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

First Branchial Cleft Sinus Mimicking an Epidermoid Inclusion Cyst: A Case Report

Khushbu Prasad, Shraddha Jain, Megha Kawale, Chandraveer Singh, Tanushree Biswal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X First Branchial Cleft Anomaly (FBCA) is an uncommon congenital anomaly that may mimic other periauricular lesions. A two-year-old male child presented with a right infra-auricular pit present at birth and eight months of intermittent painful swelling with foul-smelling whitish discharge following spontaneous rupture. An examination showed a sinus tract scar. Computed Tomography (CT) sinogram demonstrated a tract extending toward the floor of the External Auditory Canal (EAC), consistent with a Type II first branchial cleft sinus. After the infection resolved, the cyst was completely resected while preserving the facial nerve. Histopathology revealed a cyst with a keratinising stratified squamous lining, lamellated keratin, and no adnexal or mesodermal structures, confirming an Epidermoid Inclusion Cyst (EIC).

Acute Myeloid Leukaemia Unmasked by Paraplegia: A Case Report

Krupa Bhanushali, Revat Meshram, Amar Taksande, Aditya Jain Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Acute Myeloid Leukaemia (AML) is a rapidly progressive myeloid neoplasm that is characterised by clonal expansion of immature myeloid lineage cells, known as blasts in the bone marrow and peripheral blood. It is known to present with pallor, bleeding tendencies and infections. However, Extra Medullary (EM) presentations involving the central nervous system are rare and can delay clinical diagnosis. Hereby, the authors report a case of 14-year-old male child who had a unique presentation of acute myeloid leukaemia. His initial symptoms were indicative of a central nervous system disease, and later the child was diagnosed to have acute myeloid leukaemia with spinal metastasis. A case of AML which does not routinely present with lower limb weakness and bowel or bladder dysfunction can be isolated with this case report and a crucial diagnosis can be caught early on. The present case underscores the critical need for maintaining high suspicion for haematological malignancies in children presenting with neurological deficits. It also highlights the different dimensions of the disease pathology and the disease’s rapid progression to metastasis. The key role of diagnostic imaging to isolate metastasis has also been focused on.

Juvenile Psoriatic Arthritis with Incidental Horseshoe Kidney: A Rare Case Report

S Sweatha Shree, Sree Divya Mohan, MG Ravanagomagan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Juvenile Idiopathic Arthritis (JIA) represents the most common chronic rheumatologic disorder in children, encompassing a group of heterogeneous conditions with varied clinical manifestations. Juvenile Psoriatic Arthritis (JPsA) is a distinct subtype characterised by the association of arthritis with psoriasis or its related features. JPsA, a heterogeneous subtype of JIA, accounts for approximately 5% of all JIA cases, with reported ranges between 1% and 10%. An eight-year-old girl presented with subacute oligoarthritis involving bilateral hips and the right knee, along with nail pitting and minimal psoriatic skin changes, leading to a diagnosis of JPsA based on the International League of Associations for Rheumatology (ILAR) criteria. An incidental horseshoe kidney, a congenital renal anomaly with an incidence of approximately 0.2-0.25% in the general population and no established association with JPsA, was identified during evaluation. The child responded well to Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and methotrexate. The present case is notable for the rare co-existence of JPsA and an incidental horseshoe kidney, with no previously established association between the two conditions. It also underscores the importance of identifying congenital renal anomalies when planning long-term immunosuppressive therapy. Although incidental, identification of such renal anomalies is clinically relevant when planning long-term anti-inflammatory and immunosuppressive therapy.

Management of Dyslipidaemia with Modified Lekhana Basti (Triphala Gana as Prakshepa) Along with Shamana Chikitsa: A Case Report

Samiksha Satone, Shweta Parwe, Milind Nisargandha, Garima Gupta, Farid Hydri Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Dyslipidaemia is a metabolic disorder commonly associated with obesity, diabetes mellitus, hypertension, and increased cardiovascular risk, contributing significantly to global morbidity and mortality. It is characterised by abnormal levels of serum lipids, including elevated total cholesterol, triglycerides, Low-Density Lipoprotein (LDL), and/or reduced High-Density Lipoprotein (HDL). In Ayurveda, it can be correlated with Medo Dhatu Dushti , Mandagni, and Kapha predominance, where impaired digestive and metabolic fire leads to improper transformation and accumulation of Meda Dhatu. The present case report describes a 57-year-old obese male with dyslipidaemia, hypertension, and type 2 diabetes mellitus, who presented with progressive weight gain, breathlessness on exertion, excessive sweating, heaviness of the body, lethargy, and disturbed sleep. Based on Ayurvedic principles, the condition was assessed as Kapha-Meda Dushti with Agnimandya. The patient was managed with a 16-day Ayurvedic treatment protocol comprising Sarvanga Abhyanga, Swedana, Udvartana, Lekhana Niruha Basti with Triphala Gana as Prakshepa, Anuvasana Basti , and concurrent Shamana Chikitsa aimed at improving Agni , reducing Kapha and Meda, and promoting metabolic correction. Improvement was observed in lipid profile parameters, body weight, and subjective symptoms. No adverse events were reported during the treatment period. The present case suggests a potential supportive role of an integrated Ayurvedic approach combining Shodhana and Shamana therapies in the short-term management of dyslipidaemia, warranting further systematic clinical evaluation through larger controlled clinical studies.

Hirayama Disease Diagnosed by Dynamic MRI before the Onset of Clinical Muscle Wasting: A Case Report

Virendra Kumar Meena, Archana Pandey, Nida Heetawala, Ravindra Kumar Kundu Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Hirayama Disease (HD) is a rare, flexion-induced cervical myelopathy classically characterised by distal upper-limb weakness and muscle wasting. Muscle atrophy is widely regarded as a hallmark diagnostic feature, and all previously reported cases describe varying degrees of amyotrophy at presentation. A 21-year-old male presented with intermittent neck pain and a completely normal neurological examination. Neutral-position Magnetic Resonance Imaging (MRI) revealed a short-segment T2-weighted hyperintensity at the C5-C6 level without spinal cord atrophy. Dynamic flexion MRI demonstrated anterior displacement of the posterior dura mater from C5 to T1, with associated posterior epidural venous plexus engorgement findings diagnostic of Hirayama disease. Dynamic flexion MRI plays a crucial role in identifying early or subtle disease before irreversible anterior horn cell loss occurs.

Autogenous Dermis-Fat Graft in Fibrous Ankylosis of the Temporomandibular Joint: A Case Report

Sandeep Kumar Samal, Bibhu Prasad Mishra, Kohinoor Acharya, Shree Mishra, Ashutosh Panda Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Post-traumatic fibrous ankylosis of the Temporomandibular Joint (TMJ) is a debilitating condition characterised by restricted mandibular movements, impaired mastication, and reduced quality of life. Early diagnosis may be challenging, and surgical intervention is often required when conservative management fails. A 35-year-old male presented with a one-month history of progressive limitation in mouth opening, difficulty in mastication, and intermittent pain in the right preauricular region following facial trauma due to a road traffic accident involving a direct impact to the chin. Immediately after the injury, the patient was initially diagnosed with post-traumatic trismus at a local healthcare facility and managed conservatively with analgesics and muscle relaxants for approximately two weeks without symptomatic improvement. Clinical examination revealed a Maximum Interincisal Opening (MIO) of 7 mm, with Class I occlusion and restricted lateral and protrusive mandibular movements. Magnetic Resonance Imaging (MRI) demonstrated fibrous ankylosis of the right TMJ with condylar irregularity, anterior disc displacement, and reduced joint space. The patient underwent interpositional arthroplasty using an autogenous dermis-fat graft following complete excision of fibrous adhesions and creation of an adequate joint gap of approximately 10 mm. Immediate postoperative MIO was 32 mm, which improved to 38 mm at 3-month follow-up with no evidence of recurrence. Facial nerve function remained normal (House-Brackmann Grade I), and no donor site complications were observed. Autogenous dermis-fat graft serves as an effective interpositional material due to its biological compatibility and ability to reduce fibrosis and recurrence. Early physiotherapy plays a critical role in maintaining functional outcomes.

Electrocautery-assisted Surgical Excision of Pyogenic Granuloma in Maxillary Posterior Region of an 11-year-old Girl: A Case Report

Devyani Taori, Monika Khubchandani, Harikishan Kanani, Rutuja Patil, Gunjan Dare Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X An exaggerated inflammatory tissue reaction brought on by persistent local irritation or trauma can result in a benign, reactive, non neoplastic oral mucosal lesion known as a pyogenic granuloma. Clinically, pyogenic granuloma most commonly affects the gingiva and accounts for a significant proportion of reactive gingival enlargements, with a higher prevalence reported in the maxillary arch and on the facial aspect of the gingiva. It presents as a smooth or lobulated exophytic growth with a sessile or pedunculated base, ranging in colour from pink to deep red, and often exhibits a tendency to bleed on slight provocation due to its vascular nature. For such cases to be successfully managed, early identification of local etiological factors and appropriate treatment planning are crucial. The present case report highlights the role of local irritational factors and the efficacy of electrocautery in the clinical presentation and management of a pyogenic granuloma in the maxillary posterior region of an 11-year-old female who reported with a chief complaint of swelling in the upper right back region of jaw since 10 days. The growth measured approximately 2×2 cm. The lesion was associated with a mobile deciduous second molar. A provisional diagnosis of pyogenic granuloma was established, and the lesion was excised using electrocautery after removal of the causative primary tooth and satisfactory healing was observed. Pyogenic granuloma is believed to be caused by reaction to ongoing low-grade irritation. The main goals of its management include eliminating the irritants that cause pyogenic granuloma and conservative surgical excision should be planned for such cases.

Non Dysraphic Intradural Extramedullary Spinal Lipoma Presenting with Myeloradiculopathy: A Case Report

Praveen K Sharma, Sri Indira Kumar Udhay Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Non Dysraphic Intradural Extramedullary Spinal Lipomas (N-DEISLs) are benign tumours that are extremely rare, comprising less than 1% of all spinal neoplasms. There is an increase in the detection of these congenital incidental lesions in adults with the widespread use of high-resolution Magnetic Resonance Imaging (MRI). Hereby, the authors present a case report of a 55-year-old female patient presenting with acute-on-chronic left-sided myeloradiculopathy. Alongside L4-L5 lumbar spondylosis, an intradural extramedullary lipoma at the L1-L3 level was also detected on MRI. Multidisciplinary evaluation determined that myeloradiculopathy was driven by degenerative changes and not associated with the lipoma. The patient was successfully conservatively managed with neuropathic analgesics and physiotherapy, avoiding surgical intervention. A comprehensive literature search was conducted across major databases on adult N-DEISLs. The present case highlights the necessity for meticulous clinicoradiologic correlation to prevent unnecessary surgical morbidity.

Pregabalin-induced Positive Myoclonus Mimicking a Stroke: A Case Report

Mathakala Aparna, Aakriti Vij, Tushar Patil Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Pregabalin is often prescribed to relieve neuropathic pain and is largely tolerated very well. Myoclonus as an adverse effect of pregabalin use is an infrequent occurrence that may go unrecognised. This case describes a 62-year-old female patient who developed myoclonus shortly after dose escalation of pregabalin from 75 mg twice daily to 150 mg twice daily, raising concerns about an acute underlying neurological condition. An extensive evaluation revealed no evidence of a structural, metabolic, infectious, epileptic, endocrine or toxic cause. The close temporal relationship between the onset of positive myoclonus and the use of pregabalin, along with the return of the patient to her baseline physical and neurological state following discontinuation of the drug, supported the diagnosis of pregabalin-induced positive myoclonus. Physicians should perform a thorough medication review for the identification of potential adverse drug reactions, exclude other possible diagnoses, and withdraw the use of pregabalin in order to ensure that the patient has a complete return to a normal neurological state.

Modulation of Vastus Medialis Corticomotor Excitability Following Sensorimotor Perturbation Training after Total Knee Arthroplasty using Transcranial Magnetic Stimulation: A Case Report

Sowmiya Elumalai, K Kotteeswaran, Veluri Rakesh, Nivetha Dhanasekar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Total knee replacement is a treatment for end-stage knee osteoarthritis that reduces pain and restores function, but is often limited by plateaued neuromuscular function, such as reduced corticomotor excitability, which may have long-term implications for health and Quality of Life (QoL). Sensorimotor training along perturbation exercises is a relatively new technique of neurophysiological rehabilitation which can stimulate the activity of the cortex and motor control. Although the quadriceps functions as a muscle group, the vastus medialis was specifically assessed because it is highly affected by arthrogenic muscle inhibition after Total Knee Arthroplasty (TKA) and plays a key role in knee stability. The present case report examined the effects of sensorimotor training along perturbation exercises on the vastus medialis corticomotor excitability of a patient with a TKA. In the present report the objective and the subjective outcome measures were used. After unilateral TKA, a 58-year-old female patient expressed pain in knee {Numeric Pain Rating Scale (NPRS) 4/10}, stiffness of knee, and difficulty climbing stairs and standing long, 4 weeks after surgery. The clinical results were knee flexion being 95°, extension lag 10° and quadriceps strength was 3/5 on Medical Research Council (MRC) scale. The initial examination revealed a lower level of corticomotor excitability; Motor Evoked Potential (MEP) amplitude was 0.42 mV, Resting Motor Threshold (RMT) was 65%, Timed Up and Go (TUG) time was 15.1 s, NPRS score was 4/10, knee Range of Motion (ROM) was 0-95°, extension lag was 10°, and quadriceps strength was MRC grade 3/5. The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores were out of 100; 54 for pain, 55 for symptoms, 56 for Activities of Daily Living (ADL), 50 for sports/recreation, and 52 for QoL. The patient received a sensorimotor training along perturbation exercises was administered three times weekly for four weeks (12 sessions), with each 45-minute session comprising a 10-minute warm-up, 30-minute training period, and 5-minute cool-down. Conventional exercises and home advice were provided on non treatment days. The post-intervention results showed that significant changes in the corticomotor excitability and functional performance were observed. MEP amplitude increased by 0.43 mV (0.42 to 0.85 mV) and RMT decreased by 11 (65% to 54%). TUG time decreased by 4.9 s (15.1 to 10.2 s), NPRS score decreased by three points (4/10 to 1/10), knee ROM increased by 20° (0-95° to 0-115°), extension lag reduced by 8° (10° to 2°), and quadriceps strength improved from MRC grade 3/5 to 4/5. KOOS subscale scores improved by 28 points for pain (54 to 85), 27 points for symptoms (55 to 82), 31 points for ADL (54 to 85), 30 points for sports/recreation (50 to 80), and 31 points for QoL (52 to 83). The findings of the present case report suggests that sensorimotor training along perturbation exercises may serve as an adjunct to conventional rehabilitation strategies to promote corticomotor excitability and functional activities following TKA. However, further controlled trials are needed to prove its effectiveness.

Mucous Patch as a Sole Presentation of Secondary Syphilis: A Case Report

Manoharan, Geo Danny, Gayathri, Rithika Mukkawar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Secondary syphilis is a multisystem sexually transmitted infection that can present with oral manifestations, occurring in approximately 30% of patients. Varied mucosal presentations include slightly elevated plaques or ulcerated lesions covered with grey to white pseudomembrane or snail track ulcers can mimic other oral disorders and present a clinical challenge. Here, we report a case of a 36-year-old male who presented with asymptomatic erythematous oral patches and erosions for one month. History revealed recent unprotected sexual contact with multiple partners. Rapid plasma reagin test and Treponema Pallidum Haemagglutination Assay (TPHA) were positive and confirmed the diagnosis of secondary syphilis. Treatment with intramuscular benzathine penicillin resulted in resolution of lesions. Correlation of the patient’s sexual history, incubation period, clinical appearance, serological tests facilitates prompt identification and appropriate management. Serological testing remains the mainstay for diagnosis of syphilis. The present report highlights that syphilis can present solely with mucosal lesions and should be considered as a differential when evaluating oral mucosal disorders.

Residual Intrapancreatic Choledochal Cyst Following Incomplete Excision: A Case Report

Mahalakshmi Nagarajan, Srikanth Thiyagarajan, SM Gurutham Prahlad, Sriphanindranath Muthyala, R Karikal Chakaravarthi Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Choledochal Cysts (CCs) are rare, congenital anomalies characterised by dilatation of the biliary tract that predominantly affect young individuals. Surgical excision is the cornerstone of treatment; however, incomplete resection may predispose patients to serious complications, including recurrent cholangitis, pancreatitis, hepaticojejunostomy stricture, intrahepatic stone formation, and even malignant transformation. We report a 48-year-old woman who presented with a two-year history of recurrent upper abdominal pain and vomiting, ten years after excision of a CC with Roux-en-Y hepaticojejunostomy and sixteen years after an open cholecystectomy. Contrast-Enhanced Computed Tomography (CECT) demonstrated residual intrapancreatic CC containing calculi. At reoperation, the main portal vein was tracked, and a residual cyst extending into the intrapancreatic region was identified and completely excised, preserving the previous Roux-en-Y hepaticojejunostomy. The cyst contained pus and stones, and histopathological examination showed mucosal inflammation with hyperplasia, consistent with CCs. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. She remained asymptomatic at six months of follow-up. This case underscores that complete excision of the intrapancreatic component at the index operation is essential to prevent long-term morbidity.

Supraventricular Tachycardia as an Unusual Presentation of Infantile Onset Pompe Disease: A Case Report

Rutu Udapudi, AP Krithika, T Hariharasudhan, S Jayakanthan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Pompe disease is a rare autosomal recessive lysosomal storage disorder with an incidence of approximately one in 40,000 live births is caused by deficiency of acid α-glucosidase, leading to progressive glycogen accumulation in cardiac and skeletal muscle. Infantile Onset Pompe Disease (IOPD) represents the most severe phenotype and usually presents within the first year of life with hypotonia and cardiomyopathy. An 11-month-old male infant third born of third-degree consanguinity, presented with irritability, lethargy, fast breathing and refusal of feeds. Clinical examination revealed a floppy infant with generalised hypotonia, proximal muscle weakness, absent deep tendon reflexes, with a peak heart rate of 280/min. Electrocardiography (ECG) revealed Supraventricular Tachycardia (SVT). SVT reverted with two doses of adenosine. Laboratory work-up of metabolic myopathies were within normal limits except for the Creatine Phosphokinase (CPK) which was elevated. Echocardiography revealed concentric left ventricular hypertrophy with severe systolic dysfunction. Genetic study identified a homozygous pathogenic variant in the GAA gene, confirming IOPD. The child was stabilised with anti-failure therapy and referred for enzyme replacement therapy. Unfortunately, infant succumbed in two weeks. Arrhythmias, including SVT, may be an early and intrinsic manifestation of the disease. Early recognition, genetic confirmation, vigilant cardiac monitoring, and timely initiation of enzyme replacement therapy are essential to improve survival and long-term outcomes in IOPD.

Management of Bimaxillary Dentoalveolar Protrusion using the Snail Loop: A Case Report

Samiksha Tidke, Ranjit Kamble, Srushti Atole, Japneet Kaiser, Tejaswi Kamble Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Bimaxillary protrusion is a prevalent malocclusion in the central Indian population, characterised by proclined upper and lower incisors, leading to lip incompetence and a convex profile. Management requires strategic treatment planning to achieve optimal functional aesthetic outcomes. The management of bimaxillary dentoalveolar protrusion presents a significant orthodontic challenge. The present case reports of a 17-year-old female patient with Angle’s class I malocclusion, Dewey’s type II modification, treated with the extraction of the first premolars in both the upper and lower arch, followed by en-masse anterior retraction using the Snail loop fabricated with 0.019”×0.025” titanium molybdenum alloy wire with preactivation alpha and beta bends of 20° and 30°, respectively. Complete space closure was achieved within six months with monthly activations, effectively demonstrating the efficiency of frictionless mechanics. Post treatment evaluation revealed significant improvement in incisor inclination {Upper Incisor to Nasion-A-Point (U1-NA) reduced from 29° to 23°, the Lower Incisor to Nasion-B Point angle (L1-NB) reduced from 36° to 27°}, enhanced facial profile (nasolabial angle improved from 93° to 108°) and achievement of lip competence (lower lip to E-line reduced from 2 mm to 0 mm). The present case demonstrates distinctive clinical significance through its achievement of en-mass anterior retraction utilising frictionless mechanics in a critical anchorage case, accomplished without skeletal anchorage while maintaining predictable force delivery, excellent torque control, and favourable dentoalveolar and soft-tissue results. Considering the limited clinical documentation available regarding the use of snail loop for bimaxillary dentoalveolar protrusion correction, the present case report represents a valuable addition to the clinical evidence base, substantiating the biomechanical efficacy and practical applicability of this technique.

Primary Extranodal Marginal Zone Lymphoma of the Breast: A Case Report Highlighting the Clinicopathological Paradigm of an Indolent B-Cell Neoplasm

Prita Hejib, Samarth Shukla, Sunita Vagha, Jayashree Bhawani Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Primary or secondary lymphoma of the breast is an uncommon entity, accounting for less than 0.5% of all breast malignancies and approximately 1-2% of extranodal lymphomas. Diffuse Large B-Cell Lymphoma (DLBCL) is the most frequently reported histological subtype. Marginal zone B-cell lymphoma involving the breast is exceedingly rare, particularly in patients with a prior history of DLBCL. The present case describes an unusual occurrence of synchronous second primary lymphoid neoplasm of breast in a patient previously treated for DLBCL, highlighting its diagnostic rarity. The authors report a rare case of a 57-year-old female with a past history of DLBCL, diagnosed two years ago on histopathological examination of excised lymph node over left neck region. Patient received chemoradiotherapy post-diagnosis and had recovered completely. She now presented with bilateral breast lumps and an additional lump in the left axillary region. An initial histopathological diagnosis of Non-Hodgkin’s Lymphoma of breast was made which needed further immunophenotypic characterisation. Immunohistochemistry (IHC) was done which showed strong positivity for CD45, CD19, CD20, PAX5, Bcl2, Ki-67 which confirmed the diagnosis of Marginal Zone B-cell Lymphoma, emphasising diagnostic challenges. Post histopathological diagnosis and immunohistochemistry, patient received targeted therapy along with chemotherapy to which she responded well. The present case is noteworthy because of the uncommon involvement of both breasts and the axillary region in a patient with a prior diagnosis of DLBCL, suggesting potential disease recurrence or extranodal extension.

Synchronous Cystic Duct and Duodenal Neuroendocrine Tumours in a Patient with Neurofibromatosis 1: A Case Report

Vishaalpalaniswamy Ramaswamy, Angeline Mary Samy, Swaminathan Kalyanasundaram, Selvaraj Thangasamy Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Neurofibromatosis type 1 (NF1) is an autosomal dominant tumour-predisposition syndrome associated with various tumours. Amongst gastrointestinal tumours, Gastrointestinal Stromal Tumours (GISTs) and periampullary Neuroendocrine Tumours (NET) are most common. The authors describe a 43-year-old male with long-standing NF1 who presented with chronic dyspepsia and episodic right upper-quadrant pain. Imaging revealed an enhancing lesion at the cystic duct-common hepatic duct junction and a peri-duodenal lesion. 68Ga-DOTANOC PET/CT demonstrated somatostatin receptor-avid lesions in the duodenum and a regional lymph node, suggesting multifocal neuroendocrine neoplasia. The patient underwent classical pancreaticoduodenectomy. Histopathology subsequently confirmed synchronous primary neuroendocrine tumours of the cystic duct and duodenum, with the regional lymph node showing involvement by the cystic duct neuroendocrine tumour. Histopathology demonstrated a well-differentiated grade 2 NET of the cystic duct and a separate microscopic grade 2 duodenal tumour. This represents an exceptionally rare synchronous occurrence; to our knowledge, no previous report has described this co-existence, thereby expanding the spectrum of NF1-associated gastrointestinal NETs.

From Paralysis to Play: A Case Report on Neurorehabilitation and Robotic Assisted Training in Paediatric Guillain-Barré Syndrome

Riya Dilip Bhatt, Priti Nisheet Agni Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Guillain-Barré Syndrome (GBS) is a post-infectious, immune-mediated polyneuropathy affecting motor, sensory, and occasionally autonomic nerves. Paediatric GBS is rare, with limited literature on advanced rehabilitation strategies. The present case highlights the role of hybrid rehabilitation, including robotic-assisted therapy, in a four-year-old female child with GBS. The rehabilitation timeline, referenced from symptom onset, included early hospital presentation, initiation of inpatient physiotherapy, emergence of motor recovery and transition to outpatient rehabilitation services from Day 25 onwards where the child presented with generalised hypotonia, muscle wasting (notably in the thenar, hypothenar, and quadriceps), and diminished deep tendon reflexes. Breathing was thoracic with pectus carinatum and reduced bilateral air entry. No sensory deficits or cranial nerve involvement were observed on the 25th day of assessment. Nerve conduction studies revealed absent F-waves in the right median, ulnar, and bilateral peroneal and tibial nerves, indicating a generalised non length-dependent pure motor axonal polyradiculopathy, consistent with the Acute Motor Axonal Neuropathy (AMAN) variant of GBS. Differential diagnoses such as transverse myelitis and poliomyelitis were ruled out. A 20-week phased rehabilitation protocol was implemented, consisting of conventional physiotherapy, task-specific strength training, and robotic-assisted therapy using the Rymo mobi-L device. The program included five stages: initial strengthening and advanced Neurodevelopmental Treatment (NDT), gait training, robotic-assisted training, dynamic balance, and endurance training. Progressive improvements were seen in tone (normalised by week 9), reflexes, and muscle strength. Functional mobility improved significantly, with the child returning to school by week 20. The present case demonstrates that early, structured, and technologically supported rehabilitation can significantly enhance recovery in paediatric GBS, especially in severe motor variants like AMAN.

Surgical Correction of Facial Asymmetry Caused by Unilateral Condylar Hyperplasia with Co-existing Oral Submucous Fibrosis: A Case Report

Krishna Balaji Pampatwar, Bhushan Mundada, Nitin Balaji Bhola Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Condylar Hyperplasia (CH) is a rare developmental disorder of the temporomandibular joint causing abnormal overgrowth of the mandibular condyle, usually resulting in facial asymmetry, malocclusion, and limitation of function. The case management of a 25-year-old male patient diagnosed with unilateral left CH combined with grade III Oral Submucous Fibrosis (OSMF) is described herein. The patient presented with mandibular deviation, masticatory difficulty, limited mouth opening, and aesthetic worry related to facial disharmony. Clinical assessment, supported by an orthopantomogram and posteroanterior skull radiographs, was used to establish the diagnosis. The surgical treatment of choice was a left low-level condylectomy with removal of 14 mm of the condylar head, followed by mandibular lower border ostectomy and contouring, all under general anaesthesia. Intralesional triamcinolone acetonide (10-40 mg) was administered for rapid symptomatic relief and to facilitate improvement in mouth opening. This strategy was followed by noticeable improvement in facial symmetry, correction of occlusal cant, and restoration of functional mouth opening. Postoperative follow-up confirmed stable occlusion, augmented inter-incisal opening, and satisfactory aesthetic rehabilitation. The present case points to the significance of combining condylectomy with mandibular reshaping in individual patients and emphasises the role of early diagnosis, careful planning, and multidisciplinary care in obtaining predictable results.

A Case of Capillary Haemangioma of the Gingiva in a Six-year-old Child: A Diagnostic Challenge

CS Arun, Suchithra Muraleedhar Seetha Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Capillary haemangioma is a benign vascular lesion commonly observed in infancy but rarely reported in the oral cavity, especially on the gingiva. Because its clinical appearance can resemble more common reactive lesions, such as pyogenic granuloma, establishing a correct diagnosis in children can be difficult. In the present case report, the authors present the case of a six-year-old male who reported with intermittent gingival bleeding and a rapidly enlarging reddish, lobulated swelling in the posterior mandibular region. The lesion developed after minor trauma and the extraction of a primary molar, which further complicated the initial clinical impression. The lesion was soft, friable, and bled easily on manipulation, leading to an initial clinical diagnosis of pyogenic granuloma. Radiographic evaluation revealed no underlying bony involvement. Given the vascular nature of the lesion, careful surgical excision was performed under local anaesthesia. Histopathological examination revealed numerous irregular, endothelial-lined capillary channels within a connective tissue stroma, confirming the diagnosis of capillary haemangioma. Postoperative healing was uneventful, with no evidence of recurrence on 2-month follow-up. Misdiagnosis of vascular lesions such as capillary haemangioma as reactive lesions like pyogenic granuloma may result in unexpected intraoperative bleeding and inadequate surgical planning, emphasising the need for careful evaluation and histopathological confirmation. The present case highlights the close clinical resemblance between capillary haemangioma and reactive gingival lesions and underscores the importance of histopathological examination for establishing a definitive diagnosis and guiding appropriate management in paediatric patients.

A Case of Sinonasal Intestinal Type Adenocarcinoma Mimicking CNS Tumour: A Pathologist’s Perspective

Pooja Bharti, Sanjeev Kumar Singh, Arti Agarwal, Rashmi, Anita Omhare Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Sinonasal Intestinal-Type Adenocarcinoma (ITAC) is a rare neoplasm. The overall incidence of ITAC is less than 1% of all neoplasms, but almost 4% in sinonasal malignancies. This tumour tends to be very locally aggressive but rarely metastasises. It is frequently misdiagnosed clinically as a salivary gland tumour or Central Nervous System (CNS) tumour. In this case, a 50-year-old female presented with chief complaints of headache, vomiting and occasional nasal bleed for a few months. Radiological diagnosis (MRI) of CNS tumour was made. The other relevant necessary investigations and clinical management was done as per surgical oncology team. The tumour was removed by bifrontal craniotomy. On histopathological examination, two differential diagnoses of metastatic Gastrointestinal (GI) adenocarcinoma and sinonasal ITAC were made. Tumour cells exhibited strong immunopositivity for CK-20, CDX2, and Epithelial Membrane Antigen (EMA), while being negative for Glial Fibrillary Acidic Protein (GFAP). Thus, the final diagnosis made was well-differentiated sinonasal adenocarcinoma of the intestinal type. This case highlights the importance of histopathology with Immunohistochemistry (IHC) when most probable clinical as well as radiological diagnosis was CNS tumour. Histopathological examination with a combination of IHC had confirmed the diagnosis of sinonasal ITAC.

High-grade Pulmonary Mucoepidermoid Carcinoma in a Child: A Rare Case Report

Rakshana Sampath Kumar, K Chandramouleeswari, Umadevi Srinivasan, M Dougul Regis Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Mucoepidermoid Carcinoma (MEC) of the lung is a rare salivary gland-type tumour, accounting for <1% of primary pulmonary neoplasms, with female predominance in some series and a wide age range. This case reports a four-year-old girl with a four-month history of cough, haemoptysis, and breathlessness. Imaging revealed a 3.2×1.5×2.5 cm enhancing polypoidal mass arising from the left main bronchus, extending into the carina and lower trachea, with mediastinal shift and bronchiectatic changes. The patient underwent pneumonectomy and the histology showed Squamous metaplasia without dysplasia beneath that showed a neoplasm was composed predominantly of squamoid and intermediate cells, with cystic spaces lined by mucin-secreting cells and focal necrosis. Immunohistochemistry showed Tumour protein (p63) positivity in intermediate cells. Based on the Armed Forces Institute of Pathology (AFIP) and Memorial Sloan Kettering Cancer Center (MSKCC) grading systems, the diagnosis of high-grade MEC was confirmed. MEC involves the CREB Regulated Transcription Coactivator 1 (CRCT1 formerly known as MECT1) and Mastermind Like Transcriptional Coactivator 2 (MAML2) genes, located on chromosomes 19p13 and 11q21, respectively. Epidermal Growth Factor Receptor (EGFR) overexpression, observed in salivary gland MEC, is more sensitive to gefitinib than other wild-type EGFR non-small cell lung cancer cell lines and may offer potential for targeted therapy, though its role in pulmonary MEC remains uncertain. Each case of pulmonary MEC is inherently novel due to its rarity, presentation and histopathological diversity. Sharing these findings is essential for helping clinicians navigate diagnostic challenges, refine protocols, and predict patient outcomes for these uncommon lung tumours. Prognostic factors include histological grade, tumour, node, metastasis (TNM) stage, resection status, nodal metastasis, and patient age. Recognition of its molecular profile may guide future targeted therapies.

Anterior Vaginal Wall Cyst Mimicking Advanced Cystocele: A Case Report

Sweta Shrivastava, Aayushi Thakkar, Shrey Somani, Kishor Chauhan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Anterior vaginal wall cysts are rare benign lesions that can clinically mimic pelvic organ prolapse, particularly cystocele, resulting in diagnostic challenges and inappropriate management if not accurately identified. We report the case of a 28-year-old multiparous woman who presented with a one-month history of a vaginal mass. Clinical examination suggested a Grade III cystocele in the absence of urinary or bowel symptoms. Ultrasonography raised suspicion of an anterior vaginal wall cyst. A simple bedside diagnostic technique combining bladder catheterisation with simultaneous assessment of the vaginal mass demonstrated no reduction in the size of the lesion following bladder drainage and clear demarcation from the urinary bladder, thereby excluding cystocele. The patient underwent complete surgical excision of the anterior vaginal wall cyst with anterior vaginal wall repair and repair of old posterior vaginal wall tears. Histopathological examination confirmed the diagnosis of an anterior vaginal wall cyst. The postoperative course was uneventful, and the patient remained asymptomatic with no evidence of recurrence at one-month follow-up. This case highlights the importance of considering anterior vaginal wall cysts in the differential diagnosis of anterior vaginal wall masses and demonstrates the value of combining careful clinical evaluation with simple bedside techniques and ultrasonography to achieve an accurate diagnosis and appropriate surgical management.

Life-threatening Haemorrhage following Over-the-Counter Use of MTP Pills in a Patient with Uterine Fibroid: A Case Report

Deepa Kirar, Anuja Sachapara, Pramila Gupta, Heena Rajput, Sweta Shrivastav Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Cervical and lower uterine segment leiomyomas can closely mimic Retained Products of Conception on grey-scale and Doppler ultrasonography, particularly when encountered in the setting of acute post-abortion haemorrhage. Hereby, the authors present a case of a 28-year-old Gravida 3 Para 2 Living 2 (G3P2L2) female with two previous caesarean deliveries who presented with heavy vaginal bleeding after intake of Medical Termination of Pregnancy (MTP) pills at 12 weeks of gestation. Transabdominal ultrasound revealed a heteroechoic lesion with internal vascularity in the lower uterine segment, initially interpreted as Retained Products of Conception (RPOC) or subchorionic haematoma. Emergency suction and evacuation were performed, with persistent bleeding necessitating uterotonics, intrauterine balloon tamponade, and blood transfusion; a subsequent postoperative fall in haemoglobin to 7 g/dL necessitated a second transfusion. Repeat post-procedure ultrasound demonstrated a homogeneously hypoechoic mass with persistent peripheral vascularity, raising suspicion of a leiomyoma; Magnetic Resonance Imaging (MRI) subsequently confirmed an intramural lower uterine segment fibroid. The present report focuses on the diagnostic dilemma between RPOC and a co-existing lower uterine segment leiomyoma. Unsupervised MTP pill use was the precipitating event, but the principal clinical learning point is the recognition of fibroid-mimicking sonographic patterns in post-abortion bleeding.

Brachial Vein Thrombosis Following Abdominal Hysterectomy and Hernioplasty under General Anaesthesia: A Case Report

S Sreya Sri, Pooja Shah, Sara Mary Thomas Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Upper Extremity Deep Vein Thrombosis (UEDVT) is a relatively rare but serious postoperative complication. While lower limb thrombosis is more common after major pelvic surgery, UEDVT, such as brachial vein thrombosis, can occur and poses significant diagnostic and therapeutic challenges. A 46-year-old female presenting with a fibroid uterus and umbilical hernia underwent an uneventful total abdominal hysterectomy, bilateral salpingo-oophorectomy, and hernioplasty under general anaesthesia. Intraoperatively, standard monitoring was used with an intravenous line secured in the right arm. Six hours postoperatively, the patient developed acute pain, swelling, and bluish discolouration of the left hand, which was unresponsive to analgesics. Although peripheral pulses were palpable and a hand X-ray was normal, a venous duplex ultrasound of the left arm confirmed a brachial venous thrombus. No signs of Pulmonary Embolism (PE) were present. The patient was immediately treated with an intravenous Unfractionated Heparin (UFH) infusion for 24 hours, followed by subcutaneous heparin for three days. Her symptoms resolved within 72 hours, and she was transitioned to oral apixaban. Complete resolution of the clot was confirmed via ultrasound at a 3-month follow-up, and anticoagulation was safely discontinued. This case underscores the importance of maintaining a high index of suspicion for UEDVT in the early postoperative period, even in asymptomatic limbs without direct vascular intervention. Prompt diagnostic ultrasound and immediate anticoagulation are critical to managing upper extremity thrombi and preventing thromboembolic complications.

A Case of Central Nervous System Vasculitis Mimicking Reversible Cerebral Vasoconstriction Syndrome in Young Stroke: A Diagnostic Conundrum

Vignesh Mani, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Central Nervous System Vasculitis (CNSV) is a rare cause of stroke in young adults and may closely mimic Reversible Cerebral Vasoconstriction Syndrome (RCVS), a more common non inflammatory vasculopathy. Distinguishing between these entities is crucial because their treatment and prognosis differ. The authors report a 40-year-old female who presented with one month of progressive right-sided hemicranial headache followed by onset of left hemiparesis. Initial non contrast Computed Tomography (CT) brain showed right parietal infarct with haemorrhagic transformation. Magnetic Resonance Imaging (MRI) with diffusion-weighted imaging revealed multiple watershed infarcts in the right fronto-parietal region, while gradient echo sequences demonstrated right parieto-occipital lobar haemorrhage with overlying convexity subarachnoid haemorrhage. Time-of-flight MR angiography showed multifocal segmental narrowing with irregular contour of the right M2 segment of the Middle Cerebral Artery (MCA), favouring a working diagnosis of RCVS, and she was started on nimodipine. However, Cerebrospinal Fluid (CSF) analysis showed mild pleocytosis with elevated protein, and inflammatory work-up revealed raised acute phase reactants with positive Antinuclear Antibody (ANA) and anti-U1 Ribonucleoprotein (RNP), suggestive of an underlying Mixed Connective Tissue Disease (MCTD)-associated CNSV. She was treated with high-dose intravenous corticosteroids followed by monthly intravenous cyclophosphamide pulses, with good clinical and radiological improvement. The present case is unique because multifocal vasculitis involvement with combined ischaemic watershed infarcts and concomitant lobar and convexal haemorrhage simulated RCVS in a young woman without systemic autoimmune features. The report underscores the need to reconsider a vasculitis aetiology when atypical imaging, abnormal CSF and positive autoimmune markers coexist in a presumed case of RCVS, in order to avoid misdiagnosis and to initiate timely immunosuppression.

Compound Heterozygosity for Haemoglobin D Punjab and Haemoglobin Q India: A Rare Case Report

Firoz Shabbir Sheikh, Sanjay Gohil, Amit Kanhiyalal Taori, Sarika Abhijeet Gadekar, Jyothi Britto Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Haemoglobin variants constitute an important group of inherited disorders with variable clinical and haematological manifestations. The co-existence of structural variants involving both α and β globin chains is uncommon and may present diagnostic challenges during routine haemoglobinopathy screening. The authors hereby report a rare case of compound heterozygosity for haemoglobin D Punjab and haemoglobin Q India identified during haemoglobin variant analysis. A 19-year-old Sindhi unmarried woman was referred for haemoglobinopathy evaluation during investigation for menstrual irregularities. High-Performance Liquid Chromatography (HPLC) performed on the Bio-Rad D-10 system demonstrated a reduced Haemoglobin (HbA0) fraction (50.4 percent) with normal HbA2 (2 percent). A prominent peak of 25 percent at a retention time of 3.94 minutes suggestive of HbD Punjab, while an additional 13.7 percent peak at 4.66 minutes was suggestive of HbQ India. An intermediate 8.1 percent peak eluting in the HbC window was interpreted as a hybrid fraction produced by interaction between the two variants. Molecular confirmation using bidirectional Sanger sequencing identified heterozygous variants in both the β globin gene {Haemoglobin Subunit Beta (HBB) c.364G>C; p.Glu122Gln} and the α globin gene (HBA1 c.193G>C; p.Asp65His), confirming compound heterozygosity for HbD Punjab and HbQ India. The patient demonstrated mild microcytic anaemia without clinical features of haemolysis. Recognition of the characteristic HPLC pattern is important because the hybrid fraction may mimic HbC and lead to diagnostic confusion. Although this genotype is usually clinically benign, accurate identification is essential for genetic counselling and family screening.

Conservative Ayurvedic Management of a Mid-ureteric Calculus with Grade-2 Hydronephrosis: A Case Report

Abinash Kar, Neha Kumari, Amit Kumar Rai, Sujata Yadav Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Ureterolithiasis is a common urological disorder characterised by the formation of calculi within the ureters. Despite significant advancements in surgical and endourological interventions, high recurrence rates, postoperative discomfort, and the potential for complications highlight the need for safe, effective, and non-invasive treatment approaches. In Ayurveda, Ashmari (urinary calculi) is classified among the Ashtamahagada (eight extremely challenging diseases) and is managed through a holistic combination of herbal medications, dietary regulation, and lifestyle modification that aim to achieve Ashmari-bhedana (lithotriptic), Mutrala (diuretic), and Shoolahara (analgesic) effects. In this case report, a 28-year-old male diagnosed with a mid-ureteric calculus measuring 7.2 mm, a size generally considered suitable for surgical intervention, was successfully managed with conservative Ayurvedic treatment. The patient has a history of recurrent calculus formation and a past surgical history for calculus removal. An Ayurvedic therapeutic regimen comprising Gokshuradi Guggulu, Sweta Parpati, Sukumara Ghrita, Varunadi Kashaya, and Kumaryasava was administered for 10 weeks, accompanied by strict dietary and lifestyle guidance focusing on adequate hydration, avoidance of lithogenic foods, and adherence to light, easily digestible meals. The patient experienced complete symptomatic relief, with no painful episodes, urinary obstruction, or adverse effects. Follow-up ultrasonography revealed complete clearance of the calculus and normal urinary parameters. This case suggests a potential role of the Ayurvedic approach in the management of ureteric calculi of significant size; however, the findings are limited to a single case and should be interpreted with caution.

Inky Hues: A Case Report of Cydnidae Pigmentation

S Gayathri, N Ashok Kumar, C Balakumaran, B Laasyaa Reddy Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Insects can cause a plethora of cutaneous manifestations, ranging from localised contact dermatitis to anaphylaxis. Cydnidae, commonly known as burrowing bugs, are soil-dwelling insects belonging to the order Hemiptera. Cydnidae have gained importance in dermatology because of accidental contact or crushing of insects on human skin which can produce characteristic cutaneous pigmentation. A 55-year-old male, farmer by occupation, presented with multiple hyperpigmented macules over the soles upon walking barefoot during the monsoon season. On examination, multiple red-brown macules were noted on the soles, which were non tender and non itchy. A diagnosis of Cydnidae Pigmentation (CP) was made based on clinical features and seasonal presentation after ruling out other causes of acquired pigmentation and patient was reassured about the self-limiting nature of the condition. The present case highlights the underrecognised nature of CP and its potential to mimic other acquired pigmentary dermatoses. Awareness of this benign condition is essential for general practitioners as there are an increasing number of cases especially during rainy season and to avoid unnecessary investigations and interventions.

Bulbar Urethral Rupture with Sacral Fracture and Pubic Diastasis Managed by Orthopaedic Fixation and Conservative Catheterisation: A Case Report

Harrshit Salhan, Aditya L Kekatpure, Sanjay Deshpande, Gajanan L Pisulkar, Aashay Kekatpure Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Pelvic crush injuries after road traffic accidents seldom present with the combination of bulbar urethral rupture, comminuted sacral fracture and pubic symphysis diastasis to form a complex pattern mandating coordinated multidisciplinary care even in resource-constrained environments. Hereby, the authors report a case of a 26-year-old male who presented to the Emergency Department after being crushed between a reversing truck and a wall with lower abdominal and inguinoscrotal trauma and acute urinary retention. Examination revealed perineal swelling with bilateral inguinal haematoma and tenderness. Initial urethral catheterisation attempts were unsuccessful. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis with Three-Dimensional (3D) reconstruction revealed a bulbar urethra rupture, comminuted left sacral ala fracture extending to S5, and pubic symphysis diastasis, Tile Classification type C1. Definitive management included open reduction and internal fixation of the pubic diastasis with a pelvic reconstruction plate and screws, and sacral stabilisation with Iliosacral screw fixation. At the same time, the urethral injury was treated conservatively, with silicone Foley catheterisation. Postoperative recovery was uneventful, supported by structured physiotherapy and gradual mobilisation after an initial period of immobilisation. Timely surgical stabilisation of unstable pelvic fractures, combined with conservative catheter-based management of bulbar urethral rupture, can yield excellent early functional outcomes and may minimise long-term complications in patients.

Salivary Duct Carcinoma in the Palate: A Case Report of a Rare Entity

Jeyaseelan Ramasamy, Kavitha Bottu, Shubhra Chauhan, Saraswathi Gopal, Ganthimathy Sekhar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Salivary Duct Carcinoma (SDC) is a rare and highly aggressive salivary gland malignancy that closely resembles ductal carcinoma of the breast on histopathological examination. It predominantly involves the major salivary glands, whereas involvement of the minor salivary glands is uncommon, with the palate being a rare site. A 47-year-old male presented with a painful ulcerative lesion in the upper back tooth region. On examination, the lesion appeared erythematous with irregular margins and extended from the maxillary tuberosity to the retromolar trigone, involving the pterygomandibular raphe. Enlarged regional lymph nodes were also noted. Imaging with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed an ill-defined soft tissue lesion in the left retromolar trigone, showing hyperintensity on T2/Fluid-Attenuated Inversion Recovery (FLAIR) sequences. An incisional biopsy was performed, and histopathological evaluation confirmed the diagnosis of SDC. The patient subsequently underwent aggressive surgical management, including wide local excision, marginal mandibulectomy, posteroinferior maxillectomy, and neck dissection (levels I-IV) with lymph node removal. The patient remains disease-free after two years of follow-up. The present case highlights the aggressive behaviour and diagnostic difficulty of SDC when it arises in minor salivary glands. Early recognition and prompt, comprehensive treatment are crucial for improving outcomes. Careful and long-term follow-up is essential due to the high likelihood of recurrence and metastasis.

A Rare Case Report of Isolated Multiloculated Splenic Hydatid Cyst Presenting with an Incisional Hernia

Yogesh Dagar, Gunjan Priyam, Ram Pukar Bharat, Ankit Girepunje Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Cystic echinococcosis is a parasitic zoonosis caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most frequently involved organs due to portal and pulmonary filtration, whereas primary splenic involvement is uncommon, accounts for only a small proportion of cases. Isolated splenic hydatid cysts often present with vague or non-specific symptoms and may mimic other benign or neoplastic cystic lesions, resulting in diagnostic uncertainty. A 47-year-old woman presented with a progressively enlarging supraumbilical swelling of one year’s duration, accompanied by intermittent abdominal discomfort. Physical examination revealed a palpable mass in the left upper abdomen along with a reducible incisional hernia. Radiological evaluation demonstrated a large, well-defined multiloculated cystic lesion measuring 16.9×13.9×9.7 cm within the splenic parenchyma, with internal septations consistent with daughter cysts, with no evidence of involvement of other organs. Serological testing for Echinococcus infection was positive, supporting the suspected diagnosis. The patient underwent total splenectomy. Intraoperative findings confirmed extensive replacement of splenic parenchyma by multiple cystic cavities. Histopathological examination established the diagnosis by demonstrating the characteristic laminated cyst wall, germinal layer, brood capsules, and protoscolices. The postoperative course was uneventful. The patient received recommended post-splenectomy immunisations and adjunctive albendazole therapy to reduce the risk of recurrence. This case highlights the importance of considering hydatid disease in the differential diagnosis of splenic cystic lesions, even in patients without classical epidemiological risk factors. Radiological imaging and histopathological examination remain essential for diagnosis, while complete surgical excision combined with antiparasitic therapy offers excellent clinical outcomes.

Cavernous Haemangioma in the Supraclavicular Region: A Case Report

Yashasvi Trivedi, Rajesh Gattani, Kesav Sudabattula, Subhangi Parmar, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Cavernous haemangiomas are benign vascular malformations that usually present in infancy or childhood; adult-onset lesions in the supraclavicular region are exceedingly rare. The present case report is of a 33-year-old Indian male who presented with a progressively enlarging, painless cystic swelling in the left supraclavicular region of four months’ duration. Ultrasonography and Contrast-Enhanced Computed Tomography (CECT) further showed a benign cystic lesion along with cystic lymphangioma, considered as the primary differential diagnosis. The patient underwent complete surgical excision with meticulous dissection and preservation of adjacent neurovascular structures. Intraoperatively, lesion also showed a characteristic vascular appearance. Histopathological examination of the excised specimen further helped to confirm the diagnosis of cavernous haemangioma. The present case report highlights the importance of considering cavernous haemangioma in the differential diagnosis of adult supraclavicular masses and notes that complete surgical excision is a safe and definitive treatment modality.

Ventriculoperitoneal Shunt Migration into the Urinary Bladder and Prostatic Urethra Demonstrated on Imaging: A Case Report

Shirish Vaidhya, Saraswathula Bharadwaj Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Ventriculoperitoneal (VP) shunting is the most common procedure for cerebrospinal fluid diversion in Hydrocephalus (HC); problems such as blockage, infection, and distal catheter migration can occur. Intravesical migration of the distal catheter is an extremely unusual complication that can result in chronic urine problems. The authors describe the case of a 44-year-old male with Normal Pressure Hydrocephalus (NPH) who presented with dysuria, burning micturition, and urine incontinence five months after being treated for recurrent urinary tract infections and genitourinary Tuberculosis (TB). Computed Tomography (CT) brain scans revealed ventriculomegaly, which is consistent with shunt malfunction. CT urography revealed the distal VP shunt catheter within the urinary bladder lumen, with delayed images revealing further extension into the prostatic urethra, demonstrating progressive intravesical migration. There were no related peritoneal pseudocysts, abscesses, or ascites. The present case emphasises the importance of cross-sectional imaging in discovering uncommon locations of VP shunt migration and permitting prompt surgical therapy.

Bilateral Large Spermatocele Masquerading as a Large Hydrocele: A Case Report

Eeshansh Khare, Avani Shrivastava Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Common painless scrotal swellings in an adult male are hydrocele, hernia, tumours of the testis, varicocele, spermatocoele, and cysts of the testis and epididymis. Bilateral large spermatocoele is rare. A 61-year-old male patient presented with a painless large swelling in the scrotum, clinically suspected as a case of large hydrocele, underwent surgical exploration, with intraoperative findings suggestive of bilateral large spermatocoele. The possibility of the presence of a spermatocoele should always be kept in mind while counselling and operating on a large scrotal swelling in an adult, especially if radiological investigation is not done. Surgical excision is the best treatment for large spermatocoeles. Fluid cytology and histopathology are confirmatory in spermatocoele diagnosis.

An Unusual Presentation of Sporadic Hemiplegic Migraine: A Case Report

R Priyanka, Vidya Krishnamurthy, Uday Kumar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Sporadic Hemiplegic Migraine (SHM) is a rare subtype of migraine with recurrent attacks of reversible motor weakness alongside with visual, sensory and speech symptoms. It is classified as familial when a first- or second- degree relative has identical motor attack, and as sporadic when no such relative is affected. Patients with this subtype have been found to have a mutation in either CACNA1A, ATP1A2 or SCN1A. In present case, a 13-year-old male, first born to a third degree consan-guineous couple presented to the emergency department with severe headache lasting for an hour following which there was weakness in the right upper and lower limbs, blurring of vision in the left eye and de-viation of angle of mouth to left followed by tonic movements of both upper limbs which lasted for five minutes. Child had frequent headaches for last six months and there was family history of migraine with-out motor involvement in mother and maternal grandmother. He was initially considered to have Transient Ischaemic Attack (TIA)/stroke. However, after initial stabilisation there was a dramatic neurological improvement within an hour of presentation hence the possibility of Hemiplegic Migraine (HM) was consid-ered. Genetic testing was positive for CACNA1A mutation and hence the diagnosis of SHM was con-firmed. The child was treated with Calcium Channel Blockers (CCB) and was put on aspirin prophylaxis. The child had no further episodes of hemiplegia post treatment, although there had been episodes of headaches with reduced intensity and duration. Parents were counselled regarding the possible prognosis and importance of follow-up for early identification of cerebellar signs and paroxysmal manifestations. Genetic counselling is recommended for future prenatal planning.

Candiduria as a Diagnostic Clue for HIV Infection in an Adolescent with Type 1 Diabetes Mellitus: A Case Report

Olusola Adetunji Oyedeji, Oluwatosin Emmanuel Adeniji, Funso Abidemi Olagunju, Samuel Olorunyomi Oninla Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Candiduria is an uncommon urinary tract infection in immunocompetent individuals and is challenging to diagnosis. Urinalysis is the initial tool for detecting Urinary Tract Infections (UTIs), but candida species do not convert nitrates to nitrites, necessitating careful diagnostic practices and confirmation through urine cultures. This report focuses on a 16-year-old female with type 1 diabetes who developed Diabetic Ketoacidosis (DKA) and candiduria. Urinalysis indicated DKA with glycosuria and ketonuria, masking the UTI. While DKA was managed with insulin and fluids, the UTI did not respond to cefuroxime, and urine cultures showed no bacteria. After 48 hours, Candida albicans was identified via microscopy, and treatment with oral fluconazole was successful. The candiduria diagnosis also led to positive HIV screening, and the report discusses the challenges of managing her condition, especially after initiating highly active antiretroviral therapy.

Hyperuricaemia Associated with High-dose Furosemide in a Patient with Anterior Wall Myocardial Infarction and Multifactorial Acute Kidney Injury: A Case Report

Sivani Ravindran, Swetha Sathishkumar, B Syaam Ganesh, Merin Levy Philips Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Hyperuricaemia, defined as a serum uric acid level >6 mg/dL in women and >7 mg/dL in men, is a well-recognised metabolic complication of loop diuretic therapy. Furosemide can cause hyperuricaemia through reduced renal uric acid excretion. We report the case of a 57-year-old man with type 2 diabetes mellitus who presented with acute decompensated heart failure secondary to an anterior wall myocardial infarction. He received an initial intravenous bolus of furosemide (20 mg), followed by a continuous infusion at 20 mg/hour. By Day 4, serum uric acid rose to 12.2 mg/dL, and renal function deteriorated with an estimated Glomerular Filtration Rate (eGFR) decline to 33 mL/min/1.73 m², consistent with severe hyperuricaemia occurring during high dose furosemide therapy and concurrent acute kidney injury. While asymptomatic hyperuricaemia is often managed with lifestyle modifications, xanthine oxidase inhibitors remain first-line therapy for high-risk patients. This case emphasises the importance of recognising and carefully monitoring hyperuricaemia and renal dysfunction during prolonged, high-dose furosemide therapy, especially in patients with severe cardiovascular conditions.

Occupation-specific Physiotherapy and Ergonomic Rehabilitation in Seronegative Radiographic Axial Spondyloarthritis in a Young Farm Labourer: A Case Report

Gurjeet Kaur, Neha Hemant Pundkar, Irshad Qureshi, Ashutosh Bagde Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Axial Spondyloarthritis (axial SpA) is often missed in young people, often confused with mechanical Low Back Pain (LBP), especially among those with heavy manual labour, resulting in poor management and loss of function. This case report details a 22-year-old male farm labourer who had suffered from chronic LBP (4/10 with activity and 7/10 at rest) for 1.5 years, progressive stiffness in the spine (morning stiffness> 60 minutes), and decreased work capacity. On clinical examination, decreased lumbar mobility (flexion 40°), decreased chest expansion (2.5 cm), posterior chain muscle tightness, and guarded movement without neurological deficit were noted. Laboratory investigations revealed an elevated ESR (42 mm/hour), a borderline normal C-Reactive Protein (CRP: 4.2 mg/L; reference <5 mg/L), which, while within the normal range, may carry diagnostic relevance in axial SpA, and negative HLA-B27 and rheumatoid factor. Unilateral grade II sacroiliitis (modified NY criteria) and vertebral squaring with early syndesmophytes were seen on radiographs, compatible with seronegative radiographic axial SpA. The patient fulfilled the Assessment of SpondyloArthritis International Society (ASAS) criteria for radiographic axial SpA (sacroiliitis on imaging plus ≥1 SpA feature). Amor classification criteria confirmed the diagnosis at the minimum threshold (score 6, threshold ≥6); notably, the radiological sacroiliitis item scored 0 points as unilateral grade II sacroiliitis does not meet the Amor radiological criterion (which requires bilateral ≥ Grade II or unilateral ≥ Grade III), and the total of 6 points was reached through clinical features alone. Baseline assessment indicated high disease activity and functional limitation {Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 5.6; Functional Index (BASFI): 5.3; Metrology Index (BASMI): 2.4; Global Score (BAS-G): 8.5}. A structured 12-week physiotherapy program including spinal mobility and extension exercises, flexibility training, breathing exercises and postural correction was implemented, along with occupation-specific ergonomic interventions including neutral spine lifting, load redistribution (≤15 kg), work modification, and use of long-handled tools. At 12-week follow-up, clinically meaningful improvements were observed: BASDAI score was 3.4, BASFI score was 3.1, BASMI score was 1.6, BAS-G score was 4.2, pain score 3/10 during activity and 5/10 at rest, and a 34% improvement in work productivity (Work Productivity and Activity Impairment (WPAI) questionnaire). Improvements in BASDAI and BASFI exceeded established Minimal Clinically Important Difference (MCID) thresholds. This case emphasises early recognition of inflammatory back pain. It highlights the role of physiotherapy combined with occupation-specific ergonomic modifications in improving function and work participation among manual workers with seronegative axial SpA.

Intracapsular Silicone Breast Implant Rupture Presenting as Axillary Lymphadenopathy: A Case Report

Eeta Jain, Zaara Khan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Silicone breast implants are widely used for cosmetic and reconstructive purposes. Despite being designed to reduce complications, they can rupture silently and occasionally present with atypical findings such as axillary lymphadenopathy. We report the case of a 40-year-old woman who underwent bilateral augmentation mammoplasty in 2016 and presented nine years later with a painless, slowly enlarging right axillary lump. Examination revealed firm nodes and mild breast contour distortion. Mammography showed bilateral retroglandular implants with enlarged right axillary nodes. MRI confirmed rupture with characteristic "subcapsular line" sign and "keyhole" sign, without evidence of extracapsular spread. Ultrasound-guided Fine-Needle Aspiration Cytology (FNAC) revealed features consistent with a silicone-induced foreign body reaction. Surgical management included bilateral implant removal with total capsulectomy and excision of enlarged right axillary lymph nodes with intraoperative confirmation of right implant rupture. This case illustrates characteristic imaging features, along with histopathological correlation, both of which are essential for accurate diagnosis and timely management.

MRI Evaluation of Neurofibromatosis Type 2 in a Young Female with Vestibular Schwannoma and Multiple Meningiomas: A Case Report

Suvansh Bhatia, Kunal Solanki, Maulik Mukeshbhai Kothari, Ojus Seth, Samarth Shah Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Neurofibromatosis Type 2 (NF2) is a rare autosomal dominant neurocutaneous disorder characterised by the development of multiple central nervous system tumours, particularly vestibular schwannomas and meningiomas. Magnetic Resonance Imaging (MRI) plays a crucial role in early detection and surveillance of these lesions. A 22-year-old female presented with progressive hearing loss in the right ear for five months and intermittent headache. Pure tone audiometry revealed moderately severe sensorineural hearing loss in the right ear. MRI brain demonstrated a right cerebellopontine angle extra-axial mass extending into the internal auditory canal. The lesion appeared T2/FLAIR hyperintense, showed no diffusion restriction, demonstrated few blooming foci on susceptibility weighted imaging, and showed homogeneous postcontrast enhancement. The patient subsequently underwent surgical excision of the lesion, and histopathological examination of the excised specimen confirmed schwannoma. Additionally, two lesions consistent with meningiomas were identified. The first was an extra-axial lesion in the left parietal region which appeared heterogeneously hyperintense on T2/FLAIR. The second lesion was a calcified lesion located in the temporal horn of the right lateral ventricle, appearing hypointense on both T1 and T2/FLAIR sequences and demonstrating blooming on susceptibility-weighted imaging without diffusion restriction. The co-existence of vestibular schwannoma with multiple intracranial meningiomas raises suspicion for neurofibromatosis Type 2. MRI plays a key role in detection and follow-up of patients with suspected NF2.

Labial Wing-retained Modified Maryland Bridge with Monolithic Zirconia Veneers for Deep Bite Rehabilitation: A Case Report

Deepti Tambake Fulari, Krishna Milind Haval, Rohit Ishwar Dhole, Pratiksha P Sahare, Mokshada M Badadare Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Rehabilitation of missing anterior teeth in young patients presents a clinical challenge due to high aesthetic demands, ongoing craniofacial growth and the need to preserve sound tooth structure. The present case report describes a 17-year-old male with peg-shaped lateral incisors, spacing, severe vertical overlap and a missing maxillary left central incisor. A conservative treatment approach was planned using a modified Maryland bridge in conjunction with ceramic veneers, considering the patient’s age, occlusal characteristics and minimally invasive requirements. Unlike the conventional design, the prosthesis incorporated labial retentive wings combined with veneer preparations on the abutment teeth. Monolithic zirconia was selected to enhance fracture resistance in the presence of a deep bite. Additional ceramic veneers were cemented on adjacent teeth to close diastemas (between the maxillary right central incisor and lateral incisor and between the right lateral incisor and canine) and improve tooth morphology. At two-year follow-up, no biological or mechanical complications were observed and satisfactory functional, phonetic and aesthetic outcomes were maintained. The present case highlights the value of individualised prosthetic design and adhesive principles in achieving predictable, minimally invasive anterior rehabilitation in young patients with excessive vertical overlap.

Anaesthetic Management of Laparoscopic Incisional Hernia Repair in a Patient with Myasthenia Gravis: Case Report

Pooja, Depinder Kaur, Subodh Nimbria, Mamta Sharma Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Myasthenia Gravis (MG) is an autoimmune disorder of the neuromuscular junction, often complicated by perioperative respiratory and neuromuscular challenges. Patients with MG undergoing laparoscopic incisional hernia repair pose unique peri-operative anaesthetic challenges due to muscle relaxants even in the periods of complete remission due to altered neuromuscular transmission, risk of respiratory compromise, and the physiological changes associated with pneumoperitoneum. A 66-year-old female patient with well-controlled MG on medications, who developed an incisional hernia following an open cholecystectomy performed five years prior, presented for laparoscopic surgical repair. Over the last three years, the hernia progressively enlarged, prompting surgical intervention. Preoperative optimisation included stable MG control with pyridostigmine. Intraoperative management featured careful titration of neuromuscular blockade, the use of remifentanil infusion for stable haemodynamics and precise analgesia control, selective opioid choice, and vigilant neuromuscular and respiratory monitoring. Ultrasound guided fascial plane block for intraoperative and postoperative analgesia to minimise systemic opioid requirements. The patient remained haemodynamically stable throughout the procedure, with adequate surgical conditions using low-dose non-depolarising muscle relaxants guided by train-of-four monitoring. The fascial plane block provided effective pain control, reducing the need for high-dose systemic opioids. The patient achieved early mobilisation and was discharged on postoperative day three without complications. This case illustrates that meticulous clinical assessment and planning, including an appropriate analgesic regimen with a fascial plane block, judicious use of short-acting opioids (remifentanil) intraoperatively, careful neuromuscular monitoring, and stable MG disease management, can lead to a successful laparoscopic incisional hernia repair with minimal complications in a patient with MG.

Anaesthetic Management of a High-risk Patient with Chronic Post-stroke Chorea undergoing Forearm Surgery: A Case Report

Nikita Sareen, Jayashree Sen, Mittal Gedam, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Movement disorders such as chorea represent a significant challenge in anaesthetic practice due to involuntary movements, airway concerns, and associated co-morbidities, particularly when secondary to Cerebrovascular Accidents (CVA). The present case reports a 53-year-old male having chronic post-stroke choreiform movements, uncontrolled hypertension, chronic alcoholism and a potentially difficult airway, who presented with fractures of the left radius and ulna requiring surgical fixation. Neurological evaluation revealed generalised choreiform movements with ballistic components (Abnormal Involuntary Movement Scale (AIMS) score 14), likely secondary to chronic basal ganglia involvement. Neuroimaging showed features suggestive of chronic small vessel ischaemic disease without evidence of acute intracranial pathology. The patient was classified as American Society of Anaesthesiologists (ASA) physical status IV, rendering general anaesthesia high-risk because of aspiration risk, airway concerns along with potential exacerbation of involuntary movements. Ultrasound-guided supraclavicular and axillary brachial plexus blocks were performed to provide surgical anaesthesia. Persistent choreiform movements required carefully titrated monitored anaesthesia care using low-dose propofol while also maintaining spontaneous ventilation, airway reflexes. The procedure was completed successfully without any intraoperative-postoperative neurological deterioration or major complications. The uniqueness of this case lies in the successful use of peripheral nerve blocks despite persistent involuntary movements and the observed transient modulation of chorea following propofol sedation. This case underscores the importance of individualised anaesthetic planning, cautious drug selection as well as the role of regional anaesthesia with minimal sedation in managing high-risk patients with chronic post-stroke chorea undergoing peripheral surgery.

Surgical Management of a High Flow Auricular Arteriovenous Malformation Presenting with Life-Threatening Haemorrhage: A Case Report

Abhishek Kumar Rai, Hara Prasad Mohapatra, Rajat Agarwal, Amiy Arnav Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X High-flow Arteriovenous Malformations (AVM) of the auricular region is rare but difficult-to-treat vascular anomalies. As a benign entity, management of the lesion should balance aesthetic considerations, long-term function, and the avoidance of life-threatening complications. A 35-year-old male presented to the emergency department in shock with pulsatile bleeding from the left ear, following a history of progressive swelling and recurrent spontaneous haemorrhages from the left auricular region. On examination, a bruit could be heard, suggesting a high-flow AVM, and the patient was adequately resuscitated with blood products. Magnetic Resonance Angiography (MR Angiography) was suggestive of an enlarged external carotid artery with an extensive AVM around the left auricular and temporal region. A multidisciplinary team comprising plastic surgeons, interventional radiologists, surgical oncologists, and vascular surgeons reviewed the case and decided on surgical excision as the best course of action. Surgical extirpation was successfully performed along with external carotid artery ligation to control the haemorrhage with the defect being reconstructed using split thickness grafts. The patient has been on follow-up for two months with no evidence of disease recurrence. Rare locations of high-flow AVMs should always be discussed with a multidisciplinary team to determine the best course of action among the available options for the patient.

Management of Neglected Lateral Patellar Dislocation with Osteochondral Fracture and Dejour Type D Trochlear Dysplasia in the Setting of Venous Thromboembolism: A Rare Case Report

R Ajay, B Vijay Anand, S Karthikeyan, D Sidharthan, Mythilisri Eswaran Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Neglected lateral patellar dislocation, characterised by sustained lateral displacement beyond three weeks, is a multifaceted syndrome marked by progressive periarticular fibrosis, adaptive shortening, and osteochondral injury, leading to discomfort, instability, and functional limitations. This case report illustrates the management of neglected lateral patellar dislocation with displaced osteochondral fracture accompanied by Dejour type D trochlear dysplasia in a young male complicated by Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). Surgical intervention was postponed for six weeks because of PE, requiring anticoagulant therapy. Subsequent to the partial clearance of the thrombus, the patient underwent single-stage surgery that included fixing of the osteochondral fragment, deepening of the sulcus using trochleoplasty, lengthening of the lateral retinaculum, and reconstruction of the medial patellofemoral ligament using a gracilis autograft. Postoperative therapy involved early full weight-bearing and range of motion exercises, resulting in positive early outcomes at two weeks, including 0°-60° knee flexion and one-year follow-up demonstrating pain-free knee ROM 0°-120° and return to daily activity at six weeks and resumed work at eight weeks. This example underscores the essential need for a customised therapy strategy that effectively addresses both soft tissue and bony pathology, even when surgery timing is confounded by significant systemic concerns, to attain favourable functional outcomes.

Traumatic Neuroma of Tongue in a 10-Year-Old Child: A Case Report

Biswaroop Chandra, Ipsita Maity, Rajib Saha, Piyali Datta, Trishik Basak Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Traumatic neuroma is a non-neoplastic proliferation of peripheral nerve tissue. It represents a hyperplastic, reparative response of a nerve following injury, including trauma or surgical interventions. Its occurrence in the oral cavity is usually rare. When present in the oral cavity, traumatic neuroma most commonly involves lip, mandible, tongue and very rarely hard palate. A 10-year-old child presented with a history of multiple swellings on the tongue that had persisted for 3-4 years, indicating a need for thorough diagnostic evaluation and appropriate management. The patient underwent a thorough clinical examination and a Computed Tomography (CT) scan for pre-surgical assessment, followed by surgical excision of the tongue lesions. The excised tissue was subjected to histopathological examination. Histopathological examination revealed the lesions to be traumatic neuromas, characterised by disorganised proliferation of nerve tissue that typically occurs as a reparative response to nerve injury or trauma. Surgical excision was the treatment modality employed, serving both diagnostic confirmation and therapeutic purposes aiming to alleviate symptoms and improve oral function. Postoperative follow-up revealed that the patient was clinically doing well with a notable improvement in quality of life. The removal of the lesions contributed to enhanced comfort and restoration of normal tongue function. Traumatic neuroma, an uncommon entity, particularly in paediatric patients, was effectively managed with surgical intervention in this case. The diagnosis underscores the importance of considering traumatic neuroma in differential diagnoses of tongue swellings with a plausible history of trauma. Favourable clinical outcomes highlight the benefits of appropriate diagnostic work-up and surgical treatment in improving patient outcomes.

Antibioma of the Breast in a Non-lactating Woman with Methicillin-resistant Staphylococcus aureus: A Case Report

Shravani Jawadi, Venktesh Rewale, Aditya Sriharsha, Abhimanyu Chawla Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Antibioma of the breast is a chronic inflammatory pseudotumour that forms when a breast abscess undergoes partial sterilisation by antibiotic therapy in the absence of surgical drainage. It remains poorly documented, and reports involving non-lactating women are scarce. A 22-year-old non-lactating woman presented with a two-month history of left retroareolar breast swelling that had not responded to sequential courses of oral second- and third-generation cephalosporins. Examination revealed a 4×3 cm retroareolar mass with nipple retraction and erythema, raising clinical concern for inflammatory breast carcinoma. Breast ultrasonography confirmed a 3.4×2.2 cm hypoechoic collection with internal debris. Culture from ultrasound-guided aspiration grew Methicillin-resistant Staphylococcus aureus (MRSA), resistant to the beta-lactam agents used in both prior courses and susceptible to ciprofloxacin, which explained the earlier treatment failures. Cytology excluded malignancy. The patient underwent circumareolar incision and drainage under general anaesthesia with breakdown of loculations and wound packing. Ciprofloxacin was administered per the culture sensitivity results postoperatively. Delayed primary closure on day 7 resulted in complete resolution. Histopathology confirmed antibioma. Two features make this case unusual: the patient was a non-lactating woman with nipple retraction mimicking carcinoma, and the causative organism was MRSA and therefore resistant to both prescribed cephalosporin courses from the outset.

Posterior Mediastinal Neuroblastoma with Intra-spinal Extension in an Infant: A Case Report

Parth Chandubhai Savaliya, Khushi Manish Dave, Virender Singh, Ashutosh Patel, Rajesh Rathore Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Neuroblastoma is the most common extracranial solid malignancy of childhood arising from neural crest cells of the sympathetic nervous system. Although the adrenal glands are the most frequent primary site, tumours may arise anywhere along the sympathetic chain, including the posterior mediastinum. A 13-month-old female child presented with progressive upper back pain, bilateral lower limb weakness, and right-sided neck swelling for one month with a progressive nature. CT thorax revealed a heterogeneous posterior mediastinal mass extending from the superior end plate of C6 to the inferior end plate of D7 vertebral body. MRI demonstrated a 3.8×3.2×3.2 cm lesion with cranio-caudal extension from C6 to D7 (approximately 5.5 cm), resulting in severe spinal canal narrowing and cord compression. Imaging findings suggested a neurogenic tumour. Histopathological examination revealed a malignant round cell tumour - Poorly differentiated neuroblastoma. Posterior mediastinal neuroblastoma with multilevel spinal involvement is uncommon and may present with neurological symptoms such as progressive upper back pain and bilateral lower limb weakness due to spinal canal compression.

Histopathological Spectrum of Appendiceal Epithelial Neoplasms: A Series of Seven Cases

JS Sumi, KV Kalaranjini Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Appendiceal epithelial neoplasms are uncommon lesions, often detected incidentally on histopathological examination of appendicectomy or resection specimens. They comprise a heterogeneous group of tumours ranging from mucinous neoplasms to invasive adenocarcinomas, with varied morphology, biological behaviour, and clinical outcome. Their relative rarity and overlapping clinical presentation make histopathological evaluation essential for accurate diagnosis and classification. The present case series describes the clinical and histomorphological features of seven cases of epithelial appendiceal neoplasms diagnosed at a tertiary care centre. The cases included four adenocarcinomas- one goblet cell adenocarcinoma, two mucinous adenocarcinomas, and one non-mucinous adenocarcinoma- along with two Low-grade Appendiceal Mucinous Neoplasms (LAMN) and one High-grade Appendiceal Mucinous Neoplasm (HAMN). The median age at presentation was 64 years. There was a female predominance, with six females and one male. Histologically, the lesions showed varied architectural patterns, cytological atypia, mucin production, and differing extent of appendiceal wall involvement. One case was associated with pseudomyxoma peritonei, while another showed synchronous adenocarcinoma of the ascending colon. Serum Carcinoembryonic Antigen (CEA) was elevated in most evaluated cases, whereas Cancer Antigen 125 (CA-125), was elevated in one case. Classification was based on the World Health Organisation (WHO) 5th edition classification, and staging was assessed using the American Joint Committee on Cancer (AJCC) staging system. Follow-up ranged from six months to two years. During the follow-up period, four patients remained disease-free, while one patient demonstrated stable disease while receiving chemotherapy. One patient died due to disease progression, and follow-up information was unavailable for one patient. This series is important as it highlights the rarity and clinicopathological diversity of appendiceal epithelial neoplasms encountered in routine surgical pathology practice. The lesions ranged from low-grade mucinous neoplasms to invasive adenocarcinomas with distinct biological behaviour and differing prognostic implications, including variation in risk of recurrence, progression, and development of Pseudomyxoma Peritonei (PMP). Recognition of these morphological differences is essential for accurate pathological subtyping, as it directly influences staging, prognostic assessment, therapeutic planning, extent of surgical management, postoperative surveillance, and long-term follow-up.

Guided Posterior Quadratus Lumborum Block for Postoperative Pain Control in Abdominal Surgery: A Case Series

Ajinkya Akulwar, Neeta Chaudhary, Amreesh Paul Francis Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Effective postoperative analgesia is essential for patients recovering from abdominal surgery, as adequate pain relief plays a key role in achieving positive surgical outcomes. Most patients receive systemic opioid medications after their procedure; however, these medications can cause side-effects that make them less than ideal analgesic agents. There has been a significant movement toward using regional anaesthesia techniques to provide an alternative to using systemic opioids as part of a multimodal approach to postoperative analgesia for patients undergoing surgical procedures. One form of regional anaesthesia that has become quite popular is the use of fascial plane blocks. An example of a fascial plane block is the Posterior Quadratus Lumborum Block (PQLB), which has been shown to be very effective in providing analgesia to the abdominal wall by helping to deliver local anaesthetic agent to the thoracolumbar fascia. The purpose of this case series was to evaluate three patients who received PQLB performed under ultrasound guidance following general anaesthesia for postoperative analgesia. The primary variables that were evaluated included postoperative pain scores, time to the first dose of an analgesia, amount of opioids consumed, and haemodynamic stability throughout the course of each patient’s procedure. Results of this study demonstrated that patients receiving ultrasound-guided PQLB had adequate postoperative analgesia, as evidenced by low pain scores, delayed requiring supplemental analgesics, and relatively low opioid consumption. This case series demonstrated that ultrasound-guided PQLBs may be an effective option for use as part of multimodal analgesia techniques as an adjunct therapy to improve postoperative pain control and comfort for patients undergoing abdominal surgery, as well as improve the surgical recovery process for these same patients between surgical procedures.

Aggressive Metastatic Behaviour in Pancreatic Solid Pseudopapillary Neoplasm: A Series of Three Cases

Sonali Mandal, Ranajoy Ghosh, Swapnil Sen, Sraboni Sen, Aniket Halder Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Solid Pseudopapillary Neoplasms (SPNs) of the pancreas are rare low-grade malignant tumours predominantly affecting young women. Although its malignant potential is low, metastases- particularly to the liver can occur. Hereby, the authors present three unusual cases of pancreatic SPN in varied age groups are being presented - in a 17-year-old, 50-year-old and a 37-year-old female of which the all three cases were diagnosed as malignant SPN with metastases. The first case presented with abdominal pain and unusually huge palpable mass of greatest dimension of 18 cm with liver and peritoneal metastasis. Histopathology demonstrated high mitotic activity (approx. 40/10 hpf), capsular invasion, peripancreatic fat invasion, and metastatic deposits in both the liver and peritoneum, confirming malignant SPN. The second case presented with multiple liver Space-Occupying-Lesions (SOLs) which on Ultrasound-guided Fine-Needle Aspiration Cytology (FNAC) showed characteristic cytological features of SPN. The patient had a past history of distal pancreatectomy for SPN three years back. The cytologic features were suggestive of metastatic recurrence of SPN occurring after three years of primary disease, although there was no evidence of any recurrent tumour in the previous operation site in pancreas. The third case had undergone resection of pancreatic SOL for SPN which measured a maximum dimension of 24 cm and showed peripancreatic lymph node metastasis. This case is one of the largest documented SPN reported in literature. The malignant nature of the three cases were on the basis of liver and peritoneal metastasis in the first case, liver metastasis in the second case and peripancreatic lymph node metastasis in the third case. The first patient underwent surgical resection with no adjuvant therapy initiated at the time of reporting. The second patient was referred for oncology evaluation for systemic management of her metastatic recurrence. The third patient had an uneventful postoperative recovery and is currently under close follow-up. These three cases highlight the variable clinical spectrum of SPN including aggressive metastatic behaviour, exceptionally large tumour dimensions, and late recurrences. They also underscore the indispensable role of histopathology and immunohistochemistry in accurate diagnosis, and the importance of long-term follow-up even after apparently complete resection.

Histopathological Spectrum of Clinically Diagnosed Epidermoid Cyst: A Series of 20 Cases

Deepti Agarwal, Parveen Rana Kundu, Tanu Priya, Swaran Kaur Saluja, Monika B Gathwal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Epidermoid cysts are among the most common subcutaneous nodular lesions encountered in clinical practice and are often diagnosed clinically. However, a wide spectrum of benign and malignant cutaneous adnexal and soft-tissue tumours can closely mimic these lesions, posing significant diagnostic challenges. The present retrospective case series was conducted at a tertiary care hospital over a one-year period (January–December 2025) to evaluate the histopathological spectrum of lesions clinically diagnosed as epidermoid cysts. A total of 20 cases (12 males and eight females) were analysed. Clinical details were recorded and all excised specimens underwent histopathological examination. The majority of cases showed clinicopathological discordance. Skin adnexal tumours were the most frequent mimickers (11 cases), including nodular hidradenoma (n=5), pilomatricoma (n=3), eccrine spiradenoma (n=1), chondroid syringoma (n=1) and pilomatrix carcinoma (n=1). Peripheral nerve sheath tumours were identified in four cases. Other diagnoses included basal cell carcinoma (n=1), calcinosis (n=1), dermoid cyst (n=1), ganglion cyst (n=1) and papillary cystadenoma (n=1). Two cases were malignant. The present study highlights significant clinicopathological discordance and the risk of missed malignancies in clinically suspected epidermoid cysts. Histopathological examination {Haematoxylin and Eosin (H&E)} remains essential for definitive diagnosis and a multidisciplinary approach is critical for appropriate patient management.

Maternal Peripartum Hyponatraemia Leading to Early Neonatal Seizures: A Case Series

Panchampreet Kaur, Rinku Sen Gupta Dhar, Sankalp Dudeja Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Peripartum hyponatraemia is an underrecognised yet significant electrolyte disturbance that can adversely affect both the mother and the neonate. Labouring women are predisposed to hyponatraemia which can be attributed to lower baseline sodium levels, impaired renal water excretion, and/or the antidiuretic effects of oxytocin. As maternal and foetal electrolytes equilibrate across the placenta, affecting the milieu, maternal hyponatraemia may result in neonatal dyselectrolytaemia and rarely early-onset seizures. In this case series, the authors aim to highlight the importance of sodium homeostasis during pregnancy and labour, to ensure accurate fluid balance monitoring, increase awareness, and hence earlier detection of peripartum hyponatraemia to prevent unfavourable maternal and neonatal outcomes. Three parturients and their neonates who developed significant hyponatraemia were analysed for their course of labour, biochemical parameters, and clinical outcomes. Two patients (Case 1,3) were Robson class I, Case 2 Robson II A. Case 1 had a vacuum-assisted vaginal delivery, the second and third had spontaneous vaginal delivery. Case 2 received Entonox as labour analgesia. Cord blood gases were normal. The three parturients had varied clinical presentation with case 1 being asymptomatic, case 2 slightly drowsy but she was also on Entonox analgesia and case 3 had generalised tonic clonic seizures. All three neonates presented with convulsions on postnatal day 1 and responded to intravenous saline. Sepsis work-up, glucose, and calcium levels were normal. No neurodevelopmental delay was observed in neonates. A high degree of suspicion in oxytocin augmented labour and even in low-risk labouring women is required to prevent the occurrence of dyselectrolytaemia. Timely recognition and treatment can avert serious maternal and neonatal complications.

Decompression with or without Stabilisation in Cervical Ossification of the Posterior Longitudinal Ligament: A Case Series of Seven Cases

Manisha Singh, TP Jeyaselva SenthilKumar, RM Manickam, PG Sri Rahul Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Cervical Ossification of the Posterior Longitudinal Ligament (OPLL) is a common cause of cervical myelopathy requiring surgical intervention. Options include posterior decompression alone or decompression combined with stabilisation. Seven patients with radiologically proven cervical OPLL who underwent posterior cervical surgery were retrospectively reviewed. Three underwent decompression alone, and four underwent decompression with stabilisation. Neurological recovery was assessed using the modified Japanese Orthopaedic Association (mJOA) score. All patients showed postoperative neurological improvement. Patients undergoing decompression alone improved by 1-3 mJOA points, while those undergoing decompression with stabilisation, chosen for kyphosis, multi-segment OPLL, or instability, improved by 2-3 points. The mean improvement in mJOA score was 2.0 in the decompression group and 2.75 in the stabilisation group. Both surgical strategies are effective; however, stabilisation offers better outcomes in cases with kyphosis, long-segment OPLL, or dynamic instability. A tailored approach ensures optimal surgical results.

Rare Concurrence of Talon’s Cusp, Dens Invaginatus and Fusion in Maxillary Anterior Teeth: Images in Medicine

C Divya, R Anitha Kumari, Keerthi Ramesh Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X

Inverse Psoriasis Mimicking Tinea Cruris in an 11-year-old Boy: A Diagnostic Pitfall

Priyanka Thirumalai, Ramya Ramanathan, Sundari Subramanian Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X

Images of Geminated Maxillary Central Incisor with Mesiodens in Mixed Dentition

Mrunali Deshkar, Nilima Thosar, Aakriti Chandra, Akanksha Akhatkar, Ashray Nimje Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X

Congenitally Missing Mandibular Central and Lateral Incisors in a 14-year-old Adolescent: A Clinical Image

Rijuta Gujar, Punit Fulzele, Nilima Thosar, Anjori Raut, Amruta Suryawanshi Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X

Complete Coronal Pulpotomy as Vital Pulp Therapy in a Mature Mandibular Molar: Images in Medicine

Lalit Prakash Pawar, Aditya Patel, Manoj Chandak, Pratik Rathod, Nishigandha Pawar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X A 31-year-old female patient experienced pain in the right posterior mandibular region for four to five days, which was spontaneous, lingering, throbbing, non-radiating in nature, aggravated by intake of cold and hot beverages. Medical and dental histories were non-contributory, with no history of trauma, swelling or medication use. A clinical examination revealed a carious lesion in the right mandibular first molar (tooth 46). There was no tenderness to percussion, and electric pulp testing produced an elevated response relative to the contralateral tooth, signifying a vital yet inflamed pulp. A preoperative intraoral periapical radiograph showed a deep carious lesion approximating and involving the pulp chamber, with intact lamina dura, no widening of the periodontal ligament space or periapical radiolucency (Table/Fig 1a), confirming the absence of apical pathology [1-3]. The diagnosis of symptomatic irreversible pulpitis with normal apical tissues was established based on these observations, in accordance with the diagnostic criteria given by the American Association of Endodontists (AAE) (1). A complete coronal pulpotomy was planned due to the favourable periapical condition and in order to maintain pulp vitality [2,4].

Clinical Image of Giant Lobulated Exophytic Perianal Mass

Mansi Nakum, Sheetal Asutkar, Naveen Singh Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X

Are MCQ-based Postgraduate Entrance Examinations Undermining Clinical Skills in MBBS Graduates?

Navya Nandini, Mohammad Naksh Kamar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X The one nation, one examination policy, which introduced a single postgraduate medical entrance test for India’s MBBS graduates, has brought uniform evaluation and transparency to India’s medical examination system. However, it becomes crucial to review the assessment criteria of such a test. Selection must concentrate on clinical competence and acumen rather than the ability to solve Multiple Choice Questions (MCQs).

Hyperthyroidism Mimicking Primary Psychiatric Illness: A Case of Acute Psychosis

Amit Khune, Monisha Seralathan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X To editor, Hyperthyroidism typically presents with classic signs such as palpitations, tremors, heat intolerance, and weight loss. Rarely, however, it may present with neuropsychiatric symptoms including anxiety, emotional lability, or frank psychosis. Such unusual presentations pose a significant diagnostic challenge and are often mistaken for primary psychiatric illness, leading to misdiagnosis and delay in appropriate medical intervention [1-3].

Clinical Profile, Management and Outcomes of Penetrating Abdominal Injuries: A Prospective Observational Study

Deepika Shelar, Anitha Kandi, Diksha Srivastava, Sarojini Jadhav Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Penetrating abdominal trauma is a major cause of morbidity and mortality worldwide. Prompt recognition and timely intervention are crucial for improving patient outcomes. Aim: To evaluate the clinical profile, management strategies, and outcomes of patients presenting with penetrating abdominal trauma at a tertiary care centre. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery at Government Medical College and Hospital, Aurangabad (Chh. Sambhajinagar), Maharashtra, India between September 2020 and October 2022. A total of 68 patients with penetrating abdominal injuries were included. Patients were evaluated using clinical examination, laboratory investigations, and appropriate radiological imaging. Management was guided by haemodynamic status and clinical findings. Postoperative outcomes and complications were recorded. Results: The majority of patients were young adults, with peak incidence in the 21-30-year age group 28 (41.2%) patients. The mean age was 31.7±11.2 years, with a male predominance 60 (88.2%) males. Homicidal stab injuries were the most common mode of injury 56 (82.4%) patients. The most frequently injured structures were the mesentery 17 (37.0%) patients and small bowel 16 (34.8%) patients. The most common operative procedures were mesenteric repair and primary bowel repair. The negative laparotomy rate was 13.0%. The mean hospital stay was 7.0±3.4 days. The overall mortality rate was 9 (13.2%) patients, mainly due to haemorrhagic shock and septic complications. Postoperative complications were observed in 17 patients with respiratory complications, surgical site infection, and burst abdomen (23.5% each) being the most common. Conclusion: Penetrating abdominal trauma predominantly affects young adults and remains associated with significant morbidity and mortality.

Comparison of Flap Fixation and Conventional Wound Closure Following Modified Radical Mastectomy: A Prospective Cohort Study

Ananya Johari, Karthikeyan Selvaraj Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Seroma formation is the most common postoperative complication following Modified Radical Mastectomy (MRM), resulting from disruption of lymphatic channels and persistence of dead space. Although suction drains are routinely used, seroma formation remains a significant challenge. Flap fixation with quilting sutures has been proposed to obliterate dead space and reduce seroma formation. Aim: To compare the effectiveness of flap fixation and conventional wound closure in reducing postoperative drain output, duration of drainage, seroma formation, aspiration requirements, and wound-related complications following MRM. Materials and Methods: This prospective observational cohort study was conducted in the Department of General Surgery at a tertiary care centre in Chennai, Tamil Nadu, India, from July 2024 to January 2026. A total of 62 female patients with histologically confirmed operable breast carcinoma undergoing MRM were included. Patients were allocated into two groups: Group A-flap fixation (n=31) and Group B-conventional closure (n=31). In the flap fixation group A, absorbable quilting sutures were used to secure the mastectomy skin flaps to the underlying pectoral fascia, thereby eliminating dead space. Conventional wound closure was performed in the control, group B. Closed suction drains were placed in all patients. Outcomes assessed included total and mean daily drain output, duration of drainage, incidence of seroma, aspiration requirements, and postoperative complications. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered significant. Results: Baseline demographic and clinical characteristics, including age, Body Mass Index (BMI), co-morbidities, tumour size, tumour laterality, histopathological diagnosis, and disease stage, were comparable between group A and the conventional wound closure group B (p>0.05 for all). Group A demonstrated significantly lower total drain output (410.7±97.4 mL vs 612.8±115.6 mL), mean daily drain output (85.2±17.6 vs 118.4±22.9 mL/day), and shorter drain duration (4.8±1.2 vs 7.1±1.5 days) (p<0.001 for all). Seroma incidence was significantly lower in the flap fixation group {4/31 (12.9%) vs 12/31 (38.7%); p=0.018}. Clinically significant seroma requiring aspiration was also reduced {4/31 (12.9%) vs 10/31 (32.2%); p=0.049}. Conclusion: Flap fixation is a safe and effective technique that significantly reduces seroma formation, postoperative drainage, drain duration, and aspiration requirements following MRM without increasing complications. Routine incorporation of this technique may improve postoperative outcomes.

Association of NS1 Antigen, IgM/IgG Antibodies with Haematological Indices and Inflammatory Markers in Suspected Dengue Cases: A Cross-sectional Study

Mohd Tabish Ansari, Sucheta Jitendra Lakhani, Dinesh Kanhaiyalal Khandhadia Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Dengue Virus (DENV) has been re-emerging as a major public health challenge in tropical and subtropical regions, including India, with increasing incidence, changing epidemiology, and seasonal outbreaks. Early diagnosis supported by laboratory markers is essential for effective clinical management and disease control. Aim: To evaluate the association of serological markers with haematological, biochemical and inflammatory parameters in clinically suspected cases of dengue. Materials and Methods: This cross-sectional study was conducted from March 2025 to December 2025 at Adarsh Multispecialty Hospital, Gandhinagar, Gujarat, India. The study included 154 patients presenting with Acute Febrile Illness (AFI). DENV diagnosis was performed using an immunochromatographic kit for NS1 antigen and IgM and IgG antibodies from the serum sample. Haematological indices, Inflammation markers and liver function tests Serum Glutamic Pyruvic Transaminase (SGPT) and Serum Glutamic Oxaloacetic Transaminase (SGOT) were examined. Chi-square test was used for statistical analysis, and a p-value of <0.05 was considered statistically significant. Results: A total of 154 suspected Dengue Fever (DF) samples were collected, out of which 38 cases of dengue infection were confirmed. The highest positivity was seen in the age group of 21 to 30 years, 14 (36.8%), with males being more affected, making up 24 (63.2%) of the cases. The seasonal peaks happened during August and September, with 11/34 (32.4%) and 11/42 (26.2%) of cases, respectively. Testing for the NS1 antigen alone found 17/74 (23%) of infections, but combining NS1 and antibody testing raised the rate to about 20/73 (27.3%). Dengue patients showed significantly decreased platelet counts 35/38 (92.1%), White Blood Cell (WBC) counts 21/38 (55.26%), and also lymphocyte counts 20/38 (52.63%). Liver enzymes were also elevated (SGOT 161.58±372.44 U/L and SGPT 187.46±456.09 U/L). They also showed raised C-Reactive Protein (CRP) in 33/38 (86.8%) of cases and higher Erythrocyte Sedimentation Rate (ESR) in 23/38 (60.5%) of cases. Conclusion: Detection of the NS1 antigen with antibody testing gives more specific results. Significant increase in CRP levels and a drop in platelet levels in dengue-positive patients are early indicators of presumptive diagnosis. Integrated haematological, and inflammatory markers facilitate efficient risk stratification and enhance early dengue identification, enabling prompt clinical therapy during periods of peak transmission.

Perceived Quality, Cost and Support Services Influencing Health Care Utilisation Among International Patients in a Private Tertiary Care Hospital in Ahmedabad, India: A Descriptive Cross-sectional Study

Medha Wadhwa, Apurvakumar Pandya, Kruti Gupta, Pulkit Kalyan, Ruchita Kamleshkumar Patel Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Medical Value Travel (MVT) is rapidly growing due to rising healthcare costs and limited access to quality care in many countries. India has emerged as a major destination because of affordable treatment and advanced health care services. Aim: To identify factors influencing the utilisation of health care services among the international patients and assess patient perceptions and hospital selection in a leading private tertiary care hospital. Materials and Methods: A descriptive cross-sectional study was conducted for six months from February 2019 to July 2019 among 42 international patients at a leading private tertiary care hospital in Ahmedabad, India. Participants were selected by purposive sampling. Data were collected using a researcher-developed structured questionnaire and analysed using descriptive statistics. Results: Most participants were foreign nationals (n=25, 59.5%) and belonged to middle- and upper-income groups (n=35, 83.3%). Cardiac and neurological procedures were the most common treatments. High satisfaction was observed for doctor accessibility, translator support, personalised care, and clinical infrastructure. Quality of health care, affordability, shorter waiting times, visa support and logistical assistance were major factors influencing hospital choices. Conclusion: Healthcare quality, affordability, and patient-centred support significantly influence Medical Tourism utilisation. Improving transparency in pricing and strengthening support services may further enhance the position of India in the Global MVT market.

Comparison of Port-site Complications in Laparoscopic Procedures with and without Rectus Sheath Closure: A Prospective Observational Study

Divya Saini, Rajkumar Verma, Pankaj Saunakiya Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Port-site complications remain an important concern following laparoscopic surgery. The necessity of routine rectus sheath closure at 10-12 mm trocar sites to prevent such complications remains controversial. Aim: To compare port-site complications and postoperative pain in patients undergoing laparoscopic surgery with and without rectus sheath closure. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, from May 2023 to June 2024. A total of 112 patients undergoing elective laparoscopic procedures were included and divided into two groups: a Closure Group (rectus sheath closed) and a Non-Closure Group (rectus sheath not closed). Port-site complications, postoperative pain assessed using the Visual Analog Scale (VAS), duration of hospital stay, and time to return to normal activity were evaluated over a six-week follow-up period. Continuous variables were analysed using the independent Student’s t-test, while categorical variables were compared using the Chi-square test or Fisher’s exact test. Results: A total of 112 patients were included, with 56 patients in each group. The mean age was 41.82±11.24 years in the closure group and 40.37±10.96 years in the non-closure group. Baseline demographic variables, including age, sex distribution, hypertension, and diabetes mellitus, were comparable between the groups except for Body Mass Index (BMI), which was significantly higher in the closure group. The incidence of port-site hernia was identical in both groups (1.79%). Port-site infection occurred in 16.07% of patients in the closure group and 14.29% in the non-closure group, while wound dehiscence occurred only in the non-closure group. Postoperative pain scores were significantly lower in the non-closure group at all assessed time points. No statistically significant difference was observed in duration of hospital stay or time to return to normal activity. Conclusion: Routine rectus sheath closure at 10-12 mm laparoscopic port-sites did not significantly reduce early port-site complications and was associated with higher postoperative pain scores. A selective, patient-specific approach to rectus sheath closure may therefore be preferable in elective laparoscopic procedures.

Multidomain Assessment of Hand Function in Children with Cerebral Palsy: A Cross-sectional Study

Nikita V Patel, Prasad Muley, Bhavana Gadhavi Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Cerebral Palsy (CP) is the leading cause of permanent physical disability in childhood, and upper limb involvement adversely affects Activities of Daily Living (ADL) and participation. Validated, multidomain assessment of hand function is essential for evidence-based intervention planning and outcome monitoring. Aim: To characterise hand function using a comprehensive assessment tool in children with CP. Materials and Methods: This cross-sectional study was conducted across rehabilitation centres near Ahmedabad and Gandhinagar, Gujarat, India over a period of ten months (August 2025 to May 2026), enrolling 66 children with confirmed CP aged 2.3 to 15 years (36 boys, 30 girls). Assessments comprised the Manual Ability Classification System (MACS), the ABILHAND-Kids Questionnaire (Rasch logit score), bilateral grip strength (hand dynamometry), tactile threshold (aaesthesiometry), gross and fine dexterity {Box and Block Test (BBT) and Nine-Hole Peg Test (9HPT)}, and stereognosis. Shapiro-Wilk testing indicated significant departures from normality for the continuous variables; therefore, non parametric methods were used throughout (significance threshold p<0.05). Results: Mean age was 6.56±3.04 years (median 6.0; range 2.3–15.0). Spastic diplegia was the most prevalent subtype 33 (50.0%). The median ABILHAND-Kids Questionnaire logit score was 0.27 (IQR: -0.26 to 1.95). CP subtype significantly differentiated ABILHAND-Kids Questionnaire logit scores (Kruskal–Wallis H=14.45, p=0.013); spastic diplegia showed the highest manual ability and dystonic CP the lowest. Bilateral BBT (ρ=0.336–0.359, p<0.01), 9HPT (ρ=-0.283 to -0.293, p<0.05), and stereognosis (ρ=0.328-0.352, p<0.05) correlated significantly with ABILHAND-Kids Questionnaire logit scores. Right-hand grip strength was significantly greater than left (Wilcoxon p<0.001). Gender (Mann–Whitney p=0.079) and MACS level (Kruskal–Wallis p=0.907) did not significantly differentiate ABILHAND-Kids Questionnaire scores. Conclusion: Dexterity (BBT and 9HPT) and stereognosis were significantly associated with functional hand ability in children with CP. CP subtype was significantly associated with manual ability. A multidomain assessment approach is recommended for both clinical practice and research.

Comparative Evaluation of Remineralisation Potential of Grape Seed Extract, Theobromine and Acidulated Phosphate Fluoride with and without Iontophoresis on Extracted Permanent Teeth: An In-vitro Study

Priya Tomar, Binti Rani Chand Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Early enamel demineralisation is reversible through remineralisation strategies that restore mineral content and enhance enamel resistance. Traditional fluoride therapies, although effective, raise concerns regarding fluorosis and toxicity. Naturally derived agents like Grape Seed Extract (GSE) and theobromine offer biocompatible alternatives. Iontophoresis is a non invasive technique that may enhance agent delivery into the enamel structure. Aim: To compare the remineralisation potential of GSE, theobromine, and Acidulated Phosphate Fluoride (APF) with and without iontophoresis on artificially demineralised permanent enamel surfaces using polarised light microscopy. Materials and Methods: This in-vitro comparative study was conducted in the Department of Paediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India from October 2024 to December 2024. A total of 36 extracted, caries-free human premolars were collected and sectioned longitudinally to obtain 72 specimens, which constituted the final sample size (n=12 per group). Group 1 received APF gel combined with iontophoresis, while Group 2 was treated with APF gel without iontophoresis. Group 3 was assigned theobromine solution with iontophoresis, and Group 4 received GSE with iontophoresis. Group 5 was treated with theobromine without iontophoresis, whereas Group 6 received GSE solution without iontophoresis. After artificial demineralisation and 8-day pH cycling, iontophoresis (0.5 mA, 4 minutes) was applied in respective groups. Lesion depth and remineralisation were analysed using polarised light microscopy. Data were statistically evaluated using One-way Analysis of Variance (ANOVA) and paired t-test (p<0.05). Results: APF with iontophoresis showed the deepest precipitation band (12.33±2.10 μm, p<0.05) and the least lesion depth. GSE without iontophoresis had the least remineralising effect (precipitation band: 3.30±3.51 μm; lesion depth: 42.91±4.39 μm). Iontophoresis significantly enhanced the remineralisation potential of both GSE and theobromine. No significant difference was observed between APF with and without iontophoresis, indicating its high intrinsic efficacy. Conclusion: APF remains the most effective remineralising agent, regardless of delivery method. However, naturally derived agents like GSE and theobromine exhibit significantly improved efficacy when used with iontophoresis. These findings support the use of iontophoresis-enhanced natural agents that demonstrate potential as safe, minimally invasive alternatives warranting clinical evaluation.

Analytical Performance of Vitamin D Immunoassays Compared with Electrochemiluminescence Immunoassay: A Cross-sectional Study

Arun Krishnan Radhakrishnan, Ajaikumar Sukumaran, Haritha Raveendran, Dhanesh Mandam Kulathil, KV Sarath, Sona Saji, Athira Chandran, Vasudevan M Damodaran Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Vitamin D, the fat-soluble steroid hormone, is important in maintaining homeostasis of calcium and phosphorus. The diagnosis of Vitamin D deficiency has become considerably more frequent due to its importance in skeletal and non skeletal disorders. Comparison among immunoassay methods is essential as methodological differences can lead to variations in 25-Hydroxyvitamin D (25-OH Vitamin D) results, potentially affecting the clinical interpretation. Aim: To evaluate the analytical agreement and assay trueness of Chemiluminescence Immunoassay(CLIA) (Alkaline Phosphatase- and Acridinium Ester-based) and Latex-Enhanced Immunoturbidimetric Technique (LEIT) methods for 25-OH Vitamin D quantification using Roche e411 Electrochemiluminescence Immunoassay (ECLIA) as the reference platform. Materials and Methods: This cross-sectional study was conducted at the Department of Research and Development, Agappe Diagnostics Limited, Cochin, Kerala, India, from April 2025 to June 2025. A total of 153 randomly selected participants were included in the study. 25-OH Vitamin D quantification was performed using CLIA cartridge analyser Microprocessor-based Immunoassay Platform Analyser-i60 (MISPA-i60), CLIA cassette analyser MISPA-i180, LEIT cartridge analyser MISPA-i3, and Roche Cobas e411 ECLIA analyser as the reference platform. The strength of linear association between methods was evaluated using the Pearson’s correlation coefficient (r). Agreement between methods, systematic trend or heteroscedasticity across the measurement range were assessed using Bland–Altman analysis. Results: The cartridge-based CLEIA 25-OH Vitamin D reagent in MISPA-i60 had the best correlation with Roche e411, having a Pearson’s correlation coefficient of r=0.9612. The other two platforms, cassette-based 25-OH Vit D CLIA reagent in MISPA-i180 and LEIT reagent in MISPA-i3, had good correlation regressions of r=0.9409 and r=0.9246, respectively, with the Roche e411 results. Chemiluminescence immunoassay-based platforms are more or less equal in performance, while the LEIT deviates more among the methods. Conclusion: The study observed acceptable limits of deviation among the methods of CLIA and LEIT. While all evaluated methods show strong correlation, systematic bias limits their interchangeability. It is always better to stick to the same method or even the same reagent-analyser combination for the follow-up studies of 25-OH Vitamin D quantification.

Distribution of Homocysteine Levels in Type 2 Diabetes Patients and Its Association with Urine Albumin Creatinine Ratio: A Cross-sectional Study

Lalithambigai Arumugasamy, Ashutosh Chauhan, Hetal Jadav, Prachi Saileshbhai Parikh Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Homocysteine (Hcy) is a metabolite whose level increases with age, in patients with Vitamin B12 deficiency, and is associated with increased risk of Cardiovascular Disease (CVD). Diabetes patients have been reported to have an increased prevalence of B12 deficiency and have a higher than baseline risk for CVD. Aim: To assess the distribution of serum Hcy levels in type 2 diabetes patients and to study its association with Urine Albumin:Creatinine Ratio (UACR). Materials and Methods: This cross-sectional study was conducted at the Diabetes Clinic, Department of Medicine (OPD), Gujarat Medical Education and Research Society (GMERS) Medical College and General Hospital, Gotri, Vadodara, India, from February 2025 to July 2025. Demographic data were collected along with testing for eGFR, serum Hcy and UACR. The study participant data were sub-grouped into Group 1 (n=55): participants with UACR <300 mg/g creatinine and Group 2 (n=25) UACR >300 mg/g creatinine. The distribution of Hcy was described as mean and Standard Deviation (SD). Pearson’s and Spearman’s correlations were used to assess the correlation of serum Hcy with FBS, eGFR and UACR. Participants were further sub-grouped based on UACR values, and Hcy levels were compared between these groups using a t-test. Results: The study cohort had 31 males and 49 females, with a mean age of 49.3±11.5 years, and the median duration of diabetes was two years. The serum Hcy level was found to be 16.68±8.01 μmol/L among type 2 diabetic patients. The sub-group of diabetic patients with UACR >300 mg/g creatinine had higher serum Hcy levels of 19.09±11.21 μmol/L, when compared to the sub-group with UACR <300 mg/g creatinine, in whom the distribution was 15.58±5.84 μmol/L. Conclusion: The distribution of serum Hcy among diabetic individuals was higher than the normal reference range. It is not influenced by age, gender or duration of diabetes. It increases further as renal damage gets established with UACR >300 mg/g creatinine.

Pattern of Adverse Drug Reactions Linked to Anaesthetic Agents Used for Regional Anaesthesia: A Prospective Observational Study from a Tertiary Care Teaching Hospital in South Assam, India

Arunima Singha, Vijoy Sankar Kairi, Rohit Tigga Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Regional Anaesthesia (RA) is widely employed across surgical specialities owing to its benefits for perioperative analgesia, haemodynamic stability, and reduced Postoperative Nausea and Vomiting (PONV). Despite these advantages, Adverse Drug Reactions (ADRs) linked to Local Anaesthetics (LAs) and their adjuvants remain an important consideration, particularly in settings with limited pharmacovigilance resources. Aim: To determine the incidence and study the pattern, causality, and severity of adverse drug reactions associated with anaesthetic agents used in regional anaesthesia in a tertiary care teaching hospital in South Assam, India. Materials and Methods: A prospective, observational study was conducted at the Department of Pharmacology in collaboration with the Department of Anaesthesiology in Silchar Medical College and Hospital, Silchar, Assam, India, from November 2023 to October 2024, among 385 adult patients who underwent surgery under RA. ADRs occurring within 24 hours of RA administration were identified through direct clinical observation, patient interviews, and review of medical records. Causality was evaluated using the World Health Organisation–Uppsala Monitoring Centre (WHO–UMC) Causality Assessment Scale, while severity was categorised according to the Hartwig and Siegel Severity Assessment Scale. Data were summarised using descriptive statistics. Data were summarised using descriptive statistics in Microsoft® Excel® 2021 (version 2604, 64-bit). Results: Out of 385 patients monitored, 54 patients experienced a total of 54 ADRs during the study period, representing an overall ADR incidence of 14.03%. Hypotension was the most commonly reported ADR, 28 (51.85%), followed by PONV 12 (22.22%). The majority of ADRs occurred within the first six hours after RA administration 46 (85.18%). Hyperbaric bupivacaine accounted for the greatest proportion of ADRs, 42 (77.78%), followed by ropivacaine heavy (11.11%). According to WHO-UMC criteria, most ADRs were classified as “possible” (94.44%), while a smaller proportion were deemed “probable” (1.85%). All ADRs were categorised as mild based on Hartwig’s severity scale. Conclusion: ADRs associated with RA in this cohort were generally mild, occurred early, and were most frequently linked to hyperbaric bupivacaine. Although no severe reactions were observed, these findings underscore the importance of early postoperative monitoring, judicious drug selection, and strengthened pharmacovigilance to support patient safety.

Evaluation of Glial-Mesenchymal Transition Using SNAIL and IDH as Prognostic Markers in Glioma Patients: A Cohort Study from a Tertiary Care Centre in Tamil Nadu, India

Priyadharshini Kumar, Vijayashree Raghavan, Nandagopal Radha Rajesh Kanna, Palavalli Thippeswamy Navya, Vengalathur Ganesan Ramesh Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: The incidence of gliomas is increasing in India. Several poor prognostic indicators of glioma include Snail family transcriptional repressor 1 (SNAIL), Snail Family Transcriptional Repressor 2 (SLUG), and Twist Family bHLH Transcription Factor 1 (TWIST), which belong to the zinc-finger family of transcriptional repressors involved in Epithelial-Mesenchymal Transition (EMT). In gliomas, EMT is referred to as Glial-Mesenchymal Transition (GMT). During GMT, glial cells acquire mesenchymal properties, facilitating invasion into the brain parenchyma. This increases the expression of GMT markers which is associated with high-grade gliomas, higher recurrence and poor survival rates. Aim: To evaluate the prognostic significance of SNAIL expression and its association with Isocitrate Dehydrogenase (IDH) mutation in glioma patients. Materials and Methods: The present cohort study was conducted in the Department of Pathology, at Chettinad Hospital and Research Institute over a period of seven years and three months from March 2015 to June 2021, a tertiary healthcare center in Tamil Nadu, India. Paraffin blocks and medical records of 25 histologically confirmed glioma cases were retrieved from the archives of the Department of Pathology. Immunohistochemistry (IHC) was performed using SNAIL and IDH-Mutant (IDH-M) antibodies. The association of SNAIL and IDH expression with clinicopathological parameters and patient outcome was analysed using the chi-square test and Fisher’s exact test. Survival analysis was carried out using the Kaplan-Meier method. Results: Of the 25 glioma cases, 3 were Grade I, 10 Grade II, 2 Grade III, and 7 Grade IV. During a follow-up period of seven years and three months, 14 patients (56%) died and 11 (44%) were alive. Strong SNAIL expression in glioma patients was associated with poor survival, with a mortality rate of 83.3% (10 cases), compared to moderate SNAIL expression (44.4%, 4 cases) and weak expression (0%). The association between SNAIL grading and patient outcome was statistically significant (p=0.002). Only 2 (25%) of IDH-mutant-positive cases resulted in death, compared to 12 (70.58%) deaths among IDH-mutant–negative cases, which was also statistically significant (p=0.039). Conclusion: GMT plays a crucial role in transforming glial cells into mesenchymal-like cells, thereby enhancing tumour invasiveness. SNAIL, a key marker of GMT, is associated with higher World Health Organisation (WHO) tumour grade, increased recurrence, and poor prognosis in gliomas. Additionally, IDH-M gliomas demonstrate a better prognosis compared to IDH-wild-type tumours. SNAIL may serve as a potential prognostic biomarker and therapeutic target in glioma.

Utility of Automated Analyser-derived High Fluorescence Cell Counts for the Screening of Malignancy in Body Fluids: A Cross-sectional Study

Ramadevi Peraka, Aruna Lingam, Manimekhala Parsa Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Conventional microscopic Body Fluid (BF) analysis is time-consuming, requires a skilled Cytopathologist, and is prone to inter-observer variability, while automated analysers have a faster turnaround time and a higher throughput rate. The present study explores whether High Fluorescence (HF)- BF parameters can support more efficient preliminary screening. Aim: The present study investigates the utility of automated analyser-derived HF-BF parameters in screening for the presence of malignancy. Materials and Methods: A retrospective cross-sectional study was conducted at the Department of Pathology, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India, from July 2022 to July 2025. A total of 243 samples, including ascitic (AF), pleural (PF), cerebrospinal (CSF), and pericardial fluids, were collected and analysed using the Mindray BC-780(R) in the BF mode. Smear examination was done for all the samples to detect the presence of malignant cells. HF-BF relative (HF-BF%) and absolute counts (HF-BF#) were used to predict cytopathological malignancy by logistic regression. Receiver Operating Characteristic (ROC) curve analysis was used to determine the optimal cut-off values. Results: Out of 243 samples, 14 were suspicious/positive for malignancy. Both HF-BF% (β =0.0595, p=0.006) and HF-BF# (β =1.92, p=0.001) were positive predictors for the outcome. ROC-derived AUC and cut-off values for HF-BF% are 0.698 and ≥1.95%; corresponding values for HF-BF# are 0.729 and ≥51 cells/μL. Overall accuracy for HF-BF% is 52.67%, and for HF-BF# is 88.89%. Both parameters have high Negative Predictive Values (NPV) and low Positive Predictive Values (PPV) {HF-BF%: NPV=99.14%, PPV=10.24%, sensitivity=92.86%, specificity=50.22%; HF-BF#: NPV=97.64%, PPV=29.03%, sensitivity=64.29%, specificity=90.39%} Conclusion: HF-BF# showed numerically higher discriminative performance than HF-BF%; however, formal statistical comparison of the AUCs was not performed. Automated analysers enable rapid assessment; however, the moderate sensitivity and low PPV of HF-BF#, together with the low PPV of HF-BF% despite its high sensitivity, demonstrate that neither HF-BF parameter is suitable for use as a primary screening tool. Expert cytopathological examination continues to be the gold standard for diagnosing malignancy, with HF-BF counts serving mainly as supportive, exclusionary tools rather than primary diagnostic indicators.

Decoding the Clinical Patterns and Underlying Risk Factors of Posterior Circulation Stroke: A Cross-sectional Study

Alishetty Vinay, CT Meyammai, J Pradeep Kumar, Mohanraj Perumal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Posterior Circulation Stroke (PCS) constitutes a substantial proportion of ischemic strokes. It frequently exhibits non specific clinical features, making diagnosis difficult and potentially delayed. Hence, adequate knowledge of the clinical trends and risk factors is essential for early detection and improved outcomes. Aim: To assess the demographic features, clinical manifestations and vital vascular risk factors in PCS patients. Materials and Methods: This hospital-based cross-sectional study was conducted at the General Medicine Department in a Tertiary Care Centre at Kanchipuram, Chennai, Tamil Nadu, India, from July 2024 to July 2025. A total of 50 patients diagnosed with PCS were included in the study. The assessment of patients was done via brief clinical history, neurological examination and investigation of the laboratory and imaging data. A structured proforma was utilised to record demographic data, risk factors pertaining to vasculature and clinical characteristics of the PCS patients. Descriptive statistical analysis was done to evaluate the collected data, with results expressed as mean, Standard Deviation (SD), frequencies and percentages. Results: The mean age was 58.6±12.4 years. The male population constituted 32 (64%). The average BMI was 26.1±3.8kg/m2, indicating that the mean BMI was within the overweight range. The predominant risk factor was hypertension with 31 (62%), followed by smoking with 28 (56%), diabetes mellitus with 24 (48%), hyperlipidaemia with 20 (40%) and alcohol consumption with 18 (36%). Smoking was significantly associated with brainstem involvement on univariate analysis (p=0.048) and remained an independent predictor after multivariable adjustment {Adjusted Odds Ratio (AOR) 3.21; 95% CI: 1.09–9.42; p=0.034}. The p-value <0.05 was considered statistically significant. Conclusion: In this cohort, PCS was more frequently observed among older adults and males, with a substantial burden of vascular risk factors. Even though statistical associations were not identified with any of the modifiable cardiovascular risk factors except smoking, the potential outcomes of these risk factors cannot be overlooked. Early diagnoses of these risk determinants play a critical role in mitigating complications and optimising clinical outcomes.

Relationship between Eccentric Peak Force and Loading Rate at Three Months after ACL Reconstruction in Athletes and Non Athletes: A Cross-sectional Study

Shivangi Sharma, Irshad Ahmad Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Rehabilitation in the first three months is an expedient phase from a static load-bearing to a dynamic one. Understanding of neuromuscular recovery is crucial for preventing secondary injury and delay in return to sport. Aim: To assess the relationship between Eccentric Peak Force (EPF), Eccentric Peak Force Asymmetry (EPFA), Loading Rate (LR) and Loading Rate Asymmetry (LRA) at three months after Anterior Cruciate Ligament Reconstruction (ACLR) in athletes and non athletes. Materials and Methods: This study was a cross-sectional study conducted in the Total Healthsums Physiotherapy Centre, New Delhi, India, from January 2026 to April 2026. A total of 30 patients with primary ACLR (16 athletes and 14 non athletes) aged between 20 and 40 years were included as per eligibility criteria. They were performed with isometric squat testing on VALD ForceDecks dual force plates to evaluate EPF, EPFA, LR, and LRA at three months post-ACLR. Two different groups (athletic and non-athletic group) were analysed using an independent t-test or Mann-Whitney U test for parametric or non parametric distribution, respectively. Spearman's test was done to test correlation between EPF, EPFA, LR and LRA. Results: There was a significant difference in EPFA and LRA between the groups. A positive correlation was observed between EPF and LR across entire sample (rs=0.55, p=0.002) and non athletes (rs=0.56, p=0.035), but no linear relation in athletes. Also, there is no correlation between EPFA and LRA in any group but has linear relation across whole sample (rs=0.39, p=0.030). EPFA and LRA are independent constructs in two groups. Conclusion: With an increase in force, LR increases in non athletes as well as the entire sample population. There was no significant correlation between force and LR in athletes and between force asymmetry and LRA in both athletes and non athletes.

Comparative Evaluation of Bacterial Microleakage in Furcal Perforation Repair Materials Modified with Eggshell Powder: An In-vitro Study

Saroj Reddy Pawar, Anamika Chetan Borkar, Sanket Aras, Dipti Jitendra Kharajani, Vrushali Shriganesh Padwal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Furcal perforation is a clinically significant endodontic complication that may compromise the root canal-periodontal interface and adversely affect tooth prognosis. Mineral Trioxide Aggregate (MTA) and Biodentine™ are widely used calcium silicate-based repair materials, although further improvement in their sealing ability remains desirable. Eggshell Powder (ESP) is a calcium-rich natural biomaterial that may enhance interfacial adaptation and resistance to bacterial penetration. Aim: To evaluate and compare the bacterial microleakage of MTA and Biodentine™ modified with 3% and 5% by weight of ESP for furcal perforation repair. Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics, Dr DY Patil Dental College and Hospital, Pimpri, Pune, India, from September 2025 to February 2026. A total of 80 extracted mandibular molars were used. Among them, 60 specimens were allocated to six experimental groups (n=10): unmodified MTA, MTA modified with 3% or 5% ESP, unmodified Biodentine™, and Biodentine™ modified with 3% or 5% ESP. Ten teeth with unrepaired perforations and ten teeth with intact furcations served as positive and negative controls, respectively. Standardised 4-mm furcal perforations were prepared and assessed using a dual-chamber Enterococcus faecalis leakage model over 50 days. Within-material comparisons were performed using the Fisher-Freeman-Halton exact test, followed by pairwise Fisher’s-exact tests with Bonferroni correction. Results: Leakage occurred in 80%, 20%, and 50% of the control, 3% ESP-modified, and 5% ESP-modified MTA groups, respectively, with a significant overall difference among the MTA groups (p=0.034). Corresponding leakage in the Biodentine™ groups was 70%, 10%, and 20%, with a significant overall difference (p=0.023). The lowest leakage was observed with 3% ESP-modified Biodentine™. However, none of the individual pairwise comparisons remained statistically significant after Bonferroni correction. Conclusion: ESP modification was associated with significant overall differences in bacterial leakage within both MTA and Biodentine™ groups. The 3% ESP-modified formulations showed the lowest observed leakage, particularly 3% ESP-modified Biodentine™. However, the absence of statistically significant pairwise differences after multiplicity adjustment warrants cautious interpretation. Further adequately powered physicochemical, biological, and clinical studies are required before clinical application can be recommended.

Phytochemical Characterisation and Anti-inflammatory Evaluation of a Dual Extract In-situ Gel from Sesamum indicum and Rubus idaeus: An In-vitro Study

Gomathi Ramalingam, TN Uma Maheshwari, S Rajesh Kumar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Rubus idaeus and Sesamum indicum have anti-inflammatory and antioxidant qualities because they contain bioactive substances such as polyphenols, anthocyanins, tocopherols, and lignans. By reducing systemic adverse effects, combining these extracts in a topical (mucous membrane) in-situ gel may provide a safer substitute for traditional anti-inflammatory medications. The study was undertaken with the rationale of exploring a natural therapeutic approach for managing inflammation. Aim: To develop, characterise, and evaluate a dual herbal in-situ gel with extracts of sesame and raspberry for its potential to reduce inflammation in-vitro. Materials and Methods: This in-vitro study was conducted in the Institutional Research Laboratory, Nanobiomedicine lab, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India, from March to June 2025. Before biological evaluation, the herbal components were subjected to phytochemical characterisation to confirm the presence of bioactive constituents associated with anti-inflammatory activity. The formulated gel, prepared using a Carbopol-CMC gel base, was assessed at five concentrations (10-50 μg/mL). Anti-inflammatory activity was analysed using three standard in-vitro assays, namely the Bovine Serum Albumin (BSA) denaturation assay, Egg albumin denaturation assay, and Human Red Blood Cell (HRBC) membrane stabilisation assay, with diclofenac sodium serving as the standard reference drug. All experiments were performed in triplicate, resulting in a total sample size of 18, divided into two main groups based on the formulation, Group I (standard - diclofenac sodium) and Group II (sesame + raspberry gel). The data obtained were statistically analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Normality of distribution across concentrations (10-50 μg/mL) was assessed using the Shapiro-Wilk test. For normally distributed data, parametric tests including One-way Analysis of Variance (ANOVA) were used for within-group comparisons, followed by Tukey’s post-hoc test for multiple pairwise comparisons, and the Independent samples t-test for between-group analysis. Statistical significance was set at p<0.05. Results: The herbal gel showed uniform appearance, good homogeneity, suitable viscosity, pH=3.58, and 25 mm spreadability. It exhibited anti-inflammatory activity in all in-vitro assays, with significant differences (p<0.05) at most concentrations, and the highest inhibition observed in the membrane stabilisation assay. Low variability indicated reliable results. Conclusion: The raspberry-sesame dual herbal in-situ gel demonstrated favourable physicochemical properties and appreciable in-vitro anti-inflammatory activity, suggesting its potential as a safe topical herbal alternative.

Hyperbaric Ropivacaine versus Hyperbaric Bupivacaine in Transurethral Resection of Prostate under Spinal Anaesthesia: A Double-blinded Randomised Controlled Study

Manisha Manohar, Amanpreet Hira, Suresh Kumar Singhal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Subarachnoid block is the preferred technique for Transurethral Resection Of Prostate (TURP). Ropivacaine has lower cardiotoxic potential and produces less intense motor blockade than racemic bupivacaine. Aim: To compare hyperbaric ropivacaine vs hyperbaric bupivacaine in TURP under spinal anaesthesia. Materials and Methods: This double-blinded randomised controlled study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from December 2022 to January 2024 on 60 adult male patients aged 18-65 years undergoing TURP under spinal anaesthesia. Patients in Group-R (n=30) received 2.2 mL (16.5 mg) of hyperbaric 0.75% ropivacaine intrathecally. Patients in Group-B (n=30) received 2.2 mL (11 mg) of hyperbaric 0.50% bupivacaine intrathecally. The following parameters were observed: total duration of sensory block, onset time of sensory block, highest sensory level attained, two-segment regression time, onset and duration of motor block and incidence of adverse events. In between group comparisons of normally distributed continuous variables were performed using the independent Student’s t-test. For non normally distributed data, the Mann-Whitney U test was applied. Categorical variables were compared using the Chi-square test or Fisher’s-exact test, as appropriate. A p-value <0.05 was considered statistically significant. Results: Both groups were comparable in terms of demographic parameters. The total duration of sensory block was significantly shorter in Group-R compared to Group-B (121.40±34.62 min vs 164.50±23.03 min, p<0.001). The onset of sensory block was significantly delayed in Group-R compared to Group-B (7.36±3.83 min vs 4.60±1.67 min, p = 0.002). The total duration of motor block was significantly shorter in the ropivacaine group (139.6±25.7 min) compared to the bupivacaine group (180.7±18.1 min; p<0.001). Hypotension occurred more frequently in Group-B compared to Group-R (40.0% vs 0%; p<0.001). Conclusion: Intrathecal administration of 2.2 mL (16.5 mg) of commercially available 0.75% hyperbaric ropivacaine provides adequate surgical anaesthesia for TURP with optimal sensory and motor blockade, while demonstrating better haemodynamic stability as compared to bupivacaine.

Spirometric Variations in Adults with Controlled Hypertension: A Cross-sectional Study from Eastern India

Sujoy Mukherjee, Debalina Sengupta, Parthasarathy Sinha, Sanhita Mukherjee, Yogesh Kumar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Hypertension’s impact on global health is vast, yet its link to Indian pulmonary function remains unclear. Despite maintaining controlled blood pressure, hypertensive individuals may harbour undetected pulmonary deficits, necessitating a closer look at the intersection of cardiovascular and respiratory health. Aim: To compare spirometric parameters between subjects with controlled essential hypertension and normotensive healthy controls in Eastern India. Materials and Methods: A cross-sectional study was conducted at Rampurhat Government Medical College and Hospital of eastern India from April to December 2024. Total 84 non-smoking participants {42 controlled essential hypertensives (≥1 year duration), 42 normotensive} aged 18-60 years underwent spirometric evaluation. Spirometric parameters like Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1/FVC ratio, Forced Expiratory Flow 25-75% (FEF25-75%) and Peak Expiratory Flow Rate (PEFR) were measured using standardised American Thoracic Society (ATS)/European Respiratory Society (ERS) protocols. Data were statistically analysed by using Mann-Whitney U test. Results: Participants were middle-aged adults, with a mean age of 43.38 years including both the genders. However, hypertensive participants were significantly older (50.6±8.81 vs. 36.17±15.03 years, p<0.0001) with higher Mean Arterial Pressure (MAP) (103.43±8.79 vs. 88.93±6.09 mmHg, p<0.0001). All spirometric parameters except FEV1/FVC ratio were significantly impaired in hypertensives: FVC (68.52±12.77% vs. 100.6±15.69% predicted, p<0.0001), FEV1 (71.17±16.93% vs. 107.12±14.62% predicted, p<0.0001), PEFR (44.86±28.04% vs. 95.57±32.7% predicted, p<0.0001), and FEF25-75% (57.57±43.42% vs. 100.4±35.5% predicted, p<0.0001). Abnormal spirometric patterns occurred in 83.3% of hypertensives versus 9.5% of controls (OR=47.5, p<0.0001), with mixed defects predominating (59.5%). Strong negative correlations existed between MAP and spirometric indices (ρ=-0.75 for MAP-FVC). Conclusion: The present study findings indicated that controlled essential hypertension significantly impairs lung function in Eastern Indians, necessitating routine spirometry for comprehensive risk assessment.

Self-medication Behaviour in Dysmenorrhoea Management among Medical and Pharmacy Students: A Cross-sectional Study from Saudi Arabia

Mukhtar Ansari, Maryam Farooqui, Saeed Alfadly, Wan Ismahanisa Ismail, Christina Malini Christopher, Rabbiya Ahmad, KC Badri, Abir Elghazaly Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Dysmenorrhoea among young women is a prevalent health condition, which causes physical discomfort, a feeling of frustration, a decline in academic performance and withdrawal from social activities such as sports. Aim: To investigate Self-Medication (SM) practices among medical and pharmacy students for the management of dysmenorrhoea. Materials and Methods: The present cross-sectional study was conducted at Qassim University, Unaizah, Saudi Arabia, among 237 female students enrolled in medical and pharmacy schools. The study duration was three months, from January 2019 to March 2019. Data were collected using a structured, validated questionnaire with two sections: the first focused on sociodemographic details, menstrual history, and symptoms; the second on treatment approaches and healthcare-seeking behaviours. The researchers distributed the questionnaire to be completed within a one-week period; however, to increase the response rate, an additional week was added to the study duration, enabling a more thorough data collection. Data was analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 21 (IBM Corp., Armonk, NY, USA). Results: The majority of participants 141 (59.5%) were aged between 21 and 23 years. The most common symptom of dysmenorrhoea was contractions in the uterus, 182 (76.8%), while Ibuprofen 88 (37.1%) was among the most frequent self-prescribed medications for dysmenorrhoea. Degree of pain was significantly associated with activity level (p<0.001), mood disturbance (p=0.017), and absence from classes (p<0.001). The association with the number of days of menstruation was not statistically significant (p=0.057). Conclusion: Dysmenorrhoea leads young female healthcare students to frequently engage in SM practices utilising a combination of modern medications and herbal medicines.

Correlation of Sedentary Behaviours and Physical Activity with Functional Exercise Capacity in Healthy Adults of Gujarat, India: A Cross-sectional Study

Anjumakhtar Rafiuddin Siddiqui, Niraj Chawda, Bosky Mehta, Amalkumar Bhattacharya, Bhavana Rajeshkumar Gadhvi Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: With changing lifestyle patterns, sedentary behaviour has increased significantly, often coexisting with low levels of physical activity. While both factors are known to influence health, their combined association with functional exercise capacity has not been explored extensively, particularly in Indian populations. Understanding this relationship is important because it helps to identify lifestyle factors that can be modified to improve daily functional performance. Aim: To examine the correlation of sedentary behaviour and physical activity with functional exercise capacity in the healthy adult population of India, with particular focus on the Gujarat region. Materials and Methods: The present cross-sectional, multicentre observational study at various hospitals, physiotherapy colleges, Physiotherapy Outpatient Departments (OPDs), and residential societies across the Ahmedabad, Vadodara, Navsari, and Dahod regions of Gujarat, India from March 2025 to March 2026. The study included 713 apparently healthy adults (407 males and 306 females) aged 18-60 years. Sedentary behaviour and physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ), while functional exercise capacity was evaluated using the Six-Minute Walk Test (6MWT). Pearson’s correlation analysis was used to examine the relationships among physical activity, sedentary behaviour, and 6MWT distance. Additionally, a One-way Analysis of Variance (ANOVA), followed by a post-hoc Tukey’s test, was used to compare the mean 6MWT distance across physical activity categories. A p-value of <0.05 was considered statistically significant for all analyses. Results: The mean 6MWT distance of the study population was 370.88±68.47 m. Male participants achieved greater walking distances than females, and performance declined with increasing age despite gender differences. 6MWT distance increased progressively across physical activity groups (p<0.001), with significant differences observed between all groups on post-hoc analysis. Correlation analysis demonstrated that prolonged sitting time was associated with lower 6MWT performance (r=-0.517, p<0.001), whereas total physical activity was associated with better 6MWT performance (r=0.398, p<0.001). No significant correlation was observed between sitting time and total physical activity (r=-0.051, p=0.173). Conclusion: Sedentary behaviour and physical activity both significantly influence functional exercise capacity. Increased sitting time is associated with reduced performance, while higher physical activity levels are linked to improved functional capacity. These findings highlight the importance of promoting an active lifestyle while simultaneously reducing sedentary time to maintain functional health in adults.

Effect of Ergonomic Advice and Postural Correction Exercises on Craniovertebral Angle in Dental Students with Upper Cross Syndrome: A Quasi-experimental Study

Saumya Srivastava, Afif, Y Sai Sudha Samaja Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Dentistry involves prolonged static postures and repetitive movements, predisposing practitioners to Musculoskeletal Disorders (MSD), particularly affecting the neck, shoulders, and upper back. Upper Cross Syndrome (UCS), characterised by muscle imbalance and Forward Head Posture (FHP), is highly prevalent among dental professionals. Ergonomic modifications combined with postural correction exercises may provide a cost-effective and sustainable preventive strategy. Aim: To evaluate the effect of ergonomic advice and postural correction exercises on Craniovertebral Angle (CVA), muscle strength, muscle length, pain and neck disability in postgraduate dental students with UCS. Materials and Methods: The present quasi-experimental Study was conducted at the AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangaluru, Karnataka, India, over a period of 10 months from February 2023 to December 2023 among 29 postgraduate dental students aged 20-30 years with neck pain measured by Numerical Pain Rating Scale (NPRS) 3-6 and FHP (CVA <49.9°). The study duration was four weeks. CVA was measured using Markus Bader (MB) ruler software. Outcome measures included Neck Disability Index (NDI), NPRS, CVA, muscle strength with hand-held dynamometer, and muscle length by Janda technique. Participants underwent a structured intervention comprising pamphlet-based postural correction exercises and ergonomic advice. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Paired t-test was used for pre-post comparison and p<0.05 was considered statistically significant. Results: Post-intervention, statistically significant improvements were observed in all outcome measures. NDI decreased from 14.28±3.61 to 11.48±4.00 (p<0.001), NPRS reduced from 5.34±0.61 to 3.97±1.24 (p<0.001), and CVA increased from 46.89±1.35° to 48.08±2.13° (p<0.001). Muscle strength improved significantly in the neck flexors, middle and lower trapezius, and serratus anterior (p<0.05). Muscle length showed significant improvement, with reduced tightness in pectoralis major, pectoralis minor, and latissimus dorsi, and increased length of the upper trapezius (p<0.05). Conclusion: A four-week intervention combining ergonomic advice and postural correction exercises significantly improved CVA, muscle strength, and muscle length, and reduced pain and neck disability in dental postgraduate students with UCS. Early incorporation of ergonomic education and targeted exercise in dental training may help prevent chronic MSDs.

Immunohistochemical Analysis of Ki-67 Expression in Odontogenic Keratocyst, Follicular Ameloblastoma, Well Differentiated Squamous Cell Carcinoma and Normal Oral Mucosa: A Cross-sectional Study

Lloyd Antony Ivan Joseph, Nirima Oza, K Ramadoss, Barath Raj, P Kalaivani, Vanlalpeka Chhakchhuak, S Kootiswaran, Dhanalakshmi Kumar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Odontogenic Keratocyst (OKC) is a developmental odontogenic cyst whereas ameloblastoma is a benign odontogenic epithelial tumour, and squamous cell carcinoma is a malignant epithelial neoplasm. Although OKC is classified as a cyst, its high proliferative potential and aggressive behaviour often lead to uncertainty regarding its neoplastic nature. Cellular proliferation can be assessed using Immunohistochemical (IHC) markers, among which Ki-67 is considered reliable as it is expressed in all active phases of the cell cycle (G1, S, G2, and M), making it an accurate indicator of proliferative activity. Aim: To compare the Ki-67 Labelling Index (LI) of OKC, Follicular ameloblastoma, Well-Differentiated Oral Squamous Cell Carcinoma (WDOSCC) and normal oral mucosa. Materials and Methods: The present cross-sectional study was conducted in Department of Oral Pathology, Pondicherry, Mahatma Gandhi Institute of Dental Science from June 2022 till June 2024 for a period of two years. The Study included histopathologically diagnosed, paraffin-embedded archival tissue blocks of OKC, Follicular Ameloblastoma, WDOSCC, and Normal Oral Mucosa, along with Fresh Biopsy Specimens of OKC, Follicular Ameloblastoma, WDOSCC, and Normal Oral Mucosa. A total of 48 Cases were included, comprising 12 Cases each of OKC without Inflammation (Group A), Follicular Ameloblastoma (Group B), WDOSCC (Group C), and Normal Oral Mucosa (Group D). Study was carried out using three microns paraffin embedded formalin fixed tissue sections which were stained immunohistochemically with Ki-67 antibody and its Labelling Index (LI) was evaluated by manual counting of 10 camera-captured hotspot areas at X200 magnification on zig-zag pattern to avoid repetition. The results were later evaluated statistically by IBM SPSS Version 20.0. Mean and Standard deviation (SD) were used to summarise the data. A p-value of <0.05 was considered as statistically significant difference. Statistical tests employed are tests of normality, One-way Analysis of variance (ANOVA) and appropriate post-hoc tests were performed for pairwise comparisons between groups. Results: All cases of WDOSCC and normal oral mucosa were Ki-67 positive, whereas in contrast, positive expression was observed in 10 (83.3%) cases of OKC and 5 (41.7%) cases of Follicular Ameloblastoma. The mean labelling index of OKC was 17.13±10.40, Ameloblastoma was 2.14±2.97, of OSCC was 35.19±15.41, and of Normal oral mucosa was 19.29±4.09. Mean labelling index of WDOSCC was the highest followed by normal oral mucosa and OKC and the lowest in follicular ameloblastoma. Conclusion: The study findings highlight distinct differences in cellular proliferation among oral lesions, supporting the aggressive nature of WDOSCC and the comparatively lower proliferative potential of follicular ameloblastoma. OKC and normal oral mucosa had almost similar Ki-67 LI.

Effect of Cervical TheraBand Exercises and Lower-limb Balance Training on Shooting Performance and Perceptual Parameters in Air Rifle Shooters: A Randomised Controlled Trial

Shalini Solanki, Tabish Fahim Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Air rifle shooting is a precision-based sport in which competitive performance depends critically upon neuromuscular stability of the entire axial skeleton. The cervical musculature, richly innervated with muscle spindles, governs head stabilisation and spatial orientation via proprioceptive reflexes. Simultaneously, lower-limb balance provides the postural base from which proximal control propagates. Cervical proprioceptive impairment and lower-limb postural instability have each been independently shown to degrade performance, yet their combined training effects remain unexamined in the literature. Aim: To evaluate and compare the independent and combined effects of cervical TheraBand exercises and lower-limb balance training on shooting performance, perceived postural stability, and perceived exertion in competitive air rifle shooters over a six-week period. Materials and Methods: A prospective, three-arm parallel-group randomised controlled trial was conducted from April 2025 to January 2026, with 105 competitive 10 m air rifle shooters from Tapasya Shooting Academy and Royal Rifle Academy, Delhi NCR, India after getting approval from the Waves Women Empowerment Trust Independent Ethics Committee. All the subjects were, equally distributed into Group 1 (combined cervical and balance training, n=35), Group 2 (cervical TheraBand exercises only, n=35), and Group 3 (lower-limb balance training only, n=35). Randomisation was performed using a computer-generated sequence with sealed opaque envelope allocation concealment; outcome assessors were blinded to group assignment. All interventions were delivered three times per week for six weeks with progressive overload. Outcomes assessed at baseline, three weeks, and six weeks comprised: shooting score via electronic target system; Perceived Sense of Postural Sway and Instability (PSPSI, 0-8 scale); and Borg’s Rating of Perceived Exertion Category-Ratio 10 (RPE CR-10). Repeated Measures Analysis of Variance (RM-ANOVA) with Bonferroni post-hoc correction and One-way ANOVA with Tukey’s HSD were applied. Results: The mean age of participants was 20.86±2.20 years; 80 males, 25 females). All three groups showed significant within-group improvements across all outcomes (p-value <0.001). Group 1 achieved the greatest shooting score gain (+10.20 points), the largest PSPSI reduction (-3.63 points), and the greatest decrease in perceived exertion (-3.17 points) from baseline to six weeks. Intergroup F-values at six weeks (absolute scores) showed significant improvement (p-value <0.001). Post-hoc analysis confirmed Group 1 significantly outperformed both Groups 2 and 3; no significant difference was observed between Groups 2 and 3. Conclusion: A combined cervical TheraBand and lower-limb balance training programme produced superior and additive improvements in shooting performance, perceived sense of postural sway or instability, and perceived exertion compared with either training programme administered independently. Integrated multisegmental training is recommended for inclusion in the conditioning programmes of competitive air rifle shooters.

Antenatal Screening for Haemoglobinopathies and Maternal Outcomes at a Rural Healthcare Facility in Piparia, Gujarat, India: A Prospective Cohort Study

Mihir Kumar Bhalodia, Nidhi Bhalodia Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Haemoglobinopathies are inherited genetic blood disorders caused by defects in the structure or production of haemoglobin. World Health Organisation (WHO) estimates that approximately 5% of the world’s population carries a gene for a haemoglobin disorder. Each year, over nine million carrier women become pregnant, leading to more than 332,000 affected pregnancies or births worldwide, mostly in low- and middle-income countries. In India, it is estimated that over 10,000 children are born annually with thalassaemia or Sickle Cell Disease (SCD). Thus, early detection through systematic antenatal screening is crucial to identify carriers, enables risk assessment for the foetus, and guides appropriate genetic counselling for prevention of severe haemoglobin disorders. Aim: To evaluate prevalence of haemoglobinopathies in antenatal women and identify their association with maternal complications. Materials and Methods: This prospective cohort study was conducted in the Department of Pathology at a rural tertiary healthcare facility in Piparia, Gujarat, India, from January 2024 to June 2025. A consecutive sampling technique was used, and all antenatal women attending the Department of Obstetrics and Gynaecology during the study period who met eligibility criteria and provided written informed consent were enrolled. Universal antenatal screening was performed for all enrolled participants, and a total of 1,770 antenatal women were included in the study. Participants were followed prospectively from enrollment until delivery. Maternal outcomes were assessed using hospital medical records and obstetric case files, and relevant obstetric and delivery outcomes were documented using standardised clinical records. All participants underwent routine antenatal laboratory investigations, including Complete Blood Count (CBC). Blood samples were further analysed using the sickling test and haemoglobin analysis on a Bio-Rad Variant II High-Performance Liquid Chromatography (HPLC) analyser (Bio-Rad Laboratories, Hercules, California, USA) for the detection and characterisation of haemoglobinopathies. Results: In the present study, a total of 1,770 antenatal women were screened for haemoglobinopathies, and 210 were found to have a haemoglobinopathy, resulting in a prevalence of 11.86%. Of the 210 women diagnosed with a haemoglobinopathy, Sickle Cell Trait (SCT) was the most common, found in 176 participants (83.8%). The occurrence of preterm delivery, preeclampsia, and postpartum haemorrhage was significantly higher among women with haemoglobinopathies than among those without haemoglobinopathies. Women with haemoglobinopathies had a 3.35-fold higher risk of preterm delivery {Relative Risk (RR)=3.35; 95% Confidence Interval (CI): 2.74-4.10; p<0.00001}, a 2.22-fold higher risk of preeclampsia (RR=2.22; 95% CI: 1.76-2.80; p<0.00001), and a 2.80-fold higher risk of postpartum haemorrhage (RR=2.80; 95% CI: 1.93-4.07; p<0.00001) compared to women without haemoglobinopathies. Conclusion: The present study found an association between haemoglobinopathies and adverse maternal outcomes, including preeclampsia, preterm delivery, and postpartum haemorrhage. These findings highlight the importance of routine antenatal screening, early diagnosis, appropriate genetic counselling, and multidisciplinary obstetric care for pregnant women with haemoglobinopathies. Strengthening screening programs and integrating them into public health planning is essential.

Effectiveness of 0.5% Ropivacaine with Magnesium Sulfate versus 0.5% Ropivacaine Alone in Ultrasound-guided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Priya Chandran, KS Santhi, Thomas Joseph Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: In regional anaesthesia, a rapid onset of analgesia was clinically important because it improved patient comfort and may reduce the need for rescue analgesics. Evaluating the efficacy of a drug as an adjuvant can help identify approaches to achieve faster, more effective postoperative pain control. Aim: To assess the efficacy of 0.5% ropivacaine with magnesium sulfate versus 0.5% ropivacaine alone in ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: This prospective observational study was conducted in the main Operation Theatre (OT) of the Department of Anaesthesia, Kottayam Government Medical College, Kottayam, Kerala, India, from July 2023 to July 2024. The study included American Society of Anaesthesiologists (ASA) physical status I and II patients aged 18-65 years posted for upper limb surgeries under ultrasound-guided supraclavicular block. Patients having peripheral neuropathy, bleeding disorders, and allergies to local anaesthetics or magnesium sulfate were excluded. Consecutive sampling resulted in 52 patients receiving 0.5% ropivacaine with 150 mg magnesium sulfate (Group A) and another 52 receiving 0.5% ropivacaine alone (Group B). The primary outcome was the duration of postoperative analgesia. Secondary outcomes were the onset of sensory and motor block, postoperative pain using the Visual Analogue Scale (VAS), sedation (Ramsay) scores, rescue-analgesic requirements, and haemodynamic parameters. Demographic data were also recorded. Non normally distributed/ordinal outcomes were compared by Mann-Whitney U, categorical rescue analgesia by Fisher’s-exact test, and haemodynamics by repeated-measures Greenhouse-Geisser; effect sizes and per-family Bonferroni correction reported throughout. Results: A total of 104 patients (52 per group) were included. Baseline demographic characteristics were comparable between groups. The median duration of postoperative analgesia was similar in the magnesium and control groups {468.5 (IQR 155) vs 470.0 (IQR 129) min; p=0.610}. The magnesium group had a faster onset of sensory block {15.0 (IQR 10) vs 18.5 (IQR 5) min; p=0.042} and motor block {15.0 (IQR 10) vs 18.0 (IQR 5) min; p=0.042} and this difference remained significant after Bonferroni correction (VAS at postoperative 6 h was significantly lower in Group A than in Group B [p=0.007], α=0.0083). Paracetamol consumption was comparable between groups, whereas fewer patients in the magnesium group required tramadol rescue analgesia (42.3% vs 75.0%; adjusted OR 3.92, 95% CI 1.66–9.25; p=0.002). Early postoperative sedation was higher in the magnesium group {0 h: 4.0 (IQR 0) vs 3.0 (IQR 1); p<0.001}, with no clinically significant haemodynamic differences. Conclusion: Adding magnesium sulfate to 0.5% ropivacaine did not significantly prolong the duration of postoperative analgesia. However, it was associated with reduced postoperative tramadol requirements and increased early sedation, while maintaining haemodynamic stability.

Anthropometric and Neurodevelopmental Trajectories of High-risk SNCU Graduates in the First Year of Life: A Longitudinal Cohort Study

Nupur Mishra, Mangla Sood, Anupam Singh Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: While neonatal intensive care expansion has improved survival, high-risk neonates face significant Extrauterine Growth Restriction (EUGR) and neurodevelopmental morbidity. Longitudinal data on both these trajectories remains scarce in resource constrained hilly areas in North India. Aim: To evaluate the longitudinal anthropometric and neurodevelopmental catch-up growth of high-risk Sick Newborn Care Unit (SNCU) graduates over their first year and also to identify independent perinatal predictors of developmental delay. Materials and Methods: A longitudinal cohort study evaluated 170 high-risk neonates discharged from SNCU at Indira Gandhi Medical College Shimla, Himachal Pradesh, India, from July 2024 till December 2025. Anthropometric parameters {World Health Organisation (WHO)/Intergrowth-21^st Z-scores} were assessed at three, six, nine, and 12 months of corrected age. Neurodevelopment was evaluated at six and 12 months using the Developmental Assessment Scale for Indian Infants (DASII). Multivariate logistic regression was utilised to determine independent risk factors for motor and mental delay with statistical significance set at p<0.05. Results: The cohort (64.7% preterm; mean birth weight 2191±734 g) experienced profound early EUGR. By 12 months, somatic weight completely normalised (mean Z-score -0.30±0.86), but severe linear stunting persisted in 41.23% of infants. Multivariate analysis at 12 months identified prematurity (Motor aOR 19.86; Mental aOR 8.31), birth asphyxia (Motor aOR 6.15; Mental aOR 5.27), and neonatal sepsis (Mental aOR 4.05) as independent predictors of delay. Conclusion: Despite robust weight catch-up, linear stunting and neurodevelopmental delay persist. Individualised early intervention must aggressively target infants surviving sepsis and asphyxia alongside extreme preterm and prolonged SNCU stay as trigger for early enrollment.

Levetiracetam versus Phenobarbitone as First Line Antiepileptic Drug in Management of Neonatal Seizures: A Retrospective Cohort Study

Pooja Devang Patel, Manish Rasania, Nishi Ranawat, Phani Kumar Chintala, Vini Shah, Pavan Gorle Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Neonatal seizures require urgent intervention, yet the optimal first-line treatment remains a subject of ongoing debate. While Phenobarbitone (PB) remains the traditional standard of care, its use is increasingly scrutinised due to adverse effects like respiratory depression and potential neurotoxicity in the developing brain. Levetiracetam (LEV) has emerged as a promising alternative with a more favourable safety profile and superior neurodevelopmental outcomes, but direct comparative data remain limited. Aim: To compare the clinical efficacy and safety profiles of PB versus LEV in the management of neonatal seizures. Materials and Methods: This retrospective cohort study was conducted over 1.5 years (April 2021 to October 2022) in the Neonatal Intensive Care Unit (NICU) at the Department of Paediatrics, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, comparing 45 neonates treated for seizures with either PB (n=24) or LEV (n=21). Outcomes measured included clinical adverse events, breakthrough seizures, crossover protocols, discharge neurological status, and 6-month neurodevelopmental trajectories using Hammersmith Infant Neurological Examination (HINE) scores. Data entry and statistical analysis were performed using MedCalc software (v20.11), utilising Chi-square, Student’s t-test, or One-way Analysis of Variance (ANOVA) with a significance threshold of p<0.05. Results: Baseline demographics showed no significant differences between the PB and LEV groups regarding mean gestational age (38.87 vs 38.33 weeks), birth weight (2.84 vs 2.82 kg), male predominance, or mode of delivery. Immediate seizure cessation following the initial loading dose was achieved in 10/24 (41.67%) of the PB group compared to 3/21 (14.29%) of the LEV group (p=0.04). Additionally, a secondary reloading dose was required to attain seizure control in 14/24 (58.33%) of the PB cohort versus 18/21 (85.71%) of the LEV cohort (p=0.04). Retrospective data tracking revealed no statistically significant differences between the two treatment groups regarding documented in-hospital adverse effects, post-discharge breakthrough recurrence rates, or short- and long-term neurodevelopmental outcomes at the 6-month milestone. Conclusion: The PB group showed better seizure control as first-line AED as compared to LEV.

Intranasal Dexmedetomidine versus Magnesium Sulphate via Mucosal Atomisation Device for Attenuation of the Haemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation: A Randomised Clinical Study

Tejash H Sharma, Aditi Gupta, Dinesh Chauhan, Priya Kishnani, Kaushik H Sharma Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Laryngoscopy and endotracheal intubation are fundamental anaesthetic procedures performed millions of times annually worldwide. Both dexmedetomidine and magnesium sulphate have individually demonstrated efficacy in attenuating the haemodynamic stress response to laryngoscopy. Aim: To compare the efficacy of intranasal dexmedetomidine (2 μg/kg) versus magnesium sulphate (1000 mg) delivered via Mucosal Atomisation Device (MAD) in attenuating the haemodynamic stress response to laryngoscopy and endotracheal intubation under General Anaesthesia (GA). Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesiology at Dhiraj Hospital, Shrimati Bhikiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Vadodara, Gujarat, India, from July 2024 to January 2026. Enrolled 60 patients with American Society of Anaesthesiology (ASA) physical status I and II, aged 18-65 years, undergoing elective surgery under GA. Patients were randomly allocated by the chit method into two equal groups. Group D received intranasal dexmedetomidine 2 μg/kg and Group M received intranasal magnesium sulphate 1000 mg, both via MAD 30 minutes before induction. Heart Rate (HR), blood pressure and SpO2 were recorded from baseline through 10 minutes post-intubation, and postoperative sedation was assessed using the Ramsay Sedation Score (RSS). Continuous variables were compared using Welch’s t-test, ordinal data using the Mann-Whitney U test and categorical data using the Chi-square test, with p<0.05 considered significant. Results: The two groups were comparable in age, weight, height, Body Mass Index (BMI), gender and ASA status (all p>0.05). Group D showed significantly lower HR, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) than group M from drug administration through 10 minutes post-intubation (p<0.001 at all time points). At laryngoscopy, HR was 72.5±4.0 versus 88.5±5.1 bpm and MAP 90.5±3.5 versus 101.9±3.7 mmHg in groups D and M, respectively. Postoperative RSSs were significantly higher in group D (3.8±0.7 versus 2.5±0.5 at 30 minutes, p<0.001). Bradycardia (33.3% vs 10.0%) and dry mouth (40.0% vs 23.3%) were more frequent in group D; no respiratory depression occurred. Conclusion: Intranasal dexmedetomidine (2 μg/kg) via MAD is significantly more effective than magnesium sulphate (1000 mg) in attenuating the haemodynamic stress response to laryngoscopy and intubation. It also provides superior postoperative sedation with a favourable safety profile, and can be recommended as an effective, non invasive premedication strategy.

Experiences of Undergraduate Medical Students during a Supervised Emergency-based Elective in Northern India: A Mixed-methods Study

Baldeep Kaur, Shobhana Sridhar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Short emergency-based electives may help undergraduate medical students connect classroom learning with acute-care clinical practice; however, published evaluations of such electives within Indian undergraduate medical programmes remain limited. This mixed-methods educational evaluation examined learner experiences using longitudinal reflective data, with pre-post educational questionnaires providing contextual educational indicators following a two-week supervised emergency-based elective. Aim: To explore undergraduate medical students’ learning experiences during a supervised emergency-based elective and to describe associated contextual pre-post educational indicators. Materials and Methods: The present mixed-methods study was conducted at Dr. B.R. Ambedkar State Institute of Medical Sciences, Mohali, Punjab, India, from February 2026 to April 2026. It involved a retrospective secondary analysis of routinely collected educational data from four Phase III Part II MBBS students who had completed a two-week supervised emergency-based elective. Primary qualitative sources were a baseline expectations form, daily reflections on learning experience and detailed written post-elective feedback. Pre-post educational instruments were used only to contextualise the qualitative narratives and were not treated as primary outcome measures or evidence of effectiveness. Qualitative and quantitative data were analysed separately and integrated during interpretation. Results: All 4 students (100%) completed the three paired contextual instruments. Daily reflections were submitted for 45 out of 48 (93.8%). Post-elective knowledge and self-efficacy scores improved for all students, though communication self-assessment showed mixed results. Qualitative analysis revealed five themes: initial anxiety, connection of classroom learning to real patient encounters, procedural exposure gaps, communication under pressure, and development of confidence with awareness of limits. Conclusion: The supervised emergency-based elective helped students progress from initial anxiety to confidence in engaging in clinical activities under supervision. Reflections showed that students learned about professional development, communication, and recognition of personal limitations, connecting classroom knowledge to clinical practice. While these findings do not confirm independent emergency-care competence, they suggest that well-structured emergency electives can offer valuable introductory experiences in undergraduate medical education. Larger studies with validated assessments and longer follow-up are necessary to validate these observations.

Association between Radiological and Functional Outcomes Following Volar Locking Plate Fixation of Distal Radius Fractures: A One-Year Prospective Cohort Study

Shashank Singh, Chetan Peshin, Sanad Kumar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Restoring anatomical alignment is a primary objective in the surgical treatment of distal radius fractures. However, the extent to which radiographic restoration influences functional recovery at different stages after surgery remains uncertain. Clarifying this relationship may help guide postoperative assessment and rehabilitation. Aim: To investigate the association between radiological alignment and functional outcomes over one year in adults with distal radius fractures treated with Volar Locking Plate (VLP) fixation. Materials and Methods: This prospective observational cohort study was conducted at the Department of Orthopaedics, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India, from November 2024 to May 2025. A total of 55 adults aged 18-60 years with distal radius fractures were managed by open reduction and internal fixation using a VLP. Radiological outcomes were assessed using the Sarmiento radiological scoring system, while functional recovery was evaluated with the Modified Mayo Wrist Score (MMWS). Patients were assessed immediately after surgery and subsequently at six weeks, three months, six months, and 12 months. Changes in functional outcomes over time were analysed, and the association between radiological and functional outcomes was examined using the Chi-square test. Results: The mean age of the subjects was 44.75±12.45 years, comprising 29 males and 26 females. The majority of fractures were complex intra-articular injuries, with Frykman Type VII accounting for 34.5% (n=19) and Type VIII accounting for 21.8% (n=12) of the study population. Functional recovery progressed steadily, with the mean MMWS increasing from 68.27 at six weeks to 84.50 at one year. No significant association was observed between radiological alignment and functional outcome at six weeks (p=0.107). However, a significant positive association emerged at three months (p=0.005) and persisted through the six-month and one-year follow-up assessments. Conclusion: The relationship between radiological alignment and functional recovery is time-dependent and appears to evolve during fracture healing.

The Impact of Disrupted Sleep Schedules on Frontal Lobar Executive Functioning, Cognitive Flexibility, Inhibitory Control and Autonomic Reactivity among Nursing Students: A Cross-sectional Study

Nirmala Anand, Rajesh Shenoy, Medha Shubhangi, Sakshi Rao, Sofia Anjum Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Disrupted sleep schedules particularly in night shift workers like nurses are known to impair attention and psychomotor performance, however its impact on frontal lobe executive function, inhibitory control and autonomic reactivity to a cognitive load remain highly unexplored. Aim: To evaluate the influence of 12 hours of sleep deprivation due to night shift work on sleep quality, cognitive flexibility, inhibitory control, and autonomic reactivity and frontal lobe functions among nurses, and compare their findings with the day shift working nurses of a tertiary hospital. Materials and Methods: A cross-sectional study was conducted from August 2021- April 2022 on 72 nursing students out of which 36 were working night shifts at a KLE’S Prabhakar Kore tertiary care hospital and MRC, Belgaum, Karnataka, India and 36 serving as daytime controls. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Iowa Trail Making Test (ITMT), Frontal Assessment Battery (FAB) and computerised Go-NO Go test were administered to measure visual scanning, attention, cognitive flexibility, executive functions, and inhibitory control. For autonomic reactivity heart rate and blood pressures (SBP and DBP) were measured at baseline as well as during Go/No-Go task (Cognitive stressor). Group comparisons were performed using Student’s t-test and One-way Analysis of Variance (ANOVA). Results: The groups were comparable in age (21.1±1.97 years vs 21.2±2.01 years; p-value=0.64) and gender distribution. Baseline heart rate and blood pressure values did not differ significantly between the groups (p-value>0.05). Shift workers had poor sleep quality with higher scores (19±2.1) on the PSQI, compared to controls. ITMT completion times were significantly prolonged for shift workers on both part A (27±8.9 vs 19±4.2, p-value=0.001) and part B (176±7.54 vs 101±5.55, p-value =0.04). The FAB scores was significantly lower in shift workers (12.21±0.4) compared to controls (18.±0.9, 180.24, p-value =0.004). Conclusion: Night shift nurses experience poor sleep quality, impairments in frontal executive functions, disinhibition, and heightened sympathetic reactivity increasing cognitive errors in safety-critical clinical settings. Evidence based duty roster and sleep schedules are therefore essential from an occupational health point of view.

Bacteriological Profile and Antimicrobial Susceptibility Pattern of Blood Culture Isolates in Immunocompromised Patients: A Hospital-based Cross-sectional Study

Deepika Sai Painkra, Jaishriram Rathored, Mridula Parganiha, Tokeshwar Kumar Sahu Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Immunocompromised individuals have weaker immune systems and they are more likely to develop Bloodstream Infections and have lower ability to fight against infections. Multidrug-resistant bacterial infections require rapid pathogen identification because it enables healthcare providers to start targeted antimicrobial treatment, which leads to better patient outcomes. Aim: To determine the bacterial profile and antimicrobial susceptibility pattern of isolates from blood culture of immunocompromised patients admitted to a tertiary care hospital. Materials and Methods: This hospital-based cross-sectional study was carried out in the Department of Microbiology, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India, between October 2023 and April 2024. A total of 246 blood samples were collected from immunocompromised individuals under aseptic conditions and processed in the BD BACTEC FX40 automated blood culture system. The standard microbiological and biochemical techniques were used to identify the positive blood cultures. The modified Kirby-Bauer disk diffusion method was used to test for antimicrobial susceptibility, and the Clinical and Laboratory Standards Institute (CLSI) criteria for 2023 were followed in interpreting the results. Results: A total of 246 blood samples were processed, and 75 (30.49%) were culture-positive. Of the patients with culture-positive results, 30 (40%) were female, and 45 (60%) were male. Most of the patients were below 60 years of age. There were 57 (76%) Gram-negative and 18 (24%) Gram-positive bacteria. Gram-negative bacteria commonly present were Escherichia coli 10 (17.54%), Klebsiella pneumoniae 15 (26.31%), and Pseudomonas aeruginosa 18 (31.57%). Staphylococcus aureus, constituting 7 (38.89%) of Gram-positive bacteria, all Methicillin-Resistant Staphylococcus aureus (MRSA). Multidrug resistance was commonly present in Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Conclusion: The current research demonstrated that people with weakened immune systems face higher risks of developing BSIs, which are caused by multidrug-resistant Gram-negative bacteria. The establishment of enhanced local BSI surveillance systems, together with prompt microbiological testing, will lead to improved antimicrobial treatment decisions, which will result in better treatment results for patients in high-risk categories.

Distribution of Carbapenemase Genes among Clinical Isolates of Escherichia coli and Klebsiella spp. in a Tertiary Care Centre: A Cross-sectional Study

Radha Kunjalwar, Dipika Shaw, Gargi Mudey, Nisha Akoijam, Kaushik Sahoo Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Carbapenemase-Producing Enterobacterales (CPE), especially Escherichia coli and Klebsiella spp., have become a serious global health concern due to their role in nosocomial infections, limited treatment options, and high mortality. Resistance is primarily mediated by carbapenemase genes, often undetected by conventional phenotypic methods. Early molecular tool detection is crucial for effective infection control and antimicrobial stewardship. Aim: To detect carbapenemase-producing E. coli and Klebsiella spp. using both phenotypic mCIM (modified carbapenem inactivation method) and eCIM (EDTA-modified carbapenem inactivation method) and genotypic Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) methods at a tertiary healthcare centre in Central India. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India. A total of 205 non-duplicate clinical isolates were collected from June 2022 to June 2024. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) 2022 guidelines. Carbapenemase production was confirmed phenotypically using mCIM and eCIM. Genotypic detection of carbapenemase genes (blaNDM, blaOXA-48, blaKPC, blaVIM, and blaIMP) was done by real-time PCR. Data were analysed using descriptive statistics; p-value<0.05 was considered significant. Results: Out of 205 isolates, 115 (56.1%) were confirmed as carbapenemase producers, with 94 (81.7%) identified as Metallo-β-Lactamase (MBL) producers and 21 (18.3%) as serine carbapenemase producers. RT-PCR detected carbapenemase genes in 60 of 73 phenotypically positive isolates (82.19%). blaNDM gene was most prevalent 41 (56.16%), followed by blaOXA-48 35 (47.94%), blaKPC 11 (15.06%), blaVIM 9 (12.32%), and blaIMP 1 (1.36%). Co-occurrence of these genes was also common, with 13 isolates showing both NDM and OXA-48. Conclusion: The study highlights a high prevalence of NDM and OXA-48 carbapenemase genes among E. coli and Klebsiella spp. in Central India. The predominance of MBLs emphasises the urgent need for routine molecular diagnostics, stringent infection control, and antibiotic stewardship to curb the spread of these highly resistant organisms. The combination of phenotypic and rapid genotypic methods enables timely identification of resistance patterns, which is essential for targeted therapy, infection control, and healthcare settings.

Comprehensive Scientometric Analysis and Policy Impact Analysis of ICMR’s Scopus-indexed Research Output from 2014 to 2024

Saravanakumaran Subramani, Veeraramu Kannan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: The Indian Council of Medical Research (ICMR), India’s apex biomedical and public health research organisation, plays a central role in generating evidence that informs national and international health policy. Despite its institutional significance, no comprehensive longitudinal scientometric evaluation using internationally standardised bibliometric platforms has been reported. Aim: To conduct a comprehensive scientometric and policy impact analysis of ICMR’s Scopus-indexed research output from 2014 to 2024 using Elsevier SciVal, encompassing publication growth, citation impact, journal quality, subject area distribution, SDG alignment, collaboration architecture, topic cluster prominence, online visibility, funding landscape, and policy influence. Materials and Methods: Bibliometric data were retrieved from SciVal (Elsevier), sourced from the Scopus database. Indicators included annual scholarly output, Field-Weighted Citation Impact (FWCI), Field-Weighted Views Impact (FWVI), CiteScore quartile distributions, collaboration profiles, SDG-aligned output, topic cluster prominence percentiles, online views percentiles, and policy citation metrics. Global benchmarking compared ICMR’s performance against low-to-middle income country (LMIC) research councils and high-income country (HIC) benchmarks. Results: ICMR produced 11,978 Scopus-indexed publications (2014-2024), accumulating 396,907 citations and an overall FWCI of 2.04. Annual output grew at a compound annual growth rate (CAGR) of 6.63%, with the sharpest acceleration occurring during 2019-2021 (+64.6% over two years). Q1 journal publications constituted 44.5% (4943/11,097) of output. Internationally collaborative publications (25.1%) achieved an FWCI of 5.65. SDG 3 accounted for 79.5% of SDG-aligned output (FWCI=2.59). COVID-19 emerged as the leading topic cluster (FWCI=4.79; world prominence percentile=99.94). A total of 1,272 publications (10.6%) were cited in 6,506 policy documents across 546 policy bodies in 89 countries. Conclusion: ICMR demonstrated sustained above-average global research impact with notable policy translation capabilities. Strategic priorities include expanding international collaboration, scaling non-communicable disease and planetary health research, and strengthening methodological quality within domestic research partnerships.

Efficacy of Bilvadi Vati in the Management of Garbhini Chhardi (Hyperemesis Gravidarum): A Randomised Controlled Clinical Trial

Komal Borle, Sonal S Wagh Dere Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Garbhini Chhardi or Hyperemesis Gravidarum (HG) is a disabling and preva-lent pregnancy condition involving severe vomiting and nausea. Management of the condition is necessary to preserve the health of the mother and foetus. Ayurveda has provided effective and safe measures for nausea and vomiting of pregnancy. Two Ayurvedic drugs, Bilvadi Vati and Kustumbaru Kalka Vati, are given in this condition. This research examines their effectiveness in the management of Garbhini Chhardi. Aim: To evaluate the clinical efficacy of Bilvadi Vati therapy for the management of Garbhini Chhardi (HG) with respect to the severity of nausea, vomiting frequency, hydration sta-tus, and overall improvement of maternal health compared to Kustumbaru Kalka Vati. Materials and Methods: The Randomised Controlled clinical Trial (RCT) was conducted in Ayur-veda Mahavidyalaya of Sangam Sevabhavi Trust, Wardha, Maharashtra, India for 18 months from September 2019 to April 2021. A total of 90 pregnant women with Garbhini Chhardi were subjected to a RCT. The volunteers were divided into two groups randomly: Group A received Bilvadi Vati, and Group B received Kustumbaru Kalka Vati. The trial was conducted at Sangam Sevabhavi Trust’s Ayurveda Ma-havidyalaya for four weeks. The inclusion criteria for the trial were pregnant volunteers aged 12 to 14 weeks pregnant, diagnosed with Garbhini Chhardi, and willing to participate. Clinical outcomes were measured with the Pregnancy-Unique Quantification of Emesis (PUQE) scale to measure the severity of nausea and vomiting. Frequency of vomiting and hydration level were also quantified. A statistical anal-ysis using Statistical Package for the Social Sciences (SPSS) version 28.0. For pair-wise comparisons within groups, the Wilcoxon signed-rank test was used. Inter-group comparisons were performed with the help of the Mann-Whitney U test for comparisons between groups. Descriptive statistical parameters (mean, median, standard deviation) were employed for data summarising purposes, with a p-value <0.05. Results: Both groups significantly improved symptoms (p-value <0.001). Group A (Bilvadi Vati) improved more in Chardi and Daurbalya on intergroup comparison. Group A exhibited significant improvement (>60%) with 64.44% in Group A and 4.44% in Group B. Conclusion: The present study again establishes that Bilvadi Vati and Kustumbaru Kalka Vati effectively man-age Garbhini Chhardi. However, Bilvadi Vati was more clinically effective with better relief of symptoms and a greater percentage of marked improvement, greater than 75% relief.

Prevalence and Symptom Spectrum of Premenstrual Syndrome in Medical Students: A Cross-sectional Study

Nisha Singh, Lubana Shaikh, Chhavi Kiran Gupta, Sangeeta Kori, Aarti Sahasrabuddhe, Tejas Jadhav Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Premenstrual Syndrome (PMS) is the presence of recurrent symptoms during the premenstrual phase or the first few days of menses, and complete absence of these symptoms in the post menstrual phase. PMS is common, affecting many women of reproductive age group, manifesting in a variety of physical, psychological and behavioural symptoms which may impact daily activities and overall quality of life. Aim: To estimate the prevalence of PMS among female Bachelor of Medicine and Bachelor of Surgery (MBBS) students and interns, to determine the factors influencing PMS and the coping mechanisms used for relieving the symptoms. Materials and Methods: The present observational cross-sectional study was conducted over a period of three months (April 2024- June 2024), including 418 female medical students and female interns of Index Medical College, Hospital and Research Centre, Indore, Madhya Pradesh, India, using a semistructured, self-administered questionnaire; after obtaining ethical clearance. All female MBBS students and interns present on the day of data collection and provided informed consent were included. Data entered into MS excel and analysed using Statistical Package for Social Sciences (SPSS). 25.0. Chi-square assessed associations between PMS and independent variables. A p-value of <0.05 was considered statistically significant. Results: Prevalence of PMS was found to be 354 (84.69%). PMS was statistically significantly associated with factors like year of study (p-value=0.039), socioeconomic status (p-value=0.030), Body Mass Index (BMI) (p-value≤0.001), physical activity (p-value=0.0013), sleep pattern (p-value=0.008), regularity of menses (p-value=0.017), number of days of menstruation (p-value=0.034) and dysmenorrhoea (p-value=0.01). Taking rest/sleeping was found to be the most common coping mechanism used by the participants (90.78%), followed by listening to music (61.65%) and hot fomentation/ hot shower (49.51%). Conclusion: High prevalence of PMS amongst young girls is a matter of concern, impacting their daily activities and overall quality of life. Certain coping mechanisms like taking adequate rest, listening music and taking hot shower have been found to relieve the symptoms. Also meditation and Yoga can be promoted for relief of PMS symptoms and calmness of mind and body. Severe cases might be advised to seek medical treatments like HRT.

Clinical Efficacy of Photodynamic Therapy and 1% Metformin Gel as Adjuncts to Scaling and Root Planing in the Treatment of Periodontitis: A Randomised Clinical Trial

Sai Prathyusha Bantupalli, Anil Kumar Kancharla, Anwesh Reddy Nandigam, Sheema Tasneem Mohamed, Swatantrata Dey Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Photodynamic Therapy (PDT) utilises light-activated Photosensitisers (PSs) to generate Reactive Oxygen Species (ROS) disrupting bacterial biofilms and eliminating pathogens with minimal toxicity. Metformin enhances bacterial clearance, suppresses Lipopolysaccharide (LPS)-induced inflammation, and stimulates human Periodontal Ligament Fibroblasts (hPDLFs) to promote tissue repair and regeneration. Aim: To evaluate the efficacy of Photodynamic Therapy (PDT) and 1% Metformin Gel (MG) as adjuncts to Scaling and Root Planing (SRP) in managing Stage I/II Grade A/B Periodontitis. Materials and Methods: This clinical trial was a split-mouth, double-blind randomised controlled, single-centre study. Conducted in the Department of Periodontics Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India over 6 months from April 2025 to September 2025. The study included 25 systemically healthy individuals aged 18-60 years. Participants were allocated into three treatment groups: SRP + PDT (Group I), SRP + 1% MG (Group II), and SRP alone (Group III). Clinical parameters assessed were Oral Hygiene Index-simplified (OHI-S), Plaque Index (PI), Gingival Index (GI), Sulcus Bleeding Index (SBI), Probing Pocket Depth (PPD), and CAL at baseline and at one, three, and six months. Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) version 23.0. Data were expressed as mean±Standard Deviation (SD). Intergroup comparisons were carried out using Kruskal-Wallis Analysis of Variance (ANOVA) and ANOVA as appropriate. Intragroup changes over time were analysed using Friedman ANOVA to identify significant differences. Results: The study population had a mean age of 29.92±10.44 years and comprised 13 males and 12 females. All three groups demonstrated highly significant intragroup improvements (p<0.0001) in OHI-S, GI, PI, SBI, PPD, and CAL over six months, confirming the effectiveness of SRP. Intergroup comparisons showed no significant differences in OHI-S, GI, PI, or SBI (p=1.00), indicating comparable control of plaque and inflammation. Group I (PDT+SRP) exhibited the greatest reductions in PPD, with significant improvements from baseline to three months (p=0.014*) and six months (p=0.045*), followed by stabilisation between three and six months (p=0.741). A similar pattern was observed for CAL, with Group I demonstrating superior gains compared with Group II and III. Overall, PDT resulted in greater pocket depth reduction and attachment gain, likely due to its antimicrobial and biofilm-disruptive properties, whereas MG showed relatively limited sustained efficacy. Conclusion: All three treatment modalities showed statistically significant intragroup improvements (p<0.0001) in all clinical parameters over six months, confirming the effectiveness of SRP. Intergroup comparisons revealed no significant differences in plaque and gingival indices (p=1.00). However, the PDT+SRP group demonstrated statistically significant reductions in PPD and gains in CAL at three and six months (p<0.05), followed by stabilisation, indicating an early therapeutic plateau. Overall, while all treatments were effective, PDT provided a statistically significant adjunctive benefit in improving pocket depth and attachment levels.

Correlation between First Ray Length and Tip-to-Tip Pinch Strength among Young Adults: A Pilot Study

Shubha Arora, Neha Jain Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Hand anthropometry influences manual performance, yet the specific relationship between first ray length and precision pinch strength remains underexplored in Indian young adults. While hand length, forearm circumference, and Body Mass Index (BMI) have been correlated with grip strength, limited data exist on first ray anthropometry as a predictor of tip-to-tip pinch strength. Aim: To evaluate the relationship between first ray length, including thumb and pinch strength among subjects aged 18-25 years. Materials and Methods: This pilot cross-sectional study was conducted at Mahatma Gandhi College of Occupational Therapy, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India from July to August 2025. A total of 30 healthy university students (13 males, 17 females; mean age 19.3 years) were recruited by simple random sampling. Dominant hand tip-to-tip pinch strength was measured using a calibrated Baseline® hydraulic pinch gauge (Model 12-0200) following American Society of Hand Therapists (ASHT) positioning: seated, shoulder adducted and neutrally rotated, elbow flexed to 90°, forearm neutral, wrist 0-30° extension. Three trials with a 30-second rest were performed, and the mean was recorded in kilogram-force (kgf). Normality was assessed using the Shapiro-Wilk test. Pearson correlation coefficient (r) with 95% confidence interval, and simple linear regression were performed using Statistical Package for the Social Sciences (SPSS) version 26.0 at p-value <0.05. Results: Mean first ray length was 13.57±1.47 cm and mean tip-to-tip pinch strength was 4.15±0.99 kgf. Data were normally distributed. A moderate positive correlation was observed between first ray length and tip-to-tip pinch strength (r=0.68, 95% CI: 0.42-0.84, p-value <0.01, R²=0.46). Linear regression yielded: Pinch strength (kgf)=-2.08+0.46 × First ray length (cm); β=0.46, p-value <0.01. Conclusion: A moderate positive correlation was established between first ray length and maximum pinch strength. This study supports the experimental hypothesis and helps to broaden the perspective of rehabilitation professionals, suggesting that first ray anthropometry may be a useful consideration when assessing precision pinch strength and hand function. Larger studies controlling for gender, BMI, and hand span are warranted.

Clinico-Pathological Evaluation of Gynaecological Pelvic Masses: A Prospective Observational Study

Neha Ashvin Nimbark, Kinjal Niraj Shah, Aastha Mukesh Agrawal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Gynaecological abdominal and pelvic masses are a frequent clinical presentation, encompassing a broad spectrum of benign and malignant pathologies. Accurate preoperative differentiation is essential to optimise management, preserve fertility, and improve oncological outcomes. Aim: To evaluate the clinical presentation, radiological characteristics, histopathological association, and diagnostic accuracy of tumour markers and Risk of Malignancy Index (RMI) in gynaecological pelvic masses. Materials and Methods: This prospective observational study was conducted from February 2025 to February 2026, in the Department of Obstetrics and Gynaecology at Dhiraj Hospital, Vadodara, Gujarat. Thirty women aged 15-70 years with clinically and radiologically diagnosed pelvic masses were enrolled. All patients underwent detailed clinical evaluation, Ultrasonography (USG) as the primary imaging modality, and Magnetic Resonance Imaging (MRI) in selected cases. Serum tumour markers, including Cancer Antigen (CA-125), Carbohydrate Antigen (CA19-9), and Carcinoembryonic Antigen (CEA), were assessed where indicated. Surgical management was performed, and histopathological examination served as the gold standard. Diagnostic performance indices of imaging, tumour markers, and RMI were calculated. Results: The mean age of the patients was 41.1±11.7 years, with the majority in the 41–50-year age group (12; 40%). The most common clinical findings were palpable pelvic or abdominopelvic mass (19; 63.3%), lower abdominal pain (10; 33.3%), and Abnormal Uterine Bleeding (AUB) (10; 33.3%). Uterine fibroids were the most frequent pathology (9; 30%). Among ovarian masses (n = 17), CA-125 was elevated in 83.3% (5/6) of malignant and 36.4% (4/11) of benign cases. High RMI (>200) was strongly associated with malignancy (p = 0.0012), showing a sensitivity of 83.33% (5/6) and specificity of 100% (11/11), with an overall diagnostic accuracy of 94.12% (16/17). Conclusion: Comprehensive clinical evaluation combined with USG, tumour markers, and RMI enhances preoperative discrimination between benign and malignant pelvic masses, facilitating appropriate surgical planning and improved patient outcomes.

Fracture Resistance of Mandibular Second Primary Molars after Rotary Instrumentation and Adhesive Bulk-Fill Composite Restoration: An In-vitro Study

Selvakumar Haridoss, R Mathan Rajan, Anbarasi, Kavitha Swaminathan, E Vijayaragavan Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Endodontic access and canal preparation can compromise the structural integrity of primary teeth. Standardised adhesive coronal reinforcement may mitigate fracture susceptibility after pulpectomy in primary molars. Comparative evidence on paediatric rotary instrumentation systems combined with standardised adhesive restoration of primary molars is limited. Aim: To compare the fracture resistance of mandibular second primary molars in five groups: an intact reference, an unrestored access-only group, and three rotary-instrumented groups restored with the same adhesive bulk-fill composite. Materials and Methods: This laboratory-based in-vitro study, reported in accordance with the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines, was conducted in the Department of Paediatric and Preventive Dentistry at Sri Ramachandra Dental College and Hospital between December 2023 and June 2024. A total of 125 extracted mandibular second primary molars were allocated to five groups (n=25): Group I (intact, no access cavity preparation), Group II (access cavity preparation only; no instrumentation, obturation, or restoration, unrestored), Group III (XP-endo Shaper), Group IV (NeoEndo PedoFlex), and Group V (Kedo SG). Groups III-V underwent instrumentation, obturation with Metapex (calcium hydroxide–iodoform paste), and coronal restoration using etch-and-rinse adhesive with bulk-fill resin composite. The specimens were mounted with periodontal ligament simulation (light-body polyvinyl siloxane) and loaded in compression (30°; 0.5 mm/min) until fracture. The outcomes assessed were maximum force, compressive stress at maximum force, compressive displacement at break, and compressive stress at break. One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test was performed. A p-value<0.05 was considered statistically significant. Results: Group I (intact) had the highest mean maximum force (933.59±383.55 N), while group II had the lowest (325.82±128.45 N). Groups III, IV, and V showed comparable intermediate values. The maximum force and compressive stress at maximum force differed significantly across the groups (p<0.001), and the compressive stress at break also differed significantly (p=0.027), whereas the displacement at break did not differ significantly (p=0.243). Group II showed significantly lower values than all other groups for maximum force and compressive stress at maximum force, and group I showed significantly higher values than groups II, III, IV, and V for these parameters. No significant differences were detected among groups III, IV, and V. For compressive stress at break, group V (Kedo SG) was significantly higher than group I (intact), and no other pairwise differences reached significance. Conclusion: An unrestored access cavity markedly compromises the fracture resistance of mandibular primary second molars. Endodontic instrumentation, followed by a standardised adhesive bulk-fill composite restoration, substantially improved fracture resistance relative to the unrestored condition, approaching the intact reference. The three rotary systems did not differ significantly from one another. Kedo SG exhibited a significantly higher compressive stress at break than the intact reference, with no other pairwise differences observed for this parameter.

Changing Spectrum of Antimicrobial Drug Resistance among Uropathogens in Pregnant Women over Three Years at a Tertiary Healthcare Facility: A Retrospective Observational Study

Satabdi Sahu, Jayanti Prava Behera, Snigdha Rani Panigrahy, Sanghamitra Padhi, Abinash Panda, Swapna Mahapatra, Pratyush Mishra, Sandipta Subadarshani Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Infections caused by uropathogens are common during pregnancy, and empirical treatment with Antimicrobial Agents (AMAs) is also frequently encountered. The emergence of Antimicrobial Drug Resistance (AMR) in uropathogens is a major concern. Aim: To evaluate the spectrum of AMR among uropathogens in pregnant women in a tertiary healthcare facility. Materials and Methods: The present retrospective observational study was conducted in Department of Pharmacology in collaboration with the Department of Microbiology of MKCG Medical College and Hospital, Berhampur, Odisha, India, to evaluate all consecutive samples of laboratory confirmed uropathogens of urine culture sensitivity reports of pregnant women during the period of three years (July 2020-July 2023). Data were collected from past records from July 2023 to September 2023 were subsequently analysed in November 2023 to December 2023. A total sample size of 606 was estimated with inclusion or exclusion criteria. The data set included demographic parameters of pregnant subjects, such as age, type of gravida, provisional diagnosis, with its clinicopathological types and resistance pattern were observed from manually maintained case records. The association between selected parameters and AMR was established using Pearson’s chi-square test, which was found to be statistically significant (p-value <0.05). Results: Of the 2,631 cases, 1,326 (50.4%) were culture-positive for uropathogens. Among these, 606 pregnant women were identified. The mean age of pregnant women with AMR was 31±1.81 years. A rising trend of AMR among uropathogens in pregnant women was observed from 86 (14.2%) in 2020 to 262(43.2%) in 2023 out of 606 sample size. A progressive prevalence of Ciprofloxacin (CIP)-Ceftriaxone (CTR)-Cefixime (CIX) 71.6% Multidrug Resistance (MDR) was encountered in Escherichia coli (E.coli) which accounted for 75.08% of uropathogens in symptomatic bacteriuria among pregnant women with Urinary Tract Infection (UTI). Conclusion: A rising trend of AMR to different AMAs needs antibiotic use optimisation thereby promoting rational antibiotic use in the management of UTI in pregnant subjects and execution of Antimicrobial Stewardship Program (ASP) for mitigation of MDR as a future prospect. AMR to different AMAs among uropathogens in pregnant women in case of UTI limits the availability of treatment options for healthcare providers.

Lymph Node Ratio and its Association with Histopathological Parameters in Oral Squamous Cell Carcinoma: A Cross-sectional Study

Prathibha Rajendran, TN Suresh, K Sneha, Tejus V Nagi Reddy Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Oral Squamous Cell Carcinoma (OSCC) is one of the most common malignancies of the oral cavity and is associated with significant morbidity and mortality. Cervical lymph node metastasis is an important prognostic factor influencing disease outcome. The lymph node ratio (LNR), defined as the ratio of metastatic lymph nodes to the total number of lymph nodes examined, has emerged as a useful prognostic marker reflecting the extent of nodal metastatic burden and potentially providing additional prognostic information beyond conventional nodal staging. Aim: To assess the LNR in surgically treated cases of OSCC and evaluate its association with histopathological parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India, over a study period from November 2024 to September 2025. A total of ninety-six histopathologically confirmed cases of OSCC treated by primary surgical resection with neck dissection were included. Clinicopathological parameters, including age, sex, tumour site, tumour thickness, Depth of Invasion (DOI), Lymphovascular Invasion (LVI), Perineural Invasion (PNI), bone invasion, pathological T stage, N stage, TNM stage, nodal status, number of lymph nodes retrieved, number of metastatic lymph nodes, and LNR, were recorded. Using Chi-square test to determine the association between LNR and histopathological parameters. A p-value ≤0.05 of was considered statistically significant. Results: Among the ninety-six cases studied, the mean age was 56.65 years, with the majority of tumours arising in the buccal mucosa. Significant associations were observed between LNR and nodal status (p<0.001), pathological N stage (p<0.001), TNM stage (p<0.001) and tumour thickness (p=0.042). Age, sex, pathological T stage, DOI, LVI, PNI and bone invasion demonstrated no significant associations with LNR. Higher LNR values were associated with advanced disease and adverse histopathological features, indicating a greater risk of tumour progression. Conclusion: The present study demonstrates that LNR is significantly associated with important histopathological prognostic parameters in OSCC, particularly nodal status, pathological N stage, TNM stage, and tumour thickness. LNR may serve as a valuable adjunct prognostic marker for assessing nodal disease burden and may assist in risk stratification and therapeutic decision-making in patients with OSCC.

Weight, Volume, and Density of Prostatic Chips Obtained by TURP: A Prospective Observational Study

Vijaykumar Yadav, Samiran D Adhikary, Shilpi Yadav, Kaliprasad Satpathy, Lorika Sahu Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Prostatic weight and volume are often used interchangeably; however, resected prostatic chips have been observed to sink to the bottom in glycine solution, suggesting a density greater than one. Previous studies of the physical parameters of resected prostate specimens have focused mainly on weight changes during chemical processing rather than on the native baseline density. Aim: To evaluate the weight, volume and density of prostatic tissue resected during Transurethral Resection of Prostate (TURP) and assess whether this relationship varies with different histopathological patterns. Materials and Methods: This two-year prospective, observational study was conducted at the Department of Genitourinary Surgery and Renal Transplant, Apollo Hospital, Bhubaneswar, Odisha, India, from May 2016 to April 2018. A total of 55 patients who underwent monopolar TURP were included. Weight and volume of the resected prostatic chips were measured within five minutes of the surgery. Density was calculated by the formula: mass per unit volume, i.e., weight/volume (gm/mL). Statistical analysis was done using Statistical Package for Social Sciences (IBM SPSS Inc., Chicago, IL) software version 20.0. Data normality was evaluated using the Shapiro-Wilk Test. Normally distributed data were analysed by parametric tests such as one-way ANOVA, whereas non parametric Mann-Whitney U test was utilised for non normally distributed data. The linear association between the weight and volume of prostatic chips was assessed using Pearson’s correlation coefficient. Linear regression analysis was performed to estimate the association between chip volume and weight. Results were deemed statistically significant at p<0.05. Results: The mean age of the patients was 68.5±8.8 years. There were 50 patients (90.9%) with Benign Prostatic Hyperplasia (BPH) and 5 (9.1%) with Prostate Carcinoma (CaP). The average weight, volume and density of the resected chips were 9.134±6.942 gm, 8.40±6.55 mL and 1.104±0.090 gm/mL, respectively. There was a statistically significant positive correlation between the weight and volume of prostatic chips (Pearson’s correlation coefficient, r=0.994, p<0.001). The density was found to be significantly higher in patients with CaP compared to those with BPH (p=0.021). Conclusion: Human prostatic tissue demonstrated a mean density greater than the reported density of the irrigation fluid under the measurement conditions. Weight and volume of resected prostatic chips should not be assumed to be directly interchangeable because tissue density may differ from unity.

Histopathological Spectrum and Treatment Outcomes of Idiopathic Granulomatous Mastitis: A Prospective Cohort Study

Aniket Halder, Sumanta Bhattacharya, Rudradeep Banerjee, Saikat Bhattacharya, Soumitra Mondal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Idiopathic Granulomatous Mastitis (IGM) is a rare chronic inflammatory breast disease and a diagnosis of exclusion. Although traditionally described as a lobulo-centric disease, ductal involvement has not been systematically assessed. High recurrence rates and lack of consensus regarding optimal treatment remain major challenges. In this study, we have evaluated the detailed histopathological changes in IGM with emphasis on ductal pathology and assessed their association with treatment outcomes. Aim: Primary aim of the study was to evaluate detailed histopathological changes in IGM with emphasis on ductal pathology and to assess their association with treatment outcomes. Materials and Methods: The present prospective cohort study was conducted from January 2017 to December 2023 in the departments of Pathology and Surgery in two tertiary care hospitals in Eastern India. Eighty-nine histologically confirmed IGM cases were included after exclusion of specific granulomatous aetiologies. Patients were categorised into three treatment groups: steroid therapy, lumpectomy or segmental mastectomy, and Wide Local Excision (WLE) with partial or total duct excision. Statistical analysis was performed using Fisher’s-exact test and logistic regression. A p-value <0.05 was considered statistically significant. Results: A total of 59 cases of Duct ectasia (66.3%), 58 cases of periductal granulomas (65.2%), and 44 cases of duct disruption (49.4%) were common findings. Recurrence was highest in the lumpectomy group and lowest in the WLE with duct excision group. WLE with duct excision demonstrated significantly lower recurrence compared to lumpectomy (p <0.05). Conclusion: IGM demonstrates significant ductal pathology in association with lobular changes as described in literature. WLE with complete duct excision may be associated with significantly lower recurrence rates and better outcomes. Further prospective multicentre studies are warranted.

Histopathological and Biochemical Evaluation of Diffuse Hair Loss in Women: A Cross-sectional Study

PT Navya, KN Shobha Rani, N Asha Latha, Vindu Srivatsava Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Diffuse hair loss in women has multiple aetiologies, which often present a diagnostic challenge due to the significant aetiological overlap between different types of alopecia. While clinical examination provides initial clues, histopathology remains a vital tool for definitive diagnosis. Furthermore, nutritional and endocrine factors, such as iron stores and thyroid function, are frequently implicated as systemic triggers or aggravators of hair loss. Aim: To evaluate the histopathological spectrum of scalp biopsies in female patients presenting with diffuse hair loss. Materials and Methods: This prospective cross-sectional analytical study was conducted at the Department of Pathology at Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India over two years between January 2016 and December 2017. involving 50 female patients aged 15-45 years with diffuse hair loss. Scalp biopsies (4-mm punch) were examined in both horizontal and vertical sections to assess follicular density and morphology. Serum ferritin and thyroid profiles were estimated. Due to the non normal distribution of biochemical data, results were expressed as medians with Interquartile Ranges (IQR). Statistical analysis was performed using Kruskal-Wallis and Spearman’s correlation tests {Statistical Package of Social Sciences (SPSS) version 28.0}. Results: Diffuse Alopecia Areata (DAA) was the most frequent diagnosis in 28 (56%) cases, followed by Female Pattern Hair Loss (FPHL) 19 (38%) cases and Chronic Telogen Effluvium (CTE) in 3 (6%) cases. Follicular miniaturisation and perifollicular fibrosis were noted in 16 (84.2%) and 15 (78.9%) of FPHL cases, respectively, with a mean Terminal-to-vellus ratio (T:V) of 3:1. Additionally, 23 (82.1%) DAA cases showed peribulbar lymphocytic infiltration. CTE cases exhibited increased telogen hairs but maintained a normal terminal-to-vellus hair ratio (7.1:1). Suboptimal serum ferritin levels (<40 ng/mL) were identified in 18 (36%) cases, while 21 (42%) patients exhibited elevated TSH levels (>4.2 mIU/L). The FPHL group showed the lowest median ferritin levels (46.0 ng/mL; IQR: 10.0-58.4) and higher median TSH levels (5.05 mIU/L) compared to other groups. Although the correlation between the degree of severity of hair fall and TSH was not statistically significant, a clear numerical trend was observed, with median TSH levels rising from 3.8 mIU/L in Grade-I to 6.2 mIU/L in Grade-III cases. Conclusion: Diffuse Alopecia Areata (DAA) is the most common cause of diffuse hair loss in females, highlighting the necessity of scalp biopsy for accurate diagnosis. The high frequency of suboptimal ferritin and elevated TSH, along with the numerical trend between TSH and hair loss severity, indicates that these biochemical factors likely act as significant clinical aggravators. Therefore, a comprehensive diagnostic approach incorporating histopathology and routine screening for iron and thyroid status is essential for the effective management of diffuse hair loss in women.

Determinants and Outcomes of Primary Caesarean Section: A Retrospective Observational Study

C Kavyarani, C Yashaswini, Athish Kannan Karur Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: A Primary Caesarean Section (PCS) is defined as the first caesarean delivery in a woman with no previous uterine scar. PCS rates are rising globally, necessitating an understanding of associated factors to improve maternal and foetal outcomes. Aim: To determine the prevalence of PCS, examine its indications, and analyse sociodemographic and obstetric factors associated with PCS, with particular emphasis on parity. Materials and Methods: The present retrospective observational study was carried out between March 2024 and December 2024 in the Department of Obstetrics and Gynaecology at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. A total of 620 women undergoing PCS with a gestational age of >28 weeks were enrolled. Data on maternal age, Body Mass Index (BMI), parity, gestational age, antenatal co-morbidities, and indications for caesarean section were collected from medical records. Chi-square and binary logistic regression analyses identified significant associations and independent predictors of PCS. Results: Out of 2710 deliveries, 872 were PCS (32% overall rate). Among 620 included participants, 330 were predominantly under 25 years (53.2%), 394 were from lower socioeconomic status (63.5%), and 450 were primigravida (72.6%). The leading indication was foetal distress among 220 participants, accounting for 35.5% of cases, followed by cephalopelvic disproportion in 98 participants (15.8%). Fifty PCS were due to maternal request and accounted for 8.1%. Factors significantly associated with higher odds of PCS included maternal age ≥36 years (Adjusted Odds Ratio (AOR) 5.16; 95% Confidence Interval (CI): 2.39-11.26), although the wide confidence interval suggests limited precision due to the smaller number of women in this age category. PCS was also associated with increased maternal morbidity (AOR 4.19) and neonatal intensive care unit admission (AOR 2.20). Notably, all neonatal deaths occurred among multigravid mothers. Conclusion: PCS remains a major contributor to rising caesarean rates. Factors such as advanced maternal age, high BMI, diabetes mellitus, and induction of labour significantly increase the likelihood of PCS. Targeted strategies, including adherence to evidence-based guidelines, judicious labour management, and regular audits, are essential to reduce unnecessary PCSs while ensuring maternal and neonatal safety.

Comparison of Labetalol and Dexmedetomidine Infusions for Hypotensive Anaesthesia in Middle Ear Surgery: A Randomised Controlled Trial

Purnendu Bikash Pramanik, Pijush Kanti Bera, Swapnadeep Sengupta Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Hypotensive anaesthesia has become an inevitable choice for patients undergoing microscopic middle ear surgeries under general anaesthesia, especially to decrease the intraoperative bleeding leading to improved visibility and reduced complications. Out of several agents, Dexmedetomidine and Labetalol have both been established as effective agents to cause controlled hypotension. Aim: To compare the efficacy and safety of Dexmedetomidine and Labetalol for producing controlled hypotension in microscopic middle ear surgeries under general anaesthesia. Materials and Methods: This parallel group randomised controlled trial was conducted at the Department of Anaesthesiology, Tertiary Medical College, Institute of Post Graduate Medical Education and Research, in Kolkata, West Bengal, India over a period of 15 months from April 2018 to June 2019. A total of 78 patients, aged 18 – 60 years, posted for microscopic middle ear surgeries under general anaesthesia, were randomly divided into two groups. Group D received Dexmedetomidine infusion with a loading dose of 1 μg/kg followed by a maintenance infusion of 0.4 μg/kg/h, whereas Group L received Labetalol 20 mg bolus followed by infusion at a rate of 0.5 mg/min. Intraoperative blood loss assessed by the Bleeding Score (BS) and Final Opinion on Bleeding Score (FOBS), haemodynamic parameters and awakening time were measured at designated time frames. Data were summarised and analysed by Student’s Independent-samples t-test for numerical variables between groups, by Mann – Whitney U test when skewed and by Chi-square test or Fisher’s exact test for categorical variables between groups. Results: The groups were comparable demographically (p-values for age, body weight and duration of surgery were 0.679, 0.104, 0.893 respectively). BS and FOBS (2/2-3 for group D and 4/3-4 for group L) were both significantly lower in group D. Haemodynamically, both groups were equally stable, with better attenuation of intubation and extubation surge in group D. Awakening time was also less in group D in comparison to group L. Conclusion: Dexmedetomidine is a better alternative than Labetalol in producing controlled hypotension in patients undergoing microscopic middle ear surgeries under general anaesthesia. The Dexmedetomidine group showed less bleeding and improved haemodynamics than the Labetalol group. Awakening was also found to be faster in the dexmedetomidine group.

Thyroid Function and Serum Calcium Level in Children with Nephrotic Syndrome Attending a Tertiary Care Hospital in Kolkata, India: A Cross-sectional Study

Rakesh Kumar Maddheshiya, Sudip Saha, Mousumi Das, Ira Das Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Nephrotic Syndrome (NS) in children is a common renal disorder characterised by massive proteinuria, hypoalbuminaemia, and oedema. However, loss of thyroid-binding proteins and vitamin D metabolites in the urine may disrupt thyroid and calcium homeostasis. Aim: To evaluate thyroid function and serum calcium levels in children with NS attending a tertiary care hospital in Kolkata, India. Materials and Methods: The present cross-sectional study was conducted at the Department of Paediatrics in Chittaranjan Seva Sadan hospital of Obstetrics, Gynaecology and child health, Kolkata, India, from December 2022 to May 2024. Total 96 children aged 1-12 years diagnosed with NS (first episode or relapse) were enrolled in the study. Cases of thyroid disease, those on calcium supplementation within last 12 hours, blood/albumin transfusion within last four month, known cases of liver disease, acute renal failure, acid-base disorders, or steroid-resistant NS were excluded. Clinical data, thyroid profile {Triiodothyronine (T3), Thyroxine (T4), Thyroid-Stimulating Hormone (TSH)}, and serum calcium of those children who were included in the study were analysed. Continuous variables were expressed as mean±Standard Deviation (SD); categorical variables as percentages. Statistical comparisons were made using t-tests, Chi-square tests, and z-tests. In present study, significance was set at p-value <0.05. Results: In present study, out of 96 patients, 76 (79.2%) were male while 20(20.8%) were female. A total of 65 patients (67.7%) were below seven years of age while 31 patients (32.3%) were between 7-12 years of age. Mean age±SD was 58.4±34.3 months. Forty children (41.7%) had first episode, while 56 (58.3%) were relapsed cases. Hypothyroidism was present in 9(9.4%) overall, rising from 2 in 40 patients (5%) in first episodes to 3 in 4 patients (75%) in fifth episodes (p=0.0002). Mean serum calcium declined from 9.66 mg/dL in first episodes to 8.65 mg/dL by the fifth episode (p=0.0004), with hypocalcaemia observed in 75% of fifth episode cases. Conclusion: Thyroid dysfunction and hypocalcaemia are common metabolic complications in paediatric NS, particularly with recurrent episodes. Routine assessment of thyroid and calcium profiles is recommended to mitigate growth, metabolic, and bone health complications.

Metagenomic Identification of Uncommon Meningoencephalitis Pathogens and Development of Peptide-based Immunoassays for Early Diagnosis: A Prospective Observational Study Research Protocol

Payal Khulkhule, Anil Agrawal, Amit Nayak, Rajpal Singh Kashyap Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Meningoencephalitis (ME) is an inflammatory condition of the meninges and brain parenchyma, remains a major diagnostic challenge. Metagenomic Next-Generation Sequencing (mNGS) has emerged as a promising tool for unbiased detection of viral, bacterial, fungal, and parasitic pathogens often missed by conventional methods. It also enables identification of regional pathogen profiles to guide development of locally tailored diagnostics. However, mNGS-based studies from India, particularly Central India, remain limited. Need of the study: The lack of diagnostic tests for uncommon and regionally prevalent pathogens causing ME in Central India contributes to a high burden of undiagnosed cases. Even in well-equipped healthcare settings, a proportion of ME cases remain without confirmed aetiology due to diverse pathogens and overlapping clinical presentations. Addressing this gap is essential for improving aetiological diagnosis and guiding appropriate treatment. Therefore, the present study is designed to identify these uncommon pathogens using mNGS approach and to develop targeted, clinically applicable diagnostic tools to improve early detection and patient management. Aim: To characterise the aetiology of pathogens in ME cases using mNGS and to develop peptide-based immunoassays for uncommon pathogens enabling early diagnosis. Materials and Methods: The present prospective observational study will be conducted at the Neurological Intensive Care Unit (NICU) of Central India Institute of Medical Sciences (CIIMS), Nagpur, Maharashtra, India from April 2026 to April 2028, enrolling 146 clinically suspected ME patients (18-60 years). Cerebrospinal Fluid (CSF) samples will be analysed using conventional and metagenomic approaches. Patients will be categorised into undiagnosed, confirmed, and non infectious groups. Peptide-based Enzyme-Linked Immunosorbent Assay (ELISA) will be developed based on mNGS findings. Statistical analysis will include sensitivity, specificity, and Receiver Operating Characteristic (ROC) curve evaluation.

Efficacy of Phalatrikadi Vasti with Phalatrikadi Kwath versus Standard Treatment (Tab Metformin) in Diabetes Mellitus Type II (Prameha): A Research Protocol

Prasad Rukminikant Mirge, Shweta Parwe, Punam Sawarkar, Garima Gupta Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Diabetes Mellitus (DM) is a metabolic disorder marked by high blood sugar due to insufficient insulin production or impaired insulin action, leading to organ damage. Type 2 Diabetes Mellitus (T2DM) is rising globally. In Ayurveda, DM is compared with Prameha, a group of metabolic disorders. Type 1 Diabetes Mellitus (T1DM) aligns with congenital Prameha, while T2DM corresponds to lifestyle-related Prameha. Symptoms such as excessive urination, fatigue, and systemic metabolic changes described in Ayurveda closely resemble those of modern diabetes. Need of the study: Conventional hypoglycaemic drugs often cause weight gain and other side-effects, creating a need for safer alternatives. Ayurveda offers solutions through Panchakarma and herbal therapies, especially Vasti (medicated enema), a safe and non invasive method. With its diuretic, anti-inflammatory, and metabolic actions, Phalatrikadi improves insulin sensitivity and regulates metabolism, making it suitable for Prameha. Phalatrikadi decoction is Tridoshaghna (Pacifies all three doshas), Lekhaniya (scrape out excess fat) in properties, and it is widely used in practice. However, no studies have yet evaluated the administration of Phalatrikadi decoction through the rectal route. Therefore, exploring such novel therapeutic approaches may help expand research perspectives in the management of diabetes. Aim: To evaluate the comparative efficacy of Phalatrikadi Vasti followed by Phalatrikadi Kwath (Decoction) versus standard treatment (Tab. Metformin) in the management of T2DM (Prameha). Materials and Methods: The present study is a randomised open-label controlled clinical trial conducted at Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India, from October 2025 to October 2026. A total of 60 patients who met the inclusion criteria will be randomly allocated into two groups of 30 patients each. Group A (trial group) will receive Phalatrikadi Niruha Basti (decoction enema) for 16 days, followed by oral administration of Phalatrikadi for 32 days. Group B (control group) will receive Metformin 500 mg orally once daily for 48 days. The primary outcome measures included assessment of Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), and urine sugar levels at baseline and after the intervention. Paired t-test for within-group comparison and an independent t-test for baseline comparison between the groups. A p-value of <0.05 will be considered statistically significant.

Effect of Combined Plyometrics and Balance Training versus Eccentric Resistance Training with Conventional Physiotherapy for Functional Ankle Instability in Badminton Players: A Research Protocol

Monika Dhage, Swapnil Ramteke Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: As a racquet sport, badminton demands a wide range of skilled postural adjustments and movements, including jumps, lunges, rapid change of direction and quick arm movement. Acute lateral ankle sprain is a common injury among athletes. Lateral ankle sprains can cause motor behaviour disorders. Repeated ankle sprains can lead to ankle instability, which can repeatedly disrupt performance. Need of the study: The existing research has largely investigated plyometric and balance training in isolation. There is limited evidence examining the combined effect of plyometric and balance training integrated with strength, power, or endurance components. Moreover, many studies have not consistently incorporated clinically relevant outcome measures to guide rehabilitation progression. Therefore, a clear knowledge gap exists regarding the effectiveness of a comprehensive, multi-component rehabilitation program in optimising functional recovery and preventing recurrence in badminton athletes with Functional Ankle Instability (FAI). Aim: The present study aims to evaluate the effect of plyometric and balance training versus eccentric resistance training in addition to conventional physiotherapy for FAI in badminton athletes. Materials and Methods: The present three-arm parallel randomised controlled trial will be conducted at 1) Sports OPD, Ravi Nair Physiotherapy College, Sawangi, Wardha, Maharashtra, India, 2) District badminton court Wardha, Maharashtra, India, from July 2025 to June 2026. Participants will be allocated to a 6-week combined plyometric and balance training versus eccentric resistance in addition to a conventional program. Training will be performed three times per week. Outcome measures assessed will be the Sargent jump, 15 m Sprint and Y-Shaped agility. Between-group comparisons across the three arms will be performed using One-way Analysis of Variance (ANOVA) for normally distributed data or the Kruskal-Wallis test for non normal data. Post-hoc tests (Bonferroni/Tukey for ANOVA or Dunn’s test for Kruskal-Wallis) will be applied to identify differences between specific groups. Within-group pre and post-intervention changes will be assessed using paired t-tests (normal data) or Wilcoxon signed-rank tests (non normal data). A p-value of <0.05 will be considered statistically significant.

Effect of Blood Flow Restriction Training on Lipid Profile and Cardiopulmonary Endurance among Overweight and Obese Individuals: A Research Protocol for a Randomised Controlled Trial

Anish Neupane, Akanksha Saxena, Mandeep Kumar Jangra Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Overweight and obesity have become a major public health concern as they contribute to the development of co-morbid conditions like Cardiovascular Diseases (CVD), type 2 diabetes, and respiratory problems, causing a significant impairment in lipid metabolism, known as dyslipidaemia. Resistance and Aerobic Exercise (AE) are effective in reducing dyslipidaemia and improving cardiopulmonary endurance, but require moderate to high intensity to gain these physiological benefits. Need of the study: Blood Flow Restriction Training (BFRT) emerged as a novel exercise modality that uses a compression device in the proximal part of the limb to restrict blood flow. To our knowledge, existing evidence for the BFRT effect on lipid profile and cardiopulmonary endurance is limited and available studies are also confined to specific demographic cohorts, i.e., young obese males, overweight females, or other special populations. Therefore, the authors will evaluate the effectiveness of BFRT along with AE on these outcomes in both males and females. Aim: To evaluate the effectiveness of AE along with BFRT on lipid profile and cardiopulmonary endurance among overweight and obese individuals. Materials and Methods: An assessor blinded randomised controlled trial will take place at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India, from May 2026 to March 2027. Sixty participants aged 18-35 with a Body Mass Index (BMI) ≥25 kg/m² will be divided into experimental and control groups. Both groups will engage in treadmill walking for eight weeks (3 days/week, 45 minutes/session), while the experimental group will use a Blood Flow Restriction (BFR) cuff on their thighs. Lipid profiles and cardiopulmonary endurance will be measured at baseline and after eight weeks through a digital lipid analyser and a 2 km walk test, respectively. Statistical analysis will utilise a paired t-test or Wilcoxon signed-rank test for within-group comparisons, and an independent t-test or Mann-Whitney U test for between-group comparisons, with p<0.05 considered significant.

Efficacy of Newly Developed Unitised Risk Analysis Tool versus Standard Risk Analysis Tool at Clinical Laboratory: A Research Protocol

Jitesh M Pankawase, Meghali Mahakalkar, Babaji Ghewade, Vivek Chakole Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Risk management in medical laboratories is essential for patient safety and diagnostic accuracy. International Organisation for Standardisation (ISO) standards emphasise systematic identification, analysis, and mitigation of risks across laboratory processes. However, many laboratories lack a practical, parameter-specific framework that can effectively eliminate risk factors linked to individual test parameters. Need of the study: Current risk management models are often theoretical and fail to provide benchmarking tools for severity assessment, leading to poor prioritisation and overlooked risks. The Unitised Risk Analysis Tool (URAT) integrates ISO standards with Failure Mode, Effects, and Criticality Analysis (FMECA) to enable parameter-specific risk evaluation and actionable outcomes. Aim: To compare the efficacy of the newly developed URAT with the conventional Failure Mode and Effects Analysis (FMEA) tool in a clinical laboratory setting. Materials and Methods: A prospective observational study will be conducted at Dattatraya Diagnostics Centre, Wardha, Maharashtra, India from May 2025 to April 2026. Data will be collected through real-time audits, structured checklists, interviews, and FMECA scoring. Risk Priority Numbers (RPN) will be calculated for each parameter. Comparative analysis between URAT and FMEA will use paired t-tests or Wilcoxon signed-rank tests, with categorical outcomes analysed by Chi-square or Fisher’s exact tests. Reliability will be assessed using Intraclass Correlation Coefficients (ICC) and weighted kappa statistics. Statistical significance will be set at p-value ≤0.05.

Evaluating Gugguladi Dhoopana Varti as an Adjunct to Khanduchakka Ointment in Postoperative Anorectal Wounds: A Randomised Controlled Trial Research Protocol

Sakshi Ghugul, Sheetal Asutkar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Postoperative anorectal wounds commonly arise from surgical procedures performed for conditions such as fissure-in-ano, haemorrhoids, perianal abscess, and fistula-in-ano. Due to persistent infection, pain, and delayed wound healing are associated with the complex anatomical site, their management remains challenging. Khanduchakka (Ehretia laevis Roxb.) is a herbal plant, also known as Ajan Vruksha, and is traditionally used for its wound healing and analgesic medicinal properties. Gugguladi Dhoopana Varti (fumigation therapy) also has wound-healing, antimicrobial, and anti-inflammatory properties. Need of the study: Dhoopana is described in classical Ayurvedic texts as an important modality for wound management due to its potential antimicrobial and healing properties. However, its application in the management of postoperative wounds has not been adequately evaluated through systematic clinical studies. There is need to evaluate the efficacy and safety of dhoopana when applied with Khanduchakka ointment in postoperative wound management, thereby generating clinical evidence to support its incorporation into contemporary practice. Aim: To evaluate the efficacy of adjunct effect of Gugguladi Dhoopana Varti with topical Khanduchakka ointment versus topical Khanduchakka ointment. Materials and Methods: A randomised controlled trial will be conducted in Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India, from December 2024 to June 2026, in which 60 patients will be enrolled. In the control group, topical Khanduchakka ointment will be applied twice a day for seven days, and in the interventional group, Gugguladi Dhoopana Varti with topical Khanduchakka ointment will be applied for 10 minutes twice a day for seven days over postoperative anorectal wounds. The parameters like wound bed, gandha or smell, discharge, pain, and itching will be evaluated. One-way Analysis of Variance (ANOVA), paired and unpaired t-tests, and the Chi-square (χ₂) test will be applied for statistical analysis. A p-value of <0.05 will be considered statistically significant.

Determination of Palatal Soft-tissue Thickness and Safe Zone for Soft-tissue Harvest using CBCT: A Study Protocol

Vaishnavi Dilip Tarpe, Suwarna Dangore Khasbage Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Introduction: Palatal soft-tissue grafts have become popular in periodontal and peri-implant plastic surgeries because of their predictability of the results along with favourable tissue parameters. Traditional methods are either invasive or lack precision, whereas Cone-Beam Computed Tomography (CBCT) offers a reliable, non invasive and three-dimensional evaluation. Need of the study: The studies have evaluated Palatal Mucosal Thickness (PMT) using different techniques, most have focused on isolated measurements without correlating PMT with anatomical factors such as palatal vault angle and position of greater palatine groove. There is limited data using standardised CBCT protocols. Therefore, the present study provides a comprehensive CBCT-based evaluation of PMT in relation to palatal anatomy to define a clinically relevant safe zone for soft-tissue harvesting, thereby enhancing surgical predictability and minimising complications. Aim: To evaluate PMT at different tooth sites and to determine the safe zone for palatal soft-tissue harvest with the help of CBCT. Materials and Methods: The retrospective cross-sectional study will be conducted in the Department of Oral Medicine and Radiology at Sharad Pawar Dental College, Wardha, Maharashtra, India, from January 2026 to December 2026. A total of 30 subjects will be included in the study. CBCT images will be retrieved retrospectively from departmental archives and analysed. The parameters to be evaluated will include PMT, palatal vault angle and distance from Cemento-Enamel Junction (CEJ) to greater palatine groove. PMT will be measured at 3 mm, 6 mm and 9 mm from the CEJ in the region extending from canine to second molar. Palatal vault angle will be classified as shallow, moderate, or deep based on predefined criteria. The distance between the palatal CEJ and the greater palatine groove will be assessed to determine the surgical safe zone for soft-tissue harvesting. The collected data will be tabulated and analysed using Chi-square test, Student’s paired, unpaired t-test, One-way Analysis of Variance (ANOVA) Tukey’s test to evaluate statistical significance regarding PMT and safe zone for tissue harvesting and p<0.05 will be considered statistically significant.

Point of Care Diagnostics for Hepatitis B and C in Low-resource Settings: A Narrative Review

Abhay Saraf, Sunita Girish, Rohini Adepwar Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) continue to be major public health challenge especially in Low- and Middle-Income Countries (LMICs), with poor laboratory capacity and the ability to detect the disease earlier and contribute to its management. Proper and timely diagnosis is crucial for clinical intervention and global elimination. The present narrative review explores the potential for the use of Point-Of-Care (POC) testing to enhance the testing of HBV and HCV in low-resource settings. Peer-reviewed literature, global health reports, and grey literature were reviewed to assess the state of the art of POC technologies, diagnostic performance, and implementation in resource-limited settings, as well as new developments. Existing challenges and future opportunities for improving access to timely and effective HBV and HCV diagnosis are also pointed out. New technologies and features, such as mobile healthcare integration, Artificial Intelligence (AI)-powered interpretation, and self-testing, enhance their capabilities. There are still areas of challenge, including uneven policy adoption, supply chain issues, and social stigma, that make it difficult to scale. POC diagnostics have the potential to accelerate hepatitis elimination by improving access to rapid testing. Their successful implementation requires strengthened health systems, trained healthcare workers, and integration into existing healthcare services.

Takotsubo Cardiomyopathy in Myasthenia Gravis-emergency Recognition and Management of a Life-threatening Overlap: A Narrative Review

Darshil Khared, Aditya Pundkar, Charuta Gadkari, Ritu Khandelwal Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Takotsubo Cardiomyopathy (TTC), also known as stress cardiomyopathy or broken heart syndrome, is a condition where temporary left ventricular dysfunction occur. This often happens because of emotional or physical stress. Myasthenia Gravis (MG) is an autoimmune disorder that affects the neuromuscular junction, causing fluctuating muscle weakness. Co-occurrence of these two conditions is rare. However, clinicians must distinguish between them, especially in an emergency. The present narrative review examines the unusual association between TTC and MG. This review focuses on rapid recognition in emergencies, the difficulties in diagnosing it, and how to manage this potentially fatal condition. The present review thoroughly examines existing literature, including case reports and systematic reviews. The authors examined articles discussing the co-occurrence of TTC and MG. The authors also examined their biological mechanisms, clinical presentation, diagnostic approaches, and treatment strategies. They thoroughly examined peer-reviewed journals from 2005 to 2025. The present analysis indicates that distinguishing between TTC and MG is difficult when both are present simultaneously. Key challenges include differentiating TTC from Myasthenic Crisis (MC) and determining the optimal management of acute cardiac complications in patients with MG. Providing supportive care and appropriate treatment is essential to helping patients recover from such emergencies. The discussion highlights the need to identify TTC early and to appropriately manage it in patients with MG, who are at risk of such emergencies. Other studies will strengthen clinical guidelines, empowering doctors to manage rare but deadly overlap disease cases more effectively.

Measurable Residual Disease in Acute Leukaemias: A Narrative Review on Specimen Adequacy, Assay Selection, Interpretive Pitfalls and Challenges for the Practicing Pathologist

Sneha Sukumar, Samarth Shukla, Sunita Vagha, Shailly Tiwari Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Measurable Residual Disease (MRD) is a key prognostic marker in acute leukaemias, guiding therapy and risk stratification. Even in morphologic remission, residual clones drive relapse, highlighting the need for sensitive, standardised detection. This narrative review synthesises evidence from PubMed, Embase, and Scopus (2000–2025) together with international guidelines from the European LeukaemiaNet (ELN), the National Comprehensive Cancer Network (NCCN), the World Health Organisation (WHO), and the EuroFlow Consortium (EuroFlow). Multiparameter Flow Cytometry (MFC) remains the frontline tool for its accessibility and speed, though challenged by haematogone overlap, immunophenotypic shifts, and CD19-negative relapse. Molecular assays {Quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR), Next-Generation Sequencing (NGS)} provide higher sensitivity but require caution in clonal haematopoiesis; DNMT3A, TET2, and ASXL1 mutations are excluded from Acute Myeloid Leukaemia (AML) Minimal Residual Disease (MRD) reporting. Standardised Breakpoint Cluster Region (BCR)::ABL Proto-Oncogene 1, Non-Receptor Tyrosine Kinase (ABL1) monitoring exemplifies harmonised molecular metrics, though broader consensus is needed. Comparative insights across B-precursor Acute Lymphoblastic Leukaemia (B-ALL), T-cell Acute Lymphoblastic Leukaemia (T-ALL) , AML, and related neoplasms reveal disease-specific thresholds. Emerging technologies, namely, digital PCR, error-corrected NGS, single-cell profiling, promise unprecedented resolution, positioning MRD as a cornerstone of precision therapy.

Anaesthetic Management of Tracheoesophageal Fistula: A Narrative Review of Principles, Challenges and Evolving Strategies

Repalli Leela Rajeswari, Sanjot Ninave, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Tracheoesophageal Fistula (TEF), which is usually associated with Oesophageal Atresia (EA), is known to be a common congenital anomaly requiring urgent surgical intervention in the neonatal period. Anaesthetic management of TEF repair is very challenging because of the pathological communication between the airway and gastrointestinal tract, immature neonatal physiology, as well as frequent association with congenital anomalies, especially cardiac defects. Key aspects include the embryological basis, anatomical classification and pathophysiological implications influencing protection ventilation and airway, along with risk stratification using established prognostic systems such as the Spitz classification. Preoperative evaluation which is focused upon stabilisation strategies for minimising aspiration as well as respiratory compromise, detailed assessment for associated anomalies and optimisation of metabolic and respiratory status. Intraoperative management emphasises strategies into airway control inclusive of distal endotracheal tube placement, fibreoptic bronchoscopy-guided localisation of the fistula, lung-protective ventilation for reduction of gastric insufflation and barotrauma. Postoperative anaesthetic and critical care management including decisions regarding elective ventilation, analgesia, monitoring and the prevention of complications such as anastomotic leak and recurrent fistula are also reviewed. Advancements such as opioid-sparing multimodal analgesia, minimally invasive surgery techniques as well as protocol-based multidisciplinary care pathways have contributed further in improved perioperative outcomes. Despite such developments there are significant gaps also remains into high-quality evidence further guiding optimal ventilation strategies, extubation criteria, long-term outcomes. This narrative review article highlights current practices, recent advances, future directions into research for evidence-based anaesthetic management of TEF repair.

Nebulised Dexmedetomidine for Patient Comfort and Satisfaction During Diagnostic Upper Gastrointestinal Endoscopy: A Narrative Review

Ajinkya Akulwar, Neeta Chaudhary Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Diagnostic upper gastrointestinal endoscopy often causes anxiety, gagging, coughing and procedural discomfort, which can reduce tolerance and impair procedural conditions. Nebulised dexmedetomidine has drawn interest as a non invasive premedication because it provides anxiolysis and sedation with minimal respiratory depression. The present narrative review examined the available evidence on its role in improving procedural tolerance and related outcomes during diagnostic upper gastrointestinal endoscopy. A literature search was performed across PubMed, Embase, Cochrane Library, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Studies involving adult and paediatric patients who received nebulised dexmedetomidine before endoscopy were reviewed, with emphasis on patient comfort, procedural ease, gag and cough suppression, sedative sparing effects and safety. The present narrative review provides a focused summary of the emerging evidence on nebulised dexmedetomidine during diagnostic upper gastrointestinal endoscopy, with emphasis on procedural tolerance, airway reflex suppression and safety in adult and paediatric populations. Larger multicentre studies with standardised outcome measures are needed to define its role more clearly.

Delineating the Mechanisms of Action of Copper-based Therapeutics: A Comprehensive Narrative Review

Kandarpa Kumar Saikia, Pragya Bhushan Sandilya, Arundhati Gogoi, Hemchandra Deka, Sikha Borah Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Copper-based therapeutics have emerged as a promising frontier in modern metallopharmaceutical research. Copper possesses properties of unique redox activity, coordination flexibility, and multifaceted biological functions. This review discusses the metabolic significance of essential metals in human physiology, with particular emphasis on copper and its therapeutic potential. Copper plays indispensable roles in mitochondrial respiration, antioxidant defence, neurotransmitter synthesis, connective tissue formation, and iron metabolism through various copper-dependent enzymes and transport systems. The dualistic nature of copper, being both essential and potentially cytotoxic, forms the mechanistic basis for its biomedical applications. Copper complexes, nanoparticles, ionophores, and chelators exhibit remarkable anticancer and antimicrobial properties by inducing Reactive Oxygen Species (ROS) generation, DNA damage, proteasome inhibition, mitochondrial dysfunction, and the recently identified pathway of cuproptosis. Furthermore, advancements in nanotechnology and targeted delivery systems have improved the specificity, bioavailability, and therapeutic efficacy of copper-based agents while minimising systemic toxicity. Despite challenges related to stability and controlled delivery, copper therapeutics represent a highly versatile and cost-effective approach for combating cancer, multidrug-resistant infections, and redox-associated diseases. This review finds its necessity for a comprehensive understanding of copper metabolism, biological functions and its therapeutic applications. It highlights the growing significance of copper-based therapeutics in next-generation medicinal chemistry and translational biomedical research.

Pentalogy of Cantrell: A Narrative Review of Aetiopathogenesis, Diagnostic Advances and Contemporary Management Strategies

Shailabh, Imran Ali Khan, Anup Zade, Yashasvi Trivedi, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X Pentalogy of Cantrell (POC) is known as an extremely rare congenital disorder which is characterised by a distinctive constellation of five midline defects involving anterior abdominal wall, lower sternum, anterior diaphragm, diaphragmatic pericardium and heart, often accompanied by complex intracardiac anomalies. The clinical spectrum of POC usually ranges from complete forms exhibiting all five defects to incomplete type having partial expression thus contributing towards significant heterogeneity in presentation and outcomes. The present narrative review article summarises current understanding of embryologic and molecular basis of POC thereby highlighting the role of early mesodermal developmental failure during the first weeks of gestation. Advances in prenatal diagnosis using ultrasonography, foetal echocardiography, Three-Dimensional (3D) imaging as well as foetal magnetic resonance imaging have improved early detection, anatomical delineation along with prognostic assessment. Postnatal imaging supports into comprehensive evaluation and surgical planning of POC cases. Management of POC thus remains primarily surgical while it also needs a coordinated multidisciplinary approach inclusive of prenatal counselling, neonatal intensive care, cardiology and paediatric surgery. Both single-stage as well as staged surgical strategies are used based upon disease severity, patient stability along with emerging perinatal and foetal interventions offering potential benefits in selected cases. Despite improvements in diagnostic as well as therapeutic modalities, prognosis remains variable which is closely linked to the severity of intracardiac and thoraco-abdominal defects. Continued research focusing on genetic mechanisms, long-term outcomes, standardised management protocols is said to be an essential aspect to optimise care and improve survival, quality of life in patients having POC.

Retinol-binding Protein 4 and Diabetes Mellitus: A Review on Current Understanding and Clinical Importance

Roshan Takhelmayum, KM Tullanithi, Robby Kumar, Jyoti E John Journal of clinical and diagnostic research : 2026 - October - 20:0973-709X The Retinol-binding Protein 4 (RBP4) has evolved as an important metabolic signal associated with insulin resistance and diabetes mellitus. Research shows that RBP4 increases early in metabolic stress and thus a potential marker for identifying individuals at risk for type 2 diabetes, gestational diabetes, and diabetic nephropathy. The present review highlights the RBP4’s biological function, its relationship with different states of glucose intolerance, and its potential clinical utility. RBP4 regulates various metabolic pathways which include impairing Glucose Transporter 4 (GLUT4) translocation, enhancing hepatic glucose production and inducing inflammatory pathways. These molecular effect explain the elevated serum RBP4 level in insulin-resistant states and rises even before the changes in fasting glucose or HbA1c. In type 2 diabetes, elevated RBP4 level associates with insulin resistance, dyslipidaemia, and central obesity. During pregnancy, women with elevated RBP4 in the first trimester develop gestational diabetes later, indicating that metabolic changes begin even before routine screening may detect. In diabetic nephropathy, RBP4 reflects early tubular injury and may rise prior to the onset of microalbuminuria. Currently, RBP4 has been considered as a sensitive marker of early metabolic disturbance and renal stress. Prospective studies with larger cohorts and standardised assay can establish RBP4 as part of multimarker panels for predicting diabetes mellitus and monitoring high-risk pregnancy and early kidney and vascular damage. The present review brings into perspective the biological relevance of RBP4, summarises its clinical correlates, and addresses the key challenges that need to be resolved before this protein finds routine applications in diabetes mellitus management.