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

A Case Report of Cantu Syndrome Highlighting the Importance of Genetic Sequencing in Addition to Radiological Testing

Sriranjani Srinivasan, Revathi Nachiappan, Sivakumar Krishnaswamy Vijayaramanujam, Jayakumar Muthaiyan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X An infant initially suspected to have glutaric aciduria was later diagnosed with Cantu syndrome and found to be a carrier of Congenital Disorder of Glycosylation Type 1j. This case involved a five-month-old male infant with Atrial Septal Defect (ASD) and Patent Ductus Arteriosus (PDA) who was under treatment and admitted with a history of recurrent respiratory tract infections, developmental delay, and dysmorphic facies. A metabolic workup was performed. Computed Tomography (CT) brain showed features suggestive of glutaric aciduria; however, MRI brain revealed tortuosity of the cerebral vessels, which was inconsistent with that diagnosis. Hence, Whole Exome Sequencing (WES) was performed. The WES revealed a pathogenic variant in the ABCC9 gene, which is pathognomonic of Cantu syndrome. It also showed a pathogenic variant in the DPAGT1 gene, diagnostic of Congenital Disorder of Glycosylation Type 1j. This is the first reported case in which both mutations were identified in the same patient. WES was subsequently performed for the parents, and the infant’s father was found to have heterozygous pathogenic variants in both genes identified in the proband. This study emphasises the importance of genetic sequencing in establishing an early and accurate diagnosis, thereby enabling disease-specific novel treatment approaches and long-term follow-up.

Multimodal Ayurvedic Management of Bilateral Non Traumatic Avascular Necrosis of Femoral Head with Associated Skin Disorder: A Case Report

Divya Uttam Jadhav, Amit Ashok Paliwal, Sanjay Chandrakant Babar, Mahesh Pandurang Jadhav, Priyanka Dushyant Patil Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X In the femoral head, disruption of vascularity deprives bone cells of oxygen and nutrients, leading to osteocyte death, bone weakening, and eventual collapse. This pathophysiology forms the basis of Avascular Necrosis (AVN), a progressive disorder commonly seen in young adults. Risk factors include trauma, corticosteroid therapy, alcohol and tobacco use, etc. AVN of the femoral head is a progressive condition characterised by compromised blood supply leading to osteocyte death and structural collapse. In this case report a 32-year-old male presented with bilateral, non traumatic AVN of the femoral head—stage 3 on the right and stage 2 on the left—accompanied by severe pain, limited mobility, and poor quality of life. His history included prolonged corticosteroid use for a chronic skin condition, prior COVID-19 infection, and tobacco use. After unsatisfactory response to allopathic management, the patient opted for Ayurvedic treatment. Ayurvedic diagnosis was Asthi-Majjagata Vata with Twaka Vikara (Tridoshaj kushtha) and Raktavaha Strotodushti. The treatment approach integrated Shamana Chikitsa (oral medications), Shodhana Chikitsa (detoxification through kala basti), and Jalaukavacharana (leech therapy) over six months. Herbal medications like Dashamoola Kwatha, Kaishor Guggulu, Panchatikta Ghrita Guggulu, Asthiposhak Vati, and Avipattikar Churna were administered. Basti therapy, using a combination of medicated milk, oils, and decoctions, was provided in a 16-day Kala Basti regimen. Leech therapy was given biweekly to enhance circulation and reduce inflammation. Significant improvements were observed post-treatment. Pain scores on the Visual Analogue Scale (VAS) dropped from 10 to 2. Range of motion in both hips increased markedly. Straight Leg Raise (SLR) test improved from 20° to 90° on the right and from 90° to 120° on the left. The patient regained the ability to walk independently, and his sleep and digestion also normalised. Concurrently, the chronic skin condition showed resolution, eliminating the need for corticosteroids. This case highlights the effectiveness of a multidimensional Ayurvedic approach in managing non traumatic AVN, not only arresting disease progression but also enhancing joint function, systemic health, and quality of life.

Short-chain Acyl-CoA Dehydrogenase Deficiency in a Child: A Case Report

Sanjay Chavan, Sadhu Pooja, Suresha, Sarnya Verma, Shailaja Mane Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Short-chain 3-Hydroxyacyl-CoA Dehydrogenase (SCHAD) enzyme deficiency is an autosomal recessive inborn error of metabolism affecting mitochondrial Fatty Acid Oxidation (FAO). In this condition, the body fails to produce energy from fats during times of stress. Effective energy production relies on the mitochondrial β-oxidation of fatty acids, which is especially crucial during periods of fasting, infections, and other metabolic stressors. Children with this deficiency often present with transient and nonspecific symptoms. Here, we present the case of a five-year-old male child with a recurrent history of seizures, persistent hypoglycaemia, metabolic acidosis with hypotension requiring inotropic support, and a deteriorating Glasgow Coma Scale score necessitating mechanical ventilation. Upon evaluation, he was found to have hypoinsulinemia, and his electroencephalogram suggested encephalopathy. After ruling out sepsis, hyperinsulinaemia, and meningoencephalitis, inborn errors of metabolism were suspected, with a fatty acid oxidation defect being the most likely diagnosis. The patient was ultimately diagnosed with SCHAD deficiency using Gas Chromatography-Mass Spectrometry Tandem Mass Spectrometry (GCMS-TMS). The potential for rapid deterioration associated with SCHAD deficiency underscores the need for prompt evaluation and intervention, which are essential for early diagnosis and favourable outcomes to prevent morbidity and mortality. The serious complications associated with this condition also highlight the necessity for newborn screening for inborn errors of metabolism.

Gastric Mucormycosis in an Immunocompetent Patient Masquerading as Peptic Ulcer Disease: A Case Report

Venkata Koti Reddy Chennapareddy, S Shanmughanathan, AK Koushik, Sai Dheeraj Mulpuri, KM Farhanulla Basha Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X The present case describes a 42-year-old previously healthy male who presented with two weeks of dull epigastric pain, nausea, and melena. On examination, he was pale but haemodynamically stable. Laboratory evaluation revealed iron deficiency anaemia, while other haematological, renal, and liver parameters were within normal limits. Upper gastrointestinal endoscopy demonstrated two large antral ulcers with irregular margins, necrotic bases, and surrounding mucosal oedema. Histopathology confirmed gastric mucormycosis, showing broad aseptate fungal hyphae with right-angle branching, highlighted by Periodic Acid-Schiff (PAS) and Grocott’s Methenamine Silver (GMS) staining. The patient was treated with intravenous liposomal amphotericin B (5 mg/kg/day) for 21 days, followed by oral posaconazole (300 mg daily) for six weeks. Clinical improvement occurred within 10 days. Follow-up endoscopy at three months showed complete ulcer healing, and at six months, the patient remained asymptomatic with no evidence of recurrence. The present case emphasises that gastric mucormycosis, although rare, can occur in immunocompetent individuals. Early endoscopic biopsy and prompt initiation of antifungal therapy are crucial, and selected cases may achieve successful outcomes with medical management alone, without surgical intervention.

Adenoid Cystic Carcinoma of Sphenoid Sinus with Dural Extension Misleading as Meningioma: A Case Report

Ajit Kumar Singh, Urmila Senapati, Surender Singh Dhankhar, Dipti Ranjan Satapathy Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Adenoid Cystic Carcinoma (ACC) of the salivary gland is very rare malignant tumour, accounting for less than 1% of the head and neck malignancies. It usually arises from the minor salivary gland present in the epithelium of the nasal cavity to paranasal sinuses. Females between 40 and 60 years of the age are usually affected. Intracranial extension of these tumours is extremely rare and often leads to misdiagnosis as brain tumours during initial evaluation. The present case was of a 33-year-old male who presented with complaints of reeling of head, headache, and blurring of vision in left eye for seven months. Magnetic Resonance Imaging (MRI) revealed a hypointense extra-axial dural-based lesion with calcification. The lesion extended into the left cavernous sinus, sphenoid sinus, and the wall of the nasopharynx. The patient underwent surgical excision based on radiological diagnosis of meningioma. Microscopic examination of the tumour tissue revealed basaloid tumour cells arranged in cribriform, acinar, and mucinous pattern. The tumour cells exhibited a high Nuclear-to-Cytoplasmic (N/C) ratio, scant cytoplasm, and hyperchromatic angulated nuclei. No evidence of meningothelial cells noticed in the examined sections. Based on these histomorphological findings, a diagnosis of ACC was made. Immunohistochemistry (IHC) was done to support the diagnosis. It remained positive for Pan-Cytokeratin (Pan-CK) and negative for p63. Given the rarity of ACC, its occurrence in sphenoid sinus with dural extension can mislead radiologist and clinicians into diagnosing meningioma, which led to an urge to presentation of this case.

Nephrotic Syndrome Secondary to Rheumatoid Arthritis in a Known Case of Dilated Cardiomyopathy: A Diagnostic Insight

Siddharth Shah, Sunil Kumar, Devanshi Maru, Yash Anand Chordia Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disease that primarily affects joints but can lead to extra-articular complications, including renal and cardiac involvement, which can significantly impact patient prognosis. This case report describes a 44-year-old woman with a 15-year history of poorly controlled RA, characterised by multiple rheumatic nodules and inconsistent treatment adherence. She was diagnosed with Dilated Cardiomyopathy (DCMP) one year prior, with an ejection fraction of 20%, and presented with progressive bilateral pedal oedema and dyspnoea. Clinical examination revealed hepatomegaly and multiple joint nodules. Laboratory investigations showed hypoalbuminaemia, severe dyslipidaemia, and nephrotic-range proteinuria. Renal biopsy, including light microscopy, immunofluorescence, and electron microscopy, confirmed stage I membranous nephropathy secondary to RA, with negative PLA2R staining indicating a secondary aetiology rather than primary membranous nephropathy. The co-existence of DCMP and membranous nephropathy posed diagnostic and management challenges, as symptoms overlapped between cardiac and renal dysfunction. This rare combination highlights the need for comprehensive evaluation in patients with long-standing autoimmune diseases to identify uncommon renal manifestations early. Reporting this case underscores the importance of multidisciplinary care in complex comorbidities and the potential benefits of screening RA patients for renal involvement, particularly those with poor disease control, to improve outcomes and prevent progression.

Anaesthetic Considerations for a Patient with Kartagener’s Syndrome Undergoing Emergency Surgery: A Case Report

Hansikaa Ravichandran1, P Nandhini, P Rani Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Kartagener Syndrome (KS) is a rare genetic disorder resulting from autosomal recessive inheritance and is characterised by ciliary dyskinesia. It typically presents with the distinctive triad of chronic sinusitis, situs inversus, and bronchiectasis. KS poses distinct challenges during the perioperative period due to its potential impact on pulmonary function and cardiovascular anatomy. The present case details the successful perioperative management of a 55-year-old male patient with KS who underwent emergency knee-spanning external-fixator application under regional anaesthesia. The patient’s medical history included a chronic diagnosis of bronchiectasis, for which he was on irregular medications. His clinical examination revealed Grade 2 digital clubbing. Auscultation findings included heart sounds auscultated on the right hemithorax, with the apical impulse palpable in the right fourth intercostal space, indicative of dextrocardia associated with situs inversus. Diagnosis of Kartagener syndrome was confirmed with Computed Tomography (CT), which showed the cardiac apex and aortic notch on the right side and bronchiectasis changes predominantly involving the bilateral lower lobes. Given the immediate need for surgery, neuraxial anaesthesia under ultrasound guidance was planned to address the patient’s complex respiratory profile. In this case, employing a combined spinal-epidural anaesthesia technique facilitated effective pain management and haemodynamic stability while minimising the respiratory complications typically associated with general anaesthesia.

Awake Fibreoptic Intubation in a Patient with Oral Submucous Fibrosis with a Full Stomach Posted for Emergency Laparotomy: A Case Report

Akondi Sai Hrudaya Harshitha, KrishnaMoorthy Karthik, Thalikota Sai Deekshith, Karthik Lakshme Sanjana Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Oral Submucous Fibrosis (OSMF) with temporomandibular joint ankylosis presents significant challenges to airway management due to restricted mouth opening and fibrosis involving the oropharyngeal tissues. The situation becomes more critical in emergency surgeries with a full stomach, where the risk of aspiration further complicates airway planning. This was a case of a 56-year-old female with known OSMF and restricted mouth opening posted for emergency laparotomy due to a faecal fistula formation at the laparoscopic cholecystectomy port site. Given the anticipated difficult airway and full-stomach status, Awake Fibreoptic Intubation (AFOI) was planned and successfully executed. Awake fibreoptic intubation remains the gold standard in managing anticipated difficult airways, especially when complicated by additional risks like upper airway tumours or infections, cervical spine instability, congenital facial abnormalities, previous difficult intubation, and emergency conditions involving a full stomach where aspiration risk is high. This case reinforced its value in ensuring patient safety in emergency surgical scenarios.

Effect of Functional Electrical Stimulation combined with Treadmill Training and Challenging Tasks in a Patient with Stroke: A Case Report

Deepanshi Srivastava, Avi Choudhary, Jaishree, Himani Kaushik, Arushi Verma Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Stroke is one of the leading causes of death globally. Advancements in medical science and technology have contributed to a reduction in the mortality rate among individuals who have experienced a stroke. The present study presents findings from a single case report employing a single-subject research design. To achieve optimal rehabilitation outcomes, Functional Electrical Stimulation (FES) was incorporated with Treadmill Training (TT), accompanied by challenging tasks during physiotherapy. Hereby, the authors present a case report of a 66-year-old male post-stroke patient with left-sided weakness, impaired grip strength, and mobility issues following a right Middle Cerebral Artery (MCA) ischaemic stroke. His medical history includes type 2 diabetes mellitus and systemic hypertension, with no significant family medical history reported. The patient presented with notable motor deficits and functional limitations resulting from the right MCA ischaemic stroke. Interventions targeting spasticity reduction, muscle strengthening, endurance, and gait retraining were essential to improve the patient’s functional mobility and overall quality of life. The findings revealed significant improvement in various outcome measures, including the Modified Ashworth Scale (MAS), Voluntary Motor Control (VMC), Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and Functional Independence Measure (FIM), indicating positive changes and enhanced quality of life in stroke survivors. The cumulative effect of FES and TT with challenging tasks can significantly improve gait, muscle strength, and balance in patients recovering from stroke.

Ultrasound-guided Femoral Nerve Block for Positioning in a Parturient with Sickle Cell Disease and Hip Fracture: A Case Report

Sivani Dasari, Sanjot Ninave, Amol Narayan Bele Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X The anaesthetic management of parturients with sickle cell disease is fraught with significant challenges, with an increased perioperative risk of complications such as vaso-occlusive crisis, acute chest syndrome, and thromboembolism. An associated orthopaedic injury adds another layer to perioperative planning, demanding an individualised approach to maximise analgesia, enable appropriate positioning for anaesthesia, and ensure haemodynamic stability. This case discusses the anaesthetic management of a 22-year-old primigravida with sickle cell disease and hypothyroidism and a right femoral neck fracture who underwent elective caesarean section. Since positioning for neuraxial anaesthesia would be problematic due to pain and limited mobility, an ultrasound-guided femoral nerve block was performed using 15 mL of 2% lignocaine. This permitted the patient to be positioned in the sitting position for spinal anaesthesia without discomfort. Spinal anaesthesia was administered with 1.6 mL of 0.5% hyperbaric bupivacaine and 25 μg fentanyl, achieving a sensory block up to T6. The intraoperative course was uneventful, and haemodynamics were stable. A healthy newborn was delivered with good Apgar scores. Postoperative care involved adequate analgesia, hydration, oxygenation, and early prophylaxis for thromboembolism. The postoperative course was uneventful, with no sickle cell-related complications, and both mother and infant were discharged in stable condition. The case demonstrates the effectiveness of a combined regional anaesthesia technique in enhancing perioperative management in high-risk obstetric patients. The use of a femoral nerve block as an adjunct to spinal anaesthesia was a valuable, efficient, and safe procedure that minimised pain and enhanced the patient’s comfort, contributing to a favourable surgical outcome.

Advancing Mandibular Growth and Aesthetic Harmony in Post-pubertal Class-II Malocclusion, a Non Extraction Treatment with AdvanSync™ 2: A Case Report

Nikita Soni, Priyanka Niranjane, Ranjit Kamble, Smita Kumari Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Skeletal Class-II malocclusion is a prevalent type of malocclusion characterised by either a retrognathic mandible, a prognathic maxilla, or both. The present orthodontic case study describes a 15-year-old female patient with a Class II malocclusion and a retrognathic mandible, accompanied by rotated teeth, increased overjet and overbite. The patient presented with a pronounced mentolabial sulcus, a steep nasolabial angle and a convex facial profile. Cephalometric examination revealed a Class II skeletal base and limited growth potential, indicated by Cervical Vertebral Maturation Index (CVMI) Stage V. The treatment employed a non extraction, non surgical strategy using 0.022-inch McLaughlin, Bennett, and Trevisi (MBT) self-ligating brackets and the AdvanSync™ 2 hybrid Fixed Functional Appliance (FFA). This approach improved the mandible and arch alignment to correct skeletal and dental discrepancies. Treatment resulted in the establishment of a Class I canine and molar relationship, correction of rotations and expansion of the dental arches. Cephalometric analysis revealed a decrease in the A point, Nasion, B point (ANB) angle, an increase in the Sella-Nasion-B (SNB) angle and an increased mandibular length, reflecting significant skeletal advancement. The case demonstrates the effectiveness of the AdvanSync™ 2 appliance in post-pubertal patients when growth is no longer a significant factor in treatment. It underscores the value of integrating FFAs with self-ligating systems to achieve predictable and efficient skeletal and dental corrections, emphasising patient comfort and non surgical intervention in managing skeletal Class-II malocclusions.

N-Acetylcysteine as an Adjunct to Cognitive Behavioural Therapy (CBT) and Selective Serotonin Reuptake Inhibitor (SSRI) in Gaming Addiction: A Case Report

Akkash Kumar Ravichandran, Chamelee Anbu Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Internet Gaming Disorder (IGD) is increasingly recognised as a behavioural addiction in adolescents. It is often linked to academic decline, social withdrawal, irritability, and mood disturbances. Psychotherapy remains the primary treatment approach, but pharmacological options are under exploration. A 16-year-old boy presented with a two-year history of excessive online gaming, progressive academic failure, irritability, disturbed sleep, and low self-esteem. He fulfilled Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria for IGD and had moderate depressive symptoms (HAM-D score 18). His Internet Gaming Disorder Scale–Short Form (IGDS9-SF) score was 36, above the clinical cut-off. Management involved six sessions of Cognitive Behavioural Therapy (CBT), family psychoeducation, and pharmacological support with N-Acetylcysteine (NAC) 600 mg/day and escitalopram. Over three months, his HAM-D score reduced to 7 and IGDS9-SF to 14, alongside clear improvements in mood, family interaction, and school attendance. The case illustrates the potential role of NAC as an adjunct to psychotherapy and a Selective Serotonin Reuptake Inhibitor (SSRI) in IGD. Through modulation of glutamatergic pathways, NAC may reduce cravings and compulsive behaviours, enhance recovery when combined with psychotherapy and family support.

Non Surgical Management of Immature Teeth with Large Periapical Radiolucency using Combined Regenerative and Conventional Endodontic Therapy: A Case Report with 2-year Follow-up

Amrita Ghosh, Nirmalya Chatterjee, Binayak Saha, Kuntal Chowdhury Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Treatment of immature permanent teeth with blunderbuss apices and thin dentinal walls remains an enigma for endodontists. Various treatment modalities have been used to manage immature teeth, such as non vital pulp therapy with calcium hydroxide or apexification using Mineral Trioxide Aggregate (MTA), Biodentine, or bioceramic putty. However, these methods fail to address the problem of thin dentinal walls, which often leads to tooth fracture and extraction despite successful initial treatment. Regenerative Endodontic Procedures (REPs) offer the best solution for such cases, with the potential to re-establish the dentin-pulp complex, thereby facilitating apexogenesis and root maturation. The development of second-generation platelet concentrates such as Platelet-Rich Fibrin (PRF) has made the success of REPs more predictable compared to procedures that rely solely on induced intracanal bleeding. A 25-year-old female patient presented with pain and swelling in the upper anterior region, with a history of childhood trauma 17 years earlier and recent incomplete dental treatment. Clinical and radiographic examination revealed tenderness on percussion and a well-defined periapical radiolucency (~10×12 mm) involving teeth #21 and #22. Tooth #21 exhibited an open apex and a necrotic pulp, while tooth #22 had previously undergone root canal treatment. A working diagnosis of periapical pathology secondary to pulpal necrosis was made. A Regenerative Endodontic Procedure (REP) was planned for tooth #21, while tooth #22 was left untreated due to satisfactory restoration and obturation. Following disinfection using 1.5% sodium hypochlorite and placement of an interim calcium hydroxide dressing over three visits, Platelet-Rich Fibrin (PRF) prepared from autologous blood was placed as a scaffold. A collagen plug was positioned over the PRF, followed by a 3 mm layer of MTA, and the tooth was sealed with resin-modified glass ionomer cement. Follow-ups at 3, 6, 12, and 24 months revealed complete resolution of the periapical radiolucency with apical closure of tooth #21. The tooth remained asymptomatic and functional, although no response to pulp vitality tests was observed. Regenerative endodontic treatment can be successfully performed alongside conventional endodontic therapy in managing immature permanent teeth with periapical radiolucency. Two teeth involved in the same lesion can be effectively treated using different treatment modalities, and prior conventional endodontic intervention does not hinder the future success of regenerative endodontics.

Unusual Clinical Presentation of Dermatomyositis in a Young Male: A Case Report

Priyanka Singla, Aishwarya Biradar, Vinod Shinde, Manu S Babu, Mayur Ingle Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterised by distinctive dermatological manifestations and systemic involvement. This present case report involved a 25-year-old male was presented with throat pain, progressive dysphagia, and oral ulcers following a recent tooth extraction. Examination revealed ulceroproliferative lesions in the retromolar trigone that were prone to bleeding. This case emphasised an unusual presentation of DM with oropharyngeal ulcerations and leukocytoclastic vasculitis. Prompt recognition, comprehensive evaluation, and multidisciplinary management are essential for improving patient outcomes in atypical cases.

Idiopathic Intracranial Hypertension Secondary to Methotrexate in a Young Child with Juvenile Idiopathic Arthritis: A Rare Case Report

Ritika Singh, Naman Jain, Shuchi Mehra, Kapil Bhalla Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Idiopathic Intracranial Hypertension (IIH) is characterised by the signs and symptoms of increased intracranial pressure, but where a causative mass or hydrocephalus is not identified. It is also known as pseudotumor cerebri, a rare neurological disorder in children, which, if not treated properly, may lead to severe visual dysfunction. A 6-year-old male child presented with a 2-month history of progressively increasing joint pain and intermittent low-grade fever. After comprehensive evaluation and ruling out infectious, malignant, and systemic autoimmune disorders, the diagnosis of Juvenile Idiopathic Arthritis (JIA) was established and the Disease-Modifying Anti-Rheumatic Drug (DMARDs) for management drug Methotrexate was initiated. On follow-up, the child was diagnosed to have IIH for which, after detailed investigation, no cause was found and then it was ascribed to be caused by methotrexate and hence the drug was withheld. He was started on Acetazolamide subsequent to which there was resolution of symptoms. Clinicians should be aware of a potential, although rare, side effect of DMARDs like methotrexate and advise caregivers of children with chronic disorders like JIA to be on regular follow-up for early recognition of serious side effects, which would thereby halt any potential fatal or life-altering condition.

Perioperative Management of Emergency Off-pump Coronary Artery Bypass Grafting in a Patient with Pan-reactive Red Blood Cell Alloantibodies: A Case Report

Kiran Muthu Rajah, V Rajesh Kumar Kodali, Ranjith B Karthekeyan, Kamalakannan Ganapathy Sambandham, R Krishnamoorthy Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Red Blood Cell (RBC) alloimmunisation poses critical challenges in cardiac surgery, particularly during emergency Coronary Artery Bypass Grafting (CABG), due to the risks of haemolytic reactions and incompatible transfusions. This case report details the perioperative management of a 67-year-old female with severe triple-vessel coronary artery disease, left main stenosis, and pan-reactive RBC alloantibodies, who underwent emergency off-pump CABG without allogeneic transfusion. The patient presented with progressive retrosternal chest pain radiating to the left arm, lasting 4 hours, against a background of Type 2 Diabetes Mellitus (T2DM) and systemic hypertension. The electrocardiogram showed ST-segment depression and T-wave inversion in Leads I, aVL, V4, V5, and V6. Coronary angiography revealed ostial left main 80-90% stenosis, proximal left anterior descending artery 80%, mid-segment 90%, proximal ramus intermedius 60-70%, proximal left circumflex artery 80%, and right coronary artery ostial 80-90% with mid-segment 90% lesions. Echocardiography indicated hypokinesia in the basal and mid inferoseptal and inferolateral walls, mild left ventricular systolic dysfunction (ejection fraction 48%), grade 2 diastolic dysfunction, and mild mitral and tricuspid regurgitation, along with mild pulmonary hypertension. The preoperative haemoglobin level was 9.5 g/dL, and the blood group was B positive. A blood sample from the patient was sent for crossmatching for potential intraoperative transfusion. The indirect Coombs test with an 11-cell panel confirmed pan-reactive alloantibodies, rendering all screened units incompatible. The uniqueness of this case lies in the emergent setting with ongoing chest pain and moderate left ventricular dysfunction, where routine crossmatching failed across 20 donor units. This situation necessitated exclusive reliance on intraoperative cell salvage in conjunction with a multidisciplinary team approach—a strategy rarely documented in such high-risk, pan-reactive antibody scenarios in cardiac surgery.

Role of Shirodhara Karma in the Management of Anidra (Insomnia): A Case Report

Abhishek, Anup Jain, Arun Gupta, Ashok Madan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Anidra in Ayurveda can be recognised both as a symptom as well as a disorder. Anidra occurs due to the imbalance of Vata and Pitta dosha. This case highlights the management of a 48-year-old male patient suffering from chronic insomnia along with symptoms like vertigo, nausea and irregular bowel movement who did not respond to conventional treatment like benzodiazepines, antidepressants and antihistamines. A treatment plan was curated for this case, including Shirodhara with Jatamansi Sidhha Taila for a continuous period of 14 days. It is a medicated oil known for its calming and sleep-inducing properties. The procedure involves continuously pouring warm oil on the forehead (Sthapani Marma) after performing a whole-body Abhyanga and Swedana. Post-treatment assessments of the patients show significant improvement in sleep quality and duration, as evidenced by a reduction in the insomnia severity index scale from 23 (State of severe insomnia) to 7 (State of no clinically significant insomnia) after a 28-day follow-up. The associated symptoms, which seemed to be associated with the improper sleep cycle, were also resolved with no side effects. This case study shows promising results of the Jatamansi Sidhha Taila Shirodhara as an effective alternative therapy for Anidra, especially in cases resistant to conventional management. Further clinical studies are needed to validate these findings and explore the underlying mechanisms.

Idiopathic Non-hormonal Clitoromegaly in a Young Female: A Case Report

Naganitya Vangala, Adarshlata Singh, Bhushan Madke, Sree Ramya Talasila, Soham Meghe Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Clitoromegaly may be either congenital or acquired and is primarily caused by elevated androgen levels during foetal development, childhood, or puberty. We describe an unusual case of clitoromegaly in a young female who presented with genital pruritus, without any other significant clinical findings. Clitoromegaly is a rare condition, and in this case, the diagnosis was established following thorough physical examination, radiological imaging, and comprehensive laboratory investigations. The patient was diagnosed with acquired, idiopathic, non-hormonal clitoromegaly- an uncommon condition. This diagnosis can only be made after systematically ruling out all other potential causes.

Foreign Body Giant Cell Reaction with Multi Drug Resistance to Anaerobic Bacteria in Maxillofacial Region: An Unusual Case Report

Kottu Pavanika, Kanur Arjun Gopinath, Vaaka Phani Himaja Devi, Kotipalli Manikanta, Chitranjali Sunchu Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Foreign Body Giant Cells (FBGCs) are most commonly observed at the tissue/material interface, where the size of foreign particulate is too large to permit macrophage phagocytosis. The insertion of foreign bodies into human oral and perioral tissues may originate from traumatic events, postoperative dental procedures. When the infection caused by Pseudomonas aeruginosa occurs in these conditions, it can result in life-threatening conditions due to its variable antibiotic resistance, and the treatment is questionable. Here, we report a case of FBGC reaction with multidrug resistance in a 35-year-old female patient postoperatively, who has undergone Open Reduction and Internal Fixation (ORIF) under general anaesthesia for midfacial fracture.

Atypical Neurological Presentation in Brucellosis: A Rare Case Report

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Amit Chauhan, Mittal Sindhav Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Neurobrucellosis is an atypical and grave complication of brucellosis. It can present with a wide range of neurological symptoms, often mimicking other Central Nervous System (CNS) disorders, making diagnosis challenging. The present case report describes neurobrucellosis in a 47-year-old male who presented with atypical neurological symptoms, including depressed mood, dysarthric speech, increased sleepiness for 15 days, and altered sensorium for two days. Initial investigations, including routine Cerebrospinal Fluid (CSF) analysis, were non-contributory, and neuroimaging suggested acute encephalopathy with acute lacunar infarct. However, a high index of clinical suspicion due to his occupation as a farmer with cattle exposure led to advanced serological testing, which showed positive Brucella Immunoglobulin M (IgM), confirming Brucella infection. The patient was diagnosed with neurobrucellosis and responded favourably to a prolonged course of combination antibiotic therapy. This case underscores the need to include neurobrucellosis in the differential diagnosis of unexplained neurological symptoms, particularly in endemic areas or when there is a history of potential, even minimal, exposure.

Total Shoulder Arthroplasty in a 32-year-old Female with Fibrolipoma: A Case Report

Shashank Yadav, Gajanan L Pisulkar, Dhairya Vijay Veragiwala, K Neelaksh, Krishna D Sambare Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Fibrolipomas are rare benign soft-tissue tumours composed of mature adipose and fibrous tissue. Their presence in the shoulder joint is exceptionally uncommon. A 32-year-old female presented with progressive right shoulder pain and restricted motion for one year. Imaging and histopathology confirmed the diagnosis of fibrolipoma with joint surface destruction. The patient underwent surgical excision followed by Total Shoulder Arthroplasty (TSA). Postoperative recovery was uneventful, with marked improvement in pain relief and range of motion at the six-month follow-up. This case highlights that although fibrolipomas are benign, they can cause significant articular degeneration, potentially requiring arthroplasty. Accurate diagnosis, preoperative planning, and careful surgical execution are crucial for achieving excellent outcomes in young patients.

Tackling the Tenderness: A Case Report of Oral Presentation of Myelodysplastic Syndrome

S Aravind Warrier, S Harini, A Steve Thomas, J Karna, S Sushmitha Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X The Myeloidysplastic Syndromes (MDS) are a collection of haematological conditions characterised by pancytopenia, dysplasia of erythrocyte, leucocyte and megakaryocyte lineages (trilineage dysplasia) and bone marrow hypercellularity. MDS is often known as “smoldering leukaemia” and is therefore regarded as a preleukaemic syndrome, with a high risk of progression to Acute Myeloid Leukaemia (AML). However, it is regarded as a condition with a minimal propensity for malignancy in contrast to other aggressive haematology cancers. A case of 64-year-old male reported with ulcers in the mouth secondary to myelodysplatic syndrome. The patient was treated symptomatically and is currently under follow-up. Myelodysplastic illnesses are a subset of haematological malignancies, MDS is regarded as having a relatively low propensity for transformation. Oral manifestations in MDS may include ulcers, opportunistic infections and spontaneous gingival bleeding, which can result from pancytopenia or immunosuppressive therapy. Dental management in patients with MDS remains a matter of debate. However, in order to lower the risk of septicaemia originating from the oral cavity, immunocompromised patients may benefit from careful oral assessment and treatment of previous dental disease.

Eosinophilic Ulcer Mimicking Tongue Malignancy: A Case Report

Venkatesh M Rewale, Swati Kulkarni, Kamayani Deshpande, Shubham R Bobade Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Eosinophilic ulcer of the oral mucosa is a rare and benign condition that clinically mimics oral malignancy due to its alarming features such as indurated, everted margins and prolonged persistence. This case report discusses a 70-year-old female who presented with a chronic non-healing ulcer on the right lateral border of the tongue, which had been present for three months and caused discomfort during speech and mastication. Ultrasonography showed no neck lymph node involvement. A biopsy of the lesion demonstrated a dense eosinophilic infiltrate without evidence of malignancy. To confirm the diagnosis and ensure complete excision, a wide local excision with adequate margins was performed. Histopathological analysis of the excised tissue confirmed the diagnosis of eosinophilic ulcer, revealing stratified squamous epithelium with surface ulceration, a dense inflammatory infiltrate rich in eosinophils, neutrophils, and plasma cells, and no evidence of malignancy or epithelial dysplasia. Postoperative recovery was uneventful, with no recurrence noted during follow-up. Eosinophilic ulcers are commonly misdiagnosed due to their resemblance to malignant lesions. Although the aetiopathogenesis remains unclear, trauma is a suspected contributing factor. In this case report, an intricate tooth bite was identified as the contributing causative factor. Surgical excision is considered the treatment of choice, with excellent prognosis and low recurrence rates. This case emphasises the critical role of histopathological examination in differentiating benign ulcers from malignant lesions, thus preventing overtreatment. Eosinophilic ulcer should be considered in the differential diagnosis of chronic oral ulcers, especially when typical risk factors for malignancy are absent.

Marie-sainton Syndrome Through the Lens of CBCT: A Rare Case Report and Literature Review

Umapathy Thimmegowda, Nidhi S Shetty, Gadigi Sampreetha Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Marie-Sainton Syndrome (MSS), also known as Cleidocranial Dysplasia (CCD), is a rare autosomal dominant skeletal disorder primarily caused by mutations in the RUNX2 gene, which is essential for osteoblast differentiation and skeletal morphogenesis. The syndrome is characterised by generalised skeletal dysplasia, including hypoplastic or absent clavicles, delayed ossification of cranial sutures, and short stature. Distinct craniofacial features such as frontal and parietal bossing, midface hypoplasia, and brachycephaly are commonly observed. Dental anomalies are among the most prominent clinical signs and include delayed exfoliation of primary teeth, delayed or failed eruption of permanent teeth, and the presence of multiple supernumerary teeth. This report describes the case of a 13-year-old female presenting with retained primary teeth, delayed eruption of permanent teeth, and characteristic craniofacial features consistent with MSS. Clinical examination revealed frontal bossing, midface retrusion, and a high-arched palate. Cone-beam Computed Tomography (CBCT) was performed, revealing multiple unerupted permanent teeth and six supernumerary teeth distributed across all four quadrants. In addition, CBCT imaging identified other skeletal anomalies not clearly evident on conventional panoramic radiographs. This case highlights the critical role of CBCT in the comprehensive assessment and treatment planning of patients with MSS. Its ability to provide high-resolution, three-dimensional visualisation enables more accurate localisation of impacted and supernumerary teeth, aiding in surgical and orthodontic management. Early diagnosis and interdisciplinary care are essential to mitigate functional and aesthetic complications associated with this complex syndrome.

Endodontic-periodontal Management of Palato-gingival Groove: A Report of Two Cases

Shwetana Kurundkar, Aditya Singh Patel, Manoj Chandak, Pratik Rathod, Priyanka Bhojwani Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X The Palato-Gingival Groove (PGG) is a rare developmental anomaly most frequently affecting maxillary incisors, predisposing the tooth to plaque retention, localised periodontal destruction, and combined endodontic-periodontal lesions. Owing to its complex anatomy, the diagnosis and management of PGG remain a significant clinical challenge. This case report describes the management of a severe PGG in a 26-year-old male who presented with mobility and a deep periodontal pocket in the maxillary right lateral incisor. Clinical and radiographic examination, including Cone-Beam Computed Tomography (CBCT), confirmed the presence of a deep PGG associated with periapical radiolucency. Root canal therapy was performed, followed by a full-thickness flap surgery. The groove was saucerised and sealed with mineral trioxide aggregate to prevent microleakage and promote healing. Bone grafting was performed to facilitate periodontal regeneration, and the flap was repositioned and sutured. Follow-up evaluations at one, three, and five months demonstrated a significant reduction in probing depth, radiographic evidence of bone fill, and restoration of periodontal stability. The second case involved a 35-year-old male with a history of trauma to the maxillary left central incisor and previous root canal treatment, who reported recurrent pain and swelling. Clinical and CBCT examination revealed a palatal radicular groove associated with periapical pathology. Nonsurgical endodontic retreatment was performed, followed by flap surgery. The groove was sealed with light-cured Glass Ionomer Cement (GIC) to achieve a smooth surface, prevent microleakage, and enhance periodontal healing. Bone grafting and periodontal dressing were placed to promote regeneration. Follow-up evaluations at three and five months showed complete resolution of symptoms, bone fill, and satisfactory gingival healing. This report of two cases emphasises the importance of early recognition of the PGG as an etiological factor in persistent endo-perio lesions. A comprehensive approach involving endodontic, periodontal, and restorative procedures was essential in achieving favourable outcomes. The novelty of this report lies in highlighting the role of multidisciplinary management in preserving a tooth with an otherwise poor prognosis, thereby reinforcing the need for awareness and timely intervention in such rare anatomical anomalies.

Cytodiagnosis of Multicentric Giant Cell Tumour of Tendon Sheath: A Rare Case Report

Puspanjali Mishra, Aparajita Mishra, Jagdish Kumar Behera, Yespal Sharma, Sarmistha Subhadarshini Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Giant Cell Tumour of Tendon Sheath (GCTTS) is a benign soft-tissue tumour that commonly arises from the tendon sheath complex and periarticular soft tissue of small joints. These tumours are usually localised and solitary, with multiple occurrences being rare. A multicentric origin is considered unusual and very few cases have been reported to date. Hereby, the authors present a case report of a 40-year-old female with a history of multiple swellings over the bilateral tendo-Achillis region, knees, left great toe and dorsum of the right middle finger since, 10 years ago. Biochemical parameters were normal and radiological investigations did not reveal any bony abnormalities. Fine needle aspiration from all sites revealed features consistent with GCTTS. Histopathology also showed findings typical of GCTTS. The present case highlights the unusual multicentric presentation of GCTTS.

Thrombolytic Management of Submassive Pulmonary Embolism along with Deep Vein Thrombosis: A Case Report

Vijayashree S Gokhale, Atharvan Sharma Mangalapalli, Hemanjali Avuthu Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Pulmonary Embolism (PE) is a life-threatening condition, often presenting with classic symptoms such as dyspnea, chest pain, and tachycardia. However, atypical presentations can obscure early recognition, particularly in intermediate-risk, submassive PE and clots in transit. The present report describes a case of a 50-year-old male automobile mechanic with uncontrolled diabetes who presented with giddiness for one week, followed by acute onset breathlessness. Clinical evaluation revealed tachycardia, tachypnea, left leg swelling, and hypoxaemia. Electrocardiography (ECG) showed Right Ventricular (RV) strain with S1Q3T3 pattern. Echocardiography revealed RV dysfunction with a Tricuspid Annular Plane Systolic Excursion (TAPSE) of 15 mm. Computed Tomography Pulmonary Angiography (CTPA) demonstrated a large saddle embolus with extension into bilateral lobar and segmental branches. The patient was thrombolysed with streptokinase, followed by an infusion of unfractionated heparin before being started on oral anticoagulants. On day four after thrombolysis, biomarkers improved significantly; CTPA showed complete resolution with marked improvement of RV dysfunction on echocardiography. The present case emphasises the importance of maintaining a high index of suspicion for PE in atypical presentations and demonstrates successful thrombolysis in an intermediate-high risk case, even with older, cost-effective agents.

Presentation of Breast Filariasis in a Lactating Female: A Case Report

MS Aparna, Yeshwanth Raju Narayanan, Kirthi Sathyakumar, Sundara Raja Perumal Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Filariasis is a neglected tropical disease that rarely involves the breast. We report a rare case of breast filariasis in a 29-year-old lactating female who presented with a gradually enlarging, pruritic, and erythematous swelling in the left breast. Clinical examination revealed a firm, mobile mass in the upper inner quadrant, without nipple discharge or skin ulceration. Ultrasonography demonstrated a well-defined cystic lesion with echogenic linear structures exhibiting vigorous twirling movements- characteristic of the 'filarial dance sign.' Colour doppler imaging confirmed motion artefacts suggestive of live filarial infestation. Imaging, particularly real-time ultrasonography, was pivotal in diagnosis. Breast filariasis should be considered in the differential diagnosis of cystic breast lesions, particularly in endemic areas. Prompt diagnosis can prevent unnecessary interventions and guide effective antiparasitic therapy.

Rheumatoid Nodule Presenting as Symptomatic Swelling of the Oral Cavity: A Case Report

Namratha Ravishankar, Vijaya Basavaraj, Sushma Hulikere Mallaradhya Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Rheumatoid Arthritis (RA) is a multisystem autoimmune condition characterised by destructive synovitis and varied extra-articular involvement. Rheumatoid nodules are the most common extra-articular manifestations of RA. They develop most commonly in the subcutaneous tissue at the elbow and in the finger joints and may occasionally affect internal organs elsewhere in the body. A 65-year-old woman with seropositive RA on treatment with methotrexate presented with an enlarging mass in the buccal cavity. Ultrasonography revealed a well-defined solid lesion in the subcutaneous plane of the right buccinator space. A clinical diagnosis of a benign salivary gland tumour was made and the patient underwent excision of the nodule and histopathological examination showed central areas of necrobiosis surrounded by palisades of histiocytes consistent with a rheumatoid nodule. The diagnosis of rheumatoid nodules in typical locations can be made easily clinically, supported by classic histopathology. In many cases, particularly in unusual locations, the diagnosis can be challenging, requiring extensive examination of the lesion. Although a rare manifestation, clinicians should consider the possibility of a rheumatoid nodule as a possible differential diagnosis of buccal masses in patients with a history of RA or connective tissue disease. Through this case report, we review the pathogenesis, histopathological features, as well as diagnosis and differential diagnosis of rheumatoid nodules while discussing the challenges in distinguishing them from their mimics. A high degree of suspicion will avoid unwarranted surgical intervention.

Innovative Approaches in Dyskinetic Cerebral Palsy Management with Taila Dahana Agnikarma Integrated with Panchakarma Therapies: A Case Report

Jeeru Ojaswini Reddy, Uma Shetti, Azizahmed Arbar, KH Veena, Sonu Prakash Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Cerebral Palsy (CP) is a group of neurological disorders affecting movement, muscle tone, and posture due to brain injury occurring during early development. Dyskinetic CP, a subtype resulting from basal ganglia impairment, is characterised by involuntary movements such as dystonia and athetosis, leading to fluctuating muscle tone, postural instability, and difficulties with speech and feeding. This case report presents the clinical management of a four-year-old male diagnosed with dyskinetic CP treated by an optimised Ayurvedic regimen, highlighting Taila Dahana Agnikarma and Panchakarma treatments, encompassing Udwartana, Abhyanga, Swedana, Basti, kati basti and Pratimarsha Nasya. These therapies constituted the main therapeutic strategy, whereas physiotherapy and dietary management served as supporting components. The patient improved motor function, muscular tone, postural control, and gait after the intervention. Clinical examinations utilising the Modified Tardieu Scale and Composite Spasticity Index showed spasticity decrease, while goniometers showed range of motion improvements. The successful use of Taila Dahana Agnikarma in dyskinetic CP is unusual and suggests its potential as an additional therapy in paediatric neurorehabilitation.

The Blink Beyond Control: A Case of Jeavons Syndrome

Raghu Ram Yeluri, R Ramya, S Sundari Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Photosensitive epilepsy syndromes are often underdiagnosed or misdiagnosed, despite their increased prevalence in children. These syndromes may present as frequent eye blinking, with or without altered awareness, which is commonly dismissed as normal behavior. Such blinking can be the first clinical manifestation of a neurological disorder. The differential diagnosis includes epilepsy syndromes, movement disorders, and behavioral issues. This present report describes a case of a five-year-old male child with frequent eye blinking and poor academic performance. An Electroencephalogram (EEG) showed high voltage generalised epileptiform discharges consisting of sharp waves intermixed with theta activity on eye closure, suggestive of photosensitive epilepsy. The child was diagnosed with Jeavons Syndrome (JS) following a detailed clinical and neurological workup. Based on the neurologist’s recommendation, oral valproate therapy was administered, and the child has remained seizure-free since the initiation of treatment, with no recurrences reported during follow-up. Early recognition of subtle seizure presentations, such as eyelid myoclonus, is crucial for timely diagnosis and management. Increased awareness among clinicians can prevent misdiagnosis and improve long-term outcomes in children with JS.

Acantholytic (Pseudoglandular) Squamous Carcinoma of the Tongue: A Rare Case Report

Jenie Belinda Winnifred, Vasugi Gramani Arumugam, Nivetha Kathirvelu, Dina Rose Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Acantholytic Squamous Cell Carcinoma (ASCC) is a rare histopathological variant of Squamous Cell Carcinoma (SCC) characterised by the loss of cell adhesion (acantholysis), resulting in pseudoglandular or pseudovascular spaces. ASCC most commonly presents on sun-exposed skin, but intraoral cases are very rare, occurring in less than 0.1% of Oral Squamous Cell Carcinoma (OSCC). It generally affects older adults, particularly in the 6^th to 7^th decades of life, with a slight male predominance. Historically, ASCC was considered aggressive. Here, present case is of a 66-year-old male patient who was a chronic smoker and was diagnosed with an ulceroproliferative mass on the left lateral tongue measuring 5×4 cm. Imaging using contrast Magnetic Resonance Imaging (MRI) revealed a large, irregular, exophytic, enhancing lesion in the ventral aspect of the tongue. An incisional biopsy showed invasive keratinising squamous nests with prominent acantholysis. The tumour islands contained dyskeratotic cells and hollow, duct-like spaces (pseudoglands) filled with dissociated tumour cells and extracellular mucin-like pools. The diagnosis of acantholytic (adenoid/pseudovascular) SCC was supported by the results. Although immunohistochemical markers were not utilised in this instance, they typically reveal negative vascular markers, along with strong cytokeratin and p63 positivity. ASCC of the tongue has unique characteristics, and recognising acantholysis and the pseudoglandular architecture with an extracellular pool of mucin is critical to differentiate this entity from adenocarcinoma or salivary-type carcinomas. While this tumour can behave aggressively, recent series suggest that outcomes may be similar to those of conventional SCC. High recurrence rates have been reported; therefore, long-term follow-up is advised

Squamous and Glandular Precancerous Lesions of the Cervix: A Series of Five Cases based on LAST and WHO 2020 Classifications

Meltem Türk Alkan, Havva Erdem, Ibrahim Erkut Güney, Mürüvvet Akçay Çelik Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Cervical cancer is a gynaecological malignancy whose incidence and mortality can be significantly reduced through effective screening programs. Precancerous lesions of the cervix comprise a broad morphological spectrum, including squamous and glandular abnormalities, which require careful evaluation with histopathology, immunohistochemistry, and Human Papillomavirus (HPV) testing. Here the author presents a series of five cases: Cervical Intraepithelial Neoplasia grade 1 (CIN-1), Cervical Intraepithelial Neoplasia grade 2 (CIN-2), Cervical Intraepithelial Neoplasia grade 3 (CIN-3), Adenocarcinoma In Situ (AIS), and Stratified Mucin-producing Intraepithelial Lesion (SMILE) diagnosed in the clinic. The novelty of this series lied in presenting both squamous and glandular precancerous lesions, including rare variants such as SMILE, within a single case series. This comprehensive approach highlights the diagnostic diversity and underlines the practical application of current WHO and LAST classification systems. The diagnostic work-up of each case included cytological evaluation, colposcopy, haematoxylin and eosin histopathology, and immunohistochemical studies with tumor suppressor protein (p16) and Antigen Kiel 6 (Ki-67). Case 1 involved a 47-year-old woman with HPV type 18 infection and Atypical Squamous Cells of Undetermined Significance (ASC-US), diagnosed as CIN-1 with weak focal p16 expression, showing spontaneous regression on follow-up. Case 2 was a 45-year-old woman positive for HPV type 16, who exhibited diffuse strong p16 and Ki-67 expression, consistent with CIN-2, for which conisation was planned. Case 3 involved a 34-year-old woman with HPV type 16, who showed full-thickness dysplasia and glandular involvement, diagnosed as CIN-3 (high-grade squamous intraepithelial lesion), requiring repeat conisation. Case 4 was a 43-year-old woman with HPV types 16 and 68, who demonstrated coexistence of CIN-1 and AIS with strong p16 expression, and underwent total laparoscopic hysterectomy with bilateral salpingectomy. Case 5 involved a 46-year-old woman positive for HPV type 16, showing mucin-containing dysplastic cells consistent with SMILE, managed by close follow-up. These cases illustrate the diagnostic spectrum of cervical precancerous lesions, highlight the importance of immunohistochemical markers in differential diagnosis, and emphasise the clinical significance of the 2020 World Health Organisation (WHO) classification in distinguishing HPV-associated and HPV-independent lesions. Accurate diagnosis through a multidisciplinary approach enables personalised management, thereby preventing progression to invasive cervical cancer.

Evaluation of Surgical Outcomes of First Branchial Arch Anomalies: A Case Series

Samuel Joseph Arthur, Ajith John George, Emmanuel Lazarus, Madhavi Kandagaddala, Cecil Thankachan Thomas Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X First Branchial Arch Anomalies (FBAA) are rare congenital conditions that present as cysts, fistulas, or abscesses. Failure to suspect the nature of the presenting lesion often leads to inadequate treatment and compromises the outcomes of definitive procedures undertaken later. In the present case series, eight patients with FBAA were identified (4 males and 4 females) with an average age of 29.5 years at presentation. Six of them had undergone prior procedures, including incision and drainage or excision. All patients underwent excision through a parotidectomy approach. Four patients experienced recurrences within a median period of 17 months post-surgery. Notably, three of the recurrences occurred in patients who had prior attempts at excision rather than merely incision and drainage. A high degree of suspicion in young individuals with cystic lesions in the parotid space, imaging to delineate the extent of the lesion, and an attempt at complete excision are key factors in successfully treating these conditions. Long-term follow-up is required to ensure the adequacy of the treatment strategy.

Anaesthetic Challenges in a Paediatric Clubfoot Surgical Camp Held in a Remote Area: A Case Series

Anilkumar Narayan, Chaitra Venkataswamy, Prajna Jayaram, Ajay Sridhar Shandilya, L Yashaswini Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Clubfoot, a common birth defect affecting the foot, impacts a significant number of children in low- and middle-income countries. Although many cases of clubfoot can be effectively treated without surgery, some require surgical intervention. Untreated clubfoot can cause severe disabilities, leading to significant social and economic challenges for the affected individuals. Surgical camps provide crucial access to surgical care for underserved populations. This case series examines the anaesthetic management of 10 children who underwent clubfoot surgery during a surgical camp. Providing anaesthesia to children in areas with limited resources presents significant challenges, including undiagnosed medical conditions, malnutrition, restricted access to diagnostic tools, and limited availability of necessary equipment and medications. Nevertheless, spinal anaesthesia was safely administered to these patients, supported by good monitoring and experienced auxiliary staff. This case series suggests that spinal anaesthesia is a safe technique even in remote and resource-limited places in the paediatric age group.

Rare Entities of Thyroid Gland: A Series of Twelve Cases

Mili Thomas, Nikita James, Lillikutty Pothen, Meeta Thomas, Rebecca Mathews Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Thyroid disorders are frequently encountered in clinical practice, with hypothyroidism and hyperthyroidism representing the most common manifestations. However, beyond these frequently diagnosed disorders exists a group of rare thyroid lesions that present unique and often formidable diagnostic and therapeutic challenges. Despite their infrequent occurrence, these rare lesions carry significant clinical importance due to their potential for misdiagnosis, variable behaviour, and the complexity of their management. This retrospective case series examines a diverse group of rare thyroid lesions diagnosed over three years, in a tertiary care centre in South Kerala, to underscore their clinical relevance and emphasise the necessity for heightened diagnostic vigilance. In this series, the author explores 12 different conditions, which include a variety of uncommon pathologies such as dyshormonogenetic goitre and follicular adenoma with bizarre nuclei, along with several histological variants of Papillary Thyroid Carcinoma (PTC), including the tall-cell, columnar-cell, Warthin-like, and diffuse sclerosing subtypes. In addition, authors also describe cases of rare thyroid malignancies, such as the papillary variant of Medullary Thyroid Carcinoma (MTC), collision tumours, cribriform morular thyroid carcinoma, high-grade follicular carcinoma, poorly differentiated carcinoma, and anaplastic carcinoma. These cases were observed in patients ranging from 14 to 77 years of age, highlighting that such lesions can occur across a broad age spectrum. Due to their overlapping clinical and cytological features with more common thyroid conditions, accurate diagnosis of these rare lesions depends heavily on comprehensive histopathological examination, meticulous tissue sampling, and adjunctive Immunohistochemical (IHC) studies. Failure to recognise these entities can lead to misdiagnosis, delayed treatment, and suboptimal patient outcomes. This case series emphasises the critical need for increased awareness among clinicians and pathologists regarding the presentation and management of rare thyroid lesions. Early identification and tailored therapeutic strategies are essential to improving prognostic outcomes. By shedding light on these infrequent but clinically significant conditions, this study advocates for the integration of detailed histological analysis and advanced diagnostic techniques into routine thyroid pathology assessments.

Mycetoma in Atypical Sites: A Case Series from Eastern India

Sameeha Mandal, Dipankar Paul, Nupur Pal, Raja Ray, Chitrita Chatterjee Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Mycetoma, a slowly progressive, chronic granulomatous infectious disease of the skin and subcutaneous tissues, is highly endemic in India. The triad of tumefaction, multiple draining sinuses, and grains in discharge clearly defines the disease. Mycetoma has now been declared a neglected tropical disease by the World Health Organisation (WHO). The disease is notoriously difficult to treat, characterised by stigmatising deformities, disabilities, and lifelong high morbidity. A strong clinical suspicion, appropriate diagnosis, and exact categorisation of the lesion up to the eumycotic or actinomycotic level, along with culture correlation, are essential for effective therapy of mycetoma. In this case series, authors report three cases of mycetoma manifesting in atypical sites of involvement. Two cases showed involvement of extremely unusual areas of the body, such as the shoulder and flank, while the third had lesions on the plantar aspect of the foot. One case was diagnosed as actinomycetoma caused by Nocardia spp., and two were diagnosed as cases of eumycetoma caused by Madurella spp. and Exophiala spp., respectively.

Managing Obstetric Haemorrhage: A Case Series on Emergency Peripartum Hysterectomy

Parul Jaiswal, Meenal Patvekar, Prashant Suryarao, Dipak Kolate, Mohini Gokuldas Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Emergency Peripartum Hysterectomy (EPH) remains a life-saving intervention for obstetric haemorrhage when bleeding is unresponsive to conservative measures. This case series highlights the clinical profiles and outcomes of four women who underwent EPH at a tertiary care center in India over the course of one year. The cases involved risk factors such as Placenta Accreta Spectrum (PAS), uterine rupture, and prior cesarean sections. The findings emphasise the importance of early recognition of high-risk conditions and prompt escalation to surgical management. This series offers valuable insights into the complexities of managing obstetric haemorrhage and reinforces the essential role of a coordinated team approach in improving maternal outcomes.

Modelling and Simulation of Shape Memory Alloy Microactuator for Bionic Flexion Support in Older Adults: An Experimental Study

Muralidharan, Muthukumaran Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Mobility challenges among elderly people have become a concern in the healthcare and engineering sectors. One common impairment in older age is the inability to perform forward bending movements. This difficulty affects essential daily activities such as dressing and removing wearable devices, leading to reduced independence and a lower quality of life. Nitinol (NiTiNOL) is an alloy composed of approximately 45% nickel (Ni) and 45% titanium (Ti). By manipulating the thermal environment, temperature variations occur in Shape Memory Alloy (SMA) wires. SMAs are widely utilised in industry, medicine, and robotics due to their flexibility, light weight, and the ability to undergo phase transformations when subjected to thermal changes in the environment. Aim: This research aims to model and simulate a micro SMA actuator for bionic applications. Materials and Methods: In this experimental study, COSMOL Multiphysics software analysed the behaviour of SMA wires. Electrical excitation was used to attain the deformation temperature of the SMA wire. The modelled SMA wire, with a diameter of 0.375 mm and length of 50 mm, was simulated at the Centre for Sensors and Control Systems Laboratory, Hindustan Institute of Technology and Science, Chennai. Results: The SMA microactuator exhibits notable thermal behaviour linked to phase transformations and mechanical properties. The modelled SMA spring features three turns, a diameter of 0.375 mm, and a length of 50 mm. It operates between 40°C and 65°C, with the austenite temperature at 65°C. These parameters yield an actuation force of 9.31 N and a displacement of 20.3 mm. Conclusion: The simulation results have been used to develop a soft robot for clinical purposes and bionic applications. To address such biomechanical deficits, an SMA-based actuator offers compact, quiet, and flexible motion in wearable or embedded assistive systems.

Unveiling the Histopathological Characteristics of Rhinophyma

C Geo Danny, D Manoharan, G Sukanya, Nourin Basheer Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A 60-year-old male patient came to the Dermatology outpatient department with multiple asymptomatic raised lesions over both sides of the nose for the past 10 years, which started as skin-coloured raised lesions over the nose, initially small in size and gradually progressed to the current size. There was no history of pain, itching or bleeding from the lesion. There was no history of other constitutional symptoms, weight loss, loss of appetite, lesions elsewhere in the body, significant family history or history of alcohol intake. The patient did not give any proper history of previous treatment for the same. On examination, there was a bulbous outgrowth of size 2×2 cm with prominent pores and erythematous nodules over the ala of the nose, forehead and chin (Table/Fig 1). A differential diagnosis of rhinophyma, lupus pernio and lymphocytoma cutis was considered based on the history and examination findings. A 4 mm punch biopsy was taken from the nose and it revealed orthokeratosis, flattened rete ridges, dermal perivascular and perifollicular lymphohistiocytic infiltrate with prominent sebaceous gland hyperplasia, along with lymphatic dilatation [Table/Fig-2a-c]. A final diagnosis of phyma was made with involvement of the nose, chin and forehead based on histopathological findings. The patient was started on a daily low dose of oral isotretinoin 10 mg OD for four weeks and was suggested other treatment modalities like excision followed by fractional CO2 laser, following which the patient was lost to follow-up.

Myelocystocele in Focus: MRI Insights into a Rare Neurological Condition

Niharika Prasad, Purnachandra Lamghare, Garima Kaushik Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A three-month-old female child initially presented with a palpable back bulge with intact overlying skin, noticed by the mother since, birth. Clinically, there was lower extremity paralysis and sensory impairment since, birth. No ultrasound was performed, and the patient was directly advised to undergo an Magnetic Resonance Imaging (MRI) of the dorsal spine with WSS. MRI revealed a large defect in the posterior vertebral column (posterior spina bifida) at the level of D8-D12 vertebrae, through which the spinal cord, Cerebrospinal Fluid (CSF), and meninges herniated into the overlying soft tissue, forming a large, well-defined, smooth-walled cystic lesion. The lesion appeared hyperintense on T2-weighted sagittal and axial images [Table/Fig-1a,b], hypointense on T1-weighted axial and sagittal images [Table/Fig-1c,d], and demonstrated mixed signal on STIR images [Table/Fig-1e].

Palatal Fistula Secondary to Trauma: Clinical Insights and Management

Sachindra Dubey, Nitin Bhola, Akash Doshi Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A 20-year-old male patient reported to the in-patient Department of Oral and Maxillofacial Surgery with a chief complaint of nasal regurgitation, recurrent nasal and maxillary sinus infections, hypernasal speech, and difficulty in deglutition for approximately one year. The patient had been managing these symptoms conservatively with symptomatic treatment and had not sought definitive care for the underlying condition. Upon evaluation, surgical intervention was advised for the management of the palatonasal fistula.

Transient Lingual Papillitis: A Benign and Underrecognised Entity

Sanjeev Gupta, Shubham Deokar, Rohan Manoj, Kshitiz Lakhey Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A 32-year-old male presented to the Dermatology outpatient clinic with a complaint of painful lesions at the tip of his tongue for two days (Table/Fig 1). The lesion was associated with mild burning and tenderness, particularly when eating spicy or hot foods. The patient denied any recent trauma to the tongue, new medications, systemic illness, or dietary changes. He reported no history of tobacco or alcohol use and had no known food allergies. The only potentially contributory factor identified was sleep deprivation due to work-related stress over the previous week. On intraoral examination, a single, well-defined, erythematous plaque with raised papules was noted at the anterior tip of the tongue. The lesion was tender on palpation, and the surrounding mucosa appeared normal. There were no other oral lesions, fissuring, or depapillation. No cervical lymphadenopathy was present. Based on the history and clinical appearance, a provisional diagnosis of localised Transient Lingual Papillitis (TLP) was made. The patient was reassured about the benign and self-limiting nature of the lesion and advised to avoid spicy, acidic foods and other lingual irritants. No investigations or medications were advised, and he was counselled to avoid irritant foods and maintain good oral hygiene. At follow-up after seven days, the lesion had resolved completely (Table/Fig 2). No recurrence was reported at a one-month telephonic follow-up.

Pulmonary Alveolar and Pancreatic Microlithiasis: An Autopsy Case

Sneha P Janjal, Vinaya Bipin Shah, Manan Amit Mehta Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Pulmonary Alveolar Microlithiasis (PAM) is an autosomal recessive disorder characterised by a mutation in the Solute Carrier Family 34, Member2 (SLC34A2 gene [1,2]. The disease involves the deposition of calcispherites (calcium phosphate salts) within the alveoli rather than in the interstitium or along the blood vessels, and it occurs without any disturbance of calcium metabolism (3). It is most commonly observed in young adults in their third or fourth decades of life, with an almost equal gender distribution (4). Similar types of calcification may also occur in extrapulmonary sites such as the sympathetic ganglia, testes, seminal vesicles, and epididymis [4,5].

Talon Cusp on a Permanent Maxillary Lateral Incisor Mimicking a Canine

Devyani Taori, Monika Khubchandani, Nilima Thosar, Ramakrishna Yeluri, Akanksha Akhatkar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A nine-year-old male patient was examined, and an incidental finding of an unusual appearance of the lateral incisors was noted during a routine check-up at a community dental camp, unrelated to the patient’s chief complaint. The maxillary right and left permanent lateral incisors resembled canines, with a pointed cusp tip and the appearance of mesial and distal slopes when viewed from the buccal aspect (Table/Fig 1). The buccal surfaces of the teeth exhibited an irregular chalky white appearance with opacities following the perikymata, suggesting mild dental fluorosis with a Thylstrup-Fejerskov index score of 3 (1). This score indicates smooth surfaces characterised by merging, irregular cloudy patches of opacity; perikymata are frequently observed between these opacities (2).

Solitary Long Bone Metastasis in Patients with Breast Cancer: Imaging Findings

Ashok Ranjan, Mohan Shobhana Aparna, Addagarla Srilakshminagasaikrishnapraneeth, Senthil Kumar Aiyappan, Sangavi Jeyaraj Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A 63-year-old female presented with constant left hip pain for one week, aggravated by walking. There was no history of trauma. Local examination revealed the limb in an externally rotated position. A shortening of the limb was evident, with tenderness over the anterior and lateral joint lines.

Imaging Findings of Ovarian Dermoid Cyst with Concurrent Torsion and Rupture

Madhu Sowmitha Pachipala, Jatin Nehra, Sabari S Ramesh, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X A 25-year-old nulliparous woman presented to the emergency department with complaints of colicky abdominal pain for five days and vomiting of food particles for the past two days. There was no history of fever or diarrhoea. She had been treated conservatively with analgesics at a local clinic before presenting to our hospital. There was no significant past history or known co-morbidities.

Yoga-based Meditation as an Adjunct Therapy after Elective Lower Segment Caesarean Section Surgery: A Randomised Controlled Trial Assessing Stress and Wound Healing Outcomes

Parkhi Amaranath Bhagat Anand, Shubham Sanjay Kumar, Sumangala Mahesh Patil, Kshiti Niraj Sinha, Amrit Podder, Kashinath Samagandi, Madivalappa Parasappa Doddamani, Jyoti Paramanand Khodnapur Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Wound healing following abdominal surgeries such as elective Lower Segment Caesarean Section (LSCS) is a multifactorial process influenced by physiological and psychological factors. Elevated psychological stress adversely affects immune system performance, which can lead to slower tissue regeneration and heightened susceptibility to postoperative complications. Meditation grounded in yoga principles, characterised by controlled breathing and mindful awareness, has been documented to lower stress and inflammation while supporting autonomic nervous system stability. Despite these potential benefits, there is limited clinical evidence evaluating the direct role of yoga-based meditation in improving surgical wound healing. Aim: To evaluate the impact of yoga-based meditation on stress levels and wound healing outcomes in patients after elective LSCS. Materials and Methods: A randomised controlled trial was conducted in July 2022 at the Department of Obstetrics and Gynaecology, Shri B.M Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India. The study included 52 patients undergoing elective LSCS, who were randomly assigned to two groups: an intervention group and a control group. Participants were recruited at the time of admission to the postnatal ward. The intervention group received guided yoga-based meditation for 15 minutes, three times daily, over a period of 14 consecutive days. Meditation sessions focused on breath awareness, relaxation techniques, and mindfulness. The control group received standard postoperative care without meditation. Stress parameters and wound healing outcomes were assessed at baseline and on day 14. The parameters measured included Heart Rate (HR), Heart Rate Variability (HRV), Perceived Stress Score (PSS), and Galvanic Skin Response (GSR). Wound healing was assessed using the Southampton wound grading system. Statistical analysis was performed using International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) Statistics version 25.0. Between-group comparisons were made using the chi-square test for categorical variables and the Mann-Whitney U test for non parametric continuous variables. A p-value of <0.05 was considered statistically significant. Results: Of the 70 patients enrolled, 52 completed the trial (26 per group). There were no significant baseline differences in age, Body Mass Index (BMI) or parity (p>0.05). After 14 days, the yoga-meditation group showed a greater reduction in resting HR (mean change -14.48% vs -4.02%; p<0.001), a greater increase in HRV (mean change +21.81% vs +8.75%; p<0.001), and a greater reduction in PSS score (-48.2% vs -47.4%; p=0.013) compared with controls. GSR showed a marked increase, indicating enhanced parasympathetic activity. Although both groups achieved 100% Grade 0 healing by day 14 (Southampton Wound Grading System), the meditation group demonstrated a more rapid resolution of early inflammatory signs in the first week. Conclusion: Adjunctive yoga-based meditation significantly attenuates postoperative stress- both physiological and psychological and may accelerate the initial phases of wound healing following elective LSCS. This non invasive, low-cost intervention holds promise for enhancing recovery and patient well-being in the postoperative setting.

Serum Cystatin-C as a Pre-emptive Indicator of Renal Impairment in Patients with Sickle Cell Disease: A Cross-sectional Study

Vanaraj Diyora, Trushna Shah Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Sickle Cell Disease (SCD) is a chronic haemoglobinopathy frequently associated with renal complications that progress silently and contribute significantly to morbidity and mortality. Conventional renal biomarkers such as serum creatinine and urea often rise only after substantial nephron loss has occurred. Serum cystatin-C, an endogenous cysteine protease inhibitor, has emerged as a promising early biomarker of renal dysfunction, independent of age, sex, and muscle mass. Aim: To estimate serum cystatin-C level and renal function tests in adult SCD patients and to analyse their correlation with conventional renal parameters. Materials and Methods: A cross-sectional study was conducted at the Department of Biochemistry, Dhiraj General Hospital and Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India, over a period of one year from January 2023 to December 2023. A total of 204 adult male and female SCD patients were enrolled. Patients with known renal disease, renal surgery, or on nephrotoxic medications were excluded. Serum cystatin-C was estimated using Enzyme-Linked Immunosorbent Assay (ELISA), while serum urea, creatinine, uric acid, protein, albumin, and electrolytes were measured using a fully automated biochemistry analyser (EM-200). Data were analysed with Statistical Package for Social Sciences (SPSS) version 25.0 software, and analysis was performed to assess Pearson’s correlation coefficients, p-value <0.05 was considered statistically significant. Results: The current study evaluated 204 patients with SCD (83 males and 121 females), with a mean age of 21.59±3.61 years. Among this group, 23 patients (11.3%) were identified as having renal dysfunction. Patients with renal dysfunction demonstrated significantly elevated serum urea (72.5±51.9 vs. 24.7±8.02 mg/dL, p-value <0.001), creatinine (2.13±1.5 vs. 0.67±0.12 mg/dL, p-value <0.001), and uric acid, along with reduced serum protein and albumin compared to those without dysfunction. Electrolyte disturbances elevated sodium (135-145 mEq/L) K+(3.5-5.0 mEq/L), Cl-(90-110 mEq/L) were also noted. Serum cystatin-C showed a strong positive correlation with serum urea (r-value=0.7034, p-value <0.001) and creatinine (r-value=0.8031, p-value <0.001), highlighting its sensitivity in detecting renal impairment. A p-value <0.05 was considered statistically significant. Conclusion: Serum cystatin-C is a valuable early biomarker of renal dysfunction in SCD patients, showing stronger correlation with renal impairment than conventional markers. Routine incorporation of cystatin-C testing may enable timely diagnosis, monitoring, and prevention of progression to Chronic Kidney Disease (CKD) in this high-risk group.

Nesfatin-1 in Regulation of Glucose Homeostasis Across Different Stages of Glycaemia: An Observational Cross-sectional Study

R Vasanthakumari, VM Vinodhini, P Renuka, KA Arul Senghor, JS Kumar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Nesfatin-1 plays a crucial role in maintaining energy balance and regulating food intake through its action on both central and peripheral pathways. In addition to peripheral organs, including adipocytes, pancreatic islets, and stomach endocrine cells, it is primarily released by the hypothalamus. By encouraging peripheral glucose uptake and inhibiting gluconeogenesis, nesfatin-1 increases insulin sensitivity. Diabetes mellitus is preceded by prediabetes. Aim: To compare nesfatin-1 in the regulation of glucose homeostasis across different stages of glycaemia. Materials and Methods: This is an observational cross-sectional study conducted at the Department of Biochemistry, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India, from May 2024 to March 2025. The study involved 90 adults, both men and women, aged 20 to 45 years. They were divided into three groups based on American Diabetes Association’s (ADA) criteria into euglycaemic (HbA1c <5.7%), prediabetic (HbA1c 5.7-6.4%), and newly diagnosed type 2 diabetes (HbA1c ≥6.5%). Age, sex, height, weight, Body Mass Index (BMI), and Blood Pressure (BP) values were taken into account. Serum samples of the above individuals were separated and stored for analysing nesfatin-1 levels. Nesfatin-1 levels were analysed using the Enzyme-linked Immunosorbent Assay (ELISA) method. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) software version 20.0. The three groups’ continuous variables were compared using the Kruskal-Wallis test. The relationship between serum nesfatin-1 levels and metabolic markers was evaluated using Spearman’s correlation. Statistical significance was established at a p-value of less than 0.05. Results: Nesfatin-1 levels varied considerably among the three glycaemic groups (p-value=0.003), with newly diagnosed diabetics having median levels of 161.1 pg/mL, prediabetic people having 132.41 pg/mL and euglycaemic people having 149.28 pg/mL. Nesfatin-1 levels were lower in prediabetic individuals when compared to euglycaemic and newly diagnosed diabetic individuals. The prevalence of insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) ≥2.9] was higher in newly diagnosed diabetics, 17/30 (57%), than in prediabetics, 4/30 (13%) and euglycaemics, 4/30 (13%). All groups had substantial prevalences of obesity (BMI ≥25 kg/m2), 17/30 (57%) of euglycaemic people, 17/30 (57%) of prediabetic people, and 19/30 (63%) of newly diagnosed diabetic people. This suggests that insulin resistance and obesity play a part in early glucose dysregulation. Conclusion: Early disruptions in glucose metabolism may be linked to altered nesfatin-1 levels. Increased BMI and HOMA-IR are important markers of type 2 diabetes progression, highlighting the necessity of early identification and individualised treatment plans.

Phytoestrogenic Effects of Equisetum arvense (Horsetail) Extract in an Oestrogen-deficient Rat Model: An Experimental Study

KM Sukritha, N Vishali, P Jisha, T Jaseem Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Postmenopausal osteoporosis, primarily driven by oestrogen deficiency, is characterised by reduced bone mass, compromised microarchitecture, and increased fracture risk. Hormone Replacement Therapy (HRT) is effective but associated with serious adverse effects such as increased risks of breast cancer and cardiovascular events prompting interest in plant-based phytoestrogens. Equisetum arvense (EA) (field horsetail), rich in flavonoids and silica, is traditionally used for bone health, yet its oestrogenic potential in oestrogen deficient models remains underexplored. Aim: To assess the oestrogen-like activity of EA (horsetail) extract in an oestrogen deficient rat model (ovariectomised rats) by analysing both histological features and biochemical parameters. Materials and Methods: The present preclinical experimental animal study was conducted at Cape Bio Lab and Research Centre, Marthandam, Tamil Nadu, India, between January and June 2023, 54 female Albino Wistar rats (three-month-old, 200-220 g) were bilaterally ovariectomised to induce oestrogen deficiency. One-month postsurgery, rats were divided into sham operated, Ovariectomised (OVX) control, and treatment groups. The treatment groups received both E. arvense extract (60 mg/kg/day) and estradiol for 45 and 90 days. After overnight fasting, blood samples were collected via retro-orbital plexus under anaesthesia. Serum samples were analysed for biochemical parameters, including osteocalcin, Alkaline Phosphatase (ALP), Liver Function Tests (LFTs), and Renal Function Tests (RFTs). Femur bones were harvested for histological examination at the end of treatment. Results: Phytochemical analysis of EA's ethanolic extract revealed a diverse array of secondary metabolites, including carbohydrates, proteins, flavonoids, saponins, glycosides, tannins, phenolics, and fixed oils. OVX rats displayed notable bone loss and elevated markers of bone resorption, hepatic stress, and renal dysfunction. Treatment with E. arvense, especially over 90 days, significantly improved bone architecture (p<0.01), lowered Osteocalcin and ALP levels (p=0.63) and normalised LFT (p<0.001) and RFT markers (p=0.004). Protein profiles also returned to near-normal levels (p<0.05). The effects were comparable to those observed in estradiol-treated groups, with no statistically significant difference between the two treatment arms. The current study revealed that supplementation with EA notably enhanced bone microarchitecture and normalised critical biochemical markers in OVX rats. Conclusion: The EA exhibited significant phytoestrogenic, bone-protective, hepatoprotective, and nephroprotective effects in OVX rats. These findings highlight its promise as a natural alternative to Oestrogen replacement therapy for managing postmenopausal symptoms, warranting further clinical evaluation.

Clinical Characteristics, Microbiological Profile and Antimicrobial Resistance Pattern of Bloodstream Infections in Critically Ill Patients: A Cross-sectional Study

Prachi Sudhir Dubal, Ashish Sadafale, Vaishali Wabale, Sunil Bhamare, Rajesh Karyakarte Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Bloodstream Infections (BSIs) often complicate the outcomes of critically ill patients and are typically associated with high morbidity and mortality rates. There is marked variation reported in the prevalence and antimicrobial resistance patterns of pathogens causing BSIs. Updated and comprehensive data, integrating the microbiological profile and clinical characteristics, may serve as a promising framework for planning and executing management strategies for BSIs in critically ill patients. Aim: To investigate the clinical characteristics, microbiological profile, and antimicrobial resistance patterns of BSIs in critically ill patients. Materials and Methods: This cross-sectional study was conducted over a period of four years (June 2021 to May 2025) in a tertiary care academic hospital. Blood cultures from adult patients (>18 years) with a strong clinical suspicion of sepsis were included. Sepsis was diagnosed based on the criteria for Systemic Inflammatory Response Syndrome (SIRS). Bacterial pathogens isolated from blood cultures were identified, and antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion test on Mueller-Hinton agar. The clinical characteristics of patients were recorded and analysed. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM, USA). A p-value <0.05 was considered significant. Results: Out of 15,894 blood cultures received, a total of 2,764 (17.4%) were positive. Risk factors such as the use of corticosteroids and the presence of invasive medical devices were significantly associated with BSIs. Bacterial pathogens were isolated from 2,481 (89.8%) samples, while Candida was isolated from 283 (10.2%) samples. Coagulase-negative Staphylococci 411 (59.1%) were the most common Gram-positive cocci (GPC). Klebsiella pneumoniae 642 (50.1%) was the most common Gram-negative bacilli (GNB). Both GPC and GNB demonstrated high resistance to commonly used first- and second-line antimicrobial agents. Conclusion: The overall prevalence of bacterial pathogens was high in BSIs among critically ill patients, with GNB—particularly Klebsiella pneumoniae—being the most prevalent pathogen. The significant antimicrobial resistance demonstrated by both Gram-positive and Gram-negative pathogens is alarming and emphasises the importance of strengthening infection prevention and control practices, along with the effective implementation of enhanced antimicrobial stewardship programs.

Exploring the Antifibrotic Potential of Vitex negundo Compounds via Molecular Docking, Molecular Dynamics and ADMET Profiling: An In-silico Analysis

K Akilandeeshwari, D Anusha, K Priya Gayathri, Kavitha Ramasamy Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Fibrosis is the excessive accumulation of extracellular matrix in tissues due to abnormal wound healing, leading to organ dysfunction and high morbidity and mortality across multiple organs. Vitex negundo L. (Verbenaceae), commonly known as the Chinese chaste tree or "Huangjing," is an aromatic shrub native to South and Southeast Asia, China, Japan, and East Africa. It is widely recognised in traditional medicine systems for its diverse pharmacological actions. The plant exhibits anti-inflammatory, antioxidant, antifibrotic, hepatoprotective, and antimicrobial properties. These effects are primarily attributed to its rich phytochemical constituents, such as luteolin, casticin, and negundoside. Owing to its multifaceted bioactivity, Vitex negundo serves as a promising source for the development of novel therapeutic agents. Aim: To evaluate the antifibrotic potential of Vitex negundo bioactive compounds through in-silico methods, including molecular docking, molecular dynamics, and ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) profile analysis, focusing on their interaction with key fibrotic signaling pathways. Materials and Methods: This in-silico analysis was conducted in the Department of Pharmacology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India, over a period of one month, from June 2025 to July 2025. The study focused on the molecular docking of casticin, luteolin, and negundoside with TGFβR1 and SMAD3. Optimised ligand and protein structures were sourced from public databases, and ADMET properties were predicted using SWISSADME and ProTox 3.0. Molecular docking (AutoDock Vina) and visualisation (PyMOL) were used to assess binding, while 100 ns molecular dynamics simulations (AMBER ff19SB) evaluated complex stability using Root Mean Square Deviation (RMSD), Principal Component Analysis (PCA), and Molecular Mechanics/Generalised Born Surface Area (MM/GBSA) binding energy calculations. Results: Casticin, luteolin, and negundoside from Vitex negundo showed strong binding to TGFβR1 and moderate to strong binding to SMAD3, with casticin having the highest affinities. Molecular dynamics confirmed stable, rigid protein-ligand complexes for casticin and luteolin. ADMET analysis indicated high gastrointestinal absorption and low toxicity for all three compounds; however, casticin and luteolin may cause drug-drug interactions due to Cytochrome P450 (CYP) inhibition, while negundoside showed lower absorption but minimal metabolic risk. Conclusion: Vitex negundo demonstrates significant anti-inflammatory, antioxidant, and antifibrotic activities. These findings support its potential as a safe and effective therapeutic agent with anti-inflammatory properties, justifying further investigation into its antifibrotic activity.

A Prospective Observational Study on Vitreous Haemorrhage from a Tertiary Care Hospital in Southern India

Lakshmi Sativada, Dineshkanth Vudayana, Bhagyasree Reddi Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Blood within the vitreous cavity is referred to as Vitreous Haemorrhage (VH). VH is one of the most frequent conditions that present to the emergency room and is a major cause of painless visual loss. Aim: To evaluate the various aetiologies, management strategies, and outcomes following treatment in patients with VH. Materials and Methods: A prospective observational study was conducted at the Ophthalmology Department from August 2023 to August 2024 for a period of one year at Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India. Newly diagnosed cases of vitreous haemorrhage in patients over 35 years of age were included in the study and those with a history of retinal detachment were excluded. A detailed history regarding the aetiology of the VH was taken, and a complete ocular examination was performed. Necessary investigations were conducted. Treatment was administered according to the cause of VH, and this was noted. Follow-up was conducted for a three-month postoperative period. Statistical analysis was performed using Statistical Packages of Social Sciences (SPSS) software and Microsoft Excel. Results: The current study included 21 patients with a total of 23 eyes. The largest group of patients was in the age range of 45 to 50 years (42.85%), with a mean age of 54.38±3.438 years. Proliferative Diabetic Retinopathy (PDR) was determined to be the most frequent cause, seen in 11 patients (52.38%), followed by Central Retinal Vein Occlusion (CRVO), seen in 5 cases (23.80%). Anti-vascular Endothelial Growth Factor (VEGF) injections were the most commonly used treatment method, administered in 10 (43.47%) of the 23 eyes. Other treatment options included observation, laser photocoagulation, and Pars Plana Vitrectomy (PPV). Preoperative visual acuity was <1/60 to Perception of Light (PL) + in 12 (52.17%) cases, while in the postoperative follow-up, the majority of patients (20 cases, or 86.94%) were in the visual acuity group of 6/6 to 6/60. Conclusion: In the present study, the most common cause of vitreous haemorrhage was found to be PDR. Early diagnosis and timely intervention for VH lead to good visual prognosis.

Efficacy and Safety of H2 Blockers as an Add-on Therapy to H1 Antihistamines in Allergic Rhinitis: An Open Label Randomised Controlled Trial

Prasenjit Das, Debasis Ray, Biplab Nath, Shanta Sutradhar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Allergic Rhinitis (AR), affecting 10-25% of the global population, is commonly treated with antihistamines and corticosteroids. H2-blockers, when combined with H1 antihistamines, enhance treatment efficacy and reduce symptoms. There is a need to conduct studies to establish more evidence around this combination and aid in the informed clinical decision-making process. Aim: To compare the efficacy of Bilastine versus Bilastine combined with Famotidine in the management of AR at days 7 and 14 and also to compare serum IgE levels at days 0 and 14 among both groups. Materials and Mehods: This open-label Randomised Controlled Trial (RCT) was conducted in the Pharmacology and Otorhinolaryngology department of Agartala Government Medical College (AGMC) and Govind Ballabh Pant Hospital (GBPH) between 1st February 2023 and 30th June 2024. The study included 340 newly diagnosed acute AR patients aged 18 years and above from the ENT OPD. Participants were diagnosed by clinicians based on signs and symptoms such as nasal itching, sneezing, a runny nose, and nasal obstruction, with symptoms persisting for more than four consecutive weeks. Randomised participants received either Bilastine 20 mg daily or Bilastine combined with Famotidine 40 mg daily for 14 days. The primary outcomes were nasal and non nasal symptom scores, while secondary outcomes included serum IgE levels. Data were collected in an approved Case Report Form (CRF) and statistically analysed using the Independent t-test, Mann-Whitney U test, Wilcoxon signed-rank test, and Chi-square test. Results: The study included 340 participants aged between 18 and 80 years, comprising 178 (52.4%) males and 253 (74.4%) from urban areas. Rhinorrhea (83 cases, 24.4%) and nasal congestion (79 cases, 23.2%) were the most common symptoms. The combination therapy led to a significantly faster reduction in nasal symptoms (p-value=0.001). Serum IgE levels decreased in both groups (p-value=0.001 in Group A, p-value<0.001 in Group B), with a cut-off for serum IgE being <150 mg/dL. Adverse reactions were minimal, with two cases of nausea and bloating in Group A and two cases of nausea in Group B. Conclusion: AR predominantly affected younger adults (ages 21-25 years). Combination therapy showed no adverse effects and provided faster symptom relief while reducing serum IgE levels.

Clinicopathological Study of Scrotal Lesions at a Tertiary Care Hospital: A Cross-sectional Study

Siddhi Shah, Sneha Janjal, Vinaya Shah Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Scrotal masses, encompassing a range of benign and malignant conditions, present a significant clinical challenge due to their varied etiology and potential impact on male reproductive health. The evaluation and management of these masses require a comprehensive approach, integrating clinical, radiological, and histopathological assessments to ensure accurate diagnosis and optimal treatment. Aim: To evaluate the histomorphological spectrums of neoplastic and non neoplastic lesions of the scrotum. Materials and Methods: A retrospective, five-year cross-sectional study was conducted at the Department of Pathology at Hindu Hridaysamrat Balasaheb Thackeray (H.B.T) Medical College and Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, Maharashtra, India, over a period of one year from January 2018 to December 2022. A sample size of 129 cases was obtained according to the inclusion and exclusion criteria. The specimens received in the Pathology laboratory were examined grossly and microscopically. Special stains were performed as per the requirement. Relevant clinical data (age, presenting complaints, duration, clinical diagnosis, laterality, nature of specimen, whether biopsy or resection) were obtained from the requisition forms submitted with the surgical specimens. All the findings were entered into a master chart, which was later used for further statistical evaluation with the help of Microsoft Excel 2007. Results: A total of 129 cases of testicular and scrotal lesions were received in the surgical histopathology section from 21787 cases over five years, which accounts for 0.59%. Only one case was with genital ambiguity, while the rest of the cases (n=128) were males. Out of 129 cases, 115 cases (89.14%) were non neoplastic, while only 14 cases (10.85%) were neoplastic. The maximum number of cases (50 cases, 38.75%) was seen in the age group of 16 to 35 years. Seventy seven cases (59.68%) had lesions of the testicular parenchyma and epididymis, 28 cases (21.7%) from the paratestis and the tunica and 24 cases (18.6%) from the scrotal sac. Right-sided involvement (63cases, 48.83%) was more common than the left side (57 cases, 44.18%). Conclusion: Non neoplastic lesions are commoner than neoplastic masses. Most of the non neoplastic lesions present similarly on physical examination, so radiological findings help in differentiating various lesions and guide further treatment. At times, neoplastic masses can mimic non neoplastic lesions. Accurate radiological intervention, history taking and clinical details can aid in diagnosis and appropriate surgical management.

Efficacy of Intravenous Dexmedetomidine in Attenuating Haemodynamic Response and Postictal Agitation in Patients undergoing modified Electroconvulsive Therapy (m-ECT): A Randomised Controlled Trial

Garima Anant, SK Singhal, Raj Bhagavan Kumili, Shubhada Bhagat Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Electroconvulsive Therapy (ECT) is an established and effective treatment for severe psychiatric disorders, including major depressive disorder and bipolar disorder. However, ECT is often associated with significant haemodynamic fluctuations and Postictal Agitation (PIA), which may pose safety concerns. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has shown promise in stabilising haemodynamics and reducing PIA in various clinical settings. Aim: To evaluate the efficacy of intravenous dexmedetomidine in attenuating haemodynamic responses and PIA in patients undergoing modified ECT (m-ECT). Materials and Methods: This double-blinded, randomised controlled study was conducted at Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from July 2023 to September 2024, and included 100 patients undergoing m-ECT. Patients were randomly allocated to receive either intravenous 0.9% normal saline (Group C) or intravenous dexmedetomidine at a dose of 1 μg/kg (Group D), administered over 10 minutes prior to m-ECT. Haemodynamic parameters, including Heart Rate (HR), Mean Arterial Pressure (MAP), and Rate Pressure Product (RPP), were measured at multiple intervals. PIA was assessed using the emergence agitation score. Additional parameters recorded included seizure duration, time to spontaneous breathing, and time to obey verbal commands. Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 26.0. The Independent t-test and Chi-square test were applied where appropriate, with a p-value <0.05 considered statistically significant. Results: Demographic characteristics, including age, gender distribution, and American Society of Anaesthesiologists (ASA) physical status, were comparable between both groups, with no statistically significant differences. The mean age in Group C was 36.64±11.71 years, and in Group D was 38.28±12.10 years (p-value=0.467). The mean peak HR was significantly lower in Group D (97.46±9.50 bpm) compared to Group C (124.10±20.54 bpm). MAP was also significantly lower in Group D (94.6±12.2 mmHg) than in Group C (123.96±15.94 mmHg). The RPP was reduced in Group D (9154.64±1547.45) compared to Group C (10113.84±1706.19). Overall, Group D demonstrated significantly lower levels of emergence agitation, suggesting that dexmedetomidine was more effective in promoting calm recovery. The statistically significant p-value (0.006) supports this conclusion. Conclusion: Intravenous dexmedetomidine effectively reduces haemodynamic fluctuations and PIA in patients undergoing modified ECT. It provides better cardiovascular stability, lowers HR and blood pressure, and improves the quality of recovery. Although it slightly prolongs the time to obey verbal commands, the overall benefits make dexmedetomidine a safe and valuable adjunct in the anaesthetic management of m-ECT.

Single versus Double-coil Repetitive Peripheral Magnetic Stimulation Targeting Knee Cartilage and Ligaments: A Finite Element Analysis

Barbora Vrbova, Jitka Malae Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Despite the growing use of repetitive Peripheral Magnetic Stimulation (rPMS) in non-invasive rehabilitation over the past three decades, stimulation applicator designs have seen minimal innovation. A multi-coil approach with independently adjustable tilt and angle could broaden the possibilities of stimulation in physiotherapeutic practice. Aim: To theoretically compare the effects of single and double-coil configurations on a simplified model of knee tissue. Materials and Methods: The present in-silico Finite Element Modelling (FEM) study was conducted using COMSOL multiphysics, without the involvement of human or animal participants and therefore without the need for ethical clearance. The development and simulations of both configurations were carried out at the Research Centre in Prague, Czech Republic. A simplified knee cartilage model was created to assess total magnetic energy, and a cylindrical ligament model was used to evaluate energy distribution with depth. Model outputs were deterministic and were analysed descriptively without statistical testing. Results: In the cartilage model, the double-coil configuration produced up to 20% greater total magnetic energy compared to the single coil. In the ligament model, the single coil delivered higher energy superficially (≤3 cm), whereas the double-coil generated 45-121% greater energy at deeper layers (3-8 cm). Conclusion: The study theoretically indicated the potential application of the novel double-coil configuration in physiotherapy. Its enhanced energy delivery may be beneficial for conditions such as osteoarthritis and ligament injuries, particularly when deeper tissue targeting is required. Further clinical studies are warranted to confirm these findings.

Effect of Cranberry Gel on Cementum and Root Dentin Surfaces: An In-vitro Exploratory Study

Poulami Chakraborty, Sankari Malaiappan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Cranberry (Vaccinium macrocarpon), known for its rich antioxidant content, contains bioactive compounds with antimicrobial, anti-inflammatory, and regenerative properties. Given its acidic nature and therapeutic potential, it may serve as a natural alternative to conventional root biomodification agents such as citric acid in periodontal applications. Aim: To investigate the morphological and chemical effects of cranberry gel on cementum and root dentin surfaces, which are critical components in maintaining the structural integrity and function of teeth. Materials and Methods: This in-vitro exploratory study was conducted at the Department of Periodontology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, over a period of four months from July 2023 to September 2023. The study aimed to evaluate the surface changes in dentin and cementum following the application of cranberry gel. Inclusion criteria involved the use of freshly extracted, non carious, periodontally compromised mandibular molars exhibiting Grade III mobility. A total of 10 samples were selected: four blocks of cementum and six blocks of dentin, prepared using a hard tissue microtome (Isomet 1000) with standardised dimensions of 4×4×4 mm. Cementum samples were divided into two groups: baseline (untreated) and cranberry gel-treated (30 seconds). Dentin samples were categorised into three groups: baseline, cranberry gel-treated (30 seconds), and dentin pre-etched with 37% orthophosphoric acid followed by cranberry gel application. The specimens were then subjected to Scanning Electron Microscopy (SEM) to observe and compare surface topography, tubule patency, and smear layer removal. Results: The cementum surface treated with cranberry gel for 30 seconds appeared rougher compared with the baseline, indicating possible smear layer removal. Dentin surfaces treated solely with cranberry gel exhibited a smoother texture with increased visibility and opening of dentinal tubules. However, dentin surfaces pretreated with orthophosphoric acid and subsequently exposed to cranberry gel demonstrated tubule occlusion. Conclusion: The results suggest that cranberry gel may serve as an effective agent for root biomodification and offer potential benefits in the treatment of dentinal hypersensitivity. Further studies are needed to explore the clinical applications of cranberry gel in dental therapy.

Comparison of Two Completeness Scoring Tools for Adverse Drug Reaction Forms: A Cross-over Open Label Pilot Study at a Pharmacovigilance Monitoring Centre in Navi Mumbai, India

Adwait Malik, Atharav Dahibhate, Manali Deshpande, Masum Reza, Jinitha Panikar, Anant Patil, Vaishali Thakare, Deepak Langade Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Completeness of Adverse Drug Reaction (ADR) reports is critical for effective pharmacovigilance. In India, different scoring tools are used to evaluate report quality, but little is known about their comparative performance in terms of time efficiency and scoring logic. Aim: To compare the two available completeness scoring tools- Tool I (Modified from National Coordination Centre (NCC) by Mahajan M et al.,) and Tool II {(A scale prepared by experts from one of the ADR Monitoring Centres (AMC)} for ADR forms with respect to the time required for assessment and the categorisation of completeness scores. Materials and Methods: The present comparative, cross-over, open label pilot study was conducted at an AMC in Navi Mumbai, Maharashtra, India, between October 2024 to March 2025. This was a pilot study to check the feasibility so that a large, multicentric sample size could be conducted in near future. Thirty randomly selected ADR forms were independently evaluated by two professionals using two scoring tools: Tool I (Modified NCC by Mahajan M et al.,) and Tool II (Kuchya SK and Shrivastav S). A three day washout period was implemented. Completeness score distribution and time taken were analysed by using Mann-Whitney U test. Results: Tool I was more time-efficient than Tool II (62.4±8.5 vs 74.4±7.2 seconds; p<0.001). Using Tool I, 27 (90%) of reports were found to be >75% complete versus 25 (83.3%) using Tool II. Using Tool II, 5 ADR forms were in the 5 (50-75%) completeness category. The most frequent ADRs were rash 8 (26.6%) and itching 5 (16.6%), primarily associated with antimicrobials 12 (40%). Conclusion: Both tools were effective, but Tool I (Modified NCC) was significantly more time-efficient. The difference in scoring distribution highlights the need for a standardised tool to optimise ADR reporting practices.

Clinicopathological Profile of Triple Negative Breast Cancer: A Cross-sectional Study

Pranjal S Shah, Sunil Vitthalrao Jagtap, Tanaji S Kakade, Singdha Vartak, Swati S Jagtap, Rutuja Khawale Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Triple Negative Breast Cancer (TNBC) is a subtype of breast cancer, characterised by the lack of expression of Oestrogen Receptor (ER) Progesterone Receptor (PR) and Human Epidermal growth factor Receptor (HER2). TNBC is an aggressive type of invasive breast cancer. The clinical, histopathology, and immunohistochemistry study are vital in diagnosing TNBCs. TNBC have rarely been studied in relation to rare prevalence, diagnostic difficulties, and special histological variants. Aim: To study the clinicopathological profile of TNBC pateints. Materials and Methods: The present cross-sectional study, which included all the patients undergoing lumpectomy or modified radical mastectomy received in the the Surgical Pathology Section of tertiary care hospital and department of molecular biology and genetic laboratory, at Krishna Institute of Medical Sciences, Karad, Maharashtra, India from May 2019 to April 2021. During the study period, total of 302 specimens of modified radical mastectomy or lumpectomy that met the inclusion/exclusion criteria were received in the Surgical Pathology department were included in this study. All specimens were analysed using immunohistochemistry for ER, PR, and HER2 Neu expression. Out of these, 100 (33.1%) cases were negative for all three markers, reported as TNBCs. These 100 TNBC cases were evaluated based on the clinicopathological parameters such as patient age, tumour laterality, location, tumour size, histopathological type, histologic Grade, lymphovascular invasion and lymph nodal status of TNBCs and to analyse different histomorphological type. Results: In this total of 302 specimens of modified radical mastectomy, the Invasive Breast Carcinoma No Special Type (IBC NST) (82.70%, 250 out of 302 specimens) was the commonest histopathological diagnosis, followed by medullary carcinoma seven cases (7.0%), metaplastic carcinoma two cases (2.0%), invasive lobular carcinoma two cases (2.0%), one case of apocrine carcinoma (1.0%), one case of neuroendocrine carcinoma (1.0%) and one case of each (1.0%) as malignant phyllode’s tumour, mucinous carcinoma, etc. Conclusion: Prevalence of TNBC in India is considerably higher compared with that seen in Western populations. Present study included extensive analysis of breast cancer showing increasing in incidence of TNBC and is challenging to treat due to its adverse clinicopathological profile. The TNBC is associated with younger age, larger tumour size, higher histopathological Grades, extensive tumour necrosis, more regional lymph node metastasis, advanced stage at diagnosis and aggressive nature of tumour.

Morphological Features Predictive of Malignancy in Cytology Smears of Atypical Proliferative Breast Diseases: A Cross-sectional Study

Rajasree Varma Kerala Varma, CS Bindu, Simi Sidharthan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Breast lesions comprise about 34-40% of lesions evaluated by fine-needle aspiration in surgical practice. Fine-Needle Aspiration Cytology (FNAC) is increasingly used as a simple and cost-effective method to assess the nature of breast lesions, with high sensitivity and reasonable specificity, which helps in planning further treatment. However, a small percentage of breast lesions cannot be confidently diagnosed as benign or malignant and are termed grey-zone lesions. These include reactive atypia seen in some benign conditions and atypia of malignancy. Aim: To analyse the cytological features of atypical proliferative breast diseases associated with a malignant diagnosis on histopathologic examination. Materials and Methods: This was a cross-sectional study involving FNAC smears of all patients diagnosed as proliferative breast disease with atypia in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India, from January 2018 to June 2021. Clinical and cytological features were studied, and patients were followed-up until June 2022. The lesions were classified histologically into benign and malignant lesions. The cytological features in the FNAC smears were studied. The data were entered into spreadsheets in Microsoft Excel, and the variables were analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 for Windows. The Chi-square test was used to evaluate features significantly associated with a histological diagnosis of malignancy. Results: The study included a total of 162 cases diagnosed as proliferative breast disease with atypia on FNAC. Histopathological follow-up was available for these cases, with 73 benign and 89 malignant. Clinical features that were statistically significant in subjects with malignant histopathological diagnoses included age over 40 years, presence of a hard and fixed breast lump, and nipple changes. Cytological features predictive of a malignant histological diagnosis included clusters with ill-defined borders, loosely cohesive or cribriform clusters, clusters with markedly reduced or absent myoepithelial cells, reduced stromal fragments, numerous singly scattered atypical cells, markedly reduced or absent bipolar bare nuclei in the background, high mitotic rate, and necrosis. The nuclear features that were statistically significant included marked nuclear enlargement, nuclear pleomorphism, irregular nuclear contour, nuclear overlapping, and coarse nuclear chromatin. Conclusion: The diagnosis of malignancy requires a multifaceted approach, including correlation with clinical, radiological, and pathological features. For an unequivocal cytological diagnosis of malignancy, a constellation of cytomorphological features is needed; a single morphological feature cannot reliably distinguish between benign and malignant lesions. Proper knowledge of the various cytomorphological features of malignancy can help predict malignancy even if all classical cytological features are not present. Cytological study can be a useful adjunct in triaging cases where prompt histopathological assessment is mandatory.

Optimising Urinary Pathogen Detection: A Cross-sectional Comparative Study of CLED Agar, HiCrome UTI Agar and MacConkey Agar

Akansha Goyal, Himadri Rajeshkumar Trivedi, Krunal Dineshbhai Mehta, Sapna Chauhan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Urinary Tract Infections (UTIs) are commonly caused by both Gram-negative and Gram-positive bacteria. In clinical microbiology, urine culture plays a crucial role in diagnosis, with traditional media like blood agar and MacConkey agar being widely used. However, Cystine Lactose Electrolyte Deficient (CLED) agar offers a more cost-effective alternative by inhibiting the swarming of Proteus species while supporting a wide range of uropathogens. Chromogenic media, such as HiCrome UTI agar, enable rapid identification but are limited by their high cost. Aim: To compare the diagnostic efficiency of CLED agar, HiCrome UTI agar, and MacConkey agar for the isolation and identification of common urinary tract pathogens. Materials and Methods: This cross-sectional comparative study was conducted in the microbiology department of Shri M.P. Shah Govt. Medical College, Jamnagar, Gujarat, India from October 2019 to December 2020. A total of 400 urine samples from patients with suspected UTIs, collected from both the outpatient and inpatient departments of a tertiary care hospital, were included for bacterial examination. Patients were instructed to collect clean-catch midstream or catheter-catch urine in sterile containers following aseptic protocols. Demographic data such as age, sex, and clinical symptoms were recorded. Statistical analysis was performed using the Chi-square test, with a p-value of <0.05 considered statistically significant. Results: Out of the 400 urine samples processed, 189 (47.3%) showed significant growth, with 158 (83.6%) exhibiting pure bacterial growth and 31 (16.4%) showing mixed bacterial growth. A total of 220 bacterial isolates were identified, predominantly Gram-negative bacilli (85%), with Escherichia coli (44.1%) and Klebsiella spp. (30.5%) being the most common pathogens. Among Gram-positive cocci, Staphylococcus aureus (9.1%) and Enterococcus spp. (5.9%) were prevalent. CLED agar, MacConkey agar, and HiCrome UTI agar all isolated Gram-negative bacteria, but only CLED and HiCrome UTI agar supported the growth of Gram-positive cocci. Mixed bacterial growth was observed in 31 samples, with E. coli and Klebsiella spp. being the most frequent combination. A cost comparison revealed CLED agar as the most economical and effective choice for routine use in resource-limited settings. Conclusion: This study emphasises the need for strategic selection of culture media to enhance the diagnostic efficiency of UTIs, particularly in resource-limited settings. The comparative analysis highlights CLED agar as a cost-effective and reliable option, balancing diagnostic accuracy with affordability. While HiCrome UTI agar offers the advantage of rapid presumptive identification, its higher cost may limit its routine use. The findings provide valuable insights for clinical microbiology laboratories aiming to optimise resource allocation without compromising diagnostic quality.

Effect of SGLT2 Inhibitors on Renal Resistive Index in Diabetic Nephropathy Patients: A Quasi-experimental Study

Chandni Jayakumar, Sritheja Gopalakrishnan, Sushmitha Kannan, Vishnupriya Subramaniyan, Janardanan Subramonia Kumar, Pooja Prasad Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Diabetic Nephropathy (DN) is a frequent and severe complication of Type 2 Diabetes Mellitus (T2DM) that often progresses to End-Stage Renal Disease (ESRD). Renal Resistive Index (RI) and Urine Albumin-to-Creatinine Ratio (UACR) are valuable indicators used to evaluate renal microvascular health and DN progression. Doppler ultrasonography of the renal arteries is a non invasive tool for analysing renal blood flow, with RI providing insight into vascular resistance by comparing systolic and diastolic flow velocities. Aim: To assess the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on RI in T2DM patients. Materials and Methods: A quasi-experimental study involving 148 participants, categorised into normoalbuminuric and microalbuminuric groups, was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Patients received SGLT2 inhibitors for three months, after which RI and UACR were reassessed. Paired t-tests were used to compare pre- and postintervention values within groups, while independent t-tests and Chi-square tests were applied to compare baseline characteristics and outcomes between groups. A p-value <0.05 was considered statistically significant. Results: Post-treatment findings showed significant reductions in RI and UACR values, indicating improved renal haemodynamics and reinforcing the renal protective role of SGLT2 inhibitors (p-value <0.001). Conclusion: These results underscore the therapeutic relevance of SGLT2 inhibitors in preserving renal microcirculation and delaying DN progression.

Bottleneck Analysis of Iron and Folic Acid Supplementation among Children Aged 6 Months to 5 Years using the Modified Tanahashi Model: A Community-based Cross-sectional Study

Ananya Subhajita Panigrahy, Nivedita Karmee, Priyasha Panda, Monali Kar, Durga Madhab Satapathy Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Even though there is a public health intervention to provide a biweekly Iron and Folic ACID (IFA) supplementation to children of six months to five years, the prevalence of anaemia in this age group of children in India remains high. Aim: To identify potential bottlenecks in the implementation of IFA supplementation, and suggest measures to address them in children aged six months to five years using the modified Tanahashi model. Materials and Methods: The present cross-sectional study was done from August to September 2022 in randomly selected Anganwadi Centres (AWC) in Koraput district, Odisha, India. A total of 10 AWC and the front-line health service providers- Auxiliary Nurse and Midwife (ANM), Accredited Social Health Activist (ASHA) and Anganwadi Worker (AWW) were taken for facility survey. Around 100 mothers /caregivers of children in the age group six months - five years were taken for a community survey. Content analysis was done for the qualitative data. Results: As reported by about three out of 10 (30%) of the AWWs and about four out of 18 (22.22%) of ASHAs, mothers resisted to feed IFA syrup to their children due to misconceptions. About 41 out of 100 (41%) of mothers did not know the recommended schedule for IFA supplementation. None of the mothers orally administered IFA syrup to the children as per the guidelines. The ANMs reported that no screening of children for anaemia was done at the Urban Health and Nutrition Day (UHND). Conclusion: Trained health workers, maintenance of buffer stocks and easy accessibility in terms of distance were the factors increasing the coverage of IFA supplementation. However, irregular administration, less frequent household visits by the healthcare provider, low compliance in service delivery, poor adherence to guidelines, lack of screening at UHNDs, poor awareness among mothers may have resulted in sub-optimal supplementation.

Effect of Ball and Balloon Blowing Exercises on Non Specific Low Back Pain among Undergraduate Students: A Prospective Interventional Study

V Jithin Raj, Anju Ullas, GR Gireesh, PS Sreekanth Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Non Specific Low Back Pain (NSLBP) is one of the most common musculoskeletal conditions globally, adversely affecting quality of life, and occurring without any identifiable cause. Among undergraduate students, the incidence of NSLBP is considerably high due to prolonged sitting during theory sessions and extended standing hours during clinical duties. Aim: To determine the effectiveness of ball and balloon blowing exercises on NSLBP among undergraduate students. Materials and Methods: The present prospective interventional study was conducted over a period of three months, from April 2022 to June 2022. Among 724 undergraduate students surveyed at Yenepoya (Deemed to be University), Mangaluru, Karnataka, India using the Oswestry Low Back Pain Disability Questionnaire, 70 participants were identified as having 0-40% non specific low back pain. These participants were randomly assigned to the control group (n=35) and the intervention group (n=35). Participants in the intervention group performed ball and balloon blowing exercises for 10 minutes twice daily for 21 days. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS). Results: The majority of participants in both the intervention and control groups were 19-years-old and males. The paired t-test revealed a significant reduction (p<0.001) in pain scores in the intervention group between pretest and post-test 1, as well as between pretest and post-test 2. In contrast, no significant change was observed in the control group (p>0.05). These findings indicate that ball and balloon blowing exercises are effective in reducing non specific low back pain. Conclusion: Ball and balloon blowing exercises are an effective, non pharmacological intervention for reducing non specific low back pain.

Retrieval of Gall Bladder Through Umbilical Port versus Epigastric Port During Laparoscopic Cholecystectomy: A Prospective Interventional Study

Ateet Fulmali, Divish Saxena, Siddharth Dubhashi, Bhupendra Mehra Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Cholelithiasis affects 10-15% of the population and the majority of these cases are asymptomatic, often detected incidentally through abdominal sonography. Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. The choice of retrieval method for the gall bladder, either from the umbilical or epigastric port, lies in the hands of the operating surgeon. No study has recommended the superiority of extraction from either port; however, the incidence of port-site hernia and infection is more common with the umbilical port. Aim: The aim of the present study was to compare the retrieval of the gall bladder from either port concerning postoperative pain, retrieval time and the incidences of port-site infection and hernia. Materials and Methods: The present prospective interventional study was conducted in the Department of Surgery at AIIMS, Nagpur, India, over one and a half years, involving 88 patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis, with 44 patients assigned to both the umbilical and epigastric retrieval ports. Pain scores were compared using the Visual Analog Scale (VAS) at 12, 24 and 48 hours postsurgery. Patients were subsequently followed up for port-site infection and port-site hernia. Categorical variables were expressed as percentages or proportions. The chi-square test was applied for categorical variables and the independent t-test was used for continuous variables. Results: The study initially enrolled 110 patients; however, ten were lost to follow-up and 12 were excluded due to intraoperative biliary spillage and conversion to open surgery. This resulted in 44 patients in each arm. The mean age of the sample population was 47.11±15.62 years for the epigastric port group and 48.86±14.62 years for the umbilical port group. The female-to-male ratio for the epigastric extraction port was 1.32:1, while for the umbilical extraction port, it was 2.44:1. The mean VAS score postoperatively from either port was found to be statistically significant at 48 hours. The mean time for gall bladder retrieval was 6.36±4.44 minutes for the epigastric port, compared to 7.91±6.32 minutes for the umbilical port, which was not statistically significant. There were no reported cases of port-site infection or hernia. Conclusion: The present study concluded that the retrieval of the gall bladder from either port does not have a significant impact on retrieval time, postoperative pain, surgical site infections, or port-site hernias.

Serum Homocysteine as a Biomarker for Peripheral Arterial Disease Severity: A Cross-sectional Study

S Harish, MC Sapna Patel, K Sachin, Sharon Esther, P Deepak Naik, MH Ganashree, Sankar Chandra Vadan, Angitha Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Hyperhomocysteinaemia is linked to accelerated atherothrombosis, which is an independent risk factor for cardiovascular and cerebrovascular events, and a strong predictor of mortality. Understanding its role in Peripheral Arterial Disease (PAD) could uncover a modifiable target for preventing Chronic Limb-Threatening Ischaemia (CLTI). Aim: To assess the role of serum homocysteine in peripheral arterial disease. Materials and Methods: A cross-sectional study was conducted at the Department of General Surgery and Vascular Surgery, JSS Hospital, Mysuru, Karnataka, India, from June 2023 to December 2024, among 60 participants with a confirmed diagnosis of PAD, included through convenience sampling. Data was collected for the demographics, clinical history, and examination, and was recorded using a standardised questionnaire. Group comparisons were performed using Independent sample t-tests, Analysis of Variance (ANOVA) with Tukey post-hoc tests. Correlations between total Homocysteine levels (tHcy) and clinical variables were assessed using Pearson’s or Spearman’s correlation. A p-value ≤0.05 was considered statistically significant. Results: The average age of participants was approximately 55 years with a wide age range (25–85 years). Homocysteine correlated inversely with age (r-value=-0.33, p-value=0.01) but not with smoking pack-years or blood pressure. Multivariate regression confirmed diabetes as an independent positive predictor of tHcy (β=0.29, p-value=0.015). The Receiver Operating Characteristic (ROC) curve for tHcy discriminating severe PAD showed an Area Under the Curve (AUC) of 0.35. A 10 μmol L-1 cut-off maximised sensitivity (100%) but delivered 6% specificity, yielding limited clinical utility. Conclusion: While not universally predictive, elevated homocysteine levels showed strong associations with acute and severe vascular conditions, particularly in CLTI. Hence, it could serve as a supplementary indicator in conjunction with other clinical variables for stratifying vascular disease severity and tailoring patient-specific management strategies.

Effectiveness of Herbal Poultice (Punarnavadi Upanaha Sweda) in Relieving Pain and Stiffness in Osteoarthritis Patients: A Single-arm Clinical Trial

Pooja Ravindra Bondge, Pranesh Prakash Gaikwad, Mamata Nakade, Vaishali Chaudhari, Chandranshu Shukla Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: In today’s world, pharmacological, biochemical, and surgical treatments often fall short in effectively managing Osteoarthritis (OA). However, Ayurveda has suggested various therapies for its long-term efficacy, and Herbal Poultice is one among them. It is seen to provide analgesic and anti-inflammatory effects. The goal of the study was to evaluate the effectiveness of herbal poultice as a natural and supportive treatment option for knee OA. Aim: The study’s main aim was to evaluate Punarnavadi Upanaha Sweda’s efficacy in managing Janusandhigatavata, using daily poultice bandaging on the affected knee for upto seven days. Materials and Methods: The present single arm clinical trial was conducted at Dr. DY Patil College of Ayurved Hospital and Research Centre Pimpri, Pune, Maharashtra, India, from April 2023 to October 2024. A total of 32 patients diagnosed with knee OA were included, and patients who had other joint disorders or permanent joint damage were excluded. Patients were also excluded if the patient had other joint disorders or permanent joint damage. The intervention consisted of Punarnavadi Upanaha Sweda, a poultice applied externally to the affected knee joint for six hours daily over seven consecutive days, preceded by a five-minute massage. Follow-up assessments were conducted on the 14th day after the last treatment. Demographic parameters, including age, gender, and baseline pain levels, were recorded for all participants. To assess the effects of the treatment, joint pain was measured using the Visual Analog Scale (VAS), and joint restrictions were evaluated through goniometric measurements of the knee’s range of motion. Statistical analysis was performed using the Friedman test for follow-up and the Wilcoxon signed rank test for before and after assessment, and a p-value of less than 0.05 was considered statistically significant. Results: The subjective parameter viz., Janusandhishool (Pain), Janusandhishotha (swelling), Akunchana Prasarana Kashtata (joint restriction) related to the knee joint and objective parameter viz., VAS for the pain of the knee joint and goniometric measurement for the restricted knee joint movements were statistically significant (p<0.05), indicating a significant improvement from baseline assessment to the end of treatment. Conclusion: The study provides strong evidence for the effectiveness of Punarnavadi Upanaha Sweda in managing knee OA, demonstrating significant improvements in both joint pain and range of motion. These findings suggest that this Ayurvedic treatment can be a valuable option for alleviating symptoms and improving the quality of life in patients with knee OA.

Association between Physical Activity, Anxiety, and Periodontitis: A Cross-sectional Study from Andhra Pradesh, India

Anilkumar Kanakamedala, Gautami S Penmetsa, VL Aishwaraya, Rama Laxmi Koruprolu, Arun Bhupathi, NVS Sruthima Gottumukkala Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Periodontitis is a prevalent inflammatory disease affecting the supporting structures of teeth, often exacerbated by psychosocial factors such as anxiety. Concurrently, Physical Activity (PA) has been identified as a protective factor for mental health. The interplay between PA, anxiety, and periodontal disease has gained attention in recent years, particularly in understanding their implications for overall health. Aim: To investigate the association between PA levels, anxiety and periodontitis. Materials and Methods: The present cross-sectional study was conducted involving 240 participants from Andhra Pradesh, India. Participants underwent a thorough periodontal examination, including measurements of clinical attachment loss. PA levels were assessed using the International PA Questionnaire, while anxiety levels were evaluated using the Generalised Anxiety Disorder (GAD)-7 scale. Statistical analysis was performed to explore the associations among PA, anxiety, and periodontal parameters. Results: The total number of participants was 240, of which males were 110 (45.8%) and females were 130 (54.2%) with the mean age of 45±5.7 years. Results showed that out of 240 participants, 61 (25.4%) had no periodontitis, while 105 (43.8%) had mild, 68 (28.3%) moderate and 6 (2.5%) severe periodontitis. Anxiety levels among the participants, 169 (70.4%) reported no anxiety, 55 (22.9%), mild, 14 (5.8%) moderate, and 2 (0.8%) severe anxiety. PA levels were low in 103 (42.9%) of participants, moderate in 84 (35%), and high in 53 (22.1%). Significant differences were found between periodontitis and both Generalised Anxiety Disorder (GAD) scores and PA levels, with a weak positive correlation observed between periodontitis and GAD scores (p=0.029) as well as between periodontitis and PA (p<0.001). This analysis revealed that participants with lower levels of PA exhibited a significantly higher risk for periodontitis (p<0.001) and elevated anxiety scores. Furthermore, a positive correlation was found between higher anxiety levels and reduced PA, suggesting a compounded risk for periodontal health deterioration. Conclusion: The present study demonstrates a clear association between reduced PA, increased anxiety, and the prevalence of periodontal disease. The results highlight the worth of encouraging physical exercise as a possible tactic to reduce anxiety and enhance periodontal health. Further research is warranted to explore the underlying mechanisms of these relationships and to develop targeted interventions that can enhance PA and overall well-being.

Effects of Four-week Progressive Multitask Training on Balance, Gait and Activities of Daily Living Performance in Older Adults: An Experimental Study

Pranali Chougule, Saurabh Kumar, Shweta Sharma, Priyanka Rishi Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: The aging population often experiences increased disability, primarily due to insufficient physical activity, which significantly impacts their ability to perform Activities of Daily Living (ADLs). Age-related changes in cognition, gait, and balance further hinder functional independence, so there is a need to develop targeted interventions that address these challenges and promote healthy aging. Understanding the specific limitations and designing effective strategies to enhance physical activity and motor control are essential to improving the overall well-being of older adults. Aim: To assess the impact of progressive multitask training on balance, gait, and ADL performance in older adults. Materials and Methods: This experimental study was conducted at SGT Hospital, Gurugram, Haryana, from September 2023 to January 2024. A total of 60 older adults were recruited and divided into three groups: Group A (progressive multitask training), Group B (motor-cognition training), and Group C (control group, instructed to walk 30 minutes daily). Data were collected at baseline and after a Four-week intervention. Outcome measures included the Performance Oriented Mobility Assessment (POMA), Dynamic Gait Index (DGI), Timed Up and Go (TUG) test, and Functional Independence Measure (FIM). Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS). Paired t-tests and one-way Analysis of Variance (ANOVA) were applied, with a significance level set at p<0.05. Results: The mean ages for Groups A, B, and C were 67.5±2.28, 67.5±2.33, and 67.7±2.18 years, respectively. Group A showed significant improvements (t=19.9) in balance, cognition, gait, and ADL performance compared to Group B (t=18.01) and Group C (t=6.29). Group B also demonstrated improvements in all outcome measures relative to the control group, though progressive multitask training proved more effective. Conclusion: Progressive multitask training significantly enhances functional outcomes in older adults, improving balance, cognition, gait, and ADL performance. This approach may be beneficial in clinical settings to improve independence and Quality of Life (QoL) in older adults.

Assessment of Stress in First Year Medical Students by Measuring Heart Rate Variability and its Correlation with Academic Achievement: A Cross-sectional Study

Chirag Gupta, Nimarpreet Kaur, Deepti Dwivedi, Keshav Verma, Sehan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Academic stress can inhibit and suppress learning, a phenomenon referred to as “unfavorable stress,” which is associated with diminished academic performance. It is a proven fact that medical students experience this stress from the moment they enter the profession, and it continues throughout their lives. Therefore, the association between stress and cardiac autonomic functions has been studied. Exposure to various stressors stimulates multiple stress-controlling mechanisms in the body. The primary focus of the present study was to measure stress and its effects on the cardiovascular system, as well as its subsequent impact on academic performance. Aim: To measure stress in medical students using Heart Rate Variability (HRV) and Perceived Stress Scale (PSS) scores, and to relate these measurements to their academic achievements. Materials and Methods: The present cross-sectional observational study was conducted on 60 healthy medical students at Faculty of Medicine and Health Sciences (FMHS) SGT Medical College, Gurugram, Haryana, India, after obtaining approval from the Institutional Ethics Committee. The study lasted for two months, from June 2022 to July 2022. All enrolled students who provided consent and were studying during the study period were selected through a random allocation technique. One week before the sessional examinations, PSS scores, 15 minutes of HRV data, and scores from Multiple-Choice Questions (MCQs) were obtained. Statistical analysis was performed using Analysis of Variance (ANOVA), which showed significant results with p<0.005. Out of 150 students, a total of 60 were included in the study. Demographic parameters were not considered, and ANOVA and t-tests were used with a confidence interval of 95%. A p-value less than 0.05 was considered significant. Results: A total of 44 (73.33%) students reported moderate stress one week before the first internal examination, while only 24 (40%) students reported moderate stress one week before the second internal examination. This highlights that coping strategies help individuals tackle stressful situations. Conclusion: Stress can be beneficial to some extent for the academic achievement of students, but not always. Additionally, the present study provides insights into understanding the stress levels of students from the onset, which can assist them in managing schoolwork and academic achievements.

Postoperative Analgesic Efficacy of Transdermal Fentanyl Patch in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomised Controlled Trial

Shilpa Susan Samuel, MS Shravya, TN Chethanananda, Noulaspure Anand Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Total Laparoscopic Hysterectomy (TLH) is associated with significant postoperative pain, necessitating effective analgesia to enhance recovery. Transdermal Fentanyl Patches (TFP) provide a non-invasive, sustained-release opioid delivery system; however, their efficacy in TLH remains underexplored. Aim: To evaluate the postoperative analgesic efficacy of preoperative TFP (25 mcg/hr) compared to placebo in patients undergoing TLH. Materials and Methods: In the present double-blinded, randomised controlled trial, 60 female patients (aged 40-65 years, American Society of Anesthesiologists (ASA) I-II) undergoing elective TLH were randomised to receive either a 25 mcg/hr TFP (n=30) or a placebo patch (n=30) applied 10-12 hours preoperatively. Pain intensity was assessed using the Numeric Rating Scale (NRS) at 2, 4, 6, 8, 10, 12 and 24 hours postoperatively. Secondary outcomes included ambulation scores (0-3), Ramsay Sedation Scores (RSS) (1-6) and incidence of Nausea and Vomiting (N/V, 0-3). Data were analysed using t-tests, chi-square tests and general linear models, with statistical significance set at p<0.05. Results: Baseline characteristics (age, Body Mass Index (BMI), ASA grade and duration of anaesthesia) were comparable between groups (p>0.05). The fentanyl group demonstrated significantly lower pain scores at all time points (e.g., 2 hours: 3.87±0.434 vs. 6.83±0.461; 24 hours: 1.53±0.629 vs. 3.30±0.651; p<0.001). Ambulation scores were higher in the fentanyl group (e.g., 12 hours: 3.00±0.170 vs. 1.70±0.450; p<0.001), indicating better mobility. Sedation scores were lower in the fentanyl group at most time points (e.g., 24 hours: 0.13±0.346 vs. 0.77±0.430; p<0.001). The incidence of nausea and vomiting was significantly reduced in the fentanyl group (e.g., 2 hours: 0.23±0.305 vs. 2.93±0.254. Conclusion: Preoperative application of TFP (25 mcg/hr) significantly reduces postoperative pain, enhances ambulation, minimises sedation and decreases nausea and vomiting in patients undergoing TLH. These findings support the inclusion of TFP as an effective component of multimodal analgesia for gynecologic surgery and warrant further studies to assess long-term outcomes and comparative efficacy.

Physio Research Summit '25 25th January, 2025

Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Total Laparoscopic Hysterectomy (TLH) is associated with significant postoperative pain, necessitating effective analgesia to enhance recovery. Transdermal Fentanyl Patches (TFP) provide a non-invasive, sustained-release opioid delivery system; however, their efficacy in TLH remains underexplored. Aim: To evaluate the postoperative analgesic efficacy of preoperative TFP (25 mcg/hr) compared to placebo in patients undergoing TLH. Materials and Methods: In the present double-blinded, randomised controlled trial, 60 female patients (aged 40-65 years, American Society of Anesthesiologists (ASA) I-II) undergoing elective TLH were randomised to receive either a 25 mcg/hr TFP (n=30) or a placebo patch (n=30) applied 10-12 hours preoperatively. Pain intensity was assessed using the Numeric Rating Scale (NRS) at 2, 4, 6, 8, 10, 12 and 24 hours postoperatively. Secondary outcomes included ambulation scores (0-3), Ramsay Sedation Scores (RSS) (1-6) and incidence of Nausea and Vomiting (N/V, 0-3). Data were analysed using t-tests, chi-square tests and general linear models, with statistical significance set at p<0.05. Results: Baseline characteristics (age, Body Mass Index (BMI), ASA grade and duration of anaesthesia) were comparable between groups (p>0.05). The fentanyl group demonstrated significantly lower pain scores at all time points (e.g., 2 hours: 3.87±0.434 vs. 6.83±0.461; 24 hours: 1.53±0.629 vs. 3.30±0.651; p<0.001). Ambulation scores were higher in the fentanyl group (e.g., 12 hours: 3.00±0.170 vs. 1.70±0.450; p<0.001), indicating better mobility. Sedation scores were lower in the fentanyl group at most time points (e.g., 24 hours: 0.13±0.346 vs. 0.77±0.430; p<0.001). The incidence of nausea and vomiting was significantly reduced in the fentanyl group (e.g., 2 hours: 0.23±0.305 vs. 2.93±0.254. Conclusion: Preoperative application of TFP (25 mcg/hr) significantly reduces postoperative pain, enhances ambulation, minimises sedation and decreases nausea and vomiting in patients undergoing TLH. These findings support the inclusion of TFP as an effective component of multimodal analgesia for gynecologic surgery and warrant further studies to assess long-term outcomes and comparative efficacy. Physio Research Summit '25 25th January 2025, abstract-1

Clinical Profile, Antimicrobial Resistance and Molecular Detection of ESBL, MBL and Other Carbapenemase Genes in Klebsiella Species-UTI Isolates from Chronic Kidney Disease Patients: A Cross-sectional Study

Nithya Kangosseri, Vidya Pai, BH Santhosh Pai, Aditya Kumar Mishra, Haisam Bin Abdul Kadhar, Preema Dsouza Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Urinary Tract Infections (UTIs) are a common yet serious medical condition that can impact individuals of all ages and genders. UTIs in Chronic Kidney Disease (CKD) patients lead to a low quality of life, and the situation becomes worse when the pathogens exhibit antibiotic resistance due to Extended Spectrum Beta-Lactamases (ESBLs), Metallo-Beta-Lactamases (MBLs), and Carbapenemase genes. Aim: To to evaluate the clinical profile, antibiotic resistance, and frequency of resistance genes in Klebsiella pneumoniae isolates from urine samples of suspected UTIs in CKD patients. Materials and Methods: This cross-sectional study was conducted at Yenepoya Medical College Hospital in Mangalore, Karnataka, India, from January 2023 to January 2024. A total of 138 Klebsiella spp. isolates were collected and included in the study. Antimicrobial susceptibility was assessed using the Vitek2 method. The production of MBL, carbapenemase, and ESBL was confirmed by tests described in the Clinical and Laboratory Standards Institute (CLSI) 2023 document, and genes were detected using multiplex Polymerase Chain Reaction (PCR). Statistical analyses were expressed as percentages for all quantitative data, and categorical variables were compared using Fisher’s exact test, with a p-value of <0.001 considered significant. Results: Among the study participants, 79 (57.25%) were male, and approximately 84 (60.87%) were over 50 years of age. About 46 (33.33%) patients had a history of recurrent UTIs and stage 1 renal impairment. A total of 85 (61.59%) of Klebsiella spp. isolates exhibited Multidrug Resistance (MDR). The maximum resistance was observed against ceftazidime and cefepime, while lower resistance was noted for amikacin, gentamicin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole. Eighteen of the MDR isolates (72%) carried β-lactamase genes, such as bla_-SHV and bla_-CTX-M. Additionally, 33 (82.5%) had bla_-KPC, 21 (52.5%) had bla_-IMP, and OXA genes (58, 23, 51, and 48) were found in 2 (2.8%) isolates each. Conclusion: The present study emphasises the significance of the co-occurrence of ESBL and carbapenemase-encoding genes in K. pneumoniae isolates implicated in UTIs among CKD patients, which could pose challenges for effective treatment options.

Comparison of Reverse and Normal Curve Techniques for ILMA-assisted Tracheal Intubation in Adult Patients: A Prospective Interventional Study

Rashmi Pal, Harshita Dutta Prajapati, Ravi Barde, Vijender Singh Thakur Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Securing airway is the main task of Anaesthesiologist. Intubating Laryngeal Mask Airway (ILMA) was made to simplify blind intubation. Still the outcome can vary with orientation of endotracheal tube. Aim: To observe and compare the Normal Curve (NC) and Reverse Curve (RC) techniques of intubation through ILMA in adult patients with respect to success rate, intubation time, haemodynamic changes, and complications. Materials and Methods: The present prospective interventional study was done in the Department of Anaesthesiology, MGM Medical College and MY Hospital, Indore, Madhya Pradesh, India. A total of 128 adult patients American Society of Anaesthesiologists (ASA) I and II, aged 18-60 years, undergoing elective surgery under general anaesthesia were included in the study. Patients were divided into two groups, NC and RC according to orientation of endotracheal tube through ILMA. Demographic data, number of attempts, time taken for successful intubation, Heart Rate (HR), mean arterial pressue, SpO2 and postoperative complications were recorded. Statistical analysis was done with unpaired t-test and Chi-square test, p<0.05 considered significant. Results: Baseline profile like age, sex, ASA, Mallampati and weight were comparable in both groups. Intubation success was 100% in first attempt. Intubation time was longer in NC (86.9±4.9 s) than RC (76.5±6.7 s, p<0.001). HR and MAP showed slightly higher trend in NC but not significant. SpO2 stayed above 99% in all. Sore throat was more in NC (12.5% vs 4.7%) while hoarseness was rare and equal (1.6%). Conclusion: Both NC and RC gave full success for intubation. RC was faster and had less sore throat. Hoarseness was rare and equal. RC may be better choice when quick intubation and less airway irritation is desired. Larger studies are needed to confirm in wider group of patients.

Cytological Evaluation of Non Thyroidal Neck Swellings: A Prospective Cross-sectional Study from a Tertiary Care Centre in Krishnagiri, Tamil Nadu, India

Jayalakshmy Pechimuthu, P Narmadha Priya, V Palaniappan, Teleflo Boopathy, S Deenadayalan, PR Nashithasafeen Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Non thyroidal neck lesions represent a heterogeneous group of pathologies arising from lymph nodes, salivary glands, soft-tissues, and other cervical structures. Fine Needle Aspiration Cytology (FNAC) is a minimally invasive and cost-effective diagnostic tool, but its accuracy in differentiating benign from malignant lesions requires continuous evaluation against histopathology, the gold standard. Aim: To evaluate the spectrum of non thyroidal neck lesions using FNAC, categorise them cytologically, and assess the diagnostic accuracy of FNAC by correlating it with histopathology. Materials and Methods: This prospective, cross-sectional study was conducted in the Department of Pathology, Government Medical College, Krishnagiri, Tamil Nadu, India from April 2024 to March 2025. A total of 210 consecutive cases of non thyroidal neck lesions underwent FNAC, of which 103 cases had subsequent histopathological evaluation. Cytological diagnoses were classified into inflammatory, benign, and malignant categories. Histopathological specimens were processed using routine paraffin embedding and Haematoxylin and Eosin (H&E) staining. Concordance between FNAC and histopathology was assessed, and diagnostic indices—sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and overall diagnostic accuracy—were calculated. Statistical analysis was performed using Pearson’s Chi-square test (χ²) with IBM Statistical Package of Social Sciences (SPSS) Statistics Version 25.0. Results: Of the 210 cases, 115 (54.76%) were inflammatory, 51 (24.29%) benign, and 44 (20.95%) malignant. Histopathological correlation in 103 cases revealed 21 inflammatory (20.4%), 51 benign neoplastic (49.5%), and 31 malignant neoplastic (30.1%) lesions. FNAC–histopathology concordance was 92.2% (95/103), with discordance in 7.8% (8/103). Diagnostic performance metrics were: sensitivity 92.68%, specificity 90.48%, PPV 97.43%, NPV 76.00%, and overall diagnostic accuracy 92.23%. Conclusion: FNAC is a highly sensitive and specific preliminary diagnostic modality for non thyroidal neck lesions, showing excellent concordance with histopathology. While it can reliably guide initial clinical management, histopathological confirmation remains essential in inconclusive or suspicious cases.

Identification of the hub Gene (Periostin) in Epithelial Mesenchymal Transition (EMT) of OSMF and its Interaction with Gallic Acid from Triphala: An In-silico Docking Study

Sandhya Sundar, Pradeep Kumar Yadalam, Deepak Pandiar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Oral Submucous Fibrosis (OSMF) is a chronic disorder with potential carcinogenesis. A systems biology study identified Periostin as a potential therapeutic target, which could be influenced by gallic acid, a component of triphala, an Ayurvedic herbal formulation. This could help manage OSMF by understanding the molecular interactions between the hub gene and gallic acid. Aim: To identify the hub gene in Epithelial Mesenchymal Transition (EMT) of OSMF and to evaluate its interaction with gallic acid from triphala using molecular docking. Materials and Methods: The present experimental study was conducted at Saveetha Dental College and Hospitals Chennai, Tamil Nadu, India, over a period of one month from July to August 2024. The top 200 genes associated with OSMF were analysed using the Pubmed GENEMANIA 3.6.0 platform. The study identified the hub gene and key protein involved in the EMT of OSMF progression. Cytohubba, a plugin within Cytoscape, was used to identify key proteins or nodes within biological networks. The protein preparation wizard of maestro set up the system, and the Optimized Potentials for Liquid Simulations (OPLS) 2005 force field was used to simulate physiological conditions. The simulation was stable when the protein and ligand's Root Mean Square Deviation (RMSD) were compared over time. Results: The hub gene POSTN (Periostin), central to epithelial mesenchymal transformation in OSMF, was identified via network analysis. A pharmacophore model based on its co-crystallised ligand guided virtual screening of triphala constituents. Gallic acid emerged as a key compound, showing strong binding affinity to Periostin in docking studies. Molecular Dynamics (MD) simulations confirmed the stability of the Gallic acid-Periostin complex over 40 nanoseconds, supporting its potential therapeutic role. Conclusion: These findings highlight the importance of targeting Periostin in OSMF and support the therapeutic potential of gallic acid from triphala. Further research is needed to validate these findings and explore the clinical application of periostin-targeting therapies in OSMF management.

Ozone Enhanced Scaling as an Adjunct in the Treatment of Chronic Periodontitis: A Randomised Controlled Trial

Tanya Sahai, Shivani Sharma, Kumar Saurav Singh, Kriti Agarwal, Atul Parashar, Kavita Singh Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Chronic Periodontitis (CP) is an inflammatory biofilm-induced disease that damages the periodontal ligament and alveolar bone, leading to tooth loss. Ozonated water exhibits antimicrobial effects against periodontal microorganisms, like Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Ozone molecules may easily enter cells and lead to membrane lysis by release of nascent oxygen molecule. The present study was undertaken to evaluate the long-term biochemical effect of the ozone water on inflammatory cytokines. Aim: To determine the clinical and biochemical effectiveness of ozonated water irrigation as an adjunct to Scaling and Root Planing (SRP) in patients with CP. Materials and Methods: The present parallel-group randomised controlled trial was conducted in the Department of Periodontology, Santosh Dental College, Ghaziabad, Uttar Pradesh, India, between October 2022 and November 2024. Among 100 patients screened, a total of 72 participants with CP, aged 30-60 years were randomly allocated into two groups: Group A received SRP alone, and Group B received SRP with subgingival irrigation using ozonated water. Clinical parameters i.e., Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) were recorded at baseline, one month, and three months, while Interleukin-1β (IL-1β) was evaluated at baseline and three months. Wilcoxon signed-ranked and student’s independent t-test were used for data analysis using Statistical Package for Social Sciences (SPSS) version 26.0, with a significance threshold of p≤0.05. Results: The study population had a mean age of 44.3±7.2 years. The test group showed greater PPD reduction (2.14±0.49 mm vs 2.08±0.16 mm) and greater CAL gain (3.080±0.47 versus 1.63±0.25) in control group (p<0.05) three months postoperatively. At three months, the difference in mean value of PPD and CAL of control group and test group was found to be statistically significant (p=0.008* and p=0.001**, respectively). IL-1β levels reduced significantly in the test group by 2.16±1.39 and the control group by 1.26±1.02 at three months from baseline (p<0.05). At three months, the difference in mean value of salivary IL-1β level in control group and test group was statistically significant (p=0.03*). Both the groups showed significant reduction in PI and GI three months postoperatively (p<0.05). Conclusion: Subgingival irrigation with ozonated water as an adjunct to SRP provides superior improvements in clinical and biochemical parameters compared to SRP alone in the management of patients with CP.

Assessment of Anti-inflammatory and Antioxidant Properties of Trypsin, Bromelain, Rutoside and Glucosamine Combination Gel: An In-vitro Study

Madhumitha Mahalingam, Devika S Pillai, Saravanan Muthupandian Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Inflammation and oxidative stress play key roles in the pathogenesis of various musculoskeletal and soft tissue disorders. Conventional pharmacologic therapies, such as Non-steroidal Anti-Inflammatory Drugs (NSAIDs), are associated with several adverse effects, prompting interest in safer, biologically active alternatives. Trypsin and bromelain are proteolytic enzymes known for their anti-inflammatory activity, while rutoside exhibits potent antioxidant and vascular protective properties. Glucosamine, commonly used for joint health, contributes to cartilage repair and has shown mild anti-inflammatory effects. The combination of these agents in a topical gel formulation may offer synergistic benefits in managing inflammation and oxidative stress locally. Aim: The present study examined the anti-inflammatory and antioxidant properties of trypsin, bromelain, rutoside, and glucosamine combination. Materials and Methods: The present in-vitro study was conducted at Gold lab, Department of Pharmacology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, from January to August 2024. The chemicals involved in the process were sourced from SISCO Research Laboratories private limited. The active pharmacological ingredients like trypsin, bromelain, rutoside and glucosamine were mixed and tested. The anti-inflammatory and antioxidant properties of both the formulations were investigated. Albumin denaturation assay for anti-inflammatory activity and 1,1-Diphenyl-2-Picrylhydrazyl (DPPH) assay for antioxidant activity were performed. Student t-test was performed to determine the significance, where p-value less than 0.05 were considered statistically significant. Results: The combination gel exhibited a dose-dependent increase in both anti-inflammatory and antioxidant activities. Anti-inflammatory activity, assessed via the albumin denaturation assay, increased from 51.74% at 20 μg/mL to 85.02% at 100 μg/mL, closely approaching the inhibition shown by the standard drug diclofenac sodium (94.53%). Similarly, in the DPPH assay, antioxidant activity rose from 41.26% at 20 μg/mL to 95.98% at 100 μg/mL, surpassing the activity of ascorbic acid (86.86%) at the highest concentration. Statistical analysis confirmed that these increases were highly significant (p<0.05). Conclusion: The in-vitro findings demonstrated that the trypsin, bromelain, rutoside, and glucosamine combination gel possessed strong, concentration-dependent anti-inflammatory and antioxidant properties. These results suggest its potential as a topical therapeutic alternative to conventional NSAIDs for localised treatment of musculoskeletal and inflammatory conditions. Further in-vivo and clinical studies are recommended to validate its safety, efficacy, and therapeutic applicability.

Clinical Profile and Outcome of Paediatric Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study

SK Jeauddin, Bhukya Naresh, Sarbani Misra Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction:Diabetic Ketoacidosis (DKA) remains a life-threatening metabolic complication in children with Type 1 Diabetes Mellitus (T1DM), particularly in resource-limited settings. Early diagnosis and prompt management are vital for improving outcomes. Aim: To assess the clinical profile, laboratory parameters and outcomes of paediatric patients presenting with DKA and to identify factors associated with mortality. Materials and Methods: This retrospective cohort study included 40 paediatric patients diagnosed with DKA and admitted to the Paediatric Intensive Care Unit (PICU) of Malda Medical College and Hospital, Malda, West Bengal, India. Children under 12 years who were admitted with a diagnosis of DKA between January 1, 2022 and December 31, 2024, were included. Clinical history, physical examination findings, laboratory values and treatment outcomes were recorded. Data were analysed using Statistical Package for the Social Sciences (SPSS) software and associations between various parameters and outcomes were evaluated using appropriate statistical tests. Results: The highest proportion of DKA cases, 17 (42.5%), occurred in children aged 9 to 12 years. Both sexes were equally affected. Most patients, 21 (52.5%), belonged to a low Socio-economic Status (SES). Common symptoms included vomiting in 29 (72.5%), polyuria in 27 (67.5%) and polydipsia in 23 (57.5%). Dehydration was observed in 34 (85%) and Kussmaul breathing in 26 (65%) of the patients. The mean arterial pH was 7.12±0.14 and the mean HbA1c was 5.61±0.70%. The mortality rate was 10% (n=4). Significant predictors of poor outcomes included low SES (p-value=0.004), a positive family history of diabetes (p-value=0.049), lower pH (p-value=0.0016), higher HbA1c (p-value=0.0035), elevated serum urea (p-value=0.0049) and creatinine (p-value=0.0021). Conclusion: Paediatric DKA continues to pose a serious clinical challenge. SES, family history and the degree of metabolic derangement significantly impact outcomes. Early recognition and timely management are critical in reducing mortality and improving prognosis.

Antibiotic Susceptibility Pattern and Clinical Profile of Pseudomonas aeruginosa Isolated from Lower Respiratory Tract Samples: A Cross-sectional Study

Subi Das, Krishnakumar Easwaramangalath Venugopal, Sreelekshmi Prasad, Athira Shaji, Sandhra Sathish Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Pseudomonas aeruginosa can cause respiratory tract infections, skin infections in burns and blood stream infections. Respiratory tract infections, skin infections in burns and blood stream infections by P. aeruginosa are major causes of morbidity and mortality in immunocompromised patients. Emerging resistance to different drugs is becoming a major problem worldwide. Aim: To assess about the pattern of antibiotic susceptibility of P. aeruginosa isolated from lower respiratory tract. Materials and Methods: The present cross-sectional study was conducted in Amala Institute of Medical Sciences Thrissur, Kerala, India, a tertiary care centre for a period of six months, from December 2022 to May 2023 after obtaining ethical clearance. Out of 2236 lower respiratory tract samples, 71 P. aeruginosa isolates cultured from sputum and bronchial wash from inpatients of General Medicine, Respiratory Medicine and Pulmonary Medicine who were included in the study by consecutive sampling method. Pseudomonas aeruginosa were isolated from lower respiratory tract samples, identified and antibiotic susceptibility testing was done by manual and automated methods. History and clinical details of patients were collected from wards and Intensive Care Unit (ICUs) by using a proforma after getting informed consent from them. Descriptive statistics were used to determine the antibiotic susceptibility pattern of the isolates and to analyse the clinical profile of the patients. Similar study of this kind has not been published from Central Kerala recently. Results: In a six month period, out of 2236 lower respiratory tract samples, 71 Pseudomonas aeruginosa were included in the study. Mean age was 64 years. A total of 29 (40%) patients had the habit of smoking, 25 (35%) had Chronic Obstructive Pulmonary Disease (COPD), 16 (23%) had bronchiectasis. One patient had cystic fibrosis, 29 (41%) had a clinical diagnosis of pneumonia. Susceptibility of different antibiotics was as follows: Meropenem-89%, Imipenem-80%, Ciprofloxacin-85%, Ceftazidime-37% Piperacillin tazobactam and Cefaperozone sulbactam-39%. Multidrug Resistant (MDR) strains were 14 (20%). Conclusion: This study revealed that, three fourths of the patients had chronic respiratory illness. Meropenem and Amikacin were the most susceptible drugs. Several treatment options are now available for difficult to treat Pseudomonas, but the increasing rates of resistance is a major concern to be addressed.

Correlation of High-sensitivity C-reactive Protein and Fasting Lipid Profile for Assessing Cardiovascular Risk Factors in patients with Autoimmune Connective Tissue Disorders: A Cross-sectional Study

Prakash Shende, Tejas Anil Kore, Vivek Hiteshbhai Lapsiwala, Sarthak Mangal Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction:Patients with Autoimmune Connective Tissue Diseases (AICTDs) face an increased cardiovascular risk that traditional risk factors cannot fully explain. Chronic systemic inflammation in these disorders is thought to disrupt lipid metabolism, contributing to accelerated atherosclerosis. Understanding the interplay between inflammation and dyslipidaemia is crucial for improving cardiovascular risk assessment in this population. Aim: To assess the prevalence of dyslipidaemia and elevated High-sensitivity C-Reactive Protein (hsCRP) in patients with AICTDs and evaluate their correlation as potential markers of cardiovascular risk. Materials and Methods: This cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from October 2022 to February 2025. A total of 100 patients aged above 18 years, already diagnosed with AICTDs, were included in the study. Comprehensive clinical assessment, serological testing, and measurement of fasting lipid parameters and hsCRP levels were performed. Relationships between lipid parameters, hsCRP, and various clinical variables including disease type, disease duration, Body Mass Index (BMI), and steroid use were analysed. Statistical analysis was performed using Pearson’s correlation coefficient. A p-value < 0.05 was considered statistically significant. Results: The study population consisted of 100 patients, with females comprising 75% of participants and males 25%, and the majority aged between 41 and 60 years. Rheumatoid Arthritis (RA) was the most common diagnosis (46%), followed by Systemic Lupus Erythematosus (SLE) (16%), Sjögren’s syndrome (12%), and other AICTDs. Dyslipidaemia was observed in 92% of patients, with elevated triglycerides (64%), high total cholesterol (56%), and elevated Low Density Lipoprotein (LDL) cholesterol (50%) being most common. Elevated hsCRP levels (>3 mg/L) were present in 64% of patients. Significant correlations were observed between hsCRP and lipid parameters: positive correlations with total cholesterol (r-value=0.411, p-value<0.001), triglycerides (r -value=0.224, p-value=0.02), LDL (r-value=0.404, p-value<0.001), and the TC/HDL ratio (r-value=0.394, p-value<0.001), and a negative correlation with High Density Lipoprotein (HDL) (r-value= -0.227, p-value=0.02). Conclusion: AICTD patients showed a high prevalence of dyslipidaemia and elevated hsCRP, with significant inflammation–lipid correlations. This highlights inflammation-driven dyslipidaemia as a key cardiovascular risk factor, warranting comprehensive risk assessment regardless of disease subtype or duration.

Comparison of WNT1-Inducible Signaling Pathway Protein 1 Levels in Gestational Diabetes Mellitus and Normoglycaemic Pregnancy: A Cross-sectional Study

D Kaviya, P Renuka, VM Vinodhini, M Anuradha, AK Roopa Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Gestational Diabetes Mellitus (GDM) is a common condition that occurs in pregnancy with adverse outcomes. The Wingless and Int-1 ( WNT) signaling pathway is related to adipogenesis as well as inflammatory processes during pregnancy. WNT Inducible Signaling Pathway Protein 1 (WISP-1) has recently been described as a novel adipokine, which may participate in impaired glucose homeostasis. WISP-1 plays a critical part in the pathogenesis of obesity- and inflammation-related diseases. Aim: To estimate WISP 1 levels and their association with hepatic steatosis and insulin resistance in GDM. Materials and Methods: The present cross-sectional study was conducted in the Obstetrics Antenatal Outpatient Department (OPD) of SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu District, Tamil Nadu, India, from December 2023 to May 2024. A total of 41 GDM patients and 41 normal healthy pregnant women between 12 to 28 weeks of pregnancy were included. Pregnant women were diagnosed as GDM, based on the Diabetes in Pregnancy Study Group India criteria (DIPSI). The biochemical analytes such as fasting plasma glucose, Glucose Challenge Test (GCT), Total Cholesterol (TC), Triglycerides (TGL), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Aspartate Transaminase (AST), Alanine Transaminase (ALT), Hepatic Steatosis Index (HSI), WISP-1 and C-peptide levels were analysed. C-peptide derived C-Peptide Immunoreactivity Insulin Resistance (CPR-IR) index, C-peptide based Homeostatic Model Assessment of Insulin Resistance (HOMA-IR CP) was calculated. Independent t-test was used for normal distribution and data was presented as mean±SD or the Mann-Whitney U test for skewed data and data presented as median (interquartile range). Correlation analysis was performed using Spearman’s correlation between parameters in GDM group. Statistical significance was defined as probability value, p<0.05. Results: The mean age was 27.17 years in GDM group while in the control group it was 25.58 years. WISP 1 levels were found to be increased in GDM patients, 114.54 (69.29, 174.7) compared to healthy pregnant women, 95.5 (67.39, 160.76), but this difference was not statistically significant (p=0.366). C peptide 0.46 (0.27, 0.88), HOMA-IR CP 1.51 (1.51, 1.53) were found to be significantly increased in GDM patients. WISP-1 does not correlate with hepatic steatosis (ρ=-0.207, p=0.193) and insulin resistance based on C peptide (ρ=-0.219, p=0.170) in GDM patients. Conclusion: WISP-1 has no correlation with hepatic steatosis and insulin resistance based on C peptide in GDM patients.

Effectiveness of Mayo Adhesive Probability Score in Prediction of Surgical Complexity and Perioperative Outcomes during Laparoscopic Transperitoneal Simple Nephrectomy: A Prospective Observational Study

Madhusudan Panja, Soumya Mondal, Debansu Sarkar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction:The Mayo Adhesive Probability (MAP) score is a preoperative Computed Tomography (CT)-based scoring system developed to predict the presence of Adherent Perinephric Fat (APF), a known contributor to increased surgical difficulty. While extensively studied in partial nephrectomy, its application in Laparoscopic Transperitoneal Simple Nephrectomy (LTSN) remains unvalidated. Aim: To evaluate the effectiveness of the MAP score in predicting surgical difficulty and perioperative outcomes in patients undergoing LTSN. Materials and Methods: The present prospective observational study was conducted at the Department of Urology, IPGME&R ,Kolkata, West Bengal, India, from July 2024 to March 2025. Fifty patients undergoing LTSN for benign non-functioning kidneys were enrolled. Preoperative MAP scores were calculated from CT imaging. Patients were categorised into three groups: Low (0-1), Moderate (2-3), and High (4-5) MAP scores. Surgical difficulty was graded using a novel composite score based on intraoperative and postoperative parameters. Statistical analysis included the Kruskal-Wallis test and Spearman’s rank correlation using Statistical Package for Social Sciences (SPSS) v25, considering the ordinal nature of MAP scores and non-parametric data distribution. and a p-value<0.05 was considered statistically significant. Results: A total of 50 patients were included in the study, with a mean age of 53.2±10.6 years and a mean Body Mass Index (BMI) of 26.1±3.4 kg/m². Based on MAP score stratification, 12 (24.0%) patients were categorised into the Low MAP group (0-1), 23 (46.0%) patients into the moderate MAP group (2-3), and 15 (30.0%) patients into the high MAP group. A statistically significant association was observed between MAP scores and all intraoperative and postoperative difficulty markers. The high MAP group had the longest operative time (170.53±30.1 min), greatest blood loss (569.27±107.02 mL), maximum haemoglobin decline (2.05±0.48%), highest complication rate (73.3%) and prolonged hospital stay (7.53±1.36 days). The Low MAP group showed favourable metrics across all parameters (operative time 107.5±22.13 min, blood loss 258.25±37.68 mL, complications in 16.7%, and hospital stay 3.92±1.08 days). Kruskal-Wallis test confirmed statistical significance (p<0.001). Conclusion: The MAP score is a validated, reliable preoperative tool for predicting surgical difficulty in LTSN. High MAP scores are significantly associated with increased surgical complexity, prolonged operative time, blood loss, and postoperative complications.

Development, Validation and Reliability of an Open Book Examination Perception Questionnaire-I: A Cross-sectional Study

Veena A Bembalgi, Prashant B Mukkannavar, Cassindra C Cardoz, Pooja M Sublok, Shivani S Patil Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Open Book Examinations (OBEs) are being employed in education, presenting unique opportunities, and challenges to both learners and educators. However, the perception and implication of learning experience remains unanswered. Aim: To assess the content and face validity and reliability of a pretest Open Book Examination Perception Questionnaire-I (OBEQ-I). Materials and Methods: The present cross-sectional study was conducted in four phases at KLE College of Physiotherapy, Hubballi, Karnataka, India, from July 2024 to July 2025. The first phase included extensive review of literature and forming the first set of questions (n=24). In the second phase, the questionnaire was shared through a Google form with nine validators and their responses on relevance, content, domain specificity, and suggestions were collected. Based on the recommendations, some questions were deleted/reframed (n=6). The third phase comprised of sharing the revised questionnaire with 18 questions through a Google form with 36 physiotherapy students for rating the items for comprehension and clarity. In the fourth phase, Content Validity Index (CVI) for Item level Content Validity (I-CVI) and Scale Level Content Validity (S-CVI/Ave), Face Validity Index Per Item Wise (I-FVI) and scale wise (S-FVI), and reliability were calculated. Results: I-CVI for relevance of all items scored 1, except item numbers 7, 11, 14, and 20, which scored 0.88. S-CVI/Ave for relevance was 0.88. I-CVI for content was 1 for all items except item 14, which scored 0.88. S-CVI/Ave for content was 0.99. I-FVI scores for comprehension ranged from 1 to 0.8 and S-FVI/Ave for comprehension was 0.97. I-FVI for clarity ranged between 1 to 0.9 and the S-FVI/Ave score was 0.98. Conclusion: The 18-item pretest OBEQ-1 revealed an appropriate level of content and face validity based on I-CVI, S-CVI/Ave, I-FVI, S-FVI/Ave scores and suggested an impactful consideration following the analysis of reliability of scale.

Prevalence and Risk Factors of Diarrhoea among Critically Ill Patients in Intensive Care Units: A Cross-sectional Study

Karishma Khaund, Pinaki Bayan, Ningcingyile Ramlia, Khamti Mary Lyngdoh Lyngkhoi, Sangita Paul, Mridusmita Pathak, Siddhartha Goswami, Deepom Sharma Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Diarrhoea is common in critically ill patients that may be caused due to many factors such as Clostridium difficile, drugs (e.g., laxatives, antibiotics) and enteral feeds. The incidence of diarrhoea in the Intensive Care Units (ICU) has ranged in the literature from 2-95%. This wide variation may be due to lack of consistent definitions applied across studies, and ineffective metrics in monitoring patient’s bowel habits in the ICU. Diarrhoea from any cause can place patients at risk for complications such as skin breakdown, dehydration, electrolyte disturbance, renal dysfunction, hypovolaemia, malnutrition, and contamination of wounds; therefore, diarrhoea should be recognised promptly. Aim: To identify the prevalence of diarrhoea, its risk factors and its association with selected variables among patients admitted in ICU for >24 hours. Materials and Methods: The present cross-sectional descriptive study was conducted with the purpose to acquire detailed information on diarrhoea and its associated risk factors in Apollo hospitals in northeastern region, India. The study was conducted for a period of six months (October 2023-March 2024) among ICU patients who stayed for >24 hours in adult ICU of a tertiary care hospital in northeastern region, India. The diarrhoea patients were included in the study as defined by World Gastroenterology Organisation. Patients admitted under Gastroenterology Department, diarrhoea on admission and advised to use laxatives (e.g., hepatic encephalopathy) were excluded from the study. Both descriptive and inferential statistics were used to analyse the study findings. Results: A total of 1219 patients were included in the study, out of which 50 (4.2%) patients were found to have diarrhoea. The age of the patients was found to be >65 years for 32% patients with diarrhoea. Majority (82%) of the patients with diarrhoea passed stool 3-6 times/day, 4% had positive results for C.difficile, 52% of patients stayed in the ICU for >14 days. Antibiotic or antifungal therapy was administered to all patients (100%) and all of them (100%) received empirical antibiotic therapy. A 90% of patients were on ventilator for 0-15 days. This study identified the non-modifiable risk factors including age >65 years {Risk Ratio (RR) 7.5, 95% CI 0.03-0.004}, ventilation (RR 7, 95% CI 0.14 - 0.02) and modifiable risk factor i.e., sepsis (RR 11.6, 95% CI 0.35 - 0.03). In contrast, antibiotic administration was found to have low risk (RR 0.04 95% CI 0.04 - 0) for causing diarrhoea. The study also identified that in critically ill patients, diarrhoea was significantly associated with ventilator use (p<0.01), sepsis (p<0.05), and an ICU stay longer than 14 days (p<0.05). Conclusion: According to the present study findings, diarrhoea is a frequent concern in the ICU and is associated with prolonged mechanical ventilation, increased length of ICU stays, skin breakdown and renal dysfunction. The results showed that 100% samples who had diarrhoea were on antibiotics. Hence further studies will be required to strengthen the use of antibiotics.

Comparison of Free Radical Scavenging Activity of Ocimum gratissimum and Ocimum tenuiflorum Herbal Formulation and its Mediated Nanoparticles and Nanocomposite: An In-vitro Study

Nataleya Felix, Remmiya Mary Varghese, Aravind Kumar Subramanian, Rajesh Kumar Shanmugam Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Antioxidants play a crucial role in maintaining oral health by counteracting oxidative stress and Reactive Oxygen Species (ROS) to combat dental diseases. The present Investigated the antioxidant properties of an herbal formulation derived from African basil and black tulsi, both individually and in nanoparticle-based formulations. The present study addressed the need for advanced, sustainable antioxidant therapies by exploring the synergistic potential of nanoparticles synthesised via green methods from Ocimum tenuiflorum (African tulsi) and Ocimum gratissimum (black tulsi) extracts. By combining the bioactive properties of these herbs with the unique capabilities of nanoparticles, the research goals to enhance antioxidant efficacy and offer innovative solutions for oxidative stress-related dental and biomedical applications. Aim: To evaluate the efficacy of Ocimum gratissimum and Ocimum tenuiflorum herbal formulation and its mediated nanoparticles and nanocomposite in neutralising oxidative stress and their potential as advanced antioxidant products. Materials and Methods: The present in-vitro study, conducted between January and June 2023 at Nanobiomedicine lab, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, evaluated the antioxidant properties of a herbal formulation derived from Ocimum tenuiflorum (black tulsi) and Ocimum gratissimum (African basil) both individually and in nanoparticle-based formulations. The study included herbal extracts with significant phytochemical content and the methodology involved green synthesis of silver (AgNPs) and Zinc Oxide Nanoparticles (ZnONPs) using the herbal formulation, followed by their characterisation and evaluation via 2,2-diphenyl-1-picrylhydrazyl (DPPH), Hydrogen Peroxide (H2O2), and Ferric Reducing Antioxidant Power (FRAP) assays. Results: The herbal formulation exhibited antioxidant activity in all assay when compared to the standard antioxidant (ascorbic acid), which achieved a maximum inhibition of 92.4 at 50 μg/mL. Incorporation into nanoparticle structures led to further enhancement of antioxidant activity, with the nanocomposite demonstrating the highest antioxidant activity among all samples tested, achieving 90.91 inhibition in the DPPH assay, 86.5 inhibition in the H2O2 assay, and a FRAP value of 86.81 at 50 μg/mL, compared to ascorbic acid. Due to the use of a single sample per concentration, p-value cannot be computed and the results are demonstrated using bar graphs. Conclusion: The findings of this study provide compelling evidence of the potent antioxidant properties of the herbal formulation derived from African basil and black tulsi, particularly when incorporated into nanoparticle-based formulations. These results suggest that herbal-nanoparticle combinations could serve as effective alternatives or supplements to traditional antioxidants, offering a natural and sustainable approach to combating oxidative stress.

Bile Culture in Patients Undergoing Cholecystectomy: A Cross-sectional Study

Gowtham Ganesan, S Karthikeyan, Jesu Pencilin, Sasikumar Pattabi Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Due to the blockade of gallstones, the hepatobiliary system, especially the gall bladder, can undergo chemical inflammation called cholecystitis. It is mostly complicated by the invasion of gut bacteria. Aim: To evaluate the incidence of biliary microflora and prepare an antibiogram for all the gall bladder pathologies in a tertiary care hospital in South India. Materials and Methods: The current study was a cross-sectional study carried out at a tertiary care hospital in Chennai, Tamil Nadu, India, among patients undergoing cholecystectomy from March 2024 to February 2025. Bile was collected from each patient and sent for culture and antibiogram. The data were recorded into Microsoft Excel and the statistical data analysis was carried out using Statistical Package for Social Sciences (SPSS) version 26. Results: A total of 60 patients were enrolled for this study. Out of 60, 27 (45%) specimens showed no growth, 11 (18.3%) were positive for Escherichia coli (E. coli), 9 (15%) for Klebsiella, 6 (10%) for Proteus, 4 (6.7%) for Enterococcus, 2 (3.3%) for Salmonella, and 1 (1.7%) for Shigella. All the isolates except Klebsiella and Proteus were 100% sensitive for Piptaz. Amoxycillin was found to be least effective followed by ceftriaxone with all 6 and 3 isolates, respectively having ≥50% resistivity. Conclusion: Biliary microflora antibiogram revealed resistivity against commonly used antibiotics including amoxicillin, ciprofloxacin and ceftriaxone while most of the isolated microbial strains were found sensitive to Piptaz and meropenem.

Evaluation of Perfusion Index as a Tool for Early Detection of Ulnar Nerve Sparing after Brachial Plexus Block Through Supraclavicular Approach: A Prospective Observational Study

Jigisha Bharatbhai Mehta, Richa Tailor, Sara Mary Thomas Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Supraclavicular Brachial Plexus Block (SPB) is a common anaesthesia method for upper limb surgeries. However, ulnar nerve sparing can occur, leading to patient discomfort and surgical delays. Traditional assessment methods are subjective and time-consuming. The Perfusion Index (PI) has been shown to be an effective, objective, non-invasive tool for assessing peripheral nerve blocks. Aim: To evaluate PI as a tool for early detection of ulnar nerve sparing after SPB. Materials and Methods: This prospective observational study included 60 patients undergoing upper limb orthopaedic surgery under SPB. PI readings were taken at the index and little fingers at baseline and at regular intervals after the block for 30 minutes. Clinical assessment of the block was also performed. Data normality was tested using the Shapiro-Wilk test, and categorical data were compared using the Chi-square test. Results: Out of 60 patients, 44 (73.33%) had successful blocks, and 16 (26.67%) had ulnar nerve sparing. Demographic characteristics (age, weight, height, sex, ASA grade, and type of surgery) as well as baseline PI at the index and little fingers were comparable between patients with successful blocks and those with ulnar nerve sparing. PI at the little finger was significantly higher in successful blocks compared to ulnar sparing cases from two minutes onwards, reaching a maximum at 30 minutes (7.39±0.80 in successful block vs 1.68±0.27 in ulnar sparing, p<0.001). The PI ratio at the little finger showed statistically significant differences from one minute onwards, also reaching a maximum at 30 minutes (6.08±1.63 in successful block vs 1.52±0.30 in ulnar sparing, p<0.001). In ulnar sparing cases, PI and PI ratio were significantly higher at the index finger compared to the little finger (Mean PI at 30 minutes: index finger 9.22±1.71 vs little finger 1.68±0.27, p<0.001; Mean PI ratio at 30 minutes: index finger 8.08±1.15 vs little finger 1.52±0.30, p<0.001). The area under the Receiver Operating Characteristic (ROC) for PI at the little finger reached 1.0 at seven minutes, demonstrating 100% sensitivity and specificity for detecting ulnar sparing. Conclusion: PI measured at the little finger is a highly reliable, non-invasive tool for early detection of ulnar nerve sparing following SPB. It provides objective, real-time monitoring and can detect ulnar sparing as early as seven minutes post-block with high accuracy. Incorporating PI monitoring into routine anaesthesia practice can improve early detection of failed blocks, reduce surgical delays, and enhance patient comfort.

Changing Trends in Bacteriological Profile of Respiratory Isolates during Pre-COVID-19, COVID-19 and Post-COVID-19 Era: A Cross-sectional Study

Garima Mittal, Rajender Singh, Piyush Kumar Rai, Mani Bhushan Pant, Barnali Kakati Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction:The Coronavirus Disease-2019 (COVID-19) pandemic has exacerbated the global challenge of antibiotic resistance, particularly among respiratory pathogens. Findings from previous research highlight the urgent need to address antibiotic resistance in respiratory isolates during the COVID-19 era. Aim: To investigate the changing trends in bacterial isolates, their prevalence, and antibiotic resistance patterns in respiratory samples from ward and Intensive Care Unit (ICU) settings during the pre-COVID-19 (2019), COVID-19 (2020), and post-COVID-19 (2022) periods. Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India. The study covered a three-year period from January 2019 to December 2022, excluding the year 2021. Respiratory samples such as Endotracheal Aspirates (ETA), Bronchoalveolar Lavage (BAL), and sputum that were culture positive were included for bacterial isolation and analysis of antibiotic resistance patterns. Data were collected from both ward and ICU patients, and statistical comparisons across the three study periods were performed using the Chi-square test to calculate p-values. Results: A total of 830, 520, and 695 culture-positive respiratory isolates were analysed in 2019, 2020, and 2022, respectively. In the ICU, Acinetobacter spp. showed a significant increase from 26.49% in 2019 to 51.16% in 2020, followed by a marginal decline to 48.14% in 2022 (p-value <0.001). Klebsiella spp. exhibited a gradual rise in prevalence, while Pseudomonas aeruginosa initially decreased during the COVID-19 period but rebounded post-COVID-19. Antibiotic resistance patterns revealed a significant increase in resistance to colistin, imipenem, piperacillin-tazobactam, and tigecycline, particularly among Klebsiella spp. and Acinetobacter spp. in ICU settings. Conclusion: The study highlights a concerning rise in antibiotic resistance among respiratory pathogens during the COVID-19 and post-COVID-19 periods, particularly in ICU settings. These findings emphasise the need for stringent antimicrobial stewardship, strengthened infection control measures, and continuous surveillance of resistance patterns to mitigate the spread of Multidrug-Resistant (MDR) bacteria.

Role of Multi-slice Computed Tomography in Evaluation of Non-traumatic Causes of Acute Abdominal Pain in Adult Patients with Negative/Inconclusive Sonogram: A Prospective Observational Study

Awanish Sachan, Anubhav Agarwal, Ankur Malhotra, Shruti Chandak, Deepti Arora, Ashutosh Kumar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Acute non-traumatic abdominal pain is a frequent emergency presentation, associated with a wide range of possible differential diagnoses. While Ultrasonography (USG) is widely available and radiation-free, its diagnostic accuracy is limited by the patient’s habitus and bowel gas. Multi-slice Computed Tomography (MSCT) offers a comprehensive evaluation but comes with a higher cost and increased radiation exposure. Aim: To assess the diagnostic accuracy of MSCT in adult patients with acute non-traumatic abdominal pain negative or inconclusive for USG. Materials and Methods: The present prospective observational study was conducted in the Department of Radiodiagnosis at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India over a period of one year from June 2024 to July 2025. In this study, 81 adult patients who were referred for CT after an inconclusive/negative USG report underwent contrast-enhanced MSCT using a 128-slice scanner. CT findings were compared with surgical and histopathological outcomes when available, and with clinical follow up in conservatively managed cases. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), as well as the diagnostic accuracy of MSCT in cases of non-traumatic acute abdominal pain were calculated. Results: The mean age was 41.3±15.8 years, out of which 47 (58%) patients were male. MSCT diagnosed 16 (25.9%) cases of pancreatitis, 7 (16%) cases of appendicitis, and 5 (13.6%) cases of ureteric calculi among the most common pathologies. Among the 47 patients who got operated, CT findings were concordant with intraoperative results in 37 (90.2%) patients and with histopathology in all 41 patients (100%). MSCT provided new or alternative diagnosis in 66 out of 81 (81%) cases, significantly altering the management plans. Conclusion: The prompt use of MSCT in cases of an acute abdomen with equivocal USG findings significantly improves diagnostic accuracy and ensures appropriate management, outweighing its higher cost and radiation risks.

Comparison of Intubating Conditions between Cuff Inflation and Magill’s Forceps Techniques for Nasotracheal Intubation in Adults under Direct Laryngoscopy: A Randomised Clinical Trial

Richa Tailor, Dhananjay Nivrutti Dhasade, Sara Mary Thomas Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Nasotracheal Intubation (NTI) is frequently required for oral and maxillofacial surgeries, but optimal techniques for guiding the Endotracheal Tube (ETT) towards the glottis remain debated. While Magill’s forceps have traditionally been used to guide the ETT towards the glottis during NTI, the cuff inflation technique has emerged as a potentially safer alternative. Aim: To compare the intubating conditions between cuff inflation and Magill’s’s forceps techniques for NTI in adults under direct laryngoscopy. Materials and Methods: The present randomised clinical single blinded study was conducted at Dhiraj Hospital Piparia, Vadodara, Gujarat, India, from 13th July 2024 to 1st may 2025 on 80 American Society of Anaesthesiologists (ASA) I-II patients aged 18-60 years undergoing elective surgeries requiring NTI. Patients were randomly allocated into two groups using computer generated sequence: Group C (n=40) underwent NTI using the cuff inflation technique, while group M (n=40) underwent NTI using Magill’s forceps. The primary outcomes included the time required for successful intubation, number of attempts, and secondary outcomes included haemodynamic response, external laryngeal manoeuvre requirement, and complications. Data were analysed using unpaired Student’s t-test for numerical variables and Chi-square test for categorical variables. Statistical significance was set at p<0.05. Results: A total of 80 patients were included in the study with 40 patients per group groups were demographically comparable. Total intubation time was significantly shorter in group C (40.38±3.95) compared to group M (51.84±4.78 seconds) (p<0.001). Group C showed higher first-attempt success rate (80.0% vs 75.0%, p=0.008). External laryngeal manoeuvre was required less frequently in group C 6 (15.0%) patients compared to group M 14 (35.0%) patients (p=0.037). The cuff inflation technique demonstrated attenuated haemodynamic response with significantly lower increases in Heart Rate (HR) and blood pressure at 1 and 3 minutes post intubation. Complications including nasal bleeding and ETT cuff damage were significantly lower in group C. Conclusion: The cuff inflation technique provides superior intubating conditions compared to the Magill’s’s forceps technique, with shorter intubation time and fewer complications. It may be considered a safer and more efficient alternative for NTI under direct laryngoscopy in adults.

Effects of Routine Catheterisation on Urinary Tract Infection Rates After Minor Gynaecological Surgeries: A Prospective Observational Study

Shivani Patel, Rohit Dimbar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Urinary Tract Infections (UTIs) are among the most common healthcare-associated infections and significantly impact morbidity, healthcare costs, and quality of care. Catheter-associated Urinary Tract Infections (CAUTIs) constitute up to 40% of hospital-acquired infections globally, primarily driven by indwelling catheter use. Routine catheterisation during minor gynaecological surgeries is a common practice to prevent postoperative urinary retention. However, prolonged catheter use increases the risk of CAUTIs. Aim: To compare the UTI rates between catheterised and non-catheterised groups among women undergoing minor gynaecological surgeries. Materials and Methods: This prospective observational study was conducted at Dr. DY Patil Medical College, Pune, Maharashtra, India from July to December 2024, and included 150 women undergoing minor gynaecological surgeries. Participants were divided into two equal groups: catheterised (n=75) and non-catheterised (n=75). Demographic and clinical data were collected. UTIs were diagnosed based on clinical symptoms and significant bacteriuria (>105 Colony Forming Units (CFU)/mL). Statistical analysis was performed using SPSS version 28.0, with p<0.05 considered significant. Results: The incidence of confirmed UTIs was significantly higher in the catheterised group (21/75; 28%) compared to the non-catheterised group (6/75; 8%) (p<0.001). Escherichia coli was the most common pathogen, identified in 14 of 21 UTI cases in the catheterised group and 3 of 6 cases (50%) in the non-catheterised group. In the non-catheterised group, 5 out of 75 patients (6.7%) experienced urinary retention, which was successfully managed with clean intermittent catheterisation, without increasing UTI risk. Conclusion: Routine catheterisation during minor gynaecological surgeries substantially increases the risk of CAUTIs. Reducing unnecessary catheter use, adhering to evidence-based guidelines, and employing clean intermittent catheterisation are critical strategies to minimise UTI risk and improve patient outcomes.

Nutritional Status and Food Diversity among Elderly People in an Urban Area of Belagavi, India: A Cross-sectional Study

Jayasheela K Bagi, Harpreet Kour, Rutuja Ajit Dhere Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: The elderly population (aged ≥60 years) is vulnerable to malnutrition due to age-related physiological and socioeconomic factors. In urban India, challenges such as limited dietary diversity, economic dependence, and inadequate nutrient intake further elevate the risk of poor nutritional outcomes. Aim: To assess the nutritional status, dietary intake, and food diversity among elderly individuals residing in the urban area of Belagavi, Karnataka, India. Materials and Methods: A community-based cross-sectional study was conducted from March 2023 to April 2024 in the urban field practice area of Jawaharlal Nehru Medical College, Belagavi. A total of 188 elderly participants were selected using purposive sampling. Data were collected using a pre-tested, semi-structured questionnaire that included sociodemographic details, anthropometric measurements, a 24-hour dietary recall on three non-consecutive days, and a Food Frequency Table (FFT) for dietary diversity. Nutrient intake was compared with ICMR recommendations. Descriptive statistics and chi-square tests were applied to assess associations between food diversity and sociodemographic variables. A p-value <0.05 was considered statistically significant. Results: In the present study, the mean age of participants was 69.5±7.1 years, and of 188 subjects, 53.2% were male. The average energy intake was 1050.75±233.09 kcal/day and protein intake was 22.43±9.30 g/day, both significantly below ICMR guidelines. Poor food diversity (1-3 food groups/week) was observed in 89.9% of participants. Most had normal BMI, but central obesity was common according to Waist-to-Hip Ratio (WHR). Statistically significant associations were observed between food diversity and gender (χ²=6.03, p=0.043), educational status (χ²=8.94, p=0.006), and income status (χ²=5.36, p=0.018). Conclusion: This study highlights the widespread prevalence of low dietary diversity and inadequate nutrient intake among the urban elderly in Belagavi. Interventions should focus on nutrition education, improved dietary access, and social support to promote healthy aging in this population.

Factors Influencing the Delivery and Obstetric Outcome in Pregnant Women with Persistent Foetal Occiput Posterior Position: A Prospective Cohort Study

Navaneeta Reddy, H Mahesha Navada Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Occiput posterior position is the most common malposition encountered in labour and have a higher predisposition for caesarean delivery than in occiput anterior position. Aim: To evaluate the effect of maternal and foetal factors on the delivery and obstetric outcome in persistent occiput posterior position at term labouring mothers. Materials and Methods: The prospective cohort study was carried out at Father Muller Medical College Hospital, Mangalore, Karnataka, India, from November 2015 to November 2017. Thousand antenatal mothers carrying singleton, vertex presentation in labour were monitored. Antenatal factors affecting the occiput posterior position like diet and antenatal exercise were noted. They were observed throughout the 1st stage and 2nd stage of labour. The birth weight as a foetal factor affecting the delivery outcome was noted and data were analysed. Categorical data was analysed using the Chi-square test. The t-test was used for continuous data. Results: Of the 1000 antenatal mothers 67 (6.7%) were occiput posterior group. There was a higher need for induction among occiput posterior group (35.8%) as compared to occiput anterior group (15.7%) (p-value <0.001). Mothers in occiput posterior group had higher instrumental vaginal delivery (28.3%) as compared to occiput anterior group (2.8%) (p-value <0.001). Neonatal Intensive Care Unit (NICU) admission was higher in the occiput anterior group (5.7%) as compared to the occiput posterior group (4.9%), which is significant (p-value=0.003). Conclusion: The general physical activity done during the antenatal period may not appear to have an effect on the rotation of the occiput posterior position and for vaginal delivery. Counselling and special obstetric care with persistent occiput posterior position is required for improved obstetric outcome.

Effect of Music Therapy in Patients Undergoing Surgery Under General Anaesthesia: A Randomised Controlled Study

Khyati Chandrakant Jethva, Vrinda Pravinbhai Oza, Pranav Kiranbhai Baghora, Mayurika Jesingbhai Patel, Nikunj Prajapati Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Surgical procedures are uncomfortable, stressful, and cause anxiety in patients. Preoperative anxiety affects haemodynamic parameters, reduces pain tolerance, and delays postoperative recovery. Music therapy is a non-pharmacologic, cost-effective intervention that can alleviate anxiety and improve patient satisfaction. Aim: This study aims to evaluate the effects of music therapy in patients undergoing surgery under general anaesthesia. Materials and Methods: This randomised controlled study included 60 patients aged >18 years with American Society of Anesthesiologists (ASA) physical status I-III scheduled for surgery under general anaesthesia, who were randomly allocated to Group M (music) or Group C (control), 30 in each group. In Group M, soothing (raga) music was played from 20 minutes preoperatively until the end of surgery. In Group C, no music was played. Both groups were analysed for the primary outcome (intensity of pain) and secondary outcomes {haemodynamic parameters, Bispectral Index (BIS) value, patient satisfaction, quality of recovery, and Postoperative Nausea and Vomiting (PONV)}. The Student’s t-test was used to compare continuous variables and the Chi-square test was used to compare categorical variables. A p-value<0.05 was considered statistically significant. Results: No statistically significant difference was found in demographic data between the two groups. Intraoperative Mean Arterial Blood Pressure (MAP) was significantly different post-intubation for up to 60 minutes. BIS values were comparable and not significantly different. In Group M, the mean Visual Analog Scale (VAS) pain score at the 6^th postoperative hour was lower than in Group C (2.24±0.43 vs. 3.90±1.01). The patient satisfaction score (Likert scale) was higher in Group M (3.13±0.34) than in Group C (3.00±0.00). Quality of recovery (Riker Scale) was 3.82±0.38 in Group M vs 4.56±0.67 in Group C, with a statistically significant difference. Regarding PONV, Group M scored better than Group C (0.21±0.41 vs 0.83±0.69; p<0.001). Conclusion: Music interventions significantly reduce pain and PONV in surgical patients and improve overall patient satisfaction and quality of recovery.

Whole Genome Sequencing for Variant Detection in Charcot-Marie-Tooth Disease: A Cross-sectional Diagnostic Study

Hari Shankar Kumar, Bushra Jarullah, Nidhi Shah, Parth Shah, Udhaya Kotecha Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Charcot-Marie-Tooth disease (CMT) is one of the most common inherited Neuromuscular Disorders (NMDs), classified under peripheral neuropathies and characterised by progressive motor and sensory dysfunction. Although Whole-exome Sequencing (WES), gene panels, and conventional methods have improved detection rates, they often miss deep intronic, regulatory, and Structural Variants (SVs). Whole-genome Sequencing (WGS), with its comprehensive coverage of coding and non coding regions, enables the identification of variants that are often overlooked by other approaches. Aim: To assess the diagnostic utility of WGS in CMT cases that remain unresolved by WES, analysing both coding and non coding variants. Materials and Methods: The present cross-sectional diagnostic study was conducted between July 2023 and January 2025 at the Neuberg Center for Genomic Medicine (NCGM), Ahmedabad, Gujarat, India. WGS was performed on 31 clinically suspected CMT patients, including two who had previously tested negative by WES. Both coding and non coding variants including missense, nonsense, frameshift, in-frame, intronic, and 5’ Untranslated Region (UTR) mutations were analysed. Variants were classified according to American College of Medical Genetics and Genomics (ACMG) guidelines, incorporating Combined Annotation Dependent Depletion (CADD) scores and Minor Allele Frequency (MAF) thresholds. They were interpreted based on pathogenicity, inheritance patterns, and genotype-phenotype correlations. Selected non coding variants in the Gap Junction Beta-1 (GJB1; c.-16-511G>C) and Lamin A/C (LMNA; c.-142C>A) genes were validated by Sanger sequencing. Results: Sequencing data from 31 participants were processed using a standardised bioinformatics pipeline. Variants were classified according to ACMG guidelines, and their frequencies were calculated. WES and WGS results were compared to determine the additional diagnostic yield. WGS identified clinically significant non coding variants in GJB1 (intronic) and LMNA (5’ UTR) in two cases, yielding a 6.5% increase over WES. Overall, 31 variants were detected: 11 (35.5%) classified as pathogenic, 2 (6.5%) as likely pathogenic, and 18 (58.0%) as Variants of Uncertain Significance (VUS), reflecting the genetic heterogeneity of CMT. Conclusion: The WGS enhances diagnostic accuracy in CMT by detecting clinically relevant non coding variants often missed by WES. This is the first report from India confirming a GJB1 intronic variant and a Lamin A/C (LMNA) 5´ UTR variant using WGS in CMT patients. These findings support the integration of WGS into routine diagnostic workflows and highlight the value of comprehensive variant analysis for early and precise genetic diagnosis.

Do Operational Protocol Changes in Health Insurance have a Social Impact? A Retrospective Cohort analysis of Tamil Nadu State-sponsored Health Insurance Scheme Delivery in the Breast Cancer Treatment Package

Rajiv Kumar Krishnan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Endocrine management is an important component of breast cancer treatment to prevent recurrence and metastasis for a period of at least five years. Health insurance providers offer cashless treatment for this management on a monthly basis, which leads to frequent hospital visits and is a major reason for treatment default. We obtained special permission to deliver this treatment quarterly from the Government of Tamil Nadu-sponsored state health insurance scheme. This study analysed the outcome of this policy change and its social impact. Aim: To analyse the outcome of the operational change in implementing the insurance scheme. Materials and Methods: A retrospective cohort study was conducted at Government Villupuram Medical College Hospital, Tamil Nadu, India, from October 2020 to July 2024. All consecutive patients except male breast cancer and patients who received treatment only once were included in the study. A total of 71 patients’ data involving 533 hospital visits were analysed. To assess differences between paired samples in the bivariate groups, the Wilcoxon signed-rank test was applied. A p-value of <0.05 was considered significant. Results: Data analysis showed a statistically significant reduction in hospital visits: mean 8.04 visits (SD 4.60) versus an expected mean of 19.87 visits (SD 12.00). Out-Of-Pocket Expenditure (OOPE) toward travel expenses was Rs 412 per patient (SD 402) compared with Rs 1,042 per patient (SD 1,126) under routine treatment without rule relaxation. There were also savings in lost daily income due to the change in the insurance protocol for this endocrine management package for breast cancer. Conclusion: Quarterly follow-up treatment of endocrine management is effective, and the flexibility of state-sponsored health insurance schemes has a substantial social impact by reducing OOPE in cancer care.

Comparison of Root Fractures Associated with Three Different Endodontic Irrigants of Varied pH: An In-vitro Study

Asit Vats, Dax Abraham Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Vertical root fractures present significant challenges, and most often, the affected tooth is indicated for extraction. Root canal irrigants are employed synergistically alongside filing instruments during root canal therapy. The acidic nature of such irrigants is responsible for the removal of dentin during the process of biomechanical preparation. This subsequently leads to weakening of the tooth structure, ultimately leading to the fracture of the tooth. Aim: To compare the incidence of incomplete root fractures after treatment with three different root canal irrigants- citric acid, Ethylenediaminetetraacetic acid (EDTA), Regulated Ethylenediaminetetraacetic Acid (R-EDTA at two different Potential of Hydrogen (pH) levels (5.5 and 10.5). Materials and Methods: This in-vitro research was undertaken at Manav Rachna Dental College, Faridabad, Haryana, India for a period of six months from July 2024 to December 2024. Total of 48 human mandibular lateral incisors were selected and split into six groups on the premise of application of endodontic irrigants- citric acid, EDTA, R-EDTA with a particular pH. The irrigants employed were 17% citric acid pH 10.5 (Group 1), 17% citric acid pH 5.5 (Group 2), 17% R-EDTA pH 10.5 (Group 3), 17% R-EDTA pH 5.5 (Group 4),17% EDTA pH 10.5 (Group 5) and 17% EDTA pH 5.5 (Group 6). The samples were then subjected to Oil Red O Stain and analysed under a microscope for fractures. The data obtained was subjected to a Chi-squared test. Results: While no significant statistical differences were found between treatment groups (p-value>0.05), a trend was observed where lower pH formulations demonstrated more fractures compared to higher pH formulations of the same irrigant. The group treated with 17% REDTA at pH 5.5 showed the highest number of tooth fractures. Conclusion: Lowering of pH might have a role in causation of incomplete root fractures. Further analysis is required to assess the impact of R-EDTA on the structural integrity of teeth.

Assessment of Gingival, Lip and Skin Pigmentation and its Association with Willingness towards Depigmentation among South Indian Female Population: A Cross-sectional Study

Smriti Dharuman, Rakavi Ravindran, Vaishali Esvantharao, Snega Thamilselvan, Agalya Sivakumar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Facial appearance depends on various factors, including both intraoral and extraoral features. The association between skin pigmentation and gingival pigmentation has been previously established. Severe gingival pigmentation remains an aesthetic concern for individuals, regardless of skin colour. Aim: To explore the relationship between lip, skin and gingival pigmentation and the willingness of South Indian women to undergo depigmentation procedures. Materials and Methods: This cross-sectional study was conducted at the Department of Periodontology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India, from April 2023 to September 2023. A total of 500 South Indian women aged 21-39 years were included. Participants who provided informed consent and had not undergone any antibiotic therapy in the six months prior to participation were included. Individuals were excluded if they had previously undergone any form of aesthetic gum correction, or if they had periodontitis or any gingival pathology affecting gum colour, such as Addison’s disease or malignant neoplasms like Kaposi’s sarcoma. Clinical examinations were conducted to determine lip, skin and gingival colour based on established criteria and validated classifications. Gingival pigmentation and lip pigmentation was classified. Information on area of residence, income, skin type, lip pigmentation, gingival pigmentation type and willingness to undergo depigmentation procedures was also recorded after explaining the available treatment options. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, 2012). Results: The mean age of the study population was 27.23±4.39 years. Moderate gingival pigmentation was most prevalent among the participants 295 (59%). Regarding skin colour, 323 (64.6%) had brown skin, 143 (28.6%) had fair skin and 1 (0.2%) had dark skin pigmentation. The association between skin colour and gingival pigmentation was statistically significant (p<0.001). Most participants exhibited mild gingival pigmentation (LC2). LC5 and LC6 were not observed in any subjects. The association between lip colour and gingival pigmentation was also statistically significant (p<0.001). Gingival pigmentation showed a very weak positive correlation with willingness to undergo treatment (r=0.017, not significant). Lip pigmentation demonstrated a very weak negative correlation with willingness (r=-0.089, p=0.046), while skin pigmentation showed a very weak positive correlation with willingness (r=0.106, p=0.018). Conclusion: The study results demonstrated a significant association between gingival pigmentation and skin colour, as well as between gingival pigmentation and lip colour.

Prognostic Potential of Androgen Receptor Expression in Prostate Cancer: A Cross-sectional Immunohistochemical Study

Rhea Sharon Susihar, Muthu Sudalaimuthu, Nivethitha Sridharan, J Sowmiya, Kalaivani Amitkumar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Androgen Receptors (AR) play a crucial role in prostate cancer pathogenesis, which drives tumour growth and progression. High AR expression has been linked to tumour aggressiveness. However, its prognostic significance remains underexplored in the Indian population. Aim: To assess the expression of AR in prostatic adenocarcinoma and its association with established clinicopathological prognostic factors. Materials and Methods: The cross-sectional study was conducted at the Department of Pathology, SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India, from January 2018 to February 2020, and included 60 cases of prostate carcinoma. Using Immunohistochemistry (IHC), AR expression was evaluated and compared to established prognostic parameters, including age, Gleason score and grade, preoperative serum Prostate-specific Antigen (PSA) levels, and perineural invasion. The associations between parameters were assessed by performing Pearson’s Chi-square test using Statistical Package for the Social Sciences (SPSS) version 24.0. A p-value <0.05 indicated statistical significance. Results: A total of 60 patients with prostatic adenocarcinoma, aged between 41 and 84 years (mean age=69.05 years), were included in the study. Preoperative serum PSA levels ranged from 6.8 to 157 ng/mL. High AR expression was observed in a considerable number of instances (45 cases; 75%), especially in tumours exhibiting aggressive histopathological characteristics. AR expression demonstrated a statistically significant association with high Gleason scores (p-value=0.002) and Gleason grade (p-value <0.001) (34/45 high AR expression cases; 75.6% belonged to a total Gleason score of ≥9 and a grade of 5). Conversely, no association was identified between AR expression and age (p-value=0.086), preoperative serum PSA levels (p-value=0.398), or perineural invasion (p-value=0.09). Conclusion: High AR expression is markedly associated with aggressive histopathological characteristics in prostatic carcinoma, underscoring its potential as a prognostic indicator. Subsequent research may confirm AR as a target for therapeutic strategies in high-risk prostate cancer cases.

Efficacy of Thiopental and Propofol as Anaesthetic Agents in Electroconvulsive Therapy: A Randomised Double-blind Clinical Study

Ketki Jangid, Pinu Ranawat, Kamlesh Kanwar Shekhawat Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Electroconvulsive Therapy (ECT) is a well-established treatment for severe psychiatric disorders, often requiring the use of anaesthetic agents to ensure patient safety and comfort during the procedure. Thiopental and propofol are two commonly used anaesthetics in this context, each with distinct pharmacological properties and effects on seizure activity. Aim: The present study aimed to assess the differences in seizure characteristics, haemodynamic stability, recovery times, and complications between propofol and thiopental in a tertiary care hospital setting. Materials and Methods: The present randomised, double-blind clinical study was conducted at Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India, from January 2024 to December 2024. Fifty patients were randomly assigned into two groups to receive either thiopental (2 mg/kg) or propofol (1 mg/kg). First-time seizure occurrence and duration of seizure activity were recorded. Haemodynamic stability was assessed through serial measurements of systolic blood pressure, diastolic blood pressure, and heart rate. Additionally, recovery time and adverse events during 30-minute post procedure period were documented. Continuous variables were analysed and compared using an independent t-test. The association between categorical variables was tested using Chi-square tests and p-value <0.05 was considered statistically significant. Results: In both groups, demographic data including age, sex, and American Society of Anaesthesiologists (ASA) physical status were comparable. First time seizure occurrence in thiopental group was seen in 21 (84%) patients while in the propofol group it was seen in 14 (56%) patients which was statistically highly significant (p=0.03). Seizure duration was statistically significant longer in the thiopental group than in the propofol group (38 sec vs 26 sec, p=0.001). Recovery time and haemodynamic stability were comparable in both groups. Conclusion: Thiopental appears to be a better choice than propofol for induction in patients undergoing ECT due to its association with a significantly higher occurrence of first-time seizure activity and longer duration of seizure activity compared to propofol.

Effect of Otago Exercise Program versus Yoga on Risk of Fall, Gait Speed and Quality of Life in Young-old Population: A Randomised Clinical Trial

Anil Rachappa Muragod, Rutuja Namdeo Gawas Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Ageing results in degenerative changes in the musculoskeletal, vascular, and nervous systems, leading to reduced mobility, postural instability, and loss of independence. These changes increase Risk of Fall (RoF)- a major cause of morbidity in older adults- and negatively impact gait speed and Quality of Life (QoL). Exercise interventions like the Otago Exercise Program (OEP) and yoga improve balance, mobility, and well-being; however, comparative evidence in Indian community settings, particularly among the “young-old” (65-74 years), remains limited. Aim: To compare the effects of OEP and yoga on RoF, gait speed and QoL in the young-old population. Materials and Methods: The present randomised clinical trial was conducted in Belagavi, Karnataka, India (July 2024–February 2025) with 48 participants (65-74 years), randomised into Group A (OEP) and Group B (yoga), 24 in each group. Both groups received thrice-weekly sessions (30 min) for four weeks. Outcomes included Berg Balance Scale (BBS), Timed Up and Go (TUG), and Older People’s Quality of Life Questionnaire - Brief (OPQOL-Brief) at baseline, week 2, and week 4. Analysis used SPSS 23 with p<0.05. Results: Both groups improved significantly in balance, mobility, and QoL (p<0.001). Group A improved BBS from 49.45±2.47 to 54.63±1.47 and TUG from 15.84±1.74 to 11.70±1.02 sec. Group B improved BBS from 48.63±2.67 to 52.59±1.58 and TUG from 16.09±1.68 to 12.50±1.05 sec. QoL improved in both groups, with yoga showing an early advantage at week 2 (p=0.029), not sustained at week 4. Conclusion: Both OEP and yoga improved RoF gait speed, and QoL. OEP provided greater gains in balance and mobility, whereas yoga offered early QoL improvements.

Analyses of Key Performance Indicators of the Blood Centre at a Tertiary Care Referral Teaching Hospital in Southern India: A Cross-sectional Analytical Study

Jayasree Bodagala, Suresh Babu Bandi, MD Praveen, A Sharanya, KV Sreedhar Babu Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Blood transfusion services play a crucial role in patient healthcare management. The quality of blood and blood components, as well as their judicious use, directly impacts healthcare outcomes. Ensuring high-quality transfusion services can be achieved through the implementation of a Quality Management System (QMS). QMS performance can be monitored using performance measures known as Key Performance Indicators (KPI). This study was planned to assess the quality standards of our blood centre through evaluation of KPI. Aim: To analyse the quality performance of the blood centre through evaluation of KPI. Materials and Methods: This cross-sectional analytical study was conducted from November 2023 to May 2024 and from September 2024 to January 2025 in the Department of Immuno-Haematology and Blood Transfusion, Sri Venkateswara Institute of Medical Sciences Blood Centre, Tirupati, Andhra Pradesh India. Data were collected systematically, and root causes for any deviations were assessed. Corrective and preventive action measures were implemented accordingly. The key variables required for calculating KPI were extracted from various registers maintained at the blood centre. All KPI were calculated and analysed using the standard formulas prescribed by the National Accreditation Board for Hospitals and Healthcare Providers (NABH). Results: The KPI observed during the study period were as follows: Donor deferral rate: 11.03%; Adverse donor reaction Rate: 0.128%; Percentage of components prepared: 98.25%; Seroreactivity of donors: 1.24%; Turnaround Time for elective cases: 40.73 minutes; Turnaround Time for emergency cases: 7.27 minutes; Quality control failure rates: 0.62%; Adverse Transfusion reaction rate: 0.024%; Wastage rate of components: 1.21%; Percentage of outdated units: 0.44%. All of these KPI were within NABH benchmarks. However, the seroreactivity for syphilis (0.33%), the percentage of component usage (99.3%), and the percentage of whole blood wastage (5.29%) did not meet NABH benchmarks. Conclusion: All KPI were within NABH benchmarks except for the seroreactivity rate for syphilis, the percentage of blood component usage, and the percentage of whole blood wastage. These issues can be addressed through effective pre-donation screening procedures, particularly for syphilis. Uniform adoption of national policies across all states can help achieve 100% blood component usage. Additionally, involving adequately trained personnel can reduce instances of under-collection, which was identified as a major contributing factor to whole blood wastage in our study.

Early versus Late Per-urethral Catheter Removal Following Anterior Anastomotic and Buccal Mucosal Onlay Urethroplasty: A Randomised Controlled Trial

Sai Bharath Nandula, Soumya Mondal, Debansu Sarkar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: The postoperative catheter duration after urethroplasty has been less studied, and available literature is variable. The Duration of Catheterisation (DUC) in the literature ranges from as early as three days to as late as 21 days. Aim: To determine the ideal DUC after both anastomotic and Buccal Mucosal Graft (BMG) urethroplasty. Materials and Methods: The present randomised controlled study was done from June 2023 to May 2024 at IPGME&R-SSKM hospital (Institute of Postgraduate Medical Education and Research- Seth Sukhlal Karnani Memorial), Kolkata, West Bengal, India. A total of 30 patients of anastomotic and 30 patients of BMG urethroplasty were studied. Thirty patients of anastomotic urethroplasty were divided into group A (Early PUG done on Day 7) (n=15) and group B (Late PUG done on Day 14) (n=15). Thirty patients of BMG urethroplasty were divided into group I (Early PUG on Day 14) (n=15) and group II (Late PUG on Day 21) (n=15). Extravasation was assessed by performing a Pericatheter Urethrogram (PUG) and was compared by a Chi-square test. Patients without extravasation had their catheter removed immediately and patients with extravasation were kept on catheter for seven more days. The Urinary Tract Infection (UTI) and recurrence rates were compared by Fisher’s-Exact test. Results: Anastomotic urethroplasty patients had extravasation in 9/15 patients (60%) on Postoperative Day-7 (POD-7) (group A) and 2/15 patients (13.3%) on POD-14 (group B). BMG Urethroplasty patients had extravasation in 6/15 patients (40%) on POD-14 (group I) and 2/15 patients (13.3%) on POD-21 (group II). Among anastomotic urethroplasty, 3/15 patients (20%) had UTI in group A and 2/15 patient (13.3%) had UTI in group B. About 2/15 patients (13.3%) had recurrences in group A and no recurrences in group B. In BMG urethroplasty, UTI occurred in 3/15 patients (20%) in group-I and 2/15 patients (13.3%) in group B. One patient in each group A and group B (6.7%) showed recurrence of stricture. Conclusion: In conclusion, early catheter removal cannot be considered safe in all patients but should be individualised.

Wound Healing Agents as Root Biomodifiers in Gingival Recession

Vazeeha Afrin Syed, ND Jayakumar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Gingival recession causes root exposure, aesthetic concerns, and hypersensitivity. Although surgical techniques can achieve root coverage, adjunctive root surface biomodifiers, such as citric acid, Ethylenediaminetetraacetic Acid (EDTA), and platelet-rich derivatives, aim to enhance healing and attachment. Their clinical efficacy, however, remains a matter of debate. Aim: To evaluate the effectiveness of wound healing agents as root biomodifiers in improving clinical outcomes and patient satisfaction in the management of gingival recession. Materials and Methods: This review followed PRISMA guidelines and was registered with PROSPERO. A comprehensive search across PubMed, Scopus, Web of Science, and Cochrane databases identified clinical trials evaluating Root Surface Biomodification (RSB) agents in managing gingival recession. Eligible studies included surgical interventions with or without RSB, assessing outcomes like root coverage, gingival thickness, and patient-reported satisfaction. Data were narratively synthesised due to study heterogeneity. Only clinical trials involving human participants with gingival recession defects were included, with randomised controlled and split-mouth designs being the most common. The primary outcomes were root coverage percentage, gingival thickness, and Clinical Attachment Level (CAL), while the secondary outcomes included patient-reported satisfaction, aesthetic outcomes, wound healing indices, and postoperative discomfort. Control groups were consistently represented by conventional mucogingival surgical techniques performed without the use of adjunctive RSB. The efficacy of wound healing agents was primarily evaluated in terms of root coverage gain, improvement in clinical attachment, and increase in gingival thickness, with additional assessments of early wound healing and patient-reported benefits. Considerable heterogeneity in methodology was evident across studies, arising from variations in biomodification protocols, surgical techniques, follow-up duration, and outcome assessment methods, which limited comparability and precluded meta-analysis. Results: Eight studies were included, evaluating various root surface biomodifiers like Platelet-rich Fibrin (PRF), Titanium-prepared PRF (TPRF/T-PRF), citric acid, and EDTA. PRF-based interventions improved early healing and patient satisfaction but showed limited long-term advantages. Chemical agents and laser-assisted techniques demonstrated inconsistent benefits. The evidence quality ranged from moderate to high, with limitations in standardisation and generalisability. Conclusion: Conventional mucogingival surgical techniques are highly effective for root coverage, while the long-term benefits of RSB agents remain inconclusive. RSB may offer adjunctive benefits but lacks sufficient evidence for routine application in clinical practice.

Ossicular Chain Status in Long-standing Chronic Otitis Media: A Cross-sectional Study

Diksha B Sangale, Rashmi Prashant Rajasekhar, Manu Suresh Babu, Vinod Shinde, Mayur Ingale Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Chronic Otitis Media (COM) is a major cause of hearing impairment, particularly in developing countries. Prolonged disease duration often leads to ossicular erosion, exacerbating conductive hearing loss. Aim: To analyse the intraoperative ossicular chain status in patients with COM lasting over one year and associate the findings with disease type and audiometric profile. Materials and Methods: The present cross-sectional study was carried out in the Department of Otorhinolaryngology Dr. D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India, from January 2023 to June 2024. The study included 60 patients with clinically confirmed COM undergoing tympanoplasty or mastoidectomy. All patients underwent a comprehensive clinical evaluation, including otoscopic examination, Pure Tone Audiometry (PTA), and High-resolution Computed Tomography (HRCT) temporal bone imaging. Intraoperative assessment of the ossicular chain was performed during surgery, with corrective procedures undertaken as needed, and audiometric data analysed to correlate hearing loss with ossicular status. Patients were categorised into mucosal and squamosal types. Intraoperative ossicular status was recorded and audiometric data analysed using Chi-square and t-tests. Results: The mean age was 31.8±10.6 years, ranging from 7 to 55 years. Ossicular erosion was observed in 38 out of 60 patients (63.3%). The incus was the most affected ossicle 33 (55%), followed by the malleus 28 (46.7%), and the stapes 3 (5%). Complete erosion of all three ossicles was seen in 3 (5%). Ossicular erosion was significantly more prevalent in squamosal COM 22/30 (73.3%) compared to mucosal COM 8/30 (26.7%) (p<0.0001). The mean Pure Tone Average (PTA) in patients with ossicular erosion was 55.45±6.24 dB, significantly higher than 45.29±4.96 dB in those with intact ossicles (p<0.00001). Conclusion: Ossicular discontinuity is more common in squamosal COM and is associated with greater hearing loss. Timely corrective surgery can help preserve hearing.

Comparison of the Two Doses (30 mg/kg versus 50 mg/kg) of Magnesium Sulphate in Attenuation of Haemodynamic Stress Response during Laryngoscopy and Tracheal Intubation: A Randomised Clinical Study

Jatin Patel, Neelam Labana, Amit Chauhan, Payal Berawala Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Laryngoscopy and endotracheal intubation are known to elicit significant sympathoadrenal responses, which can lead to haemodynamic instability. Magnesium sulphate has been shown to attenuate this stress response through various mechanisms. Aim: To compare the efficacy of two different doses of magnesium sulphate (30 mg/kg vs 50 mg/kg) in attenuating the haemodynamic changes during laryngoscopy and tracheal intubation. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed To Be University, Piparia, Vadodara, Gujarat, India, from January 2023 to June 2024. It included 60 American Society of Anaesthesiologists (ASA) physical status grade I and II patients aged 18-65 years scheduled for elective surgeries under general anaesthesia. Patients were randomly divided using computerised randomisation into two groups of 30 each: Group I received magnesium sulphate 30 mg/kg intravenoulsy (i.v.), and Group II received magnesium sulphate 50 mg/kg i.v. diluted in 50 mL of normal saline, administered over 10 minutes before induction. Haemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) were recorded at baseline, after drug administration, after induction, during laryngoscopy and intubation, and at 1, 3, 5, 7, and 10 minutes post-intubation. Statistical analysis was performed using unpaired Student’s t-test and Chi-square test, with p-value<0.05 considered significant. Results: The demographic characteristics (mean age: group I 38.9±7.5 years, group II 41.0±8.8 years; gender ratio M:F - group I 17:13, group II 18:12; mean weight: group I 66.3±6.3 kg, group II 65.9±5.7 kg) were comparable between groups. Heart rate showed significant differences between groups during laryngoscopy (group I: 94.0±5.1 vs group II: 89.4±5.2 beats/min, p-value<0.001) and at intubation (group I: 97.7±5.5 vs group II: 93.5±5.0 beats/min, p-value=0.003). Systolic blood pressure at intubation was 131.0±6.2 mmHg in group I versus 124.8±5.4 mmHg in group II (p-value<0.001). Diastolic blood pressure at intubation was 80.7±4.7 mmHg in group I versus 76.4±4.8 mmHg in group II (p-value<0.001). Mean arterial pressure at intubation was 97.4±4.7 mmHg in group I versus 92.5±4.3 mmHg in group II (p-value<0.001). Both magnesium sulphate groups showed significant attenuation of the haemodynamic stress response to laryngoscopy and intubation compared to baseline values. Group II (50 mg/kg) demonstrated greater attenuation of blood pressure responses than group I (30 mg/kg), but with a higher incidence of hypotension (20% vs 10%). Conclusion: Both doses of magnesium sulphate effectively attenuate the haemodynamic stress response to laryngoscopy and tracheal intubation. While the 50 mg/kg dose provided better blood pressure control, the 30 mg/kg dose had a more favourable side-effect profile. The choice of dosage should be individualised based on patient characteristics and the anticipated degree of haemodynamic stress.

Development and Validation of a Scale to Measure Awareness among Healthcare Workers about Perinatal Depression in Indian Context: A Cross-sectional Study

Jaishree Deepak Ganjiwale, Jagdish Varma, Somashekhar Nimbalkar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Women in the perinatal phase experience significant physical and emotional changes, heightening their vulnerability to mental health disorders, particularly Perinatal Depression (PND). Healthcare Workers (HCWs) are often the first point of contact for expectant or new mothers, yet studies indicate poor awareness of PND among HCWs in India. This gap underscores the need for a validated tool to assess and improve HCWs’ understanding of PND. Aim: To develop and validate a tool to measure awareness of PND among HCWs. Materials and Methods: The cross-sectional study for instrument development and validation was conducted in Anand, Gujarat, Western India, using a three-round Delphi technique with 16 experts from Obstetrics, Psychiatry, Community Medicine, Social Work, and Paediatrics. Thirty questions were selected through consensus and rated for relevance on a 5-point Likert scale. After pilot testing, the tool was administered to 200 HCWs. Exploratory Factor Analysis (EFA) using principal axis factoring with oblique rotation was employed for validation. The number of respondents for the validation part was 170 for the 30 item questionnaire. Statistics and Data (STATA) 14 was used for analysis, with p<0.05 considered statistically significant. Results: EFA revealed a four-factor structure explaining 58.66% of the variance. The model showed excellent fit: Bartlett’s test of sphericity (p<0.001) and Kaiser-Meyer-Olkin (KMO=0.878). The factors included: Risk Factors and management strategies (9 questions), myths and misconceptions (4 questions), symptoms of maternal depression (3 questions), screening and treatment (2 questions). The tool demonstrated high internal consistency (Cronbach’s α=0.854). Conclusion: This validated 18-item scale reliably assesses PND awareness among HCWs in West India. It serves as a foundation for targeted educational interventions to enhance maternal mental healthcare.

Comparison of Ultrasonic and Laser-activated Continuous Chelation Irrigation on Postoperative Pain after Primary Endodontic Therapy: A Randomised Controlled Trial

Vinaya Pisal, Deebah Choudhary, Ajay Singh Rao, Nimisha Shah, Devashree Darak, Chandni Shah, Sejal Dodal, Rutvi Karande Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Irrigation solutions are used to flush away debris, remove the smear layer, and disinfect the non instrumented areas of the root canal system. To enhance root canal disinfection, various irrigation and activation techniques have been advocated. To the authors knowledge, limited research has been conducted on the clinical efficacy of various irrigants with regard to Postoperative Pain (PP). Therefore, to fill this gap, the present study was conducted. Aim: To evaluate PP after initial endodontic treatment in symptomatic teeth when continuous chelation irrigation is activated ultrasonically versus when laser irradiation is performed. Materials and Methods: A single-blinded randomised controlled trial was conducted in the Department of Conservative Dentistry and Endodontics, K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India, from October 2023 to October 2024. A total of 36 patients with symptomatic teeth requiring root canal treatment were included in the study. A preoperative Visual Analogue Scale (VAS) score was recorded for all subjects, after which they were divided into two groups. In Group A, ultrasonic activation of the continuous chelation irrigation was used, and in Group B, laser irradiation after irrigation (continuous chelation irrigation) using a 980 nm diode laser in pulsed mode was used. Postoperative VAS levels (1-10) were recorded at 6, 24, and 48 hours after therapy. Pain levels and incidence were analysed using an independent two-sample t-test and presented as means with standard deviations, with statistical significance set at p<0.05. Results: Preoperative pain levels were higher in Group A, though the difference was not statistically significant (p=0.164). PP was notably higher in Group A at 6 hours but became comparable between groups at later time points. Within-group comparisons showed a gradual reduction in pain over time, with significant differences observed between preoperative and postoperative values (p<0.001) in both groups. Pain categorisation analysis revealed no significant difference between groups, and no patients reported severe pain at 24 and 48 hours. Conclusion: The results indicate no significant difference when a continuous chelation protocol {2.5% Sodium Hypochlorite (NaOCl) and 9% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP)} is used as the final irrigant, in combination with either ultrasonic activation or laser irradiation, in symptomatic irreversible teeth. To fully understand the exact mechanism underlying these activation systems, more clinical research is necessary.

Clinico-epidemiological Profile and Predictors of Adverse Outcome in Children Admitted with Japanese Encephalitis at a Tertiary Care Hospital in Assam, India: A Retrospective Cohort Study

Chandra Jyoti Bora, Jolly Das, Akher Ali Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Japanese Encephalitis (JE) is considered one of the leading causes of Acute Encephalitis Syndrome (AES) affecting children and adolescents, particularly in tropical countries. It presents a major challenge for the health sector, particularly in management, due to its unpredictable course and lack of specific treatment. Therefore, adequate data regarding the clinico-epidemiological pattern and the identification of prognostic factors may assist treating physicians in proper triaging and delivering appropriate management. Aim: To study the clinico-epidemiological profile and predictors of adverse outcomes in children with JE at Assam Medical College and Hospital (AMCH), a tertiary care hospital in Dibrugarh, Assam. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatrics at Assam Medical College and Hospital (AMCH) from April 1, 2018, to September 30, 2019. Data from 146 children were collected, including demographic details, clinical signs and symptoms, laboratory parameters, risk factors, and mortality outcomes. Statistical methods used included Odds Ratio (OR), simple proportion test, Chi-square test, and Relative Risk (RR) estimation with 95% confidence intervals. Results: The most common age group affected was 5-12 years, with a slight male predominance 1.3:1. Among the participants, 31 (21.23%) children were vaccinated against JE. Common clinical presentations included fever (104 cases, 71.23%), seizures (95 cases, 65.06%), vomiting (88 cases, 60.27%), and headache (84 cases, 57.53%). The common complications observed were circulatory shock (31 cases, 21.23%), sepsis (21 cases, 14.38%), dyselectrolytaemia (34 cases, 23.28%), and acute kidney injury (37 cases, 25.34%). Overall mortality was 33 (22.60%). The highest mortality was observed in children with circulatory shock, altered sensorium with a Glasgow Coma Scale (GCS) score of less than 8, and refractory seizures. Of the children, 86 (58.90%) recovered completely, 33 (22.60%) died, and 16 (10.95%) were discharged with neurological sequelae. Conclusion: The case fatality rate was 22.60%. Vaccination coverage was significantly low among the children. The poor prognostic factors included shock, low GCS, the need for multiple anticonvulsants, ionotropes, hypertonic saline infusion, and ventilatory support. Therefore, this study highlights the need for extensive research and increased JE vaccination efforts in the region.

The Effect of Sandblasting on the Shutter Mechanism of Recycled Self-ligating Brackets: An In-vitro Study

Shefali Singh, Rizwan Aziz Gilani, Aishwarya Atey, Abhijeet Kadam, Pratik Rathod Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Self-Ligating Brackets (SLBs) have become a popular alternative to conventional orthodontic brackets due to their reduced treatment times, improved patient comfort, and enhanced mechanical efficiency. A key feature of SLBs is the integrated shutter mechanism that allows ligation without elastomeric or wire ties. However, bracket debonding during treatment necessitates their reuse, and recycling methods-particularly sandblasting-are commonly employed to restore their bondability. While sandblasting improves surface adhesion, its effect on the functional integrity of the shutter mechanism remains under-explored. Aim: To evaluate and compare the effects of sandblasting as a recycling technique on the shutter mechanism of various commercially available self-ligating orthodontic brackets. Materials and Methods: This in-vitro study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from November 2023 to February 2025. A total of 64 extracted premolars were divided into four groups (n=16) and bonded with SLB from four manufacturers: 3M Unitek^TM, American Orthodontics (AO) (Empower®), Ormco (Damon^TM Q2), and JJ Ortho (Selfy^TM). Brackets were bonded, tested for shutter closing force using a universal testing machine, debonded, sandblasted with 50-micron aluminum oxide, and re-bonded. Shutter Force (SF) was measured again after recycling. Statistical analysis included repeated measures Analysis of Variance (ANOVA) and post hoc comparisons. Results: DamonTM Q2 brackets exhibited the highest SF in both new and sandblasted conditions, while Selfy^TM brackets showed the lowest. Sandblasting led to a statistically significant but clinically minimal increase in SF (mean difference=0.052 N, p<0.001). However, bracket performance rankings remained consistent across conditions, with no significant interaction effect between bracket type and condition. Conclusion: Sandblasting is an effective and safe method for recycling SLB, preserving shutter mechanism functionality across all brands. Among the tested brackets, Damon^TM Q2 demonstrated superior and most consistent performance, while Selfy^TM brackets showed the lowest resistance but remained within acceptable clinical limits.

The Effect of Midazolam Premedication on Intraocular Pressure Following Induction of Different Intravenous Anaesthesia: A Randomised Clinical Trial

Leena Ingle, Rahul Suresh Bagde, Priyal Ramteke Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Thiopentone sodium, ketamine and propofol are commonly used intravenous induction agents for endotracheal intubation with suxamethonium and long-acting muscle relaxants for the maintenance of anaesthesia with air, oxygen and nitrous oxide. Premedication, induction agents, muscle relaxants, inhalational anaesthetics and anaesthetic technique can influence Intraocular Pressure (IOP). These factors are often not considered in anaesthetic practice. Aim: To compare changes in IOP after various intravenous induction agents with premedication using midazolam or without premedication. Materials and Methods: This triple-arm randomised, single-blinded clinical trial was conducted at Government Medical College, Latur, Rajasthan, India, from January 2023 to August 2024 included 210 patients of either sex, aged 20-45 years, scheduled for various operative procedures. They were randomly divided into two main groups of 105 each, with subgroups according to the induction agent and whether midazolam premedication was given. Group I-A: thiopentone 5 mg/kg; Group I-B: ketamine 2 mg/kg; Group I-C: propofol 2 mg/kg. Group II-A: thiopentone 5 mg/kg + midazolam 2 mg; Group II-B: ketamine 2 mg/kg + midazolam 2 mg; Group II-C: propofol 2 mg/kg + midazolam 2 mg. Before induction of anaesthesia, all patients were informed and consented for intraocular pressure measurement. The IOP was measured with a Schiotz tonometer at predefined time intervals. Differences in demographic data and baseline values between groups were analysed using one-way Analysis of Variance (ANOVA). For comparisons of observations within and between groups, repeated-measures ANOVA was used. Results: There were no statistically significant differences among the groups in terms of demographic variables, American Society of Anaesthesiologists (ASA) classification, type of surgery, or preoperative IOP. Intragroup analysis showed a significant increase in IOP in the ketamine group (Group I-B) immediately after induction (p=0.0231), whereas propofol (Group I-C) and all Group II subgroups (with midazolam) showed significant decreases in IOP at multiple time points (p<0.05). Intergroup comparisons revealed that the addition of midazolam significantly attenuated the rise in IOP across all induction agents, particularly in the early post-induction period (p<0.05). No adverse ophthalmic or systemic events were reported during the study. Conclusion: Midazolam, when combined with intravenous induction agents, significantly lowers IOP, counteracting the rise caused by ketamine and muscle relaxants. Routine intraoperative IOP monitoring is recommended, especially in ophthalmic patients and ketamine should be used cautiously or with sedatives to prevent IOP elevation.

Comparison of Dexmedetomidine and Midazolam as Co-induction Agents to Propofol for Proseal Laryngeal Mask Airway Insertion: A Randomised Control Trial

Anbuselvi Anoumandane, Vasanthakumar Murugesan, Sripriyanka Rajendran, Saranya Mandharan, Selvamani Subramanian Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: The Laryngeal Mask Airway (LMA) is a supraglottic device designed to secure the airway during minor to moderate surgical procedures. Second-generation LMAs, such as the ProSeal LMA (PLMA), offer enhanced safety features, including a gastric drain to reduce the risk of aspiration. Optimal insertion conditions depend on effective sedation with agents like propofol and adjuvants such as dexmedetomidine, which provide stable haemodynamics and suppress airway reflexes. Aim: To compare dexmedetomidine and midazolam as co-induction agents with propofol for ProSeal laryngeal mask airway (PLMA) insertion, assessed using the Muzi scoring system. Materials and Methods: This prospective, randomised controlled trial was conducted at the Department of Anaesthesiology, ACS Medical College, Chennai, India, over a period of 16 months and included 60 patients scheduled for elective surgeries under general anaesthesia. Patients were randomly assigned to Group I (n=30) - dexmedetomidine (0.5 mcg/kg) with propofol (2.5 mg/kg), or Group II (n=30) - midazolam (0.04 mg/kg) with propofol (2.5 mg/kg). PLMA insertion conditions, insertion time, first-attempt success rate, and haemodynamic stability were compared between the two groups using the t-test and Chi-square test. Results: There were no significant differences in age, gender, height, or weight between the groups. Group I demonstrated significantly better PLMA insertion conditions, including a higher first-attempt success rate (93.3% vs. 70%, p=0.019) and shorter insertion time (18.30±4.39 seconds vs. 21.27±6.21 seconds, p=0.04). Haemodynamic stability was superior in Group I, with lower heart rates (75.07±10.40 vs. 81.13±11.98 bpm, p=0.04) and lower systolic mean arterial pressures (115.67±5.70 vs. 119.93±5.69 mmHg, p=0.005 at 5 min; 117.20±4.69 vs. 121.07±4.83 mmHg, p=0.003 at 10 min). The requirement for additional propofol doses was lower in Group I (3.3% vs. 20%). The incidence of complications, such as sore throat (3.3% in Group I vs. 10% in Group II) and patient movement, was minimal in both groups, with no significant differences. Conclusion: Dexmedetomidine, as a co-induction agent with propofol, significantly improves PLMA insertion conditions, reduces the need for additional propofol, and provides superior haemodynamic stability, suggesting it is a more effective adjunct for PLMA insertion than midazolam.

Evaluation of Transurethral Incision versus Medical Management in Small-sized Benign Prostatic Hyperplasia: A Prospective Interventional Study

Deepak Mane, Amala Anant Ghalsasi, Vilas P Sabale Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Benign Enlargement of Prostate (BEP) is one of the leading causes of Lower Urinary Tract Symptoms (LUTS) in ageing men. Transurethral Incision of the Prostate (TUIP) has emerged as an alternative for managing Bladder Outlet Obstruction (BOO) caused by a small prostate. The management of a small prostate in BPH is still a debated topic with very scant available data and hence, requires further study. Aim: To compare TUIP versus medical management with alpha blockers for small-sized benign enlargement of the prostate in terms of efficacy, safety and outcomes. Materials and Methods: This prospective interventional study was conducted in the Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India, over 24 months from June 2023 to June 2025. Patients with proven bladder outlet obstruction with prostate volume <40 cc on Ultrasonography (USG) on USG were included in the study. Group A was given medical management with alpha blockers, and Group B was treated with TUIP. The outcome of the two was compared in terms of improvement in post-void residue, maximum flow rate and International Prostate Symptom Score (IPSS) score and incidence of retrograde ejaculation. The statistical analysis was based on the Chi-square test for categorical variables and the Student’s t-test for continuous variables for comparison of quantitative outcome parameters. A p-value <0.05 was considered statistically significant. Statistical Package for Social Sciences (SPSS) software version 24.0 was used for statistical analysis. Results: Out of 64 patients, the 51-60 year age group had the highest number of participants in both the medical and surgical groups. The mean age was 49.59±6.04 years in the medical group and 50.37±5.79 years in the surgical group. The 36-40 cc category had the highest number of patients in both groups, with the mean prostate size being 35.95±3.02 cc in the medical group and 36.05±2.71 cc in the surgical group. Post Void Residual urine (PVR) was significantly lower in the surgical group (49.06±7.87 mL) compared to the medical group (80.15±12.47 mL), with a mean difference of 31.09 mL, p-value <0.001. Maximum urinary flow rate (Qmax) was significantly higher in the surgical arm (18.37±0.82 mL/s) than in the medical arm (12.55±1.14 mL/s), with a mean difference of -5.81 mL/s (p-value <0.001). International Prostate Symptom Score (IPSS) was markedly lower in the surgical group (6.68±1.55) compared to the medical group (10.46±1.56), with a mean difference of 3.78 points (p-value <0.001). Retrograde ejaculation was observed in 11 (34.37%) of patients receiving medical therapy compared to 4 (12.50%) in the surgical group. Conclusion: The TUIP is a safe and effective alternative to alpha-blockers for the management of LUTS in men with small prostates, providing superior symptom relief and bladder emptying with minimal morbidity and better preservation of sexual function.

Ki-67 Index as a Prognostic and Diagnostic Marker in Follicular Neoplasm of Thyroid: A Systematic Review

Navaneetha K Kumar, Periyasammy Anbu, Sily Sreedharan Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Ki-67 has shown promise as a predictive and diagnostic marker in solid tumours. The Ki-67 index is a well-established proliferation marker that has been studied in various tumours, including follicular neoplasms of the thyroid. Its role in thyroid pathology, especially in differentiating between Follicular Thyroid Adenoma (FTA) and Follicular Thyroid Carcinoma (FTC), has garnered significant clinical interest. Aim: To evaluate the diagnostic and prognostic utility of the Ki-67 labeling index (Ki-67 LI) in follicular neoplasms of the thyroid. Materials and Methods: A comprehensive search of records in the databases PubMed, Embase, and Scopus, along with manual citation searching, was conducted using MeSH terms and keywords related to ‘Ki-67 antigen’ and ‘FTC.’ Peer-reviewed literature evaluating Ki-67 as a diagnostic or prognostic marker in follicular thyroid neoplasms published in English was included. Non English publications, reviews, case reports, and editorials, as well as research focusing solely on other thyroid cancers, including anaplastic or medullary carcinomas, were excluded during the screening process. The quality assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) Cochrane tool and the Quality in Prognosis Studies (QUIPS) for diagnostic and prognostic studies, respectively. A narrative synthesis and subgroup analysis of the extracted data were performed due to the heterogeneity in effect measures of Ki-67 labeling index and the outcomes. The parameters of prognostic outcomes assessed included the proportion of metastasis, recurrence, nodal involvement, survival rates, and mortality rates. The parameters of diagnostic outcomes involved the mean/median Ki-67 index to differentiate benign from malignant neoplasms. Results: A total of six eligible studies were included in this review. Follicular carcinomas demonstrated significantly higher Ki-67 labeling indices compared to adenomas. High values of Ki-67 are associated with malignancy, tumour aggressiveness, recurrence, and metastasis. The subgroup analysis indicated that the likelihood of poor prdeognosis for follicular thyroid neoplasms is approximately doubled at a cut-off of about 5% for the Ki-67 LI. Conclusion: This review included six studies involving retrospective analysis. There are variations in the techniques of immunohistochemical analysis, cell counting methods, and cut-off values chosen for the Ki-67 index among the included studies. Due to a lack of consensus regarding the reliability and standardisation of this biomarker, Ki-67 LI cannot replace standard histology. Regardless of a specific threshold, high Ki-67 levels effectively differentiate carcinomas from adenomas and indicate a poor prognosis.

Association of Cardiometabolic Risk and Sleep Quality among Adults with Self-reported Sleep Disordered Breathing: A Cross-sectional Study

Elumalai Praveen, Manisanthakumari Sudharshan, P Renuka, B Gayathri, VM Vinodhini, Elumalai Yashwantha, Vijukumar Lakshmi, N Prasath Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Sleep Disordered Breathing (SDB) refers to the periodic disruption of breathing that occurs during sleep. As a result, the affected individuals experience poor sleep quality. The effects of the same include daytime fatigue, sleepiness, functional impairment, and an overall reduction in quality of life. Recently, several studies have linked SDB with obesity, diabetes, and Cardiovascular Disease (CVD). Aim: The aim of this study was to compare the cardiometabolic risk and its correlation with sleep quality among individuals with and without self-reported SDB aged between 30-50 years. Materials and Methods: The present analytical cross-sectional study was conducted at SRM Medical College, Hospital and Research Centre, Chengalpattu, Tamil Nadu, India, from January 2024 - April 2024. The study involved 136 participants irrespective of gender, aged between 30-50 years. Out of 136 participants, 68 were apparently healthy individuals without SDB, and the remaining 68 were individuals with self-reported SDB based on the Neck Circumference (NC), Obesity, Snoring, Age, and Sex (NoSAS) score. A score of ≥8 was considered SDB positive, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Anthropometric measurements such as Weight (kg), Height (cm), Waist Circumference (WC) (cm), Neck Circumference (NC) (cm) and Body Mass Index (BMI) (Kg/m2) were noted. Biochemical parameters such as Fasting plasma glucose (FPG) and lipid profile [Total Cholesterol (TC), Triglycerides (TGL), Low-density Lipoprotein cholesterol (LDL-C), High-density Lipoprotein cholesterol (HDL-C)] were also analysed. Descriptive statistics, student’s t test, Mann-Whitney U test, Spearman correlation test, Chi-square test were used to statistically analyse the data. Results: In the present study, the average age of SDB positive group was 40.88±6.04 years and SDB negative group was 41.20±5.6 years. The SDB positive group had a male to female ratio of 40:28 and the SDB negative group had a male to female ratio of 23:45. Furthermore, the SDB positive group had higher BMI, NC, WC, biochemical parameters (FPG, TC, TGL, LDL-C) as well as lower HDL-C levels and poor sleep quality, compared to the SDB negative group. Conclusion: Individuals with SDB had poorer sleep quality and a higher risk of developing CVD as exhibited by the elevated lipid parameters, compared with that of the SDB negative group. Future studies could focus on exploring the directionality and causality of the said associations.

Correlation of Changes in Cord Blood Insulin Like Growth Factor-1, Leptin level and Foetal Growth in Neonates Born at 28 Weeks of Gestation: A Cross-sectional Study

M Gayathri, B Gayathri, P Renuka, VM Vinodhini, C Ashok, V Nandhithaa, K Niranjana Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Insulin-like Growth Factor-1 (IGF-1) is a protein that is encoded by the IGF-1 gene in humans. IGF-1 is critical for prenatal and neonatal growth, as well as for cardiovascular system, neurological system and lung development. Leptin is produced by adipose tissue and heavily involved in the control of energy balance, body weight, metabolism, and endocrine responses. IGF-1 and leptin affect the regulation of somatic growth and the development and birth weight. Aim: To estimate the level of cord blood IGF-1 and leptin levels in neonate born at ≥ 28 week of pregnancy and to correlate the cord blood level of IGF-1 and leptin in neonate with their foetal weight. Materials and Methods: The present analytical cross-sectional study was conducted in the Neonatology department at SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India, from June 2023 to October 2023. The study included 90 postpartum women most of the participants were in the age group between 20 to 35 years. Before delivering the placenta, cord blood sample was taken from the foetal side of the umbilical cord into appropriate tube, while serum IGF-1 and Leptin levels were measured using Enzyme Linked Immunosorbent Assay (ELISA). Billirubin was assessed using a Beckman Coulter auto analyser. Spearman’s correlation was performed using Statistical Package for Social Sciences (SPSS) (27.0). Results: The present study investigated the neonatal and demographic characteristics of pregnant women who were full term and newborns. Neonates were 2.7±0.6 kg on average, which is comparable with Appropriate for Gestational Age (AGA), however mother’s mean BMI was 27±5 kg/m2, which indicates overweight status. The results of the biochemical study indicated that the variability of leptin levels exceeded the mean. Elevated levels of IGF-1 (r=0.229, p=0.031) and leptin (r=0.250, p=0.018) were associated with greater foetal weight, according to Spearman’s correlation, which showed a strong positive relationship between foetal growth and both biomarkers. Conclusion: Cord blood analysis demonstrated a positive correlation between newborn weight and both IGF-1, leptin levels. IGF-1 and Leptin levels were observed to be elevated with increase in neonate birth weight.

Efficiency of the Combination of Amoxicillin and Metronidazole-coated Sutures versus Triclosan-coated Sutures for Antimicrobial and Wound Healing Properties: A Research Protocol

Chitra Laxmikant Patil, Anand Narayanrao Wankhede Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Surgical Site Infections (SSIs) pose a significant challenge in various surgical procedures, including periodontal surgery. Sutures used in the oral cavity are constantly exposed to saliva, which creates a wicking effect that can impede the healing process after surgery. To address these issues, modifications to sutures are necessary. Need for the study: Coated sutures that provide local, sustained release of antibiotics may effectively prevent biofilm formation and reduce bacterial counts in the periodontal surgical area. These innovative sutures combine two drugs, which can help mitigate the wicking effect, promote faster healing, and provide effective antimicrobial action. To date, no clinical studies have evaluated such a combination in suture form, prompting the design of this animal study. Currently, triclosan-coated sutures are the only commercially available option, and the new combination sutures could serve as an alternative. There is a lack of comparative data regarding the antimicrobial and wound-healing potential of alternative antibiotic combinations, particularly in the context of periodontal surgery. Aim: To evaluate and compare the efficacy of amoxicillin- and metronidazole-coated sutures versus triclosan-coated sutures in terms of antimicrobial activity and wound-healing properties. Materials and Methods: This in vitro experimental study on rabbits will be conducted in the Department of Pharmacology at the Central Preclinical Research Facility, Datta Meghe College of Pharmacy, Sawangi (Meghe), Wardha, India, from April 2025 to December 2025. The study will be carried out in two phases. In Phase I, amoxicillin-and metronidazole-coated sutures will be prepared and their drug release evaluated. In Phase II, an animal study will be conducted. The study will include 12 New Zealand rabbits of both sexes, with an average weight of 2-4 kg. The rabbits will be categorised into two interventional groups, with six rabbits in each group. Rabbits in Group I will receive 4-0 sutures coated with the combination of amoxicillin and metronidazole in the interdental area after flap elevation. In Group II, 4-0 sutures coated with triclosan will be used to assess antimicrobial activity and wound healing. For inter and intragroup comparisons, unpaired and paired t-tests will be applied, respectively. A p-value of <0.05 will be considered statistically significant.

A Comparative Analysis of Process Mapping and Standardised High-line Flow Process in Hospitals to Develop SOPs for Discharge: A Research Protocol

Deena Vareekal Prince, Deeplata M Mendhe Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Efficient patient discharge is a critical component of hospital workflow that directly influences bed availability, patient satisfaction, and healthcare costs. However, delays in discharge remain a persistent challenge across hospitals, particularly in resource-constrained settings like the Wardha district. These delays are often the result of administrative inefficiencies, inadequate coordination among healthcare providers, and poor communication. Need of the study: With the National Accreditation Board for Hospitals (NABH) recommending that discharge be completed within 180 minutes, delays beyond this threshold indicate systemic inefficiencies. There is a pressing need to identify the underlying causes of these delays and to develop evidence-based Standard Operating Procedures (SOPs) that can streamline the discharge process and improve hospital performance. Aim: To compare the efficacy of a process mapping plan of action versus a standardised high-line process strategy in reducing discharge Turnaround Time (TAT) and to develop validated SOPs that enhance discharge efficiency. Materials and Methods: A Randomised Controlled Trial (RCT) will be conducted at Acharya Vinobha Bhave Rural Hospital in Wardha, Maharashtra, India, from June 2025 to October 2025. Healthcare staff will be randomly allocated to either the experimental group (process mapping) or the control group (high-line process). Both quantitative and qualitative data will be collected on discharge TAT, workflow efficiency, and reasons for delay. A Chi-square test for categorical variables and a paired t-test will be used for time series data to evaluate the impact of both strategies. A p-value of <0.05 will be considered statistically significant.

Mobile Application based Healthcare Programme for Occupational and Psychosocial Rehabilitation of Breast Cancer Survivors: A Research Protocol

Vidushi Sharma, Prakash Kumar, Joyita Banerjee, Reena Sharma, Bhudev C Das Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Breast Cancer (BC) survivorship requires continuous management of various physical, functional, and psychosocial challenges that survivors often experience. Long-term care compliance is frequently compromised due to the demands of time and financial investment, and most available care systems in India are still predominantly in-person. Technology-based interventions can be a viable solution to help survivors attain a better quality of life. Need of the study: There is a notable lack of comprehensive research focused on the use of telehealth services in rehabilitative management, education, and awareness initiatives for Breast Cancer Survivors (BCS) in India. This gap highlights the need to investigate how telecommunication technologies can effectively support these individuals in managing their health, receiving educational resources, and increasing awareness about their condition. By exploring the benefits and challenges associated with telehealth services, one can develop tailored support systems that address the unique needs of BCS in the Indian context. Aim: To design a mobile Healthcare Program (m-HCP) and determine the efficacy of this newly developed text message-based m-HCP in managing fatigue, life satisfaction, and occupational performance. Materials and Methods: A quasi-experimental study will be conducted at Amity University, Noida, Uttar Pradesh, India, from June 2023 to December 2025. Patients will be recruited from NGOCansupport, New Delhi, India. Participants will receive educational messages for nine weeks and will have pre- and postintervention assessments for the levels of fatigue, occupational performance, and life satisfaction, along with feedback on the effectiveness and utility of the text-message-based m-HCP. Statistical analysis will be conducted using a paired t-test (parametric test) or a Wilcoxon signed-rank test (non parametric test), with a statistically significant difference defined as a p-value≤0.05.

Evaluating the Efficacy of Subepithelial Connective Tissue Graft and Plasma-rich Fibrin using a Modified Tunnel Technique with V-Reverse Sutures for Gingival Recession: A Research Protocol

Shweta Bhagat, Priyanka Jaiswal, Sakshi Kotecha, Geeta Bhandari Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Gingival Recession (GR) is the exposure of the root surface due to apical migration of the gingival tissue margin below the Cementoenamel Junction (CEJ). GR defects have been treated with a range of surgical techniques. Among the various treatments available for promoting root coverage, autogenous Subepithelial Connective Tissue Graft (SCTG)-based techniques are among the most effective and predictable. Need of the Study: Suturing the graft in the flap results in mobile and unstable anchorage. Thus, the V-reverse sutures technique has been introduced to stabilise the graft favours angiogenesis and repair. Despite the promising outcomes of these techniques, comparative data on the effectiveness of using V-reverse sutures in multiple recession defects are limited. The present study is required to evaluate the clinical efficacy and patient-centered outcomes of this novel suturing technique using SCTG and PRF, which may enhance treatment predictability and healing outcomes. Aim: The purpose of the present study is to compare the effectiveness of SCTG and PRF using the modified tunnel technique in combination with the V-reverse sutures technique for the treatment of multiple GRs defects in the anterior maxilla and mandible. Materials and Methods: A single-blinded randomised controlled trial will be performed from April 2025 to October 2025 at the Department of Periodontology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. A total of 20 systemically healthy patients aged 18 to 60 years with multiple GRs on the labial or buccal surfaces of the teeth will be included and examined over six months. SCTG will be placed in Group A and PRF will be placed in Group B. A total of 10 patients will be randomly allocated to each group. Clinical parameters {recession depth, periodontal probing depth, width of keratinised gingiva, gingival thickness and Gingival Biotype (BG)} will be assessed at baseline and after six months. Each patient will be questioned at the last control visit about satisfaction level with the colour, contour of gums and shape of gums; dentinal hypersensitivity; root coverage; pain and discomforts during surgery; cost-effectiveness; and postoperative discomfort. An independent t-test will be used for comparative evaluation of the effectiveness of the two groups at a 5% level of significance (p=0.05).

Comparative Efficacy of KP (Kantak Panchamoola) Decoction Enema followed by KP Tablet (Vati) versus Standard Treatment in Type 2 Diabetes Mellitus (Prameha): A Randomised Controlled Trial Research Protocol

Akshay Sanjeevkumar Rekhe, Punam Gaurav Sawarkar, Shweta Parwe, Gaurav Sawarkar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Diabetes Mellitus (DM) is a metabolic disease characterised by elevated blood sugar levels resulting from either inadequate insulin synthesis or compromised insulin activity, which can lead to organ damage. The prevalence of Type 2 DM (T2DM) is expected to rise globally. In traditional medicine, Prameha is a term used in Ayurveda to describe conditions involving metabolic dysfunctions, which aligns with diabetes. Congenital Prameha is comparable to Type 1 DM (T1DM), while lifestyle-induced Prameha corresponds to T2DM. Ancient Ayurvedic texts detail symptoms of Prameha that closely resemble those of modern diabetes, such as frequent urination, fatigue, and systemic metabolic disturbances. Need for the study: Traditional hypoglycaemic drugs often lead to weight gain and other adverse effects, creating a demand for safer alternatives. Ayurveda provides solutions through Panchakarma and herbal medicines, notably Basti (medicated enema), a holistic and non invasive treatment. This study examines Kantaka panchamoola Basti, a cost-effective option for Ayurvedic diabetes management. Kantaka panchamoola is known for its diuretic, anti-inflammatory, and metabolic benefits, helping to regulate metabolism and improve insulin sensitivity, making it suitable for Prameha treatment. Despite the wealth of literature on Ayurveda and diabetes, research on Basti is limited. Aim: To evaluate the comparative efficacy, safety and affordability of KP decoction enema followed by KP tablet versus standard treatment (Tab. Metformin) in managing T2DM (Prameha). Materials and Methods: A randomised, open-label, standard-controlled trial will be conducted at Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Maharashtra India, from May 2025 to May 2026. Sixty patients will be divided into two groups. Group A (N=30) will be prescribed Tab. Metformin for a consecutive 48 days, while Group B (N=30) will receive KP decoction enema for 16 days, followed by KP tablet for 32 days. Therapeutic outcomes will include a reduction in blood sugar levels (both fasting and postprandial) as well as urine sugar levels. Statistical analysis will be conducted using Statistical Package for the Social Sciences (SPSS) 17.0 Software. The independent samples t-test will be used for comparison of baseline characteristics between groups, and the paired t-test will be used for within-group comparison. A p-value of <0.05 will indicate a significant difference between the groups.

Evaluation of Comparative Efficacy of Ikshvaku Vamana (Lagenaria siceraria) followed by Nishakatakadi Kashaya Pana against Standard Control in the Management of Type 2 Diabetes Mellitus (Sthul Prameha): A Randomised Controlled Trial Protocol

Garima Gupta, Shweta Parwe, Punam Sawarkar, Milind Nisargandha Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Diabetes Mellitus (DM), particularly Type 2 DM (T2DM), is a metabolic disorder with an increasing global prevalence. Ayurveda correlates T2DM with Sthul Prameha, a condition dominated by Kapha and Meda. Conventional treatments like Metformin manage symptoms but often lead to side-effects and require lifelong use. Ayurveda emphasises Therapeutic Emesis (Vamana Karma) for Kapha-dominant diseases. As mentioned in the Charaka Samhita, therapeutic emesis using Lagenaria siceraria (Ikshvaku or bottle gourd) induces Vamana without causing exhaustion. Nishakatakadi decoction has also shown hypoglycaemic potential. Need of the study: Diabetes affects 387 million people globally (8.3%) and is projected to reach 592 million by 2035. India has the highest prevalence, with 69 million cases expected to double by 2040. In Ayurveda, Kapha is the primary Dushya in DM and is best addressed by Vamana, especially for obese T2DM patients (Sthul Prameha). While Metformin offers symptom management, Vamana addresses the root cause by targeting Kapha. Therapeutic emesis (Vamana Karma) using Lagenaria siceraria (Ikshvaku or bottle gourd) is effective in inducing Vamana without significant exhaustion, making it ideal for DM patients. However, clinical trials validating these therapies are scarce. Aim: To evaluate the comparative efficacy of Ikshvaku Vamana (using Lagenaria siceraria) followed by Nishakatakadi Kashaya Pana against standard control in T2DM (Sthul Prameha). Materials and Methods: A randomised single-blind two-arm superiority control trial will be conducted at Mahatma Gandhi Ayurveda College Hospital and Research Centre, Wardha Maharashtra, India, from January 2025 to January 2026. Sixty patients will be divided into two groups: Group A (n=30): Standard treatment with Metformin (500 mg BD for 28 days). Group B (n=30): Therapeutic emesis (Vamana Karma) using Lagenaria siceraria (Ikshvaku or bottle gourd) followed by Nishakatakadi decoction for 14 days. Objective parameters (Fasting Blood Sugar (FBS): 126-200 mg/dL, Postprandial Blood Sugar (PPBS): 140-300 mg/dL, Body Mass Index (BMI) ≥25) will be assessed on days 0, 14, and 28 for both groups. Data will be analysed using paired and unpaired t-tests, with p-value <0.05 considered significant.

Evaluating Predictors of Outcomes and Safety of Various Cataract Surgery Techniques in Eyes with Coloboma: A Research Protocol

Ashish Sharma, Shashank Banait Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Coloboma, a congenital defect resulting from the incomplete closure of the embryonal fissure, often affects the inferonasal part of the fundus. It is frequently associated with cataracts, which are a leading treatable cause of visual impairment. However, cataract surgery in colobomatous eyes presents significant challenges due to anatomical anomalies such as microcornea, zonular instability, poor pupillary dilation and structural irregularities. Need of the study: Cataract development is common in eyes with coloboma and significantly impacts vision, causing blurry vision, glare sensitivity and difficulties with daily activities. Cataract surgery in these eyes poses unique challenges due to the underlying anatomical abnormalities. Understanding the predictors of outcomes and the safety of different surgical techniques is crucial for optimising care and improving visual outcomes for patients with coloboma. By identifying factors associated with better or worse results, surgeons can tailor their approach to each individual patient, reducing risks and enhancing the chances of successful visual rehabilitation. Aim: The aim of this study is to evaluate different cataract surgeries for eyes with colobomas, as well as the safety and outcome predictors of various surgical methods. Materials and Methods: This hospital-based prospective interventional study will be conducted at the Department of Ophthalmology, Acharya Vinobha Bhave Rural Hospital, Sawangi, Maharashtra, India, over two years (May 2024 - April 2026) with 34 patients. The study aims to evaluate the outcomes and safety of cataract surgery techniques, including Phacoemulsification (PE) and Manual Small Incision Cataract Surgery (M-SICS). The type of surgery will depend on the degree of microcornea, cataract hardness and zonular stability. Preoperative, intraoperative and postoperative assessments will include detailed ophthalmic evaluations, visual acuity measurements, grading of microcornea and monitoring for complications such as corneal edema, using standardised grading systems. Statistical analysis will be performed using Statistical Package for the Social Sciences (SPSS)-version 23 to identify predictors of surgical outcomes, with significance set at p<0.05. The study seeks to improve surgical techniques, enhance patient safety and provide insights into counseling and risk stratification for individuals with coloboma-associated cataracts.

Efficacy of Mushkakadi Gana Udvartana versus Triphala Gana Udvartana in the Management of Obesity (Sthoulya): A Randomised Control Trial Protocol

Kashmira Bhaidkar, Vinod Ade, Shweta Parwe Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Obesity, as defined by the World Health Organisation (WHO), is a condition characterised by excessive fat accumulation, marked by a Body Mass Index (BMI) of 30 kg/m² or higher, and associated with substantial health complications. Its global prevalence is heterogeneous, affecting approximately 67% of the population in America and 31% in Southeast Asia and Africa. By 2027, it is estimated that 16% of adults will be classified as obese. This condition adversely impacts both physical and mental health and serves as a precursor to numerous co-morbidities, including diabetes, hypertension, atherosclerosis, gallstones, osteoarthritis, and infertility. In Ayurveda, obesity is correlated with Sthoulya, a metabolic disorder resulting from impaired anabolic processes. Need of the study: Obesity, recognised as a global epidemic by WHO, is primarily driven by sedentary lifestyles. It is strongly associated with an increased risk of hypertension, type 2 diabetes, coronary heart disease, hyperlipidaemia, arthritis, and several cancers, including those of the colon, gallbladder, biliary tract, breast, endometrium, and cervix. As obesity rates continue to rise, exploring natural remedies such as dry powder massage (Udvartana) is essential for effective weight management and symptom relief while minimising adverse side-effects. Pharmacological selection plays a crucial role in Ayurvedic management. The Mushkakadi Gana group of drugs, known for its Kapha-pacifying (Kaphagna) and fat-reducing (Medogna) properties, shows therapeutic potential. However, clinical trials evaluating its efficacy are limited. Aim: To evaluate the efficacy of Mushkakadi Gana Udvartana and Triphala Gana Udvartana in the management of obesity (Sthoulya). Materials and Methods: This study is designed as a randomised controlled trial and will be conducted at Mahatma Gandhi Ayurved College, Hospital, and Research Centre, Salod, Hirapur (H), Maharashtra, India over a period of 18 months (January 2025 to January 2026). A total of 60 patients will be enrolled and randomly divided into two groups. Group A (n=30): Will receive Udvartana with Triphala Gana Churna (control group). Group B (n=30): Will receive Udvartana with Mushkakadi Gana Churna (experimental group). The intervention will be administered for a duration of 15 days. Therapeutic outcomes will include reduction in body weight, BMI, skin fold thickness, anthropometric measurements, and serum lipid profile. Statistical analysis will be performed using Statistical Package for the social sciences (SPSS) version 17.0 software. An independent sample t-test will be used to compare baseline characteristics between groups, and a paired t-test will be applied for within-group comparisons. A p-value <0.05 will be considered statistically significant.

Evaluation of Colour Stability of the Dentures by Two Different Methods (Intrinsic and Extrinsic) of Characterisation using Mobile Phone Colourimeter Application: A Research Protocol

Madhu Priya, Surekha Dubey Godbole, Jahnavi Purna Gorripati Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: The aesthetics of a dental prosthesis should blend with the surrounding soft tissues, particularly in the anterior region of the dentition. Advances in laboratory technology and dental materials have enabled us to produce aesthetically pleasing, customised dentures that closely resemble each patient’s intraoral features. Need for the study: Conventional denture fabrication lacks the natural appearance of healthy gingiva. When denture bases are fabricated with Polymethyl Methacrylate (PMMA) resin, aesthetics are restricted. Consequently, attempts have been made to fabricate cosmetic dentures tili using various intrinsic techniques (colour-matching resins) and more contemporary extrinsic techniques (gingival shade composite resin). Aim: The aim of this study is to use a colourimeter software application on a mobile phone to compare the colour stability of denture characterisation using two distinct methods (intrinsic and extrinsic). Materials and Methods: This experimental study will be conducted in the Department of Prosthodontics and Crown and Bridge at Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha, Maharashtra, India, from July 2024 to January 2026. The study will involve two groups using two different characterisation methods: extrinsic (using gingival shade composite resin) and intrinsic (using colour blending resins). Colour stability will be assessed using a mobile phone colourimeter application based on Hue, Saturation, and Value (HSV), following pre- and post-staining with three solutions: tea, coffee, and turmeric solution. The normality of continuous outcome variables will be assessed initially at the 5% level of significance (p≤0.05) employing the Kolmogorov–Smirnov test. Significant differences between groups at the 5% level (p≤0.05) will be determined using an independent t-test.

Efficacy of Chevron versus Frown Incisions and Surgically Induced Astigmatism in Small Incision Cataract Surgery: A Research Protocol

Kunal Bhat, Sachin Daigavane Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction: Cataracts are a leading cause of treatable blindness worldwide, significantly affecting vision, particularly in the elderly. While various surgical techniques exist, Manual Small Incision Cataract Surgery (MSICS) remains a common option, especially in resource-limited settings. Need for the Study: The magnitude of Surgically Induced Astigmatism (SIA) is primarily influenced by the corneal incision. Incision size, shape, and axis can be modified to minimise SIA and optimise postoperative outcomes. A key challenge in cataract surgery is managing SIA, which can hinder optimal visual results. The present study will evaluate different incision types used in MSICS, including chevron, frown, and straight incisions, examining their impact on SIA and wound integrity. The discussion highlights the evolution of incision techniques aimed at minimising astigmatism and achieving better visual acuity for cataract patients. Aim: To evaluate the efficacy of chevron versus frown incisions in preventing SIA in small-incision cataract surgery. Materials and Methods: A two-arm parallel randomised controlled trial will be conducted in the Department of Ophthalmology, Acharya Vinoba Bhave Rural Hospital, Sawangi, Maharashtra, India, from June 2024 to June 2026. A total of 116 patients will be included and allocated into two groups (Group C and Group F), 58 in each. Keratometry readings, Uncorrected Visual Acuity (UCVA), and slit-lamp examination will be performed at each follow-up visit to assess postoperative outcomes. The statistical analyses will compare the magnitude of SIA between the Chevron and Frown incision groups using an independent t-test, and changes in the axis of astigmatism will be analysed using the Chi-square test. A p-value <0.05 will be considered statistically significant.

A Narrative Review on Multifactorial Relationship between Sleep Quality, Work Family Conflict and Musculoskeletal Disorders: Implications for Quality of Life among Nurses

Vijayalaxmi Kanabur Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X This narrative review examines the complex interrelationship between Work-Related Musculoskeletal Disorders (WRMSDs), sleep disturbance, and Work Family Conflict (WFC) among nursing professionals. Through systematic synthesis of contemporary literature, authors propose a multidirectional model wherein these occupational stressors interact synergistically to compromise nurses’ Quality of Life (QoL) and professional sustainability. WRMSDs, prevalent due to physical demands including patient mobilisation and prolonged standing, correlate significantly with sleep quality metrics, creating bidirectional pathways in which pain disrupts sleep and inadequate sleep lowers pain thresholds. WFC, exacerbated by irregular scheduling and emotional labour requirements, is significantly associated with both sleep disturbance and musculoskeletal symptoms. These interconnected factors collectively impact physical functioning, psychological wellbeing, and social relationships through multiple pathways. The review suggests that interventional strategies targeting these interconnected domains simultaneously may yield superior outcomes compared with traditional integrated approaches. This integrated understanding provides healthcare organisations with opportunities to develop comprehensive wellbeing programmes addressing physical, psychological, and social determinants of occupational health, ultimately improving the nursing workforce sustainability and care quality.

Biomarkers of Periodontal Disease and the Biologic Matrix Conundrum: A Narrative Review

Pratebha Balu, Narayane Ramkumar, Sudhakar Ramalingam Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Monitoring periodontal disease using clinical parameters is time-consuming and reflects past destruction only. The clinical measurements are also prone to error with possible inter-examiner variability. Within the scope of current knowledge and understanding of periodontal pathogenesis, biomarkers play a crucial role in revealing ongoing periodontal disease activity. These biomarkers are identified from various biological matrices such as saliva, Gingival Crevicular Fluid (GCF), serum, gingival tissue, or even plaque samples. Most studies have utilised saliva and GCF due to their ease of collection and non invasive sampling to identify biomarkers of periodontal disease activity; consequently, most hypotheses regarding the initiation and progression of periodontal disease have been derived from such studies. Most proteins are secreted by tissues and then seep into GCF and saliva. Therefore, protein expression occurs in the tissues and their amounts in GCF or saliva represent only a small part of the total. The sensitivity of detecting and monitoring a given biomarker in GCF, saliva, or gingival tissue is debatable. The appropriateness of the biological matrix from which the biomarkers have been isolated and identified has not been validated. The present review highlights the need to address the choice of biological matrix suitable for studying biomarkers involved in periodontal disease pathogenesis and summarises promising biomarkers of periodontal disease activity in saliva, GCF and gingival tissues.

Mirizzi Syndrome: A Narrative Review of Classification, Diagnosis and Surgical Management

Riddhi Thakor, Darshana Tote, Aniruddha Patel, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Mirizzi syndrome is a rare but serious complication of gallstone disease resulting from common hepatic duct obstruction due to either extrinsic compression or inflammatory changes. The Csendes classification is described, which provides a method for assessing the severity of the syndrome and determining whether to undertake surgical intervention. It will also outline possible diagnostic types {(Ultrasonography (USG), Computed Tomography (CT), Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP)} to increase detection rates. Treatment varies by spectrum; in mild presentations, a simple cholecystectomy is sufficient, whereas more significant presentations require biliary reconstruction. This review restates recent advances in minimally invasive and endoscopic techniques that improve patient outcomes in this syndrome. For this reason, healthcare workers need to be aware of Mirizzi syndrome so they can address each case uniquely, prevent various risks during surgery, and ultimately enhance the well-being of patients. This narrative review highlights the medical issues, underlying causes, and factors that increase the risk of the syndrome, noting that diagnosis is challenging because its symptoms are often unclear and similar to those of other biliary disorders. Therefore, the current review is necessary to consolidate current evidence on the pathogenesis, diagnostic challenges, and evolving management strategies of Mirizzi syndrome, thereby guiding clinical decision-making.

Alagille Syndrome: A Narrative Review of Molecular Pathogenesis, Clinical Manifestations, Diagnosis and Management

Deepanshu Sharma, Imran Ali Khan, Anup Zade, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Alagille Syndrome (ALGS) is a rare multisystem disorder of autosomal dominant type which is primarily caused due to mutations in the JAG1 gene and, less commonly, NOTCH2, both integral to Notch signalling. Clinically, ALGS is further characterised by cholestatic liver disease because of intrahepatic bile duct paucity, along with some cardiac and skeletal abnormalities, ocular defects, renal involvement, and distinct facial features. Diagnosis of ALGS depends upon the presence of at least three of five main clinical features, which are later supported through liver biopsy, genetic testing, and imaging. Differential diagnosis of ALGS includes biliary atresia, Progressive Familial Intrahepatic Cholestasis (PFIC), neonatal hepatitis, and syndromes with overlapping phenotypes such as Noonan and Kabuki syndromes. Management in such cases is largely supportive, which mainly focuses on relieving cholestasis and pruritus, along with proper nutritional adequacy, and addressing systemic complications. Liver transplant is reserved only for end-stage disease or intractable symptoms. A multidisciplinary approach is an essential aspect of treatment to improve patient outcomes, along with quality of life.

The Blueprinting in Microbiology for MBBS Students: A Scoping Review

Gurjeet Singh, Raksha Singh, Koyalmannam Raman Sethuraman Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Assessment methods used in medical education serve as an impetus for teachers and students alike; in microbiology, however, traditional examination may sometimes be invalid in terms of content or of lacking uniformity. To explore blueprinting in undergraduate microbiology education and how it enhances the quality of assessment. A scoping review under Arksey and O’Malley’s framework using databases from 2000 to 2024, including guidelines by the National Medical Commission (NMC) and peer-reviewed literature. The topics were fed into three categories: strategies of implementation, mapping to the cognitive domain, and influence upon learning outcomes. Blueprinting allows for a balanced representation of the content, enhanced promotion of higher-order thinking, and alignment of examination with the curriculum. Several institutions have reported greater student satisfaction and fairer-minded assessment processes since blueprints were adopted. The evolution of blueprinting has transformed assessment from farce, subjectivity, and manipulation to a structured, objective, and fair undertaking. Thus, the blueprinting ensures that the curriculum is in line with teaching and evaluation in microbiology and, in turn, follows the tenets of Competency-Based Medical Education (CBME)-The Principles. Although some implementation issues may arise, a systemic training of faculty and an unwavering support of the institution would establish blueprinting as a routine academic tool. Its widespread use would guarantee evaluation systems that are authentic, reliable, and learner-centred, which, in turn, nurture competent and confident practitioners.

Clinical Features, Molecular Pathogenesis, Diagnosis and Management of Holt-oram Syndrome: A Narrative Review

Harsh Allurwar, Anshika Agrawal, Abhishek Ingole, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Holt-Oram Syndrome (HOS) is a rare autosomal dominant disorder caused by mutations in the TBX5 gene, characterised by radial ray anomalies and congenital cardiac abnormalities. The syndrome, which was described by Holt and Oram in 1960 as a ‘heart-hand’ syndrome, presents with fully penetrant but variably expressive clinical features affecting the upper limbs and cardiovascular system. This review aims to provide a comprehensive updated overview of HOS regarding clinical spectrum, pathogenesis, diagnosis and differential diagnosis, management approach, along with some emerging therapies, with a highlight on the Indian scenario. This narrative review shows the latest information about the structural and functional roles of TBX5, modifier genes and environmental factors affecting HOS, and early diagnosis through prenatal imaging and molecular testing. Recent studies, like CRISPR/Cas9-engineered models and single-nucleus RNA sequencing, highlighted potential therapeutic targets with transcriptional disruptions. The article also explores Preimplantation Genetic Diagnosis (PGD) in preventing disease transmission and discusses the psychological and functional outcomes of patients with various severities of limb and cardiac involvement. This review is novel in the aspect of recent molecular and translational research with clinical management and prognosis, including some underreported Indian cases with unique challenges for diagnosis and management in such a low-resource healthcare scenario. It also shows the importance of multidisciplinary care and long-term follow-up in cardiac conduction anomalies of HOS. A detailed spectrum of clinical features, emerging therapeutic directions, presented in this review, aims to bridge previous knowledge gaps and also guides future research, clinical strategies for the improved care of individuals with HOS.

Wheatgrass as a New-age Therapeutic Agent: A Review on Nutritional, Antioxidant and Dental Applications

Shreya Girish Nayak, Krishnapriya S Nene, Neil M Godbole, Prachi P Patil, Siddhi S Javalekar Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Herbal drugs are increasingly consumed today to maintain a healthy lifestyle and manage various health problems. Their popularity has grown due to their perceived safety, cost-effectiveness and long history of use since ancient times, even predating conventional medicine. Wheatgrass is a promising therapeutic herbal remedy with numerous nutritional benefits and is widely used for the prevention and treatment of various disorders. It is often referred to as “green blood” because of its high chlorophyll content, which is largely responsible for its health-promoting effects. Wheatgrass is a multi-targeted natural agent that can be used alongside conventional medicine to combat cancers and other health complications. The present review article aimed to highlight the nutritional benefits of wheatgrass and its potential antioxidant, anti-inflammatory and anti-aging properties, which contribute to its use in several disease conditions, including oral infections. Given its easy availability and minimal side-effects, incorporating wheatgrass into the daily diet may maximise its benefits in maintaining both general and oral health.

Effect of Inspiratory Muscle Training on Cardiovascular Fitness and Falls Prevention in Elderly Smokers: A Narrative Review

Yatesh Sharma, Jyoti Sharma, Rabeena, Mohammad Sidiq, Aksh Chahal Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Smoking and aging both increase the risk of falls in older adults by causing deterioration in cardiovascular and respiratory function. Strengthening and enhancing the function of respiratory muscles through Inspiratory Muscle Training (IMT) has been demonstrated as a viable intervention. The present review examines the potential advantages of IMT for cardiovascular fitness and fall prevention, particularly focusing on the vulnerable group of senior smokers. Evidence from Randomised Controlled Trials (RCTs) investigating the effects of IMT on cardiovascular outcomes and fall prevention in older smokers is reviewed. The review aims to critically assess the methodological quality and clinical relevance of the existing research by following the Scale for the Assessment of Narrative Review (SANRA) guidelines. Literature from searches on Web of Science, PubMed, and Scopus was analysed. The study includes articles published between 2014 and 2025, in order to ascertain the role of physical therapists in sustainable global health initiatives. Keywords related to “Cardiovascular fitness,” ”Elderly,” “Falls Prevention,” “IMT,” and “Smoking” were optimised using Boolean operators. The included RCTs show that IMT results in statistically significant increases in inspiratory muscle strength. While improvements in core stability contributed to a reduced risk of falls, enhanced diaphragmatic function and oxygen uptake were associated with better cardiovascular performance. Although the findings are encouraging, they should be interpreted cautiously due to variations in participant characteristics, intervention duration, and outcome assessments. The current review concludes that cardiovascular fitness and IMT can reduce the incidence of falls in older smokers.

Research Publication Challenges Faced by Dentists in India: A Narrative Review of Multilevel Barriers

K Saran, G Krishnaprakash, Sibyl Siluvai, KP Indumathi Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Research articles are essential for achieving academic excellence, frequently impacting career progression, funding opportunities, and the prestige of educational Institutions. However, for dental students, postgraduates, and faculty in India and neighbouring countries, producing consistent and high-quality research remains a significant challenge. The present narrative review explores the complex and interconnected barriers affecting research productivity in the field of dentistry. These barriers are classified into three major categories. Institutional constraints this encompasses insufficient research funding, poor infrastructure, and a lack of administrative assistance. Personal challenges these include time limitations arising from academic or clinical obligations, low motivation, inadequate expertise in scientific writing, and the need to balance multiple responsibilities. Structural barriers ambiguous promotion rules, insufficient training in research methodologies, and the absence of interdisciplinary collaboration also hinder research engagement. The present review aims to identify the obstacles encountered by dentists in India regarding research publication through an analysis of peer-reviewed literature, reports from the Dental Council of India, and the University Grants Commission, as well as policy documents such as the National Education Policy (NEP) 2020. It also addresses current initiatives such as faculty development programs, research workshops, and Institutional policies designed to enhance the research culture. To overcome these obstacles, it is advisable to implement practical solutions such as establishing research cells, developing structured mentorship programs, enhancing access to statistics and writing assistance, allocating time and rewards specifically for research endeavours. The present article seeks to motivate Institutional leaders, educators, and legislators by outlining both the challenges and potential solutions, thus fostering a more conducive atmosphere for significant research among dental professionals at all levels.

Oral Microbiome: A Gateway to Systemic Diseases Insights

Sarah Mariam, Himanshi Rai, Priya Deo, Asadullah Khan, Najam Khalique Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X The human mouth is said to be a mirror of a person’s health and serves as a host to an array of microorganisms that play a crucial role in both disease and health. Different sites in the oral cavity harbour distinct genera of microorganisms, which have been meticulously explored over the years and thoroughly investigated to meet the needs of scientific organisations and research centres in establishing the association between oral microbiomes and systemic diseases. Systemic diseases are often linked to disruptions in the microbial population, and certain conditions appear to be related to oral bacteria. These processes may impact or reflect overall human health. Systemic pathophysiology can broadly be governed by immune and inflammatory factors, virulence factors of pathogens, and systemic dissemination. The oral microbiome, on one hand, acts as a protective barrier by reducing the population of pathogenic bacteria; on the other hand, it can itself function as a pathogenic entity, exacerbating or accelerating existing pathologies. Therefore, understanding the dysbiosis of the oral flora and its involvement in systemic diseases is of great importance. The present review highlights the pathways and subsequent impact of the oral microbiome on systemic health and disease.

Bleeding on Probing around Dental Implants: A Narrative Review

Gunjan Aggarwal, Shalini Kapoor Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Peri-implant bleeding is an important early sign of inflammation around dental implants and serves as a diagnostic indicator of peri-implant mucositis and peri-implantitis, both of which can lead to implant failure if, not treated promptly. The present review aims to provide insights into Bleeding on Probing (BOP) around dental implants. Data collection for this review involved gathering and analysing relevant literature to synthesise findings, identify patterns, and evaluate key results across studies. Histological studies reveal that peri-implant bleeding is associated with the infiltration of inflammatory cells such as neutrophils, macrophages, and lymphocytes, which is comparable to periodontal disease. This inflammation disrupts the peri-implant epithelium, increases vascularisation, and destroys connective tissue, all of which indicate early tissue damage around the implant. Inflammation also affects Peri-implant Crevicular Fluid (PICF), leading to increased levels of pro-inflammatory cytokines such as Interleukin (IL) 1β and Tumour Necrosis Factor (TNF)-α, as well as Matrix Metalloproteinases (MMPs) that contribute to tissue destruction. These molecular alterations make PICF an effective diagnostic tool for determining the severity of peri-implant disease. Clinically, BOP around implants is a commonly used metric to assess peri-implant health, although its prognostic value varies due to structural differences between peri-implant tissues and those surrounding natural teeth. However, significant or prolonged bleeding indicates poor healing, infection, or inadequate tissue management, all of which can impede osseointegration-the process by which the implant integrates with the bone. While peri-implant bleeding is a natural component of the healing process under controlled conditions, persistent bleeding may signal complications. Therefore, peri-implant bleeding should be monitored regularly to facilitate early detection and management, thereby preventing peri-implant disorders and ensuring the long-term success of dental implants.

Extraperitoneal Repair (TEP) versus Transabdominal Preperitoneal Repair (TAPP): A Comprehensive Review of Indications, Surgical Techniques and Patient Outcomes

Shraddha Gajbhiye, Imran Ali Khan, Anup Zade Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Laparoscopic inguinal hernia repair is now favoured over open surgery due to quicker recovery and better outcomes. The two main laparoscopic techniques are Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair, chosen based on patient and procedural factors. TEP avoids the peritoneal cavity, making it suitable for primary, uncomplicated hernias, while TAPP enters the peritoneal cavity, providing better visualisation for complex or recurrent cases. Both techniques yield low recurrence rates and similar recovery profiles, though TEP may cause less chronic pain and adhesions. TAPP, however, offers greater flexibility and clearer intra-abdominal access. TEP requires advanced skill, whereas TAPP involves risks of peritoneal injury. Ultimately, the choice depends on patient-specific factors and surgical expertise, with ongoing research needed to improve and combine these approaches.

COVID-19 and Autoimmunity: Unravelling the GAD65 Connection in Non-diabetic Patients

Shubhangi A Kanitkar, Priya Baluni, Sachin Shivnitwar, Prasad Chandrakant Bagare Journal of clinical and diagnostic research : 2026 - January - 20:0973-709X Introduction:The Coronavirus Disease-2019 (COVID-19) pandemic has raised significant concerns regarding its long-term health impacts, particularly among individuals without pre-existing conditions. Emerging evidence suggests a potential link between Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) infection and autoimmune responses, including the development of Type 1 diabetes. GAD65 (Glutamic Acid Decarboxylase 65) antibodies have been identified as key markers in the autoimmune pathway leading to Type 1 diabetes. Aim: To investigate the development of GAD65 antibodies at discharge in a cohort of non-diabetic COVID-19 patients as well as the relationships between glycaemic control, inflammatory markers, and severity of illness in a cohort of non-diabetic COVID-19 patients. Materials and Methods: The present cross-sectional observational study included 69 non-diabetic patients diagnosed with COVID-19 who were admitted to Dr. D. Y. Patil medical college, hospital and research centre, Pune, Maharashtra, India between October 2020 to October 2022. Data regarding demographic and biochemical parameters, including HbA1c and various inflammatory markers {Lactate Dehydrogenase (LDH), ferritin, D-Dimer, C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR)} and development of GAD65 antibodies were collected at discharge. Statistical analyses included Pearson’s correlation coefficients and Kruskal-Wallis tests to evaluate associations. Results: The study involved 69 participants with a median age of 48 years, ranging from 36 to 64 years including 47 males (67.1%) and females 22 (31.4%). The findings revealed no significant correlations between HbA1c and inflammatory markers {LDH (r-0.05, p-0.681); ferritin (r-0.069, p-0.576); CRP (r-0.027, p-0.824); ESR (r-0.009, p-0.942)}. However, D-Dimer levels were significantly higher in patients with severe illness (p= 0.022). One patient developed GAD65 antibodies at discharge, suggesting potential autoimmune development after COVID-19 infection. Conclusion: The study underscores the non-significant association of traditional inflammatory markers with glycaemic control while highlighting D-Dimer’s relevance in illness severity. The development of GAD65 antibodies in a patient raises considerations for emergence of autoimmunity which may lead to type 1 diabetes. Further research is warranted to explore these associations in broader populations.