Table of Contents : Journal of clinical and diagnostic research : 2024 - May - 18 Table of Contents : Journal of clinical and diagnostic research : 2024 - May - 18 Cytodiagnosis of Oncocytoma of Parotid Gland: A Report of Two Cases Shreya Ghosh, Arvind Bhake Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Among benign neoplasms of the salivary gland, malignancies are less common. One of the rarest tumours found in the oral cavity is oncocytoma, comprising less than 2% of all oral neoplasms and carrying a 1% risk of malignant transformation. Oncocytoma is rare among benign neoplasms, typically affecting females and impacting the major salivary glands. Literature discussing the cytodiagnosis of oncocytoma through Fine Needle Aspiration Cytology (FNAC) is even scarcer. Cytomorphological features indicating a predominantly oncocytic population with benign nuclear characteristics suggest the diagnosis of oncocytoma. The presence of oncocytes alongside other cell types in cytology smears suggests oncocytosis or a tumour-like presentation of Warthin&#8217;s tumour. Due to its unique features and clinical presentation, clinicians may misdiagnose this tumour as pleomorphic adenoma, haemangioma, or another form of oncocytosis due to its rarity and clinical features. Therefore, only histopathological examination can provide a definitive diagnosis. The present report discusses two unusual cytodiagnoses of oncocytoma identified through FNAC of the parotid gland in a 50-year-old female and a 70-year-old male, along with their clinicoradiological findings and subsequent tumour excision. Furthermore, the authors aim to raise awareness about the importance of a comprehensive work-up and optimal treatment selection for these lesions. ]]> Cardiopulmonary Rehabilitation along with Inspiratory Muscle Training to Improve Aerobic Capacity in Athletic Patient Following Atrial Septal Defect Closure: A Case Report Chitrakshi Chobisa, Vishnu Vardhan, Nandini Baheti Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X An Atrial Septal Defect (ASD) is a type of congenital heart defect in which there is an abnormal opening between the two atria. Hereby, the authors present a case report that describes a 16 mm diameter ostium secundum ASD that was diagnosed in an 18-year-old female district badminton player who came to casualty with chief complaints of difficulty in breathing while playing and an episode of syncope. After undergoing ASD closure surgery, cardiovascular rehabilitation and PowerBreathe device-assisted inspiratory muscle training were initiated. The present study emphasises the value of interdisciplinary treatment, including physiotherapy, to enhance overall functional status and respiratory function in the management of congenital cardiac disorders. Significant improvements were observed in pain, exercise ability, anxiety, and weariness, according to the end measures. In addition to highlighting the importance of these treatments in the postoperative care of patients with congenital heart disorders, the debate sheds light on the advantages of inspiratory muscle training and its possible effects on cardiopulmonary function. The present comprehensive approach, which combines pharmacological, surgical, and physical therapy treatments, has shown to improve patient outcomes and create opportunities for future advancements in the field of congenital cardiac disease management. ]]> Abdominal Cocoon Syndrome: A Rare Sequelae of Intestinal Perforation Abhilasha Bhargava, Chandrashekhar Mahakalkar, Shivani Kshirsagar, Simran Dhole Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Abdominal cocoon syndrome is a rare clinical presentation that has been associated with abdominal tuberculosis in rural India. It is also known as sclerosing encapsulating peritonitis, where the small bowel becomes encapsulated by a fibrous membrane due to unclear causes, leading to obstipation. Common symptoms include vomiting, nausea, and constipation. Due to these general clinical symptoms, it can be mistaken for other gastrointestinal disorders, resulting in delayed diagnosis, which may lead to adverse outcomes or even mortality. Surgery is often used to free the entrapped bowel and remove the fibrous tissue, while supportive care and problem management are crucial. The present case involves a 55-year-old male who presented with a distended abdomen and obstipation, leading to intestinal perforation and sclerosing encapsulating peritonitis, which was managed through resection and anastomosis of the small intestine. The patient was followed-up after three months with no new complaints. The present case helps in understanding the sequelae of acute intestinal perforation that can result in abdominal cocoon syndrome. ]]> Complete Agenesis of the Dorsal Pancreas Presenting as Uncontrolled Hyperglycaemia: A Case Report Akshay Kothari, Kiran Shah, Vikram Jadhav, Rameswar Reddy, Dnyaneshwar More Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Agenesis of the Dorsal Pancreas (ADP) is a rare anatomical manifestation of the pancreas, characterised by the total or partial absence of the dorsal pancreatic regions, body, and tail. The anatomy of the pancreas missing the pancreatic tail is considered partial agenesis, while the absence of the body and tail, with the presence of only the pancreatic head, is considered to be complete dorsal agenesis of the pancreas. Here the authors present the case of 20 years old male patient with uncontrolled blood sugars and recent onset of blurred vision. Diagnostic imaging, including Ultrasonography (USG) and Computed Tomography (CT), revealed the pancreatic head, but the body and tail were not seen. Using CT, the patient&#8217;s condition was identified as complete ADP. Treatment involved initiating basal bolus insulin therapy, leading to glycaemic control. The patient also underwent cataract surgery for diabetic-related complications. This case underscores the importance of considering congenital pancreatic anomalies in young adults and highlights the utility of advanced imaging techniques in confirming the diagnosis of agenesis of the dorsal pancreas. Early recognition and intervention are crucial for optimising patient outcomes. Further research is needed to enhance understanding of ADP pathophysiology and develop effective management strategies. ]]> Transmigrated Kissing Canines: A Case Report of Bilateral Impacted Mandibular Canines Shrabasti Dey, Asish Kumar Das, Subhasish Burman, Abhijit Maji, Abhishek Khatua Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Mandibular canines, also known as the &#8220;cornerstone&#8221; of the dental arch, are important factors for dental arch stability, masticatory function, and maintaining natural facial expressions and aesthetics. Due to their eruption pattern and sequence, canines are prone to impactions with a 20 times higher frequency for maxillary canines than mandibular canines. Bilateral impactions of permanent mandibular canines are rare occurrences with a low incidence of 0.12%. Migration of teeth is a frequently documented ectopia. However, pre-eruptive migration across the midline of the arch is an unusual occurrence known as transmigration. Hereby the authors present a 29-year-old female patient who reported pain and swelling of the anterior mandible. On examination, it was revealed to be associated with bilaterally impacted permanent mandibular canines associated with transmigration. The case was managed by surgical extraction of both impacted teeth leading to resolution of the pain and swelling. ]]> Role of <i>Madhutailik basti</i> and <i>Shaman chikitsa</i> in the Management of Acute on Chronic Pancreatitis: A Case Report Reeya Gamne, Sadhana Misar Wajpeyi, Vinay Nara, Sonia Mandal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Chronic pancreatitis is a condition characterised by persistent inflammation of the pancreas, leading to permanent damage and loss of its exocrine and endocrine functions. Clinical symptoms of the disease include abdominal pain, nausea, vomiting, steatorrhoea, indigestion, and weight loss. In Ayurveda, it can be correlated with <i>Grahani dosha</i>, a disorder of the duodenum and gut. <i>Mandagni</i>, which is the hypo-functioning of <i>Agni</i>, is considered the root cause of Grahani dosha and is addressed through various treatment modalities in Ayurveda. Hereby, the authors present a case report of 40-year-old male diagnosed with chronic pancreatitis presented with severe pain in the epigastric and left hypochondriac region of the abdomen, decreased appetite, nausea, and constipation for five years. After three years of conservative treatment and unsuccessful advice to undergo Endoscopic Retrograde Cholangiopancreatography (ERCP), the patient sought Ayurvedic treatment. The treatment involved <i>Shodhan</i> (purificatory) and <i>Shamana</i> (palliative) approaches, including <i>Vata pitta shamaka kriya</i>, <i>Mridu virechana</i> (mild purgation), and the use of <i>Yakrutottejaka</i> (hepato stimulant), <i>Pramehaghna</i> (pancreas protecting), and <i>Rasayana</i> (rejuvenating) formulations. Within four months, the patient experienced a significant improvement, with total remission of symptoms and a notable reduction in objective criteria such as serum lipase and serum amylase levels. The present case report suggests that Ayurvedic modalities can be effective in treating chronic pancreatitis. However, to draw definitive conclusions, further research with extensive follow-up and a larger sample size is necessary. ]]> Congenital Absence of Ileum, Caecum and Appendix in a Preterm Neonate: A Rare Case Report Asritha Komandla, Aditi Rawat, Sagar Karotkar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X There are numerous birth defects that can affect the gastrointestinal tract, starting from the oesophagus or stomach to the small and large intestines. Intestinal atresias are one of the most common causes of intestinal obstruction in newborns. The most common location is the jejunum, followed by the duodenum and the colon. Congenital absence of the ileum, caecum, and appendix is an extremely rare condition. Here, an exceptional instance of congenital absence involving the distal jejunum, ileum, caecum, and appendix in a male child is presented, who presented with chief complaints of multiple episodes of bilious vomiting after initiating the first feed and non passage of meconium. Upon initial examination, the patient was suspected to have an intestinal obstruction and subsequently underwent an exploratory laparotomy. However, intraoperative findings revealed a grossly dilated proximal jejunal loop, and the next segment of the intestine was the narrow ascending colon. In due course, the baby recovered well and was discharged. Currently, there is no documented occurrence of a comparable case involving a viable neonate in the existing body of scholarly literature. Surgeons need to understand positional variations and congenital anomalies, as well as the procedures needed to identify these abnormalities during surgery. ]]> Omental Infarction: A Forgotten Entity Virendra Athavale, Rushabh Parekh, Saili Kelshikar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Omental infarction is a cause of acute abdominal pain. It is a challenging diagnosis to make due to its infrequent occurrence, low awareness, and non specific presentation. It is generally recommended to manage it conservatively because of its self-limited nature. However, some physicians opt for surgical management due to the potential risk of abscess formation with conservative treatment. Omental infarction commonly occurs following torsion. The anatomical features of the omental sheet, such as its increased length, freely mobile lateral edge, and a weak blood supply, make it more susceptible to twisting along its long axis, leading to congestion. If the twist is severe enough or if there is prolonged obstruction to venous flow, arterial inflow may be compromised, resulting in infarction and potential complications like necrosis. Here, the authors present a case of a 64-year-old diabetic male who presented to the Emergency Department with acute right upper quadrant pain. He was diagnosed with omental infarction through Computed Tomography (CT) of the abdomen. The authors attempted conservative management, but his pain persisted despite analgesics. Subsequently, the authors opted for surgical intervention and performed an omentectomy. In cases of acute abdominal pain, conditions like omental infarction are often overlooked and should be considered in the differential diagnosis. ]]> Pathological Portrait of a Submandibular Gland Lymphoepithelial Cyst in a Non HIV Patient: A Case Report Suhit Pradeep Naseri, Snehlata Hingway, Pravin Gadkari Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Lymphoepithelial Cysts (LEC) manifest as benign, unilocular to multilocular lesions predominantly in the head and neck areas. LEC typically localise in the salivary glands, with the parotid gland being more common and the submandibular gland being a rare occurrence. Additionally, they may be observed in the oral cavity, with a particular affinity for the floor of the mouth. It manifests as a painless, solitary cystic mass situated close to or within the salivary gland. It predominantly occurs in individuals infected with Human Immunodeficiency Virus (HIV). It typically arises as a consequence of lymphocyte-induced dilation of the cystic duct, and in accordance with index case, the definitive diagnosis is consistently confirmed through postoperative histopathological examination. They are infrequently observed in immunocompetent individuals and may have a connection to Sj&#246;gren&#8217;s syndrome. Numerous contemporary investigative methods are at our disposal, with Fine Needle Aspiration Cytology (FNAC) emerging as a swift diagnostic tool for promptly confirming a LEC. Additional diagnostic modalities encompass Ultrasonography (USG) and Computed Tomography (CT). The primary treatment for an LEC continues to be surgical intervention. Understanding the characteristics and behaviour of such cysts in non HIV patients is critical for accurate diagnosis, appropriate therapy, and, perhaps, enhancing the understanding of the spectrum of conditions associated with these cyst formations. Investigating LEC occurring in the rare location of the submandibular salivary gland, this work is distinctive in that it involves an immunocompetent individual. The present case is of a 42-year-old woman who elucidates the diagnostic pathway, encompassing both FNAC and histopathology. ]]> A Case of Corneal Melt and Perforation Associated with Rheumatoid Arthritis Managed by Corneal Patch Graft Abhay Amrit Lune, Megha Ramnik Kotecha, Supriya Adinath Pokle Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Corneal melt is a rare yet severe complication of Peripheral Ulcerative Keratitis (PUK), observed in patients with Rheumatoid Arthritis (RA). The mortality rate associated with corneal melt is high, warranting aggressive treatment. A 50-year-old female, a known case of RA for 20 years, presented with complaints of blurred vision, watering, irritation, and photophobia in both eyes for the last year, with worsening symptoms in the Right Eye (RE) for the past 15 days. She was diagnosed elsewhere in a private hospital with RE corneal melt and perforation and inferior corneal thinning in the Left Eye (LE), with an ulcer defect. She underwent corneal perforation suturing in the RE before reaching the present facility. On examination, a sutured corneal perforation was present in the RE, and corneal thinning and melt were seen para-centrally and inferiorly in the LE. Surgical treatment with RE corneal patch graft repair was performed. The patient was given oral methotrexate and prednisolone for aggressive systemic control of RA and to ensure the survival of the patch graft. The vision in the RE improved following the procedure, maintaining the tectonic integrity of the cornea. On follow-up, aleucomatous opacity was noted in the RE patch graft tissue. Corneal thinning in the LE was treated topically with artificial tears and antibiotic eyedrops, which eventually healed, forming macular corneal opacity. Overall, corneal patch graft repair enabled the maintenance of tectonic support and corneal integrity, as well as vision improvement in the patient with RA presenting with the complication of corneal melt and perforation. ]]> Anaesthetic Management of Paediatric Patient with Klippel-Trenaunay Syndrome undergoing Excision of Scalp Cyst: A Case Report Shweta Singh, Sonal Khatavkar, Mounika Yerramshetty Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Klippel-Trenaunay Syndrome (KTS) is a sporadic condition characterised by the clinical triad of capillary malformation, atypical varicosity, and soft-tissue and bony hypertrophy. This triad was observed in the current case. Despite being initially described over a century ago, the exact incidence of this syndrome remains unestimated. The clinical presentation of KTS is highly diverse, ranging from asymptomatic cases to severe instances involving life-threatening bleeding and embolism. The authors present a case report of a 10-year-old girl with complaints of a cystic swelling in her left temporal region. She exhibited distinct features such as facial asymmetry, a high-arched palate, a prominent mandible, a port-wine stain on her cheeks, nasal bridge depression, and right-sided body hypertrophy. The child showed delayed developmental milestones, including holding her neck at 1.5 months, a bidextrous approach at seven months, and social smiling at six months, indicating global developmental delay. The patient was scheduled for excision of the swelling. Following the successful excision of the cyst, the child was extubated. The extubation was uneventful. In the postoperative period, the patient remained haemodynamically stable. Managing such a patient for a surgical procedure requires a meticulous approach involving accurate anaesthetic preparation and the prevention of complications. ]]> Lobular Capillary Haemangioma in the Anterior Maxillary Gingiva of a Six-year-old Patient: A Case Report Guru Vishnu, Ganesh Jeevanandan, Santosh P Kumar, Shristhy Bhardwaj Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Haemangiomas are benign proliferative tumours with vascular tissue origin. These neoplasms are recognised as benign tumours commonly found in infancy, characterised by a period of rapid growth accompanied by proliferation of endothelial cells, followed by gradual involution. The male to female ratio is observed to be 3:1, with a predominant impact on the female population, particularly during the early stages of their second decade of life. The diameter of the lesion spans from a few millimeters to several centimeters, with rare instances exceeding 2.5 cm. The present case report details the occurrence of Lobular Capillary Haemangioma (LCH) in a young male patient of six years, who exhibited gingival overgrowth in the anterior maxillary region. The patient presented with symptoms of discomfort during mastication, occlusal interference, and excessive hemorrhage during oral hygiene practices. Due to the lesion&#8217;s extensive blood supply and the confirmation of the diagnosis in the histology report, it was surgically removed in a single session while the patient was under conscious anaesthesia. The patient underwent a thorough six-month follow-up examination, which demonstrated a favourable outcome with no evidence of lesion recurrence. Although haemangiomas are prevalent soft tissue tumours in the head and neck region, they are infrequently found in the oral cavity and rarely encountered by doctors. Intraoral haemangiomas most commonly occur in the lips, tongue, buccal mucosa, and palate. However, this case report describes a rare occurrence in the maxillary anterior site, which has limited documentation. The treatment involved the use of monopolar cautery, which effectively reduced bleeding at the surgical site after the use of a scalpel. The purpose of present case report is to report an unusual case of a benign tumour occurring in the anterior maxillary region, which was diagnosed as LCH. ]]> A Rare Case of Chondrolipoma of the Breast Pooja Agarwal, Nupur Kaushik, Shwetank Prakash, Himani Singh, Deepa Rani Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X In 1971, Arrigoni MG et al., used the term &#8220;hamartoma&#8221; for breast lesions in 10 patients who presented with encapsulated breast tumours clinically and grossly resembling fibroadenomas. Hamartomas in breast lesions are very uncommon and include adenolipoma and chondrolipoma. Despite the availability of imaging modalities, it is often difficult to distinguish fibroadenoma from breast carcinoma. Chondrolipoma of the breast is a rare benign mesenchymal tumour composed of adipose and mature cartilaginous tissue, which is often mistaken for malignant lesions in preoperative studies, leading to overdiagnosis and overtreatment. Hence, a proper histopathological examination is required for a correct diagnosis. Only eight cases have been reported in the literature. This report presents one such rare case of lump in a 67-year-old female, which was suspected to be a fibroadenoma clinically and radiologically, but was diagnosed as chondrolipoma on histopathological examination. All routine investigations were within normal limits, and a clinical diagnosis of fibroadenoma was made. Mammography was done, comprising fat, soft tissue, and calcific strandings along with coarse calcific specks suggestive of BI-RADS (Breast Imaging-Reporting and Data System) Category 3: high probability of being benign. ]]> <i>Brevundimonas diminuta</i> Infection in a Congenital Atrial Septal Defect Patient: A Case Report Rajkumar Marimuthu, Shwetha Sagarnaik, RD Karthiga, Leela Kakithakara Vajravelu, J Manonmoney Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <i>Brevundimonas</i> species are aerobic, non fermenting Gram negative bacilli. <i>Brevundimonas diminuta</i> (<i>B. diminuta</i>) is not believed to be a significant pathogen, and its virulence is generally low, being rarely isolated from clinical samples. Only a few clinical cases of serious opportunistic infections, particularly in patients with compromised immunity, have been reported for <i>B. diminuta</i>. All known species of <i>Brevundimonas</i> spp. show strong resistance to most antibiotics, according to the Centers for Disease Control and Prevention (CDC). Here, a case of <i>B. diminuta</i> infection in an eight-year-old female child is described. The patient also had a minor Patent Ductus Arteriosus (PDA) and a known congenital Atrial Septal Defect (ASD). Following isolation from the blood sample, the VITEK 2 compact system identified <i>B. diminuta</i>. ]]> An Unusual Presentation of Low-grade Chondrosarcoma of the First Metatarsal Bone requiring extensive Resection: A Case Report D Udayakumar, V Udaya, B Suresh Gandhi, Naveen Jegaprasath Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Chondrosarcoma (CS) is one of the common malignant bone tumours arising from chondrocytes with variable degrees of malignancy. It is mainly noted in flat bones like the pelvis and scapula, and sometimes in long bones like the proximal femur. This case report describes a 40-year-old female who presented with pain over her right great toe for six months and swelling for four months. An open biopsy revealed low-grade CS. Subsequently, the patient underwent amputation of the first ray till the tarsometatarsal joint with meticulous dissection of the tumour mass. At eight years of follow-up, the patient had no recurrence and no functional disability. Therefore, in cases of low-grade CS, first ray amputation along with excision of the tumour mass helps avoid recurrence and metastasis, providing a satisfactory functional outcome. ]]> Variant Analysis in LDLR Gene Uncovers Genetic Basis of Familial Hypercholesterolemia: A Case Report Tanmay Ulhas Deshpande, Pratiksha Rakesh Chheda, Tavisha Jayant Dama, Krishnanaik Shivaprakash, Bipeenchandra Bhamre Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Familial Hypercholesterolemia (FH) is a hereditary disorder characterised by elevated blood cholesterol levels, predominantly Low-density Lipoprotein Cholesterol (LDL-C). This condition poses a significant risk for early-onset atherosclerotic cardiovascular diseases. A critical step toward effective clinical management is the precise identification of pathogenic variants responsible for FH. The present study aimed to unravel the genetic cause of FH through comprehensive variant effect prediction and comparison with clinical manifestations in a nine-year-old girl with hyperlipidemia. Whole Exome Sequencing (WES) was performed on the proband, and a set of three key genes associated with hyperlipidemia {Apolipoprotein E (APOE), Low -density Lipoprotein Receptors (LDLR), Proprotein Convertase Subtilisin /Kexin type 9 (PCSK9)} were evaluated for the presence of pathogenic mutations. The data were meticulously analysed based on the American College of Medical Genetics (ACMG) guidelines for variant classification. The analysis revealed two pathogenic variations in the LDLR gene: c.1A>C (p.Met1Leu) in exon 1 and a splice site variant c.1187-10G>A in intron 8. Sanger sequencing of family members confirmed the presence of one mutation each in the father and mother, while a younger sibling also carried both pathogenic variants. Genetic testing confirmed Heterozygous FH (HeFH) in the parents and Homozygous FH (HoFH) in both siblings. Proper classification of genetic variants is crucial for informed clinical decision-making and patient management. The study provides valuable insights into the molecular basis of FH in an Indian patient and contributes to the growing knowledge of the LDLR gene mutation spectrum. ]]> A Rare Case of Granular Cell Tumour of Tongue in a 13-year-old Girl Archana Shivamurthy, Archana Muniswamyreddy, Vijaya Basavaraj Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Granular Cell Tumour (GCT) is a rare benign tumour that usually affects adults in the third to sixth decades, with females being more commonly affected. Here, a rare case of GCT occurring in a 13-year-old child is presented. A young girl presented with a painless swelling on the right-side of her tongue. Her past medical history was unremarkable. Upon examination, a firm, well-defined, non pulsatile, non tender lesion measuring 1&#215;0.8 cm was noted, involving the right lateral border of the tongue. The lesion was excised and sent for histopathological examination. Gross examination revealed a 1&#215;0.8&#215;0.6 cm mass with a grey-white cut surface. Microscopy showed hyperplastic stratified squamous epithelium overlaying a submucosal tumour composed of polygonal cells arranged in sheets. The tumour cells had central small round nuclei with abundant granular eosinophilic cytoplasm and intervening skeletal muscle fibres. No necrosis, atypia, or increased mitosis were observed. Immunohistochemistry showed strong nuclear positivity and bright granular cytoplasmic positivity for S-100, confirming the diagnosis of GCT. The patient was followed-up for 14 months after surgery and reported no recurrences. GCTs typically manifest in older individuals, with the highest prevalence in the fifth and sixth decades of life. However, this case deviates from the norm, being noted in a 13-year-old child. This exceptionally unusual presentation should prompt the inclusion of GCT in the differential diagnosis of tongue neoplasms in paediatric patients as well. Periodic follow-up of these patients is recommended to detect malignant transformations and late recurrences at early stages. ]]> Haemolytic Disease of Newborn in a baby Delivered by Mother with Complete Anti-D Prophylaxis: An Unusual Case Report Tanmayi Kulkarni, Prashant Madhav Sakhavalkar, Yaminy Pradeep Ingale, Teja Achyut Deshpande Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Haemolytic Disease of the Newborn (HDN), also known as erythroblastosis foetalis, is an immune-mediated disorder among neonates with a wide range of clinical presentations. The occurrence of HDN due to ABO-Rh incompatibility between the mother and baby is becoming rare due to increased knowledge of the disease and adherence to Good Clinical Practices (GCP) during pregnancy. This case report highlights a rare case of HDN in which, despite following GCP, standard care, an uneventful antenatal period, and timely administration of Anti-D immunoprophylaxis, the mother delivered a baby with HDN. The baby was successfully managed by a group of skilled and caring clinicians. Therefore, it is crucial to screen all at-risk mothers for HDN to identify it earlier and treat it successfully. This case report is rare in terms of the baby&#8217;s survival with HDN born to a mother who had already received timely Anti-D immunoprophylaxis. Additionally, there is a need to emphasise on recent advances in diagnosis, such as foetal Doppler studies, and treatment options. ]]> Management of Viral Hepatitis with Siddha Medicines: A Case Report Gomathi Ramaswamy, Preetheekha Elangovan, Mamallan Arumugam, Subathra Thangamani, Shanmugapriya Ponnappan Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Viral hepatitis is a common cause of acute liver injury that can lead to chronic liver disease, cirrhosis, and liver cancer. Viral hepatitis shares similarities with <i>kamalai</i> in Siddha medicine and is managed in accordance with Siddha treatment. Present case is of a 14-year-old male patient who presented with symptoms of fever, fatigue, malaise, and jaundice. Laboratory investigations, abdominal ultrasound features, and clinical findings indicated positive viral hepatitis. The patient was started on Siddha management to suppress Hepatitis B Virus (HBV) replication and prevent progression to chronic hepatitis B infection. The patient&#8217;s symptoms gradually improved over the next few weeks, and follow-up blood tests showed a significant reduction in the values of elevated liver enzymes, indicating a good response to Siddha medicine treatment. The unique aspect of this case study was that it demonstrates a successful management of viral hepatitis B infection with the Siddha system of medicine. ]]> A Rare Case of Compound Heterozygous Sickle Cell Beta Thalassaemia with High HbF and Normal HbA2 Levels Detected on HPLC Ruchi Agarwal, Sunaina Hooda, Parul, Kulwant Singh, Adesh Thombre Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Compound heterozygous Sickle Haemoglobin (HbS) beta (&#946;) thalassaemia arises from the mutations associated with sickle cell and &#946; thalassaemia and significantly affects populations in low income countries like India. Elevated levels of Haemoglobin A2 (HbA2) represent the primary indicator for identifying carriers of &#946; thalassaemia. However, it&#8217;s worth noting that sometimes, High Performance Liquid Chromatography (HPLC) encounters challenges in confirming a final diagnosis when levels of HbA2 and HbS fall outside the diagnostic range. A nine-year-old male and his sister 11-year-old female patient presented with high-grade fever and jaundice since two weeks. Following admission, Complete Blood Count (CBC) and HPLC of both children were done. Hb of male and female child revealed 1.8 g/dL and 1.5 g/dL, respectively. HPLC of male child revealed Haemoglobin F (HbF) 27.4%, HbS 56.3%, HbA2 3.8% and of female child revealed HbF 39.2%, HbS 43.5%, HbA2 3%. HPLC reports of both children were suggestive of differential of compound heterozygous HbS &#946; thalassaemia and HbS homozygous. Later, HPLC of their parents was also done. HPLC of father was suggestive of thalassaemia trait and of mother suggestive of sickle cell trait, following which final diagnosis of both children was given as compound heterozygous HbS &#946; thalassaemia. Diagnosing these compound heterozygous haemoglobinopathies can be challenging. As their is resemblance in clinicopathological features of sickle cell anaemia and &#946; thalassaemia disorders, it is important to carefully differentiate between them although prognosis is better than thalassaemia major or sickle cell anaemia. ]]> Challenges Encountered during Anaesthetic Management of a Patient with Congenital Methaemoglobinemia Posted for Laproscopic Inguinal Hernia Repair: A Case Report Vinita Jain, Nidhi Sultania Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Methaemoglobinemia is a rarely encountered haematological condition that can be congenital or acquired. Methaemoglobin is an abnormal type of haemoglobin that is oxidised and incapable of delivering oxygen to tissues. This can lead to cyanosis, hypoxia, acidosis, arrhythmias, and more, depending on the methaemoglobin concentration, and can be fatal. A thorough understanding of the disease process is essential to develop a suitable anaesthesia plan and prevent complications. Ensuring adequate tissue oxygenation, assessing oxygenation using appropriate monitoring tools, and avoiding trigger agents are the cornerstones of anaesthetic management. A co-oximeter is the gold standard for monitoring, as it detects and quantifies methaemoglobin levels. Methylene blue acts as an antidote, functioning as an oxidising agent that converts itself to leukomethylene blue, which reduces methaemoglobin back to haemoglobin. In the present case of a 60-year-old male, the authors present the anaesthetic management and challenges in a diagnosed case of congenital methaemoglobinemia undergoing laparoscopic inguinal hernia repair surgery. Methylene blue was administered prophylactically preoperatively. An arterial line was established before anaesthesia induction for close haemodynamic monitoring and quick blood gas and oxyhaemoglobin sampling, as a co-oximeter was not available. Adequate oxygenation during induction and emergence was ensured to prevent hypoxia, given the lower amount of normal haemoglobin in these patients. All potential trigger agents, such as nitrous oxide, local anaesthetics, nitrates, and metoclopramide, were avoided. The patient had an uneventful intraoperative and postoperative course and was discharged after one day. ]]> Pyrexia of Unknown Origin due to Secondary Adrenal Insufficiency: A Case Report Syamasis Bandyopadhyay, Sandip Kumar Chandra, Rajeswar Samanta, Lawni Goswami Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Adrenal insufficiency is a critical condition that can often present with non specific symptoms, posing a diagnostic challenge in the context of co-existing conditions. Authors hereby, report a complex case of secondary adrenal insufficiency revealed through persistent fever and hyponatremia in a 73-year-old female with a multifaceted medical history, including hypertension, diabetes, and Takotsubo cardiomyopathy. Her symptoms of intermittent fever and diarrhoea were refractory to treatment, leading to hospital readmission. Initial laboratory investigations highlighted hyponatremia, low haemoglobin, elevated inflammatory markers, and low cortisol levels. Although a urinary tract infection with multidrug-resistant Klebsiella was identified and treated, her febrile state persisted. Extensive serological testing for a broad range of infectious diseases yielded negative results, excluding infectious etiologies as the cause of her fever. Imaging studies, including chest X-ray, Electrocardiogram (ECG), echocardiogram, Positron Emission Tomography (PET) scan, Computed Tomography (CT), and transesophageal echocardiography, failed to identify a source of infection or malignancy. Notably, a low random cortisol level coupled with an inappropriately low Adrenocorticotropic Hormone (ACTH) level prompted further endocrine evaluation. Magnetic Resonance Imaging (MRI) revealed an empty sella turcica, confirming secondary adrenal insufficiency. This diagnosis was substantiated by the patient&#8217;s positive response to steroid therapy, which led to clinical improvement and eventual discharge. The present case underlines the importance of considering adrenal insufficiency in patients presenting with unexplained hyponatremia and fever, particularly when other common aetiologies have been ruled out. It also illustrates the potential for critical endocrine disorders to mimic sepsis, underscoring the necessity of a comprehensive diagnostic approach in the face of complex presentations. ]]> Plasmapheresis as an Adjunctive Therapy for Yellow Phosphorus Poisoning: A Case Report Brian William Dmello, Ashray Vasanthapuram, Girish Narayan, Shakuntala Murty, Angeline Yvette Mascarenhas Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Yellow Phosphorus (YP) poisoning is an infrequent, yet severe medical condition characterised by multi-systemic toxicity. The ingestion or inhalation of YP can lead to gastrointestinal irritation, hepatic injury, and Acute Liver Failure (ALF). Plasmapheresis, a therapeutic intervention involving the removal and replacement of plasma components, is a potential adjunctive treatment for YP poisoning. This case report aims to explore the mechanistic rationale, clinical efficacy, and safety considerations of plasmapheresis in the management of this toxicological emergency. Here, a 16-year-old female reported to the Emergency Department (ED), having consumed 1-2 g of Ratol poison at two different times of the day. She came to the hospital on day 4 post-consumption. On admission, the patient was jaundiced and Arterial Blood Gas (ABG) analysis was suggestive of respiratory alkalosis with hypokalemia. Treatment focused on fluid therapy, vitamin K therapy, and N-Acetyl Cysteine (NAC). She developed angioedema and urticaria with no airway compromise, in response to intravenous NAC. A diagnosis of acute liver injury secondary to YP poisoning was made. Close monitoring of liver function and coagulation parameters, and bleeding complications was done. Plasmapheresis was considered as NAC reinitiating was not feasible due to potential anaphylaxis. The patient responded well to the treatment and was discharged on day 7 of hospitalisation. ]]> Retroperitoneal Abscess as an Extension of Ischiorectal Abscess: A Rare Case Report Dakshayani Satish Nirhale, Mahendra Wante, Vaishnavi Reddy Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Infections of the retroperitoneum can result from primary haematogenous spread of microbes or secondary infections originating from the retroperitoneal area or nearby organs. These abscesses can be caused by a perforated retrocaecal appendix, diverticulitis, perforated duodenal ulcers, iatrogenic gastrointestinal tract perforations, pancreatic cancer, inflammatory bowel diseases, genitourinary extravasation due to obstruction, osteomyelitis, postoperative duodenal ulcer perforations, and infections related to pelvic and puerperal conditions, as well as trauma. However, the occurrence of a retroperitoneal abscess as an extension of an ischiorectal abscess is exceedingly rare. Hereby, the authors present a case report of 27-year-old male who presented with persistent lower right quadrant abdominal pain, high-grade fever, and pus discharge from the perianal region for the last five days. He experienced difficulty passing stools and flatus for three days. Contrast-enhanced Computed Tomography (CECT) revealed a perforated appendix with fluid collection in the preperitoneal space on the right-side. Surgery revealed a significant amount of purulent discharge below the rectus muscle, extending along the right abdomen to the psoas muscle and connecting with the ischiorectal fossa. Retroperitoneal abscesses can originate from the perianal or ischiorectal region through various anatomical spaces. ]]> Marchiafava-Bignami Disease: A Rare Case Report and a Review of Literature Jiwan Shriram Kinkar, Shweta Ramnarayan Borkar, Sadaf Mohammad Sharif, Anand Manoharrao Hatgaonkar, Deepa Sangolkar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Marchiafava-Bignami Disease (MBD) is an unusual neurological illness caused by prolonged alcoholism that is distinguished by demyelination of the corpus callosum. Clinicians encounter a wide range of alcohol-related diseases in their practice, and MBD is a rare condition that requires a high clinical suspicion due to its potential to mimic withdrawal symptoms, Wernicke&#8217;s-Korsakoff&#8217;s Psychosis, and various other neurological conditions, leading to confusion in diagnosis. It is a toxic-demyelinating syndrome that typically affects chronic alcoholics, but it has been described in rare instances in chronically malnourished teetotalers. The symptoms and warning signs are diffuse, and the onset could be abrupt or gradual. This is a case of a 54-year-old chronic alcoholic who presented with neurological symptoms. Magnetic Resonance Imaging (MRI) of the brain revealed typical features of MBD. The patient was treated with high doses of thiamine along with folic acid and other symptomatic treatments, after which significant improvement was observed. This case report reviews past reported cases to shed light on the varied presentation features of the disease. It adds to the limited corpus of MBD literature and highlights the intricate diagnostic process and management complexities associated with this condition. By integrating clinical observations, neuroimaging findings, and treatment outcomes, this report underscores the importance of maintaining a high clinical suspicion in cases involving alcohol abuse and the significance of tailored therapeutic strategies. As MBD continues to present diagnostic challenges, this report contributes valuable insights into its presentation, progression, and potential pathways to recovery. Therefore, it requires a high clinical suspicion for both clinical and radiological diagnosis. ]]> Standardisation of Decision Making in Hilar Cholangiocarcinoma Management: A Case Series Soundappan Somasundaram, V Aravind Narasimhan, Pradeep Joshua Christopher, Anand Vijai Natesan, Palanivelu Chinnusamy Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Hilar Cholangiocarcinoma (CCA) is a very complex disease that requires the best multidisciplinary decisions. Improved outcomes are reported only in high-volume centres with good expertise and the latest technology in radiology for imaging and intervention, endoscopy, and surgery. However, in India, only very few centres have very good infrastructure for the same. Additionally, protocol-driven treatment is also not uniform in India. To fulfil this gap, authors believe that a strict, disciplined work-up of these complex cases is the only way to achieve optimal treatment. Authors propose a protocolised checklist involving multidisciplinary decisions for hilar CCA patients that could be used. This case series aims to assess the oncological outcome of hilar CCA using our checklist and, secondarily, to assess the immediate postoperative outcome and complications in these patients. Out of 20 patients, 13 underwent successful hepatectomy based on the decisions made. No mortality was noted in this case series. Two cases had a postoperative liver failure (Clavien Dindo 3A). All 13 patients had an R0 resection. The mean length of the tumour-free margin was 8.46 mm. Doing two-dimensional surgical simulation preoperatively and adhering to the special plane of transection helped in attaining R0 resection. Here, a small series of hilar CCA is presented which was managed successfully, signifying the importance of a protocol-based approach which can be easily adapted and reproduced. ]]> Presence of Enteric Fever with Unusual Clinical Scenarios: A Case Series Vrushali Thakar, Mahadevan Kumar, Neetu Mehrotra, Prajakta Jadhav, Sunita Bhatawadekar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <i>Salmonella</i> species are associated with bacteraemia, diarrhoea, as well as focal infections. <i>Salmonella</i> Typhi is the most pathogenic species. <i>Salmonella</i> Paratyphi B commonly affects immunocompromised hosts. The present case series showcases six cases of infection caused by typhoidal <i>Salmonellae</i> with unusual clinical scenarios. The first case report explains a case of neonatal meningitis where the causative agent was <i>S.</i> Paratyphi B. A case of lumbar spondylodiscitis is also reported where the aetiology was found to be <i>Salmonella</i> Typhi. Case three reports <i>S.</i> Typhi infection in a patient with Pre-B cell Acute Lymphoblastic Leukemia (ALL). <i>S.</i> Paratyphi B was isolated from a blood culture of a patient on haemodialysis and also from ascitic fluid from a case of Chronic Liver Disease (CLD). S. Typhi was isolated from the pleural fluid of a patient with carcinoma of the prostate. ]]> Incidentally Diagnosed Disseminated Histoplasmosis among Non HIV Patients: A Series of Three Cases with Review of Literature Priyanka Purohit, Nehal Minda, Navneet Bohra, Arshad Khan Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Histoplasmosis is a rare airborne fungal infection that is soil-based and is mostly documented in Human Immunodeficiency Virus (HIV)-positive patients. It is common in people living near valley regions. Hereby, authors report three cases of Asian women from different regions of Southern Rajasthan who died due to delayed diagnosis of histoplasmosis within a few days of admission. They all had complaints of fatigue and fever for one month. One presented with decreased urine output and pancytopenia, while the others had complaints of prolonged fever with pancytopenia and fatigue. In all three cases, bone marrow examination was done, and they shared the same diagnosis - disseminated histoplasmosis. It was further confirmed by special stains and microbiological investigations. Authors also reviewed recent articles based on South Asian region histoplasmosis case reports and found three case presentations with the same clinical presentation and outcomes. Treatment was started, but patients deteriorated and died within 10 days of admission. Delay in the diagnosis of histoplasmosis leads to the death of patients. Therefore, histoplasmosis should be considered as a differential diagnosis for prolonged fever with pancytopenia and chronic infections. ]]> Neuroimaging Manifestations and Clinical Correlates of Japanese Encephalitis: Insights from an MRI Case Series Ameer Hussain, Ajay Lucas Rubben, Vishnu Raj Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Japanese Encephalitis (JE) poses a significant public health threat across Asia and the Western Pacific, leading to considerable mortality and morbidity if not promptly diagnosed and treated. This flaviviral infection, transmitted by Culex mosquitoes, primarily affects children but can impact individuals of all ages. Prompt diagnosis relies on detecting Japanese Encephalitis Virus (JEV) IgM antibodies in serum or Cerebrospinal Fluid (CSF), alongside characteristic Magnetic Resonance Imaging (MRI) findings. In this MRI case series, three confirmed cases of JE are presented, showcasing the typical neuroimaging manifestations observed in affected individuals. All cases exhibited bilateral thalamic hyperintensities on T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR) images, a hallmark feature of JE. Additionally, one patient demonstrated involvement of the substantia nigra and bilateral frontal cortex. The clinical implications of present study findings underscore the importance of considering JE as a differential diagnosis in patients presenting with symptoms of encephalitis, especially when MRI reveals bi-thalamic signal alterations. Early recognition and initiation of appropriate treatment, including antiviral agents, are crucial for improving outcomes and reducing mortality. This study contributes to the existing literature by reinforcing the importance of neuroimaging in diagnosing JE and highlighting the distinct MRI patterns associated with the disease. Recognising these characteristic imaging features can aid clinicians in promptly identifying and managing JE cases, thereby mitigating the associated morbidity and mortality. ]]> Play Tool Kit to Strengthen Prosocial Behaviour and Empathy among Attention-Deficit/Hyperactive Children Franny Joel Emmanuel, Anil Sharma Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects individuals&#8217; ability to regulate their attention, impulses, and activity levels. It is commonly diagnosed in childhood but can persist into adolescence and adulthood. Children with such type of disorder are having copious problems related to social skills. Understanding these core symptoms is crucial in recognising and addressing the challenges faced by children with ADHD. Hence, some interventions has to be introduced in the form of a play toolkit, which has a significant effect on ADHD children&#8217;s prosocial behaviour and empathy. This play toolkit includes two components: play therapy and doodle therapy. Using play-based activities to enhance social skills, emotional regulation, problem-solving, and cooperation skills in a supportive and engaging environment is essential. Utilising creative activities like drawing, colouring, and art-based projects to facilitate self-expression, communication, and emotional understanding can indirectly improve social interactions. By incorporating these interventions into a comprehensive treatment plan, nurses and healthcare professionals can help children with ADHD develop essential social skills, improve their relationships with peers and adults, and enhance their overall well-being. ]]> Hydatid Cyst of the Spleen: Unveiling a Rare Case Simran Khan, Poornima Pandey Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X ]]> Endoscopic Finding of Large Gastric Diverticulum with Ulceration: A Rare Cause of Upper Gastrointestinal Bleeding Kamlesh Ashok Taori, Vijendra Vasantrao Kirnake, Parmeshwar Junare, Sourya Acharya, Nikhil Pantbalekundri Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X A 60-year-old male patient presented to the casualty with complaints of multiple episodes of bloody vomiting, burning epigastric pain, generalised weakness, giddiness, and passing black tarry stools for five days. The epigastric pain had an insidious onset, a burning character, was intermittent, non-radiating, aggravated after consuming spicy food, and relieved by taking some antacid medication. He also had nausea followed by multiple episodes of vomiting, containing fresh red blood, around 1-2 teaspoons in each vomit, with some reddish-black clots. He also had a past history of a burning sensation in the epigastrium for one year. He had no significant family history. ]]> Spontaneous Subcapsular Haematoma as a Complication of Acute Pyelonephritis: Imaging Findings Yeshwanth Raju Narayanan, Senthil Kumar Aiyappan, Siddhardha Kommuri, Yatham Rama Rao Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X A 70-year-old male patient presented with complaints of fever and burning micturition for the past five days associated with left loin pain and vomiting. There was no history of haematuria. The patient was a known case of diabetes and hypertension and had been on irregular treatment for the past five years. Upon examination, the patient was hemodynamically stable, and there was tenderness in the left flank region. ]]> A Classical Case of Juvenile Recurrent Parotitis Kundan Mehta, K Mithun Nilgiri Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X ]]> &#8216;Butterfly&#8217; Plaque of Antecubital Fossa: A Diagnostic Dilemma Priyadarshan Anand Jategaonkar, Sudeep Pradeep Yadav Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Dear Editor, The 20-year-old female, a farmer with no medical history or current medications, presented with a large discoid soft-tissue mass arising from the left antecubital fossa since childhood. It started as a pea-nut-sized verrucous swelling and slowly enlarged over the last one-and-a-half decades. She experienced occasional local itching but never had pain. There were no ulcerations, discharge, or similar lesions elsewhere. Her past and family histories were non contributory, and she could not recall any local trauma in the past. Primarily, inadequate elbow flexion and cosmetic disfigurement compelled her to seek medical consultation. ]]> Empowering Medical Education: Unveiling the Significance of Dissection Competitions and Self-directed Learning Chaitanya Singh, Neelesh Kanasker Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X ]]> Evaluation of Clinical Performance and Colour Match of Single and Multiple Shade Composites in Class-I Restorations: A Randomised Clinical Study Priya Porwal, Nimisha Chinmay Shah, Renu Batra, Niral Kotecha, Aishwarya Jain Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Biomimetic dentistry primarily focuses on achieving aesthetics that closely resemble natural enamel and dentin. This approach ensures that dental restorations seamlessly match the appearance of enamel and dentin, rendering them virtually invisible. Additionally, biomimetic dentistry aims to mimic not only the visual characteristics but also the physical properties of enamel and dentin, thereby ensuring functional acceptability. The introduction of new composite materials in the market is a gradual progression aimed at attaining the mentioned objectives. <b>Aim:</b> To compare clinical performance and colour matching of single and multiple shade composites in simple Class-I carious lesions after one year. <b>Materials and Methods:</b> This randomised clinical study included 21 patients with a total of 72 Class-I carious lesions with patients who provided informed consent. Teeth were randomised into two groups: Group-A (n=36) received multi-shade composite (3M Filtek z350), and Group-B (n=36) received single-shade composite (Omnichroma). Clinical performance was assessed by two blinded evaluators at baseline, six months, and one year using modified United States Public Health Service (USPHS) criteria. Colour matching was evaluated by capturing digital photographs with a DSLR camera, ring flash, and 100 mm macro lens. Colour measurements (L*, a*, b*) were analysed using Adobe Photoshop, and ?E was calculated immediately after restoration. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 21.0 software, employing Chi-square test, Friedman test, and independent t-test. <b>Results:</b> No significant difference was found in clinical outcomes after one year using modified USPHS criteria (p>0.05). However, both Group-A (p=0.002) and Group-B (p=0.007) showed increased marginal discolouration, and decreased colour match (p<0.001) from baseline to one year. There was no statistically significant difference in colour matching potential between the two groups (p=0.056). <b>Conclusion:</b> Single-shade composites effectively treat Class-I carious lesions, demonstrating satisfactory colour matching and clinical performance. ]]> Assessing Reverse Shock Index as a Survival Predictor for Trauma Patients in Emergency Settings: A Retrospective Observational Study Pooja Shah, Arpan Shah, Rutva Desai, Anuja Agrawal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Identifying trauma patients with shock is crucial, as early intervention and prompt treatment improve patient prognosis and survival. To address this, the ratio of Systolic Blood Pressure (SBP) and Heart Rate (HR), known as the Reverse Shock Index (RSI), is measured. <b>Aim:</b> To evaluate the effectiveness of RSI calculation in assessing prognosis. <b>Materials and Methods:</b> This was a retrospective observational study in which data were retrospectively collected on trauma patients treated in the Emergency Room (ER) at Dhiraj Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, from January 2021 to December 2022. Patients involved in road traffic accidents, fall from a height of &#8805;6 m, assault, and machinery injuries were included. Upon arrival, vital signs such as HR, SBP, Respiratory Rate (RR), Glasgow Coma Scale (GCS), associated injuries, and in-hospital mortality were documented. Any resuscitative procedures required, such as Cardiopulmonary Resuscitation (CPR), intubation, oxygen therapy, chest tube insertion, and blood transfusion, were also recorded. The RSI was calculated for all trauma patients and divided into two groups (RSI <1 and RSI &#8805;1). The t-test was performed with a 95% Confidence Interval (CI). <b>Results:</b> Out of 363 patients, data from 320 patients were included. Among them, 55 patients (17.2%) had RSI <1, and 265 patients (82.8%) had RSI &#8805;1. Patients with RSI <1 exhibited lower GCS scores, tachypnoea (RR >29), or bradypnoea (RR <10), along with higher mortality rates. These patients also required resuscitative interventions. Those with RSI <1 experienced more head injuries, thoracic trauma, and maxillofacial injuries (p<0.001). <b>Conclusion:</b> The RSI <1 in trauma patients demonstrated significantly higher predictive accuracy for adverse outcomes, serving as a primary tool for early intervention and aggressive care in the ER. ]]> Effects of Magnesium Sulphate, Dexmedetomidine and Lignocaine on Perioperative Haemodynamic and Postoperative Analgesia in Patients Undergoing Laparoscopic Abdominal Surgeries: A Randomised Clinical Study Ipsita Roy, Bani Parvati Magda Hembrom, Arindam Das, Arpita Choudhury Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Laparoscopic surgeries currently represent the mainstay of surgical modalities. Pneumoperitoneum imposes significant intraoperative haemodynamic alterations, which are more pronounced in elderly patients and those with co-morbid conditions. Inadequate pain relief in the perioperative period may result in various physiological and psychological traumas. <b>Aim:</b> To investigate the effects of magnesium sulphate, dexmedetomidine, and lignocaine on the haemodynamic responses and postoperative analgesia in patients undergoing laparoscopic abdominal surgeries. <b>Materials and Methods:</b> This double-blinded, randomised clinical study was conducted in the general surgery operation theatre, Post-anaesthetic Care Unit (PACU), and the male and female surgery ward of RG Kar Medical College and Hospital, Kolkata, West Bengal, India from March 1, 2021, to March 1, 2022. The study involved 105 subjects assigned to Group-L, who received an injection of lignocaine as a loading dose of 1.5 mg/kg intravenously over 2-4 minutes before induction, followed by a continuous infusion of 2 mg/kg/hour throughout the surgery. Group-M received a loading dose of MgSO<sub>4</sub> at 30 mg/kg over 15 minutes before induction, followed by 15 mg/kg/hour throughout the surgery, and Group-D received a loading dose of dexmedetomidine at 1 mcg/kg over 10 minutes before induction, followed by a continuous infusion of 0.5 mcg/kg/min throughout the surgery. Data on Heart Rate (HR), Mean Arterial Pressure (MAP), and the total dose of rescue analgesic administered in the postoperative 24 hours were recorded and analysed using Analysis of Variance (ANOVA) and Tukey&#8217;s Honestly Significant Difference (HSD) test, as well as the Chi-square test where applicable. A p-value of less than 0.05 was considered statistically significant. <b>Results:</b> The groups were comparable in terms of demographic variables and baseline haemodynamic status. The average age in Group-D was 39.13&#177;9.48 years, in Group-M was 37.30&#177;8.14 years, and in Group-L was 36.5&#177;7.2 years (p=0.26). Group-D had 60% males, Group-M had 57% males, and Group-L had 60% males. The mean Body Mass Index (BMI) of Group-D was 25.9&#177;2.03 (kg/m2), Group-L (Lignocaine) was 24.7&#177;2.7, and Group-M (Magnesium Sulphate) was 23.8&#177;3.2. Dexmedetomidine was found to be superior in maintaining haemodynamic stability throughout the perioperative period (Preinduction HR: Group-D=79.43, Group-L=79.06, Group-M=82.09; Postinduction HR: Group-D=86.49, Group-M=65.91, Group-L=72.69). There was a significant decrease in postintubation MAP, most pronounced in the Magnesium Sulphate and Dexmedetomidine groups. Post-pneumoperitoneum, the surge in MAP was most effectively prevented by Dexmedetomidine. The lowest amount of rescue analgesic (injection Diclofenac in mg) was used in the Dexmedetomidine group (55.86&#177;5.05), followed by the Lignocaine group (126.43&#177;17.69). Patients in the Magnesium group required the highest amount of rescue analgesic (156.43&#177;7.91). The number of patients receiving rescue analgesia was significantly higher in the Lignocaine and Magnesium Sulphate groups (Group-D: 6.5&#177;3.14565, Group-L: 14.75&#177;7.36, Group-M: 18.25&#177;8.057). <b>Conclusion:</b> Dexmedetomidine was more effective in maintaining haemodynamic stability throughout the perioperative period and exhibited superior postoperative analgesic properties. Magnesium Sulphate and lignocaine were more effective in preventing postintubation surges. ]]> Levocetirizine versus Bilastine as Monotherapy in the Management of Chronic Spontaneous Urticaria: A Randomised Controlled Trial Roshini Rajendran, VNS Ahamed Shariff, Vijayabhaskar Chandran, Deepa Kalappan Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Chronic urticaria is defined as the almost daily occurrence of wheals and pruritus for a minimum of six weeks, adversely affecting the quality of life and necessitating management with a drug with better efficacy and a high safety profile. This study was designed to determine how monotherapy with newer antihistamines benefits chronic spontaneous urticaria by producing earlier and longer periods of remission. Additionally, the study aimed to assess the adverse effects associated with the drugs. <b>Aim:</b> To compare the efficacy of Levocetirizine and Bilastine in chronic spontaneous urticaria. <b>Materials and Methods:</b> The study was a single-blinded randomised controlled trial conducted in the Department of Dermatology at Madras Medical College, Chennai, Tamil Nadu, India over 24 months from January 2020 to December 2021. A total of 163 patients with chronic urticaria were randomly divided into two groups: Group A with 82 patients and group B with 81 patients. The patients were treated with tablet Levocetirizine 5 mg and tablet Bilastine 20 mg for six months (with up-dosing to four-fold maximum) in Group A and Group B, respectively. The treatment response was assessed using the Urticaria Activity Score (UAS) at each follow-up. Patients were followed-up for an additional six months to observe the time of recurrence. Total 15 patients were lost to follow-up and were consequently excluded from the statistical analysis. <b>Results:</b> At the end of six months, the improvement observed in UAS was statistically similar in both groups (p-value=0.513). The time taken for remission was shorter with Levocetirizine (11.19&#177;5.31 weeks) compared to Bilastine (14.59&#177;5.02 weeks). Recurrence occurred earlier with Bilastine compared to Levocetirizine. <b>Conclusion:</b> Levocetirizine and Bilastine are equally effective in controlling urticaria at the end of six months of treatment. Patients on Levocetirizine experienced earlier remission as well as late recurrence compared to those on Bilastine. ]]> Effect of Dexmedetomidine versus Propofol on Sevoflurane related Emergence Agitation in Paediatric Patients: A Randomised Clinical Study Thasreefa Vettuvanthodi, Basheer Padinjare Madathil Abdul, Minu Subramonian, Rekha Krishnankutty Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Postoperative Emergence Agitation (EA) is a troublesome side-effect of sevoflurane anaesthesia. Drugs like dexmedetomidine and propofol offer significant benefits in reducing the incidence and severity of sevoflurane-related postoperative EA in paediatric patients. <b>Aim:</b> To compare the efficacy of intravenous dexmedetomidine and propofol in reducing the incidence and severity of EA associated with sevoflurane anaesthesia in paediatric patients. <b>Materials and Methods:</b> A randomised clinical study was conducted on 140 patients, belonging to American Society of Anaesthesiologists Physical Status (ASA PS) classes I and II, aged between 2-6 years, undergoing infraumbilical surgery lasting more than one hour. The patients were divided into two equal groups receiving dexmedetomidine 0.3 &#956;g/kg (Group SD) and propofol 1 mg/kg (Group SP) at the start of skin closure, administered over 10 minutes. The incidence of EA in the Post Anaesthesia Care Unit (PACU) was evaluated using the Watcha scale, and the severity of EA was assessed using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. A Watcha score of 3 or 4 indicated the presence of EA, while a PAED score of &#8805;12 was deemed significant. Statistical analysis of the data was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 22.0, with an Independent sample t-test for comparing normally distributed quantitative parameters, and the Chi-square test for comparing categorical outcomes between the study groups. <b>Results:</b> The mean age of the patients in group SD was 4.19&#177;0.78 years, and in group SP was 4.03&#177;0.71 years. Both study groups were found to be comparable in terms of patient characteristics such as age, sex, weight, and duration of surgery (p-value >0.05). The incidence of postoperative EA, as measured by the Watcha scale, was higher in group SP compared to group SD upon arrival and up to 30 minutes in the PACU (p-value <0.001). The severity of EA, assessed using the PAED score, was greater in group SP compared to group SD at 0, 5, 10,15 and 20 minutes in the PACU (p-value <0.001). <b>Conclusion:</b> Dexmedetomidine 0.3 &#956;g/kg was more effective than propofol 1 mg/kg in reducing the incidence and severity of EA associated with sevoflurane anaesthesia, with minimal haemodynamic effects and no clinically relevant severe adverse effects in both the groups. The significantly prolonged extubation times observed in the propofol group did not result in significantly longer stays in the PACU. ]]> Effect of Yoga on Premenstrual Syndrome: A Systematic Review Upama Misra, Saamdu Chetri Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Yoga takes an approach that addresses the mental and spiritual aspects, making it a powerful tool for treating medical conditions that often do not respond well to traditional methods. Researchers have a growing interest in studying the effects of yoga on chronic health issues and mental wellbeing. <b>Aim:</b> To investigate and summarise the impact of yoga on premenstrual syndrome. <b>Materials and Methods:</b> For this systematic review, international databases (Google Scholar, PubMed, EBSCOhost, and ScienceDirect) were systematically searched from the inception of the databases until January 31, 2024. The keywords &#8220;premenstrual syndrome&#8221; and &#8220;yoga&#8221; were employed, and &#8220;Medical Subject Headings&#8221; (MeSH) were utilised for these keywords. Two researchers independently screened articles, and consensus for inclusion was achieved through mutual discussions. All studies assessing the effect of yoga on premenstrual syndrome were extracted from the selected studies without restricting to the form or type of yogic intervention. <b>Results:</b> A total of 35 studies on the subject were scrutinised, and 12 publications meeting the inclusion and exclusion criteria were incorporated in the study for evaluation. All studies indicated that yoga is effective in reducing at least one or some of the physical symptoms, such as bloating, pain, fatigue, breast tenderness, appetite changes, and psychological changes like irritability, stress, anxiety, depression, loss of interest, attention, control, and arousal during premenstrual syndrome. There is a lack of clarity regarding the effect of yoga on many other symptoms of premenstrual syndrome. <b>Conclusion:</b> Yoga interventions demonstrate effectiveness in alleviating premenstrual symptoms in women with premenstrual syndrome. ]]> Turnaround Time of Patients in Emergency Department at a Tertiary Care Teaching Hospital in Uttarakhand, India: A Cross-sectional Study Dinesh Chandra Joshi, Ravinder Singh Saini, Shweta Samant, Nitin Kanchan Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The Emergency Department (ED) is the point of first contact for any critically ill patient needing immediate medical attention. EDs use a triage system which ensures people who are critically ill are treated first. Turnaround Time (TAT) for the ED is taken as the time from the patient&#8217;s arrival in the ED to either their hospitalisation or discharge. <b>Aim:</b> To estimate the TAT of patients in the ED at a tertiary care teaching hospital. <b>Materials and Methods:</b> This cross-sectional study was conducted from August 1 to August 31, 2022, at the ED of Himalayan Hospital, Dehradun, Uttarakhand, India. A sample size of 300 patients were selected using a simple random sampling technique. Data were collected by direct observation using a data collection sheet. Timings were recorded with the help of a stopwatch. Statistical analysis was performed using the data analysis tool in Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 23.0. Pearson coefficient of correlation (r-value) and p-value were calculated. The level of statistical significance was set at 5% (p-value <0.05). <b>Results:</b> Most of the patients attending the ED were over 60 years of age 65 (21.7%). Only 24 (8%) patients were triaged as priority 1 (Red), whereas priority 2 (Yellow) and priority 3 (Green) patients were 135 (45%) and 141 (47%), respectively. It was observed that a maximum of 79 (26%) patients reported to the ED between 4 pm to 8 pm. A total of 186 (63%) patients were given final disposal within three hours of their arrival in the ED. The overall average length of stay in the ED was 2 hours, 53 minutes, and 4 seconds, or 173 minutes. <b>Conclusion:</b> The study provided valuable insight into the causes of the increased TAT of patients in the ED. The highest time (1 hour, 48 minutes, and 59 seconds&#177;1 hour, 31 minutes, and 43 seconds, constituting 63% of the total time in the ED) was taken by radiological investigations in the ED, followed by the time of 36 minutes and 30 seconds&#177;39 minutes and 3 seconds (21% of total time in the emergency) for shifting patients. ]]> Effect of i.v. Magnesium Sulphate versus i.v. Dexamethasone on Intraoperative Haemodynamic and Postoperative Analgesia after Spinal Anaesthesia in Lower Limb Surgeries: A Randomised Clinical Study Hersimran Kaur, Sahil Garg, Pranay Sah, Ram Nandan Prasad, Bhavika Marken Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Intrathecal adjuvants have gained favour in recent years with the goal of extending the duration of a block. Among these, Dexamethasone possesses anti-inflammatory and analgesic action and can be given as an adjuvant to local anaesthetics to enhance the efficacy of regional anaesthesia, as well as to decrease the intensity of shivering. The addition of Magnesium sulphate (MgSO<sub>4</sub>) to spinal anaesthesia helps in improving postoperative analgesia in an orthopaedic setting. <b>Aim:</b> To compare the effects of Intravenously (i.v.) MgSO<sub>4</sub> and i.v. dexamethasone on intraoperative haemodynamics, the time to achieve dermatome T10 intraoperatively, and to compare postoperative Visual Analogue Scale (VAS) scores between the two groups at 1, 3, 6, 12, and 24 hours after surgery. <b>Materials and Methods:</b> This randomised clinical trial was conducted, and patients were randomly divided into two groups. Group M (n=40): MgSO<sub>4</sub> 40 mg/kg given 15 minutes before spinal anaesthesia in 100 mL normal saline infusion i.v. Group D (n=40): Dexamethasone 8 mg given 15 minutes before spinal anaesthesia in 100 mL normal saline infusion i.v. The parameters assessed included haemodynamic parameters, time to achieve dermatome T10 intraoperatively, postoperative VAS score at 1, 3, 6, 12, and 24 hours after surgery, and any side-effects like sedation, respiratory depression, nausea, vomiting, pruritus, urinary retention, bradycardia, and hypotension. Statistical testing was conducted using the statistical software Statistical Package for Social Sciences (SPSS) 28.0. <b>Results:</b> There was no significant difference in demographic variables (age and gender) between the two groups (p-value>0.05). However, the decrease in mean heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Blood Pressure (MAP) was greater in group D compared to group M at different time intervals (p-value<0.05). Additionally, dermatome level T10 was achieved earlier in group D by approximately two minutes compared to group M (6.95&#177;0.39 minutes versus 5.03&#177;0.16 minutes, respectively, p-value<0.001). <b>Conclusion:</b> An i.v. infusion of 8 mg dexamethasone in 100 mL normal saline was more effective compared to an i.v. infusion of 40 mg/kg MgSO<sub>4</sub> in terms of achieving more stable haemodynamics intraoperatively and achieving the T10 dermatome level earlier. ]]> Clinicopathological and Immunohistochemical Association of CD55 and CD59 in Colorectal Carcinoma: A Cross-sectional Study Rathin Hazra, Ananya Khan, Rajib Kumar Mondal, Sarbari Kar Rakshit Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Colorectal Carcinoma (CRC) is one of the significant causes of fatality worldwide. High-grade and high-stage cancers contribute to this fatality. In most terminal cases, new immunomarkers (CD55 and CD59) are commonly detected as positive. The expression of these immunomarkers and their clinical relevance in CRC has not yet been firmly established. While their upregulation has been demonstrated in some CRC several groups have also reported that they are not highly expressed in CRC tissues. <b>Aim:</b> To study the expression of CD55 and CD59 in CRC. <b>Materials and Methods:</b> This was a cross-sectional study involving 90 patients with colorectal growth, conducted from February 2020 to July 2021 in the Department of Pathology in collaboration with the Department of General Surgery at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Histopathological findings were evaluated, and associations of grading, staging, tumour type, tumour location, age, and sex were studied with immunomarkers (CD55 and CD59). Clinical parameters of the patients with CRC diagnosed by colonoscopic biopsy were also studied, including age, sex, clinical pictures, food habits, family history of CRC, and prior chemotherapy. The Chi-square test was used to determine the significance of the study. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM, Illinois, US). A p-value of &#8804;0.05 was considered statistically significant. <b>Results:</b> A total of 90 CRC patients were included in this study, with the majority being male 56 (62.2%) aged 51-60 years. Most cases 59 (65.6%) were moderately differentiated adenocarcinoma, followed by poorly differentiated adenocarcinoma 18 (20%) and well-differentiated adenocarcinoma 13 (14.4%). About 62 (68.9%) and 28 (31.1%) patients showed strong and weak CD55 expression, respectively. In total, 65 (72.2%) and 25 (27.8%) patients exhibited strong and weak CD59 expression, respectively. The association of CRC grade and stage with CD55 and CD59 was significant (p-value=0.0001, p-value=0.0013, p-value=0.0001, and p-value=0.0001, respectively). <b>Conclusion:</b> There are several variables to consider during the histopathological reporting of CRC, with tumour differentiation, grade, and stage being among the most important. Particularly, high-grade (poorly differentiated) and high-stage adenocarcinomas demonstrate enhanced expression of CD55 and CD59, indicating a poor prognosis. It is essential for pathologists to meticulously perform grossing and reporting of CRC and dispatch the histopathology report after proper clinicopathological correlations. These immunomarkers can also be included in a routine IHC panel for prognostic and therapeutic purposes. ]]> Comparison of Cryobiopsy and Forceps Biopsy in Suspected Lung Carcinoma Patients with Endobronchial Lesions: A Cross-sectional Study Vaishnavi Gadwal, V Vinay, Prabhpreet Sethi, Jitendra Kumar Saini, V Yasir Abdullah, Kuljeet Singh, A Swaroon Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Forceps Biopsy (FB) is usually used to obtain tissue in endobronchial lesions through a flexible bronchoscope. The mean diagnostic rate of bronchoscopic FB is 74% in central tumours. A limitation of FB is the small tissue size and the occurrence of crush artifacts. In contrast, Cryobiopsy (CB) provides larger samples without such artifacts, which are crucial for accurate histopathological diagnoses. <b>Aim:</b> To compare the efficacy and safety of CB with FB in endobronchial mass lesions suspected of lung cancer. <b>Materials and Methods:</b> A cross-sectional study was conducted on suspected endobronchial mass lesions with suspicion of malignancy from October 2015 to March 2017. About 35 patients fulfilling the inclusion criteria were enrolled, and five of these 35 patients were excluded as they were diagnosed with benign lesions. Among these 30 patients, a flexible biopsy was obtained first followed by CB using the same endobronchial cryobiopsy. Data were analysed in terms of tissue viability, mean tissue size, diagnostic yield, complications, and histological diagnosis. Parameters were compared using the Chi-square test (&#967;<sup>2</sup> test) and Fisher&#8217;s exact test. <b>Results:</b> The mean age of the study participants was 58.33&#177;10.12 years. The mean&#177;SD size (diameter) of tissue obtained by CB (0.73&#177;0.47 cm) was higher than that of FB (0.23&#177;0.08 cm) (p-value<0.001). The diagnostic yield obtained by CB was 96.7% compared to 70% in FB (p-value<0.005). Mild bleeding was seen in 86.7% of the CB group and in 60% of the FB group (p-value=0.019). None of the patients in the study experienced moderate or severe bleeding. <b>Conclusion:</b> CB emerges as a safe and dependable method, offering superior diagnostic outcomes compared to conventional FB with its capability to obtain larger biopsy samples and good-quality tissue while minimal bleeding. CB stands as a viable alternative to FB. ]]> Clinicoaetiological Profile of Infantile Tremor Syndrome in a Tertiary Care Hospital, Punjab, India: An Observational Study Anuradha Bansal, Harmesh Singh Bains Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Infantile Tremor Syndrome (ITS) is a condition that mainly affects infants aged 6-24 months. Although predominantly considered a disorder of vitamin B12 deficiency, there have been some reports of an association of other micronutrient deficiencies in ITS babies. <b>Aim:</b> To assess the clinicoaetiological profile of cases of ITS admitted to the tertiary care centre. <b>Materials and Methods:</b> This was a retrospective observational study conducted at Punjab Institute of Medical Sciences, Jalandhar, Punjab, India. All cases of ITS admitted to the Paediatric ward from April 2022 to March 2023 were enrolled. Their case records were studied for clinical signs and symptoms like presenting complaints, demographic profile, feeding history, history of tremors, and developmental milestones. Examination findings were studied for the degree of malnutrition, presence of anaemia, knuckle hyperpigmentation, sparse hypopigmented hair, other evidence of micronutrient deficiency, hepatosplenomegaly, and any focal neurological deficit. Laboratory parameters, mainly blood counts, haemoglobin, Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC), peripheral smear findings, vitamin D and B12 levels, and serum albumin, were analysed to ascertain the clinicoaetiological profile of ITS. <b>Results:</b> A total of 19 cases were included in the study. All of them had sparse hypopigmented hair and anaemia. Thirteen (68.4%) had knuckle hyperpigmentation, 11 (58%) had tremors, and 16 (84.2%) had developmental delay/regression without any other underlying cause. Only 9 (47.4%) had laboratory evidence of vitamin B12 deficiency, while 14 (73.7%) had vitamin D deficiency. All the babies were discharged home, and tremors resolved in all of them after vitamin D, B12, and zinc therapy. <b>Conclusion:</b> In addition to vitamin B12, Vitamin D deficiency was seen in most cases of ITS. Hence, all patients with ITS need to be evaluated and treated for vitamin B12 as well as vitamin D deficiency for optimal treatment of this disorder. ]]> Incidence and Predictors of Difficult Intubation in Patients Undergoing Thyroid Surgery Lalengkima Hmar Darngawn, Veena Nadarajan, Vimal Pradeep Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Thyroid enlargement is considered a risk factor for challenging direct laryngoscopy and intubation. Airway management in patients with thyroid swelling presents unique challenges, requiring thorough preparation for potential difficult airways. Although airway management in the overall population has been thoroughly researched, there is a scarcity of literature specifically addressing airway management in individuals who have thyroid enlargement. <b>Aim:</b> To evaluate the incidence of difficult intubation in patients undergoing thyroid surgery, utilising the Intubation Difficulty Score (IDS). <b>Materials and Methods:</b> This cross-sectional observational study was conducted among 258 patients in the Department of Anaesthesiology, Government TD Medical College, Alappuzha, Kerala, India. Various parameters including Modified Mallampati score, neck circumference, Body Mass Index (BMI), inter-incisor distance, retrognathia, neck extension, thyromental distance, tracheal deviation, and tracheal compression were assessed for all patients with thyroid swelling. The incidence of difficult endotracheal intubation was analysed using the IDS and the time taken for successful intubation was recorded. Data were presented as mean&#177;standard deviation (SD), frequencies, and percentages. The association between variables was analysed using the Chi-square test. <b>Results:</b> Thyroid disorders were more common in females 220 (85.3%) than in males 38 (14.7%). The variables such as BMI, Mallampati score, thyromental distance, inter-incisor distance, and neck mobility were not found to be associated with difficult intubation. However, increased neck circumference (>43 cm) was statistically significant (p-value=0.007) in relation to difficult intubation. According to IDS, 94.2% of patients had easy intubation, while 5.8% experienced difficult intubation. In terms of intubation times, 72.5% of patients were intubated within 10-15 seconds, 24.4% within 16-20 seconds, and 3.1% took longer than 20 seconds. <b>Conclusion:</b> Thyroid surgery itself is not an independent predictive factor for difficult intubation. Among the predictive factors in the study population, a neck circumference greater than 43 cm was found to be associated with difficult endotracheal intubation during thyroid surgery. ]]> A Scoping Review on the Exigent Needs to Build Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual Inclusive Competencies in the Medical Education Curriculum Jyotsna Needamangalam Balaji, Sreenidhi Prakash, Krishna Mohan Surapaneni Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA+) individuals are subjected to appreciable health inequalities, many of which are exacerbated by the absence of a standard framework for LGBTQIA+ proficient healthcare. The marginalised LGBTQIA+ population faces atrocious health outcomes and reveals deplorable medical care experiences. To provide relevant and sensitive care to LGBTQIA+ individuals and fulfill the healthcare needs of this marginalised population, healthcare service providers must acquire expertise in specific skills, guidelines, and recommendations. <b>Aim:</b> To provide a brief summary of the evidence in the scientific literature regarding the necessity of incorporating LGBTQIA+ inclusive competency into medical education curricula. <b>Materials and Methods:</b> An intricate literature search in scholarly databases like PubMed, Google Scholar, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) yielded a wide range of publications focusing on training undergraduate medical students in LGBTQIA+ healthcare. The selected scientific articles were further screened in accordance with the inclusion and exclusion criteria devised for this scoping review, aligning with the study&#8217;s objectives. <b>Result:</b> The extensive search yielded a total of 578 articles for screening. Based on the inclusion and exclusion criteria, 14 manuscripts were analysed for this scoping review, advocating the importance of integrating competencies into the medical curriculum to provide improved, unbiased healthcare services to LGBTQIA+ communities. <b>Conclusion:</b> There was notable diversity in studies in terms of the research objective, the LGBTQIA+ population(s) under focus, and the study results. Stigma and bias present potential barriers to establishing quality healthcare services for the LGBTQIA+ population. The current literature shows consensus in supporting academic efforts to shift towards pedagogical interventions that are vertically integrated and focused on clinical skills to address LGBTQIA+ health disparities. ]]> Evaluation of Preclinical Toxicity of Methanolic Extract of Sargassum tenerrimum using the Zebrafish Model Raman Yadav, Punnagai Kumaravelu, Subburaya Umamaheswari, Viswanathan Subramanian, Suvarna Jyoti Kantipudi Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> In the field of biomedicine, marine algae have gained significant attention due to the abundance of bioactive compounds they contain. However, studies on the chronic toxicity of algae are limited. <b>Aim:</b> To evaluate the in-vitro, in-vivo acute, and subchronic toxicity of <i>Sargassum tenerrimum</i> (<i>S. tenerrimum</i>) in an adult zebrafish model. <b>Materials and Methods:</b> The current preclinical toxicological interventional study was conducted at the Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, SRIHER, Chennai, Tamil Nadu, India, in September 2022. The algae <i>S. tenerrimum</i> was extracted with methanol using Soxhlet extraction. In-vitro toxicity of <i>S. tenerrimum</i> was performed using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay on the SH-SY5Y cell line. Acute toxicity was carried out for 96 hours according to Organisation for Economic Cooperation and Development(OECD) 203 guidelines, and subchronic toxicity was carried out for 14 days on the zebrafish model using the immersion method. Additionally, histopathological changes were observed after the acute toxicity study, and the Lethal Concentration 50 (LC50) value was analysed. <b>Results:</b> The MTT assay of the methanolic extract of <i>S. tenerrimum</i> revealed an LC50 value of 140.014 &#956;g/mL. An acute toxicity study conducted on zebrafish for 96 hours showed an LC50 value of 504.669 mg/L. Subchronic toxicity was done for 14 days, and on the 14<sup>th</sup> day of exposure, the LC50 value was found to be 404.196 mg/L. Histopathological changes were observed at higher concentrations (800 mg/L) of algal extract. <b>Conclusion:</b> The present study revealed that the methanolic extract of <i>S. tenerrimum</i> showed a toxic effect at higher concentrations on the zebrafish model. However, at lower concentrations, <i>S. tenerrimum</i> was deemed safe for further exploration of pharmacological activities in a zebrafish model. ]]> Exploring Cerebral Perfusion Transcranial Doppler Parameters in Patients Admitted to Combined Medical Surgical Intensive Care Unit Thomas Isiah Sudarsan, Bhuvanna Krishna Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Encephalopathy, a common complication in Intensive Care Unit (ICU) patients, is often linked to poor outcomes. Transcranial Doppler (TCD), a non-invasive tool assesses cerebral perfusion via the Pulsatility Index (PI), Resistivity Index (RI), and Time-Averaged Peak (TAP) or Mean Flow Velocity (MFV). These parameters may offer insights into cerebral perfusion and outcomes in encephalopathic patients. <b>Aim:</b> To describe the PI, RI of the Middle Cerebral Artery (MCA), and MFV or TAP measured by TCD in patients admitted to the ICU, comparing those with and without encephalopathy at the time of admission. <b>Materials And Methods:</b> This cross-sectional observational study was conducted from January 2019 to November 2020, in a combined medical-surgical ICU of a tertiary care hospital, involving 45 enrolled patients. Patients were evaluated within 24 hours of admission and subsequently every 24 hours until ICU discharge, death, or discharge against medical advice. Bilateral Middle cerebral artery TCD studies were conducted using a 1-5 MHz phased array probe or TCD mode through the transtemporal window. The PI, RI, and MFV were measured on both sides, with the higher value used for analysis, and all statistical analyses were performed using Statistics and Data 13 software. <b>Results:</b> In the present study, 88% (n=40) of patients had encephalopathy (GCS<15 and RAAS less than or more than 0). The mean APACHE II score was 19 (14-25), indicating severe illness with a predicted mortality of 30-40%. Patients with encephalopathy had significantly higher APACHE II scores compared to those without (19.5 (16-25) vs 10 (4-19)). Although there was a trend towards a higher Pulsatility Index in encephalopathic patients at admission (1.11&#177;0.378 vs 1.07&#177;0.12, p=0.81), PI, RI, and TAP values did not significantly differ in non-survivors (1.12&#177;0.49 vs 1.11&#177;0.33, p=0.750). Persistent encephalopathy was associated with a trend towards higher PI at admission (1.05&#177;0.24 vs 1.16&#177;0.46; p=0.756), and a moderate correlation was found between decreasing PI and improvement in GCS (rho=-0.489, p=0.001). <b>Conclusions:</b> PI, RI, and TAP at the time of admission were not found to be associated with occurrence and recovery of encephalopathy as well as mortality. The trend of change in PI moderately correlated with improvement in GCS suggesting the importance of trends rather than absolute values. ]]> Risk Assessment for Non Communicable Diseases among Adults in a Rural Area of Eastern India: A Single Centre Cross-sectional Study Ipsita Debata, Dibyajyoti Mandal, Basanta Kumar Behera, Prem Sagar Panda, Rosy Nayak, Priyaranjan Sahoo Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Non Communicable Diseases (NCDs) cause significant premature mortality. Prevention of major cardiovascular disease risk factors, like diabetes and hypertension, is a priority for public health. <b>Aim:</b> To estimate the risk assessment of NCD using the Community-Based Assessment Checklist (CBAC) scoring system developed by the Government of India among adults in rural areas. <b>Materials and Methods:</b> This community-based cross-sectional study was conducted among 400 adults attending the hospital at the rural health training centre of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, from March 2023 to August 2023 using consecutive sampling. Face-to-face interviews using a structured CBAC questionnaire and socio-demographic variables were used to gather data on age, tobacco consumption, alcohol intake, waist measurement, physical inactivity, and family history. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 21.0 and interpreted in frequencies, percentages, and the Chi-square test. A p-value <0.05 was considered statistically significant. <b>Results:</b> The overall risk of NCD was estimated to be 57.25%. The risk of NCD was significantly associated with age (p-value <0.00001), tobacco consumption (p-value <0.0001), alcohol consumption (p-value <0.0001), waist circumference (p-value <0.0001), physical activity (p-value=0.000018), family history of diabetes mellitus, hypertension, and cardiovascular illness (p-value <0.00001), education (p-value=0.0079), and socio-economic status (p-value=0.0415). <b>Conclusion:</b> The overall risk of NCD was estimated to be 57.25%. Most of the CBAC variables were found to have a significant association with NCD risk. However, no significant association was found between CBAC variables and gender. CBAC is a simple and economical screening tool employed at the community level so that early intervention strategies can be planned for those at risk of NCDs. ]]> Risk Assessment for Non-Communicable Diseases among Adults of 18 to 29 years Age in a Rural Area of Madurai District, Tamil Nadu, India: A Cross-sectional Study A Ra Boornema, S Vasundara, M Aarthy Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Non-Communicable Diseases (NCDs) are the leading cause of morbidity and mortality globally. In India, the Ministry of Health and Family Welfare reported a rise in mortality rates from 37% in 1990 to 61% in 2016. Additionally, the prevalence of diabetes mellitus and hypertension among young adults was higher than estimated. As the behavioural risk factors are mainly established in adolescence, screening at an earlier age becomes essential. <b>Aim:</b> To estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years and to assess the association between the risk factors and at-risk individuals. <b>Materials and Methods:</b> A community-based cross-sectional study was conducted in the field practice area of Madurai Medical College, Madurai, Tamil Nadu, India, to estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years. The National Health Mission (NHM) protocol was used for risk assessment, based on American Diabetic Association (ADA) and Joint National Committee (JNC) 8 guidelines. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) 20.0 software. <b>Results:</b> A total of 154 residents were included in the study. The mean age of the study participants was 24.64&#177;4.70 years. Approximately 60% of the study participants were males and 40% were females. A total of 54% of the participants were married. Most subjects had completed high school (33.8%), followed by 28.6% who completed postgraduation. Disease categorisation revealed that 54 (35%) were non-diabetics, 89 (58%) were pre-diabetics, and 11 (7%) had diabetes mellitus. Similarly, 24 (16%) were non-hypertensive, 115 (75%) had high normal values, and 15 (9%) had probable stage I hypertension. A statistically significant association was observed between hypertension and educational level, alcoholism, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP), whereas diabetes mellitus was not significantly associated with any variables. The probabilistic prediction for hypertension using the logistic regression model included alcoholism and SBP, which contributed to 25.6% of the variations in prediction hypertension. <b>Conclusion:</b> The study results highlight a significant burden of undiagnosed cases of diabetes and hypertension in the community. This indicates the need for systematic screening, early lifestyle modifications, appropriate treatment, and regular follow-up for such individuals. ]]> Correlation between Neutrophil to Lymphocyte Ratio and Urine Albumin to Creatinine Ratio in Diabetic Nephropathy Patients: A Cross-sectional Study BM Rakesh, N Pradeep, GJ Nischal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> One of the microvascular complications of diabetes is known as Diabetic Nephropathy (DN). The clinical manifestation of DN is an increase in the amount of albumin excreted in the urine. Albuminuria is the inflammatory process that occurs before end-stage renal failure and is a diagnostic marker. The total White Blood Cell (WBC) count is a crude but sensitive measure of inflammation. It is examined as an inflammatory marker in various cardiac and non cardiac disorders, such as acute Myocardial Infarction (MI), stroke, and heart failure. <b>Aim:</b> To find a correlation between Neutrophil to Lymphocyte Ratio (NLR) and Urine Albumin to Creatinine Ratio (UACR) in DN patients. <b>Materials and Methods:</b> This was an analytical cross-sectional study done over a period of 18 months from January 2018 to June 2019 at Vydehi Institute of Medical Sciences and Research Centre in Bengaluru, Karnataka, India. on 104 subjects diagnosed with type 2 Diabetes Mellitus (DM) registered in present study. Spot albuminuria was tested by immune turbidimetry method. Urine creatinine was tested using Jaffe&#8217;s kinetic method, from which spot UACR was calculated. The patients with albuminuria and without albuminuria were grouped into cases and controls, respectively. NLR was calculated using complete blood count and correlated with UACR. The estimated Glomerulus Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation and correlated with UACR. Cases were further subgrouped into moderately increased albuminuria and severely increased albuminuria groups. Mean and standard deviation, independent sample t-test, Chi-square test, Odds Ratio (OR) were applied to find significance. A p-value of <0.05 was considered statistically significant, and an OR more than one suggests a positive association. <b>Results:</b> A total of 104 diabetic subjects were registered, with 52 subjects having DN and 52 having normal urine albumin. The mean age was 56&#177;11.3 years and 50.6&#177;11.8 years in the case and control groups, respectively. Among the 52 subjects in the case group, 12 (23.1%) were female and 40 (76.9%) were male. In the 52 control group, 30.8% (n=16) were female, and 69.2% (n=36) were male. The mean urine albumin was 75.5&#177;121.2 mg/dL and 1.2&#177;1.2 mg/dL in the case and control groups, respectively (p<0.001). A correlation was calculated between UACR and NLR, with a cut-off value for NLR of 2.92. The cut-off value for NLR was calculated using the Receivers Operating Curve (ROC). The Chi-square test was applied, showing statistical significance (p<0.001), with an OR calculated at 4.34 (OR >1). <b>Conclusion:</b> The present study showed a significant positive correlation between NLR and UACR. Therefore, NLR may be considered a novel surrogate marker of DN, as an alternative to UACR, which is expensive and requires special equipment. ]]> Comparison of Periodontal Status between Koraga Tribes and Malavettuvan Tribes in Kasargod District of Kerala: A Cross-sectional Study Pooja Raghu, Shrinidhi M Shankar, Soumya B Gururaj, Chethana K Chidambar, Kala S Bushan, Chaitra M Prabhudev Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The lack of a healthcare system is one of the serious problems among the Koragas. The Koraga tribal community in the Kasargod district has a community health center in the area, but it lacks advanced medical and dental facilities, making it difficult for them to seek treatment in the few private hospitals in the area due to their economic backwardness. The Malavettuvan tribes are distributed only in the ghat areas of the Kasaragod District of Kerala. Their major occupation is agriculture, and they are educationally, economically, and socially backward. <b>Aim:</b> To compare the periodontal status of the Koraga and Malavettuvan tribes of the Kasargod district. <b>Materials and Methods:</b> This cross-sectional study was conducted among randomly selected 304 participants from both Koraga and Malavettuvan tribes aged 35-55 years. Clinical parameters such as the oral hygiene index, Community Periodontal Index (CPI), and loss of attachment were measured. A questionnaire was used to assess the oral hygiene habits, lifestyle, and other habits of the populations. Statistical analysis was carried out using the Mann-Whitney U-test. <b>Results:</b> The results of the present study showed a significant difference in the oral hygiene index (Median OHI of Koraga-0.40, Malavettuvan-1.20 respectively, p-value <0.001) and CPI (Median CPI of Koraga-0.60, Malavettuvan-1.50, respectively, p-value <0.001) between both groups, while there was no difference in the loss of attachment (p-value-0.991). The majority of the Koragas and Malavettuvans used toothbrush and toothpaste as cleaning aids (70.06% and 78.28%, respectively). Smokeless tobacco was prevalent among Koragas compared to Malavettuvans (36.18% and 29.60%, respectively), while cigarette smoking was more common among Malavettuvans (50.98% and 42.10% for Koragas and Malavettuvans, respectively). <b>Conclusion:</b> Even though the Koragas and Malavettuvans do not routinely seek dental care and have a primitive lifestyle with less formal education, a lower level of periodontal disease was observed among both groups. There is a need to promote more healthcare programs that emphasise oral health among these populations. ]]> Assessing the Impact of Oral Disorders on the Oral Health-Related Quality of Life of Preschool Children and their Families: A Cross-sectional Study Shakuntala Bethur Siddaiah, Pragna S Vijaya Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Oral disorders such as Traumatic Dental Injury (TDI) and Early Childhood Caries (ECC) can significantly impact the functional, social, and psychological well-being of growing children and their families. The Early Childhood Oral Health Impact Scale (ECOHIS) serves as a proxy assessment of Oral Health-Related Quality of Life (OHRQoL) in children, developed to evaluate the effects on the quality of life of preschool children. <b>Aim:</b> To assess the impact of oral disorders on the OHRQoL of children aged two to six years and their families. <b>Materials and Methods:</b> In this cross-sectional study, a total of 1000 children aged 2 to 6 years from various preschools in South Bangalore were selected. All children underwent examinations for caries, stains, and fractures. A modified questionnaire survey based on ECOHIS, consisting of 26 questions, was completed by the parents of the children. The answered questionnaire was then evaluated to assess the impact of dental conditions on the quality of life of both children and parents. Kruskal-Wallis Test, Dunn&#8217;s post-hoc Test, and Mann-Whitney Test were used to compare the mean scores of different domains of the OHRQoL scale based on ECC and dental trauma, respectively. <b>Results:</b> The severity of ECC demonstrated an adverse effect on the symptom domain (p<0.001), function domain (p=0.002), psychology domain (p=0.03), and the entire score of the Child Impact Section (CIS) (p<0.001). In the Family Impact Section (FIS), the mean scores of the family distress domain and the overall FIS were statistically significant (p<0.001). Dental trauma also showed an adverse effect on the symptoms domain (p<0.001) and the entire scores of the CIS (p=0.001). Additionally, the mean scores of the family distress domain and the overall FIS were statistically significant (p<0.001). <b>Conclusion:</b> The presence of ECC and dental trauma is likely to have a negative impact on the physical, psychological, and emotional well-being of preschool-aged children and their families. ]]> Estimation of Crown Length, Root Length and Golden Divine Ratio in Extracted Permanent Maxillary and Mandibular Central Incisors: An In-vitro Study Venkata GV Karthikeswari, Deepak Pandiar, Reshma Poothakulath Krishnan, R Ramya Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Human teeth serve many crucial functions, and aesthetics is one of these. Aesthetics and beauty are often correlated with the Golden Divine Ratio (GDR), a unique proportion hypothesised to exist in individuals or things with a harmonious appearance. <b>Aim:</b> To estimate the crown length, root length, and GDR in extracted human permanent maxillary and mandibular Central Incisors (CI) in the population of Tamil ethnicity from South India. <b>Materials and Methods:</b> This in-vitro cross-sectional study was conducted in the Department of Oral Pathology and Microbiology at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from January 2023 to October 2023. The study included a total of 90 extracted human teeth from the Institutional tooth repository, out of which 27 were upper permanent CIs and the remaining 63 were mandibular CIs. Crown length and root length were measured using digital vernier calipers, and golden ratios were derived. Statistical Package for Social Sciences (SPSS) software version 26.0. was used for descriptive analysis and deriving means and standard deviation. <b>Results:</b> The average crown length, root length, and total length of upper CIs were 8.06&#177;0.09 mm, 13.01&#177;1.47 mm, and 21.06&#177;2.36 mm, respectively. For the remaining 63 extracted permanent mandibular CIs, the mean crown length, root length, and total length were 7.85&#177;0.66 mm, 12.6&#177;0.97 mm, and 20.45&#177;1.49 mm, respectively. The Root-to-Crown (R/C) ratio and Total Length to Root Length (T/R) ratio approximated 1.618 for both sets of teeth. <b>Conclusion:</b> The crown length of maxillary and mandibular CIs from the Tamil population followed the golden ratio in the present study. ]]> Substance P Level in Patients with Degenerative Lumbar Spine Disorder undergoing Decompressive Surgery: An Observational Study Amrita Panda, Rajlaxmi Sarangi, Debadyuti Sahu, Saurabh Sharma, Narendra Kumar Das, Sibanarayan Rath Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Patients with degenerative lumbar spine disorders experience Chronic Low Back Pain (CLBP) for which they undergo decompressive surgery. Substance P (SP), a neurotransmitter which acts as a modulator of pain perception and transmits nociceptive signals via primary afferent fibers to the spinal cord and brainstem. In chronic painful conditions, SP level can be associated with the severity of pain and gets altered; however, this correlation is not present in acute pain. <b>Aim:</b> To evaluate serum SP level in CLBP patients undergoing decompressive spine surgery. <b>Materials and Methods:</b> The present study was a prospective observational study, in which 30 patients with CLBP undergoing decompressive spine surgery were enrolled. Along with them, one first-degree relative of each patient and an equal number of healthy volunteers were included in the study group. Patients were followed-up on the 5th postoperative day and at two months after surgery for the evaluation of SP levels and Visual Analogue Scale (VAS) scores. Statistical data analysis was carried out using IBM PASW Statistics (SPSS) 25.0 version software. SP levels followed a non normal distribution and were compared by Mann-Whitney U or Kruskal Wallis test (for 2 or more groups, respectively) and correlated using Spearman rank correlation. <b>Results:</b> Patients undergoing decompressive spine surgery had a significantly higher SP level (97.5 picogram/mL (pg/mL)) than healthy volunteers (23.22 pg/mL), p-value <0.001. The serum SP levels in patients were found to be significantly reduced on the 5<sup>th</sup> postoperative day (31.7 pg/mL) and at two months after surgery (48.5 pg/mL), p-value=0.043. In contrast, there was no discernible change in the VAS score, which did not correlate with the fall in SP levels on the 5th postoperative day. <b>Conclusion:</b> SP level was elevated in subjects with degenerative lumbar spine disorders undergoing decompressive surgery. Higher levels of SP can be attributed to CLBP in those patients. SP can be contemplated as a biomarker of pain due to degenerative lumbar spine pathology. However, further studies are warranted to substantiate this. ]]> Compliance of Post-Exposure Prophylaxis of Anti-rabies Vaccine amongst Animal Bite Cases Attending Secondary Healthcare Hospital in Thiruvallur District, Tamil Nadu, India: A Cross-sectional Study Sindhiya Durairajan, Kranthi Karunai Kadal, Gowri Viswanathan, Kavitha Ramasamy, Durairajan Palani Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction: </b> India has the highest burden of animal bite cases globally, with a large proportion of the population affected by dog bites. India is endemic for rabies and accounts for 36% of the world&#8217;s rabies deaths. Mortality can be prevented by Post-Exposure Prophylaxis (PEP) with effective vaccines that are available. Vaccines are provided free of charge in Government hospitals. <b>Aim: </b>To estimate the compliance rate of Anti-Rabies Vaccine (ARV) regimen managed by the intradermal route. <b>Materials and Methods: </b>This was a cross-sectional record-based study from the ARV Register of Government Hospital, Gummidipoondi, Tamil Nadu, India. The victims of animal bite cases attending the hospital for the ARV regimen for a month were selected from the register to assess adherence to the full course updated Thai Red Cross regimen and identify any constraint factors hindering them from completing the course. <b>Results: </b>Out of 108 patients, 79 completed the full course ARV regimen, resulting in a compliance rate of 73.1%. Factors such as the distance of the hospital, timings, and forgotten dates were identified as major constraints. <b>Conclusion: </b>The compliance rate was found to be moderate, with constraint factors like forgotten dates and the distance of the hospital being significant hindrances to compliance. This highlights the importance of strengthening awareness through sensitisation programs and health education in both urban and rural areas to achieve a rabies-free India. ]]> Role of CD-64 on Neutrophils and HLA-DR on Monocytes as Markers of Neonatal Sepsis: A Cross-sectional Study Suman Tomer, Gajender Singh, Harish Punia, Geeta Gathwala, Rajeev Sen, Monika Gupta Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction: </b> Neonatal sepsis remains a diagnostic burden globally, responsible for about 30-50% of the total neonatal deaths each year in developing countries. Neutrophil CD-64 is found to be a promising marker for the diagnosis of early and late infections in newborns. Human Leukocyte Antigen-DR (HLA-DR) is a glycosylated cell surface transmembrane protein expressed on monocytes, allowing antigen presentation to T-cells and playing a crucial role in initiating the immune cascade during sepsis. Decreased expression of HLA-DR on monocytes has been associated with decreased survival in newborns with sepsis. <b>Aim:</b> To evaluate the role of neutrophil CD-64 and monocyte HLA-DR expression as markers of neonatal sepsis. <b>Materials and Methods:</b> This was a cross-sectional prospective study carried out at the Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between July 2016 and June 2017. Total of 70 full-term neonates with clinical suspicion of sepsis were enrolled. A 2 mL peripheral venous blood sample was collected for flow cytometry, blood culture, and sepsis screening in all patients. The expression of cell surface markers (CD-64 on neutrophils and HLA-DR on monocytes) was measured by an eight-color flow cytometer. A composite parameter was derived by dividing the Mean Fluorescence Intensity (MFI) values of nCD-64 and their respective mHLA-DR, multiplying the ratio by 100, and terming it as the sepsis index (Sepsis Index = nCD-64/mHLA-DR x 100). A region was drawn on monocytes on an SSC/CD14 plot. Gating was performed on &#8216;not monocytes&#8217; on the SSC/CD45 bivariate dot plot, and regions were drawn on lymphocytes and neutrophils. Data were entered into a Microsoft Excel spreadsheet and analysed using Statistical Package for Social Sciences (SPSS) version 21.0 statistical software. The Chi-square test was applied for proportions, and the Analysis of Variance (ANOVA) test was applied for normally distributed data. <b>Results: </b>In this study, 70 symptomatic neonates clinically suspected to have sepsis were enrolled and categorised into the sepsis group and the no Sepsis group. The sepsis group was further subgrouped into Definite Sepsis (Blood culture positive) and Probable Sepsis (Symptomatic baby with sepsis screen positive but sterile blood culture). nCD-64 positivity was observed in all cases (n=19) of definite sepsis. nCD-64 revealed 100% sensitivity, 87.5% specificity, 86.36% Positive Predictive Value (PPV), 100% Negative Predictive Value (NPV), and 93.02% diagnostic accuracy in culture-positive sepsis. However, downregulation of mHLA-DR observed in the present study alone showed poor diagnostic utility. The Sepsis index showed sensitivity of 94.73%, specificity of 62.50%, PPV of 66.66%, NPV of 93.75%, and accuracy of 76.74% in the definite sepsis group. <b>Conclusion:</b> Flow cytometric assessment of neutrophil CD-64 may be considered a rapid and reliable marker for the diagnosis of bacterial neonatal sepsis. mHLA-DR may be beneficial for monitoring patients at a later point in time for the identification of delayed immuno-suppression in neonatal sepsis. ]]> Motivators and Barriers for Physical Activity among School-going Students in Chengalpattu District, Tamil Nadu, India: A Qualitative Study Srinivasarengan Kamala Sampath, Padmasundari Singaram, Kalpana Kosalram Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction: </b> Participating in physical activity is crucial for the holistic development and well-being of children and adolescents. Research has shown that physical activity enhances metabolic, musculoskeletal, cardiovascular, psychosocial, and cognitive health. Among children and adolescents, it also improves cardiorespiratory and muscular fitness, and consistent engagement leads to reduced adiposity in overweight individuals. <b>Aim: </b>To explore the motivators and barriers to physical activity among adolescents. <b>Materials and Methods: </b>The study employs a qualitative phenomenological approach, utilising the Colaizzi method for data analysis. A total of 15 participants were selected via purposive sampling, and in-depth interviews were conducted from March to July 2023 in the Chengalpattu district of Tamil Nadu, India. Ethical considerations were observed, with participants providing informed consent. <b>Results: </b>The main themes were identified and categorised into motivators and barriers. Barriers include lack of time, access to fitness classes, interest or motivation, social support, psychological barriers and cost. Motivators encompass improved physical health, mental well-being, physical appearance, self-confidence, athletic and academic performance and a strong immune system. <b>Conclusion: </b>The study identified financial concerns, limited access to fitness classes, lack of interest or motivation, and inadequate social support as major barriers to physical activity. Motivators include a healthy immune system, improved physical health, mental well-being, self-confidence, and enhanced academic and athletic performance. To increase adolescent physical activity, it is essential to address academic demands and incorporate physical activity courses into the curriculum. Parental involvement in education and the use of effective motivational strategies are crucial. ]]> Assessment of Anthropometric Variables in Type 2 Diabetes Mellitus among 4,473 Subjects in 10 Wards of Urban Belagavi District, North Karnataka, India: A Community-based Cross-sectional Study Madhav Prabhu, VA Kothiwale, KS Smitha, Harpreet Kour Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Type-2 Diabetes Mellitus (T2DM) is a global epidemic and a serious risk for the younger generation. A sedentary lifestyle, urbanisation, and poor dietary choices are cornerstones of diabetes. Early detection of risk factors and prevention of their progression can go a long way in delaying the onset of the disease and reducing the economic burden due to its secondary complications. <b>Aim:</b> To assess anthropometric variables of T2DM among the population in Belagavi, North Karnataka, India. <b>Materials and Methods:</b> A community-based cross-sectional study was conducted among a study population of 4,473 individuals in 10 wards of urban Belagavi district from September 2021 to September 2023 by house-to-house visits. The 10 wards were selected using a random allocation method by computer-generated random sequence. The study population was divided into three groups: the diabetic group, children of the diabetic group, and a healthy non diabetic group (Group-1, Group-2, and Group-3) with population sizes of 649, 855, and 2,969, respectively. Anthropometric parameters were recorded by trained nurses using measuring tapes, stadiometers, and weighing scales. Data were analysed using Statistical Package for Social Sciences (SPSS) 24.0 software. One-way Analysis of Variance (ANOVA) test was used to compare the data between the three groups. The Pearson&#8217;s correlation test was used to find the association between Body Mass Index (BMI) and Waist Hip Ratio (WHR). A p-value less than 0.05 was considered significant. <b>Results:</b> There were no significant differences found in anthropometric parameters among the three groups (p>0.05). However, when comparing anthropometric parameters between different generations, a statistically significant difference was observed in Neck Circumference (NC) and WHR. Further, association between BMI and WHR among the three groups revealed that WHR is a better indicator of obesity compared to BMI, with a statistically significant p-value of 0.03. WHR detected 424 (90.4%), 463 (91.32%), and 1,220 (87%) obese cases in Group-1, Group-2, and Group-3, respectively, compared to BMI, which detected 371 (58.51%), 440 (52.25%), and 1,202 (41.91%) obese cases in Group-1, Group-2, and Group-3, respectively. <b>Conclusion:</b> The NC and WHR are better indicators of anthropometric measurements. Anthropometry could be a non invasive, cost-effective predictive tool for the future risk of developing DM. The present study determined there is an impending need to conduct regular screening programs for early identification of anthropometrics other than BMI, WHR, and NC. ]]> Correlation of Glycaemic Control and BMI with Renal Profile in Type 2 Diabetic Patients with and without Non Alcoholic Fatty Liver Disease: A Case-control Study Preeti Vijaysing Padvi, Kavita More, Sandeep Rai Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction: </b> Obesity is a risk factor for the development of diabetes, and these two are directly implicated in an individual&#8217;s risk of developing Non Alcoholic Fatty Liver Disease (NAFLD), which is a major factor in Metabolic Syndrome (MS). NAFLD and Type 2 Diabetes Mellitus (T2DM) are known to frequently coexist and act synergistically to elevate the risk of hepatic as well as extrahepatic complications. <b>Aim:</b> To determine the levels of renal profile, electrolytes, Glycosylated Haemoglobin (HbA1c), and Body Mass Index (BMI) in T2DM patients with and without NAFLD, as well as in control subjects, and to assess the correlation of BMI and HbA1c with renal profile and electrolytes in T2DM patients with and without NAFLD. <b>Materials and Methods:</b> This case-control study was conducted in the Department of Biochemistry and the Diabetes Speciality Clinic in the Department of General Medicine at MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India, from December 2021 to March 2023. The study included a total of 90 subjects divided into three groups (30 in each): Group 1-Control, Group 2-T2DM with NAFLD, and Group 3-T2DM without NAFLD. Aseptic blood collection was performed, and Renal Function Test (RFT), electrolytes, and HbA1c levels were analysed. Group comparisons were done using unpaired t-tests, and correlation analysis was conducted using Pearson&#8217;s correlation with Statiistical Package for Social Sciences (SPSS) software version 25.0. <b>Results:</b> The authors found that 57% of the total enrolled population were female, while the remaining 43% were male, with a mean age of (49.03&#177;5.09) years. Mean levels of HbA1c (9.55&#177;1.78, 8.61&#177;1.42%), BMI (28.84&#177;4.19, 23.51&#177;2.09) kg/m², Urea (31.62&#177;6.28, 33.02&#177;5.11) mg/dL, Creatinine (1.29&#177;0.18, 1.36&#177;0.10) mg/dL, and Uric acid (6.74&#177;1.19, 6.01&#177;0.83) mg/dL were found to be significantly higher in Group 2 and Group 3, respectively, compared to controls. A positive significant correlation of BMI with uric acid, HbA1c with urea, creatinine, and uric acid in Group 2 and 3 was observed. However, no derangement was observed concerning electrolytes in any group. <b>Conclusion:</b> The correlation of urea, creatinine, and uric acid with HbA1c provides the authors with information on impaired renal function in diabetic as well as NAFLD participants. Hyperuricaemia in these individuals can aggravate the risk of T2DM and NAFLD, leading to its progression in Non Alcoholic Steatohepatitis (NASH), respectively. ]]> The Decline of COVID-19 Pandemic- A Journey from Fear to Freedom: A Retrospective Study from Northwest Punjab, India Maninder Kaur, Kanwardeep Singh, Shailpreet Kaur Sidhu, Jagroop Singh, Neelu Nagpal, Amandeep Kaur, Ratneev Kaur Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction: </b> Globally, Coronavirus Disease-2019 (COVID-19) pandemic era is on the decline, and now, after three years, much lower rates of mortality and morbidity are witnessed. The emergence of new variants and subvariants like Omicron is leading into a transition phase where one would only see sporadic surges. After the 3rd wave, Punjab also experienced such surges, prompting this retrospective study to observe the trend of COVID-19 and emerging variants in the Northwest region of Punjab, India. <b>Aim: </b>To assess the prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection during the past year and to analyse demographic variables like age and gender distribution of positive cases of SARS-CoV-2. <b>Materials and Methods: </b>The present study was a retrospective study, with study period of one year from 1st July 2022 to 30th June 2023, all samples (n=3,04,273) from suspected SARS-CoV-2 patients received at the Virology Research and Diagnostic Laboratory at Government Medical College, Amritsar, Punjab, India, were included in the study. The results of Real-Time Polymerase Chain Reaction (RT-PCR) were analysed to determine the prevalence in that region, and basic demographic variables of SARS-CoV-2 cases were compared. Additionally, 100 random positive samples were sent for whole-genome sequencing to study the prevalent variants and subvariants in this region. The results were analysed to study the prevalence of COVID-19 cases in the region. Demographic parameters like age group distribution and sex distribution were calculated. To study the dynamics of transmission during the one-year study period, an epidemiological curve was plotted over the period of 12 months. <b>Results: </b>Out of the total 3,04,273 samples, 2,102 samples (0.69%) tested positive for the COVID-19 virus by RT-PCR. The study showed more prevalence of infection among young adults, with 853 (40.6%) cases in the age group of 21-40 years, followed by 614 (29.2%) cases in the 41-60 years age group. Of the total positive cases, 1153 (54.85%) were males, compared to 949 (45.15%) were females. The maximum number of positive cases was reported during the months of July 2022 to September 2022, totaling 1,273 cases. Whole-genome sequencing results showed predominance of the Omicron variant, with 44 (49.44%) strains belonging to the XBB lineage of Omicron. <b>Conclusion: </b>There was a definite reduction in the prevalence of SARS-CoV-2 cases during the study period and that Omicron and its subvariants, like XBB lineages, are prevalent in this part of India as well. Despite the decrease in the number and severity of COVID-19 cases, maintaining vigilance and monitoring sporadic cases using tools like Whole Genome Sequencing (WGS) can help in tracking major pandemics in the future. ]]> Effect of Educational Intervention as Cognitive Behavioural Therapy for Intake of Junk Food, Sugar-sweetened Beverages and Energy Drinks among Medical Students from India: A Prospective Interventional Study Nidhi Bedi, Deepti Dwivedi, Nimarpreet Kaur, Sunil Chamola, Saurabh Tripathi, Pankaj Abrol Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction: </b> Junk food intake has increased many folds in the last two decades. India is still struggling with communicable diseases, though the incidence of non communicable diseases, including metabolic syndrome, has increased several times in the younger age group. There is a scarcity of data and a limited number of international studies on decreasing junk food intake, especially in India. <b>Aim: </b>To assess eating habits, nutritional status, and the effect of behavioural therapy on junk food intake in medical undergraduate students. <b>Materials and Methods: </b>A prospective interventional study was conducted in medical students of a tertiary care hospital in Northern India (Faculty of Medicine and Health Sciences, SGT University, Haryana, India) over a duration of six months, from October 2021 to March 2022. All students were given a pretest in the form of an electronic questionnaire. Students then received four educational sessions based on Cognitive Behavioural Therapy (CBT), one session per week, each lasting 30 minutes. At the end of the four sessions, all students were assessed through a post-test following the same protocol as the pretest. Statistical analysis was conducted using Statistical Packages for Social Sciences (SPSS) version 28.0 The Wilcoxon&#39;s signed-rank test was applied for comparison within pre and post-interventions. <b>Results: </b>Most of the students, 302 (68%), included in the study were less than 20 years of age, with a minimum age of 17 years and a maximum age of 25 years. A total of 443 students were included in the study. Of these, 178 out of 443 had a Body Mass Index (BMI)>25 kg/m2, classifying them as overweight (40.18%). The majority of students were not aware of the major side effects of junk food intake, but a significant improvement was noted in the post-test conducted four weeks later. A significant change (p<0.0001) was observed in the frequency of intake of junk food, sugar-sweetened beverages, and energy drinks, decreasing significantly after the four educational sessions. <b>Conclusion: </b>Short educational intervention programs, as part of cognitive-behavioural theory, have a significant impact on improving awareness and reducing the intake of junk food. More studies of longer duration and involving other components of CBT should be conducted to assess their impact on physical and mental health. ]]> Assessing the Role of Status Epilepticus Severity Score in Predicting Outcome in Patients with Convulsive Status Epilepticus: A Cross-sectional Study Ahmad Ghayas Ansari, Lubna Zafar, Ruhi Khan, Ariba Nasar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Status Epilepticus (SE) is a neurological emergency that necessitates prompt intervention and treatment. The Status Epilepticus Severity Score (STESS) is a clinical tool developed to assess the mortality rate among patients diagnosed with Convulsive Status Epilepticus (CSE). <b>Aim:</b> To assess the accuracy of STESS in predicting the outcome of CSE. <b>Materials and Methods:</b> This cross-sectional study was conducted at Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India from December 2020 to November 2022, involving 110 patients aged more than 15 years presenting with CSE lasting more than five minutes. Age, gender, seizure type, history of epilepsy, Glasgow Coma Scale (GCS), and STESS at presentation were assessed and associated with the outcome. <b>Results:</b> Among the 110 patients included in the study, there was a higher number of male patients compared to female patients. The mean age of the patients was 35.77&#177;17.9 years. The most prevalent type of seizure observed was generalised tonic-clonic seizures, accounting for 65.45% of the cases, 9.09% of the patients expired, 89% of the patients had a STESS below 2. The Receiver-Operating Characteristic (ROC) curve for STESS at presentation to predict in-hospital mortality had an area under the curve of 0.859, 95% Confidence Interval (CI) from 0.780 to 0.918, and p-value<0.0001. It had a sensitivity of 70%, specificity of 95%, Positive Predictive Value (PPV) of 58.3%, Negative Predictive Value (NPV) of 96.9%, and diagnostic accuracy of 92.73%. <b>Conclusion:</b> Assessment of in-hospital mortality at the onset of SE was reliably determined by STESS and is an useful clinical score. To fully comprehend the reasons for the high overall mortality rate following SE and potential prognostic factors, more research is required. ]]> Effectiveness of Ultrasound-guided Adductor Canal Block for Postoperative Pain Management in below Knee Orthopaedic Surgeries: A Randomised Controlled Study Elakuchi Vikas Rao, Mousumi Das, Partha Sarathi Mohapatra, Sunil Kumar Patanaik, Adyasha Singh, Duddi Sita Abhilash Deo, Lingaraj Sahu, Chaitali Pattanayak Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. <b>Aim:</b> To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. <b>Materials and Methods:</b> This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean&#177;Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. <b>Results:</b> The mean age in group A was 42.9&#177;13.5 years and in group B was 46.3&#177;13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4&#177;3.2 kg/m<sup>2</sup> and 26.3&#177;3.1 kg/m<sup>2</sup>, respectively. The mean duration of sensory block was longer in group A (12.3&#177;4.6 hours) compared to group B (4.7&#177;0.7 hours). The mean VAS scores (1.351&#177;0.659 vs 3.240&#177;0.590) were significantly lower in group A. The total opioid requirement was 42.9&#177;73.6 mg vs 205.9&#177;26.0 mg between the two groups, which was significantly lower in group A. <b>Conclusion:</b> In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries. ]]> Assessment of Delay in Door-to-antibiotic Administration Time after Arrival to the Hospital among Post-chemotherapy Febrile Neutropenia Patients: A Cohort Study Neha Rawat, Lalit Mohan Sharma, Deepak Gupta, Tanvi Singh Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Febrile Neutropenia (FN), a common side effect of chemotherapy, is regarded as an oncologic emergency necessitating prompt treatment. A delay in door-to-antibiotic administration time is associated with poor patient outcomes. <b>Aim:</b> To assess the time lag in the administration of antibiotics after arrival at the hospital in patients with solid/haematological malignancy presenting with post-chemotherapy FN. <b>Materials and Methods:</b> This was a cohort study conducted in the Department of Medical Oncology at Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India, over a period of one year from December 2019 to November 2020 among 80 patients with solid or haematological malignancy who presented with fever and Absolute Neutrophil Count (ANC) <1000/mm3 to the Outpatient Department (OPD) or the Emergency Department and were diagnosed with FN post-chemotherapy. Upon obtaining consent, these patients were enrolled, and the timing of antibiotic administration was noted for the study participants. The participants were further followed-up for the assessment of morbidity {in terms of Intensive Care Unit (ICU) admission)}, duration of hospital stay, delay in the further chemotherapy schedule, and survival status. Data was entered into MS Excel and analysed using Statistical Packages for Social Sciences (SPSS) version 16.0. Associations were established using Chi-square tests. <b>Results:</b> Out of a total of 80 study participants, the mean&#177;SD age was 45.6&#177;18.3 years, and the number of males was 43 (53.8%). Total 57 (71.25%) patients were on chemotherapy for solid organ malignancies. The median delay in door-to-antibiotic time was 120 minutes (ranging from 30 to 260 minutes). The median day of presentation with FN after chemotherapy was day 7. Delay in antibiotic administration was found to have a significant impact on the further chemotherapy schedule and doses (p=0.004). However, ICU admission rates (p=0.133), length of hospital stay (p=0.662), and mortality (p=0.201) were not significantly associated with the delay in antibiotic administration. <b>Conclusion:</b> The adoption of standardised algorithms and protocols for the management of FN and ensuring timely health-seeking by the patients shall help reduce the delay in Time-to-antibiotic Administration (TTA). ]]> Microbiological Evaluation of Paediatric Chronic Haematogenous Osteomyelitis in a Tertiary Care Hospital in Northern India and its Association with Radiological Appearance: A Retrospective Study Chetan Peshin, Rohan Ratra, Anil Juyal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Introduction: Chronic osteomyelitis in the paediatric age group is a frequent complication of improperly treated acute haematogenous osteomyelitis, leading to devastating complications such as pathological fractures and deformities in affected children. There is a growing need to comprehend the disease process and develop improved treatment strategies. Aim: To evaluate bacterial culture and antibiotic sensitivity patterns in children and adolescents with chronic haematogenous osteomyelitis in North India and to explore associations between radiological patterns and antibiotic sensitivity. Materials and Methods: The present retrospective study was conducted in the Department of Orthopaedics of tertiary care centre, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, North India, from July 2018 to June 2020. Total 100 children and young adolescents with chronic osteomyelitis who reported to OPD of hospital with pus discharge from an extremity persisting for more than six weeks, along with radiological features indicative of chronic osteomyelitis. Parameters such as site of infection, illness duration, blood parameters, bacteriological culture reports, etc., were examined. Radiological evaluation was performed using the Beit CURE (BC) classification. Data were analysed and represented in the form of frequencies and percentages. The Chi-square test was used to compare proportions, with significance set at p-value<0.05. Results: The median age of the study population was 13 years, there were 32 (32%) females and 68 (68%) males. The majority of cases (70%) belonged to the B1-B3 group. <i>Staphylococcus aureus</i> was responsible for 86 (86%) cases, followed by <i>Pseudomonas aeruginosa</i> in 7 (7%) cases. Out of the 86 <i>Staphylococcus aureus</i> (<i>S. aureus</i>) isolates, 58 (67.44%) were Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). Multidrug resistance was observed among gram-negative species, as well. <i>Pseudomonas aeruginosa</i> showed resistance to fluoroquinolones in 4 (57%) cases, aminoglycosides in 2 (28%) cases, and carbapenem in 1 (14%) case, which is considered highly effective in treating serious infections caused by multidrug resistant Gram-negative species. No significant association was found between drug sensitivity patterns and radiological features in the present study. Conclusion: <i>Staphylococcus aureus</i> remains the most predominant organism isolated from deep tissue cultures. Among <i>S. aureus</i> isolates, MRSA was the most frequently identified. Identifying the causative organism may be challenging in some cases. Among cases where the offending microbe was identified, drug resistance was widespread among both Gram-negative and Gram-positive specimens. No significant relationship was found between the radiological appearance of infected bone and the pattern of antibiotic resistance. ]]> Preferences and Perceptions of Paediatric Dentists&#8217; Attire among 4-12-year-old Children: A Cross-sectional Study Osama M Felemban, Mariam B Aldajani, Abeer M Abdullah, Yasmeen A Alqarni, Amal A Batarfi, Sara M Bagher Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Dentists&#8217; attire includes their choice of clothes and Personal Protective Equipment (PPE) required to follow infection control measures. Investigating and understanding the paediatric patient&#8217;s preferences and perceptions towards the dentist&#8217;s attire can aid in establishing a more efficient and smoother relationship between them. <b>Aim:</b> To determine the children&#8217;s preferences and perceptions of their paediatric dentist&#8217;s attire and PPE among four to 12-year-old children. <b>Materials and Methods:</b> This cross-sectional study included four to 12-year-old Arabic-speaking children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/guardians between February 2022 and April 2022. Data were collected from the participants using a validated Arabic electronic questionnaire to determine their preferences regarding different parts and types of the dentist&#8217;s attire and PPE, as well as their perceptions and feelings of comfort towards the dentist wearing the full standard PPE. Data were summarised as frequencies and percentages for categorical variables or means and standard deviations for continuous variables. The significance threshold was set at 0.05. <b>Results:</b> A total of 362 participants with a mean age of 8.4&#177;2.3 years and their parents/guardians participated in the study. Female dentists were significantly more favoured by both male and female participants, with statistical significance among females (p<0.001) and younger participants (p<0.001). Both males and females (p=0.025) and older participants (p = 0.001) significantly favoured the traditional white coats over colourful paediatric coats. Furthermore, older participants significantly preferred surgical masks over paediatric masks (p<0.001), face shields as eye protection (p<0.001), and no head cover over colourful paediatric caps (p<0.001). Male participants showed significantly better acceptability towards the dentist wearing the full standard PPE. <b>Conclusion:</b> Both genders and younger children preferred female dentists. The traditional white coat is the most preferred attire by both genders and older children. Male and older children showed higher acceptability for the full standard PPE. ]]> Potential Role of NT-proBNP and Tissue Doppler Indices to Assess the Severity of Rheumatic Heart Disease: A Cross-sectional Study Krushan Nirmit Yajnik, Kushal Pujara, Kaushik Trivedi, Himanshu Pandya Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Rheumatic Heart Disease (RHD) remains the primary cause of acquired Valvular Heart Disease (VHD) in developing countries. The role of Tissue Doppler Indices (TDI) in RHD is understudied. This study aims to fill evidence gaps identified by the American College of Cardiology/American Heart Association in the management of Valvular Heart Disease (VHD) by analysing newer echocardiographic techniques {Tissue Doppler Imaging (TDI)} and biochemical markers (NT-proBNP) against clinical parameters {New York Heart Association (NYHA)} in an understudied patient group. <b>Aim:</b> To evaluate the role of TDI and its association with the functional class of dyspnoea and serum NT-proBNP levels in RHD. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Cardiology and Medicine departments, Central Gujarat, Western India, from January 2021 to June 2022. Fifty-seven consenting adult patients with RHD who underwent echocardiography with Standard Echocardiographic Techniques (SET) to stratify VHD severity were included. Patients were divided into three sub-groups: a) Isolated MR and MR with mild/moderate MS (n=23); b) Isolated MS and MS with mild MR (n=29); and c) Isolated MS and MS with mild or moderate MR (n=48). TDI parameters (e&#8217;, a&#8217;, e&#8217;/a&#8217;, and E/e&#8217;) at medial mitral, lateral mitral, and tricuspid annuli, NYHA classification, and serum NT-proBNP levels were analysed. The Analysis of Variance (ANOVA) was used to assess the association between NYHA class and clinical and NT-proBNP parameters. The Pearson correlation coefficient was employed to determine linear relationships between NT-proBNP and TDI parameters. <b>Results:</b> The mean age was 45.4&#177;16 years, with the age groups 20-40 years (n=20) and 40-60 years (n=22) having a nearly equal distribution. The female-to-male ratio was 1.48 (34/23). In subgroup C, the a&#8217; velocity decreased from 13.74&#177;3.92 cm/s in NYHA I to 5.17&#177;1.98 cm/s in NYHA IV (p=0.0312), and the e&#8217;/a&#8217; ratio increased from 0.96&#177;0.40 in NYHA I to 2.41&#177;1.00 in NYHA IV (p=0.0210). These changes paralleled trends in a&#8217; value (p=0.0306) and e&#8217;/a&#8217; ratio (p=0.0157) with increasing NT-proBNP levels. <b>Conclusion:</b> At the tricuspid annulus, the e&#8217;/a&#8217; ratio and a&#8217; velocity can complement NT-proBNP in cases where there is a discrepancy between the clinical status of the patient and the severity of the valve lesion as determined by SET. Larger-scale studies are needed to further evaluate the association between TDI parameters and long-term clinical outcomes, as well as to identify the optimal timing for surgical intervention in RHD patients. ]]> and Postoperative Serum miR-21 Expression Levels in Oral Cancer and it&#8217;s Association with Clinical and Histological Parameters: An Observational Study Rajat Kala, Sunil Saini, Partha Roy, Meenu Gupta, Viney Kumar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The patterns of microRNA (miRNA) expression have opened up new avenues in the search for prognostic biomarkers and potential therapeutic targets for various tumours. In oral carcinogenesis research, analysing microRNAs expressed in Oral Squamous Cell Carcinoma (OSCC) unveils a complex network of interest. miR-21 is known to be overexpressed in numerous solid tumours and is linked to the progression of malignancies in hepatocellular carcinomas, breast cancer, and colon carcinomas. <b>Aim:</b> To determine the impact of surgical excision on serum miR-21 expression levels in OSCC cases and to establish correlations with clinicopathological parameters. <b>Materials and Methods:</b> The study was an exploratory prospective observational study conducted with proper institutional ethical approval at the Cancer Research Institute (CRI), Himalayan Institute of Medical Sciences (HIMS), Jolly Grant, Dehradun, Uttarakhand, India. Fifty-six histologically confirmed OSCC cases were enrolled along with 25 healthy subjects as controls from May 2021 to June 2023. The relative fold expression change was calculated using the Livak method (2<sup>-??ct</sup>). Data analysis was performed using software such as Statistical Package for Social Sciences (SPSS) version 20.0 and MS Excel. Non parametric statistical tests such as Wilcoxon signed-rank test, Mann-Whitney test, and Kruskal-Wallis test were utilised. <b>Results:</b> Out of 56 sample included, 28 exhibited high expression of miR-21 (p-value<0.001), while 27 cases showed downregulation postsurgery (p-value<0.001), with one sample showing the same level of expression. In cases where the time difference between pre and postsurgery samples was over 25 days, no significant change was observed (p-value=0.06), and similarly, in cases with a time difference below 25 days, no significant difference was noted (p-value=0.14). A significant negative correlation was found between presurgery serum Albumin to Globulin ratio (A:G ratio) and miR-21 expression (p-value <0.05), while no other parameters showed a significant correlation with miR-21. <b>Conclusion:</b> miR-21 expression decreased significantly in some OSCC cases; however, in the majority of cases, it increased postsurgery. A significant correlation was observed between miR-21 expression and the serum A:G ratio. ]]> Evaluation of Quality of Life of Parents and Growth Parameters of their Infants with Cleft Lip and Cleft Palate before and after Primary Surgery: An Observational Study Nupur Saha, Shabnam Zahir, Siddhartha Chatterjee, Arnab Santra, Mainak Das Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Cleft Lip (CL) and Cleft Palate (CP) are associated with several complications that have a significant negative impact on the Quality of Life (QoL) of affected children and caregivers. Compared to their healthy counterparts, children with these conditions experience feeding difficulties, cosmetic abnormalities, and, most importantly, diminished physical and cognitive growth, especially during the first year of their lives. <b>Aim:</b> To evaluate the growth parameters in CL and/or CP infants and the QoL of parents with a CL and/or CP child before and after primary surgery. <b>Materials and Methods:</b> For this observational study, data was collected longitudinally from the same set of Cleft lip and cleft palate (CL/CP)/CL&CP infants and their parents before and after the primary surgery. The study was conducted at the Department of Paediatric and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, West Bengal, ABMSS Kolkata Comprehensive Cleft Care Centre, West Bengal, and IMA Vaccination Centre Barasat, West Bengal, India, from December 2020 to May 2022. In this study, 66 children and 64 parents were included in each study and control group. Growth parameters {weight, length, Head Circumference (HC)} were measured using a weight analogue machine, infantometer, and HC measuring tape, and compared with those of healthy infants. The QoL of parents with CL and/or CP infants was quantified using a questionnaire form of &#8220;Revised Impact on Family Scale (RIOFS)&#8221; filled out by parents before and after six months of primary surgery and compared with the QoL of same-age healthy infants. The responses to the RIOFS questionnaire were scored according to recommended guidelines. The Statistical Package for Social Sciences (SPSS) Statistics 23.0 was used for data analysis. <b>Results:</b> Among the study groups, statistically significant differences in mean height, weight, and HC were observed between the groups of all infants with CL, CP, and CL with CP before and after the primary surgery (p<0.001). The QoL of parents from the study group improved post-surgery. The difference in mean RIOFS score between study Group-3 and study Group-4 after the primary surgery was statistically significant (p<0.001). <b>Conclusion:</b> The growth of CL and/or CP infants and the QoL of their caregivers are compromised compared to healthy infants. After primary surgery, the growth of CL and/or CP infants and the QoL of their parents partially improved. ]]> Comparison of Removal of Laryngeal Mask Airway in Deeply Anaesthetised and Awake Paediatric Patients and their Associated Complications: A Randomised Clinical Study Monica Chhikara, Deepika Seelwal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The Laryngeal Mask Airway (LMA) is frequently used for managing paediatric airways for short surgical procedures. While it is easy to insert, it can lead to several complications if not removed at the appropriate plane of anaesthesia. <b>Aim:</b> To establish better timing for the removal of the LMA in deeply anaesthetised and awake paediatric patients by comparing the complications associated with each approach. <b>Materials and Methods:</b> The present randomised clinical study, enrolled 90 American Society of Anaesthesiologists (ASA) I and II paediatric patients aged 1 to 12 years, posted for elective short surgical procedures under general anaesthesia with airway management by Classical LMA. The patients were allocated into two groups: Group D (LMA removal under a deep plane/surgical plane of anaesthesia) and Group A (LMA removal in a fully awake state). At emergence from anaesthesia and during LMA removal, both groups were studied for complications including cough, desaturation (SpO<sub>2</sub> < 95%), excessive salivation, vomiting, and laryngospasm. Descriptive statistics were reported using mean&#177;standard deviation or median (range) for continuous variables. Comparison of continuous variables was done using the Student&#8217;s t-test or Wilcoxon rank sum test. <b>Results:</b> Demographic data like age, weight, duration of surgery, heart rate, and respiratory rate were comparable in both groups. A significantly higher incidence of cough was found in group A compared to group D (p-value=0.001). The incidences of desaturation (p-value=1.000), excessive salivation (p-value=0.361), vomiting (p-value=1.000), and laryngospasm (p-value=0.142) were comparable between the two groups. Cough was the most frequent complication in group A (16 out of 45 patients), while laryngospasm was the most frequent complication in group D (8 out of 45 patients). The total number of complications (p-value=0.043) was significantly higher in group A compared to group D. <b>Conclusion:</b> The removal of the Classical LMA in paediatric patients can be safely carried out in a deeply anaesthetised state. Based on the results of present study, the removal of the LMA in deeply anaesthetised paediatric patients is associated with fewer complications compared to its removal in the awake state. ]]> Risk Factors and Angiographic Syntax Score among Young Adults and Middle-aged Patients with Acute Coronary Syndrome: A Cross-sectional Study Rajashekhar Varma Gande, Vanajakshamma Velam, Rajasekhar Durgaprasad, Sowjenya Gopal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Cardiovascular Disease (CVD) has become a major clinical and public health problem, with an increasing incidence and prevalence, particularly among the young adult population. Although there are well-established prevention strategies for reducing the incidence of Coronary Artery Disease (CAD), their effectiveness is diminished by several risk factors. <b>Aim:</b> To investigate traditional and lifestyle CVD risk factors in young adults (18-30 years) and middle-aged (31-45 years) patients and to correlate them with the angiographic profile using the syntax score in these patients. <b>Materials and Methods:</b> The study was designed as a cross-sectional study conducted at the Cardiology Department, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India, a teritary care teaching hospital during the period of August 2021 to July 2022. A total of 87 patients were included based on the study criteria. The study population was divided into two groups: Group-I (18-30 years) and Group-II (31-45 years). After obtaining informed consent, details regarding coronary risk factors such as smoking, Diabetes Mellitus (DM), hypertension, dyslipidaemia, obesity, family history of CAD, and details including physical inactivity were recorded. Coronary Angiography (CAG) was performed to determine obstructive coronary lesions, and the syntax score was calculated. All the collected data were recorded in Excel spreadsheets, and statistical analysis was carried out using Statistical Packages for Social Sciences version 25.0 software. <b>Results:</b> A male preponderance was observed in the study population (84%) with a mean age of 38.7&#177;5.5 years, and the youngest patient was a 19-year-old female. The majority of patients, 79 (90.8%), were in the middle-age group. Dyslipidaemia (94%) was the predominant modifiable risk factor in the study population (p<0.05), followed by obesity (65.5%). About half of the patients had smoking as the predisposing risk factor for CAD. The majority of patients presented with ST Elevation Myocardial Infarction (STEMI) (76.9%). Single Vessel Disease (SVD) was the most common finding (70.1%), and the common culprit vessel was the Left Anterior Descending (LAD) artery (24.1%). The angiographic syntax score was low (<16) in 70 (80.5%) of the patients, with only 6 (7%) of the patients having a higher syntax score (>22). The correlation of the mean syntax score with risk factors has shown an association with obesity (10.6), physical inactivity (10.6), followed by diabetes (10.5). <b>Conclusion:</b> The study showed that middle age, male gender, and lifestyle risk factors including dyslipidaemia, obesity, physical inactivity, and smoking seem to correlate with angiographic lesions and CAD incidence. Therefore, the inclusion of healthy lifestyle changes such as regular physical activity and the control of modifiable risk factors, including smoking cessation, in this vulnerable middle-aged group is warranted. ]]> Pressure-controlled versus Volume-controlled Ventilation during One Lung Ventilation for Empyema Thoracis: A Randomised Control Trial Shefali Gautam, Deepali Chandra, Kirtika Yadav, Neel Kamal Mishra, Sanjeev Kumar, Ravi Prakash, Dinesh Singh, Abhishek Rajput Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Volume Controlled Ventilation (VCV) is traditionally used during One Lung Ventilation (OLV); however, it is associated with complications such as volutrauma and barotrauma. On the other hand, Pressure Controlled Ventilation (PCV) allows the delivery of a required tidal volume at lower airway pressures, leading to enhanced oxygenation and ventilation. <b>Aim:</b> To compare VCV and PCV modes for OLV in patients undergoing surgery for empyema thoracis. <b>Materials and Methods:</b> A randomised controlled trial was conducted among 50 patients requiring OLV. The participants were divided into two groups, namely Group-V and Group-P, with each group receiving VCV and PCV, respectively. The two groups were compared based on the partial pressure of oxygen (during the intraoperative and post-operative period), peak and plateau airway pressures, lung compliance, and complications. The groups were analysed using the Chi-square test, and the threshold of statistical significance was set at a p-value <0.05. <b>Results:</b> Fifty participants were divided into two groups: VCV (n=25) and PCV (n=25). Both study groups were found to be comparable in terms of demographic details, haemodynamic parameters, and duration of surgery. The mean age of the patients was 27.80 years in Group-V and 31.04 years in Group-P. The authors observed improved PaO<sub>2</sub> levels, lung compliance, and reduced peak pressures during OLV in the PCV group. After lung isolation, PaO<sub>2</sub> levels of Group-P patients (93.64&#177;5.154 mmHg) were higher compared to Group-V (81.38&#177;7.975 mmHg) at 50% FiO<sub>2</sub> (p-value <0.001). Similarly, post-extubation PaO<sub>2</sub> levels were better in Group-P (99.24&#177;18.58 mmHg) than in Group-V (84.35&#177;7.677 mmHg) at 36% FiO<sub>2</sub> (p-value <0.001). The mean peak pressures were lower in Group-P (25.17&#177;4.34 cm H<sub>2</sub>O) than in Group-V (28.22&#177;4.51 cm H<sub>2</sub>O). Additionally, there was a statistically significant improvement in lung compliance among Group-P patients (p-value=0.0144). <b>Conclusion:</b> Thus, it can be inferred that PCV improves oxygenation and reduces airway pressures during OLV. However, there was no significant difference seen between the two modes in terms of post-operative pulmonary complications. ]]> Comparison of Radiation Doses of Computed Tomography Brain and Pulmonary Angiography with International Commission on Radiological Protection Guidelines: A Descriptive Study AF Fidha, George Arattu Alphy, Amita Digambar Dabholkar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Computed Tomography Angiography (CTA) is useful for evaluating and diagnosing conditions related to blood vessels, such as aneurysms, stenosis (narrowing of vessels), vascular malformations, and blockages. It provides valuable information for planning and guiding interventions or surgeries. It is also important to measure patient doses during CTA operations to evaluate and optimise the technique and balance the benefits compared to radiation hazards. <b>Aim:</b> To calculate the CT Dose Index (CTDI), Dose Length Product (DLP), and effective dose for CT brain angiography and CT pulmonary angiography, and also to compare whether the measured values are within the International Commission on Radiological Protection (ICRP) recommended levels. <b>Materials and Methods:</b> A retrospective descriptive study was conducted in the Department of Radiodiagnosis at Yenepoya Medical College Hospital Mangaluru, Karnataka, India, from September 2022 to September 2023. A total of 52 data points were collected for CT brain and CT pulmonary angiography examinations, which were acquired before October 2022. Information on CTDI and DLP was collected, and the effective dose was calculated using the conversion factor. The values were then compared with the ICRP reference level. Descriptive statistics, mean, and standard deviation for continuous variables, and frequency and percentage for categorical variables were used. <b>Results:</b> There was a significantly lower value of CTDI, DLP, and effective dose for CT brain angiography and CT pulmonary angiography compared to the ICRP recommended reference levels. The mean CTDI and DLP for CT brain angiography were 111.56 mGy and 1153.31 mGy·cm, and the mean CTDI and DLP for CT pulmonary angiography were 24.56 mGy and 713.74 mGy·cm, respectively. The mean effective dose for CT brain and CT pulmonary angiography was 2.46 mSv and 9.94 mSv, respectively. <b>Conclusion:</b> The measured values were within the recommended values of ICRP regulations. It is recommended that CT brain angiography and CT pulmonary angiography examinations are safer for diagnostic purposes. Optimising scanning protocols, utilising low-dose techniques, and implementing dose monitoring and control are important clinical aspects. Compliance with the guidelines helps to enhance patient care and reduce the risk of radiation-related complications. ]]> Role of Age, Gender and Vertical Facial Type on Anatomical Location of Mandibular Foramen in Paediatric Population: A Cross-sectional Study Topi Nyodu, Nilanjana Saha, Shiladitya Sil, Subhankar Ghosh Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Pain management is paramount in paediatric dental care, influencing patient cooperation and future perceptions of dental treatment. The widely used Inferior Alveolar Nerve Block (IANB) anaesthesia faces challenges in children due to anatomical variations. The position of the mandibular foramen, which evolves with age, growth patterns, and facial types, necessitates customised approaches for effective paediatric pain management. <b>Aim:</b> To identify the position of the mandibular foramen amongst children aged 7-14 years with respect to age, gender, and facial types. <b>Materials and Methods:</b> In a cross-sectional study conducted in West Bengal, India, 126 children aged 7-14 were investigated from March 2021 to August 2022. The Orthopantomograms (OPG) and lateral cephalograms were assessed for the location of the mandibular foramen with respect to age, sex, and facial type in clear radiographs with normal growth. Statistical analysis encompassed descriptive statistics, Analysis of Variance (ANOVA), and multiple linear regression analysis. <b>Results:</b> A total of 126 x-rays were analysed across age, gender, and facial types, showing a mean age of 10.78 years. There were 52 (41.3%) males and 74 (58.7%) females. The distribution of subjects according to facial types was as follows: short (n=33, 26.2%), normal (n=19, 15.1%), and long (n=74, 58.7%). The vertical position of the mandibular foramen increased with age. No significant gender difference was observed regarding the vertical position of the mandibular foramen. However, a significant variation across facial types was observed, with individuals with normal faces exhibiting a greater vertical position. <b>Conclusion:</b> This study revealed that the vertical position of the mandibular foramen increases with age. There was no significant difference found between males and females in the location of the mandibular foramen; however, individuals with normal faces exhibited a greater vertical position of the same. ]]> Deep Neck Space Infection among Diabetic and Non Diabetic Patients: A Prospective Cohort Study Samatha Kempalli Jayaramaiah, Deepthi Elikoranta Vide, Rani Vilas Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Deep Neck Space Infections (DNSI) were first described by Galen in the second century. They refer to infections of potential spaces and fascial planes of the neck and are a cause of significant morbidity and mortality. Additionally, the presence of Diabetes Mellitus (DM) increases the possibility of life-threatening complications. <b>Aim:</b> To compare the clinical characteristics, bacteriological spectrum, aetiological aspects, biochemical parameters, treatment protocol, complications, and mortality rate among diabetic and non diabetic patients with DNSIs. <b>Materials and Methods:</b> A prospective cohort study was conducted in the Department of Otorhinolaryngology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India from January 2022 to December 2022. 52 patients with DNSIs were grouped into diabetics and non diabetics. The age group of the patients included in the study was 18-65 years. A detailed history, clinical examination, haematological investigations, and Contrast-enhanced Computed Tomography (CECT) were performed. Patients were either treated conservatively or underwent incision and drainage, depending on the presentation. The data obtained were analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. <b>Results:</b> The age range was 18 to 65 years, with a mean age of 51 years (51.35&#177;13.46 years) in the diabetic group and 37 years (37.9&#177;13.2 years) in the non diabetic group. Patients were divided into 26 (50%) diabetics and 26 (50%) non diabetics. Of the 52 patients, 34 (65.3%) were males and 18 (34.7%) were females. Multiple space involvement was present in eight patients among the diabetic group and three patients in the non diabetic group. Odontogenic infections constituted the leading foci in 17 (65.4%) of diabetics and 13 (50%) of non diabetics. In diabetics, 12 (46%) patients had high levels (>6.5%) of HbA1c, and Klebsiella was the causative organism in 9 (39%). A total of 23 (88.5%) diabetic patients underwent incision and drainage, while 13 (50%) non diabetic patients were treated conservatively. Among the diabetics, 21 (80.8%) patients had a hospital stay of >7 days, 7 (27%) patients had complications, and the mortality rate was observed in 5 (19.2%) patients. <b>Conclusion:</b> The study emphasises a definitive association of DM in the occurrence of DNSIs. Hence, the need for early detection and treatment of primary infections is highlighted, insisting on appropriate management of blood sugar levels. ]]> Repeatability of Corneal Aberrations and Ocular Biometry Measurements Using the Pentacam&#174; AXL: A Cross-sectional Study Meznah S Almutairi, Basal H Altoaimi, Rania Fahmy, Shatha I Algowaifly, May S Alenazi Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Accurate assessment of ocular biometry and corneal aberrations for diagnosis and therapy is crucial in many clinical settings. Devices to improve the measurements of these parameters are constantly being developed. <b>Aim:</b> To evaluate the repeatability of ocular biometry and corneal aberrations obtained by the Pentacam&#174; AXL in normal eyes. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Optometry Department of King Saud Universiy, Riyadh, Saudi Arabia from September 2021 to February 2022. The study included a total of 120 eyes from 60 normally sighted adult participants whose of ocular biometry and corneal aberrations were measured three times in a single session using the Pentacam&#174; AXL. Biometric parameters include Axial Length (AL), mean K-reading (Km), Anterior Chamber Depth (ACD), Central Corneal Thickness (CCT), and Horizontal White-to-White Distance (HWTW). The aberrometry parameters include the most significant corneal higher-order aberrations (coma, trefoil, spherical aberration), and the Root Mean Square (RMS) of the higher-order aberrations. Repeatability was assessed using within-subject Standard Deviation (SD<sup>w</sup>), the repeatability limit (r), and the Intraclass Correlation Coefficient (ICC). <b>Results:</b> The current study included 120 eyes of 60 subjects with a mean age of 21&#177;2.08 years (range: 18 to 28 years). The repeatability was good for all recorded biometric measurements, with the most repeatable being AL (r=0.028, SD=0.01). All values of ICC for biometric measurements revealed excellent repeatability, being over 0.994. In addition, coma and spherical aberrations had excellent repeatability with ICC &#8805;0.935, and RMS, trefoil, secondary astigmatism, and quadrafoil aberrations had good repeatability with ICC 0.938, 0.823, 0.898, and 0.827, respectively. <b>Conclusion:</b> The Pentacam&#174; AXL demonstrated good repeatability for ocular biometry and corneal aberrations in healthy eyes. ]]> Association of Serum Vitamin D with Risk of Breast Carcinoma: An Observational Case-control Study from Western Maharashtra, India Haris Jafri, Nilam Memane, Madhura Gandhi, Samir Gupta Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Breast carcinoma is one of the most prevalent types of carcinoma and the leading cause of death among all carcinomas. Recently, vitamin D deficiency has been reported as a risk factor for breast carcinoma. Vitamin D, as an anticarcinoma agent, prevents cellular differentiation, stimulates cell death, reduces angiogenesis, tumour progression, and metastasis. <b>Aim:</b> To investigate the relationship between vitamin D deficiency and the risk of breast carcinoma. <b>Materials and Methods:</b> An observational study was conducted at the Armed Forces Medical College, Pune, Maharashtra, India, between November 2018 and October 2020. A total of 57 cases diagnosed with breast carcinoma and 57 healthy controls were analysed. Physical and reproductive health parameters were compared, along with vitamin D status using student&#8217;s t-test and Mann-Whitney U test. Logistic regression was used to assess the risk of breast carcinoma. <b>Results:</b> Out of 114 women, 57 were cases and 57 were controls with a mean age of 52 vs 48 years. The mean value of serum vitamin D levels was significantly lower (19.45 vs 27.91 ng/mL, p<0.001) than controls. The percentage of serum Vitamin D deficiency was significantly higher in cases (28 (49.1%) vs 12 (21.1%), p<0.001) compared to controls. Vitamin D concentration <20 ng/mL was significantly associated with a higher risk of breast carcinoma (OR 10.8, 95% CI 3.1-37.6). Multiparity &#8805;3 was associated with a decreased risk of breast carcinoma (OR 2.250, 95% CI 0.599-8.447) compared to parity &#8804;2 (OR 3.241, 95% CI 0.916-11.466). In luminal A and triple-negative subtypes, severe vitamin D deficiency (<20 ng/mL) was observed (p=0.045) compared to other subtypes. <b>Conclusion:</b> The present study findings showed that women diagnosed with breast carcinoma had low vitamin D levels, which were linked to an increased risk and prognosis of breast carcinoma. Furthermore, multiparity lowers the risk of breast carcinoma. ]]> Maternal Oral Health Education for Predicting Early Childhood Caries among Preschool Children: A Systematic Review and Meta-analysis Vrinda Saxena, Asmita Datla, Manish Deheriya, Saina Shoukath, Nandani Tiwari, Ankita Bhargava Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Early Childhood Caries (ECC) is a pressing public health issue in preschool-aged children. Preventive guidelines have not significantly reduced ECC incidence. Maternal education programmes have been proposed as interventions, but systematic reviews on their effectiveness are scarce. <b>Aim:</b> To evaluate the effectiveness of oral health education programmes for mothers in preventing ECC. <b>Materials and Methods:</b> Eight eligible Randomised Controlled Trials (RCTs) were identified through searches in the Cochrane Oral Health Group&#8217;s Trial Register, PubMed, and Google Scholar, as well as manual review of references from English-only studies. The interventions targeted mothers starting from 12 weeks of pregnancy onwards, with the exclusion of treatment-based methods, pharmacological interventions, and post-pregnancy programmes. The primary outcome assessed was ECC incidence, analysed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Participants exclusively received oral health educational programmes designed to prevent ECC in their children, highlighting the importance of early preventive measures during pregnancy. <b>Results:</b> Global studies varied in interventions and outcomes. A study from Brazil showed no reduction in ECC, while a study from Uganda reported reduced dental caries. Another study from Australia demonstrated a significant reduction in severe ECC. Risk of bias analysis revealed that five studies had a low risk of bias while one study had an unclear risk of bias. Moderate risk of bias was found in one study. <b>Conclusion:</b> Evidence suggests a positive impact of maternal education on ECC prevention, supporting tailored programmes for mothers with lower education. The overall recommendation strength is modest due to intervention variations and limited trials. Tailored educational programmes for mothers, especially those with lower education levels, should be integrated into maternal and child health services to effectively address social determinants of oral health. ]]> Bacteriological Profile and Antibiogram of Urinary Tract Infections at a Tertiary Care Hospital in Kerala, India: A Retrospective Study VS Roshni, KM Rafeeda, V Meghana, Vysakh Vikraman Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Urinary Tract Infections (UTIs) are caused by microbial invasion of the urinary tract, extending from the renal cortex of the kidney to the urethral meatus. Over the past years, resistance levels to the traditional drugs used for the treatment of UTIs have been gradually increasing. Therefore, a therapy based on the individual culture report and antibiotic sensitivity test is highly encouraged. <b>Aim:</b> To determine the age-wise and sex-wise prevalence of UTI, as well as to determine the bacteriological profile and antimicrobial sensitivity pattern of isolated uropathogens. <b>Materials and Methods:</b> This retrospective record-based study was conducted in the Department of Microbiology at Travancore Medical College in Kollam, Kerala, India. Samples were collected from patients with clinically suspected UTI attending the Outpatient Department (OPD) and Inpatient Department (IPD) of Travancore Medical College, Kollam, Kerela, India over a period of six months from July 2022 to December 2022. Both male and female patients with clinically suspected UTI were included in the study. The clinical diagnostic criteria included dysuria, frequency, urgency, and fever. Data were retrieved from the culture register maintained in the Microbiology laboratory, LIS (ELLIDER), and the WHONET software system. Urine culture was performed using a semiquantative technique. A growth of >105 Colony Forming Units (CFU)/mL was considered indicative of an active UTI with significant bacteriuria. Organisms were identified using Gram stain, motility testing, and biochemical reactions following standard microbiological techniques. Antimicrobial sensitivity testing was conducted using the Kirby-Bauer Disc diffusion method. The data were entered into a Microsoft Excel worksheet, and the results were analysed using simple descriptive statistics involving percentages and proportions using Statistical Package for Social Sciences (SPSS) software version 16.0. <b>Results:</b> Of the total 2,794 samples, 319 (11.4%) samples yielded significant bacteriuria. Among the positive samples, 204 (64%) were from females and 115 (36%) were from males. UTIs were most commonly seen in the age group of 61-80 years. <i>Escherichia coli (E.coli)</i>, with 148 isolates (46.4%), was the predominant organism, followed by <i>Klebsiella pneumoniae</i> with 72 isolates (22.6%). <i>E. coli</i> showed the highest susceptibility to meropenem, with 137 isolates (92.6%), and imipenem, with 136 isolates (91.9%), followed by cefoperazone/sulbactam with 129 isolates (87.2%), and piperacillin/tazobactam with 128 isolates (86.5%). <i>Klebsiella pneumoniae</i> was most susceptible to imipenem, with 42 isolates (60%), followed by meropenem, with 29 isolates (41.4%). Most non fermenters were highly susceptible to carbapenems, cefoperazone/sulbactam, and piperacillin/tazobactam. Among the gram-positive organisms, <i>Enterococcus</i> spp. was the most frequently isolated, showing 100% sensitivity to vancomycin and linezolid. <b>Conclusion:</b> In this study, UTI was found to be more prevalent among elderly females. Gram-negative organisms were the most commonly isolated pathogens in UTI, with <i>E. coli</i> being the most frequent agent. Urinary pathogens exhibited resistance to commonly used antibiotics such as ampicillin, cephalosporins, quinolones, and cotrimoxazole. Based on this study, it can be concluded that the resistance to commonly used antibiotics is very high. Due to the changing trends in the sensitivity patterns of various antibiotics, it is important to understand the antibiogram of common isolates in a specific area or hospital to ensure better empirical treatment. ]]> Efficacy of Foley Catheter Bulb with Intracervical Dinoprostone Gel versus Dinoprostone Gel Alone for Cervical Ripening and Induction of Labour: An Observational Study Sohan Bhowmick, Nilratan Das, Tanmoy Das, Arunava Biswas Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> One of the most common obstetrical interventions is the induction of labour. Cervical ripening drugs are typically used before conventional methods of induction since they are linked to an increased risk of protracted labour, chorioamnionitis, and Caesarean Sections (CS) during labour induction when an unfavourable cervix is present. The two major techniques for cervical ripening are mechanical interventions, such as the insertion of balloon catheters, and the application of pharmacologic agents, such as prostaglandins. It is widely accepted that the induction of labour, which ultimately leads to vaginal delivery, is largely dependent on the condition of the uterus&#8217; cervix. <b>Aim:</b> To compare the efficacy of a combination of Foley bulb catheter and intracervical Dinoprostone and intracervical Dinoprostone alone for the induction of labour. <b>Materials and Methods:</b> A prospective observational study was performed over 150 pregnant mothers from May 2018 to April 2019. in the labour room of North Bengal Medical College and Hospital, a tertiary care institution in Darjeeling, West Bengal, India. The pregnant women were divided into two groups: intracervical Dinoprostone gel alone (Group-1) and a combination of intracervical Foley catheter and intracervical Dinoprostone gel (Group-2) with n=75 patients in each group. Group-1 received intracervical Dinoprostone gel 0.5 mg, which was repeated every 6 hours, a maximum of three doses, or until she went into active labour, whichever occurred earlier. In Group-2, a 16 F Foley catheter was inserted into the cervix, inflated, and a single dose of intracervical Dinoprostone gel 0.5 mg was given alongside it. Participant demographic characteristics, medical and pregnancy history, indication for labour induction, labour course, and outcomes were collected. The collected data were analysed with the mean and standard deviation for numerical variables and counts and percentages for categorical variables. Odds ratio was calculated where deemed relevant. <b>Results:</b> The induction to delivery time was considered the primary outcome and was shorter in Group-2 by 28 minutes (p=0.342). Among the secondary outcomes, the duration of the latent phase of labour was shorter in Group-2 by 57 minutes, and the proportion of patients delivering within 12 hours was also higher (28%) but statistically insignificant (p>0.05). The rates of CS were unaffected by the mode of induction. None of the two methods were found to be inferior to the other in respect to neonatal outcomes or complications of labour like chorioamnionitis and postpartum haemorrhage. <b>Conclusion:</b> The combination of Foley catheter with intracervical Dinoprostone gel did not prove to be more efficient than intracervical Dinoprostone alone for labour induction in the current study. ]]> Prevalence, Correlates and Trends in Tobacco Use among Youths: A Retrospective Secondary Data Analysis of Nationally Representative Surveys (NFHS-5) in India Sangram Panda, Sabita Maharana, Ammlan Mishra, S Suneeti Kanyari, Shreyans Rai, Kedar Mehta Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Youths are the most vulnerable population to initiate tobacco use. It is the need of the hour to prevent tobacco addiction among young people to reduce the morbidity and mortality associated with it. Therefore, there is a need for necessary data to build an appropriate strategy to combat this epidemic. <b>Aim:</b> To determine the prevalence and trends of tobacco use and to assess the factors associated with tobacco use among youths (age 15-24 years) in India. <b>Materials and Methods:</b> This retrospective secondary data analysis study was conducted at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, between January 2023 and June 2023, using data from the National Family Health Survey-5 (NFHS-5), 2019-2021, which was conducted across all states of India to estimate the prevalence of tobacco use among the 15-24 age group. Data were compared with NFHS 3 and 4 to observe the trends in tobacco use. The data were analysed using Statistical Packages for Social Sciences (SPSS) software (version 21.0). Multivariate logistic regression was used to identify the significant risk factors associated with tobacco use. A p-value less than 0.05 was considered statistically significant. <b>Results:</b> The prevalence of smoking and smokeless tobacco use was 2109/14525 (14.52%) and 2237/14525 (15.40%) respectively among male youths aged 20-24 years, and it was 374/119043 (31%) and 119/119043 (1.53%) in females of similar age. For males, the prevalence has decreased from 40.07% in NFHS-3 to 27.31% in NFHS-4 and to 22.51% in NFHS-5. For females, the prevalence has decreased from 4.55% in NFHS-3 to 2.38% in NFHS-4 and to 1.33% in NFHS-5. Males and females belonging to the scheduled caste/scheduled tribe, having a poor wealth index, and in the married category had a higher prevalence of tobacco use. Youths residing in rural areas were using more smokeless tobacco. <b>Conclusion:</b> There was a declining trend of tobacco use among youths over NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 (2019-2021). Male gender, higher age, rural area, the northeast region of India, poor wealth index, education upto primary level, being married, and other categories of marriage had higher adjusted odds of using both forms of tobacco. There is a need to implement and enforce evidence-based tobacco control strategies that can substantially improve the health of the young, hence securing India&#8217;s future. ]]> Comparative Analysis of Canine Distalisation between Ceramic and Metal Brackets: A Systematic Review Arshya A Kumar, Ravindra Kumar Jain Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Orthodontic treatment frequently entails the distalisation of canines to address various malocclusions, involving moving the canines towards the posterior region of the dental arch. A crucial consideration in this treatment is the type of bracket material utilised, as it can impact the efficacy and efficiency of Canine Distalisation (CD). <b>Aim:</b> To analyse various in-vivo studies to evaluate the comparison of the rate of maxillary CD between Ceramic Brackets (CB) and Metal Brackets (MB) during fixed orthodontic treatment. Secondary factors assessed include the loss of anchorage, canine rotation, and canine tipping. <b>Material and Methods:</b> Articles were searched in electronic databases such as Google Scholar, Scopus, and PubMed. The search strategy was designed by two authors, AK and RKJ. The search did not include date restrictions. The list of references for the included articles was also searched. The systematic review included two Controlled Clinical Trials (CCT) and one Randomised Control Trial (RCT). Two authors, AK and RKJ, independently screened the titles, abstracts, and full texts of the identified studies during the literature search and then combined their findings. The information considered from the short-listed studies included the first author, year of publication, rate of CD, CB, and MB. Cochrane&#8217;s Risk of Bias (RoB) tool, RoB2 tool, and the Newcastle Ottawa scale were used to analyse bias. <b>Results:</b> The present review incorporated three studies. The analysis of the RoB indicated low RoB in one study and fair RoB in the other two. The systematic review highlighted that there was no significant difference in the rate of CD between CB and MB. <b>Conclusion:</b> The available evidence was limited and of moderate quality, showing no difference in the rate of CD performed using ceramic and MB. Hence, clinically, there is no difference in using metal or CB, even though CBs are known to have higher SR in in-vitro evaluations. ]]> A Cross-sectional Study on Neuroimaging in Epilepsy: Diagnostic Value of T2 Relaxometry in Mesial Temporal Lobe Epilepsy Iffath Misbah, Jasmine Shalika, Shazia Fathima, Paarthipan Natarajan Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The use of Magnetic Resonance Imaging (MRI) T2 relaxometry and spectroscopy has added new dimensions to the imaging of Temporal Lobe Epilepsy (TLE). Advanced techniques like MRI diffusion and MRI perfusion are new additions to the MRI protocol for epilepsy. <b>Aim:</b> To study the diagnostic value of T2 relaxation time in Electroencephalogram (EEG) confirmed seizure cases. <b>Materials and Methods:</b> A single-centre, cross-sectional study was conducted at Department of Radiodiagnosis, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, from December 2020 to November 2022 at a tertiary care hospital. All patients were subjected to MRI with a special epilepsy protocol and T2 relaxometry. Hippocampal T2 relaxation values for each slice were measured by placing a Region of Interest (ROI) on the representative image obtained from the T2 relaxometry sequence, focusing on the hippocampus in both the control and study groups. The control group (n=30) consisted of healthy volunteers, whereas the case group (n=36) comprised patients presenting with a history of seizures with positive MRI and EEG findings. Mean T2 relaxation time was calculated in each ROI, and an average was derived. Mean and Standard Deviation (SD) were calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. To determine the association of T2 relaxometry values in the study and control groups, an unpaired t-test was used. <b>Results:</b> The mean age of participants was 25.14&#177;9.35 years (ranging from 9 to 51 years). The male-to-female ratio was 1.25:1. Hippocampal atrophy (32 out of 36 cases) and T2 signal alteration (30 out of 36 cases) were the most commonly identified features in Mesial Temporal Sclerosis (MTS). MRI without T2 relaxometry had a sensitivity of 94%. In two cases, where only mild hippocampal atrophy was identified in the conventional MRI sequence, making the diagnosis dubious, T2 relaxometry revealed increased T2 relaxation time in the head of the hippocampus and guided a proper diagnosis. EEG was able to lateralise seizures in 8 out of 13 right MTS cases (61.5%), 10 out of 17 left MTS cases (58.9%), and 5 out of 6 cases of bilateral MTS (83%). <b>Conclusion:</b> T2 relaxometry allows quantification of hippocampal signal intensity, allowing the detection of even subtle changes in signal intensity that are difficult to perceive by visual assessment. ]]> Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study Arshad Ahmed, Ashok Kumar Chanda, Agniva Ghosh Dastidar, Rajiv Roy, Sudipta Dasgupta Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. <b>Aim:</b> To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. <b>Materials and Methods:</b> A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of &#8804;0.05 was considered statistically significant. <b>Results:</b> The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111&#176; in the nailing group and 114.5&#176; in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. <b>Conclusion:</b> Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome. ]]> Prevalence of OXIS Contacts between the Primary Molars in 3 to 9 Years Old Children: A Cross-sectional Study J Jasmin Winnier, Reema Manoj, Amil Joshi, Sonal J Tandel, Arwa Soni, Sanjana R Kodical Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Interproximal contacts between primary teeth have traditionally been reported as broad and flat. A new system of classification for contacts called OXIS- O (open contact), X (point contact), I (straight contact), and S (curved contact) was introduced in 2018, based on the shapes observed occlusally. Understanding interproximal contacts in primary teeth is essential to comprehend the caries risk of the individual. <b>Aim:</b> To assess the prevalence of OXIS contact areas between non carious primary molars in 3 to 9 years old children and to determine the most common type of contact before and after the eruption of the first permanent molar. <b>Materials and Methods:</b> A cross-sectional study was conducted to determine the prevalence of the types of contacts between primary teeth through direct observation in a sample size of 260 contact areas. The study was carried out in the Department of Paediatric and Preventive Dentistry, Navi Mumbai, India, between August 2022 to February 2023. Ethical clearance from the university was obtained. A single calibrated examiner examined photographs of the interproximal contacts between primary molars. The contacts were assessed as O (open contact), X (point contact), I (straight contact), and S (curved contact) using the OXIS classification system. The prevalence of each contact type was recorded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 18.0 software. The prevalence of contact types was recorded in numbers and percentages. A comparison of contact types before and after the eruption of the first permanent molar was conducted using the Chi-square test. <b>Result:</b> The most common contact type was I (65.00%) both before and after the eruption of the first permanent molar. This was followed by S (19.62%), X (11.15%), and O (4.23%) in the primary dentition. After the eruption of the first permanent molars, I contact was the highest at 66.41%, followed by S (20.90%), X (12.68%), and O (0%). <b>Conclusion:</b> This study confirms the presence of O, X, I, and S types of interproximal contact areas in caries-free primary molars in 3 to 9 years old children. ]]> Analysis of Changes in Variation of Neutrophil and Monocyte Parameters, Including Volume, Conductivity and Scatter in Sepsis Patients and Healthy Controls: A Cross-sectional Study Akanksha Raj Khandal, Sushant Khanduri, Shahbaj Ahmad, Mansi Kala Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Sepsis continues to be a leading cause of mortality and prolonged hospitalisation. The conventional method of blood culture, while considered the gold standard, has limitations such as contamination and delayed reporting. The examination of peripheral smears has uncovered signs suggestive of septicaemia; however, these findings suffer from inter-observer variability and reliance on staining quality. <b>Aim:</b> To investigate the variation of neutrophil and monocyte parameters, including Volume, Conductivity, and Scatter (VCS), in sepsis compared to healthy controls. <b>Materials and Methods:</b> A cross-sectional analytical study was conducted at the Himalayan Institute of Medical Sciences, Swami Rama Himalayan University in Dehradun, Uttarakhand, over the course of one year, from January 2021 to December 2021, involving patients over 18 years of age categorised into sepsis group based on clinical suspicion, sepsis screen, blood culture, and Sequential Organ Failure Assessment (SOFA) score (n=117). A group of healthy controls was also included (n=140). Haematological investigations were performed using the DXH 800 Haematology Analyser (Beckman Coulter, CA, USA) with VCS Technology. Categorical variables were analysed using the Chi-square test, while non parametric data was compared using the Mann-Whitney U test. <b>Results:</b> The average age in the sepsis group was 50.17&#177;13.17 years, while in the control group, it was 38.14&#177;8.78 years. The results revealed higher White Blood Cell (WBC) counts (16.76&#177;7.39)&#215;10<sup>3</sup>/cumm in the sepsis group compared to healthy controls (6.68&#177;1.42)&#215;10<sup>3</sup>, absolute neutrophil counts (13.74&#177;7.280)&#215;10<sup>3</sup> in sepsis patients, and eosinopenia in the sepsis group (0.0114&#177;0.0104)&#215;10<sup>3</sup> compared to controls (0.23&#177;0.116)&#215;10<sup>3</sup>. Moreover, mean neutrophilic volumes (158.00&#177;14.840) and monocytic volumes (182.58&#177;18.64) were higher in the sepsis group, while they were lower in healthy controls, which were (149.52&#177;5.23 and 171.17&#177;6.28), respectively. Axial light loss for neutrophil and monocyte was 142.40&#177;11.78 and 121.50&#177;17.93, respectively, while it was lower in healthy controls showing a value of 135.51&#177;7.63 and 119.45&#177;8.25, respectively. Furthermore, mean neutrophilic and monocytic conductivity and scatter were decreased in sepsis. The observed higher WBC counts and absolute neutrophil counts in sepsis patients suggest a premature release of neutrophils from the bone marrow. The alterations in cell volume reflect an immune response. Additionally, the overall scatter of neutrophils and monocytes was reduced, accompanied by increased cellular transparency. <b>Conclusion:</b> The present study contributes valuable insights into the pathophysiological mechanisms underlying sepsis, emphasising the dynamic interplay between immune cells and their functional characteristics. Understanding these variations in cellular parameters could potentially aid in the development of more targeted diagnostic and therapeutic approaches for sepsis, ultimately improving patient outcomes. Further research is warranted to delve deeper into the specific mechanisms driving these observed changes and to explore their clinical implications in the context of sepsis management. ]]> Effect of Intensive Nursing Care in Elderly Patients undergoing Video-assisted Thoracoscopic Lung Cancer Surgery: A Randomised Control Study Lin Liu, Chunyong Su Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Lung Cancer (LC) is a prominent cause of death worldwide, with both non small cell and small cell types increasing in prevalence. Multiple therapeutic options such as chemotherapy, radiation, and surgery, including Video-assisted Thoracoscopic Surgery (VATS), have been developed, although postoperative complications remain a concern. Nursing care has been advocated as a means to mitigate these adverse effects. However, the actual association between nursing care and LC postoperative complications and outcomes remains unknown. <b>Aim:</b> To assess the effects of Intensive Nursing Care (INC) on LC patients treated with VATS. <b>Materials and Methods:</b> The present study was a randomised control study in which a total of 256 Non Small Cell Lung Cancer (NSCLC) patients over the age of 60 years who underwent VATS in the Division 1 of Thoracic Surgery at Handan Central Hospital between January 2021 and January 2023 were included. The participants were randomly allocated to different groups: an INC group (n=126) and a control group receiving normal care (n=130). Lung function, reported symptoms, hospitalisation duration, psychological wellbeing (anxiety and depression scores), and occurrence of postsurgery symptoms (pain, fatigue, insomnia, dyspnea, nausea/vomiting) were assessed. T-tests or Fisher&#8217;s-Exact tests were used to compare baseline and postsurgical variables between the INC and Normal Nursing Care (NNC) groups using IBM Statistical Package for Social Sciences (SPSS) version 26.0 software. <b>Results:</b> The study population consisted of 53.1% females with an average age of 73.51&#177;7.61 years, ranging from 60 to 85 years. INC significantly improved hospitalisation duration {Mean Difference (MD)= -1.9; 95% Confidence Interval (CI), -2.6 to -1.2; p-value<0.001}, the occurrence of postsurgery symptoms (p-value<0.001), and psychological states assessed by both the Self-rating Anxiety Scale (SRAS) (MD=-17.99; 95% CI, -18.63 to -17.35; p-value=0.001) and the Self-rating Depression Scale (SRDS) (MD= -9.04; 95% CI, -9.95 to -8.13; p-value=0.008) in comparison to NNC patients. <b>Conclusion:</b> Given the global burden of LC, it is crucial to emphasise not only the development of treatments for this illness but also care regimens that alleviate complications associated with these therapies. In this study, INC as an alternative to routine nursing care in postsurgery recovery has proven to be more beneficial to patients by decreasing their hospitalisation stay, the occurrence of postsurgery symptoms, and by enhancing their mental state. ]]> Presence of Co-morbid Depression among Diabetics of Less than 5 Years Duration in a Tertiary Care Institution, Chennai, Tamil Nadu, India: A Cross-sectional Study T Susila, A Evangeline Mary, P Punithakumari, R Tamilarasi Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. <b>Aim:</b> To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. <b>Materials and Methods:</b> A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years&#8217; duration. The prevalence of depression was calculated using Beck&#8217;s Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value <0.05 was considered statistically significant. <b>Results:</b> The study included 500 participants, of whom the majority (276, 55%) were female, with a mean age of 46.2 years. The prevalence of depression was 55 (11%). It was found that being female, illiterate, and unemployed were significantly associated with depression. Among disease-related factors, diabetes duration of 3-5 years, insulin injection usage, and the presence of diabetic complications were significantly associated with depression. Regarding lifestyle factors, the prevalence of depression was significantly higher among those who were non adherent to dietary modification practices and those with family worries and work-related tension. Multivariable logistic regression analysis revealed that the independent predictors of depression among diabetics were the presence of diabetic complications {Odds Ratio (OR)-2.48 (1.27-4.84)}, family worries {OR-2.54 (1.34-4.80)}, non adherence to follow-up {OR-2.61 (1.37-4.99)}, and non compliance with dietary modifications {OR-2.93 (1.43-5.99)}. <b>Conclusion:</b> The present study revealed that about one in 10 (11%) diabetics with less than five years&#8217; duration have associated depression, with significant independent predictors being non compliant behaviours, the presence of complications, and family issues. Hence, diabetics should be screened simultaneously for depression, giving due attention to those with complications, family issues, and non compliant behaviours. ]]> Comparison of Carotid Ultrasound Parameters in Patients with Rheumatoid Arthritis and Control Subjects: A Cross-sectional Study Chinmayee Biswal, Janki Bharat Kumar Jaradi Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Rheumatoid Arthritis (RA) is considered one of the risk factors for Cardiovascular Disease (CVD). Carotid ultrasound is used to assess the extent of subclinical atherosclerosis in patients with RA. Very few studies have evaluated all carotid ultrasound findings, such as Carotid Intima-media Thickness (CIMT), carotid diameters like Luminal Diameter (LD) and Interadventitial Diameter (IAD), and plaque characteristics in patients with RA. <b>Aim:</b> To assess and compare the various carotid parameters in RA patients with controls and also to evaluate their association with age and duration of onset of the disease. <b>Materials and Methods:</b> A single-centre cross-sectional study was conducted at the Department of Radiology, GCS Medical College and Hospital, Ahmedabad, Gujarat, India, involving 40 patients with RA (Group-RA) and 40 controls (Group-C). Patients were further divided into three age subgroups. Carotid ultrasound parameters like CIMT, LD, IAD, and plaque were evaluated in both groups. Continuous variables were analysed using the t-test, and categorical data were analysed using the Chi-squared test. A p-value of < 0.05 was considered statistically significant. <b>Results:</b> Age- and sex-matched controls were included with 28 females and 12 males in both the study groups. The mean LD and IAD were significantly higher in the RA group than in controls (Mean LD- 5.88&#177;0.97 mm vs 5.26&#177;1.08 mm with p=0.009; Mean IAD- 6.85&#177;0.89 mm vs 6.30&#177;0.87 mm with p=0.006). The mean CIMT was higher in the RA group but not statistically significant (0.57&#177;0.13 mm vs 0.54&#177;0.12 mm with p=0.256). Further subgroup analysis showed that all carotid parameters were statistically significant in the 31-60 years age group as compared to 18-30 years and 61-80 years subgroups. The effect of the duration of the disease (>5 years) on the carotid parameters was also significantly higher in the 30-60 age group (p<0.001). <b>Conclusion:</b> The present study showed that various carotid ultrasound parameters can be used as a screening tool in the follow-up of RA patients to detect early changes in atherosclerosis, with LD and IAD having superior predictive capability. The study further showed that carotid ultrasound parameters have a better predictive value in the 31-60 years age group. ]]> Outcome of Modified Open Latarjet Operation in the Treatment of the Recurrent Anterior Shoulder Dislocation: A Cohort Study Rajesh Jamoriya, Abhishek Pathak, Santosh Kumar Mishra Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Shoulder instability is defined as a symptomatic translation of the humeral head about the glenoid fossa during active shoulder motion. Anteroinferior glenoid bone loss or labrum avulsion is most often a consistent finding in recurrent dislocation. The modified open Latarjet procedure is one of the most effective methods of treatment for patients with recurrent shoulder instability with glenoid bone loss. <b>Aim:</b> To determine the functional outcome of the congruent arc modification of the open Latarjet procedure. <b>Materials and Methods:</b> This prospective cohort study was conducted at a tertiary healthcare centre in Bhopal, Madhya Pradesh, India between January 2018 and December 2020. A total of 25 patients with recurrent anterior shoulder dislocation underwent treatment using the modified open Latarjet procedure. Two patients were lost to follow-up, resulting in the evaluation of 23 patients. All patients underwent a 3D Computed Tomography (CT) scan to document glenoid bone loss. The intensity of pain, activity level, strength of abduction, and Range of Motion (ROM) were assessed to calculate the Constant Shoulder Score for pre- and postoperative evaluation of functional outcomes. Follow-ups were conducted at 3 months, 6 months, 1 year, and 2 years after surgery. The data was analysed using the Wilcoxon&#8217;s signed-rank test, and Spearman&#8217;s correlation coefficient was used to identify associations between various variables. <b>Results:</b> A total of 23 male patients aged between 18 and 63 years were included. The average age of patients was 30.35&#177;11.27 years. Preoperatively, only 3 patients (13.04%) had good to excellent Constant Shoulder Scores. However, no statistically significant variation in Constant Score was observed three months after surgery. Six months post-surgery, 17 patients (73.92%) showed good to excellent scores. Nearly one year after surgery, 21 patients (91.3%) had good to excellent outcomes. At the final follow-up, 22 patients (95.65%) demonstrated good to excellent outcomes. A statistically significant improvement in good to excellent scores was noted six months postoperatively (p-value <0.001). A total of 20 patients (86.96%) achieved full ROM, with only 3 patients (13.04%) reporting mild to moderate limitations in shoulder ROM. None of the patients experienced redislocation, and the apprehension test was positive in only one patient. <b>Conclusion:</b> The modified open Latarjet procedure is a reliable method for providing stability and Self confidence to patients with recurrent shoulder instability and glenoid bone loss. ]]> Effect of Quality Improvement Interventional Tool on Emotional, Behavioural and Self-perception Profile of Children with Type 1 Diabetes Mellitus: A Pretest, Post-test Quasi-experimental Study Alok Khanna, Animesh Debbarma, Anjali Verma, Mukesh Saini, Yogesh Verma Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Psychological stress associated with Type 1 Diabetes Mellitus (T1DM) in children is relatively higher in developing countries due to limited health resources. However, no data are available regarding the impact of a Quality Improvement (QI) intervention on emotional, behavioural, and self-perception in paediatric patients with T1DM. <b>Aim:</b> To study the impact of a QI interventional tool on the emotional, behavioural, and self-perception profile in children with T1DM. <b>Materials and Methods:</b> This pretest, post-test quasi-experimental study was conducted at PGIMS, Rohtak, Haryana, India from August 2021 to July 2022. A total of 50 children, aged between 6-14 years with T1DM, were enrolled from the paediatric outpatient department and paediatric ward for the study. Initially, baseline data were collected, and patients were followed-up for six months during which required interventions were given, including one-on-one counseling with mother and child, demonstration of insulin injection, providing them with a booklet for recording blood glucose at home, etc. After six months, data were collected again for comparison. The Strengths and Difficulties Questionnaire (SDQ) and Self-perception Profile for Children (SPPC) questionnaires were used for the study. Data were statistically analysed using a paired t-test. <b>Results:</b> In the present study, there were 27 (54%) males and 23 (46%) females with an average age of 9.64&#177;2.3 years. Positive outcomes were noted in the emotional, behavioural, and self-perception profiles of children following the intervention. HbA1C values (pre: 13.12&#177;1.02%, post: 10.63&#177;1.07%), hypoglycaemic episodes (pre: 2.54&#177;0.88, post: 1.24&#177;0.43), and Diabetic Ketoacidosis (DKA) episodes (pre: 2.76&#177;0.52, post: 1.08&#177;0.27) significantly reduced following the intervention. The SDQ score was significantly lower (pre: 16.97&#177;1.48, post: 7.76&#177;2.14), and the SPPC score was significantly higher (pre: 76.52&#177;0.61, post: 94.34&#177;1.06) after the intervention. <b>Conclusion:</b> In the present study, it was found that psychological and behavioural interventions have a beneficial effect on children with diabetes in terms of better compliance with therapy, glycaemic control, as well as better relationships with family and peers, and improved coping capability. ]]> Assessing the Predictive Value of Haematological Parameters (NLR, LMR, PLR) for COVID-19 Disease Severity as quantified by CT Severity Scores: A Prospective Cohort Study Kovuri Umadevi, Lavanya Motrapu, Kasturi Dinesh, Nagarjuna Chary Rajarikam, Mohd Imran Ali Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> In the relentless global battle against the Coronavirus Disease-2019 (COVID-19) pandemic, accurate prediction of disease severity remains a critical challenge, with profound implications for patient outcomes and healthcare resource allocation. As the virus continues to evolve and pose new threats, the need for reliable prognostic indicators becomes increasingly urgent. Effective identification of patients at high-risk of developing severe illness not only facilitates timely intervention and personalised treatment strategies but also optimises healthcare resource utilisation. In this context, the exploration of novel biomarkers and predictive models holds immense promise for enhancing ones understanding of disease progression and improving clinical decision-making. <b>Aim:</b> To study the association between haematological parameters, including Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR), and Platelet-to-Lymphocyte Ratio (PLR), with Computed Tomography Scan Severity Score (CTSS) in COVID-19 patients. <b>Materials and Methods:</b> A prospective cohort study was conducted from March 2021 to July 2022 at Government General Hospital (GGH) Nizamabad, Telangana, India. The study encompassed all three COVID-19 waves, included a sample size of 159 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) positive patients, excluding pregnant women and children under 10 years. Upon admission, CTSS and ratios of NLR, LMR, and PLR were recorded in an MS Excel sheet before any medical intervention and then analysed using Statistical Package for Social Sciences (SPSS) software 22.0. <b>Results:</b> The study comprised 159 patients with a mean age of 50.86&#177;13.89 years (ranging from 16 to 85), predominantly male 90 (56.61%). The highest infection rate 85 (53.45%) was in the 41-60 years age group. The NLR was significantly elevated from a mean value of 4.58 to 11.24 (r value=0.78, p-value=<0.001), and LMR notably reduced from 8.27 to 3.80 (r value=0.67, p-value=0.003) in correlation with the severity as indicated by CTSS. Although PLR values were higher in severe cases, increasing from 173.07 in mild cases to 272.29 in severe cases, there was no significant correlation with CTSS (r-value=-0.78, p-value=0.177). <b>Conclusion:</b> CTSS emerges as a valuable radiological biomarker for predicting COVID-19 severity. However, due to its cost and limited availability in grassroots-level hospitals, there is a need for alternative severity prediction models. Present study proposes a predictive model using NLR and LMR biomarkers as alternatives to CTSS for assessing COVID-19 severity. ]]> Feedback of Patients attending a Tertiary Healthcare Institute in Banda District, Uttar Pradesh: A Descriptive Cross-sectional Study Suneel Kumar Kaushal, Mohd Maroof, Lal Divakar Singh, Tarnnum, Sandeep Kumar Gupta, Navin Kumar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The term &#39;patient feedback&#39; can be measured through various formal reactions, including levels of patient comfort, experience, perspectives, and assessments of care in terms of convenience, continuity, and quality. By recording the patient&#8217;s viewpoint on the quality of care provided by a tertiary healthcare facility, it can be acknowledged through patient feedback. This data can then be utilised to improve health services and enhance the overall patient experience. <b>Aim:</b> To assess patient satisfaction with the services provided at a tertiary care hospital in Banda. <b>Materials and Methods:</b> This descriptive cross-sectional study was conducted at the government medical college in Banda, a district in the Bundelkhand region of Uttar Pradesh, a northern state of India. The study took place from December 2022 to February 2023 at the medical college and its associated hospital. A total of 400 participants who consented to be part of the study were included. Purposive sampling technique was employed for data collection. Outpatients were interviewed upon exiting the clinics, while inpatients were interviewed in the wards. <b>Results:</b> In the questionnaire, there was a question asking, about patient&#39;s overall satisfaction during the visit to the hospital. Since everyone&#8217;s score was higher than the &#39;poor&#39; category, all categories were merged into one word, &#39;satisfied,&#39; except for the &#39;poor&#39; category to facilitate better understanding. The majority of patients from the Outpatient Department (OPD) (91, 45.5%) and Inpatient Department (IPD) (198, 99%) were satisfied with the attitude and communication of the doctor. Additionally, 98.5% of IPD patients were satisfied with the doctor&#39;s knowledge. A total of 99% of participants responded "yes" when questioned about their preference to return to the hospital for treatment. <b>Conclusion:</b> Overall, it was observed that the behaviour and care provided by hospital staff satisfied the majority of patients, who also expressed satisfaction with the indoor and outdoor services of the hospital. ]]> Correlation of Liver Attenuation with Visceral Fat Area on Computed Tomography Scan: An Analytical Study Tushar Kalekar, Aparna Prabhu, Nikith Soman, Ankita Pandey, Mudit Kumar, Deepu Palal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Introduction: In the modern world, owing to rapid urbanisation and changes in lifestyles and dietary habits, obesity has emerged as a leading problem. As a result, various morbid conditions have come into the picture which have severe effects on an individual&#8217;s life expectancy. Visceral fat plays an important role in causing fatty liver. Aim: To determine the relationship between visceral fat area and liver fat using Computed Tomography (CT). Materials and Methods: A retrospective analytical study was conducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre Pune, Maharashtra, India. The CT scans of 134 patients who underwent CT scans of the abdomen pelvis and CT KUB/CT IVU between January 2022 and June 2022 were assessed by two experienced body imaging medical doctors. Subjects aged between 18 and 75 years were included without any co-morbidities like diabetes or hypertension. Waist circumference, subcutaneous fat area, and visceral fat area were calculated at the umbilical level. The CT attenuation value was measured in the right hepatic lobe, devoid of focal lesions and vessels, using a standard ROI of approximately 200 mm<sup>2</sup>. Similarly, as an internal control, splenic attenuation was also recorded. Statistical tests were employed to determine the significance of the obtained values, including Spearman&#8217;s coefficient and Cohen&#8217;s criteria. Results: The CT attenuation of the liver (fatty liver) showed a moderate correlation with visceral fat (Spearman&#8217;s coefficient: 0.329). The association was statistically significant (p-value=0.0001). The CT attenuation of the liver (fatty liver) showed a weak correlation with subcutaneous fat (Spearman&#8217;s coefficient: -0.269). The association was statistically significant (p-value=0.0016). The CT attenuation of the liver (fatty liver) demonstrated a weak-moderate correlation with waist circumference (Spearman&#8217;s coefficient: -0.305). The association was statistically significant (p-value=0.0003). Conclusion: Visceral fat area has a stronger correlation with fatty liver than waist circumference and subcutaneous fat. Visceral fat should be considered a risk factor in the development of fatty liver, which may further lead to metabolic syndrome, in order to reduce mortality and morbidity related to it. ]]> Comparative Evaluation of Contact Angle in Biosynthesised and Chemically Synthesised Silver Nanoparticle-based Root Canal Irrigants: An In-vitro Study Neena Chandran, Sindhu Ramesh, VJ Adarsh, VKP Rakesh Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Irrigating solutions are vital in endodontics, serving to meticulously disinfect root canals, enzymatically dissolve pulpal remnants, and facilitate thorough flushing to eradicate microorganisms. This intricate process ensures optimal microbial control, tissue dissolution, and debris removal, contributing to enhanced endodontic outcomes and overall oral health in clinical practice. <b>Aim:</b> To evaluate the contact angle of Trisodium Citrate (TSC) Silver Nanoparticles (AgNP) and Biosynthesised AgNPs when used in root canal irrigation. <b>Materials and Methods:</b> This in-vitro study was conducted at White Lab, Department of Conservative Dentistry and Endodontics, Saveetha Dental College Saveetha Institute of Medical and Technical Sciences Saveetha University, Chennai, Tamilnadu, India, from January 2023 to August 2023. A total of 40 single-rooted dentine samples extracted from human teeth were utilised. Ethical clearance was duly obtained. The samples were categorised into four groups (n=10 each). The groups underwent distinct irrigation processes, including Biosynthesised AgNPs from Azadirachta Indica (Group-1), Chemically synthesised AgNPs from Trisodium citrate (Group-2), 5.25% Sodium Hypochlorite (Group-3), and Distilled Water (DW) as the control (Group-4). The contact angle of the tested irrigants was thoroughly evaluated in all the samples using an Ossila goniometer. The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0. Statistical tests used were Analysis of Variance (ANOVA). A p-value of <0.05 was considered statistically significant. <b>Results:</b> Group-1 and Group-2 showed significantly low contact angles (p=0.002) compared to the other irrigants like 5.25% Sodium Hypochlorite (NaOCl) and water used as control. There was no statistically significant difference among the tested irrigants, with TSC AgNPs and A. Indica AgNPs showing the best results followed by NaOCl and distilled water. <b>Conclusion:</b> The AgNPs in prepared root canals can serve as a good alternative as an irrigating solution. Biosynthesised AgNPs are equivalent to Trisodium citrate AgNPs in regard to wettability. ]]> Sealing Ability of Root Canal Sealers in Warm Obturation Techniques Compared to Cold Obturation Techniques: A Systematic Review Anithakumari Rangappa, Sundaravaradhan Rajaram, Naganathan Meena Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Obturation is a critical step in root canal treatment of the teeth that significantly contributes to its success. Various techniques are used for obturation of root canals. <b>Aim:</b> To compare the sealing efficiency of sealers under warm and cold obturation techniques across parameters such as Microleakage (ML), Push-out Bond Strength (PBS), and dentinal tubule penetration, which help evaluate the sealer-dentin interface in root canal systems. <b>Materials and Methods:</b> The research question was designed in the Population, Intervention, Comparison, Outcome (PICO) format, and the databases searched were Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane, and Scopus following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Inclusion criteria included in-vitro studies between January 2011 and June 2021 in the English language, comparing the influence of both cold and warm obturation techniques on root canal sealers. Key parameters considered for evaluating the sealing ability of endodontic sealers were marginal adaptation, ML, and Dentinal Tubule Penetration (DTP). Two independent reviewers assessed studies for eligibility against the inclusion and exclusion criteria and conducted data extraction. Risk of bias assessment was performed using the Cochrane risk of bias assessment tool, Review Manager (v5.4). <b>Results:</b> A total of 19 articles were finalised for review, and methodological assessment for all parameters involved in the study was conducted using the Cochrane risk of bias assessment tool. Out of the total, five studies showed a moderate risk of bias, while the remaining 14 studies showed a low risk of bias. <b>Conclusion:</b> Warm and cold obturation techniques perform similarly in producing a good apical seal when used in root canal treatment with different endodontic sealer materials. Warm obturation techniques perform better than cold obturation techniques in producing homogeneous root canal fillings, while cold obturation techniques enhance push-out bond strength at the sealer-dentin interface. ]]> Comparison of Postoperative Analgesic Effect of Dexmedetomidine and Morphine as an Adjuvant to Intrathecal Bupivacaine in Infraumbilical Surgeries: A Randomised Clinical Trial Murugappan Abhinaya, Ramamurthy Balaji, Karunakaran Mullainayaki, Anand Pushparani, Gunseelan Mirunalini Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Regional anaesthesia is the standard technique for lower limb infraumbilical procedures. To provide a better analgesic profile, adjuvants are added to local anaesthetics to enhance their action. Opioids have been used as an adjuvant for a long-time. With evolving pharmacology, various drugs satisfy the criteria of being an adjuvant. One such drug is Dexmedetomidine, a novel alpha-2 agonist. <b>Aim:</b> To compare the duration of analgesia of intrathecal Morphine and Dexmedetomidine as an adjuvant to bupivacaine in a subarachnoid block for lower limb infraumbilical surgeries. <b>Materials and Methods:</b> In this randomised clinical, double-blinded study conducted in a multispecialty hospital over the period of June 2020 to February 2021, 70 patients were randomly divided into two groups: Group M received Morphine 125 &#956;g, and Group D received dexmedetomidine 5 &#956;g as an adjuvant to 15 mg of 0.5% hyperbaric bupivacaine. The primary outcome was to compare the duration of postoperative analgesia. The secondary results assessed the block characteristics, haemodynamic parameters, rescue analgesic consumption, sedation score, and side-effects like bradycardia, hypotension, nausea, vomiting, pruritus, and respiratory depression. Data was spread in an Excel sheet and descriptive analysis done. Normally distributed continuous variables were compared using a Student&#8217;s t-test, and discrete variables were compared using a Chi-square test. A p-value of <0.05 was considered significant. <b>Results:</b> Both groups were similar with respect to age, sex, body mass index, American Society of Anaesthesiologists grading, and duration of surgery. The duration of analgesia was 956.97&#177;120.043 minutes in group M and 392.83&#177;50.354 minutes in group D (p-value <0.001). The total consumption of paracetamol was 1984.71&#177;499.111 mg in group M and 3543.86&#177;406.17 mg in group D. The onset and regression were significantly faster in group D. There was significant hypotension and bradycardia up to the 40<sup>th</sup> minute and an increase in heart rate, respiratory rate, and mean arterial pressure between 5-7 hours in group D. The sedation score was more in group D for the initial two hours. Postoperatively, the incidence of nausea, vomiting, and pruritus was more in group M. <b>Conclusion:</b> It can be concluded that 125 &#956;g of intrathecal morphine is a better adjuvant to spinal bupivacaine, providing excellent postoperative analgesia compared to 5 &#956;g of intrathecal dexmedetomidine. However, dexmedetomidine had more incidence of hypotension, bradycardia, and sedation when compared to morphine intrathecally. ]]> Effectiveness of MusicGlove on Motor and Psychological Symptoms in Parkinson&#8217;s Disease: A Quasi-experimental Study Nicky Reginald, U Ganapathy Sankar, Monisha Ravikumar, Redkar Simran Sandeep Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Individuals with Parkinson&#8217;s Disease commonly experience both physical and psychological effects, which subsequently affect their ability to perform daily activities and overall wellbeing. MusicGlove is an emerging adjunct proposed to address the motor issues but also the psychological ones with references to improving motivation and participation in individuals with Parkinson&#8217;s Disease. <b>Aim:</b> To determine the effectiveness of the MusicGlove on hand dexterity and the psychological response in individuals with Parkinson&#8217;s disease. <b>Materials and Methods:</b> A quasi-experimental study was performed on 40 individuals with Parkinson disease January 2021 to June 2021 from local community settings in Chengalpattu district, Tamil Nadu, India. They were recruited and divided into a control group (n=20) and experimental group (n=20). Hand dexterity and psychological responses were assessed using the Box and Block Test (BBT), Beck&#8217;s Depression Inventory (BDI), and Apathy Inventory (AI) as pre and post-test measures. Both groups received conventional occupational therapy for three weeks in total, and in addition to this, the experimental group received the MusicGlove. The control group included muscle stretching and strengthening activities with therapeutic putty and using activities such as connecting circles where the subject is given a sheet of paper with 25 circles, each containing 25 numbers or letters. They were asked to connect these in ascending, alternating numerical, and alphabetical order. Sessions were conducted for 30 minutes with two sets of repetitions. Descriptive statistics were used to examine data using the Statistical Package for Social Sciences (SPSS) version 24.0. <b>Results:</b> The study results revealed that there was no statistically significant difference found between the groups but clinically significant differences were found between the groups with post-test scores on motor symptoms that were measured by BBT: &#956;=-1.2534, p=0.211 (BBT Dominant); &#956;=-0.9400, p-value=0.3472 (BBT Non Dominant), and psychological symptoms that were measured by BDI; (&#956;=-1.0445, p-value=0.2983) and AI; (&#956;=-1.0445, p-value=0.9203). <b>Conclusion:</b> The study concluded that conventional occupational therapy along with MusicGlove was effective in improving hand dexterity and psychological responses in Parkinson&#8217;s disease patients. Also, further study needs to be conducted to warrant its long-term impact of intervention on hand dexterity and psychological responses. ]]> Evaluation of Cell Adhesion and Proliferation of Human Dental Pulp Stem Cells to Different Root End Filling Materials: An In-vitro Study Shreshtha Mukherjee, Geeta Hiremath, Anil Bapu Bargale, Priya Horatti Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Recent advancements in dental materials have led to the development of various restorative cements. The amalgamation of various biomimetic cements becomes necessary to improve the physico-chemical properties of the existing cements. Mineral Trioxide Aggregate (MTA) Plus and Chitosan are two such materials which are combined and chosen to check their effects on dental stem cell adhesion and proliferation. <b>Aim:</b> To compare and evaluate the cell adhesion and proliferation of human dental pulp stem cells on MTA Plus, MTA Plus-Chitosan Conjugate, and Chitosan by directly culturing the cells on the materials. <b>Materials and Methods:</b> This in-vitro study was conducted at the Central Research Laboratory in Department of Conservative Dentistry and Endodontics, S.D.M College of Dental Sciences, Dharwad, Karnataka, India over a period of 1.5 years from the month of June 2020 to December 2021. The samples were divided into four groups: Group A-MTA Plus mixed with the proprietary gel (9 specimens), Group B-MTA Plus mixed with 2% Chitosan gel (9 specimens), Group C-2% Chitosan Gel (9 specimens), and Group D-Control Group (Growth Medium). Non carious extracted permanent human premolars for orthodontic purposes were collected and sectioned for the extraction of pulp tissue. The tissue was placed in a basic medium Dulbecco modified essential medium-High Glucose (DMEM-HG). Dental Pulp Stem Cells were subjected to differentiation using differentiation media (Hi-Media) containing Dexamethasone. Cell proliferation and viability were checked using trypan blue, and cell adhesion was checked using crystal violet under an inverted light microscope. To evaluate if there were any changes in the proliferation of viable cells at 24 hours, 48 hours, and 72 hours among different materials, the Wilcoxon&#8217;s Signed-rank Test was used. Statistical significance was set at p&#8804;0.05. <b>Results:</b> The cells were able to adhere to the biomaterial and showed a spindle-shaped morphology, which was observed under the inverted light microscope. ALP activity was measured using a photometer after cell differentiation. MTA Plus-Chitosan conjugate showed a 94% increase in cell proliferation after 48 hours (n=86/91). MTA Plus showed a 91% increase in cell proliferation after 48 hours (n=109/120). <b>Conclusion:</b> Chitosan can be used as a vehicle with MTA since their conjugate showed greater proliferation activity after stem cell culture. ]]> Brain Diffusion in Brainstem Infarctions and Lesion Segmentation using Fluid-attenuation Inversion Recovery: A Diagnostic Accuracy Study Noha Abdelfattah Ahmed Madkour Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Diffusion can efficiently detect infratentorial and brainstem infarctions. Fluid-attenuation Inversion Recovery (FLAIR) is a widely used Magnetic Resonance Imaging (MRI) technique for the segmentation of brain lesions and strokes. <b>Aim:</b> To investigate the sensitivity of the Lesion Prediction Algorithm (LPA) within the Lesion Segmentation Tool (LST) in the automated segmentation of acute and subacute brainstem infarctions. <b>Materials and Methods:</b> This study was a retrospective diagnostic accuracy study where 24 patients with brainstem infarctions were referred from the Emergency Department to the Department of Radiodiagnosis at Kasr Alainy Hospital, Cairo University, Egypt. The study was conducted from September 2016 to June 2023. It included 24 patients (14 males and 10 females) with acute and subacute brainstem infarctions. MRI of the brain and diffusion were performed on all patients. Automated segmentation of brainstem infarctions using FLAIR was conducted in all cases. Manual and segmented volumes of brainstem infarctions were calculated. Sensitivity and accuracy of the LPA within the LST in automated segmentation of acute and subacute brainstem infarctions were evaluated. Pearson correlation was used to correlate volumes of White Matter Lesion (WML) burden in patients with brainstem infarctions and patients&#8217; age. <b>Results:</b> The mean age of the participants was 51.75&#177;11.95 years. The sensitivity of the LPA in automated segmentation of acute and subacute brainstem infarctions was 63.6% and 76.9%, respectively. An insignificant correlation (r=0.08; p-value=0.68) between the volumes of WML burden in patients with brainstem infarctions and patients&#8217; age was noted. <b>Conclusion:</b> The sensitivity of the automated method in the segmentation of subacute brainstem infarctions was higher than that in acute brainstem infarctions. ]]> Assessment of Nailfold Capillaroscopy Findings in Pregnant Women having Preeclampsia: A Research Protocol Shreya Nirajkumar Gupta, Sugat Ambadas Jawade, Bhushan Madke, Samyak Ganjre Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> Pregnancy causes significant vascular and cutaneous changes in a woman&#8217;s body. Preeclampsia is one of the life-threatening conditions associated with high blood pressure and proteinuria after the 20<sup>th</sup> week of pregnancy. It can cause placental hypoperfusion and placental insufficiency, leading to foetal defects or, in severe cases, foetal loss, which can be prevented by early diagnosis and treatment. There are many ways to observe and study the microcirculation non invasively the safest and most accessible method is nailfold capillaroscopy. Nail-fold Video Capillaroscopy (NVC) is a hand-held digital microscope used to observe the microcirculation at the nailfold of the hands. Thus, comparing the capillary status with healthy subjects will help establish an early diagnosis and manage cases to prevent further complications in the mother and newborn. <b>Need of the Study:</b> The pathophysiology states that preeclampsia is related to systemic endothelial dysfunction, causing the release of Tumour Necrosis Factor (TNF) alpha, a proinflammatory mediator, leading to hypoxia of the placenta and the loss of endothelial cell-lined capillaries. Thus, there is a need to find if there is an established correlation in association of decreased Capillary Density (CD) in individuals with preeclampsia. Although evidence supporting a link between decreased CD and preeclampsia is limited, timely assessment and prevention are crucial. Nailfold capillaroscopy, an accessible and non invasive imaging method, holds promising calibre for understanding microvascular changes in preeclampsia. This could facilitate post-conception monitoring and early interventions to identify and address circulatory issues in affected women with preeclampsia. <b>Aim:</b> To study and compare the nailfold capillary changes in women diagnosed with preeclampsia and women having normal and uneventful pregnancies. <b>Materials and Methods:</b> A comparative cross-sectional study will be done in the Outpatient Department (OPD) and Inpatient Department (IPD) of Obstetrics and Gynaecology and the Outpatient Department of Dermatology at AVBRH Sawangi Meghe, Wardha, Maharashtra, India, from March 2023 to March 2025. A total of 150 pregnant women will be considered in the study, with 75 women being normal pregnant women (controls) and 75 pregnant women diagnosed with preeclampsia (cases). In order to confirm the gestational age of the patients, fundal height and abdominal circumference measurements will be taken. Demographic data, Basal Metabolic Index (BMI), weight gain during pregnancy, laboratory reports including Complete Blood Count (CBC), coagulation profile (Prothrombin Time, International Normalised Ratio, Activated Partial Thromboplastin Time), liver function tests, kidney function tests, urine examinations, and serial ultrasonography reports available for the patients will be noted. Pre-examination blood pressure will be recorded and compared with the baseline to confirm the status of preeclampsia after obtaining written consent from the patients. Nailfold capillaroscopy will be performed using a (Dinolite -AF4115ZT) dermoscope equipped with a 200X magnification, high-resolution lens in a non polarised light setting with oil immersion as a fluid coupling. The observations will be used to interpret the results of the study. Results will be calculated for finding differences between the two comparative groups of cases and controls at a p-value of &#8804;0.05. ]]> Turnaround Time and Barriers in Treatment of Newly Diagnosed Cancer Patients: A Research Protocol Harshali Himmat Pal, Jitesh Pankwase Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X <b>Introduction:</b> The journey from cancer diagnosis to treatment initiation is a critical period in a patient&#8217;s life. Timely treatment is often associated with better outcomes, yet numerous challenges and barriers can impede the process. <b>Need of the Study:</b> This research will hold significant implications for healthcare providers, policymakers, and, most importantly, cancer patients. By uncovering the obstacles and delays in cancer treatment, this protocol will provide the information needed to streamline the process, potentially leading to earlier interventions, improved patient experiences, and enhanced treatment outcomes. <b>Aim:</b> To comprehensively understand and address the factors influencing the turnaround time and the barriers encountered by cancer patients in accessing treatment. <b>Materials and Methods:</b> This study will employ a mixed-methods research design, combining both quantitative and qualitative approaches. It will encompass 89 patients at Siddharth Gupta Memorial Cancer Hospital (SGMCH), situated in Sawangi (Meghe), Wardha, Maharashtra, India. The estimated duration for this study is from December 2023 to October 2024. Factors influencing the turnaround time and the barriers encountered by cancer patients in accessing treatment will be evaluated. Primary data will be collected directly from newly diagnosed cancer patients using structured surveys/questionnaires. Secondary data sources include medical records, hospital, and healthcare system data. Statistical analysis will be done using Chi-square for qualitative measurement, Independent t-test, and Analysis of Variance (ANOVA) for the quantitative measurement. A p-value of <0.05 will be considered significant. ]]> Polycystic Ovarian Syndrome and Periodontal Diseases: The Link Demystified Narayane Ramkumar, Pratebha Balu, Hanumanth Sankar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Polycystic Ovarian Syndrome (PCOS) is one of the most commonly diagnosed endocrine disorders, affecting 7-20% of women of reproductive age. In the case of PCOS, the ovaries have a large number of cystic follicles linked to persistent anovulation and androgen overproduction. PCOS is also linked to other systemic disorders, such as diabetes mellitus, cardiovascular disorders, and psychological conditions. Research studies indicate that PCOS may increase susceptibility to periodontal disease. The mechanisms underpinning the links between these two conditions are not completely understood. There is emerging evidence to support the existence of a two-way relationship between PCOS and periodontitis, with PCOS increasing the risk for periodontitis and periodontal inflammation worsening the PCOS status. This narrative review of the various pathophysiological mechanisms linking the two diseases depicts a positive correlation between the two conditions. ]]> Medical Negligence with Special Reference to Act of Commission and Omission: A Narrative Review Devesh Nagpure, Sheetal Asutkar, Shubham Biswas, Yogesh Yadav, Anita Wanjari Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X A doctor&#8217;s failure to uphold the standards of his profession, causing the death of a patient whom the doctor hoped to save, is known as medical negligence. The most embarrassing act one can commit is medical negligence, which usually results in the patient&#8217;s death. Legally, medical negligence is a breach of the duty of care leading to harm. Lack of clinical competence can be interpreted as negligence. Indian courts decide cases of medical negligence based on the Bolam test. According to Black&#8217;s Law Dictionary, negligence is defined as &#8220;conduct, action, or omission, which may be declared as negligence without any argument or proof as it violates the dictates of common prudence&#8221;. The three cardinal elements in negligence are duty of care failure, failure to exercise duty of care (Dereliction), and causation of damage to the patient on account of dereliction. References to medical negligence can be found in classical texts such as <i>Manusmriti</i>, <i>Kotilya Arthashastra</i>, <i>Charaka Samhita</i>, <i>Sushruta Samhita</i>, and others. To mitigate medical negligence, various measures can be taken, such as improved communication, strengthening training and education, emphasising quality assurance, and legal reforms. The rapid development of medical science and technology has proven to be a powerful tool for doctors to better diagnose and treat patients, but it has also become a tool to exploit people for profit. Accurate information about negligence and its laws is needed as there is not enough data in this regard. To avoid medical negligence, practitioners should show strict adherence to modern surgical ethics, which also include concepts like the importance of informed consent, doctor-doctor relationship, doctor-patient relationship, doctor-state relationship, doctor-attendant relationship, attendant-patient relationship, and patient autonomy. ]]> A Comprehensive Review of Synthesis, Properties and Applications of TiO<sub>2</sub> and ZnO Nanoparticles Suja Joseph, Deepak Nallaswamy, Shanmugam Rajeshkumar, Pradeep Dathan, Leon Jose Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Nanotechnology is an advancing field of science with the potential to improve the quality of life through its applications in the field of nanomedicine. It refers to the technology of precisely manipulating atoms and molecules and developing new materials with nanoscale dimensions. Nanoparticles (NPs) typically range in size from 1-100 nm. Nanoparticles play a major role in the prevention of infections, so they can be utilised as nanocarriers with antimicrobial therapeutic actions. This article is a literature review on different methods of synthesis, properties, and biomedical applications of Titanium Dioxide (TiO<sub>2</sub>) and Zinc oxide (ZnO) nanoparticles. Since nanoparticles can be biomodified by cost-effective methods, the use and applications of NPs will increase in the future. The unique properties of nanoparticles make them useful in various fields of science such as materials, engineering, electronics, food science, and biomedicine. Due to their advantages, nanotechnology has gained the attention of researchers, especially for its promising applications in the healthcare system for better diagnosis and treatment. ]]> Exploring the Diagnostic and Therapeutic Significance of Thyroid Hormones in Female Infertility: A Comprehensive Narrative Review Khushi, Abhishek Sharma, Vikas Tiwari, Jaishree Tiwari, Mohd Afzal Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Thyroid Hormones (TH) are essential for the healthy functioning of the female reproductive system because they regulate ovarian, uterine, and placental tissue metabolism and development. Therefore, hypo-and hyperthyroidism may result in infertility in women. Previous studies have been conducted on women with thyroid dysfunction, including prospective and retrospective studies, in-vitro and in-vivo tests for hypo-and hyperthyroidism using ovarian, uterine, and placental cell culture, and experimental animal models. In order to better understand the physiology of the reproductive system and to develop more effective therapy methods for reproductive dysfunctions that result from thyroid dysfunctions, these studies sought to shed light on the mechanisms by which TH affect reproduction. This comprehensive narrative review investigates the diagnostic and therapeutic implications of TH in female infertility. By scrutinising existing literature, the study aims to elucidate the intricate relationship between thyroid function and reproductive health in women. Such insights are crucial for enhancing diagnostic accuracy and formulating effective therapeutic interventions to address thyroid-related factors influencing female infertility. ]]> Exploring Recent Advancements in Rotator Cuff Injury Rehabilitation: A Narrative Review Brajesh Kumar, Priyanka Rishi, Neha Reyalch Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Rotator cuff injuries are prevalent musculoskeletal injuries that may impair quality of life and function. This narrative review covers current rotator cuff injury rehabilitation breakthroughs and provides insights into evidence-based techniques that improve patient outcomes. Recent advances in evaluation and rehabilitation are the topic of this narrative review. It covers the newest diagnostic techniques and imaging modalities for better diagnosis and patient stratification. It also examines how wearable gadgets and tele rehabilitation might improve recovery. Recent exercise prescription and progression advances include eccentric training, isometric movements, and neuromuscular re-education for rotator cuff repair and function. It emphasises patient-specific rehabilitation procedures and the growing significance of regenerative treatments and biologics in rotator cuff injury treatment. This evaluation also stresses patient education and collaborative decision-making for rehabilitation success. Managing rotator cuff injuries psychologically involves treating pain, fear avoidance, and psychosocial concerns. In conclusion, this narrative review summarises the latest rotator cuff injury rehabilitation techniques and modalities. Rotator cuff injury patients may benefit from these advances in outcomes, recurrence rates, and quality of life. This narrative review helps physicians, researchers, and healthcare workers treating rotator cuff injuries keep current. ]]> Clinical Profile and Prevalence of Hyponatremia in Critically-ill Patients of All Age Groups Sakshi Bhutda, Sunil Kumar, Shricha Bhutda Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Hyponatremia is defined as a serum sodium level of <135 mEq/L. It is the most prevalent electrolyte imbalance encountered in hospital admissions around the world. Hyponatremia has been reported to be present in between 3.4% to 39.4% of hospital admissions, and it is substantially more prevalent in an Intensive Care Unit (ICU). It has been connected to an increase in mortality, hospital stays, and morbidity. An imbalance of specific ionised salts (sodium, potassium, calcium, bicarbonate, and chloride) in the blood is known as an electrolyte problem. Volume abnormalities are the main cause of disturbances in salt homeostasis, which largely produce neurologic symptoms. Serious consequences arise when these electrolyte imbalances worsen, which are frequent clinical issues in the ICU. Hyponatremia has a multifaceted aetiology and it can be of three types: euvolemic, hypovolemic, or hypervolemic hyponatremia. Regardless of being a frequently encountered electrolyte disturbance, hyponatremia is poorly acknowledged. Its relationship with a myriad of fundamental illnesses and its many aetiologies with varying pathological and physiological pathways make diagnosis problematic. Clinicians should be skilled at recognising the symptoms, causes, and aetiologies of hyponatremia when treating sick patients. The signs, symptoms, and causes of hyponatremia should be readily apparent to clinicians treating unwell patients. The present review focuses on the symptoms and clinical findings of hyponatremia in the critically-ill patient and discusses the types, pathophysiology, and clinical profile of these patients. ]]> Cognitive and Integrated Intervention Therapy in the Geriatric Population and its Benefits on Daily Living Activities and Quality of Life: A Narrative Review Mantu Paul, Binod Chandra Sarma, Niharika Dihidar Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Physiotherapists have expanded their scope into a wide array of fields, including various cognitive-based therapies and mixed integrated intervention therapies. Multiple databases were used in present literature review, including Medline, PubMed, Scopus, Web of Science, and Pedro, which consisted of research studies, systematic reviews, and meta-analyses published between 2002 and 2022. The keywords searched were: cognitive, geriatric, daily living activities, life quality, integrated therapy. Out of the 163 articles retrieved, 52 primary matching articles were included in the review, and 111 articles were excluded as they did not meet the inclusion criteria. Among the matching articles, 39 showed benefits in Quality of Life (QoL) in geriatric individuals with interventions of cognitive therapy and other integrated therapies such as art therapy and music therapy, using valid and reliable outcome scales. The findings and corroborations from these studies indicated the positive effects of cognitive therapy and various integrated intervention therapies on daily living activities and life quality in the elderly population. There is limited data in the literature about the effects of cognitive and integrated intervention therapy in the elderly population. The primary aim of present review study was to analyse the existing available resources and evidence concerning the effects of cognitive therapy and integrated intervention therapy in geriatric individuals. ]]> Ayurvedic Management of Duchenne Muscular Dystrophy in Children: A Narrative Review Shruti Prakash Kapatkar, Renu B Rathi, Swecha Choudhary Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Duchenne Muscular Dystrophy (DMD) is the most common primary myopathy of children. There are many muscular diseases in children which are inherited through generations. All those are known as congenital myopathy. This disease is an X-linked recessive disorder produced by the abnormality of the gene Xp21. It is a severe condition that poses a life-threatening risk and significantly reduces a patient&#39;s lifespan. It is characterised by progressive symmetrical muscular weakness, with proximal muscles being more affected than distal ones. Additionally, individuals with DMD often exhibit pseudohypertrophy of the calf muscles. The compilation of data from classical Ayurvedic texts contributes to a holistic understanding of potential interventions, aiming to improve patient quality of life and prevent contractures. The study is crucial in bridging traditional and contemporary healthcare practices, offering valuable insights for clinicians and the wider medical community in addressing the multifaceted challenges posed by DMD. This research underscores the need for an integrative and comprehensive approach to enhance therapeutic strategies for this prevalent X-linked recessive disorder. In pursuit of this objective, concerted efforts have been directed towards raising awareness among both the general public and the medical community. Furthermore, the review delves into the exploration of various Panchakarma treatments, a traditional therapeutic approach rooted in Ayurveda. By consolidating and synthesising data derived from classical Ayurvedic texts pertaining to DMD, this review seeks to provide a holistic understanding of potential interventions. The goal is to contribute to the advancement of therapeutic strategies that can ameliorate the impact of DMD on patients&#39; lives, fostering a more comprehensive and integrated approach to managing this challenging condition. ]]> Eating Behaviour and Stress due to the Psychological Impact of COVID-19 among Bariatric Surgery Patients Resulting in Weight Regain: A Narrative Review Vidhi Monga, Rayees Mohammad Bhat Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X The Coronavirus Disease-2019 (COVID-19) pandemic has significantly changed the lifestyle of people around the globe. Epidemics are well known for initiating mental stress and patients having undergone bariatric surgery for obesity are at high risk for the common presence of psychological co-morbidities The recent lockdowns imposed by various governments to curb the COVID-19 epidemic have affected the eating habits of many people. In patients with bariatric surgeries, eating disorders can have a profound impact on their health, leading to weight regain. Individuals who have undergone bariatric surgery may represent a particularly susceptible population. The adverse effects might be manifested in the form of eating disorders, psychological problems, and negative impacts on weight loss outcomes. There have been challenges in weight loss due to lockdowns, resulting in negative psychological impacts. Furthermore, changes in socialisation, routine physical activities, emotional stress, and experiences of trauma that have been evident at global levels might have a negative impact on the eating habits of bariatric surgery patients. The current paper highlights the psychological impact of COVID-19 among bariatric surgery patients resulting in weight regain caused by eating disorders and stress and addresses the psychological morbidity in this understudied population. In addition, the impact on the psychology of patients, as their surgeries have been delayed owing to lockdown procedures, has been discussed. ]]> A Narrative Review Unveiling Novel Molecular Targets in Advancing Antidiabetic Medications: An Emerging Perspective Balamurali Venkatesan, V Natarajan, A Akhila Kalyani Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Diabetes Mellitus (DM) is a persistent metabolic disorder characterised by elevated glucose concentration in blood. Approximately, 422 million individuals globally suffer from diabetes, with the majority residing among middle-class and lower-class countries as per the reports of World Health Organisation (WHO) 2023. Strict blood sugar control in conjunction with high-dose insulin therapy might potentially prevent or delay the progression of microvascular issues, lower overall mortality, and lessen the chance of macrovascular problems. These conclusions were supported by the Diabetes Control and Complications Trial and the large longitudinal investigation known as the epidemiology of diabetes and its complications. Numerous drugs and receptors involved in glucose metabolism are currently being used to treat diabetes, including &#945;-Glucosidase inhibitors, dopamine D-2 agonists, biguanides, glinides, amylin analogues, Peroxisome Proliferator-activated Receptors (PPARs), Glucagon-like Peptide-1 (GLP-1), and biguanides. Due to the associated side effects and the financial difficulties in obtaining traditional antidiabetic regimens, the current review has placed a higher priority on investigating novel molecular targets for the development of antidiabetic medications intended to manage the progression of the illness. This emphasises how important it is to find new molecular targets associated with the illness&#8217;s onset instead of only treating its symptoms or outward signs. ]]> Introducing Electronic Question Banks in a Medical College: The Need and the Plan Saurabh Rambiharilal Shrivastava, Prateek Sudhakar Bobhate, Harshal Gajanan Mendhe, Yugeshwari Tiwade Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X ]]> Port Site Hernia after Laparoscopic Surgery: Incidence, Pathogenesis and Management Strategies Vinayak Vishnupant Kshirsagar, Yogesh Bhupal Langade, Prabhat Bhaskarrao Nichkaode, Nilam Sandeep Memane, Rakesh Diliprao Kothavale Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Although Port Site Hernia (PSH) is a rare complication after laparoscopic surgery, with an incidence of 0.65-2.8%, it can be deadly due to the inherent risk of bowel strangulation. Various factors like trocar size, design, improper closure of the defect, and postoperative infection may cause PSH, and symptoms might occur immediately within 10 days or up to 18 months of the primary procedure. A Computed Tomography (CT) scan is a helpful adjuvant in the diagnosis and evaluation of PSH. Deformities larger than 5 mm require surgical intervention in all age groups. Early cases of suspected gangrene necessitate immediate surgical intervention. In advanced situations, anatomical repair by suture or mesh repair by open or laparoscopic method is preferred for lesions larger than 5 mm. ]]> A Variant Dorsalis Pedis Artery and Its Relationship with the Deep Fibular Nerve Sulochana Sakthivel, Jahira Banu, Nithya Dhakshnamoorthy Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X During a cadaveric dissection session, a distinctive neurovascular pattern was identified in the left leg of a 66-year-old female cadaver. The Anterior Tibial Artery (ATA), while maintaining a normal origin and luminal diameter, exhibited a shortened course, terminating in the upper third of the leg. In the lower third of the leg, the Fibular Artery (FA), known as the peroneal artery, traversed through the interosseous membrane to the anterior compartment, persisting as the Dorsalis Pedis Artery (DPA). The Deep Fibular Nerve (DFN), displaying a usual course in the upper two-thirds of the leg, crossed the variant DPA posteriorly and divided into two terminal branches on its posterolateral side. The medial terminal branch proceeded to cross the artery anteriorly within the anterior tarsal tunnel. This distinctive relationship between the DFN and the variant DPA renders the nerve susceptible to compression and may result in &#8220;anterior tarsal tunnel syndrome&#8221;. ]]> Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report Navneeta Bisht, Gaurav Misra Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Spinal Anaesthesia (SA) with hyperbaric bupivacaine and opioids is a preferred technique for lower limb surgeries in many centres. Among the various complications of such anaesthesia, postprocedural voice loss is relatively uncommon and has been reported very rarely in cases other than parturient patients. The sudden onset of such symptoms after anaesthesia and various other attributable causes may have implications for the subsequent surgery. The authors reported here a case of postprocedural voice loss in a 24-year old male patient prepared for open reduction and internal fixation surgery for a femur fracture. The patient developed immediate dysphonia along with tingling of the face and itching of the nasal alae after the administration of a subarachnoid block. The patient had a normal heart rate, blood pressure, and respiratory pattern. There was no history of any previous episode or possible attributable psychological condition. The authors carefully monitored the patient, assessed various causes of such a presentation, and noticed it to be transient and without any serious implications. They attributed the cause to the rostral spread of fentanyl, and the surgery was resumed. The authors concluded that immediate and transient voice loss after SA is an unexpected and unavoidable complication for lower limb surgery and may occur in non obstetric cases as well. However, if hypovolemia and respiratory abnormalities had been excluded, reassurance and close observation may be appropriate. ]]> &#8220;A Complex Conundrum&#8221;- Fanconi-Bickel Syndrome Hamritha Ashokkumar, K Sundar Natesh, Vaanmathi Azhagar Nambi Santhi, K Vidhyasagar, Akshai Krishnan Journal of clinical and diagnostic research : 2024 - May - 18:0973-709X Fanconi-Bickel Syndrome (FBS) is a rare form of Glycogen Storage Disease (GSD) type 11 characterised by massive hepatomegaly due to the buildup of glycogen and severe hypophosphatemic rickets due to a proximal renal tubular dysfunction. Since 1940, it has been initially known as hepatorenal glycogenesis with proximal renal tubular dysfunction. It is due to a pathogenic mutation of the GLUT-2 (glucose transporter) gene. Herein, present case report a young toddler who is the firstborn of 3rd-degree consanguinity, presented with rickets, recurrent respiratory tract infections, and hepatomegaly, and was subsequently diagnosed with FBS with the help of genetic studies, showing a mutation in the GLUT-2 gene. With less than 200 cases reported so far, this child represents a unique case with recurrent respiratory infections and developmental delay as presentations along with rachitic features. ]]>