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

Book Review of Learning Radiology, Recognising the Basics: Fourth Edition

Sudhanshu Tonpe Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X

Subcutaneous Emphysema in Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia: A Rare Case Report

Vasundara, Darshana Tote, Anup Zade, Shubham Durge, Aditya Sriharsha Pedaprolu Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Surgeries for inguinal hernias are among the most commonly performed procedures worldwide. Compared to traditional open surgery for inguinal hernias, there has been a rise in the use of Total Extraperitoneal (TEP) repair. TEP has been recommended as a safe method for the repair of inguinal hernias. The present report describes a case of subcutaneous emphysema, a rare complication observed after TEP. Subcutaneous emphysema is defined as the de novo creation or infiltration of air in the skin’s subcutaneous layer, which includes the epidermis and dermis. It can occur in various body parts. Factors contributing to the development of subcutaneous emphysema include total gas volume, gas flow rate, the use of a valveless trocar system and robotic fulcrum force. A 56-year-old male was planned for elective TEP surgery. Intraoperatively, the patient experienced a rise in End-tidal Carbon Dioxide (EtCO2), which was followed by an examination that revealed subcutaneous emphysema extending up to the neck. Immediate measures were taken, including increasing the Fraction of Inspired Oxygen (FiO2) to 100% and making nicks on the anterior chest wall and supraclavicular region. A repeat chest X-ray showed no recurrence of subcutaneous emphysema and the patient was discharged seven days postoperatively. Although subcutaneous emphysema is a rare condition, it can lead to life-threatening complications, such as pneumothorax. Therefore, early diagnosis and prompt treatment are essential.

Ayurvedic Management of Pakshmashata (Madarosis): A Case Report

Priyal Bansal, Dattatray Sarvade, BS Nycy, Mohammed Farhan Sheikh Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Madarosis is characterised by either complete or partial loss of eyebrow or eyelash hair. Hair loss occurs due to interrupted blood supply to that region. In contemporary medicine, the management of madarosis includes hair transplant surgery or the use of steroids. There is no direct correlation to madarosis in Ayurveda; however, concepts like “Pakshmashata” described by Acharya Vagbhata exhibit symptoms that closely resemble this condition. In the present case report, a 30-year-old female patient presented to the Outpatient Department (OPD) of Kayachikitsa, complaining of sudden hair loss over the past month, accompanied by itching and a burning sensation in the affected area. A physical examination was conducted, and the patient was diagnosed with Pakshmashata. The treatment included Asthi Majja Pachak Kwath (a decoction for bone and bone marrow tissues), along with Manjistha (Rubia cordifolia) and Haridra (Curcuma longa), as well as a local paste (lepa). Jaloka Avcharan (leech therapy) was administered to the patient twice a month. For local application, Snehana (oil massage) with Eranda (Ricinus communis), taila was used three times a day. Significant improvement in hair growth in the affected area was observed during follow-ups on the 45^th and 60^th days.

Examining the Impact of Myofascial Release and Chest Mobility Exercises on Functional Scoliosis: A Case Report

Rohit Balasaheb Rahane, Arunmozhi Ranganathan, Priya Raj Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Scoliosis is characterised by lateral spinal curvature, twisting of the spine and chest, and abnormalities in the sagittal profile. Physical therapy plays a crucial role in preventing the progression of scoliosis and its associated deformities, and in improving outcomes and quality of life. However, specific treatment methods for correcting the curvature and enhancing function are not extensively documented. Therefore, the present case report incorporated several techniques. A 17-year-old male visited the Physiotherapy Department with complaints of continuous pain in his lower back for the past 45 days. Due to the pain, the patient was not able to play football and sleep properly. Additionally, there was a notable postural deviation with a history of more than six years. His parents ignored his walking as stylish. Moreover, the patient stated that he had continuous pain, was not able to bend the spine backward, concentrate on studies and attend social gatherings. Upon spinal examination, scoliosis with a dropped right shoulder was observed. The patient was effectively treated using Myofascial Release (MFR) techniques combined with exercises to improve chest mobility. After management, the pain score showed a reduction, and there was improvement in the disability questionnaire. Significant changes were also noted in X-ray assessments and Range of Motion (ROM).

Radiological Evaluation of Huntington’s Disease: A Case Report

Soumyabrata Debnath, R Harshith Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Huntington’s Disease (HD) is a rare neurodegenerative condition inherited in an autosomal dominant pattern, where Gamma Amino Butyric Acid-ergic (GABAergic) neurons in the basal ganglia progressively deteriorate. Symptoms include subcortical dementia, behavioural changes, midlife psychosis, and involuntary choreoathetosis movements. Imaging techniques like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) show shrinkage of the caudate nucleus and putamen, alongside enlarged lateral ventricles. Diagnosis is confirmed through molecular analysis identifying the hallmark amplified Cytosine Adenine Guanine (CAG) triplet. The case report describes a 57-year-old female diagnosed with HD, presenting symptoms of accidental falls caused by involuntary jerky movements, along with behavioural changes and cognitive decline over three years. Initial Non Contrast Computed Tomography (NCCT) of the brain revealed bilateral basal ganglia and diffuse cerebral atrophy. Quantitative analysis indicated a decreased frontal horn width to intercaudate distance (FH/CC) ratio of 1.24 and an increased Intercaudate distance to inner table width (CC/IT) ratio of 0.30. Multivoxel Magnetic Resonance Spectroscopy (MRS) showed reduced N-Acetyl Alanine (NAA) and creatine (Cr) levels with an NAA/Cr ratio of 0.84. Magnetic Resonance Tractography and Diffusion Tensor Imaging (DTI) revealed elevated Fractional Anisotropy (FA) and diffusivity in the basal ganglia, and reduced FA with increased diffusivity in white matter tracts. Genetic analysis by Polymerase Chain Reaction (PCR) confirmed HD. Newer MRI like DTI allows early identification of disease and better assessment of disease progression and response to therapy. A multidisciplinary approach involving neurologists, psychiatrists, and other healthcare professionals is essential. Genetic counseling and psychosocial support are crucial for patients and their families. Early and accurate identification of HD is vital for timely interventions and improved symptom control.

A Case Report on Aesthetic Lower Lip Reduction Surgery

Priyanka Jaiswal, Deepika Ajit Masurkar, Bhairavi Kale Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Patients these days are increasingly conscious of personal appearance, and much attention is being focused on the smile. Cosmetic dentistry is also in the race to become the most advanced and demanding dental subspecialty. Recently, aesthetic lip surgeries have been introduced, like lip repositioning, lip reduction and lip enhancement surgeries, to improve facial aesthetics. The authors present a case of a 28-year-old healthy male who reported to the Department of Periodontics with the chief complaint of poor aesthetics and large lips. His lower lip was double the size of the upper lip. Therefore, an aesthetic lip reduction surgery was planned. The lip reduction operation could successfully manage the large lower lip with no intra or postoperative complications. No recurrence was observed within a period of 12 months. Cheiloplasty balances the look of the top and lower lips, improving the appearance of the face as a whole.

Cytodiagnosis of Metastatic Thyroid Follicular Carcinoma in Left Iliac Bone with Occult Primary: A Case Report

Shreya Giri Goswami, Arvind Bhake Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Bone metastasis of Follicular Thyroid Carcinoma (FTC) is an aggressive complication. Typically, follicular carcinoma remains confined to the thyroid gland, with distant metastasis occurring in 4-15% of cases. The lungs are the most frequent site of metastasis, followed by bone (2-13%). A peculiar clinical manifestation of FTC observed is the metastasis with the primary still remaining clinically occult. Solitary bone metastases are exceedingly rare and can easily be misdiagnosed as primary bone tumours on clinicoradiological assessment. This causes delays in the diagnosis and management. In these cases, the cytomorphology of cells on diagnostic Fine Needle Aspiration (FNA) was found to be useful in suggesting the primary origin of FTC. Distant bone metastases from follicular carcinoma on histopathological examination from biopsy specimens have been reported in the literature. The cytodiagnosis and cytomorphology of metastatic FTC by Fine Needle Aspiration Cytology (FNAC) are seldomly described in the literature. Involvement of the iliac bone in the metastasis of FTC is uncommon. The FNAC of such a bony lesion helps immensely not only in the diagnosis of the metastasis but also in suggesting the primary malignancy. Authors, hereby report a clinicopathological profile of one such rare case of a 74-year-old female with cytodiagnosis of FTC with no clinical thyroid swelling. The cytodiagnosis made from the primary lytic lesion involving the left iliac bone led to the retrospective radiological and histopathological work-up of the thyroid gland, confirming the occult primary carcinoma of the thyroid gland. The present case highlights the rare presentation and cytomorphological details of metastatic thyroid follicular carcinoma.

A Case Report on Theruptor Novo: An Antimicrobial Dressing in the Management of Venous Leg Ulcer

Subhash M Kale Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Venous Leg Ulcer (VLU) is defined as any break in the skin that has either been present for longer than six weeks or occurs in a person with a history of VLU. VLUs are intricate and life-threatening ulcerations that result in significant expenses for health services. Compression therapy is the most preferable treatment choice for VLU. Beneath the compression devices (bandages or stockings), wound dressings are used as the primary layer to protect the wound and provide a moist environment to aid ulcer healing. Healthcare professionals face difficulty in making evidence-based decisions regarding the most appropriate treatment plan for a patient with varying needs due to the vast range of wound dressings. Hereby, the author presents a case study of a 53-year-old male patient with a non healing wound with pus discharge for 20 days over the lower limb. Theruptor Novo (Healthium Medtech, India) was used as the regular primary dressing along with planned treatment. By the end of three weeks, the wound size had reduced with a low exudate level, there was no sign of infection, and there was good granulation tissue growth.

Significance of Mrudu Virechan (laxatives) and Specific Medicines in the Management of Bronchial Asthma: A Case Report

Shrish Jaiswal, Renu Rathi, Sonali Sahane, Bharat Rathi, Pawan Naukarkar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Difficulty in breathing, shortness of breath, fever, and cough are common respiratory complaints seen in bronchial asthma. It is the most prevalent chronic health issue affecting individuals in the paediatric age group. Tamaka Shwasa is one among the five varieties of Shwasa Roga in Ayurveda. The purpose of present case study was to examine how an Ayurvedic treatment plan might be applied to cases of bronchial asthma. Hereby, the authors present a case report of a 10-year-old female child who was brought to the clinic by her parents, presenting with complaints of difficulty in breathing, shortness of breath, and occasional sneezing. Based on the history taken and clinical examination, she was diagnosed as a case of Tamaka Shwasa, having suffered from it since, the age of five. The child was treated according to the treatment protocol cited in classic text books of Ayurveda that is Virechana and other medications, for a period of two months, divided into two sittings. After two months, there was a notable decline in clinical features, such as cough, breathlessness, and cold, as reported by her mother. Additionally, there was a decrease in the eosinophil count. The present case study demonstrates the role of Ayurveda in the management of bronchial asthma.

Cold Urticaria: An Under-recognised Cause of Perioperative Anaphylaxis

Monika, Himani, Monica Chhikara, Akshay Jaswal, Vivek Singh Kataria Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Anaphylaxis is a rare but severe, potentially life threatening allergic reaction which commonly presents with cutaneous to multi-system involvement. The overall incidence rate of anaphylaxis during general anaesthesia varies greatly, ranging from 1:20,000 to 1:38. Cold urticaria, subset of chronic urticaria, is characterised with the presence of localised wheals to systemic and anaphylactic reactions. Physical urticaria can be due to physical stimuli such as friction, pressure, sun exposure and cold. Cold urticaria mainly comprises of physical urticaria rather which ranges from 3-33.8% with a higher incidence in cold climate. A case of physical cold urticaria was reported during perioperative period in a 40-year-old male who was posted in urology OT for a planned Ureteroscopy (URS). On pre-anaesthetic evaluation, patient’s medical, surgical and personal history found to be inconclusive. Patient was fit for surgery under ASA grade 1 and advised to be kept nil per orally for six hours for solid food and two hours for clear fluid. At the conclusion of surgery, patient developed shivering and was managed with warm blankets and radiant heater. After some time, patient develop wheals over chest, abdomen and lower back. Patient was managed with warm fluids, warming the patient, maintaining ambient OT temperature and drugs like injection pheniramine, epinephrine and dexamethasone to prevent catastrophic reaction. Through evaluation during preoperative period plays a key role in anticipation of these kind of untoward events. This case report describes the occurrence and management of this rare condition.

Adult Onset of Subacute Sclerosing Panencephalitis- A Case Report

Kedar S Takalkar, Pooja Raikar, Parag R Aradhey, Jiwan Kinkar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Subacute Sclerosing Panencephalitis (SSPE) is a rare, slowly progressive disorder that affects the entire nervous system. It primarily involves the cerebral cortex, subcortex and optic nerves. Caused by a mutated strain of the measles virus, the disease is mostly irreversible and devastating. It presents with gradually progressive cognitive impairment, extrapyramidal symptoms and sometimes seizures. Although commonly seen in unvaccinated children, SSPE of adult onset is uncommon. The disease is fatal and currently has no treatment. There have been many different presentations of this disorder, ranging from optic nerve involvement to gradual cognitive decline, but none have a good prognosis; ultimately, patients may become akinetic and mute. Here, the authors present an uncommon case of SSPE occurring at an older age (26-year-old male), with a rapid and atypical presentation resembling severe post-viral syndrome, which was later diagnosed as SSPE.

Early Onset Felty Syndrome in Rheumatoid Arthritis: A Case Report

Abhishek Kumar, P Harikrishnan, Manish Manrai, Abhinav Kumar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Felty syndrome is a rare and serious complication of Rheumatoid Arthritis (RA), characterised by a triad of RA, splenomegaly (enlarged spleen), and neutropenia (low neutrophil count). RA, a systemic autoimmune inflammatory disease marked by synovitis, commonly occurs in the fifth or sixth decade of life and often affects patients with a history of RA exceeding ten years. It is more prevalent in the Caucasian population due to the underexpression of the Human Leukocyte Antigen (HLA)-DR4 gene in African Americans. Felty syndrome requires the presence of neutropenia, defined as an Absolute Neutrophil Count (ANC) below 2000 cells/mm³, alongside splenomegaly and long-standing RA. Hereby, the authors present a case report of a 44-year-old female with a three-year history of RA, who presented with ascites for nine months and was found to have portal hypertension. Her diagnosis of Felty syndrome was confirmed based on the triad of RA, neutropenia, and splenomegaly, highlighting the importance of early recognition and management to prevent severe complications such as infections and systemic issues like portal hypertension.

Posterior Reversible Encephalopathy Syndrome with Addison’s Disease in a Known Case of Arnold Chiari Malformation

Satbir Kaur Malik, Sangram S Mangudkar, Mahabir Mishra, Sanket Genuji Shinde Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Posterior Reversible Encephalopathy Syndrome (PRES) is a life-threatening neurological disease. The aetiology of Addison’s disease has been modified from infectious to autoimmune pathology. Underlying pathogenesis is insufficient production of glucocorticoids and mineralocorticoids. Case series with PRES syndrome and Cushing’s syndrome have been reported but PRESS with adrenal insufficiency is rarely published. We hereby report an operated case of Arnold Chiari malformation presenting with first episode of generalised tonic clonic seizure and diarrhoea for four days. Postictal confusion was present for two hours. She was previously diagnosed with Addison’s disease. Patient had hypotension and dyselectrolytaemia. Systemic examinations were within normal limits. MRI brain revealed features of PRES. The authors encountered certain challenges in her management which included persistent hypokalaemia, hypocalcaemia and hypotension. Patient is on regular follow-up and she is currently asymptomatic. Prompt diagnosis of PRES and intensive case treatment is a must for the betterment of prognosis.

A Case of Haemorrhages caused by Multiple Myeloma Induced Factor Deficiencies: A Bleeding Enigma

Abhijith Lakshman, Febe Renjitha Suman, Gramani Arumugam Vasugi, Uma Lakshmi Ramdoss Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X A 74-year-old male patient presented with anaemia, thrombocytopenia, and extensive haemorrhages over both thighs and back. A coagulation work-up revealed markedly elevated Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT). Reduced functional values of fibrinogen as determined by clot-based assay (126.4 mg/dL), as well as factor V (17.5%) and factor X (27.8%), were noted. These abnormalities were corrected by mixing studies with normal plasma. Neoplastic plasma cells were seen in the bone marrow biopsy, while abdominal fat biopsies showed no amyloid deposition. Serum electrophoresis and immunofixation were positive for monoclonal gammopathy. The patient was diagnosed with multiple myeloma complicated by multiple acquired factor deficiencies. The patient showed a complete response within six months of treatment, which included bortezomib and cyclophosphamide. Multiple myeloma is a monoclonal proliferation of plasma cells that results in increased production of free immunoglobulin light chains, resulting in increased paraproteins. These paraproteins bind with and inhibit various clotting factors, resulting in their inactivation and depletion. Factor X deficiency in these cases is usually attributed to concomitant amyloidosis, whose fibrils bind to Factor X. However, these deficiencies can occur in the absence of amyloidosis as well. While various reports of this entity have highlighted isolated factor deficiencies including factors V, VII, IX, and X, multiple factor deficiency is a rare occurrence, with no other cases being reported from southern India.

Netarsudil Associated Limbal Follicles: A Case Report

Rinky Thakur, Lalit Mohan, Bibhuti Prassan Sinha Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Primary Open Angle Glaucoma (POAG) is one of the leading causes of irreversible blindness worldwide. Netarsudil, a Rho-kinase inhibitor and norepinephrine transporter, has recently been approved for reducing intraocular pressure (IOP), which is the single most clinically modifiable risk factor for this condition. Here, a case of a 53-year-old female with POAG who developed follicles along the corneal limbus following treatment with Netarsudil eye drops has been reported. The patient had been non-compliant with her POAG treatment for the past five years and presented with diminished vision (right eye greater than left) and raised IOP of 28 mmHg and 26 mmHg in the right and left eyes, respectively. The patient was started on Netarsudil (0.02%) eye drops once daily. After three weeks, the IOP had reduced to 19 mmHg and 18 mmHg in the right and left eyes, respectively; however, the patient still complained of itching and redness. A slit-lamp examination showed few follicular lesions on the limbus. Initial treatment for allergic conjunctivitis was ineffective, leading to a worsening of symptoms. Netarsudil was then discontinued, and dorzolamide was initiated instead, resulting in the resolution of symptoms within one week. The patient continued on dorzolamide without further issues. While Netarsudil is effective in reducing IOP, many of its potential adverse effects may still be unknown due to limited clinical experience. The present case report aims to contribute to the understanding of the safety profile of this drug. More such reports in the future will enhance this knowledge and help clinicians manage similar adverse situations.

Refracture of the Forearm Bones at the Same Site Three Months after Implant Removal: A Case Report

Saahil Singh, Nareshkumar Satyanarayan Dhaniwala Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Refracture at the same site after implant removal is a rare complication, as fractures generally occur close to the plate end due to stress concentration. The reported case involves a patient with refractures of forearm bones at the previous site three months after implant removal. A 48-year-old, right-handed man complained of pain and swelling in his right hand after falling on a wet floor. He had a history of a similar injury three years earlier and was treated with plate osteosynthesis. The plates were removed three months before the present trauma. Radiographs revealed fractures of the distal one-third radius and distal one-fourth of the ulna with evidence of previous screw holes. He has been treated with a Low-contact Dynamic Compression Plate (LCDCP) and remains under follow-up. Refracture three months after implant removal at the site of the previous fracture site in both bones is a very rare occurrence and the present case report highlighted the importance of making a proper decision regarding union, when considering implant removal and post-implant removal care.

Challenges in Ventilation during Total Intravenous Anaesthesia in Patients with Laryngectomy Stoma: A Case Report

Saely Shekhar Paunikar, Vivek Chakole, Sanjot Ninave, Sambit Dash Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X The complete excision of the larynx, which includes the hyoid, epiglottis, and varying segments of the upper trachea, is known as a total laryngectomy. This procedure creates a defect that necessitates pharyngeal correction, as well as the formation of a permanent tracheostomy (tracheostome). Following a total laryngectomy, the trachea is brought to the skin as a stoma, and it is no longer anatomically connected to the digestive tract or oropharyngeal cavity. As a result, bag-mask ventilation, face masks, or nasal cannulas cannot effectively provide oxygen to the lungs. Intubation of the trachea from above the stoma via the oral or nasal route will also be unsuccessful. Hereby, the authors present a unique case of 73-year-old male patient with post-laryngectomy undergoing oesophageal dilation under Total Intravenous Anaesthesia (TIVA). Various challenges encountered while ventilating a patient with a laryngectomy stoma during TIVA has been discussed. Authors also emphasised various methods that can be considered for assisting ventilation in emergency scenarios.

Iatrogenic Tracheo-oesophageal Fistula in a Teenage Girl: A Case Report

Subramanya Kattepura, Apurva Bhaskar, Sowmya Gopinath Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Acquired Tracheo-oesophageal Fistula (TEF) is a known entity in the paediatric age group; however, epidemiological data regarding this condition are sparse. Iatrogenic TEF is uncommon, present case is of a 14-year-old girl who is wheelchair-bound and on percutaneous gastrostomy feeding. She presented to the outpatient department with recurrent lower respiratory infections lasting more than six months. She is a known case of cerebral dural venous sinus thrombosis (CVT) and was artificially ventilated in the intensive care unit for three weeks. As a sequel to her neurological condition, she is paraplegic. Additionally, she experienced choking during each feeding and had bouts of prolonged coughing, which restricted her from taking oral feeds for over six months. Imaging revealed a cervical TEF. She underwent successful closure of this fistula and is now able to eat orally. This teenage girl had a fistula located above the level of the isthmus of the thyroid gland. It may have occurred during her tumultuous course in the intensive care unit, likely due to pressure necrosis of the tissue between the tracheostomy/endotracheal tube and the indwelling feeding nasogastric tube. A literature search did not reveal any similar cases in the paediatric population.

Effective Management of Irritable Bowel Disease (Grahani) through Ayurveda: A Case Report

Shubham Verma, Punam Sawarkar, Gaurav Sawarkar, Shweta Parwe Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Grahani is an important part of the Mahasrotas (gastrointestinal tract). Grahani and Agni (digestive fire) have an Adhara Adheya Sambandha (mutual relationship). Jatharagni (digestive fire) governs the process of digestion, supported by the Tridoshas (three bio-humors). Due to a chronic imbalance of the Pachaka Pitta (digestive fire), Saman Vayu (the air entity that aids digestion), and Kledaka Kapha (the type of phlegm involved in digestion), a weak digestive fire (Mandagni) can lead to the release of food in its undigested form (Ama Utpatti), resulting in Grahani Roga. This condition is accompanied by symptoms (Lakshanas) such as Atisrushta Atibadha Mala (loose or constipated stools), Trushna (thirst), Arochaka (lack of taste), Aasyavairasya (altered taste), Praseka (excessive salivation), Shoona Pada Kara (oedma in the hands and feet), Asthisara Ruk (pain in the phalangeal joints and bones), Chhardi (vomiting), Jwara (fever) and Louhagandhi Amlodgara (burps with an iron-like pungent odour). In the present case of a 38-year-old female patient, the histopathology study revealed ulcero-inflammatory strictured colitis with transmural lymphoid follicles, indicative of Inflammatory Bowel Disease (IBD). According to the basic treatment principles of Ayurveda, Grahani (IBD) can be effectively treated using a combination of Shamana (palliative care) and Shodhana Chikitsa (purificatory procedures). The general approach in Grahani treatment involves the use of Agnivardhana (appetiser) drugs with Deepana (digestive stimulant) and Pachana (digestive aid) properties, which work to enhance the digestive fire (Agni). In the present study, the patient had stopped allopathic drugs, and the Ayurvedic treatment proved to be a safe remedy without any side-effects. The present case study demonstrates the critical contribution of Ayurveda to the effective treatment of Grahani (IBD).

Unusual Audiologic Profile in Unilateral Renal Agenesis: A Case Report

Anusha Rao Subramanian, Subhashini Dhandayutham, Narendrakumar Mariappan Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Unilateral Renal Agenesis (URA) is characterised by the absence of one kidney, and typically manifests asymptomatically due to compensatory hypertrophy of the remaining kidney. The condition is often detected incidentally because routine screening for renal anomalies is not universal globally. URA is generally associated with mixed or sensorineural hearing loss. A case involving contralateral conductive hearing loss is discussed in the present case report. The present case involves a eight-year-old female with isolated URA and no other concurrent abnormalities. The present report highlights an atypical audiological profile in URA, diverging (conductive type of hearing loss) from the commonly observed sensorineural or mixed hearing loss patterns. Understanding such variations contributes to the broader knowledge of the genetic and developmental links between the auditory and renal systems. This case underscores the importance of comprehensive audiological assessments in individuals with renal anomalies, potentially broadening diagnostic considerations and therapeutic approaches.

Maxillary Mucormycosis in a Juvenile Diabetic Patient: A Case Report

Shreya Ghosh, Kishor Hiwale, Priya Chatterjee Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X One of the most fulminant and quickly spreading types of fungal infection, mucormycosis typically starts in the nose and paranasal sinuses after inhaling spores. Orbital and intracranial structures may become infected either directly or through blood vessels, leading to life-threatening complications. This infection most commonly manifests in the rhinomaxillary area, particularly in individuals with immunocompromised conditions like diabetes. Even with appropriate treatment, the disease’s mortality rate can exceed 40%, and it is challenging to detect. The standard treatment plan involves surgical debridement combined with systemically active antifungal medications, depending on the site of infection and risk factors. As a first-line treatment, lipid-based amphotericin B is recommended; however, posaconazole also shows promise. Hereby, the authors present a case report of a 15-year-old male patient with juvenile diabetes mellitus who had been experiencing pain and diffuse swelling in his left malar area for the previous two months. Following a histological analysis and clinical and radiographic evaluation by a multidisciplinary team, the patient was diagnosed with maxillary mucormycosis. Because of the abundant blood supply in the maxillofacial regions; however, more virulent fungi like Mucor can get past this obstacle. The purpose of present article is to show how early detection and treatment of mucormycosis in a young patient could prevent major morbidity and mortality from this potentially fatal illness . Additionally, it aimed to contribute to the local epidemiology of mucormycosis and raise awareness among stakeholders attention to the difficulties in treating this serious condition.

Unravelling Anaesthetic Challenges in Patient with Diffuse Systemic Sclerosis: A Case Report

Madhu, Shally Jain, Vikas Kumar, Anurag Das, Harsh Lakhanpal Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Systemic sclerosis or scleroderma is an uncommon autoimmune condition with a global incidence of 8 to 56 new cases per million per year, which commences from skin and progresses to affect multiple systems in the body. It is marked by abnormalities in blood vessels, sclerosis of connective tissues and atrophy of skin and internal organs. The systemic sclerosis treatment depends on the disease manifestation and are usually treated with vasodilators (for vasculopathy improvement and prevention of Raynaud’s phenomenon), prostacyclin analogues (for the prevention of Raynaud’s phenomenon refractory to oral vasodilators), immunosuppressants like methotrexate, cyclophosphamide, mycophenolate mofetil, low dose corticosteroids (for the treatment of skin hardening, interstitial lung disease and inflammatory arthritis) and antifibrotics like endothelin receptor antagonists (for the treatment of pulmonary artery hypertension). Avascular necrosis in systemic sclerosis can arise as a result of the macrovascular and microvascular effects of vasculitis and corticosteroid therapy. The multisystem involvement of systemic sclerosis can impact every aspect of anaesthetic care especially airway management. During perioperative management, numerous systemic manifestations like pulmonary artery hypertension, interstitial lung disease and cardiac arrhythmia should be considered. The regional anaesthesia serves as a safe alternative to general anaesthesia and useful adjunct in the management of postoperative pain, but can be technically challenging. This case report described a 61-year-old female patient who had a history of systemic sclerosis for past 25 years and was scheduled for a total hip replacement due to avascular necrosis and secondary osteoarthritis of the left hip. The patient was having difficult cannulation, interstitial lung disease and anticipated difficult airway because of microstomia, limited mouth opening and limited flexion and extension at atlantooccipital joint. But the patient was successfully managed with combined spinal epidural anaesthesia, which provided effective pain control and minimised the perioperative risk associated with general anaesthesia.

Entomophthoramycosis of Thigh: A Case Report with Review of Literature

Sruthi Kandaswamy, Manjiri Dilip Phansalkar, Gayathri Priyadharshini, Nirmal Kumar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Entomophthoramycosis is a sporadic, slow-growing subcutaneous infection that includes two distinct clinical forms: Basidiobolus ranarum (subcutaneous) and Conidiobolus coronatus (Rhinofacial), common in tropical countries like India. A 20-year-old male presented with painless progressive swelling of the anterolateral aspect of the right thigh, with a history of Incision and Drainage (I&D) not responding to antibiotics. A clinical diagnosis of a soft-tissue tumour was made. Magnetic Resonance Imaging (MRI) showed a subcutaneous lesion with inflammatory changes and overlying skin changes. Core biopsy showed spindle cells. Surgeons proceeded with a wide local excision of the lesion. Histopathology {Haematoxylin and eosin (H&E), Grocott Methenamine Silver stain (GMS), Periodic Acid Schiff stain (PAS)} proved to be subcutaneous zygomycosis showing Splendore-Hoeppli phenomenon. The patient was then started on antifungal treatment followed by skin grafting. In the present case, the granulomatous inflammation was not picked up in multiple random core biopsies and hence, a wide excision was done, leading to an avoidable extensive surgery.

Atypical Manifestations of Syphilis: A Case Series

BT Priya, R Sowmiya, Anandan Venkatesan, Ragini Rajan, M Deepa Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. Given the recent worldwide resurgence of syphilis, it is imperative to recognise various presentations of this great imitator. Apart from the classic ulcerative lesion of primary syphilis, known as a hard chancre, atypical presentations mimicking other diseases are also reported. A patient with carcinoma of the lip who was scheduled for surgery was diagnosed with an extragenital chancre during routine presurgery screening, leading to a change in the treatment plan for the patient. Other patients were initially treated for conditions such as scrotal eczema, psoriasis, and herpes before the correct diagnosis was made. Rare presentations, such as pustular lesions, paraphimosis, and cord-like thickening of the penis, were also observed in this case series. It is important to recognise these atypical manifestations, as doing so may facilitate early diagnosis and prompt management. Nine cases of syphilis in patients who exhibited atypical manifestations are presented in this case series and were diagnosed based on a high index of suspicion aided by laboratory confirmation.

Collagen-based Mesh in the Treatment of Posthernioplasty Mesh Infection in Ventral Hernias: A Case Series

Naveen Narayan, KN Rajesh, Chethan Shivannaiah, Suhas N Gowda Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Posthernioplasty mesh infection in ventral hernias presents significant clinical challenges, including increased morbidity and prolonged treatment courses. The use of Surgicoll-Mesh® (collagen-based) in the management of infected posthernioplasty abdominal wounds has yet to be explored. It is thought to offer potential advantages in reducing infection rates and promoting tissue integration. Here, a case series showcasing the successful treatment of three patients with infected posthernioplasty abdominal wounds using Surgicoll-Mesh® to cover the defects is presented. All three cases demonstrated excellent outcomes, including resolution of infection, effective wound healing and no recurrence of hernias. This series highlights the potential of Surgicoll-Mesh® in managing complex abdominal wall infections.

Giant Haematometrocolpos due to Postvaginoplasty Stenosis

Pabbisetty Sushma, Jaya Selin Praveena Joseph, Mohan Shobana Aparna, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X

Keratinocytic Verrucous Epidermal Nevi in a Child

Shivani Deepak Jangid, Bhushan Madke Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X

Thunderclap Headache in a Patient with Dengue

Krishnan Balagopal, Jeyaseelan Nadarajah, Baishyak Renuji, Riya Ann Koshy, Aswin Chembodi Gopalakrishnan Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X

Post-traumatic Myositis Ossificans: Rare Case Diagnosis Through Histopathology

Simran Khan, Shakti Sagar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Anjali Garg, Abhijit Pratap Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X

Comparison of Transdermal Nitroglycerine Patch and Oral Nifedipine for Tocolysis in Preterm Labour: A Prospective Interventional Study

Kalpana Kumari, Nahid Lari, Vandana Verma, Shaheen Bano, Vandana Gupta, Soniya Vishwakarma, Pragya Shree Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Preterm labour and delivery have a major contribution to perinatal mortality and morbidity. Tocolytic therapy reduces neonatal mortality and morbidity by prolonging gestation, allowing for corticosteroid administration and in-utero transfer to a tertiary care centre. There is a need to find out better tocolytic agent that is most effective and with the least side-effects. Aim: To compare oral Nifedipine and transdermal Nitroglycerine patch to achieve tocolysis in preterm labour. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, from January 2020 to June 2021. A total of 100 women presenting with signs and symptoms of preterm labour with live singleton pregnancy and intact membranes were included. All the women were divided into Group-A (n=50) and Group-B (n=50). Group-A received oral Nifedipine 20 mg of oral initially and 10 mg Nifedipine repeated after 30 minutes if the contractions persisted. Oral Nifedipine 10 mg was repeated every six hours till contractions subsided, and a transdermal Nitroglycerin patch (25 mg) was directly applied to the skin of the abdomen in Group-B. Demographic profile, the number of patients in which tocolysis was successful, improvement in Bishop score, prolongation in gestational age, maternal side-effects, and foetal outcomes in the form of birth weight, APGAR score, and NICU admission were recorded in both the groups on Excel sheet. Chi-square test and t-test were used to test the significance of the difference between categorical and continuous variables respectively. A p-value less than 0.05 were taken as significant. Results: In Group-A 94% (47 out of 50) achieved tocolysis while in Group-B 86% (43 out of 50) achieved tocolysis (p value-0.182). The mean prolongation of pregnancy was 17.70±13.04 and 13.14±11.03 in Groups A and B, respectively. The maternal complication was significantly higher in Group-B as compared to Group-A (22% Vs 6%, p-value-0.0097). In Group-A mean birth weight was 2.422 kg ±0.34 whereas in Group-B mean birth weight was 2.204±0.38 Kg (p-value-0.0032). Conclusion: Both drugs oral Nifedipine and transdermal Nitroglycerine were found to be effective in the treatment of preterm labour.

Reflective Capacity of CBME Batch Undergraduate Medical Students in Comparison to Non CBME Batch Students Pursuing Internship in a Medical College of Central India: A Mixed-method Cross-sectional Study

Diwakar Dhurandhar, Swanand Pathak, Tripti Chandrakar, Vaibhav Anjankar, Adarshlata Singh, Jagriti Agrawal Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Reflection facilitates the enhancement of critical thinking and profound learning through obtaining a greater understanding of oneself and the circumstances at hand. There is a limited amount of published literature evaluating the reflective abilities of medical students in India. Aim: To evaluate and compare the reflective abilities of Competency-based Medical Education (CBME) batch MBBS students in Phase III, part 2, with non CBME batch MBBS students currently undertaking their internship by administering the Reflective Practice Questionnaire (RPQ) and via Focus Group Discussions (FGD). Materials and Methods: The present mixed-method cross-sectional study was conducted from January to August 2023 among 171 CBME batch and 129 non CBME batch MBBS students studying at Pt. JNM Medical College, Chhattisgarh, India. The RPQ consists of 40 items designed to evaluate not just the reflective abilities of a study group but also to gauge various other related psychological attributes. The mean values of each subscale were estimated and compared between the CBME and non CBME batches and analysed using the non parametric Mann-Whitney U test, with a p-value <0.05 considered significant. FGDs were also conducted for confirmatory and exploratory purposes. Also, feedback regarding the implementation of training on reflection and future course correction was taken from the study participants in FGD. Results: The mean age of students in the CBME batch and non CBME batch was 22.5±0.95 years and 24.1±0.36 years, respectively. The mean values of the confidence communication subscale of RPQ in the CBME and non CBME batches were 3.78±0.728 and 4.04±0.749 respectively, with a p-value of 0.002. The mean values of the Job Satisfaction (JS) subscale in CBME and non CBME batches were 3.86±0.728 and 3.90±0.789, respectively, with a p-value of 0.003. Conclusion: There was no significant difference between the two groups, except for the two aforementioned subscales, in which mean values in the non CBME batch were significantly higher. FGD, apart from confirming the above findings, also suggested the introduction of an e-logbook and effective assessment through it.

Perception of First-year Medical Students’ Regarding Five Microskills of the One-minute Preceptor Model in Early Clinical Exposure: A Quasi-experimental Study

Mangala N Sirsikar, Shrabani Mohanty, Aga Ammar Murthuza Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Early Clinical Exposure (ECE) bridges the gap between theory and practice for medical students. The One-minute Preceptor (OMP) model, a widely used clinical teaching framework, promotes effective feedback and critical thinking efficiently. It employs five microskills: commitment, evidence probing, teaching rules, reinforcing correct actions, and correcting mistakes. This structured approach enhances clinical teaching in limited time, particularly in outpatient and ambulatory settings. Aim: To evaluate the perceptions of first-year MBBS students regarding the effectiveness of the five microskills of the OMP model during ECE. Materials and Methods: A quasi-experimental study was conducted at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, from September 2019 to June 2020, involving 188 first-year MBBS students. Data were collected through questionnaires focusing on the OMP’s five microskills. Pretest and post-test scores were compared, and session feedback was obtained using a validated 10-item questionnaire. Paired t-tests and Analysis of Variance (ANOVA) were used for statistical analysis. Results: The study sample comprised 102 females and 86 males students (mean age 19.2 years). Results showed a significant increase from pretest (10.55±4.4558) to post-test (22.29±1.687). Students reported improvements in diagnostic capabilities (67.6%), understanding of clinical history (64.9%), self-directed learning (60.6%), critical thinking (58%), clinical reasoning (57.5%), and decision-making confidence (52.1%). The OMP also promoted motivation for rectifying mistakes. Conclusion: ECE using the OMP model proved to be effective in enhancing various aspects of students’ clinical skills and reasoning abilities. The study recommends including the OMP in preclinical competency-based curricula to prepare students for busy clinical practice and outpatient settings.

Histopathological Study of Obstructive Lesions of Small and Large Intestine: A Cross-sectional Study in Uttarakhand, India

Swati Pundir, Prabhat Pant, Vindhya Joshi Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Intestinal obstruction is the impairment or arrest of the passage of contents through the intestine. Tubercular aetiology is the commonest cause of small intestinal obstruction in developing countries, while postoperative adhesions are common in developed countries. Neoplastic aetiology is more common in Large Bowel Obstruction (LBO). Clinical and radiological findings are non specific, and histopathology is required for a definitive diagnosis of the aetiology. Aim: To study histopathological examination of obstructive lesions of the small and large intestine. Materials and Methods: The present cross-sectional study was conducted from January 2020 to September 2021, including a total of 77 cases of intestinal obstruction due to mechanical causes. Detailed gross and microscopic examinations were performed, along with routine and special stains (wherever required), in the Department of Pathology at Government Medical College, Haldwani, Nainital, Uttarakhand. Data were presented in numbers and percentages. Results: The present study showed a male predominance 46 (59.8%) with a male to female ratio of 1.5:1. The most commonly affected age group was 31-40 years 20 (25.9%). Constipation (76; 98.7%) was the most common clinical symptom, followed by abdominal pain 72 (93.5%). The small intestine was more commonly involved 35 (45.5%), with the ileum being the most commonly affected site 40 (53.2%). Among cases of large intestine obstruction, the caecum was the most common site 10 (14.2%). Perforation was the most common gross finding 25 (32.9%). Non specific inflammatory pathology was the most common cause of obstruction (23.5%), followed by adenocarcinoma (20.8%). Tubercular pathology was the third most common cause (11.9%). Conclusion: The present study highlights the important pathologies in the aetiology of obstruction. Prevention and early intervention can help control some of the infective diseases and avoid such emergencies. Early diagnosis and treatment of neoplastic pathology, which is a leading cause of LBO, are beneficial for the better management of patients. A detailed histopathological study of small intestinal specimens should be conducted in constant correlation with clinical and radiological findings for an accurate diagnosis.

Initiation and Continuation of Antitubercular Therapy during Early COVID-19 Pandemic Period in Sonepat, Haryana, India: A Cross-sectional Study

Murugadass Narendran, Anita Punia, Ramesh Verma, Deepika Kataria Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has halted the progress of India made towards the ambition of achieving Tuberculosis (TB)-free status by 2025. Steps taken to control the disease have affected many national health programs, including those for TB. Aim: To understand the delays in diagnosing and initiating therapy among TB patients receiving Antitubercular Therapy (ATT) during the early COVID-19 pandemic period. Materials and Methods: This was a cross-sectional study conducted in the Sonepat District of Haryana state, India. The study was conducted among 20% of the total Nikshay Portal-notified TB patients who received treatment from the public sector in the second and third quarters of 2020. Data was collected using a pretested semistructured schedule consisting of variables related to demography, past medical history, symptoms leading to TB diagnosis, place of diagnosis, time between symptom onset and diagnosis, duration taken for initiating therapy, and reasons for delays. The Chi-square test and Fisher's exact test were used to test the significance of the differences. A p-value <0.05 was considered significant. Results: ‘Diagnostic Time delay’ was observed among 86 (35.1%) of the participants, with a 30-day median delay. ‘ATT initiation delays’ were observed in 51 (20.8%) with a four-day median delay, and 23 (8.6%) of patients reported at least one episode of treatment interruption. ‘Being diagnosed for other diseases’ 70 (28.6%) and ‘ignoring symptoms’ 28 (11.4%) constituted the major reasons for ‘Diagnostic time delay’. The non availability of drugs 11 (47.8%) and discomfort with drugs 07 (30.4%) were the major reasons for treatment interruption. Conclusion: Ignorance of symptoms and suspicion of other diseases constituted diagnostic delays, and therapy initiations were prolonged more during the pandemic period.

Comparison of Analgesic Efficacy of Levobupivacaine with or without Dexamethasone in Lower Abdominal Surgeries under Subarachnoid Block: A Pilot Randomised Controlled Trial

Rajesh Singh Rautela, Vibhor Gupta, Rachit Singhal, Rashmi Salhotra, Asha Tyagi, Naveen A Mathew Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Subarachnoid Block (SAB) is a commonly used technique for lower abdominal surgery. Dexamethasone has been proven effective as an additive when used with bupivacaine. However, there has been no study comparing the analgesic efficacy of dexamethasone with levobupivacaine under SAB. Aim: To compare the analgesic efficacy of levobupivacaine with or without dexamethasone in patients scheduled for lower abdominal surgeries. Materials and Methods: A pilot randomised double-blind controlled trial was undertaken in the Department of Anaesthesiology, University College of Medical Sciences Guru Tagh Bahudur (UCMS-GTB) Hospital, New Delhi, India on 60 patients with Americian Soceity of Anaesthesiolgy (ASA) grade I or II, aged 18-65 years, undergoing lower abdominal surgeries under SAB from January 2021 to August 2022. In Group LS, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with normal saline (1 mL) was administered, and in Group LD, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with 4 mg dexamethasone (1 mL) was given. Patients were assessed for sensory and motor block, haemodynamic parameters, pain score, and side-effects. Unpaired t-tests/Mann-Whitney U tests were used to determine significance. A p-value of less than 0.05 was considered significant. Results: The two groups were comparable in terms of demographic profile. The age in the LS group was 37.80±9.98 years, and in the LD group, it was 38.63±12.37 years. The male-to-female ratio in the LS and LD groups was 17:13 and 21:9, respectively. The weight range in both groups was between 50 to 67 kg. The Basal Metabolic Index (BMI) was 22.40±2.43 kg/m2 and 21.70±2.21 kg/m2 in the LD and LS groups, respectively. All these parameters, including height, had a p-value of more than 0.005, except for the duration of analgesia. The duration of effective analgesia was also longer in the LD group (247.00±36.69 min) than in the LS group (138.50±22.52 min) with a p-value of <0.001. The time of onset of sensory block was 9.13±2.98 minutes in the LD group and 10.30±3.06 minutes in the LS group, which was statistically insignificant. Conclusion: Authors concluded addition of 4 mg (1 mL) of dexamethasone to 2.5 mL of 0.5% isobaric levobupivacaine provides a clinically longer duration of effective analgesia with early onset and better quality of sensory and motor block than 2.5 mL of 0.5% isobaric levobupivacaine alone. Therefore, 4 mg of dexamethasone with 2.5 mL of 0.5% isobaric levobupivacaine is recommended for lower abdominal surgeries under SAB.

Analysing Public-private Partnership Practices for Haemodialysis Services using Collaborative Governance Framework: A Qualitative Study

Masyitoh Basabih, Eko Prasojo, Amy Yayuk Sri Rahayu Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Public-Private Partnerships (PPPs) are viewed as a solution for gaps in healthcare access, quality and affordability. Operational Cooperation (OC) is a common practice in haemodialysis services at regional hospitals in Indonesia. Aim: To analyse the implementation of OC for haemodialysis services at Regional Public Service Agency (RPSA) hospitals from the perspective of collaborative governance. Materials and Methods: This qualitative research utilised interviews, focus groups, and document analysis to explore the implementation of OC from a collaborative governance perspective. The study was conducted at Regional Hospitals, Regional Government Offices, the Ministry of Health, the Ministry of Home Affairs, Medical Device Companies, and the Association of Regional Hospitals of Indonesia from December 2021 to March 2022. Data were collected from in-depth interviews and Focus Group Discussions (FGDs) with 15 informants, including policymakers, hospital managers, and partner companies. Other data included nine national-level and 29 regional-level policy documents. NVivo software was used for coding and to ensure data validity through triangulation. The parameters evaluated included system context, drivers, collaborative processes, and collaboration outcomes according to Emerson’s collaborative governance framework. Results: The implementation of PPP for haemodialysis services at regional hospitals is driven by the need for these services and limited resources. Despite the incomplete policy framework, regional hospitals are taking steps to establish collaboration. Hospitals are streamlining operational process flows, creating a domino effect for other services. Even without a feasibility study, the implementation of PPP in regional hospitals in Indonesia has successfully addressed the community’s need for access to haemodialysis services. Conclusion: The implementation of PPPs in the form of OC has successfully expanded access to haemodialysis services. However, challenges related to policy, human resources, and corruption pose significant obstacles to the implementation of OC.

Reliability and Validity of Gujarati Version of Nomophobia Questionnaire: A Cross-sectional Study

Niyati Nileshbhai Patel, Dhwanit S Shah Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Nomophobia is considered a modern-age phobia whereby individuals fear being without a smartphone. The present study focuses on translating the Nomophobia Questionnaire (NMP-Q) into Gujarati to measure nomophobia. Aim: To assess the reliability and validity of the Gujarati version of the NMP-Q, aiming to enhance research, public health initiatives and clinical assessments. Materials and Methods: This cross-sectional study was conducted from May 2023 to November 2023 at the Department of Physiotherapy, Vidhyadeep Institute of Physiotherapy, Surat, Gujarat, India and comprised two phases: 1) Face and content validation through expert clinical review; 2) Test-retest reliability. Face and content validity of the Gujarati NMP-Q were determined using the consensus method with a total of 200 participants aged between 15-18 years. To assess the reliability of the Gujarati NMP-Q, internal consistency and test-retest reliability were evaluated. Test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC) and internal consistency was calculated using Cronbach's alpha. Results: A total of 200 participants (mean age 17.60±1.40 years) were included in the study. The Gujarati version of the NMP-Q demonstrated excellent test-retest reliability, indicated by a high ICC (0.986) and high internal consistency (0.972). The values for Content Validation Ratio (CVR), Item-level Content Validation Index (I-CVI), Modified Kappa (K) and Proportion of Agreement were all 1. Conclusion: The Gujarati version of the NMP-Q exhibits excellent reliability and good face and content validity. It is deemed adequate and valuable for assessing the level of fear of being without a smartphone in daily life among Gujarati-speaking school students.

Correlation between Pain, Disability, and Quality of Life in Young Adults with Chronic Non-Specific Low Back Pain: A Cross-sectional Study

Priti Mehendale, Madhavan Iyengar, Bhavana Gadhavi, Geeta Bhatt Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Chronic Non-Specific Low Back Pain (CNLBP) is characterized by persistent pain lasting more than 12 weeks. Common contributing factors include sedentary jobs, prolonged periods of inactivity or sitting, and a lack of physical activity. CNLBP can restrict everyday activities such as dressing and bathing, potentially leading to disability and a reduction in the Quality of Life (QOL). Aim: To determine the correlation between pain, disability, and QOL in young adults with CNLBP. Materials and Methods: A cross-sectional study was conducted from November 2021 to June 2024 at the outpatient department of KJ Somaiya College of Physiotherapy. After obtaining approval from the institutional ethical committee and based on the selection criteria, a total of 98 participants were included. The outcome measures utilised in the study included the Roland Morris Disability Questionnaire-24 (RMDQ-24), the World Health Organization Quality of Life Brief Version (WHO QOL BREF), and the Numerical Pain Rating Scale (NPRS) to assess disability, QOL, and pain, respectively. Pearson’s correlation test was employed to determine the correlation between these parameters. Results: The findings of the study indicated non-significant correlation between pain and disability (r=0.0021, p=0.4918), between pain and QOL (r=-0.0016, p=0.9872), and a negative, non-significant correlation between disability and QOL (r=-0.1015, p=0.3196). Conclusion: The study concluded that there was no correlation between pain and disability, QOL and disability. Similarly, a negative non significant correlation was obtained between disability and QOL in young adults with CNLBP.

Study of VEP in Ethambutol Optic Neuropathy: A Cross-sectional Study

Sofiza Mohmedsaleem Chandniwala, Jasmin Shankarlal Diwan, Neeta C Mehta, M Saifee M Chandniwala Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: One important first-line drug for treating Tuberculosis (TB) is Ethambutol (EMB), which carries a built-in risk of causing optic neuropathy, potentially resulting in permanent visual impairment. The subjective tests currently used in the diagnostic process, such as visual acuity and visual field assessments, may overlook early changes in visual function. The purpose of the present study is to investigate how well Visual Evoked Potentials (VEP) work as an evaluation tool for identifying optic neuropathy. Aim: To assess the utility of VEP in detecting subtle changes in visual function due to EMB-induced optic neuropathy. Materials and Methods: The cross-sectional study conducted at the Department of Physiology, B.J. Medical College, Ahmedabad, Gujarat, India, over approximately five months (August 2023 to December 2023) involved 62 eyes, with 30 eyes from TB patients undergoing EMB treatment and the rest serving as a control group. VEP recordings were made using a Personal Computers (PC)-based, 2-channel Recorders & Medicare Systems Pvt Ltd Nerve Conduction Velocity (NCV) Electromyography (EMG) Mark II machine with standard silver-silver chloride disc electrodes. VEP recordings were conducted regardless of the treatment period and the analysis focused on the amplitude and latency of the P100 wave, a critical component of VEP. Statistical analysis was carried out using Student’s unpaired t-test to compare the results between both groups, with p-values calculated. Results: The mean age of case was 40±17.4 years and controls was 31.12±12.54 years. The study revealed changes in VEP parameters, specifically showing a progressive reduction in P100 amplitude (p-value=0.0001). Conclusion: The present research highlights the potential of VEP as a sensitive and reliable method for assessing EMB-induced optic neuropathy. Incorporating VEP into routine ophthalmologic assessments for patients receiving EMB could improve TB management while reducing the risk of vision loss.

The Impact of Bariatric Surgery on Social Support, Resilience and Quality of Life: A Prospective Cohort Study

Vidhi Monga, Rayees Mohammad Bhatt Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Obesity has become a global health concern, with significant health risks and psychological consequences. Bariatric surgery has gained popularity as an effective treatment for morbid obesity. Therefore, with the increase in these diseases, it becomes crucial for people to manage their health and quality of life better. This study was planned to focus on the impact of bariatric surgery on quality of life, with a specific emphasis on social support and resilience. Aim: To investigate the impact of bariatric surgery on quality of life, with a focus on social support and resilience. Materials and Methods: This prospective cohort study was conducted at the Ckosmic Surgical Center in Moga, India, from June 01, 2022, to July 30, 2023. It included sixty participants who underwent pre- and post-assessments, comprising demographic data and psychological surveys. The inclusion criteria for this study were patients who had undergone bariatric surgery, had a BMI over 40 Kg/m2 or BMI over 35 kg/m2, were obese, and were aged between 18-65 years. By utilising the World Health Organisation (WHO) quality of life survey, this study compared pre and post-surgery results. The Statistical Package for Social Sciences (SPSS) analysis was employed to provide a more comprehensive evaluation of the results derived from complex datasets. Results: The results indicated significant improvements in quality of life and resilience following surgery, with a p-value of 0.01. However, social support remained stable, with no significant changes in scores. These findings contribute to the evidence supporting the benefits of bariatric surgery in treating morbid obesity. Conclusion: Bariatric surgery can enhance social support and resilience among obese patients. Therefore, the utilisation of surgeries such as One-Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) can offer substantial benefits in terms of both health outcomes and social support or resilience.

Safety and Efficacy of Bacillus coagulans SNZ 1969® Probiotic Supplementation in Reducing Infections in Malnourished Children: A Randomised, Double-blind, Placebo-controlled Study

MJ Fernandes, BR Daswani, AA Kinikar, RJ Soman Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Malnutrition, a significant global health challenge, increases children’s susceptibility to infections due to compromised immunity and altered gut microbiota. While probiotics have shown potential in improving gut health and immune responses, their efficacy in malnourished children, particularly those using Bacillus coagulans strains, remains understudied. Aim: To investigate the safety and efficacy of Bacillus coagulans SNZ 1969® among malnourished children aged between one and five years. Materials and Methods: A randomised, double-blind, placebo-controlled study was conducted at Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon Hospitals in Pune, Maharashtra, India among paediatric patients in the outpatient setting, after obtaining ethics committee clearance. Malnourished (moderately underweight) children were randomly allocated to either the probiotic group (B. coagulans SNZ 1969®) or the placebo group receiving the respective treatment for a duration of three months. Total days of illness, as well as the incidence of Gastrointestinal Tract (GIT) and Respiratory Tract Infections (RTIs), were assessed. Results: Out of 82 enrolled children, 46 (24 in the probiotic group and 22 in the placebo group) completed the full three-month study. A significant reduction in the total days of illness was observed in the probiotic group (p-value=0.009). Additionally, the probiotic group exhibited a slightly lower frequency of GIT and RTI episodes compared to the placebo group (1.32 vs. 1.48, p-value=0.077). A trend towards fewer days with respiratory symptoms in the probiotic group was noted compared to the placebo group (6.12±2.19 vs. 7.56±3.65; p-value=0.0687), along with a non significant decline in the occurrence of RTIs at the 31-60 and 61-90 day periods. Similar declining trends were observed for the occurrence of GI infections and total days with GI symptoms between the two groups (0.24±0.88 vs. 0.53±1.2; p-value=0.4593). B. coagulans SNZ 1969® treatment was well-tolerated, and no severe adverse events were reported. Conclusion: The study demonstrated a significant reduction in the total days of illness with B. coagulans SNZ 1969® treatment compared to placebo. Additionally, B. coagulans SNZ 1969® treatment was found to be associated with a non significant decrease in the occurrence of GI and RTIs, as well as a relatively shorter duration of infection among malnourished children under five years of age.

Role of Atorvastatin in the Development and Progression of Glucose Intolerance in Albino Rabbits: An In-vivo Experimental Study

Sansita Parida, Trupti Rekha Swain, Sabita Mohapatra Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Type 2 diabetes is associated with obesity and dyslipidemia, which are risk factors for cardiovascular disease. The Food and Drug Administration (FDA)-approved indications for statins are being broadened due to their lipid-lowering and pleiotropic effects; statins are currently among the most widely used drugs in patients with and without diabetes. Aim: To evaluate the role of atorvastatin at different doses in the development and progression of glucose intolerance or diabetes in albino rabbits. Materials and Methods: An in-vivo experimental study on rabbits was conducted over a total duration of eight months in the Department of Pharmacology at SCB Medical College, Cuttack, Odisha, India. The animals were divided into five groups of six rabbits each. Atorvastatin at 4 mg/kg and 2 mg/kg was calculated based on human doses corresponding to 80 mg and 40 mg, respectively. Both doses were administered to non diabetic rabbits, and 4 mg/kg atorvastatin was administered to alloxan-induced diabetic rabbits orally for six months daily. Diabetes was induced in two groups of rabbits by administering 100 mg/kg alloxan monohydrate in a 5% (w/v) solution in sterile saline intravenously. Rabbits with stabilised moderate diabetes, characterised by a fasting blood glucose level above 200 mg/dL (at least one month after alloxan injection), were used for the experiments. The effect of atorvastatin on glucose tolerance was assessed by determining Fasting Blood Sugar (FBS) and Glycated Haemoglobin (HbA1c) levels. The results were compared with those of normal and diabetic control rabbits and statistically analysed using Analysis of Variance (ANOVA) and Repeated Measures ANOVA (RMANOVA), followed by appropriate post-hoc analysis. Results: Atorvastatin at a high dose resulted in a 26.74% increase in FBS and a 20.50% increase in HbA1c; at the standard dose, it produced a 21.3% increase in FBS and a 17.99% increase in HbA1c, respectively. The diabetic group receiving high doses also showed a significant increase in FBS (11.7%) and HbA1c (10.25%). The increase in blood glucose parameters was significant in the high-dose group from the fourth month of statin therapy and in the standard-dose group at six months of therapy. Conclusion: The study revealed that atorvastatin at both doses significantly contributed to the initiation and progression of glucose intolerance in diabetic and non diabetic rabbits.

Evaluation of Drug Prescription using WHO Prescription Indicators at a Tertiary Care Teaching Hospital, Raipur Chhattisgarh, India: A Cross-sectional Study

Shikha Jaiswal, Nalini Singh Chandra, Manju Agrawal, Raka Sheohare, Ajitesh Mishra Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Prescription patterns significantly impact healthcare quality and patient outcomes. Evaluating these patterns using World Health Organisation (WHO) indicators helps identify areas for improvement and ensures rational drug use. The present study was conducted to evaluate prescription patterns via WHO indicators, aiming to uncover insights, identify discrepancies and enhance prescription quality within the institute for improved healthcare outcomes. Aim: To evaluate drug prescription patterns using WHO prescription indicators in the prescriptions of outdoor patients at a tertiary care teaching hospital in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India, from July 15, 2023, to October 15, 2023 (a duration of 3 months), involving 1,000 outpatient prescriptions at Dr. Bhimrao Ambedkar Memorial Hospital (BRAM), Raipur, Chhattisgarh. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) (No./MCI/Ethics/2023/45 Raipur, dated 12/07/2023). Data were collected using a digital form and analysed statistically. Parameters evaluated included the average number of medicines per prescription, the percentage of drugs prescribed by generic name, the percentage of prescriptions containing antibiotics, the percentage of prescriptions containing injections, and the percentage of drugs prescribed from the Essential Drug List (EDL). Descriptive statistics were used to summarise the data, and analysis was performed using Microsoft (MS) Excel 2021. Results: The present study included 1,000 prescriptions. A total of 4,320 medicines were prescribed across these prescriptions, with 2,853 (66.04%) prescribed by their generic name. Injections accounted for 483 (11.18%) prescriptions, while antibiotics were included in 663 (15.34%) prescriptions. Additionally, 2,973 (68.81%) medicines were prescribed from the EDL. The average number of medicines prescribed per prescription was 4.3. Conclusion: The study revealed that while certain aspects of prescription practices aligned with WHO indicators, notable discrepancies persisted. The percentage of antibiotics prescribed per prescription was in accordance with WHO guidelines. Strategic measures are needed to enhance prescription practices and align them more closely with WHO guidelines.

Evaluation of GATA3 and p53 Expression in Urothelial Carcinoma and their Association with Clinicopathological Parameters: A Cross-sectional Study

Anjali Agarwal, Goutami DasNayak, Urmila Senapati, Jagat Ballav Jagdev, Sarojini Raman Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Bladder cancer is the tenth most common cancer worldwide, with 90% of bladder cancers are Urothelial Carcinoma (UC). In India, its incidence is 1.6 per lakh population annually. GATA3 is a recently used immunohistochemical marker which is highly sensitive for UC. Alterations in the p53 pathway play an important role in tumour progression and the assessment of prognosis. Aim: To study the expression of GATA3 and p53 in UC and their association with clinicopathological parameters. Materials and Methods: An ambispective cross-sectional study was conducted in the Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from September 2020 to August 2022. A total of 50 cases of histologically proven UC were subjected to immunohistochemistry with GATA3 and p53. The expression of GATA3 and p53 was evaluated in UC, and their association with clinicopathological parameters like age, gender, personal habits, tumour site, symptoms and signs, histological grade, and invasion into lamina propria and muscle was studied. The Chi-square test was used to determine the relationship between all parameters, with a p-value <0.05 considered statistically significant. Results were analysed by standard software (Stata version 23.1). Results: GATA3 expression was observed in 94% (47/50) of cases of UC. GATA3 expression was associated with histological grade and muscle invasion, with 66.7% (4/6) expression in high-grade muscle-invasive UC, compared to 91.30% (21/23) in non muscle invasive UC, and 100% (21/21) in low-grade UC. Additionally, 66.7% (14/21) of low-grade UC showed p53 expression, whereas 80% (24/30) of high-grade UC demonstrated p53 expression. Conclusion: GATA3 is a sensitive and specific marker for UC. Its expression is highly variable among different histological types of UC and decreases with increasing grade of tumour in the study. p53 expression was associated with the histological grade of the tumour and was statistically significant in this study. GATA3 can be utilised to predict the probable grade of the tumour and its behaviour by correlating it with p53.

Diagnostic Performance of p16^ink4a in the Presence of E6/E7 mRNA in Formalin-fixed Paraffin Embedded Specimens: A Cross-sectional Study

Ravindra Pratap Singh, Surendra Kumar Verma Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Clinically significant High-risk Human Papillomavirus (HR-HPV) infection in Oral Cavity Squamous Cell Carcinoma (OCSCC) is not clearly defined. There is uncertainty regarding the true impact of HPV-related variability (ranging from 0% to 100%) when using the GP5+/GP6+/MY09/11 (L1) primer. The identification of HPV DNA in tumours is insufficient to establish a causal viral association; therefore, a gold standard test is required to determine HPV’s role in malignant cells by identifying the transcripts of the E6/E7 mRNA viral oncogene and the p16^ink4a biomarker. Aim: To assess the diagnostic performance of p16ink4a in the presence of E6/E7 mRNA in Formalin-fixed, Paraffin-embedded (FFPE) specimens. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at JIPMER in Puducherry, India, from February 2019 to April 2022. Combined molecular markers p16^ink4a and E6/E7 mRNA (considered the gold standard) from FFPE specimens of newly diagnosed Squamous Cell Carcinoma (SCC) were analysed to identify biologically and clinically relevant Infections using Immunohistochemistry (IHC) and real-time Polymerase Chain Reaction (PCR). Results: This study indicates that tissue samples with p16 positive expression (score of 2 or higher) showed the presence of HPV E6/E7 mRNA, with a sensitivity of 100% and a specificity of 91.67%. The relationship between p16^ink4a and E6/E7 mRNA expression in all OCSCC cases was found to be significant (p-value=0.003). Conclusion: The study found a significant relationship between mRNA and p16^ink4a overexpression in tongue SCC. This finding suggests that alterations in mRNA expression levels are associated with changes in p16^ink4a expression in tongue cancer. Such understanding could potentially aid in the development of diagnostic or therapeutic strategies targeting these molecular pathways in tongue SCC.

Influence of Different Head and Neck Positions on Oropharyngeal Leak Pressure with the LMA Protector Airway: A Cross-over Study

Deepika, Ravipati Prafulla, Susheela Taxak, Vasudha Govil, Anushmita Lallar, Elizabeth James Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: The assessment of seal pressure or leak pressure in supraglottic devices has commonly been used to confirm device functionality and for research purposes regarding laryngeal mask airways (LMAs). When used for controlled ventilation, the LMA Protector provides a better oropharyngeal seal pressure. Materials and Methods: In this cross-over study, thirty-five patients of either sex, aged 18 to 70 years, American Society of Anaesthesiology (ASA) class I and II, with a weight range of 50-70 kg, scheduled for elective surgery under general anaesthesia where a supraglottic airway device was indicated, were enrolled. In all 35 patients, the position of the patient’s head and neck was changed from neutral to flexion, extension, and right and left lateral rotation. The primary objective of the study was to compare the differences in oropharyngeal leak pressure (OLP) with changes in head and neck positions using the LMA Protector airway device. Results: The mean age of the participants was 42.26 years, and the average weight was 63.34 kg. The LMA Protector was placed in 18 females and 17 males. A Mallampati grade of I was noted in 16 patients, while a grade of II was observed in 19 patients. The OLP achieved in this study was higher, providing adequate ventilation and oxygenation in all positions. The OLP and tidal volume in flexion were higher compared to the seal pressure in the neutral position (31.89 cm H2O, SD 5.080 cm H2O vs. 34.49 cm H2O, SD 4.804 cm H2O, p<0.05). No significant difference in OLP was observed when changing to different head positions, i.e., in extension, right lateral, and left lateral positions. Conclusion: The LMA Protector is an effective device in terms of achieving high oropharyngeal seal pressure. It produced better oropharyngeal seal pressure in the flexion position compared to the neutral position.

Evaluation of Behaviour of Child and Acceptance of Multicoloured and Conventional Composite Materials: A Split-mouth Randomised Clinical Study

Nilam Vitthalrao Honaje, Nupur Suresh Ninawe, Arti Rameshwar Dolas, Surendrakumar Kaluram Bahetwar, CK Anija, Suyash Sanjay Joshi Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: The most crucial abilities for a Paediatric Dentist involve evaluating and managing children based on their behaviour. Children are often motivated to choose coloured restorative materials. They tend to hold their new fillings in high regard and are usually fascinated by the new materials in their oral cavity. Consequently, they are more likely to maintain the restoration, which greatly enhances their overall oral hygiene and fosters a favourable attitude towards therapy. Aim: To evaluate the behaviour of children and their acceptance of multicoloured and conventional composite materials: A randomised controlled trial. Materials and Methods: A split-mouth, single-blinded, randomised clinical study was conducted on 25 patients with Class I occlusal caries at the Department of Paediatric and Preventive Dentistry, Government Dental College and Hospital (GDCH), Nagpur, Maharashtra, India, from July 2023 to January 2024. Healthy children aged between 5 and 10 years, who were visiting the dentist for the first time, were selected from the Department of Paediatric and Preventive Dentistry. The chidren were divided in two groups-group 1, 13 (52%) children with blue coloured composite restorations and group 2, 12 (48%) chidren who received conventional composite restorations. Behaviour was assessed using the modified behaviour rating scale before and after treatment. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 16.0 with the Wilcoxon’s Signed-rank Test. Results: Among total of 25 children, 14 (56%) were males and 11 (44%) were females with a mean age of 8.47±1.59 years. There was a significant improvement in the behaviour of children after treatment with blue coloured compomer (p-value<0.001), whereas the change in behaviour in the conventional composite group was non significant (p-value=0.157). Conclusion: Coloured restorative materials, such as blue compomer, show promising results in paediatric dentistry by promoting positive behaviour and satisfaction among children, potentially enhancing oral hygiene practices.

Effectiveness of Nitrous Oxide Inhalation Sedation Utilising Two Distinctive Gas Dissemination Systems in Paediatric Patients Undergoing Pulp Therapy: A Non-randomised, Split-mouth, Crossover Clinical Trial

M Nandini Devi, Ganesh Jeevanandan Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: The success of any dental treatment fundamentally predicated on completing procedures with minimal discomfort and optimal patient cooperation. However, achieving this goal becomes particularly challenging in paediatric patients, whose behaviour is often influenced by a myriad of factors, including fear, anxiety and the unfamiliarity of the dental environment. While non pharmacological behaviour guidance techniques play a pivotal role in managing such challenges, there are instances where they prove insufficient, necessitating the utilisation of pharmacological behaviour management strategies such as Conscious Sedation (CS). Aim: To evaluate and compare the effectiveness of Nitrous Oxide Inhalation Sedation (NOIS) utilising two distinctive gas dissemination systems, the Matrx Porter and the Consed machines, in paediatric patients undergoing pulp therapy. The focus is on assessing patient behaviour, pain perception, and sedation outcomes. Materials and Methods: This non-randomised, split-mouth, crossover clinical trial conducted in the Department of Paediatric and Preventive Dentistry at Saveetha Dental College and Hospital in Chennai, Tamil Nadu, India from June 2022 to August 2022 employed 80 healthy but anxious children, aged 4 to 8 years, who required multiple treatments involving local anaesthetic administration across two consecutive appointments. Informed consent was acquired from their parents to perform a procedure under NOIS. The participants were sedated using the Consed machine (Group-A) during the first visit and the Matrx machine (Group-B) during the subsequent visit. Differences in pain were measured using the Modified Wong Baker’s pain rating scale, and sedation was assessed using the Ramsay sedation scale during local anaesthetic administration, behaviour using Frankl’s behaviour rating scale was assessed before the start of treatment and during local anaesthetic administration. Statistical analysis, performed with the Mann-Whitney test, evaluated pain, behaviour, and sedation levels in children undergoing dental treatment with two distinct gas distribution systems. Results: The mean age of the children included in the present study was 7.3±1.212 years. The study found significant differences in behaviour scores between the two groups at two time points: during local anaesthetic administration (p=0.039) and after completion of treatment (p=0.048). Specifically, during local anaesthetic administration, Group-B showed a higher proportion of children exhibiting improved behaviour compared to Group-A. However, no statistically significant differences were observed in pain scores during local anaesthetic administration (p=0.089) or sedation scores (p=0.074) between the Consed (Group-A) and Matrx (Group-B) machines. Conclusion: There were no observed alterations in the sedation levels of children who underwent NOIS, regardless of whether it was administered by the Consed or Matrx machine.

Comparative Evaluation of Surface Roughness and Colour Stability of Four Different Composite Resins after Application of Desensitising Agents: An In-vitro Study

Simran Rakeshkumar Gupta, Chetana Makade, Pratima Shenoi, Mohit Gunwal, Pratik Burad Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Dentinal Hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. Desensitising agents are regularly used by patients experiencing hypersensitivity, which can affect the physical properties of the existing restorative material. Aim: To evaluate the surface roughness and colour stability of four different types of composite resin restorations after exposure to a desensitising agent. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India from January 2024 to March 2024. Total 56 standardised composite resin discs of size 8×2 mm thickness were prepared using four different types of composites: microhybrid, nanofilled, nanohybrid, and flowable. They were further divided into control and experimental groups based on the application of a desensitising agent, with seven samples in each subgroup. The desensitising agent was applied twice a day for three minutes for one month. Surface roughness was evaluated using a surface profilometer, and colour stability was assessed using a spectrophotometer with the Commision on Ilumination (CIE) L*a*b* formula. The data were analysed using Student’s t-test for pair-wise comparison and One-way Analysis of Variance (ANOVA), with Tukey post-hoc tests for intergroup comparison. Results: The application of a desensitising agent on the samples resulted in a significantly greater effect on the surface roughness of the experimental subgroup than their control counterparts (p≤0.05). Among all groups, the nanofilled group exhibited the lowest surface roughness (0.418±0.047), and the colour change (1.87±0.00) was clinically acceptable. However, the flowable group had the maximum colour change amongst all the other groups (3.16±0.00). Conclusion: Within the limitations of the study, nanofilled composite resin restorative material has minimal surface roughness and colour change after exposure to the desensitising agent. It can be considered the material of choice for restoration in patients with DH.

Effect of Formal Training on Tooth Shade Matching Ability among Indian Dental Students in Diverse Clinical Settings: A Quasi-experimental Study

Akanksha Mahajan, Neha Jain, Pankaj Dhawan Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Selecting a correct shade is the key to success of any prosthesis, especially in the aesthetic zone. Variations of shade in a single tooth or the polychromatic nature of a tooth can impose greater challenges in shade matching. Therefore, it would be best if it is taught during the undergraduate course in dental schools. Aim: To evaluate the knowledge and shade matching skills among dental undergraduate students with and without training in three different clinical conditions. Materials and Methods: This post-test only quasi-experimental study was conducted with 377 undergraduate students of Indian origin studying in a dental teaching institute. The students were divided into two groups based upon their clinical training in shade matching: Group I (trained, n=197) and Group II (untrained, n=180). Three different patients, in terms of their shade complexity, were presented to both the groups and their shade matching ability was assessed. The results were subjected to statistical analysis using the Chi-square test and one-way Analysis of Variance (ANOVA). Results: Statistical analysis showed that the mean correct scores of the trained students were significantly higher than those of the untrained students (p=0.0001) in all three patients. There was a statistically significant difference (p=0.0001), as the trained group was better able to identify the correct or clinically acceptable shade compared to the untrained group in all three cases. Conclusion: The study concluded that training significantly improved the shade matching ability of dental undergraduate students in clinical conditions presenting varied complexities.

Perception and Attitude among Patients Receiving Local Anaesthesia in Chengalpattu District, Tamil Nadu, India: A Questionnaire-based Cross-sectional Study

Charumathy Rajkumar, Balaguhan Balasubramanian, GR Karthikeyan, V Sakthisri Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Dental local anaesthesia serves several purposes, the most common of which is to minimise pain during dental procedures, thereby improving patient comfort and facilitating treatment. It can also have therapeutic effects, such as temporarily relieving pulpitis pain. Patients often experience anxiety before and after receiving local anaesthesia. Aim: To evaluate the perceptions and attitudes of patients receiving local anaesthesia through a self-administered questionnaire. Materials and Methods: This cross-sectional study was conducted among 398 patients, including 218 males and 180 females, between August 2022 and October 2022, who underwent dental extractions at a dental hospital in Chengalpattu district, Tamil Nadu, India. A 15-item questionnaire was administered to the patients. The questionnaire comprised three domains: the first domain included questions before the administration of local anaesthesia, the second domain included questions during the administration of local anaesthesia, and the third domain included questions after the administration of local anaesthesia. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Results: Of the participants, 126 (40.20%) were between 46 and 60 years of age. Males constituted 218 (54.8%) and females constituted 180 (45.2%) of the sample. Additionally, 76.38% of the patients were unaware of the preinjection topical anaesthesia. Moreover, 70.35% of patients experienced anxiety before the administration of local anaesthesia. During the administration of local anaesthesia, 300 (75.4%) of patients reported experiencing moderate pain. Many patients exhibited physical manifestations of fear, including sweating in 92 (23.12%), light-headedness in 102 (25.63%), and palpitations after the administration of local anaesthesia in 190 (47.74%). Conclusion: Anxiety was more prevalent among patients prior to the administration of local anaesthesia. Patients were more anxious about the fear of the injection rather than the fear of the extraction itself. The outcomes of anaesthesia may be significantly improved by educating patients about dental treatment processes.

Relationship between Gerotranscendence and Oral Health-Related Quality of Life among Elderly Population in Tertiary Care Hospital, Wardha, Maharashtra: A Cross-sectional Study

Dolly Gabada, Sheetal Khubchandani, Priyanka Paul, Amit Reche Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Gerotranscendence represents a shift in meta-perspective, transitioning from a materialistic and rational outlook to a more cosmic and transcendent one. This phase fosters resilience in older individuals, enabling them to overcome the challenges and despondency associated with ageing, thereby promoting a positive embrace of the ageing process. Remarkably, individuals with high levels of gerotranscendence, even in the presence of poor oral health, demonstrate the capacity to cope and adapt to their circumstances. This adaptive capability may contribute to an enhancement in their self-reported Oral Health-Related Quality of Life (OHRQoL). Aim: To evaluate the relationship between gerotranscendence and OHRQoL among the elderly population in the Vidarbha region. Materials and Methods: This cross-sectional study was conducted over a 6-month period from March 2023 to August 2023 in collaboration with the Department of Prosthodontics and the Department of Public Health Dentistry at the Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra on 350 participants. The study included volunteers aged ≥70 years, residing in homes or old age homes, and those visiting tertiary healthcare centers. Methodologically, data collection employed a self-made organised proforma. Oral examinations were conducted using Type III inspections with a mouth mirror. Gerotranscendence was assessed using the Gerotranscendence Scale Type 2 (GST2), which was validated and translated into Marathi. The Geriatric OHRQoL was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), also translated into Marathi. The study used Chi-square tests for categorical variables and Pearson’s and Spearman’s tests for correlation analyses. Results: The average gerotranscendence score was 23.45 (95% confidence interval [CI]: 22.96, 23.94), reflecting a mid-level of gerotranscendence, indicating that the gerotranscendence score was neither low nor high. According to Pearson’s and Spearman’s correlation tests, the gerotranscendence score was significantly positively correlated with age and self-perceived need for treatment. The mean GOHAI score was 40.16 (95% CI: 39.55, 40.76). A substantial positive association between the GOHAI and self-perceived need for treatment was found using Pearson’s and Spearman’s correlation tests. When comparing gerotranscendence and GOHAI, Pearson and Spearman correlation tests revealed a significant positive association (p<0.001). Conclusion: Gerotranscendence was significantly positively correlated with OHRQoL, independent of objective oral status. Despite having poor oral health, elderly individuals with high levels of gerotranscendence may be better able to handle and adapt to their circumstances, which could result in an improvement in self-reported OHRQoL.

Infection Control Awareness and Practices among Dental Students in Gujarat: A Questionnaire Based Cross-sectional Study

Diptesh Sureshbhai Rami, Chirag Chauhan, Bhagyashree Shreyansh Sutaria Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: In recent years, medical advancements have led to significant progress in infection control, reducing risks in healthcare settings. However, Healthcare-Associated Infections (HAIs) remain a major global concern, affecting millions of patients each year and increasing morbidity, mortality, and healthcare costs. Dental clinics are susceptible environments for disease transmission, exposing dentists to blood-borne pathogens. Vigilance and strict infection control measures are essential in dental settings to protect both practitioners and patients. Implementing universal precautions in dental schools is crucial for controlling cross-infection, as it ensures that students are equipped with the necessary knowledge and attitudes for effective infection control. Aim: To evaluate the knowledge, attitudes, and practices of infection control among undergraduate dental students in the state of Gujarat. Materials and Methods: A cross-sectional questionnaire study involving 229 undergraduate dental students assessed knowledge and attitudes towards infection control at Ahmedabad Dental College and Hospital in October 2020. Approval was obtained, and a structured questionnaire adapted from previous literature was utilised. Rigorous content validation and analysis were conducted, revealing strong internal consistency. Data collection was conducted online and analysed using Chi-square tests for significance. Results: In the study, 185 (80.7%) of the respondents were female, and the majority of subjects were “Interns” (81, or 35.4%). The study shows significant gender differences in Hepatitis B vaccination (p=0.038), with both genders mostly vaccinated. However, attitudes and practices towards infection control did not significantly differ by gender. The study also reveals associations between the year of study and Hepatitis B vaccination (p=0.013), as well as attitudes and practices related to infection control. Notably, a considerable proportion of students across all years did not use protective eyewear during aerosol procedures. Overall, the study highlights awareness of infection control, with some variations by gender and year of study. Conclusion: The participants in this study demonstrated good knowledge and a positive attitude regarding infection control protocols. However, the practice of infection control methods varied, and consistency was not found.

Application of a Novel Colour Palette for Determination of End-point Decalcification of Hard Tissues: A Cross-sectional Study

N Fazulunnisa Begum, Reshma Poothakulath Krishnan, Deepak Pandiar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Decalcification is a technique used to remove calcium salts from hard tissue specimens, such as bone or teeth, to make them suitable for sectioning. X-rays, physical methods, and chemical methods are commonly used to determine the endpoint of decalcification. However, these procedures can be cumbersome, may deteriorate the specimen, and are often subjective. Aim: To determine the endpoint of decalcification of hard tissue specimens using a colour palette. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Pathology at Saveetha Dental College and Hospitals in Chennai, Tamil Nadu, India, over a period of 5 months. A total of 25 hard tissue specimens (10 bone and 15 teeth) were subjected to decalcification in 20% formic acid. To evaluate the endpoint of decalcification, silver nitrate solution was added to the formic acid, and the colour change was noted. The resulting colour was compared with a previously patented colour palette (Patent number: 202241047215). Once a lighter colour was obtained, the specimen was processed, sectioned, and stained using Haematoxylin and Eosin (H&E). The slides were then evaluated by two pathologists. Results: A total of 8 (80%) bone samples exhibited excellent staining, while 2 (20%) samples showed a good staining score. Regarding the tooth samples, 14 (93.3%) showed excellent staining, and one (6.66%) tooth displayed a good staining score. Conclusion: The present method is a simple and safe way to determine the endpoint of decalcification for a specimen. It does not damage the tissue, thus preserving the integrity of the hard tissue specimen.

Prevalence and Severity of Pulmonary Hypertension in Patients with Chronic Kidney Disease Stage 4 and 5: A Cross-sectional Study

Jagannath Dhadwad, Anish Chitnis Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Chronic Kidney Disease (CKD) is a multifaceted medical condition characterised by the gradual loss of kidney function over time, often leading to a myriad of complications affecting various organ systems in the body. Among these complications, Pulmonary Hypertension (PH) has emerged as a significant yet under-recognised co-morbidity, particularly in patients with advanced CKD stages 4 and 5. PH is defined by elevated mean Pulmonary Arterial Pressure (PAP) and increased Pulmonary Vascular Resistance (PVR). Understanding the intricate relationship between CKD and PH is essential for effective management and improved patient outcomes. Aim: To study the prevalence and severity of PH in patients with CKD stages 4 and 5 and to explore the relationship between PH and co-morbidities such as Type 2 Diabetes Mellitus (DM2) and systemic Hypertension (HTN) in these patients. Materials and Methods: This cross-sectional analysis was performed in the Department of General Medicine at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India on 100 cases from September 2022 to May 2024. The patients were divided into CKD stages 4 and 5 based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. PH was diagnosed based on 2D Echocardiography (ECHO) and categorised into mild, moderate and severe. Quantitative variables were compared using an unpaired t-test between CKD stages 4 and 5. Qualitative variables were compared using the Chi-square or Fisher’s-exact test. Results: The mean age of the study participants was 56.25±12.45 years. A total of 66% of the study participants were diagnosed with stage 4 CKD. In this study, a statistically non significant association was seen between the stages of CKD and the grades of PH (p-value=0.74). No significant association was found between diabetes and PH (p-value=0.97) in CKD stages 4 and 5. The median Pulmonary Artery Systolic Pressure (PASP) was found to be higher in non diabetics and non hypertensives in CKD stages 4 and 5 and this was statistically significant (p<0.0001). Conclusion: The prevalence of PH among CKD patients was 78%. However, the severity of PH was not found to be significantly associated with the severity of CKD. Co-morbidities were present in a substantial number of cases, but no significant correlation was identified.

Rapid Detection Methods for Carbapenemase Producing Gram-negative Bacilli with Reference to Phenotypic Carba M Test: A Cross-sectional Hospital based Study

P Ganesh Perumal, B Dhanush Kumar, T Priyadharsini, B Appalaraju, R Someshwaran Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Carbapenem-resistant Gram-negative Bacilli (CR-GNB) cause many serious infections, resulting in increased treatment costs, prolonged hospitalisation, and a high mortality rate among infected patients. The survival of carbapenemase-producing Gram-negative organisms is enhanced by mechanisms such as the presence of carbapenemases, reduced expression, and porin mutations. Accurate tests for rapid detection of bacterial antibiotic resistance are crucial for tracking, preventing, and containing the spread of resistant genes within hospitals and communities, as well as for guiding therapy. Aim: To evaluate the performance of the ‘Carba M test’ compared to phenotypic Carba NP tests, Carbapenem Inactivation Method (mCIM/eCIM) tests, and genotypic Carba R tests for the phenotypic detection and characterisation of various types of carbapenemase-producing GNB. Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology at PSG Hospitals, Coimbatore, Tamil Nadu, India which has 1400 beds. The study was carried out over a period of 15 months (from June 2022 to August 2023). A total of 250 CR-GNB were included as the study population. A comparative evaluation of the Carba M test, Carba NP test, Carbapenem Inactivation Method (mCIM/eCIM), and Carba R test for the rapid detection of carbapenemase-producing GNB using standard methods was done. The data were analysed, and odds ratios and p-values were calculated for statistical significance at a 95% Confidence Interval (CI). Results: A total of 250 CR-GNB were isolated during the study period, of which 83 (33.2%) were from the Medical Intensive Care Unit (MICU), followed by the Medicine department with 24 (9.6%). Enterobacteriaceae accounted for the majority of the isolates, with 229 (91.6%), followed by Pseudomonas aeruginosa with 17 (6.8%) and Acinetobacter species with 4 (1.6%). Klebsiella pneumoniae was the most common isolate among Enterobacteriaceae, accounting for 216 (86.4%). Out of the 250 CR isolates tested by the Carba R test, 100 (40%) were positive for the Oxacillinase (OXA)-48 enzyme, 35 (14%) for the New Delhi Metallobetalactamase (NDM) enzyme, 4 (1.6%) for Verona Integron-encoded Metallobetalactamase (VIM), and all were negative for Imipenemase (IMP), and Oxacillinase (OXA), and Klebsiella pneumoniae Carbapenemase (KPC) genotypes. The sensitivity of mCIM/eCIM observed in the study was 67.12%, and specificity was 85.71% when compared to the molecular genotype (GeneXpert® Carba R test). The modified Carba NP test detected carbapenemases in 229 isolates, yielding an overall sensitivity of 95.07% and a specificity of 74.07%. The overall sensitivity and specificity of the Carba M test for detecting carbapenemase-producing GNB were 97.31% and 70.37%, respectively. The isolates producing Class A/D (OXA-48-like) enzymes were identified with sensitivities of 98% and specificities of 73.68%, while those producing Class B (NDM, VIM) enzymes showed sensitivities of 94.87% and specificities of 87.5%. Conclusion: The Carba M test is a cost-effective, feasible, and rapid phenotypic test for detecting and differentiating Class B from Class A/D carbapenemases. The Carba M test could serve as a supplemental test alongside the Carba R, Carba NP test, or mCIM/eCIM for diagnosing carbapenemase production in GNB.

Autonomic Functions in Young Infertile Women with Polycystic Ovarian Syndrome: A Case-control Study

Khushboo Shrimali, Manjinder Kaur, Pooja Gandhi, Suman Sharma, Akash Sharma, Naren Kurmi, Saroj Chaudhary, Muskan Singh Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Introduction: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder in women of reproductive age, characterised by chronic anovulation, high androgen levels, Insulin Resistance (IR), and low-grade inflammation. Women with PCOS face increased risks of cardiac and metabolic issues, along with observed sympathetic overactivity. Aim: To assess the status of autonomic responses in women with and without PCOS through Autonomic Function Tests (AFT). Materials and Methods: The present study was designed as a case-control study, volunteers were recruited from the infertility centre of a tertiary care hospital and studied in the Department of Physiology. The study included 80 infertile women aged between 18 and 40 years. The study participants were divided into two groups: Group P included 40 volunteers with PCOS, while Group N included 40 healthy volunteers without PCOS and without any co-morbid conditions. Autonomic functions, which determine the sympathovagal balance, were evaluated. The data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The cold pressor test failed to raise Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) in Group P (124.45±8.55 mmHg and 83.75±8.27 mmHg, respectively) as effectively as in Group N (131.40±4.69 mmHg and 89.80±6.79 mmHg, respectively), indicating baroreceptor reflex insensitivity. Similarly, during the hand grip test, the rise in SBP and DBP was significantly lower (p-value<0.001) in Group P (119.10±7.79 mmHg and 85.45±8.49 mmHg, respectively) compared to Group N (128±6.50 mmHg and 92.65±6.5 mmHg, respectively). The 30:15 RR ratio and Valsalva maneuver results showed that DBP was significantly lower in Group P compared to Group N, with no significant difference in SBP after standing in both groups. The 30:15 RR ratio and Valsalva ratio were significantly (p-value=0.008 and p-value=0.004, respectively) lower in Group P (0.73±0.11 and 1.23±0.16, respectively) compared to Group N (0.82±0.16 and 1.36±0.23, respectively). Conclusions: The present study reported diminished sympathetic overactivity and increased parasympathetic activity due to normal Body Mass Index (BMI) in both groups.

A Pathologist Visit to the Zoo: A Review on Animal Eponyms in Pathology

Seema A Umarji, K Padmapriya, SR Mangala Gouri Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X The world of pathology encompasses a broad spectrum of diseases beyond the boundaries of specialties, with each disease having specific and interesting gross and microscopic features. Some of these features are pattern-based, while others are eponyms that compare them to objects, food, animals, etc., due to their striking resemblance and quick recall. Medical nomenclature is of vital importance, and it has significantly evolved historically, with etymological roots from Latin, Greek, and Roman languages of ancient times to the current internationally uniform codes of English and other modern languages. Eponyms are valuable medical literary epithets that have been used across specialties and include animal names, food names, discoverer names, geographic references, and more. The subject of pathology, in particular, has immense use of eponyms as they are valuable tools for assisting in adult learning, or andragogy. The specialty of pathology is unique in its complex patterns and diagnostic algorithm, always in need of alternate systems to arrive at quick and accurate diagnosis. Also known as intuitive thinking or reflex thinking, pattern viewing and eponyms trigger a reflex recognition system, reducing recall time and aiding in precise diagnosis. The present article aimed to review the terminological phenomenon of animal eponym usage in the context of pathological diagnosis.

Unravelling the Psychological Impact of Trimethylaminuria: Insights into the Management Strategies

Shravani Ganjewar, Bhagyesh Sapkale, Priyanshu Raj, Sangeeta Totade, Nitin Lade Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Trimethylaminuria (TMAU), colloquially known as fish odour syndrome, is a rare metabolic disorder characterised by the body’s inability to properly metabolise Trimethylamine (TMA), resulting in a distinctive and unpleasant fishy odour in bodily secretions. This comprehensive review explores the pathophysiology, clinical manifestations, genetic basis, diagnostic challenges, and psychological impact of TMAU, along with management strategies. Genetic mutations affecting the flavin-containing monooxygenase 3 (FMO3) enzyme, which is responsible for TMA metabolism, contribute to the condition’s hereditary nature. Diagnosis can be challenging due to intermittent symptoms and overlaps with other conditions, such as Olfactory Reference Syndrome (ORS). The psychosocial impact of TMAU can be profound, leading to embarrassment, social isolation, and mental health issues. Management strategies include dietary modifications, supplements, antibiotics, and hygiene measures to alleviate symptoms. Despite advances in understanding TMAU, further research is needed to enhance diagnostic accuracy and therapeutic approaches, ultimately improving the quality of life for affected individuals.

A Case of Liver Cirrhosis with Inflammatory Autoimmune Liver Disease Associated with Portal Hypertension and Hepatic Haemangioma

Vaibhav Chandra, Pramita Muntode, Abhay Gaidhane Sourya Acharya, Shubham Nimkar Journal of clinical and diagnostic research : 2024 - September - 18:0973-709X Autoimmune Hepatitis (AIH) is a rare autoimmune disease that damages the liver over time and, if left untreated, can progress to liver cirrhosis. Clinical manifestations range from asymptomatic patients to those with acute hepatitis or chronic liver failure. Chronic autoimmune liver disease causes persistent liver injury, which results in unresolved inflammation, proliferation of cells, and the formation of extracellular matrix proteins by stellate cells of the liver and portal myofibroblasts. Cirrhosis of the liver and the resulting loss of normal liver function are unavoidable. Cirrhotic patients have a higher risk of morbidity and mortality, and problems of portal hypertension and/or liver dysfunction result in substantial deterioration in the decompensated phase. The theory suggests that among idiopathic or cryptogenic chronic hepatitis, most of them are autoimmune in origin. It is considered one of the rare liver diseases, especially in the Indian population. Portal hypertension is a dangerous complication caused by an obstruction in portal blood flow, such as cirrhosis or portal vein thrombosis. Hepatic Haemangiomas (HH) are benign liver tumours that are made up of groups of blood-filled cavities lined by endothelial cells and fed by the hepatic artery. The vast majority of HH are asymptomatic and are discovered by chance during imaging studies for unrelated pathologies. Hereby, the authors present a case of 53-year-old female with chronic liver disease with ascites, fatty change, and nodular hepatocellular hyperplasia, which was later found to be cirrhosis of autoimmune origin.