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

A Case of Angioimmunoblastic T-Cell Lymphoma

Kanchan Dasharthrao Devde, Amol Gajanan Andhale, Amol Shankar Dongre, Himanshi Kaushik, Prerna Tekulware Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Angioimmunoblastic T-cell Lymphoma (AITL) is a rare type of peripheral T-cell lymphoma characterised by an aggressive clinical course and a poor response to current therapies. There is currently no standard of care for treatment. A case of a 59-year-old male with a history of diabetes mellitus and hypertension presented to the emergency department with chief complaints of intermittent fever, difficulty walking, and generalised weakness. The patient was evaluated for these complaints, and a general examination revealed multiple cervical, axillary, and inguinal lymphadenopathy. Further evaluation with a Positron Emission Tomography-Computed Tomography (PET-CT) scan showed Fluorodeoxyglucose (FDG) uptake in the bilateral cervical and supraclavicular lymph nodes. A biopsy of a cervical node revealed sheets of intermediate-sized lymphoid cells, with a few scattered large cells and macrophages, favoring a diagnosis of lymphoma. Further Immunohistochemistry (IHC) was required to determine the final diagnosis. IHC results were positive for CD3, CD2, CD10, PD1, ICOS, CD7, and CD4, which further supported the diagnosis of AITL. The patient was then planned for chemotherapy with the Cyclophosphamide, Adriamycin, Oncovin, and Prednisolone (CHOP) regimen on a 21-day cycle. After four cycles of the CHOP regimen, the patient presented with abdominal distention and bilateral lower limb swelling, requiring multiple blood transfusions due to low haemoglobin levels. Bone marrow biopsy findings suggested hypocellular marrow with atypical lymphoid cells, indicating progression of the disease. The patient was subsequently planned for second-line chemotherapy, considering the patient’s poor performance status, with the single agent Azacitidine. The patient was also advised to undergo Epstein Barr Virus (EBV) testing but was lost to follow-up due to poor performance status.

Anaesthetic Management of a 75-Year-Old Male with Multiple Comorbidities and Adrenal Adenoma Undergoing Robotic Nephrectomy: A Case Report

Shilpa Kore, Anushka Sharma Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Elderly patients with multiple associated comorbidities undergoing urological surgery present significant pre-operative challenges in anaesthetic management. The case discussed in this report involves a 75-year-old male with hypertension, bronchial asthma, and a history of stroke, who was diagnosed with a left renal mass and a right adrenal adenoma. Pre-operative assessment revealed high blood pressure, left-sided weakness, and multiple respiratory and cardiovascular abnormalities. Combined general and epidural anaesthesia was administered to the patient. Intraoperatively, significant haemodynamic fluctuations were observed during the manipulation of the tumour, which were successfully managed with vasoactive medications and epidural analgesia. Postoperatively, the patient was transferred to the surgical intensive care unit for monitoring and had an uneventful recovery. This case report focusses on pre-operative evaluation, intraoperative monitoring, and the use of multimodal anaesthesia in high-risk elderly patients. The haemodynamic instability during tumour manipulation indicated the presence of a catecholamine-secreting tumour, making it crucial to monitor vital signs and intervene promptly. Successful anaesthetic management requires thorough preparation and individualised anaesthetic planning for elderly patients undergoing robotic nephrectomy. Combined general and epidural anaesthesia provides effective pain management and haemodynamic stability.

Diagnostic Pitfalls and the Critical Role of Excisional Biopsy in Non-Hodgkin’s Lymphoma: A Case Report

Megha Doiphode, Priya Elangbam, Apurva Jarandikar, Gundappa D Mahajan, Vinod Shinde Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Lymphomas often pose significant diagnostic challenges, particularly when they present with atypical clinical features that can mimic other conditions. This complexity can lead to delays in accurate diagnosis and appropriate treatment. A 30-year-old female patient presented with a recurrent swelling in the cervical region. Despite multiple Fine Needle Aspiration Cytologies (FNACs) performed on the swelling, the diagnosis remained unclear and initial results were misleading. These cytological evaluations failed to definitively identify lymphoma, contributing to a delay in establishing the correct diagnosis. The present highlights common diagnostic pitfalls encountered in lymphoma detection, especially when relying solely on minimally invasive procedures like FNAC. While FNAC is a useful initial tool for evaluating lymphadenopathy, it has limitations in distinguishing lymphoma from reactive or other malignant processes due to sampling error and cytological overlap. Consequently, an excisional biopsy, which provides a larger tissue sample for detailed histopathological and immunohistochemical analysis, is essential for accurate diagnosis. This approach allows for a comprehensive examination of tissue and cellular characteristics, which are critical for classifying lymphoma subtypes and guiding treatment decisions. Despite advances in less invasive diagnostic techniques, histopathological examination of excised tissue remains the gold standard for definitive diagnosis in suspected lymphoma cases. Clinicians should maintain a high index of suspicion and proceed to excisional biopsy promptly when lymphoma is suspected but FNAC results are inconclusive, to avoid delays in diagnosis and improve patient outcomes.

A Case of Pyogenic Granuloma in the Middle Ear: An Uncommon Clinical Entity

Vinod Shinde, Saahiti Koppolu, Megha Doiphode, Yash Kalra Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Pyogenic Granuloma (PG) is a benign vascular lesion that typically appears following trauma or irritation. It may also develop in individuals with immunosuppression or as a result of other unclear mechanisms that encourage angiogenesis and vasculogenesis. It is also known as lobular capillary hemangioma, as the endothelial cells are arranged in a characteristic pattern of circumscribed capillaries positioned in lobules. About one-third of PGs are found in the head and neck region, although they are rarely seen in the middle ear. Hereby, the authors present a case of a 60-year-old female patient who presented with ear pain and ear discharge in the right ear. She had a history of a right-sided modified radical mastoidectomy performed six months prior, which was aborted intraoperatively due to profuse bleeding. The histopathological report from that surgery was suggestive of a symplastic glomus tumour. Authors excised the middle ear mass in toto with subtotal petrosectomy, considering the diagnosis of a symplastic glomus tumour, and to authors surprise, the subsequent histopathological report suggested a PG of the middle ear cavity. Hence, the present case highlights the importance of considering PG in the differential diagnosis for previously operated patients with a history of blood-tinged ear discharge and otalgia.

Infraclavicular Spindle Cell Haemangioendothelioma Mimicking Peripheral Nerve Sheath Tumour: A Case Report

Ashish Jivani, Raju Shinde, Sangita Jogdand, Dhwani Mavani, Apoorva Pande Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Haemangioendotheliomas are rare vascular tumours that exhibit a biological spectrum intermediate between benign haemangiomas and highly malignant angiosarcomas. The malignant variant, Spindle Cell Haemangioendothelioma (SCH), typically presents in soft tissues and is particularly uncommon in the infraclavicular region. Hereby, the authors present an unusual case of SCH, initially misdiagnosed as a nerve sheath tumour, and successfully managed with surgical excision. A 32-year-old female presented with progressive swelling of the right upper limb for the past six months, along with a mass in the right infraclavicular region that had been enlarging for four months. Imaging studies suggested a Peripheral Nerve Sheath Tumour (PNST), and a Tru-cut biopsy indicated a benign spindle cell lesion. Surgical excision was performed, and Histopathological Examination (HPE) confirmed the diagnosis of haemangioendothelioma (spindle cell subtype). The postoperative course was uneventful, and Adjuvant Radiotherapy (RT) was initiated due to positive tumour margins. RT was well tolerated, and the patient was asymptomatic at the six-month follow-up. Thus, although rare, malignant haemangioendothelioma should be considered in the differential diagnosis of soft tissue masses near vascular structures.

Aggressive Angiomyxoma of the Vulva Mimicking a Benign Mass: A Case Report

Priyanka Bahl, Varun Shetty, Iqbal M Ali Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Aggressive Angiomyxoma (AA) is a rare, slow-growing mesenchymal neoplasm predominantly affecting women of reproductive age, characterised by local infiltration and a high recurrence rate. The present case presents a 32-year-old woman with a vulvar mass persisting for three years, initially misdiagnosed as a Bartholin’s cyst upon clinical examination. Magnetic Resonance Imaging (MRI) revealed a well-defined, hyperintense mass on T2-weighted imaging with a characteristic laminated internal architecture, displacing adjacent structures with limited invasion of the underlying musculature and without significant infiltration of the urogenital diaphragm or pelvic organs. Complete surgical excision was achieved with a margin of 1 cm. Histopathology demonstrated a sparsely cellular myxoid tumour composed of spindle and stellate cells in a loose matrix with prominent vasculature. Immunohistochemical analysis showed strong positivity for Oestrogen Receptors (ER) and Progesterone Receptors (PR), vimentin and focal desmin, while S-100 expression was negative. Given the hormone receptor profile, the patient was initiated on adjuvant Gonadotropin-Releasing Hormone (GnRH) agonist therapy to reduce recurrence risk, administered once a month for 12 months. She remained recurrence-free at six-month follow-up. The present case underscores the diagnostic challenge posed by AA, which can closely resemble benign lesions such as Bartholin’s cysts and fibroepithelial polyps, as well as malignant neoplasms like myxoid liposarcoma, necessitating a high index of suspicion and thorough histopathological evaluation for accurate diagnosis. Accurate diagnosis requires integration of clinical, radiological and histopathological findings. The infiltrative nature of the tumour, despite its bland cytology, necessitates complete resection and prolonged surveillance. Hormonal therapy represents a valuable adjunct in receptor-positive cases, especially when surgical margins are uncertain or complete excision is infeasible.

Retrograde Intubation in a Challenging Airway Scenario: A Case Report

Utkarshini Kedia, Reema Hemant Jawale Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Retrograde intubation is a valuable technique for airway management in situations where conventional intubation is difficult or when fiber-optic bronchoscopy is unavailable. It involves introducing a guidewire through the cricothyroid membrane and retrieving it via the mouth or nostril to facilitate endotracheal tube placement. Initially described by Butler and Cirillo in 1960 and refined by Waters in 1963, it remains a practical option in select clinical scenarios. This case report describes a 35-year-old male with carcinoma of the buccal mucosa involving the gingivobuccal sulcus and retromolar trigone, who had a 15-year history of tobacco chewing. He was scheduled for commando surgery with a pectoralis major myocutaneous flap. Airway assessment revealed restricted mouth opening (0.5 cm), Mallampati grade IV, and patent nostrils, rendering standard oral intubation unfeasible. Under mild sedation, retrograde intubation was planned. An 18G Tuohy needle was inserted through the cricothyroid membrane, and a soft-tip ureteric guidewire was passed and retrieved through the nostril. A 7.0 mm cuffed flexometallic endotracheal tube was threaded over the guidewire. Successful placement was confirmed by capnography and chest auscultation. The patient remained stable and cooperative throughout the procedure and was extubated uneventfully the following day. This case highlights retrograde intubation as an effective and safe alternative for managing anticipated difficult airways when other advanced tools are unavailable.

Anaesthetic Management of a Patient with Atrial Fibrillation and Post Double Valve Replacement Undergoing Elective Nephrectomy: A Case Report

Kshitija Devendra Bora, Sheetal Jayakar, Sahil Arora, Manoj Krishna Yarlagadda Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X The coexistence of Atrial Fibrillation (AF) and a bioprosthetic Double Valve Replacement (DVR) presents a significant perioperative challenge, especially in elderly patients undergoing non cardiac surgery. AF, when associated with a low Ejection Fraction (EF) and anticoagulation therapy, significantly increases the risk of thromboembolism, haemodynamic instability, and arrhythmias during surgery. The perioperative management of a 71-year-old man with persistent AF and prior bioprosthetic DVR, scheduled for left nephrectomy for a non functioning kidney. The case is unique due to the high cardiovascular risk profile, including New York Heart Association (NYHA) class II symptoms, EF of 35%, and chronic anticoagulation therapy. Preoperative evaluation included transthoracic echocardiography and risk stratification using the CHA₂DS₂-VASc score. Antiplatelet therapy was appropriately withheld, and bridging anticoagulation with low molecular weight heparin was administered. Intraoperatively, the patient developed sudden hypotension following lateral positioning, which was promptly managed with vasopressors. Later, the patient developed unstable AF with hypotension requiring synchronised cardioversion. An epidural catheter was placed for analgesia under strict coagulation monitoring, and the procedure was completed successfully with vigilant monitoring. Postoperatively, the patient was electively ventilated, anticoagulation was resumed safely, and sinus rhythm was maintained. He made an uneventful recovery and was discharged on postoperative day 9. This case emphasises the need for individualised anaesthetic strategies, guideline-based anticoagulation management, and interdisciplinary collaboration in high risk cardiac patients undergoing non cardiac surgery. It also highlights the successful perioperative handling of AF and valve prosthesis-related challenges using appropriate scoring systems, monitoring, and intervention protocols.

A Case of Denture Marking: A Tool in Forensic Dentistry

Namita Rajesh Zilpilwar, Sharayu Vinod Nimonkar, Surekha Godbole Dubey, Arti S Agrawal, Vikram Belkhode Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Dr. Robert H. Griffiths, while serving as the president of the American Dental Association, highlighted the need for denture identification. Compared to tagging already existing dentures, adding identification during the denture packaging and processing is relatively simple. Identifying a body that has been retrieved following an accident or natural disaster is crucial. In medical malpractice lawsuits, denture marking plays an important role in the administration of justice. Essentially, denture marking serves identification purposes, including engraving distinctive and differentiating marks on the dentures. Dental prosthesis marking has long been regarded as a crucial component of forensic dentistry. Denture identification systems are beneficial for patients in medical-legal cases as well as for those receiving treatment in hospitals, assisted living centers, and other healthcare settings. This case report describes a straightforward technique for incorporating a QR code in dentures. After scanning the QR code, it provides important patient details such as name, address, emergency contact number, etc.

Acute Ischaemic Stroke Associated with Chilaiditi Syndrome Pilot Complexities: A Case Report

Amol Gajanan Andhale, Kanchan D Devde, Tushar Patil, Mathakala Aparna, Aakriti Vij Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X In the clinical setting, the concurrent occurrence of Acute Ischaemic Stroke (AIS) and an uncommon gastrointestinal disorder such as Chilaiditi Syndrome demonstrates the intricacies of diagnosing and treating more than one medical condition. Such a situation requires a concerted, multidisciplinary effort to achieve successful treatment and better patient outcomes. This specific case involves a 54-year-old male who presented to the doctor complaining of an acute onset of giddiness, dyspnoea, and shortness of breath. An urgent diagnostic workup through Magnetic Resonance Imaging (MRI) confirmed the AIS, calling for immediate intervention to prevent further neurological damage. Concurrently, routine chest X-rays uncovered Chilaiditi Syndrome, which is defined by the improper placement of the colon between the liver and diaphragm. While this syndrome may be asymptomatic and incidental, its existence complicates the overall medical picture, particularly when gastrointestinal symptoms overlap or interfere with stroke treatment. The patient’s management plan was meticulously crafted, with close monitoring of blood pressure and the use of antiplatelet drugs to treat the stroke. At the same time, the gastrointestinal manifestations of Chilaiditi Syndrome were medically managed. This coordinated care, made possible by a team of experts including neurologists and gastroenterologists, highlights the value of holistic care. The case emphasises the importance of identifying and managing concurrent conditions through teamwork. Medical professionals must address both urgent and ancillary medical issues to maximise patient care and improve recovery potential in complicated clinical situations.

Polypoid Presentation of Neuroendocrine Tumour of Stomach: A Case Report

Devendra Yadav, Jayesh Khadse, Chaitanya Mahajan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Neuroendocrine Neoplasms (NENs) are rare epithelial tumours with neuroendocrine differentiation. We report a case of a 35-year-old female presenting with abdominal pain, haematemesis, and melena for four months. Clinical examination revealed generalised tenderness. Endoscopic Ultrasound (EUS) showed a well-defined, hyperechoic lesion in the third to fourth gastric wall layers, and Fine-Needle Aspiration Biopsy (FNAB) confirmed a well-differentiated Neuroendocrine Tumour (NET G2). Ga-68 DOTATATE Positron Emission Tomography-Computed Tomography (PET-CT) demonstrated a polyp on the posterior wall of the stomach with intense somatostatin receptor expression, localised to the gastric lesion with no evidence of distant metastasis. The patient underwent laparoscopic wide local excision with intraoperative endoscopic tumour localisation. Histopathology confirmed a well-differentiated NET. Gastric NETs, especially in young adults, are rare, and early multimodal diagnosis using imaging, histopathology, and molecular markers is crucial. This case underscores the importance of a multidisciplinary approach for effective management and the potential for positive outcomes in localised gastric NETs.

Unveiling the Rare Facets of Oral Manifestations of Radial Ray Syndrome: A Case Report

V Balajee, TN Uma Maheswari Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Radial Ray Syndrome (RRS) is a rare congenital anomaly characterised by non progressive horizontal ophthalmoplegia and various systemic features, including abnormalities of the thumb, radial-sided carpals, and metacarpals. To date, there are not many documented cases that report oral manifestations associated with RRS. Hereby, the authors present a case of an 18-year-old female diagnosed with RRS. The patient exhibited skeletal Class III malocclusion, with maxillary retrusion and mandibular protrusion, counter-clockwise mandibular rotation, asymmetrical mandibular condyles, and multiple dental caries. A posteroanterior X-ray revealed asymmetry in the craniofacial structure. This case report aims to highlight the oral manifestations observed in a patient with RRS.

Bilateral Non-syndromic Eumorphic Incisiform Supplemental Primary Teeth with Unilateral Permanent Supernumerary Teeth: A Rare Case Report

Umapathy Thimmegowda, Chinmaya Gowdru Jayadevappa, Priyanka Nagraj, Praveen Malavalli Nagarajshetty Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X The dental developmental anomaly known as hyperdontia or supernumerary teeth is characterised by the development of teeth additional to the normal series. Hyperdontia is uncommon in primary dentition but occurs frequently in permanent dentition. Developmental anomalies related to the number of teeth can affect any area of the dental arches and are generally linked to several disorders, including Cleidocranial dysplasia, Gardner’s syndrome, Down syndrome, etc. It is rarely seen in non-syndromic associations. The prevalence of eumorphic supplemental teeth in primary dentition has not been extensively studied worldwide, and the statistics reported in the dental literature are inconsistent. Bilateral occurrences of supplemental central incisors are very rare. The article presented here describes the uncommon occurrence of non-syndromic bilateral supplemental central incisors in the primary dentition, along with unilateral supernumerary teeth in a six-year-old female patient.

Simple Bone Cysts with Pathological Fracture in the Left Distal Femur: A Case Report

RS Monish Anand, E Dilip Kumar Naidu, N Gowthaman, J Kevin Dhas, R Madhan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Simple Bone Cysts (SBCs), also known as unicameral bone cysts are the most common lytic benign lesions occurring in children and adolescents. These lesions can be incidentally found but commonly present to us with pathological fractures, necessitating individualised treatment plans. A 15-year-old adolescent female presented with a history of a minor fall at home, resulting in an injury to the left lower limb. The fall caused left thigh pain and difficulty bearing weight on her affected limb. The pain had an abrupt onset, was non progressive and non radiating, and worsened with movement of the left lower limb. The patient also reported a one-year history of swelling in her left thigh, which had a gradual onset and progression but was not associated with pain. An open biopsy performed at an external hospital confirmed the presence of SBC occupying the distal 3rd of the left femur. The management of SBCs requires a patient-specific approach that considers both the clinical and radiological features. In the present case, surgery was indicated because the Mirels’ score was 11. Surgical intervention is the preferred treatment option for symptomatic benign tumors, such as SBCs, as it generally leads to favourable postoperative outcomes.

Bowel Obstruction Unveiling the Hidden Burden of Polycystic Kidney Disease: A Case Report

Viraj Gupta, Gaurav Mishra, Pratap Singh Parihar, Ravishankar Patil, Saraswathula Bharadwaj Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Polycystic Kidney Disease (PKD), particularly Autosomal Dominant Polycystic Kidney Disease (ADPKD), is a genetic disorder that can lead to kidney enlargement and, ultimately, End-Stage Renal Disease (ESRD). The enlargement of these cysts can exert pressure on adjacent structures, including the gastrointestinal tract, which can lead to a range of gastrointestinal complications, including bowel obstruction. We describe the presentation of a 58-year-old male with Chronic Kidney Disease (CKD), hypertension, anaemia, and hepatitis B, who developed symptoms of weakness, somnolence, vomiting, and anorexia. Upon examination, the patient exhibited signs of dehydration and altered mental status without acute abdominal pain. Blood tests revealed worsening renal function, electrolyte imbalances, and anaemia. Imaging demonstrated significant intestinal distension due to mechanical obstruction, most likely caused by compression from large cysts associated with ADPKD. The patient was managed with fluid and electrolyte replacement, continuous dialysis, and monitoring of mental status. An interventional radiology procedure was performed to relieve the obstruction through percutaneous pigtail drainage of the right lower pole cyst. A surgical consultation was sought for potential intervention. This case report highlights the often-overlooked gastrointestinal complications of ADPKD, emphasising bowel obstruction as a hidden burden of the disease and the importance of early diagnosis and a multidisciplinary approach to prevent the deterioration of the patient’s condition.

Entangled Aetiologies: A Case Report on Post Extraction Arteriovenous Malformation in Pregnancy

Sagar Sanjay Rane, Nitin Dharampal Bhola, Sanjana Wadewale Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Arteriovenous Malformations (AVMs) are rare, high-flow vascular anomalies characterised by abnormal shunting between arteries and veins. These lesions present unique challenges in diagnosis and management due to their complex vascular anatomy, tendencies for recurrence, and potential complications. This case report discusses a 26-year-old postpartum female presenting with an AVM in the mandible, following a dental extraction during the second trimester of pregnancy. The lesion was initially managed conservatively with embolisation during pregnancy but showed significant progression postpartum, necessitating a multidisciplinary approach. Preoperative embolisation was performed using glue and Lipiodol, targeting branches of the right internal maxillary and facial arteries. This was followed by surgical resection and reconstruction using free fibula osteocutaneous grafts to restore function and aesthetics. Pathological examination confirmed the characteristics of an AVM, including fragmented elastic lamina and endothelial hyperplasia. This case underscores the importance of combining advanced diagnostic imaging, timely embolisation, and surgical intervention with aesthetic reconstruction to achieve optimal outcomes. Despite the unclear aetiology-whether trauma-induced, hormonally influenced, or congenital-the patient experienced favourable functional and aesthetic results with no recurrence at four months of follow-up. This report highlights the complexity of AVM management and reinforces the necessity of a multidisciplinary, multimodal approach for these challenging lesions.

Anaesthetic Management of a Patient with Dilated Cardiomyopathy Undergoing Ureteroscopic Lithotripsy: A Case Report

Sweta Gajapure, Vivek Chakole Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Patients with severely compromised left ventricular systolic function undergoing non cardiac surgery present a significant anaesthetic challenge, particularly when the Ejection Fraction (EF) is critically low. Dilated Cardiomyopathy (DCM), characterised by progressive ventricular dilation and impaired myocardial contractility, increases the risk of perioperative instability, arrhythmias and postoperative decompensation. The present case involves a 65-year-old female with long-standing hypertension and Type 2 Diabetes Mellitus (T2DM), who was non compliant with her medications. She developed right flank pain, intermittent fever and vomiting. Imaging revealed a perinephric collection requiring drainage, after which she was scheduled for right ureteroscopic lithotripsy and Double J (DJ) stenting. The present case is notably complex due to her severely reduced EF of 15%, documented regional wall motion abnormalities and moderate valvular regurgitation. Anaesthetic management required careful preoperative planning, including echocardiographic assessment and nephrology consultation. Etomidate was chosen for induction because of its minimal cardiovascular depressant effects, while fentanyl provided analgesia and vecuronium was used for muscle relaxation. The present case underscores the importance of individualised anaesthetic strategies for patients with severe cardiac dysfunction. With appropriate drug selection and multidisciplinary coordination, high-risk cardiac patients can safely undergo non cardiac surgical interventions.

Intraoperative Bradycardia in a Child with Orbital Glioma: A Case of Trigeminocardiac Reflex

Aishwarya Sanjay Borode, Dhawal Rameshpant Wadaskar, Kaustuv Das, Sharayu Padmakar Paunikar, Dhwani Jatin Seth Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Trigeminocardiac Reflex (TCR) is a life-threatening but rare neurogenic reflex that can manifest during neurosurgical procedures. It presents as sudden bradycardia, hypotension, or even asystole triggered by stimulation of the trigeminal nerve. It is more frequent in children due to heightened vagal tone. Authors hereby, present the case of an 11-year-old male with a right-sided optic nerve glioma with intracranial extension who was electively operated on for tumour removal. The patient had a history of loss of vision in the right eye, ptosis, and seizures treated with levetiracetam. During intraoperative dissection near the superior orbital fissure and cavernous sinus, he suddenly developed bradycardia and hypotension, characteristic of TCR. The anaesthetic team promptly identified the reflex and implemented prompt management by alerting the surgical team to cease dissection, administering intravenous atropine, increasing FiO2, and deepening the level of anaesthesia. The patient’s vital signs returned to baseline within minutes, and the surgery proceeded uneventfully. He was successfully weaned on postoperative day 2 without neurological sequelae. The case underscores the necessity of anticipation and vigilance for TCR in paediatric neurosurgical procedures involving trigeminal nerve regions. Early recognition and timely, coordinated intervention by surgical and anaesthetic teams are crucial to ensure haemodynamic stability and optimal patient outcomes. Preventive anaesthetic management, anticipating reflex phenomena, is of utmost importance in the perioperative management of such high-risk procedures.

Successful Maternal and Neonatal Outcomes in a Myasthenia Gravis Patient Presenting in Early Pregnancy: A Case Report

Vidya Gaikwad, Ashton Dsouza, Pragya Tiwari Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disorder that poses significant challenges during pregnancy due to its variable disease course and potential neonatal complications. Authors hereby, report a case of a 25-year-old primigravida with known MG on immunosuppressive therapy who presented at 8 weeks gestation. Her antenatal period was complicated by worsening respiratory symptoms during the third trimester. She underwent an emergency caesarean section at term due to foetal distress. The neonate, though initially stable, developed respiratory distress and was found to have maternal antibodies, requiring treatment with pyridostigmine. The present case highlights the importance of multidisciplinary care and preparedness for neonatal myasthenia in pregnancies complicated by maternal MG.

Anaesthetic Challenges and Management Strategies for Cystourethroscopy with Retrograde Pyelography and Left Ureteroscopic Surgery in a Patient with Kyphoscoliosis and a History of Operated Cystic Hygroma: A Case Report

Shilpa Sarang Kore, Tharun Dasarath Perni, Sandeep Dilip Veer, Sravya Bejugama Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Scoliosis is an idiopathic condition that predominantly affects females, with a ratio of 4:1, and an incidence ranging from 0.3-15%. Kyphoscoliosis, which involves both forward and lateral bending of the thoracolumbar spine, commonly results from idiopathic causes (70% of cases), with secondary causes including neuromuscular, congenital, or traumatic factors. The clinical significance of kyphoscoliosis lies in its potential to compromise respiratory mechanics and alter anatomical landmarks, posing challenges in perioperative and anaesthetic management. Addressing these challenges becomes more crucial when kyphoscoliosis is associated with other congenital anomalies, such as Cystic Hygroma (CH). CH is a common benign lymphatic cyst found in paediatric patients. Even after surgical intervention, CH can leave residual anatomical and physiological alterations that persist into adulthood, which may present anaesthetic challenges, including respiratory obstruction and the need to rule out additional congenital syndromes that necessitate comprehensive preoperative evaluation. This case report presents the anaesthetic challenges and perioperative considerations in a 18-year-old female with a history of operated CH and multiple congenital anomalies who is undergoing urological surgery. The presence of spinal deformity, restrictive lung disease, cardiac irregularities and prior surgical interventions necessitated a carefully tailored anaesthetic plan based on a multidisciplinary approach. The co-occurrence of congenital lymphatic and skeletal anomalies in this patient highlights the need for a multidisciplinary strategy, careful airway assessment and individualised anaesthetic planning to ensure optimal perioperative outcomes. This discussion explores the anaesthetic challenges and perioperative management in a case involving a child who underwent CH surgery, subsequently developed scoliosis in adulthood, and is now scheduled for cystourethroscopy with retrograde pyelography and left Ureteroscopic Surgery (URS).

Holistic Approach to Managing Sciatica (Gridhrasi) with Ayurveda: A Case Report

Nikita Rathod, Vaishali Kuchewar, Ashvini Pardhekar Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X One common condition encountered in daily life is Gridhrasi, which is identified as sciatica. The main clinical signs of Gridhrasi are stiffness and jerking sensations in the back (Prishta Kati), legs (Pada), knees (Janu), and thighs (Sphik/Jangha), as mentioned in the Charaka Samhita. According to Charaka, it can be described as either Vataja or Vata Kaphaja. Vagbhata highlights the primary symptom of Gridhrasi as the inability to raise one’s legs (Sakthyutkshepa Nigrahana). Similarly, sciatica often presents as radiating low back pain and may be associated with nervous system issues. This report describes a case of a 62-year-old male patient who exhibited the aforementioned symptoms and was admitted to an Ayurvedic hospital. The patient experienced difficulties in walking, lumbar stiffness, and pain that radiated from the lower back to the left leg. He was specifically treated for low back discomfort with Erandmooladi Vasti and Kativasti, along with Patra Pinda Sweda (fomentation with medicated leaves) for a duration of 15 days. The therapies administered included Sarvang Snehan, Nadi Swedan, Matra Basti, Niruha Basti, and Kati Basti. These treatments yielded favourable results that lasted for a month. There was significant healing following the completion of the therapy. Therefore, this Ayurvedic approach, utilising the combined techniques of Shodhana and Shamana Chikitsa, can effectively manage Gridhrasi.

Delayed Diagnosis of Follicular Thyroid Carcinoma with Skull Base and Lung Metastases in a Long-standing Neck Swelling: A Case Report

Abhiram Chadive, Lakshmi Sai Vijay Achalla, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Follicular Thyroid Carcinoma (FTC) is a differentiated thyroid cancer characterised by haematogenous metastases and the potential for distant metastases. This case report presents a 35-year-old female patient from rural India with a painless, gradually enlarging anterior neck swelling for the last 16 years. The patient presented with compressive and systemic symptoms, including stridor, hoarseness of voice, heat intolerance, and facial asymmetry. Imaging showed a large retrosternal thyroid mass with pulmonary and sphenoid bone metastases. A preoperative diagnosis of thyroid malignancy was made. The patient underwent total thyroidectomy with Level II, III, and IV neck dissection under general anesthesia, and histopathology identified FTC with distant metastases. The postoperative course was uneventful, and she was referred for Radioactive Iodine (RAI) therapy. This case highlights the importance of recognising and intervening early in cases of long-standing thyroid swellings to prevent complications from delayed diagnosis of malignancy.

Follicular Dendritic Cell Sarcoma with Nodal Involvement in A Young Woman: A Case Report

RS Sharan Dhev, D Balaji, Mohana Priya, Harshwanth Chandhar, K Shanmugapriya Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Follicular Dendritic Cell Sarcoma (FDCS) is a rare tumour that develops from follicular dendritic cells, which are essential to the immune system. It is more frequently seen in adults, with lymph node involvement being common, while extra-nodal occurrences are rare. This case report describes a 17-year-old female who presented with a four-year history of a progressively enlarging, painless swelling on the right side of the neck. Clinical examination indicated a soft, fluctuant, mobile, non-tender mass situated below the right mandibular angle, without regional lymphadenopathy. Imaging studies, including Magnetic Resonance Imaging (MRI) and cerebral angiography, identified a well-defined lesion in the right submandibular region with heterogeneous hyperintensity and internal cystic changes, abutting the salivary gland and carotid vessels, but without vascular invasion. Fine Needle Aspiration Cytology (FNAC) suggested differential diagnoses of paraganglioma and lymphoproliferative disorder. The patient underwent a wide local excision and biopsy under general anaesthesia. Intraoperatively, the tumour was well-encapsulated but near critical vascular structures, necessitating careful dissection. Histopathological and Immunohistochemical (IHC) evaluation confirmed the diagnosis of FDCS, a rare low-grade malignancy of histiocytic/dendritic cell origin, with nodal involvement. Postoperative Positron Emission Tomography-Computed Tomography (PET-CT) revealed no evidence of residual or metastatic disease. The patient’s recovery was uneventful, and no recurrence was detected during follow-up.

Osseous Metaplasia in Uterine Leiomyoma: A Case Report

Pawni Prabhat, Akanksha Sharma, Shravya Banan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X The leiomyoma uteri is one of the most common tumours of the female genital tract. It is more common in women above 50 years and is known to shrink in size after menopause. The symptoms it produces depend upon its location, whether it is submucosal, intramural, or subserosal. It is known for its histological variations in the form of hyaline degeneration, myxoid degeneration, calcification, and cyst formation. Heterologous tissue differentiation is an uncommon phenomenon, and osseous metaplasia is even rarer. Here, we report a rare case of leiomyoma with osseous metaplasia in a nulliparous woman. A 30-year-old nulliparous female presented with a history of abnormal uterine bleeding and abdominal pain, with an obstetric history of two spontaneous abortions at eight weeks and 10 weeks of gestation, respectively. Her biochemical and haematological investigations were within normal range. Ultrasound examination revealed multiple submucosal fibroids, with the largest one measuring 6×4×4 cm, for which the patient underwent myomectomy. The histopathological examination revealed leiomyoma with osseous metaplasia and hyaline degeneration with areas of calcification. There was no atypia, mitosis, or necrosis. Patient was discharged, and her two sequential follow-ups were uneventful. The novelty of this case report lies in the fact that osseous metaplasia in leiomyoma is quite a rare entity, with very few cases reported in the literature. Its recognition lies in its diagnostic significance to rule out sarcoma with heterologous differentiation. It highlights the importance of adequate sampling of gross specimens and careful histopathological examination to rule out this benign entity.

Spontaneous Remission of Congenital Non-immune Mediated Heart Block in a Foetus at 21 Weeks Gestational Age: A Case Report

Sree Divya Mohan, J Jayakaviyah Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Isolated congenital Atrioventricular Block (AVB) in structurally normal hearts has an estimated prevalence of 1 in 15,000-22,000 live births. In non-immune cases, up to 50% are associated with structural abnormalities like atrial isomerism or congenitally corrected transposition of the great arteries. Rarely, AVB of unknown origin occurs in the absence of maternal antibodies, structural heart defects, trauma, metabolic disorders, or channelopathies. The natural history of idiopathic AVB remains poorly understood. A 29-year-old primigravida with no comorbidities was found to have foetal bradycardia, with atrial contractions at 144 beats per minute and ventricular contractions at 70 beats per minute during a routine anomaly scan at 21 weeks of gestation. Foetal Echocardiography (ECG) using M-mode confirmed a 2:1 AVB in an otherwise structurally normal heart. Maternal serology was negative for anti-SSA/Ro and anti-SSB/La antibodies. Repeat foetal ECG at 23 weeks showed spontaneous resolution to normal sinus rhythm. Serial prenatal assessments remained normal, and the pregnancy progressed without complications. At term (40 weeks), she delivered a healthy female neonate with a normal ECG and sinus rhythm. Postnatal follow-up confirmed normal cardiac function and development. This case underscores the potential for a benign outcome in isolated, non-progressive AVB in structurally normal hearts without maternal autoantibodies. Although the mechanisms of spontaneous resolution remain unclear, this case supports the importance of individualised evaluation and careful monitoring before initiating corticosteroids or invasive treatment. Additional case reports and prospective studies are vital to guide future management and counselling.

Wilson Disease Presenting as Isolated Dysarthria in a Paediatric Patient: A Rare Case Report

Hunny Verma, Dinkar Yadav, Pooja Ahlawat, Alok Khanna, Anjali Verma Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Wilson disease is an autosomal recessive disorder caused by mutations in the ATP7B gene. It involves the liver, brain, eyes, blood, kidneys, and endocrine glands. The usual manifestations are hepatic (approximately 40%), neurological (approximately 35%), or psychiatric (approximately 10%). Wilson disease without hepatic manifestations is rare. A nine-year-old girl presented to the paediatric outpatient department with two months of difficulty speaking and with occasional purposeless jerky movements for one and a half months. She had tremor while speaking for the past month. The rest of the general and systemic examination was normal. Neurological complaints in an adolescent girl raise suspicion of Wilson disease. Slit-lamp examination showed a Kayser–Fleischer ring. Serum ceruloplasmin was low, and Magnetic Resonance Imaging (MRI) brain showed basal ganglia involvement, which confirms the diagnosis of Wilson disease. The child was managed with copper chelating therapy (D-penicillamine and zinc acetate) and a low-copper-containing diet with supportive care. This case highlights that isolated dysarthria can be a presenting feature of Wilson disease, emphasising the importance of considering this diagnosis in patients with unexplained speech difficulties.

Spontaneous Perforation of the Colon in a Patient with Pseudomembranous Colitis: A Case Report

Ritika Gupta, Mahesh Jadhav Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Pseudomembranous Colitis (PMC) is a severe inflammatory condition of the colon most commonly associated with Clostridioides Difficile Infection (CDI) and prolonged antibiotic use. Although it typically presents with diarrhea and abdominal pain, fulminant cases may lead to serious complications such as colonic necrosis and perforation, requiring prompt surgical intervention. In this case report, a 32-year-old female with a history of recurrent, self-limiting loose stools and prolonged, unsupervised antibiotic use presented with acute abdominal pain, vomiting, and distension. Radiological examination revealed signs of pneumoperitoneum, and an emergency exploratory laparotomy identified multiple colonic perforations with diffuse mucosal ulceration and necrosis. Histopathological examination of the resected specimen demonstrated classic features of PMC, including extensive transmural necrosis, crypt abscesses, epithelial sloughing, and dense neutrophilic infiltration, with no evidence of chronic Inflammatory Bowel Disease (IBD). The difficulty in diagnosing this case arose from the combination of long standing symptoms mimicking IBD and the absence of stool testing in the emergency setting. The case underscores the rarity of multiple colonic perforations in PMC, a feature sparsely documented in the current literature. It highlights the need for timely clinical diagnosis, early surgical decision making, and the importance of histopathological confirmation, particularly in patients with recurrent antibiotic exposure.

Surgical Management of a Chronic High-flow Arteriovenous Fistula with Pseudoaneurysm and Nerve Entrapment after Failed Percutaneous Ligation: A Case Report

R Chandan Kumar, Prashant Bahirani, Sunil Sharma, Gurrala Jhansi, Rajshree Verma Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Minimally invasive flow-reduction techniques such as Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) and No-Incision Limited Ligation Indwelling Needle-assisted Revision (NILLINR) have gained popularity for Arteriovenous Fistula (AVF) management. Still, their applicability in complex, long-standing, or structurally abnormal fistulas remains uncertain. We present a rare and challenging case of a young renal transplant recipient who developed multiple complications after failed percutaneous AVF ligation. A 30-year-old man, two years post-renal transplant and off dialysis, presented with palpitations, visible fistula prominence, and sensory loss in the dorsoradial hand region, 10 days after undergoing ultrasound-guided AVF ligation at another centre. Clinical examination revealed a constriction band at the ligation site, pseudoaneurysm, venous blowouts, and thrill. Intraoperatively, a large pseudoaneurysm, severely dilated and calcified veins, and a 6-7 cm remodelled radial artery segment were identified. Importantly, the superficial branch of the radial nerve was found entrapped within the ligature, explaining the sensory deficit. Surgical management included excision of the pseudoaneurysm and diseased veins, release and preservation of the trapped nerve, and secure ligation of blowouts. Given excellent collateral perfusion from the ulnar artery and palmar arch, arterial reconstruction was avoided. Postoperatively, the patient’s palpitations subsided, cosmesis improved, and gradual neurological recovery was noted. This case highlights several important learning points: (i) percutaneous ligation may fail in aneurysmal or calcified vessels; (ii) high-output AVFs can cause systemic manifestations such as palpitations; and (iii) nerve entrapment is a rare but serious complication of percutaneous techniques. Surgical takedown with careful intraoperative assessment offers definitive management in such complex anatomical scenarios.

Giant Angina Bullosa Haemorrhagica Associated with Severe Anaemia: A Case Report

Samuel Jeyaraj Daniel, Balaji Ganesh Jayaraman, Saranya Selvam, Abirami Thangaraj Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Angina Bullosa Haemorrhagica (ABH) is a rare oral disorder characterised by blood-filled bullous lesions in the oral cavity and oropharynx. In 1933, Balina of Argentina first characterised this condition as traumatic oral haemophlyctenosis. Subsequently, Badham introduced the term ABH to describe the disorder. The condition is also referred to by alternative names, including localised oral purpura and stomatopompholyx haemorrhagica. The lesions appear acutely and are primarily distributed over the tongue and oral mucosa without any systemic involvement. They are frequently isolated and rupture quickly, leaving an ulcerated area. The clinical appearance of this lesion can be alarming for patients and poses a diagnostic challenge for clinicians, as it may closely resemble more serious conditions such as haematological disorders and other vesiculobullous diseases. Here, we present a 72-year-old female diagnosed with ABH, notable for the unusually large size of the lesion and its rare association with severe anaemia.

Splenogonadal Fusion Presenting as Acute Scrotum: A Case Report

VK Gopi, A Rahul Dev, Dilsa Savio, K Gayathri, P Lima Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Splenogonadal Fusion (SGF) is a rare congenital anomaly characterised by abnormal attachment of splenic tissue to the gonads. We report the case of a five-year-old male child presenting with an acute scrotum, initially suspected to be testicular torsion. During emergency surgical exploration of the scrotum, a gangrenous structure was discovered. This structure was connected to the left testis by a fibrous band that had undergone torsion. It also had another fibrous band at its opposite pole, with the fibrous band extending into the peritoneal cavity. Later, ultrasound confirmed its connection to the spleen. Histopathological examination confirmed the diagnosis of SGF. The patient had an uneventful postoperative course, and follow-up imaging showed normal testicular vascularity. SGF is often misdiagnosed due to its rarity, and early diagnosis through imaging and histopathology is critical in avoiding unnecessary orchiectomies and preserving gonadal function. This case underscores the need to consider SGF as a possibility whenever unusual findings are encountered during scrotal exploration.

Primary Squamous Cell Carcinoma of the Breast: A Rare Clinical Entity with Diagnostic and Therapeutic Challenges

Divij Agarwal, Varun S Shetty, Iqbal Ali Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Primary Squamous Cell Carcinoma (PSCC) of the breast is an exceptionally rare and aggressive malignancy, often lacking well-defined clinical and radiological hallmarks. A 51-year-old postmenopausal woman arrived in septic shock with a necrotic, ulcerative mass in the upper outer quadrant of the right breast, initially misinterpreted as a chronic abscess. Imaging revealed a heterogeneous breast lesion with axillary lymphadenopathy and no distant metastasis. An emergency toilet mastectomy was performed due to progressive sepsis, followed by Vacuum-Assisted Closure (VAC) and split-thickness skin grafting. Histopathology confirmed high-grade squamous cell carcinoma with a minor ductal component (<10%). Immunohistochemistry demonstrated triple-negative receptor status, diffuse nuclear p63 positivity, positivity for CK6 and CK7, and a high Ki-67 index, fulfilling the diagnostic criteria for PSCC proposed by Macia et al. The patient remained disease-free at one-year follow-up after adjuvant radiotherapy. This case underscores the importance of recognising atypical infectious presentations of breast tumours and integrating clinical, radiologic and pathologic findings to distinguish PSCC from close differentials, including chronic abscesses, metastatic carcinomas and other inflammatory breast pathologies.

Severe Biotinidase Deficiency in a Newborn Due to a Novel Mutation: A Case Report

Ponnada Ramana Sai Sundar, Vijayalakshmi Samudi, Sundari Subramanian Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Hyperammonaemia is one of the common causes of early neonatal deterioration. Inborn errors of metabolism are frequent contributors to hyperammonaemia in newborns. Profound biotinidase deficiency is a rare cause that closely mimics inborn errors of metabolism. This report describes a rare case of profound biotinidase deficiency presenting as deterioration in the early neonatal period, characterised by hyperammonaemia, acidosis, hypoglycaemia, and ketosis. A three-day-old male patient presented with poor feeding and vomiting for six hours, along with respiratory difficulty for the same duration. The baby was hypotonic, exhibiting weak plantar and palmar grasp reflexes, poor sucking reflex, and reduced Moro reflex. The differential diagnoses considered included early onset sepsis and inborn errors of metabolism; however, the sepsis screen was negative. Blood investigations revealed severe metabolic acidosis, hyperammonaemia, hypoglycaemia, and ketonuria. Acyl carnitine levels (C5-OH) were above normal, and serum biotinidase levels were very low. This patient was diagnosed with severe biotinidase deficiency, and genetic analysis revealed a rare homozygous nonsense mutation in the Biotinidase (BTD) gene. This mutation led to a profound deficiency of the biotinidase enzyme, resulting in early neurological complaints. After the initial stabilisation of the baby, he was started on biotin supplementation and was placed under regular follow-up. Profound biotinidase deficiency should be considered as one of the causes of early neonatal deterioration. The management of profound deficiencies involves treating the acute presentation while correcting acid-base imbalances, hypoglycaemia, and related issues. The mainstay of long-term treatment is lifelong biotin supplementation.

Granular Cell Tumour of Breast Mimicking Malignancy: A Series of Six Cases

M Husnara, M Nirmal Daniel, A Santhosh Raj, Shalini Sahu, Anish Jacob Cherian Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Granular Cell Tumour (GCT) of the breast is a rare, benign neoplasm of presumed Schwann cell origin, accounting for less than 0.1% of all breast tumours. Despite its benign nature and low recurrence risk, it often mimics malignancy both radiologically and histologically, leading to diagnostic uncertainty. This case series describes six histologically confirmed cases of breast GCT diagnosed over an 11-year period, highlighting key clinical, radiological, histopathological, and immunohistochemical features. All patients were women between 32 and 42 years, presenting with solitary, unilateral breast lesions. Radiological findings in several cases were suspicious for malignancy. Tumours ranged from 1 to 4.1 cm, frequently located in the medial quadrant, and exhibited ill-defined margins in most cases. Histologically, tumours were infiltrative and composed of polygonal cells with granular eosinophilic cytoplasm and round hyperchromatic nuclei. Periodic Acid Schiff-Diastase (PAS-D) positivity and positive immunohistochemical stains for S100 (solubility in 100% saturated ammonium sulfate at neutral pH), SRY-related HMG box 10 protein (SOX10), Transcription Factor Binding to IGHM Enhancer 3 (TFE-3), and Cluster of Differentiation 68 (CD68) positivity helped confirm the diagnosis. Common histological findings included adipose and skeletal muscle infiltration, peritumoural lymphocytic infiltrates, rare features such as intranuclear inclusions and stromal elastosis. No mitoses, necrosis, or co-existing carcinoma were noted. No recurrences or metastases were observed during follow-up. Given its ability to mimic malignancy, especially on core biopsies, GCT must be considered in the differential diagnosis of breast lesions with granular cytoplasm. Misinterpretation may lead to overtreatment. Awareness of its histopathologic profile and immunohistochemical signature is essential to avoid diagnostic pitfalls.

Cryptococcal Meningitis in Post-COVID Era: A Case Series

Antara Roy, Pradip Kumar Das, Aindrilla Acharjee Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Meningitis, defined as inflammation of the meninges surrounding the brain and spinal cord, can arise from a broad spectrum of infectious and non infectious causes. Among infectious aetiologies, fungal meningitis is less common but poses significant morbidity and mortality. Cryptococcal meningitis, a life-threatening fungal infection primarily affecting immunocompromised individuals, has shown an increased incidence in the post-Coronavirus Disease-2019 (COVID-19) era. Immune dysregulation caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and the widespread use of immunosuppressive therapies are suspected contributors to this rise. The first case was a 47-year-old Human Immunodeficiency Virus (HIV)-positive man on tuberculosis treatment who presented with meningitis symptoms; India ink preparation showed a yeast cell with a refractile halo. The second case was a 75-year-old man with a prior COVID-19 infection who developed meningitis and was diagnosed with cryptococcal meningitis. The third case was a 37-year-old asthmatic female on steroids with a history of COVID-19 who presented with headache and altered sensorium. Cerebrospinal Fluid (CSF) was collected and sent for investigation. India ink showed encapsulated yeast cells and culture showed Gram-positive budding yeast cells. The fourth case was a 50-year-old male with chronic kidney disease who presented with fever, neck stiffness and altered sensorium. Gram stain of CSF and India ink preparation both showed Cryptococcus. All patients were treated with amphotericin B and fluconazole, with favourable clinical outcomes. Clinicians should maintain a high index of suspicion for opportunistic fungal infections in patients with recent COVID-19 or immunosuppressive therapy.

Management of Distal Femur Fracture with Dual Plating using Anterolateral and Medial Approach: A Case Series

Nishan Yadav, Sabuj Baran Singha, Chetan Prakash Agrawal, Bharat, Abhishek Bhardwaj Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Dual plating of distal femoral fractures is indicated in a supracondylar bone loss, trans-bi-condylar fractures, Hoffa fracture, periprosthetic femur fractures, non union after failed fixation using single plating, osteoporotic bone quality, and AO type C3 comminuted distal femur fractures. Ten patients (7 males and 3 females) came to the emergency department with a history of a roadside accident. Based on clinical history and radiographic evaluation, a diagnosis of AO type C3 distal femoral fracture was made. All were treated using dual plating via anterolateral and medial approaches. Mean operative time was 200±40 minutes. Overall, the patient outcome was favourable. The majority of patients (70%) had a good range of motion (>90°). Dual plating allows for better exposure, easy manipulation, and biomechanical stability, as well as congruous reduction of the fracture.

Effect of Dynamic Taping on Pain, Disability and Grip Strength among Patients with De Quervain’s Tenosynovitis: A Case Series

Karan Singh, Mohammad Sidiq, Taruna Verma Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X De Quervain’s Tenosynovitis (DTS) often occurs after repetitive movements of the thumb and wrist, resulting in discomfort and a negative impact on daily activities. It most commonly affects women aged 40-50 years. Conservative management includes rest, splinting, analgesics, and corticosteroid injections; surgery is considered if required. However, these treatments may restrict movement and may not provide lasting relief. This case series aimed to study how Dynamic Taping (DT) affected pain, disability, and grip strength in patients suffering from DTS. Five participants in this study (aged 25-45 years) were treated with DT, and outcomes were assessed using the Visual Analog Scale (VAS), Patient Rated Wrist and Hand Evaluation (PRWHE), and a dynamometer. The study concluded that outcomes showed significant improvements after the application of DT in addition to standard physiotherapy care.

Corneal Stigmata of Acute Malnutrition: A Case Series

Rahul Navinchandra Bakhda Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Childhood malnutrition is one of the leading causes of under-five mortality due to increased susceptibility of infections and slow recovery from illness, making it a major public health problem. Ocular involvement in malnutrition is common and more severe in early childhood. Acute malnutrition is an important cause of preventable blindness. Deficiencies of micronutrients and retinol, folate and minerals like iron, magnesium and potassium as well as other vitamins are usually seen in acute malnutrition. Vitamin A deficiency is particularly important, as it can lead to keratomalacia and permanent blindness. The present case series of children (under-five years) elaborates on the ocular consequences of acute malnutrition like conjunctival xerosis, corneal ulceration, keratomalacia, corneal abscess, corneal perforation, desmetocele, corneal scarring and xerophthalmia associated with vitamin A deficiency and their management. It emphasises the importance of preventing xerophthalmia to reduce early childhood blindness. Active corneal xerophthalmia is a medical emergency that should be treated immediately with high dosage of vitamin A. The high-dose vitamin A treatment is recommended for infants and young children with xerophthalmia, severe malnutrition, and measles. Prompt diagnosis and timely intervention are required to prevent the ocular morbidities associated with vitamin A deficiency and acute malnutrition. Vitamin A supplementation programs should be made universally available in all populations where vitamin A deficiency is a public health problem.

Non-Hodgkin Lymphoma Presenting as a Rare Cause of Malignant Small Bowel Intussusceptions in Children: A Series of Three Cases

Aniruddha D Bhagwat, Komal Sawaimul, Sarita Verma-Kokane, Dattatray B Bhusare, Ashlesha A Shimpi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Primary malignant small intestine tumours comprise less than 2% of all gastrointestinal malignancies. Lymphoma accounts for 15-20% of all small bowel neoplasms. It is a rare cause of intussusception, and Non-Hodgkin Lymphoma (NHL) is the third most common childhood cancer. The symptoms of secondary intussusception are often vague in older children and in colonic cases, which can lead to misdiagnosis. Intestinal (as opposed to lymph nodal) involvement by lymphoma is associated with an earlier diagnosis due to abdominal symptoms. Barium enema has fallen out of favour with the advent of better and newer imaging modalities. A barium series can miss the lead point. Ultrasonography (USG) and Contrast-Enhanced Computed Tomography (CECT) are sensitive and specific in diagnosing intussusception. Fluoro-Deoxy-Glucose Positron Emission Tomography (FDG-PET) of the chest, abdomen, and pelvis is highly sensitive and specific in staging lymphomas. Pre-operative determination of the etiology of intussusception in the small bowel in older children is difficult. Diagnostic challenges remain, even after investigations, in identifying a malignant lead point. Histology remains the mainstay for diagnosing malignancies. Laparotomy is the gold standard for both diagnosis and treatment. The authors emphasise the importance of early diagnosis, timely interventions, and adjuvant chemotherapy if surgical outcomes are to be improved. Survival rates and long-term follow-ups are generally favourable.

Surgical Management of Neglected Lunate Injuries: A Series of Three Cases on Proximal Row Carpectomy

Suriya Prasanna Raja, Vijay Anand Balasubramanian, S Karthikeyan, Rohit Raj Rajkumar, Sidharthan Dhasarathy Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Neglected lunate injuries, including fractures and dislocations, can lead to severe complications such as Avascular Necrosis (AVN) (Kienböck’s disease), chronic carpal instability, and Scapholunate Advanced Collapse (SLAC) wrist. These conditions often result in persistent pain, functional impairment, and progressive arthritis. Proximal Row Carpectomy (PRC) has emerged as a reliable, motion preserving surgical option for managing advanced lunate pathology, especially in resource limited settings. This case series evaluates the clinical and functional outcomes of PRC in patients with neglected or chronic lunate injuries. The case series reports on three patients (two males, one female; age range: 18-56 years) with chronic lunate collapse of varying aetiologies, including two with neglected lunate fractures and one with advanced Kienböck’s disease (Stage III). All patients presented with persistent wrist pain, restricted motion, and imaging evidence of lunate fragmentation or AVN. Surgical intervention involved excision of the scaphoid, lunate, and triquetrum, with preservation of the radioscaphocapitate ligament, allowing capitate articulation with the lunate facet of the radius. Postoperatively, patients underwent structured physiotherapy focusing on Range Of Motion (ROM) and grip strength restoration. All three patients reported significant pain relief within 6-8 weeks postoperatively, with mean Visual Analog Score (VAS) improving from 8 preoperatively to approximately 2.5 at final follow-up. Functional wrist motion was preserved at 50-60% of the contralateral side, with dorsiflexion ranging from 30° to 40° and palmar flexion from 35° to 45°. Radial and ulnar deviation were maintained within functional limits. Grip strength, although reduced compared to the unaffected hand, allowed return to daily activities without major limitations. Radiological evaluation confirmed stable radiocapitate articulation without progressive degenerative changes during the follow-up period. PRC is an effective, economical, and technically straightforward option for neglected lunate injuries, offering a good balance between pain relief and preservation of wrist mobility. While early diagnosis remains essential to prevent irreversible damage, PRC provides favourable outcomes even in delayed presentations, provided that severe radiocapitate arthritis is absent. Larger studies with long-term follow-up are warranted to validate these findings.

Choledocholithiasis Post-cholecystectomy: A Decade Later

Amit Girme, SV Sreedhanya, Bhavesh Mahajan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Choledocholithiasis, the presence of stones in the Common Bile Duct (CBD), is a rare occurrence years after cholecystectomy. This case series documents four instances of choledocholithiasis identified over a decade after cholecystectomy, exploring their clinical presentations, diagnostic methods and treatment approaches. Diagnostic imaging, including ultrasonography and Magnetic Resonance Cholangiopancreatography (MRCP), confirmed CBD stones in all patients. Therapeutic interventions, such as Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy and stenting, successfully addressed the condition. Potential contributing factors, including Remnant Cystic Duct Lithiasis (RCDL) and surgical clip migration, are discussed in relation to these cases. This series highlights the need for awareness of delayed choledocholithiasis as a possible late complication after cholecystectomy and warrants further investigation into its risk factors and preventive strategies.

Assessment of Comparative COX-1 and COX-2 Inhibition Efficacy of Ehretia Laevis Roxb. (Khandu Chakka/Ajan Vruksha) Leaves versus Diclofenac Sodium: An In-vitro Study

Rushikesh Anil Thakre, Preeti Borkar, Anita Wanjari, Ketaki Harne Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Pain is a significant problem globally. Ehretia laevis Roxb has pain-relief and anti-inflammatory properties. Cyclooxygenase (COX) is responsible for the production of prostaglandins, which control pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation by acting on COX. Aim: To assess the comparative COX-1 and COX-2 inhibition efficacy of Ehretia laevis Roxb leaves versus diclofenac sodium. Materials and Methods: This study is an analytical, experimental in-vitro study. Which was performed at Sciore Research Private Limited and affiliated with Bajaj College of Science, Wardha, and Mahatma Gandhi Ayurved College, Hospital, and Research Centre at Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India from May 2023 to June 2023. The study was performed according to the manufacturer’s protocol from Cayman Chemical (item No: 701070) and the standard operating procedures of the test facility. For in-vitro processing, Ehretia laevis Roxb powder was mixed with a 10% Dimethyl Sulfoxide (DMSO) solution to obtain a concentration of 1 mg/mL and filtered. All assays were performed in triplicate. GraphPad Prism (Version 8.4.2) was used to calculate the IC50 values by plotting log (inhibitor) vs. normalised response/variable slope. Results: Diclofenac sodium was a significantly more potent inhibitor of both COX-1 and COX-2 enzymes compared to Ehretia laevis Roxb powder. To achieve 50% inhibition of COX-1, diclofenac sodium required only 59.49 nanograms per milliliter (ng/mL), whereas Ehretia laevis Roxb powder needed a significantly higher dose of 301.6 micrograms per milliliter (μg/mL). This indicates that diclofenac sodium is roughly five times more potent for COX-1 inhibition. Similarly, for COX-2 inhibition, diclofenac sodium had an IC50 value of 14.23 ng/mL, while Ehretia laevis Roxb powder had an IC50 value of 245.0 μg/mL, indicating that diclofenac sodium is approximately 17 times more potent for COX-2 inhibition. Overall, the data suggested that diclofenac sodium has a stronger and more selective inhibitory effect on both COX-1 and COX-2 enzymes compared to Ehretia laevis Roxb powder. Conclusion: The IC50 values for diclofenac sodium for COX-1 inhibition is 59.49 ng/mL and for COX-2 inhibition is 14.23 ng/mL. The IC50 value for Ehretia laevis Roxb for COX-1 inhibition is 301.6 μg/mL and for COX-2 inhibition is 245.0 μg/mL. Various extracts of Ehretia laevis Roxb should be tested further for their COX inhibition activities.

Hyperostosis Cranii Ex Vacuo with Layered Imaging Appearance of Skull in a Patient of Dandy-Walker Malformation with Early CSF Shunting

Varsha P Rangankar, A Alekhya Reddy Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X A 26-year-old male presented with seizures characterised by clonic posturing of the bilateral upper limbs, deviation of the angle of the mouth, vertigo and an unstable gait for one month. He had a known history of Dandy-Walker syndrome with hydrocephalus, for which ventriculoperitoneal shunt placement and shunting of the posterior fossa cyst were performed at six months and nine years of age, respectively. The patient had mild cognitive impairment and an ataxic gait; however, no focal neurological deficits were evident. Laboratory parameters, including complete blood count and haemoglobin, serum calcium, phosphate, alkaline phosphatase, and parathyroid hormone levels, were within normal limits. Magnetic Resonance Imaging (MRI) of the brain revealed a posterior fossa cyst communicating with the fourth ventricle, with a hypoplastic vermis and right cerebellar hemisphere, consistent with Dandy–Walker malformation (Table/Fig 1). Diffuse calvarial thickening with widening of the diploic space was noted, with layered hyperostosis along the inner table of the calvarium (Table/Fig 1). No associated brain sagging, engorgement of dural venous sinuses, or pachymeningeal enhancement was present. Computed Tomography (CT) images demonstrated diffuse calvarial thickening with diploic space widening, fused cranial sutures and distinct layered hyperostosis along the inner table of the skull (Table/Fig 2). The density of the skull bones, including the skull base, was normal. Lumbar puncture revealed normal CSF pressure, effectively excluding an active low Cerebrospinal Fluid (CSF) pressure state. Hyperostosis cranii ex vacuo was diagnosed based on distinct imaging features in the context of longstanding early CSF shunting.

Complete Rhino-orbital Communication as a Sequela of Mucormycosis

Khushbu Nimish Doshi, Seema Sathe, Tanvi Jaiswal, Pragati Agarwal, Pooja Chitlange Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X A 65-year-old male presented to the Department of Prosthodontics and Crown and Bridge for rehabilitation of an enucleated left eye and a left maxillary defect involving the sinuses. The patient had undergone left maxillectomy four months ago due to rhino-orbital mucormycosis of the left maxilla and orbital region. He also had a history of Coronavirus Disease 2019 (COVID 2019) infection one year earlier and uncontrolled diabetes for seven years. The patient presented with exenteration of the left eye and excision of the left maxilla, with oroantral communication [Table/Fig-1,2]. Intraorally, it was classified as Aramany Class IV defect. Facial asymmetry was noted. Prosthetic rehabilitation was planned, with an obturator for the intraoral defect to close the oroantral communication and improve mastication, and an orbital prosthesis for the left eye. Due to recurrent infection in the left eye, wearing an orbital prosthesis was advised against, so planning for an orbital prosthesis was dropped. An obturator was provided to close the oroantral communication, improve mastication, and correct facial deformities caused by maxillectomy. The outcome of obturator therapy allowed the patient to eat properly, improved his speech, and enhanced his overall function. This severe anatomical disruption is a rare complication of mucormycosis, which causes angioinvasion, necrosis, and progressive tissue destruction (1). Such defects often require multistage reconstructive surgery, including local or free flap reconstruction, to restore functional and aesthetic integrity (2). The extensive orbital defect is characteristic of rhino-orbital mucormycosis, a rapidly progressive fungal infection caused by Mucorales species. This condition commonly affects immunocompromised individuals, particularly those with uncontrolled diabetes mellitus, post-COVID-19 infections, or haematological malignancies [3,4]. The destruction of the orbital and maxillary structures, as seen in this case, results from angioinvasion by fungal hyphae, leading to extensive necrosis, tissue infarction, and potential intracranial spread (5). Surgical debridement remains the cornerstone of management, often requiring orbital exenteration alongside antifungal therapy (liposomal amphotericin B or posaconazole) (6). Early recognition and appropriate surgical intervention are crucial for optimal outcomes (7). In the case report by Deek AJ et al., the role of maxillofacial surgeons in orbital exenteration and reconstructive surgery with a myocutaneous flap drawn from the anterolateral thigh was discussed (8). In current case, no surgical reconstruction was performed as the defect was not extensive; instead, an orbital prosthesis and an obturator were planned for rehabilitation. Complete rhino-orbital communication is a rare and severe sequela of mucormycosis, often seen postCOVID-19, requiring aggressive surgical and prosthetic rehabilitation. Early diagnosis and prompt surgical debridement combined with antifungal therapy are critical to prevent intracranial spread and improve patient outcomes.

Tuberculosis Presenting as Base of Skull Osteomyelitis with Stroke: A Case Report

Krishnan Balagopal, Basil Mary Eldo, Geevarghese Shibu, Kavya Sasidharan, Joel Varghese Alex Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X This 70-year-old female patient, a housewife by occupation and a known case of diabetes mellitus on treatment with oral hypoglycaemic agents, presented with a 2-week history of occipital headache and unsteadiness on walking. She was on symptomatic treatment for the same with analgesics only. There was no associated nausea, vomiting or photophobia along with headache. The unsteadiness on walking was more to the right side with no associated slurring of speech. There was no history of fever, limb weakness or seizures. There was no history of evening rise of temperature, cough or weight loss. There was no past history of exposure to tuberculosis. Clinical examination demonstrated normal vital signs. Nervous system examination revealed normal cranial nerves and motor system. Cerebellar signs were positive with significant gait ataxia to the right side. Deep tendon reflexes were well elicited. No clinical signs of meningeal irritation were noted.

Image of Succenturiate Placenta with Velamentous Cord Insertion

Aashita Zawar, Amardeep Tembhare, Sukanya Singh Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X A 30-year-old multigravida, gravid 2 para 1, conceived naturally, presented in labour at 38 weeks of gestation with spontaneous conception. Antenatal ultrasound had not detected any placental abnormalities. She underwent an uneventful vaginal delivery of a healthy male child of 2900 gm, with an APGAR score of 9 at 1 minute, not requiring Neonatal Intensive Care Unit (NICU) admission. The placenta was delivered and examined, revealing a succenturiate lobe connected to the central placental mass by foetal membranes (Table/Fig 1). Velamentous insertion of the umbilical cord was also noted (Table/Fig 2). There were no retained bits of placenta or signs of postpartum haemorrhage. There was no history of antepartum haemorrhage or rupture of velamentous vessels. Histopathology for the same was not sent as the patient was not willing.

Challenges in Managing a Pregnant Patient for Cervical Cerclage with a History of Liver Disease: The Use of Ultra Low-dose Spinal Anaesthesia

Neena John, Surentharraj Elangobaalan, S Parthasarathy Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Pregnancy-induced liver disease is an infrequent occurrence, though a number of liver diseases may appear in pregnancy. Hyperemesis Gravidarum, affecting 0.3-2% of women in the first trimester of pregnancy, is one such disorder. The less common (<1%) but identified liver-related disorders include Haemolysis, Elevated Liver Enzymes and Low Platelet (HELLP) syndrome, acute fatty liver disease of pregnancy, and intrahepatic cholestasis of pregnancy, which are seen in the second and third trimesters, respectively (1).

Estimation of Levels of Salivary Mucins MUC5B, MUC7 in Subjects with Dental Caries: A Case-control Study

S Vedhanayaki, RJ Vijayashree, B Kavitha Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Dental caries is a chronic, biofilm-mediated disease that results in the loss of tooth structure. It is considered multifactorial, and one of the contributing factors is mucin. Therefore, this study was conducted to investigate whether there is a correlation between the levels of salivary mucins MUC5B and MUC7 and dental caries. Aim: To estimate the levels of salivary mucins MUC5B and MUC7 in subjects with dental caries. Materials and Methods: A case-control study was conducted at Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India, over a period of three months (July 2022 - September 2022). Matching based on age in a ratio of 1:1 was performed, and approximately 66 samples were collected from participants aged 18 to 25 years. Of these, 33 saliva samples were collected from participants with a Decayed, Missing, and Filled Teeth (DMFT) index of over 10, forming the experimental group. Another 33 saliva samples were collected from participants with a DMFT index of less than 3, serving as the control group. The levels of MUC5B and MUC7 were assessed among both groups, and means and standard deviations were calculated. An independent sample t-test was utilised to determine whether the difference between the means of the two groups was statistically significant at a 95% confidence interval. Results: The mean concentration of MUC5B in the experimental group (24.34±9.16 μg/L) was higher than in the control group (9.39±10.44 μg/L), demonstrating a statistically significant difference (p<0.05). There was also a significant statistical difference (p<0.05) in the levels of MUC7, which were higher in the experimental group (10.27±3.21 μg/L) compared to the control group (4.81±3.96 μg/L). Conclusion: The study showed that the levels of both salivary mucins were elevated in participants with high caries. The demand for restorative treatment in developing countries exceeds the available resources. Thus, mucin levels can serve as an indicator of caries susceptibility.

Effect of Chitosan and Proanthocyanidin Dentine Biomodifiers on Immediate and Long-term Bond Strength of Composite to Dentine: An In-vitro Study

Shruti Deepak Jadhav, Varsha Sanjay Pandit, Shivani Vinayakrao Chavan, Vinaya Prabhanjan Ingale, Mineet Satish Kaul Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: The longevity of restorations depends on the strength of the bond between the adhesive and the adherent. The use of collagen stabilising agents may be of prime importance in achieving this goal, as they have the capability to increase the bond strength of restorations. Aim: To compare the efficacy of Chitosan and Proanthocyanidin as dentine biomodifiers on the Shear Bond Strength (SBS) of composite to dentin. Materials and Methods: This is an in-vitro study conducted in the Department of Conservative Dentistry and Endodontics at Bharati Vidyapeeth Dental College, Pune, Maharashtra, India, over a period of three months from July to September 2024. Twenty freshly extracted premolars with mature apices, free of cracks, restorations, or endodontic therapy, were selected for the study. The teeth were decoronated and etched with 37% phosphoric acid. Half of the samples were pretreated with Chitosan, and the other half were treated with Proanthocyanidin solution. A bonding agent was then applied and cured. Using a plastic mold, composite restoration was performed with specific dimensions, and it was cured. Samples were stored in saline until testing. The samples were then secured in resin and tested using a universal testing machine. Half of the samples (n=5) from each group were tested after 24 hours, while the other half (n=5) were tested after 30 days. An independent t-test and paired t-test were used for intergroup and intragroup comparisons, respectively, where p<0.05 was considered statistically significant. Results: The mean value of SBS in the Proanthocyanidin group was 27.18 MPa after 24 hours, whereas for Chitosan, the mean value was 26.94 MPa. When SBS was compared after 30 days, the mean value of SBS in the Proanthocyanidin group was 21.33 MPa, whereas for Chitosan, the mean value was 20.23 MPa. Conclusion: The results of the study show that the SBS of Proanthocyanidin was better than that of Chitosan; however, this difference was statistically insignificant, and the bond strength values decreased after storage of samples in saline for 30 days.

Questionnaire for Physiotherapists Disaster Health Management Core Competencies: A Preliminary Content and Face Validity Study

Jyoti Sharma, Aksh Chahal, Ranjul Rastogi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: The healthcare system faces substantial challenges from disasters that require proactive healthcare practitioners, including Physiotherapists, to lead disaster prevention, preparedness, response efforts, and recovery initiatives. Physiotherapists require validated competencies for effective disaster health management, but there is a lack of standard tool. Aim: The present study aimed on developing the core competencies questionnaire possessed by the Physiotherapists for disaster health management and seeks the preliminary content and face validation of the questionnaire. Materials and Methods: The present methodological study was exploratory mixed method research to design and psychometrics the instrument measuring disaster health management competencies of Physiotherapists in India conducted from 25-09-2023 to 28-02-2024 at Galgotias University, Greater Noida, India. The content validity of the questionnaire through two phases: questionnaire development and judgement. The development phase involved identification of constructs, followed by item generation and instrument formation. A seven-member expert panel did the judgement of the questionnaire with the Delphi method approach. After three rounds of panel discussions and based on expert comments, the questionnaire was modified and assessed for Content Validity Ratio (CVR), Item Content Validity Index (I-CVI), and Questionnaire/scale Content Validity Index (S-CVI). Further kappa statistics were performed for inter-rater reliability among experts through using IBM Statistical Package for Social Sciences (SPSS) statistics for windows version 27 (IBM Corp, Armonk, NY, USA). Final face validation was done through percentage agreement on experts’ comments. Results: The CVR analysis of 104 items produced 39 items with CVR higher than 0.99. Knowledge received 13 items and skills received 14 items while attitude included 12 items as the main constructs. The expert panel unanimously supported all chosen items because their I-CVI scores rested between 0.8 and 1. The calculated S-CVI score reached 0.95, which indicates high content validity for the questionnaire. The expert panel achieved good to very good agreement when rating construct clarity at 0.622, yet simplicity obtained very good agreement at 0.748, along with relevance scoring only moderate agreement at 0.404. The results from face validation showed that 97% of experts agreed on the items. Conclusion: Preliminary content and face validity assessment demonstrate suitable quantity indices for the tool. The research gives guidance for future psychometric testing of this new assessment questionnaire to evaluate Physiotherapists’ disaster health management competencies.

Comparison of Segmental versus Conventional Spinal Anaesthesia in Preeclamptic Parturient Undergoing Caesarean Section: A Randomised Controlled Study

Devyani Jatin Desai, Neha Kinit Shah, Arvind Kalaimani Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Spinal anaesthesia-induced maternal hypotension is still the most frequent complication observed in preeclamptic parturient. Segmental spinal anaesthesia is another alternative where the dural puncture is done at the lower thoracic vertebral level, and segments involving the surgical interventions are blocked preferentially. Aim: To compare haemodynamic variables and sensory and motor blockade characteristics after segmental versus conventional spinal anaesthesia in preeclamptic parturients undergoing Lower-Segment Caesarean Section (LSCS). Materials and Methods: The present randomised controlled study was conducted at Baroda Medical College, Sir Sayajirao General Hospital, Vadodara, Gujarat, India, from July 2022 to August 2023. A total of 70 preeclamptic parturients with American Society of Aanaesthesiologists (ASA) status II and III, posted for caesarean section, were randomly allocated to either Group S, which received segmental spinal anaesthesia at the T_9-10 or T_10-11 level, or Group C, which received conventional spinal anaesthesia at the L_2-3 or L_3-4 level. The primary parameter studied was a comparison of haemodynamic stability. Characteristics of sensory and motor blockade, ability to go to stretcher unaided, duration of postoperative analgesia, and perioperative complications were observed secondarily. Pearson’s χ²-test, student t-test and Mann-Whitney U test were applied as appropriate for the final statistical analysis. The significance of data analysed by p-value and p<0.05 was considered significant. Results: The mean age and ASA status of the patients were comparable in Group S and Group C. (25.88±5.36 vs 25.36±4.89, p=0.72 and 18/17 vs 16/19, p=0.68, respectively). Reduced incidences of hypotension (14.29% vs 37.14%, p=0.03) leading to the requirement of a lesser number of doses of vasopressor in patients with Group S than in Group C (0 (0-0 vs 0 (0-1), p=0.02). The onset of sensory blockade at the T₆ dermatome was faster (69.2±72.65 vs 200.4±134.92 seconds, p<0.0001), and the duration of sensory blockade was shorter in patients belonging to Group S in comparison to Group C (123.6±55.66 vs 203.8±45.71 minutes, p<0.0001). All patients in Group C had grade three motor blockade as opposed to none in Group S (p<0.0001), which led most (90%) of patients in Group S to shift to the stretcher unaided. Conclusion: Segmental spinal anaesthesia is a safe and alternative technique when used in a preeclamptic parturient undergoing LSCS, providing better haemodynamic stability with adequate anaesthesia and early postoperative ambulation.

Effect of Ultrasound-guided Erector Spinae Plane Block using Levobupivacaine on Postoperative Analgesia in Thoracic and Lumbar Spine Surgeries: A Prospective Observational Study

Preeti Rajendra Chandegaonkar, Shital Sudhakar Ahire, Sambharan Padman Nayak, Shweta Pravin Mhambrey Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Postoperative pain management in thoracic and lumbar spine surgeries is crucial for preventing complications, promoting early mobilisation, and improving patient outcomes. The Erector Spinae Plane (ESP) block, an emerging regional anaesthesia technique, shows promising results in the management of postoperative pain by targeting the dorsal and ventral rami of the spinal nerve, thus providing both somatic and visceral analgesia. Aim: To evaluate the efficacy of ultrasound-guided ESP block using levobupivacaine for postoperative pain relief and reduction in analgesic requirements in thoracic and lumbar spine surgeries. Materials and Methods: This prospective observational study was conducted at a tertiary care centre from June 2020 to November 2021. Fifty-two patients, aged 18-65 years, undergoing thoracic or lumbar spine surgeries were included. Group E (n=26) received an ESP block with levobupivacaine, while Group C (n=26) did not. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 1, 4, 6, 12, and 24 hours postoperatively. The requirement for rescue analgesia and adverse events, including haemodynamic stability, were recorded. Statistical analysis was performed using the independent t-test and Chi-square test for continuous and categorical variables, respectively, with a p-value <0.05 considered statistically significant. Results: Group E demonstrated significantly lower VAS scores at all postoperative intervals (p<0.001). Patients in Group E required less rescue analgesia compared to Group C (7.7% vs. 53.8%, p<0.001). Haemodynamic stability was maintained more effectively in Group E, with more stable haemodynamic parameters (p<0.001). Conclusion: Ultrasound-guided ESP block with levobupivacaine is an effective method for reducing postoperative pain and analgesic requirements in thoracic and lumbar spine surgeries. The technique also contributes to better haemodynamic stability during the perioperative period.

Geospatial Analysis of Dental Services in Jaipur, Rajasthan, India: A Retrospective Observational Study

Visha Shailesh Pandya, Pranav Pandya, Naganandini Sampath, Pankaj Chaudhary, Jahanvi Kapadiya, Satyendra Singh Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Geographic Information Systems (GIS) are tools used to integrate spatial and non spatial attribute information, providing a foundation for mapping and understanding geographic context and aiding the allocation and redistribution of dental services, thereby making dental services accessible to underserved populations. Aim: To analyse the distribution of dental services in Jaipur district using geospatial analysis, an evidence-based reorganisation tool. Materials and Methods: This retrospective observational study was conducted over nine months from October 2019 to July 2020 in the Department of Public Health Dentistry of NIMS Dental College and Hospital, Jaipur, Rajasthan, India. Data collection was carried out from October 2019 to February 2020 and data analysis was performed from March 2020 to July 2020. GIS applications used included QGIS, ArcGIS Desktop, ArcGIS Online, Google Earth Pro and Google Maps to perform geospatial analyses. All public and private dental services in Jaipur district were mapped using GIS software and overlaid with population data from the 2011 Census. Results: Jaipur district comprises 13 subdivisions with a total population of 9,847,662. The majority of dental services 1,117 (95.14%) were in the private sector, with relatively few 57 (4.85%) in the public sector. Accessibility analysis showed that dental services located in Jamwa Ramgarh, Shahpura and Bassi were highly inaccessible within 5, 10 and 15 km, respectively. The average nearest-neighbour analysis indicated a clustered distribution of dental services in Jaipur district (z=-35.28), suggesting less than a 1% probability that the observed clustering occurred by chance. Conclusion: Geospatial analysis provides insights into the population and dental services, highlighting underserved areas and guiding policymakers. A spatial join analysis of the entire Jaipur district indicated that the concentration of dental services is highest in the Jaipur subdivision compared with other subdivisions. Therefore, local health planners in Jaipur should allocate dental services to the less-served districts identified by the present study.

Assessment of Pathways to Care, Personality Traits and Quality of Life among Patients with Dhat Syndrome: A Cross-sectional Study

Nishanth Reddy, Santosh Ramdurg, Shivakumar Chaukimath Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Dhat syndrome, a culturally specific psychosomatic disorder, predominantly affects young men in South Asian countries. It is characterised by a constellation of somatic complaints, anxiety, and depressive symptoms, all attributed to the perceived loss of semen, a substance that has been traditionally considered vital for health and vitality in South Asian cultural contexts. Rooted in centuries-old beliefs, Dhat syndrome is often accompanied by profound psychological distress and misattributions regarding semen loss through nocturnal emissions, masturbation, or urination. This study seeks to comprehensively assess the clinical manifestations, care-seeking pathways, predominant personality traits, and Quality of Life (QoL) among individuals diagnosed with Dhat syndrome, thereby assessing critical gaps in culturally competent psychiatric intervention. Aim: To study the pathways of care and phenomenology among patients with Dhat syndrome, at-risk personalities, and the QoL in these patients. Materials and Methods: The present cross-sectional study was conducted at a tertiary care hospital in North Karnataka, India, involving 47 male patients diagnosed with Dhat syndrome per ICD-10 criteria. Data were collected using a semi-structured proforma for socio-demographic profile, World Health Organisation (WHO) Pathways Interview Schedule, International Personality Disorder Examination (IPDE) screening module and the World Health Organization Quality of Life - brief version (WHOQOL-BREF) questionnaires. Statistical analysis included descriptive statistics and correlation tests. Results: The study comprised 47 male patients diagnosed with Dhat syndrome, predominantly young adults (mean age 24.91±5.11 years), unmarried 31 (65.96%) and from rural 29 (61.7%) and low-income backgrounds 26 (55.3%). The mean duration of untreated illness was 3.95 years, with patients consulting 1.6 (mean) providers before reaching psychiatric care, reflecting significant delays and fragmented pathways. Cluster C personality traits were predominant in 87.2% of participants, indicating heightened anxiety, dependency, and obsessive-compulsive tendencies. The WHOQOL-BREF scores revealed that physical (46.57±18.76) and psychological health (45.26±17.22) were most affected, followed by the environmental domain (54.20±13.62) and social relations (53.17±18.28). Delays in psychiatric care were associated with poorer physical (r=-0.581, p<0.001) and psychological health (r=-0.589, p<0.001). The findings underscore the need for early psychiatric intervention, targeted psychoeducation, and culturally sensitive care to mitigate prolonged delays and associated socioeconomic and psychological burdens. Conclusion: The present study revealed prolonged care-seeking pathways, with a mean duration of untreated illness of 3.95±2.21 years. Poor QoL was significantly associated with longer illness duration. The findings underscore the urgent need for culturally sensitive psychoeducation, targeted interventions for at-risk personality profiles, and integrated mental health services to address the socio-cultural and economic barriers in managing Dhat syndrome effectively.

Haematological Parameters, Coagulation Profile and Serum Lactate Dehydrogenase in Women with Pregnancy Induced Hypertension versus Normotensive Pregnant Women: A Case-control Study

Sukanya Partha Sarathi Sarkar, Amit Ravindra Nisal, Parineeta Dnyaneshwar Shelke, Preeti Rajeev Doshi, Ravindra Chandrashekhar Nimbargi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Pregnancy-Induced Hypertension (PIH) is the most common disorder of pregnancy, affecting approximately 5-7% of pregnancies and it is a significant cause of maternal and foetal morbidity and mortality. In a proportion of these patients, the risk to the mother can be substantial, including the possible development of Microangiopathic Haemolytic Anaemia (MAHA). Altered haemogram and coagulation abnormalities, such as anaemia, thrombocytopenia, the presence of schistocytes and deranged Prothrombin Time (PT) and activated Partial Thromboplastin Time (APTT) values, are hallmarks of these patients. Aim: To compare haematological and coagulation parameters, as well as serum Lactate Dehydrogenase (LDH) levels, in normal pregnant women and those with PIH. Materials and Methods: This was a case-control study in which 100 patients were analysed in a tertiary care centre attached to a University Medical College in western India over two years. Complete Blood Count (CBC) with peripheral blood smear, PT, aPTT and serum LDH were performed on patients with PIH (50) and normal pregnancies (50). The data were analysed using Statistical Package for the Social Sciences (SPSS) version 25.0 software. For qualitative data, various rates, ratios and percentages were calculated. Chi-square test was used to find associations between two or more attributes. For quantitative data, Mean±SD was calculated. The unpaired t-test was utilised to compare the two independent groups for the data variables. A p-value of <0.05 was considered significant. Results: The platelet count was decreased in 48 out of 50 PIH patients (96%), while PT and aPTT were increased in all 50 patients with PIH. Serum LDH values were elevated in 16 patients with PIH (32%). The p-value was found to be <0.0001 in women with Preeclampsia (PE) and Eclampsia (E) compared to normal pregnant women for platelet count, PT, APTT and serum LDH. Only four PIH patients showed the presence of schistocytes on the peripheral smear. Conclusion: Patients with PIH exhibited low platelet counts, high PT/APTT values and elevated serum LDH levels compared to normal pregnant patients. PIH and Disseminated Intravascular Coagulation (DIC) can present with overlapping features, such as thrombocytopenia and abnormal liver function tests, but they differ in clinical context and severity of coagulation abnormalities.

Evaluation of Optic Disc and Retinal Nerve Fibre Layer Changes and its Association with Visual Field Defects in Patients with Normal Tension Glaucoma: A Hospital Based Interventional Study

Lavanya, Sanjitha, Gandavarapu Asritha Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Normal Tension Glaucoma (NTG) is a spectrum of primary open angle glaucoma, characterised by optic nerve head change in the form of glaucomatous cupping, visual field defects despite Intraocular Pressure (IOP) <21 mmHg. Patients remain asymptomatic until significant visual field loss occurs. An early sign of NTG is Retinal Nerve Fiber layer (RNFL) thinning. Although IOP is within normal range, further reduction can slow the disease progression. Early diagnosis of NTG is challenging due to absence of raised intraocular pressure, thus structural evaluation by optic disc, RNFL and functional evaluation by visual field indices helps in earlier diagnosis and disease progression. Aim: The aim of this study was to assess the relationship of optic nerve head and RNFL changes with visual field findings in NTG patients. Materials and Methods: The present prospective, interventional, hospital based study included 40 eyes with NTG conducted at SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India and duration of study was one year and six months. Thorough history, ophthalmic examination was done which includes visual acuity, anterior and posterior segment, IOP, Central Corneal Thickness (CCT), visual fields and Optical coherence Tomography (OCT). Patients started on 0.2% brimonidine eye drops twice a day and progression was tracked by repeat visual fields six months later. Data was analysed using independent samples t test and correlation was assessed using Pearson’s rank correlation. Statistical Package for Social Sciences (SPSS) software version 26 was used for the statistical analysis. Results: Forty eyes were studied. Mean age was 49.75 years with majority males 15 (56%). Average IOP was 14.825 mmHg, Average CCT was 528.58 micrometres. Correlation between IOP and Average RNFL was statistically insignificant (p=0.857). CCT had weak positive correlation with average RNFL, which was not significant statistically (p=0.659). Average CDR was 0.61. Average RNFL thickness was 81.4 μm. CDR weakly correlated to RNFL thickness (r=-0.179: p=0.269) but strongly correlated to visual field indices (Average Mean Deviation (MD) r=+0.955: p<0.00001). RNFL correlated with Mean Sensitivity (MS). Follow-up after six months showed that only two eyes (7%) had visual field progression and was changed to latanoprost 0.005% eye drops once daily. Conclusion: CCT and Diurnal IOP variation tests play an important role in diagnosis of NTG. Hypoperfusion might be an etiological factor in NTG. OCT aids in identifying RNFL thinning even before field defects. The progression of field defects in NTG was reduced by lowering IOP.

Aeromycological Survey of Delhi: Significance in Management of Respiratory Allergic Patients

Pamela Singh, Varun Anand, Shubhankar Singh, Sunanda Sharma, Vipul Chaudhary, Nandani Goswami Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Aeroallergens are a significant cause of respiratory morbidity and mortality, particularly in patients with respiratory allergic disorders such as asthma and rhinitis. Understanding the prevalence of local aeroallergens is critical for accurate diagnosis and effective treatment. Airborne fungal spores, one of key component of aeroallergens, vary significantly with geographical and seasonal factors. This study focused on detecting and quantifying airborne fungal spores in New Delhi to better understand their contribution to respiratory allergic disorders. Aim: To analyse the prevalence and seasonal variations of airborne fungal spores in New Delhi through systematic air sampling. Materials and Methods: The present cross-sectional study was conducted for one year at Vallabhbhai Patel Chest Institute, New Delhi, India and air sampling was conducted over 69 systematic sampling days by vertically installed Air Sentinel device on the institute’s main hospital building roof to capture airborne fungal spores. Fungal spores were collected, their species identified through microscopic examination, and specific allergen levels quantified using immunochemical methods. Seasonal variations in fungal spore prevalence were analysed, along with the correlation between total and viable spore counts. Results: A total of 217,982 fungal spores were collected, with Aspergillus, Penicillium, Cladosporium, Alternaria, Epicoccum, and Drechslera identified as the predominant airborne species. Significant seasonal variations were observed in both total and viable spore counts. Immunochemical analysis demonstrated notable seasonal fluctuations in specific fungal aeroallergen levels; however, no significant correlation was found between these levels and total or viable spore counts with Rank corelations (Batschelet; 1981). Conclusion: This study highlights the significant seasonal variations in airborne fungal spore prevalence in New Delhi, India with Aspergillus, Penicillium, Cladosporium, Alternaria, Epicoccum, and Drechslera identified as the predominant species. While specific fungal aeroallergen levels fluctuated seasonally, they showed no significant correlation with total or viable spore counts. These findings highlight the importance of continuous air quality monitoring and targeted allergen assessment to better understand the impact of fungal spores on respiratory allergic disorders, guide targeted interventions, and improve patient outcomes in high aeroallergen exposure regions.

Impact of Donor Age and Cornisol Storage Duration on Endothelial Cell Count and Morphology in Donor Corneal Tissues: A Prospective Observational Study

Abhay Lune, Pradipta Potdar, Pranav More, Shikha Rai Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Corneal transplantation remains one of the most successful forms of solid tissue transplantation and a crucial treatment modality for visual rehabilitation in patients with corneal blindness. The success of keratoplasty is largely determined by the health of the corneal endothelium, a non regenerating monolayer crucial for maintaining corneal clarity. Factors such as donor age, cause of death and storage duration influence endothelial viability, especially in intermediate-term storage media such as Cornisol, widely used in Indian eye banks. Aim: To study and serially evaluate the donor corneal Endothelial Cell Count (ECC) and morphology during Cornisol storage, in association with donor age and cause of death. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital and research centre, Pune, Maharashtra, India which included 75 donor corneoscleral rims stored in Cornisol between September 2023 and March 2025. Seventy-five donors were categorised into three age groups: Group I (0-30 years), Group II (31-60 years), and Group III (61-90 years). Specular microscopy was performed on days 0, 1, 3, 5, 7, 10 and 14, or until the end of storage. ECC, hexagonality (%HEX), and Coefficient of Variation (CV%) were analysed over time using repeated-measures Analysis of Variance (ANOVA) for intragroup comparisons, while one-way ANOVA followed by Tukey’s post hoc test was applied for intergroup comparisons. A p-value <0.05 was considered statistically significant. Results: Group I (0-30 years) had the highest baseline ECC and the lowest percentage ECC loss (7.8% by day 5). Group II (31-60 years) showed the greatest ECC loss (36.5% by Day 14), followed by Group III (61-90 years) with 30.4% loss. Intragroup ECC decline was statistically significant in all groups (Group I: p-value=0.009; Groups II and III: p-value <0.001). Intergroup differences in ECC, hexagonality and CV were also significant across most time points (p-value <0.001, except day 14 for ECC where p-value=0.2206). Percentage ECC loss was highest in corneas from trauma-related deaths (45.3%), followed by cardiorespiratory failure (41.6%) and non traumatic intracranial haemorrhage (22.4%), with statistically significant differences across most time points (except day 5, p-value=0.071). Conclusion: Younger donor corneas demonstrated superior ECC and stability of morphometric parameters. Significant deterioration was noted in older donor tissues, especially beyond day 5 of storage. Donor age, storage duration and cause of death all influenced endothelial viability, supporting early use and careful donor selection.

A Cross-sectional Study on Urinary Incontinence: Prevalence, Risk Factors, and Impact on Quality of Life among Females in Northern Border Region Saudi Arabia

Safya E Esmaeel, Reem Ibrahim S Alanazi, Yosra Radi Alrowaili, Daniya Sulaiman A Alanazi, Sadeem Talal S Alanazi, Sadeem Zwyed Alenazi, Waten Ied Atiwi Alenezi, Hajar Abdullah K Alanazi, Eslam K Fahmy Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Urinary Incontinence (UI) is the involuntary leakage of urine loss that can be objectively confirmed and is a social and hygienic concern. The pathophysiology of UI is influenced by factors such as pregnancy, age, obesity, and weakend pelvic floors. Aim: To evaluate the prevalence of UI, identify assosciated risk factors, and its impact on the quality of life among females. Materials and Methods: A descriptive cross-sectional study was conducted among 1001 females in Department of Physiology, College of Medicine, Northern Border University, Arar, Saudi Arabia from March 2025 to May 2025 Northern Saudi Arabia from March 2025 to May 2025, following approval from the local bioethical committee of Northern Border University. An online survey was conveniently distributed via social media. The information was displayed using percentages and frequencies. Independent predictors of UI were identified using binary logistic regression , with a p-value of <0.05 was considered significant. Results: A total of 1001 females were included, with Urge Urinary Incontinence (UUI) being the most common type, reported by 431 participants (43.1%), followed by mixed UI 344 (34.4%)and stress UI 255(25.5%). Significant associations between UUI and various factors, including age, marital status, education, occupation, weight, height, obstetric or surgical history, and the presence of chronic disease (p-value<0.001). Stress UI showed a more modest increase, peaking among obese individuals (59,32.1%). Overall 264 respondents (26.4%) reported a negative impact of UI on social life. Logistic regression analysis identified chronic disease as a highly significant factor, with an Odds Ratio (OR=0.529; p-value<0.001), suggesting more than double the risk of incontinence. Conclusion: Age, marital status, occupation, Body Mass Index (BMI), and chronic disease are significantly associated with UUI. These factors may influence both the risk and severity of symptoms, highlighting the importance of individualised assessment and targeted interventions.

Evaluation of Apical Sealing Ability of Different Endodontic Sealers: A Stereomicroscopic Study

Swapnali Ganapati Sutar, Jyoti Mandlik, Sarita Singh, Mineet Kaul, Shivani Chavan, Mrunal Shinde Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: The introduction of the adhesive dentistry concept has allowed materials to bond and provide intimate contact with the dentin walls of the root canal. Bondable root canal sealers, such as methacrylate resin sealer, can form a monobloc system within the root canal space, which improves the seal and fracture resistance of the filled canals. Recently, bioceramics have become one of the most popular biomaterials used in Endodontics after the clinical success of Mineral Trioxide Aggregate (MTA). Aim: The present study aimed to evaluate the sealing ability of three endodontic sealers (AH Plus, MTA Fillapex and Bio-C sealer) through an in-vitro dye leakage test. Materials and Methods: The present in-vitro study was conducted in Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India, from April 2024 to September 2024. Thirty intact single-rooted single-canaled teeth extracted for orthodontic/periodontal reasons were used in this study. These teeth were decoronated, chemomechanical preparation was done till size F3, and they were divided into three groups of 10 each. The samples in Group A were obturated with F3 Gutta-Percha (GP) cone and AH Plus sealer, in Group B, MTA Fillapex sealer was used, and in Group C, Bio-C sealer was used. The apical microleakage was measured microscopically using the linear dye penetration method. The intergroup comparisons of microleakage were made using the One-way Analysis of Variance (ANOVA) test, followed by a post-hoc Tukey test for pairwise comparisons. A p-value of less than 0.05 was considered statistically significant. Results: The MTA Fill-apex sealer group exhibited the highest level of microleakage, with a mean value of 1.48 mm, followed by the Bio-C sealer, which had a mean microleakage of 0.78 mm. In contrast, the AH Plus sealer group showed the lowest microleakage, with a mean of 0.59 mm. The differences in microleakage among the three groups were statistically significant at p≤0.05. Specifically, a significant difference was observed between AH Plus and MTA Fill-apex (p=0.002), as well as between MTA Fill-apex and Bio-C (p=0.015). However, the difference between AH Plus and Bio-C was not statistically significant (p=0.702). Conclusion: The present study findings indicated that AH plus sealer exhibited superior sealing ability compared to MTA Fillapex and Bio-C sealer. Hence, it can be concluded that AH Plus provides more effective sealing, making it a more reliable option during obturation procedures and contributing to better long-term treatment outcomes.

Psychological Distress and its Effect on Academic Performance and Attendance of Undergraduate Medical Entrants: A Longitudinal Study

Shikha Jain, Preeti Jain, Amit Goel Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Globally, the prevalence of psychological distress is alarmingly high and increasing among medical students at different phases of their training. Signs and symptoms of mental distress have also been observed in first-year entrants. Psychological distress can significantly hinder students’ ability to retain and apply knowledge. Aim: To assess changes in stress levels and academic performance among undergraduate medical students after the first term of medical education, compared with their levels at entry into the medical course. Materials and Methods: A longitudinal, observational study was conducted from July 2015 to February 2016 at the Department of Physiology, Maulana Azad Medical College, New Delhi, India. A total of 168 newly admitted students (97 male, 71 female) participated voluntarily. Data were collected using self-reported questionnaires, including a sociodemographic profile and the General Health Questionnaire (GHQ-12), in two sessions: the baseline session (at the end of the first week in medical college) and the follow-up session (at the end of the first-term exams). Academic performance was assessed at baseline by the percentage of marks secured in the best four subjects in the Class 12 examination, and at follow-up by the percentage of marks secured in combined Physiology theory and practical. Attendance was calculated as the percentage of theory and practical classes attended in Physiology. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0; Student’s t-test, Pearson’s correlation and Multivariate Analysis of Variance (MANOVA) were employed. For all analyses, p<0.05 was considered significant. Results: The mean age of students was 18.51±0.90 years. There was a significant increase (p<0.001) in GHQ-12 scores at follow-up compared with baseline. The prevalence of stress was 14.3% at baseline and 64.3% at follow-up. Stress levels increased significantly at follow-up compared with baseline (p<0.001). Academic performance decreased significantly at follow-up compared with baseline (p<0.001), where the baseline measure was the percentage secured in Class 12. The mean attendance at the end of the first-term examination was 86.12±5.44%. There was a significant correlation between attendance and academic performance at both baseline (r=0.236; p<0.01) and follow-up (r=0.444; p<0.001). MANOVA revealed an overall significant effect of gender (p<0.01) and exercise (p<0.05) on the combined dependent variables. There was a significant main effect of gender on the percentage of marks secured in both Class 12 (p<0.001) and the first-term exam (p<0.05). Conclusion: There was an overall deterioration in general psychological well-being, as indicated by a significant increase in mean GHQ-12 scores at follow-up. The prevalence of psychological distress and stress levels increased significantly, whereas academic performance declined significantly at follow-up. Continuous counselling is required to identify stressors and promote coping strategies to help students manage stress more effectively.

Heart Rate, Blood Pressure, Rate Pressure Product in Young Healthy Females at Three Time Points of Menstrual Cycle: Associations with Cycle Length and Body Weight

Hemalatha Manjeshwara, V Suganthi, Amudharaj Dharmalingam, Milind V Bhutkar, Gopinath Manavazhagan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: The menstrual cycle exerts profound cyclical effects on the functioning of the reproductive and cardiovascular systems in health and disease. Cyclical changes in the cardiovascular system due to the menstrual cycle are less studied compared with those in the reproductive system. There exist significant lacunae and conflicting findings in the literature regarding the effect of the menstrual cycle on the cardiovascular system. Hence, this study investigated cyclical variations in cardiovascular parameters across the menstrual cycle. Aim: To assess cardiovascular parameters across different menstrual phases and correlate them with cycle length and body weight in healthy young females. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology, Aarupadai Veedu Medical College and Hospital, Puducherry, India, from July 2018 to June 2024. A total of 73 regularly menstruating healthy females aged 18-24 years with cycle lengths of 21-35 days were included. Women with menstrual abnormalities, chronic illness, or those on any medications were excluded from the study. Heart Rate (HR), Blood Pressure (BP), and body weight were measured daily throughout the cycle at the same time of day. Three data points were collected: preovulatory, ovulatory, and postovulatory phases, at 21st, 14th, and 7th days preceding the last day of the cycle, respectively. Data were analysed using statistical tests appropriate for repeated measures. The Type I error was set at 0.05, and p-value<0.05 was considered statistically significant. Results: The mean heart rate significantly differed (p-value<0.001) among the three days, with the highest values in the postovulatory phase. Differences were also observed in the Rate Pressure Product (RPP) with p-value=0.0254. Systolic Blood Pressures (SBP) and Diastolic Blood Pressures (DBP) significantly correlated with body weight in each phase (p-value<0.001). Conclusion: Cardiovascular parameters varied across the menstrual phases and showed different correlations with cycle length and body weight. These findings may guide personalised drug therapy and lifestyle modifications.

External Application of Lodhra (Symplocos Racemosa) Paste with Mahamanjishthadi Ghana Vati in Mukhadushika (Acne Vulgaris): A Randomised Controlled Clinical Trial

Apeksha Ashok Majge, Kashavva Veerabasayya Hiremath, Kavyashree Shivanna Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Acne vulgaris, a common skin disease affecting younger adults, is generally managed by antibiotics, anti-seborrheic agents, hormonal therapy, and topical applications. In ayurveda, this disease is described as Mukhadushika, characterised by minute thorn-like eruptions. Its treatment includes both internal administration and external application of blood-purifying drugs. Aim: To evaluate the effect of external application of Lodhra (Symplocos Racemosa) paste adjuvant to Mahamanjishthadi Ghana Vati (MGV) herbal tablet internally in acne vulgaris. Materials and Methods: An open-label, randomised controlled clinical trial was conducted between March 2023 to June 2024, at Karnataka Lingayat Education (KLE), Ayurveda Hospital, Belagavi, Karnataka, India. A total of 50 patients of either sex, aged between 16-40 years, were assessed using the Mukhadushika Roopa (symptom) assessment score and Global Acne Grading Scale (GAGS), and were randomised into two groups. Both group A (control, n=25) and group B (intervention, n=25) were administered MGV herbal tablet (500 mg) orally, twice daily, for 30 days. Patients in group B were additionally treated with the external application of Symplocos Racemosa paste. The Dermatology Life Quality Index (DLQI) of the participants was also assessed. Study outcomes were assessed using Mukhadushika Roopa (symptoms) and GAGS on baseline, on 15th and 30th day, whereas DLQI was assessed at baseline and 30th day. Statistical results were evaluated through the Mann-Whitney U test and the Wilcoxon signed-rank test. A p-value of <0.05 was considered statistically significant. Results: Both groups showed significant improvement in all three parameters after 30 days of intervention (p-value <0.001). On intergroup comparison, Symplocos Racemosa paste showed better improvement in symptoms of acne vulgaris (p-value <0.001). Conclusion: External application of Lodhra (Symplocos Racemosa) paste, as an adjuvant to MGV herbal tablets, appears more beneficial than internal administration of MGV herbal tablets alone in acne vulgaris.

Application of a Modified Comprehensive Care Map for Elderly Postnatal Mothers after Caesarean Section to Enhance Maternal and Neonatal Outcomes: A Pilot Study

Archana Sahadeorao Teltumbde, Vaishali Taksande Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Caesarean Section (CS) is a surgical procedure with a challenging recovery period, especially for elderly postnatal mothers who may experience higher risks of complications. Effective postnatal care is essential in ensuring optimal maternal and neonatal outcomes. Aim: The present study evaluates a Modified Comprehensive Care Map (MCCM) for elderly postnatal mothers to enhance recovery, improve wound healing, reduce postnatal depression, and support neonatal well-being. Materials and Methods: The present pilot study was conducted at AVBRH, Wardha, Maharashtra, India, starting in December 2022. Thirty participants were randomly assigned to experimental group receiving the MCCM intervention and control group receiving standard postnatal care. Maternal and neonatal outcomes, including pain, depression, wound healing, and latching, were assessed. Data were collected at baseline, during hospitalisation, and follow-up visits, with statistical analysis performed. Results: Postintervention, the knowledge scores in staff nurses were significantly higher in the experimental group (p=0.0001). Similarly, postintervention, the experimental group showed significant improvements in oedema (p=0.041), ecchymosis (p=0.004), and total REEDA score (p=0.006) among mothers. A significant reduction in Postnatal Depression Scores (PDS) was observed in the mothers in experimental group (p<0.01). The experimental group had a higher percentage of pain-free mothers postintervention (46.67% vs. 23.33% in the control group). While improvement was observed in latching and sucking, statistical significance was not achieved (p=0.3006). Conclusion: The MCCM significantly improved wound healing, reduced postnatal depression, and enhanced pain management among elderly postnatal mothers.

Behaviour and Role of Community in Family Planning Practices: A Mixed Methodology Study from a Rural Area in Central Kerala, Southern India

VM Midhukrishna, N Divyamol, Shilu Mariam Zachariah, TK Abdu Saleem, KS Deepak Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: All differentials for varying acceptance of family planning methods need to be addressed for healthy population growth. The current study explores the family planning behaviour and role of the community in family planning practices in rural Kerala. Aim: To identify the family planning behaviour, by analysing the contraceptive practices by eligible couples in a selected panchayath and to assess the barriers faced by eligible couples in accepting modern contraceptives. Also to explore the perspectives of service providers about factors affecting family planning behaviour of the rural community. Materials and Methods: The present mixed method study was conducted among eligible couples and family planning service providers in Puthussery, in the Palakkad District of Kerala, India during two months period between August- September 2021. The study comprised two phases: In Phase 1, investigators collected data on sociodemography and family planning practices from the eligible couple survey reports of Family Health Centre (FHC) Puthussery; Phase 2 involved free listing and pile sorting exercise done among family planning service beneficiaries and Key Informant Interviews (KII) with service providers after getting their consents. After phase 1, data was analysed using Epi Info software 7.2.5.0. Phase 2 utilised thematic analysis based on a deductive approach. A hierarchical cluster analysis was completed to get a collective picture of perceived rationales behind a grouping of the barriers. The analysis of free list and pile sort data was undertaken using Anthropac 4.0 software. Results: There were a total of 8035 eligible couples registered to FHC. Majorty belonged to above poverty line families 4821 (60%). In most couples 1857 (23%) female partners’s age ranged between 25-29 years and had attained secondary education 4210 (52%). The modern contraceptive prevalence rate was 5817 (72.4%). Female sterilisation 4598 (57.2%) was mostly preferred followed by condoms 677 (8.4%), intrauterine devices 518 (6.4%), oral contraceptive pills 19 (0.2%) and no scalpel vasectomy 5 (0.06%). All acceptors used conventional modern contraceptives. Barriers to accepting modern contraceptives were lack of awareness, side-effects and complications, Fear and myths, privacy concerns, and non-availability. Social factors centered around gender, other sociocultural factors, social factors affecting health system performance, and factors within the health system influenced contraceptive behaviour according to providers. Conclusion: Several social, cultural, and systemic determinants shaped the female-oriented and modern contraceptive-specific family planning behaviour of the rural population. Addressing sociocultural determinants and strengthening the healthcare system are needed for broader acceptance of an expanded basket of choices in family planning. All beneficiary barriers could be addressed by proper one-to-one, couple-based, and group approaches to communication.

Role of Hyaluronic Acid in Post-traumatic Osteoarthritis: Experimental Validation in a Rat Model

Chunpei Ou, Changchun Zeng, Pengfei Zhang, Pengfei Chen, Jinqi Song, Guangming Li, Yikun Zhao, Zhe Cheng Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: The pathogenesis of Post-traumatic Osteoarthritis (PTOA) remains incompletely understood. Although Hyaluronic Acid (HA) is widely used in the clinical management of Osteoarthritis (OA), its dynamic changes and mechanistic role in PTOA progression require further investigation. Aim: To characterise the dynamic changes of HA concentration in synovial fluid and serum during post-traumatic Knee OA (KOA) development using a rat model. Materials and Methods: The present Animal Randomised Controlled Trial (Animal RCT) was conducted in the laboratory of Longhua Central Hospital, Shenzhen, Guangdong Province, China, from August 2022 to July 2024. The present study utilised 36 male Sprague-Dawley rats (two-month-old, 320±20g). Rats were randomised into a sham control group (n=18; skin incision only) and Anterior Cruciate ligament Transection (ACLT) model group (n=18). Six subgroups (A-F) were established according to observation time points (postoperative days 7, 14, 21, 28, 70, and 98), each comprising three model and three control rats. Experimental procedures were temporally randomised, with collection of: Right hind-knee synovial fluid and serum for Enzyme-Linked Immunosorbent Assays (ELISA), right hind-knee joint specimens for safranin O-fast green staining and immunohistochemical analysis of CD68+ macrophage infiltration. Statistical analyses employed linear regression curve fitting, descriptive statistics {mean±Standard Deviation (SD)}, Analysis of Variance (ANOVA), and Student’s t-test. A p-value <0.05 was considered significant. Results: Experimental groups exhibited progressive decline in synovial HA concentration with disease progression (p=0.028), reaching nadir levels at postoperative Day 70 (synovial fluid: 5.113±0.2478 ng/mL; serum: 6.671±0.8706 ng/mL), followed by modest recovery (Days 71-98). HA dynamics demonstrated significant negative correlations with IL-1 levels expression (r=-0.5335, p<0.05). Conclusion: Post-traumatic joint instability induces sustained HA depletion (≤Day 70), potentially accelerating cartilage matrix degradation through Matrix Metalloproteinases (MMP)-13 upregulation and IL-1-mediated inflammatory cascades. These findings identify promising therapeutic targets for early PTOA intervention.

Association of Electrocardiogram Findings with Gender and Advancing Age among a Healthy Elderly Rural Population: A Cross-sectional Study

Buddha Bahadur Khatri, Padmashri Kudachi, Jeet Joshi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Electrocardiogram (ECG) is a cost-effective, non invasive screening tool widely used for detecting Cardiovascular Diseases (CVD). Despite its usefulness, there is limited research on ECG abnormalities in asymptomatic elderly rural populations, particularly concerning advancing age and gender. Aim: To study the ECG findings and their association with advancing age and gender among a healthy elderly rural population. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Nehru Medical College in Belagavi district, Karnataka, India over a period of six months from May to November 2017, catering to a low socioeconomic rural population. A total of 200 elderly asymptomatic individuals aged 60 years and above were included after obtaining a brief medical history, performing a systemic examination, and conducting routine blood tests to rule out co-morbidities. A 12-lead ECG was recorded for the study participants. The ECG findings were then interpreted to assess the prevalence of ECG abnormalities and their association with age and gender. Statistical analysis was performed using the Chi-square test, with a p-value of <0.05 considered statistically significant. Results: The average age of the subjects was 66 years. Among the total participants, 74 (37%) were male and 126 (63%) were female. The largest proportion of participants was in the 60-64 years age group, whereas the ≥75 year category had the lowest representation. Out of the 200 elderly participants in this study, 78 (39%) showed atleast one abnormal finding on their 12-lead ECG. The most commonly detected issue was Left Ventricular Hypertrophy (LVH). The data clearly showed that ECG abnormalities were more common as age increased. While a greater proportion of men (43.2%) had abnormal ECGs compared to women (36.5%), this difference was not statistically significant. Conclusion: The findings of this study indicate a notable link between increasing age and the occurrence of ECG abnormalities in elderly subjects in rural areas who are otherwise healthy, emphasising age as an important contributor to underlying cardiac alterations.

Clinical Characteristics and Short-term Outcomes in Patients with Peripartum Cardiomyopathy: A Retrospective Descriptive Study from a Tertiary Care Hospital in Southern India

A Poorani Devi, Saju Denishya Prabhakaran, Richu Ravikumar, Tamilarasu Kaliappan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Peripartum Cardiomyopathy (PPCM) is a life-threatening condition characterised by heart failure that occurs towards the end of pregnancy or in the months following delivery, with no identifiable cause for the heart failure. Despite its severity, the clinical characteristics of PPCM remain relatively unexplored in the Indian subcontinent. Aim: To investigate the clinical presentation and outcomes of patients with PPCM and to analyse the maternal and foetal outcomes of those affected by PPCM. Materials and Methods: This retrospective descriptive study was conducted among PPCM patients admitted over the past 10 years in the Department of Obstetrics and Gynaecology and the Department of Cardiology at PSG Hospitals, a tertiary healthcare centre in in Coimbatore, Tamil Nadu, India. The study was carried out over a period of 6 months, from May 2021 to November 2021. A sample size of 34 cases was determined and included in the study. Essential data for the study were gathered from the hospital’s electronic medical records, including patient demographics and clinical parameters (heart rate, blood pressure, respiratory rate, haemoglobin, creatinine, electrolyte levels), medical history, treatment details (hospitalisation history, drug intake, inotrope use, readmissions, mortality), echocardiographic findings and medication status. Maternal outcomes recorded included heart failure hospitalisation, the need for inotropes and mortality. Continuous variables were expressed using mean, standard deviation, minimum and maximum values, while categorical variables were represented in terms of frequency and percentage. Results: The study encompassed 34 participants with a mean age of 29.26±5.73 years. Hypertension was the most common co-morbidity, observed in 7 patients (20.59%), followed by diabetes in 4 patients (11.76%). According to the New York Heart Association (NYHA) classification, 15 patients (44.12%) fell into Class II, while 14 patients (41.18%) were classified as Class III. The study revealed a readmission rate of 13 patients (38.24%) and unfortunately, 3 patients (8.82%) succumbed to the disease. Diuretics were the predominant type of medication used, prescribed to 26 patients (76.47%), with Tab Digoxin being the most commonly used inotrope, administered to 12 patients (47.37% of those on inotropes). Conclusion: The PPCM poses a significant challenge in diagnosis due to its symptom overlap with normal pregnancy. Timely identification of PPCM is crucial for successful treatment outcomes.

Concept Maps in Undergraduate Pharmacology Education: A Systematic Review of Their Impact on Deep Learning, Academic Performance and Student Perceptions

Jyoti M Benni, Reshma Nadaf, Basavaraj R Tubaki Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Medical education in India has shifted from traditional methods toward a competency-based approach. This shift highlights the need for advanced teaching-learning approaches that encourage meaningful learning, support long-term information retention and foster critical thinking. Recently, Concept Maps (CMs) have been increasingly used in medical education to facilitate deep learning and rational thinking. Despite their growing use, their effectiveness in pharmacology teaching for medical students has not been comprehensively reviewed. Aim: To explore whether CMs support deep learning and enhance educational outcomes in medical undergraduates and to explore students’ and faculty perceptions and attitudes toward the use of CMs in pharmacology teaching. Materials and Methods: This systematic review was registered with PROSPERO (CRD420251066308) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive literature searches were conducted in PubMed, Scopus and Google Scholar up to May 2025. Original research studies published in English, involving undergraduate medical students, focusing on the use of CM(s) as a teaching strategy specifically in pharmacology teaching and learning were included. Randomised controlled trials, quasi-experimental studies, pre-post intervention studies, or cross-sectional studies that facilitated deep learning, critical thinking, academic performance, or knowledge acquisition were included. The Quality Assessment of Diverse Studies (QuADS) tool was used to evaluate the quality of studies. Results: Five studies meeting the inclusion criteria were included in this review; all were conducted in India between 2019 and 2023. Interventions included short-term sessions and month-long modules. CMs improved academic performance and were perceived to enhance deep learning, clinical reasoning and post-test scores. Student feedback across all studies was overwhelmingly positive, highlighting improved comprehension and engagement. Faculty reported that CM development is time-consuming and that training sessions are needed, but responses were nonetheless overwhelmingly favourable. Conclusion: CMs are promising active learning techniques in undergraduate pharmacology education, shifting the focus from rote memorisation to meaningful understanding. They foster deeper understanding, better academic outcomes and higher student acceptance.

Profile of Adverse Drug Reactions in Patients on Treatment for Drug Resistant Tuberculosis: A Cross-sectional Study

Swetapadma Pradhan, Sonali Das, Manoranjan Dash, Ganeswar Das, Niharika Naik, Jyoti Patnaik Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Tuberculosis (TB) is a communicable disease. India accounted for highest number of TB cases in the world and also share largest burden of Multidrug Drug Resistant (MDR) and Extensively Drug Resistant (XDR) TB cases. Drug Resistant Tuberculosis (DRTB) regimen contains second line anti-TB drugs which are more toxic and likely causes Adverse Drug Reaction (ADR). Severe side-effects and ADRs are one of the main reasons for non-adherence and discontinuation of drug regimen. Aim: To assess the profile of the ADRs in patients on treatment for drug resistant TB. Materials and Methods: The present cross- sectional study was done in DRTB ward of Respiratory Medicine, SCB MCH, Cuttack, Odisha, India. Patients were selected as per inclusion criteria. Adverse reactions were noted by detailed history, general and systemic examination with relevant Laboratory investigations. Causality assessment of ADRs was carried out using Naranjo and World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) algorithm. Severity of ADR was carried out using Modified Hartwig and Seigel scale. Data collected was entered and analysed using IBM Statistical Package for Social Sciences (SPSS) 26, univariate analysis expressing odds ratio and 95% CI was found. Variables with a p-value < 0.05 in univariate analysis are considered significant. Results: Among the 160 DRTB cases enrolled, 85 cases developed ADRs. Among the ADRs Gastrointestinal (GIT) (52.13%) was highest followed by Central Nervous System (CNS) (15.3%) and Cardiovascular System (CVS) (7.69%). Causality assessment done by Naranjo scale showed 72.6% are probable. Among the causality assessment done by WHO-UMC, majority were of possible type i.e., 51.3%. The severity assessment using Modified Hartwig and Seigel scale detected majority ADRs are mild type (63.2%). Conclusion: The majority of ADRs are mild and the frequency of ADRs is low in oral bedaquiline containing regimens as compared to previous injectable containing drug resistant regimen. In this study most common ADR is of Gastro intestinal origin and serious ADRs are very rare.

Effect of Two Doses of Oral Melatonin on Perioperative Anxiety and Postoperative Analgesia in Patients Undergoing Orthopaedic Surgeries: A Randomised Controlled Study

Lisa Barman, Shashi Kiran, Mamta Jain, Neha Aeron, Amandeep Singh Sachdeva, Amit Singh Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Perioperative anxiety and postoperative pain are the most common complaints associated with orthopaedic surgeries leading to increased morbidity and hospital stay. Melatonin, a recent alternative to benzodiazepines with fewer side-effects, has been shown to reduce anxiety and pain in perioperative settings. Aim: To investigate the anxiolytic effect of melatonin perioperatively and its analgesic potency postoperatively. Materials and Methods: The present randomised, controlled double-blinded study was conducted including 90 patients equally distributed to three groups receiving placebo (Group P), 6 mg (M6) and 12 mg oral melatonin (M12) 60-90 minutes before surgery. Primary outcome was preoperative anxiety, assessed using State Trait Anxiety Inventory (STAI) before drug administration and 60-90 minutes after it. Postoperative anxiety, assessed using STAI and and postoperative pain, assessed using Visual Analogue Score (VAS) for the next 72 hours both at rest and in movement, time of request for rescue analgesia and total analgesic requirements within 72 hours were considered as secondary outcomes. One-way Analysis of Variance (ANOVA) and Kruskal-Wallis test were used to compare the three groups regarding continuous and dichotomous variables, respectively. Results: Ninety patients were enrolled in the study and were randomly distributed into three matched groups according to age, sex, anthropometric parameters and American Society of Anaesthesiologists (ASA) grading. Significantly reduced (p<0.001) STAI scoring was found in group M12, from the preoperative period to 72 hours postoperatively. A statistically significant reduction in VAS scoring for pain both at rest and movement was always observed in group M12 from six hours to 72 hours postoperatively (p<0.001). The time of request for first and second rescue analgesics in group M12 was significantly later than group M6 and group P. Total consumption of rescue analgesics was found to be significantly low (p<0.001) in group M12. Conclusion: A 12 mg of oral melatonin premedication reduces anxiety during perioperative phase as compared to 6 mg of melatonin and placebo, with no significant difference between the latter two. It was also found that significant reduction in postoperative anxiety and pain at rest and during movement in the M12 group, but not in groups M6 and P. M12 group also required significantly less rescue analgesic than groups M6 and P. In summary, 12 mg of oral melatonin exhibited desired analgesic, sedative and anxiolytic properties to ameliorate perierioperative anxiety and postoperative pain, without any negative haemodynamic effect.

Psychometric Evaluation of Hindi Version of Fatigue Pictogram in Individuals with Breast Cancer: A Cross-sectional Study

Suman Mehra, Pragya Kumar, Abhishek Soni Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Cancer Related Fatigue (CRF) is the most prevalent and distressing symptom among women with Breast Cancer (BC) which is underestimated and undertreated by healthcare professional. Barrier to under-reporting and under treatment of CRF include more focus on patient survival, busy clinical settings with patient overload, and lengthy CRF evaluation tools. Fatigue Pictogram (FP) is a brief, valid and reliable Fatigue Screening Tool (FST) which can be promptly administered in busy clinical settings. There is lack of brief, easily applicable FST in Hindi language which can be promptly administered in busy Oncology Clinics. Aim: To evaluate the psychometric properties of Hindi version of FP among women with BC. Materials and Methods: The present cross-sectional study was conducted in two phases. In phase 1, original English version of FP underwent forward and backward translation and a prefinal Hindi version of FP was created. The prefinal version was then pilot tested on 10 women with BC. In phase 2, psychometric properties of final Hindi version of FP were evaluated. Criterion validity was evaluated on a sample of 101 women with BC by testing against Hindi version of Fatigue Severity Scale (FSS-H) and test-retest reliability was evaluated on a sample of 50 BC survivors by administering Hindi version of FP on two occasions. Data analysis was carried out using Statistical Package for Social Sciences (SPSS) version 24.0. FP has two items (Item A and Item B) which evaluate two dimensions of CRF (severity and impact of fatigue on activity level), and has no overall cut-off score, therefore, both the items of FP were separately evaluated for psychometric properties. Spearman’s rho Correlation Coefficients (r) were calculated for establishing criterion validity of Hindi version of FP and Spearman correlation coefficient, and Wilcoxon signed-ranks test were calculated to evaluate test-retest reliability of each item separately. Results: Validity testing revealed a moderate positive correlation between Item A and FSS-H (r=0.680, p<0.001) scores and item B and FSS-H (r=0.643, p<0.001) scores. Reliability testing revealed a highly significant correlation between the Hindi version of FP scores on two occasions for both the Items (r=0.901, p<0.001 for Item A, and r=0.917, p<0.001, for Item B). Conclusion: Despite high prevalence rate, CRF is understated and undermanaged symptom. Acceptable criterion validity and excellent test-retest reliability support the application of Hindi version of FP as a FST in Hindi speaking individuals with BC.

Assessment of Antioxidant Property and Characterisation of Citrus Fruit Mediated Green-synthesised Hydroxyapatite Nanoparticles: An In-vitro Study

S Lakshmi Ajithan, Dhanraj M Ganapathy, Rajeshkumar Shanmugam, Dhanya P Nampoothiri Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Citrus fruits and their peels are recognised as excellent naturally available antioxidants. Antioxidants play a crucial role in preventing oxidative damage, Deoxyribonucleic Acid (DNA) damage, and protein modification. Therefore, developing compounds from these citrus fruit peels would be highly beneficial. Synthesising compounds of plant origin falls under green synthesis. The rationale behind this study is to create a novel class of biomaterials with improved biological properties, offering significant potential for therapeutic uses. Aim: To assess the antioxidant activity of green-synthesised hydroxyapatite nanoparticles using citrus fruit peel extract. Materials and Methods: This in-vitro study was conducted at the Nanomedicine Biolab, Department of Pharmacology, Saveetha Dental College, Chennai, Tamil Nadu, India, from March 2024 to June 2024. Hydroxyapatite nanoparticles were green-synthesised from Citrus reticulata (orange) and Citrus limonum (lemon). Only the peels of these fruits were included in the green synthesis, which was the primary inclusion criterion. Green-synthesised nanoparticles at different concentrations (10-50 μg/mL) were evaluated for antioxidant properties using the Hydrogen Peroxide assay, the Ferric Reducing Ability of Plasma assay, the 2,2-Diphenyl-1-Picrylhydrazyl assay, the 2,2-Azino-Bis-3-Ethylbenzothiazoline-6-Sulphonic Acid assay, and the Nitric Oxide Radical Inhibition assay. The results were tabulated and statistically analysed using independent t-tests, ANOVA analysis, and post-hoc tests. A p-value of less than 0.05 was considered statistically significant. Characterisation of the generated nanoparticle samples was performed using UV-Vis spectroscopy and Scanning Electron Microscopy (SEM). Results: The successful synthesis of C. reticulata and C. limonum-mediated hydroxyapatite nanoparticles and their comparable antioxidant activity with the standard (ascorbic acid) were observed. The absorbance spectrum ranged from 340 nm to 360 nm in UV-Vis spectroscopy, and distinct morphologies were observed in the SEM analysis. Conclusion: Green-synthesised C. reticulata and C. limonum-mediated hydroxyapatite nanoparticles exhibited potential antioxidant activity. These green-synthesised nanoparticles possess antioxidant properties.

Estimation of Stature from Left Tibial Length in Young Adult Males: A Cross-sectional Study

Kavita Dhidharia, Hina Sharma, Pritesh Menaria Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Estimation of stature by measurement of various bones is of immense value in the identification of an individual. Tibial length measurement is a reliable anthropometric parameter commonly used for estimating an individual’s stature, especially in forensic and archaeological contexts. It provides accurate results due to the strong correlation between tibial length and overall body height. Aim: To find the relationship between the stature and length of the left tibia of an individual and derive a linear regression equation to calculate the height from the length of the left tibia. Materials and Methods: The present analytical cross-sectional study was conducted in the Department of Anatomy, Pacific Medical College and Hospital, Udaipur, Rajasthan, India, from June 2023 to June 2024. Sample population was 200 males between the age group of 17 years to 24 years. Spreading calipers was used to measure left tibial length in the sitting position. The bony prominences used for this were medial malleolus of the tibia and medial epicondyle of left lower limb. The height was measured by stadiometer. Statistical analysis was done to determine the regression equation for stature estimation. The relationship between tibial length and height was established using a regression equation and then the p-value for the slope (regression coefficient) of that equation was calculated. Statistical Package for Social Sciences (SPSS) V 30 software was used for statistical analysis. Results: The mean height of male subjects was found to be 162.47 cm. Mean percutaneous length of left tibia (x) was found to be 35.99 cm for males. The correlation coefficient was 0.658 and the regression equation was Y = 71.361+2.575X (Tibial Length). Conclusion: The present study reveals that a positive and statistically significant correlation exists between the percutaneous tibial length and stature.

Occupational Stress and its Impact on Perceived Stress, Serum Cortisol and Insulin Resistance: A Comparative Study Across Professions

Sanjeev Srinivas Walvekar, Basavaraj Siddanna Aski, Govindanagowda Venkanagouda Naregal Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Occupational stress affects both physical and mental well-being. It is closely linked to different health issues, including insulin resistance. Because stress levels differ by profession, studying their effects on the body is important. Very few studies have compared stress and its biological effects among various professions. Aim: To determine job-related stress using biochemical markers, the Perceived Stress Scale (PSS-14) questionnaire and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) across different occupations. Materials and Methods: The present cross-sectional study was conducted in the Department of Biochemistry at BLDE (DU) Sri B.M. Patil Medical College, Vijayapur, Karnataka, India, for one year, from January to December 2014. A total of 315 randomly selected male participants were enrolled, representing three different occupational groups, including police constables, bank employees, and a control group. The study collected data regarding biochemical parameters such as fasting glucose, serum cortisol, insulin, Glycated Haemoglobin A1c (HbA1c), PSS-14, questionnaire and HOMA-IR. A one-way ANOVA was conducted to compare anthropometric and biochemical parameters across three groups, followed by Tukey’s post-hoc test to identify significant intergroup differences. Means and standard deviations were computed for each parameter in both control and study groups. Results: In the study group, police constables were the youngest, with an average age of 42.17±1.00, the highest Body Mass Index (BMI) (25.94±0.21) and waist/hip ratio (1.01±0.01). Bank employees had the highest waist (91.71±0.99 cm) and hip circumference (97.77±0.79 cm). PSS significantly increased in study subjects compared to control subjects. HOMA-IR analysis revealed high discrimination for bank employees (AUC=0.92). A significant correlation between HOMA-IR and fasting blood glucose was observed across the studied groups, with the strongest correlation found among bank employees (r=0.574, p=0.001), followed by police constables (r=0.275, p=0.004). Conclusion: The present study found that the effect of occupational stress on health varies with different occupations. The observations emphasise the need for regular health screenings and lifestyle modifications to prevent long-term complications like diabetes and Cardiovascular Disease (CVD).

Programmed Death-Ligand 1 Immunoexpression in Triple Negative Breast Carcinoma in South Indian Women: A Cross-sectional Study at a Tertiary Care Centre

D Darshitha, Padma Priya Kasukurti, Clement Wilfred Devadass Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Triple Negative Breast Cancer (TNBC) comprises 10-20% of all breast cancer cases and is characterised by a lack of differentiation, subpar response to therapy and a low survival rate. Programmed Death-Ligand 1 (PD-L1) is a type 1 transmembrane protein present in cancer cells. The interaction between PD-1 (present on immune T cells) and PD-L1 facilitates negative immunoregulation, allowing cancer cells to elude the body’s immune system, resulting in tumour proliferation. This immune “brake” system translates to the presence of PD-L1 being associated with a poor prognosis and has been linked to low overall survival. Immune checkpoint inhibitors, which are immunomodulatory chemotherapeutic drugs, have the potential to disrupt this interaction and enable Immune Cells (IC) to attack Tumour Cells (TC). Aim: To analyse the immunohistochemical (IHC) expression of PD-L1 in TNBC patients and examine its association with clinicopathological prognostic variables such as patient age, laterality of the lesion, histopathological type, grade of the tumour, tumour size, lymphovascular invasion, perineural invasion, lymph node involvement, Ki-67 labelling index and tumour stage. Materials and Methods: This retrospective, cross-sectional study was conducted on 30 cases of modified radical mastectomy specimens from treatment-naïve TNBC patients, received in the Department of Pathology at Ramaiah Medical College, Bengaluru, Karnataka, India from January 2014 to January 2023. Data such as age, sex, tumour size, histological type, histologic grade, lymph node status and hormonal receptor status were collected. Haematoxylin and Eosin (H&E) slides were reviewed and sections containing the highest proportion of viable TCs with surrounding normal breast tissue and IC interface were chosen. IHC detection of PD-L1 was performed on 4-5 μm thick sections of the tumour. The PD-L1 scores of tumour and ICs were determined and the proportions of positive and negative cases were analysed with various clinicopathological variables. Results: Among the 30 TNBC cases studied for PD-L1 immunoexpression, 70% of the cases (21/30) showed a positive TC score (>1%) and a combined positive score (TC+IC) >1%. IC positivity was observed in 73.33% (22/30) of the cases. A higher histological grade (grade 3) and a patient age older than 50 years were significantly associated with positive TC scores (p-value=0.043), IC scores (p-value=0.049), and combined positive scores in this study. Conclusion: This study highlights the significant presence of PD-L1 immune expression in TNBC, paving the way for its potential use as a promising marker for identifying patients suitable for targeted immunotherapy in the TNBC phenotype. Future studies are expected to harmonise clone selection and scoring criteria, enabling the development of companion diagnostic kits specifically relevant to TNBC.

Correlation between Activity Restriction and Fear of Falling in Community Dwelling Indian Older Adults: A Cross-sectional Study

Archna Kaushik, Prakash Kumar Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Fear of Falling (FoF) is a prevalent and debilitating concern among older adults, often leading to self-imposed activity restriction, reduced mobility and diminished quality of life. In the Indian context, these challenges are compounded by underreporting, limited awareness and insufficient geriatric support systems related to falls. Aim: To examine the relationship between FoF and activity restriction among community-dwelling Indian older adults using the Falls Efficacy Scale-International (FES-I) and the Balance Confidence Scale (BCS). Materials and Methods: A cross-sectional study was conducted on 220 community-dwelling Indian older adults. The approval from the Institutional Ethics Committee (IEC) was obtained and data collected. The collected data included demographic information, fall history, fall frequency, number of medical conditions, FES-I and BCS scores. Activity restriction was evaluated with a set of questions regarding safe engagement in mobility and community activities. Statistical analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 27.0. Pearson correlations were computed and multiple linear regression was conducted to predict the number of activities restricted based on age, total FES-I score, number of falls in the last year, number of medical conditions and total BCS score. Significance was set at p-value <0.05. Results: Of the 220 participants (mean age=68.51±6.50 years), 65 (29.6%) reported at least one fall in the past year, with varying activity restriction. Significant correlations were found between the number of restricted activities, FES-I score, falls and medical conditions. The regression was significant, F(5, 214)=34.79, p-value <0.001, explaining 44.8% of the variance in activity restriction (R2=0.45, Adjusted R2=0.44). Significant predictors of activity restriction were the number of falls (B=0.75, p-value=0.01), medical conditions (B=0.86, p-value <0.001), and FES-I score (B=0.19, p-value <0.001), while age (p-value=0.39) and BCS score (p-value=0.18) were non significant. Conclusion: FoF is closely linked with activity restriction among community-dwelling Indian older adults, posing a serious risk to independence and quality of life. Early screening and addressing FoF and balance confidence can support safe ageing and functional independence, as these reflect possible limitations even before actual limitations manifest.

Pharmacokinetic Evaluation of Injectable Platelet-rich Fibrin Containing Metronidazole as a Local Drug Delivery Agent in Periodontal Therapy: An In-vitro Study

Srashti Mangal, Priya Lele, Pramod Waghmare, Vidya Dodwad, Nishita Bhosale, Tanvi Khot, Abhinandan Bokriya Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Periodontitis is a complex disease influenced by microorganisms, systemic factors and environmental factors. Traditional treatments like scaling often fail in moderate to severe cases due to limited access to deep pockets. Local Drug Delivery (LDD) systems, such as films and gels, offer higher drug concentrations at infection sites but are flushed out by saliva and Gingival Crevicular Fluid (GCF). Injectable Platelet-rich Fibrin (i-PRF) provides a slow, sustained release of metronidazole, enhancing the outcomes of periodontal therapy. Aim: To evaluate the possibility of using i-PRF as a controlled release drug vehicle in periodontal therapy. Materials and Methods: This study was an in-vitro analysis conducted at the Department of Periodontology, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India, in September 2024. A patient with a chief complaint of food lodgement and periodontitis was selected and blood was collected for further analysis. A drug stock solution was prepared by mixing 10 mg of metronidazole in 10 mL of deionised water, which was vortexed for three minutes to achieve a final concentration of 1 mg/mL. The i-PRF was prepared. The top PRF layer was aspirated into a 2 mL syringe and maintained in liquid consistency for about 10-15 minutes until it clotted through the slow polymerisation of the fibrin structure. Samples were collected at the 1^st, 3^rd, 5^th and 7^th hours and were repeated on the 3^rd, 5^th, 7^th, 9^th and 14^th days, followed by spectrophotometric analysis. Results: In the present study, the spectrophotometric analysis indicated the presence of the drug in all samples taken over the period from one hour to the 14^th day. Initially, the concentration of the eluted samples showed a gradual decline between the 1^st and 7^th hours. A pronounced and rapid decrease in drug concentration was observed up to the 3^rd day and drug elution continued steadily until the 14^th day. Conclusion: The i-PRF shows promise and can be effectively used as an LDD system in periodontal therapy. Its favourable characteristics, such as its syringeable form, which starts as a liquid and later transforms into a gel, make it an ideal candidate for precise application. Moreover, being composed of autologous fibrin, i-PRF can be directly delivered into the periodontal pocket, where it adapts to the shape of the pocket and adheres to both soft and hard tissues. This flexibility of i-PRF improves the retention of drug-loaded i-PRF in the restricted environment of the periodontal pocket, ensuring prolonged contact and efficacy of the treatment.

Role of Pelvic Floor Exercises and Dietary Supplementation in Primary Dysmenorrhoea among Adolescents: A Systematic Review

Somiya Bhatnagar, Jyoti Sharma, Aksh Chahal, Mohammad Sidiq, Yamini Sharma Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Primary Dysmenorrhoea (PD) is a common condition characterised by chronic pelvic pain related to menstruation. It affects 70-91% of teenagers, starting before menstruation and lasting 8-72 hours. Limited literature is available on sustainable physiotherapeutic non pharmacological interventions for PD, along with Dietary Supplementation (DS). Aim: To evaluate the effectiveness of Pelvic Floor Exercises (PFE) and DS in managing PD among adolescents. Materials and Methods: A systematic review was conducted at the Department of Physiotherapy, Galgotias University, Greater Noida, Uttar Pradesh, India, from May 2024 to September 2024. The review was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY (INPLASY-202440098). A comprehensive search was conducted in online databases, including Google Scholar, PubMed, Scopus and Mendeley. Keywords related to “PFE,” “diet,” and “PD” were used. Only Randomised Controlled Trials (RCTs) published in English from 2014 to 2024 were included. The studies were screened using the Physiotherapy Evidence Database (PEDro) scale and only those with a score above five were selected. Results: Six articles met the inclusion criteria, demonstrating that PFE and certain DS can alleviate menstrual pain in adolescents with PD. Significant results showed that PFE reduces pain intensity, while DS improves Quality of Life (QOL) and reduces pain levels. Conclusion: The present systematic review highlights the potential role of PFE and DS in managing PD among adolescents. Incorporating these non pharmacological interventions into comprehensive treatment plans can provide a holistic approach to addressing menstrual pain and improving QOL for adolescents with PD.

Prevalence of Latent Tuberculosis Infection and Willingness for Preventive Treatment among Household Contacts: A Prospective Observational Study from a Tertiary Centre, Karnataka, India

Sagarika N Suresh, Keertivardhan D Kulkarni, Pothireddy Manisha Reddy Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Latent Tuberculosis Infection (LTBI) represents a state in which individuals are infected with Mycobacterium Tuberculosis (MTB) but do not exhibit active disease symptoms. Despite the absence of clinical manifestations, LTBI poses a significant public health challenge, as approximately one-quarter of the world’s population is estimated to harbour latent infection. Household Contacts (HHCs) of individuals with active Tuberculosis (TB) are frequently exposed to MTB, leading to greater risk of developing LTBI due to shared living environments. Without treatment, 5-10% of individuals with LTBI may progress to active TB during their lifetime. Early identification and management of LTBI are critical to TB control and elimination efforts, highlighting the importance of effective screening and preventive therapy strategies. Aim: To determine the prevalence of active TB and LTBI among HHCs and to assess their willingness to initiate Tuberculosis Preventive Treatment (TPT), as well as treatment adherence and associated barriers. Materials and Methods: The prospective observational study was undertaken between April 2023 and January 2025. HHCs of active TB patients were enrolled after informed consent, and a structured questionnaire was used for data collection. Chest radiography, sputum microscopy, and Tuberculin Skin Test (TST) were carried out for screening. Willingness to initiate TPT, reasons for refusal, and adherence among those treated were documented. Data were analysed using Statistical Package for Social Sciences (SPSS) v20.0, and significance was set at a p-value threshold of 0.05. Results: A total of 264 HHCs were evaluated. Females were 136 in number, constituting 51.5% of the population. The mean age was 34.55±16.45 years, and the mean Body Mass Index (BMI) was 22.29±4.16 kg/m². Active TB was diagnosed in 2 (0.76%) participants, and LTBI in 43 (16.3%). A total of 213 (81.3%) HHCs showed willingness to initiate TPT, though completion was observed in only 77 (37.2%). The primary reason for non-initiation was misconception about the disease and treatment. Conclusion: The present study revealed 16.3% LTBI prevalence within the HHCs population and low completion rates of TPT despite high initial willingness, indicating gaps in adherence. Targeted education and strengthened programmatic support are crucial to enhance LTBI management and advance TB elimination efforts.

Survival Outcome of Patients with Vaginal Malignancy: A 10-year Cohort Study from Tertiary Care Centre, Southern India

Ramani Gangadharan Ashitha, Adarsh Dharmarajan, Geetha Muttath, PP Hiba Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Vaginal malignancy is a rare gynaecological malignancy, and authors know little about its survival and prognostic factors. The management of vaginal malignancies is largely determined by factors such as histological type, tumor size, anatomical site, disease stage, and patient age. Available treatment approaches include surgery, radiotherapy, chemotherapy, or a combination of these modalities. Aim: To determine the survival outcomes of patients with vaginal malignancy treated at a tertiary cancer centre. Materials and Methods: A retrospective cohort study was conducted in the Department of Oncology, Malabar Cancer Centre (Postgraduate Institute of Oncology Sciences and Research), Thalassery, Kerala, India. a period of 10 years, from January 2010 to December 2019, at a South Indian tertiary cancer centre. A total of 49 patients with primary vaginal malignancy were registered at the hospital, and their data were retrospectively reviewed from the medical records department. After treatment completion, patients were followed-up every three months for the first two years, every six months for the next three years, and annually thereafter. The primary endpoints were Overall Survival (OS) and Disease-free Survival (DFS), which were analysed using Kaplan-Meier analysis. Results: There were a total of 49 patients with primary vaginal malignancy, of which 28 patients received curative treatment, 18 patients received palliative care, and 3 patients with poor performance status were given best supportive care. Squamous cell carcinoma was the most common histology, accounting for 44 (89.8%) cases. The median follow-up period was 139.9 months. The five-year overall survival rate was 54.8%. For patients with curative intent, the five-year overall survival rate was 67.9%, while for palliative patients, it was 25.4%. For curative patients, the two-year OS was 85.7%, and for palliative patients, it was 77.8%. The five-year DFS among curative intent patients was 84.2%, and the two-year DFS was 88.9%. Conclusion: Curative treatment significantly improved survival outcomes compared to palliative care in patients with vaginal malignancies. Early diagnosis in lower stages and preventive measures are also necessary for increasing the survival rate. Given the scarcity of large-scale data on vaginal cancers, this study adds valuable regional evidence to the global understanding of this rare malignancy and underscores the need for continued research and awareness.

Assessment of Radiological Outcomes of Extra-articular Distal End Radius Fractures Treated by Volar Locking Plating versus Percutaneous K-wire and Cast Application: A Retrospective Observational Study

Jaiwardhan Prithviraj Bhosale, AS Sreelekshmi, Yogesh Narkhede Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Extra-articular distal end radius fractures are among the most commonly encountered orthopedic injuries. Closed reduction with percutaneous K-wiring and cast application is a widely used method of treatment due to its minimally invasive nature and cost-effectiveness, although it requires prolonged immobilisation and carries a risk of malunion. Open Reduction and Internal Fixation (ORIF) using volar locking plates has emerged as an alternative by offering rigid fixation and enabling early mobilisation. Aim: To compare the radiological outcomes- specifically radial height, radial inclination, and volar tilt between percutaneous Kirschner (K) wire fixation and volar plate fixation methods in extra-articular distal end radius fractures treatment. Materials and Methods: This is a retrospective observational study conducted at Symbiosis Medical College for Women (SMCW), Pune, Maharashtra, India, involving 81 patients aged above 18 years from January 2024 to March 2024. These patients were treated between January 2021 and December 2023 for extra-articular distal radius fractures (AO Type-2R3A2 and AO Type-2R3A3). Patients were divided into two groups: 37 were treated with closed reduction, K-wiring, and casting, while 44 underwent volar plating via the Henry approach. Postoperative radiographs at three months were assessed for radial height, radial inclination, and volar tilt using the Picture Archiving and Communication System (PACS). Data analysis was performed using Statistical Package for the Social Sciences (SPSS) Statistics software, version 20, with statistical significance set at p<0.01. Results: The mean age of patients in the K-wire group was 54.72 years (range: 18-87), while the mean age for the volar plating group was 42.59 years (range: 20-73). There were 11 males (29.73%) and 26 females (70.27%) in the K-wire group, whereas the volar plating group included 29 males (65.91%) and 15 females (34.09%). The results indicated that volar plating achieved significantly better restoration of radial height, radial inclination, and volar tilt (p<0.001**), suggesting a lower risk of malunion compared to K-wiring. Conclusion: It is concluded that ORIF with volar plating yields superior radiological outcomes compared to closed reduction with percutaneous K-wiring and cast application in the management of extra-articular distal end radius fractures.

Association between Physical Activity and Autonomic Nervous System in Young Sedentary Adults: A Cross-sectional Study

Yogeshwari Raman, Venkatesh Natarajan, Priscilla Johnson, Savita Ravindra Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: A sedentary lifestyle is a key driver of early onset Non Communicable Diseases (NCDs). The Autonomic Nervous System (ANS), which governs involuntary functions and maintains internal balance, may be disrupted by physical inactivity in young adults-an area still under debate. Understanding these early changes could guide timely preventive strategies. Aim: To investigate the association between physical activity levels, ANS function, and functional capacity in young sedentary adult. Materials and Methods: This cross-sectional study was conducted at SRIHER (DU), Chennai, Tamil Nadu, India from March 2023 to May 2024. A total of 112 participants (aged 18-30 years; both sexes) with low to moderate physical activity levels, as assessed by the International Physical Activity Questionnaire (IPAQ), were enrolled. Demographic data (age, sex, height, and weight) were collected, along with baseline assessments including Body Mass Index (BMI), waist-hip circumference, perceived stress using Perceived Stress Scale (PSS), autonomic function (Ewing’s battery), and functional capacity (Six Minute Walk Test [SMWT]). Associations among variables were examined using Chi-square tests and One-way ANOVA. Results: A total of 112 participants were included in the study. Of these, 46 were male with a mean age of 25.22±4.38 years, and 66 were female with a mean age of 24.27±4.02 years. Physical activity levels showed significant associations with total Cardiac Autonomic Neuropathy (CAN) scores, particularly in sympathetic (p=0.026) and parasympathetic (p=0.044) functions. The SMWT also associated with CAN scores (p=0.005) and parasympathetic activity (p=0.011), but not with sympathetic activity (p=0.237). Conclusion: The study highlights that physical activity levels significantly impact ANS functionality, especially parasympathetic activity. The SMWT further underscores its importance in assessing CAN, stressing the need for active lifestyles to maintain autonomic homeostasis and prevent lifestyle related diseases.

Correlation between the Sense of Coherence and the Oral Health Related Quality of Life in 12-15-year-old School going Adolescents: A Cross-sectional Study

Sweta Singh, Bhavna Dave, Pratik Kariya Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Understanding the psychosocial influencers of Oral Health-Related Quality of Life (OHRQoL) is instrumental in developing holistic oral health interventions. However, the interplay between Sense of Coherence (SOC) and OHRQoL in school-going adolescents has been much less explored. Aim: To assess the correlation between SOC and OHRQoL in 12-15-year-old school-going adolescents. Materials and Methods: A cross-sectional study was conducted over a period of two years on 240 adolescents aged 12 to 15 years in Vadodara, Gujarat, India. The parameters assessed included SOC, measured using the SOC-13 scale and OHRQoL, evaluated using the Oral Impact on Daily Performance (OIDP-8) scale. A clinical examination was carried out to assess dental caries using the Decayed, Missing and Filled Teeth (DMFT) index. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 24.0. Correlational analysis was conducted to examine the relationship between SOC and QoL. Multivariate linear regression analysis was performed to assess the predictive effect of independent variables on OHRQoL. Results: The participants had a mean age of 13.07±0.89 years, with 164 (68.3%) being male. A significant negative correlation was found between SOC-13 and OIDP scores (r-value =-0.75, p-value <0.01), suggesting that a stronger SOC was associated with a lower oral impact. The multivariate linear regression model examined the influence of SOC-13, DMFT, age and sex on OIDP scores. SOC-13 was the strongest predictor of OIDP scores (β=-0.741, p-value <0.001). Conclusion: SOC was found to be negatively correlated with OHRQoL in adolescents, with SOC-13 emerging as a more influential predictor than traditional clinical or demographic variables.

Determination of Nutrient Profiles of Clove, Ajwain and Fennel Seeds: An In-vitro Study

Muthu Reka Sankar, Vijayanchali Suyamprakasam Sundaram, Mohanaapriya Dhanyakumar, Mukesh Kumar Dharmalingam Jothinathan, Archana Behera Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Spices have long been a central part of world cuisines, particularly in India, where they are not only prized for their flavoring potential but also for their medicinal properties. Indian spices and condiments, used since ancient times to enhance food flavor, are rich in macro and micronutrients, as well as significant secondary metabolites. Their nutritional and chemical attributes yield considerable medicinal effects, including antibacterial, antioxidant, and anticancer activities, thereby enhancing their economic and therapeutic importance. Aim: The research aims to investigate the nutritional composition, phytochemical profiles, and antioxidant potential of three widely used spices: ajwain (Trachyspermum ammi), clove (Syzygium aromaticum), and fennel (Foeniculum vulgare). Materials and Methods: This research employs an in-vitro study to assess the nutritional, phytochemical, and antioxidant properties of ajwain seeds, cloves, and fennel seeds. Ajwain seeds, cloves, and fennel seeds were procured from a local market in Thiruvananthapuram, Kerala. They were dried and powdered into fine powders. Nutrient content such as moisture, ash, crude fiber, fat, protein, iron, calcium, carbohydrates, and vitamin C was determined using standard Association of Official Analytical Chemists (AOAC) procedures, including the anthrone method, solvent extraction, Kjeldahl method, titration, and ascorbic acid assay. Phytochemical assays for alkaloids, phenols, terpenoids, and flavonoids were conducted using standard solvent extraction methods with water, methanol, ethanol, chloroform, and acetone. The antioxidant activity was measured using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay, and absorbance was recorded at 517 nm to determine antioxidant potential. Results: Clove was found to be abundant in carbohydrates (37.06 g/100 g), crude fiber (17.41 g), protein (9.9 g), calcium (146 mg), iron (9.6 mg), and vitamin C (5.7 mg), while fennel seeds also exhibited a nutrient-dense profile, significantly contributing to a balanced diet. Antioxidant assessments demonstrated significant dose-dependent activity in all three spices, with ajwain seeds achieving up to 33.13% inhibition at the highest concentration, clove reaching 31.09% inhibition at 1.0%, and fennel seeds showing strong antioxidative potential, particularly at higher doses, with 38.32% inhibition at 1.0%. Conclusion: This research underscores that ajwain seeds, cloves, and fennel are excellent sources of valuable nutrients and bioactive phytochemicals, displaying significant, dose-related antioxidant activities. Such properties mark them as diversified dietary and therapeutically beneficial agents, possessing broad utility in nutrition, medicine, and industry.

Efficacy of Magnesium Sulphate versus Dexamethasone with Bupivacaine in Ultrasound-guided Transverse Abdominis Plane Block for Postoperative Pain Relief in Lower Abdominal Surgery: A Randomised Double-blinded Clinical Study

Chhaya Mahesh Suryawanshi, Jekha Mary Babu Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Transversus Abdominis Plane (TAP) block is an effective regional anaesthesia technique used to provide analgesia for lower abdominal surgeries. Adjuvants like magnesium sulphate and dexamethasone needs to be explored with regards to prolonged duration and efficacy of analgesia when combined with local anaesthetics such as bupivacaine. Aim: This study aimed to assess the efficacy of 200 mg of magnesium sulphate versus 8 mg of dexamethasone as adjuvants to 0.25% bupivacaine in ultrasound-guided TAP blocks in patients undergoing lower abdominal surgeries under subarachnoid anaesthesia. Materials and Methods: The present randomised, double-blinded, clinical study was conducted at Department of Anaesthesiology, Dr. DY Patil Medical College, Hospital and Research Centre in Pune, Maharashtra, India, from January 2023 to January 2025, eighty American Society of Anaesthesiologists (ASA) grade I and II patients aged 18-65 years, scheduled for lower abdominal surgeries under spinal anaesthesia were recruited and divided into two groups to receive TAP block postoperatively with either 18 mL of 0.25% bupivacaine with magnesium sulphate 200 mg in 2 mL saline (Group A, n=40), or 18 mL of 0.25% bupivacaine with dexamethasone 8 mg (Group B, n=40). Total duration of analgesia, Visual Analogue Scale (VAS) scores, first rescue analgesic, haemodynamic parameters and any related side-effects were observed in each group post block. The Chi-square test was applied to assess categorical variables, while the student's t-test was utilised for comparisons of continuous variables. A p-value of less than 0.05 was considered to indicate statistical significance. Results: Both groups were comparable in demographic characteristics with mean (SD) age being 27.6±7.78 and 28.8±8.15 years in group A and group B, respectively. Group A had 57.5% female patients and 42.5% male patients, while group B had 65% female patients and 35% male patients. The mean duration of analgesia was significantly longer in group B (501±43.02 mins) compared to group A (399±29.93 mins), (p<0.001). Visual Analog Scale (VAS) scores showed significant differences beginning at 4 hours post block, with group B reporting lower VAS scores than group A at 4, 6, and 8 hours, (p<0.05). Time to first rescue analgesia was also significantly delayed in group B (580±48.58 mins) compared to group A (448±32.50 mins), (p<0.001). Minimal side-effects such as nausea and vomiting were observed in both groups, with no statistically significant difference. Conclusion: The addition of dexamethasone to bupivacaine significantly prolongs analgesia duration, reduces pain scores and delays the need for rescue analgesia without any adverse effects, making it a more suitable adjuvant for TAP blocks in lower abdominal surgeries.

Admission Serum Chloride Level as Predictor of Length of Stay in Acute Decompensated Heart Failure: A Prospective Observational Study

V Shayilendranath, Uthamchand, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Acute Decompensated Heart Failure (ADHF) frequently results in hospitalisation and is associated with significant morbidity. Recent evidence suggests that admission serum chloride levels may offer prognostic value beyond traditional markers such as sodium or natriuretic peptides. Aim: To assess the admission serum chloride level as predictor of length of stay in ADHF. Materials and Methods: This prospective observational study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, from August 2020 to May 2023, enrolled 60 adults (18-85 years) admitted with ADHF as defined by Modified Framingham criteria and Echocardiographic (ECHO) confirmation following ethical approval from the Institution. Informed consent was obtained from all participants. On admission, serum chloride and other blood parameters were measured. Serum chlorides levels were categorised as hypochloremia (<97 mEq/L), normochloremia (98-106 mEq/L), or hyperchloremia (≤107 mEq/L). The length of hospitalisation was recorded. The association between chloride and length of the stay was analysed using Analysis of Variance (ANOVA) in Statistical Package for Social Sciences (SPSS) version 25.0 and p-value <0.05 was considered significant. Results: The mean age of the participants were 62.7±10.8 years, with 60% males. Hypochloremia patients (n=11) had longer stays (13.09±1.58 days) than normochloremic (n=20; 7.75±1.97 days) and hyperchloremic (n=29; 4.90±1.35 days) (p-value <0.001) groups. Admission serum sodium (p-value=0.008) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (p-value <0.001) varied significantly across chloride groups. There was strong negative correlation (r-value=-0.79; p-value <0.001) and the logistic regression showed that 1mEq/L increase in chloride cut the odds of prolonged stay by 53% (p-value=0.012) and confirms as a strong, independent predictor for length of hospital stay. Conclusion: Admission hypochloremia predicts prolonged hospitalisation in ADHF, supporting chloride assessment for risk stratification. Overall, serum chloride provides stronger prognostic information for ADHF than traditional markers.

Preparation, Pharmaceutico-analysis and Dosage Standardisation of Priyangvadi Syrup for Common Childhood Ailments

Sayali Sanjay Borse, Renu B Rathi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Priyangvadi Kalka, a traditional herbal paste, is mentioned in Bhaishajya Ratnawali, specifically in the Balrogadhikar Adhyaya, which is dedicated to child health and ailments. Traditionally combined with honey, Priyangvadi Kalka is used to treat diarrhea, vomiting, fever, and dehydration-induced thirst in children, given its cooling, antipyretic, antiemetic, and antibacterial properties. However, its bitter taste, short shelf life, and paste form make it less suitable for children. Converting this paste into a sugar syrup would enhance its palatability, shelf life, and efficacy. Aim: The aim of this study is the modification, preparation, and standardisation of Priyangvadi syrup and to study the pharmaceutico-analytical properties of the syrup. Materials and Methods: This pharmaceutico-analytical study was conducted between September 2023 and January 2024 at Mahatma Gandhi Ayurved College Hospital and Research Centre Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India. Relevant Ayurvedic texts and research on each ingredient were reviewed. Raw drugs were collected, authenticated, and then used to prepare the syrup following standardised methods. The preparation of the syrup, including packaging, was completed within three days. Pharmaceutical analysis was conducted to ensure safety for children. Results: The study successfully developed Priyangvadi syrup, characterised by its brown colour and sweet taste, and confirmed through analysis to be safe for pediatric use. The syrup form enhances palatability, stability, and ease of dosage calculation for children. It can remain effective for up to one year without requiring refrigeration. Conclusion: All the ingredients help balance doshas and exhibit antiemetic, antidiarrheal, antimicrobial properties while supporting digestion. Priyangvadi syrup can effectively treat vomiting, diarrhea, dehydration, and other gastrointestinal issues in young children, improving digestion without causing harm, thus reducing the need for suppressive medicines and antibiotics. The syrup form makes it palatable, stable, and suitable for children’s dosing.

Evaluating ERAS Protocol Implementation for Elective Caesarean Delivery: A Pilot Study on Perioperative Outcomes

Aishwarya Beedkar, Neema Acharya, Shivani Singh Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: The global rise in Caesarean Section (CS) rates has spotlighted the need to optimise perioperative care to enhance maternal recovery and reduce postoperative complications. Traditional perioperative practices, such as prolonged fasting, delayed mobilisation, and opioid-based analgesia, often contribute to suboptimal recovery and extended hospital stays. Enhanced Recovery After Surgery (ERAS) protocols offer a structured, evidence-based alternative aimed at minimising surgical stress, reducing opioid consumption, and accelerating recovery. Aim: To assess the effectiveness of the ERAS protocol in improving postoperative recovery outcomes in patients undergoing elective CS. Materials and Methods: This pilot study, designed as a prospective interventional, single-blind investigation, was conducted by the Department of Obstetrics and Gynaecology at Jawaharlal Nehru Medical College (JNMC), Wardha,Maharashtra, India. from January 2022 to December 2024. A total of 208 women undergoing elective CS were randomised into two equal groups: ERAS and traditional care. The ERAS group received comprehensive preoperative education, multimodal non opioid analgesia, early oral intake, and early ambulation, while the traditional group received conventional perioperative care. Key outcomes assessed included postoperative pain scores, opioid use, incidence of ileus, and duration of hospital stay. Statistical analysis included the Chi-square test for categorical variables, with p<0.05 considered significant. Results: Baseline demographic and clinical characteristics were comparable between the groups. The mean age of participants was 27.08±4.54 years. Patients managed under ERAS reported significantly lower pain scores (VAS 6/10 in 73.21%), complete avoidance of opioids (0% vs. 87.08%), and no cases of postoperative ileus. Moreover, all ERAS patients were discharged within five days, compared to 7-10 days in the traditional group (p<0.001 for all comparisons). Conclusion: The implementation of ERAS protocols in elective CS significantly improves postoperative recovery by reducing pain, eliminating opioid dependency, enhancing gastrointestinal function, and shortening hospital stays. These findings support the broader adoption of ERAS as a standard of care in obstetric surgery.

Relationship between Sexual Harassment Prevention Knowledge, Self-esteem and Assertiveness among Adolescent Girls: A Cross-sectional Study in Mangaluru, Karnataka, India

BV Nithyashree, KC Leena Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Adolescent girls face a heightened vulnerability to sexual harassment, underscoring the critical importance of their understanding and application of prevention strategies for their safety and overall well-being. Aim: To investigate the relationship between knowledge of sexual harassment prevention strategies, self-esteem, and assertiveness among adolescent girls. Materials and Methods: The present cross-sectional study was conducted in Mangaluru, Karnataka, India. Data were collected from 142 adolescent girls in the 8th and 9th standards. The parameters studied were knowledge of sexual harassment prevention strategies, self-esteem, and assertiveness. Data collection tools included a structured knowledge questionnaire, the Rosenberg Self-Esteem Scale, and the Rathus Assertiveness Schedule. Statistical Package for Social Sciences (SPSS) version 27 was used for statistical analysis, and a p-value of less than 0.05 was considered statistically significant. Results: The study primarily included adolescent girls with a mean age of 13.54±0.59 years. The majority of participants (70.42%) demonstrated good knowledge of sexual harassment prevention. However, a significant proportion exhibited low self-esteem (59.15%) and were situationally non assertive (64.79%). Correlation analysis revealed no statistically significant linear relationships between knowledge and self-esteem (r=-0.061, p=0.469), knowledge and assertiveness (r=0.084, p=0.320), or self-esteem and assertiveness (r=0.148, p=0.079). Conclusion: Despite possessing knowledge of sexual harassment prevention, adolescent girls in this study did not necessarily demonstrate higher levels of self-esteem or assertiveness. This suggests that comprehensive interventions should focus on enhancing self-esteem and assertiveness skills alongside knowledge dissemination to empower young women and create safer environments.

Quantitative Assessment of Cholesteatoma using CT Hounsfield Units: A Retrospective Observational Study

Dani N Jijo, Rihana Parveen, MM Jaseemudheen Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Cholesteatoma is a degenerative middle ear pathology that, unless treated, can cause bone erosion and serious complications. High-Resolution Computed Tomography (HRCT) aids in the diagnosis by evaluating structural integrity and bone alterations. Hounsfield Unit (HU) measurements can be used to enhance diagnostic accuracy in cholesteatoma evaluation. Aim: To compare the HRCT-derived HU indexes in cholesteatoma-affected middle ear structures from healthy controls. Materials and Methods: The present retrospective observational study was conducted from May 2023 to April 2024 in the Department of Radiodiagnosis and Imaging of Justice KS Hegde Hospital, Mangalore, Karnataka, India. The study included 150 participants spanning a range of ages from 18 to 70 years. The study participants were divided into 75 healthy controls and 75 patients with surgically proven right unilateral cholesteatoma. HRCT images were used to determine HU values at five anatomical sites: the scutum, malleus, incus, fallopian canal, and lateral semicircular canal. The data were analysed using an unpaired t-test, with p-values <0.05 considered significant. Results: The mean age of the cholesteatoma group was 42.6±12.4 years, while the healthy group had a mean age of 45.3±11.8 years. There were 47 (62.7%) male patients and 28 (37.3%) female patients in the cholesteatoma group, 44 (58.7%) male patients, and 31 (41.3%) female patients in the non cholesteatoma group. Cholesteatoma-affected ears had considerably lower HU values than healthy controls in all examined areas (p<0.001). The malleus and lateral semicircular canal showed the most affecting changes. Conclusion: HRCT-based HU values demonstrate a promising aid for detecting cholesteatoma-related bone alterations. The constant and considerable reduction in HU values across distinct middle ear structures demonstrates its potential to improve diagnostic confidence and clinical decision-making.

Safety Profile of Non Compliant Balloon Dilatation Catheter for Predilatation and Postdilatation in Patients Undergoing Percutaneous Coronary Intervention: A Retrospective Observational Study

Atul Abhyankar, Bhargav Patel, Ankit Jain, Vikas Patel Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Despite advancements in drug-eluting stents, the risk of restenosis and adverse events remains high, especially in complex coronary lesions, highlighting the need for optimal lesion preparation and stent deployment. Aim: To evaluate the procedural performance and safety profile of the WILMA Non Compliant (NC) Percutaneous Transluminal Coronary Angioplasty (PTCA) balloon dilatation catheter (Sahajanand Medical Technologies Limited, Surat, India) in patients with Coronary Artery Disease (CAD) undergoing Percutaneous Coronary Intervention (PCI) in lesions requiring predilatation or postdilatation. Materials and Methods: This investigator-initiated, retrospective, single-center, observational study was conducted at the Cardiology department of Shree BD Mehta Mahavir Heart Institute, Surat, India, from September 2016 to June 2017. One hundred forty-seven lesions from 147 consecutive patients who had undergone PCI with pre or postdilatation using the Wilma-NC PTCA balloon dilatation catheter were included. Device-Oriented Composite Endpoints (DOCE)-a composite of cardiac death, Myocardial Infarction (MI), and target lesion revascularisation during the hospital stay-and Patient Oriented Composite Endpoints (POCE)-a composite of all-cause mortality, any MI, and any repeat revascularisation—during the hospital stay were considered as primary safety endpoints, while device and procedural success were considered as primary performance endpoints. Continuous variables were described as means and standard deviations, and categorical variables were described as frequency counts and percentages. Results: The mean age of patients was 64.0±10.4 years with a male predominance 119 (81.0%). Moderate to severe vessel tortuosity and calcification were noted in 45 (30.6%) and 42 (28.6%) lesions, respectively. All 147 (100%) patients achieved device success, lesion success, and procedural success. There were no procedural complications such as coronary artery perforation, coronary artery dissection, distal embolisation, slow flow/no-reflow phenomenon, side branch occlusion, or systemic bleeding complications observed during the hospital stay. Access site-related complications such as hematoma, pseudoaneurysm, arteriovenous fistula, and infection were absent. No adverse events (DOCE and POCE) were reported during the hospital stay. Conclusion: The results of this observational study confirm the excellent performance and safety profile of the Wilma-NC PTCA balloon dilatation catheter in patients with CAD undergoing PCI in lesions requiring predilatation or postdilatation.

Comparison between Oral Midazolam and Intranasal Midazolam for Sedative Premedication in Paediatric Patients: A Randomised Clinical Study

Shahbaz Hasnain, Reem Barkat Khatib, Subhashree Jena Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Preoperative anxiety in paediatric patients can complicate anaesthetic induction and recovery. Midazolam is a commonly used sedative, administered either orally or intranasally. Aim: This study aimed to compare oral midazolam solution and intranasal midazolam spray for sedative premedication in paediatric patients. Materials and Methods: The present randomised clinical study was conducted on 100 children undergoing elective surgeries. Participants were divided into two groups: Group O (n=50) received oral midazolam (0.5 mg/kg), and Group I (n=50) received intranasal midazolam spray (0.2 mg/kg). Sedation levels were measured at 5, 10, 15, and 20 minutes using a Five-Point Sedation Score. Additional parameters included drug acceptance, ease of parental separation, mask acceptance, venepuncture response, and postoperative recovery using the Modified Aldrete Score. Data was analysed with Statistical Package for Social Sciences (SPSS) v21 with quantitative variables by mean, median, standard deviation, and range .Qualitative variables by frequency and percentage; comparisons between groups were performed using two-tailed Student’s t-tests for continuous data and Chi-square tests for categorical data, with a significance threshold of p<0.05. Results: Baseline demographics were similar between groups (p>0.05). group I had a mean age of 2.9±2.54 years, and group O had 1.28±1.1 years. Gender distribution was nearly identical. group I showed significantly higher drug acceptance (50% good vs. 10% in group O; p<0.001), faster sedation onset, and superior sedation scores at 5, 10, and 15 minutes (p<0.001). Parental separation was smoother in group I (72% excellent vs. 40% in group O; p=0.005), as was mask acceptance (52% excellent vs. 40%; p=0.016). group I also demonstrated more favourable venepuncture responses (88% satisfactory vs. 68%; p=0.016). Postoperative recovery was faster and better in group I at all assessed intervals (p<0.05). Vital signs remained stable across both groups, with minimal adverse effects; only 6% in group I experienced mild nasal irritation. Conclusion: Intranasal midazolam spray is superior to oral midazolam for paediatric preoperative sedation, providing quicker and deeper sedation, better cooperation during procedures, smoother recovery, and higher overall acceptance, with minimal side-effects. Larger studies with extended follow-up are recommended to further evaluate long-term safety and behavioural outcomes.

Expression of Prostate-specific Membrane Antigen in Prostatic Carcinoma and its Correlation with Gleason Score and Grade Grouping: A Cohort Study

Madhusmita Mangaraj, Madhusmita Mohanty, Jagat Ballav Jagadev, Suravi Mohanty Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Prostate-Specific Membrane Antigen (PSMA), a transmembrane glycoprotein, has emerged as a promising biomarker due to its selective presence in prostate tissue, particularly in prostatic carcinoma. This has been extensively studied in imaging to assess tumour aggressiveness to aid in treatment planning. Aim: To study the Immunohistochemical (IHC) expression of PSMA in prostatic carcinoma and to correlate PSMA expression with Gleason Score (GS) and grade grouping. Materials and Methods: The present cohort study was conducted over two years (May 2022 to April 2024) at the Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. A total of 63 cases of prostatic adenocarcinoma were included; the PSMA expression was performed and correlated with clinicopathological parameters such as age, nature of specimen, location of tumour and serum Prostate-Specific Antigen (PSA) level. Statistical analysis such as mean, percentage, Standard Deviation (SD), Chi-square test was used as a test of association. The Spearman’s Rho Correlation test was used to establish correlation of the parameters with PSMA expression. All tests were performed using Statistical Package for Social Sciences (SPSS), version 26.0. Results: The PSMA expression was higher in cases with higher GSs (33 cases with GS >7) and Grade group (24 cases with Grade group 5) and the correlation was statistically significant for both (r=0.403, p-value=0.014 and r=0.391, p-value=0.016, respectively). The PSMA expression did not correlate with age (r=0.118, p-value=0.205) serum PSA levels (r=0.088, p-value=0.643), and with Peri-Neural Invasion (PNI) (r=-0.139, p-value=0.486). The study showed a 0.7 fold increase in disease recurrence after curative therapy using the Kaplan-Meier curve analysis. Conclusion: A significant overexpression of PSMA in prostatic carcinoma suggests its potential as a diagnostic and prognostic marker. High PSMA expression was seen in prostatic carcinoma with higher GS and Grade group in this study. Thus, high PSMA expression is associated with poor prognosis and disease recurrence. Following curative therapy for prostate carcinoma, PSMA can predict disease recurrence and is an independent prognostic marker on biopsies. This study proposes the use of the immunohistochemical marker PSMA for differentiating between indolent and severe disease and further categorising into low risk and high-risk patients.

Comparison between Nebulised and Intravenous Form of Magnesium Sulphate for Attenuation of Haemodynamic Response during Endotracheal Intubation in Hypertensive Patients undergoing General Anaesthesia: A Randomised Controlled Study

Sankar Iswarya, Balasubramaniam Gayathri Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Endotracheal intubation induces a significant sympathetic pressor response, particularly in hypertensive patients, leading to Heart Rate (HR) and Blood Pressure (BP) elevations. Magnesium Sulphate (MgSO4), administered Intravenous (i.v.) or via nebulisation, attenuates this response through calcium channel antagonism and catecholamine suppression. Aim: To evaluate the effects of nebulised and intravenous MgSO4 on attenuation of haemodynamic responses during endotracheal intubation in hypertensive patients undergoing general anaesthesia. Materials and Methods: This single-blinded randomised controlled study of 100 hypertensive adults undergoing elective surgery under general anaesthesia were randomised into two groups. Group A received i.v. MgSO4 (30 mg/kg) and group B received nebulised MgSO4 (40 mg/kg in 5 mL saline), 15 minutes before induction. Primary outcomes included Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP), measured at baseline, postintervention, postinduction, postintubation, and at 2, 5, and 10 minutes thereafter. The secondary outcome was time to first maintenance dose of muscle relaxant, assessed by Train-of-Four (TOF) monitoring. Data were analysed using unpaired Student’s t-test and Fisher’s exact test and p-values <0.05 were considered statistically significant. Results: Demographic data, including age, height, weight, Body Mass Index (BMI), gender, and baseline characteristics were comparable between groups. Haemodynamic parameters remained statistically similar at all time points. A transient, non significant elevation in HR was observed postintubation in the nebulisation group (87.88±11.17) compared with the i.v. group (84.28±12.53). DBP showed a trend toward elevation at 5 minutes postintubation (75.88±7.30) than the i.v. group (70.98±6.39), while baseline SBP was slightly higher in the i.v. group (127.72±8.31 vs. 124.42±7.39). The MAP remained comparable throughout. The nebulisation group demonstrated a longer interval before neuromuscular redosing (49.1±8.7 vs 44.8±8.6), suggesting a trend toward prolonged blockade. Conclusion: Both nebulised and i.v. MgSO4 effectively maintained haemodynamic stability during induction, intubation and postintubation in hypertensive patients. Nebulised MgSO4, being non invasive, better tolerated, and potentially safer, offers an attractive alternative for smoother haemodynamic control, making it a promising adjunct in the anaesthetic management of hypertensive patients.

Innovative Development and Characterisation of a Hyaluronic Acid Gelatin-based Injectable Hydrogel Infused with Ranitidine for Periodontal Applications: An In-vitro Study

Jennifer Jeyaruby Joyson, Arvina Rajasekar Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Periodontitis, a chronic inflammatory disease of the periodontium, is driven by bacterial biofilms that disrupt host immune responses and accelerate disease progression. While scaling and root planing remain standard treatments, their limitations in preventing bacterial recolonisation highlight the need for adjunctive therapies. Hydrogels offer a promising solution due to their biocompatibility, ease of application, and sustained drug release, enhancing the effectiveness of conventional periodontal treatment. Aim: To develop and characterise a Hyaluronic Acid (HA) and gelatin-based injectable hydrogel incorporating ranitidine, an H2 receptor antagonist, for periodontal applications. Materials and Methods: This in-vitro study was conducted at Saveetha Dental College, Chennai, Tamil Nadu, India, from February 2024 to May 2024. HA, gelatin, and ranitidine were combined to formulate the hydrogel. The formulation was refined and cross-linked before being stored. To assess the hydrogel’s safety, haemolytic and biocompatibility assays were conducted for both the hydrogel group and the ranitidine plus hydrogel group. Biocompatibility was evaluated using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-Diphenyltetrazolium Bromide (MTT) assay on human periodontal ligament fibroblasts, and haemolysis was detected by spectrophotometry at 545 nm following incubation with Red Blood Cells (RBCs). Fibroblast morphological alterations were observed using phase contrast microscopy. Intergroup comparisons were conducted using ANOVA, and a p-value of ≤0.05 was considered statistically significant. Results: The haemolytic assay indicated minimal haemolysis (<2%) at therapeutic concentrations, comparable to Negative Controls (NC). Biocompatibility tests revealed >90% cell viability in the ranitidine hydrogel group, with no significant morphological alterations in fibroblasts, indicating low cytotoxicity (p≤0.05). Conclusion: The developed ranitidine hydrogel demonstrated excellent biocompatibility and non haemolytic properties, underscoring its potential as a safe and effective intra-pocket delivery system for periodontal therapy.

Estimation of Salivary Advanced Glycation End Products in Polycystic Ovarian Syndrome Patients with and without Chronic Periodontitis: A Cross-sectional Study

Deebika Damodaran, Supraja Ajitkumar, Muthukumar Santhanakrishnan, Balaji Subbusamy Kanakasabapathy, Sathya Selvarajan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Polycystic Ovarian Syndrome (PCOS), formerly known as Stein-Leventhal syndrome, is a common hormonal disorder associated with chronic low-grade inflammation, oxidative burden and insulin resistance. Many studies have reported that PCOS negatively impacts periodontal health, resulting in the worsening of chronic periodontitis. Chronic periodontitis, an inflammatory condition, is one of the most prevalent oral diseases affecting the supporting tissues of the teeth. Oxidative burden plays a crucial role in the pathophysiology of both conditions. Aim: To evaluate and compare the salivary levels of Advanced Glycation End products (AGEs), which are markers of oxidative stress, in patients with PCOS, both with and without chronic periodontitis. Materials and Methods: A cross-sectional study was conducted at the Department of Periodontology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India between July 2023 and January 2024, with 48 women aged 18-35 years, divided into four groups: healthy controls (H+H), systemically healthy with periodontitis (H+P), PCOS with a healthy periodontium (PCOS+H) and PCOS with periodontitis (PCOS+P). Periodontal clinical parameters, including Oral Hygiene Index Simplified (OHI-S), Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), Bleeding On Probing (BOP) and Periodontal Inflamed Surface Area (PISA), were recorded. Salivary AGEs levels were measured using an Enzyme-linked Immunoassay (ELISA) kit. Statistical analyses were performed using IBM Statistical Package for Social Sciences (SPSS) software. Results: The PCOS+P group exhibited the highest levels of salivary AGEs (72.28±4.76 pg/mL) and clinical parameters, followed by the H+P (63.46±9.87 pg/mL) and PCOS+H (62.87±6.91 pg/mL) groups. A significant correlation was observed between the PISA scores and AGE levels for all groups, with a moderately positive correlation for the PCOS+H group (r=0.765, p<0.01). There was no significant difference (p=1.000) in AGE levels between the H+P and PCOS+H groups, suggesting independent contributions of each condition to systemic AGE levels. Conclusion: Salivary AGE levels were markedly elevated in patients with both PCOS and chronic periodontitis, suggesting a synergistic effect. The present study also highlights that PCOS and periodontitis independently contribute to oxidative stress, even in the absence of the other. These findings support the use of salivary AGEs as potential biomarkers of periodontal inflammation in patients with PCOS.

Natural versus Conventional Medicaments for Pulpotomy in Primary Teeth: A Systematic Review

Supriya Thambireddy, SVSG Nirmala Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Natural medicaments are used in the treatment of infectious diseases due to their antibacterial and anti-inflammatory properties. Pulpotomy is an effective vital pulp therapy for carious primary teeth, aimed at preserving radicular pulp vitality. While natural medicaments can serve as pulpotomy agents, their efficacy in comparison to conventional medicaments remains questionable. Aim: To analyse the scientific evidence comparing the efficacy of natural and conventional pulpotomy medicaments in primary teeth. Materials and Methods: This systematic review included human studies, Randomised Controlled Trials (RCTs), in-vivo studies, studies comparing natural and conventional pulpotomy agents, and studies conducted using primary molars. An electronic database search was performed using MeSH terms, limited to English-language publications in MEDLINE (PubMed), the Cochrane Library, and Ovid, with no restrictions on publication date. A hand search of scholarly articles was also conducted to uncover supplementary data. Relevant publications were selected based on established criteria, and quality analysis was carried out using the Cochrane risk of bias assessment tool. Results: Out of 483 articles, 11 randomised clinical trials were included in this systematic review. Ten of these evaluated clinical and radiographic efficacy, one assessed only histological efficacy, and one article examined all three outcomes of natural medicaments such as Allium sativum, Curcuma longa, Elaeagnus angustifolia, Copaifera langsdorffii, and Rosmarinus officinalis, comparing them with conventional medicaments in primary teeth. Quality analysis of the included studies indicated that four had good quality, three had fair quality, and four had poor quality. Conclusion: Based on the available evidence, it is difficult to determine the efficacy of natural pulpotomy medicaments definitively. There is a paucity of literature regarding the histological efficacy of these natural agents. More high-quality studies are recommended to seek an appropriate alternative to conventional pulpotomy medicaments in primary teeth.

Effectiveness of Nebulised Dexmedetomidine for Treatment of Post Dural Puncture Headache in Parturients undergoing Elective Caesarean Section under Spinal Anaesthesia: A Randomised Controlled Study

Thankam Abraham Reshma, Ravi Saravanan, Kanthan Karthik, Anand Pushparani Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Post Dural Puncture Headache (PDPH) following neuraxial anaesthesia is a common complication that can result in prolonged hospital stays. Central neuraxial anaesthesia remains the preferred technique for elective caesarean sections, and obstetric patients experience more intense PDPH compared to other patient categories. Aim: To evaluate the efficacy of nebulised Dexmedetomidine (DEX), a novel modality of treatment for PDPH. Materials and Methods: This double-blinded randomised controlled study was conducted at Department of Anaesthesiology SRM Medical College Hospital & Research Centre, Tamil Nadu, India. It was approved by the Institutional Ethics Committee and registered with the Clinical Trials Registry-India. After obtaining informed written consent from 60 patients, they were allocated into two groups. Group 1 received nebulisation with DEX, while Group 2 received nebulisation with 0.9% saline. Both groups received conservative management. Headache severity scores was compared as the primary outcome using a 5-point scale method, and the patient satisfaction scores as a secondary outcome using a Likert-type scale. One-way ANOVA, Student's t-test, Chi-square test, and two-tailed tests were used for statistical analysis. Results: The age distribution, Body Mass Index (BMI), needle size, and the number of spinal attempts were comparable between both groups. Patients who received DEX nebulisation (Group 1) showed a considerable improvement in pain scores (mean±standard deviation: 0.67±0.48) compared to patients who received nebulisation with 0.9% saline (Group 2) (mean±standard deviation: 1.87±0.35). The patient satisfaction score was better in Group 1 (mean±standard deviation: 4.87±0.35) compared to Group 2 (mean±standard deviation: 3.33±0.48). Two patients in Group 2 required an Epidural Blood Patch (EBP) (p-value <0.001). Conclusion: DEX nebulisation for PDPH was shown to be an effective treatment in reducing headache severity scores and alleviating PDPH symptoms in addition to conservative therapy, without causing side effects. Moreover, the DEX group displayed better haemodynamic stability compared to the placebo group.

Efficacy of Subjective and Objective Nutritional Assessment in Children: A Cross-sectional Study

N Ponmozhi, S Annie Anbarasi, V Kalpana Devi, R Vijetha, V Aarthi, M Sugesh, Chandumal Jain Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Globally, malnutrition represents a critical health concern, particularly among children. Research has consistently shown that undernutrition is highly prevalent in children admitted to hospitals, with reported rates ranging from 21-80%. This widespread issue significantly affects children and their families, impacting their physical, social and economic wellbeing, while also posing serious challenges for healthcare systems. Aim: To measure the nutritional status of children aged 2 to 12 years using both objective and subjective global nutritional assessments. Materials and Methods: This cross-sectional study was conducted to assess the nutritional status of children aged 2 to 12 years at ACS Medical College and Hospital, Chennai, Tamil Nadu, India between January 2024 and March 2024. Using both objective and subjective global nutritional assessments, the study evaluated children’s nutritional status through anthropometric measurements and physical examinations. The objective assessment included measurements of height, weight, Mid-Arm Circumference (MAC) and Triceps Skinfold Thickness (TSF), while the subjective global assessment involved a physical examination and a review of medical history. These methods were chosen based on a literature review comparing subjective and objective nutritional assessments in children. Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0 to compare nutritional indicators between well-nourished and malnourished children, with significance set at p-value <0.05. Results: The study included 250 children (mean age: 5.61±2.89 years). According to the subjective global assessment, 52% of the children were malnourished, while the objective assessment identified 66.4% as malnourished. Well-nourished children had higher measurements in height (109.9±20.6 cm vs. 106.8±19.26 cm), weight (19.6±9.4 kg vs. 17.51±10.4 kg), Body Mass Index (BMI) (15.69±3.03 vs. 15.1±3.85), TSF (11.05±3.62 mm vs. 10.17±3.14 mm), and MAC (17.28±2.59 cm vs. 15.87±2.52 cm). The subjective global assessment showed fair agreement with the objective measures (k=0.317, p-value <0.0001). These findings emphasise the necessity of using both subjective and objective assessments for a comprehensive evaluation of paediatric nutritional status. Conclusion: The study highlights significant differences in growth and body composition between well-nourished and undernourished children. The objective markers reflect the impact of malnutrition, while the fair agreement (k=0.317) between subjective global assessment and objective assessments underscores their complementary value. This emphasises the need for an integrated approach to assess nutritional status and guide targeted interventions accurately.

Clinical Spectrum and Treatment Patterns of Traumatic Cataract in a Western Maharashtra Hospital: A Prospective Observational Study

Naina Chaturvedi, Riddhi Bora, OK Radhakrishnan, Krutika Ladi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Ocular trauma is a leading cause of preventable visual impairment and blindness, particularly in younger populations. Traumatic cataract, a frequent complication of such injuries, presents significant diagnostic and surgical challenges, particularly in resource-limited settings. Despite surgical advancements, outcomes can vary depending on injury type, patient factors, and management strategies. Aim: The study aimed to determine the prevalence of cataract following ocular trauma, identify associated risk factors, evaluate different injury modes, analyse surgical management strategies, and assess visual outcome post surgery. Materials and Methods: The present prospective observational study was conducted from October 2023 to March 2025 at a tertiary care hospital in Western Maharashtra, India. A total of 63 patients with ocular trauma were enrolled. Data on demographic profiles, injury types, risk factors, and use of protective gear were collected using structured questionnaires. All participants underwent detailed ophthalmic examination and were managed surgically using appropriate techniques including Small Incision Cataract Surgery (SICS), phacoemulsification, corneal tear repair, or pars plana vitrectomy with Intraocular Lens (IOL) implantation. Visual acuity was assessed preoperatively and at defined postoperative intervals, including six months follow-up. Statistical analysis was done using Statistical Package for Social Sciences v26.0. Results: Traumatic cataract was noted in 54 (87.10%) patients. Males and individuals from rural backgrounds were more affected, though no significant associations with age, gender, or area of residence were found. The most common injury source was metallic objects for 19 (35.18%) patients. Closed globe injuries were more prevalent 39 (61.90%). A total of 58 (92.06%) patients had not used protective gear. Preoperative visual acuity was <6/60 in 41 (75.92%) patients. Postoperatively, a significant number 31 (57.4%) achieved Best Corrected Visual Acuity (BCVA) >6/12 at six months. Posterior segment complications were infrequent but associated with poorer outcomes. Conclusion: The prevalence of traumatic cataract in this study was 87.10% and it was not associated with any demographic characteristic. This study highlights that early diagnosis and timely surgical intervention significantly improve visual outcomes in affected patients. Public education on eye safety remains crucial.

Comparison of Modified between-the-Fingers Grip and Conventional Pen-holding Grip for Endotracheal Tube Handling during Orotracheal Intubation: A Randomised Clinical Trial

Richa Tailor, Jigisha Mehta, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Correct handling of the Endotracheal Tube (ETT) is essential for successful tracheal intubation. The “between-the-fingers grip” allows real-time manipulation of ETT curvature during insertion, potentially improving alignment with the laryngeal inlet compared to conventional pen-holding grip. Aim: To compare the efficacy of between-the-fingers grip with conventional pen-holding grip for endotracheal intubation regarding first-pass success rates, requirement for Backward Upward Rightward Pressure (BURP) manoeuvre, and procedural efficiency. Materials and Methods: The randomised single centre clinical study was conducted at a tertiary care academic hospital from September 2024 to February 2025. One hundred adult patients (18-60 years) undergoing elective surgery under general anaesthesia were randomised to group C (conventional pen-holding grip, n=50) and group M (modified between-the-fingers grip, n=50). A single experienced anaesthesiologist performed all intubations using direct laryngoscopy. Parameters studied included first-pass success rate, BURP requirement, intubation time, and haemodynamic changes (heart rate, mean arterial pressure). Data were analysed using Statistical package for Social Sciences (SPSS) version 23. Categorical variables were compared using Fisher’s-exact test, continuous variables using independent t-tests. Statistical significance was set at p<0.05. Results: Demographic characteristics were similar with mean age 32.6±9.8 vs 30.9±8.2 years, 50% vs 48% males, and comparable airway assessments between group C and group M respectively. First-attempt intubation success was equivalent between groups (98.0% vs 98.0%, p>0.05). BURP requirement was significantly reduced in the modified grip group (4.0% vs 24.0%, p<0.001), representing 20% absolute risk reduction. Mean intubation time was shorter with modified grip (12.7±5.1 vs 16.5±7.1 seconds, p<0.01). Haemodynamic parameters remained stable and comparable between the groups. Conclusion: The between-the-fingers grip demonstrates equivalent first-pass success to conventional technique while significantly reducing BURP requirements by 20% and intubation time by 23%. This technique offers clinical advantages particularly when skilled assistance is limited.

Combinations of Arch Forms, Palatal Vaults and Posterior Palatal Seal in Completely Edentulous Patients: A Cross-sectional Study

Ankita Tamta, Samiran Das, Soumitra Ghosh, Preeti Goel, Arunanshu Kuar, Soumadip Niyogi, Saumyadeep Ghosh, Supriyo Jana Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Complete dentures have been, and remain, a cornerstone for the treatment of edentulous patients. To achieve success with complete dentures, it is essential to evaluate the anatomic landmarks that support and restrict them in the maxilla. A denture that is properly adapted to the denture area, with the correct width, shape, and extension of denture borders, as well as an adequate Posterior Palatal Seal (PPS) and polished and occlusal surfaces located in the neutral zone, may prevent loss of retention. In a denture, the border seal in the posterior region is created by making the impression of the PPS. Aim: To assess the various combinations of Arch Forms (AF), Palatal Vault (PV) forms, and PPS in the population of West Bengal. Materials and Methods: An cross-sectional study was conducted on a total of 32 patients who fulfilled the inclusion criteria from the Outpatient Department (OPD) of the Department of Prosthodontics and Crown and Bridge at Guru Nanak Institute of Dental Sciences and Research in Panihati, Kolkata, India, from October 2017 to March 2018, using elastomeric impression material, to assess the combinations of AFs, PVs, and PPS in completely edentulous patients. A body sensor scanner was employed to scan the maxillary casts with a rotating device to compare the combinations. The Netfabb 4.9 software was used for digital sectioning of the casts. A Contouroscope was utilised to mark the deepest concavity of the palate, and an Iwanson gauge was used for measuring the PPS. Results: The most prevalent AF found was the ovoid AF (46.9%). The most prevalent PV form was the medium U-shaped vault form (65.6%). After evaluating the different combinations, it was found that the most prevalent combination was combination 14 (tapered AF, medium U-shaped PV form, and class III PPS form). Conclusion: This study establishes the various existing combinations of arch shape, PV, and PPS. These findings could serve as a guide for future diagnosis and treatment planning, helping to anticipate the combinations of AF, PV form, and PPS form.

Evaluation of Coronary Artery Bypass Graft Patency using CT Angiography: A Prospective Observational Study

Usha Panda, Tripura Mandava, Sai Raghavendra Dommaraju Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Coronary Artery Bypass Graft (CABG) surgery is a cornerstone in managing advanced coronary artery disease, and graft patency significantly influences long-term outcomes. Coronary Computed Tomography (CT) Angiography (CCTA) offers a reliable, non invasive method to evaluate graft patency. Aim: To assess graft patency in post CABG patients using CCTA, focusing on graft type (arterial vs. venous), time since surgery, and the impact of diabetes mellitus on graft occlusion and stenosis. Materials and Methods: A prospective observational study was conducted on 42 post CABG patients undergoing CCTA between June 2023 and September 2024 at the Department of Radiodiagnosis, GVP Institute of Healthcare and Medical Technology, Visakhapatnam, Andhra Pradesh, India. Data on graft type, patency, occlusion, stenosis, and associated clinical factors were analysed using Statistical Package for Social Sciences (SPSS) software (version 22). Categorical data were represented as frequencies and proportions, while the Chi-square test was applied as the test of significance. Continuous data were expressed as mean and standard deviation. A p-value of <0.05 was considered statistically significant. Results: The mean age of participants was 61.75±18.33 years. Males constituted 88.1% of the participants, while females comprised 11.9%. Of the 118 grafts evaluated, 92 (77.9%) were patent, with arterial grafts demonstrating higher patency (42 out of 45, 93.3%) compared to venous grafts (50 out of 73, 68.5%). Diabetes was associated with slightly higher occlusion rates in venous grafts (8 out of 34, 23.5% in diabetics vs. 6 out of 39, 15.38% in non diabetics), though the differences were not statistically significant. The most common graft was LIMA to LAD, accounting for 37 grafts (31.3%). Most patent grafts were observed within 1-5 years post surgery, with 31 arterial grafts (68.8%) and 42 venous grafts (57.5%) remaining patent. Mild stenosis was more common than severe stenosis. Severe stenosis and occlusion were more frequent in venous grafts, with 14 occlusions (19.18%) compared to one occlusion (2.22%) in arterial grafts. Conclusion: CCTA is an effective tool for evaluating CABG graft patency, with arterial grafts, particularly LIMA, showing superior long-term outcomes. These findings reinforce the importance of early post-surgical imaging and targeted management strategies to improve outcomes in high-risk groups.

Comparative Evaluation of Dentoalveolar Effects of Sawangi Flexiforce Expander as Against Quad Helix in Cleft Lip and Palate Patients of 7 to 12 Years in Central India Population: A Randomised Clinical Trial

Srushti Atole, Ranjit Kamble, Sumukh Nerurkar, Samiksha Tidke, Tejaswi Kamble Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Cleft Lip and Palate (CLP) is among the most prevalent congenital craniofacial anomalies, often accompanied by maxillary hypoplasia and transverse deficiency. Surgical scarring and disrupted maxillary development in CLP patients typically lead to posterior crossbites and constriction of the maxillary arch. Orthodontic maxillary expansion is a key early intervention. Although the Quad Helix (QH) is a commonly used slow expansion appliance, it has limitations related to molar tipping and control. The Sawangi Flexiforce Expander (SFE) is a newly developed appliance designed to provide more controlled and parallel expansion, and its dentoalveolar effects were evaluated in the present study. Aim: To compare and evaluate the dentoalveolar effects of the SFE against the QH appliance in CLP patients aged 7 to 12 years in the Central India population. Materials and Methods: A prospective randomised clinical trial was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Wardha, Maharashtra, India from December 2023 to June 2024. A total of 30 patients aged 7-12 years with unilateral CLP and maxillary constriction were randomly allocated into two groups (n=15 each). Group I was treated with a QH, and group II received the SFE. Expansion was done according to standard protocols. The Cone Beam Computed Tomography (CBCT) scans were taken before (T0) and after complete expansion of the maxillary arch i.e. after 6 months (T1,) to assess inter-canine width, inter-molar width, molar tipping, and inter-molar angle. Demographic details such as age and gender were recorded. Data were analysed using the Independent Sample t-test with Statistical Package for Social Sciences (SPSS) version 27.0, and statistical significance was set at p-value <0.05. Results: The SFE group (group II) showed significantly greater increases in inter-canine width (4.57 mm, p-value <0.0001) and inter-molar width (5.10 mm, p-value <0.001) compared to the QH group. Molar tipping was significantly lower in the group II (7.0°, p-value <0.001), indicating better control. The inter-molar angle was also significantly more favourable in group II (96.0°, p-value <0.001), reflecting more parallel and bodily expansion. Conclusion: The SFE demonstrated superior and more controlled dentoalveolar expansion than the QH, making it a promising, a cost-effective appliance for CLP patients.

Patterns of Executive Function Impairment in Abstinent Individuals with Alcohol Dependence Syndrome: A Cross-sectional Study

Tellcott Solomon Maria Annita, Chithiravelu Sivabackiya, OT Sabari Sridhar, Sureshkumar Kailash Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Alcohol has historically been a part of human culture, but chronic alcohol use is linked to a range of neurocognitive and psychological impairments. In recent years, attention has turned to the cognitive effects of sustained abstinence in individuals previously diagnosed with Alcohol Dependence Syndrome (ADS). Executive dysfunction, in particular, remains underexplored in abstinent individuals, especially in Indian clinical settings. Aim: To assess the pattern of executive function impairments in abstinent individuals diagnosed with ADS and to evaluate associated factors. Materials and Methods: A prospective cross-sectional study was conducted at a tertiary care hospital over six months among 49 male patients aged 18-59 years, diagnosed with ADS {International Classification of Diseases (ICD)-10 F10.2} and abstinent for at least one month. Patients with psychiatric, neurological, or chronic medical illnesses were excluded. Cognitive assessments included the Digit Symbol Substitution Test (DSST), Trail Making Test Parts A and B (TMT-A and TMT-B), the Benton Visual Retention Test (BVRT), and the Wisconsin Card Sorting Test (WCST). Data were analysed using Statistical Package for the Social Sciences (SPSS) v22.0, and a p-value<0.05 was considered significant. Results: Cognitive impairment was present on TMT in 14 (28.57%), on the BVRT in 18 (36.73%), and on the WCST in 32 (65.31%) participants. A significant association was found between cognitive impairment and daily alcohol intake (mean±SD: 10.03±4.22 vs 7.06±2.59 units/day; p-value=0.011). Executive dysfunction was significantly associated with occupation but not with educational status, economic status, marital status, past treatment history, nicotine use, or family history of substance use. Conclusion: Executive dysfunction is prevalent among abstinent patients with ADS and is significantly associated with higher daily alcohol intake and greater dependence severity, highlighting the need for early cognitive screening.

Serum and Urinary Uric Acid and Creatinine Ratio as a Biomarker in Perinatal Asphyxia: A Prospective Observational Study

Koneru Sasidhar, Raghavendra H Gobbur, Siddu Charki, Mallanagouda M Patil Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Perinatal asphyxia is a major problem that substantially increases newborn morbidity and mortality. It is defined as the inability to establish breathing at birth. An estimated 23% of the approximately four million neonatal deaths and 26% of the 3.2 million stillbirths worldwide each year are due to perinatal asphyxia. Aim: To determine serum uric acid, creatinine, urinary uric acid, and creatinine levels in neonates with perinatal asphyxia. Materials and Methods: This was a prospective observational study conducted in a Level III-A Neonatal Intensive Care Unit (NICU), Department of Paediatrics, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from March 2023 to November 2024, with a sample size of 129 neonates. Renal parameters were assessed between 24 and 48 hours of life. The study included neonates born at ≥37 weeks’ gestation with an Apgar score ≤7. Variables such as duration of oxygen therapy, renal function, length of NICU stay, duration of respiratory support (including mechanical ventilation) and complications during NICU stay were evaluated. Associations among qualitative variables were analysed using the Chi-squared test, and differences between quantitative groups were assessed using the t-test, with a significance level set at 5%. Results: A significant association was observed between low Apgar scores at five minutes and elevated levels of serum and urinary biomarkers. Elevated serum and urinary UA/Cr ratios were significantly associated with lower Apgar scores (p-value <0.001). Both serum UA/Cr and urinary UA/Cr ratios were markedly elevated in neonates with lower Apgar scores, reinforcing their potential as early indicators of the severity of perinatal asphyxia. Conclusion: Serum and urinary UA/Cr ratios show potential as biomarkers for perinatal asphyxia severity.

Videolaryngoscopy versus Direct Laryngoscopy for Endotracheal Tube Placement in Patients Undergoing Emergency Surgical Procedures: A Prospective Observational Study

Sehar Bilal, Ajaiz Rasool, Raja Suhail Shounthoo, Showkat Ahmad Gurcoo Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Endotracheal intubation during the induction of general anaesthesia is a routine procedure in the operating room. Traditionally, this procedure has been accomplished using Direct Laryngoscopy (DL) with the Macintosh blade for adults and the Miller blade for children. However, advancements in laryngoscopy techniques have led to the development of Video Laryngoscopes (VL), which have markedly improved the success rates for tracheal intubation in emergency situations and for difficult airways. Aim: To compare the intubation characteristics using VL and direct laryngoscopes for emergency surgical procedures. Materials and Methods: This prospective observational study was conducted in the Department of Anaesthesiology at SKIMS, Soura, Srinagar, Jammu and Kashmir, India, from October 2022 to September 2024. A total of 118 patients of either gender, undergoing emergency surgical procedures, were divided into two groups: Group I (intubated with direct laryngoscope) and Group II (intubated with VL). Each group comprised 59 patients. The efficiency of both techniques was assessed in terms of intubation time, ease of intubation, number of attempts, use of a gum elastic bougie, or external laryngeal manipulation, along with any associated complications. The compiled data were exported to the data editor of Statistical Package for the Social Sciences (SPSS) Version 20.0 and subjected to appropriate statistical analysis. A p-value of <0.05 was considered statistically significant. Results: This study included 118 patients of either gender, aged >18 years, with American Society of Anesthesiologists (ASA) Class I to III, undergoing emergency surgeries. The patients were distributed into two groups: Group I (DL) and Group II (VL), with 59 patients in each group. The mean age of patients in Group I was 47.9±17.68 (mean±SD) years, while in Group II it was 42.9±17.32 (mean±SD) years. The mean glottic visualisation time was shorter for Group I (DL) compared to Group II (VL) (12.8 seconds vs. 13.6 seconds; p-value=0.523). The mean tracheal intubation time was 25.5 seconds in Group I and 27.8 seconds in Group II (p-value=0.322). A greater number of patients in Group I were classified as having a Cormack-Lehane (CL) grade III compared to Group II (27.1% vs. 10.2%; p-value=0.046). Additionally, a greater number of patients in Group I experienced difficult laryngoscopy compared to Group II (27.1% vs. 10.2%; p-value=0.018). A higher proportion of patients in Group I required external laryngeal manipulation for intubation compared to Group II (47.5% vs. 11.9%; p-value <0.001). Conclusion: We observed that VL provides better glottic visualisation and superior ease of intubation compared to the direct laryngoscope. Significantly less external laryngeal manipulation was required for visualising the larynx. We can conclude that VL offers definitive advantages over conventional DL for the management of both difficult and routine airways.

Efficacy of Structured Teaching Programme on Knowledge Regarding Endometrial Cancer and its Prevention among Middle Adulthood Women: A Research Protocol

Lalhmachhuani Hmar, Ruchira Ankar Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Globally, the incidence of Endometrial Cancer (EC) is increasing, making it one of the most prevalent gynaecological cancers in high income countries. Organising EC prevention and awareness programs in a timely manner is crucial, particularly in developing nations where awareness is urgently needed. Early detection is a key factor in reducing cancer mortality. Healthcare professionals have a duty to educate the public about EC and how to prevent it. Need of the study: There is currently no established method for preventing EC. However, several studies indicate that overweight and obesity pose substantial risk factors for EC. Other risk factors include weight fluctuations and weight gain in middle age. It is critical to reduce weight and maintain a healthy weight. Raising awareness among community members is therefore crucial. Aim: To evaluate the impact of a structured education program on middle aged women’s understanding of EC and how to prevent it. Materials and Methods: The study will use a one group, quasi experimental pretest-post test design and will take place at the AVBR Hospital’s OPD in the Gynaecology department, Sawangi (Meghe), Wardha, Maharashtra, India. The duration of the study will be April 2025 to September 2025. Women who visit the OPD between the ages of 40 and 65 years will be invited to participate. Informed consent will be obtained from each participant. A quantitative method will be used to assess how well the structured teaching program affects women’s knowledge of EC and its prevention. Fifty women will participate, and a structured questionnaire will be used to collect data. Section I (demographic data) will include: age, marital status, weight, height, age at menarche, age at menopause and family history of cancer. Section II will comprise an organised survey regarding EC and its prevention. Data will be organised and analysed using descriptive and inferential statistics. For statistical analysis, data will be coded and entered into an Excel spreadsheet. Descriptive statistics will summarise demographic variables using frequency, mean, standard deviation and percentages. To assess the significance of the difference in knowledge scores between the pre-and post-tests, a paired t test will be used. To investigate the association between knowledge levels and demographic factors, the Chi square test will be applied.

Efficacy of Ischaemic Compression Technique, Strain Counterstrain Technique, and Conventional Exercises in Myofascial Temporomandibular Disorder: A Protocol for Randomised Control Trial

Siddhant Samir Deshmukh, Swapna Jawade Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Temporomandibular Joint Dysfunction (TMD) encompasses a variety of disorders affecting the Temporomandibular Joint (TMJ) and associated muscles. These conditions can significantly impact an individual’s quality of life, causing pain, limited jaw movement, and difficulties in daily functional activities. Myofascial TMD, characterised by muscle pain and tenderness, is one of the most common forms of this disorder. Existing treatment methods often include exercise techniques aimed at reducing pain and improving jaw function. Need for the study: The Strain Counterstrain Technique (SCT) has the potential to provide a patient centered, non invasive, and holistic approach to resolving the issues associated with these complex conditions. Further research into this technique is necessary for addressing TMJ disorders. This research will enhance the scientific understanding of its effectiveness and, consequently, improve treatment outcomes and management strategies for TMJ diseases in general. To enhance our understanding and patient outcomes, it is imperative to examine the Strain Counterstrain approach in TMJ disorders. Aim: To evaluate and compare the effectiveness of three different exercise techniques in treating myofascial TMD: Ischaemic Compression Technique (ICT), SCT, and conventional exercises. Materials and Methods: A Randomised Controlled Trial (RCT) will be conducted at Acharya Vinoba Bhave Rural Hospital from February 2024 to June 2025. The study will include individuals aged 18 to 65 with a confirmed diagnosis of myofascial TMD. Thirty participants will be randomly assigned to each of the three treatment groups (ICT, SCT, and Conventional Exercises), comprising a total sample size of 90. The parameters to be assessed include pain levels using the Numerical Pain Rating Scale (NPRS); active mouth opening, measured with a mandibular goniometer; and functional activities, assessed using the Jaw Functional Limitation Scale (JFLS). Continuous outcome variables will be examined using normality tests and summarised using descriptive statistics. Significance will be determined using ANOVA tests for normally distributed data and Kruskal-Wallis tests for non-normally distributed data. Categorical variables will be summarised by frequency and percentage, and Chi-square tests will be used to measure efficacy. A p-value of <0.05 will be considered significant.

Effects of Blood Flow Restriction Training on Quadriceps Muscle Strength and Biochemical Parameters among Individuals with Type 2 Diabetes Mellitus: A Protocol for a Randomised Controlled Trial

Arghya Mondal, Mandeep Kumar Jangra, Akanksha Saxena Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is characterised by poor glucose metabolism, cardiovascular complications, and musculoskeletal deterioration, which are linked to hyperglycaemia, dyslipidaemia, and sarcopenia (age-related, involuntary loss of muscle mass and strength), respectively. Blood Flow Restriction Training (BFRT) is a novel technique being used to treat various metabolic and musculoskeletal complications related to T2DM. Need of the study: BFRT is an effective training strategy for people with physical limitations. Compared to high Resistance Training (RT), mechanical load is markedly reduced with BFRT while inducing similar gains in muscle mass and strength. The present study aims to identify a better exercise programme that provides better control of diabetes and reduces the chances of cardiovascular and musculoskeletal complications. Aim: This study aims to investigate the effects of BFRT on quadriceps muscle strength, hyperglycaemia, and hyperlipidaemia in individuals with T2DM. Materials and Methods: Participants in this randomised controlled trial will be recruited using criterion-based purposive sampling from the outpatient physiotherapy department of MM Super Specialty Hospital, Mullana-Ambala, Haryana, from October 2024 to March 2025. A total of 58 individuals aged 35-70 years, diagnosed with T2DM for a minimum of two years and with Glycosylated Haemoglobin (HbA1c) ≥6.5, will be included upon physician referral and randomised into two groups: an experimental group and a control group via block randomisation. The experimental group will undergo BFRT for four weeks, while the control group will undergo RT for four weeks. Pre- and post-intervention assessments will be conducted using an isokinetic dynamometer for quadriceps muscle strength, and the HbA1c and lipid profile will be evaluated for metabolic symptoms. The Kolmogorov-Smirnov test will be used to check the normality of the data. If the data are normally distributed, paired and unpaired t-tests will be used for within-group analysis and between-group analysis, respectively. If the data are not normally distributed, the Wilcoxon Signed-Rank test and Mann-Whitney test will be used for within- and between-group analyses, respectively.

Effect of Pilates Exercise Program versus Otago Exercise Program to Improve Balance, Strength in Postmenopausal Elderly Women to Study Fear of Fall and Quality of Life: A Research Protocol

Nikita Govind Zanwar, Subrat Samal, Ravi Lashkari, Tejaswini Fating Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Elderly individuals with reduced muscle strength and lower-limb mass are more likely to fall. The frequency of age-related health problems, such as falls, is rising as the world’s population ages more rapidly. Since both fallers and non fallers frequently experience fear of falling, this may be linked to falls through shared risk factors. It has been proposed that fear of falling leads to worse balance and diminished functional ability, which in turn leads to activity limitations. These factors are thought to contribute to future falls. Due to the abrupt decrease in oestrogen and the ensuing reductions in skeletal muscle and bone density, postmenopausal women are at heightened risk for osteoporosis and fractures caused by falls. Need of the study: The Otago Exercise Program (OEP) is a tailored, home-based program of strength and balance retraining designed to prevent falls in older people living in the community. As balance disorders and falls are significant issues that may impact the functioning of an ageing population, it is important to determine how Otago may improve balance and strength in postmenopausal women. Falls resulting in fractures among postmenopausal women can seriously hinder quality of life and lead to high morbidity and mortality, as well as increased direct costs for health services. There are many studies on Otago exercise in the elderly regarding balance disorders, but no studies have been found specifically in postmenopausal women addressing balance disorders, strength and quality of life. Pilates has gained popularity recently and seems to be a practical way to improve balance and quality of life while strengthening trunk muscles. However, a direct comparison of these two methodologies for postmenopausal elderly women has not yet been conducted. Therefore, the aim is to determine the effects of the OEP and Pilates on balance, strength and quality of life in postmenopausal women. Aim: To determine the effects of the OEP and Pilates exercise, in addition to conventional exercise, on improving strength, balance and quality of life in postmenopausal elderly women. Materials and Methods: An experimental comparative, two-arm, parallel, open-label, non-blinded study will include 86 postmenopausal women aged 60 years and above. The trial will be conducted for one year from November 2024 to November 2025, meeting specific inclusion criteria. Participants will be recruited from Acharya Vinoba Bhave Rural Hospital and the Community Physiotherapy OPD Wardha, Sawangi, Maharashtra, India. Participants will be randomly assigned to two groups: Group A will receive Pilates exercises with conventional physiotherapy and Group B will undergo the OEP with conventional physiotherapy. Both groups will complete a six-week intervention. Baseline and post intervention assessments will include the Berg Balance Scale (BBS) for balance, the 30-second Sit-to-Stand test for strength, the Falls Efficacy Scale (FES-1) for fear of falling, and the Older People’s Quality of Life (OPQoL) questionnaire for QoL. The analysis will be conducted using the free version of the R software. Differences in mean outcomes between groups at post intervention will be assessed using either the independent-samples t-test or the Mann–Whitney U test, as appropriate. Within-group comparisons (pre- to post intervention) will be conducted using either the paired t-test or the Wilcoxon signed-rank test, as appropriate. A two-sided p-value of ≤0.05 will be considered statistically significant.

Comparative Efficacy of Topical Pomegranate Peel Extract and Topical Corticosteroid in Management of Oral Lichenoid Lesions: A Research Protocol

Suwarna Dangore-Khasbage, Rosalyn Lalremtluangi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Oral Lichenoid Lesions (OLL) represent a group of oral lesions that share common clinical features and histological appearances but have different aetiologies. Lichenoid lesions may include oral lichen planus, lichenoid drug eruptions, lichenoid contact reactions, or lichenoid reactions of graft-versus-host disease. A number of treatment opportunities have been reported in the literature for the management of lichenoid lesions. Need of the study: Among the various management options, corticosteroids are one of the drugs of choice. However, they are often known to cause various side-effects. Thus, it is reasonable to select a drug with minimal side-effect or the safest one. Pomegranate has been identified for its various health benefits and is expected to be helpful in the treatment of OLLs. Aim: To evaluate the comparative efficacy of topical pomegranate peel extract and topical corticosteroids in the management of OLLs. Materials and Methods: This randomised control trial double-blind study will be conducted in the Department of Oral Medicine and Radiology at Sharad Pawar Dental College and Hospital, DMIHER, Maharashtra, India, for a duration of six months from September 2025 to March 2026 (CTRI/2024/10/075071). The study will comprise 28 patients, who will be equally divided into two groups through simple randomisation. Group A will be treated with topical corticosteroids, while Group B will receive 10% pomegranate peel extract. Treatment response will be monitored after seven days, 15 days, and one month from the initial visit using two clinical parameters: 1) Visual Analog Scale (VAS) score and 2) Sign score. All observations will be recorded and subjected to appropriate statistical tests. Inter and intragroup comparisons will be made by comparing the observations of various parameters at the second and third recalls with the first recall in both groups. We will also compare the findings of both parameters at the first, second, and third recalls between the groups using the Wilcoxon Signed Rank test and Mann-Whitney U test, respectively. A p-value of <0.05 will be considered significant.

Effect of Virtual Reality Training in Adjunct to Conventional Physiotherapy on Dynamic Balance, Hop Test and Function in Badminton Players with Ankle Instability: A Research Protocol of a Randomised Controlled Trial

Palash Satone, Swapnil Ramteke Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Ankle instability, which is common in athletes, results from ligament strains or tears, leading to pain, swelling, and discomfort. Acute lateral ankle sprains are typically treated with functional management, while chronic instability is usually addressed with conservative measures and may shift to surgical intervention if rehabilitation fails. Low-grade injuries are managed with conventional physiotherapy that focuses on cryotherapy, muscle strengthening, and range of motion exercises. Additionally, virtual reality training is emerging as a modern rehabilitation tool. Need of the study: There is considerable evidence regarding the effects of conventional or exercise therapy on patients with ankle instability. Even among athletes, literature supports the effectiveness of conventional treatment for this condition. However, there is a dearth of literature on the use of virtual reality training as an adjunct to conventional therapy in patient recovery. Aim: To compare the effects of virtual reality training as an adjunct to conventional therapy on dynamic balance, hop test performance, and functional outcomes in badminton players with ankle instability. Material and Methods: A randomised controlled trial will be conducted at the Wardha District Stadium and the Department of Sports Physiotherapy at Ravi Nair Physiotherapy College, Wardha, Maharashtra, India, from March 2024 to March 2025. A total of 40 patients with ankle instability will be included and divided into two groups. Group A will receive conventional therapy, while Group B will receive virtual reality training in addition to conventional therapy for six weeks. The parameters will be assessed using the Y Balance Test (YBT), the Cumberland Ankle Instability Test (CAIT), and the Hop Test at baseline and at the end of the sixth week of the intervention. The Mann-Whitney U test or Student’s unpaired t-test will be employed to compare the groups at baseline and after six weeks. The signed rank test or Student’s paired t-test will be used to investigate within-group effects. A p-value of <0.05 will be considered statistically significant.

Effect of Electromagnetic Field on Oral Tissues: A Narrative Review

Vidya Mallipattana, Krishnanand Prakash Satelur, Mohamed Nizam Shah, Preethi Thirugnana, BK Ramnarayan Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X An emerging pattern in clinical practice involves patients presenting with unexplained systemic and neurological symptoms despite normal diagnostic workups, with metallic or dissimilar-metal dental restorations being a recurring feature. The present narrative review explores potential links between Electromagnetic Field (EMF) exposure, dental materials and systemic health effects, with a particular focus on neurological manifestations. Drawing on principles from quantum biology and physics, the review examines unique clinical cases that defy conventional medical explanations yet may be interpreted through interactions between EMFs and metal restorations at the quantum level. These cases suggest that the human body may act as a biological interface where classical and quantum physical phenomena intersect. While the review emphasises evidence-based findings, it also presents quantum-level hypotheses—such as spin dynamics and Radical-Pair Mechanisms (RPM)—for interdisciplinary consideration, underscoring the complexity of EMF-biological interactions and the need for further investigation.

A Narrative Review on Capsaicin: A Multifaceted Herbal Agent

Siddhi Javalekar, Krishnapriya Nene, Neil Godbole, Prachi Patil Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Capsaicin, the fiery compound found in chilli peppers, has attracted significant attention recently, with extensive interest in its diverse pharmacological properties, including analgesic, anti-inflammatory, anti-cancer potential and antimicrobial effects. In recent years, research has extended into its dental applications, particularly its role as an alternative or adjunctive anaesthetic and anti-inflammatory agent. The present narrative review presents an in-depth examination of all medical and dental research on capsaicin to date, highlighting its mechanism of action, systemic effects and clinical relevance in dentistry, including its potential utility as a topical anaesthetic, its role in oral mucosal conditions and implications for minimally invasive procedures.

The Power of Emotional Intelligence in Healthcare: A Narrative Review of its Neurobiological Basis, Clinical Leadership and Patient-centric Care

Rituraj Verma, Megha Yadav, Nishant Kumar Sharma, Shivank Khare Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X The multifaceted functioning of Emotional Intelligence (EI) in formal healthcare settings is a testament to quality healthcare delivery; the present paper examines its neurophysiological bases, its role in clinical leadership, dynamic teamwork, workplace performance and patient-centred care. A range of studies was available, from which those with adequate quantitative strength or clear practical implications for healthcare were selected. The inclusion criteria covered research from 1998 to 2014 and comprised systematic reviews, observational studies, peer-reviewed Level II and Level III studies and relevant articles from organisational psychology. Literature searches were conducted in databases such as PubMed, Google Scholar, ResearchGate, PsycINFO and Scopus; more than 30 articles were critically reviewed. Multiple themes informed the work, ranging from the neural correlates of EI to its practical applications for patients and healthcare leaders. The impact of emotionally intelligent behaviours on patient satisfaction, staff resilience and healthcare delivery was mapped using a thematic, evidence-based synthesis. To improve outcomes for both clinicians and patients, the present review supports the growing consensus that EI is a strategic capability that can be nurtured through focused training, assessment tools such as the Emotional and Social Competency Inventory (ESCI) and integration into organisational leadership development programmes.

Different Methods of Customised Vaginal Stent Fabrication in Vaginoplasty: A Comprehensive Review

Madhu Priya, Shruti Deshmukh, Surekha Dubey Godbole, Sweta Kale Pisulkar, Jahnavi Purna Gorripati Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X The non formation of the vagina, known as vaginal agenesis, impacts patients’ psychological health in addition to being a congenital defect. Vaginal agenesis affects one in every 4,000 to 10,000 females. Despite presenting with primary amenorrhoea, patients with vaginal agenesis appear physically normal, with normal height, breast development, body hair and external genitalia. The care of patients with vaginal agenesis involves psychosocial counselling in addition to addressing the physical anomalies. The anatomical anomaly can be treated surgically by elongating the vagina and creating a neovagina. The procedure for creating a neovagina is called vaginoplasty and the McIndoe technique is often used to establish a vaginal canal prior to graft stabilisation of the neovagina. Vaginal stenosis following the surgery is the most common complication observed. Patency maintenance is key to a successful surgery; therefore, vaginal stents are fabricated. They not only serve as a haemostat but also as a graft stabiliser and prevent the shrinking or contraction of the neovagina. This review outlines and describes various methods for fabricating customised vaginal stents. It aims to provide readers with an overview of both old and new innovations employed in the fabrication of vaginal stents/vaginal dilators, taking both anatomical and psychological effects into consideration.

Diagnostic Value of Papanicolaou Smear versus Colposcopy in Reproductive age Women with Clinically Unhealthy Cervix: A Narrative Review

Trupti Radkar, Savita Somlawar, Anuja Bhalerao Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Cervical cancer is the second most common cancer among Indian women, and timely detection of premalignant lesions is key to reducing its burden.The Papanicolaou (Pap) smear and colposcopy are two widely used methods for the same. However, the diagnostic performance of each method varies significantly, particularly in symptomatic or high-risk populations. Pap smears offer a low-cost, specific screening tool, while colposcopy is a resource-intensive procedure that requires trained specialists. Colposcopy has demonstrated higher sensitivity and correlation with histopathological outcomes than the Pap smear in high-risk women. A combined approach, especially in symptomatic women, may improve early detection rates. This narrative review evaluates the diagnostic role of Pap smear and colposcopy in reproductive-age women with a clinically unhealthy cervix, with emphasis on their accuracy, limitations, and complementary use.

Dexmedetomidine versus Remifentanil for Controlled Hypotension in surgery: A Narrative Review of Efficacy and Recovery Profiles

Sweta Janardhan Gajapure, Vivek Chakole, Amreesh Paul Francis Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Dexmedetomidine and remifentanil are essential pharmacologic drugs that are now integral to anaesthetic practice, particularly for inducing controlled hypotension and enhancing intraoperative conditions. Dexmedetomidine, a selective α2-adrenoceptor agonist, is well known for its sedative and sympatholytic properties, with profound haemodynamic stability and minimal respiratory depression. Hence it is best suited for Intensive Care Unit (ICU) sedation and for opioid sparing strategies. It is beneficial in scenarios where earlier emergence from anaesthesia and prolonged sedation are advantageous. Remifentanil, a synthetic ultra short-acting opioid, has a rapid onset and offset, enabling precise titration and swift recovery, and is therefore well suited for fast-track surgeries. Both drugs are effective in reducing intraoperative blood loss and in improving surgical field conditions through controlled hypotension. Nonetheless, remifentanil's faster onset may confer an advantage by achieving a clearer surgical field with less bleeding. While dexmedetomidine stands out for improving postoperative recovery with less pain and reduced opioid requirements, remifentanil stands out for more rapid recovery and shorter extubation times. The safety profiles of both drugs are favourable overall, with dexmedetomidine associated with bradycardia and remifentanil with nausea and shivering. This review discusses the pharmacological profiles, clinical use, safety issues and relative effectiveness of dexmedetomidine and remifentanil in controlled hypotension during surgery. It collects new information on their intraoperative haemodynamic impacts, recovery profiles, and patient-surgeon satisfaction measures in various surgical environments. One gap addressed is the absence of integrated clinical recommendations on choosing between the two agents, considering specific surgical and patient scenarios. By synthesising data from recent meta-analyses and randomised trials, the review highlights the clinical utility of drug selection as a function of surgery type, desired recovery profile and institutional practice patterns. Clinically significant guidance for anaesthesiologists and surgeons is provided by the results, with a view to maximising surgical field conditions while reducing undesirable outcomes, particularly in procedures where a bloodless field and haemodynamic stability are paramount.

Comparison of Diode Lasers and Conventional Retraction Cord for Gingival Retraction: A Pilot Study

Renuka Shivdas Pathare, Rucha Kashyap, Ankita Thakur, Chaitanya Chollangi, Mahima Vanjani, Shraddha Chincholkar Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Introduction: Gingival retraction is a crucial aspect of dental impression procedures, especially in fixed prosthodontics. It involves moving the gingival tissue away from the tooth surface to expose the preparation for recording both the prepared and unprepared surfaces. The accuracy of the marginal fit of a fixed prosthesis depends upon the location of the finish line, which is essential for maintaining the health of the periodontium. Aim: The purpose of this study was to determine the efficacy of diode lasers as a method of gingival retraction in comparison to a conventional retraction method. Materials and Methods: The present pilot study included a total of 10 healthy patients from the Department of Prosthodontics and Crown and Bridge at Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India, all of whom required a single-unit fixed prosthesis. Of the 10 patients, five underwent retraction using conventional means with a retraction cord, while the other five patients received diode laser retraction before impression making. A comparative evaluation of the vertical dimension achieved was conducted for both techniques, focusing on the fit of the prosthesis and patient comfort. The data were tabulated in Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) Version 24 software. Independent t-tests and paired t-tests were employed for statistical analysis. Results: The patients included in this study were between 20 and 50 years of age. The mean age of the patients was 35±2 years. The change in vertical dimension from before to after treatment was significantly greater in the laser group than in the retraction cord group (p=0.014). Conclusion: Diode lasers proved to be more efficient, providing better vertical displacement and greater patient satisfaction compared to the procedure using retraction cords.

Liposarcoma in the Caecum: A Case Report

Sumith S Deep, Ravi Krishnappa, Teena D Murthy, Megha Ravi Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Liposarcoma of the caecum is a very rare and unusual form of soft-tissue sarcoma characterised by malignant transformation of adipose tissue. Although liposarcomas typically develop in the deep soft tissues of the extremities or the retroperitoneum, they are extremely rare in the gastrointestinal tract, especially in the caecum, which presents significant diagnostic and treatment challenges. This case report describes the clinical presentation and treatment of caecal liposarcoma in a 45-year-old man. The patient presented with vague abdominal discomfort and intermittent right lower quadrant pain, symptoms that often mimic more common gastrointestinal disorders such as appendicitis or colitis. Due to its rarity and nonspecific presentation, diagnosis is often delayed. The size, location, depth of invasion, and relationship of the lesion to surrounding structures are determined by imaging modalities, particularly Magnetic Resonance Imaging (MRI) and Contrast-Enhanced Computed Tomography (CECT). Thus, imaging plays a crucial role in its diagnosis. Total excision provides the best chance of long-term survival, and surgical resection remains the cornerstone of treatment. The size of the tumour, histological subtype, and completeness of the surgical margins are among the factors that affect prognosis. In certain high-grade or recurrent cases, adjuvant therapies may be considered. Because caecal liposarcoma is so uncommon, prompt diagnosis requires a high index of suspicion. For these uncommon and aggressive tumours, early intervention and appropriate surgical management are essential for better outcomes.

Improving Discharge Efficiency through Standard Operating Procedures Mapping and Standardisation: A Narrative Review

Deena Vareekal Prince, Deeplata M Mendhe Journal of clinical and diagnostic research : 2025 - October - 19:0973-709X Efficient hospital discharge processes are essential for optimising healthcare delivery, reducing operational costs, and improving patient outcomes. Inefficiencies such as poorly defined workflows and inconsistent adherence to Standard Operating Procedures (SOPs) contribute significantly to delays and compromised care quality. This narrative review explores and compares the efficacy of the Process Mapping Plan of Action (PMPOA) and Standardised High Line Processes (SHLP) in minimising Turnaround Time (TAT) and enhancing discharge efficiency in medical and surgical wards. A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, selecting studies that evaluated process mapping or SOP implementation in the context of hospital discharge with measurable outcomes, including TAT and workflow optimisation. Twenty studies were analysed, revealing key contributors to discharge delays, including late ward rounds, delayed discharge orders, and communication gaps. Findings suggest that both PMPOA and SHLP strategies are effective in improving workflow, reducing TAT, and enhancing overall patient care. Incorporating structured protocols, technological tools, and continuous monitoring mechanisms can lead to sustainable improvements in the discharge process.