Table of Contents : Journal of clinical and diagnostic research : 2024 - July - 18

Bridging Immune Realms: A Striking Case Report on Autoimmune Thyroiditis Co-existing with Immune Thrombocytopenic Purpura

Kashish Khurana, Satish Mahajan, Sourya Acharya, Nikhil Pantbalekundri Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Immune Thrombocytopenic Purpura (ITP), an autoimmune disease, is characterised by isolated thrombocytopenia, with or without bleeding. Thyroid autoimmune illness can coexist with ITP. The specific clinical characteristics are still unknown. The length of ITP or the patients’ response to treatment is not related to their thyroid condition. In patients with ITP, thyroid impairment is more common. In the present case report, a 60-year-old female patient, a known case of asthma, presented to the hospital with complaints of swelling in the neck along with transient episodes of breathlessness for 3-4 years. On local examination, a butterfly-shaped mass was seen in the neck, which moved upwards on deglutination but did not move on protrusion of the tongue. Pemberton’s sign was also positive. On palpation, the thyroid measured around 8×6 cm in size, thyroid lobes were bosselated, consistency was firm, and no bruit was heard on auscultation. Based on routine laboratory findings, she was found to have refractory thrombocytopenia with a normal thyroid profile. Further investigations revealed that the patient had positive antithyroid stimulating hormone antibodies, and Fine Needle Aspiration Cytology (FNAC) showed colloid nodular goitre with haemorrhagic cystic changes. A bone marrow biopsy was performed in view of refractory thrombocytopenia, which was suggestive of ITP. The patient was advised to take tablet eltrombopag, after which the platelet counts improved drastically. Subsequently, the patient was advised to undergo thyroidectomy, but this could not be done due to haemodynamic instability.

Cytodiagnosis of Telangiectatic Osteosarcoma in a Patient with Previous Fracture Humerus Surgery with Plating: A Case Report

Simran Khan, Arvind Bhake, Garima Chandrakar, Shakti Sagar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Telangiectatic Osteosarcoma (TO) is a rare variant of osteosarcoma, accounting for 0.4-12% of cases. It is a high-grade malignancy occurring in adolescence and the adult population. It commonly occurs in the bones of the limbs but rarely in the humerus. It is assumed to originate in stem cells of the mesenchyme or from transformed osteoblasts. The initial X-ray of TO would show an osteolytic lesion over the metaphysis of the long bone. However, the radiographic imaging techniques may not correlate with the histological variant of osteosarcoma. It has been rarely diagnosed and reported in the literature in terms of diagnostic modality using Fine Needle Aspiration Cytology (FNAC). Its cytological as well as histological diagnosis is challenging. However, the diagnosis of TO has numerous implications such as prognosis, differential diagnosis, and treatment options. The present clinical and pathological case images depict the unusual features of TO involving the upper humerus by an osteolytic lesion. Its clinical and diagnostic chronology is interesting due to the occurrence of TO in a case that underwent surgery for a fractured humerus with plating. The plate fixation in this particular case was surrounded by osteolytic tumour tissue extending into the soft tissue. The FNAC under Ultrasonography (USG) guidance was carried out. The smears of the aspirated material typically showed malignant spindle cell fragments with a few gaps of remnant sinusoids entrapping sparse red blood cells. The smears also showed osteoid material which was lacy in character. This case has several noteworthy features in the form of cytomorphological description of the telangiectatic variant of osteosarcoma, its occurrence following plating, and subsequent confirmation on histology and Immunohistochemistry (IHC).

Takayasu Arteritis Presenting with Gangrene: A Case Report

Akash Inamdar, Pankaj Gharde, Raju Shinde, Abhilasha Bhargava Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Takayasu Arteritis (TA) is a chronic inflammatory disease affecting large blood vessels, particularly the aorta and its branches, making it a type of vasculitis. It is reported to be highly prevalent in Southeast Asian countries. Clinical presentations may vary, including headache, weight loss, malaise, fever, hypertension, visual disturbances, and musculoskeletal symptoms. Gangrene is a rare manifestation of TA, with relatively few cases reported globally. If gangrene is present, it is commonly noted in the lower limbs. Inflammation of the blood vessels caused by TA might lead to stenosis of the affected vessels. The underlying pathophysiology of gangrene development in TA is poorly understood but is mainly attributed to the occlusion of blood vessels. It is associated with inflammatory markers produced by lymphocytes and macrophages. Immunosuppressive drugs are recommended for symptomatic relief. Early diagnosis and intervention can be useful in managing TA, preventing adverse outcomes, and reducing its financial, social, and psychological consequences. This is a case report of a 32-year-old female, presented with gangrene and a history of rheumatoid arthritis. Further examination revealed a presentation of TA. The patient was managed by below-knee amputation for gangrene of the left leg and medical management for TA. Therefore, authors aim to draw attention to the diagnosis of TA and the rare associated morbidity, ‘gangrene,’ and the importance of timely intervention.

An Unusual Presentation of Co-existence of Leprosy, Anetoderma and Abdominal Tuberculosis: A Case Report

Shreya Nirajkumar Gupta, Meenakshi Chandak, Adarshlata Singh, Bhushan Madke, Sugat Jawade Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Leprosy and Tuberculosis (TB), both significant mycobacterial infections, often affect populations with lowered specific immunity. TB is a widespread and life-threatening mycobacterial infection. Co-infection of these diseases is uncommon in routine clinical practice, adding complexity to diagnosis and treatment planning. However, instances of co-existence suggest a potential cross-immunity theory. Leprosy, known for its varied presentations, can manifest as an asymptomatic secondary presentation of anetoderma, characterised by elastinolysis-induced loose sac-like appearances. This case report presents a middle-aged man in his late 30s undergoing Anti-Tubercular Treatment (AKT) for abdominal tuberculosis, who presented with signs of Erythema Nodosum Leprosum (ENL) and small asymptomatic atrophied macules on his trunk and back in the Dermatology department. Through comprehensive history, clinical examination, slit skin smear, and biopsy, authors elucidated a rare case of co-infection of leprosy and atypical cutaneous manifestations as anetoderma, concomitant with abdominal tuberculosis.

Paracentral Acute Middle Maculopathy: A Case Report

Sonal Paliwal, Prerna Upadhyaya Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Paracentral Acute Middle Maculopathy (PAMM) is an optical coherence tomography finding observed in patients with retinal capillary ischaemia. It is a type of ischaemic maculopathy that affects the intermediate and deep retinal capillary plexuses. PAMM has been associated with various retinal vascular disorders such as retinal artery and venous occlusions, diabetic retinopathy, sickle cell anaemia, and Purtscher retinopathy. It can also occur following a flu-like illness and transorbital compression. The authors present a case of a 37-year-old healthy female patient who exhibited signs and symptoms suggestive of PAMM a few days after experiencing a self-limiting flu-like illness.

Gastric Black Fungus: A Rare Case Report

BM Srinath, Gramani Arumugam Vasugi, P Ganesh, Sandhya Sundaram Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Mucormycosis is an opportunistic fungal infection that typically affects patients with diabetes mellitus or immunosuppression. The fungus invades nearby blood vessels, leading to thrombosis and organ necrosis. While Mucorales can infiltrate any organ in the body, the gastrointestinal system is an uncommon site for infection. Gastric mucormycosis is a rare but potentially lethal fungal infection resulting from the invasion of Mucorales into the gastric mucosa, exhibiting angioinvasive characteristics. It can lead to high mortality rates due to the increased risk of complications in immunocompromised patients. Common predisposing factors include diabetes mellitus, neutropenia, iron overload states, malnourishment, and other immunocompromised conditions. Mucormycosis is a fatal infection, necessitating prompt intervention to ensure survival. In this case report, authors present a 42-year-old man with a history of chronic alcoholism and chronic kidney disease who presented with complaints of abdominal pain and vomiting for six months, significant weight loss, and loss of appetite for one month. Initially suspected clinically and radiologically as a malignant gastric ulcer, an endoscopy was performed, and a gastric biopsy was sent for Histopathological Examination (HPE). Histological analysis of the gastric biopsy revealed multiple fragments of gastric mucosa with areas of ulceration, neutrophilic abscess, and numerous broad aseptate obtuse-angle fungal hyphae resembling Mucorales. The presence of the organisms was confirmed through special stains for fungus. Very few cases of invasive gastric mucormycosis associated with uncontrolled diabetes, alcoholism, and chronic kidney disease have been reported in the literature.

Balancing Act: Personalised Treatment with Self-ligating Brackets in a Case Involving Extraction

Ruchika Pandey, Ranjit Kamble, Jeni Mathew, Dhwani Suchak, Harikishan Kanani Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The present report explores the use of self-ligating brackets in treating Class I malocclusion with mild crowding and a constricted maxillary arch. Self-ligating brackets, designed as an alternative to expansion appliances, prove effective in expanding the maxillary arch by allowing larger archwires. The benefits include reduced friction, potentially faster and more comfortable tooth movement, and easier dental hygiene. While commonly associated with non extraction orthodontics, self-ligating brackets are adaptable to cases requiring tooth extraction for severe crowding. This assessment guides a personalised treatment plan, which may involve extraction, with careful placement of self-ligating brackets on remaining teeth. Hereby, the authors present a case report of 15-year-old female patient showchasing a unique technique for dealing with such cases, in which the advantages of self-ligating brackets are utilised to alleviate crowding with much simpler movement while also enhancing confidence.

A Case of Postpartum Methicillin-resistant Staphylococcus Aureus Toxic Shock Syndrome: A Stitch in Time

Pankti Umank Tripathi, Meenal M Patvekar, Prashant Dwarkanath Suryarao Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Toxic Shock Syndrome (TSS) is a sudden, systemic, toxin-induced disease that leads to the failure of multiple organs. It is a potentially fatal illness that might occur in the postoperative period. A 30-year-old woman in her second pregnancy, who had given birth via elective Lower Segment Caesarean Section (LSCS), presented to the Emergency Department on the tenth day after the surgery with septic features. She complained of a high-grade fever persisting for eight days, along with a rash that initially appeared on her upper limbs and gradually spread to her entire body. During the local examination, vulval excoriation with desquamation and peeling of the skin were observed. The imaging revealed a well-defined collection with heterogeneous enhancement in the infraumbilical region of the lower anterior abdominal wall. Multiple intralesional free air foci, primarily involving the bilateral rectus abdominis muscles, were also observed, along with mild fat stranding. These findings suggested an infective origin for the condition. The patient was stabilised and managed in the Surgical Intensive Care Unit (SICU). In order to combat the infection, broad-spectrum antibiotics with coverage against gram-negative bacteria were initiated. Subsequently, the patient developed a wound gap and underwent secondary wound closure. The present case report highlights the importance for healthcare practitioners to recognise the symptoms of postpartum TSS and take proactive measures to prevent its potential complications. Methicillin-resistant Staphylococcus Aureus (MRSA) is an iatrogenic and life-threatening infection; hence, proper treatment with a multidisciplinary approach will prevent maternal morbidity and mortality.

Papillary Carcinoma of Thyroglossal Cyst in a Background of Hashimoto’s Thyroiditis: A Case Report

Glory Deoja, Renu Gboy Varghese, Kevin Manuel, Peter Manoharan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Thyroglossal Duct Cyst (TGDC) is one of the most common congenital neck anomalies that occur due to incomplete involution of the thyroglossal duct. Carcinoma arising in TGDC is rare, accounting for about 1% of cases, with non neoplastic thyroid gland lesions even rarer. This report demonstrates a case of papillary carcinoma with Hashimoto Thyroiditis (HT) of TGDC in the background of HT in the thyroid gland. A 51-year-old woman presented with complaints of midline neck swelling for the past 20 years. Ultrasound revealed an infected thyroglossal cyst. Fine Needle Aspiration Cytology (FNAC) was inconclusive, and the cystic lesion was excised and sent for histopathology. Histopathology showed a thyroglossal cyst with papillary carcinoma along with a focus of HT. The patient underwent total thyroidectomy after a month, which showed features of HT and nodular hyperplasia. There was no evidence of papillary carcinoma in the thyroidectomy specimen. TGDC can harbour malignancies accounting for about 1% of cases. Since TGDC has ectopic thyroid tissue, they should be evaluated for neoplastic and non neoplastic lesions. Also, the evaluation of the thyroid gland is essential for identifying the presence of malignancy to confirm a primary or secondary metastatic carcinoma in a TGDC.

A Case of Junvenile Psammomatoid Ossifying Fibroma in Mandible: An Unconventional Variant

Lavanya Pasalkar, Sunil Mishra, Sayali Lokhande, Chetna Joshi, Shruti Patil Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The uncommon fibro-osseous tumour known as ossifying fibroma is composed of both mature bone and fibrous tissue. It is divided into subgroups known as conventional and juvenile. Both variations affect the craniofacial bones, with the juvenile trabecular form being more common in the jaws and the juvenile psammomatoid variety being more prevalent in the paranasal sinuses. Hereby, the authors present a case report of 21-year-old male patient with extremely rare case of mandibular Juvenile Psammomatoid Ossifying Fibroma (JPOF), in which a patient reported a slow-growing, painless swelling of the mandible. After surgical removal of the tumour, histological analysis revealed that it was a psammomatoid variation of juvenile ossifying fibroma with numerous psammoma-like ossifications in the fibrous stroma. In this case study, authors discussed JPOF occurring at an unusual site, emphasising the importance of early detection, clinical findings, imaging results, differential diagnosis, histological characteristics, and conservative treatment of JPOF without evidence of recurrence.

Correction of Class III Malocclusion in Late Adolescent Patient with Hyrax Appliance and Facemask Using Alt-RAMEC Protocol: A Case Report

Khyati Gupta, Rahul Muchhadia, Piyush Gupta, Priyanka Niranjane Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Class III malocclusion is always a challenging treatment and has been the subject of interest in many investigations due to the challenges it poses. It can be caused by maxillary retrognathism, mandibular prognathism, or a combination of the two. In around 40% of Class III patients, the cause is maxillary retrognathia. The condition can be treated either by camouflage or by surgery to correct the skeletal disharmony. However, camouflage treatment doesn’t result in a drastic change to the facial profile when it involves skeletal disharmony and may recur after treatment is completed. To increase the stability of this treatment, the patient’s growth and age phase are decisive factors. In young children, the circumaxillary sutures are patent, and protraction of the maxilla can be aided by opening these sutures with orthopaedic force. Protraction appliances like face masks are used to support the growth of a deficient maxilla in cases of maxillary retrognathism. The current case report of a 13-year-six-month-old male presented the correction of class III skeletal malocclusion with an anterior crossbite in a growing patient using the “Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol” and face-mask treatment with the Hyrax appliance. Skeletal class III can be due to mandibular excess, maxillary deficiency, or a combination of both. The treatment time was 18 months, and a notable improvement was observed in the soft tissue profile when assessed through cephalometric measurements and photographs.

Anaesthetic Management of a Patient with Guillain-Barré Syndrome undergoing Proximal Humerus Fracture Surgery: A Case Report

Chaitali S Patil, Rochana Girish Bakhshi, Babina Ningthoujam Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Guillain-Barré Syndrome (GBS) is an autoimmune disorder which can present in acute and chronic forms. It is an inflammatory demyelinating polyneuropathy. These patients pose potential perioperative risks of autonomic dysfunction and respiratory muscle weakness. The current case report shows a 66-year-old female with a history of a fall at home eight days prior to surgery, diagnosed with a right-sided proximal humerus fracture. The patient was a diagnosed case of GBS and hypertension since five years. For GBS, she had a history of Intensive Care Unit (ICU) admission for both upper and lower limb muscle weakness and breathlessness. She recovered with treatment of Intravenous Immunoglobulin (IVIg) and oxygen therapy. The weakness improved gradually over time but did not fully recover. The patient continued to have weakness in both lower and upper limbs prior to surgery. The patient underwent Joshi’s External Stabilising System (JESS) fixation surgery for the right proximal humerus fracture. Ultrasound-guided (USG) interscalene and superficial cervical plexus block were performed in view of pre-existing muscle weakness and to reduce the requirement of postoperative ventilator support. The intraoperative course was uneventful. The patient’s sensory and motor power returned to the same prior to surgery after the block’s effects subsided.

A Rare Complication of Atypical Pancreatic Pseudocysts: A Case of Psoas Abscess with Renal Abscess

Anuradha Dnyanmote, Kuldip Patil, IAM Prashanth, Vidita Modi, Vedanth Rao Tirmanwar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Pancreatic pseudocysts can extend beyond the boundaries of the pancreas due to the enzymatic nature of the fluid they contain. However, the extension of a pseudocyst beyond the retroperitoneum, into the psoas muscle, and within the subcapsular space of the left kidney is extremely rare, with only a few documented cases in the medical literature. In this report, authors present a case of a 36-year-old male with chronic pancreatitis and atypical pseudocysts that were left untreated due to his negligence. Secondary infection led to the formation of a psoas abscess, perinephric abscess, and a renal abscess. Complications such as intracystic haemorrhage, infection, and rupture of a pseudocyst are uncommon and can be fatal, if treatment is delayed. Pseudocysts in atypical locations, complicated by a secondary infection, are extremely rare and must be timely and effectively managed.

Autonomic Cascade Secondary to Acute Urinary Retention in a Patient undergoing Open Reduction of Forearm Fracture under General Anaesthesia: A Case Report

Lisa Barman, Chaitali Pandey, S Gowrishankar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Acute Urinary Retention (UR) is a common perioperative complication with incidences between 5-70%. Orthopaedic patients tend to have this complication at a comparatively higher incidence rate (8-55%) than any other surgeries. Acute UR is multifactorial and can occur irrespective of any pre-existing urological condition. Acute distension due to UR is sometimes associated with comparatively rare manifestations of cardiovascular morbidity in the form of rhythm disturbances and massive haemodynamic alterations. In this case, a 62-year-old, 50 kg female with no co-morbidities was scheduled for open reduction of a fractured right forearm under General Anaesthesia (GA) in the supine position. Towards the end of the surgery, there was an abrupt change in the patient’s haemodynamics, starting from hypertension with tachycardia to hypotension with tachycardia followed by extreme bradycardia. A quick inspection revealed bladder overdistension due to the blockade of the urinary catheter. After saline flushing and decompression of the bladder, the haemodynamics returned to normal within five minutes. Acute bladder overdistension is a relatively benign complication that may prove fatal if not addressed promptly.

An Unusual Case of Solitary Oral Leishmaniasis in an Elderly Woman

Kaushik Chakraborty, Joyeeta Sardar, Sayani Chakraborty Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Leishmaniasis is a chronic inflammatory disease caused by a flagellate protozoan from the genus Leishmania, transmitted by an insect vector belonging to either the genus Phlebotomus spp. or Lutzomyia spp. This disease is considered one of the most prevalent infectious diseases worldwide due to its high detection rate and the morbidity it causes. A 70-year-old woman from a low-income background, with no significant medical or drug history and no other general constitutional symptoms, presented with an asymptomatic, exophytic, granulomatous growth that has a reddish hue. The growth is located on the lingual aspect of the mandibular anterior teeth region and has been progressing over the past six months. Radiographic features suggested associated chronic periodontitis along with hyperdense calcified deposits. On excisional biopsy and histopathology, the excised specimen revealed characteristic Leishmania amastigotes and pseudoepitheliomatous hyperplasia. An abdominal ultrasound was advised to rule out any visceral involvement, but no significant findings were observed. The present case is particularly intriguing due to oral mucosal involvement by Leishmania sp. without associated primary visceral or cutaneous lesions, especially given the male predilection (M:F=7:5) and the most common site involved being the posterior palatal region for Leishmaniasis. The present case represents a rare instance. Considering the difficult socio-economic circumstances, the involvement of the World Health Organization (WHO) demonstrates an understanding of the need for collaboration in supporting underprivileged communities.

Renal Actinomycosis Camouflaging as Malignancy: A Diagnostic Challenge

Jassal Mathew, Smrthi Vijay, Lincy Joseph Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Actinomycosis is an unusual infection that typically appears in the thoracic, cervicofacial, and abdominal areas. However, the occurrence of renal actinomycosis in adults remains rare, with few cases reported since 1990. Actinomycosis is often considered “the most misdiagnosed disease” due to its tendency to be overlooked even by experienced clinicians. Hereby authors report a case of a 55-year-old male with pyrexia of unknown origin and weight loss, presenting with pallor upon general examination. Further investigation revealed microcytic hypochromic anaemia and neutrophilic leukocytosis on peripheral blood smear. A heterogeneous mass with internal vascularity in the left kidney was identified on abdominal ultrasound. Subsequent Computed Tomography (CT) abdomen confirmed an ill-defined lesion in the mid and lower pole of the left kidney, with extrarenal extension into the perinephric space, and a filling defect in the left renal vein. A provisional diagnosis of a left renal tumour infiltrating the spleen and splenic flexure of the colon was made. The patient then underwent a left radical nephrectomy, splenectomy, and limited colonic resection. Histopathological examination confirmed actinomycosis with abscess formation in the kidney and colon. The patient was treated with crystalline penicillin for eight weeks until considered disease-free. Renal actinomycosis poses challenges in diagnosis due to its ambiguous clinical and laboratory features. Often mimicking malignant neoplasms on imaging, it can confuse even experienced clinicians. Early detection is crucial for precise medical intervention and to reduce unnecessary surgeries.

A Case of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Mimicking Hashimoto’s Thyroiditis

Aishwarya Shailendra Gosavi, Kritika Singh, Surekha Bhalekar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma (DSV-PTC) is a rare and aggressive subtype of Papillary Thyroid Carcinoma (PTC). The prognosis of this variant is as good as classic PTC, but close follow-up is necessary because of frequent tumour recurrence. The authors report a case of a 30-year-old female who presented with a 6-month history of gradually progressive midline neck swelling. Antithyroid antibodies were elevated, and radiology was suggestive of a colloid goitre. Total thyroidectomy was done along with anterior compartment lymph node removal for confirmation. Interestingly, histopathology showed a picture reminiscent of Hashimoto’s Thyroiditis (HT), but the lymph node showed tumour metastasis. Thereafter, additional sections were taken to establish the diagnosis of DSV-PTC in the thyroid. The present case highlights the importance of extensive sampling in histopathology for a suspected case of malignancy, as it can be misdiagnosed as a benign aetiology.

Duodenal Neuroendocrine Tumour: A Report of Two Cases with Rare Presentations

Dwaipayan Samaddar, Madhumita Barua, Richa Pandey, Jaya Bagchi Samaddar, Penzin Dichen Bhutia Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Duodenal Neuroendocrine Tumours (D-NETs) are extremely rare tumours with a propensity to be solitary and limited to the first and second parts of the duodenum, the periampullary area contributing to only about 20% of such cases. They can be discovered incidentally at imaging or at Upper Gastrointestinal Endoscopy (UGIE) for vague Gastrointestinal (GI) symptoms. The authors encountered two successive cases (55-year-old female; 50-year-old male) of D-NETs within a couple of months in which one presented with acute upper GI bleeding and another with vague upper GI symptoms. The first case was located at the second part of the duodenum with nodal metastasis, whilst the second case had multiple D-NETs at the second and third parts of the duodenum. Sub-centimetric growths may be treated by endoscopic mucosal resections but larger ones require surgery. Both cases were more than 20 mm in size and were successfully managed by classical Whipple’s procedure. Diagnoses were confirmed and graded with histopathology and Immunohistochemistry (IHC) using chromogranin, synaptophysin, and Kiel 67 (Ki67). Normally these are mucosal and submucosal lesions, however, in the first case, the tumour invaded muscularis propria and extended upto subserosa. The authors present these two cases because of their rarity, singular presentations, and successful management in a rural set-up with logistical constraints.

An Unusual Association of Interstitial Lung Disease with Pulmonary Arterio-venous Malformation: A Case Report

Rahul Mittal, Praveen Raj Seetharaman, Subramanian Suriyan, Nagarjun Sakthivel Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Interstitial Lung Disease (ILD) in diffuse cutaneous Systemic Sclerosis (SSc) patients is present in about 53% of cases and 35% in cases with limited cutaneous SSc. Even though there are only a few case reports of ILD associated with Hereditary Haemorrhagic Telangiectasia (HHT), a direct association of SSc and HHT has not been reported. Hence, little is known about the pathogenetic link between the two diseases. In this case report, a 24 years old married female patient presented with progressive breathlessness for one year. Initial evaluation of the patient suggested the diagnosis of SSc based on clinical findings like sclerodactyly along with telangiectasia. High Resolution Computed Tomography (HRCT) of the chest revealed the presence of pulmonary arteriovenous malformation along with ILD. Past medical history and family history of epistaxis for three generations suggested the diagnosis of HHT. This case reports a rare association of Connective Tissue Disease (CTD) and an autosomal disorder of vascular dysplasia with overlapping features of telangiectasia. This case is presented to highlight the possible association of HHT with CTDs. With the currently available literature, an attempt is made to find a plausible pathogenetic link between HHT and SSc. Transforming Growth Factor-β (TGF-β) is a pleiotropic growth factor that regulates the growth and differentiation of various cell types, and immune regulation has been implicated in the pathogenesis of both HHT and SSc. The other pathogenetic mechanism common to both diseases is impaired nitric oxide-mediated vasodilation. This case report emphasises the need for further research for a better understanding of the pathogenesis of both diseases.

Management of Metastatic Primary Renal Synovial Sarcoma with Inferior Vena Cava Thrombus: A Rare Case Report

Sunil Mhaske, Shivam Singh, Vikram P Satav, Vilas P Sabale Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Synovial sarcomas constitute 5-10% of all soft-tissue sarcomas and tend to occur in the extremities, particularly the lower extremity. Renal sarcoma is a rare entity, constituting approximately 1-5% of all malignant renal tumours. Metastatic large renal synovial sarcoma with Inferior Vena Cava (IVC) thrombus is a rare surgical challenge that demands thorough preoperative evaluation and planning for its management. A 31-year-old young male presented with symptoms of left flank pain for 10 days, with a past history of similar complaints two years prior. On examination, a massively large renal mass was palpable. A Computed Tomography (CT) scan showed an IVC thrombus and metastatic deposits. The patient underwent a radical nephrectomy with ileal segment resection, followed by chemotherapy, which showed near-complete resolution of the metastatic deposits. Renal synovial sarcoma should be considered as a differential diagnosis in young patients presenting with a metastatic, exceptionally large renal mass complicated by an IVC thrombus, necessitating thorough preoperative evaluation for effective management.

Physiotherapy Assessment and Intervention for Hirayama Disease: A Case Report

Adora Correa, Saumya Srivastava, Jahnavi K Salian, Harramb Mittal Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Hirayama Disease (HD) is a type of localised amyotrophy that mostly affects motor neurons. It is benign, self-limiting, and does not progress. It is not the same as distal limb juvenile muscular atrophy, which is a symptom of motor neuron disease. Together with other immunological and physical variables, cervical cord compression, particularly during cervical flexion, is one cause of HD. Over three to five years, the illness usually worsens progressively, resulting in wasting and distal weakness in one or both upper extremities. In addition, patients may experience cold paralysis, coarse finger tremors, and non specific sensory loss. Hereby, the authors present a case report of a 22-year-old male who had been steadily developing right upper extremity weakness for three years was evaluated in the Outpatient Department. The physical examination revealed atrophy of the right forearm muscle, reduced range of motion in right wrist flexion and extension, weak wrist extensors, finger extensors, supinator muscles of the forearm, and shoulder flexors. As HD does not have a well-defined physiotherapy protocol, tailor-made treatment was given for four weeks aimed at improving upper extremity muscle strength and overall hand function. The present case report will aid the physiotherapists understand the assessment and treatment of HD.

Anaesthetic Management of a Case of Parkinson’s Disease with Extradural Haematoma and Atrial Flutter Posted for Emergency Craniotomy

Dipika Balasubramanian, Arun Ganesan, Richards Sam, Bhagyavardthan Botta, Kala Balasubramanian Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Parkinson’s Disease (PD) patients are more prone to traumatic injury due to a short shuffling gait and skeletal muscle rigidity. Diabetes mellitus is a chronic metabolic syndrome that affects all vital systems, including the autonomic nervous system. Cardiac autonomic neuropathy affects the conducting system of the heart, producing cardiac arrhythmias and silent ischaemia. Here, the authors report a case of head injury with Extradural Haematoma (EDH) in a 81 year old geriatric male patient posted for EDH evacuation. Emergency craniotomy in this patient with pre-existing PD, diabetes mellitus, and new-onset atrial flutter presents a significant challenge in anaesthetic management. In addition to that, chronic alcoholism further necessitates the selection of appropriate anaesthetic techniques and vigilant perioperative management to prevent intraoperative cardiac arrhythmias, hypotension, heart failure, and pulmonary oedema.

Cytomegalovirus Colitis and Colon Adenocarcinoma: A Case of Unusual Co-existence

Anita Pandit Javalgi, Sonali Tulsi Advani, Vidisha S Athanikar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The possible association of Cytomegalovirus (CMV) with human colorectal adenocarcinomas was first reported in 1978 by Huang and Roche, who detected CMV DNA in 4 of 7 colonic adenocarcinomas by membrane complementary Ribonucleic Acid-Deoxyribonucleic Acid (RNA-DNA) hybridisation. CMV earns its name from the characteristic cytomegalic appearance of intranuclear inclusions in infected cells, which include endothelial cells, histiocytes, macrophages, and epithelial cells. The most common site of CMV infection in the gastrointestinal tract is the colon (55%), followed by the sigmoid colon and rectum (35%) and the gastric antrum (25%). Here, a middle-aged female presenting with pain in the lower abdomen, which was insidious in onset and gradually progressive. Ultrasonography revealed a large intestine dilated and filled with multiple air-fluid levels, indicating bowel obstruction. Multidetector Computed Tomography (MDCT) showed circumferential wall thickening involving the distal half of the transverse colon and descending colon. The case was subjected to laparotomy. The resected segment of the colon was sent for histopathological evaluation, and microscopic examination showed adenocarcinoma and many mucosal ulcers, which on keen observation revealed viral inclusions. The diagnosis of colon adenocarcinoma, with a pathological staging of pT2N0Mx with CMV infection, was rendered. CMV infection was confirmed by immunohistochemistry. The patient was on post-surgery chemotherapy and receiving ganciclovir. On follow-up, the patient was recovering fine. Histopathology examination and IHC remain the gold standard in diagnosing CMV, and the concurrent occurrence of colitis and carcinoma should be kept in mind to assist in proper management.

Case of Chondroma in Prepubic Space: A Rare Occurrence

CS Sheeladevi, KR Shouree Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The pelvic bone can be affected by a various diseases, including tumours. Cartilaginous tumours may develop in this area because it contains hyaline and fibrocartilage. The pelvis is known to host malignant tumours like chondrosarcoma. On the other hand, chondroma, a benign cartilaginous tumour, is occasional. Chondroma is known to occur in different osseous and extraosseous locations. Extraskeletal/soft-tissue chondroma, though rare, is known for its occurrence in various anatomical locations. Hereby, the authors present a case report of a chondroma in the prepubic space that manifested with urinary symptoms. A 58-year-old female, known to be diabetic, came with acute urinary retention. She experienced a recent onset of burning micturition and abdominal pain. Radiological and cytological findings were non diagnostic. During pelvic exploration, a solid mass of 3×3 cm was noted in the prepubic space without a connection to the urinary bladder or underlying bone. Excisional biopsy of the mass showed benign mature chondrocytes in a background of chondroid matrix, suggesting a benign cartilaginous tumour (chondroma). The patient is now free of her symptoms and is doing well during the follow-up at three months. Authors could not find any case reports of chondroma in the prepubic space in the literature. The present case of extraskeletal chondroma in the prepubic space is an infrequent entity at an unusual site.

Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits: A Case Report

Vijayashree Gokhale, Mahabir Prasad Mishra, Ponvijaya M Yadav, Vineetha Naga Lakshmi Giduturi Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID) is a relatively rare entity. Patient’s usually present with proteinuria, elevated creatinine, and renal failure. The present case report details the clinical presentation, diagnostic assessments, and treatment outcomes of a 56-year-old female with a complex renal pathology. The patient, with a history of hypertension, presented with generalised anasarca and decreased appetite. Initial examinations revealed pedal oedema, low serum albumin, elevated Blood Urea Nitrogen (BUN), and markedly high serum creatinine levels, indicating impaired kidney function. Further investigations, including urine analysis and immunological tests, identified significant proteinuria and complement system involvement. Radiological studies demonstrated ascites and elevated renal cortical echogenicity. Renal biopsy revealed Proliferative Glomerulonephritis with conventional Monoclonal Immune Deposits-Immunoglobulin G3 (PGNMID-IgG3-kappa). Direct immunofluorescence analysis exhibited a specific staining pattern, confirming the diagnosis. Overall, the diagnostic impression suggested Proliferative Glomerulonephritis with Membranoproliferative Glomerulonephropathy (MPGN) injury pattern, emphasising the complexity of the renal pathology. Despite extensive medical interventions, including haemodialysis and immunosuppressive measures, the patient’s condition deteriorated, leading to a fatal outcome on the 67th day of admission. The present case underscores the challenges in managing advanced renal diseases and emphasises the importance of precise diagnostic methods for guiding targeted therapeutic interventions in such complex cases.

A Rare Case of Lutembacher’s Syndrome

Shivam, Santosh Sharma, Bangam Rajendra Prasad Rao, Gama Gourab, Lalatendu Mohanty Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Lutembacher’s syndrome, a rare cardiac condition characterised by the combination of congenital Atrial Septal Defect (ASD) and acquired mitral stenosis, presents significant clinical challenges. Hereby, the authors present a case report of a 28-year-old female exhibiting mild symptoms, including dysapnoea, intermittent palpitations, and lower limb swelling. Examination revealed characteristic findings, including elevated jugular venous pressure, cardiomegaly, and murmurs indicative of mitral stenosis and tricuspid regurgitation. Transthoracic echocardiography confirmed the presence of ASD and moderate mitral stenosis. The patient was ultimately diagnosed with Lutembacher’s syndrome. Prompt initiation of rheumatic heart disease prophylaxis and diuretics led to symptomatic improvement. The present case underscores the need for early recognition and intervention in Lutembacher’s syndrome, particularly in regions with high rates of rheumatic heart disease. Future research should focus on optimising treatment strategies to enhance patient outcomes. Sharing such cases contributes to a deeper understanding of this complex condition and advocates for improved management approaches.

A Rare Case of Tubular Stomach in an 80-Year-Old Female Cadaver

Monalisa Mandal, Uma Shivanal, Vidya Chikkarahalli Srikantaiah, Manjunatha Hanasoge Narayana Gowda, Surabhi Mohan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The stomach is a muscular bag that forms the most dilated part of the gastrointestinal tract. It serves as a reservoir for food and aids in the conversion of food into chyme under the influence of hydrochloric acid. The stomach is prone to conditions such as peptic ulcers, Gastroesophageal Reflux Disease (GERD), birth defects like Infantile Hypertrophic Pyloric Stenosis (IHPS) and stomach carcinoma. Surgical manipulation of the stomach is performed by bariatric surgeons for treating obesity. A comprehensive understanding of stomach variations helps clinicians identify developmental defects during disease diagnosis and prevents inadvertent damage during surgeries. In a recent case involving a specimen obtained for studying anatomical stomach variations and histological alterations, an unusual tubular stomach was discovered in an 80-year-old female cadaver during routine dissection by medical students in the Department of Anatomy. The stomach was dissected by cutting through the oesophagus superiorly and the pyloric duodenal junction inferiorly, and then removed from the abdominal cavity. An incision was made along the greater curvature of the stomach for internal examination. This tubular-shaped stomach had a smaller number of rugae and measured 28 cm in length. Tissue samples were collected for histopathological examination using Haematoxylin and Eosin (H&E) stain. Different stomach shapes are closely linked to organogenesis. Various acquired stomach variations are clinically significant, such as those occurring in oesophagectomy, which involves the surgical division of the vagal nerve and vagal sparing oesophagectomy, a procedure for weight loss.

Atypical Haemolytic Uraemic Syndrome in an Infant with Ventricular Septal Defect: A Case Report

Sheuli Paul, Shradha Rahul Salunkhe, Manojkumar G Patil, Shailaja V Mane Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Atypical Haemolytic Uraemic Syndrome (aHUS) is a rare type of thrombotic microangiopathy that occurs without Shiga toxin producing bacteria. It is a condition related to complement regulation, which may be genetic or acquired. The complement system’s alternative pathway is commonly implicated, with around 6-10% of cases being caused by autoantibodies directed against factor H. While it typically affects children between 9 to 13-years-old, it can also occur in adults. Many patients do not have circulating Complement Factor H-related proteins 1 and 3 due to a homozygous deletion involving CFHR1 and CFHR3. Authors hereby report a case of a six-month-old female child who was diagnosed with Ventricular Septal Defect (VSD) at one and a half months of age. She presented with pneumonia and subsequently developed haemolytic anaemia with thrombocytopenia, oliguria, and acute kidney failure. She was diagnosed with Antifactor H antibody-mediated HUS. She was treated with plasma therapy, but the patient succumbed due to multiorgan dysfunction.

Diagnostic Dilemma in Differentiating Odontogenic Pain and Non Odontogenic Pain: A Case Series

Shilpa Khullar Sood, Megha Jain, Divyam Girdhar, Sakshi Sharma Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Pain is one of the most common reasons why patients seek medical attention. When experiencing discomfort in the orofacial region, a dentist is usually the first medical professional consulted. While odontogenic factors are the most common causes of acute pain in the maxillofacial region, it can also be non odontogenic, making it challenging to differentiate between the two. However, with a thorough examination, taking a complete history, and ordering necessary diagnostic tests, a dentist can make an accurate diagnosis and evaluate the entire stomatognathic system and other relevant anatomical regions. Misdiagnosis can lead to unnecessary dental procedures and cause trauma to the patients. Case 1 (50-year-old female) and case 3 (63-year-old female) were finally diagnosed as Trigeminal Neuralgia (TN), which were initially misdiagnosed as odontogenic pain and were treated with unnecessary irreversible dental treatments like Randomised Controlled Clinical Trials (RCT). Case 2 ( 28-year-old female) was eventually diagnosed as a case of myofascial pain with loss of muscle tone, for which the patient required palliative physical therapy. Instead, the splint, which was worn day and night by the patient, and soft diet resulted in muscle atrophy. The present case series emphasises the importance of accurate diagnosis to prevent irreversible dental treatment and protect patients from harm.

Presentation and Management of Giant Hydronephrosis in Adults: A Case Series

Mukut Debnath, Suryadipta Ghosh, Tanmay Chakraborty, Rudra Pratap Debbarma Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Giant Hydronephrosis (GH) is rare due to improved diagnostic modalities and the ready availability of abdominal imaging. Pelviureteric junction obstruction is the most common aetiology of GH, with abdominal mass or distension being the most common presentation. If GH is not detected early, it can lead to various complications. Authors report three cases of GH in adults who presented to the emergency department with complications. One patient had abdominal distension, while the other two presented with painful abdominal swelling and fever. Two of them were admitted with sepsis, and one had haematuria. Percutaneous Nephrostomy (PCN) catheters were placed in all three cases to decompress the calyceal system, and subsequently, nephrectomy was performed on all of them as the kidneys were not salvageable.

Unveiling Morular Metaplasia of Endometrium: A Pathological Enigma

PR Resmi, Thanka Johnson, V Lakshmi Priya Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Enhancing Eye Protection during General Anaesthesia: A Simple Technique

S Parthasarathy, S Geethavarshini Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

A Clinical Image of Sliding Hernia

Aditya Sriharsha Pedaprolu, Venkatesh Manohar Rewale Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Tubercular Osteomyelitis of Femur: Imaging Findings

Dachepalli Ramya Sai, Pabbisetty Sushma, Nishant Narendra Kumar, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Thyroglossal Duct Cyst Carcinoma: A Surgical Enigma

Priyadarshan Anand Jategaonkar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Paracetamol Syrup: A Paradigm Shift in Post-immunisation Fever Management

R Akhil, Deepu Palal Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

A Conversation with ChatGPT about Myocardial Infarction

Aayza Nadeem Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Addressing Neglected Lung Health: A Call to Action for Asthma Patients

Madhura Kishor Deshmukh, Shambhavi Ghotankar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Prevalence of Hypervirulent rmpA and magA Genes in Clinical Isolates of Klebsiella pneumoniae and their association with Drug Resistant Pattern: A Cross-sectional Study

Kanimozhi Devanathan, Umadevi Sivaraman, Rajkumar Chinnadurai, Joshy M Easow, Vickneshwaran Vinayagam Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a pathogen of global concern that is hypermucoviscous, causing infections and rapidly acquiring Antimicrobial Resistance (AMR). HvKp is more virulent than classical K. pneumoniae (cKp) and frequently infects healthy individuals with community-acquired illnesses. Since hvKp commonly exists in the gastrointestinal tract, its communicable spread affects the general public and healthcare facilities. The study was necessary due to the rapid evolution of hvKp, the need to identify novel, reliable agents of hypervirulence and drug resistance, and more reliable targets for therapeutic intervention. Aim: To investigate the prevalence of hvKp strains (rmpA and magA genes) and drug-resistant patterns in clinical isolates of Klebsiella pneumoniae (K. pneumoniae) in a tertiary care hospital in Puducherry, India. Materials and Methods: The cross-sectional study included a total of 100 non duplicate consecutive isolates of K. pneumoniae collected from Mahatma Gandhi Medical College and Research Institute and Hospital, Puducherry, India. These isolates were recovered from various clinical specimens such as urine, sputum, pus, blood, and other miscellaneous specimens mainly obtained from both outpatients and inpatients between August 2021 and April 2022. The antibiotic susceptibility of cultured K. pneumoniae was determined by the disk-diffusion test following the 2020 Clinical and Laboratory Standards Institute (CLSI) guidelines. The rmpA and magA genes were detected using conventional Polymerase Chain Reaction (PCR). PCR products were sequenced using Sanger sequencing. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) statistics software for Windows, version 15.0 (available from SPSS Inc., Chicago, USA). A p-value <0.05 was considered statistically significant. Results: A total of 100 isolates were studied for phenotypic and genotypic properties. HvKp was identified phenotypically using the string test, and further, the rmpA and magA genes were identified genotypically using PCR. Out of 100 isolates, the phenotypic study showed 11 (11%) isolates as string test positive. Furthermore, genotypic results showed that 22 (22%) isolates expressed the rmpA gene, 11 (11%) isolates expressed the magA gene, and 7 (7%) isolates expressed both rmpA and magA. Most of the hvKp isolates were obtained from urine specimens of K. pneumoniae isolates and showed more resistance than cKp towards all classes of antibiotics. Conclusion: The high prevalence of rmpA and magA genes suggests their strong role and capability as genetic markers for the identification of hvKp in the laboratory. This study indicated the important role of genetic elements in the emergence of drug resistance in hypervirulent strains and showed that hvKp has a multidrug resistance pattern.

Cone Beam Computed Tomography Evaluation of Median Mandibular Lingual Canal in a Western Indian Subpopulation: A Cross-sectional Study

Rashmi Venkatesh, Kavita Badi, Palak H Shah, Chandramani B More Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The Mandibular Lingual Canals (MLC), which carry the sublingual artery, are present in the mandible near the genial tubercle. Identification of these canals is important before any dental surgical procedures. Aim: To identify and evaluate the mandibular lingual canal in Cone Beam Computed Tomography (CBCT) of the Western Indian Population. Materials and Methods: The current cross-sectional study was conducted at the Department of Oral Medicine and Radiology, Sumandeep Vidyapeeth, Vadodara, Gujarat, India between October 2022 and June 2023. A total of 100 CBCT volumes showing the mandibular anterior region were evaluated for the presence or absence of a mandibular lingual canal. The canals were further evaluated for their number, diameter, length, thickness of the buccal cortical plate, and the remaining bone above and below the canal. The evaluation was done by two separate investigators. The data were entered into Microsoft Excel and subjected to statistical analysis. Data collected were tested statistically using the Chi-square test. Results: A total of 59 males and 41 females’ mandibular CBCT volumes were evaluated, out of which 93 CBCT volumes showed the mandibular lingual canal. The maximum number (n=57) of individuals showed three canals, followed by two canals (n=26) and one canal (n=10). There was no statistical significance between genders regarding canal number, diameter, length, thickness of the buccal cortical plate, and the remaining bone above and below the canal. Conclusion: Three-canal morphology was the most common anatomical form of MLC found in the Western Indian population.

Effectiveness of Nurse-led Yoga Intervention on Body Composition and Biochemical Parameters in Overweight and Obese Adolescents: A Pilot Study

G Saritha, Anita David, P Stalin, J Julius Xavier Scott Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Obesity in children has been on the rise globally, and India is no exception. Rapid urbanisation, changing dietary patterns, and sedentary lifestyles are contributing factors to this alarming trend. Understanding the prevalence and factors associated with childhood obesity in urban areas is crucial for developing targeted interventions and public health strategies. Aim: To investigate the effects of a nurse-led yoga intervention on body composition and biochemical parameters in overweight and obese adolescents (11-13 years) in schools. Materials and Methods: This pilot randomised controlled study used a true experimental study design, specifically the pretest and post-test control group design. Data collection was conducted in schools of Puducherry. A total of 18 overweight and obese adolescents, nine in the experimental group and nine in the control group, were included. The experimental group performed a nurse-led yoga intervention three times a week for 60 minutes for six months from March 2022 to August 2022. Study outcomes on body composition and biochemical parameters such as lipid profile, adiponectin, leptin, Apolipoprotein A, and Apolipoprotein B were measured at baseline and six months after the nurse-led yoga intervention. Data analysis was performed using Social Sciences Software {Statistical Package for the Social Sciences (SPSS) version 25.0}. Both descriptive and inferential statistical tests, such as the one-way Analysis of Variance (ANOVA) F-test, repeated measures ANOVA F-test, and paired t-test, were conducted. Results: A significant difference was noted in fat percentage, water, intracellular fluid, extracellular fluid, and body fat mass index between the pretest and post-test (p<0.05), and no significant difference was observed in Basal Metabolic Rate (BMR) and fat-free mass index (p>0.05) in the experimental group. The nurse-led yoga intervention significantly improved Low-density Lipoproteins (LDL), Apolipoprotein A, and adiponectin levels; however, there were no significant differences in Fasting Blood Sugar (FBS), total cholesterol, High-density Lipoproteins (HDL), Apolipoprotein B, or LDL in the experimental group. The control group showed no significant difference between the pretest and post-test in FBS, total cholesterol, LDL, HDL, Apolipoprotein A, or Apolipoprotein B (p>0.05). Conclusion: The nurse-led yoga intervention positively impacted body composition and biochemical indicators in overweight and obese adolescents.

Differences in Stromal Immunostaining of Tumour Necrosis Factor-alpha and its Receptors in Neoplastic and Non Neoplastic Ovarian Lesions: A Cross-sectional Study

Rosekeila Simões Nomelini, Marcela Moisés Maluf Sanguinete, Millena Prata Jammal, Eliângela Castro Côbo, Renata Margarida Etchebehere, Eddie Fernando Candido Murta Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Ovarian cancer has an unknown pathogenesis, and cytokines may play an important role in the aetiology and prognosis. Tumour Necrosis Factor-alpha (TNF-α) and its receptors (TNFR1 and TNFR2) are involved in the biology of ovarian cancer, tumour pathogenesis, and their relationship with prognostic factors. They are involved in biological processes such as immunoregulation, growth modulation, and cell differentiation. Aim: To evaluate stromal immunostaining of TNF-α and its receptors (TNFR1 and TNFR2) in malignant ovarian neoplasms, comparing it with benign ovarian neoplasms and non neoplastic ovarian lesions. Materials and Methods: A cross-sectional study was carried out at the Department of Gynaecology and Obstetrics, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil, from January 1997 to December 2020. Patients with ovarian lesions who underwent surgical treatment according to pre-established criteria (n=95) were included in the study. Patients with benign (n=37) and malignant (n=43) ovarian epithelial neoplasms, and non neoplastic ovarian lesions (n=15) were included. Data evaluated included age, parity, hormonal status (menarche or menopause), histological grade, and staging. Immunohistochemical study was performed to evaluate stromal TNF-α, TNFR1, and TNFR2. Data were analysed by GraphPad Prism 6 and IBM Statistical Package for the Social Sciences (SPSS) Statistics 20.0 software. The comparison between non neoplastic tumours, benign and malignant neoplasms was performed by the Fisher’s exact test with a significance level below 0.05. Results: Considering staining intensity 0 and 1 as “weak immunostaining” and 2 and 3 as “strong immunostaining,” TNF-α stromal immunostaining was stronger (2/3) in benign ovarian neoplasms compared to non neoplastic tumours (p-value=0.0016) and in malignant neoplasms compared to non neoplastic tumours (p-value<0.0001). TNFR1 immunostaining was stronger (2/3) in the stroma of malignant neoplasms compared to benign neoplasms (p-value<0.0001) and stronger (2/3) when comparing benign neoplasms with non neoplastic ovarian lesions (p-value=0.0002). For TNFR2, stromal immunostaining was stronger (2/3) in malignant neoplasms compared to benign neoplasms (p-value =0.0091) and stronger in malignant neoplasms compared to non neoplastic lesions (p-value=0.0004). Conclusion: A stronger immunostaining for TNF-α and its receptors was found in ovarian cancer, suggesting that they may be targets for further studies to verify their role in carcinogenesis and the progression of ovarian neoplasms. A better understanding of the role of TNF-α and its receptors in the tumour stroma of ovarian tumours may lead to future studies that may clarify the mechanisms of carcinogenesis and tumour progression.

Toxicity and Local-Regional Control of Two Fractionation Schedules with Concurrent Chemotherapy and Intraluminal Brachytherapy for Oesophageal Carcinoma: A Pilot Study

MD Aqueel, Dev Kumar Yadav, Arun Kumar Yadav, Radha Kesarwani, SN Prasad Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Oesophageal cancer is the seventh most common cancer worldwide and the sixth highest cause of cancer-related mortality. Radiation plays an important role in the multimodality treatment of carcinoma of the oesophagus. Aim: To compare locoregional control and toxicity of two External Beam Radiation Therapy (EBRT) fractionation schedules of concurrent chemoradiotherapy and high-dose intraluminal brachytherapy in patients with oesophageal carcinoma at a single institute. Materials and Methods: The present study was a pilot study including a total of 33 participants with histologically confirmed oesophageal cancer. Patients were prospectively randomised into two groups. Arm I: EBRT with a total dose of 46 Gy delivered in 23 fractions at a rate of 2 Gy per fraction over 4.3 weeks, along with Concurrent Injection of Cisplatin (CDDP) 100 mg/m2 on days 1 and 22, followed by Intraluminal Radiation Therapy (ILRT) with 6 Gy per session weekly. Arm II: EBRT with a total dose of 30 Gy delivered in 10 fractions at a rate of 3 Gy per fraction over two weeks and CDDP 100 mg/m2 on day 1 only. The primary endpoint of this study was to compare the locoregional response and toxicities (both acute and late) in the two arms at the end of radiotherapy and six months. Results: At the end of the two-month follow-up, no statistically significant difference was found in the response between the two arms (p-value=0.2697). Dysphagia relief was comparable in both arms; however, this difference was not statistically significant (p-value=0.9235). Conclusion: The responses in both arms were comparable, and further randomised trials with larger sample sizes should be encouraged.

Clinical Efficacy of Ozone Therapy in Peri-implant Diseases: A Systematic Review

Bhoomi Shah, Arvina Rajasekar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: With an increasing number of dental implants being placed each year, there has been a consequent rise in the frequency of peri-implant diseases. Ozone, a potent antibacterial agent, eliminates the microbes that cause infections around implants. Aim: To assess ozone therapy’s effectiveness of ozone therapy as an adjunct in the treatment of peri-implant diseases. Materials and Methods: A complete search was conducted in electronic databases such as PubMed, Google Scholar, and Cochrane, employing the eligibility criteria. After a thorough review, six studies published from 2013 to 2023 that evaluated the effectiveness of ozone therapy in clinical trials for the management of peri-implant diseases were included in this systematic review. Results: The six selected studies evaluated ozone therapy as a treatment for peri-implant diseases and evaluated relevant clinical indices. Four studies were in-vivo, out of which one evaluated peri-implantitis and three on peri-implant mucositis. Three studies showed a reduction in the Plaque Index (PI) during follow-up, while one study stated that it showed improvement at one month, with no significant further reduction seen. Two in-vitro studies stated that ozone therapy helped reduce bacterial adherence to the implant surface. Conclusion: Considering the findings of the previous studies, the present systematic review concludes that ozone therapy shows progressive improvement in the management of peri-implant diseases.

Echocardiographic Evaluation of Infants Born to Mothers with Gestational Diabetes Mellitus: A Cross-sectional Analytical Study

Jahnabi Sikdar, Partha Sarathi Das, Dipanjan Halder, Joyashree Banerjee, Bulbul Mukhopadhyay, Ankita Rana, Suvomoy Karan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Gestational Diabetes Mellitus (GDM) is a chronic and progressive disease characterised by changes in the metabolism of carbohydrates, lipids, and proteins, leading to glucose intolerance. The foetal heart in GDM is affected throughout the gestational period, which may result in hyperplasia and hypertrophy of myocardial cells. Aim: To determine the cardiac function and structural changes in infants of gestational diabetic mothers using Doppler-echocardiographic data. Materials and Methods: A cross-sectional analytical study was conducted on 30 infants of mothers with GDM and 30 infants of non diabetic mothers at the Department of Physiology, R.G. Kar Medical College and Hospital, in collaboration with the Departments of Paediatric Medicine and Cardiology from January 2023 to August 2023. Neonatal screening echocardiography was performed by a cardiologist using a Philips Echocardiograph machine, Model: EPIQ 7C, Software Version: 4.0.2, with a linear convex probe of S8-3 MHz frequency to assess cardiac structure and function using 2D, M mode, and Conventional Doppler. The parameters studied included aortic root diameter (mm), left atrial diameter (mm), Interventricular Septal (IVS) in diastole (mm), left ventricular posterior wall thickness in diastole (mm), left ventricular internal diameter in diastole (mm), left ventricular internal diameter in end systole (mm), left ventricular fractional shortening (%), and left ventricular ejection fraction (%). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version-20.0 with an Independent Student’s t-test. Results: The mean gestational age for the cases was 38.50±2.57 weeks and 39.30±1.97 weeks for controls. The mean maternal age for cases was 25±4.37 years and for controls was 27±5.03 years. The left atrial diameter in cases (12.83±2.14 mm) was significantly smaller than that of the control (14.20±0.55 mm). The left ventricular posterior wall diameter in diastole was significantly increased in cases (4.53±0.50 mm) compared to controls (3.87±0.35 mm). Significant differences were observed in the interventricular septum in diastole {cases: 4.73±0.45 mm, control: 3.97±0.32 mm} and in the left ventricular internal diameter in end systole {cases: 12.30±1.84 mm, control: 13.83±1.02 mm} between cases and controls. Aortic root diameter was increased in 13.3% of cases. The percentage of left ventricular fractional shortening (cases: 35.47±3.74 %, Control: 38.53±2.43 %), Left Ventricular Ejection fraction (cases: 67.63±4.52 %, control: 72.17±4.89 %) were significantly decreased in cases compared to control. Conclusion: The present study demonstrated the development of ventricular hypertrophy and compromised myocardial contractility in infants of diabetic mothers.

Body Composition of Medical Staff Working on Shift Duty and Day Duty: A Cross-sectional Study

Avi Borkhatariya, Devendra Manohar Patil Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The necessity for 24-hour patient care in the medical field often requires staff to work in shifts, disrupting their circadian rhythms controlled by the hypothalamus’s Suprachiasmatic Nuclei (SCN). This disruption can lead to sleep deprivation, which is linked to significant health issues such as obesity, type 2 diabetes, hypertension, and cardiovascular disease. Sleep deprivation affects body composition by altering fat distribution, muscle mass, and Body Mass Index (BMI), and changes meal preferences towards high-calorie, carbohydrate-rich foods. Irregular eating patterns due to hormonal and gut microbiome changes can lead to over-eating and weight gain. The sedentary nature of many shift-based jobs exacerbates the imbalance between energy intake and expenditure, promoting obesity. Aim: To address the limited research on how shift work impacts the body composition of medical staff by comparing those on shift duty to those on day duty. Materials and Methods: This study was a cross-sectional study that included medical staff between the age group of 25 to 40 years working in the Parent Institute. The subjects were divided into two equal groups consisting of 100 staff working on shift duty (study group) and 100 staff working on day duty (control group). Subjects were tested for body composition by using Karada Scan. Various parameters of body composition were compared using an unpaired t-test. Results: The day duty group consisted of 36 females and 64 males (N=100) staff with a mean age of 33.0±4.6 years while the shift duty group consisted of 36 females and 64 males (N=100) staff with a mean age of 31.9±4.4 years. The study suggests a significant difference between the two groups for BMI, skeletal muscle mass, and subcutaneous fat with a p-value <0.05. Conclusion: The study showed lower skeletal muscle mass and higher body weight, body fat percentage, visceral fat, BMI, and subcutaneous fat in medical staff working on shift duty.

A Cross-sectional Study on Spectrum of Oral Cavity Lesions with Emphasis on Soft-tissue Tumours: A Lesser Dealt Domain

Vaishali Baburao Nagose, Neha Amrut Mahajan, Shirish Renurao Gondane, Vipin Narendra Todase, Vikrant V Vaze, Yuraj Hari Pawar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The oral cavity, the beginning of the digestive system, has diverse lesions affecting it other than Oral Squamous Cell Carcinoma (OSCC). Soft-tissue Tumours (STT) are uncommon lesions. Overlapping of the signs and symptoms in diverse conditions creates significant problems for reaching their definitive diagnosis. Histopathological Examination (HPE) plays a central role in giving their final diagnosis. Assessment of the clinical features, histopathology, along with Immunohistochemistry (IHC), helps in reaching an accurate diagnosis in these cases, which further aids in the proper management of the patient. Aim: To study the spectrum of oral cavity lesions and tumours with emphasis on STT. Materials and Methods: A retrospective cross-sectional study was conducted at the Department of Pathology and Otolaryngology, Dr. Ulhas Patil Medical College, Jalgaon, Maharashtra, India included the oral cavity lesion samples received over two years (from January 2021 to December 2022) in the histopathology section of a Medical College in Maharashtra, India. A total of 170 cases were included in the study. Complete clinical information including age, sex, anatomical location, clinical diagnosis, and histological subtypes were compiled. The HPE diagnosis were classified into four categories-Non neoplastic, Benign, Epithelial Proliferative lesions {including viral/Human Papillomavirus (HPV) related}/Intraepithelial neoplastic lesions/Precursor or Pre-malignant, and malignant with special emphasis on STTs found. The data was statistically analysed and the results were presented as percentages. Full details of the soft-tissue lesions were recorded, entered into an Excel sheet, and studied for the percentage-wise distribution of various recorded parameters. Results: A total of 170 cases were found. Male:female distribution was 2.78:1, and most patients were in the seventh decade, n=38 (22.35%). The most common lesions other than SCC, n=110 (64.71%) found were mucocele, chronic inflammatory lesion and wart. The Buccal Mucosa/Gingivo-buccal Sulcus (GBS) were the most commonly involved site, n=82 (48.24%). Malignant lesions were more common in the sixth and seventh decades, with a male preponderance of 2.71:1. The uncommon STTs found were-Benign: Haemangioma/pyogenic granuloma (n=2), a Schwanomma, and a Proliferative Fasciitis (PF); Malignant: two fibrosarcomas and a high-grade sarcoma. All three malignant STTs were found in males of the sixth decade involving the buccal mucosa. Conclusion: Among the variety of lesions found in the oral cavity, HPE facilitates the recognition of the STT, especially the malignant ones, aiding in proper management. Being an extremely uncommon entity at this site, the documentation of these findings is of utmost importance.

Awareness of Periconceptional use of Folic Acid to Prevent Neural Tube Defects in Young Females of Dakshina Kannada Region, India: A Cross-sectional Study

Joseph Paul Arnold, Varsha Shenoy, Prathima Prabhu, Deepshreya Sheron Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Neural Tube Defects (NTDs) are one of the common congenital anomalies leading to miscarriages and serious disabilities in newborns. NTDs are the second most common type of birth defects. Even though the aetiology of NTDs is multifactorial, Folic Acid (FA) deficiency is the most common cause. There are limited Indian studies on awareness of FA usage in the general public. Aim: To assess the awareness and usage of FA to prevent NTDs in young ladies of Mangaluru, Dakshina Kannada (DK) district, Karnataka, India. Materials and Methods: It was a community-based cross-sectional study conducted at Father Muller Medical College in Dakshina Kannada district, Mangaluru, Dakshina Kannada (DK) district, Karnataka, India from August 2023 to October 2023. A total of 300 young Indian females aged 18-35 years, residing in the study district, were randomly chosen as participants. Data were collected by an interviewer using a semistructured questionnaire with two components. Part 1 focused on socio-demographic details, while Part 2 gathered information on the awareness of FA supplements, dietary sources of FA, the best time, and dosage of FA supplements to prevent NTDs. Descriptive analysis of the data was done. Results: The study included 90 married and 210 unmarried females. The average age of the participants was 23.7±5.7 years. The study results observed that only 103 (34%) of the participants had heard about FA supplements. A total of 240 (80%) of them said they were not aware of the preferred time for FA. Only 9 (3%) females could mention the correct dose of FA. Conclusion: The study results indicate a gross lack of awareness about FA supplements to prevent NTDs in the general population of the region.

Mesenteric and Omental Lymphatic Cysts in Children: A 23-Year Retrospective Descriptive Study from Central India

Rajendra Kumar Ghritlaharey Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Lymphatic cystic malformations occur in the mesentery of the small and large bowel, omentum and retroperitoneal area and are rare, benign, intra-abdominal cystic lesions. Aim: To review the demographics, clinical presentation and surgical outcomes of children’s mesenteric and omental lymphatic cystic lesions. Materials and Methods: A single-institution, retrospective descriptive study was conducted in the Department of Paediatric Surgery, Gandhi Medical College and Associated Hospitals, Bhopal, India, from January 1, 2000, to December 31, 2023. It included cases of lymphatic cystic lesions in infants and children below 12 years of age involving the mesentery of the small and large bowel and omentum. The details collected from the case records were the age, sex, clinical presentation, radiological investigations carried out, operative findings and the outcome of the operative intervention executed for mesenteric and omental lymphatic cysts in children. The results obtained from the present study are expressed in numbers and percentages. Results: The present study analysed 18 children aged ≤12 years who underwent surgery for lymphatic cysts of the mesentery of the small bowel (n=14), large bowel/mesocolon (n=1) and omentum (n=3) during the study period. There were 11 boys and 7 girls. More than four-fifths (n=15) of the children were ≤5 years old at the time of diagnosis and operative therapy provided. One-third (n=7) of the cases clinically presented with the clinical features of intestinal obstruction. The cysts involved the mesentery of the small bowel in three-fourths (n=14) of the cases. The complete excision of the lymphatic cysts was possible in three-fourths (n=14) of the cases. In 10 children, resection of the adjacent/involved small bowel segment was also required during the operative procedures. Fifty percentage of the cases revealed volvulus of the small bowel caused by mesenteric cysts involving the small bowel. More than half of the cases required resection of the adjacent/involved segment of the small bowel along with excision of the mesenteric cysts. Conclusion: Mesenteric cysts are rare abdominal pathology with diverse clinical presentations ranging from vague abdominal pain and lump to an acute abdomen. Early referral to higher centres, diagnosis and prompt surgical excision of the mesenteric cysts can prevent volvulus, one of the most common complications and requirements of an emergency surgical procedure.

Evaluation of Antimicrobial Activity and Physical Properties of Vinyl Siloxane Ether Impression Material Modified with Zinc Oxide and Chitosan Nanoparticles: An In-vitro Study

Marthala Sruthi Reddy, Dara Hancy Sunaina, Sumeet Sharma, VVSN Raju Jampana, Lakshmi Saranya Namburu, CMR Rizwanulla Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The antimicrobial activity and physical properties of Vinyl Siloxane Ether (VSE) impression material, such as dimensional stability, flow, and setting time, play a crucial role in the success of fixed prosthodontics. During impression making, the impression material is exposed to infected blood and saliva, which are potential sources of cross-contamination. Cross-contamination can be decreased or minimised when antimicrobial agents are added to the impression material. The efficacy of nanoparticles like silver, titanium, zinc oxide, and chitosan as antimicrobial agents is continuously researched in dentistry. These particles have the benefit of being small and possessing effective antibacterial characteristics due to their vast surface area, which creates an effective interaction with microbes. Aim: To evaluate and compare the antimicrobial activity and physical properties of VSE impression material incorporated with various concentrations (0.0, 1.0, and 2.5 wt.%) of zinc oxide and chitosan nanoparticles. Materials and Methods: This is an in-vitro study conducted in the Department of Prosthodontics at KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India. Ethical Review Board for clinical trials (Material protocol no. 020/KIMS DENTAL/2022). The study was conducted in the month of June and July of 2022 year. A total of 252 samples were fabricated with VSE impression material and divided into two groups for antimicrobial activity (Staphylococcus aureus, Pseudomonas aeruginosa, and the fungus Candida albicans) and physical properties (dimensional stability, flow, setting time) with 126 samples in each group, respectively. The sample size was estimated using G Power One software with a power of 91% and an alpha error of 5%. Antimicrobial activity was determined using the disk diffusion method, dimensional stability was determined with a stereomicroscope, setting time with a Gillmore apparatus, and flow with a vernier caliper. Data were subjected to one-way Analysis of Variance (ANOVA) (p-value <0.05), T tests, and Tukey post-hoc tests, respectively. A p-value of ≤0.05 was considered statistically significant. Results: Significant changes were noted against Staphylococcus aureus bacteria when VSE was incorporated with 2.5% zinc oxide nanoparticles (p-value=0.010). The highest setting time was found for 2.5% chitosan, and the lowest setting time was for 2.5% zinc oxide (p-value <0.001). Decreased flow was observed with 2.5% chitosan, whereas increased flow was observed with 1% and 2.5% of zinc oxide nanoparticles (p-value=0.016). Enhanced dimensional stability was seen when the impression material was incorporated with 1% and 2.5% of ZnO nanoparticles (p-value <0.001). Conclusion: Based on this in-vitro study, zinc oxide and chitosan nanoparticles can be incorporated into VSE impression material as antimicrobial agents without adversely affecting their properties.

Treatment Satisfaction and Quality of Life Changes in Patients Receiving Conventional Fixed Orthodontic Appliances and Clear Aligner Therapy: A Questionnaire Based Cross-sectional Study

Kavitha Odathurai Marusamy, Saravanan Ramasamy, Elaf Jamal Fitaihi, Rawaa Fallatah, Dhuha Althahafi Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The orthodontic outcome is mainly decided by the objective evaluation by orthodontists with minimal subjective considerations. Although there is increasing patient acceptance of orthodontic aligners for malocclusion treatment, minimal evidence exists regarding their efficacy and adverse effects compared to conventional fixed orthodontic appliances. Aim: To assess patient satisfaction and quality of life changes after these two modalities of orthodontic treatment and to analyse the influencing co-factors. Materials and Methods: A web-based three-part questionnaire survey was done amongst 303 participants who underwent either fixed orthodontic therapy or invisalign treatment. The first part collected the participants’ demographic details and their treatment type. The second part of five questions addressed their preferences, facilitators, and factors preventing them from undergoing orthodontic treatment. The final part of ten questions measured the satisfaction ratio on a five-point Likert scale. Descriptive statistics were computed to provide an overview of responses using frequencies and percentages. Inferential statistics were computed using the chi-square test, and a p-value less than 0.05 was considered statistically significant. Results: This study of 303 orthodontic patients found no significant difference in overall satisfaction between fixed braces and clear aligners (p=0.989), although aligners were favoured for facial appearance, increased treatment costs were a concern for the majority. Female participants (185, 61.1%) constituted the majority of the participants, with 178 (58.7%) aged between 19-29 years. Clear aligner users experienced more discomfort with additional visits and appointment booking, while fixed braces users had greater concerns about appearance and increased brushing time. Younger patients reported higher satisfaction across several treatment aspects (p=0.013). Men were more satisfied with treatment duration and costs than women. Conclusion: In conclusion, while clear aligners provide aesthetic and hygiene benefits, overall satisfaction was comparable to fixed braces, with cost being a significant factor. Comprehensive consultations are essential to align treatment with patient needs. Future research should involve larger, more diverse samples for validation.

Impact of Accelerated Antimicrobial Susceptibility Testing on Clinical Outcomes in Critically ill Septicaemia Patients in a Tertiary Care Centre in Andhra Pradesh, India: A Prospective Observational Study

Renuka Devi Avula, Haritha Jakkula, Chakrapani Kammineni Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Bloodstream infection is a major cause of mortality and morbidity worldwide. Timely reporting of blood culture results is of utmost importance for better patient outcomes. The recently introduced Rapid Antimicrobial Susceptibility Testing (RAST) method is poised to profoundly influence clinical outcomes. Aim: To compare the results of RAST with Standard Antimicrobial Susceptibility Testing (SAST) and evaluate the impact of RAST reporting on the clinical management of septicaemia patients. Materials and Methods: This prospective, observational study was conducted in the Department of Microbiology, Government Medical College, Kurnool, Andhra Pradesh, India from May 2021 to September 2022. All positive blood culture bottles with only a single morphotype in gram staining were further processed using the RAST method, followed by conventional identification and SAST. Categorical agreement and disagreement between the RAST and SAST results were compared, along with the difference in the time at which results were available. Results: Out of 1,146 blood cultures received, 228 were flagged as positive. A total of 514 isolate and antimicrobial agent combinations were evaluated, of which 496 (96.5%) showed categorical agreement. Only 18 (3.5%) showed categorical disagreement, with the majority being Major Errors (ME) (1.56%), followed by Very Major Errors (VME) (0.97%) and minor Errors (mE) (0.97%). Conclusion: RAST results demonstrated strong concurrence with SAST results. RAST is affordable, fast, and flexible and can potentially lead to a considerably shortened time for AST results to reach the bedside of the patient. This enables rapid modifications and adjustments in antibiotic therapy, including both escalation and de-escalation.

Design and Implementation of Computer-aided Learning Module in Pharmacology for Vasoactive Drugs: An Experience from a State Medical College in Haryana, India

Jayant Kumar Kairi, Nitika Sharma Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: In the Competency-based Medical Education (CBME) curriculum, one of the core competencies involves demonstrating the effects of autonomic drugs. It is a skill competency, and students have to learn to demonstrate the acquisition of this competency in a skill lab. Computer-aided demonstrations can enhance the teaching-learning experience and fulfill the learning objectives related to the effects of vasoactive drugs. Aim: To design and evaluate a Computer-aided Learning (CAL) module to teach the effects of vasoactive drugs. Materials and Methods: The study, being a curriculum implementation project, was conducted using a mixed methods study design at Kalpana Chawla Govt. Medical College, Karnal, Haryana, India over a period of one year from October 2020 to October 2021. Here, the impact of the intervention was measured through a multiple-choice quiz on the topics learned through CAL. The study population included all students undergoing the Phase-2 stage of the MBBS course at our institute. For skill acquisition in the cognitive domain, a video bank in the computer lab was made available to 120 undergraduate medical students. During practical training, in small groups, the training videos and animations were played, showing the effects of selected common vasopressors, vasodepressors, and their antagonists to the students. Simulated experiments on vasoactive drugs were shown to the students using ExPharm software (Free version). The achievement of learning objectives was assessed through a quiz. The perception of the students toward the new method was assessed through a questionnaire, and that of the faculty was evaluated with a Focused Group Discussion (FGD). Simple descriptive statistics, specifically the mean and standard deviation, were used to generate results. Results: All the students who participated in providing feedback on the module 113 (100%) had used CAL-based learning to acquire the skills. 60.7% of students (n=68) used both the animation and simulation components of the CAL to achieve proficiency in learning about vasoactive drugs. All teachers (n=5, 100%) during the FGD expressed satisfaction with the development and outcomes of the learning module, while highlighting the need for better CAL devices and methods. Conclusion: The CAL module developed for teaching and learning the effects of vasoactive drugs in experimental pharmacology was considered to be just about satisfactory.

Language Disorders in People with Cognitive Impairment: A Cross-sectional Study

Esther Moraleda Sepúlveda, Marina Alonso Sánchez, Patricia López Resa, Noelia Santos Muriel Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The progressive ageing of the population has generated significant interest in various areas, particularly Cognitive Impairment (CI). It is necessary to know the specific characteristics of people with cognitive development to establish the basis for the intervention. Aim: To understand the relationship between the cognitive deterioration process and language characteristics, aiming to determine whether linguistic alteration could be considered a symptom of cognitive deterioration. Materials and Methods: This study employed a cross-sectional design involving two groups: 17 individuals aged over 70 years, consisting of eight with CI and nine without CI. Participants were assessed using the Mini-Mental State Examination (MMSE). Language abilities were evaluated using the Boston Naming Test and the Verbal Fluency Test in separate individual sessions. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS) program. Results: The results indicated that individuals with CI exhibited poorer performance in language tests, particularly in areas related to productive and comprehensive lexical and semantic development. These differences were statistically significant across all assessed domains (p-value<0.001). Conclusion: CI is accompanied by significant impairment in language skills, which could be considered an indicator of cognitive decline. Therefore, specific interventions targeting language abilities are warranted throughout the progression of CI.

Evaluation of Effects of Food Addiction in Rat Model: An Experimental Study

S Shanmugapriya, S Saranya Rajee, R Subhashini Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Palatable foods have potent reinforcing effects that are mediated, partly, by an abrupt augmentation of dopaminergic neurotransmitters in the brain’s reward pathways. Food addiction to highly palatable foods contributes to the increasing prevalence of obesity. Aim: To evaluate the effect of food addiction on neurobehavioural parameters and the Behavioral Satiety Sequence (BSS) during restriction to a highly palatable diet in a food addiction rat model. Materials and Methods: The experimental study was conducted in the Pharmacology Department at PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India from April 2018 to January 2019. The study included six animals out of 28 female Sprague Dawley rats aged approximately 10 weeks and weighing 180-220 g were allocated to the control group and were fed a Standard Chow diet (SC) throughout the study. Twenty-two animals (induction group) were exposed to free choice between SC and a highly palatable Cafeteria Diet (CD), a mix of equal amounts of Bounty®, Snickers®, Mars®, and Milka® chocolate made into homogenous food pellets. After six weeks, 12 animals were randomly selected to have restricted access to the CD diet with free access to SC, while the rest continued to receive a free choice between the two diets for two weeks. Central Nervous System (CNS) parameters, BSS, 24-hour food intake, and body weight were recorded. Results: A significant decrease of 25.4 seconds (18.27%) in the mean time the CD restricted group stayed on the rotarod (113.6±8.31) seconds. and a reduced locomotor activity score of 46.92 (20.94%) in the CD access group in the actophotometer (177.08±5.29) compared to SC was noted. In the open field test, the CD restricted group demonstrated a 47.33% increase in grooming (12.0±1.11) and a 30% lower number of central squares crossed (2.80±0.57). In the Elevated Plus Maze (EPM), the time spent in the open arm (15.00±8.10) was statistically lower (p=0.045). No statistically significant difference between groups was recorded in the forced swim or tail suspension tests. Disruption of the BSS in varying dimensions was apparent in both CD groups. Conclusion: The study has shown that anxiety and altered feeding behaviour were evident in the CD restricted rats in the food addiction model.

Role of CKD273 in Diabetic Nephropathy: A Systematic Review

Veena Venugopal, Sathya Selvarajan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Diabetic Nephropathy (DN) is a major cause of increased morbidity and mortality in patients with Diabetes Mellitus (DM). The development of novel biomarkers for kidney disease, especially DN, is becoming a focus of medical research. Serum creatinine and urine albumin measurements had been the gold standards for the diagnosis of DN until the advent of newer markers like Cystatin C, Kidney Injury Molecule-1, etc. Currently, there is no non invasive investigation for the prediction of DN. Nevertheless, the field of proteomics is advancing at a rapid pace, such that urinary proteomic biomarkers have found a spot in the diagnosis of DN. The role of the urinary proteomic Chronic Kidney Disease 273 (CKD273) classifier, in particular, has been demonstrated in early prediction. Aim: To highlight the performance of the CKD273 classifier in the early prediction of DN. Materials and Methods: Pubmed and Scopus databases were extensively searched using the keywords diabetes, DM, renal disease or kidney disease, proteomics or peptide, urinary markers or biomarkers. Full-text original articles conducted on humans and written in English, published between 2014 and 2022, specifically prospective and retrospective observational studies, cross-sectional studies, Randomised Controlled Trials (RCT), and case-control studies investigating the efficacy of the urinary biomarker CKD273 in the prediction of DN were included in the review. The literature search, strictly based on Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, led to the identification of eight relevant studies, which were included in the present review. The quality and Risk of Bias (RoB) of the selected articles were assessed using the Newcastle Ottowa scale (NOS) and Risk Of Bias 2 (ROB2) tool. Results: The selected studies proved the efficacy of the urinary proteomic classifier CKD273 as a cost-effective biomarker in predicting the decline in renal function in both normoalbuminuric diabetics and DN patients. Conclusion: Based on the articles included in the present systematic review, it has been found that CKD273 plays a vital role in the early prediction of renal dysfunction in normoalbuminuric diabetics as well as in the detection of progressing renal disease in DN patients. It has also been found to be cost-effective compared to established markers such as estimated Glomerular Filtration Rate (eGFR), Urine Albumin Excretion Rate (UAER), etc.

Exploring the Sustainability of Plant-based Diet for Management of Diabetes Mellitus: A Scoping Review

Aditi Kottapalli, Anu Mahajan, Arti Muley Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The increasing prevalence of diabetes necessitates sustainable care and preventative strategies for patients. Plant-based diets have emerged as a promising intervention for the management of type 2 diabetes mellitus. However, the sustainability of such diets remains a subject of debate. Aim: To investigate the impact of plant-based diets on treating type 2 diabetes mellitus and assess their sustainability. Materials and Methods: Systematic searches were performed using the PubMed, Scopus, and Web of Science databases for studies published between 2013 and 2023 following Preferred Reporting Items for Systemic Reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The Medical Subject Headings (MeSH) terms used in the search were “type-2 diabetes,” “diabetes mellitus,” “plant-based diets,” “vegan diet,” and “vegetarian diets.” The search yielded 227 studies, of which eight were included based on inclusion criteria. Covidence software was used to analyse the selected studies, focusing on the long-term effects of plant-based diets on diabetes. Results: The studies included in the review followed 12 weeks of intervention with plant-based diets, examining Glycated Haemoglobin (HbA1c) levels, insulin sensitivity, lipid profile, weight changes, and Body Mass Index (BMI). The observations included a significant reduction of approximately 0.4% in HbA1c levels and approximately 1.04 kg/m2 in BMI, along with a significant weight loss of approximately 2-6 kg. While there was no significant reduction observed in the lipid profile. Conclusion: Plant-based diets with a 12-week consumption period show positive cardiometabolic profiles due to antioxidants, fiber, vitamins, and minerals. However, long-term studies are needed to ensure sustainability.

Adverse Effects of Hydroxychloroquine on Testicular Tissue and Sperm Quality: An Experimental study on Male Albino Rats

Sagarika Mukhopadhyay, Tanushree Samanta, Suman Kalyan Khanra, Anup Jana Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Hydroxychloroquine (HCQ) is a medicine that has mainly been used to treat malaria. During the recent Coronavirus Disease-2019 (COVID-19) period, an abrupt spike in the sale of HCQ has been found. The repurposing of this drug in the treatment of COVID-19 was not only found to be ineffective but also showed many side effects. The adverse effects of the enormous exposure to this drug should be unveiled. Aim: To evaluate the acute effect of HCQ exposure on the male reproductive system by analysing the changes in antioxidant enzyme levels in testicular tissue, sperm quality, and histopathological assessment of testicular tissue using male albino rats as the subject model. Materials and Methods: The present experimental study was done by using male albino rats as the subject model. It was conducted in the laboratory of the Department of Human Physiology at Raja NL Khan Women’s College (Autonomous) in Medinipur, West Bengal, Kolkata, India, from the last week of June 2023 to the first week of August 2023. A total 10 male albino rats were obtained and randomly divided into two groups (n=5 in each group), control and HCQ-treated, and were given plain drinking water and 33 mg/kg/day HCQ, respectively, for six consecutive days through oral gavage. After the treatment tenures, rats were euthanised, and antioxidant enzymatic activity was measured by a spectrophotometer. Sperm quality and testicular histopathology were studied. A two-tailed t-test was used to compare the parameters of the control and HCQ-treated groups. Results: The total testicular weight of the control group was 2.37±0.17 g, in contrast treated group had a significantly lower testicular weight of 1.98±0.19 g. A significant decrease in total testicular protein in the treated group was found, i.e., 28.86±3.03 mg/g of tissue, compared to the control group, i.e., 60.46±2.85 mg/g of tissue. The sperm count of the control group was 4.51±0.06 million/ml of suspension, while the treated group had a significantly lower sperm count, i.e., 2.73±0.11 million/mL of suspension. The percentages of sperm motility and viability in the control group were 86±1.63% and 94±1.33%, respectively, but in the treated group, the percentages were significantly lower, i.e., 22.66±1.35% and 24±1.78%, respectively. The increasing sperm anomalies after HCQ exposure indicate poor sperm quality. Conclusion: Infertility or reduced fertility can result from testicular dysfunction, in continuation, decrease in sperm count, motility, viability, together with abnormalities in sperm morphology, was observed after this exposure. Thus, the present study provides insight into the adverse effects of the use of this drug, which might be associated with male infertility.

Enhancing Visual Perception in Children Ages 4-12 Years: A Systematic Review of Technology-based Interventions

Redkar Simran Sandeep, Ganapathy Sankar Umaiorubagam, S Deepak Vignesh Raj, D Anbarasu, Monisha Ravikumar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Visual perception plays a pivotal role in a child’s overall development and learning. Occupational therapists often employ interventions to support children in enhancing their visual perception skills, with technology-based approaches gaining prominence in recent years. This review intends to highlight the significance of visual perception interventions, especially those involving technology. Aim: To systematically synthesise the literature on the effectiveness of technology-based interventions on visual perception in children with disabilities aged 4-12 years. Materials and Methods: A comprehensive search of studies was conducted using electronic databases (Scopus, PubMed, ProQuest, and OTseeker). Additionally, studies were also considered through manual searches from printed journals (American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and the Australian Journal of Occupational Therapy) to identify existing technology-based visual perception interventions in children aged 4-12 years. Risk of Bias was conducted through guidelines for systematic review by the American Occupational Therapy Association (AOTA). Data extraction was reported by tabulating author(s) and year, sample characteristics, outcome measures used, study design, intervention details (experimental, comparator, study setting, duration), and outcomes of the studies. Results: In the present review of 13 studies, two studies used iPad interventions, while 11 used computer-based interventions, targeting various clinical groups like developmental delays, dyslexia, cerebral palsy, hearing impairment, down syndrome, hydrocephalus, and special needs. Occupational therapists led most studies, with some involving physiotherapists, educators, and multidisciplinary teams. iPad interventions focused on visual skills with structured apps, while computer methods included games and software like Microsoft Office and Computerised Visual Perception Training (CVPT) for visual training. Positive effects were seen on visual perception and motor skills across different conditions with these technology-based interventions. Conclusion: Visual perception interventions, particularly those incorporating technology, have become invaluable in the field of paediatric occupational therapy. As technology continues to evolve, occupational therapists must remain adaptive and innovative in their strategies to provide the best possible support for children with visual perception difficulties.

Association of Serum Hydrogen Sulphide Levels and Dyslipidaemia: A Cross-sectional Study

Ipsita Bhattacharya, Ankita Prasad, Ankita Bhattacharya, Pinaki Saha, Nirmalya Roy, Arpita Saha, Indira Bhaskar Biswas Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Dyslipidaemia is an important risk factor for coronary artery disease. Oxidative damage to plasma lipoproteins ultimately results in the development of atherosclerosis. Since Hydrogen Sulphide (H2S) is a cytoprotective molecule in oxidative stress, decreased H2S levels may be a cause of dyslipidaemia. Aim: To determine the relationship between the serum levels of H2S with serum Triglycerides (TG), Total Cholesterol (TC), and High-density Lipoprotein Cholesterol (HDL-C) in cases of dyslipidaemia. Materials and Methods: A cross-sectional study was conducted between December 2022 and June 2023 in the Departments of Biochemistry and Medicine at KPC Medical College, Jadavpur, Kolkata, West Bengal, India. Serum lipid profile {TC, TGs, HDL-C, and Low-density Lipoprotein Cholesterol (LDL-C) (calculated by Friedewald’s equation)} and serum H2S were measured in 70 cases of dyslipidaemia {according to National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria} aged between 30 to 80 years and compared with an equal number of healthy volunteers as controls. The means of continuous variables were compared by independent t-tests and Mann-Whitney U tests. The Chi-square test was applied to compare gender distribution. Pearson’s and Spearman’s correlation coefficients were calculated for normal and non normal distributions, respectively. Results: The mean age of dyslipidaemic patients (54.54 years±11.19) was significantly (p=0.0017) higher than that of the controls (47.02 years±16.18). Among the 70 cases of dyslipidaemia, 38 participants were male and 32 were female, while among the healthy controls (n=70), 42 participants were male and 28 were female. The serum H2S levels in cases of dyslipidaemia (37.91±6.28 μmol/L) were significantly lower than in the healthy controls (58.52±12.92, p<0.01 μmol/L). A significant positive correlation was found between serum H2S levels and HDL-cholesterol (r=0.81, p<0.001), whereas a negative correlation was found between serum H2S and TG levels (r=-0.55, p<0.001). Conclusion: In the present study, dyslipidaemia was associated with decreased levels of serum H2S. Serum H2S was positively correlated with serum HDL and negatively correlated with serum TG levels.

Awareness of Smoking Tobacco among Dental College Students: A Questionnaire-based Cross-sectional Study

Pallavi Singh Meghna Mehta, Abhishek Awasthi, Ashish Chauhan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Tobacco smoking is one of the 10th leading health indicators proposed by the World Health Organisation (WHO) Healthy People 2020, with major concerns regarding increased mortality rates. Tobacco smoke contains 2.94 mg of nicotine, 802 mg of tar, 145 mg of carbon monoxide, and greater quantities of chrysene. Hookah tobacco poses a serious health threat because of the commonly held belief among college students that this tobacco product is not addictive. Assessing practices represents an important starting point in curbing the spread of tobacco use. It is crucial to understand the use, patterns, and dependence on tobacco to develop appropriate prevention and cessation strategies. Aim: To assess tobacco smoking-related knowledge, attitudes, and practices among students of dental Institutions in Lucknow city, Uttar Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted among five dental colleges in Lucknow city from July 2023 to November 2023. A total of 1050 undergraduate dental students were included in the study, and a self-structured, close-ended questionnaire was used to collect information on the knowledge, attitudes, and practices of hookah tobacco. The reliability of the questionnaire was evaluated using Cronbach’s coefficient alpha to measure internal consistency, which was found to be 0.9. Discrete (categorical) data were summarised in numbers (n) and percentages (%). Categorical groups were compared by Chi-square (?2) test. Results: Out of the total 1050 students, 392 (37.3%) were aged between 18-21 years, 630 (60.0%) were aged between 22-25 years, and 28 (2.7%) were aged between 26-30 years. Furthermore, among the students, 355 (33.8%) were females and 695 (66.2%) were males. Among the total of 1050 dental students, the prevalence of hookah smoking was 59.1%. The presence or prevalence of hookah smoking was higher in males (29.4%) at 480 (45.7%) than in females 141 (13.4%), and the difference was statistically significant (?2=83.75, p<0.001). Conclusion: The study found that the frequency of hookah smoking continues to increase with the increasing age of the participants. The study also revealed the alarming situation of a high prevalence of hookah smoking among dental college students.

miRNA Signature and its Clinicopathological Association in Colorectal Cancer: A Cross-sectional Study

Ipseet Mishra, Sudipta Naskar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Colorectal Cancer (CRC) is a significant health problem worldwide, with more than 70,000 new cancer cases recorded in India in 2020. A better understanding of CRC prognosis is needed. The substantial intratumoural heterogeneity among tumours of different stages has entailed the research for new biomarkers to more clearly identify tumour biology and behaviour. Micro Ribonucleic Acids (miRNAs) are non coding RNAs comprised of approximately 20-25 nucleotides and play an important role in epigenetic regulations. Studies have demonstrated that miRNAs play a critical role in tumourigenesis, metastasis, and tumour response to treatment. Comprehensive knowledge of miRNAs as potential markers of colon cancer diagnosis, prognosis, and predictive factors is crucial. Aim: To assess the miRNA signature (miR21, miR31, and miR34a) in colon cancer tumour samples and to evaluate the association of the miRNA signature with the clinicopathological profile and Pathological Tumour/Node/Metastasis (pTNM) stage of CRC patients. Materials and Methods: This cross-sectional and prospective study was conducted at the Departments of Pathology, Molecular Research and Diagnostics and Surgical Oncology of Sri Shankara Cancer Hospital, Bengaluru, Karnataka, India and was comprised of a total of 69 CRC patients who underwent surgery with a curative intent. The study was conducted over an 18-month period from January 2020 to June 2021. miRNA was extracted from Formalin-fixed Paraffin-embedded (FFPE) samples, and quantitative Polymerase Chain Reaction (qPCR) was done to get corresponding ?CT (Threshold Cycles) values. The expression of miR21, miR31, and miR34a was evaluated, and their association with different clinicopathological parameters like age, sex, tumour stage, grade, Carcinoembryonic Antigen (CEA) levels, Perineural Invasion (PNI), and Lymphovascular Invasion (LVI) status was studied. The expression of the mentioned miRNAs was assigned low and high values on the basis of median values. Spearman's correlation was done to check for any significant associations. Results: All three miRNAs (miR21, miR31, miR34a) were found to have lower values in the >60 years age group compared to the <60 years age group. Higher values of miRNA were found in male patients than in females, with a p-value of 0.022 for miR21. However, miRNA expression (miR21, miR31, miR34a) did not show any statistically significant correlation with tumour location (p-values 0.543, 0.255, 0.255), lymph node status (p-values 0.676, 0.153, 0.930), TNM stage (p-values 0.273, 0.509, 0.898), LVI (p-values 0.233, 0.233, 0.733), PNI (p-values 0.686, 0.263, 0.756), and serum CEA level (p-values 0.543, 0.255, 0.255). Conclusion: The present study showed the possible tumour-suppressive role of miR34a in CRC. Although miR21 acts as an oncogenic miRNA in many cancers, in CRC, its expression differs between males and females, with most tumours in males exhibiting high expression.

Visfatin as an Early Marker for the Diagnosis of Metabolic Syndrome in Obese Adults: A Cross-sectional Study

E Sruti, Balaji Rajagopalan, Kenyi Ete, G Srinivasa Nageswara Rao Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: It is well-established that obesity plays a significant role in the development of metabolic syndrome. Visfatin is a novel adipocytokine predominantly secreted in adipose tissue, associated with a wide range of biological effects including glucose and lipid metabolism. Visfatin levels are significantly linked to inflammation and the development of obesity-related metabolic disorders. Unfortunately, the roles of visfatin in obesity, particularly in the Indian population, are scarce. Aim: To study the role of serum visfatin in diagnosing metabolic syndrome in overweight and obese adults. Materials and Methods: A comparative cross-sectional study was conducted at the Department of Biochemistry, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India, between September 2022 and October 2023. A total of 200 subjects (50 controls, 50 overweight individuals, 50 obese individuals without metabolic syndrome, and 50 obese individuals with metabolic syndrome), aged 20-70 years, were enrolled as study participants. Anthropometric parameters, lipid profiles, and fasting glucose were analysed using an auto analyser. Serum visfatin levels were measured by Enzyme-linked Immunosorbent Assay (ELISA). Statistical analysis was performed using the t-test, and categorical data were analysed using the Chi-square test. Correlation analysis was done by Pearson's correlation at a significance level of 5%. Results: The control group consisted of 17 males and 33 females with a mean age of 41.5±13.4 years, the overweight group consisted of 13 males and 37 females with a mean age of 37.1±10.9 years, the obese without metabolic syndrome group consists of 16 males and 34 females with a mean age of 40.6±12.7 years, and obese with metabolic syndrome group had 23 males and 27 females with a mean age of 42.0±9.2 years. Serum visfatin levels (ng/mL) were significantly elevated in the overweight (1.7±0.3), obese without metabolic syndrome (4.3±3.2), and obese with metabolic syndrome (10.9±6.6) groups compared to the controls (1.0±0.2). Serum visfatin levels were positively correlated with Body Mass Index (BMI) (r=0.51, p<0.001), Waist to Hip Ratio (WHR) (r=0.41, p<0.001), Neck Circumference (NC) (r=0.50, p<0.001), Fasting glucose (r=0.44, p<0.001), Total Cholesterol (TC) (r=0.41, p<0.001), Triglycerides (TG) (r=0.39, p<0.001), Low-Density Lipoprotein-cholesterol (LDL-c) (r=0.39, p<0.001), Very Low-Density Lipoprotein (VLDL) (VLDL) (r=0.39, p<0.001), Systolic Blood Pressure (SBP) (r=0.52, p<0.001), and Diastolic Blood Pressure (DBP) (r=0.45, p<0.001), and negatively correlated with High-Density Lipoprotein-cholesterol (HDL-c) (r=-0.20, p<0.002). Conclusion: The present study revealed a good relationship between serum visfatin and the anthropometric and biochemical parameters. The current data belief is that visfatin may be a promising biomarker for predicting metabolic syndrome and its associated disorders particularly in overweight and obese adults.

Faith Healing Practices in Patients with Psychiatric Disorders Attending a Tertiary Care Hospital in Madhya Pradesh, India: A Cross-sectional Survey

Vijay Niranjan, Richa Choudhary, Priyash Jain, Varchasvi Mudgal Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Faith healing has been practiced in various cultures for many decades and is an accepted mode of treatment in different cultures. Beliefs about mental illness can affect patients’ willingness to seek and adhere to treatment, so it is important to consider cultural, traditional, and folk methods for conceptualising and managing mental illnesses. Aim: To assess the clinical and socio-cultural factors associated with faith healing and the effect of faith healing methods on the patients. Materials and Methods: A cross-sectional survey was conducted at the Department of Psychiatry, MGM Medical College, Indore, Madhya Pradesh, India from January 2023 to March 2023. The sample comprised 100 consecutive patients selected by convenient sampling who had visited a faith healer for their disorder. A semi-structured proforma was administered to participants and their informants, which contained socio-demographic details, clinical information, and details of the faith healing practices they underwent. Descriptive statistics were used to assess the sample distribution, and measures of central tendency were applied. Results: The mean age of patients was 28.6±2.3 years, and the majority (66%) were male. The majority (48%) suffered from psychotic and mood disorders (28%). The majority (64%) contacted a faith healer as their first point of treatment contact. Most visited a healer on the advice of their family or friends (82%), followed by having supernatural or religious beliefs towards their illness (52%). The most common method of healing was offering a “Tabeej”/Talisman (82%), followed by “bhabooti”/“prasad”/sacred water (77%). About 20 participants, or one-fifth of the sample, reported some improvement with faith healing, while most (74%) reported no improvement. Conclusion: The majority of the sample in the study believed in supernatural causation and resorted to faith healers before seeking medicinal treatment. Thus, awareness of and sensitivity to belief systems and faith healing practices in different cultures are important for mental health professionals.

Knowledge and Attitude of School Teachers toward Epilepsy in Al-Baha City, Saudi Arabia- A Cross-sectional Study

Elfatih Mirghani M Salih, Huda Ibrahim A Elahag, Waleed Saeed S Alzahrani, Eyad Mansour Alghamdi, Abdulmajeed Abdallah Alzahrani Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Epilepsy is a neurological disorder characterised by recurrent unprovoked episodes of seizures. A seizure is a frightening event, especially when it lasts more than five minutes, known as status epilepticus, which, if not treated promptly, can lead to brain injury. Understanding first aid for a seizure is crucial and may save the patient’s life. Aim: To assess school teachers’ knowledge about epilepsy, their attitudes toward epileptic patients, and the factors that affect teachers’ knowledge in Al-Baha City. Materials and Methods: This cross-sectional study was conducted in Al-Baha City, Saudi Arabia, from November 2021 to May 2022. A total of 305 teachers working in various randomly selected schools, equally distributed between male and female schools, were enrolled. Data were collected through an electronic questionnaire to evaluate teachers’ knowledge and attitudes toward epilepsy. Statistical analysis was performed using the Chi-square test, with data considered statistically significant when the p-value was less than 0.05. Results: In the present study, out of 305 subjects, 167 (54.8%) were male, and the majority, 137 (44.9%), were aged between 35-44 years. Of the participants, 214 (70.2%) were found to have poor knowledge about epilepsy, particularly regarding its etiology, impact on learning, and treatment options. There was a positive attitude among 211 (69.2%) participants toward hiring epileptic patients in their businesses and 240 (78.7%) responded positively to allowing their children to play with epileptic patients. However, 125 (41%) participants had a negative attitude toward allowing their offspring to marry an epileptic patient. Conclusion: The school teachers’ knowledge about epilepsy was poor. While their attitudes were positive regarding hiring epileptic patients and allowing their children to play with them, their attitude was negative regarding allowing their offspring to marry an epileptic patient.

Cardiopulmonary Functions and Quality of Life in Patients with Pulmonary Tuberculosis: A Cross-sectional Study from Pune, Maharashtra, India

Suraj Barne, Manasi Harale Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Pulmonary Tuberculosis (PTB) treatment can improve health, but patients may experience sequelae of cardiopulmonary complications. PTB can contribute to complications in the cardiovascular system, including abnormal Electrocardiogram (ECG) readings, and the pulmonary system can be damaged, leading to reduced lung capacity and difficulty in breathing. It may cause a combined impact on Quality of Life (QoL). Understanding this is crucial for optimising patient care and identifying potential complications early. Aim: To assess cardiopulmonary functions and QoL in patients undergoing PTB treatment. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in Pune, Maharashtra, India from August 2019 to October 2019. Total of 32 patients (20-50 years old) receiving PTB treatment for six months were included. Haematological tests and Chest X-ray (CXR) were conducted, and QoL was measured using the St. George’s Respiratory Questionnaire (SGRQ). Exercise capacity was evaluated by measuring Oxygen Saturation (SpO2) before and after the 6-Minute Walk Test (6MWT). Results: In this study, anaemia was prevalent in 24 patients (75%). ECG abnormalities were detected in 20 (62.5%) patients, and Echocardiography (ECHO) revealed Pulmonary Arterial Hypertension (PAH) in 2 (6.25%) patients. Exercise capacity, measured by a 6MWT, decreased SpO2 in most patients 27 (84.37%), with a greater decline in females and older individuals. All patients reported significant QoL impairment, with worse activity scores in males. Conclusion: PTB treatment may impact cardiovascular function and QoL. Regular screening for complications and potentially tailored treatment plans are warranted for PTB patients.

Volumetric Evaluation of Brain Grey Matter in Asthmatic Patients using Magnetic Resonance Imaging: A Case-control Study

Dalya IA Mohamed, Elghazaly A Elghazaly, Tamer Sayed Jubartallah, Taher Osman Ali, Amani Abdulraza Alfaki, Assad Ali Rezigalla Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Asthma is a serious disease that affects not only the respiratory system but also the brain by decreasing oxygen saturation. Despite the numerous neuroimaging studies that have shed light on the effect of asthma on brain volume, there is still a need for new studies to evaluate brain volume in asthmatic patients. Aim: To evaluate the Grey Matter Volume (GMV) of the brain in asthmatic patients using Magnetic Resonance Imaging images (MRI) to detect possible changes. Materials and Methods: This is an observational analytic case-control study carried out at Al Amal Hospital in Khartoum State, Sudan, between January 2020 and October 2022. The study included 100 adult participants (50 asthmatic patients and 50 healthy controls) using MRI and automatic brain segmentation through a software program (BrainSuite). Data were analysed using Statistical Package for Social Science (SPSS) software, version 25.0 (IBM SPSS Inc., Chicago, IL), and Microsoft Excel 2013. An independent sample T-test was used to compare the mean of the measurements between controls and asthmatics. Frequencies, means, and standard deviations were taken. A p-value of 0.05 or less was accepted as statistically significant. Results: Out of all participants, 50 were asthmatics and 50 were controls. The mean age of asthmatics was (31±8.53) years and of controls was 32±8.49 years. The mean Grey Matter Volume (GMV) of the asthmatic patients was 575.93 cm3±71.46 SD and of controls was 569.55 cm3±73.77 SD. There were no statistically significant differences between the groups depending on the GMV of asthmatic and control participants (p>0.05). The mean GMV in asthmatic males was 355.50 cm3±53.26 SD and in females 321.65 cm3±32.72 SD, while in control males it was 367.63 cm3±45.77 SD and in females 318.03 cm3±34.16 SD. GMV showed significant statistical differences between asthmatic males and females (p<0.05). Conclusion: There were no statistically significant differences between the groups depending on the GMV of asthmatic and control participants (p>0.05). Asthma disease does not result in noticeable changes in GMV in either male or female brains.

A Decadal Trend Analysis of Measles Cases in Rajasthan and Future Prediction using ARIMA Model: An Observational Study

Sunita Agarwal, Shivra Batra, Pushpendra Bairwa, Parul Sinha, Pooja Choudhary, Dinesh Kumar Jain, Malvika Sharma, Sushil Kumar Singh Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Measles, a highly transmissible disease marked by fever and a maculopapular rash, posed a substantial threat to life in the 1960s. Nevertheless, the advent of the measles vaccine had a profound impact, significantly diminishing its toll on mortality. Similarly, through effective influenza surveillance and early epidemic warning systems, public health officials can timely identify influenza trends and provide crucial scientific support for prevention and control measures. This proactive approach holds great public health significance. Aim: To analyse the long-term trend of measles cases in Rajasthan, India, and the impact of Coronavirus Disease-2019 (COVID-19) on it, with future predictions using Auto-Regressive Integrated Moving Average (ARIMA) modelling. Materials and Methods: The present study was a retrospective, descriptive observational study in which monthly diagnosed measles cases were collected from the Measles Rubella Laboratory, Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, for the period of April 2010 to April 2023. An ARIMA model was developed using data from 2010 to 2020 to predict the monthly number of measles cases in 2021. The predicted values were then compared to the actual cases in 2021 to assess the model’s accuracy. Results: Out of the total positive cases, males were slightly more prone to acquire infection than females (1734 males, 54%; 1477 females, 46%). The monthly index for new measles cases ranged from 0.11 to 2.6. It reached its lowest point in July (0.106) and August (0.25) and peaked in March (2.594) and April (1.84). The overall trend was fluctuating; however, the incidence of measles cases clearly increased after the year 2021. The difference between observed cases and predicted cases for the period of April 2020 to December 2021 was not statistically significant (t-value=0.261 and p-value=0.797). Conclusion: The fluctuating trend of measles was observed during the last decade; however, the observed cases of measles showed an upward trajectory during and after the COVID-19 outbreak. This study also highlighted the monthly index of the measles cases, which peaked in March to April and was lowest in July to August.

Association between Vision-related Quality of Life and Mental Health Status among Glaucoma Patients in a Tertiary Care Hospital, Uttar Pradesh, India: A Cross-sectional Study

Alka Gupta, Astha Singh, Kumudini Sharma, Haseeb Khan, Deepti Tiwari, Astha Trivedi, Bharat Mittal Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Glaucoma is a chronic, progressive optic neuropathy that can lead to blindness. It is a multifactorial disorder, with elevated Intraocular Pressure (IOP) being one of the modifiable risk factors. Glaucoma affects the emotional and psychological wellbeing of patients, even in the early stages of the disease, impacting their Quality of Life (QoL). Aim: To assess the association between vision-related QoL and mental health status among glaucoma patients. Materials and Methods: A cross-sectional survey was conducted on 110 glaucoma patients aged 18 to 70 years who were residents of Barabanki district, Uttar Pradesh, India from September 2023 to December 2023. Glaucoma severity was graded based on mean deviation measured by visual field testing. Anxiety and depression levels were graded using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). QoL was assessed using the Glaucoma QoL-15 questionnaire. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 27.0, and the association between different variables was examined using Chi-square, Fisher’s exact test, and Analysis of Variance (ANOVA) test. A p-value of <0.05 was considered significant. Results: Among the 110 participants, 47 (42.7%) were females and 63 (57.3%) were males, with an average age of 52.6±12.2 years. 56 (50.9%) had moderate anxiety, and 59 (53.6%) had moderate levels of depression. QoL factors assessed included peripheral vision, dark adaptation and glare, central and near vision, and outdoor mobility. Statistically significant differences were observed between different severity levels of glaucoma (p-value<0.05) in relation to these factors. A comparison of glaucoma severity, anxiety level, and depression level with QoL revealed a significant difference (p-value<0.001). Conclusion: Glaucoma impacts the mental health status of patients by causing anxiety and depression, as well as affecting their QoL. As the severity of glaucoma increases, anxiety and depression levels rise, while QoL decreases.

Exploring the Effect of Lutein on TGF-β/SMAD2 Signalling Molecule Gene Expression in Lung Cancer Cells: An In-vitro Study

Sekar Aashruthaa, Anitha Roy, Perumal Elumalai Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Lung cancer is one of the most prevalent and deadly forms of cancer worldwide, accounting for a significant number of cancer-related deaths. Despite advances in diagnosis and treatment, the prognosis for lung cancer remains poor, emphasising the need for alternative and complementary therapeutic approaches. Transforming Growth Factor-beta (TGF-?) is a multifunctional cytokine that plays a crucial role in cell growth, differentiation, apoptosis and immune regulation. Suppressor of Mothers against Decapentaplegic (SMAD), a well known transcription factor, plays an essential role in carcinogenesis. Lutein, a naturally occurring carotenoid. Recent studies have suggested that lutein possess anticancer properties and could potentially be used as a therapeutic agent against various types of cancer. Aim: To assess the effect of lutein on TGF-?/SMAD2 gene expression in lung cancer cells. Materials and Methods: The present in-vitro study was carried in the Cancer and Stem Cell Laboratory Facility, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from April 2023 to May 2023. The lung cancer cell line (A-549) was obtained from the National Centre for Cell Science (NCCS), Pune, India. Cell viability of lutein-treated lung cancer cells was assessed by 3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay. Cell morphology was studied using a phase contrast microscope. The gene expression of TGF-?/SMAD2 was analysed using real-time Polymerase Chain Reaction (PCR), and the results were presented graphically as fold change. All data obtained were analysed by one-way Analysis of Variance (ANOVA) followed by Student’s t-test using PRISM software version 4. Results: The findings suggest that lutein had good cytotoxic effects on lung cancer cells. The Half-maximal inhibitory concentration (IC50) value was found to be 5.14 μM/mL. Lutein inhibited the TGF-? and SMAD2 gene expression signalling pathway and induced apoptosis in A549. Conclusion: Lutein significantly inhibited the TGF-? and SMAD2 gene expression signalling pathways, making it a potent anticancer drug. The downregulation of key genes involved in the TGF-?/SMAD2 pathway suggests a nuanced and intricate relationship between lutein and the regulatory mechanisms governing cellular signalling in lung cancer. These findings support the notion that lutein may exert a regulatory influence on the intricate balance of signalling cascades, offering a potential avenue for therapeutic intervention in lung cancer.

Immediate Effect of Mulligan Therapy on Pulmonary Function and Chest Expansion in Healthy Individuals: A Quasi-experimental Study

Harsheeta Sarada, Shaswat Verma, Akriti Gupta Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Mulligan therapy includes Sustained Natural Apophyseal Glides (SNAGs) and Mobilisation With Movement (MWM), which can be applied for spinal pain and Range of Motion (ROM). It helps to stretch the structures on the convex side of the offending movement and opens the intervertebral foramen. Pulmonary Function Test (PFT) is an important diagnostic test that helps guide decisions for management. Normal chest expansion is crucial for respiratory system function and tissue oxygenation. The contraction of external intercostal muscles moves the ribs upwards and outwards, causing the rib cage to expand, which increases the volume of the thoracic cavity. After the age of 25 years, normal pulmonary function begins to decline. Inappropriate posture leads to reduced thoracic cage mobility, thereby decreasing chest expansion. Thoracic SNAGs and MWM help stretch the structures, which will aid in chest expansion. Aim: To determine the effect of Mulligan therapy on pulmonary function and chest expansion in healthy individuals. Materials and Methods: A quasi-experimental study was conducted at Ramaiah Hospitals in Bengaluru, Karnataka, India over an 11-month period between July 2021 and June 2022. Based on the inclusion criteria, 103 participants were included, and Mulligan therapy was performed. Pre- and post-PFT and chest expansion measurements were taken and analysed using Student's t-test. Results: The results showed a statistically significant difference in chest expansion at all three levels (p<0.001) and Forced Expiratory Volume (FEV1) in the first second/Forced Vital Capacity (FVC) (p=0.04), Peak Expiratory Flow (PEF) (p=0.03), Forced Inhibitory Volume in the first second (FIV1) (p=0.01), and FIV1/FIVC (p=0.03) values in the PFTs. Conclusion: Chest expansion and FEV1/FVC, PEF, FIV1, and FIV1/FIVC show a significant change post thoracic SNAGs, intercostal MWM, costochondral, and costovertebral MWM. However, no significant changes have been observed in the other parameters of pulmonary function.

Gender based Variations in Hyoid Bone Dimensions measured using Computed Tomography: A Cross-sectional Study

A Jenal Monteiro, MM Jaseemudheen Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Identifying the age and sex of an unknown skull is challenging and crucial. Although forensic anthropology frequently receives fragmentary remains, certain parts are often obtained in great condition. In such conditions, the hyoid bone, which differs in shape and size between both genders, can be utilised to determine gender. Aim: To assess gender-based variations in hyoid bone dimensions using Computed Tomography (CT). Materials and Methods: A cross-sectional analytical time-bound study was conducted from April 2021 to March 2023 in the Department of Radiodiagnosis at KS Hegde Hospital, Mangaluru, Karnataka, India, consisting of 68 patients, including 34 males and 34 females referred for CT neck within the age range of 20-55 years. From the acquired data, different dimensions such as Hyoid Width (HW), Hyoid Length (HL), and Body Length (BL) of the hyoid bone were measured on 3D images to evaluate gender-related variations. The data were analysed using Statistical Package for Social Sciences (SPSS) version 20. The Independent sample t-test was used to compare HL, HW, and BL according to gender. Results: The mean HL in males was found to be 36.3±3.3 mm, whereas in females, it measured 30.6±1.9 mm. The mean HW in males was determined to be 41.75±5.1 mm, while in females, it was 35.2±4.5 mm. Furthermore, the mean BL in males was 19.3±2.0 mm, whereas in females, it measured 16.4±1.7 mm. Conclusion: CT measurements of the hyoid bone using 3D images can be a vital tool for gender determination in forensic medicine.

Leveraging Structural Magnetic Resonance Imaging in the Evaluation of Parahippocampal Region: An Aid to Alzheimer’s Diagnosis

Mary Rachel Myers, Chakradhar Ravipati, Thangam Vinoth Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Alzheimer’s, a prevalent degenerative dementia, succeeds Mild Cognitive Impairment (MCI), a variable precursor. The need to distinguish between them has grown with the advent of new disease-modifying treatments. Entorhinal cortex neurons collect sensory inputs from primary and association cortices, transmitting them to the hippocampus via the Perforant pathway-a White Matter (WM) tract in the parahippocampal region. Aim: To demonstrate the significance of Structural Magnetic Resonance Imaging (MRI) in distinguishing between individuals with Alzheimer’s Disease (AD) and those with MCI compared to a control group (CN). Materials and Methods: The present cross-sectional study was conducted in the Department of Radiodiagnosis at ACS Medical College and Hospital in Chennai, Tamil Nadu, India, from June 2022 to December 2022. Participants ranging in age from 45 to 82 years, underwent clinical evaluations and were subsequently classified based on their Mini-Mental State Examination (MMSE) scores. Those with MMSE scores below nine were diagnosed with AD, scores between 18 and 23 were indicative of MCI, and scores ranging from 24 to 30 signified inclusion in the healthy control group. The sample involved 30 healthy controls, 20 individuals with MCI, and 30 patients previously diagnosed with AD. Each participant underwent a comprehensive MRI scan. The diagnosis of AD and MCI was made using a novel technique that elaborates the dimensions of the parahippocampus on oblique coronal T1-weighted images. Results: The mean age of the participants was 65±5.5 years, ranging from 45 to 82 years. Among the 80 cases, 32 (40%) were males, and 48 (60%) were females. Ratios of the parahippocampal region were categorised as follows: ≤0.30 for AD, 0.31-0.39 for MCI, and ≥0.40 for cognitively normal individuals (CN). Patients with AD displayed ratios <0.3, corresponding to MMSE scores <9; those with MCI had ratios between 0.31 and 0.39, aligned with MMSE scores 18-23; while normal controls showed ratios ≥0.40, corresponding to MMSE scores 24-30. Conclusion: Using structural MRI to assess parahippocampal dimensions, effectively identifies neurological biomarkers linked to AD and MCI. This comprehensive approach not only enhances diagnostic precision but also lays the groundwork for pioneering treatment strategies aimed at tackling these cognitive conditions.

Physical and Bacterial Parameters of Well Water in Selected Rural Households of Mangaluru, Karnataka, India: A Cross-sectional Study

BV Nithyashree, Savitha Naik, KC Leena Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Water is one of the important natural resources available for mankind for its survival. In rural Karnataka, there are 1,182,990 wells, out of which 131,305 are covered wells, and 1,051,685 are uncovered. This highlights the threat to safe and potable drinking water. Aim: To assess the physical, chemical, and microbiological qualities of well water situated in the field practice area of Mangaluru, Karnataka, India. Materials and Methods: A cross-sectional study was conducted in the year 2019, between July and August, in the rural area of Kinya Panchayat, Ullal Taluk, Dakshina Kannada District. This area serves as the field practice area of Yenepoya Nursing College, Yenepoya deemed to be University. This pilot project was a time-bound study, and all twenty wells available were conveniently included in the study and comprised dug and ring residential and government wells utilised by residents for drinking and domestic purposes. Water collection followed World Health Organisation (WHO) guidelines. Baseline data included the age of the wells, colour, odour, and chlorination of the well water. Chemical parameters such as pH levels and bacteriological assessments to identify the presence of Escherichia coli, H2S, and Most Probable Number (MPN) bacterial counts were conducted using laboratory tests. Results: The colour of all 20 (100%) well water sources met WHO standards. The water was odourless in all 20 (100%) sources. The mean age of the wells was five years. The majority, 17 (85%) of the wells, were never chlorinated. Moreover, 17 (85%) of the well water sources had a pH level of ≤7, while 3 (15%) had a pH level of >7. E. coli bacteria were present in three-fourths of the well water (17 wells, 85%). No other organisms were found during testing. Ten (50%) of the well water sources had a bacterial count of 351-550 MPN {Most Probable Number (MPN) of bacteria} per 100 mL, 7 (35%) had a count of 151-350 MPN per 100 mL, and 3 (15%) had a count of less than or equal to 150 MPN per 100 mL. The results indicate that 17 (85%) of the wells’ water was not satisfactory for potable purposes, while 3 (15%) were deemed satisfactory. Conclusion: Water sources in the studied area were found to be contaminated, with most of the well water sources not meeting satisfactory potable standards. This underscores the importance of raising awareness, implementing routine monitoring, and conducting consistent and periodic examinations of drinking water, as well as disinfection processes, to address this issue.

Laboratory Reflections of Clinicoepidemiological Trends in Severe Acute Respiratory Syndrome: Coronavirus 2 Cases from Rajasthan, India: A Cross-sectional Study

Sakshee Gupta, Bhagwati Chundawat, Prachi Gupta, Jaswant Goyal Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: India has experienced many phases of the rise and fall of Coronavirus Disease-2019 (COVID-19) cases from the first quarter of 2020 to the present date. It is important to periodically assess the clinicoepidemiology and local factors affecting the pandemic in each geographical area. Emerging Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants {Variants of Concern (VOC) and Variants of Interest (VOI)} are contributing to ongoing unprecedented outbreaks, posing new challenges. Continuous surveillance is essential to keep track of currently circulating lineages. Aim: To study the clinicoepidemiological trends of COVID-19 disease in patients. Materials and Methods: A cross-sectional descriptive study was conducted on 53,311 suspected COVID-19 patients attending Jaipur National University of Medical Sciences and Research (JNUIMSRC), Jaipur, Rajasthan, India. Socio-demographic variables, clinical signs and symptoms, details of hospitalisation, and mortality data were collected between May 2020 and April 2022. All patients with Influenza-like illness and suspected COVID-19 were included in the study. Ribonucleic Acid (RNA) extraction and Polymerase Chain Reaction (PCR) were performed using Indian Council of Medical Research (ICMR) approved kits. Mean, median, and “p-values” were calculated using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 21.0 software. Results: A total of 15.77% (8410/53,311) of patients tested positive for SARS-CoV-2 by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The median age of the patient population was 43±18.44 years, with a male-to-female ratio of 1.86, 33.21% (2793/8410) of patients were asymptomatic. Cough (56.74%; 4772/8410) was the most common symptom, followed by fever (56.48%; 4750/8410) and sore throat (50.31%; 4231/8410). The surge in the number of COVID-19 positive cases varied month-wise during the study period. The case fatality rate was 3.19%. Conclusion: Asymptomatic cases have contributed to the widespread distribution of COVID-19 disease. Periodic remodeling of testing and mitigation strategies is required, given the early detection of asymptomatic infections in co-morbid and elderly patients for the management of the COVID-19 pandemic.

Efficacy of Dexamethasone and Methylprednisolone in COVID-19 Pneumonia Patients in Kolkata, India: A Retrospective Cohort Study

Boudhayan Bhattacharjee, Indranil Ray, Sumit Kumar Ghosh, Arunansu Talukdar, Udas Chandra Ghosh Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in China, the epidemic has rapidly spread all over the world in just a few months. Different steroids have been proven effective in treating COVID-19 pneumonia. However, comparative efficacy data between different steroids have been evaluated in a few studies from various parts of the world. To date, no study with a large number of patients has been conducted in the eastern part of India. Aim: To compare the efficacy of dexamethasone and methylprednisolone in terms of outcomes and disease progression in COVID-19 pneumonia patients. Materials and Methods: This retrospective cohort study included 377 patients with moderate and severe COVID-19 pneumonia admitted to Medical College and Hospital from May 2020 to December 2020, Kolkata, West Bengal, India. Patient records were divided into two groups based on the type of steroids administered (dexamethasone and methylprednisolone). Clinical, laboratory, treatment, and outcome data were tabulated for analysis. Demographic patterns in the two groups were compared, and efficacy was analysed in terms of hospital course (hospital stay length, type of respiratory support received) and final outcome (cured or death) in both groups. The data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 29.0. Qualitative variables were expressed as counts and percentages, while quantitative variables were presented as mean±Standard Deviation (SD). Results: There were no significant differences between the two treatment groups based on demographic features (age, sex), co-morbidities (diabetes, hypertension, etc.), disease severity (hypoxia, hypotension) on admission day, and smoking status. The study showed that methylprednisolone significantly reduced the requirement for high-flow oxygen (p-value=0.002), Non Invasive Ventilation (NIV) (p-value=0.001), and invasive ventilation (p-value=0.001) compared to dexamethasone. However, there was no significant difference (p-value=0.800) in the duration of hospital stay between the methylprednisolone and dexamethasone treatment groups. Kaplan-Meier survival analysis also showed a significant survival benefit among patients who received methylprednisolone compared to dexamethasone (log-rank p-value=0.039). Conclusion: The present study concludes that in COVID-19 pneumonia, the administration of methylprednisolone leads to a significant reduction in mortality and the need for high-flow oxygen, NIV, and invasive ventilation compared to dexamethasone.

Role of Extracorporeal Shock Wave Therapy in Patients with Angiogenic Erectile Dysfunction Associated with Diabetes Mellitus Refractory to Pharmacotherapy: A Prospective Observational Study

Suraj Tukaram Bhondave, Bhoopat Singh Bhati Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Erectile Dysfunction (ED) has a strong association with diabetes mellitus in men. The role of Extracorporeal Shock Wave Therapy (ESWT) in patients with ED is being evaluated and used as a treatment option by many urologists. It is considered a treatment modality intermediary between pharmacotherapies and prosthesis surgery. Literature on ESWT in patients with Diabetes Mellitus (DM) refractory to pharmacotherapy remains scarce. Aim: To evaluate the role of ESWT in patients with angiogenic ED associated with diabetes mellitus refractory to pharmacotherapy. Materials and Methods: The prospective observational study was carried out in the Outpatient Department of Urology (OPD) of Ruby Hall Clinic, Pune, Maharashtra, India between February 2020 and September 2021 on 40 patients fulfilling the inclusion criteria. Total 20 patients in each were randomised to the control group, and the ESWT group in a ratio of 1:1. Each patient was evaluated pre- and post-ESWT with colour Doppler imaging of the penis after injecting 30 mg to 40 mg of papaverine intracavernosally. Validated sexual function questionnaires such as the International Index of Erectile Function (IIEF)- Erectile Function (EF) domain, Sexual Health Inventory for Men (SHIM), and Erectile Hardness Score (EHS) were used. The IIEF questionnaire was administered to each patient at baseline, 3 months, 6 months, 9 months, and 12 months. Colour Doppler imaging of the penis, SHIM score, and EHS score were used to evaluate each patient at baseline, 6 months, and 12 months. Data were collected and tabulated in a Microsoft Excel sheet. Results were presented as mean±standard deviation. Repeated Analysis of Variance (ANOVA) tests, paired t-tests, and independent sample t-tests were utilised in the study. A p-value of less than 0.05 was considered statistically significant. Results: The most common age group among the study population was 41 to 50 years (40%). When comparing the mean IIEF score- EF domain between the ESWT and control groups at 3, 6, 9, and 12 months, the difference was statistically significant (p-values obtained at 3, 6, 9, and 12 months were 0.009, 0.0001, 0.0001, and 0.0001, respectively). Comparing the mean SHIM score and EHS between the ESWT and control groups at 6 and 12 months, the difference was statistically significant (for SHIM score, p-values obtained at 6 and 12 months were 0.005 and 0.0001 respectively; for EHS, p-values obtained at 6 and 12 months were 0.0008 and 0.0001 respectively). The improvement in mean peak systolic velocity of the right and left cavernosal arteries at 6 months and 12 months was statistically significant in the ESWT group compared to the control group (p-value=0.001). Conclusion: The ESWT for ED in diabetic patients is a novel treatment option with promising results. Clinicians and patients need to be aware about the various management strategies available for diabetic individuals who have not had success with pharmacotherapy alone.

Evaluating Serum Apelin and Nitric Oxide in Primary Hypertensive Patients with or without Microalbuminuria: A Cross-sectional Study

Mrutyunjaya Panda, Debasish Pandit, Devi Prasad Pradhan, Roma Rattan, Manmath Kumar Mandal Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Hypertension (HTN) is the third leading risk factor contributing to the disease burden in Southeast Asia. Understanding its underlying mechanism, such as endothelial dysfunction, is very important. Apelin is a recently discovered endogenous peptide hormone that, along with Nitric Oxide (NO), is implicated in endothelial dysfunction and the severity of HTN. This can significantly reduce renal function and lead to microalbuminuria/proteinuria in 5-15% of patients. Aim: To measure serum apelin and NO in patients with newly diagnosed primary HTN with or without microalbuminuria and to investigate the correlation of serum apelin with HTN in the same study population. Materials and Methods: This cross-sectional study was conducted from February 2019 to January 2021 in the Department of Biochemistry In collaboration with the Department of Medicine at SCB Medical College and Hospital, Cuttack, Odisha, India. A total of 180 participants were included in the present study. Among them, 90 were newly diagnosed hypertensive patients, and 90 were non hypertensive. The study comprised of 90 hypertensive patients, with 46 having microalbuminuria (Group-A), 44 without microalbuminuria (Group-B) and 90 normotensive controls (Group-C). All participants underwent evaluation of their biochemical profile which included Fasting Plasma Sugar (FBS), serum urea, creatinine, Total Cholesterol (TC), Triglyceride (TG), High-density Lipoprotein cholesterol (HDL-c), Low-density Lipoprotein cholesterol (LDL-c), Very Low-Density Lipoprotein (VLDL), serum apelin and NO levels, and urine albumin. The comparison between the three groups was done by using Analysis of Variance (ANOVA) test with post-hoc analysis. The Chi-square test was used to compare categorical variables. Results: The mean age of the participants was 50.48±9.73 years. study comprised of 90 hypertensive patients, with 46 having microalbuminuria, 44 without microalbuminuria, and 90 normotensive controls. The mean serum apelin levels were 394.45±84.2, 386.9±86.12, and 62.73±22.87 ng/L, respectively, among patients with microalbuminuria, without microalbuminuria, and normotensive patients. Similarly, the mean serum NO levels were 6.31±2.94, 8.32±2.63, and 20.15±4.37 μmol/L, respectively, among the three groups. The comparison of mean values indicated a significant (p<0.001) positive correlation between the level of serum apelin and HTN and its complications, such as microalbuminuria. Conclusion: The positive correlation between serum apelin levels and blood pressure underscores the potential role of apelin in hypertensive pathophysiology.

Comparative Evaluation of Coronally Advanced Flap with and without Amniotic Membrane in the treatment of Localised Miller’s Class I and Class II Gingival Recession Defects: A Randomised Controlled Trial

Rutuja Pradeep Sindgi, Mona Udayan Shah Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Gingival recession is the exposure of the root surface of the tooth, characterised by the displacement of the gingival margin apically from the Cementoenamel Junction (CEJ). Various techniques have been suggested for treating recession, such as Free Gingival Graft (FGG), Connective tissue grafts, laterally or Coronally Advanced Flaps (CAF), and Guided Tissue Regeneration (GTR)-based procedures. Different membranes have been used for GTR, one of which is the amnion membrane. Aim: To evaluate root coverage using Coronally Advanced Flap (CAF) with and without amniotic membrane in the treatment of localised gingival recession. Materials and Methods: A randomised controlled trial was conducted at Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India from March 2017 to February 2018. In this study, 30 teeth were treated, with 15 teeth undergoing CAF with amniotic membrane (Group II-Test Group) and 15 teeth treated with CAF without amniotic membrane (Group I-Control Group). Probing Depth (PD), Clinical Attachment Level (CAL), Relative Attachment Level (RAL), Recession Width (RW), Recession Depth (RD), Width of Keratinised Gingiva (WKG), Width of Attached Gingiva (WAG), and gingival biotype were assessed between baseline and after three months. Statistical analysis was performed using paired t-test, independent t-test, and Mann-Whitney U-Test. Statistical Package for Social Sciences (SPSS) software version 20.0 was used for analysis. The ? error of 5% (p-value=0.05) and ? error of 20% were taken into consideration. Results: The mean age of the study population was 30.36±4.55 years, with 18 males and 12 females. There was a decrease in RD, RW, PD, and a gain in CAL and RAL in both groups after three months compared to the baseline values. Additionally, there was an increase in WKG, WAG, and a significant change in the thickness of the gingival biotype from thin to thick in both groups at the end of three months. On inter group comparison, the changes in PD (p-value=1.00), RD (p-value=1.00), RW (0.176), CAL (0.664), RAL (1.00), WKG (p-value=0.313) were not statistically significant at the end of three months. WAG was higher in Group II compared to Group I (p-value=0.014*), and the mean root coverage was greater in Group II (15.62%) than in the control group (11.642%) (p-value=0.005) at the end of three months. There was a statistically significant difference (p-value=0.005*) in Group II (15.62%) compared to the control group (11.642%). Conclusion: Amniotic membrane in combination with CAF proves to be a successful option for root coverage in localised recession defects. However, histological evidence and a greater number of future longitudinal studies are necessary to study the efficacy of this approach.

Serum Magnesium Levels and Lipid Profile in Patients with Epileptic Seizures: A Cross-sectional Study

Monika Agrawal, Shalu Sharma, Astha Goyal, Sarita A Shinde Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Recurrent seizures of cerebral origin with episodes of sensory, motor, or autonomic expression, with or without loss of consciousness, are typical symptoms of epilepsy, a chronic neurological condition. As a voltage-dependent calcium channel antagonist, magnesium inhibits calcium ion release, which reduces neuronal excitability in hypomagnesemia. It is well recognised that the most frequently prescribed Anti-epileptic Drugs (AEDs), namely carbamazepine, phenytoin, and phenobarbital, have adverse effects on lipid profiles. Aim: To compare the levels of serum magnesium and serum lipid profiles in patients with epileptic seizures and healthy controls. Materials and Methods: The present cross-sectional study included 50 clinically diagnosed patients with epileptic seizures, aged between 18-60 years, and 50 age and sex-matched healthy controls visiting the Department of Neurology, Mahatma Gandhi Medical College (MGMC), Jaipur, Rajasthan, India from October 2019 to March 2020. A 5 mL venous blood sample was collected for biochemical investigations such as serum magnesium, serum Total Cholesterol (TC), serum Triglycerides (TG), serum High Density Lipoprotein cholesterol (HDL-C), serum Low Density Lipoprotein cholesterol (LDL-C), and serum Very Low Density Lipoprotein cholesterol (VLDL-C) and assayed. Student’s t-test was applied, and a p-value of <0.05 was considered statistically significant. Results: In the present study, epileptic cases (n=50) included 35 male patients and 15 female patients with a mean age of 36.1±15.56 years, and healthy controls (n=50) included 37 male patients and 13 female patients with a mean age of 38.26±8.54 years. When compared to healthy controls, patients with epileptic seizures had lower serum magnesium levels with mean values of 4.18±1.22 and 2.12±1.00, respectively (p-value ≤0.001). Patients with epileptic seizures had higher values of the serum lipid profile, i.e., serum TG, TC, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol than healthy controls with a p-value ≤0.001, which is statistically significant. On the contrary, serum HDL-C levels in epileptic patients (43.68±7.37 mg/dL) are lower than healthy controls (49.69±5.73 mg/dL). Conclusion: Correcting the serum magnesium levels in people with epileptic seizures may help reduce the intensity of the seizures.

Additive Effect of Brown Flaxseed Extract Gel on Postsurgical Periodontal Therapy in Periodontitis Patients: A Randomised Controlled Trial

P Swarna Meenakshi, Sankari Malaiappan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Flaxseed is known for its anti-inflammatory and antioxidant properties, which could be attributed to periodontal wound healing. Early wound healing contributes to favourable treatment outcomes. Glutathione peroxidase is a ubiquitous antioxidant biomarker known for its scavenging action of free radicals, thereby maintaining the health of periodontal tissues. Aim: To evaluate the additive effect of brown flaxseed gel following surgical periodontal therapy. Materials and Methods: This randomised controlled trial was conducted at the Department of Periodontics, Saveetha Dental College in Chennai, Tamil Nadu, India from November 2023 to February 2024. Total of 30 patients were included in the study, with 15 patients in the control group and the other 15 patients (test group) were administered brown flaxseed gel following flap surgery. The included patients were allocated into test and control groups through simple randomisation. Postoperative flap surgery, the Early Healing Index (EHI), and healing scores were evaluated at the 1^st and 2^nd weeks. Salivary glutathione peroxidase levels were also assessed at the 1^st and 2^nd weeks following periodontal therapy. An Independent t-test was used to compare the mean values between the test group and the control group. Results: The mean age of the eligible participants was 35.6±4.57 years. Better healing was observed in the test group compared to the control group in the 1^st postoperative week, as recorded by the EHI with a mean of 2.96±0.90 in the test group and 2.06±0.70 in the statistically significant control group. Salivary glutathione levels were significantly increased in the test group with a mean concentration of 14.1±.78 mu/mL and 10.5±0.42 mu/mL in the control group at the end of the 2^nd week, respectively. Conclusion: Brown flaxseed gel is an efficacious therapeutic agent in improving periodontal wound healing and also has prudent antioxidant activity.

Sociodemographic Determinants of Burden and Resilience among Caregivers of Children Diagnosed with Cancer: A Cross-sectional Study

Dipti Thakur, Sheema Aleem, Sagar Karia, Amita Mahajan, Chandrika Verma Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Caregiving encompasses various challenges and adversities, with resilience playing a crucial role in navigating these hurdles. However, resilience is influenced by individual characteristics, prompting an examination of how demographic variables impact resilience and caregiver burden among caregivers of cancer patients in India. Aim: To investigate the relationship between demographic variables and resilience, as well as caregiver burden, among caregivers of cancer patients in India. Materials and Methods: In this cross-sectional study, a clinical sample of 125 caregivers {males (46.4%) and females (53.6%)} from Indraprastha Apollo Hospital, New Delhi, India was assessed. Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC), while caregiver burden was evaluated using The Burden Assessment Schedule (BAS). Various demographic factors, including gender, age, qualification, socio-economic status, loss of work, number of children, travel for treatment, duration of treatment, type of illness, and employment status, were examined. T-tests and Analysis of Variance (ANOVA) were utilised for data analysis. Results: The predominance was of female caregivers, comprising 67 (53.6%) individuals, primarily falling within the age bracket of 30-40 years demographic variables significantly influenced resilience levels among caregivers (p-value ranged from 0.001 to 0.86). However, caregiver burden was not significantly impacted by demographics overall (p-value ranged from 0.24 to 0.98), although certain sub-domains were affected. Notably, male caregivers demonstrated higher levels of resilience compared to females (T=9.88, p=0.001), with postgraduate qualifications correlating with increased resilience (mean: 17.02) and lower caregiver burden (mean: 81.53). Additionally, age did not significantly affect the results (effect size ranged from 0.10 to 0.86). Conclusion: The study underscores the importance of tailored support strategies for caregivers, particularly focusing on enhancing resilience among female caregivers and addressing specific burden dimensions affected by demographic factors of socio-economic status and qualification. Overall, resilience was affected by gender, socio-economic status, number of children, travel, duration of treatment, and employment significantly, but caregiver burden was not significantly affected by any demographic variable.

Effectiveness of Ultrasound-guided Platelet-rich Plasma Injection Vs Pulsed Ultrasound Therapy on Improving Pain and Function in Athletes with Medial Collateral Ligament Injury of Knee: A Randomised Controlled Trial

Laimujam Sobhasini Devi, Akoijam Joy Singh, Yumnam Nandabir Singh, Yumnam Ningthemba Singh, Pheiroijam Bhupes, Kongkham Purnimala Chanu, Sagolsem Adarsh Singh, R Ramkumar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The Medial Collateral Ligament (MCL) is the most frequently injured ligament in the knee. Platelet-rich Plasma (PRP) is an autologous concentration of platelets prepared as an injection to augment the healing process. Aim: To determine the effectiveness of Ultrasound (USG)-guided PRP injection in comparison with pulsed ultrasound therapy in improving pain and function in athletes with MCL injury. Materials and Methods: A randomised control trial was done among athletes with partial tears of MCL who visited the Department of Sports Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India from October 2020 to September 2022. Patients with Magnetic Resonance Imaging (MRI)-diagnosed partial tears of MCL (N=32) were randomised into PRP injection (n=16) and pulsed ultrasound therapy (n=16) groups. The outcomes were compared using the Visual Analogue Scale (VAS) for pain and Lysholm score for function at baseline, 2nd, 6th, and 12th weeks, respectively. Analysis was done using International Business Machines-Statistical Package for the Social Sciences (IBM-SPSS) version 21.0. For comparison between the groups, independent t-test was used. A p-value <0.05 was considered statistically significant. Results: Baseline characteristics were not statistically significant. There was a statistically significant improvement seen in the intragroup comparison from baseline to the 2nd, 6th, and 12th weeks in both VAS (p<0.001*) and Lysholm score (p<0.001) in both groups. There were statistically significant differences in mean changes of VAS and Lysholm score between the two groups from baseline to the 2nd week (VAS, p=0.008*); (Lysholm score, p=0.003) and 6th week (VAS, p<0.001*); (Lysholm score, p=0.009) follow-ups respectively, with the PRP group having more improvement. However, there was no significant difference at 12th week (VAS, p=0.088); (Lysholm score, p=0.072) weeks. Conclusion: Given the better results, it is suggested that ultrasound-guided PRP injection may be used as the preferred method of treatment in the management of MCL injuries to return to sports as early as possible.

Effect of Intravenous Vitamin C and N Acetylcysteine on Postoperative Pain and Opioid Consumption after Laparoscopic Gynaecologic Oncosurgeries: A Randomised Controlled Study

ND Rachana, Namrata Ranganath, VR Pallavi, GS Shashidhar, BH Arathi, VB Gowda Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Postoperative pain is one of the common causes of increased postoperative morbidity and delayed recovery. Pain causes adverse effects such as hypertension, tachycardia, myocardial ischaemia, decreased alveolar ventilation, poor wound healing, and postoperative morbidity. Vitamin C and N-acetylcysteine (NAC), which is a novel co-analgesic, are being studied to reduce postoperative pain and opioid consumption. Aim: To study the effect of intravenous Vitamin C and NAC on postoperative surgical pain and opioid consumption after laparoscopic gynaecologic oncosurgeries. Materials and Methods: The present study was a randomised controlled study conducted at the Department of Anaesthesiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India on 300 patients of American Society of Anaesthesiologists (ASA) physical status 1 and 2 scheduled for laparoscopic Gynaeconcology surgery after obtaining written informed consent. All the selected patients were randomly allocated into three groups. Group P was the control group in Group N patients received intravenous injections of NAC (50 mg/kg) and vitamin C infusion (50 mg/kg) in Group C. Patients were explained about the visual analogue pain scale preoperatively. In the postoperative period, VAS scores were recorded and noted along with the rescue analgesics received and side-effects. Results: Haemodynamic variables were comparable among all three groups. The number of patients who had VAS scores of more than 4 was lower in group C (Vitamin C) at various time intervals when compared to the NAC and placebo groups. It was also statistically significant at 45 minutes, 60 minutes, 90 minutes, 150 minutes, 180 minutes, 300 minutes, and 10 hours (p-value=0.014, <0.001, <0.001, <0.001, 0.003, 0.005, 0.006, respectively). Postoperative opioid consumption was significantly reduced in group C (Vitamin C) compared to the other two groups (p-value<0.001). Conclusion: Intraoperative Vitamin C usage reduced postoperative pain and fentanyl consumption in the postoperative period, and NAC can be used as a part of multimodal analgesia.

Determining the Oestrogen and Progesterone Receptor Expression in Cases of Endometrial Carcinoma: A Cross-sectional Study

Resmi Rajeev, Nisha M Das, CR Jyothi Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Endometrial carcinoma is the second most common female genital tract malignancy in India with a incidence rising globally. Hormone receptors are positive in 35-90% of endometrial carcinomas. Hormone therapy can be given to patients with hormone receptor positive tumours. Aim: To determine whether Progesterone and Oestrogen receptors (PR and ER) are most often expressed in endometrial cancer cases, and to correlate this expression with histopathologic features in these cases. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology, Government Medical College, Thrissur, Kerala, India, on 37 cases of endometrial carcinoma. ER and PR expression were assessed and correlated with histopathologic parameters in carcinoma endometrium. Results: 75.6% of the patients were in the 51-70 age range. Grade I endometrioid cancer accounted for 24 (77.42%) of the 31 cases, grade II for 5 (16.13%) and grade III for 2 (6.45%). 19 (51.4%) of cases had ER positivity and 21 (56.8%) had PR positivity. While all grade III tumours were PR and ER negative, grade I tumours had 70.83% and 79.17% ER and PR positivity, respectively. While ER expression did not correlate negatively with grade (p-value=0.076), PR expression did (p-value=0.043). In 29.73% of patients, lymphocytic infiltrates were seen, and they had a strong correlation with the expression of ER and PR. All cases of papillary serous carcinomas (100%), mucinous carcinomas (100%), and clear cell carcinomas (100%), showed ER negative. Hormone receptor status did not significantly correlate with FIGO (The International Federation of Gynecology and Obstetrics) stage, lymphovascular emboli, or myometrial invasion. Conclusion: Most of the endometrioid endometrial carcinomas showed ER and PR positivity, while all of the non endometrioid endometrial carcinomas were negative for both ER and PR. ER and PR were positive in most of the grade I tumours, whereas in the high-grade tumours, they were often negative. Immunoreactivity for PR had a stronger association with tumour grade, when compared to ER.

Eruption Pattern of Deciduous Dentition in Children of Vadodara, Gujarat, India: A Cross-sectional Observational Study

Aishwarya V Antala, Pratik B Kariya, Bhavna Dave, Seema Bargale, Anshula Deshpande, KS Poonacha Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The eruption pattern of deciduous dentition can be of significant importance in forensic investigations, especially for human remains identification, age estimation, and anthropological analysis. The eruption pattern of deciduous dentition depends on geographic patterns, genetic ancestry, socio-economic status, nutritional factors, etc. Currently, the authors follow an eruption pattern chart based on the population of Western countries. Aim: To examine the eruption pattern of deciduous dentition in children from Vadodara city, Gujarat, India. Materials and Methods: This was a cross-sectional study conducted in Vadodra city of Gujarat, between November 2022 and October 2023 on a total of 1025 children between the ages of 0-36 months who met the inclusion criteria on the respective days of the hospital visit after obtaining informed consent from a legal guardian, an oral examination was carried out to check the teeth present along with their chronological age. Probit analysis was performed to determine the mean age for the eruption of each deciduous tooth using StatsDirect software. Results: The deciduous mandibular central incisor was the first tooth to erupt in the oral cavity at 6.05±1.12 months, followed by the maxillary central incisor and lateral incisors at 6.52±0.56 months and 7.92±0.62 months, respectively. The mandibular lateral incisor erupted at the age of 9.99±0.91 months. In the maxillary arch, the first molar erupted at the age of 13.51±1.12 months, the canine at 18.95±0.98 months, and the second molar at 28.05±0.94 months. In the mandibular arch, the first molar erupted at 14.12±0.82 months, the canine at 16.22±0.51 months, and the second molar at 24.75±0.99 months. Girls showed earlier eruption compared to boys; however, no inter-arch variation was observed in the mean age of tooth eruption. Additionally, there was no difference in the sequence of eruption of deciduous teeth, as reported in other studies. Conclusion: From the present study, it can be concluded that the Gujarati population demonstrates slightly earlier eruptions when compared to the standard eruption chart given by Logan WHG and Kronfeld R. The sequence of the eruption remains consistent with that of other studies, which is A-B-D-C-E.

Comparative Analysis of Root Canal Morphology in Human Mandibular Permanent Incisors using Decalcification Technique and Periapical Radiographs: An In-vitro Study

Surendra Nath Tudu, Parthasarathi Mondal, Debjyoti Karmakar, Lugu Buru Murmu, Santanu Mukhopadhyay, Snigdho Das Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Understanding the intricate root canal system of mandibular incisors is crucial for successful root canal therapy. Variations in canal anatomy pose challenges in diagnosis and treatment planning, emphasising the need for comprehensive evaluation methods. Aim: To evaluate and assess the root canal configuration of permanent mandibular incisors based on Vertucci’s classification using periapical radiographs and correlating the same with the gold standard decalcification and dye-penetration technique. Materials and Methods: The current in-vitro study was carried out from December 2018 to March 2019 in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India. It analysed the root canal morphology of mandibular central and lateral incisors using radiographic examination and decalcification-dye penetration evaluation. Data from 50 central and 50 lateral incisors (100 mandibular incisors) were procured and were assessed and subsequently analysed statistically using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 27.0 (Armonk, NY: IBM Corp). The study outcome included assessing the various canal types and configurations, types of canals (straight/curved), and the position of the apical foramen (labial/lingual) by both techniques. The existence of agreement was also tested using statistical analysis by the kappa (?) coefficient between the two techniques with an alpha level of 5%. Results: The radiological findings of mandibular central incisors revealed a predominant presence of Type-I canals, constituting 66 (66%) cases, according to Vertucci’s classification. Decalcification-dye penetration evaluation of central incisors showed a similar trend, with Type-I canals exhibiting a significantly higher percentage 35 (70%) compared to other canal types (p<0.001). Lateral incisors exhibited similar trends in both radiological findings and decalcification-dye penetration. Type-I canals were significantly more prevalent 29 (58%) compared to other types (p<0.001). Evaluation with the decalcification-dye penetration technique further supported this, with Type-I canals showing a higher percentage 27 (54%) compared to other types (p<0.001). A moderate amount of agreement was detected between the two modalities concerning canal configuration (?=0.46, p=0.049) and position of the apical foramen (?=0.43, p<0.001), while an almost perfect agreement was present on canal curvature (?=0.85, p<0.001). Conclusion: These results collectively suggest a similarity in the radiological characteristics and decalcification-dye penetration patterns between central and lateral incisors.

Soluble Vascular Cell Adhesion Molecule-1 as an Atherogenic Biomarker in Coronary Artery Disease: A Cross-sectional Study

Happy Chutia, Akash Handique, Manish Kapoor, Alice Abraham Ruram, Himashree Bhattacharyya Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Coronary atherosclerosis is a condition that affects the arteries supplying the heart. The soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) belongs to the immunoglobulin superfamily, and its expression is increased in vascular endothelial cells in atherosclerosis. Aim: To estimate serum sVCAM-1 in atherosclerotic Coronary Artery Disease (CAD) patients with varying severity and to look for its association with the Atherogenic Index (AI). Materials and Methods: This hospital-based cross-sectional study was carried out in the Department of Biochemistry at NEIGRIHMS, a tertiary care Institute in the northeastern part, Shillong India, for a period of one year (2019) with 68 angiographically confirmed newly diagnosed CAD patients and were divided into three groups as Single Vessel Disease (SVD), Double Vessel Disease (DVD) and Triple Vessel Disease (TVD). The following biochemical tests were performed on fasting serum samples: Glucose, lipid profiles {Total cholesterol, High Density Lipid (HDL)-C, Low Density Lipid (LDL)-C, Triglycerides (TG)}, Interleukin-6(IL-6), and sVCAM-1. The Chi-square test was used to assess the significance of the association of risk factors such as hypertension, smoking, and diabetes in the participants. One-way Analysis of Variance (ANOVA) was conducted to identify significant differences in the levels of the estimated parameters among the participant groups. Results: The average age of presentation for the study participants was 61±10.8 years. The study involved 68 recently diagnosed patients with confirmed CAD, of whom 59 (87%) were males and 9 (13%) were females. Among the total patients, 44 (65%) were smokers, 45 (66%) had hypertension, and 29 (43%) were diabetic. The Chi-square test revealed a significant association between smoking (p-value=0.015) and hypertension (p-value=0.008) with CAD, but no association was found with diabetic status. The level of serum sVCAM-1 was found to increase with the number of vessels involved. Significant differences were observed in the levels of serum cholesterol and LDL-C among the groups (TVD>DVD>SVD). The bivariate Pearson’s correlation test between Antherogenic Index (AI) and sVCAM-1 showed a statistically significant positive correlation (r=0.33, p-value=0.0059). Conclusion: Serum sVCAM-1 levels may be used for the follow-up study of patients with CAD, which could be more economical and convenient compared to {Total cholesterol, High Density Lipid (HDL)-C, Low Density Lipid (LDL)-C, Triglycerides (TG)} angiography.

Serum Copeptin as a Biomarker of Polycystic Ovarian Syndrome and its Correlation with Metabolic Syndrome Components: A Cross-sectional Analytical Study

Jyotsna Mirabel Coelho, Prema D’Cunha, AR Shivshankara Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Approximately 5 to 10% of women of reproductive age suffer from the prevalent endocrine illness known as Polycystic Ovarian Syndrome (PCOS). Copeptin, irrespective of age and weight, has been found to have significant associations with cardiometabolic parameters. Studies on the diagnostic and prognostic significance of copeptin and its correlation with components of metabolic syndrome in PCOS are scarce, particularly in the Indian context. Aim: To assess the utility of copeptin as a diagnostic marker of PCOS and to evaluate the correlation of serum copeptin levels with metabolic syndrome components in women with PCOS. Materials and Methods: This cross-sectional analytical study was conducted at Father Muller Medical College Hospital, Mangalore, Karnataka, India, from June 2022 to September 2023. A total of 60 subjects with PCOS were selected through convenient sampling and divided into two groups: Group 1-subjects with PCOS having metabolic syndrome, and Group 2-subjects with PCOS but not having metabolic syndrome. Blood samples for serum copeptin were taken under aseptic precautions, and levels were analysed using a commercially available Enzyme-Linked Immunosorbent Assay (ELISA) kit (Biovendor, USA) following the manufacturers’ instructions. The copeptin ELISA kit had an assay range of 0-100 pmol/L and results were expressed in ng/mL. Serum insulin levels were measured using specific Electro-chemiluminescence immunoassays. Levels of total cholesterol, High-Density Lipoprotein Cholesterol (HDL-C), and Triglycerides (TG) were determined with enzymatic colorimetric assays by spectrophotometry. Low-Density Lipoprotein Cholesterol (LDL-C) was calculated using the Friedewald formula. Insulin resistance was calculated using the Homeostasis Model Assessment Insulin Resistance Index (HOMA-IR). Statistical analysis was done by using descriptive statistics. A comparison was done by student’s unpaired t-test. The chi-square test and Pearson correlation test were used for categorical data. The Statistical Package for Social Sciences (SPSS) version 24.0 was used for analysis. Results: The mean age of the study participants was 24.24±4.721 years, ranging from 15 to 43 years. The mean age of patients with metabolic syndrome was 23.96±6.3 years, while those without metabolic syndrome was 24.40±3.52 years. The mean Body Mass Index (BMI) was 31.17±5.38 in those with metabolic syndrome and 23.2±4.7 in those without (p=0.0001). The Waist-to-Hip Ratio (WHR) of Group 1 was significantly higher than Group 2 (p=0.001). The two groups did not differ significantly with regard to serum copeptin level, i.e., 7.386±4.58 in Group 1 and 8.66±6.03 in Group 2 (p=0.736). Serum copeptin levels showed a significant correlation with fasting serum insulin (0.006) and Homeostatic Model Assessment - Insulin Resistance (HOMA-IR) (0.012). Conclusion: Serum copeptin cannot be used as an independent marker for the diagnosis of metabolic syndrome in PCOS patients but may indicate other prognostic factors.

Ratio of Height to Sternomental Displacement as a Predictor for Difficult Airway: A Prospective Observational Study

Farha, Neera Valsan, Moona Abdul Kadiru, Paul O Raphael, Mazhar Zulfikar, Bijina Bharathan, Jubairiya, Naseema Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Unanticipated difficult airway is still a cause of morbidity and mortality. Various parameters are used to predict difficult airways. Recent studies have found that measuring the Sternomental Displacement (SMDD) can help establish a difficult airway. Aim: To find whether the Ratio of Height to Sternomental Displacement (RHSMDD) could be used as a predictor for Difficult Laryngoscopy (DL) and intubation. Secondary objectives included comparing RHSMDD with routine assessment parameters like Modified Mallampati Score (MMT), SMD, Thyromental Distance (TMD), and Inter Incisor Distance (IID). Materials and Methods: A prospective observational study was conducted at Malabar Medical College, Calicut, Kerala, India among 120 adult patients undergoing elective surgeries under general anaesthesia. Airway parameters like MMT, IID, TMD, SMD, Sternomental Displacement (SMDD), RHSMDD, Ratio of Height to Sternomental Distance (RHSMD), and Ratio of Height to Thyromental Distance (RHTMD) were measured preoperatively and associated with Cormack Lehane’s laryngoscopic grading and Intubation Difficulty Scale (IDS) value. A comparison of airway parameters with laryngoscopy and intubation was done by the Mann-Whitney U test. Receiver Operating Characteristics (ROC) curves were constructed, and optimal cut-off values for significant quantitative indices were calculated. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were also calculated and compared. Results: The incidence of DL was 27.5%, and Difficult Intubation (DI) was 10.8%. Age (p-value=0.013), weight (p-value=<0.001), and height (p-value=0.019) showed a significant association with DL. It was found that only RHTMD was statistically significantly higher in the DI group (p=0.044). All other parameters did not show statistical significance in either group. The calculated cut-off value for RHTMD was ≥18.45 cm. The highest specificity (96.3%) and NPV (90.43%) were observed for Body Mass Index (BMI) alone as a predictor of DI. The highest sensitivity (93.75%) was observed for TMD alone in predicting DL. The combination of MMT+RHSMD yielded the highest sensitivity and NPV for DI. Conclusion: RHTMD showed significance in DI and remains a better predictor. RHSMDD cannot be used as a predictor for a difficult airway. The combination of parameters demonstrated high sensitivity and NPV, suggesting they can be combined with modern ultrasound airway measurement for more accuracy.

Morphometric Anatomy of Atlas (C1) and Axis (C2) on Dry Bones Versus CT Scan Images: A Cross-sectional Study from Southern India

Vinodhini Periyasamy, KS Deepa, R Mythilikrishnan, G Krishna Kishore, D Anupama Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The uniqueness of the atlas (C1) and axis (C2) cervical vertebrae helps in transmitting weight from the cranial cavity to the rest of the vertebral column. A detailed understanding of the C1 and C2 morphometric dimensions is essential for evaluating treatment protocols such as screw placement and intralaminar fixations to provide stability for the occipitocervical complex. Computerised Tomography (CT) scan images are best for demonstrating the osseous margins. Aim: To assess the relationship between the linear morphometric measurements of the CT images and dry C1 and C2 vertebrae. Materials and Methods: A descriptive, cross-sectional study was conducted using 35 atlas (C1) and 35 axis (C2) dry bones from the Department of Anatomy, Karuna Institute of Medical Sciences, Palakkad, Kerala, India, from August 2023 to October 2023. A total of 35 CT scan images were also taken for the study. Siemens Syngo software tool was utilised to assess the C1 and C2 vertebrae. Measurements of the vertebral canal, foramen transversarium, superior articular facets, vertebral artery groove, dens, and body were performed on dry C1, C2, and CT images. Descriptive statistics were evaluated using mean, standard deviation, percentage difference, and mean deviation. The unpaired t-test was used to test significance, with p-value <0.05 considered statistically significant. Results: Concerning the anatomical parameters, between the dry C1 and CT scan images, all linear parameters were statistically significant (p-value <0.05), except for the vertebral artery groove-inner and outer distances, which were not statistically significant. Regarding C2, when comparing anatomical parameters between dry vertebrae and CT scan images, the width of the body and the length of the vertebral canal were not statistically significant, while all other C2 parameters were statistically significant (p-value <0.05). Conclusion: The results obtained from the study on the atlas and axis may be valuable for operating surgeons during surgical procedures in the craniovertebral region. The present study also aids in preventing iatrogenic complications, including vertebral neurovascular injuries, and provides a roadmap for skilled surgical access.

Evaluating the Use of Audiovisual Distraction in Reducing Stress during Dental Treatment in Children using Salivary Chromogranin A: A Quasi-experimental Study

Khevna Vora, Preetam Shah, Chetana Jagtap, Shweta Chaudhary, Smita Patil, Rucha Davalbhakta Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Audiovisual Distraction (AVD), as a behaviour management technique, has gained significant importance in aiding patient cooperation during routine dental procedures. However, the scale at which it makes a difference needs to be evaluated. Objective approaches like measuring heart rate and pulse rates are unreliable methods. The quantification can be done using salivary Chromogranin A (CgA), a stress marker. Aim: To evaluate the use of AVD for reducing stress in children aged 4-7 years during dental treatment using salivary CgA. Materials and Methods: The present quasi-experimental study was conducted within the Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, from January 2022 to March 2022 after obtaining ethical clearance from the Institute and consent from parents. Six uncooperative children who required two Class-I restorative treatments for occlusal caries involving enamel and dentin were included in the study. The sample size was estimated using G*Power software v3.1.9.2 and calculated using t-tests. The treatment plan was divided into two appointments. In the first appointment, the cavity was prepared without the use of AVD. In the second appointment, AVD was incorporated during the dental procedure using the patient’s favourite cartoon. Unstimulated salivary samples were collected during both appointments, before and immediately after the procedure, which were sent to the laboratory for evaluation of CgA levels to gauge the stress levels during each appointment and the effect AVD has on the same. Results: Within the group without AV aids used, the mean salivary CgA levels showed a significant increase from 0.23 pmol/mg pretreatment to 1.26 pmol/mg protein after treatment. Within the group with AV aids, salivary CgA levels showed a significant reduction (p≤0.05) from 1.08 pmol/mg before treatment to 0.43 pmol/mg protein after treatment. There was also a significant difference in the change in salivary CgA levels from pre- to post-treatment between the two study groups. Conclusion: The study shows quantitatively that AVD reduced stress levels during dental treatment and therefore can be used as an adjunct for behaviour management. It can also be seen that Salivary CgA is a reliable short-term stress marker and can be used objectively to evaluate and quantify stress levels in children.

Comparison of Antimicrobial Efficacy of Garlic, Ginger, Cardamom Oil and Chlorhexidine against Streptococcus mutans: An In-vitro Study

Priyanka Singh, Laresh Mistry, Minakshi Bhattacharjee, VJ Kadam, Varsha M Jadhav, Ashwin M Jawdekar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Essential herbs such as garlic, ginger, and cardamom have shown antimicrobial activity with no potential adverse effects and are cost-effective. Despite these advantages, the efficacy of these agents needs to be tested against common oral pathogenic microorganisms to ensure that if found effective, they can be used in clinical settings. Aim: To evaluate and compare the effectiveness of garlic, ginger, and cardamom oils on Streptococcus mutans (S. mutans) against chlorhexidine. Materials and Methods: An in-vitro study was conducted at Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, in the Department of Microbiology and Bharati Vidyapeeth College of Pharmacy, Navi Mumbai, Maharashtra, India from January 2023 to September 2023. Oil extracts of garlic, ginger, and cardamom were loaded onto sterile filter paper discs measuring 6 mm in diameter in concentrations of 50 μL, 100 μL, and 200 μL. Additionally, 2% chlorhexidine (control group) was loaded onto similar sterile paper discs. The discs were dried and placed aseptically on culture media plates inoculated with S. mutans, and the plates were then incubated at 37°C overnight. Subsequently, the zones of inhibition were measured in millimeters. Results: Ginger oil exhibited the highest zone of inhibition, measuring 25 mm, followed by cardamom oil and garlic oil measuring 18 mm and 12 mm, respectively, at a concentration of 200 μL. The zone of inhibition measured for 100 μL concentrations of garlic, ginger, and cardamom oils were 7 mm, 16 mm, and 13 mm, respectively. For 50 μL concentrations of the oils, the zones of inhibition for garlic, ginger, and cardamom were 0 mm, 13 mm, and 9 mm, respectively. The zone of inhibition shown by chlorhexidine was 22 mm for concentrations of 50 μL, 100 μL, and 200 μL. Conclusion: Essential oil extracts from ginger, cardamom, and garlic were found to have antimicrobial activity against S. mutans, with ginger oil showing the highest effectiveness, followed by cardamom oil and garlic oil.

Knowledge of Private Practitioners in Diagnosis and Management of Tuberculosis in Context of National Tuberculosis Elimination Program: A Cross-sectional Study from Gujarat, India

Shalin S Rawal, Manisha K Gohel, Mayur Kiran Shinde, Ajay Gajanan Phatak Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: According to the World Health Organisation (WHO) global Tuberculosis (TB) report in 2019, 10 million new cases of Tuberculosis were detected worldwide, with India being one of the significant contributors. After achieving some milestones in TB control, the Government of India launched the National Tuberculosis Elimination Program (NTEP) to end TB by 2025. The role of private practitioners in the success of national health programs in India cannot be overemphasised, considering they cater to three times more population than the public sector. Aim: To understand the knowledge and perceived bottlenecks of private practitioners in achieving the goals of NTEP. Materials and Methods: A web-based cross-sectional survey was conducted by Community Medicine Department of Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, using a semi-structured questionnaire among randomly selected 110 doctors affiliated with the Indian Medical Association (IMA) from October 2020 to December 2020. The survey questionnaire was prepared by an experienced TB Chest expert and consensually validated. It covered all aspects of the Revised National TB Control Program (RNTCP) training modules. Descriptive statistics (Mean, SD, Frequency (%), etc.,) along with independent t-test and Analysis of Variance (ANOVA) were used to present the profile of the participants as well as associated factors with the knowledge score. A p-value of less than 0.05 was considered statistically significant. Results: Out of 110 invitations, 97 (88%) doctors responded. Most of the respondents were males 71 (73%), specialists (81, 83.5%), and had been practicing for more than 20 years (66, 68%). The mean (SD) score was 3.31±1.27 out of six for Multiple Choice Questions and 8.05±3.77 out of 15 for True/False questions. Only 37 (38%) participants scored above the passing benchmark of 60%, indicating a substantial knowledge gap. A higher Outpatient Department (OPD) strength (>50 patients per day) and attending a TB training program by the Government were associated with a higher total score (p=0.018). Conclusion: The knowledge of private practitioners about the diagnosis and management of Tuberculosis was found to be suboptimal. Participants also expressed a few systemic challenges like poor communication and the complexity of the system in the notification of Tuberculosis cases. Innovative training programs, proper communication, and supportive supervision will help in engaging the private practitioners to achieve TB elimination goals.

Role of Cytology for Diagnosis of Appendageal Tumours and Comparison with Histopathology: A Cross-sectional Study

Rama Das, Rajib Kumar Mondal, Sanjay Sengupta, Deboprio Das, Rathin Hazra Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Skin adnexal neoplasms are quite rare in routine pathology practice, yet the domain of Fine Needle Aspiration Cytology (FNAC) remains relatively unexplored. This current study explored different Adnexal Tumours (ATs) through FNAC, emphasising the efficacy of cytological diagnosis as a safe, simple, quick, and cost-effective tool with high sensitivity and specificity for diagnosing skin ATs. Aim: To diagnose various appendageal tumours through cytological examination, confirm and categorise them (benign/malignant) via histopathological examination, and identify any cytohistological discrepancies. Materials and Methods: This retrospective cross-sectional study was conducted over a five-year period (January 2016-December 2021) at the Department of Pathology, Nil Ratan Sircar Medical College and Hospital (NRSMCH) in Kolkata, West Bengal, India, following ethical approval. Patients underwent history and physical examination followed by FNAC. ATs were diagnosed cytologically in 78 out of 23,852 FNAC cases. The results were compared with histopathological diagnosis to assess concordance or discordance based on predefined criteria. Leishman-Giemsa (L&G) stain was used for cytological examination, and Haematoxylin and Eosin (H&E) stain for histopathology. Results: Cytologically, ATs were diagnosed in 78 cases (0.33%), with the majority being benign 69 (88.46%). There was a female preponderance (49, 62.82%) with a male-to-female ratio of 1:1.7. Nodular Hidradenoma (NH) was the most common diagnosis (16/48=33.33%). Out of 59 biopsy-confirmed lesions, 55 showed cytohistological concordance (93.22%), with only four discordant cases (6.78%). The sensitivity, specificity, positive predictive value, and negative predictive value for detecting malignancy in this series were 70%, 97.90%, 87.50%, and 94.10%, respectively. Conclusion: FNAC should be the primary choice for detecting skin ATs due to its safety, reliability, high predictive value, and low chance of discordance. Although occasional cytohistological discrepancies may occur, proper clinical correlation, aspiration from multiple sites, expert cytopathologists, and high-quality staining are essential to avoid misdiagnosis.

Comparison of Surgically-induced Astigmatism using Topography and Keratometry in Patients undergoing Phacoemulsification and Small Incision Cataract Surgery: A Prospective Interventional Study

Indrajit Shinde, Ajit Joshi, Aishwarya Pandharikar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Topographic measurement of corneal astigmatism is the current standard of care because, in addition to measuring corneal astigmatism, it identifies irregular astigmatism, which may limit optimum surgical results. The present study focuses on the use of topography to measure Surgically Induced Astigmatism (SIA), which is not a routine practice in most institutions, and compares it with keratometry values of corneal astigmatism. The present study highlights the accuracy of topography in the measurement of astigmatism, with its additional benefits being the measurement of irregular astigmatism and assessment of tear film status. Aim: To compare SIA using topography and keratometry in patients undergoing phacoemulsification and Small Incision Cataract Surgery (SICS). Materials and Methods: The present study was a prospective, interventional study conducted in the Ophthalmology Department of Bharti Vidyapeeth (deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India for 18 months (November 2019 to April 2021). A total of 100 cases (100 eyes) with cataracts were randomly divided into Group-A (n=50) and Group-B (n=50), respectively, underwent Phacoemulsification and SICS. Before the surgery, the astigmatism of each patient was noted by both topography and keratometry. On the 45th postoperative day, patients’ Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), automated keratometry readings, and corneal topography readings were taken, based on which SIA was calculated by SIA calculator version 2.0. The mean SIA in both groups was calculated and compared. An unpaired t-test was used to compare the mean of different variables in the two groups, Group-A and Group-B. A p-value of <0.05 was considered statistically significant. Results: The majority of cases were in the age group of 61-70 years, with 23 (46%) cases in Group-A and 27 (54%) in Group-B. In the study, the mean SIA by keratometry in Group-A was 0.43±0.02D and in Group-B was 1.24±0.04D (p<0.0001), and the mean SIA by topography in Group-A was 0.49±0.02D and in Group-B was 1.28±0.03D (p<0.0001), indicating that phacoemulsification causes less SIA compared to SICS. Upon comparing the mean SIA calculated by keratometry and topography in both study groups, it was found that p<0.02 in Group-A and p<0.4 in Group-B, suggesting that both p-values are not significant. This indicates that both keratometry and topography will give similar results and can be used for determining SIA. Conclusion: The study showed that phacoemulsification produces less mean SIA compared to SICS, leading to better visual outcomes and early visual rehabilitation in contrast to the SICS group. The present study also concluded that both keratometry and corneal topography can be used for the calculation of SIA as both give similar results, although topography remains an important tool in the calculation of Intraocular Lens (IOL) power in patients with corneal pathologies and post-refractive surgeries.

Role of FNAC in Diagnosis of Malignant Lymphadenopathy: A Five-Year Cross-sectional Study at A Tertiary Care Centre, Mumbai, India

Manisha S Khare, Prashant V Kumavat, Swapnil Kumavat, Yasmeen Khatib Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Fine Needle Aspiration Cytology (FNAC) of the lymph node is a simple tool in the diagnosis of suspected and unsuspected primary and secondary lymph node malignancy. It is a useful first-line investigation to distinguish between infective and malignant lymphadenopathy, especially in a low-resource setting like our country. Aim: To study the utility of FNAC in the diagnosis of lymph node malignancy and to evaluate the efficacy of cytology in diagnosing the primary site of malignancy in case of metastasis. Materials and Methods: A cross-sectional retrospective and prospective study was conducted for a five-year period from July 2015 to June 2020, in the pathology department of Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India. A total of 112 patients diagnosed with malignancy on FNAC of lymph nodes were studied. The FNAC procedure was performed by cytopathologists using a 23/24G needle attached to a 10 ml syringe. The alcohol-fixed smears were stained with Haematoxylin & Eosin (H&E) stain and Papanicolaou (PAP) stains, while the air-dried smears were stained with Giemsa stain. Diagnosis was based on cytomorphological features and clinical presentation. Results: A total of 112 patients were diagnosed with malignancy on FNAC, of which 90 were males and 22 were females, with a male-to-female ratio of 4:1. Cytological analysis of these nodes revealed metastasis in 98 cases (87.50%) and lymphoma in 14 cases (12.50%). The maximum number of patients were in the 51-60 years age group, with 38 cases (33.92%). The most common site of involvement was cervical lymph nodes, with 75 cases (66.96%). The most common cytological diagnosis was metastatic squamous cell carcinoma in 65 cases (58.02%), followed by metastatic un-differentiated carcinoma in 26 cases (23.20%). Conclusion: Fine Needle Aspiration (FNA) is a simple, safe, accurate, cost-effective, and valuable tool in the evaluation of malignant lymphadenopathy. Malignant diseases were easily diagnosed by this simple diagnostic procedure. In the case of a diagnosis of lymphoma, surgery can be completely avoided. It helps in planning further surgical management for metastatic disease, where definitive operative intervention can be performed in one session. In the case of an un-detected primary tumour, FNAC directs further investigations towards the possible primary site.

Prevalence of Hand Eczema Owing to Hand Hygiene Practices among Healthcare Workers Managing COVID-19 Patients: A Cross-sectional Study Haryana, India

Ashish Dalal, Suraj Chawla, Jyoti Sangwan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Healthcare Workers (HCWs) have borne the major brunt of the Coronavirus Disease-2019 (COVID-19) pandemic, being at the forefront. With the disease being enigmatic and no proven treatment or vaccine available during the initial stages, personal protection in general, and hand hygiene, in particular, have been the mainstays for protection against the disease, exposing HCWs to more wet work. Wet work exposure is considered a major risk factor for the occurrence of Hand Eczema (HE). Aim: To estimate the prevalence of hand dermatitis and ascertain the risk factors among HCWs exposed to wet work while caring for COVID-19 patients. Materials and Methods: A cross-sectional study was conducted among HCWs managing COVID-19 patients in a dedicated COVID-19 hospital from July to December 2020. The diagnosis of HE was based on medical history and clinical examination. Clinical features like itching, redness, scaling, clustered papulovesicles, hyperkeratosis, or fissuring largely confined to the hands, with none or only minor involvement of other areas, were used in diagnosing HE. An association of various wet work exposures with HE among study participants was analysed. Categorical variables were analysed using the Chi-square test, and a p-value <0.05 was considered statistically significant. Results: A total of 390 HCWs, of which 203 (52.1%) were females, participated in the study. The majority, i.e., 329 (84.4%) of participants, were in the age range of 21-35 years. A total of 244 (62.6%) HCWs were performing duties for 30-40 hours per week. Among all 390 HCWs studied, 102 (26.2%) were found to have features of HE. High frequency of alcoholic hand disinfectant use (>20 times daily) was significantly associated with the occurrence of HE. Similarly, the high frequency of hand washing with soap at work (>20 times) significantly increased the risk of developing HE. A prior history of atopic diathesis was found to be a significant risk factor for fresh episodes of HE. Conclusion: The present study concludes that intensive hand hygiene during the prevailing COVID-19 pandemic leads to the occurrence of HE among HCWs.

SPEAK 2024 Scientific Platform for Exchange of Advanced Knowledge, International Dental Conference as part of Continuing Dental Programme

Prof(Dr.) J Bhattacharyya Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X

Detection of gbpA and gbpB in Streptococcus mutans Isolated from Patients with Oral Potentially Malignant Disorders: A Pilot Study

I Shabnam Tamanna, AS Smiline Girija, J Vijayashree Priyadharsini Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Glucan-binding proteins (gbps) in Streptococcus mutans (S. mutans) are considered vital virulence factors contributing to plaque formation and caries progression. These proteins also aid in maintaining biofilm formation on the tooth surface and further colonisation of S. mutans. Aim: To phenotypically characterise S. mutans from clinical samples of patients with Oral Potentially Malignant Disorder (OPMD), healthy individuals with and without caries, and to assess the frequency of the gbpA and gbpB genes among the groups. Materials and Methods: This pilot study was conducted for a period of two months from May to June 2023 in the Department of Microbiology at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. Saliva samples (N=60) were collected from 20 patients in each of the three different groups: Group 1 included OPMD cases, Group 2 comprised healthy individuals with caries, and Group 3 consisted of healthy individuals without caries (control). Demographic data including age, gender, geographical location, and any previous history of clinical illness were recorded. The samples were promptly transferred to the microbiology lab and cultured on sterile Mutans Sanguis (MS) agar, followed by incubation at 37°C for 48 hours. S. mutans were phenotypically characterised, and the frequency of the gbpA and gbpB genes was assessed using Polymerase Chain Reaction (PCR). Results: The prevalence of S. mutans among the study population was found to be 9 (45%) in Group 1, 8 (40%) in Group 2, and 3 (15%) in Group 3. The study findings revealed the presence of gbps in S. mutans isolated from OPMD cases, patients with caries, and non-cariogenic healthy patients, with the frequency of gbpA as 8 (88%), 7 (87.5%), and 1 (33.3%), and gbpB as 9 (100%), 5 (62.5%), and 1 (33.3%), respectively. Conclusion: The frequency of gbpA and gbpB from the clinical strains of S. mutans associated with caries and OPMD cases was observed in the present study. Periodic surveillance of such virulent determinants would aid in a theragnostic approach to alleviate the complications caused by S. mutans in OPMD cases.

Alignment of Maxillary and Mandibular Midlines in Dentate Individuals: A Cross-sectional Analysis

Swagata Maiti, Sanjeev Mittal, Sandeep Kalra, Swati Kashyap, Preetica Sharma, Varsha Rani Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The dental midline is a vital element in smile design. The maxillary and mandibular central incisors midline should ideally be positioned coinciding with each other, Incorrect placement of midlines would lead to instability in dental composition. The dental literature fails to disclose the data as to how nature positions the midline of anterior teeth. Aim: To evaluate the relation between the midlines of maxillary and mandibular dental arches in the dentate population using standardised digital photographs. Materials and Methods: This in-vitro cross-sectional study was carried out in the Department of Prosthodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, Haryana, India between June 2021 to December 2022. A total of 155 dentate subjects (102 females and 53 males) of this demographic area, all within the age group 18-45 years of age were selected for present study. Full-face standardised photographs of the subject’s frontal profile of occluding teeth in a retracted mouth were captured with a Digital Camera (Nikon D3200 DSLR). The collected samples of intraoral images were analysed in image analysing software (Digimiser version 6.0). Lines were constructed in the software to record the maxillary midline and mandibular midline to assess the coincidence or deviation between them. Direct measurements were also obtained within these constructed lines to record the distance of deviation. Direction (right/left) and distance of deviation were recorded. The collected data were subjected to appropriate statistical testing. The statistical analysis was done using the Chi-square test, t-test, etc., and performed in the statistical software International Bussiness Machine (IBM) Statisical Packages of Social Sciences (SPSS) statistics version 25 (Armonk, USA). Results: The mandibular midline did not coincide with the maxillary midline in 134 (86%) of the tested population and within both genders and showed a significant (p-value-0.00) deviation of 1.88 mm after application of the t-test. Although 78 (50%) deviations were towards the left-side and 56 (36%) toward the right-side of the maxillary midline within both genders, the results were statistically insignificant with the Chi-square test. Conclusion: Mandibular and maxillary dental midline fails to coincide in more than four-fifths of the subjects.

Knowledge, Awareness and Attitude of Parents towards their Children with Autism at a Tertiary Care Hospital, Saudi Arabia: A Cross-sectional Study

Khalid Alawad A Mohammed, Fahad Ali Alamr, Ahmed Elabwabi Abdelwahab, Huda Ibrahim Ahmed, Ehab Ali Sorketti, Mohi Abdullah Algarni, Badr Saad Dhawi, Saeed Ali Al Suliman, Khaled Salem Alghamdi, Hanan Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Autism Spectrum Disorder (ASD) is a lifelong hereditary neurodevelopmental disorder characterised by a lack of social communication and restricted and repetitive behaviours. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classified symptoms of autism into two domains: the social communication and interaction domain. However, studies on autism in Saudi Arabia are still insufficient. Therefore, awareness and knowledge about autism can facilitate early detection and treatment, resulting in better outcomes. Aim: To evaluate parents’ knowledge, awareness, and attitude towards their autistic children in a tertiary care hospital in Saudi Arabia. Materials and Methods: This hospital-based cross-sectional study was conducted at Baljurashi Mental Health Hospital, AL-Baha region, Saudi Arabia, from January 2023 to November 2023. A total of 69 parents with autistic children who attended the outpatient clinic at Baljurashi Mental Health Hospital were included in the study. A questionnaire was administered among parents to assess their knowledge, awareness, and attitude regarding autism. Data was statistically analysed using descriptive statistics and the Chi-square test. Results: The age of the parents ranged from 16 to over 50 years, with 47 (68.1%) being males and 22 (31.9%) being females. Almost 29 (42.0%) of the parents were postgraduates, and 21 (30.4%) had a university-level education. About 24 (34.8%) of the participants believed that consanguineous marriage increases the risk of autism, 19 (27.5%) believed that some vaccines increase the risk of autism, and 39 (56.5%) knew that autism is associated with learning disabilities. Three-quarters of the participants, 54 (78.3%), stated that autism was known to them, 50 (72.5%) thought that an autistic child could be affected by a normal child, and 53 (76.8%) had good knowledge about autism. Conclusion: The study showed that the majority of parents had good knowledge about autism disorder. The findings reflect the positive impact of focused training initiatives and public awareness efforts aimed at improving parents’ knowledge, awareness, and attitude toward autism.

A Retrospective Cross-sectional Analysis of Renal Complications in Association with Cancer: Insights from 120 Autopsies

Gwendolyn Fernandes, Gloria Khumanthem, Sharada Datar, Kasturi Khot Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Kidney diseases frequently complicate cancer and its treatment, contributing to both morbidity and mortality. Malignancies can give rise to various kidney issues, such as glomerulonephritis and Chronic Kidney Disease (CKD). This association operates bidirectionally, with patients experiencing the development of renal diseases due to cancer, and CKD predisposing to cancer. Furthermore, nephrotoxicity induced by chemotherapy can result in Acute Tubular Injury (ATI) and necrosis, imposing limitations on its application. Aim: To evaluate the spectrum of renal pathology in autopsies of malignancies. Materials and Methods: This was a retrospective cross-sectional study of complete autopsies of all cases of malignancies performed in the Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. The study was carried out over a 5-year period from January 2015 to December 2019. Analysis of cases with respect to demographics, type of primary malignancy, gross and microscopic features, and the final cause of death was conducted. These findings were meticulously tabulated, with frequencies and percentages calculated for each category. Results: A total of 4392 autopsies were conducted throughout the study period, with 120 of them revealing the presence of malignancies. A total of 38 (31.6%) malignancies were diagnosed for the first time at autopsy. The commonest renal findings on gross were scars (superficial and deep) seen in 40 (33.33%), followed by cortical cysts in 25 (20.83%), granular contracted kidney in 15 (12.50%), mass lesions in 7 (5.83%), abscesses in 7 (5.83%), and swollen, oedematous kidneys in 6 (5%) autopsies. The most frequent renal pathology on microscopy were infective lesions seen in 43 (35.83%), Acute Tubular Necrosis (ATN) in 32 (26.66%), ATI in 30 (25%), followed by malignancies- primary and secondary in 11 (9.16%), tubular casts in 6 (5%), etc. Rare findings included membranous glomerulonephritis and Tumour Lysis Syndrome (TLS) (Acute urate nephropathy) in 1 (0.83%) each. The TLS case had classic histomorphological features of TLS, apart from laboratory parameters. Extensive deposits of uric acid crystals were seen obstructing the tubules as well as some of the glomeruli on microscopy. Conclusion: In one-third of the cases, the malignancy was exclusively discovered during the autopsy. The study revealed a diverse array of lesions, encompassing pyelonephritis, ATN, primary and metastatic renal tumours, cast nephropathy, membranous glomerulonephritis, and TLS. One-fifth of the cases had end-stage renal disease (advanced renal disease). A significant number of the cases exhibited tumour masses within the kidneys. One-fifth of the cases had renal pathology contributing to the final cause of death, further highlighting the association between malignancies and renal pathology.

Effect of Kettlebell Training versus Plyometric Training on Agility, Static Balance and Dynamic Balance in Volleyball Players: A Research Protocol of an Experimental Study

Pratik Raman Jaiswal, Swapnil Ulhas Ramteke Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Volleyball is a dynamic sport that places high demands on an athlete’s ability to move quickly and efficiently. Kettlebell training utilises a unique offset weight, challenging core stability, and multijoint coordination, potentially mimicking movements in volleyball. Plyometric training, on the other hand, focuses on rapid muscle contractions to develop power. Despite their popularity, limited research directly compares the effectiveness of these methods for enhancing the skills crucial for volleyball players. Need of the study: Lower limb injuries are common in volleyball players, and improving agility and balance can help in reducing the risk of these injuries. The purpose of the research is to bridge this information disparity by investigating the effects of both kettlebell training and plyometric training. By analysing the results, the authors can gain valuable insights into how each training approach influences these fundamental movement skills. This knowledge can ultimately help in the development of targeted training programs specifically designed to enhance performance and training strategies for volleyball athletes. Aim: To assess the subjects’ agility, static balance, and dynamic balance in volleyball players treated with kettlebell training and plyometric training. Materials and Methods: This two-arm parallel randomised experimental study will be conducted at the Department of Sports Physiotherapy of Ravi Nair Physiotherapy College, Wardha, Maharashtra, India, from July 2023 to July 2024. A total of 50 participants will be assigned to 2 groups, with one group receiving kettlebell training (Group-A) and the other group receiving plyometric training (Group-B). Assessments will be conducted on the first day of intervention and at the end of the sixth week of treatment, respectively. To evaluate the inequality in effect size between the groups, statistical significance will be assessed using either a parametric test or non parametric test at a 5% level of significance. For normally distributed values, a t-test (Unpaired) will be used and for non normally distributed data, non-parametric tests (Chi-square, Mann-Whitney U, and Wilcoxon’s test) will be utilised.

Adverse Event Profile and Compliance of Docetaxel with Radiation in Cisplatin-Ineligible Patients of Locally Advanced Head and Neck Squamous Cell Carcinoma: A Research Protocol

Himanshi Kaushik, Amol Dongre Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Concomitant chemoradiation with cisplatin is standard treatment for non-metastatic head and neck cancers, but often limited by toxicities, especially deranged renal function and hearing complications. This leads to limited cycles of cisplatin due to challenges in administration and is not suitable for patients with poor renal function and hearing issues. Need of the study: Not enough data is available for patients who are not suitable for cisplatin administration along with radiation either due to sensitivity to cisplatin or the adverse effects mentioned earlier. Docetaxel has been recently observed to benefit such patients in overall response outcome including Disease Free Survival (DFS) and Overall Survival (OS) when administered concurrently with radiation. Improved clinical response with minimal toxicity to normal tissue is seen with docetaxel, as it is a phase-specific agent. Therefore, this would be a good alternative to Cisplatin in patients with deranged kidney function and sensorineural hearing loss. Aim: To estimate the adverse event profile and compliance of docetaxel with radiation. Methodology: This prospective observational study will be conducted in the department of Medical Oncology and Radiation Oncology at Sidharth Gupta Memorial Cancer Hospital, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra, India, starting from May 2024 to May 2025. Patients with pathologically confirmed non-metastatic Head and Neck Squamous Cell Carcinoma (HNSCC), who are planned for Concurrent Chemoradiation (CCRT) but not suitable for cisplatin, will receive concurrent weekly docetaxel at a dose of 15 mg/sqm. Radiotherapy (RT) will be delivered according to the institutional protocol, daily dose of 200 cGy for five days a week will be given. Continuous monitoring during treatment will include weekly clinical evaluations, regular blood tests (haemoglobin, blood counts, renal functions), and grading of adverse events (CTCAE v5 criteria). Treatment response will be assessed via clinical evaluation and CECT scans (RECIST v1.1). Statistical analysis will be performed using Statistical Package for Social Sciences (SPSS) version 26.0 and will involve analysis of categorical variables with Chi-square and Fisher-exact tests, and continuous variables with unpaired t-tests and Analysis of Variance (ANOVA). Time to event analysis will be done using the Kaplan-Meier method with p-value <0.05 considered significant.

A Cross-sectional Analysis of Conventional Leishman’s Stain versus Modified Leishman’s Stain: A Study Protocol

Isha Nanaji Panbude, Sahitya Vodithala Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: The conventional Leishman’s stain and modified Leishman’s stain are widely used in medical laboratories for the microscopic examination of blood smears. The conventional stain provides good visualisation of cellular morphology, aiding in the identification of various blood cell types. The modified Leishman’s stain, on the other hand, incorporates alterations to enhance specific cellular structures, improving diagnostic accuracy. Need of the study: In the present study, the authors will observe the differences between the conventional staining method and the modified Leishman's stain method, as well as the advantages of the modified Leishman's staining over the conventional staining method. Aim: To compare Conventional Leishman’s Stain with Modified Leishman’s Stain. Materials and Methods: The cross-sectional study will be conducted from October 2022 to October 2024 at the Department of Pathology, Jawaharlal Nehru Medical College (JNMC), Sawangi (Meghe), Wardha, Maharashtra, India. Ethylenediamine Tetraacetic Acid (EDTA) blood samples will be used for staining. Conventional Leishman’s Stain employs the traditional Leishman’s staining method, while Modified Leishman’s Stain incorporates specific modifications aimed at improving staining quality and enhancing the detection of eosinophils and leukocytes. Several quality control parameters will be assessed, including staining quality, eosinophil and leukocyte visibility, and overall diagnostic accuracy for both peripheral blood smear samples. A panel of experienced haematologists, blinded to the staining technique, independently examines the slides to minimise potential bias. The numbers and morphological characteristics of eosinophils and leukocytes are meticulously recorded, and statistical analysis will be conducted to compare the two staining methods.

Efficacy of Simultaneous Application of Repetitive Transcranial Magnetic Stimulation and Virtual Reality Training on Sensory-motor and Cognitive Deficits among Stroke Patients: A Protocol for a Randomised Controlled Trial

Priya Chauhan, Sanjib K Das Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Introduction: Stroke is a significant contributor to chronic impairment on a global scale, impacting millions of individuals each year. Despite the progress made in the field of stroke management, individuals frequently experience enduring sensorimotor and cognitive impairments that have a substantial influence on their quality of life and ability to live independently. Need of the study: Virtual Reality Training (VRT) consists of rigorous, repetitive sessions that promote cerebral-hemispheric integration through the creation of a stimulating environment that combines sensory and motor functions. It is anticipated that VRT and Transcranial Magnetic Stimulation (TMS) will stimulate the affected hemisphere while inhibiting the unaffected hemisphere. Voluntary movement is also crucial for interhemispheric interaction; therefore, the present research employs VRT for physical movements while stimulating across multiple regions of the brain. Aim: To investigate the combined efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) and Virtual Reality Training for sensorimotor and cognitive deficits among stroke patients. Materials and Methods: The present study will be a single-blind, prospective, randomised controlled trial recruiting 69 patients with unilateral stroke from Jaypee Hospital Noida, Uttar Pradesh, India for a continuous period of one year from July 2023 to June 2024 and will be allocated through block randomisation to one of the three treatment groups as per the inclusion and exclusion criteria. Group 1- Simultaneous repetitive TMS (rTMS) and VRT, Group 2- rTMS combined with Sham VRT, and Group 3- VRT protocol combined with Sham Stimulation. Fugl Meyer Assessment (FMA), Montreal Cognitive Assessment (MOCA), National Institutes of Health Stroke Scale (NIHSS), and Addenbrooke’s Cognitive Examination III (ACE III) will be measured at baseline and at the end of the fourth week.

Potential Role of Immature Platelet Fraction in Dengue Fever: A Narrative Review

Reshu Gupta, Adrija Mehta, Shatakshi Singh, Saksham Shah, Divyanshi Luthra Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Dengue fever has emerged as a major international public health concern with a dramatic global increase in its frequency over the past few decades. It may present as a mild illness to a life-threatening condition with the major pathophysiological hallmark being plasma leakage as a result of increased vascular permeability and haematological abnormalities. The unpredictable nature and progression of the disease has led to research of novel haematological markers like Immature Platelet Fraction (IPF) which may help enhance the precision and efficacy of dengue management strategies by guiding the need for blood transfusion and blood lab monitoring, decreasing financial cost and hospital stay. This review provides detailed information about the immunopathogenesis of dengue, which is responsible for the fatal complexities and also gives the definition and uses of IPF by the healthcare workers. It aims to delve into the evolving role of IPF in the management of dengue, exploring its potential applications in assessing disease severity, predicting haemorrhagic tendencies and guiding therapeutic interventions. The review informs the readers about the implications and significance of the use of IPF in the treatment of dengue and how this technique can potentially reduce disease severity by timely diagnosis and treatment.

Unlocking the Enigma of Cotard’s Syndrome: A Narrative Review of its Clinical Manifestations and Therapeutic Strategies

Mudit Saxena, Bhagyesh Sapkale, Sushil Varma, Sachin R Gedam Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X This narrative review explores Cotard’s Syndrome (CS), a rare psychiatric condition characterised by delusions of death or non-existence, originally described by Jules Cotard in 1880. The syndrome presents a complex clinical picture, encompassing grandiosity, damnation, and physical breakdown. Despite its historical origins, CS remains poorly understood and often misdiagnosed. This review elucidates the clinical complexity, diagnostic challenges, and therapeutic strategies associated with CS. It highlights the neurological aspects, such as delusional misidentification and negation, shedding light on underlying mechanisms. Treatment approaches, including pharmacotherapy, Electroconvulsive Therapy (ECT), and psychotherapy, are discussed, emphasising the importance of ongoing mental health support across the illness’s stages. The review draws from a comprehensive search methodology, encompassing diverse scholarly sources, to provide a nuanced understanding of CS. By increasing awareness among clinicians and researchers, this review aimed to improve diagnosis and treatment outcomes for individuals affected by this enigmatic syndrome.

Importance of Hip and Core Muscles Strength Exercises in Patients with Knee Osteoarthritis: A Narrative Review

Manalisa Kalita, Sunita Sharma Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Knee Osteoarthritis (OA) is a prevalent cause of disability. It typically affects women more frequently than men, and as people age, it becomes more widespread. Apart from inflicting pain and impairment and affecting Quality of Life (QoL), OA raises the likelihood of mortality as well as morbidity. Regular exercise has been demonstrated to lessen knee OA discomfort. The objective of the present review is to draw attention to the body of research on the positive effects of hip and core strengthening exercises for individuals with knee OA. Electronic searches were conducted using databases including PubMed, Scopus, and Google Scholar to gather the appropriate information. The results of the review suggest that exercises for the hip and core muscles are quite beneficial for individuals with OA in their knees. However, there has been little scholarly study on core muscle strengthening, and it is not a frequently used method to treat OA in the knee. Research suggests that strengthening the hip and core muscles is a very effective exercise regimen for people with knee OA, improving their functional status, pain management, and QoL.

Bridging the Divide: Tackling Recruitment Challenges in Indian Clinical Trials: A Narrative Review

Shambhavi S Ghotankar, Rajendra Devkar, Madhura Deshmukh Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X India’s clinical trial landscape has witnessed rapid growth over the period, with the recent introduction of remote trial patient monitoring utilising technologies like Artificial Intelligence (AI). The vast and diverse population, combined with well-established medical infrastructure and skilled professionals, makes India an ideal location for conducting clinical research. Many international pharmaceutical companies have chosen to outsource their operations to India as well. However, despite India emerging as a significant hub for clinical trials, recruiting participants still presents unique challenges. This review aimed to shed light on the hurdles faced in recruiting participants in Indian clinical trials and explore potential solutions to bridge this gap. It has been highlighted that overcoming the challenges in recruiting participants in Indian clinical trials requires a multi-faceted approach involving various stakeholders. Along with the powerful steps taken by the government in reforming policies and regulatory norms, certain innovative and effective strategies need to be designed to streamline the processes of participant recruitment.

Kartagener’s Syndrome: A Narrative Review on its Clinical Implications and Management

Samanvita Kaza, Darshna G Fulmali Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Kartagener’s Syndrome, alternatively known as Primary Ciliary Dyskinesia (PCD) is a rare and intricate inherited disorder that impacts the structure and function of cilia, leading to compromised mucociliary clearance. The defining features of this condition consist of chronic sinusitis, situs inversus totalis, and bronchiectasis, forming a characteristic triad. Kartagener’s Syndrome presents numerous challenges in its diagnosis and management, and its clinical implications have significant ramifications for affected individuals. This review aims to comprehensively review and analyse the clinical impact of this syndrome, focusing on the diagnosis, treatment, and management modalities. The ciliary dysfunction in Kartagener’s Syndrome disrupts the mucus clearance and pathogens from the respiratory tract, resulting in chronic infections, progressive lung damage, and respiratory failure in severe cases. Through a narrative review of literature, reviews, and case studies, the authors have explored clinicians’ diagnostic challenges and the advances in genetic testing methods that aid in early and accurate diagnosis. The authors have discussed the multidisciplinary approach to manage Kartagener’s Syndrome, which involves respiratory therapies, antibiotics, and surgical interventions to improve the patient’s quality of life and prevent complications. The review paper also includes in-depth case studies of individuals with Kartagener’s Syndrome, highlighting the variability in clinical presentations and treatment outcomes. These case studies provide valuable insights into the diverse manifestations of this syndrome, further enhancing the existing understanding of the disease and its management. Ultimately, this review is directed to raise awareness among healthcare professionals about Kartagener’s Syndrome, its clinical implications, and its diagnostic and treatment challenges. By shedding light on this rare and intricate genetic disorder, the authors here promote early recognition and proactive management, leading to improved outcomes and better quality of life for individuals with Kartagener’s Syndrome.

Augmented Reality System Guidance for Computed Tomography-based Needle Insertion: A Narrative Review

Apurva B Gauns Dessai, Shashi Kumar Shetty, Dani N Jijo, Omkar Uttam Gaonkar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The new advancement in percutaneous intervention procedures, which provides more accurate needle placement compared to other modalities, is Augmented Reality (AR). It provides the operator with 3-dimensional (3D) or 2-dimensional (2D) structures of the anatomy along with the target during surgery to get a precise needle placement into the target. The review highlights that using AR systems for needle navigation and placement can become productivity in various interventional procedures. The AR navigation system reduces radiation exposure, procedural time, risk to the patient, and ensures higher accuracy of needle placement than conventional Computed Tomography (CT)-guided percutaneous procedure systems. The AR system can provide precisely guided needle insertion and reduce the risk of complications. As technology and research are increasing, new techniques, such as automatic image-hologram registration, can be brought into the picture. This review compares conventional image-guided procedure systems with the AR system in the interventional radiology field. This review also provides detailed information about AR as a promising tool for optimising needle placement in interventional procedures, paving the way for safer and more effective clinical practices.

Evaluation of Efficacy of Tulsi-Turmeric Oil Pulling in Oral Submucous Fibrosis ( Vata Pitta Dominant Tridosaja Sarvasara Mukharoga ): A Narrative Review

Anshika Kishor Singh, Gaurav Rajendra Sawarkar, Amol Madhav Deshpande, Rugaved Raghavendra Gudadhe, Sharayu Bhaskarrao Balkhande Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X A condition called Oral Submucous Fibrosis (OSMF) primarily affects the Indian subcontinent. It is characterised by abnormal collagen deposition and fibrosis of submucosal tissue that progresses over time. Chewing betel nut is the most prevalent behaviour among Oral Submucous Fibrosis (OSMF) patients, with a 6.3% prevalence rate. Symptoms include ulceration, burning sensation, xerostomia, and limited mouth opening. According to the Brihatrayi (three main classical books), OSMF is associated with sarvasaramukharoga, or disorders of the oral cavity. Tobacco, lime, chilies, betel nuts, and other substances act as irritants and can damage the oral mucosa. Treatment methods include Gandusha (oil pulling), Pittashamaka, yoga, Nasya (nasal drops), Pratisarana (rubbing), etc. The present review was conducted to assess and evaluate the potential efficacy of Tulsi-turmeric oil pulling as a complementary or alternative therapy in managing OSMF.

Effectiveness of Constraint-induced Movement Therapy on Hand Function in Cerebral Palsy Children: A Narrative Review

Niharika Dihidar, BC Sarma, Shalaka Baidya Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X A neurodevelopmental disease known as Cerebral Palsy (CP) first manifests in infancy and affects a variety of developing abilities, including motor control, coordination, tactile perception, cognition, and attention. The most prevalent type, accounting for 60%-70% of cases, is spastic CP. Ataxic CP accounts for 10%-15%, athetoid CP for 10%-15%, and mixed CP for 10%. Children diagnosed with hemiplegia exhibit firmness and muscle weakness due to unilateral involvement of both upper and lower limbs on the opposite side of the brain lesion. These variables may manifest upper limb motor deficits, such as restricted grasp, reach, and manipulation. These disabilities result in functional restrictions during daily activities and may cause the affected extremity to be underutilised. Hand impairment in hemiplegic CP occurs from damage to the motor cortex and corticospinal pathways, which are in charge of fine motor control of the fingers and hand. In terms of enhancing fine motor abilities and improving functional results, it has been demonstrated that Constraint-induced Movement Therapy (CIMT) is useful for individuals with CP. CIMT involves teaching a child to use their affected hand by using a constraint on the unaffected hand and repetitive extensive implementation of movements with the affected hand. The aim of the present review was to find out how CIMT affected the hand functionality in children with CP.

Isolated Case of Superior Mesenteric Artery Dissection- A Case Report

Sundara Raja Perumal, K Malathy Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X An isolated case of Superior Mesenteric Artery (SMA) dissection without bowel infarction or bowel ischaemic changes is a rare event. Due to advanced imaging studies, the incidence of isolated SMA dissection is increasing. A 55-year-old male patient with a history of abdominal pain and nausea for two days reported to Emergency services. After an initial examination, the patient underwent contrast Computed Tomography (CT) of the abdomen and was diagnosed as having an isolated dissection of the SMA. Both small and large bowel loops appear normal with no evidence of bowel ischaemic changes. The patient was put on anticoagulant medication, managed conservatively, and improved well. Superior mesenteric dissection is an uncommon condition, a diagnosis of exclusion that should be considered whenever there is a history of unexplained abdominal pain.

Amphicrine Carcinoma of the Duodenum: A Rare Entity

Supriya Prasad, Renu Sukumaran, Arun Sankar, Madhu Muralee, Priya Appanraj Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Amphicrine carcinoma, in which endocrine and epithelial cell constituents are present within the same cell, is very rare. It is different from adenocarcinoma and Mixed Neuroendocrine-Non neuroendocrine neoplasms (MiNEN). In the current World Health Organisation (WHO) classification of gastrointestinal tumours, the only mention of an amphicrine tumour is in the form of Goblet Cell Adenocarcinoma (GCA) in the appendix, which has both neuroendocrine and non neuroendocrine characteristics in the same cell. Authors hereby report the case of a 63-year-old female who presented with complaints of abdominal pain of a six-month duration. Endoscopy showed a polypoidal lesion in the duodenum. Distal radical gastrectomy was done. Microscopy of the lesion showed atypical signet-ring-like cells and goblet-like mucinous cells with fine granular chromatin. On immunohistochemistry, the tumour cells were positive for CK7, synaptophysin, and chromogranin. The cells showed Periodic Acid-Schiff stain (PAS) positive, diastase-resistant material in the cytoplasm. These cells also showed mucicarmine positivity. Considering the biphenotypic nature of tumour cells, the diagnosis of amphicrine carcinoma was given. Amphicrine carcinomas have unique features in histopathology, immunohistochemistry, special stains, and genetic profile.

Hypokalaemic Periodic Paralysis in a Patient with Rheumatoid Arthritis: A Case Report

Utkarsh Gaur, Charuta Gadkari, Aditya Pundkar Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Periodic skeletal muscle weakness in Hypokalaemic Periodic Paralysis (HPP) can lead to respiratory muscle failure and mortality. This muscle weakness is caused by decrease in serum potassium levels (<3.5 mmol/dL), which can be either primary or secondary. The present case report describes an unusual presentation of HPP in a 37-year-old female with known Rheumatoid Arthritis (RA), who complained of sudden-onset quadriparesis. Upon evaluation, the patient was diagnosed with hypokalaemia, and treatment for this condition resulted in marked improvement of the paresis. While there are several deadly neuromuscular causes of quadriparesis, dyselectrolytaemia should be evaluated and treated, especially in patients with autoimmune diseases. In such patients, hypokalaemia could be due to medications such as corticosteroids or immunosuppressants like methotrexate, or as a result of underlying renal tubular acidosis. The present report adds to the scant literature on the association between RA and HPP through detailed clinical examination, laboratory investigations, and successful management with potassium supplementation.

A Case of Paraganglioma as an Unusual Tenant of Gallbladder

Snehlata Hingway, Suhit Naseri, Pravin Gadkari Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Gallbladder paraganglioma is an exceptionally uncommon tumour. Paragangliomas are a subset of Neuroendocrine Neoplasms (NENs) called neurogenic NENs that arise from neural crest cells of the neuroectoderm. They present diagnostic challenges due to their uncommon occurrence and non specific clinical manifestations. The paraganglion system consists of two cell types, called chief and sustentacular cells. The most common location of a paraganglioma is the adrenal medulla, defined as pheochromocytoma. Pheochromocytomas, found in the adrenal medulla, are known for their high Catecholamine (CA) production, leading to significant clinical manifestations like hypertension and metabolic disturbances. A 36-year-old female, otherwise asymptomatic, underwent cholecystectomy due to persistent abdominal discomfort in the right hypochondrium for two months. Preoperative imaging demonstrated a gallstone. Laparoscopic cholecystectomy was performed. The pathological analysis following surgery documented the presence of gallbladder paraganglioma and chronic cholecystitis. Immunohistochemically, chief cells displayed widespread positivity for chromogranin, synaptophysin, and sustentacular cells displayed S100 positivity. There are no definitive guidelines for the management of gallbladder paragangliomas due to their rarity. Reporting instances of paraganglioma in the gallbladder is critical to raising clinical awareness, enhancing diagnostic criteria, optimising treatment protocols, and unravelling the underlying molecular mechanisms. All of these efforts are critical for improving patient care and outcomes in treating this uncommon and enigmatic tumour entity.

A Case Series on Variations in Location of Vermiform Appendix: Revisited with Computed Tomography

Anil Kumar Singh Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X The appendix is known to have varying locations and extents in relation to the cecum, to which it is attached in the main gastrointestinal tract. These variations have significant implications in terms of the varying clinical presentation of appendicitis, which may deviate from the classical presentation in the right iliac fossa and thus delay diagnosis. Knowledge of the different positions of the appendix helps in identifying the relatively common pathology of appendicitis, which may occur even beyond the confines of the right iliac fossa. This imaging case series depicts the spectrum of variations in the locations of the appendix as seen on Computed Tomography (CT) in a comprehensive though simpler way. The types of appendix illustrated in this imaging case series include the medial appendix with its subtypes (postileal-3, pelvic-2), subcecal (3), retrocecal (2), paracecal (1), and prececal appendix (1). In cases of the acute abdomen where appendicitis is suspected and if the appendix is not identified or only partly traced in the right iliac fossa, attempts should be made to trace the entire appendix in unconventional locations in the abdomen-pelvis. Such a scenario might be more likely if the patient is only experiencing distal appendicitis.

Vitamin D and Metreleptin: A Therapeutic Alliance for Treating Depression Associated with Obesity

Priyanka Venkatapathappa, Achal Shetty, Ashakiran Srinivasaiah, Harish Rangareddy Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X Vitamin D has multifaceted roles in brain function beyond its traditional role in bone health, impacting neurotransmitters, inflammation, and mood-regulating brain areas where its receptors are present. Conversely, Vitamin D deficiency is often observed in obese individuals. Metreleptin, a synthetic form of human leptin, has demonstrated efficacy in promoting weight loss and alleviating depression among obese patients. However, there is limited direct evidence linking metreleptin to depression reduction or establishing an interaction between metreleptin and Vitamin D in this context. Vitamin D’s neurotrophic and immunomodulatory properties influence neurotransmitter regulation, including serotonin, dopamine, and norepinephrine, vital for mood stability. The presence of Vitamin D Receptors (VDR) in regions of the brain linked to depression further supports its role in mood regulation. Moreover, Vitamin D’s anti-inflammatory effects contribute to mitigating brain inflammation associated with depression. Given the inverse relationship between obesity and Vitamin D levels, obese individuals are at higher risk of Vitamin D deficiency. Metreleptin, as a synthetic leptin analogue, has demonstrated significant efficacy in reducing obesity. Thus, the plausible combination of Vitamin D and metreleptin presents a potential novel strategy for managing depression in obese individuals. Though these therapies may address the intricate interplay of depression in the context of obesity, rigorous research is essential to validate their efficacy and safety in tandem.

Scrotal Lymphatic Filariasis: A Rare Clinical Image

Keval R Dhone, Rajiv K Sonarkar, Vandana S Tomey Journal of clinical and diagnostic research : 2024 - July - 18:0973-709X