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

Advanced Kienbock’s Disease with Chronic Regional Pain Syndrome: A Case Report

V Sheshagiri, CS Sujan Theja, BM Pramod, CS Vidya Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Kienbock’s disease is a rare and painful disorder of the wrist, of unknown etiology, characterised by osteonecrosis of the lunate bone visible on wrist radiographs. It is typically seen in individuals aged 20-40 years, often in the dominant wrist, with a history of trauma. If left untreated, it can lead to fragmentation of the lunate, collapse and shortening of the carpus, and secondary arthritic changes throughout the proximal carpal area. We present a case of Kienbock’s disease Lichtman stage IV with Chronic Regional Pain Syndrome (CRPS) in a 53-year-old female who presented with right wrist pain and swelling persisting for one month, alongside a loss of range of motion of about 20 degrees in palmar and dorsal flexion, following a fall on an outstretched hand one year prior. Initially, the patient was managed conservatively with splinting, physiotherapy, and pharmacotherapy (Vitamin C, Vitamin D, Diclofenac) until the CRPS subsided. Subsequently, the patient underwent total wrist arthrodesis with bone grafting, resulting in pain relief and a satisfactory pain score.

Ocular findings in a Case of Tuberous Sclerosis Complex: A Classic Posterior Segment Presentation

Aishwarya M Angadi, Shikha Rai Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Tuberous Sclerosis Complex (TSC) is a genetic condition caused by autosomal dominant mutations in the tumour suppressor genes TSC1 and TSC2. The most frequent manifestations of this disorder involve benign tumours affecting multiple systems, including neurological, dermatological, renal, cardiac, pulmonary and ocular systems. The classic symptom triad consists of seizures, intellectual disability and cutaneous angiofibromas. Ocular involvement, though often asymptomatic, can reveal characteristic retinal lesions that are valuable for diagnosis and monitoring. A 23-year-old female with a recent diagnosis of TSC was referred to the Department of Ophthalmology for evaluation. She had no visual complaints. Examination revealed characteristic facial angiofibromas and bilateral Retinal Astrocytic Hamartomas (RAH) without any visual impairment. Computed Tomography (CT) imaging also showed bilateral renal angiomyolipomas. Ocular involvement in TSC is common but often asymptomatic. RAH are the most frequent ocular manifestations and are usually stable over time. Recognising these findings can support diagnosis and systemic evaluation, especially in undiagnosed patients. Ocular examination plays an essential role in the multidisciplinary assessment of TSC, aiding in both diagnosis and monitoring. Awareness of these subtle but significant findings is important for early and holistic management.

A Rare Case of Cavernous Haemangioma Mimicking Arteriovenous Malformation of the Arm

Poosarla Ram Sohan, Chandrashekhar Mahakalkar, Shruthi Bikkumalla, Srinivasa Reddy, Akansha Hatewar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Cavernous haemangiomas are venous malformations that are commonly localised defects in the vasculature. These haemangiomas are typically asymptomatic but can adversely affect Quality of Life (QoL). Arteriovenous Malformations (AVMs) are also vascular defects with a congenital origin. AVMs are characterised by direct abnormal connections with high blood flow. Cavernous haemangiomas and AVMs can be differentiated using diagnostic modalities such as Magnetic Resonance Imaging (MRI) and computed tomography angiography. This case report aims to document a rare clinical presentation of cavernous venous malformations in a 30-year-old female presenting with swelling of the arm and intermittent pain for the past two years. This case illustrates an atypical presentation of cavernous haemangioma, which initially appeared as an AVM but was gradually confirmed to be a ‘cavernous haemangioma’. A 30-year-old female presented with complaints of swelling in her upper arm, which was managed by embolisation followed by surgical resection. The diagnosis was confirmed through histopathology. Histopathological examination played a crucial role in the definitive diagnosis. This case highlights a rare diagnostic challenge where imaging findings initially suggested an AVM, but histopathology confirmed a cavernous haemangioma, emphasising the importance of thorough diagnostic workup in vascular anomalies.

Ileo-ileal Knotting in a Postoperative Chronic Calcific Pancreatitis Patient: A Case Report

Swathy Elangovan, Vivekananda Subramania Nathan, R Karikal Chakaravarthi, R Sivamarieswaran, JS Athish Pranav Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Ileo-ileal knotting is an exceptionally rare and potentially fatal cause of Small Bowel Obstruction (SBO), often leading to rapid vascular compromise, bowel ischaemia, and eventual gangrene if not promptly managed. The present case report describes a 43-year-old female with a prior history of Chronic Calcific Pancreatitis (CCP) who had underwent Frey’s procedure one year earlier. She presenting with acute abdominal pain, bilious vomiting, distension, and obstipation. Imaging was indicative of mechanical obstruction. Emergency exploratory laparotomy revealed a tightly knotted ileo-ileal loop located approximately four feet from the ileocecal junction. Remarkably, the bowel appeared viable, and the knot was successfully untied without requiring resection. The present patient experienced a smooth and uneventful recovery period following the surgical procedure and was subsequently discharged on the sixth day. The present case is clinically significant as it represents a rare non-resectional outcome of ileo-ileal knotting in a postoperative abdomen, a scenario scarcely reported in current literature. Prior abdominal surgeries may predispose patients to altered bowel motility or mesenteric dynamics, increasing the likelihood of such complications. The rarity associated with diagnosing this condition underscore the significance of sustaining a keen awareness among healthcare professionals, particularly for patients in the postoperative phase who show indications of bowel obstruction. Prompt surgical intervention is essential not only for preserving life but also for ensuring the ongoing functionality of the bowel. Reporting such rare entities contributes meaningfully to surgical literature, enhances clinician awareness, and may improve diagnostic accuracy and patient outcomes in future presentations.

Defying Expectations: A Rare Case of Hypergonadotropic Hypogonadic Pregnancy

Sridivya Cherukuri, Kamlesh Chaudhari, Apoorva Dave, Sravya Gudapati Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Amenorrhoea, hypoestrogenism, and hypergonadotropinism are the hallmarks of premature ovarian failure, affecting primary fertility in young females. Hypergonadotropic hypogonadism is a gonadal disorder that delays the onset of puberty in both males and females. In females, hypergonadotropic hypogonadism is also termed ‘Primary Ovarian Insufficiency’ (POI), which is characterised by premature ovarian failure. This is a rare case of a 27-year-old pregnant female with hypergonadotropic hypogonadism. She presented with primary infertility, and her laboratory investigations suggested hypergonadotropic hypogonadism or POI. Ultrasound imaging depicted a hypoplastic uterus with streak ovaries. She was treated with In-Vitro Fertilisation (IVF), which was successful on the second attempt. Hence, based on the findings of this case, it is recommended that females with POI should be counselled and informed about the small but real possibility of pregnancy.

Diabetic Mastopathy Mimicking Malignancy: A Surgical Perspective on Diagnosis and Management

Nandhini Ganesh, Athira Gopinathan, Vindu Srivastava, Imran Thariq Ajmal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Diabetic Mastopathy (DMP) is an uncommon benign fibroinflammatory condition of the breast, predominantly seen in individuals with long-standing diabetes mellitus. It often mimics malignancy on clinical and radiological examination, leading to diagnostic uncertainty. DMP accounts for 0.5-13.5% of all benign breast lesions. Here, authors present the case of a 48-year-old postmenopausal female who presented with complaints of serous, cheesy discharge of minimal quantity from the right nipple, intermittently for the past 10 years, along with pain over the right breast for the last four weeks. Clinical evaluation revealed a firm, tender subareolar mass with nipple-areola distortion and cheesy discharge. Imaging via sonomammography revealed a Breast Imaging Reporting and Data System 3 (BIRADS 3) hypoechoic lesion with cystic areas and ductal dilatation. A wide local excision, including the removal of the distorted nipple-areola complex, was performed. Gross and histopathological examination showed fibrocystic changes with dense fibrous stroma, lymphoplasmacytic infiltration and giant cells, consistent with DMP. Close clinical follow-up is essential. Heightened clinical awareness and individualised treatment strategies can help minimise unnecessary surgeries while ensuring patient safety and reassurance.

Uterine Dehiscence Presenting as Postpartum Puerperal Sepsis Mimicking Abdominal Tuberculosis

Vaishnavi Lakkireddy, Manjusha Agrawal, Smruti Mapari, Aishwarya Beedkar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Uterine dehiscence, characterised by the partial or complete separation of a previous uterine scar, is a rare but potentially life-threatening complication following Caesarean Section (CS). This condition often presents with non-specific symptoms and may mimic other diseases, delaying diagnosis and increasing morbidity. A 24-year-old postpartum female presented with abdominal distension, fever, vomiting, and purulent discharge from the surgical site. The initial diagnosis of abdominal tuberculosis was based on ascitic fluid analysis and elevated Adenosine Deaminase (ADA) levels. Imaging and further evaluations confirmed uterine scar dehiscence. Management included relaparotomy, debridement, and resuturing of the uterine scar, followed by antibiotic therapy. The patient improved significantly postoperatively, with resolution of symptoms and normalisation of laboratory parameters. She was discharged in stable condition 14 days after surgery. This case underscores the importance of considering uterine dehiscence in postpartum patients with sepsis and abdominal distension. Early diagnosis through imaging and timely surgical intervention is critical in improving outcomes and preventing long-term complications.

Successful Management of Cardiotoxic Manifestation following Krait Snake Bite in a Child: A Case Report

Sham Lohiya, Shahzad Ahmad, Jayant Vagha, Keta Vagha Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Krait (Bungarus) envenomation is typically associated with neurotoxic symptoms, while isolated cardiotoxicity without neurological or haemotoxic features is exceptionally rare. This report describes the case of a nine-year-old child who presented with cardiorespiratory symptoms following a krait snakebite. Notably, the child exhibited no neurological deficits, coagulopathy, or systemic envenomation markers typically associated with krait bites. The clinical presentation was dominated exclusively by cardiotoxic manifestations, including cardiac rhythm abnormalities and respiratory distress. Timely administration of Anti-Snake Venom (ASV) resulted in the complete resolution of symptoms, underscoring the potential efficacy of ASV even in cases of isolated cardiotoxicity. This case highlights the importance of considering atypical presentations in snakebite cases, particularly in paediatric patients, where initial symptoms may mimic primary cardiac or respiratory conditions. Early recognition and intervention, including appropriate ASV administration, play a crucial role in preventing potential morbidity and mortality. To the best of our knowledge, this represents the first documented paediatric case of isolated cardiotoxicity following krait envenomation that was successfully managed with ASV therapy. This case adds to the growing body of literature emphasising the spectrum of krait envenomation presentations and reinforces the need for maintaining a high index of suspicion for snakebites in endemic areas, even when classical neurotoxic features are absent.

Right Inguinoscrotal Swelling Revealing Classic Seminoma: A Case Report

Satish Surapureddy, Pankaj Gharde, Dheeraj Surya, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X There are many causes of inguinoscrotal swelling, but common causes include hydrocele, tumours, and infections. The presented case involves a 40-year-old male who presented with an inguinoscrotal mass on the right side that developed over the past year, accompanied by painful episodes. Physical examination revealed a 5×6 cm tense swelling with positive transillumination. Investigations showed a right-sided chronic hydrocele, funiculitis, varicocele, and epididymo-orchitis. Dissection for the hydrocele at the onset led to the identification of a right testicular mass, necessitating a high inguinal orchidectomy. Histopathological examination confirmed classic seminoma with capsular and lymphovascular invasion. This case highlights the diagnostic difficulty of inguinoscrotal swellings, particularly when hydrocele obscures an underlying tumour. The unexpected intraoperative findings underscore the importance of flexibility in surgical planning to address potential malignancy concerns. The report emphasizes the necessity of a proper histopathological assessment to determine the nature of the testicular mass for appropriate management in future cases.

Anaesthetic Management of a Retroperitoneal Paraganglioma: A Case Report

Vinit Sunil Dhanure, Nikhil Bhalerao, Amaresh Paul, Saurabh Prakash Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Retroperitoneal tumours, especially paragangliomas, pose peculiar challenges in their surgical and anaesthetic management, as they are hormonally active due to the release of catecholamines. These tumours are typically located adjacent to critical structures, particularly the Inferior Vena Cava (IVC), aorta, and celiac trunk, making their resection hard, due to the risk of haemodynamic instability in the course of surgery. This case report of a 47-year-old male epitomises the importance of a multidisciplinary approach in the management of a retroperitoneal paraganglioma. He had a history of neurogenic bladder and had undergone embolisation of the retroperitoneal mass previously. General Anaesthesia (GA) with thoracic epidural catheterisation was employed as the anaesthetic modality for the surgical removal of the tumour. Invasive monitoring techniques, such as arterial lines and central venous catheters, were used to manage possible surges in catecholamines, haemodynamic shifts, and substantial blood loss during resection of this tumour. The intraoperative hypertensive crisis was managed with nitroglycerine and continuous monitoring and epidural analgesia ensured smooth recovery in the postoperative period. The case points out the necessity of careful preoperative evaluation, advanced intraoperative techniques, and alert postoperative care in handling complex retroperitoneal tumours like paragangliomas.

Unique Manifestation of Hirayama Disease: Bilateral Radial and Ulnar Nerve Palsy with Hypothenar Atrophy, and Atypical Snake Eye Appearance

Viraj Gupta, Gaurav Mishra, Ravishankar Patil, Shubhi Gaur, Mrunali S Bhosale Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X A rare cervical myelopathy called Hirayama disease usually manifests as muscle atrophy and distal upper limb weakness that develops gradually in young males. A 42-year-old male presented with progressive weakness and atrophy in both upper limbs for over 12 years, accompanied by fine tremors. Neurological examination revealed weakness in wrist extension and finger movements, profound atrophy of the hypothenar and interosseous muscles, and sensory deficits consistent with radial and ulnar nerve involvement. Cervical spine Magnetic Resonance Imaging (MRI) in a flexed position revealed anterior displacement of the posterior dural sac (from C3 to C7 level), with compression of the lower cervical cord, confirming the diagnosis of Hirayama disease. This case highlights a rare and severe manifestation of Hirayama disease, emphasising the bilateral involvement of multiple peripheral nerves, a finding uncommon in classical presentations. Early diagnosis, aided by dynamic MRI imaging, is crucial to prevent further neurological deterioration. Treatment options, including cervical collar immobilisation, aim to halt disease progression. This report underscores the importance of considering Hirayama disease in the differential diagnosis of atypical peripheral neuropathy presentations, particularly in young patients and, in this case, in an older age group (40-45 years). It also provides insight into the varied clinical spectrum of this condition.

Visual Loss and Rhabdomyolysis: A Case of Acute Methanol Intoxication

Tanvi Snehal Desai, Aviral Ratan Srivastava, Sarbari Swaika, Rajat Naik, Joshua Birru Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Methanol toxicity is a rare but potentially fatal condition, often associated with accidental or intentional ingestion of adulterated alcohol. Complications include high anion gap metabolic acidosis, visual disturbances, central nervous system involvement, and multi-organ dysfunction. Rhabdomyolysis, though less commonly reported, can be a serious sequel leading to Acute Renal Failure (ARF) and significant morbidity. We report the case of a 40-year-old male with chronic alcohol use who presented to the Emergency Department (ED) with bilateral lower limb weakness, pain, dark urine, abdominal discomfort, and visual blurring. He was in shock, with severe lactic acidosis (pH <6.8, lactate >15 mmol/L, a non-recordable bicarbonate (HCO3) level, and high anion gap of 40) and required immediate Intensive Care Unit (ICU) stabilisation. Laboratory investigations were deranged, including Creatine Kinase (CK) 39,000 IU/L, Lactate Dehydrogenase (LDH) 1738 IU/L, acute kidney injury, dyselectrolytaemia including refractory hyperkalaemia, hypocalcaemia, hyperphosphataemia, deranged liver enzymes, and an osmolar gap of 72, suggestive of toxic alcohol ingestion-induced rhabdomyolysis and visual loss. Further history revealed binge consumption of locally brewed alcohol (“tadi”), raising strong suspicion of methanol poisoning. Oral ethanol therapy was initiated, followed by multiple sessions of haemodialysis due to persistent acidosis, renal failure, and electrolyte imbalance. The patient showed gradual clinical improvement and was discharged with near-complete recovery. Methanol toxicity-induced rhabdomyolysis is a medical emergency that demands prompt recognition and intervention. This case underscores the importance of clinical vigilance and early empiric treatment in patients with suggestive history and biochemical findings, even before confirmatory tests are available. Timely haemodialysis and supportive care can significantly improve patient outcomes.

Unmasking the Silent Bleed: Subclavian Artery Puncture and Mediastinal Haematoma during Minimally Invasive Oesophagectomy

Sharada M Adiga Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Video-Assisted Thoracoscopic Oesophagectomy (VATS-E) is a minimally invasive procedure increasingly used for managing oesophageal cancer due to its reduced postoperative morbidity and shorter recovery times. However, it is not without risks, particularly in the perioperative management of patients requiring central venous access. Complications associated with central line placement, such as vascular injuries, can lead to significant morbidity, including rare but life-threatening conditions like mediastinal haematomas. This case report presents an unusual complication encountered during VATS-E. During the insertion of a subclavian central venous line, an inadvertent puncture of the subclavian artery occurred, resulting in the formation of a large mediastinal haematoma. The patient exhibited symptoms of haemodynamic instability, including tachycardia and hypotension, which necessitated urgent intervention. Advanced imaging revealed a localised haematoma compressing mediastinal structures. Management of this critical situation required a multidisciplinary approach involving thoracic surgeons, anaesthesiologists, and interventional radiologists. The haematoma was managed conservatively with continuous haemodynamic monitoring while ensuring that no further vascular compromise or compression occurred. The patient recovered without requiring surgical evacuation of the haematoma, highlighting the potential for non-operative management in selected cases. This report underscores the importance of prompt diagnosis, careful assessment, and collaborative management in addressing such rare complications. By sharing this case, we aim to raise awareness of this potential risk and emphasise strategies to mitigate complications during central line placement in patients undergoing oesophagectomy.

Metastatic Breast Cancer in a Patient with Neurofibromatosis Type I: A Rare Case Report Highlighting Aggressive Disease and Management Challenges

Karan Sood, Aman Sondoule, Amol Dongre, Tanuja Bhutekar, Juliana Paonam Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Neurofibromatosis Type 1 (NF1) is a genetic condition caused by a mutation in the NF1 tumour suppressor gene and is associated with a high risk of malignancies, especially breast cancer. Individuals with NF1 face an exceptionally high burden of cancer. Breast cancer is of special concern in NF1, with the risk being increased in women younger than 50 years. NF1-associated breast cancer appears to be more aggressive, often presenting as the basal subtype, and has been noted to occur at an earlier age. This case report describes a 45-year-old female with NF1 who was diagnosed with right-sided triple-negative breast cancer. She received adjuvant chemotherapy and radiotherapy but did not follow up regularly. Two years later, she developed widespread metastatic disease in her liver, bones, lungs, and pleura, with imaging revealing extensive metastases and lymphangitic carcinomatosis. Breast cancer in NF1 patients usually develops at a younger age and is more aggressive, as illustrated in this case. Patients with confirmed NF1 should undergo regular screening starting at the age of 30 years, and any suspicious mass should be biopsied. Most cases are basal; hence, discussions in a multidisciplinary tumour board are essential. Neoadjuvant chemotherapy can provide a survival advantage. Given that radiation therapy in NF1 can cause fibrosis and lead to secondary malignancies, its use should be limited wherever possible. This report emphasises the high risk of breast cancer in NF1, the management of the disease, and the necessity of early detection to improve patient outcomes.

Endometrioid Borderline Tumour of the Ovary: Pathological Analysis of a Rare Case

Srinivasan Raman, Meethu Rappai, Kalaivani Amitkumar, Balaji Radhakrishnan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Endometrioid Borderline Ovarian Tumours (EBOTs) are rare epithelial tumours with low malignant potential, also referred to as atypical proliferative endometrioid tumours. EBOTs exhibit glandular proliferation and nuclear abnormalities without invading surrounding tissue, which distinguishes them from invasive endometrioid carcinomas. The endometrioid subtype represents a rare category of Borderline Ovarian Tumours (BOTs). We present a case of a 45-year-old woman who had a right ovarian haemorrhagic cyst discovered during a routine ultrasound. The diagnostic workup included a pelvic Magnetic Resonance Imaging (MRI) scan, which showed a complex ovarian cyst with solid components, suggesting a neoplasm. Serum tumour markers, including Cancer Antigen (CA)-125, Carcinoembryonic Antigen (CEA), and CA 19-9, were all normal. Given the imaging results and clinical analysis, the patient underwent a Total Laparoscopic Hysterectomy (TLH) along with a Bilateral Salpingo-Oophorectomy (BSO). Histopathological Examination (HPE) of the removed ovary revealed glandular proliferation lined by stratified columnar cells with mild to moderate nuclear atypia and no stromal invasion. Immunohistochemistry (IHC) supported the diagnosis by showing positive results for Estrogen Receptor (ER), Progesterone Receptor (PR), and Cytokeratin 7 (CK7) with a lower proliferation index (Ki-67), which helped rule out invasive carcinoma and similar conditions. This case emphasises the need for a thorough diagnostic process, including imaging, tumour markers, HPE, and IHC for accurate classification. While EBOTs are less aggressive, careful pathological interpretation is necessary to prevent misdiagnosis and unnecessary treatment. Ongoing clinical monitoring is important due to the potential for recurrence or progression. Recognising EBOTs as a separate group allows for better patient management and improved outcomes.

Congenitally Corrected Transposition of Great Arteries in a Young Adult: A Case Report

Janhavi Satchidanand Parker, Shivam Nitin Rainchwar, Niraj Suresh More, Atul S Baviskar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Congenitally Corrected Transposition of the Great Arteries (ccTGA) is a rare congenital cardiac anomaly characterised by atrioventricular and ventriculoarterial discordance, comprising less than 0.05% of all congenital heart diseases. While often associated with abnormalities such as Ventricular Septal Defect (VSD), pulmonary obstruction, coarctation, and Ebstein anomaly, ccTGA can also occur as an isolated defect. Such cases may remain asymptomatic for decades and are sometimes discovered incidentally. We present a case of a 26-year-old asymptomatic male diagnosed with ccTGA during an evaluation for inguinal hernia surgery. The patient’s only complaint was occasional palpitations. Electrocardiography revealed Complete Heart Block (CHB), which was confirmed by echocardiography and coronary Computed Tomography (CT) angiography, showing typical findings of ccTGA. The Right Ventricle (RV) had a reduced ejection fraction of 40-45%, with mild regurgitation of the tricuspid and aortic valves. Pacemaker implantation was recommended for the management of CHB. This case highlights the importance of early recognition of ccTGA-associated complications such as CHB and underscores the need for regular follow-up to monitor for Heart Failure (HF) and other late sequelae.

Efficacy of Polyherbal Ayurvedic Formulations in the Management of Endometrial Polyp and Associated Menorrhagia: A Case Report

Manisha Mukesh Thakare, Adarsha Patil, Snehalata Shivajirao Pawar, Ashwin Shete, Rupmanjari Guruprasad Shanbhag Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X The management of endometrial polyps, benign uterine growths commonly manifesting with abnormal uterine bleeding, has traditionally relied on hysteroscopic polypectomy as the gold standard intervention. This case report aims to demonstrate the remarkable efficacy of Ayurvedic medicine as a compelling alternative therapeutic approach. A 41-year-old multiparous woman suffering from persistent menorrhagia and intermenstrual bleeding for three months underwent an ultrasonographic evaluation, which revealed a substantial endometrial polyp measuring 41×20×13 mm and a concurrent simple left ovarian cyst. After a comprehensive assessment confirmed menorrhagia and constipation as the primary clinical manifestations, the patient embarked on a holistic Ayurvedic treatment protocol. The regimen consisted of sophisticated polyherbal formulations, including Kanchanar Guggul, Ashokarishta, Chandraprabha Vati, Arshakuthar Ras, and Mamsa Pachak Vati, administered over 90 days, complemented by tailored dietary modifications. The therapeutic response was profound and progressive; menstrual bleeding diminished significantly from 5-6 pads per day to 3-4 pads per day within just 30 days, normalising to two pads per day with regular cycling by day 60. By the conclusion of the treatment period, the patient experienced complete resolution of both menorrhagia and constipation, with follow-up imaging confirming normal pelvic architecture. This compelling case illustrates how Ayurvedic intervention, focussed on restoring dosha (body humor) equilibrium through carefully selected herbal compounds, successfully resolved a symptomatic endometrial polyp, thereby circumventing surgical intervention entirely. The results underscore the significant therapeutic potential of traditional Ayurvedic approaches in addressing endometrial pathologies, particularly in early-stage presentations.

Successful Spinal Anaesthesia in Severe Kyphoscoliosis Patient for Knee Surgery: A Case Report

Bhagyashri Soor, M Sharan, Abhijit Namdev More, Supriya Gholap Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Kyphoscoliosis, a complex spinal deformity, presents unique challenges in the perioperative management of patients requiring general anaesthesia as well as neuraxial anaesthesia. General anaesthesia in patients with kyphoscoliosis is challenging due to difficult airway management, reduced lung capacity, and altered pulmonary and cardiovascular mechanics, all of which increase the risk of respiratory and haemodynamic complications. Moreover, the spinal deformity complicates positioning and affects the administration of neuraxial anaesthesia, requiring careful preoperative planning and close intraoperative monitoring. We discuss a case involving a 32-year-old male with a history of childhood kyphoscoliosis, diagnosed with a left Anterior Cruciate Ligament (ACL) tear. He had no neurological abnormalities and no other complaints apart from localised pruritus in the lower abdomen. Upon evaluation, the Cobb angle measured 80º on the X-ray of the spine, and he had moderate pulmonary hypertension observed in a Two-Dimensional (2D) echocardiogram, along with restrictive lung disease without obstruction noted on spirometry. After this assessment, ACL repair under spinal anaesthesia was planned. The common problems faced during the procedure included the identification of intervertebral spaces and unpredictable spread of the spinal anaesthetic. We report the successful anaesthetic management of an adult male with severe kyphoscoliosis scheduled for left arthroscopic knee surgery under spinal anaesthesia.

Management of Fourth Degree Perineal Tear: A Case Report

Apoorva Dhankhar, Shankar Burute Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Perineal trauma, particularly third- and fourth-degree tears, poses a significant concern in obstetric care due to its association with short- and long-term morbidities, including faecal incontinence, pain, dyspareunia, and social and psychological complications like depression. The risk of severe perineal tears increases with factors such as large birth weight, instrumental deliveries, and prolonged labour. Accurate diagnosis, effective management, and appropriate repair techniques are crucial for preventing complications and promoting recovery. This report discusses a case of a 33-year-old woman who presented with a 10-year history of faecal and flatus incontinence, with faeces passing through the vagina. Her obstetric history included three full-term home vaginal deliveries, marked by significant blood loss in the last two deliveries. Examination revealed a fourth-degree perineal tear with the absence of a separate anal opening and significant fibrosis, highlighting the complexities of managing such injuries. Surgical repair was performed using the Warren flap method. Postoperative management involved a liquid diet, antibiotics, and careful monitoring to prevent complications like wound dehiscence and delayed complications such as rectovaginal fistula. The patient’s postoperative course was uneventful, and follow-up assessments showed marked improvement, with complete healing at three months. The case emphasises the importance of skilled surgical intervention, tailored postoperative care, and comprehensive follow-up in optimising outcomes for patients suffering from severe perineal trauma.

Primary Hyperparathyroidism Presenting with Multiple Lytic Lesions: A Case Report

Kanchan Dasharthrao Devde, Kawadu Jawade, Jayant Kelwade, Mahesh Deshmukh, Amol Shankar Dongre Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Primary Hyperparathyroidism (PHPT) is a condition characterised by elevated serum calcium levels along with elevated serum Parathyroid Hormone (PTH). The main cause of PHPT is parathyroid adenoma or parathyroid gland hyperplasia. Symptoms and signs of this condition may mimic those of the first differential diagnoses, such as multiple myeloma or metastatic disease from a primary source. In this case, a lady presented with progressively increasing lower back pain and difficulty walking. Initially, the clinical diagnosis leaned towards multiple myeloma or metastatic disease of unknown origin based on Positron Emission Tomography-Computed Tomography (PET-CT) findings. However, her serum calcium levels remained persistently elevated, while her serum phosphorus levels were normal. Consequently, a serum PTH level test indicated elevated levels. A biopsy from an Fluorodeoxyglucose (FDG)-avid lytic lesion in the left iliac bone showed a giant cell-rich lesion that was positive for CD 163 and Vimentin by Immunohistochemistry (IHC), favouring a diagnosis of brown tumour of the bone. A subsequent surgical excision of the adenoma, along with the parathyroid gland, was performed. The patient received intravenous bisphosphonate therapy for the lytic lesion and was advised to follow up every three months with serum calcium and PTH levels monitored.

Rare Case of Large Arteriovenous Malformations Arising after a Parotid Tumour Excision

Sagar Sanjay Rane, Nitin Dharampal Bhola, Sanjana Wadewale Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Arteriovenous Malformations (AVMs) of the head and neck are uncommon vascular anomalies characterised by high-flow shunting between arteries and veins without an intervening capillary bed. Among these, AVMs involving the parotid region are exceedingly rare and are often misdiagnosed or mistaken for more common salivary gland tumours. Their presentation may vary from painless swelling to disfiguring facial masses with the potential for life-threatening bleeding. Accurate diagnosis typically requires advanced imaging such as contrast-enhanced Computed Tomography (CT) or Digital Subtraction Angiography (DSA), as clinical signs may be subtle or absent. Management of craniofacial AVMs remains challenging due to complex vascular anatomy, the potential for recurrence, and the risks associated with surgical or endovascular interventions. A multidisciplinary approach involving interventional radiology, surgery, and supportive specialties is essential for optimal outcomes. This report highlights the diagnostic and therapeutic complexities of a large facial AVM discovered in an adult decades after parotid surgery, emphasising the importance of considering vascular anomalies in the differential diagnosis of longstanding facial swellings. The case reinforces the need for early recognition and careful planning in managing such lesions to reduce morbidity and improve prognosis. Given their rarity, each case contributes valuable insights to the evolving understanding and management of parotid and craniofacial AVMs.

MRI in the Evaluation of Accessory Cavitated Uterine Mass: A Case Report

Laxman Chhabhadiya, Kunal Solanki, Ashutosh Patel, Parth Nikhil Doshi Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Accessory Cavitated Uterine Mass (ACUM) is a rare Müllerian anomaly typically seen in adolescents or young women presenting with severe dysmenorrhoea. It can mimic other pelvic pathologies such as adenomyosis or endometriosis. Magnetic Resonance Imaging (MRI) plays a pivotal role in identifying and characterising the lesion preoperatively. The present case report includes a case of a 21-year-old unmarried woman presenting with severe dysmenorrhoea since menarche. MRI revealed a well-defined intramyometrial cystic lesion near the right uterine cornua, which was mildly hyperintense on T1 and heterogeneously hyperintense on T2, without communication to the endometrial cavity-findings consistent with ACUM. The diagnosis was confirmed after laparoscopic excision and histopathological analysis, resulting in complete postoperative symptom relief. ACUM is a rare but treatable cause of severe dysmenorrhoea in young females. MRI offers crucial diagnostic clarity, allowing for early surgical intervention and improved quality of life.

Beyond the Norm: A Unique Case Report of Traumatic Fibroma Excision and Management of Mucosal Fenestration

V Pooja, S Senthilnathan, H Gayathri, Giftlin Denny Xavier, K Gowtham Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Mucosal fenestration is a clinical condition in which the surrounding mucosa (or gingiva) is compromised, exposing the root of the tooth to the surrounding oral cavity. This condition is most commonly observed in the anterior region of the dentition due to a thin labial cortex. “Traumatic fibroma” is a common benign exophytic lesion that develops in the oral cavity as a result of tissue injury, often referred to as an irritation fibroma. The lower labial mucosa, buccal mucosa, and tongue are the most frequently affected areas. A 52-year-old female presented with a traumatic fibroma and a mucosal fenestration defect in the lower front tooth region. The lesion had progressively enlarged over the course of one year, necessitating a multidisciplinary therapeutic approach. The root apex was exposed through the defect and exhibited a distinctly darker colouration, resembling that of a non-vital tooth. A comprehensive treatment strategy was designed, consisting of endodontic therapy, fibroma excision, root resection, regenerative periodontal surgery with bone grafts, and Guided Tissue Regeneration (GTR) to correct the mucosal fenestration. A three-month follow-up revealed satisfactory healing and closure of the defect.

Perioperative Anaesthesia Challenges in a Difficult Airway Case of a Turricephaly Child Posted for Fronto-orbital Advancement and Remodelling: A Case Report

Priya Kishnani, Vishwa Shah, Kartik H Sangam, Tejash H Sharma, Pooja Shah Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Turricephaly is a rare craniosynostosis characterised by premature fusion of the coronal sutures, resulting in a tower-shaped, elongated skull. This abnormal skull morphology presents anaesthetic concerns due to associated craniofacial deformities that complicate airway management, increase the risk of raised intracranial pressure and pose challenges in vascular access, fluid management and control of intraoperative blood loss. Present case is of a 13-year-old girl with turricephaly who underwent fronto-orbital advancement and cranial remodelling. An anticipated difficult airway was encountered, requiring multiple intubation attempts. Intraoperative anaesthesia care focused on securing the airway, maintaining normocapnia, invasive monitoring, proper fluid management, prevention of hypothermia and management of intraoperative blood loss with transfusion of blood products. Postoperatively, the patient was electively intubated and transferred to the Paediatric Intensive Care Unit (PICU) and kept on a ventilator overnight with appropriate sedation and analgesia. The patient was extubated the next day. This case highlights the importance of thorough preoperative assessment, vigilant intraoperative management including fluid management and transfusion strategies, maintenance of normothermia and meticulous postoperative care in achieving a successful outcome in such complex craniofacial surgical cases.

The Lateral Periodontal Cyst: Report of a Rare Developmental Anomaly with Literature Review

Laboni Ghorai, Surajit Bose, Jayanta Chattopadhyay Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X The Lateral Periodontal Cyst (LPC) is a relatively rare odontogenic cyst of developmental origin that accounts for less than 2% of all cysts of the jawbone. It is characterised by its location on the lateral root surface of vital permanent mandibular canines and premolars in individuals between the fifth and seventh decades of life. The cyst is typically asymptomatic and exhibits a characteristic incidental radiographic finding of a well-circumscribed round or ovoid unilocular radiolucency with minimal effect on surrounding structures. Clinically, it poses a diagnostic challenge in differentiating it from other entities that present similar clinico-radiographic pictures, such as gingival cysts, odontogenic keratocysts, lateral radicular cysts, and lesions of endodontic and periodontal origin. Although the occurrence of LPC is rare, precise diagnosis is essential to provide appropriate treatment. Hereby, the authors present a case report of a 24-year-old male patient of LPC and review the pertinent literature.

Management of Oligospermia (Kshina Shukra) by Ayurvedic Therapy: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Nitika Senger Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Male infertility is a widespread issue, often resulting from low sperm count (oligospermia) and poor sperm motility (asthenospermia). According to the World Health Organisation (WHO), a sperm concentration of less than 15 million sperm per milliliter of semen is classified as oligospermia. Oligospermia can be associated with Shukravaha Srotas Dushti in Ayurveda. Globally, infertility impacts approximately 8-12% of couples. Shukra Dhatu primarily refers to semen and its role in determining reproductive potential. A decline in Shukra Dhatu leading to Shukra Kshaya can be correlated with oligospermia. A 30-year-old male patient presented with general debility and fatigue for one year. He was married and, along with his wife, had been trying to conceive for the past four years without success. He was advised to undergo a semen analysis, which confirmed a diagnosis of oligospermia. The treatment approach emphasised Aamapachana (toxin elimination) and rejuvenation of Shukra Dhatu through Shodhan (bio-purification) and Shaman (curative) treatment to address the root cause of infertility. The outcome demonstrated notable improvements in both sperm count and motility, indicating the effectiveness of Ayurvedic therapies in managing oligospermia (Shukra Kshaya). This report underscores the potential of Ayurvedic interventions as a holistic approach to treating oligospermia and improving male fertility.

Pleural Involvement and True Hyponatraemia in Multiple Myeloma: A Report of Two Rare Cases

KJ Rajaprasath, V Keshavprakash, TA Vidya, D Reena Jose, JS Kumar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Multiple Myeloma (MM) is a plasma cell proliferative malignancy that produces monoclonal immunoglobulin. Pleural effusion in MM, caused by the direct infiltration of the pleural space by plasmacytes, leading to true myelomatous pleural effusion, is rare. Patients with MM often exhibit pseudohyponatraemia due to high serum paraprotein levels; a far less common occurrence is true hyponatraemia resulting from the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH). This report presents two such cases. In Case 1, a 45-year-old woman with no known co-morbidities presented with complaints of shortness of breath and pain in both hips. Investigations revealed anaemia, renal impairment, a reversed albumin-to-globulin ratio and the presence of an M band on serum electrophoresis. Imaging showed lytic lesions and minimal pleural effusion. A bone marrow biopsy confirmed plasmacytosis and diagnostic pleural tapping was performed, revealing malignant myelomatous pleural effusion. The pleural effusion progressed to a massive effusion, necessitating therapeutic tapping. Despite treatment with dexamethasone, cyclophosphamide and bortezomib, the patient eventually succumbed. In Case 2, a 56-year-old man, previously treated for MM, presented with complaints of back pain, giddiness and vomiting. Investigations revealed anaemia, hyponatraemia and elevated globulin levels. A Positron Emission Tomography-Computed Tomography (PET-CT) scan indicated the possibility of relapse. The patient exhibited low serum osmolality alongside high urine spot sodium and urine osmolality, while renal, adrenal and thyroid functions were normal, pointing towards SIADH. He responded well to fluid restriction, salt supplementation, tolvaptan and chemotherapy, resulting in the resolution of hyponatraemia. These cases are reported to shed light on the various presentations of MM that may be overlooked during patient evaluation.

Junctional Epidermolysis Bullosa In-utero with Pyloric Atresia and Aplasia Cutis Congenita (Carmi Syndrome): A Case Report

Samuel Jeyaraj Daniel, Balaji Ganesh, S Saranya, K Desingh Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Carmi Syndrome (CS) is an extremely rare autosomal recessive genetic disorder characterised by the co-existence of Junctional Epidermolysis Bullosa (JEB), Pyloric Atresia (PA), and Aplasia Cutis Congenita (ACC). Globally, very few cases have been reported. CS is often fatal in neonates. Authors present the case of a two-day-old male preterm newborn who exhibited widespread absence of skin, especially over the lower limbs, associated with scarring skin lesions and extensive milia from birth. Other findings included bilateral microtia, nail dystrophy in the fingernails, absence of toenails, fusion of toes, corneal opacity, and a broad nasal root. Additionally, systemic involvement included PA and congenital joint contractures (arthrogryposis). The newborn was diagnosed with CS based on clinical characteristics and X-ray results. The condition was managed using a multidisciplinary approach. Unfortunately, the neonate succumbed to death on the fourth day of life due to sepsis.

Uncommon Presentation of Dengue Fever in a G6PD-Deficient Adult: A Case Report

Meghna Dutta, Sandip Kumar Chandra, Susobhan Mondal, Syamasis Bandyopadhyay, Rajeswar Samanta Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Dengue fever presents a diverse clinical spectrum which can lead to many complications. The outcome of these presentations predominantly depends on early diagnosis and judicious management. While complications involving the haematological system, such as cytopenia and bleeding, are well-known in severe dengue infections due to various factors, the occurrence of haemolytic anaemia in dengue fever is rare. An alteration in the redox state of immune cells due to Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency may lead to atypical presentations of dengue infection, such as intravascular haemolysis. A 37-year-old male initially presented to the emergency department with a 6-day history of fever, red-colored urine and severe shortness of breath. Routine tropical fever work-up detected an infection with the dengue virus, while severe enzyme deficiency was attributed as the cause of haemolysis. The presence of splenomegaly, haematuria, hyperferritinaemia, transaminitis and raised triglycerides was suggestive of Macrophage Activation Syndrome (MAS), which was confirmed through a bone marrow biopsy. He was diagnosed with dengue fever, complicated by MAS and haemolytic anaemia due to G6PD deficiency.

Oral Manifestations and Conservative Clinical Management of a 2-year-old Child with Congenital Ichthyosis: A Case Report

Jaya Agali Ramachandra, Pradnya Dhamnekar, Ganavi G Nayak Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Congenital Ichthyosis (CI) is an uncommon genetic condition affecting tissues of ectodermal origin, including the skin, nails and tooth enamel. The thickening of the stratum corneum impairs the skin’s ability to act as a protective barrier due to aberrant epidermal cell differentiation, as well as lipid synthesis, metabolism and transport. This set of keratinisation disorders is clinically and etiologically diverse, with severe forms characterised by skin dryness, flaking and peeling, leading to a wide range of complications. CI involves mutations in various genes and presents with different symptoms that can significantly affect the patient’s quality of life. Although it affects tissues of ectodermal origin, little is known about its oral manifestations. Lamellar Ichthyosis (LI) is a type of CI that typically manifests at birth, with the infant found to be covered in a membrane. Xerostomia is one oral symptom that may increase the risk of dental caries. While many individuals with CI may present with normal dentition, some may experience dental defects, delayed tooth eruption and a higher risk of dental caries. In the context of CI, the primary consideration in dental care should include the presence of friable and tender skin, which necessitates extra caution during handling. It is crucial to ensure that any procedure minimises irritation and injury to the skin, as it is more vulnerable than usual. The present case report highlights a case of a two-year-old female child diagnosed with CI who presented with early childhood caries. Management may include a conservative approach for rehabilitation, utilising delicate handling of soft tissues to reduce patient discomfort and facilitate successful treatment.

Clinical Implication and Ontological Basis of Bilobed Spleen: A Rare Case Report

Chaitanya Singh, Neelesh Kanaskar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Anatomical knowledge regarding the external morphology of the spleen is essential for surgical intervention and radiological diagnosis. A characteristic feature of the spleen is the presence of splenic notches at the superior border; however, such notches rarely extend deep enough to be considered fissures or to separate the spleen into multiple lobes. To date, there are very few cadaveric reports of complete splenic fissures. During a routine dissection class of the abdominal region, the spleen removed from the abdominal cavity exhibited a morphological variation in the form of a complete fissure. The spleen showed a complete notch extending as a fissure from the superior to the inferior border, dividing the spleen into two lobes. This study provides valuable information regarding the anatomy and prevalence of splenic fissures and bilobed spleens. A bilobed spleen is a rare congenital malformation that should be considered distinct from other known splenic anomalies. The presence of splenic fissures in bilobed spleens can serve as a guide for surgeons during conservative splenectomy procedures.

Uncommon Presentation of Adenoid Cystic Carcinoma in the Parotid Gland: A Case Report

Sparsh Dixit, Chanrashekhar Mahakalkar, Shivani Kshirsagar, Akansha Hatewar, Mohammed Azeem Khan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Adenoid cystic carcinoma is a rare form of cancer that primarily affects the salivary glands, although it can also occur in various other tissues, including the breast, skin, cervix and prostate. This malignancy is characterised by its slow growth and distinctive histological patterns, often presenting as a painless mass in the affected area. It is most commonly diagnosed in adults aged 40 to 60 years, with a slight predominance in females. The tumour is known for its potential to recur locally and metastasise, primarily to the lungs, although it rarely spreads to regional lymph nodes. Diagnosis typically involves a combination of medical history review, physical examination, imaging studies such as ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and biopsy of the tumour tissue. The biopsy reveals the tumour’s histological characteristics, which are crucial for diagnosis. This is a case of a 65-year-old male who presented with a primary complaint of preauricular swelling for two months. The swelling was diagnosed as a low-grade malignant tumour of adenoid cystic carcinoma based on Fine Needle Aspiration Cytology (FNAC). The patient was managed with surgical excision followed by adjuvant chemotherapy and radiotherapy.

A Rare Case of Heterotopic Pregnancy in a Unicornuate Uterus

Shabista Shaikh, Prashansa Gupta, Harshad Patel, Janvi Patel, Varshini Vadithala Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Heterotopic pregnancy, a condition involving simultaneous intrauterine and extrauterine pregnancies, is a rare clinical scenario, particularly when associated with a unicornuate uterus. This rarity underscores the importance of recognising and managing such cases promptly. A 24-year-old primigravida presented at 10 weeks of gestation with per vaginal spotting and abdominal pain, along with a history of ovulation induction. Pelvic ultrasound showed a heterotopic pregnancy in a unicornuate uterus, with a possible pseudo-gestational sac and a left ruptured tubal ectopic pregnancy. The combination of a ruptured ectopic pregnancy and an intrauterine pregnancy highlights the importance of early detection and surgical management. This case emphasises the rarity of heterotopic pregnancy in a unicornuate uterus. A unicornuate uterus with rudimentary horns results from incomplete Müllerian duct fusion and carries significant risks, including rupture during pregnancy. Early diagnosis and surgical intervention are essential to prevent life-threatening complications, with treatment options varying based on the patient’s condition and gestational age.

A Rare Paediatric Case of Double Appendix Anomaly with Appendiceal Neuroendocrine Neoplasm

Kovuri Umadevi, Bhavani Shanker Nityananda, Zuafshan Sultana, Mahendra J Parage Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X This case report presents a rare congenital anomaly: the presence of a double appendix, a condition observed in approximately 1 in 25,000 appendectomy cases. The discovery of a neuroendocrine tumour in one of the appendices further underscores the exceptional nature of this case. Present case is of an eight-year-old boy who was admitted with acute abdominal pain, during which emergency surgery revealed a double appendix. While one appendix appeared normal, the other exhibited a yellow nodular lesion suggestive of malignancy. Histopathological evaluation confirmed a Grade I well-differentiated neuroendocrine tumour measuring 1.2 cm. The tumour had invaded the serosa and the proximal surgical margin but showed no lymphovascular invasion. Immunohistochemical analysis demonstrated strong positivity for chromogranin and negativity for synaptophysin, with a low Ki-67 index of 3%, corroborating the diagnosis. Following National Comprehensive Cancer Network (NCCN) guidelines, the patient underwent a right hemicolectomy to ensure complete tumour removal and minimise the risk of recurrence. Subsequent histological examination showed no residual tumour or lymph node metastases. The patient recovered well, with no recurrence noted during follow-up. This case highlights the need for careful intraoperative exploration and thorough pathological assessment, particularly when rare anatomical anomalies are encountered. Documenting such unique findings enriches medical knowledge, raises clinical awareness and underscores the value of evidence-based surgical management in achieving optimal outcomes.

Impact of Inspiratory Muscle Training on Functional Capacity in a patient with Interstitial Lung Disease and Right-sided Pleural Effusion: A Case Report

Shivani Dey, Vishnu Vardhan, Chitrakshi Choubisa Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Interstitial Lung Disease (ILD) is a term for a collection of conditions that impact the lung parenchyma. Notable features include inflammation and fibrosis. The prognosis of ILD varies, largely depending on the severity and specific subtype of the disease. Pleural effusion can trigger further dyspnoea and lead to a decrease in functional capacity. Pulmonary Rehabilitation (PR), along with Inspiratory Muscle Training (IMT) through specific disease-focussed exercise techniques, can help address these symptoms while improving general well-being by enhancing exercise capacity and respiratory dynamics. This case describes a 56-year-old male farmer who came to our hospital with complaints of breathlessness during routine activities over the past month. He reported experiencing a productive cough for two months, alongside two days of dysuria, haemoptysis, loss of appetite, and weight loss. The patient was initially treated conservatively and underwent fibre optic endoscopy, physical therapy, and IMT, which showed significant improvement. The levels of breathlessness, exercise tolerance, and quality of life improved for the patient within two weeks following multidisciplinary care.

Forward Head Posture Adaptation Correlated with Scapular Dyskinesia Type1: A Case Study

Md Akhlaque, Shanthakumar Kalimuthu, Jahanvi Dave Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X People adapt poor posture particularly in the head and neck region, as a result of their sedentary lifestyles and use of technology. Forward head posture is most frequently, the most prevalent deviation from the natural bend of the cervical spine. Changes from the normal posture pattern led to pathological issues, which affect the surrounding muscles and joints. While forward head posture is also associated with Scapular Dyskinesia (SD) type 1, it is more observed in people who have forward head posture. SD type 1 is defined as the prominence of the inferior medial scapular border and its unusual rotation around a transverse axis. It is an uncommon type of SD that can occur in the aftermath of surgery or trauma. The outcomes are Scapular Dyskinesis Test, Numerical Pain Rating Scale, Neck Disability Index, Manual Muscle Testing, Shoulder range of motion, Lateral Scapular Slide Test and Posture Assessment. A 20-year-old male student with limited range of motion, forward head posture, and mild shoulder pain was the subject of this case study. The goal was to use physical therapy techniques to reduce pain, enhance scapular function, and correct posture. Exercises for strengthening and mobilising the scapular joint or shoulder joint were used, which decreased discomfort, improved shoulder joint range of motion and correct forward head posture. The results of the study showed that SD type 1, forward head posture, and shoulder pain were all improved by advance manual therapy of the shoulder girdle joints and muscles. Improving shoulder function requires addressing scapular problems. In addition to advocating for holistic management measures to aid in their recovery, this research emphasises the significance of acknowledging SD as a major contributor to forward head posture.

A Rare Co-existence of POLR1C-related Hypomyelinating Leukodystrophy and Congenital Pulmonary Adenomatoid Malformation in a Child: A Case Report

Rohan Acharya, Kumud Pahwa, Hunny Verma, Dinkar Yadav, Kapil Bhalla Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Hypomyelinating Leukodystrophy 11 (HL-11) and Congenital Pulmonary Adenomatoid Malformation (CPAM) are rare conditions, and their co-occurrence is exceptionally uncommon. The co-occurrence of HL-11 and CPAM in a single patient has not been previously reported in the literature. A seven-year-old boy presented with progressive weakness, tremors, and developmental delay since the age of four and a half years. Developmental milestones, such as independent walking and fine motor skills, like grasping objects, were achieved later than expected for his age. Physically, the child exhibited a lean build, with height and weight in the 25th percentile for his age, and no dysmorphic features. Neuroimaging studies conducted at seven years of age revealed periventricular white matter abnormalities consistent with leukodystrophy. Genetic analysis using whole-exome sequencing identified a heterozygous mutation in the POLR1C gene, confirming HL-11. Due to recurrent pneumonia, High-Resolution Computed Tomography (HRCT) of the chest revealed a CPAM in the right lung. The index case was managed with levetiracetam, pacitane, baclofen, propranolol, occupational therapy, and supportive care. This case underscores the need to consider coexisting diagnoses in children with complex neurological symptoms and atypical respiratory findings, even when a neurological condition has been established, emphasising the importance of comprehensive evaluation for optimised patient management.

The Efficacy of Janda Approach for the Treatment of Text Neck Syndrome: A Case Report

Shavez Mansoori, Sunita Sharma, Sanam Maurya Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Text neck is an overuse syndrome which affects the head, neck and shoulders, usually resulting from excessive strain on the cervical spine from looking in a forward and downward position at any hand held devices over long period of time. This may result in headache as well as arm, shoulder and neck pain. Treatment usually consists of a combination of pharmacological, nonpharmacological, and physiotherapeutic interventions such as Kendal exercise, mobilisation, myofascial release, muscle energy technique, proprioceptive neuromuscular facilitation technique, neck stabilisation exercises, and electrotherapy. Janda approach is a treatment technique which helps in reducing pain, restoring mobility, enhancing muscle strength, and functions of the cervical spine. This case report aims to evaluate the therapeutic effects of Janda approach along with conventional treatment on pain, Cervical Range of Motion (CROM) and overall function of the cervical spine in Text Neck Syndrome. This is a case of 24-year-old male suffering from Text Neck Syndrome since 1 year. He had a complaint of pain and stiffness in the neck.The aggravating factors were reading, writing, and using a mobile phone, while relieving factors were rest or sitting with neck extension on chair. Janda approach along with conventional treatment was given for 5 days per week for 2 weeks. visual analogue scale, pressure biofeedback, CROM and Neck Disability Index were used as an outcome measures.After 2 weeks of intervention, there were significant decrease in pain and neck disability, and improved muscle strength and range of motion in cervical spine. This case report concluded that Janda approach along with conventional treatment can be used as an effective intervention protocol for reducing pain, increasing range of motion, enhancing muscle strength and reducing neck disability in patients with Text Neck Syndrome.

Unusual and Uncommon Presentations of Extrapulmonary Tuberculosis: A Case Series

Pooja Shah, Sae Pol, Abhilasha Belpatre, Tejaswini Olambe, Rajesh Karyakarte Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Tuberculosis (TB) is primarily a disease of the lungs; however, Extrapulmonary TB (EPTB) mainly affects the lymph nodes, pleural cavity and spine. Other sites are considered rare and uncommon. Authors present five interesting cases of EPTB from different sites. The first case involved thyroid TB that had spread to the neck. The Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) test was positive. The patient was started on antitubercular treatment and was discharged after undergoing incision and drainage. The second case is of an immunocompetent patient with disseminated TB, which spread from the lungs to the pleura, muscles, subcutaneous tissue and skin, resulting in fistula formation. The CBNAAT was positive, and the Line Probe Assay (LPA) indicated that the strains were sensitive to rifampicin and isoniazid. The third case details a female patient with genital TB who was unable to conceive. An ultrasound examination revealed issues in the adnexa. The CBNAAT was positive (with low levels of Mycobacterium tuberculosis detected, and rifampicin was found to be sensitive), but her sputum sample was negative. The fourth case describes disseminated TB in a seropositive female, where her synovial fluid tested positive and her Computed Tomography (CT) chest findings were suggestive of TB. The fifth case is of abdominal TB in a patient with a history of previous abdominal surgery. Her CBNAAT was positive and she recovered following treatment. In present study, all the cases presented unusual manifestations and the diagnosis was made based on radiological findings combined with microbiological laboratory investigations. Therefore, clinically suspecting these cases and confirming the diagnosis through microbiological tests is critically important.

Cytomegalovirus Infection in Infants: A Case Series on Varied Clinical Manifestations

Caroline D Shira, Emjaj Rahman Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Cytomegalovirus (CMV) is a common cause of congenital infection, presenting a wide spectrum of clinical manifestations and varying grades of severity. In the neonatal period, CMV infection may manifest as jaundice, hepatosplenomegaly, petechiae, microcephaly, and chorioretinitis. Nonetheless, congenital CMV infection may be asymptomatic in 90% of infants at birth. Late diagnosis of congenital infection can significantly affect the quality of life for children due to neurodevelopmental delays and sensorineural hearing loss. Globally, people are more informed about neural tube defects, foetal alcohol syndrome, and toxoplasmosis than about congenital CMV, even though congenital CMV infection poses a greater threat to newborns. Hence, understanding the clinical manifestations and treatment modalities for CMV infection is paramount for effective management and prevention strategies.In this case series, the authors present seven cases of congenital CMV infection, with presentations varying from cirrhosis to subarachnoid haemorrhage, aiming to shed light on the varied clinical presentations, diagnostic challenges, and management strategies for CMV infections in infants.

Embolia Cutis Medicamentosa Secondary to Commonly used Drugs: A Series of Four Cases

S Akshata Yadav, TS Rajashekar, K Sureshkumar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Nicolau syndrome, also referred to as Embolia Cutis Medicamentosa, is a rare iatrogenic complication typically following intramuscular, subcutaneous, or intra-articular drug administration. It is characterised by the sudden onset of severe pain, followed by erythema, violaceous discoloration, and skin necrosis at the injection site. This report presents a case series of four patients aged 13, 30, 43, and 56 years, who developed Nicolau syndrome after intramuscular injections of commonly used drugs such as Deriphyllin, Diclofenac, Tramadol, and Betamethasone. The clinical presentation in all cases involved acute pain followed by ulceration or necrosis over the gluteal region. Diagnosis was primarily clinical, supported by normal laboratory parameters and ultrasonographic findings showing subcutaneous tissue changes. Management included conservative approaches such as wound care with topical antibiotics, systemic analgesics, and oral antibiotics as needed. All patients recovered with residual scarring and post-inflammatory hyperpigmentation. This case series emphasises the importance of correct injection techniques, including appropriate site selection (upper outer quadrant of the buttock), using the Z-track method, aspirating before injection, and employing appropriate needle lengths to minimise risk. Given that Embolia Cutis Medicamentosa is preventable, reporting such cases is crucial to raise awareness among healthcare professionals. Early diagnosis and appropriate intervention can significantly reduce the complications and morbidity associated with this condition.

Neutrophilic Dermatoses: A Case Series of Unusual Adverse Effects with Commonly Administered Drugs

Yeragonda Susmitha, TS Rajashekar, K Suresh Kumar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Neutrophilic Dermatoses (NDs) are inflammatory conditions characterised by sterile neutrophilic infiltrates on histopathology. Multiple clinical presentations can occur in a single patient with ND. The location of the neutrophilic infiltrate (in the skin’s superficial, deeper, or subcutaneous layers), the clinical features, and the duration of the disease help to identify ND. Robert Douglas Sweet introduced the term neutrophilic dermatoses in 1964 to describe febrile neutrophilic dermatoses, now known as Sweet syndrome. The major conditions in this group include Pyoderma Gangrenosum (PG), Sweet Syndrome (SS), subcorneal pustular dermatoses, Generalised Pustular Psoriasis (GPP), and Inflammatory Bowel Disease (IBD)-associated neutrophilic dermatoses. The present case series described five female patients, aged 32 to 85, who developed painful, red, pus-filled skin lesions after taking common medications such as aceclofenac, diclofenac, and isotretinoin. The cases included Neutrophilic Eccrine Hidradenitis (NEH), Sweet syndrome, and PG, with symptoms such as fever, sore throat, and arthralgia. Skin biopsies confirmed the diagnoses, showing inflammatory changes, dermal oedema, and features such as vascular injury. Blood tests consistently showed neutrophilia and elevated inflammatory markers {Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP)}. Management consisted of stopping the suspected offending medications and initiating corticosteroid therapy, which led to improvement in symptoms. This case series highlights the importance of promptly identifying drug-induced neutrophilic disorders to avoid misdiagnosis, inappropriate treatment, and potential complications. Heightened awareness among clinicians is essential to facilitate timely diagnosis and effective management of these rare yet significant dermatological reactions. Hence, the case series aimed to summarise therapeutic innovations related to the principal neutrophilic dermatoses.

The Fungal Footprint: Radiologic Spectrum in Pulmonary, Paranasal Sinus and CNS Infections

P Jenikar, MG Sai Shankar, B Harshavardhan, Sachin Virmani Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Fungal infections can involve multiple organ systems, with imaging playing a pivotal role in their diagnosis and management. Fungal infections of Paranasal Sinuses (PNS) can be classified into invasive and non-invasive forms. Invasive fungal infections can be further divided into acute, chronic, or chronic granulomatous entities. It mainly affects immunocompromised patients with uncontrolled diabetes mellitus, Human Immunodeficiency Virus (HIV), and those on chemotherapy or chronic oral corticosteroids. Computed tomography remains the gold standard for sinonasal imaging while Magnetic Resonance Imaging (MRI) excels in assessing intraorbital and intracranial extensions. It is important to know and identify the characteristic imaging patterns of invasive and non-invasive fungal rhinosinusitis, and the radiologist is very important in refining the diagnosis to prevent a possible fatal outcome. This case series highlights the radiologic manifestations of fungal infections affecting the pulmonary system, Central Nervous System (CNS), and peripheral nervous system with characteristic imaging features ranging from invasive aspergillosis and mucormycosis to allergic fungal disease and rhinosporidiosis. Imaging findings includes sinus opacification, bony erosion, cavernous sinus invasion, orbital involvement, and cavitary lung lesions with Monod sign, ground-glass opacities and hyperdense mucus played a crucial role in diagnosis. By presenting a range of cases, this series aims to provide a comprehensive understanding of the imaging features associated with these infections, facilitating accurate diagnosis and treatment planning for radiologists and clinicians.

The Relevance of Follow-up after Primary Management of Omphalocele in Beckwith-Wiedemann Syndrome: A Series of Five Cases

Santosh B Kurbet, Rami Reddy Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Omphalocoele, also called exomphalos, though a large disease by itself, can just be one part of association of much broader growth disorder of Beckwith-Wiedemann Syndrome (BWS), which one needs to be familiar with primarily. The omphalocoele is amenable to primary surgical correction in neonatal period. With the successful treatment of omphalocoele in the spectrum of BWS does not conclude the management, as the literature suggests the follow-up is imperative as there is increased incidence of visceral malignancy and blood cancers in these patients over the years of life. Present series is of five cases of BWS treated at birth for omphalocoele by surgery successfully, kept on regular follow-up, with one child developing leukaemia and loss of life due to the disease. The emphasis thus is on the need identification of the syndrome of BWS in a case of omphalocoele and also elaborating on their follow-up, long enough after surgery because of the risk of development of various malignancies.

Navigating the Dual Challenge of Difficult Airway and Low Cardiac Reserve in Oral Cancer Surgery: A Case Series

Shilpa Sarang Kore, Dipti Rana, Amita Vishal Sale Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Oral cancers, particularly Squamous Cell Carcinomas (SCCs), cause fibrosis and structural changes within the oral cavity, creating complex airway management challenges. These cases often present anaesthetic difficulties, including restricted access for instrumentation, distorted anatomy that increases the difficulty of ventilation and intubation, and a heightened risk of bleeding or airway obstruction. Postoperative concerns, such as airway oedema, respiratory compromise, and pain management, further complicate the perioperative period. This case series explores the anaesthetic management of three patients with oral cancer and significant cardiovascular comorbidities. Two key factors that created anaesthetic challenges were restricted mouth opening of less than 2 cm (less than two finger breadths) and compromised cardiac function, which carries risks of haemodynamic instability and arrhythmias. Awake Fiberoptic Intubation (AFO) was chosen to secure the airway and avoid a situation where ventilation or intubation would be impossible. The nasal cavities were instilled with xylometazoline drops. Additionally, a transtracheal block was performed in the sitting position, using 4 mL of 4% topical lignocaine to anaesthetise the trachea, significantly reducing the cough reflex and discomfort during intubation. Sedation was provided with midazolam and fentanyl after the administration of supplementary oxygen. Fiberoptic intubation was carried out, and the airway was secured by railroading a flexometallic tube over the bronchoscope. Induction was performed with midazolam (0.04 mg/kg), fentanyl (2 mcg/kg), and vecuronium (0.1 mg/kg). Anaesthesia was maintained using sevoflurane, nitrous oxide, and oxygen. Haemodynamic monitoring was conducted with Central Venous Pressure (CVP) and Arterial Blood Pressure (ABP) measurements. The surgical procedure went uneventfully. After surgery, the patients were kept on a T-piece in the Post-Anesthesia Care Unit (PACU) and were closely monitored for airway patency, respiratory effort, and haemodynamic stability. This case series emphasises anesthetic strategies that manage complex airway and cardiovascular issues in high-risk oral cancer surgery while addressing critical postoperative considerations.

The Cryptococcus neoformans Challenge in Immunocompromised Patients: A Two Year Case Series from Western Rajasthan with Review of Literature

Snigdha Purohit, Ashina Singla, Rachna Priyadarshini, Shaveta Kataria, Ekadashi Rajni Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Cryptococcosis is a severe opportunistic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii (critical fungal pathogens), primarily affecting immunocompromised individuals such as those with Human Immunodeficiency Virus (HIV), postorgan transplant patients, or those on prolonged immunosuppressive therapy. Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. This case series highlights five patients with varied clinical presentations, including postrenal transplant complications, co-infection with TB and disseminated disease in HIV-positive individuals. Diagnosis relied on cerebrospinal fluid analysis, cryptococcal antigen testing and advanced imaging techniques. Treatment included liposomal amphotericin-B, fluconazole and supportive therapies. Despite aggressive management, outcomes varied, with some patients surviving while others succumbed to the infection. The series underscores the challenges in diagnosing and managing cryptococcosis, particularly in resource-limited settings, as well as the increased mortality associated with co-infection, which is a public health concern. Therefore, authors emphasise the need for improved diagnostic tools and integrated management strategies for better patient outcomes. With the rise in case studies of cryptococcosis, there is an increase in awareness; however, to control this menace, a high level of alertness and surveillance must be maintained at both clinical and laboratory levels. Only then can this “awakening giant” be contained.

Blunt Ocular Trauma Commonly Presenting to the Emergency Department: A Case Series from a Tertiary Care Hospital in Banaskantha, Gujarat, India

Rahul Navinchandra Bakhda Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Blunt ocular trauma is a leading cause of ocular morbidity and visual impairment. Blunt ocular trauma is also involved with trauma to other parts of the body. Head injury is commonly accompanied with blunt ocular trauma. Common causes of blunt ocular trauma are road traffic accidents, assault, alcohol-related incidents and workplace injuries. This case series includes some common ocular manifestations of blunt ocular trauma, like lid oedema, periorbital ecchymosis, subconjunctival haemorrhage and chemosis, that commonly present to the emergency department along with trauma to other parts of the body. Common presenting symptoms include pain, loss of vision, blurring of vision, redness, increased watering, swelling around the eye and bleeding. This case series mainly deals with anterior segment manifestations of blunt ocular trauma that are frequent in the emergency department. Ocular trauma can significantly affect the future quality of life. Ocular trauma is a preventable public health problem worldwide. Preventive measures should be taken by the government to educate people regarding safety precautions in the workplace, better vehicular safety measures and prevention of blunt ocular trauma. Community education is an essential part in prevention. Early diagnosis and prompt intervention can help prevent visual impairment.

Rare Clinical Image of Cutaneous Mastocytosis

Shubham Khanke, Mujahid Khan, Keyur Dudhat, Pratiksha Mahure Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Mastocytosis, a rare condition also referred to as a clonal bone marrow disorder, is characterised by an excessive presence of CD34+ mast cell progenitors and functionally impaired mast cells. This disorder can affect both adults and children, leading to symptoms such as hives, itching, and potentially life-threatening anaphylactic shock. Often misdiagnosed, mastocytosis is frequently associated with other underlying conditions, indicating that its prevalence may be underestimated. The disease can present in two distinct forms: Cutaneous Mastocytosis (CM) and systemic mastocytosis. These conditions impact multiple bodily systems, leading to a diverse array of symptoms and clinical manifestations (1).

Trichoepithelioma: A Rare Skin Condition with Significant Psychosocial Burden

Rohit Arun Waskar, Dipika Chakole, Bhagyashri Chaudhari, Sourabh Deshmukh Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Trichoepithelioma is a rare, benign tumour originating from hair follicles. These tumours are generally presented as small, firm papules or nodules that often match the skin colour or appear yellowish. They are predominantly found on the face, especially around the nose and forehead (1),(2). This case details a 58-year-old female presenting with multiple papules on her face, accompanied by mild, intermittent itchiness and dryness that persisted for the past 20-25 years. The condition significantly impacted her quality of life both socially and mentally. Despite consulting various dermatologists, the patient did not receive effective treatment. Histopathological examination of the lesions showed no evidence of malignancy. A family history was noted, as the patient’s mother also had a few similar lesions around her nose. Differential diagnoses included Basal Cell Carcinoma (BCC), syringoma, and fibrous papules of the face, which were ruled out based on clinical presentation and pathophysiological differences. BCC was excluded due to its malignant nature, syringomas were ruled out as they are typically found around the eyes, and fibrous papules are mainly confined to the nose. Therefore, the diagnosis of multiple familial trichoepithelioma, a hereditary form of benign trichoepithelioma, was confirmed (Table/Fig 1), (Table/Fig 2),(Table/Fig 3). Genetic analysis revealed that mutations in the CYLD gene on chromosome 16q12-q13 are the primary cause of multiple familial trichoepithelioma. The CYLD gene encodes a protein that negatively regulates cell proliferation and inflammation, including the Wnt/β-catenin and NF-κB pathways. A mutation in CYLD leads to uncontrolled cell growth, contributing to tumour formation (3). Histologically, trichoepitheliomas differ from BCCs by the presence of basaloid cells surrounded by fibrous stroma and keratin-filled horn cysts (4). Treatment for trichoepithelioma typically involves surgical excision or ablative laser therapy. However, these treatments may result in unsatisfactory outcomes and tumour recurrence. Pharmacological interventions, when used alone or in combination with traditional methods, may offer partial responses, but evidence supporting their efficacy remains largely anecdotal (5). In this case, the patient was treated with Ayurvedic remedies, including Tab Neem 500 mg twice daily (BD) with Haridra Jal as anupan, and local application of coconut oil to soothe dryness and provide a cooling effect. These treatments were intended as supportive care to reduce inflammation and alleviate symptoms, though their ability to fully resolve the condition is limited.

Solitary Myocysticercosis of Sternocleidomastoid Muscle

Agrawal Shilpi, Ravanagomagan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X An eight-year-old female child presented to the paediatric outpatient department with a complaint of swelling in the neck on the right side. Her mother noticed the swelling six weeks ago, and it has been progressively increasing in size. The patient is a pure vegetarian and has a history of regularly eating vegetable and fruit salads. Additionally, there was a history of consuming salad from a hotel 10 weeks prior.

Iatrogenic Carotid-jugular AV Fistula in a Patient with Polycystic Kidney Disease and Mitral Valve Prolapse: A Case of Diagnostic Complexity

Poonam Hannurkar, Jekha Mary Babu Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Dear Editor, Autosomal Dominant Polycystic Kidney Disease (ADPKD) is characterised by multiple renal cysts, progressive kidney enlargement, and dysfunction (1), eventually leading to End-Stage Renal Disease (ESRD). Extrarenal manifestations include hepatic cysts, hypertension, Left Ventricular Hypertrophy (LVH), valvular heart disease, intracranial and extracranial aneurysms, pancreatic cysts, and diverticulosis (2). Arteriovenous fistulae (AV fistulas) can be congenital, idiopathic, or acquired following trauma or iatrogenic procedures, such as Internal Jugular Vein (IJV) catheterisation [3,4]. This report highlights the need for clinician awareness and routine vascular imaging in high-risk ADPKD patients with a history of jugular catheterisation.

Major Anaesthetic Challenges during Minor Surgery: A Case of Ventricular Thrombus

Shilpa Deshmukh, Avirneni Vaishnavi Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Dear Editor, Ventricular thrombi can develop more frequently in individuals with certain underlying conditions, the most common being post-myocardial infarction and dilated cardiomyopathy (1). Their occurrence without underlying cardiac disease is unusual, and these thrombi are often identified incidentally (2). We present the anaesthetic approach for a 48-year-old male undergoing emergency incision and drainage of a 5×5 cm carbuncle on the back of the neck, who was incidentally diagnosed with a large Left Ventricular (LV) thrombus.

Comparative Effectiveness of Viddha-agnikarma in Managing Lower Back and Knee Joint Pain: A Pilot Study

Yogesh Yadav, Sheetal Asutkar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Viddha-agnikarma is a novel Ayurvedic method that combines Viddhkarma (piercing therapy) and Agnikarma (thermal cautery) to alleviate pain through targeted thermal stimulation. It offers an alternative pain management approach, particularly for chronic musculoskeletal conditions, by delivering localized relief without reliance on pharmacological treatments. Aim: To evaluate the efficacy of Viddha-agnikarma in managing chronic pain associated with the lower back and knee joints in patients unresponsive to conventional therapies. Materials and Methods: This was a prospective intervention pilot study conducted at Department of Shalya Tantra, Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Wardha, Maharashtra, India, from February 2024 to July 2024. It included 12 patients with persistent lower back or knee pain resistant to standard treatments. Each patient received Viddha-agnikarma therapy every three days, totaling seven sessions, with follow-up evaluations on day 21. Pain levels were assessed using the Visual Analog Scale (VAS) at baseline, immediately post-treatment, and during follow-up. A comparison of the differences in initial and final mean scores was conducted, and the percentage improvement in pain scores was calculated to evaluate therapeutic efficacy. Results: The study included 12 patients: seven males and five females, all from rural areas, with a mean age of 58±5.9 in Group A and 54.8±8.4 in Group B. VAS scores indicated a reduction from 8 to 0.33 for Lower Back Pain (LBP), and from 8 to 4 for knee pain. Although patients experienced some improvement in knee pain, the outcomes were less consistent and varied across individuals, indicating a need for further research into Viddha-agnikarma’s efficacy for knee pain. Conclusion: Viddha-agnikarma emerged as a promising non pharmacological alternative for chronic pain management, particularly effective for LBP, with potential benefits over conventional treatments. This pilot study supports the integration of Viddha-agnikarma into Ayurvedic pain management practices. However, larger, randomised controlled trials are necessary to validate these findings and further explore its effectiveness, especially for knee pain management.

Transurethral Pneumatic Cystolithotripsy under Local Anaesthesia as a Day-care Procedure: A Retrospective Descriptive Study from North-east India

Stephen Lalfakzuala Sailo, Cornerstone V Wann, Laltanpuii Sailo, Rajini Thabah Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Urinary bladder stones comprise only 5% of all urinary stones but are responsible for 14% of hospital admissions. Various types of treatment for bladder stones include open cystolithotomy, extracorporeal shock wave lithotripsy, cystolitholapaxy, and percutaneous suprapubic or transurethral cystolithotripsy. Aim: To report the safety and intensity of pain associated with transurethral pneumatic cystolithotripsy under local anaesthesia in adult patients as a day-care procedure. Materials and Methods: This retrospective hospital-based descriptive study was conducted in the Department of Urology at the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India, from June 2022 to January 2024, 34 patients (33 men and 1 woman) with symptomatic urinary bladder stones underwent transurethral pneumatic cystolithotripsy under local anaesthesia as a day-care procedure. Patient’s sex, age, symptoms, complete blood count, kidney function tests, random blood sugar, glycated haemoglobin (HbA1c), coagulation profile and urine analysis were collected from hospital records. Stone size and number were collected from kidney, ureter and bladder (KUB) X-ray, ultrasonography and in some cases, intravenous urography and CT scan (non-contrast) reports. Ten minutes after the instillation of 10 mL of 2% lignocaine jelly into the urethra, pneumatic energy was delivered using a 9.5 F semi-rigid ureteroscope (Karl Storz, Germany). Pain during the procedure was assessed using the Visual Analogue Scale (VAS). The operating time and status of fragmentation and clearance of the stone were also recorded. These data were entered and analysed using Microsoft Excel Software version 2019. Continuous variables were presented as mean and standard deviation or range, while categorical variables were expressed as frequencies and percentages. Results: The mean patient age was 38 years, and the mean stone size was 13.9 mm. The mean operating time was 15.4 minutes. Complete stone fragmentation and clearance were achieved in 30 out of 34 patients (88.2%), with a mean VAS score of 2.5. All patients who had a successful procedure had stones ≤20 mm. Mild haematuria was observed in 25 patients (73.5%). There were no bladder perforations and no mortality. The procedure failed in four patients, who subsequently underwent cystolithotripsy under spinal anaesthesia. Conclusion: Transurethral pneumatic cystolithotripsy under local anaesthesia as a day-care procedure was safe and effective. Adult patients tolerated the procedure well. Therefore, it is a viable treatment option for urinary bladder stones of size up to 20 mm in adult patients.

Evaluation of Bolton Anterior and Overall Tooth Size Discrepancy among Different Malocclusion Groups in Southern Indian Population: A Retrospective Study

Sandiya Rajavelu, Thirunavukkarasu Ramanathan, Muralidharan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Orthodontic treatment involves distinct phases, each with unique traits and challenges. In particular, the “Finishing” stage is renowned for the fine corrections needed to achieve optimal results. Discrepancies in tooth size contribute significantly to the difficulties encountered during this stage. Aim: To assess differences in maxillary and mandibular tooth size discrepancies among different sagittal malocclusion groups in a South Indian population using the derived Bolton formula. Materials and Methods: A retrospective study was conducted in the Department of Orthodontics at Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India, over three months, from July to September 2024. A total of 120 high-quality pretreatment orthodontic study models were selected. The inclusion criteria comprised patients aged 16 to 25 years with full permanent dentition up to the first molars in both arches. The models were categorised into three groups based on Angle’s classification of anteroposterior malocclusion: Class I (n=40), Class II (n=40), and Class III (n=40). The mesiodistal width of each tooth up to the first molar on both sides was measured at the interproximal contact points using a digital caliper. Bolton’s anterior and overall ratios were calculated using the measured values. Statistical analysis included one-way ANOVA to evaluate differences in mean Bolton ratios across groups, and the Chi-square test to assess the distribution of anterior and overall Bolton discrepancies among the malocclusion types. A p-value of <0.05 was considered statistically significant. Results: The prevalence rate of tooth material discrepancies in the anterior region for Angle Class I and Class III groups was significantly greater than that for Class II groups. The mean overall and anterior ratios were not significantly different between the malocclusion groups (p=0.13 and p=0.72, respectively). Conclusion: The present study indicated that Class I and Class III show an increased frequency of tooth material discrepancies compared with Class II.

Impact of Verbal and Visual Training on Amount of Toothpaste Dispensed by Parents and Children: A Quasi Experimental Study

Arwa Soni, J Jasmin Winnier, Shilpa S Naik, Sonal Tandel, Diksha Patil, Kruti Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Fluoride prevents dental caries however excessive utilisation of fluoridated toothpastes can lead to dental fluorosis. Hence, parents and children should be instructed regarding toothpaste dispensing quantities. Aim: To determine the effectiveness of visual and verbal aids in instructing parent-child dyad regarding toothpaste dispensing patterns. Materials and Methods: A pretest-post-test quasi experimental study was conducted comprising of 70 parents and children aged 3-6 years in the department of Paediatric and Preventive Dentistry, DY Patil University of Dentistry, Navi Mumbai, India from September to December 2023. Data on toothpaste and toothbrush type were collected. Toothpaste dispensing was assessed at baseline, after parental counselling with visual and verbal aids (T0) and after atleast three months (T1). One-way ANOVA and Tukey HSD post-hoc test was used to compare difference in weight of toothpaste dispensed at all time intervals. Unpaired t-test was used to compare amount of toothpaste dispensed by parent and child at all time intervals. Results: A total of 44 (62.9%) of parents utilised adult toothpaste and 7 (10%) used adult toothbrushes while brushing their child’s teeth. Parents and children dispensed an average 0.62±0.29 mg and 0.74±0.34 mg, respectively. However, a noticeable reduction in usage from baseline to T0 and T1 was observed in both parent and child groups (p<0.001*). Conclusion: Parents and children dispensed beyond recommended amount. Children, dispensed more toothpaste than their parents at baseline, immediately after counselling and after three months, emphasising need to monitor toothpaste use in preschoolers to avert dental caries and fluorosis. The noticeable reduction in parental usage shows positive impact of visual and verbal guidance in their dispensing habits.

Dosage of Local Anaesthetic Drug in Spinal Anaesthesia Based on Dural Sac Cross-sectional Area Measured Using Ultrasound for Transurethral Resection and Inguinal Hernia Surgeries: A Double-blinded, Randomised Controlled Study

Sandip Baheti, Tharun Dasarath Perni, Sravya Bejugama, Vaishnavi Avirneni Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Geriatric patients undergoing surgical procedures such as Transurethral Resection of the Prostate (TURP) and inguinal hernia repair often face an increased risk of complications due to age-related anatomical and physiological changes. The Dural Sac Cross-sectional Area (DSCSA) has been proposed as a parameter to optimise the dosage of local anesthetics in spinal anaesthesia, aiming to achieve effective sensory blockade while minimising haemodynamic instability. Aim: To determine the minimum required dose of intrathecal bupivacaine based on DSCSA for achieving a T10 sensory blockade in elderly patients undergoing TURP and inguinal hernia repair. Materials and Methods: This was a double-blinded, randomised controlled study conducted on 70 geriatric patients {American Society of Anaesthesiology (ASA) I and II} undergoing TURP or inguinal hernia repair at Dr. DY Patil Medical College and Research Centre, Pune, Maharashtra, India from July to November 2024. Patients were randomly allocated into two groups: the Control (C) group, which received a fixed dose of 10 mg hyperbaric bupivacaine, and the Ultrasound (U) group, where DSCSA was measured using ultrasound at the L3-L4 level, and the bupivacaine dosage was adjusted accordingly. Haemodynamic parameters, sensory blockade levels, motor block duration, and two-segment regression times were analysed. Data normality was assessed using the Shapiro-Wilk test, with quantitative variables compared using the independent t-test, qualitative variables analysed using the Chi-square test or Fisher’s exact test, and a p-value <0.05 considered statistically significant. Results: Baseline characteristics such as age, height, weight, ASA grade, and surgery duration were comparable between groups (p>0.05). The mean DSCSA in the U group was 120.03±12 mm², with a calculated mean dose of 7.99±0.77 mg bupivacaine, significantly lower than the fixed 10 mg in the C group (p<0.0001). The highest sensory level reached was T8 in the U group and T4 in the C group (p=0.004). The U group had a significantly shorter motor block duration (157.23±11.92 min vs. 199±21.86 min, p<0.0001) and two-segment regression time (52.5±13.44 min vs. 62.64±14.49 min, p=0.003). The C group experienced a greater decrease in Mean Arterial Pressure (MAP) (p<0.0001) with a higher need for vasopressor support. Conclusion: Tailoring the intrathecal bupivacaine dosage based on DSCSA significantly reduces the risk of excessive cephalad spread, minimising haemodynamic fluctuations while maintaining adequate anaesthesia. Ultrasound-guided DSCSA measurement can serve as a valuable tool for optimising spinal anaesthesia in geriatric patients.

Comparative Evaluation of Fragment Reattachment and Fracture Resistance of Tooth Stored in Different Hydration Media when Reattached with Different Materials: An In-vitro Study

Benazir Sultana Mondal, Arunabha Giri, Pratik Kumar Lahiri, Biswaroop Chandra, Shabnam Zahir, Arunim Mondal, Shrayana Bhattacharya, Simran Singh Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Different methods have been developed to restore an uncomplicated crown fracture, varying from less invasive procedures to aesthetic restorations. Fragment reattachment has been established as a better alternative for restoring aesthetics, anatomy, and improved function. The rationale of the study lies in the fact that the materials used in the study are readily available and has proved beneficial in many literatures. Aim: To compare the tooth reattachment success and fracture resistance between tooth remnant and reattached part using different reattachment materials when the fragments were in different storage conditions. Materials and Methods: The present in-vitro, experimental study was conducted at Guru Nanak Institute of Dental and Research, Panihati, West Bengal, India, Indian Institute of Engineering Science and Technology, Shibpur and Narula Institute of Technology, Agarpara for one and half years, July 2022 to December 2023. A total of 96 Maxillary permanent central incisors extracted due to periodontal problems with approximately similar dimensions, mesiodistal width at the junction of middle and incisal third approximately between 8.4 to 8.7 mm were included in the study. Sample was divided into four groups: 1 positive control (A) and 3 experimental, based on storage media (B- Normal Saline, C- Fat-free milk, D- Stored Dry). Each experimental group was further subdivided into three sub-groups according to the different reattachment material (1- Light cure GIC; 2- Nano-filled packable Composite; 3- Flowable Composite). Tooth fracture was simulated and then the fracture fragments were stored as per the standard rehydration protocol for each group and reattached accordingly. The samples were then mounted on a Universal Testing Machine (UTM) to evaluate fracture resistance. The tooth reattachment success was noted by calculating the distance between the reattached tooth fragment from the reattachment material using Scanning Electron Microscopy. One-way Analysis of Variance (ANOVA) and Tuckey’s post-hoc tests were used for intergroup and intragroup comparisons. The level of significance was fixed at p=0.05 and any value ≤0.05 was considered to be statistically significant. Results: It was seen that significant differences were seen in fracture resistance based on different storage media and different reattachment materials. Among the samples, it was found that the fracture resistance is the highest in packable composite in the fat-free milk media with a mean value of 278.09 (SD 9.54). Also, it was found that distance between restoration and tooth surface is the smallest in packable composite in the fat-free media with a mean value of 1.4131 μm (SD 0.12880). These differences were statistically significant. Conclusion: The success of reattachment of a fractured anterior tooth with its fractured fragment was affected greatly by the rehydration of the fragments and also by the type of reattachment material used.

Effectiveness of Biodentine in Apexification of Immature Teeth: A Prospective Clinical Study

Debjani Saha, Nandita Goyal, Haridas Das Adhikari, Snigdho Das, Ankit Chanani Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Apical periodontitis results from microbial infection in the root canal system, prompting endodontic treatment to eliminate infection and prevent reinfection. Apexification addresses the cessation of root development in teeth with incomplete formation and pulpal necrosis, using materials such as Calcium Hydroxide (CH), Mineral Trioxide Aggregate (MTA), or Biodentine. By utilising Biodentine’s unique properties in a single-step apexification approach, this study seeks to provide evidence-based insights into its efficacy in reducing lesion size, promoting apical healing, and minimising procedural complexities. The findings will contribute to the growing body of literature supporting Biodentine as a viable alternative to traditional apexification techniques, potentially influencing future clinical protocols for managing immature teeth with open apices. Aim: To assess the effectiveness of Biodentine as a material in the apexification of immature teeth with periapical lesions. Materials and Methods: This prospective clinical study, approved by the Institutional Ethics Committee, was conducted at Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India, from March 2014 to February 2016. Forty healthy patients aged 14 to 50 years, with traumatised maxillary incisors exhibiting incomplete root development and open apices, were included in the study. The inclusion criteria specified teeth with chronic apical periodontitis or wide apical foramina. Preoperative evaluations included clinical assessments and radiographic examinations. The apexification procedures involved thorough canal preparation, disinfection, application of Biodentine, and subsequent obturation with gutta percha. Follow-ups were scheduled at 1, 3, 6, 9, 12, and 18 months. Friedman’s ANOVA with post-hoc Dunn’s test and the Binomial test were employed for statistical analysis at an alpha level of 5%. Results: Initially, although 40 patients were recruited, only 33 completed all follow-ups and were included in the final analysis. After accounting for dropouts, the median age of participants was 29 years (IQR: 19-39.5), with an age range of 14-47 years. The study included 19 males (57.6%) and 14 females (42.4%), with no significant gender association across groups (p=0.49). The median lesion size (IQR) decreased progressively: preoperative 21 mm² (10-40), 18 mm² (9-33.5) at one month, 15 mm² (7-22) at three months, 7 mm² (3.5-16) at six months, 4 mm² (0.5-12) at nine months, 1 mm² (0-7) at 12 months, and 0 mm² (0-2.5) at 18 months, reflecting reductions of 13.44-88.91%. Younger patients (<20 years) showed greater lesion reduction at 18 months compared to older patients (33 mm² vs. 14 mm², p=0.03), with no gender differences (p=0.86). At the 18-month follow-up, pain or discomfort was absent in 29 (87.9%) patients (p<0.001). Tenderness on palpation was absent in 30 (90.9%) (p<0.001), and tenderness on percussion was absent in 29 (87.9%) (p<0.001). An abscess or sinus was not observed in any patient (33 [100%]). Clinical and radiographic success was achieved in 29 (87.9%) cases, while 4 (12.1%) cases were classified as failures (p<0.001). Conclusion: Apexification using Biodentine shows promising outcomes; however, its efficacy relative to conventional methods could not be definitively established. Comparative studies with traditional materials, larger cohorts, and extended follow-ups are needed to validate its potential as an alternative for managing immature teeth with open apices.

Association of Serum Magnesium and Cardiovascular Events in End Stage Renal Disease Patients: A Prospective Cohort Study

Arya Vijayan, Ajumala M Basheer, KS Shajidha, Arun Mathew Chacko, A Geetha Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: End Stage Renal Disease (ESRD) patients display cardiovascular complications which is a significant feature for surge in death rate and morbidity. Vascular calcification manifests prematurely in renal failure patients and progresses often in an enhanced manner in subjects with hypomagnesaemia in comparison to the common herd. Aim: The aim of the study was to evaluate if there is any association with serum Magnesium (Mg) levels and future cardiovascular events in Chronic Kidney Disease (CKD) stage-5 patients. Materials and Methods: The present prospective cohort study was conducted on 60 CKD patients presenting to the Department of Nephrology at Government Medical College, Kottayam, Kerala, India, from 6th May 2016 to 5th May 2017. 5 mL of venous blood samples were collected and separated serum was used to determine Mg using the Xylidyl blue method in a fully automated clinical chemistry analyser, the Beckman Coulter AU 480. The study subjects were also grouped based on all causes of mortality due to cardiovascular events after follow-up for one year. Statistical analysis was performed by using Fischer’s-exact test, Pearson’s Chi-square, and Pearson’s correlation test. The p-value <0.05 was considered statistically significant. Results: Sixty subjects study population were in the age group ranging from 20-79 years, including 47 (78.3%) males and 13 (21.7%) females. The mean Mg level in those who developed an event was 2.32±0.41 mg/dL and in those who did not develop an event was 2.41±0.45. This difference in mean was not statistically significant with independent t test with t value=-0.69 and p-value=0.49. There was no significant association between low serum Mg levels and occurrence of cardiovascular event with p-value >0.05. Conclusion: Although Mg has been shown to effectively slow down calcification in controlled settings, additional elements impacting calcium deposition in CKD individuals must not be overlooked.

Association of hsCRP Levels with Microvascular Complications in Prediabetics, Newly Diagnosed and on Treatment Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Jagannath Dhadwad, Prince Yadav Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Low-grade chronic inflammation is recognised as the predominant cause of the pathogenesis and progression of Type 2 Diabetes Mellitus (T2DM) and its microvascular complications. High-sensitivity C-Reactive Protein (hsCRP) is a biomarker for inflammation that may indicate the underlying mechanisms of diabetes, such as insulin resistance and vascular damage. Aim: To compare hsCRP levels across three glycaemic categories- prediabetes, newly diagnosed T2DM, and on-treatment T2DM- and to determine its correlation with glycaemic control measures Glycated Haemoglobin (HbA1c), Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS) and microvascular complications such as diabetic retinopathy, nephropathy, and neuropathy. Materials and Methods: The present hospital-based, cross-sectional, analytical study was conducted over 18 months (October 2023 to March 2025) at Dr DY Patil Medical College, Hospital, and Research Centre, Pimpri, Pune, Maharashtra, India. One hundred fifty participants aged ≥18 years were randomly assigned to three groups: prediabetics, newly diagnosed T2DM (≤18 months), and T2DM under treatment. Measurements included FBS, PPBS, HbA1c, and hsCRP using an immunoturbidimetric assay. Diabetic retinopathy was diagnosed via fundoscopy, nephropathy was assessed through the urine albumin-creatinine ratio, and peripheral neuropathy was screened using a 10g monofilament and sensory examination. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) v20. Comparisons between groups were conducted with One-way Analysis of Variance (ANOVA) and the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Mean hsCRP values were significantly higher in newly diagnosed (7.87±1.26 mg/L) and on-treatment diabetics (7.26±2.30 mg/L) compared with pre-diabetics (2.72±2.80 mg/L; p<0.001). hsCRP exhibited a strongly positive correlation with HbA1c (r=0.616), FBS (r=0.223), and PPBS (r=0.461). Patients with diabetic retinopathy, nephropathy, and neuropathy had significantly elevated hsCRP levels compared to those without complications (p<0.001). Conclusion: hsCRP is a valuable marker of inflammation associated with poor glucose control and the development of diabetic microvascular complications. Regular monitoring can aid in the early detection of risk, facilitating targeted anti-inflammatory therapy and strict glycaemic control.

Management of Binge Eating Disorder in Polycystic Ovarian Syndrome using Different Modalities: A Randomised Controlled Trial

Renuka Jakhar, Elina Dewanji Sen, Preeti Rastogi Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Difficulty in losing weight is a major problem in binge eaters. It becomes catastrophic when it is concurrent with Polycystic Ovarian Syndrome (PCOS). Weight loss programs don’t benefit to cope with binge eating disorder and vice-versa; which is the most challenging component of weight management in PCOS females that manifest binge eating also. Aim: To develop a management strategy which can address binge eating and weight management in PCOS females. Materials and Methods: The present randomised, parallel group, active controlled trial was conducted from december 2021 to december 2022 in non-pregnant females of 18-45 years of age satisfying Rotterdam criteria of PCOS having BMI ≥18.5. Eating Disorder Diagnostic Scale (EDDS) was used as a screening tool. A total of 114 participants were randomised into two groups of 57 females each ,experimental group and control group control group (n=57). Experimental group performed aerobic exercises, resistance exercises, diet modifications and Rajyoga meditation while control group performed only diet modifications and Rajyoga meditation. Eligible and willing participants visiting Weight, height, waist circumference, hip circumference, Body-Mass Index (BMI), Waist-Hip Ratio (WHR), Eating Attitudes Test (EAT) score, Bulimic Investigatory Test, Edinburgh (BITE) severity score and BITE symptom score were assessed before start of intervention and after 12 weeks of intervention. Shapiro-Wilk test indicated data were non-normally distributed. Within group analysis (pretest vs post-test) was performed using Wilcoxon signed-rank test. The between group differences were compared (experimental vs. control) using Mann-Whitney U test. IBM Statistical Package for Social Sciences (SPSS) Statistics 22.0 was used for analysis with p<0.05 statistically significant. Results: The mean ageof the participants was 26.35±4.97 years, mean weight was 73.53±16.73 kg, mean WHR 0.88±0.04 and mean BMI 28.81±5.90 kg/m2 Reduction in weight, BMI, waist circumference, EAT score, BITE severity score and BITE symptom score were statistically significant within both groups (pre-test and post-test, p<0.001) while reductions in hip circumference and WHR were statistically significant only in experimental group (pre-test and post-test, p<0.001). Conclusion: the present study results highlights the significant weight BMI binge eating symptoms in the intervention group.further researches can help the profeSsionalS in healthcare in treatment of pcos.

Nerve Conduction among Middle-aged Indian Diabetic Males without Clinical Neurodeficit: A Cross-sectional Study

Andrevich Saha, Piyali Das, Sujoy Ghosh Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Peripheral neuropathy is one of the dreaded complications of diabetes mellitus. Data pertaining to subclinical neuropathies among diabetics are deficient, especially in the Indian context. Aim: The aim of this study is to evaluate the Nerve Conduction Study (NCS) parameters in middle-aged Indian males with diabetes who do not exhibit any clinical neurodeficits, and to compare the findings with age-matched, non diabetic healthy controls. The present study also explores the correlations between NCS parameters and glycaemic control (HbA1c) in the study population. Materials and Methods: This cross-sectional study was conducted at IPGME&R Kolkata, West Bengal, India from February 2021 to July 2022. A total of 165 diabetic males without any neurological symptoms and 54 age-matched non diabetic controls were included in this study. Onset latencies, amplitudes, and conduction velocities of the median, ulnar, tibial, peroneal, and sural nerves were compared between the groups using an unpaired Student’s t-test. The correlation between NCS parameters and HbA1c levels among diabetics was checked using the Pearson correlation coefficient. A p-value of <0.05 was considered significant. Results: In the present study, 165 diabetic individuals and 54 non diabetic controls were included. When comparing the nerve conduction parameters, the diabetic individuals showed significant delays in sensory and motor nerve conduction across all peripheral nerves examined. For instance, the conduction velocities (m/s) of the motor and sensory components of the median nerve were found to be 56.73±4.96 and 65.85±9.84 in the non diabetic controls, whereas they were 53.71±7.23 and 59.71±11.87 in the diabetic patients (p<0.05 in each case). Except for the motor amplitudes of the tibial and ulnar nerves, all other peripheral nerves in both the upper and lower limbs showed significantly higher amplitudes of motor and sensory action potentials among the non diabetic controls. HbA1c was found to have significant positive correlations with NCS parameters, including the motor onset latencies of the median, ulnar, tibial, and peroneal nerves, as well as the sensory onset latencies of the median, ulnar, and sural nerves. Conclusion: Peripheral neuronal conduction is affected in diabetic patients even before any neurological symptoms appear, and the degree of neurodeficit is dependent on glycaemic control.

Serum Levels of MicroRNA-210 as a Pathogenic Factor in Patients with Diabetes and Diabetic Nephropathy: A Cross-sectional Study

Divya Singh, Ivvala Anand Shaker, Ashishkumar Agravatt Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Diabetes Mellitus (DM) is a foremost global health challenge, causing disability and premature death. It leads to severe micro and macrovascular complications, including Diabetic Nephropathy (DN), which affects 20% of patients worldwide. Up to 50% of Chronic DM (CDM) patients get end-stage DN and then require Renal Replacement Therapy (RRT). DN develops gradually and causes proteinuria and glomerulopathy. Oxidative stress, Reactive Oxygen Species (ROS), and abnormal microRibonucleic Acid (miRNAs) are involved in DM progression and complications. Aim: The study aimed to assess serum miRNA-210 levels in DM patients and those with diabetes nephropathy, as it plays a crucial role in DM along with endothelial cell function. Materials and Methods: The present Cross-Sectional Study (CSS) included 400 participants, grouped into healthy controls, diabetic patients having nephropathy, and diabetic patients not having nephropathy, matched by age and sex. Inclusion criteria covered adults with known diabetes or DN, while individuals with infections, inflammatory or haematological diseases, and pregnant women were excluded. Ethical clearance was obtained, and informed consent was secured from all participants. Biochemical, renal, inflammatory, and epigenetic markers (including miRNA-210) were measured utilising standard laboratory techniques. Also, statistical analysis was performed using MedCalc, with significance value of p<0.05. Results: Of the 400 study participants, 192 (48.0%) were female and 208 (52.0%) were male. This study discovered noteworthy differences in glycaemic, renal, inflammatory, and epigenetic markers among control, diabetic, and DN groups. C-Reactive Protein (CRP) levels were elevated in both diabetic groups 10.591±7.175 mg/L (diabetic mellitus), and 18.710±7.406 mg/L (DN) (p<0.001). IL-10 levels were low in the diabetic mellitus group (8.380±0.801 pg/mL) (p<0.001). Fetuin-A levels were 186.90±35.913 in diabetic mellitus (p<0.001). Adiponectin levels were highest in the nephropathy group (21.340±7.193 μg/mL), compared to controls (p<0.001). Conclusion: These findings highlight reduced serum miRNAs’ potential as a biomarker for early detection and disease progression.

Secretory Carcinoma of Salivary Gland: A Single-centre Cohort Study Highlighting Histomorphologic and Immunohistochemical Characteristics

KR Anila, Rutuja Karbhari Narwade, PK Pravanya, Malu Rafi, Bipin T Varghese Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Secretory carcinoma of the salivary gland is a distinct subtype of salivary gland carcinoma that was first described by Skalova A et al., in 2010. It is characterised by the ETV6-NTRK3 translocation. Before the recognition of this entity, most cases of secretory carcinoma were misdiagnosed as acinic cell carcinoma. The accurate diagnosis of secretory carcinoma is important as inhibiting the active Ets-leukemia Virus-Neurotrophic tropomyosin Receptor Kinase 3 (ETV6-NTRK3) is highly efficient in the treatment of this carcinoma. Aim: To evaluate the clinical, histomorphological, and Immunohistochemical (IHC) characteristics of secretory carcinoma diagnosed at a tertiary care centre. Materials and Methods: This cohort study was conducted in the Department of Pathology at the Regional Cancer Centre, Thiruvananthapuram, Kerala, India (a tertiary cancer centre), from June 2021 to December 2021, after approval from the scientific review committee. A total of 13 cases diagnosed as secretory carcinoma from January 2016 to December 2020 were reviewed. Histomorphological features analysed included growth pattern, cytoplasmic vacuolisation, presence of secretion, hobnailing, nuclear shape, presence of nucleoli, chromatin characteristics, presence of necrosis, lymphovascular invasion, and perineural invasion. Clinical characteristics such as age, gender, tumour site, size, and clinical presentation were documented. Furthermore, an IHC panel of S100, DOG-1, and mammaglobin was studied, and results were interpreted as positive or negative to support the diagnosis. Follow-up details of the patients concerning local or distal recurrences and terminal events, if any, were updated from the medical records as of December 2021. An analysis of the common histopathological characteristics and immunoprofile in these cases was conducted. Results: A total of 13 cases of secretory carcinoma were identified, with a mean age of 44 years and a male-to-female ratio of 12:1. The parotid gland was the most commonly affected site, observed in eight cases. The most frequent histopathological pattern was papillary cystic, seen in nine cases. The presence of luminal secretion was consistently observed in all thirteen cases. Intracytoplasmic vacuolation was seen in three cases, and hobnailing was present in five cases. The nuclei were round to oval with vesicular chromatin and prominent nucleoli in all 13 cases (100%). Aggressive histopathological features were present in only a few cases, with perineural invasion in one case, lymphovascular invasion in two cases, and necrosis in two cases. High-grade transformation was present in one case. All cases showed positive staining with S100 and negative reaction with the DOG-1 immunomarker. Among the seven cases where mammaglobin was tested, all showed a positive reaction. All patients underwent surgery, with seven cases also requiring radiotherapy. Conclusion: Secretory carcinoma of the salivary gland is relatively rare. Histopathological features are helpful in making a diagnosis. A limited IHC panel comprising S100, DOG-1, and mammaglobin helps in narrowing down the differentials and differentiating it from acinic cell carcinoma, which is the closest differential. The diagnosis of secretory carcinoma has therapeutic implications due to the availability of targeted therapy. Multicentric studies including a greater number of cases can help in better characterising this entity.

Physio Research Summit '25 25th January, 2025

Shubhashish Chatterjee Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X MM(DU) is a premier Indian University with a diverse courses in campus with NAAC Accrediation, UGC category, NIRF ranking, QS World University rankings etc. The MM(DU) provides a comprehensive range of academic programs that equip students with the knowledge and skills necessary to succeed at global level. University’s intellectually stimulating environment, coupled with our globally-focused faculty, creates an ideal setting for personal and professional development.

Effect of Time Under Tension on Strength in Athletes: A Narrative Review

Vikas Kumar, Kanika Bhatia Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X

Correlation between Work Stress and Social Media Addiction in Patients with Depressive Disorder: A Cross-sectional Study

Maria Dominic Raj, Shabeeba Z Kailash, Kailash Suresh Kumar, PR Sobia Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Depression is a leading global health concern, contributing significantly to disability and economic burden worldwide. Work stress and Social Media Addiction (SMA) have been identified as critical factors influencing mental health, often interacting to exacerbate depressive symptoms. However, the combined impact of these variables on patients with depressive disorders remains underexplored. Aim: To study the relationship between work stress and SMA in patients with depressive disorders. Materials and Methods: This cross-sectional study was conducted in the Department of Psychiatry at Chettinad Hospital and Research Institute, Chengalpattu, Tamil Nadu, India, among 96 patients aged 18-64 years diagnosed with depressive disorder according to International Classification of Diseases (ICD)-11 criteria. Participants were assessed using the Hamilton Depression Rating Scale (HDRS) for depression, the Tool for Assessment of Work Stress (TAWS-16) for work stress and the Bergen Social Media Addiction Scale (BSMAS) for SMA. Data were analysed using descriptive statistics, Pearson’s correlation, and multivariate linear regression, with significance set at p-value <0.05. Results: Among the participants, 33 individuals (34.37%) exhibited SMA, while 37 individuals (38.54%) reported mild work stress, 38 individuals (39.58%) reported moderate work stress, and 21 individuals (21.87%) reported severe work stress. Significant positive correlations were observed between HDRS and BSMAS scores (r-value=0.571, p-value <0.001), HDRS and TAWS-16 scores (r-value=0.418, p-value <0.001), and BSMAS and TAWS-16 scores (r-value=0.347, p-value <0.001). However, Chi-square analysis revealed no significant association between SMA and work stress categories (p-value=0.437). Regression analysis identified HDRS scores (p-value <0.001) as the only significant predictor of SMA severity. Conclusion: This study highlights the significant interplay between work stress, SMA and depression severity in patients with depressive disorders. The prevalence of SMA among individuals with depressive disorder was 34.4%. Addressing both occupational stressors and problematic social media use could be pivotal in managing depressive symptoms effectively.

Comparison of Tightrope versus Syndesmotic Screw Fixation for Functional and Radiological Outcomes in Patients with Ankle Syndesmosis Injuries: A Prospective Interventional Study Form Southern India

Arun Karthik Ravichandran, S Devi Prasad, L Sabari Vaasan, Praveen Raja Mathiazhagan, J Kevin Dhas, Madhan Raju, M Mohan, Aravindh Karthik Ravichandran Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Ankle syndesmosis injuries often occur due to high-energy trauma or distal fibular fractures, disrupting the stabilising ligament complex. Conventional screw fixation, while effective, requires implant removal and may be associated with complications. Tightrope fixation offers dynamic stabilisation, allowing early mobilisation with potentially fewer complications Aim: To evaluate and compare clinical and radiological outcomes of Tightrope fixation and syndesmotic screw fixation in patients with ankle syndesmosis injuries. Materials and Methods: The present prospective interventional study conducted in the Department of Orthopaedics at SRM Medical College Hospital and Research Centre, Tamil Nadu, India over a period of 18 months (September 2023 - February 2025). A total of 60 patients with ankle syndesmosis injuries were enrolled and allocated into two groups based on clinical judgment: group A (Tightrope fixation, n=30) and group B (syndesmotic screw fixation, n=30). All patients underwent open reduction and internal fixation of the ankle fracture followed by either Tightrope or syndesmotic screw fixation for stabilization of the syndesmosis, depending on group allocation. Functional outcomes were assessed using the Olerud-Molander Ankle Score (OMAS) and the Foot and Ankle Outcome Score (FAOS). Pain was evaluated using the Visual Analog Scale (VAS). Radiological parameters included tibiofibular clear space, tibiofibular overlap, and medial clear space. Postoperative follow-up was conducted at three weeks, six weeks, three months, and six months, with a total follow-up duration of six months. Complications were also recorded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 29, with a p-value <0.05 considered significant. Results: Mean age of participants in groups A and B were 43.2±18.3 years and 42.8±16.2 years, respectively. Gender distribution was also comparable across both groups (p=0.793). Regarding co-morbidities, Diabetes Mellitus (DM) was present in 8 (13.3%) of participants overall and Hypertension (HTN) was seen in 11 (18.3%), with similar distribution across groups. Smoking habits were nearly evenly distributed, with 40 (66.7%) of participants being non-smokers. OMAS and FAOS scores were significantly higher in the Tightrope group across all follow-up intervals (p<0.001). At six months, the mean VAS score was significantly lower in group A compared to group B (1.6±0.9 vs. 3.3±1.6; p<0.001). Radiological outcomes, including tibiofibular clear space and overlap, also significantly favoured group A (p<0.001). The rate of infection was lower in the Tightrope group (3.3% vs. 20%), and there were no cases of malreduction, compared to 6.7% in the screw fixation group. Conclusion: The present study demonstrates that Tightrope fixation offers superior functional recovery, pain relief, and radiological outcomes compared to syndesmotic screw fixation in ankle syndesmosis injuries treatment. Additionally, it results in fewer postoperative complications, allowing it a more feasible and efficient surgical choice for treating such injuries.

A Cross-sectional Study of Ventilator-associated Pneumonia between Pulmonary and Non pulmonary Indications of Mechanical Ventilation

Manisha Pothireddy, Keertivardhan D Kulkarni, Sanjeevkumar N Bentoor, Sagarika N Suresh, BM Prasanna Kumar, Vijaya M Sorganvi Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Ventilator-associated Pneumonia (VAP) is defined as pneumonia occurring 48-72 hours after the initiation of invasive Mechanical Ventilation (MV). It is diagnosed based on positive endotracheal tube or tracheostomy secretions culture and new or worsening infiltrates on a chest X-ray after 48 hours of MV. The incidence and severity of VAP may differ between pulmonary and non pulmonary groups due to variations in underlying diseases, immune responses, and duration of ventilation. Aim: To compare the incidence and other parameters of VAP between pulmonary and non pulmonary indications of MV. Materials and Methods: This cross-sectional study was conducted from April 2023 to December 2024 on 126 VAP patients who were on mechanical ventilation for different indications in the RICU, MICU, and SICU at BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital, and Research Centre, Vijayapura, Karnataka, India. Primarily, this study included all patients who were on MV due to pulmonary and non pulmonary indications during the study period. Inclusion criteria included patients aged over 18 years, of either sex, and willing to provide informed consent. A total of 254 patients who were on MV for more than 48 hours were screened for VAP based on clinical, microbiological, and radiological criteria for diagnosis. Out of these, 126 patients were diagnosed with VAP, 63 due to pulmonary indications and 63 due to non pulmonary indications. A chest X-ray was done immediately after intubation and repeated after 48 hours of MV for comparison. Endotracheal/tracheostomy tube secretions were sent for culture and sensitivity testing to isolate the organism and determine the resistance pattern. Demographic factors such as age and sex were studied and compared. Predictors of severity, such as the Acute Physiology and Chronic Health Evaluation (APACHE II score) and Sequential Organ Failure Assessment (SOFA) score, were calculated using ROC analysis and compared between pulmonary and non pulmonary indications of MV. Results: The mean age was significantly higher in the pulmonary group (58±16.4 years) compared to the non pulmonary group (49±18.0 years), and both groups showed a male predominance, with 45 (71.4%) in the pulmonary group and 48 (76.2%) in the non pulmonary group. The incidence of VAP in pulmonary indications was 63/134 (47%), whereas for non pulmonary indications, it was 63/120 (52.5%). The most common organisms causing VAP are Acinetobacter baumannii complex, followed by Klebsiella pneumoniae. Overall mortality and improvement are higher in pulmonary cases compared to non pulmonary cases. SOFA and APACHE II scores are strong predictors of mortality. Conclusion: VAP is one of the most common ICU-acquired infections and is associated with increased mortality and morbidity. The data from this study can provide a reference for the management of VAP and the early detection of high-risk patients.

Correlation of Visual Field Parameters with Optic Disc and OCT Findings in Primary Open-angle Glaucoma: A Cross-sectional Study

Sumit Navneet Toshniwal, (Col.) OK Radhakrishnan, Naina Chaturvedi, Swaranjali Shivaji Gore, Ayushi Toshniwal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Primary Open-Angle Glaucoma (POAG) is a chronic, progressive optic neuropathy characterised by optic disc changes and corresponding Visual Field (VF) loss. This study aimed to evaluate the pattern of VF defects and correlate them with optic disc and Optical Coherence Tomography (OCT) parameters in patients diagnosed with POAG. Aim: This study aimed to evaluate the pattern of VF defects and correlate VF parameters with optic disc and OCT parameters in patients diagnosed with POAG. Materials and Methods: The present cross-sectional study included a total of 76 eyes from 38 patients with POAG attending a tertiary healthcare center in Western Maharashtra, India between September 2023 and March 2025. All 38 patients were diagnosed with bilateral POAG, and both eyes met the eligibility criteria of reliable VF and OCT data. Therefore, all 76 eyes included in the study were from bilateral cases. There were no unilateral cases in the final dataset. Complete ophthalmic examination including Goldmann Applanation Tonometry (GAT), fundus evaluation, Humphrey VF testing and spectral-domain OCT {Retinal Nerve Fiber Layer (RNFL) and Ganglion Cell-Inner Plexiform Layer (GCL-IPL)} analysis were performed. VF patterns were classified and correlated with Neuroretinal Rim (NRR) thinning and OCT-based parameters. Results: The most common VF defect was tunnel vision, observed in 21 eyes (27.6%), followed by 18 eyes (23.7%) and with superior paracentral scotomas and 11 eyes (14.5%) with inferior paracentral scotomas. Optic disc analysis showed Neuroretinal Rim (NRR) thinning in all quadrants in 27.6% and inferior quadrant alone in 26.3%. OCT revealed an average RNFL thickness of 61.9 μm and GCL+IPL thickness of 71.9 μm. Significant correlations were observed between VF indices Mean Deviation (MD), Pattern Standard Deviation (PSD), and Visual Field Index (VFI) with both RNFL and GCL+IPL thickness. Additionally, inverse correlations were found between Vertical Cup-Disc Ratio (VCDR) and these OCT and VF parameters. VF loss patterns corresponded topographically to optic disc thinning. Conclusion: Tunnel vision and paracentral scotomas were common in moderate to advanced POAG. Structural changes in RNFL and GCL+IPL showed strong correlation with functional VF defects. OCT-based metrics, particularly GCL+IPL thickness, are valuable tools for assessing glaucomatous progression.

Effect of Lower Limb Strengthening Exercises and Motor Dual Task Training in Elderly People with Impaired Balance: An Experimental Study

Sarulatha Haridass, Manikumar Muthaiah, R Vijayaraghavan, Ramesh Kumar Jeyaraman Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Ageing progressively declines movements and functions, thereby impacting muscle strength, endurance, and power. Impaired mobility and muscle strength gradually lead to loss of balance, instability, and an increased risk of falls. The declines in these physical components must be identified early to prevent and control activity loss. Aim: To compare the efficacy of Progressive Resistance Exercises (PRE) and Motor Dual Task (MDT) on balance, gait, functional performance, self-confidence, and Health Related Quality of Life (HRQOL) in elderly people with impaired balance. Materials and Methods: This experimental study was conducted at selected elderly care homes at Bangalore, from November 2016 to May 2020. A total of 69 elderly individuals aged between 60 and 75 years were recruited according to the inclusion criteria from three residential homes in East Bangalore (Sarjapur), Karnataka. Participants included in the study were cognitively intact with a minimum Performance Oriented Mobility Assessment score (POMA) score of 24 and an Activity Specific Balance Confidence (ABC) scale score of 70% or less. Baseline data on age, sex, Body Mass Index (BMI), number of falls, and presence of physical discomfort were recorded and preserved for data analysis. Pre and post-test measures of balance and lower limb mobility, functional independence, balance confidence, and HRQOL were measured using the POMA, Short Physical Performance Battery (SPPB), ABC scale, and Euro Quality of Life (EQOL), respectively. Participants in all groups underwent eight weeks of supervised exercise training, with each exercise group performing three sessions per week for a total of 24 sessions. Each session consisted of 10 minutes of warm-up exercises, followed by main exercises (MDT training/PRE/conventional exercises) specific to their assigned groups for approximately 40 minutes, and concluded with 10 minutes of cool down exercises similar to the warm-up session. The data were analysed using Systat SigmaPlot software. A probability of 0.05 or less was considered statistically significant. Results: The between-group analysis of the POMA and SPPB was analysed using Kruskal-Wallis one-way analysis of variance, while within-group analysis used the Wilcoxon signed rank test, revealing significance in the conventional, PRE, and MDT groups (p<0.001). ABC and EQOL scores were analysed using 2-way RM ANOVA. The results showed statistically significant differences in the post-test scores of all three groups. Among the three groups, the improvement in balance (50%), functional performance (42.8%), balance confidence (24.8%), and QOL (28%) was highest in the MDT group (n=2). Conclusion: MDT training is more effective than PRE and conventional balance exercises, leading to improvements in balance, walking ability, functional performance, balance-related self-confidence, and HRQOL in elderly participants with impaired balance.

Relationship between Physical Fitness, History of Falls and Depression with Fear of Falls among Institutionalised Elderly Population: A Cross-sectional Study

Sheetal Khanderao Aurangabadkar, Sandip Kumar Parekh Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Institutionalised elderly are more prone to falls and depression due to their functional dependence and social isolation. Physical fitness plays an important role in falls prevention. Fear of Falls (FoF) can be described as an anxiety or a patient’s concern about falling that can lead an individual to avoid activities that they are capable of performing, thus reducing their physical activity and overall fitness. The consequences of FoF include an increased risk of falling, reduced physical activity, decreased social interaction and lower quality of life. FoF is one of the potentially modifiable risk factors where intervention could be effective in preventing falls. Knowledge of and relationships between risk factors and FoF will be useful in developing strategies to reduce FoF and improve the quality of life in the elderly population. Aim: To explore the relationship between physical fitness, history of falls and depression with FoF in the institutionalised elderly population. Materials and Methods: This cross-sectional study was carried out at institutional old-age homes in the Kalyan-Dombivli area, Mumbai, Maharashtra, India. The total duration of the study was four months, from August 2024 to November 2024. After obtaining permission from the old-age homes, participants were approached and screened according to inclusion criteria. The inclusion criteria were institutionalised elderly aged 60-85 years, ambulatory with or without an assistive device, both male and female. Those participants who voluntarily agreed to participate were recruited by convenience sampling. After screening 130 participants according to the inclusion criteria, 124 participants agreed to be part of the study. Demographic data such as age, gender, education, number of years residing in the old-age home, number of co-morbidities, medical and surgical history and medication history were collected. History of falls in the last 12 months was also documented. The outcome measures assessed were the Senior Fitness Test for physical fitness, history of falls, Falls Efficacy Scale-International (FoF) and Geriatric Depression Scale. Spearman correlation was used to assess the relationships between physical fitness, depression and FoF. The Chi-square test (p-value ≤0.05) was used to determine whether there was a significant difference between the history of falls and FoF. Results: The mean age of the participants was 71.4±5.8 years. Of the 124 participants, 64 had a history of falls. Concerns about falls were higher among fallers than among non fallers. The Chi-square test showed no significant difference between these two groups (p-value=0.843). Among physical fitness parameters, there was a negative correlation between the arm curl test (upper limb strength) and FoF in the fallers group. There was a significant positive correlation between the back-scratch test (left side) and FoF score (p-value=0.0156). There was no correlation between lower-limb strength, agility, or aerobic capacity and FoF. There was no significant correlation between depression and FoF among study participants (p-value=0.5879). Conclusion: There was no correlation between physical fitness parameters and history of falls except for upper-limb flexibility and strength. All participants, irrespective of fall history, showed high concerns about falls. Depression in the participants also showed no significant relationship with FoF.

Interleukin-6 as a Diagnostic Salivary Biomarker in Oral Squamous Cell Carcinoma and Oral Potentially Premalignant Disorders: A Cross-sectional Pilot Study

Pranay Pratik Ghosh, Sandhya Biswal, Subrat Kumar Sahu, Bandita Panda, Ranjana Giri Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Worldwide, Oral Squamous Cell Carcinoma (OSCC) is the 6^th major cancer and 2^nd major in India. This high prevalence is linked to carcinogens, particularly smoking tobacco and chewing betel nuts and due to lack of a quick, accurate, and cost-effective screening diagnostic tool. Immunological biomarkers have the potential to identify and offer a prognostic assessment of this condition. Interleukin-6 (IL-6) is a significant salivary marker among the many other inflammatory markers. Aim: To assess the level of IL-6 in OSCC and Oral Premalignant Diseases (OPMD) Materials and Methods: The present cross-sectional pilot study was conducted at Pathology department of Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India for detection of IL-6 level in OSCC and OPMD saliva samples. A total of 30 patients from each group diagnosed with OPMD and OSCC were recruited consecutively over the period of two years (June 2022-May 2024). Demographic features such as age, gender, habit of tobacco chewing and site of lesion on buccal mucosa were recorded. The level of IL-6 was determined from saliva sample in each group and was compared with healthy control by using Enzyme-Linked Immunosorbent Assay. Kruskal Wallis test was applied for comparison between medians of two groups. IBM Statistical Package for Social Sciences (SPSS) version 25 was used for statistical analysis. Results: The clinicodemographic features revealed that tobacco chewing was the most common aetiology in 80% of OSCC diagnosed cases and 90% in OPMD cases. The median and Interquartile Range (IQR) of salivary IL-6 in OSCC was 138.28 pg/mL (IQR 44.21-254.69), OPMD’s 24.81 pg/mL (IQR 13.69-53.38) in comparison to healthy controls, 8.71 pg/mL (IQR 5.10-13.08). Conclusion: The findings of this study demonstrate that salivary IL-6 level is higher in OSCC cases than OPMD cases and both have potential in early diagnosis. Due to wide array of functional characterisation saliva biomarkers, it can be a potential non invasive biomarker to differentiate the OSCC and OPMD cases.

Superior Mesenteric Artery First Approach versus Conventional Pancreaticoduodenectomy in Periampullary Adenocarcinomas: A Single Institutional Observational Study

Dwaipayan Samaddar, Jaya Bagchi Samaddar, Bibaswan Chakrabarty, Gautam Das Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Periampullary malignancies represent a group of malignancies at and around the ampulla of Vater, whose clinical features and management are similar, with Pancreaticoduodenectomy (PD, Whipple procedure) being the standard surgical treatment. Superior Mesenteric Artery (SMA) first approach to PD (smaPD) is a modification of conventional PD (cPD) in which the SMA is assessed early in the surgery. This improves the assessment of intraoperative resectability, reduces bleeding during surgery and enhances the dissection of retroportal tissues, resulting in a greater number of resections with no residual tumour (R0). Aim: To compare smaPD with cPD with respect to clinical, perioperative, histological, oncological and survival outcomes. Materials and Methods: This was a retrospective observational study conducted at the Department of General Surgery at North Bengal Medical College and Hospital, West Bengal, India. A total of 58 patients with periampullary adenocarcinomas who had undergone PD from 1 May 2018 to 30 November 2023 were studied. The retrospective data of 58 matched patients (smaPD vs cPD) with n=29 in each group were retrieved from the records. They were compared with respect to clinical and intraoperative findings, postoperative complications, in-hospital mortality, Overall Survival (OS) and pathology parameters. Continuous data were analysed using Student’s t-test and categorical data using the Chi-square test. OS was plotted using Kaplan-Meier survival curves and compared using the log-rank test. Results were considered statistically significant when p-value <0.05. Statistical software used: GraphPad Prism 10 (San Diego, USA) and Epi Info version 7.4.6 (Atlanta, Georgia, USA). Results: The mean operative time in group A (smaPD) was 391.74±32.15 minutes whereas in group B (cPD) it was 306.55±39.57 minutes (p-value <0.0001). The mean blood loss in group A was 365.52±108.97 mL and in group B 424.14±58.34 mL (p-value=0.0162). R0 resection was higher in smaPD but this was not statistically significant (p-value=0.315). There was not much difference in terms of postoperative complications, length of hospital stay, pathology and OS (p-value=0.4034). Vascular anomalies were observed in four patients in group A. Conclusion: The operative time was significantly longer in group A, but intraoperative blood loss was significantly lower, with more R0 resections. Advanced Multidetector Computed Tomography (MDCT) can accurately predict resectability preoperatively. In a rural setup, pursuing the smaPD technique for intraoperative assessment appears useful.

Correlation between Emotional Labour and Job Satisfaction among Physiotherapists: A Cross-sectional Survey in Multispecialty Hospitals of Delhi NCR, India

Megha Yadav, Vajrala Krishna Reddy, Anamika Pandey Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Healthcare delivery has undergone significant changes, making Emotional Labour (EL) a key factor contributing to worker wellbeing and service quality. Physiotherapists often navigate patients’ pain, fear and expectations during treatment, leading to emotional strain. Aim: To quantify the relationship between EL dimensions (surface acting, deep acting, suppression and emotional consonance) and job satisfaction to guide strategies for improving the workplace experience. Materials and Methods: A cross-sectional design was used to measure the relationships among 400 physiotherapists in direct patient care at public and private multispecialty hospitals in Delhi-NCR, India between January 2023 and January 2024. Data were collected using standardised questionnaires: the Dutch Questionnaire on Emotional Labour (D-QEL), which includes four EL dimensions and the Minnesota Satisfaction Scale, which measures general, intrinsic and extrinsic job satisfaction. Comprehensive statistical analyses determined the strength and direction of these associations. Results: General satisfaction was negatively correlated with surface acting (r-value=-0.917, p-value <0.001), deep acting (r-value=-0.896, p-value <0.001), and suppression (r-value=-0.910, p-value <0.001), whereas emotional consonance showed a positive correlation (r-value=0.870, p-value <0.001). Intrinsic satisfaction, reflecting personal fulfilment, also negatively correlated with surface acting (r-value=-0.935, p-value <0.001), deep acting (r-value=-0.918, p-value <0.001), and suppression (r-value=-0.926, p-value <0.001), but was positively correlated with emotional consonance (r-value=0.879, p-value <0.001). Similarly, extrinsic satisfaction, linked to external job factors, showed strong negative correlations with surface acting (r-value=-0.921, p-value <0.001), deep acting (r-value=-0.903, p-value <0.001), and suppression (r-value=-0.916, p-value <0.001), but a positive correlation with emotional consonance (r-value=0.872, p-value <0.001). Conclusion: Higher emotional consonance significantly improves job satisfaction, whereas surface acting and suppression contribute to dissatisfaction. Training in emotional intelligence can enhance physiotherapists’ wellbeing and overall job satisfaction, ultimately improving healthcare service quality.

Association of Pre Pregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes in Women with Gestational Diabetes: A Retrospective Observational Study

Sailaja Devi Kallur, Anisha Gala Shah, Tarakeswari Surapaneni, Latha Sashi, Ananta Ghimire, Murali Mohan Reddy, Venkat Vardehelli Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: The incidence of obesity and gestational diabetes is increasing globally. Gestational diabetes and obesity are known to be independently associated with adverse perinatal outcomes. Gaining excess weight in pregnancy, especially in obese and overweight women appears to increase the risk of maternal and neonatal complications. Aim: To evaluate the association of maternal Body Mass Index (BMI) and Gestational Weight Gain (GWG) with pregnancy outcomes in women with Gestational Diabetes Mellitus (GDM). Materials and Methods: The present retrospective observational study was conducted at Fernandez Hospital, Hyderabad, Telangana, India from January 2017 to December 2019. Singleton pregnancies with gestational diabetes were included. Those booked after first trimester or with pregestational diabetes or hyperthyroidism were excluded. Based on BMI, participants were categorised into lean (<18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²) and obese (>30 kg/m2) groups. Based on recommended weight gain for each BMI category, Institute of Medicine (IOM) has laid specific ranges. GWG in each group was divided into inadequate, adequate and excessive weight gain as per these recommendations. Maternal and perinatal outcomes were compared between groups. Regression analysis was carried out and adjusted odds ratio, along with their 95% CI was presented. The p-value <0.05 was considered statistically significant. Statistical Package for the Social Sciences (SPSS) version 25 was used for analysis. Results: Total of 2626 pregnant women were included. Obese and overweight population was 575 (21.9%) and 1095 (41.7%), respectively. Based on GWG, 1042 (39.7%) and 633 (24.1%) had inadequate and excessive weight gain respectively in the entire study population. Both obese and overweight groups had higher caesarean section rates compared to the other two groups. As per regression analysis, obese women had significant adjusted odds ratio {2.32 (95% CI 1.6-3.31)} for gestational hypertension and need for Induction of Labour (IOL) {1.48 (95% CI 1.11-1.97)}. Women with inadequate weight gain had less gestational hypertension {0.68 (95% CI 0.49-0.95)}, need for IOL {1.28 (95% CI 1.001-1.64)}, and less chance for large for gestation age babies {0.67 (95% CI 0.51-0.89)} and more preterm deliveries {1.63 (95% CI 1.20-2.20)} as compared to other groups. In excessive weight gain, odds ratio for large for gestation age babies was found to be significant (p-values <0.001), Adjusted OR {(2.01 (95% CI 1.54-2.64)}. Conclusion: Obese women had higher rate of IOL and caesarean section rate, excess GWG group had higher incidence of large for gestation age neonate.

Functional Outcome and Quality of Life after Prosthetic Rehabilitation in Patients with Maxillofacial Defects: A Systematic Review

Srushti Ravindra Ghagas, Saee Deshpande, Neelam Pande Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Maxillofacial prosthetics is a branch of dentistry focused on addressing congenital or acquired defects of the maxillofacial region. These defects may result from trauma, cancer, or other conditions, impacting speech, chewing, facial appearance, and overall quality of life. The field aims to restore both function and aesthetics, improving patients’ well-being. Aim: To evaluate the functional outcome and Quality of Life (QoL) after prosthetic rehabilitation in patients having maxillofacial defects. Materials and Methods: An electronic search was carried out across PubMed and Google Scholar to identify relevant articles published up to November 2023. Based on the framework of Population, Intervention, Control, and Outcomes (PICO), the main research question for this study was, “Does prosthetic rehabilitation improve functional outcome and QoL in patients with maxillofacial defects?” By looking at the titles, abstracts, and full texts of the articles, it was possible to verify their relevance and see if they met the inclusion criteria. This systematic review comprised Randomised Controlled Trials (RCTs), cross-sectional studies, retrospective studies, and prospective studies on patients receiving prosthetic rehabilitation for maxillofacial defects published between 1990 and 2023. Only English-language articles were considered. Studies on congenital maxillofacial defects were excluded. A quality assessment of the listed studies was conducted using the Joanna Briggs Institute (JBI) tool. Results: Out of the 155 results returned by the database search, 128 were removed due to incomplete, inconsistent, or missing information. Three additional papers were removed after evaluating 27 full text papers for eligibility. For that reason, the current systematic review includes a total of 24 papers. Nineteen studies included in this review were on maxillary defects with a total of 798 participants. Three studies addressed mandibular defects with 267 participants, and the remaining two covered facial defects with a total of 93 participants. A quality assessment of studies was done. Meta-analysis was not possible due to diversity of the data. Conclusion: Individuals with maxillofacial abnormalities experience significantly better functional outcomes and a higher QoL after maxillofacial prosthetic rehabilitation. However, using standardised evaluation instruments is crucial to guarantee consistent results and make it easier to compare results across various cases. By doing this, we can keep enhance patient well-being and more accurately assess the long term effects of prosthetic therapies.

Tweets, Tissues and #Trends: Analysis of Pathology Related Tweets on Social Media

Sachin Sadanand Kale, Mayuri Mangrulkar, Rakesh Kumar J Ajmera, Ranjan Agrawal, Meera Mahajan, S Vijay Shankar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: The social media platform X/Twitter is very active, with participants posting and discussing political topics and other issues. Pathologists have also utilised X/Twitter to share interesting cases and discuss various issues about pathology. However, awareness regarding the use of X/Twitter for pathology education was limited. Aim: To collect and analyse eight months of pathology-related posts on Twitter/X. Materials and Methods: This was a retrospective observational study conducted over a duration of eight months, from May 2023 to December 2023, in the Pathology Department of MGM Medical College, Aurangabad, Maharashtra, India. One of the authors, a junior resident in the department of Pathology, manually searched for tweets containing the hashtags #PathTwitter and #PathXterms. Data with full text links were extracted and analysed for the number of cases with images per month. The diagnostic categorisation of cases was done as benign, malignant, or non-neoplastic, and the authors independently validated the diagnoses. An organ-wise analysis of the posted cases was also carried out. The ‘Like’ count and number of ‘Retweets’ for each tweet were noted to ascertain the popularity of the topic and its author. Statistical analysis was performed by collecting the data in Microsoft Excel, and the data was presented in the form of bar diagrams, pie charts, etc. Results: A total of 600 pathology cases were posted on X/Twitter, with an average of 75 cases per month, ranging from a minimum of 38 to a maximum of 136 cases per month. Among these, benign tumours comprised 136 cases, malignant accounted for 277, and non-neoplastic cases numbered 187, as per their given diagnosis. There were 38 haematology-related and six cytology-related non-neoplastic cases. The maximum number of retweets were 398, and the maximum number of likes were 1500, both for a post on eosinophilia. Based on the 'like' count and the number of retweets, the most popular posts were related to haematology, with the most popular author on X/Twitter being Dr Nihar Desai (@nihardesai) in this study. Conclusion: The social media platform X/Twitter features a rich variety of benign and malignant pathology cases from different parts of the world. Reviewing such cases is useful for students and consultants to enhance their pathology knowledge. Twitter/X can provide networking opportunities, enabling the formation of new connections across countries and continents. It can also lead to career enhancement through academic improvement or networking.

Utilisation Pattern of Rh-D Negative Packed Red Blood Cells Inventory at a Tertiary Care Referral Teaching Hospital Blood Centre in Southern India: An Observational Study

Saddala Prashanth, MD Praveen, Bandi Suresh Babu, KV Sreedhar Babu Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Rh-D negative Packed Red Blood Cells ( PRBCs) are used in a variety of situations like emergency transfusions, exchange transfusions, intrauterine transfusions and for neonatal transfusions. The availability of Rh-D negative blood can vary by region and ethnicity and the demand for Rh-D negative blood is high. Aim: The present study aimed to evaluate the utilisation patterns of all Rh-D negative PRBCs as part of inventory management. Materials and Methods: The present cross-sectional observational study was conducted at the Department of Immuno Haematology and Blood Transfusion (IHBT) attached to Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India which is a tertiary care referral teaching hospital in South India. The data has been collected and analysed from July, 2021 to December, 2022. Data of Rh-D negative PRBC units including recipient blood groups, age of the unit at the time of issue, and Quality Control (QC) assessments were reviewed. Data has been analysed using Statistical Package for Social Sciences (SPSS) version 21.0. The Chi-square test of independence was applied for analysing categorical data which isrepresented as percentages. Results: During the study period a total of 15,322 blood units were collected. Among these 972 (6.34%) were Rh-D negative. After excluding 15 units reactive for different Transfusion Transmissible Infectious diseases (TTIs) and 1 under-collection unit, 956 (6.24%) units were included in the analysis. Majority of the PRBCs were O Rh-D negative 453 (47.39%) units. A total of 908 (94.98%) units were issued to Rh-D negative recipients, 33 (3.45%) units to Rh-D positive recipients and 15 (1.57%) units were subjected for QC. Conclusion: Effective inventory management of Rh-D negative PRBCs will ensure their optimal utilisation and will prevent the wastage. The study highlighted the importance of strategic transfusion practices to maintain a balance between availability and demand for this scarce resource.

Expression of CK20 and Ki-67 in Colon Carcinoma and their Association with Various Histopathological Parameters: A Cross-sectional Study

Asmita Mitra, Sarmila Sen, Dipan Mukhopadhyay Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: According to 2022 data, globally colon carcinoma ranks 4th. In India, colon carcinoma ranks 6th in incidence and 7th in mortality. It is the 4th most common cancer in males and 5th in females. Diagnosis of colon carcinoma in recent times has been largely depended on Immunohistochemical (IHC) markers such as Cytokeratin 20 (CK20), CDX2, Ki-67, Cadherin 17, etc., alongside histopathology. Aim: To study the association of histological parameters with IHC expression of Ki-67 and CK20 in predicting the behaviour of colon carcinoma. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology in association with the Department of General Surgery, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India on patients clinically diagnosed with colon cancer who underwent surgery (n=44). Data were collected from October 2022 to March 2024 (17 months) and analysed in April 2024. Microscopic examination was performed using Haematoxylin and Eosin (H&E) to assess histological features such as tumour grading and staging, margin status, Lymphovascular Invasion (LVI) and lymph node metastasis. IHC staining was performed with ready-to-use antibodies against CK20 and Ki-67 and the staining was recorded. For statistical analysis, the Fisher-Freeman-Halton test and Fisher’s exact test were used, with Statistical Package for the Social Sciences (SPSS) version 26.0. Statistical significance was set at p-value <0.05. Results: In this study, there were 44 cases and the ages of the patients ranged from 12 to 89 years. The male-to-female ratio was 1.4:1. 20 (45.5%) of the tumours were moderately-differentiated adenocarcinomas, followed by 13 (29.6%) well-differentiated and 5 (11.4%) poorly differentiated. Cytokeratin 20 (CK20) expression was observed in 35 (79.6%) of cases. Ki-67 expression was categorised as grade 1 (≤25%), grade 2 (26-50%) and grade 3 (≥51%). A statistically significant association was found between CK20 expression and increased tumour differentiation (p-value <0.001), absence of LVI (p-value=0.006) and decreased margin involvement (p-value=0.007). Ki-67 expression showed association with decreased tumour differentiation (p-value <0.001), higher stage (p-value=0.032), increased LVI (p-value <0.001), lymph node metastasis (p-value=0.005) and increased margin involvement (p-value <0.001). CK20 and Ki-67 expression also showed a significant inverse association with each other (p-value <0.001) based on histological differentiation. CK20 expression was gradually lost in higher Ki-67-expressing tumours. Conclusion: The most prevalent colon carcinoma was adenocarcinoma; the majority were moderately-differentiated adenocarcinomas. CK20 expression was higher in well-differentiated tumours and those without LVI, while Ki-67 expression increased with poorer differentiation, higher stage, more LVI and lymph node metastasis. An inverse relationship was observed between CK20 and Ki-67 expression based on histological parameters.

Effects of Balance Training on Chronic Ankle Instability in Athletes: A Systematic Review

Aditya Bhardwaj, Aditi Popli, Lakshay Panchal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X After an initial ankle sprain or injury it is followed by Chronic Ankle Instability (CAI), which is characterised by recurring feeling of the ankle giving away. While performing this study the effects of balance training on athletes' (CAI), two different training programmes were utilised: the Progressive Hop-to-Stabilisation Balance (PHSB) and the classic Single-limb Balance (SLB). Athletes commonly go through injury such as lateral ankle sprain, which can result in CAI, which is characterised by a continuous sensation of the ankle “giving way.” Due to this injury decline in athletes performance can be observed and neuromuscular control in also effected by this condition. We are aiming to find out how the balance training can effect athletes who have CAI. Databases such as Cochrane Library, and PubMed were utilised for this literature review. Articles between December 2004 -2024 were taken.Interestingly, the SLB group showed larger gains in self-reported sports function than the PHSB group, even though both training regimens were beneficial. This implies that dynamic postural control can be enhanced by both strategies, SLB can provide further benefits for particular functional outcomes. However, further research is warranted to explore long-term effects and potential variations in training intensity and frequency. In conclusion, this study contributes valuable insights into rehabilitation strategies for CAI among athletes. By comparing PHSB and SLB programmes it highlights their effectiveness in enhancing balance, stability, and overall athletic performance and reduce and ankle “giving away”. The implications of this research extend to improving recovery outcomes for athletes dealing with chronic ankle instability.

Effectiveness of Myofascial Release for Management of Lateral Epicondylitis: A Systematic Review Protocol

Balpreet Kaur, Kanika Bhatia, Rittu Sharma Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Lateral Epicondylitis (LE) is one of the most prevalent elbow tendinopathies, characterised by pain at the humeral lateral epicondyle when the wrist is dorsiflexed against resistance. Individuals with LE report pain and functional difficulties that impact their everyday activities, particularly those involving wrist and forearm movements. Rest, non-steroidal anti-inflammatory medications, stretching, strengthening, and ultrasound are all conservative treatment options for LE, but Myofascial Release Technique (MFR), a soft tissue mobilisation method, has emerged as a promising intervention for LE management. MFR techniques relieve tension in the forearm muscles and fascia, enhancing blood circulation and diminishing inflammation. This may ease symptoms related to tennis elbow, including pain and restricted motion. However, there are considerable differences in the evidence for MFR’s effectiveness in minimising pain and associated symptoms. This systematic review protocol was created to give a mechanism for conducting research to evaluate the efficiency of the MFR in relieving patient discomfort. A comprehensive search of electronic databases, including PubMed and Scopus will be performed to locate studies published up to the current date. Keywords such as “Myofascial Release”, “Lateral Epicondylitis”, “Tennis Elbow” will be used to construct search queries. Following a thorough examination of the titles and abstracts of these studies, along with removal of any duplicates, Randomised Controlled Trials (RCT) will be referred. Non-RCT studies and non- English papers will be excluded. This review will provide analysis of understanding of Myofascial Release and its positive effect in the treatment of LE. All the RCTs demonstrate that in individuals with LE, myofascial release has an important beneficial impact on reducing pain and impairment as well as pain-related symptoms and hand grip. It improves the quality of life of the patients as their pain levels will significantly decrease while doing daily life activities. Although additional studies are required regarding the duration of the technique to be performed.

Optimising Maternal Health in Third Trimester Pregnancy: Evidence Based Benefits of Pranayama

Kanishka, Neha Kashyap, Shikha Singh Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Third trimester of pregnancy presents with exclusive psychological, physiological challenges, comprising heightened stress, discomfort, increased physical discomfort and preparation of labour. Pranayama being a primordial practice of controlled breathing offers a non-invasive and evidence based method to enrich health by improving oxygen supply, enhancing relaxation, and reducing stress contributing to overall well-being. Pranayam is thought to regulate autonomic nervous system, promoting relaxation, reducing stress levels and also increases O2 delivery. This review aims to find out the role of different pranayams specifically in third pregnancy in optimising overall maternal health. A comprehensive literature search was conducted wherein the articles from 2010 to 2024 were included using the search terms “Optimising Maternal Health”, “Third Trimester Pregnancy” results from various digital databases like PubMed, Google Scholar, Ovid, Web of Science and the Cochrane Library. The search is then further filtered through the inclusion and exclusion criteria. It was found that pranayamas (AnulomVilom (Alternate Nostril Breathing), Bhramari (Bee Breath), Ujjayi (Ocean Breath or Victorious Breath), NadiShodhana (Channel-Cleansing Breath), Dirga Pranayama (Three-Part Breath), Sheetali and Sheetkari (Cooling Breaths) during the third trimester of pregnancy offers a range of benefits for both mother and baby. Additionally, it strengthens lung capacity, refines breathing control, and prepares the body for the physical demands of childbirth. The study concludes that among pregnancy exercises, Pranayama is highly recommended. Pranayama yoga techniques are also believed to increase the chances of a natural and uncomplicated childbirth. Pranayama can be considered a valuable secondary supplementary therapy for enhancing health and well-being due to its affordability, ease of use and minimal risk profile.

Impact of Aquatic Therapy in Improving Balance and Postural Control in Children with Spastic Cerebral Palsy: A Review

Khoolood Intkhab, Manu Goyal, Kanu Goyal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Cerebral palsy, a global movement disorder impacting 18 million individuals, particularly children, is characterised by intellectual impairments, seizures, speech, hearing, vision challenges, and physical contractures. Among therapeutic interventions, aquatic therapy has emerged as a promising approach to enhance physical abilities in children with cerebral palsy. By utilising water’s unique properties, such as buoyancy, resistance, and hydrostatic pressure, aquatic therapy improves joint mobility, range of motion, muscle flexibility, tone management, motor coordination, and balance. This systematic review evaluated the efficacy of aquatic therapy in children with cerebral palsy and identified future research directions. Following PRISMA guidelines for methodological quality, a comprehensive search of databases including PEDro, Cochrane, and PubMed was conducted to analyse studies published between 2015 and 2023. Seven studies met the inclusion criteria, encompassing 298 participants. The interventions ranged from 6 to 12 weeks, with sessions occurring one to three times per week. Outcome measures included the Gross Motor Functional Classification System and the Paediatric Balance Scale. Results demonstrated significant improvements in balance and postural control among participants, particularly those with spastic cerebral palsy. These benefits highlight aquatic therapy's potential as an effective intervention to enhance physical function and quality of life in children with cerebral palsy. By leveraging water-based exercises, this therapeutic approach offers a holistic pathway for improved motor outcomes and greater independence.

Common Musculoskeletal Complaints Arising among Women after Caesarean Section Delivery

Pari Sharma, Jahanvi Dave, Rittu Sharma Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Musculoskeletal complaints are commonly observed in women after cesarean section delivery, primarily due to physiological, hormonal, and biomechanical changes occurring during pregnancy and the postpartum. These issues include low back pain, poor posture, pelvic pain, extremity pain, DeQuervain’s tenosynovitis, abdominal muscle weakness, ligament laxity, and trunk flexor deficits. Hormonal fluctuations during and after pregnancy often lead to excessive joint mobility and postural challenges, while physical demands such as breastfeeding, lifting, carrying the infant, and managing household tasks exacerbate musculoskeletal discomfort. Sleep deprivation and muscle fatigue further complicate recovery during the early postpartum period. According to study findings, 81.2% of women experienced musculoskeletal complaints following cesarean delivery, with low back pain accounting for 75.3% of these complaints. Physiotherapeutic approaches such as manual therapy, electrotherapy and ergonomic advice aims to restore functions and decrease the discomfort. Early and advance physiotherapeutic approaches are essential to treat all these musculoskeletal conditions effectively. A comprehensive review was conducted to evaluate the prevalence and impact of musculoskeletal issues following cesarean delivery, utilising Google Scholar and PubMed as primary databases. Keywords such as cesarean section, postpartum period, muscle fatigue, and musculoskeletal, were employed to construct search queries. The findings underscore the significant impact of these complaints on postpartum recovery and maternal well-being. In conclusion, addressing musculoskeletal issues through early detection, physiotherapy interventions, and patient education is imperative to promote postpartum recovery, enhance functionality, and improve overall quality of life for mothers after cesarean section.

Effectiveness of Spinal Manipulation in Cervicogenic Headache: A Scoping Review

Nitish Kumar, Nidhi Sharma, Preeti Kapri Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Millions of individuals throughout the world suffer from headache, which are common and incapacitating conditions that reduce productivity, cause severe discomfort, and impair quality of life. Although there are other choices for treatment, spinal manipulation has become a viable substitute. By critically assessing the body of research on spinal manipulation's efficacy in treating headache disorders. The aim of the review was to assess the efficacy of spinal manipulation in reducing cervicogenic headache frequency, severity, and duration. A literature search was conducted from PubMed, The Cochrane Library, and Google Scholar database from December 2000 to December 2024. The search utilised terms such as “headache,” “spinal manipulation” and “adult” employing Boolean operators (AND, OR). Articles in which spinal manipulation was treated in this review, non-English articles were excluded. A total of 1943 articles were found from different databases, out of which only six met the inclusion criteria. These studies suggest that spinal manipulation an effective treatment for reducing pain intensity, headache frequency, and headache duration in patients with headaches. The varying outcomes observed may suggest that patients with tension-type headaches, migraines, and cervicogenic headaches may find that spine manipulation is a useful treatment for lowering headache frequency, duration, and pain severity. The quality of the included research varied, and several had methodological problems, despite the encouraging data.

Summarising the Effect of Management Strategies in Pedal Oedema: A Systematic Review

Abhijit Kumar Jha, Nidhi Sharma, Preeti Kapri Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Pedal oedema, sometimes referred to as peripheral oedema, is a common ailment that causes swelling in the tissues of the feet and ankles due to a buildup of extra fluid. Gravitational pressure, lymphatic blockage, cardiovascular illness, and renal failure are some of the causes of this disorder. Untreated pedal oedema can cause pain, discomfort, and reduced mobility, all of which can have a major negative influence on a person's quality of life. Moreover, chronic oedema can lead to infection, delayed wound healing, and skin deterioration, which highlights the significance of timely interventions. Therefore, in order to reduce symptoms, avoid problems, and enhance general health, pedal oedema management is essential. The aim of the review was to determine the most effective management strategies for the pedal oedema in middle-aged office employees. A literature search was conducted from PubMed, The Cochrane Library, and Google Scholar database from December 2000 to December 2024. The search utilised terms such as “Pedal oedema”, “Treatment outcome”, “Peripheral oedema”, “Swelling reduction” and “Quality of life” employing Boolean operators (AND, OR). Articles in which treatment outcome was measured add were included in this summary, non-english articles were excluded. A total of 1236 articles add were found from different database out of which only 6 met the inclusive criteria. The majority of the adults having pedal oedema had shown significant reduction in pedal oedema through Buerger Allen exercise. Also, diuretics showed some effectiveness in case of pedal oedema and intermittent pneumatic pedal compression also helped to reduce signs and symptoms. In addition, kinesiology tape was found to be an effective method for reducing pedal oedema. Overall findings suggest that kinesiology tape was found to be the most effective method for reducing pedal oedema.

Criteria-based Return to Sports Decisionmaking following Lateral Ankle Sprain Injury: A Narrative Review

Aditi Sen, Kanika Bhatia Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X One of the most common musculoskeletal injuries suffered by athletes competing in both recreational and competitive sports is Lateral Ankle Sprain (LAS).After suffering a LAS injury, over half of Add the people choose not to seek official medical attention and many Return To Sports (RTS) before the impairments caused by the injury are healed. The main objective of this review is to identify prospective studies that used a criteria-based RTS decision-making process for patients with LAS injury. For determining full-text publications, PubMed, Cochrane, Google Scholar, and Scopus add databases searched for article published between the 2015 to 2024, an evidence-based review, follow up study and a prospective randomised trial studies in English567 papers that were first discovered were qualified for full textand 319articles were eliminated because they contained duplicates.248 abstract and titles were assessed, out of those167 were removed due to other treatment. In this review entailed 9 published articles. This study found that, if the athlete is cleared too early or skips critical rehabilitation steps, there is a higher risk of re-injury, particularly in cases where joint instability or strength deficits remain unresolved. This may result in chronic ankle instability or long-term functional impairments. In various studies this has been demonstrated that full recovery of athletes across the criteria’,(e.g., strength deficits, balance issues, or psychological concerns)they have safely return to sport following a graded re-entry, starting with non-contact practice and gradually increasing intensity. Further rehabilitation is necessary for the athletes who have not met these criteria should not return to the sports and after full recovery with proper training regimes they can resume the sports. Attention should be given to strengthening, enhancing balance, reestablishing functional movement patterns, and resolving any psychological obstacles.

Effectiveness of Kinesiotaping and Shockwave Therapy in Managing Osgood’s Schlatter Disease: A Literature Review

Garvit Kumar, Rittu Sharma, Swarup Ghosh, Jahanvi Dave, Kanika, Kanika Bhatia Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Osgood-Schlatter disease, characterised by apophysitis of the tibial tubercle, is a prevalent condition affecting physically active adolescents during periods of rapid growth, particularly boys aged 8 to 15 years. This condition is a leading cause of knee pain in this population. It often arises from repetitive sprinting and jumping activities. Physiotherapeutic interventions, including kinesiology taping for pain management, and emerging modalities such as Extracorporeal Shockwave Therapy (ESWT), have demonstrated promising outcomes in the management of this condition.This study aims to evaluate and summarize the existing evidence on the clinical effectiveness of kinesiotaping and shockwave therapy in managing Osgood-Schlatter disease.A comprehensive literature search spanning 2015 to 2024 across electronic databases, including PubMed, Google Scholar, Scopus, and the Cochrane Library, yielded 3,967 articles using the keywords “kinesiotaping,” “extracorporeal shockwave therapy,” and “Osgood-Schlatter disease” with Boolean operators AND and OR. After eliminating duplicates, only five articles were deemed eligible for further analysis.The reviewed literature primarily assessed pain using the Visual Analogue Scale with some studies also examining return-to-sports timelines. Three studies evaluated kinesiotaping as an adjunct to conservative treatments, such as quadriceps stretching and eccentric strengthening, demonstrating statistically significant improvements (p<0.05). Only two studies assessed ESWT, which demonstrated statistically significant changes in pain reduction after the treatment sessions. Preliminary evidence suggests that both kinesiotaping and ESWT may offer pain reduction when integrated into conservative exercise programmes for Osgood-Schlatter disease. However, to draw definitive conclusions, further high-quality randomised controlled trials are necessary. These trials should evaluate the efficacy of these interventions, both as standalone treatments and as adjuncts to conservative management, utilising reliable and standardised outcome measures.

Calcaneal Eversion as a Predictor of Knee Conditions: A Narrative Review

Anjali, Kanika Bhatia, Rittu Sharma Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Calcaneal eversion refers to the outward rotation of the calcaneus away from the midline of the body, which is a critical movement in the biomechanics of the foot and ankle. The significance of calcaneal eversion on the knee is multifaceted, influencing knee alignment, rotational dynamics, and potential injury mechanisms. Understanding calcaneal eversion is essential for assessing its impact on injuries and rehabilitation. To explore the impact of calcaneal eversion on knee injuries, we conducted a literature search in databases such as PubMed and Google Scholar focussing on publications from 2014 to 2024. Search terms included “calcaneal eversion”, “knee injury”, “ankle biomechanics”, “athletes”, “alignment”. This review entailed 9 publications comprising randomised controlled trials, systematic reviews, cross-sectional surveys, observational studies and scoping reviews. This review showed that overweight individuals exhibit greater calcaneal eversion. Also, excessive calcaneal eversion can lead to abnormal tibial rotation, leading to increased risk of knee injuries due to the mechanical coupling at the ankle joint complex. Increased hindfoot and forefoot eversion correlates with medial knee displacement and lead to exacerbation of knee conditions. The review also revealed that calcaneal eversion has a coupling coefficient of 0.68, indicating a significant relationship with tibial movement. Conversely, while calcaneal eversion is linked to knee conditions, some studies suggest that not all individuals with eversion experience knee issues, indicating that other factors, such as muscle strength and overall biomechanics, act as an important marker in knee health. The study concluded that calcaneal eversion plays a crucial role in knee joint mechanics, with its impact evident in various knee pathologies.

Hindi Translation and Validation of the London Chest Activity of Daily Living Scale (LCADL)

Atreyee Sharma, Mousumi Saha, Subhashish Chatterjee Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition leading to airflow limitation, disability, and reduced independence, particularly in older adults. Many severe COPD patients experience breathlessness during daily activities, significantly affecting their ability to perform Activities of Daily Living (ADL). However, tools to assess ADL limitations in advanced COPD are scarce. Existing tools, such as the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) and Nottingham Extended Activities of Daily Living Scale (EADL), are either too lengthy or fail to detect changes after pulmonary rehabilitation. The London Chest Activity of Daily Living (LCADL) Scale, developed by Garrodetal., is a validated tool to assess ADL impairment in COPD, covering personal care, household tasks, physical activities, and leisure activities. However, cultural and linguistic adaptations are necessary for its effective use across diverse populations. This study focusses on translating and validating the LCADL Scale into Hindi for North Indian patients with severe COPD to ensure cultural relevance and clarity for better patient assessment. Aim: To develop and validate a Hindi version of the LCADL Scale, ensuring its cultural and linguistic appropriateness for evaluating activity limitations in North Indian patients with COPD. Materials and Methods: The translation process included forward translation by two bilingual translators—one with a medical background and the other a linguist. The synthesised version was back-translated into English by two independent translators. The final version was reviewed by a panel of cardiothoracic physiotherapists with at least three years of clinical experience. Results: The Hindi version of the LCADL Scale was adapted using standardised cross-cultural guidelines. Content validity was confirmed by experts, ensuring the scale effectively captured dyspnoea’s impact on daily activities and was relevant to the experiences of COPD patients in North India. Conclusion: The Hindi LCADL Scale is a valid, culturally appropriate tool for assessing activity limitations due to dyspnoea in North Indian COPD patients. It can be used in clinical practice and research to improve interventions and quality of life for COPD patients.

Enhancing Physiotherapy Outcomes in Cystic Fibrosis: The Role of Gamification in Rehabilitation

Ashish Kumar, Neha Kashyap, Urvashi Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Cystic fibrosis (CF) being a multifarious genetic disorder is characterised by chronic pulmonary complications and systemic involvement. Physiotherapy has played a key role in managing CF complications on routine basis for chronic patients. Techniques like bronchial toileting, active cycle of breathing technique, spirometry etc are a part of the routine regimens of patients with CF but adherence to same, monotonous, mundane exercises is challenging. Gamification, the application of game design principles in non gaming contexts, has emerged as a promising approach to address this issue by increasing patient engagement and motivation. This review was taken up to find out the effect of gamification in long term illness like CF in improving lung function. An exhausting data search was carried out on various databases like Ovid, Scopus, Pubmed, Cochrane etc to filter out the studies done on CF using gamification as a long term rehabilitation tool. Keywords like cystic fibrosis, virtual reality, rehabilitation were used. Through this review of existing literature and pilot interventions, this research finds crucial parameters determining the success of gamified physiotherapy, including age, disease severity, and technology accessibility. According to preliminary research, gamification greatly increases patient motivation, creates a feeling of accomplishment, and promotes exercise tolerance and pulmonary function when used in physiotherapy regimens. Additionally, the study emphasises how crucial it is for behavioural psychologists, software engineers, and physicians to work together across academic boundaries in order to enhance gamified designs for this particular patient population.

Effect of Phytonutrients for Sports Performance Enhancement: A Narrative Review

Arshad Iqbal, Probhjot Singh Nalwa Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X The potential for phytonutrients, which are naturally occurring substances found in plants, to improve athletic performance has attracted a lot of interest. The impact of several phytonutrients, including glucosinolates, flavonoids, carotenoids, and polyphenols, on sports performance and recuperation is examined in this review. Phytonutrients may lessen oxidative stress brought on by exercise, lessen muscle damage, and speed up recovery because of evidence that they have anti-inflammatory, immune-boosting, and antioxidant qualities. Certain phytonutrients may also strengthen muscles, boost endurance, and promote cardiovascular health. Although the precise processes are still being studied, the available data suggests that including foods high in phytonutrients in an athlete's diet may help maximise performance. Nevertheless, additional clinical research is required to completely comprehend the ideal doses, bioavailability, and long-term impacts of these substances in sports nutrition. The aim of this study was to investigate how phytonutrients affect athletic performance, with an emphasis on how they improve strength, endurance, and recuperation as well as how they can reduce inflammation and oxidative stress brought on by exercise. Online databases like PubMed, Google Scholar and Cochrane were searched for articles published between 2015 to 2023. A meta-analysis and systematic review of recent experimental and clinical trials were carried out. The results showed that giving athletes supplements containing phytonutrient-rich extracts, such add as curcumin, beetroot juice, and green tea catechins, greatly increased their endurance and reduced signs of inflammation and muscle damage. These substances have also been shown to promote quicker recovery and less fatigue, especially after prolonged and high-intensity activity. In conclusion, phytonutrients have the potential to be a safe, all-natural way to improve athletic performance and recovery. Athletes looking for alternatives to synthetic supplements can benefit from their various physiological impacts. To comprehend individual variations in response, adjust dosage, and ascertain long-term safety, more research is necessary. These results point to the increasing potential of phytonutrients in sports nutrition, opening the door to fresh approaches to optimise athletic performance.

Effectiveness of Transcranial Direct Current Stimulation along with Body Weight Supported Overground Gait Training on Central Pattern Generator of Locomotion in Individual with Incomplete Spinal Cord Injury: A Case Report

Bhavya Kapoor, Narkeesh Arumugam, Sharanjeet Kaur Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X

Effect of Pilates in Breast Cancer Patients Undergoing Hormonal Therapy: A Systematic Review of RCTs

Jasleen Kaur Grover, Sandeep Pattnaik, Nitin Bhardwaj, Akshat Sehgal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Breast cancer is a prevalent form of cancer that primarily originates in breast tissue, affecting women predominantly. It is characterized by the uncontrolled growth of cells, which may metastasize to other body parts if untreated. Hormonal therapy is a crucial treatment, by blocking or reducing the production of hormones like estrogen and progesterone, It prevents cancer cells from growing and spreading. Post-treatment complications following hormonal therapy can significantly impact a patient's quality of life and overall well-being. Pilates focuses on physical fitness including core strength, flexibility, posture, muscle tone, balance, and mental well-being. It emphasizes on strength, flexibility, and mind-body integration, and presents a promising intervention to address these challenges. Database including PubMed, Cochrane Library, PEDro, and Google Scholar using keywords related to “plantar fasciitis,”“Breast Cancer”, “Hormonal therapy” and “Pilates” from 2018 till date.Included RCTs involved adults (11-80 years) with breast cancer stage 0-III breast cancer undergoing hormonal therapy. excluding those with active cancer or limitations that could hinder physical activity.The outcomes considered in the study were related to the Quality of life, Physical fitness, Self-esteem, Depression, Pain, Disability, and Balance of the women having breast cancer. Data from all databases 2852 initially searched articles including 963 duplicates, only 79 were screened based on titles and abstracts. Amongst them based on the area of interest, few articles were excluded as 71 were irrelevant to breast cancer or Pilates or didn’t include hormonal therapy as a treatment option,1 was a pilot study and 2 were just the abstract. Therefore, upon scrutiny only 5 articles are included in this systematic review Following PRISMA guidelines, study quality was evaluated using CONSORT, PEDro, and ROB 2. PROSPERO registration was done with ID CRD42024568245.As a result,Pilates was found to have positive effects on physical function, mental health, and symptom management in breast cancer patients undergoing hormonal therapy. However, the studies varied regarding Pilates programmes design and sample size. Pilates may be a beneficial intervention for breast cancer patients undergoing hormonal therapy. Further research is needed to confirm the long-term benefits and develop evidence-based implementation guidelines.

The Impact of Workplace Ergonomics on Musculoskeletal Disorders in Office Workers: A Literature Review

Jaspreet Kaur, Supreet Bindra Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Occupational health and safety are critical factors for ensuring long-term organisational success and employee well-being. As workplaces increasingly prioritise productivity, quality, and efficiency, it becomes essential to focus on creating environments conducive to physical and psychological health. Adverse working conditions, such as inadequate lighting, extreme work environments, or prolonged static postures – can result in reduced motivation, impaired performance, and musculoskeletal disorders. By addressing these challenges, organizations can foster healthier and more efficient workforces, ensuring sustained productivity and employee satisfaction. This study aims to evaluate the impact of workplace ergonomic advices based on musculoskeletal disorders among office workers. A computer search of peer reviewed articles from database such as PubMed (National Library of Medicine), Google scholar Medline, Research Gate, add and Science Direct, was conducted focussing on studies published from 2011 to 2024.The findings demonstrate that ergonomic solutions, such as adjustable furniture, properly aligned equipment, and workplace designs that encourage movement, play a critical role in reducing physical strain and promoting proper posture. Additionally, practices like regular breaks and stretching exercises further reduce fatigue and prevent injury. The review highlights that implementing effective ergonomic strategies enhances workplace safety, minimises the risk of MSDs, and supports sustained productivity and employee well-being. These insights underscore the importance of prioritising workplace ergonomics in organisational health and safety policies.

Recent Advancement of 3d-motion Analysis in Sports Rehabilitation: A Narrative Review

Aashu, Bhawna Vats Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X In sports rehabilitation, 3D motion analysis involves tracking and analysing an athlete’s movement in three dimensions using cutting-edge technology, such as wearable sensors, motion capture structures, and biomechanical modelling. The aim of this review is to quantify the effective use of motion capture and 3D modelling technology to facilitate sports training. Sports rehabilitation has been modified by recent advances in 3D motion analysis, which provide comprehensive view of athletic movement patterns. Therapists may create specialised rehabilitation plans with this technology, which speeds up recovery and decreases the chance of injuries. In the clinic, the Inertial Measurement Unit (IMU) sensors are used together with tests and outcome measurements. The most widely used techniques include smartphones with standard optical cameras and IMUs. Artifical Intelligence (AI) recently emerged as one of the most researched areas of motion analysis technologies in health. It is evident that AI has several types of benefits, such as reductions in time and money and the ability for better patient care, as Machine Learning (ML) reduces illnesses, decision-making, and analysis. ML has been shown to be more effective in medical imaging, wearable technologies, risk prediction, pain phenotype prediction, and decision support when it involves sports injuries and conditions. In sports biomechanics and rehabilitation, the marker-less motion analysis system gives a fast, entirely automatic, and noninvasive technique that can significantly improve research and application From December 2020 to December 2025, a literature search was done using the PubMed, Scopus, and Embase databases. Boolean operators (AND, OR) were used in the search, which included terms like “3D motion," "wearable motion" and "biofeedback." Articles in which recent advancement in 3D motion analysis was discussed or used were included in this review. Non-English and non peer reviewed articles were excluded. 2367 articles found from different database, out of which only five met the inclusion criteria. A comprehensive study proved that motion capture and 3D modelling technologies had a beneficial impact on sports training. According to our findings, the motion recognition methodology of the suggested system can be utilised to monitor the patient's rehabilitation progress and confirm that the physiotherapy exercises are of high quality.

To Examine The Effect of Physiotherapy Intervention in Pelvic Floor Weakness in Women with Post-Ovarian Cystectomy: A Study Protocol

Himanshi Arora, Jatin Sangwan, Urvashi Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X

Clinical and Functional Outcome of Infected Non Union of the Femur Managed with Monolateral External Fixator: A Prospective Interventional Study

Ishan Rajendra Shevate, Selvi Ashishkumar Khajanchi, Rahul Salunkhe Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: The treatment of infected non unions of long bones is one of the most challenging tasks in modern orthopaedic trauma practice. With the increasing prevalence of Road Traffic Accidents (RTAs) and associated high-energy trauma, primary fractures are often presented with gross contamination, soft-tissue degloving, bone loss and vascular compromise. Infected non unions of the femur are managed through debridement, external fixation, bone grafting, microvascular composite tissue transfer, bone transport via an external fixator over a nail and Ilizarov circular or monolateral fixators. Aim: To evaluate the clinical and functional outcomes in infected non unions of the femur treated with a monolateral external fixator. Materials and Methods: This study was a prospective interventional study that included 17 males and one female patient, with a mean age of 35 years, who were treated at Dr. DY Patil Tertiary Care Hospital in Pune city, Maharashtra, India with a monolateral external fixator between January 2021 and January 2024. All patients had high-energy RTAs, compound fractures and gross contamination initially. Implant removal was performed, followed by radical debridement and stabilisation with the rail fixator. The mean duration of non union was 13 months (range: 4-24 months). The mean number of previous surgical procedures was 3.4 (range: 1-4). Corticotomy and bone transport were performed in six patients who had shortening or bone loss of more than 2 cm. Distraction of the corticotomy was initiated one week later at a rate of 1 mm per day until lengthening was achieved. Monthly outpatient department follow-ups, with X-rays, were conducted and the fixator was maintained until the healing of three cortices and eradication of infection were confirmed. The average follow-up duration was 2.3 years (range: 1-4 years). A paired t-test was used for statistical analysis during follow-up. Results: Union was achieved in 17 out of 18 patients, resulting in a union rate of 94.4%. The mean time to bony union was 7±2 months (range: 4-12 months). Infection was eradicated in all but one patient, who continued to experience a discharging sinus. The mean length achieved in the corticotomy and lengthening group was 4±0.75 cm. According to Paley’s bone and functional outcome scoring, all but one patient had excellent to good results at the one-year follow-up. Significant improvement was observed in the Lower Extremity Functional Score (LEFS) and in the Physical Component Score (PCS) of the 36-Item Short Form Health Survey questionnaire (SF-36) at the one-year follow-up (p-value <0.05); however, there was no improvement in the Mental Component Score (MCS) of the SF-36. Conclusion: A monolateral external fixator can provide stable fixation for the management of infected non unions of the femur and is an effective method for eradicating infection.

Assessment of Pressure Support Ventilation versus T-Piece Ventilation in Spontaneous Breathing Trials for Successful Extubation in Mechanically Ventilated Patients: A Open-labelled Block Randomised Controlled Trial

O Johnson, Vikas Raj, Ali Hasan Faiz Karnam, Sivakumar Segaran, Nayyar Iqbal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Spontaneous Breathing Trials (SBTs) are vital in determining readiness for extubation in patients undergoing mechanical ventilation. Pressure Support Ventilation (PSV) and T-piece ventilation are two commonly used methods for conducting SBTs. Aim: To compare the rates of weaning failure, extubation failure, reintubation, and 28-day mortality between patients undergoing SBT using PSV and those using T-piece ventilation. Materials and Methods: A randomised controlled trial with an open-label design was conducted at the Department of General Medicine, PIMS, Pondicherry, Tamil Nadu, india, from from 11 Nov 2019 to 20 Oct 2021. A total of 160 patients requiring mechanical ventilation were randomly allocated into two groups using block randomisation. One group underwent SBT with PSV, while the other group used T-piece ventilation. Ethical approval was obtained, and informed consent was secured from all participants. Primary outcome measures included rates of weaning failure, extubation failure, reintubation, and 28-day mortality. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 26, with a p-value below 0.05 considered statistically significant. Results: The study included 64 patients, predominantly male (79.69%) and aged 51-60 years (23.4%), with 45.31% reporting smoking habits and 42.18% consuming alcohol. The mean systolic blood pressure was 130.94±20.69 mmHg, the mean diastolic blood pressure was 80.00±12.55 mmHg, and the mean pulse rate was 99.41±20.78 beats/min. The mean APACHE II score was 16.29±7.85. The weaning failure rate was 42.9% in the PSV group and 57.1% in the T-piece group, a difference that was not statistically significant (p=0.38). Extubation failure was observed in 14.07% of patients, with no significant difference between groups (p=0.24). Similarly, the reintubation rates (p=0.098) and 28-day mortality rates (p=1.000) were comparable. Conclusion: Both PSV and T-piece ventilation were equally effective for SBTs, with no significant differences in weaning failure, extubation failure, reintubation, or 28-day mortality. The findings suggest that either approach can be utilised effectively based on patient-specific considerations.

Different Positioning Practices in Neonatal Intensive Care Unit and their Effects on Neuromotor Development of Preterm Neonates: A Systematic Review

Dhwani Chanpura, Neha Mukkamala, Nalina Gupta Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Advances in neonatal intensive care have markedly improved the survival of preterm infants. However, without appropriate interventions, many preterm infants face long-term disabilities. Preterm infants often adopt postures that differ from those they would typically develop in utero. Therapeutic positioning is among the earliest neurodevelopmental interventions implemented in the Neonatal Intensive Care Unit (NICU). The primary goals of positioning are to provide support, facilitate movement and optimise neurodevelopment. Aim: To examine various positioning practices and their effects on neuromotor development in preterm infants admitted to the NICU. Materials and Methods: A literature search of PubMed, MEDLINE, CINAHL, DARE, ScienceDirect and Embase was conducted covering from January 2000 to June 2024, focusing on studies that examined different positioning techniques and their effects on posture and neuromotor development. Articles were screened against predefined inclusion and exclusion criteria. Eligible studies were identified and the methodological quality of the included studies was assessed. A qualitative synthesis of the findings was performed. Results: Eleven studies were included in this review. The included studies employed various postural strategies, such as different types of nests, mattresses and postural support devices (rolls or diapers) and assessed their effects on posture and neuromotor development. Conclusion: Positioning strategies for preterm infants are diverse. By adopting specific positions or using particular equipment, NICU care can address some of the unique needs of preterm infants during their stay. Positioning in certain positions may be associated with pain relief, improved flexion posture, enhanced neuromotor development and shorter lengths of hospital stay.

Frequency of spaP Genetic Determinants in Streptococcus mutans Isolated from Patients with Oral Premalignant Disorders: A Cross-sectional Study

K Preethi, AS Smiline Girija, J Vijayashree Priyadharsini, Kannika Parameshwari Kannan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: The surface-associated Protein (spaP) of Streptococcus mutans is crucial for its virulence, aiding in adherence and biofilm formation. This study explores the prevalence of the spaP gene in clinical strains of S. mutans to understand its potential role in the progression of Oral Premalignant Disorders (OPMD). Aim: To phenotypically characterise S. mutans from clinical samples of patients with OPMD and to assess the frequency of spaP genes in clinical strains of S. mutans. Materials and Methods: This cross-sectional study was conducted at the Department of Microbiology, Saveetha Dental College and Hospitals, Chennai, India, from January 2023 to April 2023. A total of 60 saliva samples were randomly collected from three groups: Group 1 (OPMD, n=20), Group 2 (healthy individuals with dental caries, n=20), and Group 3 (healthy individuals without caries, n=20). The primary inclusion criteria were participants within these three groups, with exclusions for those with systemic diseases, ongoing infections, or recent antibiotic/antifungal use (within the last three months). Saliva samples were cultured on Mutans Sanguis Agar (MSA), and colonies were characterised through Gram staining and catalase testing. Genomic Deoxyribonucleic Acid (DNA) was extracted, and Polymerase Chain Reaction (PCR) was performed to detect the spaP gene. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) v25.0, with significance considered at p<0.05. Demographic parameters such as age, sex, and clinical status were analysed. Results: The prevalence of S. mutans was found to be 45% (n=9) in OPMD patients, 40% (n=8) in healthy individuals with caries, and 15% (n=3) in healthy individuals without caries. The frequency of the spaP gene was found to be 88% (n=8) in OPMD patients and 75% (n=6) in healthy individuals with caries. Conclusion: The comparative evaluation of the prevalence of S. mutans and the frequency of the spaP gene among the strains suggests a significant role of the spaP gene in association with both caries and OPMD conditions.

Association of Premenstrual Dysphoric Disorder with Depression and Anxiety in Women of Reproductive Age Group: A Cross-sectional Study

Manisha Upadhyay, Saurav Kumar, Meenu Saini, Priya Kumari Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Premenstrual Dysphoric Disorder (PMDD) is a mood disorder affecting women during the luteal phase of the menstrual cycle. Its association with depression and anxiety has been documented. Despite of its significant impact on women’s quality of life, physical and mental health, PMDD remains under evaluated and under researched in the Indian population. Aim: To evaluate the association of PMDD with depression and anxiety. Materials and Methods: The present cross-sectional study was conducted from August 2024 to January 2025 among 100 women aged 15-49 years presenting to Outpatient Department of Gynaecology in GS Medical College, Hapur, Uttar Pradesh, India with PMDD like symptoms. The Premenstrual Symptom Screening Tool (PSST) was applied to all these women and PSST score was calculated some other variables like age, education, occupation, length of menstrual cycle, duration and amount of menstrual flow was also recorded. All 100 patients diagnosed with PMDD and those who were having mild premenstrual symptoms were further screened and scored for anxiety and depression by using Beck’s Anxiety Inventory (BAI) and Beck’s Depression Inventory (BDI) scale. Association of PMDD with severity of anxiety and depression was analysed using Chi-square test. The difference in PSST score among various categorical groups like education, occupation, marital status and amount of menstrual flow was analysed using F-test of Analysis of Variance (ANOVA). Regression analysis was run to identify the significant predictors of PMDD. Results: Out of 100, 65 women were diagnosed to have PMDD using PSST and 35 women had mild Premenstrual Syndrome (PMS). Significant differences in PSST Score were observed among groups categorised by education (p=0.01) and menstrual flow (p=0.006) implying that these factors influence PSST scores. Duration of menstrual flow found to be a significant predictor of PSST Score (p=0.04). The results showed a significant association between PSST score and both depression (χ2=84.22, p<0.001) and anxiety (χ2=64.84, p<0.001). Most women with PMDD experienced severe depression and moderate-to-high anxiety levels. Conclusion: PMDD was significantly associated with increased severity of depression and anxiety. Low education levels and heavier or prolonged menstrual bleeding were the contributing factors.

Functional Outcome of High Energy Schatzker Type V and VI Tibial Plateau Fractures Treated with Hybrid External Fixator: A Prospective Interventional Study

Akshat Mittal, Aditya Kumar Singh, Manvendra Singh Rawat, Chandra Shekhar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: High-energy Schatzker type V and VI tibial plateau fractures are severely injured intra-articular fractures commonly accompanied by serious soft-tissue injury and instability. Conventional internal fixation may be problematic because of the serious risk of infection and soft-tissue complications. Hybrid external fixators provide a less invasive option, hoping to stabilise the fracture without compromising soft-tissue integrity and facilitating functional recovery. Aim: To evaluate the functional results of hybrid external fixation of bicondylar tibial plateau fractures. Materials and Methods: The present prospective interventional study was conducted at Government Doon Medical College, Dehradun, Uttarakhand, India over a period of 12 months from September 2021 to August 2023, focusing on high-energy Schatzker type V and VI tibial plateau fractures. A total of 41 patients were treated using a hybrid external fixator; however, three patients were lost to follow-up. Two-plane radiographs were taken in all the cases, and radiographs taken immediately after surgery were assessed to check the quality of fixation and reduction. All the patients were checked at six weeks, six months, and twelve months, and functional results were scored by the Modified Hospital for Special Surgery (MHSS) knee scoring system. Removal of the fixator was done at a mean of 2.5±0.5 months from the time of surgery. Data were analysed via statistical tests used Chi-square test or Analysis of Variance (ANOVA), with significance at p<0.05. Results: Thirty-eight patients (31 men, 7 women) who had follow-up were included in the study. There were 13 Schatzker V fractures and 25 Schatzker VI fractures. All patients exhibited good coronal and sagittal plane alignment and preserved articular width on supine X-rays of the knee in Anteroposterior (AP) and lateral views. Good to excellent results were achieved in 36 (94.73%) patients based on the MHSS knee score. The average range of knee flexion was 115.79±21.29 degrees, and the average MHSS score was 80.34±10.30 at final follow-up. 2 (5.26%) patients got superficial infections after external fixation whereas 1 (2.63%) patients had nonunion, and another (2.63%) developed varus deformity. A total of 36 (94.74%) patients went back to their previous level of work and activity. No cases of deep infection were observed. Conclusion: Hybrid external fixator in Bicondylar tibial plateau fractures gives a favourable functional outcome as it provides rigid fixation and allows immediate knee mobilisation.

Salivary Metallothionein Level in Type 2 Diabetes Mellitus Patients with and without Chronic Periodontitis: A Cross-sectional Study

EN Keerthi, Supraja Ajitkumar, Muthukumar Santhanakrishnan, Sathya Selvarajan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Metallothionein (MT) is a cysteine-rich protein involved in cellular defence mechanisms, including the regulation of oxidative stress and immune responses. Oxidative stress is a common link between Diabetes Mellitus (DM) and periodontitis, two chronic inflammatory conditions with a bidirectional relationship. Although MT has been widely studied in diabetes, its role in periodontal disease and the combined impact of both conditions on MT expression remain unclear. Aim: To evaluate the levels of MT in the saliva of diabetic patients with and without periodontitis. Materials and Methods: The present cross-sectional study was conducted at Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu India, over two months (February to March 2021), involving 76 participants divided equally into four groups (n=19): healthy controls, Chronic Periodontitis (CP), Type 2 Diabetes Mellitus (T2DM), and T2DM with periodontitis (T2DM+CP). Clinical periodontal parameters-gingival bleeding index, Plaque Index (PI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Periodontal Inflamed Surface Area (PISA)-were recorded. Salivary metallothionein levels were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Data were analysed using Statistical Package for Social Sciences (SPSS) software with the Shapiro-Wilk test, one-way Analysis of Variance, Dunn’s post-hoc test, and Spearman’s correlation (p<0.05). Results: The T2DM+CP group showed significantly higher periodontal parameters and glycaemic levels compared to the other groups (p<0.05). Salivary MT levels were also highest in this group and were statistically significant, with a p-value of <0.05 when compared to the other groups. A positive correlation was observed between MT and glycaemic levels, and a moderately positive correlation (r-value of 0.507) was noted between MT levels in patients with T2DM and periodontitis. Conclusion: Elevated salivary MT levels in diabetic patients with periodontitis suggest a potential role as a biomarker of oxidative stress and disease activity. Further longitudinal and interventional studies are needed to validate MT as a diagnostic and prognostic marker.

Diastolic Dysfunction in Patients with Hypertension Assessed by 2D Echo and Doppler Imaging and its Association with Clinical Profile and ECG Findings: A Cross-sectional Study

Vikram Vikhe, Diksha Sabharwal, Asmita Samal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Hypertension is a major risk factor for cardiovascular diseases and is strongly associated with Diastolic Dysfunction (DD), which can lead to Heart Failure with preserved Ejection Fraction (HFpEF). Despite its clinical significance, DD often remains underdiagnosed, necessitating routine echocardiographic screening for early detection. Aim: To evaluate the prevalence of DD in hypertensive patients using 2 Dimensional (2D) echocardiography and doppler imaging, along with its association with clinical characteristics and Electrocardiogram (ECG) findings. Materials and Methods: The present cross-sectional analytical study was conducted at Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India from February 2023 to September 2025. A total of 100 hypertensive patients were recruited using a purposive sampling method. Each participant underwent clinical assessment, Blood Pressure (BP) measurement, ECG, and (2D echo and doppler imaging). The prevalence and severity of DD were analysed, and its associations with age, duration of hypertension, severity of hypertension, and ECG findings were evaluated. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20, with a p-value <0.05 considered significant. Results: DD was detected in 46% of hypertensive patients, with 19% having grade 1 DD, 11% grade 2, and 16% grade 3. The prevalence of DD increased with age, from 25% in patients below 40 years to 62.5% in those aged 71-80 years. A significant association was found between hypertension duration and DD (p=0.023*), with 26.1% of patients with 1-5 years of hypertension exhibiting DD, increasing to 66.7% in those with more than 15 years. Among patients with grade 3 hypertension, 75% had DD confirming that worsening hypertension increases DD risk. On ECG analysis, 17% of patients had Left Ventricular Hypertrophy (LVH), and 70.6% of them had DD (p=0.026*), indicating a strong association between LVH and DD. Echocardiographic findings showed 46% had impaired LV relaxation, and 27% had elevated Left Atrial Pressure (LAP). Comparative analysis revealed that patients with DD had significantly higher mean age, longer hypertension duration, and higher Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (p <0.05), whereas Body Mass Index (BMI), Blood Sugar Levels (BSL), and lipid profiles did not show significant differences. Conclusion: The study found that DD is prevalent in nearly half of hypertensive patients, with its prevalence increasing with age, hypertension severity, and duration. Significant associations were observed between LVH on ECG and echocardiographic evidence of DD, reinforcing the need for early screening and stringent BP control to prevent progression to heart failure. Routine echocardiographic assessment of hypertensive patients should be emphasised to detect and manage DD at an early stage.

Management and Outcomes in Head and Neck Cancer Patients with Malignancy Related Hypercalcaemia, an Oncological Emergency: A Cohort Study from a Tertiary Care Hospital in Tamil Nadu

P Jerome Sunny, Gautam Srinivas Waran, Rajendra Benny Kuchipudi, Swathi Bapani, Manu Mathew, C Praveenraj, Nitin Kapoor, Rajesh Isiah Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Malignancy-Related Hypercalcaemia (MRH) is a paraneoplastic syndrome often associated with various malignancies but has limited evidence available Head and Neck Cancers (HNC). Head and neck squamous cell carcinomas with MRH is rare but it has a unique propensity to induce hypercalcaemia, even in the absence of bone metastases. Despite its clinical significance, hypercalcaemia in this patient population is frequently missed, as its symptoms are often attributed to the underlying malignancy or its treatment. Aim: The present study aimed to analyse data on patterns of care, define the clinical profile of hypercalcaemia in HNC patients, evaluate treatment strategies employed during hospitalisation, and assess survival outcomes. Materials and Methods: The present cohort study was done and analysis was conducted on HNC patients hospitalised at Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India between January 2014 to July 2024 with symptomatic hypercalcaemia (serum total calcium >10.5 mg/dL) based on inpatient medical records. Data were extracted for the clinical profile, patterns of management and survival follow-up was from electronic medical records and telephonic follow-ups. Based on the serum total calcium levels, hypercalcaemia was categorised as mild, moderate and severe for the ranges, 10.5-11.9 mg/dL, 12-13.9 mg/dL; and more than 14 mg/dL, respectively. Descriptive statistics were used for categorical and continuous variables. Survival was analysed using Kaplan-Meier estimates using stata version 16.1 and python version 3.9.21. Results: Total of 19 patients was included in the study. The cohort was predominantly men 17 (89.47%), with median age of 51 years. 17 (89.47%) of patients had oral cavity cancers as the primary site of malignancy, with 9 (52.94%) originating from the tongue and 8 (47.05%) buccal mucosa. Most common presenting symptom was bone pain 13 (68.42%). Hypercalcaemia management included 14 (73.68%) of patients receiving a combination of hydration and bisphosphonates like zoledronic acid, 5 (26.31%) received hydration alone and 2 (10.52%) hydration and bisphosphonates patients were administered calcitonin also. Of the 19 patients, four were lost to follow-up, Overall mortality rate in the followed up patients (n=15) was 100%, with 8 (53.3%) of deaths occurring during the hospitalisation within seven days. Median survival was seven days and 11 (73.3%) of patients succumbed within 30 days of hypercalcaemia diagnosis. Conclusion: MRH remains a significant marker of poor prognosis. HNC patients who present with symptoms such as fatigue, lethargy, bone pain, or altered mental status should be evaluated for hypercalcaemia. Despite aggressive management, survival remains limited, emphasising the need for improved preventive and therapeutic strategies in future and necessity of early integration of palliative care team and psychological support in these patients.

A Longitudinal Study on Antimicrobial Resistance Dynamics in Pseudomonas aeruginosa at a Government Superspeciality Hospital

Harika Kanugula, Swathi Suravaram Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Pseudomonas aeruginosa, primarily an opportunistic hospital pathogen, has now become an increasing cause of infections in the community as well. It significantly contributes to the rising burden of Antimicrobial Resistance (AMR), making treatment challenging. In high-risk settings such as superspeciality hospitals, the impact of AMR is magnified, necessitating continuous surveillance of susceptibility patterns to guide empirical therapy and escalation/de-escalation strategies for definitive treatment as part of antimicrobial stewardship. Aim: To analyse the Antimicrobial Susceptibility Testing (AST) patterns of Pseudomonas aeruginosa isolates at a government superspeciality hospital. Materials and Methods: This longitudinal study analysed data from three years (January 2021 - January 2024) at the 250-bedded ESIC super-speciality government teaching hospital, Hyderabad , Telangana, India. Adhering to Clinical and Laboratory Standards Institute (CLSI) M-100 guidelines, samples were collected and processed on clinical requests; those showing growth were analysed using an automated identification and AST analyser. Among all the samples received in the microbiology laboratory, 517 samples with growth of Pseudomonas aeruginosa were included. Colistin resistance was confirmed using Colistin Broth Disc Elution (CBDE) and compared with automated analyser results to assess the difference between both methods. Suitable antibiotics with potential for treatment were evaluated based on CLSI M39 guidelines. Demographic parameters such as age groups (paediatric and adult), gender distribution and sample types (urine, blood, respiratory specimens and exudates) were considered to evaluate resistance patterns. Descriptive statistics were used and presented in terms of percentages. Results: In the current study, among the 517 isolates of Pseudomonas aeruginosa, 440 (85%) were from adults and 77 (15%) from paediatric population. Pseudomonas aeruginosa showed varying susceptibility rates to different antibiotics, ranging from 193 (43.8%) to 276 (62.7%) in adults and 32 (41.5%) to 38 (49.3%) in paediatric population. Multidrug Resistant (MDR) isolates totalled 170 (32.8%), with 123 (43.2%), 6 (12.5%), 20 (22.1%) and 21 (22.5%) among the received urine, blood, respiratory and exudate samples, respectively. MDR Pseudomonas aeruginosa rates increased from 2021 to 2023, reaching 68 (43.6%). Colistin susceptibility rates were relatively better, with 371 (84.3%) in adults and 70 (90.9%) in the paediatric population. Colistin susceptibility ranged from 38 (79%) to 83 (93%) across samples. A discrepancy of 76 (14.7%) was observed between the CBDE and automated methods for detecting colistin resistance. Conclusion: This study highlights the increase in MDR Pseudomonas aeruginosa, with higher resistant rates observed among paediatric population. While colistin remains effective, its resistance requires ongoing monitoring, necessitating the need for alternative strategies, enhanced infection control measures and antimicrobial stewardship to effectively combat the growing threat of AMR in Pseudomonas aeruginosa.

Comparative Analysis of Conventional and Rapid Antimicrobial Susceptibility Testing in Patients with Gram-negative Bacteraemia Directly from Blood Culture in a Tertiary Care Hospital: A Cross-sectional Study

S Shanmugapriya, S Alagammai, B Appalaraju Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Early administration of appropriate antimicrobial therapy in Gram-negative bacteraemia would influence the patient’s prognosis. Conventional Antibiotic Susceptibility Testing (AST)- disk diffusion and VITEK-2 rely on bacterial isolates obtained from subculturing positive blood cultures. Direct AST done from positive blood culture fluid would reduce subculturing time. Aim: To compare rapid AST directly from the positive blood culture with the conventional method of performing in isolated colonies obtained from positive blood cultures. Materials and Methods: The present cross-sectional study was done on 350 blood culture samples received at the diagnostic Microbiological laboratory of PSG hospital, Coimbatore, Tamil Nadu, India from August 2024 to October 2024. Consecutive positive blood cultures received during the study period showing monomicrobial (gram negative bacilli identified by doing gram stain of culture fluid) was included in the study. Blood culture samples were subjected simultaneously to susceptibility testing by Direct Sensitivity Test (DST) by Kirby bauer disk diffusion method (CLSI recommended) and Antibiotic Sensitivity Test (AST) by Vitek-2 Compact which is an automated (BioMerieux) reference method from positive blood cultures flagged by BacT/ALER3D System. AST was done directly from the positive blood culture fluids and on sub cultures by disc diffusion and VITEK 2 method. Data analysed using Statistical Package for Social Sciences (SPSS) v.28.0 and p-value less than 0.05 was considered statistically significant. Results: Antibiotic susceptibility test results of Klebsiella pneumoniae and E.Coli between direct and conventional disc diffusion method showed complete agreement in 98% of the samples in total. More than 95% samples showed complete agreement for all the antibiotics. On comparison between direct and conventional VITEK 2 method, 99% of the samples showed complete agreement between two tests in total. A 100% of samples showed complete agreement for the antibiotics like ceftazidime, ceftazidime+clavulanic acid, cefoxitin, cotrimoxazole, meropenem, ertapenem, piperacillin-tazobactam, cefaperazone-sulbactam, colistin. 91.25 and 90.7% samples showed complete agreement for amikacin and Ciprofloxacin. Conclusion: The therapeutic value of this approach is underlined by the excellent agreement rates obtained for antibiotics of critical importance. This may contribute to improved outcomes through earlier directed therapy.

Assessment of Processed Food Consumption and Eating Habits among Medical Students: A Cross-sectional Study

Shweta R Chougule, Anil Vasant Mahajan, Abhay R Saraf, Pratap Bhan Kaushik, Maajid Mohi Ud Din Malik Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: The consumption of processed foods has emerged as a significant public health concern, particularly among medical students who represent future healthcare providers. The demanding nature of medical education often leads students to rely on convenient yet nutritionally inferior food options, potentially affecting both their personal health and their future ability to counsel patients effectively. Aim: To assess the consumption patterns of processed foods and eating habits among medical sciences students to identify factors influencing these patterns. Materials and Methods: A cross-sectional study was conducted among 536 medical students at Dr. DY Patil School of Allied Health Sciences, Pimpri, Pune, Maharashtra, India, from September to November 2023, using a self-structured questionnaire. Data were collected on the frequency and types of processed foods consumed, eating habits, factors influencing food choices, and awareness of health risks. Chi-square tests and t-tests were used for statistical analysis, with p<0.05 considered statistically significant. Results: Among participants, 179 (33.4%) consumed processed foods several times a week, and 74 (13.8%) consumed them daily. Packaged snacks (319, 59.5%) and fast food (227, 42.4%) were the most commonly consumed items. Taste preference (310, 57.8%), convenience (231, 43.1%), and availability (217, 40.5%) were the primary drivers of consumption. Notably, 416 (77.6%) participants reported receiving education on the associated health risks through their academic curriculum, and 424 (79.1%) expressed concern about these risks; however, a significant knowledge-behaviour gap was observed. Encouragingly, 295 (55.0%) consumed breakfast daily, and 379 (70.7%) ate home-cooked meals regularly. Conclusion: This study reveals the high prevalence of processed food consumption among medical students, despite their awareness of its health risks. The findings highlight the importance of targeted interventions at the medical school level, including improved nutrition education within the curriculum, institutional efforts to provide healthier food choices, and initiatives that encourage time management strategies to promote better eating habits among future healthcare providers.

Exploring Short-term Outcomes of Dry Needling in Knee Osteoarthritis Patients: A Prospective Study

Kavitha Rani Nagendra, Arun Heddur Shanthappa, SJ Karthik, Prabhu Ethiraj Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Osteoarthritis (OA) of the knee is one of the most encountered musculoskeletal and rheumatologic diseases in the Outpatient Department of Orthopaedics. Around 250 million people worldwide suffer from OA knee. There is evidence that physiotherapy has been shown to be highly effective in treating OA knee. Dry Needling (DN) uses a similar needle to those used in acupuncture, but the application of the technique is different. In regard to DN, within the muscle, the needle is moved up and down exactly at the myofascial trigger points. Aim: To assess the short-term efficacy of DN in patients with knee OA. Materials and Methods: The present prospective study was conducted in the department of Physiotherapy attached to RL Jalappa Hospital and Research Centre in Kolar, Karnataka, India for a duration of six months from December 2022 to May 2023. This study included 40 patients who met the specified inclusion criteria and were closely monitored over a span of three and a half weeks, with an intervention of CZ Hong’s Fast in and Fast out needling technique subsequent to the identification of trigger points in the affected limb. At the end of three and a half weeks, the collected data on quantitative measure for Visual Analog Scale (VAS), Knee Range of Motion (ROM), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) was tested for normality conditions, and mean±SD was used to present the data. The difference in pre and post mean were tested by paired t-test, p-value <0.05 was considered as statistically significant. Results: At the end of 10 sessions of DN, there was a significant reduction in the Pain Pressure Threshold (PPT) (p-value=0.001), VAS score, (p-value=0.001), increase in Knee ROM, (p-value=0.001) and reduction in the disability scores of WOMAC (p-value=0.001) and KOOS scores (p-value=0.001.) Conclusion: The findings of the present study suggested that the PPT, WOMAC score and knee flexion range showed clinically relevant improvement for patients who underwent DN for 10 sessions added to therapeutic exercise program for older adults. However, these results should be interpreted with caution because of the small sample size and short follow-up.

Latest Trends and Modern Technology in the Diagnostics of Antimicrobial Resistance: A Scoping Review

Jyotsna Needamangalam Balaji, Sreenidhi Prakash, Nanthini Devi Periadurai, Kalyani Mohanram (Posthumous), Krishna Mohan Surapaneni Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Antimicrobial Resistance (AMR) is emerging as a global threat, claiming millions of lives due to therapeutic failures. For a long time, the detection of AMR has been confined to conventional culture methods, which are tedious and resource-demanding. This results in delays, inaccuracies, or misdiagnoses, worsening the burden of AMR worldwide. Thus, the need of the hour is for rapid, feasible and accurate diagnostic methods that use novel technologies for the precise detection of resistant strains and degrees of resistance among different microbes. This will aid healthcare providers in combating this hidden pandemic. Aim: To extensively analyse and report on the evidence and gaps in the current trends in diagnosing AMR. Materials and Methods: The present scoping review obtained information on newer diagnostic approaches for AMR by reviewing 491 articles retrieved from scientific databases like Google Scholar and PubMed. Based on the eligibility criteria for this review, 13 scientific research articles were included. The filtration process involved three levels: title screening, abstract screening and full-text screening. The articles selected after full-text screening were independently analysed by the authors and the collected data were scrutinised by other authors of this study. The extracted data were categorised and represented using tables, charts, figures and graphs. The entire manuscript was written in adherence to the reporting guidelines of the PRISMA-2020 extension for scoping reviews. Results: The selection process yielded 13 articles that met the eligibility criteria. The predominant method for diagnosing AMR is the Polymerase Chain Reaction (PCR) technique. Most diagnoses were conducted using samples from urinary tract infections and sexually transmitted infections. Automated amplification tools have proven to diagnose AMR rapidly and cost-effectively compared to conventional culture methods. Conclusion: Given the rapidly spreading AMR, newer, faster and more accurate modes of diagnosis should be developed to combat this hidden pandemic. Compared to traditional culture methods, genome amplification and Point-Of-Care (POC) techniques have proven to be beneficial and superior. Therefore, measures should be taken to advance these molecular techniques to broaden the scope of newer AMR diagnostics.

Comparison of Auditory Brainstem Evoked Responses between Migraine Patients and Healthy Controls: A Cross-sectional Study

Daniya Khalid, Jyotsna Shukla, Abhishek Saini, Rajni Fulwariya Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Migraine is a complex neurological disorder associated with noise hypersensitivity most evident during attacks (ictal), however persistent during the post-attack (interictal) period as well. Previous studies on cortical auditory potentials have established abnormal sensory processing during the interictal phase but findings related to subcortical (brainstem) involvement remain inconclusive. Aim: To compare Wave I and Wave V amplitude of Auditory Brainstem Evoked Responses (ABER) between migraineurs during the interictal phase and healthy controls at 40-, 50-, and 60-dB above Sensation Level (SL) for both ears. Materials and Methods: The present study was a cross-sectional study conducted at the Department of Physiology, SMS Medical College, Jaipur, Rajasthan, India. Thirty-five diagnosed migraine patients during the interictal phase from the Neurology Outpatient Department (OPD) and 35 age and gender-matched healthy controls were enrolled. The Wave I and V amplitude (μV) were measured, at 40-, 50-, and 60-dB above SL bilaterally, in both groups. Statistical Package for Social Sciences (SPSS) software version 25 was used to analyse the results and an unpaired student’s t-test was employed for comparison in a side-specific manner. The significance level was assigned at a p-value <0.05. Results: The amplitudes of Wave V at 50-db SL (p-value: left ear=0.03, right ear=0.01) and 60-dB SL (p-value: left ear=0.005, right ear=0.013) were significantly higher among migraineurs during interictal phase than their matched controls. The amplitude difference for Wave I was statistically insignificant between the two groups at all recording intensities. At 40 dB SL, both Wave I (p-value: left ear=0.68, right ear=0.63) and Wave V (p-value: left ear=0.30, right ear=0.50) amplitudes did not exhibit any significant difference in results between migraine patients and healthy controls. Conclusion: The subcortical auditory dysfunction is significant for brainstem nuclei beyond the cochlear nucleus (peripheral auditory neurons) at higher intensities, indicating a more noticeable central processing disorder. This could eventually lead to irreversible auditory pathway damage, ABER can be utilised as a tool for early detection and localisation of the insult, providing an opportunity for early intervention and use of prophylactic measures.

Fracture Resistance of Endodontically Treated Premolar Teeth Restored with Glass Ionomer Cement, Glass Ionomer Cement with Fibres and Nanoceramic Composite Restorative Material: An In-vitro Study

Sruthi Kapu, Ravi Chandra Ravi, Sri Naagaja Krishnaveni Komireddy, Lalitha Sri Roja, Desavath Anjaneya Naik, Bandana Mishra Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Restoring endodontically treated maxillary premolars is challenging due to their weakened state from caries, trauma, and the endodontic access itself, making them prone to fracture. Long-term success hinges on their ability to withstand biting forces. The core build-up, replacing lost tooth structure, is crucial. The restorative materials chosen for both the core and final crown significantly influence the tooth’s overall fracture resistance, as their mechanical properties dictate stress response. Aim: To evaluate the fracture resistance of endodontically treated premolar teeth restored with Glass Ionomer Cement (GIC), GIC with fibres and nanoceramic composite restorative material. Materials and Methods: The present in-vitro study included eighty maxillary premolar teeth which were extracted due to orthodontic purpose were collected and divided into four groups with 20 teeth in each group. Group I was noted as negative control with no preparation. Groups II, III and IV were restored with GIC, GIC with fibres and with nanoceramic composite, respectively. After restoration, the samples were subjected to evaluation of fracture resistance by using universal testing machine and values were subjected to statistical analysis. Results: The highest fracture resistance of 913.858 N(newtons) was noted for nanoceramic composite. There was no statistically significant difference observed between Groups III and IV (p=0.9870); however, both groups exhibited higher fracture resistance compared to Group II. Conclusion: The fracture resistance with fibre reinforcement was higher than conventional CIC and similar to that of nanoceramic composite.

Dexamethasone versus Clonidine as Adjuvants to Ropivacaine in Popliteal Sciatic Nerve Blocks for Postoperative Analgesia in Foot and Ankle Surgeries: A Randomised Clinical Study

Sheetal Jayakar, Grace Mammen Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Effective postoperative pain management is crucial in foot and ankle surgeries to enhance patient comfort and recovery. Popliteal Sciatic Nerve Blocks (PSNBs) are particularly useful in this context, as they provide site-specific, long-lasting analgesia with minimal systemic side effects, offer motor-sparing benefits, and facilitate early postoperative mobilisation. When combined with adjuvants like dexamethasone or clonidine, they may significantly improve the quality and duration of pain relief. Aim: To compare the analgesic efficacy, sensory and motor blockade, haemodynamic variability, and patient satisfaction when dexamethasone and clonidine are used as adjuvants to ropivacaine in PSNBs for patients undergoing foot and ankle surgeries. Materials and Methods: A prospective, randomised, double-blind trial was conducted in the department of Anaesthesiology, Dr. DY Patil Medical College and Research Centre, Pimpri, Maharashtra, India from March 2024 to March 2025 on 50 American Society of Anaesthesiologists (ASA) I and II patients aged 18-75 years undergoing elective foot and ankle surgery. Using a computer-generated randomisation sequence, patients were randomly assigned to two equal groups (n=25 each). Group RD received 28 mL of 0.5% ropivacaine with 2 mL (8 mg) dexamethasone, while Group RC received 28 mL of 0.5% ropivacaine with 2 mL (100 μg) clonidine. All blocks were administered under ultrasound guidance via the lateral approach. The primary outcome was the duration of analgesia, while secondary outcomes included Visual Analogue Scale (VAS) scores, durations of sensory and motor blocks, haemodynamic variability, and patient satisfaction. Statistical analysis was performed using independent t-tests and Chi-square tests, with p<0.05 considered significant. Results: Group RD demonstrated significantly prolonged analgesia (24.24±2.18 hours) compared to Group RC (18.00±2.45 hours, p<0.001). VAS scores were significantly lower in Group RD after 12 hours postoperatively (2.08±0.49 vs 3.36±0.49, p<0.001). The duration of the sensory block was 21.80±2.94 hours in Group RD versus 14.16±2.94 hours in Group RC (p<0.001), and the motor block duration was 21.36±4.48 hours versus 18.96±4.48 hours, respectively (p=0.03). Haemodynamic variability was comparable across groups, with no adverse effects, and patient satisfaction was higher in the dexamethasone group, though this was not statistically significant. Conclusion: Dexamethasone, when used as an adjuvant to ropivacaine in PSNBs, provides superior and longer-lasting analgesia, extended block duration, and better pain control compared to clonidine, with excellent safety and tolerability.

Association between Body Mass Index, age at Menarche with Skeletal Maturity Indicators using Hand Wrist Radiograph in Bengali Female Population: A Cross-sectional Study

Subhas Seth, Suman Maiti, Samarendra Ray, Manish Jha, Kaushik Roy Chaudhuri, Arunavo Nandy, Pratik Kumar Lahiri, Kaushik Dutta Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Estimation and use of craniofacial growth is crucial in addressing skeletal discrepancies for orthodontic correction of young and growing children. It is crucial to determine each patient’s skeletal age and compare it to their dental and chronological ages before diagnosing a proper treatment plan. An essential biological indicator for determining a female’s physiologic maturity is her age at puberty. Menarche and hand wrist skeletal maturation can be used to determine the beginning and conclusion of the pubertal growth spurt. Aim: To find association between Body Mass Index (BMI), age at menarche with hand-wrist radiograph in Bengali female population. Materials and Methods: The present cross-sectional study was conducted at Department of Orthodontics and Dentofacial Orthopaedics in collaboration with the Department of Pedodontics, Guru Nanak Institute of Dental Sciences and Research, Kolkata, India from March 2022 to January 2024. Hundred subjects were evaluated in the age range of 9-15 years. Subjects’ menarcheal age, BMI and Skeletal Maturity Indicators (SMI) using hand wrist X-ray were assessed and tabulated. Statistical analysis was done to find association between these three parameters. (GraphPad Prism Software version 9.5, La-Jolla, California) was used for analysis. Parametric tests, One-way Analysis of Variance (ANOVA), Post-hoc Tukey’s and Chi-square (χ2) test were used for inferential statistics. Results: The mean menarche age of subjects were 12.2±1.2 years. It was observed that obese girls had the onset of menarche at an early stage (10.06±0.35 years), followed by overweight girls (11.15±0.72 years), normal weight girls (12.73±0.68 years), and then underweight girls who had their menarche at 14.2±0.14 years; p<0.001*. Higher skeletal maturity (stage VII, VIII), 40%, 42.5%, respectively was achieved only at higher age groups and was dependent on the age at menarche (p<0.001**). BMI showed an inverse association to skeletal maturity. Subjects with healthy BMI (healthy) showed good skeletal maturation rate. Conclusion: Obese girls experienced menstruation earlier as compared to healthy and underweight girls. Data indicated that menarche and BMI percentile were inversely associated. Significant statistical relation was seen in between the BMI percentile and the SMI and between peak pubertal growth assessed by hand-wrist X-ray as SMI and the menarche onset.

Nootropic Activity of Methanolic Extract of Evolvulus alsinoides Linn. Whole Plant in Mice with Sodium Nitrite Induced Amnesia: An Experimental Study

Karnam Nithya, Naiyma Choudhary, Rajesh Kumar Manchi, S Rajaram, BSR Sangeeta Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Many ancient medical systems, including Ayurveda and Unani, have utilised plants as therapeutic agents for ages. Both structured and unstructured types of medicinal plants have been used extensively to treat a variety of illnesses, including cognitive impairment. One plant identified as having the ability to cure neurological conditions and enhance cognitive function is Evolvulus alsinoides Linn, also referred to as Vishnukranthi. Aim: To evaluate the effect of Evolvulus alsinoides methanolic extract in treating sodium nitrite-induced amnesia in male Swiss albino mice through behavioural, biochemical and histological parameters. Materials and Methods: This experimental study was conducted at ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Velappanchavadi, Chennai, Tamil Nadu, India. Healthy male Swiss albino mice weighing between 25 and 30 g were used as subjects. The experiment was designed to evaluate the potential cognitive-enhancing effects of Evolvulus alsinoides through two behavioral tests: the Elevated Plus Maze (EPM) test and the passive avoidance test. The EPM test is commonly employed to assess anxiety and memory by measuring the time animals spend in the open arms versus the closed arms of the maze. It also evaluates the total transitions made by the animals between the arms, providing insights into their exploratory and memory behaviour. Results: A notable difference was observed between the sodium nitrite-treated group (GSN) and the sodium nitrite-treated with piracetam group (GSNP), where the piracetam-treated mice (GSNP) exhibited a significant reduction (p-value=0.0001) in the number of transitions. The Evolvulus alsinoides-treated groups (GSNLD and GSNHD) showed a significant reduction in the number of transitions when compared to the GSN group. In the passive avoidance test, the comparison between GSN and groups GSNLD and GSNHD (treated with Evolvulus alsinoides) showed a statistically significant improvement in step-down latency in the treated groups. Biochemical parameters of brains indicated reduced GSH and AChE levels, which were considered supportive evidence for the behavioural parameters. Conclusion: These findings suggest that Evolvulus alsinoides may be a promising agent for the development of new treatments for memory impairment and cognitive disorders.

Plasminogen Activator Inhibitor-1 Levels in Heart Failure Patients: A Cross-sectional Study

Amrit Pal Kaur, Jaskiran Kaur, Gurinder Mohan, Sahiba Kukreja Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Heart Failure (HF) is a worldwide health concern and a major cause of morbidity and mortality globally. Among the numerous biomarkers associated with HF, Plasminogen Activator Inhibitor-1 (PAI-1) has received attention for its role in poor fibrinolysis and thrombosis. Aim: This study aimed to compare serum PAI-1 levels in patients diagnosed with HF to those of healthy participants. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry, in collaboration with the Department of Medicine at Sri Guru Ram Das Hospital, Amritsar, Punjab, India. The study comprised 50 individuals with confirmed HF from the inpatient department of the Medicine Department and 50 healthy individuals of comparable age, conducted from October 2019 to December 2023. Serum levels of PAI-1, N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), Brain Natriuretic Peptide (BNP), creatinine, and Urine Albumin-to-Creatinine Ratio (UACR) were investigated and compared. The data were statistically analysed and presented as mean and standard deviation (SD). Odds ratio and Student’s t-test were performed. Results: The study included 100 participants, with a mean age of 62.3±10.4 years, comprising 68% males and 32% females, ensuring age and gender representation across both HF patients and healthy controls. The mean±SD of serum PAI-1 was 10.09±1.68 ng/mL in healthy individuals and 35.16±11.14 ng/mL in HF patients, indicating that PAI-1 could be a valuable indicator for diagnosing HF. A comparison with healthy controls showed significantly higher levels of PAI-1 (p<0.001) in HF patients. PAI-1 had a significantly high odds ratio (OR) (585.8, 95% CI: 32.5-10554.5), showing a strong association. Furthermore, as the condition became more severe, the levels of these biomarkers increased significantly. Conclusion: Serum levels of PAI-1 are significantly associated with HF, indicating that they could be used for the identification of HF. Further studies are required to validate these findings and evaluate the clinical benefit of targeting PAI-1 in HF management.

Burden of Chronic Kidney Disease: A Cross-sectional Study Assessing Socio-demographic Correlates and Co-morbid Conditions in Chengalpattu District, Tamil Nadu, India

Vaishnavi Nagarajan, Aamina Hussain, VV Anantharaman Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: The global prevalence of Chronic Kidney Disease (CKD) is approximately 10-15%, with India experiencing an increasing burden due to lifestyle changes, diabetes, hypertension and environmental factors. Despite the high prevalence, region-specific epidemiological data remain scarce. Understanding the occurrence and contributing factors of CKD in Chengalpattu district is crucial for developing effective prevention and management strategies. Aim: To estimate the prevalence of CKD in Chengalpattu district. To identify the socio-demographic determinants and co-morbid conditions associated with CKD. Materials and Methods: A community-based cross-sectional study was conducted in Chengalpattu district from June 2024 to December 2024. A multistage sampling technique was used to select 420 adults. Adults who gave consent and were over 18 years old were chosen according to the Screening for Occult Renal Disease (SCORED) criteria. The study tool included socio-demographic details and the SCORED questionnaire. The Modification of Diet in Renal Disease (MDRD) equation was utilised to measure the estimated Glomerular Filtration Rate (eGFR). Data entry and analysis were performed using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 26.0, respectively. The Chi-square test was used to identify associations between selected variables, with a p-value <0.05 considered statistically significant. Results: The study revealed that the overall prevalence of CKD was 55.5% (206 participants). Out of 420 participants, 371 were tested for eGFR, among whom the majority were in CKD stage 2 {177 (47.7%)}. A smaller proportion was diagnosed with stage 3a {22 (5.9%)}, stage 3b {2 (0.5%)}, stage 4 {4 (1.1%)} and stage 5 {1 (0.3%)}. The majority of participants were aged over 50 years {245 (58.3%)}, with a higher proportion of females {286 (68.1%)} and unemployed individuals {140 (33.3%)}. Proteinuria was found to be a strong and significant predictor of CKD, with an adjusted odds ratio of 11.55 (5.61-26.12). Age over 50 years showed a borderline significant effect on CKD {p-value=0.054, OR=3.71 (0.98-14.01)}. Conclusion: The study findings indicate that CKD is a significant public health issue in the region, with a substantial proportion of the population exhibiting risk factors such as advanced age, male gender, a history of co-morbidities and proteinuria. This underscores the urgent need for early screening, lifestyle modifications and improved access to nephrology care.

Audiological Profile of Heavy Vehicle Drivers: A Cross-sectional Study from Southern India

D Balaji, RB Namasivaya Navin, K Gowthame, S Prabakaran, A Ashmitha, R Muthukumar, S Rajasekaran, B Sarath Kumar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Noise-Induced Hearing Loss (NIHL), a permanent sensorineural hearing loss that usually develops undetected until it becomes functionally significant, can result from ongoing exposure over time. Aim: To ascertain the prevalence of hearing loss and the audiological profile among heavy vehicle drivers in South India. Materials and Methods: A cross-sectional study was conducted at the Department of ENT, Chettinad Hospital and Research Institute (a tertiary care centre), Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India, from September 2024 to February 2025 among 90 participants. The study population consisted of heavy vehicle drivers (e.g., truck, bus, or lorry drivers) aged 18 to 60 years with a minimum of five years of occupational exposure, attending the Ear, Nose and Throat (ENT) Outpatient Department (OPD). Demographic details, local examinations and pure tone audiometry were conducted for all eligible participants and the findings were documented. A paired t-test was applied to find the difference in hearing loss between the left and right ears. A p-value of <0.05 was considered statistically significant. Results: The overall percentage of hearing loss among the 90 drivers was 26 (28.9%) in their better ear (right ear) and 30 (33.3%) in their left ear. However, at higher frequencies (3000 Hz to 8000 Hz), the mean hearing loss was consistently greater in the left ear compared to the right ear. The differences were statistically significant at 3000 Hz, left ear (30.5 dB) vs. right ear (28.9 dB) (p=0.041); at 4000 Hz, left ear (37.8 dB) vs. right ear (35.2 dB) (p=0.028); at 6000 Hz, left ear (45.1 dB) vs. right ear (42.7 dB) (p=0.015); and at 8000 Hz, left ear (43.9 dB) vs. right ear (40.6 dB) (p=0.008). Conclusion: There is a significant increase in hearing loss in the left ear compared to the right ear at higher frequencies (≥3000 Hz), indicating that high-frequency hearing may be more affected in the left ear among the study population.

Comparison of Platelet Rich Plasma Therapy, Granulocyte Colony Stimulating Factor, and Estradiol Valerate on Endometrial Thickness in Patients with Infertility: A Prospective Interventional Study

Roopal Khare, Madhulika Shukla, Saurabh Shukla Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: According to World Health Organisation (WHO) infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”. Aim: To compare the effect of Platelet Rich Plasma (PRP) therapy, Granulocyte Colony Stimulating Factor (GCSF) and estradiol valerate on endometrial thickness in infertile patient with thin endometrium. Materials and Methods: The present prospective interventional, single-blind study was conducted on patients attending the outpatient clinics with complaints of infertility in the Department of Obstetrics and Gynaecology, GSVM Medical College, Kanpur, India, from January 2019 to September 2020. A total of 75 patients attending the outpatient clinics with infertility were included. The patients were divided randomly into three groups of 25 each. Patients in the group 1 were given PRP 0.1 mL infusion following ovulation induction with letrozole. Patients in group 2 were given GCSF infusion following ovulation induction with letrozole and patients in group 3 were given estradiol valerate following ovulation induction with letrozole. They were then instructed to come on day 13 when Transvaginal Scan (TVS) was done to assess the thickness and character of endometrium. Kruskal Wallis Test and paired t-test were used. Results: Mean age of the patients was 28.1±4.36 years. The change (increase) in endometrial thickness is significant in the PRP group compared to the GCSF group and highly significant compared to the estradiol valerate group (4.19±2.06 vs 2.78±1.72 vs 1.94±1.69). However, the increase in endometrial thickness is comparable among GCSF and EV groups. The pregnancy rate was higher in PRP compared to GCSF and EV (32% vs 8% vs 20%). Conclusion: It was found that the local administration of PRP is significantly effective in increasing endometrial thickness thus improving the possibility of pregnancy in patient with refractory endometrial thickness (<6 mm).

Evolving Antimicrobial Susceptibility Patterns in Salmonella spp. Isolated from Blood Specimens, Over 10 Years: A Retrospective Observational Analysis

Dinesh Kumar Perumal, Priyadarshini Shanmugam, R Alice Peace Selvabai, Perumal Jayaraman Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Species of Salmonella, particularly Salmonella Typhi and Salmonella Paratyphi, remain a significant cause of Bloodstream Infections (BSIs) in developing countries, complicated further by rising antimicrobial resistance. These infections contribute substantially to morbidity, mortality and the public health burden, especially in regions with poor sanitation and limited access to healthcare. The emergence of Multidrug-Resistant (MDR) Salmonella strains has rendered many first-line antibiotics less effective, complicating treatment strategies. Aim: To assess the prevalence of Salmonella spp. and the antimicrobial patterns of Salmonella isolates over a ten-year period (2014–2024) at a tertiary care hospital in Tamil Nadu, India. Materials and Methods: This was a retrospective observational study conducted at Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India. Blood culture records from January 2014 to December 2024 were reviewed. All patients with confirmed Salmonella-positive blood cultures were included. Blood samples were processed using standard microbiological protocols, including conventional and automated (BACTEC) methods and antibiotic susceptibility was tested using the Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Demographic details such as age and gender were documented. Data were compiled using Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 20.0; categorical data were expressed in percentages. Results: Among the 304 isolates, S. Typhi was the most frequently identified species (225, 74%), followed by Salmonella Paratyphi A (66 isolates, 21.7%), Salmonella Paratyphi B (7 isolates, 2.3%) and Salmonella Typhimurium (6 isolates, 2%). A male predominance (213, 70.1%) was observed and the greatest occurrence (162, 53.3%) was recorded in the 21-60 years of age group. Antibiotic sensitivity analysis revealed sustained susceptibility of all serotypes to ceftriaxone, tetracycline, chloramphenicol and cotrimoxazole. However, a predominant level of ciprofloxacin resistance was reported in S. Typhi and S. Paratyphi A isolates. Year-wise data showed fluctuating resistance patterns, with a notable dip in ceftriaxone sensitivity in 2020 and variable trends in ampicillin and chloramphenicol resistance. Conclusion: Over the past decade, S. Typhi remained the predominant pathogen isolated from BSIs, particularly affecting adults. Although conventional antibiotics continue to be effective, alarming fluoroquinolone resistance trends underscore the need for routine antimicrobial surveillance and judicious antibiotic use. The findings reinforce the importance of empirical therapy guided by local susceptibility patterns and highlight the ongoing challenge of managing drug-resistant Salmonella infections in endemic regions.

Prevalence and Determinants of Acute Respiratory Infections among Under-five Children in Rural Health and Training Centre, Tamil Nadu, India: A Cross-sectional Study

PL Thameen Raja Mohamed, Shravan Kumar Sasidharan, Vinodhini Balamurugan, AH Irfaunul Azees, M Balakumar, T Sivaharivelan, Ramesh Harihara Iyer, Suresh Varadarajan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Acute Respiratory Infections (ARIs) are a leading cause of morbidity and mortality among children under-five, especially in low-resource settings. In India, the burden of ARIs is notably high in rural areas due to environmental and socioeconomic risk factors. Aim: To estimate the prevalence of ARIs and identify associated determinants among children under-five in a rural population. Materials and Methods: A cross-sectional study was conducted from November 2017 to October 2018 in the service area of the Rural Health and Training Centre (RHTC) in Thiruvallur district, Tamil Nadu, India, among 323 children under-five from nine randomly selected villages using multistage sampling. Data on ARI episodes and associated factors were collected using a pretested, semi-structured questionnaire administered in Tamil. Descriptive statistics and logistic regression were performed using Statistical Package for the Social Sciences(SPSS) v23, with significance set at p<0.05. Results: The prevalence of ARIs was 24.5% (n=79). Significant determinants included kutcha/semi-pucca housing (OR: 2.45, 95% CI: 1.4-4.2; p<0.001) and pet ownership (OR: 3.27, 95% CI: 1.78-6.0; p<0.001). Female children were at a higher risk of developing ARIs compared to males (OR: 1.90; p=0.049). Other factors, including overcrowding, socioeconomic status, and birth weight, showed no significant association. Conclusion: Poor housing and pet exposure significantly contribute to the prevalence of ARIs in rural children. Public health measures targeting these modifiable environmental factors are essential to reduce the disease burden.

Comparison of Core and Pelvic Floor Strengthening versus Yoga Poses for Primary Dysmenorrhea among Young Adult Females: A Comparative Experimental Study

Adeeba Ahsan, Pramod Kumar Sahu, Jyoti Sharma, Aksh Chahal, Mohammad Sidiq Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Dysmenorrhea is the most common gynecological condition in women of reproductive age. Primary Dysmenorrhea involves pain in the lower abdomen and pelvis, with potential radiation to the inner thighs and legs, occurring without identifiable pelvic pathology. Additional symptoms may include stress, nausea, vomiting, headaches, and fatigue, primarily due to excess prostaglandin hormone production. Aim: To compare the effects of physiotherapeutic pelvic floor and core strengthening exercises against yoga poses on primary dysmenorrhea in young adult females. Materials and Methods: This comparative experimental study was carried out at the Department of Physiotherapy, Galgotias University, Uttar Pradesh, India from September to December 2023. Total 60 female subjects between the ages 18-25 years with clinically diagnosed primary dysmenorrhea with regular menstrual cycles were included. Participants were randomised to two groups (n=30 in each group). Group A engaged in core and pelvic floor strengthening exercises, and Group B practiced some specific yoga postures. Both interventions were implemented three times per week over eight weeks. Pre and post intervention measurements were made using the WaLIDD scale (Working ability, Location, Intensity, Days of pain, Dysmenorrhea) and EQ-5D-5L questionnaire to gauge the effect of pain and quality of life. Demographic data such as age, Body Mass Index (BMI), and menstrual history were observed. Statistics were conducted with the help of Statistical Package for Social Sciences (SPSS) version 22 IBM USA, using paired and independent t-tests. The p-value <0.05 was deemed to be statistically significant. Results: The study results suggested a significant difference between the pre and post assessment of the WaLIDD and EQ-5D-5L scale in Group A (p<0.05) and similarly in Group B (p<0.05). But no significant difference was reported when group A and group B were compared. Conclusion: The study concluded that both the physiotherapeutic pelvic floor and core strengthening exercises and yoga poses are significantly efficient at easing the signs and symptoms of primary dysmenorrhea in young adult females. Physiotherapeutic pelvic floor and core strengthening and yoga pose both can be used as non-pharmacological treatment for primary dysmenorrhea without any side-effects.

Clinical Presentation and Short-term Outcomes of Endovascular Onyx Embolisation in Dural Arteriovenous Fistula: A Prospective Observational Study

Rahul Arkar, Rashmi Saraf Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Dural Arteriovenous Fistulas (dAVFs) are abnormal vascular channels formed between venous sinuses or cortical veins and dural arteries, with idiopathic or multi-factorial causations, varied clinical presentations, and complex radiological angio-architecture. However, intra-arterial embolisation is the preferred management. Aim: To study the clinical presentation and short-term outcomes of endovascular onyx embolisation for dAVFs. Materials and Methods: The present prospective observational study was conducted at a tertiary care centre in Maharashtra, India from September 2016 to August 2017. Adults presented to an Emergency department with the symptoms of headache, convulsions, vomiting, or stroke and subsequently underwent Digital Subtraction Angiography (DSA) were screened. Patients diagnosed with dAVFs and treated with endovascular embolisation under general anaesthesia via the transfemoral route using a liquid embolic agent (onyx) were studied. Clinical presentation and angio architecture of dAVF have been reported along with the post embolisation complications. Results: A total of 10 (8 males) patients were studied. Patients had an age range of 21-45 years. Convulsions 5 (50%) neurodeficit, and headache 4 (40%) each) were the most common presenting complaints. Left transverse sinus was the prominent dAVF location observed 4 (33.33%). A total of 12 arteries were embolised, (10 (83.33%) arteries showed no angiographic residue after a single session of embolisation, and 2 (16.67%) patients had minimal residue after two sessions of trans-arterial onyx embolisation). Conclusion: Endovascular onyx embolisation should be the treatment of choice for dAVFs. Onyx in appropriate concentration and a finely-honed technique achieves better cure rates.

Effects of Intravenous Magnesium Sulphate Administration on Postoperative Analgesia in Infraumbilical Surgeries under Spinal Anaesthesia: A Double Blinded Randomised Clinical Study

Shahbaz Hasnain, Subhashree Jena, Reem Khatib Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Inadequate management of postoperative pain can lead to complications like prolonged recovery time, ileus, nausea, urinary retention, and infection. Although spinal anaesthesia is highly effective in intraoperative pain relief, its effects wear off after surgery, with a tendency to produce opioid dependence. Magnesium sulphate, an NMDA receptor blocker, has the potential to augment spinal anaesthesia effects and postoperative analgesia. Aim: To determine whether intravenous magnesium sulphate infusion could improve postoperative pain management in patients who had undergone spinal anaesthesia for infraumbilical surgery. Materials and Methods: The present double-blind, randomised clinical trial including 60 American Society of Anaesthesiologists (ASA) I-II patients who had infraumbilical spinal anaesthesia was conducted at Dr. D. Y. Patil Medical College in Pune, Maharashtra, India. Patients were given 15 mg of 0.5% hyperbaric bupivacaine intrathecally, along with a random assignment to receive either intravenous magnesium sulphate (Group M) or normal saline (Group C). Statistical Package for Social Sciences (SPSS) v27 was used to assess and analyse postoperative pain {Visual Analogue Scale (VAS)}, haemodynamics, block characteristics, time to first analgesia, and side-effects. The data was collected, compiled and tabulated. Data entry was done in Microsoft Excel and tables and apt charts was formed. Quantitative data was analysed using unpaired student t-test and qualitative data was analysed using Chi-square test analysed by SPSS software 27. Results: Demographic characteristics and haemodynamic data were similar across groups. The mean age of the patients was 41.93±11.64 in Group M and 36±13.5 in Group C. VAS scores in Group M were lower from 45 minutes through to 16 hours postoperative compared with Group C. Analgesic duration was longer, and the time to the first rescue analgesia in Group M was longer than in Group C. The time to onset for sensory and motor block was identical, but blocks lasted significantly longer in Group M. Conclusion: Intravenous magnesium sulphate as an adjuvant to spinal anaesthesia safely extends postoperative analgesia, decreases pain severity, and postpones the need for rescue analgesia without inducing significant haemodynamic instability or side-effects. Therefore, magnesium sulphate is an effective and safe adjuvant for enhancing postoperative pain relief in infraumbilical operations.

Clinical and Radiographic Outcomes in Distal Radius Fractures Using K-wires versus Fragment-specific Plates: A Prospective Interventional Study

Satyam Jawa, Vinod Nair Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Orthopaedic practice frequently deals with Distal Radius Fractures (DRFs); however, the treatment strategies for optimal functional outcomes remain uncertain. K-wiring (Kirschner Wire) is a minimally invasive technique preferred for simple fractures, whereas Fragment-Specific Plating (FSP) offers targeted fixation for complex fracture patterns. Aim: To compare the functional and radiological outcomes of DRFs managed with K-wiring versus FSP. Materials and Methods: The present prospective interventional study was performed in the Department of Orthopaedics of a tertiary care hospital at Pune, Maharashtra, India, over 24 months from January 2023 to December 2024. A total of 40 patients were randomly categorised: K-wire group (n=20) and Plate group (n=20). Functional outcome was assessed with the Mayo modified wrist score, while radiological outcomes included radial inclination, radial height, and volar tilt. The patients were followed-up at 3, 6, and 12 months. Results: At three and six months, significantly greater proportion of patients in the Plate group had higher range of motion (p=0.003 and 0.029, respectively), and total scores (p=0.017 and 0.039, respectively). Similarly, at 6 and 12 months, patients in the Plate group had higher grip strength scores (p=0.025 and 0.010, respectively). Moreover, at three and 12 months, patients in the plate group had higher satisfaction (p=0.003) and higher pain scores (p=0.028), respectively. Both the groups had comparable radial inclination at all the intervals (p>0.05) and volar tilt at three months (p=0.116). At three months, the mean radial height was significantly greater in the plate group (p=0.012). Furthermore, at six and 12 months, the plate group demonstrated significantly higher radial height (p=0.003 and <0.001, respectively) and volar tilt (both p<0.001) compared to the K-wire group. However, the K-wire group was associated with significantly reduced operative time and shorter duration of hospital stay (both p<0.001). Conclusion: Both K-wiring and FSP are effective surgical methods for managing DRFs. However, FSP provides significantly better functional and radiological outcomes, and should be preferred, particularly in patients with complex DRFs.

Effectiveness of Dynamic Taping Combined with Resistance Band Training on Dynamic Balance, Jumping Performance, Agility, Sprint Speed and Lower Limb Strength among Young Male Football Players: A Pilot Study

Mohd Asif, Mohammad Sidiq Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Football, a high-intensity sport, requires abilities such as dynamic balance, agility, jumping performance, sprint speed, and lower limb strength. These demands place repetitive stress on the hips, knees, and ankles of young individuals, making them susceptible to lower limb injuries such as hamstring strains, ankle sprains, Anterior Cruciate Ligament (ACL) tears, meniscus injuries, Patellofemoral Pain Syndrome (PFPS), and shin splints. Dynamic taping is an advanced intervention in sports physiotherapy that differs from classic kinesiology taping in its biomechanical properties and uses. Dynamic taping provides additional features, including multidirectional joint support, enhanced joint stability, and proprioceptive feedback, without limiting joint movement. Its unique elasticity allows for greater force absorption and enhanced neuromuscular control. The combination of dynamic taping with Resistance Band Training (RBT) may suggest a coactive strategy to improve athletic performance and reduce injury risk. However, the evidence to support this vital combination remains limited. Aim: To investigate the effectiveness of dynamic taping combined with RBT on key performance factors in young football athletes. Materials and Methods: This pilot study was conducted at the Growing Star Sports Club in Delhi, India, from December 2024 to January 2025 with a total sample size of 12 participants who were selected and allocated to either the experimental group, which engaged in dynamic taping combined with resistance band exercises, or the control group, which performed only resistance band exercises, using simple random sampling. Double blinding was used during assessments to minimise bias. Vertical jump, sprint speed, Y-balance test (YBT), t-test agility, and lower limb strength were evaluated before and after the 4-week intervention (3 sessions per week). The analysis was performed using descriptive statistics and paired-samples t-tests. Results: The baseline characteristics of participants in the control (n=6) and experimental (n=6) groups were comparable in terms of age (15.67±1.03 vs. 15.83±0.75 years) and Body Mass Index (BMI) (20.21±1.22 vs. 19.54±0.94). Post-intervention, the experimental group showed greater improvements in vertical jump, lower limb strength, agility, balance, and sprint speed, with significant effect sizes (Cohen’s d: vertical jump d=4.73, agility d=2.48). Strong correlations were found between improvements in lower limb strength (r=0.88) and balance (r=0.86) (p<0.05). Conclusion: The findings of the study suggest that dynamic taping combined with RBT can significantly enhance key athletic performance measures in football players.

Assessment of Salivary pH, Flow Rate, Buffering Capacity and Alpha-amylase Enzyme Activity in Caries-free and Caries-active Children: A Cross-sectional Study

Pallavi Nagappa Kuri, Umapathy Thimmegowda Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: It is generally accepted that the caries process is largely controlled by a natural protective mechanism in saliva. The pH, flow, buffering, and remineralising capacity of saliva are recognised as critical factors that affect and regulate the progression and regression of the caries process. Salivary Alpha-Amylase (SAA) is an enzyme in saliva that has a high affinity for binding to oral streptococci and plays a role in carbohydrate digestion, potentially leading to enamel demineralisation. Aim: To estimate and associate the pH, flow rate, buffering capacity, and SAA levels in the saliva of children with and without caries. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatric and Preventive Dentistry at Rajarajeswari Dental College and Hospital in Bengaluru, Karnataka, India where 50 children were included. They were divided into two groups: Group A (Caries-active) and Group B (Caries-free), each consisting of 25 children. Unstimulated saliva samples were collected and analysed using a pH meter and Ultraviolet (UV) spectrophotometer, with parental consent and after obtaining ethical clearance. The Mann-Whitney Test was used to compare mean salivary amylase scores between the two groups. An Independent Student’s t-test was used to compare the mean initial pH values, buffering capacity values, and Salivary Flow Rate (SFR) between the two groups. Spearman’s correlation test was conducted, and the level of significance was set at p<0.05. Results: The mean age of the children in the caries-active group was 5.52±0.71 years, while in the caries-free group it was 5.40±0.76 years. Assessment and correlation were conducted between caries scores and all parameters in the study group. Salivary pH, flow rate, and buffering capacity showed a statistically significant negative correlation with caries activity (rho=-0.60, -0.53, -0.38), whereas alpha-amylase showed a statistically significant strong positive correlation with caries activity and caries score. Comparison of the mean values of all parameters based on the number of caries (<6 and >6) showed statistically significant results at p<0.05. Conclusion: Based on the results, it can be concluded that SAA levels were increased in children with Early Childhood Caries (ECC), showing a significant positive correlation with caries activity.

Development of Gene-based Conventional PCR Assay for Diagnostic Application of Streptococcus pneumoniae Infections as an Alternative to Conventional Culture: A Cross-sectional Study

Jignishaben Sanjaykumar Patel, Jignaben Pranav Naik Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Streptococcus pneumoniae (S. pneumoniae), an opportunistic pathogen, is the primary cause of pneumonia and is classified as a high-priority bacterial pathogen. However, it is often underdiagnosed by conventional microbiological tests. The present study was conducted to develop a simple, rapid and reliable molecular method for the early and accurate diagnosis of S. pneumoniae using the Duplex Polymerase Chain Reaction (PCR) Assay. Among various genes responsible for the pathogenesis of pneumococci, the LytA gene and the CpsA gene were targeted for the molecular identification of S. pneumoniae. Aim: To evaluate the developed duplex PCR assay alongside the microbial culture of the S. pneumoniae pathogen. Materials and Methods: This study was carried out at the microbiology department of Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India, from March 2020 to March 2022. A molecular method for the detection of S. pneumoniae present in various clinical samples by PCR was developed. The optimised Duplex PCR assay employs primers specific for the LytA and CpsA genes of S. pneumoniae. The method involves the extraction of bacterial genomic DNA, PCR amplification and agarose gel electrophoresis to analyse the amplification products. The performance of the newly developed Duplex PCR assay was evaluated and compared its results with previously described assays, such as monoplex PCR assays targeting a single gene and conventional microbiological tests. Different clinical samples (n=75) from patients with pneumonia-like symptoms were used for PCR analysis and culture. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the PCR assay were determined in comparison with the gold standard microbial culture test. The level of significance was assessed using Fisher’s exact test, with tests considered significant at a p-value <0.05. Results: The duplex PCR assay demonstrated the best performance in terms of sensitivity and specificity, with no misidentifications found among non-pneumococcal strains for the CpsA and LytA genes. The assay was capable of detecting 6 CFU/mL of S. pneumoniae American Type Culture Collection (ATCC)® 49619™. The specificity of the developed Duplex PCR assay was 100% for both LytA and CpsA-specific genes. In total, 20% (n=15/75) of different clinical samples yielded positive results using the culture method. S. pneumoniae was isolated from 7 (9.3%) of sputum samples, 4 (5.3%) of blood cultures, 3 (4%) of cerebrospinal fluid (CSF), and 1 (1.3%) of pleural fluid samples, respectively, by conventional microbiological culture methods. Using the S. pneumoniae-specific Duplex PCR assay, 23 (30.7%) of samples tested positive for S. pneumoniae, as these samples exhibited amplification for both the LytA and CpsA genes. Of these, S. pneumoniae was detected in 9 (12%) of nasopharyngeal/oropharyngeal (NP/OP) swabs, 6 (8%) of sputum samples, 4 (5.3%) of blood cultures, 3 (4%) of CSF samples, and 1 (1.3%) of pleural fluid samples, respectively. The sensitivity, specificity, PPV and NPV of PCR for detecting S. pneumoniae in comparison with the culture method were 100%, 96.7%, 88% and 100%, respectively. Conclusion: The developed and optimised S. pneumoniae-specific Duplex PCR assay targeting the CpsA and LytA genes, as described in this study, is a powerful strategy that resulted in no false identifications. This significantly increases the sensitivity and specificity of pneumococcal identification compared to standard microbial culture and monoplex PCR assays targeting only a single gene.

Efficacy between Ultrasound Therapy and Fluoroscopy-guided Intra-articular Steroid Injection in L3-L4 and L4-L5 Facet Arthropathy: An Interventional Cohort Study

Subhadeep Batabyal, Saumen Kumar De, Tanvir Ahmed, Rathindra Nath Haldar Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Lumbar facet joint or Zygapophyseal Joint (ZJ) arthropathy is one of the common causes of low back pain, particularly prevalent at the L3-L4 and L4-L5 levels. Evidence shows the efficacy of Ultrasound Therapy (UST) and intra-articular steroid injections in lumbar facet arthropathy, but there is a paucity of data regarding the comparative efficacy between the two. Aim: To compare the efficacy of fluoroscopy-guided corticosteroid and local anaesthetic injection in the facet joint with UST in cases of L3-L4 and L4-L5 facet arthropathy. Materials and Methods: An interventional cohort study was conducted in the Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India, for 18 months, from April 2017 to September 2018. Participants aged between 18 and 70 years with unilateral chronic low back pain due to L3-L4 and L4-L5 facet arthropathy of more than six months duration were included in the study. A total of 17 participants in Group 1 received fluoroscopy-guided corticosteroid and local anaesthetic injections, while Group 2 (also consisting of 17 participants) received UST. Demographic variables such as age and gender, as well as clinical parameters including Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and lumbar range of motion (flexion), were assessed. UST was delivered over the L3-L4 and L4-L5 regions in continuous mode using a frequency of 3.0 MHz at 0.5 W/cm2, covering an area of approximately 100 cm2 and lasting for 5-10 minutes per session over six continuous days. Comparisons between groups were made using Student’s unpaired t-test, while within-group comparisons were analysed using repeated measures Analysis of Variance (ANOVA) for continuous variables. Fisher’s-exact test was used for categorical variables. A two-tailed p-value of <0.05 was considered statistically significant. Results: The groups were comparable in terms of age and gender distribution. The average ages were 47.76±11.06 years for Group 1 (intra-articular injection) and 48.12±11.35 years for Group 2 (UST). In Group 2, there were statistically significant changes in VAS, ODI and lumbar flexion scores from baseline to two weeks, four weeks and 12 weeks, but not from four weeks to 12 weeks. In the intergroup comparison, a significant improvement in VAS was observed at 12 weeks of follow-up. There was a statistically significant difference in ODI at only 12 weeks (p-value <0.001) of follow-up. A statistically significant difference in lumbar flexion measurements was found at only six weeks of follow-up. Conclusion: Both treatments are efficacious for short-term pain relief (up to four weeks). However, intra-articular facet joint injection demonstrates greater efficacy for long-term pain relief (up to 12 weeks).

Mild Cognitive Impairment and Hand Dexterity in Individuals with Type 2 Diabetes Mellitus: A Cross-sectional Study

Spoorthi Uday Shetty, Jayesh Chandran, Yughdtheswari Muniandy Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) presents various complications, but Mild Cognitive Impairment (MCI) has recently gained considerable attention due to its potential progression to dementia. Hand dexterity is highlighted as crucial for cognitive tasks, suggesting that even minor cognitive impairments can impact daily activities. Despite this, there has been no exploration of the relationship between MCI and hand dexterity in individuals with T2DM. Aim: To determine the relationship between MCI and hand dexterity in people with T2DM. Materials and Methods: This cross-sectional study included 45 diabetic patients aged 40-60 years from Justice KS Hegde Charitable Hospital in Mangaluru, Karnataka, India. The study was conducted from May 2023 to March 2024. Participants were recruited based on specific inclusion criteria and screened using tools such as the Semmes Weinstein Monofilament and the Montreal Cognitive Assessment (MoCA). Subsequently, selected participants underwent the hand dexterity test using the Box and Block Test (BBT) and their performance values were recorded. The categorical variables were presented as frequency and percentage. The continuous variables were presented as mean±SD. Correlation was performed using Pearson’s correlation coefficient. Linear regression was conducted for significant correlations. A p-value <0.05 was considered statistically significant. Results: Individuals in the study scored lower than expected values on both right and left hand tasks compared to normative scores. Moderate positive correlations were found between BBT scores and MoCA scores for both right (r-value=0.469, p-value=0.001) and left (r-value=0.516, p-value <0.001) hand tasks with p-value <0.05. Conclusion: The study reveals a significant positive correlation between BBT and MoCA scores. This suggests that hand dexterity is closely linked to cognitive function, emphasising the importance of integrating manual dexterity assessments into cognitive evaluations, particularly in populations where both motor and cognitive abilities are clinically relevant.

Efficacy of Low-level Laser Therapy on Motor Recovery and Functional Independence among Individuals with Incomplete Spinal Cord Injury: A Randomised Controlled Trial

Divya Rathore, Jasobanta Sethi, Chitra Kataria Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Incomplete Spinal Cord Injury (ISCI) results in permanent neurological deficits, leading to challenges in self-care, respiration, sphincter management, motor function and overall functional ability. Despite advancements in the treatment of spinal cord injuries, many individuals still experience motor deficits and struggle with functional independence, significantly lowering their quality of life and limiting their capacity for independent living. Low-Level Laser Therapy (LLLT) has been shown to be effective in neuroprotection, including cell regeneration, Schwann cell activation, cell growth, reduction of spasticity and improvement of various functions. However, its effectiveness in enhancing these functional domains in individuals with incomplete spinal cord injuries remains underexplored. Aim: To assess the effectiveness of LLLT on motor recovery and functional independence among individuals with ISCI. Materials and Methods: This randomised controlled trial was conducted at the Indian Spinal Injury Centre in Vasant Kunj under Amity University Noida from January 2023 to November 2024. A total of 104 participants who had suffered ISCI between six months to one year prior to enrollment and were classified as grade C or D were recruited. The experimental group received LLLT, while the control group received placebo LLLT on nine points around the fractured vertebrae. Both groups underwent conventional therapy. Evaluations were performed at baseline and after four weeks of intervention using amplitude-based surface Electromyography (EMG) on the lower extremities to assess motor recovery and the Spinal Cord Independence Measure (SCIM) to evaluate improvements in self-care, respiratory function, sphincter management and mobility. The normality of the data was checked using the Kolmogorov-Smirnov test. Paired t-tests and Independent t-tests were conducted within and between the groups, respectively, using a p-value of ≤0.05. Results: Both groups showed improvement; however, the experimental group demonstrated better improvement in EMG scores in the majority of the muscles of the lower extremity compared to the control group, suggesting a positive impact on motor recovery. SCIM scores indicated significant improvement within the groups, but non significant differences were found between the groups regarding self-care, respiratory function, sphincter management and mobility. Conclusion: The study indicated that LLLT had a positive effect on motor recovery and functional independence. These findings may serve as an effective measure for both clinicians and the patient community.

Early Active Mobilisation Protocol following Six-strand Core Repair for Flexor Tendon Injury: A Prospective Observational Study

Nemichand, R Chandan Kumar, Prashant Bahirani, Itisha Agrawal Sunil Sharma Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Flexor Tendon Injuries (FTIs) in Zones II-V pose significant functional challenges due to adhesion formation and loss of tendon gliding. Early Active Mobilisation (EAM) following six-strand core repair improves outcomes by enhancing tendon healing while minimising complications. Aim: To evaluate the efficacy of EAM after six-strand flexor tendon repair by assessing functional recovery, grip strength and complications. Materials and Methods: A prospective observational study was conducted over 18 months at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India involving 38 patients (aged 18-60 years) with complete flexor tendon lacerations in Zones II-V. All patients underwent a six-strand modified Kessler repair and received postoperative immobilisation in a dorsal splint. EAM was initiated on postoperative day 2, following the Belfast and Sheffield Mobilisation Protocol. Functional outcomes were assessed at 6, 8 and 12 weeks using the Buck-Gramcko II criteria, grip strength was measured using a Jamar dynamometer and pain was evaluated using a Numeric Pain Rating Scale (NPRS). Descriptive statistics were presented as means/standard deviations and medians/interquartile ranges (IQRs) for continuous variables, as well as frequencies and percentages for categorical variables. Group comparisons for categorical variables were conducted using the Chi-square test. Results: The mean age of patients was 26±5.5 years for females and 32±9.9 years for males. The study population comprised 30 males (78.95%) and 8 females (21.05%), with an age range of 18-60 years. The majority of injuries occurred in Zone V, involving 22 patients (57.89%). At 12 weeks, 20 patients (52.63%) achieved excellent outcomes, 13 patients (34.21%) had good outcomes, 3 patients (7.90%) had fair outcomes and 2 patients (5.26%) had poor outcomes. Most patients, i.e., 32 (84.21%), resumed work at six weeks. Grip strength improved to over 56 kg in 84.21% of cases and pain scores progressively decreased. Complications were minimal, with 1 patient (2.63%) experiencing a wound infection and 1 patient (2.63%) with skin necrosis; there were no tendon ruptures. Conclusion: EAM following six-strand flexor tendon repair is a safe and effective approach that promotes optimal functional recovery, reduces adhesions and facilitates an early return to work.

Comparison of Clonidine versus Gabapentin as an Oral Premedication on Haemodynamic Response to Laryngoscopic and Tracheal Intubation in ENT Surgeries: A Double Blind, Randomised Clinical Study

Priya Kishnani, Devendra Joshi, Tejash H Sharma, Dinesh K Chauhan Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Laryngoscopy and tracheal intubation are recognised as potent stimuli which cause significant haemodynamic responses. Various pharmacological strategies have been employed to attenuate the haemodynamic responses associated with this, including opioids, beta-blockers, calcium channel blockers, and α-2 adrenergic agonists. Aim: The present study aimed to compare the efficacy of oral clonidine versus oral gabapentin in attenuating haemodynamic responses during laryngoscopy and endotracheal intubation. Materials and Methods: The present study was a double blinded, randomised clinical study and it was conducted at Dhiraj Hospital from April 2024 to April 2025. The study was approved by the Institutional Ethics Committee (SVIEC/ON/Medi/SRP/April/24/76) and registered with Clinical Trials Registry - India (CTRI/2024/10/075366). Sixty patients aged 18-60 years of American Society of Anaesthesiologist physical status I-II, posted for elective surgeries under general anaesthesia were randomised into two groups (n=30 each): Group Dg received oral gabapentin 800 mg and Group Dc received oral clonidine 0.2 mg, 30 minutes prior to induction. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were noted at baseline, after medication, after induction, during intubation, and at 1, 3, 5, and 7 minutes post-intubation. Data were analysed using unpaired Student’s t-test for numerical variables and Chi-square test for categorical variables. Statistical significance was set at p<0.05. Results: Demographic profiles were comparable between groups. The mean age of patients was 39.97±9.92; 44.23±11.72 years (p=0.13), gender distribution showed 46.67%; 36.67% males (p=0.43), ASA I physical status 66.67%; 70% (p=0.78) in Group Dg and Group Dc, respectively. During intubation, HR was 91.83±6.84 bpm; 97.10±11.38 bpm, p=0.0338 in Group Dc and Group Dg, respectively. During intubation, 1, 3, 5 and 7 minutes post-intubation, SBP (143.20±7.30: 127.73±5.06, 137.40±7.22: 118.03±6.36, 131.33±5.93: 108.70±8.16, 127.80±6.65: 105.87±9.73, 123.73±6.33: 104.27±8.74, p<0.0001), DBP (105.23±6.04: 87.33±8.87, 102.23±5.30: 87.50±6.31, 98.77±5.26: 81.97±6.71, 94.83±5.76: 76.63±7.42, 91.33±6.21: 70.27±8.13) in Group Dc and Group Dg, respectively. Conclusion: Oral clonidine is better than oral gabapentin at reducing the HR and especially the blood pressure spikes that occur during laryngoscopy and endotracheal intubation for general anesthesia. This makes clonidine a potentially better choice for premedication, particularly for patients at higher risk of heart problems.

Influence of Ergonomic Breastfeeding on Risk of Developing Musculoskeletal Disorders on Lactating Mothers and Quality of Infant’s Latch: A Quasi-experimental Study

Aditi Prayag, Salima Bijapuri, Shweta Bhatbolan, Suma Patil, KB Komal, Navami Mahaveer Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Breastmilk is recognised as the best infant nutrition, but Exclusive Breastfeeding (EBF) rates remain as low as 63.7% in India and 48% worldwide. One barrier is the development of Musculoskeletal Disorders (MSDs) in postpartum mothers due to a lack of education on proper breastfeeding posture. These factors can impact the quality of the infant’s latch, resulting in early cessation of breastfeeding. Aim: This study aimed to assess the impact of ergonomic breastfeeding on the risk of developing MSD in lactating mothers and infant latch quality. Materials and Methods: The present quasi-experimental study was conducted in SDM Hospital, Dharwad, Karnataka, India, from August 2022 to January 2024, involving 70 participants. Postpartum mothers were evaluated to determine if they met the inclusion criteria. Baseline information was gathered, including the assessment of infant mouth attachment and effective suckling using the World Health Organisation (WHO) B-R-E-A-S-T feed observation form and Rapid Upper Limb Assessment (RULA). Mothers received ergonomic education on the advisable breastfeeding position during each session. On the discharge day, the mothers were reassessed. Statistical methods such as the Chi-square test, Wilcoxon matched pair test, and Mann-Whitney U test were used, with significance set at a p-value of <0.05. Results: Seventy lactating mothers participated, with a majority above 25 years 40 (57.14%) and multiparous 38 (54.3%). Cradle hold was the most preferred breastfeeding posture 56 (80%). Postintervention, significant improvements (73.23%) were noted in infant attachment and suckling scores (mean increase 5.47, p<0.0001) and maternal posture as per RULA scores for both right (2.41±1.47) and left side (2.54±1.39). No significant association was found with delivery type. Conclusion: Ergonomic breastfeeding education reduces MSD risk and promotes effective infant latch. This highlights the essential role of physiotherapists in promoting effective breastfeeding ergonomics and preventing musculoskeletal issues in postpartum mothers, irrespective of the type of delivery or parity.

Mandibular Flexure and its Impact on the Biomechanics of Implant-supported Prostheses: A Systematic Review

Mahima Agrawal, Anjali Borle, Surekha Godbole, Rushikesh Kalpande Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Mandibular flexure, a biomechanical phenomenon that occurs during functional mandibular movements, greatly influences the biomechanics of implant-supported prostheses. The rigid connection between implants and prosthetic frameworks affects stress distribution and may increase peri-implant bone stress, as well as impact the stability of the prostheses. Aim: To integrate the literature on the current research regarding the impact of mandibular flexure on the biomechanics of implant-supported prostheses. Materials and Methods: The present review assessed studies investigating mandibular flexure and its impact on implant-supported prostheses using the following keywords: “mandibular flexure,” “implant-supported prostheses,” “Finite Element Analysis (FEA),” “Cone Beam Computed Tomography (CBCT),” and “peri-implant bone loss.” Data were extracted from clinical, radiographic, in-vivo, and FEA studies. Outcomes included stress distribution, peri-implant bone loss, prosthetic failure, and material performance. A structured analysis was performed to identify patterns across variables such as framework design, implant placement, loading conditions, and biomechanical methods. Nine studies were included in the review. Results: Across the nine studies included in the review, mandibular flexure significantly impacted the distribution of stress around the implant, with magnitudes of stress ranging from 0.073 mm deformation in brachyfacial types to 300 N in specific loading scenarios. Segmented frameworks reduced stress by up to 20% compared to non segmented designs. Bone loss was most pronounced in distal implants, with rates exceeding 15% in high-stress regions. Material performance varied, with titanium and cobalt-chromium frameworks showing superior biomechanical stability compared to polymeric alternatives. Dynamic and oblique loading conditions caused higher stress concentrations than static loading. Conclusion: Mandibular flexure affected implant-supported prostheses by altering stress distribution and increasing bone loss around the implants, especially in distal areas. Framework segmentation and material optimisation proved to be effective in mitigating these effects. These results highlight the importance of individualised biomechanical solutions to improve the longevity of prostheses and clinical outcomes.

An Investigation of Physiotherapy Interventions in the Management of Lower Cross Syndrome: A Literature Review

Vaishali Rai, Sandeep Pattnaik Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Lower Cross Syndrome (LCS), characterised by muscular imbalances with weak gluteals/abdominals, tight hip flexors/lumbar extensors, contributes to a range of musculoskeletal complications. Physiotherapy interventions have been its primary treatment modality. Given the increasing prevalence of sedentary lifestyles and the availability of diverse physiotherapy interventions,there is a critical need to understand the most effective physiotherapy interventions for managing LCS. This literature review, therefore aims to investigate the effectiveness of various physiotherapy interventions in managing LCS. To achieve this, an extensive search for full-text articles addressing the role of physiotherapy intervention for the treatment of LCS, published in the English language between 2019 and 2024, was thus carried out through the databases PubMed, EMBASE, Cochrane Library, PEDro and EBSCOhost using a combination of keywords, including 'Lower Cross Syndrome,' 'Postural Disorder,' 'Exercise Therapy,' and 'Physiotherapy,' and Boolean operators to refine the search strategy.No geographical limitations or study design restrictions were applied for study inclusion. Following the comprehensive search, a total of 5 randomised clinical/control trials and 2 experimental studies met the eligibility criteria. The study population comprised males and females aged between 11 and 50 years. The physiotherapeutic interventions included 6 to 24 sessions of conventional physiotherapy involving stretching and strengthening exercises and the use of specific manual therapy techniques like Janda’s approach, Sahrmann’s approach, muscle energy technique, proprioceptive neuromuscular facilitation technique, dynamic neuromuscular stabilisation training, and lacrosse ball massage technique. The effectiveness of these interventions was assessed using outcome measures, including the Oswestry Low Back Pain Disability Questionnaire for functional disability, Modified Thomas test and goniometry for hip flexibility, sit-and-reach test for overall flexibility, visual analogue scale and numeric pain rating scale for pain, manual muscle testing for abdominal and gluteal strength, Y-balance test and functional movement screening for postural control, McGill Pain Index and plank test for muscle function, and clinical measurements such as costovertebral angle, lumbosacral angle, and anterior pelvic tilt for postural assessment. Findings suggest that physiotherapy plays a crucial role in LCS management. A comprehensive approach encompassing strengthening, stretching, manual therapy, and patient education is recommended. Future research should focus on standardised protocols and long-term outcomes to enhance treatment efficacy.

The Role of Transcranial Direct Current Stimulation in Managing Pain and Enhancing Mobility in Knee Osteoarthritis: A Narrative Review

Yashasvi Parmar, Sunita Sharma, Vanshika Uppal Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Knee osteoarthritis (OA) is a common condition characterised by chronic pain and reduced mobility, particularly in the elderly population. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, has proven to be a promising intervention in managing OA. This narrative review aims to synthesize existing evidence on the effectiveness of this intervention in patients with OA, with a primary focus on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale as a key outcome.A comprehensive literature search was conducted in PubMed and Scopus databases from 2017 to 2024 to identify studies that investigated various aspects of tDCS, including its effects on clinical and experimental pain, neurophysiological mechanisms, combination therapies, and feasibility in different settings, according to predefined eligibility criteria. The review summarises findings from randomised controlled trials and pilot studies. Evidence indicates that tDCS over the primary motor cortex with the cathode over the contralateral supraorbital area effectively reduces pain severity, enhances pain modulation mechanisms, and improves mobility in knee OA patients. The findings highlight that tDCS improves functional outcomes as measured by WOMAC and benefits in clinical and experimental pain modulation. Preliminary findings are promising, necessitating large-scale trials to optimise protocols, address inconsistencies, and assess long-term effects. This review underscores the clinical relevance of using tDCS in managing OA and identifies gaps for future research, in long-term efficacy and standardised protocols.

Prevalence of Retained Primitive Reflex among Healthy Preschool going Children

Yukta Sharma, Akanksha Saxena, Mandeep Jangra Journal of clinical and diagnostic research : 2025 - September - 19:0973-709X Introduction: Primitive reflexes are brainstem-mediated involuntary movements, emerging around the 25th week of pregnancy and fading by six months, supporting motor development. Cortical maturation inhibits these reflexes via motor control pathways. Persistent reflexes may signal neurological conditions like cerebral palsy or milder issues such as learning difficulties. Improper integration can affect motor skills, coordination, behaviour, and learning. Aim: To investigate the prevalence of persisting brainstem-mediated reflexes like Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR) and Tonic Labyrinthine Reflex (TLR) among preschool going children. Materials and Methods: This observational study includes 240 school-going children of age 4-6 years from two different schools of Ambala and Punjab and they were screened for persistence of primitive reflex using the Sally Goddard Institute for Neuro- Physiological Psychology battery reflex test. Results: This study showed the maximum persistence/prevalence of right ATNR (83%), whereas extension STNR had the low prevalence rate of (46%). Left ATNR had the prevalence of 78%, extension TLR had 47% prevalence rate, and flexion STNR and flexion TLR had 65% prevalence of persistence. Conclusion: Persistence of ATNR is maximum where as persistence of STNR and TLR has low prevalence. Early screening and interventions to address persistent reflexes like reflex integration therapy can be used to avoid the neurological impairments like attention, reading, coordination, learning difficulties, inability to perform motor tasks and gait impairments which can prevent developmental delay.

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