 (68.7%) were on the right side. The presence of PCC on the right and left was compared using the Chi-square test, which was not statistically significant; the p-value was 0.539. Out of 201 posterior condylar foramina, 165 (82.1%) were patent. The patent foramen openings were of two types: intrasinus type 102 (61.8%) and retrosinus openings 63 (38.2%). Conclusion: Detailed analysis of PCC will help in the planning of surgical intervention involving the skull base. This study will be useful for the anatomist, neurosurgeons and radiologists.

HER2/neu Expression in Endometrial Carcinoma: A Cross-sectional Study on Immunohistochemical Positivity and Tumour Grade

G Sreelekshmi, S Lesitha, M Surekha Vijayan, Anjit Unni

Introduction: Endometrial carcinoma is the most common invasive cancer of the female genital tract. Serous carcinoma of endometrium is highly aggressive and has a predilection for deep myometrial and lymphovascular invasion, peritoneal and distant metastatic spread. HER2/neu is an important prognostic protein in high-grade and higher-stage endometrial serous carcinomas Aim: To study the expression of HER2/neu in relation to tumour grade in endometrial carcinoma. Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Government medical college, Thrissur, Kerala, India, over a period of 18 months from 1st January 2018 to 30th June 2019. A total of 63 cases of both hysterectomy specimens and endometrial biopsies whose histopathologic diagnosis was endometrial adenocarcinoma were included. Four micrometer thick sections were obtained for Haematoxylin and Eosin (H&E) and immunohistochemical staining with rabbit monoclonal HER2 antibody following antigen retrieval was done. H&E staining was done to assess the tumour grade. HER2/neu staining was evaluated using regular light microscope at the magnification of 40x. The Immunohistochemistry (IHC) score was determined by evaluating subcellular localisation, circumferential versus incomplete staining, intensity and the percentage of cells positive. Intensity of HER2 expression was graded according to the 2014 American Society of Clinical Oncology/College of American Pathologist (ASCO/CAP) guidelines for HER2 reporting. Data thus obtained was analysed using software Statistical Package for Social Sciences (SPSS) version 20.0. The statistical test used is the Fisher’s-exact test and p-value<0.05 was considered statistically significant. Results: Most of the patients were in the age group of 51-60 years (23 out of 63 patients, 36.50%). Among the 63 patients seven were nulliparous and 56 were post menopausal women. Most of the patients presented with complaints of post menopausal bleeding which was noted in 85.71% of patients (54 out of 63). More than half of myometrial invasion was noted in 33 cases of hysterectomy specimens. HER2 positivity (score 2 and score 3) was observed in 7 (11.11%) cases. None of the grade 1 endometrial carcinoma showed HER2 positivity. Grade 2 endometrial carcinoma showed HER2 positivity in 1 (6.67%) case. Grade 3 tumours showed HER2 positivity in 6 (28.57%) cases. Compared to grade 1 and grade 2 endometrial carcinoma, grade 3 endometrial carcinoma showed increased HER2 expresssion. A statisticaly significant association between HER2 expression and tumour grade was obtained (p-value=0.004). Conclusion: As tumour grade in endometrial adenocarcinoma increases expression of HER2/neu also increases. A statistically significant association between HER2 expression and tumour grade was obtained (p-value=0.004). The study suggests that endometrial carcinoma shows HER2/neu expression in significant proportion of cases and its expression is more in high-grade endometrial carcinoma. Patients with HER2/neu positive endometrial carcinoma may benefit from adjuvant HER2/neu targeted therapies like trastuzumab. Further clinical studies are necessary to establish the prognostic and therapeutic significance of HER2/neu in endometrial adenocarcinoma.

Efficacy and Safety of Ormeloxifene in the Medical Management of Abnormal Uterine Bleeding: A Prospective Cohort Study

Introduction: Abnormal Uterine Bleeding (AUB) is a frequent cause of morbidity in women, significantly impacting quality of life through heavy menstrual bleeding and anaemia. Ormeloxifene, a selective oestrogen receptor modulator, is increasingly adopted as a medical management option for AUB in India. Aim: To evaluate the efficacy and safety of ormeloxifene in women with AUB attending a tertiary care hospital in North India. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at the Government Medical College and Hospital, Chandigarh, India, from September 2018 to September 2019. A total of 59 women meeting the inclusion criteria were enrolled in the study. All participants initiated ormeloxifene therapy. During the treatment and follow-up period, three women discontinued the study. Therefore, 56 women completed the full six-month course of therapy and were included in the final efficacy and safety analyses. Patients received ormeloxifene 60 mg biweekly for 12 weeks, followed by 30 mg biweekly for another 12 weeks. The primary outcome was reduction in menstrual blood loss, measured by the Pictorial Blood Loss Assessment Chart (PBAC). Secondary outcomes included change in haemoglobin and adverse effects. Data were analysed using Statistical Package for Social Sciences (SPSS) version 22.0, with significance set at p<0.05. Results: The mean baseline PBAC score was 332.9 (range, 180-498), which decreased significantly after treatment (p<0.001). Mean haemoglobin increased from 9.44±1.6 g/dL to 12.22±1.3 g/dL (p<0.001). At six months post-treatment, 28.2% (13/47) of women, all perimenopausal, maintained amenorrhoea. The overall success rate at the end of therapy was 82.1%. Treatment failure occurred in 12.5% (7/56), primarily in those with anovulatory AUB, all of whom underwent hysterectomy. Adverse effects were mild and self-limited; no serious adverse events were reported. Conclusion: Ormeloxifene is an effective and well-tolerated treatment for AUB, resulting in significant reductions in menstrual blood loss and improvements in haemoglobin levels, with minimal side-effects.

Barriers to Healthcare Utilisation and Navigational Strategies among Transgender Communities in Manipur, India: A Qualitative Study

Introduction: Transgender individuals face significant healthcare barriers despite legal recognition. Discrimination, stigma, and lack of supportive healthcare infrastructure contribute to poor health outcomes. Aim: To explore health-seeking behaviours and barriers to healthcare access among transgender individuals in Imphal, Manipur, India. Materials and Methods: A community-based phenomenological, qualitative study was conducted in Imphal, Manipur, India, from April 2025 to July 2025. Nine in-depth interviews were carried out with five transgender women and four transgender men, recruited through snowball sampling until data saturation was reached. Interviews were conducted in Manipuri, audio-recorded, transcribed, translated, and analysed thematically, with support from field notes. Results: Participants frequently delayed healthcare because of financial constraints and anticipated stigma, and preferred transgender-specific services over government or private facilities. Key barriers included misgendering, verbal harassment, denial of care, and limited access to hormone therapy. A lack of knowledgeable healthcare providers further hindered care-seeking. Conclusion: The findings highlight the critical importance of transgender-specific health centres and trained, sensitive healthcare providers. Improving healthcare equity may require inclusive practices and empathetic care to ensure respectful, comprehensive services and improve the health and well-being of transgender individuals.

Effect of Strain Counter-strain Technique versus Conventional Physiotherapy on Acute Non-specific Neck Pain and Disability among College Amateurs: A Randomised Controlled Trial

Introduction: Non-specific neck pain frequently presents in conjunction with Myofascial trigger points (MTrPs) in the upper trapezius muscle. The Strain Counter-Strain (SCS) technique is a widely recognised method for the treatment of MTrPs. Additionally, modalities such as hot packs, therapeutic ultrasound, and Transcutaneous Electrical Nerve Stimulation (TENS) have demonstrated efficacy in the management of Upper Trapezius Myofascial Pain Syndrome (UTMPS). However, there is a paucity of literature directly comparing the SCS technique with conventional physiotherapy within the same clinical trial, particularly for the treatment of acute neck pain in athletic populations. Aim: The present study aimed to compare the effectiveness of the strain counter-strain technique and conventional physiotherapy in reducing upper trapezius muscle tenderness among college amateur athletes. Materials and Methods: A single-blinded randomised controlled trial was conducted in the Department of Physiotherapy at NIMS University, Jaipur, India, from September 2024 to March 2025. A total of 66 patients with trigger points in the upper trapezius muscle were recruited and randomly allocated into two groups. Group I (n=33; males=17, females=16) received the strain counter-strain technique applied to the upper trapezius muscle, while Group II (n=33; males=15, females=18) received conventional physiotherapy. All participants were evaluated at baseline using the Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI). Statistical analysis was performed using paired and unpaired t-tests, with a p-value of <0.05 considered statistically significant. Results: The SCS technique was significantly more effective than conventional physiotherapy in reducing pain and disability. Statistically significant improvements were observed in NPRS scores (p-value <0.0035) and NDI scores (p-value <0.0486). Conclusion: The SCS technique demonstrated significantly greater efficacy in alleviating pain and reducing disability compared with conventional physiotherapy in individuals with acute non-specific neck pain, particularly those experiencing tenderness in the upper trapezius region. This innovative approach appears to be a valuable therapeutic option for the management of neck pain, offering improved pain relief and functional outcomes.

An Experience of Modified Electroconvulsive Therapy at a Tertiary Care Hospital in Puducherry, India: A Retrospective Study

Sujaritha Venkatraman, Melody Munusamy Annamalai, John Alexander Dinesh

Introduction: Electroconvulsive Therapy (ECT) originated as a form of biological/neuro modulatory treatment for psychiatric disorders. In recent decades, its use is declining despite evidence-based international guidelines, but on the contrary, there has been an increase in research on ECT. Aim: To explore the sociodemographic profile, clinical profile, ECT parameters, side-effects and outcomes of modified ECT among patients who received ECT over the past six years (2019-2025). Materials and Methods: This retrospective study was conducted in Department of Psychiatry, Aarupadai Veedu Medical College and Hospital (AVMCH), Vinayaka Mission’s Research Foundation (VMRF-DU), Puducherry, India in March 2025 to September 2025. The medical records were obtained for 71 patients who received ECT in the last six years (May 1st, 2019-May 31st, 2025). The data were collected using a semi-structured proforma for sociodemographic details, clinical profile, ECT parameters and the clinical response. The data was entered in MS Excel 365 and statistical analysis was done using mean and standard deviation for continuous variables, percentage and frequency for categorical variables. Results: A total of 64 records were included out of 71. The most common ICD 10 diagnosis of subjects who received ECT was bipolar affective disorder- 21 (32.8%), followed by Schizophrenia- 19 (29.6%). The most common indication for ECT, irrespective of diagnosis was irritability/aggression/violence- 19 (29.7%). The clinical response of the subjects who received ECT were improved in 43 (67.2%), partially improved in 15 (23.4%) and not improved in 6 (9.4%). Conclusion: In the present study, no major life-threatening complications was found with minimal and manageable side-effects following modified ECT. ECT was indicated predominantly for mood disorders followed by psychotic disorders, especially, for those patients with irritability/aggression.

Effectiveness of Manual Therapy in Patients with Obstructive Airway Disorders: A Scoping Review

Dinkey A Mankad, Tejas R Chokshi, Kalpesh Satani

Introduction: Obstructive Airway Disorders (OAD) refer to a group of conditions that cause airflow limitation within the lungs, including chronic bronchitis, emphysema, asthma, and other related disorders. Manual Therapy (MT) has been suggested as a component of pulmonary rehabilitation programs for patients with OAD. MT may improve mobility in the thoracic region, thereby reducing the effort required for breathing by enhancing oxygen delivery and lymphatic circulation. Common MT techniques include massage, Myofascial Release (MFR), muscle energy techniques, ligament balancing, joint mobilisation, and manipulation. Aim: To review the effectiveness of MT interventions, either alone or in combination with exercise, on lung function, exercise capacity, and quality of life in patients with OAD. Materials and Methods: In the present scoping review, in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a literature search was conducted across MEDLINE, EMBASE (Excerpta Medica Database), PEDro (Physiotherapy Evidence Database), and the Cochrane Central Register of Controlled Trials databases using the terms OAD, Chronic Obstructive Pulmonary Disease (COPD), MT, joint mobilisation, and osteopathic manipulation. Searches included all relevant studies available from 2005 to May 2024. The primary outcomes were lung function and exercise capacity, while secondary outcomes included symptoms, Quality of Life (QoL), and adverse events. Results: Of the 1,400 articles screened, 10 met the inclusion criteria and were included in the review. A total of 441 participants were analysed, with ages ranging from 18 to 65 years. Interventions included Osteopathic Manipulative Therapy (OMT), massage, manual soft-tissue release, diaphragmatic release, and MFR. The mean age of participants was 38 years. The duration of rehabilitation ranged from 2 to 10 weeks. Various MT interventions-including soft-tissue release, MFR, Chuna therapy, joint mobilisation, and manual diaphragm release-when combined with conventional physiotherapy, resulted in significant improvements in pulmonary function parameters (Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) across different patient populations. Conclusion: MT techniques improve QoL, lung function, exercise capacity, and respiratory symptoms, and reduce adverse events. Therefore, MT can be used as an adjunctive treatment modality in patients with OAD.

Prevalence of Medication Errors in the Medicine Department of a Tertiary Care Teaching Hospital: A Cross-sectional Study

Pritama Paul, Abhishek Bhattacharjee, Uttam Kumar Paul, Nikhil Era

Introduction: Medication Errors (ME) pose a major global threat to patient safety, causing adverse drug effects, increased morbidity and mortality, and higher healthcare costs while eroding patient trust. In the Medicine Department of a tertiary care teaching hospital in Eastern India, the prevalence of MEs lacks comprehensive documentation, thereby hindering targeted interventions. Aim: To evaluate the prevalence and characteristics of MEs within the Medicine Department of a tertiary care teaching hospital. Materials and Methods: This Institution-based cross-sectional observational study was conducted in the Departments of General Medicine and Pharmacology of a tertiary care teaching hospital of MGM Medical College and LSK Hospital, Kishanganj, Bihar, India, from March 2024 to February 2025. Data from 3,056 patient cases were collected through direct observation, covering prescribing, administration, transcription, and dispensing errors. Severity was classified using the National Coordinating Council for ME Reporting and Prevention’s (NCCMERP) Index. Data were analysed using descriptive statistics and subgroup analyses with SPSS version 21.0 and Microsoft Excel, with p<0.05 considered statistically significant. Results: Overall ME prevalence was 9.26% (283/3,056 cases), highest in the 51-60 years age group (31.8%). Prescribing errors dominated 131 cases (46.3%), followed by administration 63 (22.3%), transcription (50, 17.7%), and dispensation (38, 13.6%) errors- all highly significant (p<0.001). Key prescribing factors: error-prone abbreviations (14%) and illegible handwriting (12%). Most errors 164 cases, (58%) were categorised as “Error, No Harm” (Categories B–D) according to the NCC MERP index. Antibiotics (15%), Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (12%),and multivitamins (11%) were most frequently associated with medication errors. Conclusion: Prescription errors are prevalent in this setting, especially among middle-aged patients. Targeted interventions- improving prescription legibility, abbreviation use, transcription, and administration- are crucial. Collaborative efforts focusing on antibiotics and analgesics will enhance safety and reduce adverse outcomes.

CDK4 Expression in Invasive Ductal Carcinoma of the Breast and its Association with Prognostic Parameters: A Cross-sectional Study

Manju Alex, Kalyani Raju, GN Manjunath

Introduction: Breast cancer is a growing public health concern in India, often diagnosed at advanced stages, leading to poor outcomes. Identifying effective biomarkers is crucial. Cyclin-Dependent Kinase (CDK)4, a key regulator of the cell cycle, is frequently overexpressed in breast cancer, promoting tumour growth and emerging as a potential therapeutic target. Aim: To determine the expression of CDK4 marker in Invasive Ductal Carcinoma (IDC) of the breast and its association with prognostic parameters. Materials and Methods: The present cross-sectional analytical study utilised retrospective data from Sri Devaraj Urs Medical College, Kolar, Karnataka, India, utilising data spanning from January 2018 to December 2021.The study period extended over 18 months, from April 2023 to October 2024. Ninety histologically confirmed IDC breast cases were analysed, excluding recurrent cases, chemotherapy/radiotherapy-treated cases, improperly fixed specimens, male breast carcinomas and secondary metastases. Immunohistochemical analysis of CDK4 was conducted, evaluating nuclear and cytoplasmic staining separately and its association with prognostic parameters as size, grade, stage of tumour, metastatic lymphnodes, lymphovascular invasion, tumour infiltrating lymphocytes and expression of ER, PR, Her2/Neu, Ki67 in IDC breast was done. All data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) 22 version software. Categorical variables were presented as percentages. Associations between CDK4 expression and clinicopathological factors were tested using Chi-square test. A p-value <0.05 was considered statistically significant. Results: The study included 90 IDC cases, mean age was 52.5 years. CDK4 showed cytoplasmic positivity in 63.3% (n=57) and nuclear positivity in 47.8% (n=43). Nuclear CDK4 positivity showed significant association with HER2/Neu positivity (p=0.004), advanced stage (p<0.001), larger tumours (T3/T4) (p<0.001), presence of LVI (p=0.022), poor prognosis (p<0.001), and higher tumour grade (p<0.001). Cytoplasmic CDK4 expression showed no significant association with prognostic parameters. Conclusion: As per the present study findings nuclear CDK4 expression significantly associated with aggressive tumour characteristics and worse prognosis in breast IDC, highlighting its potential as a prognostic biomarker and therapeutic target. Cytoplasmic CDK4 expression, though frequent, had limited prognostic utility. The findings emphasize the biological importance of subcellular localisation of CDK4 in breast cancer.

Evaluation of Safety and Efficacy of AMBU^® AuraOnce™ Laryngeal Mask Airway in Supine and Trendelenburg Position in Patients undergoing Perianal Surgeries: A Prospective Observational Study

Dharitri Dutta, Chetan Mehra, Vikram Mahajan, Vijay Shankar

Introduction: Oropharyngeal Leak Pressure (OLP) is a crucial marker for assessing the safety and efficacy of airway devices. Positional changes during surgeries may influence airway dynamics and require objective assessment. Aim: To compare the changes in OLP using the AMBU® AuraOnce™ Laryngeal Mask Airway (LMA) in patients undergoing perianal surgeries in supine and Trendelenburg positions. Materials and Methods: This prospective observational study was conducted among 35 adult patients undergoing elective perianal surgeries between March 2023 and February 2024, Department of Anaesthesiology, Indraprastha Apollo Hospital, New Delhi, India. The OLP, intracuff pressure, ETCO2, heart rate, mean arterial pressure, and SpO2 were measured during surgeries under general anaesthesia with AMBU® AuraOnce™ LMA, which required both supine and Trendelenburg positions. Data were analysed using a paired t-test for continuous variables and Chi-square for categorical variables, with p-value <0.05 considered statistically significant. Results: The mean age and Body Mass Index (BMI) were 47.14±12.87 years and 27.37±4.5 kg/m2. A total of 21 male and 14 female patients were assessed. The mean OLPs of patients in the supine and Trendelenburg positions after LMA insertion were 20.17±1.32 cmH2O and 20.40±1.12 cmH2O, respectively; however, the mean OLP difference in both positions was not statistically significant (p-value >0.05). The mean arterial pressure, End-Tidal Carbon Dioxide (ETCO2), and Peripheral oxygen saturation (SpO2) in supine and Trendelenburg positions were 87.7±16.36 mmHg and 90.23±7.28 mmHg, 31.66±3.18 mmHg and 31.63±3.45 mmHg, 99.6±0.60% and 98.97±0.70%, respectively. Conclusion: The AMBU® AuraOnce™ LMA can maintain a stable OLP, ventilation parameters, and haemodynamic profile, when the patient requires a change in position from supine to Trendelenburg position during perianal surgeries.

Impact of Staging Laparoscopy on Treatment Intent in Non Metastatic Gastric Cancer: A Cross-sectional Study

Introduction: Stomach cancer remains a leading cause of cancer-related mortality worldwide, with a poor prognosis primarily due to late-stage diagnosis. Despite advances in imaging modalities, the sensitivity in detecting peritoneal metastases is limited. Diagnostic Laparoscopy/Staging Laparoscopy (SL) is a minimally invasive tool that enables direct visualisation of intra-abdominal disease, thereby improving staging accuracy and guiding treatment decisions. Aim: To determine the proportion of patients with imaging-diagnosed non metastatic, resectable Gastric Cancer (GC) in whom SL alters the intended treatment plan. Materials and Methods: This retrospective cross-sectional observational study was conducted in the Departments of Surgical Oncology and Surgical Gastroenterology at Government Medical College, Kottayam, Kerala, India, from February 1, 2019, to February 28, 2025. Data were analysed in March 2025. The study was designed as a surgical audit to assess the utility of staging laparoscopy (SL) in patients with biopsy-proven, resectable gastric cancer without evidence of metastasis on imaging. Register-based data were collected regarding SL findings and any modifications made to the treatment plan based on the SL results. Data were analysed using descriptive statistics and the Chi-square test for associations; results were presented as frequencies, percentages, means±Standard Deviation (SD), Odds Ratios (OR), and p-values. Results: The mean age of the study participants was 59±9.76 years. Occult metastases were identified in 11 patients (40.7%); positive peritoneal cytology was present in 12 patients (44.4%). The presence of ascites was significantly associated with positive cytology (p=0.014), with an OR of 8. Furthermore, peritoneal deposits were present in 83.3% of cytology-positive cases, reinforcing the prognostic significance of SL. As a result, curative intent surgery was avoided in 11 (40.7%) of patients, redirecting them to palliative chemotherapy. No major complications were observed, and the mean hospital stay was one day. Conclusion: Gastric cancer has a propensity for early peritoneal dissemination that may be missed on routine imaging. Therefore, patients planned for curative-intent therapy should undergo diagnostic laparoscopy to detect occult peritoneal disease that may alter treatment intent. The present study highlights that a significant number of patients experience a change in their treatment plans when SL is performed at the start of treatment.

Effect of Ramadan Fasting on Visual and Auditory Reaction Time in Malaysian Medical Students Studying in India: A Prospective Observational Study

Introduction: Ramadan fasting, a significant religious practice, is associated with physiological and circadian alterations that may affect neurocognitive function, particularly reaction time, an objective marker of sensory-motor processing speed and alertness. Reaction time is especially relevant in medical students, who require sustained mental alertness and efficiency. Despite its importance, there is limited and inconsistent evidence on how Ramadan fasting affects reaction time in healthy Southeast Asian medical students. Aim: To assess the impact of Ramadan fasting on visual and auditory reaction times among healthy Malaysian medical students studying in India. Materials and Methods: This prospective observational study was conducted in the Department of Physiology at USM-KLE International Medical Programme, Jawaharlal Nehru Medical College (JNMC) Campus, Belagavi, Karnataka, India, from February 2025 to March 2025. A total of 104 apparently healthy Malaysian medical students aged 18-25 years who were observing Ramadan fasting were included. Visual (green and red light) and auditory (tone and click) reaction times were measured using a standardised reaction time apparatus one week before Ramadan and during the fourth week of fasting to assess cumulative physiological and circadian effects of sustained fasting on reaction time. Data were analysed using the Wilcoxon signed-rank test and Mann-Whitney U test via Statistical Packages of Social Sciences (SPSS) version 23.0, with p<0.05 considered statistically significant. Results: The study included 40 males and 64 females with mean age 21.47±1.66 years. In male participants, both visual and auditory reaction times were significantly prolonged during the fasting period compared to the prefasting phase (p<0.001 for all parameters). Similarly, female participants also demonstrated a statistically highly significant increase in both visual and auditory reaction times during fasting compared to prefasting values (p<0.001 for all parameters). However, no significant gender differences in visual or auditory reaction times were observed during the fasting period. Conclusion: Ramadan fasting is associated with a significant delay in visual and auditory reaction times in both genders, indicating transient cognitive slowing in healthy young adults. These findings highlight the neurocognitive implications of Ramadan fasting, particularly in tasks requiring rapid visual and auditory responses.

Evaluating the Effectiveness of Dhava-Aswakarnadi Medicated Water in Reducing Pesticide Residues on Cauliflower: An Experimental Study

Krup S Vasavda, Rekha Parmar, Ravi Kalsariya, Hemant Toshikhane

Introduction: Health is a pressing concern, and the serious effects of chemical exposures cannot be ignored. Previous studies have reported the harmful effects of pesticide residues on vegetables and human health. Ayurveda, with its well-established purification methods, emerges as a potential solution for contaminated produce. Aim: To evaluate the effectiveness of medicated vegetable wash (Dhava-Aswakarnadi Yoga water) in reducing pesticide residues on cauliflower (Brassica oleracea) in comparison to standard washing practices. Materials and Methods: This experimental comparative study was conducted at the All India Network Project on Pesticide Residues, ICAR Unit-9, Anand Agricultural University, Anand, Gujarat, India, from January 2025 to April 2025. The study focused on four widely used pesticides: Acetamiprid, Azoxystrobin, Prefenofos, and Indoxacarb. Succulent cauliflower (Brassica oleracea) was selected as the test vegetable and exposed to the chosen pesticides. Each cauliflower was then divided into three samples (tap water, boiled water, and medicated water) for comparison with a control sample, and different washing methods were evaluated. Analysis of 48 samples was carried out using advanced Gas Chromatography–Mass Spectrometry (GC-MS/MS) at the All India Network Project on Pesticide Residues, ICAR Unit-9, Anand Agricultural University, Anand, Gujarat. One-way Analysis of Variance (ANOVA) was employed to assess the effects of three different water washes on pesticide levels in relation to the control group. A p-value≤0.05 was deemed statistically significant. Results: The treatment with Dhava-Aswakarnadi modified medicated water resulted in the lowest pesticide residue levels across all tested compounds (p-value ≤0.001). Conclusion: Traditional processing methods play a useful role in reducing harmful pesticide residues, such as Acetamiprid, Azoxystrobin, Prefenofos, and Indoxacarb, which pose serious health risks when consumed regularly. GC-MS/MS analysis demonstrated that medicated water is an effective washing method. It is essential to raise awareness about this method and encourage the adoption of traditional vegetable-washing practices.

Evaluating the Efficacy of Vamana Karma with Shatapushpa Churna in Polycystic Ovarian Syndrome: A Quasi-experimental Study

Vaishali Dave, Rita Makkim, SN Gupta, Hemant Toshikane

Introduction: Polycystic Ovarian Syndrome (PCOS) is clinically characterised by irregular menstruation, obesity, and the presence of ovarian cysts. In Ayurvedic literature, this condition is described as Vyadhi Sa?kara, denoting a complex disorder arising from the overlap of multiple disease entities. Contemporary management in modern medicine primarily relies on the use of oral contraceptive pills; however, these agents are frequently associated with adverse effects, underscoring the need for safer and more holistic therapeutic approaches. Aim: To evaluate the therapeutic effectiveness of Vamana Karma with oral administration of Shatapushpa Churna in the management of PCOS. Materials and Methods: The present quasi-experimental study was conducted at PD Patel Ayurveda Hospital, Kheda, Gujarat, India. between January 2023 and September 2024, enrolling 68 patients with PCOS. The diagnosis was established through a combination of clinical history, physical examination, laboratory investigations, and radiological imaging. The intervention comprised Vamana Karma (therapeutic emesis) with a 7-day preparatory and post-treatment regimen, followed by oral administration of Shatapushpa Churna (dill seed powder) at a dose of 3 g twice daily for 54 days. Treatment outcomes were evaluated using symptom relief, pelvic ultrasonography, and Body Mass Index (BMI), with statistical analysis performed using the Wilcoxon Signed-rank Test. A p<0.05 was considered statistically significant. Results: A total of 68 patients were enrolled in the study, of whom 60 completed the treatment. Among the total participants, 49 (82%) participants were aged 20-30 years, predominantly urban 58 (97%), 55 (92%) Hindu, 42 (70%) unmarried, and 37 (62%) from the upper middle class. Post-intervention, significant improvements in menstrual cycle regularity (p<0.001) reduction in ovarian volume (p<0.001), and BMI (p<0.001). No Serious Adverse Events (SAE) were reported. Conclusion: The combination of Vamana Panchakarma (Therapeutic emesis) therapy and the vata-kapha balancing properties of Shatapushpa Churna (dill seed powder) shows promising results in the management of PCOS. These findings highlight the potential role of Ayurvedic interventions in addressing this multifactorial condition. Larger, long-term studies are warranted to validate these outcomes and assess broader clinical applicability.

Efficacy of Aceclofenac and Ibuprofen in Controlling Pain and Swelling Following Periodontal Surgery: A Prospective Interventional Study

Introduction: Postoperative pain and swelling are common sequelae of major periodontal surgery, including mucogingival surgeries and flap surgeries. In the first 24 hours after the procedure, pain is typically at its highest. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) have emerged as a mainstream and effective option for alleviating pain and swelling. Aim: To compare and evaluate the effectiveness of two medications, aceclofenac and ibuprofen, in the management of pain and swelling after periodontal surgery. Materials and Methods: A prospective interventional study was conducted in the outpatient Department of Periodontology of Vidarbha Youth Welfare Society (VYWS) Dental College, Amravati, Maharashtra, India. A total of 76 patients undergoing periodontal surgery were enrolled. They were randomly divided into two groups: Group-A received 400 mg ibuprofen and Group-B received 100 mg aceclofenac tablets. Pain intensity was assessed using a Visual Analogue Scale (VAS), and postoperative swelling was evaluated using the Tissue Oedema Index (TEI) on days 3 and 8 postsurgery. Data analysis was performed with the Wilcoxon signed-rank test for intragroup comparisons and the Mann–Whitney U test for intergroup comparisons. Results: Pain intensity decreased significantly with the ingestion of both drugs. On day 3, pain intensity was 5.00±1.73, decreasing to 0.80±1.79 on day 8 for Group-A (p-value=0.034). For Group-B, pain intensity on day 3 was 4.60±0.55, decreasing to 0.40±0.89 on day 8 (p-value=0.041). The outcome for patients treated with 400 mg ibuprofen was not significantly different from that of patients treated with 100 mg aceclofenac (p>0.05). Conclusion: The results indicate that both ibuprofen and aceclofenac can be used effectively for pain control after periodontal surgery.

Comparison of Complete Dentures Fabricated by Conventional and Neutral Zone Technique by Assessing the Oral Health-related Quality of Life of the Patients: An In-vivo Study

Introduction: Complete denture therapy is the most extensively used form of treatment for replacement of completely missing dentition as it is most affordable with least amount of complications. In prosthodontics, complete denture is considered successful only when it is harmonious between patient’s comfort, aesthetics and function by maintaining an appropriate balance between oral musculature. Patient’s satisfaction plays a major role in determining the success during treatment procedures. To have a good treatment outcome, it is eminent for a complete denture to be stable and retentive in the oral cavity. For the denture to be stable, it is necessary for it to be in harmony with the surrounding musculature. Aim: To compare complete denture prosthesis, fabricated by conventional and neutral zone technique by assessing the Oral Health Related Quality of Life (OHRQoL) of the patients. Materials and Methods: This was an in-vivo study conducted in the Department of Prosthodontics including Crown and Bridge, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from March 2019 to April 2021. A total of 20 completely edentulous patients dissatisfied with their existing dentures were selected based on the following primary inclusion criteria: patients with previously worn complete dentures for at least one year who reported dissatisfaction with function or comfort. Each participant was assessed for baseline OHRQoL using the Oral Health Impact Profile (OHIP)-14 questionnaire before starting the treatment. Two sets of complete dentures were fabricated for each patient: one set using the conventional technique, and a second set where only the mandibular denture was fabricated using the neutral zone technique. Patients were blinded to the nature of the denture received and were randomly allocated to wear either the conventional or neutral zone denture first. Each set was worn for a period of 8 weeks following final adjustment. After each period, patients reassessed their OHRQoL using the OHIP-14 questionnaire. Age, gender, duration of edentulism, and previous denture-wearing experience were recorded for each participant. The compiled data were analysed using the Mann-Whitney U test to compare the OHIP-14 scores between the two denture type. A p-value of <0.05 was considered statistically significant. Results: The mean OHIP-14 scores showed a marked improvement in OHRQoL from 46.90 (pre-treatment) to 28.90 after rehabilitation with conventional dentures, and further reduced to 19.15 with neutral zone dentures. This indicates a progressive enhancement in patient-perceived oral health outcomes. Mann-Whitney U test revealed a statistically significant difference between the neutral zone and conventional denture groups across all OHIP-14 domains (p<0.001), confirming the superior efficacy of the neutral zone technique in improving OHRQoL. Conclusion: Neutral zone dentures demonstrated improved patient satisfaction and oral health–related quality of life compared with conventional dentures. However, further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.

Efficacy of T-PRF in Peri-implant Soft-tissue Augmentation and its Impact on Initial Marginal Bone Loss using the Bilayer Technique: A 6-month Prospective Clinical Trial

Introduction: Adequate peri-implant soft-tissue thickness plays a critical role in stabilising marginal bone and improving long-term implant success. Limited evidence exists regarding the effect of Titanium-prepared Platelet-rich Fibrin (T-PRF) on peri-implant phenotype modification and early bone remodelling. Aim: To assess the effect of bilayer T-PRF on peri-implant soft-tissues augmentation and initial Marginal Bone Levels (MBL). Materials and Methods: This prospective, single-centre, single-arm clinical study included 15 systemically healthy patients reporting to Department of periodontics in GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India with a single posterior edentulous site. The study period was May 2024 and November 2024. At implant placement, soft-tissue augmentation was performed using T-PRF membranes. Clinical parameters recorded at baseline, 3 and 6 months included Buccal Mucosal Thickness (BMT), Supracrestal Tissue Height (STH), Keratinised Mucosal Width (KMW) and Ridge Defect (RD), along with Plaque Index (PI) and Wound Healing Index (WHI) at one, three and six months postoperatively. MBL were assessed radiographically at baseline, three and six months. Patient-reported Outcome Measures (PROMs) were evaluated using a 100-mm Visual Analogue Scale (VAS) on postoperative days 1, 3, 7 and 14. Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) version 25.0 Descriptive statistics, Repeated measure Analysis of Variance (ANOVA), Banferroni Post-hoc test, Friedman test Wilcoxon sign rank test and Pearson's correlation test were used to analyse the data. p<0.05 was considered significant. Results: The mean age of the study participants was 34±9.5 years Significant gains were observed in BMT (1.93 mm), STH (2.10 mm), and KMW (0.43 mm) from baseline to six months (p<0.05). Mean MBL at six months was 0.55 mm mesially and 0.46 mm distally. BMT showed a strong negative correlation with MBL (r=-0.72), STH a moderate correlation (r=-0.58), KMW a weak correlation (r=-0.32), and RD a very weak, non significant correlation (r=-0.14). PROM scores progressively decreased and approached zero by day 14. Conclusion: The T-PRF effectively enhanced peri-implant soft-tissue thickness and was associated with minimal early Marginal Bone Loss (MBL). Its sustained growth-factor release and favourable biological behaviour support its use as a biomaterial for peri-implant soft-tissue augmentation.

Gene Ontology-based Functional Enrichment and PPI Network Mapping of APOE4-associated Genes in Alzheimer’s Disease: A Method to Identify Potential Therapeutic Targets

Introduction: Apolipoprotein E (APOE) is a protein involved in cholesterol circulation and has been reported to play a role in neurodegenerative conditions such as Alzheimer’s Disease (AD). Improper lipidation of APOE leads to aggregation of transmembrane amyloid-β (Aβ) proteins and hyperphosphorylation of tau proteins in AD. APOE4, a variant of the apolipoprotein E gene, affects lipid transport, amyloid-β clearance, and neuroinflammation, thereby increasing the risk of neurodegenerative diseases. It also exhibits distinct DNA methylation patterns and post-translational modifications that alter its stability and function compared to other isoforms. Aim: To identify and evaluate APOE4-interacting proteins as potential therapeutic targets using functional enrichment tools. Materials and Methods: This computational bioinformatics study was carried out using open-source, web-based databases between January and September 2024. APOE protein–protein interaction (PPI) networks were constructed using STRING database (v11.5), GeneMANIA (v3.6.0), and BioGRID (v4.4.212) with a confidence cut-off score of 0.5. Interacting proteins were ranked based on interaction scores, and the top 10 candidates were selected for further functional analysis. Results were summarised in tabular and graphical formats. Results: A total of 32 genes were found to be associated with lipoprotein receptor activity, carbohydrate metabolism, cholesterol metabolism, and ribosome biogenesis, involving glucagon signalling and HIF-1 signalling pathways. Amyloid Precursor Protein (APP), Microtubule-Associated Protein Tau (MAPT), and Triggering Receptor Expressed on Myeloid cells 2 (TREM2) were repeatedly identified across multiple tools, with the highest confidence scores of 0.998, 0.997, and 0.995, respectively, in STRING database, and scores of 0.586 and 0.474 for APP and MAPT, in GeneMANIA. These three genes were present among other genes involved in apolipoprotein binding, with an enrichment score of 216.5 provided by the DAVID database. Conclusion: APP and MAPT were identified as promising druggable targets, highlighting their importance in AD. In the present study, APOE4-interacting, drug-targetable, functionally enriched AD-related genes were shortlisted from hundreds of proteins reported across different Gene Ontology (GO) databases.

Intergenerational Pattern and Cultural Beliefs on Menarche: A Mixed-method Cross-sectional Study among Mothers and Adolescent Girls in Puducherry, India

Saranya Periyasamy, Devi Kittu, Lopamudra Debasish

Introduction: Several studies have reported a declining trend in the age at menarche among adolescent girls in both developed and developing countries. However, there is a dearth of community-based studies in India that compare the age at menarche between adolescent girls and their mothers. Aim: To estimate the mean age at menarche among adolescent girls and compare it with that of their mothers. In addition, to explore the cultural beliefs surrounding menarche among adolescent girls. Materials and Methods: A cross-sectional, community-based mixed-method study was conducted at the Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India, from November 2021 to December 2022 among 340 participants (adolescent girls and their mothers) using a multistage sampling method. Adolescent girls aged 10-19 years residing in the service areas of the Urban Health Training Centre (Lawspet) and the Rural Health Training Centre (Karikalampakkam) of Indira Gandhi Medical College and Research Institute (IGMC&RI), Puducherry, were included. The Mann-Whitney U test was applied to compare differences in age at menarche, and a p-value of <0.05 was considered statistically significant. Focus Group Discussions (FGDs) with adolescent girls and their mothers were conducted using purposive sampling, and qualitative data were analysed using content analysis. Results: The mean age at menarche among adolescent girls in urban and rural areas was 12.49±1.067 years and 12.62±1.187 years, respectively. Similarly, the mean age at menarche among mothers in urban and rural areas was 14.07±1.541 years and 14.21±1.227 years, respectively. A declining trend in age at menarche was observed among adolescent girls, with a reduction of 1.59 years compared to their mothers. Content analysis revealed that inadequate access to accurate information, cultural stigmatisation of open discussions surrounding menarche, and internalised anxiety related to conforming to traditional practices—often unquestioned due to fear of social or familial repercussions—contributed to a heightened sense of vulnerability among participants. Conclusion: The observed downward shift in the age at menarche highlights the need for timely awareness regarding early puberty among adolescent girls, parents, and school teachers, as well as the importance of addressing the cultural silence surrounding menstruation.

Assessment of Pro-inflammatory Cytokines in Type 2 Diabetes Mellitus Patients With and Without Complications: A Case-control Study

Sabiha Naz, Pawan Kare, Tripti Saxena, Simmi Dube

Introduction: Numerous factors play a significant role in the development of vascular complications in Type 2 Diabetes Mellitus (T2DM) patients. Among all of them, inflammation is considered an important factor in the development of these complications. Pro-inflammatory cytokines like Interleukin-6 (IL-6) and Tumour Necrosis Factor–α (TNF-α) interfere with insulin signalling pathways in pancreatic β-cells, contributing to insulin resistance. The role of these pro-inflammatory cytokines in the development of vascular complications in T2DM patients remains incompletely understood. Aim: To assess the serum levels of pro-inflammatory cytokines (IL-6 and TNF-α) and to determine their association with vascular complications in T2DM patients. Materials and Methods: This observational, case-control study was conducted at the Outpatient Department (OPD) of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from July 2024 to March 2025. A total of 246 T2DM cases (123 without and 123 with vascular complications) were recruited and matched with 246 healthy, age and gender-matched controls. Baseline parameters {age, gender, duration of disease, Body Mass Index (BMI), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)} were recorded and serum levels of IL-6 and TNF-α were analysed. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 30.0. Statistical analyses included unpaired ‘t’ test, Pearson’s correlation multiple logistic regression and multiple linear regression. A p-value <0.05 was considered statistically significant. Results: Significant differences in mean age were observed between controls and cases with complications (p-value <0.001), while other comparisons were not statistically significant. Males outnumbered females. Significant (p-value <0.001) increase in IL-6 and TNF-α levels were found in T2DM cases with complications as compared to cases without complications and controls. Pearson’s correlation analysis revealed a significant positive correlations of IL-6 (r-value=0.872; p-value <0.001) and TNF-α (r-value= 0.912; p-value <0.001) with T2DM duration in T2DM cases without complications, similarly it also showed significant positive correlations of IL-6 (r-value=0.843; p-value<0.001) and TNF-α (r-value=0.806; p-value <0.001) with T2DM duration in T2DM cases with complications. Logistic regression analysis demonstrated that higher IL-6 and TNF-α levels were independently associated with vascular complications. Conclusion: In the present study, serum levels of IL-6 and TNF-α were found significantly increased in T2DM cases with complications as compared to cases without complications and were also found significantly associated with T2DM duration and vascular complications. Therefore, the assessment of these biomarkers may serve as potential markers for risk stratification of vascular complications in T2DM.

Comparison of Telerehabilitation versus Hospital-based Rehabilitation in Delivering Combined Kinetic Chain Exercises in Perimenopausal and Postmenopausal Women with Knee Joint Osteoarthritis: A Pilot Study

Introduction: Osteoarthritis (OA) is the most frequent musculoskeletal condition affecting middle-aged and geriatric populations. Among all joints, the knee joint has the highest prevalence of OA. Although physiotherapists play a crucial role in the management of Knee OA (KOA), the availability of rehabilitation specialists in remote areas remains inadequate relative to population needs. The use of telecommunications technology to deliver rehabilitation remotely may help address accessibility bar-riers. Aim: To compare the effectiveness of a Combined Kinetic Chain Exercise (CCE) delivered via tele-rehabilitation versus in-person physiotherapy sessions. Materials and Methods: This was an assessor-blinded, experimental design conducted at the Department of Physiotherapy, Gauhati Medical College and Hospital, Bhangagarh, Guwahati, Assam, India between January 2021 and July 2021. It utilised balanced, randomised allocation of 24 patients to two parallel groups: A) retro-walking training combined with conventional CCE via hospital-based rehabilita-tion (control group); or B) retro-walking training combined with conventional CCE delivered via telere-habilitation (experimental group). The Numeric Pain Rating Scale (NPRS), Timed Up and Go Test (TUG) and Lower Extremity Function Scale (LEFS) were used to measure pain, mobility and physical function, respec-tively. The Statistical Package for Social Sciences (SPSS) 21.0 version was used for all statistical analyses. Paired t-test was utilised for within-group analysis and unpaired t-test was used for between-group analyses. Results: After six weeks of treatment, no statistically significant difference was observed between the postintervention outcome measures of Group A and Group B, according to a comparative statis-tical analysis between the two groups (p-value>0.05). Conclusion: Hence, it can be concluded that no statistically significant difference was ob-served between hospital-based rehabilitation and telerehabilitation in delivering CCE. Both approaches can be utilised depending on the patient’s accessibility concerns and prevailing circumstances.

Anatomical Variations of Nutrient Foramina in Dry Adult Femur Bones among North Indian Population: A Cross-sectional Study

Introduction: The diaphysis of the femur is primarily supplied by the nutrient artery, which traverses the nutrient foramen. Typically, the femoral diaphysis presents with one or more nutrient fo-ramina. Usually, two nutrient arteries originate from the first and third perforating branches of the profunda femoris artery. When only a single major nutrient artery is present, it originates from the second perforating branch. Generally, the nutrient foramen or foramina are located in the middle third of the femoral shaft, on or close to the linea aspera. Aim: To comprehensively analyse the nutrient foramina in the femur by determining their number, location, and direction. Materials and Methods: The present cross-sectional study was conducted on 50 dry adult femurs (25 right-sided and 25 left-sided) of unspecified sex, obtained from the bone bank of the Department of Anatomy, SGT University, Gurugram, Haryana, India. The number, location, and direction of the diaphyseal nutrient foramina were observed over a period of six months from May 2024 to October 2024 using visual inspection (subjective evaluation). All measurements were performed twice to minimise error, and the mean value was recorded. The data were analysed using Statistical Package for Social Sciences (SPSS) software (version 30). The mean, range, percentages, t-values, and p-values were calculated and present-ed in tabular form. Results: All nutrient foramina were directed proximally. The number of foramina ranged from zero (one bone) to four (one bone). The majority of bones (32 femurs) had double foramina. Single foram-ina (14 femurs) were generally located in the upper third of the shaft, while double foramina (32 fe-murs) were more commonly located in the middle third. In the present study, a single nutrient foramen (2%) was observed on the popliteal surface of the left femur, a finding not reported in earlier studies. Conclusion: Diaphyseal nutrient foramina show significant variation in number and location. The present study will be beneficial for orthopaedic surgeons in planning surgical procedures involving the femur, such as arthroplasty, bone grafting, and fracture reduction, where maintenance of adequate blood supply is essential for successful outcomes.

Effect of Two Different Concentrations of Chlorhexidine Digluconate on the Shear Bond Strength of Resin Composite to Biodentine using Self-etch and Etch-rinse Bonding Strategies: An In-vitro Study

Introduction: Chlorhexidine (CHX) has been most commonly used as an antimicrobial component as well as for disinfection before the placement of restorations. CHX has demonstrated successful inhibi-tion of dentin Matrix Metalloproteinase (MMP) collagenolytic activity when used in concentrations of 0.2% and 2%, however this may influence the bond strength of composite resin to Biodentine when applied before adhesive procedures. The present study endeavours to evaluate a bonding strategy that would best suit the preconditioning with CHX. Aim: To evaluate the effect of two different concentration of CHX on Shear Bond Strength (SBS) between resin composite and Biodentine, using self-etch and etch-rinse bonding strategies. Materials and Methods: The present in-vitro study was carried out in the Department of Con-servative Dentistry and Endodontics in Mahatma Gandhi Mission Dental College and Hospital, Navi Mumbai, Maharashtra, India, from January 2022 to May 2022 on 108 acrylic blocks. A central cavity was prepared in the acrylic block and randomly divided into six main groups. Group 1 (control) Biodentine placement; self-etch adhesive application followed by resin composite. Group 2 (control) Biodentine placement; etch and rinse adhesive application followed by resin composite. Since two different bonding strategies, self- etch and etch-and-rinse were used, two control groups were included. Each of these bonding methods has different application protocols and bonding mechanisms, which could independently affect the SBS between resin composite and Biodentine, therefore two control groups were included. Including both con-trols allows for a fair and unbiased comparison with the experimental groups where CHX (at 0.2% or 2%) was used. This ensures that any observed differences in bond strength can be accurately attributed to the effect of CHX, rather than differences between the bonding strategies themselves. Group 3 Biodentine placement; application of 0.2% CHX prior to application of self-etch adhesive followed by resin compo-site placement. Group 4 Biodentine placement; application of 2% CHX prior to application of self-etch adhesive followed by resin composite placement. Group 5 Biodentine placement; for etch and rinse adhe-sive system application 0.2% CHX after acid etching prior to application of adhesive followed by resin composite placement. Group 6 Biodentine placement; for etch and rinse adhesive system application 2% CHX after acid etching prior to application of adhesive followed by resin composite placement. Thereafter the samples were subjected to the shear bond testing in a universal testing machine. The obtained data was tabulated and statistically analysed for normality using Shapiro-wilk test. Further statistical analysis was done using One-way Analysis of Variance and Two-way ANOVA followed by Tukey–Kramer Test for pair-wise comparisons. Post-hoc test was done to compare control group compared with CHX treated group irrespective of bonding technique. Results: Surface treatment of Biodentine with 0.2% or 2% CHX reduced the bond strength of com-posite resin to Biodentine irrespective of bonding strategies. The One-way ANOVA test showed there was statistically significant difference in SBS of the resin composite bonded to Biodentine when the differ-ent bonding strategies and surface treatment are applied( p<0.001 ). Two-way ANOVA test showed statisti-cally significant difference in SBS between etching technique and different concentrations of CHX with p<0.001. A higher SBS was observed when the Biodentine was pretreated with 0.2% CHX (Group 3 and Group 5) compared to 2% CHX (Group 4 and Group 6) (p<0.001). Post-hoc test statistically significant differ-ence found in SBS when control groups when compared to groups treated with CHX, irrespective of bonding technique (p<0.001). Conclusion: Application of 2% and 0.2% CHX on Biodentin reduced the SBS with resin composite, irrespective of the bonding strategy. Between the self-etch and etch-rinse adhesive system used in this study, etch-rinse showed higher SBS for 0.2% CHX compared to self-etch adhesive system.

Colourimetric Detection of Formalin Concentration in Fixing Solutions using Schiff’s Reagent: An In-vitro Study

K Namira Fateen, Reshma Poothakulath Krishnan, Deepak Pandiar

Introduction: Formalin is a widely used tissue fixative in histopathology. Maintaining a pre-cise formalin concentration in fixing solutions is essential, as both over-fixation and under-fixation can compromise tissue quality and pose health risks to laboratory personnel and Pathologists. Existing techniques such as gas chromatography and spectrophotometry are accurate but expensive and impractical for routine use. Hence, a simple, affordable, and reliable method for monitoring formalin concentrations in routine laboratory procedures is required. Aim: The present study aimed to develop a method to detect and quantify formalin concentration using Schiff’s reagent and to further validate it using a colour palette. Materials and Methods: The present in-vitro study was conducted in the Department of Oral Pathology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from July 2024 to November 2024. Formalin solutions with concentrations of 2%, 5%, 10%, 20%, 25%, 50%, 75%, and 100% were prepared. Schiff’s reagent was added to each solution, and the resulting colour changes were recorded. A colour palette was generated based on this gradient, covering the full spectrum of formalin concentrations from 2 to 100%. This colour palette was patented and published in the Official Journal of The Patent Office (202541045779). Fifty filter paper strips (10 for each concentration) soaked in Schiff’s reagent were immersed in the different formalin solutions. Two Oral Pathologists independently assessed all 50 strips and compared them with the colour palette to confirm concentration-dependent colour changes. Kappa sta-tistics were calculated using Statistical Package for Social Sciences (SPSS) software version 23 to as-sess inter-rater reliability. Results: A gradient of purple colour intensity corresponding to formalin concentration was ob-served, confirming the specificity of Schiff’s reagent for formalin detection. Higher concentrations of formalin produced a more intense dark violet, while lower concentrations resulted in lighter shades. Kappa statistics demonstrated excellent inter-rater agreement, with a κ value of 0.92. Conclusion: According to the present study findings, Schiff’s reagent reliably detects forma-lin concentrations, providing an accessible, cost-effective colourimetric method for the safe and effec-tive use of formalin in routine laboratory practice.

Effect of Intradialytic Exercise Program on Physical Function, Depression and Quality of Life in Diabetic Nephropathy Patients: A Pre-post Interventional Study

Kashish Prabhakar Shetty, Purusotham Chippala

Introduction: Diabetic Nephropathy (DN) is a prevalent complication of Diabetes Mellitus (DM) that frequently results in impaired physical functioning, a reduced Quality of Life (QoL) and a decline in psychological well-being. Patients who undergo Haemodialysis (HD) are at a higher risk of experienc-ing depression, fatigue and functional decline. Although there is potential for exercise therapy to im-prove outcomes for Chronic Kidney Disease (CKD), limited evidence exists regarding its structured appli-cation in DN patients receiving HD. Aim: To assess the effect of Intradialytic Exercise (IDE) program on the physical function, de-pression and QoL of DN patients who are undergoing HD. Materials and Methods: This pre-post interventional study was carried out at Department of Nephrology in Justice KS Hegde Charitable Hospital, Deralakatte, Mangaluru, India. The study was con-ducted from July 2024 to February 2025 and involved 15 patients with DN who were receiving maintenance HD.Participants underwent an 8-week IDE program (three sessions per week for one hour each). To assess the intervention’s effects, outcome measures included the 6-Minute Walk Test (6MWT), 30 -Second Sit-to-Stand test (30STS), handgrip strength, lower limb strength, the Hospital Anxiety and Depression Scale (HADS) and the Kidney Disease Quality of Life-36 (KDQoL-36). Paired sample t-tests were used to evaluate difference between baseline and post intervention scores. Results: Significant improvements were observed in 6MWT (9.98%), 30 STS (38.06%), handgrip strength (10.62%) and lower limb strength (20.75%) (p<0.001). Depression scores on the HADS significant-ly decreased (24.14%) (p=0.001), while the KDQoL-36 scores indicated a marked enhancement (10.46%) in QoL (p=0.008). Conclusion: Intradialytic exercise program significantly improves physical function, reduces signs of depression and enhances the QoL of DN patients receiving HD.

Evaluation and Comparison of Mechanical and Frictional Properties of Different Coated and Uncoated Orthodontic Wires: A Systematic Review

Eman Ibrahim Alshayea

Introduction: Patients seek orthodontic treatment with clear, aesthetic brackets and archwires to enhance facial appearance without compromising their smile. The introduction of coated metallic and fibre-reinforced archwires represents a promising advancement in orthodontics. These wires exhibit me-chanical properties comparable to Stainless Steel (SS) archwires and have marked a significant develop-ment in the field. Aim: To provide a comprehensive understanding of the influence of aesthetically coated metallic and fibre-reinforced archwires on the rate of orthodontic tooth movement, as well as their impact on mechanical properties compared with uncoated wires. Materials and Methods: A search strategy was implemented from January 2005 to August 2025 using electronic databases, including Web of Science, PubMed, Science Direct, Scopus, and Medline, with no language or geographical restrictions. Both in-vivo and in-vitro studies comparing coated and uncoat-ed archwires were included. Two independent reviewers screened the studies, and data were extracted us-ing a customised form. The risk of bias was assessed using the RoBDEMAT tool. Results: A total of 479 articles were identified through electronic searches and by screening reference lists. After reviewing titles, abstracts, and full-text articles, 26 Randomised Controlled Trials (RCTs) met the inclusion criteria and were included in the final analysis. The orthodontic wires evaluated included SS, Nickel–Titanium (NiTi), Titanium-molybdenum Alloy (TMA), and Cobalt–Chromium (Co-Cr) wires. Most studies lacked clear reporting on randomisation methods, sample size justification, con-trol group selection, and operator blinding. However, all studies employed standardised testing proce-dures, detailed outcome measures, consistent experimental conditions, and appropriate statistical anal-yses. Conclusion: Orthodontic wires coated with various aesthetic materials exhibit lower frictional forces, making them ad-vantageous for retraction mechanics during fixed orthodontic treatment. In addition, coated archwires exert lower force values during loading and unloading than uncoated wires of the same dimension.

Association of Interleukin-6 in Degenerative Lumbar Disorder: A Systematic Review

Introduction: Degenerative disorder of lumbar spine, lumbar spondylosis is characterised by disc degeneration and osteophyte formation. Low Back Pain (LBP) is exacerbated by chronic degeneration, which leads to inflammation, elevated cytokine production and activation of inflammatory pathways. Interleukin-6 (IL-6) and other cytokines worsen disc degeneration and discomfort and increased levels of IL-6 is associated with the severity of this condition. Aim: To find out the association between IL-6 levels and degenerative lumbar disorders and its related conditions. Materials and Methods: The present systematic review was conducted following PRISMA guidelines and the protocol was registered in PROSPERO (Registration No.: CRD42024479518). An extensive search of four databases i.e., PubMed, Scopus, Web of Science and Embase from October 2023 to May 2024 was carried out. Studies with cohort, case-control, cross-sectional, human research designed were considered for this review. Two independent reviewers extracted the data and evaluated the methodological quality and risk of bias using National Heart Lung and Blood Institute (NHLBI) scale. Disagreement between the two primary investigators during the evaluation process was resolved by a second pair of reviewers through discussion. Results: Out of total 106 articles, six studies met the inclusion criteria and were included in the qualitative synthesis. No studies were eligible for quantitative meta-analysis due to heterogeneity in study design and outcome reporting. The outcome of included studies consistently showed elevated IL-6 levels in patients with lumbar spondylosis or disc degeneration and related disorders. Increase IL-6 expression was associated with enhanced inflammatory activity and greater severity of clinical symptoms. Conclusion: The present review suggests a significant strong association between IL-6 and degenerative lumbar disorders, indicating that IL-6 plays a vital role in the pathophysiology of this condition.

Availability and Policy Alignment of Oral Hypoglycaemic Agents in India: A Cross-sectional Study

Sophia B Modi

Introduction: “Oral Hypoglycaemic Agents” (OHAs) are central to the pharmacological manage-ment of Type 2 Diabetes Mellitus (T2DM). While evidence-based treatment guidelines increasingly recom-mend newer therapeutic agents, essential medicine lists and public procurement systems may not always reflect evolving evidence, potentially limiting equitable access to optimal diabetes care. Aim: To assess the availability of Research Society for the Study of Diabetes in India (RSSDI) recommended OHAs in national and state public medicine lists in India. Materials and Methods: A cross-sectional study was conducted in Government Medical College, Thiruvananthapuram, Kerala, India between January 2025 and March 2025. All OHAs recommended in the RSSDI clinical practice recommendations 2022 were included. A total of eight guideline-recommended OHA drug classes and 24 individual OHAs were assessed for inclusion in the National List of Essential Medicines 2022 of India (NLEM 2022), availability in the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) catalogue, and presence in State Essential Drug Lists (EDL) from Kerala, Tamil Nadu, Maharashtra, and Assam. Data were analysed using descriptive statistics. Results: Among the eight guideline-recommended OHA drug classes, 3 (37.5%) were included in the NLEM. State-level analysis of 24 OHAs showed that only 2 (8.3%), metformin and glimepiride, were listed across all four states, while 12 (50%) were not included in any of the reviewed State EDL. Assessment of the PMBJP catalogue showed that 19 of 21 OHAs (90.5%) were available. Conclusion: Substantial gaps exist between the RSSDI guidelines 2022 recommendations and public sector availability of OHAs in India, with marked inter-state variability. In contrast, the Jan Aushadhi scheme demonstrated wider inclusion of recommended OHAs, highlighting its potential role as a complemen-tary access pathway. Strengthening the alignment between clinical guidelines and public procurement pol-icies may support more equitable guideline-concordant diabetes care.

Correlation between 2D:4D Ratio (Hormonal Fingerprints) and Dermatoglyphics with Dental Caries and Malocclusion among Undergraduate Dental Students of Bhubaneswar City: A Cross-sectional Study

Introduction: Early identification of genetic and developmental predispositions to dental car-ies and malocclusion is vital and non-invasive markers such as the 2D:4D ratio (Second finger: Fourth finger Ratio) and dermatoglyphics may provide a simple, cost-effective tool for risk assessment. Aim: The present study aimed to determine the correlation between the 2D:4D ratio (hormonal fin-gerprints) and dermatoglyphic patterns with dental caries and malocclusion among undergraduate dental students in Bhubaneswar City, Odisha, India. Materials and Methods: The present cross-sectional study was conducted among 259 undergradu-ate dental students at Kalinga Institute of Dental Sciences in Bhubaneswar, Odisha, India, from June to August 2024. Participants who were present during data collection and provided informed consent were included. Dental caries and malocclusion were assessed using the International Caries Detection and As-sessment System (ICDAS) II and Dental Aesthetic Index (DAI), respectively, through a Type III clinical examination. The 2D:4D digit ratio was measured with vernier calipers, and dermatoglyphic patterns were analysed from fingerprint impressions. Statistical analysis involved the Chi-square test, Fisher’s ex-act test, and Spearman’s correlation, with significance set at p<0.05. Results: Among the 259 dental students, 163 (62.93%) had dental caries, and 220 (84.94%) showed normal or minor malocclusion. A low 2D:4D ratio (<1) was seen in 197 (76.06%) of the students. Caries was significantly associated with low 2D:4D ratios (69.94%, p=0.003), while higher malocclusion severity was linked to high ratios (94.59%, p<0.001). Loops were the most common fingerprint pattern among those with caries (p<0.0001), although no significant link was found with malocclusion. The 2D:4D ratio showed a moderate negative correlation with loops (ρ=-0.3765, p=0.0038) and a positive correlation with whorls (ρ=0.3903, p=0.0074). Conclusion: The study found significant associations between 2D:4D ratios, dermatoglyphic pat-terns, and dental conditions, suggesting potential links between genetic and developmental factors and oral health. While these findings highlight meaningful correlations, predictive conclusions cannot be drawn due to the exploratory nature of the analysis.

Evaluation of Etching Times to Determine the Penetration Depth of Resin Infiltration on Artificially Demineralised Teeth: An In-vitro Experimental Study

Introduction: The evolution of caries management has shifted towards minimally invasive ap-proaches, with resin infiltration emerging as a promising treatment for non cavitated carious lesions. Resin infiltration is a minimally invasive treatment for early enamel lesions, but its effectiveness depends on optimal etching. Current protocols lack consensus on the ideal etching time for maximum resin penetration. This study evaluates how varying etching durations affect infiltration depth in demineral-ised enamel, aiming to improve clinical outcomes and refine evidence-based guidelines for non invasive caries management. Aim: To evaluate the effectiveness of resin infiltration by varying etching times and assessing the material’s penetration depth in enamel. Materials and Methods: This in-vitro experimental study was conducted Department of Paediat-ric and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Ben-gal, India, from January 2017 to December 2018. It involved 40 premolars extracted for orthodontic pur-poses that had sound enamel. The samples were divided into four groups, with the control group etched for two minutes as recommended by the manufacturer, and the experimental groups etched for one, three, and four minutes (R1-R4), respectively. Artificial lesions were created using a caries demineralisation solution. The resin infiltration process involved etching with Hydrochloric acid (HCl) gel { Infiltra-tion Concept (ICON®) }, (ICON® Etch), drying the lesions with ICON® Dry (ethanol), and then applying ICON® infiltrant. The treated teeth were sectioned, stained with Sodium Fluorescein dye, and analysed using a fluorescent microscope. The results were tabulated and statistically evaluated using paired t-tests, with a significance level set at p-value<0.05. Results: Etching the teeth for four minutes (p-value=0.002) prior to resin infiltration result-ed in the deepest penetration of the material, thus being more efficacious in arresting the progression of caries in comparison to three minutes (p-value=0.044), two minute and one minute (p-value=0.002) etching times. It also showed four minute etching time to have greater penetration of the material into the lesion. Conclusion: According to the results obtained, two minute etching, used as the control, was adequate but less effective than the three and four minute groups, and the one minute etching was the least effective. This finding highlights the importance of optimising the etching time for improved res-in infiltration outcomes in the management of non cavitated carious lesions.

Comparison of Salivary Cortisol Levels among Patients with Temporomandibular Disorder with and without Depression and Healthy Controls: A Cross-sectional Study

Introduction: Temporomandibular Disorders (TMDs) are musculoskeletal conditions often linked to psychological stress. Cortisol, a key stress biomarker, may play a role in the pathophysiology of TMD. The present study compares salivary cortisol levels in young adults with TMD, with and without de-pression, and in healthy controls to explore the psychological and physiological interplay in these con-ditions. Identifying distinct cortisol patterns across these groups could aid in understanding the role of stress-related endocrine function in TMD. Aim: To test salivary cortisol levels in young adults diagnosed with TMD, both with and without depression, and to compare these results with an age-matched control group without TMD and depression. Materials and Methods: The present cross-sectional observational study was conducted at Vish-nu Dental College, Bhimavaram, between January and May 2024. The present study included individuals aged 18-28 years of both genders who experienced pain in the Temporomandibular Joint (TMJ) region for a mini-mum of three months, in accordance with the Research Diagnostic Criteria for TMD (RDC/TMD). A total of 45 patients were divided into three groups: TMD with depression (n=15), TMD without depression (n=15), and a control group (n=15). Patients were evaluated for TMD based on the RDC/TMD criteria. Psychological status was assessed using the RDC/TMD Axis 2 self-report for all participants, including those with TMD and the control group without TMD. Post awakening salivary samples were collected between 7 and 8 a.m., and salivary cortisol levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Data analysis was performed using a paired t-test, and Pearson correlation was used to examine the relation-ship between morning and evening cortisol levels. An Analysis of Variance (ANOVA) test was conducted to compare cortisol levels across groups, with a p-value <0.001 considered significant. Results: A strong, significant correlation was found between morning and evening salivary cor-tisol levels in all groups (TMD with depression: r=0.99; TMD without depression: r=0.989; controls: r=0.725; p<0.001). Morning cortisol was highest in TMD patients with depression (55.7 ng/mL), followed by those without depression (19.63 ng/mL) and controls (12.66 ng/mL). Evening levels followed a similar pattern. Females showed significantly higher cortisol levels than males, especially in the TMD without depression and control groups (p<0.001). In TMD with depression, females had higher levels, though this was not statistically significant. Conclusion: Assessing salivary cortisol levels may provide insight into psychological factors that contribute to the development of TMD. Salivary cortisol could serve as a valuable indicator in de-tecting psychological elements potentially linked to TMDs.

Anterior Alveolar Bone Thickness in Various Sagittal and Vertical Growth Patterns: A Cephalometric Cross-sectional Study

Ishita Chopra, Shruti Patil, Ameet Vaman Revankar, Ravi V Shirahatti

Introduction: Orthodontic diagnosis, treatment planning, and results are significantly influenced by anterior tooth movement. When orthodontic forces shift teeth close to the cortical bone, further tooth movement becomes more difficult, necessitating Orthodontists to evaluate the range of tooth movement prior to starting orthodontic therapy. Aim: To compare the anterior Alveolar Bone Thickness (ABT) in different sagittal and vertical growth patterns using lateral cephalograms. Materials and Methods: The present cross-sectional study included pretreatment lateral cephalograms of patients collected from the Orthodontic departmental archives of SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India, who had visited between June 2022 to January 2024. Healthy individuals within age group of 18-25 years with no previous history of orthodontic treatment were included in the study. A total of 176 cephalograms were traced manually and categorised as Group 1: Class-I (n=47) (ANB-2-4 degrees), Group 2: Class-II (n=87) (ANB>4 degrees), and Group 3: Class-III (n=42) (ANB< 2 degrees).The total samples were again divided based on the FMA angle as Group A: Hypodivergent (FMA<22 degrees) (n=60) Group B: Normodivergent (FMA: 22-25 degrees) (n=59) and Group C: Hyperdivergent (FMA>25 degrees) (n=57). Certain cephalometric landmarks (a,b,c,d) were marked and the average ABT was calculated using a caliper/scale, and statistical analysis was done with Two-way Analysis of Variance (ANOVA), and a p-value <0.05 was considered. Results: The measured values of the U1-lab (maxillary labial ABT) showed significantly higher values for Group 3 compared to Group 2 (p-value=0.024). U1-pal (maxillary palatal ABT) (p-value=0.013), U1-lab (p-value=0.001), and (Md-Alv) (total mandibular alveolar thickness) (p-value=0.012) were found significantly higher in Group A compared to C. Conclusion: The study concludes that Class-III individuals have thicker anterior ABT than Class-II individuals, and hyperdivergent individuals possess thinner anterior ABT than other vertical jaw base divergences.

Knowledge, Attitudes and Practices of Palliative Care among Postgraduate Medical Students: A Multicentre Cross-sectional Study from Kolhapur, India

Introduction: Palliative care is a multidisciplinary approach designed to enhance the quality of life of patients with life-limiting illnesses. Despite its growing importance, palliative care remains insufficiently represented within Indian postgraduate medical training, leading to gaps in knowledge, attitudes, and clinical practice. Aim: To assess the Knowledge, Attitude, and Practice (KAP) of postgraduate medical students regarding palliative care in selected medical Institutions across Maharashtra, Karnataka, and Goa. Materials and Methods: This multicentre, cross-sectional observational study was conducted between August 2021 and January 2022 in tertiary care medical colleges across Maharashtra, Karnataka, and Goa, India A structured, validated online questionnaire was distributed to 1st-, 2nd-, and 3rd-year postgraduate students using Google Forms and Survey Monkey. The survey captured demographic characteristics, levels of KAP, and previous exposure or training in palliative care. Data were analysed using EpiInfo version 7.2. Descriptive statistics summarised variables; Chi-square and Fisher’s exact tests assessed associations between categorical variables; Student’s t-test and one-way Analysis of Variance (ANOVA) were applied to continuous variables. Principal Component Analysis (PCA) and K-means clustering were used to identify learner profiles. A p-value <0.05 was considered statistically significant. Results: Of 500 invited students, 345 (69.0%) responded, and analysis was performed on these respondents (n=345). Most participants were aged 24-35 years, 87 (25.22%), with balanced gender distribution males, 179 (51.87%), females, 166 (48.13%). Internal medicine, dental sciences, and orthopaedics were the most represented specialties. Knowledge levels were predominantly average in 182 students (52.75%), attitudes were largely neutral in 194 students (56.23%), and practice levels were moderate in 168 (48.7%) of respondents. Misconceptions persisted, particularly regarding opioid use and the World Health Organisation (WHO) analgesic ladder. Practical exposure was limited, with only 46.96% having participated in palliative rounds. PCA revealed three distinct learner clusters varying in readiness and confidence. Conclusion: Although foundational knowledge was adequate, gaps in attitude, misconceptions, and limited clinical exposure highlight the need for structured, competency-based palliative-care training within postgraduate curricula.

Comparison of Platelet Indices and Erythrocyte Sedimentation Rate in Spinal Tuberculosis and Non-tuberculous Spondylitis: A Cross-sectional Study

Introduction: Spinal Tuberculosis (TB), also known as Pott’s spine, remains a significant cause of morbidity and often mimics non-infective spinal disorders both clinically and radiologically. Consequently, diagnosis of spinal TB is challenging owing to its non-specific clinical presentation and radiological overlap with other infective and non-infective spinal disorders. Aim: The present study aimed to evaluate and compare haematological parameters particularly Erythrocyte Sedimentation Rate (ESR) and platelet indices in tuberculous and non-tuberculous spondylitis to assess their diagnostic utility. Materials and Methods: The present cross-sectional comparative study was conducted for a pe-riod of one year, from May 2024 to April 2025, at a tertiary care hospital, in the Departments of Pa-thology and Orthopaedics. A total of 64 patients aged ≥18 years were included: 33 patients with tubercu-lous spondylitis (diagnosed by acid-fast bacilli staining, culture, Polymerase Chain Reaction (PCR), histopathology, or clinico-radiological features) and 31 patients with non-infective spinal pathologies (such as degenerative disorders, scoliosis, and tumours). Haematological parameters including Haemoglo-bin (Hb), Total Leukocyte Count (TLC), ESR, platelet count, Mean Platelet Volume (MPV), Plateletcrit (PCT), Platelet Distribution Width (PDW), and Platelet Large Cell Ratio (P-LCR) were analysed using au-tomated analysers (Sysmex XN-1500 for complete blood count and Alifax Test-1 for ESR). Statistical anal-ysis was performed using Statistical Package for Social Sciences (SPSS) version 23. Group comparisons were carried out using the independent t-test or Mann-Whitney U test, and correlations were assessed using Pearson or Spearman correlation coefficients. A p-value <0.05 was considered statistically signif-icant. Results: Patients with spinal TB had higher ESR (22.4±14.3 vs 20.9±20.1 mm/hr), MPV (12.0 vs 11.7 fL), PDW (15.9 vs 15.3 fL), and P-LCR (40.2 vs 37.4), and lower Hb levels (11.5 vs 12.3 g/dL) com-pared with non-TB cases; however, these differences were not statistically significant (all p>0.05). ESR showed a weak negative correlation with Hb (r=-0.300, p=0.090) and negligible correlations with platelet count (r=0.044), PDW (r=-0.123), MPV (r=-0.135), P-LCR (r=-0.070), and PCT (r=0.026), all with p>0.05. Conclusion: Although elevated ESR and mild haematological alterations are commonly observed in spinal TB, they lack sufficient specificity to reliably distinguish tuberculous spondylitis from non-tuberculous spinal conditions. Platelet indices also demonstrated limited diagnostic relevance. These parameters should therefore be used only as supportive tools within a comprehensive diagnostic framework that includes clinical evaluation, imaging, and microbiological investigations.

Determinants of Depression among Young Adults in Selected Colleges in Chengalpattu District, Tamil Nadu, India: A Cross-sectional Study

Introduction: Mental health is vital for overall well-being, enabling individuals to cope with stress, function effectively and engage in society. Depression contributes significantly to the disease burden, especially among young adults facing academic, financial and social pressures. Despite global and national efforts, stigma and limited access to care remain barriers. Tamil Nadu has a high preva-lence of mental health disorders, with young adults particularly at risk. Identifying prevalence and risk factors of depression is crucial for developing targeted interventions and reducing stigma. Aim: To assess the association between selected socio-demographic, lifestyle and social determi-nants and depression among young adults in Chengalpattu district, Tamil Nadu, India. Materials and Methods: This cross-sectional study was conducted among 424 undergraduate col-lege students aged 18 to 25 years enrolled in various courses at medical, allied health sciences and engineering colleges in Chengalpattu district, Tamil Nadu, India, from September 2024 to November 2024. Data were collected through face-to-face interviews using a pre-tested semi-structured questionnaire. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Socio-demographic characteris-tics, lifestyle factors, social interactions and co-morbidities were assessed. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 27.0. Descriptive statistics were used to summarise data. Bivariate logistic regression was applied to identify associated factors, followed by multivariate logistic regression for variables with a p-value<0.05 considered to be significant. Results: The mean age of the participants was 20.63±1.49 years. Depression was observed among 165 (38.9%). Among those with depression, 53 (32.3%) had minimal, 48 (28.8%) mild, 40 (24.3%) moderate, 16 (9.9%) moderately severe and 8 (4.7%) severe depression. Depression was significantly associated with age ≤20 years (p-value=0.028), type of college (p-value=0.013), family structure (p-value=0.030), fa-ther’s occupation (p-value <0.001), and limited social interaction (p-value=0.002). Conclusion: A high prevalence of depression was observed among college-going young adults in the Chengalpattu district. Younger age, academic discipline, family structure, parental occupation and reduced social interaction were key determinants. This highlights the importance of early intervention, lifestyle changes and enhanced social support systems to effectively address growing mental health chal-lenges.

Assessment of Iron Stores among Non Anaemic Pregnant Women in their First Trimester: A Cross-sectional Study

Introduction: During the first trimester of pregnancy, iron stores begin to deplete without any apparent signs of Iron Deficiency Anaemia (IDA). This gradual depletion can result in ineffective erythropoiesis, eventually leading to anaemia in the second and third trimesters. In India, where most pregnancies are unplanned, assessing iron stores during the preconception period is particularly chal-lenging. Aim: To determine the prevalence of depleted iron stores among non anaemic pregnant women in their first trimester. Material and Methods: A cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Medical College, Kolkata, West Bengal, India, from April 2021 to March 2022. A total of 150 pregnant women in their first trimester, attending the Outpatient Department (OPD) and having haemo-globin levels ≥11 g/dL and Packed Cell Volume (PCV) ≥33%, were enrolled. Data were collected and ana-lysed based on variables such as age, socioeconomic status, parity, haemoglobin levels, PCV, Mean Cor-puscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC), serum iron, serum ferritin, and Total Iron Binding Capacity (TIBC). Standard statistical methods were used for data analysis. Numer-ical variables were presented as mean±Standard Deviation (SD), and categorical variables were expressed as counts and percentages. A p-value of <0.05 was considered statistically significant. Results: The mean age of subjects was 24.63±4.88 years (range: 17-39 years; median: 24 years). The mean haemoglobin was 11.97±0.75 g/dL, while the mean PCV was 37.08±2.82%, mean MCV was 84.30±5.15 fL, and mean MCHC was 32.66±1.61. Among the total participants, 66 women (44%) had serum iron and fer-ritin levels below the normal range, indicating iron deficiency despite being non anaemic. Whereas for TIBC, 84 women (56%) had normal levels, and 66 (44%) had elevated TIBC. A statistically significant pos-itive correlation was observed between serum ferritin and serum iron (p<0.0001), while a statistically significant negative correlation was found between TIBC and serum iron (p<0.0001). Conclusion: The study found that a significant proportion of non anaemic pregnant women in the first trimester had depleted iron stores.

Knowledge, Attitude and Practice Regarding Healthy Lifestyle Practices among Practising Doctors in Belagavi, India and their Association with Cardiometabolic Parameters: A Cross-sectional Study

Harpreet Kour, Vinu Vij, Shaifali Gupta, Lakshmi Sundar

Introduction: Physicians are at heightened risk for unhealthy lifestyles owing to occupational pressures, despite their expertise in health promotion. This dissonance between knowledge and personal practice represents a critical, under-addressed issue within the medical community. Aim: To evaluate the Knowledge, Attitude, and Practice (KAP) regarding healthy lifestyles among doctors and examine their association with cardiometabolic parameters. Materials and Methods: This cross-sectional study was conducted at the Department of Physiol-ogy, Jawaharlal Nehru Medical College (JNMC), Belagavi, India, from March 2025 to October 2025. Using convenience sampling, 83 practising doctors from various clinical specialities within Belagavi district were enrolled. A structured KAP questionnaire was developed through literature review and expert valida-tion. Knowledge was scored across 10 items (correct/incorrect). Attitudes and practices were assessed using 10 items each on 5-point Likert and frequency scales, with total scores calculated per domain. A composite KAP index was derived by standardising and summing the three domain scores. Anthropometric {Body Mass Index (BMI), waist circumference), physiological-Blood Pressure (BP) and biochemical- Random Blood Glucose (RBG)} parameters were measured using standardised protocols. Relationships were assessed using Pearson’s correlation and multivariable linear regression, with adjustment for confounders in-cluding age, experience, and medication use. Results: The mean age of participants was 49.4±9.46 years, with 21.24±9.26 years of experi-ence. Participants demonstrated moderate knowledge (mean 6.86±1.59/10) and positive attitudes (mean 40.76±3.64/50), but only moderate practice engagement (mean 33.61±6.45/50). The mean Body Mass Index (BMI) of participants was 24.48±2.37 kg/m², waist circumference 82.7±6.78 cm, Systolic Blood Pressure (SBP) 116.76±6.57 mmHg, Diastolic Blood Pressure (DBP) 76.27±4.7 mmHg, and Random Blood Glucose (RBG) 98.8±15.01 mg/dL. Practice scores showed significant inverse correlations with BMI (r=-0.232, p-value=0.035), DBP (r=-0.354, p-value=0.001), and RBG (r=-0.272, p-value=0.013). Adjusted regression mod-els confirmed that the 28 doctors (33.7%) in the highest composite KAP tertile had significantly lower diastolic blood pressure (β=-3.14, 95% CI: -5.68, -0.59) and random blood sugar (β=-8.54, 95% CI: -16.62, -0.46) compared to those in the lowest tertile. Conclusion: A significant KAP gap persists among physicians regarding healthy lifestyles. Nota-bly, self-reported practices, rather than knowledge or attitudes, were independently associated with better cardiometabolic health outcomes.

Comparison of Intubating Conditions using King Vision™ Video Laryngoscope versus I-view™ Video Laryngoscope: A Randomised Clinical Study

Simran Sharma, Ruchi Kapoor, A Naveen Mathew, Ashok Kumar Saxena

Introduction: Video Laryngoscopes (VLs) offer better glottic visualisation than direct laryn-goscopy, thereby minimising the risk of hypoxia and trauma associated with Difficult Intubation (DI). The King Vision™ VL is a portable device with disposable hyperangulated channelled and non channelled blades. The I-view™ Intersurgical™ VL is a novel, fully disposable single-use device with a Macintosh-type blade that offers a familiar and intuitive intubation technique. Aim: To compare the intubating conditions using the non channelled King Vision™ VL and the I-view™ VL in adult patients receiving general anaesthesia for elective surgical procedures. Materials and Methods: This randomised single-blind clinical was conducted at the Department of Anaesthesiology, Guru Teg Bahadur Hospital, Delhi, India. A total of 40 adult patients (American So-ciety of Anaesthesiologists (ASA) I-II) were randomly assigned to Group KV (King Vision VL, non chan-nelled, size 3 blade; n=20) or Group I (I-view VL; n=20). Time to successful intubation (TTI) was the primary outcome. Secondary outcomes included the Intubation Difficulty Score (IDS), Percentage of Glot-tic Opening (POGO) score, Fremantle score (FS), first-attempt success rate, need for additional manoeu-vres, haemodynamic responses and complications, were compared between groups. Normally distributed quan-titative variables were evaluated using unpaired t-tests and qualitative variables were assessed using Chi-square or Fisher’s-exact test, as appropriate. Statistical analyses were all performed using Sta-tistical Package for the Social Sciences (SPSS) version 20.0, with a significance level of p-value <0.05. Results: Baseline demographics and airway parameters, including age, weight, Body Mass Index (BMI), ASA class and airway assessment scores, were comparable (p-value >0.05). Mean TTI was similar between Group I and Group KV (49.5±10.7 seconds vs. 52.7±9.3 seconds, p-value =0.312). First-attempt success was higher in Group I (85% vs 70%, p-value =0.250), with fewer additional manoeuvres (30% vs. 45%, p-value =0.439). POGO scores, IDS and Fremantle scores were comparable (p-value >0.05). Both groups achieved a 100% overall success rate. Haemodynamic responses (Heart Rate (HR) and blood pressure) were significantly lower in Group I following intubation (p-value <0.05). No complications occurred in either group. Conclusion: Both King Vision™ and I-view™ VLs provided comparable intubation conditions regard-ing time to intubation, glottic visualisation and difficulty in adult elective surgical patients. The I-view™ demonstrated advantages, including higher first-attempt success, fewer additional manoeuvres and attenuated haemodynamic responses.

Antibacterial, Antioxidant Activities and GC-MS Analysis of Methanol Extracts of Andrographis paniculata, Indigofera tinctoria, Moringa oleifera, and Justicia adhatoda: An In-vitro Study

Introduction: Medicinal plants possess different groups of phytocompounds such as flavonoids, alkaloids, phenols, and tannins and saponins and offer protection against various infectious diseases. It has been proved that medicinal plants have antimicrobial, antispasmodic, emetic, and anticancer properties. The conventional synthetic drugs often lead to undesirable side effects and contribute to resistance, highlighting the need for alternative therapeutic agents. Medicinal plants have traditionally been used as effective remedies for a wide range of ailments in traditional medicine systems. Aim: To evaluate the antioxidant and antibacterial properties of Andrographis paniculata, Indigofera tinctoria, Moringa oliefera, and Justicia adhatoda methanol extracts, in in-vitro. Materials and Methods: The present in-vitro study was conducted at the Department of Microbiology, Dr ALM PGIBMS, University of Madras (January-December 2017). Methanol extracts of powdered A paniculata, I tinctoria, M oleifera, and J adhatoda were prepared via 48-hour maceration with methanol, followed by Seitz filtration and lyophilisation. Antibacterial activity was evaluated using the agar-well diffusion method against six gram-negative and two gram-positive bacterial pathogens. Antioxidant potential was assessed using the DPPH (2,2-diphenyl-1-picrylhydrazyl) assay. Major phytochemical constituents were identified through Gas Chromatography-Mass Spectrometry (GC-MS) analysis. Data were analysed using Excel and two-way Analysis of Variance (ANOVA); graphs were made in GraphPad Prism 5. and p<0.05 was considered significant. Results: I#IAI?I. paniculata showed higher zone of inhibition against Shigella, S. aureus and Enterococcus. I. tinctoria showed higher zone of inhibition against I#IPI?I. aeruginosa. S. aureus and Shigella. and showed moderate inhibition against I#IKI?I. pneumoniae. M. oleifera had higher zone of inhibition against P. aeruginosa and moderate activity against Enterococcus and P. vulgaris. J. adhatoda had moderate inhibition against Enterococcus and K. pneumoniae. A. paniculata and I. tinctoria had shown the highest antioxidant activity. The 1-Hexene, 1-butoxy-2-ethyl, cyclopentaneundecanoic acid methyl ester, 17 Alpha-ethyl-6beta-methooxy-3alpha, 5cyclo-5alpha androstane-17 beta diol and Methyl Z-tetradecnoate were the major phytochemicals identified in A. paniculata, I. tinctoria, I#IMI?I. oleifera and J. adhatoda, respectively. Conclusion: Combinations of these four extracts might have broad-spectrum antibacterial proper-ties. The extracts of A. paniculata, I. tinctoria, and J. adhatoda have significant antioxidant properties. Using these medicinal plants could support recovery from bacterial infections and oxidative stress of chronic diseases, along with additional healthcare benefits.

Characterisation of Mutations in rpoB Gene and Assessment of Risk Factors in Patients with Rifampicin-resistant Tuberculosis: A Cross-sectional Study from Eastern India

Ayurvashi Anjali, Vidyut Prakash, Rinku Kumari, Kamlesh Kumar

Introduction: Tuberculosis (TB) continues to be a significant public health challenge in In-dia, with alarming prevalence rates and unique socio-demographic risk factors. Resistance to Rifampicin (RIF), is caused by mutations in the rpoB gene of the causative agent. It is usually situated in a region at the 507-533 amino acid residues (81 bp) within the rpoB gene, known as the Rifampicin Resistance Determining Region (RRDR). Aim: To assess the prevalence of Rifampicin Resistance (RR) and identify mutations in the RRDR of the rpoB gene. Materials and Methods: This cross-sectional study was conducted at ESIC Medical College, Pat-na, in collaboration with the NABL-accredited laboratory associated with Tertiary care Hospitals, Patna, Bihar, India from July 2024 to January 2025. A total of 502 clinical samples from suspected cases of TB were analysed by GeneXpert MTB/RIF testing. Deoxyribonucleic Acid (DNA) extraction was done only for the MTB complex with RR followed by automated DNA sequencing. Data obtained from these 68 RR-MTB clinical samples were enrolled in this study. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software with the association of multivariate logistic regression with p-value <0.05. Results: In this study, 46.57% (68/146) of all MTB-positive patients were RR. The highest al-teration was at the Ser/Leu substitution at codon 531 present in 45.6% (31/68) isolates, followed by His/Tyr substitution at codon 526 in 25% (17/68), mutation at codon 516 in 16.17% (11/68) isolates and mutations at codon 511 demonstrated in 13.23% (9/68) isolates. Conclusion: Mutations within the RRDR of the rpoB gene, particularly at codons 531 and 526, were identified as the predominant drivers of RR among pulmonary TB patients in Eastern India. The study highlights the importance of integrating rapid molecular diagnostics with socio-demographic risk assessment to enable early detection, guide individualised treatment, and strengthen regional TB control strategies.

Incidence of Paragonimus Metacercariae in Freshwater Crabs in Ammapettai Village: A Pilot Study

Sunil Kumar Jada, Priyadarshi Soumyaranjan Sahu, Eswarr Bellamkonda

Introduction: Paragonimus westermani is a significant lung fluke parasite that affects humans by causing a disease called paragonimiasis, transmitted through the consumption of inadequately cooked or pickled freshwater crabs (the second intermediate host) containing metacercariae. This infec-tion is one of the many neglected tropical foodborne parasitic zoonoses found in various parts of the world, particularly in developing countries. It continues to pose a significant public health challenge in regions where such practices of eating undercooked or improperly prepared seafood are common. Aim: To explore Paragonimus metacercariae infestation in freshwater crabs in a rural area. Materials and Methods: This pilot study involved a survey to find freshwater crabs, which are intermediate hosts for Paragonimus westermani, in Ammapettai village over three months from Octo-ber 2019 to December 2019. Crab consumption is common in this area. A total 80 crabs were collected from ponds, paddy fields, and lakes. Crabs were humanely euthanized by piercing the sternum; legs and claws were then removed. The shell (carapace) was lifted off and discarded. Each crab was carefully dissected, and its body parts- main shell (carapace), claws (chelipeds), and legs (periopods)- were examined sepa-rately for parasite infestation. Statistical analysis using the chi-square test was performed to check if there was any significant difference in parasite infestation between different parts of the crab col-lected in rural area. Results: Microscopic examination revealed an overall incidence of Paragonimus metacercarial infestation in five of 80 (6.25%) crabs. Among other parasites, only monogeneans were detected in two crabs that constitute 2.5% of the total numbers. Conclusion: The results of the research are helpful for predicting the future risks from the pulmonary paragonimiosis in humans.

Evaluating the Peel Bond Strength of Polymethylmethacrylate and Maxillofacial Silicone Elastomer Reinforced with Titanium Oxide Nanoparticles: A Comparative In-vitro Study

Shruti Varma, Deeksha Gupta, Sonal Mehta, Dhwani Patel

Introduction: Maxillofacial prostheses typically last around six months. The facial prostheses are usually provided with an acrylic substructure. This aids in enhanced retention and stability of silicone material. For good results acrylic and silicone materials must bond well with each other. Aim: The aim of the present study was to evaluate and compare the Peel Bond Strength (PBS) of Polymethylmethacrylate (PMMA) acrylic resin and maxillofacial silicone elastomer reinforced with Titanium oxide (TiO₂) nanoparticles. Materials and Methods: The present comparative in-vitro study was conducted in the Department of the Prosthodontics and Crown and Bridge in Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India. for a time period of six months from February to July in the year 2022. A total of 64 rectangular shaped maxillofacial silicone elastomer specimens with well-formed shaped and no visual irregularity were equally divided into two groups. group A silicone was without TiO₂ nanoparticles and group B silicone was added with TiO₂ nanoparticles. group A was further subdivided into A1 (PMMA acrylic resin and Silicone elastomer bonded with primer) and A2 (PMMA acrylic resin with retentive holes and Silicone elastomer) with 16 specimens in each subgroup. Similarly, group B was subdivided into B1 (PMMA acrylic resin and silicone elastomer reinforced with TiO₂ bonded with primer) and B2 (PMMA acrylic resin with retentive holes and Silicone elastomer reinforced with TiO₂) with 16 specimens in each sub-group. The acrylic and silicone specimens were bonded together with primer in subgroup A1 and B1 and with retentive holes in A2 and B2. The PBS was assessed through a 180° peel test on a universal testing machine and the mode of failure between the two materials was visually inspected. The data was statistically analysed using Independent t-test and one-way Analysis of Variance (ANOVA) (p=0.05). Results: The difference between A1 and A2 was statistically significant (p=0.05). However, PBS values in other subgroups pairs (A1-B1; A2-B2; B1-B2) did not show a statistical significance. Tests indicated that specimens bonded with primer A-330 Gold platinum experienced adhesive bond failure. Conclusion: Within the limitations of this study, retentive holes offer significantly stronger PBS between PMMA acrylic resin and maxillofacial silicone compared to primer alone. However, incorporating nanoparticles into maxillofacial silicone does not enhance the PBS between the given two materials.

Colour Stability of Aligners in Distilled Water, Mouthwash and Carbonated Drinks: An In-vitro Study

Introduction: Clear aligners have gained immense popularity in orthodontics due to their aesthetic appeal and convenience. However, colour stability is a crucial factor that can affect patient satisfaction and treatment outcomes. Commonly consumed mouthwashes and carbonated beverages may cause discolouration of aligners, necessitating an investigation into their effects. Aim: To assess the impact of various mouthwashes and carbonated drinks on the colour stability of orthodontic aligners over a prolonged exposure period. Materials and Methods: An in-vitro experimental study was conducted in the Department of Bio-chemistry, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India, in September 2024 using 45 clear aligner samples (SmartTrack). The samples were immersed in control solutions (distilled water), mouthwash (chlorhexidine), and carbonated drinks for two weeks. Each sample underwent simulated daily exposure at 37°C, and colour assessments were performed using a Ultraviolet–visible (UV-Vis) spectrophotometer at the end of the study. Optical density values were obtained and converted to Commission Internationale de l'Éclairage Laboratory* colour system (CIELAB) values. Statistical analysis included descriptive statistics (mean, median, standard deviation, and range), intragroup analysis (Fisher’s-exact test), and intergroup analysis (Mann-Whitney U test). Results: Significant colour changes were observed in aligners immersed in carbonated drinks, which demonstrated the highest ?E values, the standard measurement of colour difference given by CIE. A p-value <0.05 indicated statistical significance, particularly at the T1 timepoint. Mouthwashes also contributed to noticeable discolouration, though to a lesser extent than carbonated drinks. Conclusion: Both carbonated beverages and mouthwashes negatively impact the colour stability of clear aligners, with carbonated drinks causing more pronounced discolouration. Clinicians should inform patients about these effects and recommend appropriate care routines to maintain the aesthetic quality of aligners. Further research is warranted to explore methods for enhancing the stain resistance of aligner materials.

Correlation of Dermatoglyphics and Hormonal Fingerprints with Dental Caries among 3-6-year-old Children: A Cross-sectional Study

Introduction: Dermatoglyphics, which develops concurrently with tooth enamel during embryogenesis, has been explored as a genetic marker. The second-to-fourth digit ratio (2D:4D), or hormonal fingerprints, is another potential biological marker for predicting dental caries. Early detection of children at high risk for caries may enable timely preventive interventions, and reducing progression of caries and improve long-term oral health outcomes. Aim: To evaluate the correlation between dermatoglyphics and hormonal fingerprints as predictors of dental caries among three to six-year-old children. Materials and Methods: This cross-sectional study was conducted among school-going children aged 3-6 years enrolled in government, private schools and anganwadi centres in Bhimavaram, Andhra Pradesh, India from October 2024 to December 2024. including 98 healthy children aged 3-6 years with parental consent. Participants were divided equally into two groups- caries-active (def ≥1) (group I) and caries-free (def=0) (group II) per World Health Organisation (WHO) oral health assessment criteria. Fingerprints of all 10 digits were recorded using the Cummins and Midlo ink method, then examined under 2× magnification and classified as arch, loop, or whorl. The 2D:4D ratio of the right hand was measured with a digital Vernier caliper and categorised as high (≥1) or low (<1). Statistical analysis performed using Chi-square and Independent t-tests for group comparisons, Pearson’s correlation for associations, and regression analysis for predictive value, with statistical significance was set at as p-value <0.05. Results: Fingerprint patterns were significantly associated with dental caries, with loops as the predominant dermatoglyphic pattern among caries-active children, followed by whorls (p-value <0.05). Hormonal fingerprints were not significantly associated with caries activity (p-value >0.05) but correlated positively with loop patterns in the right hand and both hands combined (p-value <0.05). Regression analysis showed no significant predictive association between either markers and caries (p-value >0.05). Conclusion: The higher prevalence of loops in caries-active children suggests dermatoglyphics as a predictor for assessing dental caries risk. However, the cross-sectional single-centre design limits causal inference and generalisability.

Exploring the Impact of Hip, Ankle and Stepping Strategy Training on Balance and Gait Parameters among Individuals with Neurological Conditions: A Scoping Review

Jatin Sangwan, Akanksha Saxena

Introduction: Co-ordinated hip, ankle, and stepping strategies play a crucial role in postural control, which is often impaired in patients with neurological conditions such as stroke, multiple scle-rosis, Parkinson’s disease, and Diabetic Peripheral Neuropathy (DPN). Despite their widespread clinical use, the available evidence has not been systematically mapped to determine their effects on balance and gait parameters. Aim: To collate, synthesise, and report existing evidence on the effects of hip, ankle, and stepping strategy training (SST) on balance and gait parameters among individuals with neurological con-ditions. Materials and Methods: This scoping review followed PRISMA-ScR guidelines. The review proto-col was registered on the Open Science Framework (OSF) with the registration DOI: 10.17605/OSF.IO/CAF63. Three electronic databases—PubMed, Scopus, and ScienceDirect—were searched for studies published in the English language. The search strategy included relevant keywords, Boolean operators (AND, OR, NOT), Med-ical Subject Headings (MeSH) terms, and filters such as publication year range, randomised clinical tri-als, and language. Results: Fourteen studies were included in this scoping review. Study characteristics were sum-marised based on the populations investigated, types of postural-strategy training employed (hip, ankle, and stepping strategies), and intervention duration. Ankle Strategy Training (AST) on unstable surfaces demonstrated significant improvements in Centre Of Pressure (COP) sway. When combined with Hip Strategy Training (HST), greater improvements were observed in proximal extremity control and limits of stabil-ity. Several studies also reported that perturbation-based training enhanced reactive balance by in-creasing tolerance to perturbation intensity, improving confidence during community mobility, reducing fall risk behaviours, and enhancing gait parameters. Conclusion: Postural-strategy training improves balance and gait parameters in individuals with neurological conditions. Each strategy offers distinct benefits, while multistrategy training yields greater functional improvements than single-strategy interventions.

Evaluation of In-vitro Synergy of Ceftazidime-Avibactam and Aztreonam against Carbapenem-resistant Enterobacterales Isolates from ICU Patients in a Tertiary Care Hospital: A Cross-sectional Study

Nidhi Yaduvanshi, Nidhi Tejan, Kanchan Kumari, Sangram Singh Patel, Chinmoy Sahu

Introduction: Carbapenemase-Resistant Enterobacterales (CRE) show rapid global dissemination and pose a significant therapeutic challenge due to limited effective treatment options. Although the combination of Ceftazidime–Avibactam (CZA) and Aztreonam (ATM) has emerged as a promising strategy against such isolates, standardised and easily implementable laboratory methods for detecting in-vitro synergy remain limited. Aim: To evaluate in-vitro synergy of CZA and ATM against CRE isolates from various clinical sam-ples. Materials and methods: This cross-sectional study was conducted in the Department of Microbi-ology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from June 2024 to December 2024. A total of 121 non duplicate, monomicrobial Gram-negative isolates obtained from Intensive Care Unit (ICU) patients, all of which were resistant to carbapenems (imipenem, mero-penem), were included in the study. Identification was performed using Gram staining, biochemical tests, and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Car-bapenemase production was assessed by the modified Carbapenem Inactivation Method (mCIM) and Ethylene-diamine-tetraacetic Acid (EDTA)-modified Carbapenem Inactivation Method (eCIM). Synergy between CZA an ATM was tested by the Double Disc Diffusion Method (DDDM) and CZA+ATM, CZA + ATM Broth Disc Elution Method (BDEM). Demographic and clinical data, such as age, sex, and co-morbidities, risk factors, were recorded. Results: Out of 121 isolates of CRE, 76 (62.8%) isolates were identified as K. pneumoniae followed by 32 (26.5%) E. coli and 13 (10.7%) E. cloacae. Also, mCIM in combination with eCIM tested positive in 92 (76%) isolates, whereas mCIM alone tested positive in 29 (24%) isolates. Syn-ergy was observed in 89 isolates by the DDDM, whereas CZA + ATM BDEM showed synergy in 92 isolates. Conclusion: This study demonstrated a high prevalence of CRE, predominantly in Klebsiella pneumoniae, among ICU patients, with carbapenemase production confirmed in the majority of isolates by mCIM/eCIM. A high rate of in-vitro synergy was observed between CZA and ATM using both DDDM and BDEMs, with excellent concordance between the two techniques. These findings support the routine use of phenotypic synergy testing in clinical laboratories to guide effective therapeutic options against CRE.

Automated Detection of Acute Appendicitis from Contrast-enhanced CT Images using CNN with GAN-based Data Augmentation: A Retrospective Observational Study

Introduction: Acute appendicitis is a common cause of acute abdominal pain, which should be appropriately diagnosed, so that the subsequent perforation, or unjustified surgeries, may be prevented. The use of Artificial Intelligence (AI) powered structures can combine clinical and imaging data to ena-ble faster, more precise detection. Aim: To develop an automated system for detecting acute appendicitis using Convolutional Neural Networks (CNNs) and Generative Adversarial Networks (GAN)- based data augmentation. Materials and Methods: A retrospective observational study has been conducted at the General Medicine Unit, Vinodhagan Memorial Hospital, Thanjavur, Tamil Nadu, India from January 2022 to June 2025, to analyse clinical data from 500 patients, of whom 100 underwent Contrast-enhanced Computed To-mography (CECT) scans according to clinical indications. The training input included 70 original CT im-ages, which were enhanced using a GAN to produce 140 synthetic images, for a total of 210 training imag-es. The validation set (10 images) and Independent test set (20 images) consisted solely of original CT-acquired images to avoid bias in evaluating the model. A Feedforward Neural Network (FNN) was used to process the clinical symptoms (body temperature, abdominal pain, nausea, and appetite loss) and provide the probability of appendicitis. The CT Images of high probability patients were collected for further analysis. The analysis of CT images was processed using a three-dimensional Residual Network (3D Res-Net)-based CNN. GANs were used to generate synthetic images to improve model robustness through data augmentation. The system was evaluated based on accuracy, sensitivity, specificity, and F1 score, and the results were compared with surgical outcomes. Results: The image-based CNN with GAN augmentation produced the best diagnostic results with an accuracy of 90%, precision of 0.91, recall of 0.91, F1 score of 0.91, specificity of 0.89, and AUC-ROC of 0.90. The FNN model, which uses symptoms as the independent variable, achieved an accuracy of 80% and an AUC-ROC of 0.81. The CNN baseline with no augmentation got the 85% accuracy and an AUC-ROC of 0.85. Conclusion: GAN-based augmentation improves model generalisation on small datasets. The model has great potential for clinical implementation, thereby preventing misdiagnosis and unnecessary surger-ies.

Clinical Evaluation of Hapushadi Yapan Basti in the Management of Katigata Vata (Lower Back Pain): A Single Arm Clinical Study

Introduction: Lower back pain is widely emerging as one of the most common global health is-sues. It can range from mild to severe. For most, it is temporary due to the self-limiting nature of underlying conditions such as muscle strain and ligament sprain, which typically resolve spontaneously within 2 to 6 weeks. Additionally, the body’s natural inflammatory response and pain modulation mecha-nisms contribute to the transient nature of lower back pain, although it can make everyday activities difficult to perform. Different Ayurvedic therapies, like Upnaha (Herbal Poultice), Raktamokshana (Blood Letting), and Agnikarma, have shown good results in treating lower back pain conditions but Basti therapy (Ayurvedic drugs enema) has the maximum potential to minimise pain related to bones and joints and facilitate a speedy recovery to normal functions. Aim: The main aim of the present study was to assess the effect of Hapushadi Yapan Basti in reducing the lower back pain. Materials and Methods: A single-arm clinical study was conducted with a sample size of 36 patients experiencing lower back pain, selected randomly at Panchakarma Out Patient Department (OPD) of Dr. D.Y. Patil College of Ayurveda and Research Centre, Pune, Maharashtra, India. The study was conduct-ed from April 2023 to September 2024. The primary inclusion criteria included patients exhibiting textu-al symptoms of Katigata Vata (Kati Sandhi Shula, Kati Sandhi Graha, Sparshashatva) within the age range of 18 to 70 years, who were also fit for Basti Karma. Patients received Hapushadi Yapan Basti for seven days. The demographic factors assessed included age, sex, religion, occupation, diet, Prakriti (physical constituents), Koshtha (bowel hab-its), and Agni (Digestive Fire). Assessments of sign and symptoms before and after intervention was carried out using Visual Analogue Scale (VAS) and coin test. The Wilcoxon Signed Rank test revealed a significant reduction in assessment parameters with p<0.05. Results: A statistically significant improvement was observed in patients experiencing lower back pain, as evidenced by a notable reduction in pain intensity, tenderness, and restricted movement. This significant effect was confirmed by a p-value of less than 0.05, indicating a high probability that the observed improvements were due to the intervention rather than chance. Conclusion: The study conclusively demonstrates the efficacy of Hapushadi Yapan Basti Therapy in reducing lower back pain and alleviating associated symptoms such as tenderness and re-striction of movement, thereby achieving its intended objectives.

Association of Plasma Trimethylamine N-oxide Levels with Stroke Severity and Outcome in Patients with Acute Ischaemic Stroke: A Prospective Observational Study

R Kavin Shankar, Anuradha B Patil, AO Saroja, Sagar M Nitturkar

Introduction: Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, has been implicated in cardiovascular and cerebrovascular disease. However, its association with stroke severity and early functional outcomes in Acute Ischaemic Stroke (AIS) remains inconsistent, particularly in In-dian populations. Aim: To evaluate plasma TMAO levels in patients with AIS and to examine their association with stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS), and 90-day func-tional outcomes measured by the modified Rankin Scale (mRS). Materials and Methods: The present prospective observational study included 80 adults with first-ever AIS admitted to a Tertiary Care Centre, Belagavi, Karnataka, India, between May 2024 and April 2025. Plasma TMAO levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA). Stroke severity was assessed at admission using NIHSS, and functional outcomes were evaluated at 90 days using mRS. Associations between TMAO levels and clinical variables were analyzed using the appropriate Krus-kal-Wallis test, Mann-Whitney U test, and Spearman’s rank correlation test. Results: The median plasma TMAO concentration was 2.24 μmol/L (IQR:1.78-2.75), and the median NIHSS score at admission was 11.0 (IQR:6.0-15.0). No significant correlation was observed between plasma TMAO levels and NIHSS scores or categorical 90-day mRS outcomes. However, a moderate inverse correlation was identified between plasma TMAO levels and 90-day mRS scores (ρ=-0.399, p<0.001), indicating better functional recovery with higher TMAO concentrations. TMAO levels did not differ significantly across major clinical comorbidities except congenital heart disease (p=0.047). Conclusion: Plasma TMAO levels showed a significant inverse relationship with functional disa-bility at 90 days but were not associated with acute stroke severity. These findings suggest that TMAO may reflect aspects of post-stroke recovery rather than acute neurological injury.

Effectiveness of Structured Near Peer-Guided Mentorship Intervention in Improving Academic Performance and Mental Well-being among University Nursing Students: A Quasi-experimental Study

Introduction: The significance of mental health is becoming more widely recognised as it adds to quality of life. Mentoring relationships can enhance both professional and personal growth, which in turn can improve mental well-being. Aim: To assess the prevalence of mental well-being and effectiveness of structured peer-guided mentorship in improving academic performance and mental well-being among undergraduate nursing students who need additional curricular support and have low mental well-being. Materials and Methods: A quasi-experimental pre-post-interventional study was conducted at the Department of Physiology and Medical Education, Sri Sidhartha Institute of Nursing affiliated under Sri Siddartha Academy of Higher Education (SSAHE), Agalakote, Tumkur, Karnataka, India, among 249 under-graduate nursing students between November 2022 to March 2023 to assess the prevalence of mental well-being by using Warwick Edinburg Mental Well-being Scale (WEMWBS) in English after validating it in cur-rent setting. Internal consistency was evaluated utilising Cronbach’s alpha. Of these 249 students, year I and II students had relatively lower mental well-being scores and were found in need of addition-al curricular support based on their formative assessments scores. A total of 80 students of year I and year II were selected who had formative assessment scores less than 50%. These students underwent near peer-guided mentoring for core competencies in their academic year. Paired t-test was used and data was analysed using IBM Statistical Package for Social Sciences (SPSS) statistics (version 26.0). Results: Among undergraduate nursing students, it was demonstrated that low mental well-being scores was more common in years I and II relative to later years. The near peer-guided mentorship pro-gramme was associated with a statistically significant (p-value<0.001) at 5% level improvement in aca-demic performance and mental well-being scores. Conclusion: The nursing professionals need to be cared for their mental well-being in their earlier years of academic life with suitable educational interventions as they are affected by the tran-sition phase at university. This will enable individuals to reach their full potential and achieve aca-demic performance to their best.

Vesical Imaging Reporting and Data System (VI-RADS) as an Imaging Biomarker of Urinary Bladder Tumour: A Cross-sectional Study

Introduction: The Vesical Imaging Reporting and Data System (VI-RADS) score is an emerging imaging tool that can predict detrusor invasion of bladder tumours. The VI-RADS score has been introduced for standardised reporting of Multiparametric Magnetic Resonance Imaging (MP-MRI) in bladder tumours. It incorporates components of structural (T2-weighted), functional (DWI), and Dynamic Contrast-Enhanced imaging (DCE). Aim: To assess the role of Multiparametric MRI- (MP-MRI) based VI-RADS score in predicting detrusor invasion in bladder tumour patients determined by Histopathological Examination (HPE). Materials and Methods: The present cross-sectional study was conducted in the Department of Radiodiagnosis and the Department of Urology at IPGME&R, Kolkata, India, from January 2021 to August 2022. Adult patients with cystoscopically proven bladder tumours were included in the study after providing informed consent. Each patient was assessed by cystoscopy and MP-MRI of pelvis. Subsequently, each patient underwent Transurethral Resection of Bladder Tumour (TURBT) and biopsy for HPE.Both descriptive and analytical statistics were used in the present study. The diagnostic accuracy of the VI-RADS score with HPE have been analysed. The association between VI-RADS scores and ADC values, tumour grades, and morphological variants were also assessed. Efficacy of individual components of VI-RADS score with muscle invasiveness is also analysed by Cohen’s kappa values. Results: The median age of the study subjects is 60 years, with 29 out of 35 subjects being male (82.8%). Known risk factor smoking is detected in 11 subjects (31.4%). The present study showed sensitivity of 100% and specificity of 76.1% with a cut-off VI-RADS score of 3; AUC 0.869 (CI- 0.712 to 0.959), p<0.0001. VI-RADS score is predictor of muscle invasion and tumour grades (Odds ratio 5.43, CI 1.77 - 16.61, p<0.01). ADC values are more related to tumour grades (lower median value 0.00090 vs 0.00097; p<0.05). Individual components of the VI-RADS score (T2WI, DCE, DWI) are effective in predicting tumour muscle invasion (AUC values, respectively, 0.886, 0.869, 0.869; p<0.0001). Sessile variants of tumours have a higher VI-RADS score compared to other morphological types (median 4 vs 2, with p<0.05). Conclusion: The results of the present study suggest that MP-MRI-based VI-RADS score is an imaging predictor of bladder tumour detrusor invasion. and also a predictor of tumour grades.

Association of Vitamin-D Deficiency with its Clinical Features among Children in a Primary Care Setting: A Cross-sectional Study

Introduction: Vitamin D plays a critical role in bone health, immune function, and metabolic regulation. Deficiency of vitamin D in children and adolescents is increasingly associated with adverse metabolic, cardiovascular, and neurological outcomes. Aim: To assess the prevalence of Vitamin D Deficiency (VDD) and its association with biochemical parameters and clinical features among children attending primary care settings. Materials and Methods: The present cross-sectional study was conducted from October 2023 to March 2024 involving 128 children aged 1-18 years, recruited from the Outpatient Departments of Paediat-rics and Community Health centres affiliated with the Hamdard Institute of Medical Sciences and Re-search, New Delhi, India. Serum vitamin D levels were used to categorise participants as deficient (<12 ng/mL), insufficient (12-20 ng/mL), or sufficient (>20 ng/mL). Biochemical markers, including calcium, phosphorus, Alkaline Phosphatase (ALP), and Parathyroid Hormone (PTH), along with clinical features of VDD, were evaluated. Data were statistically analysed using the unpaired t-test and Analysis of Variance (ANOVA). Results: The mean age of the participants was 7.51±0.40 years, with 76.6% children and 23.4% adolescents. A high prevalence of VDD (76.6%) was observed, while only 10.9% of participants had optimal vitamin D levels. Despite biochemical evidence of deficiency, no clinical signs of rickets were detected, suggesting the presence of compensatory mechanisms. A significant association was found between se-rum vitamin D levels and ionised calcium (p<0.001), with higher calcium levels observed in participants with optimal vitamin D status (p=0.033). Socioeconomic factors such as dietary insufficiency, urban residence, and limited sun exposure may have contributed to the high prevalence of deficiency observed in this study. Conclusion: The present study reveals a widespread prevalence of vitamin D deficiency among children and adolescents, posing significant long-term health risks. Urgent public health interventions are required, including mandatory food fortification, targeted supplementation for high-risk groups, and campaigns promoting safe sun exposure to effectively address this preventable condition and improve future generational health.

Anatomical and Developmental Abnormalities of Kidney and Ureter: A Cadaveric Study from Karnataka, India

Introduction: Cadaveric studies of kidneys and ureters serve as the foundational bedrock for understanding human urological anatomy, providing irreplaceable insights into structural variations that directly impact clinical practice across surgery, radiology and medical education. These meticulous dissections reveal a landscape far more complex and variable than textbook illustrations suggest, with profound implications for patient safety and procedural success. Aim: To evaluate the prevalence of anatomical and developmental abnormalities of kidneys and ureters in human cadavers. Materials and Methods: The present retrospective study was conducted during routine dissections of 34 cadavers over a period of five years from August 2019 to July 2024 at Department of Anatomy, The Oxford Medical College, Hospital and Research Centre in Bangalore, Karnataka, India. The study was planned and executed from December 2024 to November 2025. All specimens included in the present study were adult cadavers of which 20 were males and 14 were females. Photographs of the anomalous and developmental abnormalities were taken for proper documentation. Descriptive statistics were used to statistically analyse the data. Results: Out of 34 cadavers, 1 (2.94%) cadaver showed Hydronephrosis (HN) in left kidney, 1 (2.94%) cadaver showed partial duplication of right ureter, 5 (14.7%) cadavers showed lobulated kidneys and 6 (17.6%) cadavers showed cystic kidneys. Conclusion: Cystic kidney was the most common anomaly observed in the present study. Knowledge of anatomical variations is essential for urological, transplant and vascular surgeries. The identification of duplicate ureters and anomalies during cadaveric dissection provides surgeons with critical preoperative planning information.

Development and Validation of Algorithm for Cervical Vertebral Bone Age Assessment in Maharashtra Population: A Cross-sectional Study

Introduction: The skeletal maturity of individuals has been shown to vary over age, gender, ethnicity, etc. The commonly used methods for Cervical Vertebral Bone Age (CVBA) assessments are subjective and prone to inter-operator bias. This has led to the quest for establishing objective techniques. One such objective method for bone age estimation using multiple regression formulae for males and females has been established by the authors for the population of Maharashtra. However, the practical use of the equations is questionable, encouraging us to develop an automated technique for more practicality. Aim: To establish and validate an algorithm for the quantitative assessment of CVBA in the population of Maharashtra. Materials and Methods: This cross-sectional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India over a period of January 2024 to June 2025. This research developed an Artificial Intelligence (AI) algorithm for the objective estimation of CVBA. The research utilised 1000 radiographs from healthy individuals of Maharashtra origin (ages 9-20 years) to train a You Only Look Once (YOLO) v11 object detection algorithm, identifying C3 and C4 vertebral landmarks after data augmentation. A Python program later assessed bone age using these detections and gender-specific methodologies based on pre-existing Maharashtrian formulae, which are stepwise multiple linear regression formulae. The algorithm was tested with 150 independent lateral cephalograms and validated by comparing unused 150 lateral cephalograms with hand-wrist radiographs using the Tanner-Whitehouse (TW3) hand-wrist method (gold standard), employing statistical analyses such as the Mann-Whitney U test, Spearman's rank correlation, and Intraclass Correlation Coefficient (ICC). Results: The mean age estimated using AI technology and hand wrist age was 13.04±1.95 and 12.78±1.82 years, respectively and indicated a negligible difference in the age estimated by the AI and hand wrist age (TW3 method). There was an almost perfect agreement in the age estimated using AI and hand-wrist age (TW3 method) (ICC=0.994). There was an excellent positive correlation in the age estimated using AI and hand-wrist age (TW3 method) (Spearman’s rho=0.974). Conclusion: The average age of AI algorithm was very close to TW3’s hand-wrist method average estimated age. This was consistent across the genders. Thus, the algorithm that was built was dependable as it was closely related to the gold standard.

Revolutionising Periodontal Healing: An In-vitro Study on Antibacterial and Antioxidant Synergy in Graphene Oxide and Resveratrol Nano-enhanced Suture Coatings

Maria Sharon Velraj, Arvina Rajasekar

Introduction: Periodontitis is a chronic inflammatory disease commonly treated by Periodontal Flap Surgery (PFS), where sutures are essential for wound closure. However, suture-related bacterial colonisation and oxidative stress may impair healing and increase postoperative complications. Nano-enhanced suture coatings with antibacterial and antioxidant properties may improve periodontal wound healing outcomes. Aim: To evaluate the antibacterial and antioxidant efficacy of reduced Graphene Oxide (rGO) and Resveratrol (RV) nano-enhanced silk suture coatings for periodontal surgical applications. Materials and Methods: This in-vitro experimental study was conducted at Department of Periodontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India, from January 2025 to April 2025. Silk sutures were divided into four groups: uncoated (control), 0.05% rGO-coated, 0.1% rGO-coated and 0.1% RV-loaded rGO-coated (RV-rGO). Fourier Transform Infrared Spectroscopy (FTIR) was used to confirm chemical integration and Scan-ning Electron Microscopy (SEM) was performed to assess surface morphology. Antibacterial activity against Streptococcus mutans and Escherichia coli was evaluated using the zone of inhibition assay and antioxidant activity was assessed using the 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) radical scavenging assay. All data are presented as mean±Standard Deviation (SD). Results: Data were collected as zone of inhibition values (mm) and absorbance readings and presented as mean±standard deviation. FTIR spectra demonstrated characteristic Amide I and II bands of silk fibroin and additional peaks confirming the successful integration of rGO and RV. SEM analysis revealed a roughened suture surface with uniformly distributed nanoparticles in the RV-rGO group. The RV-rGO-coated sutures showed the highest antibacterial activity (SM: 25±1 mm; EC: 23±1 mm) and superior antioxidant activity (72% DPPH scavenging). Conclusion: The RV-rGO nano-enhanced silk sutures exhibit synergistic antibacterial and antioxidant effects, supporting their potential to enhance periodontal wound healing and reduce suture-related complications.

Effectiveness of a Modified Skull Model for Nasopharyngeal Swab Training among Undergraduate Medical Students: A Prospective Interventional Study

Poornima S Bhat, K Santhana Krishnan, M Nisha, Vanshika Singhal

Introduction: Nasopharyngeal swab collection is considered one of the most sensitive methods for obtaining upper respiratory tract specimens; however, it requires adequate anatomical understanding and proper technique. Inadequate training may lead to patient discomfort, procedural complications, and false-negative results. Aim: To assess the effectiveness of a modified skull model in improving knowledge, confidence, and technical skills related to nasopharyngeal swab collection among undergraduate medical students. Materials and Methods: The present prospective interventional study was conducted among 75 Phase III MBBS students by the Department of Otorhinolaryngology at Varun Arjun Medical College & Rohilkhand Hospital, Uttar Pradesh, India, a tertiary care teaching hospital in Northern India between November 2024 and mid-February 2025. A cadaveric skull model was modified using silicone, cotton pads, and coloured inks to simulate nasal and nasopharyngeal anatomy. Participants received a structured demonstration followed by supervised hands-on practice until three consecutive successful swabs were achieved. Knowledge, confidence, and procedural skills were assessed before and after training using a structured questionnaire and an observational checklist. Results: The mean knowledge score improved significantly from 1.85±1.06 before training to 8.10±1.20 after training (p<0.0001). Confidence levels increased markedly, with 64 participants (85.3%) reporting high confidence (Likert 4-5) after training. Significant improvement was also observed in procedural skills, including swab direction, insertion depth, and correct identification of the nasopharyngeal sampling site (p<0.0001). Conclusion: The modified skull model proved to be an effective, affordable, and reproducible tool for improving knowledge, confidence, and technical proficiency in nasopharyngeal swab collection among undergraduate medical students.

Effectiveness of Tobacco Cessation Intervention in Tobacco Cessation Clinics, India: A Systematic Review

Introduction: Tobacco use presents a formidable public health challenge globally, and India is no exception, bearing a significant proportion of the worldwide disease burden attributable to tobacco consumption. Recognising this critical health crisis, Tobacco Cessation Clinics (TCC) have been established across India to provide specialised support for individuals aiming to quit. Aim: The present systematic review was aimed to explore the effectiveness of tobacco cessation intervention in TCCs in India. Materials and Methods: A search for relevant studies was conducted using the keywords ‘tobacco cessation India,’ ‘smoking cessation clinics India,’ ‘tobacco use cessation intervention India,’ and ‘pharmacotherapy smoking cessation India’. The search yielded 330 studies in PubMed, Google Scholar, Embase, and SCOPUS between 2004 and 2024. After duplicates were removed 52 full-text articles were retrieved and assessed for eligibility. Eligibility criteria included Randomised Controlled Trials (RCT) or quasi-experimental studies or cohort studies of any smoking cessation intervention with no age or gender limitation. The risk of bias was assessed using similar criteria for RCT and non-randomised studies guided by the Cochrane Handbook for Systematic Reviews. Results: A total of 10 studies (1613 Indian tobacco users) with mean age of the participants ranged from 34 years to 50 years were included. The current systematic review identified different cessation methods, with some employing both behavioural change and pharmacological methods, and some utilising only one method. The most commonly used interventions were cognitive behaviour education (n=23), motivational interviewing (n=19), and pharmacotherapy (n=3). Among them, counselling and behavioural support can improve smoking cessation rates along with pharmacotherapy, but the effect varies depending on the characteristics of the support provided. Conclusion: There were numerous tobacco cessation interventions for tobacco users in India, but the most effective intervention to change tobacco consumption behaviour is the combination of pharmacological and behavioural interventions. However, longer follow-up periods indicated reduced effectiveness.

Effectiveness of Task-specific Closed-chain Exercises on Functional Mobility in 6 to 12-year-old Spastic Diplegic Children: A Randomised Controlled Trial

Monika Mahadev Gawas, Sachin S Gawande

Introduction: Cerebral palsy is the leading cause of childhood disability worldwide. Children with spastic diplegia often have trouble with balance, making walking and reaching movements difficult. As a result, they may be less active, have lower strength, require assistance in daily activities, and find it difficult to take part in community activities in adulthood. Children with disabilities have lower engagement in school activities. Targeting the 6 to 12-year age group is therefore crucial, as early functional gains can influence long-term independence and participation. Aim: To determine the effectiveness of task-specific closed-chain exercise training on balance, gait parameters (cadence, stride length, step length and speed), and gross motor function in children aged 6 to 12 years with spastic diplegic cerebral palsy. Materials and Methods: The present single-blinded, randomised controlled trial was conducted at Goa Medical College (Bambolim) Goa, India. The study was carried out from October 2022 to November 2023. 30 participants were randomly allocated into two groups (n=15 each); group A: Task-specific closed-chain exercises and group B: Conventional physiotherapy. Both groups received 45-minute sessions, three times per week for six weeks. Outcome measures included the Paediatric Balance Scale (PBS), Gross Motor Function Measure (GMFM-88) Dimensions D and E, the 10-Meter Walk Test (10MWT), and observational assessment of gait parameters (cadence, stride length, step length and gait speed) using paper-and-ink footprint analysis. Assessments were done at baseline (0 weeks), post-intervention (6 weeks), and follow-up (10 weeks). Statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 24, with significance set at p<0.05. Demographic comparisons done using Chi-square and t-tests, while independent and paired t-tests assessed inter- and intra-group differences. Results: Both groups were homogenously distributed in age, gender, and physical ability level. Between-group comparisons revealed no statistically significant differences at any time point for PBS scores, gait parameters and gross motor function p>0.05. Within-group analysis showed improvements in PBS scores, gait parameters (gait speed, stride length, step length, cadence) and gross motor function from baseline to follow-up. group A demonstrated stronger gains overall, with large effect sizes in gait parameters and gross motor function {Stride length: group A (d=0.7), group B (d=0.4), GMFM-E: group A (d=0.8), group B (d=0.7)}. group B, however had greater improvement in PBS scores group A (d=0.7), group B (d=0.8). Conclusion: Task-specific closed-chain exercises helped children with spastic diplegia to improve their balance, walking, and overall movement abilities. This alongside conventional physiotherapy led to positive changes, the task-specific exercises proved beneficial in walking and gross motor skills. These exercises help children to move more confidently and independently, allowing them to take part more comfortably in everyday and community activities.

Effect of a Mind-Body-Spirit Intervention on Stress and Cardiovascular Parameters among Patients Undergoing Haemodialysis: A Pilot Study

Nancy Priya Mathias, Devina E Rodrigues, Priya Reshma Aranha

Introduction: Chronic Kidney Disease (CKD) affects more than 800 million people worldwide. Patients undergoing haemodialysis often experience increased stress and compromised cardiovascular health, which may affect treatment outcomes. Addressing these psychosocial and physiological challenges is therefore essential for improving patient well-being. Aim: To determine the effect of a Mind-Body-Spirit intervention on stress and cardiovascular parameters among patients undergoing haemodialysis. Materials and Methods: A quantitative pilot, quasi-experimental non equivalent pre-test–post-test control group design was used in the dialysis units of Yenepoya Medical College Hospital and Father Muller Medical College Hospital, Mangaluru, Karnataka, India, from November 30, 2023, to April 30, 2024. Thirty patients were purposively selected and allocated to an intervention group (n=15) and a control group (n=15). Data were collected using a demographic questionnaire and the Perceived Stress Scale (PSS); Blood Pressure (BP) and heart rate were measured using a calibrated digital BP monitor. The intervention group received the Mind-Body-Spirit intervention three times weekly for 12 weeks, while the control group received standard care. Demographic variables were summarised using frequency and percentage. Changes in stress, Blood Pressure (BP) and heart rate across time and between groups were analysed using two-way repeated measures Analysis of Variance (ANOVA) (p<0.05). Results: The total study sample included 30 participants. Most were aged 35-45 years, comprising 16 (53.3%), male 23 (76.7%), and unemployed 16 (53.3%). Most participants had undergone haemodialysis for 1-5 years 18 (60.0 %) and hypertension was the most common comorbidity 18 (60.0%). Baseline demographic and clinical variables were comparable between groups (p>0.05). The intervention group showed significant reductions in stress (p=0.026), systolic BP (p=0.015), diastolic BP (p=0.003), and heart rate (p=0.028). Conclusion: The Mind-Body-Spirit intervention significantly reduced stress and improved cardiovascular parameters among patients undergoing haemodialysis. Integrating such interventions into CKD care may enhance psychological resilience and cardiovascular health.

Risk for Smartphone Addiction among Adolescents: A Descriptive Study from Karnataka, India

Brigit AP Nee Sr Deepa Peter, Priya Reshma Aranha, AP Krishna

Introduction: Smartphones are widely used by adolescents in their everyday life and help them in communication, learning, and entertainment. However, too much and uncontrolled smartphone use can lead to addiction, which may cause sleep problems, emotional issues, and poor academic performance. Adolescents are particularly vulnerable due to ongoing psychological and behavioural development. Aim: To identify adolescents at risk for smartphone addiction in selected schools in Mangalore, India. Materials and Methods: A cross-sectional descriptive study was conducted in three private English-medium high schools in Mangaluru, Karnataka, India, from January to March 2025. A total of 540 adolescents aged 13-16 years were screened using a baseline proforma and the Smartphone Addiction Scale–Short Version (SAS-SV), a 10-item standardised tool with a 6-point Likert scale. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0, employing descriptive statistics such as frequency and percentage. Results: The study revealed that 180 (33.3%) adolescents were addicted to smartphones, 165 (30.6%) were at high-risk and 195 (36.1%) had no risk. Although daily use was moderate 250 (46.3%) using smartphones for 1-3 hours and 240 (44.4%) for less than one hour, and 236 (43.7%) had used smartphones for more than three years. Most adolescents reported healthy habits, with 248 (45.9%) sleep between 10-11 p.m., 487 (90.2%) keeping phones away at night, only 2.8% waking to check phones, and 83.1% engaging in daily physical activity; parental use was also moderate (fathers 46.1%, mothers 45.6% up to four hours/day). Despite this, the high prevalence of addiction and risk highlights the need for early screening and preventive interventions in schools and communities. Conclusion: The study concluded that that nearly two-thirds of adolescents were affected by smartphone addiction or were at risk, despite moderate use and generally healthy lifestyles. This suggests that long-term exposure, rather than daily duration alone, plays a key role, highlighting the need for early screening and preventive interventions in schools and communities.

Utility of Neutrophil to Lymphocyte Ratio in Hypertensive Disorder of Pregnancy: A Case-control Study

Priyanka, Monika Kalyan, Monika Garg, Navneet Kaur, Satish Kajal, Mukesh Saini

Introduction: Hypertensive Disorders of Pregnancy (HDP), encompasses gestational hypertension, Preeclampsia and eclampsia, remain leading causes of maternal and perinatal morbidity and mortality globally. Among several biomarkers under investigation, the Neutrophil-To-Lymphocyte Ratio (NLR) has emerged as a potential indicator of systemic inflammation, with relevance in predicting disease severity and outcomes in HDP. Aim: To evaluate the utility of NLR as a biomarker in HDP. Materials and Methods: This prospective case-control study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from January 2021 to December 2021 (12 months). The study population included 100 pregnant women diagnosed with HDP (gestational hypertension, Preeclampsia, eclampsia, chronic hypertension and preeclampsia superimposed on chronic hypertension) and 100 normotensive pregnant women as controls. Complete Blood Count (CBC) were analysed and NLR was calculated. Data were compiled in Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., USA). Continuous variables were expressed as mean±Standard Deviation (SD), while categorical variables were presented as frequencies and percentages. Comparison between two groups was performed using independent sample t-test for normally distributed variables or the Mann-Whitney U test for non parametric data. Categorical variables were compared using the Chi-square test or Fisher’s-exact test, as appropriate. The association between NLR and the severity of HDP was assessed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The mean NLR was significantly higher in hypertensive pregnant women (mean±SD: 3.69±0.95) compared to normotensive controls (2.81±0.15). Among cases, patients with preeclampsia and eclampsia had higher NLR values (4.23±0.62 and 5.00±0.00, respectively) than those with gestational hypertension (3.00±0.25). A positive association was observed between NLR levels and disease severity (p<0.001), with the highest values seen in severe preeclampsia and eclampsia (4.23±0.62 and 5.00±0.00, respectively). Conclusion: The NLR is a simple, inexpensive and readily available biomarker that may serve as an early predictive indicator for hypertensive disorders of pregnancy. Its integration into routine antenatal screening could enhance risk stratification and improve clinical management.

Expression of Programmed Death Ligand-1 in Head and Neck Squamous Cell Carcinoma: A Cross-sectional Study

Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) is among the most prevalent malignancies worldwide, with poor survival outcomes despite advances in multimodal therapy. Tumour immune evasion through the Programmed Death-1/Programmed Death Ligand-1 (PD-L1) PDL-1/PD-L1 immune checkpoint pathway has emerged as a crucial mechanism in HNSCC progression. PD-L1 expression, detectable by Immunohistochemistry (IHC), is a promising predictive and prognostic biomarker, especially when evaluated alongside histological grading systems such as Anneroth’s multifactorial grading. Aim: To evaluate PD-L1 expression in HNSCC using IHC and associate it with Anneroth’s histological grading. Materials and Methods: This cross-sectional study conducted at Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak over a one-year period from 1^st December 2023 to 31^st December 2024 included 60 histologically confirmed cases of HNSCC. Histopathological diagnosis was established on routine Haematoxylin and Eosin (H&E) stain. Tumours were classified and graded according to WHO criteria and Anneroth’s multifactorial grading system. PD-L1 expression was assessed using IHC and quantified by the Combined Positive Score (CPS). The status of PDL-1 was assessed and association with various clinicopathological prognostic parameters including age, gender, histologic type, histologic grade, Anneroth`s grading parameters and CPS score. The collected data were analysed with the help of Statistical Package for Social Sciences (SPSS) version 24.0. All the data enlisted in the investigation proforma (name, age, gender, clinical diagnosis and history) were collected. Cases were compared to controls. Association was evaluated using Chi-square test. The p-value less than 0.05 were accepted as statistically significant. Results: Age of the patients ranged from 31-90 years with a median age of 58.0 years. The majority of cases, 21 (35.0%) were in the age group of 51-60 years. 47 (78.3%) cases were male and 13 (21.7%) cases were female. A 13 (21.7%) cases were well-differentiated, 37 (61.7%) cases were moderately differentiated and 10 (16.7%) cases were poorly differentiated SCC. In Anneroth’s multifactorial grading system, majority of cases i.e., 37 (61.7%) assigned grade 2, 12 (20.0%) cases were assigned grade 1, 10 (16.7%) cases assigned grade 3 and one (1.7%) cases assigned grade 4. PD-L1 positivity was observed in 45 (75%) cases, with 26 (43.3%) cases showing low expression (CPS 1-20) and 19 (31.7%) cases showing high expression (CPS ≥20). PD-L1 expression was significantly associated with World Health Organisation (WHO) histological grading, with the highest prevalence among moderately differentiated tumours (p-value=0.037). Similarly, PD-L1 expression positively correlated with higher Anneroth's grades (p-value=0.020). No significant association was found between PD-L1 expression and age (p-value=0.079) or presenting complaints (p-value=0.764). Conclusion: PD-L1 expression in HNSCC is significantly associated with both WHO and Anneroth’s histological grades, highlighting its role in tumour aggressiveness and immune evasion. Incorporating PD-L1 profiling alongside detailed histopathological grading provides valuable prognostic information and may guide patient selection for immune checkpoint inhibitor therapy.

Comparative Clinicomicrobiological Profile, Risk Factors, and Outcomes of Patients with and without Ventilator Associated Pneumonia: A Retrospective Observational Study from a Tertiary Care Hospital in Northern India

Nidhi Yaduvanshi, Chinmoy Sahu, Kanchan Kumari, Sangram Singh Patel

Introduction: Ventilator Associated Pneumonia (VAP) is a common Healthcare Associated Infection (HAI) in mechanically ventilated patients, leading to increased morbidity, mortality, Intensive Care Unit (ICU) stays, and healthcare costs. VAP is most commonly caused by Gram negative, non fermenting bacteria notably Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacterales such as Klebsiella pneumoniae all of which frequently exhibit Multidrug Resistance (MDR), making treatment challenging. Timely diagnosis followed by appropriate, targeted antibiotic therapy is critical in improving patient outcomes. Aim: To evaluate and compare the clinicomicrobiological profile, risk factors, and clinical outcomes of VAP and Non VAP patients admitted to a tertiary care hospital in Northern India. Materials and Methods: This retrospective, laboratory-based observational study was conducted in the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India from March 2024 to August 2024. The study included adult patients admitted to ICU and managed on mechanical ventilation, who fulfilled the predefined inclusion criteria for VAP. A total of 243 respiratory samples were analysed during the study period. The methodology involved collection and microbiological processing of Endotracheal (ET) aspirates and bronchoalveolar lavage samples, followed by organism identification and antimicrobial susceptibility testing as per standard guidelines. Demographic parameters such as age and sex were recorded. Statistical analysis was performed using appropriate tests, including the Chi-square test or Fisher’s exact test for categorical variables and the Student’s t-test or Mann-Whitney U test for continuous variables, with a p-value of <0.05 considered statistically significant. Results: Of the 243 respiratory samples, 197 (81.07%) samples were obtained through ET aspirates, while remaining 46 (18.93%) were BAL fluid. VAP was diagnosed in 68 (27.98%) patients, while 175 (72.02%) patients were identified as not having VAP. The incidence of VAP was 36.28 per 1000 ventilator days. Among risk factors, supine head position, tracheostomy, total days on MV, length of stay in hospital, re-intubation were significantly higher in VAP group. Among the 68 patients diagnosed with VAP, only 65 had culture-positive samples. Of these 65 isolates, 53 (81.53%) were caused by Gram-negative bacilli (GNB). Of them A. baumannii 13 (20%) was the commonest, followed by P. aeruginosa 11 (16.92%) and K. pneumoniae 10 (15.38%). Among, Gram-positive cocci (GPC) 12 (18.46%), Methicillin-resistant Staphylococcus aureus (MRSA) 9 (13.84%) was the commonest followed by E. faecium 3 (4.61%). Conclusion: The incidence of VAP was high in the present study. Mortality rate was slightly higher in VAP group, it was not statistically significant. A. baumannii and P. aeruginosa are emerging MDR nosocomial pathogens. Therefore, accurate species identification and AST are essential for improving patient outcomes.

Comparison of Patellofemoral Morphometric Parameters in Individuals with Patellofemoral Pain Syndrome versus Healthy Controls: A Cross-sectional Study

Sandhya Nagolu, Lavanya Prathap, Subhadra Devi, S Jeyakumar

Introduction: Patellofemoral Pain Syndrome (PFPS) is one of the most common causes of anterior knee pain, yet its radiographic diagnostic indicators remain poorly defined. Aim: To evaluate morphometric parameters, including Q angle, sulcus angle, patellar tilt angle, and Insall-Salvati ratio, in individuals with PFPS compared to healthy controls. Materials and Methods: A cross-sectional study with 110 clinically confirmed PFPS patients and 110 age- and sex-matched controls was conducted at the Department of Anatomy, Saveetha Medical College and the Department of Radiology, HOSMAT Hospitals Bangalore Rural, Karnataka, India, between 01.02.2025 and 31.10.2025. Standardised lateral, and skyline (Merchant/ Tangential) view radiographs were analysed using INSTARISPACS® software to obtain morphometric parameters such as the Q angle (clinical parameter during patient assessment), sulcus angle, patellar tilt angle, and Insall–Salvati ratio. Group differences were assessed using the independent t-test. Correlation analysis and binary logistic regression were performed to identify predictors of PFPS. Results: A total of 220 participants (110 PFPS cases and 110 controls) were included. The mean age of cases was 38.9±8.2 years, while controls had a mean age of 37.9±9.1 years. In the PFPS group, 48 (43.64%) were male and 62 (56.36%) were female, whereas the control group included 57 (51.82%) males and 53 (48.18%) females. The mean Q angle in the PFPS group was significantly higher than the control values (21.55±2.76° vs. 15.8±2.5°, p-value <0.001). The Insall–Salvati index was slightly but significantly higher in PFPS patients than in controls (1.05±0.30 vs 1.00±0.12; p-value=0.021). Spearman’s correlation analysis demonstrated a moderate negative correlation between Q angle and sulcus angle (r=-0.292, p-value <0.001) and a moderate positive correlation between Q angle and patellar tilt angle (r=0.466, p-value <0.001). Conclusion: Radiographic measurements, particularly Q angle and patellar tilt angle, are reliable indicators of PFPS. Patellofemoral structural alignment has a greater impact on PFPS than anthropometric characteristics such as body composition. Further longitudinal studies are recommended to validate these markers for early detection and intervention.

Association between Gallbladder Wall Thickness and Surgical Outcomes Following Laparoscopic Cholecstectomy in Patients with Gall Stone Disease: A Prospective Observational Study

Nandhini Ganesh, Sivamarieswaran, B Arun, Dheenu Saravanan, RS Sharan Dhev

Introduction: Gallstone disease is a prevalent gastrointestinal disorder, often managed surgically via Laparoscopic Cholecystectomy (LC), which is considered the current gold standard. However, Gallbladder Wall Thickness (GBWT), assessed preoperatively using ultrasonography, is known to influence the complexity and outcomes of LC. Increased GBWT may predict intraoperative challenges and postoperative complications, but standardised risk stratification based on GBWT remains underutilised. Aim: To evaluate the association between GBWT and intraoperative as well as postoperative outcomes in patients undergoing LC for symptomatic gallstone disease. Materials and Methods: This prospective observational study was conducted at the Department of General Surgery, SRM Medical College Hospital and Research, Chennai, Tamil Nadu, India from March 2024 to March 2025. included 137 patients undergoing LC. Preoperative GBWT was measured using ultrasonography and patients were stratified into four groups: normal (≤2 mm), mildly thickened (>2-4 mm), moderately thickened (>4-6 mm), and severely thickened (>6 mm). Intraoperative parameters (surgery duration, bleeding, bile duct injury, conversion to open surgery ) and postoperative outcomes (bile leak, wound infection, ileus, hospital stay) were assessed. Appropriate statistical tool *chi-square test for categorical variables and Analysis of Variance (ANOVA) or t-test for continuous variables were used. Results: The mean age of the participants was 46.5±12.7 years. Increasing GBWT was significantly associated with longer operative time, higher conversion rates, increased intraoperative bleeding, and higher rates of bile duct injury, bile leak, wound infection, and prolonged ileus. Mean hospital stay also rose progressively with GBWT, reaching 14±5.7 days in the severely thickened group. Conclusion: The GBWT is a reliable, non invasive preoperative predictor of surgical difficulty and complications in LC. Incorporating GBWT-based stratification can optimise surgical planning and improve patient outcomes.

Clinical and Epidemiological Profile of Common Vector-borne and Zoonotic Infections in North West Region of Punjab: A Retrospective Observational Study

Introduction: Infections caused by vector-borne pathogens and zoonotic agents are a great economic burden in developing countries like India because their numbers keep increasing every year. National programs like the National Vector Borne Disease Control Program and National One Health Program for Prevention and Control of Zoonoses have been actively tracking their load through their network of Diagnostic Laboratories. Aim: To evaluate the clinical and epidemiological profile and seropositivity of vector-borne and zoonotic diseases in the North West region of Punjab, India. Materials and Methods: This retrospective observational study was conducted in the Department of Virology, Guru Nanak Dev Hospital, Amritsar, Punjab, India from January 2024 to December 2024. It was done on samples of suspected patients of Acute Febrile illness attending the OPD/IPD of Guru Nanak Dev Hospital. A total of 1,308 serum samples were received in the Virology Research and Diagnostic Laboratory and tested for various infections, including Dengue, Chikungunya, Brucella, Leptospira, Scrub typhus, and Toxoplasma, using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Demo-graphic parameters like age, sex and seasonality were studied from patient records for these samples. Statistical analysis was done using Chi-square and Fisher's exact test and a p-value of <0.05 was considered significant. Results: A total of 1,308 samples were tested, out of which 108 samples (8.25%) were positive for at least one or more of the infections. Leptospira infection was the most common, with 50 out of 248 cases (20.16%), followed by scrub typhus with 18 out of 235 cases (7.65%), chikungunya with 11 out of 171 cases (6.43%), brucellosis with 10 out of 170 cases (5.88%), dengue with 17 out of 410 cases (4.14%), and toxoplasmosis with 2 out of 74 cases (2.7%). Conclusion: The present study highlights that infections such as Leptospira, Brucella, and scrub typhus should be considered in the differential diagnosis of acute febrile illness, in addition to dengue and chikungunya. Strengthening diagnostic facilities at both peripheral and tertiary levels is essential for timely treatment, along with coordinated efforts from the community and health sector for effective prevention and control.

Pharmacological Evaluation of Metformin, Dapagliflozin alone and in Combination, in a Wistar Rat Model of Diabetic Neuropathy: An Experimental Study

Introduction: Diabetic Neuropathy (DN) is a common and debilitating complication of Diabetes Mellitus (DM), involving the sensory, motor, and autonomic nervous systems, with limited disease-modifying treatment options. Emerging evidence suggests that commonly used antidiabetic agents may exert additional neuroprotective effects beyond glycaemic control. Aim: To evaluate the individual and combined effects of metformin and dapagliflozin on the Wistar rat model of DN. Materials and Methods: This experimental study was conducted in the Department of Pharmacology, KAHER’s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India from January 2022 to December 2022. Thirty-two male Wistar rats were used, of which six served as normal controls. Diabetes was induced in the remaining animals by a single intraperitoneal injection of Streptozotocin (STZ) (60 mg/kg). After confirmation of diabetes (fasting blood glucose >250 mg/dL), rats were randomly allocated to Diabetic Control (DC), metformin (180 mg/kg), dapagliflozin (0.9 mg/kg), or combination treatment groups and treated orally for eight weeks. Sensory neuropathy was assessed by measuring the Paw Withdrawal Latency (PWL) using Eddy’s hot plate at 2, 4, 6, and 8 weeks. At the end of eight weeks, motor neuropathy was evaluated by measuring Motor Nerve Conduction Velocity (MNCV) of the sciatic nerve, and autonomic dysfunction was assessed by measuring gastrointestinal transit using the charcoal meal method. Histopathological changes in the sciatic nerve were examined for perineural inflammation using Haematoxylin and Eosin (H&E). The quantitative data were expressed as Mean±SEM and analysed using ANOVA followed by Tukey’s post-hoc test, and p-value <0.05 was considered significant. Results: A total of 32 rats were included (n=6 each in normal control and treatment groups; n=8 in DC). At eight weeks, DC rats exhibited significant neuropathic alterations compared with normal controls, including prolonged PWL (8.33±0.25 vs 3.58±0.33 s; p-value=0.0000011), reduced MNCV (11.48±1.24 vs 56.67±3.33 m/s; p-value=0.0001), and decreased intestinal transit (49.25±4.74% vs 85.69±0.97%; p-value=0.0000011). Metformin and dapagliflozin significantly improved thermal latency (5.42±0.24 s; p-value=0.000119 and 5.58±0.15 s; p-value=0.0000022), nerve conduction velocity (28.52±4.03 m/s; p-value=0.0004 and 27.67±2.49 m/s; p-value=0.0007), and intestinal transit (74.66±3.79%; p-value=0.000245 and 69.85±3.10%; p-value=0.01347) compared with DC. Combination therapy further improved PWL (5.17±0.21 s), MNCV (34.00±5.89 m/s), and intestinal transit (77.44±2.08%). Sciatic nerve inflammation score was significantly elevated in DC (2.50±0.22) and reduced with metformin (0.33±0.21), dapagliflozin (0.33±0.21), and combination therapy (0.00±0.00). Conclusion: Metformin and dapagliflozin, alone and more effectively in combination, significantly ameliorated sensory, motor, and autonomic neuropathy in STZ-induced diabetic rats, which high-lights the potential of combination antidiabetic therapy for DN, warranting further mechanistic and translational studies.

Efficacy of Intravenous Paracetamol Infusion versus Intravenous Pentazocine for Labour Analgesia: A Prospective Observational Study

S Anushree, SB Chiranth, CP Sudha

Introduction: Labour pain is recognised as one of the most intense pain experiences. While neuraxial analgesia remains the gold standard, its limited accessibility in resource-constrained settings necessitates the use of systemic agents. Aim: The present study compares the analgesic efficacy, maternal-fetal outcomes, and side-effect profiles of Intravenous (i.v.) paracetamol versus i.v. pentazocine. Materials and Methods: The present prospective observational study was conducted from December 2017 to May 2019 at Kempegowda Institute of Medical Sciences, Bangalore, India. A total of 60 primigravida parturients were divided into two groups: Group A (n=30) received i.v. paracetamol (1g), and Group B (n=30) received i.v. pentazocine (30 mg) during the active phase of labour. Pain relief was assessed using the McGill Pain Intensity Scale at 0, 1, 2, and 4 hours post-administration. Maternal cardiorespiratory parameters, labour duration, mode of delivery, and neonatal outcomes were recorded. Statistical Package for the Social Sciences (SPSS) version 20 was used for statistical analysis. Results: The mean age was 25.3±3.2 years in Group A and 24.9±3.6 years in Group B. Group A, consisting of i.v. paracetamol, demonstrated significantly greater analgesic efficacy (mean McGill score at 2 h: 1.80 vs 2.62; p<0.001) with fewer maternal side-effects (0% vs 16.6%). Neonatal outcomes favoured paracetamol, with one neonate in the pentazocine group having APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score <7 at one minute (p=0.3) and no cases of APGAR <7 at five minutes in either group. No significant differences were observed in labour duration or delivery mode. Conclusion: Both intravenous paracetamol and pentazocine provided effective analgesia for labour. Paracetamol seemed to be more effective achieving a greater reduction in pain scores compared to pentazocine, and has less maternal side-effects.

Contactless Monitoring of Vital Parameters by Ballistocardiography Compared with Bedside Monitors: A Prospective Observational Study

Introduction: Ballistocardiography (BCG) is a technique of contactless monitoring of the body’s vital parameters. During ventricular systole, aortic blood flow produces minuscule body displacements which can be picked up by piezoelectric sensors placed under the patient’s mattress. The BCG monitor connected to the sensors analyses these body displacements and generates basic vital parameters, which are displayed on a mobile device or computer. BCG devices may demonstrate improved compliance due to its unobtrusive nature, as well as affordability compared to standard bedside monitors, although their reliability remains unclear. Aim: To evaluate the accuracy of patients’ vital parameters as measured by the BCG device (Dozee), by comparison with simultaneous readings on a reference device, the Philips IntelliVue MP20 bedside monitor. Materials and Methods: This two-month prospective, observational study was conducted at the Intensive Care Unit (ICU) of Manipal Hospital, Yeshwantpur, Bengaluru, Karnataka, India from May 2023 to June 2023. All patients admitted to the ICU were assessed for the study, excluding those who were haemodynamically unstable or agitated, as well as those receiving haemodialysis, resulting in 121 patients who met the inclusion criteria. Routine vital parameters were obtained from each device, including Heart Rate (HR), Respiratory Rate (RR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Peripheral Oxygen Saturation (SpO2) and Temperature (Temp). Mean values from the Dozee device were similar to that of the bedside monitor using One Way Analysis of Variance (ANOVA) using F-test and a p-value<0.05 was taken as significant. Patients’ vitals were recorded at four-hour intervals during their stay in ICU. Results: A total of 121 patients were included with a mean age of 62.6±16.6 years. The readings of each parameter were obtained at four-hour intervals. About 900 - 1000 readings were obtained. There was a good agreement between the values measured by the BCG device and the bedside monitor, with a p-value of <0.001 across all parameters: HR (mean 86.9 vs 82.9 beats/min), RR (20.8 vs 19.6 cycles/min), SBP (124.8 vs 122.8 mmHg), DBP (68.0 vs 67.7 mmHg), MAP (87.0 vs 85.3 mmHg), SpO2 (96.2 vs 95.1 %) and Temp (97.5 vs 96.9 ° F). However, reliability of the data varied across the parameters, with the most accuracy noted only in HR and BP readings. The BCG device also failed to give readings in about 44 (4.4%) of 1000 readings obtained on the bedside monitor. Conclusion: BCG devices can substitute for regular bedside monitors, although it is reliable only for measuring three vital parameters, HR, BP and RR. Although the contactless technology allows for better patient compliance, the present study suggests that it is safe for use only in bedbound patients who are relatively stable, or in conditions where bedside monitors or nursing care are unfeasible or unavailable.

Efficacy of First Line Afatinib in Epidermal Growth Factor Receptor Mutation Positive Metastatic Non-squamous Non-small Cell Lung Cancer: A Prospective Cohort Single-arm Observational Study among Indian Patients

Introduction: Lung cancer remains a leading health burden in India, with Non-Small Cell Lung Cancer (NSCLC) being the most prevalent type. Epidermal Growth Factor Receptor (EGFR) mutations, commonly seen in non-smokers, offer an opportunity for targeted therapy. afatinib, a second-generation EGFR TKI, has shown improved outcomes over first-generation TKIs, but Indian data remains scarce. Aim: To evaluate the safety and efficacy of first-line afatinib in Indian patients with metastatic EGFR mutation-positive Non-Squamous NSCLC (NS-NSCLC). Materials and Methods: The present prospective, single-arm observational study was conducted from June 2016 to May 2018 at Dharamshila Narayana Superspeciality Hospital, New Delhi, India. Adults with Stage IV, EGFR mutation-positive NS-NSCLC were treated with oral afatinib (starting dose 40 mg/day). Responses were assessed every 12 weeks via Positron Emission Tomography-Computed Tomography (PET-CT) scan using Positron Emission Response Criteria in Solid Tumours (PERCIST) criteria. Patients progressing on treatment were evaluated for T790M mutation and switched to Osimertinib if found positive for mutation. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Categorical variables were expressed as percentages, and continuous variables as mean±SD or median values. Survival outcomes were estimated using Kaplan-Meier analysis, with comparisons by log-rank test. A p-value <0.05 was considered statistically significant. Results: Of the 217 patients screened, 27 were enrolled in the study. The median age was 55 years. Among them, 17 patients (62.96%) were female and 19 (70.37%) were never-smokers. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0-1 was observed in 20 patients (74.07%). The most common EGFR mutation was exon 19 deletion, present in 15 patients (55.56%). The median Progression-Free Survival (PFS) was 13.8 months, and 18 patients (66.67%) achieved one-year Overall Survival (OS). The Objective Response Rate (ORR) was 77.78% (n=21), with 25 patients (92.59%) achieving clinical benefit. The most common adverse events were diarrhoea in 21 patients (77.78%) and rash/acne in 20 patients (74.07%), though severe toxicities were uncommon. Dose reduction was required in 9 patients (33.33%), without any observed impact on PFS. Conclusion: First-line afatinib was found to be effective and well tolerated in Indian patients with EGFR mutation-positive metastatic NS-NSCLC. It provided superior PFS compared with other first-generation TKIs like gefitinib and erlotinib, and with manageable adverse effects. afatinib also resulted in meaningful improvements in response rate, OS, and clinical benefit. These results support afatinib as a standard first-line treatment option in this patient population.

Prevalence of Scapular Dyskinesia among Bank Employees in Belagavi, Karnataka, India: A Cross-sectional Study

Introduction: Scapular Dyskinesis (SD) is an abnormal movement or positioning of the scapula, often resulting from muscular imbalance and poor posture. Office-based professionals, such as bank employees, are at increased risk due to prolonged sedentary work. Aim: To estimate the prevalence of SD among bankers in Belagavi using the Scapular Dyskinesis Test (SDT) and Lateral Scapular Slide Test (LSST) and to explore associated demographic characteristics. Materials and Methods: A cross-sectional observational study was conducted on 131 employees (aged 20-45 years) from 40 banks in Belagavi, Karnataka, India between February 2024- August 2024. SDT and LSST were used to assess scapular motion on both sides. Data were analysed using Statistical Package for Social Sciences (SPSS) v29.0.10. Chi-square tests were applied, with a p-value < 0.05 considered significant. Results: A total of 131 bankers, 77 males (58.8%) and 54 females (41.2%) were included. The mean age was 35.5±7.75 years (range: 23-45 years). On the SDT, dyskinesis was present in 86 (65.6%) dominant and 69 (52.7%) non dominant limbs; of the dominant-side findings, 70 (53.4%) were subtle and 16 (12.2%) were obvious. On the LSST, 112 (85.5%) dominant and 103 (78.6%) non dominant limbs showed positive findings. Higher prevalence by LSST may detect static scapular asymmetry more readily than SDT, which evaluates dynamic movement patterns. Considering either test, the overall prevalence was 115 (87.8%). Chi-square analysis showed no significant difference between dominant and non dominant limbs for both SDT (χ²=0.52, p=0.472) and LSST (χ²=0.25, p=0.619). Prevalence did not differ statistically between males and females on SDT (51/77, 66.2% vs 35/54, 64.8%; p=0.884) or LSST (67/77, 87.0% vs 45/54, 83.3%; p=0.583). No significant associations were observed with age, work experience, or daily working hours (p>0.05) Conclusion: The study demonstrated a high prevalence of SD among bankers in Belagavi, particularly in the dominant limb. These findings suggest the potential value of early detection and ergonomic interventions, and preventive strategies to reduce the risk of Musculoskeletal Disorders (MSD) in sedentary occupational settings, particularly those related to the shoulder. Early physiotherapy-based interventions focusing on muscle re-education, ergonomic workstation adjustments, and activity modification can help prevent shoulder dysfunction and enhance occupational performance.

Epidemiological Assessment of Permanent Tooth Extraction: A Retrospective Cross-sectional Study from Hail Dental Centre, Saudi Arabia

Introduction: Tooth loss affects quality of life by impairing chewing, speech, and appearance, and is associated with psychological and nutritional issues. Although the prevalence has declined in developed countries because of improved dental care, permanent tooth extraction remains a common occurrence, primarily caused by dental caries and periodontal disease. Demographic and behavioural factors- such as age, gender, socioeconomic status, smoking, and systemic health conditions- also influence extraction rates. In Saudi Arabia, national studies have explored these causes; however, data from the northern regions, particularly Hail, are limited. Given Hail’s unique demographics and healthcare access, understanding local patterns of tooth loss is essential for targeted public health strategies. Aim: To determine the primary causes of permanent tooth extraction and examine associated demographic and clinical factors. Materials and Methods: A cross-sectional study was conducted at the Department of Oral Surgery Clinics of Hail Dental Centre from May 2025 to July 2025, Saudi Arabia. Data on 381 permanent teeth extracted from 254 patients were retrospectively collected from clinical records. Demographic variables, including age, gender, smoking status, medical history, antibiotic use, the number and type of teeth extracted, reasons for extraction, and and procedural complexity were assessed. Associations between variables were assessed using the Chi-square test, Fisher’s-exact test, and the Monte Carlo correction. Multinomial logistic regression analysis was performed to identify independent predictors. Results: Dental caries (59.3%) was the leading cause, followed by orthodontic treatment (25.7%) and periodontal disease (11.4%). Surgical extractions accounted for 24.8%. Antibiotic use correlated with extraction reasons and medical status (p-value <0.05). Smokers demonstrated higher rates of periodontitis and failed root canal extractions. Multivariate analysis identified age ≥60 years, diabetes, smoking, and female gender as significant predictors. Conclusion: Dental caries and orthodontic treatment were the leading causes of tooth loss in the Hail region of Saudi Arabia. Factors such as age, systemic health conditions, and smoking status were significantly associated with the reasons for tooth extraction, underscoring the need for preventive and integrated oral systemic health strategies in this population.

Comparison of Fentanyl and Dexmedetomidine as Additives to Caudal Levobupivacaine in Paediatric Patients Undergoing Infraumbilical Surgeries: A Randomised Clinical Trial

V Devendra Kumar, Nirmala Devi Kagalkar, S Puneeth Kumar

Introduction: In children, the most commonly used postoperative analgesic technique is epidural block via the caudal route. Levobupivacaine is an effective analgesic with a safer pharmacological profile. One of the primary drawbacks of a single-shot caudal block is its short duration of action. Fentanyl, although most commonly used opioid, it has many side-effects. Dexmedetomidine is an α2 agonist with the property of prolonging the analgesic effect of local anaesthetic. The effectiveness of fentanyl and dexmedetomidine as additives to caudal levobupivacaine has not been extensively studied; so, in the present investigation, the efficacy of aforementioned drugs was assessed in paediatric caudal analgesia using the Face, Legs, Activity, Cry, Consolability (FLACC) score. Aim: To compare the analgesic efficacy and safety of fentanyl and dexmedetomidine as adjuvants to caudal levobupivacaine in paediatric patients undergoing infraumbilical surgeries, using the FLACC score for postoperative pain assessment. Materials and Methods: This randomised, double-blind clinical trial was conducted at Shri BM Patil Medical College Hospital and Research Centre, BLDE DU, Bijapur, Karnataka, India, from December 2019 to August 2021 In this randomised clinical trial, caudal block was used to provide perioperative analgesia for children undergoing infraumbilical surgery. The children (n=46 per group) were randomly divided into two groups and given 0.75 mL/kg levobupivacaine 0.25% with dexmedetomidine 1 μg/kg and 0.75 mL/kg levobupivacaine 0.25% with fentanyl 1 μg/kg to group D (dexmedetomidine) and group F (fentanyl), respectively. Haemodynamic parameters, sedation score, side-effects, FLACC score, and length of analgesia were all noted. Statistical analysis was performed using the Mann-Whitney U test, with a p-value <0.05 considered significant. Results: The two groups were comparable in terms of age, gender, weight, and duration of surgery. Both groups had stable comparable haemodynamic profiles, except at 20, 25, and 30 minutes post-block where MAP was higher in the fentanyl group. The mean Ramsay Sedation Score (RSS) was 2.1±0.3 (Group F) and 3.2±0.4 (Group D). The FLACC score was 3.79±0.47 (Group F) and 2.61±0.61 (Group D) at six hours. The mean duration of analgesia was 6.48±1.05 hours (Group F) and 8.76±1.06 hours (Group D). The mean discharge time was shorter in the dexmedetomidine group (3.13±1.22 days) compared to the fentanyl group (4.01±1.18 days). Conclusion: With similar haemodynamics and arousable sedation, dexmedetomidine is a more potent adjuvant to levobupivacaine for caudal analgesia than fentanyl. Dexmedetomidine is linked to shorter recovery time and fewer adverse effects following surgery.

Efficacy of Rocuronium Pretreatment on Succinylcholine-induced Fasciculations and Myalgia: A Randomised Controlled Trial

Introduction: Succinylcholine is a widely used muscle relaxant for its quick onset and short duration of action, however it is associated with fasciculations and myalgia. This may cause discomfort to the patient and can be avoided by using rocuronium as a pretreatment. This effect of rocuronium was evaluated during this study. Aim: To establish the efficacy and safety of using rocuronium as a pretreatment to reduce succinylcholine-induced fasciculations and myalgia. Materials and Methods: This is a double-blinded randomised controlled trial conducted at MM Institute of Medical Science and Research, Mullana, Ambala, Haryana, India between October 2022 and November 2023 and included 40 patients of the American Society of Anaesthesiologists (ASA), physical sta-tus I or II, posted for elective surgery under general anaesthesia, divided into two groups of 20 patients each. Group I patients were administered rocuronium 0.06 mg/kg, diluted up to 2 mL, and Group II patients were administered normal saline (2 mL). All patients received propofol induction 2 mg/kg and succinylcholine 1.5 mg/kg after 30 and 90 seconds of study drug respectively, and the intensity of fasciculations was assessed. Intensity of myalgia was assessed in the immediate postoperative period and after 24 hours. The statistical significance was examined using the Chi Square test. p-value <0.05 was considered statistically significant. Results: Baseline demographic data was comparable among both the groups (mean age in Group I was 42.95 years with 8 females and 12 males while in Group II age was 40.55 years, with 9 females and 11 males). The group that was administered rocuronium had 2 patients with mild fasciculations, 1 patient with mild myalgia and 1 patient with moderate myalgia. Group II had 9 patients with mild fasciculations, 6 with moderate fasciculations, 1 with severe fasciculations, 4 with mild myalgia, 2 with moderate myalgia, 1 with severe myalgia. There was a statistically significant reduction in the incidence and intensity of fasciculations (p-value 0.001). There was also a significantly lesser mean heart rate and mean arterial pressure in the rocuronium group compared to the saline group after intubation at 1 min, 3 min, and 5 min. There was a reduction in postoperative myalgia in the rocuronium group in the immediate post-operative period and after 24 h, but the difference was statistically non significant. Conclusion: Rocuronium pretreatment is safe and effectively reduces succinylcholine-induced fasciculations and provides more stable haemodynamics at a dose of 0.06 mg/kg administered 30 sec before propofol induction. Therefore, rocuronium can be used safely and effectively as a precurarisation drug.

Comparison of Range of Motion, Strength and Proprioception of Shoulder Joint in Overhead and Non-overhead Athletes: A Cross-sectional Study

Dhyan Patel, Neha Mukkamala

Introduction: The overhead throwing motion is a complex, highly coordinated musculoskeletal sequence that exerts multidirectional and supraphysiological stresses on the shoulders. The repetitive action causes adaptive structural modifications for the athlete to effectively conduct overhead motions. However, the modifications may lead to injuries and pain over time. Aim: To examine the difference in proprioception, Range Of Motion (ROM), and shoulder strength between overhead and non-overhead athletes. Materials and Methods: The present cross-sectional study was conducted in Vadodara, Gujarat, India from March 2023 to March 2024. Overhead and non-overhead athletes from various sports complex par-ticipated in the study. The players were above 18 years of age, played at least one hr/day, minimum three days/week, since at least a year. Players with acute shoulder pain, shoulder and neck surgeries were excluded from the study. Non-overhead athletes were also included for comparison. Shoulder ROM was assessed passively by using inclinometer, shoulder strength by handheld spring dynamometer and shoulder proprioception by inclinometer. Unpaired t-test was used for comparison between both groups and paired t-test was used for comparison within groups. Results: Total 160 athletes (80 overhead and 80 non-overhead athletes) participated in the study. Mean age of overhead athletes was 26.90 years and a non-overhead athlete was 26.05 years. Shoul-der flexion, extension, External Rotation (ER) ROM was significantly more (p<0.001) and Internal Rota-tion (IR) was significantly less (p<0.001) in overhead athletes compared to non-overhead athletes. Shoulder Flexion, Extension, ER range was significantly more in dominant hand of overhead athletes (p<0.001). Shoulder strength was significantly more in non-overhead athletes (p<0.001). Shoulder flex-ors, extensors and internal rotators strength was significantly more in dominant hand of overhead ath-letes (p<0.001). Proprioception of ER 900 was more significant in non-overhead athletes (p<0.001). There was no significant difference in shoulder proprioception with respect to dominance. Conclusion: Shoulder flexion, extension, ER ROM was significantly more in overhead athletes and shoulder strength (except external rotator strength) significantly more in dominant hand of overhead athletes compared to non-dominant hand of overhead athletes. However, non-overhead athletes had more IR range compared to overhead athletes. The shoulder strength was significantly more in non-overhead ath-letes compared to overhead athletes.

Development, Validation and Test-retest Reliability of the Stroke Specific Gait Assessment Scale: A Cross-sectional Study

Tamana Sharma, Etika Rana, Sudhamoy Maity, Subhasish Chatterjee, Mousumi Saha

Introduction: Gait impairments are frequently observed after stroke and can significantly af-fect a patient's independence and overall Quality of Life (QoL). Despite their prevalence, standardised tools designed to assess gait in stroke survivors are lacking. The Stroke-Specific Gait Assessment Scale (SSGAS) was created to offer a detailed and comprehensive evaluation of gait function in stroke rehabil-itation to address this gap. The present study outlines the development of the SSGAS and examines its content validity. Test-retest reliability was assessed using Interclass Correlation Coefficients (ICC) analysis. Aim: To develop and analyse the content validity and test-retest reliability of the SSGAS to assess gait in individuals who have suffered a stroke. Materials and Methods: The present cross-sectional content validation study was conducted at a tertiary hospital, Ambala, Haryana, India, from August 2024 to March 2025. The SSGAS was developed through extensive clinical research and consultation with a panel of experts to ensure it addressed the key gait parameters impacted by stroke. The scale consists of 24 items, each rated on a 0-4 ordinal scale. A group of eight validators, including physiotherapists and neurologists, reviewed the scale for relevance, clarity, and completeness. Content validity was measured using the Item-level Content Validi-ty Index (I-CVI) and Scale-level Content Validity Index (S-CVI), both of which were assessed against established validity thresholds.Test-retest reliability was assessed using ICC. Results: The SSGAS demonstrated a high degree of validity, with an I-CVI of 0.98 and an S-CVI of 0.98 overall. These results indicate strong agreement among experts, affirming the scale’s compre-hensiveness and clarity. The experts also expressed that the scale is both practical and valuable for planning rehabilitation and monitoring patient progress. Test-retest reliability was assessed with 51 patients and the ICC score was 0.99 which shows excellent reliability. Conclusion: The SSGAS has been validated as a comprehensive tool for assessing gait in stroke patients. Its excellent content validity underscores its potential as an essential resource in clinical practice and research, providing important information for developing personalised rehabilitation plans and tracking patient outcomes. Further research is recommended to examine the scale’s reliability across different populations of patients with stroke.

Quality of Life and Functional Status in Advanced Cancer Patients and its Association with Caregiver Burden: A Cross-sectional Study

Introduction: The incidence of cancer is likely to increase from 1.46 million in 2022 to 1.57 million in 2025 in India. Majority of the cancer patients are diagnosed at the locally advanced stage. Symptoms experienced by patients are multi-dimensional and not only impacts patients’ Quality of Life (QoL) and function but also increase caregiver burden. There is scarcity of evidence encompassing the intricate relationship between QoL, Functional status, symptoms and its association with caregivers’ burden. Aim: To assess the symptom burden, performance status and QoL among patients suffering from advanced malignancy and its correlation with caregivers’ burden. Materials and Methods: The present cross-sectional survey was conducted at Cancer Centre of Shree Krishna Hospital, a rural Tertiary Care Teaching Hospital between December 2018 and August 2020. All patients who had multiple cancers or simultaneous non oncological critical illness requiring admissions were excluded. Detailed history and primary oncological diagnosis with staging were noted. Questionnaires viz. Edmonton symptom assessment system, EORTC QLQ-C30, Karnosfky Performance status, Zarit Burden Interview (ZBI) and Caregivers Strain Index (CSI) were administered by the investigator. Descriptive statistics, Analysis of Variance and correlation coefficient were employed to explore participant’s profile and association of patient characteristics with QoL and caregivers’ burden as well as their interactions. STATA (14.1) was used for the analysis. A p-value of less than 0.05 was considered statistically significant. Results: Out of 138 eligible patients, 125 (90.6%) participated. Majority of the participants were from age group 41-60 {72 (57.6%)}, had stage 4 disease {93 (74.4%)} and suffered from Head and Neck or breast cancer {71 (56.8%)}. The mean (SD) QoL summary score was significantly higher in patients experiencing up to 3 symptoms as compared to those experiencing 4 or more {82.29 (10.49) vs. 65.41 (11.50), p<0.001**}. The domains, global health status and financial difficulties and symptoms viz. fatigue, appetite loss and pain hampered the QoL. The mean (SD) Caregivers Strain Index (CSI), Zarit score and QoL summary score were 5.49 (3.00), 27.63 (12.75) and 77.1 (13.3), respectively. The CSI and Zarit score correlated significantly {r=0.69, p<0.001**}. The CSI score showed significant negative correlation with Quality-of-life summary score {r=-0.29, p=0.01*}. Conclusion: Despite advanced cancer staging, most patients remained functionally independent. QoL in advanced cancer patients was found inversely related with symptom burden and early palliative care may reduce caregiver burden.

Arthroscopic Meniscal Repair and Partial Meniscectomy in Degenerative Meniscal Tears: A Comparative Study on Pain Relief, Functional Outcomes and Postoperative Complications

A Robin, K Rajavel, Muthu Kumar Balaji

Introduction: Osteoarthritis (OA) of the knee is a progressive joint disorder, with degenera-tive meniscal tears being a common contributing factor. Surgical interventions such as Arthroscopic Me-niscal Repair (AMR) and Arthroscopic Partial Meniscectomy (APM) are widely performed; however, their long-term impact on joint health remains a topic of debate. Aim: To compare the pain relief, functional outcomes, and complication rates of AMR versus APM in individuals diagnosed with early-stage primary OA and degenerative meniscal tears. Materials and Methods: This was a hospital-based observational comparative study conducted in the Department of Orthopaedics at SRM Medical College Hospital and Research Centre, Kattankulathur, Kan-chipuram, Tamil Nadu, India, from June 2023 to May 2025. A total of 70 participants were included, with 35 patients assigned to the AMR group (Group A) and 35 patients to the APM group (Group B). Postopera-tive pain levels and functional recovery were assessed using the Lysholm Knee Score (LKS) and the Visual Analogue Scale (VAS). Statistical analysis was performed utilising IBM Statistical Package for Social Sciences (SPSS) version 21.0, considering a p-value of less than 0.05 as statistically significant. Results: The mean age of participants was 51.41±4.9 years. Patients in the AMR group demon-strated significantly lower VAS scores (p-value=0.0001) and higher LKS scores (p-value=0.0001) compared to the APM group, indicating superior pain relief and functional recovery. Complication rates were also lower in the AMR group (p-value=0.046). However, surgical duration was comparable between both groups (p-value=0.372). Conclusion: Meniscal preservation through AMR provides superior functional recovery and pain relief compared to APM, with a lower risk of postoperative complications. These findings reinforce the importance of meniscal preservation in optimising long-term joint health in patients with degenerative meniscal tears. Further, multicentre studies with extended follow-up are required to validate these results and assess the long-term progression of OA postmeniscal surgery.

Relationship between CT-derived Muscle Parameters and Bone Attenuation in the Indian Population: A Retrospective Observational Study

Deepa Rebecca Korula, Vamsi Krishna Maddineni, P Roselin

Introduction: Psoas muscle area and attenuation provide a practical, reproducible marker for overall skeletal muscle health and can be readily measured on routine abdominal Computed Tomography (CT). CT-derived femoral neck and lumbar vertebral attenuation have been proven as quantitative, reproducible imaging biomarkers of bone quality, which help in the detection and screening of osteoporosis. Thus, the combined assessment of CT-derived muscle parameters and bone attenuation may assist radiologists and clinicians in characterising the muscle-bone unit, and improving risk stratification for fractures, frailty, and adverse clinical outcomes. Aim: To measure the psoas muscle area and attenuation, femoral neck attenuation, and lumbar vertebral attenuation across various age groups on plain CT abdomen scans and to assess the correlation between these parameters, age, and gender in the Indian population. Materials and Methods: This retrospective observational study was conducted in the Radiology Department at Madha Medical College and Research Institute, Chennai, Tamil Nadu, India from January 2025 to June 2025. Analysis was done from July 2025 to August 2025. The study included consecutive CT abdomen studies of 796 patients (467 males and 329 females) in the age range of 11-90 years. The variables that were measured included the psoas area, psoas attenuation, Hounsfield Unit Average Calculation (HUAC), vertebral attenuation, and femoral neck attenuation. The association between age and outcome variables was assessed by Pearson’s correlation coefficient at a 95% confidence interval. Results: The overall mean age was 43.8±16.176 years. All the variables showed a decrease with increasing age, with a statistically significant decline (p-value <0.01) noted in the psoas muscle area and attenuation, femoral neck attenuation, and vertebral attenuation (particularly L3 and L4 vertebrae). Males exhibited significantly higher attenuation values at all vertebral levels (L1-L4), with a mean lumbar HU of 192.88±49.43 compared to 169.09±61.69 in females (p-value <0.001). Males showed a significantly larger psoas cross-sectional area (8.41±2.75 cm²) compared to females (4.32±1.42 cm², p-value <0.001). The strongest correlation was found between the lumbar attenuation and the femur attenuation (r=0.690) and between the psoas attenuation and the HUAC (r=0.668). Weak correlation was found between the psoas area and the HUAC (r=0.095), all statistically significant (p-value <0.01). Conclusion: The muscle and bone parameters measured on CT in the present study showed good correlation and these simple measurements on CT scans can be used in the future as prognostic indicators for osteosarcopenia, which may significantly assist in the treatment plan and prognostication of patients, especially in areas where Dual-energy X-Ray Absorptiometry (DXA) scan is unavailable.

Evaluation of Microalbuminuria and Loss of Nocturnal Blood Pressure Dipping in Prediabetic Individuals: A Cross-sectional Study

Introduction: Diabetes can lead to serious problems, such as microvascular and macrovascular disorders. Pre-diabetes is a serious condition in which blood sugar levels are high but not high enough to be called diabetes mellitus a critical period for intervention to prevent disease progression. Timely identification of issues like microalbuminuria and changes in nocturnal blood pressure dipping patterns might yield significant insights into the pathophysiology of pre-diabetes and suggest potential therapeutic approaches. Aim: To determine the prevalence of microalbuminuria and abnormal nocturnal blood pressure dip-ping patterns among prediabetic individuals and to evaluate their relationship with gender. Materials and Methods: The cross-sectional study was conducted at the Department of General Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India encompassing both In-patient (IP) and Outpatient (OP) Departments from March 2024 to June 2024, on 110 prediabetic people, aged 18 years or older. The baseline tests were Fasting Blood Sugar (FBS), Oral Glucose Tolerance Test (OGTT), Glycated Haemoglobin (HbA1c), and lipid profile, which included Total Cholesterol (TC), Low-Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglycerides (TG), and Very Low Density Lipoprotein (VLDL). The amounts of microalbumin in the urine and blood pressure were monitored for 24 hours to observe night-time BP dipping pattern. The statistical analysis was performed using SPSS (version 22.0). An Independent t-test and Chi-square test for correlation were employed, with p-value <0.05 being statistically significant. Results: The study comprised 110 prediabetic patients, with a mean age of 46.5±8.2 years; of whom 64 (58.2%) were male and 46 (41.8%) were female. No notable variations (p>0.05) were detected be-tween males and females regarding glycaemic indicators (FBS, OGTT, HbA1c). Males had markedly elevated TG and reduced HDL levels; however, these variations were not statistically significant, and other lipid parameters exhibited similarity among genders. Microalbuminuria had a marginally greater prevalence in males (46.9%) than in females (41.3%); yet, this disparity was not statistically significant (p=0.86). A significant percentage of subjects (n=80; 72%) demonstrated either absent or irregular nocturnal blood pressure dropping patterns. Furthermore, microalbuminuria was more prevalent in those exhibiting irregular dipping patterns, observed in 46.5% of non dippers and 32.4% of inadequate dippers, in contrast to merely 16.7% among normal dippers, indicating a possible link between impaired night-time blood pressure regulation and early renal impairment in prediabetic patients. Conclusion: Regular examination of microalbuminuria and BP dipping in those who are prediabetic this may facilitate the early detection of cardiovascular and renal complications. No significant metabolic differences were observed between men and women, indicating that gender may not play a major role in metabolic risk among individuals with prediabetes.

Clinical Profile and Outcomes of Malabar Pit Viper (Trimeresurus malabaricus) Envenomation: A Retrospective Observational Study from Kerala, Southern India

Devapriya Rejeev, Sreelakshmi Mohanachandran, Aneesh Basheer

Introduction: Kerala reports a high incidence of snakebites, with about 37 venomous species. Besides the “Big 4” (Cobra, Krait, Russell’s Viper, and Saw-scaled Viper), the Malabar Pit Viper (MPV) is also notable, especially in the Western Ghats. MPV is endemic to high-altitude, forested regions and presents with local symptoms like pain and swelling, along with haematotoxicity. Aim: To evaluate the clinical characteristics, management, and outcomes of patients with confirmed MPV envenomation at a tertiary centre in Wayanad, Kerala, India. Materials and Methods: The present retrospective observational study was conducted using data from patients admitted over a two-year period, from January 2021 to December 2022. Hospital records were reviewed to identify confirmed cases of MPV envenomation. Cases were included based on either the physical presentation or photograph of the snake brought by the patient, or a clinical diagnosis confirmed by the treating physician. Data collected included patient demographics, anatomical site of the bite, local and systemic manifestations, results of the 20-minute Whole Blood Clotting Test (WBCT), administration of antivenom, and any complications encountered. All data were anonymised and entered into Epicollect5 for collection and management. Statistical analysis was performed using R software. Results: Of the 61 patients admitted with snakebites, 20 (32.8%) were confirmed cases of MPV envenomation. The majority of bites occurred on the upper limbs (n=14, 70%). Local pain and swelling were reported in 13 patients (65%). A prolonged 20-minute WBCT was observed in eight patients (40%). Despite limited evidence of efficacy against MPV venom, 15 patients (75%) received Anti-Snake Venom (ASV). Complications were noted in two patients (10%): one developed cellulitis and the other had an adverse reaction to ASV. All patients recovered fully without any long-term sequelae. Conclusion: MPV (Trimeresurus malabaricus) bites are a notable cause of envenomation in Wayanad, Kerala, typically causing local symptoms with generally good patient outcomes. The routine use of Indian polyvalent ASV is of limited benefit and carries risk of adverse reactions. Developing region and species-specific antivenoms could improve treatment efficacy, reduce risks, and optimise clinical management.

Laparoscopic-assisted Transversus Abdominis Plane Block versus Conventional Periportal Infiltration for Postoperative Pain Management after Elective Laparoscopic Cholecystectomy: A Prospective Interventional Study

Introduction: Managing postoperative pain is critically important for recovery following Laparoscopic Cholecystectomy (LC). While conventional periportal infiltration with local anaesthetics is commonly used, the laparoscopic-assisted Transversus Abdominis Plane (TAP) block is gaining attention for its potential to provide superior analgesia and reduce opioid requirements. Aim: To compare the efficacy of laparoscopic-assisted TAP block versus conventional periportal infiltration in reducing postoperative pain, opioid requirement, and hospital stay in patients undergoing elective LC. Materials and Methods: The present prospective interventional study was conducted on patients scheduled for elective LC in the Department of General Surgery at SRM Medical College Hospital and Research Centre (SRM MCHRC), Tamil Nadu, India, from September 2024 to February 2025. The subjects were randomly divided into two groups: Group A (n=40) underwent laparoscopic-assisted TAP block, while Group B (n=40) underwent conventional periportal infiltration (control group). Postoperative pain was assessed using the Wong Baker FACES Pain Rating Scale (WBFPS) at 3, 6, and 12 hours after surgery. Rescue analgesia requirement, total opioid consumption within the first 24 hours after surgery, and Length of Hospital Stay (LHS) were recorded. Independent t-tests were used to compare continuous variables between the two groups, with p<0.05 considered statistically significant. Results: The mean age of participants in Groups A and B was 43.5±14.5 years and 41.3±13.0 years, respectively. Group A comprised 22 females (55%) and 18 males (45%), while Group B included 20 females (50%) and 20 males (50%). Patients in the TAP block group demonstrated significantly lower pain scores at 3, 6, and 12 hours postoperatively compared to the control group (p<0.05). The time to first rescue analgesia was significantly prolonged in Group A (7.7±1.7 hours) compared to Group B (2±0.8 hours, p<0.001). Consequently, patients in the TAP block group required lower doses of opioid analgesics within the first 24 hours. The mean LHS was significantly shorter in Group A (2.0±0.7 days) compared to Group B (3.7±1.2 days, p=<0.001). Conclusion: The laparoscopic-assisted TAP block is markedly superior to periportal infiltration in managing postoperative pain following LC. It provides more effective pain control, reduces opioid consumption, and shortens hospital stay, making it an important component of multimodal analgesia.

Comparative Evaluation of the Impact Strength of Polymethyl Methacrylate Heat-cure Acrylic Denture Base Resin Reinforced with Aramid Fibres and Glass Fibres: An In-vitro Study

Introduction: Polymethyl Methacrylate (PMMA) is widely used as the material of choice for denture base fabrication due to its favourable handling properties, aesthetics, and cost-effectiveness. However, its low fracture and impact resistance remains a major clinical limitation, often leading to denture failure. Reinforcement of PMMA with fibres such as aramid and glass has been proposed to enhance its mechanical properties. Aim: To compare the impact strength of conventional heat-cure PMMA denture base resin, PMMA-reinforced with aramid fibres, and PMMA-reinforced with glass fibres. Materials and Methods: This in-vitro experimental study was conducted at the Department of Prosthodontics, Maratha Mandal’s Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India from a period of 6 month from June 2025 to December 2025. A total of 30 rectangular test specimens were prepared using preformed stainless-steel metal dies (50×10×3 mm) with a 45-degree notch at the center. The specimens were divided into three groups (n=10 each): Group A: Conventional heat-cure PMMA (control), n=10, Group B: PMMA-reinforced with aramid fibres (1% by weight) n=10, Group C: PMMA-reinforced with glass fibres, n=10. A monomer-polymer ratio of 1:2 by weight was used. After reaching the dough stage, the material was packed, processed at 73°C for 30 minutes, bench-cooled, and deflasked. The specimens were tested using an Izod impact strength testing machine with a load of 2.9 joules/m. Impact strength was recorded in joules and kJ/m². Statistical analysis was performed using One-way Analysis of Variance (ANOVA) for overall comparison and the Bonferroni Post-hoc test for intergroup comparison with p≤0.05 was considered statistically significant. Results: The highest impact strength was observed in Group B (aramid fiber reinforced PMMA), followed by Group C (glass fiber reinforced PMMA), and lowest in Group A (control). Statistically significant differences were observed between Group B and Group C (p<0.001) and between Group C and Group A (p=0.021). However, the difference between Group B and Group A was statistically insignificant (p=0.199). Conclusion: Within the limitations of this in-vitro study, incorporation of 1% by weight aramid fibres into heat-cure PMMA significantly improved the impact strength compared to conventional PMMA. Fiber reinforcement, particularly with aramid fibres, can be considered a promising approach to enhance the fracture resistance of denture base resins.

Tobacco Agar as a Novel Medium for Chlamydospore Induction in Candida Species: A Cross-sectional Study

Akansha Goyal, Himadri Rajeshkumar Trivedi, Hiral Gadhavi, Sapna Chauhan

Introduction: Candida species, especially Candida albicans and Candida dubliniensis, are major opportunistic pathogens in humans, distinguished by their ability to form chlamydospores. Traditional diagnostic methods rely on phenotypic traits, with chlamydospore production serving as a key differentiator. Tobacco agar has emerged as a potential low-cost, effective medium to induce chlamydospore formation, particularly useful in resource-limited settings. Aim: To evaluate the efficacy of tobacco agar in inducing chlamydospore formation for the pre-sumptive identification of Candida species. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology at Shri MP Shah Government Medical College, Jamnagar, Gujarat, India over the period of six months from October 2019 to March 2020. A total of 100 non duplicate sputum samples from patients suspected of fungal respiratory infections were included based on Bartlett’s criteria. Samples were cultured on Sabouraud Dextrose Agar, and isolates showing creamy white colonies were presumptively identified as Candida spp. These were further subcultured on in-house prepared tobacco agar using the Dalmau plate technique to induce chlamydospore formation and aid species-level identification. Microscopic evaluation began 48 hours post-inoculation, and isolates were classified based on germ tube and chlamydospore presence. Fisher's exact test assessed the association between incubation parameters and chlamyd-ospore development, with a significance threshold of p-value < 0.05. Results: Candida species were isolated from 30 (30.0%) of 100 sputum samples. Among these, 19 (63.3%) showed germ tube formation and chlamydospore production consistent with C. albicans/C. dubliniensis, while 11 (36.7%) were identified as non albicans Candida. Chlamydospore induction occurred in 19 (63.3%) isolates on both tobacco agar and Cornmeal Agar (CMA). Optimal induction was noted at 28°C after 48-72 hours, with no formation at 37°C or 24 hours. Conclusion: Tobacco agar demonstrates reproducible morphological responses in Candida isolates under controlled conditions, which may support presumptive differentiation Its use may encourage broader adoption of low-cost, observation-based tools in diagnostic mycology.

Antimicrobial Resistance Patterns and Molecular Characterisation of Gram-negative Non Fermenters: A Cross-sectional Study from Odisha, India

Subhasmita Das, Sasmita Hotta, Sasmita Khatua

Introduction: Non fermenting Gram-negative Bacilli (NFGNB) are emerging as major opportunistic pathogens in healthcare settings. NFGNB are intrinsically resistant to many antibiotics and can survive in harsh conditions. Aim: To investigate antimicrobial resistance patterns and perform molecular characterisation of NFGNB isolated from clinical samples in order to understand resistance mechanisms and epidemiological distribution. Materials and Methods: This cross-sectional study was conducted from September 2021 to October 2023 at SCB Medical College, Cuttack, Odisha, India. A total of 920 clinical samples from various body fluids were collected from both inpatients and outpatients across hospital departments and analysed using bacteriological and molecular methods. Standard protocols were followed for sample processing, culture, and species identification. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines using appropriate quality control strains. Ex-tended-Spectrum Beta-Lactamase (ESBL) and Metallo-Beta-Lactamase (MBL) detection was carried out using phenotypic methods (disc diffusion and E-test) and genotypic techniques Polymerase Chain Reaction (PCR) targeting TEM, SHV, and CTX-M genes). Demographic variables included age and sex distribution of enrolled patients. Data were analysed using Chi-square tests, with p-value<0.05 considered statistically significant. Results: Of the 920 clinical samples analysed, 159 (17.3%) were positive for NFGNB. The predom-inant isolates were Pseudomonas aeruginosa (96; 60.37%) and Acinetobacter baumannii (48; 30.18%). Among NFGNB-positive cases, males (111; 69.81%) were more frequently affected than females (48; 30.19%). The highest number of cases occurred in the 31-40-year age group (42; 26.41%), followed by 21-30 years (32; 20.12%) and 41–50 years (25; 15.72%). TEM showed 86 isolates (54.08%), indicating a high prevalence of resistance. Conclusion: Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant NFGNB isolates, exhibiting high levels of multidrug resistance and ESBL production. Emerging carbapenem resistance highlights the urgent need for continuous surveillance and strengthened infection control measures. Targeted combination therapy guided by susceptibility testing is essential for effective clinical management.

ChatGPT’s Performance in Answering Formative Pharmacology Examination Questions for Phase II Medical Undergraduate Students: A Cross-sectional Study

Netravathi Basavaraj Angadi, Vidya Mahalmani, Bhargav Annam

Introduction: The emergence of Artificial Intelligence (AI) tools like ChatGPT has sparked interest in their potential role in medical education. The increasing volume and complexity of pharmaco-logical knowledge pose significant challenges for undergraduate medical students. AI-based language models such as ChatGPT offer rapid access to information, explanations, and problem-solving support, potentially supplementing traditional teaching methods. However, systematic evaluation of their performance, reliability, and educational accuracy in pharmacology assessments remains limited, necessitating formal investigation. Aim: To evaluate ChatGPT’s performance in answering formative pharmacology examination questions for Phase II medical undergraduate students. Materials and Methods: This was a cross-sectional study conducted in the Department of Pharmacology at Jawaharlal Nehru medical college in Belagavi, Karnataka, India over a period of one month (December 2024). All pharmacology questions included in the December 2024 formative undergraduate examination, covering general pharmacology, central nervous system drugs, cardiovascular drugs, and autacoids were included. The study protocol was reviewed and approved by the department scientific review commit-tee and ethical committee approval was waived off as it did not involve human subjects. ChatGPT (version 3) was used to answer Multiple-Choice Questions (MCQs), short answer questions, short essay questions, and long essay questions. The responses generated by ChatGPT were evaluated for accuracy, completeness, quality of explanation, and level of knowledge. Acceptability of responses was assessed through qualitative review by pharmacology subject experts. Comparison between groups was performed using Pearson’s chi-square test. Descriptive statistics were applied, and results were expressed as frequencies and percentages. Results: ChatGPT demonstrated high accuracy, with correct response rates of 13 (86.7%) for recall, 7 (70%) for interpretation, and 9 (81.8%) for problem-solving questions. ChatGPT demonstrated com-parable performance across all three knowledge levels, with no statistically significant difference observed (p-value=0.8). The majority of explanations 29 (80.6%) were rated as good, 4 (11.1%) as needs revision and 3 (8.3%) as unacceptable. While performance was consistent across knowledge levels, challenges were noted in complex problem-solving scenarios requiring deep integration of concepts. Conclusion: ChatGPT showed strong potential as an AI-assisted learning tool in pharmacology education, particularly for factual recall and conceptual understanding. However, improvements are needed in complex reasoning and nuanced explanations. This study supports further research into AI’s role in enhancing medical curricula.

Efficacy and Safety of Aspirin with Sertraline versus Sertraline Monotherapy in the Treatment of Major Depressive Disorder: A Randomised Clinical Study

Vineeta Debbie Nesam, B Sharmila

Introduction: Major Depressive Disorder (MDD) is the most common mood disorder, affecting over 322 million people worldwide. Many patients receiving first-line antidepressants, such as Selective Ser-otonin Reuptake Inhibitors (SSRIs) like sertraline, fail to achieve full remission or show only gradual symptomatic improvement. The adjunctive use of aspirin, through inhibition of prostaglandin synthesis and modulation of inflammatory pathways, reduces systemic inflammation and may enhance the therapeutic response to antidepressant treatment. Aim: To study the efficacy and safety of combined sertraline and aspirin therapy versus ser-traline monotherapy in reducing depression severity among patients with MDD. Materials and Methods: The present randomised clinical study was conducted at Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, from January 2020 to January 2021. One hundred patients aged 40-70 years diagnosed with major depression based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria were randomised into two groups. Group A received sertraline 200 mg plus aspirin 150 mg once daily, while Group B received sertraline 200 mg once daily. Treatment was administered for 12 weeks, with follow-up assessments conducted at baseline and at the 4^th, 8^th, and 12^th weeks. Depression severity was assessed using the Beck Depression Inventory (BDI) scale. Safety monitoring included complete blood counts, liver and renal function tests. Data were analysed using the independent t-test. Results: Fifty patients were randomly assigned to each group after screening. The mean age was 51.4±1.5 years in Group A and 50.2±2.5 years in Group B. The study population showed a female predomi-nance (66 females and 34 males). Baseline BDI scores were 27.7±7.435 in Group A and 30.32±7.620 in Group B, with no statistically significant difference between the groups (p=0.085). At the 8^th and 12^th weeks, Group A showed a significantly greater reduction in depression severity scores com-pared to Group B (p=0.001). The most common adverse effect in Group A was gastritis, reported by 24 par-ticipants (48%), while insomnia was most frequent in Group B, affecting 18 participants (36%). Conclusion: Combination therapy with aspirin and sertraline demonstrated superior efficacy com-pared to sertraline monotherapy in the treatment of MDD. Aspirin’s anti-inflammatory and antioxidant properties may help to reduce disease progression and alleviate depressive symptoms. However, the high incidence of gastritis necessitates careful patient selection and monitoring.

Assessment of Haematological and Lipid Profile Parameters in Patients with Ischaemic Heart Disease: A Cross-sectional Study

A Risana, DL Pavithra, K Deeksha

Introduction: Ischaemic Heart Disease (IHD) remains a leading cause of morbidity and mortality worldwide. Its multifactorial pathophysiology involves atherosclerosis, endothelial dysfunction, and alterations in haematological and lipid profile parameters. Evaluating these parameters may offer in-sight into disease progression and potential risk factors. Aim: To evaluate the haematological variations and lipid profiles in patients with IHD. Materials and Methods: The present retrospective cross-sectional study was conducted over 12 months from April 2024 to April 2025 at the Central Laboratory of Yenepoya Medical College Hospital, Mangalore, Karnataka, India after the approval of Yenepoya Ethics Committee-2 (YEC-2). Retrospective data of 95 patients diagnosed with Ischaemic heart disease, aged 25-70 years, were randomly retrieved from the Laboratory Information System (Backbone). Patients with diabetes, renal, autoimmune, or inflam-matory conditions were excluded. Haematological (Haemoglobin(Hb), Red Blood Cell(RBC), White Blood Cell (WBC), Neutrophil, Lymphocyte, Packed Cell Volume (PCV), Erythrocyte Sedimentation Rate (ESR), Platelet, Red cell Distribution Width (RDW)) and Lipid profile (Total Cholesterol, High Density Lipoprotein(HDL), Low Density Lipoprotein(LDL), Very Low Density Lipoprotein(VLDL), Triglycerides) parameters were ana-lysed to assess their association with IHD. Statistical analysis was carried out to evaluate the associ-ation between haematological parameters and lipid profiles in order to determine their correlation with IHD. Data were expressed as mean±standard deviation. Pearson’s correlation (Independent sample t-test) was used to assess relationships between haematological parameters and lipid profiles. A p-value ≤0.05 was considered significant. The data were analysed using Statistical Package for Social Sciences (SPSS) software version 27. Results: The mean patients age was 54.6±10 years, with 70 males (73.7%) and 25 females (26.3%). Anaemia was observed with a mean Hb of 12.25±2.245 g/dL. Elevated ESR (37.28±27.837 mm/hr) and increased RDW (15.03±6.308 %) were also noted. Lipid profiles showed low HDL (37.6±21.6 mg/dL) and high TG (165.3±84.7 mg/dL), particularly in males. Significant positive correlations were noted between Hb and TG (r=0.25, p=0.01), Hb and VLDL (r=0.23, p=0.02), LYMPH and HDL (r=0.27, p=0.01), and ESR and HDL (r=0.21, p=0.04). Females had significantly lower Hb and PCV; lipid differences by gender were not statistically significant. Conclusion: Alterations in haematological indices and lipid profiles are prominent among IHD patients, suggesting their utility in early risk assessment. Hb and LYMPH count showed significant asso-ciations with lipid parameters, highlighting the interplay between inflammation and lipid metabolism. Incorporating haematological and lipid evaluation in routine screenings may enhance early detection and management of IHD. Further large-scale, multicentre, prospective studies are recommended.

Analysis of Red Blood Cell Parameters and Serum Iron Profile in Patients with Chronic Kidney Disease: A Retrospective Cross-sectional Study

M Fathima Henna, Renuka Patil, SA Mohideen Sharfan

Introduction: Chronic Kidney Disease (CKD) is a progressive loss of kidney function that frequently leads to anaemia, primarily due to erythropoietin deficiency. Anaemia in CKD exacerbates cardio-vascular risk, reduces quality of life, and accelerates disease progression, particularly in advanced stages. Regular monitoring of Red Blood Cell (RBC) parameters is essential for accurate anaemia classification and management. Aim: To analyse RBC parameters and the serum iron profiles in patients at different stages of CKD and to determine their associations with renal function markers. Materials and Methods: The present retrospective cross-sectional study was conducted at Yenepoya Medical College and Hospital, Mangalore, Karnataka, India. Data from 113 CKD patients aged ≥18 years, collected between May 2024 and May 2025, were analysed. Parameters assessed included RBC count, haemoglobin, haematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), serum iron profile (serum iron, Total Iron-Binding Capacity [TIBC], and serum ferritin), peripheral smear findings, blood urea, and serum creatinine. The relation-ships between RBC parameters, iron profile parameters, serum creatinine, and blood urea were analysed using Pearson’s correlation coefficient. A p-value <0.05 was considered statistically significant. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 27. Results: Among the 113 patients, 79 (69.91%) were male, and 84 (74.34%) were in stage 5 CKD. Moderate anaemia was the most common severity, observed in 79 patients (69.91%). The severity of anaemia increased with advancing CKD stage. The mean haemoglobin level was 8.21 g/dL. Serum creatinine showed moderate, statistically significant negative correlations with RBC count, haemoglobin, and packed cell volume (r=-0.31 to -0.33, p<0.001). Blood urea also demonstrated moderate negative correlations with these parameters (r=-0.24 to -0.28, p <0.01). Serum iron exhibited a weak positive correlation with se-rum creatinine (r=0.26, p=0.006). Normocytic normochromic anaemia (91%) was the predominant peripheral smear pattern. Conclusion: Anaemia is a common and progressive complication of CKD, with severity increasing as renal function declines. Monitoring RBC parameters and iron profiles is essential for accurate anaemia classification, optimising treatment strategies, and preventing unnecessary iron supplementation, particularly in advanced stages of CKD.

Cardiac Autonomic Activity among Normal and Type 2 Diabetic Patients: A Cross-sectional Study

Nayana M Nair, Jiji Inassi, KK Anoop, Saran Ajay Kumar, Sandra Christina George

Introduction: Diabetic Cardiovascular Autonomic Neuropathy (DCAN) is one of the most dreaded but least recognised complications of diabetes, which manifests as a spectrum of abnormalities, ranging from resting tachycardia and decreased Heart Rate Variability (HRV) to “silent” myocardial infarction. Early identification of DCAN is essential, as timely intervention can delay or reverse autonomic dysfunction. Limited Indian data on this subject underscore the need for further research. Aim: To assess cardiovascular autonomic function in patients with Type 2 Diabetes Mellitus (T2DM) in comparison with healthy controls and also to analyse its association with age, gender, Body Mass Index (BMI), duration of diabetes, and glycaemic control. Materials and Methods: This cross-sectional study was conducted in the Department of General Medicine and Physiology at Government Medical College, Kozhikode, Kerala, India, from January 2020 to January 2021, involving 98 patients diagnosed with T2DM (diabetic group) and 98 healthy controls (control group). Cardiovascular autonomic function was assessed using a 16 channel Physiolab and PHYSIOPAC software system employing Ewing’s five standard cardiovascular reflex tests. Glycaemic parameters such as Fasting Blood Sugar (FBS), Post-prandial Blood Sugar (PPBS) Random Blood Sugar (RBS), and HbA1c were also measured. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) software version 18.0, with unpaired t-tests for quantitative parameters and Chi-square tests for qualitative variables. Fischer’s-exact test was used to determine the association between various parameters. Results: The study population comprised adults aged 33-60 years, with a mean age of 50.34±6.09 years in the diabetic group and 50.84±6.55 years in the control group (p-value=0.581). Gender distribution was comparable, with 47 males and 51 females in each group (p-value=1.00). The prevalence of Cardiac Autonomic Neuropathy (CAN) was significantly higher among diabetic subjects (74.5%) compared with controls (9.2%) (p-value <0.001). Severity of CAN showed a positive correlation with age (p-value=0.002), BMI (p-value <0.001), duration of diabetes (p-value <0.001), and HbA1c (p-value <0.001), but not with gender (p-value=0.09). Parasympathetic dysfunction preceded sympathetic involvement in diabetic patients. Conclusion: T2DM is strongly associated with reduced cardiovascular autonomic function. Early detection through routine autonomic function testing, coupled with optimal glycaemic control and life-style modification, is recommended to prevent progression of DCAN.

Method-dependent Variation in Serum Electrolytes: A Cross-sectional Study Comparing Direct and Indirect Ion-selective Electrodes

Shivani Jaswal, Karanvir Gosal, Seema Gupta, Manpreet Kaur, Maryam Jamal, Jyoti

Introduction: Serum electrolyte measurement, particularly sodium, potassium, and chloride, is among the most commonly ordered investigations in routine and emergency care. Rapid and accurate reporting is essential for timely clinical decisions. Most modern electrolyte analysers utilise Ion-selective Electrode (ISE) technology, available in two forms: direct ISE (dISE), which measures electrolytes in undiluted serum, and indirect ISE (iISE), which measures them after pre-dilution. These methodological differences may influence reported values. Aim: To compare the serum sodium, potassium, and chloride levels measured using dISE versus iISE methods. Materials and Methods: The cross-sectional study was conducted in the Clinical Biochemistry Laboratory, Government Medical College and Hospital, Chandigarh, India, from March 2024 to and June 2024. A total of 150 serum samples were obtained from the outpatients, inpatients, and Intensive Care Unit (ICU) patients. Paired serum samples available for simultaneous direct and iISE estimation were included. Deidentified residual samples were analysed and assigned a unique code. dISE was performed using the ABL800 FLEX (Radiometer) on undiluted serum, while iISE was performed using the Beckman Coulter AU5800 on prediluted serum; both followed the manufacturer’s calibration and two-level internal Quality Control (QC) protocols. Testing order was randomised, and paired measurements were completed within 30-60 minutes to avoid analyte instability. Statistical analysis included Bland–Altman plots to assess agreement and Spearman’s correlation to evaluate the association between the two methods. Analysis was stratified by clinically relevant electrolyte ranges, with p<0.05 considered statistically significant. Results: dISE yielded significantly higher sodium and chloride levels than iISE. Subgroup analysis using clinically relevant thresholds demonstrated significant correlations for serum sodium ≤140 mEq/L, potassium ≥4.5 mEq/L, and chloride levels across both concentration groups (>103 and <103 mEq/L), with correlation coefficients of r=0.546, 0.870, 0.602, and 0.703, respectively (p<0.0001). Conclusion: A significant difference was observed between dISE and iISE methods for serum electrolyte measurement, particularly within specific clinical ranges. These findings highlight the need for methodological consistency in electrolyte analysis, especially in emergency and critical care settings, to prevent misinterpretation and inappropriate clinical decisions arising from analytical variability.

Medication Adherence among Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study at an Urban Health Training Centre in Mysuru, India

Rachana K Nair, Mansoor Ahmed

Introduction: Diabetes is one of the four priority non-communicable diseases globally, due to its significant burden and associated complications. Effective management of diabetes requires good medication adherence, which plays a crucial role in minimising complications and adverse health outcomes. However, non adherence to diabetic medications remains a major public health challenge. Key factors contributing to poor adherence include irregular access to medications, polypharmacy (increased number of drugs), side-effects, and lack of awareness. Assessing the extent and impact of these factors is essential for developing appropriate interventions aimed at improving medication adherence among individuals with diabetes. Aim: To estimate the proportion of medication compliance among registered patients with type 2 diabetes mellitus in the Urban Health Training Centre (UHTC) of MMCRI, Mysuru, Karnataka, India. Materials and Methods: The present community-based cross-sectional study was conducted among registered type 2 diabetes mellitus patients under UHTC, MMCRI, Mysuru, Karnataka, India. from June 2021 to May 2022 (1 year). Inclusion criteria included consenting adult patients registered during the data collection period. A sample size of 220 was estimated based on a 50.9% adherence rate. Multistage sampling was used: Stage-1 involved selection of number of patients in each subcentres by probability proportional to size, and Stage-2 used simple random sampling to select the registered number of patients under the subcentre. Ethical clearance was obtained. Data were collected monthly by interviewing patients at their residences using a structured questionnaire. It included, sociodemographic features and medication adherence scale. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Data were analysed using MS Excel and Statistical Package for Social Sciences (SPSS) v23, applying proportions, frequencies, and Chi-square tests (p=0.05). Results: In the study, 107 (48.6%) of participants were male and 113 (51.3%) were female. Among them, 129 (58.6%) demonstrated good adherence to diabetic medications, 13 (5.9%) had moderate adherence, and 78 (35.45%) showed poor adherence. The findings revealed that medication adherence declined with increasing age. Additionally, factors such as socioeconomic status, gender, and educational level were significantly associated with adherence levels. Conclusion: With the growing burden of diabetes in India, ensuring consistent medication adherence is crucial to prevent complications and enhance the overall quality of life for patients.

Outcomes and Predictors of Mortality among Young Children with Acute Meningoencephalitis: A Prospective Observational Study

Richa Singh, Manisha Verma, Chandrakanta Kumar, Parul Jain

Introduction: Acute Meningoencephalitis (AME) is a life-threatening condition in young children, particularly in low-resource settings, with overlapping features of meningitis and encephalitis. Despite advances in diagnostics and vaccination, evolving pathogens like dengue virus and Orientia tsutsugamushi contribute to high morbidity and mortality due to delayed diagnosis and treatment. Aim: To assess short-term outcomes, and predictors of mortality of AME in children under five years of age. Materials and Methods: The present prospective observational study was conducted at King George’s Medical University, Lucknow, Uttar Pradesh, India, from January 2020 to September 2021. Total 101 children aged between 1 month to 5 years with AME were enrolled in this study after taking a written informed consent from their parents. Detailed clinical history (fever, seizures and its type, altered sensorium, headache, diarrhoea, vomiting, bleeding, swelling, rash) and demographic details were recorded. Outcomes were classified as complete recovery, recovery with neurological sequelae, or mortality. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23 for Windows. Logistic regression analysis was performed to identify independent predictors of mortality. Results: Total 101 children were enrolled with AME, with a mean age of 37.92±18.32 months, with 66 (65.3%) of the cases being male and a male-to-female ratio of 1.9:1. Out of 101 cases 69 (68.3%) were successfully treated and discharged. Among the 69 children who were discharged, 39 ( 56.5%) cases were fully conscious and recovered completely. However, 30 (43.5%) cases had some degree of altered sensorium at discharge. Of these, three children (4.3%) required nasogastric (RT) feeding, and two children (2.8%) were discharged with both tracheostomy and RT feeds in place. Persistent neurological sequelae were noted in several cases: seizures in five children (7.2%), visual and hearing impairments in five children (2.8%) each, and focal neurological deficits in two children (2.8%). The overall mortality rate was 9.9%, with factors such as immunisation status, Glasgow Coma Scale (GCS) score, renal dysfunction, and the need for mechanical ventilation associated with worse outcomes. Conclusion: According to the results of the present study key predictors of mortality in children with AME included severe GCS scores, renal dysfunction, and the need for mechanical ventilation. Early diagnosis, immunisation, and prompt treatment are crucial for improving outcomes.

Analytical Development and Optimisation of a Semi-in-House ELISA for the Detection of SARS-CoV-2 by using Spike and Nucleocapsid Protein Antigens

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a betacoronavirus that emerged in late 2019, is the causative agent of Coronavirus Disease 2019 (COVID-19). The viral spike (S) and Nucleocapsid Protein (NP) are key structural components and principal targets for antigen detection. Developing reliable in-house immunoassays targeting these proteins is essential to enhance laboratory capacity and reduce dependence on commercial diagnostic kits. Aim: To analytically develop and optimise semi-in-house direct and sandwich Enzyme Linked Immuno Sorbent Assay (ELISA) for individual and simultaneous detection of SARS-CoV-2 spike (S) and NP antigens. Materials and Methods: This was an analytical laboratory-based study conducted between April 2025 and October 2025 at King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia. For direct ELISAs, assay conditions were optimised using checkerboard titration. Recombinant SARS-CoV-2 S and/or NP antigens were used as positive controls, while MERS-CoV S and/or NP antigens were included to evaluate potential cross-reactivity. Horseradish Peroxidase (HRP)-conjugated monoclonal antibodies specific to SARS-CoV-2 S and/or NP served as detection antibodies. Optimal antibody concentrations were defined as those producing the highest positive-to-negative Optical Density (OD) ratio, including blank controls. For sandwich ELISAs, plates were coated with monoclonal anti-SARS-CoV-2 antibodies targeting S/RBD and/or NP as capture antibodies. Subsequent steps followed the optimised protocol established for the direct ELISA format. Analytical performance was evaluated by determining the assay cut-off value, Limit Of Detection (LOD), linear dynamic range, and intra- and inter-assay Coefficients of Variation (CV%). Cross-reactivity was assessed using MERS-CoV recombinant proteins and heat-inactivated virus preparations. Results: Direct ELISAs detected S antigen at ≥6.25 ng and NP antigen at ≥3.125 ng per well whereas sandwich ELISAs improved analytical sensitivity four-fold (LOD 0.78 ng). Detection using heat-inactivated virus demonstrated analytical sensitivity down to 0.049×10⁵ TCID₅₀/mL. Intra-assay CV ranged from 3.1-6.1% and inter-assay CV from 6.2-9.2%. No cross-reactivity with MERS-CoV was observed under tested conditions. Conclusion: The developed semi-in-house ELISAs demonstrated acceptable analytical sensitivity and reproducibility for research applications. Clinical validation using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed patient samples is required before diagnostic implementation.

Association of Poorly Differentiated Clusters with Clinicopathological Features and Tumour Budding Count in Invasive Breast Carcinoma: A Cross-sectional Study

KN Kusuma, Apoorva Pandit, S Vijay Shankar

Introduction: Poorly Differentiated Clusters (PDC) and Tumour Budding Count (TBC) have emerged as potential histological markers of tumour aggressiveness. While their prognostic significance is well-documented in colorectal carcinoma, their role in invasive breast carcinoma remains underexplored. Aim: To assess the frequency of PDCs in invasive breast carcinoma and to analyse their association with various clinicopathological factors, tumour budding and molecular profile. Materials and Methods: This cross-sectional study was done from January 2022 to December 2025 at the Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Karnataka, India. Clinicopathological details were noted down and PDC and TBC were assessed and graded on routine Haematoxylin and Eosin (H&E) slides. Further Immunohistochemistry (IHC) was done for Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor 2 (HER2), and Ki-67 for molecular classification of tumour. Statistical Package for the Social Sciences (SPSS) software version 25.0 was used to assess association between PDCs and TBC, clinicopathological features and molecular profile of tumour. Chi-square and multivariable logistic regression tests were done and p-value of <0.05 was considered significant. Results: The study included 44 cases of invasive ductal carcinoma breast, no special type. Age of the patients ranged between 34 and 75 years. Majority of cases were of grade 2 (27 cases; 61.36%) and T2 stage (28 cases; 63.64%). PDC showed an association with tumour grade and tumour budding with a p-value of <0.05 and 0.02, respectively. There was no association with lymph node metastasis, lymphovascular invasion and tumour size. Similarly, hormone receptor, HER2 and Ki-67 expression did not show any association (p-value>0.05). On multivariate analysis, only TBC grade 1 showed a statistically significant association with PDC (OR=0.052, 95% CI: 0.003-0.864, p-value=0.039). Conclusion: PDC evaluation is a simple and cost-effective morphological indicator of tumour aggressiveness on routine H&E section. It may compliment the conventional prognostic factors and aids in improved risk stratification.

Functional Evaluation of an EMR Teleglaucoma System in a Malaysian Urban Setting

Introduction: Teleophthalmology has become much more popular after the Coronavirus Disease 2019 (COVID-19) pandemic because it can be implemented at a distance without contact with the patients. However, teleophthalmology for glaucoma has not been implemented in Malaysia. The present study project adapted an in-house Electronic Medical Record (EMR) system for teleophthalmology in glaucoma (teleglaucoma). Aim: To evaluate the functionality of a teleglaucoma system in Malaysia. Materials and Methods: The present cross-sectional research was conducted in July 2023, which involved eye healthcare professionals working at a primary health clinic and an eye clinic affiliated with a tertiary university hospital in Malaysia. The participants were recruited using a purposive sampling method. A google form questionnaire, consisting of three sections -demographic information, evaluation of functionality (yes/no), and an open-ended question for system improvement were given to participants after they had completed using the teleglaucoma system. Descriptive analysis was used to analyse the data. Results: Ten eye healthcare professionals were recruited for the study. The findings of the study revealed that most eye healthcare professionals were able to use the functions in the system. Most ophthalmic personnel (71.4%, n=5) could use 90% of the system functions, while the rest (28.6%, n=2) could use 80% of the functions. All ophthalmologists were able to use the function in the system. Some participants suggested several system enhancements, including the ability to upload multiple images, an improved interface with a standardised template for patient history, and a side-by-side image display. They also suggested an ‘edit’ button to modify clinical sheets after they have been submitted. Conclusion: The adapted EMR-based teleglaucoma system was found to be functional by eye healthcare professionals. The EMR enables ophthalmologists to review patient information, diagnose, and manage glaucoma remotely. Therefore, this system can be used for glaucoma screening in healthcare clinics that are virtually connected to a hospital with ophthalmology services. Future studies comparing the teleglaucoma system with opportunistic case finding should be conducted to determine the effectiveness of the system.

Prophylactic Intravenous Phenylephrine to Prevent Propofol-induced Hypotension during Induction of General Anaesthesia: A Randomised Clinical Trial

Sagar Harishchandra Pawar, Vijaykumar T Kallyanappagol, Santoshkumar Alalamath

Introduction: Propofol is commonly used intravenous induction agent which are frequently complicated by peri-induction hypotension. Reduced Mean Arterial Pressure (MAP) during anaesthesia contributes to significant postoperative morbidity, including renal and myocardial injury. Preventive strategies aimed at maintaining haemodynamic stability during this critical period are of clinical value. Phenylephrine offers a simple, rapid option for counteracting propofol-induced vasodilatation. Aim: To assess effectiveness of i.v. phenylephrine in preventing propofol-induced hypotension during induction of general anaesthesia. Materials and Methods: This randomised clinical trial was conducted from October 2024-December 2025 at Department of Anaesthesiology, Shri BM Patil Medical College, Hospital and Research Centre, BLDE DU, Vijayapura, Karnataka, India. The study included 130 American Society of Anaesthesiologists (ASA) I–II patients (18–65 years) undergoing elective general anaesthesia and were randomised (1:1) to receive i.v. phenylephrine 100 μg or saline before propofol induction. Primary outcome was hypotension (≥20% MAP fall). Secondary outcomes included Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), MAP, and Heart Rate (HR) at 5, 10, and 15 minutes. Analysed using Statistical Package for the Social Sciences (SPSS) version 20.0, normally distributed continuous variables (Shapiro-Wilk test) were expressed as mean±SD and evaluated via independent student’s t-tests. Results: The control group’s average age was 37.76±15.69 years (50.8% female, 49.2% male), the study group averaged 34.38±14.30 years (49.2% female, 50.8% male). Postinduction hypotension was lower in the study group (32.3%, n=21 vs 73.8%, n=48; p-value <0.001). At 5, 10, and 15 minutes, Group A maintained higher MAP, SBP, and DBP than Group B (all p-value <0.001), Group A vs Group B MAP was 87.88±8.694 vs 79.45±9.384 (p-value <0.001), 86.51±9.045 vs 74.86±9.890 (p-value <0.001), and 87.60±9.375 vs 77.55±8.816 mmHg (p-value <0.001); SBP was 117.80±10.145 vs 107.48±11.172 (p-value <0.001), 116.46±10.827 vs 102.37±11.870 (p-value <0.001), and 117.43±11.243 vs 105.25±10.070 mmHg (p-value <0.001); DBP was 71.45±9.038 vs 65.18±9.084 (p-value <0.001), 70.20±9.00 vs 60.98±8.977 (p-value <0.001), and 71.32±9.059 vs 63.45±8.646 mmHg (p-value <0.001). Group A HR was lower at 10 minutes (88.60±11.900 vs 93.29±14.021 bpm, p-value=0.009) and 15 minutes (85.18±11.144 vs 91.75±12.668 bpm, p-value=0.001). Conclusion: A single 100 μg bolus of phenylephrine administered immediately before induction with propofol effectively attenuated peri-induction hypotension and maintained stable haemodynamic. This simple intervention improves perioperative safety in patients at risk of hypotension.

A Comparative Assessment of Functional Outcomes of Conservative Treatment versus Dynamic External Fixator for Proximal Interphalangeal Joint Fracture-dislocation: Cross-sectional Study

Introduction: Finger joint dislocations, particularly involving the Proximal Interphalangeal (PIP) joint, pose common challenges in hand injuries. Despite various treatment modalities available including extension block splinting, extension block pinning, Open Reduction and Internal Fixation (OR-IF), hemi-hamate arthroplasty, volar plate arthroplasty, and Dynamic External Fixator (DFS), comparative studies assessing functional outcomes are scarce. Definitive treatments for a particular type of PIP fracture-dislocation are not defined. Dynamic external fixation is a minimally invasive and cost-effective surgical treatment that allows early joint mobilisation with soft-tissue preservation. Aim: To compare the functional outcomes of conservative treatment versus DFS for PIP joint fracture-dislocation. Materials and Methods: A comparative prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from August 2022 to August 2024. Patients aged 18-50 years with PIP fracture-dislocations less than three-week-old were included. Patients were randomised to receive conservative management using buddy strapping (Group A) or DFS (Group B). Functional assessments, radiographic monitoring, and pain evaluations were conducted preoperatively and at follow-up appointments for a duration of three months. The association between categorical variables was examined using Chi-square tests, with a p-value <0.05 indicating statistical significance. Results: Group B exhibited significant improvements in Range Of Motion (ROM) (88.3±7.7) (p-value=0.001), extensor lag (1.9±1.7°) (p-value=0.013), intra-articular step-off (1.1±1.1) (p-value=0.002), grip strength (81.4±5.9) (p-value=0.001), and pain scores (0.5±0.7) (p-value=0.001) compared to Group A’s ROM (76.3±7.4), extensor lag (3±2°), intra-articular step-off (2±1.3), grip strength (70±6.2), and pain scores (2.2±1.1) at three months follow-up. Disability scores (Quick Dash) were also significantly lower in Group B (10.9±4.4) (p-value <0.001) compared to Group A (31.6±13.5) at three months. Conclusion: DFS-Suzuki frame treatment showed superior outcomes compared to conservative treatment for PIP fracture-dislocations. It resulted in improved motion, strength, and pain scores, along with reduced disability.

Agent-based Multimodal Periodontal Disease Simulator: An In-silico Study of Bone Loss Dynamics

Varun Batra, Pradeep Kumar Yadalam, Gunjan Batra Handa

Introduction: Periodontitis is a chronic inflammatory disease that leads to irreversible damage to the gums, periodontal ligament, and alveolar bone. Its progression is driven by a complex interaction of microbial imbalance, host immune responses, and patient-specific risk factors like smoking and diabetes. Digital Twin (DT) technology- virtual models that mimic anatomical and physiological behaviours- has shown promise in orthodontics and implantology, but its use in periodontal disease remains unexplored. Hereby, authors introduce an agent-based, multimodal periodontal disease simulator that generates synthetic patient groups, models inflammation and bone loss over time, and produces synthetic radiographic images. Aim: To develop and evaluate an agent-based, multimodal in-silico simulator to model periodontal disease progression by simulating inflammatory dynamics, alveolar bone loss, and synthetic radiographic features, and to assess the performance of machine learning models trained on the generated data. Materials and Methods: Three interacting agents were created: Data agent generated a cohort of 600 patients with demographic data, risk factors, and baseline imaging. The computational simulation used synthetic data and agent-based modeling without involving human participants, clinical facilities, or time-bound data collection, so Institutional location and study duration are not applicable. Inflammation agent simulated month-by-month inflammatory trajectories based on risk factors and graph-based neighbour interactions, and bone loss agent translated inflammation into bone loss scores and updated lesion masks. Results: Machine learning models trained on this synthetic data achieved high accuracy in classifying severity {accuracy ˜ 0.98, macro F1˜0.97, Receiver Operation Characteristic-Area Under Curve (ROC-AUC)˜0.997}, although continuous bone loss regression performed poorly (R²˜0.10). Simple adaptive thresholding for lesion segmentation yielded moderate mean Intersection over Union (IoU) (˜ approximately 0.67) and Dice (˜approximately 0.75) scores. An ablation study of the network indicated that even small interactions among neighbours increased average bone loss, suggesting population-level effects. Statistical evaluation employed a Random Forest classifier and regressor for severity classification and bone loss prediction, with segmentation assessed via IoU, dice, precision, and recall. Conclusion: Although the dataset is synthetic and not validated, this work demonstrates the potential of combining agent-based modeling, graph theory, synthetic imaging, and machine learning to explore the dynamics of periodontal disease.

Comparison of Clinical Outcomes of Gingival Depigmentation using Diode Laser versus Scalpel Surgery: A Prospective Interventional Study

Ambili Gopalakrishnan, RM Baiju, Bindu R Nayar, MR Sreelakshmi, B Jithin

Introduction: Pigmentation of the gingiva, when it is not related to the skin complexion, is a dampening factor in an otherwise acceptable smile window. Gingival depigmentation is a periodontal plastic surgical procedure to remove melanin hyperpigmentation. Various techniques for depigmentation have been tried in the past to treat gingival pigmentation and the extent and rate of recurrence following the procedure varies according to the treatment modalities used and duration of follow-up. Currently there is no universally accepted gold standard technique for optimal outcomes in terms of pain, repigmentation, and patient satisfaction. Aim: To evaluate the effectiveness of the 810 nm diode laser versus the conventional scalpel method for gingival depigmentation in terms of repigmentation, pain and patient perception. Materials and Methods: The present prospective interventional study was conducted in Department of Periodontics at Government Dental College, Kottayam, Kerala, India for a total duration of 18 months, from April 2013 to September 2014. Individuals of age 18-40 years with thick gingival biotype having brown or black diffuse gingival pigmentation were included in the study. They were randomised into two groups of ten each, scalpel group and laser group. Pigmentation changes were assessed using Dummett and Gupta Oral Pigmentation Index (DOPI) and from standardised photographs using Image analysis software (ImageJ 1.46r) at baseline, one month, three months, and six months. Pain was recorded using a Visual Analog Scale (VAS), and patient feedback was obtained via questionnaire at one week post-treatment. Independent samples t-test and Chi-square test were used for statistical analysis. The p-value of less than 0.05 was considered statistically significant and Statistical Package for Social Sciences (SPSS) software version 23 was used. Results: At the six-month follow-up, both the laser and scalpel groups showed comparable levels of repigmentation, with no statistically significant differences across any parameter. The DOPI score increased slightly in both groups, with the laser group showing a mean of 1.6±0.34 and the scalpel group 1.4±0.44 (p=0.36). The area of pigmentation measured 75.8±37.33 mm² in the laser group and 89.9±43.51 mm² in the scalpel group (p=0.52). Similarly, the intensity of pigmentation at six months was 140.1±13.79 for the laser group and 142.1±13.11 for the scalpel group (p=0.70). Patient-perception outcomes remained positive and identical in both groups, with 100% reporting that the treatment met their expectations and resulted in an improved smile. Intraoperative and postoperative pain scores were comparable between the scalpel (3.40±1.65; 3.40±2.01) and laser groups (2.80±1.75; 2.50±1.90), with no statistically significant differences (p=0.50; p=0.30). Conclusion: The results revealed that both scalpel as well as laser were equally efficient for depigmentation of the gingiva. Choice of technique to be used mainly depends on the availability, clinician’s choice, experience, gingival biotype and the degree of pigmentation. Long term follow-up with larger multicentric trials are required to assess which technique offers sustained and stable results.

Evaluating the Effectiveness of Four Brushing Techniques on Children’s Oral Hygiene and Dental Issues: A Quasi-experimental Study

Krishnarekha, Jeyaseelan Ramasamy, Kavitha Bottu

Introduction: Oral health is closely linked to effective tooth brushing; however, current guidelines often lack age-specific recommendations, despite the fact that dental development spans from infancy through early adulthood. Aim: To evaluate the impact of four age-appropriate brushing techniques on children’s oral hygiene and the prevalence of dental disorders. Materials and Methods: This quasi-experimental study was conducted in the Outpatient Department (OPD) of the Paediatric and Preventive Dentistry division at Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India, over a two-month period from July 1, 2022 to August 31, 2022. Participants were divided into four age groups and each group was taught a brushing technique suited to their developmental stage: the Fones technique for children aged 4 to 6 years, the horizontal scrub technique for those aged 6 to 8 years, the Bass technique for children aged 8 to 10 years and the modified Bass technique for those aged 10 to 12 years. Oral health was assessed using the Oral Hygiene Index-Simplified (OHI-S) and the Decayed, Missing and Filled Teeth (DMFT) index, which were recorded before and after the intervention. Statistical analysis, including Pearson's correlation and paired t-tests, revealed a significant association between improved oral hygiene and reduced dental caries, with significant p-values. Results: A total of 80 children aged 4-12 years (mean age: 8.41±2.45 years) were equally as-signed to four age-specific brushing technique groups (n=20 each). The mean OHI-S score of the entire sample significantly decreased from 1.47±0.84 at baseline to 0.81±0.33 after one month (p=0.01). All techniques showed significant improvements in oral hygiene: Group A (Fones), p<0.001; Group B (horizontal scrub), p=0.002; Group C (Bass), p<0.001; and Group D (modified Bass), p=0.001. The modified Bass technique demonstrated the greatest reduction in the 10-12-year age group. A total of 7 (35%) children in Group A (Fones technique, 4-6 years) relied on their parents for brushing instruction. No significant correlation was found between baseline oral hygiene and caries experience (r=0.008, p=0.947). Conclusion: Personalising brushing techniques according to a child’s dental development markedly enhances oral hygiene and lowers the risk of dental diseases. These findings emphasise the importance of establishing age-specific oral hygiene guidelines as a proactive preventive measure. Adopting tailored approaches can promote lifelong oral health from early childhood onward.

Effectiveness of Mulligan SNAG Mobilisation on Muscle Activation, Pain, Disability and Sleep Quality in Acute Neck Pain: A Randomised Controlled Trial

Uzma Sayyad, Shagoofa Musstaq, Ashi Saif

Introduction: Neck pain is a disabling problem faced frequently by people across the globe and acute neck pain is more prevalent among the adult age group due to posture abnormalities and dysfunctions. It is necessary to establish the treatment strategies that can help reduce the overall disability and functional impairments and impact the sleep quality. Aim: To determine the effect of Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisations on Electromyographic (EMG) activity of neck muscles (upper trapezius and splenius capitis), sleep quality, neck disability, pain and pain pressure threshold in subjects with acute neck pain and compare it with conventional rehabilitation. Materials and Methods: A single-blinded randomised control trial was carried out with a sample of 32 subjects, recruited from the Department of Centre for Physiotherapy and Rehabilitation, Jamia Millia Islamia, New Delhi, India from October, 2018 to March, 2019. The study included adults (male and female) aged 18-40 years with acute neck pain lasting ≥4 weeks, Numeric Pain Rating Scale (NPRS) score ≥6, and symptoms reproduced by neck motion. Participants were divided into two groups (n=16 in each group). Subjects in Group-1 were given intervention for neck pain in the form of Mulligan SNAG mobilisation along with cervical stabilisation exercises three times per week for four weeks. Subjects in Group-2 received only cervical stabilisation exercises three times per week for four weeks. For investigating the effect of the two interventions on EMG activity of neck muscles, sleep quality, neck disability, pain and pain pressure threshold, repeated measures Analysis of Variance (ANOVA) was applied for para-metric variables and Wilcoxon Signed-rank Test was used to establish the within group difference of non parametric variables. Level of significance was set at p<0.05. Results: The result indicated that both the treatments improved the parameters. Group×Time interaction was found to be significant (p>0.05) in splenius muscle activity and group effect was significant (p>0.05) in pain pressure threshold, However, significant time effect was seen in all the variable (p>0.05). Conclusion: The present study concludes that Mulligan SNAG mobilisation can be used as an adjunct to conventional exercise programmes to improve subjective sleep quality parameters, neck extensor muscle activity, neck disability, pain and pain pressure threshold in patients with acute neck pain.

Prevalence and Pathological Patterns of Pulmonary Tuberculosis in Cadavers: A Cross-sectional Study

Introduction: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Despite being a TB-endemic country, many pulmonary TB cases remain clinically undiagnosed and are detected on postmortem examination. Cadaveric lung histopathology helps reveal this hidden disease burden and characteristic TB patterns that are often missed during life, supporting improved diagnostic awareness, infection control, and public health surveillance. Aim: To examine the histology of normal lung and TB infected cadaveric lungs. Materials and Methods: This cross-sectional study was conducted in the Research Laboratory of the Department of Anatomy, Uttar Pradesh University of Medical Sciences Saifai, Uttar Pradesh, India, from December 2024 to June 2025. A total of 30 lungs from 15 adult cadavers were included in this study. Demographic and background data of each cadaver- including age, sex, cause of death were collected. It assessed gross and histopathological features of cadaveric lungs using Haematoxylin and Eosin (H&E) and Ziehl-Neelsen staining. Results: Out of 30 cadaveric lungs, three exhibited features of TB, including prominent scarring, cavitation, with mild pneumonic consolidation mainly seen in the right lung apical region. Histological analysis showed necrotising granulomatous inflammation, composed of epithelioid histiocytes, accompanied by number of multinucleated Langhans giant cells and lymphocytic aggregation. Conclusion: This study demonstrated that pulmonary TB can remain clinically undiagnosed and is detectable only through cadaveric lung histopathology.

Inter-rater Reliability of Tooth Shade Selection by Conventional Visual Method and Intraoral Camera: An In-vivo Study

Sunetri Mondal, Samiran Das, Jayanta Bhattacharyya, Shubhabrata Roy

Introduction: Visual shade matching has been practiced in dentistry for decades to find a shade of restoration that perfectly match with adjacent tooth for natural aesthetic look. Intraoral cam-era is an adjunct tool for visual shade matching that can reduce the shortcomings of conventional meth-od. It is especially beneficial for subjective shade matching with in-built optimal lighting conditions while eliminating all environmental influences. The study’s rationale is to determine whether or not external lighting and background affect a clinician’s visual shade-matching performance. Aim: To determine the inter-rater reliability of shade matching by conventional visual method and using intraoral camera (SOPRO 717) assisted visual method, while taking account into the environmen-tal influence on visual shade matching. Materials and Methods: The study was conducted in-vivo in the Department of Prosthodontics, Guru Nanak Institute of Dental College and Hospital in Kolkata West Bengal, India, over a period of 18 months from May 2022 to November 2023. Five dental professionals with normal colour vision performed the shade selection procedure on 30 patients of 24 to 60 years. Each dental professional or examiner matched the shade of tooth with VITA System 3D-Master® shade guide by conventional visual method and with in-traoral camera; before and after the insertion of restoration. Chi-square test was used to determine the reliability among examiners and p-value<0.05 was considered to be statistically significant. Results: When two methods were compared, it showed that shade selection using intraoral camera was more aligned with the selected shades based on consensus than conventional method. The Chi-square statistic was 24.6544. The p-value was <0.00001 (significant at p<0.05). Reliability among five raters or examiners showed statistically significant difference (p<0.05) for conventional visual method indi-cating less agreement level among examiners. Whereas agreement level was higher for intraoral camera. Conclusion: Intraoral camera is a reliable assistance for visual shade selection as it reduces certain level of subjectivity and help the observer for easy decision making by increasing the agreement level.

Correlation of Bacterial Colonisation with Time Duration in Indwelling Ureteral Double J Stents: A Prospective Observational Study

Introduction: Ureteral Double J (DJ) stents are commonly used in urology to ensure urinary drainage. However, prolonged indwelling time increases the risk of bacterial colonisation and biofilm formation, which can lead to infections and antibiotic resistance. Understanding the correlation between stent duration and microbial colonisation is crucial for optimising patient management and reducing com-plications. Aim: To evaluate the correlation between stent indwelling time and bacterial colonisation of ureteral DJ stents in patients with urologic indications. Materials and Methods: A prospective observational study was conducted from February 2024 to February 2025 on 70 patients who underwent DJ stenting for urological indications such as urolithiasis, ureteric stricture, pyelonephritis, or postoperative shunting in Department of Microbiology, Government Medical College and Department of Urology, Super-specialty Hospital, Nagpur, Maharashtra, India. The demographic profile of patients including age and gender were recoded and analysed for correlation with colonisation. The stents were aseptically removed after varying indwelling durations up to 12 weeks; Upper and lower segments of stent were cultured by roll plate method and flushing with trypticase soya broth on blood and MacConkey’s agar. Bacterial isolates were identified and subjected to antimicrobial susceptibility testing as per Clinical and Laboratory Standards Institute (CLSI) 2023 guidelines. Bio-film formation was quantified using microtiter plate assay. Data were analysed using Statistical Package for the Social Sciences (SPSS) software and statistical significance was determined by the Chi-square test with p-value<0.05 considered significant. Results: Bacterial colonisation was found in 39 stents (55.71%). The predominant organism was Escherichia coli-14 (35.90%) isolates, followed by Klebsiella pneumoniae-8 (20.51%) isolates and Pseudomonas aeruginosa-7 (17.95%) isolates. Colonisation rates increased with stent duration: 3 (7.69%) at 0-2 weeks, 9 (23.08%) at 2-4 weeks and 17 (43.58%) at 4-6 weeks indicating a positive cor-relation between stent indwelling time and bacterial colonisation of ureteral DJ stents in patients with urologic indications. Biofilm formation was detected in 28 (71.79%) of isolates, with higher intensity in longer indwelling stents. Multidrug resistance was observed in 11 (28.21%) of isolates. Conclusion: Longer stent duration correlates with higher bacterial colonisation and biofilm formation. These findings highlight the need for timely stent removal and targeted antibiotic therapy to mitigate infection risk and resistance.

Role of Novel ACR Bone-reporting and Data System in Risk Stratification of Bone Tumours in South Indian Population: A Retrospective Observational Study

Introduction: The American College of Radiology (ACR) Bone-Reporting and Data System (Bone-RADS) gave a structured framework for assessing and reporting bone tumours. Aim: To evaluate the diagnostic performance of the ACR Bone-RADS score on radiographs in as-sessing bone tumour risk, with a specific focus on associating radiological findings with histopathological outcomes. Materials and Methods: A retrospective observational study was conducted on 51 patients who underwent radiographic examination for suspected bone tumours between January 2024 and January 2025 at Apollo Institute of Medical Sciences and Research, Hyderabad, India. Bone tumours were categorised as benign, intermediate or malignant based on a reference standard of histology or clinical–radiological consensus by a senior radiologist. Five radiographic characteristics (margin, periosteal reaction, endosteal erosion, pathologic fracture, and extra-osseous mass) were assessed by two radiologists, who calculated a cumulative score (points from radiographic features and cancer history) and assigned a Bone-RADS category to each radiograph. The diagnostic performance of Bone-RADS and inter-reader concordance were assessed using univariate logistic regression analyses and Chi-square analysis. Results: In the current study, the mean age of the study population was 26.06±13.625 years, and the majority of participants were males. The Bone-RADS score demonstrated good diagnostic performance with an AUC of 0.718 (CI: 0.572, 0.863; p<0.001) and high sensitivity (85.19%) and low specificity (58.33%). Statistically significant radiographic predictors of malignancy in the current study are tumour margination, periosteal reaction, and extraosseous soft-tissue. Excellent interobserver reliability (ICC=0.95) was noted for Bone-RADS point total/category. Conclusion: The current study findings suggest that the implementation of ACR Bone-RADS in clinical practice enhances diagnostic precision, facilitates communication among healthcare providers, and improves patient management outcomes.

Clinical, Dermoscopic and Histopathological Characteristics of Lichen Planus: A Cross-sectional Study

Introduction: Lichen Planus (LP) is a common papulosquamous disorder encountered in Dermatology Outpatient Departments. It exhibits characteristic dermoscopic and histopathological features. Dermoscopy serves as a non invasive bridge between clinical diagnosis and histopathological confirmation. Aim: To describe the dermoscopic, clinical and histopathological features of LP and its variants. Materials and Methods: This cross-sectional study was conducted at the Department of Dermatology, Venereology and Leprosy at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India, from December 2023 to May 2025. Adult patients (>18 years) with clinically diagnosed LP were included in the study. A detailed history and clinical examination was done, and findings were recorded in predesigned proforma. This was followed by dermoscopy and histopathological examination, and findings were noted. The data was analysed using descriptive statistics, including frequency, percentage, mean, and standard deviation. Results: A total of 100 patients were enrolled, out of which 43 were males, and 57 females with a ratio of 1:1.3. Majority patients (n=56) were in age group 18-40 years 56 (56%). The duration of disease commonly seen was between three to six months 37 (37%). The most common site of involvement was the lower limbs, seen in 72 (72%) patients. The most common variant of LP seen was classical LP 65 (65%) followed by hypertrophic LP 12 (12%) and LP pigmentosus 7 (7%). On dermoscopic examination, Wickham’s striae was the most specific and sensitive finding found in 75 (75%) patients with reticular 25 (25%) being the most common morphological pattern. On histopathology, basal cell degeneration with band-like infiltrate was found as most frequent finding 92 (92%) while wedge-shaped hypergranulosis 75 (75%) was most specific finding. Conclusion: Dermoscopic findings are specific for LP and, many times, can replace histopathology for diagnosis of the condition.

Effect of Chitosan Nanoparticles on Composite Bond Strength to Enamel Following Laser and Non-laser assisted Bleaching: An In-vitro Study

Introduction: Bleaching is a popular treatment used to enhance the appearance of stained anterior teeth with resin-based restorations. However, additional interventions may be required following bleaching, as the application of peroxide gel can adversely affect bond strength. The present study focuses on gaining valuable insights into the use of novel chitosan nanoparticles to overcome the challenges of post-laser-assisted bleaching bond strength. Aim: To comparatively evaluate the adhesive bond strength between composite resin and enamel pretreated with chitosan nanoparticles after both non laser and laser -assisted bleaching. Materials and Methods: The laboratory-based in-vitro study was conducted at the Department of Conservative Dentistry and Endodontics, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India in March 2026. The study included 50 anterior intact teeth and devoid from caries, fractures or any prior dental fillings. “Samples were randomly allocated into five groups of ten samples each.” Group 1 -no bleaching-no antioxidant, Group 2-chemical bleaching-composite restoration after 2 weeks, Group 3-chemical bleaching-chitosan nanoparticles - immediate composite restoration, group 4- laser assisted bleaching - composite restoration after 2 weeks, Group 5- laser assisted bleaching - chitosan nanoparticles - immediate composite restoration. The bond strength of these samples was evaluated using universal testing machine at crosshead velocity of 1 mm per minute. Data were analysed using one-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test for group comparisons and “Student’s t test” for correlating antioxidant and non antioxidant groups, with significance set at p<0.05. Results: Significant differences in mean shear bond strength were noted among the groups (p<0.05). The highest value was recorded in Group 1 (control: 22.0±0.73 MPa), followed by Group 5 (21.1±1.11 MPa) and Group 4 (20.5±1.13 MPa), while Group 2 (bleaching without antioxidant) showed the lowest (19.3±1.23 MPa). Tukey’s post-hoc analysis indicated significant differences between Group 1 and all other groups (p=0.0001), and between Group 2 and Groups 4 (p=0.03) and 5 (p=0.002). Conclusion: 0.2% chitosan nanoparticles have the ability to restore adhesive bonding to laser-bleached enamel surfaces, enabling immediate bonding of composite resin and reducing the waiting time for adhesive restorative procedures.

Comparative Evaluation of Microhardness of CAD/CAM-milled, 3D-printed and Conventional Chairside Interim 3-Unit Fixed Dental Prosthesis: An In-vitro Study

Introduction: Interim Fixed Dental Prostheses (FDP) are essential for maintaining aesthetics, function and occlusal stability during comprehensive dental treatments. The surface microhardness is the key determinant of their durability and resistance to wear. Aim: To evaluate and compare the “microhardness” of fixed dental prosthesis made using traditional techniques, Computer-Aided Design (CAD)/Computer-Aided Manufacturing (CAM) milling and 3D printing. Materials and Methods: This in-vitro study was carried out at the Department of Prosthodon-tics and Crown and Bridge, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India, between October 2024 to December 2024. A total of 30 specimens (N=30) were fabricated using traditional techniques, CAD/CAM machining and 3D printing. The samples were thermocy-cled for 5,000 cycles in order to simulate the oral condition. Vicker’s microhardness test was used to measure microhardness. One-way Analysis of Variance (ANOVA) was used for comparisons between groups (i.e., more than two groups) and the Tukey's post-hoc test was used for comparisons between groups. The p<0.05 was deemed statistically significant. Results: The 3D-printed group, CAD/CAM group and traditional group had mean microhardness val-ues of 25.70±1.42 HV, 29.90±1.60 HV and 33.80±1.32 HV, respectively. One-way ANOVA test showed f-value=78.2809 and p<0.0001*, which showed that there was statistically significant difference. On pair-wise comparison using Post-hoc Tukey's Honest Significant Difference (HSD) test, highly statistically significant difference was seen between all groups where Conventional showed greater microhardness then followed by CAD/CAM-milled and 3D-printed. Conclusion: These findings suggest that the “conventional bis-acryl technique” provides superior surface microhardness, which may enhance clinical performance and longevity. Additional in-vivo research is required to assess other clinical and mechanical factors.

Depression, Anxiety and Stress in Meditation Practitioners versus Non Meditation Practitioners: A Cross-sectional Study

Ram Kumar Gupta, Abhishek Kumar Bhardwaj

Introduction: Recent rapid technological advancements and societal changes have dramatically transformed modern life, leading to a significant increase in mental health concerns. Meditation, an ancient practice, has gained considerable attention in recent years for its psychological and neurological benefits. Aim: To compare levels of depression, anxiety and stress between Meditation Practitioners (MPs) and Non meditation Practitioners (NMPs) and to examine the relationship between different parameters of meditation practice and levels of depression, anxiety and stress. Materials and Methods: A cross-sectional study was conducted in the Department of Humanities and Liberal Arts, DIT University, Dehradun, Uttarakhand, India, from March 2024 to November 2024. Each participant was assessed for depression, anxiety and stress using the Depression, Anxiety and Stress Scale-21 (DASS-21) scale. Various aspects of meditation practice were evaluated using a socio-demographic data sheet. Participants were higher education students residing in the northern region of India. Individuals with a minimum of one year of experience in any established meditation practice and who practiced meditation at least twice a week were classified as MPs. After applying the criteria, a total of 400 participants were included, with 200 MPs (Meditation group) and 200 NMPs (Non meditation group). Pearson’s correlation, independent t-tests and regression analyses were performed using Statistical Package for Social Sciences (SPSS) version 29.0. Results: The mean age of MPs was 21.80±4.4 years, while that of NMPs was 22.30±3.6 years. MPs demonstrated significantly lower levels of depression (MP=9.50±7.8; NMP=12.82±9.4; p<0.001), anxiety (MP=10.67±7.0; NMP=13.66±9.2; p<0.001), stress (MP=12.76±7.4; NMP=15.14±8.2; p<0.01) and total DASS scores (MP=32.92±19.5; NMP=41.62±24.0; p<0.001). Meditation experience showed a negative correlation with depression scores (r=-0.151; p<0.05), while frequency of weekly meditation practice demonstrated negative correlations with anxiety (r=-0.224; p<0.01). The total DASS scores were (r=-0.151; p<0.05). Conclusion: The findings suggest that meditation serves as an effective intervention strategy for improving mental health.

Assessment of Nailfold Capillaroscopy Findings in Pregnant Women with Preeclampsia Compared to Gestational Age-matched Normotensive Pregnant Women: A Cross-sectional Study

Introduction: Preeclampsia is a hypertensive disorder of pregnancy characterised by endothelial dysfunction. Nailfold Capillaroscopy (NFC) offers a non-invasive method for evaluating microvascular changes at the nailfold. Aim: To compare nailfold capillary changes in women diagnosed with preeclampsia and women with normal, uneventful pregnancies matched for gestational age. Materials and Methods: The present cross-sectional observational study was conducted in the Departments of Dermatology and Obstetrics and Gynaecology at a tertiary care centre, Acharya Vinoba Bhave Rural Hospital, Wardha, Maharashtra, Central India, from March 2023 to March 2025. The study included 80 pregnant women diagnosed with preeclampsia and 80 gestational age-matched normotensive controls. All participants underwent NFC using a digital video capillaroscope with 50× magnification. Capillary morphology, density, and abnormal patterns such as tortuosity, branching, ramification, and avascular areas were recorded and compared using the Chi-square test and multivariate logistic regression analysis. Results: The preeclampsia group, with a mean age of 28.4±4.2 years, exhibited significantly higher rates of abnormal capillary morphology, including serpentine capillaries {5 (6.25%) vs. 0 (0%), p=0.043} and branched capillaries {2 (2.5%) vs. 0 (0%), p=0.043}, compared with healthy gestational age-matched pregnant controls, who had a mean age of 27.9±3.9 years. Increased capillary density (>7/mm) was significantly more prevalent in the pre-eclamptic group {9 (11.25%) vs. 2 (2.5%), p=0.048}. Disorganised capillary architecture was observed in 18 (22.5%) pre-eclamptic women compared with 6 (7.5%) controls (p=0.012). Specific microvascular markers, including giant capillaries (n=6, p=0.010), avascular areas (n=4, p=0.036), and meandering capillaries (n=5, p=0.015), were exclusively noted in the preeclampsia group. Multivariate analysis confirmed bizarre capillaries (OR: 7.8), tortuous capillaries (OR: 6.4), avascular areas (OR: 5.9), and neoangiogenesis (OR: 4.5) as independent predictors of preeclampsia (all p<0.01). Conclusion: According to the present study findings NFC reveals prominent microvascular abnormalities in women with preeclampsia, indicating its potential as a bedside tool for early identification and risk stratification.

Association Between ABO Blood Groups and Big Five Personality Traits in Healthy Young Adults: A Cross-sectional Study

T Thoufeeq Nahas Yoosuf, AV Shilpa, Biju Bahuleyan

Introduction: The pursuit of optimal health is a universal human aspiration. This ideal state can be conceptualised as a harmonious interplay between external and internal health. While numerous factors contribute to an individual’s health profile, the potential influence of blood type on these aspects remains a topic of ongoing exploration. The present research project delves into this question, aimed to elucidate the relationship between the ABO blood group system and personality traits in healthy young adults. Aim: To categorise young adults aged between 18 and 25 years according to ABO blood groups and to analyse the association between personality traits and varying blood groups. Materials and Methods: The present cross-sectional study was carried out on 187 healthy young medical students of both genders aged between 18 and 25 years at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, between June 2024 and May 2025. Subjects were categorised into different groups based on their ABO blood grouping using the slide agglutination method, while personality traits were assessed using the Big Five Personality Questionnaire. Comparisons were made between blood group, personality traits, and gender. Statistical analysis was performed using the Chi-square test in Statistical Package for the Social Sciences (SPSS) version 22. Results: The study population had a mean age of 20.05±1.08 years. In terms of gender distribution, females and males constituted 128 (68.4%) and 59 (31.6%) participants, respectively. Both genders showed a higher association with the openness personality type, while females exhibited a wider variation in personality traits (p=0.042). Analysis of ABO blood grouping revealed that most subjects belonged to the O blood group. A statistically significant association was observed between ABO blood group and personality type (p=0.038), with individuals having A, B, and O blood groups predominantly exhibiting the openness personality type, while those with the AB blood group tended to show the agreeableness personality type. Conclusion: The current body of research presents mixed findings regarding the relationship between blood groups and personality traits. Further studies with larger sample sizes and more rigorous methodologies are needed to clarify these associations.

AI-driven Convolutional Neural Network for Early Detection of Oral Premalignant Disorders and Oral Squamous Cell Carcinoma using Smartphone-captured Images: A Research Protocol

Manjari Gaurishankar Chaudhary, Suwarna Dangore-Khasbage, Utkarsha Pacharaney

Introduction: The overall prevalence in the world of 4.47% is seen in Oral Potentially Malignant Disorders (OPMD), with the maximum prevalence of 10.54% found in Asian populations with approximately 1% ability to transform into malignancy, considering the malignant transformation is comparatively less, the progression of the lesion leads to increase morbidity and mortality and will lead to obtrusive treatment for the patient. The psycho-stimulating qualities keep betel quid popular even though there is a risk of developing oral cancer. Hence, prompt detection of these OPMD is very crucial, so that the survival rate and treatment cost decrease. The need of the hour is low-cost, easy-to-use imaging devices so that an early diagnosis of OPMD and Oral Squamous Cell Carcinoma (OSCC) can be made. Need of the study: In remote areas, populations are at higher risk due to limited resources and access to healthcare infrastructure. Low-cost, user-friendly screening devices, like a smartphone-simple touchscreen that can provide sufficient collection of images with transmission of data connected to the internet. An easily accessible high-performance Convolutional Neural Network (CNN) model for clinicians can be used to detect and classify clinically potentially malignant oral lesions and precancerous neoplasms so that an early diagnosis can be made. They can be used to detect and classify clinically oral potentially malignant lesions and precancerous neoplasms in the healthcare field, with promising results. Aim: To evaluate the diagnostic reliability of Artificial Intelligence (AI)’s deep learning algorithm-based CNN algorithm for the detection of types of OPMD and OSCC lesions in smartphone-based photographic images for early diagnosis Materials and Methods: The present cross-sectional study will be conducted in the Department of Oral Medicine and Radiology, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India, from January 2024 to January 2026. The minimum subjects included in the study will be 217. The analysis will evaluate diagnostic accuracy metrics, including Sensitivity (S), Specificity (E), Positive Predictive Value (PPV), Negative Predictive Value (NPV) Area Under Curve (AUC) the Receiver Operating Characteristic (ROC) Curve for CNN performance. Image segmentation outcomes will be assessed using the Dice coefficient (F1) and IoU. Comparison with human experts will involve paired t-tests or Wilcoxon tests, supported by Cohen’s Kappa for reliability. Subgroup analysis will stratify performance by OPMD subtypes and demographic variables. A p<0.05 will be considered statistically significant.

Comparative Evaluation of Dysgeusia in Patients with End-stage Renal Disease with or without Xerostomia as a Contributory Factor: A Research Protocol

Tanaya Teredesai, Suwarna Dangore-Khasbage

Introduction: End-Stage Renal Disease (ESRD) is the final stage of Chronic Kidney Disease (CKD), when the kidneys can no longer function on their own. At this stage, ESRD patients present with multiple signs and symptoms, including dysgeusia. A common oral finding is significant xerostomia, frequently seen in ESRD patients due to reduced salivary flow, dehydration and medication effects, which can alter the oral environment and impact taste perception. Xerostomia has been identified as a significant contributor that may exacerbate taste disturbances. Need of the study: Dysgeusia, a persistent alteration in taste perception, is a common yet often overlooked complication in patients with ESRD. The pathophysiology of dysgeusia in ESRD is multifactorial, involving uraemic toxin accumulation, medication side-effects and nutritional deficiencies. This can significantly affect the quality of life, making early diagnosis and appropriate management crucial in ESRD patients. Previous studies have stated the association of xerostomia in ESRD patients. However, there is a paucity in the literature regarding the association of the severity of xerostomia with the grading of dysgeusia in ESRD patients. Aim: To evaluate and compare dysgeusia in patients with ESRD with or without xerostomia as a contributory factor. Materials and Methods: This prospective observational study will be conducted in the Acharya Vinoba Bhave Rural Hospital, along with the Oral Medicine Radiology Department at Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India, from April 2025 to March 2026. Patients will be divided into two groups: Group-A, suffering from ESRD with xerostomia and Group-B, without xerostomia. Xerostomia evaluation will be done by subjective and objective methods using a questionnaire and Modified Schirmer test protocol. Then these patients will be graded for dysgeusia. Outcome will be recorded and statistical analysis will be done by performing student’s t-test and Chi-square test. A p-value of <0.05 will be considered statistically significant.

Evaluating Anticancer Activity of Karveeradi Yoga in Cervical Cancer Cell Lines: An In-vitro Study Research Protocol

Jeenal Parsotambhai Vaniya, Nilima Wadnerwar

Introduction: Ayurveda, a traditional Indian system of medicine, emphasises the use of natural remedies. Karveeradi Yoga, derived from classical Ayurvedic scriptures, consists of potent herbs such as Nerium indicum and Moringa oleifera, which have traditionally been used for detoxification and for treating conditions resembling cancer. Cervical cancer, a significant global health burden, arises from persistent Human Papillomavirus (HPV) infections and necessitates the exploration of effective alternative treatment options. Need of the study: The rising incidence of cervical cancer highlights the limitations of conventional therapies, including their high toxicity, cost, and adverse side-effects. In view of these challenges, exploring the anticancer potential of Ayurvedic formulations such as Karveeradi Yoga may offer safer and more affordable therapeutic alternatives. Aim: To standardise Karveeradi Yoga and evaluate its anticancer activity in cervical cancer cell lines. Materials and Methods: An in-vitro experimental preclinical study will be conducted from June 2025 to December 2025 at the Biocyte Institute of Research and Development, Sangli, Maharashtra India, in collaboration with the Department of Agada Tantra, Mahatma Gandhi Ayurved College and Hospital and Research Centre, Wardha, Maharashtra, India. Raw materials will be authenticated, standardised, and prepared according to Bhavprakash Samhita. Physicochemical and phytochemical analyses will be performed. Two cervical cancer cell lines, HeLa and SiHa, will be subjected to MTT assay, flow cytometry, and IC₅₀ determination. Positive controls (standard chemotherapy agents) and vehicle controls will be included. Statistical analysis will be performed using Analysis of Variance (ANOVA) or t-tests, with p-value <0.05 considered statistically significant.

Comparative Clinical Assessment of Yastimadhu Rasayana and Ashwagandha Rasayana in Young Adults with Easy Mental Fatigability: A Research Protocol

Mahima Shrivastava, Saurabh Deshmukh, Sachin Agrawal

Introduction: In Ayurveda, the term “Gla¯ni” refers to lassitude or exhaustion, including mental dejection, mental tiredness, languor, and overall fatigue and is indicative of various disorders. Mental fatigue is a growing concern in both clinical and occupational settings, often manifesting as reduced concentration, impaired cognitive performance, and diminished overall productivity. Traditional medicine has long sought remedies to counteract such fatigue, with several Rasayana (rejuvenative) formulations being highlighted for their neurocognitive benefits Need of the study: Ashwagandha is well-known for its adaptogenic properties, particularly in reducing stress and mental exhaustion. Its role in alleviating fatigue highlights the potential of other Rasayana agents. Yastimadhu (Glycyrrhiza glabra), a Medhya-rasayana, is recognised in Ayurvedic pharmacology for enhancing mental clarity, energy, and cognitive resilience. While classical texts, such as those by Acharya Bhavprakash, discuss its benefits for mental fatigue, Yastimadhu remains underexplored in modern research. This study focuses on Yastimadhu churna as a potential treatment for mental fatigue, aiming to connect traditional Ayurvedic knowledge with contemporary scientific validation, thus supporting the integration of traditional medicine into modern clinical practice. Aim: To evaluate and compare the clinical efficacy of Yastimadhu Rasayana versus Ashwagandha Rasayana in young adults exhibiting symptoms of easy mental fatigability. Materials and Methods: The present randomised, single-blind, two-arm, parallel-group, controlled trial will be conducted at the at Mahatma Gandhi Ayurveda College, Hospital, and Research Centre (H), Wardha, Maharashtra, from February 2025 to February 2026. The trial will involve two months of treatment administration followed by a four-week follow-up period. A total of 100 individuals who meet the specified inclusion and exclusion criteria will be recruited. At baseline, mid-intervention, and post-intervention, mental fatigability will be assessed using the Chalder Fatigue Scale (CFS), according to Ayurveda’s classic symptoms of Gla¯ni and Buddhi, as well as the Modified Fatigue Impact Scale (MFIS) and the Psychomotor Vigilance Test (PVT-10). The Wilcoxon signed-rank test will be used for non-normally distributed data, while paired t-tests will be applied to normally distributed groups. Independent group-based t-tests will compare continuous normally distributed variables, and Mann-Whitney tests will be used for non-normal data. A significance level of p<0.05 will be applied.

Pharmaceutico-analytical Standardisation of Gandhakadi Pottali Prepared by Two Methods and Comparative Evaluation of their Antioxidant and Hepatoprotective Activity: A Research Protocol

Deepali Watkar, Mujahid Khan

Introduction: In Ayurveda, various herbs and herbo-mineral preparations are described for the prevention and management of liver diseases. Gandhakadi Pottali is one of the classical Ayurvedic formulations indicated for hepatosplenomegaly (Yakrit-Pliha Vyadhi). For herbal and herbo-mineral formulations to be safe and effective, standardisation is necessary. One of the major challenges in the present scenario is the quality control of these medicines. Although some work has been carried out on the standardisation of its individual constituents, the pharmaceutico-analytical standardisation of Gandhakadi Pottali, along with the evaluation of its antioxidant and hepatoprotective properties, has not yet been studied. Need of the study: The modern line of treatment for hepatotoxicity has certain limitations due to the lack of effective hepatoprotective drugs. Therefore, there is an urgent need to utilise traditional therapies for the prevention and treatment of hepatic disorders. These ancient approaches have potential to ameliorate or reverse liver injury. Aim: To study the pharmaceutico-analytical standardisation of Gandhakadi Pottali prepared by two methods (Bhavana Process and Gandhaka Drava Method) and to carry out a comparative evaluation of their antioxidant and hepatoprotective activities. Materials and Methods: The study design is an in-vitro interventional study, the duration of the study will be 24 months, from April 2023 to April 2025. Gandhakadi Pottali will be prepared by two methods: one mentioned in Rasa Ratna Samucchaya (Bhavana Process) and the other by the Gandhaka Drava Method. Both preparations will be evaluated and compared for their antioxidant and hepatoprotective activities. Pharmaceutical work will be carried out at the Department of Rasa Shastra and Bhaishajya Kalpana, MGACH and RC, Wardha, Maharashtra, India. Analytical work will be conducted at a certified analytical laboratory, VNIT, Nagpur, Maharashtra, India. Experimental work will be carried out at the Central Indian Institute of Medical Sciences (CIIMS), Nagpur, Maharashtra, India. Comparisons between groups will be conducted using the Student’s t-test.

Assessment of Nasopalatine Canal Proximity to Maxillary Central Incisors and its Association with Risk of Root Resorption in First Premolar Extraction Cases in Angle’s Class I Bimaxillary Protrusion Cases: A Protocol for CBCT Based Observational Research

Tejaswi Kamble, Ranjit Kamble, Ashray Nimje

Introduction: Orthodontic treatment for Angle’s Class I bimaxillary protrusion commonly re-quires extractions of first premolars to contribute to improved dental and aesthetic appearance of the face. Retraction of the upper anterior teeth plays a prime role in the success of treatment; however, careful evaluation of anatomical structures, such as the Nasopalatine Canal (NPC), is essential. This canal, located posterior to the Maxillary Central Incisors (MCI), may be a risk factor also for resorp-tion of roots during orthodontic movement of teeth. Root resorption is a common complication that could affect treatment outcomes; thus, assessment is imperative in extraction cases. Need of the study: Despite the clinical significance of NPC proximity in orthodontic retrac-tion, research on its direct influence on root resorption of patients undergoing first premolar extrac-tions isn’t plentiful. These relationships should be appreciated, given that they may develop into risk-based treatment regimens to minimise complications. Pertinent imaging like Cone-Beam Computed To-mography (CBCT) will provide an in-depth view of NPC, thereby giving a better understanding of its prox-imity to maxillary incisors, which will be useful during treatment planning. Aim: To assess the proximity of NPC to MCIs and the risk of root resorption in first premolar extraction cases in Angle’s class I bimaxillary protrusion cases using CBCT. Materials and Methods: This prospective observational study will include records of 30 adult patient’s pre and post-treatment CBCT undergoing orthodontic treatment with the extraction of first premolar in every quadrant. This study will be conducted in the Department of Orthodontics and Dentofa-cial Orthopaedics at Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India and for a duration of 21 months, June 2025- February 2027. The patients will be classified into contact and non-contact groups based on NPC proximity to the MCIs. The length of the root will be measured and other changes in morphology would be assessed prior to the retraction of teeth and after retraction, the ex-tent of root resorption will be checked. The data will be statistically analysed using the Chi-square test, student’s paired and unpaired t-tests, One-way ANOVA, and Tukey’s test using IBM Statistical Package for Social Sciences (SPSS) Statistics, Version 27.0 and GraphPad Prism version 7.0 software.

Efficacy of Diagonal Patterns and Progressive Resisted Exercises on Muscle Strength, Functional Recovery, Fatigue and Quality of Life in Guillain-Barré Syndrome: A Protocol for Randomised Controlled Trial

Rushika Piyush Shah, Irshad Qureshi

Introduction: Guillain-Barré Syndrome (GBS) is an acute autoimmune polyradiculoneuropathy, most commonly presenting as Acute Inflammatory Demyelinating Polyradiculopathy (AIDP) variant. It causes symmetrical muscle weakness, sensory disturbances and profound fatigue, leading to significant impairment in daily functioning. Physiotherapy plays vital role in the rehabilitation of GBS, particularly during plateau phase; however, the most effective exercise strategies are yet to be clearly established. Need of the study: Evidence on the comparative efficacy of Proprioceptive Neuromuscular Facilitation (PNF) and Progressive Resistive Exercise (PRE) in GBS rehabilitation is limited. Identifying which intervention yields superior functional recovery can guide clinical decision-making and approaches alongside standard physiotherapy. Aim: To evaluate the effectiveness of strengthening exercises using diagonal movement patterns of PNF and PRE on improving muscle strength, enhancing functional recovery, reducing fatigue and improving quality of life in patients with GBS during plateau phase of recovery. Materials and Methods: A single-centre, registry-based, Randomised Controlled Trial (RCT) will be conducted on 51 patients diagnosed with GBS in the plateau phase at Acharya Vinoba Bhave Rural Hospital (AVBRH), Neuroscience Department, Sawangi, Wardha, India. Planned duration of study is from August 2025 to August 2026. Participants will be randomly allocated (1:1:1 ratio) into three groups: Group-1- PNF with conventional physiotherapy, Group-2- PRE with conventional physiotherapy and Group-3- standard physiotherapy alone. Intervention will be delivered 60 minutes, five days a week, over three months, with intensity individualised to fatigue levels; this study will take place for one year.

Efficacy of Transcutaneous Electrical Diaphragmatic Stimulation and Myofascial Release on Mobility and Function in COPD Patients: A Research Protocol

Shanvi, Mousumi Saha, Subhasish Chatterjee, Suman Pradhan, Shivi Bajpai

Introduction: The progressive respiratory condition known as Chronic Obstructive Pulmonary Disease (COPD) is characterised by decreased diaphragmatic excursion, impaired pulmonary function and a limited ability to carry out Activities of Daily Living (ADL). Myofascial Release (MFR) and Transcutaneous Electrical Diaphragmatic Stimulation (TEDS) have become viable techniques to improve respiratory kinematics and functional performance. Need of the study: In people with COPD, the diaphragm often struggles to move properly due to an overinflated lung. This constant strain puts the muscle at a mechanical disadvantage that worsens with time. TEDS can trigger muscle contractions by delivering small electrical signals and help to strengthen the breathing muscles. Similarly, diaphragmatic MFR has reduced breathlessness and increased Peak Expiratory Flow Rate (PEFR) in COPD patients. However, specific research on its combined impact on the diaphragm remains limited. Aim: To evaluate the efficacy of TEDS and MFR improves ADL performance, diaphragmatic mobility and Pulmonary Function Test (PFT) indices in COPD patients. Materials and Methods: A single-blinded, randomised controlled trial will be conducted at the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, MM (DU), Mullana, Ambala, Haryana, India, from July 2025 to February 2026, involving participants who meet predefined inclusion criteria. Subjects will be randomly allocated to either an experimental or a control group. The experimental group will receive TEDS at 30 Hz for 20 minutes daily, five days per week, alongside diaphragmatic MFR administered in two sets of 10 repetitions with a one-minute rest interval. The control group will undergo sham TEDS and an identical MFR regimen. Both groups will receive interventions over a period of three weeks. Pre- and post-treatment evaluations will include ultrasonography assessment of diaphragmatic mobility and thickness, spirometric analysis of PFT parameters and ADL measurement via the London Chest ADL Scale. For normally distributed data, paired t-tests (within groups) and independent t-tests (between groups) will be used; for non normally distributed data, Wilcoxon signed-rank tests (within groups) and Mann-Whitney U tests (between groups) will be used. A p-value of <0.05 will be considered as statistically significant.

Correlation of Physical Activity Level with Chronic Musculoskeletal Pain in the Elderly Population of Rural Areas: A Research Protocol

Noel Samuel Macwan, Sarvang Desai

Introduction: Ageing is a universal natural process and biological. It is known to be associated with declining health status. The elderly have reduced mobility and functional independence due to arthropathies, which are the result of bone fragility, degeneration of cartilage, reduced elasticity, loss of muscle strength etc. Reduced vision, hearing, decline in memory and inability to control certain physiological functions are other associated problems with ageing. Need of the study: Musculoskeletal problems are commonly found in the ageing population resulting in long-term pain and physical disability affecting the functioning of the elderly. There are limited studies done on the Indian population particularly in elderly comparing the correlation of musculoskeletal problems with Physical Activity (PA) levels till date, hence the need of this study arises. Aim: This study intends to determine the correlation of chronic musculoskeletal pain and PA levels among elderly dwelling in the rural areas. Materials and Methods: The present cross-sectional study would be conducted from the year March 2023 - December 2025. Patients visiting Sumandeep Vidyapeeth and nearby villages that are in 8-10 km radius of the University will be included. The Brief Pain Inventory (BPI) and McGill Pain Questionnaire would be used to assess the chronic Musculoskeletal pain. Also, assessment of the PA levels of the elderly would be carried out using International Physical activity for the Elderly Questionnaire. For Statistical analysis Spearman test or Pearson’s test will be applied. A p-value <0.05 will be considered as statistically significant.

Effect of Kinesio Taping on Pain, Balance, and Spinal Posture in Lower Cross Syndrome: A Randomised Clinical Trial Research Protocol

Vaishali Rai, Aarunee Srivastava, Chakshu Jot Kaur, Sandeep Pattnaik

Introduction: Lower Cross Syndrome (LCS) is one of the most common postural dysfunctions char-acterised by an imbalance in muscles involving tightness in the hip flexors and lumbar extensors, along with weakness in the abdominal and gluteal muscles. This often leads to anterior pelvic tilt, increased lumbar lordosis, balance impairment, and chronic lower back pain. Need of the study: Kinesio Taping (KT) has shown potential benefits in managing pain and pos-tural dysfunction, evidence specific to LCS remains limited and inconclusive. Therefore, a randomised clinical trial is proposed to systematically evaluate its effects on pain, balance, and spinal posture in this population. Aim: To determine the efficacy of KT on pain intensity, impaired balance, and abnormal spinal posture in individuals suffering from LCS. Materials and Methods: This two-arm, parallel-group, randomised clinical trial will be con-ducted at Maharishi Markandeshwar (Deemed to be University) from January 2025 to December 2026. Thirty-six individuals diagnosed with LCS will be divided into either the experimental group or the control group. Each group will receive a four-week conventional physiotherapy programme consisting of standard-ised stretching and strengthening exercises. Whereas the experimental group will also receive KT applied with 10-15% tension to the erector spinae and quadratus lumborum, while the control group will receive sham taping with 0% stretch. Outcomes will include pain intensity, balance, and posture, to be assessed using the Numeric Pain Rating Scale, Berg Balance Scale, and REEDCO Posture Assessment Scale, respec-tively, at baseline and post-intervention. Not-normally distributed variables will be analysed using the Mann–Whitney U test (between groups) and the Wilcoxon signed-rank test (within groups), while normally distributed variables will be analysed using independent and paired t-tests. Statistical significance will be set at p<0.05.

Comparative Evaluation of Active Noise Cancellation Headphones, 8D Audio and White Noise for Reducing Dental Anxiety Among Children Aged 6-9 Years: A Research Protocol

Ashray Mansaram Nimje, Nilima Thosar, Aakriti Chandra, Mrunali Deshkar

Introduction: Dental anxiety is a significant challenge in paediatric dentistry, commonly triggered by unfamiliar environments, invasive procedures, and distressing sounds from dental equipment. Non-pharmacological techniques, such as auditory distraction, have gained interest for their ability to shift a child’s focus away from anxiety-inducing stimuli. ANC (ANC) headphones, Eight-dimensional (8D) audio, and white noise are emerging tools that may help alleviate dental fear by masking or modulating unpleasant auditory experiences during treatment. Need of the study: Despite the widespread application of auditory distraction methods, lim-ited evidence exists on the comparative effectiveness of ANC headphones, especially when used with dif-ferent sound types such as 8D audio and white noise. With increasing demand for child-friendly and non-invasive anxiety management techniques, this study aims to identify the most effective auditory approach to improve behaviour and reduce anxiety in children. Aim: To compare and evaluate the efficacy of ANC Headphones with 8D audio and white noise for reducing dental anxiety in children aged 6-9 years. Materials and Methods: A randomised controlled trial will be conducted on paediatric patients aged 6-9 years at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from June 2025 to December 2026. Participants will be randomly divided into three groups: Group 1 will receive ANC headphones with 8D Audio, Group 2 will receive ANC headphones with White Noise, and Group 3 will receive ANC headphones only. Anxiety levels will be assessed pre, during, and post-treatment using the Modified Child’s Dental Anxiety Scale (MCDAS) and Venham’s Anxiety and Behaviour Rating Scale (VABRS). Physio-logical markers such as pulse rate, blood pressure, and oxygen saturation will also be recorded. Data will be analysed using appropriate statistical tests, including Analysis of Variance ( ANOVA), t-tests, and Pearson’s correlation.

Evaluation of Mangosteen Gel as an Adjunct to One Stage Full-mouth Disinfection in Stage II Periodontitis Patients: A Research Protocol of Randomised Controlled Clinical Trial

Shivani Thakre, Pavan Bajaj, Sneha Dare, Mahima Kothekar

Introduction: Periodontitis is a long-term inflammatory disease that deteriorates the tissues supporting teeth. A new staging and grading system helps improve understanding and management of its severity and progression. Stage II periodontitis is characterised by moderate Clinical Attachment Loss (CAL) and Probing Depths (PD) with horizontal bone loss. One Stage Full-Mouth Disinfection (FMD), using agents like Chlorhexidine (CHX), aims to eliminate intraoral reservoirs of pathogens and improve perio-dontal outcomes. Recent interest has emerged in natural adjuncts such as Garcinia mangostana (mango-steen), known for its antioxidant and anti-inflammatory properties, for their potential role in perio-dontal therapy. Need of the study: Although FMD has shown benefits over conventional therapy, the adjunctive use of herbal agents like mangosteen gel remains underexplored. Considering the reduced antioxidant ca-pacity observed in periodontitis patients, investigating a potent natural antioxidant like mangosteen as an adjunct to one stage FMD could improve clinical outcomes. Aim: To evaluate the effectiveness of mangosteen gel in one-stage FMD treatment of Stage II per-iodontitis patients, focusing on improvements in PD, CAL and Bleeding On Probing (BOP). Methods and Materials: This randomised controlled parallel arm clinical trial will involve 30 systemically healthy individuals diagnosed with Stage II periodontitis, recruited from the outpatient Department of Periodontics at Sharad Pawar Dental College, Sawangi (Meghe), Wardha. The study proposal (ref. no. DMIHER(DU)/IEC/2024/51) has been approved by the DMIHER Institutional Ethical Committee (IEC). The patients will be randomly divided into two groups and the planned overall duration of the study will be one year from December 2024 to November 2025, while it will include a follow-up period of six months. Group-A will receive one-stage FMD, performed within 24 hours and consisting of subgingival Scaling and Root Planing (SRP) with adjunctive measures described in the original FMD protocol by Quirynen M et al., including CHX mouth rinse, tongue brushing, and pocket irrigation. Group-B will undergo the same FMD regimen as Group-A, with the addition of subgingival application of mangosteen gel in all periodontal pockets one week postoperatively. Since CHX is an integral component of the established FMD protocol, the present study specifically evaluates the adjunctive effect of mangosteen gel beyond this standard regimen. Clinical data, including the Probing Pocket Depth (PPD), CAL, BOP will be recorded at baseline, three months, and six months. To determine the importance of variations within and across groups, the data will be analysed using appropriate statistical methods, including the Wilcoxon signed-rank test. Using IBM SPSS Statistics, SPSS v17 statistically significant p-value is defined as being less than 0.05.

Comparative efficacy of Vrushadi Vati versus Tablet Clomiphene Citrate in the Management of Kshina Shukra (Oligospermia): A Randomised Clinical Trial Protocol

Mahesh Sharma, Sourabh Deshmukh, Nitika Senger

Introduction: Infertility is defined as the failure of a couple to conceive after one year of regular, unprotected sexual activity. Oligospermia is one of the causes of male infertility, when there are fewer than 20 million sperm per millilitre of semen. In Ayurveda, oligospermia is correlated with Kshina Shukra. Need of the study: A study on oligospermia is needed to address the growing concern of male infertility, which affects many couples and often has limited treatment options. Modern medicines such as Clomiphene citrate and Letrozole, which have long been used in the management of oligospermia, may be associated with adverse effects including dizziness, visual disturbances, flushing (skin redness), head-aches, and nasal congestion. Vrushadi Vati, a herbal compound mentioned in Harita Samhita, contains Rishbhak (Malaxis muscifera), Bruhti (Solanum indicum), Kantakari (Solanum xanthocarpum), Pippali (Piper longum), Gokshur (Tribulus ter-restris), Kapikacchu (Mucuna pruriens), Shatavari (Asparagus racemosus), and Sharkara (white sugar), all of which possess aphrodisiac properties. No previous study has been conducted on Vrushadi Vati in Kshina Shukra (oligospermia). Aim: Evaluation of comparative efficacy of Vrushadi Vati versus Tab Clomiphene citrate in the management of Kshina Shukra (oligospermia). Materials and Methods: This will be a randomised controlled trial conducted at the Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha, from March 2024 to February 2026. Patients will be randomly divided into two groups using a computerised method, each having 22 pa-tients: Group A (n=22): Tab Clomiphene citrate (control group), Group B (n=22): Vrushadi Vati (experimental group). Treatment will be administered for 90 days. Follow-up will occur on the 30th, 60th, and 90th day, with parameters including sperm count and sperm motility assessed on the 30th and 90th days. Statistical analysis will be performed using the Wilcoxon signed-rank test. Assessment parameters will be compared before and after treatment within each group by performing paired t-tests and between groups using unpaired t-tests. A p-value <0.05 will be considered statistically significant.

Evaluation of Abhyanga and Unmardan with Dashmool Taila in the Management of Vedana (Muscular Pain): A Randomised Controlled Trial Protocol

Farid Hassan Dawood Raza Hussain Hydri, Vinod Ade, Shweta Parwe

Introduction: Pain is a significant diagnostic marker and a primary reason individuals seek medical care. Recognised as the fifth vital sign, it serves an essential role in the body’s defense mechanism. Chronic pain impacts approximately 30-50% of the population and is often associated with con-ditions such as arthritis, spinal disorders and muscular pain. Conventional management relies on NSAIDs and opioids, but their long-term use poses risks. Dashmool, a vata-pacifying Ayurvedic prep-aration, offers a safer alternative. Ayurveda attributes pain primarily to vata imbalance, caused by occlusion (Avarana) or tissue depletion (DhatuKshaya). Pain management aims to balance Vata and enhance tolerance. Among various therapies, Abhyanga and Unmardan are widely used. Abhyanga involves oil application to nourish tissues and calm Vata, while Unmardan, a deep tissue kneading technique, targets deeper muscular structures. Given the high prevalence of pain and the need for safer alternatives, exploring these therapies could provide valuable insights. Need of the study: Chronic pain is a major health concern due to its high prevalence and im-pact on physical and emotional well-being. Various massage techniques are used for pain management, but research on Unmardan for Vedana (muscular pain) is lacking. No comparative studies have evaluated Abhyanga and Unmardan for muscular pain relief. Abhyanga, a key external oleation therapy, is widely used and mentioned in classical texts as part of Dinacharya (daily regimen). Acharya Sushruta states that Abhyanga helps prevent Vata and kapha disorders, but scientific research on its effects remains limited. Aim: Evaluation of comparative efficacy of Abhyanga and Unmardan with Dashmool Taila in the management of Vedana (Muscular pain). Materials and Methods: The present randomised single-blind two-arm superiority Controlled trial will be conducted at Mahatma Gandhi Ayurvedic College Hospital & Research Centre, Wardha ,Maharashtra, India (January 2025-January 2026). Sixty patients will be divided into two groups. Group A (n=30): Abhyanga with Dashmoola Oil, Group B (n=30): Unmardan with Dashmoola oil. The procedure will be done for 45 min. Up to seven days and follow-up will be taken on the 0, 8th and 16th day in both the groups on the objective parameters {Visual Analogue Scale (VAS) Scale, Numer-ic pain rating scale, Quality of life scale}. Paired and unpaired t-tests will analyse data, with p<0.05 considered significant.

Comparative Efficacy of Gorakhmundi Vati versus Hingwadi Vati with Adjuvant Marma Chikitsa in the Manage-ment of Vishaada (Mild Depres-sion): A Randomised Controlled Trial Protocol

Hemangi Gunwantrao Patil, Sourabh G Deshmukh, Trupti Thakre, Aishwarya Kadam

Introduction: “Depression, including mild and moderate forms, significantly affects affects the quality of life”. It is characterised by persistent “sadness, lack of interest in activities, fa-tigue, and cognitive impairments”. According to the World Health Organisation (WHO), depression is a leading cause of disability worldwide, with a complex aetiology involving biological, psychological, and social factors. Despite the availability of pharmacological and psychotherapeutic interventions, the need for integrative and holistic treatment options has gained prominence due to side effects, limited efficacy, and high relapse rates associated with conventional therapies. Need of the study: The WHO identifies depression as a leading global health issue, affecting over 280 million people worldwide. Although modern treatments are effective, they are often accompanied by side effects and high relapse rates, necessitating integrative therapeutic approaches. Ayurveda of-fers holistic interventions rooted in ancient texts. Gorakhmundi vati, derived from Sphaeranthus indicus, is described in Bhavaprakasha Nighantu as possessing Medhya (brain tonic) and Manovikara Nashaka (alleviator of mental disorders) properties. Hingwadi vati, mentioned in classical texts like Charaka Samhita and Sharangadhara Samhita, sup-ports the gut-brain axis by enhancing digestion and mental clarity through Agni Deepana and Mano Prasadana actions. Marma therapy, described in Sushrut Samhita, helps balances the flow of Prana through vital energy points, thereby promoting mental and emotional stability. This study integrates these approaches, provide evidence-based validation for the holistic management of depres-sion. Aim: To evaluate the comparative efficacy of “Gorakhmundi vati versus Hingwadi vati, with adjuvant therapy of Marma Chikitsa,” in the management of Vishaada (mild depres-sion). Materials and Methods: This randomised controlled trial will be conducted at Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Salod, Wardha, Maharashtra, India, from July 2025 to April 2026. A total of 114 patients will be enrolled and randomly allocated into two groups. Group A will receive Hingwadi vati (500 mg) thrice daily after meals with warm water, combined with Marma therapy. Group B will receive Gorakhmundi vati (500 mg) thrice daily after meals with warm water, combined with Marma therapy. The Hamilton Depression Rating Scale (HDRS) will be used as the primary outcome measure. Patients will be assessed on the 0th day, 15th day, and 30th day. Statisti-cal analysis will include descriptive statistics {mean±Standard Deviation (SD), frequencies, and per-centages} and inferential statistics. The paired t-test or Wilcoxon signed-rank test will be used to assess within-group changes, while the Independent t-test or Mann-Whitney U test will be used for be-tween-group comparisons. The Chi-square test or Fisher’s Exact test will evaluate categorical outcomes. A p-value <0.05 will be considered statistically significant.

Assessment of the Prevalence, Risk Factors, and Barriers to Cataract Surgery among Individuals Aged 50 Years and above at a Tertiary Care Setting in Vidarbha Region, Maharashtra: A Research Protocol

Janmejay Shaileshkumar Patel, Pravin Tidake

Introduction: Cataract remains the predominant cause of visual impairment and preventable blindness among individuals aged 50 years and above. Although primarily age-related, several modifiable and non-modifiable risk factors contribute to cataract development. While cataract surgery is a safe and highly effective treatment, various barriers-such as personal attitudes, financial constraints, social support issues, and lack of awareness-can delay or prevent timely intervention. Need of the study: The Vidarbha region of Maharashtra, India, with its rural and semi-arid geography, experiences high Ultraviolet (UV) radiation exposure, which is a recognised risk factor for cataract development. Despite advancements in ophthalmic care, a significant proportion of the elderly population in this region remains visually impaired due to untreated cataracts. Limited healthcare access, low literacy rates, and lack of awareness exacerbate this issue. Current data on cataract prevalence, risk factors, and barriers to surgery are scarce for this region. Understanding these parameters within the local context is critical for developing targeted interventions, such as health education, screening programmes, and surgical camps. This study seeks to address this gap and generate evidence to guide regional healthcare planning. Aim: To assess the prevalence, risk factors, barriers, and attitudes toward cataract surgery among individuals aged 50 and above in a tertiary care setting in Vidarbha, Maharashtra. Materials and Methods: A cross-sectional, questionnaire-based survey will be conducted among individuals aged 50 years and above attending the Ophthalmology Outpatient Department of AVBRH Hospital, Sawangi, Wardha, over a period of two years (March 2024 to March 2026). Participants will be selected using simple random sampling. Data will be collected through face-to-face interviews using a structured, pretested questionnaire administered by the clinical/research team, covering demographic details, risk factors, and barriers to cataract surgery. Ophthalmic examinations will include visual acuity testing, slit-lamp evaluation, and fundus examination. This data will be recorded for further analysis. Data will be analysed using Statistical Package for the Social Sciences (SPSS) software, with chi-square tests and logistic regression applied to identify significant associations.

Efficacy of Haritaki Vati (Terminalia Chebula Retz.) in Sthaulya (Overweight): A Randomised Controlled Trial Research Protocol

Vishal Gajananrao Chinchone, Vaishali Kuchewar, Nikita Rathod

Introduction: Overweight or Sthaulya is one of the Ashtaunindita Purusha or eight undesirable body constitutions according to Ayurveda. It is directly associated with non-communicable diseases like diabetes, cardiovascular disease, and hypertension, therefore being one of the most important health factors in modern medicine. Need of the study: Overweight is among the major causes of non-communicable diseases and de-creased quality of life worldwide. Current treatments have very high costs and adverse effects. Haritaki is an Ayurvedic herbal medicine that is easily affordable, widely available, and safe for chronic use. However, there is a notable lack of studies assessing its effectiveness through rigorous methodologies, such as placebo-controlled and double-blind clinical trials. This study is spe-cifically designed to fill this gap in research. Aim: To evaluate the efficacy of Haritaki Vati (Terminalia Chebula Retz.) vs routine care in the management of Sthaulya (overweight). Materials and Methods: This double-blind, randomised, placebo-controlled clinical trial will be conducted from December 2024 to December 2026 at Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha. 60 participants, aged between 19 and 30 years and having a Body Mass Index (BMI) ranging from 25 to 29.9 kg/m2, will be enrolled and randomly assigned to two groups. Group-A will receive Haritaki Vati at a dose of two grams per day, administered in two divided doses, while Group-B will receive starch-based placebo tablets. The intervention period for both groups will be 90 days, with follow-up evaluations scheduled on days 30, 60, and 90. Anthropometric parameters such as BMI, waist-to-hip ratio, and mid-upper arm circumference will be recorded at baseline and during each follow-up. Statistical analysis will be carried out using paired and unpaired t-tests, and results will be considered statistically significant at a p-value of less than 0.05.

Structural Vertebral Changes in Osteoporotic Women and Their Associations with Prakriti (constitution), Agni (digestive fire) and Koshtha (nature of bowels): A Research Protocol

Snehal Bisen, Gaurav Sawarkar, Amol Deshpande

Introduction: The vertebral column is essential for supporting an upright posture. However, factors such as a sedentary lifestyle or other changes can alter its natural curvature, leading to issues like back pain, stiffness, and difficulty with movement. To prevent these symptoms, it is important to take an individual’s Prakriti (constitution) into consideration. Need of the study: Osteoporosis, marked by reduced bone density and weakened bone microarchitecture, significantly raises fracture risk. Using X-ray imaging and Ayurvedic questionnaires, research explores how individual constitutional traits may influence spinal degeneration. The findings aim to support personalised approaches to osteoporosis management based on Ayurvedic principles. Aim: This study aims to evaluate the structural vertebral column changes in osteoporotic females based on Prakriti (constitution), Agni (digestive fire) and Koshtha (nature of bowels). Materials and Methods: A cross-sectional study will be conducted from Jan 2025 to Dec 2025 at MGACH & RC and AVBRH, located in Sawangi (Meghe), Wardha. A total of 152 subjects will be included in the study. The study will include female participants who have been clinically diagnosed with osteoporosis. X-ray {Anterioroposterior (AP) & lateral view}, range of movement, Naditarangini for Prakriti (constitution) analysis and subjective parameter: Sambhata, Lower back pain (stiffness) will be assessed. Baseline characteristics will be summarised using descriptive statistics. Comparisons between groups will be made using the independent t-test or One-way ANOVA for normally distributed data, and Mann-Whitney U or Kruskal-Wallis tests for non-parametric data. The Chi-square test (or Fisher’s exact test, when applicable) will be used to assess the association between Prakriti, Agni, Koshtha and structural changes in the vertebral column. Post-hoc analysis will be performed using Tukey’s test or Benjamini-Hochberg correction. All tests will be two-tailed, with a p-value <0.05 considered statistically significant.

Comparing the Effect of Gelatamp and Simvastatin-impregnated Gelfoam on Postoperative Outcomes in Patients Undergoing Surgical Removal of Mandibular Third Molars: A Randomised Controlled Trial Research Protocol

Yash S Shete, Deepankar Shukla, Nitin Bhola

Introduction: Surgical removal of impacted mandibular third molars is common in oral surgery but often leads to pain, swelling, trismus, and delayed healing. To improve recovery, materials like Gelatamp, a silver-impregnated gelatin sponge and simvastatin, a drug with anti-inflammatory and bone-healing effects, have been used. Comparing their effects may help identify the better option for enhancing postoperative outcomes. Need of the study: The role of Gelatamp and simvastatin-impregnated gelfoam in improving postoperative outcomes after mandibular third molar surgery remains under-explored and requires further research. Comparative evaluation of these agents is essential to better understand their effectiveness in controlling postoperative complications like pain, swelling, and healing, which are key aspects of patient recovery. Aim: To compare the efficacy of Gelatamp and simvastatin-impregnated gelfoam in enhancing post-operative outcomes in patients undergoing surgical removal of impacted mandibular third molars. Materials and Methods: This single-masked protocol for randomised controlled trial will be conducted in the Department of Oral and Maxillofacial Surgery of Sharad Pawar Dental College associated with Datta Meghe Institute of Higher Education and Research, a tertiary care centre situated in the state of Maharashtra, India from May 2025 to January 2027. The minimum sample size required was calculated as 39, which was rounded up to 40 to improve statistical power. Therefore, a total of 40 patients will be included in the study. These patients will be randomly allocated into two equal groups using a computer-generated randomisation list: Group A (n=20): Gelatamp will be placed in the extraction socket. Group B (n=20): Simvastatin-impregnated Gelfoam will be placed in the extraction socket. Patients aged 16-50 years attending the Outpatient Department (OPD) and indicated for surgical extraction of a mandibular third molar will be included. Following extraction, the surgical site will be filled with either Gelatamp or simvastatin-impregnated Gelfoam and sutured appropriately, after considering all applicable exclusion criteria. A fixed dose of either material will be administered by the investigators, as decided by the principal investigator and the secondary investigator to track the patient’s effects and primary outcomes, including pain, soft-tissue healing, and bone regeneration, as well as secondary out-comes, including haemostasis and postoperative swelling. Various demographic, clinical, and outcome variables will be compared using the Chi-square test, Fischer’s-exact test for categorical data, and inde-pendent t-test for continuous data with a normal distribution. The following parameters will be evaluated: immediately postoperatively, pain, bleeding, and bone density; on postoperative Days 1 and 2, pain, soft tissue healing, swelling, and secondary bleeding; on Day 7, swelling and haemostasis (along with suture removal); and at three months, final assessment of bone regeneration. The p-value <0.05 will be considered significant.

Isolation and Identification of Listeria monocytogenes from Spontaneous Abortion Cases in Humans and its Association with Household Cattle: A Research Protocol

Ankit K Badge, Nandkishor J Bankar, Pratibha Dawande, Sarita Ugemuge

Introduction: Listeria monocytogenes (L. monocytogenes) is a Gram-positive bacterium responsible for listeriosis, a foodborne disease causing significant health problems, especially for pregnant women. During pregnancy, immune modulation increases the vulnerability to infections, resulting in severe complications such as spontaneous abortions. Rural populations are disproportionately affected due to poor sanitation, limited healthcare access, and close human-animal interactions. Need of the study: Studying the association between humans and household cattle is important, as household cattle can carry and transmit the L. monocytogenes, a zoonotic pathogen that may spread through contaminated food, water and contribute to spontaneous abortions in humans. Aim: To investigate the association between L. monocytogenes in women with spontaneous abortions and their household cattle. Materials and Methods: This cross-sectional study will be conducted at Datta Meghe Medical College, Nagpur, Maharashtra, India. The study for human samples will be conducted from January 2025 to December 2026, and this study will recruit 385 women aged 18-45 years with confirmed spontaneous abor-tions and their association with household cattle from rural settings. The study on animal samples col-lected from rural settings will be conducted after receiving approval from the animal ethics committee. Vaginal swabs and faecal samples will be collected and analysed for L. monocytogenes using selec-tive culture methods and Real-Time Polymerase Chain Reaction (RT-PCR). Data will be statistically ana-lysed using the chi-square test to identify correlations, and p-value <0.05 will be considered statisti-cally significant.

Comparative Evaluation of Bala Taila Nasya and Pippalyadi Taila Nasya in the Management of Tension Type Headache (Vataja Shirashoola): A Randomised Controlled Trial Protocol

Vedangi Dinesh Wargantiwar, Vinod Ade, Shweta Parwe

Introduction: Tension Type Headache (TTH) is the most common primary headache disorder, impacting daily life, productivity, and mental health significantly. Traditional treatments like Non-Steroidal Anti-Inflammatory Medication (NSAIDs), muscle relaxants, and antidepressants provide symptomatic relief but are plagued with side-effects like gastric ulcers, Medication-Overuse Headaches (MOH), and dependence. Vataja Shirashoola, a TTH in Ayurveda, results from the derangement of Vata Dosha. Nasya therapy, the intra-nasal application of medicated oils, is a traditional Ayurvedic therapy popularly known to act directly on the central nervous system, enhancing circulation and analgesia. Bala Taila and Pippalyadi Taila are two Nasya oils that possess neuroprotective and analgesic properties, yet no clinical trials have evaluated their relative or comparative efficacy. Need of the study: TTH, which is frequently associated with Vataja Shirashoola, is prevalent across the world, but fewer trials are comparing Nasya therapies in its management. Although Bala Taila have been evaluated separately, but its comparison with Pippalyadi taila has not been carried out. Objective measures such as pain scales and quality-of-life questionnaires were also absent in earlier studies. This study attempts to bridge this deficiency through a Randomised Controlled Trial (RCT) incorporating standardised clinical outcomes. Aim: To evaluate the efficacy of Bala Taila Nasya and Pippalyadi Taila Nasya in the management of Vataja Shirashoola (TTH) in terms of pain reduction, improvement in mobility of the neck, and Quality of Life (QoL). Materials and Methods: The present study will be randomised controlled trial (RCT) will be conducted in the Panchakarma Department, Mahatma Gandhi Ayurveda College, from January 2024 to December 2025. Sixty patients aged 18-60 years with a diagnosis of TTH (Vataja Shirashoola) will be divided randomly into two groups: Group P will be administered Bala Taila Nasya, and Group Q will be administered Pippalyadi Taila Nasya, eight drops in each nostril daily for seven days. The study is of a parallel-group, open-label type. Numerical Rating Scale (NRS), cervical ROM, and a QoL questionnaire will be assessed assessed on days 0, 8, and 16. Demographic information such as age, sex, duration of headache, and lifestyle will be recorded. Statistical analysis will be performed using Statistical Package for the Social Sciences (SPSS) version 26.0 with paired t-tests, Analysis of Variance (ANOVA), and Chi-square tests. A p-value <0.05 will be taken to be statistically significant.

Anticancer Activity of Rasamanikya in Acute Promyelocytic Leukemia: An In-vitro Cell Line Study Protocol

Komal Nandal, Nilima Wadnerwar

Introduction: Acute Promyelocytic Leukaemia (APL) is a subtype of Acute Myeloid Leukaemia (AML) characterised by the translocation of chromosomes 15 and 17, leading to the PML-RAR-α fusion gene. Conventional treatments, including chemotherapy and radiation, often have significant side-effects, such as organ damage and secondary cancers. Need of the study: This study will explore the potential anticancer efficacy of Rasamanikya, a traditional Ayurvedic arsenical formulation derived from Shuddha Haratala (arsenic trisulfide), is evaluated in treating APL through in-vitro studies. Rasamanikya, mentioned in ancient Ayurvedic texts as a remedy for blood and skin disorders, is believed to act as an immunomodulator and enhance erythropoiesis. The mineral formulation is rapidly absorbed and acts systemically, potentially reducing adverse effects of conventional therapies while maintaining efficacy. This study aims to evaluate the optimal dose and anticancer potential of Rasamanikya for APL treatment, providing a bridge between traditional medicine and modern oncology. Aim: To evaluate the anticancer activity of Rasamanikya in APL. Materials and Methods: The experimental analytical in-vitro study will be conducted at the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Kharghar, Navi Mumbai, and Aakar Biotechnologies Private Limited, Lucknow, Uttar Pradesh, selected for their availability of different cell types, during the period from March 2026 to August 2026 The formulation Rasamanikya, essential for the study, will be sourced from Dattatraya Ayurved Rasashala, Wardha. Its preparation will take place in the Department of Rasa Shastra and Bhaishajya Kalpana at Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha. The study aims to assess Rasamanikya through in-vitro methods by examining its organoleptic and physicochemical properties in APL. For statistical analysis, the One-way ANOVA test will be applied, with a p-value of less than 0.05 considered to indicate statistical significance.

Role of Ki-67, Cyclin D1, and p53 in Early Diagnosis and in the Prognosis of Oral Squamous Cell Carcinoma: A Cross-sectional Study Research Protocol

Khushi Soni, Keshav Hiwale

Introduction: Oral Squamous Cell Carcinoma (OSCC) accounts for more than 90% of all oral cancers. It is among the top three cancers in India, along with cervical and breast cancer. Oral Epithelial Dysplasia (OED) represents a premalignant lesion that can evolve into OSCC. Early detection of OED and prediction of OSCC prognosis remain a major challenge in clinical practice. Molecular markers have emerged as promising adjuncts to histopathology in the assessment of OED and OSCC. Need of the study: Histopathological grading is the most widely used method for assessing OED and OSCC. Despite updated grading systems, histology often fails to reliably predict malignant progression and clinical outcomes. A delay in diagnosis affects survival rates, underscoring the need for additional laboratory tools for early detection and prognosis. Immunohistochemistry (IHC) biomarkers such as Ki-67, Cyclin D1, and p53 have shown individual promise in several studies. On the other hand, studies on their combined use remain limited. This study aims to investigate the combined potential of these three biomarkers in early diagnosis and prognosis across the full histological spectrum of OED and OSCC. Aim: To correlate the expression levels of Ki-67, Cyclin D1, and p53 with the histopathological grades of OED and OSCC and to demonstrate their utility in early diagnosis and prognosis. Materials and Methods: A single-centre prospective cross-sectional study will be conducted between July 2025 and May 2026 at the Department of Pathology, Jawaharlal Nehru Medical College, DMIHER, Sawangi (Meghe), Wardha, Maharashtra, India. The target sample is planned to consist of 61 cases (30 OED, 31 OSCC), with a projected dropout rate of 10% to provide at least 55 analysable cases. According to the “World Health Organisation WHO 5th edition (2022)” criteria, OED will be classified as mild, moderate, or severe, and OSCC as Well Differentiated (WD), Moderately Differentiated (MD), or Poorly Differentiated (PD). IHC will be performed using validated antibody clones. The scoring will assess the labelling index (LI %) for Ki-67 and p53, the Immunoreactivity Score (IRS) for Cyclin D1, and layer-specific expression patterns. Inter-observer agreement will be assessed. Spearman’s rho (ρ) correlation coefficient will be employed to determine the association between biomarker expression scores and OED/OSCC histopathological grade progression. A p-value of less than 0.05 will be regarded as statistically significant.

Insight to Different Approaches in Surgical Closure of Oro-antral Communication: A Literature Review

Dinesh Chand Patatidar, D Aditya, Deepika Patatidar

An Oroantral Communication (OAC) is an unnatural non epitheliased continuation in between maxillary antrum and oral cavity. When it doesn’t heal spontaneously or left untreated, this tract becomes epithelised and termed as oroantral fistua. Most common cause of Oro-antral communication is the extraction of maxillary posterior teeth. However there are so many other causes that can lead to development of OAC/fistula like pathologies, facial trauma, forcing a tooth/tooth root into the sinus cavity during attempted removal etc. To prevent the development of fistulas and further sinus problems, it is generally recommended that all of these defects should be closed within 24-72 hours. Various surgical techniques have been described for the closure of OAC. The aim of this literature is to review surgical treatment strategies of OAC and other treatment options along with their advantages and disadvantages, including new techniques.

Arginine in Preventive Dentistry: Mechanisms, Clinical Applications, and Future Perspectives

Arginine, becoming a promising biomimetic agent in preventive dentistry, is uniquely positioned to modulate plaque biochemistry and enhance resilience on tooth surfaces. Extensive in-vitro, in situ, and clinical evidence demonstrates that arginine can elevate plaque pH, influence microbial ecology, and promote remineralisation, thereby allowing it to distinguish between active, caries prone biofilms and healthier plaque environments. Research across enamel, dentin, and root surfaces indicates that arginine-fluoride formulations enhance mineral gain, strengthen enamel structure, and slow lesion progression. At the same time, clinical trials consistently report meaningful reductions in dentin hypersensitivity due to rapid tubule occlusion. Beyond biochemical mechanisms, arginine promotes favourable shifts in oral microbiota via enhancement of arginine deiminase activity and suppression of acidogenic species such as Streptococcus mutans (S. mutans). Continuing developments in formulation chemistry and the incorporation of calcium rich carriers continue to expand its potential as a therapeutic ingredient in both dentifrices and professional care products. In the present review, arginine has been considered a valued adjunct to modern preventive dentistry, with established benefits in caries control, remineralisation, and the management of hypersensitivity. Nonetheless, further long-term large-scale clinical research needs to be conducted with a view to establishing standardised concentrations, optimally delivering systems, and validating completely its role alongside conventional fluoride-based strategies.

Analysis of PCR Techniques for Detection of Leptospira: A Narrative Review

Mushrraf Khan, Aditi Warghade, Tokeshwar Kumar Sahu, Jaishriram Rathored

Leptospirosis, a widespread zoonotic disease caused by pathogenic Leptospira species, is recognised as posing significant challenges to both public health and veterinary sectors. Traditional diagnostic methods, including serological assays and culture techniques, are often characterised by limited sensitivity, particularly during the early stages of infection. In contrast, enhanced accuracy and rapid detection capabilities have been demonstrated by molecular diagnostics- especially Polymerase Chain Reaction (PCR)-based approaches. In this review, the development and application of various PCR-based methods, including conventional PCR, nested PCR, quantitative real-time PCR (qPCR), digital PCR, and Loop-Mediated Isothermal Amplification (LAMP), have been explored for detecting Leptospira in clinical and environmental samples. These technologies have been shown to not only improve sensitivity and specificity but also facilitate early and reliable diagnosis. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, focusing on studies published between 2000 and 2025. The selected literature has highlighted the diagnostic strengths, limitations, and practical considerations associated with each method. Furthermore, the future integration of multiplex PCR assays and portable diagnostic tools is discussed to expand point-of-care testing, particularly in resource-limited settings. Standardisation of protocols and cross-platform validation are emphasised as critical for achieving widespread, effective use. Overall, leptospirosis diagnostics continue to be redefined by PCR-based strategies, supporting improved disease surveillance and control.

Methylated DNA in Oral Brush and Salivary Rinse as a Non-invasive Biomarker in the Diagnosis and Prognosis of Oral Cancer: A Narrative Review

BS Vaanrhaangh Anal, Sarowar Alom, Srimoyee Ghosh

Oral cancer is one of the significant health challenges globally, with late-stage diagnosis contributing substantially to poor prognosis and limited survival rates. Although tissue biopsy is the current gold standard for diagnosis, its invasive nature and limited sensitivity for early lesions restrict its effectiveness in routine screening and longitudinal monitoring. These limitations have driven growing interest in non-invasive molecular approaches that could support earlier detection and more effective clinical monitoring. Deoxyribonucleic Acid (DNA) methylation, a well-established epigenetic modification involved in gene regulation, has emerged as early and consistent events in oral carcinogenesis. Aberrant methylation of Tumour Suppressor Genes (TSG) DNA repairs genes, and other regulatory elements have been consistently reported in Oral Squamous Cell Carcinoma (OSCC). Importantly, these methylation changes can be detected not only in tumour tissue but also in non-invasive oral samples, such as oral brush biopsies and salivary or oral rinse specimens. This narrative review examines the diagnostic and prognostic potential of DNA methylation biomarkers detected through non-invasive sampling methods such as oral brush and salivary rinses. We summarise key findings from existing studies and discuss the relative strengths and limitations of these sampling approaches. Oral brush-based assays generally provide higher sensitivity due to enriched epithelial cell content and lesion-specific signals, whereas salivary and oral rinse-based assays offer greater feasibility for large-scale screening and repeated follow-up. Several multi-gene methylation panels have demonstrated encouraging performance in distinguishing malignant and potentially malignant lesions from normal oral mucosa, as well as in predicting disease recurrence and patient outcomes. Overall, methylation-based assays using oral brush and salivary rinse samples represent promising adjunctive tools for oral cancer detection and monitoring. While further validation, standardisation, and regulatory approval are required before routine clinical implementation, the integration of methylation-based assays into clinical practice holds the potential to significantly advance the early diagnosis and personalised management of oral cancer.

Liquid Biopsy for Early Detection of Rare Cancers: A Narrative Review

Prakhar Bansal, Pramita Gharde, Shrishti Bansal

Liquid biopsy is a novel oncology technology with the potential to detect cancer non invasively by analysing biomarkers in bodily fluids such as blood, urine, and saliva. Liquid biopsy is an early solution to cancer detection, disease monitoring, and personalised treatment planning. Detecting circulating tumour Deoxyribonucleic Acid (DNA) (ctDNA), Circulating Tumour Cells (CTCs), and exosomes is best in detecting hard-to-reach tumours by conventional biopsies. The current review endeavours to critically evaluate the advancement and challenges of liquid biopsy in oncology and discuss implications for detecting rare and hard-to-detect cancers. The Narrative review will discuss clinical applications, technical progress, and limitations of liquid biopsy in optimising the early detection and management of patients in oncology. An extensive literature review critically evaluated current and seminal research articles on liquid biopsy, clinical trials, peer-reviewed journals, and meta-analyses. The focus was on applying liquid biopsy to detect early-stage tumours, integrate them with other diagnostic platforms, and monitor the response to treatment in rare tumours such as pancreatic cancer, neuroblastoma, and mesothelioma. Liquid biopsy has emerged as a critical technology for enhancing the accuracy of cancer and early detection, particularly for tumours otherwise difficult to biopsy. As promising as the technology is, it is plagued by limitations in the form of sensitivity, tumour heterogeneity, and low levels of tumour biomarkers during the early stage. Additionally, standardisation and regulatory approval continue to pose challenges to clinical adoption. Liquid biopsy is a technology poised to revolutionise oncology with its non invasive and reproducible potential for early detection, disease monitoring, and personalised therapy. Additional research and technological innovation are required to overcome current limitations, achieve greater clinical acceptance, and offer greater utility in detecting rare cancers.

From Data to Diagnosis: The Role of Machine Learning in Preeclampsia Prediction

R Saroash Zulfishaan, R Anusha, Preet Agarwal, Leena Chand

Preeclampsia (PE) is a complex, potentially life threatening hypertensive disorder of pregnancy, that affects approximately 2-5% of pregnancies worldwide. It is characterised by elevated Blood Pressure (BP), Proteinuria and multiorgan dysfunction, posing significant risks to both maternal and foetal health. Timely identification of high-risk pregnancies is crucial to prevent severe complications. However, conventional diagnostic approaches relying on clinical assessments and biomarkers analysis often fall short in early and accurate prediction. Recent advancements in Machine Learning (ML) have opened new avenues for improving early prediction and diagnosis of PE, offering the potential for more targeted and timely interventions. This review explores the integration of ML algorithms with clinical, laboratory and demographic data to develop robust predictive models for PE. Studies employing Support Vector Machines (SVM), Logistic Regression (LR), Random Forest (RF) and Deep Neural Networks (DNN) has demonstrated the ability to uncover complex non linear patterns associated with PE risk. These models often surpass traditional diagnostic methods in accuracy and offer transformative potential in prenatal care. By incorporating ML based tools into routine obstetrics practice, it can help healthcare providers predict PE early and implement preventive strategies to reduce the risk of complications such as eclampsia and organ failure. This review offers a comprehensive, evidence-based review of ML models in PE prediction by integrating clinical, biochemical, imaging and genomic data. By bridging obstetrics and data sciences, it highlights model performance, personalisation, and clinical relevance, making it a timely and translational resource for improving maternal-foetal outcomes through AI driven healthcare.

Agnikarma and its Role in Pain Management: A Narrative Review on Exploring Ayurvedic Interventions for Musculoskeletal Disorders

Pradnya Prashant Dakhole, Sheetal Asutkar

Pain management, particularly in chronic musculoskeletal disorders, remains a challenge to modern medicine and relies considerably on drug interventions full of multiple side-effects. Ayurveda (ancient system of medicine) has non-surgical and holistic interventions such as Agnikarma (application of therapeutic heat) that induce equilibrium in the body’s energies. Agnikarma is of specific utility in managing Vata (movement) related disorders characterised by joint pain, stiffness of muscles, inflammation, and limitation of movement. This narrative review aimed to discuss the application of Agnikarma in pain management, explicitly referring to musculoskeletal disorders such as sciatica and osteoarthritis, by correlating Ayurveda’s concepts with present-day pain management modalities. This review consolidates data from clinical trials and case reports of recent decades that confirm the efficacy of Agnikarma in pain management. Other Ayurvedic interventions, such as Siravedha (venepuncture), Basti (medicated enema), and swedana (fomentation), are also outlined in the context of how they add to the efficacy of Agnikarma in managing Vata-related musculoskeletal disorders. The review demonstrates that Agnikarma effectively reduces pain, inflammation, and stiffness of muscles, resulting in long-term relief and enhanced mobility in Sciatica, Osteoarthritis, and allied disorders. It enhances blood supply, heals tissues, and reduces inflammation. Along with other Ayurvedic treatments such as siravedha, Agnikarma is even more effective in relieving pain in the short term and curing in the long term. Agnikarma is a practical, non-surgical intervention that targets the cause of pain, particularly in Vata-related disorders. By providing long-term relief from pain with minimal side-effects, Agnikarma is a valuable alternative to drug interventions.

Microbial Adhesion and Biofilm Formation on Clear Aligners: A Literature Review

VP Shravani, Ravindra Kumar Jain

Oral cavity is a host for a variety of microorganisms, these microbes tend to adhere to retentive areas in the oral cavity such as deep occlusal grooves on posterior teeth, interdental areas and form biofilm. This leads to the development of dental caries and gingivitis. Patients undergoing fixed appliance orthodontic treatment are more prone for enamel demineralisation caused by adherence of microbial colonies. Clear aligners, which are made of clear thermoplastic material are commonly used in clinical practice recently. Clear aligners are a series of plastic trays which have to be worn for 22 hours a day for effective tooth movement and have to be changed for every two weeks. These aligners cover the tooth completely, making it difficult for the antibacterial effect of saliva to act on the tooth surfaces. Hence, the present review aimed to assess the microbial adhesion and biofilm formation in patients undergoing clear aligner therapy and the effectiveness of various methods to clean aligners.

Role of Ayurvedic Nutricosmetics in Skin and Hair Rejuvenation: A Narrative Review

Vinay Kumar, Sadhana Misar Wajpeyi, Pankaj Yadav, Bhishmani Tarare

Healthy skin is a symbol of overall health condition of an individual. Ayurvedic herbs are useful for correcting the pathogenesis and establishing the original and natural colour and complexion of healthy skin and hair. In recent years, there has been a growing awareness among consumers about the side-effects of synthetic skincare products and the role of internal nutrition in the care of skin and hairs. The expansion of nutricosmetics markets worldwide reflect this trend for safer, natural and holistic options. Although there are many well-experimented Ayurvedic formulations for the skin and hair care, there is a lack of records and scientific evidence with regard to Ayurvedic aspect related to nu-tricosmetic approach leading to the present study. In the present study it carefully connects tradition-al Ayurvedic knowledge-like the application of Keshya, Varnya, Rasayana, and Vayasthapana herbs with the latest developments in oral skincare supplements. It also offers a comprehensive and preventive viewpoint on skin and hair health by exploring the Ayurvedic method in a unique way, starting with Dincharya, Ritucharya, Shodhana, and Shamana. This work aligns Ayurvedic classifications with contemporary pharmaceutical actions and gut-skin axis ideas.

Unusual Presentations of Dental Impactions: CBCT-based Pictorial Review

The advent of Cone Beam Computed Tomography (CBCT) has significantly transformed the field of Oral maxillofacial radiology. This has brought a true paradigm shift from two-dimensional to three-dimensional imaging. Impacted teeth are frequently encountered in clinical practice and may predispose to dental caries, infections, resorption of adjacent teeth, neural compression, periapical pathology, and the development of cysts or tumours. CBCT plays a pivotal role in the evaluation of impacted teeth by defining the exact position of the tooth and its relation to the vital structures. Moreover, it also reveals the hidden aspects of an impacted tooth, like its morphological alterations, that are not shown on two-dimensional radiography. Authors, hereby present a plethora of such deceptive impactions caught on a CBCT.

Integrating Genomics into Psychiatry in India: A Narrative Review on Opportunities and Challenges

Anik A Pal, Prafulla S Ambulkar, Asokekumar Pal

Genomic medicine is transforming psychiatry by revealing the genetic aetiology of mental illness. The diversity of India’s population presents a singular opportunity to incorporate genomic information into psychiatric practice. This review discusses recent developments in psychiatric genomics, such as Genome-Wide Association Studies (GWAS), Polygenic Risk Scores (PRS), and pharmacogenomics, which facilitate more tailored mental health interventions. Pharmacogenomics promises to individualise treatments based on genetic profiles, whereas epigenetics and gene-environment interactions shed light on the biological underpinnings of mental health across various sociocultural settings. Genomic psychiatry in India has the potential to be applied in personalised medicine, early risk prediction, targeted therapies, and informing national mental health policy. Yet, the uptake of genomic psychiatry is hindered by infrastructure constraints, ethical as well as privacy issues, and the requirement of cultural competence. The proposed directions include increased research, combining genomic Learning Health Systems (gLHS), and use of Artificial Intelligence (AI) in predictive analytics. This review sums up with major recommendations for progressing genomic psychiatry in India through modifications in policy, funding for research, and public education efforts.

A Comprehensive Review of Sexually Transmitted and Reproductive Tract Infection Through the Lens of History: Current Realities and Future Strategies

Divya Madamanchi, Akash Nagar, Gayatri R Nair, Suman Ray

Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs) have significantly influenced human health, societal norms and medical practices throughout history. From ancient references to the modern Human Immunodeficiency Virus (HIV) pandemic, STIs/RTIs have shaped public health responses and awareness. The present review synthesises historical developments, global epidemiological trends and contemporary management approaches, with a focus on India. Unique to this paper is its comparative evaluation of syndromic and aetiological management, tabulated diagnostic approaches and integration of India’s National Acquired Immunodeficiency Disease (AIDS) Control Programme (NACP) Phase V strategies. The review also identifies key challenges in surveillance, asymptomatic case management and healthcare worker training. The present review uniquely integrates a detailed historical trajectory of STIs/RTIs- from ancient medical texts to modern epidemics- while linking these lessons to current diagnostic strategies, syndromic management and India’s NACP Phase V framework. This historical perspective provides a broader context for understanding persistent challenges and shaping future interventions. In conclusion, while India has made significant progress through structured national programmes, gaps remain in early diagnosis, awareness and resource accessibility. Strengthening surveillance, adopting global best practices and integrating digital technologies are essential for future progress. The present review offers an overview of STIs/RTIs by integrating historical context, epidemiology and current prevention and management strategies, with a particular focus on India.

Advancements in Perioperative Pain Management: The Role of Perfusion Index as a Continuous Non Invasive Measure

Snehal Venkatesh Kabra, Sanjot Ninave

Pain management in the perioperative setting is crucial for patient comfort and optimising surgical outcomes. Poorly managed pain will trigger deleterious physiological effects, such as tachycardia, hypertension, and elevation of stress hormones, which can hinder recovery and potentially lead to chronic pain syndromes. Classic methods of evaluating pain, such as observations of Heart Rate (HR), Blood Pressure (BP), and pain scores using a subjective rating system, are unreliable because they depend on factors related to non painful stimuli. The Perfusion Index (PI) is a novel tool proposed to continuously and non invasively evaluate peripheral flow and sympathetic activation in response to painful stimuli. This review consolidates current evidence on PI as a dynamic, objective indicator of nociception in real-time clinical settings. It highlights its potential to bridge the gap between physiological monitoring and subjective pain assessment. This review examines the physiological basis of PI and its role in assessing pain and analgesia. Immediate feedback on peripheral perfusion offered by PI can assist anaesthesiologists in modifying their analgesic interventions, enhancing pain control, and reducing opioid consumption. Incorporation of PI into practice may lead to advances in individualised pain management strategies, particularly for high-risk patients.

Clinical Features, Molecular Pathogenesis, Diagnosis, and Management Strategies of Zinner Syndrome: A Comprehensive Review

Vidhi Shah, Anup Zade, Imran Ali Khan, Akshat Dubey, Bhagyesh Sapkale

Zinner syndrome is a rare congenital defect of the male reproductive organs, which is traditionally characterised by the presence of the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and obstruction of ejaculatory ducts. It is a result of malformed development of the mesonephric (Wolffian) duct during embryogenesis, commonly asymptomatic, and is discovered incidentally by imaging. Mass effect can cause symptomatic patients to present with lower urinary tract symptoms, lower abdominal or pelvic pain, reproductive dysfunction, and bowel symptoms, uncommonly. Magnetic Resonance Imaging (MRI) is the diagnostic gold standard, Computed Tomography (CT), Ultrasound (US) and emerging modalities can help in early detection. Individualised management includes conservative observation and minimal invasive, robotic-assisted or endoscopic intervention with new therapies emerging to help relieve the symptoms and preserve fertility. Genetic research, such as whole exome sequencing, has proposed a role of genetic factors such as GATA3 and PAX8, among others, in the pathogenesis. The present article is a review of clinical presentation, imaging, pathogenesis, and treatment.

Treatment Paradigms in Age-Related Macular Degeneration: A Narrative Review Bridging Innovations in Dry and Wet AMD

Ashish Sharma, Shashank Banait

Age-related Macular Degeneration (AMD) is still the largest cause of vision loss in the elderly globally, with two distinct clinical forms: dry (non exudative) and neovascular or wet (exudative) AMD. Dry AMD advances slowly and is characterised by drusen and Geographic Atrophy (GA), whereas wet AMD is distinguished by Choroidal Neovascularisation (CNV) and frequently results in fast and severe vision impairment. In recent years, there has been substantial progress in recognising and managing both forms. This comprehensive analysis looks at existing therapy options as well as emerging developments in AMD treatment. For dry AMD, dietary supplements, lifestyle changes and experimental treatments such as complement inhibitors and neuroprotective chemicals are considered. In the area of wet AMD, anti-vascular endothelial growth factor medications such as Ranibizumab, Aflibercept and Brolucizumab remain the cornerstone of therapy. Newer agents, such as Faricimab and port delivery systems, offer longer dose intervals and promise better patient compliance. Furthermore, the function of gene therapy, stem cell transplantation, as well as sustained drug delivery systems is highlighted as emerging frontiers in AMD treatment. The review also looks at how these developments affect visual results, treatment burden and quality of life. Despite recent treatment advances, unmet needs remain, notably in avoiding the advancement of dry AMD and managing refractory instances of neovascular AMD.

Optimising Perioperative Care in Craniotomy Patients : A Narrative Review of Opioid-free Anaesthesia Approaches

Payodhi Modi, Sanjot Ninave

Opioid-free Anaesthesia (OFA) for craniotomy is a method employed increasingly for intraoperative and postoperative pain management with reduced opioid side-effects. Standard opioid regimens, although best for analgesia, cause respiratory depression, sedation, nausea and emesis. OFA employs multimodal therapy and utilises regional modalities, such as scalp blocks and systemic non opioid analgesics, including dexmedetomidine, ketamine, lidocaine, acetaminophen, Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and gabapentinoids, in an effort to preserve stable cerebral physiology and thereby prevent stress reactions. This approach aims to achieve a stable haemodynamic and analgesic profile. The intraoperative management of OFA is supported by titration of the anaesthetics mentioned above, with vigilant observation and add-on depth monitoring of anaesthesia and nociception to maintain analgesia during prolonged and severe stimulation, such as skull pinning, dura opening and incision. Postoperative multimodal pain control is extended for a sufficient time to avoid opioids but encourages recovery and allows early neurologic evaluation. OFA reduces opioid side-effects, optimises patient comfort and even hospital stay, but heterogeneity of population, protocol and outcome necessitates individual treatment and close observation. Risk with OFA is also present, such as haemodynamic instability, residual sedation and insufficiency of analgesia and therefore necessitates close observation and management by rescue analgesic therapy. This narrative review aims to evaluate OFA in terms of pharmacology, intraoperative technique, postoperative outcome, theoretical advantage and limitation and value added in the capacity to differentiate a global view, aggregate deficits of knowledge and build lines of future research with the objective of systematising treatment and maximising perioperative care of neurosurgery patients. The scope of this review extends to examining the broader implications of OFA protocols in the context of reducing opioid use, promoting patient safety and optimising postoperative recovery. It also emphasises the need for future research to establish standardised, evidence-based guidelines that could further enhance the efficacy and safety of OFA in neurosurgery.

Birt-Hogg-Dubé Syndrome: A Narrative Review of Clinical Spectrum, Molecular Pathogenesis, and Multisystem Management Strategies

Shailabh, Imran Ali Khan, Anup Zade, Bhagyesh Sapkale

Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant rare disease with variable manifestations in the skin, lungs, and the kidneys, as a result of germline mutations in the Folliculin (FLCN) gene. It has a clinical presentation that includes fibrofolliculoma, trichodiscomas, acrochordons, pulmonary cysts with recurrent Spontaneous Pneumothorax (SP) as well as multifocal renal tumours including hybrid oncocytic, chromophobe, and clear cell carcinomas. FLCN inactivation, interference with mTOR, and AMPK signalling play a role in pathogenesis and provide tissue-specific abnormalities. Diagnosis is mostly based on clinical criteria, radiologic, skin biopsy and molecular confirmation with Next-Generation Sequencing (NGS) enhancing early detection. Treatment of BHD is organ-specific, so skin lesions are managed with dermatological surgeries, pulmonary cases are managed with Video-Assisted Thoracoscopic Surgery (VATS) or pleurodesis, nephron-sparing surgery, ablation, or surveillance of tumours are used in the cases involving the kidneys. Lifelong follow-up is suggested because of the risk of tumour recurrence in many such cases of BHD. On early identification, proper treatment, and organised monitoring, the patients with BHD syndrome will be able to lead a nearly normal life, which stresses the need to use multidisciplinary care to reduce morbidity and increase the prospects of long-term outcomes.

Trikatu and its Therapeutic Potential: A Narrative Review of its Bioactive Compounds and Pharmacological Mechanisms

Shivani Durgadas Darje, Dattatray Sarvade

Trikatu is an essential Ayurvedic formulation of Piper nigrum, P. longum, and Zingiber officinale, traditionally revered for balancing the body’s humours and enhancing digestion. Its therapeutic value is supported by a rich array of bioactive phytochemicals. The present narrative review aimed to thoroughly synthesise the available pharmacological and clinical data on Trikatu’s health benefits. Specific objectives included summarising its active components, evaluating its antimicrobial and anti-inflammatory properties, and reviewing its effectiveness in managing metabolic and endocrine disorders. Major databases, including PubMed/Medline, Google Scholar, Scopus, and Cochrane Library, were searched. Retrieved studies were qualitatively assessed and synthesised to summarise the therapeutic potential and activities. Preclinical findings confirmed potent antimicrobial activity against common pathogens, often rivaling standard antibiotics, and significant anti-inflammatory action. It also demonstrated protective effects on the liver and heart. Clinical studies provided strong support for its role in metabolic health, showing significant improvements in lipid pro-files for patients with dyslipidaemia, alongside positive outcomes in managing symptoms of hypothyroid-ism and Polycystic Ovarian Syndrome (PCOS). Trikatu exhibits a strong, multi-faceted therapeutic potential consistent with its traditional applications. However, despite compelling evidence, the formal integration of Trikatu into contemporary medicine requires further rigorous, high-quality Randomised Controlled Trials (RCTs) to confirm its efficacy and ensure standardised clinical safety.

Impact of Alcohol Consumption on Regional and General Anaesthesia: A Narrative Review

Meenal Rajput, Karuna Taksande

Alcohol use has a profound impact on the anaesthesiology practice, affecting the safety and efficacy of general and regional anaesthesia. Ethanol is a Central Nervous System (CNS) depressant that modifies the pharmacokinetics and pharmacodynamics of anaesthetic drugs through multiple drug interactions. Chronic alcohol consumption stimulates hepatic enzymes like cytochrome P450, enhancing the metabolism of anaesthetic agents. This can make them less effective, necessitating increased doses to produce the desired effect, and increase the risk of toxicity as a result of the formation of toxic metabolites. On the other hand, acute alcohol consumption can depress hepatic enzyme activity, leading to delayed drug elimination, prolonged anaesthetic action, and increased risk of adverse effects like respiratory depression and delayed recovery from anaesthesia. These drug-related changes require judicious perioperative planning and personalised anaesthetic management. The extent of this review is to analyse the effect of ethanol upon the clinical use of anaesthesia, with emphasis on regional versus general techniques. It will discuss how alcohol influences preoperative evaluation, such as liver function and risk of withdrawal, intraoperative medication dosing, haemodynamic stability, and selection of anaesthetic drugs. In addition, it takes postoperative considerations into account, including prolonged sedation, changed pain response, and alcohol withdrawal complications. Comparing regional and general anaesthesia in alcohol consumers with different patterns of alcohol consumption, this review seeks to accentuate optimal practices for maximising anaesthetic care. It is vital to understand these interactions in order to minimise perioperative complications as well as to enhance patient outcomes. In conclusion, increased awareness and individualised strategies for anaesthetic care in alcohol-impaired patients are necessary parts of safe and successful surgery.

Fospropofol for Procedural Sedation: A Narrative Review of Pharmacology, Efficacy, and Safety Considerations

Fospropofol is an aqueous-soluble prodrug of propofol designed for short-term sedation in diagnostic and therapeutic interventions under monitored anaesthesia care. In contrast to lipid formulations of propofol, fospropofol is enzymatically converted to active propofol, exhibiting a slower onset of action but with several benefits, including decreased pain on injection, improved chemical stability, and a significantly lower risk of microbial contamination. This review provides an overall discussion of fospropofol’s chemical structure, pharmacologic profile, pharmacokinetic properties, and pharmacodynamic actions, highlighting its unique characteristics when compared with conventional propofol. Fospropofol offers well-tolerated and effective sedation, with high patient satisfaction and a good safety profile. Potential side-effects, particularly those affecting the respiratory and cardiovascular systems, are examined. The review discusses regulatory factors, formulary issues, comparative assessment with other sedatives, and clinical use considerations. New indications, off-label uses, and future research directions are investigated to inform both immediate clinical practice and future innovation. This review aims to educate anaesthesiologists and clinicians on the evolving role of fospropofol and to encourage further studies into its expanding clinical applications. This review highlights the evolving role of fospropofol in sedation, underscoring its potential as a safer alternative to traditional propofol, with unique pharmacologic benefits and promising opportunities for future therapeutic applications.

Complementary and Alternative Medicine Practices in the Management of PCOS Via Gut Microbiome Modulation: A Narrative Review

Manika Setia, Madhvi Awasthi

Polycystic Ovary Syndrome (PCOS) is a condition characterised by hormonal imbalance, chronic inflammation, and changes in the gut microbiome. Recent research highlights the importance of the gut-hormone axis in the progression of certain gynaecological conditions, suggesting that modulation of the gut is a new approach in the management of PCOS. Complementary therapies such as probiotics, prebiotics and polyphenols have shown promising results by altering the gut microbiome, supporting oestrogen metabolism, and modulating immune function. Complementary therapies like yoga and meditation can be used as an adjunct therapy to improve the symptoms of PCOS. Sleep, yoga, and meditation have been shown to improve gut dysbiosis, regulate circadian rhythm and normalise cortisol levels in the body. These effects may contribute to better hormonal balance and improvements in anthropometric parameters in individuals with PCOS. However, PCOS and the gut microbiome are highly multifactorial and are influenced by several variables. Therefore, longitudinal, well-structured studies are required to establish the relationship between them. The modulation of the gut microbiome through complementary therapies is an emerging area of research, and gut-targeted complementary approaches may have promising potential as adjuncts to conventional therapies to improve gut microbiota.

Therapeutic Applications of Cranberries in Oral Disorders: A Narrative Review

Rupal Jain, Mrunal Meshram, Unnati Shirbhate, Vidya Lohe, Neha Pankey

Cranberries (Vaccinium macrocarpon) contain polyphenols with antiviral, antibacterial, anti-inflammatory, and antioxidant properties, making them promising agents for the prevention of various health disorders. They often treat Urinary Tract Infections (UTI) by preventing bacterial notably filamentous E. coli, from adhering to uroepithelial cells. A new field called phytodentistry shows how people are becoming more interested in the use of natural substances like cranberry polyphenols, to improve oral health. This is because synthetic oral biocides are being phased out. After all, they cause resistance and unpleasant reactions. Cranberries have demonstrated potential efficacy in treating dental caries, periodontal diseases, precancerous conditions, oral cancer, and oral manifestations of systemic diseases such as renal disorders, cardiovascular diseases, and inflammatory bowel disorders. This is due to their antiviral, antifungal, and antibacterial activities and their anti-inflammatory properties. Although multiple in-vitro and animal studies have yielded encouraging results, more clinical trials are required to validate the efficacy of cranberries in these domains. The present review aimed to explore cranberries’ benefits in oral health and encourage further research into their role in preventing and managing oral diseases.

Hard-tissue and Soft-tissue Management for Implant Site Development: A Narrative Review

Muskan Aggarwal, Sheela Kumar Gujjari

Loss of teeth may occur due to various causes, such as periodontitis, dental caries, or trauma. The extraction of a single tooth or multiple teeth can lead to significant changes in both hard-tissues and soft-tissues. When a tooth is absent, the alveolar process undergoes resorption, which is more pronounced on the buccal aspect of the ridge. Tooth loss adversely affects aesthetics, phonetics, and function, thereby becoming a major concern for affected individuals. The goal of implant dentistry has gradually evolved from merely achieving successful osseointegration to attaining final restorative outcomes that closely resemble natural dentition and the surrounding oral tissues. Implant placement becomes challenging in areas with insufficient bone, and improper placement may result in significant functional and aesthetic compromises following prosthetic rehabilitation. Insufficient bone volume, height, or width is the most common clinical challenge in dental implant rehabilitation and is a clear indication for bone grafting to enhance bone availability. Implant placement should be prosthetically driven, aiming to restore the natural position of the tooth and promote a natural emergence profile from the surrounding soft-tissues. To achieve optimal aesthetics and function, hard-tissue augmentation, soft-tissue augmentation, or a combination of both may be required. The present review provides an overview of evidence-based procedures undertaken to preserve hard-tissues and soft-tissues for the successful outcome and long-term survival of dental implants.

Modern Perspectives on Fournier’s Gangrene: A Narrative Review of Surgical Advances, and Adjunctive Therapies

Ayush Gandhi, Pooja Batra, Bhagyesh Sapkale

Fournier’s Gangrene (FG) is a rare but rapidly progressive necrotising fasciitis of the perineal, genital, and perianal areas, more commonly occurring in older males with comorbidities such as diabetes mellitus and immunosuppression. This narrative review aims to define variations in the clinical presentation of FG, given its broader impact, and to highlight unresolved diagnostic challenges due to its non-specific initial presentation and specific atypical presentations in females. Aetiopathogenesis involves polymicrobial aerobic and anaerobic organisms synergistically infiltrating along fascial planes. Emerging literature notes a rare association between FG and Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors. A definitive treatment remains urgent surgical intervention for debridement, broad-spectrum intravenous antibiotics, and intensive supportive care. There are advanced therapies that may improve patient outcomes, such as Vacuum-Assisted Closure (VAC), Hyperbaric Oxygen Therapy (HBOT), negative-pressure wound therapy, and novel options in reconstructive surgery. These include reconstruction using gracilis muscle flaps or super-thin Anterolateral Thigh (ALT) flaps to improve functional and aesthetic results. This narrative review shows the importance of heightened clinical suspicion, particularly in the more aggressive form of necrotising fasciitis, the need for multidisciplinary care, and the incorporation of techniques in surgical practice and adjunctive therapy that may improve surgical outcomes for patients with FG.

Interleukin-18 an Emerging Player in the Age-related Macular Degeneration Treatment: A Narrative Review

Srashti Jain, Sachin Daigavane

The goal of this review was to investigate the role of chronic inflammation in age-related disorders, with a particular focus on the possible use of Interleukin-18 (IL-18) as an immunotherapy for Age-related Macular Degeneration (AMD). The literature has been extracted from numerous scientific databases, comprising PubMed, Scopus, WoS, Springer Nature, and Google Scholar, with an emphasis on English-language papers about IL-18 and AMD. Evidence shows that age-dependent modulation of proinflammatory cytokines like IL-1 and IL-18 connects the ageing process to inflammasome-mediated caspase-1 activation. IL-18, in particular, shows antiangiogenic characteristics in the retina, choroid, and cornea, indicating that it might be used as therapeutic role in preventing pathological neovascularisation in AMD. The review emphasises that, while IL-18 may be a potential immunotherapeutic drug, successful AMD care necessitates a multidisciplinary strategy that includes sophisticated diagnostic technologies and clinical skills.

Gene Therapy in Prosthetic Dentistry: A Narrative Review

Gene therapy is a promising emerging field in implant dentistry that aims to enhance osseointegration, bone regeneration, and soft-tissue repair around dental implants. By analysing methods of gene transport, current advancements in genetic modification techniques, and the clinical effects of gene therapy in implant dentistry, the present review highlights the revolutionary potential of gene therapy in improving the outcomes of dental implant prostheses. Accordingly, the present article reviews the challenges, potential applications, and future opportunities of gene therapy in implant dentistry. By analysing the methods of gene transport, advancements in genetic modification techniques, and the clinical effects of gene therapy, the present review illustrates the revolutionary potential of gene therapy in improving the outcomes of dental implant surgeries.

A Narrative Review on Multidimensional Modelling of Psychosis and Depression: Integrating In-vivo, Genetic and Computational Approaches

Sneha Ray, Swanand S Pathak, Barani Raj Selvarasu

Psychiatric illnesses such as psychosis and depression profoundly affect individuals’ functioning, quality of life and overall health. Psychosis most notably schizophrenia- afflicts approximately 0.3-0.7% of the global population and is associated with severe disability, cognitive decline and increased premature mortality. Major Depressive Disorder (MDD) is even more prevalent, affecting nearly one in four individuals worldwide. Despite their clinical differences, both conditions share dysregulated neurotransmitter pathways involving dopamine, serotonin and noradrenaline. Current treatments, including antipsychotics and antidepressants, offer only partial relief, with many patients experiencing delayed therapeutic onset, adverse effects, treatment resistance, or suboptimal response. These limitations underscore the urgent need for improved mechanistic understanding and more effective therapeutic strategies. The present review examines the contribution of preclinical in-vivo models to the study of the pathogenesis and treatment of psychosis and depression. Widely used behavioural paradigms such as the Open Field Test (OFT), prepulse inhibition, catalepsy bar test, amphetamine or apomorphine-induced stereotypy and Phencyclidine (PCP)-induced locomotor activity are evaluated for their ability to mimic key symptom domains. Genetic models, including the G72/G30 transgenic mouse and the extrapyramidal-primed monkey model, offer insights into gene-behaviour associations and the neurobiological underpinnings of antipsychotic side-effects. Complementing these, computational approaches such as Temporal Difference (TD) learning models provide systems-level perspectives on dopaminergic prediction errors and behavioural adaptation. The review highlights the pressing need for multidimensional, integrative frameworks that bridge molecular, behavioural, genetic and computational domains. Advancing such comprehensive models will improve translational relevance, enable identification of novel therapeutic targets and support the development of more precise and effective treatments for psychosis and depression.

Navigating Blunt Chest Trauma: A Narrative Review of Clinical Manifestations, Diagnostic Modalities and Management Strategies

Pankaj Katariya, Swati Deshpande, Mansi Nakum, Bhagyesh Sapkale, Amol Gupta

Blunt Chest Trauma (BCT) is an essential and often seen clinical entity in emergency and trauma surgical medicine, primarily associated with road traffic accidents, falls, and directs impacts during sports and warfare. BCT includes a variety of injuries (ranging from rib fractures, pulmonary contusion, pneumothorax, haemothorax, cardiac injury, and injuries that involve the great vessels). If these injuries can be recognised and treated rapidly, morbidity and mortality associated with BCT can be reduced. It is also essential to assess the advances in both conservative and surgical management, ranging from new minimally invasive endoscopic techniques to comprehensive treatment pathways. Early presentation, multidisciplinary team management, and establishing pathways based on high-quality evidence will lead to the best results. This narrative review examines the aetiology, mechanisms, classification, clinical features, and the role of imaging and modern biomarker technology in the diagnosis of BCT.

Modern Paradigms in Sepsis Management: A Journey from Recognition to Personalisation: A Narrative Review

Dhwani Sheth, Neeta Verma, Amreesh Paul, Shafaque Maqusood, Saurav Shah

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a major global health concern, particularly in intensive care settings. Despite advances in medical science, it continues to be one of the leading causes of mortality and long-term morbidity worldwide. The present review highlights recent advances in sepsis diagnosis and treatment, ranging from early detection strategies and personalised therapies to emerging therapeutic interventions. Early and accurate diagnosis is central to successful sepsis management. The introduction of advanced biomarkers such as Procalcitonin (PCT) and Interleukins (ILs), along with Artificial Intelligence (AI) and machine learning platforms, has significantly enhanced early recognition and risk stratification. Point-of-care testing and rapid diagnostic technologies now allow for prompt pathogen identification and antimicrobial resistance profiling, facilitating timely and targeted intervention. Haemodynamic monitoring has also evolved, with goal-directed fluid resuscitation and vasopressor therapy guided by dynamic physiological parameters. Novel vasopressors and adjunctive treatments are under investigation to optimise tissue perfusion while minimising organ injury. Antimicrobial stewardship has gained increasing importance, with emphasis on early pathogen detection, resistance characterisation, and individualised antibiotic dosing to curb the emergence of multidrug-resistant organisms. Immunomodulatory therapies, including corticosteroids, cytokine modulators, and emerging monoclonal antibodies, are being explored to restore immune balance. Extracorporeal organ support technologies have improved survival in refractory cases, while advances in managing sepsis-induced coagulopathy have strengthened supportive care strategies. Furthermore, genomic and proteomic tools are enabling personalised therapeutic approaches, revolutionising precision medicine in sepsis care. Nanotechnology also holds promise for developing novel diagnostic platforms and targeted drug delivery systems. Collectively, these innovations represent a paradigm shift toward timely, patient-centred, and precision-based sepsis management. Continued research and clinical implementation are essential to maximise their benefits and reduce the global burden of this complex syndrome. The present review uniquely integrates emerging precision-based strategies, advanced diagnostics, AI-driven tools, and individualised therapies to demonstrate how novel technologies are reshaping sepsis diagnosis, treatment, and outcomes.

Distribution of Groin Injury Subtypes in Football Players: A Narrative Review

Groin injury accounts for 3-31% of all sport related injuries, frequently affecting field athletes and football players, where repetitive kicking, side-to-side movement, and twisting impose high mechanical demands such as in soccer and American football. This review aimed to determine the distribution of different subtypes of groin injury in football players using the standardised terminology and anatomical classification systems. A comprehensive search was conducted across PubMed, British Journal of Sports Medicine (BJSM), Sage Journals, ResearchGate, and Google Scholar, following, covering studies published up to December 2024. The search included studies focusing on distribution of groin injury subtypes among football players. Eligible studies included football players novices to experts, sex and age group, articles investigating the distribution of different subtypes of groin injury using standardised terminology and anatomical classification systems, and were published in English. Two independent reviewers screened and extracted data. Of 1,245 studies identified, 11 met the inclusion criteria, encompassing 4,226 groin injuries. 2,476 (58.58%) were adductor-related injuries, which were most prevalent, subsequent to iliopsoas-related injuries, n=635 (15.02%). The remaining injuries n=1176 (27.82%) were attributed to other anatomical regions, including inguinal, pubic, and hip-related injuries, often underreported (Total injury location exceed total number of injuries due to multiple location injuries per player). Common risk factors included high training loads, insufficient recovery, previous groin injuries, and muscular imbalances. Based on current findings adductor-related injuries dominate groin pathology in football, followed by iliopsoas but other categories remain underreported. These results emphasise the need for standardised diagnostic criteria to improve injury classification and reporting. Broader adoption of standardised terminology and improved preventive interventions are essential for advancing clinical management and reducing injury burden. Future research should aim at refining diagnostic criteria and developing targeted preventive interventions.

Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices: Enhancing Safety and Standardising Practices

KR Meghavarshini, Vimal Raj, Richa Kothari, Suraj Gowda, Dilip A Reddy

MRI has evolved as an indispensable and multifaceted diagnostic tool in radiology since its introduction in the 1980s (1). Technological advancements have expanded its applications in diagnosis and treatment planning, significantly improving clinical outcomes. CIEDs, such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronisation therapy devices, are widely used for treating arrhythmias (2).

Co-occurrence of Severe Pulmonary Stenosis and Pelvi-ureteric Junction Obstruction in a Neonate: A Case Report

Raghu Yeluri, S Jagadeeswari, MG Ravanagomagan

Severe Pulmonary Stenosis (PS) in neonates is a critical congenital cardiac condition that may initially present with subtle or no clinical signs. When coexisting with antenatal hydronephrosis, the clinical picture becomes more complex and may obscure the underlying pathophysiology. The present report describes a full-term male neonate born to consanguineous parents who was antenatally diagnosed with left-sided hydronephrosis and postnatally found to have a grade 3 pansystolic murmur. Echocardiography revealed severe PS with a pressure gradient of 89 mmHg. A successful Balloon Pulmonary Valvotomy (BPV) was performed, and the hydronephrosis was managed conservatively. The present case is unique as it highlights the uncommon co-occurrence of dual-organ anomalies-critical congenital heart disease and renal outflow obstruction-in a stable neonate with no overt symptoms at birth. The consanguineous background raised suspicion of a possible genetic association, necessitating genetic counselling for the family. Management required timely multidisciplinary intervention involving neonatology, paediatric cardiology, and nephrology, ensuring a favourable outcome. Vigilant neonatal examination, early recognition of subtle signs, and coordinated care are essential in managing infants with multiple congenital anomalies. The present case underscores the importance of considering genetic evaluation, long-term follow-up, and counselling in similar scenarios.

Recurrent Phyllodes Tumour in a Young Woman 15 Years after Initial Excision: A Case Report

Phyllodes tumours are rare fibroepithelial neoplasms of the breast, accounting for <1% of all breast tumours. These tumours exhibit variable biological behaviour, ranging from benign to malignant, with a high potential for recurrence. Early identification and complete surgical excision are crucial in preventing regrowth and malignant transformation. A 28-year-old female presented with a rapidly enlarging right breast lump one week postpartum following a caesarean section for a Dichorionic-Diamniotic (DCDA) twin pregnancy. She stated that she had a similar breast lump in adolescence (at the age of 13), which had been surgically removed. Imaging studies suggested a phyllodes tumour, including Ultrasound (USG), Magnetic Resonance Imaging (MRI), and MR Spectroscopy (MRS). The patient underwent a wide local excision, and histopathology confirmed a recurrent phyllodes tumour. The patient had an uneventful postoperative recovery and was advised on long-term monitoring due to the risk of recurrence. This case underscores the need for recognising phyllode tumours as a differential diagnosis in recurrent breast lumps. Given their potential for regrowth even after long intervals, close follow-up with imaging is essential for early detection and intervention. Surgical excision with adequate margins remains the mainstay of treatment to minimise recurrence risk.

History of Anaesthetics Drugs and Evolution of Anaesthesiology: A Comprehensive Review

D Venkata Naga Sai Krishna Sanka, Vivek Chakole, Shyamolima Bhuyan

Anaesthesia is the loss of sensation partially or totally with or without loss of consciousness. It has been estimated that its origins lie in ancient civilisations, where such natural substances as opium and mandrake were employed to alleviate pain. The 19th century marked the start of the scientific age of anaesthesia following the discovery of gases such as nitrous oxide and ether. That discipline has now developed into anaesthesiology - a multidisciplinary, complex speciality encompassing pharmacology, physiology and perioperative care of patients, including surgery, critical care and pain management. The history of anaesthetics is one of sheer wonder, awe and amazement as to how the simple sedative herbs of the ancient civilisations have given way to the highly advanced drugs and methods of the modern medical world. The ancient societies used opium and mandrake, which are natural substances, to alleviate pain during operations. The 18th and 19th centuries provided the scientific basis for anaesthesia when nitrous oxide, ether and chloroform were discovered, making it possible to have painless surgeries. The 20th century saw safer inhalational agents, local anaesthetics, intravenous drugs and muscle relaxants as well as improved patient monitoring systems. The history of anaesthetics and anaesthesiology is one of the greatest developments in the field of medicine. Anaesthesia has transformed patient care and surgery practice; from agonising surgical operations to risk-free and pain-free interventions. This review is the only one to cover the timeline of anaesthetic drugs and the timeline of the anaesthesiology as a medical specialty. Through the combination of historical landmarks, pharmacological developments and technological innovations, the study offers a broad look at how the contemporary anaesthetic practice developed out of the primitive experimental methods. This paper draws attention to the ongoing interaction between drug development, clinical practice, and patient safety unlike other works that emphasise isolated discoveries and provides a comprehensive picture of the evolutionary process anaesthesiology is going through.

Comparison of Krushna Jeerakadi Yoga (Lotion) and Mrudvikadi Lotion for Mukhapaka (stomatitis) in Children: A Randomised Intervention-al Study Protocol

Parag Rajendra Bodke, Rahul M Jumle, Sonam Kanzode, Tushar Nadanwar

Introduction: The oral cavity is one of the most vital components of the human body, playing a key role in digestion and communication. Stomatitis (Mukhapaka) is a common inflammatory condition of the oral mucosa frequently encountered in the paediatric population. It is characterised by symptoms such as pain, ulceration, and excessive salivation, which often interfere with daily activities such as eating and speaking. In Ayurveda, this condition is associated with the vitiation of Pitta and Kapha doshas. Need of the study: Due to contemporary dietary habits, irregular meal timings, night-time wakefulness, and improper oral hygiene practices, children are increasingly prone to inflammatory oral disorders. Although modern medicine utilises antibiotics and anti-inflammatory drugs for treatment, there remains a need for an affordable, safe, and effective Ayurvedic therapeutic approach. Classical Ayurvedic texts mention Krushna Jeerakadi Yoga and Mrudvikadi Lotion as effective treatments; however, their relative efficacy has not yet been established through clinical trials. Aim: To assess the comparative effectiveness of an altered dosage form of Krushna Jeerakadi Yoga (Lotion) and Mrudvikadi Lotion in paediatric patients suffering from Mukhapaka (Stomatitis). Material and Methods: The present study will be a randomised controlled interventional clinical scheduled to be conducted from June 2025 to June 2026 involving 60 children aged 5-16 years diagnosed with Mukhapaka. Participants will be randomly divided into two groups of 30 each. Group A will receive Mrudvikadi Lotion (control group), while Group B will receive the altered dosage form of Krushna Jeerakadi Yoga Lotion (trial group) for seven days. Clinical evaluation will be conducted on the 3^rd, 5^th, and 7^th days, with a final assessment on the 14^th day. Outcomes will be measured using the World Health Organisation (WHO) Stomatitis (oral mucositis) Grading Scale along with symptom-relief parameters.

Correspondence: Medication Adherence and its Association with Treatment Satisfaction and Diabetes-Related Psychological Distress among Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study from Rural Thiruvallur District, India

AH Irfaunul Azees

This is the letter in response to the issue highlighted in the above article published in Volume 19, Issue 8, pp. LC08-LC13.