Journal of clinical and diagnostic research

Brass Metal Cookware Associated Lead Poisoning Presenting as Recurrent Abdominal Pain: A Case Report

Lead is known to exert toxic effects on nearly all tissues and organ systems, with the nervous, gastrointestinal, and haematopoietic systems being particularly vulnerable. In humans, lead interferes with haemoglobin synthesis, leading to anaemia, and its disruption of porphyrin metabolism can trigger abdominal pain due to vasospasm. Cases due to lead poisoning are an uncommon presentation in healthcare facilities and often overlooked as a cause of anaemia and abdominal pain. Although occupational exposure remains a well-established source of lead poisoning, non-occupational factors, such as the use of metal cookware, are gaining importance as potential contributors in daily life. We report a case of a 48-year-old man presenting with a two-month history of crampy abdominal pain, fatigue, and constipation. After a detailed history and physical examination, other possible causes were excluded and revealed his recent use of a new cookware to ferment rice. Subsequent testing showed an elevated blood lead level of 87.2 μg/dL. The patient recovered after chelation therapy. Lead poisoning can cause nonspecific symptoms like abdominal pain, anaemia, and neuropathy, often leading to misdiagnosis. Delayed diagnosis may result in irreversible harm. It should be considered in emergency cases of unexplained abdominal pain after ruling out common causes. This case highlights the importance of paying attention to subtle, often overlooked aspects of a patient’s daily routine. Maintaining a broad differential diagnosis and asking targeted questions can be crucial in identifying uncommon causes and achieving a timely, potentially life-saving diagnosis.

Isolated Tonsillar Tuberculosis Masquerading as Malignancy: A Rare Extrapulmonary Presentation

Sahasyaa Adalarasan, Vinod Kumar

Tuberculosis (TB) is a bacterial infection caused by the bacilli, Mycobacterium Tuberculosis (MTB). While it primarily affects the lungs, various other organs like the lymph nodes, pleura, and peritoneum can be involved in Extrapulmonary Tuberculosis (EPTB). Involvement of the tonsils, however, is extremely rare, even in a TB-endemic country like India. Tonsillar TB may occur secondary to pulmonary infection through lymphatic or haematogenous dissemination, and its presentation often mimics malignancy (fever, loss of weight). This case report contains a case of a 56-year-old male patient who presented with progressive dysphagia, significant weight loss, low-grade fever, and cervical lymphadenopathy. Clinical examination revealed a unilateral tonsillar enlargement with firm neck nodes, initially raising a strong suspicion of malignancy. Routine blood investigations were normal, and a diagnostic tonsillectomy was performed, whose histopathological examination revealed granulomatous inflammation with caseous necrosis. The diagnosis was then confirmed by microbiological evidence of MTB. The novelty of this case report lies in the isolated tonsillar involvement without active pulmonary disease, its close clinical resemblance to malignancy, and the diagnostic challenge involved. Early recognition and accurate diagnosis are crucial for initiating appropriate therapy and preventing transmission.

Integrating High-Intensity Laser Therapy with Exercise Regimen for Impingement Syndrome: A Case Report

Maheshkumar Baladaniya, Shraddha Baldania

“Subacromial Impingement Syndrome (SAIS)” refers to conditions disrupting the balance between structural rigidity and soft tissue inflammation, leading to irritation in the subacromial space, primarily affecting the rotator cuff and bursa. High-Intensity Laser Therapy (HILT) is a non-invasive, painless treatment that increases mobility and stimulates deeper tissues. It can be used with anti-inflammatory and analgesic effects. In the present case report, a 62-year-old woman reported with right shoulder pain and limited motion for four months. Clinical metrics included a Pain Disability Index (PDI) score of 36, a Shoulder Pain and Disability Index (SPADI) score of 69%, and a Shoulder Function Index (SFInX) of 40, suggesting impingement syndrome. A high-intensity laser was applied to the site. The exercise regimen included posture improvement, pectoral and trapezius stretching, shoulder Range of Motion (ROM) exercises, gentle stretches, and finger stair exercises over four weeks. At treatment's end, significant functional improvements were noted, including reduced pain, increased ROM, and enhanced muscle strength.

New Horizons in Physiotherapy for Spinal Muscular Atrophy (SMA) Type 1 in the Era of Disease-modifying Treatments: A Case Report

Vidhi Hitesh Doshi, Kirta Haresh Melwani, Dipali Suvarna, Varsha Solanki

Spinal Muscular Atrophy (SMA) type 1 is a severe autosomal recessive neuromuscular disorder caused by SMN1 gene mutations, leading to progressive muscle weakness and respiratory compromise. Without intervention, affected infants can rarely sit independently or live beyond two years of age. The advent of disease-modifying therapies and the timely implementation of physiotherapy have changed the disease trajectory and helped in increased survival. This report describes a two-year and five-month-old female child with genetically confirmed SMA type 1 on disease modifying treatment and regular physiotherapy who achieved independent sitting - an uncommon milestone for this phenotype. During hospitalisation for bronchopneumonia at a tertiary care hospital, physiotherapy was continued with chest physiotherapy and truncal activation exercises, progressing to functional strengthening and postural control activities. Functional gains were documented using the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and the Revised Hammersmith Scale for Spinal Muscular Atrophy (RHS-SMA). This case underscores the vital role of structured physiotherapy in translating pharmacological advances into meaningful functional recovery in children with SMA type 1.

Diagnostic Challenge and Management Dilemma of William Syndrome: A Case Report

Neha Pruthi, Neha Yadav, Dinkar Yadav, Kapil Bhalla, Neeraj Kumar

Facial dysmorphism can be a manifestation of different congenital syndromes. However, diagnosing them remains a challenge. William syndrome is a relatively rare genetic multi-system disorder occurring due to a microdeletion on the chromosomal locus 7q11.23. Herein, a case of a 13-year-old child is being reported, who presented with complaints of delayed attainment of developmental milestones, syndromic facies, intellectual delay, poor scholastic performance and unclear speech. Fluorescent In-Situ Hybridisation (FISH) confirmed the diagnosis. Treatment was started with a multidisciplinary approach, including behavioural counselling, genetic counselling, occupational therapy and treating the electrolyte disturbances. After detailed counselling and discussion with the parents as well as the child, the child is doing fine and improving in various domains of life. The quality of life of the child seems to be improving. Uniquely, this child had persistent learning difficulties with an IQ score of 73.8, mild corpus callosum stenosis on Magnetic Resonance Imaging (MRI), and a rare finding of transient asymptomatic hypercalcaemia (14.3 mg/dL) in adolescence, which is most reported in infancy. The child had no cardiovascular involvement, such as supravalvular aortic stenosis, which is typically seen in 70-80% of cases. This case underscores the expanding neurodevelopmental and biochemical phenotype of Williams syndrome. Recent studies also stress the role of early neuropsychological assessments, ongoing cardiac surveillance and individualised learning strategies for long-term outcomes.

Urinary Bladder Diverticulum Presenting as a Palpable Abdominal Mass in a Neonate: A Case Report

R Sivaranjani, MG Ravanagomagan, S Jagadeeswari

Congenital Bladder Diverticulum (CBD) is a rare neonatal anomaly that typically presents with urinary tract infections, haematuria, or voiding dysfunction. However, it can occasionally present as an abdominal or suprapubic mass, which is an uncommon manifestation in the absence of urinary symptoms. This case report describes a full-term female neonate born at 39 weeks whose antenatal ultrasound revealed an abdominopelvic cyst. Postnatal MRI demonstrated a large, wide-necked diverticulum (3.3×3.9×2.8 cm) arising from the right superolateral wall of the bladder, extending into the right iliac fossa. The infant remained asymptomatic with respect to urinary symptoms, with normal urine output and no infection. Conservative management was undertaken, involving regular ultrasonographic monitoring and a planned Micturating Cystourethrogram (MCU). Over a six-month follow-up period, there was no increase in the size of the diverticulum, no evidence of vesicoureteral reflux, and preserved renal function. This case report underscores that in neonates, bladder diverticulum can present as a cystic abdominal mass even in the absence of classic urinary signs. Early anatomical imaging and longitudinal follow-up are crucial for identifying potential complications and guiding appropriate management. This case highlights the importance of considering congenital bladder anomalies in the differential diagnosis of neonatal abdominal cysts, even when urinary symptoms are absent.

Non-surgical Management of Splenic Volvulus and Infarction of Ectopic Spleen in an Adult Female: A Case Report

Ectopic spleen, or Wandering Spleen (WS), is a rare condition caused by laxity of splenic suspensory ligaments. While often asymptomatic, it may present with life-threatening complications such as torsion and infarction. We present a case of a 41-year-old female with a history of breast cancer who developed left-sided abdominal pain. Imaging confirmed an ectopic spleen in the pelvis resting on the urinary bladder, receiving its blood supply from the coeliac trunk. Computed Tomography (CT) also showed a well-demarcated area of non-enhancement at its inferior pole, along with twisting of the vascular pedicle associated with surrounding free fluid representing splenic volvulus and infarction. Enoxaparin 72 mg SQ BID was initiated for concurrent splenic vein thrombosis, and the patient was discharged on Rivaroxaban 20 mg PO OD. Over 16 months, serial imaging showed resolution of infarction and maintained splenic vascularity without surgical intervention. This case demonstrates that conservative management of WS with infarction may be viable with close monitoring and anticoagulation.

Hybrid Airway Management in an Elderly Patient with Chronic Kidney Disease on Maintenance Haemodialysis undergoing Lower Limb Orthopaedic Surgery: A Case Report

Swati Lahiri, Patmos Warjri, Snigdha Datta, Rajdeep Chatterjee

Chronic Kidney Disease (CKD) is defined as kidney damage leading to a decline in Glomerular Filtration Rate (GFR) for three or more months. CKD affects multiple organ systems and poses significant perioperative risks due to impaired sodium and water excretion, fluid overload, pulmonary complications, cardiovascular dysfunction, electrolyte imbalance, and neurological manifestations. Perioperatively, patients with CKD exhibit increased incidences of hypotension, arrhythmias, pulmonary oedema, sepsis, and need for vasopressors or mechanical ventilation, resulting in markedly elevated morbidity and Intensive Care Unit (ICU) mortality compared to non CKD individuals. This case report describes a 69-year-old hypertensive male with End-Stage Renal Disease (ESRD) on haemodialysis, who presented with a right femoral neck fracture for hemiarthroplasty. His medical history included hypertension, CKD stage V, prior bladder carcinoma treated with intravesical Bacillus Calmette-Guérin, and recent deranged renal function requiring intensive dialysis. Preoperative evaluation revealed American Society of Anaesthesiologists-Physical Status (ASA-PS) class IV, Mallampati grade III with restricted neck movement and oral fibrosis, anaemia, electrolyte imbalance, and preserved left ventricular systolic function with diastolic dysfunction. General anaesthesia was induced with thiopentone, fentanyl, and midazolam. Initial airway management using a Guedel’s airway was ineffective; oxygenation was subsequently secured with a second-generation supraglottic device, followed by successful intubation using a McCoy laryngoscope after administration of rocuronium. The patient was extubated on postoperative day 2 in critical care unit and later shifted to the ward after receiving 2 units of blood transfusion and 2 cycles of haemodialysis. This case highlights the anaesthetic challenges in ESRD patients with difficult airways and multiple co-morbidities, emphasising the need for careful planning and multidisciplinary management.

Chronic Inflammatory Tongue Lesion in an Elderly Immunocompromised Female with Familial Predisposition: A Case Report

Anoushka Sidhwa, Utkarsh Gaur

Tongue lesions are often quite difficult to diagnose. This is especially true in older adults and those with weakened immune systems because such lesions can be even more difficult and can even seem to be premalignant and/or infectious lesions. They can be caused by immune and/or nutritional dysregulation, as well as by more systemic illnesses. This report describes a 71-year-old female with Chronic Lymphocytic Leukaemia (CLL) and autoimmune arthritis who presented with a persistent, painful ulcerative lesion on the mid-dorsal surface of the tongue. The lesion had been present for six months and was associated with occasional spontaneous bleeding. Comprehensive clinical, haematologic, and radiologic evaluation ruled out fungal infection and malignancy. Histopathology revealed epithelial atrophy with subepithelial inflammatory infiltrate, consistent with a benign chronic inflammatory process. Also, remarkable was the family background of this patient, as her mother suffered an undiagnosed condition for many years and her brother had a fissured tongue, or a tongue with deep grooves, but had no symptoms of any disease, which could point to a possible hereditary condition in that family. The patient was diagnosed and managed conservatively with a mouthwash with benzydamine, mucopain, and vitamin A and multivitamin supplements, which improved the ulcer by 90% in the eight weeks and complete symptom resolution on follow-up at 12 weeks. This case underscores the importance of a systematic, multidisciplinary approach in evaluating chronic tongue lesions in immunocompromised individuals. Early recognition of benign inflammatory patterns can prevent unnecessary invasive investigations and patient anxiety. The co-existence of autoimmune and haematologic disorders, along with familial occurrence, further highlights the multifactorial nature of such lesions and their relevance in oral medicine practice.

Tailored Sedation for Oesophageal Dilatation in Goldenhar Syndrome: Avoiding Airway Instrumentation with High-flow Nasal Cannula (HFNC) Support

Payodhi Modi, Sanjot Ninave, Angan Ghosh

Goldenhar syndrome, or oculo-auriculo-vertebral spectrum, is a rare congenital anomaly involving craniofacial dysmorphia, vertebral deformity, and atypical outer ear, and is classically complicated by challenging airway management. In this case report, the anaesthetic management of a nine-year-old male with Goldenhar syndrome who also had a recurrent benign oesophageal stricture with odynophagia has been described. The patient also had many previous oesophageal dilatations and had generalised anatomical deformities such as asymmetrical facial deformity, mandibular hypoplasia, absent pinnae, scoliosis, and tracheal shift. Due to the presence of extremely high-risk airway complications, sedation was the procedure of choice without general anaesthesia. Intravenous sedation by ketamine, fentanyl, and midazolam was employed for the procedural sedation, and the maintenance of adequate ventilation as well as oxygenation during the procedure was with a High-Flow Nasal Cannula (HFNC). The anaesthetic team had a difficult airway cart and rescue airway devices on hand, even though invasive airway management was not employed. The procedure proceeded successfully with stable haemodynamics and satisfactory spontaneous ventilation. This case sets an example of the need for individualised anaesthetic planning, appropriate use of sedation, and the value of HFNC in the management of syndromic children with difficult airways.

Spinal Epidural Abscess Unmasking Streptococcus Gallolyticus Endocarditis: A Rare but Treatable Entity

Cherisha Selvaraj, Rangaramanujanaidu, N Vasanthi

Infective Endocarditis (IE) is a microbial infection of the endocardial surface of the heart, most often involving the cardiac valves, leading to the formation of vegetations composed of organisms and inflammatory debris. While many patients with IE experience joint, muscle and back pain, actual infections at these sites are uncommon. Spinal abscess formation represents an uncommon yet clinically significant complication seen in patients with IE. Among these various spinal locations, involvement of the lumbar region is particularly rare. When it does occur, it typically results from haematogenous spread of infecting microorganisms from the cardiac vegetation to the vertebral or epidural spaces. These abscesses may present with back pain, neurological deficits or signs of systemic infection, making early recognition and treatment crucial to prevent serious outcomes. Although surgical intervention is typically the mainstay of therapy for spinal abscesses, conservative management can still be considered and prove to be effective in selected cases. We present a case of a 52-year-old gentleman with complaints of low back pain over a duration of three months, who, on Magnetic Resonance Imaging (MRI) was diagnosed to have a lumbar epidural abscess caused by Streptococcus gallolyticus endocarditis. He was subsequently treated with an 8-week course of intravenous antibiotics. This case highlights the importance of considering spinal epidural abscess as a potential complication in patients with bacterial endocarditis, thereby underscoring the critical need to include spinal epidural abscess in the differential diagnosis when evaluating patients with bacterial endocarditis who develop new or unexplained spinal symptoms.

Effective Management of Tinea Cruris using Ayurvedic Remedies: A Case Report

Vivek Goswami, Punam Sawarkar, Shweta Parwe, Gaurav Sawarkar, Mahima Dubey

Tinea cruris, or jock itch, is a fungal infection of the groin area caused by fungi belonging to the genera Trichophyton, Epidermophyton, and Microsporum. It presents with intense itching, red scaly patches, and rashes that may extend from the groin to the thighs. In severe cases, blisters or pustules can form. This condition is common in warm, humid climates and often affects athletes, obese individuals, and those who sweat excessively. The major external covering of the body, the skin, is primarily affected by fungal infections. In Ayurveda, skin fungal infections are termed Kshudra Kushtha (minor skin diseases), which clinically resemble the symptoms of tinea cruris. In the present case study, a 45-year-old male patient presented with symptoms including itching in the lumbar and peripheral back region, piercing pain, burning sensation, and discoloration with redness of the skin. He was treated with Panchakarma procedures, including Haridradigana medicated enema, and oral Ayurvedic medications for antifungal palliative care, including Aryogyavardhini Vati, Gandhak Rasayana, Avipattikar Churna, Krumikuthar Rasa, and Chandraprabha Vati. After 14 days of treatment, the patient was assessed using a symptomatic assessment scale. Tinea cruris was successfully treated using this specific combination of detoxification and palliative treatment in Ayurveda. Further clinical trials with larger sample sizes are warranted to validate these findings.

Synchronous Mesonephric-like Adenocarcinoma and Endometrioid Borderline Tumour in Bilateral Ovaries: A Case Report

Pritam Ray, Amit Mandal, Devmalya Banerjee, Sugat Sanyal

Mesonephric Like Adenocarcinoma (MLA) is a rare aggressive carcinoma recognised in the 2020 WHO classification, with fewer than 200 cases reported worldwide. It shows KRAS mutations in 70-81% of cases, a strong association with endometriosis (50-70%), and a characteristic immunoprofile (PAX8+, TTF1+, GATA3 patchy+, ER-, WT1-). The histogenesis of MLA is increasingly linked to Müllerian epithelium, often in association with endometriosis. The coexistence of an MLA and an endometrioid borderline tumour within bilateral ovaries is exceedingly rare and provides further evidence of divergent Müllerian differentiation. This is a case report of a 45-year-old nulliparous woman presenting with abdominal pain and bilateral ovarian masses. Preoperative serum Carcinoembryonic Antigen (CA)-125 was 455 U/mL and CA 19-9 was 346 U/mL. Intraoperative frozen section of the left ovarian mass indicated an epithelial malignancy. Permanent section analysis confirmed MLA in the left ovary (PAX8+, TTF1 strong+, GATA3 patchy+, ER–, WT1–, wild-type p53). The right ovary harbored an endometrioid borderline tumour (PAX8+, ER+, TTF1–, GATA3–, wild-type p53). Endometriosis was concurrently identified in both ovaries and fallopian tubes. The patient underwent complete staging surgery followed by chemotherapy and remains clinically and radiologically disease-free at the time of reporting. This case highlights the critical role of comprehensive immunohistochemical profiling in the precise diagnosis of rare ovarian tumours and provides further evidence supporting a Müllerian origin for MLA.

Medial Canthal Haemangioma Mimicking a Dermoid Cyst: A Diagnostic Challenge

G Karthika, MK Rajasekar

Haemangiomas are benign vascular neoplasms typically diagnosed in infants and rarely seen in adults. Their occurrence in the medial canthal region is particularly uncommon and may clinically mimic more frequent benign lesions such as dermoid cysts. This is a rare case of an adult-onset medial canthal capillary haemangioma that was initially misdiagnosed as a dermoid cyst, emphasising the diagnostic challenge posed by such presentations. A 46-year-old female presented with a 10-year history of a painless, slowly progressive swelling over the right medial canthus. The lesion was soft, mobile, non-tender, and measured approximately 0.5×0.5 cm, without associated visual disturbances or discharge. Based on clinical examination, a provisional diagnosis of dermoid cyst was made. The lesion was surgically excised under local anaesthesia, revealing a well-circumscribed, encapsulated soft mass. Histopathological analysis demonstrated proliferation of capillary-sized blood vessels lined by flattened endothelial cells within a fibrous stroma, confirming the diagnosis of capillary haemangioma. The postoperative period was uneventful, and no recurrence was noted at three months follow-up. Adult-onset periorbital haemangiomas are extremely rare, with few cases documented in the literature. Their clinical presentation frequently overlaps with dermoid cysts due to similar location, consistency, and benign nature. Misdiagnosis is therefore common, highlighting the need for a high index of suspicion. Unlike infantile haemangiomas, adult variants do not undergo spontaneous involution and often require surgical excision for definitive management. This case underlines the importance of considering vascular tumours in the differential diagnosis of long-standing periorbital swellings in adults. Accurate diagnosis through histopathological confirmation is essential to avoid mismanagement and contributes to the limited existing literature on this rare clinical entity.

Nasopharyngeal Carcinoma: A Case of Delayed Diagnosis with Favourable Outcome

Shaheera Tarnoom, MK Rajasekar

Nasopharyngeal Carcinoma (NPC) often presents with subtle, non-specific otological or neurological symptoms that can mimic common benign conditions, leading to significant diagnostic delay. This case report describes a 50-year-old male who presented with a six-month history of right-sided headache and two-month progressive hearing loss, and was repeatedly managed as otomastoiditis and trigeminal neuralgia at multiple clinics. Despite various imaging findings suggestive of middle ear pathology, persistent unilateral symptoms prompted a diagnostic nasal endoscopy at the presenting hospital, which revealed a suspicious nasopharyngeal lesion. Histopathology confirmed non-keratinising undifferentiated NPC (T2bN0M0, Stage II). The patient underwent coblation-assisted biopsy, grommet insertion, and subsequently received definitive chemoradiotherapy with excellent therapeutic response on follow-up. This case highlights the clinical challenge of diagnosing NPC in non-endemic settings and underscores the importance of early nasopharyngeal evaluation in patients with unexplained unilateral otitis media with effusion, cranial nerve symptoms, or atypical headache. Prompt recognition and multidisciplinary management can significantly improve outcomes even in cases with delayed diagnosis.

An Unusual Synchrony of Bowen’s Disease and Merkel Cell Carcinoma: A Case Report

Kewecho Akami, Neikhrietsonuo Kesiezie, Deepak Kharb, Moameren, Visar Linyu

Bowen’s Disease (BD), recognised as Squamous Cell Carcinoma (SCC) in situ, typically affects older individuals and postmenopausal women, whereas Merkel Cell Carcinoma (MCC) is an aggressive neuroendocrine skin malignancy with a predilection for elderly white males. This case report delves into the unique convergence of BD and MCC in a 45-year-old woman, presenting as BD in the left breast and arm, coupled with MCC in the left wrist with metastasis to the left axilla. The patient was treated with wide local excision of the breast and arm lesions, coupled with en masse clearance of the left axilla due to metastatic MCC. This unique case underscores the intricate interplay between different cutaneous malignancies, emphasising the need for continued research to unravel the underlying mechanisms and optimise therapeutic strategies in rare and challenging dermatological presentations.

Erythema Induratum a Forgotten Tuberculid or an Evolving Entity: A Case Report

S Gayathri, A Sakthi Megalai, C Balakumaran, M Kavya Prabha

Erythema induratum, also known as Bazin’s disease, is a rare, chronic inflammatory disorder of the subcutaneous fat. It affects both sexes but occurs predominantly in middle-aged women. Erythema induratum of Bazin is classified under cutaneous tuberculosis. Present case is of a 49-year-old male with recurrent, multiple discharging nodules on both lower legs, with spontaneous resolution of some lesions. Histopathological examination revealed mixed panniculitis with evolving granulomas composed of epithelioid cells and lymphocytes. Both the Mantoux test and the Interferon Gamma Release Assay (IGRA) were positive. Based on the clinical presentation and histopathological findings, a diagnosis of tuberculosis-associated erythema induratum was made, and the patient was started on Antitubercular Therapy (ATT).

A Rare Case of Ovarian Dysgerminoma with Torsion in Pregnancy

Early identification of the clinical and imaging characteristics of ovarian dysgerminoma is crucial for prompt care of this rare malignant germ cell tumour, which primarily affects young women and adolescents. We describe the case of a young woman who experienced sporadic lower stomach discomfort and secondary amenorrhoea for three months. A large, multilobulated, solid-cystic mass originating from the right adnexal region with prominent internal septations and moderate post-contrast enhancement was seen on Contrast-Enhanced Magnetic Resonance Imaging (CE-MRI) of the pelvis following clinical evaluation and initial laboratory investigations. However, there was no evidence of ascites or metastatic spread. With dysgerminoma as the primary differential, these imaging features clearly supported a malignant germ cell tumour. Histopathology verified the diagnosis of ovarian dysgerminoma after the patient had surgical exploration and lump excision. Although ovarian tumours in pregnancy are uncommon, dysgerminoma in pregnancy is extremely rare, emphasising the importance of maintaining a high level of suspicion in reproductive-age women presenting with adnexal masses.

An Ayurvedic Approach in Management of Polycystic Ovary Disease: A Case Report

Vaishali Bhanushankar Dave, Rita Makkim, SN Gupta, Hemant Toshikane

Polycystic Ovary Disease (PCOD) is characterised by a set of symptoms, including signs of hyperandrogenism (either clinical or biochemical), chronic anovulation (irregular or absent ovulation), and the presence of polycystic ovaries. Many cases also involve insulin resistance and obesity. It is a hormonal disorder that can significantly impact mental health. Individuals with PCOS often struggle with body image issues due to physical symptoms like weight gain and skin problems, leading to increased anxiety and depression. The stress of managing these challenges, particularly concerns about fertility, can exacerbate emotional distress. It is vital to address comprehensive care and improve the overall quality of life for those affected. In contemporary medicine, oral contraceptive pills are commonly used; however, they can have various side-effects with prolonged use. While these medications are effective for temporary relief, they do not provide a cure for underlying conditions. In this case, a 24-year-old woman presented with irregular menstruation, weight gain, and facial acne. After assessing her symptoms, conducting an Ultrasonography (USG), and analysing her blood hormone profile, she was diagnosed with PCOD. The treatment focused on managing Artavkshaya (hypomenorrhoea or oligomenorrhoea). Vaman karma (emesis therapy) was started on the sixth day of her menstrual cycle, followed by oral medications. Observations such as the duration and frequency of the menstrual cycle, as well as USG data showing the number of follicles and ovarian volume before and two months after treatment, yielded highly significant results. Thus, Vaman karma (emesis therapy) combined with oral medications appears to be an effective treatment strategy for polycystic ovarian disease.

Unique Presentation of Colpocephaly in a Preterm Triplet: A Case Report

Smita Dey, Vijayalakshmi Samudi

Colpocephaly is a rare congenital cerebral malformation characterised by disproportionate dilatation of the occipital horns of the lateral ventricles, most commonly associated with partial or complete agenesis of the corpus callosum. It results from defective neuronal migration and abnormal white-matter development during embryogenesis. The condition may manifest during infancy with developmental delay, seizures, and varying degrees of intellectual or visual impairment. Present case report a 10-month-old male infant, the first-born of triplets conceived through in-vitro fertilisation, who presented with global developmental delay and recurrent seizures. The perinatal period was complicated by respiratory distress and neonatal sepsis, necessitating ventilation and intensive care. MRI brain revealed thinning of the corpus callosum, bilateral cerebral volume loss, and disproportionate enlargement of the occipital horns-findings consistent with colpocephaly. The infant was managed with physiotherapy, occupational therapy, and speech therapy, leading to gradual improvement in tone, posture, and social interaction on follow-up. Antiepileptic therapy was continued with good seizure control. This case is unique due to the coexistence of colpocephaly, prematurity, perinatal depression, and neonatal sepsis in a triplet born via assisted reproduction- an extremely uncommon combination. The report underscores the multifactorial aetiopathogenesis of neurodevelopmental impairment in such cases. Early recognition, timely neuroimaging, and multidisciplinary intervention play a vital role in optimising outcomes and providing appropriate parental counselling.

Skeletal Dysplasia in a Neonate with Clinical Features of Edwards Syndrome: A Case Report

Ketki Giradkar, Sham Lohiya, Abhiraj Parekar

Neonatal skeletal dysplasias present a unique diagnostic challenge due to their phenotypic overlap with various syndromic and metabolic conditions. Edward syndrome, also known as trisomy 18, is a genetic disorder caused by the presence of an extra copy of chromosome 18 in a cell. Skeletal dysplasias, a heterogeneous group of disorders affecting bone and cartilage development, are not commonly associated with trisomy 18 but can co-exist and complicate the clinical picture. In this case, a female neonate presented with the symptoms of skeletal dysplasia, such as a depressed nasal bridge, prominent frontal bossing, short, stubby fingers with apparent overcrowding, a short trunk, and bilateral rocker-bottom feet. Her X-ray demonstrated shortened metacarpals and phalanges with metaphyseal flaring. Routine laboratory investigations showed a normal alkaline phosphatase level (116 U/L) and serum calcium (8.2 mg/dL), but a significantly deficient vitamin D level (9.93 ng/mL); her mother’s vitamin D level was also found to be deficient. In the present case, clinical findings of Edwards syndrome co-existed with skeletal dysplasia. This highlights the need to integrate clinical, biochemical and genetic insights for early diagnosis and holistic patient care. Additionally, comprehensive genetic and multi evaluations are essential to differentiate complex congenital anomalies and guide optimal neonatal management. Early identification is critical, not only for immediate clinical management but also for guiding long-term prognostic and genetic counselling strategies.

Cutaneous Scalp Metastasis Unveiling an Occult Lung Adenocarcinoma: A Case Report

Siddharth Davuluri, Sreekar Agumbe Pai, Vagata Ramaiah Anil Kumar

Cutaneous metastasis from internal malignancies is an uncommon clinical occurrence, with skin involvement as the initial manifestation of visceral malignancy being particularly rare. We report the case of an 84-year-old male who presented with a hyperpigmented proliferative lesion on the left parietal scalp, clinically suspected to be a primary skin malignancy. Wide local excision was performed, and histopathological examination surprisingly revealed metastatic adenocarcinoma. Immunohistochemistry (IHC) of the tissue showed positivity for Cytokeratin (CK) 7, CK 20 and Thyroid Transcription Factor (TTF1), indicative of a pulmonary origin. Subsequent Fluorodeoxyglucose Positron Emission Tomography (FDG PET)-Computed Tomography (CT) imaging identified a metabolically active mass in the right lower lobe of the lung, along with right paratracheal lymphadenopathy and skeletal metastases. This case highlights the critical role of histopathology and IHC in identifying metastatic skin lesions and determining their origin. Lung adenocarcinoma is known to metastasise to the skin, although scalp involvement as the initial presentation is extremely rare. This case underscores the importance of considering metastatic disease in atypical skin lesions, particularly in elderly patients, and illustrates the need for a multidisciplinary approach to diagnosis and management.

Coeliac Plexus Block for Pain Management in a Case of Intractable Pain of Chronic Pancreatitis: A Case Reportbilaterally

Kattula Leela Krishna, Vivek Chakole, Sanjot Ninavave, Vishnu Priya

Chronic pancreatitis is a progressive inflammatory disease of the pancreas, frequently seen in middle-aged chronic alcohol consumers. It is characterised by irreversible morphological changes, such as parenchymal atrophy, ductal dilatation, and calcifications, often resulting in persistent abdominal pain. While initial management is primarily conservative with analgesics and enzyme replacement, pain in some patients remains refractory, necessitating interventional approaches. One such technique is the coeliac plexus block, which disrupts the visceral afferent pain pathways. We report a case of a 50-year-old chronic alcoholic male from a resource-limited setting who presented with intractable epigastric pain radiating to the back, severely impacting his quality of life. Imaging revealed classic features of chronic pancreatitis, including pancreatic calcifications and ductal dilatation. Laboratory investigations confirmed elevated pancreatic enzymes and inflammatory markers. Despite optimal medical management, his pain remained uncontrolled. A fluoroscopy-guided posterior para-aortic coeliac plexus block was administered using a combination of 0.25% bupivacaine and triamcinolone. The patient experienced significant and sustained pain relief, with a Numerical Rating Scale (NRS) score reduction from 8/10 to 2/10. He was discharged in a stable condition and reported improved appetite and daily functioning during follow-up. This case emphasises the utility of fluoroscopic coeliac plexus block as a viable, safe, and effective intervention in the management of chronic pancreatitis-related pain, particularly when conventional therapy fails. The report also underscores the importance of selecting an appropriate technique based on clinical scenario, resource availability, and patient suitability.

Type 2 Variant of Mayer-Rokitansky-Kuster-Hauser Syndrome: A Case Report

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is an autosomal dominant condition that may co-occur with cardiac, renal, and skeletal abnormalities. It affects females causing utero-vaginal agenesis. Radiological assessment tools such as ultrasound and Magnetic Resonance Imaging (MRI) can be utilised for the confirmation of MRKH syndrome and for planning further management. Management of MRKH syndrome includes both non-surgical and surgical approaches, depending on the clinical presentation. The current report presents a case of a 21-year-old female who presented with a complaint of primary amenorrhoea and dyspareunia. Examination of the genitalia revealed normal external urethral meatus, labia majora and minora, and pubic hair development. Speculum examination confirmed the lack of a vaginal canal. Radiological findings were suggestive of uterine agenesis. Genetic analysis showed a 46,XX karyotype, thereby ruling out the chromosomal abnormalities. Based on the above findings and clinical evaluations, a final diagnosis of MRKH syndrome was confirmed. The patient declined surgical interventions at present and was managed non-surgically. In MRKH syndrome patients, counselling is crucial attributed to the associated physical abnormalities, related queries and mental stress.

Squamous Cell Carcinoma of the Gallbladder in a Young Female: A Rare Case Report

M Srividhya, D Gowri Manohari, N Preethisri, S Gomathi, K Swaminathan

Gallbladder Carcinoma (GBC) is relatively rare worldwide, accounting for 0.6-1.2% of all cancers. GBC is the most common hepatobiliary malignancy with aggressive biological behaviour. Adenocarcinoma is the predominant histological variant, while Squamous Cell Carcinoma (SCC) of the gallbladder comprises <1% of GBC. It is most commonly found in elderly females and rarely found in young adult females. It is common in smokers and alcoholics. It is usually present in an advanced T staging or diagnosed only after a cholecystectomy done for a presumed benign condition. Therefore, SCC of the gallbladder has a poor prognosis. This case report discusses a rare case of SCC of the gallbladder in a 32-year-old young adult female presenting with abdominal pain and fever mimicking features of acute cholecystitis. Initial blood investigations show leucocytosis, and elevated serum Chorio Embryonic Antigen (CEA) and increased Cancer Antigen (CA) 19.9. Radiological evaluation suggested growth in the gallbladder, and she underwent open cholecystectomy, with fragments of the left and right lobes of the liver being removed to look for metastasis. Postoperative histopathology shows moderately differentiated SCC with infiltration into the serosa, fragments from both lobes of liver are free from infiltration and Immunohistochemistry (IHC) P63 shows moderate to strong nuclear positivity,confirming SCC. The final Impression was given as moderately differentiated SCC of the gallbladder- pT3NxMx. This case presents an unusual instance of SCC of the gallbladder in a young adult female.

Clear Cell Chondrosarcoma Masquerading as a Benign Lesion of Bone: A Rare Case Report

Clear Cell Chondrosarcoma (CCC) accounts for about 2% of all chondrosarcoma subtypes and typically presents in individuals during their third to fourth decades of life. This type of tumour most commonly arises in the proximal epiphyseal region of the femur, followed by the humerus, tibia, and small bones. It is frequently observed in males and often manifests as a painful lesion that reduces mobility, leading to misdiagnosis as a benign condition. Histopathologically, the tumour is characterised by round to polygonal cells having clear to vacuolated cytoplasm, arranged in diffuse sheets and lobules, accompanied by reactive woven bone formation and rare mitotic activity. Due to high recurrence rates associated with conservative treatments such as curettage, wide excision of the affected bone followed by reconstruction is recommended. We report a rare case of CCC involving the proximal end of the femur in a 30-year-old male patient who presented with right hip pain for five months. Radiological investigations revealed a well-defined osteolytic lesion confirmed by MRI. Biopsy showed clear cells, reactive woven bone and a few multinucleated giant cells. Herein, we discuss the several differentials possible and discuss the challenges encountered during final diagnosis.

Epithelioid Trophoblastic Tumour Masquerading as Ectopic Pregnancy in Uterine Caesarean Scar: A Case Report

M Anjana, TR Preethi, KR Anila, Kiran Raj, P Rema

Gestational trophoblastic disease includes a spectrum of proliferative disorders ranging from non-neoplastic hydatidiform moles to malignant neoplastic conditions, each with phenotypic features of the different trophoblastic cells in the placenta. Epithelioid Trophoblastic Tumours (ETTs) are exceedingly rare, accounting for only 1-2% of all gestational trophoblastic neoplasms. Workup of persistent gestational trophoblastic disease requires serial measurement of Beta-human chorionic gonadotropin (β-hCG) along with imaging studies and monitoring of response to standard chemotherapy. Cases with atypical clinical features or chemoresistance should undergo tissue evaluation to exclude the rarer types of intermediate trophoblastic neoplasms. Diagnosis of ETT is challenging owing to the rarity of these tumours, long latency from antecedent gestation and significant histologic overlap with other more common gynaecological tumours. Awareness of these rare tumours with a high index of suspicion is crucial for accurate diagnosis. ETT needs to be distinguished from its mimics, including cervical squamous cell carcinoma and choriocarcinoma, as this has significant clinical and therapeutic implications. We present the case of a 37-year-old female with a prior history of caesarean delivery who presented with amenorrhoea and a positive urine pregnancy test. She was diagnosed as a case of caesarean scar ectopic pregnancy based on clinical and imaging findings. Later, excision of the scar ectopic was done, however β-hCG remained elevated. Medical management with methotrexate and standard chemotherapy for persistent gestational trophoblastic disease was unsuccessful, and the patient subsequently underwent hysterectomy due to persistent elevation of β-hCG and Contrast-Enhanced Computed Tomography (CECT) finding of a lower uterine segment mass lesion. Histopathological examination revealed an epithelioid trophoblastic tumour.

Extraskeletal Ewing’s Sarcoma of the Ileum in a Child: A Case Report

Ewing Sarcoma (ES) is the second most common malignant bone tumour. Primary Extraosseous Ewing sarcoma (EOES) is highly rare, with a reported incidence of 10-15%. The ages ranged from 9 to 69 years, and 60% of patients with small intestinal ES were younger than 30 years. The most common sites of EOES are the paravertebral region, lower extremities, chest wall and retroperitoneum. There are so far 31 cases reported as EOES of the ileum worldwide. Herein, a case of EOES-ileum is presented with intussuception. The Ultrasonography (USG) investigation showed a hypoechoic lesion measuring in the terminal ileum, forming a lead point for intussuception. During digital rectal examination, a friable mass was passed through the anus, which was sent for Histopathological Examination (HPE), showing a small, round, blue malignant tumour. Immunohistochemistry performed showed diffuse CD99, NKX2.2 positive, favouring extra-skeletal ES. Colonoscopy also confirmed a mass in the terminal ileum, following which right hemicolectomy was performed. HPE showed a polypoidal submucosal mass of an undifferentiated malignant small round blue cell tumour of the ileum with the same immunophenotype of EOES. There was no metastasis identified. She was started on chemotherapy (VDC-IE regimen for 48 weeks) on follow-up.

Sinus Bradycardia as a Manifestation of Iron Deficiency Anaemia: A Case Report and Anaesthetic Implications

Iron Deficiency Anaemia (IDA) is the world’s leading nutritional disorder. While the conventional cardiovascular response to anaemia involves tachycardia due to sympathetic stimulation, anaemia-related autonomic dysfunction may paradoxically present as bradycardia. Such an atypical presentation can complicate perioperative management, particularly in patients scheduled for major surgery. Hereby, the authors present a case of a 54-year-old postmenopausal woman with an ovarian tumour and symptomatic IDA who exhibited autonomic dysfunction manifesting as sinus bradycardia. Her haemoglobin level was 4.7 g/dL, with markedly low ferritin levels consistent with chronic iron deficiency. She was transfused with three units of packed red blood cells, after which her haemoglobin improved to 11.2 g/dL. Combined epidural–general anaesthesia was administered for tumour resection. Intraoperatively, episodes of bradycardia and hypotension occurred but were successfully managed with intravenous glycopyrrolate and fluid boluses. The postoperative course was uneventful, with no recurrence of bradycardia. The present case highlights the importance of recognising anaemia-induced autonomic dysfunction as a potential perioperative complication. Careful anaesthetic planning, preoperative optimisation, vigilant haemodynamic monitoring, and timely intervention can result in favourable outcomes in such challenging situations.

Complexities in Managing Mixed Germ Cell Tumour during Pregnancy: A Multidisciplinary Approach

Khushboo Shah, Deepti Shrivastava

Malignant ovarian tumours during pregnancy are rare, and the proportion is also too small. Mixed Germ Cell Tumours (MGCTs) are rare yet very aggressive ovarian cancers that generally afflict women of young age and consist of at least two different germ cell tumour components. Their presence during pregnancy poses distinct clinical and ethical dilemmas, and intervention must be undertaken early enough to maximise survival of the mother, considering the viability of the foetus. In this case, a 28-year-old primigravida with 16+4 weeks of gestation presented with acute pain in the right lower abdomen. Ultrasound was found to have a viable intrauterine pregnancy and a complex right adnexal mass with haemoperitoneum, which was indicative of a ruptured ovarian cyst. Emergency exploratory laparotomy showed a ruptured right ovarian mass, which was actively bleeding, and right salpingo-oophorectomy was done. Histopathological analysis revealed a malignant mixed germ cell tumour composed of yolk sac tumour and immature teratoma. Postoperatively, tumour markers were significantly high. The multidisciplinary tumour board discussed the case and advised termination of pregnancy and subsequent systemic chemotherapy due to the aggressive tumour behaviour and an urgent need for treatment. The patient was subjected to Medical Termination of Pregnancy (MTP) after counselling; later, she was treated with Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy. The patient responded well to treatment, experiencing a drop in tumour markers and showing no signs of residual disease. The case highlights the role of early detection and timely surgical intervention of ovarian malignancy identified in pregnancy. It also highlights the importance of multidisciplinary decision-making and the need to balance maternal prognosis and fetal considerations. Aggressive MGCTs need emergent management, and, in some cases, a pregnancy may have to be terminated to administer immediate chemotherapy.

Segmental Spinal Anaesthesia with Posterior Quadratus Lumborum Block for Laparoscopic Cholecystectomy in a Patient with Bronchiectasis: A Case Report

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

Anaesthetic management in patients with bronchiectasis presents unique challenges due to compromised respiratory function and increased postoperative risks. Regional anaesthesia techniques, such as Segmental Spinal Anaesthesia (SSA) and ultrasound-guided Posterior Quadratus Lumborum Block (PQLB), offer viable alternatives to General Anaesthesia (GA). Their combined use ensures adequate analgesia while minimising respiratory complications, contributing to improved perioperative outcomes. This is a case report of anaesthetic management in a 43-year-old female with bronchiectasis who underwent laparoscopic cholecystectomy. The administration of GA in such cases is associated with significant respiratory risk. Hence, SSA was utilised in combination with ultrasound-guided PQLB. SSA can provide excellent analgesia for laparoscopic cholecystectomy and can limit the usage of systemic opioids. It can be advantageous in conditions with reduced respiratory functions, as spontaneous ventilation can be maintained and respiratory complications minimised. The use of ultrasound-guided PQLB further potentiated analgesia on the abdominal wall, with an additional reduction in opioid needs and prevention of respiratory depression caused by opioids. This case emphasises the importance of a customised regional anaesthesia technique in challenging and complex cases that could help improve pain relief with safe maximisation in patients with chronic issues and respiratory challenges.

Aquagenic Wrinkling of Palms: A Case Report

G Sukanya, S Gayathri, C Geo Danny, M Ilanjiyan

Aquagenic wrinkling of the palms is a rare skin condition characterised by rapid wrinkling of the palms after water exposure, occurring within 2-4 minutes, compared to the normal physiological response which takes about 11 minutes. This condition predominantly affects young adult females and involves the eccrine secretory coil and acrosyringium. Cystic fibrosis-associated forms, drug-induced cases, and idiopathic forms have been described. Initial assessment of aquagenic wrinkling of the palms can be performed in a primary care setting. A comprehensive medical history and physical examination should be conducted, with additional investigations as required based on the patient’s presentation. The present case report presents a case of a 23-year-old male with aquagenic wrinkling of the palms, demonstrating wrinkling of the skin within two minutes of water immersion without any underlying systemic condition or drug-induced factors.

Fatal Takostubo Cardiomyopathy Following Surgery for Ameloblastoma in a Young Female: A Case Report

Takotsubo Cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is a rare but potentially fatal condition triggered by physical or emotional stress. Reporting a case of a 23-year-old female with no prior co-morbidities who developed TTC following surgical resection of a mandibular ameloblastoma. The patient presented with a painless swelling of the left mandible for 8 years, diagnosed as ameloblastoma based on imaging and histopathology. She underwent segmental mandibulectomy with vascularised fibula free flap reconstruction under general anaesthesia. The procedure was uneventful; however, in the immediate postoperative period, the patient developed haemodynamic instability, bradycardia, and hypoxia. Despite aggressive resuscitation, she deteriorated into cardiogenic shock. Echocardiography (ECHO) revealed severe left ventricular dysfunction with apical ballooning, consistent with TTC. Given her recent history of asymptomatic Coronavirus Disease 2019 (COVID-19), a possible interplay between postviral myocardial involvement and surgical stress may have contributed to this catastrophic outcome. Despite intensive management, the patient succumbed to refractory heart failure and pulmonary oedema. This case underscores the need for heightened awareness of TTC in young, healthy individuals undergoing major surgery, particularly in the postCOVID-19 era. Early recognition, multidisciplinary intervention, and optimised perioperative cardiovascular monitoring are crucial to improving outcomes in such cases.

Musculotendinous Slip of Adductor Magnus with Femoral Artery Variation: A Case Report

Vanitha Naik, Gajanand Pujari Chethan Purushothama, Nagashree M Venugopalacharya

The adductor canal and adductor hiatus are clinically important due to their narrow anatomical configuration. The present case report (a 65-year-old male cadaver) describes a variation in the left lower limb in which the medial circumflex femoral artery arose from the left femoral artery, and a musculotendinous band was present at the popliteal opening of the adductor hiatus, effectively dividing it into two compartments. The femoral artery passed deep to this band, while the popliteal vein remained superficial. The band originated from the linea aspera and inserted into the hamstring part of the adductor magnus. An indentation produced by the band was visible on the popliteal artery, which also demonstrated a reduced diameter at the level of compression compared to measurements taken proximal and distal to the band. Additionally, dilation of the artery was observed distal to the band. Such fibrous bands may develop due to repetitive physical activity, leading to increased stress around the vessels. Recognition of these bands is crucial for distinguishing mechanical vascular compression from traumatic vessel occlusion, atherosclerotic obstruction, and neuromuscular impairments. Awareness of these anatomical variations can also aid surgeons and physiotherapists during lower limb interventions.

Temporomandibular Joint Dysfunction as the First Presentation of Tardive Dystonia: A Case Report

Monisha Seralathan

Tardive dystonia is a chronic, often disabling hyperkinetic movement disorder that develops after prolonged exposure to dopamine receptor-blocking agents, most commonly antipsychotic medications. It is characterised by sustained or intermittent muscle contractions causing abnormal postures or repetitive movements, frequently affecting the craniofacial, cervical, and axial muscles. Unlike acute dystonic reactions, tardive dystonia has a delayed onset and may persist or worsen even after withdrawal of the offending drug, leading to significant functional impairment and reduced quality of life. Diagnosis is particularly challenging when the orofacial region is involved, as symptoms may mimic Temporomandibular Joint (TMJ) dysfunction, including jaw pain, restricted mouth opening, abnormal movements, and facial discomfort, often resulting in misdiagnosis and delayed intervention. This case report describes a 56-year-old woman with a seven-year history of paranoid schizophrenia who developed insidious, progressive oromandibular dystonia following prolonged antipsychotic exposure. She initially presented with jaw pain, progressive trismus, involuntary tongue movements, dysarthria, and marked functional disability, and was treated for TMJ dysfunction with minimal improvement. Comprehensive dental, neurological, and metabolic evaluations excluded alternative aetiologies, while a detailed medication history revealed sustained neuroleptic exposure, leading to a diagnosis of tardive dystonia supported by a high Abnormal Involuntary Movement Scale (AIMS) score. Gradual discontinuation of the offending antipsychotics and switching to quetiapine resulted in complete resolution of dystonic symptoms and sustained psychiatric stability on follow-up. This case highlights a key diagnostic pitfall and emphasises the need for heightened clinical suspicion of tardive dystonia in patients with atypical orofacial symptoms and long-term dopamine antagonist use.

Accessory Spleen (Splenenculus) in the Greater Omentum: A Rare Case with Histological and Embryological Insights

Rahul Kisan Ukey, Manisha B Sinha, Amit Purushottam Tirpude, Dharam Singh Rathia

The spleen is a wedge-shaped secondary lymphatic organ, situated in the left hypochondrium, sandwiched between the stomach and the diaphragm, extending along the 9th to 11th ribs. An accessory spleen is an extrasplenic lymphoid tissue found separately from the primary spleen. The most common locations for an accessory spleen are at the hilum of the spleen and near the tail of the pancreas. It may also be found in the lienorenal ligament, gastrosplenic ligament, in the wall of the stomach, mesentery, rarely in the greater omentum, spermatic cord or gonads. During routine undergraduate cadaveric dissection, an accessory spleen was found to be attached to the posterior layer of the greater omentum. It was measured about 3.5 cm x 3 cm x 2 cm in dimensions. The sections of the tissue were stained with the Haematoxylin and Eosin (H & E) stain and the histological features were suggestive of splenic tissue. Surgeons should be aware of the presence of accessory spleens, as the recurrence of haematological disorders may occur after splenectomy. Although during splenectomy for non-haematological disorders or splenic rupture, preserving the accessory spleen is advisable as it performs all the functions of a normal spleen. During radiographic imaging, an accessory spleen can be mistakenly diagnosed as an enlarged lymph node or a tumour. Although, most of the cases are asymptomatic, complications such as abdominal pain or vomiting may occur due to torsion.

A Rare Case of Sequential Hypersensitivity Reactions to Cefuroxime and Vancomycin in the Perioperative Setting: A Pharmacovigilance Perspective

Shahu Ingole, Yogita Karandikar, Vinay Narladkar

Surgical antibiotic prophylaxis commonly involves beta-lactams and vancomycin. Adverse Drug Reactions (ADRs) to these agents are known, but sequential hypersensitivity to both in the same patient is extremely rare. A 35-year-old male scheduled for Anterior Cruciate Ligament (ACL) reconstruction surgery was administered intravenous (i.v.) cefuroxime. Within minutes, the patient developed a localised urticarial rash over the right forearm, which resolved promptly with i.v. corticosteroids. Given this hypersensitivity, vancomycin was chosen as an alternative for surgical prophylaxis given as slow i.v. infusion along with vancomycin-impregnated beads placed locally at the surgical site. While the test dose of vancomycin was uneventful, the full dose led to a rapid onset of generalised erythema, urticaria, facial oedema, breathlessness, and hypotension. A diagnosis of Red Man Syndrome (RMS) was made. We hypothesise that the local placement of vancomycin-impregnated beads may have contributed to the severity of RMS, although evidence is limited. This unique case underscores a rare instance of dual Hypersensitivity Reactions (HSR) to two unrelated antibiotics cefuroxime and vancomycin and to the best of our knowledge, previously unreported in such rapid succession. Literature suggests no significant cross-reactivity between these agents and the occurrence of sequential ADRs in this patient is likely coincidental. Both WHO-Uppsala Monitoring Centre (UMC) and Naranjo’s ADR Probability Scale suggested a ‘Probable’ causal relationship for each ADR. Timely ADR reporting and AMC-led causality assessment are crucial for enhancing drug safety, optimising future antibiotic use, and promoting a culture of clinical vigilance and institutional learning.

A Case of Primary CNS Diffuse Large B-cell Lymphoma Mimicking Glioblastoma: A Diagnostic Conundrum

Sabhyata Singh, Saonskruti Rajule, Pallavi Kakade, Arvind Arte

Primary Central Nervous System-Diffuse Large B-cell Lymphoma (PCNS-DLBCL) is a rare extranodal lymphoma that can mimic high-grade gliomas on imaging and histology, causing diagnostic delays. We report a 72-year-old immunocompetent man with hypertension and diabetes who presented with sudden-onset aphasia. MRI revealed a left frontal intra-axial lesion and additional supratentorial enhancing foci, suggestive of glioblastoma or metastases Stereotactic biopsy showed sheets of large atypical cells with perivascular clustering, necrosis, and mitoses. Glioma markers (GFAP, IDH1 R132H, p53) were negative in tumour cells, while GFAP highlighted reactive glia. Immunohistochemistry revealed strong membranous CD20 positivity, BCL2 and c-MYC expression (~50–60% of tumour cells), CD10 negativity, and a high Ki-67 index (70–80%), consistent with high-grade PCNS-DLBCL. Epstein–Barr virus-encoded RNA (EBER) in situ hybridisation was negative. The patient received high-dose Methotrexate (MTX) and was tumour-free at 12 months follow-up.This case underscores that imaging and morphology alone may be misleading, and comprehensive immunophenotyping is critical for accurate diagnosis and appropriate therapy.

Unicornuate Uterus with Non-communicating Rudimentary Horn: A Case Report

Müllerian malformations are structural anomalies of the female genital tract due to failure of fusion or development of the paramesonephric (Müllerian) ducts. Unicornuate uterus is a rare Müllerian malformation that can have a communicating or a non-communicating horn. A unicornuate uterus can present with symptoms ranging from obstructive menstrual flow during earlier puberty to adverse reproductive outcomes later. Obstructive menstrual flow symptoms can mimic dysmenorrhoea during adolescence and is often misdiagnosed and treated symptomatically with analgesics. Further, there is an undue delay in diagnosis and surgical intervention, which can lead to adverse outcomes in the individuals. Here, we present a case of a 13-year-old adolescent girl with a complaint of severe dysmenorrhoea since menarche. Clinical examination was unremarkable except for tenderness in the lower abdomen. MRI imaging showed a right-sided unicornuate uterus with a left-sided non-communicating rudimentary horn associated with haematometra and haematosalpinx. Rudimentary horn resection led to symptomatic relief This case report highlights the need for early diagnosis and prompt management in providing better clinical outcomes.

Ectopic Parathyroid Adenoma of the Thymus: A Case Report

Ectopic Parathyroid Adenomas (EPAs) are uncommon, constituting less than 1% of all parathyroid adenomas. Although most adenomas arise from the superior or inferior parathyroid glands, ectopic locations such as the thymus, retroesophageal space, mediastinum, or carotid sheath can pose significant diagnostic challenges. Thymic EPAs, in particular, are rare and often evade conventional cervical exploration. We report the case of a 23-year-old female presenting with fatigue, bone pain, and recurrent renal calculi. Biochemical evaluation revealed hypercalcaemia with elevated serum Parathyroid Hormone (PTH) levels, suggesting Primary Hyperparathyroidism (PHPT). Initial Ultrasonography (USG) and Technetium (Tc)-99m sestamibi scans failed to localise the lesion in the neck. The novelty of this case lies in the extreme elevation of PTH, diagnostic localisation in the thymus despite misleading thyroid findings, and confirmation of the ectopic adenoma embedded within thymic parenchyma. This case underscores the importance of considering mediastinal EPA in young patients with severe hyperparathyroidism and non-localising neck imaging, and highlights the critical role of combined imaging modalities and histopathology in reaching a definitive diagnosis.

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Child with Recurrent Giddiness: A Case Report

Jini Joseph, Sujith Janardhanan, Renu P Kurup, Tajimal Aboo Rabia, Rema Devi

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA), or abnormal origin of the Right Coronary Artery (RCA) from the main pulmonary artery, is an uncommon congenital coronary anomaly, occurring in fewer than 0.1% of all congenital heart defects and significantly less frequent than Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA). Myocardial infarction and sudden cardiac death are potential complications, even in asymptomatic individuals. The authors hereby, present a case of a 12-year-old boy who presented with recurrent episodes of giddiness, particularly during prolonged standing. Echocardiography and Coronary Computed Tomography Angiography (CCTA) confirmed the diagnosis of ARCAPA, demonstrating an anomalous origin of the RCA from the Main Pulmonary Artery (MPA) along with mild dilatation of the left atrium and left ventricle. The patient underwent successful surgical repair involving translocation of the right coronary artery from the main pulmonary artery to the aorta. The postoperative outcome was excellent, with stable haemodynamics.

Local Recurrence of Soft-tissue Sarcoma of the Shoulder with Scapular Involvement: A Case Report

Soft-Tissue Sarcomas (STS) are rare malignant mesenchymal tumours with a high tendency for local recurrence and distant metastasis. The authors report a 28-year-old male with a history of excision of a high-grade soft-tissue sarcoma of the right shoulder who presented within six months with a rapidly enlarging recurrent mass at the operative site. Contrast-enhanced Magnetic Resonance Imaging (MRI) demonstrated a large heterogeneous soft-tissue lesion in the posterior scapular region with internal necrosis, infiltration of adjacent periscapular muscles and periosteal reaction along the scapula, suggestive of local recurrence with early osseous involvement. Computed Tomography (CT) of the chest revealed multiple pulmonary nodules consistent with metastatic disease. In view of advanced recurrent disease, the patient was managed with Intensity-Modulated Radiotherapy (IMRT) using a dose of 30 Gy in 10 fractions, which resulted in reduction in tumour bulk with symptomatic improvement. The present case emphasises the importance of MRI in early detection, local staging and treatment planning in recurrent soft-tissue sarcoma.

Incidental Diagnosis of Myositis Ossificans in a Neglected Hip Fracture: A Case Report

Myositis Ossificans (MO) is a condition characterised by the formation of heterotopic bone that typically occurs following trauma. Location around the hip is rare, and it can imitate malignant bone tumours, which can make diagnosis challenging. We discuss the incidental discovery of MO in a patient with a neglected hip fracture and the implications of delayed imaging and prolonged immobilisation. We describe a male, aged 71 years, who presented with an inability to walk associated with recurrent episodes of left hip pain for eight months, with acute worsening over two days. Twelve months earlier, he had undergone surgery, and two months after the surgery, he fell from a height, which left him with unrelenting hip pain and a state of immobilisation. Despite this, he did not undergo imaging studies or receive definitive management. The patient presented to a tertiary care hospital after eight months for persistent hip symptoms and imaging revealed an old femoral neck fracture with incidental MOs in the adjacent soft-tissue. The patient was conservatively managed for MO with analgesia and physiotherapy. Here, we emphasise the importance of early diagnosis and proper treatment of incidental MOs discovered during cases of delayed trauma. The potential for MO should be considered as a diagnosis when clinicians evaluate their post-trauma patients to decrease the possibility of misdiagnosis and ultimately provide optimal care for the patients.

Prostatic Adenocarcinoma Presenting Primarily as Orbital Space Occupying Metastatic Lesion: A Rare Case Report

Anita Omhare, Geeta Maurya, Sanjeev Kumar Singh, Sunita Kumari Meena, Rashmi

Brain metastasis from prostate cancer is very rare, occurring in less than 1% of metastatic cases. Brain metastasis may be misdiagnosed as a primary brain tumour on imaging. We present a case of a 65-year-old male patient, who presented to the Ophthalmology department with left eye swelling, lid oedema and proptosis. Clinically, provisional diagnosis of left orbital cellulitis had been made. MRI of brain showed features of left fronto-temporal space occupying lesion. The lesion was surgically resected. On the basis of histopathological findings, differential diagnosis of lacrimal duct carcinoma, polymorphous adenocarcinoma and metastatic malignancy had been made. Further investigation showed prostate specific antigen level of 105 ng/mL. Immunohistochemistry (IHC) of antibodies (AR, P53, PSA, AMACR, EGFR, E-Cadherin, CD45, HMB45, S100, Her2neu, GFAP, P63, CD117, CK7, CK20, SMA and Vimentin) applied and after interpretation, diagnosis of metastatic prostatic adenocarcinoma was made. This case was not known to have any prostatic pathology before diagnosis of brain metastasis. Although brain metastasis from prostate cancer is rare, it should be considered in patients presenting with such clinical features. Early diagnosis may contribute to improved survival outcomes.

Integrative Management of Chronic Cerebral Venous Sinus Thrombosis with Ayurveda and Physiotherapy: A Case Report

Mohnish V Gokhale, Vaishali Kuchewar, Ashvini Pardhekar, Vinay Nara

Chronic Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially debilitating condition involving thrombi in the venous sinuses of the brain, impairing venous drainage and increasing intracranial pressure. This condition is often challenging to diagnose due to its nonspecific symptoms, and it may present in various forms, from acute to chronic, often mimicking other neurological disorders. A 54-year-old male presented with persistent headaches, slurred speech, and imbalance, later confirmed as chronic CVST via Magnetic Resonance Imaging (MRI) venography. Despite well-controlled hypertension, the patient had a history of cerebrovascular insult, further complicating the clinical picture. What makes this case unique is the chronic presentation with partial sinus recanalisation and stable neurological function, achieved through a structured integrative approach. Ayurvedic therapies like Shiro Basti, Matra Basti, and Rasayana medications, combined with targeted physiotherapy, played a crucial role in recovery. Diagnostic findings such as a Vata-Pitta imbalance and therapeutic International Normalised Ratio (INR) range also contributed to the individualised treatment plan. This case highlights the value of integrative medicine in chronic neurovascular disorders, emphasising the role of Ayurveda and physiotherapy in improving clinical outcomes, preventing recurrence, and restoring quality of life. This case highlights the promising role of integrating Ayurveda and physiotherapy in managing chronic CVST. The combination of these therapies led to significant clinical improvements, suggesting their potential in enhancing neurovascular recovery. Further studies are needed to solidify these approaches in chronic neurological rehabilitation.

X-linked Chronic Granulomatous Disease Presenting Clinically as Tuberculosis in a 10-Month-Old Child: A Case Report

Sahibjot Singh Romana, Uday Pratap Singh, Kanav Goyal, Arnav Jagota

Chronic Granulomatous Disease (CGD) is a rare primary immunodeficiency with an estimated incidence of 1 in 200,000-250,000 live births caused by defects in the Nicotinamide Adenine Dinucleotide Phosphate (NADPH) oxidase complex. NADPH oxidase deficiency leads to an impaired phagocyte respiratory burst and increased susceptibility to recurrent bacterial and fungal infections, with excessive inflammation and granuloma formation. This is a case report of 10-month-old infant who initially presented with pneumonia and cervical lymphadenitis. The child had a history of multiple hospital admissions for infections, raising concern for an underlying immunodeficiency. Laboratory evaluation showed an elevated C-Reactive Protein (CRP) with neutrophil predominance. The tuberculin skin test was positive, while mycobacterial PCR (polymerase chain reaction) was negative. Blood cultures grew Staphylococcus aureus. Cervical lymph node biopsy demonstrated granulomatous inflammation. Functional testing with the Nitroblue Tetrazolium Test (NBT) and Dihydrorhodamine (DHR) flow cytometry revealed a defective oxidative burst. Whole-exome sequencing identified a CYBB (cytochrome b-245 beta chain) mutation, confirming a diagnosis of X-linked CGD. The patient’s active infection and inflammatory manifestations were treated successfully. This case highlights the importance of early screening for CGD in infants with recurrent or severe infections, the use of definitive functional and genetic testing for accurate diagnosis, and the timely initiation of antimicrobial prophylaxis to reduce morbidity and mortality.

Therapeutic Impact of 980 nm Diode Low-level Laser Therapy on Neurosensory Recovery Following Mandibular Third Molar Removal: A Case Report

Paraesthesia due to nerve injury is a common complication following the extraction of impacted mandibular third molars, often affecting the Inferior Alveolar Nerve (IAN). Low-Level Laser Therapy (LLLT) has shown promising results in promoting neurosensory recovery in such cases. This case report presents the management of postoperative nerve paraesthesia in a 24-year-old female patient using 980 nm diode laser therapy. The treatment was delivered in contact mode at 0.5 W, applying three joules per point for 30 seconds at each irradiation site. Sensory function was assessed using the Visual Analogue Scale (VAS), in-prick, and brush stroke tests (conducted at each visit for comparative assessment). Initially, the patient recorded a VAS score of 10. By the fourth session, the score decreased to eight. After ten sessions, complete recovery was noted in the chin, gingiva, and oral mucosa (VAS=0), with partial improvement in the lower lip (VAS=8) and mandibular left central incisor (VAS=6). Full recovery was observed after 20 sessions. This report suggests that LLLT is a safe, non-invasive, and effective modality for enhancing nerve regeneration and managing paraesthesia following third molar surgery.

Benefits of Slump Mobilisation Combined with Suboccipital Myofascial Release on Pain, the Range of Motion, and Quality of Life in Cervicogenic Headache: A Case Report

Sukhpreet Kaur, Mandeep Kumar Jangra, Akanksha Saxena, Arghya Mondal

Cervicogenic Headache (CGH) is classified as a secondary type of headache with both muscular and neurological impairments. There are many physiotherapeutic interventions for its management like spinal manipulation, mobilisation, Myofascial Release (MFR), postural correction exercises, and electrotherapy but evidence for sustained long-term effects remains limited. Slump mobilisation is an emerging technique that can alleviate pain by targeting dural tension in the spine, restoring mobility, reducing pain, and addressing underlying musculoskeletal and neural dysfunctions. This case report aims to evaluate the effects of Slump mobilisation combined with suboccipital MFR on pain, cervical ROM, and overall Quality Of Life (QOL) in an individual with CGH. A 36-year-old female having CGH as diagnosed by (CGH International Study Group, CHISG) criteria since one year came with neck stiffness and pain in neck radiating to the head and forehead. Stress, watching television, and using mobile phone aggravated her symptoms, while analgesics relieve them. Slump mobilisation was performed in three sets, each consisting of 30–40 repetitions over two minutes, with one-minute breaks between sets, suboccipital MFR was given for four minutes for three days/week for four weeks. Pain was assessed using Headache Impact test- 6 (HIT-6) and the Pain Pressure Threshold (PPT) was assessed by algometer to assess tenderness of splenius capitis, rectus capitis and upper trapezius muscle and Cervical Range of Motion (CROM) by using universal goniometer. The QOL was assessed using 36-Short-form questionnaire at baseline and post-intervention. Significant improvements were observed on HIT-6 (66 to 50), PPT of trapezius (right) from 1.59 to 3.46, trapezius (left) from 1.57 to 2.49, splenius capitis (right) from 1.65 to 2.89, splenius capitis (left) from 1.46 to 2.72, rectus capitis (right) from 1.53 to 2.52, and rectus capitis (left) from 1.42 to 2.57. Cervical ROM also showed improvement in all the movements. Additionally, the SF-36 scores improved from 40.37% to 84.87%. The present case highlights that slump mobilisation combined with suboccipital MFR can be used as an effective intervention in the management of CGH.

When Anomalies Meet Tumour: A Case of Leiomyomas in a Horseshoe Kidney

Pankaj Kumar, Hemant K Goel, Nitin Paighan

The horseshoe kidney is one of the most common congenital renal fusion anomalies of the genitourinary system. It may be associated with other diseases chiefly involving the gastrointestinal tract, skeletal, cardiovascular and central nervous system. With cases of renal tumours of varied types, the occurrence of smooth muscle tumours is rare. The patient may be asymptomatic or present with abdominal/flank pain, palpable mass or haematuria. The increased use of imaging has led to incidental findings of these leiomyomas. The below-presented case is a rare presentation of renal leiomyoma in a 39-year-old female with horseshoe kidneys. The diagnosis was confirmed on immunohistochemistry data. This unique association of renal leiomyoma with horseshoe kidneys is, as per our knowledge, the first reported case, suggesting clinicians consider such a rare differential diagnosis in renal pathology. Knowledge of such rare associations focuses on designing definite treatment protocols for minimising radical nephrectomy.

Physiotherapy Rehabilitation Post Lower Segment Caesarean Section to Strengthen the Core and Quadriceps Muscle: A Case Report

Bhagyashree Panda, Mansi Jain, Yamuni Bhandari, Ritika Mani, Kritika Bodwal

Women often experience reduced physical strength following a Lower Segment Caesarean Section (LSCS), which may limit their ability to perform daily activities. A 32-year-old female presented with lower limb weakness, particularly involving the quadriceps muscles, five months after undergoing LSCS. The patient reported to the Physiotherapy Outpatient Department (OPD) with complaints of mild low back pain, difficulty climbing stairs, balance disturbances, and generalised lower limb weakness. The patient was assessed through physical examination, special tests, and a review of medical records. A four-week, individualised exercise protocol was implemented with the aim of improving core stability and quadriceps strength. Each session included warm-up and cool-down exercises to prevent fatigue and injury. Outcome measures included the Timed Up and Go (TUG) test for functional mobility and the hip-bridge test for core strength. Exercises were performed three times per week with 30-second rest intervals. These assessments helped ensure improved functional performance and injury prevention. Quadriceps strengthening exercises enhanced muscle strength and balance, while core training improved postural stability. The intervention resulted in significant improvements.

Case of Peripheral Cemento-ossifying Fibroma Mimicking Pyogenic Granuloma: A Diagnostic Challenge

L Vishalatchi, R Kadhiresan, A Lubna Firdose, U Arunmozhi

Peripheral Cemento-ossifying Fibroma (PCOF) is a relatively common reactive gingival lesion that originates from the periodontal ligament. It often presents as a firm, nodular gingival overgrowth and is frequently misdiagnosed due to its clinical similarity to other benign lesions such as Pyogenic Granuloma (PG) and Peripheral Giant Cell Granuloma (PGCC). This case report highlights a diagnostic challenge in identifying PCOF in a 51-year-old female patient who presented with a slowly enlarging gingival growth in the maxillary anterior region. The lesion was reddish-pink, pedunculated, and measured 8×8 mm. It bleeds on slight provocation and clinically resembled a PG. Radiographic evaluation showed no alveolar bone involvement. A provisional diagnosis of PG was made, with differential diagnoses including fibrous hyperplasia, PGCC, and PCOF. The lesion was surgically excised using internal bevel gingivectomy, and the excised tissue was sent for histopathological examination. Microscopic analysis confirmed the diagnosis of PCOF, revealing Parakeratinised stratified squamous epithelium with ulceration, cellular fibrous stroma, bony trabeculae, and cementum-like calcifications. Postoperative healing was uneventful, and no recurrence was observed at 3-month follow-up. This case underscores the importance of histopathological evaluation in distinguishing PCOF from clinically similar lesions. Given the potential for recurrence, complete excision and regular follow-up are essential. Accurate diagnosis not only aids in appropriate management but also ensures optimal functional and aesthetic outcomes for the patient.

Novel Use of the MADgic Atomiser for Emergency Airway Management in Complex Neck Trauma: A Case Report

Priyanka Gadvi, Chaitanya Kamat, Purvashree Deshmukh

Penetrating neck injuries present as a formidable challenge to anaesthesiologists and the trauma care team due to the risk of rapid airway compromise, exsanguination and involvement of multiple vital structures. Securing the airway remains the top priority, especially in patients presenting with neck injuries, active bleeding, tissue disruption, and altered sensorium. Safest methods to secure the airway is in an awake and spontaneously breathing patient. We report a case of a 55-year-old male who presented with a deep anterior neck laceration in hypovolaemic shock in an emergency, in whom a conventional airway was deemed impossible. Then, as a game-changer, the MADgic Atomiser, a mucosal atomiser, was used to facilitate topical anaesthesia in airway management. The traumatic airway being complex, airway management in such a scenario is extremely difficult. Multidisciplinary teamwork remains the gold standard. Here, in this case, oxygenation was utmost important, looking at the blood loss and Glagow Coma Scale (GCS) of the patient. Hence, direct placement of a tracheostomy tube through the exposed tracheal lumen was initiated, followed by definitive oral endotracheal intubation using a C-MAC for further management. This case highlights the novel use of MADgic Atomiser, an innovative airway adjunct, C-MAC, and the critical role of adaptability, along with multidisciplinary teamwork in managing life-threatening neck injuries.

Early Laboratory Recognition of Acute Promyelocytic Leukaemia in Critically Ill Patients: A Case Report

Acute Promyelocytic Leukaemia (APL) is a haematologic emergency associated with high early mortality due to life-threatening coagulopathy and disseminated intravascular coagulation. In critically ill patients, particularly in intensive care settings, the diagnosis may be masked by postoperative or sepsis-related changes, resulting in dangerous delays. Early recognition through automated analyser abnormalities and prompt morphological confirmation is crucial for survival. A 52-year-old woman recovering from major surgery in the Post-Operative Intensive Care Unit presented with anaemia (Hb 7.9 g/dL), severe thrombocytopenia (32,000/μL) and a leukocyte count of 7,590/μL with apparent monocytosis. Abnormal leukocyte scatterplots prompted urgent peripheral smear review, revealing hypergranular promyelocytes with multiple Auer rods, including bundles. Haematology consultation was activated immediately, and bone marrow evaluation confirmed APL. All-trans Retinoic Acid (ATRA) therapy was started without delay, with rapid stabilisation of haematologic and coagulation parameters. This case highlights that, in critically ill patients, APL may be “masked” by the intensive care context, and laboratory vigilance is essential. Early interpretation of scatterplot abnormalities, urgent smear review and multi-disciplinary coordination between laboratory staff, intensivists and haematologists are fundamental to achieving a timely, life-saving diagnosis and treatment.

Segmental Spinal Anaesthesia Combined with TAP Block for Caesarean Section in a Patient with Eisenmenger Syndrome: A Case Report

Richa Tailor, Jatin Patel, Mahendi Mehta, Sara Mary Thomas

Pregnancy in patients with Eisenmenger Syndrome (ES) is associated with extremely high maternal and foetal morbidity and mortality, and anaesthetic management for caesarean section is particularly challenging because of fixed pulmonary hypertension, right-to-left shunting, and limited cardiovascular reserve. Present case report is of a 35-year-old gravida 3 with two previous abortions, diagnosed with ES, who presented at 35 weeks of gestation for elective caesarean section due to severe oligohydramnios and intrauterine growth restriction. Cardiac evaluation revealed a large Ventricular Septal Defect (VSD) with Patent Ductus Arteriosus (PDA) and bidirectional shunting, moderate-to-severe Tricuspid Regurgitation (TR), left ventricular systolic dysfunction with an ejection fraction of 45%, secondary polycythaemia, thrombocytopenia, and baseline oxygen saturation of 84% on room air. Following detailed multidisciplinary planning, segmental spinal anaesthesia was administered using low-dose isobaric ropivacaine with fentanyl under invasive haemodynamic monitoring. A prophylactic noradrenaline infusion was commenced to maintain Systemic Vascular Resistance (SVR) and prevent hypotension. Caesarean delivery was completed uneventfully with stable maternal haemodynamic throughout the procedure. A low-birth-weight neonate was delivered and managed in the Neonatal Intensive Care Unit (NICU). Postoperative analgesia was provided using bilateral Transversus Abdominis Plane (TAP) block, allowing effective pain control without significant haemodynamic compromise. The patient was monitored in a cardiac intensive care unit and had an uneventful postoperative course before discharge in stable condition. This case demonstrates that with meticulous multidisciplinary planning, invasive monitoring, judicious fluid administration, early vasopressor support, and low-dose segmental spinal anaesthesia, caesarean section can be safely accomplished in carefully selected patients with ES. However, pregnancy in ES remains extremely high risk and should to be strongly discouraged.

Barotrauma Induced by Mechanical Ventilation Leading to Vascular Collapse in a Frail Elderly Patient: A Case Report

A Vignesh, V Sathyaprabu

Subcutaneous Emphysema (SE) is a serious clinical condition that occurs when air enters the subcutaneous tissue. It can lead to serious consequences, especially in frail patients or patients with comorbidities. While SE is generally considered a benign condition and often managed symptomatically, it can become life-threatening (especially in patients who cannot protect their airways and who may be on mechanical ventilation). Therefore, we report a case of SE involving a 77-year-old obese male with multiple comorbidities, including Chronic Obstructive Pulmonary Disease (COPD). The patient underwent intubation, an in-transport phase of mechanical ventilation the patient developed massive SE leading to significant desaturation and swelling when we reconnected the patient to the ventilator. We responded with emergency Cardiopulmonary Resuscitation (CPR) and bilateral Intercostal Drainage (ICD) to relieve the tension, and the patient regained haemodynamic stability. Imaging was done and revealed massive SE, bilateral pneumothorax, and pneumomediastinum. The patient came out of the acute respiratory compromise but succumbed to Chronic Kidney Disease (CKD) and Coronary Artery Disease (CAD)-related complications after three days. A literature review corroborates the various causes of risks for procedural errors in ventilation and surgical procedures. This case report is unique in demonstrating a rapid progression to multicompartmental air leak (pneumoperitoneum, pneumomediastinum, and pneumothorax) leading to cardiopulmonary arrest in a high-risk patient during intra-hospital transport, emphasising the catastrophic potential of barotrauma and the need for vigilance in ventilatory practices, particularly when using a Bain circuit for transfer.

Successful Management of Subclinical Hypothyroidism with PCOD and Class I Obesity: A Case Report

Dimple D Dalal, Kavita Sutagatti, B Gayathri, S Nanditha, Bagmibidbatta Ghadei

Subclinical Hypothyroidism (SCH) is a metabolic disorder characterised by normal T3 and T4 levels with elevated Thyroid Stimulating Hormone (TSH). Symptoms including weight gain, fatigue, hair fall, and impaired metabolism correspond to Rasapradoshaja Vikara (disorders of vitiated Rasa Dhatu) described in Ayurvedic texts. This case report evaluates the effectiveness of Shodhana (purification) and Shamana (pacification) therapies in managing SCH and Polycystic Ovarian Disease (PCOD) in a 30-year-old female with Class I obesity. She underwent the Panchakarma procedures including Udwartana, Vamana, and Virechana. Post-treatment, her TSH levels normalised, her weight reduced, and her Body Mass Index (BMI) dropped from 31.2 to 25.9 kg/m². Symptoms such as hair fall and fatigue resolved completely. Maintenance therapy included Shamana medications and dietary modifications. The interventions improved Agni, reduced Ama, and balanced Kapha-Pitta doshas, demonstrating the potential of Panchakarma in managing metabolic disorders and reducing reliance on conventional medications, warranting further research.

Rare Co-existence of Pleomorphic Adenoma Parotid and Darier’s Disease: A Surgical Case Report

Avinash Kumar, Jitender Kumar, Ekta Yadav, Garima Sinha, Rashmi Gautam

Pleomorphic adenoma is defined as a benign tumour that affects the salivary glands. The most commonly involved salivary gland is the parotid gland, particularly the superficial lobe of the parotid gland. This condition presents as a painless swelling that gradually increases in size if not treated promptly. It is also referred to as a benign mixed tumour due to its histopathological features, which consist of a combination of myoepithelial and ductal elements. Although it can affect individuals of any age, it is most common during the 4^th to 7^th decades of life. Darier’s disease, a rare genetic skin disorder, can sometimes be associated with salivary gland manifestations, particularly causing obstruction to the flow of salivary ducts due to abnormal cell growth involving the duct lining. Here, the authors discuss a case of a 47-year-old male patient diagnosed with Darier's disease. The patient also presented with a painless swelling in the left parotid region, which had been present for two years and gradually increased in size. It was diagnosed as pleomorphic adenoma based on cytopathological examination. Preoperative investigations were conducted to assess the patient’s fitness for surgery. A left superficial parotidectomy was performed under general anaesthesia, and the excised specimen was sent for histopathology. Histopathological examination confirmed it to be pleomorphic adenoma of the parotid gland. The present case represents a rare occurrence of co-existence between Darier’s disease and pleomorphic adenoma of the parotid gland.

Toxoplasma Encephalitis with Pneumonia in an HIV-infected Pregnant Woman: A Case Report of Successful Perinatal Outcome

Beyona Susan Benny, Rupa Padwalkar

Toxoplasma Encephalitis (TE) is one of the most severe opportunistic infections of the Central Nervous System (CNS) in patients with advanced HIV, especially when CD4 counts fall below 100 cells/μL. Though common among immunocompromised individuals, its occurrence in pregnancy is rare, and published data on maternal and foetal outcomes are limited. A 24-year-old at 32 weeks of gestation presented to the emergency department with fever, hemiparesis, and breathlessness for eight days. Examination revealed left-sided hemiparesis (power 3/5), brisk reflexes, bilateral extensor plantar response, and preserved sensation; cranial nerves were intact. Bilateral crepitations were noted (right > left), with oral candidiasis and stable obstetric findings, including a cephalic foetus with Foetal Heart Sound (FHS) of 130/min. ELISA confirmed HIV-positive status with positive Toxoplasma serology showed IgG and negative IgM, suggesting reactivation of latent infection. Computed Tomography (CT) brain revealed a 2.5×2.5×2.2 cm hypodense lesion in the right capsuloganglionic region; Magnetic Resonance Imaging (MRI) showed a well-marginated ring-enhancing lesion in the right thalamus with an eccentric mural nodule, highly suggestive of a toxoplasma abscess. A primary diagnosis of HIV-positive status with TE and bilateral pneumonia was made. Empirical antimicrobial therapy (including clindamycin and septran), Antiretroviral Therapy (ART) and supportive care were initiated. With multidisciplinary management, the patient’s neurological status improved, and she delivered a healthy male infant at 37 weeks via elective caesarean section. Dual neonatal antiretroviral prophylaxis was administered. This rare case of TE with pneumonia during late pregnancy contributes to the limited literature. It demonstrates that early neuroimaging, serological interpretation, and timely multidisciplinary intervention can ensure favourable maternal and perinatal outcomes in HIV-infected pregnancies complicated by opportunistic infections.

Primary Meningothelial Meningioma Arising in the Parotid Region: A Case Report

Manoj Dongre, Sudhir Jayakar, Virendra Athavale, Guneet Singh, Digvijay Jadhav

Meningiomas are common intracranial neoplasms arising from arachnoidal cells, accounting for approximately 24-30% of all primary brain tumours. However, extracranial meningiomas are rare, constituting only 0.9-2% of all meningiomas. Among these, meningothelial meningioma is an even rarer histological variant, with very few reported cases occurring in the head and neck region. The parotid gland is an uncommon site for such tumours, and their presentation often mimics primary salivary gland neoplasms, posing a significant diagnostic challenge. Here, we present a rare case of a 46-year-old female diagnosed with a meningiothelial meningioma in the parotid gland, emphasising its unusual presentation, diagnostic dilemma, and surgical management. This case highlights the importance of considering meningiomas in the differential diagnosis of parotid masses and the role of immunohistochemistry in achieving a definitive diagnosis.

Diagnostic Challenge in a TORCH-negative Infant: A Case Report of Pseudo-TORCH Syndrome

Rutu Udapudi, J Jayakaviyah

Pseudo-TORCH syndrome type 1 is a rare autosomal recessive neurodevelopmental disorder that clinically and radiologically resembles congenital TORCH infections despite its non-infectious aetiology. Accurate identification remains challenging due to early-onset neurological manifestations and phenotypic overlap with infectious causes. Recognising its distinguishing clinical features is essential for timely diagnosis and counselling. The present case involves a five-and-a-half years old girl born to third-degree consanguineous parents who developed seizures within four hours of life, followed by progressive microcephaly and profound global developmental delay. Developmental assessment at 66 months revealed a mean developmental age of 3.5 months (global Developmental Quotient˜5), signifying severe impairment across all domains. Clinical examination demonstrated spasticity, generalised hypertonia, involvement of cranial nerves III, IV, IX, and X, along with nystagmus and chorioretinitis. The child experienced focal-clonic seizures refractory to multiple anti-seizure medications, with only partial symptomatic improvement. A significant family history, including a sibling with Aicardi-Goutières syndrome and another pregnancy terminated for congenital anomalies, suggested autosomal recessive inheritance and highlighted genetic heterogeneity among pseudo-TORCH-like syndromes. Genetic testing confirmed pseudo-TORCH syndrome type 1. This case highlights the importance of considering genetic aetiologies in infants presenting with TORCH-like features, particularly in populations with consanguinity. Early diagnosis facilitates appropriate management, prognostication, and targeted genetic counselling for affected families.

Malignant Proliferating Trichilemmal Tumour: Report of a Rare Case

Ganthimathy Sekhar, Samyukta Srinivasan, Winston Noronha, Josephine Arun

Malignant Proliferating Trichilemmal Tumour (MPTT) is a rare, invasive adnexal neoplasm arising from the outer root sheath of hair follicles, most commonly affecting elderly women. Only about 61 cases of MPTT of the scalp have been documented in world literature in the past 24 years. The scalp is the most common location, it is also seen less frequently on the upper and lower limbs, neck, trunk, and groin. These are metastatic, invasive tumours that exhibit aggressive biological traits. The authors report a rare case of an 80-year-old male who presented with two scalp swellings- one long standing in the left temporal region and the other a recurrent ulcerated nodule in the parieto-occipital region recurring two years after excision. Histopathology confirmed an epidermoid cyst in the temporal lesion and the possibility of a high grade MPTT in the parieto-occipital swelling, characterised by trichilemmal keratinisation, cellular atypia, and an infiltrative growth pattern. Immunohistochemistry (IHC) of the tumour showed focal CD34 positivity and 40% Ki-67 positivity confirming the diagnosis of MPTT. Subsequently the patient underwent wide local excision which on histopathological examination showed no involvement of the margins. No recurrence or metastasis was observed during follow-up after three years. This case is presented for its rarity, non specific clinical presentation, and to emphasise the importance of having a high-index of suspicion of malignancy for a recurrent swelling occurring in the scalp and performing IHC to confirm the diagnosis and differentiate it from other similar appearing malignant neoplasms of the scalp. Early surgical management is critical for a favourable outcome.

ANA-Negative Class V Lupus Nephritis with Isolated Anti-Smith Antibody Positivity: A Case Report

Lupus Nephritis (LN) is a severe manifestation of Systemic Lupus Erythematosus (SLE) and is typically associated with Antinuclear Antibody (ANA) positivity. ANA-negative LN is exceedingly rare and may delay diagnosis, especially when renal disease is the initial presentation. We report a case of a 38-year-old woman presenting with nephrotic syndrome who was diagnosed with biopsy-proven pure Class V LN despite repeatedly negative ANA and anti-double-stranded DNA antibodies. Extended serological testing revealed strongly positive anti-Smith (anti-Sm) antibodies with markedly reduced complement levels. The patient achieved partial remission following treatment with Mycophenolate Mofetil (MMF) and corticosteroids. This case highlights the diagnostic importance of renal biopsy and extended Extractable Nuclear Antigen (ENA) testing in suspected SLE with negative ANA serology and underscores the need for heightened clinical suspicion in atypical presentations.

Tubercular Empyema with Molluscum Contagiosum and Cutaneous Metastasis in a Patient with Prior Glossectomy and Subsegmental Mandibulectomy: A Rare Case Report

Shailly Rajnish Tiwari, Jagrati Yadav, Samarth Shukla, Harsh Manojkumar Thesia

Tubercular Empyema (TE) is an uncommon manifestation of extrapulmonary tuberculosis, and its coexistence with molluscum contagiosum is exceedingly rare. Molluscum Contagiosum (MC) typically affects children, so its occurrence in a 46-year-old male might raise suspicion of immune suppression. The simultaneous occurrence of these infections in a patient with cutaneous metastasis and a prior history of oral carcinoma surgery presents a unique diagnostic and therapeutic challenge. The patient in the present case report was apparently in good health until 7 months ago when he developed intermittent episodes of fever not associated with chills or rigors. During the same period, he experienced shortness of breath when walking short distances, graded as Modified Medical Research Council (MMRC)+2, which subsided with rest. He also reported localised lower back pain for the past 7 months, accompanied by loss of appetite. Over the past 2 years, he experienced unintentional weight loss of approximately 10 kg. There was no history of orthopnea, paroxysmal nocturnal dyspnea, haemoptysis, palpitations, wheezing, or sore throat. He denied any nausea, vomiting, seasonal or diurnal variation in symptoms and had no history of biomass exposure. The patient reported exposure to a pet dog and had no history of drug allergies. He also presented with right-sided pleural effusion, cutaneous molluscum contagiosum, and metastatic squamous cell carcinoma confirmed on biopsy. Imaging revealed multiloculated collections with bony erosion suggestive of tuberculosis. He received anti-tubercular therapy, antibiotics, and analgesia, showing partial improvement, with oncology follow-up advised for metastatic disease management.

Silent Diverticulum, Sharp Consequences: A Rare Case of Meckel’s Perforation by Ingested Dental File

The most common gastrointestinal tract abnormality, which occurs as a result of incomplete obliteration of the vitelline (omphalomesenteric) duct in embryo formation, is Meckel’s diverticulum. Objects like toothpicks, fish bones or dental instruments may be lodged in the lumen of the diverticula causing local inflammation and in uncommon cases, perforation. A 26-year-old male patient presented to the emergency department after accidentally swallowing a dental file during a routine dental procedure. He was asymptomatic, not haemodynamically deranged, and showed no signs of acute abdomen. The file was located in the distal jejunum without the presence of free intraperitoneal air or fluid on a non-contrast Computed Tomography (CT) scan of the abdomen. Initial follow up radiograph showed progressive transit of the foreign body. However, further serial radiographs at a time interval of six hours showed no change in position. A follow-up non contrast CT scan revealed the object in the distal ileum, where it had perforated the wall of a blind-ending tubular structure triggering the suspicion of a perforated Meckel’s diverticulum. Laparoscopic diagnosis of a perforated Meckel’s diverticulum was made. Laparoscopic segmental resection of the affected bowel and primary ileo-ileal anastomosis was done. Histopathological examination showed the presence of a true diverticulum with mucosal ulceration, haemorrhagic infarction, and transmural inflammation. Neither ectopic gastric nor pancreatic mucosa was identified. Recovery after surgery was uneventful, and the patient was discharged. This case report highlights a rare but important clinical complication which is to be suspected and treated without delay and helps the future clinicians in deciding on an appropriate timely management.

Autoimmune Lymphoproliferative Syndrome: A Rare Paediatric Case Report

Autoimmune Lymphoproliferative Syndrome (ALPS) is a rare disorder characterised by T-cell dysregulation resulting from impaired Fas cell surface death receptor (FAS)-mediated apoptosis. Approximately 500 cases have been reported globally. Pancytopenia with splenohepatomegaly in children presents a wide spectrum of differential diagnoses ranging from infectious and malignant to immunological aetiology. A three-year-old male child presented with fever, spleno-hepatomegaly, and pancytopenia. After excluding infectious and malignant causes, a diagnosis of ALPS was made. A positive direct Coombs test prompted the consideration of immunological causes for pancytopenia and splenomegaly. Hence, a double-negative T-cell subset (CD3+/TCR α/β+CD4-CD8-) in the peripheral blood was sent, which was elevated, confirmed the diagnosis of ALPS. The patient received treatment with intravenous human immunoglobulin, dexamethasone, and sirolimus, resulting in the resolution of cytopenia and splenomegaly. The present case highlights the diagnostic challenge of ALPS, even in the absence of lymphadenopathy. A dramatic clinical response to sirolimus was observed, emphasising the therapeutic potential of targeted Mammalian Target of Rapamycin (mTOR) inhibition in managing ALPS. Given the underdiagnosis of this condition, ALPS should be considered in cases of unexplained pancytopenia accompanied by lymphadenopathy or splenomegaly and autoimmunity.

Histoid Leprosy Presenting as Fibroma on Initial Histopathology: A Rare Case Report

Khushbu Vaidya, Madhuri Kilnake, Raju Shinde, Ashish Khune, Joben Samuel

Leprosy, caused by Mycobacterium leprae, persists in many developing nations. Histoid leprosy, an uncommon variant of lepromatous leprosy, may occur even in untreated individuals, thereby challenging its earlier association with drug resistance. This is a case of a 45-year-old female with a previous history of infiltrating ductal carcinoma, who made a full recovery with lumpectomy and chemotherapy six years ago, and presented with multiple multinodular lesions over her trunk and limbs. The clinical presentation and initial histopathological findings suggested a soft-tissue tumour, raising concern about the recurrence of malignancy. However, further investigation revealed fusiform histiocytes and Acid-Fast Bacilli (AFB), confirming a diagnosis of histoid leprosy. Through this case, we aim to highlight the challenges in diagnosing histoid leprosy due to its clinical resemblance to soft-tissue tumours, particularly in patients with a history of malignancy. The case illustrates the potential for diagnostic confusion in endemic regions where both infectious and neoplastic conditions may coexist.

Incidental Detection of Right-sided Malrotation of the Duodenum and Duodenojejunal Flexure in an Adult Male Cadaver: A Case Report

Shrikant Bharti, Jolly Agarwal, Abhinav Kumar, Shivangi Thakur, Anjali Sharan

This is a rare congenital anomaly, which is characterised by abnormal rotation and fixation of the intestines during embryonic development, which may or not present symptoms in life. In present case, during dissection of the abdominal cavity of a 72-year-old male cadaver, it was found that duodenum and DJ junction was malpositioned (above the transpyloric plane), and pancreas was also present in the ‘C’-loop. Its first part was positioned normally, but its second, third, fourth and duodeno-jejunal juction was placed above the transpyloric plane, which is normally present to left of the midline below transpyloric plane. This type of malrotation occurs when the midgut fails to complete its second and third 90-degree rotations during embryonic development. This case presents the anatomical variation of intestinal malrotation that can remain asymptomatic throughout the life. In symptomatic cases, life threatening complications such as volvulus can be imminent.

Noonan-like Syndrome with Loose Anagen Hair Due to SHOC2 Mutation: A Case Report

Deepika Yadav, Dinkar Yadav, Jyoti Kadian, Ishita Singh, Kapil Bhalla

Noonan syndrome is an autosomal dominant genetic condition, although some cases arise from de novo mutations, which has an approximate prevalence of 1:1000 to 1:2500 live births with many underlying gene mutations in RAS/MAPK pathways whereby common gene mutations being PTPN11 and SOS1. However, some rare pathogenic gene mutation like SHOC2 may be seen leading to phenotypical Noonan syndrome. The authors report novel clinical features in the index case, described as Noonan-like Syndrome with Loose Anagen Hair (NS/LAH). Authors, hereby, report a 12-year-old male who presented with global developmental delay, speech impairment, short stature, characteristic dysmorphic features, left-sided hemiparesis, and skin findings including ichthyosis and atopic dermatitis. Whole exome sequencing identified a pathogenic SHOC2 mutation consistent with the diagnosis of NS/LAH. Uniquely, a concurrent pathogenic BRCA1 variant was identified, though the child exhibited no signs of malignancy at presentation. This case expands the known clinical spectrum of SHOC2-related RASopathies by presenting an unusual association with unilateral motor deficits and a novel co-occurrence with a BRCA1 mutation. While SHOC2 mutations are known to disrupt RAS/MAPK pathway signalling, their relationship with motor asymmetry and overlapping cancer-risk gene variants like BRCA1 is not well-established. We emphasise the importance of comprehensive genetic evaluation in children with atypical phenotypes and unexplained developmental delays. Early recognition and long-term surveillance are critical in such complex genetic cases to identify evolving features and associated risks.

Skeletal and Cardiac Myopathy with Acquired Factor X Deficiency in a Patient with Monoclonal Gammopathy of Clinical Significance: A Rare Case Report

Pragya Garg, S Meghana, Neeraj Jain, Lalit Duggal

Monoclonal gammopathies include several types of plasma cell proliferative disorders, which might be benign to malignant. Monoclonal Gammopathy of Clinical Significance (MGCS) refers to small plasma cell clones that cause organ damage without meeting criteria for multiple myeloma. The common MGCS syndromes include renal, neurologic and cutaneous, while there is evidence of haematological and multi-organ involvement. MGCS-associated myopathy is a rare presentation, including amyloid light chain amyloidosis and sporadic late-onset nemaline myopathy. MGCS presenting solely with myopathy may lead to misdiagnosis with other common causes of myopathies, delaying management. The condition being rare, it lacks standardised guidelines on management, while data from certain reports suggest treating monoclonal gammopathy for optimal results. This article presents a case of a 57-year-old man with progressive thigh pain, ecchymoses, and proximal muscle weakness for four months. MRI showed muscle oedema, and autoantibody positivity initially suggested immune-mediated myositis. However, recurrent bleeding with deranged coagulation revealed acquired factor X deficiency. Further evaluation demonstrated elevated lambda light chains, abnormal kappa/lambda ratio, and 5% clonal plasma cells on bone marrow biopsy. Cardiac imaging revealed infiltrative cardiomyopathy without amyloidosis. These findings confirmed MGCS with multisystem involvement (myopathy, cardiomyopathy, and coagulopathy). The patient improved on daratumumab, bortezomib, cyclophosphamide, and dexamethasone. This case illustrates the diagnostic challenge of MGCS, which may mimic autoimmune myositis. Awareness of such atypical presentations is crucial, as therapy is guided by organ injury rather than tumour burden. Early recognition and clone-directed treatment are essential to preserve organ function.

Atypical Presentation of Pseudomonas aeruginosa Meningitis as a Sequel of Mastoiditis: A Case Report

Ankita Poddar, Sampurna Borbora, Yugeshwari Tiwade, Nandkishor Jageshwar Bankar

Bacterial meningitis is associated with significant morbidity and mortality. One of the causative agents, Pseudomonas aeruginosa is a less commonly encountered pathogen, predominantly associated with post-neurosurgical infections. Here, in this case report, the patient presented with persistent headache, otalgia, vomiting, and cough. The Computed Tomography (CT) scan suggested the possibility of Central Venous Sinus Thrombosis (CVST). Diagnostic work-up revealed right-sided mastoiditis. Microbiological analysis of Cerebrospinal Fluid (CSF) showed growth of Pseudomonas aeruginosa. The patient received intravenous antibiotics as per sensitivity report, which showed clinical improvement and resolution of the infection. This case highlights the importance of early diagnosis, culture and antimicrobial susceptibility testing, and appropriate antimicrobial therapy in managing Pseudomonas aeruginosa meningitis secondary to mastoiditis. An integrated, multidisciplinary approach involving neurologists and otolaryngologists is important to ensure favourable clinical outcomes.

Anaesthetic Implications of Concurrent Difficult Airway and Giant Pulmonary Bullae in a Head and Neck Cancer Patient: A Case Report

Deepti Sharma, Ruchi Saxena, Chandni Verma, Archana Gautam, Md Asim Rasheed

Difficult airways are commonly encountered and pose significant challenges in patients with head and neck malignancies. This complexity is further compounded by the incidental finding of giant pulmonary bullae, which carries a risk of barotrauma and intraoperative complications. We report a 44-year-old patient with lower lip carcinoma who was posted for composite resection and flap reconstruction. Patient gave history of intermittent mild asthma and tuberculosis. On examination, patient had limited mouth opening with coincidental giant pulmonary bullae of the right lung. Given the time-sensitive nature of the cancer surgery, it was decided to proceed with cancer surgery. Carefully balanced anaesthetic plan was formulated to mitigate both risks simultaneously. Awake Fibreoptic Nasotracheal Intubation (AFNI) with EZ bronchial blocker was planned. To achieve favourable outcomes in such high-risk patients, we must avoid factors that increase intrathoracic pressure, nitrous oxide etc., and encourage lung-protective ventilation, vigilant intraoperative monitoring, smooth extubation and be ready to manage pulmonary complications. The uniqueness of this case report lies in the rare coexistence of two major anaesthetic challenges- a difficult airway and giant pulmonary bullae. Literature commonly reports either difficult airway in head and neck cancers or bullous lung disease, but their simultaneous occurrence in a time-sensitive oncologic surgery is extremely uncommon.

Hybrid Odontogenic Tumour Presenting as Unicystic Ameloblastoma with Calcifying Odontogenic Tumour: A Rare Case Report with Review of Literature

Veena Vijay Naik, Punnya V Angadi

Tumours originating from the odontogenic apparatus exhibit a high level of diversity and complexity. They exhibit a wide range of morphologies because this tissue is formed by time-dependent, closely regulated interactions between mesenchymal and epithelial elements. Notably, hybrid lesions—which consist of two or more separate regions displaying distinctive morphologic traits of different entities—are uncommon and, when they do occur, provide a diagnostic difficulty. Despite the identification of numerous hybrid lesions, their prevalence and combinations remain unknown. Ameloblastoma with Calcifying Epithelial Odontogenic Tumour (CEOT) is an extremely rare hybrid tumour, with five cases reported previously. The current paper reviews the pertinent literature and describes one more instance of a hybrid odontogenic tumour composed of ameloblastoma with CEOT. In the present case, the lesion in the mandible was provisionally diagnosed as a dentigerous cyst based on clinical and radiographic findings. But based on the histopathologic evaluation of the incisional biopsy specimen, the diagnosis of unicystic ameloblastoma with intramural proliferation was given. However, histopathology of the excised tumour revealed areas of plexiform ameloblastoma with mural proliferations along with areas of CEOT. Hence, a final diagnosis of hybrid odontogenic tumour of unicystic ameloblastoma with CEOT was confirmed. Hybrid odontogenic lesions create a diagnostic challenge. Diverse differentiation and intricate inductive connections are possible in odontogenic tumours that arise from odontogenic epithelium. Thus, it may be said that pluripotent odontogenic epithelium simultaneously causes the development of such disparate histopathological patterns inside a single tumour, resulting in the development of a hybrid tumour.

Microinvasive Management of Enamel Hypomineralisation with Resin Infiltration Technique: A Case Report

Enamel hypomineralisation exists as a developmental defect that produces white opacities which affect tooth appearance, mainly in front teeth. The current treatment methods for these lesions might be too invasive, while they succeed in hiding them to some extent. The microinvasive technique of resin infiltration enhances dental appearance by altering the optical properties of porous enamel. A 23-year-old female patient reported to the department with a complaint of white discolouration, affecting the front teeth. After clinical examination diagnosis was made as enamel hypomineralisation. The aesthetic issue and non cavitated status of the lesions led to the choice of resin infiltration (ICON®, DMG, Germany) as the treatment approach. The aesthetic results obtained after the treatment were maintained through the 12-month follow-up period with no evidence of relapse or reappearance of the pre-existing lesions. The patient experienced no postoperative tooth sensitivity and expressed complete contentment with the results. Resin infiltration represents an effective and conservative treatment option for the aesthetic management of enamel hypomineralisation. The selection of suitable cases along with protocol adherence will generate predicted outcomes that maintain most tooth structure and enable patients to reach their highest level of satisfaction.

Effectiveness of Short-term Pulmonary Rehabilitation in a Patient with Rheumatoid Arthritis Associated Interstitial Lung Disease: A Case Report

Dinkey Mankad, G Palani Kumar, Kalpesh Satani

Interstitial Lung Diseases (ILDs) comprise a heterogeneous group of chronic conditions characterised by lung parenchymal involvement with different degrees of inflammation and fibrosis resulting in impaired gas exchange. Rheumatoid arthritis is commonly associated with ILD. Pulmonary-rehabilitation plays a significant role in Rheumatoid Arthritis associated ILDs (RA-ILD). A 37-year-old female patient came to the respiratory medicine department with a complaint of breathleness since 11-years, cough along with expectoration since one year, neck pain, generalised weakness since one-month and diagnosed as acute exacerbation of ILD-associated with rheumatoid arthritis with cor pulmonale. Tailor-made pulmonary rehabilitation which includes early mobilisation active breathing exercises, incentive spirometry, exercise training (aerobic, resisted and flexibility) and airway clearance techniques was given for a period of two-weeks. Follow-up assessments were performed after two weeks and after four weeks of telerehabilitation (i.e., at six weeks from baseline) to evaluate the overall treatment outcomes using the following outcome measures -Modified Medical Research Council dyspnoea grading scale, Six Minutes Walking Distance (6MWD), St. George Respiratory Questionnaire-SGRQ and Hospital Anxiety And Depression Scale (HADS). The primary physiotherapeutic outcomes were reduction in dyspnoea and improvement in functional capacity and quality of life. Findings of this case report indicate that short term pulmonary rehabilitation is feasible and effective in patients with RA-ILD and showed significant improvement in the aerobic capacity, cardiorespiratory symptoms and quality of life of the patient with RA-ILD Despite combined pulmonary and musculoskeletal limitations, the patient demonstrated meaningful improvements in functional capacity and dyspnoea. The findings emphasise the feasibility and clinical value of early, time-efficient pulmonary rehabilitation in RA-ILD.

Atypical Morphological Patterns of Alopecia Areata with Trichoscopic and Histopathologic Correlation: A Case Series

Alopecia Areata (AA) is an autoimmune disease that affects the hair follicles, clinically characterised by patchy areas of hair loss, commonly affecting the scalp but also involving any hair-bearing area of the body. Various morphological patterns are described till date, the most common being patchy hair loss. Atypical patterns like annular and rectangular AA are also reported. This case series includes three morphological patterns of AA, which differ from classic forms, namely the central sparing pattern characterised by preserved islands of terminal hair within areas of patchy hair loss, the paw pattern in which multiple patches of hair loss cluster together to resemble the shape of a paw, and the punctate pattern marked by numerous small punctate areas of hair loss. Diagnosis of AA was confirmed by trichoscopic and histopathologic features. Awareness of such patterns is essential for dermatologists to aid in proper management. Hereby, the author reports three unusual morphological patterns of AA previously not documented in the literature.

Infections Unmasking a Hyperinflammatory Storm: A Case Series of Secondary Haemophagocytic Lymphohistiocytosis Triggered by Leishmaniasis, Melioidosis and Dengue

Haemophagocytic Lymphohistiocytosis (HLH) is a rare, aggressive hyperinflammatory syndrome resulting from uncontrolled activation of cytotoxic T lymphocytes and macrophages, leading to excessive cytokine release and progressive multiorgan dysfunction. Although HLH is a familial disorder in the paediatric population, it is increasingly recognised in adults predominantly as a secondary or acquired form triggered by infections, malignancies, or autoimmune diseases. Adult HLH remains diagnostically challenging due to its nonspecific clinical presentation, frequent overlap with severe sepsis, and lack of awareness among clinicians; often resulting in delayed diagnosis and high mortality. Infectious etiologies are among the most common triggers of secondary HLH, particularly in tropical countries; however, diverse pathogens may precipitate a similar cascade. Visceral leishmaniasis, melioidosis, and dengue fever are individually well-known causes of febrile illness, yet their association with HLH in adults is infrequently reported and often underdiagnosed. The coexistence of HLH with these infections further complicates clinical management, as immunosuppressive therapy must be carefully balanced against ongoing infection. All 3 cases were diagnosed with secondary HLH at 3 different occasions, and we suspected HLH because inspite of giving the appropriate treatment for the respective diseases, patients did not improve. All patients fulfilled the HLH-2004 diagnostic criteria and demonstrated haemophagocytosis on bone marrow examination. This case series underscores the importance of maintaining a high index of suspicion for HLH in adults presenting with prolonged fever, splenomegaly, and cytopenias, especially in endemic regions. By highlighting rare infectious triggers and emphasising early diagnostic strategies, this report aims to contribute to existing literature and improve the timely recognition and management of adult secondary HLH

Unveiling Procoagulant States in Acute Pulmonary Embolism: A Case Series and Insights

Venous Thromboembolism (VTE) is a common yet potentially life-threatening condition. The most frequent presentations of venous thrombosis are Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). The causes of venous thrombosis can be hereditary or acquired, often involving multiple risk factors in a single patient. Thrombophilia is a general term used to describe various inherited or acquired conditions that increase a person’s risk of VTE. Several genetically determined defects associated with thrombophilia are linked to at least a third of all VTE cases. The most common hereditary thrombophilias include gain-of-function mutations in factor V, specifically the Factor V Leiden (FVL) mutation, and the Prothrombin Gene Mutation (PGM). Additionally, deficiencies of antithrombin, protein C, and protein S are significant hereditary risk factors. Among the acquired thrombophilias, Antiphospholipid Syndrome (APS) is notable. Here, the authors describe five cases of acute Pulmonary Thromboembolism (PTE) linked to underlying thrombophilia. These cases highlight the importance of evaluating thrombophilia in patients who experience recurrent or unprovoked thromboembolic events. Case 1 involved a 26-year-old postpartum female with bilateral PTE, extensive DVT, Right Ventricular (RV) dysfunction, and heterozygous FVL mutation. In case 2, a 30-year-old healthy male athlete, presented with haemoptysis and pulmonary infarction due to segmental PTE and was found to have a heterozygous FVL mutation with low-normal protein C levels. In case 3, a 25-year-old male presented with bilateral distal PTE, severe pulmonary hypertension, and triple-positive Antiphospholipid Antibody (APLA) syndrome. Case 4 involved a 33-year-old male with a history of PTE and Cerebrovascular Accident (CVA), developed recurrent PTE due to non-compliance with anticoagulation and was diagnosed with protein C deficiency. Case 5 comprised a 30-year-old blind female with active tuberculosis and bronchiectasis, presented with segmental PTE and was found to have an FVL mutation along with protein S deficiency.

Varying Course and Outcomes in Mephentermine-induced Psychosis: A Case Series

Archana Javadekar, Sindhuja Balu, Shravani Javadekar, Mukesh Patel

Mephentermine, a sympathomimetic amine commonly used to treat hypotension, is increasingly being misused for its stimulant and euphoric properties, particularly among young adults. Despite its structural similarity to amphetamines, reports of mephentermine-induced psychosis remain rare in the literature. This case series presents three young adult males who used mephentermine from one month to one year and developed acute psychotic symptoms. Presentations ranged from fear to hearing voices to aggression. They all had different lengths of recovery period. This emphasises the role of early detection and treatment. One patient responded rapidly to low-dose risperidone and achieved remission within two weeks. Another, with a prolonged history of use and more severe symptomatology, required antipsychotics and Electro Convulsive Therapy (ECT), yet showed only partial improvement. The third patient, with a prior psychiatric history and concurrent cannabis use, demonstrated significant symptom reduction with mood stabilisers and supportive care. The spectrum of presentations, ranging from brief psychotic episodes to treatment-resistant states mimicking schizophrenia, highlights the variability in clinical outcomes based on duration, dose, and co-morbid vulnerabilities. These cases underscore the need for increased clinical vigilance regarding stimulant misuse, especially injectable mephentermine, and the importance of early detection and comprehensive management strategies. Given the limited existing literature, this report aims to contribute to the understanding of mephentermine-induced psychosis and draw attention to its growing misuse in non-medical settings.

Comminuted Patella Fracture and its Non-union Treated with Modified Cerclage Wiring (Wire Mesh Technique): A Case Series

Non-union of the patella is relatively rare, occurring in 2.4-12.5% of cases, yet it frequently requires surgical treatment due to discomfort and functional impairment. The proximal fracture fragment is usually displaced by the quadriceps, resulting in a gap that hinders recovery. Managing non-union in comminuted patella fractures is extremely challenging due to the presence of numerous tiny pieces and difficulties in attaining stable fixation. The present case series presents an innovative cerclage wiring procedure, referred to as the “Wire Mesh Technique,” employed for patients with comminuted patellar fractures and non-union. The present case series included three male patients aged 35, 42, and 66 years, each exhibiting non-union of comminuted patella fractures subsequent to trauma. All patients experienced difficulty bearing weight and extending the affected knee, characterised by extensor lag and limited range of motion. Radiographic assessments confirmed non-union of the patella in every case. After clinical and radiographic evaluation, the wire mesh procedure was utilised to address insufficient healing and the complex arrangement of fragments. Postoperative rehabilitation included early in-bed mobilisation and quadriceps exercises starting on day zero, walker-assisted non-weight bearing on day two, and gradual range of motion exercises initiated on day ten. Full weight-bearing began at two months. Postoperative imaging showed optimal implant placement and medullary healing. Patients successfully regained weight-bearing capacity and experienced enhanced knee flexibility and motion. This approach reduces circular tension and improves stability, facilitating rapid mobilisation and positive outcomes in complicated patellar fracture non-unions.

Silent Growth: A Case Series on the Intriguing Journey of Sinonasal Schwannomas

Eileen Benny Kuriakose, J Shiva Priya, M Vinoth, L Somu

Sinonasal schwannomas are rare benign tumours arising from Schwann cells, comprising less than 4% of all head and neck schwannomas. Their clinical presentation is often non specific, leading to frequent misdiagnosis. The authors present three cases of sinonasal schwannomas to illustrate the diagnostic and therapeutic challenges associated with these tumours. The patients, including two adult females and one adolescent male, presented with unilateral or bilateral nasal obstruction and associated symptoms such as nasal discharge, epistaxis and snoring. Imaging using Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) revealed well-defined, enhancing soft-tissue masses confined to the nasal cavity and paranasal sinuses, without evidence of orbital or intracranial extension. Provisional diagnoses included juvenile nasopharyngeal angiofibroma and antrochoanal polyp. All patients underwent complete tumour excision via a transnasal endoscopic approach. Histopathological examination {Haematoxylin & Eosin (H&E)} confirmed the diagnosis of schwannoma in all cases, demonstrating the characteristic biphasic Antoni A and Antoni B patterns with Verocay bodies. One case was diagnosed as an ancient schwannoma. There were no significant intraoperative or postoperative complications and no recurrences were observed during follow-up periods ranging from 6 to 12 months. These cases underscore the importance of considering schwannoma in the differential diagnosis of unilateral nasal masses. While imaging aids in assessing the extent of the lesion, definitive diagnosis relies on histopathological examination. Endoscopic surgical excision is a safe and effective treatment option, offering excellent outcomes with minimal morbidity.

Gross Staining Techniques in Autopsy: A Revisit

Vinaya B Shah, Sneha P Janjal

A 55-year-old man presented to the casualty with haematuria and haemoptysis of about six months’ duration. Investigations revealed nephrotic-range proteinuria, while biochemical and coagulation studies were within normal limits. A kidney biopsy was performed, following which the patient succumbed shortly after the procedure. An autopsy revealed around one litre of blood in the abdomen along with a huge blood clot weighing approximately 900 g. Both the kidneys, liver, pancreas, and the spleen were enlarged and pale in appearance. Histopathological examination of these tissue showed amorphous extracellular deposition of eosinophilic material, which was highlighted by Congo red staining and confirmed the presence of amyloid. Along the path of modernisation in molecular pathology, a number of sensitive and specific tests have been developed to identify amyloid in tissue sections, like polarisation microscopy, electron microscopy, and immunohistochemistry for amyloid fibrils. However, the older, simple technique of gross demonstration has either been forgotten or has lost its significance in the process.

Evaluation and Comparison of the Antimicrobial Efficacy and Sealing Ability of Fish Bone Paste with Calcium Hydroxide Paste as Pulp Capping Material: A Research Protocol for an In-vitro Study

Akanksha Akhatkar, Nilima Thosar, Aakriti Chandra, Mrunali Deshkar

Introduction: Indirect Pulp Capping (IPC) is defined as a procedure wherein a small amount of carious dentin is retained in deep areas of the cavity to avoid exposure of pulp, followed by placement of a suitable medicament and restorative material that seals off the carious dentin and encourages pulp recovery. Calcium hydroxide has been the gold standard for pulp capping material due to its exceptional biocompatibility, antibacterial properties, and ability to encourage the formation of reparative dentin. Fish Bone (FB) powder is a naturally occurring substance that has shown promise as a pulp capping material. It contains a lot of calcium, phosphates, and other bioactive substances that could help with dentinogenesis and repair. To ascertain whether it can be a suitable substitute for or addition to calcium hydroxide, its antimicrobial activity and sealing capacity must be thoroughly assessed. Need of the study: The current study can demonstrate the antimicrobial effectiveness and sealing ability of FB paste as a pulp capping material. Aim: To evaluate and compare the anti-microbial efficacy and sealing ability of FB paste with calcium hydroxide paste as pulp capping materials through an in-vitro study. Materials and Methods: An in-vitro study will be conducted in Department of Paediatric and Preventive Dentistry at Sharad Pawar Dental College, Wardha, Maharashtra, India, from May 2025 to December 2025, in which FB paste and calcium hydroxide paste will be prepared to evaluate and compare the anti-microbial efficacy and sealing ability for an in-vitro investigation in the Department of Paediatric and Preventive Dentistry at Sharad Pawar Dental College, Wardha, Maharashtra, India. The agar diffusion method will be used to evaluate the antibacterial efficacy of calcium hydroxide paste and FB paste against Enterococcus faecalis. After being cultivated in brain-heart infusion broth for the entire night, the E. faecalis stock culture will be injected onto Muller-Hinton agar plates. A copper puncher will be used to create wells on the plates that are 4 mm in diameter and 4 mm deep. The wells will then be promptly filled with freshly created, specially designed test materials. After being incubated at 37°C for 24 and 72 hours, the agar plates will be evaluated. The diameter of the zone of inhibition will be measured in millimetres after incubation. The dye penetration method will be used to evaluate the sealing ability of calcium hydroxide paste and FB paste. After preparing a Class I cavity, pulp capping material consisting of calcium hydroxide and powdered FBs will be inserted into the cavity. All samples will undergo 500 thermocycling cycles with 60-second dwell intervals to replicate dental conditions, and each tooth will receive two coats of nail polish with a 1 mm margin around the restoration border. Following a 24-hour incubation period at room temperature in 5% methylene blue dye, the samples will be rinsed under running water and then sectioned mesiodistally using a diamond disk with water cooling. To assess the material's capacity to seal, the degree of dye penetration will be evaluated. The Chi-square test, student paired and unpaired t-test, One-way Analysis of Variance (ANOVA), and Tukey test will all be used in the statistical analysis.

Clinical Image of Arteriovenous Malformation of the Left Upper Limb: An Uncommon Vascular Anomaly

Prastuti Pramod Dhande, Sheetal Asutkar, Shubham Bobade, Sakshi Ghughal

A 27-year-old patient visited the Outpatient Department (OPD) with a primary complaint of longstanding swelling in the left forearm and hand, accompanied by dilated veins in the same region for the past four years (Table/Fig 1). The swelling had gradually increased over time, causing pain and discomfort during activity. There was no family history of similar symptoms. Two years ago, the patient was diagnosed with an Arteriovenous Malformation (AVM) in the thenar eminence, identified through a venous Doppler study. An embolectomy was subsequently performed; however, the condition later recurred. The patient had no significant medical history.

A Silent Intruder: Diagnosing and Managing a Uterine Polyp in a Young Female

Sheetal Asutkar, Ayushi Gautam, Shipla Jamdade

Endometrial polyps are asymptomatic benign neoplasms of the uterine lining that often result in Abnormal Uterine Bleeding (AUB), an illness that is frequently encountered in clinical practice (1). While the polyps are generally asymptomatic, when symptomatic, they can have a profound impact on a woman’s reproductive life if undetected or untreated. Prompt diagnosis, usually with non-invasive imaging modalities, and treatment are necessary to avoid further morbidity (2). The case illustrates the diagnosis and management of a benign endometrial polyp in a 39 year old female patient presenting with abnormal uterine bleeding for more than 3 months. She also had mild lower abdominal pain but no associated fever or systemic symptoms. Her menstrual cycle was regular, and she was not on hormonal therapy. Since her symptoms were chronic, an abdomen-pelvis ultrasound was done, and this was positive for a well-defined hyperechoic lesion measuring approximately 12 mm in diameter in the endometrial cavity. This report was provisionally suggestive of the presence of an endometrial polyp. Differential diagnoses for the lesion were endometrial hyperplasia, submucosal fibroids, and endometrial carcinoma. The focal type of the lesion, soft echotexture, and absence of alarming systemic symptoms also indicated the exclusion of malignancy (3). These diagnostic pointers and the patient’s clinical history indicated the possibility of a benign endometrial polyp. Due to the persistence of her symptoms and the diagnosis made, a decision for treatment was taken to undergo a hysterectomy. Though hysteroscopic polypectomy is usually considered the gold standard for removal of a polyp (4), in this patient, hysterectomy was planned as the patient was married and had completed her family with two children due to the persistence of her symptoms and absence of desire to preserve fertility. Consent of hysterectomy was taken prior to the surgical procedure. Interestingly, the patient herself did not desire the preservation of fertility, and the decision to undergo the removal of the uterus was thus a rational one. The surgery was smooth, and a histopathological examination of the resected tissue reconfirmed the preoperative diagnosis of a benign endometrial polyp with no malignancy or atypia. The postoperative period was smooth. (Table/Fig 1) shows the intraoperative image of a uterine polyp during hysterectomy. [Table/Fig-2,3] shows the different aspects of the resected uterine polyp specimen.

A Rare Familial Occurrence of Bilateral Entoconulid in Maxillary Primary Second and Permanent First Molars in Siblings: Images in Medicine

An 11-year-old boy reported to the Department of Paediatric and Preventive Dentistry with a complaint of a carious tooth in the lower left back region of the jaw with no pain or discomfort. The patient had no history of previous medical conditions, ongoing medication, allergy or surgeries. Furthermore, the patient had no history of previous dental procedures or treatments, including restorations or pulp therapies. On further examination, the patient revealed a sixth accessory cusp or entoconulid on both the 2nd deciduous molars and 1st permanent molars in the maxillary arch (Table/Fig 1). The family history revealed no notable hereditary dental or medical conditions, except for the sister of the patient, a 13-year-old female, who was examined and noted to have a similar entoconulid on the maxillary first permanent molar (Table/Fig 2). This finding possibly suggested a potential familial tendency or genetic component related to dental morphology. On clinical examination, there was no evidence of caries, pulpal involvement, or periodontal issues. Each additional cusp was not in occlusion and had a groove that separated it from other cusps. Other than preventive measures like pit and fissure sealant, maintaining oral hygiene, and diet counselling, no invasive treatment was advised for the non-occlusion because the accessory cusps did not interfere with the patient’s functional bite or cause habitual jaw repositioning.

Intraoperative Image of Modified Radical Mastectomy with Axillary Lymph Node Dissection of Left Invasive Breast Carcinoma

Tushar Nagtode, Shubham Bobade

A 52-year-old female presented to the Department of General Surgery with a chief complaint of a lump in the left breast, not associated with pain, discharge, or redness, which had progressively increased in size over the past month. She had no history of systemic illnesses or prior surgeries, and there was no family history of similar complaints. On examination, a hard, non-tender, fixed lump measuring 3.5×3 cm was identified in the lower outer quadrant of the left breast. Fine Needle Aspiration Cytology (FNAC) was performed, and the findings were suggestive of ductal carcinoma.

Pseudo-Saber-Sheath Trachea Sign in Ankylosing Spondylitis

Praveen Kumar Chinniah, Madhavi Kandagaddala, Aparna Irodi

A 42-year-old male, a non smoker, with a history of weight loss for three months and intermittent back pain for the past two years (on and off in nature), with no history of fever, no significant past medical or family history, and no associated co-morbidities, underwent a Computed Tomography (CT) chest examination.

MRI Findings in Long Head Biceps Tendon Rupture with Popeye Deformity

Prasad Desale, Rajasbala Dhande, Pratapsingh Parihar, Siddhi Patil

A 56-year-old woman presented to the orthopaedic outpatient clinic with acute pain and a visible bulge in her right upper arm following a heavy lifting incident two days prior. On clinical examination, there was weakness during elbow flexion and a prominent soft-tissue swelling that became more pronounced with flexion, suggestive of Popeye’s sign (Table/Fig 1). The Hook test for distal biceps tendon rupture was negative. Plain radiographs were unremarkable.

Bilateral Talon Cusp Associated with Mesiodens

A 10-year-old boy reported to the Department of Paediatric and Preventive Dentistry for a routine dental checkup. The boy had a normal appearance as per his age, with no significant medical and dental histories. A completely erupted mesiodens was observed during the intraoral examination. Labially, an extra cusp was seen, which extended from the cervical 1/3rd till the middle 1/3rd of the tooth, being pyramidal in shape, and merged onto the labial surface of the supernumerary tooth. Palatally, an oval-shaped cusp projected from the cingulum up to more than 2/3 of the lingual surface (Table/Fig 1). Based on the history, it had been found that the extra tooth had erupted three years back. The mesiodens had a similar resemblance in shape to a maxillary incisor, but was smaller in size.

Intramuscular Schwannoma: Ultrasound Imaging Findings

Shaik Ishma Mustafa, Jatin Nehra, Sangavi Jeyaraj, Senthil Kumar Aiyappan

A 48-year-old female who was asymptomatic until two months ago, presented with a solitary swelling over the lower left anterior arm, which was gradual in onset, progressive in nature, and attained the present size of ~ 3×2 cm with no complaints of pain or discharge. There was no history of trauma. Past history and family history was unremarkable. On examination, the patient was conscious, oriented, and afebrile. Vitals were normal. On inspection, fullness was noted over the lower left anterior arm, with a smooth surface and no visible skin changes, scars, or discharge. On palpation, the swelling was soft with a well-defined edge. The swelling was firm, non-pulsatile, and mobile in all directions. Skin over the swelling was pinchable. No tenderness or warmth over the swelling was noted, and there were no palpable left axillary lymph nodes. The laboratory investigations revealed a haemoglobin level of 11.6 g/dL and a total leukocyte count of 7,140/cu mm, with neutrophils constituting 67.4% and lymphocytes 26.3%. Renal and liver function tests were within normal limits. The patient underwent an ultrasound examination for the swelling. A well-defined, round hypoechoic intramuscular lesion of approximately ~ 2.4×1.9 cm was noted in the left anteroinferior deltoid muscle with no internal vascularity or surrounding inflammation. A few tiny cystic areas were noted within the lesion, suggestive of cystic degeneration. Fat was noted in the upper pole of the lesion (Table/Fig 1). USG-guided FNAC of the swelling revealed features suggestive of a benign spindle cell neoplasm. Excision biopsy of soft-tissue swelling showed features compatible with schwannoma with cystic degeneration. The patient is doing well and is on follow-up.

IgG4-related Disease Presenting as Orbital Apex Syndrome

This 67-year-old male patient, was a known case of hypertension, ischaemic heart disease and diabetes. He was on treatment for the last three years with Telmisartan 40 mg daily, Aspirin 150 mg once daily, Atorvastatin 40 mg once at night and Glimepride 1 mg daily. He presented with a one-month history of intermittent right hemicranial headache without any nausea or photophobia. This was followed by aggravation of symptoms over the last two weeks with double vision on lateral gaze and drooping of the right eyelid. There was no history of fever, seizures, bladder involvement or limb weakness. There was no skin rash, cough with expectoration or weight loss. The patient reported no prior history of similar symptoms. General examination was unremarkable and vital signs were normal. Central nervous system examination showed right eye proptosis with optic nerve involvement in the form of reduced visual acuity of the right eye and also Bilateral papilledema. Examination also revealed ptosis of the right eye with involvement of both medial rectus and lateral rectus suggestive of right third and sixth nerve involvement. There was no other cranial nerve involvement. There was no motor weakness, sensory loss or meningeal signs.

Imaging Findings of Macronodular Adrenal Hyperplasia

A 67-year-old female presented with complaints of pain and difficulty while walking for three days. There was no history of trauma, fever, chest pain, cough, breathlessness, abdominal pain, nausea or vomiting. Family history and personal history were unremarkable. On examination, the patient was conscious and oriented. No pallor, icterus, cyanosis, clubbing or significant lymph node enlargement was noted. Vitals: temperature: afebrile, Pulse rate: 70/min, Blood Pressure (BP): 140/80 mmHg, and SpO2 of 98% on room air. Systemic examination was regular. On local examination, diffuse non-pitting oedema was present extending from the left foot to the knee joint. Calf tenderness, erythema and local rise of temperature of left lower limb was present. Laboratory investigations revealed a haemoglobin value of 10.6 g/dL and a total leukocyte count of 10,400/cu.mm, (neutrophils: 67.8%, lymphocytes: 7%), serum creatinine was 1.2 mg/dL. Thyroid and liver function tests were within normal limits. The patient underwent left lower limb venous Doppler, which showed evidence of deep vein thrombosis in left common femoral vein extending across saphenofemoral junction into the great saphenous vein (Table/Fig 1). Diffuse subcutaneous oedema and thickening of fat planes were noted in the left lower limb. The right lower limb Doppler was normal. CT pulmonary angiogram was done which showed incidental finding of enlarged bilateral adrenal glands in the form of large distinct nodules demonstrates a mean attenuation of -4 to 7 Hounsfield Units (HU) on CT, with no evidence of calcification. Right adrenal gland measured 2.3×1.5 cm and left adrenal gland measured 2×2.8 cm. Both adrenal gland shows homogenous postcontrast enhancement [Table/Fig-2a-d,3a]. There was evidence of small filling defect involving the subsegmental branch of lateral segment of right lower lobe- suggestive of pulmonary thromboembolism (Table/Fig 3b). Blood investigations including serum cortisol 11 mcg/dL (6-23 mcg/dL), and plasma Adrenocorticotrophic Hormone (ACTH) level 20 pg/mL (6-76 pg/mL) was normal. Following the investigations, patient was diagnosed as a case of femoral deep vein thrombosis with incidentally detected bilateral adrenal macronodular hyperplasia. The patient was treated with intravenous anticoagulants and planned for catheter-directed thrombolysis; however, the patient expired after 48 hours due to cardiac arrest. There was no relationship between adrenal macronodular hyperplasia and cardiac arrest, since the hormonal levels were normal and the cause for cardiac arrest was pulmonary thromboembolism.

Herpes Simplex Encephalitis in a Neonate: Neuroimaging Findings

A 21-day-old male baby born of a non-consanguineous marriage presented to the casualty department with a history of high-grade, intermittent fever for one day. The baby was conscious on arrival and was further admitted under the Department of Paediatrics. The baby was delivered by normal vaginal delivery with a normal Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of 8 and was discharged on Day 3 of life. On examination, the baby was active with normal vital parameters. After 12 hours of admission, the baby had generalised tonic clonic seizures, which were aborted with Inj. phenobarbitone loading dose of 20 mg/kg and maintenance dose of 5 mg/kg. The baby was also started on oxygen with nasal prongs at 2 L/min. The baby had two more episodes of generalised tonic clonic seizures for which Inj. levetiracetam 20 mg/kg was loaded and continued as maintenance dose. To rule out inborn errors of metabolism, serum ammonia was sent and was within normal limits. Ultrasonography (USG) of the cranium was performed and revealed no significant abnormalities. Blood investigations, including serum electrolytes, calcium, magnesium, and complete haemogram, were within normal limits. On day 2 of admission, a lumbar puncture was performed. Cerebrospinal Fluid (CSF) analysis revealed an increased total leukocyte count with lymphocytic predominance, along with elevated protein levels. The baby was subjected to Magnetic Resonance Imaging (MRI) of the brain. MRI of the brain showed multiple patchy areas of restricted diffusion and corresponding low Apparent Diffusion Coefficient (ADC) values involving cortical and subcortical white matter of bilateral frontal and parietal lobes, bilateral centrum semiovale, bilateral corona radiata and posterior limb of bilateral internal capsule, thalamus, left medial temporal lobe and left insular cortex. These imaging features with selective diffusion restriction involving bilateral frontal and parietal lobes, left medial temporal lobe and left insular cortex were suggestive of herpes simplex encephalitis [Table/Fig-1,2]. CSF Polymerase Chain Reaction (PCR) was sent and returned positive for Herpes Simplex Virus (HSV)-1. The baby was started on Inj. Acyclovir at a dose of 20 mg/kg/day, which was continued for 21 days. Chorioretinitis was ruled out after obtaining Ophthalmology opinion. The baby was weaned off to room air on Day 3 of admission and was maintaining saturation at room air. On Day 3 of admission, Inj. phenobarbitone and levetiracetam was changed to oral form. Phenobarbitone was tapered and stopped on Day 5 of admission. Baby had no further episodes of seizures in the hospital stay and improved gradually.

Machine Learning and Artificial Intelligence Model, Transforming the Future of Clinical Biochemistry: A Letter to Editor

Astha Yadav, Joel Sam

Machine Learning (ML) and Artificial Intelligence (AI) models are tools of modern computing innovation that are leading the way for revolution in changing the functioning of modern life. These digital tools help solve complex problems encountered even by advanced systems. This technology has started to be utilised in healthcare, where it helps in designing predictive models of diseases, diagnosis of patients and their prognosis. Clinical biochemistry has been the cornerstone of this advancement and has helped physicians make better treatment decisions. The introduction of AI and ML models into clinical biochemistry would bring significant changes in the way it functions (1).

Challenges in Implementing Competency-based Medical Education Curriculum in Pharmacology: An Indian Perspective

Ravi Kant Tiwari, Dheeraj Kumar Mulchandani

Dear Sir, Competency-Based Medical Education (CBME) represents a shift from the traditional medical training to an outcome-oriented approach (1). The CBME curriculum was introduced in 2019 and revised in 2024, but there still seems to be a lag in the form of curriculum design and limited time. Hence, there is a need for a curriculum re-review and support for active learning. CBME emphasises that learners should achieve specific competencies (skills, knowledge and attitudes), active learning formats such as Self-Directed Learning (SDL), Small-Group Discussions (SGD), Demonstration-Observation-Assistance-Performance (DOAP), which can improve learners’ skills and confidence. The idea of CBME is good and is highly praised, but the ground reality is that there is a lag between the curriculum and its implementation [2-4]. There are some competencies that demand a detailed understanding, but they are clubbed into a single competency. For example, competency pH 8.3, which is mentioned as, “Explain the kinetics, dynamics, adverse effects, indications of the following antibacterial drugs: sulphonamides, quinolones, beta-lactams, macrolides, tetracyclines, aminoglycosides, and newer antibacterial drugs” (5). This single competency is a combination of seven topics from antimicrobials. The concepts and clinical applications of beta-lactam antibiotics are extensive. To elaborate, beta-lactam antibiotics include penicillins, β-lactamase inhibitors, cephalosporins etc. This constitutes a vast and complex topic that is difficult to cover in a single class. Given their vast clinical importance, identifying important adverse events, major clinical indications and the rationale of antibiotic selection requires a clear and comprehensive understanding. To support understanding of this topic, it should be divided into various subsections and the time allotted should be redistributed.

Simulation-based Education: A Vital Inclusion for Competency Building in Ayurveda Education

Seema H Thakare, Sumant Pande

Dear Editor, Simulation-Based Learning (SBL) provides learners with realistic, immersive learning experiences that closely mimic real-world clinical situations, making it a valuable tool for training and evaluation (1). It has become a key part of medical education. It helps learners to build both technical and non-technical skills like resuscitation, technical procedures, communication, and teamwork in a safe, controlled setting, improving their readiness for real-life practice [2,3]. As healthcare education evolves, there is a growing need to bridge the gap between theory and practice, and SBL has played a key role in addressing this need in modern medicine.

Efficacy of Ultrasound-guided Pericapsular Nerve Group Block versus Suprainguinal Fascia Iliaca Compartment Block in Proximal Femur Fractures: A Randomised Double-blinded Clinical Study

Roshin Reeba Joseph, MA Shiril Ashraf, Bincy V Thomas

Introduction: Regional anaesthesia techniques such as the Suprainguinal Fascia Iliaca Compartment (S-FICB) block and the Pericapsular Nerve Group (PENG) block provide effective analgesia for patients with hip fractures. The PENG block is considered superior to other hip joint blocks, such as the femoral nerve block and fascia iliaca block, particularly because it preserves quadriceps femoris motor function. Aim: To compare the efficacy of S-FICB and PENG blocks in facilitating optimal positioning of proximal femur fracture patients for spinal anaesthesia. Materials and Methods: This double-blinded, randomised clinical study was conducted at the Department of Anaesthesiology, Government Medical College, Kottayam, Kerala, India. A total of 60 patients aged 18-75 years, belonging to American Society of Anaesthesiologists (ASA) physical status classification I and II, undergoing elective surgery for proximal femur fractures under subarachnoid block, were enrolled. Patients were sequentially allocated into two groups of 30 each. Each group received either S-FICB or PENG block under ultrasound guidance using 20 mL of 0.2% ropivacaine. The primary outcome measure was the difference in Numerical Rating Scale (NRS) pain scores at Rest (NRS-R) and on passive 15° leg lifting (NRS-D), measured every 10 minutes up to 30 minutes after the block in both groups. Secondary outcomes included comparison of Ease of Spinal Positioning (EOSP) scores between PENG and S-FICB groups and evaluation of haemodynamic parameters before and after Peripheral Nerve Block (PNB) and after positioning for Subarachnoid Block (SAB). Categorical variables were analysed using the Chi-square test and continuous variables using Student’s t-test. A p-value <0.05 was considered as statistically significant. Results: Both groups were comparable in demographic variables. The mean±SD age was 65.93±10.91 years in Group A and 63.57±12.37 years in Group B. Group A consisted of 30% males and 70% females, while Group B had 50% males and 50% females. NRS scores reduced significantly in both the PENG and S-FICB groups. The mean±SD EOSP score was 2.07±0.74 in the S-FICB group and 2.43±0.50 in the PENG group (p-value <0.05), indicating significantly greater ease of positioning in the PENG group. Conclusion: Both blocks resulted in a significant and comparable reduction in NRS pain scores. However, the immediate reduction in pain was more pronounced in the PENG group compared to the S-FICB group. Therefore, the PENG block improves ease of positioning for subarachnoid block in patients with proximal femur fractures.

Diagnostic Performance of 2D ROI Sampling and 3D Volumetric Methods in Liver Attenuation Assessment using Non Contrast CT: A Retrospective Observational Study

Annamalai Vairavan, Roselin Peter

Introduction: Fatty liver disease, or hepatic steatosis, is a highly prevalent condition that can be non-invasively diagnosed using Computed Tomography (CT) attenuation values. However, the optimal method for attenuation measurement remains uncertain. Aim: To compare the performance of three CT-based techniques-Two dimensional (2D) sampling, Three dimensional (3D) sampling, and whole-liver segmentation-using non-contrast scans. Materials and Methods: The present retrospective analysis of 230 patients (121 normal, 109 with fatty liver) was conducted in the Radiology Department at Madha Medical College & Research Institute, Chennai, Tamil Nadu, India. The study included patients who underwent both Ultrasonography (USG) and CT between January 2023 and December 2023. Fatty liver diagnosis was confirmed using both ultrasound and non-contrast CT attenuation values {<50 Hounsfield Units (HU)}. Liver attenuation was measured using 2D Region of Interest (ROI) sampling, 3D volumetric sampling, and fully automated whole-liver segmentation. Agreement was assessed using correlation analysis, Analysis of Variance (ANOVA) with post-hoc comparisons, and interobserver agreement statistics (Intraclass Correlation Coefficient (ICC), Kappa). Results: The mean age of the study population was 51.1±11.7 years. All three methods showed strong correlation, with 2D sampling demonstrating near-perfect agreement with whole-liver segmentation (Pearson’s R=0.98). Mean attenuation values declined consistently from normal to mild and moderate-severe steatosis across all methods (p<0.001). Pairwise comparisons revealed only minimal differences, with whole-liver segmentation recording slightly lower values but without significant clinical advantage (2D vs. 3D: 0.85 HU, p=0.006; 2D vs. segmentation: 2.48 HU, p<0.001; 3D vs. segmentation: 1.63 HU, p<0.001). Interobserver agreement was excellent (ICC=0.989, κ=0.97-1.00), confirming high measurement reproducibility. Conclusion: 2D sampling emerges as the clinically optimal method for liver fat quantification, offering high correlation with whole-liver metrics, excellent reproducibility, and operational efficiency. In the absence of advanced automation, it provides a practical and reliable tool for routine clinical assessment of hepatic steatosis.

Microbial Flora Dynamics in Gallstones: A Prospective Observational Study of Cholecystectomy Patients

Introduction: Gallstone disease is a common cause of morbidity worldwide, with numerous studies suggesting the role of bacteria in the pathogenesis of gallstone formation and in infective complications arising from stones lost in the peritoneal cavity post-surgery. Although molecular and microscopy methods can detect the presence of bacteria, they do not provide information about the infectious potential of the microorganisms. Aim: To analyse the bacteriological profile of gallstones in patients with cholelithiasis undergoing open or laparoscopic cholecystectomy. Materials and Methods: A prospective observational study was conducted on patients undergoing cholecystectomy for symptomatic cholelithiasis from February 2024 to May 2025 in the Departments of Surgery and Microbiology at a tertiary care hospital in Central Maharashtra (Chhatrapati Sambhajinagar), India. The study included 76 patients undergoing open or laparoscopic cholecystectomy for acute, chronic, or acute-on-chronic cholecystitis. Demographic details like age and gender were recorded, along with clinical presentation, intraoperative findings, and co-morbidities. Post-cholecystectomy, gallstones were aseptically collected and subjected to culture and sensitivity testing. Positive cultures were further processed for identification and susceptibility using the Vitek 2 system, while negative cultures were reported after five days of incubation. Results: The peak incidence in females was observed in the 41-60 years age group (20 cases, 26.3%), whereas in males it was observed in the 61-80 years age group (23 cases, 30.3%). Culture positivity was observed in 49 gallstones (64.5%). Enteric bacteria predominated amongst the isolates, with Escherichia coli (E. coli) being the most common (18 cases, 31.57%), followed by Enterococcus species (8 cases, 14.03%). Salmonella paratyphi A was isolated in 2 cases (3.50%). Escherichia coli showed high susceptibility to aminoglycosides (18 cases, 100%), tigecycline (17 cases, 94.4%), and carbapenems (16 cases, 88.8%). Enterococci were highly susceptible to teicoplanin, tigecycline and linezolid. Follow-up was conducted post-discharge at 5 days, 15 days, and monthly thereafter. Conclusion: Gallstones act as a significant microenvironment for bacterial colonisation. Gallstone cultures, rather than bile cultures alone, provide a better understanding of gallstone-associated microbiota, their role in disease pathogenesis, and postoperative complications. This information can help optimise antibiotic strategies, especially in high-risk or polymicrobial cases, leading to improved patient outcomes.

Morphological Alterations and Mucin Histochemistry in Helicobacter pylori Positive and Negative Gastric Biopsies: A Cross-sectional Study

Amritha Kesavan, Deepti Ramakrishnan, Joy Augustine

Introduction: Helicobacter pylori (H. pylori) is an important causative agent of chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric carcinoma. Its prevalence is increasing in the developing nations. Hence, its earliest detection and eradication is of utmost importance. Aim: To compare the morphological alterations and mucin histochemical changes in H. pylori-positive and negative gastric biopsies. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Amala Institute of Medical Sciences, Thrissur, Kerala, India from January 2017, to June 2018. A total of 42 cases each of H. pylori-positive and negative biopsies were studied after staining with Haematoxylin-Eosin (H&E) and Giemsa stains. Morphological alterations such as inflammation, intestinal metaplasia, dysplasia, and carcinoma were studied. Gastritis was graded according to the visual analogue scale of Updated Sydney System. Gastric dysplasia was graded according to the Padova International Classification. Combined PAS-Alcian Blue and High Iron Diamine-Alcian Blue stains were used to assess the mucin histochemical changes. The results were compared between the two groups. Statistical analysis was done by Fisher’s exact test and Chi-square test (IBM Statistical Package for the Social Sciences (SPSS) version 23.0). Results: Out of 84 gastric biopsies analysed, 79 cases were diagnosed with chronic gastritis (94.05%), followed by 3 cases of carcinoma (3.57%) and 2 cases of dysplasia (2.38%). Age of the patients ranged from 21 to 83 years, with 49 males (58.33%) and 35 females (41.67%). Cases of dysplasia and carcinoma were obtained in H. pylori-negative group. Chronic inflammation was significantly associated with H. pylori infection (p-value = 0.038). Intestinal metaplasia was more prevalent in the H. pylori-negative group, with Type III intestinal metaplasia constituted the maximum number of cases. Two cases of carcinoma showed Type III metaplasia in adjacent areas. Conclusion: Morphological alterations and mucin changes of the gastric mucosal epithelium have been shown to be precursor lesions for the development of gastric carcinoma. Type III intestinal metaplasia is significantly associated with gastric carcinoma. Subtyping intestinal metaplasia helps identify patients at risk, facilitating follow-up and effective management.

Tympanoplasty Outcomes in Active and Inactive Chronic Otitis Media of Mucosal Type: A Prospective Interventional Study

Rajeev Kumar Nishad, Priyanka Das, Reetu Verma

Introduction: Chronic Otitis Media (COM) is a leading cause of preventable hearing loss, particularly in developing nations. It is characterised by tympanic membrane perforation and recurrent ear discharge resulting from long-standing middle ear infections. The disease is classified into inactive (dry) and active (wet) types based on the absence or presence of mucopurulent discharge. Aim: To compare the success rate of graft uptake and hearing improvement in tympanoplasty performed in patients with inactive (dry) and active (wet) mucosal COM. Materials and Methods: This prospective interventional study was conducted at FH Medical College and Hospital, Agra, Uttar Pradesh, India over a period of 1.5 years. A total of 110 patients diagnosed with mucosal COM were divided into two groups: inactive and active. Preoperative and postoperative assessments, including Pure Tone Audiometry (PTA), were performed to evaluate hearing improvement, and clinical examination was used to assess graft uptake. The follow-up period was three months post-surgery. The two groups were compared for graft uptake and hearing improvement using an Independent samples t-test. Results: The graft uptake rate was 87.5% in the inactive group and 84.78% in the active group. Hearing improvement, measured by reduction in PTA thresholds, was slightly better in the inactive group (12.19 dB improvement) compared to the active group (11.09 dB improvement). However, the difference was not statistically significant. Conclusion: Tympanoplasty is an effective surgical intervention for mucosal COM, with high success rates in both inactive and active cases. Although inactive ears demonstrated marginally better graft uptake and hearing improvement, the presence of active discharge at the time of surgery did not significantly affect the overall surgical outcome.

Epidermal Growth Factor Receptor Expression by Immunohistochemistry and its Relation with the Stage, Grade and Tumour Budding Score in Colorectal Carcinoma Cases: A Cross-sectional Study

Introduction: Adenocarcinoma of the colon is the most common malignancy of the Gastrointestinal (GI) tract and a major cause of mortality and morbidity all over the world. Identification of molecular markers associated with carcinogenesis, tumour growth, invasion, and metastasis is essential for developing potential therapeutic management strategies. The Epidermal Growth Factor Receptor (EGFR) is one of the most important genes involved in this carcinogenesis pathway. Aim: To estimate the magnitude of EGFR expression by Immunohistochemistry (IHC), in which the immunospecific tumour cells show membranous positivity for EGFR and are scored accordingly under light microscopy. Materials and Methods: This was an Institution/hospital-based a single-centred cross-sectional observational study of 29 cases of colon carcinoma. These cases had undergone colectomy operation over 1 year and 6 months from December 2022 to May 2024 at Department of Pathology and Department of General Surgery, Murshidabad Medical College and Hospital, Berhampore, West Bengal, India. Histopathological examination was conducted under a light microscope to confirm the final diagnosis. The scoring system was used to evaluation of EGFR immunostaining. Association between EGFR expression with stage, grade, and tumour budding score was established by the Chi-square test. Values were considered significant at p<0.05 (calculated with the help of Statistical Packages for Social Sciences (SPSS) version 20.0). Results: The study comprised 29 colorectal carcinoma cases, with the highest incidence observed in 9 (31.03%) cases and were in the age group of 41 to 50 years. The male-to-female ratio was 1.4:1. The majority of the tumours were found in the ascending colon 7 (24.14%) cases, followed by the rectum 6 (20.68%) cases, sigmoid colon 6 (20.68%) cases, and caecum 5 (17.24%) cases. Of the 29 cases, 24 were classified as Adenocarcinoma Not Otherwise Specified (NOS) (82.76%), 4 as Mucinous Adenocarcinoma (13.79%), and only 1 as Signet ring cell carcinoma. Among 29 colorectal carcinoma cases, 16 (55.17%) were EGFR positive, and this had a significant association with the stage (p<0.013), grade (p<0.004), and tumour budding score (p<0.033). Conclusion: As the majority of the colorectal carcinoma cases were EGFR positive and had a significant association between the expression of EGFR with high pathological Tumour Node Metastasis (TNM) T stage (T3 and T4), moderately and poorly differentiated carcinoma (G2 and G3 combined) and moderate to high tumour budding score, this finding can be of prognostic significance. Therefore, the EGFR immunohistochemistry biomarker should be included in the standard diagnostic protocol for colorectal cancer, as it helps to screen the EGFR-positive CRC cases, and based on that appropriate chemotherapy can be started.

Coagulation Profile in Type 2 Diabetes Mellitus and its Association with Glycaemic Control and Long-term Complications: A Cross-sectional Study

Anindita Banerjee, Gargi Mukherjee, Ayan Kundu, Debarshi Saha

Introduction: Diabetes Mellitus (DM) causes numerous complications due to the formation of Advanced Glycation End-products (AGEs) in the presence of persistent hyperglycaemia. These products also alter the coagulation activity, leading to microvascular and macrovascular complications in the long-term. Diabetic patients are not routinely screened for assessing their thrombotic status Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) that could be associated with their glycaemic index (HbA1C). Aim: To evaluate the coagulation profile among Type 2 Diabetes Mellitus (T2DM) patients and its association with their glycaemic index and long-term complications. Materials and Methods: This cross-sectional observational study was conducted in the Department of Pathology, IQ City Medical College and Hospital (tertiary care hospital), Durgapur,West Bengal, India over a period of six months April 2023 to October 2023, in which 60 diabetic (patients with pre-diagnosed type II diabetes mellitus) and 60 non diabetic (apparently healthy individuals) were included. Glycosylated Haemoglobin (HbA1c), PT, aPTT were compared between diabetic and non diabetic, the diabetic with good glycaemic control (HbA1C <7) and diabetic with poor glycaemic control (HbA1C>7) and diabetic with and without complications by Student’s t-test using Statistical Package for Social Sciences (SPSS) version 16.0. The p-value <0.05 was considered statistically significant. Result: Among 60 diabetic and 60 non diabetic individuals in the age group of 30 to 75, 52 (43.33%) were females and 68 (56.67%) were males. Among the diabetics, 29 (48.33%) had good glycaemic control, and 31 (51.67%) had poor glycaemic control. Among them, 17 (28.33%) of the diabetic cases had clinical features of microvascular complications. The mean PT, International Normalised Ratio (INR) and aPTT were significantly lower in diabetic compared to non diabetic (p-value <0.05). The coagulation profile showed no significant changes in good and poor glycaemic control groups and in diabetics with and without microvascular complications. Duration of diabetes was significantly longer in patients with complications than those without (p-value=0.003). HbA1c was increased in diabetics with complications, but did not show statistical significance. Conclusion: A hypercoagulant state occurs in diabetes and results in a deranged coagulation profile that has been supported by the significant decrease in PT, INR and aPTT among diabetics in the present study. Microvascular complications are more strongly associated with the duration of diabetes.

Association of Sociodemographic Characteristics and Smoking with Various Subtypes of Lung Cancer: A Record Based Study

Arunima Gupta, Joydeep Basu, Chaitiparna Das

Introduction: Lung cancer is a major cause of cancer-related deaths in India. The occurrence of adenocarcinoma is more common than squamous cell carcinoma in many areas, even among the non-smokers. Aim: To assess whether histological types of lung cancer vary with sociodemographic factors, smoking status, and the form of smoked tobacco. Materials and Methods: This retrospective record-based study reviewed 342 lung cancer cases from May 2022 to December 2024 at a tertiary centre with 310 cases being confirmed histological subtypes. Records with missing demographic or smoking details were excluded, along with 32 Fine-Needle Aspiration Cytology (FNAC) cases that did not have subtype information. Demographic details with smoking categories, and type of smoked tobacco were collected from patient files and cross-checked. Active, passive, and non-smokers were identified from the documentation, and tobacco forms were listed. The collected data and variables were analysed with the Chi-square test, and mean age across subtypes was calculated with Analysis of Variance (ANOVA). Results: Adenocarcinoma formed the largest group (37.4%), followed by squamous cell carcinoma (33.2%), large cell carcinoma (16.1%), and small cell carcinoma (13.2%). Men included approximately 80.6% of the sample, and the mean age was 62.68 years. More than half of the patients were active or passive smokers, while 23.2% had never smoked. The distribution of histological types was similar among the genders, age, and rural or urban areas. Smoking status did not change the histological pattern (p=0.246). The type of smoked tobacco also showed no difference in subtype distribution (p=0.976). Conclusion: Adenocarcinoma is the dominant lung cancer subtype and occurs in all sociodemographic and exposure groups. Routine histologic and molecular analysis for every patient is needed to guide the treatment protocol and improve diagnostic accuracy.

Impact of Lower Limb Muscle Strength on Forward Reactive Stepping in Diabetic and Non Diabetic Patients: A Cross-sectional Study

K Charulatha, Praveen Kumar Chennimalai Ravi

Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by persistent hyperglycaemia, which leads to systemic complications affecting the musculoskeletal and nervous systems. This contributes to lower limb weakness, sensory deficits, and impaired postural control, thereby increasing the risk of falls. While most balance assessments focus on anticipatory control. Reactive balance is critical for responding to sudden disturbances, which is often overlooked. The Balance Evaluation System Test (BESTest) includes a reactive balance component, making it a suitable tool for this purpose. Aim: To evaluate the impact of lower limb muscle strength on forward reactive stepping in diabetic and non diabetic patients. Materials and Methods: A cross-sectional study was conducted among 46 diabetic (aged 45-60 years, diabetes duration 3-5 years) and 46 non diabetic individuals in the Department of Endocrinology and Physiotherapy Outpatient Department (OPD) Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India, from February 2025 to April 2025. Diabetic neuropathy patients were excluded using the Diabetic Neuropathy Symptom Score. Handheld Dynamometer (HHD) was used to measure the strength of hips abductors, knee extensors and ankle plantar flexors. Forward reactive stepping was assessed through the compensation stepping correction component of the BESTest, and parameters like First Step Length (FSL) and First Step Time (FST) were analysed using Tracker 6.1.3 software. Pearson’s correlation and Independent t-tests were applied. Effect sizes were reported. Statistical significance was set at p-value<0.05. Results: In diabetic participants, muscle strength showed no significant correlation with FSL but demonstrated moderate negative correlations with FST (r-value=-0.448 to -0.548, p-value <0.001). In non diabetic participants, weak positive correlations were found between muscle strength and FSL (r-value=0.285–0.350), and moderate negative correlations were found with FST (r-value=-0.331 to -0.560). Between-group comparisons showed significant differences in correlations, suggesting diabetes influences the strength- balance relationship. Conclusion: In diabetic individuals, lower limb muscle strength alone may not significantly influence reactive balance, likely due to sensory or neuromotor impairments. Thus, effective balance interventions should include components beyond strength training.

Medial Cerebral Sulci Variability for Surgical Corridors: A Scoping Review of Cadaveric Evidence

Priyanka R Gohil, Priyanka N Sharma, Hetal V Vaishnani, Kinjal V Jethva

Introduction: Medial sulci are key intraoperative landmarks and radiologic boundaries that determine safe interhemispheric approaches and accurate Magnetic Resonance Imaging (MRI) interpretations. The cingulate, paracingulate, calcarine, parieto-occipital, callosal, rostral, supra-rostral, and subparietal sulci are the principal surgical corridors and radiologic boundaries on the medial surface. These structures serve as essential neuroanatomical landmarks and surgical corridors in micro neurosurgical procedures; however, they exhibit considerable morphological variability. This scoping review consolidates cadaveric morphology and morphometry to define reliable versus variable medial sulcal features that guide surgical corridors and radiologic localisation. Aim: To synthesise cadaveric morphological and morphometric data on the medial cerebral sulci and determine which sulci demonstrate consistent versus variable anatomical patterns. Materials and Methods: In the present scoping review, the comprehensive literature search identified 4,440 records in total. After applying the eligibility criteria of the original cadaveric anatomical studies that described the morphology and/or morphometry of the cingulate, paracingulate, calcarine, parieto-occipital, and subparietal sulci in the human brain, a total of eight cadaveric studies were included. Data were extracted on sample characteristics, morphological classification, and quantitative morphometry of the medial cerebral sulci. Results: A total of 8 cadeveric studies met the inclusion criteria collectively examining 422 hemispheres.Across 422 hemispheres, the cingulate sulcus was consistent, whereas the paracingulate sulcus was variable in shape. The present study mapped sulcal configurations to interhemispheric approach planning. The calcarine sulcus demonstrated relatively stable morphometry, with mean anterior and posterior segment lengths of 23-35 mm. The parieto-occipital sulcus was a reliable boundary between the cuneus and precuneus, with mean lengths of approximately 40 mm. The subparietal sulcus was described less frequently, highlighting a gap in the detailed morphometric literature. Conclusion: Cadaveric evidence confirms both consistent and highly variable features of the medial cerebral sulci. The paucity of detailed morphometric descriptions for certain sulci, especially the subparietal, callosal, rostral and supra-rostral sulci, underscores the need for further targeted anatomical research.

A Systemic Review and Meta-analysis of the Prevalence of Chronic Obstructive Pulmonary Disease in India

Parijat Ghatak, Pranjal Gogoi

Introduction: The increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) worldwide, and particularly in India, is of major concern as it causes a high economic burden. It also leads to disability, impairs the quality of life, loss of productivity, increased hospital admissions, and premature death. Therefore, understanding the true burden of COPD to plan healthcare policies and provide disease-specific strategies for prevention and management, an accurate estimate of the prevalence of COPD in India is critical for healthcare planning. Aim: To estimate the pooled prevalence of COPD in India (2012-2025) and to examine patterns by region and population type. Materials and Methods: This systematic review and meta-analysis followed the PRISMA 2020 guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and local journals for studies published between 2012 and 2025, using relevant MeSH terms and Boolean operators. Eligible studies included population-based, spirometry-confirmed, or questionnaire-based prevalence reports. Hospital-based studies, disease-specific cohorts, reviews, conference abstracts, and those without complete prevalence data were excluded. Data extraction and Joanna Briggs Institute (JBI) risk-of-bias assessment were performed independently by two reviewers. A meta-analysis was performed to estimate the pooled prevalence of COPD across Indian studies using a random-effects model with 95% confidence intervals. Subgroup analyses were conducted by region, age group, gender, population setting, exposure type (biomass fuel use, smoking, occupational dust), and diagnostic criteria (post-bronchodilator spirometry versus symptom-based diagnosis). Statistical heterogeneity was assessed using the I² statistic, and potential publication bias was evaluated through funnel plot inspection and Egger’s regression test. Results: Out of 1,462 records identified, 26 studies met the inclusion criteria and were included in both the qualitative synthesis and meta-analysis. The pooled prevalence of COPD was estimated to be 11.3% (95% CI 9.4-13.4%), with the highest estimates in northern and eastern regions of India. Subgroup analyses revealed a higher prevalence among the elderly, smokers, and households exposed to biomass fuel. Conclusion: Early diagnosis of COPD at the primary healthcare level is essential to initiate timely management and reduce disease burden. Reliable estimate of the true prevalence of COPD in India is required, for which a nationwide population-based survey for screening of COPD with adequate training and resources.

The Effectiveness of a Nurse-led Transitional Care Model on Health Outcomes and Quality of Life among Patients with Ischaemic Heart Disease: A Mix-method Research

Ranjana Verma, Honey Pal Singh, Cinosh Mathew

Introduction: Ischaemic Heart Disease (IHD) and other cardiovascular conditions remain the foremost contributors to global illness and death, with India bearing a considerable share of this burden. Although progress has been made in treatment through medical and surgical approaches, inadequate patient awareness, limited self-care practices, and poor adherence to lifestyle changes continue to affect outcomes and Quality of Life (QoL). Nurse-led interventions, focusing on patient education, counselling, and ongoing support, have emerged as a potential strategy to address these challenges. Aim: To assess the impact of a nurse-led transitional care model on health outcomes (selected bio-physiological parameters) and QoL among individuals with IHD. Materials and Methods: A two-phase design was adopted. Phase I employed a mixed-methods exploratory approach at Dhiraj Hospital, Vadodara, Gujarat, India and Railway Hospital, Lucknow, India. The study period for Phase I was 7 weeks, including (quantitative data collection for 4 weeks and qualitative data collection for consecutive 3 weeks). Based on these findings, a structured video-assisted nurse-led intervention was developed. In Phase II, an experimental study was carried out involving 90 post-operative IHD patients, who were randomly allocated to intervention and control groups. The intervention group received structured counselling, video-assisted education, and weekly telephone follow-ups for 12 weeks, while the control group continued with routine care. Outcomes were assessed using the McNew Heart Disease Health-Related Quality of Life Questionnaire and clinical parameters such as Blood Pressure (BP), Body Mass Index (BMI), and lipid profile, as shown by the results of the mean, standard deviation, and Unpaired t-test results. Results: In Phase I, a total of 46 patients were included, and the mean age of participants was 55.36±7.00 and 56.2±6.34 among the control and intervention groups. The majority of the population (n=17) highlighted major gaps in patients’ understanding of lifestyle adjustments, medication adherence, recognition of danger signs, and follow-up practices. In Phase II, after 12 weeks of intervention, patients in the experimental group showed significant improvements in clinical variables life including systolic BP (p-value=0.001), diastolic BP (p-value=0.016), and BMI (p-value=0.004). Lipid profile changes were not statistically significant, as evident from the mean, standard deviation, and the Unpaired t-test results. Quality of life showed marked improvement in physical, social, and global domains (p-value <0.001), though the emotional domain did not show significant change. Overall, 64.4% of participants in the intervention group reported good QoL compared to only 13.3% in the control group. Conclusion: The nurse-led intervention effectively improved QoL and clinical outcomes in IHD patients, highlighting the value of structured education, video learning, and follow-up, with larger multicentric studies needed to validate these findings.

Evaluating the Efficacy of Racecadotril in Combination with Oral Rehydration in Children with Acute Diarrhoea: A Randomised Controlled Trial

Uddhava V Kinhal, V Vidhyadhar, N Supriya

Introduction: Acute watery diarrhoea in early childhood frequently necessitates hospital admission. Although Oral Rehydration Salts (ORS) with zinc effectively prevent and treat dehydration, they do not consistently shorten illness duration or reduce early stool losses. Racecadotril, a motility-sparing antisecretory agent, may help address this therapeutic gap. Aim: To evaluate whether adding racecadotril to ORS plus zinc improves short-term clinical outcomes in hospitalised infants and toddlers with acute watery diarrhoea. Materials and Methods: A randomised, double-blind, parallel-group, placebo-controlled trial was conducted in the paediatric wards of the Indira Gandhi Institute of Child Health (IGICH), Bengaluru, Karnataka, India. A total of 140 children aged 3-24 months with non dysenteric acute watery diarrhoea and mild-to-moderate dehydration were allocated (1:1) to receive either racecadotril (1.5 mg/kg every 8 hours, up to 5 days) plus ORS and zinc, or a matching placebo plus ORS and zinc. The primary endpoint was duration of hospital stay (hours). Secondary endpoints included stool frequency (Days 1-3), stool consistency (Days 1-3), and total ORS requirement. Analyses followed intention-to-treat principles; Mann–Whitney U and covariate-adjusted ANCOVA were used for continuous outcomes, and χ² tests for proportions. A p-value of <0.05 was considered as statistically significant. Results: Racecadotril significantly improved outcomes in children with acute diarrhoea (p-value <0.001). Compared with the control group, it shortened hospital stay by nearly 17 hours (p-value <0.001) and consistently reduced stool frequency over the first three days of treatment (day 1, p-value=0.001; day 2, p-value=0.003; day 3, p-value=0.018). By day 2, a greater proportion of children receiving racecadotril passed formed stools (41.4% vs 21.4%; p-value=0.010), though this difference was no longer evident by day 3 (p-value=0.149). ORS requirement was also markedly lower in the racecadotril group (p-value <0.001). Adverse Events (AEs) were rare, mild, and comparable between groups (5.7% each; p-value>0.05), with no serious events reported, underscoring the favourable safety profile of racecadotril. Conclusion: Racecadotril, when used as an adjunct to ORS and zinc in infants and toddlers with acute watery diarrhoea, may offer meaningful clinical benefits by accelerating recovery, reducing treatment burden, and enabling earlier discharge, all without added safety concerns.

Correlation of Immunoglobulin Free Light Chains in Risk Stratification for Chronic Obstructive Pulmonary Disease Patients: A Cross-sectional Observational Study

R Geethanjali, MV Preethi, P Nirmaladevi, R Gogulakrishnan, V Amuthavalli

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. Immunoglobulin free Light Chains (IgLCs) have been implicated in various inflammatory diseases; however, their role in COPD risk stratification remains unclear. Aim: To assess the correlation between IgLC levels and COPD severity and to evaluate their potential role in disease monitoring. Materials and Methods: This cross-sectional observational study was conducted at Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, between March and December 2018. A total of 120 stable COPD patients aged over 40 years (post-bronchodilator FEV1/FVC <70%) with no exacerbations in the preceding three months were included. COPD severity was staged according to the GOLD (Global Initiative for Chronic Obstructive Pulmonary Disease) criteria using spirometry. Venous blood samples were analysed for serum κ and λ free light chains using immunoturbidimetry, along with standard biochemical parameters. Demographic and exposure-related data, including age, sex, Body Mass Index (BMI), smoking status, biomass exposure, and history of tuberculosis, were recorded. Associations between IgLC levels, COPD severity, lung function (FEV1%), and biochemical parameters were analysed using Pearson’s correlation, Analysis of Variance (ANOVA), and Chi-square tests. A p-value <0.05 was considered statistically significant. Results: The study included 120 COPD patients, comprising 45 (37.5%) males and 75 (62.5%) females, with a mean age of 59.2±10.6 years. The distribution across COPD stages was as follows: 20 (16.7%) in Stage I, 32 (26.7%) in Stage II, 40 (33.3%) in Stage III, and 28 (23.3%) in Stage IV. No significant differences were observed across disease stages with respect to sex, smoking status, biomass exposure, or history of tuberculosis (p-value >0.05). Pulmonary function (FEV1%) declined significantly with increasing COPD severity, from 82.10±1.21% in Stage I to 26.21±2.45% in Stage IV (F=308.166, p-value <0.0001). Serum κ and λ free light chain levels increased progressively with disease severity (κ: 2.94±0.57 g/L to 5.50±0.81 g/L, F=87.318, p-value <0.0001; λ: 1.50±0.26 g/L to 2.80±0.53 g/L, F=43.616, p-value <0.0001), whereas the κ:λ ratio remained stable across all stages (p-value=1.000). Conclusion: Elevated IgLC levels showed a strong correlation with worsening COPD severity, declining lung function, and reduced BMI. Despite increases in individual κ and λ light chain concentrations, the κ:λ ratio remained stable across disease stages.

Clinical Spectrum of Adenovirus Infection in Hospitalised Children: A Retrospective Study from Hyderabad, Telangana, India

Introduction: Human adenoviral infections, though prevalent among children, are often under-reported. Although adenoviral infections are usually self-limiting, they can cause significant morbidity and hospitalisations in children. Aim: To evaluate the demographic, clinical, laboratory and radiological characteristics of paediatric patients hospitalised with Human Adenovirus (HAdV) infection. Materials and Methods: This was a hospital-based retrospective study conducted in the Paediatric Outpatient Department (OPD) and inpatient wards of Rainbow Children’s Hospital, Hyderabad, Telangana, India for a period of 11 months from February 2023 to December 2023. A total of 210 children aged one month to 16 years who tested positive for adenovirus by Polymerase Chain Reaction (PCR) on a nasopharyngeal swab were included in the study. The demographic, clinical, laboratory, and radiological profiles of these cases were analysed. The statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software version 27.0 (Armonk, NY, USA). Results: Of the 210 children who tested positive for adenovirus, 126 (60%) were males and 129 (61.42%) were between one and five years of age. Notably, 141 children (67.14%) were hospitalised during the summer season. Most cases occurred during the summer months, predominantly among males aged 1-5 years. Symptoms included high-grade persistent fever in 205 cases (97.62%), cough and cold in 129 (61.42%), vomiting in 59 (28.1%) and loose stools in 27 (12.86%). Less frequent presentations were pneumonia in 12 cases (5.71%), seizures in 8 (3.81%), burning micturition in 5 (2.38%) and conjunctivitis in 4 (1.9%). Children were categorised into three groups: A, B and C- based on their clinical presentation as respiratory, gastrointestinal or mixed types, respectively. A significant difference in C-Reactive Protein (CRP) distribution was observed among the three groups (p-value <0.0001). CRP positivity (>10 mg/L) was most frequent in group A, 78/99 (78.8%), followed by group C 36/52 (69.2%), while group B showed a lower proportion 21/59 (35.6%). Group A children had significantly higher CRP levels and a longer duration of fever. Of the 210 cases, 195 children (92.86%) were treated with antibiotics. Conclusion: The HAdV infections present with high-grade fever and respiratory symptoms are their predominant manifestation. HAdV infections should be considered as a differential diagnosis in children with prolonged fever and multisystem involvement. In addition, gastrointestinal involvement was common. All children had favourable outcomes and were discharged without any complications. Early and accurate diagnosis of HAdV infection using rapid diagnostic tests prevents unnecessary antibiotic use and aids parental counselling and should be routinely employed.

Impact of Regularity and Near-peer Mentors on Junior Medical Students’ Personal Learning Plan Program: A Randomised Clinical Study

Rituparna Basu, Adarshlata Singh

Introduction: The practice of self-regulated learning and reflection has played a key role in the achievement of lifelong learning, continuous professional development and the delivery of standard healthcare. Self-regulated learning skills may be cultivated among medical students from the onset of their medical career through the diligent practice of specially designed tools of self-regulated learning, such as Personal Learning Plans (PLPs). Previous research has recommended the study of PLPs programs in different settings to observe the effectiveness of such programs. Aim: To study the impact of PLPs’ regularity and near-peer mentoring on first-year medical students through their academic performance. Materials and Methods: This randomised, single-blinded, educational interventional study was conducted among 346 first-year students (batch 2023-24-172, batch 2024-25-174) of Jawaharlal Nehru Medical College (JNMC), Wardha, Maharashtra, India, from April 2023 to August 2025. Cases and controls were selected using simple randomisation. The cases were trained and used PLPs for Anatomy lectures for six months. Trained near-peer mentors were assigned to cases 2024-25 batch. Regular users in both batches were noted. Three assessments were taken per batch and scores were recorded. Students’ post-intervention feedback was documented. The collected data were analysed using Python-based statistical scripts. Results: Academic scores of trained students who submitted PLPs regularly were consistently higher than those of trained students who did not, especially in the later assessments (cases regular 2023-24 vs cases irregular 2023-24 was 11.90±1.73 vs 8.79±2.02 and cases regular 2024-25 vs cases irregular 2024-25 was 17.27±0.75 vs15.60±0.83, respectively, in the third assessment). There was a significant performance gap between cases 2023-24 and 2024-25, with an extremely large effect size for the third assessment (d=3.4560, where d denoted Cohen’s d effect size), which suggested that the use of near-peer mentors in PLP intervention had a substantial impact. Post intervention feedback on cases of both batches was positive. Conclusion: There was a significant improvement among students with PLPs intervention and near-peer mentors when compared to the students taught using traditional teaching methods.

Improving Gait Speed, Functional Mobility and Fall-related Confidence in Older Adults: A Quasi-experimental Comparison of Physiotherapy-based Training and Virtual Reality-based Training

Introduction: Ageing is associated with a progressive decline in gait speed, functional mobility, and increased concern about falling, which collectively compromise independence and quality of life in older adults. Conventional physiotherapy has been shown to improve mobility but may be limited in addressing dynamic, task-specific gait challenges. Virtual Reality (VR) based training offers an immersive and engaging approach that may enhance functional outcomes beyond traditional therapy. Aim: To compare the effects of physiotherapy-based training and VR-based training on functional mobility, gait speed and fall-related confidence in older adults. Materials and Methods: A single, quasi-experimental, pre–post-test study with two non randomised parallel groups was conducted at the Department of Physiotherapy, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India, from January 2025 to March 2025. One hundred community-dwelling older adults (60–85 years) were allocated to a physiotherapy comparison group (n=50) or VR intervention group (n=50). Outcomes included the Timed Up and Go test (TUG), Four-Metre Walk Test (4MWT) and Falls Efficacy Scale-International (FES-I). Within-group changes were analysed using paired t-tests, while between-group differences in change scores were examined using an Independent sample t-tests. Results: Both groups showed significant pre-post improvements across all outcomes (p-value <0.001). However, the VR group demonstrated significantly greater improvement than physiotherapy for TUG (?=5.48±1.13 vs 1.46±1.13 s; t=-17.80, (p-value <0.001), 4MWT (t=-2.58, (p-value=0.011), and FES-I (?=21.60±7.60 vs 13.34±4.85; t=-6.48, (p-value <0.001). Effect sizes were large for TUG and FES-I. Conclusion: VR-based training produced superior improvements in functional mobility, gait speed, and fall-related confidence compared with physiotherapy supporting its role as an effective rehabilitation approach for older adults.

Barriers and Facilitators to Outcome Measure Utilisation among Physiotherapists: A Scoping Review

Pankajpreet Singh, Supreet Bindra, Richa

Introduction: Outcome Measures (OMs) are standardised tools used to determine a patient’s current health status regarding impairment, activity limitation, participation and quality of life. They are a key component of Evidence-based Practice (EBP). There is diverse evidence on the factors that influence physiotherapists’ decisions regarding the usability of OM from a clinical point of view and the choice of OMs in clinical settings. In the present study, a scoping review was performed to analyse the currently available evidence on physiotherapists’ use of OMs. The review focused on facilitators and barriers to implementing OMs in clinical practice. Aim: To evaluate the utilisation of OMs by physiotherapists and to determine barriers and facilitators related to their use. Material and Methods: A scoping review was conducted at the Department of Physiotherapy, Sri Guru Granth Sahib World University, Punjab, India in January 2025. A comprehensive search was conducted in online databases, including PubMed and CINAHL. Keywords related to “OMs”, “Facilitators”, “Barriers” and “Physiotherapist” were used. Only survey studies published in English from January 2006 to December 2024 were included. Appraisal tool (AXIS) for cross-sectional studies was used for quality assessment. Results: A total of 33 studies were selected. All the included studies had an AXIS score of 11 or higher. Most studies discussed barriers and facilitators for utilising OMs. A larger proportion of the studies were conducted in the Western world and on the general usage of OMs. Overall, although physiotherapists widely acknowledge the value of OMs, their routine use remains inconsistent due to persistent contextual barriers. Conclusion: The present scoping review highlights that, although OMs are widely recognised as essential tools for enhancing evidence-based physiotherapy, their use remains inconsistent in clinical settings. There is a variation in the item frequency across the studies, which reflects the absence of standardised assessment tools and the diverse methodological approaches. Different studies used diverse questionnaires, different clinical populations and prioritised different domains of barriers and facilitators, resulting in heterogeneity. Moreover, there is a need to develop more evidence on the utilisation of OMs by physiotherapists in the Eastern world, and studies should be conducted on region- and condition-specific.

Comparison of Gastric Residual Volume using Ultrasound in Diabetic and Non- diabetic Fasting Surgical Patients: A Prospective Observational Study

L Rajeswari, Parul Mullick, Richa Chauhan, Smita Prakash

Introduction: Standard preoperative fasting guidelines may not be applicable to patients with co-morbidities such as diabetes mellitus due to delayed gastric emptying. Point-of-care ultrasonography allows assessment of Gastric Residual Volume (GRV) and may help predict the risk of pulmonary aspiration. Aim: To compare GRV in fasting diabetic and non-diabetic patients undergoing elective surgery using ultrasonography. Materials and Methods: The present prospective observational study was conducted over a period of 18 months, from January 2020 to June 2021 at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, included 30 diabetic patients with a disease duration of ≥10 years (Group D) and 30 non-diabetic patients (Group ND) undergoing elective surgery under General Anaesthesia (GA). Preoperative gastric ultrasonography was performed to assess antral dimensions and gastric contents in the Right Lateral (RL) and Semi-Sitting (SS) positions, and GRV was calculated. Gastric aspirate volume obtained via an orogastric tube was also recorded. Data were analysed using independent t-tests and Chi-square or Fisher’s exact tests with Statistical Package for Social Sciences (SPSS) version 21.0. Results: Groups ND and D were comparable with respect to sex (p=0.426), age (55.6±5.6 vs. 57.8±3.8 years), and Body Mass Index (BMI) (22.2±1.8 vs. 21.6±1.8 kg/m²; p=0.189), but differed significantly in American Society of Anesthesiologists (ASA) physical status (ND: ASA I; D: ASA II; p<0.0001). Qualitative antral grading differed significantly between the groups in both the RL (empty/fluid/solid: 83.3/16.7/0% vs. 26.7/63.3/10%; p<0.0001) and SS positions (96.7/3.3/0% vs. 53.3/46.7/0%; p=0.0002). Diabetic patients had significantly higher antral Cross-Sectional Area (CSA) and calculated GRV in both the RL position (CSA: 10.9±0.9 vs. 6.7±1.9 cm²; GRV: 112.2±12.2 vs. 53.2±30.1 mL) and the SS position (CSA: 8.3±1.8 vs. 4.3±1.4 cm²; GRV: 180.2±5.8 vs. 164.7±10 mL) (all p<0.0001). Gastric aspirate volume was significantly higher in diabetic patients (8.4±4.8 vs. 1.6±2.4 mL; p<0.0001). A significant correlation was observed between aspirated gastric volume and calculated GRV in the RL position in both diabetic (r=0.633) and non-diabetic patients (r=0.874) (p≤0.0002). Conclusion: Diabetic patients demonstrated significantly higher antral CSA, GRV, and aspirated gastric volume compared to non-diabetic patients, indicating an increased risk of pulmonary aspiration. Bedside gastric ultrasonography is a useful tool for assessing gastric volume and may aid in guiding safer anaesthetic management in this high-risk population.

Correlation of Pulmonary Function with Health-related Quality of Life among College Students: A Cross-sectional Study

M Chinmayi, Abeeshna Ashok

Introduction: Health-Related Quality of Life (HRQoL) is a multidimensional concept reflecting an individual’s perceived physical and mental health. Pulmonary function is a critical component of physical health and its impairment can significantly affect daily activities and overall well-being. College students often undergo lifestyle changes that may increase sedentary behaviour, potentially affecting both respiratory health and HRQoL. However, the direct relationship between these two factors in this specific demographic remains insufficiently documented. Aim: To investigate the correlation between pulmonary function, measured using spirometry and HRQoL, assessed using the 36-Item Short Form Health Survey (SF-36) questionnaire, among college students. Materials and Methods: This cross-sectional study was conducted among students of the Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India, from July 2024 to December 2024. It included 100 college students (75 females and 25 males) aged 18-25 years. Participants were screened for physical activity levels using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and individuals classified as inactive or minimally active were included. Pulmonary function was assessed using a computerised spirometer to measure Forced Expiratory Volume in one second (FEV₁), Forced Vital Capacity (FVC) and the FEV₁/FVC ratio. Health-related quality of life was evaluated using the SF-36 questionnaire, which yields a Mental Component Summary (MCS) and a Physical Component Summary (PCS). Statistical analysis was performed using Pearson’s correlation coefficient to determine the relationship between pulmonary function test parameters and HRQoL scores. Results: A weak but statistically significant positive correlation was observed between pulmonary function parameters and components of HRQoL (p-value <0.05). FEV1 showed a positive correlation with both MCS (r-value=0.222, p-value=0.026) and PCS (r-value=0.289, p-value=0.004). Similarly, FVC demonstrated positive correlations with MCS (r-value=0.204, p-value=0.042) and PCS (r-value=0.261, p-value=0.009). The FEV1/FVC ratio also showed a significant positive correlation with MCS (r-value=0.244, p-value=0.014) and PCS (r-value=0.230, p-value=0.021). Male participants exhibited significantly higher FEV1 and FVC values compared to females (p-value <0.001); however, no significant gender-based differences were observed in HRQoL scores. Conclusion: The present study demonstrates a significant positive correlation between pulmonary function and health-related quality of life among college students. Better respiratory function is associated with higher perceived physical and mental well-being. These findings emphasise the importance of promoting respiratory health through lifestyle interventions, such as increased physical activity, to enhance overall quality of life in this population.

Comparison of Triple Airway Manoeuvre and Reverse Insertion Technique for I-gel® Placement in Paediatric Patients under General Anaesthesia: A Randomised Controlled Trial

Garima Anant, Manisha Manohar, Anamika, Sanjay Johar

Introduction: I-gel^®, a second-generation supraglottic airway device with a soft, anatomically shaped cuff, which produces an airway seal without the need for air inflation. Distinctive features of the paediatric airway may interfere with ideal insertion of Supraglottic Airway Devices (SADs). Therefore, it is important to recognise the most effective technique for I-gel^® placement in paediatric patients to minimise airway-related complications. Aim: To compare the triple airway manoeuvre and reverse insertion technique for I-gel^® placement in paediatric patients under general anaesthesia. Materials and Methods: This single blinded, Randomised Controlled Trial (RCT) was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India, over a period of 14 months from July 2023 to September 2024 in 100 paediatric patients (7-12 years), American Society of Anaesthesiologists-Physical Status (ASA-PS) grade I and II of either gender planned for elective surgery. Randomisation was performed into two groups using a computer-generated random number table, with 50 patients in each group. In Group R, I-gel^® placement was done using the reverse insertion technique (n=50) and in Group TAM, I-gel^® was placed using the triple airway manouvre, i.e. head tilt, jaw thrust, mouth open (n=50). Mean insertion time was measured as the primary outcome. Other parameters studied were the number of attempts, overall success rate, ease of I-gel^® insertion, ease of nasogastric tube insertion and postoperative complications. Wilcoxon-Mann-Whitney U test, Chi-squared test, Fisher’s-exact test were used to analyse data. A p-value <0.05 was considered statistically significant. Results: The demographic profile of all 100 patients was comparable in both groups, based on age, gender, Body Mass Index (BMI) and ASA-PS classification. The mean±SD of insertion time in group R was 18.65±8.07 sec and in group TAM was 16.84±6.93 sec. The device was successfully placed on the first attempt in 90% of patients in group R compared with 84% in group TAM. The overall success rate was 100% in both groups. Conclusion: TAM and reverse insertion techniques of I-gel^® placement were comparable clinically. The experience of the investigator with the technique should determine the choice of technique.

Nursing Competence and its Associated Workplace Factors in a Resource-limited Setting in Garo Hills, Meghalaya, India: A Cross-sectional Study

Khusi A Sangma, Elsa Sanatombi Devi, Glenn Christo Kharkongor

Introduction: Nursing competence is a cornerstone of high-quality patient care, yet there is limited empirical evidence from rural regions of Northeast India, particularly Meghalaya. These areas face unique systemic challenges, including workforce shortages, high patient loads and limited resources, which may further impede the delivery of effective healthcare services. Aim: To assess the level of nursing competence among nurses employed in secondary healthcare centres in the Garo Hills region of Meghalaya and to examine whether selected workplace factors predict variations in competence. Materials and Methods: A cross-sectional study was carried out in 16 Secondary Healthcare Centres (District Hospitals and Community Health Centres) across the Garo Hills region of Meghalaya, from 11^th July 2023 to 19^th August 2023. Using purposive sampling facilitated by Institutional gatekeepers, 226 nurses were approached, with 222 responding to the questionnaire. Data were collected using the validated Nurse Professional Competence Scale – Short Form (NPC-SF), which assesses multiple domains of nursing competence. Prior to data collection, ethical approval was obtained, and written informed consent was secured from all the participants. Descriptive statistics summarised demographic, workplace characteristics and competence data, while multiple linear regression analysis was applied to identify predictors of competence. Results: The mean overall competence score was 5.34±1.28, indicating a moderate level of nursing competence. Among the competence domains, documentation and administration of nursing care scored highest (5.51±1.27), while nursing care scored lowest (5.03±1.16). The majority of nurses (96.85%) reported working more than 50 hours a week, with 82.88% frequently involved in overtime duties. Regression analysis revealed that workplace factors such as overtime involvement and departmental distribution did not significantly predict competence {(R^²=0.018, F (4,217)=0.99, p-value=0.413)}. Conclusion: Nurses in the Garo Hills, Meghalaya, demonstrated a moderate level of competence across all assessed domains. The findings suggested that nursing competence may be influenced by broader organisational, educational, and psychosocial factors not captured in the present study.

Correlation between Body Mass Index and Radiation Dose Metrics in Adult Thorax and Abdomen Computed Tomography Examination: A Cross-sectional Study

Pritee Prachee Pradhan, Maajid Mohi Ud Din Malik

Introduction: Computed Tomography (CT) procedures contribute significantly to medical radiation exposure and therefore necessitate the implementation of optimisation measures that balance diagnostic image quality with patient safety. Body Mass Index (BMI) influences radiation absorption; however, standard CT protocols do not adequately account for patient-specific body dimensions. Aim: To analyse the relationship between BMI categories and radiation dose metrics—volumetric CT Dose Index (CTDIvol), Dose-Length Product (DLP), Effective Dose (ED) and Size-Specific Dose Estimates (SSDE)—while examining gender-based and protocol-specific differences in adult thoracic and abdominal CT examinations. Materials and Methods: This Cross-sectional study was conducted at the Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India, from April 2025 to July 2025. The study included adult participants (aged 18-70 years) who underwent thoracoabdominal CT examinations 2025 at a tertiary care centre. A total of 200 participants were classified according to the World Health Organisation (WHO) BMI classification as underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2). Standard acquisition protocols included non contrast and contrast-enhanced abdominal studies, as well as non contrast and contrast-enhanced high-resolution thoracic imaging. Technical parameters (tube voltage, tube current-time product, pitch, slice thickness and field of view) and dosimetry-related data were consistently recorded. Statistical analysis included Pearson’s correlation, Analysis of Variance (ANOVA) and linear regression models. Results: The BMI demonstrated a positive correlation with CTDIvol (r=0.266, p<0.001), DLP (r=0.180, p=0.011) and ED (r=0.168, p=0.017). No significant correlation was observed between BMI and SSDE (r=0.043, p=0.549). Overweight (BMI 25.0-29.9 kg/m2) and obese (BMI ≥30.0 kg/m2) participants received approximately 30% higher CTDIvol values (mean 14.4 vs. 11.1 mGy, p=0.003) and a 23% higher DLP compared to normal-weight individuals. Gender-related disparities persisted after adjustment for BMI, with male participants exhibiting a 28% higher DLP (647.7 vs. 504.1 mGy•cm, p<0.001). Protocol-specific analysis revealed that contrast-enhanced thoracic CT had the highest radiation dose (mean DLP 746.4 mGy•cm), which was 47% higher than that of high-resolution thoracic protocols. Conclusion: The BMI significantly influences radiation dose in thoracoabdominal CT examinations, supporting the need for BMI-stratified Diagnostic Reference Levels (DRLs). The poor correlation between BMI and SSDE suggests limitations in size calibration for individuals with extreme body habitus. Observed gender-based differences in radiation dose may warrant the development of sex-specific protocol adaptations. Overall, these findings support the personalisation of CT protocols and dose optimisation based on anthropometric parameters and anatomical features, particularly when advanced reconstruction algorithms are employed.

Perceptions of First Year Indian Medical Students towards Different Teaching-learning and Assessment Methods in Human Anatomy: A Cross-sectional Study

Sajan Skaria, Khushboo Joshi, Aprajita Johri

Introduction: Anatomy is considered a difficult subject with a broad curriculum, and many students encounter difficulty in understanding it effectively. Modern-day learning involves the integration and use of new technologies and resources. Aim: To examine the perceptions of medical students regarding various teaching, learning, and assessment methods. Materials and Methods: This cross-sectional survey was conducted among undergraduate medical students (n=266) of the American International Institute of Medical Sciences, Udaipur, Rajasthan, India, after obtaining ethical clearance. A structured questionnaire consisting of 28 questions encompassing the current teaching, learning, and assessment methods in anatomy was used for the study. The data obtained were analysed and represented as percentages. Results: More than half of the participants, 164 (61.65%), believed that a one-year duration is adequate for proper understanding of the subject. About 82 (30.83%) of the participants felt that classical large-group lectures were the best teaching method. Students appreciated problem-based teaching, small-group demonstrations, and the use of advanced teaching-learning methodologies. A total of 248 (93.23%) of the participants enjoyed teaching at the dissection table. The majority of participants found difficulty in learning embryology 190 (71.43%) and histology 140 (52.63%). They expressed difficulty in comprehending the sequence of events, inability to visualise structures, and inadequate time allocation in embryology, as well as difficulty in identifying structures under the microscope and insufficient lecture and practical time in histology. Participants were satisfied with continuous assessment methods such as weekly assessments and part-ending tests. Conclusion: The survey received a mixed response from the participants. They were satisfied with the existing one-year anatomy curriculum. Participants appreciated classical chalkboard teaching and cadaveric dissection even in the age of multimedia and artificial intelligence. Problem-Based Learning (PBL) and clinical case discussions as part of Competency-Based Medical Education (CBME) encouraged critical thinking and application of knowledge among the participants. Students expressed anxiety regarding embryology and histology but appreciated continuous assessment strategies

Mutation Analysis of NOS1 Exon 18 Polymorphisms with the Risk of Parkinson’s Disease: A Cross-sectional Study

Gurushantappa S Kadakol, Bhushan B Kulkarni, Ashwini Hiremath

Introduction: Nitric Oxide Synthase 1 (NOS1) has been implicated in Parkinson’s Disease (PD) pathogenesis through its role in neuronal signaling and oxidative stress. However, evidence of specific genetic contributions in Indian populations remains limited. Aim: The present study aimed to examine whether genetic variations in exon 18 of the NOS1 gene are associated with PD in a South Indian cohort. Materials and Methods: The present observational cross-sectional study was conducted between March 2022 and May 2023 at a Tertiary Care Hospital, Karnataka, India. One hundred clinically diagnosed PD patients underwent detailed neurological assessment and 1 mL venous blood collection. Deoxyribonucleic Acid (DNA) was extracted and exon 18 of NOS1 (chromosome no 12 ) was amplified by PCR and sequenced using Sanger sequencing. Variants were analysed and verified using bioinformatics tools and reference sequences. Results: The cohort comprised 65 males and 35 females, with 64 cases classified as sporadic, 34 idiopathic, and 2 familial. Demographic data showed that 67% were urban residents. Sequencing of exon 18 detected a synonymous single nucleotide variant (g.119313C>T, rs1047735) in three patients: two heterozygous and one homozygous. This variant (c.2706C>T) results in p.His902=, without amino acid change. Conclusion: Only synonymous variants were found. Although these variants do not change the amino acid sequence, they may influence NOS1 regulation at the RNA level. Larger case-control studies with functional analyses and broader genomic approaches such as whole-exome sequencing are necessary to clarify whether NOS1 exon 18 variants contribute to PD susceptibility.

Association between Patients Presenting with Hypertensive Emergency in MICU and Target End-organ Damage across Different Genders and Age Groups: A Cross-sectional Study

Vipin Porwal, Vipasha Garg, Masum Talesara

Introduction: Hypertensive emergencies represent life-threatening conditions characterised by acute elevations in blood pressure with evidence of target organ damage. They remain a significant contributor to cardiovascular, neurological, and renal morbidity and mortality, often leading to hospitalisation. Early detection of end-organ involvement is therefore crucial to prevent irreversible damage and improve clinical outcomes. Aim: To study the association between patients presenting with hypertensive emergency in the Medical Intensive Care Unit (MICU) and target end-organ damage across different genders and age groups. Materials and Methods: The present cross-sectional study was conducted among adult patients aged 18-80 years presenting with blood pressure ≥180/120 mmHg at R. D. Gardi Medical College and Charitable Hospital, Ujjain, Madhya Pradesh, India, over a period of six months, from June 2024 to November 2024. Demographic data, medical history, and other clinical information, including Electrocardiography (ECG), Two Dimensional (2D) echocardiography, chest X-ray, funduscopic examination, ultrasonography of the abdomen, and neuroimaging studies, were collected. Data were analysed using SPSS software (Statistical Package for the Social Sciences (SPSS) Inc., Chicago, IL), version 29.0.10, with a p-value <0.05 considered statistically significant. Results: Among the 96 patients, 58 (60%) were male and 38 (40%) were female. The mean {±Standard Deviation (SD)} age was 58.66±12.62 years (range: 18-80 years). A past history of hypertension was present in 58 (60.4%) patients, with a mean duration of 6.51±4.34 years (range: 1-20 years). The most common forms of acute target organ damage were Cerebrovascular Accident (CVA) with retinopathy in 24 patients (25%), followed by Myocardial Infarction (MI) with retinopathy in 15 (15.6%), retinopathy alone in 13 (13.5%), retinopathy with pulmonary oedema and acute heart failure in 11 (11.5%), and MI alone in 10 patients (10.4%). Conclusion: Hypertensive emergencies were more frequent among middle-aged and elderly males, most of whom had a prior history of hypertension. CVAs and retinopathy were the leading complications, followed by MI either alone or in combination with retinopathy. Strengthening early detection and ensuring strict blood pressure control are essential to reduce the burden of target organ damage in these patients.

Dexmedetomidine versus Dexamethasone as an Adjuvant to 0.5% Ropivacaine in Ultrasound-guided Infraclavicular Brachial Plexus Block: A Randomised Controlled Study

Shaheen Nazar, Sanjeeb Kumar Giri, Saswati Das, Shreyasi Mallick

Introduction: Infraclavicular brachial plexus blocks provide effective surgical anaesthesia and postoperative analgesia for upper limb surgeries. The use of adjuvants with local anaesthetics has gained significant attention for enhancing block quality, prolonging the duration of analgesia, and reducing postoperative opioid requirements. Both dexmedetomidine and dexamethasone have emerged as promising adjuvants; however, their comparative efficacy in infraclavicular blocks remains under investigation. Aim: To compare the efficacy of dexmedetomidine versus dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided infraclavicular brachial plexus block. Materials and Methods: The present triple-blinded, randomised controlled trial was conducted on 58 American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective forearm surgery between August 2023 and October 2024 at PBMH, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. Group I (n=29) received 20 mL of 0.5% ropivacaine with 8 mg dexamethasone, while Group II (n=29) received 20 mL of 0.5% ropivacaine with dexmedetomidine (1 μg/kg). The primary outcome was the duration of sensory block. Secondary outcomes included the onset of sensory and motor block, duration of motor block, time to first analgesic request, total analgesic requirements, haemodynamic parameters, and adverse effects. Data were analysed using unpaired t-tests and Mann-Whitney U tests for continuous variables, and Fisher’s exact test for categorical variables. Repeated measures Analysis of Variance (ANOVA) was used for haemodynamic parameters (p<0.05 considered significant). Results: The mean age was 38.83±11.57 years in Group I and 39.97±13.51 years in Group II, with comparable gender distribution (male/female: 15/14 vs. 12/17), Body Mass Index (BMI) (24.35±2.86 vs. 24.12±4.13 kg/m2), and ASA status. Group II (dexmedetomidine) demonstrated a significantly faster onset of sensory block (7.69±2.09 vs. 9.83±1.98 minutes, p<0.01) and motor block (11.24±2.34 vs. 13.21±1.88 minutes, p<0.01). The duration of sensory block (792.8±170.8 vs. 610.3±89.38 minutes; p<0.01) and motor block (667.8±152.6 vs. 535.9±88.7 minutes; p<0.01) was significantly prolonged in the dexmedetomidine group. Time to first analgesic requirement was 883.4±159.5 versus 706.6±100.5 minutes (p<0.01), with 24-hour tramadol consumption of 135.69±57.64 versus 189.32±64.05 mg (p<0.01) in Groups II and I, respectively. Haemodynamic parameters remained stable in both groups, with no significant differences in adverse effects. Conclusion: Dexmedetomidine (1 μg/kg) as an adjuvant to 0.5% ropivacaine in infraclavicular brachial plexus blocks provides a faster onset, prolonged duration of analgesia, and reduced postoperative analgesic requirements compared to dexamethasone (8 mg), with a comparable safety profile.

Anthropometric Profile of the Children Admitted to Tertiary Healthcare Centre and its Association with Maternal Education and Occupation: A Retrospective Observational Study

Introduction: In the recently published National Family Health Survey (NFHS)-5 data, Anand district’s performance was not promising in terms of nutrition of mother and child; and being the only tertiary care teaching hospital in the district, there is a need to generate the study data. Aim: To evaluate the anthropometric profile of paediatric patients across different age groups at a Tertiary Care Centre, and to study its association with maternal education and occupation. Also, to compare the anthropometry indicators of NFHS-5 of Anand district with anthropometry of hospitalised children. Materials and Methods: The present retrospective observational study was conducted at the Department of Paediatrics of Pramukhswami Medical College and Shree Krishna Hospital in Anand district in Gujarat state between January 2023 to December 2023. A total of 1099 patients admitted under the Paediatric Department between the age groups of one month to 18 years in the Paediatric Ward and Paediatric Intensive Care Unit were included. All pertinent baseline details and their anthropometry were measured and plotted on World Health Organisation (WHO) and Indian Academy of Paediatrics (IAP) growth charts. Expected age values were calculated, and Z-scores were determined for classification. Mothers were also surveyed about their education and employment status. The Chi-square test was used to study the association between maternal education and occupation, and the Z-test for proportion compared results with NFHS 5 data. Results: A total of 1099 paediatric patients were admitted during the study period. The median (Q1,Q3) age of study cohort was 67(21,137) months and males were 651(59.24%). Among all patients, 70% were stunted and 85% were underweight. Data for children under 5 significantly differed from NFHS-5 data (p<0.001), with higher rates of stunting (69.5% vs. 38.4%), underweight (84.8% vs. 46.6%), wasting (77.8% vs. 28.6%), and severe wasting (29.6% vs.10.9%). Maternal education and occupation were linked to child growth, with stunting associated with maternal education and underweight linked to maternal occupation in older children. Conclusion: The study revealed higher prevalence rates of stunting, wasting, and underweight among indoor paediatric patients compared to NFHS-5 data for the Anand district.

Predictors of Outcome in Patients with Dyspnoea of Pulmonary Origin admitted to a Respiratory Intensive Care Unit: A Prospective Observational Study from Eastern India

Introduction: Dyspnoea is one of the most common presenting complaints in the Respiratory Intensive Care Unit (RICU). It reflects a wide spectrum of underlying pulmonary conditions with varying severity and outcomes. Early identification of clinical and laboratory predictors can aid in risk stratification and management planning in critically ill patients. Aim: To evaluate the demographic and clinical profiles, initial Arterial Blood Gas (ABG) findings, and factors associated with short-term outcomes in patients with pulmonary-origin dyspnoea admitted to the RICU. Materials and Methods: A prospective observational study with follow-up until ICU discharge was conducted in the RICU of the College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India from December 2023 to 2024. A total of 76 patients presenting with dyspnoea of pulmonary origin were enrolled. Demographic parameters, presenting symptoms, primary diagnosis, microbiological findings, co-morbidities, neurological status, initial ABG parameters, oxygen or ventilatory support, and outcomes were recorded. Patients with non pulmonary causes of dyspnoea were excluded. Data were analysed using Statistical Package for the Social Sciences (SPSS) statistical software (Version 26.0), employing appropriate statistical methods. A p-value <0.05 was considered as statistically significant. Results: Of the 76 patients included, 67.1% were male, with a mean age of 59.5±11.74 years. Hypertension and diabetes mellitus were the most common co-morbidities, and obstructive airway disease was the predominant diagnosis (55.3%). Non survivors were significantly older (p-value=0.041) and more likely to have altered sensorium {Richmond Agitation Sedation Scale (RASS) < +1; p-value <0.0001}, Acinetobacter baumannii infection (p-value <0.0001), metabolic and mixed acidosis (p-value <0.0001), initial arterial pH ≤7.20 (p-value=0.044), septic shock (p-value <0.0001), Acute Respiratory Distress Syndrome (ARDS) (p-value=0.001), ventilator-associated pneumonia (p-value=0.001), and massive haemoptysis (p-value=0.008). The requirement for Invasive Mechanical Ventilation (IMV) was the strongest predictor of mortality (p-value <0.0001). On bivariate logistic regression analysis, age {Odds Ratio (OR) 1.07, p-value=0.007), RASS < +1 (OR 7.29, p-value <0.0001}, Acinetobacter baumannii infection (OR 30.00, p-value=0.002), metabolic acidosis (OR 7.13, p-value <0.0001), and mechanical ventilation (OR 304.5, p-value <0.0001) were significantly associated with mortality. On multivariate analysis, metabolic acidosis (OR 6.67, p-value=0.005), mechanical ventilation (OR 68.47, p-value <0.0001), and RICU stay <6 days or >12 days (OR 1.18, p-value=0.015) independently predicted poor outcomes. Conclusion: Older age, lower RASS scores, gram-negative infection, severe acidosis, and the need for invasive mechanical ventilation were associated with increased mortality. Early identification of these adverse prognostic markers and timely intervention may improve outcomes in RICU patients presenting with dyspnoea of pulmonary origin.

Prevalence, Risk Factors and Management of Vernal Keratoconjunctivitis: A Cross-sectional Study from a Tertiary Care Centre in Western Maharashtra, India

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic, recurrent allergic eye condition affecting children and adolescents, particularly in warm and dusty climates. It can lead to significant ocular morbidity if not recognised and treated early. Aim: To investigate the prevalence, risk factors, clinical presentation, and management practices of VKC among children attending a tertiary care centre in Western Maharashtra, India. Materials and Methods: A cross-sectional observational study was conducted over 18 months (September 2023-March 2025) at a tertiary healthcare facility in Maharashtra, India. One hundred patients (200 eyes) clinically diagnosed with VKC were enrolled. Data were collected through detailed history taking, standardised ophthalmological examination, and a structured questionnaire. Descriptive and inferential statistics were applied using Statistical Package for the Social Sciences (SPSS) version 27.0, and the Chi-square test was used to assess associations. A p-value of <0.05 was considered statistically significant. Results: VKC most commonly affected males, with 72 (72%) cases. The highest prevalence was observed in the 12-14-year age group, with 37 patients (37%). A significant association was noted between the VKC form and age group (p-value=0.007). The palpebral form was the most prevalent, seen in 69 patients (69%), followed by the limbal form in 16 (16%) and the mixed form in 15 (15%). The most frequently reported symptoms were ropy discharge in 94 patients (94%), foreign body sensation in 81 (81%), and tearing in 76 (76%). Reported risk factors included eye rubbing in 86 patients (86%), dust exposure in 54 (54%), and Ultraviolet (UV) radiation exposure in 41 (41%). Corneal involvement was noted in 19 patients (19%), with scarring being the most frequent complication, occurring in six patients (6%). A statistically significant association was observed between the mixed VKC form and higher complication rates (p-value <0.001). Management strategies included cold compresses in all patients (100%), topical antihistamines in 83 (83%), and mast cell stabilisers in 75 (75%). Corticosteroids were required in 23 (23%), and immunosuppressants were administered to 11 (11%). Conclusion: VKC was observed predominantly in young male patients, with the highest frequency in the 12-14-year age group. The palpebral form was the most common clinical type, and symptoms such as ropy discharge, itching, and tearing were frequently reported. Risk factors included dust exposure, UV radiation, and a history of allergy or eye rubbing. The mixed form of VKC was associated with a higher incidence of complications. A stepwise treatment approach was found to be effective, and early identification with appropriate management can help prevent long-term visual impairment.

Micronutrient Intake and Haemoglobin Status in Early Pregnancy: A Cross-sectional Study from North Karnataka, India

Bhagyashri B Mudagoudra, Sheetal Harakuni, Yeshita V Pujar

Introduction: Nutrition during pregnancy plays a crucial role in maternal and foetal health. Iron Deficiency Anaemia (IDA) remains a significant public health problem in India, contributing to adverse pregnancy outcomes. Understanding dietary micronutrient intake in early pregnancy is essential for designing effective interventions. Aim: To evaluate dietary intake of key micronutrients (iron, folic acid, and Vitamin C) and assess their association with Haemoglobin (Hb) concentration during the first trimester of pregnancy in North Karnataka, India. Materials and Methods: A cross-sectional study was conducted among 175 first-trimester pregnant women attending antenatal clinics (ANCs) at KLE Hospital and Research Centre, Belagavi, Karnataka, during June 2023 to May 2024. Dietary intake was assessed using a validated Food Frequency Questionnaire (FFQ). Parameters studied included Hb levels and daily intakes of iron, folic acid, and Vitamin C. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20.0 for the Chi-square test, Spearman’s rank correlation, one-sample t-test and Two-way Analysis of Variance (ANOVA using Statista app. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 25.35±3.98 years, with a mean gestational age of 9.58±2.10 weeks. Mild anaemia was observed in 64 (36.57%) participants, moderate anaemia in 6 (3.43%), and 105 (60%) had normal Hb levels. Mean daily intakes of iron (7.84±3.20 mg), folic acid (58.33±25.67 mcg), and Vitamin C (28.70±18.68 mg) were significantly lower than the Recommended Dietary Allowances (RDA) (p-value <0.001 for all). Spearman’s correlation showed Hb levels in the study participants were not significantly associated with their dietary intake of iron (r-value=0.0023, p-value=0.9755), folic acid (r-value=0.0075, p-value=0.9219), or Vitamin C (r-value=–0.0309, p-value=0.6848). Conclusion: Micronutrient intake among pregnant women in early pregnancy was markedly inadequate, contributing to a significant burden of anaemia. There is an urgent need for targeted interventions such as dietary counselling, supplementation, and food fortification to improve maternal nutritional status and reduce anaemia-related risks.

Comparison of Lipid Profiles among Diabetics and Non diabetics at a Semi-urban Primary Care Health Setting in Chennai, Tamil Nadu, India: A Cross-sectional Study

Introduction: Lipids form an important constituent of the human cell membrane with wide functional importance. The alterations in lipid levels can result in an imbalance of the homeostatic reserve and, therefore, can result in a diseased state. Aim: To analyse and compare lipid profiles between diabetic and non diabetic individuals amongst the study group and find an association between diabetic status and lipid parameters. Materials and Methods: A cross-sectional study was conducted in the Outpatient Department (OPD) of a primary care health setting, Sakthi Multi-speciality clinic, Poonamallee, Chennai, South India, between July 2024 to September 2024. The present study included 55 patients who attended a primary health care setting. A convenient consecutive sampling technique was followed in recruiting both male and female patients above 18 years of age with or without co-morbid illness. The elements of lipid profile analysis were presented as median and interquartile range. The Mann-Whitney U test was employed for comparing continuous variables between diabetic and non diabetic groups and Fisher’s exact test for associations between categorical variables. Kendall’s Tau-B correlation was used to assess associations among continuous variables within the diabetic subgroup. A p-value <0.05 was considered statistically significant. Results: Of the total 55 participants who consented to participate in the study, 41 were males and 14 were females. Among them, 11 participants were known cases of Diabetes Mellitus (DM). A total of 44 participants with capillary blood glucose levels less than 126 mg/dL and no prior history of co-morbid illness were considered to be apparently normal. The median and Interquartile range of Total Cholesterol (TC), Triglycerides (TG), Very Low-Density Lipoprotein (VLDL), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and ratio of cholesterol to HDL were found to be 160 (IQR=40), 105 (IQR=37.5), 34 (IQR=8), 108 (IQR=54.5), 21 (IQR=7.5), 4.7 (IQR=0.0), respectively. The analysis revealed a significant difference in the LDL (p-value <0.01) and ratio of cholesterol to HDL (p-value-0.054) in the diabetic group compared to the non diabetic group. The association between diabetic status and independent variables revealed a significant association between diabetic status and LDL. TC/HDL was moderately correlated with Fasting Blood Sugar (FBS) (τ=0.59, p-value=0.03) and Postprandial Blood Sugar (PPBS) (τ=0.57, p-value=0.03). A positive correlation was observed between FBS and TC (τ=0.41, p-value=0.08), TGs (τ=0.44, p-value=0.06), HDL cholesterol (τ=0.41, p-value=0.08), LDL cholesterol (τ=0.55, p-value=0.02) and VLDL (τ=0.44, p-value=0.06) although not statistically significant. Conclusion: Strong association between altered lipid parameters and Diabetic status, with the presence of moderate effect sizes, suggests potentially meaningful relationships that warrant a greater insight into the discernment of the disease. The current pilot study may direct future research to comprehensively understand the metabolic derangements playing a causative role in the pathogenesis of DM and Metabolic Syndrome.

Comparison of Maternal and Neonatal Outcomes Following Induction of Labour at 39 Weeks versus 40 Weeks in Low-risk Pregnancies: A Retrospective Cohort Study

Taru Gupta, Saumya Rajput, Nupur Gupta, Jyoti Bagla

Introduction: Optimum timing of delivery is crucial for a healthy pregnancy outcome. The decision to terminate low-risk full-term pregnancies, i.e., between 39 weeks 0 days and 40 weeks 6 days, has remained controversial. The risk-to-benefit ratio must be weighed in relation to the induction of labour and the prolongation of pregnancy. Aim: To compare foeto-maternal outcomes after elective induction of labour in low-risk antenatal women at 39 and 40 weeks of gestation. Materials and Methods: The present study was a retrospective cohort study conducted in the Department of Obstetrics and Gynaecology, ESIC PGIMSR Basaidarapur, New Delhi, India, from December 2020 to April 2022. Eighty low-risk pregnant women carrying a live singleton foetus in cephalic presentation, who had undergone elective induction of labour, were selected and assigned into two categories: Group A: Elective induction at 39 completed weeks (N=40), Group B: Elective induction at 40 completed weeks (N=40). Labour induction was performed according to standard institutional protocol. The primary outcome studied was the caesarean section rates. Data were analysed using Statistical Package for Social Sciences (SPSS) v25.0. Quantitative variables were summarised as mean±Standard Deviation (SD) or median {Interquartile Range (IQR)} and compared using the independent t-test. Categorical variables were expressed as numbers (%) and compared using the Chi-square or Fisher’s exact test. Results: Sociodemographic data were comparable between the two groups, with the mean age of participants being 25.7±3.48 years in the 39-week group and 25.9±3.48 years in the 40-week group. The distribution of women according to parity was comparable between the two groups. Nulliparous women comprised 24 (60%) in the 39-week cohort and 30 (75%) in the 40-week cohort, while multiparous women comprised 16 (40%) and 10 (25%) of the 39 and 40-week cohorts, respectively (p=0.152). The rate of caesarean delivery was significantly increased in women undergoing elective induction of labour at 40 weeks versus 39 weeks, at 22 (55%) vs. 11 (27.5%), respectively (p=0.013). Instrumental delivery occurred in 3 (7.5%) women induced at 39 weeks but in none induced at 40 weeks. There was a non-significant increase in postpartum haemorrhage occurred after eIOL at 40 weeks: 1 (2.5%) in the 39 weeks group versus 6 (15%) in the 40 weeks group (p=0.108). No significant between-group differences were observed in adverse neonatal outcomes. APGAR score at 1 and 5 minutes were comparable, with 3 (7.5%) and 4 (10%) babies having APGAR <7 at 1 minute in the 39 and 40-week groups, respectively, while APGAR <7 at 5 minutes was seen in 1 (2.5%) and 3 (7.5%) babies, respectively. The mean duration of NICU stay was 2.25±1.2 days for neonates born at 39 weeks and 3.0±1.5 days for neonates born at 40 weeks. Conclusion: Elective induction of labour at 39 weeks is associated with a reduced incidence of caesarean section compared to induction at 40 weeks of gestation. There is no increased incidence of adverse neonatal outcomes after induction at 39 weeks. This suggests that clinical practice can be modified to incorporate elective induction at 39 completed weeks in the absence of high-risk foeto-maternal factors, instead of waiting until 40 weeks, to reduce maternal morbidity associated with caesarean section.

Morphometric Analysis of Crucial Cerebral Sulci by Dissection Method: A Cross-sectional Study

Introduction: Morphometric analysis of cerebral sulci provides critical insights into brain structure, functional organisation, and hemispheric asymmetry. Understanding variations in major sulci such as the Central Sulcus (CS), Calcarine Sulcus (CalS), and Parieto-Occipital Sulcus (POS) is essential for neurosurgical planning and comparative neuroanatomy. Aim: To analyse the morphometry of crucial cerebral sulci by dissection method. Materials and Methods: The present cross-sectional study, was conducted in the Department of Anatomy at the Faculty of Medicine and Health Sciences, SGT University, Budhera, Gurugram, Haryana, India, from June 2024 to August 2025, on 30 cerebral hemispheres (15 right and 15 left) of unknown sex, preserved in 10% formalin. The samples were obtained from the dissection hall and the museum of the same department. The data were collected by assessing parameters of the CS, CalS, and POS and were entered into a Microsoft Excel spreadsheet. The mean and standard deviation (M±SD) of all parameters were analysed using Statistical Package for the Social Sciences (SPSS) software version 21. An independent t-test was used for the comparison of parameters of right and left with a significance level (p<0.05). Results: The CS was highly conserved, showing no significant right-left differences (Right: 11.32±0.70 cm; Left: 11.49±0.88 cm; p=0.55). The CalS demonstrated significant hemispheric asymmetry, with anterior CalS right>left (p=0.02) and posterior CalS left >right (p=0.04). The POS bifurcation to the subparietal sulcus exhibited right>left asymmetry (p=0.04). Parameters involving the posterior splenium also showed symmetric and hemisphere-related differences, while other sulcal measurements were largely symmetrical. Conclusion: While the CS remains a stable anatomical landmark, CalS and POS display reproducible hemispheric asymmetries, particularly in posterior regions. These findings were consistent across Indian and international populations and highlight the importance of considering sulcal asymmetry in neurosurgical approaches, radiological mapping, and functional cortical studies. Understanding these morphometric patterns can improve surgical safety, imaging accuracy, and comparative neuroanatomy.

Decoding Visual Symptoms in Migraine: The Role of Binocular Vision Abnormalities: A Cross-sectional Study

Liba Sara Varghese, Rashmi Jain, Vijayalakshmi Subramaniam, K Yashaswini

Introduction: Migraine is a chronic, neurovascular disorder characterised by recurrent attacks of headaches. Migraine is also associated with a variety of symptoms, including sensitivity to light, sound, and smell, as well as nausea, dizziness, difficulty concentrating, and fatigue. Accommodative issues can manifest as blurred vision at distance and/or near, headaches, poor concentration, and reading difficulties. There is a relationship between binocular vision impairments and migraine headaches, as both conditions can produce visual symptoms that diminish a patient’s overall quality of life. Aim: To quantify visual symptoms and their correlation with specific binocular vision dysfunctions in a cohort of migraine patients. Materials and Methods: This cross-sectional study was conducted at Yenepoya Medical College, Mangaluru, Karnataka, India, from June 2024 to January 2025. The study included 72 migraine patients (with or without aura), diagnosed with specific binocular vision anomalies such as Accommodation Insufficiency (AI), Convergence Insufficiency (CI), Accommodation Excess (AE), or Convergence Excess (CE). Visual symptoms of all 72 patients were assessed using the 14-item Symptom Questionnaire for Visual Dysfunctions (SQVD). Scores were categorised into mild, moderate, and severe using a predefined percentage-based cut-off derived from principles often applied in knowledge/attitude/practice assessments. Statistical analyses included one-way Analysis of Variance (ANOVA) and regression analysis to examine relationships between visual symptom scores and binocular vision anomalies, age, and gender. Results: The cohort comprised predominantly females 64 (89%) with a mean age of 22.29±2.67 years. The average SQVD score was 10.08±4.14. The severity distribution indicated that 52 (72.2%) experienced mild, 16 (22.2%) moderate, and 4 (5.6%) severe visual symptoms. A one-way ANOVA revealed no statistically significant difference in visual symptom scores among the four binocular anomaly groups (p-value=0.454). Regression analysis identified age as a significant negative predictor of visual symptom scores (β=-0.4, p-value=0.035), indicating that scores decreased with increasing age. Binocular anomaly types and gender were not statistically significant predictors. Conclusion: Visual symptoms are prevalent among young adult migraine patients, with photophobia often being a major contributor. While binocular vision anomalies frequently co-exist with migraine, this study found no statistically significant correlation between specific binocular vision dysfunction types and overall visual symptom severity as measured by the SQVD. Further research is warranted to explore the complex interplay of various visual disturbances in migraine and their impact on quality of life, particularly considering age-related trends and the distinct pathophysiology of photophobia.

Prevalence of Morphological Variations of Posterior Communicating Artery and its Association with Age, Sex, and Laterality using Magnetic Resonance Angiography: A Cross-sectional Study

Introduction: The Posterior Communicating Artery (PCoA) is a vital component of the circle of Willis, providing collateral circulation between the anterior and posterior cerebral circulations. Morphological variations such as hypoplasia, aplasia, foetal-type configuration, and duplication may influence cerebral haemodynamics and predispose individuals to neurovascular disorders. Magnetic Resonance Angiography (MRA) allows accurate non-invasive assessment of these variations. Aim: To determine the prevalence of PCoA morphological variations and assess their association with age, sex, and laterality using Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA). Materials and Methods: The present cross-sectional study included 150 patients who underwent brain MRA between May 2024 and August 2025 in department of Radiology, Dhiraj hospital, BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India and excluded those with cerebrovascular abnormalities confirmed by clinical evaluation and imaging review. High-resolution 1.5T TOF-MRA images were analysed for PCoA morphology and classified into normal, hypoplasia (<1 mm), aplasia (non-visualisation), foetal-type configuration, and duplication. Two Radiologists independently assessed the images, with consensus in case of disagreement. Chi-square/Fisher exact tests were used to evaluate associations between variations and demographic factors such as age and sex. Results: Among 300 arteries examined, hypoplasia was the most common variation type in 122 (40.66%) cases, and duplication was present in 5 (1.66%) cases. No statistically significant associations were noted between PCoA morphology and age and sex. However, laterality showed significant differences. Conclusion: Hypoplasia emerged as the predominant PCoA variation in this cohort. PCoA morphology demonstrates significant laterality-related differences at the aggregate level. In contrast, PCoA morphology shows no statistically significant association with sex or age. Observed absolute differences, particularly in aplastic configurations, may be anatomically and clinically relevant and warrant further investigation in larger, adequately powered studies. Routine MRA evaluation of PCoA morphology is essential for understanding individual cerebrovascular risk and for planning neurosurgical and endovascular interventions.

Diagnostic Performance Analysis using CBCT Assisted Artificial Intelligence for Detection of Supernumerary Teeth and Odontomes: A Retrospective Study

Balajee Venkatesh, A Hari Priya

Introduction: Artificial Intelligence (AI) is revolutionising dentistry by enhancing diagnostic precision, particularly for complex conditions like supernumerary teeth and odontomes. Accurate detection of these anomalies is essential for effective management and improved patient outcomes. Aim: To evaluate the diagnostic performance of the machine learning models- Logistic Regression (LR), Random Forest (RF), and k-Nearest Neighbours (kNN), Gradient Boosting (GB), Artificial Neural Network (ANN), Stochastic Gradient Descent (SGD)- in detecting supernumerary teeth and odontomes using Cone Beam Computed Tomographies (CBCTs). Materials and Methods: The present retrospective study analysed CBCT images of the maxillary and mandibular arches from patients who visited Saveetha Dental College and Hospital between February and September 2024 in Chennai, Tamil Nadu, India. A total of 240 high-resolution CBCT scans were included, categorised into three groups: supernumerary teeth (n=80), odontomes (n=80), and normal dentition (n=80), and patients exhibiting other dental anomalies were excluded. The dataset was divided into training (70%) and testing (30%) sets. Following preprocessing, multiple machine learning models- LR, RF, kNN, GB, ANN, and SGD- were employed for analysis using Orange data mining software. Results: The present study evaluated the diagnostic performance of six machine learning models- LR, kNN, RF, ANN, SGD, and GB- for classifying CBCT images into supernumerary teeth, odontomes, and normal dentition. LR achieved the highest overall performance with an Area Under Curve (AUC) of 0.960, accuracy of 86.3%, and Mathews Correlation Coefficient (MCC) of 0.829, demonstrating strong generalisation across all classes. NN and GB also performed well, with comparable AUCs (0.960 and 0.944, respectively) and balanced classification metrics. RF showed good performance (AUC=0.951) but with a higher LogLoss, indicating less confident predictions. SGD and kNN underperformed, with kNN yielding the lowest accuracy (53.7%) and high misclassification rates. Confusion matrix analysis further supported these findings, highlighting LR, ANN, and RF as the most reliable models for distinguishing among the three diagnostic categories on CBCT images. Conclusion: The LR proved to be the most effective model for detecting supernumerary teeth and odontomes. Future research should address dataset diversity and class imbalances while exploring ensemble modelling approaches to enhance diagnostic capabilities further.

Unravelling the Significance of Immunohistochemistry in Differentiating Neoplastic Lesions of Liver Biopsy: A Cross-sectional Study

BE Chaitra, Gale Kathleen Edward, Ritika Johri

Introduction: Liver cancer globally remains the fourth-leading cause of cancer-related mortality. Metastatic lesions are more common in the liver tissue due to its rich portal and systemic venous blood supply. Even though an accurate histopathological diagnosis of tumours is possible in some cases. Distinguishing the hepatocellular carcinoma from metastatic lesion with similar morphology, poor differentiation and sub classification of carcinomas with unknown primary tumours always remains a problem. A multidisciplinary approach of histomorphological evaluation combined with systematic Immunohistochemistry (IHC) study is essential in differentiating neoplastic lesions. Aim: To evaluate the role of IHC in differentiating the neoplastic lesions of liver biopsy to hepatic origin and metastatic lesion. Materials and Methods: The present cross-sectional study of 50 neoplastic liver biopsy reported in the Departments of Pathology in oncquest laboratory for 3 years from march 2021 and February 2023, Bangalore, Karnataka, India. Clinical details were retrieved by request forms. All the tissue blocks were processed for Haematoxylin and Eosin (H&E) sections and for IHC. Primary panel includes HepPar1, CK7,CK20,CK19 and KI67. The second panel includes arginase, glypican 3, CEA, CDX2 and SATB2. The third panel was decided further based on results of second panel, clinical details and radiological findings. A known positive and negative controls were used for each batch of slides. The slides were reviewed by two Pathologist and results were analysed. Results: Of the total 50 cases 37 were male (74%). The primary panel classified and second panel confirmed the liver biopsy into hepatic origin and metastatic lesion. The lesions classified were Hepatocellular Carcinoma (HCC) 7 (14%) cases, cholangiocarcinoma 2 (4%) cases, hepatic adenoma 6 (12%) cases and metastatic deposits 35 (70%) cases by the end of secondary panel. The third panel determines the origin of metastatic deposits. Metastatic lesions were the most common lesions in liver biopsy 35 (70%) cases. Colorectal adenocarcinoma was the most common lesion in metastatic deposits (74%). Conclusion: Diagnosing liver tumours on core biopsy specimen can be challenging. Accurate diagnosis is essential to establish the optimal treatment strategy. A systematic approach of initial differentiation by primary panel, confirmation by secondary panel and narrowing down the primary site of metastasis using third panel is highly recommended.

Role of Oral Curcumin as an Analgesic for Pain Management in Breast Cancer Surgery: A Randomised Control Trial

Sheeja Jacob, Sunil Saini, Madiwalesh Chhebbi

Introduction: Postoperative pain management is of prime importance to the surgeon, as it significantly influences a patient’s recovery. A multimodal approach to pain management is an essential component of postoperative care. Curcumin, a natural antioxidant and anti-inflammatory compound, also exhibits analgesic properties. However, its use in the postoperative setting has not been extensively studied. Aim: To evaluate the role of oral curcumin as an analgesic in the management of postoperative pain following breast cancer surgery. Materials and Methods: This was a single-blind, randomised controlled trial that was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India and included 60 patients undergoing surgery for breast cancer between October 2023 and April 2024. The study group was administered oral curcumin lozenges twice daily, along with standard analgesics, from Postoperative Day (POD) 1. The control group received a placebo. Postoperative pain was assessed from POD 0 to POD 7 using the 11-point Numeric Pain Scale (NPS) and compared using the independent t-test performed with the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Sixty patients were enrolled (30 in each group). One patient in the study group was excluded from the final analysis as the study protocol was not followed; therefore, 59 patients were analysed. A statistically significant difference in pain scores between the study and control groups was observed on POD 6 and POD 7 (p-value=0.006). No significant difference was observed between the groups regarding the use of SOS analgesics (p-value=0.322) or drain output (p-value>0.05). No adverse events were reported by any patient in the study group. Conclusion: This study demonstrated that curcumin may be beneficial in postoperative pain management. The use of a nutraceutical such as curcumin, with its favourable safety profile and minimal side-effects, offers a promising option. A longer follow-up period is warranted to fully explore the analgesic potential of curcumin. Additionally, studies employing a double-blind design and larger sample sizes are recommended to provide further evidence of its effectiveness in postoperative pain management.

Comparing High Flow Nasal Canula Oxygen Therapy and Non-invasive Ventilation in COPD Patients with Acute Hypercapnic Respiratory Failure: A Single-centre Cross-sectional Study

Golam Ahammad Mondal, Pulak Kumar Jana, Sourindra Nath Banerjee, Sukanta Kodali

Introduction: Non-invasive ventilation (NIV) is frequently employed as a treatment option for Acute Hypercapnic Respiratory Failure (AHRF) resulting from Chronic Obstructive Pulmonary Disease (COPD). Though it is frequently employed there are group of patients who are not tolerant to NIV,few recent studies had shown that High Flow Nasal Cannula (HFNC) can be used to treat hypercapnia. Aim: To compare the outcome of using High Flow Nasal Cannula (HFNC) versus NIV for COPD patients with AHRF. Materials and Methods: The present single centred cross-sectional interventional study was performed from September 2022 to March 2024 at the Department of Respiratory Medicine, NRS Medical College and Hospital, Kolkata, West Bengal, India. A total of 30 COPD patients with AHRF were included in this study and they were assigned in consecutive and alternate manner to the HFNC group and NIV group. Data during their hospital stay such as demographic data, vital data, arterial blood gases, mean duration of hospital stays, and treatment failure were recorded and analysed. Results were analysed by unpaired student t-test and p-values were derived using Graph Pad Prism version 10. A p-value of <0.05 was taken as statistically significant. Results: The HFNC group had a mean age of 57.33±9.02 years (range 45-70), while the NIV group had a mean age of 60.93±3.41 years (range: 53-66), with no significant difference (p=0.1291). Both groups had comparable distributions in gender (male: 66.67%, female: 33.33%) and smoking habits (HFNC- smoker: 66.67%, NIV- smoker: 73.33%), ensuring baseline comparability and ABG parameters. PaCO₂ after 24 hours of intervention shows that improvement in both the group was similar and the difference was statistically not significant (64.07±9.06 vs 57±9.62; p=0.056). From both groups one patient (6.67%) needs invasive ventilation. The difference in days spent in the hospital and days on device were also statistically not significant (p>0.05) between two groups. Conclusion: HFNC is an effective option to treat hypercapnic respiratory failure in COPD patients. HFNC therapy did not result in increased treatment failure or prolonged hospitalisation when compared to NIV.

Effect of Forward Head Posture on Aerobic Fitness of Collegiate Students: A Cross-sectional Observational Study

Mansi Dewan, Barnali Bhattacharjee, Charu Chhabra, Gurpreet Singh

Introduction: A state of musculoskeletal equilibrium with little to no physical strain or stress is known as proper posture. While poor posture is caused by body parts that are not aligned with gravity, proper alignment with gravity lessens the strain on tissues. Reducing cardiovascular risks, mortality rates, and maintaining extended physical activity all depend on aerobic fitness. Aim: The current study aimed to investigate the effect of increasing severity of Forward Head Posture (FHP) on aerobic fitness of young adults between 18-25 years of age therefore, depicting their cardiovascular status. Materials and Methods: The present cross-sectional observational study was carried out over the course of six months from Feb 2020 to August 2020 at the Rehabilitation Centre of Jamia Hamdard, Hamdard Nagar, New Delhi, India. It evaluated the cardiovascular fitness levels of 82 college students over the course of six months using the 3-minute step test and FHP utilising University of Texas Health Science Center at San Antonio, (UTHSCA) 3.0. Healthy adults (Male: 41: Female: 41; Mean BMI: 48.2±5 kg; Mean age: 21.32±5 years for females, 20.58±5 years for males) from a variety of university courses who did not appear to have a history of lower limb injuries, cardiopulmonary disease, congenital malformations, neurological disorders, balance and proprioception issues, or cervical/thoracic spine trauma, were included in the study. The 3-minute step test was used to gauge aerobic fitness by measuring oxygen intake and endurance capacity during resting levels, 15 and 30 seconds post the completion of test, and the photogrammetric method of postural evaluation was used to measure postural misalignment. Results: The results showed a positive relationship between reduced aerobic fitness and the degree of FHP, especially in female students with a p-value of 0.0525 for the resting pulse rate, p=0.530 for the 15-second post-test, and p=0.039 for the 30-second post-test. According to the findings, bad posture may be associated with a decrease in cardiovascular endurance. It also depicted no statistically significant differences for males with a p-values of 0.325, 0.306 and 0.933 for resting pulse rate, post 15 seconds and 30 seconds of test, respectively for males. Conclusion: According to the study, maintaining good posture and reaching appropriate fitness levels is crucial, particularly for young people who are more likely to lead sedentary lives. More research is encouraged to examine the wider consequences of FHP on fitness and health, given its detrimental impacts.

Effect of Dapagliflozin on Renal Function in Type 2 Diabetes Mellitus Patients with Nephropathy: A Prospective Cohort Study

Niket I Doshi, Sanjay T Thorat

Introduction: Diabetes remains a major global health concern, particularly in developing nations such as India. Diabetic Nephropathy (DN) is a severe complication of Type 2 Diabetes Mellitus (T2DM) which is the primary cause of End Stage Renal Disease (ESRD) and an increased cardiovascular risk. Aim: To evaluate the effect of dapagliflozin on glycaemic control and renal function in patients with T2DM and DN. Materials and Methods: The present single centre prospective cohort study was carried out in a Tertiary Care Hospital setting over a duration of eighteen months (September 2022 to February 2024). Patients aged >18 years diagnosed with T2DM and DN were included. The primary outcomes included change in Glycated Haemoglobin (HbA1c), serum creatinine, serum urea, estimated Glomerular Filtration Rate (eGFR), and urinary albumin levels from baseline over time. The data were summarised using descriptive statistics and the effects of dapagliflozin on parameters were evaluated using paired t-tests. A p-value of <0.05 was considered statistically significant. Results: A total of 100 patients were enrolled, most being male (72%) and the mean age was 60.86 years. Dapagliflozin treatment led to a significant reduction in HbA1c level from 7.51±0.86% to 6.53±1.27%, serum urea from 51.28±35.94 mg/dL to 30.88±12.39 mg/dL, and serum creatinine from 1.13±0.27 mg/dL to 0.92±0.22 mg/dL (all p<0.0001). The mean eGFR significantly improved from 72.30±21.28 mL/min/1.73m² to 87.55±20.53 mL/min/1.73m² (p<0.0001) whereas the mean urinary albumin level decreased from 1.91±1.00 to 0.92±1.05 (p<0.0001). Conclusion: The results showed that dapagliflozin was effective in improving both renal and metabolic parameters in patients diagnosed with T2DM and DN. The results confirm effectiveness of dapagliflozin in preserving renal function, reducing albuminuria, and enhancing glycaemic control, and renoprotective effects in DN.

Pattern of Antidiabetic Prescription and Prevalence of Hypoglycaemic Events in Individuals Aged above 65 Years: A Cross-sectional Study

Anupama Dhavaleshwar, Lohit Kumbar, Radhika M Sherkhane

Introduction: Diabetes Mellitus (DM) is a global health issue with micro- and macrovascular complications. With a rapidly rising population and increasing life expectancy, the prevalence of diabetes also increased. Hypoglycaemia represents the major barrier to optimal glycaemic control at any age, with elderly individuals being especially vulnerable owing to the burden of co-morbid diseases. Aim: To analyse the prescription pattern and prevalence of hypoglycaemia associated with antidiabetic medications in individuals aged above 65 years. Materials and Methods: A cross-sectional study was conducted at the Endocrinology Outpatient Department of SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India, from April 2022 to March 2023. A total of 400 elderly diabetic patients who were on antidiabetic drugs for at least one year were included in the study. Parameters like age, gender, height, weight and Body Mass Index (BMI) were recorded. Baseline parameters like Fasting Blood Sugar (FBS), Glycosylated Haemoglobin (HbA1c), lipid profile, urine analysis, creatinine, microvascular (neuropathy, nephropathy, and retinopathy) and macrovascular {Coronary Artery Disease (CAD), stroke and peripheral arterial disease} complications were recorded. The prescription pattern of antidiabetic drugs, including oral antidiabetic drugs and injectables, was analysed. Statistical analysis was done by using Chi-square test and Fisher’s-exact test. A p-value <0.05 was considered statistically significant. Results: The study included 400 elderly diabetic patients (260 males and 140 females) and demonstrated significant differences in selected anthropometric and biochemical parameters. Hypoglycaemia was reported in 74 (28.5%) males and 39 (27.9%) females, with no significant difference (p-value= 0.502). The sulfonylureas 303 (75.8%) and metformin 281 (70.3%) were the most prescribed drugs. In males, longer duration of diabetes, lower Systolic (SBP), lower FBS, higher HbA1c, and higher sodium predicted hypoglycaemia; in females, lower FBS and haemoglobin were predictors. Less frequent blood glucose monitoring was significantly linked to hypoglycaemia in males but not females. Conclusion: In the present study, sulfonylureas and metformin were the most commonly prescribed agents. While the overall incidence of severe hypoglycaemia was low, nearly one-fourth of patients reported level 1 hypoglycaemia. The study identified gender-specific predictors of hypoglycaemia, highlighting the importance of individualised therapy. The significant association between less frequent self-monitoring and hypoglycaemia in males further emphasises the need for education and behavioural interventions.

Histopathological and Immunohistochemical Expression of Ovarian Tumours: A Cross-sectional Study from a Tertiary Care Centre Indore, India

Sasmal Prasanjit Rampada, Amit Varma, Prakhar Garg, Raghvendra Chandel

Introduction: Ovarian tumours constitute 3% of all malignancies in women and 30% of all cancers affecting the Female Genital Tract (FGT). Cervical and endometrial cancers have a higher incidence than ovarian cancer. According to GLOBOCAN 2022 (Global Cancer Observatory’s estimates for the year 2022), there were 722,138 ovarian cancer cases worldwide, including 45,333 new cases reported in India. India has the second highest incidence of ovarian cancer globally (6.6%), with the highest rates noted in Pune and Delhi. Immunohistochemical (IHC) markers play a crucial role in subtyping, grading, and assisting in the diagnosis and prognosis of ovarian tumours. Aim: The present study aimed to analyse the histopathological and immunohistochemical expression of ovarian tumours and evaluate the role of IHC in differentiating primary ovarian neoplasms from metastatic tumours. Materials and Methods: The present ambispective two-year cross-sectional study was conducted from January 2023 to December 2024 on 188 cases at Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India. Haematoxylin and Eosin (H&E)-stained sections along with IHC-stained slides of ovarian neoplasms were prepared and examined. IHC was performed in 58 cases using common primary markers such as Cytokeratin 7 (CK7), Cytokeratin 20 (CK20), Paired Box Gene 8 (PAX8), and Wilms’ Tumour Gene 1 (WT1) to identify primary ovarian tumours. Secondary markers such as Caudal-Type Homeobox 2 (CDX2), Special Adenine-Thymine-rich Sequence-Binding Protein 2 (SATB2), Oestrogen/Progesterone Receptors (ER/PR), and Calretinin were used to differentiate tumours of FGT, Gastrointestinal Tract (GIT), breast, and metastatic origin. Additional markers like Inhibin and Octamer-Binding Transcription Factors (OCT) were used for morphological subtyping of sex cord-stromal and germ cell tumours. Results: Out of the 188 cases, surface epithelial tumours were the most common (149 cases), including 82 benign serous cystadenomas, 24 malignant Serous Carcinomas (SCs), and 22 mucinous cystadenomas. Most metastatic tumours (21 cases) presented with omental nodules and abdominal pain and were predominantly of SC type. IHC was performed on 58 cases using CK7/CK20 followed by WT1 and Napsin A, which helped differentiate ovarian tumours from other genitourinary tract tumours. Of these, 37 cases were confirmed as primary ovarian tumours. These included 24 cases of SC, 4 adult granulosa cell tumours, and one case each of Mucinous Carcinoma (MC), neuroendocrine carcinoma (small cell carcinoma), Sertoli-Leydig cell tumour, seromucinous cystadenoma, borderline serous tumour, and mature cystic teratoma. Conclusion: The most common neoplasms observed were surface epithelial tumours, with benign serous cystadenoma being the predominant type, most frequently affecting women of reproductive age. IHC played a significant role in tumour differentiation, grading, and prognostication.

Clinical and Microbiological Profiles of Bronchial Anthracosis: A Hospital-based Cross-sectional Study in the Kashmir Valley, India

Introduction: Bronchial anthracosis is a chronic respiratory condition characterised by the deposition of carbon particles in the bronchial mucosa. It is frequently associated with prolonged exposure to environmental pollutants, biomass smoke, and occupational dust, particularly in low-resource and rural settings. Aim: To elucidate the clinical and microbiological profile of patients with bronchial anthracosis in the mountainous valley of Kashmir, India. Materials and Methods: This cross-sectional study involved 88 patients diagnosed with bronchial anthracosis who were recruited from a tertiary care hospital. Data were collected on demographics, co-morbidities, exposure history, and microbiological findings through Bronchoalveolar Lavage (BAL). Statistical analysis was performed using percentage distribution and logistic regression analysis. Results: The mean age of the patients was 62.4±8.7 years, with females comprising 59.0% of the study population. Biomass fuel exposure (34.1%) and smoking (39.8%) were identified as significant risk factors. Common co-morbidities included Chronic Obstructive Pulmonary Disease (COPD) and hypertension. The chief complaints were cough (26.1%) and breathlessness (13.6%). BAL analysis revealed various pathogens, with Mycobacterium tuberculosis identified in 10.2% of cases. Logistic regression analysis demonstrated significant associations between bronchial anthracosis and age, smoking, and biomass fuel exposure, emphasising the influence of environmental risk factors. Conclusion: The findings highlight the significant role of environmental and occupational exposures—particularly biomass fuel use and smoking—in the development of bronchial anthracosis. Older adults, especially housewives and farmers, were the most affected groups, emphasising the need for targeted public health interventions. The association of bronchial anthracosis with respiratory infections and co-morbidities such as COPD underscores the importance of early detection and appropriate management. Preventive strategies, including reduction of indoor air pollution and implementation of smoking cessation programmes, are essential to mitigate the disease burden in the ethnic population of Kashmir, India.

Calibration and Discrimination of POSSUM and P-POSSUM Scores in Elective General Surgery: A Prospective Observational Study

Priyanka Bahl, Iqbal Ali, Varun Shetty

Introduction: Risk stratification is central to perioperative decision-making and audit. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and its Portsmouth Modification (P-POSSUM) are widely used. Yet performance can vary by population and patient-procedure profile. Aim: To evaluate the calibration and discrimination of POSSUM and P-POSSUM in elective general surgery at a tertiary Indian centre. Materials and Methods: The present prospective observational study was conducted in the Department of General Surgery at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, between January 2023 and March 2025. A total of 200 consecutive adults undergoing elective, non-cardiac general surgery were included. Primary endpoints were postoperative morbidity and 30-day all-cause mortality. Performance was assessed using Observed versus Expected (O:E) rates, Hosmer-Lemeshow goodness-of-fit, and Area Under the Receiver Operating Characteristic curve (AUROC). Diagnostic metrics {sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV)} were calculated. Results: The mean age of the cohort was 52.4±14.8 years, with a predominance of males (male-to-female ratio 1.67:1). Observed morbidity was 52/200 (26.0%; 95% Confidence Interval (CI) 20.0-32.7) and 30-day mortality 8/200 (4.0%; 95% CI 1.8-7.8). POSSUM-predicted morbidity was 67/200 (33.5%; 95% CI 27.0-40.3) and mortality 12/200 (6%; 95% CI 3.1-10.0), giving O:E values of 0.78 (morbidity) and 0.68 (mortality). P-POSSUM predicted mortality 8/200 (4%; 95% CI 1.7-7.3) with an O:E of 0.96. Calibration by Hosmer-Lemeshow was acceptable for all models with p>0.85. P-POSSUM demonstrated superior discrimination for mortality compared with POSSUM (AUC 0.893, 95% CI 0.812-0.974 vs 0.841, 95% CI 0.732-0.950; p=0.042). For morbidity, the original POSSUM morbidity model showed moderate performance (AUC 0.772, 95% CI 0.689-0.855). Conclusion: In elective general surgery, POSSUM remains adequate for morbidity estimation but overpredicts mortality. P-POSSUM shows near-unity calibration and better discrimination for mortality and should be preferred for perioperative risk stratification and audit in similar populations.

Efficacy of Oral Pregabalin versus Narrowband Ultraviolet B Therapy in Patients with Uraemic Pruritus: A Randomised Clinical Trial

Dhanyamol Mathew, Manipriya Rajan, Sampath Vadivelu

Introduction: Uraemic pruritus is a common and distressing symptom experienced by patients with Chronic Kidney Disease (CKD). It affects 15-49% of patients with predialysis CKD and 50-90% of those undergoing dialysis. Uraemic pruritus significantly impairs the quality of life of these patients; however, well-designed clinical trials evaluating effective treatment options remain limited. Although studies have demonstrated the benefits of pregabalin and Narrowband Ultraviolet B (NB-UVB) phototherapy, limitations such as small sample sizes, methodological variability, and lack of long-term follow-up highlight the need for further research, particularly studies comparing systemic therapies with phototherapy. Aim: To compare the efficacy and assess the adverse effects of oral pregabalin and NB-UVB phototherapy in the treatment of uraemic pruritus. Materials and Methods: This randomised clinical trial was conducted in the dermatology outpatient department of Madras Medical College, Chennai, Tamil Nadu, India from September 2020 to August 2021. The study included 30 patients in each treatment group. Patients aged over 18 years, diagnosed with CKD, presenting with symptoms of uraemic pruritus, and willing to give informed consent were included. Patients younger than 18 years, those with acute illness, liver cirrhosis, or decompensated heart failure were excluded. Additionally, patients allergic to pregabalin, those with a history of photosensitivity, pruritus due to secondary causes, and pregnant or lactating women were excluded. The intensity of pruritus was assessed using the Visual Analogue Scale (VAS). Group A received oral pregabalin 75 mg on alternate nights for 12 weeks, while group B underwent NB-UVB phototherapy with the dose titrated upward over the same duration. Patients in both groups were followed-up fortnightly during the 12-week treatment period and subsequently on a monthly basis until the 24th week. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 23.0. The Chi-square test was used to compare qualitative variables between the two groups, and the independent sample t-test was used to compare mean values. A p-value of <0.05 was considered as statistically significant. Results: The mean age of the participants was 48.01±12.66 years. Male predominance was observed in both groups, accounting for 63.3% in group A and 53.3% in group B. Both groups showed a similar distribution in terms of age, gender, mean duration and intensity of pruritus, and mean estimated Glomerular Filtration Rate (eGFR) (p-value>0.05). The mean baseline VAS score was 8.89±0.69 in the pregabalin group and 8.73±1.07 in the NB-UVB group. At the end of the follow-up period, the mean VAS score in the pregabalin group was significantly lower than that in the NB-UVB group (p-value=0.001). Pruritus relapse was observed eight weeks after the final dose of oral pregabalin in group A. Both treatment modalities were associated with minimal adverse effects. Conclusion: A faster and more pronounced reduction in mean VAS scores was observed in patients treated with pregabalin compared to those receiving NB-UVB phototherapy. The adverse drug reactions observed in this study were minimal.

Posterior Chain Flexibility and Lower Back Pain among Construction Workers: A Cross-sectional Study

Amlan Tamuli, Lopa Das, Rohit Sarma, PH Jeny Sharma

Introduction: Lower back pain is a common issue that has a substantial impact on individuals. Patients may experience pain in the lower back region, which may vary depending on the presence or absence of nerve involvement. Lower back pain is more common in occupations involving prolonged standing, sitting, or heavy lifting. While research exists on posterior chain flexibility and lower back pain in farm workers, studies on construction workers remain limited, highlighting the need for the present study. Aim: To investigate Low Back Pain (LBP) incidence and severity in construction workers, linking findings to posterior chain flexibility. Materials and Methods: The present study was a cross-sectional study was conducted in South Western Assam, India,from December 2023 to May 2024. The study was affiliated to The Assam Royal Global University. The primary inclusion criteria included construction workers both male and female between the ages of 20 to 45 years of age and minimum of three months of working experience who consented to participate in the study were included and the exclusion criteria included pregnant and nursing mothers, subjects with previous back injuries and subjects with recent accident or other ailments were excluded from the study. Sampling was done using convenience sampling method. Informed consent was taken from the participants. LBP was assessed using the Visual Analog Scale (VAS), flexibility was assessed using the sit and reach test, and back pain related disability was assessed using the Oswestry LBP Disability Questionnaire. Results: Out of total 95 participants,LBP prevalence was 100%. The correlation between age and VAS score is 0.173 with a p-value of 0.093 indicating a weak positive correlation. The VAS score and sit and reach test results have correlation of -0.192 with p-value of 0.062 indicating a weak negative correlation whereas age shows significant positive correlation with Oswestry LBP score, with a correlation coefficient of 0.229 and a p value of 0.025. The VAS score is strongly positively correlated with Oswestry LBP score, with a correlation coefficient of 0.595 and a highly significant p-value of less than 0.001. Conclusion: Posterior chain flexibility is significantly linked to reduced LBP-related disability and weakly associated with lower LBP severity.

In-vitro Activity of Ceftazidime-avibactam Against Multidrug-resistant Pseudomonas Aeruginosa: Cross-sectional Study from a Tertiary Care Hospital

Shoaib Mohmad Khan, Humaira Bashir, Seema Aleem, Sheikh Zainab

Introduction: Multidrug-resistant (MDR) Pseudomonas aeruginosa poses a major therapeutic challenge in tertiary-care settings, necessitating local, Clinical and Laboratory Standards Institute (CLSI) -anchored susceptibility data for empiric therapy and stewardship. This study characterises Ceftazidime–Avibactam (CZA) activity and Minimum Inhibitory Concentration (MIC) distribution to support stewardship and local guideline updates Aim: To evaluate the in-vitro activity of CZA against MDR Pseudomonas aeruginosa clinical isolates from a tertiary care hospital in North India. Materials and Methods: This was a hospital-based, cross-sectional study conducted in the Bacteriology Division, Postgraduate Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India, from January 2022 to December 2022 and included 108 non duplicate MDR Pseudomonas aeruginosa clinical isolates. Standardised workflows encompassed specimen culture and identification, Kirby-Bauer disc diffusion, and ceftazidime-avibactam MIC determination by E-test interpreted per CLSI M100 (2022), while demographic parameters recorded for context included age group and gender. Susceptibility was reported as proportions, and predictors of CZA non susceptibility were estimated using multivariable logistic regression. A p-value of <0.05 was considered statistically significant. Results: Ceftazidime-Avibactam susceptibility was 63/108 (58.38%) and exceeded most β-lactam comparators, while aztreonam showed the highest susceptibility at 98/108 (90.74%). The MIC distribution clustered at 2-8 μg/mL with a peak at 8 μg/mL. In multivariable modelling, burn diagnosis {adjusted Odds Ratio (aOR)=2.15; 95% Confidence Interval (CI) 1.05-4.41}, carbapenem non susceptibility (aOR=2.72; 95% CI 1.34-5.51), and ceftazidime non susceptibility (aOR=2.08; 95% CI 1.01-4.29) independently predicted CZA non susceptibility. Conclusion: Ceftazidime-avibactam was the most active among core antipseudomonal β-lactams, while aztreonam showed the highest overall susceptibility. The MIC histogram peaked at 8 μg/mL, with most isolates clustering between 2-8 μg/mL. Burn diagnosis, carbapenem non susceptibility, and ceftazidime non susceptibility independently predicted CZA non susceptibility.

Efficacy of Polyherbal Compound Pathadi Tablet and Pathadi Oil in Psoriasis: An Open-label Single Arm Clinical Trial

Digambar Dipankar, Rupali Patil

Introduction: Psoriasis is a chronic inflammatory skin disease that affects the quality of life and is associated with systemic co-morbidities. Although conventional therapies are effective, they are limited by safety concerns, relapse after discontinuation, high costs, and limited accessibility in low-resource settings. Ayurveda offers a holistic approach to skin disorders; however, existing evidence primarily highlights purification therapies, which are not always feasible. To address this, the polyherbal compound Pathadi Yogah, referenced in Ashtanga Hridaya for the treatment of skin disorders, was standardised into tablets and oil formulations to make psoriasis treatment more accessible. Aim: To evaluate the clinical efficacy of Pathadi tablet (oral) and Pathadi oil (topical) in patients with plaque psoriasis. Materials and Methods: This single-arm, open-label interventional clinical trial was conducted at the Department of Kayachikitsa, Dr. D. Y. Patil College of Ayurveda and Research Centre, Pimpri, Pune, Maharashtra, India between January 2022 and December 2024. Total of 50 patients (18-60 years of age) with mild-to-moderate plaque psoriasis were included. Patients received the Pathadi tablet (500 mg, twice daily before meals with lukewarm water) and Pathadi oil (topical, twice daily) for 30 days. Assessments were performed at baseline and on days 7, 14, 21, and 30 using the Psoriasis Area and Severity Index (PASI), Simplified PASI, Physician Global Assessment × Body Surface Area (PGA×BSA), and Dermatology Life Quality Index (DLQI). Laboratory parameters were measured at baseline and after treatment. Data were analysed using the Friedman test and the paired t-test. Results: Among the 50 patients included, 25 were males and 25 females with a mean age of 32.4±10.8 years. The scores for erythema, induration, scaling, and itching were significantly reduced (p-value <0.001). The mean PASI declined from 6.04±2.61 to 1.46±1.10 (75.8% reduction, p-value <0.001). The DLQI score improved from 17.74±4.55 to 2.86±2.55 (83.9% reduction, p-value <0.001). A PASI 50 score was achieved in 48 (96%), PASI 75 in 34 patients (68%) and PASI 100 in 9 patients (18%). The Erythrocyte Sedimentation Rate (ESR) values decreased significantly. No adverse events were observed and the patient’s compliance was high. Conclusion: Pathadi tablet and Pathadi oil significantly improved disease severity and quality of life in patients with plaque psoriasis within 30 days. The combined oral and topical approach proved to be a safe, affordable, and easily accessible alternative. Further, larger randomised controlled trials with longer follow-up periods are needed to validate long-term efficacy and relapse prevention.

Prevalence of Hypomineralised Second Primary Molar and its Possible Association with Molar Incisor Hypomineralisation in Children Aged 6-9 Years of Mehsana District, Gujarat, India: A Cross-sectional Study

Introduction: Dental enamel in primary teeth may exhibit a developmental defect known as Hypomineralised Second Primary Molars (HSPM), which presents with clinical signs and symptoms similar to Molar Incisor Hypomineralisation (MIH). Second Primary Molars (SPMs) may serve as a reliable indicator for predicting future hypomineralisation of permanent incisors and molars prior to their eruption. Early identification of HSPM can aid in anticipating future dental challenges such as tooth sensitivity, increased susceptibility to caries and restorative complications in the permanent dentition. Currently, there is limited literature regarding the prevalence of HSPM in Gujarat, India. Aim: To determine the prevalence of HSPM and its possible association with MIH among children 6-9 years in the Mehsana District of Gujarat, India. Materials and Methods: A cross-sectional study was conducted among children aged 6-9 years in the Department of Paediatric and Preventive Dentistry, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India. The district was divided into three zones and a total sample size of 840 children was calculated. Each zone included 280 children selected from both private and government schools. The European Academy of Paediatric Dentistry (EAPD) guidelines were followed for the assessment of both MIH and HSPM, wherein only First Permanent Molars (FPMs) and SPMs were assessed. The collected data were tabulated and analysed using the Chi-square test and the Odds Ratio (OR) was calculated to assess the association between MIH and HSPM. A p-value of <0.05 was considered statistically significant. Results: The study revealed a prevalence of 36/840 (4.2%) for HSPM and 44/840 (5.2%) for MIH in the Mehsana District. Both MIH and HSPM were present in 22/54 (40.7%) of the affected children, suggesting a strong association between the two conditions (OR=44.75; p<0.001; 95% CI=22.55-105.38). The most common type of defect observed in SPMs was white creamy opacities (47.36%), followed by yellowish-brown lesions (31.57%). Conclusion: The present study highlights a notable prevalence of HSPM and MIH among children aged 6-9 years in the Mehsana district, with a significant association between the two conditions. Early identification of HSPM may serve as a predictive marker for MIH, emphasising the importance of timely diagnosis and preventive care to mitigate future dental complications in the permanent dentition.

Standardisation of Antimicrobial Compounds from Aspergillus flavus against the Escherichia coli and Staphylococcus aureus: An In-vitro Analysis

B Jasmine, Manonmoney Jayaraman, Ria, Leela Kakithakara Vajravel

Introduction: The increasing prevalence of antibiotic resistance among pathogenic microorganisms poses a significant challenge to global public health. Previously effective treatments against common pathogens such as Escherichia coli (E.coli) and Staphylococcus aureus (S.aureus) are becoming progressively less effective. These organisms are responsible for a wide spectrum of diseases, ranging from minor infections to severe systemic illnesses. As resistance to conventional antibiotics continues to rise, the need for novel antimicrobial agents has become increasingly urgent. Natural products have long served as a rich source of antimicrobial substances, and among them, fungi are well recognised for their ability to produce a diverse array of bioactive metabolites with potential therapeutic applications. Aim: The aim of the current study was to isolate and identify bioactive metabolite-producing Aspergillus flavus (A.flavus) strains from soil samples and to evaluate their antimicrobial activity against clinical isolates of E.coli and S.aureus. Materials and Methods: The present in-vitro experimental study was conducted in the Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India, from January to December 2023. The current study involved the isolation of A.flavus from soil samples collected from dump yards and the isolation of E.coli and S.aureus from clinical specimens. The total sample size was 50, comprising 25 E.coli and 25 S.aureus isolates obtained from various clinical samples, including urine, pus, sputum, blood, ear swabs, wound swabs, tracheal aspirates, and tissue samples. Soil samples were collected from four different dump yard sites surrounding the SRM Medical College Hospital and Research Centre. Only A.flavus was isolated from soil samples using the spot method, while E.coli and S.aureus isolated from clinical samples were included in the study. Other fungal and bacterial isolates were excluded. Antimicrobial activity was assessed using the perpendicular cross-streaking method and the agar well diffusion method. Bioactive compounds were extracted through fermentation, followed by separation using Thin-Layer Chromatography (TLC). Compound identification was performed using Gas Chromatography-Mass Spectrometry (GC-MS). Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software, and all data were expressed as mean±standard deviation. Results: The isolated A.flavus strains demonstrated antimicrobial activity against both E.coli and S.aureus. TLC analysis revealed four distinct bioactive compounds with Rf values of 0.70, 0.80, 0.87, and 0.89. GC-MS analysis identified a total of 23 volatile compounds. The antimicrobial activity produced Zones Of Inhibition (ZOI) ranging from 23 to 18 mm against E.coli and from 16 to 24 mm against S.aureus. Conclusion: The bioactive compounds extracted from A.flavus exhibited significant antibacterial activity, particularly against the Gram-positive organism S.aureus. These findings highlight the potential of A.flavus as a promising source of novel antimicrobial agents, especially in the context of increasing antibiotic resistance. Further studies are warranted to optimise the production and purification of these compounds and to explore their potential clinical applications.

The Correlation of Carotid Intima-media Thickness with Calcium-phosphorus Product in Patients Undergoing Maintenance Haemodialysis: A Cross-sectional Study

Sneha Salim, SS Ramesh, BU Lavanya

Introduction: The risk of Cardiovascular Disease (CVD) morbidity and mortality remains high in all stages of Chronic Kidney Disease (CKD). Elevated calcium and phosphorus have direct effects on vascular smooth muscle cells, promoting vascular calcification and arteriosclerosis. Carotid Artery Intima-Media Thickness (CIMT) is a well-established index of systemic atherosclerosis and correlates with the incidence of coronary artery disease and stroke in the CKD population. Aim: To study levels of Serum Calcium-Phosphorus product (S. CaxP) and CIMT in patients undergoing Maintenance Haemodialysis (MHD) and to correlate CIMT with S. CaxP. Materials and Methods: This was a cross-sectional study conducted at the Department of General Medicine, K.R. Hospital (Krishna Rajendra Hospital), Mysore Medical College and Research Institute (MMCRI), Irwin Road, Mysuru, Karnataka, India over a period of one and a half years between January 2020 and July 2021. Data were collected from patients visiting the Outpatient Department (OPD) or those admitted for MHD, as well as through the medical records of stage 5 CKD patients who were admitted to the hospital for MHD. Subjects’ serum calcium, serum potassium, S. CaxP, and CIMT were evaluated. The Student’s t-test and the Chi-square test were employed to assess the significance between the groups. A p-value <0.05 was considered statistically significant. Results: Of the 76 individuals included in the study, 27 were females with mean age 44.07 years and 49 were males with a mean age 43.81 years. The mean CIMT among the study population was 1.2108±0.28966 mm, and the mean S. CaxP was 46.9237 mg²/dL². There was a positive correlation between CIMT values, S. Calcium, S. phosphorus, S. CaxP, and the duration of MHD. High S. CaxP is a significant and independent risk factor associated with advanced arteriosclerosis in CKD patients, independent of age, gender, Diabetes Mellitus (DM), Hypertension (HTN), and hyperlipidemia. Conclusion: Patients with CKD have a high risk of CVD. Although these patients share many cardiovascular risk factors with the general population, additional factors, such as abnormal calcium/phosphorus metabolism, elevate their risk for CVD. The present study concludes that there is a positive correlation between serum calcium-phosphorus product levels and CIMT, as well as with the duration of maintenance haemodialysis.

Estimating Osteogenic Potential of Rose Hip Seed Functionalised Hydroxyapatite Nanoparticles as a Bone Graft Substitute: An In-vitro Study

Radhika Srimagesh, Ratna Parameswaran, Seerab Husain

Introduction: Green synthesis is an environmentally friendly, non toxic method for formulating Hydroxyapatite Nanoparticles (HApNPs) and functionalising them using plant derivatives, such as Rose hip Seed extracts (Rh). Rose hip seeds have demonstrated osteogenic properties, making them ideal for synthesising a nanoparticle bone graft substitute capable of inducing bone formation. Aim: To evaluate the osteogenic potential of Rose hip seed functionalised HApNPs. Materials and Methods: The present study was an in-vitro investigation conducted in the Department of Orthodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India from December 2022 to December 2024. synthesis of Rose hip Seed Extract-functionalised HApNPs (RhHApNPs) was carried out. The nanoparticles were subjected to physical characterisation, including HApNPs Field Emission Scanning Electron Microscopy (FESEM) analysis Energy-dispersive X-ray (EDX) analysis X-ray Diffraction (XRD) analysis Attenuated Total Reflection Fourier Transform Infrared Spectroscopy (ATR-FTIR) analysis. Biological characterisation involved a haemolytic test, while chemical characterisation included the Calcium Mineralisation Assay, Alkaline Phosphatase (ALP) activity test, and collagen estimation test. The outcomes of these tests were represented graphically using Origin software. Results: The FESEM analysis revealed elongated, hexagonal, and spherical-shaped RhHApNPs, with a particle size range of 10-50 nm. EDX analysis demonstrated characteristic elemental peaks for Ca, P, O, and C in RhHApNPs. The XRD test indicated 55.6% crystallinity. ATR-FTIR analysis identified peaks of PO4³-, along with the presence of other functional groups. The blood compatibility test results showed that the rate of haemolysis was below 5%, indicating good blood compatibility. RhHApNPs exhibited greater mineralisation density compared to non RhHApNPs, evidenced by higher Optical Density (OD). The ALP Activity test showed increased levels of ALP expression in RhHApNPs compared to non functionalised counterparts. The collagen estimation assay revealed collagen formation over NIH 3T3 cell line culture. Conclusion: The newly synthesised RhHApNPs were elongated, hexagonal, and spherical, with a size range of 10-50 nm, demonstrating a Ca/P weight % of 1.99 and a crystallinity of 55.6%. The RhHApNPs also exhibited good haemocompatibility and increased osteogenic activity when compared to non functionalised HApNPs.

Impact of Malnutrition on Morbidity and Paediatric Risk of Mortality Score among Critically-ill Children: A Prospective Observational Study

T Divin Kalappa, Rajdeep Pal, Neelu Elon, Apoorva Appaso Dhulaj, Mumtaz Sharif

Introduction: Malnutrition among critically ill children admitted to the Paediatric Intensive Care Unit (PICU) continues to be a serious health concern, particularly in developing nations where the prevalence of malnutrition is disproportionately high. Malnourished children have weak immune system. This leads to higher chances of mortality and morbidity in such children. Aim: To evaluate the impact of malnutrition on mortality and morbidity in critically ill children who were admitted to PICU in a hospital in Navi Mumbai. Materials and Methods: The present prospective observational study was conducted in the PICU of the Dr. D. Y. Patil, Nerul Hospital from October 2022 to November 2023. Study included 144 children aged between 1 and 12 months who were admitted in the PICU of the institution. Anthropometric measurements based on World Health Organisation (WHO) growth standards were used to evaluate nutritional status. PRISM 3 scores were established within the initial 24 hours of admission. Clinical variables and outcomes with respect to their nutrition, mortality, PICU stay and ventilation duration was compared. IBM Statistical Package for Social Sciences (SPSS) Statistics 26.0 was used to analyse the data, and a p-value of less than 0.05 was deemed statistically significant. Results: The study population’s mean age was 4.13±3.65 years, with 45.1% of participants being female and 54.9% being male. Using Odd’s ratio, severe malnutrition in children under five-year-old was significantly linked to an increased risk of death (OR=11.4, p=0.004) and the need for ventilation (OR=17.3, p<0.001). Severe thinness was associated with a significant increase in the odds of ventilation (OR=24.0, p=0.015) and prolonged PICU stay (OR=37.5, p=0.008) in children older than five years. In both age groups, there was no significant difference in PRISM 3 scores between nutritional groups (p=0.442 and p=0.910, respectively). Conclusion: In critically ill children, severe malnutrition and thinness are powerful indicators of negative outcomes like higher mortality, the need for ventilation, and lengthier PICU stays. In PICU settings, improving prognosis and lowering complications requires early nutritional assessment and focused intervention.

Exploring Virtual Reality’s Effects on Balance, Function, Daily Activities and Quality of Upper Limb Skills in Children with Hemiplegic Cerebral Palsy: A Systematic Review and Meta-analysis

Introduction: Hemiplegic Cerebral Palsy (CP) significantly affects balance, functional abilities, daily activities, and overall quality of upper extremity skills. Virtual Reality (VR) can enhance the quality of life in children with CP by controlling training intensity and providing feedback to deliver customised treatment in a fun, safe, and engaging environment. Aim: To examine the effectiveness of VR on balance, functional abilities, daily activities, and the quality of upper limb skills in children with hemiplegic CP. Materials and Methods: A systematic search of Web of Science, Physiotherapy Evidence Database (PEDro), EBSCO, Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Excerpta Medica database (EMBASE) and ProQuest was conducted for articles published between March 2014 and September 2024. Randomised Controlled Trials (RCTs) were included if the sample comprised children with hemiplegic CP and reported outcomes related to balance, function, daily activities, and upper limb skills. Pre and postintervention mean differences, standard deviations, 95% Confidence Intervals (CI), and p-values were calculated, along with the difference between intervention and control groups after treatment. Random-effects models were used to interpret pooled effects based on improvements in balance, function, daily activities, and upper limb skill quality. Heterogeneity was assessed using the I2 statistic. Results: Fifteen randomised trials were included. Results revealed significant improvements in the VR groups compared to the control groups for balance (MD 4.84; 95% CI: 1.44-8.23; p<0.05), hand function (MD 2.05; 95% CI: 0.17-3.92; p=0.03), and upper extremity skill quality (MD 5.12; 95% CI: 3.50-6.74; p<0.05). However, no significant improvement was observed for Activities of Daily Living (ADL) (MD 0.86; 95% CI: -8.93 to 7.21; p=0.83). Conclusion: VR-based rehabilitation may improve balance, functional abilities, and upper extremity skill quality more effectively than conventional rehabilitation in children with CP. However, VR did not show a significant effect on activities of daily living.

Role of Visual Evoked Potential as a Screening Tool for Subclinical Optic Neuropathy in Patients with Diabetes Mellitus: A Cross-sectional Study

Abhishek Kumar Jaiswal, Anil Kumar, Navneet Kumar Kaushik, Jeevan Deep Dande

Introduction: Diabetes poses a major health challenge in India, with rising cases leading to serious complications like optic neuropathy and vision loss. These conditions often remain silent in the early stages, making timely detection crucial. Visual Evoked Potentials (VEPs), a simple non-invasive test, offer promise in identifying early optic nerve changes in diabetic patients and may improve outcomes through earlier intervention. Aim: To assess P₁₀₀ latency and N₇₅-P₁₀₀ amplitude of VEP as a screening tool for detecting subclinical optic neuropathy in patients with Diabetes Mellitus (DM). Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of Physiology in collaboration with the Department of Medicine at Shaheed Hasan Khan Mewati Government (SHKM) Government Medical College, Nalhar, Nuh, Haryana, India, from November 2022 to October 2023. A total of 240 subjects aged 18 to 60 years were enrolled, comprising 80 individuals with Type 1 Diabetes Mellitus (DM), 80 with Type 2 DM (case group) and 80 non diabetic individuals (control group). Participants were selected using a systematic random sampling method. The VEP test was performed and VEP parameters were compared between the case and control groups. Results: The mean age of the Type 1 DM, Type 2 DM and control groups was 26.61±6.71 years, 43.32±11.09 years and 30.7±11.23 years, respectively. Gender distribution showed that males comprised 53.75% of the Type 1 DM group, 60% of the Type 2 DM group and 70% of the control group. Females accounted for 46.25%, 40% and 30%, respectively. Analysis revealed a significant increase in P₁₀₀ latency in both Type 1 diabetics (105.30±4.79 msec; p<0.001) and Type 2 diabetics (102.69±6.94 msec; p<0.001) compared with healthy controls. The N₇₅-P₁₀₀ amplitude was significantly reduced in Type 1 diabetics (5.73±1.98 μV; p=0.04) and Type 2 diabetics (5.87±2.89 μV; p>0.05) compared with controls; however, the difference reached statistical significance only in Type 1 diabetics. Conclusion: This study revealed that P₁₀₀ latency was prolonged and N₇₅-P₁₀₀ amplitude was reduced in both Type 1 and Type 2 diabetic patients compared with healthy controls. These results suggest structural changes in the optic nerve, including demyelination and axonal loss. The study recommends incorporating VEP testing into screening protocols for early detection of neurological complications in diabetic patients.

Correlation of Carotid Intima-media Thickness with Cardiovascular Dysfunction in Known Hypothyroid Patients: A Cross-sectional Study from a Tertiary Care Hospital in Kolkata, India

Introduction: Hypothyroidism is linked to adverse changes in lipid metabolism and cardiac function, increasing cardiovascular risk. The major cardiovascular changes that occur in hypothyroidism include a decrease in cardiac output and cardiac contractility, a reduction in heart rate, and an increase in peripheral vascular resistance. Carotid intima-media Thickness (CIMT) is an established marker of subclinical atherosclerosis. Aim: To evaluate the correlation between CIMT and cardiovascular parameters in patients with hypothyroidism. Materials and Methods: The present cross-sectional observational study was conducted at the Medical College and Hospital, Kolkata, West Bengal, India (General Medicine Department, Inpatients and Outpatients) between December 2022 and May 2024. A total of 100 patients with established primary hypothyroidism were enrolled. Data collected included demographics (age, sex), Body Mass Index (BMI) and Blood Pressure (BP), thyroid function tests {Thyroid-Stimulating Hormone (TSH), Free Thyroxine (FT4), anti-Thyroid Peroxidase (anti-TPO) antibody}, lipid profile, liver and renal function tests, fasting glucose and HbA1c, Complete Blood Count (CBC), 12-lead ECG, Two-dimensional Echocardiography (2D ECHO), and carotid Doppler ultrasound to measure CIMT and carotid artery flow velocities. Statistical analyses (Pearson’s correlation, Chi-square test and Student’s t-test) were performed using appropriate software, with p<0.05 considered significant. Results: Of the 100 patients, 54% were female. Most (82%) had overt hypothyroidism and 18% had subclinical hypothyroidism. Mean±SD body mass index was 26.2±2.8 kg/m², and mean diastolic blood pressure was 89.4±3.0 mmHg. Mean±SD total cholesterol was 197±33 mg/dL, triglycerides 188±71 mg/dL, low-density lipoprotein cholesterol 116±95 mg/dL, and high-density lipoprotein cholesterol 46.93±4.9365 mg/dL. Sinus bradycardia was present in 43%, and diastolic dysfunction (grade I–II) on echocardiography was observed in 42% of patients. The mean common carotid artery intima-media thickness (CCA-CIMT) was 0.62±0.13 mm (right) and 0.60±0.14 mm (left). The corresponding mean internal carotid artery CIMT (ICA-CIMT) values were 0.60±0.14 mm (right) and 0.62±0.14 mm (left). Crucially, CIMT showed significant positive correlations with total cholesterol (r=0.72, p<0.001), triglycerides (r=0.69, p<0.001), LDL-cholesterol (r=0.20, p=0.05), peak systolic velocities in the right and left common carotid arteries (p<0.001 for both), and TSH (r=0.25, p=0.01), and a significant negative correlation with HDL-cholesterol (r=-0.26, p=0.008). Conclusion: In patients with hypothyroidism, CIMT is positively correlated with atherogenic lipid parameters and TSH. These findings suggest that increased CIMT reflects subclinical atherosclerotic and cardiovascular risk in hypothyroid patients and underlines the importance of early cardiovascular evaluation in this population.

Diagnostic Performance of D-Dimer Compared to Wells and Geneva Scores for Pulmonary Embolism in COVID-19: A Retrospective Cohort Study

Introduction: Classical clinical prediction rules (Wells and Geneva) are widely used to assess the risk of Pulmonary Embolism (PE). Still, their performance in Coronavirus Disease 2019 (COVID-19) is uncertain, given frequent D-Dimer (DD) elevations unrelated to thrombosis. Aim: To compare the diagnostic performance of an optimised DD cut-off against Wells and Geneva scores in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients with suspected PE. Materials and Methods: A retrospective, single-centre cohort study was conducted at Department of Internal Medicine, Consorci Sanitari de Terrassa, Barcelona, Spain, from Consorci Sanitari de Terrassa (Barcelona, Spain) from January 2021 to June 2021. Adult COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) for suspected PE were analysed. Receiver Operating Characteristic (ROC) analysis was used to assess DD, Wells, and Geneva; the optimal DD threshold was identified by Youden’s index. Group comparisons used t-test or Mann-Whitney U for continuous variables and Chi-square or Fisher’s-exact test for categorical variables; p-value <0.05 was considered significant. Results: CTPA was performed in 586 patients, of whom 148 had confirmed COVID-19 infection. PE was diagnosed in 13.5% (20/148) of cases. Patients with PE had significantly higher DD levels than those without PE (p-value <0.05). A DD threshold of 3126 ng/mL yielded 80% sensitivity and 68.5% specificity, potentially avoiding 87 CTPAs while missing 4 PE diagnoses. In comparison, the Wells score showed poor performance {Area Under Curve (AUC) 0.60, 95% Confidence Interval (CI) 0.48-0.72; sensitivity 55%, specificity 56%}, whereas the revised Geneva score was even less accurate (AUC 0.41, 95% CI 0.26-0.55; sensitivity 45%, specificity 55%). Conclusion: In the present cohort of COVID-19 patients with suspected PE, an optimised DD cut-off demonstrated superior discriminatory performance compared to conventional clinical prediction rules. Therefore, in COVID-19 settings with suspected PE, a DD threshold of approximately 3,126 ng/mL may help reduce unnecessary Computed Tomography (CT) pulmonary angiographies when interpreted in conjunction with clinical probability and physician judgment.

Undergraduate Medical Students’ Readiness to Adopt Artificial Intelligence in Healthcare: A Cross-sectional Study

Shweta Patil, Kranti Tekulapally

Introduction: Artificial Intelligence (AI) is revolutionising healthcare and is being used in all fields of medicine. For future clinical practice, medical students must gain expertise in this emerging technology. Aim: To assess the readiness of medical students to adopt AI in healthcare. Materials and Methods: A cross-sectional study was conducted among Bachelor of Medicine and Bachelor of Surgery (MBBS) students at RVM Institute of Medical Sciences and Research Centre, Secunderabad, Telangana, India, from March 2024 to June 2025. Demographic information and responses to the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) were collected using a 5-point Likert scale through a Google Form circulated via WhatsApp. Data from 269 students (response rate: 32%) who completed the entire data collection form were analysed. Using appropriate tests based on data normality, associations were examined between readiness and age, gender, year of study, and prior AI training, with p-value <0.05 considered statistically significant. Results: The mean age of participants was 20 years. Most were females, 184 (68%) and half of them were in their second year of MBBS, 135 (50%). Only 17 students (6%) had prior AI training, mainly through seminars 8 (47%). Among them, 92 (34%) of the participants reported having partial knowledge of AI applications in healthcare. The mean MAIRS-MS score was 65.53±11.99. No correlation was observed between age and total MAIRS-MS scores. Significant differences were found in cognitive ability and overall readiness based on gender (p-value <0.001). A moderate positive correlation between cognition scores and year of study (p-value <0.001) indicated cognitive improvement with academic progression. Students with prior AI training scored higher in ability (p-value=0.002), vision (p-value <0.001), and overall MAIRS-MS (p-value=0.002). Cognitive scores were highest between ages 18-21 and declined slightly in older participants. Ability and overall readiness increased with age, while vision and ethics scores remained consistent across age groups. Conclusion: The present study demonstrates a moderate level of AI readiness among medical students, highlighting the need for structured AI training within the medical curriculum. Integrating AI literacy aligns with the Competency-Based Medical Education (CBME) framework, which emphasises outcome-based learning, self-directed training, and the development of higher-order cognitive and analytical skills essential for future clinical practice.

Fixed-dose Hyperbaric Levobupivacaine versus Reconstituted Hyperbaric Levobupivacaine for Spinal Anaesthesia in Infra-umbilical Surgeries: A Double-blinded Randomised Clinical Study

Vivek Sharma, Pallavi Ahluwalia, Md Shahbaz Alam, Mukesh Kumar Prasad

Introduction: Spinal anaesthesia is a commonly used technique for infra-umbilical surgeries, with the choice of anaesthetic formulation playing a crucial role in efficacy and patient outcomes. Baricity or the density of the anaesthetic solution relative to cerebrospinal fluid, affects the spread and distribution of the drug, influencing the level and duration of anaesthesia. Fixed-dose Combination (FDC) vials provide convenience and precise dosing, whereas reconstituted formulations allow for more personalised adjustments but require additional preparation. Aim: To compare the clinical effects of FDC hyperbaric levobupivacaine and reconstituted isobaric levobupivacaine in spinal anaesthesia. Materials and Methods: A randomised double-blind clinical study was conducted at the Department of Anaesthesiology, Teerthanker Mahaveer Medical College and Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India, enrolling 132 participants scheduled for infra-umbilical surgeries between November 2022 and April 2024. Participants were randomly allocated into two equal groups using a computer-generated randomisation table. Group F received a FDC of 0.5% hyperbaric levobupivacaine (15 mg/3 mL) with dextrose 80 mg/mL and 25 μg fentanyl, while Group R received a reconstituted mixture of 0.5% isobaric levobupivacaine (15 mg/3 mL) with dextrose 50 mg/mL and 25 μg fentanyl. All drugs were administered intrathecally under aseptic conditions. Haemodynamic variables were recorded at predefined intervals, and demographic characteristics {age, gender, Body Mass Index (BMI), American Society of Anaesthesiologists (ASA) grade} were compared between groups. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 17.0 with Independent t-tests and Chi-square tests, with p-value <0.05 considered statistically significant. Results: A total of 132 patients completed the study (66 per group). Baseline demographics differed in weight, height, BMI, and ASA grade (p-value <0.05). Sensory and motor block characteristics were comparable between groups (p-value >0.05). Group F required a significantly lower total analgesic dose (172±34.2 mg vs 193±37.3 mg; p-value=0.001) and showed lower VAS scores at 30 minutes, one hour, four hours, six hours, and eight hours (p-value <0.05). Haemodynamic variables, including Systolic Blood Pressure (SBP) and Mean Arterial Pressure (MAP), were more stable in group F at several intervals. Conclusion: Both fixed-dose hyperbaric levobupivacaine and reconstituted isobaric levobupivacaine provided effective spinal anaesthesia for infra-umbilical surgeries. While fixed-dose vials offer greater convenience and dosing accuracy, reconstituted formulations allow for personalised adjustments but require additional preparation. The choice between these formulations should be guided by surgical needs, patient characteristics, and cost considerations, ensuring optimal anaesthesia outcomes.

Impact of Simulation-based Learning on the Performance of Cardiorespiratory Skills in Undergraduate Physiotherapy Students: A Stratified Randomised Controlled Trial

Shreevidya Karthik, Anuprita Thakur, Nivedita Shahane, Nikita Tipnis

Introduction: Simulation-based Learning (SBL) is widely recognised for bridging the gap between theoretical knowledge and clinical practice in health professional education. However, its systematic application in Indian physiotherapy education is limited, and its impact on developing essential cardiorespiratory clinical skills remains understudied. Aim: To assess the effect of SBL in improving cardiorespiratory skills among Indian Physiotherapy students compared with traditional bedside training. Materials and Methods: The present single-blinded, Stratified Randomised Controlled Trial (SRCT) was conducted at D.Y. Patil Deemed to be University, Navi Mumbai, Maharashtra, India from September 2022 to December 2022. Ninety IVth year Bachelor of Physiotherapy (BPT) students participated in a two-day theory session and were then allocated to two groups (n=45 per group). Over three weeks, the control group underwent only traditional bedside teaching, whereas the experimental group completed a 27-hour SBL module in addition to traditional bedside training. Both groups were assessed at baseline and after three weeks of basic cardiorespiratory skills training such as subjective evaluation, Blood Pressure (BP) measurement, auscultation, teaching breathing exercises, nebulisation techniques, and transfers using an adapted, validated checklist. Baseline and post-training scores were compared using Wilcoxon signed rank test and Mann-Whitney’s U test with significance set at p<0.05. Results: Both groups were demographically comparable, with similar mean age (21.04 years) and a female predominance consistent with Indian physiotherapy cohort. Within-group analysis indicated that experimental group (SBL+ traditional training) showed significant improvement in all skills (p<0.05), with large effect sizes (r=0.80-0.90). Control group (traditional training) also showed significant improvement in all skills (p<0.05) except in subjective evaluation and transfers. Between-group post-intervention comparison revealed significantly higher post-intervention scores in experimental group as compared to control group (p<0.05); however, teaching breathing exercises and huffing, although statistically significant, demonstrated a smaller effect size (r=0.29). Conclusion: Participants receiving SBL with traditional training showed greater improvement across most cardiorespiratory skills compared to those trained solely through traditional bedside teaching. The smaller effect size for teaching breathing exercises and huffing suggests that efficacy of SBL’s effectiveness may vary by skill type.

Comparison of Two Different Kinesiotaping Techniques on Moderate to Severe Hallux Valgus: A Pilot Study

Amita Aggarwal, Apoorva Nale, Shardul Sutar

Introduction: Moderate to severe hallux valgus causes pain in the foot, balance deficits, gait impairments and eventually falls. With a chronic progressive onset the severity of hallux valgus increases. Regular kinesiotaping delivered will not be able to correct all biomechanical changes of foot. To check if modified kinesiotaping is able to address this problem, highlights the need of the present study. Aim: The study aimed to compare the effect of two different kinesiotaping techniques on angle of hallux valgus, medial arch, great toe pronation, and balance (static and dynamic). Materials and Methods: The present pilot study with 20 young adults having moderate to severe hallux valgus were selected from Outpatient department of Dr. D.Y. Patil College of Physiotherapy, Pune, Maharashtra, India, based on inclusion and exclusion criteria. The study duration was six months from September 2019 to February 2020. Demographic data includes age, gender, body mass index and side affected with hallux valgus. Both genders, with ages between 18 to 65 years, not undergoing any other intervention and having hallux valgus angle 20-40, i.e., moderate and >40, i.e., severe, were included in the study. For a total sample size of 20, subjects were divided into two groups based on convenience sampling. Group A was given Toe Spread Out (TSO) exercise and modified kinesiotaping technique while Group B was given TSO exercise and kenzo kase kinesiotaping technique. The treatment was given for two weeks, and taping was performed five times during the given period. Subjects were reassessed post two weeks of session. Hallux valgus angle, pes planus, great toe pronation and balance were assessed by joint protractor app, navicular drop test and Neurocom balance master, respectively, at baseline and after two weeks of treatment. For normally distributed data paired t-test and independent student t-test was used for intragroup and intergroup comparison. If the data is not normally distributed then Wilcoxon test for intragroup and Mann Whitney for Intergroup was used. Results: According to present study findings there was statistically significant difference for hallux valgus angle (p=0.046), navicular drop (p=0.003), and great toe rotation (p=0.038) was noted. Conclusion: The findings of this study strongly support the use of the modified taping technique in moderate to severe hallux valgus over the Kenso-kase taping technique. Furthermore, the correction of navicular drop and great toe pronation has an additional positive impact on the improvement in hallux valgus.

Analysis of Functional Tasks to Provoke Contraction in Paretic Anterior Tibial Muscles in Individuals with Early Subacute Stroke: A Quasi-experimental Study

AjithKumar Anbazhagan, Sivakumar Ramachandran

Introduction: Improving control of ankle dorsiflexors is crucial for enhancing gait and posture control after a stroke. Several training methods have been explored for their efficacy in promoting contraction of the weakened dorsiflexor muscles. However, majority of studies have been done in chronic stroke survivors, leaving a need to study their effect in early subacute phase of stroke. Aim: To test the effectiveness of commonly used functional tasks in stimulating dorsiflexor activity in early subacute phase of stroke. Materials and Methods: The present quasi-experimental study was conducted with 27 subjects recruited at an acute stroke care set-up at Sri Ramachandra Medical centre, Tamil Nadu, India. India. Twenty-seven subjects with first-time stroke with hemiplegia/paresis with Brunnstrom stage less than 2 were enrolled in the study from March 2023 to July 2023. Dorsiflexor activity was tested in five different functional task. The evaluation of muscle activity was conducted using Surface Electromyography (SEMG). The average output in microvolts (μV) of SEMG was recorded and taken for analysis. Analysis of Variance (ANOVA) and Post-hoc Tuckey were used to compare the differences in dorsiflexor activity between each functional task. Statistical significance was kept at p<0.05. Results: All the five functional task provoked dorsiflexor activity. Among the five functional tasks, stand and reach (18.49 μV) elicited a more pronounced contraction in the dorsiflexors. Wall-leaning in a standing position (15.5 μV), reaching while sitting (14.2 μV), transitioning from sitting to standing (12.8 μV), and triple flexion in the supine position (10.42 μV) also elicited dorsiflexor activity in decreasing level of efficacy. Moreover, they did not exhibit a statistically significant difference in quantum of EMG activity recorded when tested with ANOVA at p<0.05. Conclusion: All the five functional tasks provoked dorsiflexor activity in early subacute phase of stroke in a varying level. In particular stand and reach was the most effective functional task to provoke paretic side dorsiflexor activity.

Evaluation of Adverse Reactions among Blood Donors in South Gujarat: A Cohort Study under the Haemovigilance Programme of India

Introduction: Blood donation is vital part of any blood transfusion services in healthcare. There are various Adverse Donor Reactions (ADRs) associated with blood donation. These reactions affect blood donation and, in terms supply of blood. Understanding the prevalence and nature of ADRs is crucial for improving the overall donor experience, so that the present study was done to estimate the incidence of ADRs among blood donors, along with typing such donors with reactions according to the National Blood Donor Vigilance Programme (Haemovigilance Program of India - HvPI). Aim: The present study was conducted to find out the incidences and types of ADRs among whole blood and apheresis donors. Materials and Methods: The present prospective observational cohort study was conducted at a blood centre attached to Tertiary Care Government hospital of South Gujarat, India, from February 2021 to December 2024, according to guidelines given by the Department of Biologicals, Government of India, under the National Haemovigilance Programme. During the present study analysis of ADRs among whole blood donors and apheresis donors, along with effect of gender, site of donation, and type of donation on ADRs. The analysis was done using two-tailed Chi-square test and odds ratios at 95% confidence interval. Results: Among total of 34,202 blood donations during the study period, the overall incidence of ADRs was 168 (0.49%). Majority of ADRs were Vasovagal Reactions (VVR), constituting 96.42% of all types. Most ADRs (56.54%, i.e., 95 out of 168 ADRs) occurred in donors aged 18-30 years, with first-time donors exhibiting a higher prevalence of 52.38%. Notably, ADRs were more frequent in females than in males (0.74% vs. 0.48%). Outdoor donation camps showed a higher rate of ADRs compared to in-house donations (0.51% vs. 0.38%), although these findings were not statistically significant (p-value >0.05 at 95% confidence interval). Conclusion: The present study highlighted the importance of age, gender, donation type, and donation site in relation to ADRs. Effective donor counselling and observation, especially for first-time donors, are crucial in minimising ADRs and enhancing donor safety. Understanding the factors influencing ADRs can be helpful to improve donor recruitment and retention, ultimately contributing to a safer and more sustainable blood donation system.

Comparative Evaluation of Reagent Lot-to-Lot Variability using In-house, NABL 112 and CLSI EP26-A Protocols: A Cross-sectional Study in a Clinical Biochemistry Laboratory

Introduction: Reagent lot-to-lot variation represents a subtle yet significant source of analytical uncertainty in clinical laboratories. Even minor shifts between reagent lots can alter assay calibration, bias, and precision, thereby compromising longitudinal comparability and, ultimately, patient safety. Despite explicit requirements in the International Organisation for Standardisation (ISO) 15189:2022 and the National Accreditation Board for Testing and Calibration Laboratories (NABL) 112, verification procedures remain heterogeneous across laboratories and often rely on limited empirical evaluation rather than statistically defined acceptance criteria. Aim: To undertake a comparative assessment of reagent lot-to-lot variability across seven key biochemical analytes using three verification frameworks-an in-house laboratory protocol, NABL 112, and the Clinical and Laboratory Standards Institute (CLSI) EP26-A guideline-in a NABL-accredited clinical biochemistry laboratory. Materials and Methods: The present cross-sectional study was conducted over a twelve-month period in a tertiary care, NABL-accredited laboratory in Gujarat, India. Paired patient samples and quality control materials were analysed across reagent lot transitions on Siemens analysers. Verification outcomes were evaluated using regression analysis, Total Allowable Error (TEa), Measurement Uncertainty (MU), and Critical Difference (CD) metrics, as prescribed by the respective protocols. Results: All analytes met the acceptance criteria under the in-house and NABL 112 protocols. Under the CLSI EP26-A framework, Thyroid-Stimulating Hormone (TSH) failed acceptance (observed difference=2.3 mIU/L>rejection limit (RL)=0.88 mIU/L), while all other analytes conformed. The EP26-A protocol required larger sample sizes and narrower rejection limits, demonstrating greater sensitivity in detecting clinically meaningful differences between reagent lots. Conclusion: While conventional verification protocols ensure operational efficiency, the CLSI EP26-A approach provides a statistically robust and clinically aligned framework for detecting reagent lot variability. Integrating its principles into routine practice could enhance analytical reliability, regulatory compliance, and long-term traceability of patient results within accredited laboratory systems.

Bacterial Profile and Biofilm Detection in Burn Wound Isolates, Comparing Three Phenotypic Methods: A Cross-sectional Study from a Tertiary Care Hospital, Jamnagar, Gujarat, India

Introduction: Burn wounds are highly susceptible to bacterial infections, particularly from organisms that produce biofilms and exhibit multidrug resistance. These biofilms make infections more difficult to treat by protecting bacteria from antibiotics and slowing the healing process. Identifying the microorganisms involved and understanding their resistance patterns are essential for guiding treatment and improving outcomes in burn patients. Aim: To investigate the microbial profile, antibiotic susceptibility, and biofilm production in bacterial isolates from burn wound infections in patients at a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology, Shri M.P. Shah Government Medical College, Jamnagar, Gujarat, India, over a one-year period (October 2018-September 2019). A total of 100 samples were collected from patients with burn wounds, yielding 48 bacterial isolates. Swab samples were cultured for bacterial growth, identified using standard biochemical methods, and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Biofilm production was assessed using the Tissue Culture Plate (TCP), tube adherence, and Congo Red Agar (CRA) methods. Demographic details including age, sex, type, and extent of burns were recorded. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 24.0, applying the Chi-square test, with p-values <0.05 considered statistically significant. Results: Of the 100 burn wound specimens, 40 (40.0%) showed positive cultures, yielding a total of 48 bacterial isolates. The predominant pathogen was Pseudomonas aeruginosa (17; 35.4%), followed by Staphylococcus aureus (12; 25.0%), with methicillin resistance identified in 7 (58.3%) of the S. aureus isolates. Biofilm formation by the TCP method was detected in 38 (79.2%) isolates. Multidrug resistance (MDR) was observed in 34 (70.8%) isolates, of which 33 (97.1%) were biofilm producers, compared with 3 (21.4%) among non Multidrug Resistant Organisms (MDROs) (χ²=30.25, p-value <0.001). Deep burns accounted for 25 (52.1%) culture-positive cases and superficial burns for 23 (47.9%), with biofilm positivity rates of 20 (80.0%) and 18 (78.3%), respectively. Conclusion: Pseudomonas aeruginosa and Staphylococcus aureus were the most common bacterial isolates from burn wound infections, with a notable prevalence of MDR strains. Biofilm production was frequently observed, particularly among Pseudomonas aeruginosa isolates, and showed a strong association with multidrug resistance. These findings highlight the importance of considering biofilm formation when managing burn wound infections, as it plays a critical role in antimicrobial resistance and may contribute to treatment failure.

Surgical Outcome of Oesophageal Diversion and Exclusion Procedure in the Management of Oesophageal Perforation: A Retrospective Observational Study

Introduction: Oesophageal perforation is a life-threatening condition with high mortality rates. Various treatment options are available for the management. Oesophageal exclusion with diversion completely diverts the secretions entering the mediastinum, thereby prevents mediastinitis. Aim: The present study aimed to estimate mortality and the causes of oesophageal perforation in patients who underwent oesophageal exclusion and diversion procedure. Materials and Methods: The present retrospective observational study was conducted in Surgical Gastroenterology Department at Madras Medical College,Tamil Nadu, India from January 2019 to May 2024. A total of 46 patients had oesophageal perforation; 14 patients were managed conservative treatment, 32 patients were managed by operative treatment, including 25 patients who underwent oesophageal exclusion and diversion procedure. The surgical outcome of these 25 patients who underwent diversion cervical oesophagostomy and oesophageal exclusion for oesophageal perforation were evaluated. Parameters like age, sex, cause of perforation, location of oesophageal perforation, duration from symptom onset to hospital admission, postoperative morbidity, and mortality were recorded. Results: The mean age of the patients was 44.16 years, with 16 male and 9 female. Mortality rate was 4 (16%). The thoracic portion of the oesophagus was the most common site of perforation in 24 (96%) patients. Spontaneous perforation (9 patients, 36%) was the most common cause of oesophageal perforation, followed by foreign body-induced perforation (8 patients, 32%). Conclusion: Oesophageal diversion and exclusion procedure can be safely performed in a septic patients and in patients with delayed presentation. Oesophagostomy reversal is also an easy technique that does not cause much morbidity to the patients. In most of the patients, oesophagostomy that spontaneously closed doesn’t require reversal.

Efficacy and Safety of Topical Adapalene (0.1% w/w) and Clindamycin (1% w/w) versus Topical Adapalene (0.1% w/w) and Benzoyl Peroxide (2.5% w/w) in Inflammatory Acne Vulgaris: A Phase-IV Open-label Comparative Study

Soumik Biswas, Arijit Ghosh, Suchibrata Das, Ananya Mandal, Pragnadyuti Mandal

Introduction: Acne vulgaris, a chronic inflammatory condition, is characterised by open and closed comedones, erythematous papules and pustules. In current treatment guidelines, topical retinoids, such as adapalene, are commonly prescribed in combination with antimicrobials, including clindamycin. This combination has been proven to reduce acne lesions more quickly and prevent antimicrobial resistance. Benzoyl Peroxide (BPO) has a synergistic effect that enhances the penetration of adapalene in the skin and prevents the growth of Propionibacterium acnes. No published studies have compared topical adapalene and clindamycin versus topical adapalene and BPO. Aim: To compare the efficacy and safety of a combination of topical adapalene (0.1% w/w) and clindamycin gel (1% w/w) with a combination of topical adapalene (0.1% w/w) and BPO (2.5%w/w) gel for the treatment of inflammatory acne vulgaris . Materials and Methods: This study was a prospective randomised, open-label, parallel group interventional trial, which was conducted in the Departments of Pharmacology and Dermatology at NRS Medical College and Hospital, Kolkata, West Bengal, India, from January 2023 to August 2023. The total sample size was 34, with 17 in each group. Patients fulfilling the inclusion criteria were assigned to one of the two study groups in a parallel-arm design. Patients in Group A had received topical adapalene (0.1% w/w) and clindamycin (1%w/w) and patients in Group B had received topical adapalene (0.1% w/w) and BPO (2.5%w/w). Randomisation was done by the coin-toss method. Changes in Total Lesion Count (TLC), Investigator Global Assessment (IGA) score and Cardiff Acne Disability Index (CADI) score were recorded at weeks 0, 4, 8, and 12. Friedman’s test and repeated measure Analysis of Variance (ANOVA) test were used for intragroup comparison and Mann-Whitney U test and Unpaired t-test were applied for intergroup comparison. Chi-square test was used for categorical data. A p-value<0.05 was considered statistically significant. Results: No statistically significant intergroup differences existed at baseline in TLC, IGA score and CADI score. Intragroup comparisons in both groups showed a significant decrease in TLC, IGA and CADI scores at week 12 from their respective baseline values (p-value<0.05), but intergroup comparison showed no statistically significant difference at week 12. Conclusion: It was observed that consecutive topical treatment with clindamycin and adapalene appears to possess additive effects that can be of valuable therapeutic benefit for acne patients. It has been observed that topical treatment with adapalene and BPO has good efficacy and tolerability. It has been found that both treatment therapy is beneficial and safe for mild to moderate acne vulgaris patients.

Prevalence of Gynaecological Problems and Common Medical Disorders in Postmenopausal Women: A Cross-sectional Study

Devyani Misra, Vandana Gautam, Shailja Bhamri, Pooja Gupta

Introduction: Menopause is marked by cessation of menses brought about by declining ovarian function. This period may present with gynaecological problems, which are often the reason for gynaecological consultations. Many women also suffer from medical disorders and may be unaware of underlying cardiovascular risk factors. Aim: To evaluate the prevalence and nature of gynaecological problems and common medical disorders like hypertension, diabetes mellitus and hypothyroidism in postmenopausal women. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department (OPD) of Obstetrics and Gynaecology, at Dr.Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India, from January 2023 to December 2023. A total of 284 women were enrolled after consent, basic demographic details, including age at menopause and reason for consultation, were noted, and blood pressure, height, and weight were recorded. Following a thorough gynaecological consultation, investigations like complete blood count, blood sugars, and thyroid function test were done. Data was recorded, and analysis was done using mean, Standard Deviation (SD) and percentages. Results: The mean age at presentation was 58.15±7.70 years, mean duration since menopause was 11.24±8.74 years. Among them, 136 females (49.4%) attained menopause in the age group 45-49 years. The most common gynaecological reason for consultation was postmenopausal bleeding in 161 (56.7%), followed by urogenital prolapse in 115 (40.5%) and urinary symptoms in 67 (23.6%). During basic examination and investigations, 32 (11.3%) new cases of hypertension, 52 (18.3%) new cases of diabetes mellitus, 19 (6.3%) new cases of hypothyroidism and 12 (4.2%) new cases of other medical problems were diagnosed. Conclusion: Menopause may present challenges due to gynaecological problems. Basic medical disorders can be diagnosed by simple tests at the time of a gynaecological consultation. The gynaecological visit may therefore help in the diagnosis and management of medical disorders, and help in improving the overall health of the postmenopausal woman.

Perception of Budding Indian Medical Graduates Towards Competency-based Medical Education: A Cross-sectional Study in a Private Medical College of Northwestern Karnataka, India

Introduction: Competency-Based Medical Education (CBME) has fundamentally reshaped India's medical education since its adoption in 2019-20 under the former Medical Council of India (MCI), now National Medical Commission (NMC). This learner-centric, patient-focused curriculum aims to cultivate "Indian Medical Graduates" (IMGs) who are globally relevant and competent as first-contact physicians. CBME emphasises essential knowledge, skills, values, professionalism, gender sensitivity and adaptability, aligning with international standards to prepare IMGs for diverse healthcare roles. Aim: To assess the perception of Bachelor of Medicine, Bachelor of Surgery (MBBS) students from all Phases towards CBME and its implementation. Materials and Methods: This cross-sectional study was conducted at KAHER’s, Jawaharlal Nehru Medical College (JNMC), Belagavi, Karnataka, India from April 2024 to June 2024. The study encompassed 759 undergraduate students from Phase I, Phase II, III Part I and III Part II, with no dropouts. A structured, validated questionnaire was distributed to participants via WhatsApp/Email to assess their perceptions regarding CBME and its new components: self-directed learning, small group teaching and mentorship. The responses were captured on a 5-point Likert scale and analysed statistically using the statistical software R version 4.4.0 and Microsoft Excel. Results: The study included 759 students with a mean age of 20.46±1.46 years. The participant group was predominantly female (56.52%) compared to male students (43.08%). Regarding the foundation course, the majority of students 691 (91.04%) had a positive perception, with only 7 (0.92%) reporting a negative perception and 61 (8.04%) remaining neutral. A total of 633 (83.4%) students had a positive attitude toward Self-Directed Learning (SDL) and Small Group Teaching (SGT), while 699 (92.09%) favored the new components of CBME. Overall, CBME received positive feedback from 699 (92.09%) students, with only 8 (1.05%) expressing negativity and 52 (6.85%) remaining neutral. Conclusion: The study found that undergraduate medical students had a predominantly positive perception of the CBME curriculum. Key components like the foundation course, SDL, SGT and integration were well received. These results align with the study’s objective, confirming effective implementation at the institutional level.

Efficacy of Dexmedetomidine for Prevention of Postspinal Anaesthesia Shivering in Orthopaedic Surgeries: A Double-blinded Randomised Controlled Study

Aayushi Bagga, Utkarsh Prasad, Sateesh Verma, Sanjiv Kumar, Vinita Singh

Introduction: Post-spinal Anaesthesia Shivering (PSAS) refers to involuntary, repetitive skeletal muscle contractions triggered by a fall in core body temperature that generate heat but can cause significant discomfort, increase intracranial and intraocular pressures and raise oxygen demand with potential clinical consequences. Aim: To assess the efficacy of two intravenous (i.v.) doses of dexmedetomidine, administered prior to spinal anaesthesia, in preventing PSAS in patients undergoing lower limb orthopaedic procedures. Materials and Methods: This double-blinded, randomised controlled study was conducted at Department of Anaesthesia, King George’s Medical University, Lucknow, Uttar Pradesh, India in collaboration with the Department of Orthopaedics, for a period of 12 months, from October 2022 to September 2023. A total of 75, American Society of Anaesthesiologists (ASA) physical status grade I/II patients were scheduled for elective lower limb orthopaedic surgeries after ethical approval. Participants were randomly assigned to three groups (n=25 each) via a computer-generated sequence: Group I received 100 mL of normal saline; Group II received dexmedetomidine 0.25 μg/kg diluted in 100 mL saline; and Group III received dexmedetomidine 0.5 μg/kg in 100 mL saline. Infusions were administered over 10 minutes. Blinding was maintained for both the administering and observing anaesthesiologists. Categorical data (gender, ASA grade, incidence of shivering, consumption of tramadol) was analysed using Chi-square tests and continuous data {age, height, weight, Body Mass Index (BMI), duration of surgery and spinal anaesthesia, onset of shivering after spinal anaesthesia, temperature, Ramsay sedation score, Heart Rate, (HR) Systolic Blood Pressure (SBP)} was analysed using Analysis of Variance (ANOVA) tests, with level of significance (p-value<0.01) considered as statistically significant. Results: Demographic variables (age, gender, weight, height, BMI, ASA status and duration of surgery) were comparable across the three groups, in terms of their p-value. The mean onset time of shivering, tramadol consumption and post-spinal temperature fall were not statistically significant. The mean Ramsay sedation score at 10 minutes was highest in group III (3.8±0.98), followed by group II (2.4±0.82) and group I (1.8±0.69), showing a highly significant difference (p-value<0.0001). HR and SBP declined after spinal anaesthesia and rose again at the time of shivering in all groups, with statistically significant differences observed between groups. The duration of spinal anaesthesia increased progressively from group I (153.12±2.84 min) to group II (168.32±3.24 min) and group III (171.44±3.98 min) (p-value<0.0001), while the incidence of adverse events was infrequent. Conclusion: Preoperative i.v. dexmedetomidine effectively reduces the incidence of shivering following spinal anaesthesia. A lower dose (0.25 μg/kg) is associated with fewer sedative and cardiovascular effects and may be preferable for routine use.

Emotional Regulation and Serum Cortisol Levels in Patients with Depressive Disorders versus General Population: A Cross-sectional Study

Introduction: Depressive disorders are among the most prevalent and disabling mental health conditions and are increasingly conceptualised as illnesses involving maladaptive emotional regulation. In parallel, neuroendocrine mechanisms—particularly Hypothalamic–Pituitary–Adrenal (HPA) axis dysregulation—have been implicated, with elevated morning cortisol reflecting sustained stress-system activation in depression. Aim: To determine the levels of emotional regulation and serum cortisol in patients with depressive disorders, in comparison with the general population. Materials and Methods: This single-centre, cross-sectional study was conducted in the outpatient Department of Psychiatry, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, over eight months (November 2024-June 2025). A total of 74 participants were recruited using purposive sampling: 37 patients with depressive disorders and 37 individuals from the general population. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D-17), emotion-regulation difficulties were evaluated using the Difficulties in Emotion Regulation Scale (DERS total and subscales), and morning serum cortisol (8:00–9:00 AM) was measured via chemiluminescent immunoassay. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 26.0. Independent-samples t-test, Chi-square/Fisher’s exact test, and Pearson correlation were applied, with two-tailed p-value<0.05 considered as statistically significant. Results: Both the groups were demographically comparable, with no significant differences in age, gender, marital status, education, residence, or socio-economic background. In the depressive disorder group, the mean±SD age at illness onset was 33.2±7.5 years, with an average illness duration of 21.5±18.5 months. Most patients had mild to moderate depression, and the majority were experiencing their first episode. A statistically significant difference was observed in previous psychiatric hospitalisation, reported in 6 (16.2%) of patients but none in the control group (p-value=0.011). Patients with depressive disorders had significantly higher DERS scores compared with the general population, indicating greater difficulties in emotional regulation. Subscale scores for non acceptance, goals, strategies, and clarity were significantly higher in patients, while impulse and awareness domains showed no significant differences. Serum cortisol levels were markedly elevated in the depressive group and strongly correlated with HAM-D scores (r-value=0.826) and DERS total scores (r-value=0.711). Conclusion: Patients with depressive disorders exhibited significantly higher emotional dysregulation and serum cortisol levels compared to the general population.

Analgesic Efficacy of Hyperbaric Ropivacaine versus Hyperbaric Bupivacaine with Fentanyl in Infraumbilical Surgeries under Spinal Anaesthesia: A Double-blinded Randomised Clinical Trial

Anurag Kharel, Arati Rai, Meyong P Bhutia

Introduction: Spinal anaesthesia is a preferred technique for infraumbilical surgeries because of its rapid onset, reliable action, and minimal systemic effects. Although hyperbaric bupivacaine provides effective sensory and motor blockade, its association with hypotension and bradycardia has prompted interest in alternatives such as hyperbaric ropivacaine, which offers comparable anaesthesia with potentially better haemodynamic stability. Aim: To compare the haemodynamic effects and analgesic efficacy of hyperbaric bupivacaine and hyperbaric ropivacaine, both combined with fentanyl, in patients undergoing infraumbilical surgeries under spinal anaesthesia. Materials and Methods: This randomised, double-blind clinical trial included 70 patients undergoing elective infraumbilical surgeries over a period of two years at Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India. Patients were equally allocated to receive spinal anaesthesia with either hyperbaric bupivacaine 0.5% or hyperbaric ropivacaine 0.75%, both combined with 25 μg fentanyl. Sensory and motor block onset times, intraoperative haemodynamic parameters, side-effects, and postoperative pain scores assessed using the Numeric Rating Scale (NRS). Data were compared between groups using the unpaired Student’s t-test, with p-value <0.05 considered statistically significant. Results: The mean age was 39.7±12.6 years in Group B and 44.0±11.7 years in Group R (p-value=0.141). Bupivacaine demonstrated a significantly faster onset of sensory blockade (3.55±0.19 vs 4.10±0.27 minutes; p-value <0.001) and motor blockade (6.91±0.25 vs 9.85±0.24 minutes; p-value <0.001), as well as a longer time to first rescue analgesia (227.8±8.7 vs 209.9±6.9 minutes; p-value <0.001). Although hypotension occurred more frequently in the bupivacaine group (42.85% vs 25.71%), the difference was not statistically significant. Postoperative pain scores were comparable between the two groups at all assessed time intervals. Conclusion: Both anaesthetic agents provided effective spinal anaesthesia for infraumbilical surgeries. Hyperbaric bupivacaine offered a faster onset of block and longer duration of analgesia, whereas hyperbaric ropivacaine demonstrated better haemodynamic stability, making it a suitable option for patients requiring rapid recovery or those with cardiovascular risk factors.

Trichoscopic Analysis of Androgenetic Alopecia in Men Less than Forty Years of Age: A Retrospective, Observational Study from a Tertiary Care Hospital

S Asiya Begum, Rahul Krishna Kota, Sowmya Harshitha Padmanabhuni

Introduction: Androgenetic Alopecia (AGA) is the most common cause of hair loss worldwide. It is a non-scarring, progressive, patterned, and androgen-dependent condition seen in genetically predisposed individuals. AGA presents as gradual loss of terminal scalp hair. Trichoscopy is non-invasive dermoscopic imaging of the scalp and hair. It helps assess the disease activity, severity, and prognosis in trichology. Aim: To identify and evaluate the association of trichoscopic features with severity of AGA in men under forty years of age. Materials and Methods: The present retrospective, observational study was conducted in the Dermatology Department at Medical College and Research Institute, Bengaluru, Karnataka, India. The duration of the study was 12 months between January 2019 to December, 2019. Fifty men under the age of 40 with AGA were enrolled. Diagnosis was made based on clinical examination of all the areas of the scalp. Age, history, clinical type, and duration of disease were noted. Trichoscopic evaluation of the scalp was done and relevant images were captured. A digital trichoscope (Firefly DE330T videodermatoscope USA) was used. AGA grades 1 & 2 were categorised as mild; grades 3 & 4 as moderate, and grade 5 & 6 as severe. Chi Square test was used for statistical analysis. The results were considered statistically significant if the p<0.05. Results: Among the 50 subjects, the youngest was 17 years and the oldest was 40 years. Seven trichoscopic features were observed, which were anisotrichosis, peripilar sign, white dots, yellow dots, predominance of single-hair follicular units, focal atrichia, and scalp pigmentation. All cases (100%) exhibited anisotrichosis, irrespective of AGA severity, making it the most common feature. Significant associations were found between AGA grading and the presence of white dots (p=0.035), focal atrichia (p=0.0007), and honeycomb pigmentation (p=0.0024). Conclusion: The study found an association between white dots, focal atrichia and honeycomb pigmentation of the scalp and the grade of AGA. Trichoscopy detects early changes in hair follicles, often preceding visible and irreversible baldness. It is an excellent non-invasive tool that allows for the rapid scanning of large areas.

Stress and Its Associated Factors among First Year Students of a University of Health Sciences in Southern India: A Descriptive Survey

Introduction: Stress is a common issue affecting individuals across various demographics. Undergraduate students in healthcare professions experience stress due to academic expectations and other reasons as well. First year students, in particular, face multiple challenges adjusting to new educational, social, and environmental demands, leading to stress that can impact well-being and academic performance. Aim: To assess stress levels and identify factors contributing to stress among first year undergraduate students at a University of Health Sciences. Materials and Methods: The present descriptive survey design was conducted in Mangaluru, Karnataka, India from July 2023 to May 2024. The study involved 70 first year students selected from 260 students pursuing B.Sc. Nursing, Bachelor of Physiotherapy (BPT) and Bachelor of Pharmacy (B.Pharma). Stress levels were assessed using the Student Stress Inventory (SSI), and contributing factors were measured using a structured checklist of factors, including 30 items that would assess interpersonal, intrapersonal, environmental, health, and academic factors associated with stress. Descriptive data was analysed using frequency and percentage. Chi square test was used to find association between stress, factors related to it and demographic variables. Results: The mean age of students was 18.42±0.80 years, the majority (38.5%), were from B.Sc nursing and BPT, 64.6% were females; as for the place of residence, the majority (80.8%) were residing in hostels. Among the students, 62.3% reported mild stress, 36.9% moderate stress, and 0.8% severe stress. The study identified several factors leading to stress, including homesickness (16.5%), sleeping patterns (20.8%), academic pressure (20.8%), and concerns about grades (21.5%). A significant association was found between stress levels and selected demographic variables (p<0.05). Conclusion: The present study highlights that among the first year undergraduate students, majority (62.3%) have mild and 36.9% have moderate stress. The findings underscore the need for targeted interventions and support systems to address the specific stressors students face during their initial transition into university life. Ultimately, understanding these factors is crucial for developing effective strategies to promote future healthcare professionals’ mental health and academic success.

Analysis of GLS1 Gene Expression Levels in Stage 2 Grade B Periodontitis Patients with and without Type 2 Diabetes Mellitus: An Ex-vivo Study

Jennifer Jeyaruby Joyson, Jaiganesh Ramamurthy

Introduction: Diabetes Mellitus (DM), a metabolic condition marked by hyperglycaemia and periodontitis, a chronic inflammatory disease of the tissues supporting the teeth, are linked by similar pathophysiological pathways. Chronic hyperglycaemia deteriorates glycaemic control by weakening the host immune response and raising the risk of periodontal disease. Conversely, periodontal inflammation aggravates systemic inflammation and insulin resistance. Since Glutaminase 1 (GLS1) is associated with the inflammatory processes in both diseases, the present study investigates the expression levels of GLS1 in patients with diabetes and periodontitis to establish a potential pathophysiological link between the two diseases. Aim: To assess and compare subgingival GLS1 gene expression among healthy individuals, patients with periodontitis and patients with both periodontitis and type 2 DM. Materials and Methods: A ex-vivo study was conducted at Department of Periodontics, Saveetha Dental College, Saveetha Institute of Technical and Medical Sciences, Saveetha University, Chennai, Tamil Nadu, India, from June 2024 to July 2024. A total of 30 participants aged over 18 years with Stage 2 grade B periodontitis and stable glycaemic control {Glycated Haemoglobin (HbA1c)<7} were categorised into three groups with n=10 each: healthy controls, patients with periodontitis and patients with both periodontitis and DM. Patients with other co-morbidities were excluded. Clinical parameters, including Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) and HbA1c levels, were assessed. Gingival tissue samples were collected and analysed for GLS1 expression using quantitative real-time Polymerase Chain Reaction (qRT-PCR). Demographic and clinical data, including age, gender, glycaemic control and periodontal status, were also collected. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) Statistics 27.0 (IBM Corp.) and GraphPad Prism 7.0 (GraphPad Software). One-way Analysis of Variance (ANOVA) and post-hoc tests were utilised for intragroup and intergroup comparisons, with a significance level set at p<0.05. Results: The periodontitis and diabetes group had a significantly lower mean age compared to healthy controls (p<0.05), with no significant difference in gender distribution across groups (p> 0.05). Clinical parameters (PPD, CAL, HbA1c) were significantly higher in the periodontitis and diabetic groups (p<0.05). GLS1 expression was highest in the periodontitis group and significantly differed from both the healthy and diabetic groups (p<0.001), while no difference was observed between the healthy and diabetic groups (p=0.9369). Conclusion: The GLS1 expression was elevated in periodontitis patients but reduced in those with both periodontitis and DM, suggesting its potential as a biomarker influenced by systemic diseases. GLS1 may serve as a potential biomarker and therapeutic target, offering new avenues for integrated management of these chronic conditions. Further research is needed to fully elucidate the molecular mechanisms of GLS1 in the bidirectional relationship between periodontitis and DM.

Early Feeding Practices among Saudi Mothers and Dental Caries in Young Children: A Cross-sectional Study

Introduction: Several risk factors have been associated with Early Childhood Caries (ECC), including feeding practices, nocturnal feeding, delayed weaning from breast- or bottle-feeding, and parental awareness. The purpose of present study was to address a gap in the literature by examining the specific feeding practices of mothers in Jeddah and their relationship with dental caries, while also considering demographic and socioeconomic factors that may influence these practices. Aim: To assess the prevalence of breast- and bottle-feeding practices among Saudi mothers of healthy children aged 1 to 2 years in Jeddah, Saudi Arabia, and to investigate the relationship between various feeding practices and children’s demographic characteristics, maternal socioeconomic status, and maternal knowledge of appropriate feeding practices. Materials and Methods: A cross-sectional study was conducted at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia from September 2023 to December 2023. The study included mothers of children aged 1 to 2 years who participated in three community awareness events held across different areas of Jeddah. A trained dentist interviewed the mothers using a validated Arabic questionnaire to assess potential confounding factors. Data were analysed using the Independent t-test for continuous variables and the chi-square test for categorical variables, with a significance level set at p<0.05. Results: The mean age of the study participants was 30.91±7.97 years. Out of the 1,438 mothers who participated in the study, 345 (24.0%) practised exclusive breastfeeding, of whom 70 (20.2%) reported dental caries in their children. Exclusive bottle-feeding was reported by 251 (17.5%) mothers, with 54 (21.5%) reporting dental caries in their children, while mixed feeding was practised by 842 (58.6%) mothers, among whom 186 (22.1%) reported dental caries. Nocturnal breastfeeding and bottle-feeding were practised by 1,119 (77.8%) and 935 (65.0%) mothers, respectively. The mean maternal knowledge score regarding appropriate feeding practices was 2.65±1.29 out of five. Multinomial regression analysis demonstrated statistically significant associations between feeding practices and birth order, type of delivery, maternal education level, maternal occupation, and average monthly household income. Conclusion: The present study highlights a low rate of exclusive breastfeeding and insufficient knowledge of appropriate feeding practices among mothers in Jeddah, Saudi Arabia. Feeding practices were significantly influenced by birth order, mode of delivery, and maternal socioeconomic status. No significant association was found between feeding methods and dental caries. Enhancing maternal education regarding appropriate feeding practices and promoting exclusive breastfeeding may be important strategies for improving child health outcomes.

Comparative Analysis on Colour Changes of Nano and Microhybrid Composite with Exposure to Cigarette and Cigar Smoke: An In-vitro Analysis

Introduction: The aesthetic longevity of dental composites is crucial, especially for smokers, as smoke exposure can cause discolouration. Cigarette and cigar smoke may affect the colour stability of restorations, raising concerns for both patients and clinicians. Therefore, it is necessary to study the types of discolouration caused by both smoking agents and the selection of composite materials. Aim: To assess and compare the colour changes in nanohybrid and microhybrid composites when exposed to cigarette and cigar smoke. Materials and Methods: This single-blinded, in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, over a duration of one month (1st Oct to 31st Oct 2024). A total of 120 composite specimens were prepared in a standardised manner. All samples were then randomly allocated into two groups: Group 1 (Nanohybrid, n=60) and Group 2 (Microhybrid, n=60) were each further divided into three subgroups: Subgroup A (Cigarette smoke exposure, distributed as A1 and A2, n=20 each), Subgroup B (Cigar smoke exposure, distributed as B1 and B2, n=20 each), and Subgroup C (Control- artificial saliva, distributed as C1 and C2, n=20 each). Pre-exposure Commission Internationale de l’Éclairage (CIE) Value (L*), Saturation (a*), and Hue (b*) value of all the samples were recorded. A customised smoke chamber was created simulating oral smoking. In this smoke chamber, all the samples were exposed to smoke for 15 days testing period following the exposure criteria. Post-exposure CIE L*a*b* value of all the samples was recorded. Colour changes (?E) were measured using Adobe Photoshop. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) and Tukey’s post-hoc test. The data was analysed using IBM Statistical Package for Social Sciences (SPSS) version 21.0; keeping confidence interval at 95% and a p-value <0.05 was considered to be statistically significant. Results: The pre- and post-smoke exposure values of microhybrid and nanohybrid composites show a highly statistically significant difference (p-value <0.05), where ? was >10. Microhybrid composites showed greater discolouration than nanohybrid composites. Cigar smoke caused more discolouration than cigarette smoke, with the highest discolouration observed in the microhybrid-cigar group, followed by nanohybrid-cigar, microhybrid-cigarette, and the lowest in the nanohybrid-cigarette group. Conclusion: A cigar produces more discolouration than a cigarette. Nanohybrid composite material is more colour stable compared to microhybrid composite material.

Assessment of the Cytotoxicity and FTIR Properties of Clitoria Ternatea Gel for Caries Removal: An In-vitro Study

Pragathi Pareek, R Ramesh

Introduction: Minimally Invasive Dentistry (MID) emphasises the selective removal of carious dentin while preserving healthy tooth structure, particularly essential in paediatric care. Natural, biocompatible alternatives to conventional Chemomechanical Caries Removal (CMCR) agents are increasingly being explored to reduce cytotoxic risks. Clitoria ternatea Gel (CTG), known for its phytochemical richness and medicinal properties, is investigated in this study as a novel CMCR agent. Aim: To evaluate the cytotoxicity and structural impact of CTG on human gingival fibroblast cells and dentinal collagen using MTT assay and Fourier Transform Infrared (FTIR) spectroscopy, respectively. Materials and Methods: The present in-vitro study was conducted at the Blue Lab, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from 1st to 30th December 2024. The primary inclusion criterion was the use of cultured human gingival fibroblast cells for cytotoxicity evaluation. A total sample size of 35 wells was used, with six concentrations of CTG (100, 300, 500, 700, 900, and 1000 μg/mL) tested in quintuplicate. CTG was formulated using Clitoria ternatea flower extract combined with a gel base of Hydroxypropyl Methylcellulose (HPMC) and Carbopol 934. For cytotoxicity analysis, fibroblast cells were seeded in 96-well plates and treated with CTG for 24 hours, followed by an MTT assay. Optical Density (OD) was measured at 595 nm to determine cell viability. For FTIR spectroscopy, dentinal collagen was treated with CTG and analysed for wavenumber shifts in the Amide I and II regions. Statistical analysis was performed using One-way Analysis of Variance (ANOVA), t-tests, with a p-value <0.05 considered statistically significant. Results: The FTIR spectra revealed wavenumber shifts in Amide I and II peaks, suggesting partial degradation of denatured collagen with minimal impact on sound structure. The MTT assay indicated dose dependent cytotoxicity, with cell viability above 60% at ≤300 μg/mL and an IC50 value of ~500 μg/mL. Conclusion: CTG exhibits selective collagen degradation and acceptable cytocompatibility at lower concentrations, supporting its use as a minimally invasive, plant-based CMCR agent in paediatric dentistry.

Comparing the Staining Efficacy of Leishman Giemsa Cocktail with MGG and Leishman Stain in Fine Needle Aspiration Cytology Smears: A Cross-sectional Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is a primary investigative tool for diagnosing both non-neoplastic and neoplastic swellings. It is safe, rapid, cost-effective, and has high sensitivity and specificity. FNAC smears are routinely stained using Haematoxylin and Eosin (H&E), Papanicolaou (PAP), and May-Grünwald-Giemsa (MGG) stains. The Leishman-Giemsa cocktail (LG cocktail) is a relatively new stain composed of a mixture of Leishman and Giemsa stains. Leishman stain is widely used for haematology smears but is not commonly employed for cytology smears. The present study evaluates the staining efficacy of the LG cocktail and compares it with MGG and Leishman stains in FNAC smears. Aim: To analyse the staining efficacy of the LG cocktail stain in FNAC smears and to compare the Quality Index (QI) of the LG cocktail with MGG and Leishman stains in FNAC smears. Materials and Methods: The present cross-sectional study carried out on 100 FNAC cases at Thanjavur Medical College and Hospital over a period of one month (July 2023), following approval from the Institutional Ethics Committee (Approval No. 1121/2023). FNAC samples were obtained from patients referred from the Department of General Surgery OPD and the Department of Otorhinolaryngology OPD. Informed consent was obtained from all participants. Apart from the routine smears prepared for H&E and MGG staining, two additional smears were prepared for each case and stained with the LG cocktail and Leishman stain. The stained slides were evaluated and scored for nuclear morphology, cytoplasmic details, clarity of staining, background details, and overall staining quality. Each parameter was graded as satisfactory, good, or excellent. The QI was calculated by dividing the score obtained by the maximum possible score. The QI values of MGG, LG cocktail, and Leishman stains were analysed for statistical significance using Statistical Package for the Social Sciences (SPSS) software version 26, and paired sample tests were applied. Results: The QI of the LG cocktail stain was 0.76, while that of MGG was 0.67 and Leishman stain was 0.46. Smears stained with the LG cocktail demonstrated excellent nuclear and cytoplasmic details, better background material staining, and superior overall staining efficacy compared with MGG and Leishman-stained smears. Conclusion: The LG cocktail stain demonstrated superior staining efficacy in FNAC smears when compared with MGG and Leishman stains. Although Leishman stain requires a shorter staining duration and is more economical, its cytoplasmic detail and background staining are inferior. Therefore, Leishman stain alone is not preferred for FNAC smears.

Impact of Social Media’s Medical Misinformation about Diabetes Mellitus on Patient’s Behaviour: A Cross-sectional Study

Introduction: Social media serves as a key source of health information, shaping public perceptions and behaviours. However, the spread of misinformation, particularly regarding diabetes management, has influenced treatment decisions and self-care practices. The present study explores the impact of social media-driven misinformation on individuals with diabetes. Aim: To assess how social media influences diabetes-related beliefs, the prevalence of misinformation, and its effect on adherence to evidence-based treatment. Materials and Methods: The present cross-sectional study was conducted among 300 participants with diabetes at SRM Medical College and Research Institute, Chennai, Tamil Nadu, India, from January 2024 to June 2024. Data were collected using a structured questionnaire covering demographics, social media usage, diabetes-related beliefs, and trust in treatment options. Descriptive and inferential statistical analyses were performed to evaluate the impact of misinformation on disease management. A p-value<0.05 was considered statistically significant. Results: The present study found that 183 participants (61%) spent over two hours daily on social media, increasing their exposure to both accurate and misleading health content. Around 131 participants (43.7%) believed diabetes-related claims based on high engagement metrics, while 77 (25.7%) endorsed unverified traditional remedies such as black cumin and Senna auriculata. Notably, 165 participants (55%) were “very likely” to follow advice from social media videos, and 56 (18.7%) expressed a willingness to discontinue prescribed medications in favour of alternative remedies. Misinformation was prevalent, with 154 participants (51.3%) believing that insulin is harmful and 161 (53.7%) thinking that the spleen regulates blood sugar. Despite this, 140 participants (46.7%) acknowledged the effectiveness of allopathic treatment, though skepticism remained regarding medication safety and regulatory processes. Conclusion: Social media significantly influences diabetes management, with misinformation leading to altered treatment decisions and reliance on unverified remedies. Targeted public health interventions, improved patient education, and regulatory oversight are essential to counteract misinformation. Strengthening patient-provider communication is critical to ensuring adherence to evidence-based diabetes care. Future research should explore effective strategies to mitigate misinformation and enhance trust in scientifically validated treatments.

Correlation Between Levels of Physical Activity and Pulmonary Functions in School-going Children of Ahmedabad, India: A Cross-sectional Study

Himadri Kishorkumar Lakhani, Prasad Muley, Bhavana Gadhavi

Introduction: Physical activity is generally acknowledged as a determinant of overall health, but its physiological effects on the pulmonary system in healthy children and adolescents have not been thoroughly studied. It is proven that physical activity imposes a substantial load on the cardio-pulmonary system and promotes adaptive improvements in its efficiency. Hence, it can be assumed that physical activity may enhance pulmonary functions in younger populations too. Aim: The present study aims to find out if any correlation persists between physical activity level and pulmonary function in school-going children and adolescents (8-14 years). Materials and Methods: The present cross-sectional study was conducted on school-going children aged between 8 to 14 years from four different schools of Ahmedabad, India from August-2024 to November-2024. The Physical Activity Questionnaire for Children (PAQ-C) was filled out by children, and pulmonary function was measured through a standard digital spirometer. As the data were normally distributed (using Kolmogorov-Smirnov test), Pearson’s correlation was used to analyse the correlation between PAQ-C and pulmonary functions {Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Forced Expiratory Flow between 25% and 75% of Vital Capacity (FEF 25-75% ), Peak Expiratory Flow Rate (PEFR), Slow Vital Capacity (SVC), Maximum Voluntary Ventilation (MVV)}. 75%, PEFR, SVC, MVV). Moreover, multiple regression for all pulmonary functions was done for various independent variables {physical Activity, age, gender, height, weight and Body Mass Index (BMI)}. Results: Out of the total 534 children, 292 were boys and 242 were girls. Physical activity was reported by 34.08 (182), 35.5% (190), 26.4% (141), and 3.9% (21) of children with PAQ-C levels of 1-1.99, 2-2.99, 3-3.99, and 4-4.99, respectively. There was no statistical correlation found between physical activity levels and pulmonary function tests (Pearson’s correlation test) in these children. Furthermore, when PAQ-C was used as the key independent variable and gender, age, height, weight, and BMI as covariates, the regression model was very stable for FVC, FEV1, SVC, and FEF at 25% to 75%. However, PAQ-C had no influence on Pulmonary Function Test (PFT) except for the small effect on PEFR. Conclusion: The lack of a statistical relationship between physical activity levels and pulmonary function in school-aged children shows that, within this age range, pulmonary function may be more significantly influenced by growth and development variables like height, age and gender rather than physical activity.

Clinical Profile and Surgical Outcomes of Giant Presacral Schwannomas: A Retrospective Descriptive Study from Tamil Nadu, India

Introduction: Presacral tumours are an extremely rare entity. Schwannomas account for only 3% of tumours in this region. Schwannomas are benign, unifocal and often asymptomatic. Presacral lesions are usually asymptomatic, although a few of these patients may present with compressive symptoms or neurogenic pain. Diagnosis and characterisation of nerve sheath tumours, of which schwannoma is a part, is usually done with Magnetic Resonance Imaging (MRI). Surgical excision is the mainstay of management, although it is associated with high morbidity. Although a few case reports are available, large datasets are sparse. Aim: To study the clinical presentation, imaging features and management of patients who underwent excision of presacral schwannomas. Materials and Methods: The present retrospective descriptive study was conducted in General Surgery Unit-IV in Christian Medical College and Hospital, Vellore, Tamil Nadu, India, from July 2013 to July 2024. All patients above 18 years of age, histopathologically confirmed presacral schwannomas, were identified and included. The demographic profile, presenting symptoms, imaging findings, preoperative assessment, surgical details, postoperative complications, and follow-up were recorded. Descriptive statistics were calculated, with mean and median serving as the measure of central tendency and the standard deviation representing the measure of dispersion. Results: A total of 20 patients were identified with a mean age of 41.3 years (±14.05), with 13 patients being male and the remaining female. Eleven patients presented with pressure symptoms due to direct compression of the pelvic organs. Imaging of choice was MRI in 19 patients. Seventeen patients had preoperative biopsy done, of which 16 were schwannoma and one was neurofibroma. Median largest diameter of these tumours at the time of presentation was 10.55 cm with a range of 6.8 to 25 cm. 19 patients underwent a laparotomy (transperitoneal approach) with intracapsular excision of the tumour. The mean operating time was 2.85 hours (±1.12), with a mean blood loss of approximately 500 mL (±240). 10% of patients developed postoperative neurological deficits. Three patients had neuropathic pain, which settled with medication in the postoperative period. Five patients developed a surgical site occurrence. The mean duration of hospitalisation for these patients was 7.7 days. The mean follow-up period was 27.8 months. 90% (18) of the patients had classical schwannoma on histopathology. Conclusion: Management of large presacral tumours is a daunting task even for the most experienced surgeons. Intracapsular excision of these tumours needs to be considered while planning these operations, based on the possible morbidity profile for these patients.

Validation of an Extended Technology Acceptance Model Framework Incorporating Organisational Culture and Trust in AI usage within Hospitals: A Cross-sectional Study

Jigyasa Rathore, Akanksha Singh, Ujjwal Rao

Introduction: The hospital landscape is rapidly evolving, with Artificial Intelligence (AI) emerging as a central component of both administrative and clinical workflows. The classic Technology Acceptance Model (TAM), however, does not adequately account for the dynamic and complex nature of hospital workflows. Aim: To empirically validate an extended TAM that incorporates Organisational Culture (OC) and Trust in AI (TAI), and to examine how these factors influence healthcare professionals’ perceptions of usefulness, Ease of Use (EOU), behavioural intention, and actual AI usage in hospital settings. Materials and Methods: The present cross-sectional survey was conducted across 5 hospitals in India’s National Capital Region using a 27-item instrument. Data were collected via Google Forms between November 2024 and January 2025 from tertiary and quaternary care hospitals known to have adopted or piloted AI applications, including robotic process automation, virtual assistants, and diagnostic imaging systems. Partial Least Squares-Structural Equation Modelling (PLS-SEM) was employed to assess reliability, validity, model fit, path significance, and mediation effects. Results: The results validated the core TAM along with the proposed extended constructs. Key findings indicated that perceived EOU strongly predicted trust, while TAI directly predicted Actual Use (AU), exerting a stronger effect than behavioural intention. Organisational culture indirectly influenced AI adoption by shaping EOU and trust, fully mediating its effect on behavioural intention. Conclusion: AI adoption follows a mediated pathway in which OC indirectly influences intention to use through EOU, trust, and perceived usefulness, with trust emerging as a critical direct antecedent of actual usage. These findings underscore the practical imperative for healthcare administrators to implement robust AI governance mechanisms to enhance trustworthiness and to foster an innovative organisational culture.

Comparing the Effect of Various Intensities of Transcranial Direct Current Stimulation on Cognitive Functions in Normal Subjects: A Randomised Clinical Trial

Introduction: Transcranial Direct Current Stimulation (tDCS) is a technique used to regulate neural activity by applying a low-level electrical current to specific brain regions. It modulates neuronal excitability and activity without directly inducing action potentials. The effects of tDCS are dependent on the type of current used, with anodal stimulation generally increasing and cathodal stimulation decreasing the excitability of brain cells. Aim: To determine the efficacy of tDCS in improving the dual-task cognitive function. Materials and Methods: This randomised clinical trial was conducted in the Maharishi Markandeswar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India, a tertiary health care centre, from August 2022 to April 2023. This study was conducted with 32 participants, dividing them into four groups, each receiving a different level of tDCS intensity (0.5 mA for Group A, 1.0 mA for Group B, 1.5 mA for Group C, and 2.0 mA for Group D). The stimulation was applied to the F3 region (active site) and F4 region (control site) of the frontal cortex, following the 10-20 Electroencephalography (EEG) system. Each session lasted 20 minutes and took place three times a week over a period of three weeks. Throughout the study, participants performed dual-task cognitive exercises, and their cognitive function was assessed both before and after the intervention using the Montreal Cognitive Assessment (MoCA) and Trail Making Test (TMT). Finally, data analysis was performed using Statistical Package for Social Sciences (SPSS) 26.0 software. For datasets satisfying the assumptions of parametric testing, a paired t-test was utilised for within-group comparisons, while an One-way Analysis of Variance (ANOVA) test was used to evaluate group variations. Results: It was assessed whether the demographic data and outcome measures followed a normal distribution, using the Shapiro-Wilk test. The analysis showed no statistically significant between-group dfferences in cognitive performance among healthy participants groups exposed to varying intensities of t-DCS. Although slight fluctuations were observed in the mean MoCA and TMT-A and TMT-B scores across different groups, the p-values remained above the standard level of significance (p-value>0.05). This suggests that the different intensities of t-DCS did not produce a statistically significant effect on cognitive function. Conclusion: The present study found no significant differences in cognitive performance across the various tDCS intensity levels, suggesting that the tested parameters may not have a substantial impact on cognitive function in healthy individuals.

Efficacy of Commiphora myrrha (Myrrh) in Management of Gingivitis: A Systematic Review

Vandana Sekizhar, Keerthana Nehru, Naveenaa Chellapandian

Introduction: The oral cavity is the second largest microbial niche in the human body, following the gut. The colonisation of microorganisms on the teeth and gums harbours harmful bacteria, which can trigger inflammation, potentially leading to periodontal breakdown and tooth loss. To eliminate bacterial biofilms, several methods are employed. Among these, the most effective are chemical methods, which include antiseptic and antimicrobial agents. Although these agents can have potential benefits, they also come with side-effects. To minimise the side-effects of chemical-based plaque control, there is a paradigm shift towards herbal alternatives. One such plant known for its medicinal properties is Commiphora myrrha, which possesses antimicrobial properties that improve plaque control. Aim: To assess the efficacy of Commiphora myrrha in the management of gingivitis. Materials and Methods: A comprehensive search was conducted using Medline via PubMed, Cochrane, ProQuest and Google Scholar. The combination of keywords used was: Myrrh OR Commiphora myrrha OR Herbal extract AND Gingivitis AND Plaque AND Inflammation, Myrrh AND Commiphora myrrha AND Gingivitis. Articles published from January 1, 2014, to December 31, 2024, were included to identify the efficacy of Commiphora myrrha in the management of gingivitis. After a thorough search, a total of five articles were included in the review. The inclusion criteria were: patients aged between 18-35 years, signs of chronic gingivitis in at least six sites, Bleeding on Probing (BOP) and periodontal pockets with a depth of no more than 3 mm. Exclusion criteria included patients with periodontal pockets greater than 3 mm, those with severe malocclusion, use of antibiotic or anti-inflammatory medication, pregnant or breastfeeding women, oral prophylaxis in the past six months, a history of allergy to chemical or herbal products and patients using smoking or smokeless tobacco. The reporting of this systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality assessment of the studies was performed using the Cochrane risk of bias assessment tool for Randomised Controlled Trials (RCT), the Risk of Bias in Non randomised Studies (ROBINS) tool for non randomised trials and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: A total of five studies were included (four randomised and one non randomised controlled trial), comprising 166 patients who met the inclusion criteria. One of these studies was conducted in India, three in the Kingdom of Saudi Arabia and one in Egypt. Diagnoses in all five studies were based on clinical and histological examination. The p-values of the included studies were as follows: p<0.006, p<0.05, p=0.08, p<0.001 and Zahid p>0.05. All five studies found Commiphora myrrha to be effective in reducing gingival inflammation, with results comparable to chemical plaque control and minimal side-effects. Therefore, Commiphora myrrha shows promise as an effective adjunct therapy for managing gingivitis. Conclusion: The present systematic review demonstrates that Commiphora myrrha exhibits significant anti-inflammatory properties. When used in combination with other oral healthcare regimens, Commiphora myrrha could offer beneficial effects in improving overall oral health and managing gingivitis.

Comparing Diagnostic Value of Serum Histone Deacetylase 1, Prostate Specific Antigen (PSA) and PSA Density in Differentiating Prostate Cancer from Benign Prostatic Hyperplasia: A Cross-sectional Study

Sagar Mahadev Nitturkar, Anuradha B Patil, Rajendra B Nerli

Introduction: Prostate Cancer (PCa) and Benign Prostatic Hyperplasia (BPH) often present with overlapping clinical symptoms, complicating accurate diagnosis. Although Prostate-Specific Antigen (PSA) and PSA Density (PSAD) are widely used diagnostic tools, their limited specificity underscores the need for novel biomarkers. Histone Deacetylase 1 (HDAC1), an epigenetic regulator implicated in tumour progression, may serve as a non-invasive biomarker for PCa detection and risk stratification. Aim: To compare the diagnostic value of serum HDAC1, PSA, and PSAD in differentiating PCa from BPH, and to assess their association with the Gleason score. Materials and Methods: The present study was conducted at KAHER’s Jawaharlal Nehru Medical College and KLE Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi, Karnataka, India, from December 2022 to November 2024. A total of 130 male patients aged over 40 years were included, comprising 65 patients with PCa and 65 with BPH. Serum HDAC1 levels were quantified using a high-sensitivity Enzyme-Linked Immunosorbent Assay (ELISA). The correlation between serum HDAC1 levels and the Gleason score was assessed using Spearman’s rank correlation coefficient (ρ). Multivariate logistic regression analysis was performed to identify independent predictors of PCa. Data analysis was conducted using the Mann-Whitney U test, Receiver Operating Characteristic (ROC) analysis, logistic regression, and Spearman correlation, using the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Serum HDAC1 levels were significantly elevated in patients with PCa compared with those with BPH (p<0.001). Compared with PSA (AUC=0.789) and PSAD (AUC=0.697), HDAC1 demonstrated superior diagnostic performance (AUC=0.922). Multivariate logistic regression analysis identified HDAC1 as an independent predictor of PCa (Odds Ratio (OR)=6.624, p<0.001). HDAC1 also showed a strong positive correlation with the Gleason score (ρ=0.649, p<0.001). ROC analysis further confirmed the ability of HDAC1 to distinguish high-grade (Gleason ≥7) from low-grade (≤6) PCa (AUC=0.803). Conclusion: Serum HDAC1 is a promising non-invasive biomarker with high sensitivity and specificity for distinguishing PCa from BPH and predicting tumour aggressiveness. Its integration into clinical diagnostic algorithms may enhance early detection and reduce reliance on invasive procedures.

Association between Obesity and Peripheral Arterial Diseases among Non-smokers: A Cross-sectional Study

S Venkatesh, Davana Sunkari

Introduction: Obesity, especially abdominal obesity, is known to be a major risk factor for cardiovascular diseases. Peripheral Arterial Disease (PAD) is associated with obesity, and it is diagnosed using the Ankle-brachial Index (ABI). While the links between the ABI and cardiovascular diseases, such as myocardial infarction and stroke, are well established, its association with obesity has been studied less extensively. Aim: The present study was undertaken to study the association between Body Mass Index (BMI), Waist-hip Ratio (WHR), Sagittal Abdominal Diameter (SAD) with ABI in Non-smokers and compare the results between obese and non-obese groups. Materials and Methods: The present cross-sectional study was conducted from January to June 2018 with 160 non-smoking adults aged between 25 to 45 years, at the Lifestyle Laboratory in the Department of Physiology at Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India. The participants underwent a thorough assessment, during which their height, weight, Waist Circumference (WC), hip circumference, and SAD were measured. Body Mass Index (BMI) and WHR were calculated for all individuals. The LifeDop 150R hand-held Doppler device and Diamond mercury sphygmomanometer were utilised to measure Ankle and Brachial Blood Pressure and to calculate the ABI. Statistical analyses included a t-test for comparing the two groups and a Chi-square test to examine the relationship between the two groups. Results: In the present study, 160 non-smoking, non-diabetic, non-hypertensive adults aged between 25 to 45 years were examined, consisting of 132 females and 28 males. A significant association was found between the ABI and BMI when categorised as normal or abnormal BMI, but not when classified as normal, overweight, or obese. The obese and non-obese groups as per their WHR and SAD did not show a significant association with ABI. Conclusion: In the present study, a significant association was found between obesity and PAD, as measured by BMI and ABI. Hence the relationship between obesity and changes in ABI values warrants extensive study.

Utility and Accuracy of Intraoperative Squash Smear Cytology for Intraspinal Lesions: A Cross-sectional Study

Introduction: Intraoperative cytological diagnosis has gained importance because of its technical simplicity, ability to display abnormal cellularity, nuclear and cytoplasmic details. It helps the surgeon to plan the extent of surgery and modify it accordingly. Aim: To study the cytomorphology of spinal lesions by intraoperative squash cytology. Materials and Methods: The present retrospective cross-sectional study was conducted for three years from January 2021 to December 2023 at a tertiary care hospital, Mumbai, Maharashtra, India. Total of 72 cases of intraspinal lesions were included in the study. Intraoperative squash smears were made and were stained with rapid Haematoxylin & Eosin (H&E) stain. Paraffin H&E-stained sections were prepared from the residual tissue and additional tissue was sent for histopathology. Smear cytology diagnoses were correlated with histopathological findings. Statistical analysis was done, and diagnostic accuracy was calculated. Results: The study included 72 cases with Male:Female (M:F)=1.8:1. The diagnostic accuracy for schwannoma was highest (21/72), followed by meningioma (19/72) and neurofibroma (9/72). By comparing the results, intraoperative squash smear cytology had a sensitivity of 98.5% and specificity of 75%. The accuracy of the study was 95.8% and three cases were discordant. Conclusion: Intraoperative squash cytology is a fairly accurate, reliable and cost-effective method for rapid diagnosis of Intraspinal lesions. When correlated with histopathological findings, it demonstrates high diagnostic concordance, reinforcing its role as a supportive tool in the intraoperative setting. Its simplicity, rapid turnaround time, and minimal resource requirement make it especially beneficial in resource-limited settings.

Clinicopathological Profile of Surgically Resected Renal Angiomyolipomas: A Cross-sectional Study of 31 Cases from a Tertiary Care Centre

Introduction: Although Renal Angiomyolipoma (AML) is a relatively rare entity, it is the most common benign mesenchymal kidney tumour, made up of varying amounts of thick-walled blood vessels, smooth muscle, and adipose tissue. AML occurs either sporadically or in association with Tuberous Sclerosis Complex (TSC). It is often detected incidentally during imaging, though it can present with flank pain, haematuria, or life-threatening haemorrhage, thereby posing diagnostic and therapeutic challenges. Aim: To analyse the clinicopathological features of surgically resected renal AMLs and evaluate the association between radiological and histopathological findings. Materials and Methods: This was a retrospective, cross-sectional study conducted in the Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, in which the clinicopathological features of surgically resected renal AMLs received between January 2014 and October 2023 were studied. Data retrieval, analysis, and manuscript preparation were carried out between December 2023 and March 2024. Clinicoradiological details- including age, gender, clinical presentation, tumour size, laterality, imaging features (fat-rich or fat-poor), presence of haemorrhage, association with TSC/LAM, and type of surgical procedure were retrieved from the hospital information system of the study Institute. The data were analysed using Statistical Package for the Social Sciences (SPSS), IBM Corp, Armonk, NY), version 26.0. Categorical variables are reported as frequencies and percentages, whereas the mean (standard deviations) or medians with interquartile ranges, as appropriate, were used for continuous variables; the associations between categorical variables were analysed using the Chi-square test, where p-value <0.05 was considered to indicate statistical significance. Results: The study included a total of 31 patients, with a mean age of 48.9±16.8 years, and a mean tumour size of 10.0±6.1 cm, resulting in a female-to-male ratio of 2.4:1. Twenty-seven cases were symptomatic, while four were incidental. The major subtype was classical (24), followed by leiomyoma-like (4), epithelioid (2), and lipoma-like (1). Fat-poor AML patients who underwent surgery for Renal Cell Carcinoma (RCC) on imaging were confirmed via histopathology (epithelioid-1, leiomyoma-like-3). Bleeding was observed with tumour size ≥6.0 cm (n=10 cases; p-value=0.012). TSC-associated cases (n=3) were younger (mean age-30.3 years vs sporadic-50.4 years) and had a larger mean tumour size of 16.8 cm (vs sporadic-8.8 cm). One patient had concurrent RCC. Conclusion: TSC-associated cases present at a younger age when compared to sporadic AMLs. Fat-poor AMLs can typically mimic RCC on imaging. Larger tumours are known to cause haemorrhage, particularly TSC-associated, from the rupture of pseudoaneurysms. Immunohistochemistry (IHC) for Human Melanoma Black (HMB) 45 and Smooth Muscle Actin (SMA) was useful in establishing a diagnosis in atypical AMLs.

Association of SARS-CoV-2 Serology in Cord Blood with Maternal COVID-19 Vaccination Status: A Prospective Cohort Study

Sanober Wasim, Sana Gupta, Rakesh Kumar, Girish Gupta, Garima Mittal

Introduction: Maternal vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) offers an opportunity to protect both pregnant women and their newborns. Understanding how vaccine timing and dosing influence transplacental antibody transfer is essential for optimising perinatal immunisation strategies. Aim: To assess the SARS-CoV-2 Immunoglobulin G (IgG) status and its association with maternal Coronavirus Disease 2019 (COVID-19) vaccination status. Materials and Methods: A prospective observational cohort study was conducted at the Department of Neonatology, Paediatrics, Swami Rama Himalayan University, Dehradun, Uttarakhand, India, from October 2021 to January 2022. The study included all 200 mothers who delivered during the study period and their neonates. Maternal SARS-CoV-2 infection and vaccination status were recorded on admission. Umbilical cord blood was collected at birth and IgG was assessed. Neonates born to mothers with confirmed infection underwent polymerase chain reaction testing. Primary analysis compared Cord blood IgG concentrations across vaccination subgroups and examined associations with the number of doses, interval since vaccination, and gestational age at delivery. The Kruskal-Wallis test was used to determine statistically significant differences between groups. A two-tailed p-value<0.05 was considered statistically significant. Results: The mothers had a mean age of 27.1±4.3 years (median 26 years; range 18-45years) with a mean gestational age at delivery of 37.64±2.39 weeks (median 38 weeks; range 26-41weeks), and neonatal birth weight was 2.72±0.60 kg. Cord blood IgG concentrations were markedly higher in neonates of vaccinated mothers than in those of unvaccinated mothers (p-value=0.001). Titers did not differ between one-dose and two-dose recipients. Antibody concentrations declined as the interval between the final vaccine dose and delivery lengthened, within nine months of vaccination (76.72±10.64 AU/mL; n=52), at 9-12 months (10.65±7.73 AU/mL; n=10), and at 12-14 months (6.92±6.07 AU/mL; n=8; p-value=0.016), while later gestational age at birth was associated with higher titers. Conclusion: Maternal SARS-CoV-2 vaccination, particularly when administered close to delivery, enhances passive antibody transfer to the newborn, whereas immunity acquired through infection alone is less effective. These findings support the use of universal vaccination during pregnancy and suggest that a booster dose in late pregnancy may maximise neonatal protection.

Prevalence and Severity of Depression among Spouses of Individuals with and without Alcohol Dependence Syndrome: A Cross-sectional Study

Introduction: Alcohol dependence is a major public health concern, as its consequences not only affect individuals with this problem, but also their families, particularly spouses, due to the intimate nature of the marital relationship. Spouses of individuals with Alcohol Dependence Syndrome (ADS) usually experience financial strain, marital discord, emotional distress, and stigma, which, over a period when accumulated and not addressed on time, increase their vulnerability to depression. Depression in this context is frequently underrecognised, despite its association with suicidal ideation, impaired coping, decreased marital satisfaction and in the long run, when encapsulated, results in impaired overall Quality of Life. Aim: To assess the prevalence and severity of depression among spouses of individuals with ADS, in comparison with Healthy Controls (HC). Materials and Methods: The present cross-sectional comparative study was carried out in the De-addiction Clinic, Department of Psychiatry, Sri Ramachandra Hospital, Porur, Chennai, Tamil Nadu, India, from June 2023 to December 2024. The sample consisted of 400 participants, which included 200 spouses of individuals with ADS and 200 spouses of individuals without ADS. Standardised tools like Patient Health Questionnaire-9 (PHQ-9) were used to screen for depression, and those who screened positive were referred to Clinician Psychiatrist to confirm the diagnosis of depression. Statistical Package for Social Sciences (SPSS) version 28.0 was used for statistical analysis. Results: The prevalence of depression among spouses of individuals with ADS was 69.5%, compared to 36.5% among spouses in the control group. Both the severity and prevalence of depression were higher among spouses of individuals with ADS and the results were statistically significant with a p-value (p<0.001). Conclusion: The study showed that depression was nearly twice as common among the spouses with ADS group, and moderate to severe levels were markedly higher. These findings indicate a substantial mental-health burden among spouses of individuals with ADS. Integrating spouses into relapse prevention interventions may improve treatment outcomes given their crucial role in De-addiction management.

Effectiveness of Lumbar Stabilisation Exercises versus Conventional Physiotherapy in Improving Pain, Kinesiophobia and Disability in Non-specific Chronic Low Back Pain Patients: A Prospective Interventional Study

Ankita Kalita, Dapkupar Wankhar

Introduction: Non-specific Chronic Low Back Pain (NSCLBP) is a prevalent musculoskeletal condition affecting daily functioning and causing socioeconomic burden worldwide. Altered activation of the deep trunk muscles, particularly transversus abdominis and multifidus, is considered important in symptom recurrence. Aim: To evaluate if lumbar Stabilisation Exercise (SE) program improves pain, disability and kinesiophobia compared to conventional physiotherapy in NSCLBP. Materials and Methods: The present prospective interventional study was conducted at Jorhat Medical College and Hospital, Assam, India, for one year from October 2023 to October 2024. A total of 268 adults (18-65 years) with NSCLBP were randomly assigned to two groups (group A and group B), 134 participants in each group. Group A received a lumbar SEs with conventional treatment, while group B received only conventional physiotherapy {Motor Control Exercises (MCE) and Neuro Muscular Electrical Stimulation (NMES)}. Pain, disability, and kinesiophobia were measured using the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Tampa Scale for Kinesiophobia (TSK), respectively. Outcomes were analysed using Statistical Package for Social Sciences (SPSS) version 26. Group differences were analysed using independent t-tests for parametric data. p<0.05 was considered as significant. Results: The mean age in group A was 42.2±9.2 years and in group B was 44.3±7.9 years. Group A had 97 females and 37 males while group B had 101 females and 33 males (p=0.320). Group A’s pre-post score improvement was as follows: VAS (5.55±1.23 to 2.02±1.179), TAMPA (42.07±4.500 to 31.33±1.249) and ODI (24.19±6.31 to 11.16±3.84) (p<0.001**). Group B's pre-post scores also showed a noticeable improvement; VAS (5.63±1.19 to 3.40±1.04), TAMPA (42.23±4.403 to 36.28±1.983), ODI (24.61±6.141 to 17.48±2.658) (p<0.001**). Both groups improved, but group A showed greater reductions in all measures (p<0.001**) demonstrating better outcomes. Conclusion: Lumbar SE program combined with conventional physiotherapy significantly improves pain, disability, and kinesiophobia in NSCLBP compared to conventional physiotherapy alone, advocating deep trunk muscle activation. Future studies with long-term follow-up are recommended in this study.

Impact of Neoadjuvant Chemotherapy on Hormone Receptor Status and Systemic Inflammatory Markers in Breast Cancer Patients: A Retrospective Cohort Study

K Hari Krishna, MS Supreetha, PN Sreeramalu

Introduction: Breast Cancer (BC) remains the leading cause of cancer-related morbidity and mortality among women worldwide. Neoadjuvant Chemotherapy (NACT) is important in treating both locally advanced and early-stage BCs, as it helps make breast-conserving surgery possible and improves patient outcomes. However, not all patients respond to NACT equally. Finding reliable prognostic markers after NACT is essential for selecting optimal follow-up treatments and improving patient outcomes. Systemic inflammatory markers derived from peripheral blood, including abnormal blood counts, the Neutrophil-To-Lymphocyte Ratio (NLR), and the Platelets-to-Lymphocyte Ratio (PLR), have been widely investigated as surrogate indicators of host-tumour interaction in BCs. These should be contextualised with pre-treatment hormonal receptor status and tumour biology, when evaluating response to NACT. Aim: To determine whether changes in systemic inflammatory markers (NLR and PLR) and Hormone Receptor (HR) status during NACT are associated with pathological response by Miller-Payne scoring (MPS). Materials and Methods: This retrospective cohort study was conducted in the Department of Pathology, RL Jalappa Hospital, Kolar, Karnataka, India, from January 2023 to December 2024. It included data of 25 patients, collected retrospectively from the registers maintained in the department, who had pre-treatment biopsy and post-NACT resection specimens, along with hormonal receptor status. Pathological response was assessed using the MPS scoring. Peripheral blood parameters like WBC, absolute neutrophils, lymphocytes count and platelets count were obtained, and NLR, and PLR were calculated using standard formulae. Paired t-test and Spearman’s correlation coefficient were used for statistical analysis. Results: A total of 25 BC patients treated with NACT were analysed. The median age at diagnosis was 51 years, with 12 patients (48%) aged ≤50 years and 13 patients (52%) aged >50 years. Pathological response assessed by MPS showed grade 3 as the most common response (40%), while major pathological response (grades 4-5) was observed in 20% of cases. Neutrophil proportion increased significantly after chemotherapy (p-value=0.024), whereas changes in total White Blood Cell (WBC) count, lymphocyte proportion and platelet count were not significant. A significant reduction in NLR category was observed after treatment (p-value=0.003), whereas PLR did not change significantly (p-value=0.06). Spearman correlation showed no significant correlation between NLR (ρ=0.25, p-value=0.23) or PLR (ρ=0.06, p-value=0.76) and pathological response. Although Receiver Operating Characteristic (ROC) yielded a high Area Under the Curve (AUC) values for NLR (AUC=1.00) and PLR (AUC=0.94) these results should be interpreted as exploratory due to small sample size and lack of external validation rather than definitive. HR status, Human Epidermal Growth Factor Receptor 2 (HER2) and Ki-67 did not show significant association with pathological response. Conclusion: Systemic inflammatory markers demonstrated post-treatment changes following NACT; nevertheless, NLR and PLR did not show a significant correlation or association with pathological response. Although ROC analysis indicated potential discriminatory value, inflammatory markers cannot be considered independent predictors of response.

Effect of Alkalinised Lignocaine in Reinforced Endotracheal Tube Cuff on Postextubation Cough and Sore Throat during Prone Percutaneous Nephrolithotomy: A Randomised Controlled Trial

Introduction: Reinforced flexometallic Endotracheal Tube (ETT) is preferred in prone surgeries. Their large outer diameter, stylet use, and position related cuff pressure changes and laryngeal oedema may increase the risk of postoperative airway complications. Aim: To evaluate the effect of intracuff alkalinised lignocaine on postextubation cough, and sore throat in patients undergoing Percutaneous Nephrolithotomy (PCNL) in prone position. Materials and Methods: This randomised controlled study included 140 patients posted for PCNL at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India and were randomly allocated into two groups: intracuff air (Group A) and alkalinised lignocaine (Group L). Postextubation cough was assessed immediately, Postoperative Sore Throat (POST) and hoarseness were assessed postoperatively at one hour and 24 hours. Statistical analysis was done using Statistical Package for the Social Sciences 23.0 with Fisher’s exact test and Independent t-test, p-value of <0.05 considered statistically significant. Results: Demographic variables such as age, sex distribution, height, weight were comparable between the groups with p-value of >0.05. Mean duration of anaesthesia was comparable (114.6±13.44 minutes in Group A vs 113.71±13.95 minutes in Group L). There was significant reduction in postextubation cough in Group L compared to Group A (No cough: 61.4% vs 8.6%, p-value<0.001). At one hour postoperatively the incidence of sore throat was significantly lower in Group L than Group A (No sore throat: 75.7% vs 37.1%, p-value<0.001). Hoarseness was comparable between the groups. Conclusion: Intracuff alkalinised lignocaine in reinforced endotracheal tube significantly reduced the incidence of postextubation cough, early POST in patients undergoing PCNL in prone position. This intervention reduces the postoperative airway morbidity, so it may therefore be considered an useful strategy for reducing postoperative airway related complications.

Prevalence, Pattern and Risk Factors of Premature Hair Greying among University Students in Northern India: A Cross-sectional Study

Rajveer Kaur, Dona Boban, Kiranjeet Kaur

Introduction: Premature hair greying (PHG) is of the significant concern in adolescents which has a direct pessimistic impact on one’s social wellbeing. Existing studies have focussed on epidemiology of PHG on basis of patients visiting dermatological clinics with small sample size, thus not reflecting prevalence. Therefore, an effort was made to check prevalence of PHG among the University students. Aim: To assess the prevalence of PHG among university students, and explore its association with factors such as smoking, alcohol consumption, dietary intake, and family history. Materials and Methods: A cross-sectional study was performed using structured questionnaire at Chitkara University, Rajpura, Punjab, India. The sample size came out to be 315; however, based on exclusion and inclusion criteria, the final sample size was 308. The structured questionnaire designed by the researcher aimed to assess the prevalence, cut-off age of PHG and risk factors associated with PHG among the Chitkara University students, Punjab belonging to different parts of Northern India. The risk factors included role of genetics, smoking, alcohol intake and dietary preferences impacting PHG. The continuous variables presented as mean ± standard deviation. The bivariate analysis was done using Fischer’s exact test and Chi-square test. The significance value was set at 0.05. Results: The prevalence of PHG was found to be 31.8%, among which 65 (66.3%) were females and 33 (33.7%) were males. Geographical distribution showed Punjab constituting the highest with 36 (36.7%) followed by Himachal Pradesh 24 (24.5%), Chandigarh 13 (13.3%), Jammu and Kashmir 11 (11.2%), Haryana 10 (10.2%) and other North Indian states 4 (4.1%). The mean age of the participants were 19.37±1.9 years. In females, the parietal area was the most affected by PHG while in males, it was more common in the frontal area of the scalp. There was an association between the family history and PHG (p-value < 0.0001); however, no association was seen concerning smoking, alcohol consumption and dietary patterns. Conclusion: The prevalence of PHG in youngsters is escalating having an onset age as low as 10 years and variation in the hair greying pattern on the scalp Of all the factor tested, family history was found to be the significant risk factors associated with PHG. Thus, further studies at larger population are needed to reach to conclusive evidence.

Knowledge-oriented Leadership and Workforce Engagement for Sustaining Quality Accreditation in Healthcare: A Cross-sectional Study from Delhi NCR, India

Archana Koul, A Bhoomadevi, Praveen Kumar

Introduction: Healthcare Workforce Engagement (HWE) is widely recognised as a critical factor influencing patient safety, service quality, and organisational effectiveness. However, in large multispecialty hospitals, workforce engagement alone may not adequately translate into sustained accreditation outcomes due to variations in leadership practices, coordination mechanisms, and knowledge-sharing processes. Evidence remains scarce on how Knowledge-Oriented Leadership (KOL) influences the relationship between workforce engagement and Hospital Quality Accreditation (HQA), particularly in the Indian healthcare context. Aim: To examine the moderating role of KOL between HWE and perceived quality accreditation factors in private accredited multispecialty hospitals within the Delhi National Capital Region (NCR) region. Materials and Methods: A cross-sectional research design using a structured, self-administered questionnaire on a seven-point Likert scale was employed in private multispecialty accredited hospitals of the Delhi NCR region, involving healthcare professionals working in the quality department, administrative department, nursing department, and allied health departments over a period between December 2024 and May 2025. A sample of 451 respondents was included using a stratified random sampling technique to ensure representation across different functional roles and departments. The questionnaire included three sections: (i) demographics of respondents, (ii) items measuring HWE, and (iii) items assessing KOL and perceived HQA sustainability practices. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) and Analysis of Moment Structures (AMOS) to perform Structural Equation Modelling (SEM), enabling examination of latent constructs model fit indices, and the moderating effect of KOL on the relationship between HWE and HQA sustainability. Results: Among the 451 respondents, most were aged 20-30 years (33.9%). Females constituted 51.7% of the sample and males 48.3%. SEM results revealed that KOL dimensions significantly moderated the relationship between HWE and HQA sustainability. Specifically, mentoring (β=0.270), delegating (β=0.303), innovative role modelling (β=0.253), recognising achievements (β=0.206), and stimulating knowledge diffusion (β=0.205) demonstrated statistically significant moderating effects. Collectively, these leadership dimensions strengthened the positive association between workforce engagement and HQA sustainability, with a strong overall standardised effect (β=0.631, p-value <0.001), indicating that higher levels of KOL enhance the impact of workforce engagement on sustaining accreditation outcomes. Conclusion: The findings of this study suggest that KOL has a significant moderating effect between HWE and accreditation outcomes.

Evaluation of the Effect of Three Commercially Available Whitening Toothpastes on Microhardness of Nanohybrid Resin Composite: An In-vitro Study

Introduction: The whitening effect of the whitening toothpaste is due to the presence of bleaching and abrasive components. The most common oral hygiene measure is cleansing of the teeth using toothpaste and toothbrush. Nanohybrid resin composites are most popular composites currently used. Hardness is a surface property of a restorative material to resist deformation. One of the most commonly used microhardness tests for restorative materials is Vickers hardness test. The present study was conducted to assess the effect of different whitening toothpastes on restorative material properties and their interaction. Aim: To evaluate the effect of Colgate Visible White, Sensodyne White and Himalaya Sparkling White whitening toothpastes on microhardness of nanohybrid resin composite. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences in Guntur, Andhra Pradesh, India from July 2023 to October 2023. Sixty samples (n=60) of nanohybrid resin composites were prepared. Baseline data of Vickers microhardness were recorded for all the samples and divided into four groups (n=15) according to the whitening tooth paste used for brushing. group 1: Toothbrush alone was used for brushing with no whitening toothpaste; group 2: Colgate Visible White; group 3: Sensodyne White; group 4: Himalaya Sparkling White. A brushing regimen was performed using powered toothbrush for 28 days. Samples were stored in artificial saliva before and after brushing. Microhardness values for all the groups were determined using digital vickers microhardness Tester. One-way Analysis of Variance (ANOVA) test, was used and p-value is of <0.05 was considered significant. Data was analysed using Statistical Package for the Social Sciences (SPSS), Version 21. The mean and Standard Deviation (SD) were used to depict descriptive statistics. Results: Sensodyne White (group 3) showed the lowest microhardness (80.04±5.364), followed by Colgate Visible White (group 2: 89.89±5.218), Himalaya Sparkling White (group 4: 103.581±4.774) and the control group with no whitening toothpaste (group 1: 111.589±4.125). The difference between groups was statistically significant (p<0.001). Conclusion: In the present study, the reduction in microhardness was less with Himalaya Sparkling White compared to other whitening toothpastes. However, the reduction in microhardness was less when toothbrush used alone.

Effectiveness of Daoyin Training in Individuals with Chronic Neck Pain: A Scoping Review

Rashi Mandhan, Akanksha Saxena, Mandeep Kumar Jangra

Introduction: Millions of people worldwide suffer from Chronic Neck Pain (CNP), which is a common ailment that significantly impairs quality of life with a prevalence of between 5.9% to 22%. Alternative methods are necessary as traditional therapies frequently offer little alleviation. Various techniques to alleviate CNP are used worldwide, the most recent being the Daoyin Training (DT), a traditional Chinese exercise which has gained attention for its potential therapeutic benefits. Baduanjin, Yijinjing, Wuqinxi, Tai chi and Qigong are various interventions under the wide term DT. Aim: To explore and identify the benefits and potential applications of DT in managing CNP. Materials and Methods: The present scoping review is registered on OSF with Doi: 10.17605/OSF.OI/BPDN and followed PRISMA-ScR guidelines. The experimental studies using Daoyin therapy as a treatment technique in CNP patients were included and reviews, book chapters, conference proceedings and other language articles were excluded. Four databases from 2005-2025: PubMed, Science Direct, Ovid-SP and Scopus were searched and 20918 articles were retrieved, out of which 6497 duplicates were removed via Mendeley. The remaining 14421 articles were screened by titles and abstracts, from which only eight full text articles were further analysed based on selection criteria and later only four articles were selected for review. The authors found out that treatment sessions in all four studies were spanned from three to six months and all studies assessed pain and neck disability. Results: Three studies utilised Qigong whereas one gave Tai Chi exercises. Overall findings suggest that Qigong and Tai Chi both are equally beneficial in relieving pain and reducing disability when compared to traditional exercises. However, they are found to be superior than sham or no intervention. Conclusion: As per the present study derivations DT can be used in managing pain and disability in individuals with CNP.

Memory Enhancing Property of Momordica Charantia Nano Dry Powder in Aluminium Chloride Induced Neurodegenerative Changes in a Rat Model: An Experimental Study

K Archana, K Bhuvaneswari, Ramanujam Narayanan

Introduction: Alzheimer’s Disease (AD) is one of the most common age-related neurodegenerative disorders worldwide. Nearly 10% of individuals aged over 70 years experience significant memory loss, and in more than half of these cases, the underlying aetiology is AD. Consequently, AD has become a major public health concern and a prominent focus of contemporary research. Momordica charantia (MC) is well known not only for its culinary uses but also for its antioxidant, antidiabetic, and neuroprotective properties. Therefore, the present study focuses on exploring its memory-enhancing activity based on its anticholinesterase and antioxidant properties. Aim: The primary aim of the present study was to investigate the role of MC in aluminium chloride-induced AD (neurodegenerative changes) in a rat model and to assess its antioxidant and anti-inflammatory properties. Materials and Methods: The present experimental study was conducted at PSG Institute of Medical Sciences and Research between March 2019 and March 2020. Following approval from the Institutional Animal Ethics Committee (IAEC), 29 Sprague Dawley rats were divided into three groups (A, B, and C), and two rats were maintained as normal and time controls. AD was induced using aluminium chloride (100 mg/kg, once daily, orally) for 15 days. After confirmation of AD induction, the treatment protocol was initiated as follows: Group A received rivastigmine (0.62 mg/kg, once daily, orally). Group B received MC nano dry powder (600 mg, once daily, orally). Group C received MC nano dry powder (600 mg, once daily, orally) along with aluminium chloride (100 mg/kg, once daily, orally for 15 days). After 30 days of treatment, animals from all groups were assessed for behavioural parameters. The study was terminated after sacrificing all animals for biochemical analysis of serum Superoxide Dismutase (SOD), serum Malondialdehyde (MDA), beta-amyloid 1-42, glutamate, dopamine, 5-hydroxytryptamine (5-HT), and norepinephrine. Two dissected rat brains from each treatment group and one from the control group were submitted for histopathological examination. All parameters were measured before AD induction, after induction on day 15, and at the end of the study (day 30). Data analysis was performed using paired t-tests and one-way Analysis of Variance (ANOVA) followed by post hoc Tukey’s multiple comparison test using SPSS version 24 and GraphPad Prism software. A p-value <0.05 was considered statistically significant. Results: Statistically significant differences (p<0.001) were observed in behavioural parameters, beta-amyloid levels, and 5-HT levels among the rivastigmine-treated group, the MC-treated group, and the prophylactic group. Sections obtained from animals pretreated with MC prophylaxis showed minimal architectural disruption in cortical layers II and III, along with mild disruption of hippocampal architecture (CA1, CA2, and CA3). Sections from animals treated with rivastigmine and MC showed relatively well-preserved hippocampal architecture across the CA1, CA2, and CA3 regions. Conclusion: MC nano dry powder may serve as a promising natural supplement for memory enhancement. However, adequate clinical trials are required to validate its safety, optimal dosing, and long-term effects in humans.

Evaluation of a New Parent Support Intervention for Postpartum Depression and Bonding in Mothers: A Pilot Study

Jalpa Prajapati, Anjali Pushkar Tiwari

Introduction: Postpartum is an equally important period for both mother and child; even a minor neglect during this phase can have a lasting adverse effect. The emotional and physical well-being of postpartum mothers has a direct link to the health of the newborn, and any degree of neglect may contribute to significant complications. Evidence suggests that proactive, theory-based, and multi-component interventions- especially psychoeducational and mindfulness-based programs- show considerable promise in the prevention of the development of PPD. Additionally, social support measures, such as parent support groups, have demonstrated effectiveness in enhancing psychological well-being and strengthening the maternal- child relationship. Aim: To evaluate the effect of the new parent support group on the development of Postpartum Depression (PPD) and on the level of postpartum bonding in mothers of selected hospitals in central Gujarat, India. Materials and Methods: The present pilot Study was conducted in selected Hospitals of central Gujarat, India, from April to June 2025. Fifty mothers experiencing postpartum blues symptoms were recruited using block randomisation. After ensuring that each participant understood their information would remain anonymous, the researcher explained the purpose of the research and solicited any concerns they may have. After that, participants were divided into an experimental and a control group. New parent support group intervention was given to the experimental group only, whereas the control group continued with routine postpartum care till 21 days. The primary outcome measures of the study were assessed using the Edinburgh Postnatal Depression Scale (EPDS), and maternal-infant bonding was assessed using the postpartum bonding scale. Statistical Package for Social Sciences (SPSS) VERSION 20.0 was used for the statistical analysis. For comparisons within and between groups, the paired t-test and independent t-test were used, respectively. Results: The participants in the control group were significantly younger than the experimental group. The findings of the study revealed that there was significant decrease in EPDS score (p-value <0.001) and improvement in maternal postpartum bonding score post intervention of experimental group compared to control group (p-value <0.001). Conclusion: As per the present study findings, the new parent support group significantly reduced the development of PPD and improved postpartum bonding among mothers.

Impact of Mandibular Third Molar Surgical Extraction on Temporomandibular Joint Function: A Prospective Cohort Study

Meghna Budati, Suresh Venugopalan

Introduction: The surgical extraction of third molars is a routine procedure, but its potential impact on Temporomandibular Joint (TMJ) function remains unclear due to the joint’s anatomical proximity to the extraction site. Postoperative changes may alter joint biomechanics and potentially lead to dysfunction. Joint Vibration Analysis (JVA) serves as a non-invasive and objective tool to assess such changes by measuring the intensity of TMJ vibrations. The current study aimed to address this gap by using JVA, a non-invasive and dynamic tool, to evaluate early changes in TMJ function following third molar surgery. Aim: To evaluate changes in TMJ function following mandibular third molar extraction using JVA, specifically analysing the total integral value as an indicator of joint vibration intensity. Materials and Methods: The present prospective cohort study was conducted at Saveetha Dental College and Hospitals, Chennai, India, Tamil Nadu, India, July to December 2023, involving 60 participants (aged 18-35 years) undergoing unilateral mandible third molar extraction. Participants with no prior TMJ disorders or systemic conditions were included. TMJ function was assessed preoperatively and one week postoperatively using JVA, with total integral values recorded bilaterally. Paired t-tests and independent t-test were used for statistical analysis, with a significance level set at p<0.05. Results: The paired t-test demonstrated a significant increase in the total integral value on the extraction side (16.69 to 21.97), indicating altered joint dynamics post-extraction. On the normal side, the increase was minor and statistically non-significant (14.73 to 15.55). The paired t-test results suggested statistically significant mean difference on the extraction site (p=0.001),while non-significant difference between pre and post extraction values on the normal side(p=0.099).These findings suggest that third molar extraction may contribute to biomechanical stress on the TMJ, potentially predisposing it to dysfunction. Conclusion: The findings indicate that third molar extraction can significantly impact TMJ function, particularly on the extraction side. The increase in total integral values suggests potential joint instability or early dysfunction. While the clinical significance of these changes requires further investigation, this study highlights the need for long-term follow-ups and larger studies to better understand TMJ adaptations post-extraction.

Detection of High Risk Human Papilloma Virus in Cervical Tissue, Urine and Plasma of Patients with Squamous Cell Carcinoma of Uterine Cervix Using Real-time Polymerase Chain Reaction: A Cross-sectional Study

AR Bhadra, Kalyani Raju, Arvind Natarajan, P Rathnamma

Introduction: Human Papillomavirus (HPV) has been detected in approximately 95% of cervical cancer cases, underscoring its role as the primary cause of the disease. Recent studies have demonstrated that HPV detection in urine samples is a highly effective, non invasive method for early cervical cancer screening, particularly among young women. Aim: To detect High-risk HPV (HR-HPV) in cervical tissue, urine, and plasma samples from patients with Squamous Cell Carcinoma (SCC) of the cervix. Materials and Methods: The present cross-sectional study was conducted in the Departments of Obstetrics and Gynaecology, Pathology, and Microbiology at Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India over a period of 18 months from May 2023 to October 2024. The study included 75 newly diagnosed cases of primary SCC of the cervix, confirmed by cervical biopsy. For each case, cervical tissue, urine, and blood samples were collected. Deoxyribonucleic Acid (DNA) extraction was performed using the Truenat instrument, and Real-Time Polymerase Chain Reaction (RT-PCR) was employed to detect various high-risk HPV types. Statistical analysis was carried out using Statistical Packages of Social Sciences (SPSS) version 24.0. Descriptive statistics were used to summarise demographic and clinical variables. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated for different diagnostic tests using the area under the Receiver Operating Characteristic (ROC) curve. Confidence intervals were computed for these diagnostic measures. Optimal cut-off values were determined based on the highest combined sensitivity and specificity using ROC curve analysis. Likelihood ratios were also calculated. Results: The mean age of study participants were 53.92±10.86 years. Among the 75 cervical cancer cases, high-risk HPV DNA was detected in 58 (77%) of cervical tissue samples, 41 (55%) of urine samples, and 8 (11%) of blood samples. Urine testing, being non invasive, showed a sensitivity of 68.96%, specificity of 94.11%, PPV of 97.56%, and NPV of 47.05%, making it a reliable diagnostic method. Plasma testing, in contrast, demonstrated limited sensitivity (13.79%) despite high specificity and PPV. Conclusion: The present study highlights the significance of urine-based HR-HPV detection as a non invasive screening method for cervical cancer. It offers a promising avenue for future research, innovation, and development in cervical cancer screening, prevention, early detection, and treatment strategies.

Synergistic Effects of Photobiomodulation and Surgical Corticotomy on Accelerated Orthodontic Tooth Movement: A Prospective Clinical Study on Canine Retraction

Amit Rajabhau Pawar, Arvina Rajasekar

Introduction: Prolonged orthodontic treatment often leads to patient discomfort and reduced compliance, necessitating faster approaches. Corticotomy surgery promotes quicker tooth movement by stimulating localised bone remodeling. Photobiomodulation (PBM), a non-invasive light therapy, enhances cellular function and healing. Their combined application may offer a synergistic effect in accelerating canine retraction during orthodontic therapy. The present study was conducted based on the rationale that combining PBM with corticotomy may produce a synergistic effect, further accelerating tooth movement and potentially reducing overall treatment duration. Aim: To investigate the combined effects of PBM therapy and surgical corticotomy on accelerating orthodontic tooth movement, focusing on the extent and rate of canine retraction. Materials and Methods: The present prospective split-mouth clinical study was conducted between January and September 2024 at Saveetha Dental College, Chennai, Tamil Nadu, India, with 15 patients aged 18-35 years. Fifteen patients indicated for bilateral first premolar extractions in both arches to manage crowding, with intact canines, second premolars, and first molars, good periodontal health, and plaque and gingival index scores of 0.1-0.9 and 0.1-1.0 respectively, were included. Each of the 15 patients had one side (test side) treated with PBM and surgical corticotomy, while the other side (control side) received only surgical corticotomy. Canine retraction was measured at 4, 8, and 12 weeks using intraoral scans, and the extent and rate of movement were statistically analysed using independent t-tests, and one-way repeated measures Analysis of Variance (ANOVA). A p-value below 0.05 was deemed statistically significant. Results: The test group showed significantly greater canine retraction at 4 weeks (2.5±0.3 mm vs. 1.5±0.2 mm, p=0.005), 8 weeks (4.8±0.4 mm vs. 3.0±0.3 mm, p=0.003), and 12 weeks (6.3±0.5 mm vs. 4.0±0.4 mm, p=0.008) compared to the control group. The retraction rate was significantly higher in the test group across all monthly intervals (p<0.05). Conclusion: PBM therapy in conjunction with surgical corticotomy significantly accelerates the extent and rate of canine retraction, suggesting its potential as an effective adjunct in orthodontic treatment.

Evaluating the Efficacy of Levonorgestrel-releasing Intrauterine System in the Management of Menorrhagia: A Prospective Cohort Study

Introduction: Although heavy menstrual bleeding rarely poses a life-threatening risk, it significantly disrupts women’s lives, causing discomfort and inconvenience. The term “menorrhagia” encompasses the notion of heavy menstrual bleeding. Despite effective conservative surgical solutions, a substantial number of women still choose hysterectomy. Preserving patient autonomy in selecting treatments for menstrual disorders is essential for sustainable care. The Levonorgestrel-releasing Intrauterine System (LNG-IUS), infused with progesterone, emerges as a promising surgical alternative due to its potential to decrease blood loss during menstruation. Aim: To evaluate the effectiveness of LNG-IUS in controlling heavy menstrual bleeding in women with menorrhagia. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India, for 1 year. Fifty women experiencing heavy menstrual bleeding (>80 mL per cycle) underwent LNG-IUS treatment. Menstrual blood loss was assessed using modified imaging assessment of blood loss Pictorial Blood Loss Assessment Chart (PBAC) at three, six, and nine months postinsertion. Efficacy markers encompassed the observation of increased haemoglobin (Hb) levels, the reduction of PBAC scores both before and after LNG-IUS insertion. Further evaluation encompassed parameters such as the regularity of menstrual cycles and the monitoring of adverse effects after LNG-IUS implantation. Continuous variables were expressed in terms of means, standard deviations (SD), while categorical variables were expressed in terms of frequency and percentage. Analysis of Variance (ANOVA) test was used. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of the subjects was 35.16 years. The analysis revealed a significant reduction in menstrual blood loss, reflected by a decrease in PBAC score from an average of 198.86 before treatment to 8.78 after nine months of supplementation. Furthermore, haemoglobin percentage (Hb%) improved notably, increasing from an initial average of 9.1% to 10.6% after nine months. About 32% of patients achieved amenorrhoea after nine months. Spontaneous device expulsion occurred in one patient during the sixth month, while another requested removal in the ninth month. Conclusion: As a non-surgical avenue for menorrhagia, LNG-IUS offers a practical alternative. Positive feedback and sustained adherence highlight its potential as a substitute for managing heavy menstrual bleeding.

Impact of Total Progressive Motile Spermatozoa Concentration Following Pellet Swim-up versus Double Density Gradient Centrifugation on Intrauterine Insemination Outcome: A Retrospective Cohort Study

Sowbarnika Arunkumar, Kavidharshini Nanthakumar, Puvithra Thanikachalam

Introduction: Intrauterine Insemination (IUI) is a widely used treatment modality for infertile couples; however, the factors determining successful outcomes have been extensively studied. The prewash Total Motile Sperm Count (TMSC) has been shown to be a poor predictor of IUI outcomes and data regarding postwash Total Progressive Motile Spermatozoa Concentration (TPMSC) have remained inconsistent, with proposed values varying widely across studies. Aim: To evaluate the impact of TPMSC following sperm preparation by pellet and swim-up (PSU) and Double Density Gradient Centrifugation (DDGC) on the IUI outcomes. Materials and Methods: This retrospective cohort study included 490 patients who underwent IUI at an Assisted Reproductive Technology (ART) Clinic, Chennai, Tamil Nadu, India between January 2015 and January 2025. After considering the inclusion and exclusion criteria, the study cohort was broadly categorised based on the sperm preparation method (PSU: n=363, DDGC: n=127) and were then divided into four groups - Group I: TPMSC <5 x10⁶/mL, Group II: TPMSC 5-9x10⁶/mL, Group III: TPMSC 10-20x10⁶/mL, Group IV: TPMSC >20x10⁶/mL. The primary outcome was positive pregnancy rate, assessed and compared across TPMSC categories, while secondary outcomes included biochemical pregnancy, clinical pregnancy, ectopic pregnancy, and miscarriage rates. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) software, with categorical data evaluated using the Chi-square test. Results: A significant increase in pregnancy rate was observed in the group with TPMSC >20 x106/mL (24.3%, p-value <0.001) when the sample was prepared by PSU, compared to lower TPMSC categories. In contrast, no such association was observed with the DDGC technique (p-value=0.154). There was no significant difference in biochemical, ectopic, clinical pregnancy and miscarriage rates among the groups. Conclusion: The overall clinical pregnancy rate was 15.1% in the PSU group and 15% in the DDGC group. However, no association was observed between TPMSC and secondary outcomes in either the PSU or DDGC groups.

Effectiveness of E-learning versus Conventional Museum-based Teaching in Pathology Education: A Prospective Interventional Study

Introduction: Conventional pathology museums are invaluable resources for teaching the pathophysiology of disease through preserved pathological specimens. However, their use has declined due to the rise of web-based learning and logistical constraints such as limited time, fixed schedules, and staff shortages. Aim: To modernise pathology museum teaching by designing, developing, and implementing innovative digital practices and to compare their effectiveness with conventional pathology museum-based teaching. Materials and Methods: The present prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Kattankulathur, Kanchipuram, Tamil Nadu, India. Phase II MBBS students were randomly assigned into two groups. The experimental group (n=63) received QR code-assisted teaching, while the control group (n=63) received conventional museum-based teaching on cutaneous malignant tumours. An E-learning module was developed using the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model, which comprises analysis, design, development, implementation, and evaluation stages, and was integrated with Kern’s six-step approach to curriculum development. Learning effectiveness was assessed by comparing pretest and post-test scores. Categorical outcomes were analysed using the Chi-square test, while ordinal outcomes and multi-group comparisons were evaluated using Analysis Of Variance (ANOVA). Results: Among the participants, 69 students (54.7%) reported visiting the pathology museum rarely. The E-learning group demonstrated significantly greater improvement in mean knowledge scores (4.57±1.97) compared with the conventional teaching group (3.24±1.97) (p=0.0001). Confidence in the effectiveness of E-learning pedagogy was high, with 65 students (51.58%) expressing positive perceptions. Conclusion: Technology-enhanced learning was significantly more effective than conventional teaching methods in enhancing pathology knowledge acquisition. Digitalisation should therefore complement physical pathology museums by preserving the tactile and visual benefits of specimen-based learning while leveraging technology to improve accessibility, engagement, and educational effectiveness.

Translation, Cross-cultural Adaptation, and Validation of the Kannada Version of the Pain Catastrophising Scale in Post-stroke Chronic Shoulder Pain: A Cross-sectional Study

Introduction: Pain catastrophising is a critical factor in the persistence of chronic pain and adversely affects rehabilitation outcomes after stroke. The Pain Catastrophising Scale (PCS) is a gold-standard tool for assessing maladaptive pain-related cognitions. However no validated Kannada version exists for individuals with Post-Stroke Chronic Shoulder Pain (PSCSP), limiting clinical assessment for Kannada-speaking populations. Aim: To translate, culturally adapt, and validate the adult PCS into Kannada for individuals experiencing PSCSP. Materials and Methods: This cross-sectional study was conducted at a physiotherapy OPD at KLE Hospital and Medical Research Centre, Hubballi, Karnataka, India from June to November 2025. Following Beaton DE et al., guidelines, the PCS was translated and culturally adapted. About 60 participants with PSCSP were recruited for psychometric validation, and 31 were reassessed to determine test-retest reliability. Participants completed the Kannada PCS (K-PCS), Visual Analogue Scale (VAS), Fear-Avoidance Beliefs Questionnaire (FABQ-KA), and World Health Organisation Quality of Life Scale (WHOQOL-BREF). Internal consistency was evaluated using Cronbach’s alpha and test–retest reliability via the Intraclass correlation coefficient (ICC). Construct validity was Examined through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analyses (CFA). Convergent and divergent validity were assessed using Spearman’s correlation coefficients, while discriminative validity was determined through Receiver Operating Characteristic (ROC) curve analysis. A p-value < 0.05 was considered significant. Results: The K-PCS demonstrated excellent content validity (S-CVI/Ave=0.95). It demonstrated good internal consistency (α=0.87) and excellent test-retest reliability (ICC=0.96). EFA identified a three-factor structure accounting for 62.2% of the variance, which was supported by CFA (CFI=0.92; RMSEA=0.07). Moderate positive correlation with the VAS (rho=0.38, p-value=0.003) supported convergent validity. Weak correlations with FABQ-KA and WHOQOL-BREF indicate that the K-PCS measures a construct distinct from fear-avoidant beliefs and quality of life, supporting its divergent validity despite expected overlap in musculoskeletal pain populations. ROC analysis indicated excellent discriminative ability (AUC=0.97). Conclusion: The Kannada version of the PCS is a valid, reliable, and culturally appropriate instrument for assessing pain catastrophising in PSCSP. Its strong psychometric properties support its use in clinical and research settings to guide targeted rehabilitation for Kannada-speaking stroke survivors.

Evaluation of Lipocalin-2 Levels in Gingival Crevicular Fluid and Serum of Periodontitis Patients: A Cross-sectional Study

Introduction: Periodontitis is a chronic inflammatory disease affecting the supporting structures of teeth, and directly challenges the immune response, presented in elevation of many inflammatory mediators and cytokines. Lipocalin-2 (LCN-2), which belongs to the lipocalin family, plays a role in numerous pathophysiological processes. Additionally, it acts as an inflammatory mediator in several inflammatory conditions and may possess antimicrobial characteristics. Aim: To compare the levels of LCN-2 in the serum and Gingival Crevicular Fluid (GCF) of patients with different stages of periodontitis and periodontally healthy individuals in Saudi Arabia. Materials and Methods: The present cross-sectional study was conducted on patients seeking dental management at the Dental Teaching Hospital, College of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia between February and November 2024. Forty systemically healthy non-smoking individuals were categorised into four groups: periodontally healthy individuals and those with stages I, II, and III generalised periodontitis (n=10 per group). The clinical periodontal parameters were documented, and GCF and serum samples were obtained from all the participants. The GCF and serum LCN-2 levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA). One-way Analysis of Variance (ANOVA) and Tukey’s multiple-comparison tests were used to assess the results, and a p-value <0.05 was deemed statistically significant. Results: The clinical periodontal parameters revealed significant differences in clinical attachment loss among the periodontitis stages (p<0.001). Patients at each of these stages had significantly higher GCF LCN-2 levels compared to the healthy individuals (p<0.05), although the differences between the stages were not statistically significant. However, only the stage II periodontitis patients exhibited significantly higher serum LCN-2 levels than the stage I patients and healthy individuals (p<0.05). Conclusion: Significantly higher LCN-2 level in GCF was found in patients with different stages of periodontitis compared with the healthy controls, indicating that LCN-2 might be considered a local inflammatory marker in periodontitis.

A Retrospective Observational Study on Retinal Detachment at a Tertiary Care Centre from Andhra Pradesh, India

Satya Sravani Lingam, Lakshmi Sativada, Dineshkanth Vudayana

Introduction: Retinal detachment refers to the separation of the neurosensory retina from the underlying Retinal Pigment Epithelium (RPE). For normal retinal function, the retina must remain in close contact with the RPE, and detachment that affects the foveal centre can result in significant vision loss in the affected eye. Retinal detachment is a sight threatening condition requiring prompt diagnosis and intervention to prevent permanent vision loss. Aim: To identify the risk factors, types, aetiology, treatment methods, and postoperative visual outcomes in cases of retinal detachment. Materials and Methods: This was a retrospective observational study on 25 patients having retinal detachment who presented to the ophthalmology OPD at Great Eastern Medical School and Hospital, Ragolu, Andhra Pradesh, India from January 2023 to May 2024. The data including age, sex, type and aetiology of retinal detachment, preoperative and postoperative visual acuity, surgical technique used, and follow-up visual outcomes were collected from patient records. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. A p-value of < 0.05 was considered statistically significant. Results: The mean age was 53.96 years, men outnumbered women. Rhegmatogenous Retinal Detachment (RRD) seen in 19 cases (76%) was more common than Tractional Retinal Detachment seen in six cases (24%). Among RRD, Posterior capsular rupture and trauma were in seven cases each (36.4%) which were the most common causative risk factors, followed by myopia and macular hole induced in two (10.5%) and RC coloboma in one case (5.2%). Among TRD, Proliferative Diabetic Retinopathy (PDR) 83.3% (n=5) was the most common causative risk factor in five (83.3%) and one case (16.7%) reported as a complication of uveitis Pars Plana Vitrectomy (PPV), Membrane Peeling (MP), endolaser, fluid air exchange, silicone oil infusion was done with Scleral Buckling (SB) in 20 cases (80%) and without SB in four case (16%). Pneumatic retinopexy was done in one case (4%). Significant postoperative visual improvement was observed in RRD (p-value=0.001), whereas TRD showed no statistically significant change (p-value=0.566). Conclusion: Thorough examination, including fundus peripheries plays a key role in identifying prerequisite factors responsible for retinal detachment. The occurrence of retinal detachment cannot be directly prevented, but it is crucial for all patients to recognise its symptoms. The earlier patients seek treatment for a retinal detachment, the better their chances of preserving vision.

Prevalence, Risk Factors and Clinical Outcomes of Multidrug-resistant Gram-negative Sepsis: A Cross-sectional Study from a Railway Hospital in Western India

A Meenu, Ajay Khobragade, Ashwini P Jadhav

Introduction: Multidrug-resistant (MDR) Gram-negative Bacteria (GNB) represent a growing global health threat, particularly in Intensive Care Units (ICUs), where they contribute significantly to morbidity and mortality. There is a paucity of data regarding MDR sepsis, specifically among railway beneficiaries at tertiary care settings in India. Aim: to determine the prevalence, risk factors and clinical outcomes of MDR-GNB sepsis among patients admitted to the ICU of Jagjivan Ram Hospital, Mumbai, Maharashtra, India. Materials and Methods: A cross-sectional study was conducted at the Department of General Medicine, Jagjivan Ram Hospital, Mumbai, Maharashtra, India, from December 2022 to December 2024, on 100 adult patients with sepsis admitted to the ICU. Patients with culture-proven Gram-negative sepsis were included. Identification and sensitivity testing were performed using the Bacterial Detection System (BACTEC) and Vitek Identification and Susceptibility Testing System (VITEK-2) system in accordance with the Clinical and Laboratory Standards Institute (CLSI ) guidelines. Clinical outcomes (length of stay, mortality) and risk factors were compared between the MDR and non-MDR groups using Chi-square and t-tests, with statistical significance set at p-value<0.05. Results: The prevalence of MDR-GNB was 67%. The study population was predominantly elderly (55% aged >60 years) with a male preponderance (55%). Common co-morbidities included Diabetes Mellitus (DM) (86%) and Ischaemic Heart Disease (IHD) (39%). Significant risk factors for MDR infection included prior antibiotic use (p-value<0.05) and invasive instrumentation. Klebsiella pneumoniae and Escherichia coli were the predominant pathogens. Mortality was 55.2% in the MDR group and 57.6% in the non-MDR group; this difference was not statistically significant (p=0.82). Conclusion: A high burden of MDR-GNB sepsis was observed in this tertiary ICU, driven by advanced age, comorbidities, and prior antibiotic exposure. The association with high mortality underscores the urgent need for strict antimicrobial stewardship and infection control protocols.

Clinicodemographic Profile, Risk Factors and Associated Co-morbidities in Children with Severe Acute Malnutrition: An Observational Study from a Tertiary Care Centre in Assam, India

Kumud Pathak, Akshara M Sivan

Introduction: Severe Acute Malnutrition (SAM) is a major cause of morbidity and mortality among children. Malnutrition during the early years of life can adversely affect overall growth, impair immunity, increase susceptibility to infections, delay development, and result in poor scholastic performance. Aim: The present observational study was conducted to determine the clinical spectrum, sociodemographic profile, risk factors, and associated co-morbidities among children with SAM in a tertiary care centre in Assam, India. Materials and Methods: The present hospital-based descriptive observational study was conducted at the Nutritional Rehabilitation Centre (NRC) of Tezpur Medical College and Hospital from September 2023 to August 2024. All children aged six months to five years admitted with SAM as per World Health Organisation (WHO) diagnostic criteria during the study period were included. After obtaining informed consent from parents or guardians, detailed sociodemographic and nutritional histories were recorded. Clinical features, associated co-morbidities, and relevant laboratory investigations were documented. Data were entered in a predesigned proforma and analysed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 16. A p-value of <0.05 was considered statistically significant. Results: Among the 65 children with SAM, 41 (63.07%) were males and 24 (36.9%) were females. Thirty-four children (52.3%) belonged to the 1-2-year age group. Of the total participants, 49 (75.4%) belonged to the lower socioeconomic strata, and 34 (52.3%) were residents of tea garden areas. Acute gastroenteritis was present in 21 (32.3%) children, acute respiratory infections in 18 (27.7%), moderate to severe anaemia in 15 (23.1%), delayed developmental milestones in 12 (18.5%), skin infections in 13 (20.0%), urinary tract infections in 11 (16.9%), seizure disorders in 8 (12.3%), culture-proven sepsis in 5 (7.7%), tuberculosis in 10 (15.4%), and vitamin A deficiency in 3 (4.6%) children. Conclusion: Sociodemographic factors significantly influence the occurrence of malnutrition. Risk factors such as young age, poor literacy levels, and lack of awareness regarding nutrition contribute to malnutrition and its associated co-morbidities.

Analysis of Various Techniques for Tooth Shade Matching: An Umbrella Review

S Advaitha Narayan, Madhuram Krishnamurthy, K Shanmugapriya, Ashok Leburu

Introduction: Precise shade matching plays a crucial part in restorations, as highlighted by the goal of aesthetic excellence in dentistry, which is moulded by social trends and innovative technologies. Even if conventional approaches are widely used, new digital equipment requires a re-evaluation due to issues like subjective interpretation and unpredictability in shade guides. Aim: To evaluate and compare the existing literature in order to determine the best reliable dental shade selection methods for tooth colour matching. Materials and Methods: In the present umbrella review duration of literature search was from January 2000 to February 2025. The PROSPERO database contains the designed and registered protocol of this umbrella review (CRD42023412138). Inclusion criteria included systematic reviews including cross-sectional studies, cohort studies, case-control studies, randomised controlled trials and studies evaluating the impact of accurate tooth shade selection. Exclusion criteria comprises systematic reviews assessing shade selection methods other than instrumental or conventional techniques. In order to create the umbrella review, researchers used the PRISMA principles. The search method included the following terms: “tooth shade,” “natural tooth shade,” “shade selection,” “conventional and instrument shade selection,” “digital shade selection,” “spectrophotometer shade selection,” “colourimeter shade selection” were included. In order to find the applicable systematic reviews, the search terms were AND ((systematic review) OR meta-analysis) were used. Data was sourced from four electronic databases (PubMed, EBSCHO host, Cochrane and Scopus databases) were used to perform a literature search until 2025. The methodological quality and risk of bias of the included systematic reviews were assessed using the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) checklist. The AMSTAR 2 score for the reviews ranged from ‘low’ to ‘critically low quality’. Results: Six systematic reviews published between 2012 and 2023 were included in the current umbrella review. Shade selection methods included instrumental approaches {spectrophotometers, colourimeters, photo-colourimetric techniques, Intraoral Scanners (IOS), and digital imaging (cameras/smartphones)} and Conventional approaches {Visual shade selection with shade guides (Vita 3D Master, Vita Lumin)}. Three reviews conducted meta-analysis (using fixed and random effects models). Substantial heterogeneity was reported in pooled estimates. Instrumental shade-matching methods, especially spectrophotometers, provide the most accurate, reliable, and reproducible outcomes in dentistry. Digital approaches (cameras, smartphones, photo-colourimetry) serve as strong alternatives, particularly with standardised protocols and cross-polarisation. Visual methods, although less accurate, retain clinical relevance as affordable, supplemental tools. IOSs currently do not surpass traditional methods in accuracy. Conclusion: The most exact and precise method of matching shades is to use a spectrophotometer. Though visual shade matching is inconsistent, they are not less accurate than colourimetric measures.

Oral Health Status, Hygiene Practices and Barriers to Dental Care among Individuals with Schizophrenia: A Cross-sectional Study

BS Suganya Priyadharshini, Sathyaseelan Manivel, Sriram Balaji, Jeevithan

Introduction: Individuals with schizophrenia were at increased risk of poor oral health due to a combination of illness-related, behavioural and systemic factors. Despite its impact on quality of life, oral health remains underexplored in psychiatric populations in India. Aim: To determine the prevalence of clinically diagnosed dental conditions, oral hygiene practices and service utilisation among individuals with schizophrenia in a tertiary psychiatric setting. Materials and Methods: A cross-sectional study was conducted in the Department of Psychiatry at a tertiary care teaching hospital (KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India) over five months from March 2025 to July 2025, among 71 adults (18-65 years) with a Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) diagnosis of schizophrenia. Psychiatric severity was assessed using the Brief Psychiatric Rating Scale (BPRS). Oral health was evaluated using the Decayed, Missing, and Filled Teeth (DMFT) index. Information on oral hygiene practices, dental service utilisation and perceived barriers to care was collected using a semi-structured questionnaire. Results: The mean DMFT index indicated a moderate burden of dental morbidity, with decayed teeth being the most frequent findings. A significant association was observed between age and DMFT scores (p-value=0.015), peaking in the 41–50 year age group. No significant associations were found with gender, illness duration, or illness severity. Oral hygiene practices were suboptimal, with most participants brushing only once daily and over two-fifths never having visited a dentist. Xerostomia was reported by 11.3% of participants. The most common barriers to dental care were perceptual barriers, primarily lack of perceived need, dental anxiety and financial concerns- while structural barriers such as accessibility were less frequently cited. Conclusion: The burden of preventable dental morbidity is high in adults with schizophrenia, compounded by low service utilisation and perceptual barriers.

Epidemiological Investigation of an Acute Gastroenteritis Outbreak in a Tribal Colony of Palakkad District, Kerala, India

C Sreedevi, PM Sheeba, N Divyamol, Kiran Thomas, Lintu Mathew, KS Deepak

Introduction: Diarrhoeal disease is a major cause of morbidity and mortality, especially among vulnerable population groups. Globally, India remains one of the nations with the highest rates of diarrhoeal diseases reported annually. Identifying the causes and factors leading to an outbreak of diarrhoea is an important public health response for the prevention and control of the same, especially in vulnerable populations. The current investigation was undertaken when an outbreak of acute gastroenteritis with three fatalities was reported from a tribal colony in Palakkad district, Kerala, India In general, the tribal populations are socially, culturally, and economically backward and live in resource-limited, remote areas. Identifying the determinants of disease is crucial to accelerate public health interventions among these populations. Aim: To describe the epidemiology of the acute gastroenteritis outbreak and propose recommendations for control and prevention of the same in a tribal colony in Palakkad district. Materials and Methods: The present descriptive study was conducted from 03/07/2024 to 30/07/2024, in a tribal colony of Kanjirappuzha Panchayath Palakkad district, Kerala, India to investigate an outbreak of acute gastroenteritis. There were a total of 23 cases in the outbreak. The investigators identified the cases from the outpatient, inpatient and line list records available at the hospitals and Family Health Centre (FHC), where the patients sought treatment. For active case finding, the investigators visited the colony and conducted an environmental assessment. The data were analysed by descriptive statistics using Statistical Package for Social Sciences (SPSS) version 20.0. Results: The outbreak had 23 cases of acute gastroenteritis, with 43.5% (n=10) of patients over 45-year-old and 52.2% (n=12) females. There were three fatalities, two involving Acute Kidney Injury (AKI). The attack rate in the outbreak was 14.8% and the case fatality rate was 8.7%. The epidemic curve indicated a point-source outbreak with possible secondary transmission. Residents had an inadequate, intermittent water supply and often used unsanitary alternatives. Laboratory tests found both Rota and Astro viruses from the rectal swabs of two patients (PCR), and all the water samples (six in number) tested for bacteriological standards gave unsatisfactory results. Conclusion: An outbreak of mixed viral gastroenteritis caused by Astrovirus and Rotavirus occurred in the tribal colony, resulting in three deaths. The major cause of the outbreak was identified as a lack of safe drinking water. Enhanced Water, Sanitation, and Hygiene (WaSH) practices coupled with regular water quality surveillance are recommended to prevent future outbreaks.

Identifying Clinical Domains of Functional Disability Scale for Upper Cross Syndrome: A Longitudinal Study

Kanika Bhatia, Shikha Singh

Introduction: Upper Cross Syndrome (UCS) represents a musculoskeletal condition originating from postural deviations caused by muscle imbalances, resulting in pain symptoms along with reduced mobility and functional restrictions. A standardised functional disability scale specific to UCS does not currently exist; therefore, researchers need to identify essential clinical domains for evaluation purposes. The present research investigated vital clinical domains for functional disability assessment in UCS so that clinicians can develop improved diagnostic and therapeutic rehabilitation approaches. Aim: To identify and categorise the essential clinical domains contributing to functional disability in individuals with UCS. Materials and Methods: The present prospective cross-sectional study was conducted at the Department of Physiotherapy of a deemed university located in Haryana, Northern India from November 2024 to February 2025. A research framework consisting of three distinct phases was designed to determine UCS related disabilities. Phase one involved the evaluation of ten clinically diagnosed UCS patients to document their reported disabilities. Phase two consisted of a systematic review of the literature related to functional disability domains associated with UCS. Phase three included expert surveys involving nine musculoskeletal physiotherapists to review, validate, and refine the identified domains. Descriptive statistics were used to classify and organise the identified clinical domain areas. Results: The assessment identified three vital functional disability domains in UCS: (1) Pain, (2) Activity limitation, and (3) Social and functional performance limitation. Patient assessments revealed pain predominantly in the neck, shoulders, and jaw, which intensified during prolonged sitting and repetitive movements. Limitations in overhead activities and sustained sitting were observed due to restricted cervical and shoulder mobility. Additionally, patients reported sleep disturbances and reduced social involvement. All experts unanimously endorsed pain and postural dysfunction as defining components of UCS. Conclusion: The evaluation of disability related to UCS primarily relies on the assessment of pain, activity limitation, and social and functional performance limitations. Future research should focus on developing a standardised, UCS specific functional disability scale that integrates these domains to assist clinicians in improved decision making and to enhance patient results.

Efficacy of Kerosene and Cedarwood Oil as Xylene Alternatives in Tissue Processing and H&E Staining: An In-vitro Study

K Sravya, A Sarika, M Mythri, B Santosh, Sirigala Lavanya

Introduction: Xylene is the most commonly used clearing and deparaffinising agent in histopathology laboratories. Xylene-associated health hazards include neurotoxicity, respiratory effects, and potential carcinogenicity. The literature describes several xylene substitutes used as clearing agents, such as benzene, toluene, chloroform, petroleum ether, oil of wintergreen (methyl salicylate), cedarwood oil, carbon tetrachloride, clove oil, dioxane, aniline oil, and kerosene. Commonly used alternative deparaffinising agents include toluene, Ultraclear, refined mineral oil, dishwashing liquid, coconut oil, and limonene. Aim: To assess the efficacy of kerosene and cedarwood oil as alternative clearing and deparaffinising agents to xylene in tissue processing and Haematoxylin and Eosin (H&E) staining. Materials and Methods: The present in-vitro study was conducted on 60 formalin-fixed tissue specimens, which were divided into three groups (A, B, and C) of 20 specimens each. All tissues underwent routine tissue processing. Alcohol-dehydrated specimens in Group A were cleared with xylene, Group B with kerosene, and Group C with cedarwood oil. After the impregnation process, tissue blocks were prepared using paraffin wax. Sections were cut, and during subsequent H&E staining, xylene was used as the deparaffinising agent for Group A, kerosene for Group B, and cedarwood oil for Group C. All slides were evaluated under a light microscope by two blinded observers for cytoplasmic staining, nuclear staining, staining contrast, and the presence of artifacts. Results were tabulated. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, Fisher’s exact test, and Chi-square tests were applied. Results: The majority of xylene-processed tissues exhibited good cytoplasmic and nuclear staining. Kerosene-processed tissues showed equal proportions of good and fair cytoplasmic staining, with predominantly fair nuclear staining. Cedarwood oil-processed tissues displayed fair cytoplasmic and nuclear staining. Differences in cytoplasmic and nuclear staining among the groups were not statistically significant (p=0.122 and p=0.127, respectively). Most xylene- and cedarwood oil-processed tissues demonstrated good staining contrast, whereas kerosene-processed tissues predominantly showed fair staining contrast. This difference was statistically significant (p<0.001). Kerosene-processed tissues exhibited a higher number of artifacts, while xylene and cedarwood oil processed tissues showed fewer artifacts. This difference was also statistically significant (p=0.002). Conclusion: Although kerosene is a more cost-effective and less toxic option than xylene, its inferior staining quality and higher incidence of tissue artifacts suggest that it may be suitable only after adequate purification to minimise impurities. Cedarwood oil emerges as a strong alternative to xylene, providing good staining quality with fewer artifacts, minimal tissue damage, and lower toxicity. However, its higher cost and longer processing time must be considered before routine use.

Evaluating the Therapeutic Efficacy of Carbamazepine and Oxcarbazepine in Trigeminal Neuralgia: A Randomised Clinical Trial

Preeti Patil, Ramnarayan Belur Krishna Prasad, Mohan V Raj, N Sangamithra

Introduction: Trigeminal Neuralgia (TN) is neuropathic pain disorder manifesting as intense, episodic, shock-like facial pain that severely affects quality of life. Although carbamazepine is the first drug of choice for the treatment of TN, it causes adverse effects like drowsiness, ataxia, myelosuppression and other serious side-effects. Oxcarbazepine (OXC), a keto-analogue of carbamazepine, may serve as superior substitute as it has lesser side-effects and improved safety profile. Aim: To compare the effectiveness and safety of carbamazepine and OXC in patients with classical TN. Materials and Methods: This study was a randomised clinical trial was conducted in the Department of Oral Medicine and Radiology, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India. Patient recruitment was carried out over a period of eight months, from February 2025 to September 2025. In this randomised clinical trial, 60 patients with TN were allocated to receive either carbamazepine (100 mg twice daily, titrated up to 1200 mg/day) or OXC (150 mg twice daily, titrated up to 1800 mg/day). Pain intensity was assessed using a 0-10 Visual Analogue Scale (VAS) at baseline, two, four, and eight weeks. Adverse effects were recorded throughout the 8 months of study period. Within-group comparisons of VAS scores over multiple follow-up points were performed using repeated measures Analysis of Variance (ANOVA). Between-group comparisons at each follow-up point were conducted using an Independent sample’s t-tests Results: The mean age of participants in group A and B was 53.8±6.2 and 52.4±5.9 respectively. Intragroup comparison using ANOVA showed both medications significantly reduced pain scores over time (p-value <0.01). Independent samples t-test showed OXC produced a greater reduction in VAS scores at four weeks (2.5±0.9 vs 4.1±1.1; p-value=0.01) and eight weeks (1.9±0.8 vs 3.1±1.0; p-value=0.01) compared to carbamazepine. Adverse effects were reported in 53.3% of patients receiving carbamazepine and 23.3% of those receiving OXC. Conclusion: OXC was more efficient in reducing pain compared to carbamazepine at the end of four and eight weeks and had fewer side-effects. Hence, OXC can be recommended as a safer and better substitute in the long-term management of TN. However, larger studies with longer follow-up are warranted to confirm these results.

Efficacy of Hyaluronic Acid and Injectable Platelet-rich Fibrin in the Treatment of Gingival Recession using Coronally Advanced Flap Technique: A Split Mouth Randomised Clinical Trial

Introduction: Injectable Platelet-Rich Fibrin (I-PRF) provides a promising substitute for the conventional Connective Tissue Grafts (CTG), in gingival recession management cases. Being a bioactive material, it has the ability to promote tissue regeneration and healing. Hyaluronic Acid (HA) is synthesised in the plasma membrane and contributes in periodontal regeneration by supporting the cellular activity like cell migration, proliferation and tissue hydrodynamics, thereby improving tissue healing. Aim: To evaluate the efficacy of I-PRF and HA along with Coronally Advanced Flap (CAF) technique in the management of isolated Class I gingival recession. Materials and Methods: The present prospective, split-mouth, randomised clinical trial was conducted at the Department of Periodontology, Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India from January to March, 2024. A total of 23 participants who had Class I recession bilaterally were recruited and grouped as: Control site (treated with CAF+IPRF) and the test site (treated with CAF+I-PRF+ HA) and non-eugenol periodontal pack was given which was removed after 14 days. The baseline value was recorded for the clinical parameters {Recession Depth (RD), Keratinised Tissue Width (KTW), Recession Width (RW), Keratinised Tissue Thickness (KTT) and Mean Root Coverage (MRC)}. These parameters were then recorded at one month and three months. Analysis of Variance (ANOVA) with Bonferroni post-hoc correction was applied for intragroup comparisons and paired t-test for intergroup comparison. A p-value≤0.05 was considered statistically significant. Results: A significant reduction in RW and RD as well as enhancement in KTT and KTW by the end of three months was observed for all the parameters recorded. The test site (HA+I-PRF) showed better performance in comparison to the control group (p<0.001). The test protocol achieved MRC of 72.62%, significantly outperforming the control group (p<0.001) while securing superior gains in both tissue width and thickness. Conclusion: According to the results of the present study HA and I-PRF provided successful coverage of the gingival recession and was also beneficial in increasing the gingival phenotype thickness.

Effect of Dexmedetomidine and Propofol on Extubation-induced Cardiovascular and Airway Responses: A Randomised Controlled Trial

Introduction: Tracheal extubation is a critical phase of general anaesthesia and is often associated with undesirable haemodynamic and airway reflex responses, which may result in serious complications, especially in high-risk patients. Pharmacological agents like dexmedetomidine and propofol have shown potential in attenuating these responses. Aim: To compare the efficacy of single intravenous bolus doses of propofol and dexmedetomidine with placebo in attenuating cardiovascular and airway responses during extubation. Materials and Methods: The double-blinded Randomised Controlled Trial (RCT) was conducted in the Department of Anaesthesiology and Critical Care, JNIMS, Porompat, Imphal, Manipur, India, from May 2018 to April 2021. It was conducted on 96 American Society of Anaesthesia (ASA) physical status grade I and II patients aged 18–62 years, scheduled for elective surgery under general anaesthesia with endotracheal intubation. Patients were randomly allocated into three groups: Group A received 0.4 mg/kg propofol in 50 mL Normal Saline (NS), Group B received 0.4 μg/kg dexmedetomidine in 50 mL NS, and Group C received 50 mL NS over 10 minutes, 15 minutes before extubation. Haemodynamic parameters were recorded at specified time intervals. Quality of extubation was assessed using a 4-point scale and sedation was assessed using the Ramsay Sedation Scale. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0, with Analysis of Variance (ANOVA) and Chi-square tests. Results: Demographic variables and baseline haemodynamic parameters were comparable across groups. Both propofol and dexmedetomidine significantly attenuated the increase in heart rate and blood pressure following extubation compared to placebo (p-value <0.05). Dexmedetomidine provided better control of heart rate than propofol in the immediate post extubation period (84.28±10.993 vs 95.34±11.27). Sedation scores were higher in the dexmedetomidine group; however, all patients were easily arousable, without any respiratory depression or delay in postoperative recovery. Conclusion: Low-dose single bolus administration of propofol and dexmedetomidine is effective in attenuating haemodynamic responses during tracheal extubation. Dexmedetomidine provided better heart rate control, while both drugs maintained blood pressure stability, thereby supporting their use for smooth extubation, particularly in patients at risk of haemodynamic instability.

Diagnostic Concordance of Large Language Models with Postoperative Surgeon Diagnoses: A Comparative Analysis of ChatGPT, Claude, and Gemini

Tasneem Shaik Zaheerudeen, Nembian Raja Rajan

Introduction: Large Language Models (LLMs) are increasingly explored for clinical diagnostic support, yet their real-world performance compared to clinician diagnoses remains inadequately characterised. Aim: To evaluate the diagnostic concordance of three leading LLMs, ChatGPT, Claude and Gemini against postoperative surgeon diagnoses. Materials and Methods: The present single centre retrospective observational comparative study including a total of 106 surgical cases from SRM Medical College and Hospitals, Kattankulathur, Chennai, Tamil Nadu, India, performed between March and September 2025, with documented presenting symptoms and confirmed postoperative diagnoses were analysed. Standardised prompts containing patient demographics, symptoms and clinical history were submitted to ChatGPT (GPT-4, version GPT-4-0613), Claude (Claude 3 Opus, version claude-3-opus-20240229) and Gemini (Gemini Pro, version gemini pro-1.0) between March 25, 2025 and September 24, 2025. Each LLM-generated diagnosis was independently categorised as concordant or discordant with the surgeon's diagnosis by two investigators. Model accuracy was calculated with Clopper-Pearson 95% confidence intervals. Pair-wise differences were assessed using McNemar’s exact test and inter-model agreement was quantified with Cohen’s kappa. Qualitative analysis identified strengths and limitations of Artificial Intelligence (AI) diagnostic reasoning. Results: Mean patient age was 42.6±16.0 years; 70 (66.0%) were male. Diagnostic accuracy was 80.2% (95% CI: 71.3-87.3%) for ChatGPT (85/106 concordant), 83.0% (95% CI: 74.5-89.6%) for Claude (88/106 concordant) and 80.2% (95% CI: 71.3-87.3%) for Gemini (85/106 concordant). Pair-wise comparisons revealed no statistically significant differences (ChatGPT vs Claude, p=0.581; ChatGPT vs Gemini, p=1.000; Claude vs Gemini, p=0.375). Inter-model agreement was moderate to high (κ=0.592-0.843). All three models correctly diagnosed 78 cases (73.6%), while all three failed in 13 cases (12.3%). Qualitative analysis revealed that LLMs excelled at pattern recognition for classic presentations (e.g., appendicitis, hernias) but struggled with atypical symptoms, rare conditions and cases lacking imaging data. Conclusion: ChatGPT, Claude and Gemini demonstrated comparable diagnostic concordance with postoperative surgeon diagnoses in this retrospective cohort. While LLMs show promise as adjunctive diagnostic tools, significant limitations in handling atypical presentations, contextual interpretation and accountability concerns preclude independent clinical deployment. These findings underscore the necessity of human oversight rather than replacement role of AI in surgical decision-making.

Expression of Galectin 3 in Invasive Breast Carcinoma and its Association with Histological Grade: A Cross-sectional Study

Ipsita Parida, Sujata Raychaudhuri, Anand Kumar Verma, Tanweer Karim

Introduction: The histological grade of breast carcinoma is one of the most valuable prognostic parameters. Galectin 3, a novel marker, plays a salient role in promoting or inhibiting the putative hallmarks of cancer and cancer progression. A change in expression can be utilised for deciding the targeted therapy. Aim: To evaluate the expression of Galectin 3 in Invasive breast carcinoma and to assess its association with histologic grade. Materials and Methods: A prospective, cross-sectional study was conducted over one year and five months duration, from April 2023 to August 2024, on 35 patients in the Department of Pathology, Employees’ State Insurance Corporation (ESIC) Medical College and Hospital, Basaidarapur, New Delhi, India. These cases were diagnosed as Invasive Breast Carcinoma, No Special Type (NST) on histopathology, and graded as per the Nottingham Histologic score. Fully automated Immunohistochemistry (IHC) was performed using primary antibodies against Galectin 3 (Clone: E412). A score of 0 to 2 was assigned based on the percentage positivity of IHC expression of tumour cells for Galectin 3. The association between the Galectin 3 positivity score and the histologic grade of the tumour cells was studied. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29.0, and the χ² test was applied to assess associations. A p-value <0.05 was considered statistically significant. Results: Galectin 3-positive tumours were noted in 10 cases (28.6%). A Nottingham score of 6 was seen in maximum cases, 14 (40.0%). A trend towards association was observed, but it did not reach statistical significance (p=0.054). No association was seen between histologic grade and galectin score (p-value=0.056). No significant association (p-value=0.504) was noted between histologic grade and Galectin 3-positive expression (both scores 1 and 2). Conclusion: The present study evaluated the association between Galectin 3 expression, which may have a prognostic value, with histologic grading of breast carcinoma, which is an established prognostic factor. In this study, there was no association between Galectin 3 expression and histologic grade.

Efficacy of Nebulised Dexmedetomidine for Patients Comfort and Satisfaction during Diagnostic Upper Gastrointestinal Endoscopy: A Randomised Controlled Study

Bhavini Shah, Reshma Salim

Introduction: Diagnostic upper Gastrointestinal (GI) endoscopy is used to evaluate GI disorders. It causes patient discomfort because of its invasive nature. Conventional sedatives, although effective, have risks of respiratory depression and prolonged recovery, especially in high-risk patients. Dexmedetomidine, a selective α-2 adrenergic agonist, has been found to be an effective sedative with lesser respiratory side-effects. Aim: To assess the efficacy of nebulised dexmedetomidine for patients comfort and satisfaction during diagnostic upper GI endoscopy. Materials and Methods: The present randomised controlled trial was performed at Dr. D. Y. Patil Medical College Hospital And Research Centre, Pimpri, Pune, Maharashtra, India, from September 2024 to February 2025 on 64 patients aged 18-70 years, American Society of Anaesthesiologists (ASA) I and II, undergoing elective diagnostic upper GI endoscopy. Participants were randomly assigned into two groups- group D (dexmedetomidine) and group C (normal saline). Both groups underwent 15-minute preprocedure nebulisation with the respective drugs. Patient satisfaction was the primary outcome measured, and secondary outcomes measured were haemodynamic parameters, stress response, procedural ease, patient tolerance, and side-effects. Chi-square or Fishers exact test and independent t-tests or Mann-Whitney U test were used with a p-value <0.05 considered statistically significant. Results: The demographic comparison between group D and group C revealed no statistically significant differences in age, gender distribution, or ASA status (p>0.05 for all variables. The mean age for group D was 38.5±13.8 and Group C was 41.9±12.8. group D demonstrated substantially better haemodynamic parameters compared to group C (p<0.05). Patient satisfaction was greater in group D (100%-very satisfied) than in group C (68.8%-very satisfied) (p<0.05). Endoscopists perceived ease of procedure and patient tolerance was greater in group D, with significantly less coughing (9.4% vs. 46.9%, p=0.001). Sedation scores were equal among the two groups. Conclusion: Nebulised dexmedetomidine immensely increases patient comfort, satisfaction, and haemodynamic stability during diagnostic upper GI endoscopy. It lessens cardiovascular stress, limits side-effects such as coughing, and optimises procedural results, recommending it as a viable alternative to the standard sedatives used in GI endoscopy.

Pattern and Factors Influencing Junk Food Consumption among Children: A Cross-sectional Study

P Ashwathy, Sharin Neetal Dsouza, Priya Reshma Aranha

Introduction: The consumption of various fast food options is rising everywhere in the world, in both developed and developing nations. A growing number of individuals across all age groups, but especially teenagers and young adults, are drawn to eating fast food as a result of shifts in people’s dietary and lifestyle patterns. The adoption of a fast food and junk food consumption patterns in the modern world has a number of deleterious effects on health. Aim: To investigate the pattern and factors influencing junk food consumption among children. Materials and Methods: This cross-sectional study was conducted in Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, from December 2021 to May 2022. A total of 133 children between the age group of 8 and 14 were chosen using a non probability purposive sampling technique. A rating scale was utilised to analyse the factors influencing junk food consumption, and data was collected using a demographic proforma and a structured checklist to assess the pattern of junk food consumption. The acquired data were evaluated using descriptive and inferential statistics. To determine the association between pattern and factors influencing junk food consumption and demographic characteristics, chi-square test was utilised. Results: In present study, majority of research participants 71 (53.4%) said they ate junk food twice a week along with the family. Out of 133 children, 111 (83.5%) have access to junk food at home, and 90 (67.7%) of participants don’t have a set time for eating junk food. Junk food taste 88 (66.2%), advertisements 78 (58.6%), availability 67 (50.4%), ease of availability in school surroundings 59 (44.4%), affordability 56 (42.1%), and the ability to be quickly prepared 78 (58.6%) were all strongly agreed upon by the majority of participants. Conclusion: Youngsters frequently consume junk food, which is impacted by a variety of factors, including flavour, marketing, pricing, ease of access, and family customs. The majority of kids had easy access to junk food at home and didn’t follow any set eating habits.

Knowledge of Dialyser Reuse Practice among Medical and Allied Healthcare Professionals Working in Haemodialysis Units: A Cross-sectional Study

Shreya Gujar, Amita Digambar Dabholkar

Introduction: Dialyser reuse is commonly practised in resource-limited areas. It allows multiple uses of the same dialyser for one patient. While it is cost-effective and environmentally friendly, it requires strict safety protocols. Aim: To examine the knowledge and practices of dialyser reuse among healthcare professionals in haemodialysis units across Maharashtra, India. Materials and Methods: A cross-sectional study was conducted across dialysis units in the Mumbai, Pune, and Aurangabad regions of Maharashtra, India, from December 2024 to February 2025. A total of 200 participants, which included dialysis technologists, students, and allied healthcare professionals, were included. A validated questionnaire assessed awareness of reprocessing steps, sterilisation agents, eligibility criteria, safety measures, and risks of improper reuse. Data were analysed using descriptive statistics. Results: The mean age of the participants was 21.68±2.17 years, with the majority of 113 males (56.5%). Among the 102 respondents who preferred reuse, 58 (56.86%) correctly identified the reuse criterion of fibre bundle volume ≥80%, and 51 (50%) recognised the importance of both visualisation and Total Cell Volume (TCV) testing. Renalin was preferred by 83 (81.37%), but only 32 (31.37%) knew the correct dilution. Manual reprocessing was more common at 54 (52.94%) compared to automated methods at 45 (44.11%). Reported issues with single-use dialysers included “single-use syndrome” at 66 (64.70%) and hypotension at 25 (24.5%). Clotting was the top reason for dialyser rejection at 77 (75.4%). Pyrogen reactions were noted as the main drawback of reuse at 69 (67.6%). Overall, only 40-45% of participants demonstrated consistent, satisfactory knowledge across these areas. Conclusion: The findings reveal a basic awareness of reuse practices but highlight significant gaps in knowledge regarding validation tests, sterilant concentrations, and safety concerns. Structured training, regular refresher sessions, and competency evaluations are necessary to close this knowledge-practice gap and ensure safe, standardised dialyser reuse in haemodialysis care.

A New Surgical Technique for Treating Pseudocyst of Pinna: A Prospective Interventional Study

Rakhi Kumari, Ragini Kullu, Dhananjay Kumar

Introduction: Pseudocyst of pinna is a cystic swelling of pinna in which collection of serous fluid occurs between the auricular cartilage and perichondrium. Successful treatment of pseudocyst of pinna is very challenging because of high chances of recurrence and cosmetic deformity. Various treatment modalities have been described in the literature but none gives fully satisfactory result. Aim: To present a new surgical technique for treating pseudocyst of pinna and to evaluate recovery and recurrence. Materials and Methods: A prospective interventional study was done on 38 patients with pseudocyst of pinna at the Department of Ear, Nose and Throat (ENT), Sheikh Bhikhari Medical College, Hazaribag, Jharkhand, India, from September 2022 to February 2025. Aspiration and drainage with creation of a small triangular window in the most dependent part of pseudocyst was done. Mechanical obliteration of dead space was done with compression suture. Suture was removed on 7^th postoperative day by the time window heals by secondary healing. Patients were kept on regular follow-up. The data were collected and entered in Excel sheet. The data was presented in the form of frequency table and percentages. Results: Most of the patients in the present study were males (89%) with a mean age of 29 years and around 37% patients belonged between 21 to 30 years. All of them had unilateral pinna involvement. The concha was the most common site. Recurrence was not seen in any of them. One patient developed thickening of pinna due to late presentation. Conclusion: Small triangular draining window in the most dependent part of pseudocyst with compression suture gives faster recovery, good cosmetic outcome and recurrence can be prevented.

Respiratory Syncytial Virus Infection in the Context of COVID-19: A Retrospective Study from Eastern India

Introduction: Respiratory Syncytial Virus (RSV), a pathogenic virus, is one of the leading causes of acute respiratory tract infections, especially in infants, immunocompromised individuals and older adults. Prior to the Coronavirus Disease-2019 (COVID-19) pandemic, infections caused by this virus had a tendency to follow a predictable seasonal trend. The post-COVID picture of RSV has not been studied and there is a dearth of data, especially in the eastern part of the Indian subcontinent. Aim: To describe the distribution of RSV in the eastern part of India in the context of COVID-19. Materials and Methods: A retrospective study was carried out at a tertiary care hospital of West Bengal, namely Calcutta School of Tropical Medicine (Virology Unit) based on patient records of 954 Nasopharyngeal (NP) and Oropharyngeal (OP) swabs collected from indoor as well as outdoor patients between January 2021 and December 2024. The inclusion criterion was the presence of symptoms of lower respiratory tract infection, irrespective of age and gender. Following collection in appropriate Viral Transport Medium (VTM) containers and transport to the laboratory, maintaining cold chain, the samples were subjected to Ribonucleic Acid (RNA) extraction and real-time Reverse Transcriptase Polymerase Chain Reaction (rtRT-PCR). Results: Out of 954 samples tested, 244 (25.6%) were found to be positive for RSV. In 2021, 50 out of 51 (98.04%) RSV positive samples showed presence of RSV A, while in 2022 and 2023, 155 out of 157 (98.7%) and 28 out of 32 (87.5%) RSV positive samples showed presence of RSV B, respectively. Conclusion: The present study illustrates the behaviour of RSV in the context of the post-COVID scenario in eastern India, demonstrating the preponderance of RSV B since 2022 and showing its winter predominance in contrast to the summer predominance it displayed in the pre-COVID era.

Enhancing Breast Cancer Knowledge through Structured Education among Self-Help Group Women of Reproductive Age: A Community-based Interventional Study from Rural Area of North Chennai, India

Santha Sheela Kumari, B Hemamalini, K Sowmini

Introduction: In rural India, one-third of women have not heard about breast cancer. This lack of awareness often leads to late diagnosis of the disease. Providing health education to Self -help Group (SHG) women could increase awareness within the community, thereby facilitating early diagnosis of the disease. Aim: To measure the effectiveness of health education on knowledge about breast carcinoma among SHG women of reproductive age in a rural area of North Chennai. Materials and Methods: This community-based interventional study was conducted among 80 SHG women, aged between 20 to 50 years, in a randomly selected village of Ponneri Taluk, Minjur Block, Tiruvallur District, Tamil Nadu, over a period of 12 months from December 2018 to December 2019. After collecting baseline data using a validated semi-structured questionnaire, all participants received education on breast cancer and breast self-examination through a structured teaching program conducted at an anganwadi centre. A post-intervention assessment was conducted after three months. Data were analysed using International Business Machine (IBM) Statistical Packages for the Social Sciences (SPSS) statistics version 21.0. Descriptive statistics summarised demographic characteristics and baseline knowledge scores. To assess the effectiveness of the structured teaching program, McNemar’s chi-square test was applied to evaluate changes in dichotomous knowledge responses before and after the intervention. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of participants was 36.68±9.96 years {mean±Standard Deviation (SD)}. Post-intervention, awareness that breast cancer is the most common cancer among women Increased from 28.8% to 56.3%. Recognition of the 35-50 age group as the most common for breast cancer occurrence rose from 28.8% to 52.8%. Understanding of the hereditary nature of breast cancer improved from 17.5% to 66.3% and awareness that breast cancer can be detected early increased from 10% to 65%. Knowledge of risk factors and signs of breast cancer improved significantly, with overall knowledge increasing by 1.3% to 63.7% for risk factors and from 0% to 83.7% for signs of breast carcinoma. These changes were statistically significant (p<0.05). Conclusion: The results of the present study suggest that there was poor awareness about breast cancer, its risk factors, signs, and symptoms among rural women, which could be improved through health education. However, to ensure this improvement, it is essential for women to undergo regular breast cancer screening.

Cervical Dysplasia among Women Living with HIV: A Comparative Accuracy of Different Screening Methods

Pratibha Chaddar, Juhi Agarwal, Sushruta Shrivastava

Introduction: Cervical cancer remains a significant public health concern, particularly among women living with Human Immunodeficiency Virus (HIV), due to the synergistic role of HIV in promoting high-risk Human Papillomavirus (HPV)-induced carcinogenesis. Early detection through effective screening methods is crucial to reduce morbidity and mortality. Aim: To determine the prevalence of cervical dysplasia and associated risk factors in HIV-positive females, and to compare the diagnostic accuracy of conventional cytology with alternative cervical screening methods. Materials and Methods: The present cross-sectional study was conducted at Gandhi Medical College from 1st August 2020 to 31st July 2021 after obtaining ethical clearance from the institute. A total of 250 HIV-positive females registered at the Antiretroviral Therapy (ART) Centre underwent cervical screening using conventional Papanicolaou (Pap) Smear, Liquid-Based Cytology (LBC), Visual Inspection With Acetic Acid (VIA), and Visual Inspection With Lugol’s Iodine (VILI). Data were compiled using Microsoft Excel and analysed using IBM Statistical Package for Social Sciences (SPSS) software version 20. Categorical data were presented as frequency and percentage, whereas continuous data were expressed as mean±standard deviation. Results: The mean age of the study participants was 38.01±9.18 years. Only 8 (3.2%) participants were aware of cervical screening, highlighting a critical gap in awareness. Risk factors significantly associated with abnormal cytology included age between 30-49 years, late menopause (46-50 years), higher parity, and CD4 count<500 (p<0.05). Liquid-Based Cytology demonstrated the highest sensitivity (100%) and negative predictive value, outperforming other screening methods. VIA and VILI showed positive findings in 16 (6.4%) and 9 (3.6%) cases, respectively, with VILI showing the highest specificity. Conclusion: Cervical dysplasia was detected in 9.6% of screened HIV-positive women (24 out of 250 women), highlighting a substantial burden of pre-invasive disease. The findings underscore the value of regular cervical screening using Pap smear, LBC, VIA, and VILI as effective tools for early detection. Integrating cervical cancer screening into routine HIV care and improving awareness among women living with HIV may substantially reduce HPV-related morbidity and mortality.

Instructional Video versus Real-time Demonstration for Training Phase I MBBS Students in Basic Clinical Skills: A Quasi-experimental Study

Sajitha Nandanan, Beena Kumari

Introduction: Clinical skill training is traditionally imparted through demonstrations, where students directly observe the procedure. However, with increasing student numbers and limited faculty, real-time demonstrations may face issues such as overcrowding, limited opportunities for supervision and inconsistency when taught by different faculty. Instructional videos for clinical skills are now gaining attention as an alternate teaching method. Aim: To compare the effectiveness of instructional video with real-time demonstration, for training in basic clinical skills, among phase I MBBS students, and to analyse the perception of students of the two methods. Materials and Methods: This quasi-experimental study was conducted in the Department of Physiology of Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India, from February 2025 to July 2025. It included 150 MBBS students of phase I. Six clinical skills in physiology were selected for teaching, which included knee jerk, biceps jerk, plantar reflex, pupillary light reflex, ocular movements and Rinne’s test. Students were divided into three batches of 50 each. Each batch was further divided into two groups of 25 each; one group was trained in a clinical skill by real-time demonstration, whereas the other group was taught using an instructional video, recorded in the department. Following the intervention, the students in both groups were assessed by an Objective Structured Practical Examination (OSPE) by faculty in the department. After three sessions, crossover was done so that all students could be exposed to both teaching methods. The preference of students to both methods was assessed by a 5-item Likert scale. The post-intervention OSPE scores were compared, and statistical analysis was performed using the Mann-Whitney U test. Results: Out of the 150 students included in the study, 108 were females and 42 were males. The participants were aged 18–21 years, with a mean age of 19.2±1.4 years.Students taught via instructional videos showed significantly higher median and mean OSPE scores for plantar reflex {median of 4 (IQR 3-4), mean score of 3.68±1.03, p-value <0.01} and pupillary reflexes {median=4, IQR (3-4.5), mean=3.8±0.91, p-value=0.001}. For the other skills, knee jerk, biceps jerk, ocular movements, and Rinne’s test, although differences were not statistically significant, the instructional video method showed higher central tendency measures. The mean preference score was significantly higher for instructional videos across all five items. Conclusion: Instructional videos were found to be an effective and preferred method for clinical skill training among students in phase I of the MBBS.

Complete Blood Count and C-reactive Protein in Influenza Positive Children versus Influenza Negative Children Admitted at a Tertiary Care Centre: A Retrospective Observational Study

Introduction: Children’s respiratory illnesses are primarily caused by Influenza A and B viruses, which frequently result in severe morbidity. Polymerase Chain Reaction (PCR) testing is still the gold standard for diagnosis, although it can be time-consuming and not always practical in environments with limited resources. Since influenza infections can produce characteristic alterations in haematological parameters and inflammatory markers, evaluating these changes may aid in early diagnosis and management. Aim: To compare Complete Blood Count (CBC) parameters and C-Reactive Protein (CRP) levels between influenza-positive and influenza-negative children. Materials and Methods: This retrospective cross-sectional study was conducted at the Department of Paediatrics at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India, between January 2023 and December 2023. It included 268 children aged 29 days to 5 years admitted with respiratory illness. Demographic, clinical, laboratory and outcome parameters like hospital stay, Oxygen requirement were obtained from medical records. Complete Blood Count (CBC) indices, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Platelet-To-Neutrophil Ratio (PNR), Lymphocyte multiplied by Platelet (Lym*Plt) and CRP levels were compared between influenza-positive and influenza-negative groups. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Mann-Whitney U test, Chi-square test and Receiver Operating Characteristic (ROC) curve analysis were applied. A p-value <0.05 was considered statistically significant. Results: The study showed that the median, Interquartile Range (IQR) age of the participants was 20 months (1 to 60 months). About 161 (60.1%) were male children and 107 (39.9%) were female children. About 100 (37.3%) had influenza A or B infections. About 168 (62.7%) had other associated infections. Median NLR (p-value <0.01) and Absolute Neutrophil Count (ANC) (p-value <0.003) were significantly higher in influenza-positive children compared to influenza-negative children. PNR (p-value <0.04) and lymphocyte count (p-value <0.014) were significantly lower in the influenza-positive group. ROC curve analysis shows that ANC, followed by NLR, PNR, and Lymphocyte, showed better discrimination for Influenza A or B infection. Conclusion: NLR, ANC, PNR, and lymphocyte counts demonstrated significant correlations with Influenza A and B infections. Infants showed a higher incidence of influenza, with no significant difference between gender. The observed haematological changes showed modest discriminatory ability and may serve as supportive adjunctive markers rather than definitive diagnostic tools. In low-resource settings, accessible parameters may improve diagnostic accuracy, support timely treatment, and enhance outcomes for children with respiratory illnesses.

Smartphone Addiction and Depressive Symptoms among Urban Adolescents in India: A Cross-sectional Study

K Smitha, AM Ashwin, SR Ravisha

Introduction: Smartphone use has increased rapidly among adolescents, raising concerns about excessive use and its association with mental health problems, particularly depression. This is particularly concerning during adolescence, a critical developmental period characterised by emotional, cognitive, and social changes that increase vulnerability to behavioural addictions. Excessive smartphone use may disrupt sleep, academic performance, and social interactions, potentially contributing to depressive symptoms. Aim: To determine the prevalence of smartphone addiction among adolescent and examine its relationship with depressive symptoms. Materials and Methods: A cross-sectional study was conducted among 1,120 adolescents aged 15-18 years between March and December 2018, in the Department of Paediatrics, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India. Smartphone addiction was assessed using the Smartphone Addiction Scale (SAS), and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics were computed for SAS and PHQ-9 scores. Associations between smartphone addiction and demographic variables were analysed using Chi-square test. Non normal PHQ-9 distributions across age groups were examined using the Kruskal-Wallis test. A p-value <0.05 was considered statistically significant. Results: A high prevalence of smartphone addiction was observed among the adolescents (86.7%), with males showing higher addiction levels than females. Participants in the high smartphone addiction group had significantly higher PHQ-9 scores and a greater proportion of moderate to severe depression compared with the low-use group (p-value <0.001). Conclusion: Smartphone addiction was common in this adolescent population and showed a strong association with depressive symptoms. These findings highlight the need for increased awareness, early identification, and targeted interventions to address problematic smartphone use among adolescents. Further longitudinal research is required to explore causal relationships and broader mental health implications.

Effect of Ultrasound-guided Pterygopalatine Fossa Block on Postoperative Pain Relief in Paediatric Adenotonsillectomy under General Anaesthesia: A Randomised Controlled Trial

Introduction: Adenotonsillectomy is a surgical procedure which involves removal of the adenoids and tonsils. Even though adenotonsillectomy is considered a day care procedure it is often associated with significant postoperative pain. An early and clear-headed recovery necessitates an effective postoperative pain management without any sedation related side-effects. Aim: To examine the effectiveness of ultrasound-guided Pterygopalatine Fossa (PPF) block in children undergoing adenotonsillectomy. Materials and Methods: The present randomised, double-blinded, controlled study was performed on 60 paediatric patients aged 6-16 years scheduled for adenotonsillectomy under general anaesthesia, in Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. Children were randomly allocated to receive either a bilateral suprazygomatic PPF block with 0.2% ropivacaine (Group R) or 0.9% normal saline (Group C). Pain levels were evaluated postoperatively using the modified Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) scale, Statistical analysis was performed with independent sample t-tests and Chi-square tests. Results: Sixty children between the ages 6-16 years were selected for the study. Group R had significantly longer duration of analgesia compared to Group C. The time to first analgesia (Group R-524±188.5 min vs Group C-92.8±95.3 min, p=0.0005). Also, there was statistically significant lower paracetamol consumption (27.4±8.1 mg/kg vs 53.3±7.23 mg/kg, p=0.0005) and shorter recovery time (7.8±1.0 min vs 15.9±4.1 min, p=0.0005) in children who received the block with ropivacaine. Also, Group R exhibited consistently lower pain scores at all post-extubation time points (p<0.001) and a significant reduction in sevoflurane consumption. These findings show effective pain control and improved perioperative outcomes. Conclusion: Ultrasound-guided suprazygomatic PPF block with ropivacaine is an effective technique for postoperative pain management in paediatric adenotonsillectomy patients, providing longer-lasting pain relief, faster recovery, lower pain scores, and stable perioperative haemodynamics, making it a beneficial addition to multimodal analgesic regimens.

Prescription Analysis of Analgesic Use at Admission in Orthopaedic Trauma Patients: A Cross-sectional Study from Tertiary Care Centre, Belagavi, Karnataka, India

K Arunkumar, Shivappa K Saidapur, Nayana K Hashilkar

Introduction: Analgesics form an essential part of the management of patients with orthopaedic trauma. Appropriate pain control helps in early mobilisation and recovery, whereas irrational prescribing can lead to adverse drug reactions and inadequate analgesia. Studying prescribing patterns is therefore important to assess rational drug use in hospital practice. Aim: To study the prescribing pattern and rationality of analgesic use at the time of hospital admission among inpatient orthopaedic trauma patients at a tertiary care hospital in Belagavi, Karnataka, India. Materials and Methods: This cross-sectional study was carried out in the Department of Orthopaedics, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India, from August 2025 to October 2025 at a tertiary care centre. A total of 250 inpatient orthopaedic trauma patients were included by the universal sampling. Data were obtained from prescription records using a structured proforma. Pain intensity was assessed using the Visual Analogue Scale (VAS). Prescriptions were analysed with respect to route of administration, number of analgesics prescribed, generic versus branded prescribing, compliance with the National List of Essential Medicines (NLEM), adherence to the World Health Organisation (WHO) analgesic ladder, and WHO core drug use indicators. The data were expressed as frequencies and percentages. Results: Injectable analgesics were prescribed in 180 patients (72.0%). Most patients received a single analgesic, accounting for 206 patients (82.4%), while 44 patients (17.6%) received two analgesics. Paracetamol was the most frequently prescribed drug and was used in 244 patients (97.6%), followed by tramadol in 23 patients (9.2%) and diclofenac in 20 patients (8.0%). Most drugs were prescribed by generic name in 223 patients (89.2%), and all prescribed analgesics were included in the NLEM in 250 patients (100%). Based on VAS scoring, moderate pain was observed in 105 patients (42.0%). WHO Step I analgesics were used in 215 patients (86.0%). Conclusion: The study showed that analgesic prescribing in orthopaedic trauma inpatients was generally consistent with principles of rational drug use with a preference for single-drug therapy, high use of generic medicines, and good compliance with the WHO analgesic ladder.

Clinical, Radiological and Spirometric Profiles in Post Tuberculosis Lung Disease Patients: A Cross-sectional Study

Manoranjan Dash, Smrutirekha Swain, Subhaprada Mishra, Rajesh Panigrahi

Introduction: Tuberculosis (TB) remains a primary global health concern, with significant post treatment sequelae affecting survivors. Pulmonary Tuberculosis (PTB) often leads to irreversible structural lung damage, collectively termed Post Tuberculosis Lung Disease (PTLD), which leads to chronic respiratory abnormalities, impacting Health-Related Quality of Life (HRQoL). Despite microbiological cure, patients continue to suffer significant morbidity; however, data on PTLD’s clinicoradiological profile and impact on Quality of Life (QoL) remain scarce. Aim: To characterise the clinicoradiological patterns, spirometry abnormalities and health-related QoL in PTLD patients. Materials and Methods: A cross-sectional study was conducted in the Department of Respiratory Medicine at SCB Medical College and Hospital, Cuttack, Odisha, India, from October 2022 to March 2024. It enrolled 103 microbiologically cured patients with PTB who had radiological sequelae. Of 103 patients initially screened, three were excluded (two for active TB, one for foreign body obstruction), resulting in a final analysis cohort of 100 patients with radiologically confirmed PTLD. Participants underwent a comprehensive assessment, including clinical symptom profiling, physical examination, chest radiography, High Resolution Computed Tomography (HRCT), American Thoracic Society/European Respiratory Society (ATS/ERS)-compliant spirometry and St. George’s Respiratory Questionnaire (SGRQ) for QoL evaluation. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 22.0, with non parametric tests (Kruskal-Wallis, Mann-Whitney U) and a significance threshold of p-value ≤0.05. Results: The mean age in the cohort was 51.39±13.73 years, with male predominance (71%). Common symptoms included cough (54%), breathlessness (40%) and haemoptysis (28%). Radiologically, fibrosis (56%) and emphysema (38%) were the predominant findings. Spirometry revealed a mixed pattern (52.1%) as the most common abnormality. SGRQ revealed severe QoL impairment (Total score: 58.8±10.6), with the Symptoms domain most affected (81.8±14.6). Haemoptysis was significantly associated with worse QoL (Total SGRQ: 67.5 vs. 52.3; p-value=0.008). Conclusion: PTLD leads to persistent respiratory symptoms, structural lung damage and impaired HRQoL. Early recognition and multidisciplinary management, including pulmonary rehabilitation and psychological support, are essential to mitigate long-term disability.

An In vivo Study Comparing the Evaluation of Test Characteristics of Chemiluminescent Illumination, Lugol’s Iodine and Toluidine Blue Staining in Patients with Oral Leukoplakia

Introduction: Oral Leukoplakia (OL), the most common among Oral Potentially Malignant Diseases (OPMDs), with a significant malignant transformation rate. Being asymptomatic and similar in appearance to various benign inflammatory and infectious lesions, its diagnosis is often challenging. Therefore, it is essential to detect and enhance both clinical and occult lesions, as the areas undergoing premalignant and malignant changes could be highlighted by in-vivo staining. Aim: To compare the test characteristics of chemiluminescence (ViziLite®), 1% Lugol’s iodine, and 1% toluidine blue in-vivo staining in patients with OL. Materials and Methods: This in-vivo study screened intraoral white and mixed lesions, recording details about tobacco habit and past medical history at the Vydehi Institution of Dental Sciences and Research Centre, Bengaluru, Karnataka, India Outpatient Department from March 2020 to March 2021. After 10-14 days, allowing resolution of any intraoral trauma, 30 patients with OL and 15 patients with frictional keratosis underwent chemiluminescent illumination, 1% Lugol’s iodine, and 1% toluidine blue in-vivo staining. Three observers (κ statistic 0.85) concluded the staining results. The positive samples, at least one stain were biopsied and histopathologically assessed by blinded oral pathologists to report Oral Epithelial Dysplasia (OED). Chi-square test compared and correlated individual staining results with each other and with the histopathological diagnosis, for calculation of sensitivity, specificity, accuracy, predictive values, and the area under the Receiver Operating Characteristic (ROC) curve using Area Under Curve (AUC). Results: The chemiluminescence test was highly sensitive (96.6%) but a had the lowest specificity (0%), with a diagnostic accuracy of 93.3%, and its ROC indicated a poor overall test. Lugol’s iodine demonstrated desirable sensitivity (85.2%) and 100% specificity, identifying the one true negative sample, with its ROC indicating excellent performance except for keratinised oral mucosa. Toluidine blue showed high sensitivity (93.1%) but 0% specificity, as it identified all the true positives but failed to detect the one true negative. The diagnostic accuracy was 90.0%, although the ROC graph revealed contradictory results about Toluidine Blue staining. Among the three tests, Lugol’s iodine results were statistically significant (p=0.029). Conclusion: In the present study, 1% Lugol’s Iodine showed better test characteristics compared to chemiluminescence and 1% toluidine blue for screening patients with OL, except for lesions on the hard palate and gingival sub-sites.

Influence of Childhood Sleeping Disorders on Traumatic Dental Injuries and Body Mass Index among School Children: A Cross-sectional Study

Introduction: Sufficient sleep is a crucial factor in child’s behaviour and overall well-being. Observable indications of insufficient sleep among youngsters include increased daytime drowsiness and frequently being late or absent from school. Furthermore, potential consequences encompass overeating, weight gain, and increased vulnerability to accidental injuries. Research suggests that reduced sleep duration corresponds with elevated Body Mass Index (BMI) levels and an elevated risk of Traumatic Dental Injuries (TDIs) in obese children. Studies have shown that overweight/obese children have a higher prevalence of TDI compared to lean children, with urban Indian schoolchildren at particular risk, though research on the link between TDI and sleep problems remains limited. Aim: To determine any association between childhood sleeping disorders with TDI and BMI among school children. Materials and Methods: The present cross-sectional study was done from January 2020 to March 2021 including children (6-13 years age) from the Department of Paediatric and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, and local schools of Kolkata suburban region, West Bengal, India using a simple random sampling method. The children’s BMI was calculated using the Centers of Disease Control and Prevention (CDC) BMI calculator for child and adolescent, and a visual inspection for signs of TDI was conducted following the International Association of Dental Traumatology (IADT) (2020) guidelines. Parents were provided with Sleep Behaviour Questionnaires (SBQ) and guidance for completion. Subsequently, the collected data was compiled and analysed statistically with SPSS software version 20 using Kruskal Wallis test A p-value of 0.05 was considered significant. Results: The study identified a TDI prevalence of 153 (25.5%) among 600 participants. Significant association (p=0.033) was observed between TDI and SBQ scores. Mean SBQ scores reflected a BMI-related trend (obesity> overweight> healthy), indicating that overweight or obese children experience more sleep issues. The link between TDI and BMI was notably strong (p<0.001), with individuals having high BMI being 2.436 times more likely to exhibit TDI. Conclusion: The present study provides a positive correlation among childhood sleeping disorders, TDIs and BMI among school children. Information gathered about sleep habits before a dental visit can help educate parent/caregivers on preventing dental injuries.

Diagnostic Accuracy of Scrape Cytology in Comparison to Histopathology in Neoplastic Breast Lesions: A Cross-sectional Study

Sweta, Mukta Saini, Mayank Agrawal, Rajeev Sen

Introduction: Breast cancer is a predominant health issue among women, and has high morbidity and mortality rates. A diverse array of imaging techniques are available ranging from mammography and breast-specific gamma imaging to nanomedicine. Histopathological Examination (HPE) is the definitive standard for diagnosing breast lesions. The drawback of histopathology lies in its reliance on protracted processing methods, resulting in delayed reporting, rendering it unsuitable for intraoperative diagnosis where scrape cytology may serve as an option for early detection as well as treatment. Aim: To study the accuracy of scrape cytology in comparison to histopathology in neoplastic breast lesions. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, SGT Medical College Hospital and Research Institute, Gurugram, Haryana, India, for a period of two years from June 2022 to May 2024 This study included Fine Needle Aspiration Cytology (FNAC) confirmed 170 postoperative lumpectomy and mastectomy specimens for neoplastic lesions. All specimens were received in 10% neutral buffered formalin. Areas of growth were grossly identified and scraped with a scalpel. After cytological smear preparation the formalin fixed specimens were prepared for HPE and stained with Haematoxylin and Eosin (H&E) stains. The diagnostic accuracy of scrape cytology in comparison to histopathological diagnosis was done by Chi-square test. Results: Out of total 170 cases, 94 were found to be benign and 76 were found to be of malignant aetiology on scrape cytology, which was confirmed by HPE. In the study, 168 cases were diagnosed accurately with a diagnostic accuracy of 98.82%. Among the benign cases, fibroadenoma was the most common diagnosis, accounting for 74 cases. In the malignant group, Invasive Ductal Carcinoma (IDC) was the most frequent diagnosis, with 54 cases. Of 94 cases identified as benign in scrape cytology, 92 came out to be benign, and 02 cases were diagnosed as malignant on histopathology that included 01 case of malignant Phyllodes tumour and 01 case of lobular carcinoma. Conclusion: Scrape cytology was compared to HPE, which is considered the gold standard for diagnosis. Scrape can be utilised in resource-limited locations with no special instruments or equipment required compared to histopathology. Scrape is also helpful in studies where FNAC yields non diagnostic results and can improve interpretation skills of FNAC.

Expression of c-Myc in Invasive Breast Carcinoma of No Special Type: A Cross-sectional Study

Indranil Das, Ranjita Panigrahi, Ajit Kumar Singh, Sabyasachi Parida

Introduction: Breast cancer is the most common malignancy among women worldwide, accounting for approximately 30% of all female cancers. It is the second leading cause of cancer-related mortality among women globally, with a median age of 61 years at diagnosis. Aberrant expression of c-Myc leads to genomic instability and tumourigenesis. Cellular Myelocytomatosis Oncogene (c-Myc) regulates the Tumour Microenvironment (TME) and plays a role in angiogenesis and stromal cell proliferation. Its overexpression in Invasive Breast Carcinoma (IBC) is associated with poor prognosis. Targeting c-Myc may offer therapeutic benefits, as its inhibition sensitises breast cancer cells to chemotherapy and radiotherapy. However, its role in diagnosis and treatment of IBC warrants further evaluation. Aim: To study the expression of c-Myc in Invasive Breast Carcinoma of No Special Type (NST). Materials and Methods: The present cross-sectional study was conducted at KIMS, Bhubaneswar, Odisha, India, from March 2023 to March 2025, and included 55 histologically confirmed cases of IBC. Immunohistochemistry (IHC) for Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2/neu), Ki-67, and c-Myc was performed in all cases. c-Myc expression was evaluated, and overexpression was defined as ≥20% of tumour cells showing moderate to strong nuclear staining. The association of c-Myc overexpression with various clinicopathological parameters, including age, laterality, histological grade, Ductal Carcinoma In Situ (DCIS), Lymphovascular Invasion (LVI), Perineural Invasion (PNI), tumour stage, nodal stage, nodal status, ER, PR, HER2/neu status, molecular subtypes, and Ki-67 index, was analysed. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 26. The Pearson’s chi-square test was used for categorical variables, and a p-value <0.05 was considered statistically significant. Results: Out of 55 cases, moderate to strong nuclear staining was observed in 20 cases (36.36%), weak staining in 13 cases (23.63%), and negative staining in 22 cases (40.00%). c-Myc nuclear positivity showed a significant association with the presence of a DCIS component (p=0.026) and with molecular subtypes (p=0.05). c-Myc overexpression also showed statistically significant associations with nodal status (p=0.04) and the presence or absence of DCIS (p=0.046). Conclusion: c-Myc plays an important role in the progression of breast carcinoma and can be effectively evaluated by IHC. In the present study, c-Myc overexpression showed statistically significant associations with positive nodal status and presence of DCIS components in IBC. Therefore, c-Myc may serve as a prognostic biomarker for predicting clinical outcomes in patients with IBC. Further studies with larger sample sizes are essential to better elucidate the role of the c-Myc pathway. Evaluation of c-Myc overexpression may open new avenues for targeted management of breast carcinoma.

Impact of Medicated Vegetable Wash versus Lukewarm Water on Pesticide Residue Levels in Brassica oleracea: An In-vitro Study

Krup Vasavda, Rekha Parmar, Ravi Kalsariya, Hemant Toshikhane

Introduction: Fresh vegetables and fruits are essential sources of micronutrients and macronutrients vital for human health. Pesticides are primarily employed to enhance agricultural yield; however, it is important to recognise that they pose significant risks to human health. These chemicals can be toxic and may cause acute or chronic health effects depending on the nature, duration, and level of exposure. Aim: To evaluate the effectiveness of different medicated vegetable washes in removing pesticide residues from Brassica oleracea. Materials and Methods: This in-vitro study was conducted at the All India Network Project on Pesticide Residues, ICAR Unit-9, Anand Agricultural University, Anand, Gujarat, India. The study focused on three commonly used pesticides: chlorantraniliprole, emamectin benzoate, and chlorpyrifos. Succulent cauliflower (Brassica oleracea) was selected as the test vegetable and was exposed to the selected pesticides. Residue analysis was performed using advanced gas chromatography–mass spectrometry (GC–MS/MS). Results: The results demonstrated a substantial reduction in pesticide residues, with removal rates of 80.52%, 58.82%, and 36.02% for chlorantraniliprole, emamectin benzoate, and chlorpyrifos, respectively. The greatest reduction was achieved using medicated water, followed by lukewarm water, highlighting a promising approach in enhancing food safety. Conclusion: Medicated water was effective in reducing pesticide residues on vegetables. Increasing public awareness of this method and promoting traditional washing practices may enhance food safety and provide consumers with healthier produce.

Association Between Menstrual Disorders and Stress, Anxiety and Depression among Female Medical Students: A Cross-sectional Study

Sonali Sain, Surajit Lahiri, Atanu Biswas, Nitish Kumar Sen

Introduction: Menstrual disorders are common health problems among female medical students. Medical students are exposed to substantial academic and occupational stress, which may be exacerbated by co-existing menstrual disorders. Aim: To assess the occurrence of menstrual disorders and their association with stress, anxiety and depression among the female medical students. Materials and Methods: This Institution-based, cross-sectional study was conducted among all female medical students at the Department of Community Medicine of Bankura Sammilani Medical College and Hospital, West Bengal, India, over 6 months from January 2023 to June 2023. A structured interview was conducted among 520 female medical students. The questionnaire consisted of two parts. The first part contained the information regarding the socio-demographic profile, and personal and menstrual history. The second part contained the questions from DASS 21 (Depression, Anxiety and Stress Scale 21) tool. Inferential statistical analysis was performed using MS Excel and Epi Info. Results: A total of 441 participants (84.8%) had at least one menstrual disorder, including 177 (34.03%) from dysmenorrhoea and 159 (30.57%) from menorrhagia and metrorrhagia. Among the 441 subjects who had menstrual disorders, 176 (39.90%) suffered from stress, 242 (54.87%) suffered from anxiety, and 232 (52.60%) suffered from depression. Participants with menstrual disorders had higher odds of depression (OR=1.23) and anxiety (OR=1.52), but lower odds of stress (OR=0.77); however, the findings were not statistically significant (p-value >0.05). Conclusion: Although menstrual disorders were highly prevalent, no significant association was observed between menstrual disorders and stress, anxiety and depression among female medical students.

Evaluation of Correlation between Psoriasis Severity and Proteinuria: A Cross-sectional Study

S Krishnapriya, Dhanin Puthiyottil, VP Aneeb Raj, Bifi Joy

Introduction: Psoriasis is a chronic inflammatory skin disease characterised by well demarcated erythematous scaly plaques. Psoriasis has been found to be associated with various systemic involvement including renal, metabolic syndrome and cardiovascular abnormalities. The association between psoriasis severity, chronicity and proteinuria is documented in literature. Understanding this relationship may help in early identification of subclinical renal involvement and guide timely intervention. Aim: To assess the correlation between albuminuria with chronicity and severity of psoriasis. Materials and Methods: The present cross-sectional study included 50 patients with psoriasis who fulfilled the inclusion and exclusion criteria, who were studied for a period of 12 months from April 2024 to March 2025. The study was conducted in the Department of Dermatology at the Government Medical College Kannur, Kerala, India. After obtaining consent, detailed history was taken and clinical examination was done. The severity of psoriasis was assessed by psoriasis Area Severity Index (PASI) and chronicity by the duration in days from the diagnosis. Urine Albumin Creatinine Ratio (UACR) was measured in these patients. The estimated Glomerular Filtration Rate (eGFR) was calculated in all patients using CKD-EPI equation. Descriptive statistics like frequency, percentage, mean and standard deviation were used for statistical analysis. Correlation between UACR values with PASI score were measured by Spearman rank correlation coefficient. All p-values <0.05 were considered significant. Results: Out of the 50 patients who were enrolled in the study, 54% (n=27) were males. Duration of psoriasis ranged between 84-17885 days. The mean±SD of eGFR was found to be 87.5±22.97 in mL/min/1.73 m2. The PASI score ranged from 1 to 12 with mean±SD of 3.9±2.28. The UACR ranged from 1.5 to 33.0 mg/g with a mean±SD of 7.76±7.33. Among the 50 patients, UACR levels very weak positive correlation with PASI which was not statistically significant (p=0.684). Among the 50 patients, UACR levels showed a very weak positive correlation with chronicity, which was not statistically significant (p=0.387). Conclusion: The present study could find a very weak positive correlation between severity and chronicity of psoriasis and UACR levels. However, there was no statistically significant correlation between neither with chronicity nor with the severity. The take home message is at least in relatively less severe cohort of psoriasis UACR may not be a strong independent marker of renal involvement.

Variations of Nutrient Foramina in Dry Adult Femur Bones: A Cross-sectional Study from Gujarat, Western India

Introduction: Nutrient foramina in the femur serve as critical entry points for nutrient arteries supplying the bone marrow and inner two-thirds of the bone, playing a vital role in bone growth and healing. Understanding these variations is essential in orthopaedic surgery to prevent vascular injury and promote fracture healing. Aim: To determine the prevalence, placement, number, location, size, and direction of nutrient foramina in adult dry femora. Materials and Methods: A cross-sectional osteological study was conducted in the Department of Anatomy, Government Medical College, Vadodara, Gujarat, India, from August 2013 to January 2014, on 311 dry adult femora. The parameters assessed included total oblique length, zonal distribution (proximal, middle, and distal thirds), surface placement, number, size (categorised by needle gauge), and direction of the nutrient foramina. Data were descriptively analysed using Statistical Package for Social Sciences (SPSS) 23.0 (IBM Corp., Armonk, NY, USA). Results: The mean oblique length of the femur was 42.65±2.8 cm (range, 34-50 cm). All femora exhibited nutrient foramina, with 510 foramina identified. Most foramina were located in the middle third of the shaft (68.6%), predominantly on the posterior surface (69%). Most femora had one (52%) or two (44.4%) nutrient foramina. Sizes varied, with large foramina (>0.81 mm) being most common (51.8%). The direction was predominantly upward, away from the knee joint, with only one rare downward case observed, and all identified foramina appeared patent on gross examination. Conclusion: The present study, which was conducted on a large sample size, demonstrated a relatively consistent pattern within the studied sample in the distribution, size, direction, and patency of the femoral nutrient foramina. These findings provide reliable anatomical data to assist orthopaedic surgeons in preserving femoral vascularity and reducing the risk of delayed union or non union of fractures.

Comparative Evaluation of Single-donor Plateletpheresis using Haemonetics^® MCS^® Plus and Trima Accel^®: A Retrospective Study from a Tertiary Cancer Centre, India

Lekshmi Sudev, K Vijayalakshmi

Introduction: Single-Donor Platelets (SDPs) collected through automated apheresis systems are essential for transfusion support in thrombocytopenic patients. The performance of cell separators varies with their centrifugation technology and operating protocols. Aim: To compare the procedural efficiency, product quality, and donor safety of single donor plateletpheresis performed using Haemonetics^® MCS^® Plus and Trima^® Accel systems at a tertiary cancer centre in India. Materials and Methods: A retrospective analysis was conducted at the Division of Transfusion Medicine, Regional Cancer Centre, Thiruvananthapuram, Kerala, India, on 414 SDP procedures (207 with each system) performed between January and March 2023. Donor demographics, procedural parameters, and product quality were assessed. Key metrics included platelet yield, collection efficiency, blood volume processed, procedure duration, anticoagulant use, and donor reactions. Data were analysed using t-test or Wilcoxon rank-sum test for continuous variables and Chi-square or Fisher’s-exact test for categorical variables, with p-value <0.05 considered significant. Results: The Trima Accel^® system demonstrated a shorter procedure time (49.25±7.67 minutes vs 62.55±8.00 minutes; p-value <0.001), lower blood volume processed (2489.25±154.26 mL vs. 2668.87±268.85 mL; p-value < 0.001), higher collection efficiency (64.0±12.0% vs. 60.0%±8.0; p-value=0.003), and fewer adverse reactions (9.2% vs. 16.4%; p-value=0.039) compared with Haemonetics^® MCS^® Plus. Platelet yield and product quality were comparable between both systems. Conclusion: Trima Accel^® demonstrated better procedural efficiency, donor safety, and product consistency compared to Haemonetics^® MCS^® Plus, while maintaining comparable platelet yield and quality.

Survival and Risk Modelling of Mucormycosis Outcomes in Post COVID-19 Era: A Retrospective Observational Study

Introduction: Mucormycosis is a rare but potentially lethal fungal infection with a high morbidity and fatality rate that is brought on by filamentous fungi. With high death rates, mucormycosis has become a serious opportunistic illness, especially in the post Coronavirus disease 2019 (COVID-19) period. With more instances reported globally, the COVID-19 pandemic has reignited interest in this pathogen. Understanding the time to adverse outcomes and their predictors can inform clinical prioritisation and resource allocation to reduce mortality. Aim: To evaluate survival time and identify independent predictors of mortality among hospitalised mucormycosis patients using time-to-event analysis. Materials and Methods: This retrospective observational study was conducted at the Department of Community Medicine, Dr. V.M. Government Medical College, Solapur, Maharashtra, India, a tertiary care government hospital, from April 2025 to June 2025. A total of 270 confirmed mucormycosis cases admitted between January 2021 to December 2022 were included. Survival analysis using the Kaplan-Meier method was performed to estimate survival probabilities and compared using the log-rank test. Hazard ratios (HRs) and 95% Confidence Intervals (CIs) were computed for each covariate. Statistical analysis was done using IBM Statistical Package for Social Sciences (SPSS) statistics version 25.0, with p-value <0.05 considered statistically significant. Results: Of 270 patients, 66 (24.4%) died. Older age (>60 years), COVID-19 positivity, and absence of surgical intervention were significantly associated with reduced survival. Patients aged 20-40 years (HR=0.24; 95% CI: 0.08–0.68; p-value=0.008) and 41-60 years (HR=0.57, p-value=0.03) had better survival compared to those >60 years. COVID-19 positivity increased mortality risk nearly two-fold (HR=1.92, p-value=0.015). Lack of surgical intervention was associated with a markedly higher hazard of death (HR=4.57, p-value <0.001). Conclusion: Advanced age, COVID-19 positivity, and absence of surgical management independently predicted mortality in mucormycosis patients. Early diagnosis and timely surgical intervention are crucial to improving survival in the post pandemic period.

Use of Albumin in Children with Dengue Shock: A Prospective Interventional Study from a Tertiary Care Hospital in Southern India

V Revathi, Chandan Kumar Kalal, S Jagadeeswari

Introduction: Dengue Shock Syndrome (DSS) is a major cause of paediatric morbidity and mortality in tropical regions. While isotonic crystalloids remain first-line therapy, a subset of children remains haemodynamically unstable and requires rescue fluids. Evidence supporting albumin use in paediatric DSS is limited. Aim: To evaluate the effectiveness and safety of 5% human albumin in children with dengue shock unresponsive to crystalloid resuscitation. Materials and Methods: This prospective interventional study was conducted in the Paediatric Intensive Care Unit (PICU) of the Department of Paediatrics, Sree Balaji Medical College Hospital, Chennai, Tamil Nadu, India, a tertiary care teaching hospital, from June 2024 and December 2024. Children aged 1-12 years with DSS who failed to stabilise after 30 mL/kg of isotonic crystalloids and subsequently received 5% albumin were included. Clinical parameters, laboratory values, fluid requirements, adverse events, and outcomes were analysed. Statistical analysis was performed using paired t-tests and descriptive statistics. Results: Of 357 dengue admissions, 126 (35.3%) developed DSS. Fifty-eight children received albumin (mean age 7.2±3.1 years; 55% males). Mean time to shock reversal was 4.6±1.2 hours. Four children (6.9%) required a second albumin bolus. Haematocrit decreased significantly (45.3±6.2% to 39.8±5.5%; p-value=0.003) and platelet counts improved over 48 hours (42.1±15.7×103/μL to 78.5±22.3×103/μL; p-value=0.001). Two children developed mild transient allergic reactions; no serious adverse events or mortality occurred. Mean hospital stay was 5.3±1.6 days. Conclusion: In children with dengue shock refractory to crystalloids, albumin was effective and safe as a rescue fluid. Its use was associated with early shock reversal and favourable clinical outcomes without significant adverse effects. Larger multicentre studies are required to define its optimal role.

Co-occurrence of bla_OXA-23 and bla_NDM-1 Genes in Carbapenem-resistant Acinetobacter baumannii Isolated from Bloodstream Infections: A Cross-sectional Study

Kannika Parameshwari Kannan; AS Smiline Girija; J Vijayashree Priyadharsini

Introduction: Acinetobacter baumannii is a clinically significant Multidrug-Resistant (MDR) pathogen and a organism recognised by the World Health Organisation (WHO) due to its remarkable capacity to survive in hospital environments and acquire resistance determinants, particularly against carbapenems. Aim: To investigate the prevalence of bla_OXA-23 and bla_NDM-1 resistance determinants in carbapenem-resistant A. baumannii (CRAB) strains associated with Bloodstream Infections (BSIs) among Intensive Care Unit (ICU) patients. Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of Microbiology, Saveetha Medical College and Hospitals, Chennai Tamil Nadu, India, from March 2023 to January 2025. A total of 36 non duplicate A. baumannii isolates were recovered from ICU patients diagnosed with BSIs. Bacterial identification and antimicrobial susceptibility profiling were carried out using the VITEK^® 2 automated system. Molecular detection of the bla_OXA-23 and bla_NDM-1 resistance genes was performed by Polymerase Chain Reaction (PCR), followed by confirmation through Sanger sequencing. Sequence homology was evaluated using BLASTn, and multiple sequence alignment was employed to examine genetic variability among the isolates. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS), applying Fisher’s exact test, with a p-value <0.05 considered statistically significant. Results: All isolates exhibited high resistance to β-lactams, fluoroquinolones, carbapenems, and aminoglycosides, while complete susceptibility was observed to tigecycline and colistin. The bla_OXA-23 gene was detected in 34 (94.4%) of isolates, and bla_NDM-1 in 19 (53%), with both genes co-existing in 19 (53%) of strains. Sequence analysis of representative amplicons showed 100% identity with reference bla_OXA-23 and bla_NDM-1 genes in BLASTn analysis. A significant association between bla_OXA-23 and bla_NDM-1 was observed (p-value=0.018). Conclusion: The study confirmed the presence of bla_OXA-23 and bla_NDM-1 genes among clinical isolates of A. baumannii, demonstrating their strong association with carbapenem resistance. Sequencing revealed minor allelic variations but high conservation, indicating genetic stability for these resistance determinants. The co-existence of both genes suggests synergistic mechanisms contributing to MDR, underscoring the importance of continuous molecular surveillance and effective antimicrobial stewardship strategies.

Effect of Vitamin E and Evening Primrose Oil on Pain and Lump Size in Women with Fibrocystic Breast Disease: A Prospective Interventional Study

K Sasi Kumar, Suraj Subramaniam S

Introduction: Fibrocystic Breast Disease (FBD) is a common benign breast condition among women of reproductive age, frequently presenting with breast pain and palpable lumps. Although Vitamin E and Evening Primrose Oil (EPO) are widely used as non hormonal treatments for symptomatic relief, evidence regarding their effectiveness in reducing lump size remains limited and inconsistent. Aim: To evaluate the effect of Vitamin E and EPO on pain reduction and lump size among patients presenting with breast pain and palpable breast lumps. Materials and Methods: A prospective interventional study was conducted among patients attending the Outpatient Department (OPD) of General Surgery at G. Kuppuswamy Naidu Memorial Hospital (GKNMH), a tertiary care multispecialty hospital in Coimbatore, Tamil Nadu, South India, between May 2023 and October 2024. A total of 92 women presenting with breast pain and palpable breast lumps attending the OPD were recruited through purposive sampling. Women with pain were assessed with the Visual Analogue Scale (VAS), and those with palpable lumps underwent radiological examination. Radiological examination was performed based on age. Following the clinical examination, women participants were equally distributed into the Vitamin E oil group (n=46) and the EPO group (n=46) using a random number allocation method. Women who got even numbers received a Vitamin E capsule of 600 mg, and those with odd numbers received EPO of 1000 mg, and the outcomes were assessed after 30 days. Changes in the pain level and lump size at the end of the treatment were presented as frequency and proportion. Paired t-test and Independent t-test were used to compare within-group and between group difference in pain score and lump size. Results: Among the 92 patients who were recruited, 44 (47.8%) were in the age group of 41-50 years. Almost two-thirds 69 (75.0 %) of them were menstruating, of whom the majority 61 (88.4%) reported having regular menstrual cycles. Pain was the predominant presenting symptom in 79 (85.9%), and most of them had no co-morbidities 70 (76.1%). During the follow-up, among women who received Vitamin E oil, 32 (80.0%) reported pain regression, and 7 (77.7%) reported lump regression, and among women who received EPO, 34 (87.2%) reported pain regression, and 10 (100.0%) reported lump regression. There was no statistically significant difference observed between the two groups. Conclusion: Both Vitamin E and EPO were effective in reducing pain and lump size; However no statistically significant difference was observed between the two groups, indicating comparable effectiveness of the interventions, making it a suitable alternative treatment option for FBD.

ACE2 Centred Co-expression Network and Pathway Enrichment Analysis of Immune Regulatory Mechanisms in Oral Squamous Cell Carcinoma: An In-silico Study

Shivani Sivasakthivel, Pratibha Ramani

Introduction: Angiotensin-Converting Enzyme 2 (ACE2), the viral entry cellular receptor for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been recently known for its regulatory activity in Tumour Microenvironment (TME). ACE2 acts by local renin angiotensin dynamics through its influence on immune signalling and tissue remodelling. Even though the ACE2 expression is detected in Oral Squamous Cell Carcinoma (OSCC), its molecular role in OSCC remains unclear. Aim: To identify the ACE2 associated immune networks and biological pathways in OSCC using transcriptomic analysis. Materials and Methods: This was an in-silico transcriptomic and bioinformatic based observational study, was conducted in October 2025 in the Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. Transcriptomic data from the GSE9844 dataset (26 OSCC and 12 normal tongue samples) were analysed with an integrated bioinformatics approach. Gene-wise Spearman correlations with ACE2 were computed using R software (version 4.2.0), followed by preranked Gene Set Enrichment Analysis (FGSEA) and single-sample GSEA (ssGSEA) using the GSVA package (version 1.46.0) to identify Hallmark pathways enriched in ACE2 associated expression profiles. Leading-edge genes from overlapping pathways were used to construct a Protein–Protein Interaction (PPI) network in Search Tool for the Retrieval of Interacting Genes/Protein (STRING) database (version 11), and hub genes were determined by degree centrality. Results: ACE2 expressions have shown statistically significant positive associations with immune-related pathways, including Interferon-α/γ (IFN), Tumour Necrosis Factor (TNF-α)/ Nuclear Factor kappa-light-chain-enhancer of activated B cell (NF-κB) signalling, Interleukin-6 (IL-6)-Janus Kinases (JAK)- Signal Transducer and Activator of Transcription 3 (STAT3) activation, and inflammatory pathways with a Spearman correlation coefficient (ρ) >0.25 and a False Discovery Rate (FDR) <0.05 in both enrichment algorithms. Molecular network analysis identified STAT 3, Vascular Endothelial Growth Factor A (VEGFA), Mitogen-Activated Protein Kinase (MAPK1) and Matrix Metalloproteinase (MMP) as key hubs regulating immune, angiogenic, and extracellular matrix remodelling processes in oral cancer. The ACE2 subnetwork has been identified adjacent to Dipeptidyl peptidase 4 (DPP4), Basigin (BSG) (CD147), and cytokines (IL-6, TNF), indicating potential crosstalk between ACE2 and inflammatory mediators. These findings show ACE2 within an IFN-driven, STAT3 centred regulatory framework in OSCC. Conclusion: Present study highlighted that ACE2 is closely linked with IFN, inflammatory signalling pathways in OSCC, suggesting its role in regulating the tumour immune microenvironment. ACE2 gene is strongly associated with STAT3, VEGFA, MAPK1, and MMP9 that indicates the involvement in immune modulation and tissue remodelling, positioning ACE2 as a potential biomarker for immune activity and tumour progression in oral cancer.

Histomolecular Trends of Breast Carcinoma: Insights from Tertiary Care Centre of Northern India

Priyanka Seth, Aminder Singh, Harpreet Kaur, Kunal Jain, Pragya Sharma

Introduction: The most prevalent cancer among women worldwide is breast cancer. This can be separated into three molecular subtypes: Luminal, HER2-enriched, and triple negative. There is significant regional variation in epidemiology profile of this malignancy in India. The present study provides insightful information about breast cancer cases from North India. Aim: To study the distribution and patterns of histomorphology and molecular subtypes of carcinoma breast over a period of one year. Materials and Methods: The present prospective cross sectional study conducted in a Tertiary Centre in Ludhiana, Punjab, India, over a period of 12 months (September 2022 to September 2023). All cases of Invasive Breast Carcinoma (IBC) undergoing Immunohistochemistry (IHC) testing were included in the study. A total of 15,395 biopsy and surgical specimens were received during this period, out of which 203 cases were of IBC on which IHC testing was done. Molecular subtypes were determined using expression of oestrogen and progesterone receptors, HER2/neu and Ki-67. Additional markers including CK, GATA-3, mammaglobin, CK5/6, SOX-10, p40, Vimentin, etc., were put, wherever required. Trends of molecular subtypes and histomorphology were studied. The histopathology parameters included Modified Bloom Richardson (MBR) grade, Ductal Carcinoma In Situ (DCIS) (pattern and grade), tumour necrosis, skin invasion, lymphovascular and perineural invasion, tumour margins, lymph node status, Extranodal Extension (ENE) (if any), etc. All collected data was entered into Microsoft Excel spreadsheet and anaysed using software Statistical Package for Social Sciences (SPSS) 26. Normality of continuous variables was assessed using Shapiro-Wilk test, and data was presented as mean ± Standard Deviation (SD). Fisher-exact test was utilised if any of the frequencies were <5, and the Chi-square (χ2) test was used to examine the association between categorical variables. Results: Infiltrating Duct Carcinoma (IDC), NOS formed the largest histological group 181 (89.2%) cases with majority - (115; 56.6%) belonging to MBR grade 2. Majority cases belonged to pT2 106 (68.8%) without any nodal involvement 68 (54.4%). Among the molecular subtypes, Luminal-B emerged as the most prevalent 110 (54.2%) cases, followed by Triple negative 51 (25.1%), HER2/neu enriched 28 (13.8%); and Luminal-A 14 (6.9%). Conclusion: Looking at the deviation from the established patterns and significant heterogeneity in its pathological features and molecular characteristics, there is a need of region-specific breast cancer profiling and tailored management guidelines. This will deliver more efficient, equitable, and personalised breast cancer care to patients, while ultimately contributing to a reduction in morbidity and mortality.

Trends and Determinants of Maternal Mortality: A Seven-year Retrospective Analysis from a Tertiary Care Hospital in Kashmir, India

Ruksana Sami, Najma Saqib, Sheikh Fahad

Introduction: Maternal mortality remains a critical indicator of healthcare quality and access, particularly in low- and middle-income settings. Despite progress in India, regional disparities persist, with the union territory of Jammu and Kashmir facing unique challenges in timely obstetric care. Aim: To analyse the trends, causes, and demographic distribution of maternal deaths over seven years at a Tertiary Maternity Hospital in Kashmir, India. Materials and Methods: The present retrospective analysis was conducted at LD Hospital, Srinagar, Kashmir, India, including all maternal deaths from April 2018 to March 2025. Data on age, referral status, residence, and cause of death were extracted from hospital records and analysed using descriptive statistics. Results: Among 151,870 live births, 173 maternal deaths occurred, yielding an overall Maternal Mortality Ratio (MMR) of 114 per 100,000 live births. MMR peaked at 141 in 2021-22 during COVID-19 disruptions and declined to 71 in 2024-25. The mean age of deaths was 29.7 years, and approximately 70% were referrals. Conclusion: Although maternal mortality declined after 2022, preventable causes remain predominant. Strengthening referral systems and timely emergency obstetric care are essential to further reduce maternal deaths.

Comparison of Hyperbaric Ropivacaine (0.75%) with Hyperbaric Bupivacaine (0.5%) for Spinal Anaesthesia in Lower Limb Surgeries: A Randomised Clinical Study

Sachin Beohar, Parul Jain, Mohan Babu Nema

Introduction: Spinal anaesthesia, also known as subarachnoid block, is the most commonly used anaesthetic technique for lower limb and lower abdominal surgeries due to its good safety profile and high success rate. Hyperbaric bupivacaine has long been the preferred agent for spinal anaesthesia. However, ropivacaine is less potent and has a shorter duration of action compared to bupivacaine. Aim: To compare hyperbaric ropivacaine (0.75%) with hyperbaric bupivacaine (0.5%) for spinal anaesthesia in patients undergoing lower limb surgeries. Materials and Methods: This single-blinded randomised clinical study was conducted in the Department of Anaesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India, over a period of 12 months from 1st October 2022 to 30th September 2023. A total of 80 patients aged between 18 and 60 years, posted for lower limb surgeries, were enrolled and randomly allocated into two groups: Group R: Patients receiving 3 mL of hyperbaric ropivacaine (0.75%); Group B: Patients receiving 3 mL of hyperbaric bupivacaine (0.5%). The onset and duration of sensory and motor blockade, haemodynamic parameters, vasopressor and fluid requirements and the incidence of adverse effects were recorded in all patients. Statistical analysis was performed using the independent t-test, Chi-square test and Fisher’s-exact test. A p-value<0.05 was considered statistically significant. Results: The demographic profile of patients with respect to age, gender, Body Mass Index (BMI), American Society of Anaesthesiologists (ASA) grade and duration of surgery was comparable between the two groups (p>0.05). The mean onset time of sensory and motor block in Group R was significantly longer than in Group B (6.25±6.22 min vs 3.50±0.93 min and 11.82±2.85 min vs 8.44±0.91 min, respectively; p<0.05). Conversely, the mean duration of sensory and motor block in Group R was significantly shorter compared to Group B (174.62±22.17 min vs 225.12±19.03 min and 143.50±21.67 min vs 192.35±17.88 min, respectively; p<0.0001). Ropivacaine demonstrated better haemodynamic stability than bupivacaine. The incidence of hypotension was significantly lower in Group R compared to Group B (p<0.05). Conclusion: The present study indicates that hyperbaric ropivacaine (0.75%) may be preferred over hyperbaric bupivacaine (0.5%) for lower limb surgeries, as it provides a shorter duration of motor blockade and better haemodynamic stability.

Plug-assisted Retrograde Transvenous Obliteration with or without Partial Splenic Embolisation for Gastric Variceal Bleeding: A Retrospective Study

Vishal Nandkishor Bakare, Aniketh Davangere Hiremath, Amol Sonyabapu Dahale

Introduction: Gastric variceal bleeding is a severe complication of portal hypertension with limited efficacy of endoscopic therapy in patients with large fundal varices or spontaneous shunts. Plug-Assisted Retrograde Transvenous Obliteration (PARTO) offers a minimally invasive alternative by occluding the Gastro-renal Shunt (GRS) and achieving durable variceal control. Partial Splenic Embolisation (PSE) may further lower portal pressure and improve hypersplenism. Aim: To compare outcomes between PARTO alone and PARTO with PSE, in terms of variceal regression, Oesophageal Varices (EV) progression, and complication rates. Materials and Methods: A retrospective observational study was conducted in the Department of Interventional Radiology at Dr. D Y Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from May 2023 to May 2025. The study included 20 patients with gastric variceal bleeding secondary to portal hypertension who underwent PARTO or PARTO + PSE after resistant to or failed endoscopic management. Group A (n=15) underwent PARTO alone, and Group B (n=5) underwent PARTO with adjunctive PSE. Technical and clinical success, variceal regression, EV progression, rebleeding, and complications were evaluated. Statistical analysis included Fisher’s exact and unpaired t-tests, with significance set at p-value <0.05. Results: Technical success was achieved in 20/20 patients (100%), and clinical success in 19/20 (95%). Rebleeding occurred in 1 patient (5%), exclusively in the PARTO-alone group. Complete gastric variceal obliteration was observed in 15 patients (75%), with partial regression in 5 (25%). EV progression occurred in 6 patients (30%); 5/15 (33%) in the PARTO group vs 1/5 (20%) in the PARTO+PSE group. Minor complications were more frequent in the PARTO + PSE group (100% vs 33%, p-value=0.04), predominantly the post-embolisation syndrome. Mean hospital stay was numerically longer in the combined group; however, this difference was not statistically significant (9.3±0.8 vs 4.5±1.1 days). Conclusion: PARTO is a safe and highly effective treatment for gastric variceal bleeding refractory to endoscopic therapy, achieving high technical and clinical success with low rebleeding rates. Adjunct PSE may offer haemodynamic modulation in selected patients with hypersplenism/splenomegaly, but was assosciated with higher post-procedural morbidity and longer hospital stay without a statistically significant outcome benefit.

Comparison of MRI-based Assessment of Spinal Cord Injuries and their Clinical Profile with American Spinal Injury Association Grading: A Retrospective Observational Study

Kavneet Singh, Asif Tamboli

Introduction: Spinal Cord Injuries (SCIs) remain a significant public health concern, necessitating precise diagnostic tools and comprehensive management strategies. Magnetic Resonance Imaging (MRI) is the gold standard imaging technique for patients with SCI and spinal trauma. Aim: To evaluate the role of MRI in spinal trauma and compared imaging findings with the clinical profile according to the American Spinal Injury Association (ASIA) impairment scale. Materials and Methods: This was a single-centre, retrospective, observational study conducted at the Department of Radiodiagnosis, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from May 2022 to May 2024. MRI scans and medical data of patients with suspected acute SCIs were evaluated. Patients aged ≥18 years who underwent MRI within two days of trauma were included in the study. MRI findings and the clinical profile according to the ASIA impairment scale were documented. Descriptive statistics were used, and data are reported as mean and percentage. Results: A total of 67 patients were included in the study, predominantly male 52 (77.6%), with a mean±Standard Deviation (SD) age of 41.1±20.5 years. Cervical spine involvement was the most common, observed in 27 (40.3%) patients, and 22 (32.8%) patients had severe spinal cord compression. At admission, 28 (41.8%) patients had complete impairment (ASIA Grade A), while at discharge, 24 (35.8%) patients remained in Grade A. Patients with Grade A and C impairment at admission showed better prognosis and progressed to Grade D by discharge. A total of 18 (26.9%) patients had Grade D impairment at admission, which increased to 24 (35.8%) patients at discharge. Improvement in sensory scores and neurological outcomes was observed in 13 (17.9%) and 14 (20.9%) patients, respectively. Conclusion: The MRI was beneficial in the evaluation of trauma-induced spinal injuries and provided vital diagnostic information. The MRI findings showed good correlation with the clinical profile of patients.

Effects of a Cognitive-behavioural Chronic Pain Management Program on Depression, Pain Physiology Knowledge and Quality of Life in Chronic Musculoskeletal Pain Patients: A Prospective Interventional Study

Thangamani Ramalingam Alagappan, Sudipta Tamaal Roy, Aparna Vajpayee

Introduction: Chronic Musculoskeletal Pain (CMP) is a widespread condition that demands focused attention from physiotherapy professionals due to its substantial impact on physical functioning, mental health, and overall Quality of Life (QoL). Aim: The present study primarily aimed to evaluate the intra-intervention effects of a cognitive-behavioural chronic pain management program on depression, pain physiology knowledge, and QoL in individuals with CMP. Materials and Methods: The present prospective, interventional study at Spinex (Physiotherapy Primary Care Facility), Surat, Gujarat, India between July 2023 and July 2024 was employed with 38 participants completing the Cognitive-Behavioural chronic pain management intervention for eight weeks. Depression levels were measured using the Patient Health Questionnaire (PHQ-9), pain physiology knowledge using the Neurophysiological Pain Questionnaire (NPQ), and QoL using the World Health Organisation QoL (WHO-QoL) scale. Psychological distress was evaluated using the Subjective Units of Distress Scale (SUDS). Data were analysed for intra-intervention differences using paired t-tests and effect sizes with IBM Statistical Package for Social Sciences (SPSS) Statistics Version 25, with statistical significance set at p<0.05. Results: Significant improvements were observed in all evaluated domains. Depression scores decreased markedly with a mean difference of 4.55 (CI: 3.08-6.02, p<0.001) and a large effect size (Cohen’s d=1.02). Pain physiology knowledge improved significantly by 1.42 points (CI: 0.80–2.04, p<0.001) with a moderate effect size (Cohen’s d=0.75). QoL improved across all domains, with the physical domain showing the highest effect size (Cohen’s d=1.03, p<0.001). SUDS scores reduced consistently from baseline to the fourth follow-up (Mean difference=3.13, p<0.001). Conclusion: The cognitive-behavioural chronic pain management program demonstrated significant positive effects on depression, pain physiology knowledge, QoL, and psychological distress. These findings highlight the efficacy of structured cognitive-behavioural interventions in managing chronic pain and its psychological impact.

Comparative Effect of 8-week High Intensity Interval Training and Circuit Training Programme on Body Composition and Body Image in Female Students: A Non-randomised Interventional Study

Introduction: Body composition and body image are closely related yet distinct components of overall health, particularly in young adult females. Body composition provides objective data on fat and lean mass, whereas body image reflects an individual’s perception of and satisfaction with their appearance. Evaluating both allows for a more comprehensive understanding of the physical and psychological impacts of exercise. Aim: To compare the effects of High-Intensity Interval Training (HIIT) and circuit training on body composition and body image in female university students. Materials and Methods: The present non-randomised interventional study was conducted in the Department of Physiotherapy and Sports Sciences at Delhi Pharmaceutical Sciences and Research University (DPSRU), Delhi, India, from March 2024 to August 2024. Female students aged 18-25 years provided informed consent and were randomly assigned to an 8-week HIIT programme (n=10), circuit training programme (n=10), or a control group (n=10). Body composition parameters {weight, Body Mass Index (BMI), body fat percentage, skeletal muscle mass, and Waist-Hip Ratio (WHR)} and body image were assessed using a bioelectrical impedance analyser and a body image questionnaire at baseline, the 4^th week, the 8^th week, and post-intervention. Self-esteem was measured using a 5-point Likert scale throughout the study. Between-group variations in all parameters were analysed using one-way Analysis of Variance (ANOVA), followed by Tukey’s post hoc test for pairwise comparisons. Within-group changes across baseline, the 4^th week, and the 8^th week were assessed using repeated-measures ANOVA. Results: Both HIIT and circuit training significantly improved body composition and body image compared with the control group. Significant differences were observed in weight (Group B vs C: p=0.047; Group C vs A: p=0.046), BMI (p=0.026; p=0.033), body fat percentage (p=0.043; p=0.033), WHR (p=0.037; p=0.047), and body image scores (p=0.047; p=0.027). HIIT demonstrated a stronger impact on these measures. No significant changes were observed in skeletal muscle mass (p=0.339) or self-esteem (p=0.767). Conclusion: Both HIIT and circuit training are effective in improving body composition and body image in female university students. The choice of training programme may be guided by individual preferences and specific fitness goals.

Content Validity of a Comprehensive Physiotherapy Protocol for Children with Spastic Diplegic Cerebral Palsy Across GMFCS Levels: A Cross-sectional Study

Shrikrishna Shinde, Moh'd Irshad Qureshi, HV Sharath

Introduction: Children with spastic diplegic cerebral palsy present with multidomain functional limitations that require structured physiotherapy interventions tailored to Gross Motor Function Classification System (GMFCS) levels. Establishing content validity is essential to ensure that such protocols are clear, relevant, and clinically appropriate. Aim: To establish the content validity of a multidomain physiotherapy protocol developed for children across GMFCS levels I-V. Materials and Methods: A cross-sectional methodological content validation study was conducted at the Department of Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India, from June 2025 to November 2025. A comprehensive multidomain physiotherapy protocol comprising 30 items across Stability, Mobility, Strength, Endurance, Cognitive, and Respiratory domains for GMFCS levels I-V was evaluated. Nine experts in paediatric neurorehabilitation independently rated each item for relevance, clarity, and appropriateness using a four-point ordinal scale. Quantitative content validity analysis was performed by calculating the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Indices (S-CVI/AVE and S-CVI/UA). Results: The I-CVI values ranged from 0.78 to 1.00 across domains. S-CVI/AVE values demonstrated high agreement (0.89-1.00). While most S-CVI/UA values ranged from 0.80 to 1.00, a lower S-CVI/UA value of 0.40 was observed as an outlier in the respiratory domain, reflecting partial lack of universal agreement among experts. Conclusion: The developed physiotherapy protocol demonstrated excellent content validity, supporting its clarity, relevance, and clinical appropriateness for use across all GMFCS levels.

Effect of Green Tea on Body Composition in Healthy Adults: A Randomised Controlled Trial

Siddharth Praveen Choudhary, Rajeshree Meshram, Tejaswini Sonwane

Introduction: Green tea has gained attention for its potential benefits in weight loss and improving metabolic health, particularly concerning obesity and Metabolic Syndrome. Green tea and its extracts have shown positive results in weight reduction by causing energy expenditure, and fat oxidation, and also by preservation of fat-free body mass. Aim: To compare the effect of green tea on weight, Body Mass Index (BMI), body fat percentage, blood pressure and basal metabolic rate in study and control groups at the start of study and at the end of eight weeks. Materials and Methods: The present randomised controlled trial was conducted in Indira Gandhi Government College and Hospital, Nagpur, Maharashtra, India, from April to May 2021, involving healthy MBBS students aged 18-25 years. The present study was completed with 32 participants in each group: Group I consumed green tea daily for eight weeks, while Group II was control group. The study assessed anthropometric measures, such as weight, BMI, body fat percentage, blood pressure and Basal Metabolic Rate (BMR) before and after the intervention using body composition analyser QUADSCAN-4000. Parameters between same group at time duration 0 and 8 weeks were compared by paired t-test. Comparison between control and experimental groups were done by unpaired t-test. Results: The mean age of subjects (16 males, 16 females) was 20.09±09 years and of control group (16 males, 16 females) was 19.38±1.10 years at the start of study. The green tea drinking group experienced significant reductions in weight (mean -2.20 kg, p-value <0.001), BMI (mean -0.80 kg/m², p-value <0.001), waist circumference (mean -2.69 cm, p-value <0.001), hip circumference (mean -2.19 cm, p-value <0.001) and body fat percentage (mean -1.80%, p-value <0.001) at the end of eight weeks. BMR in the subject group showed a significant decrease (mean -24.9 kCal/day, p-value <0.001). Conclusion: Based on the present study findings it was concluded that regular consumption of Green tea for eight weeks could cause a reduction in body weight and BMR. Green tea has improved body composition by reducing fat percentage which is associated with decreased risk of cardiovascular disease.

Utility of the Soluble Transferrin Receptor-ferritin Index in Differentiating Anaemia in Rheumatoid Arthritis from Iron Deficiency Anaemia: A Cross-sectional Study

MV Preethi, R Geethanjali, M Sampath Kumar, RP Vinod Kumar, K Ramadevi

Introduction: Anaemia is a common complication in patients with Rheumatoid Arthritis (RA), predominantly due to Anaemia of Chronic Disease (ACD) or a combination of ACD and Iron Deficiency Anaemia (IDA). Differentiating anaemia associated with RA from pure IDA remains challenging because of overlapping biochemical markers. Aim: The present study aimed to evaluate the efficacy of the soluble Transferrin Receptor-Ferritin (sTfR-F) index in differentiating anaemia associated with RA from pure IDA. Materials and Methods: The present cross-sectional study was conducted at the Institute of Biochemistry, Rheumatology, and Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, from December 2017 to November 2018. The study included 90 participants categorised into three groups: RA with anaemia (n=30), IDA without chronic disease (n=30), and healthy controls (n=30). Haematological parameters, serum ferritin, sTfR, and inflammatory markers {C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR)} were measured. The sTfR-ferritin index was calculated, and its diagnostic performance was assessed using Receiver Operating Characteristic (ROC) curve analysis. Group comparisons were statistically analysed using one-way Analysis of Variance (ANOVA) with post hoc Tamhane’s test. Results: The mean ages of participants in the RA, IDA, and control groups were 46.1±4.25 years, 34.3±5.16 years, and 39.8±5.63 years, respectively, with a predominance of females (86.7%). Haemoglobin levels were significantly lower in the IDA group (7.8±2.09 g/dL) compared with the RA (9.79±1.63 g/dL) and control (13.83±1.51 g/dL) groups. Ferritin levels were markedly reduced in the IDA group (8.22±8.47 ng/mL) compared with the RA (120.4±151.63 ng/mL) and control (84.66±59.18 ng/mL) groups. The sTfR levels and the sTfR-ferritin index were significantly higher in the IDA group (p<0.001). The sTfR-ferritin index effectively distinguished ACD from IDA, with an optimal cut-off value of 3.9 (sensitivity 60%, specificity 83.3%). Among patients with RA, a cut-off value of 2.12 identified iron depletion with 76.5% sensitivity and 100% specificity. Conclusion: The sTfR-ferritin index is a superior marker for detecting iron deficiency and effectively differentiates pure ACD from ACD with concomitant iron deficiency. Ferritin levels correlate with inflammation in RA, while sTfR levels are elevated in IDA and inversely related to haemoglobin concentrations. This makes the sTfR-ferritin index a reliable and clinically useful marker for differentiating anaemia associated with RA from pure IDA.

Association of Serum TREM2 with Acute Coronary Syndrome and its Severity: A Cross-sectional Study

MS Sudharhsan, P Renuka, VM Vinodhini, M Vengatesh, KA Arul Senghor

Introduction: Acute Coronary Syndrome (ACS) remains a major cause of morbidity and mortality worldwide, primarily driven by plaque rupture and thrombotic occlusion in coronary arteries. Traditional biomarkers provide limited insight into the inflammatory and lipid-driven mechanisms underlying plaque instability. Soluble Triggering Receptor Expressed on Myeloid Cells 2 (sTREM2), a shed form of a membrane-bound receptor expressed on macrophages and other myeloid cells, has been implicated in lipid metabolism, immune regulation and tissue homeostasis. Although its role in neurodegenerative and metabolic disorders has been increasingly recognised, its relevance in atherosclerosis and acute coronary events is still being elucidated. Exploring sTREM2 in this setting may offer novel perspectives on immune-metabolic activity in coronary artery disease. Aim: To investigate the association between serum sTREM2 levels and ACS, as well as disease severity. Materials and Methods: The present observational cross-sectional study was conducted at the Department of Biochemistry, SRM Medical College Hospital and Research Centre, Potheri, SRM Nagar, Kattankulathur, Tamil Nadu, India, between December 2023 and August 2024. A total of 180 participants were enrolled, including 90 newly diagnosed ACS patients and 90 age- and gender-matched healthy controls. Inclusion criteria for the ACS group included adults aged over 25 years with a confirmed diagnosis of ACS {ST-Elevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial Infarction (NSTEMI), or unstable angina} based on clinical presentation, Electrocardiographic (ECG) changes and cardiac biomarkers. Controls were healthy volunteers with no history of cardiovascular disease. Serum sTREM2 levels, lipid profile, Apolipoprotein B (ApoB) and high-sensitivity C-Reactive Protein (hs-CRP) were measured. ACS severity was assessed using the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX I) score. Demographic parameters including age, gender, Body Mass Index (BMI). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0. Data normality was assessed using the Shapiro-Wilk test. Group comparisons were conducted using the Mann-Whitney U test and Kruskal-Wallis test. Spearman’s correlation was used to evaluate relationships between variables and Receiver Operating Characteristic (ROC) curve analysis assessed the diagnostic utility of biomarkers. A p-value <0.05 was considered statistically significant. Results: Serum sTREM2 levels were significantly higher in ACS patients {115.19 (78.18-191.67) pg/mL} compared to controls {70.74 (51.16-89.03) pg/mL} (p<0.001). ACS patients also exhibited elevated hs-CRP, ApoB, Total Cholesterol (TC), Low-Density Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL), along with reduced High-Density Lipoprotein (HDL) levels. A positive correlation was identified between sTREM2 and body weight, BMI, TC, LDL and the TC/HDL ratio, while a negative correlation was noted with HDL. sTREM2 levels increased progressively with ACS severity as determined by the SYNTAX I score. No significant correlation was found between sTREM2 and hs-CRP or ApoB. ROC analysis demonstrated moderate diagnostic accuracy for sTREM2, with an Area Under the Curve (AUC) of 0.771. Conclusion: The present study demonstrates that serum sTREM2 levels are significantly elevated in ACS patients and correlate with disease severity. These findings suggest that sTREM2 may serve as a novel biomarker for ACS stratification, providing insights into the inflammatory and lipid-related mechanisms driving disease progression. Further longitudinal studies are required to validate its prognostic and clinical utility.

Evaluating the Diagnostic Accuracy of Rheumatoid Factor, Anti-citrullinated Protein Antibody and Anti-carbamylated Protein Antibody in Early Detection of Rheumatoid Arthritis: A Cross-sectional Study

Introduction: Rheumatoid Arthritis (RA) is a systemic autoimmune disease that primarily affects synovial joints. Joint infiltration with immune cells is a characteristic feature of RA. Antibodies associated with RA include Rheumatoid Factor (RF), Anti-Citrullinated Protein Antibody (ACPA), and Anti-Carbamylated Protein (Anti-CarP) antibodies. However, proper classification and accurate diagnosis in arthritis patients still remain challenging. Aim: To evaluate and compare the diagnostic accuracy of RF, ACPA, and Anti-CarP antibodies in the early detection of RA, and to assess their prevalence in clinically diagnosed RA patients. Materials and Methods: A cross-sectional study was conducted with 171 patients at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India, between November 2022 and June 2023. Patients clinically diagnosed with RA according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria were included. RF latex agglutination test, ACPA Enzyme-Linked Immunosorbent Assay (ELISA), and Anti-CarP ELISA were performed on the serum samples. Demographic details of the patients were obtained using direct observation of medical records. Statistical analysis was performed using the chi-square test, and p-value <0.05 was considered statistically significant. Results: In this study, male patients (110; 64.3%) were more prevalent than female patients (61; 35.7%). Among the 113 RF-positive patients, 100 (88.5%) tested positive for ACPA, while 13 (11.5%) were ACPA-negative. In addition, 110 (97.3%) were Anti-CarP positive, while three (2.7%) were Anti-CarP negative. Of the 58 RF-negative cases, ACPA was positive in 10 (17.2%) and negative in 48 (82.8%), while Anti-CarP was positive in 2 (3.4%) and negative in 56 (96.6%). The sensitivity of ACPA and Anti-CarP was 88.5% and 90%, respectively, while the specificity was 82% for ACPA and 96.5% for Anti-CarP which reveals the results were statistically significant (p-value <0.0001). Conclusion: Anti-CarP antibodies may be included in the diagnostic panel for RA.

Evaluating Antibacterial Efficacy of Extract of Punica granatum against ESBL and Carbapenemase Producing Multidrug Resistant Uropathogenic Escherichia coli: An In-vitro Study

Introduction: Uropathogenic Escherichia coli (UPEC) is the primary causative agent of Urinary Tract Infections (UTIs) and has shown a concerning rise in Multidrug Resistance (MDR), including the production of Extended-Spectrum Beta-Lactamases (ESBLs) and carbapenemases. This resistance compromises the efficacy of conventional antibiotics, posing serious clinical threats such as pyelonephritis and urosepsis, in both community- and hospital-acquired settings. Aim: To evaluate the in-vitro antibacterial activity of Punica granatum extract against MDR Uropathogenic E. coli, including ESBL- and carbapenemase-producing MDR UPEC isolates. Materials and Methods: This in-vitro study was conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Jawaharlal Nehru Medical College (JNMC), Wardha, Maharashtra, India, over a period of seven months from May 2023 to November 2023. A total of 273 non duplicate UPEC isolates were included. These isolates were obtained from symptomatic UTI patients of all age groups and both sexes who provided clean-catch midstream urine samples during the study period. Identification of UPEC isolates was performed using standard biochemical methods. Phenotypic detection of ESBL and carbapenemase production was carried out in accordance with Clinical and Laboratory Standards Institute (CLSI) 2022 guidelines. Molecular characterisation involved Polymerase Chain Reaction (PCR) amplification for the detection of CTX-M genes (ESBL) and NDM genes (carbapenemase). The antibacterial activity of Punica granatum extract, prepared in different concentrations, was assessed using the Kirby-Bauer disc diffusion method. Mean zones of inhibition were compared using Student’s t-test, and a p-value of <0.05 was considered as statistically significant. Results: Out of 273 UPEC isolates, 192 (70.3%) were identified as MDR. Among these, 82 were ESBL producers and 62 were carbapenemase producers, while 48 isolates were non producers of both ESBL and carbapenemase enzymes. The P. granatum extract demonstrated significant antibacterial activity, with mean zones of inhibition of 21.18±1.4 mm against ESBL-producing UPEC and 21.54±0.93 mm against carbapenemase-producing UPEC at 100% concentration, comparable to gentamicin. The antibacterial activity of the extract was dose-dependent, with minimal effect observed at lower concentrations. Solvent controls showed negligible antibacterial activity, confirming the specificity of the extract. Conclusion: The study highlights a high prevalence of MDR UPEC, particularly among hospitalised patients, underscoring the urgent need for alternative therapeutic strategies. The significant antibacterial activity of Punica granatum extract against ESBL- and carbapenemase-producing UPEC suggests its potential as a natural, plant-based adjunct or alternative to conventional antibiotics in the treatment of UTIs, especially in resource-limited settings.

Association of VISmax Score with Outcome in Critically-ill Children: A Prospective Cohort Study

Umesh Pandwar, Arun Kumar Kori, Nitesh Upadhyay, Jyotsna Shrivastav

Introduction: Sepsis is a leading cause of morbidity, mortality and hospitalisation. Severity score is therefore vital to improve the outcome of patients with sepsis and septic shock. VISmax score (Maximum Vasoactive-Inotropic Score) is simpler and easier to use compared to other scales such as Paediatric Risk of Mortality Score (PRISM) Paediatric Logistic Organ Dysfunction score (PELOD) and Paediatric Sequential Organ Failure Assessment score (pSOFA) score. Aim: To determine the association of VISmax score with outcome of critically-ill children in Paediatric Intensive Care Unit (PICU) and also to evaluate the association between VISmax score and PRISM III score to predict the outcome in PICU. Materials and Methods: This prospective cohort study was done in PICU of a Gandhi Medical College and associated Hamidiya hospital, a tertiary care hospital of central India during the period of September 2022- October 2023. The study population included 330 critically-ill children between 1-13 years of age with the requirement of Vasoactive medications since admission. Maximal VIS score (VISmax) in the initial six hours after admission was calculated using the highest doses of vasoactive and inotropic medications administered. Five categories of VISmax were established: 0-5, >5-15, >15-30, >30-45, and >45 points. The association of different categories of VISmax with outcome of children in term of mortality was evaluated using Student’s t-test. Results: A total of 330 patients satisfying the inclusion criteria were included in study with a mean age of five years (IQR 1-13 years) and male (n=188) outnumbered female. The median VISmax was 10.0 (IQR: 0.0-37.0). The (median (IQR) VISmax of non survivors was significantly higher than that of survivors (37.0 (10-54.0) vs. 5.0 (5.0-18.0); p-value <0.001). Significant association was found between VISmax in the first six hours of admission and outcome. A positive correlation between PRISM III and VISmax scores (r-value=0.362, p-value <0.001), indicating that these two severity measures align in assessing patient acuity. Mortality was 10.9% overall and 46.34% in the highest VISmax group (>45 points). Conclusion: VISmax in the first six hours of admission in PICU was significantly associated with outcome and mortality, hence can be used to guide intensive therapy accordingly.

Anaemia and Haematological Profile in Children with Moderate and Severe Acute Malnutrition at a Tertiary Care Centre in Karnataka, India: A Cross-sectional Study

Introduction: Protein-Energy Malnutrition (PEM) remains a significant contributor to childhood morbidity and mortality worldwide, with anaemia being one of its most common and serious complications. Understanding the haematological profile of malnourished children is essential for early diagnosis and effective management. Aim: To assess the prevalence of anaemia and evaluate haematological profiles among children with Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM). Materials and Methods: A cross-sectional study was conducted at the Department of Paediatrics at Karwar Institute of Medical Sciences, Karwar, Karnataka, India, over six months from January 2025 to June 2025. A total of children aged 6 months to 5 years, diagnosed with MAM or SAM according to World Health Organisation (WHO) criteria, were enrolled. Children with primary haematological disorders, critical illness, or those outside the age criteria were excluded. Demographic details, anthropometric measurements, and haematological parameters including complete blood count, peripheral smear and serum ferritin were assessed. Data were analysed using descriptive statistics, the Chi-square test, and the Student’s t-test. Results: Of the 81 children, 59 (72.8%) had MAM and 22 (27.2%) had SAM. There were no significant differences between the groups in age, gender, or socio-economic status. However, children with SAM demonstrated significantly lower Body Mass Index (BMI), Haemoglobin (Hb), Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC), platelet count, and serum ferritin levels than children with MAM (p-value <0.05). Pneumonia (32.9%) was the most common associated diagnosis. Peripheral smear examination revealed a predominance of microcytic hypochromic anaemia, with a significant difference between the groups (p-value=0.0093). Overall, the prevalence of anaemia was high and its severity correlated strongly with the degree of malnutrition (p-value=0.0001). Conclusion: Anaemia was highly prevalent among children with PEM and was more severe in those with SAM. Routine haematological screening and early nutritional intervention are vital to improving clinical outcomes.

Development and Standardisation of Facial Kit for Skin Rejuvenation: A Novel Ayurvedic Cosmetology Remedy

Chetali Kothari, Mrudul Chitrakar

Introduction: The importance of having healthy skin drives the demand for herbal and safe products that led to the development of a novel Ayurvedic facial kit by using Yashtimadhu Taila (Liquorice oil) and Modified Shastika Shali Pinda Sweda (Navara rice bolus sudation) for facial skin rejuvenation. Aim: To introduce a novel, natural procedure in Ayurvedic cosmetology and standardise the formulation of a facial kit. Materials and Methods: This was an in-vitro, experimental, laboratory-based formulation study. The formulation was prepared at Dr. DY Patil University- School of Ayurveda, Nerul, Navi Mumbai, India and all analytical evaluations were carried out at Adhrsya Lifesciences, a certified laboratory. For this in-vitro study, a facial kit was developed in sequential stages as part of an experimental, laboratory-based formulation study. Yashtimadhu (Glycyrrhiza glabra, Liquorice) and Amalaki (Emblica officinalis, Indian Gooseberry) were authenticated and subjected to phytochemical analysis. Yashtimadhu Taila was prepared and standardised as per classical Ayurvedic reference. A modified Shastika Shali Pinda Pottali (Navara rice bolus bag) incorporating Yashtimadhu was prepared, standardised and subjected to nutritional analysis. Finally, the kit was assembled, consisting of Yashtimadhu Taila, the prepared bolus for massage and Mukha Lepa (face pack) derived from the paste of opened bolus bags. Results: Nutritional analysis of Shastika Shali Pinda (bolus) revealed the presence of Antioxidant, Antibacterial properties along with essential nutrients such as Vitamin-A, B, D and E, minerals like calcium, phosphorus, magnesium, as well as protein, carbohydrate, Polyunsaturated Fatty Acids (PUFA) and Monounsaturated Fatty Acids (MUFA). Standardisation confirmed that Yashtimadhu Taila and Shastika Shali Pinda met the required quality parameters, demonstrating compliance with safety and quality parameters. Conclusion: The tests on Yashtimadhu Taila (oil) and Shastika Shali Pinda (bolus) confirm that they are safe for use and possess properties beneficial for improving skin health.

Knowledge, Attitudes and Practices Related to the use of Antibiotics in Odontogenic Bacterial Infections among Indian Dentists: A Cross-sectional Study

Sanket Sawant, Krunal Dalal, Ramiya Ravindranath, Puja Nijhara

Introduction: Odontogenic Infections (ODIs) are common, originating from dental or supporting structures, often presenting as periapical abscesses, pericoronitis, or periodontal abscesses, and are polymicrobial in nature and often require antibiotic treatment. If left untreated, they can lead to severe complications. Most ODIs can be managed with local treatments, and antibiotics are only recommended when systemic symptoms are present, to prevent Antimicrobial Resistance (AMR). Despite clear guidelines, inappropriate antibiotic prescribing remains widespread in dental practice, contributing significantly to the growing burden of AMR, especially in countries like India. Aim: To understand the Knowledge, Attitudes, and Practices (KAP) of Indian dentists in treating ODIs. Materials and Methods: The present descriptive cross-sectional survey was conducted across 12 Indian cities from August to September 2024 with 250 dentists. A questionnaire comprising seven main questions and 47 Likert-style statements was utilised. Using Computer-Assisted Personal Interviewing (CAPI), KAP on antibiotic use was assessed. Data were analysed descriptively using R software (v4.3.1). Results: Of the 250 dentists enrolled in the study, 110 were from metro cities, 80 were from tier 1, and 60 belonged to tier 2 cities. Most dentists, 225/250 (90%), scored 50-79% on knowledge questions. Most dentists (n=232/250; 92.8%) emphasised updating antibiotic knowledge for ODIs. Notably, 68.4% agreed (171/250) that adding metronidazole to amoxicillin-clavulanic acid improves outcomes. Of the participants, 36% (n=90/250) of dentists believed antibiotic resistance is rarely encountered in practice, while 38% (n=95/250) had no opinion. Only 46% (n=115/250) felt that clinical experience alone should guide antibiotic selection for ODIs, with 30.4% (n=76/250) believed it as sometimes. A majority (78%; 194/250) believed local measures should be prioritised before prescribing antibiotics. Additionally, 58.8% (n=147/250) agreed that culture and sensitivity testing is essential for selecting oral antibiotics. Most dentists follow thorough clinical protocols- 96.4% (n=241/250) assess patient history and symptoms, and 90.8% (n=227/250) use X-rays. While 49.2% (n=123/250) prescribe empiric broad-spectrum antibiotics, 85.6% (n=214/250) switch if there's no improvement. Conclusion: The present study identified current practices and possible gaps in appropriate antibiotic prescribing for ODIs. Targeted education programs for dentists, leveraging appropriate methods, are desirable to mitigate antibiotic misuse.

Microbiological Profile of Ascitic Fluid in Patients of Decompensated Liver Cirrhosis in a Tertiary Care Hospital: A Cross-sectional Study

Introduction: The presence of ascites indicates an advanced stage of liver disease and its infection is a frequent complication among patients of cirrhosis, of which Spontaneous Bacterial Peritonitis (SBP) is the most common and potentially fatal. Ascitic fluid analysis is crucial in the microbiological diagnosis of peritonitis as drug-resistant bacterial infections in the peritoneal cavity pose a public health issue. There is limited information available on the bacterial profile and antibiotic resistance of ascitic fluid isolates and also there is paucity of such studies from North India. Aim: To determine the aetiology, microbiological profile and current antimicrobial susceptibility pattern of the isolates from ascitic fluid sample of decompensated cirrhosis. Materials and Methods: A cross-sectional study was conducted from January 2023 to December 2023 on 200 ascitic fluid samples from cirrhotic patients admitted in medicine ward and ICU of GGSMCH Faridkot, Punjab, India. Patients of either gender, aged 18-80 years having ascites due to decompensated cirrhosis of liver were included in the study. Samples were collected by the bedside paracentesis and processed by conventional microbiological techniques. Pathogens were identified and their sensitivities to various antibiotics were determined. Data were expressed as mean±SD for quantitative variables, number and percentage for qualitative ones. The p-value <0.05 was considered significant. Results: Majority of patients were in age group of 41-60 years 112 (56%) with male predominance. Based on Polymorphonuclear (PMN) count and culture, 80 (40%) were found to have ascitic fluid infection of which 35 (43.75%) were Culture Negative Neutrocytic Ascites (CNNA) followed by 27 cases (33.75%) of classical (SBP) and 18 cases (22.50%) of (MNB). No case of polymicrobial bacteriascites were found. Most common organism isolated were GNB 34/45 (75.56%) of which Escherichia coli 16/45 (35.56%) was most common followed by GPC 8/45 (17.78%) and yeast 3/45 (6.67%). The Gram-negative bacteria showed the highest sensitivity towards carbapenems. Conclusion: Escherichia coli was the most common cause of SBP. The prognosis of SBP is good provided they are diagnosed at earlier stage, and therefore laboratory analysis including culture and sensitivity of all suspected case of SBP will enhance the success rate.

Assessment of Clinically Occult Nodal Metastasis by Evaluation of Histological Parameters and Immunohistochemical Markers (Cyclin D1 and E-cadherin) in Early Stage Oral Squamous Cell Carcinoma: A Cross-sectional Study

Introduction: Oral Squamous Cell Carcinoma (OSCC) is a prevalent malignancy, particularly in South Central Asia and Melanesia. Despite advancements in diagnosis and treatment, the optimal approach for early stage OSCC (T1-T2, N0) remains debated. While Elective Neck Dissection (END) helps identify occult metastases, it may also contribute to unnecessary morbidity in patients without nodal involvement. Thus, accurate predictive markers for occult nodal metastasis are crucial. Aim: The present study aimed to assess clinically occult metastasis by evaluation of various histopathological parameters and Immunohistochemistry (IHC) markers (E-cadherin and cyclin D1) in early stage OSCC. Materials and Methods: The present prospective cross-sectional observational study was conducted at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. The study included 50 biopsy-confirmed early stage (T1/T2, N0) OSCC patients from June 2023 to May 2024. Histopathological examination followed College of American Pathologists (CAP) and American Joint Committee on Cancer (AJCC) 8th edition guidelines. Immunohistochemistry (IHC) was performed for E-cadherin and cyclin D1 expression. Statistical analysis (Student’s t-test and Chi-square test) was conducted to identify significant association between various histopathological parameters (Worst Pattern of Invasion (WPOI), tumour budding, Tumour-Infiltrating Lymphocytes (TIL)’s, tumour differentiation, T-stage, Lymphovascular Invasion (LVI) Perineural Invasion (PNI) and IHC markers (E-cadherin and cyclin D) in predicting occult nodal metastasis in early stage OSCC. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Results: Among the 50 patients, 24 were Lymph Node (LN)-positive, while 26 were LN-negative. Significant predictors of nodal metastasis included pT2 stage, Depth Of Invasion (DOI) exceeding 5 mm, WPOI grade 5, high tumour budding score, tumour differentiation, TIL’s and LVI (p<0.05). Furthermore, LN-positive cases showed a higher prevalence of molecular markers such as E-cadherin loss (p=0.001) and cyclin D1 overexpression (p=0.04), emphasising their role as potential predictive biomarkers. Conclusion: Identifying histopathological and immunohistochemical predictors of occult LN metastasis can optimise surgical decisions, especially in the context of end for early stage OSCC, leading to more tailored treatment strategies.

Comparative Evaluation of Fracture Resistance in Endodontically Treated Teeth Restored with Conventional Composite, Manually Placed Braided Glass Fibre-reinforced Composite, and Premixed FRC: An In-vitro Study

Introduction: Endodontically treated teeth pose restorative challenges due to dentin loss and altered biomechanics, whereas fibre reinforcement enhances strength by redistributing stresses. However, the optimal level of fibre placement within the cavity and the comparative effectiveness of premixed versus manually placed fibres remain unclear, creating uncertainty in clinical decision-making. Aim: To analyse and compare the fracture resistance of maxillary premolars restored with conventional composite, manually placed braided glass Fibre-Reinforced Composites (FRCs) at different cavity levels, and a premixed FRC. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, from July 2025 to October 2025. Seventy extracted maxillary premolars underwent endodontic treatment followed by standardised mesio-occluso-distal cavity preparation. The specimens were then randomly allocated into five groups (n=14). Group A received a conventional composite; Groups B, C, and D received braided glass fibre placed at the gingival, middle, and occlusal thirds, respectively; and Group E was restored with a premixed FRC. After thermocycling, fracture resistance was evaluated using a universal testing machine. Data were analysed using one-way Analysis of Variance (ANOVA) followed by Tukey’s Honestly Significant Difference (HSD) post-hoc test at a significance level of 5%, using GraphPad version 10.1.2 (GraphPad Software, La Jolla, California, USA). Results: The mean {±Standard Deviation (SD)} fracture resistance values were highest in Group E (1196.43±148.22 N), followed by Group D (1108.24±152.79 N), Group C (926.70±120.67 N), Group B (822.01±160.94 N), and Group A (707.33±70.82 N). Group E demonstrated significantly higher fracture resistance than Groups A, B, and C (p<0.0001), but did not differ significantly from Group D (p=0.4223). Group D showed significantly higher values than Groups A and B (p<0.0001) and Group C (p=0.006). Group C exhibited significantly higher fracture resistance than Group A (p=0.0008), whereas the differences between Groups A and B and between Groups B and C were not statistically significant. Conclusion: Fibre incorporation significantly improved fracture resistance, particularly with premixed FRCs and occlusal fibre placement.

Efficacy of a Nurse-led Clinical Care Pathway in Improving the Quality of Nursing Care and Parent Satisfaction among Under-five Children with Lower Respiratory Tract Infections: A Prospective Interventional Study

Archana Parshuram Taksande, Ashish Varma, Bibin Kurian

Introduction: Lower Respiratory Tract Infections (LRTIs) are frequent among children of early young age due to polluted air, overcrowding, poor sanitation etc., that increase their susceptibility to infection. Limited healthcare resources in many rural districts postpone the treatment thereby, leading to severe illness. Aim: To study the impact of Nurse-Led Clinical Care Pathway (NLCCP) for children under five with LRTI on nursing quality, hospital stay and parent satisfaction. Materials and Methods: A prospective interventional study was conducted in Maharashtra, India from January to March 2024 among children diagnosed with LRTIs. A total of 60 children were enrolled in the study and divided equally into control and experimental groups. Paediatric nurses (n=30) provided the NLCCP to the experimental group, while the control group received routine care, including assessment, examination, symptom management, laboratory tests, antibiotics, discharge planning, etc. The experimental group also received play activities, psychological, sociocultural, and spiritual support. Data were collected using the 37-item Quality of Nursing Care Scale for Hospitalised Acute Respiratory Infection Children (QNCS-HARIC) checklist and analysed with Statistical Package for Social Sciences (SPSS) using descriptive statistics. Results: Post-test findings from the QNCS-HARIC tool showed major differences between the groups. The control group recorded a mean score of 82.97 (SD 3.12), while the experimental group reached 138.47 (SD 10.74). The t-test value (27.169, p<0.01) showed that the pathway improved nursing care scores. Parent satisfaction followed a similar pattern. The t-test (-7.28, p<0.01) confirmed that parents in the experimental group reported much higher satisfaction at discharge. Conclusion: The NLCCP supports healthcare workers (staff nurses) in enhancing their knowledge, skills, and the overall quality of nursing care. It also contributes to reducing hospital stays of children with LRTIs, while demonstrating significantly higher parent satisfaction compared to the control group.

Chitosan-based Biocomposite Enriched with Vaccinium sect. Cyanococcus and Zingiber officinale Extracts: An Ex-vivo Evaluation of Anti-inflammatory and Antioxidant Properties

Maria Sharon Velraj, Arvina Rajasekar

Introduction: The integration of natural polymers with bioactive botanicals offers a sustainable and multifunctional strategy for developing therapeutic biomaterials. Chitosan, a biodegradable polysaccharide with inherent antioxidant properties, serves as an effective matrix for drug delivery and tissue engineering. Vaccinium sect. Cyanococcus (blueberry) and Zingiber officinale (ginger), both rich in polyphenolic compounds, are known for their potent antioxidant and anti-inflammatory effects. The rationale lies in harnessing their synergistic anti-inflammatory and antioxidant potential to create a bioactive platform for targeted tissue regeneration and oxidative stress modulation in clinical applications. Aim: To formulate and evaluate a chitosan-based biocomposite enriched with blueberry and ginger extracts for its ex-vivo anti-inflammatory and antioxidant activity. Materials and Methods: The present laboratory-based ex-vivo study was conducted at the Department of Periodontics, Saveetha Dental College, Chennai, Tamil Nadu, India. from January to March 2025. Powdered blueberry and ginger (2 g each) were extracted in distilled water at 50-60°C, filtered, and condensed. Chitosan was solubilised in 1% acetic acid, and the plant extracts were gradually incorporated under constant mechanical stirring. The resulting biocomposite was evaluated using three anti-inflammatory assays-Bovine Serum Albumin (BSA) protein denaturation, egg albumin denaturation, and Human Red Blood Cell (HRBC) membrane stabilisation- and three antioxidant assays- 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging, hydrogen peroxide scavenging, and Ferric Reducing Antioxidant Power (FRAP). All tests were performed in triplicate. Statistical analysis was conducted using IBM Statistical Package for Social Sciences (SPSS) version 23.0 with independent t-tests between test and control groups where p<0.05 was considered to be significant. Results: The biocomposite demonstrated a pronounced, concentration-dependent anti-inflammatory action, with 83.54±1.2% inhibition at 50 μg/mL in the BSA model. Notable suppression was also observed in albumin denaturation and erythrocyte protection. Antioxidant assessments indicated strong scavenging and reducing capabilities, evidenced by DPPH and FRAP values of 90.36±1.4% and 83.29±1.5%, respectively, and H2O2 neutralisation around 80.21±1.3% at the highest concentration. Conclusion: This phytochemical-enriched chitosan biocomposite demonstrates promising ex-vivo anti-inflammatory and antioxidant properties, supporting its potential for biomedical applications in oxidative stress modulation and tissue regeneration.

Menstrual Health and Hygiene Education in Secondary Schools: A Cross-sectional Analysis

Suroshree Mitra, Anu Arora, Apurv Shimpi

Introduction: Menstrual Health and Hygiene (MHH) education is critical for adolescent girls’ wellbeing; however, socio-cultural taboos and inadequate school-based programs in India hinder its effective implementation. Aim: To evaluate MHH education practices across secondary schools affiliated with the Secondary School Certificate (SSC), Central Board of Secondary Education (CBSE), Indian Certificate of Secondary Education (ICSE), and International Baccalaureate (IB) boards in Pune, Maharashtra, India. Materials and Methods: This cross-sectional study was conducted across all four zones of Pune district (North, South, East, and West), Maharashtra, India, from March to June 2022. The sample included 40 English-medium, co-educational secondary schools (12 SSC, 18 CBSE, 9 ICSE, and 1 IB). Schools were selected using disproportionate stratified random sampling from 68 approached institutions, yielding a response rate of 58.8%. A validated questionnaire (Cronbach’s alpha=0.82) was administered to one science or biology teacher per school to assess curriculum integration, teaching methods, content delivery, male sensitisation, and session frequency. Data were analysed using descriptive statistics with Statistical Package for the Social Sciences (SPSS) version 25.0, with significance set at p-value <0.05. Results: Among the 40 schools, CBSE demonstrated the highest consent rate (18 schools; 90%) and the greatest management committee involvement (12 schools; 66.67%), whereas ICSE excelled in male student inclusion (eight schools; 88.89%). Overall, MHH education was compulsory in 23 schools (57.5%). Extracurricular activities were conducted in only two schools (5%). Lecture-based teaching predominated in SSC (four schools; 33.33%), CBSE (six schools; 33.33%), and ICSE (four schools; 44.44%), while the IB school relied exclusively on discussion-based teaching (one school; 100%). Most schools (30; 75%) conducted one to two sessions annually and 16 schools (40%) allocated no time for practical demonstrations. Conclusion: MHH education in Pune’s secondary schools primarily emphasises biological aspects but lacks practical training, extracurricular engagement, and assessment strategies. Board-specific strengths—such as CBSE’s administrative support and ICSE’s gender inclusion—offer valuable models for improvement. Standardised curricula, interactive teaching approaches, and enhanced male sensitisation are essential to improve MHH literacy and reduce stigma.

Comparative Clinical and Antimicrobial Evaluation of Abutilon indicum Mouthwash versus Chlorhexidine in Gingivitis Management: A Prospective Clinical Study on Herbal Approach to Periodontal Therapy

Nivedha Nedumaran, Arvina Rajasekar

Introduction: Gingivitis, a precursor to periodontitis, is primarily driven by plaque biofilms and the host’s inflammatory response. While chlorhexidine is the gold standard mouthwash, its side-effects necessitate safer alternatives. Abutilon indicum (Atibala) exhibits antimicrobial, anti-inflammatory and antioxidant properties, making it a promising candidate for adjunctive periodontal therapy. Aim: To evaluate the clinical and antimicrobial efficacy of Atibala-based mouthwash in patients with gingivitis and compare its effectiveness with 0.12% chlorhexidine. Materials and Methods: The present prospective clinical study was conducted at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from June to September 2024. Forty systemically healthy participants aged 25-35 years with clinically diagnosed gingivitis were enrolled and assigned into two groups: Group A received 0.12% chlorhexidine mouthwash (control), and Group B received 0.6% Atibala-based mouthwash (test). All participants underwent ultrasonic scaling at baseline. They were instructed to use 10 mL of the assigned mouthwash diluted 1:1 with water twice daily for one month. Clinical parameters, including Gingival Index (GI) and Plaque Index (PI), and total microbial count were assessed at baseline and after one month. Supragingival plaque samples were collected to assess microbial load expressed as CFU/mL. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) Version 23.0 where the intergroup comparison was performed using independent t-test and intragroup comparison was made using paired t-test, with p<0.05 considered statistically significant. Results: Both groups showed a significant reduction in GI, PI, and microbial load from baseline to one month (p<0.05). At the one-month follow-up, there was no statistically significant difference between the two groups for GI (p=0.66), PI (p=0.74), or microbial count (p=0.77), indicating comparable efficacy. Conclusion: Atibala-based mouthwash demonstrated effectiveness equivalent to chlorhexidine in managing gingivitis, suggesting its potential as a natural adjunct in periodontal care. Further research is warranted to explore its long-term effects and molecular mechanisms.

Comparison of Modified Constraint-Induced Movement Therapy (mCIMT) Hand Arm Bimanual Intensive Training and Mirror Therapy to Improve Upper Extremity Function in Children with Hemiplegic Cerebral Palsy: A Double-blinded Randomised Clinical Trial

Rahul Bisen, Suvarna Ganvir

Introduction: Hemiplegic Cerebral Palsy (CP), a non-progressive neurological disorder resulting from early brain injury, leads to unilateral motor deficits, predominantly impacting Upper Extremity (UE) function. Characterised by limited pincer grasp and wrist extension due to spasticity and learned non-use, this impairs daily activities such as play and self-care, thereby reducing Quality Of Life (QOL). Need of the study: In children with hemiplegic CP, impaired UE function affects independence and QOL, prompting the need for advanced interventions beyond traditional therapies. Techniques such as modified Constraint-Induced Movement Therapy (mCIMT), Hand-Arm Bimanual Intensive Training (HABIT), and mirror therapy differ in their approaches to improving outcomes related to learned non-use and central nervous system plasticity. Current evidence on UE interventions is often rated low due to a scarcity of high-quality comparative trials, underscoring the necessity for a well-designed trial to determine the most effective technique for enhancing UE movement quality. Aim: To compare the effects of mCIMT, HABIT, and mirror therapy on UE function in children with hemiplegic CP. Materials and Methods: A double-blinded Randomised Controlled Trial (RCT) will be conducted from January 2023 to January 2026 at Dr Vithalrao Vikhe Patil Foundation’s College of Physiotherapy, Ahilyanagar, special schools, and private clinics. Thirty-three children with hemiplegic CP, aged 3-12 years, meeting inclusion criteria, will be randomised into three groups (n=11 each): Group-A (mCIMT), Group-B (HABIT), and Group-C (mirror therapy). Interventions will be administered for five days/week for four weeks, alongside conventional therapy, with pre- and post-assessments at two and four weeks using the Quality of Upper Extremity Skills Test (QUEST). Data will be analysed with repeated measures Analysis of Variance (ANOVA) or Kruskal-Wallis tests at a 0.05 significance.

Evaluating Efficacy of White Paraffin with Oral Methotrexate versus Siddharthaka Snana Ointment with Oral Guduchi Ghrita in Ekakushtha (Psoriasis): A Randomised Clinical Trial Research Protocol

Sourabh Deshmukh, Vaishali Kuchewar

Introduction: Psoriasis is a chronic, immune-mediated inflammatory disorder that primarily affects the skin and joints, with a global prevalence ranging between 1% and 3%. It is characterised by erythematous plaques covered with silvery-white scales, resulting from hyperproliferation and dysregulated differentiation of keratinocytes. Psoriasis in Ayurveda can be linked with Ekakushta. Need for study: Methotrexate is widely used for psoriasis but limited by long-term side-effects like hepatotoxicity and Gastrointestinal (GI) discomfort. This calls for safer alternatives. An Ayurvedic approach using Siddharthaka Snana ointment and Guduchi Ghrita shows promise. The ointment form enhances skin application and compliance, while Guduchi offers immunomodulatory and hepatoprotective benefits. Ghrita improves its bioavailability and shelf life. Evaluating this combination may offer a safer, effective, and sustainable option for psoriasis management. Aim: Evaluation of comparative efficacy of white paraffin with oral methotrexate versus Siddharthaka Snana ointment with oral Guduchi Ghrita in Ekakushtha (Psoriasis). Materials and Methods: A randomised controlled trial will be conducted at Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha, Maharashtra India, from February 2024 to December 2026. The patients will be split into two categories: A, Group A: Trial group (Siddharthaka Snana Ointment with Oral Guduchi Ghrita) and Group B: control group(Liquid paraffin and oral Methotrexate). Laboratory investigations such as complete blood count, erythrocyte sedimentation rate, and random blood sugar will be assessed on the 0^th day. Moreover, liver function test will be assessed on 0^th, 7^th, 15^th, and 60^th day. The objective parameters candle grease sign, Auspitz sign, and Psoriasis Area and Severity Index (PASI) score and subjective parameters Aswedadanam, Mahavastum, Matsyashaklopamam, Krishna Arun Varna, Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI) will be assessed on at baseline, 7^th, 15^th, 30^th, 45^th and 60^th day. The Kolmogorov-Smirnov test will be used to determine whether continuous data has a normal distribution. The Wilcoxon rank test will be applied alternately for non-normal distribution. A p-value <0.05 will be considered significant.

Exploring the Anti Diabetic Efficacy of Trikatvadi Guggulu through Pharmaceutical and Analytical Approaches: An In-vitro Research Study Protocol

Kamlesh Choudhary, Anita Wanjari

Introduction: Diabetes mellitus is a metabolic disorder characterised by high blood glucose levels resulting from inadequate insulin synthesis by the pancreas or the body’s inability to respond to insulin. Prameha can be translated as Prabhutmutrata (polyuria) or Avilmutrata (turbid urine). It is a Tridoshaja, Kapha-dominant illness. Acharya Charak, Sushrut, and Vagbhata classify it under the Ashtamahagada category. There are 20 types of Pramehas in Ayurveda. Four Vataja Pramehas, six Pittaja Pramehas, and ten Kaphaja Pramehas are classified based on their Dosha dominance. Madhumeha is one of the varieties of Vataja Prameha. Trikatvadi Guggulu is an important herbal formulation mentioned in Vaidya chintaamani.It has a high therapeutic value, and its contents Trikatu, Triphala, Musta, and Guggulu. The liquid medium used for Bhavana is Gokshura Kashaya. It is traditionally indicated in Prameha, Vata Vyadhi, Mutraghata, Mutradosha, etc. Need of the study: Diabetes mellitus is a global health burden with increasing prevalence and limited curative options. Current modern treatments primarily focus on glycaemic control and symptom management, but they often have adverse effects, emphasising the need for safer and more effective therapeutic alternatives. In Ayurvedic literature, Prameha, which closely resembles diabetes, is described as a chronic and difficult-to-treat disorder that requires holistic management. Trikatvadi Guggulu, an Ayurvedic polyherbal formulation, is traditionally indicated for Prameha and related urinary disorders. Although its ingredients-Trikatu, Triphala, Musta, Guggulu, and Gokshura-are known to possess antidiabetic properties, the compound formulation itself lacks adequate evaluation through standardised in-vitro assays. Thus, there is a pressing need to validate the antidiabetic potential of Trikatvadi Guggulu through modern scientific methods. The present study will focus on filling that gap by conducting a detailed pharmaceutical, analytical, and in-vitro assessment of Trikatvadi Guggulu, thereby contributing valuable evidence toward its therapeutic efficacy and supporting its standardisation for future clinical applications. Aim: To evaluate the pharmaceutical and analytical characteristics of Trikatvadi Guggulu and to assess its in-vitro pharmacodynamic potential with respect to antidiabetic activity. Materials and Methods: The present experimental analytical in-vitro study will be conducted at the Central Research Laboratory of Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India, from July 2025 to November 2025. The raw materials required for the preparation of Trikatvadi Guggulu will be procured from Dattatraya Ayurved Rasashala, Wardha, and the formulation will be prepared in the Department of Rasa Shastra and Bhaishajya Kalpana, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha, India. Organoleptic and physicochemical parameters will be evaluated. The antidiabetic effect of Trikatvadi Guggulu will be assessed using established in-vitro methodologies. One-way Analysis of Variance (ANOVA) will be employed for statistical analysis of the in-vitro results. A p-value of <0.05 will be considered statistically significant.

Incidence of Skip Metastasis and Its Correlation with Depth of Invasion in Oral Squamous Cell Carcinoma: A Cross-sectional Study Protocol

Archana Sonone, Alka Hande, Swati Patil, Aayushi Pakhale, Preethi Sharma

Introduction: Oral Squamous Cell Carcinoma (OSCC) is the most common malignancy of the head and neck region, with a global mortality of approximately 177,000 deaths reported in 2018. Despite advances in diagnostic techniques and therapeutic modalities, the five-year survival rate remains around 50%. Cervical Lymph Node (LN) metastasis is a critical prognostic factor, even in early-stage OSCC. Although OSCC generally follows a predictable pattern of LN spread, a phenomenon known as skip metastasis—wherein tumour cells bypass adjacent lymph nodes and involve non sequential nodes—has been observed, particularly in carcinomas of the tongue. This atypical metastatic behaviour complicates treatment strategies and underscores the need for further investigation. The 8th edition of the Tumour Node Metastasis (TNM) staging system emphasises parameters such as extranodal extension and Depth of Invasion (DOI), which may correlate with metastatic patterns. Need of the study: This study aims to investigate the association between DOI and skip metastasis in OSCC to enhance the understanding of lymphatic spread patterns. By clarifying this relationship, the study seeks to support more accurate risk stratification, refine surgical management—particularly neck dissection strategies—and ultimately contribute to improved prognostication and personalised treatment planning for patients with OSCC. Materials and Methods: This is a cross-sectional study over a period of 12 months, from July 2025 to June 2026 will be conducted in the Department of Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), a tertiary care hospital in Sawangi Meghe, Wardha, Maharashtra, India. A total of 80 Haematoxylin and Eosin (H&E)-stained OSCC slides will be analysed for lymph node involvement, both qualitatively and quantitatively, under low and high magnification (400×). The depth of invasion will be measured from the deepest point of tumour infiltration into the connective tissue using a Leica DMLB2 research microscope. Blinded evaluations will be performed independently by two histopathologists, including the primary investigator and a co-researcher.

Comparative Efficacy of Lekhan Basti with Ushkadi Gana versus Triphala Gana as against Standard Control in Dyslipidaemia (Medoroga): A Research Protocol for a Randomised Controlled Trial

Samiksha Satone, Shweta Parwe, Punam Sawarkar, Milind Nisargandha

Introduction: Ayurveda addresses Medoroga using a holistic approach, focusing on correcting imbalances and utilising cleansing therapies like medicated enema (Basti). Ushakadi Gana includes herbs with potential lipid-lowering and metabolic effects, but it faces challenges in accessibility and cost. Triphala Gana offers a more accessible herbal alternative. This study aims to compare the efficacy of both formulations, providing insights into their application for managing dyslipidaemia (Medoroga). Need of the study: In modern medicine, Atorvastatin is the drug of choice for treating dyslipidaemia (Medoroga). Dyslipidaemia can be correlated with Medoroga in Ayurveda. The ingredients of Ushakadi Gana are not easily available for the preparation of Basti and do not include herbal drugs. The Ushakadi Gana Basti is effective, it poses challenges due to its high cost, limited accessibility, and concerns regarding its mineral content, which is contraindicated for patients with renal and hepatic impairments. Lekhan Basti with Triphala Gana offers an alternative due to its herbal composition. Aim: To evaluate the efficacy of Lekhan Basti with Ushadi Gana versus Lekhan Basti with Triphala Gana compared to standard control in managing dyslipidaemia (Medoroga). Materials and Methods: A randomised single (assessor) blind triple-arm superiority controlled trial will be conducted at Mahatma Gandhi Ayurvedic College, Hospital and Research Centre, Salod, Wardha, Maharashtra, India, from January 2025 to March 2026. A total of 129 patients will be divided into three groups, each comprising 43 patients. Group A (n=43): Lekhan Basti with Triphala Gana for 16 days, Group B (n=43): Lekhan Basti with Ushakadi Gana for 16 days and Group C (n=43): Standard treatment with Atorvastatin (1 tablet, 10 mg) daily after food for 48 days. Therapeutic outcomes, lipid profile levels, Body Mass Index (BMI), and weight will be assessed at baseline and follow-up. Analysis of Variance (ANOVA) tests will be applied for statistical analysis, with p-value <0.05 considered significant.

Evaluate the Effect of Dexmeditomedine as an Adjuvant to 0.5% Bupivacaine in Ultrasound-guided Axillary Nerve Block: A Research Protocol

Pardhasaradhi Kapusetti, Karuna Taksande

Introduction: Effective perioperative pain management is a key component of enhanced recovery in upper limb surgeries. Ultrasound-guided Axillary Brachial Plexus Block (ABPB) is a reliable regional anaesthesia technique. Bupivacaine, a long-acting local anaesthetic, is commonly used for such blocks. Dexmedetomidine, a selective α2-adrenergic agonist, has been suggested to enhance block quality and prolong analgesia when used as an adjuvant. Need of the study: However, there is limited evidence for forearm fractures comparing the efficacy of dexmedetomidine with bupivacaine versus bupivacaine alone in axillary blocks, highlighting the need for this study to establish its clinical benefit and safety profile. Aim: To evaluate and compare the effect of dexmedetomidine as an adjunct to 0.5% bupivacaine and 0.5% bupivacaine without dexmedetomidine in ultrasound-guided axillary nerve block for forearm and hand surgeries. Materials and Methods: A single-blinded randomised controlled study will be conducted at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi (Wardha), Maharashtra, from October 2025 to October 2026. Patients will be randomly allocated into two groups of 30 each: Group-BD will receive 20 mL of 0.5% bupivacaine with 0.2 mL dexmedetomidine, and Group-B will receive 20 mL of 0.5% bupivacaine with 0.2 mL saline. Sensory and motor block characteristics, duration of analgesia, pain scores, and complications will be recorded and analysed. The data will be analysed using the Shapiro-Wilk test for normality, independent sample t-test or Mann-Whitney U test for group comparisons, Chi-square or Fisher’s exact test for categorical data. A p-value <0.05 will be considered statistically significant.

Efficacy of Peganum harmala Linn. Capsule versus Trigonella foenum-graecum Linn. Capsule in the Management of Primary Dysmenorrhoea: A Research Protocol

Aditi Padoley, Jaimala Jadhav

Introduction: Primary dysmenorrhoea, also known as Kashtartava in Ayurveda, refers to painful menstruation that significantly affects the quality of life for many women, characterised by intense cramping and associated symptoms like headache, nausea, and back pain. Ayurveda, a holistic medical system, offers several herbal treatments for Kashtartava, among these, Peganum harmala Linn. seeds are recognised for their analgesic, antispasmodic, and anti-inflammatory properties. Similarly, Trigonella foenum-graecum (Methi) seeds, traditionally used for various gynaecological conditions, show potential for pain relief in management of kashtartava. Need of the study: Harmal (Peganum harmala L.) has been traditionally used as a remedy in Ayurveda, but there has been limited scientific research on its medicinal properties, especially in treating primary dysmenorrhoea and painful menstrual periods. This research project will investigate the potential of Harmal seeds in addressing primary dysmenorrhoea (Kashtartava). Aim: To evaluate the efficacy of Harmal (Peganum harmala Linn.) capsule versus Methi (Trigonella foenum-graecum Linn.) capsule in the management of primary dysmenorrhoea (Kashtartava). Materials and Methods: A double-blind randomised controlled parallel design clinical trial will be conducted from June 2025 to September 2026. The patients will be recruited from the Outpatient Department (OPD) (Prasuti Tantra avam Striroga OPD) of Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India. Sixty patients will be randomised into two groups (each group contains 30). In Group A, Peganum harmala L. (harmal seeds) powder capsule 500mg BD, before a meal with water, will be given for three days, and Group B will be given Trigonella foecum-graceum (Methi seeds) powder capsule 2 gm BD, before a meal with warm water will be provided for three days. Regular follow-ups will be done on the 1^st and 3^rd day for three months at consecutive cycles. The Chi-squared test will be used to compare baseline characteristics between the two groups. A paired t-test or Wilcoxon signed-rank test will be used to assess the reduction in pain within each group from baseline to post-treatment. An unpaired t-test or Mann-Whitney U test will be used to compare post-treatment pain reduction between the two groups. A p-value<0.05 will be considered statistically significant.

Comparative Evaluation of Antidiabetic Activity of Five Geographical Indicators of Haridra (Curcuma longa Linn.) in Wistar Albino Rats: A Research Protocol

Akhil Annappa Patil, Sneha Vidhate, Dattatray Sarvade

Introduction: Diabetes mellitus is a rapidly progressing metabolic disorder with a high global prevalence, leading to severe complications. Ayurvedic literature extensively documents the use of Haridra (Curcuma longa Linn.) in the management of Prameha (Diabetes mellitus). Different geographical indicators of turmeric exhibit variations in their phytochemical composition and efficacy. Need of the study: Haridra (Curcuma longa Linn.) is a traditionally used and classically described drug that has been utilised since ancient times for its various medicinal benefits. Different geographical indicators of turmeric have been used in India for centuries. According to various research studies, these varieties show differences in morphological characteristics, phytochemical profiles, and efficacy. Although Haridra is a proven drug for its antidiabetic activity, geographical variations have not been explored to date. Aim: To compare the antidiabetic activity of five geographical indicators of Haridra—Erode, Kandhamal, Lakadong, Sangli, and Waigaon—in Wistar albino rats. Materials and Methods: An analytical experimental study will be conducted in the Department of Dravyaguna Vigyan, Mahatma Gandhi Ayurveda College, Hospital and Research Centre (MGACH & RC), Salod, Wardha, Maharashtra, India, from May 2025 to September 2026. Mature rhizomes of Haridra (Curcuma longa Linn.) will be collected from fields located in Erode, Kandhamal, Lakadong, Sangli, and Waigaon during the appropriate season. Standard pharmacognostical and phytochemical characterisation will be performed on all samples using established methods such as macroscopy, microscopy, and High Performance Thin Layer Chromatography (HPTLC) fingerprinting, as prescribed in the Ayurvedic Pharmacopoeia of India (API). The animal experiment will be conducted using 48 Wistar albino rats of either sex. The rats will be divided into eight groups, including a control group with positive and negative controls and five experimental groups administered different geographical varieties of Haridra. Diabetes will be induced using Alloxan, and fasting blood glucose levels will be measured at regular intervals. Phytochemical analysis of curcumin and other bioactive compounds will be conducted to correlate with the observed pharmacological effects. Statistical analysis will be performed using descriptive and inferential statistics, including Student’s paired t-test, one-way ANOVA, and Tukey’s multiple comparison test. A p-value of <0.05 will be considered as statistically significant.

Comparative Evaluation of Antimicrobial Efficacy of Different Root Canal Filling Materials Combined with Theobromine in Primary Teeth: A Research Protocol of an In-vitro Study

Devyani Taori, Monika Khubchandani, Dhruba Chandi, Harikishan Kanani

Introduction: Preserving the health and structure of primary teeth is crucial for a child’s growth and development. Premature extraction of primary teeth can lead to unfavourable changes in the eruption pattern and alignment of permanent teeth. To ensure the success of endodontic therapy in primary teeth, it is essential to use a biocompatible obturating material with effective antimicrobial properties. An ideal root canal filling material for primary teeth should not harm the periapical tissues, should promote the normal development of the permanent successor tooth and should undergo resorption simultaneously with root resorption. Additionally, it should be easy to place, adhere to the root canal walls, resorb if extruded beyond the apex, appear radiopaque on radiographs and not cause tooth discolouration. Zinc oxide Eugenol (ZnOE), iodoform-based pastes and calcium hydroxide are commonly used obturating materials for primary teeth. However, ZnOE has several disadvantages, including slow resorption, potential tissue irritation, bone and cementum necrosis and interference with the eruption of permanent teeth. Theobromine is a crystalline, water-insoluble alkaloid found in cacao plants. It has been shown to strengthen tooth enamel and exhibit antibacterial activity against microorganisms such as Lactobacillus acidophilus and Enterococcus faecalis. Need of the study: There is a need to identify root canal filling materials suitable for primary teeth that combine effective antimicrobial activity with biocompatibility and appropriate resorbability. Existing materials, such as zinc oxide eugenol, possess limitations that may compromise treatment outcomes. Therefore, investigating formulations enhanced with theobromine may represent a potential advancement in paediatric endodontics. Aim: To assess and compare the antimicrobial effectiveness of root canal filling materials, including zinc oxide eugenol and calcium hydroxide, combined with theobromine in primary teeth. Materials and Methods: An in-vitro study will be conducted at the Department of Paediatric and Preventive Dentistry at Sharad Pawar Dental College and Hospital, in collaboration with the Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi, Wardha, Maharashtra, India, involving 25 patients aged 4-8 years. Microbial samples will be collected from infected primary molar teeth. The antimicrobial efficacy of four different root canal filling materials—zinc oxide mixed with theobromine, zinc oxide eugenol, calcium hydroxide mixed with theobromine and calcium hydroxide mixed with saline—will be evaluated. Vaseline will serve as the negative control. The mean zone of inhibition will be considered the primary outcome measure. Data will be tested for normality using the Shapiro–Wilk test. If the data are normally distributed, one-way Analysis of Variance (ANOVA) followed by Tukey’s post hoc test will be applied. If the data are not normally distributed, the Kruskal–Wallis test followed by the Mann-Whitney U test with Bonferroni correction will be used. A p-value of <0.05 will be considered statistically significant.

Plant Derived Antioxidants and Their Protective Action on Ultraviolet-induced Corneal Injury: A Narrative Review

K Deeksha, Rahima Banu

Cornea acts as the first line of primary defense against various harmful effects of Ultraviolet (UV) radiation. Constant UV exposure leads to various ocular surface diseases such as pterygium, photokeratitis, and may also lead to ocular surface neoplasias. Available literature suggests association between UV induced oxidative damages and corneal diseases. Prolonged exposure to UV radiation leads to cellular modifications such as activation of NF-κB leading to pro-inflammatory cytokine release and apoptosis. Upregulation of Matrix Metalloproteinases (MMPs) particularly MMP-1, MMP-2, and MMP-9, involved in tissue remodelling and degradation of extracellular matrix. Changes in cytokine expression which includes IL-1, IL-6, IL-8, and TNF-α, which are involved in inflammation and cellular injury. Genetic changes include downregulation of PAX6, a critical gene for eye development and maintenance and UV-induced activation of Deoxyribonucleic Acid (DNA) damage pathways such as JNK and MAPK, leading to apoptosis. This review mainly focuses on the use of natural antioxidants derived from plants such as Rosmarinus officinalis, Curcuma longa (Curcumin), Camellia sinensis (Green tea polyphenols), Centella asiatica, Ginkgo biloba, Allium cepa (Quercetin), Glycyrrhiza glabra (Glycyrrhizin), Zingiber officinale (Ginger), Nigella sativa, Lycopene which can be used as therapeutic targets (NF-κB signaling pathway, MAPK and JNK pathways, P53 phosphorylation, MMPs (e.g., MMP-1, MMP-2, MMP-9), oxidative stress markers] in treating UV-induced inflammation and oxidative damages in cornea. PubMed literature search was performed using keywords antioxidants, ultraviolet radiation, oxidative stress, inflammation, cornea on July 3rd 2021, which resulted in 165 papers of which 81 were chosen after applying specific filters and relevant curation by the authors. This study reviews the various biochemical pathways involved in cell injury and cell death in response to UV exposure. The study also reviews the natural antioxidants and the various medicinal plants from where these are derived. The authors conclude that inflammatory mediators have a major role in stimulating oxidative stress leading to apoptosis and cell death and ocular surface diseases such as photokeratitis, pterygium, Climatic Droplet Keratopathy (CDK), Dry Eye Disease (DED), pinguecula, corneal ulceration. Targeting these inflammatory mediators by the use of natural antioxidants which are dietary-derived plant polyphenols with anti-inflammatory potential are reported to have beneficial effects.

Prefabricated versus Customised Space Maintainers in the Era of Evidence-based Dentistry: A Comprehensive Narrative Review

Premature loss of primary teeth continues to be one of the most common challenges in paediatric dentistry, with wide-reaching consequences if left untreated. Space loss, midline deviations, crowding, and subsequent malocclusion often develop or develop frequently, often necessitating complex orthodontic treatment during adolescence. Space Maintainers (SMs) have therefore become a cornerstone of preventive paediatric dentistry. Customised appliances historically have been regarded as the gold standard because of their adaptability, long-term stability, and versatility across different clinical scenarios. In contrast, prefabricated SMs were developed as chairside alternatives that require less clinical time, eliminate laboratory steps, and improve feasibility for uncooperative children or in community settings. With the introduction of fibre-reinforced composite resin and Three-dimensional (3D) printing, the paradigm is shifting towards minimally invasive and aesthetic solutions. However, concerns remain regarding their longevity, adaptability, and impact on gingival health. The reviewed articles highlight the distinct advantages and limitations of both prefabricated and customised appliances, along with emerging evidence supporting fibre-reinforced and digitally fabricated SMs. Studies involving animal models and non-clinical narrative reviews were excluded. This narrative evaluation serves as a clinical reference for dental professionals and researchers seeking evidence-based guidance in appliance selection for paediatric space management and insight into future digital advancements in preventive orthodontics.

Structured Care Protocol for Caregivers of Cerebral Palsy Cases: A Narrative Review

Indu Prakash Alwadkar, Deeplata Mendhe Mahesh Mendhe, Jaya Pranoykumar Gawai

Structured care protocols such as Parent and Caregiver Training (PACT) frameworks have emerged as a promising strategy to address the substantial multidimensional burden experienced by caregivers of individuals with Cerebral Palsy (CP). Caregivers frequently face physical, emotional, social, and financial stressors, compounded by inadequate information, poor access to services, and limited structured support, particularly in low-resource settings. This narrative review synthesises current literature on the concept, characteristics, and impact of structured care protocols for CP caregivers, with specific emphasis on educational, psychosocial, skill-building, and resource-navigation components. A focused search of major databases identified studies and reviews describing caregiver-focused interventions, structured programs, and multidisciplinary models of care relevant to CP. The evidence indicates that PACT-type protocols can enhance caregiver knowledge, practical caregiving skills, self-efficacy, and perceived competence, which in turn are associated with reduced stress, lower caregiver burden, and improved quality of life for both caregivers and children. Key elements include systematic education on CP and home-based management, training in daily care and therapeutic activities, facilitation of access to medical, rehabilitative, social, and financial resources, and integration of psychosocial support and peer networks. Emerging work also highlights the potential of digital health platforms to improve scalability, continuity of support, and personalisation of these interventions across diverse sociocultural contexts. Nonetheless, gaps remain regarding standardised PACT models, culturally adapted content, and robust long-term outcome data, especially in developing countries. Future research should prioritise the development, implementation, and controlled evaluation of context-appropriate structured care protocols to optimise caregiver well-being and child outcomes in CP.

Management of Melasma (Vyanga) through Ayurveda Interventions: A Comprehensive Review

Rashmi Ramakant Balage, Jaymala Jadhav

Melasma is a skin condition characterised by hyperpigmentation patches on facial skin due to increased melanin synthesis. Important aetiological factors for development of melasma include genetic predisposition and Ultraviolet (UV) radiation exposure, resulting in melanocyte overactivity. ‘Vyanga,’ described in Ayurveda under category of ‘Kshudra Roga,’ denotes facial blemishes or patches characteristic to this condition. Many Ayurveda interventions are being used, but extent of their clinical efficacy evidences is scarce. In present review, clinical research articles were retrieved from databases focused on Ayurveda research, viz., AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) Research Portal and Digital Helpline for Ayurveda Research Articles (DHARA). A review of 12 such articles exhibited usage of variety of interventions with positive outcomes. It was observed that, along with classically mentioned remedies such as Manjishtha (Rubia cordifolia), a number of rational combinations, such as ‘AYUSH face pack,’ were designed and successfully used. In conclusion, Ayurveda could play a very important role in the management of melasma.

Antimicrobial Peptides in the Prevention and Management of Oral Diseases: A Narrative Review

Jaya Agali Ramachandran, K Swetha, Muhammed Thameem, Ganavi G Nayak

Antimicrobial Peptides (AMPs) are a diverse class of host-defence molecules that respond to microbial invasion and challenge. Owing to their broad spectrum of antimicrobial activity and the low rates of induced resistance resulting from the co-evolution of pathogens with host AMPs, these peptides play a crucial immunomodulatory role against microbes. This, in turn, contributes to effective defence against oral infections such as dental caries and periodontal diseases. Numerous studies and existing literature suggest that AMPs have a promising future in controlling the formation and growth of biofilms by oral pathogenic microorganisms, thereby helping to reduce the incidence and prevalence of dental caries, which commonly affects children, as well as other oral diseases. Consequently, researchers are actively developing synthetic AMPs with improved stability and biocompatibility that could potentially replace conventional antimicrobial therapies. The scope of the present review is to summarise AMPs, including their origin, structural characteristics, mechanisms of action and recent advances in their application for combating various oral diseases.

Role of Virechana Karma as a Cardioprotective Modality: A Narrative Review

Aniket Rajput, Manoj Shamkuwar, Nitin Jindal, Ritika Nagpal

Cardiovascular disorders lead to many deaths worldwide due to strokes and heart attacks, with dyslipidaemia being the main risk factor. This condition is similar to Medo Rog (disorder of fat metabolism) in Ayurveda. Other recognised metabolic risk factors for CVDs include diabetes, Hypertension (HTN), obesity, and Non-alcoholic Fatty Liver Disease (NAFLD). The present review aimed to assess the effectiveness of Virechana Karma (therapeutic purgation) as a cardioprotective method by examining its impact on key metabolic risk factors. Virechana Karma demonstrates significant potential to regulate lipid imbalances, serve as a primary therapy for eliminating vitiated Pitta and Kapha Doshas, and improve Agni. This holistic biopurification approach could be an effective alternative or supplementary therapy for managing the main pathophysiological elements of CVDs, acting as a cardioprotective strategy

Balance Training in Post Knee Arthroplasty Rehabilitation: A Narrative Review

Anjali Vikas Nawkhare, Mitushi Deshmukh, Aishwarya Borhade

Osteoarthritis (OA) often results in significant degeneration of the knee’s tendons, ligaments, muscles, and joint capsules, frequently resulting in reduced proprioception. Total Knee Arthroplasty (TKA) is a widely used surgical intervention aimed at alleviating pain and improving the Quality of Life (QoL) for individuals with end-stage Knee Osteoarthritis (KOA). However, despite its effectiveness, many patients experience only modest functional improvements following surgery, highlighting the need for enhanced rehabilitation strategies. The present narrative review explores the impact of incorporating balance and proprioceptive training into postoperative rehabilitation for TKA patients, focusing on physical function, pain relief, and overall well-being. The purpose of the present review is to evaluate how proprioceptive and balance training affects physical function, pain management, and general QoL in postoperative rehabilitation for TKA patients. Regaining stability, mobility, and confidence in performing daily tasks is often challenging for individuals who have undergone TKA. Although the procedure primarily addresses structural joint damage and alleviates pain, it does not automatically improve sensory-motor function or neuromuscular coordination, both of which are essential for independent mobility and fall prevention. Findings indicate that early integration of balance and proprioceptive exercises can significantly improve recovery outcomes after TKA, enhancing balance, physical function, and QoL. Techniques such as Progressive Dynamic Balance Training (PDBT), combined kinetic chain exercises, and Neuromuscular Electrical Stimulation (NMES) have demonstrated particular effectiveness. However, variability in study designs and outcome measures underscores the need for standardised rehabilitation protocols. In conclusion, balance and proprioceptive training appear to offer substantial benefits for TKA patients by improving functional outcomes and reducing fall risk. Further research is needed to develop consistent training protocols, examine long-term outcomes, and validate findings in larger and more diverse patient populations.

Tracking the Biochemical Trail of Neuroinflammation in Diabetic Neuropathy: A Narrative Review

TY Susanna, Ankita Kumari, K Prabhakar

Diabetic Neuropathy (DN) is a long-term persistent neuro impairment associated with Type 2 Diabetes Mellitus (T2DM). DN develops when chronic hyperglycaemia damages peripheral and autonomic nerves, giving rise to a broad spectrum of clinical symptoms. The mechanism of DN is elaborate and multicomponent, mediated by persistent hyperglycaemia, lipid metabolic dysfunction, oxidative imbalance, impaired mitochondrial activity, and neuroinflammation, together giving rise to progressive peripheral nerve injury. Persistently raised glucose levels promote the accumulation of glycotoxins, leading to alteration in protein synthesis and function. Inflammatory mediators such as Interleukin-6 (IL-6), C-Reactive Protein (CRP), IL-18, IL-8, and Tumour Necrosis Factor alpha (TNF-α) further amplify nerve damage by activating Nuclear Factor kappa B (NF-κB) and Mitogen-Activated Protein Kinase (MAPK) signaling pathways. Modern strategies for managing DN focus on glycaemic control, lifestyle modifications, and emerging treatments namely Sodium-Glucose Cotransporter 2 (SGLT2) targeting drugs and Glucagon-Like Peptide-1 (GLP-1) mimetic. Further the identification of biochemical markers and molecular targets may facilitate early diagnosis and enable more personalised interventions. Continued collaboration between basic science scientists and clinicians will be essential in translating biochemical insights into tangible benefits for individuals. Despite our growing knowledge of the complexity of DN has sustainably improved in prior years, yet such knowledge of biochemical aspects and earlier predictor of neuropathy associated with diabetes are not entirely clear. Hence, the present review tends to describe the present comprehension about biochemical aspects, mechanism of neurological progression, and interconnected pathways involved in DN.

Clinical Features and Pathogenesis of Noma: A Narrative Review Highlighting the Emerging Strategies for Prevention and Management

Bhagyesh Sapkale, Sonali Choudhari

Noma, also known as cancrum oris, is a rapidly progressive gangrenous infection that affects the oral and facial tissues of malnourished children in impoverished regions, particularly in sub-Saharan Africa. The disease typically begins as acute necrotising gingivitis and rapidly progresses to extensive tissue destruction, facial disfigurement, and high mortality if left untreated. This narrative review explores the clinical progression of Noma, its World Health Orgnisation (WHO) classification and simplified staging systems, the pathogenesis involving malnutrition, immunosuppression, and microbial dysbiosis, as well as the polymicrobial nature of the disease. Diagnosis of Noma is primarily clinical, although emerging microbiome-based diagnostic techniques show promise for early detection. Management requires a comprehensive approach that combines early antibiotic therapy, nutritional rehabilitation, wound care, and delayed reconstructive surgery. Preventive strategies include adequate vaccination (particularly against measles), community-based oral health education, and improvements in Water, Sanitation, and Hygiene (WASH) initiatives. Strengthening local healthcare infrastructure and establishing sustainable surgical programmes are essential for long-term control and rehabilitation of Noma. Addressing the socio-economic determinants of Noma through holistic public health efforts remains crucial for reducing its burden and achieving global eradication.

Congenital Intestinal Malrotation: A Narrative Review of Age-specific Presentations, Evolving Diagnostics and Surgical Innovations

Satish Surapureddy, Pankaj Gharde, Bhagyesh Sapkale

Congenital intestinal malrotation is a developmental anomaly resulting from incomplete or aberrant rotation and fixation of the midgut during embryogenesis. Normally, the midgut rotates 270 degrees around the Superior Mesenteric Artery (SMA); any deviation from this normal rotation leads to abnormal positioning of the Duodenojejunal Junction (DJJ) and caecum. In neonates and infants, the condition is characterised by bilious vomiting, abdominal distension, and failure to thrive. In older children, it may present with chronic abdominal pain and intermittent vomiting. Adults often exhibit nonspecific Gastrointestinal (GI) symptoms or atypical features resembling pancreatitis, which commonly leads to delayed diagnosis. The Ladd procedure remains the gold-standard surgical intervention, although newer restorative techniques are emerging. Outcomes depend largely on prompt diagnosis and timely surgical management, with current recommendations emphasising early recognition, operative treatment, and appropriate follow-up to minimise morbidity and mortality.

Optimising Anaesthesia for Endovascular Thrombectomy in Acute Ischaemic Stroke: A Narrative Review on the use of General Anaesthesia versus Conscious Sedation

Angan Ghosh, Sanjot Ninave

Acute Ischaemic Stroke (AIS) due to Large Vessel Occlusion (LVO) remains a leading cause of mortality and long-term disability worldwide, with Endovascular Thrombectomy (EVT) established as the gold standard of treatment when performed rapidly. Anaesthetic management is pivotal in influencing procedural success, safety, and neurological outcomes, yet the choice between General Anaesthesia (GA) and Conscious Sedation (CS) remains controversial. GA offers advantages of airway protection, patient immobility, and optimal procedural conditions; however, it is often associated with haemodynamic instability, potential delays in treatment initiation, and risks of prolonged recovery. In contrast, CS allows for continuous neurological assessment and may reduce treatment times, but carries the risk of patient agitation, airway compromise, and the need for conversion to GA, which can adversely affect outcomes. Recent randomised controlled trials, meta-analyses, and large-scale observational studies have attempted to clarify this debate, with many reporting broadly comparable rates of functional independence, recanalisation success, and mortality between GA and CS. However, subtle differences persist regarding haemodynamic stability and complication profiles. Evidence also suggests that protocol-driven approaches, hybrid strategies, and institutional preparedness significantly influence outcomes, highlighting that anaesthetic technique cannot be considered in isolation. The evolving literature supports a balanced, patient-centred approach in which anaesthetic choice is guided by clinical condition, airway safety, operator preference, and institutional expertise rather than a rigid protocol. Ultimately, tailored anaesthetic management remains critical to maximising neurological recovery, minimising peri-procedural risks, and optimising workflow efficiency in patients undergoing EVT for AIS. This review introduces a novel, patient-centred framework for anaesthetic management in EVT, focussing on individual clinical and institutional factors to optimise outcomes and workflow efficiency.

Challenges and Opportunities of Public Health Dentistry in India: A Narrative Review

G Krishnaprakash, Sibyl Siluvai, KP Indumathi

Oral health is fundamental to overall well-being, as it influences physical health, social confidence, mental stability, and daily functioning. Public Health Dentistry (PHD) addresses oral health at the population level by developing strategies to improve access and outcomes. This narrative review examines the current state, challenges, and opportunities in PHD in India. It incorporates peer-reviewed literature as well as policy documents and strategic reports from relevant government health agencies and professional dental organisations to ensure contextual relevance and completeness. The review highlights key areas, including workforce distribution, oral health awareness, mobile dental services, and community outreach. However, persistent challenges such as insufficient manpower, limited funding and a lack of integrated policies continue to pose significant obstacles. Disparities in access to dental care between urban and rural areas underscore the need for targeted interventions to address these inequities. The review emphasises the importance of a robust national oral health policy, integrating oral health care into general health services, and fostering interdisciplinary collaboration. Newer techniques, such as teledentistry and mobile health applications, have the potential to address service deficiencies, particularly in remote or isolated areas. Enhancing community-based oral health education and targeted prevention can lead to lasting improvements in population oral health. Coordinated action among government agencies, academic institutions, and local health systems is crucial to maintain service delivery that is reliable, accessible, and sustainable. A community-centered and equitable approach is essential for reducing the prevalence of oral illnesses in India. Overall, aligning public health priorities with oral health needs can contribute to meaningful and long-term improvements in national health outcomes.

Artificial Iris Implants for Post Ocular Damage Reconstruction: A Comprehensive Review

Kunal Bhat, Sachin Daigavane

Traumatic aniridia, the partial or complete absence of the iris resulting from ocular injury, presents a complex challenge in ophthalmology. The iris plays a crucial role in regulating light entry into the eye, reducing glare, and enhancing image quality. Significant iris loss disrupts these functions, leading to debilitating symptoms such as photophobia (light sensitivity), glare, decreased visual acuity and cosmetic disfigurement. These symptoms can severely impair a patient's daily life and overall well-being. While various management options exist, including coloured contact lenses and corneal tattooing, they often fall short in addressing both the functional and cosmetic consequences of substantial iris loss. Artificial Iris (AI) implantation has emerged as a promising surgical technique to address these issues. This procedure involves the placement of a prosthetic device to replace the missing or damaged iris tissue. There are several different kinds of Prosthetic Iris Devices (PIDs), with varying levels of technical difficulties in implant and design. These include customised AI, endocapsular tension ring-based PID, and AI-Intraocular Lens (IOL) prosthesis. The aim of this review was to analyse various iris reconstruction techniques using artificial implantation following ocular damage. In addition to giving a thorough explanation about the ocular trauma and its related issues, this review article focuses regarding the AI implantation. The various implantation methods for anterior segment repair following ocular damage are highlighted in this article. The custom-made iris implant's adaptability allows for a wide range of uses, and the material's ability to fold minimises the requirement for large incisions within the eye, which is already traumatised.

Acute Colonic Pseudo-obstruction: A Narrative Review of Pathophysiology, Advances in Diagnosis, and Management

Nayan Mundhada, Raju Shinde, Aarushi Kaul, Krinal Parikh, Bhagyesh Sapkale

Acute Colonic Pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is a clinical condition characterised by massive colonic dilatation without mechanical obstruction. It commonly occurs in postoperative, critically ill, or severely immobilised patients. The pathophysiology involves autonomic dysregulation, neuromuscular transmission defects, electrolyte imbalances, and inflammatory mediators. Clinically, ACPO presents with progressive abdominal distension, pain, and altered bowel movements, often mimicking true colonic obstruction. Diagnosis primarily relies on imaging modalities such as plain radiographs and Computed Tomography (CT), while advanced tools like CT colonography, colonic manometry, and Point-of-Care Ultrasound (POCUS) are emerging. Treatment includes conservative supportive care, administration of neostigmine, and colonoscopic decompression. Surgical intervention is reserved for complications such as ischaemia or perforation. Emerging methods, including Percutaneous Endoscopic Cecostomy (PEC) and neuromodulation, are under investigation for prompt treatment of ACPO. Early and timely diagnosis, along with individualised treatment strategies, are essential to prevent severe complications and improve patient outcomes. The present narrative review highlights current knowledge of ACPO, its dynamic pathophysiology, emerging diagnostic options, stepwise management, and novel therapies that may enhance patient outcomes.

Zollinger-Ellison Syndrome: A Narrative Review of Clinical Presentation, Pathogenesis, Diagnosis and Modern Management Approaches

Zollinger-Ellison Syndrome (ZES) is rare disorder which is caused by gastrin-secreting neuroendocrine tumours known as gastrinomas, primarily located in the duodenum or pancreas. These tumours further result in excessive production of gastric acid, leading to recurrent, treatment-resistant peptic ulcers, chronic diarrhoea, and gastroesophageal reflux. Clinical features presented in patient include abdominal pain, weight loss, anaemia, and prominent gastric folds. Diagnosis of ZES is based upon elevated Fasting Serum Gastrin (FSG) levels, low gastric pH, and confirmatory secretin stimulation tests. Imaging methods such as Ga-68 DOTATATE PET-CT and Endoscopic Ultrasound (EUS) help in localisation of tumour, while Multiple Endocrine Neoplasia type 1 (MEN1)-associated cases require additional endocrine screening. Management in such cases involves high-dose Proton Pump Inhibitors (PPI) for suppression of acid and surgical resection is useful for localised tumours. Advanced and metastatic cases may prove helpful from Somatostatin Analogs (SSA) PPI or Peptide Receptor Radionuclide Therapy (PRRT). Novel agents like sunitinib and everolimus control tumour. Early diagnosis, multidisciplinary treatment can thus improve clinical outcomes and quality of life in patients with ZES. The narrative review is inclusive of clinical presentation, pathogenesis, diagnostic, and contemporary management and emerging approaches of ZES.

A Narrative Review of 3D Printing Applications in Airway Management: Customised Solutions for Difficult Airways

Gummalla Abhigna, Vivek Chakole, Saurabh Prakash, Amreesh Paul Francis

Difficulty in airway management continues to be one of the most significant problems of anaesthesia practice, where anatomical pathology or complexity may make traditional methods ineffective. Over the past decade, three-dimensional (3D) printing has emerged as a transformative technology, producing highly personalised solutions that bridge diagnostic imaging and therapeutic intervention. By converting patient-specific information into physical devices and models, 3D printing enables physicians to better understand individual airway anatomy, predict complications, and provide customised care. The uses of the technology are widespread in various fields, ranging from creating personalised airway stents, bioresorbable splints, and intubation devices to lifelike anatomical models for preoperative planning and procedural training. These innovations advance clinical outcomes and greatly enhance healthcare providers' preparedness and proficiency through experiential training. In preoperative planning, models printed with 3D printing have been found especially valuable in depicting complex reconstructions and practising high-stakes procedures, particularly in paediatric and oncologic patients. Though it has tremendous potential, widespread use of 3D printing in airway management is balanced by a few challenges, such as inconsistency in material properties, very high cost of production, limitations in sterilisation, and absence of regulatory standardisation. Improvements in bioprinting, artificial intelligence-based design, and integration with smart devices are progressively widening its clinical applicability and viability. This review aims to critically analyse the current applications and future prospects of three-dimensional printing in airway management. The present review consolidates current applications of 3D printing specifically in airway management, a niche yet critical area of anaesthesia.

Advances in Brucella Detection: A Comprehensive Review of Traditional and Emerging Techniques

Mushrraf Yusuf Khan, Aditi Warghade, Jaishriram Rathored

Brucellosis remains a major zoonotic infection across the world. Brucella melitensis, B. abortus, and B. suis are considered to be most frequently attributed to human infection and transmission may occur either as a direct contact with infected animals or ingestion of unpasteurised animal products. The diagnostic issues are complex in nature due to the non specific clinical presentation of the condition and infrastructure constraints of the traditional laboratory techniques, particularly in resource-limited settings. This review compares both conventional and novel diagnostics for the detection of Brucella, and presents the advantages and limitations of each. The older methods, including Rose Bengal Plate Test (RBPT), Standard Tube Agglutination Test (SAT), Enzyme-Linked Immunosorbent Assay (ELISA), and bacterial culture, remain popular, but lack sensitivity, have variable specificity, and are costly in terms of resources. In comparison, molecular methods such as Polymerase Chain Reaction (PCR), quantitative PCR (qPCR), nested PCR and droplet digital PCR (ddPCR) are more sensitive and have a faster turnaround time, but require an advanced laboratory infrastructure. Improvements in the development of diagnostics like CRISPR-Cas-based assays and lateral/vertical flow immunoassays suggest great potential in the easier deployment in the field. The review hence underlines the dire need of low-cost, high speed and highly accurate diagnostic tools that can discriminate at the species level. The priorities of future research are the incorporation of the one health point of view, the systematic standardisation and multicentre validation of new diagnostic platforms.

Panchakarma in Preconception Care: A Narrative Review on Its Efficacy, Success Rates, and Mechanisms in Enhancing Reproductive Health

Neha, Shweta Parwe, Milind Nisargandha

Ayurveda, the ancient life science, provides a holistic paradigm that balances mind, body, and spirit to attain health and avoid disease. Panchakarma, a basic Ayurvedic detoxification therapy, is traditionally used as a preconceptional remedy to cleanse the body, Beeja Shuddhi (purification of the seeds), enhancing reproductive health and fertility. Although it is well-established in Ayurvedic medicine, scientific evidence for Panchakarma’s use in reproductive health is scarce, and more research is needed. The present review synthesises ancient Ayurvedic concepts with recent biomedical concepts on efficacy, success rate, and biological mechanisms of Panchakarma as a preconception care intervention. A narrative literature search on Ayurveda-based databases, integrative medicine databases, and reproductive health databases, such as experimental studies, clinical case reports, and previous reviews that examined the effect of Panchakarma on fertility, detoxification, hormonal homeostasis, and reproductive tissue health, was conducted. New evidence suggests that Panchakarma therapies control reproductive health by eliminating systemic toxins (Ama), dosha rebalancing (bioenergetic principles), and rejuvenating Shukra Dhatu (reproductive tissue). Clinical trials document improved sperm quality and menstrual health with Panchakarma therapies. Putative biological mechanisms include modulation of oxidative stress, inflammatory processes, and endocrine function, by modern theories of fertility optimisation. This review illustrates the integration of ancient Ayurvedic concepts and modern biomedical knowledge, suggesting Panchakarma as a holistic, preventive approach towards preconception care. However, well-designed clinical trials are needed to substantiate standard treatment protocols and affirm their efficacy in modern reproductive medicine.

Surgical Management of Microspherophakia in Young Patients and Associated Visual Outcomes: A Narrative Review

Suyash Singh, Sachin Daigavane

Microspherophakia (MSP) is a rare crystalline lens development abnormality characterised by increased anteroposterior thickness and decreased equatorial diameter. It is connected with a variety of ocular and systemic diseases, the most serious of which is secondary glaucoma. Early identification, proper lens and glaucoma care, and adequate visual rehabilitation can all help to avoid glaucoma-related blindness. Because MSP mostly affects young people, a multidisciplinary approach with ongoing follow-up is strongly advised. The rarity of this illness has hampered the availability of large-scale prospective investigations, with current information primarily obtained from case reports and retrospective analysis. This makes the development of standardised treatment guidelines problematic. The purpose of this review is to examine the surgical aspects of managing MSP in young patients and to evaluate the associated visual outcomes. To alleviate zonular weakness, surgical treatment options include techniques such as lens extraction with or without Intraocular Lens (IOL) implantation, as well as more sophisticated approaches such as scleral-fixated IOLs, iris-claw lenses, and capsular tension devices. Recent research suggests that prompt surgical intervention can greatly improve visual acuity and overall quality of life in afflicted patients. Nonetheless, long-term treatment must include possible problems such as glaucoma, zonular instability, as well as IOL displacement. This review emphasises the significance of individualised surgical methods, coordinated multidisciplinary therapy, and long-term follow-up in achieving excellent visual results in young people with MSP. It also emphasises the importance of bigger prospective studies and the creation of standardised surgical guidelines for improving evidence-based clinical practice.

Clinical Features, Pathophysiology, and Management of HELLP Syndrome: A Narrative Review

Haemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP), collectively referred to as HELLP syndrome, is a serious complication of Pre-Eclampsia (PE) that can occur anytime after the 28^th week of pregnancy or postpartum. Common symptoms include upper right abdominal pain, nausea, and generalized weakness, which can delay diagnosis. Early identification of HELLP syndrome is critical to prevent severe maternal and foetal complications, such as liver rupture, Disseminated Intravascular Coagulation (DIC), and placental abruption. Placental dysfunction, systemic inflammation, and endothelial injury contribute to the development of this syndrome. Recent studies also suggest that antiangiogenic molecules and long non-coding Ribonucleic Acids (RNAs) may play a role in its pathophysiology. Platelet counts are monitored to classify HELLP syndrome as complete or partial, and additional classification is based on the Mississippi and Tennessee criteria. The differential diagnosis includes Acute Fatty Liver of Pregnancy (AFLP), thrombotic thrombocytopenic purpura, and haemolytic uraemic syndrome, each requiring a distinct management approach. Prompt delivery is the mainstay of treatment, often supplemented with corticosteroids to promote foetal lung maturity, along with management of maternal hypertension and seizures. Emerging therapies, such as plasma exchange and eculizumab, may be considered when conventional measures fail. Notably, HELLP syndrome without hypertension requires careful monitoring due to the need for rapid diagnosis and intervention. The purpose of the present review is to provide an overview of the clinical manifestations, pathophysiology, diagnostic challenges, and newer treatment strategies for HELLP syndrome, aiming to improve maternal and foetal outcomes through timely detection and intervention.

Role of Quorum-sensing Inhibitors in Managing Oral Biofilms: A Narrative Review

Sneha Dare, Pavan Bajaj, Shivani Thakare, Mahima Kothekar

One of the most robust microbial ecosystems in the human body is found in oral biofilms. These biofilms create serious difficulties in the treatment of periodontal disease, dental caries, and peri-implant diseases. Traditional antimicrobial approaches often fail due to the intrinsic resistance of biofilm communities and their ability to evade host defenses. Quorum Sensing (QS) is a regulatory system that responds to bacterial cell population density, virulence factor expression, and modulates gene expression. Oral biofilms on dental implants and tooth surfaces can be disrupted using advanced QS-based strategies. A complex bacterial communication system, i.e., QS lets oral bacteria coordinate their activities, including biofilm development. Through chemical signals, bacteria sense and respond to population density, controlling gene expression, producing biofilm growth, and higher pathogenicity. One interesting approach to stop biofilm generation and lower pathogenicity is disrupting QS signalling pathways. The addition of Quorum Sensing Inhibitors (QSI) to tooth surface biofilms and biofilms related to dental implants has lately attracted much attention in studies. Recent advances in nanotechnology, including nanoparticle- and microparticle-mediated QSI delivery, present innovative solutions for sustained release and surface functionalisation of dental implants, thereby preventing colonisation at its earliest stages. The emergence of QSI-based treatments has the potential to solve the worldwide concern of antibiotic resistance while simultaneously improving treatment outcomes. This review will deal with the current understanding of QS mechanisms in oral biofilms and the strategies to manage the oral biofilms using QS inhibition.

A Narrative Review on Yoga as a Tool for Psychological Wellness in the Operating Theatre: Evidence and Practical Tips for Anaesthesiologists

Janhavi Dahake, Neeta Verma

Burnout is highly prevalent among anaesthesiologists and is assosciated with negative outcomes at both the provider and organisational levels. Beyond the operating theatre and intensive care units, anaesthesiologists perform diverse clinical responsibilities. This review summarises the available evidence on yoga as a practical approach to supporting the mental well-being of healthcare professionals, with a particular focus on anaesthesiologists working in the high-pressure environment of the operating theatre. in view of these effects, yoga appears particularly relevant to the mental and physical demands of anaesthesia practice. However, the limited number of studies specifically involving anaesthesiologists, this review synthesises speciality-focused evidence alongside broader healthcare data to provide a structured framework for implementing yoga in anaesthesia practice.

Recent Advances in Dental Bone Grafts: A Narrative Review

Regenerative therapy is considered an essential treatment option in dentistry and maxillofacial surgery for the management of defects caused by degenerative diseases, trauma, congenital abnormalities, and inflammatory conditions. Restoration of hard-tissue architecture requires predictable grafting techniques, as loss of alveolar bone compromises structural integrity and function. Bone graft materials exhibit varying degrees of osteogenic, osteoinductive, and osteoconductive potential and are categorised as autografts, allografts, xenografts, alloplasts, and emerging phytogenic substitutes. Due to their inherent cellular vitality, autografts continue to be regarded as the gold standard, despite limitations related to availability and donor-site morbidity. However, synthetic alternatives such as Hydroxyapatite (HA), β-Tricalcium Phosphate (β-TCP), calcium phosphate cements, and bioactive glasses offer advantages including biocompatibility, structural stability, and a reduced risk of disease transmission. Advances in material science have enhanced regenerative outcomes through the development of growth factor-enriched scaffolds, composite grafts, and nanostructured ceramics. Emerging technologies-including Three-Dimensional (3D)-printed customised scaffolds, controlled-release systems, and stem cell integration-enable precise defect reconstruction with improved biological performance. The present review aimed to analyse the characteristics, clinical applications, and potential future directions of bone grafting materials in dental and craniofacial regeneration.

The Microbiota-gut-brain Axis and its Role in Depression: A Narrative Review

Deepti Jangpangi, Namita Deka, SK Bajaj

The mutual peaceful coexistence of microbiota with their host ensures normal gut motility and secretory functions, mucosal immune function and absorption of nutrients. Emerging evidences suggest the role of gut microbiota in a bidirectional communication between Central Nervous System (CNS) and gastrointestinal system, referred to as gut-brain axis. The findings largely drawn from preclinical studies show that gut microbiome can modulate brain and behaviour via vagal nerve, inducing tryptophan metabolism pathways, affecting synthesis of neurotransmitters, production of bacterial metabolites, such as Short-Chain Fatty Acids (SCFAs), by Hypothalamus-Pituitary-Adrenal Axis (HPA) alterations and through neuroimmune pathways. Psychological stress could lead to abnormal changes in composition of gut microbiome and disruption of intestinal barrier functions and it also has an underlying role in neurobiology of depression which has multifactorial aetiology. The perturbations of gut microbiota have been associated with depression and might have a contributory role in development of depressive symptomatology. The current understanding of microbiota gut-brain axis is still in early stages and drawn from preclinical and clinical data and therefore it warrants further research to elucidate its role in stress and depression and future development of novel therapies targeting microbiota-gut-brain axis for stress related disorders such as depression.

Integrative Role of Pranayama in the Ayurvedic Management of Tamaka Shwasa: A Critical Review of Shamana, Shodhana, and Rasayana Therapies

Premkumar Panjabrao Badwaik, Vinod Nandu Ade

Tamaka Shwasa (Bronchial Asthma) is a chronic, recurring airway inflammatory disease, blamed in Ayurveda on Vata and Kapha dosha vitiation. Although existing management revolves around corticosteroids and bronchodilators, holistic medicine is gaining popularity as it has long-term safety and systemic action. Pranayama (regulated respiration) is gaining recognition with increased pulmonary efficiency and mental poise. The present narrative review endeavoured to critically analyse the integrative effectiveness of Pranayama combined with Ayurvedic modalities Shamana (palliative treatment), Shodhana (purificatory) and Rasayana (rejuvenation) in the management of Tamaka Shwasa based on a wide range of classical texts and modern research. A total of 21 articles comprising clinical trials, conceptual models and case reports were chosen based on their applicability to the integrative use of Pranayama in combination with Ayurvedic treatments. Literature was searched through indexed journals between 2004 and 2025, highlighting clinical outcomes like Peak Expiratory Flow Rate (PEFR), eosinophil count, symptomatic relief and patient-reported relief. The review substantiates uniform positive trends, particularly in multi-therapy protocols combining Vamana karma (emesis), Pippali Rasayana, Shringyadi Churna and regular Pranayama. These combinations showed significant improvements in breathlessness and PEFR values, decreased eosinophilia and outperformed monotherapy protocols. Incorporating Pranayama in Ayurvedic treatment provides a multi-faceted approach for Tamaka Shwasa in addressing its pathogenesis and systemic resilience. It supports the harmony of ancient breath science and targeted herbal and purificatory interventions in chronic respiratory diseases.

Impact of COPD on Susceptibility and Severity of Viral Infections

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is linked to worse outcomes in respiratory viral infections, especially COVID-19. Understanding genetic and mechanistic connections may improve risk assessment and treatment strategies. Aim: To investigate the genetic and biological links between COPD and respiratory viral infections. Materials and Methods: Using three COVID-19 outcomes- SARS-CoV-2 infection, COVID-19 hospitalisation, and critical COVID-19 as representative cases. In parallel, we conducted literature-based functional pathway analysis to identify and map shared molecular, cellular, and tissue/organ-level mechanisms linking COPD to both COVID-19 and viral infections more broadly, enabling visualisation of biologically plausible pathways contributing to disease susceptibility and severity. Results: Our Mendelian Randomisation (MR) analysis revealed a genetic predisposition in individuals with COPD to an increased risk of severe COVID-19 {Odds Ratio (OR)=1.16, 95% CI: 1.01–1.34, p=0.033}, while no reverse causal effect of COVID-19 on COPD was observed (p>0.37). Functional pathway analysis highlighted key overlapping molecular players- such as Transmembrane Serine Protease (TMPRSS2), Angiotensin-Converting Enzyme 2 (ACE2), Tumour Necrosis Factor (TNF), Interleukin (IL)-6, Interferons (IFNs), Dipeptidyl Peptidase-4 (DPP4) and Human Leukocyte Antigen (HLA) alleles- and dysregulated biological processes, including inflammation, oxidative stress, apoptosis, coagulation, angiogenesis, and immune responses. These findings support a model where SARS-CoV-2 infection exacerbates pre-existing pathological pathways in COPD, contributing to more severe disease outcomes. Conclusion: This study provides genetic and mechanistic evidence supporting the heightened vulnerability of COPD patients to severe COVID-19 and general viral infections. The identified shared molecular pathways may inform future therapeutic targets and guide clinical risk stratification in chronic respiratory disease management.

Effective Management of Bell’s Palsy (Ardita) Through Ayurvedic Intervention Combined with Acupuncture: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Trupti Thakre, Rohit Waskar

Bell’s palsy is an acute peripheral facial nerve paralysis of unknown etiology, leading to sudden weakness or paralysis of the facial muscles on one side. Although the condition is usually self-limiting, patients often experience significant functional and psychological distress during the course of the disease. In Ayurvedic classics, a similar presentation is described as Ardita, a disorder of Uthamanga (head region) characterised by deviation of the face and dysfunction of oral and ocular movements. This case report describes a 40-year-old male patient who presented with deviation of the mouth towards the right side, drooling of saliva, difficulty in chewing, and inability to close the right eye for 7 days. He was clinically diagnosed with Bell’s palsy and managed with an integrative protocol involving Ayurvedic therapies and acupuncture. Treatment included Snehan (oil massage), Nasya (nasal medication), Tarpana (ocular therapy), and selected internal medicines for symptomatic relief. The patient’s recovery was assessed using the House-Brackmann scale over a period of one month. Notable improvement was observed, with restoration of facial muscle function and resolution of ocular symptoms, without any adverse effects. The novelty of this case lies in the integrative approach of combining classical Ayurvedic modalities with acupuncture, which is rarely documented in the management of Bell’s palsy. This holistic treatment not only promoted functional recovery within a short duration but also demonstrated safety and patient satisfaction. The report highlights the potential of Ayurveda, when applied in conjunction with complementary therapies, as a natural, risk-free alternative to conventional management of Bell’s palsy.

Superior Rectus Muscle Entrapment Following Orbital Roof Fracture: A Rare Case Report

Aishwarya M Angadi, Pradipta Pramod Potdar, Kalibo Jakhalu, Shikha Rai

Superior Rectus (SR) palsy is a rare and often overlooked consequence of orbital trauma, particularly when associated with orbital roof fractures. The SR muscle plays a critical role in ocular elevation, and its dysfunction can lead to diplopia, ptosis, and significant visual impairment. While inferior and medial rectus entrapments are more commonly reported, SR involvement is exceedingly uncommon due to its protected anatomical location. Here, the authors report a rare case of a 20-year-old male who presented with persistent binocular diplopia and restricted upward gaze in the left eye, two months following a road traffic accident. Clinical examination revealed left upper eyelid ptosis and limited elevation, while imaging studies confirmed an orbital roof fracture with suspected entrapment of the SR muscle. Due to persistent symptoms and functional impairment, surgical intervention was undertaken via a sub-brow orbitotomy. Intraoperatively, a displaced bony fragment was identified and removed, relieving the muscle entrapment. Postoperative follow-up showed significant improvement in ocular alignment and resolution of diplopia. The present case highlights the importance of maintaining a high index of suspicion for extraocular muscle entrapment in orbital roof fractures and underscores the role of early imaging and timely surgical intervention in preventing long-term ocular morbidity.

Ayurvedic Management along with Physiotherapy in the Rehabilitation of Traumatic Paraplegia: A Case Report

Mahima Dubey, Punam Sawarkar, Shweta Parwe, Gaurav Sawarkar

A stroke, according to the World Health Organisation (WHO), is “a clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours or leading to death, with no apparent cause other than a vascular origin.” Stroke is a medical emergency and ranks as the second leading cause of mortality worldwide. It occurs when a cerebral artery becomes blocked or ruptures, causing brain cells to die abruptly due to a lack of oxygen. In Ayurveda, stroke is referred to as Pakshaghata. Present case discusses the use of physiotherapy and Ayurveda in the treatment of traumatic paraplegia. A 33-year-old male patient, diagnosed with paraplegia via Computed Tomography (CT) scan of the brain, presented with the following symptoms: inability to stand and walk without support, inability to lift the right arm, slurred speech, and loss of bowel and bladder control for the past three months. The patient had been receiving allopathic treatment for three months without significant relief. Seeking better rehabilitation, he approached an Ayurvedic hospital. The patient received Ayurvedic treatment, including Panchakarma and Shaman Chikitsa (palliative treatment), along with physiotherapy, and experienced significant improvement. This case highlights the role of Ayurvedic procedures and medications combined with physiotherapy in managing paraplegia and improving the patient’s quality of life. The combined effect of Shodhan (Purification) Chikitsa and Shaman Chikitsa proved beneficial. Procedures such as Bahya Abhyanga (external oleation) and Swedan (sudation) help open the pores, allowing the medicinal properties of medicated oils to be absorbed through the skin and reducing stiffness. Vasti (medicated enema) is considered Ardhachikitsa (half treatment) in managing Vata (bodily humour) disorders and plays a significant role in treatment.

Evaluation of Triple Antibiotic Paste-modified Soft Liner on Antibacterial Activity and Wound Healing Following Dental Implant Placement: A Prospective Interventional Study

Dnyaneshwar Parekar, Arvina Rajasekar, Thiyaneswaran Nesappan

Introduction: Soft liners used in temporary prostheses during implant healing may harbour microbial biofilms, potentially impairing peri-implant tissue health. Incorporating antimicrobial agents into these liners could reduce bacterial colonisation and promote early wound healing. Aim: To evaluate and compare the antibacterial activity and wound healing potential of a Triple Antibiotic Paste (TAP)-Modified Soft liner (TMS) versus a conventional soft liner in patients undergoing dental implant placement. Materials and Methods: This prospective interventional study was conducted at the Department of Implantology, Saveetha Dental College and Hospital, Chennai, India, between April 2024 and July 2024. It included 40 systemically healthy participants with a single missing tooth and was randomly assigned into two equal groups. Group 1 (Control) received a conventional soft liner in a temporary partial denture post-implant placement, while Group 2 (Test) received TMS in the same prosthesis. Antibacterial activity was assessed on days 0, 3, and 7 against Streptococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis using the agar well-diffusion method. Wound healing was evaluated on days 7 and 14 using the Landry Wound Healing Index (WHI). Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) software, version 23.0 (Armonk, NY, USA), utilising an Independent t-tests, with significance set at p-value <0.05. Results: The mean age of participants in the control group was 44.7±8.1 years, while the test group had a mean age of 45.3±7.5 years, with no statistically significant difference between the groups (p-value=0.78). Group 2 (TMS) demonstrated significantly larger zones of inhibition for all three test organisms on days 0, 3, and 7 (p-value <0.05), indicating superior and sustained antibacterial activity. Wound healing scores were significantly higher in group 2 at both day 7 (3.20±0.63 vs 2.00±0.82; p-value=0.002) and day 14 (4.70±0.48 vs 3.20±0.63; p-value <0.001), reflecting enhanced tissue healing. Conclusion: TMS demonstrated superior antibacterial activity and enhanced early wound healing compared to conventional liners, indicating their potential as a bioactive adjunct to improve peri-implant healing. Further long-term studies are needed to confirm these findings.

Effect of Infusion of Dexmedetomidine on Succinylcholine-induced Fasciculation and Myalgia in ENT Surgeries: A Research Protocol

Kola Kavya Praneetha, Jayashree Sen

Introduction: Succinylcholine, a depolarising neuromuscular blocker, is widely used to facilitate rapid sequence intubation due to its rapid onset and short duration of action. However, it is associated with adverse effects, including transient elevations in Intraocular Pressure (IOP), which can be harmful in patients with ocular trauma or glaucoma. Need of the study: Several pharmacologic agents have been studied to attenuate these IOP changes, with mixed efficacy and potential side-effects. Dexmedetomidine, a selective α2-adrenergic agonist with sedative, analgesic, and sympatholytic properties, has shown promise in attenuating sympathetic responses during laryngoscopy and intubation. Therefore, further investigation is warranted in this clinical setting. Aim: To evaluate the efficacy of dexmedetomidine premedication in reducing succinylcholine-induced fasciculations and myalgia during general anaesthesia in patients undergoing elective Ear, Nose and Throat (ENT) surgeries. Materials and Methods: The present randomised, double-blind control trial will be conducted in the Department of Anaesthesia, Acharya Vinoba Bhave Rural Hospital, a unit of Jawaharlal Nehru Medical College (DMIHER), Sawangi, Wardha, Maharashtra, India, over a period from July 2024 to June 2026. The study will include patients scheduled for elective surgeries under general anaesthesia. Patients will be randomly assigned to one of two groups: the study group, which will receive intravenous dexmedetomidine premedication (0.5 μg/kg), and the control group, which will receive normal saline. Standard anaesthesia protocols will be followed in both groups, and succinylcholine will be administered to facilitate intubation. IOP, Heart Rate (HR), and blood pressure will be recorded at baseline, after study drug administration, after succinylcholine injection, and following intubation. Data will be analysed using t-test, Chi-square test, and repeated-measures Analysis of Variance (ANOVA), with p<0.05 considered significant.