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

Haemorrhagic Cystitis in a Case of Secondary Pelviureteric Junction Obstruction: A Rare Case Report

Abhirudra Mulay, Suraj Bhondave, Amala Ghalsasi, Radhika Salpekar, Ujjwal Bhardwaj Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Haemorrhagic cystitis ranges in severity from a transient condition to a life-threatening condition which may quickly resolve or require intervention on a priority basis. It is characterised by bleeding from the bladder mucosa and diffuse inflammation. Case of fungal haemorrhagic cystitis with secondary Pelviureteric Junction Obstruction (PUJO) is relatively rare. Hereby, the authors present a case of 57-year-old male who presented to Emergency Department with painful haematuria and increased frequency of micturition, found to have bladder clots and right secondary PUJO on diagnostic investigation. Clot evacuation and bleeder fulguration with right Double J (DJ) stenting was done. Urine culture and sensitivity report was suggestive of budding yeasts. Uncontrolled diabetes mellitus, with an HbA1c of 8.1%, could explain it. He was discharged on postoperative day two with oral cephalosporins and oral antifungals with Foley catheter in-situ. It was followed by Diethylene Triamine Penta Acetic Acid (DTPA) scan 15 days later, which revealed an enlarged, poorly functioning hydronephrotic obstructed right kidney with Glomerular Filtration Rate (GFR) of 5.7 mL/min, and satisfactorily functioning hydroureteronephrotic left kidney with GFR of 54.6 mL/min. Right open simple nephrectomy was done through the 11th rib flank incision to prevent future complications. Haemorrhagic cystitis should be kept as a differential diagnosis in patients with haematuria not responding to conservative management with multiple co-morbidities. Management of underlying cause remains the key to treatment.

Familial Occurrence of Mycoplasma-induced Rash and Mucositis: A Case Report of Two Siblings

Roja Aepala, Satyanarayana Kavali, Srividya Devarakonda, Nikhil Dasari, Sai Goutham Manikyala Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Mycoplasma pneumoniae is a common pathogen responsible for respiratory infections, including community-acquired pneumonia, and up to 25% of patients develop extrapulmonary complications. Mycoplasma-Induced Rash and Mucositis (MIRM) is a recently identified clinical entity typically preceded by pneumonia-like symptoms such as fever and cough. The differential diagnoses for MIRM include Erythema Multiforme (EM), Stevens-Johnson Syndrome (SJS), Herpetic gingivostomatitis, Kawasaki disease and Toxic Epidermal Necrolysis (TEN). This condition primarily affects children and adolescents, with a mean age of 12 years and shows a male predominance. The authors report a rare occurrence of MIRM in two siblings, underscoring the condition’s rarity and clinical importance. The combination of prominent mucosal involvement at two sites, with sparse cutaneous findings, preceded by a prodrome of respiratory symptoms and the absence of a drug history, raised suspicion of Mycoplasma infection, which was confirmed by positive Mycoplasma IgM antibodies. Both siblings recovered well with a macrolide antibiotic and a short course of corticosteroids. While sporadic cases of MIRM are reported, familial occurrences in siblings highlight a genetic or environmental predisposition. Early recognition is crucial, as demonstrated by its occurrence in siblings, where prompt diagnosis led to favourable outcomes. Increased awareness among physicians can aid in accurate diagnosis, appropriate management and effective counselling.

Anastomotic Strictures after Whipple Procedure: A Report of Two Cases

Puvvada Prashanth, Sankareswaran Sugaprakash, Raju Prabhakaran, Chidambaranathan Sugumar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Whipple procedure is a major surgery performed for periampullary cancers. With improved surgical techniques and intensive care, perioperative mortality has become a rare event, occurring in less than 2% of cases; however, morbidity remains common, occurring in 30-50% of cases. Hereby, authors present a case report of two patients who were operated on for periampullary cancer and have now presented with anastomotic site strictures, hepatolithiasis and pancreatitis. Case 1 was a 58-year-old male who underwent the Whipple procedure with pancreaticojejunostomy 13 years ago for periampullary growth. The patient now presented with pancreatitis, dilated Main Pancreatic Duct (MPD), hepatolithiasis and a peptic ulcer with stricture at all three anastomotic sites. A lateral pancreaticojejunostomy, revision of hepaticojejunostomy with removal of calculi and redo gastrojejunostomy were performed using the same Roux limb. Case 2 was a 58-year-old male who underwent the Whipple procedure with pancreaticogastrostomy four years ago for a serous cystadenoma of the pancreas and presented with pancreatitis, dilated MPD and pleural effusion. The patient was diagnosed with pancreatitis due to anastomotic stricture at the pancreaticogastrostomy site and laparotomy with lateral pancreaticojejunostomy was performed. Both patients were discharged uneventfully. While individual anastomotic strictures and their management have been discussed in the literature following the Whipple procedure, Case 1, which presented with strictures at all three sites simultaneously and Case 2, which presented with pancreatitis, are noteworthy and unique. Surgery is the best approach to managing anastomotic strictures, as it offers a one-time solution.

Thoracic Anaesthesia in a Patient with Mechanical Mitral Valve: A Case Report

Shilpa Sarang Kore, Reem Barkat Khatib, Shubhangi Humane Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Oesophageal diverticulum is a rare condition characterised by an outpouching of the oesophageal wall, often associated with dysphagia, regurgitation, and a risk of aspiration. Surgical resection, typically via thoracotomy, presents significant anaesthetic challenges, particularly in patients with pre-existing cardiac disease requiring One-lung Ventilation (OLV). Patients with Rheumatic Valvular Heart Disease (RVHD), Atrial Fibrillation (AF), and prosthetic mitral valves pose additional perioperative risks, including haemodynamic instability, anticoagulation management, and pulmonary complications. Hereby, the authors present case of a 49-year-old male with longstanding RVHD, Mitral Valve Replacement (MVR), and left ventricular systolic dysfunction (ejection fraction 35%) who presented with worsening dysphagia, regurgitation, and dyspnoea. Imaging confirmed a 50×49×86 mm oesophageal diverticulum with bilateral pleural effusion. Preoperative optimisation included anticoagulation management, rate control for AF, and pleural drainage. The patient underwent oesophageal diverticulectomy under general anaesthesia with a left-sided double-lumen tube and thoracic epidural analgesia. Intraoperative challenges included transient AF, hypotension requiring vasopressors and inotropes, and desaturation during OLV, all of which were managed with recruitment manoeuvres and apnoeic oxygenation. Postoperatively, anticoagulation was restarted, and the patient was extubated on day two without complications. The present case underscores the importance of meticulous perioperative planning, haemodynamic monitoring, and multidisciplinary coordination in managing complex cardiac patients undergoing thoracic surgery. A tailored anaesthetic approach focusing on oxygenation, cardiac stability, and balancing anticoagulation is crucial for optimal outcomes.

Chicken Bone in the Oesophagus: A Diagnostic and Therapeutic Challenge

Saahiti Koppolu, Anuja Satav, Rashmi Kelkar, Urmila Phad, Rashmi Prashant Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Foreign body ingestion is a frequently encountered medical emergency that requires prompt evaluation and intervention. While many ingested objects pass through the gastrointestinal tract without complications, sharp foreign bodies, such as chicken bones, pose a high risk of perforation. This can lead to severe complications, including mediastinitis and abscess formation, making early diagnosis and a multidisciplinary approach essential for safe removal and improved patient outcomes. In the present case, a 49-year-old male presented to the Otorhinolaryngology {Ear, Nose and Throat (ENT)} Outpatient Department (OPD) with dysphagia, throat pain and changes in voice for two weeks. He was diagnosed with a retropharyngeal abscess, which was managed conservatively with intravenous (i.v.) antibiotics. The patient reported a history of consuming chicken before the onset of symptoms. On examination, he was haemodynamically stable. A Computed Tomography (CT) scan revealed an inverted V-shaped hyperdense foreign body penetrating the right lateral oesophageal wall and extending into the apical segment of the right upper lung lobe. A multidisciplinary team, including a pulmonologist, anaesthesiologist, ENT surgeon and gastroenterologist, opted for endoscopic removal under general anaesthesia. During the procedure, the foreign body slipped into the hypopharynx, posing an airway risk. The anaesthesiologist successfully removed the intact chicken bone using a laryngoscope and Magill’s forceps. Postoperatively, the patient was conservatively managed by ENT, kept nil per oral and discharged a week later in stable condition. The present case underscores the significance of multidisciplinary coordination in managing airway emergencies during foreign body removal.

Navigating Airway Challenges in a Case of Neurofibromatosis: An Anaesthetic Perspective

Sandip Baheti, Supriya Gholap, Amala Kale Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Neurofibromatosis type 1 (NF1) often involves multisystem manifestations, including pulmonary fibrosis, hypertension and neurofibromas in the larynx and oropharynx, leading to airway challenges. This case report highlights the anaesthesia and airway management of a 48-year-old male with NF1 and a large parapharyngeal mass causing hoarseness, dysphagia and airway compromise, displacing major neck structures; he was posted for excision of the parapharyngeal mass. Indirect videolaryngoscopy during preoperative evaluation showed a funnel-shaped epiglottis, significant oedema of the surrounding tissues and a fixed left vocal cord, with a Mallampati score of IV. Fibreoptic intubation was initially planned; however, elective fibreoptic intubation might fail even with prior recognition of intraoral pathology due to grossly distorted anatomy and bleeding from trauma. Utilising the airway preparation carried out for fibreoptic intubation, videolaryngoscopy using C-MAC (Karl Storz GmbH & Co. KG, Germany) was performed to assess the feasibility of intubation under sedation and spontaneous respiration, which yielded a Percentage of Glottic Opening (POGO) score of 50%, corresponding to a Modified Cormack and Lehane grade of 2b. The possibility of pressure effects was ruled out, as the tumour was located laterally. After assessing the possibility of intubation with C-MAC, nasal intubation was successfully achieved using a size 6.5 flexometallic tube under deep sedation, following the administration of Inj. Midazolam 1 mg, Inj. Fentanyl 80 μg, and Inj. Propofol 1 mg/kg. The tumour was excised without complications and the patient was extubated uneventfully. This report emphasises the importance of preoperative planning and a stepwise, adaptable approach to airway management in such complex scenarios.

Shoulder Pain: To Think Beyond the Myo-osseous Elements: A Case Report

MJ Abhinand, B Vijayanand, Karthikeyan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Shoulder pain and weakness present a complex clinical landscape, often originating from common aetiologies such as rotator cuff tears, tendinitis and joint osteoarthritis. However, the significance of suprascapular nerve injury, particularly when associated with entrapment by ganglion cysts at specific notches, should not be ignored. This is exemplified by the case of a 22-year-old semi-skilled labourer who presented with right shoulder pain for two years, which began after trauma. He experienced muscle weakness and joint line tenderness and was diagnosed with a ganglion cyst in the spinoglenoid notch, causing suprascapular neuropathy. He subsequently underwent open decompression. This case emphasises the need to consider uncommon causes in shoulder diagnostics. Diagnostic tools such as Magnetic Resonance Imaging (MRI), Electromyography (EMG) and Nerve Conduction Studies (NCS) play crucial roles in identifying and evaluating suprascapular nerve dysfunction. While conservative management involving rest, physiotherapy and Non Steroidal Anti-Inflammatory Drugs (NSAIDs) is often the initial approach, surgical interventions, including percutaneous aspiration, open excision, or arthroscopic decompression, may be warranted in cases of non responsivenes or the presence of space-occupying lesions. This positive postoperative outcome underscores the effectiveness of timely surgical intervention when conservative measures prove insufficient. The case contributes valuable insights into the understanding and management of suprascapular nerve injuries, highlighting the necessity of a comprehensive approach for optimal patient outcomes.

Effect of Medicated Enema and Herbal Formulation over Inflammatory Biochemical Markers in Rheumatoid Arthritis: A Case Report

Vaishnavi Subhash Bodhe, Punam Gaurav Sawarkar, Gaurav R Sawarkar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Rheumatoid Arthritis (RA) is the predominant type of autoimmune inflammatory arthritis, affecting approximately 0.75% of the Indian population. It is a painful condition that impacts an individual’s overall physical and mental well-being, making daily tasks challenging. This is a single case study primarily aimed at investigating the efficacy of a medicated enema (Vaitaran Vasti) and oral herbal formulations on the inflammatory biochemical parameters of RA. The present case involves a 53-year-old female patient who was diagnosed with RA a few months ago based on clinical symptoms, such as multiple joint pain and morning stiffness throughout the body lasting for about 60 to 90 minutes. The patient was assessed based on clinical features and biochemical parameters, which are gold standard measures in conventional medicine for RA. After undergoing treatment, the patient’s quality of life improved significantly due to a substantial reduction in all clinical symptoms, including pain, stiffness, swelling, and bipedal oedema. Moreover, the values of the RA test and CRP levels were significantly reduced from 64 IU/L and 96 mg/L to 16 IU/L and 24 mg/L, respectively, after 15 days. The patient did not require oral pain relievers. Ayurvedic treatment yielded excellent outcomes in this case, especially when conventional medical options were limited. Exploring Ayurveda as a treatment avenue has provided a glimmer of hope.

Management of Chronic Granular Hypertrophic Pharyngitis (Vrunda) through Ayurveda: A Paediatric Case Report

Riya Rajendra Rathor, Renu Bharat Rathi Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X The inflammation of the oropharyngeal mucous membranes, known as pharyngitis, is typically caused by a bacterial or viral illness but can also be attributed to allergies, trauma, malignancy, reflux, or various toxins. One of the most prevalent causes of paediatric antibiotic prescriptions is acute pharyngitis, which accounts for 2-5% of paediatric ambulatory visits. The primary clinical features of the modified Centor Score and Fever PAIN scoring systems are largely used to diagnose the cause and severity of pharyngitis. In the present case, a 15-year-old female who had been experiencing symptoms of a foreign body sensation, chronic cough, intermittent fever, and difficulty swallowing for a year was diagnosed with chronic granular hypertrophic pharyngitis and was treated with an Ayurvedic treatment protocol. The Ayurvedic therapy used for this patient comprised oral medication, Panchakarma therapy, and Pranayama. Patient follow-up and treatment were conducted consistently on the 7th and 15th days, and dietary modifications were also advised. After following the treatment, the patient showed improvement in chronic symptoms, and Kawala therapy provided relief from the symptoms. This case study aims to demonstrate the effectiveness and importance of Ayurvedic treatment principles in treating chronic granular hypertrophic pharyngitis, or Vrunda, in a paediatric patient.

Case Report on Proliferative Periostitis of the Left Mandible: A Radiographic Diagnostic Dilemma and Work-up

T Sivasankari, Priyavardhini Pannerselvam, Reethu Ravichandiran, Naveenaa Chellapandian, Mathan Boje Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Proliferative periostitis, often referred to as Garre’s osteomyelitis, is a distinct type of chronic osteomyelitis marked by the formation of new bone along the periosteal surface. This condition typically occurs in response to a low-grade, persistent infection or irritation, most commonly associated with dental infections or trauma. Early detection and addressing the underlying cause of the infection are crucial for successful management and positive outcomes. Hereby, the authors present a case of a 13-year-old male diagnosed with proliferative periostitis, in whom no evident source of infection could be identified, presenting a diagnostic challenge. Authors highlight the importance of using various radiographic techniques to facilitate a prompt diagnosis, which prevented unnecessary treatment delays and invasive procedures.

Concurrent Trigeminal Neuralgia and Hemifacial Spasm due to Anterior Inferior Cerebellar Artery Tortuosity: A Rare Case Report

Ankita Thakur, Paresh Korde, Abhiram Sai, Prachi Wankhade Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X The Anterior Inferior Cerebellar Artery (AICA) plays an important role in the pathophysiology of both Hemifacial Spasm (HFS) and Trigeminal Neuralgia (TN). The AICA follows a tortuous course, which may affect the facial nerve and trigeminal nerve by compressing these structures. This compression is the common underlying aetiology for both TN and HFS. To date, TN remains an idiopathic condition that is hypothesised to be caused by an underlying irritative lesion involving the trigeminal ganglion. TN is characterised by paroxysmal, lancinating, unilateral pain, often localised along the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve. In contrast, HFS manifests as involuntary, irregular, or tonic contractions of the facial muscles. It typically begins in the orbicularis oculi and progressively spreads to involve the perioral, platysmal and lower facial muscles. Unlike TN, HFS persists even during sleep and worsens over time. The present case report discusses a 65-year-old male who presented a rare combination of TN characterised by continuous pain and HFS; the concomitant occurrence of both conditions is unique in itself. The present case demonstrates how a dilated, tortuous AICA loop causes a particularly peculiar presentation in a patient, involving both TN and HFS, along with the surgical management and treatment that facilitated a good prognosis for the diagnosis. Additionally, it highlights the rarity of these manifestations stemming from a single aetiological agent, specifically a dilated Anterior Inferior Cerebellar Artery (AICA) loop. Furthermore, it underscores the importance of early diagnosis, neuroimaging and timely surgical intervention, particularly when addressing uncommon neurovascular conflicts that manifest with overlapping cranial neuropathies.

Beyond Classification: A Unique Case of Mullerian Malformation Featuring a Normal Uterus with the Absence of Unilateral Ovary and Fallopian Tube

Kamlesh Chaudhari, Sravya Gudapati, Apoorva Dave, Deepti Shrivastava Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Müllerian malformations represent a range of genetic conditions impacting the female reproductive tract, often posing diagnostic and therapeutic challenges. According to the reports, these anomalies cause the Müllerian ducts to abruptly form during foetal development. Müllerian ducts are related to the normal formation of reproductive internal and exterior organs in the females. This is a case of a 29-year-old female with a major complaint of primary infertility, for the past 10 years. The patient was screened by ultrasonography and hormonal profile along with the husband’s semen analysis. On further evaluation, a unilateral absence of the left fallopian tube and ovary was noted, with the presence of a normal uterus, which defied current classification systems for Müllerian anomalies. This case highlights the complexity and diagnostic dilemmas associated with Müllerian malformations, emphasising the importance of a multidisciplinary approach and personalised management strategies in such cases.

Anaesthetic Considerations in Emergency Lower Segment Caesarean Section in Preeclamptic Parturient with Neurofibromatosis: A Case Report

Charmi Hitenbhai Shah, Upasna Vineet Bhatia, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Neurofibromatosis type I (NF1) is an autosomal dominant genetic disorder characterised by multiple cutaneous manifestations and potential systemic involvement that can complicate anaesthetic management, especially in obstetric patients. This case report describes the anaesthetic management of a 27-year-old primigravida with NF1 and preeclampsia who presented to obstetric department for emergency cesarean delivery due to foetal distress. The patient displayed classic NF1 features including café-au-lait spots and multiple cutaneous neurofibromas. Airway assessment revealed Mallampati Grade III classification without palpable oropharyngeal masses. Given the emergency situation and potential airway challenges, general anaesthesia was selected using rapid sequence induction with propofol and succinylcholine. Anaesthesia was maintained with oxygen, nitrous oxide, sevoflurane, and atracurium, with fentanyl administered after delivery. The patient maintained stable haemodynamics throughout the procedure despite preeclampsia with baseline blood pressure of 140/100 mmHg. Despite the potential for difficult airway management and cardiovascular complications in patients with NF1, the perioperative period was uneventful with successful mother and baby outcomes. This case emphasises the importance of thorough preoperative assessment, anticipation of potential complications, and a tailored anaesthetic approach in managing parturients with NF1, particularly in emergency scenarios complicated by preeclampsia.

Pilomatrixoma or Sebaceous Cyst in a Middle-aged Woman: A Case Report

Sujal Ramesh Agarwal, Veena KL Karanth, Sarah Johnson, Vidya Monappa Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Pilomatrixoma, is a rare benign skin neoplasm originating from matrix cells of hair follicles. Frequently encountered during the first two decades of life, mostly involving the head and neck area. In this report, a woman in her late 40s presented with swelling and associated pain on her right arm. On physical inspection, a hard, non tender mass was found. A provisional diagnosis of a sebaceous cyst was made and she subsequently underwent an excision biopsy for the same. Histopathology of the specimen revealed features of pilomatrixoma. Pilomatrixoma can be confused with other benign skin masses encountered frequently in clinical practice like sebaceous cysts, especially in uncommon age groups and locations. Preoperative diagnosis is difficult to establish and a definitive diagnosis can be made only after histopathological examination. Diagnosis is through histopathology and a thorough understanding of the histological features of other cutaneous conditions is essential.

Evaluation of Effectiveness of Gugguladi Dhoopana as an Adjuvant in Postoperative Management of Fistula-in-ano: A Series of Three cases

Sakshi Ghugal, Sheetal Asutkar, Shubham Bobade, Yogesh Yadav Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Dhoopana Karma is one of the traditional Ayurvedic treatments for fumigation, which aids in enhancing wound healing and preventing infections within wounds following surgeries. This treatment can be administered through the fumes produced by herbal preparations, based on their theoretically potent antimicrobial and anti-inflammatory actions, as well as their wound healing properties. Dhoopana Karma utilises the formulation Gugguladi Dhoopana Dravya, which includes Guggul, Nimba, and Sarjaras. These substances are well-known for their tissue regeneration and infection-controlling activities. Hereby, the authors present a case series of three male patients and present study was aimed to determine whether Dhoopana Karma is effective in the treatment of postoperative anal fistula. The present condition requires prolonged care and is often associated with infections and poor healing. Three patients diagnosed with complex anal fistula underwent partial fistulectomy accompanied by Ksharsutra (medicated seton) ligation, followed by daily Dhoopana Karma with Gugguladi Dhoopana Dravya for 10 days. Each session lasted 10 minutes. Pain, wound bed condition, odour, discharge, granulation tissue, and itching were monitored regularly. The fumigation process involved in Dhoopana Karma helps to stimulate blood circulation, promotes the removal of toxins, and reduces inflammation at the wound site. Dhoopana can be utilised as an alternative to the modern concept of sterilisation and has multiple applications in wound management. All cases showed dramatic improvement, with significant reductions in pain, discharge, and odour, along with enhanced granulation tissue formation during the 30-day follow-up period. Dhoopana Karma with Gugguladi Dhoopana Dravya appears to be a beneficial adjuvant treatment for the postoperative management of anal fistula, leading to early recovery and more efficient wound healing.

Rare Non-germ Cell Testicular Tumors: A Series of Three Cases

Vilas Pandurang Sabale, Ujjwal Bhardwaj, Deepak Mane, Vikram Satav, Abhirudra Mulay Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Testicular neoplasms are the most common malignancy among men aged 20-40 years. More than 95% are germ cell tumours and 5% are sex cord stromal tumours. The most common presentation is a painless scrotal lump. Sometimes, it may present as a painful lump, mimicking an inflammatory lesion. Case 1, a 34-year-old male presented with right testicular pain and a lump for one month, with normal tumour markers. Clinically, it appeared as a testicular malignancy, but with normal tumour markers, it mimicked an inflammatory lesion, creating a management dilemma. A Computed Tomography (CT) scan ruled out retroperitoneal lymph node metastasis. Right high inguinal orchidectomy with frozen section was performed, suggesting malignancy. Immunohistochemistry confirmed leiomyosarcoma. Case 2, an 82-year-old male presented with a painless right testicular lump for one month, with a history of acute urinary retention secondary to benign prostatic enlargement {treated with Transurethral Resection of the Prostate (TURP)}. Clinically, it was a hard lump suggestive of malignancy, confirmed on ultrasound, although tumour markers were normal. A CT scan was negative for lymphadenopathy. Right high inguinal orchidectomy was performed. Histopathological examination showed non-Hodgkin’s lymphoma; the patient subsequently underwent chemotherapy. Case 3, a 29-year-old male complained of right testicular pain. Examination revealed a tender nodule (1×1 cm) on the posterolateral aspect of the right testis, clinically appearing as a firm mass, confirmed on ultrasonography, although tumour markers were misleadingly normal. High inguinal orchidectomy was performed, with histopathological examination positive for intratesticular adenomatoid tumour. High inguinal orchidectomy was the treatment of choice in all three cases, followed by adjuvant chemotherapy or radiotherapy depending on histopathology. Conclusion: Testicular tumours may mimic inflammatory lesions, creating management dilemmas. Thorough clinical examination and investigations are required for planning and management. Normal serum tumour markers and ultrasound cannot rule out malignancy.

Multifaceted Role of the Acellular Dermal Matrix in Novel Wound Healing: A Case Series

Naveen Narayan, Dharini Kishor, Yashas Hosur Ramegowda Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Acellular Dermal Matrix, Matriderm^®, a collagen and elastin matrix, has emerged as a versatile tool in wound coverage, promoting healing and reducing scarring, thus offering numerous advantages in various clinical scenarios. The varied uses demonstrated here include concomitant application of the acellular dermal matrix while grafting with a full-thickness skin, application over bare bone in Split-Thickness Skin Grafting (STSG) and in the treatment of mucocutaneous fistulae in the oral cavity. The outcome with the use of Matriderm® in all these cases was satisfactory. Hereby, the authors present a case series of four patients that provide an understanding of Matriderm^®’s efficacy in promoting healing and regeneration in complex wounds. Matriderm^®, an acellular dermal matrix composed of collagen and elastin, supports tissue regeneration and reduces scarring, making it a valuable tool in complex wound management. The present case series highlights its versatility and potential in advancing wound care.

Follicular Carcinoma of Thyroid with Solitary Vertebral Metastasis

Jatin Nehra, Shaik Ishma Mustafa, Kirthi Sathyakumar, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X A 48-year-old female presented with a one-month history of back pain radiating to both lower limbs, which had worsened over the past three days. The pain had an insidious onset and was gradually progressive, radiating from the upper back to the plantar aspect of the feet. She also reported gait instability for three days, rest pain and sleep disturbances. There was no history of recent trauma, fever, significant weight loss, chronic cough, or night sweats. The patient had a history of thyroidectomy for follicular carcinoma of the thyroid seven years back. The family history was unremarkable.

Keloid Scarring in the Earlobe: From Piercing to Treatment

Parindita Sarmah, Sagar Gaurkar, Prasad Deshmukh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X A 48-year-old female office worker presented in Ear, Nose and Throat (ENT) Outpatient Department (OPD) with a progressively enlarging, painless mass on both her earlobes, which she noticed about eight months ago. Both the lesions started after she had an ear piercing several years ago; and initially were small but have grown over time. The patient reports occasional itching but no pain, drainage, or signs of infection. She is concerned about the cosmetic appearance of the mass. There is no history of recent trauma to the area, and the patient denies any changes in the surrounding skin. She has no significant medical history and no known allergies. Although her maternal aunt has a history of keloids, there is no family history of similar lesions in other areas of the patient’s body.

Right-sided Bronchial Collapse undergoing Dilation and Stenting

Subha Teresa Jose Vazhakalayil, Sakshi Gupta Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Dear Editor, The anaesthesiologist plays a critical role during tracheobronchial stenting in patients under general anaesthesia, as they are responsible for the safe induction and maintenance of anaesthesia, managing a shared airway and treating life-threatening postoperative complications (1). Here, a case of the successful management of anaesthesia during bronchoscopic stenting is discussed.

Efficacy of External Beam Radiotherapy with Concurrent Capecitabine versus Radiotherapy alone for the Treatment of Painful Bone Metastasis in Primary Breast Cancer Patients: A Prospective Interventional Study

Lucy Pattanayak, Tapan Kumar Sahoo, Manoranjan Meher, Pragyna Paramita Das, Tapas Kumar Dash Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The development of widespread distant metastasis, including skeletal metastasis, is common among breast carcinoma patients, irrespective of multimodal treatment. Symptomatic skeletal metastasis is usually treated with External Beam Radiotherapy (EBRT). Capecitabine can act as a radiosensitiser antineoplastic drug and can be added concurrently with EBRT. Aim: To compare the safety and efficacy of EBRT with concurrent capecitabine against EBRT alone in pain control of painful bone metastasis. Materials and Methods: This prospective interventional study was conducted in the Department of Radiation Oncology at Acharya Harihar Postgraduate Institute of Cancer, Cuttack, Odisha, India from September 2022 to March 2024. Histologically proven breast cancer patients with painful bone metastasis were included and randomly assigned to group A, receiving palliative radiotherapy only (n=20), and group B, receiving palliative radiotherapy with concurrent capecitabine (n=22). Radiotherapy was administered at a dose of 30 Gy in 10 fractions at 3 Gy per fraction over two weeks. The patients were assessed once weekly during the treatment and at the end of the treatment, patients were evaluated every four weeks until 12 weeks. Response to treatment was evaluated using the Visual Analog Scale (VAS) and analgesic score. Statistical Package for the Social Sciences (SPSS) Version 21.0 (Armonk, NY: IBM Corp) was used for data analysis. Results: The mean age was 49.90 years for group A and 46.36 years for group B, respectively. The median pain score was 7 (4-10) in group A and 8 (5-9) in group B at baseline; at the end of 12 weeks, it was 2.5 (0-9) for group A and 0 (0-5) for group B (p-value=0.024). All the patients exhibited some level of response at the end of 12 weeks, with a Complete Response (CR) observed in 4 (20%) patients in group A, whereas it was seen in 14 (63.6%) patients in group B (p-value=0.004). Furthermore, there was a decrease in the consumption of analgesics in both groups from week 0 to week 4, with the median analgesic score changing from 2 (1-4) to 1 (0-3) in group A and from 3 (1-4) to 1 (0-2) in group B, without any significant difference between the groups (p-value=0.786). Conclusion: In comparison to radiotherapy alone, concurrent chemoradiation offers superior pain control and response rates in breast cancer patients with painful bone metastasis. Therefore, capecitabine administered concurrently with radiotherapy is safe for managing painful bone metastasis.

Impact of Clinical Pharmacological Intervention on Treatment Adherence among Adult Patients with Bronchial Asthma and COPD: A Randomised Clinical Study

Agnik Pal, Santanu Munshi, Santanu K Tripathi Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Adherence to the management of asthma and Chronic Obstructive Pulmonary Disease (COPD) is often suboptimal, which increases morbidity and mortality associated with these chronic respiratory diseases. The effectiveness of asthma and COPD education and self-management programmes on medication adherence and health outcomes is less well evaluated. Aim: To assess the impact of clinical pharmacological interventions, such as counselling and monitoring reinforcement, on treatment adherence in adult patients with asthma and COPD. Materials and Methods: This randomised clinical study was conducted in the Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, Eastern India. Eighty screen-eligible patients were randomly divided into two groups: the Intervention Group (IG) and the Non Intervention Group (Non IG), and were followed-up bimonthly for one year. The intervention consisted of a basic introduction to asthma or COPD, factors causing exacerbations, prevention of attacks, appropriate inhaler use techniques, etc. The appropriateness of inhalation technique was assessed using a structured observation checklist and the Device Appropriateness Index (DAI). An 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess adherence. Additionally, the Adherence Index (AI) of the patients was calculated by multiplying the MMAS-8 score with the DAI score. Results: In the study, there were 29 (52.73%) males and 26 (47.27%) females in the asthma group, while the COPD group comprised 18 (72%) males and 7 (28%) females, with mean ages of 42.86±14.3 years in the asthma group and 51.12±8.6 years in the COPD group. The MMAS-8 score was found to be better in the IG compared to the Non IG, with statistically significant differences observed from the 4th follow-up visit onwards. By the 6th follow-up visit in the IG, 42.5% demonstrated high adherence and 57.5% showed moderate adherence, with no patients falling into the low adherence category. There was significant improvement in the DAI in the IG compared to the Non IG from the first follow-up visit onwards and this improvement persisted across all subsequent visits. Conclusion: The findings of the present study suggest that clinical pharmacological intervention is of great value in optimising treatment adherence among asthma and COPD patients, and it can be routinely incorporated into clinical care.

Insights into Disaster Management among Emergency Paramedical Staffs: A Cross-sectional Study at a Tertiary Care Hospital in Tamil Nadu, India

M Lavanya, K Bincy, Roshni Mary Peter, N Keerthana, MVM Pradeep Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Disasters can be natural (e.g., cyclones and earthquakes) or man-made (e.g., chemical spills). Unpredictable disasters and multifaceted damage necessitate that healthcare providers be prepared to manage victims with varying skills and care to mitigate the impact of these disasters. Aim: To assess various aspects pertaining to disaster preparedness and management among paramedical staff in the emergency department of a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital in Chengalpattu, Tamil Nadu, India. Seventy paramedical staff members in the emergency department were included in the study and given a pretested semistructured questionnaire. The collected data was entered into Excel, and the associations between demographic factors and insights were measured using the Chi-square test in Statistical Package for the Social Sciences (SPSS) Version 27.0. Results: In this study, 44 (62.9%) participants were female. This study showed that 91.4% of the staff had adequate knowledge, while 82.9% demonstrated adequate practice. In the knowledge domain, there were no significant differences across demographic variables. However, in the practice domain, there was a significant difference based on gender (p-value<0.05). A significant association was found between knowledge and practice adequacy (χ²=26.91, p-value<0.001), indicating that staff members with adequate knowledge are more likely to practice adequately. Conclusion: This study concluded that the levels of knowledge and practice regarding disaster preparedness are adequate among the majority of staff. Management should organise medical education and training programs frequently to achieve standardised levels of preparedness.

Awareness of Stroke among the General Population of Arar City, Saudi Arabia: A Cross-sectional Study

Mohamed M Abd El Mawgod, Waleed Yousef Q Alanazi, Rakan Musharraf K Alanazi, Nasser Hamoud K Alanazi, Mohammed Fahad M Alfehaid Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Stroke is a critical global health problem. In Saudi Arabia, it is a major cause of morbidity and mortality that is becoming increasingly serious. Considering lifestyle changes that contribute to an increased risk of stroke in Saudi Arabia, a greater community understanding of stroke symptoms and risk factors may influence how promptly patients are treated. Aim: To assess the awareness of stroke symptoms, risk factors and complications among the study subjects. Materials and Methods: A cross-sectional study was conducted, including 500 adults from Arar City, the capital of Northern Saudi Arabia, from November 1, 2023, to April 30, 2024. The study was approved by the local bioethical committee of Northern Border University. Socio-demographic data, along with information on symptoms and risk factors, were collected. Statistical Package for the Social Sciences (SPSS) software version 26.0 was used for data analysis. The data was presented as frequencies and percentages. Results: A total of 500 respondents were included in the study; their mean age was 40.1±11.7 years, with about 299 (59.8%) being males. More than two-thirds were married (359, 71.8%), and the majority were university educated (445, 89%). Most respondents correctly identified that stroke can be haemorrhagic or embolic. Hypertension was the most frequently cited risk factor (456, 91.2%). Speech difficulty was the most reported symptom (359, 71.8%), followed by walking difficulty (358, 71.6%), disturbed vision (301, 60.2%), and sudden severe headache (288, 57.6%). Conclusion: The Northern Saudi population demonstrated a relatively good level of literacy regarding stroke risk factors, symptoms and outcomes. Awareness programs are suggested to improve the control of modifiable risk factors for stroke, such as hypertension, diabetes, obesity and smoking.

Surrogate Markers of Insulin Resistance to Predict the Prognosis of COVID-19 Disease: A Retrospective Analysis

Susmita Banerjee, Shuvankar Mukherjee, Sukla Mitra Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Coronavirus Disease-2019 (COVID-19) patients exhibit an extensive range of disease manifestations. Disturbances in metabolic and lipid profiles occur due to the release of cytokines. The lipid elements of the COVID-19 virus play a significant role in the fusion of the viral membrane to the host cell, in addition to replication. Although the COVID-19 scenario is multifaceted, high risks are observed in patients with co-morbidities such as Insulin Resistance (IR). Lipid ratios and the Triglyceride-Glucose index (TyG) could serve as simple biochemical markers of IR, thereby aiding in the assessment of prognosis in admitted COVID-19 patients, particularly those with comorbid conditions like IR. Aim: To assess the severity of COVID-19 infection based on lipid ratios and the TyG index. Materials and Methods: This retrospective study was conducted at Diamond Harbour Government Medical College and Hospital, 24 Parganas, West Bengal, India, data from 189 diagnosed COVID-19 patients, aged between 18 and 60 years in and around diamond harbour, were collected after obtaining the necessary ethical clearance. All the patients, including referred cases, were admitted to the COVID-19 ward of Diamond Harbour Government Medical College and Hospital. Data from biochemical tests, such as Fasting Blood Glucose (FBG), Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL) and C-Reactive Protein (CRP), which were analysed using an autoanalyser (Transasia XL 640), were recorded. The lipid ratios and TyG index were calculated. The optimal cut-off values for all the above indices were derived from the point with the maximum Youden index by plotting the Receiver Operating Curve (ROC). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Software version 20. Results: The Fasting Blood Sugar (FBS), TG, TG/HDL, TC/HDL and TyG index levels were significantly higher in the severe COVID-19 patients (p<0.05). The optimal cut-off values calculated for the TyG index, TG/HDL and TC/HDL were 9.34, 3.55 and 3.83, respectively. Conclusion: In COVID-19 patients, a TyG index and lipid ratios of TG/HDL and TC/HDL exceeding 9.34, 3.55 and 3.83, respectively, could serve as early indicators of COVID-19 severity, thus assisting in the assessment of prognosis.

Comparative Analysis of Three Pain Scales for Evaluation of Procedural Pain in Neonates: A Cross-sectional Study

Preethi Subramanian, Sudharshan Raj Chitgupikar, Shreya Jalapu, Takreem Ilyas Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Neonates frequently undergo painful procedures in the Neonatal Intensive Care Unit (NICU), necessitating reliable Pain Assessment Tools (PAT). While various pain scales exist, no single tool is universally accepted due to differences in validity and clinical applicability. Aim: To compare the validity and internal consistency of Neonatal Infant Pain Scale (NIPS), Premature Infant Pain Profile Assessment Revised (PIPP-R), Douleur Aigue Nouveau-né (DAN) scale, for assessing procedural pain in neonates before, during and after a heel prick procedure. Materials and Methods: A cross-sectional study was conducted among 60 term neonates in a rural teaching hospital. The neonates underwent a heel prick procedure and pain scores were assessed using NIPS, DAN and PIPP-R at four time points: baseline, 30 seconds, two minutes and four minutes postprocedure. Construct validity was evaluated using repeated measures Analysis of Variance (ANOVA), concurrent validity by Pearson correlation and internal consistency by Cronbach’s alpha. Coefficient of variation was analysed to assess scale precision. Results: All three pain scales demonstrated peak pain scores at 30 seconds postheel prick, with a subsequent decline over time. NIPS and DAN exhibited high concurrent validity (r=0.939 at 30s, r=0.860 at 2 minutes). Cronbach’s alpha for NIPS, DAN and PIPP-R at 30 seconds was 0.808, 0.919 and 0.805, respectively, indicating high internal consistency. The removal of physiological parameters (heart rate, SpO2) from PIPP-R significantly improved its internal consistency (Cronbach’s alpha increased from 0.805 to 0.917 at 30s and from 0.822 to 0.906 at 2 minutes), whereas using only physiological parameters yielded low or negative alpha values. PIPP-R had the lowest coefficient of variation, indicating the highest precision, while DAN had the highest. Conclusion: NIPS and DAN have good concurrent validity between them. PIPP-R had the least coefficient of variation and hence most precise. DAN has high internal consistency across the timelines.

Morphometric Analysis of the Proximal and Distal Ends of Adult Dry Femur Bone: A Cross sectional Study in the Population of North Karnataka, India

Shilpa M Bhimalli, Agamdeep Singh Bedi, Mugdha Malik, Vinod Chandgadkar, Sheetal V Pattanshetti, Daksha Dixit Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Orthopaedic surgeons require anatomical knowledge of the proximal and distal ends of the femur when performing knee replacement or knee arthroplasty procedures. The application of morphometric analysis is advantageous to biochemical research. It enhances the understanding of many other factors that influence bone, such as its strength, structural integrity, and functions. Aim: To quantify the morphometric parameters of the proximal and distal ends of the adult femur, including measurements of size, shape, and angular relationships. Materials and Methods: A cross-sectional study on 102 adult dry femur bones of unknown gender and age collected from Department of Anatomy, JN Medical College, Belagavi, Karnataka, India from October 2024 to January 2025. The femur specimens were analysed using different methods. This includes osteometric board, Vernier caliper, Goniometer and thread. The data collected was statistically analysed using software International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) Statistics 27.0. Results: The current study found that the average femur length was 433±31.3 mm. The proximal part of femur showed femoral torsion averages 19.63±4.3 degrees, while the Neck Shaft Angle (NSA) has a mean of 125.35±16.86 degrees. Transverse diameter of head (in mm) measured 39.59±3.78 mm, and neck (mm) 25.65±3.42. Vertical diameter of head (in mm) is 40.01±3.69 and neck (in mm) is 29.44±4.07. The distal part of femur, showed bicondylar width (in mm), 66.41±7.46, intercondylar width (in mm) 21.32±5.03 and intercondylar depth (in mm) 24.97±2.54, medial condyle thickness (in mm) 23.84±3.86 and lateral condyle thickness (in mm) 23.93±3.16, medial condyle length (in mm) 56.06±4.77 and lateral condyle length (in mm) 57.29±4.21. Conclusion: The study’s measurements of the proximal and distal femur revealed population-specific values, particularly for North Karnataka. These findings have significant implications for forensic identification, anthropological studies, and clinical applications. Population-specific morphometric data enhances accuracy and relevance in these fields.

Impact of Intraoperative Colloid versus Crystalloid Administration on Postoperative Outcomes in Major Gastrointestinal Surgeries: An Interventional Study

Manoj Kumar, Jay Brijesh Singh Yadav, Himanshu Prince, Matendra Singh Yadav, Prashant Kumar Mishra, Purva Kumrawat, Meera Kumari, Raghvendra Singh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Colloids and crystalloids are frequently used for fluid resuscitation. However, their differing physiological properties may impact postoperative outcomes in distinct ways. Emerging evidence indicates that these variations could play a role in influencing surgical morbidity. Aim: To evaluate the impact on postoperative outcomes using crystalloids and colloids intraoperatively in patients undergoing major surgeries. Materials and Methods: This double-blinded, interventional study was conducted from July 2019 to December 2020 at Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India. A total of 150 patients, aged 16-60 years, American Society of Anaesthesiologists (ASA) Grade I, II and III, undergoing elective major surgery were enrolled in the study and divided into three groups, with 50 patients per group: group RL (n=50), Group Hetastrach and Ringer’s Lactate (HS-RL) (n=50) and Group Tetrastarch and Ringer’s Lactate (TS-RL) (n=50). All patients received Ringer’s Lactate (RL) at a rate of 7.0 mL/kg/hour before induction. Intraoperatively, group RL received Ringer’s Lactate alone at a rate of 8.0 mL/kg/hour, group HS-RL received both Ringer’s Lactate and 6% hetastarch at a rate of 8.0 mL/kg/hour and group TS-RL received 6% tetrastarch and Ringer’s Lactate at a rate of 8.0 mL/kg/hour. The patients were observed for 8 days postoperatively for vital signs, Arterial Blood Gas (ABG) analysis, ambulation, Postoperative Nausea and Vomiting (PONV) and complications. The data were represented as mean standard deviations and percentages and analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. A p-value of <0.05 was considered statistically significant. Results: Two patients were excluded from the study due to missing data in group RL (n=48). The demographic characteristics were statistically not significant among the groups (p-value>0.05). The proportion of patients who could ambulate independently or with assistance was higher in the HS-RL group 23 (46%) patients compared to the TS-RL group 16 (32%) patients, followed by patients in group RL (3 patients, 6.25%) (p-value <0.05). Intravenous fluids were administered to most patients for five days. Statistically, there was no significant difference among the groups (p-value=0.230). The data were represented as mean standard deviations and percentages and analysed using SPSS version 20.0. A p-value of <0.05 was considered statistically significant. Conclusion: Colloids are superior to crystalloids in terms of independent ambulation, ambulation with assistance, temperature regulation and reduction of nausea and vomiting. Overall, the present study concluded that colloids are able to effectively reduce postoperative complications more effectively than crystalloids without any serious side-effects.

Comparative Evaluation of Oral Melatonin versus Oral Alprazolam as Premedication in Patients Undergoing Tympanoplasty: A Randomised Control Study

Nupoor, Shikha Agarwal, Harsh Vardhan, Nikhil Nayar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Preoperative anxiety is commonly experienced by patients who are admitted to hospital for any surgery and the role of premedication becomes important from an anaesthetist’s point of view, to relieve anxiety, provide sedation and ensure adequate analgesia. Aim: To compare the effects of oral melatonin versus oral alprazolam as premedication and their impact on postoperative recovery characteristics in patients undergoing tympanoplasty. Materials and Methods: In this randomised controlled study which was conducted from August 2022 to March 2024 at the Department of Anaesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India, a total of 70 adult patients were randomly allocated into two groups. Group M (n=35) received oral melatonin 6 mg and group A (n=35) received oral alprazolam 0.50 mg 120 minutes before surgery. The objectives of the study were to compare anxiety, sedation, cognition and pain using the Visual Analogue Scale (VAS), Ramsay Sedation Score (RSS), Digit Symbol Substitution Test (DSST) score and Numerical Rating Scale (NRS), respectively. The Shapiro-Wilk test, Independent t-test, Chi-square test and Fisher’s-exact test were used for statistical analysis. Results: The age distribution, gender, body mass index, American Society of Anaesthesiologists (ASA) status and mean duration of surgery were comparable between the two groups. Mean VAS scores were significantly lower in group M at 60 minutes (3.03±1.29 vs 3.77±1.21) and at 120 minutes (2.17±1.12 vs 2.91±1.12). Even in the postoperative period, compared to group A, the VAS score was lower in group M after extubation at various time intervals. RSS scores were lower in group M compared to group A at 60 minutes and at 120 minutes of drug administration. In the postoperative period, compared to group A, group M had lower sedation scores after extubation at 30 minutes, 60 minutes, 90 minutes and 120 minutes (p-value <0.0001). Compared to group A, group M had statistically significantly higher DSST scores at various time intervals in both the preoperative and postoperative periods (p-value <0.0001). group M had significantly lower NRS scores after extubation at various time intervals (p-value <0.0001) compared to group A, indicating that pain was significantly lower in the postoperative period with the use of melatonin. Conclusion: Oral melatonin (6 mg) is shown to be an effective alternative to alprazolam (0.5 mg) as a premedication. Oral melatonin offered superior anxiolysis while inducing less sedation compared to alprazolam. In addition, there was better preservation of cognitive function with melatonin compared to alprazolam.

Evaluation of Chlorogenic Acid in Parkinson’s Disease Model: An In-vitro Study in 6-OHDA Induced SH-SY5Y Cell Line

Sunprakathi Alwarsamy Perumalsamy, Kranthi Karunai Kadal, Gowri Viswanathan, Kavitha Ramasamy Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Parkinson’s Disease (PD) is the most common neurodegenerative movement disorder. Mitochondrial dysfunction is a key pathological driver of PD. Pharmacological agents used in PD are not disease-modifying therapies and do not influence mitochondrial activity. Diets rich in polyphenols have been shown to prevent pathologies associated with ageing. Aim: To evaluate Chlorogenic Acid (CGA), a phenolic acid, for its neuroprotective effect against PD in a 6-Hydroxydopamine (6-OHDA) induced SH-SY5Y cell line using in-vitro assays. Materials and Methods: An in-vitro study was conducted at the Department of Pharmacology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from September 2023 to November 2023. The human neuroblastoma cell line SH-SY5Y was induced using 6-OHDA. The activity of CGA against cytotoxicity in the 6-OHDA induced SH-SY5Y cell line was evaluated using the MTT assay with different concentrations (3.125 μM, 6.25 μM, 12.5 μM, 25 μM and 50 μM). Mitochondrial Membrane Potential (MMP) was evaluated using flow cytometry and antiapoptotic activity was assessed using Cytochrome C immunofluorescence by fluorescence microscopy. One-way Analysis of Variance (ANOVA) with Tukey’s posthoc analysis was used to identify statistical significance at p-value <0.05. Results: The CGA exhibited the maximum protective concentration on the 6-OHDA induced SH-SY5Y cell line at 25 μM, with a restoration of cell viability of 43.04%. CGA also improved the mitochondrial membrane potential and reduced the levels of cytochrome C release thus maintaining the mitochondrial membrane integrity. Conclusion: The findings provide evidence that CGA may exert an anti-PD effect through its action on mitochondrial dysfunction and the release of pro-apoptotic factors. The observed action on neuronal cells makes CGA a potential candidate for anti-PD treatment.

Effect of Electrical Muscle Stimulation and Resistance Training on the Lipid Profile in Sedentary Type-II Diabetic Individuals: An Experimental Study

Vishwajeet Trivedi, Neelima Mishra, Kamran Ali Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Diabetes Mellitus (DM) is associated with dyslipidaemia, a major contributor to cardiovascular complications. Resistance Training (RT) is known to improve lipid metabolism, but adherence can be challenging. Electrical Muscle Stimulation (EMS) has emerged as a potential alternative, promoting muscle activation and metabolic improvements. Aim: To evaluate and compare the effects of EMS and RT on lipid profile parameters, including Total Cholesterol (TC), Low Density Liopprotein Cholesterol (LDL-C), High Density Liopprotein Cholesterol (HDL-C) and Triglycerides (TG), in sedentary individuals with diabetes. Materials and Methods: An experimental study with a pretest/post-test design was conducted in the Department of Physiotherapy at GD Goenka University, Gurugram, Haryana, India starting from October 2023 until September 2024. A total of 66 sedentary type II diabetic subjects (both males and females) with a fasting blood glucose level between 100 mg/dL and 250 mg/dL and on oral hypoglycaemic drugs, without any major systemic or diabetic complications, were included in the study. Subjects were assigned to three groups through a convenient sampling method: EMS, RT and a control group. The EMS group, with a mean age of 53.0±3.7 years, received Russian current stimulation on three alternate days per week for 12 weeks. The RT group, with a mean age of 52.0±4.84 years, performed progressive resistance exercises on three alternate days per week for 12 weeks, while the control group, with a mean age of 49.77±6.75 years, received standard patient education on diet and physical activity. Lipid profile parameters, including TC, HDL-C, LDL-C, Very Low Density Liopprotein Cholesterol (VLDL-C), TGs and cholesterol/HDL ratio, were assessed at baseline, postintervention (12 weeks) and after a three-month follow-up. The pre-post data for intervention groups were analysed using Analysis of Variance (ANOVA) at three time points with p-value <0.05. Results: Repeated measures ANOVA showed significant group-time interactions for TC (p-value <0.001, η²=0.348), LDL-C (p-value=0.003, η²=0.120), triglycerides (p-value <0.001, η²=0.213), HDL-C (p-value <0.001, η²=0.162) and cholesterol/HDL ratio (p-value=0.002, η²=0.194), while changes in VLDL were not significant (p-value=0.713). Pairwise comparisons indicated significantly lower TC, LDL-C and cholesterol/HDL ratio in the EMS and RT groups compared to controls (p-value <0.01), with no difference between EMS and RT (p-value >0.05). Triglycerides decreased significantly in both intervention groups (p-value <0.05), with EMS showing a greater reduction, though not statistically different from RT (p-value=1.000). HDL-C changes were minor and nonsignificant across groups (p-value>0.05). These findings suggest that both EMS and RT effectively improve lipid profiles, with RT favouring cholesterol modulation and EMS being more effective for triglyceride reduction. Conclusion: Both EMS and RT effectively improved lipid profiles in individuals with Type 2 Diabetes Mellitus (T2DM), with RT demonstrating superior benefits in reducing cholesterol and LDL-C, while EMS was more effective in lowering triglycerides. EMS may serve as a viable alternative for individuals with exercise limitations, offering a non pharmacological approach in managing diabetic dyslipidaemia.

Socio-demographic, Clinicoaetiological and Treatment Profile of Children with Epilepsy Aged 6 to 15 Years: A Cross-sectional Study from Western Maharashtra, India

Shiji Chalipat, Amodini Arora, Shailaja Mane Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The International League Against Epilepsy (ILAE) task force proposed that epilepsy be considered a disease of the brain defined by any of the following conditions: 1) At least two unprovoked (or reflex) seizures occurring more than 24 hours apart; 2) One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures occurring over the next 10 years; 3) A diagnosis of an epilepsy syndrome. Aim: To study the sociodemographic, clinicoaetiological and treatment profile among children with epilepsy aged 6-15 years. Materials and Methods: This cross-sectional observational study was conducted in the Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India over a period of 24 months from July 2022 to July 2024. A total of 98 children, aged 6-15 years, diagnosed with epilepsy of any aetiology and with a duration of at least six months, seen in the Outpatient Department (OPD) or admitted in the ward of Dr. D. Y. Patil Medical College, comprised the study population. A detailed medical and neurological history, along with clinical examinations, was documented using a structured clinical proforma. The type of epilepsy and its syndromic classification were also determined. Results: The mean age of the study population was 9.17 years, with a male gender preponderance. Eighty-five (86.7%) children were born preterm. Normal vaginal delivery was the most common mode of delivery, occurring in 63 (64.3%). A total of 69 (70.4%) had a normal weight at birth. Thirty-five (35.7%) of the study subjects required admission to the Neonatal Intensive Care Unit (NICU). Fifty-five (56.1%) exhibited developmental delay, and IQ assessment revealed borderline IQ in the majority, with 58 (59.1%) subjects falling into this category. The commonest age of onset of seizures was greater than 5 years in 43 (43.9%) subjects. Twenty-nine (29.6%) had epilepsy for more than 2-5 years. Focal onset seizures were the most common, occurring in 66 (67.4%), and 14 (14.3%) experienced seizures daily. Fifty-three (54.1%) experienced uncontrolled seizures and belonged to the refractory category. Abnormal neurological findings were seen in 56 (57.1%) subjects. Seventy-one (72.4%) had abnormal Electroencephalogram (EEG) findings. Fifty-eight (59.2%) subjects received polytherapy. One (1.0%) patient underwent epilepsy surgery, 10 (10.2%) were on a ketogenic diet, while 87 (88.8%) subjects were on drug therapy alone. Structural aetiology was identified in a majority, with 49 (50%) subjects, and the most commonly administered Anti-Seizure Medication (ASM) was levetiracetam. Conclusion: Children with epilepsy require prompt stabilisation and resuscitation, along with meticulous history-taking, detailed examination and stepwise implementation of laboratory investigations, EEG and neuroimaging to delineate the underlying aetiology and plan treatment for better prognostic outcomes.

Effect of Oral Clonidine Premedication on Induction Dose of Propofol and Perioperative Haemodynamic Parameters in Patients Undergoing Laparoscopic Cholecystectomy: A Double-blinded Randomised Controlled Study

Dheer Singh, Rakesh Bahadur Singh, Matendra Singh Yadav, Amit Kumar Singh, Purva Kumrawat, Chandra Bhushan Yadav Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Clonidine increases the effects of anaesthesia and possesses antihypertensive qualities. During laparoscopic cholecystectomy, pneumoperitoneum is created by inflating Carbon Dioxide (CO2), which stimulates autonomic pathways, resulting in catecholamine release, activation of the renin-angiotensin system and vasopressin release. Clonidine may be an ideal agent for controlling the stress response to pneumoperitoneum during laparoscopic surgery. Aim: To observe the clinical efficacy of two different dosages of oral clonidine premedication on the induction dose of propofol and changes in perioperative haemodynamic parameters in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This randomised, double-blinded study was conducted at the Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, India, from January 2019 to December 2020. The study examined 60 patients with American Society of Anaesthesiologists (ASA) grades I and II who were scheduled for elective laparoscopic cholecystectomy under general anaesthesia. One hour before induction, the patients were randomly assigned to three groups for premedication: Group A (n=20) received a placebo, group B (n=20) received 150 μg of oral clonidine and group C (n=20) received 300 μg of oral clonidine. The patients were managed with standard general anaesthesia. Haemodynamic parameters and the propofol induction dose of the three groups were compared using an unpaired t-test and one-way Analysis of Variance (ANOVA); a p-value of <0.05 was considered statistically significant. Results: A total of 60 patients were included in the study, with 20 patients in group A (Placebo), 20 in group B (150 μg oral clonidine) and 20 in group C (300 μg oral clonidine). When comparing the two different dosages of oral clonidine (150 μg vs 300 μg), it was found that the higher dose (300 μg) was more effective in attenuating the pressure responses to laryngoscopy, intubation, pneumoperitoneum and extubation. In comparing the clonidine groups, group C (1.42±0.14 mg/kg) and group B (1.61±0.02 mg/kg) both exhibited a substantial reduction in the induction dose of propofol compared to the placebo group A (1.84±0.13 mg/kg). Conclusion: Throughout the perioperative periods, the clonidine groups (C > B) maintained haemodynamic variables better than the placebo group (A) and the clonidine groups also experienced a significant reduction in the induction dose of propofol. In comparing the two dosages of oral clonidine, it was found that the higher dose (group C) was superior in attenuating the pressure response to laryngoscopy, intubation, pneumoperitoneum and extubation.

Intralesional Bleomycin in Periungual Warts: A Prospective Randomised Controlled Study

Kallolinee Samal, Nibedita Dixit, Srigopal Mohanty, Debjit Kar, Siddhartha Dash, Manoj Kumar Nayak Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Periungual Warts (PW) are difficult to treat because of their challenging location, high recurrence rate and resistance to treatment. Bleomycin is a cheaper and readily available drug that has potential efficacy in treating warts, although limited data on its use are available in the literature. Aim: To study the efficacy and safety of Intralesional (IL) bleomycin in treating PW. Materials and Methods: A prospective randomised controlled study was conducted at the Department of Dermatology, SCB Medical College and Hospital, Odisha, India, from September 2019 to August 2020. A total of 56 patients with PW were randomised equally by block randomisation into two groups: Group A and Group B. Group A received 1 U/mL IL bleomycin, while Group B was given dH2O. Follow-up assessments were conducted at four, twelve and 24-week intervals. All follow-up visits included photographic documentation to confirm the cure rates before and after treatment. To evaluate the treatment’s safety and effectiveness, the number and size of wart lesions, as well as injection side-effects, were noted at baseline and during each follow-up visit. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0 (SPSS Inc., Chicago, IL). The Chi-square test was used to compare the study and control groups and to conduct follow-up analysis. Statistical significance was set at a level of ≤0.05, with a confidence interval of 95%. Results: Group A and B patients had 54 and 42 wart lesions, respectively. The complete cure rate in Groups A and B was 74.1% (40/54 warts) and 4.8% (2/42 warts), respectively, after four weeks. After the second follow-up, at twelve weeks, the cure rate was significantly higher in the experimental group: 97.3% versus 4.76% (p=0.00001). All cases during the IL injection experienced pain at the injection site and haemorrhagic eschar was observed in every case within the first week of the IL injection. No significant systemic adverse effects were noted. Conclusion: Intralesional bleomycin is highly efficacious and safe for the treatment of warts. Systemic side-effects are negligible, making it an effective treatment option for clearing warts in difficult areas, such as PW.

Comparative Evaluation of Two Audio-analgesic Tracks on Reduction of Anxiety Level in Patients Undergoing Root Canal Treatment: A Randomised Clinical Study

Ajay Singh Rao, Namrata Bajpai, Nimisha Chinmay Shah, Deebah Choudhary, Meetu Mathur, Vishnu Pratap Singh Rathore, Ridhhi Vasa Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Patients often experience dental anxiety, which can range from mild apprehension to severe phobia. In addition to pharmacological treatments, methods like sedation, aromatherapy, behavioural techniques, and music therapy have proven effective in reducing anxiety. Music, in particular, has been well-studied in clinical settings. Aim: To compare the reduction in anxiety levels of patients undergoing endodontic therapy with two different audio-analgesic tracks. Materials and Methods: This randomised clinical study was carried out in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from May 2019 to November 2019. A total of 120 patients were enrolled in the study. Before initiating endodontic therapy, patients were assessed for baseline anxiety using the Visual Analogue Scale (VAS), along with measurements of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Pulse Rate (PR). Participants were randomly divided into three groups: Group A: Om chanting music; Group B: weightless music; and Group C: control (no music). Vitals (SBP, DBP, PR) were recorded at three intervals: before treatment, at 30 minutes, and at one hour. The results were then statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0, employing the Analysis of Variance (ANOVA) test and Tukey’s Post-hoc analysis. Results: Out of the 120 patients, 82 (68.33%) were male and 38 (31.66%) were female, with a mean age of 35 years. The results indicated that SBP was significant during (p=0.004) and after treatment (p=0.002). Additionally, DBP was significant after treatment (p=0.037). PR was highly significant before, during, and after treatment (p<0.001 for all). The differences in SBP between groups B and C during treatment (p=0.003), as well as between groups A and C (p=0.004) and groups B and C (p=0.008) after treatment, were statistically significant. Additionally, a significant difference in DBP was observed between groups A and C after treatment (p=0.043). However, no significant differences in Heart Rate (HR) were found before, during, or after treatment among the groups (p>0.05). Conclusion: In the present study, both music tracks demonstrated clinically and statistically acceptable performance compared to the control group, with the Om chanting track having a more substantial influence on anxiety levels, SBP, and DBP than the weightless track. Additionally, there was a significant difference in HR, indicating the efficiency of music in reducing anxiety during dental treatment.

Factors Influencing Binge-watching Behaviour and its Impact on Loneliness among Undergraduate Medical Students: A Cross-sectional Study from Chengalpattu District, Tamil Nadu, India

R Suba Shree, P Kaveri, Roshni Mary Peter, VV Anantharaman, M Logaraj Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Binge-watching, a common behaviour among youth, is especially prevalent among medical students due to academic pressures and the accessibility of streaming services. This behaviour may lead to potential mental and physical health impacts. Aim: To assess the prevalence of binge-watching and identify associated risk factors among undergraduate medical students. Materials and Methods: A cross-sectional study was conducted among MBBS students in Chengalpattu, Tamil Nadu, India using multistage sampling. A total of 400 students were selected through simple random sampling. Socio-demographic details, including age, gender, family type, residence, year of study and risk factors for binge-watching (such as sleep duration, participation in recreational activities, Over-The-Top (OTT) platform subscription status, the number of OTT platforms subscribed to, frequency of binge-watching, devices used for binge-watching and consumption of snacks or junk food during binge-watching), were gathered using a pretested semistructured questionnaire. The University of California, Los Angeles (UCLA) Loneliness Scale and the Binge-watching Addiction Questionnaire assessed loneliness and binge-watching behaviour. Statistical analysis included mean and standard deviation, independent t-tests for continuous variables, Chi-square tests, univariate regression for categorical variables, and binary logistic regression for significant variables (p-value<0.05) to control for confounders. Results: The participants had a mean age of 20.71±2.04 years, with the majority being females (58.6%) and from nuclear families (86.1%). Most students (84.4%) had subscriptions to OTT platforms, with 50.8% binge-watching more than twice a week. The prevalence of binge-watching was 64% (381 participants). The overall mean binge-watching score was 33.14±13.012. Mild binge-watching was observed in 172 students (70.5%), moderate binge-watching in 53 students (21.7%), and problematic binge-watching in 19 students (7.8%). The overall mean loneliness score was 44.44±9.39. Univariate analysis identified significant associations between problematic binge-watching and being a hosteller, lack of recreational activities, OTT platform subscription and consumption of snacks or junk food. Binary logistic regression revealed significant associations between problematic binge-watching and factors such as the absence of recreational activities (AOR=2.298, p-value=0.012) and consuming snacks (AOR=2.518, p-value=0.006). Higher loneliness scores were significantly associated with problematic binge-watching (46.67±8.85) compared to mild binge-watching (43.51±9.47) (p-value=0.016). Conclusion: The study revealed a high prevalence of binge-watching among medical students, which was linked to loneliness and a lack of recreational activities. This emphasises the need for awareness and interventions to promote balanced media consumption.

Molecular Evidence of the High-risk Human Papillomavirus 56 Genotype in Cervical Abnormalities using Multiplex Nested PCR Assay: A Cross-sectional Study from a Tertiary Care Center in Puducherry, India

A Mashila, R Prabha, R Ramya, Rupal Samal, M Balasubramanian, S Sowmya, J Pradeep Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Human Papillomavirus (HPV) is a group of Deoxyribonucleic Acid (DNA) viruses linked to both benign and malignant diseases. High-Risk (HR) HPV genotypes, especially HPV 16 and HPV 18, are key contributors to cervical cancer. Aim: To determine the prevalence of HR HPV genotypes, including HPV 16, 18, 31, 45, 51 and 56, in cervical abnormalities in women by comparing cytological Pap smear results with in-house Multiplex Nested Polymerase Chain Reaction (PCR) to refine diagnostic protocols. Materials and Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, tertiary care hospital and the Mahatma Gandhi Medical Advanced Research Institute, Puducherry, India over a period of six months, from November 2023 to May 2024. The study included 100 symptomatic women presenting with complaints such as vaginal discharge, abnormal bleeding and pelvic pain. OBG endocervical samples were cross checked against cytological pap smear and multiplex nested PCR. The PCR amplified products were further confirmed by bidirectional Sanger sequencing. The sequenced data were analysed and annotated using MEGA software version 10.0 and submitted to the National Centre for Biotechnology Information (NCBI) database. Results: A total of 100 samples were analysed, with 14 (14%) detected as HPV DNA in symptomatic women. HPV 16 was observed in four patients (28.57%), followed by HPV 56 in four patients (28.57%). HPV 18 and HPV 31 were detected in two patients each (14.29%), while HPV 45 and HPV 51 were observed in one patient each (7.14%). Symptoms such as abnormal vaginal bleeding, pelvic pain and vaginal discharge were predominant with specific HPV genotypes. The detection limit of Multiplex Nested PCR was higher than that of the Pap smear. Co-infections with organisms like Candida albicans and Trichomonas vaginalis were noted in HPV-negative cases. The sequenced samples were published with GenBank accession numbers PQ518860 – PQ518863. Conclusion: While nested PCR exhibited higher sensitivity compared to the Pap smear, this study concludes that routine HPV genotyping and cytology screening for HR HPV strains are essential to improve early diagnosis and prompt treatment outcomes in HR groups.

Assessment of Bite Force in Patients with Periodontitis Before and after Splinting in Anterior Teeth using Computerised Occlusal Analysis System: A Clinical Study

Sathyalakshmi Ravikumar, Dhanvanthraj Venkatesan, Tarunkumar Kanmani, Rajalakshmi Ashokkumar, Vamsi Lavu Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Bite force is a measure of the functional status of the masticatory system. It is determined by the combined activity of the jaw elevator muscles, which are influenced by reflex mechanisms and jaw biomechanics. Measuring bite force can yield valuable information for assessing the activity and function of the jaw muscles. Recording devices and techniques are important factors in obtaining bite force measurements. Aim: To compare the occlusal function in terms of changes in bite force parameters before and after the splinting of periodontally weakened anterior teeth using the NUPAI bite scan (Fuji™) method in patients with stage I and II periodontitis. Materials and Methods: This prospective clinical study was conducted in the Department of Periodontology at Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India between May 2023 and February 2024. The bite force parameters assessed included pressed area, average pressure, and maximum pressure using the NUPAI bite scan (Fuji™) in a total of 25 individuals before and after extracoronal splinting of periodontally weakened anterior teeth. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20.0, and data were summarised as mean and standard deviation. A paired t-test was conducted to find significant differences in the various variables within the group. A p-value of less than 0.05 was considered statistically significant. Results: Maximum bite pressure and average bite pressure were found to be greater after the procedure of extracoronal splinting compared to before splinting, with mean values of 26.59±4.32 MPa (before splinting) and 30.45±4.29 MPa (after splinting) (p-value=0.005), and 9.11±1.75 MPa (before splinting) and 9.86±1.83 MPa (after splinting) (p-value=0.015), respectively. However, the mean pressed area before and after the splinting procedure was 22.76±34.49 mm² and 19.00±19.40 mm², respectively, showing no statistically significant difference between them (p-value=0.323). It can be inferred that, without appreciably altering the contact area, the splinting technique successfully increased bite force by improving both maximum and average pressures. Conclusion: The present study concluded that the splinting procedure used in phase I therapy aids in improving the patient’s occlusal function, and the NUPAI bite scan system allows for quantitative recording of this improvement.

Simple and Discriminatory Reaction Times in Preovulatory and Postovulatory Phases of Menstrual Cycle in Healthy Young Females: A Cross-sectional Study

Hemalatha Manjeshwara, V Suganthi, Amudharaj Dharmalingam, Milind V Bhutkar, Gopinath Manavazhagan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The menstrual cycle plays a significant role in the functioning of the cardiovascular and central nervous systems. Cognitive processing is affected differently during the various phases of the menstrual cycle, in addition to emotional processing. Cognitive domains such as attention, awareness, and memory show variations across the phases of the menstrual cycle. However, considerable conflicts exist in the scientific literature regarding the changes in these parameters during the menstrual cycle. Reaction times have been established as an objective measurement of cognitive processing in humans. Aim: To observe and compare simple and discriminatory visual and auditory reaction times in healthy adult females in the pre and postovulatory phases of their menstrual cycles. Materials and Methods: This cross-sectional observational study was conducted in the southern part of India during the years 2018-2024. Interested volunteers were questioned regarding their menstrual history to rule out any abnormalities. Healthy young adult females were included in the study after obtaining their informed consent in writing. Preovulatory reaction times were measured on the 10th or 11th day, while postovulatory reaction times were measured on the 20th or 21st day of the menstrual cycle. Simple and discriminatory visual and auditory reaction times were measured in triplicate at a resolution of one millisecond, with the minimum value included for analysis. The Kolmogorov-Smirnov test was used to analyse the normality of the distribution, and the Wilcoxon signed-rank sum test was used to test the significance of the difference in medians of the paired samples. Statistical Package for Social Sciences (SPSS) version 16.0 was employed for the analysis. Results: Simple Visual Reaction Times (SVRT) significantly differed between the pre and postovulatory phases (p-value 0.048). Simple Auditory Reaction Times (SART) also significantly differed between the pre and postovulatory phases (p-value 0.003). Discriminatory Visual Reaction Times (DVRT) and Discriminatory Auditory Reaction Times (DART) did not statistically differ between the pre and postovulatory phases (p-value=0.938, p-value=0.076, respectively). Conclusion: Simple visual and auditory reaction times were significantly prolonged in the postovulatory phases.

Comparing Abdominal Circumference to Gastric Residual Volume for Assessing Feed Intolerance in Low Birth Weight Infants: A Prospective Cohort Study

B Sunil, R Sushmitha Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Babies with feed intolerance usually present with vomiting, abdominal distension and the presence of gastric residues. Feed intolerance can be clinically diagnosed through the assessment of prefeed Gastric Residual Volume (GRV), the colour of gastric aspirates, abdominal distension, emesis, bloody stools and increased apnoea and/or bradycardia. Aim: To evaluate prefeed Abdominal Circumference (AC) and GRV for feed intolerance in low birth weight infants and also to assess the time taken to achieve 150 mL/kg full feeds. Materials and Methods: This prospective cohort study was conducted in the Department of Paediatrics at the Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India, from January 2021 to June 2022. A total of 100 neonates weighing less than 2.5 kg were included in the study. Group 1 was subjected to measurement of prefeed AC, while group 2 was subjected to measurement of prefeed gastric aspirate as a measure of feed intolerance. Inferential statistics such as the Chi-square test, t-test and other appropriate tests were used whenever applicable. A p-value of less than 0.05 was considered statistically significant. Results: Between the two groups considered in the study, the mean age of infants in group 1 and group 2 were 34.48 days and 33.04 days, respectively, with a mean birth weight of 1.82 kg and 1.72 kg in group 1 and group 2, respectively. In the present study, nine infants were in group 1 and 14 infants were in group 2, both showing signs of feed intolerance. The mean time required to reach full feeds in infants of group 1 was 8.72 days, while in group 2, it was 10.88 days. Conclusion: Both AC and GRV are useful indicators of feed intolerance; however, AC shows better results in terms of achieving full feeds, feed tolerance and the period of recovery. Nonetheless, the results obtained in the AC group are not statistically significant compared to the results obtained from the prefeed gastric aspirate group.

Absence of Anterior Guidance and its Effects on Early Discal Changes in Temporomandibular Joint: A Cross-sectional Study

Lokesh Sai Karanam, Suresh Venugopalan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Anterior guidance plays a crucial role in occlusal harmony and Temporomandibular Joint (TMJ) function. Its absence may contribute to early joint changes, potentially leading to dysfunction. Joint Vibration Analysis (JVA) provides a non invasive method to assess TMJ status and detect subclinical discal changes. Aim: To evaluate the effect of the absence of anterior guidance on TMJ function using JVA and to assess early discal changes. Materials and Methods: This cross-sectional study was conducted at the Department of Prosthodontics, Saveetha Dental College, Chennai, Tamil Nadu, India, over the period of March 2024 to August 2024 total of 30 participants were categorised into three groups based on anterior guidance: Group 1 served as the control group and consisted of participants with intact anterior guidance. Group 2 included participants without anterior guidance who had previously undergone orthodontic or prosthodontic therapy. Group 3 comprised participants without anterior guidance and without any prior history of orthodontic or prosthodontic treatment. JVA parameters, including total integral, integral values greater than 300 Hz and integral values less than 300 Hz, were analysed. Statistical analysis was performed using Statistical Package for Social Sciences (SSPSS) version 23.0, employing One-way Analysis of Variance (ANOVA) and Tukey’s post hoc test for group comparisons. Results: Participants without anterior guidance exhibited significantly higher total integral values (p-value <0.05), indicating subclinical discal changes in the TMJ. A significant difference (p-value=0.02) was observed in maximum mouth opening among the groups. The higher integral values greater than 300 Hz and less than 300 Hz in the groups without anterior guidance further supported the presence of early joint dysfunction. Conclusion: Early subclinical discal changes in the TMJ were noted in patients with an absence of anterior guidance. JVA can serve as an effective diagnostic tool for the early detection of TMJ dysfunction.

Clinical Utility of Serum Lactate and Albumin in Predicting Mortality in Patients with Sepsis Admitted to the Intensive Care Unit: A Prospective Cohort Study

Benjamin Isac John, AS Sathiqali, Rohith George, B Mukhtarahmed Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Sepsis is a life-threatening condition characterised by systemic inflammation and multiorgan dysfunction in response to infection. Despite the specificity of prognostic scoring systems such as Sequential Organ Failure Assessment (SOFA) and Acute Physiology And Chronic Health Evaluation II (APACHE II), their limited sensitivity and reliance on multiple laboratory parameters highlight the need for simpler, effective biomarkers. Serum albumin, a negative acute-phase reactant and lactate, an organ hypoperfusion marker, are potential biomarkers for assessing the severity of sepsis. Aim: To evaluate the prognostic significance of serial serum lactate and albumin levels, as well as their ratio, in predicting outcomes in Intensive Care Unit (ICU) patients with sepsis. Materials and Methods: This prospective cohort study was conducted in the medical ICU of Yenepoya Medical College and Hospital, Mangaluru, Karnataka, India that included 95 adults admitted to the medical ICU with suspected sepsis, meeting the Sepsis-3 criteria. Serum lactate and albumin levels were measured on days 1, 3 and 5 post-diagnosis. Patient outcomes, including mortality and duration of hospital stay, were documented. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0, which included Pearson’s correlation to evaluate relationships between lactate and albumin levels, Student’s t-test for group comparisons and Receiver Operating Characteristic (ROC) curve analysis to assess the predictive accuracy of the Lactate/Albumin Ratio (LAR). Results: The study included 95 ICU patients with sepsis (mean age: 50.25±14.65 years; 63.16% male). Prolonged hospital stays (>15 days) were noted in 61.06% of patients, with 78.94% recovering. Survivors showed rising albumin levels (day 1: 2.82 g/dL; day 5: 3.43 g/dL) and declining lactate levels (day 1: 2.77 mmol/L; day 5: 1.27 mmol/L), while non survivors exhibited minimal increases in albumin (day 1: 2.87 g/dL; day 5: 3.05 g/dL) and persistently elevated lactate levels (day 1: 3.02 mmol/L; day 5: 3.35 mmol/L). On day 5, survivors had significantly higher albumin levels and lower lactate levels than non survivors. The LAR declined in survivors (day 1: 1.07; day 5: 0.54) and demonstrated marked predictive accuracy for mortality on day 5 (AUC=0.81, sensitivity=68%, specificity=95%), with diagnostic accuracy peaking at 89.21%. Conclusion: The day 5 LAR is a strong predictor of mortality in ICU patients with sepsis. The inverse correlation between lactate and albumin levels underscores their utility for early risk stratification and management of sepsis.

A Study on Plasma Fibrinogen as a Risk Factor for Premature Acute Myocardial Infarction

Maneesha Maniya, Vignessh Raveekumaran, Sethuraj Selvaraj, KS Chenthil Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Acute Myocardial Infarction (AMI), a significant coronary event, is increasingly prevalent among younger populations, presenting unique challenges in risk assessment and prevention. Premature AMI, defined as occurring before the age of 55, is often linked to non traditional risk factors such as elevated Plasma Fibrinogen (PFg), a key component in atherothrombosis and vascular inflammation. Aim: To determine the prevalence of elevated PFg levels in premature AMI patients (<55 years) and evaluate its association with AMI among patients admitted to a tertiary care hospital in Puducherry, India. Materials and Methods: A hospital-based case-control study was conducted in the Coronary Care Unit (CCU) and Intensive Care Units (ICU) under the Department of General Medicine at a tertiary care teaching hospital in rural Puducherry, India. Over 18 year among 112 patients: 56 with AMI (cases) and 56 age- and sex-matched controls without AMI. Data were collected through clinical evaluations, Electrocardiography (ECG), Echocardiography (ECHO) and biochemical assays. PFg levels were classified as normal (<340 mg/dL) or elevated (>340 mg/dL) and the associations with AMI were analysed. Results: The mean PFg level in AMI patients was significantly higher (409±52.3 mg/dL) than that in controls (226±46.2 mg/dL) (p<0.001). Elevated PFg levels were observed in 48.2% of AMI patients, correlating strongly with traditional risk factors such as smoking and lipid abnormalities. Conclusion: Elevated PFg is a significant risk factor for premature AMI. Incorporating PFg measurement into cardiovascular risk assessments could aid in the early identification and targeted intervention for this at-risk population.

Acoustic and Psychological Effects of Omkar Chanting in Novice Indian Adults: A Quasi-experimental Study

Jayashree Pattanayak, Yamini Belur, Judu Ilavarasu Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The physiological and psychological effects of Omkar chanting are gaining popularity. However, limited research has focused on the acoustic effects of Omkar chanting and how the produced sounds and vibrations influence both mental and vocal physiological states. Aim: This study explores the effects of 10 days of Omkar mantra chanting on voice quality and psychological well-being in Indian adults without prior regular chanting experience. Materials and Methods: A quasi-experimental study was conducted online in India involving 100 healthy adults (aged 20-45 years) over 10 days in three batches, from November 2023 to December 2023. Participants attended daily 30-minute Omkar chanting sessions. Four participants were excluded due to unclear audio recordings. Voice parameters and psychological well-being were assessed using PRAAT software, the World Health Organisation-Five Well-being Index (WHO-5), and the Subjective Vitality Scale, before and after the intervention. Data were analysed using paired sample t-tests to evaluate changes in voice parameters, vitality, and overall well-being. The level of significance was fixed at 0.05. Results: After 10 days of Omkar chanting, participants experienced significant improvements in their vocal quality, including reduced fundamental frequency (F0) for “A kara” (females: 223.06 to 216.58 Hz; males: 138.65 to 129.23 Hz) and “U kara” (females: 223.40 to 216.22 Hz; males: 138.40 to 131.13 Hz), as well as decreased jitter and shimmer values, reflecting increased vocal stability. There were significant increases in the mean WHO-5 scores (from 15.19 to 21.88) and mean vitality scores (from 23.76 to 35.34), (p-value <0.001), suggesting a positive impact on psychological well-being. These results indicate the beneficial effects of Omkar chanting on vocal health and psychological well-being in adults with no prior chanting experience. Conclusion: Omkar mantra chanting positively improves vocal stability, resonance, and mental health in adults aged 20-45 years. These findings suggest that incorporating mantra chanting into daily routines can be a simple yet effective tool for enhancing both vocal health and mental well-being, making it beneficial for those seeking natural practices for stress reduction and overall well-being.

Effect of Storage Time and Temperature on Important Biochemistry Parameters in Stored Human Blood Samples: A Cross-sectional Study

Tajveer Singh Kanda, Heena Singla, Rajinderjit Singh Ahi Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Backbone of modern healthcare depends on accuracy of laboratory test results. Sometimes in busy laboratories, samples may have to be stored or transported at different temperatures and for different time periods before they could be analysed. In particularly such samples, validation of test results is very important. Aim: To study the effect of storage time and temperature on important biochemistry analytes. Materials and Methods: It was cross-sectional study, carried out in Department of Biochemistry at GGS Medical College, Faridkot, Punjab, India from January 2023 to December 2023. Total 40 patients’ samples were first analysed immediately (0-hour samples) for important biochemical parameters i.e., glucose, urea, creatinine, uric acid, total bilirubin, direct bilirubin, Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP), sodium, potassium, chloride, amylase, triglycerides, cholesterol, calcium, phosphorus, Creatine Kinase Myoglobin-Binding fraction (CK-MB), Lactate Dehydrogenase (LDH) and N-Acetyl Cysteine Activated Creatine Kinase (CK-NAC). Then samples were stored in two separate aliquots, to be stored at 2-8°C and at room temperature for analysis after 24-hour and 72-hour. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 22 software. If p-value was less than 0.05, difference was considered statistically significant. Results: At 2-8°C, mean values of blood glucose, direct bilirubin, amylase and CK-MB showed statistically highly significant decrease in 24-hour samples, and their mean values were further lower in case of 72-hour samples (all p-values <0.05). Statistically significant increase was noted in mean values of creatinine, uric acid, potassium and phosphorus in samples stored at 2-8°C for 24-hour, which were further higher in 72-hour samples (all p-values again <0.05). In samples stored at room temperature, similar pattern was seen but the changes were more significant as compared to samples stored at 2-8°C. (All p-values again <0.05). Additionally, in samples stored at room temperature, statistically significant decrease was seen in mean values of ALT, while statistically significant increase was noted in mean values of triglycerides, cholesterol, calcium and LDH, while no change was seen in mean values of potassium (p>0.05). Conclusion: Patient samples should be tested as soon as possible to obtain the correct values, particularly for these mentioned parameters.

Comparison between the Clinical Pulmonary Infection Score and Modified Centre for Disease Control Criteria for Diagnosis of Ventilator-associated Pneumonia: A Cross-sectional Study

Aniket Debnath, Saikat Batabyal, Sumit Roy Tapadar, Arunabha Datta Chaudhuri Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Ventilator-Associated Pneumonia (VAP) is a frequent complication of Mechanical Ventilation (MV). The incidence of VAP is not precisely known and ranges from 13 to 51 per 1,000 ventilator days. A uniform surveillance definition for VAP is not available. The Centre for Disease Control (CDC)/National Healthcare Safety Network (NHSN) and the Clinical Pulmonary Infection Score (CPIS) algorithms are widely used. Aim: To compare the modified CDC criteria and the CPIS algorithm for VAP. Materials and Methods: A cross-sectional study was conducted at the respiratory care unit of the Department of Respiratory Medicine at RG Kar Medical College and Hospital in Kolkata, West Bengal, India, over a period of 18 months, from January 2021 to June 2022. A total of 60 adult patients on MV for more than 48 hours, with a high index of suspicion for VAP, clinically and radiologically, were included in this study. The microbiological (bacteriological quantitative culture) and radiological profiles {CXR parenchymal opacities, Ultrasonography (USG) and Contrast-Enhanced Computed Tomography (CECT) thorax} of VAP infections were assessed and compared. Statistical analysis was conducted after entering the data into a Microsoft Excel spreadsheet. Results: Among the 60 patients, most were male (76.67%) and aged between 51 and 60 years (40%). A total of 48 (80%) patients had a positive CPIS score, while 42 (70%) had positive modified CDC criteria. A fair degree of concordance was found between the two algorithms. Pseudomonas was the most common organism identified in both early and late-onset VAP. Among all antibiotics, Polymyxin B was found to be sensitive to all the organisms. Conclusion: The VAP is the most frequent infection associated with Intensive Care Unit (ICU) admissions. Polymicrobial aetiology and MDR strains were found in a significant number of cases. In the present study, the CPIS criteria demonstrated a fair concordance with the modified CDC criteria and slightly better sensitivity than the modified CDC criteria in diagnosing VAP.

Comparison of Intranasal Dexmedetomidine with Intravenous Dexmedetomidine as Premedication in Patients undergoing Laparoscopic Surgeries under General Anaesthesia: A Randomised Controlled Trial

Priyanka Gupta, Vandana Koul, Mayank Gupta, Subah Bharaj Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The sympathetic stress response due to pneumoperitoneum during laparoscopic surgeries necessitates a balanced anaesthesia technique. Dexmedetomidine (DEX) has emerged as a promising option. While intravenous (i.v.) DEX is well established in attenuating the haemodynamic stress response to pneumoperitoneum, the Intranasal (IN) route remains underexplored for this purpose. Aim: To compare the efficacy and safety of IN and i.v. DEX in attenuating the haemodynamic stress response to pneumoperitoneum. Materials and Methods: In this randomised triple-blind controlled trial which was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. A total of 75 adults classified as American Society of Anaesthesiologists (ASA) physical status I or II, scheduled for elective laparoscopic surgery, were randomly allocated to one of three groups (25 in each group): control, IN DEX (IN group), and i.v. DEX (i.v. group). DEX was administered at a dose of 1 μg/kg via the IN or i.v. route before induction. Heart Rate (HR) and Mean Arterial Pressure (MAP) were monitored until 10 minutes postextubation at appropriate time intervals, along with preoperative sedation scores and any side-effects. All statistical calculations were performed using Statistical Package for the Social Sciences (SPSS) 21.0 version (SPSS Inc., Chicago, IL, USA) statistical program for Microsoft Windows. Results: Patients were comparable with respect to age (p-value=0.769), gender (p-value=0.321), and weight (p-value=0.672). HR and MAP were significantly lower in the IN and i.v. groups compared to the control group during pneumoperitoneum, but were comparable between the IN and i.v. groups. Both of these groups had better sedation scores compared to the control group. None of the groups experienced any significant side-effects. Conclusion: Both IN and i.v. DEX have similar efficacy and safety in alleviating the haemodynamic stress response to pneumoperitoneum. Side-effects such as bradycardia, hypotension, nausea, vomiting and shivering were comparable among the three groups. Both IN and i.v. DEX provided comparably satisfactory preoperative sedation, which was significantly better than that of the control group.

Clinical and Biochemical Effects of Preoperative Oral Carbohydrate Loading versus Fasting in Major Abdominal Surgeries: A Randomised Clinical Study

A Nanda Lakshmi, KP Biji, S Syamkumar, VK Prathapan, A Krishnadas, KR Radha, J Preetha Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Surgery and preoperative fasting result in Perioperative Insulin Resistance (PIR) and can lead to increased postoperative morbidity, mortality and prolonged hospital stay. Enhanced Recovery After Surgery (ERAS) protocols advocate oral carbohydrate loading preoperatively, contrary to conventional fasting practices. Aim: To compare preoperative oral carbohydrate loading with fasting in terms of mean changes in perioperative blood sugar, albumin levels and patient well-being in major abdominal surgeries. Materials and Methods: This prospective randomised clinical study was conducted in the surgical gastroenterology operating theatre of Government Medical College Hospital, Kozhikode, Kerala, India, during 2021-2022 among 54 patients. Patients undergoing elective major abdominal surgeries under general anaesthesia were randomly divided into two groups. One group received preoperative oral carbohydrate loading (CHO) (n=27), while the other group followed conventional fasting (FAST) (n=27). Changes in perioperative blood sugar were the primary objective. Changes in perioperative albumin levels, subjective patient well-being, time for resumption of oral intake and duration of postoperative hospital stay were secondary objectives. Continuous variables were assessed using mean and standard deviation. The Student’s t-test was used to statistically analyse quantitative data and the Chi-square test was employed for qualitative data. Results: There was a significant difference in the perioperative blood sugar values (p-value <0.05) and the albumin levels (p-value <0.001) among patients who received preoperative carbohydrate loading and those who followed conventional fasting. The group that received preoperative oral carbohydrate loading had a significantly lower mean blood sugar value compared to the conventionally fasted group during the perioperative period. Postoperative serum albumin values were significantly higher in the carbohydrate-loaded group compared to the fasted group. The carbohydrate-loaded group reported better subjective well-being, shorter time for resumption of oral intake and a reduced duration of hospital stay (p-value <0.05). Conclusion: Preoperative loading with oral carbohydrates stabilises perioperative blood sugar levels and albumin levels and improves patient well-being in major abdominal surgeries.

Lifestyle Risk Factors in Male Androgenetic Alopecia: A Cross-sectional Study

Mayuresh Shamsunder Pavaskar, Suganita, Deepika Agarwal, Sonal Sachan, Vandana Yadav Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Male Androgenetic Alopecia (AGA) is a prevalent form of hair loss affecting a significant portion of the population worldwide. While genetic predisposition is a primary factor, lifestyle factors such as smoking, alcohol consumption, obesity and psychological stress have been increasingly recognised as potential contributors to the progression and severity of male AGA. This study was conducted to identify these risk factors in male AGA utilising various tools like the Depression, Anxiety and Stress Scale (DASS) 21 scale, Body Mass Index (BMI), smoking index and Alcohol Use Disorders Identification Test (AUDIT) scale. Aim: To identify lifestyle-related risk factors such as smoking, alcohol consumption, obesity and psychological stress in male AGA. Materials and Methods: A hospital-based observational cross-sectional study was conducted in the dermatology department of a tertiary care facility, involving 100 male patients with AGA aged 18 to 55 years. The study utilised consecutive sampling methods for the enrollment of participants. Each patient underwent a thorough clinical evaluation and the severity of alopecia was determined using the Hamilton-Norwood classification. Detailed questionnaires assessed risk factors including smoking history (using the smoking index), alcohol consumption (using the AUDIT scale), psychological stress levels (using the DASS-21 scale) and obesity was assessed by measuring BMI. Data were analysed using statistical software Statistical Package for the Social Sciences (SPSS) version 26.0 (SPSS Inc., Chicago, IL, USA). Results: Among the study population, the mean age was 28.78±5.91 years. Family histories included 12 with maternal AGA, 56 with paternal AGA and 32 with no family history. Significant associations were found between AGA severity and several factors, including higher alcohol screening scores (4.71±5.30) (p-value=0.0006) and a greater smoking index (17.31±15.10) (p-value=0.016). The results for BMI (22.33±3.91) (p-value=0.056) and DASS-21 stress score (14.96±5.9677) (p-value=0.351) were not found to be significant with the severity of AGA. Overall, the findings underscore the multifactorial nature of AGA, influenced by lifestyle, genetic predisposition and anthropometric measures, with implications for clinical management and future research. Conclusion: The study highlights the multifaceted nature of AGA, influenced by lifestyle habits and factors. The findings suggest a strong association between higher alcohol and smoking indices and the severity of AGA. These insights could inform prevention strategies and targeted interventions for individuals affected by AGA.

The effectiveness of an Interactive Toy as an Active Distraction Compared with a Passive Distraction in Alleviating Dental Anxiety and Pain while Administration of Local Anaesthesia in Children: A Randomised Clinical Trial

Pinjari Alam Meerza, SVSG Nirmala Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Painless dentistry requires Local Anaesthesia (LA), however, due to the pain of the injection itself, it could be a very anxious process. During invasive dental treatments, distraction can be used as a non pharmacological behaviour management technique by diverting the individual’s attention away from painful stimuli. Aim: To evaluate the effectiveness of an interactive toy as an active distraction compared with the colourful headset with music as a passive distraction in alleviating dental pain and anxiety while administration of LA in children aged between 4 and 9 years. Materials and Methods: The trial design was an interventional, prospective, parallel-based block randomisation which was was conducted on 60 children aged between 4 and 9 years, who were randomly assigned into two groups with 30 each. The study was conducted on children who reported to the Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India for six months, from April 2023 to September 2023. Children in Group 1 received interactive toy, whereas Group 2 received colourful headset with music. Using pulse rates and Chotta Bheem Chutki (CBC) scale dental anxiety was evaluated. While pain was evaluated using Faces, Leg, Activity, Cry and Consolability (FLACC) scale and Modified Wong-Baker Faces Pain Rating Scale (MWBFPRS). Paired t-test, independent t-test, Wilcoxon rank test and Mann-Whitney U test was used to quantify anxiety and pain. Results: Anxiety scores were statistically reduced in interactive toy group (p<0.05). The mean pain scores of FLACC and MWBFPRS were lower in interactive toy group compared to colourful headset with music group, showing a statistically significant difference (p-value <0.001). Interactive toy group significantly reduced anxiety and pain in age groups of both (4-6 and 7-9 years) and also among the gender. Conclusion: Interactive toy, as an active distraction technique, was effective in alleviating anxiety and pain compared to colourful headset with music in children while administering LA. Interactive toy group significantly reduced anxiety and pain in both the age groups and also among the gender.

Alteration in Taste Perception among Young Children following the Use of Oral Irrigants in Pulpectomy Procedure: A Randomised Controlled Trial

Praveen Kumar, R Ramesh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The impact of oral irrigants on taste perception during pulpectomy procedures focuses on how these sensory experiences affect patient comfort and cooperation. This study aims to identify child-friendly irrigants with natural taste profiles that minimise discomfort and enhance procedural success. Aim: This study evaluated the effects of different oral irrigants-chlorine dioxide, Saline, Chlorhexidine Gluconate, and Sodium Hypochlorite-on taste perception in children undergoing pulpectomy procedures. Materials and Methods: A randomised controlled trial was conducted at Saveetha Dental College and Hospital from July to December 2024, involving 100 children aged 6-9 years undergoing pulpectomy procedures. Participants were randomly assigned to four groups based on the irrigant used: chlorine dioxide, saline, chlorhexidine gluconate, and sodium hypochlorite. The study assessed taste perception using a 5-point Likert scale and a validated questionnaire at baseline and during the second visit. Demographic parameters such as age, gender, and oral health metrics were recorded to ensure group homogeneity. Statistical analysis included paired t-tests, one-way Analysis of Variance (ANOVA), and effect size estimation, with a p-value of <0.05 considered significant. Results: Significant differences in taste alteration scores were observed across the four oral irrigants. Chlorine dioxide exhibited the most substantial reduction in taste alteration scores from T0 (2.96±1.24) to T1 (1.40±0.76), followed by Saline (T0: 3.12±1.01; T1: 2.24±1.27). In contrast, chlorhexidine and sodium hypochlorite showed minimal changes between baseline and follow-up scores. ANOVA revealed statistically significant differences in taste perceptions for chlorine dioxide (p<0.001), Saline (p=0.007), and Chlorhexidine (p=0.033), while Sodium Hypochlorite exhibited borderline significance (p=0.057). Effect size analysis indicated that chlorine dioxide (Eta²=0.398) had the largest impact, particularly influencing sweetness and bitterness perceptions, which played a crucial role in the overall treatment experience. Conclusion: The study underscores the importance of selecting irrigants that balance clinical efficacy with sensory acceptability. Chlorine dioxide demonstrated the greatest impact on taste alteration, necessitating the development of paediatric-friendly formulations to enhance patient cooperation and comfort.

Effect of Sport-specific Polarised Training on Agility in Elite and Subelite Badminton Players: A Randomised Controlled Study

Manish Nagpal, Nitesh Malhotra Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Training Intensity Distribution (TID) is used by elite athletes prior to their competitions to enhance their performance. It has been employed in various endurance sports like running and cycling, but it is underutilised in sports where other components such as agility, strength and coordination are also part of the training. Badminton is one such game that requires aerobic fitness, skill, coordination, along with agility for rapid changes of direction and movements such as jumping, squatting and lunging. Badminton players need to practise these movement patterns to strike the shuttlecock and keep moving back and forth on the court. Aim: To evaluate the effect of sport-specific polarised training via a badminton field test on agility in badminton players. Materials and Methods: This double-blinded randomised controlled was conducted in an indoor badminton court at Manav Rachna Sports Academy in Faridabad, Haryana, India. Twenty badminton players aged between 15 to 26 years participated in this study, in which players were randomly assigned to two groups: an Experimental Group (EG) (n=10) and a Control Group (CG) (n=10). Over a 9-week period, the EG engaged in sport-specific polarised training via a badminton field test using BlazePod agility lights and an Edge lactate analyser to differentiate between three zones of training, while the CG followed the traditional training prescribed by their coach. In the badminton field test, the speed of the lights was kept at 16 lights per minute for low intensity (zone 1), 20 lights per minute for threshold intensity (zone 2), and above 22 lights per minute up to exhaustion for high-intensity training (zone 3). A four-corner agility test was used to evaluate the agility of the badminton players before and after the 9-week training protocol. Statistical analysis was conducted using a One-way Analysis of Variance (ANOVA). Result: The results showed that an 11.8% improvement was observed in the polarised training or EG, compared to a 3.6% improvement in the CG. This indicates that performing repeated sport-specific movements at different intensities, as done in polarised training, increases aerobic capacity and also improves agility in badminton players. Conclusion: There was an improvement in the agility of badminton players following sport-specific polarised training.

Comparative Study of Intravenous Granisetron against Ondansetron in Preventing Postoperative Nausea Vomiting in Patients undergoing General Anaesthesia: A Double-blinded Randomised Controlled Study

Sufala Sunil Vishwasrao, Sunil Mhatarba Vishwasrao, Amar Nagesh Kumar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Postoperative Nausea and Vomiting (PONV) remain a significant issues following general anaesthesia, affecting patients’ comfort and recovery. The choice of antiemetic agents is paramount in minimising these symptoms. Aim: To compare the efficacy and safety of intravenous (i.v.) Granisetron and Ondansetron in preventing PONV in patients undergoing general anaesthesia in a tertiary care hospital in Tamil Nadu, India. Materials and Methods: A double-blind, randomised controlled trial was conducted at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Madhurantagam, Tamil Nadu, India, from December 2021 to March 2023 involving 66 patients aged 18-65 years, scheduled for elective surgeries under general anaesthesia. Participants were randomly assigned to receive either 2 mg of intravenous Granisetron (Group A) or 4 mg of intravenous Ondansetron (Group B) prior to induction. The primary outcome was the incidence of PONV within 24 hours of surgery. Secondary outcomes included the need for rescue medication and the occurrence of adverse effects. Data were analysed using Chi-square and independent t-tests, with a p-value<0.05 considered statistically significant. Results: The majority of participants were between 29 and 48 years of age in both groups. The mean age of the patients in Group A and Group B was 34.61±10.88 and 43.64±13.26 years, respectively. The Complete Response (CR) (no emesis and no requirement for rescue antiemetics) was significantly higher in the Granisetron group, with 28 (85%) compared to the Ondansetron group, which had 19 (58%) (p<0.05). The incidence of nausea and vomiting was lower in Group A throughout all postoperative time intervals. Adverse effects such as headache and dizziness were comparable between the groups and were mild in nature. No serious adverse events were reported in either group. Conclusion: Intravenous Granisetron demonstrated better efficacy in preventing PONV than Ondansetron, with a higher CR rate and reduced need for rescue medication. Both drugs were well-tolerated, with a similar safety profile. These findings suggest that Granisetron could be a more appropriate option for PONV prophylaxis in patients undergoing general anaesthesia. Further multicentre studies are recommended to validate these results across a diverse patient population.

One-Pot Green Synthesis of Strontium and Zirconium Nanoparticles: An In-vitro Study of their Antioxidant and Cytotoxic Activity

Kishorwara Ramamoorthy, T N Uma Maheswari, Saravanan Muthupandian, Devika S Pillai Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The one-pot synthesis approach for Strontium and Zirconium Nanoparticles (Sr-Zr NPs) utilises pomegranate (Punica granatum) extract as a natural reducing and stabilising agent. This eco-friendly approach leverages the high antioxidant content of pomegranate to eliminate the need for toxic chemicals in nanoparticle production. Aim: To synthesise zirconium and strontium nanoparticles from the extract of Punica granatum and to assess their antioxidant and cytotoxic properties. Materials and Methods: The present in-vitro study was carried out in the Laboratory, Department of Pharmacology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India over a period of six months from November 2023 to May 2024. Pomegranate peel aqueous extract was prepared by drying and grinding the peels, followed by autoclaving, heating, and centrifugation to extract bioactive compounds. Zirconium and strontium nanoparticles were synthesised by mixing the extract with zirconium chloride and strontium chloride solutions, followed by continuous stirring. The formation of nanoparticles was confirmed by a colour change. The nanoparticles were characterised using Fourier Transform Infrared Spectroscopy (FTIR) and UV-visible Spectroscopy (UV-Vis). Their antioxidant efficacy was assessed using the 2,2-diphenyl-1-picrylhydrazyl (DPHH) assay, while cytotoxicity was evaluated using cell viability assays. Results: The synthesised Sr-Zr NPs were characterised by their structural and optical properties, exhibiting distinct UV-Vis absorption peaks at 286 nm and 371 nm. At the highest concentration tested (100 μg/mL), Sr-Zr NPs exhibited approximately 89% inhibition, whereas L-ascorbic acid showed 92% inhibition, demonstrating the potent antioxidant activity of the nanoparticles. The IC50 value, representing the concentration at which 50% of the cells were inhibited, was determined to be 90 μg/mL. At this concentration, cell viability was reduced to approximately 50%, indicating significant cytotoxic activity. Conclusion: The study highlights the potential of Sr-Zr NPs for biomedical applications, particularly in antioxidant therapies and cancer treatment, due to their potent biological activities and favourable optical properties. The use of pomegranate extract not only enhances the biocompatibility of the nanoparticles but also aligns with sustainable development goals, offering a promising pathway for the green synthesis of biocompatible nanoparticles with therapeutic potential.

Evaluation of Marginal Leakage of Composite Resin Restoration in Cervical Cavities Prepared by Conventional Method versus Er,Cr:YSGG Laser: An In-vitro Stereomicroscope Analysis

Binayak Saha, Amrita Ghosh, Mousumi Biswas, Kuntal Chowdhury, Ujjwal Das, Snigdho Das, Haridas Das Adhikari, Abhijit Niyogi Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Modern dentistry emphasises minimally invasive techniques, with Erbium, Chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) lasers gaining popularity for hard and soft tissue preparation. These lasers offer advantages such as smear layer removal and surface modifications that enhance restorative material retention. However, their efficacy in minimising marginal leakage in composite restorations remains underexplored, especially when combined with acid etching. Understanding these effects is critical to advancing minimally invasive restorative techniques. Aim: To evaluate the marginal leakage of composite resin restorations in cervical cavities prepared by conventional methods and Er,Cr:YSGG lasers. Materials and Methods: This in-vitro experimental study was conducted in the Department of Conservative Dentistry and Endodontics at Dr. R. Ahmed Dental College and Hospital in Kolkata, West Bengal, India, from October 2008 to February 2010. Total 45 freshly extracted, caries-free, and restoration-free permanent human molars were selected as the study sample. The primary inclusion criteria included teeth with intact cervical regions and no prior restorations or decay. The teeth were randomly divided into three groups of 15 each. Class V cavities were prepared on the buccal or lingual surfaces of the teeth, with occlusal margins in enamel and gingival margins in dentin or cementum. Group I cavities were prepared using a tungsten carbide bur and restored after acid etching. Group II cavities were prepared with an Er,Cr:YSGG laser and restored without acid etching, while Group III cavities were laser-prepared and restored after acid etching. All cavities were restored using composite resin following the application of an adhesive system. The samples were stored in distilled water, thermocycled, and immersed in a 2% methylene blue solution to assess microleakage. Statistical analysis was performed using the Chi-square test, with the significance level set at p<0.05. Results: The distribution of microleakage scores showed a statistically significant association (p=0.004). Group II cavities exhibited the highest leakage, whereas the group III sample had the lowest. The power analysis demonstrated an achieved power of 87%, confirming that the sample size was adequate. Conclusion: The findings suggest that while laser preparation alone may result in higher leakage, combining laser preparation with acid etching significantly reduces microleakage, achieving outcomes that are comparably better than those of conventional bur-prepared cavities with acid etching. These results emphasise the potential of combining laser technology with acid etching for improved restorative outcomes.

Impact of a Module on Early Clinical Exposure in Pharmacology: A Prospective Interventional Study from a Medical College in West Bengal, India

Sarmila Nath, Kalyan Brata Mandal, Anjana Ghosh Dastidar, Quazi Shabnam Waheed Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The National Medical Commission (NMC) has introduced the concept of Early Clinical Exposure (ECE) in the undergraduate medical curriculum to provide some clinical relevance to what students are studying in their preclinical years. Past studies conducted across different disciplines have proven the effectiveness of ECE sessions. Against this background, a module on ECE was designed and implemented among Phase 2 students studying Pharmacology at a Medical College in West Bengal, India. The perceptions of participating students and faculty regarding the module were obtained through feedback forms. Aim: To evaluate the impact of a module of ECE for teaching the topic on anaesthetic drugs to undergraduate medical students studying Pharmacology. Materials and Methods: The study was conducted over a period of three months at a medical college in West Bengal. A total of 180 Phase 2 students studying Pharmacology and six faculty members from the Departments of Pharmacology and Anaesthesiology participated in the study. Following informed consent and sensitisation, students were randomly divided into a control group and a study group. The study group was exposed to ECE sessions, followed by lecture classes involving both the study and control groups. The impact of the ECE sessions on knowledge gain was assessed through a formal test one week after the lecture classes. Perceptions from students and faculty were obtained through a Google Form containing semiclosed questions. Quantitative analysis was conducted using the Independent t-test, Chi-square test and percentages as appropriate. Following the entire process, faculty members from both departments held a meeting to discuss the challenges in implementing the module and how to overcome these barriers in the future. Results: There was a significant increase in knowledge among the study group (p-value: 0.0018) compared to the control group. About 155 (86.1%) of students considered the module to be an effective learning tool and 138 (76.7%) students opined that the sessions were well planned. A total of 66.67% of faculty members believed that this module of ECE could be implemented in the curriculum. Conclusion: The current module on ECE had a positive impact on the participating students. With a few modifications, it could be included in the undergraduate Pharmacology curriculum in the future.

Effect of Intrathecal Bupivacaine Kept at Room Temperature versus Body Temperature on Shivering During Lower Limb Orthopaedic Surgery Under Spinal Anaesthesia: A Double-blind Randomised Controlled Trial

Anil Kumar, Shuchi Nigam, Shipra Verma, Urvashi Yadav, Alankrita Acharya, Shailendra Kumar Patel Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Perioperative shivering is very common after spinal anaesthesia. Shivering can cause discomfort, interfere with monitoring and lead to serious complications, particularly in patients with cardiorespiratory disorders. Aim: To compare the effect of intrathecal bupivacaine at room temperature and body temperature on perioperative shivering in patients undergoing lower limb orthopaedic surgery. Materials and Methods: This randomised, double-blind study was conducted at Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India, which included 70 patients of either sex, aged 18-65 years, classified as American Society of Anaesthesiologists (ASA) physical status I and II and scheduled for lower limb orthopaedic surgery under spinal anaesthesia. Patients were randomly allocated into two groups. All patients received a subarachnoid block with 3 mL of 0.5% bupivacaine heavy combined with 10 μg of fentanyl. Group W received the study drug stored at body temperature (35±1°C), while group C received the study drug stored at room temperature (20±1°C). The primary outcome measured was the incidence of shivering; the secondary outcomes measured were the onset and severity of shivering and changes in body temperature. Side-effects of spinal anaesthesia, including bradycardia, hypotension, nausea and vomiting, were also noted. Data were expressed as mean and standard deviation for continuous variables and numbers and percentages for categorical variables. An independent t-test was used to compare the means between the groups and a Chi-square test was used for categorical variables. Results: Both groups were comparable in terms of demographic parameters such as age, weight and height (p-value>0.05) as well as haemodynamic status. The incidence of shivering was 11 (31.43%) patients in group W and 25 (71.43%) patients in group C; the difference was statistically significant (p-value <0.001). The onset time of shivering in group W was 13 minutes compared to four minutes in group C (p-value=0.015). In group C, 40% of patients developed shivering of grade more than one, compared to 22.86% in group W. Conclusion: Warming intrathecal bupivacaine to body temperature significantly reduces the incidence, delays the onset and decreases the severity of perioperative shivering in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia, compared to bupivacaine administered at room temperature.

Problematic Smartphone Use and its Association with Sleep Disturbances: A Cross-sectional Study

Ajay Thangaraj, Kamatchinathan Premkumar, Vaishali Shanmugam, G Sheelapriya Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The widespread integration of smartphones into daily life has raised concerns about their potential impact on Sleep Quality (SQ). Excessive smartphone use, particularly before bedtime, may contribute to sleep disturbances through prolonged screen exposure, cognitive stimulation and night-time interruptions. Given the critical role of sleep in overall health and wellbeing, understanding the association between problematic smartphone use and sleep disturbances is essential. Aim: To examine the association between Problematic Mobile Phone Use (PMPU) and SQ among adults, highlighting its potential impact on sleep patterns and overall wellbeing. Materials and Methods: This cross-sectional study was conducted at Indira Medical College and Hospitals, Tiruvallur, Tamil Nadu, India from January to June 2024. A total of 92 adult participants were included in the study. Problematic Smartphone Use (PSU) was assessed using a modified PMPU Questionnaire, while SQ was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Correlation analysis, multiple regression and logistic regression were performed to examine relationships and identify predictors of SQ. Results: A significant positive correlation was observed between PMPU scores and PSQI scores (r=0.61, p-value <0.001). Multiple regression analysis identified the PMPU score as the strongest independent predictor of poor SQ (β=0.512, p-value <0.001), even after controlling for age, gender and mobile phone use duration. The association was strongest among younger participants (18-25 years: r=0.68, p-value <0.001) and slightly more pronounced in females (r=0.65, p-value <0.001). Logistic regression confirmed that each 10-point increase in PMPU score raised the odds of poor SQ by 2.35 times (OR=2.35, 95% CI: 1.62-3.41, p-value <0.001). Conclusion: This study demonstrates a significant association between PMPU and decreased SQ. Beyond screen time and content, PMPU represents an important factor influencing sleep health.

A Cross-sectional Study on Stature Estimation from Arm Lengths among North Indian Population using Machine Learning

Arunima Dutta, Gyamar Anya Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: During forensic investigations, cases are often encountered where the deceased bodies are in a partially or completely decomposed, charred, or skeletonised condition. In such scenarios, the examination of skeletal remains becomes imperative to establish the identity of an individual. Anthropometric measurements assist in identifying these parameters with accuracy. Aim: To assess the relationship between upper limb dimensions and stature in North Indian adults using regression formulae and a decision forest-based model for stature estimation from these dimensions. Materials and Methods: A cross-sectional study was conducted among 262 (M=120/F=142) students aged between 18 and 25 years using random sampling. This study was carried out in the Department of Forensic Science, Faculty of Applied and Basic Sciences, SGT University, Gurugram, Haryana, India from October 2023 to January 2024. The primary inclusion criteria stipulated that participants should be of North Indian origin (New Delhi NCR, Haryana and Punjab regions) and should not have suffered from any congenital or traumatic deformities of the upper and lower limbs. The stature, forearm length and Total Arm Length (TAL) were measured based on anthropometric points. Descriptive statistics, p-values, t-values and Pearson’s correlation coefficient were studied using Statistical Package of Social Sciences (SPSS) software version 21.0 and a decision forest model was designed on a cloud-based coding platform using Python programming language. Results: The present study depicts a higher mean value of TAL (55.9±4.18) and stature (175.41±5.63) for males in comparison to females. All the measurements were statistically significant, with p-values <0.001. It also reveals a strong positive correlation between TAL and stature for both males (r-value=0.951) and females (r-value=0.975). The decision forest model achieved an accuracy of 0.951 and a Root Mean Square Error (RMSE) of 1.75. Conclusion: The present study suggests that stature shows strong correlations with forearm length and TAL for both sexes. The decision forest model can classify the sexes with an accuracy of 77.5% using TAL. However, demographic variations must be considered when applying the regression formulae. Additionally, such anthropometric data should be updated regularly due to secular and temporal changes within the population.

Frequency of bspA and mutS Genes in Tannerella forsythia Isolated from Patients with Aggressive Periodontitis: A Cross-sectional Study

AS Smiline Girija, S Sekar Babu, K Karthik, J Vijayashree Priyadharsini, Jaiganesh Ramamurthy, Kannika Parameshwari Kannan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Tannerella forsythia (T. forsythia) is a predominant periodontal pathogen contributing to the progression of periodontitis. Among its virulence factors, the bspA gene, which encodes cysteine protease and the mutS gene, associated with DNA mismatch repair, is considered significant. Aim: To determine the frequency of the bspA and mutS genes in clinical strains of T. forsythia isolated from periodontitis patients and to evaluate their antibiotic resistance profiles. Materials and Methods: This cross-sectional study was conducted at Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, from January 2023 to May 2023, including 45 patients categorised into three groups: Gingivitis (Group I), Periodontitis Stage II (Group II), and Aggressive Periodontitis (Group III). The inclusion criteria were patients aged 18-60 years with periodontal disease, while smokers, pregnant women and those undergoing orthodontic treatment were excluded. Demographic parameters, including age, gender and periodontal health status, were recorded. Subgingival plaque samples were cultured anaerobically to identify T. forsythia, which was confirmed by Polymerase Chain Reaction (PCR). Genomic DNA was extracted for the detection of the bspA and mutS genes. Antibiotic susceptibility was tested using the E-strip method. Data analysis included descriptive statistics, Kruskal-Wallis test and Analysis of Variance (ANOVA) using Statistical Package for the Social Sciences (SPSS) software, with statistical significance set at p-value<0.05. Results: T. forsythia was detected in four out of 15 samples (26.7%) from Group III and in one out of 15 samples (6.7%) from Group II, while no samples from Group I showed its presence. The bspA and mutS genes were detected in three out of four strains (75%) and two out of four strains (50%), respectively. All isolates (100%) demonstrated resistance to metronidazole and clindamycin. Conclusion: This study highlights the prevalence and virulent characteristics of T. forsythia in periodontal diseases, particularly in aggressive periodontitis. The detection of specific virulence genes and the antibiotic resistance patterns observed underscore the pathogenic potential of this bacterium. Regular monitoring of T. forsythia and its antimicrobial susceptibility is crucial for effective periodontal disease management. The findings suggest that targeted treatment strategies, considering the resistance profiles of T. forsythia, are necessary for better clinical outcomes in periodontal care.

An In-vitro Study for Pharmaceutical and Analytical Profile of Herbal Drug: Panchpallav Gargles

Riya Rajendra Rathor, Renu Bharat Rathi Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Contemporary pharmaceutical analytical methods and standardisation must be employed to examine the composition of various Ayurvedic medications. Panchpallav Gargles (Kavala), which are prescribed for oral cavity ailments, are mentioned in Bhavprakash by Acharya Bhavmishra. This formulation is suggested in the form of decoction (Kashaya Kalpana) for mouthwash (mukha dhavana) in diseases of the mouth and throat (Mukhagata and Galagat rogas). Panchpallav Gargles is recommended due to their ease of preparation, pleasant and palatable taste, longer shelf life, and ease of administration. Aim: To study the physicochemical parameters of Panchpallav Gargles through an analytical investigation aimed at determining the fundamental properties. Materials and Methods: This in-vitro study was conducted at the Dattatraya Ayurved Rasashala of the Mahatma Gandhi Ayurved College and Research Centre, Salod, Hirapur, Wardha, Maharashtra, India over a period of one year and conducted the pharmaceutical manufacture and analytical analysis of the mouthwash. In present in-vitro study, three batches of gargles were prepared following the reference from Bhavprakash by Acharya Bhavmishra. A constant temperature of 90 to 100 °C was maintained throughout the procedure, and the average time required for the preparation of Panchpallav gargles was two days. The formulation was tested for physicochemical analysis, microbiological characteristics, and organoleptic criteria, including colour and smell. The analytical testing required 15 days to yield the findings. Results: The analytical standards for the Gargles were 5.2 for pH and 1.45 for refractive index, respectively. No microbial contamination was identified in the gargles. Conclusion: The outcomes of the standardisation meet the requirements specified in the Ayurvedic Pharmacopoeia of India (API). Additionally, its usage showed no Adverse Drug Reactions (ADRs) or side effects in the paediatric population and yielded better results in cases of acute pharyngitis.

Predicting the Gender-based Aerobic Capacity in Chronic Obstructive Pulmonary Disease Patients with superadded Infection: A Study Protocol

Prachi Rana, Subhasish Chatterjee, Sameer Singhal Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Chronic Obstructive Pulmonary Disease (COPD), a prevalent respiratory condition, can be prevented and treated. Among various triggers, infections are a leading cause of COPD exacerbations. Assessing aerobic capacity is essential in the management of COPD, as it serves as a fundamental indicator of both quality of life and mortality. However, determining this target value necessitates the estimation of a gender-based predictive aerobic capacity value for each individual. Need of the study: The newly developed gender-based reference equation for aerobic capacity may have the potential to accurately calculate predicted values that assess the individual patient’s aerobic capacity. Aim: To develop a gender-based prediction equation to assess aerobic capacity in COPD patients with infection. Materials and Methods: This cross-sectional study will recruit COPD patients with infections from the In-Patient Department (IPD) at a tertiary care super-specialty hospital (Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India), using purposive sampling be conducted over a period of one year (from July 2024 to June 2025). The Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC) ratio will be recorded using the post-bronchodilator PFT report, while aerobic capacity will be assessed through the Six-Minute Walk Test (6MWT) for 80 participants. Data will be analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Depending on the data type, Chi-square, Spearman’s, or Pearson’s tests will be used to assess the relationship between FEV1/FVC and 6MWT. Multivariate linear regression with a step-wise approach will be employed to create a predictive equation for aerobic capacity. Subsequently, a standardised equation for aerobic capacity will be derived.

Efficacy of Tulsi-Turmeric Oil Pulling versus Sesame Oil Pulling on Temporomandibular Joint Movement in Oral Submucous Fibrosis (Vata Pitta dominant Tridosaja Sarvasara Mukharoga): A Randomised Controlled Trial Protocol

Anshika Kishor Singh, Gaurav Rajendra Sawarkar, Punam Gaurav Sawarkar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Oral Submucous Fibrosis (OSMF) is a chronic oral condition characterised by inflammation and fibrosis, leading to restricted mouth opening, burning sensations, loss of taste, and ulcerations. Chewing betel nut is a significant risk factor, and OSMF carries a 2-30% risk of progressing to carcinoma, with a prevalence of 0.5% in the Indian subcontinent, predominantly affecting females. Current treatments are often ineffective and have adverse effects, prompting interest in natural remedies such as Tulsi and Turmeric, which may alleviate symptoms and effectively manage the condition. Need of the study: Current treatments for OSMF are often limited and have adverse effects, instigating interest in natural remedies like Tulsi and Turmeric, which may alleviate symptoms and manage the condition effectively. Exploring alternative therapies such as oil pulling, a traditional practice in Ayurveda, may offer new hope for patients. Oil pulling is a natural, non-invasive, and cost-effective treatment. By comparing two different oils-Tulsi-Turmeric and Sesame-this study aims to identify the most effective oil for improving mouth opening, thus providing evidence-based guidance for practitioners and patients. Aim: The present study compares the efficacy of Tulsi-Turmeric oil pulling versus Sesame oil pulling on Temporomandibular Joint (TMJ) movement in OSMF patients with Vata Pitta dominant Tridosaja Sarvasara Mukharoga (a disease affecting the whole oral cavity). Materials and Methods: A prospective randomised standard control double-blind superiority clinical trial (RCT) will be conducted at the Shalakya Tantra Department of Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod Wardha, Maharashtra, India, from October 2023 to October 2025. Sixty participants will be divided into two groups of thirty participants each. One group will receive Tulsi-Turmeric oil pulling, while the other will receive Sesame oil pulling for thirty days. The TMJ movement assessment will involve the evaluation of the range of movements laterally, anteroposteriorly, and vertically, along with palpation of the TMJ and surrounding muscles to identify tenderness. Other assessments will include IID scoring, cheek flexibility, and Visual Analog Scale (VAS) scores before and after the intervention. Descriptive statistics will summarise demographic data, and results will be expressed as mean±standard deviation for continuous variables and frequencies for categorical variables. The paired t-test and unpaired t-test will be applied for intra-group and inter-group comparisons. A p-value of <0.05 will be considered significant.

Expression of CXCR-4 and CD 133 and it’s Correlation with Prognostic Pathologic Factors in Resectable Oral Squamous Cell Carcinoma: A Research Protocol

Nirlipta Swain, Arvind Shridhar Bhake Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Cancer Stem Cells (CSCs), known for their self-renewal and resistance to therapy, drive tumour progression, metastasis, and recurrence. Markers such as Cluster of Differentiation 133 (CD133) and CXC Chemokine Receptor-4 (CXCR-4) are linked to poor prognosis in cancers, including Oral Squamous Cell Carcinoma (OSCC). CD133 promotes Epithelial-Mesenchymal Transition (EMT) and chemoresistance, while CXCR-4 enhances invasion via CXCL12 signalling. Their co-expression exacerbates outcomes; however, region-specific data, particularly from high-incidence areas like India, remain scarce. Need of the study: The expression and prognostic correlation of CXCR-4 and CD133 in resectable OSCC enhance early detection, assess tumour aggressiveness, and may identify potential therapeutic targets. Aim: This study aims to evaluate the immunohistochemical expression of CXCR-4 and CD133 in resectable OSCC and analyse their correlation with key prognostic pathological factors, including tumour grade, tumour size (T-stage), Depth of Invasion (DOI), Lymphovascular Invasion (LVI), Perineural Invasion (PNI), lymph node metastasis (N-stage), and Lymph node metastasis and surgical margin status. Materials and Methods: This observational, cross-sectional study will be conducted at Jawaharlal Nehru Medical College, DMIHER. Seventy-five OSCC tissue samples will undergo immunohistochemical analysis using monoclonal antibodies against CXCR-4 and CD133. The expression levels of these markers will be assessed semi-quantitatively. Subsequently, their correlation with key prognostic pathological factors will be analysed. Statistical analysis will be performed using SPSS version 27.0, with a p-value of less than 0.05 considered statistically significant.

Correlation of Preoperative Scoring System with Intraoperative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy: A Research Protocol

Amol Ashok Gupta, Swati Deshpande Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard of care for benign gallbladder disease. The incidence of conversion from LC to open cholecystectomy is 14.3%. A high degree of anatomical variation exists in the cystic duct, cystic artery and gallbladder, making this surgery challenging at times, even in the hands of the most experienced surgeons. Need of the study: Understanding the correlation between the preoperative score and the intraoperative score early in the disease course can facilitate timely conversion to open surgery, thereby reducing the risk of inadvertent injury. Additionally, this approach can improve the efficiency of operating room scheduling and ensure that a more skilled laparoscopic surgeon is available. Furthermore, it can assist surgeons in managing complications or legal issues that may arise postoperatively. Aim: This study aims to assess the correlation between preoperative grading and an intraoperative scoring system to forecast difficulties in LC and the potential for conversion to open cholecystectomy. Materials and Methods: A prospective observational study will be conducted in the inpatient department of General Surgery at Acharya Vinoba Bhave Rural Hospital (AVBRH) in Sawangi, Wardha, Maharashtra, India, from March 2024 to February 2026. A total of 35 patients with cholelithiasis will be included in the study. Patients will be scored based on a preoperative scale (the Modified Randhawa scoring system) and counselled regarding the difficulty and possibility of conversion, which will then be correlated with an intraoperative score to assess their predictive value for the risk of conversion. The correlation between preoperative and intraoperative scores will be assessed using Pearson or Spearman correlation coefficients. For intergroup comparisons, the t-test or Mann-Whitney U test will be applied with a 5% significance level. Logistic regression models will be evaluated using the Hosmer-Lemeshow test and ROC curve analysis.

Evaluation of the Efficacy of Yavanna (Rajaswala Paricharya diet) versus Routine Care in the Management of Kashtartava (Primary Dysmenorrhoea): A Randomised Controlled Trial Protocol

Niharika Sharma, Pradnya Dandekar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Menstrual pain is a common problem among women of reproductive age, negatively affecting their daily activities and quality of life. In Ayurveda, a classic diet and lifestyle regimen is recommended during menstruation, known as Rajaswala Paricharya. Adhering to this diet during menstruation in otherwise healthy women is thought to produce shuddhaartava (i.e., a painless, healthy menstrual cycle). Aim: To assess the efficacy of the Rajaswala Paricharya diet (Yavanna – barley porridge diet) compared to routine care (Mefenamic acid) in cases of primary dysmenorrhoea. Need of the study: Modern medical treatments for dysmenorrhoea (primary dysmenorrhoea) include Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and oral contraceptives, which may produce certain side-effects such as gastrointestinal disturbances, stomach ulcers, and allergic reactions. Therefore, the present study aims to develop a treatment that is simple to administer, highly effective in alleviating the condition and has minimal or no side-effects, ensuring patient acceptance. Materials and Methods: A single-centre, randomised, single-blinded, parallel-group controlled trial will be conducted at MGACH, Wardha, Maharashtra, India, over three consecutive cycles (a three-month period) from July 2024 to March 2025. The subjects will be divided into two groups: the control group and the experimental group. The experimental group will follow the Rajaswala Paricharya diet (Yavanna) by consuming 100-250 grams of barley per day in two divided meals, according to appetite, as the intervention. The control group will take a tablet of mefenamic acid at 250 mg twice daily during menstruation for three consecutive cycles. Patients will be assessed for pain using changes in the Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score and the Visual Analog Scale (VAS) score on the first three days of the menstrual cycle over four consecutive cycles (the first cycle after registration for baseline assessment followed by three consecutive cycles for after-treatment assessment). Statistical analysis will be conducted using a paired t-test and Chi-square test, with statistical significance set at p-value ≤0.05.

Melkersson-Rosenthal Syndrome: A Review of Clinical Presentation, Diagnosis and Management

Megha Tidke, Pramod Borghare, Piyush Pardhekar, Raza Salim Sheikh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Melkersson-Rosenthal Syndrome (MRS) is a rare neuro-mucocutaneous disorder characterised by a triad of recurrent facial palsy, orofacial swelling and fissured tongue. The complete triad occurs in fewer than 25% of cases, complicating timely diagnosis and management. The present review focuses on the clinical features, diagnostic difficulties and management approaches of MRS, hence establishing its clinical relevance and treatment results. A literature survey is conducted based on case reports, clinical trials and MRS reviews. The approach towards the diagnosis and different modes of treatments with multidisciplinary management analysis, is done. MRS is a condition with some diagnostic difficulties because it often presents variably and even mimics other diseases like angioedema, Bell’s palsy and Crohn’s disease. The gold standard of histopathology is the presence of non caseating granulomas. The acute symptoms can be treated with corticosteroids, as early as 30 to 60 mg/day; however, long-term treatment has to be avoided because of complications such as osteoporosis. Immunocompressants, like methotrexate and azathioprine, are used in refractory cases. Some of the considerations and measures would be surgical interventions, cheiloplasty and nerve decompression. However, these are risky to be accompanied by scarring, nerve damage, recurrence of symptoms and so on. A multidisciplinary approach involving dermatologists, neurologists and psychologists is critical for improving patient outcomes and quality of life. In conclusion, MRS remains a diagnostic and therapeutic challenge because of its persistence and various presentations. Accurate and early diagnosis, immediate intervention and a multidisciplinary approach to treatment will be necessary to prevent complications. Future studies on the genetic and immunological basis of MRS will help develop better diagnostic and therapeutic options.

A Narrative Review on Microbial Biofilm Formation in Septicaemia due to Gram-negative Bacteria: A Cause of Concern

Akoijam Nisha Devi, Gargi Mudey, Dipika Shaw, Shahin Vishani, Anjali Patond Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Septicaemia, or bloodstream infection, is a serious condition associated with high morbidity and mortality. Gram-negative bacteria, particularly Enterobacterales, are the primary causative agents of septicaemia. Globally, there is an increasing prevalence of antibiotic-resistant gram-negative bacteria reported in bloodstream infections. One of the major mechanisms of antibiotic resistance in gram-negative bacteria is their ability to form biofilms. Biofilms facilitate the transfer of Antimicrobial Resistance (AMR) genes among the bacteria present within the biofilm. Biofilm formation poses a challenge for treatment management; additionally, biofilms protect the bacteria from antibiotics and the host immune response, thus helping the organisms to establish resistance to antibiotic agents. To date, no conclusive strategies or appropriate agents are available to combat bacteria in microbial biofilms formed inside the human host. The best way to fight biofilm-forming bacteria is to prevent infection and eradicate it before biofilms are formed by following proper preventive measures and using appropriate antibiotics. This review article aims to help readers understand the complex relationship between biofilm-forming ability and AMR among gram-negative bacteria causing septicaemia. Furthermore, the review explores the impact of biofilm formation on the pathogenesis of septicaemia and discusses strategies and agents to prevent and combat biofilm formation.

Applicability of Next-generation Sequencing Techniques in Assessing Non-alcoholic Fatty Liver Disease: A Comprehensive Review

Ali Mahzari Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Non-alcoholic Fatty Liver Disease (NAFLD) is a burgeoning global health concern, with a spectrum of severity ranging from simple steatosis to Non-alcoholic Steatohepatitis (NASH). While liver biopsy remains the gold standard for diagnosis, the need for non invasive alternatives has spurred interest in Next-generation Sequencing (NGS) technologies. NGS technologies enable the simultaneous sequencing of millions of Deoxyribonucleic Acid (DNA) or Ribonucleic Acid (RNA) fragments, providing a high-throughput approach to analyse genetic variations, gene expression and epigenetic modifications. A comprehensive literature search was conducted to identify studies investigating the use of NGS in NAFLD. Data extraction focused on NGS techniques, study design, key findings and clinical implications. NGS has demonstrated potential in unraveling the complex genetic and molecular underpinnings of NAFLD. The identification of genetic variants, epigenetic modifications and non coding RNA alterations has advanced our understanding of disease pathogenesis. Moreover, NGS-based approaches have shown promise in differentiating NAFLD subtypes and predicting disease progression. However, challenges related to data analysis, standardisation and clinical translation persist. NGS offers a promising avenue for improving NAFLD diagnosis, prognosis and management. While significant advancements have been made, further research is needed to fully realise its clinical potential.

Artificial Intelligence in Paediatric Urology: Transforming Diagnosis and Treatment

Wesam Khan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Artificial Intelligence (AI) is revolutionising healthcare, including paediatric urology. Paediatric urology has played a crucial role in the development of clinically relevant AI models. This narrative review explores the applications, benefits and challenges of AI in paediatric urological diagnosis and treatment. It aims to determine the current state of AI in paediatric urology, identify key applications, evaluate their impact on clinical outcomes and explore potential future directions. The literature search was extensively conducted using the PubMed, Scopus and Web of Science databases. The findings from the literature search indicate that AI has the potential to significantly improve paediatric urological care by providing more accurate diagnosis, optimising treatment decisions and enhancing surgical outcomes. However, challenges such as data quality, model generalisability and ethical implications must be resolved for widespread implementation.

Phytotherapeutics for Wound Healing: A Systematic Review on Effectiveness of Indian Herbal Extracts in Rat Models

Nitesh Laxman Shambharkar, Pramod Khobragade Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Wound healing is a multifaceted process that encompasses a coordinated set of chemical and cellular events aimed at restoring the integrity of the skin and underlying tissues. Globally, many individuals turn to medicinal plants as an alternative therapy for this purpose. The present review focuses on evaluating the in-vivo wound healing activity of herbal plant extracts native to India, comparing them with povidone-iodine. Plant extracts show potential as promising wound healing agents due to their rich active compounds, wide availability and low risk of side-effects. Data were gathered from various sources, including scientific databases such as Google Scholar, PubMed and ScienceDirect. Keywords such as “wound healing,” “animal studies,” “herbal,” “Wistar albino rats,” “India,” and “Ayurvedic” were used to identify relevant articles, which were then analysed. The present review compiles data from articles published over the past 14 years on the in-vivo wound healing potential of medicinal plants in rats, with povidone-iodine consistently used as a reference in these studies. The findings highlight the potential of medicinal plants to contribute to drug discovery as effective wound healers, which may lead to the development of new, safe drug molecules. Further research is required, including novel formulations and targeted drug delivery systems, alongside clinical trials, to scientifically validate these findings and transition them from the laboratory to industry for broader societal benefit.

The Upbringing of Children with the Help of Ayurveda Principles: A Narrative Review

Arun Naphe Khatri, Rahul Jumle Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X In the contemporary world, parenting faces unique challenges due to technological advancements and lifestyle changes, leading to the need for a holistic approach to child-rearing. Ayurveda, an ancient system of natural medicine, offers valuable insights into enhancing children’s physical, mental, and emotional well-being. The present review explores how understanding a child’s Doshic constitution (Prakriti) can guide parents in providing personalised care, including tailored nutrition, daily routines, and activities that support optimal health. Ayurvedic practices, such as herbal remedies and mindfulness techniques, can help address common childhood concerns and promote balance and resilience. By integrating these principles into modern parenting practices, Ayurveda provides a time-tested framework that fosters the overall well-being of children.

Hypotensive Effects of Statins: A Rapid Review

Smruti Besekar, Sangita Jogdand, Satyawan Singh Patel Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Recently, hypertension has become a major global health concern that plays a substantial role in morbidity and mortality related to Cardiovascular Disease (CVD). Although statins primarily reduce cholesterol levels, they have also been shown to possess Blood Pressure (BP)-lowering properties that may provide further cardiovascular protection. Aim: To explore the hypotensive effects of statins on BP and to determine whether they can serve as an adjunct to antihypertensive drugs. Materials and Methods: This study was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement (PRISMA-S) guidelines. Databases such as PubMed, MEDLINE and Web of Science were employed to conduct a thorough literature search, focusing on research studies published between 2004 and 2024. Search terms such as “antihypertensive effect,” “hypertension,” and “statins” were used to identify relevant studies. The articles included observational studies, pooled analyses, clinical trials, Randomised Controlled Trials (RCTs) and literature syntheses that demonstrated the impact of statins on BP. All three authors contributed equally to this study and independently extracted the data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-S) standards to ensure accuracy and consistency. Results: Eleven studies met the inclusion criteria. The results indicated that statins, particularly lipophilic statins such as simvastatin and atorvastatin, have a slight but noteworthy impact on decreasing BP in individuals with dyslipidaemia and hypertension. Statins exhibit a stronger BP-lowering effect when used in conjunction with other antihypertensive medications, particularly those that target the Renin-Angiotensin-Aldosterone System (RAAS). Additionally, the study emphasised that the effects of statins vary depending on the type and dosage and that the combination of statins and RAAS inhibitors may lower BP more effectively. Conclusion: Statins have a moderate effect on BP, especially when combined with other antihypertensive drugs. Although there is evidence to support their use in improving cardiovascular protection, further studies are required to determine whether statins qualify as antihypertensive medications. These results highlight the potential for statins to be used as an adjuvant treatment to help hypertensive individuals better regulate their BP and reduce their overall cardiovascular risk.

A Review on Navigating Ethical Challenges in Modern Radiology: Balancing Artificial Intelligence Integration and Patient Privacy

Saraswathula Bharadwaj, Shirish Vaidya, Pratap Singh Parihar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Artificial Intelligence (AI) in modern radiology has increased efficiency and accuracy, but it has also raised ethical questions regarding privacy and equitable healthcare delivery. AI systems rely on enormous databases containing sensitive information, making it crucial to ensure data anonymisation and compliance to maintain patient confidentiality. Nonetheless, genuine anonymisation remains challenging, especially with the rising complexity of data reidentification tools. Furthermore, AI systems may unintentionally perpetuate biases present in training datasets, raising concerns about the fairness and veracity of diagnostic results. The opacity and interpretability of AI models hamper ethical decision-making. The present review emphasises the importance of a multidisciplinary approach to addressing these ethical challenges, urging collaboration among radiologists, ethicists, technologists, and lawmakers. Strategies like robust regulatory frameworks, ongoing education, and the development of explainable AI systems are essential for ensuring the responsible integration of AI. By combining innovation with ethical responsibility, radiology can realise AI’s transformative potential while prioritising patient-centred care.

Case Report on Epidermalization of Cervix: A Gynaecopathological Conundrum

Chaitanya Indrani, Anjali Antony, Astha Agrawal Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X The cervix could exhibit changes like adenosis, squamous hyperplasia, hyperkeratosis and parakeratosis which are usually reactionary changes. This is generally found in cases secondary to uterine prolapse where there is scope in the cervix for continuous irritation and epidermoid metaplasia. A young woman (36-year-old Para 3 Living 3) came with complaints of mass per vagina and heavy menstrual bleeding. On examination, she had cervical elongation and histopathology after hysterectomy showed epidermalisation of the cervix. This unfamiliar finding raises the question of ectodermal-type structures in tissue that originated from mesoderm or endoderm. Considering the primary cause that expose the cervix and vagina, like uterine prolapse or cervical elongation, this phenomenon could be a metaplastic change more than a developmental oddity.

Clinical Evaluation of Vajigandhadi taila matrabasti versus Sahacharadi taila matrabasti in the Management of Gridhrasi (Sciatica): A Study Protocol

Anil Ambadas Bhawade, Shweta Dadarao Parwe Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: In Ayurveda, Basti, or medicated enema, is recognised as a crucial component of Panchakarma, constituting half of the therapeutic approach. Matra Basti, a specific form of Basti Karma, is particularly effective in addressing disorders related to the nervous system, neuromuscular conditions and nutritional imbalances. Gridhrasi, commonly known as sciatica, is characterised by pain that extends from the lower back to the legs. These conditions frequently develop due to a variety of factors, such as poor sitting posture, excessive physical strain and a sedentary lifestyle. Need of the study: In Ayurvedic practice, different medicated oils are prescribed based on the patient and the specific disease condition. Both Vajigandhadi oil and Sahacharadi oil are Ayurvedic formulations recommended for the treatment of Gridhrasi (sciatica) through per rectal administration. However, the comparative efficacy of these two oils in alleviating sciatic pain remains unclear. To address this knowledge gap, the present study will be conducted. Aim: To compare the efficacy of Vajigandhadi taila matrabasti (a form of unctuous enema) with Sahacharadi taila matrabasti (another form of unctuous enema) for the management of Gridhrasi (sciatica). Materials and Methods: A randomised controlled clinical trial will be conducted at MG Ayurved College, Hospital and Research Centre located in Salod (H), District Wardha, Maharashtra, India, from December 2022 to December 2025. In this study, a total of 80 participants will be randomly assigned to two groups, each consisting of 40 patients. Participants in group A will receive a Vajigandhadi taila matrabasti (a type of unctuous enema) at a dosage of 72 mL, administered rectally after meals for 14 days. Conversely, group-B will receive a Sahacharadi taila matrabasti (an unctuous enema) at the same dosage and administration schedule. Parameters will be assessed on the initial day, the 14^th day and again after 30 days for follow-up purposes. Statistical analysis will be conducted using R (version 4.3.2) software. Objective parameters will be analysed using Independent t-tests, while subjective parameters will be analysed using Chi-square tests. Results will be presented as mean and standard deviation, with statistical significance at p-value <0.05.