Table of Contents : Journal of clinical and diagnostic research : 2023 - January - 17 Table of Contents : Journal of clinical and diagnostic research : 2023 - January - 17 Obstructed Left Paraduodenal Hernia with Spontaneous Reduction Demonstrated on Computed Tomography: A Case Report Varsha P Rangankar, Krishnarjun Muralinath, Parag V Patil, Sameeh UZ Zaman Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Paraduodenal hernias (PDH) are the most frequently occurring internal hernia, caused due to nonfusion between inferior mesentery and parietal peritoneum. The herniation of the bowel through the fossa of Landzert results in the left paraduodenal hernia which constitutes 75% of PDH. A case of a 34-year-old male with obstructed left PDH and a spontaneous reduction is demonstrated on Computed Tomography (CT). The patient had a cluster of jejunal loops forming a sac-like mass in the left anterior pararenal space, with surrounding mass effect with twisting and stretching of the mesenteric vessels at the hernia orifice, which showed a spontaneous reduction on subsequent contrast-enhanced and delayed CT studies. Despite the imaging evidence of spontaneous reduction of left PDH in our case, surgery remains the mainstay in terms of management for left paraduodenal hernia. ]]> Customised 3D Printed guides for Mandibular Fracture Management- A Report of Two Cases Chitra Chakravarthy, Ravi S Patil, V Chethan Babu, Shivraj Wagdargi, Daisy Arahna Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X In treating mandibular fractures, accurate anatomical reduction and reconstruction remains quite challenging and arduous for the oral maxillofacial surgeon using traditional devices and methods. Therefore, advanced techniques have become essential to simplify and achieve safe and desirable anatomical reduction with lesser operative time. Introduction of 3 Dimensional (3D) printed guides helps to achieve bony consolidation in the correct anatomic position to facilitate standard mouth opening and restore the pretrauma occlusion. In the following case reports (7-year-old male, 35-year-old male), the preoperative surgical planning began with the construction of 3D imaging in both the cases after radiographic examination. For virtual reconstruction, the images from the multiplanar Computed Tomography (CT) scan were converted into Digital Imaging and Communications in Medicine (DICOM) format. The present reports have proposed using an inexpensive customised 3D printed cast metal surgical guide in the treatment of two cases of mandibular fracture. A customised 3D printed surgical guide and an occlusal stent were designed and fabricated to assist in placing screws and plates for approximation of fractured segments and to guide the occlusion during surgery. They also highlight the efficacy and functionality of a customised 3D printed cast metal surgical guide in increasing the reduction accuracy, reducing surgical difficulties, and improving clinical outcomes with a lesser operative time in treating mandibular fractures. ]]> Purple Glove Syndrome- A Catastrophic Complication of Phenytoin Injection Vivek Lahane, Ruchita Kabra, Amol Andhale, Sourya Acharya, Sunil Kumar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Purple Glove Syndrome (PGS) is a rare complication of intravenous phenytoin administration, which is illustrated by delayed soft tissue injury of the skin conterminous to the point or distal to the site of intravenous phenytoin infusion. The clinical features of PGS include pain, oedema, and bluish discolouration over the extremity. The present case report describes about a 60-year-old male, who presented to the Emergency Department with the chief complaints of generalised tonic clonic seizures, lasting for 10 minutes, for which he was managed with inj. phenytoin sodium. The computed tomography scan of brain revealed right-sided subdural haematoma. After 24 hours of hospital stay, the patient started complaining of severe pain in the arm and forearm. There was purple-bluish discolouration around the intravenous site, peripheral oedema and pain. The various risk factors linked to PGS, include old age and large and multiple doses of phenytoin. ]]> Multidisciplinary Management in a Patient with Hemifacial Microsomia and Microglossia Santosh Kumar, Priyanka Jayaswal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Hemifacial Microsomia (HFM) is the second most common congenital craniofacial anomaly following cleft lip and palate. On contrary, microglossia is a very rare congenital anomaly. To the best of authors&#8217; knowledge, HFM associated with microglossia has not been reported in the literature. Hereby, the authors present a case report of a 13-year-old girl, who presented with features of hemifacial microsomia, blindness, microglossia, hypodontia, bilateral transposition between upper first premolar and canine, anterior crowding and deep bite. Patient&#8217;s treatment was started with fixed orthodontic appliance and arches were aligned by maintaining the transposed position of the teeth. After completion of orthodontic treatment, maxillary right and left first premolars were contoured into lateral incisor and canine, respectively, to have satisfactory functional and aesthetic outcome. ]]> Primary Cardiac Burkitt&#8217;s Lymphoma- A Deadlock Vinay Praveen Ayyala, Mamatha Reddy, Soujanya Karpay, Ramesh Gadepalli, Milap Shah Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Burkitt&#8217;s lymphoma is a high-grade, extremely aggressive form of B-cell non Hodgkin lymphoma with a very fast replication time (tumour doubling time of around 25 hours). The three forms of Burkitt&#8217;s lymphoma are documented which include endemic, sporadic, and immunodeficiency associated. It is enormously rare with less than 30 cases reported till date. Primary cardiac lymphoma is a rare cardiac neoplasm. The most common type is diffuse large B-cell lymphoma. Diagnosis is usually late and with poor prognosis. Primary cardiac lymphoma is more common in immunodeficient patients. This is a case of primary cardiac Burkitt&#8217;s lymphoma which was diagnosed in a 58-year-old immunocompetent male. The patient&#8217;s two-dimensional echocardiography and plain Computed Tomography (CT) scan of the chest revealed presence of massive pericardial effusion with mild to moderate bilateral pleural effusion. Cardiac Positron Emission Tomography (PET) CT revealed a soft tissue mass at atrioventricular groove which indicated either pericardial lymphoma or inflammatory serositis. The patient was opted for surgery, but the mass was noted involving the free wall of right ventricle including the diaphragmatic surface which extended onto atrioventricular groove and base of right atrial appendage. Thus, a decision to not proceed further with surgical repair was made. The histopathological and cytogenetic findings confirmed the presence of Burkitt&#8217;s lymphoma. Later, it was discovered that the patient died within one month of diagnosis. ]]> Osteopathic Manual Therapy along with Cranial Electric Stimulation in Primary Dysmenorrhoea Sunita Sharma, Kamran Ali, Harneet Narula Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Primary dysmenorrhoea is described as lower abdominal discomfort that occurs soon before or during menstruation but pathology is called secondary dysmenorrhoea. Gynaecological dysfunctions are routinely treated using osteopathy and other physiotherapy treatments. The case report determines pre and postuterocervical angle, pain, physical activity level and psychological state after osteopathy manual therapy and conservative management on primary dysmenorrhoea. A 22-year-old female was diagnosed with primary dysmenorrhoea and was referred to the physiotherapy Outpatient Department (OPD) for conservative management. Physiotherapy assessment included Visual Analog Scale (VAS) for pain, International Physical Activity Questionnaires (IPAQ) for physical activity and Depression, Anxiety and Stress Scale-21 items (DASS-21) for psychological assessment at baseline. She received Cranial Electric Stimulation (CES), osteopathic manual therapy, deep breathing exercise, core strengthening exercise, lower limb stretching exercises and music therapy for relaxation. She received intervention for seven days a month for four consecutive months during menstruation cycles. After four months, her pain and psychological status improved significantly, uterocervical angle increased and there was an increase in physical activity. Thus, CES with osteopathic manual therapy along with conventional therapy helps reduce pain, increase physical functions, improve psychological status and even has a positive effect on uterocervical angle. ]]> Unravelling the Convoluted Story of Perioperative Care in Three-year-old Child with Tetralogy of Fallot Undergoing Repair Surgery Aishwarya Nayak, Sanjot Ninave, Dhawal Wadaskar, Prasad Panbude, Amol Bele Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Tetralogy of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in children. Single step corrective surgery, early on in life, provides a fair expectation of favourable outcome in these individuals. However, complex, and skilled anaesthetic management is required by experienced team of healthcare providers. Preoperative surgical preparation, intraoperative key anaesthesia principles and postoperative care Intensive Care Unit (ICU) are all perioperative considerations in these patients. The present article reports challenges faced in the perioperative anaesthesic management of a 3-year-old male child having uncorrected TOF, who underwent Waterston shunt and later Intracardiac Repair (ICR). He presented with postoperative complication like cyanotic spell, gastrointenstinal bleeding, sepsis; but later, recovered successfully. ]]> Bronchioloalveolar Carcinoma Mimicking as Pneumonia: A Case Report Bhavesh Patel, Cheguri Vasavi, Arti Dhawal Shah, Chirag Chakravarti, Anchal Jain Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Bronchioloalveolar Carcinoma (BAC) also known as alveolar cell carcinoma is a subtype of adenocarcinoma that is more common in women and non smokers. It accounts for almost 5% of all lung cancers. Bronchioloalveolar carcinoma may appear as a wide variety ranging from solitary nodule to patchy, lobar or multilobar opacities. The mucinous, non mucinous, ambiguous or mixed are the histological types of BAC. The mucinous variety of BAC sometimes may present as a consolidation which is indistinguishable from an infective pneumonia on a radiological picture. Hereby, authors present a case of 65-year-old male patient, who was evaluated for non resolving pneumonia for a time span of one year. He presented to the Respiratory Medicine Outpatient Department with a cough and expectoration for the past nine months. Antibiotic courses did not provide the patient any sort of relief and there was no change in the size of the lesion. Chest X-ray has shown right sided non homogenous opacity and later Contrast Enhanced Computerised Tomography (CECT) thorax and biopsy (computed tomography-guided) was done from the same site for further evaluation. Cytology done from CT-guided biopsy sample showed typical lepidic growth pattern. Histopathologically, it showed mucinous variety of BAC. Usually, the patients have no symptoms but an abnormal chest X-ray, while a few have features like coughing with expectoration and pain in the chest. Only cytology or biopsy can help with a proper diagnosis, which can be done via needle biopsy (CT or fluoroscopy guided) or transbronchial biopsy and Bronchoalveolar Lavage (BAL). It has rarely been documented in the literature that BAC masquerades as a consolidation with very little change. ]]> Anaesthetic Management of Intracranial Abscess in a Patient with Surgically Uncorrected Double Outlet Right Ventricle with Transposition of Great Arteries Kiranmai Chidipothu, Roshan Nisal, Vivek Chakole, Neeta Chaudary Verma Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Double Outlet Right Ventricle (DORV) with Transposition of Great Arteries (TGA) is a rare variant. The ventriculoarterial discordance due to this anatomical defect leads to parallel circulation. The postnatal survival depends on mixing of oxygenated and deoxygenated blood at various levels by defects like Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA). Anaesthetising children with cyanotic Congenital Heart Disease (cCHD) and brain abscess necessitates use of anaesthesia protocol appropriate to both cCHD and intracranial surgery. Anaesthetic considerations related are maintenance of intravascular volume and preload, avoidance of precursors to acidosis such as hypothermia, hypercarbia, and hypotension and challenge for anaesthesiologist is to maintain Pulmonary Vascular Resistance (PVR) and Systemic Vascular Resistance (SVR) by pharmacological and ventilatory means. This report is about a seven-year-old child who was posted for emergency craniotomy and abscess drainage, after routine preanaesthetic check-up. Induced with fentanyl, ketamine and atracurium, anaesthesia was maintained on oxygen, air and sevoflurane. Intraoperatively, normothermia was maintained, and blood pressure was maintained by noradrenaline infusion, metabolic acidosis was corrected with soda-bicarbonate. In between the procedure, the patient had an episode of Supraventricular Tachycardia (SVT), which was managed with lidocaine, metoprolal and adenosine. In such cases, it is vital to pay attention to any potential anaesthetic interactions. ]]> Sarcomatoid (Spindle Cell) Carcinoma Arising in Mature Cystic Teratoma as a Mural Nodule: A Case Report Renu Sukumaran, Suchetha Sambasivan Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Mature cystic teratomas are the most common ovarian germ cell tumours.Malignant transformation is rare in mature cystic teratoma. Spindle cell/sarcomatoid carcinoma is an uncommon type of squamous cell carcinoma. A 45-year- old female presented with abdominal distention and discomfort. Magnetic Resonance Imaging (MRI) showed multiloculated cystic mass measuring 21&#215;20&#215;14 cm with heterogeneously enhancing solid component measuring 5x3.5 cm in right adnexal region. Excision of the mass done. Macroscopic examination showed irregular cystic mass containing pultaceous material and hair, and a mural nodule measuring 5x5 cm. On histopathological examination, the cyst wall showed mature teratomatous elements. Sections from mural nodule showed sheets of atypical spindle cells with increased mitosis and foci of necrosis. On immunohistochemical examination, the spindle cells showed patchy weak to moderate positivity for cytokeratin, 34 beta E12, CK5/6 and P40. Diagnosis of spindle cell/sarcomatoid carcinoma arising in mature cystic teratoma was given. Malignant transformation in mature cystic teratoma is rare and should be suspected in large sized tumours in older patients. Sarcomatoid carcinoma is an extremely rare form of secondary malignant neoplasm arising from mature cystic teratoma. ]]> Wilson&#8217;s Disease with Late Hepatic Involvement Mahavir Raghunath Mundra, Manju Chand Ankhede, Pradip Jain, Ashish Anjankar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Wilson&#8217;s Disease (WD) is an autosomal recessive condition that affects copper metabolism and manifests itself clinically in different ways. The diagnosis is indicated by low serum copper and ceruloplasmin concentrations, increased urine copper excretion and/or increased hepatic copper concentrations. The present case report is about a 55-year-old male with chief complaints of loss of appetite, abdominal swelling, tremors in hand and head, slurring of speech for 10 days. Ultrasound (USG) findings were suggestive of liver cirrhosis with portal hypertension and liver function tests were also deranged. He was prescribed diuretics and asked to review after 10 days. Kayser-Fleischer ring was observed through slit lamp examination in both the eyes, which is a hallmark of WD. The Magnetic Resonance Imaging (MRI) of brain also revealed positive findings-hyperintensity throughout the mesencephalon for WD. Thereafter, the patient was treated with penicillamine and his symptoms improved after few days. ]]> Massive Right-sided Pleural Effusion due to Pancreaticopleural Fistula: A Rare Case Report Chirag H Chakravarti, Kaushani Hetalbhai Patel, Bhavesh M Patel, Arti D Shah Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Pancreaticopleural Fistula (PPF), a rare occurrence, is characterised by an abnormal connection between pleural and peritoneal cavity. It forms usually due to the rupture of pancreatic pseudocyst. Pancreatic pseudocyst is formed due to the repeated episodes of acute or chronic pancreatitis. Most pancreatic pathologies, such as acute and chronic pancreatitis, cause clinically insignificant effusions that resolve with disease control, whereas PPF causes massive effusion and is thus rarely considered as a cause of massive pleural effusion due to its low incidence. PPF are most common in middle-aged alcoholic males and typically present as massive recurrent left-sided pleural effusions. In the present case, a 50-year-old male presented to the Department of Respiratory Medicine with the complaint of right-sided chest pain, progressive breathlessness, abdominal pain and loss of appetite. Patient was labourer by occupation, chronic alcoholic, non diabetic. Contrast Enhanced Computed Tomography (CECT) thorax with abdomen showed massive right-sided pleural effusion and pancreatitis. A diagnosis of PPF was confirmed as its cause. Pleural fluid analysis for elevated amylase, confirms the diagnosis and investigations such as CECT thorax and abdomen, Endoscopic Retrograde Cholangiopancreatography (ERCP), or Magnetic Resonance Cholangiopancreatography (MRCP) may be used to establish the fistulous communication between the pancreas and the pleural cavity. PPF should always be considered as a differential diagnosis while finding a cause for right-sided pleural effusion. ]]> Pilocytic Astrocytoma Arising in Ovarian Mature Cystic Teratoma: An Unusual Neuroectodermal Malignant Transformation Occurring in Pregnant Female Kalaivani Amitkumar, Abbirami Rajarajan, R Bhuvanamhadevi, Sowmya Dayalan, Muthu Sudalaimuthu Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Mature cystic teratomas are usually benign, however malignant transformation occurs rarely. It is identified in only 0.17-2% of cases. Malignant cells can arise from cell of any type, but most common malignant transformation found to be squamous cell carcinoma (80% cases) followed by adenocarcinoma. While neural tissue is identified in nearly 80% cases of mature cystic teratomas, neuroectodermal tissue with malignant transformation is the most exceptional event. There is minimal data available on primary neuroectodermal tumours of ovary, majority are astrocytoma of different grades, only few cases were reported in the literature so far. Authors report a extremely rare and unique case of pilocytic astrocytoma arising from a mature cystic teratoma in a pregnant female. A 33-year-old pregnant female in her first trimester came for regular antenatal visit, Ultrasound (USG) abdomen and pelvis single live intrauterine gestation corresponding to 10 weeks and incidental complex right ovarian cyst likely to be mature cystic teratoma. Patient underwent right ovarian cystectomy five months after normal vaginal delivery and provisional diagnosis was given as complex right ovarian dermoid cyst. Final detailed histopathological examination revealed a tumour with glial tissue within the cyst, reported as pilocytic astrocytoma {World Health Organization (WHO) grade 1} arising in mature cystic teratoma. To the best of authors&#8217; knowledge this is the third case showing pilocytic astrocytoma component in ovarian teratoma and the first case of this entity occurring in a pregnant female. Authors present an unusual case where radiology gave preliminary diagnosis however, extensive histopathological examination, histochemistry and immunohistochemistry helped in definite diagnosis. ]]> Uterine Fibroid and Extensive Myxoid Degeneration- Is it Benign or Malignant? Swati Sugandha, Gazal Mahajan, Monika Jindal, Santosh Minhas Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Uterine leiomyomas are the most common benign uterine tumours that may undergo various types of degenerative changes. Rarely, myxoid degeneration can occur in giant leiomyomas that may pose difficulty in diagnosis and may be confused with choriocarcinoma, sarcomatous transformation or even hydatid cyst. This manuscript reports a large leiomyoma weighing approximately 4.5 kg, arising from the posterior wall of the uterus with myxoid degeneration in a 39-year-old female patient. She underwent a total abdominal hysterectomy with bilateral salpingectomy and left oophorectomy. Malignancy was ruled out after a histopathological examination. Through this case, the authors wish to highlight and learn about this rare pathology and understand the diagnostic challenges, thereby helping future gynaecologists to be familiar with the same. ]]> Undiagnosed Case of Ventricular Septal Defect with Eisenmenger Syndrome and Epistaxis Presentation Rajesh Naranbhai Pankhaniya, Rahul Tandon, Bhadra Trivedi, Megha Anant Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Eisenmenger syndrome is a rare irreversible cardiac condition as a consequence of increased Pulmonary Arterial Hypertension (PAH). This causes a reversal of flow and cyanosis. This pulmonary arterial condition developed because of unrestricted pulmonary flow. It is seen mostly in unrepaired acyanotic congenital cardiac defects with an initial left to right shunt. The common conditions are large Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), Atrioventricular Septal Defect (AVSD), and atrial septal defect. The patient presented with cyanosis and worsening exertional dyspnoea due to the reversal of the shunt. It can be prevented with early diagnosis and by successfully repairing the defect. The mode of diagnosis is a good physical examination and two-dimensional (2D) echocardiography. This case report is about an 11-year-old female patient who presented with a complaint of exertional dyspnoea for five years. She had very low oxygen saturation on room air when presented in the paediatric Outpatient Department (OPD). She went for 2D echocardiography as her physical examination and laboratory investigation were not supporting any diagnosis. Her echocardiography (echo) showed large sub-aortic VSD with Eisenmenger complex and prescribed tablet Sildenafil. On the next day of admission, her dyspnoea improved, and maintained saturation without oxygen of 96-97%. She was successfully discharged and called for regular follow-up. ]]> Microsurgical Approach for the Coverage of Gingival Recession Defects using Vestibular Incision Subperiosteal Tunnel Access (VISTA<sup>TM</sup>) Technique- A Case Report Aishaan Sharma, Ridhima Uppal, Shalini Kapoor, Amit Bhardwaj, Aayushee Gupta Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Gingival recession which is described as the loss of gingival attachment due to apical migration of the gingival margin from the cementoenamel junction leading to the exposure of the root surface, is one of the most prevalent diseases in the world. The treatment of gingival recession is therefore essential to achieve good aesthetics, relieve root hypersensitivity, prevent root caries and cervical abrasions. Till date, many root coverage techniques have been implicated for the coverage of recession defect. This case report focuses on the Vestibular Incision Subperiosteal Tunnel Access (VISTA<sup>TM</sup>) technique for the root coverage procedure and simultaneous application of the microsurgical principles helps in executing the procedure in the most minimally invasive manner. Here, this technique has been accomplished in a 24-year-old female, with the chief complaint of poor aesthetics in the region of maxillary central incisors due to recession defects. Furthermore with the use of microsurgical instruments and magnifying loupes; complete coverage of the recession defects was achieved in a single stage surgery along with superior aesthetics, causing minimal trauma to the patient that was followed by an uneventful inflammatory phase. ]]> Full Mouth Rehabilitation of a Child with Aicardia-Gouti&#232;res: A Rare Syndrome Pradnya Dileep Pathak, Preetam P Shah, Laxmi S Lakade, Maya U Shinde Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Aicardi-Gouti&#232;res Syndrome (AGS) is a rare genetic disorder with autosomal recessive inheritance. AGS is characterised by an early-onset encephalopathy that usually, but not always, results in severe intellectual and physical disability. Involuntary muscular spasms between the ages of four months and four years are the typical starting point for Aicardi syndrome. Hepatosplenomegaly, increased liver enzymes, thrombocytopenia, and abnormal neurologic signs in a subgroup of AGS children at birth strongly imply congenital infection. Agenesis of the corpus callosum, chorioretinal lacunae, and seizures are all symptoms of Aicardi syndrome. They frequently exhibit the subacute onset of a severe encephalopathy that is characterised by intense irritability, sporadic sterile pyrexias, loss of abilities, and slowed head growth. In 40% of cases, skin lesions like chilblains can appear on the fingers, toes, and ears. This disease can be diagnosed with Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans with the appearance of calcification of the basal ganglia. The associated behavioral challenges with syndromic patients demand pharmacological management of oral rehabilitation. The literature is scarce regarding the oral manifestations of this syndrome. Hence, authors present the successful full-mouth rehabilitation of severe Early Childhood Caries (ECC) in a 3-year-old child with AGS under General Anaesthesia (GA). ]]> Neurocutaneous Melanosis: A Diagnostic Challenge Uma Kumar, Pooja Jain, Udita Singhal, Shalini Trivedi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Neurocutaneous Melanosis (NCM) is a rare congenital syndrome presenting as a large or multiple congenital melanocytic nevi and benign or malignant pigment cell tumours of the leptomeninges. The syndrome is defined as an error in the morphogenesis of the embryonal neuroectoderm. It is one of the rare phakomatoses seen in childhood and shows variable presentations. The authors hereby presents a case report of a 15-year-old male patient with NCM, who presented with recurrent episodes of seizures and difficulty in walking. On physical examination, the patient had multiple congenital cutaneous nevi on the trunk, back, and hands. Immunohistochemistry(IHC) with Haematoxylin & Eosin (H&E) staining confirmed the diagnosis of leptomeningeal diffuse melanocytosis was made. ]]> Unruptured Pseudoaneurysm of Cystic Artery: A Case Report Ajay Rajyaguru, Sachin Singh, Mitesh Savani, Jatin Bhatt Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Cystic Artery Pseudoaneurysm (CAP) is a rare, abnormal dilation of the artery supplying the gallbladder. The main causes could be acute cholecystitis and iatrogenic injury during cholecystectomy. Ruptured pseudoaneurysm of cystic artery generally presents with haemobilia, and upper gastrointestinal bleeding or intraperitoneal bleeding. Only a few cases of unruptured CAP are reported that are successfully treated with open or laparoscopic cholecystectomy. This case is one of the rare cases of unruptured CAP where a 78-year-old female patient who was a known case of hypothyroidism, presented with upper abdominal pain and vomiting, diagnosed with acute calculous cholecystitis with CAP. She was managed with laparoscopic cholecystectomy, converted to open cholecystectomy and discharged with uneventful postoperative period. Due to the high risk of rupture, the patient required urgent surgical intervention either by open or laparoscopic cholecystectomy by a skilled laparoscopic surgeon. The operating need for conversion to laparotomy should be considered neither a failure nor a complication but an attempt to avoid intra and postoperative complications. ]]> Ileal Neuroendocrine Tumour Causing Carcinoid Syndrome in Absence of Hepatic Metastasis Iti Jain, Ameet Kumar, Balram Goyal, Prerna Guleria Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Carcinoid syndrome consists of the classic symptom triad of flushing, diarrhoea, and valvular heart disease. It occurs in the majority of patients with liver metastases. This report presents a 68-year-old female who suffered from chronic diarrhoea with a history of multiple admissions for the same. On evaluation, a Computed Tomography (CT) scan showed a terminal ileal lesion and bulky ovaries. Suspecting Neuroendocrine Tumour (NET) with carcinoid syndrome, a Gallium 68 DOTANOC (DOTA-1-Nal3-octreotide) scan was done which revealed somatostatin receptor expression in enhancing soft tissue lesion in terminal ileum as well as in bilateral adnexa. This confirmed the diagnosis of NET of the ileum and bilateral ovarian metastases. The patient underwent laparoscopic curative resection of the primary tumour along with bilateral oophorectomy. The patient was diagnosed with ileal NET and presented with clinical symptoms of carcinoid syndrome, yet did not have evidence of hepatic metastasis, but instead had bilateral ovarian metastasis which itself is a rare entity. ]]> Bifurcated Arc of Buhler Co-existent with an Arc of Riolan-A Rare Case Report Harsha Pratap, Sarah Ramamurthy Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X The Arcs of Buhler and Riolan are collateral channels that connect the major midline ventral branches of the abdominal aorta, which supply the gastrointestinal tract. These arcs occur with a relative rarity of 1-10%. During routine dissection of the abdominal cavity of a 50-year-old, embalmed male Indian cadaver in the Department of Anatomy of a National Institute in South India, the presence of a large vertical tortuous bifurcated artery was noticed, posterior to the body of the pancreas, connecting the coeliac trunk to the superior mesenteric artery. This was identified to be an Arc of Buhler (AOB) and measuring 8 mm in external diameter. In addition, an Arc of Riolan (AOR) was identified, connecting the left division of the Buhler&#8217;s arc to the left colic artery. The presence of a large bifurcated AOB or its co-existence with an AOR has not been described previously. The identification of such anastomotic channels in symptomatic patients may help in diagnosing impending bowel ischemia. Aneurysms of AOB, though rare, are life-threatening and have been treated successfully. The knowledge of mesenteric vascular anatomy is important during abdominal surgeries and endovascular procedures. Recognising a vascular variation is crucial to avoid inadvertent bleeding or bowel ischaemia. ]]> Rare Presentation of Pleural Empyema due to Non Typhoidal Salmonella-A Case Report S Shanmuga Priya, M Mohamadiya Rizwana, D Senthil, B Appalaraju, M Arun Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Non typhoidal <i>Salmonella</i> usually causes bacteraemia, enterocolitis, and endovascular infection, but pleuro-pulmonary illness is uncommon, mainly observed in patients with a background of malignancy, underlying pulmonary diseases. Localisation of the infection has been witnessed at various sites following a bacteraemia but case reports on pulmonary focus are minimal. Here, we report a case of a 36 year old male patient who presented to Emergency Department with an underlying non Hodgkin&#8217;s Lymphoma along with a left sided pleural effusion. Pleural fluid tapping was done and the sample was sent for microbiological analysis. The pleural fluid culture along with serotyping confirmed the organism as <i>Salmonella enterica</i> serovar Typhimurium. The patient was discharged after parenteral Ceftriaxone therapy and symptom resolution. This case adds to the growing body of evidence of rare presentation of non typhoidal <i>Salmonella</i> as a probable etiological agent of infection in exudative pleural effusions. ]]> Pirfenidone Induced Dress Syndrome Post COVID-19 Infection-An Unusual Case Report Shilpi Shukla, Krushan Nirmit Yajnik, Devangi Soaham Desai, Rita Vora Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Drug Reaction, Eosinophilia and Systemic Symptoms (DRESS) is an idiosyncratic drug reaction characterised by extensive skin rash, fever, lymphadenopathy and internal organ involvement. Since eosinophilia may or may not always be present, the condition is now more preferably called Drug-Induced Hypersensitivity Syndrome (DIHS). The authors here report a case of DRESS syndrome, secondary to Pirfenidone, an anti-fibrotic given to the patient for post COVID-19 fibrosis. The 51 years old male patient, presented with multiple pus-filled erythematous lesions, 3 months after the initiation of Pirfenidone. Laboratory results showed deranged liver and renal functioning, along with reactive Dengue Nonstructural protein 1(NS 1) antigen. He showed significant improvement in the dermatological lesions and multisystem laboratory involvement with tapering doses of steroids. ]]> Periodontal Management of Leukocyte Adhesion Deficiency Type-I with Photodynamic Therapy-A Case Report Divyasree Nadakuditi, Gopinath Cheni, Sowmya Lahari Sekuri, Kishore Kumar Katuri Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Leukocyte Adhesion Deficiency type I (LAD-I) is a rare autosomal recessive disorder affecting the immune system which is characterised by defects in white blood cell integrin receptors leading to impaired adhesion and chemotaxis with increased susceptibility to recurrent infections, delayed wound healing, and periodontitis. A case of aggressive form of generalised periodontitis in a 19-year-old girl with LAD-I is presented in this case report. The medical diagnosis was made on the basis of characteristic clinical and laboratory findings suggestive of LAD, particularly the total absence of Cluster of Differentiation (CD)18, CD11a, CD11b, and CD11c which were determined by flow cytometry. After non surgical periodontal therapy, photodynamic therapy with Low Level Laser Therapy (LLT) was performed. After 3 months, reduced inflammatory signs and improved periodontal health was observed. This report highlights the importance of the differential diagnosis of severe immunodeficiency disorders. It also emphasises the joint role of medical and dental specialists to control oral infections and thereby preventing tooth loss. ]]> Abdominal Ectopic Pregnancy: Challenging Obstetrical Paradox in Series of Three Cases Animesh Naskar, Abantika Ghosh, Bharat Chandra Mandi, Suchita Mandal, Pritilata Show Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Abdominal Ectopic Pregnancy (AEP), a rare life-threatening obstetrical complication, is defined as ectopic implantation within the peritoneal cavity outside the uterus, tubes, ovaries, or intra-ligamentous locations. A series of three rare cases of early AEP is presented: (First case: a 32-year-old, gravida 2, para 1; Second case: a 31-year-old, gravida 3, para 2; and Third case: a 39-year-old gravida 4, para 2). All the cases were of early (<20 weeks) primary AEP and they all presented with acute abdomen, unstable vitals, and haemoperitoneum. The first case had omental implantation with a gestational sac of (3&#215;3) cm and was diagnosed by strong clinical suspicion with intraoperative confirmation for the same, whereas the second and third cases had implantation on Pouch of Douglas (POD) and sigmoid colon respectively; and was diagnosed by sonography with intraoperative confirmation during laparotomy. All three cases were successfully managed by a multidisciplinary team approach, blood transfusions, and emergency laparotomy with complete removal of the placenta. They had a good postoperative recovery. The reports of histopathology of tissues retrieved peroperatively from the implantation sites showed chorionic villi which confirmed the product of conceptions. Presentation of this case series provides an opportunity to illustrate a rare variant of ectopic pregnancy with a challenging obstetric dilemma and to discuss the importance of strong clinical suspicion for such a grave maternal condition, on the part of the attending obstetrician, to make an early diagnosis and prompt treatment, so that maternal morbidity and mortality can be avoided. ]]> Vascular Malformations in Paediatric Age Group: Learning through Mistakes Sushanta Bhanja, Sunetra Roy, Dafodil Ghatak, Ananya Mondal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Vascular malformations were known in all paediatric age groups including neonates to adolescence. These were known since very long time. Many such cases were missed earlier due to lack of diagnostic imaging techniques. Proper diagnosis of such lesions is very challenging. So, proper identification and early treatment is of utmost importance. Any misdiagnosis can lead to inappropriate management and outcome. With recent advances in imaging techniques and better interventional facilities, the rate of diagnosis has improved but still the rate of misdiagnosis remains high. Though the newer treatment modalities are available, but their availability is restricted to tertiary care multifacility hospitals. Therefore, even after proper diagnosis, the management remains inadequate. This series is about three different patients of vascular malformations, belonging to different paediatric age groups. The clinical presentations, diagnosis and management were varied but diagnosis was possible due to high level of clinical suspicion and modern imaging techniques. The first patient initially seemed to have a post-traumatic swelling or juvenile idiopathic arthritis, but was later diagnosed as peripheral vascular malformation. The second patient was suspected to have haemangioma, but final diagnosis based on radiographical findings revealed low flow vascular malformation of face. The third patient was diagnosed with vascular malformation of head, but was clinically thought to be a sebaceous cyst. ]]> Effects of Perinatally Acquired Cytomegalovirus Infection on Growth Hormone Axis Sayan Chatterjee, Shreya Ray Chaudhuri, Subhasish Bhattacharya Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Cytomegalovirus (CMV) is one of the most common causes of perinatally acquired infection worldwide. It affects almost every organ system with varied type of clinical manifestation. In this case series, effect of perinatally acquired cytomegalovirus infection was studied on relatively unexplored area i.e, on growth hormone axis. Effect of standard antiviral treatment was also studied in these children. Five children were diagnosed to have perinatally acquired cytomegalovirus infection and it was found that all of these children were suffering from growth hormone deficiency (as evidenced by low insulin-like growth factor 1 and insulin-like growth factor binding protein 3 level as well). Some of the children were also found to have other endocrine manifestations like hypothyroidism and hypoglycaemia. They were treated with intravenous Ganciclovir followed by oral Valganciclovir and most of them responded well. ]]> Subconjunctival Fat Prolapse Sundara Raja Perumal, Senthil Kumar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Subconjunctival fat prolapse is an extremely rare condition. Confirmation of the fatty nature of this lesion and demonstration of the focal tenon capsule defect makes Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of orbit the investigations of choice. This manuscript report a 69-year-old female, who presented with complaints of swelling in lateral aspect of both orbit, since two years. On clinical examination, there was yellowish coloured swelling in the superolateral quadrant of bilateral orbit. CT scan show herniation of intraconal fat content through the defect at the tenon capsule, intermuscular septum and thus, confirmed the nature of lesion and the diagnosis. The patient was not willing for surgical correction and preferred regular follow-ups. ]]> Weber-Ferguson Approach with Surgical Obturator for Mucormycosis of Maxilla: A Classic Case Arun Kumar, Senthil Kumar, Davidson Rajiah, Kamal Akannan, Kirush Nambigai Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X ]]> Granular Corneal Dystrophy Type 2 in a Middle-aged Male Rasika Bagewadi, Sachin Daigawane Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X ]]> Brucellosis Infection- A Leukaemia Mimic Santosh Govind Rathod, Sauliha Yaseen Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X ]]> Carotid Intima Media Thickness as a Marker of Atherosclerotic Burden in Patients with Systemic Lupus Erythematosus: A Cross-sectional Study from a Tertiary Care Centre of Eastern India Rishav Mukherjee, Soumya Sarathi Mondal, Rishav Sanghai, Subhendu Bikash Naiya, Lamsaka Lyngdoh, Raja Bhattacharya Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Systemic Lupus Erythematosus (SLE) patients have an increased burden of atherosclerosis leading to adverse Cardiovascular (CV) events. Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid artery ultrasound is recommended to assess and follow progression of subclinical atherosclerosis and correlate with traditional/non traditional CV risk factors in SLE. <b>Aim:</b> To study the correlation between Carotid Intima Media Thickness (CIMT), traditional/non traditional CV risk factors in SLE. <b>Materials and Methods:</b> The hospital-based, descriptive, cross-sectional study was conducted in the Department of Internal Medicine, Medical College Kolkata, Kolkata, West Bengal, India, from April 2019 to August 2020. Patients with SLE, diagnosed by Systemic Lupus International Collaborating Clinics (SLICC) 2012 criteria, aged >12 years, irrespective of therapy status, were recruited by consecutive sampling. Subjects were classified as Lupus Nephritis (LN) and Lupus without Nephritis (LWN). Demographic data, parameters to define SLE (SLICC 2012 criteria), blood parameters like lipid profile, fasting plasma glucose, anti-Double stranded Deoxyribose Nucleic Acid antibody (anti-dsDNA Ab), C3/C4 levels, 24 hour urine protein values, haemoglobin, C-reactive Protein (CRP), serum homocysteine and Carotid Intima Media thickness as measured by Ultrasonography (USG) doppler study, duration of disease and medication history were considered as study variables. Statistical analysis was done by using Z-test, t-test, Analysis of variance (ANOVA), Chi-square test (for categorical data) and other non parametric statistical tests and correlation tests wherever applicable. A p-value <0.05 was considered to be statistically significant. <b>Results:</b> Fifty five SLE patients were studied. Subgroup analysis was performed between LN (n=36) and LWN (n=19). The mean age of the study subjects was 33 years with mean disease duration of 4.6 years. LN patients had longer disease duration, younger age of disease onset and longer duration of steroid usage. The mean systolic Blood Pressure (BP) was significantly higher in LN subgroup. Framingham Risk Scores (FRS) was positively correlated with duration of SLE disease and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) scores and duration of steroid therapy. The mean CIMT of the study population is 0.91 mm with 10.9% plaque prevalence whereas, mean CIMT of the LN subgroup and LWN subgroup was 1.02&#177;0.27 mm and 0.86&#177;0.3 mm, respectively; however no statistically significant difference in CIMT was observed between two subgroups. CIMT positively correlated with anti-dsDNA Ab levels, FRSs, anaemia, SLE Disease activity scores, 24 hour urine protein, duration of steroid usage, serum creatinine and CRP. No correlation between CIMT and age of subjects, Fasting Plasma Glucose (FPG), Triglycerides (TG) serum homocysteine was observed. <b>Conclusion:</b> Systemic lupus erythematous patients have a high atherosclerosis burden and are at increased risk of adverse CV events. LN patients, early age of lupus onset, longer disease duration with prolonged steroid therapy, significant proteinuria, higher anti-dsDNA Ab levels and hypocomplementemia were observed to have higher mean CIMT and plaque formation. ]]> Morphological Characteristics, Immunophenotyping and Cytogenetics in Acute Myeloid Leukaemia Patients at a Tertiary Care Centre, Gujarat, India Rahul Ranka, Beena Brahmbhatt Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Acute Myeloid Leukaemia (AML) is a group of disorders characterized by a spectrum of clinical, morphological, immunophenotypic and associated chromosomal abnormalities. The identification of cytogenetic abnormalities at diagnosis is important for the evaluation of the response to therapy and the identification of an early re-emergence of disease. <b>Aim:</b> To examine the morphological characteristics of AML and emphasize the role of immunophenotyping and cytogenetics in subtyping AML. <b>Materials and Methods:</b> The cross-sectional study was a prospective study that took place from June 2018 to November 2021 at a tertiary-care cancer center, Department of Oncopathology in Gujarat, India. Following the inclusion and exclusion criteria, a total of 232 patients were diagnosed, with 21 being eliminated owing to the unavailability of samples for cytogenetic testing. Diagnosis of AML was based on morphology of Bone Marrow (BM) aspirates and flow cytometric immunophenotyping. Chromosomal analysis was performed on BM and peripheral blood by using standard cytogenetic technique. <b>Results:</b> There were 115 (54.50%) males and 96 (45.49%)females with age group between 1-72 years. The most common subtype was diagnosed as AML M1. Flow cytometry was done on 178 (84.36%) bone marrow and 33 (15.63%) peripheral blood samples. The CD33, CD13, MPO and CD117 were expressed in the vast majority of AML patient, aberrant expression of CD7and CD19 was seen. Total case 121 (57.34%) had normal karyotypes (the majority of cases), 86 (40.75%) cases had anomalous karyotypes consistent with t (8;21), t (15;17), and Inv16, and 4 (1.89%) cases were non informative. <b>Conclusion:</b> The study concluded that flow cytometry and cytogenetics should be performed routinely in all cases of AML. A multimodal diagnostic approach combining cytomorphology, multiparametric flow cytometry accompanied by cytogenetic is needed to arrive at definitive diagnosis of AML. ]]> Prevalence, Clinical Correlates and Explanatory Models of Substance Use among Patients with Schizophrenia: A Cross-sectional Study from a Tertiary Care Hospital, Southern India Naveen Kolloju, Rajesh Gopalakrishnan, Anju Kuruvilla Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Prevalence rates of Substance Use Disorders (SUDs) in patients with schizophrenia are reported to be about twice of that of the general population. Co-morbid SUDs in these patients can affect the natural course of the illness, quality of life and treatment compliance. Increased rates of hospital admissions, longer duration of inpatient stay, more severe psychopathology, increased rates of criminal activity and violent behaviour have also been reported in this group of patients. Data from the region on substance use in patients with schizophrenia is sparse. <b>Aim:</b> To study the prevalence of SUD&#8217;s in patients with schizophrenia and the risk factors associated with SUD&#8217;s and patient Explanatory Models (EM) regarding the same. <b>Materials and Methods:</b> The present cross-sectional study was conducted in the Psychiatry Outpatient Clinic at Christian Medical College, Vellore, Tamil Nadu, India, from November 2016 to May 2017 in 103 consecutive patients with schizophrenia. Symptom severity was assessed using the Positive and Negative Symptom Scale (PANSS), substance use patterns with the Drug Abuse Screening Test (DAST), Alcohol Use Disorders Identification Test (AUDIT) and Fagerstrom&#8217;s Test for Nicotine Dependence (FTND) and patient EMs for substance use with a semistructured questionnaire. Socio-demographic and clinical details were also recorded. Data was analysed using Statistical Package for Social Sciences (SPSS) software version 16.0.1. Chi-square test and the student&#8217;s t-test were used to assess the significance of association for categorical and continuous variables respectively. The Pearson&#8217;s correlation coefficient was employed to assess the statistical significance of the association between two continuous variables. A p-value <0.05 was considered as statistically significant. <b>Results:</b> The mean age of the participants was 37.54 years. The majority of the participants were males (n=60, 58.3%), 62 (60.2%) were married, 97 (94.2%) were literates and 54 (52.4%) participants were employed. The prevalence of substance use was seen in 30 (29.1%) participants. Nicotine was the most common substance of abuse (n=21, 20.4%) followed by alcohol (n=19, 18.4%). Male gender, being employed and a family history of substance use were factors significantly associated with any substance use with p-values 0.001, 0.001 and 0.01, respectively. Patient&#8217;s explanations for the use of the nicotine included the feeling of relaxation it produced (n=13, 61.9%), and feeling more energetic and active (n=12, 57.1%). Making one more relaxed and social (n=14, 73.7%) was the most common patient explanation for alcohol use. <b>Conclusion:</b> Alcohol and nicotine were common substances of abuse among the participants in this study. It is useful to understand patient&#8217;s explanations for substance use in order to develop effective intervention programmes tailored to the individual patient&#8217;s beliefs. ]]> Association of Oral Squamous Cell Carcinoma and Human Papilloma Virus Status in Chronic Periodontitis Patients: A Cross-sectional Study Shikha Sharma, Shobha Prakash Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Apart from the alcohol and tobacco which are considered as an important cause for carcinogenesis, periodontal infections have also been considered equally important cause for it. Infections are increasingly considered as potential trigger for carcinogenesis apart from alcohol and tobacco. The role of the Human Papilloma Virus (HPV) in causing Oral Squamous Cell Carcinoma (OSCC), highlights the significance of the oral infections in the development of the OSCC. <b>Aim:</b> To detect the relationship between Chronic Periodontitis, HPV, and OSCC. <b>Materials and Methods:</b> This was a cross-sectional study conducted on 15 chronic generalised periodontitis patients with OSCC affecting alveoli and gingiva. DNA was extracted from the biopsy of the tissue sample for the detection of HPV by Polymerase chain reaction (PCR). The parameters assessed were the Clinical Attachment Loss (CAL), Tumor Node Metastsis (TNM ) staging of OSCC, HPV status and the presence of the periodontal marker bacteria. Chi-square test and spearman correlation were used to find association and correlation between the parameters. <b>Results:</b> A total of 15 cases of chronic generalised periodontitis patients with oral squamous cell carcinoma were included in the study (7 males and 8 female patients, with a mean age of 50.8 years). Of these, HPV was found in 4 patients only. On comparison between Chronic Generalised Periodontitis (CGP) and OSCC, a non-significant association and a negative correlation was found. Similar analysis was observed between CGP and HPV. When comparison was done between HPV and OSCC, non-significant association (p-value 0.774) and a negative correlation(r- value= -0. 169) was found. <b>Conclusion:</b> This study did not yield a significant association and correlation between these three parameters. Further prospective studies should be conducted which may help in the prevention of periodontitis and subsequently decreasing the incidences of OSCC. ]]> Comparison of Treatment Outcome in EGFR Positive and Negative Patients with Non Small Cell Lung Cancer: A Longitudinal Study Farzana Khanum, Nafees Ahmad Khan, Huma Firdaus, Rakesh Bhargava, Zuber Ahmad, Mohammad Shameem, Kafil Akhtar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Lung cancer is one of the most common malignancies to occur worldwide. Two main subtypes of lung cancer include small cell lung cancer and Non Small Cell Lung Cancer (NSCLC). Patients with advanced stage NSCLC who achieve good response with Tyrosine Kinase Inhibitors (TKI) have been found to have Epidermal Growth Factor Receptor (EGFR) mutation. The first biomarker identified for targeted treatment in lung cancer was EGFR and patients of NSCLC with EGFR mutation have superior survival outcome when treated with targeted therapy as compared to conventional chemotherapy. <b>Aim:</b> To compare the outcome of targeted therapy to mutation to EGFR and conventional therapy in non mutant lung cancer patient of NSCLC. <b>Materials and Methods:</b> The present longitudinal study was conducted in the Department of TB and Respiratory Diseases, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India from July 2017 to November 2019 on a sample size of 80. Patients diagnosed with NSCLC and EGFR mutation status were included in the study. They were started on TKI if tumour was EGFR positive and on conventional chemotherapy (cisplatin plus paclitaxel) if no mutation was detected on histopathology. Among the study group, 35 patients were EGFR positive and started on geftinib (group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). Outcomes were measured in terms of progression-free survival, Overall Survival (OS), and toxicities. Statistical analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 20.0. <b>Results:</b> Among the study group, 35 patients were EGFR positive and started on geftinib (Group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). The mean age of EGFR positive patients was 58.91 years and for EGFR negative patients was 60.11 years. In group I, there was no complete response while 28.5% had partial response, 45.5% had stable disease and 25.7% had progressive disease. In group II, 15.5% patients had complete response, 33.3% had partial response,17.7% had stable disease and 33.3% had progressive disease. Mean progression-free survival in group I (5.65 months) was significantly higher than group II (4.26 months). The mean OS in group I (7.85 months) was slightly higher than group II (6.72 months). Both haematological and non haemaotlogical toxicities were significantly higher in group II. <b>Conclusion:</b> Patients with EGFR positive expression subjected to Gefitinib had significant mean progression-free survival with an acceptable range of non haematological toxicities and no haematological toxicities, as compared to the EGFR negative patients on conventional chemotherapy. ]]> Intubating Conditions and Efficacy of Rocuronium versus Atracurium in Paediatric Patients undergoing Elective Surgeries under General Anaesthesia: A Randomised Clinical Trial Shilpa Bansal, Mridul M Pandit Rao, Minnu Mridul Pandit Rao Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Atracurium and rocuronium are non depolarising Neuromuscular Blockers (NMBs) with an intermediate duration of action and are used safely in the short and intermediate duration of surgical procedures in paediatric population. <b>Aim:</b> To compare the efficacy and safety of NMBs (rocuronium versus atracurium) at a dose 2 x (ED95) for elective surgeries under general anaesthesia in paediatric patients. <b>Materials and Methods:</b> The present randomised, double-blinded, clinical trial study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Science and Research (AIMSR), Bathinda, Punjab, India, from October 2021 to April 2022. Seventy American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes of 1-12 years age, undergoing elective surgeries under general anaesthesia were included in the study. These patients were randomly divided into two groups: patients receiving rocuronium (0.6 mg/kg) (group R, n=35) and patients receiving atracurium (0.5 mg/kg) (group A, n=35) for endotracheal intubation. Assessments were done for timing of intubation, intubation score, interpretation of relaxogram, haemodynamics, adverse events, extubation (normal or delayed) and recovery time. All the data was entered in Microsoft Excel sheet and results were expressed as percentages and mean&#177;Standard Deviation (SD), chi-square test and unpaired t-test. <b>Results:</b> Time of intubation was faster with rocuronium than atracurium (66&#177;20.32 vs 100.29&#177;21.76 seconds). Intubation score was significantly lower in group A (2.14&#177;0.36) than group R (3.74&#177;0.44). Heart Rate (HR) increased significantly after intubation with atracurium. Adverse effects like bronchospasm, hypotension, skin reaction and wheeze were found in patients receiving atracurium but not in rocuronium group. Faster onset and recovery with short clinical duration was found with rocuronium on relaxogram. Delayed extubation was found in 45.7% patients in atracurium group and 5.7% patients in rocuronium group. <b>Conclusion:</b> Rocuronium gives excellent intubating conditions with faster induction time, shorter clinical duration, high recovery index, minimal side-effects and good haemodynamic stability than atracurium in paediatric patients. ]]> Evaluation of Hearing Impairment and Levels of Trace Elements in Patients with Oral Submucous Fibrosis Surekha Rathod, Vivek Harkare, Abhay Kolte Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Oral Submucous Fibrosis (OSMF) is a slowly progressive premalignant condition. Trace elements like Copper (Cu) and Zinc (Zn) were found to have diagnostic and prognostic values in malignancies. Disease activity at in an earlier stage by determining the exact stage of OSMF based on eustachian tube dysfunction and serum Cu, Zn, and Iron (Fe) levels. <b>Aim:</b> To assess the Eustachian tube dysfunction and level of trace elements in OSMF patients. <b>Materials and Methods:</b> This case-control study was carried out in VSPM Dental College and Research Centre Nagpur and Department of Ear, Nose and Throat (ENT) and Biochemistry of NKP Salve Medical College, Nagpur, Maharashtra, India, from March 2018 to February 2019. Two hundred patients were equally divided into individuals without OSMF and with OSMF. A Pure Tone Audiometry (PTA) was used to measure degree of hearing impairment while estimation of trace elements Cu, Zn and Fe was done by atomic absorption spectrophotometry. The unpaired t-test, Chi-square test and one-way Analysis of Variance (ANOVA) test were used for statistical analysis. <b>Results:</b> All 200 individuals were matched with age and sex in both the groups. Normal hearing was found in 61% of the ears and Conductive Hearing Loss (CHL) in 39% of the ears with OSMF. A positive association of hearing loss in both the ears with stages of OSMF were seen which was statistically significant with p-value of 0.001. The level of Cu (103.44 mg/dL) was found increased in OSMF individuals while the levels of Zn (78.93 mg/dL) and Fe (84.05 mg/dL) was reduced. <b>Conclusion:</b> Within the limitations of the study, there was association between the severity of OSMF, degree of hearing loss and levels of trace elements. One of the most serious side-effects of OSMF is hearing loss. Level of copper increased while level of zinc and iron were reduced in OSMF patients. ]]> Seroprevalence of SARS-CoV-2 Among Children Visiting a Tertiary Hospital in Himachal Pradesh, India Pancham Kumar, Mohit Bajaj, Ambika Sood, Anjula, Rakesh Sharma, Raju Katoch, Ankit Chaudhary Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Research on Coronavirus Disease-2019 (COVID-19) seroprevalence in children and adolescent population across the globe is quite limited. In India, there is a dearth of data on COVID-19 seropositivity, especially in unvaccinated paediatric population, particularly in the Himalayan region. <b>Aim:</b> To estimate the seroprevalence of COVID-19 in children presenting in a tertiary care health institution. <b>Materials and Methods:</b> A hospital-based cross-sectional serosurvey was conducted on 500 children, from October 2021 to March 2022 in paediatric age group, attending Indira Gandhi Medical College Shimla, Himachal Pradesh, India, for various health related concerns such as fever, cough, loose stools, vomiting and fast breathing using convenience sampling. Socio-demographic profile was recorded and blood sample was drawn for COVID-19 antibody titre estimation. Chi-squared and Fisher&#8217;s-exact tests for proportions was used for testing statistical significance. <b>Results:</b> A total of 500 children, age ranged from 12 hours to 17 years 7 months were enrolled with maximum children belonging to 01-05 years age group and there was slight male preponderance. Seropositivity in males (27.3%) was significantly higher than females (8.3%). Highest (42.3%) seropositivity was seen in age group of 06 months to 01 year. About 10.8% of cases were positive for Immunoglobulin (Ig)G antibody, 4.4% were positive for IgM antibody, while about 6.6% cases were positive for both antibodies. <b>Conclusion:</b> The seroprevalence status of children and adolescents is quite low in this region, revealing the high susceptibility of children to SARS-CoV-2 in the study region. It further emphasises benefits of serological testing in children for SARS-CoV-2 as well as the need of safe and effective vaccination for the unimmunised, unprotected and vulnerable paediatric age group. ]]> Gender Difference in Hand-eye Coordination in Young Adults-A Cross-sectional Study B Swathi, Saumya Srivastava, KM Krishnaprasad Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The ability of the visual system to coordinate the information acquired from the eyes to control, and guide the hands in completing a task is known as hand-eye coordination. The typical hand-eye coordination involves the synergistic function of numerous sensorimotor systems, including the visual system, vestibular system, and proprioception, as well as the head, eye, and arm control systems. <b>Aim:</b> To investigate which gender is superior and efficient in learning hand-eye coordination using the mirror drawing task. <b>Materials and Methods:</b> A cross-sectional study was conducted at a tertiary care hospital, Mangalore, Karnataka, India from April 2020 to April 2021 involving a total of 90 young adults divided into two groups of 45 males (group A) and 45 females (group B). A mirror drawing task was given to each student with four trials and two minutes rest in between the trials. Subjects were expected to trace a shape, most typically a polygon while only seeing the upturned reflection of their hand in a mirror and staying within the confines of a double boundary using a mirror drawing test. The number of errors, time taken to complete the task, and efficiency index of each student was calculated manually using the efficiency index formula and compared between the two groups. <b>Results:</b> Total 90 participants were included with a mean age of 21.2 and 21.8 years for group A and group B, respectively. Group A (males) showed a greater efficiency index (5.52&#177;2.29) when compared to group B (females) (4.61&#177;1.77) (p-value-0.039). The Spearman&#8217;s ratio of mean error and mean time was 0.575 in males and 0.483 in females. <b>Conclusion:</b> The males outperformed in efficiency index when compared to females in hand-eye coordination with repeated practice. The study concluded that males were having greater efficiency index and less number of errors and less time taken compared to females. ]]> Association of Preoperative Audiological and Radiological Ossicular Findings with Peroperative Findings in Patients with Chronic Otitis Media- A Prospective Clinical Study Sagar Jani, Pushkar Khare, Sanjay Kumar, Bhavya Khatri Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Chronic Otitis Media (COM) refers to a chronic infection of mucosa lining the middle ear cleft and is the leading cause of conductive hearing loss in adults. The erosion or disruption of ossicular chain is determined while during the surgery. Complete disruption of ossicular chain can lead up to 60 dB hearing loss. Preoperative High-Resolution Computed Tomography (HRCT) scan of temporal bone can give a clue of ossicular integrity. <b>Aim:</b> To determine the association of preoperative audiological and radiological findings with the peroperative findings in cases of chronic otitis media. <b>Material and Methods:</b> This prospective clinical study was conducted in the Department of Otorhinolaryngology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh, India, from October 2019 to August 2021. Seventy five patients of unilateral uncomplicated chronic otitis media (mucosal or squamosal), with conductive hearing loss, aged between 10 to 50 years were included in the study. Audiological assessment was done in form of pure tone audiometry using Alps 2100 instrument to measure hearing loss in decibels (dB). Radiological assessment was done using bilateral X-ray mastoid Schuller&#8217;s view, and HRCT temporal bone. Association of audiological and radiological findings was determined with intraoperative findings using Statistical Package for Social Sciences (SPSS) version 24.0. <b>Results:</b> The mean age of the study population was found to be 26.34&#177;9.14 years. Females 42 (56%) were found to be affected more than males 33 (44%). Significant association was found between severity of hearing loss and necrosed ossicles seen peroperatively as p-value <0.05 in mucosal type of CSOM. Chances of peroperative ossicular necrosis (mucosal) were more in sclerosed (76.47%) and diploic (84.61%) mastoid as compared to pneumatized mastoid (7.69%) with statistically significant difference as p-value<0.01. Maximum accuracy of reporting for HRCT was found for the involvement of part of Incus. <b>Conclusion:</b> There was a significant association of audiological findings and number of ossicles necrosed peroperatively. hence, it can be concluded that greater the degree of hearing loss, more the chances of ossicular necrosis peroperatively. ]]> Effects of Low Dose Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-guided Interscalene Brachial Plexus Block: A Randomised Clinical Trial Simpika Thakur, Sarvjeet Kaur, Amanjot Singh, Jaspreet Kaur Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Ultrasound-guided Interscalene Brachial (USG-ISB) plexus block is known to provide effective analgesia for upper limbs surgery. Low-dose dexamethasone as additive with levobupivacaine in USG-ISB plexus block is known to provide effective analgesia for upper limbs surgery. <b>Aim:</b> To evaluate whether dexamethasone, use as an additive with levobupivacaine during an USG-ISB plexus block for upper limb surgery, has sufficient analgesic effect. <b>Materials and Methods:</b> The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from March 2018 to August 2019. Sixty patients who were scheduled to have upper limb surgery using USG-ISB with 0.5% levobupivacaine were randomly assigned to one of two groups. Group A (n=30) received one ml of normal saline, while group B (n=30) received 4 mg of dexamethasone. A four-point Verbal Numerical Rating Scale (VNRS) for pain was used to evaluate postoperative analgesia. The duration of analgesia, time to onset and duration of sensory and motor blockade, and pain ratings were measured. Unpaired student&#39;s t-test, Chi-square and Fisher&#8217;s-exact tests were used to analyse the data. <b>Results:</b> The mean duration of analgesia was significantly longer for group B than for group A (854.67&#177;10.08 min vs 743.00&#177;23.22 min; p-value<0.001). The onset of sensory and motor blocks in group B began to develop earlier (8.42&#177;0.35 min, and 9.72&#177;0.55 min) than those in group A (10.10&#177;0.80 min, and 11.02&#177;0.84 min; p-value<0.001). The duration of the sensory and motor block in group B was longer (653&#177;16.17 min and 582.83&#177;14.18 min) than that in group A (595&#177;17.29 min and 487.33&#177;21.04 min; p-value<0.001). <b>Conclusion:</b> Perineural dexamethasone with levobupivacaine provides greater postoperative analgesia, also speed up the onset of sensory and motor effects, and prolongs the duration of interscalene brachial plexus block. ]]> Comparative Study of Magnesium Sulphate versus Dexmedetomidine as an Adjuvant to Epidural Bupivacaine- A Randomised Controlled Trial PK Mohammed Shafi, Moona Abdul Kadiru, Neera Valsan, Biju Abraham, Ravi Kumar, Jijo Sebastian Aloysius Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Neuraxial adjuvants are used to improve or extend analgesia. They have been utilised in several trials to prolong postoperative analgesia along with spinal anaesthesia, but as epidural anaesthesia is more haemodynamically stable, adding adjuvants to the above will have substantially less detrimental effects. Dexmedetomidine and magnesium sulphate may be used as adjuvants in neuraxial anaesthesia along with local anaesthetics. <b>Aim:</b> To determine the impact of adding magnesium and dexmedetomidine in the lower limb and lower abdominal procedures as an adjuvant to epidural bupivacaine. <b>Materials and Methods:</b> This randomised, single blinded study was conducted on 90 ASA (American Society of Anaesthesiologists) class I and II patients in the Department of Anesthesiology Government Medical college, Kannur, Kerela from September 2015 to September 2016. Following randomisation using the lottery approach, the patients were divided into groups M, D, and C, and given the appropriate drugs through the epidural route. Group D: Bupivacaine 0.5% 10 mL+Dexmedetomidine 0.5 mcg/kg (in 1 mL 0.9% saline); group C: Bupivacaine 0.5% 10 mL+Saline 0.9% (1 mL); group M: Bupivacaine 0.5% 10 mL+MgSO<sub>4</sub> 50 mg (in 1 mL 0.9% saline). Monitoring was done for the onset, duration, haemodynamic parameters, level of motor and sensory block attained and any adverse outcomes. Data were collected, and statistical analysis was done by Statistical Package for Social Science (SPSS) version 17.0 and Analysis of Variance (ANOVA) with repeated measurements and the contingency coefficient test were both used. <b>Results:</b> Group D had greater postoperative analgesia (307.3&#177;77.3 minutes), while the duration for the onset of sensory (13.1&#177;1.3 minutes) and motor blockade was much shorter. Prolonged motor block and sedation, Ramsay sedation score>3 was observed in Group D. <b>Conclusion:</b> The addition of dexmedetomidine to epidural bupivacaine may be beneficial in the context of the prolonged duration of motor and sensory blockade and arousable sedation. ]]> Clinical Outcomes of Remdesivir in Moderate and Severe Cases of COVID-19: A Retrospective Cohort Study Ruth Priya Senthiappan, Archana A Dambal, K Mohan, Kiran R Aithal, Rajendra Kumar Parakh, Bhargav Vuppumalla Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Remdesivir is a nucleotide analogue prodrug that perturbs viral replication. Remdesivir has been used in various trials previously for the treatment of Coronavirus Disease 2019 (COVID-19). Some clinical trials found that remdesivir had a mortality benefit, while other studies did not. It was also seen that remdesivir shortened the duration of hospital stay among COVID-19 patients in some trials while in other trials remdesivir did not have any influence on the duration of hospital stay. <b>Aim:</b> To study the clinical outcomes of Remdesivir in moderate and severe cases of COVID-19. <b>Materials and Methods:</b> The present retrospective, cohort study was conducted in the Department of General Medicine, SDM Medical College and Hospital, Dharwad, Karnataka, India, from September 2021 to May 2022, in which 400 case records of patients admitted with moderate to severe COVID-19 were studied. Among these 314 patients received remdesivir and 86 patients did not receive remdesivir. Categorical variables, nominal variables were represented as proportions and frequencies and continuous variables were represented as mean&#177;SD. Statistical analysis was done using Chi-square test. <b>Results:</b> A total of 400 COVID-19 patients were included in the study, among which 314 received remdesivir and 86 did not receive remedisivir. Those who received remdesivir had a mortality rate of 13.69% as compared to 11.63% among those who did not receive remdesivir (p-value=0.6170). In the remdesivir group, 36.62% had a hospital stay of >11 days, while it was 30.23% among the non remedisivir group (p-value=0.3060). <b>Conclusion:</b> In this study, remdesivir did not reduce mortality nor did it reduce the duration of hospital stay among moderate to severe COVID-19 patients. ]]> Cardiac Troponin I Levels in Acute Exacerbation of COPD Patients: A Cross-sectional Study Anand Koppad, Geeta C Chintamani, G Krupahree, Sushma Shetty Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Chronic Obstructive Pulmonary Disease (COPD) is associated with right ventricular overloading and pulmonary hypertension. In COPD patients co-morbidities determine the outcome and quality of life. Cardiac Troponins (cTn) are suspected to be elevated in right ventricular failure. <b>Aim:</b> To find the incidence of cardiac Troponin-I levels and association of elevated cTnI levels with clinical outcome in acute exacerbation of COPD. <b>Materials and Methods:</b> The cross-sectional study comprised of 102 patients with acute exacerbation of COPD. These patients were admitted in medical wards and Intensive Care Unit (ICU) in the Department of General Medicine, Karnataka Institute of Medical Sciences Hospital, Hubli, Karnataka, India, from 2018-2020. Investigations included complete blood count, renal function tests, serum electrolytes, liver function tests, Electrocardiography (ECG), ECHO and chest X-ray. Association of cardiac troponin I and acute exacerbation of COPD was evaluated. The cTnI level &#8805;0.01ng/mL was considered positive. <b>Results:</b> The serum cTnI was found to be positive in 43 (42.2%) patients with acute exacerbation of COPD. The patients with cTnI levels &#8805;0.01 ng/mL had significantly higher need for Non Invasive Ventilation (NIV) 32 (74.4%), invasive ventilation support 5 (11.6%), prolonged duration of hospital stay 33 (76.7%), and higher mortality 15 (34.9%) rate as compared to patients having cTnI <0.01 ng/mL. <b>Conclusion:</b> The cTnI is elevated in a significant subset of patients with acute exacerbation of COPD. cTnI elevation was associated with higher need for NIV and invasive ventilator support. Levels of cTnI &#8805;0.01 ng/mL may be considered as a biomarker to predict morbidity and mortality in acute exacerbation of COPD patients. ]]> Correlation of Baseline Inferior Vena Cava Diameter and Collapsibility with Age and Sex in Normovolaemic Children: A Cross-sectional Study Metty Mathews, Mebin Mathew, Prameela Joji, Neetu Gupta Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Ultrasound measurement of Inferior Vena Cava (IVC) diameter and collapsibility is increasingly used for volume status assessment and fluid responsiveness in paediatric and adult population. There is a wide variation in the age specific IVC diameters in paediatric population, whereas age specific variation in IVC collapsibility in euvolaemic children is not much known. <b>Aim:</b> To analyse the correlation of baseline IVC diameter and collapsibility with age and sex in euvolaemic children. <b>Materials and Methods:</b> This cross-sectional study was conducted at Kerala Institute of Medical Sciences, a tertiary care hospital in south Kerala, India, over a study period from June 2014 to May 2016. A total of 80 children in the age group of one month to 15 years, who presented without evidence of volume depletion were enrolled. The IVC was assessed approximately 2 cm distal to IVC-hepatic vein junction, Motion mode (M-mode) measurement of maximum (expiratory) and minimum (inspiratory) width of IVC diameter was measured. Collapsibility Index was also calculated for each subject by measuring difference between the maximum and minimum IVC diameters divided by the maximum diameter. The statistical data was analysed using the statistical software Statistical Package for Social Sciences (SPSS) version 16. All the numerical data was expressed as mean&#177;Standard Deviation (SD). Quantitative analysis was performed using Analysis of Variance (ANOVA) and t-test. The correlation of IVC parameters were assessed using Karl Pearson correlation coefficient. The p-value less than 0.05 was considered as significant. <b>Results:</b> Eighty euvolaemic children between the age one month and 15 years were enrolled in the study. The mean age of study group was 5&#177;4 years. Males 41 (51.3%) and females 39 (48.8%) were almost equally distributed. A significant strong positive correlation was found between IVC expiratory and inspiratory diameter with age using Karl Pearson correlation, r= 0.912, p<0.001; r=0.876, p<0.001, respectively. No significant correlation was found between IVC collapsibility and age, Karl Pearson correlation, r=0.079, p=0.485. No correlation was found between sex and the IVC parameters. <b>Conclusion:</b> According to the present study results, IVC diameter showed a positive correlation with age but not with sex. The IVC collapsibility had no correlation with either age or sex. ]]> Blood Pressure Reference Values of Nigerian Full-term Neonates in the First Week of Life at a Nigerian Tertiary Hospital: A Cross-sectional Survey Adebimpe Ajibola Afolabi, John Akintunde Okeniyi, Joshua Aderinsola Owa, Francis Folorunso Fadero, Babatunde Adeola Afolabi, Olusola Adetunji Oyedeji Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Knowledge of normative Blood Pressures (BP) is critical for appropriate neonatal care. Hypertension and hypotension are abnormalities of BP which could be a sign, outcome or complications of diseases or intervention carried out on neonates. Yet, there is a dearth of data on BP concerning Nigerian full-term neonates. <b>Aim:</b> To determine BP values of apparently healthy term Nigerian neonates in relation to their weight in the first eight days of life and also to determine the BP values of apparently healthy term neonates in the first eight days and also to correlate the BP with postnatal age, weight and to generate percentile of age/sex specific BP. <b>Materials and Methods:</b> This cross-sectional study was done from September 2012-April 2013, including 386 consecutive apparently healthy term newborns delivered at the UNIOSUN Teaching Hospital (UTH), Osogbo, Southwest Nigeria. Their weights and right arm Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) BPs measured using oscillometric method on days 1, 3, 5 and 8. Student&#8217;s t-test and Pearson correlation coefficient was used to statistically analyse the data. <b>Results:</b> Out of 386 newborns studied, the mean birth weight were 3.10&#177;0.38 Kg; {3.24&#177;0.37 kg for boys and 2.97&#177;0.33 kg for girls}. The mean values of SBP on day 1 were 67.3&#177;5.6 mmHg; 71.0&#177;6.0 mmHg on day 3; 73.8&#177;5.2 mmHg on day 5 and 77.2&#177;2.9 mmHg on day 8, respectively. A similar trend was also noticed in the mean values of DBP with 36.9&#177;5.0 mmHg on day 1; 41.5&#177;5.2 mmHg on day 3; 43.7&#177;5.3 mmHg on day 5 and 46.4&#177;4.7 mmHg on day 8, respectively, the rise being significant (p-value <0.001). There were a positive correlations between the weight and DBP on the 5th day (r=0.128; p-value =0.012), between weight and SBP at 49-72 hours and on day 8 (r=0.105; r=0.168, respectively) as well as weight and MAP on day 8 (r=0.166). <b>Conclusion:</b> Neonatal BP in the first eight days following birth correlated positively to weight and age without significant gender differences. ]]> Evaluation of Diagnostic Accuracy of Alvarado, Appendicitis Inflammatory Response and Adult Appendicitis Scoring System in Diagnosing Acute Appendicitis: A Prospective Cohort Study Reena Meena, Ashok Kumar Sharma, Dheer Singh Kalwaniya, Aditya Tolat, Garima Tyagi, Vakulabharanam Naga Rohith, Pawan Kumar Gurivelli Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Appendicitis is one of the most common surgical emergencies, but its clinical diagnosis is still a big challenge for surgeons to decrease the negative appendectomy rate. <b>Aim:</b> To validate and compare alvarado, Appendicitis Inflammatory Response (AIR) score and adult appendicitis scoring system in diagnosing acute appendicitis. <b>Materials and Methods:</b> A prospective cohort study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, from December 2020 to May 2022 on 100 patients who were clinically suspected of acute appendicitis. All three scores {AIR, Adult Appendicitis Score (AAS), Alvarado} were calculated. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV). DeLong test were used to compare the area under the curve of three scores with each other for predicting acute appendicitis and the final result was compared with the histopathological report. The data was presented as numbersvand percentage and the p-value <0.05 was considered statistically significant. <b>Results:</b> The mean age of study subjects was 30.28&#177;10.9 years. It was found that the AIR score had more sensitivity (92.55%), followed by the AAS (84.04%) score and Alvarado (60.64%) score for diagnosing acute appendicitis but the specificity of the Alvarado score was highest (100%), followed by AAS (83.33%) and AIR (66.67%) score. AIR score had more NPV (36.40%) as compared to AAS (25%) and Alvarado score (14%). The diagnostic accuracy of AIR (91%) was higher than AAS and Alvarado&#8217;s score 84% and 63%, respectively. <b>Conclusion:</b> Appendicitis Inflammatory Response (AIR) score and AAS can be used over Alvarado score for better diagnosis of acute appendicitis in emergency patients and to reduce the rate of negative appendectomy. ]]> Clinical Profile, Complications and Outcomes of Measles among Children: An Observational Study from a Tertiary Care Hospital, South Gujarat, India Kirti Premabhai Mehta, Ashruti Mahesh Patel, Ankur Patel Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Measles is re-emerging as an infectious disease in children and hence the prevalence has been increasing worldwide. According to the World Health Organisation (WHO), in the year 2018, more than 140,000 deaths occurred globally due to measles and its complications; most common in children <5 years of age. <b>Aim:</b> To evaluate the clinical profile of measles and its complications leading to death in children for better immunisation coverage and prevention of the disease. <b>Materials and Methods:</b> This was a prospective, observational study carried out in the Department of Paediatrics, New Civil Hospital (tertiary care hospital), Surat, Gujarat, India. Patient data was collected from January 2021 to December 2021 and data was analysed from January 2022 to June 2022. Study was done on all children with history of fever with rash and laboratory confirmed positive patients for measles Immunoglobulin M (IgM) antibody titer. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 27.0. <b>Results:</b> During the study period only, 42 children with fever and rash had laboratory confirmed measles IgM positive antibody titre. Out of total, 42.86% of the study participants belonged to 1-4 years age group and 50% were unvaccinated. Males were more affected than female. Majority (81%) of cases occurred during late winter and spring seasons and most (78.57%) of the patients belonged to urban slum areas. Most common presenting complaint observed was maculopapular rash in all the children. Majority (95.24%) of the children were in eruptive stage of the disease. A total of 31 patients out of 42 developed complications with pneumonia as most common 38.71% children. All the patients recovered completely and were discharged from the hospital. <b>Conclusion:</b> There was decreasing trend of measles in young children. It can be due to recent immunisation campaigns and better coverage. Half of the patients in study were unvaccinated which indicates, there&#8217;s still work left to be done to immunisation scheme for better coverage. ]]> Stress, Coping, Self-efficacy and Birth Satisfaction among Low-risk Pregnant Women: A Cross-sectional Study KK Ajini, N Rajeev Kumar, JS Ajith Prasad Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Pregnant women worry about their physical changes, child delivery and impending parenthood. Wide range of psychological, biological and social factors influence emotional wellbeing during pregnancy which can be described by the extent of birth anxiety, self-efficacy and psychosocial adaptations. The factors like coping and self-efficacy help to overcome the stress and provide better birth satisfaction resulting in good mother and infant bonding. <b>Aim:</b> To know stress levels among low-risk pregnant women and to assess the influence of coping and self-efficacy of these women on birth satisfaction after delivery. <b>Materials and Methods:</b> A prospective, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India, from January 2019 to June 2019. Total 188 pregnant women who reached term and without any known risk factors in the current pregnancy were enrolled. Data was collected using proforma and questionnaires by conducting semi-structured interview to measure pregnancy specific stress, coping, self-efficacy and birth satisfaction. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. Multiple regression analysis was used for analysing the influence of stress, coping and self-efficacy on birth satisfaction. <b>Results:</b> Study showed that 14.36% of women had high levels of stress. Antenatal women residing at rural areas had high levels of stress than their urban counterparts (p-value=0.004). Employed women had high levels of self-efficacy (p-value=0.038). significant negative correlation was seen between the stress and self-efficacy (r-value=-0.479, p-value<0.00001) <b>Conclusion:</b> Stress do exist even among low-risk pregnant women. Abilities like coping and self-efficacy improves birth satisfaction in women. Birth satisfaction is an important factor in ensuring positive birth experience and respectful maternity care. ]]> Ambulatory Blood Pressure Monitoring in Normotensive Type 2 Diabetes Mellitus: An Observational Study Charan Neeradi, Bhavani Madduluri, R Venkateshwaran, Rathinam Palamalai Swaminathan Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Hypertension (HTN) is a major cause of cardiovascular morbidity and mortality, particularly in diabetic people. Because HTN and Type 2 Diabetes Mellitus (T2DM) frequently co-exist, HTN is a significant risk factor for chronic problems masked HTN affects around a one third of T2DM patients who have normal Blood Pressure (BP) readings in the clinic. T2DM patients frequently have normal office BP (BP) and no nocturnal BP falling. The non dipping BP pattern raises the risk of cardiovascular events and damage to target organs. Multiple BP recordings can be obtained with Ambulatory BP Monitoring (ABPM). By providing variability of BP, and diurnal variation in BP, it assists the treating physician in the diagnosis and management of HTN. <b>Aim:</b> To elucidate the prevalence of non dipping pattern in T2DM and the characteristics of diabetics who have non dipping pattern using ambulatory monitoring. <b>Materials and Methods:</b> This was an observational study carried out in the Department of Medicine at JIPMER, Pondicherry, India. Between January 2016 and December 2017, 110 patients with T2DM were visited to Medicine Outpatient Department and the Diabetic Clinic. Out of 110, a total of 62 patients, with an average age of 46.67 years, were included in the study. Sun Tech Oscar 2&#8217; 24 hourR ABPM system was used for the study of ambulatory BP of patients, at specified times. <b>Results:</b> Sixty-two normotensive T2DM patients, mean age of 46.67 years were analysed in the 24 months. A total of 62 patients, the non dipping pattern was seen in 47 (76%) of the 62 individuals evaluated for ABPM, while the dipping pattern was seen in 15 (24%) of the normotensive T2DM patients. A non dipping pattern was associated with a higher Body Mass Index (BMI) (p-value=0.03). A non dipping habit was also substantially associated with high PPBS values (p-value=0.02). <b>Conclusion:</b> Patients with a history of HTN and smoking had a higher chance of non dipping patterns, which may lead to end-organ damage and future cardiovascular events. ABPM can be used as a screening tool to predict cardiovascular events in T2DM. ]]> Efficacy of Buteyko Breathing Technique on Anxiety, Depression and Self Efficacy in Coronary Artery Bypass Graft Patients: A Randomised Clinical Trial Moli Jain, Vishnu Vardhan, Vaishnavi Yadav, Pallavi Harjpal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction: </b> Psychiatric issues, particularly depression and anxiety, have been observed in the proportions of patients undergoing cardiovascular surgery.Such findings provide a window of opportunity for integrating intervention, targeting psychological components into post-Coronary Artery Bypass Graft (CABG) patient management to provide effective care. The Buteyko Breathing Technique (BBT), which is named after its inventor Konstantin Pavlovich Buteyko, is one of the numerous breathing techniques that aims to regulate breathing. By alternating between periods of controlled breathing reduction and breath holding. <b>Aim:</b> To explore the effect of BBT as a psychological rehabilitation technique on anxiety, depression, and self-efficacy in post-CABG subjects having anxiety and depression. <b>Materials and Methods: </b>This randomised clinical trial was performed at Cardiovascular and Thoracic Surgery Unit, Acharya Vinobha Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from June 2021 to May 2022. Total 44 post CABG patients who all screened positive for anxiety and depression by General Anxiety Disorder-7 (GAD-7) questionnaire and Patient Health Questionnaire-9 (PHQ-9) were enrolled. They were randomly assigned using computed generated block randomisation. They were allocated using the Sequentially Numbered Opaque Sealed Envelope (SNOSE) method to group A Conventional group (n=22) and group B Experimental group (n=22). Both groups competed the in-hospital phase 1 cardiac rehabilitation as per American Association of Cardiovascular and Pulmonary Rehab (AACVPR) guidelines, whereas group B received additional BBT for psychosocial rehabilitation for 2 weeks post surgery. The evaluations were performed using the GAD-7 questionnaire, PHQ-9, General Self-Efficiency Scale (GSS), Breath Holding Test (BHT), and Borg Rate of Perceived Exertion Scale (RPE), at baseline on Post Operative Day (POD)1 and at their last rehabilitation session. Patients in both groups were given self management and education hand-outs at the time of discharge. Statistical Package for Social Sciences (SPSS) version 27.0 was used for statistical analysis. <b>Results:</b> The mean age of patients in A-group was 59.72&#177;7.84 years and in B-group 60.81&#177;7.42 years, respectively. The age, gender, height, weight, and BMI of the patients were similar between the groups. On intra group comparison ,there was statistically significant difference observed for GAD-7, PHQ-9, GSS, BHT, and RPE in group A and group B following the intervention, but the change was more pronounced in group B. The results for the inter group comparison showed a significant difference in group B on Anxiety, Depression, self-efficacy, BHT, and RPE as compared to the group A, i.e. group B showed a larger improvement in outcome measure scores than group A. <b>Conclusion:</b> The present study demonstrated that On intra group weeks of BBT along with phase 1 cardiac rehabilitation in post CABG patients brings favourable changes in levels of anxiety, depression and self-efficacy. ]]> AVMCH International Conference Abstracts B Vishnu Bhat Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Nasal cavity is divided by a vertical osseocartilaginous partition that is approximately median in position known as nasal septum. Deviation of the nasal septum can be defined as any midline deviation. Septal deviations may be cartilaginous type, bony type, or both cartilaginous and bony type. <b>Aim:</b> To look for normal bony structural variations in nasal septum on CT scan in patients attending tertiary care hospital. <b>Materials and Methods:</b> This cross-sectional observational study was conducted for a period of one year. Non-contrast CT scan Nose and Paranasal sinuses (NCCT Nose and PNS) was done using Siemens Somatom Emotion 16 slice Multidetector Spiral Computerized Tomography (CT) scan and data was acquired in axial plane. <b>Results:</b> In our study of 200 cases, 120 (60%) cases were males while females were 80 (40%) .169 (84.50%) cases were having DNS. 126 (63%) were having bony DNS, 3 (1.5%) were having cartilaginous DNS and 40 (20%) were having both bony and cartilaginous DNS out of 169 cases of DNS, 81 (47.93%) cases had DNS towards right side, 74 (43.79%) had DNS towards left, 12 (7.10%) cases had bilateral DNS while two cases had bony DNS on right side and cartilaginous DNS on left side. <b>Conclusion:</b> When significantly deformed, the nasal septum may cause dysfunction and cosmetic deformity, potentially having an impact on many functions of the nasal cavity. ]]> Diffusion Tensor MRI of Brain in Healthy Adult Population: Normative Fractional Anisotropy Values at 3 Tesla MRI Deepakkumar V Mehta, Dolly A Sharma Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Diffusion Tensor Imaging (DTI) technique and its clinical application are increasing in clinical routine practice, still very less normative data is available. Awareness regarding regional differences in Fractional Anisotropy (FA) measurements is very important when routinely DTI is used in clinical Magnetic Resonance Imaging (MRI). <b>Aim:</b> To determine the normative FA values data at 3 Tesla (3T) MRI and to determine the degradation of FA values in various regions of brain values with age. <b>Materials and Methods:</b> This cross-sectional study involved a total of 52 participants without any abnormal findings ( presence of tumour, stroke, infarct, degeneration, etc) and whose brain scanning was performed at 3T MRI, in the Department of Radiodiagnosis, Shree Krishna Hospital, and Pramukhswami Medical College, Karamsad, Anand, Gujarat, India. A DTI protocol was set for the healthy patient&#8217;s brain scanning. The colour-coded DTI brain images were postprocessed carefully to draw a circular Region of Interest (ROI) in the required areas of white matter and FA values were noted. Descriptive statistics were used to find out the normative data in 11 regions of the brain on right and left side. Pearson correlation was used to check the correlation of FA values with age. <b>Results:</b> There were 52 patients in the present study, with a male to female ratio of 1.7:1 and a mean age of 52 years. The highest FA values were observed in the splenium (0.809), genu (0.767), the body of the corpus callosum (0.627), and the posterior limb of the internal capsule (0.721), rest areas showed moderate to low FA values. Pearson correlation was used to find the variation in the FA values with age in three age groups 18-40, 41-60 and >60 years, where moderate changes in FA values with age were seen in a few regions of the brain such as genu (right side) with p-value=0.003 and foramen magnum at CVJ level (right side) with a p-value of 0.001. <b>Conclusion:</b> Generally, FA values intend to change with the presence of multiple tract areas, field strength, coil sensitivity, and partial volume averaging. FA values were also found to be affected with respect to increasing age. ]]> Awareness and Perception of New AYUSH Guidelines among Dentists of Chennai, Tamil Nadu, India: A Questionnaire Survey M Pavithra, Arvind Muthukrishnan Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) is an alternative medical system and has found acceptance globally for its use of rich medical plants, minerals, and other natural commodities in treating different illness. In November 2020, AYUSH changed its curriculum guidelines for its postgraduate students, which allowed them to perform a variety of general surgery, including orthopedic, ophthalmology, Ear Nose Throat (ENT), and dental treatments. <b>Aim:</b> To assess the awareness and perception among the dentists of these new AYUSH guidelines and to record their opinion. <b>Materials and Methods:</b> The cross-sectional study was conducted in Department of Oral Medicine and Radiology at Saveetha Dental College, Chennai, Tamil Nadu, India,from January 2021 to February 2021. A self-constructed questionnaire of 15 questions was circulated via google forms. The response was collected from 123 dentists. Statistical analysis was done on the IBM software 24 version. Chi-square test was used to assess the relationship between dentists&#8217; awareness of dental procedures included under the new AYUSH curriculum and their perception of ayurvedic practitioners performing the dental treatment efficiently. <b>Results:</b> Only 58.5% (n=79) of dentists were aware of the term AYUSH and 53 (43%) dentists were aware of the new guidelines added to the postgraduate curriculum in AYUSH. About, 57.7% of dentists reported that the Ayurvedic practitioners cannot handle the complications occurring during dental procedures. <b>Conclusion:</b> Dentists were not in favor of AYUSH practitioners performing dental treatments. The present study also concluded that dental procedures cannot be effectively and efficiently performed by AYUSH practitioners. ]]> Clinical Characteristics of Photodermatoses in Indian Patients and their Phototesting Findings: A Cross-sectional Study Aishwaria Suresh, TP Thankappan Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Phototesting helps to confirm photosensitivity, identify the action spectra, reproduce lesions by photo provocation for biopsy, calculate starting dose of desensitisation therapy, assess the severity of the photodermatoses, and monitor response to treatment. The effect of sunlight on darker skin has only been sparingly studied and hence, this study was undertaken in our population. <b>Aim:</b> To identify the spectrum of photodermatoses, with their clinical characteristics and phototesting findings. <b>Materials and Methods:</b> A cross-sectional study was conducted in Outpatient Department (OPD) of the Department of Dermatology, Pushpagiri Medical College, Tiruvalla, Kerala, India from January to December 2015. A total of 30 patients clinically diagnosed as photodermatoses were subjected to phototesting using the whole body phototherapy unit with Ultraviolet A (UVA) and UVB exposure. After 24 hours the UV-exposed areas were examined for the Minimal Erythema Dose (MED), and for the reoccurrence of skin lesions to determine the action spectra for the disorder, and the values were expressed in mean, frequency, and percentage. <b>Results:</b> Polymorphic Light Eruption (PLE) remains the most common photodermatosis (n=25) with a definite female preponderance (n=19). The mean MED-UVB for type IV skin with photodermatoses was found to be 766 mj/cm<sup>2</sup> and for type V skin was found to be 900 mj/cm<sup>2</sup>. MED-UVA was not observed in the majority of patients (n=24). Among the 25 patients with PLE, 16 patients had normal MED values to both UVA and UVB, four had reduced MED-UVB alone, one patient to UVA alone, and three patients had reduced MED to both. MED-UVB was not observed in one patient. MED-UVA was not observed in 21 patients (normal). Of the three patients with photoallergic dermatitis, one patient had reduced MED-UVB and MED-UVA. The other two patients had normal MEDs. The chronic actinic dermatitis patient had reduced MED to UVB and UVA and the actinic lichen planus patient had normal MEDs. <b>Conclusion:</b> Phototesting remains a very useful tool in the evaluation and management of photodermatoses and PLE was the most common photodermatoses in studied population. ]]> Efficacy of Three Different Photobiomodulation Therapies on Primary and Secondary Implant Stability in D3 and D4 Bone Type- A Research Protocol for Randomised Controlled Trial Ashika Singhania, Anjali Bhoyar Borle, Seema Sathe Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Introduction: Osseointegration is considered one of the most important deciding factors to check for implant stability, which decides successful outcome of the implant. Photobiomodulation has been used to improve the implant stability by enhancing osseointegration. Photobiomodulation (PBM) or Low-level Laser Therapy (LLLT) causes an enhanced effect in the bone implant contact. <b>Need for the Study:</b> There are no definitive therapies/protocol of LLLT in cases of bone density of D3 and D4. Also There are no studies in literature which compares the different laser settings so that a standardised setting can be established. Therefore, there is need to generate evidence whether reducing the number of appointments and reducing the amount of energy given in D3 and D4(compromised) bone can help achieve early loading in patients. <b>Aim:</b> To evaluate and compare the effect of three different photobiomodulation therapies on primary and secondary implant stability in D3 and D4 bone type in comparison to control group to achieve early loading. <b>Materials and Methods:</b> This randomized controlled, double blinded study allocated 108 patients having D3 or D4 bone according to Misch classification into six groups. Three different PBM therapy which is either Therapy A, B or C(placebo) will be used. The implant stability will be measured by Ostell meter in Implant Stability Quotients (ISQ) scale, immediately after surgery, after 3 weeks, after 12 weeks and after 6 months of surgery. The bone density will be measured before surgery and 3 months after surgery. <b>Expected Outcome:</b> At the end of the study, an evidence will be generated whether reducing the number of appointments and reducing the amount of energy given in D3 and D4(compromised) bone can help achieve early loading in patients. Patients treated using PBM therapy either protocol A or protocol B may show enhanced implant stability. ]]> Antiproliferative and Proapoptotic Effects of Vitamin D3 in Human Neuroblastoma Cell Lines SH-SY5Y: An In-vitro Study Kruti N Parikh, Kavitha Ramasamy, Kranthi Karunai Kadal, Punnagai Kumaravelu Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Neuroblastoma is the most common and earliest childhood tumour with complicated biological and clinical characteristics. The treatment includes chemotherapy, radiation therapy, surgical resection, stem cell therapy and many other modes, making the management difficult to tolerate and unacceptable. Thereby increasing the need to develop novel therapies or repurpose already existing ones with anticancer potential. Many studies have shown that vitamin D3 has anticancer properties. Vitamin D3 receptors have been found in neuroblastoma cell lines, according to research. Anticancer property of vitamin D3 hasn&#8217;t been studied much in neuroblastoma cell lines. <b>Aim:</b> To evaluate the antiproliferative and proapoptotic effects of vitamin D3 on human neuroblastoma cell lines-SH-SY5Y. <b>Materials and Methods:</b> The present study was an in-vitro study in which human neuroblastoma cell lines SY5Y (a total of 2 cell lines) were obtained from National Centre for Cell Science (NCCS), Pune, Maharashtra, India, and control cells are cells from the cell lines that were left untreated. The antiproliferative effect of vitamin D3 in human neuroblastoma cell lines evaluated using the MTT (3-(4,5-dimethylthiazolyl-2)-2,5 diphenyltetrazolium bromide) assay. After 48 hours of incubation and treatment with six different (0.01, 0.1, 1, 10, 100, and 1000 ng/mL) concentrations of vitamin D3, the percentage of viable cells was determined using spectrophotometry and compared with control cells (untreated cells from cell lines). Different vitamin D3 (250 ng/mL, 500 ng/mL, 1000 ng/mL) doses were applied to cells and they were then incubated for 24 hours, Cell death and malformations were then observed using a phase contrast microscope, and Deoxyribonucleic Acid (DNA) fragmentation was investigated using gel chromatography. The obtained results were expressed as percentage of inhibition and tabulated in Microsoft Excel Sheet Version 16.16.27 and scatter plot graph was used to calculate IC<sub>50</sub> (Half maximal inhibitory concentration). <b>Results:</b> The vitamin D3 showed antiproliferative property in SH-SY5Y cells at an IC<sub>50</sub> of 164 ng/mL when tested against human neuroblastoma cells using the MTT assay. Phase contrast microscope demonstrated that vitamin D3 treated cells showed condensation of nuclei, shrinkage of the cytoplasm, convolution of outline and cell peeling demonstrating apoptosis. DNA fragmentation also showed typical DNA ladder formation confirming apoptosis in vitamin D3 treated cells, which showed that the treated cells&#8217; DNA was more damaged than the control cells&#8217; DNA. <b>Conclusion:</b> Vitamin D3 exhibited both proapoptotic and antiproliferative properties, as demonstrated by the MTT assay, Phase Contrast, and DNA fragmentation. ]]> Comparison of Central Corneal Thickness Measurement using Optical and Ultrasound Pachymetry in Primary Open Angle Glaucoma Patients S Akhil, Prakriti Chourasia, Sandeep Kumar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> A thinner Central Corneal Thickness (CCT) is an important criterion in determining the probability of progression from Ocular Hypertension (OHT) to Primary Open Angle Glaucoma (POAG). The most common devices for measuring CCT are ultrasound and optical pachymeters. Ultrasound pachymetry is a quick and precise approach to quantify corneal thickness that is also portable and inexpensive. The advantages of optical method include operator independency and noninvasiveness. <b>Aim:</b> To compare central corneal thickness using optical and ultrasound pachymetry in patients with POAG. <b>Materials and Methods:</b> This cross-sectional study was conducted at the Department Ophthalmology, ESI Post Graduate Institute of Medical Sciences and Research, Basaidarapur, Delhi, India, from October 2020 to April 2022. There were 105 POAG patients (210 eyes), divided into three subgroups of 35 subjects each (70 eyes each), based on the number of anti-glaucoma medications being instilled, topically (one/two/three drugs), and 35 healthy antiglaucoma controls (70 eyes). Central corneal thickness measurements were taken by Ultrasonic Pachymeter (USP) TOMEY SP-100, and by CEM-530 Non Contact Specular Microscope (NCSM) (optical). Statistical analysis was performed by the Statistical Package for Social Sciences (SPSS) program for Windows, version 17.0 (SPSS, Chicago, Illinois). <b>Results:</b> The mean CCT taken with NCSM and USP was 540.83&#177;35.51 &#956;m and 538.74&#177;36.22 &#956;m, respectively, in Right Eyes (RE) of 35 glaucoma patients on one drug, (p-value=0.80). Similarly, Left Eyes (LE), mean CCT with NCSM was 544.17&#177;33.98 &#956;m, and with USP was 541.69&#177;36.6 &#956;m (p-value=0.76). Mean CCT taken with NCSM and USP was 539.83&#177;30,85 &#956;m and 537.66&#177;30.5 &#956;m, respectively in RT eyes of 35 glaucoma patients on two drugs (p-value=0.76). Left eyes, mean CCT was 541.91&#177;29.79 &#956;m with NCSM as compared to USP which was 540.11&#177;29.89 &#956;m (p-value=0.80). On comparing the mean CCT values of RE in glaucoma subjects who were controlled on three antiglaucoma drugs it was found to be 528.37&#177;26.44 &#956;m using NCSM and 527.09&#177;26.17 &#956;m using USP (p-value=0.84). The meanvalues of CCT for LE was 521.94&#177;26.53 &#956;m with NCSM and with USP was 520&#177;26.52 &#956;m, respectively (p-value=0.81). Comparison of mean CCT measurements using NCSM and USP in 35 age-matched controls RE eye was found to be 517.83&#177;21.27 &#956;m and 515.97&#177;20.91 &#956;m, respectively (p-value=0.71). Similarly, for LE mean CCT values were 518.8&#177;24.21 &#956;m and 516.8&#177;24.37 &#956;m, respectively (p-value=0.73). <b>Conclusion:</b> The CCT measured using NCSM was found to be higher than that measured using USP in POAG subgroups patients as well as healthy age-matched controls, however the difference was not statistically significant. There was highly significant linear correlation between the CCT measured using NCSM and USP in all POAG subgroups as well as healthy controls. This suggests that the devices could be used interchangeably in glaucoma patients as well as healthy subjects of similar age group. ]]> Rare Antinuclear Antibody Patterns: Relevance in Routine Laboratory Reporting Vidya Bhakta Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Uncommon patterns on Human Epithelial 2 (Hep 2) substrate during Antinuclear Antibody (ANA) screening by Indirect Immunofluorescence (IIF) microscopy are not routinely reported by many laboratories since their clinical relevance is not well established. <b>Aim:</b> To elucidate rare ANA patterns on Hep 2 and their possible association with clinical presentation. <b>Materials and Methods:</b> A retrospective study was conducted on ANA reports in the duration January 2021 to March 2022 at the Department of Laboratory Medicine, Dr. Sulaiman Al Habib Medical Group, Olaya Medical Complex, Riyadh, Saudi Arabia, to recognise rare ANA patterns. Gold standard method of IIF on Hep 2 was used for screening. Statistical evaluation was done to obtain frequencies of various ANA patterns. Those with frequency of less than 1% were classified as rare patterns. <b>Results:</b> Overall, 4207 consecutive ANA reports were evaluated out of which 1388 were positive and 210 (4.99%) demonstrated rare ANA patterns including nuclear, cytoplasmic and mitotic subtypes. Most commonly encountered among the rare ANA patterns was intercellular bridge (AC 27) with frequency of 0.78% (n=33). Systemic Lupus Erythematosus (SLE) (10/210) was the most often observed clinical association with rare cytoplasmic and mitotic patterns at titer &#8805;1:160. <b>Conclusion:</b> Uncommon ANA patterns may be useful in initial work-up of autoimmune illness hence, should be routinely reported. Further studies to enlighten the significance of these patterns, analogous antibodies could be of diagnostic relevance in autoimmune and other diseases. ]]> Emergence of Multidrug Resistant Vibrio cholerae O139 in Acute Diarrhoea Patients Attending a Tertiary Care Hospital, West Bengal, India Nabamita Chaudhary, Tanusri Biswas, Purbasha Ghosh, Saswati Chattopadhyay, Raston Mondal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> India is a developing country with many poor sanitation areas. Cholera, a water borne disease is rampant in areas of poor sanitation and is mainly due to Vibrio cholera of O1 and O139 serogroups causing acute cases of rice watery diarrhoea and high mortality. Infection due to Multidrug Resistant (MDR) Vibrio is on the rise. It is endemic in over 50 countries including India leading to a number of epidemics and pandemics. Till date, about seven pandemics have been identified due to cholera infection. <b>Aim:</b> To isolate <i>Vibrio cholerae</i> from acute diarrhoea cases with their antibiotic susceptibility and identify MDR strains, if any. <b>Materials and Methods:</b> A hospital-based, cross-sectional study was conducted in the Department of Microbiology, Burdwan Medical College, Purba Burdwan, West Bengal, India, from January 2021 to December 2021. Rectal swabs/faeces collected in Cary-Blair Transport Media were brought to the laboratory and incubated at 37&#176;C for six hours; a loopful was inoculated in nutrient agar, MacConkey agar and selective media Thiosulphate-Citrate-Bile Salts-Sucrose agar (TCBS). Gram stain, motility, colony characteristics, oxidase test, cholera-red reaction and slide agglutination test was done. Diagnosis was confirmed; antibiotic susceptibility done and interpreted as per Clinical and Laboratory Standard Institute (CLSI) guidelines. The data was collected and entered into Microsoft Excel software and presented as frequency and percentages. <b>Results:</b> Total 60 samples were collected and tested, out of which 24 (40%) were positive for <i>Vibrio cholerae</i> and nine in 24 (37.5%) samples were MDR strains. Twelve samples were from femlaes and 12 were from males, majority {5 (41.67%) females, 9 (75%) males} belonged to the age group of 0-5 years. Serotyping revealed that <i>Vibrio cholerae O1</i> serogroup was identified in 8 (33.33%) cases and O-139 serotype in 16 (66.67%) samples. Rest were Escherichia coli (n=10, 25%), Klebsiella pneumoniae (n=5, 12.5%) and Staphylococcus aureus (n=1, 25%). <b>Conclusion:</b> There is a rise of infections due to MDR strains of Vibrio O139 sero group in the community which needs early diagnosis and treatment for control. <i>Vibrio cholerae</i> strains were more resistant to fluoroquinolones, macrolides, tetracycline and Ampicillin. ]]> Comparative Evaluation of Nasal Index and its Role in Sexual Dimorphism in Central Indian Population: A Cross-sectional Study Saurabh Sharma, Raman Grover, Paran Joshi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Nasal Index (NI) is a sensitive anthropometric index. It exhibits sexual difference and has become useful tool in forensic medicine and reconstructive surgery. It is an important anthropometric parameter for classification of gender of a person whose identity is not known. <b>Aim:</b> To determine the values of the nasal parameters such as Nasal Height (NH), Nasal Breadth (NB) and NI, clinically and radiographically for male and female and also to compare the NI and its role in sexual dimorphism. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Department of Anatomy of a premium Medical College in Bhopal, Madhya Pradesh, India, between July 2017 and July 2019, study included total 392 subjects (196 males and 196 females), aged between 18 to 60 years. Posteroanterior (PA), Cephalogram (Ceph) was taken for all the study subjects. NH and NB were measured both clinically and radiographically. NI was then calculated as NB/NH&#215;100. The data was analysed statistically using unpaired Student&#8217;s t-test. <b>Results:</b> As males and females were equally divided, major subjects belonged to the age group of 41-50 years (31.63%), followed by 51-60 years (27.04%). Radiographic findings of NH were found to be statistically higher in males (47.46&#177;2.26 mm) while clinical findings of NH were found to be statistically higher in females (55.66&#177;3.21 mm). Radiographic findings and clinical findings of NB were found to be statistically higher in males (33.95&#177;2.41 mm, 37.19&#177;2.44 mm) as compared to females (30.55&#177;1.50 mm, 32.41&#177;1.58 mm). Radiographic findings and clinical findings of the NI were found to be statistically higher in males (71.70&#177;6.21, 69.94&#177;5.87) as compared to females (67.02&#177;5.21, 58.44&#177;4.70). <b>Conclusion:</b> Nasal parameters showed significant differences between males and females in Central Indian population, suggesting sexual dimorphism and also serve as important clinical and radiographical tools useful in nasal surgeries, anthropometry and forensic medicine. ]]> Assessment of Level of Motivation, Locus of Control and their Associated Factors among Alcohol Dependent Males: A Longitudinal Study Kamatchinathan Premkumar, Chinnaian Sivagurunathan, Mani Ezhilvanan, Ashokkumar Vikram Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Alcohol dependence is a major health problem across the globe. Relapses are a characteristic feature of Alcohol Dependence Syndrome (ADS) with various factors studied to identify the ideal management options. Motivation levels are a reflection of an individual&#8217;s readiness to act on a new healthy behaviour. Locus of control reflects individuals&#8217; beliefs about the degree of control they exert over their life events. <b>Aim:</b> To assess the motivation level and locus of control in alcohol dependent males and determining their relationship with successful recovery. <b>Materials and Methods:</b> This hospital-based, longitudinal was conducted at the Psychiatry Ward of a Tertiary Care Medical College and Hospital, Puducherry, India. Total 150 adult males, who fit the criteria for alcohol dependence as per International Classification of Diseases (ICD-10). The motivation level and drinking pattern were assessed by the application of Readiness to Change Questionnaire and Rotter&#8217;s Locus of Control scale. Categorical data were presented as frequency and proportions. The Fisher&#8217;s-exact test was used to evaluate differences between groups for categorised variables. <b>Results:</b> Total 150 patients were recruited for this study, the mean age was 37&#177;5.6 years. Overall, 94 (62.7%) participants had their first drink at 18 to 24 years of age and 64 (42.7%) participants reported onset of dependence at the age of 26-30 years. Overall, 70 (46.7%) participants were in the precontemplation level of motivation, as assessed by the Readiness To Change Questionnaire. A majority (n=126, 84%) of the cases had an external locus of control and a majority of lapses happened during 1st and 2<sup>nd</sup> months of the study. Age and educational status were found to have statistically significant association with motivation. Level of education, socio-economic class, motivation, pattern of drinking and locus of control had statistically significant association with lapsed cases. <b>Conclusion:</b> The locus of control of an individual, motivation level, and the pattern of drinking serve as prognosticators of lapse in patients with ADS. Individuals with poor motivation to change and those with an external locus of control require intensive follow-up and specific intervention programmes to prevent relapse. ]]> Age and Gender Specific Effect of Lip Form on Maxillary and Mandibular Incisal Display with Lips at Rest in Elderly Indian Population: A Cross-sectional Study Renu Kundu, Dipti S Shah Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Maxillary and mandibular incisal display at rest and smile is an integral part of dento-facial aesthetics. Its correlation with lip form and the effect of age and gender has not been studied in elderly Indian population. Dental photography has been given a great importance in prosthodontics and the study of various aesthetic parameters on digitalised photographs can act as additional diagnostic tool. <b>Aim:</b> To determine correlation between lip form and incisal display in elderly subjects and to determine age and gender related changes. <b>Materials and Methods:</b> A cross-sectional study was conducted in the Department of Prosthodontics, Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from November 2020 to September 2021. The study sample comprised of digital photographs taken in natural head position of 324 elderly Indian subjects (180 males &144 females) and they were divided into 4 age groups: Group I consisting of 157 subjects aged (31-45 years), Group II consisting of 107 subjects aged (46-55 years), Group III consisting of 47 subjects aged (56-65 years) and Group IV consisting of 13 subjects aged >65 years. The various parameters (lip form, maxillary and mandibular incisal display) were then analysed using Image J (Fiji app) image analysis software. The statistical analysis was done using Pearson correlation (significant when p<0.05), scatter plot, and Independent t-test (significant when p<0.05) and one-way Analysis Of Variance (ANOVA) post-hoc Tukey-Kramer test to compare the parameters of different groups. <b>Results:</b> The results of this study showed that there is a significant correlation between lip form and maxillary & mandibular incisal display at rest (r=0.388, p=0.001). Females have more incisal display for a particular type of lip form as compared to male subjects. A statistically significant difference was found in maxillary incisal display and lip form between male and female groups (T=-5.934, p-value=0.001 and T=-2.367, p-value=0.019 respectively) but no statistically significant difference was found in mandibular incisor display between male and female groups (T=1.832, p-value=0.068). Hence, females above 30 years of age had more maxillary incisal display as compared to males but almost same mandibular incisal display. Also, straight lip form was more common among elderly male subjects (63.6% as compared to females 36.4%) but females had moderate lip form most commonly (52.1% as compared to males 47.9%). High lip form was reported equally in both male and female subjects with 50% in each group. <b>Conclusion:</b> It has been concluded from the study that for a particular type of lip form (either straight, moderate or high), females have more average incisal displays as compared to males. A strong correlation exists between lip form and incisal display in elderly Indian population. Hence, lip form can be used as a definitive parameter to determine Incisal displays in prosthetic rehabilitation to get optimum aesthetic outcomes. ]]> Bedside Prognostic Indicators of Fatal Outcome among Children with Cerebral Malaria at a Tertiary Nigerian Hospital Ayobami Oyetunji Alabi, Michael Olaniyan Onigbinde, Ayodele Ojuawo, Victor Idowu Joel-Medewase, Grace Olukemi Alabi, Olanike Taye Oladibu, Bukola Adetutu Sayomi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Cerebral Malaria (CM) is a severe manifestation of malaria and commonly causes poor outcomes. It affects upto one million people per year worldwide predominantly sub-Saharan African children. It is clinically expedient that children with CM are identified promptly and easily to halt fatal outcomes. <b>Aim:</b> To evaluate bedside prognostic indicators of poor outcome among children with CM. <b>Materials and Methods:</b> A prospective, observational study was conducted at LAUTECH Teaching Hospital Ogbomoso, Oyo State, Nigeria among children diagnosed with CM from February 2018 to September 2018. Fifty children with age range of 6 months to 12 years were included in the study. Outcome indicators were full recovery, alive with neurological sequelae and death. Nine of the identified clinical factors demonstrable on bedside were assigned score of 1 each and each score summated to form Bedside Prognostic Index (BPI). The median BPI Score &#8805;4 indicated fatal outcome. Receiver Operating Characteristic (ROC) curve validated the predictive ability of the BPI score on clinical outcomes. Chi-square test and student t-test were used for statistical analysis. <b>Results:</b> Out of total 50 children, 30 (60%) recovered fully, 11 (22%) participants had neurological deficit(s) and 9 (18%) participants died. The median BPI score among completely recovered, survived with neurological deficit(s) and died was 8, 6 and 4, respectively. BPI score &#8805;4 was an independent predictor of fatal outcome {Odd&#8217;s Ratio (OR)=7.875, p-value=0.013, Confidence Interval (CI)=1.547-40.091} with sensitivity and specificity of 80% and 76.67% respectively. The ROC of the predictive ability of BPI on clinical outcomes was 80.2%. <b>Conclusion:</b> Poor outcome was significantly associated with BPI of &#8805;4 in children with CM. The use of this scoring index should be encouraged to promptly manage children with CM at risk of poor outcome. ]]> Evaluation of Posterior Tibial Slope for Anterior Cruciate Ligament Tear and Meniscal Tear: A Cross-sectional Study Sathya Sabina Muthu, U Shrikrishna, Kayalvizhi Ravichandran Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The Posterior Tibial Slope (PTS) is an angle formed by the tibial plateau and supports the biomechanics of the knee joint. This slope is found to be a factor in differentiating ACL tear injuries. Earlier studies have shown the association of PTS with Anterior Cruciate Ligament (ACL) tears but have not evaluated the PTS values for different gradings. <b>Aim:</b> To evaluate the PTS on X-ray and Magnetic Resonance Imaging (MRI), for patients with different grades of ACL tears, and patients identified with meniscal tears. <b>Materials and Methods:</b> This cross-sectional study was conducted from April 2020 to March 2021 at the Department of Radiodiagnosis and Imaging, KS Hegde hospital, Mangaluru, Karnataka, India. A total of 30 patients were studied, in which 20 patients with ACL tears underwent both X-ray and MRI, while the 10 patients with meniscal tears were only subjected to MRI. The PTS was evaluated for different grades of ACL tears on X-ray and MRI by an experienced Radiologist. The number of patients with grade I, grade II, and grade III ACL tears were 7, 6 and 7, respectively. Paired t-test was used to evaluate the mean PTS for the identified grade of the ACL tear. One-way Analysis of Variance (ANOVA) and Bonferroni post hoc test was used to analyse the difference between grades of the ACL tear. <b>Results:</b> The mean age of the study population was 32.50&#177;16.363 years, and the male-to-female ratio was 4:1. Both right, as well as the left knee, were included in the study, and the left-to-right knee ratio was 3:2. There was a significant difference in PTS between Grades of ACL tears (p-value-0.001). The PTS was observed to increase as the severity of the ACL injury increased.The mean PTS value obtained on x-ray for grade I, grade II, and grade III ACL tears were 10.85&#177;0.54, 14.18&#177;0.62, and 16.46&#177;1.56, respectively. While the mean PTS value obtained on MRI for grade I, grade II,and grade III ACL tears were 10.85&#177;0.53, 14.19&#177;0.60, and 16.47&#177;1.55, respectively. There was no significant difference in the PTS measured for ACL tears between the X-ray and MRI (p-value>0.05). Further, the results did not show any difference of significance in the PTS measured on MRI between ACL tears and meniscal tears (p-value>0.05). <b>Conclusion:</b> The PTS can be used as an aid in the identification of the severity of the ACL injury. The PTS could also be used as a tool to recognise the presence of ACL tears on X-ray and this could be an important prognostic factor towards the functional outcome. ]]> Invasive Fungal Infections in Acute Haematological Malignancies: A Cross-sectional Study Anita Nandi Mitra, Prerna Pramanik, Rupsa Bhattacharya Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Fungal infections are common complications of acute haematological malignancies i.e. acute myeloid and acute lymphoblastic leukaemia. The cells in these two groups are different morphologically and immunologically. Hence the interaction with the different types of fungi may vary. <b>Aim:</b> To identify the acute leukaemia cases and fungal infection among myeloid and lymphoid groups and to find out association of types of invasive fungal infection according to cell line affected. <b>Materials and Methods:</b> A cross-sectional observational hospital-based prospective study was conducted in a risk group of acute haematological malignancy over a period of six months from July 2021 to December 2021 in a tertiary care Hospital, Medical College Kolkata, West Bengal, India. Study tools were questionnaire based on European Organisation for Research and Treatment of Cancer /Mycoses Study Group (EORTC/MSG) criteria, clinical reports and standard laboratory procedures were practiced in Microbiology laboratory. The data was entered in excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) 28th version. <b>Results:</b> A total of 24 cases of Invasive Fungal Infections (IFI) were observed out of the 78 patients included in the study. This corresponds to an IFI prevalence of 30.77%. Patients with proven IFI constituted 8 (33.33%), probable IFI accounted for 15 (62.5%) where as those with possible IFI accounted for 1 (4.2%) of total IFI cases. There were age and sex wise variation in IFI. The prevalence of IFI was found to be higher in Acute Myeloid Leukaemia (AML) (48.5%) patients as compared to Acute Lymphoblastic Leukaemia (ALL) (19.14%). Of all AML patients invasive candidiasis was the most common type followed by aspergillosis. In ALL patients invasive candidiasis also constituted 44.44% followed by dematiaceous mycosis, followed by aspergillosis. <b>Conclusion:</b> AML patients suffer more from IFI than ALL ones. Invasive non albicans candidiasis affected both types but more incidence was seen in AML affected group. Aspergillus spp. affected lungs of both groups but dematiaceous fungi were isolated only from ALL affected paediatric patients and in samples other than pulmonary or blood sample. ]]> Staged Management of Severe Postburn Contracture of Elbow and Knee- A Prospective Interventional Study Anup Kumar Tirkey, Rasmi Ranjan Mohanty, Bibhuti Bhusan Nayak Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Long-standing burns at major joints like the elbow and knee often lead to contractures, despite of best treatments and their management poses a great challenge owing to underlying contracted tendons, neurovascular bundle, and joint ligaments. Attempts at release and correction of contractures may lead to injury to the adjacent neurovascular structures. <b>Aim:</b> To evaluate the effectiveness of staged release as a means of definitive treatment of severe burn contracture. <b>Materials and Methods:</b> A prospective interventional study was conducted on 30 patients in the Department of Burns, Plastic and Reconstructive Surgery Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India, from December 2018 to December 2020. In the first stage, the maximum excisional release of contracture was done, avoiding any stretching of the neurovascular bundle, then bedside graded traction was applied at the joint until the complete release of contracture was observed. The resultant raw area was covered with a split-thickness skin graft in the second stage. The collected data included- site and side of the contracture, cause of initial burn, Improvement in flexion arc (in degrees), duration of splintage after surgical release, complications and Patient and Observer Scar Assessment Scale (POSAS). Paired t-tests were performed to analyse changes in preoperative versus postoperative measurements. <b>Results:</b> Eighteen cases of knee contractures and 12 cases of elbow contractures were included in the study. Among the patients that were analysed, 17 were females and 13 were males, with a female-to-male ratio of 1.3:1. The age range was 18-50 years, with a mean age of 36&#177;8.79 years. The mean Range Of Motion (ROM) of elbow contracture with a severe degree of contracture improved from 25% of functional ROM to 124.29% at 6 months postoperatively. Similarly, the mean ROM of knee contracture with a severe degree of contracture improved from 25.76% of functional ROM to 102.58% at 6 months postoperatively. For both elbow and knee contracture cases the differences in mean ROM were statistically significant with all p-values <0.05. The average time at which the patients reported to the hospital, after developing contracture was 36.8 months, and it ranged from 24 months to 62 months. According to POSAS patient scale, the overall score was 6 and 5 for the elbow and knee respectively and the POSAS observer scale overall score was 6 for both the elbow and knee, respectively. <b>Conclusion:</b> The staged release procedure applied in the present study was an effective way of dealing with long-standing contractures with minimal complications. ]]> Histopathological Spectrum of Spinal Tumours at a Tertiary Care Hospital, Gujarat, India: A Retrospective Study Khushbu Kantilal Tilva, Urvi Parikh Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The anatomic structures in the spinal area are diverse and unpredictable, often representing an excellent test for both the neuroclinicians and neuropathologists, thereby showing a broad heterogeneous spectrum of pathological lesions. Clinical history, radiological features, and pathological examination are required to diagnose spinal tumours. <b>Aim:</b> To study the histopathological spectrum of spinal tumours in a tertiary care teaching hospital in Gujarat, India. <b>Materials and Methods:</b> In this retrospective study, data was collected from the records of 100 patients who had spinal tumours and who attended the Department of Pathology. Histopathological diagnosis of the spinal biopsy specimen was the primary outcome variable. Age, gender, location of the tumour, and clinical features were other study relevant variables. The status of the spinal tumour (benign/malignant) was considered an explanatory variable. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. Categorical outcomes were compared using the Chi-square test. <b>Results:</b> A total of 100 subjects were included, among which 42 participants were males, and 58 were females with the mean age 34.62&#177;17.64 years. The maximum number of spinal tumours were noted in (21-30 year) 3rd decade (29%) of life. Benign spinal tumours (73%) were more common than malignant spinal tumours (27%). Schwannoma was the most common (37%) spinal tumour, followed by meningioma (20%), and ependymoma (14%). The distribution of spinal tumours based on anatomical location, 31% intradural intramedullary, 49% intradural extramedullary, and 20% extradural tumours. There was a significant difference between nerve sheath tumours and meningioma with gender (p-value <0.001). <b>Conclusion:</b> The study identified schwannoma and meningiomas as the most common tumours. The thoracic region was the most frequently involved spinal level, followed by the cervical, and the most affected location was the intradural extramedullary. ]]> Comparison of Analgesic Efficacy of Nalbuphine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Bupivacaine in Patients undergoing Lower Limb Orthopaedic Surgeries: Randomised Clinical Trial Vijay V Katti, NR Swathi, Renuka Holyachi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Postoperative pain management poses a major challenge in patients who undergo lower limb orthopaedic surgeries. Methods that reduce the requirements of systemic analgesics and have minimal adverse effects on haemodynamic stability are the need of the hour. Nalbuphine, a kappa agonist/partial &#956; antagonist can be utilised in spinal anaesthesia as an auxiliary to local anaesthetic. <b>Aim:</b> To evaluate the efficiency of intrathecal hyperbaric bupivacaine versus nalbuphine plus fentanyl as adjuvants in patients undergoing lower limb orthopaedic surgeries. <b>Materials and Methods:</b> This prospective randomised clinical trial comprised 70 American Society of Anaesthesiologists (ASA) grade I and II patients aged between 18 to 60 years who had been posted for elective lower limb orthopaedic operations. Patients were randomly assigned to either Group NB (intrathecal bupivacaine with nalbuphine) or Group FB (Intrathecal bupivacaine with fentanyl). Onset and duration of sensory and motor block, haemodynamic alterations, side-effects, and requirement for systemic analgesics in the postoperative period were examined. <b>Results:</b> There was no statistically significant difference in beginning of sensory and motor blockage between the two groups. In comparison to group FB, group NB&#8217;s sensory blockade lasted substantially longer (126.06&#177;6.52 minutes vs. 103.34&#177;3.7 minutes; p-value<0.001). In group NB, the length of the motor block was considerably longer (p-value<0.001). When compared to patients in group FB (230.83&#177;7.98 minutes), patients in group NB experienced analgesia for a mean time of 278.31&#177;9.58 minutes, which was noticeably longer. There was no discernible difference between group NB and group FB (p-value>0.05) in terms of symptoms such as nausea, vomiting, bradycardia, and hypotension throughout the intraoperative period. <b>Conclusion:</b> In patients scheduled for elective lower limb orthopaedic procedures, intrathecal nalbuphine 1 mg as an adjuvant to 0.5% hyperbaric bupivacaine for subarachnoid block extend the duration of sensory block, motor block, and the postoperative analgesia more successfully than intrathecal fentanyl 25 &#956;g. ]]> Artificial Neural Network as a Predictive Tool for Gender Determination using Volumetric and Linear Measurements of Maxillary Sinus CBCT: An Observational Study on South Indian Population Priyadharshini Dhandapany, RC Jagat Reddy, S Vandana, John Baliah, T Sivasankari Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Determination of age and gender using bones of skull is central aspect of forensic odontology. Maxillary sinuses in this regard have shown high accuracy in predicting gender. <b>Aim:</b> To identify gender using the volumetric and linear measurements of maxillary sinuses obtained from a Cone Beam Computed Tomography (CBCT) by using Artificial Neural Network (ANN) based tool. <b>Materials and Methods:</b> A retrospective study was conducted on 80 volumes of CBCT (derived from n=80 patients) with equal gender distribution. The CBCT images were analysed for eight linear and two volumetric measurements namely the maxillary sinus height, maxillary sinus length, maxillary sinus width, distance between infraorbital foramen and distance between maxillary sinus. The data from these parameters were reported by two experts and subjected to discriminant analysis and McNemars test for gender determination. The same data was also fed to the ANN software and the accuracy of its gender prediction was analysed by Receiver Operating Characteristics Curve (ROC) and Area Under the Curve (AUC). <b>Results:</b> The ROC test and AUC (ANN &#8211;test) had shown high accuracy for prediction of gender form the data of the CBCT parameters for maxillary sinuses. McNemars test showed that the difference in proportion between the actual gender and ANN predicted gender was not significant (p-value=0.687) and the agreement between the actual gender and ANN in measuring the gender was 84.6%. The male sex was predicted correctly upto 89.7% and female sex upto 94.9%. <b>Conclusion:</b> This study has found ANN to have an encouraging predictive power in gender determination based on linear and volumetric measurements of maxillary sinus obtained from CBCT. ]]> Role of Handmade Models in Teaching Early Stages of Human Embryology: A Quasi-experimental Study from South Kerala, India Vandana Latha Raveendran, Reba Babu Alex, Umesan Kannanvilakom Govinda Pillai, Aswathy Maria Oommen Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Physical models are being used in embryology lectures along with PowerPoint presentations to improve the spatial orientation of students. But the demonstration of the sequence of changes is not possible with commercial models due to nonavailability and high expenses. The latest audio-visual aids including three-dimensional projections like simulation-based screens, or virtual reality enhance the visual-spatial ability of the students but are very costly and not affordable for all institutions. <b>Aim:</b> To compare the effectiveness of hand-made physical models with the PowerPoint presentation mode of teaching in understanding the 3D concept of embryology, among first-year MBBS students and to assess the students&#8217; perception of this model-based teaching. <b>Materials and Methods:</b> The study was conducted using a quasi-experimental study design, on 218 phase 1 medical students of Government Medical College, Thiruvananthapuram, Kerala, India, from February 2020 to August 2020. The students were divided into two equal groups. Group B was taught the topic &#8220;Second week of embryonic life&#8221; with a PowerPoint lecture session (n=109) and the Group A had in addition a demonstration with the handmade models (n=109). Pretest and post-test were conducted with an internally validated questionnaire. Feedback on the student&#8217;s acceptance of teaching/ learning with models were also collected. The improvement of the test scores was analysed using paired t-tests in both the test and control groups. <b>Results:</b> Statistically significant improvement in knowledge score was obtained while comparing the post-test scores of the intervention group (mean score was 4.83&#177;2) with that of the non intervention group (mean score was 3.99&#177;2.06) (student&#8217;s t-test, p-value <0.05). It was observed, 99.1% of students were satisfied with this model-assisted teaching, especially with the series of models demonstrating the sequence of events. A 93.1% of students said that they needed such model-assisted lectures in other subjects also. <b>Conclusion:</b> Series of models pertaining to a particular event is beneficial and effective for learning complex concepts of embryology. Also, it&#8217;s a long-lasting, innovative mode of teaching which can be done cost-effectively. ]]> Evaluation of Nuclear Morphometry and Ki-67 Proliferative Marker in Astrocytomas: A Ambispective Study Palak Nanda, Sapna Patel, Apoorva Cherukuri Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Astrocytomas are the commonest primary Central Nervous System (CNS) tumours. Its diagnosis is based on histopathological criteria defined by the World Health Organization (WHO) 2016 that grades astrocytoma into four grades. The subjective nature of WHO grading has prompted for more objective methods to evaluate nuclear features. Furthermore, Ki-67, a marker of cellular proliferation is a useful diagnostic tool that also helps in prognostic evaluation and to plan adjuvant therapy in astrocytomas. <b>Aim:</b> To evaluate the nuclear morphometry and Ki-67 proliferative marker in astrocytomas and to assess the relationship of WHO grade with proliferative activity using Ki-67 immunostaining. <b>Materials and Methods:</b> This ambispective study was conducted in the Department of Pathology, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India, with a total duration of four years (October 2017 to September 2021). From 35 astrocytoma cases, Haematoxylin and Eosin (H&E) stained slides were retrieved and reviewed appropriately by two pathologists and graded using the WHO criteria. Nuclear morphometric analysis was performed on the H&E slides using Olympus BX-41 research microscope. The parameters evaluated were mean nuclear length, mean nuclear diameter, mean nuclear perimeter, mean nuclear area, Mean Nuclear Roundness Factor (MNRF) and mean nuclear ellipse form. The cases were then stained with Ki-67 antibody. The relationships between WHO grade of astrocytoma and nuclear morphometry and WHO grade with proliferative index was analysed. <b>Results:</b> According to WHO grading, four cases were Grade 1 (11.4%), 12 grade 2 (34.3%), six grade 3 (17.1%) and 13 grade 4 (37.1%). Significant correlation was seen between WHO grading and mean nuclear length, diameter, perimeter, area and Ki-67 with p-value of less than 0.001. <b>Conclusion:</b> Astrocytoma is an extremely heterogeneous disease with unpredictable outcome. The widely used WHO grading is subjective, while nuclear morphometry, using computer assisted image analysis, can ensure more objective assessment. The Ki-67 index could provide valuable information and may compliment the other parameters. ]]> Interleukin-17 Inhibitor in Treatment of Psoriasis during COVID-19 Pandemic: An Ambispective Study Ramesh Aravamudhan, V Sampath, Rajkumar Kannan, Parimalam Kumar, Venkatesan Srinivasan, MM Sridevi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Psoriasis is a genetically mediated chronic inflammatory disease that is frequently associated with metabolic co-morbidities. These metabolic co-morbidities have a huge impact in deciding the appropriate immunosupressant of choice in the current scenario of Coronavirus Disease (COVID-19) pandemic. Treatment of psoriasis especially with biologicals is challenging during covid pandemic since immunosuppressive therapy might interfere with antiviral immunity. <b>Aim:</b> To report the safety profile of Interleukin-17 (IL-17) inhibitor, namely injection secukinumab in patients of psoriasis vulgaris during COVID-19 pandemic. <b>Materials and Methods:</b> An ambispective interventional study was performed on 23 patients of psoriasis who were administered secukinumab at a dose of 300 mg subcutaneously during COVID-19 pandemic.The study was conducted at the Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India among the patients attending the psoriasis clinic between the July 2021 to March 2022. The demographic characteristics of the study group, previous treatment for psoriasis and the relationship between risk of COVID-19 infection and secukinumab were noted. Efficacy of secukinumab was calculated using Psoriasis Area and Severity Index (PASI) scores. Statistical analysis was conducted with Statistical Package for Social Sciences (SPSS) statistics software version 21.0 by Fischer&#8217;s-exact test. <b>Results:</b> Out of 23 patients, 17 patients (11 males, six females) completed full course of nine doses (five weekly doses followed by four monthly doses) of secukinumab. The PASI 75 and PASI 90 were achieved in 9 (52.94%) and 8 (29.41%) patients respectively at the end of 12 weeks. None of the patients developed COVID-19 infection during the course of treatment and three months following therapy. Patients with psoriasis who had a history of COVID-19 infection did not show signs of reinfection when started on secukinumab. Both inactivated vaccine (Covaxin) and vector based vaccine (Covishield) were found to be safe in concomitant use with secukinumab. <b>Conclusion:</b> Secukinumab is found to be safe and effective in psoriasis treatment during COVID-19 pandemic. There is no increased risk of COVID-19 infection or reinfection, COVID-19 associated hospitalisation and mortality among patients with psoriasis administered with secukinumab. The drug can also be safely used with COVID-19 vaccines. ]]> Evaluation of Oxidative DNA Damage among Type 2 Diabetes Mellitus Patients and Healthy Individuals in Duhok, Iraq: A Case-control Study Hivi Mohammed Mahmoud, Ardawan Fathi Ali, Wahid Mohammed Hassan, Idris Haji Ahmed, Dhia Jaafer Altimimi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The association between oxidative Deoxy Ribonucleic Acid (DNA) damage and diabetes is well established. Increased glucose levels can stimulate free radical production. However, data regarding DNA damage in type 2 Diabetes Mellitus (DM) patients and healthy individuals are controversial and scarce in Iraq. <b>Aim:</b> To assess the DNA damage among patients with type 2 Diabetes Mellitus (DM) and healthy individuals and to analyse its relationship with oxidative stress biomarkers. <b>Materials and Methods:</b> This case-control study was conducted at the Duhok Diabetes Center, Duhok, Kurdistan Region, Iraq, from September 2016 to March 2018. In this study, biomarkers of both oxidative stress and DNA damage including Total Antioxidant Capacity (TAC), Malondialdehyde (MDA) and serum 8-Hydroxy-2-deoxiguanosine (8-OHdG) were measured in 297 patients with type 2 diabetes and 188 healthy individuals. Selection of cases and healthy individuals was done using random sampling technique. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 18.0 and a p-value <0.05 was set as a cut off value of statistical significance. <b>Results:</b> The mean age, sex and Body Mass Index (BMI) were similar between patients and healthy individuals. Significantly higher 8-OHdG and MDA levels (p<0.001 and p<0.010, respectively) together with lower TAC levels (p=0.010) were found in diabetics compared to healthy individuals. In diabetic patients, a positive correlation of 8-OHdG was observed with MDA (r=0.220), and a negative correlation was observed with TAC (r= -0.47). Based on the estimated cut-off point of DNA damage (8-OHdG of 4.0 ng/mL), 84.51% of patients had high levels of DNA damage compared with healthy individuals (28.7%). <b>Conclusion:</b> Oxidative DNA damage increased in diabetic patients, and was associated with lower antioxidant capacity. Antioxidant supplementation may be an effective public health intervention to reduce DNA damage and oxidative stress. ]]> Effectiveness and Safety of Fixed-dose Combination of Perindopril/Amlodipine/Indapamide, and Telmisartan/Amlodipine/Chlorthalidone in Grade 2 Hypertensive Patients at High Cardiovascular Risk: A Real-world Observational Study Shambo Samrat Samajdar, Shatavisa Mukherjee, Santanu Kumar Tripathi, Jyotirmoy Pal, Shashank Joshi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Fixed-dose combination containing triple antihypertensive agents (Angiotensin-Converting Enzyme Inhibitor (ACE-I)/Angiotensin Receptor Blocker (ARB), diuretic and Calcium Channel Blocker (CCB)) is recommended to achieve target Blood-Pressure (BP). However, none of the study has compared ACE-I based and ARB-based triple fixed dose combinations. <b>Aim:</b> To evaluate the effectiveness and safety of fixed-dose combination of Perindopril (Per)/Amlodipine (Aml)/Indapamide (Ind) and Telmisartan (Tel)/Aml/Chlorthalidone (Chl) in grade-2 hypertensive patients at high Cardiovascular (CV) risk. <b>Materials and Methods:</b> This retrospective, observational, single-centre study enrolled treatment-na&#239;ve grade-2 hypertensive patients who were at high CV risk and were treated with ACE-I based (Per/Aml/Ind; Per/Aml/Ind group) or ARB-based (Tel/Aml/Chl; Tel/Aml/Chl group) triple fixed-dose combination for atleast one-month at the study centre. Office Blood Pressure (BP) at one-month follow-up was used as a parameter to measure treatment effectiveness. Safety was assessed based on the occurrence of Adverse Events (AEs). <b>Results:</b> A total of 69 patients (n=32 in Per/Aml/Ind group and n=37 in Tel/Aml/Chl group) were included. Office Systolic BP (SBP)/Diastolic BP (DBP) were 181.44&#177;8.52/95.19&#177;7.25 mmHg and 183.32&#177;6.65/94.81&#177;7.14 mmHg in patients belonging to Per/Aml/Ind and Tel/Aml/Chl groups, respectively. There was a significant reduction in office SBP/DBP at one-month follow-up (Per/Aml/Ind: 129.31&#177;6.44/75.06&#177;4.85 mmHg and Tel/Aml/Chl: 129.10&#177;5.90/75.00&#177;4.82 mmHg; p-value=0.0001). Between-group comparisons did not showed any significant difference in terms of reducing office BP. Both groups exhibited identical safety profile. <b>Conclusion:</b> The study demonstrated comparable treatment effectiveness and safety profile with triple fixed dose combinations containing Per/Aml/Ind and Tel/Aml/Chl in a real-world setting. ]]> Detection of Creatinine in Vaginal Secretions of Women with Premature Rupture of Membranes in Third Trimester from Semiurban Population: A Cross-sectional Study Hemant Gopalrao Deshpande, Monalisa Sarkar, Madhukar Jagannath Shinde, Chetan Gulati, Shubham Joon Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Spontaneous rupture of the membranes any time beyond the 28th week of pregnancy but before the onset of labour is called Premature Rupture of Membranes (PROM). There are many techniques for diagnosing PROM that is based on both clinical assessments and biological studies. Each of these procedures has benefits and drawbacks. Since foetal urine is the major source of amniotic fluid, the presence of vagina and a high creatinine level may aid in the diagnosis of PROM. <b>Aim:</b> To determine the cut-off levels of serum creatinine in predicting the PROM. <b>Materials and Methods:</b> A cross-sectional study was conducted at Dr. DY Patil Medical College, Hospital and Research Centre in Pune, Maharashtra, India from June 1 2020 to June 5 2021. Two equal groups of 140 each pregnant women with gestational ages ranging from 28-42 weeks were created: one with a history of vaginal leaking (the study group, P), and the other with gestationally matched no leakage (the control group, C). Patient&#8217;s details such as age, gestational age, and obstetric history were noted. Each patient was examined and cervicovaginal secretions were collected. A 5 mL of saline was flushed in the posterior fornix of vagina. This fluid with vaginal wash was aspirated and creatinine concentration from vaginal fluid was determined by Jaffee synthetic chemical colorimetric method. The Student&#8217;s t-test and the Chi-square test were used to analyse the data. <b>Results:</b> The study group&#8217;s vaginal fluid creatinine level was substantially higher (p-value<0.001). The cut-off value of 0.6 mg/dL had highest sensitivity 96.1% and specificity 100%. The area under the Receiver Operating Characteristics (ROC) curve was 0.917. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of serum creatinine at cut-off 0.6 mg/dL was 100% and 96.3% respectively. <b>Conclusion:</b> Vaginal fluid creatinine is simple and easily available, which makes it acceptable to the candidate for a diagnosis of PROM. ]]> Oral Morbidity Pattern and its Behavioural Determinants among Adults of Urban Slums of Siliguri, India Sasthi Narayan Chakraborty, Kaushik Ishore, Subhasis Mukherjee, Sharmistha Bhattacherjee, Rakesh Kumar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Understanding oral health and not merely dental health are becoming priorities as mouth often offers first sign and symptoms of many localised and systemic diseases. Like any other urban slums, Siliguri slum peoples were also prone for many illnesses and oral health was a different concern as because offering areca nut with betel to guests was a common practice in that particular area. <b>Aim:</b> To find out oral morbidity pattern among study subjects and to ascertain few behavioural determinants of oral morbidity. <b>Materials and Methods:</b> Community based cross-sectional study was performed in slums of Siliguri city, West Bengal, India, from January 2017 to January 2019. As Siliguri is a large city with more than 5 lac population and 154 slums, cluster sampling was adopted to choose samples from each cluster slum. Total 210 samples were studied derived from World Health Organisation (WHO) sample size formula and applying principles of 30 cluster sampling and data regarding socio-demographic profile, behaviour details and clinical history and examination was collected via self-structured, pretested schedule. Results were analysed in Statistical Package for the Social Sciences (SPSS) version 20.0 software and was presented in frequency tables, Chi-square test was applied for testing statistical significance. <b>Results:</b> Out of 210 study subjects, 154 of them (73.3%) had any form of oral morbidities, 136 study subjects (64.8%) had dental morbidities. Bleeding was commonest symptom for 96 study subjects (62.3%). A total of 59 study subjects (28.1%) had irregular brushing habit and 132 subjects (62.9%) did not wash their mouth after each major meal. A total of 94 subjects (44.8%) had the habit of any form addiction. <b>Conclusion:</b> Adult slum dwellers of Siliguri reported a huge proportion of oral morbidities, majority of which was dental morbidities, irregular brushing habit, lack of mouth wash after meal and addiction were associated with oral morbidities. ]]> Translucency and Wear of Pressable Lithium Disilicate and Zirconia-reinforced Lithium Silicate Glass-ceramics: An In-vitro Study Shruti S Potdukhe, Janani M Iyer, Jyoti B Nadgere Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> New ceramic materials have been introduced with less research on their aesthetic outcome and durability for clinical implications. Lithium disilicate is one of the widely used materials for restoration. Recently, Zirconia-reinforced Lithium Silicate (ZLS) glass-ceramic enriched with 10% zirconia in highly dispersed glass phase of ceramic has been introduced. <b>Aim:</b> To investigate the translucency of pressable Lithium Disilicate (LS<sub>2</sub>) and ZLS and their effects on wear of opposing enamel. <b>Materials and Methods:</b> This in-vitro study was carried out at MGM Dental College and Hospital, Mumbai, Maharashtra, India, between January 2017 and January 2020. Twenty disks of 15&#215;3 mm; 10 each of LS<sub>2</sub> and ZLS were fabricated by hot pressing method. For translucency Commission Internationale de l&#8217;Eclairage (CIE) L*a*b values for each sample were measured against black and white background using a laboratory reflectance spectrophotometer. Translucency was calculated using Translucency Parameter (TP)= {(L*B-L*W)<sup>2</sup>+(a*B-a*W)<sup>2</sup>+(b*B-b*W)<sup>2</sup>}<sup>1/2</sup>. For wear testing same 20 disks were used as an antagonist. Enamel specimen of 20 maxillary premolar were abraded against each antagonist with two body wear testing machine in rotational motion under a constant load of 20 N at 350 rpm for 5000 cycles. The initial readings and final readings of enamel specimen in &#956;m were measured using contact stylus profilometer. Non parametric Mann-Whitney U test was used to compare the significance of difference between two groups. <b>Results:</b> The TP values obtained were 23.07 and 24.04 for LS<sub>2</sub> and ZLS, respectively (p-value=0.004). The mean wear values obtained were 0.71860 &#956;m and 1.09500 &#956;m for LS<sub>2</sub> and ZLS, respectively (p-value=0.049). The difference for both the parameters was statistically significant. <b>Conclusion:</b> Within the limitation of this study, ZLS showed higher translucency values than LS<sub>2</sub>. Wear rate of opposing enamel was more with ZLS than LS<sub>2</sub>. Thus ZLS may provide excellent aesthetics which can be used as an option for rehabilitation in aesthetic zone. ]]> Effect of Hot and Cold Beverages on the Flexural Strength of Nanofilled and Nanohybrid Composites: An In-vitro Study Tanvi Sanjit Kadu, Sharad Kamat, Girish Nanjannawar, Sonali Subhash Kinikar, Divya Makhijani Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Nanocomposites is the latest development in the field of dentistry. It has improved mechanical properties. The clinical success is dependent on the effect of changes in the oral temperature due to consumption of various beverages. <b>Aim:</b> To evaluate and compare the effect of hot and cold beverages on the flexural strength of nanofilled and nanohybrid composites. <b>Materials and Methods:</b> This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics at Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India, from March 2021 to December 2021. Two types of nanocomposites (nanofilled and nanohybrid) were tested for flexural strength under effect of hot (like tea) and cold (like carbonated drink) beverages. All composite specimens were immersed in tea, carbonated beverage and distilled water thus the present study included six groups. A total of 60 specimens (25 mm in length, 3 mm in width, 2 mm in thickness were prepared using teflon moulds with 10 samples for each combination. Maximum load for distortion of the sample was measured after seven days of immersion and flexural strength was calculated. One-way Analysis of Variance (ANOVA) test, Post-hoc Tukey test and Independent t-test were utilised to compare the differences in flexural strength among study groups. Statistical significance was fixed at p-value &#8804;0.05. <b>Results:</b> The flexural strength of nanohybrid composite immersed in tea was 85.78 MPa, in aerated drink was 95.55 MPa and in distilled water was 126.78 MPa. The flexural strength of nanofilled composite immersed in tea was 73.66 MPa, in aerated drink was 85.35 MPa and in distilled water was 120.54 MPa. Nanohybrid composite compared to nanofilled composite showed higher flexural strength in all beverages. <b>Conclusion:</b> Nanohybrid composites were found to have greater mechanical properties as compared to nanofilled composites when subjected to both hot and cold temperatures. ]]> Predictors of Length of Hospital Stay in Patients with COVID-19: A Retrospective Study Sujata Jayant Khatal, Shilpa Shaunak Sule, Ajinkya Jayaji Pandhare, Yashodeep Ashokrao Girwalkar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Known independent predictors of extended Length Of Stay (LOS) in Coronavirus Disease 2019 (COVID-19) included older age, chronic kidney disease, elevated maximum temperature, and low minimum oxygen saturation. Additional known predictors of prolonged hospitalisation included male sex, chronic obstructive pulmonary disease, hypertension, and diabetes. Elevated levels of C-Reactive Protein (CRP), creatinine, and ferritin are proven determinants of hospitalisation and LOS. Determining predictors of LOS will aid in triaging and management of COVID-19 patients. <b>Aim:</b> To assess the clinical, biochemical and radiological profile of admitted COVID-19 patients and determine the predictors of prolonged length of stay at hospital. <b>Materials and Methods:</b> It was a retrospective, cross-sectional observational, record-based study included hospital records of 544 confirmed COVID-19 patients, above age of 18 years admitted at Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India, during February 2021 to June 2021. Possible determinants of LOS were studied including their demographic, epidemiological, clinical and radiological characteristics. The patients were divided into two groups as per median LOS i.e, group I with LOS <10 days (n=277) and group II with LOS &#8805;10 days (n=267). Statistical analysis was done using Chi-square test, proportion test, Z test, Mann-Whitney U test, regression analysis by Statistical Package for the Social Sciences (SPSS) software version 23.0. <b>Results:</b> Mean age in group I and II was 47.83&#177;16.34 years and 53.21&#177;15.63 years (p-value <0.0001), respectively. The fatigue was significantly more in group II than group I (p-value=0.018). Diabetes mellitus was more (p-value=0.026) and severity of illness (p-value<0.0001) was significantly higher in group II than group I. In univariate analysis, mean Neutrophil/Lymphocyte ratio (p-value<0.0001), serum LDH (p-value<0.018), blood urea level (p-value<0.0001), random blood sugar (p-value=0.003), glycated haemoglobin (HbA1c) (p-value=0.072) and serum creatinine (p-value=0.41) were significantly more in group II. Median CRP (p-value<0.0001), D-dimer (p-value<0.0001), serum ferritin (p-value<0.0001), procalcitonin (p-value<0.0001), Serum Glutamic Oxaloacetic Transaminase (SGOT) (p-value=0.002) was significantly higher in group II. Lung involvement {chest radiograph or High-Resolution Computed Tomography (HRCT) chest} was significantly (p-value<0.0001) more in group II. <b>Conclusion:</b> Fatigue, older age, diabetes mellitus, severity of illness, mean neutrophil/lymphocyte ratio, CRP, D-dimer, serum ferritin, serum Lactate Dehydrogenase (LDH), procalcitonin, blood urea, SGOT were associated with prolonged LOS among hospitalised COVID-19 patients. ]]> Knowledge and Attitude about Eye Donation among First and Second versus Final Year MBBS Students: A Cross-sectional Study Sumit Goyal, Neha K Sethi, Charu Chadha, Gagandeep Kaur, Urvashi Grover, Anchal Garg Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The cure of corneal blindness requires manifold increase in the rate of eye donation. The present study was undertaken to assess the knowledge and attitude about eye donation among medical students. A secondary objective of the study was to assess the impact of knowledge of eye donation after studying ophthalmology among the final year students of the MBBS (Bachelor of Medicine Bachelor of Surgery) graduation course. <b>Aim:</b> To assess knowledge and attitude about eye donation among first, second and final year medical students. Also, to assess the impact of studying &#8216;Ophthalmology&#8217; on their knowledge. <b>Materials and Methods:</b> A cross-sectional study was conducted by collecting information on a predesigned, structured questionnaire on &#8216;Google forms&#8217; and sending a soft copy to 601 students of two medical colleges i.e, GGS Medical College, Faridkot and Dayanand Medical College, Ludhiana, Punjab, India, by email, from March 2019 to April 2019. There were questions about awareness and source of information about eye donation in medical students, knowledge of criteria, and willingness to donate eyes. Responses were accepted till a period of seven days. Students were divided into two groups; group A (n=320 students) with 165 students in first professional year and 155 in second professional year, who had not studied Ophthalmology. Group B (n=281 students) with 142 students in final (part I) professional year and 155 in final (part II) professional year, who had/were studying Ophthalmology. Results were analysed and compared using Chi-square test. <b>Results:</b> Out of 601 students, 527 responded (272 of group A and 255 of group B). The results on knowledge and willingness to donate eyes were quite encouraging. Most of the questions were answered by more than 400 students. Majority of students cited teachers/friends as their source of knowledge. However, there was a saw significant gaps in knowledge in the students, specially before reading Ophthalmology (p-value<0.05). <b>Conclusion:</b> More efforts in the form of counselling techniques, short trainings, videos, need to be put into medical curriculum, ophthalmology teaching and short in-job trainings to make the MBBS students an important link in increasing cornea retrieval. ]]> Neutrophil-Lymphocyte Ratio as a Predictor of COPD Exacerbations: A Cross-sectional Study Karan Sharma, Kranti Garg, Jawahar Lal Joshi, Vishal Chopra, Ramesh Kumar Kundal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Chronic Obstructive Pulmonary Disease (COPD) is characterised by a modified inflammatory response to chronic irritants which is often associated with some degree of systemic inflammation. Exacerbations in COPD are characterized by exaggeration of the ongoing inflammation. A number of inflammatory mediators are found to be raised in COPD exacerbations but most of them are expensive and not readily available. The Neutrophil-lymphocyte Ratio (NLR) is a rapid, easy and cheap biomarker that has been shown to be raised in patients of COPD. <b>Aim:</b> To evaluate the role of NLR in patients of stable and acute exacerbation of COPD. <b>Materials and Methods:</b> This cross-sectional observational study was conducted in Department of Pulmonary Medicine at Government Medical College, Patiala, Punjab, India. Study included 150 patients of stable COPD, 150 patients of Acute Exacerbation COPD (AECOPD) and 100 subjects as controls. NLR was calculated from a peripheral blood sample of the study participants. Continuous variables were summarised as mean with standard deviation and compared between groups using Unpaired t-test. A p-value <0.05 was considered statistically significant. <b>Results:</b> The mean age in AECOPD group was 61.7&#177;10.4 years, in stable COPD group was 63.1&#177;8.9 years and 63.2&#177;7.8 years in controls. Mean NLR was found to be highest in AECOPD group (4.0&#177;1.7) followed by stable COPD (2.9&#177;0.8) and then control (1.8&#177;0.4).NLR showed good predictive value for predicting exacerbations in stable COPD patients with sensitivity and specificity of 75.3% and 70.7% respectively (cut-off 3.4 and AUC=0.806). <b>Conclusion:</b> NLR is an easily available biomarker of inflammation and can be used as a predictor of exacerbation in patients of COPD. ]]> Assessment of Haptoglobin 2-2 Genotype in Type 2 Diabetes and Cardiovascular Patients in North Indian Population: A Case-control Study Puneet, Atul Kumar Upadhyay, Manpreet Kaur, Rattan Deep Singh Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Haptoglobin (Hp), an acute phase protein, is a plasma inflammatory marker. It is important in both infectious and non infectious illnesses. When intravascular haemolysis occurs, the dead red blood cells are discharged into the circulation and link to Hp to form the haemoglobin (Hb)-haptoglobin (Hb-Hp) complex that is recognised by the macrophage scavenger receptor CD163. The Hp1 and Hp2 are its two alleles. The Hp2 is formed by a partial duplication of the Hp1 gene. The Hp1 has five exons, but Hp2 has seven exons owing to the duplication of Hp1 third and fourth exon. There are three genotypes of Hp: Hp1-1, Hp2-1, and Hp2-2. The encoded products of genotypes are attached to haemoglobin with varying degrees of affinity: Hp1-1 has the most affinity, Hp2-1 has medium affinity, and Hp2-2 has the lowest affinity. Hp allelic and genotypic variation differs amongst populations and different geographic regions of the world. <b>Aim:</b> To study the haptoglobin 2-2 genotype in type 2 diabetes and cardiovascular patients in north Indian population. <b>Materials and Methods:</b> It was a case-control study and a total of 200 participants were recruited randomly including 50 participants of type 2 Diabetes Mellitus (DM), 50 participants of Cardiovascular Disorders (CVD), 50 participants with Cardiovascular Disorders With type 2 Diabetes Mellitus (CVDWDM) and 50 normal healthy controls from Punjab Institute of Medical Sciences (PIMS) Hospital and clinics and Aashirwad laboratory of Jalandhar, Punjab, India in February 2021 to January 2022. Anthropometric variables were determined by using standard methods and biochemical parameters were measured by commercial available kits. Allele specific Polymerase Chain Reaction (PCR) or Amplification Refractory Mutation System (ARMS) PCR was used to detect Hp genotypes. Data were represented as mean&#177;Standard Deviation and the statistical difference i.e. p<0.05 between all parameters was determined by using the Mann-Whitney U test. <b>Results:</b> Anthropometric parameters i.e. Body Mass Index (BMI) was found to be statistically significant in CVDWDM as compared to CVD, N and T2DM i.e. p=0.023, p=0.01 and p=0.014. Waist Circumference (WC) was found to be statistically significant in CVDWDM as compared to CVD, N and T2DM i.e. p=0.02, p=0.013 and p=0.012 and Hip Circumference (HC) was found to be statistically significant in CVDWDM as compared to CVD, N and T2DM i.e. p=0.02, p=0.017 and p=0.014. However, Apolipoprotein A1 mean value was found to be higher and statistically significant i.e. p=0.03 in Type 2 Diabetes Mellitus (T2DM) as compared to healthy participants. Triglycerides mean value was increased in T2DM as compared to CVD, CVD as compared to N and CVDWDM as compared to healthy controls (p-value=0.012,0.04,0.015, respectively). The findings had shown that a 349 bp band was detected in patients with T2DM, CVD and CVDWDM, implying that the Hp2-2 genotypes were observed but not in healthy controls. <b>Conclusion:</b> The study finds that people with DM, CVD, or CVDWDM all have a 349bp band. It means that the genotypes of the Hp2-2 allele were found in patients of diabetes, CVD and diabetics with CVD but not in the healthy individuals. ]]>`&id=17340 Umbilical Cord Bilirubin as a Predictor of Neonatal Jaundice in Babies with ABO Blood Group Incompatibility versus without Incompatibility Cuddalore Subramanian Arulparithi, s manjani, Jane Allen Christa, C Bhuvanesh, Karthikeyan Monica, Dande Naga Mahesh Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Severe hyperbilirubinaemia cause long-term morbidity that can be prevented by early prediction of the development of significant jaundice by measuring Umbilical Cord Bilirubin (UCB). <b>Aim:</b> To measure the predictability of UCB as an early marker of development of significant hyperbilirubinaemia needing phototherapy. <b>Materials and Methods:</b> The study was a prospective observational study conducted at Vinayaka Mission Medical College, Karaikal, Pondicherry, India. A total of 50 babies born between February and August 2022 were included in the study. Bilirubin levels were obtained at birth by umbilical cord sampling and rechecked again at third or fourth day. Blood group incompatibility was defined as A or B blood group babies born to O group mothers. Phototherapy was started when the bilirubin levels were above or upto 2 mg/dL below the cut-off for that patient as indicated by the curve for the risk group of the patient as per the American Academy of Paediatrics (AAP) guidelines. Phototherapy also was started if clinically indicated by visual assessment by Kramers rule. <b>Results:</b> Results were analysed by Receiver Operating Characteristics (ROC) curve analysis for measurement of sensitivity and specificity for predicting significant neonatal hyperbilirubinaemia. ROC curve anlaysis revealed that a cut-off of UCB of 1.95 mg/dL resulted in an accepatable sensitivity and specificity for predicting significant jaundice requiring phototherapy at 75% and 68% respectively. ROC curve analysis revealed that Area Under Curve (AUC) for UCB levels of all babies for predicting jaundice requiring treatment was 0.765, 95% CI 0.592 to 0.937. Separate ROC analysis showed that AUC for UCB for predicting phototherapy in babies with blood group incompatibility (AUC 0.80, 95% CI 0.418 to 1.00) was more significant than the AUC for babies without blood group incompatibility (AUC 0.490, 95% CI 0.29 to 0.69). <b>Conclusion:</b> UCB has high predictability for significant jaundice requiring phototherapy. The prediction is more when babies with blood group incompatibility is considered compared to babies without blood group incompatibility. ]]> Comparative Cone Beam Computed Tomographic Evaluation of Conventional and Conservative Endodontic Access Cavity Designs on Pericervical Dentin Thickness and Fracture Resistance of Teeth: An In-vitro Study Aashray Patel, Vaishali Parekh, Chintan Joshi, Niraj Kinariwala, Sweety Thumar, Mona Somani, Ankita Khunt, Neelam Desai Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The concept of &#8216;extension for prevention&#8217; accelerates treatment processes but eliminates precious dentin at the pericervical area, resulting in biomechanically weakened tooth structure after endodontic treatment. Pericervical Dentin (PCD) is a new paradigm for endodontic success supports the idea that the amount of residual tooth structure is closely associated with long-term retention of the tooth and resistance to fracturing. <b>Aim:</b> To determine the impact of two endodontic access cavity designs and biomechanical preparation on the pericervical dentin thickness using 3D Cone Beam Computed Tomographic (CBCT) visualisation technique and fracture resistance of the maxillary anterior teeth under compressive load using universal testing machine. <b>Materials and Methods:</b> The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from October 2020 to March 2021. Study was carried out on the 30 single rooted freshly extracted maxillary central incisors and were randomly divided into two groups of conventional and conservative access preparation groups (n=15). Group 1 was conventional group, samples were accessed using endo access bur #1. Group 2 was conservative group, samples were accessed using CK micro-endodontic bur under a dental operating microscope. Cleaning and shaping was done using 17% Ethylenediamine Tetraacetic Acid (EDTA) as lubricant and 4% Hyflex CM rotary file system. The CBCT scans were taken preoperatively, following access cavity preparation and postobturation to evaluate the amount of pericervical dentin loss in mesial, lingual, facial and distal surfaces of the teeth at the levels of 1 mm to 4 mm above and below Cementoenamel Junction (CEJ). The samples were then loaded to fracture in the Universal Testing Machine, and the data were analysed using Independent sample t-test using Statistical Package for Social Sciences (SPSS) software version 20.0. <b>Results:</b> In comparison to the group 2, group 1 led to an increase in substantial tooth structure loss in the pericervical region. Among all surfaces, pericervical dentin loss was more pronounced on the lingual surface in the group 1 than in the group 2 (p-value <0.001). Higher fracture resistance was observed in group 2 (1136.75 N) compared to group 1 (687.22 N) under compressive load (p-value <0.001). <b>Conclusion:</b> Incisal cavity design is a less invasive method of accessing maxillary central incisors that preserves pericervical dentin. Under compressive load, pericervical dentin conservation provided greater fracture resistance in the conservative group than in the conventional group. ]]> Subclinical Hypothyroidism among Overweight and Obese Children: An Observational Cross-sectional Study Himanshu Verma, Ruchi Mishra, Smriti Rohatgi, Jyoti Bagla Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Subclinical Hypothyroidism (SH) is often treated by thyroxine hormone by general pediatricians considering deranged thyroid profile, attributing the derangement to be the cause of obesity. However, childhood obesity increases the risk of SH by means of adaptive mechanisms. <b>Aim:</b> To study the prevalence of SH and their lipid profile derangement in overweight and obese children of Indian population. <b>Materials and Methods:</b> The present study was a cross-sectional study conducted in which 60 children, between 5 to 15 years of age, presenting in Department of Paediatrics at ESI PGIMSR Basaidarapur, New Delhi, India from October 2019 to April 2021 were enrolled. The children were grouped into two with 30 in each-overweight (Body Mass Index (BMI) between 23<sup>rd</sup> to 27th adult equivalent) and obese (BMI more than 27<sup>th</sup> adult equivalent) children. They were assessed for biochemical derangement including thyroid profile and lipid profile. <b>Results:</b> The mean age of the study sample was 9.3 years and male/female was 41/19. Mean BMI of the obese children was 24.24 kg/m<sup>2</sup> and that of overweight was 20.4 kg/m<sup>2</sup>. Seven (23.33%) children in overweight group and nine (30%) in obese group were diagnosed with SH (normal T4 with high TSH level). Nine out of the total 16 children with SH also had dyslipidaemia. <b>Conclusion:</b> About 23% in overweight and 30% in obese children were found to have subclinical hypothyroidism. Nine out of these 16 children with subclinical hypothyroidism also had dyslipidaemia. ]]> Effect of Core Muscle Stabilisation Exercises on Disability Associated with Non Specific Low Back Pain in Postmenopausal Women: A Prospective Longitudinal Study Santosh Kumar Singh, Jigyasa Singh, Rahul Shankar, Snehashish Mukherjee, Rakesh Yadav Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Non Specific Low Back Pain (NSLBP) is a frequent problem faced by the majority of postmenopausal women at some stage of their lives, resulting in a significant level of disability. <b>Aim:</b> To evaluate the effectiveness of core stabilisation exercises compared to traditional physical treatment in postmenopausal women with NSLBP. <b>Materials and Methods:</b> A prospective longitudinal study was conducted from January 2022 to August 2022, including 50 postmenopausal women aged 45-60 years with NSLBP. They were placed into two groups. Conventional LBP physical therapy methods were administered to group 2. The identical traditional and Core muscle Stabilisation Exercises (CSE) were implemented in the group 1. The Modified Oswestry Disability Index (MODI) was used for the assessment of disability. The Mann-Whitney U test and Friedman Analysis of Variance (ANOVA) were conducted to analyse changes in disability scores across and among groups at the ends of the second, fourth, and sixth weeks of treatment. <b>Results:</b> Of 50 patients initially enrolled in the study, 33 patients were available for the final follow-up. Group 1 consisted of 16 patients, while group 2 had 17 patients. Significant reduction in disability was found across the two groups at the second, fourth, and sixth weeks of treatment (p-value<0.05). In the sixth week of treatment, group 1 had a statistically greater decrease in ODI score (41.16&#177;13.53) than group 2 (30.74&#177;13.28) (p-value =0.003). <b>Conclusion:</b> CSE were found to be more effective than conventional physical therapy in reducing disability associated with NSLBP in postmenopausal women. ]]> Assessment of Maxillary Sinus Floor Topography and Root Position of Maxillary Third Molars using Cone Beam Computed Tomography Jahangir Haghani, Maryam Rad, Sudeh Mohseni, Hamed Ebrahimnejad Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Maxillary sinuses have variable sizes. Knowledge of anatomic correlation between maxillary molars and sinus floor is essential for preoperative assessment in maxillary essment of posterior teeth. <b>Aim:</b> To assess maxillary sinus floor topography and root position of maxillary impacted third molar position using Cone Beam Computed Tomography (CBCT) imaging. <b>Materials and Methods:</b> This retrospective study was conducted on the 1080 CBCT images of the upper jaw of patients admitted to Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran, from March 2015 to December 2018. Among these, CBCT images that had atleast one maxillary impacted third molar were evaluated for the position, number and shape of roots and distance from the sinus floor. Data were analysed by Statistical Package for Social Sciences (SPSS) version 26.0, using the Pearson Chi-square test. <b>Results:</b> In the present study, of 1080 CBCT, 100 (9.26%) showed atleast one maxillary impacted third molar. Of 100 patients, 62% were women and the mean age of samples was 35.73&#177;10.27 year. The roots of 17 impacted molars (13.1%), protruded into the sinus cavity, and 18 (13.84%) of teeth had four roots. Distance from the sinus floor in the left and right-sides were 2.38&#177;0.15 and 2.33&#177;0.17 mm, respectively. Root distance from the alveolar crest in the left and right-sides were 3.40&#177;0.22 and 3.51&#177;0.27 mm, respectively. <b>Conclusion:</b> The results of the present study showed that roots of 51% of impacted third maxillary molars had a relation with the sinus floor. The most frequent tooth position was mesioangular. ]]> Intrathecal Hyperbaric Bupivacaine 0.5% with Varying Dose of Buprenorphine in Elective Adult Lower Limb Orthopaedic Surgeries: A Randomised Control Study Mohammed Irfan, Mohammed Mishal, Akil Hussain, Surya Prakash Chittora, Ganga Shankar Garg Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Postoperative pain is a universal phenomenon and usually under treated and its intensity varies widely among patients. Spinal anaesthesia with opioid and local anaesthetics to prolong postoperative analgesia is common practice in recent years. Buprenorphine is an agonist - antagonist opioid. Intrathecal buprenorphine (30-150 &#956;g) along with local anaesthetics is safe and known to increase the postoperative analgesia without affecting sensory or motor blockade and with lesser side effects. <b>Aim:</b> To compare the anaesthetic characteristics and its side effects in subarachnoid block with bupivacaine 0.5% heavy and varying dose of buprenorphine (90 &#956;g and 120 &#956;g). <b>Materials and Methods:</b> This randomised control study was conducted in the Jhalawar Medical College, Jhalawar, Rajasthan, India, from March 2019 to November 2019. The study included 90 patients belonging to American Society of Anaesthesiologists (ASA) class I and II of either sex age between 18 to 60 years posted for elective lower limb orthopaedic surgeries.The patients were divided into three groups; group A which included a patient count of 30 received plain hyperbaric bupivacaine 0.5% (2.5mL) with 0.5 mL saline. Group B which included 30 patients, receive plain hyperbaric bupivacaine 0.5% (2.5 mL) along with buprenorphine 90 &#956;g diluted in 0.5 mL saline. Group C with a patient count of 30 received hyperbaric bupivacaine 0.5% (2.5 mL) with buprenorphine 120 &#956;g mixed with 0.5 mL saline. Analgesic characteristics, haemodynamic parameters, side effects, sedation scores by Ramsay sedation score and pain scores by Visual Analogue Score (VAS) (0-10) were measured postoperatively till 24 hours.Statistical analyses of data were done by one Way Analysis of Variance (ANOVA) test and chi-square test where p-value less than 0.05 was considered to be a statistically significant value. <b>Results:</b> The onset time of sensory blockade (group A: 5.14&#177;1.34, group B: 4.54&#177;1.10, group C: 4.50&#177;1.18 in minutes), time of onset of motor blockade (group A: 10.10&#177;1.00, group B: 9.43&#177;1.30, group C: 9.21&#177;1.49 in minutes) and maximum level of sensory block at T6 level (group A: n-01/30, group B: n-04/30, group C: n-04/30) were comparable between the three groups and were not statistically significant. Sensory recovery time was significantly (p<0.0001) delayed in group B and C (178.9&#177;7.18 min and 189.23&#177;7.4), while in group A it was 152.86&#177;8.9 min. Duration of postoperative analgesia was significantly (p<0.0001) prolonged in group C (group A 165.53&#177;8.5, group B 391.49&#177;19.8, group C 493.23&#177;18 in minutes). Side-effects like Postoperative Nausea and Vomiting (PONV) and sedation were increased with dose of buprenorphine but easily treatable and not significant (p>0.05). <b>Conclusion:</b> A higher dose of buprenorphine shows to provide an adequate and longer postoperative analgesia without any major side effects. ]]> Implementation of Competency Based Medical Education Curriculum in Paediatrics for Phase 2 MBBS Undergraduates- A Descriptive Study S Revathy, V Sandhya, R Prabhavathi, Chejety Rakesh Reddy, M Govindaraj Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Adoption of Competency Based Medical Education-Undergraduate (CBME-UG) curriculum is made mandatory in medical colleges by National Medical Commission (NMC). CBME-UG curriculum enumerates the expected knowledge and skills in detail and it focuses more on observable outcomes that are important in day-to day medical practice. This curriculum holds the teacher as well as learner equally responsible in running the educational programme. <b>Aim:</b> To put forth the approach adopted in implementation of CBME-UG curriculum for phase 2 MBBS students in paediatric subject. <b>Materials and Methods:</b> This article describes the steps applied in transforming the traditional structured teaching method to the CBME method for undergraduate phase 2 MBBS students in the Department of Paediatrics at Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India, during January 2021 to December 2021. The duration of one year was divided into preimplementation phase (three months) and implementation phase (nine months). The faculty of the department, a coordinator to overview the programmeme, the postgraduate residents, and the students of phase 2 MBBS were the stakeholders identified in order to run the CBME-UG educational programmeme. <b>Results:</b> Preimplementation phase consisted of designing the department module and sensitisation of involved stakeholders. The contents of the module were curriculum planner for three years, time-table plan for phase II MBBS students, structuring of teaching sessions, designing the assessment method, and designing the feedback method. Implementation phase during clinical postings for the phase II MBBS students incorporated the strategies designed in preimplementation phase. The teaching sessions, assessment, the feedback sessions, and student-doctor programmeme were implemented with realistic and feasible planning. <b>Conclusion:</b> The CBME curriculum was successfully implemented among undergraduate second year medical students in term of student feedback and performance. It was noted that appropriate planning and sensitisation of students as well as the teachers, helped in running the programme smoothly. ]]> Suprapatellar versus Infrapatellar Approach for Intramedullary Nailing in Tibial Shaft Fractures: A Prospective Interventional Study Girish Sahni, Sukhjot Singh, Ashish Kavia, Hari Om Aggarwal, Harjit K Singh Chawla Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Tibial diaphyseal fractures are the most prevalent type of tibia fracture. A well known surgical method for treating tibial shaft fractures was the traditional infrapatellar approach for tibia Intramedullary Nailing (IMN). However, due to increased valgus and procurvatum deformities, IMN insertion through the infrapatellar route poses problems. Recently, suprapatellar nailing in the semi-extended position has been promoted as a safe and effective surgical treatment. <b>Aim:</b> To compare the clinical and functional outcomes of tibial shaft fractures treated with IMN utilising the Suprapattelar (SP) and Infrapatellar Methods (IP). <b>Materials and Methods:</b> A prospective interventional study was conducted on 40 patients, in the Department of Orthopaedics, in Government Medical College, Patiala ,Punjab, India from November 2019 to May 2021. The patients were divided into two groups on the basis of tibial shaft fractures treated with IMN utilising the S.P and those treated with I.P techniques during a two year period (20 in each group) with six months follow-up. Group A patients were treated with IMN in tibia through suprapatellar technique and group B Patients were treated with IMN in tibia via infrapatellar approach. The outcomes of IMN in tibial shaft fractures via SP and IP approach were compared in terms of fluoroscopy time, average surgical time, anterior knee pain using Visual Analogue Scale (VAS) score, average blood loss, fracture union time and functional outcome (in terms of the lower extremity functional Score). For statistical analysis student t-test and chi-square test was used, p-value <0.05 was considered as significant. <b>Results:</b> There were significant differences between SP and IP IMN in terms of fluoroscopy duration (94.25 vs 129.40 seconds, p-value-0.001), anterior knee pain (VAS score) (19.65 vs 29.85, p-value-0.001), average blood loss (49.30 vs 62.45 mL, p- value 0.001), and functional result (75.45 vs 70.05, p-value=0.001). The fracture union time between the two groups was non significant (90.50 vs 90.30 days, p-value=0.876). <b>Conclusion:</b> In terms of fluoroscopy time, anterior knee pain, average blood loss, and knee ratings, the SP technique was superior to the IP strategy. ]]> Role of Inflammatory Markers and Clinical Correlate in Children Infected with the Novel SARS-CoV-2: A Prospective Observational Study Amitabh Singh, Shruti Jain, Vikramjeet Dutta, Sumita Saluja, Rajni Gaind, Shobha Sharma Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Inflammatory markers have been used as predictors of adverse outcomes in adults with Coronavirus Disease-2019 (COVID-19) infection. Children mostly have mild infections and raised inflammatory markers have been reported only with severe COVID-19 or Multisystem Inflammatory Disorder (MIS-C). Studies in children showing the role of inflammatory markers in disease prognosis are few, and findings are not conclusive. <b>Aim:</b> To find out correlation, if any, between the inflammatory markers {Interleukin-6 (IL-6), C-reactive Protein (CRP), procalcitonin, Pro-B-type natriuretic Peptide (Pro-BNP), ferritin, D-dimer} with clinical presentation, prognosis, and outcome in children with acute COVID-19. <b>Materials and Methods:</b> The prospective, observational study was conducted at a tertiary care COVID-19 Paediatric Intensive Care Unit {PICU (Vardhaman Medical College and Hospital, New Delhi)}, Northern India, between September 2020 and December 2020. All children aged less than 12 years, with a positive COVID-19 report were enrolled and investigated. Data was collected for clinical presentation, severity, treatment and outcome. The following variables were recorded: Complete Blood Count (CBC), Kidney Function Test (KFT) and Liver function Test (LFT), Absolute Lymphocyte Count (ALC), Absolute Neutrophil Count (ANC), Neutrophil-lymphocyte Ratio (NLR), Platelet Count (PLT), C-reactive Protein (CRP), Procalcitonin (PCT), serum ferritin, Lactate Dehydrogenase (LDH), fibrinogen, and Erythrocyte Sedimentation Rate (ESR) and ProBNP. Coagulation parameters like Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), International Normalised Ration (INR), D-dimer were taken. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. <b>Results:</b> A total of 35 children were admitted during the study period. Seventeen children met the criteria for severe disease. Seven children met the criteria for MIS-C. Children presenting with conjunctivitis (n=3) were more likely to have signs of peripheral inflammation hypotension (n=4), tachycardia (n=6), and raised IL-6 levels (pg/mL) as well as the need for inotropic support. IL-6 values were higher in children (Mean&#177;SD= 182.47&#177;149.83). Median IL-6 value 199.8 (96.17-275.24) was highest in children with CRP <10 mg/dL (p-value<0.01). Children with raised D-dimer (Mean&#177;SD=1881.94&#177;1265.66 mg/dL) had a longer duration of stay (p-value=0.031). <b>Conclusion:</b> The study didn&#8217;t find any correlation between inflammatory markers with clinical presentation and the outcome of COVID-19 infection in children. ]]> Comparison of Primary Stability of Two Different Implants Designs- A Prospective Clinical Study A Veena Sravanthi, Prakash Manne, Haragopal Surapaneni Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Any implant treatment must begin with successful implant integration. The effectiveness of implant osseointegration is determined by various factors, including implant design, implant diameter and density, and surgical technique. Osseointegration is dependent on implant design. <b>Aim:</b> To assess the primary stability of tapered and cylindrical implants by using Resonance Frequency Analysis (RFA) and Insertion Torque Values (ITV). <b>Materials and Methods:</b> This in-vivo, prospective clinical study was conducted in the Department of Prosthodontics at Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India in the month of November 2019. Twenty patients were selected for the study. Tapered Bioline implants (Bioline Dental GmbH & Co. KG-Germany) were spaced in 10 patients (group 1) and cylindrical Bioline implants (Bioline Dental GmbH & Co. KG-Germany) in the other 10 patients (group 2). For both implant designs, primary stability was assessed immediately after implant placement using RFA by Osstell Mentor and ITV by a torque wrench. Kolmogorov-Smirnov test, Shapiro-Wilk test were used for checking normality. Mann Whitney U test, Independent t tests, Spearman correlation tests were done by using software Statistical Package for Social Sciences (SPSS) Version 23.0. <b>Results:</b> The mean ISQ (Implant Stability Quotient) for tapered implants was 76.6&#177;2.3, and for cylindrical implants mean ISQ is 59.75&#177;4.2 (p-value <0.001). The mean ITV for tapered implants was 43.5&#177;2.58 Ncm, and for cylindrical implants, the mean ITV was 33&#177;4.21 Ncm (p-value <0.001). The correlation between ITV and RFA was 0.928 which was highly significant (p<0.001**). <b>Conclusion:</b> Within the scope of this investigation, tapered implants showed better primary stability than cylindrical-shaped implants as determined by ISQ and insertion torque values. ITV and ISQ values showed a positive correlation in determining the primary stability of implants. ]]> Patient Satisfaction with Anaesthesia: Perioperative Questionnaire versus Face-to-face Survey Mathew George, N Kiran, M Ravi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Factors favouring patient satisfaction in anaesthesia are availability of services based on Institutional facilities, mutual between with anaesthesiologist and patients, skill of healthcare experts and patient requirements. When one wishes to improve response rates and raise the calibre of the data captured, face-to-face surveys are among the greatest methods for gathering data. It can be challenging to quantify subject satisfaction in anaesthesia, since subjective indications vary by person, culture and background. Patients rating of their own satisfaction can estimate the care given during procedure, which cannot be easily assessed in any other way. <b>Aim:</b> To assess patient satisfaction regarding the care provided during anaesthesia and to find out whether dissatisfactions are better elicited through face-to-face interviews or questionnaire. <b>Materials and Methods:</b> This cross-sectional study was conducted on patients undergoing surgery under general or regional anaesthesia at Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India, from November 2021 to February 2022. Estimated sample size was 74. As per American Society of Anaesthesiologist (ASA) grades 1 and 2, adults in the age group of 18&#8211;65 years were divided into two groups using chits. In group A, face-to-face interview was done on postoperative day 2 by anaesthesiology resident. In group B, questionnaire was given on postoperative day 2 by anaesthesiology resident. The questions on anaesthesia-related dissatisfaction were posed in a semi-dichotomous scale (no/yes-mild, moderate, severe); the questions on satisfaction with anaesthesia care were given on a 4-item scale (extremely satisfied/satisfied/neutral/dissatisfied). The data was analysed by using Statistical Package for the Social Sciences (SPSS) software version 22.0, and R environment version 3.2.2 and Microsoft word and Excel have been used to generate graphs and tables. <b>Results:</b> Patient population included in study was 74, among which 63 (85.1%) patients were extremely satisfied with the care given by Anaesthesia Department in general, 7 (9.5%) were satisfied, 4 (5.4%) were neutral, and no one were dissatisfied. Among questionnaire group 36 (97.3%) patients were extremely satisfied with anaesthesia care in general, while 27 (73%) of face-to-face group were extremely satisfied with anaesthesia care in general. Among anaesthesia related dissatisfactions 65 (87.8%) of patients did not complain of postoperative nausea and vomiting. In the present study, 52 (70.3%) patients were extremely satisfied with pain relief after surgery. <b>Conclusion:</b> Face-to-face interview identifies more patients who report lower degree of satisfaction with anaesthesia, it can be concluded that, interviewing is better suited for detecting quality problems with anaesthesia care than written questionnaire. ]]> Comparative Study of Outcomes of COVID-19 Infection in Vaccinated and Unvaccinated Patients- A Retrospective Analysis Bhaskar Kakarla, Swaroopa Deme, Sugunasree Aakula, Abhilash Naini, Radhika Soanker, Nageswara Rao Modugu, Raju YSN Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Vaccine development was the highest priority during the Coronavirus disease 2019 (COVID-19) pandemic. An ideal vaccine should decrease the risk of infection and reduce the incidence and severity of the disease. Risk of disease or infection following COVID-19 vaccination needs to be evaluated for its efficacy and effectiveness. <b>Aim:</b> To compare the severity of the disease, oxygen requirement, and mortality between vaccinated and unvaccinated COVID-19 patients. <b>Materials and Methods:</b> This retrospective study was done on the data of the patients who were admitted to Nizams Institute of Medical Sciences, Hyderabad, Telangana, India. All the admitted patients with COVID-19 disease, diagnosed by either Reverse Transcriptase Polymerase Chain Reaction (RTPCR) or rapid antigen detection method from April 2021 to October 2021, were included. Parameters recorded were: age, gender, co-morbidities, clinical staging as per institute protocol, vaccination status, oxygen requirement, the requirement of non invasive or invasive ventilation, inflammatory markers like C-Reactive Protein (CRP), ferritin, D dimer, Computed Tomography (CT) severity index, and outcomes. <b>Results:</b> The mean age of patients was 49.7&#177;14.8 yrs in the unvaccinated group, and 52.75&#177;16.2 yrs in the vaccinated group. Out of 175 patients, 102 (58.28%) were unvaccinated. There were 25 (14.28%) deaths, of which 20 (80%) were unvaccinated and 5 (20%) were vaccinated. Oxygen requirement was more among the unvaccinated 73/96 (76.04%). High flow oxygen/mechanical ventilation requirement was higher in unvaccinated compared to vaccinated, 38 (76%) vs 12 (24%), respectively (p-value <0.005). The mortality rate was higher in unvaccinated patients with co-morbidity, with an odds ratio of 3.32 (1.2-9.3), p-value=0.02. Serum ferritin levels were significantly higher in the unvaccinated group, 858.15&#177;935.5 vs 473.4&#177;663.2 ng/mL, p-value 0.007. CT severity index in the unvaccinated group was 13.82&#177;5.4, and for the vaccinated group, it was 11.58&#177;5.49. <b>Conclusion:</b> Severe disease, oxygen requirement, and mortality were low in vaccinated patients. Vaccination has also resulted in a statistically significant decrease in mortality in patients with co-morbidities. Serum ferritin levels were also found to be lower in vaccinated patients. ]]> <i>Acinetobacter Meningitis</i>: A Retrospective Study on its Incidence and Mortality Rates in Postoperative Patients at a Tertiary Care Centre in Northern India Mitra Kar, Akanksha Dubey, Romya Singh, Chinmoy Sahu, Sangram Singh Patel, Nida Fatima Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> <i>Acinetobacter</i> is a non fermenting, Gram negative bacillus, a causative pathogen of hospital-acquired infections due to its inherent Multidrug-Resistant (MDR) property. It is held responsible for the majority of nosocomial meningitis in patients undergoing neurosurgical procedures. <b>Aim:</b> To identify the clinical characteristics, drug-resistance and mortality rate among the patients suffering from meningitis caused by <i>Acinetobacter baumannii</i>. <b>Materials and Methods:</b> This retrospective, single-centre study was carried out in the Bacteriology section of the Department of Microbiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from February 2019 to February 2022. A total of 150 Cerebrospinal Fluid (CSF) samples from routine bacterial culture-confirmed patients were included in the study. All clinical data were extracted from the Hospital Information System (HIS). All the isolates were identified by Matrix Assisted Laser Desorption/Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay and antibiotic sensitivity testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. <b>Results:</b> The study included 150 (7.55%) cases of culture-proven bacterial meningitis among 1986 CSF samples collected from February 2019 to February 2022. There were 45 (30.0%) cases of <i>Acinetobacter</i> meningitis. Thirty-five (77.8%) patients had undergone neurosurgical procedures for the removal of space-occupying lesions from the brain parenchyma. Forty-two (93.3%) isolates were resistant to amikacin and a cumulative resistance of almost 93.3-95.6% was observed among cephalosporins. Fluoroquinolone resistance was observed in 43 (95.6%) patients and carbapenem resistance was observed in 42 (93.33%) isolates. Overall, 12 (26.7%) succumbed to their infections. <b>Conclusion:</b> <i>Acinetobacter</i> meningitis causes delay in the recovery of the patient undergoing intracranial surgery, amounting to a delay in brain parenchyma healing in the case of neurosurgical patients. ]]> Low Dose Bupivacaine (0.25%) with Fentanyl vs Ropivacaine (0.25%) with Fentanyl for Caudal Analgesia in Paediatric Patients: A Randomised Clinical Study Balwinder Kaur Rekhi, Parmod Kumar, Kanica Mishra, Manjeet Singh, Gurjit Singh Gandhi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Caudal epidural block is one of the most common regional techniques in paediatric anaesthesia for infraumbilical surgeries. Though bupivacaine is widely used because of its long duration, ropivacaine is a newly emerging drug having differential neuraxial blockade with less motor block and reduced cardiovascular and Central Nervous System (CNS) toxicity. To further increase the duration and quality various adjuvants have been added. <b>Aim:</b> To compare low dose bupivacaine-fentanyl with ropivacaine-fentanyl in terms of hemodynamic stability, duration of analgesia, postoperative pain, level of sedation, and side-effects profile among patients undergoing infraumbilical surgery. <b>Materials and Methods:</b> A double-blind, randomised study was conducted on 60 children undergoing elective infraumbilical surgery. Patients were randomly divided into two groups of 30 each into Bupivacaine-Fentanyl (BF) group and Ropivacaine-Fentanyl (RF) group, using a simple envelope method. After securing airway, caudal block was given. Group BF received 0.25% bupivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg and Group RF received 0.25% ropivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg. Postoperative pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale, for 12 hours. The hemodynamics, duration of analgesia, rescue analgesia requirement and side effects (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) were noted and analysed statistically. <b>Results:</b> The mean duration of analgesia in the BF group was 270&#177;46.60 minutes and in the RF group was 430&#177;68.83 minutes (p-value <0.001). Patients requiring rescue analgesia were 12 in Group BF and 5 in Group RF. Mean FLACC reached &#8805;4 at 4.5 hours in group BF and at 7 hours in group RF. There was no significant difference in hemodynamics and side-effects profile (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) between the two groups. <b>Conclusion:</b> Low dose caudal ropivacaine-fentanyl combination is superior to that of caudal bupivacaine-fentanyl with respect to duration and intensity of intraoperative and postoperative analgesia. ]]> Identification of Predictors for Late or No Registration of Pregnancy by Selecting an Appropriate Logistic Model after Comparing ANC Visits and Skilled Birth Attendant Pawan Dubey, Akash Mishra, Neelima Alka Singh, Rabindranath Mishra, Sachit Ganapathy Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> India is a major contributor to both maternal and neonatal death worldwide. Majority of these fatalities can be averted by adequate utilisation of Antenatal Care (ANC) services. Large scale surveys like National Family Health Survey follow hieratical characters in which subjects within the clusters are often correlated. The ordinary logistic model ignores this correlation and provide compromised estimate of effect size of predictors. Multilevel model that incorporates correlation is the appropriate method. <b>Aim:</b> To demonstrate the adequacy of multilevel logistic model over ordinary logistic model in hieratical data sets with ANC visits >4 and delivery assisted by Skilled Birth Attendant (SBA). <b>Materials and Methods:</b> This retrospective, cross-sectional study was conducted at the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from October 2021 to March 2022. The data of 174607 women, who delivered the children within five years, obtained using cluster sampling, from country wide survey during 20th January 2015 to 4th December 2016 (India&#8217;s National Family Health Survey-IV) was used. Firstly, the model adequacy of ordinary and multilevel logistic models was evaluated for ANC >4 visits and delivery assisted by SBA, the same data set of fourth round National Family Health Survey by considering the outcomes;. Thereafter, predictors of late or no registration of pregnancy were identified using three level logistic model. <b>Results:</b> Because of high Variance Partition Coefficients (VPC) at state and district levels, the multilevel model applied on components ANC >4 visits and delivery assisted by SBA suggested better accuracy of the multilevel logistic model (-2Log L=189334 for ANC >4 visits and 141148 for delivery assisted by SBA) than the ordinary logistic model (-2Log L=220268 for ANC >4 visits and 151978 for delivery assisted by SBA). For the late (registration in third trimester of pregnancy) or no registration of pregnancy, each predictor was found significantly associated in which the most important were women&#8217;s education, child birth order, caste and wealth quintile. <b>Conclusion:</b> The present study concluded that multilevel logistic model in clustered design data was useful instead of individual level for more precise estimate of effect size of the predictors. ]]> Acyclovir with Steroid and Steroid Alone in the Treatment of Idiopathic Facial Nerve Palsy: A Randomised Double-blinded Clinical Study from a Tertiary Care Centre, Chennai, India SR Karthika, K Priya, S Rajasekaran, D Balaji Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introdutcion:</b> Idiopathic palsy of facial nerve is an acute disease which causes lower motor neuron palsy characterised by facial asymmetry leads to psychological effects and limits one&#8217;s social life. Steroids are very effective in the management of Bell&#8217;s palsy. The usage of antiviral is still in debate due to the idiopathic aetiology of Bell&#8217;s palsy. <b>Aim:</b> To evaluate the efficacy of acyclovir with steroid and steroid alone in the management of Bell&#8217;s palsy with respect to the recovery time. <b>Materials and Methods:</b> The randomised double-blinded clinical study was conducted in the Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, from September 2021 to February 2022 among 100 patients with idiopathic facial nerve palsy. Patients were divided into two groups, 50 patients in each. One group treated with acyclovir (400 mg oral five times daily) and methylprednisolone (1 mg/kg/day), and other group treated with steroid alone. Both the groups received physiotherapy in the Department of Physiotherapy and taught about home facial exercises. The patients were on regular follow-up for six months to monitor the time of the recovery. House-Brackmann grading system was used for initial assessment and monitor the recovery of the patient. The improvement of House-Brackmann grade to I or II was considered a satisfactory recovery. The association between two groups were assessed by Chi-square test (&#967;2), repeated measures and paired t-test. The statistical significance was considered when p-value <0.05. <b>Results:</b> Out of 100 patients, 52 patients were male and 48 were female, while the age range was 19-58 years. At two months, 43 (86%) patients recovered in the combination group and 41 (82%) in the steroid alone group (p-value=0.038). At six months, 48 (96%) patients recovered in the combination group and 42 (84%) in the steroid alone group (p-value=0.178). The overall recovery rate was higher in the combination group (96%) compared to steroid alone group (84%). <b>Conclusion:</b> The combination of acyclovir with steroids in the treatment of Bell&#8217;s palsy has better recovery compared to steroid alone therapy. ]]> Morningness-eveningness Preferences among Medical Students: A Cross-sectional Study Anju Sharma, Navneet Kumar Kaushik Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Morningness and eveningness is a phenomenon which looks at the differences among the individuals regarding their diurnal preferences, sleep-wake pattern of activity and alertness in evening or morning. Morning chronotypes are individuals who exhibit morning tendencies like rising early in the morning while evening chronotypes prefer to get up later in the morning and stay awake later at night time and also perform their best during late afternoon or evening. Morning chronotypes are known to exhibit better physical and mental health, greater self-esteem and academic performance. <b>Aim:</b> To estimate the prevalence of morningness and eveningness among medical students. Association of chronotype with academic performance was also determined. <b>Materials and Methods:</b> The present cross-sectional study was conducted on 110 apparently healthy medical students at Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India from October 2021 to January 2022. All the participants were sent a validated Morningness-Eveningness self-assessment Questionnaire (MEQ). Data of chronotypic preferences expressed as frequencies of participants (%) and association determined using Pearson&#8217;s Chi-square test and p-value <0.05 was considered statistically significant. <b>Results:</b> Study revealed that 67 (61%) students belonged to the Intermediate (I) chronotype, around one-fourth {26 (24%)} were Morning (M) type while 17 (15%) were Evening (E) type. Morningness was more frequently reported by females as compared to males in 8 (28%) vs. 18 (22%), respectively. Higher scores (&#8805;50%) were more prevalent among M types as compared E types in 10 (38%) vs. 3 (18%), respectively}; however, association between chronotype and academic performance could not reach significant level (p-value=0.15). <b>Conclusion:</b> The distribution of chronotypes in study sample provided the evidence that majority of students could be classified as intermediate type. Morningness was more frequent in females as compared to males. Further studies with large sample size are needed to explore the influence of chronotype on academic performance. ]]> Association of Serum Calcium and Serum Uric Acid Level with Inflammatory Markers to Predict the Outcome of COVID-19 Infection: A Retrospective Study BN Kruthi, N Asha Rani, D Namitha Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Novel Coronavirus Disease 2019 (COVID-19) is an acute respiratory disease and the severity of COVID-19 is highly variable, ranging from asymptomatic infection to life-threatening disease. Therefore, biomarkers are required to assess the prognosis of the disease at the earliest. <b>Aim:</b> To determine the correlation of serum calcium and serum uric acid levels with inflammatory markers of COVID-19 infection and also to assess serum calcium and serum uric acid levels in predicting the outcome of COVID-19 infection. <b>Materials and Methods:</b> A retrospective study was conducted in Adichunchanagiri Institute of Medical Sciences, B.G Nagara, Karnataka, India from 1st April 2021 to 30th June 2021. Out of 483 COVID-19 infected patients admitted during the study period, data of 136 patients, investigated for serum calcium and serum uric acid levels were collected from medical records. Patients were categorised into survived and non survived group based on the outcome. Descriptive statistics, Analysis of Variance (ANOVA) test, Student&#8217;s t-test were applied. Receiver Operating Characteristic (ROC) curve was used in predicting the outcome of COVID-19 infection. <b>Results:</b> Of the 136 COVID-19 positive patients, 87 were male and 49 were female patients. Mean age of non survived was significantly higher (59.19&#177;12.6 years) as compared to survived patients (44.44&#177;13.35 years). Further, Random Blood Sugar (RBS), C-Reactive Protein (CRP), Lactate Dehydrogenase (LDH) and D-dimer values were significantly higher among non survived patients (233&#177;135.37 mg/dL, 9.92&#177;3.93 mg/L, 422.88&#177;191.51 IU/L and 586.19&#177;258.9 ng/mL, respectively) as compared to survived patients. Significant positive correlation was found between serum uric acid levels with LDH (r-value=0.231; p-value=0.007). Whereas, serum calcium showed negative correlation with CRP (r-value=-0.55; p-value=0.526) and D-dimer (r-value=-0.052; p-value=0.551). The ROC curve analysis showed that area under curve for serum uric acid level (0.530) was more as compared to serum calcium (0.460). <b>Conclusion:</b> Serum uric acid is emerged as a better biomarker towards the prediction of outcome of patients. Early evaluation of serum calcium levels and serum uric acids could aid in predicting the outcome of the disease. ]]> Pure Tone Audiometry Findings before and after Radiotherapy in Head and Neck Cancer Patients: A Hospital-based Prospective Interventional Study MD Taher Ahmed Mazumder, Jyotirmoy Phookan, Nabajyoti Saikia, Monikuntal Sarmah Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Radiotherapy is still the major treatment modality for Head and Neck malignancies preferred by patients as well as surgeons. Temporal bone and brain stem are mostly included in the portals. So the middle ear, inner ear and brain stem may receive a significant radiation dose causing hearing loss. <b>Aim:</b> To study the effect of radiotherapy on hearing in patients with head and neck cancer. <b>Materials and Methods:</b> This study was a hospital-based prospective interventional study, done in Assam Medical College and Hospital, Dibrugarh, Assam, India, from 1st July, 2020 to 30th June, 2021. A total of 33 patients with head and neck malignancies receiving radiotherapy as a mode of treatment attending Ear Nose Throat (ENT) Outpatient Department (OPD) and Department of Radiation Oncology were included. Pure Tone Audiometry was done for hearing assessment before and after radiotherapy. Microsoft excel version 2010 was used for recording the data. <b>Results:</b> A total of 66 ears (33 patients) have been evaluated. Out of 33 patients, 29 patients (87.88%) had decreased hearing in one/both the ear after radiotherapy. Out of 29 patients, 19 patients (65.51%) had hearing loss less than 10 dB whereas, 10 patients (34.49%) had hearing loss >10 dB, which is considered as significant hearing loss. Among the 19 patients, 3 patients (15.78%) had hearing loss <10 dB on the same ear, i.e. on the same side of malignancy where the radiotherapy was given. Other 16 patients (48.48%) had hearing loss on both ear. <b>Conclusion:</b> Effect of radiotherapy with or without chemotherapy on hearing is a well known phenomenon. This study also established the fact of hearing loss in majority of patients receiving radiotherapy. ]]> Correlation of Lactate Dehydrogenase Level with Severity of Disease and In-hospital Outcome in Individuals Diagnosed with COVID-19: A Retrospective Study Kawther Ghassan Bohuliga, Wijdan Hasan Alkhidady, Naif Khalid Alqannas, Mohammed Ahmed ­Alghamdi, Ammar Hassan Alnemer, Intisar Ahmad Siddiqui, Faris Hussain Alameer, Tarek Ezzeldin Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The presence of tissue damage in the lungs, kidneys, heart, or other organs can be detected by monitoring the level of Lactate Dehydrogenase (LDH) in the blood and considered a reliable biomarker in early prediction of patients&#8217; prognosis. <b>Aim:</b> To determine extent of correlation between LDH level with the spectrum and in-hospital outcome of Coronavirus Disease-2019 (COVID-19) infected patients. <b>Materials and Methods:</b> This retrospective research was undertaken during March 2020 to May 2020, based on the data of 205 COVID-19 infected patients, reported at Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. Patients&#8217; records were retrieved and the following data were recorded-age, gender, nationality, co-morbidities, lactate dehydrogenase level, number of days since the patient tested positive (upto 7,14 and >14 days), COVID-19 symptoms [mild, moderate, or severe as per British Thoracic Society guidelines (CURB (Confusion, Blood Urea Nitrogen, Respiratory Rate, Blood Pressure)-65)]. The data was collected and tabulated as mean&#177;SD, frequency and percentages. Analysis was carried out using specialised software of Statistical Package for Social Sciences (SPSS) version 20.0. <b>Results:</b> On analysis of the collected data of all 205 included patients, the LDH level was found significantly high among males, 46-60 years old, and among non Saudi patients. The severity of COVID-19 symptoms and LDH levels were found to have a strong relationship (p-value <0.001). Patients between the ages of 46 and 60 were more likely (4.3 times) to have poor outcomes, and diabetes mellitus was predicted to be 2.32 times more likely to be associated with poor COVID-19 outcomes. Raised LDH levels were >5 times more likely to lead to in-hospital poor outcomes compared to those with borderline LDH levels. <b>Conclusion:</b> The LDH level is a reliable predictor for the cause of COVID-19. The results of the present study suggest that patients aged 46-60 years, diabetic patients, or those suffering from severe symptoms of COVID-19 have raised levels of LDH. ]]> Effect of 3% Grape Seed Extract on the Bond Strength of Bleached Enamel with Natural and Commercially Available Bleaching Agents: An In-vitro Study Yandra Lakshmi Suvarna, Garlapati Roopadevi, Bolla Nagesh, Vemuri Sayesh, Bandaru Pydiah Naidu, K VNS Sruthi, Mayana Aameena Banu, Shaik Aafreen Kamal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Following bleaching with natural and commercial bleaching agents, to reverse the bond strength of enamel various antioxidants are used. The 3% Grape Seed Extract (GSE) has been more potent to be used as an antioxidant and has shown the immediate improvement in the Shear Bond Strength (SBS) values. <b>Aim:</b> To evaluate the effect of 3% GSE as an antioxidant on the bond strength of bleached enamel with natural {Sweet Potato Extract (SPE)}, commercial {35% Hydrogen Peroxide (H<sub>2</sub>O<sub>2</sub>)} bleaching agents. <b>Materials and Methods:</b> This experimental in-vitro study was conducted at Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India, over a period of one week in January 2021. According to the bleaching agent used, the labial surfaces of 40 extracted maxillary central incisors have been divided into two groups. Group I (n=20) include teeth bleached by SPE (natural) for about 30 minutes. Group II (n=20) included teeth bleached using 35% H<sub>2</sub>O<sub>2</sub> (Pola office) for about eight minutes. Each group were again divided into two subgroups (n=10) based on the application of 3% GSE. After bleaching procedures, composite resin cylinders were bonded incrementally on the labial surface and stored in artificial saliva at 37&#176;C for 24 hours. The samples were subjected to SBS under Universal Testing Machine. Data obtained were analysed using One-way Analysis Of Variance (ANOVA) and Tukey&#8217;s post-hoc test. <b>Results:</b> On comparison of mean SBS values, statistically significant difference (p-value <0.05) was observed in all groups. The SBS values observed in 35% H<sub>2</sub>O<sub>2</sub> bleached teeth were highly significant than the teeth bleached using 3% GSE application. <b>Conclusion:</b> Application of 3% GSE immediately after bleaching the enamel surfaces, neutralises the deleterious effects of bleaching and increases SBS significantly. ]]> Prevalence of Odontogenic Tumours: A Study of 122 Cases among Karnataka Population J Chandrakala, NS Sahana, G Suganya, Jyoti Tahasildar, Maji Jose, Jeevitha Murugesh, S Renuga, Rhea Verghese Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Tumours arising from odontogenic tissues are rare and constitute a heterogeneous group of interesting lesions. Studies on incidence of Odontogenic Tumours (OT) published from many countries show a distinct geographic variation. <b>Aim:</b> The aim of present study was to compare and correlate the frequency of individual OT in India as well as the other parts of the world based on 2005 World Health Organisation (WHO) classification. <b>Materials and Methods:</b> This Institution-based retrospective study conducted in Department of Oral Pathology and Microbiology at Government Dental College and Research Institute, Bengaluru, Karnataka, India, from April 2015 to September 2016. Total of 122 cases of odontogenic tumours documented in duration of 10 years (2005 to 2014) were categorised based on WHO 2005 classification. The histological type, age, gender, anatomical site and symptoms were systematically tabulated. <b>Results:</b> Odontogenic tumours constituted 9.5% (122 cases) of the total oral biopsies (1284 cases) received in a 10-year period. Among these, 95.9% of the tumours were benign and 4.1% were malignant. The most frequent tumour being ameloblastomas 39.3% followed by keratocystic odontogenic tumour 35.2%, odontome 4.9%, calcifying cystic odontogenic tumour 4.9% and adenomatoid odontogenic tumour 4%. While odontome, generally regarded as the most frequent OT in American and European countries, only accounted for 4.9%, the third most common tumour in the present study. The mean age of patients was 32.37 years (range: 9-70 years). Their exist a slight male predominance, more predilection to posterior region of mandible and majority of tumours presented with pain and swelling. <b>Conclusion:</b> The relative frequency of odontogenic tumours reported in our Institution was similar to the studies reported in India, Asian and African population, but differs from that of European and American countries. There is a definite geographic variation in the prevalence of OT published worldwide. ]]> Comparative Evaluation of the Efficacy of Gingival Crevicular Blood with Finger Capillary Blood and Venous Capillary Blood to Assess Blood Glucose Levels for Screening of Diabetes Mellitus in Chronic Periodontits Patients: A Cross-sectional Study Chandni Patel, Vallari Shah, Bela Dave, Sapan Patel, Shreya Gajjar, Tanvi Hirani, Gaurav Girdhar, Surabhi Joshi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Diabetes mellitus is defined as a clinically and genetically diverse cluster of illnesses involving conflict in carbohydrate and protein metabolism. Periodontitis is a complex condition with several causes. The interaction between these two conditions appears to be cyclical as well as bidirectional. Gingival crevicular blood obtained through routine periodontal oral assessment could be utilised for blood glucose estimation. <b>Aim:</b> To examine the efficacy of gingival crevicular blood elicited during routine periodontal probing, as a reliable source for screening of diabetes mellitus, and to compare it with finger capillary blood and venous capillary blood in chronic periodontitis patients. <b>Materials and Methods:</b> This cross-sectional, in-vivo, clinical study was conducted in the Department of Periodontology at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from January 2021 to January 2022. The study included 50 patients, who were diagnosed with chronic periodontitis in the age range &#8805;30 years, and met the inclusion and exclusion criteria. A prior detailed history was compiled. The clinical parameters recorded were sulcus bleeding index, plaque index, gingival index, probing pocket depth, and clinical attachment level. Each patient&#8217;s blood samples were collected from three different sites, Gingival Crevicular Blood (GCB) collected from gingival crevice, Finger Capillary Blood (FCB) collected from finger bed and and Venous Capillary Blood (VCB) collected from forearm for determining the blood glucose levels. Glucose levels were compared by one-way Analysis of Variance (ANOVA). Karl Pearson&#8217;s correlation was used for the comparison. Statistical Package for Social Sciences (SPSS) version 26.0 was used for statistical analysis and p-value &#8804;0.05 was considered as statistically significant. <b>Results:</b> The mean Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) was 5.5&#177;0.61 mm and 6.76&#177;0.82 mm, respectively. The mean Plaque Index (PI) and Gingival Index (GI) score was 1.41&#177;0.25 and 1.45&#177;0.21, respectively. The mean GCB, FCB, and VCB glucose level of the subjects were 171.58&#177;85.63 mg/dL, 179.14&#177;80.31 mg/dL and 186.96&#177;87.57 mg/dL, respectively. There was no statistical difference seen among the three methods, thus, either of the methods can be used for measuring blood glucose levels for screening of diabetes mellitus in chronic periodontitis patients (p-value=0.66). Posistive correlation between FCB and VCB (r-value=0.976, p-value <0.001). VCB and GCB, when correlated showed strong positive and highly statistically significant results (r-value=0.934, p-value <0.001). Similarly, GCB and FCB showed a positive correlation (r-value=0.920, p-value <0.001) which was statistically highly significant. <b>Conclusion:</b> The results suggested that, the efficacy of gingival crevicular blood when compared with finger capillary blood and venous capillary blood glucose levels showed positive correlation, suggesting either can be used in dental clinics for diabetic screening purpose without any extra invasive procedures. ]]> Laminin 332: A New Hope as a Prognostic Marker in Triple Negative Breast Carcinomas Gayatri Rath, Sushanta Kumar Singh, Ashok Kumar Panda Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Laminin expression is supposed to be associated with a number of invasive carcinomas, particularly squamous cell carcinoma of the oral cavity and uterine cervix. Overexpression of laminin is seen in a high proportion of triple negative breast carcinomas, which is associated with an unfavourable clinicopathological state and poor prognosis. <b>Aim:</b> To evaluate the role of laminin 332 expression as a prognostic marker in triple negative breast carcinomas. <b>Materials and Methods:</b> This prospective study was conducted in the Department of Pathology, SCB Medical College, Cuttack, Odisha, India, during the period from January 2018 to December 2020. Total number of histologically diagnosed breast carcinoma cases reported was 322, over a span of two years. Out of which, 59 cases showed Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal growth Receptor 2 neu (HER2neu) negativity. These triple negative breast carcinoma cases were further subjected to laminin immunostaining, excluding three due to lack of sufficient tissue. The results were interpreted and represented in a tabular manner taking into account the clinicopathological manifestation, tumour grading and correlation with laminin expression. <b>Results:</b> Only the 56 triple negative breast carcinomas were subjected to laminin immunostaining. Majority 50 (89.28%) were elderly patients above 50 years of age. Also, a higher proportion of cases i.e. 36 (64.29%) were grade 3 tumours. Histopathologically, 55 (98.21%) cases were Infiltrating Duct Carcinomas (IDC). Lymph node metastasis and lymphovascular invasion were found in 32 (57.14%) and in 36 (64.29%) cases respectively. Laminin was strongly positive in those with higher grade (grade-3) tumours 24 (66.67%), those with lymph node involvement 17 (53.12%) and those showing lymphovascular invasions 28 (77.78%). <b>Conclusion:</b> Laminin immunostaining is an important prognostic marker in a number of epithelial malignancies. This study was intended to predict the role of laminin as a prognostic biomarker in the triple negative breast carcinoma cases. ]]> Correlation of Six Minute Walking Test, Sit to Stand Test and Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease V Meghashri, A Raveesha, Guruprasad, Charchit Mehta, Manchu Deepthi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Assessment of functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients helps in determining the severity of the disease. While spirometry is the gold standard, six Minutes Walk Test (6MWT) and one minute Sit To Stand Test (STST) are simple and practical tests to assess exercise capacity and physical condition. <b>Aim:</b> To find the diagnostic accuracy of these of 6MWT and one minute STST in comparison with spirometry. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Department of General Medicine at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, from January 2019 to December 2019. All cases of COPD diagnosed using GOLD 2018 criteria were included in the study. Patients performed 6MWT and one minute STST. Heart rate, blood pressure, oxygen saturation, SpO2, dyspnea, and fatigue (Borg scale) were noted pretest and post-test. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. A p-value<0.05 was considered statistically significant. <b>Results:</b> The mean age of the patients was 64.09&#177;8.31,while there were 112 (94.9%) males and 6 (5.1%) female. Overall, 81.54% of the participants had severe/very severe COPD group, walked <332.49 meters, and only 18.46% could walk more than 332.50 m. SpO<sub>2</sub> decreased from 93.98&#177;0.82 to 91.75&#177;1.39. During the one minute STST SpO<sub>2</sub> decreased from 93.98&#177;0.82 to 91.75&#177;1.39. A positive correlation was observed between the one minute STST, and it had good predictive validity in predicting COPD as compared with spirometry (area under the curve of 0.915 95% CI 0.866 to 0.963, p-value <0.001). 6MWT has a sensitivity of 81.54%, the specificity of 79.25%, and one minute STST had a sensitivity of 89.23%, specificity of 67.92% in predicting COPD. <b>Conclusion:</b> In a remote clinical setting where spirometry is not available, 6MWT and one minute STST are the best methods for assessing COPD severity. ]]> Prevalence of Psychiatric Morbidity and their Clinical Correlates in Patients Post COVID-19: A Cross-sectional Study from Rural Northern India Abhishek Pathak, Rohit Pathak, Nitin Ranjan Gupta, Piyush Chopra Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Myriad of complications were observed in post Coronavirus Disease (COVID-19) survivors, psychiatric morbidities among one of them. Recent body of research has shown that significant number of patients developed psychological symptoms following COVID-19. Most of the Indian studies have assessed psychological morbidity among COVID-19 patients during admission. However, very few Indian studies have assessed the psychological impact of COVID-19 during the follow-up period, especially in rural India. <b>Aim:</b> The study aimed to determine the prevalence of depression and anxiety and evaluate related socio-demographic (age, gender, education, occupation and marital status) and clinical factors (severity of COVID-19, presence of medical co-morbidity, Oxygen requirement, Intensive Care Unit (ICU) referral, duration of admission) in patients post-COVID-19. <b>Materials and Methods:</b> This was a cross-sectional study conducted at Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India. among 96 patients post-COVID -19 after their discharge from the hospital. Data collection was done between July 2021 to September 2021, using a semi-structured proforma and a psychiatric diagnosis was made (based on International Classification of Diseases- 10th Edition Diagnostic Criteria for Research criteria and clinically approved by two qualified psychiatrists). Rating scales such as Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were used for severity assessment. Data was analysed using Microsoft Statistical Package for Social Sciences (SPSS) version 20.0. A p-value of <0.05 was considered significant. <b>Results:</b> In 96 patients, 70 (72.91%) were males. 38 patients (39.58%) were of the age group 45-60 years. 36 (37.50%) patients had Depression. Anxiety was seen in 40 (41.66%) participants. Among the clinical variables, the severity of the COVID-19 infection (p-value<0.01), presence of co-morbidity (p-value<0.01), and ICU referral (p-value<0.01), were found to be associated significantly with the presence of depression in the participants. Among 36 depressive patients, mild depression was present in 17 (47%), moderate depression in 12 (33%), severe depression in 5 (14%) and very severe in 2 (6%) of the participants. Anxiety was associated significantly with the gender (p-value=0.02), co-morbidity (p-value<0.01), severity of illness (p-value<0.01), oxygen requirement (p-value=0.04) and ICU admission (p-value<0.01). Mild anxiety was observed in 18 (45%), moderate anxiety in 16 (40%) and severe anxiety in 6 (15%). <b>Conclusion:</b> The prevalence of depression and anxiety is high in patients post COVID-19. The severity of these disorders is significantly associated with presence of medical co-morbidity and severity of COVID-19. Hence, thorough evaluation and management of these disorders in post-COVID-19 patients can help in improving the overall outcome. ]]> Impact of Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth Prepared by Hero Shaper and RaCe File Systems: An In-vitro Study Sonali Subhash Kinikar, Sharad Kamat, Santosh Hugar, Tanvi Kadu, Divya Makhijani Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Tooth fracture is one of the most undesirable phenomena in Endodontically Treated Teeth (ETT) and usually leads to tooth extraction. Basically, removal of any hard tissue from the canal walls raises the chance of root fracture. <b>Aim:</b> To evaluate the impact of root canal taper on fracture resistance of ETT prepared by two different file systems (Hero Shaper and RaCe file systems). <b>Materials and Methods:</b> This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli and Praj Metallurgical Laboratory Pune, Maharashtra, India, frome February 2021 to November 2021. The study included 44 freshly extracted mandibular premolar teeth were randomly divided into four groups. Group 1a had Hero Shaper 4%, group 1b had 6% Hero Shaper, group 2a had RaCe 4% and group 2b had RaCe 6% file system. After cleaning and shaping the root canals, obturation was completed using cold lateral compaction and root canals were embedded in standardised autopolymerising acrylic resin blocks, subjected to a vertical load in universal testing machine to cause vertical root fracture. The forces required to induce fractures were measured in Newtons. Data was analysed by using independent t-test and two-way Analysis of Variance (ANOVA) test for intergroup comparison. A p-value&#8804;0.05 was considered as statistically significant. <b>Results:</b> Among instrumented groups, group 1a (Hero Shaper 4%) showed higher fracture resistance of 372.5 Newtons and group 2b (RaCe 6%) showed lowest fracture resistance of 314.56 Newtons as compared to other groups. Statistically significant difference (p-value=0.026) was seen in the mean fracture resistance among the group 1a and 1b, and group 2a and 2b. At pair wise comparison there was statistically significant difference in group 1a and group 2a (p-value=0.016). <b>Conclusion:</b> Amongst the instrumented groups, Hero Shaper file system showed the higher fracture resistance, than RaCe file system. Marked reduction in fracture resistance of ETT was seen with the use of greater taper instruments. ]]> Preprocedural Nebulisation with 4% Lignocaine and Ketofol Sedation during Endoscopic Retrograde Cholangiopancreatography Procedure for Abolition of Gag Reflex: A Randomised Double-blinded Study Dandub Gialchhen Negi, Arti Sharma, Sonam Norbu, Jyoti Pathania, Brij Sharma Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Endoscopic Retrograde Cholangiopancreatography (ERCP) is preferably carried out under deep sedation with propofol alone or with adjuncts to reduce the dose of propofol thereby reducing the intraprocedural complications and improving the patient and endoscopist acceptance of the procedure. There is no consensus on the ideal dose of ketamine as adjunct to propofol to be used in such scenario. <b>Aim:</b> To evaluate the sedation characteristics, abolition of gag reflex and haemodynamic profile of the patients undergoing ERCP under ketofol sedation, with or without 4% lignocaine prenebulisation. <b>Materials and Methods:</b> This randomised double-blinded study was undertaken in Indra Gandhi Medical College, Shimla, from September 2018 to October 2019. Sixty patients of American Society of Anaesthesiologists (ASA) physical class I and II aged between 25-65 of both sexes posted for routine ERCP were included. In group 1, patients were nebulised with 6 cc normal saline, and group 2 with 6 cc 4% lignocaine 15 min prior to procedure in the recovery room. Entropy-guided ketofol induction (ketamine and propofol used in 1:2 concentration) was used, followed by propofol infusion at the rate of 8 mL/hr. Gag reflex, haemodynamic and sedation characteristics were observed peri and postoperatively. <b>Results:</b> The mean time to onset of sedation and duration of recovery room stay were comparable in both the groups. Total mean dose of propofol and ketamine used was 105.67 mg, 55.33&#177;18.75 mg in group 1 and 101.83 mg, 48.67&#177;15.588 mg in group 2. Gag reflex was similarly obtunded and endoscopists&#8217; rating of the procedure were similar in both the groups perioperatively (p-value >0.05). <b>Conclusion:</b> Target controlled entropy guided infusion with ketofol is an effective drug combination to achieve all aspects of safe sedation practice in ERCP procedure. ]]> Assessment of Behavioural Preparedness on Recovery Outcomes in Patients Undergoing Abdominal Surgeries KS Uplabdh Gopal, Shreya Vikas Venurkar, Aditij Dhamija, Suhas Narayandas Jajoo Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> Behavioural preparedness is the process of preparing patients for the psychological and emotional challenges that may be encountered during and after surgery. This can include providing education about the surgical procedure and postoperative recovery, as well as training in coping strategies and techniques to manage anxiety, fear, and other negative emotions. Prior sensitisation is a form of behavioural preparedness that involves providing patients with information about the potential outcomes of their surgery in advance, in order to help them better understand and prepare for potential challenges. It has been suggested that providing this type of education and training may reduce patient anxiety, increase co-operation with medical staff, and improve recovery, potentially leading to shorter hospital stays and reduced medication needs. <b>Aim:</b> To assess the effects of behavioural preparedness and prior sensitisation on psychological aspects, recovery outcomes, and user satisfaction in patients undergoing abdominal surgeries. <b>Materials and Methods:</b> The study will be undertaken on patients in the Inpatient Department (IPD) of Department of Surgery in a rural tertiary care hospital in central India, during a period spanning two months. All adult patients (aged 18-60) undergoing elective abdominal surgical procedures under anaesthesia in the IPD of surgery will be eligible. The patients will be randomly selected and interviewed preoperatively, dividing them into two groups those receiving the intervention and those receiving standard care with no intervention. The investigator will provide an oral presentation to the intervention group regarding their recovery outcomes and expectations. Subjects will be evaluated with a Visual Analog Scale (VAS) scale for pain, RAND Short Form health Survey (SF-36) questionnaire for physical mobility, RAND Patient Satisfaction Questionnaire III (PSQ-18) instrument for user satisfaction, length of hospital stay and analgesic switchover time on a survey form and the Spielberger State-Trait Anxiety Inventory (STAI) forms Y1 and Y2 for comparison of preoperative and postoperative negative affects. Effects of the intervention on recovery outcomes will be compared via the Chi-square test, the Mann-Whitney U test for comparison of qualitative data between the two groups and the Student&#8217;s Unpaired t-test for comparison of quantitative data between the groups. Wilcoxon&#8217;s Signed Rank test and the Student&#8217;s paired t-test will be used for analysing qualitative and quantitative input between preoperative and postoperative states. <b>Conclusion:</b> The study seeks to determine if a significant difference occurs from providing patients withprior knowledge about their outcomes and establishing the benefits of psychological preparedness as a cost-effective method in improving outcomes and postoperative recovery. ]]> Comparison of Open Flap Debridement, with and without Diode Laser in the Management of Chronic Periodontitis: A Randomised Split Mouth Clinical Trial Aishwarya Rathod, Priyanka Jaiswal, Deepika Masurkar, Pooja Chitlange Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The goals of periodontal therapy include preventing illness, slowing or stopping disease development, replacing lost periodontal tissues, and preserving the therapeutic outcomes. The apical repositioning of the gingival edge during traditional periodontal surgery exposes the root surface to the oral cavity and reduces pocket depth. It may lead to attachment loss, Gingival Recession (GR). It is also commonly recognised that periodontal surgery causes pain and suffering. Laser assisted periodontal therapy has been the subject of study in an effort to address these drawbacks. <b>Aim:</b> To compare the efficacy of diode laser as an adjunct to Open Flap Debridement (OFD) with that of OFD alone in the management of chronic periodontitis patients. <b>Materials and Methods:</b> This randomised clinical trial with split mouth study design will be conducted in Periodontics Department at Sharad Pawar Dental College, Wardha, Maharashtra, India, for a duration of six months. Thirteen patients (26 quadrants) with generalised chronic periodontitis patients will be selected. The Probing Pocket Depth (PPD) &#8805;5 mm after phase I therapy will be included in this split mouth study. Diode laser (920 nm) will be used as an adjunct to OFD (test) as compared with conventional flap surgery (control). Clinical parameters like Plaque Index (PI), Papillary Bleeding Index (PBI), PPD, Relative Attachment Level (RAL) and Relative Gingival Marginal Level (RGML) and GR will be recorded at baseline and six months post-therapy. Visual Analogue Scale (VAS) will be used to determine patient discomfort intraoperatively and after one week. A questionnaire for patient-based outcomes will be administered after period of six months postsurgery and response will be recorded. Student&#8217;s paired t-test will be used for comparing the treatment groups at baseline and six months. ]]> Effectiveness of Titanium Prepared Platelet Rich Fibrin Membrane vs Platelet Rich Fibrin Membrane in the Treatment of Multiple Gingival Recession Defects using M-VISTA Technique: Protocol for a Randomised Clinical Trial Shrishti Satish Salian, Prasad V Dhadse Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The focus of root coverage procedures is now shifting to minimally invasive surgical approaches. Periodontists are being required to adopt newer and more unique procedures to thoroughly cover the exposed roots. Due to the sensitivity of various techniques and the fact that it involves a wide variety of operations and their variants, periodontal plastic surgery provide a substantial challenge. A variety of minimally invasive techniques and platelet concentrates which are abundant in growth factors have been assimilated that provide the added benefit of better and rapid healing. <b>Aim:</b> This study aims to evaluate the effectiveness of Titanium-Prepared Platelet Rich Fibrin (T-PRF) and Platelet Rich Fibrin (PRF) membrane in Miller&#8217;s Class-I and Class-II multiple Gingival Recession (GR) using Modified-Vestibular Incision Supra-Periosteal Tunnel Access (M-VISTA) technique. <b>Materials and Methods:</b> The planned protocol would be randomised clinical trial and will be performed over a period of two years. Twenty-two patients will be selected according to the inclusion criteria, each having multiple GR (>2 mm, Class I or II recession) on buccal/labial aspects of teeth in maxilla or mandible, and would be randomly distributed into the two groups (control and test). The M-VISTA technique would be carried out for root coverage using T-PRF (test group) and PRF (control), respectively as regenerative materials and their effectiveness will be compared by measuring the Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Relative Gingival Marginal Level (RGML), Recession Depth (RD) and Width of Keratinised Gingiva (WKG). Student&#8217;s paired and unpaired t-tests will be used to evaluate data from the baseline to 3 and 6 months for each group. <b>Expected Results:</b> The authors expect better results of root coverage using the M-VISTA technique in combination with T-PRF (test group). Better results in terms of PPD, CAL, RGML, RD, and increase in thickness of attached gingiva are expected. <b>Conclusion:</b> Combined effect of using T-PRF in the M-VISTA procedure is expected to improve the periodontal parameters including, the soft tissue outcomes and the plaque and bleeding index. ]]> Digital Smile Design- An Overview of 3D Digital Workflow Pooja Mohan Chitlange, Priyanka Paul Madhu, Amit Reche Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Smile designing is a branch of cosmetic dental procedure that corrects imperfections of the teeth and restores dental health and appearance of the person. Today Digital Smile Design (DSD) is changing the future of dental practice worldwide. It&#8217;s a unique approach to modern dentistry is revolutionising smile designing clinics worldwide. DSD is a software which used worldwide, is based on specific photographs and software analysis. DSD is a tool (software) that helps in easy communication and discussion between all the smile designers, dental laboratory technician as well as with patients. DSD especially can be used in a multidisciplinary approach and hence not only used in prosthetic rehabilitation but also used in other branches of dentistry like Orthodontic, Periodontics, etc., The concept of smile designing is not new. The need of aesthetic can be traced from the earliest civilisations of both the Phoenicians (about 800 BC) and Etruscians (about 900 BC). They used to carve animal tusks to simulate the shape, form and hue of natural teeth. Pierre Fauchard (1678-1761) from of France, together with several colleagues modernised and promoted dentistry and also started aesthetic practices. There are many parameters such as dentofacial parameter, gingival parameter, ease of use, documentation ability, cost, time required, systematic digital workflow and organisation, and compatibility of the program with Computer-aided design/Computer-aided Manufacturing (CAD/CAM) or other parameters that may affect the user&#8217;s decision. DSD helps both clinician and patient to improve treatment planning and stimulate the final results of the treatment. There are many software available, and the clinicians can use any of the software according to their needs. Some software can be used easily as a mobile app. This article reviews the basic principles of smile design, various parameters of smile design, comparison of various software, uses, advantages and limitations of DSD. ]]> Oxygen Therapy and Associated Risk Factors for Home Isolated COVID-19 Patients: A Review Pradeep Kumar Yadav, Rajiv Ratan Singh Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X During the second wave of the viral pandemic, hospitals were overcrowded by the escalation of Coronavirus Disease-2019 (COVID-19) cases. To effectively address the drastic escalation of the COVID-19 pandemic, innovative solutions are warranted. The rising demand for critical-care services burdens hospitals; hence, to alleviate the burden on the healthcare system, asymptomatic patients or those with mild symptoms can be treated at home through continuous monitoring and care. Affected patients are at risk of hypoxia, which urgently requires oxygen therapy. Depending on the extent of oxygen demand, patients can boost their oxygen levels by making use of a nasal cannula, face mask, oxygen cylinder, and/or oxygen concentrator. Several risk factors are associated with the augmented probability of COVID-19 progression to severe status due to increased oxygen requirement, and they include advanced age, obesity, glucose intolerance, hypertension, and cardiovascular disease. A close monitoring of oxygen saturation (SpO<sup>2</sup>) along with other clinical investigations like complete and differential blood counts, serum electrolytes, random blood sugar, liver function tests, coagulation profile (Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT) and International Normalized Ratio (INR)), renal function test, C-reactive protein (CRP), D-dimer and ferritin level are mandatory for patients receiving home-based oxygen therapy. An awareness of safety considerations such as perfectly fitting, proper sized mask, availability of ventilation, knowledge of caregiver about danger signs and good functioning of fire alarm system at home are of prime importance before setting up oxygenation devices at home, and this further mandates a comprehensive evaluation of home-based management and treatment of mildly symptomatic patients with COVID-19. ]]> Comparative Preference of Airtraq Laryngoscope Over Macintosh Laryngoscope- A Review Yatharth Bhardwaj, Amol Singam Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Tracheal intubation using a Macintosh laryngoscope can save lives. However, because intubation is a difficult procedure to master, failures can have disastrous results. A more recent intubation tool than the Macintosh is the Airtraq optical laryngoscope, which offers glottic plane visualization without requiring correct tracheal, pharyngeal and oral axes alignment. Airtraq can improve the incidence of failed first intubations and the time required to manage an airway, especially in patients who have had cervical spine trauma which requires manual stabilization of the cervical spine. With no differences in hemodynamics or intubation duration, the Airtraq laryngoscope offered patients a better laryngeal vision than the Macintosh laryngoscope by providing shorter laryngoscopy and intubation time, and easier intubation. The aim of this literature review was to compare these two laryngoscopes with respect to endotracheal intubation. This review article was put together after a comprehensive study of the literature using the electronic databases PubMed, Medline, Embase and Google. Airtraq laryngoscope was found to be superior to Macintosh laryngoscope as it provides a better view of the glottic region with more ease and less intubation time than the conventional Macintosh laryngoscope. ]]> Activated Leucocyte Cell Adhesion Molecule (CD166): A Biomarker in Diagnosis and Prognosis of Breast Cancer Vemareddy Hemalatha, Bhawna Dev, N Vanitha Rani, MG Rajanandh Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X The global incidence of breast cancer and associated mortality is rising annually despite advanced diagnostic aids and treatment methods. This is due to the failure and difficulty in detecting the disease at an early stage. Due to an increase in the breast cancer mortality rate, biomarkers associated with early and prompt detection are being extensively studied, owing to their sensitivity, specificity, cost-effectiveness, and minimally invasive or non invasive analysis. Among those carbohydrate antigens, carcinoembryonic antigens, and circulating tumour cells are the most commonly observed serum biomarkers in the detection of cancer. In recent years, extensive research is carried out on cell adhesion molecules and their role in the process of cell adhesion which is essential for the development and homeostasis in multicellular organisms. These cell adhesion molecules accelerate appropriate cell response and intercellular communication. Activated Leucocyte Cell Adhesion Molecule (ALCAM) or Cluster of Differentiation 166 (CD166) is a transmembrane glycoprotein and emerging as a promising biomarker for primary detection of tumour cells with metastatic potential and is also upregulated in breast tumours. This review ascertains the usefulness of the ALCAM as a potential diagnostic and prognostic marker for early detection, classification, and prognosis of breast cancer and also elucidates the role of the various other biomarkers. ]]> Predictors of Heart Rate Variability: A Systematic Review Rani Jose, Neetha Kamath, Sreeja Gopalakrishnapillai, Salina Sunil Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X <b>Introduction:</b> The heart has the ability to maintain cardiac output in accordance with the body&#8217;s momentarily changing demands by adjusting its rate of contractions and this ability is termed Heart Rate Variability (HRV), which is manifested as a fluctuation of R-R interval in milliseconds on an Electrocardiography (ECG). Maintenance of good HRV levels is significant for the patient population since they influence the prognosis and quality of life. <b>Aim:</b> To identify the predictors of HRV. <b>Materials and Methods:</b> The present study was a systematic and literature review which was based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines 2020. Randomised Controlled Trials (RCTs) published in English from 2014 to 2021 were identified from Cochrane Library, Science Direct, PubMed, and Google Scholar databases. The keywords with Boolean operators were used as &#8220;influencing factors or determinants or predictors and HRV.&#8221; The quality assessments of the studies were performed with Cochrane risk-of-bias assessment tool. Narrative syntheses upon the selected studies were done. <b>Results:</b> The significant findings from the nine selected RCTs were summarised. Physical exercise, breathing exercise, diet, music, and mind-body interventions such as yoga and meditation were identified as the factors enhancing HRV or predictors of HRV. <b>Conclusion:</b> The findings of this systematic review strive to facilitate healthcare providers to devise the strategies to support the risk group of low HRV by the implementation of enhancing factors of HRV to achieve a better outcome. ]]> Lymphangiectasia Mimicking Lichenoid Contact Reaction Vaishnavi Muthukumaran, Aravind Warrier Sankara, CV Divyambika, H Thamizhchelva, N Malathi Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Lymphangiectasia, otherwise known as acquired lymphangioma, is unusual to occur in the oral cavity. Among the frequently recognised forms of congenital and acquired entities, the acquired form of the lymphangiectasia may be caused due to trauma or obstruction to the lymphatic system. Commonly, this condition is asymptomatic; however, the needs of aesthetics and functions warrant treatment. This was a case report of a 55-year-old male patient, who came with a chief complaint of burning sensation in his left cheek region for the past three weeks. Clinically, silver amalgam restoration was evident in relation to the tooth numbers 26,27,36 and 37. Soft tissue examination revealed evidence of greyish radiating striae interspersed with hyperpigmentation on the left buccal sulcus and left lateral border of the tongue. Considering the clinical features, a working diagnosis of lichenoid contact reaction was proposed. Further, an incisional biopsy was performed. Histopathological examination showed thin stratified squamous epithelium with vacuolar spaces, which strongly supported the diagnosis of lymphatic malformation. The patient was symptomatically managed with topical triamcinolone acetonide 0.1% twice daily for two weeks. At two weeks follow-up, the patient was symptom-free and hence the medication was withdrawn. The patient is currently under regular follow-ups. ]]> Primary Oral Tuberculosis Imitating Malignancy- A Rare Case Report Pulin Saluja, Aparna Dave, Manpreet Arora, Ishita Singhal Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Tuberculosis is caused by <i>Mycobacterium tuberculosis</i> and is an ancient disease causing major morbidity and mortality worldwide. Though tuberculosis affects lungs in the majority of the cases but can affect other organs including the oral cavity as a primary site. Oral lesions can be seen in both primary and secondary forms of tuberculosis. The present article reports a case of a primary oral tubercular ulcer of buccal mucosa in a 36-year-old female, which based on clinical features was provisionally diagnosed as squamous cell carcinoma. The diagnosis of oral tuberculosis was confirmed by histopathology, blood and immunological investigations. The patient then was kept on Antitubercular Therapy (ATT) and the lesion showed healing markedly. Thus, oral tubercular lesions are rare and are difficult to diagnose, so every chronic, abnormal looking lesion should be examined cautiously for early diagnosis and prompt treatment. ]]> Massive Pulmonary Embolism Dominating Initial Presentation of Nephrotic Syndrome- A Case Report Umer Sharief Choorisaz, Basharat Quyoom Dar Journal of clinical and diagnostic research : 2023 - January - 17:0973-709X Hypercoagulability is a well-recognised feature of Nephrotic Syndrome (NS) and may manifest clinically in the form of Renal Vein Thrombosis (RVT), Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE); these may uncommonly be among the presenting features of the syndrome. Prompt recognition and management requires that patients with NS should be followed with a high index of suspicion for thromboembolism. Here, the authors report a case of 35-year-old male patient who, while under evaluation for proteinuria, presented with massive PE. He was eventually diagnosed with primary Membranous Nephropathy (MN); a cause of NS with the highest associated risk of thromboembolism. The patient was managed with mechanical ventilation, anticoagulation and supportive care. He also received Rituximab during hospital stay. He was discharged in stable condition on apixaban and advised close follow-up. ]]>