Table of Contents : Journal of clinical and diagnostic research : 2025 - July - 19

Ectopic Hidradenoma Papilliferum of Axilla: A Case Report

Purbasha Misra, Samarth Shukla, Rajesh Godavarthi Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X A benign adnexal tumour is a non cancerous growth located in the uterine tubes, ovaries, or near the uterus, including the surrounding connective tissue. While adnexal tumours can also be cancerous, they are predominantly benign. Moreover, adnexal masses can be non gynaecological, such as bladder diverticulum, appendicitis, apocrine gland tumours, sebaceous gland tumours, eccrine gland tumours and nerve sheath tumours. These tumours can occur at any age due to various causes. Some adnexal tumours are sporadic, while others may be linked to conditions such as Brooke-Spiegler syndrome and Birt-Hogg-Dubé syndrome. The tumours can be solid or fluid-filled and while some resolve spontaneously, others require therapy or surgical intervention. This case describes one such benign adnexal tumour: hidradenoma papilliferum, or papillary hidradenoma, which is a rare subcutaneous benign adnexal tumour of the apocrine glands in the anogenital regions. It typically occurs in females aged 30 to 50 years but is rarely reported in males. Hidradenoma papilliferum that is localised outside the anogenital region is referred to as ectopic. Ectopic presentations are primarily reported in the head and neck regions, especially on the external ear and eyelid, where modified apocrine glands are present. It is rarely reported in the nose, arm and axilla. This case report details a 53-year-old female who presented to the Surgery Outpatient Department (OPD) with a small swelling in her axilla accompanied by mild pain. Histopathological examination confirmed the nodular lesion as hidradenoma papilliferum. The location of the tumour was extremely rare and is often misdiagnosed as syringocystadenoma papilliferum and trichoepithelioma.

Anaesthetic Management of a Centrally Located Bronchial Carcinoid Tumour: Challenges in Airway Management and Perioperative Care

Shubhangi Humane, Dipti Rana, Shilpa Sarang Kore Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Bronchial Carcinoid Tumours (BCT) is a rare form of neuroendocrine tumours with severe anaesthetic challenges since they are centrally positioned in the bronchial tree, which can make them highly problematic in airway management. Even though they are commonly indolent, sometimes they may obstruct the airway, cause bleeding, or occasionally precipitate a carcinoid crisis. Hence, proper preoperative preparation is essential. We present a case report on the anaesthetic management of a 58-year-old female admitted for the removal of a BCT by wedge resection complicated by bronchial asthma. She had a centrally placed endobronchial tumour, as was evident from imaging. To facilitate one-lung ventilation by intubating her with a Double-Lumen Tube (DLT), we utilised a video laryngoscope and a paediatric bougie. A thoracic epidural was placed to provide optimal pain control in the perioperative period. Because of the extensive invasion of the tumour, planned wedge resection was converted into a pneumonectomy. Following surgery, she was extubated on the first postoperative day and made an uneventful recovery without a carcinoid crisis. To manage the complexity of resections for BCTs, this case stresses the versatility of advanced anaesthesia techniques and good perioperative care.

Fibroepithelial Polyp in the Oropharynx: A Case Report

Aishwarya Verma, Mohak Kumar, Paresh Chavan Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Fibroepithelial polyps are uncommon, benign hyperplastic lesions resulting from chronic irritation, typically found in the oral cavity but rarely in the tonsillar region. We present the case of a 21-year-old male with an 8-day history of a foreign body sensation in the right throat, insidious in onset and varying in intensity. The sensation was exacerbated by cold weather and spicy or oily foods. On clinical examination, a 1 cm soft, non-tender, fluctuant mass was identified in the right tonsillar fossa. Videolaryngoscopy corroborated the localised nature of the lesion, and a Computed Tomography (CT) scan of the neck and chest revealed no significant abnormalities. Given the benign presentation, surgical excision was performed using a tonsillar snare under general anaesthesia. Histopathological analysis confirmed a fibrovascular polyp lined by hyperplastic stratified squamous epithelium, with no evidence of malignancy. The patient recovered uneventfully post-surgery. Although rare in the tonsillar region, fibroepithelial polyps should be included in the differential diagnosis of benign oropharyngeal masses. Surgical excision remains the definitive treatment, with Histopathological Examination (HPE) essential for diagnostic confirmation.

The Domino Effect: Hyperventilation, Hypocapnia, and Tetany in Airway Management

Subha Teresa Jose Vazhakalayil, Sandeep Veer, Brinda Badam, Jayant Mane Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Airway management represents one of the most critical challenges in anaesthesiology, particularly in patients with history of head and neck surgeries due to altered anatomy. Routine procedures like tracheostomy can occasionally present with unforeseen challenges, demanding prompt adaptability. We describe a case involving a 60-year-old female with bilateral vocal cord palsy following thyroidectomy for Hashimoto’s thyroiditis four years ago. The patient had undergone a modified Dennis Kashima procedure, which involves injecting a bulking agent or placing a graft into the affected vocal cord to reposition it towards the midline, improving voice quality and airway protection in cases of vocal cord paralysis. The patient was tracheostomised for the first time under Local Anesthesia (LA) followed by Intensive Care Unit (ICU) stay for recovery two years ago and now came in for microlaryngoscopic biopsy under general anaesthesia in view of new onset persistent hoarseness of voice and progressive dyspnoea. The complication in our case arose due to repeated failed attempts in securing the airway, prompting anxiety and rapid breathing which in no time led to systemic complications like hyperventilation induced hypocapnia and hypocalcaemia which eventually landed patient to present with classical signs of tetany, supported by arterial blood gas analysis, confirmed hypocalcaemia (0.59 mmol/L). The condition was managed successfully with rebreathing using a Bain’s circuit and intravenous calcium gluconate, which restored patient stability. This case shows the importance of the anaesthesiologist in unpredictable airway management scenarios along with neutralising the systemic complications like hypocalcaemia a potentially life-threatening condition that can precipitate neuromuscular irritability, seizures, arrhythmias, and cardiac arrest, if left uncorrected at the same time. Preparation, teamwork, flexibility, and vigilant monitoring in such a difficult situation are far more elemental to the practice of true optimal patient care.

Successful Iohexol Sclerotherapy for Non-parasitic Chyluria: A Case Report

Shashikant Asabe, Onkar Sangha, Vikram Satav, Vilas Sabale Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Chyluria is a medical condition characterised by the passing of milky urine due to the abnormal drainage of lymphatic fluid, known as chyle, into the urinary tract. This condition can result from a variety of aetiologies, both parasitic and non-parasitic, with Wuchereria bancrofti being the primary causative agent. Diagnosis includes clinical presentation, laboratory investigations, and imaging studies. Management encompasses a wide array of conservative therapies and surgical interventions. A 60-year-old male presented with chyluria and chyle clots for one year. He had received medical treatment for filariasis and dietary modifications at various hospitals before being referred to this centre. The patient was investigated and diagnosed with non-parasitic chyluria due to a left pyelo-lymphatic fistula and subsequently underwent sclerotherapy with Iohexol contrast, which resulted in complete resolution. This minimally invasive procedure involves the injection of a contrast agent that helps seal affected lymphatic vessels, preventing further chyle leakage into the urinary system. Severe chyluria can be effectively managed with Iohexol contrast sclerotherapy. This case underscores the importance of timely intervention and the use of sclerotherapy with Iohexol contrast as a treatment for severe chyluria, offering a promising therapeutic option for patients with persistent or complicated cases.

Combined Effects of Wall Squat and Treadmill Walking Exercises on Pain and Functional Disability in Non Specific Chronic Low Back Pain: A Case Report

Prem Jiteshkumar Shah, S Aravind Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Low Back Pain (LBP) is the most prevalent musculoskeletal condition worldwide, significantly affecting daily functioning and quality of life. It is mostly non specific in about 90% of cases, where there is no identifiable disease or structural reason to explain the pain. Physiotherapists play a key role in managing patients with chronic LBP. They use various strategies to alleviate pain, enhance pain tolerance, reduce stress on the lumbar region, strengthen lumbar stabilisers and improve functional abilities. Numerous studies have demonstrated the positive effects of isometric strengthening and aerobic exercise in chronic pain conditions. In this context, the authors present a case of a 22-year-old female patient, demonstrating the positive benefits of a combination of wall squat and treadmill walking exercises to improve pain and functional disability in a patient suffering from non specific chronic LBP.

A Case of Psychogenic Polydipsia in an Elderly: An Overlooked Diagnosis

Bhumika Vaishnav, Harshitha Ummaleti, Saish Mondkar, Bhavin Sanghani, Kshitij Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Primary polydipsia, or psychogenic polydipsia, is characterised by excessive fluid intake without an underlying physiological cause. If left untreated, primary polydipsia may result in life-threatening hyponatremia and can lead to complications such as nausea, vomiting, confusion and seizure episodes, potentially becoming life-threatening if not recognised and managed early. The aetiology of this condition is incompletely understood and is frequently attributed to psychiatric disorders, most commonly chronic schizophrenia. Psychogenic polydipsia occurs in up to 20% of psychiatric patients, and this case serves as a reminder to be cognisant of water overconsumption. This case report presents a 74-year-old male with a three-year history of excessive thirst and polyuria, which worsened following the death of his elder brother. Laboratory investigations showed normal random blood sugar and HbA1c levels, normal renal and liver function tests and mild hyponatremia, while radiological investigations were grossly normal. Ultimately, a water deprivation test ruled out diabetes insipidus, leading to a diagnosis of primary polydipsia. The patient was started on oral medication and psychotherapy after diagnosis, and he improved significantly with treatment. He was discharged on oral atypical antipsychotics, with water restriction and regular psychotherapy sessions for further improvement. This case highlights the importance of a thorough diagnostic evaluation of excessive thirst in elderly patients and the necessity of initiating appropriate treatment, which can prevent complications such as severe dilutional hyponatremia in this population.

Impression Technique for Crafting Precise Cast Metal Posts in Permanent Anterior Teeth: A Report of Two Cases

Joyeta Ghosh, Anandamoy Bagchi, Brahmananda Dutta, Anubhav Roy, Amitava Bora Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Restoring endodontically treated young permanent anterior teeth with significant structural loss presents considerable restorative challenges, necessitating durable and well-fitting treatment options such as custom cast metal posts. Achieving precise post space impressions is critical for success; however, conventional methods have limitations. This case report presents two clinical cases involving three anterior teeth with large canals and introduces a direct technique for crafting custom cast metal posts, evaluated for its dimensional accuracy and clinical fit. Three young patients requiring post-and-core restorations following endodontic treatment of anterior teeth were managed using this technique. Subsequent fabrication and cementation of cast metal post-cores resulted in restorations demonstrating satisfactory volumetric accuracy, dimensional stability, and overall fit upon radiographic evaluation by independent examiners. No adverse postoperative signs or symptoms were observed during follow-up periods of three to six months. This technique proved to be a cost-effective, clinically efficient, and accurate method for obtaining post space impressions, particularly suitable for the large, tapered canals often found in young permanent anterior teeth. It offers a viable alternative to traditional materials, although further long-term clinical studies are warranted on different post space impression techniques.

Massive Ovarian Oedema in a 23-year-old Patient: A Case Report

Supriya Mehrotra, Bandana Mehrotra, Sanjay Mehrotra, Ashok Kumar Kapoor, Hari Shyam Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Massive Ovarian Oedema (MOE) is a rare gynaecological disorder that has been rarely reported in our country. Approximately six cases have been reported previously in India. The lesion may either present as a primary disease or develop secondarily, subsequent to an ovarian lesion or pregnancy. Moreover, the primary lesion may induce strangulation of blood vessels and lymphatics, resulting in ischaemia. If abdominal pain persists, the patient may require laparoscopic salpingo-oophorectomy. A 23-year-old female in the reproductive age group developed pain in the lower pelvic region. Upon examination, she exhibited unilateral enlargement of the right ovary. On palpation, an abdominal/pelvic mass was noted. The patient underwent surgery. The ovary was sectioned, and several slices of approximately 1 cm thickness were prepared. A significant amount of water-like serous fluid emerged from the cut surface. A few areas with a gelatinous appearance were also observed. Other findings from the current lesion included necrosis and haemorrhage, along with signs of fibrosis. Extensive fibrosis may lead to strangulation. Most of the cysts contained watery serous fluid. Persistent strangulation of the ovarian pedicle might have resulted in massive oedema. The presence of adult worms of Enterobius vermicularis in the appendix of the patient with MOE might have an aetiological role.

Segmental Spinal Anaesthesia with Sequential Hyperbaric and Isobaric Ropivacaine for Laparoscopic Hysterectomy in a High-risk Kyphoscoliosis Patient: A Case Report

Anupama Kumari, Jigisha Mehta, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Anaesthesia management in patients with multiple comorbidities and anatomical challenges poses significant perioperative risks when scheduled for complicated surgeries. This case report highlights the successful application of sequential hyperbaric and isobaric ropivacaine in segmental spinal anaesthesia in a 65-year-old female patient with kyphoscoliosis and multiple comorbidities undergoing Laparoscopic-Assisted Vaginal Hysterectomy (LAVH). Her comorbidities included bronchial asthma, type 2 diabetes mellitus, hypertension, hypothyroidism, ischaemic heart disease, and early-stage Chronic Kidney Disease (CKD). Her anaesthetic management was further complicated by a challenging airway (Mallampati grade III, limited mouth opening, and restricted neck movements), uncontrolled blood pressure, elevated blood glucose levels, and compromised renal status. Considering her complex medical profile and anatomical challenges, segmental spinal anaesthesia was chosen as the primary anaesthesia modality, with general anaesthesia as a fallback plan and the necessary instruments readily available. Surgical anaesthesia was achieved with two-drug sequential segmental spinal anaesthesia administered in the T9-T10 intervertebral space using hyperbaric ropivacaine 0.75% (9 mg) and isobaric ropivacaine 0.75% (11.25 mg), with a 60-second interval between the two drug injections. The operative course was uneventful, requiring only mild sedation and analgesia. A single episode of intraoperative hypotension and bradycardia was managed promptly. The patient experienced excellent postoperative analgesia and required intravenous analgesics eight hours after the surgery. She was later discharged uneventfully on the fourth postoperative day. This case demonstrates the feasibility and safety of using sequential hyperbaric and isobaric ropivacaine for segmental spinal anaesthesia in high-risk patients with anatomical challenges, offering a viable alternative to General Anaesthesia (GA) in complex surgical scenarios.

Gingival Depigmentation using Microneedling Technique and Hyaluronic Acid Mesotherapy: A Case Report

N Krithika, H Nilofer Farjana, Anitha Balaji, Ramya Vinayakam, J Angelinfiona Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Gingival depigmentation is a common aesthetic procedure. Gingival pigmentation is primarily physiological due to the production of melanin. Various techniques have been practised to treat gingival depigmentation. Invasive techniques, such as the scalpel method, chemical peeling, and gingivectomy, may cause postoperative discomfort, risk of complications, and potential for gingival recession. To overcome these issues, a novel therapeutic modality called Microneedling (MN), utilised in dermatology, has been investigated for gingival depigmentation. Recently, in the field of dermatology, a technique known as MN, which involves repetitive puncturing, has been widely applied. It is simple, economical, and demonstrates good tolerability in patients. Additionally, this technique provides a dual benefit in both cosmetic and therapeutic realms. Hyaluronic Acid (HA) has anti-oedematous and anti-inflammatory effects and accelerates tissue recovery. In the present case, MN-assisted gingival depigmentation was performed in combination with 0.8% HA gel. It was observed that the Dummett-Gupta Oral Pigmentation Index (DOPI) scores gradually reduced on the 7^th, 14^th, and 21^st day, and the results were found to be clinically predictive.

Management of a Complex Urethrovaginal Fistula Post-pelvic Injury in a Young Female: A Rare Case Report

Vilas P Sabale, Amala Anant Ghalsasi, Vikram P Satav Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Urethral injuries associated with pelvic fractures in female patients are a rare condition. The diagnosis and management of traumatic injury to the female urethra are not well-understood, as the literature on the subject is very limited. Hereby, the authors present a case of a 29-year-old female patient who presented with continuous incontinence. The patient had a history of trauma while riding a bicycle 18 years ago, resulting in a pelvic fracture, bladder rupture, and urethral rupture. She was managed with fracture fixation, bladder repair, and Suprapubic Catheter (SPC) insertion. Urethral repair was performed after six months, but the patient remained incontinent. Upon presentation to our hospital, the patient was diagnosed with vaginal stenosis and a large urethrovaginal fistula. She was managed with vaginoplasty followed by urethrovaginal fistula repair using gracilis muscle interposition. This procedure failed, resulting in the recurrence of the Urethrovaginal Fistula (UVF) and ongoing incontinence. The patient was re-operated, and fistula repair was accomplished using a local vaginal flap. This case highlights the complex nature of urethral injury in females, the challenges posed by delayed complications, and the necessity for multiple procedures.

Giant Proliferating Trichilemmal Tumour: A Case Report

Kondapalli Sri Sai Teja Sampath, Sudhir Ramchandra Jayakar, Guneet Singh, Siddharth Tiwari, Nayani Nithin Kumar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X A Trichilemmal Cyst (TC), which can also be referred to as a trichodermal cyst or trichodermal isthmus-degenerative cyst, is a noncancerous growth on the skin that arises from the outer sheath of hair follicles and is characterised by its rare occurrence and limited documentation. Herein, we report a 54-year-old female who presented with a swelling over her scalp for 15 years, which gradually progressed to a size of 8×5 cm. Computed Tomography (CT) scan revealed an extra-cranial well-defined lobulated heterogeneously enhancing isointense lesion with specks of calcification above the occipital bone in the midline with no intracranial or bony extension, likely benign in aetiology. She underwent surgical excision of the entire swelling, and histopathological analysis confirmed the diagnosis of Proliferating Trichilemmal Tumour (PTT) with squamous differentiation. The wound healed well without any recurrence after a follow-up of one year. Inspite of their enhanced propagation, TCs are usually benign and non-invasive. But in a few cases, these can transform to trichilemmal carcinoma, these carcinomas may cause local invasion, resulting in significant morbidity and mortality.

Creative use of Clear Aligners with Tongue Spikes for Open Bite Correction: A Case Report

Ricardo Alexandre Laske, Rosilene Andrea Machado, Gil Guilherme Gasparello, Thiago Martins Meira, Orlando Motohiro Tanaka Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Anterior Open Bite (AOB) is a complex dental condition caused by a variety of factors, including genetics, environmental influences, and functional issues. Managing AOB presents considerable challenges due to the high likelihood of relapse, particularly in cases linked to tongue dysfunction. Accurate diagnosis and thorough treatment planning are essential, especially when addressing factors such as tongue posture, which impacts speech, swallowing, and chewing. Achieving and maintaining an ideal overbite is particularly challenging, making it one of the most difficult aspects of orthodontic treatment. This case report demonstrates the effectiveness of using clear aligners with sharpened tongue spurs to address orthodontic relapse, misalignment, and AOB in an adult female patient. The application of a mandibular clear aligner combined with a tongue spike successfully treated the AOB caused by the patient’s tongue rest posture, leading to improved aesthetics, function, and patient satisfaction. The patient’s compliance with the aligner and adherence to proper tongue posture were crucial, similar to the requirements when using Temporary Anchorage Devices (TADs), multiloop archwires, and vertical elastics. Strict adherence to the clear aligner regimen was essential for achieving favourable results. Additionally, while it is generally recommended to consult with a myofunctional therapist before and during orthodontic treatment, in this case, the patient did not attend any such consultations. By combining functional effectiveness with a minimally invasive, aesthetic, and patient-centred approach, this method provides a valuable option for managing AOB associated with abnormal tongue posture. The results from this case highlight the potential for integrating innovative techniques into clear aligner therapy to achieve optimal outcomes in adult orthodontic treatments.

Chronic Subdural Hygromas, Cerebral Atrophy, and Developmental Delay Following Paediatric Traumatic Brain Injury: A Case Report

Damam Sreeharsha, RJ Meshram, Amar Taksande Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Traumatic Brain Injury (TBI) contributes significantly to the burden on healthcare systems. The variability in patient profiles and injury mechanisms complicates prevention, diagnosis and treatment, limiting advancements in the field. Although imaging modalities like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are essential in the diagnosis of TBI, they may miss subtle lesions. Children with TBI are at a high-risk of long-term neurological sequelae and these include seizures and developmental delays. This case report presents a six-year-old male child, fifth of birth order born out of non-consanguineous marriage, with developmental delays following history of fall at 2-3 months of age. Initial imaging studies reported bilateral Subarachnoid Haemorrhage (SAH) and inter-hemispheric bleeding. Subsequent scans revealed right-sided subdural hygroma and ischaemic infarcts. MRI brain findings demonstrated gliosis and cystic encephalomalacia. The patient developed Generalised Tonic-Clonic Seizures (GTCS), which were controlled with anticonvulsants. Later anticonvulsants were discontinued after a seizure-free period of two years. Upon recent admission, severe anaemia required blood transfusion and repeat MRI brain showed chronic subdural hygromas and cerebral atrophy. The patient was stabilised and discharged with ongoing developmental and neurological follow-up. This case underscores the significant long-term neurological and developmental consequences of paediatric TBI, highlighting the importance of early diagnosis, regular monitoring, and multidisciplinary management. Non-surgical approaches, combined with appropriate neuroimaging and clinical assessments, can effectively manage complications such as subdural hygromas and anaemia. Further research is needed to optimise care and improve outcomes for children affected by TBI.

Conservative Treatment of Medial Meniscus Tear Through Ayurveda: A Case Study

Mahesh Sharma, Sourabh Deshmukh, Nitika Senger Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Meniscal tears are common knee injuries caused by acute trauma in younger individuals and degenerative changes in older adults, often linked to osteoarthritis. The menisci play a crucial role in shock absorption, load distribution, and knee joint stability. In Ayurveda, meniscal tears can be correlated with Sira Snayu Gata Vata (vascular and ligamentous disorder). A 47-year-old male presented with pain, swelling, tenderness, and restricted movement in the right knee for six months. He was advised to undergo Magnetic Resonance Imaging (MRI) investigation by a physician, which revealed a medial meniscus tear in the right knee joint. In clinical examinations, the McMurray test, Apley grind test, and the bounce home test were positive. Ayurvedic treatments, including Shodhan (bio-purification) and Shaman (palliative) therapies, were administered as an alternative to corticosteroids, aimed at reducing potential complications. This study evaluates the effectiveness of Ayurvedic treatment and rehabilitation strategies in improving functional outcomes for meniscal tears. In cases of medial meniscus injury, meniscectomy is often performed surgically. This case study demonstrates significant improvement in the assessment parameters of medial meniscus tears with Ayurvedic treatment and rehabilitation therapies, highlighting their potential as a non-invasive therapeutic approach for meniscal injuries.

Thromboelastography-guided Blood Product Management: A Series of Three Cases

B Megala, A Ashwin, R Krishnamoorty, Niranj Rathan, Sampat Kumar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Thromboelastography (TEG) is a diagnostic tool used to assess blood clotting in real time by measuring the viscoelastic properties of blood. It measures the clot’s strength and stability. It provides a comprehensive view of haemostasis, which includes clot formation, strength, and dissolution. This can be useful in clinical settings by guiding transfusion and anticoagulation therapy in various medical conditions. It can be useful in blood product administration for the patient’s specific needs. TEG can help assess the functional capacity of the liver in relation to clotting factor production and the overall coagulation process. In obstetric patients, particularly during labour and complications during delivery, TEG can help manage and predict bleeding risks associated with conditions like preeclampsia or Disseminated Intravascular Coagulation (DIC). Here, we discussed three separate cases (1 male, 2 females) described, each presenting unique clinical scenarios, including those from Intensive Care Unit (ICU) settings. A case of Postpartum Haemorrhage (PPH) with Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome, a case of haemophilia A, and a case of snake bite with signs of envenomation were managed with TEG to guide component-based therapy, based on the specific needs of each patient.

Therapeutic Leukapheresis in Acute Leukaemia with Hyperleukocytosis: A Series of Three Cases

G Kavinkumar, A Ashwin, R Krishnamoorthy, Niranj Rathan, Sampat Kumar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Acute Myeloid Leukaemia (AML) is a haematological malignancy marked by uncontrolled proliferation of immature myeloid cells, impairing normal blood cell production. Hyperleukocytosis, defined as a leukocyte count >100,000/μL (4000-11,000 cells/μL), increases blood viscosity and causes leukocytes to clump, leading to reduced blood flow and stasis. This leukostasis can result in complications like end-organ damage, tumour lysis syndrome, and disseminated intravascular coagulation. Chemotherapy may exacerbate these issues by triggering tumour lysis syndrome and other severe complications. Therefore, therapeutic leukapheresis can be the treatment of choice in such situations. In this case series, we share our experience in managing three AML cases that presented with life-threatening symptoms. All three patients presented to our centre with signs and symptoms of leukostasis, with hyperleukocytosis evident in their complete blood cell counts. If left untreated, these cases could have led to severe complications and even death. After evaluating the clinical and laboratory parameters, therapeutic leukapheresis was initiated to reduce leukocyte counts, leading to significant improvement in the patient’s condition. This case series emphasises the critical role of leukapheresis as a potentially life-saving intervention.

A Case of Paediatric Linear Morphea with Infraorbital Atrophy: A Clinico-dermoscopic-histopathologic Association

Sandra Arora, Sanjeev B Gupta Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X An 11-year-old male presented to the Outpatient Department (OPD) of Dermatology with depression and darkness under his right eye for the past two years. He developed a light-coloured lesion as the condition gradually progressed over a span of 1.5 years to involve the left side of the chest. Thereafter, the lesions remained stable, with no new lesions or increase in the size of existing lesions observed. Similar lesions were not noted in family members. His general condition appeared fair, and his build and weight were normal for his age.

Microabrasion as an Effective Treatment for Severe Dental Fluorosis: Images in Medicine

Priyanka Rajesh Bhojwani, Anuja Ikhar, Aditya Patel, Manoj Chandak, Shweta Sedani Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X A 28-year-old male presented to the dental clinic with white and brown discolourations, as well as hard, pitted areas on the enamel [Table/Fig-1,2], seeking aesthetic treatment. After obtaining a detailed medical history and performing a clinical examination, including electrical pulp testing and cold testing, a radiographic evaluation was conducted. The radiographs revealed no periapical lesions or caries, and no signs of resorption were observed in the teeth of interest. All the associated teeth were vital, with a healthy periodontium. The patient was diagnosed with severe enamel fluorosis, classified as grade 4 according to the Dean’s Index (1).

Navigating Airway Obstruction during Resection of Anterior Mediastinal Mass: An Anaesthetic Perspective

Chhaya Mahesh Suryawanshi, Jekha Mary Babu Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Dear Editor, An Anterior Mediastinal Mass (AMM) poses significant challenges for the anaesthesiologist due to its impact on surrounding mediastinal structures (1). They can cause airway and circulatory compression under general anaesthesia, leading to dreaded complications (2). Effective management of AMM resection requires understanding its relationship with cardiorespiratory structures, thorough preoperative evaluation and anticipation of intraoperative complications. Strategies such as awake fiberoptic intubation, spontaneous ventilation, judicious use of muscle relaxants, positional adjustments, access to rigid bronchoscopy and in severe cases, elective cardiopulmonary bypass if available, enhances a safer outcome. This case explores the anaesthetic management and complexities faced in managing the resection of a large AMM.

The Silent Heart: Unveiling Mitral Stenosis in the Postoperative Period

Aparna Bagle, Rashmi Kelkar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X To the Editor, Mitral Stenosis (MS) is a valvular heart condition marked by the narrowing of the mitral valve opening. The normal mitral valve area is 4-6 sq cm (1). While rheumatic fever is the most common cause, the stenosis generally does not become clinically important until several decades after the initial infection (2). It usually manifests 20 to 40 years after an episode of rheumatic fever and is more common in females (3). Common symptoms include orthopnea and paroxysmal nocturnal dyspnea (4). As the condition progresses, patients may also experience palpitations, chest pain, hemoptysis, and thromboembolism, particularly with an increased left atrial volume.

Hereditary Dehydrated Stomatocytosis due to PIEZO1 Mutation and Potential Therapeutic Target for Sickle Cell Anaemia

Afaq Ahmad Khan, Santosh G Rathod Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Dear Editor, A 32-year-old female born out of a third-degree consanguineous marriage presented to the haematology clinic with generalised weakness, pallor, icterus, and pain in the left hypochondriac region. All these symptoms were for six months and progressive in nature. There was no history of similar complaints in other family members. On evaluation, the blood count showed: haemoglobin 9.9 g/L, red blood cell counts 3.37.000/mm3, white blood count of 7.1×109/L, platelets 128×109/L, Mean Corpuscular Volume (MCV) 98.3 fL, Mean Content Haemoglobin (MCH) 29.12 pg, Mean Corpuscular Haemoglobin Concentration (MCHC) 29.80 g/dL. Further evaluation revealed a total bilirubin of 2.4 mg/dL, indirect bilirubin of 2.1 mg/dL, Lactate Dehydrogenase (LDH) 1450 U/L, and haptoglobin of <8 mg/dL. The reticulocyte index on presentation was 9.0%, the electrolytes Na+ was 135 Meq/L, and the K+ was 4.5 Meq/L. The ultrasound of the abdomen showed splenomegaly 6 cm below the left costal margin. To find out the cause of haemolysis, we performed peripheral smear examination that showed numerous stmomatocytes anisopiokilocytosis, macrocytes, microcytes and spherocytes (Table/Fig 1). In order to rule out autoimmune haemolytic anaemia, Antinuclear Antigen (ANA), Anti-ds Deoxyribonucleic Acid (anti-ds DNA), and direct and indirect Coombs tests were performed, and they were all negative. The paraoxysmal nocturnal haemoglobinuria profile was found to be negative. We performed High-Profile Liquid Chromatography (HPLC), showing HbA2 at 5.3%, HbA at 73%, and HbF at 0.5%, ruling out haemoglobinopathy as the cause of haemolysis. Genetic tests encoding the beta and alpha globin chains ruled out structural modifications to haemoglobin. Enzyme activity related to red blood cell metabolism was normal. In order to rule out red blood cell structural defect as the cause of haemolysis, we performed the Eosin-5-Maleimide (EMA) test, which had a value within the normal range of 14% (normal test range >11%), ruling out the spherocytosis. This test is normal in all forms of stomatocytosis. Osmatic fragility test was negative in this patient.

Circulating Endothelin-1 as a Diagnostic Marker in Patients with Acute Myocardial Infarction: A Cross-sectional Study

Anitha Rajendiran, S Sumathi, S Giridharan, V Kuzhandaivelu Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: The most common form of Coronary Heart Disease (CHD) is Acute Myocardial Infarction (AMI). When a coronary artery is blocked, it results in a substantial reduction in blood flow, which causes some of the heart muscle supplied by that artery to become infarcted. The development of Myocardial Infarction (MI) is regulated by a variety of complex processes. Vascular blockage and cardiac ischaemia may be exacerbated by endothelial dysfunction, platelet activation, and inflammation. Aim: To investigate the potential role of Endothelin-1 (ET-1) in the diagnosis of AMI. Materials and Methods: This cross-sectional research was carried out at Mahatma Gandhi Medical College and Research Institute in Pondicherry, India over the duration of one year (2023-2024) with a sample size of n=50 for the AMI group and n=30 for the healthy control group. Ethical clearance was obtained prior to the study. Upon admission, a 5 mL sample of peripheral venous blood was collected, centrifuged, and biochemical parameters such as glucose (random), urea, creatinine, and lipid profile were assessed using standard appropriate methods. The Enzyme-Linked Fluorescence Assay (ELFA) method was used to test troponin I, and the ET-1 immunoassay ELISA kit was utilised to quantify ET-1. Data were recorded and analysed using Statistical Package for Social Science (SPSS) Version 23 software. Categorical variables were analysed using the Chi-square test, whereas non-normally distributed continuous data were assessed with the Mann-Whitney U test. A Receiver Operating Characteristic (ROC) curve was plotted to identify the optimal cut-off value for ET-1 levels in patients with AMI. Bivariate correlation analysis was performed using the Spearman correlation test. Results: Serum ET-1 levels were significantly higher in AMI subjects compared to the control group (14.02±12.2 pg/mL vs. 3.1±2.8 pg/mL, p<0.001). The ROC curve analysis indicated that the serum ET-1 cut-off level was found to be 6.1 pg/mL. Additionally, serum ET-1 levels showed significant correlations with troponin I levels (correlation coefficient: 0.513, p=0.001). Conclusion: Elevated serum ET-1 levels at the time of admission were associated with higher troponin-I levels in patients with AMI. Hence, ET-1 can be a promising diagnostic marker for AMI assisting in early detection and prognosis.

Effectiveness of Tai Chi Exercise on VO₂max in Patients with Cancer after Chemotherapy: An Experimental Study

Seema Das, Somyata C Satpathy Sarma, Subarna Sankar Das, Trishna Kakati Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Tai Chi, originally a Chinese martial art, is now recognised as an effective form of aerobic exercise beneficial for cardiac rehabilitation and mental well-being. It involves gentle movements, deep breathing, and relaxation, promoting body awareness and focus. Classified as a moderate-intensity exercise (2.6-6.5 MET), Tai Chi has shown clinical benefits, particularly for individuals with chronic conditions. Aim: This study aimed to evaluate the effectiveness of Tai Chi exercises by comparing baseline and post-exercise VO₂max scores in cancer patients after chemotherapy. Materials and Methods: A quasi-experimental study commenced in March 2022 and was completed in September 2022, affiliated with the College of Physiotherapy and Medical Sciences under Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India. A total of 30 subjects were assessed, of whom sevenwere excluded, two declined, and 21 participated. After seven dropouts, 15 participants (aged 20-60 years, diagnosed with breast, stomach, or colorectal cancer) at stage II who had completed all doses of chemotherapy completed a 6-week Tai Chi programme (30-minute sessions twice a week). VO₂max was measured pre- and post-intervention. Demographic data (gender, height, weight, cancer type, chemotherapy doses, and vital signs) were considered. SPSS software version 25 was used, the Shapiro-Wilk test for normality was applied, and a paired t-test was conducted for parametric analysis, with statistical significance set at p<0.05, where p<0.001 was considered highly significant. Results: Fifteen post-chemotherapy patients participated in a 6-week Tai Chi programme. Pre- and post-programme VO₂max values were analysed using paired sample t-tests, with the Shapiro-Wilk test for normality. The sample consisted of 33% males and 67% females, with a mean age of 42.8 years (SD=8.41). VO₂max increased from a pre-exercise mean of 32.92 to a post-exercise mean of 36.64. Statistical analysis in SPSS version 25 showed significant improvement (p<0.001). Conclusion: The study indicates that a 6-week Tai Chi exercise programme significantly improves VO₂max in cancer patients post-chemotherapy, suggesting its potential as an effective rehabilitative intervention for enhancing cardiovascular fitness and overall well-being in this population.

Impact of Preoperative Prism Adaptation Test and Patch Test Measurements on Surgery in Concomitant Horizontal Strabismus: A Prospective Interventional Study

Rahul Singh, Disha Chaudhary, Charu Sagar, Vandana Kohli Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Concomitant horizontal strabismus poses significant challenges in achieving optimal surgical outcomes, with risks of undercorrection or overcorrection remaining a concern. Preoperative assessment techniques, such as the Prism Adaptation Test (PAT) and Patch Test, have been utilised to better estimate the angle of deviation and plan surgeries accordingly. The PAT is thought to refine surgical corrections by revealing the maximum angle of deviation. However, its specific impact on surgical outcomes-especially in comparison to the patch test-remains underexplored. Aim: To evaluate the impact of preoperative PAT and patch test measurements on surgical outcomes in patients with concomitant horizontal strabismus, focusing on their role in optimising surgical corrections and minimising postoperative undercorrection and overcorrection. Materials and Methods: This prospective interventional study was conducted over 15 months at Department of Ophthalmology, Employees’ State Insurance Corporation (ESIC) Postgraduate Institute of Medical Sciences and Research (PGIMSR), Basaidarapur, New Delhi, India, from October 2017 to February 2018 and included 30 subjects diagnosed with concomitant horizontal strabismus. Preoperative deviation measurements were obtained using the Prism Bar Cover Test (PBCT) at three distances: near (33 cm), intermediate (6 m), and far (12 m). These measurements were recorded both before and after a one-hour monocular occlusion (patch test). Following this, participants underwent the PAT. Based on their responses to these tests, subjects were categorised into three groups: non responders, patch test responders, and PAT responders. Surgical corrections were planned and performed using the maximum deviation identified by the PAT. Postoperative outcomes were assessed eight weeks after surgery using Hirschberg’s test and the Prism Alternate Cover Test (PACT). The study’s parameters included analysing preoperative and postoperative deviations, categorisation of test responses, and surgical outcomes. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 17.0, and a p-value of <0.05 was considered statistically significant. Results: The study included a total of 30 participants, comprising 18 males and 12 females, with a mean age of 20.83±12.03 years. Among them, 14 individuals presented with esotropia, while 16 exhibited exotropia. The study found that PAT significantly improved surgical outcomes. The actual residual deviation postsurgery ranged from 0 to 16? with PAT measurements, compared to an estimated range of 5 to 25? if surgeries were based on PBCT measurements before occlusion and 0 to 21? after occlusion. The mean residual deviation was lowest in PAT responders (6.8±6.07?) compared to patch test responders (8.5±6.09?) and non responders (11.5±7.09?) (p-value=0.02). Satisfactory alignment was observed in 90% of PAT responders, 80% of patch test responders, and 50% of non responders (p-value <0.04). Conclusion: The study concludes that the PAT significantly improves surgical precision and outcomes in patients with concomitant horizontal strabismus. By providing a more accurate assessment of deviation angles, the PAT reduces the risk of undercorrection and overcorrection compared to conventional preoperative measurements. These findings highlight the importance of incorporating PAT into preoperative evaluations to achieve optimal postoperative alignment and minimise residual deviations. The study underscores PAT’s value in enhancing surgical planning and outcomes, suggesting its routine use in clinical practice. Further research is warranted to evaluate its long-term effects on binocular vision and overall quality of life.

Trimester Specific Effect of Pregnancy on Maternal Cognitive Function using Critical Flicker Fusion Frequency: A Cross-sectional Study

J Roshni, S Anu, M Ramji Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Critical Flicker Fusion Frequency (CFFF) measures cognitive function by detecting the threshold at which flickering light appears steady. This threshold reflects neural processing and cortical arousal, making it useful for diagnosing conditions like Alzheimer’s and schizophrenia. During pregnancy, hormonal fluctuations can cause cognitive symptoms (“pregnancy brain”). Monitoring cognition ensures safety, productivity, and early detection of complications like pre-eclampsia. Despite importance, CFFF research during pregnancy is limited, especially across trimesters. Aim: To find out objective cognitive changes in various trimesters of pregnancy using CFFF in primigravid women and compare with non pregnant women. Materials and Methods: The present observational cross-sectional study was conducted from October 2023 to March 2024 in the Department of Physiology of Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India. The study involved 155 primigravid women in various trimesters and 50 non pregnant women in the age group of 21-25 years. The subjects were categorised into three groups. Group A- 1^st trimester group with Gestational Age (GA) between 0-13 weeks, Group B - 2^nd trimester group with GA between 14-27 weeks, Group C- 3^rd trimester with GA between 28-40 weeks. CFFF was measured in all these groups and the association was analysed. CFFF was measured with CFF M1 model instrument (Mavom Labs, Bangalore) using Netra software. Data were statistically analysed by using Chi-square test. Results: The study included 53 pregnant primigravid women in the 1^st trimester, 51 in the 2^nd trimester, 51 in the 3^rd trimester, and 50 non pregnant samples of similar age, marital status and with the average husband’s income of 42,261.29 with significant variability (SD=28,048.74). A significant decrease in CFFF values were observed in 1^st (p-value <0.001) and 3^rd (p-value <0.001) trimesters in pregnant women when compared to non pregnant individuals. The 2^nd trimester showed a significant increase in CFFF (p-value <0.001). Conclusion: The CFFF measurements could provide a useful tool for identifying individuals at risk of more severe cognitive decline or sensory processing difficulties during pregancy and take appropriate measures.

Evaluating Objective Structured Practical Examination as a Formative Assessment Tool in Biochemistry: A Cross-sectional Study from a Medical College in Telanagna, India

Amtul Rahman Amberina, Ravirala Tagore, B Ramya Sree Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: National Medical Council (NMC) advocates for Competency-Based Medical Education (CBME). This learner-centred curriculum emphasises continuous assessment that measures competencies and provides feedback. Objective Structured Practical Examination (OSPE) provides an improved objectivity and reliability than conventional assessment method. Thus, the present study was focused to assess cognitive as well as psychomotor domains in 1^st-year medical students by implementing modified OSPE. Aim: To evaluate OSPE module for the comprehensive assessment of both theoretical knowledge and practical skills among Phase 1 medical students in biochemistry, and to evaluate students’ perception of the OSPE through a structured questionnaire. Materials and Methods: This prospective, interventional cross-sectional study was conducted from November 2024 to January 2025 in the Department of Biochemistry at Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India. A total of 126 students were recruited for the study after obtaining institutional ethical clearance (IEC No: 226/OCT/2024). All the students were taught about diabetes mellitus and estimation of Random Blood Sugar (RBS); the procedure was recorded and the video was shared with students through WhatsApp. OSPE stations were organised to estimate the RBS values and students were assessed using a prevalidated checklist. The student feedback on OSPE was solicited through a standardised questionnaire and analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: All 126 students (100%) agreed that the OSPE instructions were clear and that the procedural video was helpful. A majority, 120 (95.2%), found the time allotted to be sufficient, while 6 (4.8%) did not. Similarly, 120 (95.2%) students confirmed that the OSPE questions were covered in lectures, and 123 (97.6%) students felt that the OSPE was well organised. Overall, 124 (98.4%) students reported that the OSPE was a valuable learning experience and supported conducting similar sessions regularly. The reliability score was 0.94. The student’s performance was very good, with 125 (99.2%) students scored more than 80% in procedure station and more than 75% in response station. Conclusion: The performance of students in the OSPE was very good, as most students scored good marks and their perception towards OSPE was more positive and opted to conduct regularly. So, the OSPE can be used as an assessment tool in formative assessment.

Birth Preparedness and Complication Readiness among Adult Males in Chengalpattu District, Tamil Nadu, India: A Cross-sectional Study

Vaishnavi Nagarajan, Aamina Hussain, VV Anantharaman Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: The active participation of males is vital for enhancing maternal and child health outcomes. Supporting mothers in timely healthcare decisions ensures better access to services and care. The World Health Organisation (WHO) defines maternal mortality as deaths caused by pregnancy-related complications or their management within 42 days of pregnancy termination, excluding incidental causes. Birth Preparedness and Complication Readiness (BPCR) is intended to reduce the three primary delays that lead to maternal mortality: delays in recognising the need for medical care, reaching a healthcare facility and receiving timely and proper treatment. Aim: To assess males’ levels of BPCR and identify the factors that influence their participation in these critical aspects of maternal health. Materials and Methods: A community-based cross-sectional study was conducted in Chengalpattu district of Tamil Nadu, India. The research work was carried out from December 2024 to February 2025. The sample size was calculated as 412, and at the end of the data collection, through simple random sampling, 420 samples were collected. Eligible participants were males aged 18 years and above. After obtaining ethical clearance, data collection was carried out using a validated questionnaire adapted from the Johns Hopkins Programme for International Education in Gynaecology and Obstetrics (JHPIEGO) questionnaire devised by The Maternal and Neonatal Health Programme, affiliated with Johns Hopkins University. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics, Chi-square tests, and logistic regression (both bivariate and multivariate) were applied to assess associations among variables. A p-value of <0.05 was considered statistically significant. Results: Among the 420 individuals, 193 (45.95%) were in the 30-39 years age group. Most participants (267, 63.57%) were first-time fathers. Commonly recognised danger signs during pregnancy include nausea and vomiting and severe headaches, which were recognised by 341 (81.2%) and 249 (59.3%) participants, respectively. Multivariable analysis revealed that cultural influence on decision-making was a statistically significant predictor of BPCR, influencing male participation in maternal health planning (AOR=0.091, 95% CI: 0.057-0.143, p-value <0.001). Conclusion: The study infers that early and informed male involvement in BPCR significantly enhances maternal health outcomes, emphasising the need for targeted awareness and engagement strategies.

Assessment of the Stress Distribution in Internal Resorption Cavities Filled with MTA and Biodentine in Mature Teeth: A Finite Element Analysis Study

Basam Ram Chowdary, Tsalla Krishna Ravali, Vemuri Sayesh, Bolla Nagesh, Veeramachaneni Kavyasri, Garlapati Roopadevi, BS Anila, Aameena Banu Mayana Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Internal Root Resorption (IRR) is the gradual deterioration of dentine due to clastic activity, typically appearing as a radiolucent area in the radicular dentine in communication with the root canal. Bioceramic materials such as Mineral Trioxide Aggregate (MTA) and Biodentine are available to restore the resorption cavity, offering biocompatibility and better sealing to the dentine. The present study employs the Finite Element Analysis (FEA) method to simulate stress behaviour, providing valuable insights into the effectiveness of these materials in reducing stress concentrations and reinforcing structurally compromised teeth. The findings aim to support clinical decision-making for achieving long-term restoration success. Aim: To evaluate and compare the stress distribution patterns in tooth models with IRR restored with MTA and Biodentine at the apical, middle and coronal thirds, employing FEA. Materials and Methods: This FEA study was conducted in the Conservative Dentistry and Endodontics department at Sibar Institute of Dental Sciences in Guntur, Andhra Pradesh, India, from June 2024 to August 2024. Seven three-dimensional (3D) FEA models of mandibular first premolars were designed: M1 (IRR at apical third restored with MTA), M2 (IRR at middle third restored with MTA), M3 (IRR at cervical third restored with MTA), M4 (IRR at apical third restored with Biodentine), M5 (IRR at middle third restored with Biodentine), M6 (IRR at cervical third restored with Biodentine) and M7 (control model). A force of 300 N was applied to the buccal side at a 30° inclined angle to the occlusal plane. Linear analysis was conducted to assess the Von Mises stress values along the central XY plane of the tooth model. The maximum and minimum Von Mises stresses were recorded and directly compared for each virtual tooth model. Results: Stress analysis showed maximum stress concentrations near the edges of the resorption cavities for both materials. In MTA-filled models, peak stress values were 73.35 MPa (apical), 104.35 MPa (middle) and 102.79 MPa (coronal), while Biodentine-filled models showed slightly lower peaks at 72.33 MPa (apical), 103.65 MPa (middle) and 101.86 MPa (coronal). Minimum stress values ranged from 0.0002 MPa to 0.0022 MPa across models, primarily in regions distant from the cavities. Conclusion: Biodentine exhibited slightly better stress redistribution than MTA, with lower peak stress values across all resorption levels; however, both materials left the cavity edges as critical stress concentration zones. These findings emphasise the need for additional restorative measures to address structural vulnerabilities.

Knowledge, Attitudes, and Perceptions of Wet Cupping Therapy (Hijamah) among the Public in Northern Saudi Arabia: A Cross-sectional Study

Mohamed M Abd El Mawgod, Hassan Mohammad, Nawaf S Alenezi, Omar Mosab M Alenazi, Ashwaq Ibrahim H Alanazi, Taif Saleem Alanazi Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Traditional medicine, particularly cupping therapy (Hijamah), is prevalent in both developed and developing nations, especially in the Kingdom of Saudi Arabia. Currently, it provides numerous health benefits, such as the prevention and treatment of various health problems including headaches, fatigue and bone aches. Aim: To explore the knowledge, perceptions and attitudes of the adult population in the Northern Border region of Saudi Arabia towards Hijamah. Materials and Methods: A cross-sectional study design was utilised among the adult general population in the Northern Border region of Saudi Arabia, between 1^st March 2024 and 30^th September 2024. A self-administered structured questionnaire containing questions about demographics, knowledge, attitudes and perceptions of Hijamah was employed. Qualitative data were presented as frequencies and percentages. Results: The study included 392 participants, whose mean age was 36±11.7 years. The majority of the participants believed that wet cupping is a helpful practice 367 (93.6%). Slightly less than 80% 303 (77.3%) accept it as an alternative therapy. The most frequently mentioned use of wet cupping is for fatigue relief 314 (80.1%), followed by headaches 299 (76.3%), back pain 270 (68.8%) and joint pain. Most people 328 (83.7%) agree that wet cupping remains a conventional therapeutic practice today. Conclusion: The majority of the adult population in the Northern Border Region understands the practice of Hijamah, accepts it as an alternative medicine, believes it has a favourable impact and commonly uses it to relieve fatigue, headaches and bone pains.

A Narrative Review on Factors Affecting Access to Oral Health Services in Türkiye

Onur Bayrakci, Duygu Kalkay, Hazel Celik Guzel Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Oral health is an essential public health problem directly affecting people’s general health and quality of life. Rates of utilisation of oral health services in Türkiye are affected by various factors such as people’s socioeconomic status, geographical location, and ease of access to the health system. Low income, inadequate education, and lack of health insurance in private sector coverage are the main barriers in accessing oral health services. Socioeconomic inequalities affect people’s utilisation rates of oral health services and regular care habits, leading to both treatment delays and higher health costs. Increasing preventive oral health awareness and addressing the relationship between access to oral health services and social and economic factors are critical for developing sustainable policies to improve individuals’ quality of life and reduce health inequalities. In recent years, Türkiye has confronted significant challenges with elevated inflation and unemployment rates. These factors have substantially constrained access to healthcare services. Presently, Türkiye ranks sixth with the highest inflation rate globally. This review aimed to analyse the access to oral health services in Türkiye and the factors affecting this access. In addition, solutions to reduce existing inequalities are presented.

Impact of COVID-19 Lockdown on Profile of Ocular Injuries: A Retrospective Cohort Study from a Tertiary Care Centre, West Bengal, India

Trisha Ghosh, Sanjay Kumar Daulat Thakur, Anup Mondal, Sourav Dey Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Ocular trauma represents a significant yet preventable contributor to visual impairment. The enforcement of lockdown measures during the Coronavirus Disease-2019 (COVID-19) pandemic led to people remaining confined to their homes, which likely influenced both the risk factors and the pattern of ocular injuries during this period. Aim: To determine the characteristics and visual outcomes of patients with ocular trauma during the COVID-19 and post-COVID-19 periods. Materials and Methods: This retrospective, hospital-based cohort study was conducted among patients presenting to the Department of Ophthalmology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India. Data were collected on patient demographics, mode and location of injury, time interval between injury and presentation, presenting Visual Acuity (VA) and the management of ocular trauma. Categorical variables were summarised using frequencies and percentages, while continuous variables were expressed as mean±standard deviation deviation. Group differences were analysed using Pearson’s Chi-square test. Results: A total of 2,010 eyes of 1,940 patients were included in this study. Males were more predominant in both the COVID-19 and the post-COVID-19 lockdown periods. The mean age of the study population was significantly lower during COVID-19 (25.48±20.3 years) compared to the post-COVID-19 period (29.97±17.3 years) (p-value=0.006). Injuries sustained at home were considerably higher than workplace injuries during the COVID-19 pandemic. Patients with ocular trauma during COVID-19 had delayed presentation. The incidence of closed globe injuries was notably higher during the COVID-19 period, with corneal epithelial defects being the most prevalent type, observed in 25.7% of cases (p-value=0.002). Sharp objects were the leading cause of injury during this time, accounting for 21.4% of cases. In contrast, during the post-COVID-19 period, the most common causative agents were plant leaves (20.3%), followed by animal-related injuries (15.3%). Furthermore, the proportion of patients presenting with trauma-related blindness was greater during the COVID-19 period (10.1%) compared to the post-lockdown phase (9%). Conclusion: During the COVID-19 pandemic, the number of patients seeking care for ocular trauma significantly decreased, while injuries occurring within the home environment increased. Enhancing public awareness and implementing preventive strategies could help reduce the risk of eye-related complications and vision loss associated with domestic activities.

Ocular Toxicity Associated with Tamoxifen Administration in Patients with Breast Cancer: A Systematic Review

Tejaswi Vadde, Neha Narayan, Amulya Varshini Banka, Shravani Divity, Yethindra Vityala Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Tamoxifen (TAM), a selective Oestrogen Receptor (ER) modulator, is widely used for treating and preventing ER-positive Breast Cancer (BC). TAM, administered as an adjuvant therapy for hormone receptor-positive BC, reduces recurrence but can cause ocular toxicity, including retinal degeneration, macular oedema, and corneal changes. However, the underlying mechanisms behind these effects remain unclear. Aim: This systematic review aimed to evaluate the ocular toxicity induced by TAM in patients with BC and to assess the reported adverse events. Materials and Methods: A systematic review was conducted which included a comprehensive search of electronic databases and grey literature sources to identify relevant studies published between May 2018 and May 2024. Observational studies (case-control and cross-sectional) published in the English language that detailed the ocular Adverse Effects (AE) of TAM in patients with BC were considered for inclusion. Three reviewers screened the selected studies based on the title and abstract. Disagreements were resolved by discussion with another reviewer. Data extraction included study characteristics, patient demographics, intervention details, and ocular changes. Results: Five studies met the inclusion criteria and were included in the review. The analysis revealed that TAM-induced ocular toxicity results in diverse structural and functional changes within eye tissues, including retinal degeneration, macular thinning, alterations in choroidal thickness, and vascular modifications. The severity of ocular toxicity correlated with cumulative TAM exposure, highlighting the need for long-term eye monitoring in patients receiving extended therapy. Conclusion: This systematic review indicated a possible link between TAM use and ocular toxicity, although the evidence is limited by methodological constraints. These results highlight the necessity of eye monitoring for patients undergoing TAM treatment, especially for those receiving long-term regimens.

Role of One Month Yoga Training on Arterial Stiffness in Young Adults with Familial Hypertension: A Prospective Interventional Study

Yashwanth Yellanki, Manjunatha R Aithala, Chandini Sheik, Amrit Podder, Madivalappa P Doddamani, Jyoti P Khodnapur Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Family history of hypertension is an important non modifiable risk factor that may lead to development of hypertension in otherwise healthy individuals. This is reflected in altered vascular stiffness parameters in these subjects. Yoga has been shown to improve these parameters and may help prevent or at least postpone the future development of hypertension. Aim: To find out the association between family history of hypertension and vascular stiffness and to determine the effect of yoga as a therapeutic tool in subjects at risk of future hypertension. Materials and Methods: This prospective interventional study was conducted from September to November 2023 at Centre for Yoga and Exercise Physiology, Shri B.M. Patil Medical College and Research Centre, Karnataka, India. Study included a total of 126 apparently healthy consenting undergraduate individuals aged between 18 and 30 years. Anthropometric, physiological, as well as arterial stiffness parameters like pulse wave velocity and Arterial Stiffness Index (ASI), were recorded using Periscope preintervention at week zero and post-yoga intervention at week four. Statistical Package for the Social Sciences (Version 20.0) was used to analyse the data. For normally distributed data, an independent t-test was used and for non normally distributed data Mann-Whitney U test was used, with p-value <0.05 considered statistically significant. Results: The study consisted of 46.8% boys and 53.2% girls, with a mean age of 19.94±1.422 years. Significant associations were found between male and females in anthropometric, physiological and arterial stiffness parameters, including Rt. Brachial ASI (p-value=0.002), Rt. Ankle ASI (p-value=0.034), and vascular age (p-value=0.013). At week 0, subjects with family history of hypertension showed appreciable differences in the mean values of vascular parameters, but significant association was only brachial ASI (p-value=0.013). Statistically significant results were observed when the effect of yoga was assessed between week 0 and 4 across most parameters; but group-specific effect of yoga intervention, particularly for subjects with family history of hypertension, was observed only on Rt. Ankle ASI (p-value=0.027). Conclusion: This study revealed a gender difference in arterial stiffness parameters, as well as the significant effect of four weeks of yoga intervention following the prescribed yoga protocol in young adults. Although not statistically significant, differences in mean values also indicate group-specific differences in arterial stiffness parameters favouring stiffer vessels in subjects with family history and the group-specific effects of yoga might warrant further study.

Hepatoprotective Effects of Momordica dioica Against Acetaminophen-induced Liver Damage in Rats: An Experimental Study

Pushpalatha Tanneeru, Kalpana Ramachandran, V Gayathri, D Haripriya, Shonam Tamrakar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Hepatotoxicity from acetaminophen is a major contributor to liver damage. Among the most popular analgesics, acetaminophen has few adverse effects when taken in therapeutic dosages; however, acetaminophen abuse frequently results in hepatotoxicity. Aim: The aim of this study is to investigate the histopathological changes induced by a therapeutic dose of N-acetyl-para-aminophenol (APAP) and to explore the hepatoprotective role of the oral co-administration of Momordica dioica fruit extract in mitigating hepatotoxicity induced by APAP in rats. Materials and Methods: The present experimental study was conducted in the central animal facility of Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, between February to April 2024. Thirty-six healthy male albino Wistar rats were utilised in this study, randomised and divided into six groups (G1-G6) of six rats each. The rats were administered APAP (i.p.) and Momordica dioica (MD) orally for 42 days as follows: (G1) Control (normal saline), (G2) APAP (250 mg/kg), (G3) APAP (250 mg/kg)+silymarin (250 mg/kg), (G4) APAP (250 mg/kg)+Vitamin C (200 mg/kg), (G5) APAP (250 mg/kg)+Vitamin C (200 mg/kg)+MD (250 mg/kg), and (G6) APAP (250 mg/kg)+Vitamin C (200 mg/kg)+MD (500 mg/kg). All animals in groups G2-G6 received the respective drug or ally according to their treatment group for 42 days, one hour prior to acetaminophen induction. Results were analysed using one-way ANOVA for statistical significance. Results: The results demonstrated that rats given a therapeutic dose of APAP for 42 days experienced substantial histological alterations alongside elevated blood chemistry indicators. Co-administration of Momordica dioica extract resulted in significantly fewer histopathological lesions and restored or decreased levels of the tested blood chemistry parameters. Rats treated with silymarin exhibited no histological alterations, while liver histology in the Momordica dioica extract group revealed (100%) normal hepatic architecture with minor alterations. According to histochemical staining, APAP-induced hepatotoxicity was characterised by minimal to mild fibrosis (6/6), hydropic degeneration (6/6), necrosis (6/6), and steatosis (6/6). Conclusion: The oral co-administration of Momordica dioica extract possesses significant hepatoprotective properties and mitigates APAP-induced hepatotoxicity by enhancing its antioxidant role and improving tissue integrity. Momordica dioica supplementation could represent an effective treatment against APAP-induced hepatotoxicity.

Correlation of Cartridge Based Nucleic Acid Amplification Test Grading Based on Cycle Threshold Value with Clinicoradiological Profile and Time to Culture Positivity in Pulmonary Tuberculosis Patients: A Cross-sectional Study

Mohammed Javed Qureshi, Bhanu Pratap Choudhary, Chand Bhandari, Harsh Maheshwari, Manoj Saini, Dheeraj Merotha Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Tuberculosis (TB) remains a global health challenge, with India bearing the highest burden, including Multidrug-Resistant (MDR) TB. Early diagnosis is critical in controlling transmission, often achieved using GeneXpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF), which detects TB bacilli, RIF resistance and provides Cycle Threshold (CT) values reflecting bacillary load. Correlating CT values with clinical, radiological and microbiological parameters can enhance the evaluation of disease severity and guide management. Aim: To evaluate the correlation of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) CT values with clinical, radiological and microbiological parameters to assess bacillary load and disease severity in pulmonary TB. Materials and Methods: This cross-sectional study was conducted at Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India from April 2023 to April 2024. Patients diagnosed with pulmonary TB based on CBNAAT were enrolled. The study period spanned 12 months. The study included 110 participants (calculated for 95% confidence, 80% power and 7.5% error, based on 62% smear-positive prevalence and 90.5% GeneXpert sensitivity). Eligible participants were adults (≥18 years) providing consent, including all sputum smear-positive cases and smear-negative suspects. Patients with extrapulmonary TB, undetectable sputum CBNAAT-MTB, and pregnant women were excluded. Data collected included name age, sex, symptoms and signs (cough, expectoration, fever, breathlessness, weight loss, chest pain, haemoptysis, clubbing, icterus, pallor, cyanosis, lymph node, oedema, chest examination), vitals (blood pressure, oxygen saturation, heart rate, temperature, respiratory rate, Body Mass Index (BMI), mid upper arm circumference) Bandim scores, co-morbidities and demography, Chest X-ray (CXR) grading, sputum fluorescent microscopy grading and time to positivity in liquid culture. Correlation analyses were performed using Spearman’s rho and Pearson’s tests. IBM Statistical Package for the Social Sciences (SPSS) version 29.0 was used for statistical analysis, and a p-value <0.05 was considered significant. Results: The study included 110 patients, with the largest group (41) aged 21-40 years, followed by 30 patients in the 41-60 years age range. The mean age of the participants was 44.93±18.07 years. It demonstrated significant correlations between CBNAAT CT values and various diagnostic parameters. CBNAAT CT values were inversely correlated with Bandim scores (Spearman’s rho=-0.82, p-value <0.001), chest X-ray grading (Pearson’s r-value=-0.429, p-value=<0.001), and sputum fluorescent microscopy grading (Spearman’s rho=-0.63, p-value=<0.005), indicating lower CT values were associated with higher bacillary loads. Conversely, a positive correlation was observed between CBNAAT CT values and liquid culture time to positivity. Bivariate analysis showed that high bacillary loads were significantly associated with higher Bandim scores, advanced chest X-ray grading and elevated sputum microscopy grading (p-value <0.05). Conversely, low bacillary loads were characterised by higher CBNAAT CT values, milder radiological findings and reduced sputum microscopy grading. These findings underscore the utility of these variables in distinguishing between low and high bacillary load cases. Conclusion: CBNAAT CT values are strongly correlated with clinical, radiological and microbiological parameters in pulmonary TB. Lower CT values are indicative of higher bacillary loads, while higher CT values suggest lower bacillary loads. These findings highlight the potential of CBNAAT CT values as a surrogate marker for bacillary burden in pulmonary TB.

Psychological Risk Factors and Clinical Outcome Variables in Vaginismus: A Systematic Review

Safya E Esmaeel, Manal Mazyad Alanazi, Shahad Aqeel Alenezi, Fai Salamah Alanazi, Dhay Ayed Alruwaili, Rahaf Khalid Alobaidan, Eslam K Fahmy, Manal S Fawzy Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Vaginismus is a genito-pelvic pain marked by involuntary muscle contraction, pain, and avoidance of vaginal penetration, significantly affecting women’s health and quality of life. Despite its impact, vaginismus remains under-recognised and poorly understood. Aim: This systematic review aims to synthesise recent evidence on psychological, risk, and clinical variables in women with vaginismus. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors searched PubMed, SCOPUS, Web of Science, and Science Direct for English language articles published between Jan 2019 and Dec 2023 using combinations of keywords and MeSH terms related to “vaginismus,” “psychology,” “risk factors,” and “sexual disorders.” Studies were included if they addressed vaginismus concerning risk factors, psychological aspects, or associated variables in human subjects. Two reviewers independently screened and selected studies, with disagreements resolved by consensus. Data extraction, screening, and quality assessment were performed using Rayyan Qatar Computing Research Institute (QCRI). Results: Fourteen studies were included, including 3,086 female subjects. Sexual intimacy, self-image, fear of sex, sexual quality of life, education level, family structure, childhood trauma, cultural ideas about first sexual experiences, and misunderstandings about sexuality were among the several elements linked to vaginismus. Vaginismus is connected to anxiety and depression, underscoring the need for psychotherapy in treatment. Vaginismus was found to increase with grade, potentially lowering success rates and necessitating longer treatment times. Conclusion: This review highlights that vaginismus is a multifactorial disorder best managed through individualised, multidisciplinary care. Early recognition and tailored interventions, particularly combining psychological and physical therapies, are key to improving outcomes and quality of life for affected women.

Comparison of Milligan-Morgan Haemorrhoidectomy versus Laser Haemorrhoidoplasty in Patients with Grade II and III Haemorrhoids: A Prospective Observational Study

Asfar Ahamed Nawabjan, Sathish Rajkumar, Chudar Arumugam, Mohamed Marzook, Jasmine Sharmila, Lalith Kumar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Haemorrhoidal disease results from abnormal dilation of anal cushions, influenced by dietary habits and pelvic anatomy. Surgical management remains essential for symptomatic cases, with Milligan-Morgan haemorrhoidectomy as the gold standard despite significant postoperative pain. Laser haemorrhoidoplasty has emerged as a minimally invasive alternative with faster recovery and fewer complications. Aim: To compare the clinical outcomes of Milligan-Morgan haemorrhoidectomy and laser haemorrhoidoplasty in patients with grade II and III haemorrhoids, focusing on postoperative pain, hospital stay, complications, and recovery time. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India, from January 2022 to June 2023 (including three months of follow-up). A total of 40 patients were randomly assigned into 2 groups, group A (laser) with 20 patients and group B (Milligan Morgan) with 20 patients. The postoperative outcomes, including duration of intervention, pain, hospital stay, return-to-work time (recovery time) were assessed. Statistical analysis was performed using Statistical Package For Social Sciences (SPSS) software, with p<0.05 considered significant. Results: The mean age of the study participants was 41.35±13.95 in the laser group vs 43.3±12.75 in the open group, with no significant age or sex difference. The laser group had significantly lower postoperative pain {Visual Analogue Scale (VAS) 4.60±1.14 vs. 9.15±0.67 on Day 1, p<0.001}, shorter operative time (19.85 min vs. 54.75 min), reduced intraoperative blood loss (7±2.51 mL vs. 23±5.23 mL, p<0.001), and shorter hospital stay (1.1 vs. 1.85 days, p<0.001). Recovery time was significantly faster in the laser group (7.75±2.40 vs. 21±4.45 days, p<0.01). Complications such as secondary bleeding in 4 (20%) patients, urinary retention in 5 (25%) patients and anal stenosis in 5 (25%) patients occurred only in the open group. Conclusion: Laser haemorrhoidoplasty offers significant advantages over Milligan-Morgan haemorrhoidectomy, including reduced pain, faster recovery, and fewer complications.

Clinical Outcomes of Non Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Non Valvular Atrial Fibrillation Patients: A Cohort Study in a Rural Tertiary Care Hospital, Gujarat, India

Sohilkhan Riyazkhan Pathan, Bharat M Gajjar, Sunilkumar Karna, Kushal Pujara Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Atrial Fibrillation (AF) is the most common arrhythmia, with an increased risk of ischaemic stroke and subsequent morbidity and mortality. Oral anticoagulants such as Vitamin K Antagonists (VKAs) and non VKA Oral Anticoagulants (NOACs) are effective stroke prevention treatments, when used properly. The CHA₂DS₂-VASc and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly (age >65 years), and Drugs/alcohol) scores are utilised to guide clinical decision-making in stroke prevention and bleeding risk management for patients with AF. However, real-world evidence on anticoagulation strategies and their effectiveness in rural Indian populations remains limited. Aim: To evaluate the clinical outcomes of NOACs versus VKAs in Non Valvular Atrial Fibrillation (NVAF) patients in a rural tertiary care hospital in India. Materials and Methods: An ambidirectional cohort study, conducted from January 2014 to December 2024, evaluated baseline demographic and clinical characteristics and anticoagulation therapy (NOACs or VKAs) in NVAF patients. Clinical outcomes evaluated encompass major (example: ischaemic or haemorrhagic stroke) and minor bleeding, and all-cause mortality. Fisher’s exact test was used to compare patient and clinical characteristics between the NOAC and VKA groups. The log-rank test and Cox proportional hazards analysis were used to compare bleeding risk and mortality between NOAC and VKA groups. Results: Among the 347 patients with NVAF, those prescribed NOACs were significantly older (median age 74 vs. 58 years, p-value <0.0001) and had higher CHA2DS2-VASc scores (median 4 vs. 3, p-value <0.0001) than VKA users. NOAC users also had a higher prevalence of hypertension, diabetes, ischaemic heart disease, prior stroke and chronic kidney disease (p-value <0.0001). Major bleeding was slightly more common in NOAC patients (2.9 vs. 2.1 events per 1,000 person-months, p-value=0.40). The log-rank test showed no significant difference in major bleeding event between NOAC and VKA groups (p-value=0.10). However, all-cause mortality was higher in NOAC users (11.6 vs. 7.7 per 1,000 person-months). Conclusion: Although NOACs are generally favoured in AF management, this study found higher mortality and bleeding risks among NOAC users in a rural Indian cohort. Older age, higher burden of co-morbidities, being underweight and higher stroke and thromboembolic risk can contribute to adverse outcomes among NOAC users. These findings highlight the need for individualised anticoagulation strategies, particularly in resource-limited settings.

Comparison of Oral Pregabalin and Clonidine Premedication in Attenuating Pressor Response to Laryngoscopy and Intubation: A Prospective Interventional Study

Jyotsna Mulamoottil Jose, Basheer Padinjare Madathil Abdul, Minu Subramonian, Anto Abey Illickal Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Laryngoscopy and intubation during the induction of general anaesthesia can lead to sympathetic system-mediated haemodynamic pressor response, which, if exaggerated, may lead to hazardous complications like myocardial ischaemia, arrhythmias, and cerebral haemorrhage. Although several pharmacological and technical methods are available to attenuate this stress response, the search for an ideal agent continues. Aim: To compare the effects of orally administered clonidine and pregabalin in attenuating the haemodynamic pressor response to airway instrumentation during the administration of general anaesthesia. Materials and Methods: The present prospective interventional study was conducted between June 2020 and July 2021 at Government Medical College, Kozhikode, Kerala, India. A total of 176 American Society of Anaesthesiologists (ASA) Physical Status I patients aged between 18 and 65 years were included. Patients were categorised into two groups: Group P received oral pregabalin 150 mg and Group C received oral clonidine 200 mcg, 60 minutes before the induction of GA. Haemodynamic parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)} and Ramsay sedation scores were recorded at predefined intervals. Statistical analysis was performed using International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) software, with data expressed as mean±Standard Deviation (SD). Differences between groups were assessed using the Chi-square test, independent samples t-test, and Mann-Whitney U test, with a p-value of <0.05 considered statistically significant. Results: Demographic variables and baseline parameters were comparable between the groups. A statistically significant reduction in HR was observed in the clonidine group compared to the pregabalin group (p<0.05) at multiple time intervals post-drug administration. SBP, DBP, and MAP values showed reductions in both groups, with no significant intergroup differences (p>0.05). A higher incidence of bradycardia and hypotension was noted in the clonidine group (p<0.05). Sedation scores, compared using the Mann-Whitney U test, revealed significantly higher sedation in the pregabalin group at one hour after drug administration and 15 minutes after extubation. Conclusion: Both clonidine 200 mcg and pregabalin 150 mg, when administered orally one hour before the induction of anaesthesia, are effective in attenuating the haemodynamic pressor response. Clonidine is superior to pregabalin in reducing tachycardia; however, clonidine carries a higher risk of bradycardia and hypotension, whereas pregabalin results in greater postoperative sedation.

Comparison of Intrathecal Nalbuphine vs Intrathecal Clonidine as Adjuvant with Hyperbaric Bupivacaine in Pelvic and Lower Limb Orthopaedic Surgeries: A Randomised Clinical Study

Payal Kalpesh Berawala, Shraddha Gordhanbhai Jogani, Nilesh Vrajmohan Shah, Tejash H Sharma, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Addition of an adjuvants to local anaesthetic like bupivacaine, helps to make sensory and motor blockade better compare to bupivacaine alone. In this study, comparison was done amongst nalbuphine—a mixed opioid with high efficacy as an agonist of kappa receptors—and clonidine, a selective alpha-2 adreno receptor agonist. Aim: To determine the effects of intrathecal nalbuphine and clonidine as adjuvant with hyperbaric bupivacaine 0.5% on onset and duration of sensory and motor block with duration of total postoperative analgesia in pelvic and lower limb orthopaedic surgeries. Materials and Methods: This randomised clinical study was done on 50 patients aged between 18 and 65 years with American Society of Anaesthesiologists (ASA) Grade I or II, of either gender. They were randomly divided 25 in each group as Group BCL (clonidine), containing hyperbaric 0.5% bupivacaine 3.4 mL + 30 μg clonidine (total 3.6 mL) and Group BN (nalbuphine) containing hyperbaric 0.5% bupivacaine 3.4 mL + 1 mg nalbuphine (total 3.6 mL). Parameters studied were motor and sensory block characteristic like time of onset, duration of sensory and motor block, two-segment regression time, total duration of postoperative analgesia and side-effects. Haemodynamic changes were also noted. Statistical analysis done by using Student’s t-test and Chi-square test. Tests were considered statistically significant if p-value was <0.05. Results: Demographic data, including age, gender, weight, ASA grading and duration of surgery for both the groups, were comparable and statistically non significant. BCL group (4.15±0.57 minutes) had significantly faster onset for motor block than BN (5.06±0.42 minutes) (p-value <0.0001). Group BCL has significantly longer motor block duration (335.2±23.69 minutes) than BN (285.2±23.21 minutes), with significantly longer sensory block duration in group BCL (400.6±30.29 minutes) than BN (357.8±29.51 minutes) (p-value <0.0001). The duration of postoperative analgesia was significantly extended in the BCL group (445.8±33.87 minutes) than BN (410.8±26.56 minutes) (p-value ≤0.0002). Conclusion: Present study concluded that addition of clonidine 30 μg with hyperbaric bupivacaine 0.5% in spinal anaesthesia, compared to nalbuphine 1 mg, shortens the onset time of motor block and prolongs the duration of both sensory and motor block, while also increasing total postoperative analgesia period, all with haemodynamic stability and minimal side-effects.

Association of Placental Morphometry with Neonatal Birth Weight in a Semi-urban Population: A Cross-sectional Study

Hemant Deshpande, Shivani Patel Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Placental morphometry, including weight, circumference, and cotyledon count, plays a critical role in foetal growth and neonatal outcomes. Understanding the associations between these parameters and birth weight may provide valuable insights for the early detection of growth abnormalities. Aim: To evaluate the relationship between placental weight, circumference, and cotyledon count with neonatal birth weight in a semi-urban population. Materials and Methods: This cross-sectional study included 120 mother-newborn pairs delivering at term at Dr.D.Y.Patil Medical College Hospital, Pimpri, Pune, India, from October to December 2024. Systematic sampling was used. Placental weight, circumference, and cotyledon count were measured post-delivery. Neonatal birth weight was recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 28. Pearson’s correlation and multiple linear regression were performed, adjusting for maternal age, parity, and Body Mass Index (BMI). A p-value of <0.05 was considered statistically significant. Results: The mean maternal age was 26.5±3.8 years, with a mean BMI of 24.8±2.5 kg/m2. Primiparous women constituted 56.7% of the participants, and 51.7% of the newborns were male. Pearson’s correlation analysis identified that placental weight (r=0.75, p-value <0.001) showed the strongest correlation with birth weight, followed by circumference (r=0.68, p-value <0.001) and cotyledon count (r=0.59, p-value <0.001). Regression analysis identified placental weight (β=0.52, p-value <0.001), circumference (β=0.33, p-value <0.01), and cotyledon count (β=0.24, p-value <0.05) as significant predictors. The mean birth weight to placental weight (BW: PW) ratio was 6.15±1.2. Conclusion: The findings of this study underscore the association between placental morphometry and neonatal birth weight, with placental weight being the strongest predictor.Hence,these findings can contribute in improving neonatal outcomes in semi-urban settings.

Nomophobia and its Relationship with Depression, Anxiety and Stress among Undergraduate Medical Students in a District of West Bengal: A Cross-sectional Study

Tousif Ahamed, Ritu Ghosh, Malay Kumar Das, Dilip Kumar Das Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Nomophobia is the fear or anxiety that individuals experience when they are without their smartphones or unable to use them. The implications of nomophobia among undergraduate medical students could be significant, as medical education is demanding and stressful. The extent of nomophobia may affect mental health status. The potential relationship between nomophobia and mental health, particularly depression, anxiety, and stress, is a subject of growing interest. Aim: This study aimed to estimate the magnitude of nomophobia, the prevalence and degree of depression, anxiety, and stress, as well as to assess the relationship between nomophobia and mental health status, and to identify the correlates of nomophobia among undergraduate medical students. Materials and Methods: A descriptive cross-sectional study was conducted at Murshidabad Medical College, West Bengal, India, between September to November 2023, among 222 undergraduate medical students from three consecutive batches (2020-21, 2021-22, 2022-23), selected through stratified random sampling. A self-reported questionnaire comprising the validated Nomophobia Questionnaire (NMP-Q) and the Depression, Anxiety, and Stress Scale (DASS) was used to collect data. Both bivariate and multivariable logistic regression analyses were applied to identify the predictor variables. Correlation analyses were conducted using Spearman’s coefficient. A p-value of 0.05 or below was considered statistically significant. Results: The mean age of the participants was 21.47±1.86 years, with a median age of 21.50 years. Among the participants, 151 (68.0%) were male, 145 (65.3%) were Hindu, and 196 (88.3%) belonged to nuclear families. The distribution of nomophobia among participants was as follows: 29 (13.1%) had mild, 160 (72.1%) had moderate, and 33 (14.8%) had severe nomophobia. Depression, anxiety, and stress were found to be present in 121 (54.5%), 154 (69.4%), and 83 (37.4%) of the participants, respectively. Significant predictors of severe nomophobia included students aged under 21 years (aOR: 6.088; 95% CI: 2.053–18.055), those belonging to joint families (aOR: 6.836; 95% CI: 2.392–19.537), and those who used smartphones for more than five hours daily (aOR: 5.314; 95% CI: 1.919–14.721). Nomophobia was significantly correlated with depression (Spearman’s rho: 0.200, p-value=0.003) but not with anxiety and stress. Conclusion: Nomophobia is universally prevalent among medical students, with varying severity. The findings suggest the need for targeted health education interventions for the holistic well-being of medical students.

Effect of Pain Neuroscience Education versus Conventional Patient Education on Pain, Quality of Life, Kinesiophobia and Pain Catastrophising in Individuals with Post-Stroke Chronic Shoulder Pain: A Randomised Controlled Trial Protocol

Pooja Motar Sublok, Prashant Mukkannavar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Post-Stroke Shoulder Pain (PSSP) is a prevalent complication that affects 10-22% of stroke survivors. Research shows that chronic pain is influenced by biological, psychological and social factors and these factors can impact physical function, kinesiophobia, pain catastrophising, disability and quality of life. These elements may contribute to chronic pain in patients with PSSP. Understanding Post-Stroke Chronic Shoulder Pain (PSCSP) is crucial for developing effective interventions and improving the overall wellbeing of stroke survivors. Need of the study: This study seeks to address the gap in understanding PSCSP, particularly the overlooked psychosocial factors in physiotherapy. By integrating the biopsychosocial model with Pain Neuroscience Education (PNE) and conventional physiotherapy, it aims to improve pain management and the wellbeing of stroke survivors. Aim: To compare the effect of PNE versus Conventional Patient Education (CPE) on pain intensity, quality of life, kinesiophobia and pain catastrophising in individuals with PSCSP. Materials and Methods: This research protocol is planned to conduct a randomised controlled trial in Hubballi, Karnataka, India, with 80 participants (40 per group), calculated at 90% power and 5% significance using G-power software. The duration of the study will be approximately four years, from June 2023 to August 2027. Participants aged ≥18 years with PSCSP (≥3 months), first-ever unilateral ischaemic or haemorrhagic stroke and chronic stroke lasting more than six months, meeting cognitive criteria (Mini-Mental State Examination (MMSE) >24), Visual Analogue Scale (VAS) (>1 mm) and Brunnstrom stages (III–V), will be included. Participants will be excluded if they have pre-stroke shoulder/neck pain, have undergone surgery, experienced acute strokes, have severe deficits, uncontrolled conditions, or contraindications to Transcutaneous Electrical Nerve Stimulation (TENS) (e.g., epilepsy, pacemaker). Group A will receive PNE, while Group B will undergo CPE. Both groups will receive graded motor imagery, TENS and task-specific exercises for six weeks, with a two-week follow-up. Outcomes (VAS, quality of life, Tampa Scale for Kinesiophobia, pain catastrophising and disability) will be assessed at baseline, six weeks and eight weeks.

Evaluation of Comparative Efficacy of Goghrita with Saindhava Matrabasti versus Goghrita Matrabasti in Sciatica (Gridhrasi): A Randomised Controlled Trial Research Protocol

Girish Bhupal, Shweta Parwe, Milind Nisargandha, Shalini Pathania Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: Modern lifestyles contribute to nutritional deficiencies and health issues, with low back pain affecting 80-90% of individuals. Sedentary living, poor posture and stress often lead to sciatica, characterised by pain radiating down the leg, which is classified in Ayurveda as Gridhrasi, a Vata disorder. Need for the study: Due to sedentary lifestyles, poor posture and job challenges, sciatica is becoming increasingly common. Traditional therapies have significant disadvantages. While contemporary treatments such as analgesics, physiotherapy, or surgery frequently alleviate symptoms, they do not address the underlying issues. Recurrence and adverse effects are common. Ayurvedic therapies that provide comprehensive and long-lasting relief, such as Matrabasti, require evidence-based acceptance. This treatment reduces pain and stiffness by lubricating the muscles and nerves. Aim: To evaluate and compare the efficacy of Goghrita (cow clarified butter) with Saindhav Lavana (rock salt) Matrabasti (enema) versus Goghrita Matrabasti in Gridhrasi (sciatica). Materials and Methods: A randomised single-blind (assessor) superiority trial will be conducted at the Department of Panchakarma, Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India, from November 2024 to January 2026. Subjects will be divided into two groups of 30 each. In group A (Control), Goghrita Matrabasti 60 mL will be administered after meals for nine days and in group B (Experimental), Goghrita 60 mL with 5 grams of Saindhav Lavana will be given after meals for nine days. The assessment will be based on subjective parameters such as Spandana (Twitching), Ruk (Pain), Stambha (Stiffness), Toda (Pricking pain), Aruchi (Loss of taste), Tandra (Stupor) and Gaurava (Heaviness), as well as objective criteria including the Visual Analogue Scale (VAS) scale, the Straight Leg Raising Test (SLRT), Range of Motion and the Schober test on the 0th, 9th, 18th day. Statistical analysis will be conducted using paired and unpaired t-tests for intra- and intergroup comparisons and a Chi-square test for categorical data. A p-value <0.05 will be considered statistically significant.

Efficacy of Gunja Beeja Ointment versus Diclofenac Sodium Ointment in the Management of Avabahuka (Frozen Shoulder): A Research Protocol for a Randomised Controlled Trial

Shreya Parkhi, Sadhana Durgaprasad Misar Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Introduction: primarily caused by vitiated Vata affecting the Amsa Sandhi, manifests as shoulder dysfunction. Acharya Sushruta, categorise Avabahuka as a Vata Vyadhi, recommending Vatavyadhi Chikitsa. Symptoms include loss of upper limb movement, pain, and shoulder joint stiffness. In modern medicine, Avabahuka is analogous to Frozen Shoulder or Adhesive Capsulitis, impacting 2-5% of people in general and 10-15% of diabetics. Charaka Samhita recommends Lepa (paste) for immediate relief. Need of the study: The modern treatment includes analgesics and local intra-articular injections of corticosteroids, and physiotherapy. Nonsteroidal anti-inflammatory drugs have side effects such as nephrotoxicity, infectious arthritis and cartilage damage. There is a need for a safe and effective Ayurvedic herbal drugs which can be beneficial in such cases. Gunja Beeja contains Abrin and Abralin that has analgesic, anti-inflammatory and antimicrobial activities. No randomised controlled trial has been conducted on Gunja Beeja ointment in Avabahuka. Aim: To evaluate the efficacy of Gunja Beeja ointment versus diclofenac sodium ointment in the management of Avabahuka (Frozen Shoulder). Materials and Methods: This single-blind, parallel randomised controlled trial will take place over a period of one and a half years (February 2025-January 2026) at the Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACH & RC), Salod (H) Wardha, Maharashtra, India. The study registered under CTRI/2024/07/070559 involves 60 patients meeting the inclusion criteria, randomly assigned into two groups of 30 each. Group 1 will receive Diclofenac sodium ointment while Group 2 will receive Gunja Beeja Ointment with shoulder exercises in both groups, once daily for seven days. Assessments will be conducted on days 0, 7, and 14, with follow-up on day 14. Outcomes will be measured using range of shoulder movement (Goniometer), pain (Visual Analogue Scale), stiffness (scoring method), muscle atrophy (measured in centimeters), and the Disability of Arm, Shoulder, and Hand (DASH) questionnaire.

Properties, Fabrication Techniques, and Clinical Outcomes of Lithium Disilicate, Zirconia, and Zirconia-reinforced Lithium Silicate Crowns: A Narrative Review

Yousef Tariq Eshmawi Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X All-ceramic crowns have gained immense popularity in modern day dentistry owing to their enhanced aesthetics, biocompatibility, and durability. Among these, lithium disilicate (LS₂), zirconia (Z), and zirconia-reinforced lithium silicate (ZLS) are three most desired restorative materials, each offering varying benefits. The advances of material science and digital dentistry are constantly refining their clinical behaviour, making material selection a major part of restorative decision making. This review article provides a general summary of these three all-ceramic crown materials and discusses their evolution, specifically the development in the translucency of zirconia and the transformation of ZLS as a hybrid material. It covers the most important properties of each of these materials, such as aesthetics, biocompatibility, strength, and bonding procedures. It also discusses the effect of traditional vs. computerised impression methods on their clinical success. A lot of this review also contrasts traditional and digital impression technology. It discusses how developments such as intraoral scanning (IOS) and Computer-Aided Design and Computer-aided Manufacturing (CAD/CAM) technology impact the accuracy, efficiency, and clinical success of crown restorations. Through critical examination of the literature, this review is intended to provide clinicians with information necessary for evidence-based decision making in material selection and impression-taking techniques, which will ultimately maximise patient outcomes and long-term restorative success.

Unravelling the Intricacies of Auto Brewery Syndrome and its Microbial Dynamics: A Narrative Review

Bhagyesh Sapkale, Shreya Singh, Dhruba Chandi Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X Auto Brewery Syndrome (ABS), often referred to as Gut Fermentation Syndrome (GFS), is a sporadic disorder characterised by the internal production of alcohol, leading to symptoms that resemble alcohol intoxication, including vertigo, slurred speech and confusion. The article explores uncommon presentations of ABS, such as an oral version and a new variation in which endogenous fermentation within the urinary system results in the production of ethanol. One of the main causes of ABS is thought to be a fungal dysbiosis of the gut, which occurs due to an overabundance of yeast. The pathophysiology of ABS is associated with the mycobiome, a component of the gut microbiota that ferments certain carbohydrates into ethanol, mimicking food allergies or intolerances. Using a comprehensive search strategy that includes the PubMed, Science Direct and Google Scholar databases, this review investigates ABS with a focus on recent research published in the last 10 years. The involvement of gut bacteria is emphasised, particularly the abnormal development that results in endogenous alcohol synthesis. Microbiological strains associated with ABS, including high alcohol-producing variant of Klebsiella pneumoniae (HiAlc KPN) and Candida albicans, are examined. The article discusses the challenges associated with diagnosing ABS, including the use of breath analysers, clearance rates and variations in endogenous ethanol production among different ethnic groups. Furthermore, medicolegal issues are addressed, such as the use of ABS as a defence in drunk driving cases. In conclusion, ABS illuminates the intricate relationship between the human body and its microbiota, highlighting the potential consequences of microbial imbalance.

A Narrative Review on Hormonal and Reversible Contraception: Advances, Options, and Implications for Reproductive Health

Krushan Shah, Bhagyesh Sapkale, Rajesh Godavarthi, Kamlesh Chaudhari Journal of clinical and diagnostic research : 2025 - July - 19:0973-709X This narrative-based systematic review aims to examine contraception, focusing on new developments and alternative techniques. Pregnant teenagers often face challenges regarding their social standing in society. To minimise teen pregnancy, the availability of services in terms of the supply of hormonal contraceptives and Long Acting Reversible Contraception (LARC) must be improved. There are many situations that require the use of Emergency Contraception (EC) to provide preventive measures after risky encounters. As there are currently no other male contraceptive options on the market, a male hormonal contraceptive is necessary. The market is primarily driven by contraceptive biomaterials, most of which are elastomers such as ethylene vinyl acetate and polydimethylsiloxane. Keywords from the Web of Science and PubMed databases included barrier techniques, LARC, contraception, and others. To maintain reliability and academic rigor, the inclusion criteria focused solely on English language research, reviews, and articles published in the last 10 years. Exploring new hormone combinations with better metabolic properties is an important aspect of the advanced conception of contraceptives. Lower androgenicity forms of natural chemicals and progestins are employed in LARC techniques to reduce thrombogenesis. Potential alternatives include transdermal systems and other vaginal rings. The sequelae, particularly the interactions between hormonal contraceptives and antiepileptic drugs, should also be discussed. Some types of contraception include tubal ligation through hysteroscopy, the impact of antiepileptic drugs on the effectiveness of hormonal contraceptives, and improved barrier methods of contraception. In certain medical contexts, Point of Care Contraceptives (POCCs) play important roles. This paper provides a comprehensive overview of contraceptives, their forms, and key considerations. The evaluation of LARC products for patient satisfaction, superior efficacy, and the promotion of condom use for the control of Sexually Transmitted Diseases (STDs) is also illustrated. According to this framework, reversible contraceptives provide people with greater control over family planning; Intrauterine Devices (IUDs) and subdermal implants are among the most effective contraceptive methods. The use of LARC techniques is discussed in this abstract, which underlines their importance and recognises that they are considered the most effective method of contraception when used regularly.