Journal of clinical and diagnostic research

Cytodiagnosis of Warthin's Tumour in Submandibular Salivary Gland- A Rare Case Report

Poornima Pandey, Arvind Bhake

The cytodiagnosis of Warthin’s tumour by Fine Needle Aspiration Cytology (FNAC) in the submandibular salivary gland in literature is sparsely reported. Constituting an outnumbered portion of salivary gland neoplasms, it is a monomorphic adenoma that mainly arises in parotid gland. The occurrence of it in minor salivary gland and submandibular salivary gland is minuscule. Therefore, the confrontation of cytomorphological features of Warthin’s tumour poises the problem of interpretation. In spite of the fact that, Warthin’s tumour dispense as a clinically benign, slow growing and asymptomatic lesion with minimal rate of recurrence, nevertheless this entity is contemplated peculiar because of its unknown origin and cytomorphological appearance. The cytopathological smears prepared depict papillaroid sheets of oncocytoid cells which entails careful distinction for its diagnosis. The present article outlined such rare case of Warthin’s tumour for its cytomorphological character and its clinical finding for its medical rarity. Here by, authors describe a case of Warthin’s tumour of two years duration in a 44-year-old male patient in the right submandibular gland. The clinical examination had revealed it to be a mass of 4x4 cm lying just below the angle of mandible, with solid as well as cystic components. As a part of presurgical diagnosis the patient was referred for FNAC. The smears were prepared from both components of swelling and the peculiar case was pondered over for various concepts regarding its clinicopathological features with main emphasis on cytomorphology.

Bilateral Congenital Macular Coloboma: A Case Report

Manisha Nada, Kiranmai Garg, Jitender Phogat, Anjali Kharolia, Surender Kumar

Macular coloboma is a rare disorder with congenital retinochoroidal defect. It has been divided into three categories- Pigmented macular coloboma, non pigmented macular coloboma and macular coloboma with abnormal vessels. Here, the authors present two cases of bilateral congenital macular coloboma. The first case was a 25-year-old male with diminution of vision in both eyes since childhood with no associated family history and no history of any systemic illness. His serological investigations were unremarkable. Case-2 was a nine-year-old male who was accompanied by his mother with vague history of rubbing of both eyes since two months with no significant medical and family history. Patient was found to have diminished vision bilaterally during ophthalmological examination. No evidence of infectious disease could be found on laboratory investigations. Paediatric consultation of the patient was unremarkable. Diagnosis was made after correlating the clinical and Ocular Computed Tomography (OCT) findings. Case-1 is on regular follow-up since three years while Case-2 was lost to follow-up. It is very important to reach at a diagnosis in such cases as there are many conditions which can mimic macular coloboma and treatment modalities vary accordingly. Although visual prognosis in cases of macular coloboma is poor, regular follow-up of the patient is of utmost importance in order to monitor visual acuity and posterior segment for any retinal breaks at the edge of coloboma.

Intramural Plexiform Hemangiomatous Proliferation: An Uncommon Vascular Variant in Unicystic Ameloblastoma

Ameloblastoma are the benign, locally aggressive, slow growing solid or cystic neoplasms of the jaws containing odontogenic epithelium in a connective tissue stroma. Their polymorphous nature is reflected by the diversity of known histological patterns of presentation. The hemangiomatous ameloblastoma is the less commonly encountered histological pattern of ameloblastoma with increased vascularity. The presence of ameloblastoma in the maxillary area is rare entity, and the hemangiomatous variation of unicystic ameloblastoma in the anterior maxillary region has never been recorded in the literature. Authors hereby, present a case of a 22-year-old man who complained of swelling in the upper front tooth region with buccal cortical expansion and wispy trabeculation. This study is noteworthy since, it is the first to reveal the hemangiomatous type of unicystic ameloblastoma in the maxillary anterior region.

Acral Acanthosis Nigricans with Concurrent Vitamin B12 Deficiency in an Indian Patient: An Atypical Presentation

Pihu Sethi, Kriti Maheshwari, Shalini Bahadur, Shivani Kalhan

Acanthosis Nigricans (AN) is characterised by velvety, papillomatous, brownish-black, hyperkeratotic plaques, typically on the intertriginous areas and neck. It is more commonly seen in people of African American descent and rarely occurs in the Indian population. The present case includes a 28-year-old male who presented to the Outpatient Department with asymptomatic hyperpigmentation over the skin of both feet and knuckles of both hands for three months. The distribution pattern over the knuckles was suggestive of vitamin B12 deficiency; however, the atypical distribution over the feet leads to suspicion of a differential diagnosis of lichen planopigmentosus, vitamin B12 deficiency, and acral AN. Dermoscopy was done to aid in the diagnosis and revealed linear crista cutis and sulcus cutis, which are features suggestive of AN. On investigation, serum vitamin B12 levels were below 100 μg/mL, and histologic sections showed hyperkeratosis with papillomatosis and mild acanthosis. The patient was treated solely with 1500 mcg mecobalamine daily for ten days and followed-up. The dermoscopic and histopathological findings were consistent with the diagnosis of acral AN, and thus a final diagnosis of acral AN superimposed with vitamin B12 deficiency was made. This case is being reported due to its rare occurrence in the Indian population, the atypical clinical presentation of AN in the form of macules, and to highlight dermoscopy as an essential non-invasive tool aiding in the diagnosis. The diagnosis of acral AN should not be overlooked despite the finding of low serum vitamin B12 levels in such a case, and the authors wish to create awareness among clinicians to investigate the patient further.

Chromobacterium violaceum Related Urinary Tract Infection: A Case Report

Chromobacterium violaceum (C. violaceum) is a motile, gram-negative bacillus found in water and moist soil. Infections due to C. violaceum are uncommon but have a significant mortality rate (upto 80%) due to their tendency for haematogenous dissemination resulting in sepsis. The organism has been reported to cause skin and soft tissue infections, diarrhoea, bacteremia, and visceral abscess; Urinary Tract Infection (UTI) is rarely seen. Here, a 41-year-old male diabetic who presented with fever, altered sensorium and burning micturition caused by C.violaceum is presented. Initial investigations revealed an increased Random Blood Sugar (RBS) level, high anion gap metabolic acidosis with normal renal and liver function (except for hypoalbuminemia). Diabetic ketoacidosis, probable meningitis and urosepsis were considered as differential diagnosis. On culture of a urine sample, C. violaceum was isolated, which was susceptible to all the antibiotics tested except amikacin. Blood culture was reported as sterile. The patient was successfully treated with a susceptible antibiotic (ciprofloxacin), and repeat culture of the urine was also sterile. Early diagnosis and adequate treatment are necessary to reduce the risk of progression to fatal infection.

Pseudomonas mendocina Meningitis in a Postoperative Patient: A Case Report and Review of Literature

Mitra Kar, Akanksha Dubey, Chinmoy Sahu, Sangram Singh Patel

Pseudomonas mendocina is a Gram negative bacillus belonging to the Pseudomonadaceae family. It was first isolated in 1970 from soil and water in the Mendoza region of Argentina. Although it rarely causes infection, 21 cases of infections ranging from infective endocarditis, bacteraemia, meningitis, soft tissue infections, and urinary tract infections have been reported worldwide, mostly among patients with underlying co-morbidities. This report is the first case of pyogenic meningitis due to Pseudomonas mendocina reported from a 1600-bed teaching hospital in Northern India and the second case of Pseudomonas mendocina infection from the Indian subcontinent. The presented case was of a 31-year-old female who was diagnosed with pituitary macroadenoma on Magnetic Resonance Imaging (MRI). She underwent endoscopic endonasal trans-sphenoidal excision of the tumour after two months of diagnosing the tumour, following which she developed meningitis. On two consecutive aerobic bacterial cultures and identification by Matrix-Assisted Laser Desorption/Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS), growth of Pseudomonas mendocina was observed. After Antibiotic Sensitivity Testing (AST), the patient was started on Piperacillin-tazobactam and Amoxicillin-clavulanic acid which alleviated her symptoms of meningitis and she was discharged after 27 days of hospital stay.

An Unusual Case of Renal Infection with Mycobacterium senegalense

Mycobacterium senegalense is a Non Tuberculous Mycobacteria (NTM) that belongs to the rapid growers Mycobacterium fortuitum group. In this case report, the authors describe a unique infection of Mycobacterium senegalense in a 62-year-old diabetic male who had bilateral pyelonephritis and acute kidney injury. The patient had been experiencing on-and-off haematuria for a week. Mycobacterium senegalense is difficult to diagnose due to its expansive symptoms, and routine diagnostic tests have lower sensitivity. Furthermore, it remains resistant to commonly used antibiotics. The patient underwent multiple antibiotic regimens for a long period of time, and the isolate grown from the urine sample was identified as Mycobacterium senegalense using Matrix Assisted Laser Desorption Ionisation-Time of Flight (MALDI-TOF). Finally, the patient responded to antitubercular therapy.

Erythrodermic Atopic Dermatitis Associated with Dust Mite and Alternaria alternata in an Eight-Year-Old Child: A Case Report

Palak P Shah, Ruchi Shah

Atopic Dermatitis (AD) is a chronic inflammatory condition of the skin characterised by itching, recurrent lesions, and lichenification. Erythroderma, also known as generalised exfoliative dermatitis, is characterised by erythema that covers more than 90% of the body’s surface. These erythematous lesions are much more prone to infection. In the present case, an eight-year-old girl presented with a chief complaint of rashes all over the body with severe itching for two years and presented to the Allergy and Asthma Centre. She had a positive history of atopy and multiple septicaemia-related hospitalisations for the last two years. Skin biopsy led to the diagnosis of Spongiotic Dermatitis consistent with Erythroderma secondary to AD. Multiple allergies, including those to dust mites (DP der p2, p21, DF der f2) and Alternaria alternata (alt 1), were identified by Component-Resolved Diagnosis (CRD). Cyclosporin, Omalizumab (a monoclonal antibody against immunoglobulin E), and allergen-specific sublingual immunotherapy were given for the management and all gave excellent results in the patient. AD can be properly diagnosed and treated in its early stages, breaking the cycle that leads to severe erythroderma. To fully comprehend the molecular and immunological genesis of these allergic types, more research is required.

An Unusual External Genital Lesion and its Treatment- A Case Report

Adithya V Naragund, ND Deevish, Rohith Muddasetty, Sharath S Kumar

Lesions around the external genitalia are embarrassing, physically, socially, and emotionally depressing. Patients generally present late for treatment. Here, the authors describe a case of 32 years old female patient, who presented with multiple giant warts-like lesions involving the external genitalia since past 6 months. Any presence of pain, bleeding from the lesion, or alteration in bowel, bladder, or menstrual habits were denied. Lesion posed diagnostic and therapeutic challenges. She underwent resection of the lesion with reconstruction using a bilateral gluteal fasciocutaneous flap and split skin graft with diversion sigmoid colostomy. She further developed anal stricture and subcutaneous fistula, requiring anal dilatation and seton placement. After a brief period of Keigels’s exercises and anal dilatation, she underwent a reversal of sigmoid colostomy. The patient had to undergo staged surgeries to restore near normal external genitalia. This case is an unusual presentation of a genital lesion that was treated with a multidisciplinary team approach to restore her anatomy.

Unusual Presentation of Bladder Tumour: Haematuria only after Administration of Anti-Platelet Drugs

Stephen Lalfak Zuala Sailo, Laltanpuii Sailo, Veracious Cornerstone Wann

Anti-thrombotic agents are used for the treatment and prevention of cardiovascular diseases. Bleeding is the most important side-effect of these agents. The common causes of haematuria after anti-thrombotic administration are benign prostatic hyperplasia, haemorrhagic cystitis, renal calculi, renal infarction, infection, and adult polycystic kidney disease. Haematuria only after anti-thrombotic administration can be the presentation of a bladder tumour. Here, 71 years old male patient, with a bladder tumour was reported, who presented with haematuria only after he took dual anti-platelet drugs (tablet Ecosprin and tablet Clopidogrel). He took these drugs after he underwent the insertion of cardiac stents. He never had any previous history of haematuria. After the complaint, ultrasonography was performed and it reported a normal urinary system. So, the anti-platelet drugs were suspected to be the cause of haematuria. Tablet Clopidogrel was stopped and patient was sent home on Tablet Ecosprin. However, one month later, he again developed haematuria. Repeat imaging studies (ultrasonography and computed tomography) detected a urinary bladder mass. Transurethral resection of the mass was performed and a biopsy reported high-grade, muscle-invasive transitional cell carcinoma. This case highlights the fact that all cases of haematuria, irrespective of anti-thrombotic agents’ administration, should be suspected to be due to urological malignancy and the patients should undergo complete urological investigations, including cystoscopy.

Type IVA Choledochal Cyst in Adult: A Case Report

Choledochal cyst is a congenital disease of the biliary tract with extrahepatic and/or intrahepatic biliary tree dilatation. There is a female majority (4:1). Controlling biliary sepsis and curing pancreatitis are prerequisites of surgery. Here, a 35-year-old female patient, came with complaints of epigastric and right upper abdominal pain for three days. On examination per abdomen was soft, non distended, right hypochondriac tenderness was present, no guarding, bowel sounds were audible. Magnetic Resonance Cholangiopancreatography (MRCP) was done which showed fusiform dilatation of Common Bile Duct (CBD), Common Hepatic Duct (CHD), right and left hepatic duct, along with mild dilatation of central intrahepatic biliary radicals (4.8-5 mm)- suggestive of choledochal cyst type IVA. Hepatico-duodenostomy was done. The entire extrahepatic biliary tree should be removed when the choledochal cyst is diagnosed whether or not symptoms are present. Despite being congenital, the condition is typically discovered in adulthood as well. The treatment of choledochal cysts has evolved. The current standard of care is cyst excision and hepaticojejunostomy.

Retrograde Intrarenal Surgery for Nephrolithiasis with Partially Migrated Renal Artery Embolisation Coil: A Case Report

Ashit Shah, Nisarg Mehta, Jaimin Shah, Aruj Shah

Transcatheter renal artery embolisation is an effective and minimally invasive treatment option for acute renal bleeding. However, it is associated with a variety of complications, which can be classified as early or late according to the time of presentation. Coil migration leading to renal calculi formation is a late complication of transcatheter or percutaneous renal arterial embolisation. A 47-year-old diabetic male patient presented with a recurrent right renal staghorn calculus. Four years ago, the patient underwent a right Percutaneous Nephrolithotomy (PCNL). Following the procedure, he had to undergo a renal arterial embolisation for postoperative haemorrhage. The patient this time did not consent for repeat PCNL, therefore a staged right Retrograde Intrarenal Surgery (RIRS) was performed. Complete clearance of stone and extraction of the migrated coil was achieved in a three-staged procedure. Embolisation coils in the proximity of the pelvi-calyceal system, can migrate into the system, and form a nidus for stone formation. These stones and the migrated coil can be managed effectively and safely with RIRS.

Laparoscopic Abdomino-perineal Resection Followed by Early Postoperative Acute Small Bowel Obstruction- A Case Report with Review of Literature

M Vinoth, Abhijit Joshi

Abdominoperineal Resection (APR) is a long established therapeutic surgical procedure for cancers of the lower rectum. With the advent of minimal access surgery, APR too has come under its ambit. The large pelvic peritoneal defect and raw area left behind, after dissection are unique to APRs. This report describes the case of a 75-year-old male patient diagnosed with low rectal cancer, who underwent a laparoscopic APR and developed an early post-operative adhesive acute small bowel obstruction. Having failed a trial of conservative management, the same was successfully managed by a re-look laparoscopy. The risk of post-operative adhesions decreases significantly with laparoscopy. APR (whether open or laparoscopic), is a unique operation that causes the formation of a large pelvic raw area, which is very prone to attracting small bowel adhesion/s. The advent of various anti-adhesion barriers (liquid and films) has helped in decreasing the incidence of adhesions. However, in spite of the availability of a wide array of options, there is no consensus among surgeons as to the most optimum agent. Ideally, a tension free closure of the pelvic peritoneal defect formed during APR should be attempted. Failing this, covering of the wide pelvic raw area by a dual mesh or an anti-adhesion barrier agent (fluid or film) or omentopexy have been reported as adhesion preventing manoeuvres. Interceed® promises to be a useful long term adhesion preventing barrier option.

Administration of Spinal Anaesthesia with Modified Paramedian Technique in a Patient with Kyphoscoliosis: A Case Report

Yatharth Bhardwaj, Amol Singam, Vidur Mago

Kyphoscoliosis is a condition that affects the spine, with adolescents accounting for 75-90% of cases of idiopathic scoliosis. Patients with scoliosis may experience difficulties when receiving anaesthesia during surgical procedures. There is often multisystem involvement, including the cardiovascular, nervous, and respiratory systems. Patients who have scoliosis often have difficulties with their airways (affected airway morphology, difficult intubation with laryngoscopy), respiratory systems (hypoxia, alveolar vascular constriction, pulmonary hypertension), and cardiac systems (cardiomyopathy, right ventricular enlargement, but also cor pulmonale). Scoliosis can bring on a restrictive pulmonary disease, which can lead to a decrease in both total lung volume and functional residual capacity, as well as an increase in breathing rate. Owing to the deformities of the vertebra, subarachnoid blocks in patients with kyphoscoliosis generally constitute a special hurdle for the anaesthesiologist. Midline and paramedian approach for spinal anaesthesia has been practiced for a long time, but a novel approach, the modified paramedian technique, allows the entry of the needle from far away from the midline, hence reducing the number of punctures taken and lesser complications. Respiratory and airway concerns are customarily addressed in kyphoscoliotic patients. Authors present a unique case of 35-year-old male with severe kyphoscoliosis with neurofibromatosis posted for right above knee amputation by spinal anaesthesia using modified paramedian technique. Authors planned for subarachnoid block for this patient with modified paramedian approach which resulted in right-sided dense block with patchy sensory and motor block on left-side. For a successful operation, scoliosis patients require a thorough preoperative evaluation, a well-equipped set-up, and a teamwork.

Type I Segmental Darier’s Disease: Successful Treatment with Oral Acitretin- A Case Report

Unilateral type I segmental Darier’s Disease (DD) is a rare variant of DD. It is characterised by eruptions which are erythematous and keratotic papules. The authors hereby report a case of an 18-year-old male patient who presented with waxy hyperpigmented keratotic papules on the right side of the trunk and lower limb and was confirmed by histopathology. He was treated with oral acitretin, 25 mg once a day, which showed a marked clinical improvement within four months.

Primary Endobronchial Plasmacytoma with Mediastinal Lymph Nodes treated with Radical Radiotherapy: A Case Report with Review of Literature

Malignant proliferation of plasma cells arising outside the bone marrow or osseous sites is known as extramedullary plasmacytoma. Solitary Extramedullary Plasmacytoma (SEP) is commonly located in upper respiratory tract and sinuses. Involvement of lower respiratory tract is rarely seen in case of SEP. Here, the authors report a case of endobronchial plasmacytoma in a 41-year-old male patient, without any medical risk factors presenting with complaint of blood stained sputum. Radiological imaging confirmed an endobronchial mass in right main bronchus. Histopathology with immunohistochemistry confirmed the diagnosis of plasmacytoma. Work-up for multiple myeloma was negative. Thus, patient was subsequently planned for radical radiotherapy for the primary disease. The patient tolerated the treatment well and was asymptomatic at the time of last follow-up. Solitary Endobronchial Plasmacytoma (SBP) is a rare presentation of SEP. Radical radiotherapy yields excellent local control rates and symptomatic benefit. Close surveillance for development of multiple myeloma is required at periodic intervals.

Pulmonary Talc Granulomatosis- An Uncommon Finding at Autopsy

Ruchi Agarwal, Monika Yadav, Kulwant Singh, Sunaina Hooda, Mayank Nangru

Talc is a chemically hydrous magnesium silicate used as a lubricant in consumer goods and in various orally prescribed medications due to its diluting nature. Pulmonary disease resulting from occupational exposure to talc has been named talcosilicosis or talcoasbestosis. Inhalational exposure results in talcosis, whereas talc granulomatosis is found in intravenous drug abusers who inject tablets intended for oral use. Here, the authors present the case of a 25-year-old deceased male whose heart and pieces of lung, liver, and kidney were received for histopathological examination. Sections from the heart, liver, and kidney were histologically unremarkable. Microsections from the lung tissue revealed multiple non-caseating epithelioid cell granulomas with foreign body-type giant cells, mainly in the perivascular area. Under polarised light, crystalline needle-shaped foreign bodies were seen mainly in the centre of the granuloma. The final diagnosis of talc granulomatosis was given. Because pulmonary talcosis has a very low incidence, the diagnosis can be challenging. Therefore, it is essential to suspect this entity in all cases of granulomatous inflammation of the lung to prevent misdiagnosis.

Optic Nerve Head Melanocytoma Co-existing in a Case of Thyroid Eye Disease: Co-incidence or Cause?

Janani Rajagopal, Gopal K Das

Optic Nerve Head Melanocytoma (ONHM) is a rare benign pigmented tumour of the uveal tract, seen commonly at the optic nerve head. The tumour is associated with a few ocular and systemic conditions. It usually remains stationary and rarely (1-2%) undergoes a malignant transformation. With the progressive understanding of its benign nature with advancing imaging modalities, observation with regular follow-up is the mainstay of treatment. A 35-year-old female, presented with complaints of foreign body sensation in both eyes. She was a known case of graves’ disease under treatment with anti-thyroid drugs and beta blockers. Ocular examination revealed classic signs of thyroid eye disease. The left eye fundus revealed a large, black, globular tumour in the optic nerve head obscuring the entire disc and Ultrasound B scan revealed a tumour at the optic nerve head with high echogenicity. Optical Coherence Tomography (OCT) through the mass revealed a dome-shaped elevation with obscuration of underlying details due to heavy pigmentation, with no signs of subretinal exudation or edema. Thyroid profile was within normal limits. A diagnosis of left eye ONHM was made. The patient was started on tapering doses of systemic steroids and was regularly followed-up to monitor the tumour growth for 18 months. This is the first reported case of ONHM co-existing with thyroid eye disease and this association could be coincidental or embryological. This case highlights the need for ophthalmologists to be familiar with this benign condition and for regular careful follow-up of such patients.

Atypical Presentation of Alcoholic Liver Disease as Isolated Direct Hyperbilirubinaemia with Non Resolving Pneumonia Secondary to Multidrug Resistant Escherichia coli and Aspergillus Co-infection: A Case Report

Rashmi Mishra, Sandeep Garg, Raghu V Gowda, Praveen Bharti, Priya Sharma

It is uncommon for a patient with Alcoholic Liver Disease (ALD) to present with isolated hyperbilirubinaemia that is not accompanied by substantial hepatic abnormalities. Patients with ALD are more likely to develop bacterial and Invasive Fungal Infections (IFI) early in the course of their disease, and both are linked with more severe systemic inflammation, a poorer clinical prognosis, and a higher mortality rate. Due to escalating antibiotic usage, lengthy hospital stays, and intensive medical procedures, hospitalised cirrhotic patients are increasingly at risk of acquiring IFI. In patients with alcoholic liver failure, persistent IFI is a primary cause of death and treatment resistance. This case involved a 34-year-old male with an unusual combination of worsening sepsis and jaundice without any other significant abnormalities in liver function. He was given adequate antibiotics to treat the isolated organism Escherichia coli (E. coli), but his pneumonia persisted. After positive tests for an IFI, he was given antifungal medications as well. However, he failed to improve and eventually succumbed to his illness.

B Lymphoblastic Lymphoma of Thigh: A Case of an Unusual Location

Pallavi Nair, MT Sugeeth, AV Jayasudha

B-Lymphoblastic Lymphoma (B-LBL) is a malignancy of immature B lymphoid cells. They have a low propensity for bone marrow involvement. They typically present as generalised lymphadenopathy, bone lesions, mediastinal or skin lesions. They present with more skin and soft tissue involvement than acute lymphatic leukaemias. They are treated with systemic chemotherapy similar to their leukaemic counterparts. They have a favourable prognosis with a survival of 90%, although it worsens with age. Here, we present the case of a 23-year-old gentleman who was evaluated for a swelling in the posterior aspect of right thigh clinically resembling a sarcoma. Imaging studies showed a lesion in the posterior compartment of right thigh which showed contrast enhancement and hyperintensity in T2 images. Pelvic and inguinal nodes were enlarged. Ultrasound guided biopsy from the lymph node was suggestive of B-LBL. There was no bone marrow involvement. He was treated according to Berlin-Frankfurt-Munster (BFM) 95 protocol and achieved remission post induction. He completed induction, consolidation and reinduction and is currently on maintenance treatment.

Thrombosis of Extrasplanchnic and Splanchnic Venous System in Acute Pancreatitis- A Case with Rare Combination of Vascular Complication

Vascular complications in acute pancreatitis are common and seen in 25% of cases. While it is common to have venous thrombosis in the Superior Mesenteric Vein (SMV), portal vein, and splenic vein, thrombosis of extra-splanchnic vessels such as Inferior Vena Cava (IVC) and left renal vein due to acute pancreatitis is a rare entity, with more adverse outcomes. A 48-year-old male presented with severe epigastric pain, vomiting, and constipation for seven days. Outside Ultrasonography (USG) report was suggestive of acute pancreatitis. His serum amylase, serum lipase, and D-dimer levels were raised. Computed Tomography (CT) of abdomen and pelvis revealed acute necrotising pancreatitis with peripancreatic fluid collection and thrombosis of splenic vein, left renal vein, and IVC. Thrombosis in pancreatitis can occur due to pancreatic proteolytic enzymes which can cause intimal injury. An enlarged pancreas, walled-off necrosis, and pancreatic pseudocyst can compress veins, resulting in venous stasis. Pancreatitis has a systemic hypercoagulable or prothrombotic state. The patient was given symptomatic treatment along with an injection (inj.) of clexaine and monocef. He showed improvement in 10 days and was symptomatically well on follow-up. Early detection of these findings and targeted treatment for the same is crucial to prevent morbidity and mortality of such patients.

Radiological Overview of Tubercular Arthritis of Wrist Joint: A Case Report

Susmita Rani Ghosh, Ramachandra Dasar, Soumyabrata Debnath, Ashu Chakma, De Asim

Musculoskeletal Tuberculosis (TB) involving the wrist is very rare worldwide. Most cases of tuberculous arthritis arise in patients born in and migrated from endemic regions, particularly in patients who are co-infected with Human Immunodeficiency Virus (HIV). The authors present a rare case of tuberculous arthritis of the wrist joint in a 64-year-old male who had pain, swelling, and decreased range of motion in the left wrist for six months. X-ray and Computed Tomography (CT) showed erosion of carpal bones, reduced joint space, and soft tissue oedema and abscess. Ultrasonography (USG) showed joint effusion and soft tissue oedema were seen around the wrist joint, and on Magnetic Resonance Imaging (MRI) along with this marrow oedema were also noted. Aspirated fluid culture from abscess suggested Mycobacterium positive culture and Ziehl–Neelsen (Z-N) staining showed acid-fast bacilli. Antitubercular therapy was the mainstay of treatment. A high level of suspicion should be kept for TB in every infection of the wrist joint.

MR Neuroimaging Findings in Adult Diabetic Patients- Two Case Reports

Vishal Rajkumar Gudlani, Prashant Titare, M Pooja, Varsha Rote-Kaginalkar

Diabetes Mellitus (DM) can affect any part of the central and peripheral nervous systems. Significant variations in glucose levels are often symptomatic. Hypoglycaemia as well as hyperglycaemia can present a wide variety of clinical symptoms. Imaging helps by suggesting the correct diagnosis and ensuring early treatment. We hereby present two cases, one of hypoglycaemic encephalopathy and a case of diabetic striatopathy. A 40-year-old female with a 25-year-old history of type 2 diabetes was brought into the emergency room in an unresponsive state since afternoon. The blood glucose was 28 mg/dL, and immediate administration of D 25%x2 stat was done. MRI revealed hyperintensities in the bilateral hippocampi and in the cortex of the bilateral high parietal region on T2WI/FLAIR. Despite intensive medical treatment the patient’s neurologic condition didn’t improve, due to irreversible brain tissue damage, and the patient ultimately died. A 63-year-old male was brought by relatives to causality with complaints of involuntary movements of the right-side of the body since three months, but symptoms have exaggerated since three days. Newly diagnosed DM since three months was on medication T.Metformin 500 mg BD. MRI revealed T1 hyperintensities in posterior half of left putamen. Patient was put on Inj. haloperidol 0.5 mg SOS, T.Aspirin 150 mg OD, T.Atorva 20 mg HS, T.sodium valproate 200 mg BD, T.tetrabenazine 25 mg BD and T.Serenace 0.5 mg BD and patient had improved symptomatically after 15 days of treatment. Imaging can play a crucial role in diagnosis and guide treatment and markedly influence the prognosis of patient.

A Case of Oral Focal Mucinosis on Hard Palate: A Lesion Derived from the Periodontal Ligament

Iram Rafique Pawane, Arvina Rajasekar, Nadathur Doraisamy Jayakumar

Oral Focal Mucinosis (OFM) manifests on the gingiva as a painless, fibrous mass that is asymptomatic and matches the colour of the surrounding mucosa. It is commonly reported on the gingiva. Histologically, it is characterised by focal myxoid degeneration of connective tissue. Its diagnosis seldom can be made clinically and predominantly relies on histopathological analysis. This case report describes a 40-year-old female who had a gradually increasing swelling on the palate in relation to upper right posterior teeth, for 4-5 months. The lesion was excised and sent for histopathological and immuno-histochemical analysis. There was presence of foci of loose mucinous connective tissue stroma interspersed within dense connective tissue stroma. The mucinous stroma showed numerous stellate and spindle-shaped fibroblasts evident between thin collagen fibres with evidence of separation of collagen fibres.

Mini-implant Supported Temporary Replacement of Teeth in Children- A Case Report

Nupur Saha, Mainak Das, Arnab Santra, Shabnam Zahir

Dental agenesis or hypodontia is a frequent cause of tooth loss in children, most common being the maxillary lateral incisors. The absence of teeth affects aesthetics and results in functional impairment that hampers the psychological development of the young child. Treatment options available for replacement of congenitally missing teeth include fixed and removable dentures, resin-related retention devices, and single-tooth implants. The main deterring factor for implant placement in young children is the impending growth. To overcome this drawback, one can use self-drilling, one-piece orthodontic mini screw implants as a temporary abutment for the replacement of congenitally missing teeth. Mini-implant with temporary crown can serve as a permanent dental restoration for a growing child as the mini-implant is well maintained throughout his/her growth period without significant changes in skeletal morphology. This case report deals with a 12-year-old young girl patient, who has been treated with self-drilling orthodontic mini-implant with a strip crown for her congenitally missing bilateral lateral incisors, without any complications with six months follow-up.

Triple Negative Invasive Ductal Carcinoma of Breast with Oral Metastasis: A Case Report

Metastatic oral malignancies have been reported in the mandible, tongue, and gingiva. Oral metastasis of breast cancer typically presents as a benign oral lesion clinically. However, at histology, it shares several features with metastatic carcinoma, and Immunohistochemistry (IHC) can be useful in the differential diagnosis. The clinical presentation in this case report consisted of swelling in the upper front tooth region in a 35-year-old woman. The lesion was excised under local anaesthesia and underwent histological and immunohistochemical examination to rule out any malignancy. The histological findings, including Pan CK positivity suggesting an epithelial origin and the absence of reactivity to Oestrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor-2 (HER2) indicated metastatic triple negative breast carcinoma. The histological diagnosis of metastatic breast carcinoma can be confirmed by IHC. The current case report illustrates the necessity of including a panel of IHC markers in confirming the diagnosis of metastatic lesions in oral cavity. By utilising such panels, one can expedite the prognosis and prevent delay in diagnosis.

Modified Vestibular Incision Supraperiosteal Tunnel Access in Recession Type 2 with Thin Phenotype: A Report of Two Cases

Gingival Recession Type 2 (RT2) presents complexity in achieving complete Root Coverage (RC) and associated parameters such as interproximal attachment loss and bone loss further have a negative influence on the stability of achieved RC. Complete RC might be attainable in RT2, though certain factors like tooth malposition, avascular root surface area, frenal pull, and thin Periodontal Phenotype (PP) may limit the amount of RC. Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique proposed in the last decade has been promising in the maxillary anterior region in the management of Miller Class I/RT1 and even some RT2 gingival recession. In this case report, two systemically healthy female patients, having RT2 gingival recession in mandibular incisors labially positioned/rotated with thin PP were treated with Modified-vestibular incision supraperiosteal tunnel access (m-VISTA) along with Subepithelial Connective Tissue Graft (SCTG). Fifty percent RC was achieved in case-1 and 100% in case 2. The results were maintained during the follow-up period of nine months in case 1, and one year in case 2. Gingival RT2 with malpositioned tooth may be successfully treated with m-VISTA and SCTG as demonstrated in achieving stability of percentage RC and patients’ satisfaction in terms of aesthetics and resolution of hypersensitivity in the present case report.

Post COVID-19 Infection with Staphylococcus Aureus Bacteraemia: A Case Series

Meruva Karthik, Alekhya Abburu, Kainat Aftab

Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteraemia, Toxic Shock Syndrome (TSS), and endocarditis. It has been the main contributor to secondary bacterial infections during viral pandemics, greatly raising patient morbidity and fatality rates. It is unknown how this secondary bacteraemia would affect people who have Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2). Herein, the authors present a series of case studies of 8 patients (4 males and 4 females) infected with Coronavirus Disease-2019 (COVID-19) at a tertiary hospital in Hyderabad, India, who eventually developed S. aureus bacteraemia with widespread seeding of secondary infections including cellulitis and abscess formation. Adult patients aged 20-60 years of age who were infected with COVID-19 from June 2022 to August 2022 and had positive bacterial cultures for S. aureus during admission were included in the study. A total of eight patients hospitalised for COVID-19 with secondary bacteraemia were identified. Of these patients admitted with severe limb infections, three patients expired after a week of ongoing treatment from their blood cultures. Multivariate analysis identified the onset of bacteraemia (>4 days from the date of admission) and age as significant predictors of mortality in admitted patients. Systemic Inflammatory Response Syndrome (SIRS) scoring and blood cultures were used to identify the mortality risk with a p-value of 0.05 statistical significance. The patients were subsequently treated with antibiotics and given conservative management. Some of the patients admitted to the Intensive Care Unit (ICU) who had critical co-morbidities expired within a week of ongoing treatment. The final outcome of the present case series was that bacteraemia caused by S. aureus is associated with a high mortality rate in COVID-19 patients. More research is needed to understand the relationship between COVID-19 and secondary S. aureus bacteraemia.

Immunologic Desensitisation of Allergens and its Impact on Insulin Use in Type 1 Diabetes Mellitus: A Case Report

Mohammed Rasheeduddin Imran, Sayeeda Anjum

Type1 diabetes mellitus, also known as juvenile diabetes is an autoimmune disorder. It is a chronic condition in which there is a destruction of pancreatic beta cells by autoimmune response. Here, author’s present a case of 13-year-old girl, weighing 32 kg and with a Body Mass index (BMI) of 13.9 kg/m2 who reported to the family medicine clinic with complaints of weakness, increased appetite and thirst, and increased frequency of micturition for the past two months. Personal history revealed a consistent weight loss over the past six months with the problem of lice in the hair for past two months. A family history of diabetes, hypertension, and allergies was present. General physical examination revealed no abnormality and vitals were within normal limits. Blood investigations revealed increased levels of random blood sugar levels, glycated Haemoglobin (HbA1c) and Immunoglobulin (Ig)E. Hormonal assays were within normal limits, and skin prick test result revealed strong positive reactions to some allergens. The treatment included subcutaneous insulin, regular physical exercise and immunologic desensitisation of food allergens through Sublingual Immunotherapy (SLIT). The treatment resulted in controlled blood glucose levels with a reduction in insulin dose, a decrease in HbA1c levels, increased body weight and an improved BMI.

Extra Pulmonary Tuberculosis in Pregnancy: A Case Report

Annareddy Lakshmi Priya, Patil N Ravi

Tuberculosis (TB) in pregnancy is a major health problem that poses a sustainable risk of morbidity to mother and fetus if not diagnosed and treated at correct time. The diagnosis in pregnancy is challenging, especially in the absence of lung involvement. It usually mimics other diseases as most of the patients with extra pulmonary TB present usually with nonspecific symptoms which misleads the diagnosis. Hence, it is very important to address even nonspecific symptoms in pregnancy as a neglected diagnosis and delayed treatment may lead to severe perinatal morbidity and mortality like fetal distress, preterm delivery, fetal growth retardation, seizures due to intra cranial space occupying lesion, perforation of intestinal lesions, pneumoperitonitis, high chances of intensive care unit admission for mother and neonate. Hereby, authors report two cases. The first case was about a 29-year-old primigravida with numbness and paresthesia of unilateral limbs. She was diagnosed with an intracranial tuberculoma and treated with Antitubercular Drugs (ATT) for nine months. She underwent a cesarean section in view of an intracranial space-occupying lesion. Another patient was a prima gravida who presented with persistent gastroenteritis symptoms like vomiting and diarrhea. She was diagnosed to have ileocecal mass with suspicion of malignancy or infectious aetiology. In view of deteriorating maternal condition, emergency cesarean section was done along with resection of ileocecal mass. On histopathological examination it was found to be ileocecal TB and she was started on ATT.

Endoscopic and Intraoral Approach for Removal of an Ectopic Third Molar associated with a Dentigerous Cyst in the Maxillary Sinus: A Case Report

Kani Bilginaylar, Hasan Mete Inancli, Meliz Kneebone

Dental ectopia is the presence of deciduous, permanent, or supernumerary teeth in non dentate areas. It is very rare, especially in the maxillary sinus. Treatment is surgical removal because left untreated, there is a tendency to form a cyst, tumour, or lesion that can cause the perforation of the orbital floor and the obstruction of the nasal cavity. Although, panoramic radiography is the common form of radiological examination for this type of eruption, Cone Beam Computed Tomography (CBCT) is the gold standard for pinpointing the exact location of the ectopic tooth and evaluating the characteristics of any associated lesion prior to a surgical procedure. A 17-year-old woman was referred with swelling, asymmetry, and local pain in her right maxillary region. On radiological examination, an ectopic third molar surrounded by a dentigerous cyst obstructing both the right maxillary and ethmoid sinuses was observed. The tooth was attached to the zygomatic bone, right under the orbital floor. Ectopic maxillary third molars are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. The treatment of this eruption and its management is heterogeneous and multidisciplinary. In the present case, under general anaesthesia, the ectopic tooth and all cystic tissue occupying the entire right maxillary and ethmoid sinuses were successfully enucleated with an intranasal endoscopic approach by an otolaryngologist and with lateral sinus antrostomy, utilising a standard Caldwell-Luc approach, by an oral and maxillofacial surgeon. After the 6th and 12th months, the patient had no signs of sinus infection and had an uneventful recovery.

Clinicopathological features of Adult Granulosa Cell Tumour of Ovary- A Case Series of 14 Cases

Adult Granulosa Cell Tumour (AGCT) is the most common sex cord stromal tumour of ovaries. These tumours in comparison with epithelial tumours are of low-grade malignant potential and have low recurrence rate after surgical procedure. In this case series, a retrospective search for ovarian AGCT cases from January 2016 till January 2021 was done. A total of 14 cases were included. Parameters studied in this case series were age, laterality, gross, architectural pattern, call Exner bodies, nuclear grooves, necrosis, mitotic count and tumour staging. After studying all the cases, it was reported that mean age of presentation was 44 years (range 21-64 years), unilateral with right-sided dominance (71.4%), grossly 78.5% of the cases were solid cystic with haemorrhagic area, with mean tumour size of 9 cm, 57.1% of the cases had call Exner bodies, and all the cases showed nuclear groves. Most of the cases, 85.7% presented with low mitotic count of <4/10 High Power Field (HPF). Rare presentation of endometroid carcinoma-endometrium World Health Organisation (WHO) Female Genital Tract (FGT) fifth edition), and mature teratoma of contralateral ovary were observed in one case each. This case series outlines characteristic histomorphological feature, frequent presentation at lower stage, and low mitotic count, these characteristic features act as prognostic marker for recurrence prediction.

Facial Neurocutaneous Markers and their Clinical Profile- A Case Series

Bibekananda Mukherjee, Barnali Das, Joydeep Das

Cutaneous birthmarks are a heterogeneous group of congenital skin lesions with high diagnostic value. A good clinician, by looking at the skin, eyes, and face, can diagnose conditions like Neurofibromatosis type 1 (NF1), Tuberous Sclerosis Complex (TSC), Ataxia-telangiectasia, Von Hippel-Lindau disease, Sturge-Weber Syndrome (SWS), and others. The author reports, in the present case series, six cases presenting with one or more of the following seven different types of facial neurocutaneous markers like Café-au-lait Macules (CALM), neurofibromas, facial angiofibromas, forehead plaque, hypomelanotic macules (ash-leaf) on the trunk and extremities, capillary malformation in the face (port-wine stain), and ocular telangiectasia. Using these cutaneous markers as red alerts, the authors did a focused clinical examination, ophthalmic and auditory evaluation, neuroimaging, renal and cardiac evaluation to come to a diagnosis. This helped us in detecting clinical syndromes like NF1, TSC, SWS, and unveiled the hidden morbidities like hypertension, intracranial tumours, intracardiac rhabdomyoma, glaucoma, and other ocular abnormalities. The present case series emphasises the need for all paediatricians and ophthalmologists to develop a clinical eye to identify neurocutaneous markers in children who may arrive at their clinic with various problems for early diagnosis and treatment of various neurocutaneous syndromes and their co-morbidities.

The Spectrum of Clinical Manifestations of Serious Human Parvovirus B19 Infection in Children without any Underlying Diseases- A Case Series

Subham Bhattacharya, Mrinal Kanti Das, Supratim Datta

Human Parvovirus B19 causes mild to life-threatening illnesses, especially in immunosuppressed individuals. In the immunocompetent individuals, the severe spectrum of clinical manifestations of the virus infection is not widely known. This case series presents the spectrum of clinical manifestations of serious Parvovirus B19 infection in children without any chronic haematological or immunodeficiency disease. The series comprises a total of 12 children who tested positive for Parvovirus Immunoglobulin M (IgM) antibody, and their age range was between 1-12 years. Fever, fatigue, and arthritis were the most common manifestations. Pure red cell aplasia, the specific manifestation of Parvovirus infection, was seen only in one-third of the patients. All the children were treated with Intravenous Immunoglobulin (IVIG) along with supportive therapy. All except one had a successful recovery.

Aggressive Angiomyxoma: An Unusual Scrotal Mass

D Jayakumar, Bhuvanamha Devi Ramamurthy, Sowmya Dayalan

Scrotal masses are a frequent complaint in general practice. The treating doctor must distinguish a benign from a malignant scrotal lump to perform precise surgery and provide ongoing care. A 61-year-old male presented with a painless scrotal mass for six months. On clinical examination, the scrotal mass was firm and fixed to the perineal membrane (Table/Fig 1)a. Magnetic Resonance Imaging (MRI) scan revealed a 13×8×5 cm heterogeneous soft tissue mass (Table/Fig 1)b in the peranal/perineum lesion abutting the anterior wall of the anal canal, root of the penis, and scrotum. The possibility of myxoid/spindle cell neoplasm of the perineum was mentioned, and the remark of a locally aggressive neoplasm, likely of malignancy, was made in view of presence of infiltrating margins. Trucut biopsy was reported as a benign soft tissue tumour. Trans-scrotal excision was performed, and the postoperative resected specimen was sent for histopathological examination (Table/Fig 1)c. Gross appearance of the external surface was grey white to grey brown. Cut surface was homogenous grey white soft in consistency with solid region at one pole measuring 7×5×0.5 cm (Table/Fig 1)d. No areas of necrosis or haemorrhage noted. Tissue bits from representative sites were given. The microscopic examination revealed an unencapsulated infiltrative hypocellular lesion composed of spindle to stellate shaped tumour cells with delicate cytoplasmic processes and bland nuclear chromatin. No atypia or increase in mitosis was noted. The tumour cells were seen to be embedded in a myxoid stroma with scattered delicate collagen fibers (Table/Fig 2)a. Entrapment of mature adipose tissue was noted at foci (Table/Fig 2)b. Numerous small and medium sized thick walled hyalinised blood vessels were also noted and it was reported as Aggressive Angiomyxoma (AAM). The patient did not have recurrence at three and six month postoperative follow-up period. Scrotal masses account for 1% of cases in the surgical Out Patient Department (OPD). Although some types of scrotal masses are more prevalent at particular ages, they can appear at any age (1). AAM is a very rare benign spindle cell mesenchymal tumour that usually occurs in the pelviperineal region, more commonly in females than males (M:F is 1:7) in their fourth decade (2). It was first described in 1983, by Steeper and Rosai. So far only 36 cases of scrotal AAM are reported in the literature. AAM usually present as a painless mass. About 30% of these tumours recur locally, as it shows infiltrative nature hence the term ‘Aggressive’, although distant metastasis is extremely uncommon, MRI aids in determining the tumour’s extent (3). Its aetiology is not clearly established yet. Few studies hypothesised that AAM might develop from stem cells with the capacity for multiple differentiation near arteries that eventually give rise to fibroblasts and myofibroblasts (4),(5). Most AAM patients noted to have a long history of asymptomatic mass or swelling in the scrotum. The tumour size range from 1.5 cm to as big as 25 cm. The genital location and subtle clinical presentation of the tumour delay the treatment requirement by patients, which leads to a progressively growing tumour size with a high rate of clinical misdiagnosis. It is challenging to get an accurate preoperative diagnosis, and the differential diagnosis includes non neoplastic and neoplastic lesions (5). On macroscopic examination, AAM is typically a soft, lobulated, grayish-white, fairly delineated tumour with vague infiltrative margins and myxoid appearance. The essential diagnostic criteria of AAM include the histological features of ill marginated lesion with uniformly dispersed tumour cells in abundant myxoid stroma, vascular components and invasive proliferation. The bland tumour cells may be spindled, star or oval-shaped with bland nuclei and sparse mitoses. The vessels may vary from thick hyalinised or thin-walled walls of different diameters. The aberrant HMGA2 expression is considered as desirable for diagnosis however is not essential, as its sensitive but not specific marker for AAM. It is useful especially to define tumour margin, as the non tumourous mesenchyme lacks positivity to HMGA2 (6). AAM in the scrotum is typically treated with a large local excision with tumour-free surgical margins (7). When surgical complications are common or fertility retention becomes an issue, some specialists think incomplete or partial resection is permissible. The likelihood of local AAM recurrence is significant and differs by gender, particularly within 2-3 years. Myxoid liposarcoma, angiomyofibroblastoma, myxoid neurofibroma, and myxoma are the tumours in the main differential diagnosis of AAM. Malignant myxoid neoplasms should be recognised from AAM since the management protocol varies for the both. Although it is not usually necessary, immunohistochemistry aids in distinguishing AAM from other mesenchymal tumours. Desmin, Vimentin, Smooth Muscle Actin (SMA), and CD34 are all positive in AAM, while S-100, CK, and CD68 are all negative (6). Due to its infiltrative boundaries, AAM might radiographically evoke suspicion of malignancy, as in the present case. Owing to the rarity of this lesion and lack of distinct imaging findings, an accurate preoperative diagnosis is frequently challenging. From the experience with above described case and literature reviews, it was observed that the preoperative imaging techniques and intraoperative pathology investigations can partly aid with the diagnosis. However, the gold standard for the diagnosis of AAM relies on the thorough histological evaluation of postoperative specimens. Despite being an uncommon phenomenon in the male genital region, the surgeon should consider it as one of their differential diagnosis to prevent over diagnosing malignancy and subsequent treatment.

Decannulation- Dos and Don’ts

R Sumitha

Dear Editor, The term “Decannulation” refers to the process of weaning which involves removal of tracheostomy tube and maintaining spontaneous respiration with airway protection. This step though appears very simple requires a near normal neuromuscular coordination for effective cough reflex, phonation, swallowing and respiration. Standard protocol (clearance from the primary care physician/surgeon, psychological counselling and endoscopy (retrograde or transnasal) to visualise the laryngeal air column) should be followed during this process before planning closure. It will help to prevent complication which can become life threatening. Tracheostomy tube plays a major role as the patient has to be spigotted. Spigotting is a process of closing the tracheostomy tube while maintaining the tube in-situ. It is a preparatory procedure before decannulation to assess the patients airway. Patient was encouraged to breathe normally through the nose, via the port in the tube while maintaining the track. All normal activities should be encouraged during spigotting to check the anatomical patency of airway and physiological respiratory effort by the patient. The reasons for failed decannulation include elderly patients, obesity, infections, poor neurological coordination, tenacious secretions with poor cough reflex,small size Shiley tube and subglottic granulations [1,2]. The method of decannulation varies depending on the patient, clinical scenario and the facilities available. While some authors prefer tracheostomy tube occlusion after downsizing the fenestrated tubes or changing to non fenestrated tube before closure [2,3], others directly cap the tracheostomy tube without downsizing (4). In some hospitals, the tracheostomy tube is removed directly (5). Here, the author would like to highlight her experience and difficulties during decannulation in two patients, one due to obesity and other due to improper care during spigotting. Both the cases were appropriate candidates for removal of tube but problems were encountered. Case 1 A 52-year-old obese female patient weighing around 90 kg was intubated for Chronic Obstructive Pulmonary Disease (COPD) with retained secretions. To aid regular suctioning, a tracheostomy was done five days later, and the patient was on tracheostomy tube for 25 days. Once the primary cause was resolved decannulation was planned. Standard protocol followed. Spigotting was attempted with 6 size double lumen Shiley tracheostomy tube but, the patient did not with stand spigotting for more than 30 minutes. Computed Tomography (CT) neck was done and there was no narrowing of subglottic and laryngeal air column. On flexible bronchoscopy the port of Shiley was not visible in tracheal lumen. As the patient was very obese with short neck, the curvature of tube was not enough and the port was in the subcutaneous tissue. Since, there was lot of intraluminal space round the tracheostomy tube, patient withstood closure for around 30 minutes and after that developed desaturation (Table/Fig 1). In this patient, the author changed Shiley’s to Fuller’s biphlanged metal tube. Since the outer tube is biphlanged, there was effective communication between the upper and lower airway and not just on a small single port like the Shiley tube. Spigotting was done only with the outer tube in place to maintain the track. Decannulation was done after 48 hours, and it was uneventful. Case 2 A 65-year-old male patient who met with Road Traffic Accident (RTA). Burr hole craniotomy was done. Glasgow Coma Scale (GCS) score of patient was low. Patient was on ventilator support for four months so that, surgical tracheostomy was done. Once the primary condition was resolved patient was referred for closure. Without following standard protocols spigotting was done and the patient was sent home for two days. On the 3rd day, patient came to hospital and as the patient said, he was comfortable so that, decannulation was done and sent home. Five hours later, patient presented in emergency room with respiratory difficulty so that, emergency intubation was done. Then on retrograde clinical evaluation, patient revealed that, he was not comfortable with closure and every one hour, was removing the spigott and did not close the tracheostomy tube in night. Then on flexible bronchoscopy, there was subglottic stenosis with narrowing of air column. Revision tracheostomy was done. Patient was explained about the condition and the need for surgical laryngeal and tracheal reconstruction. Patient was not willing and went to home town with the tube. Decannulation is a procedure to remove the tracheostomy tube, close the stoma and allow the patient spontaneous breathing through the nose. It has to be done meticulously with proper planning, as it can lead to emergency situations. This is mainly documented to stress that, decannulation is equally important and life saving like tracheostomy and all medical and paramedical personnel should be trained in it.

Effects of Menstrual Cycle on Working Memory and its Correlation with Menstrual Distress Score: A Cross-sectional Study

Kajol Kumari Tulsyan, Soumen Manna, Himani Ahluwalia

Introduction: The menstrual cycle is a well-known physiological model for studying the effects of ovarian steroid hormones on cognitive functions, such as Working Memory (WM). Hormonal fluctuations during the menstrual cycle also affect menstrual distress related symptoms, which can independently affect cognitive functions. However, data regarding changes in WM functions during different phases of the menstrual cycle and the correlation of various WM functions with menstrual distress-related symptoms have been inconclusive. Aim: To examine the verbal and visuospatial WM functions during the proliferative (day 10-14) and secretory phase (day 21-25) of the menstrual cycle and to correlate various WM functions with menstrual distress symptom scores. Materials and Methods: A cross-sectional, observational study was carried out in the Department of Physiology at VMMC and Safdarjung Hospital, New Delhi, India, over a period of 18 months, from November 2020 to May 2022. A total of 40 young adult females with a history of regular menstrual cycles were selected for the study. Computerised software-based dual-task n-back WM tasks were given twice in the same menstrual cycle- first during the proliferative phase (day 10-14) and second during the secretory phase (day 21-25). In addition, a standardised Menstrual Distress Questionnaire (MDQ) based on various menstrual distress symptoms was administered to each subject after completion of the WM task, first during the proliferative phase (day 10-14) and second during the secretory phase (day 21-25). Based on the MDQ, a Menstrual Distress Score (MDS) was calculated. Descriptive statistics, such as mean, median, standard deviation, and mode, were calculated, and Pearson’s coefficient/Spearman’s rank correlation coefficient was used to assess the correlation between WM parameters and MDS. Data were compiled and analysed using the statistical software Graph Pad Prism. Results: The mean age of the study population was 23.4 years, with an average menstrual cycle length of 30 days. In the WM task, the overall proportion of correct responses across all tasks was significantly better in the secretory phase of the menstrual cycle than in the proliferative phase (p-value=0.040). Similarly, significantly improved performance in WM tasks during the secretory phase was also seen in the overall hit rate of the visual target (p-value=0.020) and auditory targets (p-value=0.044). On the other hand, the correlation of WM parameters with MDS did not show any statistical significance, except for a significant negative correlation (r-value -0.369; p-value=0.019) between the parametric sensitivity (subject’s ability to correctly distinguish a target from a non-target) of auditory WM in the secretory phase and MDS in the proliferative phase. Conclusion: The visual and auditory WM skills were significantly improved during the secretory phase compared to the proliferative phase of the menstrual cycle in terms of the target hit rate. However, increased MDS had no significant detrimental effect on the performance of WM tasks during the normal menstrual cycle.

Significance of Nuclear Morphometry in Salivary Gland Neoplasms: A Cross-sectional Study

Jahnavi Reddy Yeduguri, Kalyani Raju, Azeem SM Mohiyuddin

Introduction: Fine Needle Aspiration Cytology (FNAC) is one of the most common and efficient investigations performed for salivary gland swellings, which is very helpful in diagnosing inflammatory, benign, and malignant lesions. The morphology of the nucleus determines the behaviour of the cell/tissue as benign or malignant. Nuclear morphometry analysis is done using various software. Aim: To determine the nuclear morphometry parameters in salivary gland neoplasm of FNAC smears by Image J software and to determine its association with the cytological diagnosis. Materials and Methods: This was a retrospective laboratory observational cross-sectional study conducted for four years (2018-2021) at a tertiary healthcare centre, attached to Sri DevarajUrs Medical College, Kolar, Karnataka, India. All the FNAC smears of salivary gland neoplasms were considered and classified by cytomorphology as benign and malignant tumours. All smears were analysed using Image J software for nuclear morphometric parameters such as area of the nucleus, perimeter of the nucleus, feret diameter, minimum ferret and skewness. The nuclear morphometric findings of benign and malignant tumours were compared and statistical analysis was doneby using Student’s t-test, p-value of <0.05 was considered statistically significant. Results: A total of 52 cases were studied. The average age of presentation of benign and malignant salivary gland neoplasm was 38.7 and 49.4 years, respectively. Among, 30 (57.6%) benign neoplasms there were 23 (76.7%), pleomorphic adenoma was the commonest and among 22 (42.4%) malignant squamous cell carcinoma 16 (72.7%) deposits was the commonest. The nuclear morphometry analysis showed that the mean values of area (p-value ≤0.001), perimeter (p-value ≤0.001), ferret diameter (p-value ≤0.001) and minimum ferret (p-value=0.001) of malignant lesions were comparatively higher than benign and was statistically significant. Conclusion: Nuclear morphometry along with routine cytopathological evaluation will improve the accuracy of diagnosis of neoplastic lesions of salivary gland. This information can be used to plan better treatment and predict prognosis of the disease. Digital morphological analysis helps in obtaining quantitative values from qualitative data which can be utilised further for automation.

Evaluating Compliance of Preoperative Investigations with National Institute for Clinical Excellence Testing Guidelines for Patients undergoing Elective Surgery: An Observational Study

Rahul Kurra, Lavanya Kaparti, T Sumanth, M Ravi

Introduction: All patients posted for surgery are subjected to a series of tests. Recent studies have shown that many of these tests may not be necessary as they do not alter the anaesthetic technique. There are many international guidelines for ordering preoperative investigations. Aim: To determine the proportion of patients who underwent compliant testing and to identify the most common investigations which were not compliant with National Institute for Health and Care Excellence (NICE) guidelines. Materials and Methods: This was a prospective observational study conducted on all patients undergoing elective surgery at Sri Devaraj Urs Medical College and RL Jalappa hospital, Kolar, Karnataka, India, from May 2022 to July 2022. The grade of surgery and the American Society of Anaesthesiologists (ASA) Physical Status of the patients were noted. The compliance of the tests with NICE guidelines was noted. Results: The preoperative investigations were done in 60 adult patients undergoing elective surgery. Renal function tests were the most non compliant (60%) as per NICE guidelines. Echocardiography (ECHO), Thyroid function tests and Electrocardiography (ECG) were compliant in 78.3%, 91.7% and 60% of the patients, respectively. Conclusion: The tests which were most non compliant were coagulation profile and renal function tests. Further studies need to be conducted to check compliance with Indian guidelines.

Gross Congenital Anomalies at Birth in Northeast India- A Retrospective Observational Study

Introduction: Congenital Anomalies (CAs) are a significant cause of neonatal mortality in both developed and developing nations. CAs can have different patterns, prevalence rates, and risk factors across time and different geographic regions. Aim: To find out the incidence of CA occurring among institutional live births and to study the associated maternal and perinatal risk factors in Northeast region of India. Materials and Methods: This retrospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) at a Tertiary Care Hospital in Guwahati, Assam, India from January 2019 to December 2019. All newborns with CAs during this period were included. Maternal and labour ward records were obtained, including data on maternal and antenatal factors such as age, parity, history of consanguinity, family history of congenital abnormality, and mode of delivery. The data were analysed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 26.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). Proportions were calculated, and associations were tested with the Chi-square test and Fisher’s-exact test. A p-value of less than 0.05 was considered statistically significant. Multivariate regression analysis was performed to find the independent factor(s) for congenital anomaly. Results: During the study period, there were 13,530 deliveries, which included 13,290 (98.2%) live births and 240 (1.8%) stillbirths. Out of 13,290 newborns, 349 had one or more CAs, accounting for an incidence of 2.6%. The Gastrointestinal (GIT) system was the most commonly affected (33.8%), followed by the Central Nervous System (CNS) (20.9%) and craniofacial (11.7%) system. Cases of congenital anomalies were found in 2.7% of multiparas, whereas in primiparas, the proportion was only 2.3%. In univariate analysis, birth weight, gender, gestational age, maternal age, parity, and mode of delivery showed a significant association with the incidence of congenital anomaly (p<0.05*). Regression analysis showed that three variables significantly affected the occurrence of CAs: gender Odd’s Ratio (OR) (OR=0.341), gestational age (OR=32.7) and, parity (OR=0.016). Conclusion: This study highlights the prevalence of GIT, CNS, and craniofacial anomalies in this region. The major determinants for CAs were gestational age, gender, and parity.

Influence of Vitamin D Status and IL-10 Gene Promoter Polymorphism (rs1800871) on Plasma IL-10 Levels in Apparently Healthy Individuals from Southern India: A Cross-sectional Study

Introduction: Interleukin-10 (IL-10) is a major anti-inflammatory cytokine, that plays an important role in regulating inflammatory responses of the immune system. Changes in IL-10 level and its function can cause an imbalance in immune response, which can be associated with various disease conditions. Aim: To study the influence of vitamin D status and IL-10 gene promoter polymorphism (rs1800871) on circulating IL-10 cytokine levels in apparently healthy South Indian population. Materials and Methods: A cross-sectional study was conducted at the Department of Clinical Pharmacology, JIPMER, Puducherry, India from January 2016 to December 2017. Apparently healthy South Indian volunteers (N=101) of either sex, age more than 18 years, were recruited for the study, after obtaining written informed consent. Serum 25-hydroxy vitamin D and plasma IL-10 levels were measured by using Chemiluminescence and Enzyme Linked Immunosorbent Assay (ELISA), respectively. IL-10 rs1800871 genotyping was performed by Real Time-polymerase Chain Reaction (RT-PCR). Values were expressed as median, Inter-quartile Range (IQR) and proportions were described as number with percentage. Results: The median serum vitamin D and plasma IL-10 levels observed among the study population were 18.21 ng/mL IQR, 11.3-23.08 ng/mL) and 9.04pg/mL (IQR, 7.75, 11.34 pg/mL) respectively. The genotype and allele frequencies of rs1800871 were consistent with those of the African, South Asian population of 1000 genome project. Plasma IL-10 levels were not significantly different across genotypes (p-value=0.091), even though the median level among homozygous mutant (TT) volunteers was observed to be less (8.35 pg/mL vs 9.69 pg/mL, 9.83 pg/mL). The correlation between vitamin D and IL-10 levels was observed to be insignificant (p-value=0.143). Conclusion: The present study has reported the rs1800871 genotype frequency, circulating serum vitamin D levels and plasma IL-10 levels in the apparently healthy South Indian population. IL-10 cytokine levels were not significant across the different genotype and vitamin D status groups. No significant correlation was observed between the IL-10 and vitamin D levels among the sample studied.

Effect of Non surgical Periodontal Therapy on Gingival Parameters of Diabetic and Non Diabetic Periodontitis Patients: A Prospective Clinical Study

Amit Mani, Shivani Sachdeva, Shubhangi Mani, Mrunmayee Gaydhani, Hemant Pawar

Introduction: Non Surgical Periodontal Therapy (NSPT) has been an effective treatment for suppression of gingival inflammation and improvement of periodontal health in patients. Periodontitis and diabetes have an inter-relationship with each other. Surgical intervention is not always advisable for periodontitis patients with diabetes. Hence, assessing the response of non surgical periodontal treatment in diabetic patients can lead to better and non invasive treatment options. Aim: To evaluate the effect of NSPT by observing changes in Gingival Index (GI), Plaque Index (PI), Clinical Attachment Loss (CAL), and volume of Gingival Crevicular Fluid (GCF) in diabetic and systemically healthy periodontitis patients. Materials and Methods: This was a prospective clinical study conducted in the Department of Periodontology, Rural Dental College, Loni, Maharashtra from January 2021 until June 2022. Total of 90 patients were assessed and were divided into three groups. Group A (n=30) included the patients with healthy periodontium and without any systemic disease. Group B (n=30) included the patients with controlled diabetes, with CAL in ranges of 3-4 mm (stage II periodontitis). Group C (n=30) included the patients who are systemically healthy, with CAL in ranges of 3-4 mm (Stage II periodontitis). Clinical parameters including GI, PI, Periodontal Probing Depth (PPD), CAL and volume of GCF were evaluated at baseline. NSPT was performed and parameters were evaluated after three months and then compared with baseline. Statistical analysis was done by descriptive statistics as mean, SD, percentage etc. Results: A total of 90 patients were included, of which 44 were male patients and 46 were female patients, within the age range of 18-60 years. Patients were grouped 30 each in all three groups A, B, and C with mean age 39.60±7.89, 45.70±10.02 and 43.90±9.64 respectively. The sites of group B showed statistically significant improvement in PPD at three months (1.80±0.76) compared to group C. Sites of group B also showed significant improvement in GI (1.46±0.45). There was no significant difference in the improvements of PI, Volume of GCF and CAL between group B and C at three months. Conclusion: The present study demonstrated marked improvements in the clinical parameters and their outcomes when the systemically healthy periodontitis patients and diabetic patients are treated with NSPT.

Comparison of the Efficacy of Autologous Platelet-Rich Plasma and Saline Dressing in Healing of Diabetic Foot Ulcer- A Randomised Control Study

S Gowsick, D Balaji, Arul, ES Unnikrishnan, R Manish

Introduction: According to research by the World Health Organisation (WHO), there are 347 million diabetics worldwide, and by 2030, it will overtake smoking as the seventh leading cause of death and diabetic people have a lifetime risk of up to 25% for developing a foot ulcer. Many novel techniques are emerging to fasten wound healing, including cellular therapies using Platelet-Rich Plasma (PRP) and collagen-based dressings. Aim: To compare the efficacy between instillation of autologous PRP and conventional dressing using normal saline/povidone iodine in Diabetic Foot Ulcers (DFU). Materials and Methods: This randomised control clinical study was conducted in the Department of General Surgery at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. The duration of the study was 18 months, from April 2021- September 2022. A total of 174 DFU patients were included in the study, meeting inclusion and exclusion criteria’s. Patients were divided into case (n=87) and control group (n=87). For six weeks, the case group got autologous PRP, while the control groups regularly had standard dressings. Wound areas were measured using ruler scale weekly and percentage of healing was monitored for 12 weeks. The data were analysed with International Business Machines (IBM)- Statistical Package for Social Sciences (SPSS) version 21.0. Results: In a group of 87 each, 174 patients with chronic non healing DFUs were randomly assigned to the study group (PRP) or the control group (conventional dressing method) throughout the 9 months study. The age of the patients ranged from less than 40 years to over 61 years. The age group between 51 and 60 years had the highest percentage of patients (50.6%), followed by the age group over 61 years (23.6%). About 12 weeks after the treatment, it was discovered that, the case group had a 86% reduction in wound area of 86.51±15.71 mm, whereas, the control group had a 61% reduction in wound area of 65.47±30.18 mm and 65.1% of patients from the case group showed wound healing, while 42.7% of patients from the control group showed wound healing. These findings were found to be statistically significant (p-value <0.001). Conclusion: The use of PRP led to a higher rate of wound healing in less time when compared to traditional wound care in the therapy of chronic DFUs, as shown in the present study. For chronic DFUs, PRP was able to speed up healing, making it a potentially viable and promising treatment.

Anatomical Localisation and Morphometric Study of Lister's Tubercle of Radius: A Cross-sectional Study

Introduction: Fractures of the distal radius are one of the most common injuries and it accounts for 8-15% of all fractures of the upper limb. Lister’s Tubercle (LT) is an important anatomical, surgical landmark during various orthopaedic and other surgical procedures on the distal radius. Aim: To determine the anatomical localisation of LT in relation to radial styloid process and ulnar notch and to measure the morphometric parameters of LT on dry radii. Materials and Methods: The present cross-sectional study was done on 180 radii, 90 right-sided and 90 left-sided obtained from the Department of Anatomy, Medical College Baroda, Vadodara, Gujarat, India, from December 2021 to August 2022. Localisation and length, width and height of the lister tubercle were measured with the help of a vernier calliper. Mean and range of each parameter was calculated. All measurements were made by two observers to avoid bias interpretation. The data were entered in Microsoft Excel window 10. Results: On right-side the LT was nearer to the styloid process in 04 radii (ratio was less than 1) while it was nearer to the ulnar notch in 86 radii (ratio was more than 1). Highest ratio of two distance was 1.768 (LT nearer to ulnar notch) while the lowest distance was 0.8706 (LT nearer to styloid process). On left-side LT was nearer to styloid process in 28 radii (ratio was less than 1) while it was nearer to ulnar notch in 62 radii (ratio was more than 1). Highest ratio of two distance was 1.42 (LT nearer to ulnar notch) while the lowest distance was 0.79 (LT nearer to styloid process). The mean length of LT on right-side was 12.30±1.46 mm, breadth 4.66±0.98 mm, while height was 2.87±0.57 mm and the mean length of LT on the left-side was 13.19±1.511 mm, width 4.89±1.17 mm, while the height was 2.96±0.692 mm. Conclusion: The present study shows that in majority of cases, LT was nearer to the ulnar notch and the distance between LT and radial styloid process was more. The anatomical localisation and morphometric data of LT will be is useful in various surgical procedures like screw fixation in volar plating and micro nail techniques.

Stability of Midline Diastema Closure by Frenectomy and Orthodontic Treatment: A Systematic Review

Suvetha Siva, Shreya Kishore, Janani Ravi

Introduction: Midline diastema is one of the most common aesthetic complaints in mixed and sometimes in permanent dentition stage. High frenal attachment is the major aetiological factor causing midline spacing. Combined frenectomy and orthodontic treatment can be done to close the midline diastema which may also increase the stability and reduce relapse. Aim: To assess the stability of midline diastema closure by using frenectomy and orthodontic treatment. Materials and Methods: A systematic review was conducted on clinical trials showing the stability of midline diastema closure using frenectomy and orthodontic treatment, articles were searched from 1995 to 2022. A total of 521 articles were retrieved. Among these 433 articles were screened. The risk of bias was assessed for all the studies included in this review. Results: A total of five studies were included in the systematic review which had clinical trials showing the stability of midline diastema closure in patients having midline diastema of at least 0.5 mm. Four studies using orthodontic treatment have shown some amount of relapse and one study using orthodontic treatment and frenectomy has shown prominent closure of median diastema. Conclusion: Closure of maxillary median diastema is more prominent when performed using combined frenectomy and orthodontic treatment than orthodontic treatment alone and the risk of relapse is minimal. However, furthermore clinical studies are required to confirm the stability of midline diastema closure by using orthodontic treatment and frenectomy.

Cyberbullying Victimisation and Psychological Well-being: A Cross-sectional Study among Medical Students in Western India

Chintan D Savani, Mihir P Jani, Anu H Patel, Parth R Modi, Veji K Odedara

Introduction: Cyberbullying is the voluntary and repetitious abuse that is inflicted through computers, mobile phones, or other electronic devices, using language that can defame, threaten, harass, bully, exclude, discriminate, demean, humiliate, stalk, disclose personal information, or contain offensive and vulgar comments. Within the last decade, cyberbullying has received a high level of attention from researchers worldwide due to the continuous advancements of technological tools and their link with mental health issues. Aim: This study aimed to assess the prevalence of cyberbullying victimisation and its effect on the psychological well-being of medical students. Materials and Methods: A cross-sectional study was conducted on 502 medical students studying at Medical College Baroda, Gujarat in western India from January 2022 to June 2022. Medical students were assessed for cyberbullying victimisation using the Cyber-Victimisation Scale (CYBVICS). The impact of cyberbullying on psychological well-being was assessed using the Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder (GAD-7) for screening depression and anxiety, respectively. Data were analysed with Epi Info. Qualitative variables such as socio-demographics and clinical parameters were summarised in frequency and percentages. The Chi-square test was applied to evaluate the association between categorical variables, and p-values less than 0.05 were considered significant. Results: Among 502 medical students, 71 (14.14%) were victims of mild cyberbullying, whereas 90 (17.93%) and 103 (20.52%) had experienced moderate and severe cyberbullying victimisation, respectively. Among all participants, 20 (4%) (Chi-square=39.329, p=<0.0001) and 16 (3.19%) (Chi-square=21.686, p=<0.0001) screened positive for depression and anxiety, respectively. Conclusion: Cyberbullying victimisation was much more prevalent among medical students and had a strong negative impact on the psychological well-being of students, causing significant depressive and anxiety symptoms. The severity of impact increased with the increasing severity of cyberbullying victimisation. Such studies will help healthcare professionals and institutional interventions to protect those likely to fall victim to cyberbullying.

Utilisation of Supplementary Nutritional Services of ICDS by Paediatric Beneficiaries of Central Kerala, India: A Cross-sectional Study

Ruth Abraham, Nileena Koshy, Rajany Jose

Introduction: Integrated Child Development Scheme (ICDS) is a unique programme for childhood care and development. ICDS has expanded progressively over the past four decades, and the budget allotment for the programme has been increasing over the years. However, the expansion in coverage has not been translated into a proportionate increase in utilisation. Aim: To evaluate the utilisation of supplementary nutritional services of ICDS and to assess the reasons for not utilising the same by paediatric beneficiaries. Materials and Methods: This community based cross-sectional study was conducted in the Department of Community Medicine, Government Medical College (selected Rural Community Health Centre), Thrissur district, Kerala, India, during January 2019 to August 2019. A total of 290 children, aged between six months to six years, were permanent residents were selected to participate in the study. Data were collected using pre-tested structured proforma by interviewing all the study subjects. Univariate analysis and logistic regression were used for statistical analysis to find the factors affecting the non utilisation of ICDS services. Results: Among the 290 participants, 141 (48.6%) were in the age group of six months to three years while 149 (51.4%) were in the age group 3-6 years, and 154 (53.1%) were boys and 136 (46.9%) were girls. The regular utilisation of supplementary nutrition was 67 (47.5%, 95% CI- 39.1, 56.1) in the age group six months to three years and 83 (55.7%) in 3-6 years. The main reasons for non utilisation were that children attended playschool and a lack of perceived benefits. Those who lived near Anganwadi Centres (AWC) had significantly higher utilisation. Utilisation among children between 3-6 years of age was significantly lower in those with higher maternal education (p-value <0.001), and who reach Anganwadi by vehicle (p-value <0.001). Conclusion: The study found that regular utilisation of supplementary nutrition was poor. Those who were staying away from Anganwadi and who had higher maternal education had lower utilisation of ICDS nutritional services. Public-private partnerships in providing hot cooked meals from Anganwadi in playschools can be explored to increase utilisation.

A Study on Clinical Empathy among Undergraduate Medical Students: A Cross-sectional Study from Malappuram District, Kerala, India

MM Fasila, Remya Ramachandran, VC Sunena, KC Lamees

Introduction: Mercer and Reynolds defined empathy as the ability to understand the patient’s situation, perspective, and feelings, communicate that understanding, check its accuracy, and act on that understanding with the patient in a helpful way. Clinical empathy is shown to boost patient’s feelings of satisfaction, which helps with compliance. The results of earlier research have been mostly contradictory, with some studies demonstrating an increase in empathy and others showing no change or a decline. Aim: To assess clinical empathy among medical students and to study the associated factors with it. Materials and Methods: A cross-sectional study was conducted in the Department of Community Medicine, MES Medical College, Perinthalmanna, Malappuram, Kerala, India, over a duration of four months from December 2018 to April 2019. The english version of Jefferson Scale of Empathy-S questionnaire (JSE-S) was used to assess clinical empathy. The JSE is a self-administered inventory that contains 20 questions, half of which were negatively phrased, while the other half were positively phrased. The students were asked to mark one out of seven options provided on a Likert scale in response to each item. The scale was reversed for negatively phrased items. Permission to use the questionnaire was obtained. The data collected were coded and entered into MS Excel and analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Baseline characteristics of the study subjects were explained in terms of frequency, percentage, mean and SD. Appropriate statistical techniques including t-test and Analysis of Variance (ANOVA) were applied to compare the means of two independent groups and more than two independent groups respectively. Pearson’s correlation test was applied to study the relation between two quantitative variables, age and empathy score. A p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 21.36±1.54 years. A total of 360 participants, 263 (73%) were females, 251 (69.7%) of the study subjects were in the age group of 21 to 23 years. A total of 189 (52.5%) of the study participants chose people oriented specialty. The total mean JSE-S empathy score was 105.8±18.5. There was a statistically significant difference (p<0.001) in mean empathy scores among different age groups, gender and the academic year. Conclusion: Importance should be given to encourage every single individual from the primary level of understanding to matured state of mind to become empathetic. Clinical empathy should be nurtured starting from the commencement of the Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum and beyond.

Assessment of Social Functioning among Adolescent School-going Children in Hooghly District, West Bengal, India: A Cross-sectional Study

Introduction: Adolescents form a socially significant segment of the population. The analysis of social functioning, a sensitive indicator of underlying mental ailments among them, is a good measure to find out their mental health status. Aim: To assess social functioning skills and their associated factors among adolescent school-going children in Hooghly District, West Bengal, India. Materials and Methods: A descriptive, cross-sectional questionnaire-based was conducted among 1056 (mean {SD) age=15.53±1.3 years} school-going adolescent children in four randomly selected English medium private co-educational schools, from Class IX to XII, in Hooghly District, West Bengal, India, for a period of two months from June 2022-July 2022. The Child and Adolescent Social and Adaptive Functioning Scale (CASAFS), a validated tool consisting of 24 items designed to measure psychosocial functioning, was used. A Likert scale scoring was done for each item. Adolescents scoring below the 75th percentile of the total score were classified as “poor social adaptive functioning skill” and those above 75th percentile as “good social adaptive functioning skill”. The data were analysed using IBM Statistical Package for the Social Sciences (SPSS), version 23.0 software. Descriptive statistics like mean, median, percentile, standard deviation were generated. Analytical statistics like chi-square test was applied to find out the relationship between categorical variables i.e., social functional skill and socio-demographic profile and a p-value of <0.05 was considered significant. Results: Out of 1056 students included in the study. There were 318 (30.1%) Class IX students, 229 (21.7%) Class X students, 204 (19.3%) Class XI students and 305 (28.9%) Class XII students. The age of the students ranged from 13 to 18 years. 219 (20.7%) had the good social functioning skill and 837 (79.3%) had poor social functioning skill. The mean (SD) score of all the domains combined was 70.5 (8.05), with ‘Family Relationship domain’ having highest mean (SD) score 19.5±3.0 and ‘Peer relationship domain’ having the least mean (SD) score 15.9±3.1. ‘Good social functioning skills’ were significantly associated with those belonging to the age group of 17-18 years, having increased number of siblings (p=0.001) higher mother’s educational status (p=0.003). Conclusion: From the present study, it was observed that a very meager number of students possessed good social functional ability. Improvement of social functioning skills indirectly helps in improving mental health and adolescents are the corner stones to initiate this process.

Phubbing Phenomenon and its Determinants among Medical College Students in Greater Noida: A Cross-sectional Study

Introduction: Smartphones and computers provide access to the Internet, which makes us highly reliant on them and leads to phubbing. Phubbing is described as the behaviour of ignoring others by looking at your mobile phone during a conversation with another individual and escaping from interpersonal communication. Almost all medical students have smartphones, so it is imperative to study this behaviour among them. Aim: To assess phubbing and its determinants among medical students of the School of Medical Sciences and Research, Gautam Buddha Nagar. Materials and Methods: A cross-sectional study was carried out from July 2021 to September 2021 among medical students of the School of Medical Sciences and Research, Sharda University, Gautam Buddha Nagar, India. A total of 422 MBBS students, who were present during data collection were included. Data were collected using a self-administered structured questionnaire, consisting of the socio-demographic profile, phubber’s characteristics, phubbing scale, smartphone addiction scale, and self-control scale. The data were analysed using frequency, percentage, and unadjusted odds ratio. Results: A total of 422 MBBS students data were analysed. Mean age, 21.28±1.27 years. The prevalence of phubbing was 42.7 percent in present study. Among them, 151 (83.9%) were college phubbers. On the phubbing scale, the majority of the participants, 306 (72.5%) reported that their phone was always within their reach. There was a significant association found between smartphone addiction (OR: 3.880; 95% CI: 2.290-6.574) and lack of self-control (OR: 1.992; 95% CI: 1.250-3.172) with phubbing. Conclusion: This study found a high prevalence of phubbing behaviour. The results presented that phubbing is determined by a lack of self-control and smartphone addiction. Findings highlight the need to regulate smartphone and social media usage during college time and at home.

Diagnostic Accuracy of Ultrasonography in Patients with Plantar Fasciitis: A Cross-sectional Study

Introduction: Plantar Fasciitis (PFS) is the most well-known cause of plantar heel pain seen predominantly in middle aged women. Imaging findings of Magnetic Resonance Imaging (MRI) is considered to be the gold standard in the diagnosis of PFS, but MRI is expensive. Hence; there is a need to study the accuracy of Ultrasonography (USG), as USG is inexpensive, free of radiation and readily available. Aim: To evaluate the diagnostic accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of ultrasound in comparison with MRI for the diagnosis of PFS, in patients with heel pain. Materials and Methods: The present cross-sectional study was conducted in the Department of Radiodiagnosis, SRM Medical College and Research Centre, Kattankulathur, Tamil Nadu, India, from December 2019 to July 2021. USG and MRI of foot were performed in 40 patients with heel pain. MRI protocol included three plane Proton Density Fat Saturated (PDFS), T1 sagittal, T2 axial and Short inversion Time Inversion Recovery (STIR) sagittal sequences. USG scans were done in prone position with the patient’s feet dorsiflexed. The Plantar Fascia (PF) thickness was measured in both USG and MRI and association of the ultrasound and MRI measurements of PF thickness was done using Chi-square test. Results: Mean age of the cohort was 36.83±10.08 years. Out of this subject population, majority were females 29 (72.5%). Nineteen (47.5%) females were overweight i.e., BMI from 25-29.9 kg/m2. The accuracy, sensitivity, specificity, PPV and NPV of plantar fascia thickness of USG as compared to MRI was found to be 80%, 60%, 82.9%, 33.3% and 93.5%, respectively. Conclusion: Despite MRI being the imaging modality of choice in diagnosing PFS, accuracy of ultrasound was comparable to that of MRI and it can be used as the initial investigation and follow-up.

Shear Bond Strength, Bonding Time and Adhesive Remnant Index of Adhesive Precoated Flash Free Adhesive System vs Conventional Adhesive System using Metal Brackets: An In-vitro Study

Introduction: With advances in materials for bonding in orthodontics, errors regarding amount of adhesive to be used can be controlled. Adhesive Precoated (APC™) Brackets were introduced to reduce the step of applying conventional adhesive on base of the bracket. Moreover, APC™ Flash Free Adhesive System (FFAS) eliminated the step of removing excessive adhesive around the brackets. Aim: To compare Shear Bond Strength (SBS), Bonding Time (BT) and Adhesive Remnant Index (ARI) between Conventional Adhesive System (CAS) and APC™ FFAS using metal brackets. Materials and Methods: This in-vitro study was carried out in the Department of Orthodontics and Dentofacial Orthopaedics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. A total of 78 teeth with metal braces were split into two groups, with 39 samples each receiving treatment with the CAS and the APCTM FFAS. Shear bond forces were applied to each sample using a universal testing machine and recorded in Megapascals (MPa) to provide an indication of SBS. Both Groups’ BT was quantified in terms of seconds. The stereomicroscope indexes of Artun J and Bergland S were used to determine ARI. Microsoft Excel was used for data entry, while Statistical Package for Social Sciences (SPSS) version 24.0 was used for analysis. The normality of the data was tested using two different t-tests. Descriptive statistics were represented in terms of mean and standard deviation. A significant level of 0.05 was used. Results: The SBS values were 10.35±3.55 MPa and 11.23±3.82 MPa in CAS and FFAS respectively. No significant difference was found among the two groups (p≤0.29) in SBS. BT was significantly (p≤0.001) less in FFAS (95.54±8.72 seconds) compared to CAS (140.85±16.62 seconds). ARI was significantly (p≤0.002) less in FFAS (1.79±0.80) in comparison with CAS (1.23±0.74). Conclusion: FFAS brackets perform better in comparison to CAS in case of BT and ARI. Both groups show no significant difference in SBS.

Sellar Metrics and Morphology in Ethnic Dogra Population of Jammu Region- A Cross-sectional Cephalometric Study

Faisal Arshad, Akshay Gupta, Parveen Akhtar Lone, Ritesh Gupta

Introduction: Sella turcica is an important landmark seen during cephalogram tracing and evaluation. Its morphology varies in individuals, gender groups, age groups, and ethnicities. Aim: This cephalometric study was done on a novel population of Dogra ethnicity residing in Jammu to determine the characteristics of sella and its correlation with the sagittal skeletal structures. Materials and Methods: This study was a cross-sectional study done on cephalograms and included a total of 87 patients, equally classified as Skeletal Class-I, Class-II, Class-III, respectively. The pre-treatment profile cephalogram of the patient was obtained in a standardised method. Manual tracing of all the cephalograms was done on an acetate paper with a tracing pencil under optimal illumination. Area, size, shape, bridging of the sella were measured using a novel template and tabulated in excel sheet and sent for statistical analysis. Results: The results showed mean area of sella was highest in skeletal Class-III (32.79±3.28 mm) followed by skeletal Class-I (28.31±1.63 mm) and least in skeletal Class-II subjects (23.27±2.91 mm). Skeletal Class-III had the greatest mean sella length (10.85±0.80 mm), depth (10.54±0.89 mm), Anteroposterior (AP) diameter (13.20±0.83 mm) followed by skeletal Class-I and least in Class-II. Normal sella turcica was prevalent among all the skeletal. Conclusion: The dimensions of the sella obtained from this study provide an estimate about the morphology and size of sella in Dogra population thus providing knowledge to the local Orthodontist about the varied appearance of sella and helps in distinguishing the physiological and pathological patterns of sella.

Evaluation and Comparison of Moment-to-Force Ratio of a New “PRP Loop” with that of Opus Loop and L Loop- A Finite Element Method Study

Smita Kumari, Priyanka Niranjane, Pallavi Daigavane, Ranjit Kamble

Introduction: Extraction space closure is one of the most challenging procedures in the field of orthodontics which requires a robust understanding of biomechanics. There are two commonly used methods of space closure, one involves friction, also called sliding mechanics, and the other is frictionless. The advantages of frictionless mechanics are that there is no force loss due to friction and low anchorage taxing. The preferred method for the retraction of teeth is loop mechanics, which ensures controlled tooth movement. Aim: To evaluate and compare the Moment-to-Force (M/F) ratio of PRP loop with that of the Opus loop and L loop using the Finite Element Method (FEM). Materials and Methods: An in-vitro study was conducted by using FEM analysis at DMIHER University with technical assistance from the Department of Mechanical Engineering VNIT Nagpur. Computer models of the loop designs were prepared on Analysis of Systems (ANSYS) version 10 (V10) software. Opus loop, L loop and PRP loop were modeled as SOLID 64 beam elements. Different pre-activation bends were given to the models in α and β nodes of the loop. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 27.0 software to compare the means of all three loops. Results: A total of 36 FEM models were studied. PRP loop showed a greater M/F ratio than the Opus and L loop with 15ºα and 25ºβ pre-activation bends in both 0.017×0.025 and 0.019×0.025-inch Titanium Molybdenum Alloy (TMA) wire, i.e., 9.09 and 9.12, respectively. On comparison of the M/F ratio of PRP loop, Opus loop and L loop prepared with 0.017×0.025 and 0.019×0.025 TMA wire, at 15ºα and 25ºβ pre-activation bend in 0.019×0.025 TMA, PRP loop showed the highest M/F ratio of 9.12 as compared to 0.017×0.025 TMA wire. Conclusion: The study concluded that the PRP loop is an efficient retraction loop with an ideal moment force ratio for translatory movement of tooth. PRP loops had a higher M/F ratio than the Opus loop and L loop, indicating that PRP can be used for translatory movement of teeth in wires of different materials. Therefore, for the proper utilisation of PRP loop, it must be prepared with either 0.017×0.025 inch TMA or 0.019×0.025 inch TMA wire.

Cleaning Efficacy of Regular, Orthodontic and Electric Toothbrushes around Orthodontic Brackets: An In-vitro Study

R Rebekah, R Navaneethan

Introduction: Plaque formation increases when mechanical disruption occurs in the oral cavity’s self-cleaning systems during fixed orthodontic therapy. Hence, it is imperative that oral prophylaxis must be performed with more care in orthodontic patients. This can be efficiently done with the help of toothbrushes. There are various types of toothbrushes such as regular, orthodontic and electric toothbrushes which are most commonly used by patients to maintain proper oral hygiene and prevent plaque accumulation. Aim: To identify which toothbrush has the best cleaning efficiency, when used around orthodontic brackets. Materials and Methods: This in-vitro study was conducted in the laboratory set-up at Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India. The study was conducted for a period of two weeks from 17th January 2022 to 30th January 2022, and used 24 permanent premolars extracted for orthodontic purposes which were divided into three groups: regular, orthodontic and electric toothbrushes. There were eight tooth samples in each group. Following premolar bracket bonding, a biofilm was formed around the teeth using E.faecalis culture in-vitro for three days. The samples were then carefully removed and treated with a disclosing agent before being put through a brushing simulation. The “Plaque index for Orthodontic Patients” (PIOP) index was used to estimate plaque scores before and after brushing based on how much biofilm was remaining on the tooth surfaces. One-way Analysis of Variance (ANOVA) and Tukey’s Post-hoc tests were used to determine the statistical significance. Results: The mean plaque scores after simulation in the toothbrush groups were 3±0.75 (regular), 1.75±0.70 (orthodontic) and 2.37±0.74 (electric). There was a statistically significant difference in mean plaque scores between groups as determined by one-way ANOVA {F(p=0.008)}. A Tukey’s Post-hoc test revealed that the cleaning efficacy of orthodontic toothbrushes was statistically significant compared to the other two groups. Conclusion: The orthodontic toothbrushes produced a statistically greater level of tooth-cleaning effectiveness.

Evaluation of First, Second and Third Generation Probe after Phase I Therapy in Chronic Periodontitis Patients- A Randomised Clinical Study

Introduction: Periodontitis manifested by the presence of periodontal pocket depth and loss of attachment level is detected and measured by using periodontal probes. Various generations of probes have been discovered and are used to measure the pocket depth. There has been a huge difference in the accuracy of different generations of probe. Aim: To compare the interprobe accuracy of first, second and third generations of probe on clinical parameters in patients with chronic periodontitis. Materials and Methods: This randomised comparative clinical study was conducted at the Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India and included 30 chronic periodontitis patients, randomly allocated into three groups with each group consisting of 10 patients. The study was conducted over a period of eight months, from February 2001 to October 2001. Conventional periodontal probe, True Pressure Sensitive (TPS) probe and Florida probe were used to examine the patients. The probes were used in sequence of I, II and III for first 10 patients, II, III and I for next 10 patients and III, I and II for the last 10 patients to avoid bias due to examiner memory of clinical parameters. The recorded clinical parameters were Plaque Index (PI) (Silness and Loe 1964), Gingival Index (GI) (Loe and Silness 1963), Bleeding On Probing (BOP) index (Ainamo and Bay 1975), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). At baseline, all the clinical parameters were recorded by two examiners i.e., Examiner-1 and Examiner-2. Examiner-I recorded all the clinical parameters postoperatively at Ist, IInd, IIIrd and IVth consecutive weeks. The statistical analysis was done using paired t-test, One-way Analysis of Variance (ANOVA), studentised range test and Karl Pearson’s correlation coefficient test for calculation and comparison of interexaminer and intraexaminer variability. Results: Among the 30 patients included in the present study, 22 were males and eight were females. The mean age of the patients involved in the study was 45.16±1.33 years. The mean value of PI and GI showed a statistically significant reduction at different intervals with a value of 0.16±0.21 and 0.22±0.21 postoperatively (4th week). The probing depths measured using Williams periodontal probe, TPS probe and Florida probe were reduced to 4.2±0.4 mm, 3.9±0.4 mm and 3.5±0.4 mm, respectively at the end of 4th week. The CAL measured using Williams periodontal probe, TPS probe and Florida probe were reduced to 7.0±0.6 mm, 6.6±0.5 mm and 6.1±0.6 mm, respectively at the end of 4th week. Conclusion: The TPS probe, Williams probe, and Florida probe showed their superiority regarding the accuracy of recording clinical parameters in the decreasing order respectively.

Assessment of Abdominal Aorta Diameter on Contrast-enhanced Computed Tomography: A MDCT-based Observational Study

Rakhee Shashikant Naik, U Raghuraj

Introduction: The average size of the abdominal aorta is less than 3 cm, which varies over time. An increase in abdominal aortic dimensions of more than 3 cm can result in the presence of ectasia, which can further convert into an aneurysm. The expansion rate can also lead to aortic dissection and rupture. Its increasing dimensions can influence to give rise to numerous other abdominal aortic conditions and be fatal due to the aortic wall stress. Monitoring the variation in the abdominal aorta is now possible with the various advancements in imaging techniques including Computed Tomography (CT). Aim: To measure the Anteroposterior (AP) and Right-Left (RL) diameters of the abdominal aorta on Contrast-enhanced Computed Tomography (CECT) abdomen and to analyse its variation with age and gender. Materials and Methods: A cross-sectional observational study was conducted in the Department of Radiodiagnosis at KS Hegde Charitable Hospital, Deralakatte, Mangaluru, Karnataka, India. The duration of the study was 11 months, from April 2020 to March 2021. A total of 81 patients referred for CECT abdomen divided into two age groups of 20-40 years and 41-80 years. The scan was performed using 16-slice Multidetector Computed Tomography (MDCT). On the reconstructed axial images, the abdominal aortic diameters were measured at the level of T12-L1. The non parametric Mann-Whitney U test was used to compare the RL and AP diameters with respect to age groups. Unpaired t-test was used to compare the RL and AP diameters with respect to gender. Paired t-test was used to compare AP diameter on contrast and non contrast scans. Results: The mean age of study participants was 47±14.83 years and was divided into two age groups between 20-40 years and 41-80 years. Out of the 81 cases, 31 (38%) were in the age group of 20-40 and 50 (62%) were in the age group of 41-80 years. There was a significant increase in the AP and RL abdominal aortic diameter with age (p-value <0.001) and males were found to have significantly higher abdominal aorta diameter than females (p-value <0.001) in both the age groups of 20-40 and 41-80 years. Also, the abdominal aorta diameter measurements on Non Contrast Computed Tomography (NCCT) and CECT abdomen showed no notable difference. Conclusion: The present study concluded that, there was a remarkable variation in the diameter of the abdominal aorta with age and gender. Besides, the abdominal aorta diameter measurements on NCCT and CECT abdomen showed no notable difference.

Distribution of Different Types of Cystic Breast Lesions and their Imaging Features: A Retrospective Observational Study

Neha Singh, Prasant Agrawal, Deepak Kumar Singh, Mandvee Ojha

Introduction: Cystic disease of the breast is very common and present in women aged 35-50 years. They can be detected incidentally or present with lump, pain, or discharge. Confusion occurs in the appropriate classification and management of such cystic lesions. These lesions characteristically appear as circumscribed masses on mammography, but can be properly evaluated on ultrasound. Although the variable imaging features sometimes necessitate biopsy for confirmation of the diagnosis. Aim: To estimate the prevalence of different types of cystic breast lesions and to study the imaging spectrum and features of cystic breast lesions. Materials and Methods: This descriptive observational retrospective study was undertaken on all the women who presented for screening or diagnostic mammography and had ultrasonographically detected cystic component in the breast lesions. Based on the mammography and ultrasonographic features, cystic lesions were classified and final Breast Imaging Reporting and Data System (BI-RADS) category was assigned. Fine Needle Aspiration Cytology (FNAC) or biopsy was performed whenever required. The values were represented in number and percentage. Results: Out of 836 women who had undergone mammography and Ultrasonography (USG), 134 patients were diagnosed with cystic breast lesions. Simple cyst with or without fine septa was most common type of cystic lesion present in 53 (39.6%) cases. It was followed by complex solid cystic lesion seen in 36 (26.8%) cases, complicated cyst 30 (22.4%) and complex cyst with thickened wall or septa in 15 (11.2%) cases. Conclusion: Cystic breast lesions are common entities with variable and overlapping imaging characteristics, based on which they can be categorised as BI-RADS 2 to BI-RADS 5 lesions.

MRI Evaluation of Cervical Spondylotic Canal Stenosis and Change in its Severity on Flexion and Extension Positioning: A Cross-sectional Study

Introduction: Cervical spondylosis is a degenerative disorder of the cervical spine and has varied pathological forms of presentation. It presents as either varying degrees of intervertebral disc bulge, spinal cord compression, altered cord signals, neural exit foraminal stenosis, annular tears, facet joint degeneration and ligamentum flavum hypertrophy in combination or isolation. Magnetic Resonance Imaging (MRI) being known for its excellent soft tissue resolution helps assess and grade these pathologies efficiently. Aim: To evaluate the flexion-extension MRI in regular cervical spondylosis imaging by assessing the effect of flexion and extension positioning on the severity of cervical spondylotic canal stenosis and spinal canal dimensions. Also, to compare the change in cervical canal dimensions on flexion and extension with that of neutral positioning. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis, JSS Medical College, Mysuru, Karnataka, India, from January 2021-June 2022. A total of 50 participants, aged above 18 years with a clinical suspicion of cervical spondylosis and without history of trauma, tumour, infection, prior cervical surgery and with Nurick grade <3 were included in the present study. In all the subjects, spinal canal dimension, degree of stenosis was assessed and graded, further assessment for presence of foraminal stenosis, ligamentum flavum hypertrophy and facetal arthropathy were also documented. Data were statistically analysed using Chi-square test and Mc Nemer’s test. Results: Out of total 50 cases, 26 (52%) were males and the rest were females with mean age of 46 years. Least cervical canal space dimension of 0.4 cm at C6-7 level in the neutral position and at C3-4, C5-6 and C6-7 levels in extension were noted thus, proving the importance of extension positioning in recognising maximum levels and severity of involvement. Narrowest diameter was demonstrated on flexion and extension. Additionally, the elderly were seen more affected by central disc bulge, foraminal stenosis, facetal arthropathy and ligamentum flavum hypertrophy as compared to the middle aged and the younger patients, more so in extension (12%). Conclusion: Disc bulge and grade of stenosis vary extensively and are more conspicuous on additional flexion and extension imaging. Severity of the grade of stenosis and demonstration of maximum number of levels involved on extension as compared to flexion or neutral positioning thereby, benefitting clinical management plan.

Correlation of Magnetic Resonance Imaging findings with Clinical Grading in Lumbar Disc Degeneration: A Cross-sectional Study

Introduction: Low Back Pain (LBP) is the most common musculoskeletal symptom encountered on a daily basis in clinical practice and has a significant impact on healthcare resources. Magnetic Resonance Imaging (MRI) is the most sensitive tool for diagnosing spinal degenerative disease and has proven to be a standard imaging modality for its evaluation. Assessment of the correlation between clinical and radiological severity of lumbar disc degeneration will help in better management of the LBP patients. Aim: To determine the correlation between the clinical and radiological severity of lumbar disc degeneration in non surgical LBP patients. Materials and Methods: This observational, cross-sectional study was conducted at the Department of Radiology and Imaging, Sagar Hospitals, Bengaluru, Karnataka, India, from December 2019 to June 2021. A total of 90 patients with LBP who were referred for MRI evaluation were included. Modified Oswestry questionnaire was given to the patients and the clinical severity of the LBP was quantified. Patients with disc degeneration were evaluated on MRI based on six parameters viz., T2-signal intensity, Disc Extension Beyond Interface (DEBIT), annular fissure, modic changes, endplate integrity and osteophytes. Fisher’s exact test was used for qualitative data to look into the association between clinical and MRI grades of severity. Correlation was assessed for continuous variables using Pearson correlation analysis. Results: The study included a total of 90 patients with LBP, with a mean age of 57±13.75 years with equal sex preponderance (45 (50%) male and 45 (50%) female). Clinically, 51 (56.7%) of the study population revealed moderate disability. On quantifying the MRI total score of disc degeneration, 65 (72.3%) of the patients were found to show mild degeneration. In terms of involvement of all the evaluated six MRI parameters, the L4-L5 disc was most commonly affected, followed by the L5-S1 disc. Disc desiccation 353 (78.45%) and osteophytes 336 (74.67%) were the most consistently observed variations. Disc bulges 251 (55.78%) were the next most frequently observed parameter in disc degeneration. Conclusion: The correlation between the clinical and radiological severity of disc degenerative disease was found to be weakly positive and statistically insignificant. Disc desiccation, osteophytes and disc bulges were the most commonly observed parameters that contributed to lumbar degenerative disease.

Activity of Labile Coagulation Factors, Factor X and Fibrinogen Level in Frozen Plasma versus Fresh Frozen Plasma

Introduction: Fresh Frozen Plasma (FFP) is a blood component separated from whole blood and frozen below -30°C within 8 hours of donation for optimum preservation of coagulation factors. However, logistic and geographical reasons may hamper separation of plasma within 8 hours and the separation may have to be delayed to between 8 and 24 hours and then frozen below -30°C which is called as Frozen Plasma (FP). Plasma separated between 8 and 24 hours is a licensed blood component in the United States of America (USA) for therapeutic use similar to FFP. It is not licensed in India leading to frequent shortage of plasma. Aim: To compare the activity of factors V, VIII and X and the level of fibrinogen between FFP and FP, so as to assess the therapeutic use of FP for formulating recommendation as licensed blood component. Materials and Methods: A prospective observational study was conducted in the Department of Transfusion Medicine at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. The duration of the study was 10 months, from January 2018 to October 2018. Fifty units each of FFP and FP matched for the camp location, age, gender and blood group were selected. There were 44 males and six females in each of FFP and FP groups. They were compared for the activity of labile coagulation factors (factors V and VIII) and stable factor X. The level of fibrinogen was also measured in both components. It was done within 30 days of preparation of plasma. The mean values of each of the four parameters for FFP and FP were calculated and compared for statistical significance (p) by using unpaired Student’s t-test. Microsoft Excel 2016 was used for statistical analysis. The p-value <0.05 was considered statistically significant. Results: The mean age of FFP and FP individuals (blood donors) was 31.2 and 31.3 years respectively, while the median age in years was 31 and 30.5, respectively. The activity/level of all the tested coagulation factors was lower in FP as compared to FFP. The difference was statistically significant for factor VIII (p-value <0.05). It was not significant for factor V, X and fibrinogen. The level/activity of coagulation factors in FP, though lower than that in FFP, fell within normal reference range in 90-95% of units. Conclusion: FP may be used as a therapeutic alternative to FFP excluding patients of haemophilia A in whom factor VIII concentrate and cryoprecipitate are considered better therapeutic modalities. Results of similar multicentre studies will help in formulating recommendations regarding licensing.

Effect of Deep Breathing Exercise using Smartwatch on Behaviour, Anxiety and Pain in Children during Buccal Infiltration Anaesthesia-A Randomised Clinical Trial

Varshitha Yendodu, SVSG Nirmala, Sivakumar Nuvvula

Introduction: Despite the newer innovation and recent technological advances in modern dentistry, fear and anxiety constitute an important theme in dentistry. They are a usual reaction to stressful conditions that help children while staying alert in situations of an impending threat. Aim: To evaluate the effect of deep breathing exercise in reducing dental anxiety, behaviour and pain using smartwatch during maxillary buccal infiltration in children aged 7-11 years. Materials and Methods: A prospective interventional and single-blinded randomised clinical trial conducted in the Department of Paediatric and Preventive Dentistry, NDCH, Nellore, Andhra pradesh, India, from November 2019 to October 2020. A total of 70 children of age between 7-11 years. They were randomly allocated into two groups, 35 in each. Children in group I were trained for deep breathing exercise using smartwatch and group II (control group) was traditional tell show do technique. The reaction of children during maxillary buccal infiltration anaesthesia was recorded in terms of behaviour (Frankl’s behaviour rating scale), anxiety {Facial Image Scale (FIS) and pulse rate}, and pain perception (Wong-Baker FACES pain rating scale and face, leg, activity, cry and consolability scale). Data were tabulated using Kolmogorov-Smirnov test and Kruskal- Wallis for data distribution. Independent Student’s t-test or Mann-Whitney test (Quantitative variables) and Chi-square test or Mann-Whitney test (Qualitative variables) were used to test statistical significance using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The mean age of children in smartwatch group was 8.9±1.4 years and in control group was 8.9±1.6 years with no statistical significant difference. Statistically significant decrease in pulse rate was observed in smartwatch group (p=0.003), subjective anxiety and pain was lowered in intervention group. Objective pain was decreased significantly in smartwatch group (p=0.007). Conclusion: Children performing deep breathing exercise using smartwatch had efficiency to reduce dental anxiety and pain perceived during maxillary buccal infiltration anaesthesia.

Effect of Soft Tissue Manual Technique and Breathing Exercises on Pulmonary Function, Chest Expansion and Functional Status in Post COVID-19 Survivors: A Quasi-experimental Study

Renuka Chandrakant Khedekar, Santosh P Dobhal, Abhishek Mishra

Introduction: It is known that around one third of Coronavirus Disease-2019 (COVID-19) patients develop severe pulmonary complications and acute respiratory distress syndrome, leading to long-term impairments in Pulmonary Function Test (PFT) and physical performance. Due to deteriorating health status of the COVID-19 survivors after their recovery, rehabilitation is must. Aim: To evaluate the effect of soft tissue manual technique and breathing exercises on PFT, chest expansion and functional status in Post COVID-19 Survivors. Materials and Methods: This quasi-experimental study was carried out in the Department of Cardiorespiratory Physiotherapy, MGM hospital, Aurangabad, Maharashtra, India, from November 2021 to July 2022. Total 54 subjects diagnosed with COVID-19 who required oxygen therapy and had persistent respiratory symptoms for three weeks to six months after the infection, were included. All the subjects received one week of soft tissue manual techniques which included proprioceptive neuromuscular function, muscle energy technique for recruitment of diaphragm, muscles of respiration and the ribcage. Breathing exercises were incorporated at the end of the session to ensure relaxation of the subjects. Subjects were assessed for PFT, chest expansion and post COVID-19 Functional Status Scale (PCFS) pre and post-treatment. Data were analysed through Wilcoxon signed-rank Test. Results: Amongst total 54 subjects included, 10 (18.6%) males and 44 (81.4%) females with mean age of 29.92±11.94. After one week of intervention p-value was 0.0001 for Forced Expiratory Volume (FEV1), FEV1/Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF) with mean values for FEV1 at baseline was 1.91±0.51 and post-treatment was 2.45±0.34, FVC was 2.25±0.50 before the treatment whereas it was 2.73±0.36 post-treatment with p-value of 0.002, FEV1/FVC and PEF was 83.99±12.03 and 4.36±1.78 at baseline whereas, post-treatment it was 87.76±7.29 and 5.88±0.95 respectively. The p-value of 0.0001 was also similar for chest expansion. No statistically significant difference was found in post COVID-19 functional status (p-value=0.013). Conclusion: Positive changes in the ribcage’s activation and integration with its muscles were seen in all of the study variables. Therefore, it is concluded that soft tissue manipulation techniques and breathing exercise improves functional status, thoracic expansion, in post COVID-19 survivors.

Correlation between BMI and Static Biomechanical Lower Extremity Kinetic Chain Variables in Overweight Young Adults: A Cross-sectional Study

Nishant Kumar Bali, Deepak Raghav, Amit Dwivedi

Introduction: Lower Extremity Alignment (LEA) is a main influencing factor in the active motion of the human body. Changes in the lower limb kinetic chain can be pushed by Body Mass Index (BMI). The gait may be impacted, which may result in more energy usage. However, little is known about how BMI and other static alignment parameters such as Quadriceps (Q)-angle, tibial torsion and plantar arch index are related. Aim: To determine the correlation between BMI and lower extremity kinetic chain variables such as pronated feet, femoral anteversion, Q-angle, tibial torsion, plantar arch index, angle of toe and pelvic inclination. Materials and Methods: The present cross-sectional study was conducted in the Department of Physiotherapy, Santosh Hospital Ghaziabad, Uttar Pradesh, India, from January 2021 to December 2021. A total of 160 participants age ranged between 18 years and 30 years with a BMI between 25 kg/m2 and 29 kg/m2 were included in the study. The following parameters were measured: pronated foot, angle of toe, plantar arch index, pelvic inclination, femoral anteversion, Q-angle and tibial torsion. Correlation between BMI with the seven static alignment parameters mentioned above was statistically analysed by using Pearson’s correlation coefficient and Spearman’s correlation test. Results: The mean age of the subjects was 23.82±2.021 years and mean BMI of the participants was 26.37±1.501 kg/m2. There was significant correlation between BMI and pronated foot on both sides (r-value=0.256, 0.199, p-value=0.001, 0.012), BMI and plantar arch index on both sides (r-value=0.198, 0.161, p-value=0.013, 0.043). However, no significant correlation was found between BMI and Q-angle (r-value=0.137,0.144, p-value=0.087, 0.72), BMI and tibial torsion (r-value=0.024, 0.066, p-value=0.766, 0.413), BMI and anteversion (r-value=0.111, 0.134, p-value=0.164, 0.92), BMI and angle of toe (r-value=0.127, 0.139, p-value=0.111, 0.081) and, BMI and pelvic inclination (r-value=0.012, 0.013, p-value=0.885, 0.870). Conclusion: BMI was positively correlated with the pronated feet and plantar arch index, and this relationship was statistically significant. However, no statistically significant relationship between BMI and pelvic tilt, femoral anteversion, Q-angle, tibial torsion and angle of toe.

Dosimetric and Volumetric Analysis in Endobronchial Brachytherapy in Lung Carcinoma: A Cross-sectional Study

Introduction: High Dose Rate (HDR) brachytherapy plays an important role in the treatment of lung carcinoma. The treatment of lung carcinoma with Endobronchial Brachytherapy Treatment (EBBT) is delivered in three fractions and the effect of EBBT on the Target Volume (TV) after delivering the three fractions in the lung carcinoma needs to be assessed. The TV is covered with the prescribed dose and Organs At Risk (OARs) doses are evaluated. Aim: To assess the doses to OAR nearby the tumour and analyse the effect of the TV, tumour location, and site on the doses to OARs in EBBT in lung carcinoma. Materials and Methods: A cross-sectional study was conducted in the Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University Dehradun, Uttarakhand, India, from January 2018 to December 2020. Thirty patients with lung carcinoma were included in dosimetric and volumetric assessments. A flexible lumencare catheter was inserted into the bronchial lesion. Computed Tomography (CT) scan was acquired and exported to Treatment Planning System (TPS) through Digital Imaging and Communications in Medicine (DICOM) networking system. An optimised treatment plan was generated. The TV and OARs were delineated on the CT scan of the patient. A total of three EBBT sessions were given with a 7 Gy dose per fraction and prescribed the dose at 1.0 cm from the center of the catheter. Doses to OARs and the effects of TV on doses to OARs were evaluated with the help of “Dose Volume Histogram (DVH) tool” in the TPS. Thirty patients, with varying TV and site, were grouped as left lung and right lung tumour lesions and also grouped as TV <22 cc and TV >22 cc for the analysis purpose in this study. The data was entered in Microsoft Office Excel 2007 and analysed in Statistical Package for the Social Sciences (SPSS) version 22.0 statistical analysis software (IBM Corp., Armonk, N.Y., USA) tool. Results: The mean doses to OARs in 1st, 2nd and 3rd EBBT sessions were within their tolerance limit. The mean dose difference between left and right lung tumour site were analysed and found mainly the mean dose to oesophagus and maximum dose to oesophagus, contralateral lung, left coronary artery and descending aorta were significantly higher in left lung compared to right lung with p-value 0.015, 0.027, 0.001, 0.007 and 0.001, respectively. The maximum dose to the contralateral lung and spinal cord were significantly higher in middle-lower bronchial lesion with p-value 0.024 and 0.023, respectively. The mean dose difference between left and right lung tumour volume for TV <22 cc and TV >22 cc was analysed and found mainly for the group TV >22 cc the mean dose to oesophagus and maximum dose to oesophagus, Heart, contralateral lung, left coronary artery and descending aorta were significantly higher in the left lung compared to right lung with p-value 0.002, 0.008, 0.027, 0.003, 0.006 and 0.001, respectively whereas in the TV <22 cc group only the contralateral lung max dose was significantly higher in left lung compared to right lung with p-value 0.046. Conclusion: The OARs doses were increased significantly in left lung compared to right lung carcinoma. The TV was large in the middle-lower bronchial region, therefore, the doses were found higher, and TV in the lower bronchial region is less so the dose was less.

Effect of Topical Application of Breast Milk on Episiotomy Wound Healing: A Quasi-experimental Study

Anjali Patel, Angelina Makwana, Anjali Tiwari

Introduction: Many mothers are given an episiotomy during a normal vaginal delivery. There are many alternative interventions used by the community to heal the episiotomy wound. Applying breast milk topically to a wound is simple, free of charge and has no side-effects. Breast milk contains therapeutic qualities that aid in the healing of wounds. Aim: To evaluate the effect of topical breast milk application on postpartum women’s episiotomy wound healing. Materials and Methods: This pretest, post-test quasi-experimental study was conducted in three selected health centres of Central Gujarat from February 2022 to March 2022. Using a pretest, post-test control group design, the quantitative quasi-experimental study design was used. A total of 40 postnatal women were recruited for experimental (20) and control group (20). Intervention of topical application of breast milk was offered two times a day for seven continuous days in experimental group and routine care was provided to participants in control group. Participants of experimental and control group was assessed using Redness, Edema, Ecchymosis, Discharge and Approximation (REEDA) scale on 1st, 3rd, 5th and 7th day. Descriptive and inferential statistics was applied to analyse the data. Results: A total 40 postnatal mothers participated in the present study with mean age of 23.05±3.80 years. Topical application of breast milk displayed positive effect on episiotomy wound healing in experimental group. The result exhibited that the experimental group’s episiotomy wound healing significantly improved (before: 14.75±0.55, after: 4.55±1.32) as compared to the control group (before: 14.65±0.59, after: 9.35±1.46). Conclusion: The study proved that there was a significant gradual healing of episiotomy wound after the use of breast milk topically in postpartum women. This also indicates that human breast milk can be an alternative strategy for accelerating episiotomy wound healing process.

Association of Human Leukocyte Antigen Gene Variants rs13192471 and rs6457617 with Rheumatoid Arthritis Susceptibility: A Case-control Study from North-western India

Introduction: Rheumatoid Arthritis (RA) is a systemic, chronic, inflammatory, and autoimmune disease which is characterised by the progressive ruination of joint structures. The Human Leukocyte Antigens (HLA) genes: HLA-DRB1 and HLA-DQB1, belonging to HLA family, presented on human chromosome six, are involved in the immune system. Various studies involving Genome-wide Association Studies (GWAS), meta-analysis, and replication studies have shown the association of HLA-DRB1 variant rs13192471 and HLA-DQB1 variant rs6457617 with RA susceptibility in different population groups. Aim: To perform a replication case-control based association study of variants rs13192471 and rs6457617, in order to determine their association with RA, in an independent cohort from the population of North-western India. Materials and Methods: The case-control study conducted at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, duration of the study was, from May 2019 to June 2022. In this study, Deoxyribonucleic Acid (DNA) was isolated from 188 RA cases and 310 healthy controls, followed by qualitative and quantitative analyses. The genotyping was performed on a Real Time-polymerase Chain Reaction (RT-PCR) using TaqMan Allele Discrimination Assay. Statistical power of the study was estimated using PS: Power and sample size calculator version 3.1. Results: The statistical analysis of the genotyping data showed a significant association (p=0.005) of variant rs13192471 with RA susceptibility, whereas the variant rs6457617 did not show an association (p=0.275) with RA in the studied population cohort. Conclusion: The present study successfully replicated the association of HLA-DRB1 variant rs13192471 in the population group of North-western India. It is pertinent to screen these variants for RA susceptibility in other population groups of India before their use as potential genetic biomarkers in the Indian population.

Effects of Isoflurane versus Propofol for Postoperative Neurocognitive Recovery in Patients Undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

B Monisha, Ravi Madhusudhana, MP Sujatha

Introduction: Propofol and isoflurane are commonly used in general anaesthesia. Both the drugs are neither neuroprotective nor neurotoxic. In clinical settings, inhaled anaesthetics like isoflurane are frequently used. However, it has been claimed that isoflurane anaesthesia could be a factor inducing cognitive impairment. Propofol is metabolised quickly, primarily in the liver, and its by products are inert. After the initial dose, the half-life of propofol is 2 to 8 minutes, and even with prolonged infusions, propofol promotes quick recovery. Aim: To evaluate the effects of propofol and isoflurane on postoperative recovery patterns in patients receiving general anaesthesia and to determine how they affect cognitive function and memory. Materials and Methods: A double-blinded randomised clinical study was conducted at the Department of Anaesthesia, RL Jalappa Hospital and Research Centre, Tamaka, Kolar, Karnataka, India, during the period from January 2022 to March 2022. In the present study, 60 patients of between age 50-90 years were included. Patients were split into two groups: group A received an intravenous infusion of propofol, and group B received isoflurane. Patients in both groups had their cognitive ability and memory tested before surgery. In the present study, baseline Mean Atrial Pressure (MAP), Heart Rate (HR), Pulse Oximetry (SpO2) and Ramsay Sedation score were comparable in both groups. The novel variables, such as surgery types, duration, and medications were evaluated in both groups. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed one hour before and four hours after surgery. Comparison of a continuous variable across the groups was performed using the Student’s t-test or Mann-Whitney U test, depending on the normality of the distribution. A comparison of categorical variables across the two study groups was made using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Age group of 50-60 years was more represented in both group A (66.7%) and group B (70%). In group A, most participants were females (56.7%), and in group B, the majority were males (60%). In group A, the postoperative assessment showed a mean MoCA score of 25.6±1.52; in group B postoperative assessment showed a mean MoCA score of 24.17±1.46 with a p-value of 0.001, which was statistically significant. The postoperative assessment showed a mean MMSE score of 26.3±1.58 in group A and in group B, the postoperative assessment showed a mean MMSE score of 24.9±1.4 with a p-value of 0.001, which was statistically significant. Conclusion: The current results imply that postoperative delirium is more frequently present after isoflurane anaesthesia than after propofol anaesthesia.

Comparison of the Pharmacokinetics, Bioequivalence and Safety of Aqueous Progesterone Formulation Administered as either Intramuscular or Subcutaneous Injection versus Oil-based Progesterone Formulation Administered as Intramuscular Injection: A Randomised Study

Sonal Mehta, Alok Chaturvedi

Introduction: Progesterone is the treatment of choice for support of the luteal phase of controlled ovarian stimulation cycles in women undergoing an Assisted Reproductive Technology (ART) treatment. Available progesterone preparations include oral, vaginal and oil-based Intramuscular (i.m.) formulations. Oral formulation have poor bioavailability whereas vaginal formulations cause side-effects such as vaginal discharge and/or local irritation. Oil-based progesterone formulations for i.m. use are associated with discomfort and pain at the injection site. Hence, a novel aqueous-based progesterone formulation for i.m./Subcutaneous (s.c.) was developed to avoid the local tolerability issues of the existing parenteral formulations. Aim: To assess single-dose Pharmacokinetics (PK) and relative bioavailability of i.m. (test-1; T1) or s.c. (test-2; T2) administration of novel aqueous progesterone formulation with i.m. (reference; R) administration of oil-based progesterone formulation. Materials and Methods: In this open-label, three-sequence, three-period, single-dose, cross-over study, 51 healthy human postmenopausal female subjects between 45 to 65 years of age were included. The study was conducted at Lambda Therapeutic Research Limited, Ahmedabad, Gujarat, India, between 21 May 2018 to 06 July 2018. Subjects were randomised to a single 25 mg dose of T1, T2 or R in three-periods (Period-I: T1, R, T2; Period-II: T2, T1, R; Period-III: R, T2, T1) with ≥18 days washout period. Blood samples were collected at prespecified time points in each period and analysed using validated liquid chromatography with tandem mass spectrometry. PK parameters {maximum plasma concentration (C_max), time to reach C_max (T_max), area under the plasma concentration vs. time curve (AUC_0-t), AUC from time 0 to 8 (AUC_0-8), plasma half-life (t1/2)} were calculated from the plasma concentration vs. time profile by non compartmental model. The total study duration was about 47 days (11 hours prior to the drug administration in Period-I until the last ambulatory sample in Period-III). All patients provided written informed consent form and an approval from the Conscience-Independent Ethics Committee (CIEC) was taken. Descriptive statistics were calculated and reported for PK parameters for baseline corrected and uncorrected data. Results: Of 72 screened patients, 51 patients were included for the PK and statistical analysis. The mean±SD age of the patients was 55.1±4.67 years. The baseline corrected PK data shows that in T1, T2 and R arms, mean (range) T_max were 1.00 (0.50–1.75), 1.00 (0.75–1.75) and 8.00 hours (1.00–12.00), mean±SD t½ (h) were 15.43±5.81, 15.27±6.68 and 19.80±6.35; mean±SD C_max (ng/mL) were 101.91±73.07, 51.67±14.81 and 18.89±7.89, and mean±SD AUC_0-t (ng/mL) were 385.10±89.29, 349.63±64.41 and 371.50±56.25, respectively. Similarly, the AUC_0-8 was also comparable in all three arms. The baseline uncorrected data were also in line with baseline corrected data. For AUC_0-t and AUC_0-8, 90% CIs were 98.44-107.06% and 97.96-106.15%, respectively, for T1/R ratio, and 90.01-97.90 and 89.90-97.42, respectively, for T2/R ratio. Six Adverse Events (AEs) in four subjects were reported. All AEs were mild in nature and there were no deaths, significant or serious AEs reported. Overall, all the treatments were well-tolerated without any new safety concerns. Conclusion: Novel aqueous progesterone formulation i.m./s.c was bioequivalent with oil-based progesterone formulation i.m. with respect to AUC. The s.c. administration of aqueous progesterone formulation could offer a convenient alternative to the i.m. oil-based progesterone formulation for luteal phase support to patients undergoing ART treatments.

Diagnostic Accuracy of Urine Volume Estimation by Ultrasound to Prevent Unnecessary Catheterisation in the Intrapartum Period: A Cross-sectional Study

Introduction: Catheterisation for urinary retention could cause bacteriuria and even frequent Urinary Tract Infection (UTI), especially in a traumatised urethra and bladder wall. Currently, there are no recommended non invasive ways to assess urinary retention in laboring women other than clinical estimation by palpation. Ultrasonography (USG) is a good non invasive diagnostic aid for measuring bladder volume in the intrapartum period, thereby avoiding unnecessary urinary catheterisation. Aim: To assess the diagnostic accuracy of USG, estimation of urine in comparison to actual catheterised volume in antenatal women in labour and not in labour. Materials and Methods: This was a cross-sectional study done in the Department of Obstetrics and Gynaecology at Christian Medical College, Vellore, Tamil Nadu, India, from February 2018 to August 2021. The present study was done on 405 females out of which 211 women, who were not in labour and 194 women who were in labour. Bladder volume was measured by using an abdominal portable basic ultrasound machine. A palpable bladder was also assessed clinically, by palpation and percussion and both these measurements were compared to the actual volume of urine at catheterisation. The Intraclass Correlation Coefficient (ICC) for methods of estimation of urine volume was done. To find the association between groups and study variables. Chi-square test and Fisher’s-exact test were used. Results: The mean age of the study participants was 28.29±4.6 (group 1) and 25.95±4.2 (group 2). A total of 405 women were recruited with 211 women in group 1 (not in labour) and 194 women in group 2 (in labour). Clinical examination for predicting palpable bladder with urine volume of more than 150 mL showed a sensitivity of 80-90% and a specificity of 3-5%. Comparison of ultrasound estimation of bladder volume and actual urine volume showed an intraclass correlation of 0.88 (95%CI:0.86- 0.90, p<0.001) in both not in labour and in labour group. Conclusion: Estimation of urine volume by USG revealed an excellent association with catheter measurement for the prediction of a significant bladder volume, requiring catheterisation.

Cataract Surgery Trends during Lockdown and Unlocking Periods of COVID-19 Pandemic: A Cross-sectional Hospital-based Study

Introduction: Coronavirus Disease-2019 (COVID-19) has affected healthcare access to population around the world. India also had its own set of problems for patients with disruption of healthcare services during the pandemic. This also brought in unique challenges for ophthalmologists who adapted to new challenges to provide quality care to the patients including those reporting for cataract surgery. Aim: To find out cataract surgery trends and demographic variables during lockdown and unlocking periods of COVID-19 pandemic. Materials and Methods: This cross-sectional hospital-based study was conducted at Ophthalmology department of a tertiary care centre in eastern India, from January 2020 to March 2022. Trends in cataract surgery including numbers, demographic factors, visual acuity at presentation, difference during first and second lock and unlock periods etc were compared during various lock and unlock period over more than two years. Results: A total of 3,843 patients were planned for surgery and 3,594 patients underwent cataract surgery. A total of 218 patients reported being positive for COVID-19 preoperatively and voluntarily dropped out from surgery. A total of 24 patients were found to be positive during preoperative Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) work-up and were excluded from surgery. Seven patients didn’t report for the surgery. A total of 59 patients reported febrile illness during one month postoperative period. There was dip in cataract surgery during lockdown periods (from 178.33 every month in pre COVID-19 period to near zero during first lockdown period) but recovery was much faster during second unlock period compared to first unlock period. Conclusion: The study concludes that there was drastic decrease in number of patients undergoing cataract surgery during COVID-19 pandemic. Predominantly young, male patients who had advanced morphology of cataracts with poor visual acuity accessed healthcare set-up for cataract surgery during initial lock and unlock period. Similar trend was seen during second lock and unlock period with rapid recovery of numbers and demography of cataract surgery patients to pre-COVID-19 levels.

Impact of Anti-stigma Educational Intervention about Mental Illness among Medical Students: A Quasi-experimental Study

Naga Chaitanya Duggirala, VV Jagadeesh Settem, Prabhath Koilada, T Jaya Chandra

Introduction: Stigma about mental illness continues to complicate the lives of those who are stigmatised, even as treatment improves their illness. Health professionals sometimes discriminate based on the general public’s stigmatising views towards people with mental illness. There is a pressing need to improve understanding of the range of factors contributing to this. Aim: To assess the impact of anti-stigma educational intervention about mental illness among medical students and to identify the impact of this on their attitudes, knowledge, behaviour, and empathy. Materials and Methods: This quasi-experimental study was conducted at a tertiary teaching hospital, Visakhapatnam, Andhra Pradesh, India, from September 2015 to August 2016. A total of 170 medical students from the 4th semester were included and divided into test and control groups, with 85 students in each group. Stigma was measured by assessing attitude, knowledge, behaviour, and empathy. For the test group, it was assessed at baseline, immediate post-intervention, and one year later as Test 1, 2, and 3, and baseline for the control. Mental health-related knowledge was measured with Mental Health Knowledge Schedule (MAKS) scale, attitude with Mental Illness Clinician’s Attitudes (MICA) scale, Reported and Intended Behaviour Scale (RIBS) to measure behaviour, and empathy by Jefferson Scale of Empathy Student Version (JSE-SV) scale. T-test was used to statistically analyse the data. Results: A total of 85 participants were included in each group. Gender-wise, the mean±SD of MAKS scores were statistically significant in test 3, and also within the test group. Gender-wise MICA scores were statistically not significant in the groups, within the test group, statistically, there was a significant difference between test 2 and 3. Within the test group, for RIBS scores, there were statistically significant differences between test 1, 2, and 2, 3, and gender-wise, there was no significance. For JSE-SV scores, there was a statistically significant difference between the gender in test 2 but no significant difference among the test groups. Conclusion: This study’s findings show that the mental health-related knowledge, attitude towards the illness, and intended behaviour of the students towards the mentally ill have significantly improved post-intervention and also had a long-term impact.

Self-reported Medication Adherence in Schizophrenia and Bipolar Disorder Patients during COVID-19 Pandemic in a COVID Care Hospital: A Cross-sectional Study

Sajal Sathiadevan, Nithin Kondapuram, Nimmy Chandran, Bibin V Philip, KS Deepak

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has made it difficult for patients with Schizophrenia and Bipolar Affective Disorder (BPAD) to receive ongoing care, which has led to nonadherence to medication and undesirable health outcomes. Lower treatment adherence in severe mental illness might lead to symptom exacerbation and relapses and might cause a strain on the health system during the COVID-19 pandemic. Aim: To assess treatment adherence in Schizophrenia and BPAD patients during the prevailing COVID-19 situation in India. Materials and Methods: This cross-sectional study was conducted among 92 patients with Schizophrenia and BPAD through a questionnaire between January and September 2021 in a COVID-19 care hospital at Government Medical College Palakkad/District Hospital Palakkad, Kerala, India. Demographic and clinical data, adherence to treatment, along with Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D), Clinical Global impression (CGI S&I), Work and Social Adjustment Scale (WSAS), Modified COVID Threat Scale (CTS), and Medication Adherence Rating Scale (MARS) were collected. The outcomes included adherence to medication, deterioration of psychopathology, improvement in severity, and social functioning. Descriptive statistics were used to define the sample characteristics, presented as mean and standard deviation, and frequency and percentages. Spearman’s Correlation coefficient was used to find the correlation between MARS and other variables: CTS, BPRS, YMRS, HAM-D, CGI, and WSAS. Results: A total of 92 patients were interviewed, which comprised 43 patients with Schizophrenia and 49 patients with Bipolar disorder. As assessed by the MARS rating scale, 19 patients (20.65%) had a MARS score less than six, suggesting poor adherence, and 73 (79.35%) had a MARS score of six or greater, suggesting better adherence to treatment. This was supported by negative correlation with BPRS, YMRS, HAM-D, and CGI-S and CGI-I scales, which implies that the COVID-19 pandemic did not hinder the patients from taking medication. The mean MARS score was 7.31±2.11. A total of 37 (40.2%) patients had acute exacerbation of the illness during the COVID-19 related lockdown, and 37 (40.2%) had exacerbation during the six months prior to the COVID-19 lockdown. There was a negative correlation between MARS scores and the CTS but was not statistically significant. Conclusion: Despite the COVID-19 pandemic-related restrictions, patients with Schizophrenia and BPAD were adherent to medication, and the number of relapses during the COVID-19 pandemic was similar to the period before the pandemic. COVID-19-related anxiety did not have an impact on medication adherence and relapse in this study.

Characteristics of Neurovascular Injury Associated with Tendon Injury of Hand: A Retrospective Study

Sandip Basu, Sanjay Kumar

Introduction: Normal function of a hand depends much on the integrity of its anatomical structures. Musculotendinous injuries of the hand are frequently associated with neurovascular injury. Repair or reconstruction of all structures is important for optimal restoration of hand function. Aim: To determine the characteristics of neurovascular injury associated with musculotendinous injuries of the hand. Materials and Methods: The present study was a retrospective observational study conducted in the trauma care centre of a tertiary care teaching hospital from September 2020 to August 2021. Patients sustaining acute tendon injury of the hand of all age group and both sexes were included (n=38). Various epidemiological data like age, sex, occupation etc., and clinical and operative findings were collected and were analysed. Descriptive statistics were used and results were expressed in terms of frequency and percentages. Results: The mean age of the study population was 24 years, with 30 male patients and 8 female patients. As far as the side of involvement was concerned, 17 (44.7%) patients had a left-side injury, and 21 (55.3%) patients had a right-side injury. Majority of the patients, 27 (71.1%) sustained flexor Zone V injury. As to the neurovascular involvement, isolated median nerve, i.e., 10 (41.7%) and radial artery i.e., 8 (44.4%) injuries were more common. Conclusion: Neurovascular injuries associated with tendon injury of the hand are a common finding. Prior knowledge of their presence and association with specific tendon injuries is beneficial for their identification and management, which ultimately leads to optimal restoration of hand function.

Preoperative Single Dose Intraincisional vs Intravenous Ceftriaxone in Preventing Surgical Site Infection Post-Hernioplasty Conducted at a Tertiary Care Centre at Chengalpattu, Tamil Nadu, India

A Pravindhas, K Navaneetha, A Ajay Raja, R Lakshmana, Neethish K Paul

Introduction: Among the hospital acquired infections, Surgical Site Infection (SSI) still remains as the major problem for surgeons. Inguinal hernia surgeries are considered as clean surgeries, incidence of SSI in posthernioplasty is found to be 3.1%-4.5%. However, in tertiary care centres in developing countries like India, the incidence is found to be high at 11-14%. Aim: The aim of the present study was to compare the efficacy of preoperative single dose ceftriaxone infiltration at the incision site and preoperative Intravenous ceftriaxone only in preventing SSI in hernioplasty. Materials and Methods: A prospective interventional study was conducted at SRM Medical College and Research Institute, Chengalpattu, Tamil Nadu, from May 2021 to October 2022 for a duration of 18 months in 100 Patients, who attended the surgical outpatient block or other known cases of inguinal hernia who were referred to the surgery department from other departments. They were divided into group A or group B randomly. Hernioplasty was done on these groups, preoperative, intraoperative and postoperative wound swab was sent for these patients. Postoperatively patients were followed-up on 3rd, 7th and 14th day and assessed for development of SSI. The continuous variables were presented as mean and SD. The categorical variables were expressed in percentages. The significance of continuous scale data between two groups were determined using student t-test. The Chi-square/Fischer’s-exact test was used to evaluate the significance of the categorical data analysed. Data analysis was computed using Statistical Package for Social Sciences (SPSS) version 27 and Microsoft excel office 2019. Results: Male preponderance was seen 91% in inguinal hernias. Most of the patients belonged to the age group of 41-60 (54%) years of age. Ten patients (20%) developed SSI who got i.v. antibiotic injection but only three patients (6%) developed SSI who got intraincisional antibiotic injection with a p-value of 0.037 (<0.05) showing significance. One patient developed haematoma for with re-exploration was done on Postoperative Day (POD) #3. Two patients developed wound gapping for which secondary suturing was done on POD #7 and suture removal was done on POD #21. For rest of the all the patient’s suture removal was done on POD #14. Intraopertive and postoperative and organism growth was seen only in the 13 patients who developed SSI. Most common organism isolated was staph, Aureus (38.5%, 5 cases). All 13 patients who developed SSI had some co-morbidity. Out of the 13 patients who developed SSI 11 patients (84%) had surgery for more than 30 minutes. Mean hospital stay was 3-5 days (87%). Conclusion: In the present study, there was significant reduction in incidence of SSI in the group, that received preoperative single dose Intraincisional ceftriaxone than the other group that received only preoperative intravenous ceftriaxone. Preoperative intraincisional antibiotics significantly reduces the rate of SSI because of the higher concentration achieved at the incision site.

Efficacy of Kumkum as a Surrogate for Eosin in Routine Histological Sections: An Observational Study

Ayeesha Sithika Thajudeen, Rameejan Begum, S Nivetha, J Jayapriya

Introduction: Stains are a crucial component of laboratory procedure. They help in highlighting the different tissues, both normal and abnormal, which plays an important role in diagnostic histopathology. Synthetic dyes are utilised for majority of the stains in histology. Among the natural surrogates studied, Kumkum is less researched. Aim: To compare the staining characteristics of Kumkum, which imparts red colour as an alternative to eosin. Materials and Methods: This observational study was conducted at Histopathology section, Pathology department at Chettinad Hospital and Research Institute for a period of six months from January 2022 to June 2022. In 50 tissue blocks, each was made into two sections and one was stained with routine Haematoxylin and Eosin (H&E), while the other was stained with Haematoxylin and Kumkum solution (H&K). The Cellular Architecture (CA) (based on distinct or indistinct nucleus, cytoplasm) and quality of staining (poor, satisfactory or good) of H&E and H&K solution were compared and a scoring system was given. The scores were analysed with Chi-square test using SPSS software (version 25). Results: Out of 100 slides, 45 (90%) stained with H&E and 48 (96%) with H&K showed distinct CA. A total of 47 slides (94%) stained with H&K and 41 (82%) with H&E showed good quality of staining. Conclusion: Kumkum solution appears to be an efficient counterstain in place of eosin in highlighting the normal structures in histopathological sections. It highlighted the RBCs in the arteries and cytoplasm of the cells in glandular and squamous epithelium better than or equally good as eosin.

Outcome of Miniperc Technique in Paediatric Age Group: A Prospective Interventional Study

Introduction: Reducing the Percutaneous Nephrolithotomy (PCNL) tract size in paediatric patients with renal stones reduces the morbidity associated with the procedure. Miniperc (Mini PCNL) is a modification of standard PCNL using small size instruments. Aim: To evaluate the postoperative outcome of Miniperc technique in the treatment of renal stones in paediatric age group. Materials and Methods: This was a prospective interventional study conducted at the Department of Urology, Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu, India from January 2020 to January 2022. There were 25 patients with renal stone disease belonging to the paediatric age group (<8 years) who were operated on by a single surgeon using the Miniperc technique. For all the cases 14F-16F sheaths, 12 Fr Nephroscope and 8-9.5 Fr semirigid ureteroscope, pneumatic lithotripsy and 30-Watt Holmium laser as energy sources were used. Stone Free Rate (SFR), operative time, hospital stay, and complication rates were assessed. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The mean age of the children was 5.2±3.2 years and the average stone size was 1.9 cm. Mean operative time was 74 minutes. The mean hospital stay was 1.5 days. The overall SFR was 89.7%, (N=22) which increased after secondary procedures to 94.12% (N=23). Intraoperative bleeding was seen in 3 (12%) patients and postoperative fever in 4 (16%) patients. Conclusion: Miniperc is a promising and safe technique for paediatric renal stone disease management.

Laboratory and Imaging Profile of Primary Hyperparathyroidism: A Record Based Retrospective Study

Introduction: Primary Hyperparathyroidism (PHPT) is an uncommonly diagnosed symptomatic disease that occurs in India. Unlike Western countries, where the disease is asymptomatic, various manifestations occur in India that are skeletal, muscular, and renal. Studies on PHPT from developing countries like India have shown that symptomatic PHPT is still common compared to developed countries. Data on PHPT from Kerala (a state with health indices comparable to the Western world) are lacking. Aim: To compare the preoperative and postoperative calcium and Parathyroid Hormone (PTH) levels among the participants. Materials and Methods: A record-based retrospective study was conducted at Amrita Institute of Medical Sciences, Cochin, in the Department of Endocrinology. All 116 patients who had PHPT from January 2013 to December 2019 were included in the study. The data available in the hospital records were analysed for various laboratory values and imaging diagnoses. The preoperative and postoperative calcium and PTH levels were compared. Data were analysed by paired sample t-test (Wilcoxon sign-rank test). The data analysis was done using coGuide. Results: The mean age was 53.42±14.89 years in the study population. Among the 116 subjects, 46 (39.66%) were males and 70 (60.34%) were females; 83 (71.55%) had the symptomatic disease. The majority, 80 (68.97%) participants underwent single parathyroidectomy. The difference between preoperative and postoperative calcium and PTH was statistically significant (p-value <0.001). Conclusion: PHPT largely occurs in the fifth decade of life, and the majority were symptomatic. Females were more affected compared to males in the present study. Preoperative imaging is recommended in routine practice.

Correlation Between Serum Ferritin Levels and Echocardiographic Changes in Children with Beta-thalassaemia Major- A Cross-sectional Analytical Study

Eshita Das, Neha Karar, Dipanjan Halder, Prativa Biswas, Arghya Roy Naskar

Introduction: Heart failure secondary to iron overload is the leading cause of mortality in patients with beta-thalassaemia major. Prevention of myocardial siderosis is a key step in reducing the rate of mortality in thalassaemia children. Aim: To study the correlation between serum ferritin levels and echocardiography parameters in children with beta-thalassaemia major. Materials and Methods: This cross-sectional analytical study was conducted in the Department of Paediatrics, RG Kar Medical College and Hospital, Kolkata, India, from March 2020 to July 2021. A total of 85 beta-thalassaemia major children aged between 2-12 years, without any active infections or congenital heart diseases, were included in this study. Blood samples were obtained from these children for serum ferritin level assessment, and echocardiography was performed to evaluate their cardiac function. Data were statistically analysed using the Chi-square test. Results: The mean age of patients was 7.24±2.76 years, and the age range was 1-12 years. The mean serum ferritin levels in the study were 1938.67±992.57, and more than three-fourths of our population had serum ferritin levels above 1000 ng/mL. Thirty percent of the present study population had abnormal echo findings. A significant correlation was noted between serum ferritin levels and echo parameters like Fractional Shortening (FS), Deceleration Time (DT), Early and Late Ratio (E/A), and Left Ventricular Mass (LV Mass). However, a negative correlation was found between serum ferritin levels and Ejection Fraction (EF). Conclusion: The present study concluded that due to the significant correlation between serum ferritin levels and echocardiographic parameters, it is beneficial to conduct echocardiography in all patients with beta thalassaemia major in their first decade to gain a better understanding of cardiac function.

Ultrasonographic Evaluation of Thyroid Gland Volume and Nodularity in Pregnant versus Non Pregnant Females: A Cross-sectional Study

Alka Agrawal, Prachi Shukla, Silky Taya, Akansha Gawali, Manish Rathore

Introduction: Continuous stimulation of thyroid gland occurs during pregnancy in order to meet the demands of growing foetus. This might result in variations in thyroid gland morphology which may be misdiagnosed if not assessed accurately. Ultrasonography can measure these variations during pregnancy in the form of change in volume, echotexture, nodularity etc. Aim: To compare the thyroid volume and nodules using ultrasound, amongst different trimesters of pregnancy and with non pregnant women of similar age and find the correlation with different factors. Materials and Methods: A time-bound, hospital-based, cross-sectional observational study was done in the Department of Radiodiagnosis, Maharaja Yeshwantrao (MY) Hospital, Indore, Madhya Pradesh, India, from April 2021 to August 2022 on 240 patients. All subjects were divided into groups of 60 women each, which included non pregnant women in group 1 and pregnant women during each trimester in rest three groups, as group 2, 3 and 4, respectively. Thyroid volume and nodules were measured in each group. The descriptive data was calculated using mean and standard deviation and then compared using Analysis of Variance (ANOVA) test. Linear regression analysis was also used to assess the correlation. Results: Most 125 (52%) of the women belonged to the younger age group i.e., 21-25 years. Majority i.e., 114 (47.5%) of pregnant women were primigravida. Mean total thyroid volume in non pregnant group, 1st trimester group, 2nd trimester group and in 3rd trimester group were 5.44±0.82 mL, 5.85±0.64 mL, 6.25±0.67 mL and 7.24±1.16 mL, respectively, with up to 24% increase of thyroid volume during the course of pregnancy (p-value=0.001). Thyroid nodule incidence was 12.2% in pregnant women and 5% in non pregnant women. Conclusion: With pregnancy, there is an increase in thyroid gland size along with a small increase in thyroid nodularity. Also, the interplay of a few factors such as Body Mass Index (BMI), parity, age etc., was noted.

Evaluation of Diagnostic Accuracy of Contrast-enhanced Computed Tomography in Acute Abdomen: A Cross-sectional Study

Introduction: Acute abdomen is one of the most frequent causes of presentation to the Emergency Department (ED). The clinicians favour radiological examinations to reach the proper final diagnosis after thorough physical examinations, lab investigations, and clinical interpretation. Contrast-enhanced Computed Tomography (CECT) imaging aids in preventing delayed necessary treatment or unnecessary surgery. Aim: To investigate the specificity and sensitivity of CECT in cases of the acute abdomen using histopathological, clinical, and intraoperative surgical findings as gold standards. Materials and Methods: A cross-sectional study was conducted in the Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from September 2020-2022. Evaluation of 115 patients was done based on inclusion (Patients presenting with clinical symptoms of acute abdomen and undergoing CECT Abdomen, followed by a clinical, biochemical, surgical, or histopathological examination) and exclusion criteria. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy of CECT were calculated. The data were analysed using Statistical Package for Social Sciences (SPSS) version 22. Results: The study included 115 patients with ages ranging from 9-88 years. An increased incidence in males was observed, M:F ratio of 1.4:1. The most common age group was 31-40 years (n-25; 21.7%), followed by 41-50 years (n-20; 17.4%). Cholecystitis was the most common cause of acute abdomen, accounting for 22.6% (n-26) of total cases followed by appendicitis. The overall accuracy rate of CECT was 93% with an accuracy of 98-99% in cases of cholecystitis appendicitis, pancreatitis, ovarian cyst, and bowel obstruction. Conclusion: CECT shows higher sensitivity and specificity in identifying different aetiology of acute abdomen. It also helps in optimal decision-making for management and improved outcomes.

Epidemiology and Predictors of Visual Outcome in Patients with Occupational Eye Injuries- A Prospective Observational Study

Introduction: Work Related Eye Injuries (WREI) constitute majority of eye injuries affecting younger age group. Trauma mainly affects people from lower socioeconomic background. People with workplace related eye injuries face an added financial burden. Challenges with respect to workplace related eye injuries include lack of occupational safety and health cover, lack of related information about pattern and exact incidence and management protocols. Aim: To study epidemiological profile, risk factors and predictors of visual outcome in occupational eye injury patients. Materials and Methods: This prospective observational/cohort study was conducted in Department of Ophthalmology, at Rajiv Gandhi Medical college and CSM Hospital, Kalva, Thane between October 2020 to February 2022. Study population included 42 patients having occupational eye injuries. After obtaining written informed consent, detailed history regarding their occupation, mode of injury and awareness and history of use of any Protective Eye Device (PED) at the time of injury was noted. Best Corrected Visual Acuity (BCVA), detailed anterior segment examination and fundus examination was done. Ocular injury was classified as Open Globe Injury (OGI) or Closed Globe Injury (CGI) and ocular trauma scale was calculated. Patients were treated medically or surgically as indicated and followed-up next day and subsequently BCVA was noted and progress at each follow-up till six months was recorded. Factors related to good visual outcome (better or equal to 6/24) and bad visual outcome (visual acuity worse than 6/24) were identified. Continuous variables were described as the mean and variation of each observation from the mean value (Standard deviation) represented as mean±SD (analysed using independent t-test). Univariate analysis was done for identifying factors associated with bad visual outcome and p-value of <0.05 was considered significant. Results: Forty-two patients were included in study (40 males and 2 females). There were 21 patients each in OGI and CGI. Most commonly affected were construction workers- 15 (35.72%). A total of 45% workers had access to PED at workplace but none of them used them. Univariate analysis showed open-globe injury, Zone-1 injury, presence of iris prolapse, traumatic cataract, vitreous prolapse/RD were related to bad visual outcome (<6/24). At six months, the median logMAR BCVA improved significantly from logMAR 0.8 to 0.18 (0-1.3) (p=0.0002). Conclusion: Occupational ocular trauma is commonly seen in younger males. Poor visual outcomes are associated with OGI and Zone-1 injuries, presence of iris prolapse, traumatic cataract, vitreous prolapse/retinal detachment. Lack of use of protective eye gear was universally noted along with its unavailability in many places. Conducting regular educational programs on ocular safety at workplaces, sensitising the workers and their employees regarding the hazards of ocular trauma and strict implementation of mandatory use of eye protective devices is recommended.

Comparison of the Anti-microbial Efficacy of Clove, Cinnamon, Turmeric, Nutmeg, and Peppermint Essential Oil against Oral Pathogens: An In-vitro Study

M Subhashree, Rahul Mohandas, R Pradeep Kumar

Introduction: Antibiotics are routinely used in dental practice to treat microbial diseases. However, the spread of drug resistant pathogens has drawn researchers’ interest in finding new anti-microbial agents against oral microbial diseases. Aim: To compare the anti-microbial activity of clove oil, cinnamon oil, turmeric oil, nutmeg oil, and peppermint oil against oral pathogens. Materials and Methods: It was an in-vitro study. The organisms used in this study were Streptococcus mutans, Candida albicans and Enterococcus faecalis. Agar Well Diffusion Method was used to assess the anti-microbial efficacy of the five essential oils against oral pathogens. Five discs/concentration/micro-organism were used in the study. The zone of inhibition was measured after incubation. Kruskal Wallis Test was used to compare the difference in the anti-microbial activity of the oils. Results: The mean zone of inhibition of clove oil against Streptococcus mutans, Candida albicans, and Enterococcus faecalis was highest at 100 μL (29.8 mm, 44.75 mm, 40.33 mm, respectively), cinnamon oil was highest at 100 μL (39.8 mm, 40.33 mm, 40 mm, respectively), turmeric oil was highest at 100 μL (41.8 mm, 40.50 mm, 40 mm, respectively), peppermint oil was highest at 100 μL (41.8 mm, 27.16 mm, 17 mm, respectively). Nutmeg oil against was highest at 100 μL (24 mm, 24.83 mm, 9.3 mm, respectively). Conclusion: Clove oil, cinnamon oil, turmeric oil, nutmeg oil, and peppermint oil had anti-microbial activity against oral pathogens. Based on the findings, the most effective oil against Streptococcus mutans was turmeric oil and peppermint oil. The most effective oil against Candida albicans and Enterococcus faecalis was clove oil.

Effect of Low Dose Intravenous Magnesium Sulphate on Sensory Regression Time in Patients undergoing Spinal Anaesthesia- A Randomised Placebo-controlled Double-blinded Study

Babita Lahkar, Vidyasagar V Reddy, Vikramjit Baruah, Priyam Saikia

Introduction: Adjuvants like intravenous (i.v.) Magnesium Sulphate (MgSO₄) are used to improve the efficacy and duration of spinal anaesthesia and postoperative analgesia. However, it is unclear whether this prolongation of analgesia duration is an independent effect of MgSO₄ or if it is due to the increased duration of spinal anaesthesia itself. Aim: To evaluate the effect of intraoperative i.v. low dose MgSO₄ on two-segment regression time of sensory block, regression time up to L2 dermatome from the highest level of sensory block and postoperative analgesic requirement. Materials and Methods: This randomised placebo-controlled blinded study was conducted in the Department of Anaesthesia, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India from September 2020 to August 2021. A total of 60 patients, satisfying American Society of Anaesthesiology (ASA) physical status I and status II, aged between 40-70 years, and undergoing femur fracture surgery under spinal anaesthesia were enrolled in the present study. Patients in the magnesium group (Group M, n=30) received MgSO₄ 5 mg/kg infusion, and control group (Group C, n=30) received at the same volume of saline during operation. Unpaired t-test was used to test the significance in normally distributed continuous variable and Mann-Whitney U test was used to test the significance of the difference between the quantitative variables. The software Predictive Analytics Software (PASW) 18.0 was used for statistical analysis and the graphs were generated using the Microsoft Excel 2007. A p-value of less than 0.05 was considered significant. Results: There were no significant differences between the two groups with respect to patient characteristics (age, weight, and height). The mean time for two segment regression in the group M was prolonged by approximately 13 minutes compared to group C (104.96±11.37 minutes versus 91.2±11.86 minutes, respectively, p<0.001). The mean regression time up to L2 dermatome in the group M was prolonged by 15 minutes compared to the group C. (171.23 minutes versus 156.43 minutes, respectively, p=0.0003). The total consumption of tramadol in the group M was significantly lesser than the control group (192.5±58.03 mg and 245.0±43.74 mg, respectively, p=0.0002). Conclusion: An i.v. infusion of 5 mg/kg MgSO₄ prolongs two segment regression time upto L2 dermatome and reduces postoperative opioid consumption without any complication in patients undergoing femur fracture surgery under spinal anaesthesia.

Association of Cardiac Autonomic Function Derangement with Obesity and Glycated Haemoglobin: A Cross-sectional Study

Piyush Bansal, Prerna Panjeta, Praveen Prashant, Komal

Introduction: Hyperglycaemia (as assessed by Glycated haemoglobin (HbA1c)) and obesity lead to the production of advanced glycation end products in blood, which are responsible for damage to the microvasculature, slowly leading to cardiac autonomic dysfunction. Thus, chronic prediabetic hyperglycaemia, as measured by HbA1c may affect cardiac autonomic function in different ranges of obesity (overweight and obese). Aim: To study the association of cardiac autonomic dysfunction with Body Mass Index (BMI) and HbA1c. Materials and Methods: The cross-sectional study was conducted at BPS Government Medical College, Sonepat, Haryana, India, from June to December 2019. This study included age and sex-matched 50 healthy, 50 overweight, and 50 obese subjects aged 18- 50 years. Serum HbA1c, lipid profile and cardiac autonomic function tests for the parasympathetic system (Resting heart rate, Expiration-inspiration difference on deep breathing, Heart rate response to standing/30:15 stand ratio, Valsalva ratio) and sympathetic system {postural hypotension/fall in Systolic Blood Pressure (SBP) and change in Diastolic Blood Pressure (DBP) on sustained hand grip test} were performed. Chi-square test and Mann-Whitney test were used for statistical analysis. Results: The prevalence of sympathetic autonomic dysfunction was highest in the obese group (36% in males n=25, and 32% in females, n=25) followed by overweight group (12% in males, n=25 and 12% in females, n=25). The prevalence of parasympathetic autonomic dysfunction was highest in the obese group (40% in males, n=25 and 32% in females, n=25), followed by the overweight group (24% in males, n=25 and 16% in females, n=25). Further, HbA1c was highest in obese males (6.27±1.54) and females (5.94±0.45), followed by overweight males (5.89±0.92) and females (5.46±1.84). Males and females with autonomic dysfunction had significantly higher HbA1c (Males 6.4±0.42 and Females 6.2±0.38) than those without it (Males 5.4±0.86 and Females 5.2±0.75) in the obese and overweight groups taken together. Conclusion: The prevalence of parasympathetic and sympathetic dysfunction is incrementally increased with higher obesity (BMI) and HbA1c. Overweight and obese subjects with cardiac autonomic dysfunction had higher HbA1c and worse lipid profiles than overweight and obese subjects without autonomic dysfunction.

Hypovitaminosis D Implicated in the Development of Stress, Metabolic Syndrome and Hepatic Steatosis among Health Science Undergraduates attending a Tertiary Care Institute in Tamil Nadu, India

SK Aishwarya, B Gayathri, M Prabu, P Renuka, VM Vinodhini

Introduction: Vitamin D deficiency is prevalent worldwide and its association with stress has become an emerging problem. A collection of linked physiological, biochemical, clinical, and metabolic risk factors is known as the Metabolic Syndrome (MS). High stress level is found associated with vitamin D deficiency and features of metabolic syndrome symptoms. Aim: To estimate the prevalence of vitamin D deficiency, perceived stress, metabolic syndrome and hepatic steatosis among health science Undergraduate (UG) students and also to evaluate the association of vitamin D with perceived stress score, calcium, phosphorus, components of metabolic syndrome and indicators of liver steatosis. Materials and Methods: This cross-sectional study was conducted at SRM Medical College, Hospital and Research Centre, Chennai, India, from February 2022 to August 2022. A total of 80 health science UG students in the age group of 19-25 years were included. The parameters included Fasting plasma glucose, Triglycerides (TGL), High Density Lipoprotein Cholesterol (HDLC), Gamma-glutamyl Transferase (GGT), phosphorus, calcium, and a Perceived Stress Scale (PSS) score scale. Data were statistically analysed using Pearson’s correlation test and Receiver Operating Characteristic (ROC) curve was used to assess the relationship of vitamin D with stress, metabolic syndrome and liver steatosis. Results: In the present study, majority 56 (70%) had vitamin D deficiency, 23 (28.75%) had insufficiency and 1 (1.25%) had sufficiency. An estimated 6 (7.5%) of students experienced low stress, 63 (78.75%) experienced moderate stress and 11 (13.75%) experienced high perceived stress. Indicators of metabolic syndrome occurred in 13 (16.25%) of the population. Nearly 6 (7.5%) of the participants displayed manifestation of fatty liver. A negative association was found between vitamin D with stress score, Body Mass Index (BMI), waist circumference, Blood Pressure (BP), phosphorus, fasting plasma glucose, TGL, HDLC, GGT, Fatty Liver Index (FLI) score. Conclusion: In the present study, vitamin D deficiency was most prevalent (70%), followed by metabolic syndrome, high stress and hepatic steatosis. Vitamin D showed a negative correlation with stress score, BMI, waist circumference, BP, phosphorous, fasting plasma glucose, TGL, HDLC, GGT and FLI score.

Correlation of Blood Pressure with Microalbuminuria and Dyslipidaemia in Patients with Essential Hypertension: A Case-control Study

Introduction: Hypertension (HTN) is one of the most common disease affecting the people around the world. Microalbuminuria and dyslipidaemia has been considered as an early indicator of vascular damage, endothelial dysfunction and renal disease. Studies, conducted to evaluate microalbuminuria, dyslipidaemia in essential hypertensive patients are scarce. Aim: To assess the microalbuminuria, dyslipidaemia in essential hypertensive patients and also, to correlate these parameters with Blood Pressure (BP). Materials and Methods: This case-control study was conducted in the Department of Biochemistry at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Sambalpur, Odisha, India, from January 2020 to February 2021. The study included 70 healthy individuals as controls and 70 essential hypertensive patients as cases in the age group of 25 to 55 years. According to Joint National Committee (JNC) 7 guidelines, out of 70, 20 cases were categorised as stage I (BP≥140-159/90-99 mmHg) and 50 as stage II (BP≥160/100 mmHg). Renal profile, lipid profile, total protein and albumin, microalbumin and Albumin-creatinine Ratio (ACR) were evaluated. Pearson correlation coefficient was applied to statistically analyse the data. Results: In the present study, 38 (54.3%) were males and 32 (45.7%) were females. Whereas, in controls, 44 (62.8%) were males and 26 (37.2%) were females. The mean age in cases 44.4±8.58 years, Systolic Blood Pressure (SBP) 156.0±35.1 mmHg, Diastolic Blood Pressure (DBP) 101±12.9 mmHg, serum creatinine 1.08±0.29 mg/dL, serum uric acid 7.37±1.8 mg/dL, serum total cholesterol 171±44.7 mg/dL, serum triglycerides 173±48.4 mg/dL, Low-density Lipoprotein Cholesterol (LDL-C) 107±38.8 mg/dL, Very Low-density Lipoprotein Cholesterol (VLDL-C) 35.1±10.2 mg/dL, microalbuminuria 75±31.9 mg/L, and urinary ACR 78±44.1 were significantly increased and serum High-density Lipoprotein Cholesterol (HDL-C) 31.7±7.07 mg/dL levels were decreased in cases than controls. Urinary ACR was significantly increased in stage II. ACR was positively correlated with SBP, DBP, creatinine, uric acid, total cholesterol, triglycerides, VLDL-C and negatively correlated with HDL-C. Conclusion: Blood pressure was positively correlated with lipid profile parameters, except HDL-C. Increased urinary albumin excretion rate may be useful and inexpensive marker for the identification of patients with higher cardiovascular risk and organ damage.

Trend Analysis of Malaria Prevalence in a District of Western Ghats, Karnataka, India: A Retrospective Study

Lavanya Jagadish, Vishwajith, K Archana Rao

Introduction: Malaria, among vector-borne diseases, has remained a major threat to public health for decades due to its course and complications. As an endemic region, malaria poses a great threat as it can cause multi-organ failure. Despite continuous monitoring and effective implementation of control measures, India still contributes to the majority of cases in the sub-Asian region. Aim: To estimate the prevalence of malaria, to determine the seasonality and to analyse the trend of the disease over a period. Materials and Methods: This was a retrospective study conducted at Chikamagalur a district in Karnataka, India, in the year 2022 over a period of six months. The study was done by collecting the data of patient details from the laboratory register. The results were analysed, positive results were calculated for disease burden by Plasmodium vivax (P. vivax) and Plasmodium falciparum (P. falciparum). Results: Out of 27,474 samples, 94 were found positive for malaria parasite of which P. vivax cases were 90 (95%) and 4 (5%) were P. falciparum cases. The prevalence rate was 0.34%. There was a 24% drop in malaria cases from 2019-2021 when compared to 2015-2018. Conclusion: The present study shows decline in the number of malaria cases from 2015 to 2021. The cases showed seasonal variation with maximum cases being reported in September. As India is in the decline phase of cases, with the collective efforts of clinicians, laboratory personnel and community health workers, elimination of malaria could be a possibility.

Screening for mecA and mecC Gene Carriage among Clinical Isolates of Methicillin Resistant Staphylococcus aureus at a Tertiary Care Hospital: A Cross-sectional Study

Rakshita Ramesh, Deepa Sinha, R Ambica, GB Shantala

Introduction: Staphylococcus aureus (S. aureus) has emerged as one of the most important human pathogen, and has been a leading cause of hospital and community acquired infections. Methicillin-Resistant Staphylococcus aureus (MRSA) carrying the mecA gene is resistant to the majority of β-lactam antibiotics. In 2007, a new S. aureus strain harboring mecA gene homologue, mecC, was found in England which posed diagnostic problems. Accurate and rapid detection of MRSA is required for effective treatment. Aim: To screen for mecA and mecC genes among methicillin resistant isolates of S. aureus using conventional Polymerase Chain Reaction (PCR) and to associate their presence with Kirby-Bauer disc diffusion and automated Vitek 2 methods. Materials and Methods: This cross-sectional observational study was conducted in the Department of Microbiology, Victoria hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India, from July to October 2019. A total of 60 non duplicate S. aureus samples were obtained from various clinical samples during the study period. Isolates were subjected to antibiotic susceptibility by cefoxitin disc diffusion and automated Vitek-2. Isolates were screened for mecA and mecC gene carriage using conventional PCR. Descriptive statistics were used for the comparison of data, and appropriate statistical charts were used to present the data. Results: Among 60 S. aureus isolates, 41 (68.33%) were considered MRSA by conventional Disc Diffusion Method (DDM), and 48 (80%) were considered MRSA by automated Vitek-2. By conventional PCR, only 34 (56.67%) isolates carried the mecA gene, and none of the clinical isolates possessed the mecC gene. Conclusion: An overall MRSA prevalence of 56.67% was observed by PCR in present study. The mecC gene was not detected in any of the S. aureus isolates. The study indicates the presence of mecA and mecC negative phenotypically identified MRSA isolates. Rather than absolute dependence on the mecA gene as the defining standard in determining MRSA, alternative mechanisms of resistance-presence of mecC, mecB genes, hyperproduction of b-lactamase; can potentially be a knowledge trove for researchers to delve into.

Impact of COVID-19 Pandemic on the Utilisation of Medical Oncology Services at a Tertiary Care Hospital in Srinagar, India: A Retrospective Study

Introduction: Coronavirus Disease-19 (COVID-19) Pandemic affected healthcare delivery worldwide from all quarters be it routine or essential care, including cancer care. All aspects like screening, diagnosis, and treatment were affected regardless of the developmental status of countries. Aim: To find out the extent and magnitude of cancer care affected during pandemic by comparing the data during pandemic for outpatient visits, new registrations, admissions, and day-care chemotherapy sessions with prepandemic data. Materials and Methods: This retrospective study was conducted in the Department of Medical Oncology of State Cancer Institute in Srinagar, India. The parameters assessed were the number of outpatient visits, new registrations, admissions, and day care chemotherapy sessions from the department of Medical Oncology. Anonymised cumulative data of all the patients who availed these services was included. Data were collected for eight months, during pandemic in 2020 and were compared with the data from previous year 2019. The effect of lockdown was assessed by comparing these parameters with the non lockdown period. Statistical analysis was done by independent t-test. Results: The number of outpatient visits dropped from 15425 from non lockdown period to 12670 in lockdown period (p-value=0.019), number of new admissions from 1613 to 1418 (p-value=0.001), and chemotherapy sessions from 9374 to 8081, (p-value=0.004). The number of patient registrations also declined but the drop was not significant (p-value=0.171). All the parameters except in-patient admission improved during the non lockdown period with the highest improvement in registration, but inpatient admission revealed a similar reduction as in the lockdown period. Conclusion: The COVID-19 pandemic and the subsequent lockdown had a significant impact on the number of outpatient visits, new admissions, and chemotherapy sessions. This suggests that the treatment protocols and chemotherapeutic management of cancer care were badly affected by the pandemic.

Comparative Analysis of Red Cell Parameters of First-time and Repeat Blood Donors: A Descriptive Study

Introduction: Blood transfusion services form an essential component of any healthcare system and it is imperative to provide adequate and safe blood for management of patients. Voluntary blood donors form the backbone of this service. However, regular donation by such voluntary donors may cause significant depletion of iron stores in the body. This has the potential to adversely affect the donor’s health, and also to lower the quality of blood being collected subsequently. The temporary deferral of such donors also causes reluctance to return for future blood donations, leading to decrease in size of the donor pool. The prompt detection of subclinical iron deficiency in voluntary blood donors is the need of the hour. Aim: To compare and analyse the difference in red cell parameters of first-time and repeat blood donors. Materials and Methods: A descriptive study was conducted by the Department of Blood Bank and Pathology at Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, India, from July 2021 to December 2022. After prospective donors were assessed for suitability of blood donation, written informed consent was obtained, and 5 mL venous blood was collected into an Ethylenediaminetetraacetic Acid (EDTA)-anticoagulated vial via the antecubital fossa. Complete blood count was performed within one hour of collection using an automated haematology analyser. The parameters analysed in the study were Red Blood Cell (RBC) count, haemoglobin, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), and Red cell Distribution Width (RDW). The generated data was compiled and statistical analysis, with Kruskal-Wallis test (at a p-value of 0.05) and post-hoc Dunn test was performed to determine the significant differences, if any. Results: The study included 455 participants, out of which 210 were repeat blood donors. The significant differences for MCV, MCH and RDW between groups defined by number of donations (p-value <0.001) were observed. The difference was most significant between the donors having five or more donations compared to donors having no previous donations. No significant differences were observed for other parameters, with p-values for RBC count, haemoglobin, and MCHC being 0.3, 0.07, and 0.09, respectively. Conclusion: Repeat blood donors having low MCV and MCH along with high RDW, with haemoglobin values within normal range, are most susceptible to having subclinical iron deficiency, which needs to be identified and managed pre-emptively, before development of Iron Deficiency Anaemia (IDA). This is necessary in order to retain regular and repeat voluntary blood donors, and also to ensure adequate quality of collected blood.

Expression of ERG in Prostatic Acinar Adenocarcinoma Diagnosed on TRUS-guided Biopsy and its Association with WHO Grade Group- A Prospective Observational Study

SM Sarfaraj, Soumya Dey, Dilip Kumar Pal, Chhanda Datta, Moumita Sengupta

Introduction: Prostate cancer is a common malignancy affecting men and the second leading cause of cancer related death in India. Numerous molecular biomarkers have been evaluated for their potential role in predicting disease progression, their response to therapy and survival. Erythroblast Transformation Specific (ETS) related Gene (ERG) is one of the newest addition in the existing list of biomarkers of prostate cancer. Aim: To analyse the expression of ERG in prostatic adenocarcinoma and to evaluate its association with World Health Organisation (WHO) grade group. Materials and Methods: This was a prospective observational study was conducted in the Department of Pathology in association with Department of Urology, IPGME&R, SSKM Hospital, Kolkata, West Bengal, India. The duration of the study was 1.5 years, from January 2019 to June 2020. A total of 267 cases of Transrectal Ultrasound (TRUS) guided tru-cut biopsy was included. Clinical data including preoperative Prostate Specific Antigen (PSA) level, Digital Rectal Examination (DRE) were obtained. Histopathological reports were prepared by two pathologists along with Gleason scoring and WHO grading as per 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Formalin Fixed Paraffin Embedded (FFPE) sections of representative blocks of each tumour was selected for Immunohistochemistry (IHC) study. Only the cases which had more than 10% nuclear staining were considered as positive. Statistical analysis was performed with help of Epi Info (TM) 7.2.2.2 and Chi-square test was used to test the association of different study variables. Results: The mean age of the study participants was 65.55 years, and the age range was 45-93 years. Among the 80 malignant cases where, ERG immunostaining was assessed, 28 cases (35%) showed positive expression. Among these positive cases, 50% cases were weakly positive, 28.57% showed moderate positivity and 21.43% had strong positive expression. Highest positivity was observed in WHO grade group V (44.83%). The intensity of ERG expression was also higher in high grade group (13) than low grade group cancer patients. Conclusion: ERG expression in the prostate cancer can be a prognostic factor as the expression and intensity of expression both increases with higher grade group of cancer.

Effect of Mean Platelet Volume on Platelet Rich Plasma Based Injection Therapy in Patients with Osteoarthritis of the Knee Joint- A Longitudinal Study

Introduction: There are different types of arthritis seen in elderly patients, of which Osteoarthritis (OA) is the most common. Platelet Rich Plasma (PRP), which is derived from blood, contains many growth factors. Platelet count and indices in PRP has association with pain score of OA, further study will prove its significance. Aim: To find the correlation of platelet parameters like platelet count, Mean Platelet Volume (MPV) and Plateletcrit (PCT) with clinical OA improvement score in PRP-treated patients of OA. Materials and Methods: The longitudinal study was done in the Department of Pathology, PDU Civil Hospital, Rajkot, Gujarat, India, from January 2021 to October 2021. Study was conducted on 40 patients, who were administered intra-articular injection of PRP prepared using double spin method. It was injected at the site of maximum pain in the knee joint. Platelet count, MPV and PCT were noted in the pre and post intervention. Patients were followed-up at two months and six months. The data was analysed using Friedman Analysis of Variance (ANOVA) and Pearson’s correlation test. Results: The mean age of patients was 58.57±4.95 years and there were 26 (65%) females and 14 (35%) males. Increase in platelet count, MPV, PCT in PRP prepared by double spin method and improvement in Visual Analog Scale (VAS) (Before-8.38±0.63; After-4.28±0.85), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (Before-63.30±4.99; After- 43.67±5.22) and International Knee Documentation Committee (IKDC) (Before-45.04±6.06; After-66.14±5.78) score were found to be statistically significant. Correlation of platelet parameters WOMAC with Platelet count (p-value=0.052, R-value=-0.310), VAS with MPV (p-value=0.005, R-value=0.436) and IKDC with PCT (p-value=0.032, R-value=0.339) were also statistically significant at six months follow-up. Conclusion: Single dose intra-articular injection PRP in OA knee with KL Grade 1 and 2 is valuable, efficient and cost-effective treatment to reduce or delay in knee replacement. The study showed the significant correlation of platelet parameters with OA improvement scores.

Significance of Plasma Thromboplastin Cell Block Technique as an Adjunct to Fine Needle Aspiration Cytology in Diagnosis of Breast Lesions

Sivagama Sundari, Vijayashree Raghavan, Rajesh Kanna

Introduction: Despite the fact that Fine Needle Aspiration Cytology (FNAC) has been widely utilised in the preoperative diagnosis of breast lumps, the Conventional Smears (CS) have drawbacks, including difficulty in understanding the pattern or architecture of the lesion, determining invasiveness, Immunohistochemistry (IHC), false positives, and false negatives. Cytologists advise using Cell Blocks (CB) to increase the diagnostic precision of FNAC. In this study, the significance of using Plasma Thromboplastin Cell Block (PTCB) routinely as an addition to CS in FNAC of palpable breast lesions. Aim: To determine the significance of PTCB as an adjunct in addition to CS to diagnose breast lesions. Materials and Methods: The present prospective observational study was conducted in the Department of Pathology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, between July 2021 and June 2022 on 30 samples of palpable breast lesions. From the fine needle aspirates, smears were prepared and stained with Leishman and Papanicolaou stains. The residual material in the hub was rinsed in saline. The plasma-thromboplastin method was used to prepare CB, and Haematoxylin and Eosin (H&E) sections were made. A point scoring system was used and findings were compared to histopathology. IHC markers namely Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2), Proliferation marker Ki-67 was utilised wherever appropriate. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of total 30 subjects, majority (n=9, 30%) were in the age group of 41-50 years. The mean scores of CS {background (0.93±0.25), cellularity (1.7±0.55), morphology (1.7±0.47) and architecture (1.03±0.32)} and PTCB {background (1.77±0.43), cellularity (1.77±0.48), morphology (1.8±0.48) and architecture (1.5±0.57)} were compared using the point scoring system. Though the mean scores of all four parameters were higher in PTCB than in CS, the statistically significant difference was seen in background (p-value=0.001) and architecture categories (p-value=0.0001). The PTCB finding as a screening test for predicting histopathological diagnosis showed a sensitivity of 94.44%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 92.3%, and 96.67% accuracy. IHC staining was feasible in CB and findings were comparable to biopsy. Conclusion: The routine use of PTCB technique in FNAC of breast lesions, along with smears, will aid in IHC, reducing diagnostic pitfalls, thereby reducing misdiagnosis and invasive procedures, particularly in suspicious for malignancy cases, which can lead to inappropriate radical treatment causing physical and psychological stress to patients.

Peritumoural and Intratumoural Distribution of Langerhan Cell in Oral Squamous Cell Carcinoma and its Association with Known Prognostic Factors

Sandhra Papparath Usman, Deepti Ramakrishnan, S Divya

Introduction: Oral Squamous Cell Carcinoma (OSCC) accounts for about 2/3rd of the Head and Neck Squamous Cell Carcinomas (HNSCC). It is the sixth most common cancer worldwide and the third most common cancer in developing countries including India. More than half the HNSCC patients have advanced disease at the time of diagnosis and overall long-term survival is low (50%), despite aggressive therapeutic regimens. This has demanded the need for prognostic indicators that can be used to improve the ability to select a more individualised approach for treatment relative to the risks of recurrence, metastases and death. Aim: To study the intratumoural and peritumoural distribution and density of Langerhans Cells (LC) in OSCC using Immunohistochemistry (IHC) markers Cluster of Differentiation-1a (CD1a) and Langerin and to study its association with known prognostic factors. Materials and Methods: This was a hospital-based cross-sectional study conducted at the Department of Pathology, Amala institute of Medical Sciences, Kerala, India during a period of 18 months, from January 2019 to June 2020. In total, 28 specimens of wide local excision with cervical lymph node dissection done for OSCC were enrolled in the study. Small biopsy samples and cases who had undergone neoadjuvant treatment as well as cases of recurrent OSCC were excluded. Clinical details were obtained from the patients’ case files. The immunohistochemical staining for LCs using CD1a and Langerin was done. The distribution of LCs was compared to the tumour grade and lymph node status along with lymphovascular and perineural invasion. Statistical analysis was performed using sample t-test after identifying normality of distribution. The p-value of <0.05 was taken as significant. Results: Fourteen cases of well differentiated and 14 cases of moderate to poorly differentiated OSCC were selected for the study. The LC distribution in these cases was compared to prognostic factors like histological grade, Lymphovascular Invasion (LVI), perineural invasion, tumour size, depth of invasion, T stage and lymph node status. A significant positive association was observed between the tumour differentiation and peritumoural CD1a positive cell density (p-value: 0.001). Further, a negative association was also established between the lymph node staging and peritumoural CD1a positive cell density (p-value: 0.004). There was no association between the LC density and presence of lymphovascular or perineural invasion in OSCC. Conclusion: A depleted peritumoural LC density in OSCC reflects poor tumour immunity, associated with higher grade and higher stage of lymph node metastasis. LC density may hence be of prognostic value in OSCC.

Clinical Evaluation of Non Resolving Dyspepsia by Upper Gastrointestinal Endoscopy: A Diagnostic Perspective

Abdul Ahad Wani, Shariq Mehraj, Tahir Ashraf, Aamir Shafi

Introduction: Dyspepsia is a common problem in regular outpatient clinical practice. In Kashmir province of North India little research has been done on studying clinically important endoscopic findings in non resolving dyspeptic patients of different ages and ethnicities. The purpose of this study was to assess the diagnostic value of Upper Gastrointestinal Endoscopy (UGIE) in patients with non resolving dyspepsia who had not undergone endoscopic evaluation previously. Aim: To determine the diagnostic value of endoscopy in patients with non resolving dyspepsia and to correlate the endoscopic findings with clinical perspective of patients with or without alarming symptoms and signs. Materials and Methods: This retrospective cross-sectional, single-centre study was done in the Department of General Medicine, SKIMS Medical College and Hospital (tertiary care hospital), Srinagar, Jammu and Kashmir, India, from July 2017 to June 2022. Study involved 1600 patients who presented with non resolving dyspepsia and underwent endoscopic evaluation. Non resolving dyspepsia was defined as persistent upper abdominal discomfort associated with heart burn or bloating after three to six weeks of adequate proton pump inhibitor therapy. Data was gathered and analysis was done based on demographics, clinical symptoms with or without alarming features by using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: A total of 1600 patients were included in the study. The mean±Standard Deviation (SD) age of the study group was 52±10 years, and 63% of the patients were males. Epigastric pain was the predominant symptom (61%) followed by heartburn (22%). Abnormal endoscopic findings were noted in 47.75% of the patients involved in this study. Gastritis (19.4%) was the most common finding observed. Gastric carcinoma was the least common diagnosis, seen in 2.93% of subjects, mostly in the elderly age group. Conclusion: In the present study, patients with dyspepsia frequently had normal or clinically insignificant upper gastrointestinal endoscopic findings regardless of age. Based on the present study conducted in a large number of patients, an invasive procedure like UGIE should be reserved for patients having definite alarming features, as the majority of patients don’t have clinically significant findings and should be treated adequately on Functional Dyspepsia (FD) protocol before a definitive investigative procedure is performed. The present study strongly indicates overuse of UGIE, especially in the absence of alarming features.

Recommendations for Conducting Mortality and Morbidity Meetings Derived from Perceptions of Faculty and Residents, and Qualitative Analysis of Records

Archana Arvindrao Dambal, Siddaganga, Kiran Ramchandra Aithal, Deepak

Introduction: Even though Mortality and Morbidity meetings (M&Ms) are incorporated into postgraduate training programs for imparting the attributes of self-appraisal, audit and quality control, they are not uniformly structured across institutes. This study describes the pattern of conducting M&M at a Medical College in North Karnataka in the context of the perceptions of faculty and residents of our medical college and proposes recommendations. Aim: To generate recommendations for conducting structured M&Ms meetings derived from the perceptions of faculty and residents, and prior feasibility experience at a medical college hospital. Materials and Methods: The present mixed method study was conducted in the Department of General medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, in the month of July 2022. The perceptions of faculty and residents of medicine were obtained by a paper survey. The results of the survey were compiled and analysed by one of the authors. The responses were matched with the records of M&Ms as conducted in the Department of General Medicine from November 2017 to May 2019. The cases were thematically analysed as deviation from standard protocols of care, multidisciplinary consults, iatrogenic cause of death, unresolved diagnosis, and system failure by other authors. Any recorded recommendations were noted. The attendance for such meetings was measured as a surrogate of importance attached. Data was entered in the Microsoft Excel spread sheet. Descriptive statistics were calculated by frequency and proportions for qualitative variables. Results: A total of 150 participants (65 were faculty, including senior residents, and the remaining 85 were postgraduate residents) completed the survey. The survey participants preferred the presentation by 3rd-year residents and junior faculty. While selecting the cases for M&Ms, they preferred systematic selection turn-wise. The survey participants considered that while analysing M&M cases, conflicts in multidisciplinary consults, iatrogenic cause of death, human error, and deviation from standard protocols of care should be emphasised. During November 2017 to May 2019, a total of 38 M&Ms were held (19 mortality and 19 morbidity meetings). The criterion for mortality case selection was subjective. Five cases were presented during each meeting. The predominant case presentations included interdepartmental transfer issues and procedural lapses. The Department of General Medicine had 30 postgraduate residents and 25 faculty members. The average attendance of residents and faculty was 90% and 78%, respectively. Conclusion: Regularly conducted M&M in a medical college hospital are important in training medical students for audit of medical errors, quality control and appraisal in a safe environment. Prospective selection of cases by recognising potential incidents; and evidence based, structured, uniform conduct of M&Ms by participation of teams involved in healthcare can reduce errors.

Early Post-stroke Seizures in Acute Ischaemic Stroke: A Retrospective Study

Roy Thomas

Introduction: Seizures represent an important complication of ischaemic stroke causing a substantial burden to post-stroke patients. Seizures occurring within one week after acute stroke onset are called early onset seizures. Several studies have tried to identify the risk factors for early seizures after stroke with controversial results. Aim: To determine the risk factors for early post-stroke seizures in a retrospective cohort of acute ischaemic stroke. Materials and Methods: This retrospective cohort study included medical records of 552 adult patients with acute ischaemic stroke between March 2017 to September 2022 admitted to Travancore Medical College Hospital, Kollam, Kerala, India. The patients were divided into two groups: stroke patients with early onset seizures and stroke patients without early onset seizures. The following parameters were compared between the two groups: age, gender, presenting symptoms, ischaemic subtype (TOAST {Trial of Org 10172 in Acute Stroke Treatment} classification), vascular territory involved, lesion location and lateralisation, infarct size, stroke severity based on the National Institute of Health Stroke Scale (NIHSS), vascular risk factors, treatment (thrombolysis, antiplatelets, anticoagulants use) and related complications (haemorrhagic transformation, infection, gastrointestinal haemorrhage, hyponatraemia). Univariate analysis was done using Chi-square test and multivariate analysis using logistic regression test. Statistical Package for the Social Sciences (SPSS) version 27.0 statistical software was used, p-value <0.05 was considered statistically significant. Results: Among 552 patients, 76 (13.8%) were stroke patients with early onset seizure group and 476 (86.2%) were stroke patients without early onset seizure group. A total of 84.2% of patients developed seizure within 24 hours of stroke onset. A total of 409 (74.1%) patients were males. Patients with early onset seizures were younger. The most common seizure type was unknown onset to bilateral tonic-clonic seizures (85.5%). Multivariate analysis identified severe NIHSS, supratentorial, cortical location, large artery disease, anticoagulation use, haemorrhagic transformation and hyponatraemia as independent factors for early onset seizures. Conclusion: Severe NIHSS at presentation, large artery disease, supra tentorial, cortical location of infarct, use of anticoagulants, haemorrhagic transformation and hyponatraemia were significant risk factors for early seizures in acute ischaemic stroke. An early identification and understanding of these risk factors would help to prevent seizures in acute stroke patients.

Electrocardiographic Changes among Moderate and Severe COVID-19 Patients in a Tertiary Care Teaching Hospital at Shahdol, Madhya Pradesh, India: A Record-based Study

Introduction: Electrocardiographic (ECG) abnormalities in Coronavirus Disease 2019 (COVID-2019) patients are largely unknown. ECG changes in COVID-19 disease may guide to initiate therapeutic anticoagulation, more so in moderate and severe disease. Aim: To identify various ECG changes in moderate and severe COVID-19 patients and to ascertain the association between initial ECG changes and disease outcome. Materials and Methods: This was retrospective record-based study was conducted in the Department of Internal Medicine, Birsa Munda Medical College, Shahdol, Madhya Pradesh, India, on 216 patients with laboratory-confirmed COVID-19 in a tertiary care teaching hospital from March 2021 to June 2021. Demographic and clinical data including ECG were extracted from medical records of the patients and if needed, the patients were followed-up till outcome. COVID-19 disease severity was considered based on oxygen saturation at room air (moderate: 94%-90%; severe: <90%). Data were entered using the Epicollect5 mobile application to minimise errors. Results: A total of 216 patients were included (35 to 54 years), the majority were male. Mortality rate was 46.3%. Total 57.4% of ECG changes were classified as abnormal. Sinus tachycardia was the most common abnormality followed by ischaemic changes. Left axis deviation in ECG was more commonly seen than right axis deviation. Total 53.2% of patients with abnormal ECG findings and 36.9% with normal ECG findings died. Mortality was very high in patients with ischaemic changes. Conclusion: COVID-19 patients with ischaemic changes in ECG were significantly associated with increased mortality. Hence, early detection of these changes in COVID-19 patients is vital and will help primary care physicians to intervene early and help in deciding therapeutic anticoagulation requirements in patients with COVID-19.

Effects of Serum Albumin Level in Lower vs Upper Extremity Surgery: A Hospital-based Retrospective Study

Tushar Kanti Bandyopadhyay, Amita Pathak

Introduction: Trauma and major surgery often lead to low serum albumin levels in patients. Several studies have reported depressed serum albumin levels in upper and lower extremity and other major surgeries. Metabolic stress response from major surgical interventions and prolonged immobility is primarily responsible for low serum albumin levels in these patients. Aim: To investigate the preoperative and postoperative serum albumin levels in patients who underwent extremity surgery and compare the changes in albumin levels between those who underwent upper extremity surgery versus lower extremity surgery. Materials and Methods: This was a hospital-based retrospective study. The study included 120 patients who presented to the Emergency Department of Surgery and Orthopaedics at Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India due to trauma. The study was conducted from November 30, 2018 to November 30, 2021. All patients underwent either lower or upper extremity surgery (Group 1 and Group 2, respectively) by orthopaedic surgeons and were consecutively selected regardless of their ages. The serum albumin levels at the time of admission and on the third day after surgery were obtained from the hospital patient records. Continuous variables were expressed as mean±standard deviation. The normality test of the numerical variables was done using the Kolmogorov-Smirnov test. Results: The mean age of the population in the upper extremity surgery group was 38.8 years vs 30.5 years in the lower extremity group. A statistically significant difference in the preoperative and postoperative serum albumin levels was found in both groups (p<0.05). Moreover, the mean difference between preoperative and postoperative serum albumin levels was found to be significantly higher in the lower extremity group (1.52±0.32 g/dL) than in the upper extremity group (0.95±0.39 g/dL) (p<0.05), and the coefficient of correlation between these two groups (r>0.7) indicated a significant difference between albumin levels in the two groups. Conclusion: This study revealed that both upper and lower extremity surgeries caused hypoalbuminaemia. The study was novel in finding that lower extremity surgery caused more severe hypoalbuminaemia in the patients compared to those who underwent upper extremity surgery. A correlation study was done between the two groups, and it was found to be significant with a p-value of <0.05 and an r-value of >0.7. The reason for this significant difference was the longer duration of lower extremity surgery, requiring more fluid support during the surgery and resulting in increased metabolic stress.

Effect of Low T3 Syndrome on Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Low Triiodothyronine (T3) syndrome is a hormonal imbalance that significantly influences cardiovascular haemodynamics by altering the vascular endothelial function through the Nitric Oxide (NO) pathway. In Acute Coronary Syndrome (ACS), inflammation disrupts plaque, which stimulates thrombosis, coagulation, activation of the sympathetic system, and release of cytokines, mainly Interleukin 6 (IL-6), a pleotropic and pro-inflammatory cytokine that exerts inhibitory effects on thyroid axis function. Aim: To study the association of low T3 syndrome and severity of Coronary Artery Disease (CAD) in ACS. Materials and Methods: This cross-sectional study was conducted in the Intensive Critical Care Unit (ICCU) under the Department of Cardiology at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, from July 2021 to August 2022. A total of 120 consecutive ACS patients who underwent Coronary Angiography (CAG) were included in the study. The severity of CAD was assessed using the Gensini risk scoring, system, and the patients were divided based on their thyroid function status. Low T3 syndrome was defined as <0.846 ng/mL with normal values of Thyroxine (T4) and Thyroid Stimulating Hormone (TSH). Receiver operating characteristic curves were generated to correlate low T3 syndrome and angiographic severity of CAD. Multinomial logistic regression analysis demonstrated that LT3S is an independent risk factor for CAD. The Chi-square test was used for ordered categorical data with the severity of coronary artery lesions. Results: The severity of coronary artery lesions in the low T3 syndrome group (n=29, 24.16%) and hypothyroidism (n=20, 16.6%) group was significantly greater than that of the euthyroid group (n=71, 59.1%), with all groups showing statistical significance (p-value=0.047). Multinomial logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor for moderate (Odds ratio=2.34, 95% CI: 0.47-11.39, p<0.02) and severe (Odds ratio=8.56, 95% CI: 1.52-47.9, p<0.015) lesions. Conclusion: The results of this study suggest that patients with low T3 syndrome are associated with more severe and diffuse CAD and low T3 syndrome is an independent risk factor for ACS.

Association of Low Serum Albumin Levels and its In-hospital Adverse Outcomes among Patients Presenting with Acute Coronary Syndrome in a Tertiary Care Hospital of West Bengal, India

Bichitra Biswas, Kuntolika Mani, Ranajit Bari, Sandip Ghosh, Chanchal Kumar Jana

Introduction: Acute Coronary Syndrome (ACS) is characterised by hypercoagulability and inflammation. In the acute presentation of Ischaemic Heart Disease (IHD), such as ACS, serum albumin may also play an important role. Many patients with an ischaemic cerebrovascular accident, a condition similar to ACS, had low serum albumin levels. Aim: To estimate serum albumin levels in patients with ACS and their relation to hospital adverse outcomes. Materials and Methods: The present prospective observational study was conducted in the Department of General Medicine at R.G. Kar Medical College and Hospital, West Bengal, India. The duration of the study was 18 months, from July 2019 to October 2020. Patients with ACS were included irrespective of age, sex, race, and predisposing factors such as Hypertension (HTN), Diabetes Mellitus (DM), hyperthyroidism, and dyslipidaemia. A total of 125 patients were included, and details such as relevant history, examination findings, laboratory investigation, Electrocardiography (ECG), Echocardiography (ECHO), chest X-ray Posteroanterior (PA) view were included. Chi-square test and logistic regression were applied. Results: A total of 94 (75.2%) patients were male. 49 (39.2%) study patients had DM. A total of 10 (8%) patients presented with cardiac arrest at admission. In-hospital death occurred in 9 (7.2%) cases. 59 (47.2%) patients had a normal serum albumin level (3.5-4.5). 61 (48.8%) had mild to moderate hypoalbuminaemia (2.5-3.5), and only 5 (4%) had severe hypoalbuminaemia (<2.5). The association of in-hospital complications vs serum albumin level was statistically significant (p<0.0001). A multivariate logistic regression analysis showed that male gender (p-value=0.026), smoking (p-value=0.008), arrhythmia (p-value=0.002), increased creatinine (p-value=0.032), and hypoalbuminaemia (p<0.001) were statistically significant independent predictors of in-hospital adverse outcomes. Conclusion: The low serum albumin level, measured immediately on hospital admission in ACS patients, was associated with in-hospital complications, and when adjusted for other covariates, hypoalbuminaemia predicts in-hospital adverse outcomes independently.

Prevalence and Aetiological Profile of Short Stature in School Children between 6-11 Years of Age- A Community Based Prospective Observational Study

Jasmine Kandagal, Suman Rath, Madhuri Maganti, Caroline Elizabeth George

Introduction: Growth is a complex process influenced by genetic background, different functions of the endocrine system, nutrition, the effect of any chronic disease, and the level of individual physical activity. Regular height measurement is one method to evaluate growth. Short stature might be the first sign of various pathological conditions. Early recognition of short stature allows early intervention, optimising the possibility of achieving good health and normal adult height. Community based studies utilising standard protocols are less common in India, as many studies are limited to children visiting tertiary care centres with complaints of short stature. Aim: The present study aimed to assess the prevalence and aetiological profile of short stature in urban school children of Bangalore. Materials and Methods: This prospective observational study was conducted among five schools in Devarajevanahalli, Bangalore, from November 2015 to January 2017. Written informed consent was taken from the principal. Children from 6-11 years were recruited into this study until the sample size was reached. A total of 1128 children were chosen for the study. Anthropometric measurements like height, weight, and Body Mass Index (BMI) were taken. Height was plotted on Indian Academy of Pediatrics (IAP) growth charts. Those with height <3rd centile were considered to have short stature. Children with short stature were followed after one year to see their height velocity. Children with height velocity of <25th centile were evaluated. A detailed history focussing on nutrition and a complete physical examination, along with relevant investigations, were done. The cause of short stature was assessed and grouped into physiological and pathological short stature. Continuous variables like height, weight, and BMI were presented as mean [standard deviation (SD)] and were compared using unpaired t-test. Categorical variables like gender and height velocity were expressed as actual numbers and percentages, and association was done using the Chi-square test. Height between age categories among boys and girls was compared using ANOVA test. Results: Out of 1128 school children, 62 were found to be short. The prevalence of short stature was 5.50%. Among the 62 children, 31 remained short after one year. Out of the 31, only 22 children were investigated, as the remaining were not willing to undergo investigations. Out of the 22 children, pathological short stature was found in 13 (59.1%) and physiological short stature in nine (40.9%). In pathological short stature, chronic malnutrition with Iron Deficiency Anaemia (IDA) was present in 10 (45.5%). Hypothyroidism, idiopathic short stature, and uncontrolled asthma were seen in one case each (4.5%). In physiological short stature, familial short stature was found in 6 (27.3%) and constitutional delay of growth and puberty in 3 (13.6%). Conclusion: The overall prevalence of short stature was 5.50%, representing a significant percentage of our society that needs proper attention. Chronic malnutrition with IDA was the most common cause of short stature in this study. As a significant percentage of children had treatable causes, growth monitoring with standard growth charts should be mandatory in all schools.

Prevalence of Insomnia among Paediatric Cancer Patients: A Hospital-based Observational Study

Introduction: Insomnia and other sleep disturbances are the common occurrences in paediatric patients suffering from cancer. These may be attributed to the disease itself or its treatment and accompanying psychosocial stress. Sleep disorders including insomnia are known to have a detrimental effect on the quality of life in these patients. Aim: To estimate the prevalence of insomnia among cancer patients aged 1-15 years admitted in the paediatric oncology ward. Materials and Methods: A prospective observational, hospital-based study was conducted in the Paediatric Oncology ward, Shri Maharaja Gulab Singh (SMGS) Hospital, Government. Medical College (tertiary care institute), Jammu, India, from June 2022 to August 2022. A total of 50 patients, in the age group of 1-15 years, diagnosed with malignancies like leukaemia, lymphoma, aplastic anaemia, hepatoblastoma, etc., were enrolled after taking informed consent from their parents. Insomnia Severity Index (ISI) was administered to parents of children below 10 years age and to patients themselves who were between 10-15 years to screen for symptoms of insomnia with the help of their parents/investigators as and when required. Continuous variables were expressed as mean±Standard Deviation (SD) and categorical variables were summarised as frequencies and percentages. Results: The study subjects were distributed according to their age into three groups, as 1-5 years (n=26), 6-10 years (n=16), and 11-15 years (n=8). There were 24 (48%) males and 26 (52%) females. In this study, 32 (64%) study subjects did not have insomnia, 5 (10%) had subthreshold insomnia, 13 (26%) had moderate insomnia and none had severe insomnia. Conclusion: The prevalence of insomnia found in the study was 26%. Insomnia is common in paediatric cancer patients necessitating its recognition and management for improved quality of life.

Impact of Environment on Motor Function and Methods of Mobility in Children with Cerebral Palsy: A Cross-sectional Study

Hemachithra Chinniah, Elansuriyan Sambandam

Introduction: Activities of Daily Living (ADL) in children with Cerebral Palsy (CP) include a variety of environmental settings. Environmental setting plays an important role in clinical assessment and therapeutic intervention to improve the mobility of children with CP. There are various environmental factors, such as movable surfaces, stairs, carpeting, and physical obstacles, which can either facilitate or constrain the mobility of children with CP. Aim: To study the differences in motor function and gait speed at different environmental settings and find out the usual mobility methods of children with CP in home, school and community settings. Materials and Methods: A cross-sectional study was conducted in the Outpatient Department (OPD) of Paediatrics at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India. The study was conducted for seven months, from February 2022 to August 2022. A total of 50 CP children aged between 4-12 years were included, and their demographic details were collected. The type of CP, gross motor function, gait speed, and methods of mobility were evaluated at home, community, and school in all the children with CP. Gross Motor Function Measurement (GMFM 88-E), One-Minute Walk Test (1MWT), and a parent checklist for mobility methods were used as outcome measures to collect the data and analyse it using the Wilcoxon signed-rank test and Friedman test. Results: The mean age of the study population was 8.34±1.62 years, which included 29 (58%) male children and 21 (42%) female children. Gross motor function and gait speed varied across the environment, and statistically significant differences (p-value=<0.001) were observed in the home, community, and school. Results related to methods of mobility showed that most of the children, 38 (76%), walked alone at home and were carried by adults in the community 30 (60%), while they used all mobility methods in school. Conclusion: The present study concluded that gross motor function, gait speed, and methods of mobility varied across different environmental settings (home, community, and school). Motor function and gait speed were better at home, followed by school, than in the community. The common method of mobility was walking alone at home and being carried by adults in the community.

Paediatric Appendicitis: Has SARS-COV-2 Influenced the Clinical Profile and Management during the Pandemic Period?

Shinaz Sadiq, MK Binu, UR Maneesha, SV Beena, CS Aravind

Introduction: The Coronavirus Disease-2019 (COVID-19) had profound repercussions on routine medical practices all over the globe. There are fewer studies on the impact of the pandemic on childhood surgical conditions like Acute Appendicitis (AA), which is the most common paediatric surgical emergency. Aim: To analyse whether COVID-19 has influenced the clinical profile and management of paediatric appendicitis during the pandemic period. Materials and Methods: A retrospective study was carried out in the Department of Paediatric Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India, comparing AA cases during the pandemic period (group A=from February 2020 to January 2022) with AA cases during the prepandemic period (group B=from February 2018 to January 2020). Analysis of data regarding patient demographics (age, sex), duration of symptoms and hospital stay, type of appendicitis, total and differential leucocyte count, ultrasonographic findings, treatment modality and complications was done. Subgroup analysis of children in group A was done by comparing AA cases with active/recent COVID-19 infection (Subgroup A1) with the rest of AA in the group (Subgroup A2). Pearson’s Chi-square test was used for the analysis of categorical variables and independent t-test was used for numerical data. p-value <0.05 was considered significant. Results: There were 826 AA cases, with 375 children in group A and 451 in group B. A significant reduction in the number of AA cases was noted during the first year of the pandemic (n=167 vs n=242, p-value=0.009) and a significantly higher number of cases were managed conservatively during the pandemic period (n=48 vs n=10, p-value <0.0001). Children with active/recent COVID-19 infection presented late (p-value=0.03), had a significantly higher incidence of complicated appendicitis (p-value=0.02), decreased total leucocyte count (p-value=0.01), decreased polymorph count (p-value=0.02) and higher incidence of the conservative modality of treatment (p-value <0.005). Conclusion: Overall, there were no significant differences in the clinical profile of AA during the pandemic period. However, children with AA who had active/recent COVID-19 infection had a longer duration of symptoms and a higher incidence of complicated appendicitis. The pandemic influenced the management protocols with an increase in the number of AA cases being managed conservatively when compared to the prepandemic period.

Subcutaneous Onlay Laparoscopic Approach versus Laparoscopic Intraperitoneal Onlay Mesh Repair for Paraumbilical Hernias: A Randomised Clinical Trial

Introduction: Paraumbilical hernias are currently treated most effectively with a minimally invasive strategy. After the introduction of Intraperitoneal Onlay Mesh Placement (IPOM), it has been performed as a traditional technique for paraumbilical hernias, though there are many techniques such as placement of mesh in the preperitoneal/retromuscular space or subcutaneous space. However, there has been a constant debate over the choice of a better approach. Aim: To compare the short-term outcomes of IPOM and Subcutaneous Onlay Laparoscopic Approach (SCOLA) repair (subcutaneous onlay mesh placement) for paraumbilical hernias. Materials and Methods: A randomised clinical trial was conducted in the Department of General Surgery, SRM medical college hospital and research centre, Chennai, Tamil Nadu, India, from March 2021 to August 2022. Study was conducted on patients undergoing laparoscopic hernia mesh repair for paraumbilical hernia. A total of 60 individuals were included in the study. They were placed in groups A and B according to block randomisation with concealed cover. Group A got laparoscopic SCOLA repair and group B got laparoscopic IPOM repair. The patients were tracked for a total of six months. A comparison of two groups was done to evaluate which technique is superior over the other in terms of duration of hospitalisation, cost-effectiveness, duration of surgery, postoperative pain, postoperative complications, speed of recovery and returning to routine activity and recurrence. Results: Total 60 participants were divided into two groups, 30 subjects each in group A and group B with a mean±Standard Deviation (SD) age of the subjects in SCOLA group and IPOM group was 37.50±8.41 years and 37.87±9.18 years, respectively. Laparoscopic SCOLA repair for paraumbilical hernia has a comparable outcome to the traditional laparoscopic approach like IPOM in terms of postoperative wound healing (p-value=0.25). A 6-month follow-up revealed no recurrence in either group. Being a newer procedure that requires extensive dissection, the operating time (p-value=0.001), seroma formation (p-value=0.057) and number of hospital days (p-value=0.001) were higher for SCOLA. Also, it was noted that patients who underwent IPOM had significantly more pain experienced as compared to those undergoing SCOLA (p-value 0.45, 0.01 and 0.66 on postoperative days 1, 3 and 5, respectively). Moreover, a significant advantage of SCOLA is its cost-effectiveness. Conclusion: With the advantages of cost-effectiveness and lesser pain, SCOLA approach may be used more frequently in selected patients.

Early Exposure vs Delayed Exposure of Postoperative Wounds in Elective Inguinal Hernia Surgery: A Longitudinal Study

Athul Ashok, Sandeep Abraham Varghese

Introduction: Wounds and their management are fundamental aspects of the practice of surgery. A closed wound that heals in a timely fashion is considered to be a good indicator of surgical intervention. Many experimental studies have shown that precisely sutured incision with good haemostasis gets sealed with fibrin within 6 to 24 hours and the wound becomes adequately protected from outside moisture. Hence, early exposure to clean surgical wounds would be a cost-effective measure, especially in a resource-poor country like ours by avoiding unnecessary dressings for a long period of time. Aim: To assess the effectiveness of early exposure (24 hours) and delayed exposure (72 hours) in wound management after elective inguinal hernia surgery. Materials and Methods: A longitudinal study was conducted in the Department of General Surgery of Government Medical College, Kottayam, Kerala, India from September 2020 to August 2021. All elective cases (n=200) posted for inguinal hernia of age more than 18 years were consecutively allocated to two groups, group A early exposure of surgical wound site and group B delayed exposure. The wound site examination, on the third day along with white blood cell count was assessed. Wound site examination on 7th day and 30th postoperative day and length of hospital stay were recorded. Southampton wound grading system was used for recording healing parameters. All data were described using means for continuous variables and percentages for categorical variables Chi-square test was used for categorical variables with significance level at p<0.05. Results: Out of the 200 patients studied, 92 (92%) were males in group A and 94 (94%) of them were males in group B. The wound contamination in those patients where postoperative dressing was removed after 24 hours (group A) and 72 hours (group B), it was found that majority of patients had wound Grade-0 irrespective of dressing i.e., 96% and 97%, respectively (p-value=0.395) with reference to wound condition on postoperative day 7. In group A patients had (96 cases in 0-10 days) compared to group B (97 cases in 0-10 days) although statistically, it was not significant (p-value >0.05). Conclusion: There is not much difference in wound healing and incidence of surgical site infection in patients, whose wounds were kept open 24 hours after surgery when compared to those, whose wounds were dressed daily for the next two days consecutively.

Clinicoradiological Study of Diffuse Axonal Injury: A Longitudinal Study

Dheeraj Godara, Avinash Sharma, Anand Sharma, Akash Chhari, Ankit Meena

Introduction: Damage to the axons in neural brain tracts, corpus callosum, and brainstem, known as Diffuse Axonal Injury (DAI), can result in considerable morbidity and mortality in patients with head injuries. This type of injury involves microscopic damage and can have severe consequences. Aim: To investigate the incidence, clinical features, and radiological findings of DAI on Magnetic Resonance Imaging (MRI) and to associate MRI grading with neurological outcome using the Glasgow Outcome Scale (GOS). Materials and Methods: A longitudinal study was conducted in the Department of Neurosurgery, Jayarogya group of Hospitals, Gajra Raja Medical College, Gwalior,Madhya Pradesh, India, from December 2017 to November 2019. All the patients with Glasgow coma scores of eight or less with Computed Tomography (CT) and MRI brain findings consistent with DAI were included. The study collected data on patients including sociodemographic information, clinical variables related to trauma, details of hospital admission and stay, and variables related to the severity and consequences of DAI. Glasgow Coma Scale (GCS) was noted after resuscitation, MRI brain was done in stable patients. The neurological outcome was assessed after six months using the GOS and associated with MRI brain grading. The analyses were done using Statistical Package for Social Sciences (SPSS) version 26.0 and the frequencies were reported as percentages. Results: A total of 694 patients with head injury were included, and out of these, 94 had DAI. The mean age was 33.97 years with a male:female ratio of 4.33:1. Grade 1, grade 2, and grade 3 MRI brain findings were present in 50% (N=50), 31.25% (N=20), and 18.75% (N=12) of cases, respectively. The most common site for contusions was the parietal-temporo-occipital region, found in 85.93% of cases. Regarding functional outcome, a poor outcome was observed in 26.67% (n=4) of grade II DAI and 75% (n=9) of patients with grade III DAI. Conclusion: DAI is a major mechanism involved in Traumatic Brain Injury (TBI). In affected patients, long term hospitalisation is necessary. Patients with MRI grade I and II had a good outcome.

Association of CD10 and VEGF Expression with Tumour Characteristics and Treatment Response in Patients of Carcinoma Breast- A Prospective Cohort Study

Introduction: Majority of breast cancer patients receive systemic therapy. This has led to an extensive search for effective factors to predict the outcome. Two such markers for breast cancer are Cluster of Differentiation 10 (CD10) and Vascular Endothelial Growth Factor (VEGF). There is limited data available in the literature to support these parameters in breast cancer patients, especially from the Indian subcontinent. Aim: To ascertain the association of pre-chemotherapy levels of CD10 and VEGF with tumour load in breast cancer and treatment response. Materials and Methods: A prospective cohort study was conducted in the Department of Surgery in collaboration with the Department of Pathology at Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from November 2015 to February 2017. A total of 39 patients with Locally Advanced Breast Cancer (LABC) were included in the study. Preoperative levels of CD10 and VEGF were estimated in large needle core biopsy specimens. Standard anthracycline based chemotherapy was given to all patients as a 21 days cycle for three cycles. All patients underwent modified radical mastectomy after Neoadjuvant Chemotherapy (NACT). Levels of CD10 and VEGF were estimated again in the mastectomy specimen. Increase/decrease or no change in VEGF and CD10 expression percentage was ascertained for each patient after systemic therapy. Variables that were studied in the present study were Tumour, Nodes, and Metastasis (TNM) staging of patient, expression of VEGF and CD10 in large needle core biopsy specimens and its association with tumour load, response to NACT and its association with CD10 and VEGF and histopathological characteristics like presence or absence of lymphovascular invasion oestrogen, progesterone and Human Epidermal Growth factor Receptor 2 (HER2)/neu receptor status. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 22.0. Association between two ordinal variables was established using Kruskal-Wallis test. A comparison of ordinal paired data was done using Wilcoxon signed-rank sum test. The p-value <0.05 was considered significant. Results: The mean age of study participants was 42.0±11.4 years. Increase in TNM staging lead to higher CD10 and VEGF expression (p-value <0.05 and <0.029, respectively). There was a significant reduction in CD10 and VEGF expression postchemotherapy (p-value <0.05). CD10 expression was found higher in subjects with ER-negative status (22 patients) with p-value=0.014 and HER2/neu positive status (19 patients) with p-value=0.028. Subjects with HER2/neu positive status had higher VEGF expression (20 patients) with p-value=0.032. Conclusion: CD10 and VEGF can be used as independent markers for indicating poor prognosis and can be used as target for development of novel therapies in carcinoma breast.

Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block versus Epidural Block for Postoperative Analgesia Following Lower Abdominal Cancer Surgeries- A Randomised Clinical Study

Introduction: Effective post-operative analgesia improves patient’s outcome and satisfaction. Many methods are available to provide best analgesia after major abdominal surgery. Epidural anaesthesia is “gold standard” but it is associated with its own drawbacks. Transversus Abdominis Plane (TAP) block is a comparable technique to epidural to provide reliable analgesia in lower abdominal surgeries. Aim: To compare the efficacy of Ultrasonography (USG) guided TAP block and the epidural block for the post-operative pain management in lower abdominal cancer surgery. Materials and Methods: This randomised clinical double-blinded study, conducted in 60 female patients undergoing lower abdominal cancer surgery under General Anaesthesia (GA) from July 2022 to September 2022. Patients were randomised to Group-E and Group-T. Group-E (Epidural) received injection (inj.) 0.2% Ropivacaine (10 mL) plus inj. Morphine 2 mg via epidural. Group-T (TAP) received inj. 0.2% Ropivacaine (20 mL) plus inj. Morphine 2 mg on each side via USG guided TAP block postoperatively. The Visual Analog Scale (VAS) Score, first rescue analgesia, total analgesic consumption and any side-effects in 24 hours were recorded. The Statistical Package for Social Sciences(SPSS) version 22.0 International Business Management (IBM) Corporation (NY) was used for statistical analysis. Unpaired t test, Chi-square test and Fisher’s-exact test and one-way Analysis of Variance (ANOVA) test were used as and when appropriate. Results: Data of total 60 female patients , 30 patients in each group(Group E mean age: 47.33±9.614 years and Group T mean age: 47.77±12.370 years) was collected and analysed. Both the groups were comparable with respect to age, height, weight, American Society of Anaesthesiologists (ASA) grade, mean duration of surgery and duration of anaesthesia (p>0.05). More patients in group-E had moderate pain at rest and coughing (VAS-4 to 6) at six hours and 12 hours which is statistically significant (p<0.05). None of the patient in both groups had severe pain. The time for the need for the first rescue analgesic was lower in Group-E (399.6±25.32 min), and in Group-T it was higher (462.6±26.94 min) which is also statistically highly significant (p<0.001). Conclusion: TAP has advantage over epidural in terms of effective postoperative analgesia, time of need and quantity of postoperative analgesics.

Effect of Addition of Magnesium Sulphate to Fentanyl and Hyperbaric Bupivacaine in Spinal Anaesthesia for Abdominal Hysterectomy: A Randomised Clinical Study

MN Pooja, KT Prathibha

Introduction: Subarachnoid block is the most acceptable and popular mode of anaesthesia for gynaecological surgeries. Addition of opioids to intrathecal bupivacaine is routinely practised. Magnesium sulphate (MgSo₄), when used intrathecally has an advantage in preventing central sensitisation to peripheral nociceptive pain because it is an N-Methyl-D-Aspartate Receptor (NMDA) antagonist. Aim: To find out the efficacy of MgSo₄ as intrathecal additive to combination of fentanyl and hyperbaric bupivacaine in prolonging duration of analgesia. Materials and Methods: This randomised clinical study was conducted between June 2022 and November 2022 in women of American Society of Anaesthesiologists (ASA) grade I and II aged 50 to 70 years scheduled for abdominal hysterectomy under spinal anaesthesia. They were randomly divided into two groups of 30 each (group ‘S’ and group ‘M’). Group ‘S’ received spinal anaesthesia with 3 mL (15 mg) of hyperbaric bupivacaine, 0.5 mL (25 μg) of Fentanyl and 0.1 mL of 0.9% normal saline while group ‘M’ received 3 mL of hyperbaric bupivacaine, 0.5 mL (25 μg) of Fentanyl and 0.1 mL (50 mg) of 50% MgSo₄ intrathecally. End points of observation were time for onset of sensory and motor block and duration of analgesia. Data were entered in Microsoft Excel using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Demographic profile was comparable between both the groups. Delay in onset of sensory block was observed in group ‘M’ (9±0.68 minutes) compared to group ‘S’ (4.88±0.47 minutes) (p<0.001). Similarly, onset of motor blockade too was delayed in group ‘M’ (11.92±0.71 minutes) compared to group ‘S’ (6.83±0.65 minutes) (p<0.001). Postoperative analgesia was significantly prolonged in group ‘M’ (262±8.3 minutes) compared to group ‘S’ (235±12.3 minutes) with a p-value of <0.001. Haemodynamic profile and side-effects showed no significant difference between both the groups. Conclusion: Addition of MgSo₄ (50 mg) to combination of fentanyl and hyperbaric bupivacaine when given intrathecally prolongs the duration of spinal analgesia significantly in patients undergoing abdominal hysterectomy without significant side-effects.

Comparison of Intravenous Tranexamic Acid versus Combined Intravenous and Local Infiltration of Tranexamic Acid in Reducing Perioperative Blood Loss in Patients Undergoing Primary Unilateral Total Hip Arthroplasty: A Randomised Clinical Study

T Sita Rao, Monu Yadav, Akhya Kumar Kar, D Padmaja

Introduction: The use of Tranexamic Acid (TXA) in primary unilateral Total Hip Arthroplasty (THA) is well documented. However, considering the potential side effects including deep vein thrombosis and pulmonary embolism, the ideal route of administration of TXA to patients undergoing THA is still not known. Aim: To compare the efficacy of single dose intravenous (i.v.) TXA administration versus combined intravenous and local infiltration of TXA in reducing the perioperative blood loss in primary unilateral THA patients. Materials and Methods: This prospective, randomised clinical study, was conducted in the Department of Anaesthesiology and Critical Care at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, between October 2020 to May 2021. 60 patients were randomly allocated into two groups: the combined group C (i.v. administration of 10 mg/kg of TXA combined with local infiltration of 600 mg TXA diluted to 60 mL with normal saline) and the single i.v. group S (i.v. administration of 10 mg/kg of TXA). The perioperative blood loss was calculated in terms of three variables- intraoperative blood loss, drainage blood loss and total blood loss. The number of postoperative blood transfusions noted. Student’s t-test and Fischer’s-exact tests were applied for statistical analysis. Results: A total of 60 patients scheduled to have primary unilateral THA. Both the groups were similar in demographic features, baseline biochemical values and procedural distribution. There was a statistically significant reduction in the (mean±SD) intraoperative blood loss (697.26±221.43 mL), drain blood volume (254.66±81.36 mL) and total blood loss (952.26±263.57 mL) in the combined group C when compared to the single group S. There was no statistically significant difference (p-value=0.671) in the postoperative blood transfusion rate between the two groups. Conclusion: Intravenous combined with local infiltration of TXA significantly reduced the perioperative blood loss in patients undergoing primary unilateral THA when compared to single dose intravenous administration of TXA.

Clinical Profile of Cutaneous Adverse Drug Reactions in HIV Patients: A Cross-sectional Study

Introduction: Cutaneous Adverse Drug Reactions (cADRs) are one of the most common clinical presentations in patients with Acquired Immunodeficiency Syndrome (AIDS). These patients are more prone to developing cADRs due to various factors such as altered drug metabolism, immune dysregulation, genetic predisposition, polypharmacy, and oxidative stress. Therefore, a methodical study of cADRs, including risk factors, patterns of drug eruption, and prognostic factors, is of crucial clinical significance. Aim: To determine the prevalence of cutaneous drug reactions in Human Immunodeficiency Virus (HIV) patients and also study the various patterns of cADRs. Materials and Methods: This cross-sectional study was conducted at the outpatient department of Infectious Diseases and Medical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India, from April 2020 to December 2020. A total of 150 HIV patients above 18 years who were taking Anti Retroviral Therapy (ART) were included in this study. After screening for cADRs, it was classified as Morbilliform Eruption, Erythema Multiforme, Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and Fixed Drug Eruption (FDE), etc. The severity of the reaction was graded based on the Modified Hartwig and Siegel severity assessment scale. Pearson Chi square test and Bivariate Pearson Correlation were performed to statistically analyse the data. Results: Among the total of 150 HIV patients (87 males and 63 females), the mean age of the study population was 41.07 years. There was a male predominance with a male-to-female ratio of 1.3:1. About 44% (n=6) of the study population had opportunistic infections. The prevalence of drug eruptions in this study was found to be 6% (n=9). Out of which, 55.6% (n=5) of the population had a morbilliform eruption, and 22.7% had urticarial (n=2) and pruritus (n=2), respectively. About 56% (n=5) of the drug reactions were caused by the Tenofovir/Lamivudine/Efavirenz regimen, and the remaining 44% (n=4) of the drug eruptions were caused by the Abacavir/Lamivudine/Dolutegravir regimen. Conclusion: The prevalence of drug eruptions in this study was 6%, and the majority of the population had a morbilliform eruption.

Safety and Efficacy of Oral Itraconazole versus Combination with Oral Isotretinoin in Superficial Dermatophytosis: A Randomised Clinical Trial

Divya Priyadarshi, Deepika Agarwal, Ankur Talwar

Introduction: Dermatophytes are the most common skin infections and are mainly treated with itraconazole. However, the persistent nature of the disease has emerged as the major concern over the last few years. Oral isotretinoin, a keratolytic drug, is also used in conjunction with itraconazole to manage dermatophytosis. Aim: To evaluate the safety and efficacy of oral itraconazole versus a combination of oral isotretinoin and oral itraconazole in the treatment and prevention of recurrence of superficial dermatophytosis. Materials and Methods: A randomised clinical trial was conducted in the Dermatology Outpatient Department (OPD) of the Hind Institute of Medical Sciences, Barabanki district of Uttar Pradesh over a 12-month period. A total of 180 adult patients clinically diagnosed with superficial dermatophytosis were recruited and randomised into groups A and B. Patients in group A were treated with oral itraconazole 200 mg daily, and patients allotted in group B received oral itraconazole 200 mg plus oral isotretinoin 20 mg daily. Both groups were evaluated every 15 days for two months, and then followed-up for an additional two months to assess the relapse rate. Treatment efficacy was assessed by potassium hydroxide (KOH) test done on skin scrapings, erythema score, scaling score, and a 5D pruritus scale, while safety was evaluated by monitoring adverse reactions at each sequential visit during the two-month study period. The data were analysed using Chi-square tests and unpaired t-tests and Statistical Package for the Social Sciences (SPSS) software version 26.0, with a p-value <0.05 considered significant. Results: Of the 180 patients enrolled, 162 patients (83 in group A and 79 in group B) completed the trial. The patients in group B had early and complete mycological cure, seen in 77/79 (97.5%) patients, compared with 74/83 (89.2%) in group A (p=0.06), with a significantly lower recurrence rate (p=0.01). At each follow-up, both groups were assessed based on the clinical signs of erythema and scaling, rated on a 4-point scale (0, 1, 2, 3), and the clinical symptom of itching on a 5D pruritus scale ranging from 5-25. There was a statistically significant difference in the treatment response between the studied groups (p<0.05). Hepatic derangements were the most common adverse effects observed in both groups. Conclusion: Oral isotretinoin can be an effective add-on therapy in the management of superficial dermatophytosis, as it induces early remission with a significantly lower recurrence rate.

Effectiveness of Preoperative Education and Music Intervention on Postoperative Outcomes among Patients Undergoing Abdominal Surgery: A Quasi-experimental Study

Hezil Reema Barboza, MS Moosabba, Fatima D Silva, Amar Sunil Lobo

Introduction: The preoperative phase includes various procedures that aim to prepare the patient physically and psychologically to promote postoperative recovery. Preoperative education and music intervention may play an important role in improving the postoperative outcomes. Aim: To study the effectiveness of preoperative education and music intervention on postoperative outcomes, such as anxiety and pain, and to assess the satisfaction of patients, regarding surgical experience on discharge. Study also aims to initiate early feeding and its effects on postoperative recovery. Materials and Methods: A quasi-experimental study was conducted in Surgical Wards of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, between January 2021. A total of 52 patients undergoing major abdominal surgery were selected and divided into intervention and control groups. Two days before the surgery, patients in the intervention group were given preoperative education and were encouraged to listen to preferred music in the evening. Music intervention was given for two days before the surgery and continued in the postoperative phase for three days. Immediately after the music intervention, the anxiety was assessed by State-Trait Anxiety Inventory (STAI) and severity of pain using numerical rating scale. Early feeding was initiated postoperatively and the patients were observed for discomfort and complications. The patients satisfaction was evaluated for their surgical experience on discharge using a patient satisfaction questionnaire. An independent t-test and Mann-Whitney U test were used to compare the variables between the groups. Results: The mean age in the intervention group was 43.46±14.89 years and control group 44.07±12.64 years. The majority of subjects in the both groups were males. A reduction in anxiety scores was observed among patients in the intervention group that was statistically significant (p<0.05) at preoperative day 1, 2, postoperative day 1, 2 and 3. The mean pain scores decreased from preoperative day 1 to postoperative day 3 in the intervention group than in the control group. In the intervention group, 7.7% of the patients received oral feed within an hour of surgery whereas, 26.9% were in the fourth hour and 26.9% were in the sixth hour of surgery. They did not report discomfort and complications such as nausea and vomiting. In the intervention group, the mean satisfaction was 60.30±5.00, indicating a higher level of satisfaction among patients. Conclusion: Preoperative education and music intervention reduces the severity of anxiety and pain. Early oral feeding is safer and effective in patients undergoing elective abdominal surgery. These interventions help in improving the postoperative outcomes and satisfaction with surgical experience.

Development, Evaluation, and Comparison of an Indigenous ‘APDS’ AI-based Digital Application for Effective Shade Selection of Silicone Maxillofacial Prosthesis: Protocol for A Cross-sectional Study

Priyadarshani G Pawar, Anjali Bhoyar, Seema Sathe

Introduction: Reconstruction of maxillofacial defects is challenging in achieving aesthetic results. Replicating natural skin colour in maxillofacial prosthesis has been traditionally done using trial-and-error methods. However, with their respective limitations, multiple methods have been developed recently, like colourimeter and spectrophotometer. Need of the study: The natural appearance of the prosthesis significantly impacts the emotional and psychological well-being of patients. Thus, aesthetics have become a primary concern. Consequently, the challenge of accurately matching the colour of maxillofacial prostheses is evident. To address this, there is a need to develop customised shade guides and advanced digitised shade-matching applications with the assistance of Artificial Intelligence (AI). Therefore, a concoction of a customised silicon shade guide is contemplated with Advanced Programme in Data Sciences (APDS) AI-based digital application, and its reproducibility in clinical practice will be analysed. Aim: Phase 1- To develop and validate a customised broad spectrum silicon shade guide and APDS AI-based digital application for the Indian population. Phase 2- Comparative evaluation of the efficacy of indigenous APDS AI-based digital application with available shade guide systems for shade selection for silicone maxillofacial prostheses. Materials and Methods: This cross-sectional study involves fabricating the shade guide using medical-grade room temperature vulcanising silicone, based on an observational survey. The shade guide will consist of three main groups (ABC), divided into different subgroups representing lighter to darker skin shades. The accuracy of the shade guide will be evaluated using aspectrophotometer. The APDS AI-based digital application will be developed using the reference from the customised broad-spectrum maxillofacial shade guide. The efficacy of the application will be evaluated through visual assessment of colour matching by fabricating facial veneers for participants. Investigators will assess the consent of perfect colour match. The data will be statistically analysed.

Digital Dentures- The Future of Complete Dentures in Oral Rehabilitation

The conventional method of fabricating Complete Dentures (CDs) consists of many clinical and laboratory steps, making it more susceptible to certain problems and inevitable errors. With the advances in the field of technology, these errors can be avoided or minimised. Digital technology making use of computers for designing and or manufacturing CDs is referred to as digital dentures. In this, entire dentures are made by machining the denture’s bases using Computer-Aided Design and Manufacturing (CAD/CAM). Technology’s quick development in the form of CAD/CAM has had a significant impact on all areas of dentistry, but notably prosthodontics and restorative dentistry. This system has not only simplified the process of fabrication of CDs but also reduced the clinical chairside time, number of dental appointments and helped to deliver error free dentures. It also helps to store the data in digital form which can be utilised further for fabricating other sets of dentures for that particular patient. The most important advantage over conventional denture is that, it lacks polymerisation shrinkage of the acrylic resin and exhibit high strength. Furthermore, it also eliminates laboratory work time. The provision of prosthodontic treatment requires the patient, a qualified physician, and competent laboratory personnel on various levels. The goal of the current review article was to demonstrate how modern technology can replace the traditional approach not only by making labour easier but, also by enabling precise full denture production.

Remineralisation of Enamel using Natural and Plant Products: A Narrative Review

Preventive approaches towards dental caries have been the focus of research in dentistry since the last century. Fluoride and various non fluoride remineralising products are already in the market. Despite this, in the last two decades, the scientific community has increased its exploration of alternative caries prevention solutions, including herbal remedies. The primary objective of this article was to review the current status and developments in the field of remineralisation using natural products, ethnopharmacological agents, and their active compounds. It could be concluded from the current review that natural phytochemicals have considerable promise as supplementary anticariogenic therapies for the prevention and treatment of dental caries. However, the ultimate efficacy of therapeutic solutions containing cariostatic natural substances depends on their capacity to demonstrate a significant reduction in individual caries progression. To establish the effectiveness of natural products in preventing dental caries or promoting remineralisation, well-designed Randomised Controlled Trials (RCTs) are necessary. In addition, additional research is required to discover the precise cariostatic modes of action and effective dosage of natural substances.

Literature Review on Morphology and Morphometry of Foramen Ovale in Indian Skulls

Foramen ovale is seen in the base of the skull connecting the infratemporal fossa and middle cranial fossa. Knowledge of the exact location and dimensions of foramen ovale is essential for trigeminal rhizotomy, electroencephalogram of the temporal lobe and endonasal endoscopic trans-sphenoidal approach to the infratemporal fossa. In this literature review, articles reporting morphology, morphometry, and variations of foramen ovale in Indian skulls from standard databases between 1979 and 2022 were selected. The sample size ranged between 20 and 250 skulls. The common shape observed was oval (96.9%) and duplication of foramen ovale was seen commonly on the right-side. The presence of accessory bony structures, namely spine, tubercle, spur, septa and bar was reported but was difficult to compare due to a lack of uniform classification. The length, breadth, and area of foramen ovale ranged from 5.0-8.9 mm, 3.1-6.0 mm, and 19.1-34.2 mm2, respectively. In the majority of the studies, no significant difference was observed in these parameters between the sides and between the sexes. These data will be useful while attempting surgical or invasive procedures in the skull base of Indian subjects and help to avoid damage to the structures passing through the foramen ovale and the resulting complications.

Systemic Assessment of Fabricated Injury in Sexual Assault Cases: A Narrative Review

Sachin Kumar Tripathi, Richa Choudhary, Rajiv Ratan Singh, Pradeep Kumar Yadav

Sexual assault on females may ruin the entire life of the victim. Victims of such incidents rarely get support from any quarters of society, including their family members. On the other hand, men can be made the victim of such heinous crimes by false accusations by women for various motives. As most of the judgments on sexual assault cases are based on circumstantial history, and oral evidence, it may be very hard to disprove the allegation. According to the figures from National Crime Records Bureau’s (NCRB) crime in India report 2020, less than 8% of all cases under investigation for rape were found to be false. In 2014, the Delhi commission for women submitted a report stating that, 53.2% of rape cases registered between April 2013-July 2014 was false. In India, the threat of false rape cases on one pretext or the other is increasing since the new amendment to the rape law in 2013. This fact is evident from the study of court judgments and media reports. In most false sexual assault cases, the victim took advantage of a fabricated injury to strengthen the case. There are various motives behind fabricating injury to register false sexual assault cases some of which are, to bring a charge of rape, heartbreak, anger, or some other mala fide motive induces a woman to file a false rape case majority, some women just do it to seek the attention of the media and have publicity, to defame others, to gain a large sum of money by a false allegation and to obtain compensation from the Government, In most cases, it is also found that to cover up first sexual intercourse women falsely accuse their partner of sexual assault. Various studies of disguised injuries in assault incidents showed that, the limbs, neck, and chest are the most favoured sites for disguised injuries.

Current Status of Intranasal COVID-19 Vaccine, its Usage and Efficacy: A Narrative Review

Ratan Tandon, Abhishek Joshi

The creation of a vaccine against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has received top focus worldwide. The majority of the COVID-19 vaccine candidates are administered Intramuscularly (IM). Intranasal (IN) vaccines offer a great benefit due to the first involvement of mucosa of the nasal cavity in the due course of disease, also SARS-CoV-2 is spread through respiratory secretions which are infectious, and mucosal immunity due to IN vaccination could contribute significantly to controlling this disease. IN vaccination has been shown in preclinical and clinical investigations to produce significant levels of neutralising antibodies, mucosal IgA, and T-cell responses that protect against SARS-CoV-2 infection in the respiratory pathway. Blocking Coronavirus Disease-2019 (COVID-19) infection and transmission requires the immune system response at the initial infection site of the virus. Many IN vaccines are currently under trial for their safety and efficacy, while some are recently approved for use in specific conditions in India and are proven to be protective against the virus and also safe. In this context, this review will provide knowledge of the IN vaccines for their effectiveness and application.

Anaemia in the Elderly: A Narrative Review

Anaemia is a common morbidity in elderly people (i.e., people who belong to the age group of 60 years or higher). Present-day knowledge is that senescence is the consequence of homeostatic interference. The processes responsible for maintaining it comprise hormones, immune-regulating mechanisms along with oxidative stress/antioxidant equilibrium. Anaemia is caused by any change in these factors. The moment anaemia comes into the picture, it hampers the supply of oxygen causing further deterioration, culminating in debility and infirmity. Anaemia in the senile citizens can lead to certain adverse health events, including functional dependence and may amplify the risks of therapeutic complications, falls, dementia and mortality. Anaemia has a high potential of producing serious impediments in elderly people when compared with younger adults. As a result of which, the Quality Of Life (QOL) of the senescent age group is adversely affected. Hence, early diagnosis of anaemia aids in preventing unforeseen medical situations later. More emphasis is being given to this aspect because of the fact that despite its fair prevalence amongst the elderly, the chances of it being missed on routine clinical examinations are higher.

Faecal Microbiota Transplant: A New Biologic Frontier in Medicine

Ankita Thakur, Sourya Acharya, Samarth Shukla

Faecal Microbiota Transplantation (FMT) refers to the process of introducing the gut microbiome into a compromised patient’s Gastrointestinal (GI) tract after obtaining it from a healthy donor. It is one of the chief treatment options for people afflicted with a chronic Clostridium difficile infection. Recently, other possible applications of FMT have been gaining worldwide attention as an emerging approach to treating a multitude of disorders, such as metabolic syndrome, neurological diseases like autism, Inflammatory Bowel Disease (IBD), and so on. FMT is not currently being used in clinical practice due to practical objections, though research on how to overcome the these is ongoing. This article seeks to explore FMT as a procedure, its current indications and the results from various studies, applications of FMT as a course of treatment in other diseases, and the limitations that the procedure poses for the same, upon which further studies can commence, and advancements can be made in the field of medicine.

Grapeseed Extract and its Role in Maintaining Oral Health: A Literature Review

Payal S Waghmare, Priyanka Paul Madhu, Amit Reche

Plant products are becoming a topic of discussion because of their properties and many medicinal benefits. Among these natural products, Grapeseed Extract (GSE) is becoming an essential part of medicine. It possesses antibacterial, antioxidant, anti-inflammatory, and antiviral properties. GSE’s antibacterial property makes it effective in controlling various bacterial diseases and aiding in the treatment process. It has also been found to inhibit oral bacteria. GSE has shown considerable results in patients with periodontal diseases and treatment of bone loss. GSE is a potent antioxidant and reduces free radicles and oxidative stress thus inhibiting various adverse effects. GSE contains antioxidant properties which protects body from premature ageing. Its antifungal properties are useful in treating and preventing fungal infections, including oral candidiasis. Phytochemicals present in Grapeseed Extract, such as resveratrol and Proanthocyanidin (PA), have demonstrated benefits in cancer treatment and prevention of recurrence. The protective properties of plant extracts and phytochemicals are also being explored in the prevention of common oral diseases, such as dental caries in both children and adults. Current studies are investigating the remineralisation efficiency of phytochemicals in dentistry. It has been shown to increase the dentine resin bond strength if it is added in the primer and also effectively reduces the polymerisation. Another important consideration is determining the safe doses of GSE, which refers to the quantity or percentage added to products to ensure safe tolerance and maximise its effects. Overall, GSE possesses several beneficial properties and holds great clinical importance.

Posture Correction Interventions to Manage Neck Pain among Computer and Smartphone Users- A Narrative Review

Fatima Khanum, Abdur Raheem Khan, Ashfaque Khan, Ausaf Ahmad, Hashim Ahmed

Digital technology has affected practically every aspect of modern life. Sitting is something that humans do for a number of purposes, including work (particularly for those who work in the computer industry), and for enjoyment. Daily computer use causes frequent neck and back pain. Flexed head and neck postures might cause neck pain during work. Pauses and postural modifications help avoid pain and sickness. Recent wearables can sense spinal alignment and provide immediate feedback on improper posture. Posture monitoring can help treat or change a user’s posture. In this narrative review, Google Scholar, PubMed, Cross-Ref, Cochrane, and ResearchGate were searched for English-only papers using review-specific keywords and fifty-one items were found. The search was narrowed by using more particular terms, such as “wearable postural correction sensors,” “forward head posture,” “neck discomfort in smartphone or computer users,” and “neck workouts.” Only current papers from 2015 onwards were considered. After filtering for relevancy, twenty-five articles were included. Researcher should identify intervention functions, policy categories, and tactics for behaviour change. Researchers have also examined neck discomfort, forward head posture in young individuals while using smartphones and computers, and posture correction using a wearable postural correction sensor. And also appropriate arrangement and support to administering a home and workplace fitness programme that eliminates pain and impairment while enhancing Forward Head Posture (FHP) and endurance. This review aimed to thoroughly examine existing literature for evidence concerning prevalent problems among smartphone and computer users such as neck discomfort and forward head position, postural correction sensor, and impact of exercises on neck discomfort.

Management of Colocutaneous Fistula with Surgical Intervention: A Case Report

BB Sunil Kumar, Pritvik B Sharath

A colocutaneous fistula is a type of enterocutaneous fistula where communication exists between the colon and the skin of the abdominal wall. The present case report is of postoperative colocutaneous fistula in a 32-year-old male patient, who had undergone left open nephrectomy. This is unique, as nephrectomy is not a procedure that is usually associated with such colocutaneous fistulas, particularly as this was a case of non functioning kidney and was not associated with severe inflammation or adhesions, which are usually prerequisites for a fistula to arise. Following surgery, patient developed feculent discharge from the drain in the early postoperative period. A Contrast Enhanced Computed Tomography (CECT) scan was done to evaluate the cause of the leak was done, which showed a colocutaneous fistula arising from the proximal descending colon with an abscess surrounding the fistula tract. The abscess was drained and conservative management was initially attempted to allow for spontaneous resolution of the fistula as spontaneous closure is the norm, when there are no unfavourable factors hindering spontaneous closure, as was the case in this patient. However, despite all factors being favourable for spontaneous closure of the fistula, it failed to occur in the present case. Furthermore, this patient required multiple surgical procedures, which is also unusual for a fistula such as this, where all factors being favourable for its spontaneous healing. Closure of the fistula was finally achieved by resection of the fistula tract along with the segment of the bowel containing the internal opening. The present case report highlighted the challenges posed by cases of colocutaneous fistulas and shows that thorough knowledge of all the treatment modalities available for its treatment, is required to successfully treat it.

Single and Double Fused Roots with C-shaped Canal Configuration in the Posterior Teeth of a Patient: A Rare Case Report

Afzal Ali, Banu Ariciog?lu, Hany Mohamed Aly Ahmed, Asma Zoya, Hakan Arslan

Cone Beam Computed Tomography (CBCT) allows three-dimensional evaluation of external root morphology and internal canal configuration of teeth thus allowing accurate diagnosis of rare complexities in the root canal system. This case study presented root canal re-treatment of a maxillary first molar #16 of a 29 years old female patient, wherein, thorough radiographic examination revealed single root morphology in all the teeth. CBCT analysis confirmed the root form and root canal configuration. Endodontic retreatment of the #16 was performed. The maxillary first molars had double fused roots with C-shaped canal configuration while maxillary second and third molars had O-shaped canals with single roots bilaterally. The mandibular first molars had two completely fused roots with C-shaped canal configuration. While the mandibular second and third molars also had C-shaped canal configuration with single roots. The canal configuration of maxillary and mandibular molars was classified according to Martin’s and Fan’s classification respectively. This unique finding of single and double fused roots with C-shaped canal configuration in the posterior teeth in a single patient has rarely been reported in literature.

Endobronchial Small Cell Lung Cancer Masquerading as Carcinoid Tumour in a Young Female: A Case Report

Mrinmayee Vijay Mayekar, Pankaj Wagh, Babaji Ghewade, Ulhas Jadhav

Bronchial Carcinoid Tumours, also known as BCTs, are remarkable neuroendocrine malignancies that can denature chemical compounds with biological activity. The phrase “bronchial adenomas” was once used to refer to BCTs; however, this nomenclature is no longer utilised because BCTs are neither glandular nor invariably benign. Instead, the term “Bronchial Cystic Tumours” is used to refer to BCTs in this context. They are normally a neoplasm that expands slowly and displays a variety of behaviours, yet they are also capable of expanding rapidly and being significantly more aggressive in general. Despite the fact that smoking is a significant risk factor for Small Cell Lung Cancer (SCLC), which is a more severe form of lung cancer than carcinoid, surgery is still the treatment of choice for carcinoid tumours, while chemoradiation and chemotherapy are the only options for patients with stage four SCLC. Here, the authors discuss the case of a 30-year-old young female patient who was erroneously diagnosed with endobronchial carcinoid, which turned out to be SCLC. Because of the significant connection between smoking and SCLC, malignancies are not usually seen in young females. The relevant patient’s investigations were consistent with small cell carcinoma of the lung. Immunohistochemistry for CD56 and synaptophysin turned out to be positive. The patient received six cycles of chemotherapy with an injection of Cisplatin and an injection of Etoposide every three weeks. She was followed-up after three months and did have symptomatic relief.

Imaging Implications in Plunging Ranula- A Rare Case Report

Sushmitha Sudharsan, Sankara Aravind Warrier, Vaishnavi Muthukumaran

Plunging ranula is an intraoral swelling plunging deep into neck and extending beyond the floor of the mouth. Clinical diagnosis is challenging to the clinician as, they mimic other neck lesions like reactive lymphadenopathy, cystic hygroma, thyroglossal duct cyst, abscess and so on. Herein, the authors present a case of a 34-year-old male with history of swollen neck for past three months reported to the outpatient ward. On examination apart from the extraoral swelling in the left side of the neck, there was also an evidence of dome-shaped fluctuant deep seated swelling in the floor of the mouth. Biochemical analysis of the patient was within the normal limits. Further two-dimensional (2D) radiographs findings also, were non contributory. An anechoic presentation indicating fluid-filled sac was evident on ultrasound imaging. Sialogram of the case revealed the classic tail sign indicating a defect beyond the mylohyoid muscle; thus, three-dimensional (3D) imaging paves the way for deriving a final diagnosis. Furthermore, patient has been enlightened about the available treatment options and is under regular follow-up. Adding as a novelty, the present case is discussed with complete clinical, videographic and radiographic presentation of plunging ranula.

Plasmablastic Myeloma- A Diagnostic Dilemma

Shiva Kumar Komaravelli, MB Deepak, S Bharath Ram, Hamza Dalal, KS Nataraj

Plasmablastic neoplasms comprise various haematolymphoid tumours with plasmablastic morphology which includes Plasmablastic Myeloma (PBM) and Plasmablastic Lymphoma (PBL). Distinguishing between these two entities remains a major diagnostic challenge. In view of Epstein Barr Virus (EBV)-Encoded RNA (EBER) negativity, Human Immunodeficiency Virus (HIV) negativity, high Serum Free Light Chain (SFLC) assay and absence of hypermetabolic lymphadenopathy, a final diagnosis of PBM was made. This report is about a 55-year-old lady who presented with fatigue, significant loss of weight, and appetite. She had mild enlargement of the liver, spleen and no significant lymphadenopathy. There were atypical cells in peripheral blood. Bone marrow evaluation showed 51% atypical mononuclear cells. Flow cytometry was negative for acute leukaemia diagnostic markers. Immunohistochemistry (IHC) on the bone marrow biopsy revealed positivity for Cluster of Differentiation (CD) 138, Multiple Myeloma 1 (MUM1) with kappa light chain restriction and negative for EBER. The free light chain showed a kappa:lambda light chain ratio of 28,885 (0.26-1.65). The diagnosis of PBM was made and she was started on a daratumumab-based immunotherapy regimen. She achieved complete remission after induction with Measurable Residual Disease (MRD) <0.01%. She is presently doing well on follow-up with the disease in remission status.

Different Medicinal Treatment Modalities in the Management of Patent Ductus Arteriosus in Paediatric Population- A Narrative Review of Available Drug Approaches

Kushal Desai, Amar Taksande

Regardless of the size of a patient’s Patent Ductus Arteriosus (PDA), it is crucial for paediatric and adult cardiologists to have a thorough understanding of the condition’s origin, clinical ramifications, and treatment options. Possessing a PDA, no matter how small, might cause complications. Ibuprofen and indomethacin, both cyclo-oxygenase (COX) inhibitors, are used as the gold standard pharmacologic therapy for closing a PDA that has been produced surgically. These non-selective COX inhibitors bring about ductal constriction, in addition to lowering the synthesis of prostaglandin. However, these drugs may also have a broad array of unintended consequences. Interest in paracetamol for PDA constriction has recently increased due to fewer adverse effects than indomethacin or ibuprofen. Evidence that paracetamol is now a topic of intense study lends credence to this hypothesis. Information on the long-term effects of paracetamol is scarce in the paediatric population.

Prevalence of Anaemia and its Association with Severity of COVID-19 among Hospitalised Patients: A Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) emerged as a global pandemic and was associated with various haematologic abnormalities. There are very few studies from India regarding the association between anaemia and disease severity of COVID-19. Aim: To check the prevalence of anaemia and its association with the severity of the disease among hospitalised COVID-19 patients. Materials and Methods: This was a cross-sectional study involving 203 patients admitted to the general ward and Intensive Care Unit (ICU) of a tertiary care hospital in eastern India. Complete blood count at admission along with other relevant clinical and laboratory parameters were noted. Haematological parameters of the patients were described and then correlated with disease severity and death. Spearman’s correlation and Chi-square test were used to determine the associations. Results: Out of 203 patients with COVID-19, 145 (71.4%) had anaemia. The study included 107 males (52.7%) and 96 females (47.3%), of which 77 (80%) females had anaemia compared to 68 (63.5%) males. Co-morbidities were present in 73 patients. Haemoglobin levels were significantly negatively correlated with disease severity (p<0.001). This was even true for patients without any other co-morbidities (p<0.05). Haemoglobin was also negatively correlated with deaths in this study (p<0.05). Conclusion: The prevalence of anaemia in admitted patients with COVID-19 was very high, and low haemoglobin levels were associated with more severe disease and death. Therefore, low haemoglobin levels in COVID-19 may be considered a risk factor for more severe disease and death.

Effect of Aerobika Device versus Acapella Device on Sputum Volume and Lung Functions in Chronic Obstructive Lung Disease Patients- A Research Protocol

Vishakha Tayade, Vishnu Vardhan

Introduction: Chronic Obstructive Lung Disease (COPD) is an incurable, gradually worsening respiratory condition characterised by airflow limitation and blockage that cannot be completely reversed. Productive cough caused due to mucus hypersecretion is a common symptom of COPD. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. Therefore, Oscillating Positive Expiratory Pressure (OPEP) devices are designed to aid in sputum clearing in COPD patients. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Need of the study: Chronic Obstructive Pulmonary Disease (COPD) makes it challenging for air to flow freely into and out of the lungs. Shortness of breath, cough, and mucus in the lungs are all possible symptoms. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. To help clear away excess sputum, numerous airway clearance devices can be used. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Aim: To compare the effect of Aerobika vs. Acaplla device on sputum volume and lung function in COPD patients. Materials and Methods: A comparative study will be performed in respiratory medicine OPD of Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha. Ethical approval was received from the Ethical Review Committee of Datta Meghe Institute of Medical Sciences, Deemed to be University. In this study 30 patients diagnosed with COPD will be categorised into two groups one group will receive aerobika device with conventional physiotherapy and another group will receive acapella device with conventional physiotherapy twice a day. Treatment will be given five days for one week. The assessment will be done on day one of the treatment and at the end of treatment which is first week. Sputum volume and lung function will be assessed by sputum collector and Pulmonary Function Test (PFT), respectively. The statistical analysis will be done using chi-square test. The parameters will be compared between both the groups for sputum volume and lung function over a period of one week. Data will be analysed in a statistical software SPSS 27.0.V.

Evaluation of Stress Level in Patient with Moderate Obstructive Sleep Apnoea Using PSS Questionnaire- A Research Protocol

Bhawna Shyamsukha, Sharayu Nimonkar, Vikram Belkhode, Surekha Godbole

Introduction: Obstructive Sleep Apnoea (OSA) is a sleep condition in which the upper airway becomes partially or entirely blocked during sleep, leading to reduced sleep arousals and arterial oxygen saturation. According to the epidemiological survey, OSA is relatively common among people. Hence, there is need to analyse emotional stress in patients suffering from OSA. Need of the study: OSA and emotional stress are inter-connected hence, a diagnosis of OSA is necessary to determine the patient’s level of emotional stress. Aim: The research protocol aims to determine the stress level among patients suffering from moderate OSA and to compare the effect of gender on stress among such patients. Materials and Methods: A cross-sectional study will be conducted over a period of six months from May 2022 to October 2022 at Respiratory ward of Datta Meghe Institute of Medical Sciences, Maharashtra, India. This study is planned to assess emotional stress among patients suffering from moderate OSA with sample size of 20 subjects (10 male, 10 female) without any other demographic criteria. Polysomnography (PSG) will be used to record the patients’ data. The patients will be charged for the PSG procedure. An overnight PSG will be performed in Department of Sleep Medicine at the chosen study institute. An online questionnaire consisting of 14 statements will be used to gather and analyse information. The questionnaire will assess stress levels using the previously validated questionnaire, Perceived Stress Scale (PSS) questionnaire, provided by the American Sociological Association (ASA). Participants will be asked to rate their stress according to a PSS score. Descriptive analysis will be used for statistical analysis.

Correction: 2014 Oct:8(8): BE01 - BE04

K.Prabhavathi, K.Tamarai Selvi, K.N.Poornima, A.Sarvanan , Role of Biological Sex in Normal Cardiac Function and in its Disease Outcome - A Review (Published in Journal of Clinical and Diagnostic Research. 2014 Aug, 8(8): BE01 - BE04 ) An error was brought to the attention of the editors regarding a factual inaccuracy in the line supported by reference 5 (page 1, right column). The statement "As men ages they lose an average of 1gm of cardiac mass everyday" was erroneously printed and has now been corrected to "As men age, they lose an average of one gram of cardiac mass per year." During the correction process, we again re-reviewed the manuscript for any other oversights. The following edits to have been made to improve or correct the message conveyed. - A sentence was added preceding reference [11] on page 1. - On page 3, the word "Wild-type" has been added in the sentence supported by reference no. [32]. - Three typo errors in the reference numbering within the text have been corrected. On page 1, the reference [3] has been changed to reference [7] following the words "regular exercisers." On page 3, the reference number [36] has been changed to [35] after the word "agonist," and on same page the reference [38] has been changed to [39] following the words "plasma membrane".