Table of Contents : Journal of clinical and diagnostic research : 2026 - July - 20

Cinematic Rendering for Preoperative Assessment of Retropancreatic Head Paraganglioma: A Case Report

Sirui Yang, Li Guo Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Retropancreatic paragangliomas are exceptionally rare Neuroendocrine Tumour (NET) that pose significant diagnostic challenges due to their imaging overlap with several peripancreatic and retroperitoneal pathologies, most notably pancreatic NET (pNET), Solid Pseudopapillary Neoplasms (SPNs), retroperitoneal schwannomas, and Pancreatic Ductal Adenocarcinoma (PDAC). The present report is of a 70-year-old male with an incidentally detected retropancreatic mass. Contrast-Enhanced Computed Tomography (CECT) demonstrated intense arterial enhancement, initially prompting consideration of pNET in the differential. Cinematic Rendering (CR) reconstruction revealed a characteristic “honeycomb” hypervascular architecture not previously described in the literature, precisely delineated preserved tissue planes between the tumour and adjacent major vascular structures, and definitively excluded vascular invasion. CR-guided preoperative planning enabled successful duodenum-preserving resection with minimal morbidity, avoiding traditional pancreaticoduodenectomy. Histopathology confirmed paraganglioma with benign features. This case illustrates that CR technology may aid in characterisation, showing potential for accurate preoperative diagnosis and organ-sparing surgical planning in complex retroperitoneal tumours.

Axillary Lymphatic Malformation in a Child: A Case Managed with Surgical Excision

Shivika Jindal, S Karthikeyan, Kambala Prasanna Kumar, Sasikumar Pattabi, Balakrishnan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Lymphatic malformations are rare, benign, congenital, slow-flow vascular anomalies that result from abnormal embryological development of the lymphatic system. The cervicofacial region is where they tend to appear frequently, while involvement of the axillary region is relatively uncommon. The present case report is of a one-year-seven-month-old male child who presented with a gradually progressive, painless swelling in the left axilla for a duration of seven months. There was no associated history of trauma, redness, fever, discharge, or restriction of upper limb movements. On clinical examination, the swelling was soft, non tender, non pulsatile, without signs of inflammation. Magnetic Resonance Imaging (MRI) demonstrated a well-defined T2/STIR hyperintense subcutaneous cystic lesion involving the left axillary and adjacent chest wall region, suggestive of a slow-flow lymphatic malformation. Intraoperatively, the lesion was well circumscribed and carefully dissected from the surrounding soft-tissues, allowing complete excision without injury to adjacent structures. Histopathology confirmed lymphatic malformation. After surgery, the patient recovered without any complications. There was no recurrence or functional limitation after two weeks of follow-up; long-term follow-up was advised. This case highlights that axillary lymphatic malformation, although rare, must be considered in the differential diagnosis of paediatric axillary swellings. Careful radiological evaluation and complete surgical excision in selected well-localised lesions can result in excellent clinical outcomes with minimal risk of recurrence.

Intermuscular Abscess Mimicking an Incarcerated Inguinal Hernia with Co-existing Direct Hernia: A Case Report

S Pinkash Raj, Ganesh Guru, T Raghupathy, Ramalakshmi, K Barathi Raja Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Inguinal swelling is most commonly attributed to hernia; however, certain inflammatory and infective conditions can mimic its presentation, leading to diagnostic challenges. This is a case report of a 62-year-old male who presented to hospital with painful right inguinal swelling associated with low-grade fever. The first imaging evaluation using ultrasonography revealed a right inguinal defect through which omental fat was seen protruding. However, further imaging was suggested due to persistent pain and inflammatory signs. Upon performing, MRI pelvis, a well-defined lobulated collection measuring 5.8×5.2 cm in the right inguinal region with restricted diffusion and extension through the inguinal canal, suggestive of abscess formation. Upon incision and exploration, approximately 20 mL of thick purulent fluid was evacuated, consistent with an abscess cavity. Exploration during surgery revealed the presence of a direct inguinal hernia sac along with an intermuscular abscess and it was repaired using tissue based herniorrhaphy without mesh placement due to presence of active infection. This case is unique due to the co-existence of an intermuscular abscess with a co-existing inguinal hernia, which contributed to diagnostic ambiguity. Early recognition of such dual pathology is essential to avoid misdiagnosis and to guide appropriate surgical management. The patient had an uneventful recovery. This case highlights the importance of considering dual pathology in inguinal swellings and underscores the diagnostic value of MRI in differentiating abscess from hernia.

Postoperative Catatonia with Delayed Emergence in a Cochlear Implant Recipient: A Case Report

Mohammed Arfak, V Rajesh Kumar Kodali, Soma Ganesh Raja Neethirajan, Suvarna Jyothi Kantipudi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Catatonia is a neuropsychiatric syndrome marked by motor, behavioural, and autonomic abnormalities and is now recognised as a trans-diagnostic entity that can be overlooked in perioperative care because it may mimic delayed emergence from anaesthesia or other postoperative complications. This case report aimed to increase clinical vigilance for postoperative catatonia after cochlear implantation in an adolescent, emphasising diagnostic differentiation when routine organic evaluations are unrevealing. A 15-year-old girl (Body Mass Index [BMI] 28.4 kg/m²; American Society of Anaesthesiologists [ASA] II) underwent elective left cochlear implantation under general anaesthesia with propofol, fentanyl, atracurium, sevoflurane (Minimum Alveolar Concentration [MAC] 0.9-1.0), and intraoperative dexmedetomidine infusion; reversal was achieved with neostigmine and glycopyrrolate. Postoperatively, she maintained spontaneous respiration and stable vital signs yet remained unresponsive to commands and painful stimuli and subsequently developed immobility and mutism. Systematic evaluation excluded common aetiologies of delayed emergence. Psychiatric assessment led to a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of major depressive disorder; catatonia was suspected with a Bush-Francis Catatonia Rating Scale score of 22. A lorazepam challenge (2 mg i.v.) produced marked improvement within 20 minutes, confirming the diagnosis, and scheduled lorazepam (2 mg i.v. four times daily) with sertraline (25 mg orally twice daily) resulted in significant recovery within two days, enabling ward transfer on Postoperative Day (POD) 3 and discharge on day 5 with scheduled psychiatric follow-up. This report highlights that postoperative catatonia, potentially precipitated by perioperative stressors and neurotransmitter dysregulation, should be included in the differential diagnosis of delayed emergence, and that early psychiatric consultation and benzodiazepine therapy can rapidly reverse symptoms and reduce morbidity.

Sarcomatoid Variant of Bladder Urothelial Carcinoma Involving the Vesicoureteric Junction without Ureteric Extension: A Case Report

Karunakaram Sriram, Karthik Krishna Ramakrishnan, S Soorya Prakash, Vadupuudaya Bhanu, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Sarcomatoid Urothelial Carcinoma (SUC) is a rare and aggressive histologic form of bladder cancer illustrated by biphasic epithelial as well as mesenchymal differentiation. Imaging findings often overlap with conventional urothelial carcinoma, making reliable preoperative identification difficult. We report a case of a 56-year-old male presenting with intermittent painless haematuria and increased urinary frequency for three months. Contrast-enhanced computed tomography demonstrated a heterogeneously enhancing intraluminal bladder mass arising from the left lateral wall and extending to the vesicoureteric junction. Importantly, the distal ureteric lumen remained preserved without mural thickening, intraluminal tumour extension, or upstream hydroureter or hydronephrosis. High-grade urothelial cancer with sarcomatoid differentiation was discovered during a cystoscopic biopsy. The patient underwent radical cystectomy with pelvic lymph node dissection as well as ileal conduit diversion. Final histopathology confirmed sarcomatoid variant urothelial carcinoma invading the superficial muscularis propria (pT2aN0) with negative ureteric margins. This case highlights an important radiologic staging pitfall in which tumour proximity to the vesicoureteric junction may simulate ureteric invasion and emphasises the importance of careful assessment of distal ureteric morphology to avoid overstaging and unnecessary surgical modification.

Psoriasis-associated Petrous Hyperostosis Causing Trigeminal Neuralgia: A Case Report

Rohini Chaudhari, Sourabh Zambre Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Trigeminal Neuralgia (TN) is most commonly caused by Neurovascular Conflict (NVC); bony aetiologies are rare. We report a 31-year-old woman with a 10-year history of psoriasis who presented with a 3-month history of intermittent, severe, paroxysmal right lower jaw pain triggered by chewing, consistent with right V3 TN. Magnetic Resonance Imaging (MRI) of the brain with Constructive Interference in Steady State (CISS) sequence, done after three months of onset of first symptom, demonstrated attenuation of the right cisternal trigeminal nerve, effacement of the right cerebellopontine cistern, and thickening of the right petrous bone. A hypertrophied suprameatal tubercle caused narrowing of the right internal auditory meatus. Mild generalised calvarial hyperostosis was also noted. Computed Tomography (CT) with bony windows confirmed hypertrophic changes at the suprameatal tubercle. A coincidental neurovascular loop was identified adjacent to the right trigeminal nerve. The history of psoriasis, missed at the initial consultation, was elicited on directed enquiry. The constellation of petrous hyperostosis, calvarial thickening, and clinical presentation led to the diagnosis of TN secondary to bony compression in the setting of psoriasis-related bone disease. The patient was treated with oxcarbazepine 300 mg once daily, achieving 60-70% symptomatic relief, and was counselled regarding surgical intervention, including bony decompression and Microvascular Decompression (MVD). This case highlights that psoriasis, a known cause of skeletal hyperostosis, can rarely produce surgically correctable TN through bony compression of the trigeminal nerve at the porus trigeminus. A thorough systemic history, recognition of imaging asymmetry, and precise characterisation of the compressive element are critical to directing appropriate surgical management and avoiding unnecessary nerve-ablative procedures.

Effect of Vestibular Rehabilitation and Gaze Stabilisation Exercises in individuals with Motion Sickness: A Case Report

Isha Goel, Subhasish Chatterjee, Mousumi Saha, Mritunjay Kumar, Kashish Maggu Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Motion sickness is a vestibular disorder resulting from sensory conflict between visual, vestibular, and somatosensory inputs, leading to symptoms such as nausea, dizziness, sweating and postural instability. Vestibular Rehabilitation Therapy (VRT) is a non-pharmacological intervention that facilitates central vestibular compensation through adaptation and habituation mechanism. The present case report describes the effect of vestibular rehabilitation and gaze stabilisation exercises in a young adult with motion sickness. A 23-year-old female with complaints of motion- induced nausea and dizziness was screened using the Motion Sickness Susceptibility Questionnaire Short-Form (MSSQ- Short). Baseline symptom severity was assessed using the Motion Sensitivity Testing or Motion sensitivity Quotient (MSQ), Motion Sickness Assessment Questionnaire (MSAQ), and Vestibular Rehabilitation Benefits Questionnaire (VRBQ). Following baseline assessment, the subject underwent a four-week vestibular rehabilitation programme consisting of vestibular rehabilitation exercises and gaze stabilisation exercises, performed three sessions per week for four weeks. Post-intervention reassessment showed that there was a considerable reduction in the intensity of motion sickness, along with data on all outcomes measures that show an increase in tolerance of motion as well as visual stimuli. This case report highlights that vestibular based rehabilitation is a safe and effective non-pharmacological management approach for individuals with motion sickness.

Anaesthetic Challenges in a Patient with Acoustic Schwannoma: A Case Report Highlighting Complex Airway Management

Taruneepriya Aradhyula, Dhawal Wadaskar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X The confluence of acoustic schwannoma with Rheumatoid Arthritis (RA) creates unique anaesthesia problems. Acoustic schwannoma surgery necessitates thorough airway and haemodynamic control, whereas RA is linked with systemic co-morbidities-restricted joint mobility, cervical spine instability and possible medication interactions, all of which have a substantial impact on anaesthetic preparation. Hereby, the authors describe the anaesthetic care of a 40-year-old female who had a history of RA and was scheduled for acoustic schwannoma excision. Preoperative testing indicated, swelling in the left eye, vomiting, weight loss and a burning sensation in the oral cavity. These characteristics prompted concerns about airway management, posture and perioperative infection risks. Special precautions were used intraoperatively to ensure stable haemodynamics during posterior fossa surgical placement. Perioperative steroid supplementation and infection prevention measures were used. The procedure was completed successfully and without complications and the patient recovered normally. Anaesthetically, this example demonstrates the intricate relationship between RA and acoustic schwannoma surgery. To reduce perioperative risks, comprehensive preoperative screening, early detection of airway issues, careful intraoperative posture and interdisciplinary planning are were required. An individualised anaesthetic approach is critical for improving patient outcomes in such difficult situations.

Combined General and Caudal Anaesthesia for Splenectomy in a Child with Thalassaemia Major: A Case Report

Snehal Venkatesh Kabra, Sanjot Ninave, Pooja Rajendra Wahane Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Thalassaemia major is a chronic haemolytic disorder necessitating frequent transfusions of blood with ultimate iron toxicity and organ impairment. Splenectomy in such patients usually becomes necessary for the management of hypersplenism and repeated requirement of transfusion. Complications like cardiopulmonary deterioration, haemodynamic instability, and intraoperative bleeding add to the anaesthetic challenges in such a scenario. We present an uneventful elective splenectomy in a five-year-old child with thalassaemia major, splenomegaly, and mild cardiac dysfunction under combined general and caudal anaesthesia. Preoperative evaluation included haematological evaluation, iron level, and echocardiogram revealing mild mitral and tricuspid regurgitation, left atrial and ventricular dilatation, and normal ejection fraction. Induction of anaesthesia was achieved with standard intravenous anaesthetics and atracurium, and following induction of anaesthesia and tracheal intubation, a single-dose caudal block was administered, with correct placement confirmed using the loss-of-resistance technique and the ‘whoosh test. A single-unit transfusion of a packed red blood cell unit, judicious intraoperative fluid resuscitation, and active haemodynamic monitoring were performed. The operation was uneventful and smooth, and the postoperative course was uneventful with proper pain control and early mobilisation. The case is helpful to bring to light the importance of careful perioperative preparation, judicious selection of anaesthesia, and close postoperative monitoring to obtain safe outcomes in children with thalassaemia major who are subjected to splenectomy.

Normal Saline-Furosemide Combination for Refractory Pedal Oedema in Palliative Care: A Case Report

Chaitanya R Patil, Yogesh Anap, Nilesh A Dhamne, Suraj B Pawar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Pedal oedema is a distressing and disabling symptom commonly encountered in patients with advanced malignancy in the palliative care setting. It is frequently multifactorial in origin, arising from hypoalbuminaemia, venous stasis, impaired mobility, or direct tumour-related obstruction, and is often refractory to conventional diuretic regimens. We present the case of a 62-year-old male with primary pulmonary leiomyosarcoma metastatic to bone and liver who developed progressive pedal and scrotal oedema of six weeks’ duration, causing significant impairment of mobility, sleep, and quality of life. The patient had previously received chemotherapy and radiotherapy, and further oncological treatment was not planned due to progressive disease and poor performance status. On assessment, he had bilateral grade 3 pitting oedema extending to the inguinal region, with thigh and calf circumferences increased by 4-5 cm from baseline. Investigations revealed stable renal function, mild hypoalbuminaemia, and no evidence of cardiac failure, deep venous thrombosis, or nephrotic syndrome. Conventional management with oral diuretics and fluid restriction produced minimal improvement. A trial of intravenous furosemide 20 mg administered with 100 mL normal saline over 30 minutes was initiated, aiming to overcome diuretic resistance. This resulted in increased urine output and partial reduction in oedema within 48 hours. The intervention was repeated weekly, leading to progressive improvement in swelling, mobility, and comfort over six weeks, without adverse events. Although complete resolution was not achieved, the patient experienced meaningful relief and regained functional independence for basic activities. This case highlights the potential role of normal saline–furosemide combination therapy as a pragmatic and well-tolerated approach for refractory oedema in advanced cancer within the palliative care context.

Sarcomatoid Carcinoma of the Penis: Report of Two Cases

R Vijayakumar, Sachin Dharwadkar, J Vivekanandan, Sajan Sehgal, Amruthraj Gowda Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Penile sarcomatoid squamous cell carcinomas are biphasic tumours that combine both sarcomatoid and carcinomatous elements. These tumours are incredibly uncommon, high-grade and aggressive forms of penile cancer. Hereby, the authors described an exceptionally rare urogenital neoplasm in 70 and 65-year-old males, presenting as a proliferative growth on the glans penis, Physical examination revealed induration of the underlying tissues with clinical node-negative disease at the time of presentation. Metastatic evaluation was unremarkable; these patients underwent partial penectomy with clear surgical margins. Histology revealed a sarcomatoid variant of squamous cell carcinoma of the penis and Immunohistochemistry (IHC) confirmed the positivity for cytokeratin, p63 with co-expression of vimentin. These patients are currently under surveillance and one among them developed ipsilateral inguinal node metastasis, for which inguinal lymphadenectomy followed by cisplatin-based chemotherapy was administered. The rarity of these cases emphasises the need of IHC, morphological and histological analysis, thorough and in-depth inquiry in diagnosis, staging, therapy and follow-up.

Adrenal Cortical Adenoma Presenting with Haemorrhagic Shock: A Case Report

Akanksha Yachmaneni, Suhas Jajoo, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Spontaneous rupture of an adrenal cortical adenoma is an infrequent cause of retroperitoneal haemorrhage and acute abdomen. This report presents a unique case of a 24-year-old Indian male with sudden-onset left-sided abdominal pain, altered consciousness, hypotension, tachycardia, and abdominal distension. Contrast-enhanced CT angiography revealed a large, ill-defined, necrotic, and haemorrhagic mass measuring 11.3×10.6×13.6 cm in the left suprarenal region, which displaced the kidney inferiorly, and bilateral pleural effusions were noted. Emergency exploratory laparotomy was done, which identified and successfully resected a ruptured adrenal mass, later confirmed histologically as an adrenal cortical adenoma with extensive intratumoral necrosis and haemorrhage. Unlike typical adrenal cortical adenomas, which are small, incidental, and hormonally silent, the present case was a surgical emergency with life-threatening haemorrhage but without endocrine abnormalities. The case highlights the importance of considering adrenal haemorrhage as a differential diagnosis of acute abdomen with shock, even in the absence of trauma or hormonal symptoms.

Ovarian Inguinal Hernia in a Reproductive Age Group Woman: A Case Report

Vinodhini Selvaraj, Asfar Ahamed Nawabjan, J Lalithkumar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Inguinal hernia is less common among women than among men. An inguinal hernia with adnexal structures like the fallopian tube and ovary as content is most rarely reported in the reproductive age group. A 39-year-old female presented with left inguinal region swelling since birth, associated with pain for over a month. Clinical examination revealed a reducible left inguinal hernia of size 3×3 cm. Hence, she underwent laparoscopic Transabdominal Preperitoneal (TAPP) mesh repair. During the surgery, content of hernial sac were found to be the left ovary and fallopian tube, one of the rarest in reproductive age group women. Inguinal hernia with adnexal structure-like ovary and fallopian tube are extremely rare finding in reproductive age group women. This case study is to underscore the importance of intraoperative vigilance and to reinforce on the importance of meticulous handling of such rare finding to safeguard the reproductive function with appropriate management plans.

Biochemically Silent Pheochromocytoma Presenting with Left Flank Pain and Constipation: A Rare Case Report

Nupur Kaushik, Pawni Prabhat, Khalda Nasreen Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X The adrenal glands each have two zones: the cortex and the medulla. Adenomas and carcinomas are tumours arising from cortex whereas pheochromocytomas and neuroblastomas arise from medulla. Hypoplasia, hyperplasia, cytomegaly, cysts, nodules and accessory tissue are some of the Non-neoplastic lesions of adrenal gland. Adrenal Incidentaloma (AI) or adrenal lesion discovered radiologically is very rare. We report a case of AI with the evidence of pheochromocytoma in 22-year-old female who presented with atypical symptom of left flank pain and constipation with a negative history for sweating, hypertension, chest pain, weight gain, excess hair growth on the body, acne, menstrual irregularity and normal Blood Pressure (BP) finding throughout the course of illness. Biochemical parameters for adrenal hormone were within normal limits. The mass was excised and sent for histopathological examination. The diagnosis of pheochromocytoma was made which was confirmed on immunohistochemistry. PASS scoring was done. IHC was strongly positive for synaptophysin and chromogranin and negative for calretinin and inhibin. Though pheochromocytoma has variable clinical manifestation and diagnosis is usually established by strong clinical suspicion, measurement of catecholamines and its metabolites along with radiographic localisation and histopathological confirmation of excised mass. Malignant potential of pheochromocytoma is only established by metastasis, long-term follow-up in patients after resection is necessary. Our case presents as a diagnostic challenge because of normal biochemical investigation and rare presentation. Surgery is recommended irrespective of size and normal biochemical study to prevent complication.

Contralateral Preaxial Polydactyly and Triphalangeal Thumb with a Familial Pattern: A Case Report

R Sivaranjani, Vijayalakshmi Samudi, MG Ravanagomagan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Congenital anomalies of the hand arise due to disturbances in limb development during early embryogenesis and demonstrate considerable clinical heterogeneity. Among preaxial hand anomalies, polydactyly and triphalangeal thumb are commonly encountered as isolated entities; however, the occurrence of these anomalies in contralateral hands of the same individual is rare and sparsely described. This report describes a one-year-old male child presenting with preaxial polydactyly affecting one hand and a triphalangeal thumb involving the opposite hand. The child was born at term to non-consanguineous parents following an uneventful antenatal and perinatal period. A positive family history of similar congenital hand anomalies was present. Clinical examination revealed a well-formed supernumerary digit adjacent to the thumb on one hand, while the contralateral hand showed an elongated thumb with three distinct phalanges. The remaining digits and limbs were normally developed, and no dysmorphic features were identified. Radiographic evaluation confirmed the clinical findings, demonstrating an additional preaxial digit on one side and a triphalangeal configuration of the thumb on the other. Comprehensive systemic examination, developmental assessment, and screening investigations did not reveal any associated congenital anomalies, supporting the diagnosis of an isolated familial limb defect. This asymmetric presentation highlights the wide phenotypic spectrum of preaxial hand malformations and underscores the importance of careful evaluation to exclude syndromic associations and radial ray defects. Early recognition is essential for appropriate genetic counselling, prognostication, and planning of surgical management. Documentation of rare familial combinations of congenital hand anomalies contributes to a better understanding of limb developmental disorders and their inheritance patterns.

Ayurvedic Management of Kleine-Levin Syndrome: A Rare Case Report

Mahesh Sharma, Sourabh Deshmukh, Trupti Thakre, Rohit Waskar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Kleine-Levin Syndrome (KLS) is a rare neurological disorder that predominantly appears during adolescence. This condition is characterised by intermittent periods of extreme drowsiness, unusual behavioural patterns, and impaired cognitive functions, including experiences of feeling disconnected from reality (derealisation). Individuals affected may also show signs of increased food intake (hyperphagia) and heightened sexual urges (hypersexuality). An 18-year-old male reported recurrent bouts of extended sleep duration, each beginning abruptly and lasting for roughly 12 to 14 days. These episodes occurred around four to five times within the last year. During such phases, the patient experienced pronounced somnolence, sleeping for approximately 15 to 16 hours daily. Based on the clinical presentation and symptomatology, a diagnosis of KLS was established. The present case was managed with Ayurvedic Shodhana (biopurification) and Shamana (palliative) therapies, demonstrating significant improvement in the assessment parameters of Sleeping Beauty Syndrome. This case study emphasises the possibility of utilising Ayurvedic treatment as a supportive or substitute method in addressing KLS, thus expanding the range of therapeutic choices for this rare and challenging condition.

Isolated Segmental Fracture Dislocation of the Tarsal Navicular: A Case Report

Sukesh M Kaveeshwar, G Vignesh, Gowtham Senguttuvan, Lionel John Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Isolated segmental fracture–dislocation of the tarsal navicular is an exceptionally uncommon midfoot injury due to the bone’s rigid anatomy and strong ligamentous support. It typically results from high-energy trauma causing severe abduction force on a plantar-flexed foot. A 31-year-old presented to casualty with pain, deformity, and was unable to weight bear on the left foot after falling from a height of 10 feet. Clinical examination revealed a dorsal-medial bony prominence without neurovascular deficit. Radiographs and Computed Tomography (CT) of the left ankle confirmed an isolated dorsal dislocation of the navicular with segmental fractures at its medial and lateral ends. Attempts at closed reduction failed due to soft-tissue interposition. Open reduction was performed through a dorsomedial approach, revealing rupture and interposition of the talonavicular joint capsule. Due to comminution and instability from fractures on both sides of the navicular, naviculo-cuneiform arthrodesis was performed using a 4 mm cannulated cancellous screw to stabilise the medial column. Postoperatively, the limb was immobilised in a below-knee slab for six weeks of non weight-bearing. Gradual weight-bearing was allowed thereafter. At one-year follow-up, the patient achieved an American Orthopaedics Foot and Ankle Society (AOFAS) midfoot score of 90, with excellent function and no radiographic evidence of avascular necrosis or arthritis. Segmental navicular fracture-dislocation is a serious injury that compromises the medial column of the foot. Early surgical intervention with careful soft-tissue handling can result in excellent functional outcomes and prevent long-term complications.

Successful Conservative Management of a Deep Plantar Diabetic Foot Ulcer in the Presence of Superficial Venous Insufficiency: A Case Report

Syed Inayath Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Diabetic Foot Ulcers (DFUs) are a common and challenging complication of diabetes, often leading to significant morbidity and increased risk of amputation. This case report describes a 56-year-old male with type 2 diabetes and hypertension who presented with chronic non-healing ulcer over the plantar aspect of the left foot of one-year duration, measuring approximately 5×3 cm, associated with pain and swelling. Clinical examination revealed maggot infestation, callus formation, and serous discharge. Laboratory evaluation demonstrated leucocytosis {White Blood Cell (WBC) 14,000/mm³} and suboptimal glycaemic control {Glycosylated Haemoglobin (HbA1c) 7.2%}, which improved to 6.5% on follow-up after intensification of therapy. Plain radiographs showed no evidence of osteomyelitis, and the ulcer was classified as Wagner Grade 2. Management included regular sharp debridement, moisture-retentive dressings, stepwise antibiotic therapy, glycaemic optimisation, and offloading using pressure-relieving footwear. Doppler studies revealed superficial venous insufficiency with lower-limb oedema, which was addressed through supportive measures. No growth was found on the wound swab culture. Within two weeks, marked clinical improvement was observed, with reduction in ulcer size to approximately 2.5×1 cm and the development of healthy granulation tissue. This case highlights the importance of early diagnosis, structured wound care management in achieving favourable outcomes, even in the presence of complicating factors such as venous disease and metabolic instability.

Pulmonary Melioidosis: Microbiological Insights for Early Diagnosis and Management: A Case Report

M Mohan Kumar, Priyadharshini Aghoram, John Maria Louis, Priyadarshini Shanmugam Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Melioidosis, a life-threatening clinical condition and a multisystem disease with varied presentations associated with high mortality. This disease can affect any organ, but pulmonary involvement is the commonest, followed by skin and soft-tissue infections, bones and joint infections, visceral abscesses, and septicaemia. This is a case report of a 45-year-old male, diabetic with poor glycaemic control, an occasional drinker, with a history of travel to an endemic area, prior to his illness, presented with a history of fever for the past one month, evening rise of temperature and cough with dyspnoea for 10 days associated with a history of weight loss. Initial evaluation led to the clinical suspicion of community-acquired pneumonia, pulmonary tuberculosis and other clinical conditions such as interstitial lung disease, post-COVID sequelae with secondary infections, malignancy, Human Immunodeficiency Virus (HIV) related lung infections. Baseline blood workup showed anaemia, leucocytosis, elevated Erythrocyte Sedimentation Rate (ESR) and C-reactive protein. Chest X-ray and High-Resolution Computed Tomography (HRCT) chest were suggestive of lung consolidation that involved the right upper lobe predominantly. Sputum culture and sensitivity yielded the growth of Burkholderia pseudomallei, the causative agent of Melioidosis, which resolved the clinical dilemma in diagnosis. He responded well to parenteral Meropenem treatment based on the antimicrobial susceptibility report and showed a good clinical improvement. His glycaemic control was achieved with insulin therapy. Hence, this case report depicts how the microbiological analysis helped in prompt diagnosis and timely management that prevented morbidity and mortality.

Anterior Chest Wall Pyomyositis with Extensive Spread: A Case Report

P Nikhil Bharadwaj, SM Gurutham Prahalad Reddy, A Ajay Raja, Kirthi Sathyakumar, Vijayan Purushothaman Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Pyomyositis is an acute bacterial infection of skeletal muscle, most commonly caused by Staphylococcus aureus, including Methicillin-Resistant Strains Aureus (MRSA). Though tradi-tionally seen in tropical regions, cases in temperate climates are rising, especially in immunocompro-mised individuals. We report a case of a 75-year-old male who developed anterior chest wall swelling and pain after minor trauma. He had underlying hyperglycaemia and acute kidney injury. Imaging revealed a large collection from the right upper abdominal wall extending into the chest, neck, and mediastinum, with contralateral spread. Empirical antibiotics was started, and emergency incision and drainage yield-ed ~1000 mL of purulent substance. Despite therapeutic intervention, the patient’s condition progres-sively deteriorated, ultimately resulting in death. Subsequent culture findings confirmed MRSA infec-tion. This case is notable for the unusual anatomical spread, emphasising early recognition and inter-vention in at-risk individuals.

Severe Hypovitaminosis D with Co-existing Anaemia (Pandu) Managed with Lifestyle Modification and Ayurvedic Intervention: A Case Report

Bawadkar Prasad, Suketha Kumari, Sonali Konkeri, Kartik Sharma, Gaurihar Sarkale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Hypovitaminosis D, a commonly found micronutrient deficiency characterised by musculoskeletal pain, fatigue and declining functional capacity, which, when co-exists with anaemia (Pandu), it represents signs of impaired metabolism and nourishment of tissues rather than a pure isolated deficiency state. A 22-year-old female patient, presented with complaints of bilateral calf muscle myalgia of one month du-ration, associated with fatigue, anorexia, generalised weakness, weight gain along with hair fall. She had a history of irregular and heavy menstrual bleeding and was diagnosed with anaemia six years ago. Clinical examination showed pallor and koilonychia and laboratory investigations revealed severe hypovitaminosis D, with serum 25-hydroxyvitamin D level of 7.5 ng/mL and mild anaemia with haemoglobin 10.1 g/dL. Serum calcium, vitamin B12 and thyroid-stimulating hormone levels were within normal limits. The therapeutic strategy was designed to correct impaired metabolism and utilisation of nutrients rather than providing direct vitamin D or iron supplementation. She was administered with Trayushnadi Loha Vati (500 mg BD) for 51 days, with advice on regular morning sun exposure along with dietary adjust-ment. Monthly follow-up was carried-out to assess compliance and clinical response. At the end of treatment course, significant improvement was reported in subjective as well as objective parameters with reduction in Visual Analogue Scale (VAS) score from 8 to 2, improvement in haemoglobin levels to 11.3 g/dL and normalisation of serum 25-hydroxyvitamin D levels to 75.9 ng/mL. No adverse effects were re-ported. This case highlights the potential role of metabolism-centred Ayurvedic approach in the management of severe hypovitaminosis D with co-existing anaemia.

Rifabutin-induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome in a Patient on Antitubercular Therapy: A Rare Case Report

Bhanu Pratap Choudhary, Harsh Maheshwari, Rahman Jhasim, Aswathy Unnikrishnan, Rajshri Somani Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe, life-threatening adverse drug reaction characterised by skin eruptions, haematological abnormalities, and multi-organ involvement. It is most commonly associated with anticonvulsants and sulphonamides, whereas cases linked to antitubercular drugs are extremely rare. Here, the authors report the case of a 50-year-old male with pulmonary tuberculosis who developed generalised maculopapular rash, pruritus, and lymphadenopathy one week after initiation of Rifabutin, which had been introduced as a substitute following Rifampicin intolerance. Laboratory evaluation revealed marked leukocytosis, eosinophilia, and elevated hepatic transaminases {Aspartate Aminotransferase (AST) and Alkaline Phosphatase (ALP)}. Based on Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria, a definitive diagnosis of DRESS syndrome was established. Rifabutin was immediately discontinued, and the patient was managed with intravenous corticosteroids, topical emollients, and antihistamines, followed by a tapering course of oral prednisone. Over the next four weeks, significant clinical improvement occurred, with normalisation of eosinophil counts and liver function tests. The present case highlights the importance of early recognition of Rifabutin-induced DRESS, timely drug withdrawal, and appropriate immunosuppressive therapy to prevent fatal outcomes. Clinicians should maintain a high index of suspicion in patients developing systemic symptoms with rash during antitubercular therapy.

Megaloblastic Anaemia with Ataxia in a Four-Year-Old Child: A Case Report

M Swetha, Rutu Udapudi, AP Krithika, Jayakaviyah Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Vitamin B12 deficiency is an important yet frequently neglected cause of megaloblastic anaemia in children, most notably among populations with limited access to animal food sources. Although rare, children can still experience neurological effects from vitamin B12 deficiency, including ataxia as well as sub-acute combined degeneration of the spinal cord; however, these are usually reversible if treated quickly. We present a four-year-old male patient with an extremely low vitamin B12 level who presented to our clinic with skin pallor and hyperpigmentation, as well as difficulty in walking. Upon further digging into the patient’s medical history and after initial examination of the patient, it was found that he had sensory ataxia and gross tremors on hand examination, a positive Babinski response, and loss of proprioception; complete work up revealed megaloblastic anaemia (with low vitamin B12 level, high homocysteine and methylmalonic acid), as well as MRI of the brain confirming subacute combined degeneration of the spinal cord. After receiving Intramuscular (IM) vitamin B12 injections, the patient demonstrated excellent improvement in both clinical and haematological parameters, disease remission at follow-up (3 months) and complete resolution of neurological symptoms. Our findings point towards the need to consider vitamin B12 deficiency when evaluating a child with unexplained anaemia and neurological symptoms, especially in those with high risk for developing vitamin B12 deficiency due to dietary considerations.

Tuberculous Pleural Effusion Complicated by Empyema Thoracis in a Newly Diagnosed PLWHA: A Case Report

Ronak Shah, Parth Shah, Mittal Sindhav Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X The co-existence of Pulmonary Tuberculosis (PTB), empyema thoracis, and Human Immunodeficiency Virus (HIV) infection constitutes a formidable diagnostic and therapeutic challenge. In immunocompromised individuals, such triple pathology can evolve rapidly and is associated with significant morbidity and mortality, particularly in TB-endemic regions. A 32-year-old male with a past history of pulmonary TB, 15 years prior presented with progressive exertional dyspnoea, dry cough, right-sided pleuritic chest pain, low-grade fever for seven days, and significant weight loss of one month duration. SpO₂ was 90% on room air. Chest X-ray demonstrated complete opacification of the right hemithorax without tracheal deviation. HRCT thorax revealed gross multiloculated pleural effusion with underlying lung collapse and smooth interlobular septal thickening. Pleural fluid analysis confirmed empyema. HIV serology was reactive and pleural fluid Cartridge-Based Nucleic Acid Amplification Test (CB-NAAT) was positive for Mycobacterium tuberculosis (MTB). Sputum culture identified Klebsiella pneumoniae sensitive to amikacin and tigecycline. The patient was managed with intercostal drain insertion, broad-spectrum antibiotics (Piperacillin-Tazobactam and Levofloxacin), Anti-Koch's Therapy (AKT), and amikacin, with gradual clinical and biochemical improvement. This case underscores the critical importance of systematic microbiological workup including CB-NAAT, pleural fluid Adenosine Deaminase (ADA), and HIV screening in all patients presenting with pleural effusion in endemic regions. The triad of TB, empyema, and HIV demands a multidisciplinary approach with concurrent management of all three conditions for favourable outcomes.

Wilson’s Disease Presenting as Status Epilepticus and Acute Fulminant Hepatic Failure in a Young Adult: A Case Report

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Mittal Sindhav Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Wilson's disease (hepatolenticular degeneration) is a rare autosomal recessive disorder of copper metabolism caused by mutations in the ATP7B gene, resulting in pathological copper accumulation in the liver, brain, and other organs. Neuropsychiatric and hepatic manifestations may coexist or present in isolation, and the disease is frequently underdiagnosed due to its protean clinical features. A 19-year-old male presented with a one-week history of low-grade fever, frontal headache, and abdominal pain, complicated by Status Epilepticus (SE) with refractory generalised tonic-clonic seizures and a Glasgow Coma Scale (GCS) score of E1V1M2 on admission. Investigations revealed Acute Fulminant Hepatic Failure (AFHF) with markedly elevated transaminases {Serum Glutamate Pyruvate Transaminase (SGPT): 3938 U/L, Serum Glutamate Oxaloacetate Transaminase (SGOT): 3804 U/L}, coagulopathy (INR: 2.01), and hyperammonaemia (187.2 μg/dL). Magnetic Resonance Imaging (MRI) brain on epilepsy protocol demonstrated cortical and subcortical white matter hyperintensities consistent with metabolic encephalopathy. Diagnosis of Wilson's disease was established by a markedly elevated 24-hour urinary copper of 1069 mcg/24 hours (reference: 15-60 mcg/24 hours) and a subnormal serum ceruloplasmin of 18 mg/dL (reference: 20-60 mg/dL). The patient was managed with mechanical ventilation, multiple antiepileptic agents, empirical antimicrobials, N-acetylcysteine, and copper-lowering therapy with zinc sulfate and D-penicillamine. He was successfully extubated and discharged neurologically intact after eleven days of intensive care. At two-month follow-up, he remained seizure-free with significant clinical and biochemical improvement. This case highlights Wilson's disease as a rare but treatable cause of SE and acute liver failure in young patients. Early consideration of Wilson's disease in young adults presenting with combined neurological and hepatic dysfunction is critical, as prompt initiation of copper-lowering therapy can result in complete neurological recovery and prevent mortality.

Pregnancy in Bicornuate and Couvelaire Uterus: A Case Report

Rutuja Kale, Shamsunder Kale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X In the general population, the incidence of uterine malformations is estimated to be 3-5%. Pregnancy in a bicornuate and couvelaire uterus is a rare anomaly. Pregnancy in a bicornuate uterus, a congenital Müllerian duct anomaly caused by incomplete fusion of the uterine horns, is associated with an elevated risk of adverse obstetric outcomes due to the altered uterine morphology, abnormal placental implantation dynamics and limited cavity volume. Women with a bicornuate uterus have been shown in large population-based studies to have increased risks of malpresentation, preterm delivery and notably placental abruption compared with pregnancies in normally shaped uterus, with abruption risks reported up to three times higher in this group. Hereby, the authors present a case of a 23-year-old female, gravida 2 para 1 living 1, previously preterm delivered, who came to the labour room with features of obstructed labour. The patient was posted for caeasarean section. Intraoperatively, there was a bicornuate couvelaire uterus with a broad ligament haematoma, with stillbirth of the baby. Obstetric hysterectomy was done in view of an atonic uterus with failure of conservative management. Regular check-ups, timely diagnosis, early ultrasound and delivery planning in a well- equipped hospital improve both maternal and fetal outcomes.

Behavioural and Executive Dysfunction as the Initial Manifestation of Disseminated Neurocysticercosis: A Case Report

GR Nivashini, Karthik Krishna Ramakrishnan, Seetha Lakshmi Natarajan, R Sam Raja, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Neurocysticercosis (NCC) is the most prevalent parasitic infection of the central nervous system globally and the most common cause of acquired epilepsy in endemic areas. Neuropsychiatric manifestations, including cognitive impairment, depression, and behavioural disturbances, are also becoming increasingly common. Multisystem cysticercosis, which involves the central nervous system and extracranial sites such as skeletal muscles, subcutaneous tissues, and visceral organs, is uncommon. This is a case report of a 22-year-old male with progressive behaviour change, which included apathy, social withdrawal, and executive dysfunction. He was initially diagnosed with major depressive disorder with minimal response to antidepressant treatment. Assessment of an asymptomatic forearm swelling showed intramuscular cystic lesions with an eccentric echogenic focus on ultrasonography, suggestive of cysticercosis. Non-Contrast Computed Tomography (NCCT) of the brain revealed numerous calcified nodular lesions in both cerebral hemispheres and deep gray nuclei, without associated edema or mass effect. The cysticercus antibody serological test was positive. The general clinic-radiological picture favoured dissemination of cysticercosis with mixed stages of evolution. After a course of albendazole with corticosteroid, the patient showed improvement in executive functioning and behavioural symptoms. This case underscores how NCC should be considered among the differential diagnoses of treatment-resistant psychiatric manifestations in endemic areas.

Acute Decompensated Heart Failure Precipitated by Atrial Fibrillation with Rapid Ventricular Response in Severe Biventricular Systolic Dysfunction: A Case Report

Roshni Sadaria, Abhiraj Parmar, Ronak Shah Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Acute Decompensated Heart Failure (ADHF) is a life-threatening clinical syndrome characterised by abrupt worsening of cardiac function and haemodynamic instability. The prevalence rate of ADHF in India is higher than in Western countries, around almost 1%, with younger age groups being more affected. A 65-year-old male presented to the emergency department with progressively worsening breathlessness, intermittent chest discomfort, and dizziness. Clinical examination revealed an irregular tachyarrhythmia, bilateral basal pulmonary crepitations, and mild peripheral oedema suggestive of cardiac decompensation. Electrocardiography demonstrated Atrial Fibrillation (AF) with rapid ventricular response, while transthoracic echocardiography revealed dilated cardiac chambers with severe global hypokinesia and markedly reduced Left Ventricular Ejection Fraction (LVEF) of approximately 20%. Laboratory evaluation showed markedly elevated N-terminal pro-B-type natriuretic peptide levels, acute kidney injury, and significant elevation of hepatic transaminases compatible with congestive hepatopathy with possible hypoxic hepatic injury. The patient was managed with intravenous rate control with amiodarone for AF, diuretic therapy, anticoagulation, fluid restriction, and initiation of guideline-directed therapy for heart failure with reduced ejection fraction. Gradual clinical and biochemical improvement occurred during hospitalisation. This case highlights AF with rapid ventricular response as a potentially reversible trigger of acute cardiac decompensation. Early recognition and prompt, targeted management of such precipitating factors are crucial to improving clinical outcomes and reducing morbidity and mortality in patients with heart failure.

Silicotuberculosis with Suspected Distal Renal Tubular Dysfunction and Nephrogenic Diabetes Insipidus: A Case with an Unusual Association

Surya Pradha Muthu, M Rajkumar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Silicosis is a chronic occupational lung disease associated with an increased susceptibility to tuberculosis. However, renal manifestations in the context of silica exposure are uncommon and remain incompletely understood. The present case is of a 52-year-old underground hard rock miner with a history of prolonged silica exposure who presented with fever, cough, progressive breathlessness, polyuria, and lower limb weakness. Radiological evaluation demonstrated bilateral reticulonodular opacities with calcified mediastinal lymph nodes. Tissue GeneXpert testing confirmed Mycobacterium tuberculosis, establishing the diagnosis of silicotuberculosis. During hospitalisation, the patient developed severe hypokalaemia with normal anion gap metabolic acidosis, raising suspicion of distal renal tubular dysfunction; however, definitive diagnostic parameters for distal renal tubular acidosis were incomplete. Persistent polyuria with low urine osmolality suggested possible nephrogenic diabetes insipidus, although confirmatory testing could not be performed due to clinical instability. Despite initiation of antitubercular therapy and intensive supportive care, the patient’s condition deteriorated with progressive respiratory failure and refractory shock, ultimately resulting in death. This case underscores the diagnostic complexity of silicotuberculosis with concurrent electrolyte and renal abnormalities, while highlighting that the relationship between silica exposure, tuberculosis, and renal tubular dysfunction remains uncertain and likely multifactorial, warranting cautious interpretation.

Cryptococcal Spondylitis Mimicking Tuberculous Spine in a Previously Treated Case of Spinal Tuberculosis: A Rare Case Report with Review of Literature

M Sanjay, D Pruthvy Kartheek, HB Rakshitha, K Amita Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Spinal tuberculosis is a common cause of vertebral infection in endemic regions such as India, where the burden of tuberculosis remains high. Conversely, specific fungal infections may manifest with clinical and radiological characteristics that closely resemble those of other conditions, thereby complicating the diagnostic process and potentially resulting in the administration of inappropriate therapies. The present case is of a 76-year-old male patient who experienced persistent lower back pain for a duration of six months and had a prior medical history of treated tuberculosis. Radiological assessment via Magnetic Resonance Imaging (MRI) revealed lytic destruction affecting the T10 vertebral body, pedicle, and right transverse process, as well as involvement of the adjacent vertebrae, specifically T9 and T11. Given the clinical suspicion of recurrent tuberculosis, a more comprehensive evaluation was subsequently performed. Histopathological examination of the lesion demonstrated granulomatous inflammation with the presence of fungal organisms. Special staining with Periodic Acid–Schiff (PAS) confirmed features consistent with cryptococcal infection. The patient was later managed with appropriate antifungal therapy. This case highlights the importance of considering fungal aetiologies in patients with spondylodiscitis who do not respond to anti-tubercular treatment. Early tissue diagnosis supported by special stains plays a crucial role in establishing the correct diagnosis and guiding timely management. Increased awareness of such atypical presentations is essential to avoid delays in treatment and to improve patient outcomes.

Granular Cell Tumour of the Endobronchus: A Case Report

A Sanjuta Angelyn, Lawrence D'Cruze, Gramani Arumugam Vasugi, S Josephine, Irfan Ismail Ayub Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Granular cell tumour is a rare tumour of mesenchymal origin arising from Schwann cells. It is a benign tumour and most common sites include skin, oral cavity and gastrointestinal tract. These tumours are found incidentally. Only 1 to 2% tumours are malignant. Malignant criteria is based on histopathological features. A 48-year-old male came with complaints of cough, loss of weight and appetite for past three months. Past history of tuberculosis, active smoker and an alcoholic for past 10 years. CT scan showed areas of fibrosis and cavitatory changes in bilateral upper lobes and right middle lobe. Emphysematous changes in left upper lobe, lingual segment and right lower lobe. Bronchoscopy showed a nodule in endobronchus measuring 1×0.8 cm. Sputum culture and bronchial wash were negative. Smear for acid fast bacilli and fungal organisms were negative. Histopathology of the nodule showed features of granular cell tumour. This case highlights the unique location of the tumour as it is most commonly seen in skin and gastrointestinal system. Respiratory tract granular cell tumour is very rare. Treatment includes complete excision of the tumour and close follow-up is essential.

Isolated Hepatic Metastasis Following Curative Treatment of Stage II Poorly Differentiated Buccal Mucosa Squamous Cell Carcinoma: A Case Report

Ram Pukar Bharat, Krishna Balaji Pampatwar, Yogesh Dagar, Amol Shankar Dongre Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Distant Metastasis (DM) in early-stage Oral Squamous Cell Carcinoma (OSCC) is uncommon and is usually associated with advanced locoregional disease. However, intrinsic tumour biology may occasionally overridess conventional prognostic determinants. We report a rare case of early isolated hepatic metastasis following curative-intent treatment of stage II, poorly differentiated squamous cell carcinoma of the right buccal mucosa. A 50-year-old male from central India presented with a non-healing ulcer involving the right buccal mucosa. Diagnostic evaluation included detailed clinical examination, Orthopantomogram (OPG) to assess mandibular involvement, and Contrast-Enhanced Computed Tomography (CECT) of the face, neck, and thorax, which revealed a localised mucosal lesion without bone invasion, extranodal extension, or DM. Ultrasonography of the neck demonstrated enlarged cervical lymph nodes without definitive metastatic features. Incisional biopsy showed severe epithelial dysplasia, while frozen section analysis was suggestive of squamous cell carcinoma. The patient underwent wide local excision with ipsilateral modified radical neck dissection. Final histopathological examination confirmed a poorly differentiated squamous cell carcinoma staged as pT2N0M0, with a Depth of Invasion (DOI) of 5 mm, negative surgical margins, absence of Perineural Invasion (PNI) and Lymphovascular Invasion (LVI), and no nodal metastasis. In view of poor differentiation and dysplasia at the surgical margin, adjuvant Intensity-Modulated Radiotherapy (IMRT) was administered. Despite satisfactory locoregional control, follow-up imaging prompted by abdominal symptoms revealed multiple hepatic revealed multiple hepatic lesions on abdomen CECT, without locoregional recurrence or pulmonary metastasis. Ultrasound-guided liver biopsy confirmed metastatic squamous cell carcinoma. This case highlights the dominant influence of adverse tumour biology in early haematogenous dissemination and underscores the limitations of stage-based prognostication, supporting biologically informed surveillance in selected early-stage OSCC patients.

Pulmonary Venous Atresia with Abnormal Drainage in a Neonate: A Case of Missing Vein

Sagar Malani, Nilay Nimbalkar, Prajakta Kirdat Patil, Anand Hatgaonkar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Pulmonary Venous Atresia (PVA) is a rare congenital cardiovascular anomaly in which one or more pulmonary veins fail to establish a normal connection with the left atrium, resulting in obstruction of pulmonary venous return and progressive pulmonary venous hypertension. When associated with Partial Anomalous Pulmonary Venous Connection (PAPVC), pulmonary venous drainage is redirected into the systemic venous circulation, leading to abnormal haemodynamics and right-sided cardiac volume overload. Early recognition is essential because delayed diagnosis may result in severe cardiopulmonary complications. This case report describes a 30-day-old male neonate who presented with persistent respiratory distress, feeding difficulty, tachypnoea, and mild central cyanosis. Chest radiography demonstrated mild cardiomegaly with prominent pulmonary vascular markings. Transthoracic echocardiography revealed dilatation of the right atrium and right ventricle with a relatively small left atrium; however, pulmonary venous connections were not clearly visualised. Multidetector Computed Tomography (MDCT) angiography was therefore performed for detailed anatomical evaluation. Imaging demonstrated absence of the right pulmonary veins and the left lower pulmonary vein, consistent with PVA. The remaining left upper pulmonary vein drained anomalously into the left innominate vein through a vertical vein, representing PAPVC. The infant underwent surgical rerouting of the anomalous vertical vein to the left atrium with closure of the Atrial Septal Defect (ASD), successfully restoring physiological pulmonary venous drainage. Postoperatively, oxygen saturation improved and respiratory symptoms resolved. This case highlights the importance of MDCT angiography in accurately delineating complex pulmonary venous anomalies and guiding timely surgical management.

Lipoma of the Bilateral Supraclavicular Region: A Case Report

Subhangi Parmar, Rajesh Gattani, Yashasvi Trivedi, Saurabh Gawand, Kesav Sudabattula Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Lipomas occur in various parts of the body, with the extremities and trunk being common sites. It is rare to observe a lipoma bilaterally in the supraclavicular region. It is clinically significant because of its proximity to critical neurovascular structures. This is a case of a 60-year-old female who presented with a four-month history of swelling over the bilateral supraclavicular region, which gradually progressed to its current dimensions over this period. Physical examination revealed a smooth, globular swelling over the bilateral supraclavicular regions with normal skin texture. Radiological screening showed bilateral fatty masses suggestive of lipoma. The patient was managed by surgical excision. The histopathological analysis of the excised specimen confirmed the diagnosis of the lipoma. This case report highlights the importance of a multidisciplinary approach to managing bilateral lipomas in sensitive anatomical areas to prevent adverse outcomes.

Unveiling Hidden Fractures: A Case Report on Proximal Tibial Stress Injury

VS Ambrish, M Muralikrishnan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Proximal tibial stress fractures are not common and can be missed in the earlier stage, especially when the radiographs are normal. Patients may present with vague knee pain without a history of major trauma, which may delay in diagnosis. The present case report describes a 55-year-old woman who presented with persistent left knee pain and difficulty in bearing weight for 10 days following a minor workplace injury. She had a past history of corticosteroid use. Clinical examination and investigations were done and Magnetic Resonance Imaging (MRI) confirmed a proximal tibial stress fracture. She was treated conservatively with strict non weight-bearing, long knee orthosis support, analgesics, and a short course of inj. teriparatide along with calcium and vitamin D supplementation. The patient improved gradually, and follow-up radiographs at eight weeks and four months showed satisfactory healing with return of normal function. This case highlights the need to consider proximal tibial stress fracture in patients presenting with persistent knee pain after minor trauma, need to consider the proximal tibia stress fracture and emphasises the role of early imaging and appropriate conservative management.

Cyst with an Enhancing Nodule: An Atypical Presentation of Angiomatous Meningioma

Sourabh Zambre, Rohini Chaudhari, Alok Umredkar, Ashwini Umredkar, Pushkar Chaudhari Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Angiomatous meningioma is a rare and histologically distinct subtype of meningioma, comprising fewer than 3% of all meningiomas, that poses a significant diagnostic challenge due to its deceptively aggressive radiological appearance. Unlike the majority of World Health Organisation (WHO) Grade 1 meningiomas, this subtype frequently demonstrates imaging characteristics more commonly associated with high-grade or malignant intracranial neoplasms, including cystic degeneration, an enhancing mural nodule, disproportionate peritumoral oedema, and mass effect with midline shift, features that can readily mislead the treating clinician toward a presumptive diagnosis of a more sinister lesion. We present the case of a 51-year-old male with a two-year history of progressive headache and a three-month history of personality change characterised by episodic rage and expressive dysphasia, in whom neuroimaging demonstrated a large right frontal cystic lesion with an intensely enhancing nodule adherent to the falx cerebri and surrounding oedema. Gross total resection was achieved via right frontal craniotomy at Simpson Grade I, and histopathological analysis confirmed the diagnosis of angiomatous meningioma, WHO Grade 1, characterised by a predominance of vascular channels with interspersed meningothelial cells. This case underscores the importance of including angiomatous meningioma in the differential diagnosis of cystic intracranial lesions with enhancing mural nodules, particularly when attached to dural structures, and highlights that radical surgical resection remains both the diagnostic and therapeutic cornerstone, carrying an excellent long-term prognosis.

Fatal Non O1/Non O139 Vibrio cholerae Bacteraemia without Gastrointestinal Manifestations: A Case Report

Avinash Kumar, Sangeeta Datta, Biswaroop Chatterjee, Asish Kumar Mukhopadhyay Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Non-O1/non-O139 Vibrio cholerae (NOVC) are increasingly recognised as a cause of severe invasive infection including bacteraemia especially in people who are elderly or have co-morbidities. NOVC infections often lack gastrointestinal manifestations, and the frequent absence of exposure to well-recognised sources such as seafood or marine/estuarine water lowers the index of suspicion for Vibrio cholerae and delays targeted diagnostic testing. Authors present here a case of NOVC bacteraemia in an 80-year-old female from West Bengal, India. She was brought in with acute respiratory distress and altered sensorium, and was found to be in septic shock at the time of admission. There was no history of diarrhoea, seafood consumption, or recent travel to the sea. Despite prompt initiation of intensive care and empirical broad-spectrum antimicrobial therapy, she rapidly deteriorated and died within 48 hours of admission. Blood cultures grew Vibrio cholerae which was confirmed as NOVC serotype O17 by a national reference laboratory. Antimicrobial Susceptibility Testing (AST) demonstrated susceptibility to all relevant antimicrobial agents. This case highlights the potential of NOVC to cause bacteraemia with an aggressive clinical course and lethal potential.

Primary Costochondral Gout with Concomitant Streptococcal Anterior Chest Wall Abscess: A Rare Diagnostic Challenge

Naushad Ahamed, Nanthakumar Logithasan, G Sowmya, Preetam Arthur Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Gout is a metabolic disorder caused by deposition of monosodium urate crystals in joints and soft-tissues. Gout classically affects peripheral joints such as the first metatarsophalangeal joint (podagra). Atypical presentation involves deposition in axial and other thoracic structures. Costochondral joint involvement is exceedingly rare and mimics infectious, inflammatory, or neoplastic aetiologies. The authors hereby, report the case of a 42-year-old male with poorly controlled diabetes and poor compliance to medications, presented with acute-onset chest pain with fullness in the left side of chest and high-grade fever for the past three days. On examination there was tenderness over the anterior chest wall and imaging revealed a localised large anterior chest wall collection adjacent to the costochondral junction involving the pectoral muscles and nearby structures. Image-guided aspiration yielded purulent material, which grew Streptococcus species. Cytological examination showed acute inflammatory infiltrates with monosodium urate crystal deposition consistent with gouty arthritis. He was managed with intravenous antibiotics, urate lowering agents, anti-inflammatory agents and analgesics resulting in significant clinical and radiological improvement. This case shows the diagnostic complexity associated with atypical presentation of gout, in patients with metabolic risk factors. High index of suspicion and early recognition with appropriate therapy is essential for a favourable outcome.

X-linked Severe Combined Immunodeficiency Syndrome with Hereditary Spherocytosis in an Infant: A Rare Case Report

Shweta Singh, Reema Agrawal, Ishita Pathak, BD Bhatia Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Combined Immunodeficiency is an uncommon and inherited Primary Immunodeficiency Disorder (PID) that affects both cellular and humoural immune function and leads to early death. This case report describes the rare co-existence of X-linked Severe Combined Immunodeficiency (SCID) and Hereditary Spherocytosis (HS), highlighting new mutations, challenges in diagnosis and managing complex paediatric cases. A five-month-old male infant, born through vaginal delivery, presented with persistent fever, respiratory dis-tress and moderate hepatosplenomegaly with a family history of undiagnosed male sibling death at two months of age. Laboratory findings revealed neutrophilic leukocytosis and microcytic hypochromic anaemia. The chest imaging demonstrated diffuse infiltrates, a few unilateral cystic lesions, and an absent thymus shadow. While empirical treatment for pneumonia was initiated, multiplex PCR identified multidrug-resistant Pseudomonas aeruginosa and Serratia marcescens, along with Rhinovirus infection. Whole Exome Sequencing (WES) revealed a pathogenic mutation in the Interleukin 2 Receptor gamma (IL2RG) gene associated with X-linked SCID, and also mutations linked to HS. Antimicrobial prophylaxis was started, and haematopoietic stem cell transplantation was planned; however, financial constraints hindered the treatment, and the infant died at ten months of age. This case emphasises the importance of meticulous family history and timely genetic testing in infants with persistent infections. Early diagnosis can pave the way for targeted and curative interventions.

CBCT Diagnosis of Radix Entomolaris in a Mandibular First Molar Mimicking Multitooth Pathology: A Case Report

D Bala Selva Kumar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Anatomical variations in mandibular molars, particularly the presence of a Radix Entomolaris (RE), may complicate endodontic diagnosis and treatment. When associated with sinus tract misdirection, such variations can mimic pathology involving adjacent teeth and lead to diagnostic uncertainty. A 33-year-old female presented with intermittent pain in the lower left posterior region with a persistent sinus tract. Sinus tract tracing and periapical radiographs initially suggested involvement of adjacent teeth. However, clinical examination and vitality testing excluded pathology in neighbouring teeth. Radiographic evaluation revealed an additional distolingual root in the mandibular first molar, suggestive of RE. Root canal treatment was performed using modified access, flexible nickel-titanium instrumentation and calcium hydroxide intracanal medication. Post-obturation Cone-Beam Computed Tomography (CBCT) confirmed that the periapical lesion was confined to the distal root, explaining the misleading sinus tract pathway. The patient became asymptomatic, with complete resolution of the sinus tract.

Ayurvedic Management of Tobacco-induced Stomatitis (Pittaja Mukhapaka): A Case Report

Mangesh Shrirang Bondre Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Tobacco-induced stomatitis, also called nicotine stomatitis, presents as raised papules with red central depressions, mainly on the posterior hard palate. In Ayurveda, mukhapaka is classified into Vataj, Pittaja, Kaphaj, and Sannipataj types, each with distinct symptoms. This case study discusses a 42-year-old male with ulceration of the hard palate, pricking pain (toda), burning sensation (daha), altered taste (aasyvairasya), and blackish lip discolouration (vaivarnya). Following 30 days of Ayurvedic treatment, he experienced marked improvement.

Catheter Directed Streptokinase Therapy for Loculated Tubercular Psoas Abscess: A Case Report

K Mithun Nilgiri, Vinay Kumar Goud Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Psoas abscess is a known complication of musculoskeletal tuberculosis and may pose significant therapeutic challenges, particularly when loculated or associated with drug resistance. We present a case of a 33-year-old male with a history of decompression laminectomy for Pott’s spine, who presented with fever and low back pain. Imaging revealed a loculated left psoas abscess. Microbiological evaluation confirmed rifampicin-resistant Mycobacterium tuberculosis, and the patient was initiated on a Multidrug-Resistant Tuberculosis (MDR-TB) regimen. Image-guided pigtail catheter drainage was performed. However, follow-up imaging demonstrated persistent loculated collection with minimal drain output. In view of inadequate response to conventional drainage, catheter-directed fibrinolytic therapy using streptokinase was administered in two cycles. This resulted in a significant increase in drainage output and subsequent radiological resolution of the abscess. The patient showed marked clinical improvement with resolution of symptoms, and the catheter was successfully removed. This case highlights the potential role of fibrinolytic therapy as a minimally invasive and cost-effective adjunct in the management of loculated tubercular psoas abscesses, particularly when conventional drainage is insufficient. It may help avoid surgical intervention in selected cases and offers a valuable therapeutic option in resource-limited settings.

Multifocal Urothelial Carcinoma Involving Renal Pelvis to Urinary Bladder: A Case Report

M Namrata, Raya Banerjee, Dipkana Das Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Urothelial carcinomas are malignancies arising from the lining epithelium of the urinary tract. It can develop anywhere starting from the renal pelvis to the urethra, involving the bladder and ureter in between. Multifocal occurrences as well as metachronous or synchronous recurrences have been reported in urothelial carcinoma, particularly in cases of upper tract urothelial carcinomas. Seeding of cancer cells and field cancerisation are two well explored hypotheses explaining the possible cause for such unique tumour characteristic. Here, we report a case of multifocal urothelial carcinoma in a 68-year-old female, presenting with carcinoma involving the renal pelvis, extending along the entire length of the ureter to finally infiltrate the bladder wall. Neo-adjuvant chemotherapy could not be administered due to poor renal function owing to hydronephrosis. Patient was surgically managed by radical nephrectoureterectomy and radical cystectomy. Postsurgery, resection margin of the specimen revealed microscopic evidence of residual neoplastic lesion of low malignant potential, necessitating the need for active long-term surveillance for possible recurrence. However, patient unfortunately succumbed to possible disease related health complications closely after surgery, preventing follow-up and further evaluation of the disease course. Synchronous bladder carcinoma with upper tract urothelial carcinoma is novel owing to its multifocality and an aggressive clinical course. Such a presentation of upper tract urothelial carcinoma indicates a simultaneous affliction of the entire urinary tract increasing the risk of residual disease and recurrence even with extensive radical surgery. Long-term aggressive follow-up is usually warranted in these cases to improve overall survival and cancer-specific survival.

Jejuno-jejunal Intussusception Secondary to Metastatic Adenocarcinoma of Lung: A Case Report

Ram Pukar Bharat, Ravi Kanodia, Yogesh Dagar, Vijay Jeyachandran, Amol Shankar Dongre Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Adult intussusception is an uncommon cause of bowel obstruction and is usually associated with an underlying pathological lesion, often malignant. Intussusception secondary to metastatic lung adenocarcinoma is exceedingly rare. We report the case of a 64-year-old man with previously diagnosed moderately differentiated adenocarcinoma of the lung, Stage IIIA, positive for Epidermal Growth Factor Receptor (EGFR) mutation, who was treated with paclitaxel-carboplatin chemotherapy, gefitinib, definitive chemoradiotherapy, and subsequently whole-brain radiotherapy for cerebral metastases. He presented acutely with abdominal pain, vomiting, and a palpable abdominal mass. Imaging demonstrated jejuno-jejunal intussusception, and an emergency laparotomy with bowel resection and primary anastomosis was performed. Histopathological examination with Immunohistochemistry (IHC) confirmed metastatic adenocarcinoma consistent with a pulmonary primary. Although the patient initially had an uneventful postoperative recovery, he succumbed to progressive systemic disease one month later. This case highlights the rarity of small-bowel intussusception secondary to metastatic lung adenocarcinoma and emphasises the importance of prompt recognition and surgical intervention to achieve palliation in advanced-stage malignancy.

Giant Cell Tumour of the Metatarsal: A Rare Case Managed with Excision and Partial Amputation

Aditya Sudhir Dalvi, Nitin Narendra Samal, Nareshkumar Satyanarayan Dhaniwala, Vibhav Vinay Deshmukh, Saraswat Sharma Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Giant Cell Tumour (GCT) of bone is a benign but locally aggressive tumour that usually affects the ends of long bones. Its occurrence in the small bones of the foot is uncommon, and involvement of the metatarsals is particularly rare. This is a case of a 45-year-old female who came with a gradually increasing swelling over the left foot for three years. On examination, the swelling was noted over the region of the first and second metatarsals. Radiographs showed a lytic expansile lesion, and further evaluation with ultrasonography and Fine Needle Aspiration Cytology (FNAC) suggested a GCT. MRI was performed to assess the extent of the lesion and involvement of surrounding structures. Considering the extent of disease, the patient underwent wide excision of the tumour with amputation of the first metatarsal and stabilisation of the second metatarsal under spinal anaesthesia. The diagnosis was confirmed on histopathological examination, supported by immunohistochemistry. Postoperatively, the patient recovered well, with the wound healing satisfactorily. She was started on physiotherapy and gradual weight-bearing, and showed good functional improvement on follow-up. GCTs at uncommon sites like the metatarsals can present late and may behave more aggressively. This case highlights the importance of timely diagnosis and appropriate surgical planning in achieving good outcomes. Reporting such rare presentations is useful in guiding management in similar clinical situations.

Multidisciplinary Rehabilitation of a Patient with Sickle Cell Disease: A Case Report

(Major) Vaibhav Chandankhede, Lalit Raut, Pragya Kulkarni, Ghanishtha Burile, Ashish Ganjare Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Chronic haemoglobinopathy Sickle Cell Disease (SCD) is frequently exacerbated by recurrent infections such as aspiration pneumonitis, which may necessitate long-term airway management techniques like tracheostomy. These interventions often result in dysphagia and respiratory complications, thereby requiring a multidisciplinary approach to care. This report describes recurrent aspiration pneumonitis resulting in tracheostomy and ventilator dependence in a 19-year-old male patient with homozygous SCD. The patient underwent a structured multidisciplinary rehabilitation programme that included ENT-guided swallowing therapy and physiotherapy aimed at respiratory and musculoskeletal recovery following several unsuccessful attempts at decannulation. The patient underwent progressive mobilisation, breathing control techniques, chest physiotherapy, and staged oral-motor and swallowing exercises over a period of 4-6 weeks. Functional outcomes improved significantly following these interventions. The Volume-Viscosity Swallow Test (V-VST) showed post-treatment progression, respiratory effort improved (Modified Borg Dyspnoea Scale decreased from 7 to 2-3), and swallowing ability improved from Functional Oral Intake Scale (FOIS) Level 2 to Level 6. The Ryle’s tube was removed after the patient was successfully decannulated. In patients with SCD and complex pulmonary and oropharyngeal involvement, this case emphasises the importance of early, coordinated rehabilitation-including physiotherapy and ENT collaboration- in restoring function and improving quality of life.

Management of Protrusio Acetabuli Using Hybrid Total Hip Replacement and Bone Grafting: A Case Report

Aditya Sudhir Dalvi, Nitin Narendra Samal, Dhairya Veragiwala, Amit Gaurkar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Protrusio acetabuli is an uncommon condition in which the femoral head gradually migrates medially into the pelvis, resulting in pain, restriction of hip movements, and progressive arthritis. Surgical management in elderly patients is difficult because of poor bone quality, medial wall defects, and altered hip anatomy. Total hip arthroplasty with acetabular reconstruction is often required to restore hip function and relieve pain. A 73-year-old female presented with severe bilateral hip pain for five years, with marked worsening over the last year. She had difficulty walking and performing daily activities. Radiographs, CT scan, and MRI revealed bilateral protrusio acetabuli associated with advanced osteoarthritis and avascular necrosis of both femoral heads, more severe on the right side. The patient underwent right-sided hybrid total hip replacement using a posterolateral approach. During surgery, the medial acetabular wall was found to be thinned and deficient. The excised femoral head was morselised and used as an autograft to reconstruct the medial wall and support acetabular cup placement. Postoperatively, the patient showed good pain relief and gradual improvement in mobility with protected rehabilitation. This case highlights the importance of careful preoperative assessment and proper acetabular reconstruction in complex protrusio acetabuli. Use of femoral head autograft helped restore bone stock and achieve stable implant fixation. Reporting this case is important because successful hybrid total hip arthroplasty with bone grafting in elderly patients with protrusio acetabuli is technically demanding and infrequently reported.

Marfan Syndrome: A Case Report and Review of Literature on Multipronged Approach

F Massillamani, N Santana Senthilkumar, D Gowsalya, GC Lalithapriya, G Swetha Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Marfan Syndrome (MFS) is a rare autosomal dominant inherited disorder of connective tissue due to the mutations in the Fibrillin-1(FBN1) gene located on chromosome 15q21.1. Alterations in this gene lead to widespread abnormalities affecting the ocular, cardiovascular, and skeletal systems, which are the characteristic features of the primary disease. Pulmonary, nervous system, cutaneous and oral cavity can also be affected in the secondary form of disease. Various oral manifestations of Marfan syndrome include bifid uvula, high arch palate, constricted arches, malocclusion and temporomandibular joint dysarthrosis. The most widely used diagnostic standard for Marfan syndrome is the revised Ghent nosology, which incorporates major and minor criteria developed through international expert consensus to ensure accurate identification of the disorder and to enhance patient management and outcomes. This paper discusses a 38-year-old female patient who reported with a complaint of pain in the right lower back tooth region, which had persisted for three weeks. Patient’s history revealed that she had undergone mitral valve replacement surgery, sclerotomy for glaucoma and spinal fusion surgery for scoliosis. Management of the patient required a multidisciplinary approach integrating cardiology, ophthalmology, orthopaedics, and dental specialties to address this complex multisystem disorder. All dental surgical procedures requires antibiotic prophylaxis for the patients with Marfan syndrome who had undergone cardiac surgeries. Orthognathic surgery should be performed during early adolescent period for patients presenting with severe skeletal malocclusion.

A Case Report on Cabozantinib-induced Hand-Foot Skin Reaction

Bhakti Jaiprakash Sarda, Bhushan Madke, Ashish Vaidya, Naga Nitya Vangala Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Cabozantinib is a multi-targeted tyrosine kinase inhibitor that targets Vascular Endothelial Growth Factor Receptor (VEGFR) 2, c-MET, and RET. It exhibits antiangiogenic and antitumorigenic effects and has the potential to treat a variety of malignancies. Palmar-Plantar Erythrodysesthesia (PPE), one of the most common side-effects of tyrosine kinase inhibitors, can have a considerable impact on patients’ quality of life and medication adherence, making it a key therapeutic obstacle in maximising the efficacy of targeted cancer therapy. We describe a rare early-onset bullous type of PPE that developed within 15 days of starting cabozantinib in a 32-year-old woman with papillary renal cell carcinoma. The patient developed severe bullous and hyperpigmented acral lesions, which hampered everyday activities. The response followed a dosage-dependent pattern, with partial improvement and relapse after dose adjustment and full resolution after additional dose reduction and topical treatment. This case emphasises the need to identify unusual and early signs of PPE to provide prompt care while maintaining oncologic therapy.

IgA Vasculitis with Central Nervous System Involvement in a Child: A Case Report

KV Thiruppathi, Anusha Chelladurai, Shivaashankari Dharmalingam, O Mahalakshmi, Gowshika Krishnakumar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Henoch Schönlein Purpura (HSP), now termed IgA vasculitis, is a small vessel vasculitis classically characterised by palpable purpura, abdominal pain, arthralgia and renal involvement. Neurological manifestations such as seizures or encephalopathy are distinctly uncommon and may precede the appearance of palpable rash, leading to significant diagnostic confusion with acute Central Nervous System (CNS) infections. This report discusses a 13-year-old boy who presented with continuous fever, severe colicky abdominal pain, recurrent vomiting and multiple episodes of generalised tonic clonic seizures, in the absence of early purpura or altered sensorium. Antenatal, birth and developmental histories were unremarkable; however, family history was notable for seizure disorder in multiple paternal relatives. Clinical examination revealed fever, mild dehydration and diffuse abdominal tenderness, without focal neurological deficits or meningeal signs. Initial investigations showed neutrophilic leucocytosis, elevated inflammatory markers, abnormal electroencephalography and Magnetic Resonance Imaging (MRI) of the brain demonstrating focal cerebritis with micro haemorrhages. Cerebrospinal fluid analysis was not suggestive of bacterial meningitis. Urinalysis revealed microscopic haematuria with trace albuminuria. Despite broad-spectrum antimicrobial therapy, the child had persistent fever and abdominal symptoms. Subsequently, non-blanching palpable purpura developed over all extremities and the genital region, accompanied by transient hypertension. After exclusion of infectious, autoimmune and post-infectious inflammatory causes, skin biopsy demonstrated leucocytoclastic vasculitis, confirming IgA vasculitis. Initiation of corticosteroid therapy resulted in rapid resolution of fever, abdominal pain, seizures and rash. This case underscores the diagnostic challenges of CNS-predominant IgA vasculitis and emphasises the importance of recognising evolving dermatological signs, which may be delayed or masked by early steroid administration as a part of meningitis protocol potentially misleading towards alternative diagnosis.

A Case of Glutaric Aciduria Type I: An Unusual Cause of Macrocephaly and Developmental Delay

G Premalakshmi, Shanthi Ramesh, Jagdeep Ramesh Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Glutaric Aciduria Type I (GA-I) is a rare autosomal recessive neurometabolic disorder caused by deficiency of glutaryl-CoA dehydrogenase, leading to accumulation of glutaric acid and 3-hydroxyglutaric acid with subsequent neurotoxicity. A seven-month-old male infant presented with developmental regression, macrocephaly, and recurrent seizures since five months of age. Seizures were characterised by tonic posturing of all four limbs with upward deviation of eyes, followed by postictal drowsiness. Neuroimaging revealed widened Sylvian fissures with a characteristic “bat-wing” appearance, hypoplastic temporal lobes, basal ganglia involvement, and a left-sided subdural haematoma. Tandem mass spectrometry showed elevated glutaryl carnitine (C5-DC: 0.47 μmol/L), and genetic analysis identified a homozygous missense variant in the GCDH gene (c.769C>T; p.Arg257Trp), confirming the diagnosis. The child was managed with a lysine-restricted diet, L-carnitine, riboflavin, and antiepileptic therapy. The subdural haematoma was managed conservatively following neurosurgical consultation. This case highlights the importance of early recognition of GA-I in infants presenting with macrocephaly, developmental delay, and characteristic neuroimaging findings, as prompt diagnosis and metabolic therapy can prevent irreversible neurological injury and improve long-term outcomes.

Thoracic Segmental Spinal Anaesthesia for Colostomy in a Child with Severe Acute Malnourishment: A Case Report

S Sreya Sri, Jatin B Patel Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Thoracic Segmental Spinal Anaesthesia (TSSA) is an emerging regional technique that provides targeted neuraxial blockade, offering a compelling alternative to general anaesthesia in paediatric patients with significant co-morbidities. By injecting local anaesthetics at the thoracic level, clinicians can achieve precise sensory blockade of specific dermatomes while minimising haemodynamic fluctuations and avoiding the risks associated with airway manipulation and general anaesthetic neurotoxicity. The present case report describes the successful use of TSSA in a 1.5-year-old female weighing only 5 kg, presenting with a low-type Anorectal Malformation (ARM) and recto-vestibular fistula. The patient exhibited severe malnutrition (below the 3rd percentile), delayed developmental milestones, anaemia, and a history of recurrent respiratory infections. Preoperative ultrasound further revealed a solitary kidney. Given the patient’s compromised respiratory status and the potential impact of general anaesthesia on her already delayed neurodevelopment, a segmental spinal anaesthesia approach was selected for the planned colostomy. Under sedation with ketamine and midazolam, a 25 Gauge paediatric spinal needle was used to administer 0.5 mL of isobaric levobupivacaine with 0.5 mcg dexmedetomidine at the T12-L1 interspace. A sensory level of T6-L4 was achieved. The two-hour procedure remained haemodynamically stable with minimal blood loss. Postoperatively, the patient showed complete reversal of the blockade within one hour and was discharged following an uneventful two-week recovery. The current case highlights that TSSA as one of the effective anaesthetic strategy for high-risk, malnourished paediatric patient.

Dermal and Ophthalmological Manifestations of Goltz Syndrome in a Four-month-old Female Child: A Case Report

Ritika Singh, Prerna Rohilla, Kapil Bhalla Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Goltz syndrome, also known as Focal Dermal Hypoplasia (FDH), is a rare X-linked dominant genodermatosis characterised by multisystem involvement affecting the skin, skeletal system, eyes, and craniofacial structures. Mutations in the Porcupine O-acyltransferase (PORCN) gene are responsible for the multisystem involvement. The authors report a case of a four-month-old female who was brought with linear hypopigmented atrophic skin lesions, patchy alopecia, facial dysmorphism, and bilateral iris colobomas. She also had a partial cleft lip and palate. Radiological imaging revealed anterior rib notching and fused pelvic kidneys. Genetic testing confirmed a pathogenic variant in the PORCN gene (c.374-2del), hence, establishing the diagnosis of Goltz syndrome. The child was managed conservatively with topical medication and nutritional supplementation. A multidisciplinary approach was planned for long-term follow-up. The present case highlights the importance of early recognition of the characteristic cutaneous and extracutaneous features of Goltz syndrome, which often present in the neonatal or early infantile period, and can be further supported by genetic testing. Prompt diagnosis enables comprehensive care and improved quality of life through timely multidisciplinary interventions.

Choroid Plexus Carcinoma in Early Childhood: A Fatal Consequence in a Case Exhibiting Leptomeningeal Dissemination

Sneha Sukumar, Samarth Shukla, Sourya Acharya, Shailly Tiwari Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Choroid Plexus Carcinoma (CPC) is a rare, extremely aggressive childhood intraventricular malignancy which makes up less than 1% of paediatric brain neoplasms. It has the features of fast growth with high mitotic activity and a susceptibility for Cerebrospinal Fluid (CSF) spread. The prognosis is poor, despite the early recognition and early response. Hereby, the authors present a case of a two year and five month-old female child with progressive macrocephaly, left-sided weakness, dysphagia and loss of voice. Neuroimaging showed an intraventricular mass with leptomeningeal spread, provisionally diagnosed as choroid plexus neoplasm. An emergency craniotomy, tumour resection and External Ventricular Drain (EVD) placement were done. A friable, greyish, highly vascular mass was excised intraoperatively. Histopathology revealed crowded papillae merging into sheets, high cellularity, necrosis, nuclear pleomorphism and brisk mitotic activity. Immunohistochemistry showed cytokeratin and Ki-67 positivity with Glial Fibrillary Acidic Protein (GFAP) negativity and confirmed CPC (WHO Grade III). The child underwent extensive excision but had a rapidly progressive postoperative decline and died from the illness. This case highlights the aggressive nature of CPC in children, underlines the essential role of histopathology and immunohistochemistry in diagnosis and highlights the dismal prognosis even with an urgent surgical management. Documenting such cases contributes to the limited literature and underscores the need for improved treatment strategies.

Cannabis-associated Emerging Psychosis Presenting with Prominent Somatic Delusions and Koro-like Symptoms: A Case Report

Nisha Balaji, Suvarna Jyothi Kantipudi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Cannabis use is a recognised risk factor for psychotic disorders, particularly among young adults. We report a case of cannabis-associated psychosis in a 24-year-old man presenting with persistent somatic delusions and Koro-like symptoms. Despite normal neurological, ophthalmological, and urological evaluations, the patient developed a fixed belief of bodily “power” shifting sides, resulting in perceived genital shrinkage and significant distress. Mental state examination revealed somatic delusions without hallucinations or formal thought disorder. Treatment with risperidone and cognitive behavioural therapy led to symptom reduction and emerging insight. The uniqueness of this case lies in the predominance of culturally influenced somatic delusions resembling Koro in the context of cannabis associated psychosis, without more commonly reported psychotic symptoms such as hallucinations or persecutory delusions. This atypical phenomenology may complicate diagnosis and delay appropriate psychiatric intervention. Awareness of such unusual presentations is important for clinicians to ensure early psychiatric intervention.

Role of PRF in Surgical Management of Periapical Abscess in a Child: A Case Report

Alekhya Achanta, Rajesh Kumar Ragulakollu, Naga Supraja Atluri, S Monica Raj, Anusha Borra Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Dental trauma in adolescents frequently leads to pulpal necrosis and subsequent periapical abscess formation. Timely diagnosis and early intervention play a crucial role in tooth preservation and maxillofacial growth. This case report presents management of a 12-year-old child diagnosed with periapical abscess in mandibular anterior region, which developed secondary to dental trauma. Cone-Beam Computed Tomography (CBCT) aided in accurate diagnosis and assessment of lesion extent and cortical bone involvement. Non-surgical Root Canal Treatment (RCT) followed by surgical enucleation of the cystic lesion was done for affected teeth. Autologous Platelet Rich Fibrin (PRF) from patient’s blood was applied to the bony defect to enhance healing and regeneration. Six months’ follow-up revealed uneventful healing, resolution of symptoms, and radiographic evidence of bone regeneration. In conclusion, this case highlights the effectiveness of an integrated approach in managing periapical lesions in paediatric patients and improving clinical outcomes over time. PRF provides a scaffold that enhances healing and supports clinical outcomes.

Dental Manifestations in a Child with Atopic Dermatitis: A Case Report

Nagendran Jeyavel, Mallika Sampath Kumar, Indhu Deepika, Svedha Balaji, Sarika Kannan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Atopic Dermatitis (AD) is a chronic inflammatory disorder commonly affecting children and is characterised by immune dysregulation and epidermal barrier dysfunction. Although AD primarily involves the skin, it is increasingly recognised as a systemic disease, and long-term pharmacologic therapy may adversely influence oral health. This case report describes the dental findings and management of an 11-year-old female diagnosed with AD, who presented during the mixed dentition period with multiple retained deciduous teeth, dental caries, gingivitis, root stumps, and delayed eruption of permanent teeth. The patient also exhibited markedly elevated serum immunoglobulin E levels and was under regular dermatologic care. Comprehensive clinical and radiographic evaluation revealed extensive oral disease requiring multidisciplinary management. Dental treatment included oral prophylaxis, extraction of retained deciduous teeth and root stumps, restorative procedures, preventive strategies, and dietary counselling, all performed during a stable phase of the dermatologic condition. Follow-up visits demonstrated improvement in oral hygiene status and reduction in gingival inflammation. This case highlights the association between AD and increased susceptibility to oral diseases, possibly related to immune imbalance, xerostomia, and prolonged medication use. Early dental evaluation and co-ordinated medical-dental care are essential to reduce oral complications and improve quality of life in paediatric patients with AD.

Sebaceous Carcinoma of the Eyelid Masquerading as a Benign Lesion: A Rare Case Report

Ashish Sharma, Shashank Banait Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Sebaceous carcinoma, a rare and aggressive malignancy originating from sebaceous glands, is commonly observed in the Asian population and associated with syndromes like Muir-Torre syndrome and prior radiation therapy. Clinically, it often mimics benign conditions such as chalazion or blepharitis, thereby delaying diagnosis. This case report discusses an 80-year-old male presenting with progressively enlarging masses on the upper and lower left eyelids. Magnetic Resonance Imaging (MRI) suggested neoplastic aetiology, and surgical excision confirmed sebaceous carcinoma through histopathology and immunohistochemistry, with strong positivity for Cytokeratin 7 (CK7) and Epithelial Membrane Antigen (EMA). Histological examination revealed malignant epithelial cells arranged in islands & ribbons, with basaloid cells, squamous epithelial pearl formation, and comedonecrosis. These findings highlighted the tumour’s aggressive nature and the need for comprehensive management. Postoperative recovery was uneventful, but follow-up was emphasised due to high recurrence risk.

Navigating the Diagnostic Pitfalls of Myoid Hamartoma: A Case Report

MG Viha Vaishalee, Priyathersini Nagarajan, Sandhya Sundaram Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Breast is the site for many benign and malignant conditions. Beside the common diseases of the breast, some of the rare conditions of the breast can present with overlapping clinical and radiological features posing a diagnostic challenge. Breast hamartomas are benign lesions with varying clinical, radiological and histological features. They are generally asymptomatic, but sometimes can grow into large sizes causing asymmetry of the breast. Clinical features may also vary depending upon the size and duration of the lesion. This case report details a rare case of Myoid hamartoma of the breast in a 55-year-old woman presenting with a painless gradually progressive breast lump for seven years. Initial clinical evaluation and imaging studies suggested the diagnosis of Phyllodes tumour. Histopathological and immunohistochemistry examination of the excised lesion helped in establishing the definitive diagnosis of myoid hamartoma. Due to the rarity of this lesion, diagnosis can be delayed due to its overlapping features with other lesions of the breast. Excision of the lesion is considered curative and histopathological examination can prevent misdiagnosis and over treatment. Thus, this case underscores the diagnostic challenge posed by lesions that exhibit suspicious radiological features but benign pathological origins. Documenting this case reinforces the necessity of multidisciplinary approach in diagnosing rare entities.

Nasal Cavernous Haemangioma Mimicking Mucormycosis: A Rare Case Scenario

Pragati Shikha, Sagar Gaurkar, Prasad Deshmukh, Megha Kawale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Haemangiomas are benign vascular tumours that arise from abnormal proliferation of the cells lining blood vessels, leading to localised growths filled with blood. Microscopically, haemangiomas are usually categorised into three types: capillary, cavernous, and mixed. While haemangiomas commonly occur in the head and neck region, their presence in the nasal cavity is quite rare. When nasal haemangiomas do occur, they are usually of the capillary type, found on the nasal septum, and most often seen in children and females. A 77-year-old male patient presented to Department of Otorhinolaryngology with complaints of right-sided obstruction and nasal discharge since one month. The initial endoscopic and radiological investigation were suggestive of mucormycosis. The patient underwent Functional Endoscopic Sinus Surgery (FESS) and the necrotic nasal mucosa was sent for histopathological examination which was suggestive of cavernous haemangioma. This case underscores the importance of considering vascular tumours like cavernous haemangioma in the differential diagnosis of nasal masses, and how imaging combined with histopathology is essential for accurate diagnosis and appropriate treatment.

Surgical Resection of Proximal Jejunal Adenocarcinoma: A Rare Case Report

SB Vasanthbalan, S Rajendran, SR Gargi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Adenocarcinoma of the small intestine is a rare gastrointestinal malignancy (proximal jejunum). In India, its incidence is reported to be extremely rare, with lymphomas occurring as the commonest type of malignancy. Diagnostic challenges arise due to the vague, non-specific symptoms, thereby affecting treatment outcomes. Surgical resection remains the mainstay of treatment. Hereby, the authors report the case of a 71-year-old male who presented with continuous vomiting for one week. There was no history of haematemesis, haematochezia, haematuria, palpitations, or breathlessness. He had no known co-morbidities. Abdominal examination revealed a vague mass in the left hypochondrium with minimal tenderness. Laboratory investigations showed anaemia. Upper gastrointestinal endoscopy revealed a growth in distal duodenum (D3-D4) suggestive of proximal jejunal lesion. A Positron Emission Tomography and Computed Tomography (PET-CT) scan was performed to evaluate extent and staging, showing a metabolically active circumferential irregular asymmetrical endophytic ulcero-proliferative thickening involving the distal part of the duodenum and Duodenojejunal (DJ) junction/proximal jejunum with luminal narrowing. Contrast-Enhanced CT (CECT) confirmed a distal duodenal mass at the (D3-D4) DJ junction/proximal jejunum. Endoscopic biopsy was taken and histopathogical examination confirmed the type of tumour as adenocarcinoma. The patient underwent radical segmental resection of the proximal jejunum with side-to-side duodenojejunostomy at the D2 level under general anaesthesia. The histological type was adenocarcinoma grade G1 (well-differentiated). After an initial stay in the Intensive Care Unit (ICU) for observation the postoperative period was uneventful and patient is shifted to ward. He was discharged on postoperative day 10 in stable condition, tolerating a soft diet with a healthy surgical wound. The patient is on one year follow-up with adjuvant chemotherapy course for six months Folinic acid, Fluorouracil, Oxaliplatin (FOLFOX).

Clinical Spectrum of Tetralogy of Fallot with Right Ventricular Outflow Tract Variants from Infancy to Adulthood: A Case Series

Ragavendra Chanthanamuthu, Aishwarya Ramanathan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Tetralogy of Fallot (TOF) with Right Ventricular Outflow Tract (RVOT) variants, such as TOF with pulmonary atresia (10-15% of TOF cases) and TOF with Absent Pulmonary Valve (APV) (3-6% of TOF cases), presents diverse clinical features and management challenges across age groups. The present case series describes a seven-month-old male infant with TOF and APV featuring respiratory distress, a 14-year-old male adolescent with unoperated TOF and pulmonary atresia showing progressive cyanosis, and a 31-year-old female adult with TOF, pulmonary atresia post-bilateral Blalock-Taussig (BT) shunts experiencing exertional dyspnoea. These cases highlight age-specific presentations, diagnostic findings, and tailored management strategies. Early diagnosis, lesion-specific palliation or repair, and lifelong surveillance are essential to reduce long-term complications such as Right Ventricular (RV) dysfunction and arrhythmias, particularly in resource-limited settings.

Unmasking Hidden Vascular Threats through the Eye: A Case Series of Carotico-Cavernous Fistulas and Orbital Arteriovenous Malformations

Shivanand C Bubanale, Shubhra Bhargava, Navin Mulimani, Bhagyajyothi Khanagavi, Nivedita S Nanda Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Carotico-Cavernous Fistula (CCF) and orbital Arteriovenous Malformation (AVM) are rare but vision-threatening vascular disorders that often present initially with ocular signs. Early recognition by ophthalmologists is critical to prevent irreversible visual morbidity. This case series describes the clinical spectrum, imaging features, and outcomes of four patients with orbital vascular anomalies presenting primarily with ophthalmic manifestations. All patients presented with varying combinations of proptosis, conjunctival congestion, chemosis, diplopia, headache, and a history of trauma. Comprehensive ophthalmic evaluation was supplemented with contrast-enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), followed by Digital Subtraction Angiography (DSA) for definitive diagnosis and classification. Three patients were diagnosed with traumatic CCFs, including one direct high-flow and two indirect low-flow variants, while one patient had a rare high-flow infraorbital AVM with orbital extension. DSA played a pivotal role in delineating angioarchitecture and guiding management. All CCF cases were successfully treated with endovascular embolisation, resulting in rapid improvement of proptosis, resolution of conjunctival congestion, and symptomatic relief. The AVM case required a combined approach of embolisation followed by surgical excision, achieving complete resolution without recurrence. This case series uniquely highlights how subtle ophthalmic signs can be the first indicators of serious intracranial vascular pathology. Early ophthalmic suspicion, timely imaging, and multidisciplinary intervention are essential for optimal visual and anatomical outcomes.

Xeroderma Pigmentosum with Multiple Cutaneous Malignancies: A Series of Four Cases

Upasana Das, Kananbala Sahu, Smrutirekha Behera Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Xeroderma Pigmentosum (XP) is an autosomal recessive disease. The pathogenesis lies in the Nucleotide Excision Repair (NER) genetic defect leading to various cutaneous and other malignancies developing at a very young age alarming the identification of precursor lesions and to adapt preventive measures. The DNA damage that occurs in exposure to UV rays in sunlight, gets repaired by a set of XP genes. The function of each gene works in a coordinated manner and the defective nucleotide gets excised from the DNA strand and a correct base pair is inserted. But in XP, the DNA repair mechanism defect leads to clinical manifestations involving the skin, eye and central nervous system. Here we report four cases of XP patients, out of them, two were siblings with a history of consanguineous marriage of their parents. All the patients were highly sensitive to sunlight and developed freckles, hyper and hypopigmentation, dryness, atrophy and even cutaneous malignancies. Ophthalmological examination revealed corneal dryness, scarring and partial blindness in two cases. Neurological examination revealed suboptimal intelligence and disturbed gait in two cases. The clinical diagnosis of XP was established and biopsy from the skin lesions revealed pyogenic granuloma, squamous cell carcinoma and basal cell carcinoma. Unfortunately, XP has no cure. But with rigorous sun protection, preventive measures and regular follow-up, they have not developed any new malignancies. As these paediatric patients are prone to develop malignancy with sun exposure, avoidance of UV light exposure is the preventive measure and children are encouraged to attend evening schools. Early identification of the disease and precancerous lesions may decrease the morbidity of XP patients.

Panhypopituitarism following Haemotoxic Snake Envenomation: A Case Series Emphasising Early Diagnosis

Umakanta Mahapatra, Rahin Mahata, Krishnendu Roy, J Fedric Winston, Soumik Das Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Snake envenomation remains a significant health problem in tropical regions. Haemotoxic snake bite commonly causes Acute Kidney Injury (AKI) and coagulopathy; however, panhypopituitarism is rare and frequently overlooked. Delayed diagnosis may result in serious morbidity due to unrecognised adrenal/thyroid insufficiency. This case series describes the clinical presentation, hormonal profile, radiological findings, and outcomes of four patients who developed panhypopituitarism following haemotoxic snake envenomation, highlighting the importance of early diagnosis. Patients presented within weeks to months after the snake bite with features such as fatigue, hypotension, hyponatraemia, and hypoglycaemia. Hormonal evaluation revealed secondary adrenal insufficiency and central hypothyroidism in all cases, with associated secondary hypogonadism in some patients. Magnetic Resonance Imaging (MRI) of the pituitary demonstrated features consistent with empty sella syndrome. All patients received appropriate hormone replacement therapy, resulting in significant clinical and biochemical improvements. A high index of suspicion is required, and early endocrine evaluation should be carried out in patients with persistent or unexplained symptoms following envenomation. Timely diagnosis and hormone replacement therapy can lead to favourable outcomes.

Emerging Role of Myroides odoratimimus in Catheter-associated Urinary Tract Infection: A Case Series of Nine Patients from a Tertiary Care Centre

Merlyn Blessy Jebamani, Sanjana Priyadarshini, Tessa Antony, Priyadarshini Urjan Mohan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Catheter-Associated Urinary Tract Infections (CAUTI) is one of the most common healthcare-associated infections and contribute to increased morbidity and prolonged hospital stay. Although Enterobacterales predominate, Myroides species are emerging opportunistic pathogens causing CAUTI with intrinsic multidrug resistance, posing diagnostic and therapeutic challenges. These bacteria are not commonly found in the normal human flora, but are known to cause infections, when introduced via contaminated water or medical equipment in hospital settings. In the current case series nine cases of CAUTI caused by Myroides odoratimimus were identified in a tertiary care centre. The patients were in the age group between 36 and 77 years and had indwelling urinary catheters for more than 10 days duration and Diabetes Mellitus (DM) as a major risk factor. All patients had a diagnosis of CAUTI based on catheter, symptom and culture criteria. Symptoms like fever more than 38°C could be non specific for urinary tract infection, and due to this, it is difficult to differentiate between true infection and colonisation. Identification was performed using Matrix-Assisted Laser Desorption Ionisation-Time Of Flight Mass Spectrometry (MALDI-TOFMS) and conventional methods. Antimicrobial susceptibility was performed using (VITEK® 2 Compact™, BioMérieux, France). The interpretation for antibiotic susceptibility was based on Minimum Inhibitory Concentration (MIC) breakpoints recommended for other non enterobacterales according to Clinical and Laboratory Standards Institute (CLSI) M100 -35^th edition. All the isolates were found to be resistant to multiple antibiotic classes, with consistent susceptibility to minocycline. Targeted therapy resulted in clinical recovery and wellbeing in seven patients, while one patient was discharged against medical advice and lost to follow-up, and one patient succumbed to severe underlying illness.

Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery in Ovarian Cancer Patients: A Series of Five Cases

Bodhisattva Bose, Pratik Solanki, Arijit Mukherjee, Rajkumar Kottayasamy Seenivasagam Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Ovarian cancer is a leading cause of gynaecological cancer related-death in Indian women. Majority of ovarian cancer patients present in advanced stage with peritoneal disease, which poses a significant major challenge in the clinical management. The role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cytoreductive Surgery (CRS) in ovarian cancer with peritoneal disease has evolved over the last decade as a promising modality with potential advantages. HIPEC after CRS is relatively new treatment modality for these patients with advanced or recurrent disease in ovarian cancer. Authors are sharing their experience of five ovarian cancer patients managed with HIPEC and CRS in a single institute. Five patients diagnosed with ovarian cancer underwent HIPEC following CRS in standardised manner from April 2021 to May 2022 after proper evaluation and consent. Interval cytoreduction in three and secondary cytoreduction in two patients with Platinum sensitive recurrence were performed. All the patients were followed in immediate postoperative period and for 12 months after surgery. Complete cytoreduction was achieved in all patients. A 30-day morbidity was grade I and II. One patient who underwent splenectomy as a part of cytoreduction succumbed to death in postoperative period due to septic shock. One patient developed locoregional recurrence during the follow-up period after six months. Rest of the three patients were disease free during 12 months of follow-up. HIPEC is a promising method along with CRS in advanced ovarian cancer with peritoneal disease and selected patients with recurrent disease.

Cribriform Morular Thyroid Carcinoma, Elusive Malignancy with Difficult Diagnosis: A Case Series of Five Cases

Anila Kunjulekshmyamma Raveendran Nair, Aruna Vijayakumar, Preethi Thattaruparambil Ramadas, Sreekumar Ananthakrishna, Elizabeth Mathew Iype Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Cribriform-Morular Thyroid Carcinoma (CMTC) are very rare thyroid carcinoma and has been recently renamed in the 2022 WHO classification as a thyroid tumour of uncertain histogenesis. Preoperative diagnosis of CMTC is challenging due to overlapping cytomorphological features, between Papillary Thyroid Carcinoma (PTC) and cribriform thyroid carcinoma. Authors analysed clinicopathological and Immunohistochemical (IHC) features of five cases of CMTC diagnosed at our centre. Clinical characteristics, treatment received, and follow up data were obtained from electronic medical records. Haematoxylin and Eosin (H&E) stained slides and Immunohistochemistry (IHC) slides were reviewed, histomorphological and IHC profile of all the cases were analysed. The salient histomorphological features noted were cribriform pattern, tall cell areas, solid growth with squamoidmorules, absent/scant colloid and rare psammoma bodies. All the five cases consistently expressed beta-catenin. TTF1 was positive in all cases, with negative staining in squamoid areas. Diagnosis of CMTC warrants initiation of genetic screening for APC mutation.

Synovial Haemangioma of the Paediatric Knee: A Case Series

Aditya Sharma, KV Arun Kumar, Pradeep Elangovan, Sree Shangamithra, Sayan Khan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Synovial haemangioma is a rare benign vascular lesion arising from synovial tissue, accounting for approximately 0.07% of all soft-tissue tumours and 0.78% of resected haemangiomas. Because of its low prevalence, the diagnosis is frequently delayed or missed. The condition causes chronic or recurrent knee effusion and pain without a preceding history of trauma; if left untreated, it can progress to chondral damage. Magnetic Resonance Imaging (MRI) is the preferred investigation and guides surgical planning. Three paediatric patients- a six-year-old boy, a four-year-old boy and a 12-year-old girl presented between December 2021 and June 2025 with atraumatic knee pain and swelling of 8 to 18 months’ duration. All three demonstrated lobulated intra-articular lesions on MRI that were hypointense on T1 and hyperintense on T2 and Computed Tomography (CT) angiography confirmed multiple dilated vascular channels in each case. Open en-bloc excision with total synovectomy was performed; histopathology confirmed synovial haemangioma in all cases. At six months, follow-up MRI showed no residual tumour and Visual Analogue Scale (VAS) scores had fallen to one in every patient. Synovial haemangioma should be considered in any child presenting with atraumatic, chronic knee pain and swelling. Early MRI, followed by en-bloc excision with synovectomy, is the treatment of choice and yields excellent short-term outcomes with low recurrence.

Facial Aberrant Reinnervation Syndrome (FARS) Causing Synkinetic Dystonia of Platysma

Sourya Acharya, Amol Andhale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Facial Aberrant Reinnervation Syndrome (FARS) is a sequela of facial nerve injury. The clinical presentations are varied in form of facial synkinesis, facial muscle hypertonicity, and facial muscle spasm/twitching, which occur following facial nerve injury and recovery. Facial synkinesis is a symptom that manifests as pathologic contraction and baseline hypertonicity of muscles innervated by the facial nerve because of FARS.

Unwrapping the Lysosomal Dysfunction: Clinical Imaging of Hurler’s Multisystem Impact

Namrata Sant, Shreya Tonpe, Bushra Shaikh, Naila Syyada Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Hurler's syndrome is a rare lysosomal storage disorder caused by deficiency of lysosomal enzyme α-iduronidase. It follows an autosomal recessive pattern of inheritance, leading to progressive accumulation of Glycosaminoglycans (GAGs) within lysosomes, resulting in cellular damage and multiorgan dysfunction (1). Individuals with mucopolysaccharidosis type I (MPS-I Hurler syndrome) cannot degrade GAGs such as dermatan and heparan sulphate, important components of extracellular matrix and cartilaginous tissues including heart valves and joints. Estimated global prevalence of Hurler syndrome is 1 in 100,000 live births usually in early childhood [2,3]. It is characterised by progressive multisystem involvement causing skeletal deformities, dental irregularities, coarse facial features, organ enlargement, and cardiovascular complications [4,5].

IgG4 Related Disease Presenting as a Lung Mass: Imaging Findings

Sangavi Jeyaraj, Yuvashree Suresh, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X A 60-year-old male patient presented with complaints of left upper limb weakness and sensory loss, mild left lower limb weakness for five days, accompanied by difficulty in passing urine for three days. He was previously admitted to another institute for similar complaints, where he was diagnosed to have D2-D3 spinal extradural lesion with cord compression, for which he underwent D2-D3 laminectomy with excision of the lesion. At that time the patient recovered well and the histopathology report showed evidence of IgG4 related disease. The patient’s general condition was fair and vitals were normal with blood pressure of 110/70 mmHg and pulse rate of 85 beats per minute in present admission. Neurological examination revealed significant motor weakness (power 3/5) and mild sensory deficits in the left upper limb. There was also mild weakness in bilateral lower limbs on examination (power 4/5). Laboratory investigations revealed anaemia (haemoglobin: 10.8 g/dL; reference range for males: 13-17 g/dL) and a markedly elevated C-reactive protein level (>130 mg/L; reference value: <10 mg/L), suggesting an active inflammatory process. He was subjected to a chest X-ray, plain CT of the thorax, and contrast-enhanced MRI of the dorsal spine. Chest X-ray showed an ill-defined radio-opaque mass in the left upper zone (Table/Fig 1a). Plain CT chest showed subtle cortical erosion involving the posterior aspect of the left first rib (Table/Fig 1b). Plain and contrast-enhanced MRI of the dorsal spine revealed a T2 hypointense thickening of the dura of the spinal cord from C7 to D2 vertebral bodies. There was associated extradural intense enhancing soft tissue at that level, extending into bilateral D1-D2 neural foramina [Table/Fig-2a-c]. The mass on the left-side was extending to involve the upper lobe of the left lung with formation of a relatively well-defined mass measuring 5.7×4.8 cm in the left upper lobe with contrast enhancement [Table/Fig-3a,b]. CT guided biopsy from the left upper lobe lung mass was done, and specimen was sent for Histopathological Examination (HPE). Histopathology of the lung biopsy specimen from the left upper lobe confirmed interstitial lung disease characterised by plasma cell-rich inflammation, fibrosis, and obliterative vasculitis, which were consistent with IgG4-related lung disease. Serum IgG4 levels were elevated at 189 mg/dL (reference range: <135-140 mg/dL). The patient was treated with intravenous methylprednisolone 1 g once daily for five days, resulting in symptomatic improvement, and was subsequently discharged. Presently, the patient has partially recovered and can do his day-to-day activities.

Temporal Limbal Dermoid in a Six-year-old Child with Induced Astigmatism: Images in Medicine

Mohammed Arif Kaderi, Sachin Vishwanath Daigavane Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X A six-year-old boy presented to the Outpatient Department of Ophthalmology with the chief complaint of growth of a white, hairy mass in the right eye since birth, which had gradually increased in size over time. The parents sought medical advice when the lesion enlarged and the child began experiencing foreign body like sensation. He was born full-term with normal developmental milestones.

Physiotherapy-based Interventions in the Management of Migraine Headache: A Systematic Review

Shweta Jain, Amita Aggarwal Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Migraine headache is a worldwide disabling problem commonly associated with neck pain and other symptoms, having a significant negative influence on people’s quality of life and productivity. Medicines remain a mainstay for the management, but non pharmacological management, including Physiotherapy interventions, is recommended as an alternative treatment option to reduce migraine headaches. The present review presents an updated appraisal on the effectiveness of various Physiotherapy interventions in alleviating headache parameters, as well as what is supported by available scientific literature about physiotherapies for migraine headaches and the gaps that may still exist in our understanding of these interventions. Aim: To provide a thorough overview of variety of physiotherapy treatments available for the management of Migraine headache. Materials and Methods: The present review was conducted in Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India. For the present review, PubMed, Embase and the Cochrane was searched for Randomised Controlled Trials (RCTs) that performed physiotherapy interventions for treating migraine headaches, pub-lished between January 2015 and August 2025, with Physiotherapy Evidence Database (PEDro) Scale score 6 or higher. Results: A total 792 studies were identified in the database over the past 10 years, then based on the inclusion/exclusion criteria, 12 publications selected for study. Pooled analyses found various Physiotherapy interventions effective in reducing headache parameters, but still, the literature found no standardised physiotherapy protocol to manage migraine headache. Conclusion: The management of migraine especially that associated with neck pain should include physiotherapy and may also benefit from relaxation training, manual therapy and multimodal care; however, the evaluated RCTs employed a variety of methodologies. Therefore, any conclusion requires future, well-structured RCTs on physiotherapy for migraine.

Prevalence, Determinants, Clinical Manifestations and Management Strategies of Dentophobia in the Western Region of Saudi Arabia: A Cross-sectional Study

Rayan B Yaghmoor, Mohammed I Alsaif, Hassan H Alwafi, Nashwa S Alqurashi, Asaiyl M Alkhuzai, Wael E Yaghmoor Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Dental Fear and Anxiety (DFA) are major obstacles in receiving proper dental care around the world, often causing people to avoid treatment and resulting in poor oral health. Dentophobia is a severe form of this condition and involves an intense and irrational fear that is triggered by dental procedures. However, there is still limited region-specific information about the factors that influence dentophobia and how it is best managed. Aim: To determine the prevalence of dentophobia and its associated clinical manifestations in the Western Region of Saudi Arabia. Materials and Methods: The present study was a cross-sectional study conducted at the Dental Teaching Hospital at Umm Al-Qura University in Makkah in the Western Region of Saudi Arabia between May 2024 and September 2024. An online questionnaire was distributed through social media platforms using a convenience sampling approach. A total of 483 qualified adult participants were included. It was analysed through descriptive statistics and binary logistic regression. A p-value of <0.05 was considered statistically significant. Results: The prevalence of dentophobia was 321(66.5%). Sound of dental drills 117 (24.2%) and previous painful experiences 102(21.1%) were the most frequent triggers. Individuals who had a bachelor degree were much more likely to be dentophobic (Odds Ratio (OR)=1.80, p=0.009). Good past dental experiences had high levels of protection (OR=0.13, p<0.001). Fear of dental treatment was identified to be the cause of avoidance in 151(31.3%) of the participants, whose fear towards invasive procedures (local anaesthetic injection, drilling, and extraction) was the greatest. Conclusion: Dentophobia is very common in the Western Region of Saudi Arabia. To mitigate fear and enhance dental attendance and oral health outcomes, positive dental experiences and dentist-patient communication, as well as behavioural techniques, are required.

Prevalence of Faecoliths Across Histopathological Presentations of Appendicitis: A Retrospective Cross-sectional Study

Mohammad Bukhetan Alharbi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The surgical management of appendicitis can be challenging because of its di-verse clinical manifestations and high incidence of undesirable consequences. However, further studies are warranted to elucidate the role of faecoliths in the pathophysiology of appendicitis in its different presentations. Aim: To investigate the prevalence of faecoliths in various pathological presentations of appendicitis identified in pathology specimens. Materials and Methods: A retrospective cross-sectional study was conducted on hospitalised patients with acute appendicitis in the Hail Health Cluster in Hail City, Saudi Arabia, from 1st January 2000 to 30th December 2020. The study was analysed between March 2024 and April 2024. The pathology re-ports of 955 individuals were examined to determine the prevalence of faecoliths in appendix specimens. The demographic distribution was analysed using descriptive statistics. The association among variables were evaluated, with faecolith status as the dependent variable and age group, gender, and appendicitis status as factors. All analyses were conducted using Statistical package for Social Sciences (SPSS) version 20.0. Interpretations were conducted at a 95% confidence level. Results: Of the 955 specimens, 709 were from males and 246 were from females. A total of 38 (3.98%) patients had faecoliths, with the prevalence of faecoliths in males being 26/709 (3.67%), and in females, it was 12/246 (4.88%). The peak prevalence of faecoliths occurred in the age group of 50-59 years (11.76%). Conversely, the lowest percentage was observed in the age group of 20-29 years (2.70%). The status of the patients with appendicitis, either with or without faecoliths, indicated that 374 (39.16%) had acute appendicitis, 297 (31.09%) had acute suppurative appendicitis, and 108 (11.31%) had gangrenous perforated appendicitis, 80 (8.38%) had other pathologies, 40 (4.19%) had acute on chronic appendicitis, 37 (3.87%) exhibited chronic appendicitis, and 9 (0.94%) had recurrent acute appendicitis. Additionally, 10 (1.05%) individuals had normal appendices. Conclusion: Faecoliths were observed across multiple histopathological presentations of appendicitis, but no substantial association with gender or age. Therefore, it may be necessary to reconsider the notion that faecoliths induce appendicitis by obstructing the appendiceal lumen, as this may not be universally present.

A Comparative Evaluation of Beta Vulgaris and Zingiber officinale Staining with Conventional Haematoxylin and Eosin: An Experimental Study

Sangeetha Ramu, Inchara Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Exfoliative cytological staining is a fundamental technique in pathology, providing contrast to cellular components for microscopic examination. Haematoxylin and Eosin (H&E) stain is the gold standard in cytopathology; however, concerns about the health and environmental hazards of synthetic stains necessitate the exploration of natural alternatives. Beetroot (Beta vulgaris)and ginger (Zingiber officinale) possess natural staining properties, potentially serving as substitutes for haematoxylin and eosin, respectively. Aim: To evaluate the staining efficacy of beetroot (Beta vulgaris) and ginger (Zingiber officinale) extracts as alternatives to conventional H&E staining in exfoliative cytology smears from oral white lesions. Materials and Methods: The present experimental study was conducted on exfoliative buccal smears obtained from patients with oral white lesions at the Department of Oral Medicine and Oral Pathology, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India.The study duration was from February 2023 to October 2023, with a total sample size of 80 buccal smears from patients aged 18-60 years with clinically diagnosed oral white lesions (n=20 per group). Group 1 (Control) received conventional H&E staining, Group 2 received beetroot extract and eosin, Group 3 received ginger extract and haematoxylin, and Group 4 received beetroot and ginger extracts with vinegar mordant. Staining quality was scored (0-2 scale) by a calibrated pathologist for presence/absence of staining, nuclear staining intensity, cytoplasmic staining intensity, and clarity/crispness. Data were analysed using Statistical Package for the Social Sciences (SPSS) Software version 26.0. Chi-square test was used for Intergroup comparisons (p<0.05 considered significant). Results: Presence of staining was observed in 20/20 (100%) of smears (Group 1), 17/20 (85%) (Group 2), 17/20 (85%) (Group 3), and 15/20 (75%) (Group 4) (p=0.136). Strong nuclear staining was observed in 18/20 (90%) (Group 1), 14/20 (70%) (Group 2), 17/20 (85%) (Group 3), and 13/20 (65%) (Group 4) (p=0.413). Strong cytoplasmic staining occurred in 16/20 (80%) each for Groups 1-3 and 15/20 (75%) (Group 4) (p=0.990). Clarity and crispness were present in 18/20 (90%) (Group 1), 17/20 (85%) (Group 2), 16/20 (80%) (Group 3), and 16/20 (80%) (Group 4) (p=0.799). All Intergroup differences were statistically non significant (p>0.05). Conclusion: Beetroot and ginger extracts provide staining efficacy comparable to conventional H&E across all parameters, offering biosafe, cost-effective, and ecofriendly alternatives for exfoliative cytology applications.

Clinicoradiological, Histopathological and Immunohistochemical Features of Solid Pseudopapillary Neoplasms of Pancreas: A Cross-sectional Study

Mary Diana Vincent, Renu Sukumaran, Anitha Mathews, T Priyakumari, Madhu Muralee, M Venugopal, Aleyamma Mathew Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Solid Pseudopapillary Neoplasm (SPN) of the pancreas is a low-grade malignant tumour generally associated with good prognosis. This neoplasm usually shows characteristic morphologic features, but sometimes the differential diagnosis with other pancreatic neoplasms including well-differentiated Neuroendocrine Tumours (NET) and acinar cell carcinomas can be challenging, especially in cytology and biopsy specimens. In these cases, immunohistochemistry (IHC) is critical for accurate diag-nosis. Given the diagnostic overlap with other pancreatic tumours and the limited clinicopathological and immunohistochemical data from the Indian population, a comprehensive evaluation of SPN is essential to facilitate accurate diagnosis and appropriate patient management. Aim: To analyse the clinicopathological, radiological and immunohistochemical features of SPN of pancreas. Materials and Methods: The present cross-sectional study included all cases diagnosed and reported as SPN from 1 August 2014 to 31 July 2024. Data retrieval and analysis were performed from Oc-tober 2022 to June 2025 in the Department of Pathology, Regional cancer centre (RCC), Thiruvananthapu-ram, Kerala, India were included. Demographic details, clinical presentation, radiological findings, gross features, histomorphology, and immunohistochemical profiles were retrieved and analysed after the study was approved by the Institutional Ethics Committee. Haematoxylin and Eosin (H&E)- stained sections were reviewed in detail to assess histomorphological features. The IHC for cytokeratin, β-catenin, CD10, vimentin, Progesterone Receptor (PR), synaptophysin, and chromogranin was evaluated. Descriptive statistical analysis was performed, and data were expressed as frequencies, percentages, mean, and range. Results: A total of 24 cases were identified, with 21 (87.5%) females and a female-to-male ra-tio of 7:1; the mean age was 30 years (range: 9-58 years). Abdominal pain was the most common presenting symptom in 18 (75%) cases, and the pancreatic body-tail was the most frequent tumour location in 14 (58.33%) cases. Tumour size ranged from 2.5 to 17 cm (mean: 7.5 cm), with tumours confined to the pan-creas in 22 (91.66%) cases and metastasis in 2 (8.33%) cases. Histologically, all cases (100%) showed solid and pseudopapillary patterns. IHC revealed diffuse expression of CD10 in 95.24% (20/21), PR in 94.73% (18/19), vimentin in 100% (10/10), nuclear β-catenin in 92.85% (13/14), synaptophysin in 86.66% (13/15), and paranuclear dot-like CD99 in 100% (6/6) of cases tested. Follow-up information retrieved from records was available for 20 (83.33%; 20/24) patients, of whom 17 (85%; 17/20) were alive at last recorded contact. Conclusion: The SPN predominantly affects young females and typically arises in the pancreatic body-tail. Despite its low-grade behaviour, a minority of cases may exhibit aggressive features, includ-ing local invasion and metastasis. A combination of histomorphology and a characteristic IHC profile is essential for accurate diagnosis and distinction from histologic mimics.

Morbidity Patterns and Job Satisfaction among ASHAs: A Community-based Cross-sectional Study

Vinutha M Dsouza Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: In India Accredited Social Health Activists (ASHAs) play a vital role in connecting the public health system and the community. They are crucial for providing maternal and child health services, raising health awareness and easing access to healthcare at the local level. Despite their critical responsibilities, ASHAs often work under challenging conditions, including limited incentives, demanding workload and constrained resources, which influence both their health status and job satisfaction. Understanding morbidity patterns and satisfaction levels among them is therefore important for improving their well-being and strengthening community health services. Aim: To assess morbidity patterns and domain-wise job satisfaction among ASHAs. Materials and Methods: A community-based cross-sectional study was conducted among 150 ASHAs in Dakshina Kannada district, Karnataka, India, from October 2025 to November 2025, among 150 ASHAs. Data on sociodemographic characteristics, chronic health conditions (hypertension, diabetes and anaemia) and satisfaction across nine job domains (communication, nature of work, co-workers, pay, promotion, supervision, fringe benefits, contingent rewards and operating conditions) were collected using the Job Satisfaction Scale. Descriptive statistics were used to summarise the findings. Results: Among the participants, 21 (14%) were hypertensive, 13 (9%) had diabetes and 15 (10%) were anaemic. Most ASHAs (76.7%) reported a moderate satisfaction towards the work, while 23.3% expressed satisfaction. Domain-wise analysis showed moderate satisfaction with pay (62.52%) and promotion opportunities (55.7%), high satisfaction with supervision (78.65%) and moderate satisfaction with fringe benefits (55.5%) and contingent rewards (65.68%). The lowest satisfaction was observed in operating conditions (63%). These findings suggest that although ASHAs generally perceive supervisory support positively, remuneration and work environment remain important challenges that affect their performance. Conclusion: Job satisfaction among ASHAs is influenced by both personal health and work-related factors. Addressing chronic health conditions, improving incentives, enhancing supervisory support and strengthening operating conditions may increase satisfaction, enhance motivation and sustain the effectiveness of ASHAs in delivering community health services.

Effect of Nalbuphine as an Adjuvant to 0.5% Levobupivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Surgery: A Randomised Controlled Study

Abhinav Gupta, Shaista Jamil, Poonam Singh, Harsh Vardhan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Ultrasound-guided supraclavicular brachial plexus block is a preferred regional anaesthesia technique for upper limb surgeries due to its rapid onset and high efficacy. Levobupivacaine is widely used for its prolonged action and reduced cardiotoxicity. Nalbuphine, a mixed opioid agonist-antagonist, has emerged as a promising adjuvant with potential to enhance the analgesic effects of local anaesthetics without increasing opioid-related side-effects. Aim: To evaluate the clinical efficacy of nalbuphine as an adjuvant to 0.5% levobupivacaine in ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: This randomised, double-blind controlled trial was conducted in the Department of Anaesthesiology, Sharda School of Medical Sciences and Research (SSMS&R), Sharda University, Greater Noida, Uttar Pradesh, India, over 18 months from May 2023 to November 2024. It includes 90 American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective upper limb surgeries were divided into two groups (n=45). Group N received 20 mL of 0.5% levobupivacaine with 10 mg nalbuphine; Group S received 20 mL of 0.5% levobupivacaine with saline. Ultrasound-guided supraclavicular brachial plexus block was administered, and duration of analgesia, onset, duration of sensory and motor block, VAS scores, haemodynamic parameters and complications were recorded over 24 hours. Statistical analyses such as Student’s t-test, Chi-square test and Mann-Whitney U test were used. Results: Group N had significantly longer duration of analgesia (725.16±29.42 vs. 550.73±20.30 min), faster onset of sensory (6.93±0.94 min) and motor (11.40±1.48 min) block than group S (9.42±0.72 min and 15.29±1.85 min respectively; p<0.0001). Duration of sensory and motor block was prolonged in group N (602.58±18.93 min and 525.56±15.94 min) as compared to group S (473.42±13.19 min and 420.58±15.50 min; p<0.0001). Rescue analgesic requirement was lower (75.00 vs. 113.33±37.91 mg; p<0.0001) in the nalbuphine group. No complications were reported in either group. Conclusion: Nalbuphine as an adjuvant to levobupivacaine significantly improves the onset and duration of anaesthesia and postoperative analgesia without affecting haemodynamic stability or increasing side-effects. It appears to be a safe and effective agent for enhancing the quality of supraclavicular brachial plexus blocks.

Development and Validation of a Breast Cancer Information Leaflet to Advance Health Literacy in Oncology: A Methodological Study

Vivek Nilkanth Patil, Madiwalayya Shivkantayya Ganachari, Rohan Bhise, Manjula Gudhoor, Vishwa Rajakumar Byakod Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Breast cancer continues to be a significant global health concern, with increasing incidence rates, particularly in Asian populations. Providing patients with clear and reliable educational resources is essential for improving awareness and involvement in their care. Aim: To develop and validate a Patient Information Leaflet (PIL) for individuals with breast cancer to enhance their understanding of the disease, its treatment, and proper medication use. Materials and Methods: This methodological validation study was conducted at Department of Pharmacy Practice, KLE College of Pharmacy, KAHER, Belagavi Karnataka, India, and KLE Cancer hospital, Belagavi, over a period of four months from July 2025 to November 2025. The study followed a structured multi-phase process for the development and validation of the PIL, which was prepared using current oncology guidelines. A 10-item evaluation questionnaire was developed and reviewed by a multidisciplinary panel of experts, who rated each item on a 5-point Likert scale. Content validity was assessed using Item-level and Scale-level Content Validity Indices (I-CVI and S-CVI). The responses were analysed using Statistical Package for Social Sciences (IBM SPSS) version 20.0, with Cronbach’s alpha applied to assess internal consistency and readability indices used to evaluate the suitability of the leaflet for the target population. Results: A total of 60 experts participated in the validation. The PIL showed good internal consistency (Cronbach’s a=0.870). Content validity indicated strong expert agreement, with I-CVI values ranging from 0.81 to 0.96 and an S-CVI/Ave=0.91. Readability assessment yielded a Grade A rating (Flesch Reading Ease: 65.21; Flesch–Kincaid Grade Level: 5.53), indicating that the leaflet is clear, easy to understand, and appropriate for a broad audience. Conclusion: The validated leaflet serves as an effective and accessible educational tool for enhancing breast cancer awareness and supporting informed decision-making. Its high reliability and excellent readability make it suitable for clinical use as well as community health education. Further patient-centered evaluations are recommended to assess its impact on real-world understanding and health outcomes.

Efficacy and Safety of Tamsulosin Monotherapy versus Diclofenac Sodium for Non Neurogenic Female Voiding Dysfunction: A Prospective Interventional Study

Iqbal Singh, Himanshu Agrawal, Nitu Singh, Himanshu Tanwar, Sanjay Gupta, Kiran Guleria Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: α1-Adrenergic Receptor (AR) antagonists such as tamsulosin improve urinary flow and Lower Urinary Tract Symptoms (LUTS) in men, but evidence in women with Female LUTSs (FLUTS) and Fe-male Voiding Dysfunction (FVD) remains limited, particularly in the Indian population. Aim: To compare the efficacy and safety of tamsulosin monotherapy versus diclofenac sodium in women with non neurogenic FLUTS and FVD. Materials and Methods: This prospective interventional study was conducted in the Outpatient Surgical Clinic of the Department of General Surgery, University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital, New Delhi, India, from May 2023 to March 2024. It enrolled 150 women (18-80 years) with International Prostate Symptom Score (IPSS) >8 and non neurogenic FLUTS. Participants were randomised into two groups, Group I-to receive tamsulosin 0.4 mg once daily (n=75) and Group II diclofenac sodium 75 mg SOS (n=75). Outcomes included changes in Qmax, IPSS, Post-Void Residual volume (PVR), and Voided Volume (VV) over eight weeks. Quantitative variables were analysed using repeated-measures Analysis of Variance (ANOVA); categorical variables using Chi-square test. A p-value <0.05 was considered statistically significant. Results: A total of 150 women were equally randomised to the two groups, with comparable base-line characteristics and age distribution (majority aged 21-50 years). The tamsulosin group showed sig-nificantly greater improvement in Qmax (+32.4% vs +23.4%; p<0.001), IPSS reduction (-16.08 vs -5.71; p<0.001), and PVR reduction (22.8 mL vs 47.65 mL; p<0.05). VV showed no significant difference at the first visit but increased significantly in the treatment group from the second visit onward compared with controls (p<0.001), with progressive improvement through follow-up. Adverse effects were mild and transient. Conclusion: Tamsulosin monotherapy is safe and significantly more effective than diclofenac sodium in improving voiding parameters and symptom scores in women with non neurogenic FLUTS and FVD.

Maternal and Perinatal Outcomes of Primiparous Saudi Women of Different Age Groups: A Prospective Cohort Study

Iffat Imran Nazir Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Adolescent pregnancies are at an increased risk of operative delivery, preeclampsia, anaemia, Postpartum Haemorrhage (PPH), and perineal tears. Advanced maternal age is associated with a higher-risk of hypertensive disorders, gestational diabetes, and caesarean sections. The present study compared multiple age groups of primigravidae in Saudi Arabia regarding their maternal and perinatal outcomes, providing age-specific insights that have not been previously documented. Aim: To examine maternal, obstetric, and clinical factors associated with caesarean delivery and preterm birth, and to evaluate major neonatal outcomes among a cohort of primigravida women in Saudi Arabia. Materials and Methods: The present prospective cohort study included 932 primigravida women with complete data from a tertiary-care setting in Makkah, Saudi Arabia, from January 2023 to December 2024. Patients were assigned to three groups according to their age and were followed up until delivery. Group A adolescents (13-19 years), Group B included adults (20-34 years), and Group C included the elderly (≥35 years). Their antenatal records, delivery room notes, and neonate assessment sheets were used to collect the data. Group differences were evaluated using Chi-square, Fisher’s-exact, or likelihood-ratio tests as appropriate. Multivariable logistic regression models were fitted to identify predictors of caesarean delivery, preterm birth, and key neonatal outcomes. A p-value <0.05 was considered statistically significant. Results: Adult mothers had lower odds of caesarean delivery compared with adolescents Adjusted Odds Ratio (AOR=0.54). Underweight and overweight women showed reduced odds relative to normal-weight women, while obesity more than doubled the odds of caesarean delivery (AOR=2.28). Gestational diabetes demonstrated a borderline association with caesarean delivery. For preterm birth, caesarean delivery was the strongest predictor (AOR=2.72). Maternal underweight significantly increased the risk of preterm birth (AOR=2.08). Elderly mothers showed a borderline protective effect (p=0.090), whereas maternal anaemia demonstrated a borderline association with higher pre-term risk (p=0.099). Neonatal outcomes showed expected trends, with low birthweight linked to maternal underweight and preterm delivery, and Neonatal Intensive Care Unit (NICU) admission associated with pre-term birth and emergency delivery patterns. Conclusion: Maternal age exhibited a non linear association with various maternal and perinatal outcomes, underscoring the need for age-specific antenatal surveillance and individualised obstetric management, particularly at the extremes of reproductive age.

Standardisation and Quality Assessment of Aragwadhadi Oil and Aragwadhadi Ointment: A Pharmaceutico-analytical Study

Premadevi Kalmegh, Bharat Rathi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Aragwadhadi oil, a classical Ayurvedic herbomineral formulation containing arsenicals like Manahshila (realgar) and Haratala (orpiment), is traditionally used for Shvitra (vitiligo) and other skin conditions. Aragwadhadi ointment is a contemporary adaptation for easier application. Aim: To establish a Standard Manufacturing Procedure (SMP) for Aragwadhadi oil and ointment, and assess their quality through analytical parameters. Materials and Methods: This pharmaceutico-analytical study was conducted at the Department of Rasashastra and Bhaishajya Kalpana, MGACHRC, Wardha, Maharashtra, India between January 2024 to December 2024. Ingredients were authenticated and purified using classical Shodhana procedures. Aragwadhadi oil was prepared via Sneha Kalpana and converted into an ointment using white wax. Analytical evaluations included organoleptic, physicochemical, and microbiological studies. Results: The formulations exhibited stable organoleptic properties (uniform colour, consistency, odour) and acceptable physicochemical parameters: specific gravity (oil: 0.921±0.02; ointment: 0.938±0.03), acid value (3.25±0.14 and 2.98±0.11 mg KOH/g), iodine value (78.4±1.2 and 74.9±1.4 g I₂/100 g), and peroxide value (4.1±0.3 and 3.8±0.2 meq O₂/kg). Microbial contamination was absent {Total Plate Count (TPC)<10 Colony-forming Units /mL; no fungal growth}. Conclusion: The pharmaceutico-analytical standardisation confirmed the safety, consistency, and potential efficacy of the formulations. This approach integrates traditional Ayurvedic knowledge with modern scientific techniques.

Efficacy of Intramatricial Triamcinolone Acetonide versus Fractional CO₂ Laser with Topical 0.1% Betamethasone Valerate in the Management of Nail Psoriasis: A Prospective Interventional Study

Jayakalyani Vijayananth, Fathima Sherfudeen, Shanthini Srinivasan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Nail psoriasis is a refractory disease occurring in 65% of patients with psoriasis. Intramatricial steroid injections are considered as first line therapy for nail psoriasis. Laser-assisted Drug Delivery (LADD) with topical steroids helps in better drug penetration with fewer side-effects compared to other modes of treatment. Aim: To determine and compare the efficacy of intramatricial triamcinolone acetonide versus fractional CO₂ laser with topical betamethasone valerate 0.1% ointment in the management of nail psoriasis. Materials and Methods: This prospective, open-labelled and interventional study was done for a period of 12 months (November 2023 to October 2024) at the Department of Dermatology Venereology Leprosy, Chengalpattu Medical College Hospital, Chengalpattu, Tamil Nadu, India. A total of 44 patients were divided into groups A and B by simple random sampling each consisting of 22 patients. Group-A patients were given intramatricial triamcinolone acetonide injection (2.5 mg/mL, 0.1 mL per session). Patients in Group-B received fractional CO₂ laser (40 mJ, 0.8 mm distance) followed by twice daily application of topical steroid. Four treatment sessions were performed at four weekly intervals. Assessment was done using modified Nail Psoriasis Severity Index (mNAPSI) score and grading of improvement at baseline, during each treatment session and at six months. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 27.0. Significance tested using independent t-test and Chi-square test and p-value of <0.05 was considered statistically significant. Results: Both groups showed significant improvement at the end of six months (Group-A: p<0.001; Group-B p=0.0016). 40% and 30% patients in Group-A and B, respectively showed 100% improvement but it was not statistically significant (p=0.19). Side-effects were noted in 75% and 15% of patients in Group-A and B, respectively. No recurrence was noted in six months follow-up. Conclusion: Fractional CO₂ laser with topical betamethasone valerate 0.1% is safe, effective and convenient for patients because of fewer side-effects comparing to intramatricial triamcinolone injection. Fractional CO2 LADD can be considered a newer modality of treatment in nail psoriasis.

Evaluation of Antibacterial Properties, Cytotoxicity and Setting Time of an Epoxy Resin-based Root Canal Sealer After Incorporation of Chitosan Nanoparticles at Different Concentrations: An In-vitro Study

Sakshi Surendra Gandhi, Aniket Jadhav, Jyoti Mandlik, Sarita Singh Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Persistence of microorganisms within the root canal system is a major cause of endodontic failure, with Enterococcus faecalis commonly implicated in post-treatment disease owing to its ability to survive under adverse conditions and penetrate dentinal tubules. Although Epoxy Resin-based (ERB) root canal sealers possess favourable sealing properties, their antibacterial efficacy is limited and diminishes over time. Incorporation of bioactive nanoparticles such as chitosan may enhance antimicrobial activity while maintaining biocompatibility. Aim: To evaluate the setting time, antibacterial properties and cytotoxicity of chitosan nanoparticles in combination with a root canal sealer across various concentrations (0%, 10%, 20%, 30%) of chitosan nanoparticles. Materials and Methods: An in-vitro experimental study was conducted at Rajiv Gandhi Institute of Information Technology and Biotechnology and Katraj Metallurgical Laboratory, Pune, Maharashtra, India from July 2025 to December 2025. A total of four groups were included based on chitosan nanoparticle concentrations (0%, 10%, 20%, and 30%) incorporated into an epoxy resin–based sealer. The inclusion criteria comprised standardised sample preparation and the use of Enterococcus faecalis {American Type Culture Collection (ATCC) 29212}. Antibacterial activity was evaluated using the agar diffusion test, cytotoxicity using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on Vero cell lines, and setting time using the Gilmore needle test. Data were analysed using the Kolmogorov–Smirnov test and One-way Analysis of Variance (ANOVA) followed by post-hoc Tukey test, with significance set at p<0.05. Results: Chitosan incorporation demonstrated a concentration-dependent antibacterial effect against Enterococcus faecalis. The control group (0%) and the 10% chitosan group exhibited no zone of inhibition (0 mm), indicating absence of antibacterial activity. In contrast, the 20% and 30% chitosan groups showed measurable zones of inhibition, which were significantly greater than both the control group and the 10% chitosan group (p<0.05). Among all groups, the 30% chitosan group demonstrated the highest antibacterial efficacy (p<0.05). Cytotoxicity analysis revealed significantly higher cell viability in chitosan-modified groups compared to the control (p<0.05). The 30% group demonstrated the longest setting time, whereas the 10% group showed the shortest setting time (p<0.05). All groups exhibited setting times within International Organisation for Standardisation (ISO) recommended limits. Conclusion: Chitosan nanoparticle incorporation significantly enhanced the antibacterial activity and cytocompatibility of the ERB sealer, without adversely affecting setting time at specific concentrations. This modification shows potential for improving the biological performance of endodontic sealers.

Comparative Analysis of Microbial Adherence on Resorbable and Non-resorbable Braided Suture Materials in Periodontal Flap Surgery: A Randomised Clinical Study

Sudipta Ghosh, Haimanti Ghosh, Dibyendu Kumar Kundu, Shibendu Biswas, Abhijit Chakraborty Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: It is very essential to achieve stable wound closure during the initial stages of periodontal flap surgery wound healing, not just accurate surgical technique. For proper periodontal healing, several factors are required, such as proper flap adaptation, immobilisation of flap, and main-taining clot stability. For that purpose, different types of suture materials are routinely used to se-cure the flap and to achieve adequate tissue adaptation. But after placement of sutures in oral environ-ment, they are exposed to saliva, dental plaque and a complex microbial environment. For this reason, sutures can experience bacterial adhesion and the formation of biofilm, which could affect the healing process. Aim: This study aims to evaluate and compare microbial colonisation on resorbable and non-resorbable braided suture materials used in periodontal flap surgery and to assess their influence on postoperative wound healing and plaque accumulation. Materials and Methods: This randomised clinical study with microbiological evaluation of su-ture-associated bacterial adherence included 38 systemically healthy patients requiring undisplaced per-iodontal flap surgery. Patients were randomly allocated into two groups. In Group-A, flap closure was performed using 4-0 braided silk sutures, whereas in Group-B, 4-0 braided polyglactin 910 sutures were used. On postoperative Day 7 and Day 14, suture segments were retrieved and immediately transferred for microbial analysis. To assess the condition of the clinical sites and postoperative healing, routine clinical parameters were evaluated during follow-up visits. The primary outcome measure was microbial adherence to suture materials, quantified as Colony-Forming Units (CFU). Statistical analysis was per-formed using the Independent Samples t-test for comparison of continuous variables and Fisher's Exact Test for comparison of categorical variables. Results: The study demonstrated higher bacterial colonisation on polyglactin 910 (Vicryl) su-tures (Group-B) compared with silk sutures (Group-A) at both postoperative time intervals. On Day 7, the higher mean bacterial load observed in the Vicryl group was not statistically significant (p=0.425). However, on Day 14, Vicryl sutures exhibited significantly higher mean CFU values compared with silk sutures (p=0.044). No postoperative infection, suppuration, or other adverse complications were observed at the surgical sites during the follow-up period. Conclusion: The findings of the present study indicate that both braided suture materials are prone to progressive bacterial colonisation in the oral environment, regardless of whether they are re-sorbable (polyglactin 910) or non-resorbable (silk). Although polyglactin 910 demonstrated significantly higher bacterial colonisation at the 14th postoperative day, both materials showed comparable clinical healing outcomes. Therefore, selection of suture materials for periodontal flap surgery should consider not only microbial adherence characteristics but also handling properties, surgical requirements, and patient-related factors.

Aetiological Profile and Treatment Response of Patients with Hypercalcaemia: A Prospective Observational Study from a Tertiary Care Centre in Southern India

BR Suraj, Anantharam Jairam, Prashant G Kedlaya, Sowrabha Rajanna, Maria Tomy Prothasis, Anirban Palit Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Hypercalcaemia requiring nephrologist care is relatively uncommon and represents a select subgroup of patients who are more severe and complex with metabolic derangements and renal failure. Aetiological profiling of hypercalcaemia is important in this regard for its appropriate management. Aim: The present study aimed to identify the aetiological profile of hypercalcaemia and assess treatment response in patients presenting to a tertiary care centre in South India. Materials and Methods: The current prospective observational study was conducted at St Johns Medical college hospital, Bangalore, Karnataka, India from January 2024 to September 2025, including 27 adult patients (>18 years) with persistent corrected calcium levels >10.5 mg/dL. Aetiology was deter-mined using biochemical markers and imaging. Patients were followed for 30 days to assess treatment response and outcomes. Frequencies and standard deviations were calculated. Chi-square test was applied for categorical data analysis. Paired t-test was used to analyse treatment outcome. Results: The mean age was 53.8±14.4 years, with 55.6% females. The mean serum calcium at presentation was 12.98±1.74 mg/dL. The most common aetiologies were malignancy (37.03%, n=10, primarily plasma cell dyscrasia at 25.92%), followed by primary hyperparathyroidism (parathyroid adenoma, 22.20%, n=6) and iatrogenic causes (22.20%, n=6). Other causes included sarcoidosis (11.10%, n=3) and infective (7.40%, n=2). Mean calcium decreased to 9.17±1.07 mg/dL after 30 days in 24 patients. Notably, 40.74% had pre-existing Chronic Kidney Disease (CKD), and 12 out of 16 patients developed Acute Kidney Injury (AKI) secondary to hypercalcaemia. Non-specific symptoms like nausea/vomiting (77.77%) and fatigue (66.66%) were prominent. The cumulative mortality rate was 11.11% (n=3). Conclusion: Malignancy, primary hyperparathyroidism, and iatrogenic causes are the predominant aetiologies of hypercalcaemia in this region. Non-specific symptoms should prompt early suspicion. Increased awareness of judicious vitamin D supplementation as well as periodic health check is crucial to mitigate iatrogenic hypercalcaemia.

Determinants of Average Glandular Dose in Digital Breast Tomosynthesis: A Cross-sectional Study

Saquib Nishandar, Harshal Pagare, Sagar Parit, Sanika Udgave, Maajid Mohi Ud Din Malik Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Per-view dosimetric data from Digital Breast Tomosynthesis (DBT) units operating in Indian tertiary care settings remain limited. Stratification of Average Glandular Dose (AGD) by patient age, breast density and machine exposure parameters has not been adequately characterised in a Western Indian cohort. Aim: To measure the determinants of per-view and per-breast AGD in 80 women undergoing DBT and to benchmark institutional dosimetric performance against the 3 mGy per-view Diagnostic Reference Level (DRL) published by the European Commission. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis and Imaging Technology, Dr. D.Y. Patil School of Allied Health Sciences, Dr. D.Y. Patil Vidyapeeth (Deemed-to-be-University), Pune, Maharashtra, India (November 2025 to February 2026). Consecutive female patients aged 30-83 years referred for diagnostic DBT were enrolled after written informed consent. All acquisitions were performed on a Hologic Selenia Dimensions unit with Tungsten/Rhodium (W/Rh) target-filter and Automatic Exposure Control (AEC) in Craniocaudal (CC) and Mediolateral Oblique (MLO) projections. AGD, tube voltage (kVp) and tube current-time product (mAs) were read directly from the system exposure log per projection. Breast density was assigned by a consultant radiologist using ACR BI-RADS^® (5^th edition) categories A-D. Statistical tests applied were Pearson’s correlation, independent-samples t-test, One-way Analysis of Variance (ANOVA) with Tukey’s Honestly Significant Difference (HSD) post-hoc comparisons and multiple linear regression, run in two specifications - with and without mAs - because mAs mechanistically mediates the effect of other predictors. Results: Mean per-view AGD across 314 projections was 2.55±1.02 mGy (median 2.38; IQR 1.74-3.09 mGy). MLO views delivered higher doses than CC views (left MLO 3.02±1.08 vs. left CC 2.10±0.76 mGy; right MLO 2.85±1.06 vs. right CC 2.22±0.83 mGy). Overall, per-view compliance with the 3 mGy/view EC limit was 225/314 views (71.7%). Compliance fell to 51.9% for left MLO and 59.0% for right MLO projections. Bilateral total AGD varied across BI-RADS^® categories (F=3.90, p=0.012) and across age decades (F=7.05, p<0.001); women aged<50 years received higher doses than women ≥50 years (11.29±2.85 vs. 8.70±2.60 mGy; t=4.08, p<0.001). At the per-view level, a four-predictor model containing mAs, kVp, age and BI-RADS^® category explained 96.7% of AGD variance (R²=0.967), within which mAs was the dominant contributor (β=0.0095 mGy per mAs; t=75.2; p<0.001), while kVp lost statistical significance once mAs was retained. With mAs excluded, kVp (β=0.265, p<0.001), breast density (β=0.190, p=0.029) and patient age (β=-0.031, p<0.001) jointly explained 35.3% of the variance in AGD. Conclusion: Dose performance of the studied DBT unit is broadly aligned with international DRLs, but approximately three out of 10 views, concentrated in MLO projections of younger women with heterogeneously dense breasts, exceed the 3 mGy threshold. Recalibration of the AEC ceiling and use of lower kVp for thinner breasts are the most direct corrective actions.

Assessment of Preoperative Anxiety using the APAIS Score from Ward to Day of Surgery: A Prospective Cohort Study

Siri Kandavar, M Mahesha Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Preoperative anxiety is commonly associated with adverse outcomes like increased anaesthetic needs and prolonged recovery. However, its trajectory from ward admission to surgery remains poorly characterised. Aim: To assess the trajectory of preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) from ward admission to the day of surgery. Materials and Methods: This prospective cohort study was conducted in the Department of Anaesthesiology, K S Hegde Medical Academy (a tertiary care hospital ), Mangaluru, Karnataka, India, over six months from October 2022 to March 2023 and enrolled 65 adult patients (20-60 years, ASA I-II) undergoing elective major/minor surgery under general or regional anaesthesia using convenience sampling. Anxiety was assessed at three time points: before Pre-Anaesthetic Checkup (PAC), after PAC and on the day of surgery. Demographic data and its association with anxiety were recorded. Chi-square tests analysed associations. Paired t-tests assessed anxiety changes across time points using a Bonferroni-corrected significance threshold of p<0.017. Results: Among 65 patients, mean age distribution was 20-34 years (23.1%), 35-44 years (46.1%) and >45 years (30.8%). Females comprised 64.6% and males 35.4%. American Society of Anaesthesiologists (ASA) status: I (72.3%), II (27.7%). Paired t-test showed a significant reduction in anxiety after PAC compared with pre-PAC levels (mean difference 0.969, t=3.484, p=0.001). Anxiety increased slightly on the day of surgery, but this was not significant compared with post-PAC scores (mean difference -0.277, t=-1.893, p=0.063). Anxiety remained significantly lower on the day of surgery compared with pre-PAC levels (mean difference 0.692, t=2.347, p=0.022). Chi-square analysis showed no significant associations between anxiety and age, gender, or co-morbidities at any time point (p>0.05). Information needs remained consistently low across all groups. Conclusion: Preoperative anxiety significantly reduced following PAC and remained lower on the day of surgery, although this difference did not remain statistically significant after Bonferroni correction. Demographic characteristics such as age, gender and co-morbidities do not influence this trajectory, indicating that effective information delivery plays a greater role in reducing anxiety than patient demographics. The APAIS is a valuable tool for assessing anxiety trajectory in clinical practice.

Clinical Profile and Outcome in Patients Infected with Carbapenem-resistant Acinetobacter baumannii Infection in ICU Setting: A Prospective Observational Study

Suyash Phayde, Jayaprakash Appajigol Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Carbapenem-Resistant Acinetobacter baumannii (CRAB) causes hospital-acquired infections in Intensive Care Units (ICU), with high resistance and mortality in critically ill patients. It is a major problem in healthcare, especially where infection control and monitoring are limited. Few treatment options exist, so early identification of risk factors is needed for appropriate patient management. Aim: To evaluate the clinical profile, risk factors, treatment patterns, and outcomes of ICU patients with CRAB infection. Materials and Methods: This prospective observational study was conducted in the Department of General Medicine at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karna-taka, India from January to December 2024. Adult ICU patients (≥18 years) with culture-confirmed CRAB infection were enrolled consecutively. Data were obtained from medical records and laboratory systems from admission until discharge or death. Clinical evaluation included demographics, co-morbidities, antibiotic exposure, ICU factors, laboratory findings, and severity scores (APACHE II, qSOFA, NEWS2). Identification and susceptibility testing used standard microbiological methods. Data analysis was per-formed using IBM SPSS Statistics version 25.0. Associations were assessed using Chi-square with a p-value <0.05 considered statistically significant. Results: Fifty adult ICU patients with culture-confirmed CRAB infection were included. Males accounted for 34 (68%) of the study population, while females accounted for 16 (32%). Hypertension was present in 16 (32%) and diabetes mellitus in 13 (26%). Antibiotic exposure occurred in 44 (88%), most for 4-7 days in 28 (56%). ICU stay >14 days was seen in 17 (34%), and invasive procedures in 37 (74%). Pneumonia was the most common infection in 27 (54%). Colistin sensitivity was noted in 25 (50%) and pan-resistance in 20 (40%). Clinical improvement occurred in 25 (50%), while mortality was 20 (40%). NEWS2 showed the highest prognostic value {Area under the Receiver Operating Characteristic Curve (AUC) 0.774, sensitivity 85%, p=0.004}. Conclusion: CRAB infection in ICU patients is associated with high mortality and limited treatment options, with frequent pan-resistance. NEWS2 outperformed APACHE II and qSOFA in mortality prediction. High antibiotic exposure and prolonged ICU stay highlight the need for strict antimicrobial stewardship and infection control.

Automated versus Manual Blood Pressure Screening among Blood Donors: Agreement and Eligibility Outcomes

Shiny Jasmine, Subhashini, Saisudha Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Blood Pressure (BP) measurement is a critical component of predonation screening to ensure donor safety and eligibility. Automated oscillometric devices are increasingly used due to ease of use and reduced observer variability; however, evidence regarding their agreement with manual auscultatory methods in blood donor settings remains limited. Aim: To assess the agreement between automated and manual BP measurements and to evaluate their impact on donor eligibility classification. Materials and Methods: A cross-sectional analytical study was conducted over a period of eight months (July 2024 to March 2025) among 200 blood donors at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. BP was measured using both manual sphygmomanometer and a validated au-tomated device following standard protocol. Agreement between both the methods was assessed using paired t-test, Pearson correlation, Intraclass Correlation Coefficient (ICC), and Cohen’s kappa. Results: The mean age of the participants was 34.09±9.05 years, with females constituting 53.5% and males 46.5% of the study population. The mean Systolic Blood Pressure (SBP) was 128.75±11.52 mmHg (manual) and 128.32±11.52 mmHg (automated), while Diastolic Blood Pressure (DBP) was 84.32±9.23 mmHg and 84.68±9.69 mmHg, respectively. A statistically significant but clinically negligible difference was observed for SBP (mean difference 0.43 mmHg, p-value <0.001), while no significant differences were noted for other parameters. ICC showed excellent agreement for SBP (0.997) and good agreement for Mean Arterial Pressure (MAP) (0.794), whereas DBP showed moderate agreement (0.528). Overall agreement in donor eligibility classification was 85.5% with moderate agreement (κ=0.69, p-value<0.001). Conclusion: Automated BP devices demonstrate good agreement with manual methods and can be reliably used for blood donor screening, with minimal impact on donor eligibility classification, particularly in high-volume settings.

Beneficial Role of Vitamin D Supplementation and Clinical Outcomes in Patients with Dengue Fever: A Randomised Controlled Trial

Subramanian Mariselvan, Siva Ranganathan Green, Shayilendranath Venkatesan, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Dengue Fever (DF) continues to be a major public health burden in tropical and subtropical countries. Severe forms such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are characterised by vascular leak, bleeding, and increased mortality. Vitamin D, with its immunomodulatory and endothelial protective properties, has been proposed as a potential adjunct therapy. Aim: To evaluate the effect of vitamin D supplementation on clinical outcomes, platelet recovery, and disease severity in hospitalised dengue patients. Materials and Methods: The present study employed a double-blinded randomised controlled trial over a period of 12 months (from July 2023 to July 2024), included 144 serologically confirmed dengue patients admitted to a tertiary care hospital at Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. Participants were allocated into two groups: Group A received vitamin D supplementation (2000 IU/day) along with standard care, and Group B received standard care alone. Clinical parameters (bleeding, transfusion requirements, warning signs, ascites, pleural effusion, and shock) and laboratory indices {Platelet Count (PC), Total Count (TC) and Packed Cell Volume (PCV)} were serially monitored. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 25; Mann-Whitney U-test, Wilcoxon signed-rank test, and chi-square test were applied as appropriate (p<0.05). Results: The overall mean age of the study participants was 37.15±12.14 years and majority were male patients (Group A: 49/72; Group B: 42/72). PC increased significantly within both groups from day 0 to day 5 (baseline change +20,811±15,240 (Group A) and +21,234±14,890 (Group B); p<0.001) and day 10 (baseline change +77,295±21,445 (Group A) and +75,884±22,156 (Group B); p<0.001). However, Group A demonstrated significantly fewer bleeding manifestations (9 vs 36; p<0.001), reduced platelet transfusion requirement (7 vs 30; p<0.001), and lower incidence of DHF across age and gender subgroup (p<0.05). No significant differences were observed in hospital or ICU stay. Conclusion: Vitamin D supplementation in dengue patients significantly reduced bleeding complications, transfusion needs, and progression to severe dengue, though platelet recovery and hospitalisation outcomes remained unaffected. These findings highlight the potential role of vitamin D as a safe, low-cost adjunct in dengue management, warranting validation through larger multicentric trials.

Evaluation of Chamomile Tea in the Management of Recurrent Aphthous Stomatitis: A Prospective Comparative Study

Seelam Hadhassa Vardhini, Kotha Pavani, Yalamanchali Samata, Nunsavathu Purnachandra Rao Naik, Saranu Sethu Manjusha, Chennupati Tejaswi, Sonti Aishwarya Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Recurrent aphthous stomatitis (RAS) is among the most prevalent oral mucosal disorders, the aetiology of which remains unclear. Treatments suggested for RAS are often palliative to relieve pain, which include local anaesthetics, analgesics, corticosteroids, and immune modulators. Prolonged use of corticosteroids is correlated with several detrimental outcomes. There is a growing trend in the adoption of herbal medications as a more secure alternative for ulcer treatment. One among various alternative herbal treatment options includes Matricaria Chamomilla (MTC). Chamomile essential oil offers broad therapeutic effects, including anti-inflammatory, antimicrobial, and antioxidant actions. Hence, the rationale of the study was to evaluate the efficacy of chamomile tea in the management of RAS. Aim: To analyse and compare the therapeutic efficacy of chamomile tea and topical triamcinolone acetonide in the management of RAS. Materials and Methods: The present study was a prospective comparative study conducted at the Outpatient Department (OPD) of Oral Medicine and Radiology of SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India from October 2024 to December 2024. A total of 24 participants aged between 18 and 60 years, of both genders, who had developed aphthous stomatitis within the last 48 hours were included. The participants were divided into two groups, each consisting of 12 individuals. Group A was instructed to use chamomile tea twice a day for 1 week in a swish and spit method for 10 minutes, whereas group B was advised to use triamcinolone acetonide 0.1% w/w oral mucosal paste twice daily for a duration of one week. Burning sensation and size of the ulcer were assessed periodically using the Visual Analogue Scale (VAS) and ruler, respectively. Descriptives were performed and categorical variables were analysed using the Chi-square test. An Independent t-test was utilised for intergroup comparisons, while repeated measures of Analysis of Variance (ANOVA) was applied for intragroup comparisons, with a significance level set at p<0.05. Results: Intergroup comparison of VAS score of the ulcer between the chamomile group and the triamcinolone acetonide group showed reduced burning sensation, which was not statistically significant (p-value of 0.155). Intergroup comparison of the size of the ulcer between the chamomile group and the triamcinolone acetonide group at day 1, 3 and 7 showed a notable decrease by day 3. Intragroup comparison of burning sensation and VAS score showed statistically significant results with p<0.001. Conclusion: Chamomile tea is effective in alleviating the burning sensation and reducing the size of the ulcer. Chamomile may serve as a potential herbal alternative in the management of RAS.

Effectiveness of Saltwater Rinse Against Various Periopathogens Identified in the Elderly Population with Prosthetic Needs: A Prospective Clinical Study

Shreya Jain, Neerja Mahajan, Harekrishna Jayendra Raval, Riya Patel, Krishna Dave, Sanat Gokhale, Siddharth Golechha Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Elderly denture wearers face increased oral health risks due to reduced saliva, systemic conditions, and hygiene challenges. Many commercially available mouthwashes contain harmful ingredients, limiting long-term use. The study assesses the effectiveness of a saltwater rinse as a safe, cost-effective alternative to reduce periopathogens and improve periodontal health for elderly denture users. Aim: To investigate periopathogens in edentulous and partially edentulous patients using Polymerase Chain Reaction (PCR) and to determine the Minimum Inhibitory Concentration (MIC) of sodium chloride for saline mouth rinse. Materials and Methods: The present prospective clinical study in the Department of Prosthodontics and Crown and Bridge, at KM Shah Dental College and Hospital, Vadodara, Gujarat, India from May 2022 to March 2024 involved 42 healthy participants (24 males, 18 females) with partial (Group A, n=21) and complete edentulism (Group B, n=21). Eight periopathogens were identified using PCR, and the MIC of sodium chloride evaluated was 3.5 M. Participants rinsed with saltwater twice daily for 14 days, with microbial samples collected before and after to assess Colony-Forming Units (CFUs) and periodontal health. Data were analysed at a 95% confidence level (p<0.05) using paired t-tests and Wilcoxon signed-rank tests. Results: The 14-day saltwater rinse significantly reduced microbial counts and improved periodontal health. In completely edentulous participants, CFUs decreased from 2.5 to 1.1, while in partially edentulous participants, CFUs dropped from 2.3 to 1.2 (p<0.001). Additionally, the Visible Plaque Index (VPI) improved from 2.4 to 1.8 (p<0.001), Clinical Attachment Level (CAL) from 4.5 to 3.5 (p<0.001), Gingival Bleeding Index (GBI) from 2.01 to 1.2 (p<0.001), and Periodontal Probing Depth (PPD) from 3.5 to 2.7 (p<0.001). Conclusion: A 3.5 M saltwater rinse effectively reduces oral microbial load and improves periodontal health, suggesting its potential as a simple, safe, and cost-effective home-made adjunct for routine oral hygiene maintenance in both completely and partially edentulous elderly individuals.

Evaluation of Tumour Eosinophilia and Histological Grade in Squamous Cell Carcinomas of the Upper Aerodigestive Tract: A Cross-sectional Study

Poojitha Ram Vemireddy, Rama Devi Pyla, Shilpa Gupta, Anil Reddy Konduru Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Tumour-Associated Tissue Eosinophilia (TATE) refers to the presence of eosinophilic infiltration within and around tumour tissue. Its role in Squamous Cell Carcinoma (SCC) of the upper aerodigestive tract remains controversial, with studies suggesting both tumour-promoting and tumour-suppressing effects. Aim: To assess the degree of tissue eosinophilia in SCC of the upper aerodigestive tract and to correlate it with tumour differentiation. Materials and Methods: This cross-sectional study was conducted over a period of two years, from May 2023 to April 2025 at a tertiary care medical center, Vijayapura, Karnataka, India. A total of 70 biopsy specimens of histologically confirmed SCC of the upper aerodigestive tract (oral cavity, larynx, and oesophagus) were included. Eosinophils were counted in 10 High-Power Fields (HPF) in both intratumoral and peritumoral regions using Hematoxylin and Eosin (H&E) stained sections. Cases were graded as Grade I (0-20 eosinophils), Grade II (21-40 eosinophils), and Grade III (>40 eosinophils). Tumours were classified as well, moderately, or poorly differentiated. Data were analysed using SPSS® version 17.0. Descriptive statistics were used to summarise eosinophil grades and tumour differentiation, and Spearman’s rank correlation coefficient was applied to assess the association between TATE grade and tumour differentiation, with p<0.05 considered statistically significant. Results: Of the 70 cases, 25 were well-differentiated, 35 moderately differentiated, and 10 poorly differentiated. Grade III TATE was most common in well-differentiated SCC with 16 cases (64%), while Grade II was predominant in moderately differentiated tumours, with 23 cases (65.7%). Poorly differentiated SCCs showed minimal eosinophilic infiltration, with 8 cases (80%) exhibiting only Grade I TATE. A statistically significant inverse correlation was observed between TATE grade and tumour differentiation (Spearman’s ρ=-0.78, p<0.001). Conclusion: High eosinophil infiltration was associated with better tumour differentiation. TATE may serve as a supplementary histopathological marker in assessing tumour differentiation and bio-logical behaviour in SCC of the upper aerodigestive tract, although further studies with larger cohorts and clinical follow-up are warranted.

Knowledge, Awareness, Practical Exposure, Perceptions, and Educational Preferences Regarding 3D Printing Technology among Dental Undergraduates: A Cross-sectional Survey

Thummapati Lakshmi Padmavathi, Roja Lakshmi Karri, S Harikrishnam Raju, Geetanjali Darna, Meduri Badrinath, Vineela Naraharisetti Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Three-dimensional (3D) printing technology has revolutionised various fields, including dentistry, by enabling the production of personalised dental models, surgical guides, implants, crowns, bridges, and orthodontic appliances. Despite its benefits, there is limited data on dental undergraduates’ awareness of this technology in India. The present study addresses the gap by evaluating dental students’ awareness, knowledge, and exposure to 3D-printing across academic levels. Aim: To assess the awareness, knowledge, practical exposure, and perceptions regarding the benefits, safety, future applications, and educational preferences of 3D-printing technology among dental undergraduate students across different academic years. Materials and Methods: A cross-sectional, questionnaire-based survey was conducted among dental undergraduates from four dental colleges in Andhra Pradesh, India, with GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India, as the primary coordinating centre, from August 2023 to January 2024. A total of 313 dental undergraduate students, from first year to internship, who were actively enrolled and consented to participate, were included. Data were collected using a pre-validated, self-administered 22-item questionnaire distributed via Google Forms through WhatsApp. The questionnaire assessed awareness, knowledge, practical exposure, perceived benefits, and views on the safety, future use, and educational preferences related to learning 3D-printing technology in dentistry. Demographic variables such as age, gender, and academic year were recorded. Data were analysed using descriptive statistics, and inter-group differences across academic years were evaluated using the Chi-square test, with statistical significance set at p<0.05. Results: Among 313 participants, female students represented the majority of participants, 232 (74.1%), while males accounted for 81 (25.9%). Awareness of 3D-printing technology varied significantly across academic years (p<0.001), with interns demonstrating the highest level of awareness 58 (90.63%), while comparatively lower awareness was observed among early-year students. The internet emerged as the predominant source of information for early-year students (p<0.001), whereas formal college education played a more prominent role among interns, 18 (28.13%). Practical exposure with 3D-printing increased significantly with academic progression (p<0.001), with the highest practical exposure reported by interns, 34 (53.13%). Knowledge of specific applications, including Invisalign aligners and surgical guides, showed statistically significant variation across academic years (p<0.001). The majority of participants perceived 3D-printing as beneficial for improving patient care 276 (88.18%) (p=0.018) and most supported its integration into the undergraduate curriculum, 260 (83.07%). Cost and lack of awareness were identified as the primary barriers to adoption. Conclusion: The study revealed higher levels of awareness and practical exposure among interns, whereas junior students demonstrated comparatively lower awareness. This finding highlights the need to integrate 3D-printing more actively into the dental curriculum. Providing students with practical exposure and addressing barriers such as cost can help future dental professionals harness this innovative technology to improve clinical practice and patient care.

Microbial Profiles, Antibiotic Resistance and Mortality in Autoimmune Blistering Disorders: A Cross-sectional Observational Study

HP Sudhesshna Devi, Mridula Thangaraj Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Autoimmune Blistering Disorder (AIBD) is characterised by autoantibodies targeted against structural proteins of the skin and mucosa. The prognosis of this disorder has significantly improved with the introduction of steroids, immunosuppressives, biologics and antibiotics. Despite these advances, septicaemia remains a leading cause of mortality in these patients. Aim: To evaluate microbial profiles, antibiotic resistance patterns, and mortality in hospitalised patients with AIBDs. Materials and Methods: The present cross-sectional observational study was conducted at the Department of Dermatology in Saveetha Medical College and Hospital in Chennai, Tamil Nadu, India, from March 2021 to May 2025. The study included 43 inpatients above 18 years with an established AIBD diagnosis based on clinical, histopathological and Direct Immunofluorescence (DIF) findings. All patients were subjected to cutaneous and blood cultures at admission prior to initiating antibiotics, and antibiotic susceptibility testing was performed when bacterial growth was detected. Disease severity was assessed using the Autoimmune Bullous Skin Disorder Intensity score (ABSIS) and demographic parameters, including age, sex, AIBD subtype, Body Surface Area (BSA) involvement and co-morbidities were recorded. Data analysis utilised Chi-square test and Analysis of Variance (ANOVA), with p<0.05 considered statistically significant. Results: Among 43 patients, 31 (72.1%) had growth in cutaneous culture, with Staphylococcus aureus (11/31, 35.5%) most common; blood culture growth occurred in three patients (7.0%), yielding four organisms. Staphylococcus aureus demonstrated high sensitivity to cefazolin, cefuroxime, and cefotaxime in 11 isolates (100%), followed by cotrimoxazole and gentamicin in 10 isolates (90.9%). The overall mortality rate observed in this study was 1 (2.33%). The mortality rate among patients with positive blood cultures was 1 (33.33%). Conclusion: All patients with growth in blood culture had growth in cutaneous culture, but the vice-versa was not true. Three patients had growth in both cultures, of which one patient died. Secondary bacterial infection/bacteraemia in AIBD remains the leading cause of mortality, especially in patients with co-morbidities and greater BSA involvement. This necessitates the judicious and prompt use of antibiotics and periodic updates on changing bacteriological profiles in AIBD to reduce mortality.

Comparison of Intrathecal Dexmedetomidine versus Intrathecal Clonidine as Adjuvant with Hyperbaric Levobupivacaine for Subarachnoid Blockade Characteristics in Lower Limb Orthopaedic Surgeries: A Double-blind Randomised Clinical Study

Jatin B Patel, Radhika Jain, Charmi Shah, Jigisha Mehta Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Spinal anaesthesia remains the cornerstone technique for lower limb orthopaedic surgeries due to its rapid onset, reliable surgical conditions, and cost-effectiveness. Alpha-2 adrenergic agonists such as clonidine and dexmedetomidine have emerged as promising adjuvants to local anaesthetics, offering advantages over opioids including absence of respiratory depression and pruritus. Aim: To compare intrathecal dexmedetomidine versus clonidine as adjuvants to hyperbaric levobupivacaine in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: The present randomised, double-blind clinical study was conducted at the Department of Anaesthesiology, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India from January 2023 to December 2023. Sixty American Society of Anesthesiologists (ASA) I-II patients undergoing lower limb orthopaedic surgeries were randomly allocated into two groups: Group-LC (n=30) received 3 mL of 0.5% hyperbaric levobupivacaine with 30μg clonidine (total volume 3.5 mL), and Group-LD (n=30) received 3mL of 0.5% hyperbaric levobupivacaine with 5μg dexmedetomidine (total volume 3.5mL). Parameters assessed included onset and duration of sensory and motor blockade, haemodynamic parameters, sedation scores, duration of postoperative analgesia, and incidence of side-effects. Data analysed using Jamovi version 2.0. Quantitative variables compared using unpaired Student’s t-test and categorical variables using Chi-square test. The p-value <0.05 was considered statistically significant. Results: Both groups were comparable in demographic characteristics. Onset of sensory blockade (2.88±0.23 min) and motor blockade (1.45±0.30 min) of Group-LD was significantly faster compared to Group-LC sensory blockade (3.02±0.45 min) and motor blockade (1.58±0.32 min). The duration of sensory and motor blockade was longer in Group-LD (394.30±7.66 min and 358.43±9.53 min) compared to Group-LC (277.23±8.65 min and 322.63±14.52 min). The duration of absolute and effective analgesia was longer for Group-LD (443.93±6.48 min and 473.60±9.43 min) compared to Group-LC (314.20±8.59 min and 364.67±11.72 min). Haemodynamic parameters were comparable with no significant differences in side-effects. Conclusion: Dexmedetomidine (5μg) as an adjuvant to hyperbaric levobupivacaine provides faster onset and prolonged duration of sensory and motor blockade compared to clonidine (30μg), with extended postoperative analgesia and comparable safety profile.

Effects of a Six-month Yoga Intervention on Psychological Well-being and Perceived Stress among Undergraduate Healthcare Students: A Quasi-experimental Study

Sushant Bharat Singh, Meena Ramanathan, Ananda Balayogi Bhavanani, Shivasakthy Manivasakan, Priya Rajkumar, Anandaraj Lokeshmaran Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Mental health and well-being are among the major concerns among undergraduate healthcare students who often experience high stress levels and poor mental health during training. International statistics show that the prevalence of depression in this group is about 28%, which is consistent with Indian findings. Yoga, as a mind-body practice, is a propitious intervention for improving overall well-being. Aim: To study the effect of a six-month structured Yoga program on the psychological well-being and perceived stress of undergraduate healthcare students. Materials and Methods: The study was a quasi-experimental trial to assess the effectiveness of six-month Yoga intervention on psychological well-being and perceived stress among undergraduate healthcare students conducted from February 2021 to September 2021 at School of Yoga Therapy, Institute of Salutogenesis and Complementary Medicine, Sri Balaji Vidyapeeth (Deemed-to-be University), Puducherry, India. At baseline and post-intervention, the levels of psychological well-being and perceived stress were measured using the General Well-Being Schedule (GWB) and Perceived Stress Scale (PSS-10). The Yoga group underwent a six-month yoga practice program, while sex-matched controls did not practice Yoga. A total of 158 participants (Yoga: 78; Control: 80) were analysed. Jeffreys’s Amazing Statistics Program (JASP) 0.95.3 for Windows was used for statistical analysis. For normally distributed variables, independent samples t-tests compared means between groups and paired samples t-tests assessed pre-post changes within groups. When variables did not meet normality assumptions, non parametric equivalents, the Mann-Whitney U test and the Wilcoxon signed-rank test, were used. The p<0.05 was considered statistically significant. Results: A total of 158 participants completed the study. The yoga group had 39 males and 39 females, while the control group included 40 males and 40 females. At baseline, no significant differences were observed between the groups. After the intervention, the Yoga group showed significantly improved well-being and reduced perceived stress (p<0.001 in both cases). In contrast, the control group deteriorated in well-being (p<0.001) with no significant change in stress levels (p=0.106). Between-group comparisons affirmed larger improvements in the Yoga group (p<0.001 in both cases). Conclusion: A six-month Yoga program proved effective in improving the psychological well-being of undergraduate healthcare students, as well as decreasing perceived stress levels, despite the pandemic-related pressures. The results support the inclusion of Yoga-based interventions into healthcare programs to encourage sustainable mental health and well-being of the population.

Effect of Egoscue Exercises versus Rigid Taping in Asymptomatic Individuals with Forward Head Posture: A Randomised Clinical Trial

Priyanka Naik, Santosh Metgud Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Forward Head Posture (FHP), commonly observed in both active and sedentary individuals, is associated with prolonged mobile phone use, poor ergonomic habits, and faulty postural alignment. This results in an altered Craniovertebral Angle (CVA) and muscle imbalance affecting daily functional activities. Egoscue exercises and rigid taping are recognised as effective interventions to address postural dysfunction; however, their comparative effectiveness in asymptomatic individuals re-mains underexplored. Aim: To compare the effectiveness of Egoscue exercises and rigid taping on CVA and Pectoralis Minor Index (PMI) in asymptomatic individuals with FHP. Materials and Methods: A randomised clinical trial was conducted at a tertiary healthcare centre in Belagavi, Karnataka, India, from November 2024 to April 2025. A total of 63 individuals aged 18-30 years were screened, of which 52 participants met the inclusion criteria and were randomly allocated into two groups (n=26 each). Group A received Egoscue exercises, while Group B received rigid taping along with conventional therapy. Outcome measures included CVA assessed using the Kinovea application and Pectoralis Minor Index (PMI), evaluated pre- and postintervention. Data were analysed using the Wilcoxon signed-rank test and Mann-Whitney U test (p-value <0.05). Results: Baseline demographic characteristics showed comparable Body Mass Index (BMI) between Group A (22.27±4.45 kg/m²) and Group B (21.68±4.99 kg/m²), with similar gender distribution; however, mean age differed significantly between Group A (22.85±3.08 years) and Group B (26.00±4.63 years). Both groups demonstrated statistically significant improvements across all outcome measures (p-value<0.05). Between-group comparison revealed significant differences favouring Group B, with large to very large effect sizes for CVA (1.38), right PMI (0.99), and left PMI (1.48), indicating the efficacy of rigid taping. Conclusion: Postintervention, rigid taping was associated with greater improvements than Egos-cue exercises; however, interpretation of efficacy is limited by the baseline age difference, which may have influenced outcomes. Incorporating rigid taping into physiotherapy practice may enhance postural correction in individuals with FHP.

Perception of Reproductive Health among School-going Adolescents: A Cross-sectional Study from the Field Practice Areas of a Medical College in Western Maharashtra, India

Aishwarya Ohri, Swati Ghonge, Akhil R Nair, Soveli Suvechha Khuntia Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Adolescent reproductive health awareness is critical for preventing Sexually Transmitted Infections (STIs), unintended pregnancies, and conditions affecting the reproductive tract. School-based reproductive health education though recognised as effective, remains marginal and socially constrained in India. Aim: To assess the perception, knowledge, attitudes, and barriers related to reproductive health among school-going adolescents aged 14-19 years in the field practice areas of a Medical College in Pune, Western Maharashtra, India. Materials and Methods: A cross-sectional study was conducted from January 2025 to February 2026 among 150 school-going adolescents (Classes X-XII). A self-structured questionnaire comprising 33 items across five domains was used. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0; descriptive and inferential statistics (Chi-square test) were applied. Statistical significance was set at p-value <0.05. Results: The mean age was 15.8±1.1 years; 77 (51.4%) were female. While 147 (98.0%) identified basic reproductive organs correctly and 143 (95.3%) were aware of STIs, knowledge gaps were substantial: only 67 (44.7%) had contraceptive knowledge; 104 (69.3%) incorrectly believed fertilisation occurs in the uterus; and 66 (44.0%) attributed the determination of the baby’s sex solely to the father. Cultural taboos were prevalent, with 41 (27.3%) holding menstrual impurity beliefs. Of 85 participants who reported barriers (56.7%), fear of being judged was the most common (30.6%). A statistically significant association was found between gender and the type of barrier faced (χ2 = 14.267, p-value=0.011). An overwhelming 146 (97.3%) agreed that reproductive health education should be made mandatory. Conclusion: Substantial gaps exist in contraceptive awareness, STI literacy, and practical re-productive health knowledge. Structured, culturally sensitive, age-appropriate reproductive health education programmes are urgently needed within school curricula.

Smartphone Addiction and Working Memory in Undergraduate Medical Students: A Cross-sectional Study Examining the Mediating Role of Sleep

Karunamoorthy Vanathy, Dhavakumar Priyadarsini, Arumugam Parthiban Prashannth Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Excessive smartphone usage is recognised as a behavioural addiction that can interfere with sleep and hinder cognitive abilities like working memory. Medical students, because of their academic pressure and dependence on digital gadgets, constitute a notably susceptible population. Aim: To evaluate the link between smartphone addiction and working memory performance and to assess if sleep duration acts as a mediator in this connection among undergraduate medical students. Materials and Methods: The present cross-sectional study was conducted among 170 undergraduate medical students from April to September 2025 at Bhaarath Medical College and Hospital, Chennai, Tamil Nadu, India. Students aged 18-24 years of either gender who provided written informed consent, owned a smartphone and had been using it regularly for at least one year were included in the study. Smartphone addiction was assessed with the Smartphone Addiction Scale-Short Version (SAS-SV), while sleep duration was determined from a 7-day sleep diary. The objective evaluation of working memory was conducted through a computerised 3-back task that provided data on accuracy rate, reaction time, sensitivity index (d´) and response bias (c). Data analysis involved Pearson correlation, multiple linear regression and mediation analysis. Results: The study included 170 undergraduate medical students with mean age: 19.18±1.25 years, of whom 55% were males and 45% were females. Increased smartphone addiction scores were strongly correlated to reduced sleep duration (r=-0.46, p<0.001) and diminished working-memory performance, indicated by lower d´ (r=-0.55, p<0.001) and accuracy, along with longer reaction times. Sleep duration partially mediated the adverse relationship between smartphone addiction and working memory (indirect effect=-0.030; 95% CI:-0.043 to -0.019 ), representing around 47% of the overall effect. Conclusion: Smartphone addiction negatively impacts working memory in medical students, in part due to decreased sleep duration. Focused strategies emphasising healthy sleep practices and responsible smartphone usage could alleviate cognitive decline and improve academic outcomes in this group.

Prevalence of Postpartum Depression among Postnatal Mothers in a Rural Developmental Block of Purba Bardhaman District, West Bengal, India: A Cross-sectional Study

Haimanti Bhattacharya, Chinmay Nandi, Sagnik Mukherjee, Sima Roy Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Postpartum depression is a complex mood disorder affecting a significant proportion of women after childbirth. It is characterised by feeling of severe sadness, anxiety and exhaustion. It impairs daily functioning, mother-infant bonding and overall family dynamics. Aim: To estimate prevalence of postpartum depression and find out its associated factors in Bhatar rural developmental block of Purba Bardhaman district, West Bengal, India. Materials and Methods: The current study was a cross-sectional study conducted from January 2024-July 2024 in Bhatar rural developmental block of Purba Bardhaman district, West Bengal, India. The study population consisted of the postnatal mothers within six weeks to six months of last delivery irrespective of outcome of delivery. The calculated size of 145 postnatal mothers were selected by simple random sampling, interviewed using a pre-validated schedule and Edinburgh Postnatal Depression Scale (EPDS) scale. Chi-square test was applied to assess associations and p<0.05 was considered statistically significant. Results: A total of 16(11%) postnatal mothers had postpartum depression. Age of marriage were less than 18 years in 81 (55.86%) mothers, 107 (73.79%) were schedule tribe, 140 (96.55%) were Hindu, 59 (40.69%) were above secondary, 113 (77.93%) had joint family, 140 (96.55%) mothers were homemaker, 125(86.21%) came under lower middle socioeconomic status. Family h/o psychiatric illness (p-value=0.009), h/o abortion (p-value=0.024), sex of baby as desired (p= 0.011), initiation of breastfeeding (p=0.003), Exclusive Breastfeeding (EBF) status on the day of survey (p=0.004) and birth weight of baby (p=0.012) were found statistically significant with postpartum depression. Binary logistic regression revealed that family history of psychiatric illness was associated with increasing risk of postpartum depression. Conclusion: The study revealed that prevalence of postpartum depression among postnatal mothers was 11%, indicating a significant public health concern. Thus, strengthening the integration of maternal mental health care into routine maternal health services during postpartum period was of utmost importance.

Comparison of Different Concentrations of Isobaric Ropivacaine with Dexmedetomidine versus Isobaric Ropivacaine for Patients Undergoing Laparoscopic Cholecystectomy under Segmental Spinal Anaesthesia: A Randomised Control Pilot Study

Aastha Srivastava, Kanishak Ahuja Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Segmental Spinal Anaesthesia (SSA) refers to blocking of the required dermatomes essential for the proposed surgical procedure with very low effective local anaesthetic drug dose. Thoracic SSA offers a safer alternative to General Anaesthesia (GA) with fewer cardiorespiratory complications especially for American Society of Anaesthesiologists (ASA) 2 and 3 patients. Aim: To compare the different concentrations of isobaric ropivacaine with dexmedetomidine versus isobaric ropivacaine for patients undergoing laparoscopic cholecystectomy under SSA. Materials and Methods: The present randomised control study was done in the Department of Anaesthesia at Gautam Buddha Chikitsa Mahavidyalya, a tertiary care centre from November 2024 to July 2025. In the present study, 32 patients were randomly divided into two groups, Group R+D and Group R using the fish bowl method of randomisation. Subjects in Group R+D were administered 1.8 mL ropivacaine 0.5% +5 micrograms dexmedetomidine whereas subjects in Group R were administered 2 mL of 0.75% ropivacaine. Haemodynamic parameters like Heart Rate (HR), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) were compared in all the groups. The patient and surgeon satisfaction scores and the need for rescue analgesic was also assessed. Repeated measure Analysis of Variance (ANOVA) was applied for comparing the means of one group in different time intervals. For comparing the means between two independent groups, independent t-test was used. A p-value less than 0.05 was considered statistically significant. Results: Age was comparable in both the groups (p=0.07). Mean HR recorded was found to be significant at 25, 30, 40, 50 minutes. (p=0.04 at 25, 30, 40 minutes and p=0.01 at 50 minutes). At 60 minutes, the mean HR recorded to be statistically significant (p=0.01). The recording in SBP was noted to be significant at a time interval of 5 minutes intraoperatively (p=0.04). Within the Group, the p-value was significant for the SBP in Group R+D (p=0.03) and the value was significant for DBP in Group R (p=0.04). So, there was significant hypotension produced in the groups but the difference was not significant while comparing with each other. The intraoperative incidence of side effects was comparable in both the groups (p=0.63). The surgeon satisfaction score (p=0.48) and the patient satisfaction score (p=0.51) were also comparable in both the groups. Rescue analgesic was not required in any of the patients. Conclusion: Thoracic SSA is a reliable and effective alternative for laparoscopic cholecystectomy. Both drug combinations evaluated in this study provided good anaesthesia and can be effectively used for segmental spinal technique. While the duration of segmental spinal lasted significantly more in the ropivacaine and dexmedetomidine group, the haemodynamic parameters and the satisfaction scores were higher in the ropivacaine group.

Evaluation of Radiological and Functional Outcomes of Proximal Femoral Varus Derotation Osteotomy in Perthes’ Disease: An Ambispective Cohort Study

Dhwanil Deepak Joshi, Pareshbhai Maheshbhai Rathava, Yash Siddharth Parikh, Kishan Naranbhai Chhayani, Dhruv Jayshil Vyas, Garasiya Rahulkumar Bharatbhai Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Perthes’ disease is an idiopathic, self-limiting avascular necrosis of the capital femoral epiphysis in children. Varus Derotation Osteotomy (VDRO) is a widely practised surgical containment method aimed at preventing femoral head deformation. However, evidence regarding its radiological and functional outcomes, particularly from the Indian subcontinent, remains limited. Aim: To evaluate the radiological and functional outcomes of proximal femoral VDRO in Perthes’ disease and to assess the influence of age at surgery and disease stage on the final outcome. Materials and Methods: This ambispective cohort study was conducted at the Department of Orthopaedic Surgery, St. Stephen’s Hospital, New Delhi, India from October 2020 to September 2021. A total of 30 patients (31 hips) who underwent VDRO for Perthes’ disease were evaluated. Radiological parameters including Centre-Edge (CE) angle, Reimer’s Migration Index (RMI), neck-shaft angle, VDRO angle, and varus angle were measured preoperatively, postoperatively, and at final follow-up. Femoral head sphericity was assessed using Mose’s criteria and Stulberg classification. Functional outcome was evaluated using the Iowa hip score. Chi-square test was used for association analysis with p-value <0.05 considered significant. Results: The mean age at surgery was 8.13±1.43 years (range: 6-11 years) with a male predominance (29/30, 96.67%). The mean CE angle improved from 26.10±4.82° preoperatively to 34.16±3.91° at final follow-up, and the mean RMI decreased from 18.42±4.65 to 3.81±2.18. Twenty-three hips (74.19%) achieved spherical femoral heads, and 21 hips (67.74%) were classified as Stulberg grade 2. The mean Iowa hip score was 96.16±3.04 (range: 90-100). Statistically significant associations were observed between age at surgery and femoral head sphericity (p-value=0.040), Modified Elizabethtown classification and sphericity (p-value=0.019), and Modified Elizabethtown classification and Stulberg grade (p-value=0.023). Conclusion: Proximal femoral VDRO is an effective treatment for Perthes’ disease, yielding favourable radiological and functional outcomes. Early surgical intervention before advanced fragmentation significantly improves femoral head sphericity and overall hip outcome.

Comparative Evaluation of Kashmarya-Kshudrasaha Ksheerapaka and Ashwagandha Ksheerapaka Combined with Yogic Practices in Vatika Artava Dushti (Menstrual disorder): A Single-blind Randomised Clinical Trial

Lavina Jain, Hetal H Dave, Durgawati Devi, Jyotsna Thakur Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Artavadushti is a major cause of Yonivyapad (gynaecological disorders) and can significantly impair female fertility by disrupting normal reproductive functions. Symptoms of Vatika Artava Dushti (ayurvedic term for menstrual disorder) diminish women’s Quality of Life (QoL). The present study explores safe and affordable Ayurvedic and yogic therapies that target root causes to improve reproductive health. Aim: To assess the efficacy of Kashmarya-Kshudrasaha Ksheerapaka and Ashwagandha Ksheerapaka with Yogic practices in treating Vatika Artava Dushti. Materials and Methods: A total of 31 patients clinically diagnosed with Vatika Artava Dushti were enrolled for randomised control trial from the Outpatient Department (OPD) and In-patient Department (IPD) of the PrasutiTantra and StriRoga department at the National Institute of Ayurveda, Jaipur, Rajasthan, India, following screening based on inclusion criteria. One participant withdrew due to conception, resulting in 30 patients completing the trial. Written informed consent was obtained from all participants. They were randomly assigned into two groups of 15 each: Group A received Kashmarya-Kshudrasaha Ksheerapaka along with Yogic practices, while Group B received Ashwagandha Ksheerapaka with Yogic practices. The complete duration of the study was 60 days. Menstrual blood colour was evaluated using the RH/NIA/VADC Shade Card©, while pain levels and dysmenorrhoea severity were measured with the Visual Analogue Scale (VAS) and the Verbal Multidimensional Scoring System. The present study also assessed participants’ QoL and stress using the World Health Organisation-BREF (Brief Version) scale and Perceived Stress Scale (PSS), respectively. Data were recorded throughout the trial to monitor changes. To analyse the results, both within-group and between-group comparisons were made. Subjective improvements were tested using the Wilcoxon Signed Rank Test, and objective data with the paired t-test. For comparing groups, the Mann-Whitney U and Unpaired t-tests were applied based on data type. Results: Among 30 participants, Group A (Kashmarya-Kshudrasaha Ksheerapaka + Yogic practices) showed 75.38% overall relief, while Group B (Ashwagandha Ksheerapaka + Yogic prac-tices) showed 63.50%. Group A had greater improvement in menstrual flow duration, pad usage, menstrual blood colour (p=0.0039), days of discolouration (p=0.0023), and pain scores (VAS reduction p<0.0001). Intermenstrual intervals improved significantly in both groups. QoL and perceived stress improved in both groups. No adverse effects were reported. Conclusion: Kashmarya-Kshudrasaha Ksheerapaka combined with Yogic practices showed greater clinical improvement than Ashwagandha Ksheerapaka with Yogic practices in managing Vatika Artava Dushti, particularly in menstrual blood colour, pain, and days of discolouration. Both interventions significantly improved QoL and stress without adverse effects, suggesting a safe, holistic approach to menstrual disorders.

Assessment of the Toxicity Profile in Patients with Breast Carcinoma Receiving Paclitaxel Chemotherapy: A Prospective Observational Study

Ashish Jivani, Raju Shinde, Ashish Vaidya, Pooja Batra, Sanjeev Gianchandani Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Paclitaxel is a commonly used chemotherapeutic agent in the management of breast carcinoma however, it is frequently associated with treatment-limiting toxicities that can adversely affect patient outcomes and quality of life. Aim: To evaluate the toxicity profile of paclitaxel-based chemotherapy in patients with breast carcinoma and to compare toxicities between weekly and three-weekly treatment regimens. Materials and Methods: The present prospective observational study was conducted among 40 histopathologically confirmed female patients with breast carcinoma receiving paclitaxel chemotherapy at Jawaharlal Nehru Medical College between April 2023 and March 2025, in Maharashtra, India. Toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE) and pain was assessed using the Visual Analogue Scale (VAS). Among 40 patients, 21 patients received weekly paclitaxel (80 mg/m2) and 19 patients received three-weekly paclitaxel (175 mg/m2). Anaemia and neurological status were assessed before each cycle. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 22 and a p-value <0.05 was considered statistically significant. Results: The mean age in the three-weekly and weekly groups was 51.95±8.38 years and 52.33±8.50 years, respectively, with no statistically significant difference (p=0.886). A highly significant increase in Chemotherapy-Induced Peripheral Neuropathy (CIPN) was observed, with 35 out of 40 patients (17 patients in the three-weekly and 18 patients in the weekly groups) developing neuropathy by the final cycle (p<0.0001). Pain scores increased significantly following chemotherapy (p<0.001), with a greater rise observed in the three-weekly group. Treatment-emergent toxicities included thrombophlebitis in 29 patients (72.5%), while hypersensitivity reaction, cardiac toxicity, and thrombocytopenia were observed in one patient each (2.5%). Conclusion: Both weekly and three-weekly paclitaxel regimens were associated with a significant increase in peripheral neuropathy and pain, with a relatively higher toxicity burden observed in the three-weekly schedule.

Prevalence and Determinants of Exercise-induced Bronchoconstriction in Urban School Children: A Cross-sectional Study from Bengaluru, India

AR Somashekar, Pavithra Nagaraj, Vidyasagar Dharmapuri, Vijayan Nancy Jeniffer, Sri Vidya Krishnamurthy Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Exercise-induced Bronchoconstriction (EIB) is a serious illness that affects children living in urban areas with high pollution levels. Indian data on its prevalence using objective exercise challenge testing are limited, with most studies relying on symptom-based assessment alone. Aim: To estimate the prevalence of EIB and identify associated factors among urban school children using standardised spirometry-based evaluation in Bengaluru urban school children aged 9-18 years. Materials and Methods: A cross-sectional study was conducted over 12 months from September 2018 to August 2019, in 15 randomly selected schools across Bengaluru, Karnataka, India involving 984 children. The study was conducted by the Department of Paediatrics, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India. Spirometry, or pulmonary function testing, was performed on 984 par-ticipants, before and after a 6-Minute Walk Test (6MWT). A reduction of ≥10% in FEV1 post-exercise con-firmed the diagnosis of EIB. A modified version of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire was used to gather anthropometric, demographic information and environ-mental exposures. Risk factors and variations in EIB prevalence were analysed using t-tests, Analysis of Variance (ANOVA), logistic regression, and McNemar’s test. Results: The overall prevalence of EIB was 58% (p-value <0.0001, OR=0.166, 95% CI 0.124-0.223). Children living in industrial areas had a higher prevalence (67.5%) than children living in non industrial areas (45.2%; p-value=0.001). Prevalence was significantly higher in children aged 12-14 years (71.5%) compared to the younger (11.7%) and older age groups (16.8%) (p-value=0.001). EIB prevalence was influenced by socio-economic status, with higher rates (60.3%) observed in lower socio-economic groups and lower rates (18.8%) in higher socio-economic groups (p-value=0.014). Children engaged in regular physical activity had an increased risk (64.4%; p-value=0.002, OR=1.52) compared to children with no regular physical activity. No significant associations were found with parental smoking (p-value=0.132) or family history of asthma (p-value=0.38). Conclusion: This study demonstrated a high prevalence of EIB among urban school children aged 9-18 years in Bengaluru, with significant associations with age group, residential environment, socio-economic status, and physical activity.

Effectiveness of an Educational Intervention on Community Pharmacists’ Knowledge, Attitudes, and Dispensing Practices Regarding Topical Corticosteroids in North Kerala, India: A Quasi-experimental Study

Sreeraj Kandoth, Narayana Charyulu Rompicherla, Sarath Chandran Chadrashekar Shenoy, Uday Venkat Mateti, SM Sarin, Juno Jerold Joel Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Topical Corticosteroids (TCs) are essential in dermatological care, offering rapid relief for inflammatory skin conditions. However, irrational use- including inappropriate potency selection, unsupervised application, and cosmetic misuse- remains widespread, leading to adverse effects and treatment failure. Community pharmacists, given their accessibility and frequent patient contact, are well-positioned to promote rational TC use through informed dispensing and patient education. Yet, gaps in knowledge and practice persist often driven by attitudinal and regulatory challenges. Aim: To evaluate the effectiveness of a structured educational intervention in enhancing community pharmacists’ knowledge, attitudes, and dispensing practices related to TCs and their combinations in North Kerala, India. Materials and Methods: A quasi-experimental study was conducted among 60 community pharma-cists from north Kerala using a validated 21-item questionnaire covering three domains: knowledge (five-items), attitude (four-items), and practice (seven items)-along with four demographic questions and one demographic identifier, during January 2025 to June 2025. The intervention comprised a focused training module addressing rational TC use, regulatory guidelines, Adverse Drug Reactions (ADR), and patient counselling. Statistical analysis included McNemar’s test for paired nominal data and the Wilcoxon signed-rank test for ordinal responses. Results: Post-training, significant improvements were observed in all domains. Knowledge scores increased markedly, with correct responses regarding the mechanism of action increased from 42.86% to 83.93% (p-value <0.001). Attitudinal shifts included enhanced information-seeking behaviour (from 10.71% to 53.57%) and a notable reduction in financial motivation influencing dispensing decisions p-value <0.001). Practice behaviours improved substantially: the previously widespread habit of dispensing TCs without a valid prescription showed a sharp decline following the intervention (p-value <0.001), and patient counselling practices increased significantly (from 17.86% to 78.57%, p-value <0.001). A significant improvement was observed in pharmacists’ attitude toward informing patients about adverse drug reactions during dispensing, increasing from 12.5% (7/56) pre training to 76.8% (43/56) post-training (p-value <0.001). Conclusion: The intervention significantly improved pharmacists’ competence in rational TCs dispensing and patient-centered care. Incorporating such modules into continuing professional development could strengthen primary-care pharmacotherapy and reduce irrational medication use.

Effectiveness of Neck and Scapular Stability Exercises on Pain and Disability of Neck and Shoulder among Toy Makers of Neelasandra, Channapatna Taluk, Ramanagara District, Karnataka, India: A Quasi-experimental Study

Anusha V Shenai, VK Paul Daniel, Stephiya Davis, R Pruthviraj Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Toy makers are exposed to prolonged repetitive upper-limb activity and sustained postures, placing them at high-risk for Work-Related Musculoskeletal Disorders (WMSDs), particularly affecting the neck and shoulder regions. Despite this occupational burden, limited research has examined targeted rehabilitation strategies for this artisan population. Aim: To determine the prevalence of WMSDs and evaluate the effectiveness of neck and scapular stability exercises on neck and shoulder pain and disability among toy makers in Channapatna, Karnataka, India. Materials and Methods: A quasi-experimental study was conducted among 210 toy makers (30-60 years) working minimum of one hour/day with chronic neck and shoulder pain (>3 months). Baseline WMSD prevalence was assessed using the Standardised Nordic Musculoskeletal Questionnaire. Outcomes included Shoulder Pain and Disability Index (SPADI), Neck Disability Index (NDI), shoulder rotator strength (hand-held dynamometry), and deep cervical flexor performance {Cranio-Cervical Flexion Test (CCFT) using pressure biofeedback}. The intervention followed a hybrid model over four weeks with supervised in-person sessions and telerehabilitation via video call, using standardised progression. Pre-post assessments were performed by a blinded assessor. As data were non normally distributed (Kolmogorov-Smirnov), pre-post changes were analysed using Wilcoxon signed-rank test (p-value <0.05). Results: Twelve-month prevalence of WMSDs was highest for shoulder (91.4%) and neck (72.9%), with work limitation reported in 47.1% and 41.9%, respectively. Postintervention, SPADI and NDI scores reduced significantly (both p-value <0.001). Bilateral shoulder rotator strength and CCFT performance improved significantly (all p-value <0.001), with reduced pressure variation indicating improved cervical motor control. Conclusion: A hybrid supervised-telerehabilitation neck and scapular stability program produced clinically meaningful reductions in pain and disability with significant gains in strength and cervical motor control, supporting targeted stabilisation as a scalable intervention for occupational WMSDs.

Development and Content Validation of a Novel Iliotibial Band Friction Syndrome Index Questionnaire: A Cross-sectional Study

Ritika Kashyap, Manu Goyal, Aditi Nagpal, Chhaya, Muskan Bathla, Kanu Goyal Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The Iliotibial Band Friction Syndrome (ITBFS) diagnosis is based on clinical reasoning. Ober’s test and the Noble compression test are examples of diagnostic techniques, but there is no specific diagnostic standard assessment questionnaire for ITBFS. Neither the original nor the modified Ober’s test appears to accurately measure ITB tightness. To the best of our understanding there is no tool available to diagnose the patients with ITBFS. Aim: To develop and validate an index tool for ITBFS. Materials and Methods: The present cross-sectional content validation study was conducted at Maharishi Markandeshwar Super Speciality Hospital, Mullana, Ambala, Haryana, India, from August 2025 to December 2025. The study was conducted in two sequential phases to ensure a systematic and scientifically rigorous approach: Phase I: Questionnaire development and Phase II: Content validity assessment. Based on the findings from the literature, an initial pool of items was generated. The generated items were reviewed through focused discussions with two experts in musculoskeletal and sports physiotherapy. A panel of seven physiotherapy experts participated in the validation process. The Scale Content Validity Index (S-CVI) {S-CVI/UA (Universal agreement) and S-CVI/A(Average)} was also computed to determine the overall content validity of the questionnaire. Results: The developed tool possesses excellent content validity, supported by strong agreement among expert panelists with item-level content validity that was greater than 0.8 for every tool item. The S-CVI/A of the created Iliotibial Band Friction Syndrome Index (ITBFSI) tool was 0.985. Additionally, the S-CVI/UA value of 0.9 further supports strong universal agreement across the included items. Conclusion: ITBFSI is a valid tool which can help to diagnose the patients with ITBFS.

Microbial Spectrum, Resistance Patterns, and Outcomes in Febrile Neutropenic Cancer Patients: A Retrospective Observational Study

Godson Shaji, Sreeraj Vasudevan, Geethalakshmi Velayudhan, Mariya Johnson, Alga Thomas, Vidhu Joshy, Reena John, Anil Jose Thazath Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Febrile Neutropenia (FN) represents a critical medical emergency in the field of oncology, necessitated by the profound state of immunosuppression that follows cytotoxic chemotherapy. In regions like India, the management of FN is increasingly complicated by an escalating prevalence of Multidrug-Resistant (MDR) pathogens, which threatens to render traditional empirical antibiotic regimens obsolete. Aim: To analyse short-term outcomes, including 30-day mortality and reinfection, in oncology patients with FN. Materials and Methods: This retrospective observational study was conducted at Amala Institute of Medical Sciences, Thrissur, in Central Kerala, India, from January to December 2024. A total of 340 FN episodes were analysed. Blood cultures were processed using the BACT/ALERT automated system. Organism identification and Antimicrobial Susceptibility Testing (AST) were performed via the VITEK 2 Compact using specific identification cards. Interpretation of resistance followed the Clinical and Laboratory Standards Institute (CLSI) M100 34th edition (2024) guidelines. Descriptive statistics, including means with standard deviations and frequencies, were used to summarise baseline data. Predictors of 30-day mortality were identified using univariate and penalised multivariable (ridge) logistic regression analysis with a p-value <0.05 considered statistically significant. Results: Among the 340 FN episodes, 149 (43.8%) were culture-positive. Gram-Negative Bacilli (GNB) predominated (53.7%), led by Klebsiella spp. (25.0%) and Acinetobacter baumannii (17.5%). High resistance was noted among Enterobacterales, with 71.1% ESBL production and 35.56% phenotypic Carbapenem-resistant Enterobacterales (CRE). The 30-day all-cause mortality rate was 21.5% (32/149), primarily driven by GNB infections (56.2%). MDR organism positivity was the only significant independent predictor of mortality (aOR: 3.64; 95% CI: 1.67-7.91; p-value=0.0011). Reinfection within 30 days occurred in 38.5% of survivors. Conclusion: There is a high burden of ESBL and Carbapenem resistance GNB among FN in the study, which demands the use of aggressive antimicrobial therapy. These findings underscore the necessity for active microbiological surveillance and the early initiation of aggressive empirical antimicrobial therapy to improve clinical outcomes and mitigate the high burden of reinfection in FN oncology patients.

Development and Validation of the Tamil Version of Gerotranscendence Scale among Institutionalised Elderly People in Chennai, India: A Cross-sectional Study

S Vaishnavi Prashanth, Preetha Elizabeth Chaly, SG Ramesh Kumar, Akila Ganesh, Mohammed Meera Riyaz Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The concept of gerotranscendence reflects a shift in an individual’s understanding of self, relationships and existential perspectives in later life. Validated tools to assess this construct in Indian regional languages are limited particularly for populations living in long-term care settings. Aim: To translate, culturally adapt and validate the Tamil version of the Gerotranscendence Scale (GTS-T) among Institutionalised elderly in Chennai, Tamil Nadu, India. Materials and Methods: A cross-sectional study was carried out among the 182 elderly residents aged ≥65 years. The 10-item GTS was translated into Tamil following standard World Health Organisation (WHO) forward-backward translation and expert review protocols. Content validity was assessed using the Content Validity Index (CVI). Convergent validity was examined through the correlation with the Sense of Coherence (SOC) scale, while discriminant validity was established by comparing GTS-T scores between participants with (Group I,n=40) and without (Group II, n=40) Oral Frailty (OF). Cross-cultural validity was tested using Confirmatory Factor Analysis (CFA) with a three-factor model. Reliability was assessed through internal consistency (Cronbach’s α) and test-retest stability using the Intraclass Correlation Coefficient (ICC). Results: Among 182, 94 (51.6%) were males and 88 (48.4%) were females with the mean age 71.8±5.4 years. The GTS-T showed significant content validity (I-CVI=0.60-1.00; S-CVI=0.88). CFA supported a three-factor model cosmic, coherence, and solitude with factor loadings above 0.40. Convergent validity demonstrated a moderate positive correlation with the SOC scale (r=0.56, p<0.001). Discriminant validity was supported by significantly higher GTS-T scores among participants without OF (22.3±3.8) than those with frailty (18.7±4.3; p=0.03). The scale demonstrated good internal consistency (Cronbach’s α=0.86) and strong test-retest reliability varied across items (ICC range: 0.192-0.862), indicating heterogeneous temporal stability with some items demonstrating poor reliability. Conclusion: The GTS-T showed satisfactory psychometric properties, including content, convergent, discriminant and cross-cultural validity along with high internal consistency and test-retest reliability proving its suitability for Tamil-speaking elderly populations.

Radiographic and Clinical Association between Pelvic Incidence-lumbar Lordosis Mismatch and Disability in Chronic Low Back Pain: A Retrospective Single-centre Study

Shivaani Venkatramanan, KV Arun Kumar, E Pradeep, Chockalingham Kasi, Gaurav Kumar, Sudharsanan Kumar, Sayan Khan, Steve Merwyn Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Pelvic Incidence- Lumbar Lordosis (PI-LL) mismatch is a key sagittal alignment parameter that may influence pain and disability in patients with Chronic Low Back Pain (CLBP). While its relevance in spinal deformity and surgical cohorts is established, its role in non surgical CLBP patient remains underexplored. Aim: To assess the relationship between the mismatch of PI-LL and the level of functional disability in individuals diagnosed with CLBP, based on findings from standing lateral lumbosacral spine radiographs. Materials and Methods: This retrospective study was conducted at a tertiary care teaching hospital included 120 patients with CLBP. Standing lateral lumbosacral radiographs were used to measure PI and LL, and PI-LL mismatch was calculated. Functional disability was assessed using the Oswestry Disability Index (ODI), and pain severity using the Visual Analogue Scale (VAS). Patients were divided into minimal disability (ODI ≤20%) and moderate-to-severe disability groups (ODI >20%). Correlation analysis, Receiver Operating Characteristic (ROC) curve, and multivariate regression were performed. Results: The mean PI-LL mismatch was significantly higher in the moderate-to-severe disability group (12.9±8.0°) than in the minimal disability group (2.5±4.1°, p-value <0.001). PI-LL mismatch showed a strong positive correlation with ODI (r=0.62) and VAS (r=0.51). ROC analysis identified an optimal PI–LL mismatch cut-off of 9.1°, approximating the clinically relevant threshold of 10° for predicting moderate-to-severe disability (specificity: 89.5%, sensitivity (78%), PPV: 94.1%). In multivariate analysis, PI-LL mismatch remained an independent predictor of disability (β=0.55, p-value <0.001), along with pain severity. Conclusion: PI-LL mismatch is an independent predictor of disability in CLBP. A mismatch of approximately >10° may identify patients at higher risk of functional impairment and guide targeted management strategies.

Comparison of Estimated Glomerular Filtration Rate from Venous and Umbilical Cord Blood in Preterm and Low-birth-weight Neonates using Creatinine and Cystatin-C: A Case-control Study

M Vasanthan, PJ Shiny, S Shenbaga Lalitha, C Ashok, VM Vinodhini, Subash Sundar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Premature and Low-Birth-Weight (LBW) neonates demonstrate underdeveloped organs, including low nephron counts, rendering them susceptible to renal impairment subsequently. Therefore, early and accurate detection of kidney dysfunction is important for management. Traditionally, serum creatinine is used for estimating Glomerular Filtration Rate (GFR), which maternal levels and neonatal muscle mass may influence. Therefore, cystatin-C, a non protein-bound, low-molecular-weight marker, is tested for this study for the early detection of renal dysfunction. Aim: To identify creatinine or cystatin-C as a better marker in premature and LBW neonates. Materials and Methods: This case-control study was conducted from June to October 2022 at the SRM Medical College Hospital, Tamil Nadu, India. The participants were from Chengalpattu district, including 63 rural and 47 suburban pregnant women. The primary inclusion criteria were neonates diagnosed as premature and LBW, with a sample size of 53 neonates per group. A 3-5 mL of venous and cord blood samples of neonates were collected, serum was separated and stored at -20°C to estimate creatinine, cystatin-C levels and GFR. The results were expressed as mean values, and statistical significance was assessed using the Student’s t-test, with a p-value <0.05 considered statistically significant. Results: Cystatin-C were found to be 1.9±0.8 mg/dL and significantly higher in cord blood samples in comparison with the control. The cystatin-based eGFR value was found to be 91.4±43.2 mL/min and 149±35.4 mL/min for venous and cord blood samples, respectively. Whereas only cystatin-C was statistically significant in venous blood samples. However, GFR based on creatinine and cystatin-C was significantly decreased in both venous and cord blood samples. Conclusion: The AUC for cystatin-C in cord blood samples was found to be 0.7, indicating its reliability compared to creatinine. Moderate accuracy observed indicates the need for a larger number of samples for the establishment of a diagnostic marker. Thereby, for cystatin-C to be used as a marker for renal dysfunction further validation is required.

Clinicopathological Evaluation of Mucocele and Associated Salivary Gland Changes: A Five-year Retrospective Study

Rupa Ramkumar Sharma, Shradha Jaiswal, Bhupesh Bhayyaji Bagulkar, Atul Bhat, Sumiran Sinha, Anagha Soni Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Oral Mucoceles is a painless, asymptomatic swelling which results from the accumulation of mucin caused by either obstruction or severance of the duct of a minor salivary gland present in the oral cavity. Aim: To evaluate the clinicopathological features of oral mucoceles and the associated histopathological changes in adjacent salivary gland tissue. Materials and Methods: A cross-sectional study was conducted at the Department of Oral and Maxillofacial Pathology and Microbiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India from January 2020 to December 2024, comprising 43 histologically confirmed cases of Oral Mucoceles (OM). Clinical parameters, including age, gender, lesion site, history of trauma, and duration, were recorded. Histopathological evaluation included the type of mucocele (extravasation or retention), severity of inflammation (mild, moderate, severe), acinar type (serous/mucous), presence of necrosis, and glandular architectural changes. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 13.0, and associations between categorical variables were tested using the Chi-square test, with results presented in tables. Results: Among the total 43 cases studied, OMs predominantly affected young male individuals, with 30 males (69.8%) and 13 females (30.2%). In the present study, OMs were observed among patients aged between 13 and 60 years, with a mean age of 27.9 years. The lower lip was the most common site, 37 cases (86%), and most lesions exhibited a pinkish-red hue, 38 cases (88%). A spontaneous onset was observed in 36 cases (83%), while a minority were associated with trauma. Extravasation-type mucoceles were overwhelmingly predominant, 42 cases (97%), and no recurrences were noted. The most frequent histopathological alterations in the associated salivary glands were ductal distension and acinar atrophy, 23 cases (53%). Conclusion: OMs are frequently seen in young individuals and are usually associated with the extravasation phenomenon. Correlating clinical presentations with histological features may assist in clinicopathological interpretation and improve management strategies for OMs.

Systemic Immune Inflammatory Index and Systemic Inflammatory Response Index in Invasive Ductal Carcinoma of the Breast and their Association with Molecular Types, Grade and Stage of Disease: A Cross-sectional Study

Manju Alex, Kalyani Raju, KS Gopinath Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Breast cancer is the most frequently encountered malignant tumour in women around the world with high incidence and mortality rates worldwide. The concept of being able to prognosticate breast cancer based on routine peripheral blood examinations is attractive given the ease of access, replicability, and lower cost. Aim: To estimate the Systemic Immune-inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI) in invasive ductal carcinoma of breast and to study association between SII and SIRI with prognostic parameters such as molecular subtypes, Grade and Stage of the disease. Materials and Methods: This retrospective cross-sectional analytical study was conducted at Departments of Pathology and Surgical Oncology, Sri Devaraj Urs Medical college, Tamaka, Karnataka, India, from February 2024 to August 2024 it included 90 histopathologically confirmed cases of invasive ductal carcinoma of the breast diagnosed between January 2018 and December 2020. Clinicopathological data such as age, tumour grade, stage, and molecular subtype were obtained from medical records. Neutrophil, lymphocyte, monocyte, and platelet counts were obtained from case files. The SII and SIRI were calculated using standard formulas. Optimal cut-off values were derived using Receiver Operating Characteristic (ROC) curve analysis, and patients were categorised into high and low index groups. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Associations between inflammatory indices and prognostic parameters were assessed using the Chi-square test, with p<0.05 considered statistically significant. Results: A total of 90 patients with invasive ductal carcinoma of the breast were included in the study. Based on ROC analysis, the cut-off values for SII and SIRI were 568.83 and 0.831, respectively. High SII levels showed a statistically significant association with histological grade (p=0.002). However, no significant association was observed between SII and tumour stage (p=0.235) or molecular subtype (p=0.770).Similarly, elevated SIRI levels were significantly associated with histological grade (p=0.013) and tumour stage (p=0.022). No significant association was observed between SIRI and molecular subtypes (p=0.734). Conclusion: Systemic inflammatory indices such as the SII and SIRI represent accessible, inexpensive, and non invasive tools that may aid in prognostic assessment and risk stratification in patients with invasive ductal carcinoma of the breast. Their evaluation using routine peripheral blood parameters highlights the potential clinical utility of inflammation-based biomarkers in the overall management and prognostication of breast cancer.

Diagnostic Accuracy of Skin Prick Test in Invasive Fungal Sinusitis: A Cross-sectional Study

Sumit Bhatti, Williams C Sunny Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Invasive Fungal Sinusitis (IFS) is a life-threatening infection with a rapid progression. Early diagnosis is crucial for optimal patient outcomes. Skin Prick Testing (SPT) is a simple, non invasive test that could potentially aid in early detection. Aim: To assess the diagnostic accuracy of SPT in identifying IFS caused by Mucor, Aspergillus, Rhizopus and Fusarium. Materials and Methods: A cross-sectional study was conducted at Department of Ear, Nose and Throat (ENT), KEM Hospital, Pune, Maharashtra, India, from August 2017 to April 2019. Patients with clinically and radiologically suspected IFS were evaluated and the diagnosis was confirmed by histopathological examination of sinonasal tissue, which was considered the gold standard. The primary outcome measured was the diagnostic utility of SPT by comparing SPT results with histopathological findings. Statistical analysis included calculation of sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), with categorical variables analysed using the Chi-square test or Fisher’s-exact test, as appropriate. Results: A total of 25 patients with IFS were enrolled, with a mean age of 63.3±10.1 years. SPT revealed positive results in 13/25 (52%) of patients for Mucor, 9/25 (36%) for Aspergillus, 2/25 (8%) for Fusarium and 1/25 (4%) for Rhizopus. SPT for Mucor demonstrated high sensitivity (81.2%) and specificity (100%), while SPT for Aspergillus showed perfect diagnostic accuracy (100% sensitivity, specificity, PPV, NPV and accuracy), whereas SPT for Fusarium and Rhizopus sensitivity could not be calculated and 0% PPV despite high specificity (92% and 96%, respectively), limiting their diagnostic value. Conclusion: The SPT demonstrated excellent diagnostic accuracy for Aspergillus and good accuracy for Mucor, whereas it had limited value for Fusarium and Rhizopus.

Genetic Variant of Arylamine N-Acetyltransferase-2 G590A Polymorphism (rs1799930) in Xenobiotic Biotransformation and Tobacco-associated Periodontitis: A Cross-sectional Observational Study

Dhathri Priya Bandi, Dhayanand John Victor, Sangeetha Subramanian, Balasubramanian Krishnaswamy Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Xenobiotic compounds in tobacco smoke necessitate metabolic detoxification via N-acetyltransferase enzymes; individuals harbouring the N-Acetyltransferase-2 (NAT2) (G590A) polymorphism exhibit impaired biotransformation proficiency, thereby amplifying their susceptibility to periodontal degradation in periodontal disease patients. Although tobacco use is a well-established risk factor for periodontal disease, marked inter-individual variability in disease severity among tobacco users suggests the influence of genetic determinants involved in xenobiotic metabolism. Aim: To evaluate the role of the NAT2 G590A polymorphism (rs1799930) in xenobiotic biotransformation and to assess its association with tobacco-associated periodontal disease. Materials and Methods: This cross-sectional observational study was conducted in the Outpatient Department of Periodontology, SRM Dental College and Hospital, Chennai, Tamil Nadu, India, over a duration of one year (January 2013 to December 2013). A total of 110 individuals clinically diagnosed with chronic periodontitis were recruited and grouped based on tobacco exposure into smokers (Group-I, n=55) and non smokers (Group-II, n=55). Peripheral venous blood samples were collected under aseptic conditions, and genomic Deoxyribonucleic Acid (DNA) was isolated using a standard commercial extraction kit. The N-acetyltransferase-2 (NAT2) G590A polymorphism (rs1799930) was genotyped using Polymerase Chain Reaction (PCR)- Restriction Fragment Length Polymorphism (PCR-RFLP) with allele-specific primers, followed by DNA sequencing for validation. Statistical significance was assessed using the Chi-square test for genotype and allele frequencies, with a p-value <0.05 considered statistically significant. Results: Compared to non smokers, smokers with chronic periodontitis patient had a considerably greater frequency of N-Acetyltransferase-2 (G590A) polymorphism (p=0.005). A predominance of the heterozygous GA genotype was observed in smokers with periodontal disease (Group-I) (67.6%) versus Group-II (32.4%), translating to a markedly elevated risk for disease susceptibility {Odds Ratio (OR)=3.542; 95% Confidence Interval (CI): 1.465-8.560; p=0.005}. Carriers of the GA genotype exhibited significantly greater periodontal destruction, reflected by increased Probing Pocket Depth (PPD) (p<0.001) and Clinical Attachment Loss (CAL) (p<0.001), indicating enhanced susceptibility to tobacco-induced periodontal damage. Conclusion: The conspicuous overrepresentation of the NAT2 (G590A) polymorphism among smokers with chronic periodontitis underscores the cardinal role of genetic predisposition in shaping disease trajectories. The slow acetylator genotype, reflecting impaired xenobiotic detoxification, potentiates tobacco-induced periodontal tissue damage and highlights the relevance of genotype-based periodontal risk stratification.

Protocol Development for Virtual CAD/CAM Surgical Guides in Non Restorable Single Tooth Implant Rehabilitation: A Computational Simulation Study

Vyankatesh Naidu, Santosh Jaju Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Accurate implant positioning in single non restorable tooth rehabilitation is critical due to limited anatomical space and sensitivity to angular deviation. Virtual Computer-aided Design (CAD)/Computer-aided Manufacturing (CAM) surgical guides improve drilling control; however, their mechanical stability depends strongly on guide design and stabilisation strategy. Developing a structured protocol that integrates mechanical validation within digital guide fabrication remains essential for predictable guided implant placement. Aim: To develop and computationally evaluate a virtual CAD/CAM protocol for tooth-specific surgical guides incorporating bend-plate reinforcement for improved stability in single-tooth implant rehabilitation. Materials and Methods: This computational simulation study was conducted at the Department of Mechanical Engineering, G H Raisoni College of Engineering, Nagpur, Maharashtra, India, over a period of six months, from June 2025 to November 2025. Cone Beam Computed Tomography (CBCT)-derived anatomical data were processed using Medical Information Mart for Intensive Care (MIMICS) and 3-Matic software to design three guide geometries: pilot-drill, complete-drill and palatal-supported guides. Each geometry was evaluated under three stabilisation strategies tooth-supported, anchor-pin-assisted and bend-plate-assisted resulting in nine biomechanical configurations. Finite Element Analysis (FEA) assessed deformation, Von-Mises stress and Factor Of Safety (FOS) under simulated drilling loads. Virtual implant positioning deviation was quantified using coronal, apical, angular and depth error metrics. Comparative numerical analysis was performed. Results: Progressive improvement in mechanical stability was observed from tooth-supported to anchor-pin and bend-plate-assisted configurations across all guide designs. Bend-plate-reinforced guides demonstrated the lowest deformation and stress responses with higher safety margins, while the palatal-supported bend-plate design exhibited the most favourable biomechanical performance. Virtual deviation analysis showed corresponding reductions in implant positional errors, indicating enhanced trajectory control with increased stabilisation. Conclusion: The proposed virtual CAD/CAM protocol successfully integrates bend-plate reinforcement into tooth-specific surgical guides, resulting in improved mechanical rigidity and predictive implant positioning accuracy. This framework provides a scalable foundation for future experimental validation and clinical translation in guided implant surgery.

Adaptation of the PERMA-Profiler for Measuring Well-being among Healthcare Professionals at a Tertiary Care Teaching Hospital in Kerala, India: A Cross-sectional Study

Vinod Kumar Puzhikunnathu, Boney Rajan, Renjitha Bhaskaran Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The well-being of healthcare employees is crucial for their work performance, the quality of care they provide, and their ability to manage patient stress in high-pressure environments. The Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA) model is multidimensional. However, there is limited research on its applicability within the Indian healthcare context, where hierarchical organisations and professional pressures may impact employee well-being. Aim: The present study aimed to evaluate the reliability and validity of the Workplace PERMA-Profiler among Healthcare Workers (HCW) in Kerala, India and to develop a culture-specific tool to assess and enhance their well-being. Materials and Methods: The current cross-sectional study was conducted at Amala Institute of Medical Sciences in Kerala, India from August to December 2021, involving 406 participants including doctors, house surgeons, nursing staff, and Ayurveda practitioners. Out of these, 330 completed the 23-question questionnaire based on the Workplace PERMA-Profiler, assessing well-being on an 11-point scale (0-10). Mean scores for each factor were calculated, and participants were analysed by designation and department. The internal consistency of the Workplace PERMA-Profiler was evaluated using Cronbach’s alpha, and Confirmatory Factor Analysis (CFA) for 15 items was performed to confirm 5-factor structural validity. Model fit was assessed using indices such as χ2, Comparative Fit Index (CFI), Tucker-Lewis index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardised Root Mean Square Residual (SRMR). A p-value of <0.05 was deemed statistically significant. Results: Cronbach’s alpha (α) ranged from 0.31 to 0.90, with strong model fit indicated by CFI and TLI above 0.9, and square root mean square residual values below 0.06. The root mean square error was about 0.05. The highest correlation was observed between meaning and accomplishment (ρ=0.746), and accomplishment and happiness (ρ=0.673), and females exhibit a larger representation of positive well-being (Very high and high functioning), with males being more focused on the normal functioning category (p-value=0.012). The first CFA of the PERMA profiler showed that most items load adequately on their intended latent factors. The factor loading (β) ranged from 0.31 to 0.85 for positive emotion and 0.637-0.76 for accomplishment. Professors and associate professors exhibited high levels of well-being. Conclusion: Senior residents, especially those under 30, reported lower well-being compared to professors, who enjoyed greater satisfaction and emotional stability. This suggests a need for mentorship and support to improve well-being and foster a healthier clinical workforce.

Menstrual Hygiene and Waste Disposal Practices among Reproductive-age Women in Rural and Urban Tamil Nadu, Southern India: A Cross-sectional Study

Rock Britto Dharmaraj, Neethu George, Chellathurai Brilly Swarna, Balaji Gowsalya, Sowrath Saravanan Hari Prasath, Gobichettipalayam Panneer Selvam Harini, Kannan Harine, Ramesh Harita Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Despite menstruation affecting women for approximately 2,100 days throughout their lifetime, menstrual waste disposal remains an under-researched “double invisibility” issue with significant public health and environmental implications. Aim: To assess the menstrual hygiene practices, the different menstrual waste disposal methods practised among rural and urban populations, and to study the various demographic variables associated with the menstrual hygiene and menstrual waste disposal practices. Materials and Methods: The present analytical cross-sectional study was conducted among the field practice area of Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur, Tamil Nadu, South India from September 2024 to November 2024. Reproductive-age women (15-49 years) from rural and urban areas of Perambalur district, Tamil Nadu were included. A multi stage sampling methodology was employed, randomly selecting 5 villages and 5 urban wards, followed by population proportion to size sampling and convenience sampling within households to achieve representative participant selection. Data was collected through structured face-to-face interviews using a pretested questionnaire covering sociodemographic characteristics, menstrual hygiene practices, and waste disposal patterns. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 26, employing Chi-square tests, Fisher’s exact test, and independent t-tests to examine associations between sociodemographic factors and disposal practices, with significance set at p<0.05. Results: Among 505 participants (mean age 30.09±7.45 years), 303 (60%) practised safe disposal through dustbins while 202 (40%) used unsafe methods, primarily burning 181 (35.8%). Safe disposal practices were significantly associated with residence {urban (100%) vs rural (29.1%), p<0.001}, marital status {unmarried (100%) vs married (37.7%), p<0.001}, educational attainment {graduates (64.7%) vs basic schooling (50.0%), p=0.006}, family type {nuclear (65.9%) vs joint (35.1%), p<0.001}, housing infrastructure {pucca (71.0%) vs kutcha (0%), p<0.001}, toilet facilities {in-house (71.8%) vs open space (0%), p<0.001}, water supply {piped/stored (100%) vs borewell (2.9%), p<0.001], and monthly expenditure {>Rs.100 (100%) vs < Rs.100 (35.3%), p<0.001}. Conclusion: Menstrual waste disposal practices are significantly influenced by sociodemographic factors, with urban residence, higher education, and better socioeconomic status strongly associated with safe disposal methods, highlighting the need for targeted interventions in rural and marginalised communities.

Evaluation of Trigger Factors of Acute Migraine Episodes among Medical Students: A Cross-sectional Study

Eesha Goel, Suman Bala, Yashpal Singh, Nikku Yadav, Ashwani Bhat, Akanksha Uniyal Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Migraine is most common headache disorder among all age group. Recurrent head-aches has been found to have direct impact on academic performance of students. Recognition and management of triggers play the important role in reducing impact of migraine. Aim: To evaluate the pattern of headache and trigger factors associated with migraine among the medical students. Materials and Methods: A cross-sectional study was carried out among 300 undergraduate medical students of Himalayan Institute of Medical Sciences, Dehradun from May 2022 to June 2022.Demographic details and response of participants were noted using a structured and validated questionnaire. The participants were asked to choose triggers on the basis of their experiences of last five episodes of acute migraine from a list of trigger factors. Frequency of triggers, severity of migraine episode and missed classes due to migraine were evaluated. The data was analysed using IBM SPSS version 22. To study the association between two qualitative variables, chi-square test was used. The p-value <0.05 was considered as statistically significant. Results: Among 300 medical students of mean age of 19.9±2 years, 28% were diagnosed with Migraine. Migraine prevalence was higher in females (63.5%). All the migraineurs reported to have at least one trigger and majority of them (85%) had more than three triggers. Stress was the most commonly re-ported trigger (85%) followed by sleep deprivation (75%), emotional changes (49%) and excessive use of mobile phone (42%). Participants with more than three triggers hade more frequent (2.67±1.87) headache episodes (p=0.04*), higher number of missed classes due to headache (7.39±3.706) (p<0.001**) and more severe episodes as per NRS scale (6.58±1.608) (p<0.001**). Conclusion: According to the present study findings, the students reported that higher number of triggers had more frequent, more severe and disabling headache episodes.

Equity in Clinical Trial Participation in India with a Focus on Reporting Gaps and Recruitment Reach in Oncology and Vaccination from 2020 to 2024: A Systematic Review

Arijita Manna, S Tejesh, Rovena Yazhini, Hotha Sai Srinivas Karpuram Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: To ensure the generalisability of research findings, equitable participation in research studies is very important. In India’s context, women, rural populations, and tribal populations have been observed to be less represented in certain critical research areas like oncology and vaccination research. Aim: To assess demographic discrepancies in recruitment for oncology and vaccination research conducted in India. Materials and Methods: A Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) -guided review of Clinical Trials Registry-India (CTRI) records spanning January 1, 2020, to December 31, 2024, was undertaken (PROSPERO registration: CRD420251086878; ethics approval: IIPHH/TRCIEC/442/2025). The analysis focused on prespecified indicators: sex-disaggregated participant counts, rural representation (defined as inclusion of ≥1 rural/PHC/CHC/community/outreach site), and tribal participation. To evaluate reporting completeness, a study-specific Equity Transparency Index (ETI) was applied, encompassing five domains. Descriptive statistics were generated, and associations were tested using χ² and Fisher’s exact tests, implemented in R software (version 4.5.1). Results: A total of 113 trials (n=68 oncology, n=45 vaccination) were analysed, with a planned enrolment of 192,330 participants. Sex-disaggregated data were available for only 31,940 (17.8%) oncology participants and 841 (6.4%) vaccination participants, primarily from women-only trials. Rural recruitment was reported in 55 (80.9%) oncology studies and 44 (97.8%) vaccination studies, with an overall rural enrolment of 76.0%. Reporting for Scheduled Tribes (ST) was very low, 3 (4.4%) oncology; n=0 vaccination, with these three studies inflating the oncology participant count significantly. No trials reported socio-economic indicators, leading to low-to-moderate transparency scores across funding sources. Conclusion: Although rural recruitment is improving, significant gaps in reporting {sex, tribal status, and Socio-economic Status (SES)} hinder meaningful equity assessments. It is crucial to mandate equity-focused reporting and plans to improve trial approval processes.

Effects of Systemic Steroid Treatment on Quality of Life and Computed Tomography Scoring in Patients of Chronic Rhinosinusitis: A Prospective Cohort Study

Devender Dayal, Himanshu Kumar Mittal, Nitin Gupta, Surinder Kumar Singhal Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Chronic Rhinosinusitis (CRS) is a clinical condition characterised by mucosal inflammation of the nose and paranasal sinuses, with symptoms lasting for more than or equal to 12 weeks. Steroids can improve the symptoms and Computed Tomography (CT) scores in many patients. Aim: To study the effects of systemic steroids on the quality of life and CT scoring in patients with CRS. Materials and Methods: This prospective cohort study was conducted over 18 months (January 2020 to June 2021) in the Department of Otorhinolaryngology-Head and Neck Surgery at Government Medical College and Hospital, Chandigarh, India. It included 60 patients, all over the age of five, who were clinically diagnosed with CRS. The Quality-of-Life (QoL) assessment was performed using the Sinonasal Outcome Test (SNOT)-22 questionnaire, and Lund-Mackay (LM) CT scoring was performed for each CRS patient included in the study before and after a short course of Oral Corticosteroids (OCS). Tablet Deflazacort was given over a period of two weeks, starting initially at a dose of 0.8-0.9 mg per kg of body weight (60 mg) once per day and tapered every three days to 30 mg, 18 mg, 12 mg, and 6 mg, respectively. The patients were re-evaluated after two weeks, and the results were compared within each study group. Changes in outcome parameters were assessed by using the Wilcoxon signed rank test. The Chi-square test was used to assess the significance of associations between outcome parameters and patient characteris-tics. Data Analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 25.0 software. Results: The average age of the participants was 35.67±13.83 years with 44 (73.3%) partici-pants being males and 16 (26.7%) females. Mean duration of symptoms was 6.5 months. Mean values of pre-steroid SNOT-22 score 52.60±20.51 improved to 15.40±13.24 after steroids (p-value <0.001). Mean values of pre-steroid LM CT Score was 16.02±6.07 which improved to 9.25±6.23 after steroids (p-value <0.001). Additionally, a statistically significant difference was observed in both categories when comparing pre-steroid and post-steroid SNOT-22 and LM CT scores (p-value <0.001 and p-value <0.001, respectively). Conclusion: The use of systemic steroids has shown a significant improvement in terms of QoL and CT scoring in patients of CRS and hence they can be used effectively in the management of this con-dition.

Comparison of Intravenous Esmolol and Intravenous Lidocaine for Attenuation of Haemodynamic Responses to Laryngoscopy and Tracheal Intubation: A Double-blinded Randomised Controlled Study

Upasna Bhatia, Harshal Sonagara Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Laryngoscopy and tracheal intubation are potent noxious stimuli that trigger significant haemodynamic surges through sympathetic activation and catecholamine release, leading to transient spikes in Heart Rate (HR) and Blood Pressure (BP). These changes may pose serious risks to patients with underlying cardiovascular conditions. Pharmacological attenuation of this response is a recognised goal of modern anaesthetic practice. Aim: To compare the efficacy of intravenous esmolol (1.5 mg/kg) and intravenous lidocaine (1.5 mg/kg) in attenuating the haemodynamic response to laryngoscopy and tracheal intubation in American Society of Anaesthesiologists (ASA) I and II patients undergoing elective surgery under general anaesthesia. Materials and Methods: This randomised, double-blind, controlled study included 60 ASA I and II patients aged 18-55 years, divided equally into two groups (n=30 each). Group E received i.v. esmolol 1.5 mg/kg, and Group L (control) received i.v. lidocaine 1.5 mg/kg, both administered three minutes be-fore intubation. Haemodynamic parameters, HR, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Rate-Pressure Product (RPP), were recorded at nine time points from baseline through 10 minutes postintubation. Continuous variables were expressed as mean±Standard Deviation (SD) and compared using Student’s unpaired t-test. A p-value <0.05 was considered statistically significant. Results: There were no significant differences in demographic variables between the groups. The mean age was 30.20±9.16 years in Group E and 33.10±11.18 years in Group L (p-value=0.277). HR at one minute postintubation was significantly lower in the esmolol group (71.80±12.85 bpm) compared to the lidocaine group (95.60±15.08 bpm; p-value <0.0001), with this difference persisting up to 10 minutes. SBP at intubation was significantly reduced in the esmolol group (127.26±13.16 mmHg vs 138.26±8.38 mmHg; p-value <0.0001), with sustained lower values across subsequent time intervals. DBP and MAP were also significantly lower in the esmolol group following intubation. The RPP was markedly lower in the esmolol group at intubation (9294.27±1717.70 vs 13340.53±2365.12; p-value <0.0001), indicating superior attenuation of the sympathetic response and reduced myocardial oxygen demand. Conclusion: While both agents help mitigate the stress response to intubation, intravenous esmolol provided superior control of HR, BP, and RPP, thereby ensuring better cardiovascular stability during the peri-intubation period. Hence, esmolol may be considered a more reliable agent for blunting intubation-induced sympathetic stress response.

Early Response-driven Tooth Survival Prognostication after Periodontal Therapy: A Cox-based Machine Learning Survival Model

Jennifer Jeyaruby Joyson, Pradeep Kumar Yadalam Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Accurate long-term prognosis of individual teeth is crucial for periodontal treatment planning. However, risk assessments mainly rely on baseline characteristics and overlook disease behaviour changes after therapy. Recent evidence indicates early clinical response better predicts tooth loss than initial severity, but few models incorporate this. Most tools depend on baseline data, making prognosis after therapy difficult. Aim: To develop and validate a Tooth-Level Survival Model (TSF-Net) predicting five-year extraction risk using one-year post-treatment clinical data response. Materials and Methods: This retrospective cohort study was conducted at Department of Periodontology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India, from September 2025 to December 2025. The study used electronic records at a dental institution, analysing 2,432 teeth from 120 patients treated for up to five years. It examined one-year changes in Clinical Attachment Level (CAL), Pocket Depth (PD), mobility, plaque and occlusal trauma as predictors. Survival analysis employed an elastic-net penalised Cox model with internal splits. Analyses were performed in R and Python; p<0.05 was significant. The study adhered to Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Prediction model Risk Of Bias Assessment Tool (PROBAST) guidelines. Results: During follow-up, 571 teeth (23.5%) were extracted; the model achieved a test concordance index of 0.71, with occlusal trauma {Hazard Ratios (HR) ˜2.0}, unfavourable CAL response (HR ˜1.55) and PD response (HR ˜1.31) as significant predictors; risk stratification showed five-year extraction rates of 1.5%, 22.3% and 40.0% across low-, moderate- and high-risk groups (log-rank p<0.001). Conclusion: The TSF-Net provides an interpretable, response-driven tooth-level survival prediction framework that enhances dynamic periodontal prognosis and supports individualised clinical decision-making.

Clinical Profile, Aetiological Assessment and Treatment Response of Nutritional Anaemia in Children based on IAP 2022 Guidelines: A Cross-sectional Observational Study

Mukundkumar Vaja, Maitri Joshi, Nidhi Shah, Apurva Patil, Pavan Gorle, Namratha Reddy Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Nutritional anaemia remains a significant public health concern in India, particularly affecting children due to inadequate dietary intake and increased physiological demands. The Indian Academy of Paediatrics (IAP) 2022 guidelines provide updated criteria for diagnosis and management of nutritional anaemia in the paediatric population. Despite the high prevalence of nutritional anaemia in India, there is limited data on the clinical profile, aetiological distribution, and treatment outcomes based on these updated guidelines in tertiary care settings. Aim: To assess the prevalence, aetiological profile, clinical characteristics, and therapeutic response of nutritional anaemia in children aged six months to 14 years based on the IAP 2022 guidelines at Dhiraj Hospital, a tertiary care centre in Vadodara, Gujarat, India. Materials and Methods: The present prospective interventional study was conducted at the Department of Paediatrics, Dhiraj Hospital, SBKS Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India from January 2023 to June 2024 (18 months). A total of 92 children aged six months to 14 years diagnosed with nutritional anaemia as per IAP 2022 criteria were enrolled. Detailed clinical history, anthropometric measurements, dietary assessment, and laboratory investigations including complete blood count, peripheral smear examination, serum ferritin, vitamin B12, and folate levels were performed. Treatment was initiated as per IAP guidelines and response was assessed at four weeks and three months. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26.0 with Chi-square test, t-test, and Analysis of Variance (ANOVA) as appropriate. A p-value of <0.05 was considered statistically significant. Results: The mean age of the study population was 4.82±2.67 years with female predominance (77/92, 83.7%). Iron deficiency anaemia was the most common type observed in 53.3% (n=49) of patients, followed by vitamin B12 deficiency anaemia in 27.2% (n=25), and mixed/dimorphic anaemia in 16.3% (n=15). Majority of children (70.7%, n=65) had moderate anaemia while severe anaemia was observed in only 3.3% (n=3). Urban predominance was noted in 83.7% (n=77) of children, which reflects the catchment area of Dhiraj Hospital, an urban tertiary care centre primarily serving the urban population of Vadodara. Lower-middle socioeconomic status was observed in 72.8% (n=67). Significant risk factors identified included vegetarian diet (81/92, 88%), malnutrition (73/92, 79.3%), delayed initiation of complementary feeding (66/92, 71.7%), and short duration of exclusive breastfeeding (53/92, 57.6%). Treatment response was good (defined as haemoglobin rise ≥1 g/dL or haemoglobin normalisation) in 96.7% (n=89) of patients with mean haemoglobin rise of 1.87±0.54 g/dL at 4 weeks and 2.72±0.68 g/dL at three months (p <0.001). Conclusion: Iron deficiency anaemia is the predominant type of nutritional anaemia in children, followed by vitamin B12 deficiency. The IAP 2022 guidelines provide an effective framework for diagnosis and management with excellent treatment response rates when combined with dietary counselling and compliance monitoring.

Healing the Healers: A Qualitative Phenomenological Study on Yoga Nidra and Nurses’ Well-being

Shany Thomas, Anusha Prabhakaran, Siddaram Sarate, Rachit Patel, Periadurachi Kumar, Bhalendu Vaishnav Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Nurses often face substantial challenges and stress due to multitasking and com-prehensive roles in the clinical setting, which can adversely affect their physical, psychological and emotional health. This, in turn, impacts the quality of patient care. Among various conventional thera-pies, Yoga Nidra, a guided meditation approach, remains the preferred way for promoting deep relaxation and mental clarity through a structured, simple framework, helping individuals to achieve inner calm and peace. Deep-rooted in indigenous wisdom, Yoga Nidra offers a conventional intervention to support nurs-es’ well-being. Aim: To explore the lived experiences and perceived impact of Yoga Nidra on nurses’ well-being. Materials and Methods: A qualitative phenomenological study was conducted at Shree Krishna Hospital in the Charotar region of Gujarat, India, from July 2024 to August 2024, to explore the effects of Yoga Nidra on nurses’ well-being. Twenty-five nurses from various clinical settings were recruited through purposive sampling. All 25 participants submitted their reflective diaries; three were incom-plete and excluded. The participants were encouraged to attend yoga Nidra sessions facilitated by the investigators and to maintain reflective diaries to document their experiences with the practice. De-scriptive statistics were used to summarise demographic characteristics. Results: The mean age of the participants was 45 years, and their work experience was 20 years. All participants were female; the majority, 24 (96%), were married. Most of the participants, 14 (56%), were working in general wards, and 15 (60%) belonged to the staff nurse cadre. The broad themes generat-ed from the analysis of reflective diaries were improved emotional well-being, Physical well-being, cog-nitive and behavioural transformation, and perceived effectiveness and challenges. Conclusion: Yoga Nidra proved to be a viable and culturally tailored intervention to support the well-being of nurses operating within the complex healthcare environments. Integrating Yoga Nidra into staff wellness initiatives may contribute to a more resilient and effective nursing workforce, ben-efiting both healthcare organisations and the quality of patient care.

Development, Validation and Pilot Testing of a Multidimensional Rehabilitation Protocol for Autonomic, Vasomotor and Cognitive Symptoms in Postmenopausal Women: A Two Phasic Feasibility Study

Poornima Maurya, Mandeep Kumar Jangra, Akanksha Saxena Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Nearly 87.7% of postmenopausal women experience autonomic, vasomotor, cognitive and psychological symptoms. These symptoms not only lower a woman’s quality of life but also have a significant impact on her daily activities. Menopausal Hormone Therapy (MHT) is their most common management which comes with risk of breast cancer and deep vein thrombosis. So there is an urgent need for non pharmacological treatment alternatives. Aim: To develop, validate and assess effectiveness of a multidimensional rehabilitation protocol for autonomic, vasomotor and cognitive symptoms in postmenopausal women. Materials and Methods: This two Phasic feasibility study was conducted at Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India, between December 2023 to February 2025. A 45-50 minute rehabilitation protocol was developed which comprises of warm up, resistive, cognitive and cool down exercises. Then Delphi survey was conducted to evaluate the essentiality and relevance of the developed protocol by multidisciplinary experts and finally Content Validity Index (CVI) of protocol and its content/items was calculated. 12 postmenopausal women of age≥ 45 received the rehabilitation protocol for three days/week for four weeks. Pre-post treatment evaluations were done for postmenopausal symptoms by Menopause Rating Scale (MRS), autonomic symptoms by Composite Autonomic Symptom Score 31 (COMPASS31) and Hot Flash-Related daily Interference Scale (HFRDIS) while cognition assessed on Montreal Cognitive Assessment Scale (MoCA). Results: Seven experts responded, evaluated and suggested modifications. Item-level CVI of each item was between 0.86-1 whereas Scale-level CVI by was found to be 0.93 which were above the satisfactory level. The results after protocol was administered showed significant improvements in various domains of MRS- symptom severity decreased from median scores 30 (27.25–31.75) at baseline to 18 (16.00–21.50) post-intervention, COMPASS31 scores exhibited a notable decline from 64 (55.25–66.00) to 52 (47.25–54.75), HFRDIS from 62 (54.00–65.50) to 43 (39.25–47.75) and MoCA scores improved from 21 (20.00–22.75) to 25 (23.25–25.75) post-intervention. Conclusion: This multidimensional rehabilitation protocol is valid and effective in improving cognition and symptom severity of postmenopausal women and in future may serve as a adjunct to pharmaceuticals.

Assessment of Resilience and Coping Strategies among Patients Undergoing Haemodialysis: A Cross-sectional Study

KK Ishthak, BH Santhosh Pai, Aksa Shibu Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Chronic Kidney Disease (CKD) is a growing global health concern, with its prevalence increasing annually. Haemodialys (HD) is a life-sustaining medical procedure essential for patients with End Stage Renal Disease (ESRD). However, being diagnosed with CKD and undergoing HD can be psychologically distressing, requiring significant resilience and effective coping strategies from patients. Understanding resilience and adaptive coping mechanisms, as well as their inter-relationship, is crucial for developing patient-centered care models and formulating comprehensive treatment strategies that support both physical and mental well-being. Aim: To investigate the relationship between resilience and adaptive coping strategies among CKD patients undergoing HD. Materials and Methods: This cross-sectional study was conducted in the Dialysis unit of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, from September 2024 to January 2025. A total of 73 adult patients with CKD undergoing Maintenance HD (MHD) were included in the study. Data were collected using a validated questionnaire comprising 66 items. The primary outcome was resilience, assessed at two time points: resilience at the time of CKD diagnosis (21 items) and resilience after initiation of HD (15 items). The secondary outcomes included emotional coping (10 items), social coping (10 items), and religious/spiritual coping (10 items). The questionnaire was administered to patients who were currently undergoing HD, and responses related to the time of CKD diagnosis were recorded based on patients’ recollections and memories of their initial experiences with the disease. The categorical variables were summarised using frequency and percentage. The continuous variables were summarised using mean and standard deviation. Pearson’s correlation was used to find the correlation between resilience and utilisation of adaptive coping. Results: The mean age of the subject was 48.7±12.01. The mean resilience score after diagnosing with CKD was 67.8±13.72. The score decreased after initiation of HD to 48.3±10.65. Pearson’s cor-relation analysis revealed significant positive correlation between resilience after HD and social coping strategies (r=0.345, p=0.003); emotional coping and social coping (r=0.678). Conclusion: The result of the study shows a positive relationship between resilience and the utilisation of adaptive coping strategies.

Formulation and Characterisation of a Hydrogel Infused with Scutellaria baicalensis Root Extract and Zinc Oxide Nanoparticles: An In-vitro Evaluation of Antioxidant, Anti-inflammatory, and Cytotoxic Effects

A Mohamed Thaha, Arvina Rajasekar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Scutellaria baicalensis, rich in bioactive flavonoids such as baicalin and baicalein, exhibits potent antioxidant, anti-inflammatory, and antimicrobial activities. However, its clinical translation is limited by poor solubility and bioavailability. Hydrogels offer a promising delivery platform, and incorporation of Zinc Oxide Nanoparticles (ZnO NPs) can further enhance therapeutic efficacy through their antimicrobial, antioxidant, and wound healing properties. Aim: To formulate and characterise a S. baicalensis root extract-mediated ZnO NP-infused hydrogel and evaluate its in-vitro cytotoxicity, antioxidant activity, and anti-inflammatory potential. Materials and Methods: This in-vitro experimental study was conducted at Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from March 2025 to May 2025. ZnO NPs were synthesised via green synthesis using S. baicalensis extract. The hydrogel was prepared using sodium alginate, incorporating both extract and ZnO NPs. Cytotoxicity was assessed by brine shrimp lethality assay. Antioxidant activity was evaluated using 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) radical scavenging and Ferric Reducing Antioxidant Power (FRAP) assays. Anti-inflammatory activity was determined via Bovine Serum Albumin (BSA) and membrane stabilisation assays. All assays were performed in triplicate, and statistical analysis was conducted using One-way Analysis of Varinace (ANOVA) and Independent t-tests. A p-value <0.05 was considered statistically significant. Results: The hydrogel exhibited high biocompatibility, with no significant cytotoxicity at therapeutic concentrations. Antioxidant assays showed significant dose-dependent activity, reaching 73.72±1.86% DPPH inhibition and 0.74±0.04 FRAP absorbance at 50 μg/mL. Anti-inflammatory assays demonstrated up to 76.39±0.99% inhibition of protein denaturation and 73.14±2.39% membrane stabilisation. No significant differences were observed compared between the hydrogel formulation and standard controls (p>0.05) under the tested experimental conditions. Conclusion: S. baicalensis - ZnO NP hydrogel demonstrated potent antioxidant and anti-inflammatory effects with excellent biocompatibility, supporting its potential for localised management of oxidative stress and inflammation.

Differential Responsiveness of Internal Jugular Veins in the Trendelenburg Position Beyond Diameter Measurements: A Cross-sectional Study in Neonates

Sajin Philip Thomas, VV Subramanian, Anity Singh Dhanyee, VR Hemanth Kumar, Karthikeyan Kadirvel, R Charulatha Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: To circumvent the challenges faced with neonatal central venous cannulation, variations in position, lateral neck rotation, ultrasound technology are being used with fair success rate. However, there is paucity of data regarding the degree of relative responsiveness between the Right and Left Internal Jugular Veins (RIJV, LIJV) and the physiological effect of patent shunts or Persistent Left Superior Vena Cava (PLSVC) on positioning success in neonates. Aim: To assess the differential response of the RIJV and LIJV to 10° Trendelenburg position in neonates by measuring Cross-Sectional Area (CSA), Anteroposterior Diameter (APD), Mediolateral Diameter (MLD) and Skin-to-Vein Distance (SVD), respectively. Materials and Methods: The present cross-sectional study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, from May 2024 to April 2025. A total of 60 neonates between 36 weeks and one month of gestational age born in-hospital were recruited. The RIJV and LIJV were scanned using high-frequency linear-array transducer (L25xp, 13-6 MHz) of the X-Porte Ultrasound system (FUJIFILM Sonosite, Inc). The CSA, anteroposterior and MLDs and SVD were measured in the supine and 10° Trendelenburg position. Bilateral pre-post changes were analysed using the Wilcoxon-Signed Rank test between supine and Trendelenburg position. Results: The median age and weight of neonates were 268±15 (262-277) days and 2.87±0.5 (2.69-3.20) kg with equal gender distribution. The CSA of RIJV (W=537, p=0.03) and LIJV (W=232, p<0.001) increased significantly from supine to 10° Trendelenburg position. Although, the CSA of RIJV (W=1319.5, p=0.001) was greater than the LIJV (W=1301, p=0.005) in both supine and Trendelenburg position. But the LIJV was found more responsive to the Trendelenburg position with 11.7±27% (4.7-18.7) increase in size compared to 7.2±26% (0.5-14) for RIJV, respectively (W=678, p=0.12). Likewise, there was a significant increase in the anteroposterior and MLDs as well, but the SVD remained unchanged. Conclusion: The responsiveness of LIJV is greater in the 10° Trendelenburg position, but its smaller size necessitates separate ultrasound-guided catheter to avoid disproportionate Catheter-to-Vein Ratio (CVR), thereby reducing thrombosis risk considerably.

Normative Values of Calf Muscle Flexibility in Healthy Adults: A Weight-bearing Lunge Test Analysis

Chakshujot Kaur, Vaishali Rai, Paras Saini, Anamika Rajpoot, Satwinder Kaur, Tanishka Sharma, Sandeep Pattnaik Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The Weight-Bearing Lunge Test (WBLT) plays a crucial role in assessing calf muscle flexibility. It is regarded as a reliable method for evaluating its reference values. Despite its clinical relevance, normative values for healthy adults are limited. Aim: To establish normative values for calf muscle flexibility in healthy adults using the WBLT. Materials and Methods: This cross-sectional study was conducted at Maharishi Markandeshwar (Deemed to be University) Mullana, Ambala, Haryana, India between April 2025 to February 2026 with 500 participants to establish the normative values of the flexibility of the calf muscle. Healthy adults aged between 30 and 50 years were recruited. The WBLT was used as a primary outcome measure. After obtaining informed consent, participants performed the test for both limbs. Three trials were conducted for each limb, and the distance between the wall and the great toe was measured in centimetres. The average of the three trials was recorded for analysis. The normality of data was assessed using the Kolmogorov-Smirnov test. Descriptive statistics are presented as geometric mean with 95% CI and mean with Standard Deviation (SD) along with range. A p-value <0.05 was considered significant. Results: The reference values for calf muscle flexibility were 9.94 cm and 9.7 cm for the right and left-sides, respectively. Gender analysis revealed that males recorded higher geometric mean values than females on both sides. Across both genders, asymmetry was seen with the right limb showing slightly greater flexibility than that of left. Flexibility appeared to peak in the 35-39 years group (10.26 cm on the right-side). Widest variations in flexibility (7.76-15.30 cm) were seen in the age group 45-50 years. Conclusion: This study established normative values for WBLT in adults aged between 30 and 50 years, revealing a constant pattern of bilateral asymmetry where the right limb was more flexible than the left. Flexibility peaked between 35-39 years and declined further, indicating that age is a significant determinant of calf muscle flexibility.

Effects of Psychosocial Interventions on Stress and Coping Strategies among Caregivers of Patients with Breast Cancer: A Quasi-experimental Study

EJ Shaji, M Nalini, Fatima D’Silva, Rajee Raghunath, Sunu Cyriac, U Shrinivasa Bhat Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Breast cancer diagnosis undoubtedly has a devastating impact on patients. While the brunt of it is borne by the patients themselves, their primary caregivers carry a significant burden as well. Aim: The present study aims to understand the effectiveness of psychosocial interventions in mitigating the stress experienced by the caregivers of patients with breast cancer and in enhancing their coping skills. Materials and Methods: The present quasi-experimental study was undertaken between the months of May 2023 and December 2024. Primary caregivers aged 18-65 who accompanied breast cancer patients to the hospital for treatment were included in the study. Consecutive sampling techniques were used. Breathing exercises and a personalised counselling session were administered as interventions. The data were subjected to analysis. Fisher’s-exact or Chi-square tests were used to analyse categorical variables. The Kingston Caregiver Stress Scale and Modified Brief Cope Scale were used to assess stress and coping strategies. A comparison of both these variables in the experimental and control groups, respectively, was made using the student t-test and a repeated-measures analysis of variance was done to assess the effectiveness of the interventions. Results: During the second post-test, the mean stress in the experimental group decreased from 26.01±5.14 at baseline to 21.74±3.91, whereas the mean stress in the control group decreased from 25.23±4.59 at baseline to 23.78±4.81. Coping strategies of the experimental group improved from a pre-test score of 72.55±9.08 to 77.09±9.78, whereas the score of the control group decreased from a base-line score of 71.74±8.82 to 68.73±9.09. The findings showed a significant change in stress levels in the experimental group across the pretest, first post-test, and second post-test (p<0.001). Post-hoc tests showed significant differences between the first post-test and pretest (p=0.047) and between the second post-test and first post-test (p=0.004). There was a significant change in coping mechanisms between the pre-test and second post-test for caregivers (p=0.014). Conclusion: The psychosocial interventions that were implemented in the current study were effective in alleviating stress and augmenting coping strategies among the participants.

Accuracy, Efficacy and Reliability of Extraoral Scanners: A Systematic Review

Pranoti Pramod Ranit, Anuj Chandak, Saee Deshmukh, Neelam Pande, Samidha Pande Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Extraoral Scanners (EOS) have become fundamental tools in digital workflows, enabling precise digitisation of dental impressions, casts, and prosthetic components. Despite the tech-nological advancements, the success of any digital workflow is highly dependent on the quality of the input data provided by the scanning system. This highlights the critical importance of evaluating the accuracy, efficacy, and reliability of EOS. Aim: The purpose of the present systematic review is to evaluate the accuracy, efficacy and re-liability of EOS. Materials and Methods: An electronic search (PubMed, Scopus, Cochrane Library, Web of Sci-ence, Google Scholar) was used to find the pertinent publications written exclusively in English and published up until November 2024. Based on the Population, Intervention, Control, and Outcomes (PICO) framework, the main research question for the present study was “How is the accuracy, efficacy and re-liability of EOS?” By looking at the titles, abstracts, and full texts of the articles, it was possible to verify their relevance and see if they met the inclusion criteria. Quality assessment was conducted using the QUIN tool for in-vitro studies and the JBI tool for analytical cross-sectional studies. Results: Out of the 139 results returned by the database search, 118 were removed due to incom-plete, inconsistent, or missing information. Three papers were removed after 21 full-text papers were evaluated for eligibility. Accordingly, a total of 14 studies were included in the present systematic review. Meta-analysis was not performed due to significant heterogeneity among the included studies. Conclusion: Most of the available studies indicate that EOS demonstrate higher accuracy when compared to intraoral scanners. This accuracy is generally evaluated in terms of trueness and precision, which are crucial parameters for ensuring the success of various prosthetic restorations. EOS, by mini-mising distortions and providing more consistent digital impressions, hold promising results for improv-ing the overall quality of prosthesis fabrication.

Comparative Evaluation of Surface Treatment and Metal Mesh Reinforcement on Flexural Strength of Repaired Heat Polymerised Acrylic Resin Denture Base: An In-vitro Study

Priyanka Rajendra Masram, Sunil Ronad, Surekha Godbole, Girija Arun Dodamani, Suresh Nagaral Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Edentulism, or the loss of natural teeth, poses a significant public health burden. Complete dentures play a vital role in restoring the overall quality of life. Polymethyl Methacry-late (PMMA) is the preferred denture base material, but is prone to fracture under stress. Denture repair success depends on strong adhesion between the fractured parts, where surface treatment and reinforcement can enhance Flexural Strength (FS). Among various techniques, airborne-particle abrasion using Aluminium Oxide (Al2O3) and reinforcement with metal mesh are widely used to improve mechanical performance. Although both methods have been studied individually, comparative data under uniform experimental conditions remain limited. Aim: To assess the effect of surface treatment and reinforcement using metal mesh on the FS of repaired heat polymerised acrylic resin denture base. Materials and Methods: This in-vitro experimental study was conducted at the Department of Prosthodontics and Crown and Bridge, Annasaheb Chudaman Patil Memorial Medical College (ACPM) Dental College campus, Dhule, Maharashtra, India, from June 2022 to September 2022. A total of 48 samples were fabricated and divided into three groups, 16 specimens in each group, i.e., Group A, Group B, Group C with the dimensions 65×10×2.5 mm included in the present study. Group A samples were sectioned into two halves, repositioned in the flask and repaired using heat-cure acrylic resin without any surface treatments or reinforcement. The resin was polymerised using the short curing cycle, i.e., 74°C for two hours followed by 100°C for one hour, after which the specimens were bench-cooled and deflasked. Group B samples were treated with the airborne-particle abrasion process with 100 μmm Al2O3 for 10 seconds at a pressure of 0.2 MPa from a distance of 10 mm after fracture. Group C specimens were reinforced with metal mesh. The FS was analysed with a universal testing machine, a 3-point bend test. Comparison of surface roughness, comparison of FS among three groups was statistically significant, using one-way Analysis of Variance (ANOVA) test or Kruskal-Wallis test with p-value p≤0.05, followed by a post-hoc test for pairwise comparison. Results: Among all the groups, surface treatment (group B) had the highest value, i.e., 73.73 and standard deviation, followed by reinforcement by metal mesh (group C), which is 61.14 and the control group (group A) is 55.13, respectively. Differences among all groups were statistically significant (p≤0.05). Conclusion: Surface treatment with Al2O3 significantly improved the FS of repaired heat polymerised PMMA denture resin. Although metal mesh reinforcement demonstrated a numerical increase in FS, the difference was not statistically significant.

Association of Serum Ferritin, Vitamin D and Vitamin B12 Levels with Tumour Stage, Grade and Molecular Profile in Breast Cancer Patients Before and After Treatment: A Prospective Observational Study

Akansha Gajanan Hatewar, Chandrashekhar Chintamanrao Mahakalkar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Breast cancer prognosis varies widely among patients, partly due to tumour heterogeneity. Systemic biomarkers reflecting inflammation, immune function and metabolic status, such as serum ferritin, vitamin D and vitamin B12, have been implicated in carcinogenesis. However, their peritreatment dynamics and collective prognostic significance in breast cancer require further clarification. Aim: The present study aimed to evaluate the association between clinicopathological parameters of breast carcinoma, including tumour stage, tumour grade, Lymphovascular Invasion (LVI) and molecular subtype with serum vitamin D, vitamin B12 and ferritin levels at pretreatment and post-treatment assessment. Materials and Methods: The present prospective observational study was conducted among 42 newly diagnosed, histopathologically confirmed female breast cancer patients at a tertiary care centre, Wardha, Maharashtra, India. Serum vitamin D, vitamin B12 and ferritin levels were measured before treatment and at the defined post-treatment assessment. Biomarker levels were analysed in relation to tumour stage, tumour grade, LVI, and molecular receptor status {Estrogen (ER), Progesterone (PR) and HER2}. A p-value of ≤0.05 was considered statistically significant. Results: The mean age of the patients was 54.67±12.76 years. The predominant histology was Invasive Ductal Carcinoma (IDC) in 37 (88.09%) patients, the most common tumour grade was Grade 2 in 27 (64.29%) patients, and the most frequent stage was Stage IIA in 19 (45.24%) patients. Serum vitamin D showed a significant post-treatment decline in Stage IIA, IIB and IIIB disease, across all tumour grades, and across LVI and molecular subgroups. Stage IA and Stage IIIC subgroups were described without inferential interpretation because each included only two patients. Serum ferritin increased significantly post-treatment in Stage IIA, IIB and IIIB disease and across all tumour grades. Vitamin B12 de-creased significantly post-treatment in Stage IIB disease, Grade 3 tumours, LVI-positive cases, and molecular subgroups, with the greatest decline among HER2-positive patients (p<0.05). Intergroup comparisons of absolute pretreatment and post-treatment biomarker levels were not statistically significant across tumour stage, grade, LVI status or molecular profile (p>0.05). Conclusion: Serial assessment of serum vitamin D, vitamin B12 and ferritin demonstrated measurable post-treatment biomarker changes in patients with breast carcinoma. The consistent decline in vita-min D, selected decline in vitamin B12 and rise in ferritin may reflect treatment-related inflammatory, nutritional and metabolic alterations. As absolute biomarker levels did not show significant intergroup association with tumour stage, grade, LVI status or molecular profile, these markers should be interpreted as peri-treatment biological indicators rather than independent prognostic markers. Larger multicentric studies with longitudinal follow-up are required to define their clinical utility.

Association of Neutrophil-Lymphocyte Ratio and C-reactive Protein with Disease Severity in Infants with Acute Bronchiolitis: A Retrospective Study

Sanjana Prakash Shindhe, Vishwanath Laxman Machakanur, BM Prashant, MN Manjula Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Acute bronchiolitis is a leading cause of hospitalisation in children under two years of age. Its clinical severity assessment is largely clinical; easily available inflammatory mark-ers that correlate with severity may assist early risk stratification. However, data regarding the util-ity of Neutrophil–Lymphocyte Ratio (NLR) as a severity marker in Indian paediatric populations remain limited. Aim: To evaluate the relationship between NLR, C-Reactive Protein (CRP), and disease severity in children aged 0-24 months hospitalised with acute bronchiolitis. Materials and Methods: This retrospective study was conducted at the Department of Paediat-rics, Karwar Institute of Medical Sciences, KRIMS, Karwar, Karnataka, India over two years (Data were collected from April 2023 to April 2025 and analysis was done in the period of May 2025 to September 2025) with a sample size of 182 children the study included children between the age group of 0-24 months. Disease severity was categorised as mild, moderate, or severe using a standardised bronchiolitis severity classification based on respiratory rate, heart rate, oxygen saturation, retractions, ap-noea/cyanosis, and FiO2 requirement. Complete blood count and admission CRP were recorded; NLR was cal-culated from differential leukocyte counts. One-way Analysis of Variance (ANOVA) was used to compare means of continuous variables across the three severity groups (mild, moderate, severe). Chi-square test was applied to compare categorical variables between groups. Kruskal-Wallis test (non parametric) was used for comparison of skewed continuous variables (e.g., CRP and NLR across severity groups). Results: Among 182 children, 70 (38.5%) had mild, 60 (33.0%) moderate, and 52 (28.5%) severe bronchiolitis. Age and sex distribution were comparable across severity groups (p-value =0.08 and p-value=0.41). Mean age in months was 5.1±4.3 for mild, severly affected with severe disease were predom-inantly males (57.7%) when compared to females (42.3%). Clinical parameters worsened significantly with increasing severity, including higher heart rate and respiratory rate and lower SpO2 (all p-value<0.001). CRP and NLR increased significantly across severity categories (CRP p-value=0.01; NLR p-value=0.004). Post-hoc analysis showed significantly higher CRP and NLR in moderate/severe groups com-pared with mild disease. Disease severity correlated positively with CRP (r-value=0.17, p-value=0.03) and NLR (r-value=0.21, p-value=0.008). Conclusion: The values of NLR and CRP at admission correlate significantly with the severity of acute bronchiolitis and may serve as a practical adjunct marker for severity assessment in hospitalised infants.

Morphometry of the Foramen Magnum in Relation to Cranial Parameters: Evidence from South Indian Skulls

JE Benilsha, Durga Devi Ganesan, Krishnaveni Sharath Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The Foramen Magnum (FM) is a critical anatomical region at the craniovertebral junction that transmits vital neurovascular structures and serves as an important landmark in forensic identification and neurosurgical procedures. Variations in dimensions and morphology exhibit population-specific patterns, making regional morphometric data essential for clinical and medico-legal applications. Aim: To analyse the morphometric characteristics of the FM and its relationship with cranial dimensions in dry adult skulls from South India. Materials and Methods: A cross-sectional study was conducted on 50 well-preserved adult dry skulls from the Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. In the FM, Anteroposterior (APD) and Transverse Diameters (TD) were measured. The Maximum Cranial Length (MCL) and Maximum Cranial Breadth (MCB) were also measured using standardised osteometric instruments. Standard formulas were used to compute the Foramen Magnum Index (FMI) and the Cephalic Index (CI). Direct visual assessment was used to determine the FM shape. Descriptive statistics, linear regression, and Pearson’s correlation were used to evaluate the data, with a significance level of p<0.05. Results: The mean APD and TD of the FM were 33.7±2.02 mm and 27.66±2.42 mm, respectively. The average length and breadth of the skull were 180.37±1.75 mm and 130.65±1.11 mm, respectively. The CI showed that all skulls were dolichocephalic (72.44±0.73). The most prevalent FM morphology was oval (64%), followed by tetragonal (36%). The TD of the FM and cranial breadth were significantly positively correlated (p=0.005). Cranial length and APD showed a slight and non significant correlation (p=0.238). Conclusion: The sample had an oval FM morphology and a primarily dolichocephalic cranial pat-tern. While cranial length had little effect on anteroposterior diameter of FM, a coordinated transverse growth pattern was observed between cranial breadth and the TD of the FM. These results offer population-specific information with implications for neurosurgery and forensic anthropology.

Development and Validation of an Admission Risk Model for Intensive Care Unit Admission in Adults with Dengue: A Retrospective Cohort Study

Veena Shankar Kunnath, Madhumati J Patil, Siddharth Shivakumar Nair, Sheetal U Harakuni Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Dengue outbreaks can place a major burden on hospitals, especially in countries such as India, where early triage is important in resource-limited settings. The novelty of this study lies in using routinely available admission variables to predict Intensive Care Unit (ICU) admission, a practical triage endpoint less studied than World Health Organisation (WHO)-defined severe dengue or mortality. Aim: To develop and validate an admission-based risk model for predicting ICU admission in adults with laboratory-confirmed dengue. Materials and Methods: A retrospective cohort study was conducted at a tertiary care teaching hospital in Belagavi, Karnataka, India, from April 2024 to March 2025. A total of 102 adults with fever, thrombocytopenia, and laboratory-confirmed dengue were included. The primary outcome was ICU admission during the same hospitalisation. Five admission-time predictors were evaluated: age, warning or severe signs, haematocrit, platelet count, and serum Aspartate aminotransferase (AST). Ridge-penalised multivariable logistic regression was used for model development. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 29.0 and a custom Python-based script. A p-value <0.05 was considered statistically significant. Internal validation was performed using 1000 bootstrap resamples. Temporal external validation was conducted using an earlier cohort from the same hospital comprising 146 complete cases collected between September 2022 and September 2023. Results: Of 102 adults with laboratory-confirmed dengue, 50 (49%) required ICU admission. These patients more frequently had warning or severe signs, older age, lower platelet counts, and higher AST levels. Univariable analyses demonstrated associations for age, warning/severe signs, and platelet count with ICU admission; haematocrit and AST were not independently associated. The final five-variable model demonstrated moderate discrimination in the development cohort (AUC 0.766; Brier score 0.203). Bootstrap internal validation yielded an optimism-corrected AUC of 0.687; In the temporal validation cohort, the model demonstrated an AUC of 0.676 and a Brier score of 0.209, with reduced calibration performance compared with the development dataset. Conclusion: This five-variable admission model, based on routine clinical and laboratory parameters, demonstrated moderate performance to predict ICU admission in adults with dengue. It may support early risk assessment and triage during outbreaks, especially in resource-constrained settings, although further external validation and recalibration are required before routine clinical implementation.

Comparison of Amount of Intrusion and Extent of Periapical Root Resorption with Temporary Anchorage Devices and Connecticut Intrusion Arch in Adult Population: A Prospective Interventional Study

Japneet Kaur Kaiser, Ranjit Kamble, Srushti Atole, Nandlal Toshniwal, Ruchika Pandey Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Deep bite is a common vertical malocclusion often requiring maxillary incisor intrusion for correction, especially in adult patients. Two widely used methods for intrusion are Temporary Anchorage Devices (TADs) and the Connecticut Intrusion Arch (CIA). While both are effective in achieving intrusion, they may differ in their biological impact, particularly in terms of root resorption. Given the limited clinical evidence comparing these two techniques in terms of both efficacy and safety, the present study was undertaken to provide a Cone Beam Computed Tomography (CBCT)-based evaluation to guide clinical decision-making. Aim: To evaluate and compare the amount of intrusion and the extent of periapical root resorption of maxillary anterior teeth using TADs and CIA in adult patients assessed using CBCT. Materials and Methods: The present prospective interventional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India, from March 2022 to January 2023. A total of 20 post-pubertal patients diagnosed with deep bite were selected based on defined inclusion criteria: increased overbite >3 mm and reduced lower anterior facial height. The selected patients were randomly divided into two groups (n=10 each): Group I (TADs) and Group II (CIA). All patients were bonded with 0.022” MBT (McLaughlin, Bennett, and Trevisi) brackets and underwent standard levelling and alignment. An intrusion force of 100 g was applied to the anterior teeth segment for six months. CBCT scans were obtained at four-time intervals- T0 (baseline), T1 (1 month), T2 (3 months), and T3 (6 months). Intrusion was measured as the perpendicular distance from the incisal edge to the palatal plane. Root resorption was assessed by comparing root length changes from T0 to T3. Statistical analysis was performed using SPSS Version 27.0. Data were expressed as mean±Standard Deviation (SD). The Shapiro-Wilk test was used to assess normality, and independent sample t-tests were applied to compare groups. A p-value <0.05 was considered statistically significant. Results: Both TADs and CIA produced comparable amount of maxillary anterior intrusion, with no statistically significant differences between groups at any time point (p>0.05). However, root resorption in central incisors was significantly higher in the TAD group (1.21±0.25 mm for 11, 1.19±0.23 mm for 21) than in the CIA group (0.72±0.52 mm and 0.84±0.44 mm, respectively), with p-values of 0.016 and 0.041. No significant differences were observed in lateral incisors. Conclusion: TADs and CIA are equally effective in achieving maxillary anterior intrusion. How-ever, TADs are associated with greater root resorption in central incisors. CIA may be a safer alternative when root preservation is a clinical priority.

Assessing Knowledge, Attitudes, Practices and Perceived Barriers towards Research among Dental Interns, Chhattisgarh, India: A Cross-sectional Study

Aruhi Sinha, Milind Wasnik, Ramakrishna Chevvuri, Sopan Singh, Abhinav Parakh, Poonam Narang Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Research is fundamental to advancing dental science and evidence-based clinical practice. The rationale for the study is to address the lack of comparative evidence on research prepar-edness among interns in government and private dental colleges in Chhattisgarh. Aim: To assess knowledge, attitudes, practices, and perceived barriers towards research among dental interns in government and private dental Colleges in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted under the Department of Public Health Dentistry, from March 2024 to April 2024 among dental interns from the Government Dental College, Raipur, Chhattisgarh, India, It also included three Private dental colleges-Rungta College of Dental Sciences and Research, Triveni Institute of Dental Sciences, Hospital and Research Centre, and Chhattis-garh Dental College and Research Institute (CDCRI), Raipur, Chhattisgarh, India, where the study was planned and executed. All interns posted during the study period were approached, and those who provided informed consent were included, resulting in a total sample of 113 participants. Data were collected using a validated 24-item self-administered questionnaire (Cronbach’s alpha=0.98) distributed electron-ically through Google Forms. Responses were analysed using Chi-square and Fisher’s-Exact tests in Sta-tistical Package for Social Science (SPSS) version 20.0, with a p-value <0.05 considered significant. Results: Among 113 interns, a good level of self-rated understanding of research concepts was reported by 50 (58.1%) government interns and 15 (55.6%) private interns (p=0.980). Research being man-datory was supported by 78 (90.7%) government interns and 26 (96.3%) private interns. Challenges in con-ducting research were reported by 53 (61.6%) government interns and 13 (48.1%) private interns. Confi-dence in appraising research articles was noted by 53 (61.7%) government interns and 22 (81.5%) private interns, while 15 (55.6%) private interns and 28 (32.6%) government interns used online sources to stay updated (p=0.032). Conclusion: Interns from both Institutions strongly supported integrating research into dental education; however, challenges such as limited confidence and resource gaps highlight the need for structured research training and mentorship to strengthen research competency.

Effect of Dual Task Training and Virtual Reality on Cognitive Motor Interference in Patients with Parkinson’s Disease: A Randomised Clinical Pilot Study

Sandhya Saini, Sarita Pandey, Kanika Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Rehabilitation plays a vital role in managing Parkinson’s Disease (PD), particularly in addressing both motor and cognitive impairments. Dual Task Training (DTT) improves motor symptoms and cognitive performance, while Virtual Reality (VR) enhances motor function compared to conventional therapy. However, limited evidence exists on the combined effects on Cognitive-Motor Interference (CMI) in individuals with PD. Aim: To evaluate the effects of DTT and VR individually and in combination on CMI in patients with PD. Materials and Methods: The present study was a three-arm, single-blinded randomised clinical pilot trial involving 36 participants with PD aged 50-80 years. The participants were randomly allocated into three groups, using sequentially numbered, opaque, sealed envelopes. For five days a week for four weeks, experimental Group 1 received VR treatment, Group 2 received DTT, and Group 3 received a combined treatment of Group 1 and Group 2. Outcome measures, such as the Montreal Cognitive Assessment (MoCA), Movement Disorder Society-Unified Parkinson’s disease Rating Scale (MDS-UPDRS) and the Timed Up and Go test (TUG), were used to assess the subject preintervention and postintervention. Normality was assessed using the Shapiro-Wilk test. As the data were normally distributed, a paired t-test was used for pre and post-comparisons, and one-way Analysis of Variance (ANOVA) was used to assess intervention effects. Results: Participants demonstrated significant improvements in MoCA, MDS-UPDRS, and TUG Scores (p-value <0.001). The VR+DTT group showed the most improvements in MoCA (18.75±1.91 to 26.33±3.22), MDS-UPDRS (62.50±6.98 to 50.25±9.31), and TUG (24.33±3.17 to 17.17±3.97). A significant difference was found between groups in MoCA (p-value <0.001) and TUG (p-value=0.001), but not in MDS-UPDRS (p-value=0.232). Conclusion: This study concluded that combining DTT with VR may be a promising approach to improve CMI in patients with PD.

Knowledge, Attitude, and Practice Regarding Rabies Prevention and Post Exposure Prophylaxis among Adults in Anakaputhur, Chengalpattu District, Tamil Nadu: A Community-based Cross-sectional Study

R Neevadetha, S Hariharan, JR Madhumita Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Rabies is a fatal but preventable zoonotic disease in India, with dog bites be-ing the primary mode of transmission. Despite vaccine availability, human deaths continue due to gaps in awareness and preventive practices related to rabies. Assessing community knowledge, attitudes, and practices is essential for improving rabies prevention. Aim: To assess knowledge, attitude, and practices related to rabies prevention and post-exposure care among adults. Materials and Methods: A community-based cross-sectional study was conducted from November 2024 to January 2025 in Anakaputhur, Chengalpattu District, Tamil Nadu, India. Using multistage random sampling, 300 adults aged ≥18 years were interviewed using a structured, pretested questionnaire as-sessing knowledge, attitudes, and practices related to rabies prevention. Data were analysed using de-scriptive statistics, Chi-square tests, and multivariable logistic regression. Knowledge, attitude, and practice scores were categorised using mean values, and Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs) were reported. Results: Among the 300 participants, the majority were aged 18-30 years (115, 38.3%), and 162 (54.0%) were women. Based on mean-based categorisation, 179 (59.7%) participants demonstrated adequate knowledge, 161 (53.7%) had a favourable attitude, and 147 (49.0%) exhibited good practice. Knowledge levels were significantly associated with gender (p=0.023), education level (p=0.019), occupation (p<0.001), and pet ownership (p=0.002). Attitude and practice levels were not significantly associated with sociodemographic variables. Multivariable logistic regression analysis showed that employment in the public (AOR=16.38; 95% CI: 4.73-56.71) and private (AOR=3.37; 95% CI: 1.07-10.63) sectors was asso-ciated with adequate knowledge, while non-pet ownership was associated with lower odds of adequate knowledge (AOR=0.34; 95% CI: 0.17-0.68). Conclusion: Awareness and attitudes towards rabies were adequate; preventive practices remained suboptimal among half of the participants. Occupation and pet ownership were significant determinants of adequate knowledge. Strengthening practice-focused health education on rabies prevention and appropriate preventive practices through primary healthcare services is essential.

Musculoskeletal Effects of GLP-1 Receptor Agonists in Patients Undergoing Pharmacologic Weight Reduction: A Retrospective Analysis of Bone Density and Sarcopenia in Orthopaedic Practice

Anurag Mittal, Poojangi Varshney Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) are increasingly used for the treatment of obesity and type 2 diabetes mellitus. Patients receiving these agents frequently pre-sent to orthopaedic clinics during pharmacologic weight reduction. Aim: To evaluate changes in skeletal muscle mass and Bone Mineral Density (BMD) in patients receiving GLP-1 receptor agonist therapy. Materials and Methods: A retrospective study was conducted at a tertiary orthopaedic centre (World College of Medical Sciences Research and Hospital), Jhajjar, Haryana, India between 1 January 2023 and 31 December 2025. A total of 142 patients aged ≥18 years receiving GLP-1 receptor agonists for at least 12 months with available baseline and follow-up body composition data were included. Changes in body weight, lean body mass, Appendicular Skeletal Muscle Index (ASMI), and BMD were analysed using paired Student’s t-test and Pearson correlation analysis. Results: A total of 142 patients were included with mean follow-up of 19.4±7.1 months. Mean weight reduction was 16.3%±4.8% (p-value<0.001). About, 29.8% of weight loss occurred from lean muscle mass. ASMI declined significantly (p-value<0.01). Dual-energy X-Ray Absorptiometry (DXA) measurements were available in 86 patients and showed modest reductions in BMD that did not reach statistical significance. Conclusion: GLP-1 receptor agonists result in statistically significant reductions in skeletal muscle mass and although reductions in BMD were observed, these did not reach statistical significance. Orthopaedic surgeons should therefore consider evaluation of muscle mass and bone health when assessing patients undergoing pharmacologic weight loss prior to elective surgery.

Association of Complete Blood Count-derived Inflammatory Indices with Preeclampsia, Eclampsia and Normotensive Pregnancies: A Case-control Study

Parvej Singh, Kalyani Raju, M Munikrishna Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Preeclampsia (PE) and Eclampsia (E) are hypertensive disorders of pregnancy with significant global maternal and perinatal morbidity and mortality. Despite existing diagnostic criteria, early prediction remains challenging. Haematological parameters, Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI) and Pan-Immune-Inflammation Value (PIV) derived from Complete Blood Count (CBC) parameters have shown potential as minimally-invasive biomarkers of inflammation in various diseases but are underexplored in obstetric contexts. Aim: To evaluate and compare CBC-derived inflammatory indices (SII, SIRI and PIV) in PE, eclampsia and normotensive pregnancies and to assess their diagnostic utility using Receiver Operating Characteristic (ROC) analysis. Materials and Methods: A case-control study was conducted at Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India, from October 2024 to March 2025, involving 236 participants including 118 controls and 118 cases (59 PE and 59 eclampsia). Haematological parameters including absolute counts of neutrophils, lymphocytes, monocytes and platelet count were used to calculate SII, SIRI and PIV. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16.0, inferential statistics like Analysis of Variance (ANOVA) (or Kruskal-Wallis test) was used and ROC curves were used to evaluate predictive performance. Results: Absolute neutrophil/lymphocytes/monocytes count, neutrophil/monocyte percentage and platelet count showed significant association between normal subjects, PE and eclampsia cases. SII and SIRI levels were significantly elevated in the eclampsia group compared to controls (p<0.001 and p=0.042, respectively), while PIV showed borderline significance (p=0.058). Among PE patients, only PIV demonstrated statistically significant predictive ability (AUC=0.623, p=0.008). For predicting eclampsia, SII showed the highest AUC (0.668, p=0.001), followed by SIRI (AUC=0.628, p=0.005) and PIV (AUC=0.602, p=0.027), suggesting moderate discriminatory power. Conclusion: The study underscores the association of haematological parameters and inflammatory markers with PE and eclampsia. These findings highlight the potential utility of these minimally-invasive and cost-effective parameters in early risk stratification and diagnosis of the disease.

Maternal and Perinatal Outcomes of Adolescent Pregnancy: A Prospective Observational Study from Tamil Nadu, India

D Sumeethra @ Phoornima, G Anuradha, KP Mohana Sundari, D Nithya Devi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: According to the literature, adolescent women have an increased incidence of adverse pregnancy outcomes. Aim: To determine the maternal and neonatal outcomes of adolescent pregnancy. Materials and Methods: A hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynaecology (OBG) at Tiruppur Medical College and Hospital, a tertiary care centre in Tamil Nadu, India. The study included 150 adolescent pregnant mothers, defined as pregnancies occurring between the ages of 10 and 19 years, who delivered at the facility during the study period from September 2024 to February 2025. Maternal and neonatal outcomes among these participants were ana-lysed. Results: The mean age of presentation was 18.79±0.48 years. Mean age of marriage was 17.82 years, 40% of them were educated up to high school and 84% of them were primigravida. There is an in-crease in incidence of obstetric complications like anaemia (34%), preeclampsia (28%), preterm labour (14%), caesarean section (28%), wound infection (8%), vaginal infection (26%) and neonatal complications like low birth weight (38%), foetal growth restriction (26%), Neonatal Intensive Care Unit (NICU) admis-sion (12%) Conclusion: The present study provides insights into the complications of adolescent pregnancy and helps us to formulate directions of action to improve our healthcare system.

Association of Tumour Budding with Histomorphological as Well as Hormonal Receptors Status in Breast Carcinoma Cases: A Cross-sectional Study

M Nalini, Sheetal, Bimala Pokhrel, Jyothi A Raj, Yumna Khan, Niharika Divakar, Nischal N Gowda Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The most common cancer in India among females is breast carcinoma. To improve the diagnostics and prognostics of breast cancers various prognostic factors are being evaluated world-wide where Tumour Budding (TB) is one of the important prognostic indicator. TB is considered as the first step process of tumour metastasis and invasion, related to the Epithelial-Mesenchymal Transition (EMT). Aim: To study TB in breast carcinoma and its association with key prognostic markers in breast cancer. Materials and Methods: The present study was a cross-sectional study conducted in the Central Laboratory, Histopathology Section in Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India between the period of January 2022 to January 2023. A total of 30 Modified Radical Mastectomy (MRM) breast carcinoma cases were included in the study. Grossing of the adequately fixed specimen by buffered formalin (10%) was done and representative bits taken and processed. Haematoxylin and Eosin (H&E) stained sections were evaluated for TB. Counting of TB was done. Association between the TB and pathological variables like hormone receptor status such as Oestrogen Receptor (ER), Progesterone Recep-tor (PR) and HER2/neu receptor status were studied. Association between the TB and other histological parameters such as lymphovascular invasion, metastasis and necrosis which are key prognostic markers were studied. The results were interpreted and analysed by using few statistical tests including Z-test and p-value with significance. Results: In the present study, total number of 30 cases of breast carcinoma were included where Invasive ductal breast carcinoma, Not Otherwise Specified (NOS) was the most common histological type of carcinoma constituting 27 cases (90%). In all the cases TB were studied and further categorised into high TB and low TB. A 7 (23.33%) cases showed high TB and 23 (76.66%) cases showed low TB. In high TB 6 cases showed ER positivity, three cases PR positivity and five cases showed HER2/neu positivity. In high-grade TB 4 (13.33%) cases shows lymphovascular invasion, 6 (20.00%) cases shows lymph node metastasis and 3 (10.00%) cases shows tumour necrosis. With the above findings and with the help of standard deviation (Z-test) and p-value, significant association was observed in high TB with ER positivity with p-value of 0.03 and high TB shows significant association with lymph node metastasis with p-value of 0.03. Conclusion: TB has been proved to be an important individual prognostic factor in colon and oesophageal carcinomas, and the findings of the current study showed that high TB was significantly associated with ER positive status and lymph node metastasis which also demonstrates the high utility of TB in prognostication of breast carcinoma. Hence, it was conclude that TB is an easy to identify and unique significant prognostic factor in evaluating invasive breast carcinoma cases.

Clinical and Laboratory Characteristics associated with Adenovirus, H3N2, H1N1, and RSV in Children: A Cross-sectional Study from a Tertiary Care Hospital, Chennai, India

N Revathi, A Abdul Rahim, RV Aarthy, M Jayakumar, Pavithra Gnanavel Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The seasonal recurrence of influenza and adenovirus is a significant public health concern among children worldwide. Without definitive real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) results, the differentiation between an infection caused by the influenza virus or adenovirus is difficult, given its non specific clinical presentation. Hence, clinical and laboratory predictors for diagnosing influenza and adenovirus could help in optimal management of these infections. Aim: To assess various demographic, clinical and laboratory characteristics associated with H3N2, H1N1 and Human Adenovirus (HAdv) and Respiratory Syncytial Virus (RSV) in paediatric population. Materials and Methods: This cross-sectional study was carried out at Paediatrics department of Government Omandurar Medical College and Hospital, Chennai, Tamil Nadu, India for about 10 months from April 2023 to February 2024. A total of 114 children satisfying inclusion criteria aged between one month to 12 years and whose nasopharyngeal swab for RT-PCR analysis tested positive for adenovirus, H3N2, H1N1 and RSV were included. The demographic, clinical and laboratory results were analysed between various viral infection groups using independent t-test and Chi-square test. A p-value <0.05 was considered statistically significant. Results: The mean age group of children infected with RSV was 1.156±0.92 years. Abdominal pain 7 (9.4%), diarrhoea 4 (5.4%), pharyngeal congestion with tonsillar exudates 23 (31%) and skin rashes 6 (8%) were the significant clinical features seen in children with HAdv when compared with other groups, whereas severe respiratory distress was seen in H1N1 and RSV infections. Neutrophilia 40 (54%) and thrombocytopenia 14 (18.9%) with elevated C-Reactive Protein (CRP) (mean 47.99 mg/L) values were associated with HAdv infections. Among those infected with HAdv, children with CRP >50 mg/L had a significantly higher occurrence of diarrhoea, severe respiratory distress, tonsillar exudates and low platelet counts compared with the low CRP group (<50 mg/L). Conclusion: Present study concluded that predominant Gastrointestinal (GI) symptoms, skin rashes, tonsillopharyngitis, neutrophilic leucocytosis, thrombocytopenia and elevated CRP can be used as predictors for diagnosing HAdv earlier in children.

Prevalence of Thyroid Disorders in Women with Polycystic Ovarian Syndrome: A Cross-sectional Study from Bengaluru, Karnataka, India

Hiranmayi Uppangala, S Madhusudhan, RK Radhakrishna, PN Shakuntala Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder in repro-ductive-age women, often associated with metabolic and psychological complications. Emerging evidence suggests a link between PCOS and thyroid dysfunction, particularly hypothyroidism, yet data on their co-existence remains limited, especially in Indian settings. Existing studies lack uniformity and suffi-cient sample sizes. The present study addresses these gaps by assessing the prevalence of thyroid disor-ders in women with PCOS. Aim: To determine the prevalence of thyroid disorders in women with PCOS in a tertiary care set-ting in Bengaluru, Karnataka, India. Materials and Methods: The present cross-sectional study was conducted over a period of six months from July 2024 to December 2024 at ESIC Medical College and PGIMSR, Rajajinagar, Bengaluru, Kar-nataka, India involving 70 women aged 18-40 years diagnosed with PCOS based on the Revised 2003 Rotter-dam criteria. Women who were pregnant, had postpartum status within six months, had prior thyroid sur-gery, or refused to participate were excluded from the study. Participants underwent detailed clinical evaluation and relevant biochemical investigations, including thyroid function tests {serum Thyroid-Stimulating Hormone (TSH), free Triiodothyronine (T3), and free Thyroxine (T4)} and anti-Thyroid Peroxi-dase (anti-TPO) antibody assessment. Abdominal and pelvic ultrasonography was performed to confirm poly-cystic ovarian morphology. Data were compiled and analysed using Statistical Package for the Social Sci-ences (SPSS) software version 22. Continuous variables were expressed as mean±standard deviation, while categorical variables were presented as frequencies and percentages. Results: In the present cross-sectional study of 70 women with PCOS, the mean age was 27.83±5.50 years. Among the participants, 37 women (52.9%) were married, and 26 women (37.1%) reported irregular menstrual cycles. Of the 37 married women, 18 (48.6%) had fertility issues. Hypothyroidism was observed in 32 women (45.7%), hyperthyroidism in eight women (11.4%), and overall abnormal thyroid func-tion was detected in 41 women (58.6%). Obesity, defined as Body Mass Index (BMI) >30 kg/m², was present in 46 women (65.7%), while clinical hyperandrogenism was noted in 15 women (21.4%). Elevated HbA1c levels (>6%) were found in 49 women (70%), and raised triglyceride levels (>150 mg/dL) were ob-served in 23 women (32.9%). Anti-TPO antibody positivity was detected in one woman (1.4%). Conclusion: The present study demonstrated a high prevalence (58.6%) of thyroid dysfunction, particularly hypothyroidism, among women with PCOS, along with frequent menstrual irregularities, obesi-ty, and metabolic abnormalities, supporting the need for routine thyroid screening in women with PCOS.

Impact of Heart Rate Variability Enhancement Programme on Functional Outcomes and Quality of Life of Patients with Heart Failure with Mid-range Ejection Fraction: A Quasi-experimental Study

Neetha Kamath, Rani Jose, Safia Manzil Ashraf, Fatima D'silva, Basavaraj Utagi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Low Heart Rate Variability (HRV), an indicator of autonomic imbalance, is correlated with an elevated risk of Heart Failure (HF). Nonetheless, its association with HF with mid-range Ejection Fraction (HFmrEF) has not been previously investigated. Aim: To evaluate the effect of the HRV Enhancement Programme (HRV-EP) on functional outcomes and QoL of patients with HFmrEF. Materials and Methods: This quasi-experimental study was conducted at the Department of Cardiology, Government Medical College Kannur, Pariyaram, Kannur, Kerala, India from February 2024 to December 2024. involving patients with HFmrEF. Utilising a consecutive sampling technique, the study was completed with 60 participants in each group. The intervention group engaged in the HRV-EP in conjunction with Guideline-directed Medical Treatment (GDMT) daily for 16 weeks, while the control group received only GDMT. The study assessed functional outcomes such as Resting Heart Rate (RHR), Blood Pressure (BP), HRV, Six Minute Walking Distance, (6MWD) and Ejection Fraction (EF) and the Quality of Life (QoL). Data were collected at baseline and following the interventions at the 10^th and 16^th weeks using a semi-structured interview schedule, biophysiological measures, and the Minnesota Living with HF Questionnaire for QoL. Results: The comparison between groups with two way repeated measure mixed Analysis of Variance (ANOVA) revealed significant differences across various time points. Specifically, Systolic Blood Pres-sure (SBP) (p<0.001) and Diastolic Blood Pressure (DBP) (p=0.008) were significantly lower in the intervention group compared to the control group. Additionally, HRV (p<0.001), 6MWD (p<0.001), and EF (p<0.001) were significantly higher in the intervention group relative to controls. However, RHR did not exhibit a significant difference between the groups (p=0.550). The intervention group also demonstrated significant improvements in overall QoL (p<0.001), as well as in the physical (p<0.001) and emotional domains (p=0.007). Conclusion: The HRV-EP is a safe, effective home intervention for enhancing vagal tone and improving outcomes among HFmrEF patients. Community-based cardiac rehabilitation can implement HRV-EP.

Expanded Screening of Inherited Metabolic Disorders by Tandem Mass Spectrometry: A Hospital-based Cross-sectional Study from a Single Paediatric Centre in Southern India

B Vinodh Kumar, P Ponmalar Ponnugandhi, Pramila Kadiyala Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Inborn Errors of Metabolism (IEMs) are a heterogeneous group of genetic disorders that often present in infancy and early childhood. Expanded Newborn screening (NBS) using Tandem Mass Spectrometry (TMS) enables simultaneous detection of multiple metabolic disorders and facilitates early diagnosis and intervention. Aim: To determine the spectrum and pattern of Inherited Metabolic Disorders (IMD) identified through expanded screening using TMS in a hospital-based paediatric population. Materials and Methods: The present hospital-based cross-sectional study was conducted at the Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from July 2021 to June 2024 and included 3,817 paediatric patients aged two days to 12 years who were clinically suspected of having IMD. Screening was performed using TMS on dried blood spot samples. Descriptive statistical analysis was carried out, and results were expressed as numbers and percentages using Microsoft Excel 2010. Results: Out of 3,817 screened children, 93 cases (2.44%) were diagnosed with IMD, comprising 22 distinct conditions. The most frequently detected disorders were Glutaric Acidaemia Type I (12 cases; 12.90%), Propionic/Methylmalonic Acidaemia (MMA) (11 cases; 11.83%), and Maple Syrup Urine Disease (MSUD) (7 cases; 7.52%). Approximately, 75.27% (70/93) of affected children were diagnosed within the first year of life. Conclusion: Expanded screening using TMS is an effective diagnostic approach for identifying a wide spectrum of IMDs in clinically suspected paediatric patients and highlights the need for wider implementation in tertiary care settings.

Dietary Practices among School-going Adolescents of Tiruvallur, Tamil Nadu, India: A Cross-sectional Study

Mahalakshmi Muthukumarasamy, Abinaya Ravi, Prathyusha Kadiyala, Shravan Kumar Sasidharan, Ruma Dutta, G Merlin Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Adolescence is a critical period of rapid growth and increased nutritional requirements. However, unhealthy dietary behaviours and the coexistence of undernutrition and overnutrition pose major public health challenges in India. Aim: To assess Knowledge, Attitude and Practices (KAP) regarding dietary habits and identify factors associated with poor dietary practices among school-going adolescents in Tiruvallur district, Tamil Nadu, India. Materials and Methods: The present school-based analytical cross-sectional study was conducted among 400 adolescents in Tiruvallur district, Tamil Nadu aged 12-17 years selected through multistage sampling from September 2025 to November 2025. Data were collected using a pre-tested structured questionnaire assessing sociodemographic details, dietary behaviour, knowledge, attitude, and lifestyle practices. Anthropometric indices Height-for-age Z score (HAZ), Weight-for-age Z score (WAZ), Body Mass Index (BMI)-for-age Z score (BAZ) were calculated using World Health Organisation (WHO) AnthroPlus soft-ware. Chi-square test and multivariable logistic regression were used to identify factors associated with poor dietary practice. Results: Frequent fast-food consumption 366 (91.5%) and screen time while eating 288 (72.0%) were common behaviours among the participants. Although 258 (64.5%) had adequate knowledge and 240 (60.0%) had a favourable attitude, only 170 (42.5%) demonstrated good dietary practices. Male gender, lower maternal education, abnormal BMI-for-age, inadequate knowledge, and unfavourable attitude were independently associated with poor dietary practices (p<0.05). Conclusion: Despite adequate knowledge levels, poor dietary practices were common, highlighting the need for school-based and family-focused interventions to bridge the knowledge-practice gap.

Eligibility Restrictiveness and Generalisability in Radiation Immunotherapy Trials for Head and Neck Squamous Cell Carcinoma: A Systematic Review of Trial Protocols

Baljit Singh, Neha Sharma, Abhishek Soni, Ashok Chauhan, Paramjeet Kaur, Rajeev Atri, Rakesh Dhankhar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) commonly affect older patients who often have multiple co-morbidities. With the growing use of Radiation Immunotherapy (RT-ICI) combinations in head and neck malignancies, concerns have emerged regarding the representativeness of trial populations. Aim: The present study aimed to evaluate the prevalence and cumulative burden of restrictive eligibility criteria in contemporary Phase II-III RT-ICI trials. Materials and Methods: This systematic review of trial protocols was conducted using Clini-calTrials.gov as the primary data source, following a registry-based cross-sectional analytical approach. Interventional Phase II-III radiation immunotherapy trials in Head and Neck Squamous Cell Carcinoma (HNSCC) registered between January 1, 2020 and December 31, 2025 were included. While the search parameters were confined to this period, final data extraction and clinical audit were performed in 2026. Eligibility criteria were reviewed across selected domains, including age limits, performance status, renal function, autoimmune disease, prior malignancy, steroid use, cardiac disease, and investigator discretion. Trials were excluded if they were early-phase (Phase I or Phase I/II), focused exclusively on non-head and neck malignancies, included mixed tumour populations without separate HNSCC analysis, or evaluated immunotherapy without concurrent radiation therapy. A Composite Restrictive Index (CRI), based on age restriction, Eastern Cooperative Oncology Group (ECOG) 0-1 status, creatinine clearance ≥60 mL/min, and autoimmune exclusion, was proposed and used to assess the combined effect of major eligibility criteria. The distribution of these criteria across domains was evaluated using Chi-square testing, and effect size was measured using Cramér’s V. Results: Thirty-two eligible trials were identified. Restrictive eligibility criteria were highly prevalent, with 84.4% of trials limiting enrollment to ECOG 0-1 patients and 87.5% excluding individuals with autoimmune disease. Age restrictions were present in 56.3% of trials, while 43.8% required a creatinine clearance ≥60 mL/min. Additional exclusions included prior malignancy (81.3%), chronic steroid use (71.9%), and significant cardiac disease (65.6%). Subjective exclusion criteria were noted in 81.3% of protocols. The mean CRI was 2.72 (SD 1.08), with 31.3% of trials applying all four restrictive domains. No significant clustering of restrictive criteria across domains was observed (p=0.091). Conclusion: Modern RT-ICI trials in HNSCC tend to apply multiple eligibility restrictions across key clinical domains. This may limit the applicability of their results to the wider, more di-verse patient population encountered in everyday practice.

Trends of Urinary Calcium-creatinine Ratio during Pregnancy as an Early Predictor of Pre-eclampsia: A Prospective Cohort Study

Subhrata Nanda, Sibaram Panda, Mayadhar Panda Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Hypertensive disorder in pregnancy is a major cause of maternal and perinatal morbidity and mortality worldwide. Urinary Calcium:Creatinine Ratio (CCR) has been reported as a potentially useful biomarker for predicting Pre-eclampsia (PE). Aim: To assess the trend of urinary CCR during pregnancy and to evaluate its association with the development of PE among antenatal women. Materials and Methods: A prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR) Burla, Odisha, India, from February 2024 to February 2025 among pregnant women attending before the 20th week of pregnancy for antenatal check-ups. A total of 245 cases were finally selected and their urinary calcium and creatinine estimation were performed to find out CCR. Pregnancy-induced hypertension was detected in the patients as per guideline laid by the American College of Obstetricians and Gynaecologists (ACOG). Comparison of mean urinary CCR between the PE and non PE groups was done using an Independent t-test. Results: Out of a total of 245 study participants, 35 (14.3%) developed PE. A progressive decline in urinary CCR was observed in women who developed PE compared to normotensive women. From 32 weeks of gestation onwards, mean CCR values were significantly lower in the PE group (p<0.001). Declining trend of urinary CCR demonstrated a sensitivity of 85.7%, specificity of 95.7%, for detecting PE. Receiver Operating Characteristic (ROC) curve analysis showed excellent discriminatory ability with an approximate Area Under the Curve (AUC) of 0.94. Conclusion: Decreasing trends of CCR can be used as an effective marker in the early predictive marker for PE.

Effect of Open versus Closed Kinetic Chain Exercise Program on Balance and Fall in Diabetic Neuropathy Patients: An Experimental Study

Dikshita Rabha, Asmina Rahman, Lopa Das, Madhumita Das Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Diabetic Neuropathy (DN) is a diverse group of clinical or subclinical symptoms affecting Peripheral Nervous System (PNS) resulting from diabetic mellitus. A very common ailment that significantly impairs patients’ Quality of Life (QoL) causes pain, and increases falls is DN. Aim: To analyse the effect of four weeks of Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) exercise program on balance and falls in DN. Materials and Methods: The present experimental study was conducted on 30 patients at Royal Global University, Guwahati, Assam, India for six months from December 2023 to May 2024. The subjects were selected as per the inclusion (Clinically diagnosed controlled DN, Both male and females aged 35 to 70 years, Berg Balance Scale (BBS) score between 35-45, Timed Up and Go (TUG) score- not below 15 sec-onds) and exclusion. OKC and CKC exercise program was done for four weeks and the duration is six month from December 2023 to May 2024 to improve balance by utilising BBS and TUG. Every session lasts roughly thirty minutes, with ten minutes of walking for a warm-up and a quadriceps and hamstring stretch for a cool-down. The Statistical analysis has been done utilising paired t-test with p-value of <0.001 to com-pare pre- and post-intervention values. Results: In terms of BBS, the pre-intervention score for OKC was 39.2 and the post-intervention score was 48.87 (SD±2.72) and for CKC was 38.53 and post-intervention was 51.73 (SD±2.02) with the p-value of <0.001. In terms of TUG test, the pre-intervention score for OKC was 16.33 and the post-intervention was 13.6 (SD±0.83) and for CKC the pre intervention was 15.93 and post was 11.8 (SD±0.86) with the p-value of <0.001. Conclusion: The study showed statistically larger improvement of CKC in TUG as well as BBS in functional mobility, alongside balance, compared to the OKC group. Hence, CKC Exercise programs could be utilised in day-to-day clinical practice as well as a home exercise program to enhance strength along with balance, which eventually results in prevention of falls in DN.

Clinical and Radiographic Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents for Primary Molars: A Randomised Clinical Trial

Kotra Shivani, Javangula Pavitra, Nanduri Manikya Kumar, Mohammad Abdul Sadik, Manchikalapati Naga Jyothi, Mavuri Padma Praveena Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Ferric sulphate (FS) has traditionally been used for pulpotomy in primary molars, but its limitations have led to the search for more biologically favourable alternatives. Chitosan (CH), a biocompatible material with antimicrobial and regenerative properties, shows promising potential yet lacks sufficient comparative evidence. Therefore, the present study evaluates and compares the clinical and radiographic success of Chitosan and Ferric Sulphate in primary molar pulpotomy. Aim: To evaluate and compare the clinical and radiographic success of CH and FS as pulpotomy agents in primary molars. Materials and Methods: This randomised clinical trial was conducted in the Outpatient Department (OPD) of Paediatric Dentistry at GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India, from July 2022 to August 2023. A total of 70 primary molars from healthy children aged 4-9 years, each with at least one deep carious but restorable molar, were included and randomly allocated into two groups: Group I (Ferric Sulphate-FS) and Group II (Chitosan-CH). Standard pulpotomy was performed under local anaesthesia and rubber dam isolation, followed by placement of a zinc oxide eugenol base, and stainless-steel crowns were cemented one day later. Clinical and radiographic evaluations were carried out at 3, 6, 9, and 12 months. Demographic data such as age, gender, and tooth type were recorded. Statistical analysis was performed using the Friedman test, Chi-square test and Multiple Analysis of Variance (ANOVA), with significance set at p-value <0.05. Results: The clinical success rate was 33/35 (94.3%) for the FS group and 35/35 (100%) for the CH group, while the radiographic success rate was 32/35 (93.4%) for FS and 34/35 (98.8%) for CH group. Although both groups exhibited significant improvement over time in clinical as well as radiographic parameters (p<0.05 for intragroup), the differences in overall clinical success (p=0.18) and radiographic success (p=0.12) between FS and CH were not statistically significant according to the Chi-square test. Failures were observed only in the FS group, whereas the CH group showed no clinical or radio-graphic failures. Conclusion: Chitosan has demonstrated promising clinical and radiographic success as a pulpotomy material. It has shown success rates in both clinical outcomes and radiographic findings, suggesting that it may serve as a promising alternative pulpotomy material with comparable clinical and radiographic outcomes.

Assessment of Awareness, Knowledge, and Education Needs Regarding Community Oral Health Services among Dental Students in Lucknow, India: A Convergent Mixed-methods Approach

Aayushi Aggarwal, Vinay Kumar Gupta, Nishita Kankane, Gaurav Mishra, Sumit Kumar, Seema Malhotra, Sreeja Gummalla, Sifpsa Diwakar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Community Oral Health Services (COHS) play a crucial role in improving access to oral healthcare in India. Despite the growing emphasis on COHS integration in national health policy, there is a notable lack of evidence on awareness and knowledge of COHS among dental students, the future primary workforce for its implementation. Existing studies have largely assessed practising dental surgeons or medical graduates, leaving a critical evidence gap at the training level. Understanding these gaps early, during dental training, is essential to inform timely and targeted curricular reforms. Aim: To assess the awareness, knowledge, and educational needs regarding COHS among dental students in Lucknow, India. Materials and Methods: A convergent mixed-methods study was conducted at the Department of Public Health Dentistry, among dental students enrolled at the Faculty of Dental Sciences, King George's Medical University, and affiliated private dental colleges in Lucknow, Uttar Pradesh, India, from October 2024 to March 2025. A total of 195 dental interns, post-interns and postgraduates gave voluntary informed consent. A validated structured questionnaire assessed awareness (8 items) and knowledge (11 items) of COHS. The qualitative component involved two Focus Group Discussions (FGDs) with 22 purposively selected dental interns, analysed by thematic analysis. Demographic parameters, including age, gender, place of residence, study level, specialisation, and Institution type, were recorded. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney U tests, Spearman's correlation, and multivariate regression were applied; p<0.05 was considered significant. Results: Awareness of general national health initiatives was high- Ayushman Bharat: 170/195 (87.2%), National Health Mission (NHM): 158/195 (81.0%), Pradhan Mantri Jan Arogya Yojana (PM-JAY): 154/195 (79.0%); however, dental-specific initiatives were lower; e-Dant Seva: 85/195 (43.6%) and dental care units at Primary Health Centres (PHCs): 74/195 (37.9%). Median knowledge score was 54.55% {Interquartile Range (IQR):27.27-63.64%}, significantly lower than the median awareness score of 75.00% (IQR: 50.00-87.50%). Postgraduates scored highest in both awareness and knowledge (p<0.001). Government Institution students showed significantly better awareness than private Institution students (p=0.043). FGDs revealed a disconnect between theoretical knowledge and practical exposure, with three themes: Academic knowledge, practical knowledge, and learning and training needs. Conclusion: The study highlights gaps in dental students’ awareness and knowledge of COHS, with limited field exposure and insufficient curriculum emphasis being key barriers. Integrating community-based training, COHS-focused modules, and structured rural postings into dental curricula could enhance preparedness for public health roles. These findings emphasised the need for revisions in dental education to align with national oral health priorities and improve workforce readiness for COHS implementation.

Assessment of Balance in Subjects Following Coronary Artery Bypass Graft Surgery: A Quasi-experimental Study

Shubha Akadas, Sweta D Kulkarni Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Coronary Artery Bypass Graft (CABG) surgery is commonly performed to improve cardiac outcomes; however, many patients experience functional limitations in the early postoperative period. Balance impairment and increased fall risk are frequently overlooked during routine cardiac rehabilitation. Aim: To evaluate changes in balance and fall risk before and after CABG surgery using the Berg Balance Scale (BBS) and Morse Fall Scale (MFS). Materials and Methods: A quasi-experimental study was conducted at the Department of Physiotherapy, SDM Narayana Hrudayalaya, Dharwad, Karnataka, India, from January 2022 to December 2022. Thirty adults who underwent elective CABG were included. Balance was assessed within 24 hours preoperatively and again after postoperative medical stabilisation (approximately 5-7 days postsurgery) using the BBS and MFS. Pre- and postoperative scores were compared using paired t-tests. Results: The mean age of the subjects was 59.8±8.2 years; 17 (56.7%) males and 13 (43.3%) females. The mean BBS score significantly decreased from 48.0±5.0 preoperatively to 37.3±5.0 postoperatively (p<0.001). Conversely, the mean MFS score significantly increased from 22.5±10.6 to 38.0±7.6 following surgery (p=0.002), indicating a higher fall risk in the early postoperative period. Conclusion: Patients recovering from CABG demonstrate significant balance impairment and increased fall risk shortly after surgery. Incorporating routine balance assessment and early physiotherapy interventions may enhance patient safety and functional recovery.

Hindi Translation, Validation and Test-retest Reliability of the Anterior Knee Pain Scale in Individuals with Patellofemoral Pain Syndrome: A Cross-sectional Study

Md Rafe Ansari, Shweta Sharma, Sonali Rana, Divanshi, Shree Krishna Shilpakar, Aditi Popli Jivani Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal condition characterised by anterior knee pain aggravated by activities such as stair climbing, squatting, running, and prolonged sitting. The Anterior Knee Pain Scale (AKPS) is a widely used patient-reported outcome measure for assessing symptoms and functional limitations in individuals with PFPS. However, a validated Hindi version of the AKPS is unavailable. Aim: To translate the AKPS into Hindi and evaluate its content validity, internal consistency, and test-retest reliability among individuals with PFPS. Materials and Methods: This cross-sectional study was conducted at MM Superspeciality Tertiary care Hospital, Mullana, Ambala, Haryana, India, from March 2025 to January 2026. The AKPS was translated into Hindi following standardised procedures, including forward translation, synthesis, back translation, expert evaluation using the Delphi method, and pre-testing. Content validity was assessed using the Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI/Ave). Test-retest reliability and internal consistency were evaluated in 51 individuals with PFPS using the Intraclass Correlation Coefficient (ICC), Cronbach’s alpha, and Bland-Altman agreement analysis. Results: The Hindi version of the AKPS demonstrated excellent content validity, with an S-CVI/Ave of 0.977. Most items achieved complete expert agreement (I-CVI=1.00), while two items demonstrated acceptable agreement (I-CVI=0.85). Internal consistency was excellent, with Cronbach’s alpha was 0.977. Test-retest reliability showed an ICC for single measures of 0.955 (95% CI: 0.923-0.974, p<0.001), indicating excellent reliability. Bland-Altman analysis revealed a mean difference of -0.44±1.896, with 95% Level Of Agreement (LOA) ranging from -4.16 to 3.28, indicating good agreement between repeated measurements. Conclusion: The Hindi version of the AKPS is a valid, reliable, and reproducible tool for assessing symptom severity and functional limitations in Hindi-speaking individuals with PFPS, and it can be effectively utilised in both clinical practice and research settings.

Prevalence of Helicobacter pylori Infection in Gallbladder Specimens of Patients with Calculous Cholecystitis: A Cross-sectional Study

SB Vasanthbalan, Magesh Chandran, S Madan, Ajay Gokul, Kuberan Krishnan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Helicobacter pylori (H. pylori) infection is highly prevalent in developing countries and is well known for its role in gastroduodenal diseases. In recent years, its possible association with extra-gastric disorders, including hepatobiliary diseases, has been increasingly studied. Gallstone disease is a common surgical condition with multifactorial aetiology, and the contribution of chronic infection to its pathogenesis remains unclear. Aim: To determine the prevalence of H. pylori infection in gallbladder specimens of patients with calculous cholecystitis and to evaluate its association with clinicopathological parameters. Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of General Surgery in collaboration with the Department of Pathology, in tertiary hospital, Chennai, Tamil Nadu, India, between July 2024 and February 2026. A total of 85 patients aged 18-75 years with clinically and radiologically confirmed calculous cholecystitis who underwent laparoscopic or open cholecystectomy were included by consecutive sampling. Gallbladder specimens were examined histopathologically for detection of H. pylori and associated mucosal changes. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 26.0. Categorical variables were compared using Chi-square test/ Fisher's exact test as appropriate and mean age was compared using student t-test. A p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 44.8±11.6 years. Females constituted 53/85 (62.4%) patients. Multiple gallstones were present in 58/85 (68.2%) patients. H. pylori infection was detected in 52/85 gallbladder specimens, giving a prevalence of 61.2%. H. pylori positivity was significantly associated with multiple gallstones (44/58, 75.9%) compared with single gallstones (8/27, 29.6%; p-value <0.001). Positivity was also higher in acute-on-chronic cholecystitis (10/12, 83.3%) than in chronic cholecystitis (42/73, 57.5%; p-value=0.046). No significant association was observed with age (p-value=0.160) or sex (p-value=0.470). Conclusion: A considerable proportion of patients diagnosed with calculous cholecystitis exhibited infection with H. pylori. The observed association between this infection and an increased incidence of gallstones, coupled with the presence of inflammatory alterations, implies a potential role for H. pylori in the pathogenesis of gallstone disease.

Assessment Tools for Balance Confidence in Individuals with Spinal Disorders: A Scoping Review

Manoj Joshi, Rittu Sharma, Nikita Vaid, Basliyal Shivani, Mehak Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Spinal disorders commonly lead to impairments in balance, mobility and participation in daily activities. Beyond physical deficits, reduced balance confidence is a critical yet underassessed factor contributing to fear of falling, activity restriction and poor rehabilitation out-comes. Despite its clinical relevance, there is variability in the instruments used to evaluate balance confidence in individuals with spinal disorders. Aim: To identify and summarise the assessment tools used to evaluate balance confidence in individuals with spinal disorders and to report their psychometric properties across different spinal conditions. Materials and Methods: This scoping review was conducted at the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, using the five-stage Arksey H and O’Malley L frame-work and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was performed in PubMed, Scopus, Physiotherapy Evidence Database (PEDro) and the Cochrane Library to identify relevant studies published between January 2015 and November 2025. Eligible studies were screened, selected and data were systematically charted and synthesised to summarise the assessment tools and their psychometric properties. Results: Eight studies met the eligibility criteria for inclusion, with most focusing on individuals with Spinal Cord Injury (SCI). The Activities-specific Balance Confidence (ABC) scale was the most commonly used self-reported measure and demonstrated strong reliability and validity, particularly in incomplete SCI populations. Fear of falling was primarily assessed using the Falls Efficacy Scale-International (FES-I) and Spinal Cord Injury Fall Concern Scale (SCI-FCS). Performance-based measures, including the Mini-Balance Evaluation Systems Test (Mini-BESTest), Brief-BESTest, Berg Balance Scale (BBS) and Functional Reach Test (FRT), showed favourable psychometric utility for assessing balance and fall risk. Evidence for non SCI spinal disorders was limited, highlighting a gap in the current literature. Conclusion: Assessment of balance confidence in individuals with spinal disorders requires a multidimensional approach that integrates both self-reported and performance-based measures. The ABC Scale appears to be the most consistently supported tool for evaluating balance confidence, particularly in SCI populations. However, evidence remains limited for other spinal conditions, underscoring the need for further validation of balance confidence measures across broader spinal disorder populations.

Cephalometric Evaluation of Facial Pattern and Hyoid Bone Position among Six to Nine-Year-Old Children with and without Obstructive Sleep Apnoea: A Cross-sectional Observational Study

Yash Bafna, Devangee Dineshbhai Bhoot, Shobha Fernandes, Harikishan Ashokbhai Kanani, Monika Khubchandani, Ramakrishna Yeluri Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Obstructive Sleep Apnoea (OSA) is characterised by repeated instances of the upper airway partially or completely collapsing during sleep, leading to a decrease in airflow (hypopnoea) or a complete absence of airflow (apnoea) that lasts for at least 10 seconds. Craniofacial structure and hyoid bone position significantly influence airway patency. Cephalometric evaluation of these parameters in children with and without OSA can help identify early morphological indicators of airway obstruction. Aim: To cephalometrically evaluate and compare the facial pattern and hyoid bone position among six to nine-year-old children with and without OSA in Visnagar, Gujarat, India. Materials and Methods: A cross-sectional observational study was conducted at the Department of Paediatric and Preventive Dentistry, Narsinhbhai Patel Dental College and Hospital (NPDCH), Sankalchand Patel University (SPU), Visnagar, Mehsana, Gujarat, India from July 2023 and September of 2023. A total of 60 subjects, aged six to nine years, were divided into two groups: Group A (n=30) children diagnosed with OSA and Group B (n=30) children without OSA. Twelve parameters were examined in the lateral cephalometric study. An Independent t-test was used as the statistical analysis. A p-value<0.05 was considered statistically significant. Results: Compared to the control group, children with OSA demonstrated significantly greater anterior lower facial height (p=0.035) and total anterior facial height (p<0.001), increases in the amount of anterior and inferior hyoid bone positions, and narrow upper and lower pharyngeal airway spaces (p<0.001). Conclusion: The research indicates that children who have OSA experience significant and early changes in the growth and development of their faces. Children with OSA have an apparent rise in their lower and total anterior face heights. OSA patients were shown to have a more inferior and anterior hyoid bone location than healthy nasal breather children, with statistically significant differences.

Comparing the Effect of Relining and Thermocycling on the Push-out Bond Strength of Glass Fibre Posts: An In-vitro Study

Ghadeer I Basunbul, Dalea M Bukhary Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Endodontically Treated Teeth (ETT) with substantial coronal loss often require post placement for restoration. The adaptation of the post to the root canal is critical for success. Aim: To evaluate the bond strength and durability of customised (relined) glass Fibre Posts (FP) compared to conventional FP in teeth with non circular root canals. Materials and Methods: This in-vitro study was conducted at King Abdulaziz University, Jed-dah, Saudi Arabia, from January 2024 to December 2024. To create a standardised dentin substrate, healthy adult premolars extracted for orthodontic or traumatic reasons were used. A total of 40 single-rooted teeth with non circular canals with similar root lengths were randomly divided into two groups: 1) conventional FP; and 2) customised (relined) Fibre Posts (FPC). Composite resin was used for relining the FPC group. All posts were luted with RelyX^TM Unicem Aplicap^TM. Each group was further divided into immediate testing and Thermocycling (TC) (6000 cycles) subgroups before undergoing push-out bond strength tests. Statistical analysis was performed using Two-way ANOVA , followed by Bonferroni post-hoc tests, and p<0.05 was considered statistically significant. Results: The bond strength of FPC to root dentin was significantly higher than that of FP (p=0.006). Thermocycling did not show a significant impact on the push-out strength for either FP (p=0.56) or FPC (p=0.819). Conclusion: Relining glass FPs with composite resin significantly increases their bond strength to root canal dentin, whereas thermocycling has no significant effect. Thus, the bond strength of FPs to root canal dentin is markedly improved by relining with composite resin, and no statistically significant reduction in bond strength is observed after thermocycling.

Effectiveness of AI Simulation as a Clinical Learning Tool for First-year MBBS Students: A Pilot Study

Gokul Suresh Revathy, Abhima Mallika Bhasurangan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Traditional methods of medical education, including lectures and textbook-based learning, often emphasise passive knowledge acquisition and may fall short in preparing students for real-world clinical reasoning. With the advent of Artificial Intelligence (AI) and Large Language Models (LLM), simulation-based learning has gained attention as a tool for enhancing engagement, knowledge retention, and decision-making skills in medical training. Aim: To evaluate the effectiveness of AI-driven clinical simulations in improving knowledge acquisition and retention among first-year MBBS students, compared to conventional teaching methods. It also aimed to assess students’ perception of AI simulations as a teaching-learning method using structured feedback. Materials and Methods: The current pilot study was conducted in the Department of Physiology of Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala, India for a period of 6 months from December 2024 to May 2025. Among 60 Phase 1 MBBS students, allocated into 2 groups. Utilising a crossover design, each group received both AI simulation (ChatGPT-based) and traditional lecture-based teaching for different clinical cases. Six clinical cases were used for the intervention. Pre-test and post-test assessments were conducted to measure immediate learning gains. Retention was evaluated using two follow-up tests administered at one-month interval. Statistical analysis included paired and unpaired t-tests, Mann-Whitney U tests, and effect size calculations. Additionally, structured feedback was collected from students in the AI group to assess perceptions of the learning experience. Results: AI group showed significantly higher improvement in Cases 1 and 4. Gains were comparable in other cases, with trends favouring AI. Retention Test 1: AI group outperformed traditional group (p=0.0323, r=0.272). Retention Test 2: AI group retained a small advantage (p=0.0678, r=0.240). Students reported positive perceptions across domains, with mean Likert scores above 4.0. Conclusion: AI simulation is an effective pedagogical tool for improving clinical knowledge and fostering deeper understanding in early medical learners. It promotes sustained engagement and meaningful learning, with measurable improvement in retention.

Comparative Evaluation of Radiopacity and Dentin Penetration Depth of Calcium Silicate-based Materials used for Apexification Procedure: An In-vitro Study

CH Varaha Venkata Narasimha Raju, Anupreeta Anwarullah, Desavath Anjaneya Naik, Ravi Chandra Ravi, Konagala Ravi Kumar, Basavaraju Pavani Yesaswani, Devika Chinnam, Sruthi Kapu Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Successful apexification requires materials that provide reliable sealing ability, favourable biological properties and adequate radiographic visibility. Newer calcium silicate–based bioceramic materials have been introduced to overcome the limitations of traditional Mineral Trioxide Aggregate (MTA). Aim: To assess and compare the dentinal tubule penetration depth and radiopacity of four commercially available calcium silicate-based materials used for apexification. Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India, from October 2024 to April 2025. A total of 80 single-rooted human mandibular premolars were prepared to simulate open apices and randomly allocated into four groups (n=20 each): Group 1-Control- ProRoot MTA®, Group 2- Biodentine® , Group 3- Biostructure MTA Putty® and Group 4-Bio-C Repair®. In each group, a 6 mm apical plug was prepared using the respective material, mixed with 0.1% Rhodamine B dye to facilitate microscopic evaluation. Radiopacity was measured using standardised digital radiographs with an aluminium step wedge, and grey scale values were obtained using ImageJ analysis. Dentinal tubule penetration at 4 mm and 2 mm from the apex was evaluated with Confocal Laser Scanning Microscopy (CLSM). Data were analysed using One-way Analysis of Variance (ANOVA), independent t-tests, and Tukey’s post-hoc test, with the level of significance set at p-value ≤0.05. Results: ProRoot MTA demonstrated the highest radiopacity measured in Grey Scale Value (242.93±2.84 GSV), followed by Bio-C Repair (241.12±2.61 GSV), Biostructure MTA Putty (233.17±6.01 GSV), and Biodentine (186.91±3.99 GSV). Biodentine showed significantly lower radiopacity than all other materials (p<0.001), while no significant difference was observed between ProRoot MTA and Bio-C Repair (p=0.5014). For penetration depth, Biodentine demonstrated the highest mean dentinal tubule penetration depth (641.40±126.89 μm), followed by ProRoot MTA (608.35±203.18 μm), Bio-C Repair (577.32±138.02 μm), and Biostructure MTA Putty (453.16±135.64 μm). Biostructure MTA Putty showed significantly lower penetration depth compared to the other materials (p<0.001). However, no statistically significant differences were found among ProRoot MTA, Biodentine, and Bio-C repair (p>0.05). Conclusion: Biodentine exhibited the greatest dentinal tubule penetration, whereas ProRoot MTA showed the highest radiopacity. Bio-C Repair showed a favourable balance between penetration and radiographic detectability. Selection of apexification materials should consider both sealing potential and radiographic visibility. Further clinical studies are required to validate these findings.

Knowledge, Attitudes, and Practices Regarding Disaster Management among MBBS Students: A Cross-sectional Study from Punjab, India

Asees Kaur, Rohit Batish, Ankushpreet Kaur, Simmi Oberoi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Disasters pose significant threats to healthcare systems and communities. Medical professionals, particularly future physicians, require adequate preparedness training to respond effectively to disaster situations. Assessing Knowledge, Attitudes, and Practices (KAP) among medical students is essential to identify training gaps and strengthen curriculum development. Aim: To assess knowledge, attitudes, and practices regarding disaster management among under-graduate MBBS students in a tertiary care hospital. Materials and Methods: The present cross-sectional descriptive study was conducted at Government Medical College, Patiala, Punjab, India, from November 2024 to April 2025, among 463 MBBS students. Data was collected using a pre validated, semi structured Google forms questionnaire covering sociodemographic characteristics and disaster management KAP (10 items on knowledge, 10 items on attitude and 7 items on practice). Categorical variables, including sociodemographic characteristics and KAP levels, were expressed as frequencies and percentages. Continuous variables were presented as Mean±Standard Deviation (SD). Results: The mean age of participants was 19.36±3.21 years, with 286 (61.8%) being female and 364 (78.6%) belonging to Class I socioeconomic status. Only 209 (45.1%) had prior exposure to the disaster topic and 162 (35.0%) were aware of disaster planning. Significant knowledge gaps existed regarding post-disaster infection management {114 (24.6%)}, triage (102 i.e., 22.0%) and local emergency response systems {130 (28.1%)}. Although 343 (74.1%) supported mandatory training, only 127 (27.4%) felt confident in their ability to manage a crisis. Only 109 (23.5%) had experienced a disaster, and 72 (15.6%) had participated in preparedness activities. Conclusion: Although MBBS students had favourable opinions of disaster training, there were clear deficiencies in both practical exposure and fundamental disaster management skills.

Assessment of Operator Experience on the Accuracy and Time Required for Intraoral Scanning with Three Different Scanners: A Prospective Study

Amritha Nehru, Ravindrakumar Jain Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Digital workflows in orthodontics increasingly rely on Intraoral Scanning (IOS) due to their advantages in efficiency, patient comfort, and precision. However, the impact of operator experience on scan performance remains a critical factor, especially with the introduction of new scanning technologies. Aim: To evaluate the influence of operator experience on scanning time and accuracy using three different Intraoral Scanners (IOS). Materials and Methods: The present prospective study was conducted at Saveetha Dental College, Chennai, Tamil Nadu, India from November 2024 to December 2024. Twenty adult participants underwent IOS performed by three operators with differing levels of experience: high (>50 scans), moderate (10-50 scans), and low (<10 scans). The study design was based on operator experience levels, with three subgroups corresponding to the type of IOS used: TRIOS 5 (3Shape), Runyes Three-dimensional (3D) and Cerec Primescan AC. Each participant was scanned nine times, once by each operator using all three scanners, resulting in a total of 180 intraoral scans. Outcome measures included scanning time and accuracy. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software, with intergroup differences assessed by Analysis of Variance (ANOVA) and correlations analysed using Kendall’s tau. A p-value of ≤0.05 was considered significant. Results: Scanning time was significantly influenced by operator experience (p<0.05), with highly experienced operators completing scans faster with the different scanners. Operator experience did not significantly affect scan accuracy (p>0.05). TRIOS 5 demonstrated the shortest scan times (1.24±0.14 minutes), while Primescan AC required the longest (5.78±0.64 minutes). Conclusion: Operators with high experience required less time to scan, irrespective of the scanner type used. The accuracy of scanning doesn’t depend on the operator’s experience or the type of scanner used. Clinically, enhancing operator skill can improve workflow efficiency and patient comfort without compromising scan quality.

Intralesional Measles Mumps Rubella Vaccine versus Cryotherapy in Multiple Extragenital Warts: A Prospective Interventional Study

Shreya Srinivasan, Geo Danny, Sukanya Gurusamy, Manoharan Dhanaraj, Narayanan Baskaran Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Verruca, commonly known as warts, is a common cutaneous infection caused by Human papillomavirus (HPV), often challenging to treat effectively. Traditional therapies like cryotherapy have limitations, prompting interest in immunotherapeutic alternatives, including intralesional Measles Mumps Rubella (MMR) vaccine. Aim: To evaluate the clinical outcomes of cryotherapy vs intralesional MMR vaccine in patients with multiple extragenital warts. Materials and Methods: The present prospective interventional study was conducted in the dermatology Outpatient Department (OPD) of Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India over a period of 18 months. A total of 50 patients diagnosed with multiple extragenital warts were enrolled, with 25 patients in each treatment group: Cryotherapy (CT) (Group CT) and intralesional Measles Mumps Rubella vaccine (Group MMR). The treatment outcomes were measured using a Visual Analogue Scale (VAS), percentage of clearance of the largest lesion and Likert’s patient satisfaction scores. For continuous variables, comparisons between the two treatment groups were made using the independent t-test. For categorical variables, Chi-square test was used. Results: Both groups had comparable wart characteristics, with verruca vulgaris being the most common type, with 10(40%) of patients in the MMR group and 11 (44%) of patients in CT group. Clinical improvement assessed using the VAS score showed better and faster clearance, predominantly in the early weeks of treatment (week 2 and week 4) in the MMR group. The assessment based on the size of the largest wart and patient satisfaction using the Likert score also demonstrated better clearance in Group MMR at two, four and six weeks. Blisters 10 (40%) and hypopigmentation 5 (20%) were exclusively observed in the CT group. Conclusion: While response to both therapies were good and comparable, intralesional MMR can be considered as a superior alternative to cryotherapy because administration of MMR into a single large lesion showed significant clinical improvement of not just the lesion injected, but clearance of warts at distant sites as well which was in contrast to cryotherapy where each and every wart was to be treated.

Evaluation of Antibody Response to Two Doses of Covishield Vaccine with a 5-Week Gap between Doses after 21 Days Post Second Dose: A Cross-sectional Study

Nina M Veigas, Annavarapu N Umalakshmi, Shailaja N Alapaty, Suhas N Dhulipala, Mangala N Sirsikar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) resulted in unprecedented global morbidity and mortality. Covishield (ChAdOx1 nCoV-19), a recombinant chimpanzee adenoviral vector vaccine manufactured by the Serum Institute of India under licence from Oxford-AstraZeneca, was the primary vaccine used in India’s national COVID-19 immunisation programme that commenced on 16 January 2021. Although most studies have evaluated 4-week or extended 8-12 week dosing intervals, real-world evidence regarding the immunogenicity of an intermediate 5-week dosing schedule remains limited, representing an important gap in knowledge. Aim: To evaluate the SARS-CoV-2 IgG antibody response 21 days after the second dose of Covishield vaccine administered with a 5-week interval and to assess its association with age, sex, and co-morbidities among healthcare workers at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India. Materials and Methods: A cross-sectional observational study was conducted at Vydehi Institute of Medical Sciences and Research Centre (VIMS and RC), a tertiary care teaching hospital in Bengaluru, Karnataka, India, between March and June 2022. A total of 326 vaccinated healthcare workers were enrolled; 324 were analysed (2 excluded due to equivocal results). Participants included healthcare workers and hospital staff who received two doses of Covishield with a 5-week (35-day) inter-dose inter-val. SARS-CoV-2 IgG antibodies against the spike protein were measured 21 days after the second dose using Chemiluminescent Immunoassay (CLIA). Spearman’s rank correlation assessed the association between age and antibody levels; Mann-Whitney U test was used for gender and co-morbidity comparisons. A p-value <0.05 was considered statistically significant. Results: Out of total 324 participants, 171 (52.8%) were male and 153 (47.2%) female, with a mean age of 36.8±11.2 years. Detectable IgG antibodies (≥1 S/CO) were observed in 320 participants (98.8%). The median IgG titre was 4.84 S/CO (IQR: 2.00-13.90); mean 11.20±14.56 S/CO. The IgG distribution was significantly right-skewed (Shapiro-Wilk p-value<0.0001). Spearman’s rank correlation showed no significant association between age and IgG levels (ρ=0.106, p-value=0.057; R²=0.011). No statistically significant difference was observed in antibody levels based on sex (U=13,005.000, p-value=0.856) or co-morbidity status (U=1,656.500, p-value=0.058). Conclusion: Two doses of Covishield administered with a 5-week interval induced a robust humoural immune response in 98.8% of participants. Antibody levels were independent of age, sex, and co-morbidity status, indicating consistent immunogenicity across demographic and clinical subgroups in this working-age healthcare worker cohort.

Effect of Dexmedetomidine-Lidocaine and Magnesium Sulphate-Lidocaine Gargles versus Lidocaine alone on Haemodynamic Response to Laryngoscopy and Postoperative Sore Throat: A Double-blinded Randomised Controlled Trial

Venkata Sai Krishna Praneeth Koneru, Pushparani Anand Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Direct laryngoscopy and tracheal intubation may cause a transient sympathetic surge causing tachycardia and hypertension, which may be worrisome in surgical patients. Postoperative Sore Throat (POST) is another frequent complication to endotracheal intubation that affects the comfort of the patient. Aim: To compare the effectiveness of dexmedetomidine-lidocaine and magnesium sulphate-lidocaine against lidocaine alone on haemodynamic responses during laryngoscopy and POST in elective surgical patients. Materials and Methods: This double-blinded randomised controlled trial was conducted on 180 adult participants (American Society of Anaesthesiologists (ASA) I-II) that were subjected to elective surgery under general anaesthesia. The participants were separated into three categories (n = 60 each): dexmedetomidine - lidocaine (Dex + Lido), magnesium sulphate - lidocaine (MgSO4 + Lido), and lidocaine alone. Patients rinsed their allocated solution 20 minutes prior to anaesthesia induction. The heart rate and Mean Arterial Pressure (MAP) were recorded at different positions. The statistical significance was determined as p-value <0.05, and it was tested with the help of One-way Analysis of Variance (ANOVA) and Chi-square tests. Results: The demographic and clinical baseline information including age, weight, surgery time, and ASA status did not differ between the groups (p-value> 0.05). The combination of dexmedetomidine and lidocaine significantly reduced the haemodynamic response, resulting in lower heart rates (85.82±9.45 vs 89.42±11.51 vs 93.82±10.19 bpm at 0 min; p-value=0.001) and MAP (97.18±7.21 vs 100.30±7.90 vs 102.45±9.14 mmHg; p-value=0.002). VAS scores were consistently lower for the dexmedetomidine group (2.50±0.78 vs 3.41±0.69 vs 4.50±0.81 at 24 hours; p-value<0.001). Conclusion: Preinduction gargling of dexmedetomidine - lidocaine is effective at attenuating the haemodynamic response to laryngoscopy and at reducing POST compared with magnesium sulphate - lidocaine or lidocaine alone. This simple intervention may act as an effective adjunct in improving peri-intubation haemodynamic stability and postoperative patient comfort.

Formulation Development and Physicochemical Analysis of a Herbal Cream Containing Extract of Tridax Procumbens (Jayanti)

Tushar Nagtode, Shubham R Bobade Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The use of herbs in medicine, tracing back to ancient cultures, reflects a rich history of discerning beneficial uses from plants through trial and error. Standardising herbal medicines involves establishing criteria for inherent characteristics, consistent parameters and qualitative and quantitative values to ensure quality, efficacy, safety and reproducibility. Tridax procumbens, known as Jayanti in Sanskrit, exhibits diverse pharmacological activities, making it a potential agent for wound healing. This herbal cream consists of a single herbal component. This simpli-fies the formulation, physicochemical analysis, and development processes while ensuring quality. Existing literature indicates the topical use of T. procumbens for wound healing. Aim: To formulate, develop, and evaluate the physicochemical properties of a cream containing Jayanti (T. procumbens) intended for topical wound healing applications. Materials and Methods: This was an experimental laboratory-based pharmaceutical formulation study conducted at Dattatray Ayurveda Rasashala, Mahatma Gandhi Ayurvedic College Hospital and Research Centre, Wardha, Maharashtra, India, from July 2023 to July 2024. Raw drugs and materials were sourced from the local market. The cream development process began with the preparation of ghee according to the classical method of Ayurveda. The cream formulation was then developed using base ingredients commonly found in modern cosmetics. Four batches were prepared for formulation. Organoleptic parameters such as colour, odour, and texture, along with physicochemical parameters including loss on drying, pH, spreadability, rancidity, iodine value, peroxide value, and microbiological contamination, were evaluated. Results: The study developed and assessed a herbal cream with satisfactory physicochemical properties. The results showed a loss on drying of 1.12%, a pH of 5.3, a spreadability test result of 1.3 gm/sec, the absence of rancidity, an iodine value of 18.78, a peroxide value of 7.99, and a negative microbiological contamination test. Conclusion: The herbal cream meets all evaluation criteria and demonstrates acceptable physico-chemical characterisation and formulation stability. The cream shows promise as a potential wound-healing formulation, attributable to its safe, effective and non toxic herbal composition.

Evaluating the Role of Platelet Parameters in Predicting Complicated Appendicitis: A Prospective Cross-sectional Study

Lakshay Mehra, Bhavna Sharma, Sujata Raychaudhuri, Jayati Chakraborty, Anand Kumar Verma Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Acute appendicitis is largely a clinical diagnosis, but has a high negative appendicectomy rate of 10-30%. If diagnosis is delayed, it can lead to serious complications like abscess formation, perforation and gangrene. Currently, there is a lack of quick and easy to use ancillary tests to predict complicated cases. Platelet parameters are a promising tool to predict complications and support clinical decision making. Hence, they should be evaluated for the same. Aim: To evaluate platelet parameters namely Platelet Count (PC), Mean Platelet Volume (MPV), Plateletcrit (PCT) and Platelet Distribution Width (PDW) as a tool to predict complications in appendicitis patients. Materials and Methods: A prospective, observational, cross-sectional study was conducted at the Department of Pathology, ESI-Post Graduate Institute of Medical Sciences and Research (ESI-PGIMSR), Basaidarapur, New Delhi, India, from April 2024 to July 2025 where blood samples were taken from all patients planned for emergency appendicectomy prior to the surgery. Platelet parameters such as PC, MPV, PCT and PDW were observed. These parameters were then correlated with histologic features of the removed appendix. Pearson’s correlation coefficients (r) were calculated for the same. Cases with histologic features like gangrene and thrombosed vessels were taken as complicated appendicitis. The mean of the platelet parameters in these cases were compared with the rest of the cases (uncomplicated) using unpaired t-test to see if significant differences existed. Multivariate regression analysis to predict gangrene was also done. Results: Seventy-two patients were included in the present study with a male to female ratio of 1.8:1. Among these, 25 cases showed both features, ensuring no duplication in total count. Statistically significant reduced MPV (7.7±0.8 fL) and elevated PC (338.4±79.6×10³/μL), PCT (0.26±0.07%) and PDW (17.7±3.0%) were observed in complicated cases (i.e., with gangrene and thrombosed vessels) versus uncomplicated (n=47) ones. Additionally, multivariate regression analysis identified PC >300×103/μL, MPV <8.0 fL, PDW >16%, and PCT >0.25% as significant predictors for gangrene development. Conclusion: These findings highlight the potential role of platelet indices in predicting the complications in clinical settings, contributing to quicker decision for patients with complicated appendicitis.

Efficacy of Infrazygomatic Approach Combined with Anterior Middle Superior Alveolar Nerve Block versus Standard Technique for Scaling and Root Planing: A Randomised Clinical Trial

Arockia Antony Praveen, Venkadassalapathy Santhosh, Dhayanand John Victor, Rathinasamy Kadhiresan, C Vikram, Sheryl Dolly, L Vishalatchi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: A profound anaesthetic technique is essential for performing periodontal procedures with an effective onset and adequate duration of action. The infrazygomatic approach combined with the Anterior Middle Superior Alveolar (AMSA) nerve block may serve as a better alternative to the conventional AMSA technique alone in the maxillary region, as it helps minimise palatal mucosal blanching and improves the extent of anaesthesia. The present study was conducted to evaluate whether the addition of the infrazygomatic approach enhances anaesthetic efficacy, reduces intraoperative discomfort, and shortens surgical duration during non surgical periodontal therapy compared to the AMSA technique alone. Aim: To assess the efficacy of anaesthesia in the maxilla by giving AMSA and an infrazygomatic approach, along with AMSA injections with 2% lidocaine and 1:80000 adrenalin anaesthetic solution. Materials and Methods: A randomised, single-blinded, parallel-arm clinical trial was conducted in the Department of Periodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India, from August 2021 to October 2021, to evaluate the efficacy of two different anaesthetic techniques in terms of pain intensity and duration of surgery. A total of 80 patients meeting the primary inclusion criteria {age 18–70 years, American Society of Anaesthesiologists (ASA) physical status I and II } were selected and randomly allocated using allocation concealment into two groups- Control group and Test group consisting of 40 patients each. The outcome assessor was blinded to the group allocation. The procedures were performed following a standardised protocol, and pain intensity and duration of surgery were recorded. Demographic parameters such as age and gender were documented. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software version 26.0, (Armonk, NY: IBM Corp., 2019). Descriptive statistics were used to calculate mean and standard deviation, and inferential analysis was performed using the Mann–Whitney U test. A p-value <0.05 was considered statistically significant. Results: Eighty participants were included in the analysis with equal gender distribution in both groups (24 males and 16 females in each group). The mean age was 35.93±6.05 years in the test group and 41.95±7.67 years in the control group. The test group demonstrated significantly lower pain scores compared to the control group, with mean Visual Analogue Scale (VAS) scores of 0.65±0.74 versus 3.88±1.80 (Z=7.14; p<0.01) and Wong–Baker FACES® pain scores of 0.60±0.93 versus 3.50±1.91 (Z=6.61; p<0.01). The mean duration of surgery was also significantly shorter in the test group (59.0±6.71 minutes) compared to the control group (83.62±8.69 minutes; p<0.01). Intergroup comparisons using the Mann–Whitney U test revealed highly statistically significant differences favouring the infrazygomatic approach combined with AMSA anaesthesia. Conclusion: The infrazygomatic approach with AMSA was found to be an effective method in order to provide good patient compliance. It was also found to be effective in reducing intraoperative pain perception compared to the standard AMSA technique. Hence, this technique can be considered as a beneficial adjunct during non surgical periodontal therapy.

Physical Function and Quality of Life across Cachexia Stages in Patients with Head and Neck Cancer: A Cross-sectional Study

Bindya Sharma, Twinkle Y Dabholkar, Yogesh G Dabholkar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Cachexia is a complex syndrome marked by progressive loss of muscle and fat, leading to functional decline and reduced Quality of Life (QoL). The impact of cachexia in Head and Neck Cancer (HNC) remains an underexplored area. They are particularly vulnerable because of swallowing difficulties and early weight loss, which predispose them to cachexia even at diagnosis. Since conventional measures such as skeletal muscle mass are not routinely practiced, there is a need to identify simple, clinically feasible markers of functional impairment. Aim: To explore physical function like Handgrip Strength (HGS), Six-Minute Walk Distance (6MWD), physical activity using International Physical Activity Questionnaire- Short Form (IPAQ-SF) and QoL using Functional Assessment of Anorexia and Cachexia Therapy (FAACT) across cachexia stages in HNC patients. Materials and Methods: A cross-sectional analysis was conducted among 32 newly diagnosed HNC patients between March 2023 and March 2024 at Dr. D. Y. Patil University Hospital, Navi Mumbai, Maharashtra, India. Cachexia staging was performed using the CASC-IN tool, which integrates weight loss, symptom burden, and C-Reactive Protein (CRP) levels. Functional assessments included HGS, 6MWD, IPAQSF, and FAACT. Data were analysed using Oneway Analysis of Variance (ANOVA), posthoc tests, and effect sizes were calculated. Results: Patients with cachexia showed markedly lower HGS (28.43±2.86 lbs) compared with non-cachectic (40.43±7.81 lbs) and pre-cachectic (33.3±5.43 lbs) groups (p<0.001, η²=0.48). No significant differences were observed in 6MWD (393–404 m; p=0.228). Physical activity was lowest in pre-cachexia (115.62±59.36 METs), intermediate in cachexia (224.31±170.02 METs), and highest in non-cachexia (344.55±232.05 METs), with a significant group effect (p=0.031, η²=0.21). QoL scores were substantially reduced in both cachectic (53.61±14.79) and pre-cachectic (51.69±7.71) groups compared with non-cachectic patients (70.33±11.12) (p=0.002, η²=0.34). Conclusion: The HGS emerged as the most sensitive marker of cachexia related muscle dysfunction, while declines in QoL and physical activity were evident even in precachexia. This study demonstrated that each stage of cachexia had different physical functional characteristics in HNC patients and early intervention can prevent functional decline.

Effect of Postural Exercises on Physiological and Biological Markers of Perceived Distress among Undergraduate Health Professionals Students: A Research Protocol for Randomised Controlled Trial

Ashish Gupta, Shweta Parikh, R Harihar Prakash, Jagdish Varma Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Health professional students experience high levels of Psychological Distress (PD) compared to other profession students. Persistent distress may adversely affect both psychological well-being and physiological regulation, including alterations in biological markers such as cortisol and physiological marker Heart Rate Variability (HRV). While Progressive Muscle Relaxation (PMR) is widely used for stress reduction, the potential additive benefits of physiotherapy-led postural exercises on psychological and biological markers of distress remain unexplored. Need of the study: Posture is closely linked to emotional expression and PD, yet posture-based interventions are largely unexplored in Physiotherapy. Current management primarily relies on re-laxation techniques with minimal integration of posture-focused strategies. Postural exercises are simple, safe and non invasive; there is a need to evaluate their role as interventions for improving psychological and biological markers of distress among health professions students. Aim: To evaluate the adjunct effect of a physiotherapy-led Postural Exercise Program (PEP), in addition to PMR, on psychological and biological markers of perceived distress among undergraduate students of health professions. Materials and Methods: A two-arm parallel randomised controlled trial will be conducted at the Department of Physiotherapy, K M Patel Institute of Physiotherapy, Bhaikaka University, Karamsad, Gujarat, India. A total of 64 undergraduate students from 1^st to the final year will be recruited through advertisement-based outreach. Eligible participants will be randomised with 1:1 allocation into Group-A (postural exercises + PMR) and Group-B (PMR alone). The intervention will be administered for 10 sessions over two weeks (5 sessions/week). Outcomes, including perceived stress, anxiety, burnout, self-esteem, blood cortisol levels and HRV, will be assessed at baseline and post-intervention. Intra and intergroup comparison will be done with paired and unpaired t-test and a p-value of <0.05 will be considered statistically significant.

Comparative Evaluation of Sticky Bone and Mineral Trioxide Aggregate as Pulpotomy Agents in Primary Molars: A Research Protocol for a Randomised Controlled Trial

Yash Yogendra Naik, Ramakrishna Yeluri, Harikishan Kanani, Rutuja Patil Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Pulpotomy is a technique that involves the amputation of coronal pulp, followed by the application of a medicament to the remaining pulp to sustain the life of the radicular pulp. Pae-diatric dentists still consider pulp therapy, particularly the vital pulpotomy, to be controversial. While pulpotomy evolved slowly over the period of the first 50 years, the pace of change since the 1960s has continued to accelerate dramatically. Need of the study: Sticky bone provides a stable fibrin scaffold, sustained release of growth factors, angiogenic stimulation, enhances wound healing, and improved tissue regeneration. These regen-erative properties may enhance the stability of dentin bridges, mitigate inflammation, and expedite the healing of the pulp. At present, there is a lack of clinical evidence assessing sticky bone in paediat-ric pulp therapy, despite its growing utilisation in periodontal procedures, socket preservation, and bone augmentation. Aim: The present study aims to compare the clinical and radiographic outcomes of sticky bone and Mineral Trioxide Aggregate (MTA) as pulpotomy agents in primary molars. Materials and Methods: A parallel-arm, Randomised Controlled Clinical Trial (RCT) will be conducted at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from October 2025 to November 2026. A total of 54 primary molars in healthy children aged 5-10 years will be included, with the sample equally divided into two groups of 27 teeth per group. Group A will receive a Sticky Bone (autologous T-PRF matrix mixed with bone graft material), and Group B will receive MTA (BioStructure MTA Putty) over the radicular pulp. Both groups will have the access cavity restored with Glass Ionomer Ce-ment (GIC), followed by a Stainless Steel Crown (SSC). Clinical outcomes, including pain, swelling, presence of sinus tracts, mobility, and tenderness upon percussion, will be evaluated at 1, 3, 6, and 9 months. Concurrently, radiographic outcomes, such as the absence of periapical or furcal radiolucency, root resorption, and preservation of the periodontal ligament space, will also be assessed at 3 and 9 month intervals. Data will be evaluated using Chi-square test and t-tests, with a p-value of <0.05 being statistically significant.

Effect of Myokinetic Chain Training on Agility, Endurance, Reaction Time and Grip Strength in Recreational Tennis Players: A Research Protocol for A Randomised Controlled Trial

Gargi Bisht, Nitin Kumar Indora Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: The kinetic chain is an integrated, multisegmented, sequential joint-motion and muscle-activation mechanism that results in dynamic upper-extremity dominating actions like throwing, kicking, and serving. Efficient kinetic chain function supports force generation, transfer, and movement control during sports-specific activities. Need of the study: Recreational tennis players have been deliberately chosen as they repre-sent the largest segment of the global tennis-playing community, yet remain underrepresented in sports science research. This protocol is among the first to simultaneously examine the effects of a structured myokinetic chain training program on agility, endurance, Reaction Time (RT), and grip strength in this population. Previous studies have largely focused on elite athletes or have investigated these performance parameters in isolation. By applying the concept of myokinetic chain training- which emphasises proximal-to-distal sequential activation- to non elite players, this study introduces a novel clinical and scientific perspective. Such an approach has the potential to bridge the gap between sports rehabilitation and performance enhancement, offering meaningful insights for recreational athletes. Aim: To evaluate the effect of 6-week kinetic chain training on endurance, RT, grip strength, and agility in recreational tennis players. Materials and Methods: A randomised parallel-group study will be conducted between February 2026 and April 2027 at the Sports Complex of Maharishi Markandeshwar (Deemed to be University), Haryana, India. The study will recruit 50 recreational tennis players aged 18-26 years through random sampling. Participants will be randomly allocated into two groups: Group A will undergo kinetic chain training, while Group B will receive conventional training. The primary outcome measures will include RT and agility, while secondary outcomes will consist of endurance and grip strength. For between-group comparisons, the independent t-test will be applied to normally distributed variables, and the Mann-Whitney U-test will be used for non-normally distributed variables. As multiple outcome measures will be analysed, a Bonferroni correction will be applied to reduce the risk of Type I error from multiple comparisons. A p-value of <0.05 will be considered statistically significant.

Clinical Evaluation of Yashtimadhu Taila Shirodhara and Yoga Nidra in Chronic Insomnia: A Research Protocol for Randomised Crossover Trial

Samruddhi Kisanrao Vaidkar, Pranesh Prakash Gaikwad, Mamata Mahadeorao Nakade, Vaishali Raghunath Chaudhari Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Chronic insomnia, caused by factors such as stress, anxiety, depression, poor sleep habits, environmental influences, or underlying health conditions, significantly impairs quality of life and may lead to headaches, body heaviness, mental disturbances, and reduced agni. Ayurveda uses diet, lifestyle changes, and Panchakarma treatments, such as Nasya, Shirodhara, and Shirolepa, to restore balance of mind and body. Shirodhara involves dripping oil or liquid on the forehead, Yashtimadhu Taila, which improves sleep quality. Yoga Nidra reduces stress and enhances relaxation, promoting better sleep duration and quality. Need of the study: Both Shirodhara and Yoga Nidra have demonstrated benefits in improving sleep; however, a comparative evaluation is lacking. Yashtimadhu Taila Shirodhara is described in Ayurveda for calming the mind and inducing sleep, while Yoga Nidra enhances relaxa-tion and mental balance. This study seeks to provide scientific validation of these therapies as holis-tic, patient-friendly approaches for managing chronic insomnia. Aim: To evaluate and compare the effects of Yashtimadhu Taila Shirodhara with Yoga Nidra in the management of chronic insomnia through a randomised crossover study. Materials and Methods: A randomised crossover study will be performed on patients from Dr. D. Y. Patil College of Ayurved and Research Centre, Pimpri, Pune, Maharashtra, India from March 2025 to March 2026. A total of 40 patients, aged 25 to 60 years, suffering from chronic insomnia, will be ran-domly divided into Group A or Group B in a 1:1 ratio. A sleep diary will be provided. Twenty patients will receive Yashtimadhu Taila Shirodhara, and the other 20 will receive Yoga Nidra for sev-en days. After a washout period of 10 days, crossover will occur, and the same patients will receive alternate therapy for seven days. Subjective and objective parameters will be assessed on the 8^th, 18^th and 25^th day. Repeated measures Analysis of Variance (ANOVA) test, Friedman test, Mann-Whitney U test will be used, and a significance level of p-value <0.05 will be taken.

Targeting the Sacroiliac Joint: A Research Protocol for a Study on Pain, Functional Recovery, and Disability in Lumbar Disc Prolapse

Aarunee Srivastava, Vaishali Rai, Satwinder Kaur, Sandeep Pattnaik Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Lumbar Prolapse Intervertebral Disc (PIVD) is a major cause of Low Back Pain (LBP) and disability, often associated with radiating symptoms and activity limitations. Altered spinal mechanics and compensatory movement patterns increase stress on the Sacroiliac Joint (SIJ), leading to SIJ Dysfunction (SIJD). The co-existence of SIJD with lumbar disc pathology complicates diagnosis and management due to overlapping clinical features. Need of the study: Although SIJ mobilisation has shown potential to improve lumbopelvic mechanics, reduce pain, and enhance neuromuscular control, there is limited structured evidence regarding its effectiveness in patients with lumbar PIVD. Additionally, concerns regarding the safety of manual therapy in acute disc pathology necessitate further investigation. Therefore, a systematic evaluation of SIJ mobilisation is essential to establish its role in reducing pain, functional recovery and reducing disability outcomes in this population. Aim: To investigate the efficacy of SIJ mobilisation on pain, functional recovery and disability in patients with lumbar PIVD. Materials and Methods: A quasi-experimental design, which requires 35 participants selected through specific inclusion and exclusion criteria. The study will be conducted at a tertiary care hospital in North India from January 2025 to December 2026. The study will provide all participants with SI mobilisation treatment, both posterior-anterior and lumbar extension glides, and core strengthening exercises. The study will use three outcome measures: pain intensity assessment by the Visual Analogue Scale (VAS), functional mobility assessment by the Timed Up and Go (TUG) test, and disability assessment by the Oswestry Disability Index (ODI), which will be measured before the intervention and after its completion. Statistical analysis will be performed using a paired t-test or Wilcoxon signed-rank test based on data normality, with the level of significance set at 0.05.

Genotypic Diversity of Norovirus Variants in Acute Gastroenteritis Cases and its Correlation with the Severity of Diarrhoea: A Research Protocol

Nandkishor J Bankar, Gargi Mudey, Ankit K Badge, Meena Mishra Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Norovirus (NoV) is a leading cause of acute gastroenteritis globally, especially in children under five. Despite its burden, data from India on circulating genotypes and their clinical implications remain limited. Need of the study: This study is needed for the early diagnosis and treatment of NoV-related diarrhoea also it will help epidemiologists to enable the detection of emerging and prevalent strains of NoV for better disease control, thereby reducing morbidity. Aim: To determine the genotypic diversity of NoV variants in patients with acute gastroenteritis and to assess the correlation between specific genotypes and the clinical severity of diarrhoea. Materials and Methods: This cross-sectional study will be conducted in December 2024 – November 2026 at the Department of Microbiology, Datta Meghe Medical College, Nagpur, Maharashtra, India en-rolling 766 participants with a history of acute gastroenteritis. Stool or rectal swab samples will be collected and analysed using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for NoV detection, followed by genotyping and bioinformatics-based sequence analysis to determine genetic diversity and variant distribution. Demographic parameters, including age, sex, and residential background (urban/rural), will be recorded for all participants. Additionally, machine learning, specifically graph-based techniques and graph neural networks, will be applied for advanced genomic feature extraction and analysis. Descriptive statistics, Chi-square or Fisher’s exact test, multiple regression, and Spearman correlation will be used to analyse clinical and molecular data, with a p-value <0.05 considered statistically significant. Temporal and spatial trends will also be assessed.

Efficacy of Baladi Granules versus Baladi Ksheerpaka in Primary Knee Osteoarthritis: Protocol for an Open-label Multi-arm Non-inferiority Randomised Controlled Trial

Amit Kumar Rai, Vaishali Kuchewar, Bharti Gupta Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Osteoarthritis (OA) is a major contributor to Years Lived with Disability (YLD) in the middle-aged and elderly population. The conventional approaches for OA management are not able to provide satisfactory relief due to associated Adverse Effects (AE). So, there is a critical need for safe and effective therapeutic options for OA management. Need of the study: Baladi Ksheerpaka, indicated in Ayurvedic texts for Vatavyadhi such as Sandhigatavata (OA), contains Bala (Sida cordifolia Linn.) and Brihat Panchamula. Experimental studies have reported their anti-inflammatory and analgesic properties. For better adherence and compliance, the said formulation will also be administered as granules mixed with lukewarm milk in the present study, and their efficacy will be compared. Aim: To compare the efficacy of Ayurveda interventions, Baladi granules, and Baladi Ksheerpaka in the management of primary knee OA. Materials and Methods: This open-label, multi-arm, non-inferiority Randomised Controlled Trial (RCT) will be carried out at the Central Ayurveda Research Institute, New Delhi, India, from July 2025 to November 2025. Individuals of any gender aged 50 to 70 years diagnosed with primary knee OA as per the American College of Rheumatology (ACR) criteria, and having grade 1 to 3 radiographic changes in the affected knee, will be included. A total of 111 participants will undergo random assignment in a 1:1:1 ratio to receive Baladi granules or Baladi Ksheerpaka, or Yograj Guggulu (control group) for eight weeks. Abhyanga with Nirgundi Taila and hot fomentation will be advised in all three groups. The primary outcome is the change in knee pain score from baseline, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include the change in the score for other subscales of KOOS {other symptoms, function, and Quality of Life (QoL)}, the Numeric Pain Rating (NPR) Scale, and the pain disability index; change in the range of motion of the affected knee joint(s); and change in the need for rescue analgesic medication from base-line. The safety outcomes include the incidence of AE and changes in liver and Kidney Function Tests (KFT) from baseline. The results will be presented and analysed using appropriate statistical methods.

Comparison of Electric Pulp Test Threshold Values at Different Sites in Immature and Mature Permanent Teeth in 6 to 14-year-old Children: A Research Protocol

Shepali Hule, Ramakrishna Yeluri, Nilima Thosar, Ishani Rahate Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: A crucial step in determining the appropriate treatment for a tooth is to assess the viability and overall status. In immature permanent teeth, where innervation is not fully developed, the electric pulp test can still be utilised by adjusting and increasing the threshold values to obtain a reliable response. Need of the Study: Previous studies on electric pulp testing in immature permanent teeth have shown mixed results due to variations in patient cooperation and differences in testing methodologies, which further contribute to inconsistent threshold values. Due to insufficient evidence in the literature regarding correct site placement, as well as the unavailability of reference threshold values for such immature teeth, this study will be conducted. Aim: To evaluate and compare the electric pulp test threshold values obtained at different sites in immature and mature permanent incisor and molar teeth. Materials and Methods: The present cross-sectional study will be carried out at Department of Paediatric and Preventive Dentistry of Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India from November 2025 to April 2026. Ninety immature and 90 mature permanent teeth will be classified based on the status of root completion of 6 to 14-year-old children. The teeth will be isolated with a rubber dam by an examiner. A standard Electric Pulp Tester (EPT) will be used following the manufacturer’s guidelines. The probe with conducting medium will be placed on test sites, and children will signal sensation by raising their hand, the corresponding digital reading will be recorded. A trial on a non-study tooth will ensure the child recognises the stimulus. If no response occurs at maximum output, the tooth will be excluded. EPT will be applied at incisal, middle, and cervical thirds of incisors, and mesiobuccal occlusal, middle, and cervical thirds of molars. Threshold values will be evaluated by comparing immature and mature permanent teeth. EPT thresholds will be analysed using tests based on data distribution: repeated measures Analysis of Variance (ANOVA)/Friedman test for within-tooth comparisons, t-test/Mann-Whitney U for between-group comparisons, and Two-way or mixed ANOVA for multiple factors. A p-value of <0.05 will be considered statistically significant.

Evaluation of Comparative Efficacy of Shatyadi Yoga versus Dicyclomine Syrup in Management of Udarshula (Abdominal Pain) in Children: A Research Protocol

Prachi Vijay Warukar, Sonam Kanzode Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Udarshula is the most common complaint among infants and children due to dependency on others for food. Population-based research indicates that chronic abdominal pain affects 10-12% of school-aged children and nearly 20% of middle and high school students. Vata Anuloman is a term used in Ayurveda to describe a treatment that helps to normalise Vata dosha and clear the obstruction of the pathway of Vayu, which can cause abdominal pain. Shatyadi yoga mentioned in Kashyap Samhita visheshkalpadhyay, has shula prashamana as well as deepana, pachana property. Need of the study: Shatyadi Yoga, a classical Ayurvedic formulation, offers a poten-tially safer alternative but lacks comparative clinical evidence. This study proposes to evaluate both treatments effectiveness and support integrative, evidence-based paediatric care. It addresses the need for safer, effective options and bridges gaps in Ayurvedic research. Aim: To evaluate the comparative efficacy of Shatyadi Yoga versus dicyclomine syrup in the management of Udarshula (abdominal pain) in children. Materials and Methods: This double-blind superiority clinical trial will be conducted from February 2025 to January 2026, at Mahatma Gandhi Ayurveda College, Hospital & Research Centre, Salod (H) Wardha. A total of 60 patients who meet the inclusion criteria will be randomly assigned to two groups. Group 1 will receive Shatyadi yoga, while Group 2 will receive dicyclomine syrup, administered twice daily for 14 days. Assessments will be conducted on day 0, day 3, and day 7, with follow-ups on days 14 and 28. Outcomes will be measured using the Faces Pain Scale-Revised (FPS-R) and a self-reported assessment of pain severity from the International Association for the Study of Pain (IASP), along with a parental questionnaire. Statistical analysis will be performed using the paired t-test and unpaired t-test, and a p-value of less than 0.05 will be considered statistically significant.

Evaluating Ayurvedic Digestive Function (Agnimandya) in Common Childhood Ailments in Comparison with Healthy School Going Children: A Case-control Study Protocol

Faiz Ahmad Mohammad Firoz Shah, Renu Bharat Rathi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Agni (digestive fire) plays a central role in health in Ayurveda, and its balance is crucial for digestion and metabolism. Jatharagni (digestive fire) imbalance may result in different metabolic disorders. The present study aims to assess the prevalence and status of Jatharagni in children with various health conditions using questionnaires and standardised assessment scales. Need of the study: Ayurveda views Agni imbalance as a key factor in many childhood dis-orders, like digestive, respiratory, and musculoskeletal issues. Early identification of Agnimandya in healthy school-going children can help prevent future diseases. Research in this area aids in spotting early risk factors, enabling timely interventions to promote overall health and well-being, and supporting children’s physical and mental development. Aim: Validation of Agnimandya concept and comparative assessment in common paediatric ailments (respiratory system disorder, gastrointestinal disorder and musculoskeletal system disorder) versus healthy school-going children nearby Wardha, Maharashtra, India. Materials and Methods: The present case-control study will be conducted at the Kaumarbhritya Outpatient Department (OPD) and Inpatient Department (IPD) of Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (Hi), and nearby Zilla Parishad (ZP) schools in Wardha, Maharashtra, India over 15 days from 15th November to 30th November 2025. Children aged 10 to 16 years will be enrolled and categorised into four groups: Group A (Cough/Kasa), Group B (Karshya/underweight), Group C (Constipation/Vibandha), and Group H (healthy controls), with 35 participants in each group (total n=140). Data will be collected through structured interviews using validated questionnaires and Agni assessment scales. Parameters like Agnimandya (imbalance of digestion), and subjective symptoms such as Kasa (cough), Karshya (underweight), and Vibandha (constipation) will be analysed for association with Jatharagni status. The study is expected to clarify the relationship between Agnimandya and selected paediatric disorders and contribute to evidence-based validation of Ayurvedic assessment principles. Kruskal-Wallis test, Mann-Whitney U test, and Chi-square test will be applied as appropriate. A p-value <0.05 will be considered statistically significant.

Evaluating the Efficacy of Yashtimadhu Ghrita Eye Drops versus Chakshushya Basti with Panchatikta Ksheera Basti in Dry Eye Associated Osteoarthritis: A Randomised Control Trial Research Protocol

Roshna Sanjay Bhutada/Rathi, Shweta Parwe, Komal Kedar, Mitali Sanjay Rathi Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Dry eye is one of the most commonly observed conditions, with a prevalence of about 5-50% in all ocular conditions and higher variations in clinical practice. The prevalence of Oste-oarthritis (OA) was revealed to be a significant risk factor for Dry Eye Syndrome (DES) in the twins UK cohort. According to research, DES is far more likely to occur in places with high levels of air pollu-tion than in cities with cleaner air. Need of the study: Conventional allopathic care is confined to symptomatic relief via lubri-cating eye drops and does not address the underlying tear-film instability or meibomian gland dysfunc-tion. This gap in effective, mechanism-based therapy highlights the need for studies that explore alter-native interventions capable of restoring tear-film homeostasis and improving long-term ocular surface health. Aim: To study efficacy of Yashtimadhu Ghrita eye drops along with Panchatikta ksheera basti versus Yashhtimadhu Ghrita eye drops and Chakshushya basti in the management of dry eye associated osteoarthritis disease-associated OA. Materials and Methods: A randomised standard control, single-blinded trial will be conducted at Mahatma Gandhi Ayurved College, Hospital and Research Centre Salod, Maharashtra, India from May 2025 to December 2025, involving 25 subjects in each group. Parameters that will be evaluated are the Womac scale, Schirmer’s test, and the Tear film break-up test. Chakshushya and Yashtimadhu Ghrita eye drops will be administered in Trial Group A. In control Group B, Panchatikta ksheera basti and Yashhtimadhu Ghrita eye will be given. The therapeutic enema, Yog Basti, will be pro-vided for the first eight days, followed by a gap period (Parihar kal) of eight days. After this, Aschyotan (eye drops) will be administered for the next eight days, leading up to the last follow-up on the 48th day. The routes of administration will be anal and topical. Data analysis will be conduct-ed using the paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U test, with significance set at p<0.05.

Comparative Study on Efficacy of Marma Chikitsa and Agnikarma in Pain Management of Knee Joint: Protocol for a Randomised Controlled Trial

Mayur Mhaske, Amol Deshpande, Gaurav Sawarkar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Knee pain, often linked to Osteoarthritis (OA), presents substantial challenges in pain management and functional improvement. Traditional Ayurvedic therapies, such as Agnikarma (therapeutic heat application) and Marma Chikitsa (stimulation of vital energy points), have long been used for pain relief. The study draws on the anatomical descriptions in Acharya Sushruta’s Sharirsthana, particularly ‘Marma Vigyana,’ which highlights the importance of 107 Marma points. Need of the study: Agnikarma and Marma Chikitsa are two different techniques used for treating knee joint pain. Agnikarma has several contraindications, including use in Pitta Prakruti, children, the elderly, patients with multiple wounds, and during summer. Improperly per-formed Agnikarma can cause complications and requires costly, specialised instruments. In contrast, Marma Chikitsa is cost-effective, requires no instruments, has minimal complications, and can be self-administered after training. Although both methods show promise, comparative studies with modern physiotherapy are limited. The present study aims to address this gap and provide evidence for integrating traditional and modern approaches to knee pain management. Aim: The current study aims to evaluate the efficacy of Marma Chikitsa and Agnikarma in pain management of the knee joint. Materials and Methods: A randomised controlled open-label equivalence clinical trial will be conducted at Mahatma Gandhi Ayurveda College Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India from October 2024 to October 2026. A total of 78 patients diagnosed with knee joint pain will be recruited and randomly allocated into two groups: Group A (Marma Chikitsa) and Group B (Agnikarma). Pain intensity {Visual Analogue Scale (VAS)}, functional status (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Index), Range of Motion (ROM) (Goniometer), and walking time before and after interventions will be assessed on zero-day, seventh day and 15th and final analysis at 30^th Day. Statistical data will be expressed as mean±SD, and paired t-test and unpaired t-test will be applied. A p-value <0.05 will be considered statistically significant.

Correlation of Serum Uric Acid and Urinary Uric Acid in Vatarakta (Gout) in Context with Dhatwagni Siddhant: A Case-control Study Protocol

Digvijay Singh, Bhushan Mhaiskar, Varun Gupta, Vikas Chaurasiya Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Vatarakta, in contemporary medicine, gouty arthritis is an Ayurvedic condition involving a Vata dosha imbalance that affects Rakta dhatu (blood tissue) are comparable. The purpose of this study is to investigate, within the context of the Ayurvedic concept of Dhatwagni Siddhant (Tissue metabolism theory), the relationship between Serum Uric Acid (SUA) and urine uric acid in Vatarakta (gout). Need of the study: There is limited research comparing serum and urinary uric acid levels in Vatarakta (Gout), especially in relation to Ayurvedic principles like Dhatwagni Siddhant. This study aims to bridge the gap between Ayurveda and modern science by correlating traditional Hetu with biochemical markers. It will help validate Ayurvedic concepts and support integrative approaches for better diagnosis and management. Aim: To study the correlation between SUA and urinary uric acid in Vatarakta (Gout) in the context of Dhatwagni Siddhant. Materials and Methods: A case-control study will be conducted at Mahatma Gandhi Ayurved College, Hospital and Research Centre from May 2025 to March 2026, including 86 patients (43 in each group) aged 30-65 years, diagnosed with Vatarakta (gout) at Mahatma Gandhi Ayurved College, Hospital and Research Centre Salod (H) Wardha for the case group, and healthy volunteers for the control group. SUA and urinary uric acid tests will be the objective parameters. Normality will be assessed using the Shapiro-Wilk test, with appropriate parametric (Independent t-test, Pearson’s correlation) or non-parametric (Mann-Whitney U test, Spearman’s correlation) tests applied accordingly. Chi-square test will be used for categorical variables, and a p-value <0.05 will be considered statistically significant.

Effect of Active Release Technique versus Graston Technique on Pain, Function and Range of Motion in Recreational Runners with Medial Tibial Stress Syndrome: A Research Protocol for a Randomised Controlled Trial

Arjavi Pakhan, Subrat Samal Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Introduction: Medial Tibial Stress Syndrome (MTSS), commonly known as shin splints, is a com-mon overuse injury characterised by pain along the medial border of the tibia, often seen in runners. It occurs due to repetitive stress on the tibial periosteum and surrounding soft-tissues, leading to dis-comfort and restricted movement. Manual therapy is often used to address these soft-tissue changes. The Active Release Technique (ART) reduces symptoms by releasing muscle tension through movement-based pres-sure. The Graston technique (GT) uses instrument assisted strokes to break adhesions and improve myofas-cial mobility. Need of the study: MTSS is a prevalent overuse injury that leads to considerable pain and functional impairment in athletes, often affecting their performance and delaying recovery. Although both the ART and GT are used to manage soft-tissue dysfunctions, limited research directly compares their effectiveness in MTSS. The comparison aims to provide evidence-based treatment strategies and en-hance the effectiveness of physiotherapy management for individuals with MTSS. Aim: The study aims to evaluate the effect of ART and GT on pain, function and Range of Motion (ROM) in recreational runners with MTSS. Materials and Methods: A randomised controlled trial will be conducted at Acharya Vinobha Bhave Rural Hospital, Datta Meghe Higher Education and Research, Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha, Maharashtra, India, from June 2025 to June 2026. A total of 66 participants will be included. The outcome parameters to be assessed will include the Visual Analogue Scale (VAS), Lower Extremity Functional Scale (LEFS), and ROM. The collected data will be statistically analysed us-ing Student’s t-test and Chi-square test in Statistical Package for the Social Sciences (SPSS) version 27.0, with a p-value of <0.05 considered statistically significant.

Bioactive Compounds Produced by Bacillus subtilis: A Brief Review

Munuru Srikanth, Shaik Sharmila Begum, RV Geetha Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Bacteria generate a wide array of bioactive compounds, each serving vital functions in medicine, agriculture, and industrial applications. Bacillus subtilis is one such bacterium that produces extensive and effective bioactive substances, which include lipopeptide molecules like surfactins, iturins, and fengycins, bacteriocins like bacillomycin, bacilysocin and subtilosin. Bacterial bioactive compounds can make an immense contribution to therapeutic applications, playing a key role in drug discovery and the innovation of new antimicrobial treatments. These bioactive compounds are antimicrobial and has potential anticancer properties. This is due to their specific targeting abilities. These molecules usually show diverse mechanisms in destroying cells, usually by cell wall disruption, known for their immunosuppressive and anti-inflammatory activities. Industrial-scale optimisation strategies may improve production efficiency and enhance commercial feasibility.

Optimising Pain Control: A Narrative Review of Anaesthesia Modalities in Brachytherapy

Taruneepriya Aradhyula, Tejshri Telkhade, Dhawal Wadaskar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Brachytherapy (BT), offers focused radiation administration while preserving nearby healthy tissues and is a crucial therapeutic option for a number of cancers. On the other hand, patient tolerance, precise placement and total treatment results can all be greatly impacted by procedural pain and discomfort. Current anaesthetic techniques utilised in BT, including topical, local infiltration, regional blocks and General Anaesthesia (GA), are assessed in the present narrative review. Research indicates that the tumour site, procedure complexity, patient co-morbidities and institutional expertise all have an impact on the choice of anaesthetic. While neuraxial and GA enhance comfort in more extensive intracavitary and interstitial implants, especially in gynaecologic and prostate malignancies, Local Anaesthesia (LA), sometimes in conjunction with conscious sedation, is helpful for low-complexity operations. New developments like ultrasound-guided localised methods provide better analgesia with less systemic side-effects. Although there are many possibilities, there is no standard anaesthetic procedure and practice varies greatly. In order to maximise pain management, reduce peri-procedural anxiety; and enhance procedural success, future research will focus on customised multimodal analgesia. Future research is necessary to provide evidence-based anaesthetic recommendations for BT.

Role of Vamana Karma in Restoring Follicle Maturation and Ovulation in Polycystic Ovarian Syndrome: A Narrative Review

Anjali Pradip Karande, Manoj Shamkuwar, Nitin Jindal, Ritu Sahrawat Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Women of reproductive age with Polycystic Ovarian Syndrome (PCOS), a common endocrine-metabolic disorder, often experience chronic anovulation, hormonal imbalances, and infertility. Ayurveda Experts consider PCOS as a Kapha Vata condition on the basis of its presentation. Classical texts suggest Vamana Karma (therapeutic emesis) to address reproductive issues linked to Kapha. The present review combines insights from Ayurvedic literature and contemporary studies, exploring the effects of Vamana Karma on follicle maturation and ovulation. The current narrative review suggests that Vamana Karma may contribute to hormonal regulation, metabolic balance, and follicular development by mitigating Kapha imbalance and enhancing hepatic function. Clinical observations indicate potential improvements in menstrual regularity, ovarian morphology, endocrine markers, and insulin sensitivity. Collectively, these findings highlight Vamana Karma as a promising integrative approach for managing PCOS. However, its efficacy and safety remain to be established through rigorously designed randomised controlled trials.

Diagnostic and Prognostic Utility of C-reactive Protein and Urinary Trypsinogen Activation Biomarkers in Acute Pancreatitis: A Narrative Review

B Pooja, Samir Ahmad, Manivannan Rajarathinam, Guru Prasad Narayanan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Acute Pancreatitis (AP) is a leading gastrointestinal cause of hospital admission and has an unpredictable early course. Although most cases are mild, a subset progresses to necrosis and/or persistent organ failure with substantial morbidity and mortality. Early identification of high-risk patients remains a clinical priority. The present review aims to critically appraise the diagnostic and prognostic utility of C-Reactive Protein (CRP) and urinary trypsinogen-based markers, including urinary trypsinogen-2 and urinary Trypsinogen Activation Peptide (uTAP) in AP, with emphasis on clinically relevant outcomes. The present narrative review was conducted using a structured literature search of PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar, evaluating CRP and/or urinary trypsinogen markers in human AP. Eligible studies included those on diagnostic accuracy and prognostic outcomes related to conditions like pancreatic necrosis and Intensive Care Unit (ICU) admission. Urinary trypsinogen markers may indicate early enzyme activation, aiding rapid diagnosis and risk assessment, especially shortly after symptoms begin. CRP, an acute-phase reactant driven by Interleukin (IL)-6, becomes more valuable when measured over time; in particular, a 48-hour CRP correlates well with severe AP and adverse outcomes. The performance of these biomarkers is timing-dependent and varies by method. Using urinary trypsinogen testing followed by CRP measurement may enhance patient triage and outcomes, but standardisation and validation are necessary for wider use.

Budd-Chiari Syndrome: Narrative Insights into Clinical Spectrum, Genetics and Contemporary Management Strategies

Ashna Nagpal, Pankaj Gharde, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Budd-Chiari Syndrome (BCS) is a rare potentially life-threatening disorder that occurs due to the hepatic venous outflow obstruction at the hepatic veins and/Inferior Vena Cava (IVC) causing hepatic congestion, portal hypertension, and inconsistent liver dysfunction. Clinical manifestations are heterogeneous, such as acute fulminant hepatic failure, chronic insidious ascites and hepatomegaly, and its manifestation varies with the rate of obstruction, the presence of veins, and other co-morbidities. Diagnosis depends on clinical examination, laboratory test and imaging, the first-line method is Doppler ultrasound and Contrast Enhanced Computed Tomography (CECT), Magnetic Resonance Imaging (MRI), or venography are used as second-line imaging modalities. Etiology is in most cases prothrombotic by nature and inherited, somatic, and polygenic risk factors play the role such as Factor V Leiden, JAK2 V617F and other molecular defects. Management is based on the combined multidisciplinary approach; anticoagulation is administered in the first step, followed by endovascular procedure, including angioplasty, stent placement, or Transjugular Intrahepatic Portosystemic Shunt (TIPS) and finally liver transplantation is carried out in refractory cases. Early detection and early intervention are important for improving clinical outcomes. This narrative review offers a clear overview of clinical, genetic and management aspects of BCS with a special focus on the recent developments and the emerging treatment plans.

Minimising Excess Cement in Cement Retained Implant Prosthesis for Enhanced Clinical Outcome: A Literature Review

Mohini Sanjay Khandekar, Seema Sathe, Surekha Dubey, Tanvi Jaiswal, Pooja Chitlange Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Cement retained implant prosthesis is a fixed dental prosthesis that is retained by dental cement applied to the abutment or implant component. It is a widely employed treatment modality to rehabilitate edentulous spaces. It has several advantages such as ease of use, predictable outcomes, decreased lab costs and ability to provide a secure and aesthetically pleasing result as there is no visible access screw hole. However, the main challenge encountered with cement retained implant prosthesis is minimising excess cement around the implant crown. It is a well-documented risk factor for causing inflammation, bone loss, and peri-implant disease, which can ultimately lead to implant failure. Several techniques have been described in the literature to minimise excess cement, including abutment design modifications, cementation protocols, and the use of barriers or indexing methods. The present literature review critically evaluates the methods aimed at minimising residual cement during cementation of the implant crown. It underscores the importance of technique sensitivity, clinician training, and continued research to develop universally effective methods. Incorporating these strategies can prevent peri-implant disease and ensure long-term implant success by providing a safer alternative to traditional cementation practices.

A Narrative Review on Anti-inflammatory Activity of Rubia cordifolia Linn

Kirti Naharwal, Anita Santoshrao Wanjari, Sakshi Yashwant Khapre, Puja Maldhure Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Herbal medicine, deeply rooted in traditional practices, has gained global attention for its efficacy and minimal side-effects. Among such medicinal plants, Rubia cordifolia Linn. (Manjistha), commonly known as Indian Madder, is a prominent Ayurvedic herb valued for its anti-inflammatory, antioxidant, and antimicrobial properties. Traditionally, its roots have been employed as blood purifiers, analgesics, and tonics, contributing to treatments for skin ailments, urinary tract disorders, and in-flammation. This review explores the pharmacological potential of Rubia cordifolia, emphasising its anti-inflammatory activities. The review highlights the plant’s efficacy in managing inflammation-related conditions, supported by preclinical studies and traditional applications. Key phytochemicals identified in Rubia cordifolia include anthraquinones, triterpenoids, and naphthoic acid esters, which contribute to its bioactivity. Anti-inflammatory activity was evaluated using in-vitro and in-vivo assays, with additional antioxidant assessments conducted through radical scavenging tests. The roots demonstrated significant anti-inflammatory effects, largely attributed to anthraquinones, which also exhibit antioxidant and antitumour properties. This supports the traditional use of Manjistha in treating inflammatory disorders. The review suggests the synergy of its phytochemical profile may contribute to its therapeutic applications and potential as a natural remedy. The findings underscore Rubia cordifolia’s therapeutic potential as an alternative remedy for inflammatory diseases, reflecting its significance in medicine and Ayurveda. However, further clinical trials are necessary to validate its safety and effectiveness for broader medical use.

Diagnosis of Desquamative Gingivitis using Different Diagnostic Modalities: A Narrative Review

Ayush Gupta, Amitha Ramesh, Nina Shenoy, Rahul Bhandary, Mamatha Shetty Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X The condition known as chronic Desquamative Gingivitis (DG) was first documented in 1894. In 1932, Prinz the term ‘chronic diffuse desquamate gingivitis’ to describe instances of chronic diffuse inflammation that were marked by significant shedding of the outer layer of cells in the marginal gingiva. In 1960, it was proposed that this was a non specific clinical response of the gingiva to various mucocutaneous conditions and not a diagnosis per se. To effectively diagnose mucocutaneous lesions, one must possess a thorough understanding of their genesis and clinical progression. Additionally, proficiency in various biopsy procedures using modern diagnostic technologies is essential. Accurate diagnosis is crucial in cases with DG, as the appropriate therapy and subsequent monitoring will be determined by the specific illness present. Nevertheless, the illnesses responsible for DG typically provide diagnostic challenges due to the clinical similarity of their lesions and the limited ability of conventional histological investigation to distinguish between them. Immunohistology, namely immunofluorescence, is now being used more often with standard histology to enhance the accuracy of diagnosing DG disorders. Direct immunoflourescence analysis is not only proving very useful for differential diagnosis, but also adds insight into possible pathogenic mechanisms of DG.

Association Between Risk Factors of Neck Pain and Obesity: A Narrative Review

Ahmad Merajul Hasan Inam, Abdur Raheem Khan, Mohammad Mustafa Khan, Ashfaque Khan, Mohd Javed Iqbal Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Prevalence of Neck Pain (NP) and obesity is increasing worldwide across all age groups. It has been observed that women are at greater risk of NP and obesity than men. NP and obesity share common risk factors, which can be used for early screening of NP and its associated disability. The present narrative review aimed to explore the association between the risk factors of NP and obesity. Several studies have reported that NP is associated with neck circumference and waist circumference, although the exact mechanism remains unclear. Some studies have shown that neck circumference is associated with cardiometabolic risk, similar to waist circumference. Early screening for NP in obese individuals is required to reduce NP-associated disability and obesity-related cardiometabolic risk. Exercise-based interventional studies are needed to understand the effectiveness of exercise in managing NP in obese individuals. Regular health awareness programmes are also required to improve spinal and cardiometabolic health in the general population.

Virtual Reality and Video Games for Trunk Rehabilitation in Post-stroke Patients: A Scoping Review

Ruchika, Subhasish Chatterjee, Mousumi Saha, Abhishek Mandal, Anmol Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Impaired trunk control after a stroke significantly affects functional activities and balance. Virtual Reality (VR) and game-based rehabilitation methods to facilitate trunk control in stroke patients have become popular. The objective of the present scoping review was to map, gather and evaluate information on VR and video game-based interventions for the restoration of trunk control in stroke survivors. A search of PEDro, Cochrane and PubMed database (2016-2025) identified total eight studies including five randomised controlled trials (including pilot randomised trials), two non-randomised or quasi-experimental designs and one laboratory based experimental study (n=247 participants) on VR/Video game-based trunk training lasting 4-12 weeks using devices like Nintendo Wii, Kinect, Oculus Quest 2, Driving simulations, non-immersive Doctor Kinetic gaming system and immersive Cave Automatic Virtual Environment (CAVE) system. These interventions lead to significant improvement in the various outcome measures of trunk control. Gait, quality of life and motivation also demonstrated improvement. However, some studies did not report exact p-values, and one experimental study assessed postural responses rather than clinical outcomes. VR and video games therapies might be an effective supplementary treatment to standard trunk rehabilitation following a stroke, improving control, balance and function.

A Narrative Review on the Role of Nicotine in Modulating HPA Axis Dynamics: Insights into Stress, Anxiety, and Peer Pressure

Monika Srivastav, Priyanka Bhangale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X India is the second-largest tobacco consumer and third-largest tobacco producer in the world. Stress is considered an important factor associated with nicotine dependency. Stress increases cortisol secretion in the bloodstream. Stress affects the pathway that sends signals from brainstem nuclei to the hypothalamic-pituitary axis and the release of adrenocorticotropic hormone and cortisol in mammals. This comprehensive review elucidates the intricate relationship between cigarette smoking and the Hypothalamic-Pituitary-Adrenal (HPA) axis. Additionally, it delves into the psychological factors, including peer pressure, depression, and anxiety, that influence an individual’s propensity to engage in smoking behaviour. Prolonged nicotine use impacts the expression of numerous essential neuropeptides in the brain, including Arginine Vasopressin (AVP) and Corticotropin-Releasing Factor (CRF). Nicotine produces transient euphoric effects and transient elevation of cortisol levels. Patients with anxiety/panic disorders have a greater tendency to depend on nicotine consumption, and peer pressure also plays a key role in the increase in smoking among young adults. This review attempts to close this gap by examining how nicotine affects HPA function and its consequences for metabolic control, stress-response modulation, and addiction biology. Comprehending this connection is essential for developing treatment plans to reduce nicotine-related health problems and improve smoking cessation techniques. In conclusion, nicotine intake indirectly modulates the hypothalamic-pituitary-adrenal axis activity and transiently alters cortisol secretion, contributing to stress-response dysregulation and nicotine dependence.

Situs Inversus Totalis: A Narrative Review of Clinical Features, Diagnostic Advances, and Evolving Surgical Management

Deepanshu Sharma, Imran Ali Khan, Anup Zade, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Situs Inversus Totalis (SIT) is a rare congenital condition where thoracic and abdominal organs are in complete transposition as mirror image with an estimated prevalence of 1/10000 births. Majority of the patients show no symptoms and SIT is usually identified incidentally during imaging, Electrocardiogram (ECG ) or clinical examination. The symptomatic cases tend to be related to the associated pathologies, such as acute appendicitis, cholecystitis, or cardiac malformation, and will be atypical because the reversed anatomy of the organs. It is diagnosed by a combination of adequate history taking, physical examination, chest and abdominal imaging, echocardiography, and prenatal imaging and genetic testing are also becoming more important. Surgical treatment involves careful adaptation to the mirrored anatomy where it involves modified laparoscopic surgery but may also include Three-dimensional (3D)-assisted and robotic-assisted surgeries. New technologies, such as fluorescence cholangiography, AI-assisted imaging, and others, contribute to the high safety and accuracy of surgery and diagnosis. This narrative review article aimed to comprehensively summarise about embryology, clinical presentation, diagnostic modalities, associated anomalies as well as surgical considerations of SIT along with particular emphasis on recent technological advances such as fluorescence cholangiography and AI-assisted imaging which enhance diagnostic accuracy and operative safety.

Efficacy of Yogic Practices in Children with Down Syndrome: A Narrative Review

Amisha Rawat, Sobika Rao Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Down syndrome is a genetic disorder in which an individual has an extra copy of chromosome 21 in each cell. It cannot be cured but can be managed with early intervention and alternative therapies. The present review aimed to review the existing literature on the efficacy of yogic practices in children with Down syndrome. Yoga has a holistic approach, and an early yogic intervention may be feasible in managing the symptoms of Down syndrome. The reviewed studies suggest that Yoga, through its various modalities like Asanas, Pranayamas, Kriyas, and relaxation techniques, positively influence the basic components such as balance, coordination, cardiorespiratory efficiency and also shows improvement in quality of life in children with Down syndrome.

Dry Eye Disease and Screen Exposure in School Children: Is There a Link?

Prutha Shrikant Bhagat, Archana Thool Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Dry Eye Disease (DED) is characterised by tear film instability, which can cause ocular surface damage. Patients with dry eye illness may have ocular pain/discomfort as well as visual abnormalities, which can have a significant influence on quality of life. Increased usage of digital displays for work, communication, and leisure, particularly during pandemics, may exacerbate dry eye. The duration of smartphone use was also found to be longer in school children suffering from DED than in those without. A frequently recognised concept for the association between digital screen use and dry eye illness is that it alters blinking dynamics, resulting in ocular dryness. The present study discusses evidence that digital screen usage is linked to dry eye illness, that digital device use modifies blinking dynamics, and that dry eye impacts mental health and workplace productivity in digital screen users. People who use digital screens can benefit from effective DED prevention and management strategies.

Pseudothrombocytopenia: A Narrative Review of Mechanisms, Laboratory Recognition, and Clinical Implications

S Manjani, R Madhumittha, K Khowsalya Subrajaa, Kundavai Chandrasekar, PT Navya Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Pseudothrombocytopenia (PTCP) is a laboratory artefact characterised by spuriously low platelet counts resulting from in-vitro platelet clumping, most commonly due to Ethylenediaminetetraacetic Acid (EDTA)-dependent agglutination. Although clinically benign, failure to recognise PTCP can lead to significant consequences, including unnecessary platelet transfusions, inappropriate corticosteroid therapy, avoidable bone marrow biopsies, and delays in surgical procedures. The prevalence of PTCP ranges from approximately 0.1% in the general population to 0.1-2% among hospitalised patients, with higher detection rates in critically-ill, oncology, and autoimmune disease populations. PTCP may be transient or persistent and can recur in predisposed individuals. The present review summarises the mechanisms, laboratory recognition, confirmatory approaches, and clinical implications of PTCP, emphasising the role of peripheral smear examination, analyser flag interpretation, and alternative anticoagulants. Emerging technologies, including artificial intelligence-assisted detection, have further enhanced diagnostic accuracy. Increased awareness among clinicians and laboratory professionals is essential to ensure appropriate interpretation of platelet counts and to prevent unnecessary interventions.

A Narrative Review on Cerebral Visual Impairment in Children: Aetiology, Ocular Manifestations, and Parental Perspectives

Nikitha Vijaya Bangera, Ashwitha H Gamsa Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Cerebral Visual Impairment (CVI), a neurodevelopmental visual processing disorder, has emerged as the major cause of visual impairment in children in high-income, developed nations. The present narrative review combines various pieces of recent literature regarding the aetiology, epidemiology, ocular manifestations, parental aspects, as well as rehabilitation strategies, related to CVI. A detailed literature search using PubMed, Google Scholar, and various other search engines on CVI-related literature, mainly published within the last ten years, was undertaken. Perinatal Hypoxic-Ischaemic Encephalopathy (HIE) has emerged as the major cause of CVI, which is characterised by complex refractive errors as well as various other ocular disorders. Parents report delayed diagnosis, a lack of professional understanding, and considerable emotional impact, but also highlight how environmental modification and co-coordinated multidisciplinary support make a big difference. An effective rehabilitation approach involves correcting refractive errors alongside a multidisciplinary, family-centred model that emphasises environmental adaptations, tailored visual strategies, and targeted neuro-rehabilitation interventions, such as Cognitive Rehabilitation Therapy (CRT). The CVI rehabilitation calls for coordinated care pathways to manage the co-occurring ocular problems and focus on the early detection of the effects of CVI on the child’s functions and neurorehabilitation. The findings have shown the urgent need for developing standardised instruments to assess the child’s visual functions and the development of training programs for professionals and family support services that promote the visual well-being of the visually impaired child.

Camurati-Engelmann Disease: A Narrative Review of Clinical Features, Molecular Pathogenesis, Diagnosis, and Emerging Targeted Therapies

Shashank Yadav, Ratnakar Ambade, Harsh Patel, Ansh Khanduja, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Camurati-Engelmann Disease (CED) is a very rare, autosomal-dominant type sclerosing bone dysplasia that is characterised by progressive diaphyseal hyperostosis, cortical thickening of long bones, along with variable involvement of skull-base. This narrative review synthesises the current evidence regarding clinical features, molecular basis, diagnosis, as well as management strategies of CED. Clinically, patients having CED, usually present in childhood or adolescence age with chronic pain in limbs, proximal muscle weakness, fatigability, along with a waddling gait, while cranial hyperostosis may lead to hearing impairment, cranial nerve deficits, or raised intracranial pressure. Pathogenic heterozygous mutations in Transforming Growth Factor Beta 1 (TGFB1), also less commonly Transforming Growth Factor Beta 1 (TGFB2), can cause disruption of the latency-associated peptide domain of TGF-β, which can result in excessive TGF-β activation along with downstream dysregulation of bone remodeling pathways. Diagnosis of CED primarily depends upon identification of typical clinical features, characteristic imaging findings of symmetric diaphyseal sclerosis, also definitive confirmation although is done using genetic testing. Management of CED is usually symptomatic, which is inclusive of analgesics, glucocorticoids, and emerging usage of angiotensin II receptor blockers such as losartan. Surgical decompression is usually reserved only for few cases which present with skull-base complications. Novel therapeutic strategies that target TGF-β axis, including receptor inhibitors, ligand traps, as well as Rho-GTPase pathway modulators, also represent promising options as disease-modifying treatment. Improved understanding of various molecular mechanisms for CED along with long-term clinical outcomes is essential for enhancing patient care and quality of life. This narrative review article focuses on uniquely merging updated molecular insights on dysregulated TGF-β signalling along with contemporary diagnostic algorithms, emerging targeted therapies, thus providing a consolidated, clinically oriented framework which is currently lacking in existing literature about CED.

Recent Surgical Advances in the Management of Congenital Heart Disease: A Narrative Review

Krupa Bhanushali, Revat Meshram, Amar Taksande Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Congenital Heart Disease (CHD) remains the most common cause of death due to congenital disabilities. The number of adults with CHD is rapidly growing, even though it is still the primary cause of morbidity and mortality in children. Various treatments for different types of CHD are currently available in the literature. Over recent decades, surgical management has undergone a transformative shift, driven not only by refined techniques but also by the integration of hybrid procedures, simulation technologies, and precision-based planning. The current review summarises major recent advances in valve-sparing repair techniques, hybrid neonatal strategies, 3D-printed surgical simulation, AI-based imaging guidance, and robotic-assisted congenital cardiac surgery. These innovations collectively show a clear shift towards more precise, less invasive, and outcome-driven management of complex CHD. The present review highlights key advancements in surgical approaches to CHD, from early neonatal repairs to robotic-assisted and imaging-guided innovations, offering a forward-looking perspective on how modern tools are reshaping outcomes for complex cardiac lesions.

Caroli Disease: A Narrative Review of Clinical Spectrum Pathogenesis, Diagnostic Advances, and Management Strategies

Aniruddha Patel, Ranjana Lanjewar, Imran Ali Khan, Riddhi Thakor, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Caroli disease is a rare congenital disease of segmental and non obstructive dilatation of intrahepatic bile ducts. This can be simple Caroli disease or Caroli syndrome in combination with congenital hepatic fibrosis and frequent Autosomal Recessive Polycystic Kidney Disease (ARPKD). The symptoms of the patient are usually recurrent cholangitis, hepatomegaly, pruritus, and in serious cases, portal hypertension, bile stones, or Cholangiocarcinoma (CCA). Pathogenesis consists of the development of the malformed ductal plate during embryogenesis, which is often associated with the mutations in PKHD1 gene encoding cholangiocyte cilia and bile duct architecture. Imaging is the most important part of the diagnosis, with the hallmark of the phenomenon of a central dot being identified in the Magnetic Resonance Cholangiopancreatography (MRCP), complemented by ultrasonography, Computed Tomography (CT), Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI), and genetic testing. The management focuses on complications, antibiotics and biliary drainage in case of cholangitis, segmental resection of the liver in case of localised disease and liver transplant in case of diffuse disease. Multidisciplinary management, that is needed to decrease recurrent infections, review progress in patient and enhance outcomes, should be conducted on a long-term basis.

Arsenic Exposure and Non-Communicable Diseases: A Review on Mechanisms and Global Impact

Prayash Borah, Robert Ravi Selvaraj Pandian, Vidhya Srinivasan Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Arsenic is a naturally occurring metalloid that poses a significant public health concern due to its widespread contamination in the groundwater and food chain globally. Prolonged exposure to arsenic through consumption of contaminated drinking water and foods has been identified as a major risk factor in development of a number of Non-Communicable Diseases (NCD), mostly Diabetes Mellitus (DM), heart disease, a number of cancers (skin, bladder, lung, liver) as well as respiratory and skin diseases. Epidemiological and laboratory experiments repeatedly show that arsenic has its toxic effects due to some complicated biochemical mechanisms, oxidative stress, chronic inflammation, endocrine and the immune system dysfunction, alterations in the genes and epigenetic alterations. The problem of arsenic contamination is becoming a global crisis which is affecting both developing and developed countries, with South and Southeast Asian countries severely impacted. Millions of people remain at risk despite growing awareness. In this review, available scientific information on arsenic-induced NCDs is presented in the most elaborate manner with the dire need for a community health response from the global community, including adequate surveillance of water and food security, implementation of efficient arsenic-control technology, and area-specific community-based responses to this ever-increasing menace that is arsenic-induced NCDs.

An Emerging Form of Diabetes: Type 5 Diabetes Mellitus

Manisha Varshney, Jegan Duraiswamy, Pinaki Purusottam, Siddhi Patel Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X The International Diabetes Federation (IDF) at the World Diabetes Congress 2025 in Bangkok, Thailand came up with the new classification of diabetes along with types 1, 2, 3 class (c) and gestational diabetes [1-3]. The IDF has officially recognized Type 5 Diabetes Mellitus (T5DM), formerly known as malnutrition-related diabetes, which was previously overlooked. At the World Diabetes Congress in Bangkok, Thailand, on April 8, 2025, a formal vote was held to confirm this decision, and the IDF approved the new classification. It was an essential step towards the long-ignored condition. The World Health Organisation (WHO) has still not classified it as a distinct category of diabetes due to the lack of proper evidence and diagnostic criteria.

Chronic Osteomyelitis of Distal Femur Managed with External Fixator and Weight Bearing Calliper: A Paediatric Case Report

Aditya Dalvi, Nitin Samal, Dhairya Veragiwala, Amit Gaurkar Journal of clinical and diagnostic research : 2026 - July - 20:0973-709X Chronic osteomyelitis is a long-standing infection of bone that can occur following trauma, fracture, or inadequate treatment of an initial infection. In children, delayed diagnosis may result in persistent pain, deformity, limb dysfunction, and difficulty in walking. Management is often difficult because the infected bone has poor blood supply and may contain sequestrum and chronic sinus formation. Timely surgical treatment with adequate stabilisation is therefore important for successful recovery. An eight-year-old child presented with pain, swelling, and discharge from the distal thigh for three months following treatment of a distal femur fracture with an above-knee slab. Clinical and radiological examination showed malunion of the distal femur with features suggestive of chronic osteomyelitis, including sequestrum formation. The patient underwent sequestrectomy with thorough debridement of infected tissue. Stabilisation was achieved using an external fixator, and autologous bone grafting was performed to aid bone healing. The postoperative period was uneventful. After six weeks, the external fixator was removed and gradual mobilisation was started with the help of a weight-bearing calliper and physiotherapy. The patient showed improvement in pain, infection control, and functional mobility during follow-up. This case highlights the importance of early identification and aggressive surgical management of chronic osteomyelitis in children. The present report is clinically significant because satisfactory limb function and infection control were achieved using sequestrectomy, external fixation, bone grafting, and structured rehabilitation in a case of paediatric distal femur infection.