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

Delayed Onset of Linezolid-induced Peripheral Neuropathy: A Case Report and Review with Symptom of Atypical Timeframes

Swapnil N Deshmukh, Ronak Agarwal, Vasu Agarwal Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Linezolid, a key drug in Multidrug-resistant Tuberculosis (MDR-TB) treatment, is known for its efficacy but is frequently associated with peripheral neuropathy, particularly with prolonged use. The authors hereby present a case of a 17-year-old young female diagnosed with extra-pulmonary MDR-TB, who developed delayed-onset peripheral neuropathy after five months of Linezolid therapy. She initially tolerated an all-oral longer regimen, including Bedaquiline, Linezolid, Cycloserine, Clofazimine, Levofloxacin and Pyridoxine. However, she later reported tingling and numbness in both lower limbs, with hyperesthesia. A neurological examination confirmed sensory axonal neuropathy. Linezolid was discontinued, leading to symptomatic improvement. To confirm, a rechallenge was performed, starting with 300 mg once daily and increasing to 600 mg once daily. Within a week, symptoms recurred, reinforcing the diagnosis of Linezolid-induced Peripheral Neuropathy (LIPN). The drug was permanently discontinued and replaced with Pyrazinamide as per Programmatic Management of Drug-resistant Tuberculosis (PMDT) guidelines. Despite its importance in MDR-TB management, there is a lack of standardised protocols for monitoring and mitigating LIPN. Future research should focus on dose-response relationships, adjunctive therapies and biochemical markers such as folate, homocysteine and oxidative stress indicators to refine treatment strategies. A balanced approach is crucial to ensuring efficacy while minimising neurotoxicity. The present case highlights the need for stringent neurological monitoring and individualised treatment adjustments in patients receiving prolonged linezolid therapy.

A Rare Case of Anti Neutrophil Cytoplasmic Antibody Associated Vasculitis Presenting as Pyelonephritis

Chetan Phadke, Shreeharsh Godbole Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis (AAV) is a condition affecting small and medium-sized vessels, predominantly impacting the kidneys. Microscopic Polyangiitis (MPO) is primarily associated with antibodies to myeloperoxidase. MPO frequently presents as glomerulonephritis, but pyelonephritis has not been mentioned hitherto in the literature as an initial presentation. Granulomatosis with Polyangiitis (GPA) is known to present as pyelonephritis, but not MPO. Such an unusual presentation may masquerade as an infectious condition when the underlying cause may, in fact, be an autoimmune one. This case report concerns a patient who presented with pyelonephritis. The patient also exhibited lung involvement that appeared to be pneumonia. Sepsis was suspected initially, and antibiotics were commenced. He also experienced renal failure and required haemodialysis. As the condition did not resolve, extensive investigations were conducted. An autoimmune panel and a renal biopsy revealed AAV as the underlying condition. Prompt treatment with glucocorticoids and rituximab resulted in a dramatic improvement in the patient’s condition. The patient did not require further haemodialysis, and he subsequently recovered and was discharged. The patient is on regular follow-up and requires only a small maintenance dose of prednisone. This case report demonstrates that pyelonephritis may not always have an infection as its underlying cause. A high index of suspicion for an autoimmune cause may result in early treatment and can be life-saving.

Diverticulitis Leading to Caecal Perforation with Retroperitoneal Abscess: A Case Report

Anuradha Dnyanmote, Saicharan Reddy Nagarla, Kuldip Patil Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Diverticulitis, a condition predisposing to inflammation or infection, presents with clinical similarities to acute appendicitis and is associated with an increased risk of perforation. This case report details a 25-year-old male presenting to the emergency department with a perforated appendix and suspected caecal perforation, diagnosed via Ultrasound (US) and Computed Tomography (CT) scans. Emergency surgery revealed gangrenous changes in the caecum, a base-of-appendix perforation, and a leaking retroperitoneal abscess. Surgical intervention involved resection of the appendix, caecum, and a segment of the ascending colon, with ileo-transverse anastomosis and a temporary ileostomy. Post-surgery, the patient showed symptomatic improvement. This case highlights the crucial need for prompt diagnosis and surgical intervention in managing complex scenarios involving retroperitoneal abscesses and associated complications.

Mini-Open Double-row Subscapularis Repair with Biceps Tenodesis for a Missed Lafosse Type 3 Subscapularis Tear with Biceps Subluxation: A Case Report

MJ Abhinand, B Vijayanand, S Karthikeyan, Tathagath Tiwari Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X The accuracy of diagnosing full-thickness Subscapularis (SSC) tendon tears depends on the presence or absence of Long Head of Biceps Tendon (LHBT) and subluxation is quite variable. This case report outlines a middle aged man with symptomatic medial dislocation of the long head of the biceps with associated rotator cuff injury. Magnetic Resonance Imaging (MRI) of the left shoulder reported hyper intensity of SSC tendon and long head of biceps tendon rupture. Patient successfully underwent diagnostic arthroscopy with mini-open double row repair of the subscapularis with biceps tenodesis at the base of the bicipital groove. Patient regained full and painless Range Of Motion (ROM) following six months of surgery. SSC tear can be easily missed even in MR imaging studies by radiologist. Clinical expertise is required for shoulder examination and when combined with MR study can help in identifying the lesion accurately.

Stenotrophomonas Maltophilia Pneumonia in a COPD Patient with Left Atrial Myxoma: A Case of Rare Clinical Presentation

Ronak Prakashkumar Shah, Parth Rohitkumar Shah Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Stenotrophomonas maltophilia (S.maltophilia) is an emerging multidrug-resistant pathogen, often implicated in respiratory infections in patients with chronic lung disease. The present case report presents a unique association between S. maltophilia pneumonia and an incidental left atrial myxoma, contributing to respiratory distress. Hereby, the authors present a case report of a 52-year-old male with Chronic Obstructive Pulmonary Disease (COPD) presented with bilateral lower limb oedema, progressive dyspnoea, productive cough, and intermittent fever for 15 days. Upon admission, he exhibited tachycardia, tachypnoea, and hypoxaemia (SpO2 88% on room air). Chest examination revealed bilateral wheezing and crackles. Investigations showed leukocytosis, elevated inflammatory markers, and an abnormal chest X-ray with fibrotic changes and minimal pleural effusion. Echocardiography identified a 3.5 cm left atrial myxoma prolapsing into the mitral valve, along with severe pulmonary hypertension. Contrast-enhanced CT (CECT) confirmed the myxoma and revealed emphysematous and pneumonic changes. The patient was initially managed as a case of acute community-acquired pneumonia with acute decompensated heart failure using broad-spectrum antibiotics, bronchodilators, steroids, and diuretics. Due to respiratory distress and type 2 respiratory failure, Bilevel Positive Airway Pressure (BIPAP) support was initiated. Sputum culture identified S. maltophilia, which was sensitive to Trimethoprim-Sulfamethoxazole (TMP-SMX), leading to a targeted antibiotic regimen. The patient showed significant clinical improvement, allowing for weaning from BIPAP and oxygen support. Once stabilised, he was referred for surgical resection of the left atrial myxoma. The present case emphasises the importance of early recognition and targeted treatment of S. maltophilia pneumonia in COPD patients. Additionally, it highlights the role of comprehensive cardiovascular assessment in patients with persistent respiratory symptoms.

An Unusual Presentation of Idiopathic Pulmonary Arterial Hypertension in a Young Male: A Case Report

Vishnu Prabhakar, KP Shaily, Sachinkumar Dole, Manosri Mandadi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Idiopathic Pulmonary Arterial Hypertension (IPAH) is a progressive disease of the pulmonary vasculature without any known underlying risk factors. For the diagnosis Pulmonary Artery Hypertension (PAH), the mean Pulmonary Artery Pressure (mPAP) should be persistently more than 20 mmHg at rest. Early diagnosis, along with investigations like 2D Echocardiography (ECHO) and right heart catheterisation, and prompt treatment, are essential for the management of PAH. Drugs such as endothelin receptor blockers, phosphodiesterase inhibitors, and calcium channel blockers are used for treatment. Hereby, the authors reported an unusual case of IPAH in a young male, with haemoptysis being the predominant presenting complaint. A 24-year-old male patient presented with the primary complaints of streaky haemoptysis and dyspnoea. He had multiple hospital admissions for similar episodes of haemoptysis in the past, which had been managed symptomatically. After conducting a thorough investigation and detailed work-up, he was diagnosed with idiopathic PAH. The patient showed symptomatic improvement, with resolution of haemoptysis and dyspnoea, after initiating treatment.

Right Testicular Vein Draining into Right Renal Vein: A Case Report

Santanu Kumar Sarma, Alakesh Gogoi, Jayasri Devi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X During routine dissection of an adult male cadaver about 50 years of age, the right testicular vein was seen to drain into the right renal vein at a right angle which is rare. At a 90° angle, the left testicular vein drain into the left renal vein. The caudal part of subcardinal vein is responsible for the development of gonadal vein and it drains into the supra-subcardinal anastomosis. In this exceptional case, the right supra-subcardinal anastomosis instead contributed to the formation of the right renal vein, which consequently received the right testicular vein. On the left side, the supra-subcardinal anastomosis is incorporated into the left renal vein, serving as the drainage site for the left gonadal vein. This pattern of drainage has to be kept in mind by the physicians as this may lead to varicocele on the right which may be implicated in male infertility.

Ayurvedic Modalities and Shamana Chikitsa in the Management of Writer’s Cramp Syndrome: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Trupti Thakre, Nitika Senger Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Writer’s cramp syndrome is an uncommon handwriting disorder characterised by involuntary upper limb spasms and tremors in the hands. Most patients adopt unusual wrist and finger postures, using excessive force when holding and pressing the pen to the page; tremors commence during writing. Muscle spasms worsen with writing, often rendering the writing of more than a few sentences impossible. Numerous Vata dosha illnesses-Akshepaka, Apatantra, Apatanaka, and Kampavata-are associated with tremor in Ayurvedic literature. This case report evaluates the efficacy of Ayurvedic treatments for writer’s cramp syndrome. A 30-year-old male patient, diagnosed with writer’s cramp syndrome, showed significant improvement in writing and writing movements after one month of regular treatment. Ayurvedic treatments, including Shamana (curative treatment) and Shodhana (bio-purification treatment), played a significant role in managing the syndrome.

Surgical Management of Bilateral Superolateral Displacement of Condylar Segment with Intracapsular Fracture in Complex Facial Trauma: A Case Report

Divya Suvarna Dixit, Nitin Bhola, Bhushan Mundada, Deepankar Shukla Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Facial fractures are a common result of trauma due to road traffic accidents, falls, assaults, sports injuries, and various pathological conditions. These fractures can involve several bones, making treatment more challenging in achieving both functional and aesthetic rehabilitation due to the complexity of the anatomical structures involved. The present case report describes the treatment of a 45-year-old female who suffered severe facial injuries after a bike accident, including fractures in her upper jaw (Le Fort fractures), lower jaw (mandibular symphysis), and both sides of the jaw joints (condylar fractures with Temporomandibular Joint (TMJ) dislocation). She presented to the department with swelling, pain, difficulty in opening her mouth (limited to only 15 mm), and malocclusion. Computed Tomography (CT) scans confirmed the fractures. The patient underwent surgery under general anaesthesia, during which the fractures were repaired using plates and screws, and the dislocated jaw joints were repositioned using a specific technique called the Ellis Maneuver. After surgery, her jaws were held in place with Intermaxillary Fixation (IMF) for three weeks, followed by physiotherapy. To allow her to eventually open her mouth to 32 mm and restored normal jaw movements. Postoperative scans confirmed proper healing and positioning of the fractured bones. Bilateral condylar fractures with TMJ dislocation are particularly challenging because they affect both how the jaw moves and how it bites. Research shows that open surgery generally leads to better outcomes than conservative approaches, especially for displaced fractures. The present case emphasises the importance of early surgery, personalised treatment, and teamwork in successfully treating severe facial injuries.

Transarterial Embolisation of a Giant Splenic Artery Pseudoaneurysm: A Case Report

Sambhaji Pawal, Rohan Thakur, Ritesh Kumar Sahu, Aniketh Hiremath Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Giant splenic artery pseudoaneurysm (PSA) is a rare abnormal outpouching from the arterial wall, measuring more than 5 cm in diameter. It is highly prone to rupture and can cause life-threatening haemorrhage and thus, treatment is recommended for all PSAs, irrespective of size and location. Endovascular management with transarterial embolisation of the PSA and the PSA-bearing arterial segment is most commonly performed. Here, the authors present a case of a 54-year-old patient with chronic pancreatitis, who presented with haemodynamic instability and was diagnosed by Computed Tomography (CT) scan as having a giant pseudoaneurysm of the splenic artery with rupture leading to haemoperitoneum. The patient underwent emergency endovascular intervention via right femoral arterial access, with diagnosis confirmed by selective angiograms of the coeliac and splenic arteries. Subsequently, superselective embolisation of the pseudoaneurysm and the lower pole branch of the splenic artery was performed using N-Butyl Cyanoacrylate (NBCA) glue mixed with lipiodol. Postembolisation angiograms confirmed the complete exclusion of the PSA and the lower pole branch, indicating technical success. Postoperatively, there was an improvement in the patient’s haemodynamic status and he was eventually discharged with normal vital signs and stable haemoglobin counts. This case demonstrates the rare diagnosis of a giant splenic PSA, managed by an endovascular approach using NBCA glue mixed with lipiodol for embolisation.

Therapeutic Plasma Exchange in Guillain-Barré Syndrome during Pregnancy: A Case Report

Lakshmi N Nair, A Ashwin, R Krishnamoorthy, Niranj Rathan, Sampat Kumar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Guillain-Barré Syndrome (GBS), also known as Acute Inflammatory Demyelinating Polyradiculopathy (AIDP), is an autoimmune disease affecting motor and sensory peripheral nerves. While the exact cause of GBS is not fully understood, it is commonly triggered by viral or bacterial infections. GBS is relatively rare during pregnancy. Therapeutic Plasma Exchange (TPE) is an effective and well-established treatment for GBS, classified as Category I by the American Society for Apheresis (ASFA). The primary objective of TPE is to remove plasma containing antibodies, immune complexes, and other toxic proteins from the patient, replacing it with a different solution, such as colloids and crystalloids. Hereby, authors report an interesting case of a 22-year-old multigravida female diagnosed with GBS during her first trimester, who was successfully treated with multiple cycles of TPE.

Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report

Sandra Arora, Jahanvi Goyal, Sanjeev B Gupta, Aayush Gupta Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Actinomycetoma is a chronic, localised, progressive granulomatous infection of the skin and subcutaneous tissues, typically affecting the lower extremities. It is caused by Actinomycetes bacteria, which are commonly found in soil and water. The infection usually results from minor trauma, such as walking barefoot or exposure to thorny vegetation. Upon inoculation, the bacteria form grains that help evade the host immune response, facilitating the establishment of infection. It is characterised by discharging sinuses and the presence of granules. This condition predominantly affects individuals in rural, resource-limited areas with limited access to healthcare. Although it affects both men and women, men are more commonly affected due to occupational exposure. The disease progresses slowly, often leading to severe complications, including tissue destruction and sinus tract formation, with amputation being the only option in advanced cases. Authors hereby report a case of Actinomycetoma in an 86-year-old male farmer who presented with painful erythematous nodules and purulent discharge from lesions on his left leg for the past four years. The diagnosis was established through clinical, histopathological and microbiological investigations, including Gram stain, Gomori Methenamine Silver (GMS), and Periodic Acid-Schiff (PAS) stain. Treatment with a combination of amoxicillin-clavulanic acid and trimethoprim/sulphamethoxazole was initiated. This led to a complete resolution of the condition within three weeks, demonstrating the efficacy of this treatment as a safe and cost-effective option. This case highlights the importance of early diagnosis and appropriate treatment for Actinomycetoma, emphasising the value of affordable therapeutic interventions.

Whipple’s Procedure for a Single Gunshot Wound: A Rare Case Report

Pushkar Galam, Ankireddypalle Shanmukha Shashank Reddy, Dakshayni Satish Nirhale, Mahendra Wante, A Kavya Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Traumatic pancreatoduodenectomy, also known as a traumatic Whipple procedure, is a complex surgical procedure reserved for severe traumatic injuries to the pancreas, duodenum, or periampullary structures. This case report details the management of a 19-year-old male who sustained a single gunshot wound to the abdomen, resulting in high-grade pancreatic and duodenal injuries. The procedure involved resection of the pancreatic head, the first and second parts of the duodenum (D1 and D2), a partial gastrectomy and a cholecystectomy. Liver haemorrhage was also controlled. Despite postoperative complications, including a pancreatic fluid leak and acute respiratory distress syndrome, the patient recovered and was discharged home. This case highlights the rarity of this procedure in trauma, its associated mortality and morbidity rates and the importance of timely and effective multidisciplinary care.

Posterior Midline Soleus Splitting Approach for Tibial Nerve Schwannoma Resection: A Case Report

Somya Goel, Firoz Borle, Raju Shinde, Ashish Jivani, Khushbu Vaidya Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Assessment of tibial nerve lesions is challenging for surgeons when accessing tumours without damaging adjacent tissues. Careful planning of the surgical incision is paramount in any surgical procedure. Selecting the precise location to ensure optimal visualisation while considering anatomical landmarks and potential postoperative morbidity is crucial. Additionally, the size and placement of the incision are critical factors for aesthetic outcomes. Accessing tibial nerve lesions surgically is particularly difficult, especially if the lesion is located beneath the belly of the soleus muscle. The ideal method to access the tumour should avoid damage to the adjacent musculature and be ergonomic to allow dissection under magnification. In the present report of a 27-year-old male, the posterior midline soleus splitting approach to a case of tibial nerve schwannoma at the mid-tibial level is presented. In this method, the patient was placed in a prone position and approached via the posterior aspect of the calf muscle. This approach involves splitting the two heads of the soleus, dissecting the tibial nerve and reaching the tumour. This approach has the advantage of accessing the tibial nerve lesion through an avascular plane, thereby avoiding the morbidity associated with soleus dis-insertion.

Rupoid Psoriasis on Hands: A Case Report

Sourabh Deshmukh, Trupti I Thakre Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Rupia derives its etymological roots from the Greek word “Rhupos,” meaning dirt. “Rupioid” describes distinct, cone-shaped plaques with dense, dark, lamellate, and adherent crusts on the skin, resembling oyster or limpet shells. Rupioid psoriasis, a morphological subtype of plaque psoriasis characterised by hyperkeratotic lesions, is a prevalent dermatological condition affecting approximately 2.5% of the global population. Given its autoimmune nature, psoriasis lacks a definitive cure. Its clinical features are similar to those observed in Kitibha Kushtha, a type of Maha Kushtha (major skin disease) in Ayurveda. The treatment approach involves purificatory therapies alongside internal medicine. This case report details a 46-year-old male patient who presented with symptoms of rupioid psoriasis for eight years. The patches thickened and gradually darkened to a blackish hue. The itching intensified gradually. The intervention included purificatory therapies, emesis, and purgation, followed by internal medicine and topical application. The combination of purificatory therapies, followed by external and internal administration of Ayurvedic formulations, proved highly effective in managing the patient’s Kitibha Kushtha (rupioid psoriasis).

Revisiting the Importance of History Taking and Clinical Examination in a Postpartum Case!

R Heena Kishore Vaswani, Shilpa Kshirsagar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Secondary Postpartum Haemorrhage (PPH) is an uncommon but potentially life-threatening complication that occurs between 24 hours and 12 weeks postpartum. Retained Products of Conception (RPOC), a condition in which placental or foetal tissue remains in the uterus following childbirth, miscarriage, or abortion, is one of the leading causes of secondary PPH. Haematological conditions such as Von Willebrand’s disease and thrombocytopenia, choriocarcinoma and infection and dehiscence of the caesarean section scar are some of the rarer causes of secondary PPH. This condition can lead to complications such as abnormal uterine bleeding, infection and endocrine disruptions. Hereby, authors present a case of secondary PPH due to RPOC, in which the patient presented with complaints of intermittent, dull-aching lower abdominal pain and occasional passage of small clots per vaginum. Although the patient was symptomatic, she believed that it was a normal phenomenon to experience irregular vaginal bleeding postdelivery and therefore did not mention it initially. This history was elicited, which further led us to conduct a thorough clinical examination.

Antenatal Diagnosis of Thoracopagus and Parapagus Dicephalus Dibrachius Dipus Conjoined Twins: A Report of Two Cases

Aastha Garg, Simmi Aggarwal, Inderjeet Kaur, Ravinder Garg Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Conjoined twins are a rare obstetric phenomenon, occurring in approximately 1% of monochorionic twin pregnancies. Many present with life-incompatible anomalies; thus, early prenatal diagnosis is crucial for optimal management and delivery. We report two cases: a pair of 18-week-gestation thoracopagus twins (one with dorsolumbar meningocele, deformed limbs, and low-set ears), and a 21-week-gestation parapagus dicephalus dibrachius dipus conjoined twin pair with two separate heads, a common thorax and abdomen, and a single pair of upper and lower limbs. Both were diagnosed via routine ultrasonography and underwent medical termination. This case series highlights ultrasonography’s potential in diagnosing and managing complex twin presentations, thereby reducing maternal morbidity and mortality.

Sugammadex: Breaking Through Residual Paralysis after Neostigmine’s Limits

Aparna Bagle, Sania Rodrigues Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Persistent neuromuscular blockade following the use of Neuromuscular Blocking Agents (NMBAs) remains a significant postoperative concern, often resulting in delayed recovery and prolonged stays in the Post- Anaesthesia Care Unit (PACU). It occurs when the effects of NMBAs are not fully reversed before emergence from anaesthesia, leading to complications such as hypoxaemia, impaired airway reflexes, aspiration, and respiratory failure. Despite the use of traditional anticholinesterase reversal agents, incomplete recovery of neuromuscular function can still occur due to factors such as improper dosing of reversal agents, variability in patient response to NMBAs, and the lack of adequate neuromuscular monitoring during surgery. These challenges pose risks for patients and highlight the need for effective management strategies. This report describes two cases of residual neuromuscular blockade that persisted despite the administration of anticholinesterase agents. Both patients experienced delayed recovery of muscle strength in the immediate postoperative period, raising concerns about inadequate blockade reversal. In both cases, the administration of sugammadex, a novel selective relaxant-binding agent, led to rapid and complete resolution of the neuromuscular blockade. These cases emphasise the efficacy of sugammadex in addressing persistent neuromuscular blockade, particularly in situations where traditional reversal agents fail to achieve full recovery.

Cervical Elongation in a Young Girl: A Rare Case Report

Vandana Verma, Snehlata Meena, Parul Sinha, Zoya Rahaman Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Cervical elongation is a common complaint in perimenopausal and post-menopausal women, often associated with uterovaginal prolapse. However, isolated cervical elongation without uterovaginal prolapse is rare in adolescents and young reproductive-aged women. This case report details a 20-year-old girl presenting with cervical elongation without Pelvic Organ Prolapse (POP). A 2 cm portion of the cervix was protruding from the introitus. The cervix was firm, the uterus normal sized, fornices deep, and cervical length approximately 8 cm. Successful cervical amputation with new cervical lip formation was performed. Management of POP in young girls is challenging, lacking a gold standard surgical approach due to varied presentations across age groups. Counselling regarding surgical pros and cons is crucial.

NF1 with Ewing’s Sarcoma and Thoracopulmonary PNET with Gastrointestinal Neoplasm: A Case Report of Synchronous Malignancies

Kovuri Umadevi, Syed Umar Ahmed, Gundluru Surendra Babu, Dola Sundeep Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Synchronous malignancies are rare and pose significant diagnostic and therapeutic challenges due to their complex presentations and diverse aetiologies. This report highlights two unique cases emphasising the importance of a multidisciplinary approach to management. The first case involves a 24-year-old male with Neurofibromatosis type 1 (NF1), presenting with Ewing’s sarcoma affecting the rib and lung. NF1, a genetic disorder caused by mutations in the NF1 gene, predisposes individuals to various malignancies, including sarcomas. This patient exhibited characteristic NF1 features such as café-au-lait spots, multiple neurofibromas, and Lisch nodules. Imaging revealed a destructive thoracic mass and histopathology, supported by immunohistochemistry, confirmed the diagnosis of Ewing’s sarcoma. The patient underwent surgical resection followed by chemotherapy, resulting in a favourable outcome. The second case describes a 75-year-old chronic smoker who presented with thoracopulmonary Primitive Neuroectodermal Tumour (PNET) and a high-grade dysplastic adenomatous polyp in the cecum. Imaging and histological evaluations confirmed the coexistence of these malignancies. The thoracic tumour was surgically resected and treated with a chemotherapy regimen, while the gastrointestinal lesion required a hemicolectomy. The patient’s postoperative course was uneventful, and follow-up assessments revealed no residual disease. These cases underscore the pivotal role of integrating advanced imaging, targeted biopsies, and molecular diagnostics to accurately identify and manage synchronous malignancies. Genetic predispositions, such as NF1, and environmental factors, including smoking, highlight the interplay of inherited and acquired risk factors in multifocal tumourigenesis. Multidisciplinary collaboration and individualised treatment strategies are critical for optimising patient outcomes, particularly in complex cases like these.

Concurrent Variants in SLC29A3 and EFL1 Genes Presenting as Infantile Onset Transfusion-dependent Anaemia in a Child: A Case Report

D Karthik, Pramila Gopal Menon, Parag Tamhankar, Shailaja Mane, Dnyaneshwar Upase Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Histiocytosis-Lymphadenopathy Plus Syndrome (HLPS) and Shwachman-Diamond Syndrome (SDS) are both rare genetic disorders that primarily affect paediatric patients and present with a wide range of systemic manifestations. HLPS, an autosomal recessive disorder caused by mutations in the SLC29A3 gene, is characterised by histiocytosis, chronic systemic inflammation, lymphadenopathy, hearing loss and haematological abnormalities. It belongs to a group of inherited histiocytosis syndromes associated with immune dysregulation, leading to recurrent infections and organ dysfunction. SDS, on the other hand, is a congenital bone marrow failure syndrome typically caused by mutations in either the SBDS, DNAJC21, or EFL1 genes. It is primarily characterised by exocrine pancreatic insufficiency, skeletal anomalies and varying degrees of cytopenias, particularly neutropenia. Patients with SDS are at an increased risk of developing Myelodysplastic Syndromes (MDS) and leukaemia. The haematological abnormalities in SDS can lead to recurrent infections, anaemia and thrombocytopenia, further complicating its clinical presentation. Present case is of a two-year-old child with transfusion-dependent anaemia, wherein whole exome sequencing identified a pathogenic homozygous variant in the SLC29A3 gene and a novel homozygous variant of uncertain significance in the EFL1 gene, which is likely modifying the phenotype. Although SLC29A3 and EFL1 gene-related disorders share some haematological and immunological features, their co-existence in a single patient has not been previously reported in the medical literature. Given the complexity of their overlapping manifestations, diagnosing such a case requires comprehensive clinical evaluation and genetic testing. Understanding the interplay between these two conditions can provide valuable insights into their pathophysiology and contribute to improved diagnostic and therapeutic interventions.

Naloxone in Buprenorphine Overdose: A Life Saving Intervention

Aviral Ratan Srivastava, Sarbari Swaika, Tanvi Snehal Desai Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Buprenorphine acts as a partial agonist at μ-opioid and ORL-1 (nociceptin) receptors, an antagonist at κ-opioid receptors, and an agonist at σ-opioid receptors. It is available in a range of formulations, including intravenous, sublingual, buccal and transdermal delivery systems. A serious drawback of buprenorphine is its potential for abuse and overdose. For the treatment of opioid dependence, the Food and Drug Administration (FDA) authorised buprenorphine and naloxone in 2002. Naloxone, when administered subcutaneously, blocks the effects of opioid agonists by competitively binding to mu, kappa and delta opioid receptors, thereby eliminating the euphoria and reinforcing properties typically associated with abuse. A 53-year-old obese female presented to the emergency department with increased drowsiness following a road traffic accident that occurred two days prior. The patient sustained multiple rib fractures along with pulmonary contusions, as well as abrasions over the chest and elbow, for which she was prescribed buprenorphine transdermal patches at the primary healthcare facility. Non Contrast Computed Tomography (NCCT) of the brain and cervical spine revealed no acute abnormalities. There was no tenderness upon palpation of the long bones and the pelvic compression test was negative. The Focused Assessment with Sonography for Trauma (e-FAST) was also negative. Upon examination, three drug-eluting patches of undetermined composition were identified affixed to the patient’s anterior thorax and were subsequently removed. Through differential diagnosis, buprenorphine overdose was concluded, supported by significant observed clinical parameters. Naloxone was administered intravenously, followed by an infusion, resulting in a marked improvement in the patient’s condition. Within 20 minutes of receiving naloxone, the patient’s Glasgow Coma Scale (GCS) score demonstrated significant improvement, highlighting the efficacy of naloxone in reversing the effects of a buprenorphine overdose.

Unusual Presentation of Seizure in a Child: A Case of Abdominal Epilepsy and Associated Diagnostic Dilemmas

M Sherin Fathima, R Ramya, S Sundari Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Abdominal Epilepsy (AE) is a rare and often under-recognised form of epilepsy that typically presents in children with gastrointestinal symptoms, such as recurrent vomiting. This condition can easily be misdiagnosed due to its atypical presentation, leading to delayed treatment and prolonged distress for patients and their families. Despite its rarity, AE should be considered in children with unexplained recurrent vomiting, particularly when other diagnoses fail to explain the symptoms. This is a unique case report of a 14-year-old boy who presented with a history of headache, persistent vomiting and dehydration that did not resolve with initial conservative treatment. Given the persistent nature of his symptoms, an Electroencephalogram (EEG) was performed, which confirmed the diagnosis of AE. The EEG revealed characteristic epileptic discharges that were not initially recognised as related to gastrointestinal symptoms. Following the diagnosis, the patient was started on sodium valproate, which led to a significant improvement in his symptoms. This case highlights the importance of considering AE in children with recurrent vomiting, especially when initial treatments do not yield results. It underscores the need for careful diagnostic work-up, including EEG and appropriate treatment with anticonvulsants.

Disseminated Multidrug-resistant Tuberculosis with Rare Extrapulmonary Manifestations and Pulmonary Thromboembolism: A Case Report

Kundan Mehta, Pratiksha Dutta Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Tuberculosis (TB) remains a leading global cause of illness and death. In 2023, 10.8 million individuals worldwide were diagnosed with TB, including 6.0 million men, 3.6 million women and 1.3 million children. That year, TB caused 1.25 million deaths. Disseminated TB is characterised by the involvement of two or more non contiguous sites due to the haematogenous spread of Mycobacterium Tuberculosis (MTB), arising from progressive infection, reactivation of latent foci, or, rarely, iatrogenic causes. Disseminated TB represents less than 2% of all TB cases and up to 20% of extrapulmonary TB cases in immunocompetent adults. Commonly affected sites include lymph nodes, pleura, bones, joints and meninges, with rarer sites such as the breast, pericardium and skin. Breast TB accounts for less than 0.1% of breast pathologies and 3-4.5% of surgical breast cases in developing countries. Tuberculous pericarditis affects 1-2% of pulmonary TB patients. Delayed diagnosis of disseminated TB can lead to life-threatening complications, including meningitis, pericarditis, intestinal perforation, osteomyelitis, sepsis and pulmonary thromboembolism. TB is a prothrombotic condition due to elevated levels of procoagulants (fibrinogen, Factor VIII), decreased anticoagulants (protein C, protein S) and platelet activation, which can contribute to thrombosis. The present case of a 25-year-old female describes disseminated Multidrug-Resistant Tuberculosis (MDR-TB) involving the lungs, pleura, abdomen, brain and rarer sites such as the breast and pericardium, complicated by pulmonary thromboembolism. The present case emphasises the necessity of a comprehensive diagnostic approach in patients with atypical presentations and underscores the importance of early, intensive treatment for disseminated TB, especially MDR-TB, to prevent severe complications and improve outcomes.

An Amalgamation of Triple Entity: A Rare Co-existence of Antrochoanal Polyp, Ethmoidal Polyp and Fungal Sinusitis

Parindita Sarmah, Sagar Gaurkar, Prasad Deshmukh, Shakti Sagar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X The co-existence of Antrochoanal Polyp (ACP), ethmoidal polyposis, and fungal sinusitis presents a unique diagnostic and therapeutic challenge due to overlapping symptoms and distinct treatment approaches. ACPs typically cause unilateral nasal obstruction, while ethmoidal polyps contribute to chronic rhinosinusitis, and fungal sinusitis may lead to facial pain and sinus opacification. Contrast-Enhanced Computed Tomography (CECT) aids in differentiation, while Functional Endoscopic Sinus Surgery (FESS) is essential for ACP and ethmoidal polyps, along with additional medical or surgical management for fungal sinusitis. A comprehensive approach ensures symptom resolution and minimises recurrence.

Enteric Duplication Cyst in a One-year-old Child: A Case Report

Patil Rashmi, Veerla Siddharth, Dhananjay Vaze, Jadhav Pranav, Aniruddha Bhagwat Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract, predominantly occurring in the ileum, although they can present in various locations, such as the retroperitoneum. These cysts may contain heterotopic tissues and can mimic other cystic lesions of the pancreas and peripancreatic region, posing diagnostic challenges. Hereby, the authors present a case of a one-year-old male child who presented with acute epigastric abdominal pain, vomiting, and fever. Clinical examination revealed a palpable epigastric mass. Ultrasonography (USG) and Contrast-enhanced Computed Tomography (CECT) demonstrated a large, multiloculated cystic lesion in the retroperitoneum, anterior to the pancreas, causing extrinsic gastric compression. Exploratory laparotomy revealed a thick-walled cystic mass adherent to the coeliac artery and splenic vessels, which was completely excised. Histopathological examination confirmed an enteric duplication cyst with a hamartomatous component, comprising multiple epithelial types, pancreatic acini, smooth muscle tissue, and arteriovenous malformations. The present case highlights the importance of considering enteric duplication cysts in the differential diagnosis of retroperitoneal cystic lesions in infants. Complete surgical excision is crucial to prevent potential complications such as infection, perforation, or malignant transformation.

A Rare Case of Scrub Typhus Presenting as Pre Septal Cellulitis

Aishwarya M Angadi, Nagyang Dani, (Col) OK Radhakrishnan, Harshita Kashyap Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Scrub typhus, a vector-borne disease caused by Orientia tsutsugamushi, is known for its diverse clinical manifestations. However, atypical presentations, such as preseptal cellulitis, are rarely documented and pose diagnostic challenges. Hereby, the authors present a case study of a 24-year-old female agricultural worker from a rural area who presented with fever, abdominal pain, vomiting, and facial rashes, along with significant swelling over the right eye since two days. She reported a history of an insect bite on her right upper eyelid. On further examination, an eschar on right upper eyelid, a hallmark of scrub typhus, was noted. Diagnostic tests confirmed scrub typhus with a positive Weil-Felix Test and Immunoglobulin M (IgM) Enzyme-linked Immunosorbent Assay (ELISA). The patient was successfully treated with antibiotics doxycycline, Meropenam and supportive therapies, showing significant improvement. The present case underscores the necessity of considering scrub typhus in the differential diagnosis of preseptal cellulitis, particularly in endemic regions. Recognising atypical presentations is crucial to prevent misdiagnosis and to ensuring timely and appropriate management.

A Rare Case of Benign Oncocytic Cystadenoma of Parotid Gland

R Prathipa, Vimal Chander, S Prakashiny Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Benign oncocytic cystadenoma of the parotid gland is a rare salivary gland tumour, constituting less than 1% of all salivary gland neoplasms. It is characterised by cystic spaces lined with bilayered oncocytic epithelium, composed of eosinophilic granular cytoplasm due to abundant mitochondria. While these tumours are typically asymptomatic, they can present as painless, slow-growing swellings in the preauricular region, often leading to misdiagnosis as other benign salivary gland tumours. Authors hereby, present the case of a 71-year-old female with recurrent right-sided parotid swelling. Eight years prior, she was diagnosed with low-grade mucoepidermoid carcinoma of the right submandibular gland. One year ago, she underwent total parotidectomy for a recurrent swelling, which was diagnosed histopathologically as a mucus retention cyst. Three months ago, she developed another swelling in the same region, prompting excision and biopsy. Histopathology revealed a cystic lesion lined by bilayered oncocytic epithelium with papillary projections, focal lymphoid aggregates and no evidence of malignancy, confirming oncocytic cystadenoma. Oncocytic cystadenomas present diagnostic challenges due to their rarity and overlap with other salivary gland lesions. Surgical excision is curative, with a low recurrence rate. Awareness of this rare entity is essential for accurate diagnosis and management.

Anaesthetic Management of a Patient with Thyroid Carcinoma: A Case Report of a Complex Perioperative Course

Anupama Kumari, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Thyroid carcinoma is a rare but aggressive malignancy that poses significant challenges for anaesthesiologists. The anaesthetic considerations for these patients are multifaceted, involving careful evaluation of airway management, cardiovascular stability, and postoperative care. It requires meticulous planning, precise technique, and close monitoring to ensure optimal outcomes. A thorough understanding of the unique challenges posed by thyroid cancer is essential for anaesthesiologists to provide high-quality care. Hereby, the authors present a case report of a 52-year-old female patient with a large thyroid carcinoma who presented with a difficult airway in which awake fibreoptic intubation was successfully used to secure the airway. Despite meticulous surgical resection of the mass under general anaesthesia, the patient experienced an accidental vascular injury to an aberrant neck vessel, which led to severe bleeding. Even with optimal anaesthetic management, including judicious fluid and blood transfusion, the patient developed delayed postoperative complications and unfortunately succumbed to death 15 days later. The present case highlights the complexities and challenges involved in the anaesthetic management of patients with thyroid carcinoma. It emphasises the need for careful preoperative planning, meticulous intraoperative management, and vigilant postoperative care to optimise patient outcomes.

Delayed Primary Repair of Patella Tendon Tear with Autologous Soft-tissue Graft Augmentation: A Report of Two Cases

Ishan Rajendra Shevate, Selvi Ashishkumar Khajanchi, Rahul Salunkhe, Vikram Reddy Cheemala Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X A patellar tendon rupture is an infrequent injury that results in the loss of active knee extension, leading to significant disability. Chronic patellar tendon ruptures are challenging to manage due to the proximal retraction of the patella, contracture, atrophy of the quadriceps muscle and scarring of the surrounding tissues. Delayed primary repair of patellar tendon tears with autologous soft-tissue graft augmentation is an effective surgical technique for restoring knee extensor function and structural integrity in cases where immediate repair is not feasible. This case report discusses two cases in which the patellar tendon tear was neglected, resulting in the loss of both extension and flexion of the knee, thus causing difficulties in daily living. The patients presented late to the orthopaedic Outpatient Department (OPD) with patellar tendon injuries, which were treated by delayed primary repair with soft-tissue autograft augmentation utilising semitendinosus grafts. This study highlights the fact that this approach provides strong tendon reinforcement, minimises the risk of re-rupture and promotes robust tendon healing by leveraging the biological benefits of autologous tissue. The outcomes of this study suggest good functional recovery, improved stability and satisfactory Range of Motion (ROM) in the knee.

An Endoscopic Approach to External Auditory Canal Osteoma Excision: A Rare Case Report

Apurva Anil Jarandikar, Diksha B Sangale, Rashmi Prashant Rajashekhar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X External Auditory Canal (EAC) osteoma is an infrequent, unilateral, benign, solitary neoplasm with relatively slow growth. It appears as a single, pedunculated hyperdense lesion. These lesions remain asymptomatic and are often found incidentally, being treated conservatively. However, in larger lesions that obstruct the EAC, they may infrequently exhibit otalgia, conductive hearing loss, tinnitus, a sense of mass, or aural fullness. Histopathological findings, radiographic imaging, and clinical examination may all be utilised to provide a diagnosis. Although asymptomatic cases are managed conservatively, symptomatic and large EAC osteomas are treated with surgical excision, which can be approached endoscopically or microscopically via endaural, transcanal, or postaural approaches. This case involves a 28-year-old male patient who visited the ENT department complaining of a mass in his right EAC, decreased hearing, and a sensation of blockage in the right ear that had been present for 1.5 years. Imaging and histopathological analysis determined it to be a right EAC osteoma. An endoscopic approach was employed for the surgical excision of the bony mass. This approach has been found to facilitate faster postoperative recovery, with better analgesia and cosmesis.

Extraosseous Chordoma of Retropharyngeal Space: A Case Report

Devyani Mohanlal Bathani, Nishit Gupta, Ashray Jain, Srishti Manoj Balwant, Tapan Nagpal Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Chordomas are slow-growing malignant bone tumours derived from notochord remnants that occur infrequently, most commonly involving the axial skeleton. Extraosseous chordomas, particularly those located in the retropharyngeal space, represent a much less frequent presentation. Hereby, the authors described the initial presentation, diagnosis, and operative treatment of a 70-year-old man with progressive dysphagia and a right neck mass. Early imaging raised suspicion of a retropharyngeal abscess; however, operative exploration revealed a solid mass. Surgical resection and subsequent histopathological and immunohistochemical studies established the diagnosis of an unusual extraosseous chordoma. The novelty of present case lies in its rare presentation and location, which mimicked an infectious process typical of the retropharynx, thereby emphasising the importance of considering uncommon neoplasms in the working diagnosis. In clinical practice, present case highlights the necessity of thoroughly investigating all retropharyngeal masses, even those that appear to be infectious. The technical difficulties associated with tumour resection in this sensitive anatomical site, combined with the diagnostic challenges requiring sophisticated pathological evaluation, underscore the clinical significance of present case. Furthermore, this report contributes to the limited literature on extraosseous retropharyngeal chordomas, promoting enhanced clinical awareness and potentially informing future management strategies for this rare tumour.

Salivary Duct Carcinoma with Comedo Necrosis in Level 1B Lymph Nodes: A Case Report

Srishti Manoj Balwant, Gaurav Datta, Devyani Mohanlal Bathani, Ashray Jain, Tapan Nagpal Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Salivary Duct Carcinoma (SDC) is a rare and highly aggressive cancer that originates in the ductal epithelium of the salivary glands, primarily affecting the parotid and submandibular glands. Cases involving minor salivary glands are uncommon. Due to its high grade, SDC requires aggressive treatment, including complete local excision and postoperative radiotherapy for optimal patient outcomes. The present report discusses a case involving a 50-year-old male with a solitary, firm, non tender swelling measuring approximately 4×4 cm in the right submandibular region, extending to the tonsillolingual junction. The right floor of the mouth displayed a fixed, congested mucosa attached to a palpable mass, causing oral bleeding. Histopathology revealed a cribriform pattern with comedo necrosis. Immunohistochemistry confirmed the diagnosis of SDC, with tumour cells showing positive results for cytokeratin-7, c-erb B2 and Mindbomb Homolog-1 (MIB-1). The mass was surgically excised, followed by postoperative radiotherapy. The patient was monitored for 21 months without any local recurrence or distant metastasis, indicating successful treatment. Complete surgical excision of the swelling, followed by postoperative radiotherapy, can lead to disease-free survival with early diagnosis and proper management.

Vesicular Mole with Myometrial Invasion: A Case Report

Hemant Deshpande, Saba Chaudhary Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Invasive vesicular mole (chorioadenoma destruens) is a rare form of Gestational Trophoblastic Disease (GTD) characterised by abnormal trophoblastic proliferation and myometrial invasion. The authors report the case of a 42-year-old multiparous woman who presented with prolonged vaginal spotting, amenorrhoea and elevated Beta-Chorionic Gonadotropin (HCG) levels (1,260,350 mIU/mL). Ultrasound and Magnetic Resonance Imaging (MRI) findings revealed a heterogeneous endometrial mass with myometrial thinning, raising suspicion of gestational trophoblastic neoplasia. The patient was started on multi-agent chemotherapy {Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Oncovin (EMACO)} due to high beta-hCG levels. However, persistent bleeding and imaging findings of residual disease necessitated surgical intervention. Histopathology confirmed an invasive vesicular mole with myometrial invasion. Postoperatively, beta-hCG levels declined to undetectable levels (<5 mIU/mL) and the patient was discharged in stable condition with close follow-up. Invasive vesicular mole is a rare but aggressive form of GTD that requires prompt diagnosis and treatment. Early initiation of chemotherapy and tailored intervention can lead to successful outcomes with normalisation of beta-hCG levels.

Balancing Maternal Cardiac Risk and Anaesthetic Safety: A Case Series on Segmental Spinal Anaesthesia

Roshani Nitin Manwani, Prachi Korde, Anjali Borkar, Amreesh Paul Francis Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Pregnancy evokes significant alterations to the physiologic conditions in females and it is more dramatic for women suffering from valvular heart diseases or congenital cardiovascular diseases. Increases in blood volume and cardiac output, as well as the tendency for decreases in systemic vascular resistance, can augment and worsen underlying disease and make anaesthesia for delivery and labour more complicated. In the management of cardiovascular diseases in women, a tailored, multidisciplinary approach can ensure the best outcome for both mothers and neonates. The present case series reports the application of Segmental Spinal Anaesthesia (SSA) in pregnant women suffering from complex cardiac conditions who require a caesarean section. The use of SSA has been recognised to minimise haemodynamic changes compared to spinal anaesthesia. By providing a regional block to select portions of the spinal cord, SSA mitigates hypotension and does not suffer from the sympathetic blockade that is readily seen in a traditional spinal anaesthetic. The present case series underscores the importance of individualised anaesthetic planning, holistic assessment of patients and multidisciplinary collaboration among obstetricians, anaesthetists and cardiologists.The findings suggest that SSA can be a safe and effective anaesthetic technique for high-risk obstetricpatients, particularly those with cardiovascular diseases, thereby providing a promising alternative togeneral anaesthesia or conventional spinal techniques for caesarean sections.

Neuroimaging Perspectives on Metabolic Encephalopathies: A Case Series

Manender Naini, Vasudha Battula, Anusha Putcha, Nikhitha Mangalagiri, Chandrashekar Patil Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Encephalopathies arise from various causes, such as toxic exposures, autoimmune conditions and metabolic disturbances. Their symptoms are typically non specific and may include seizures, localised neurological issues, movement abnormalities, or more severe outcomes like coma, lasting complications, or death. Here, the authors enumerate a few commonly encountered metabolic encephalopathies, (2 females, 4 males) such as the involvement of the splenium in Cytotoxic Lesions of the Corpus Callosum (CLOCCS), the mamillary bodies in Marchiafava-Bignami Disease (MBD) and the lentiform nucleus in uraemic encephalopathy. Knowledge of these patterns aids in achieving a specific diagnosis. Each pattern is linked to the most likely differential diagnosis, aligning more closely with the real-world challenges faced by radiologists.

Combined Anti-glomerular Basement Membrane and Anti-Nuclear Cytoplasmic Antibody (ANCA) associated Crescentic Glomerulonephritis: A Series of 6 Cases

Shivashangari Moorthy, Twisha Adhikari, Sanjeet Roy, Sabina Yusuf, Vikram Raj Gopinathan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Anti-GBM and ANCA-mediated glomerulonephritis are common causes of crescentic glomerulonephritis. Dual or double-positive glomerulonephritis is rare, with few cases reported in the literature and a worse prognosis. This case series of six patients describes the clinico-pathological features of anti-glomerular basement membrane glomerulonephritis (anti-GBM GN) with concomitant ANCA vasculitis and assesses the specific histopathological injury pattern in this combined presentation. The patients had a mean age of 42 years, with a female predominance. Almost all presented with haematuria and features of RPGN. One patient presented with pulmonary-renal syndrome, and another with systemic vasculitis. Approximately 66% of cases showed mixed lesions, and other features such as small vessel necrotising vasculitis were noted. All cases showed moderate to intense (2-4+) linear IgG staining, along with serum positivity for P-ANCA (MPO) or C-ANCA (PR3). These features aided in categorising concomitant anti-GBM and ANCA cases. In conclusion, anti-GBM antibodies and ANCAs (double-positive patients) rarely co-exist and are associated with poor renal survival. Intense linear glomerular staining suggests concurrent anti-GBM, as these patients may have small vessel vasculitis, which is not a feature of anti-GBM alone. This mandates ANCA antibody testing in all cases of rapidly progressive renal failure, even if clinically and pathologically consistent with anti-GBM GN, enabling prompt and aggressive immunosuppressive management.

Laparoscopic Management of Ectopic Pregnancy: A Case Series

Parul Bhugra, Nirmala Duhan, Roopa Malik, Reetu Hooda, Sakshi Gupta Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Ectopic pregnancy is a significant cause of maternal morbidity and mortality in the first trimester. Laparoscopy plays a crucial role in the management of ectopic pregnancy. Eight cases of tubal ectopic pregnancies that were managed laparoscopically were retrospectively analysed. The mean age at presentation was 28.12±4.79 years. Pelvic pain was the most common symptom, present in all 8 patients (100%), followed by vaginal bleeding in 6 (75%) patients. Out of the eight ectopic pregnancies, 4 (50%) were ampullary, while 2 (25%) each were isthmic and interstitial pregnancies. Laparoscopic salpingectomy was performed in 4 (50%) patients, while salpingostomy was required in 3 (37.5%) patients. In 1 patient (12.5%), laparoscopy was converted into laparotomy. There were no complications in any of the patients. All patients were discharged on postoperative day two, except for the patient in whom laparoscopy was converted into laparotomy. The present study emphasises that laparoscopic management of ectopic pregnancy is associated with shorter operative time, reduced duration of hospital stay and is safe in expert hands.

Haemangioendothelioma of Different Sites: A Series of Four Cases

Reshma Rachel Alex, Neetha Unnikrishnan, PV Priya, V Letha, S Sankar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Haemangioendothelioma is a rare vascular tumour of endothelial origin. It is considered a tumour with intermediate malignant potential. It is locally aggressive and can occasionally metastasize. Four cases of epithelioid haemangioendothelioma have been reported in a tertiary medical centre in the Department of Pathology, Government Medical College, Kottayam, Kerala, India, over a span of two years, specifically between August 2022 and August 2024. Two of the cases involved 10-year-old girls who presented with hoarseness of voice for six months and swelling in the thigh for three years, respectively. The third case was that of a 43-year-old female with a lesion in the liver. The fourth case involved a 48-year-old male who presented with swelling in the left arm. Microscopy of all cases revealed a neoplasm with numerous small-sized blood vessels lined by plump endothelial cells. Immunohistochemistry (IHC) was performed, leading to a diagnosis of haemangioendothelioma. The estimated prevalence of this tumour is less than one in a million, which makes the present study the first of its kind.

Unmasking the Silent Danger: A Case Series of Wellens’ Syndrome and Its Implications for Early Intervention

Hariharan Narasaiyan, N Swaminathan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Wellens’ syndrome represents a critical Electrocardiographic (ECG) pattern indicative of severe proximal Left Anterior Descending (LAD) coronary artery stenosis, demanding urgent diagnosis and treatment. This case series details four patients with diverse clinical presentations and risk factors, all exhibiting Wellens’ syndrome. The cases illustrate both classic ECG features-biphasic or deeply inverted T waves in precordial leads-and atypical features, such as biphasic T-wave inversion extending to lateral leads and post-prandial chest pain in a patient with prior right coronary artery Percutaneous Coronary Intervention (PCI). This series underscores the need for clinicians to maintain a low threshold of suspicion for Wellens’ syndrome, even with atypical signs and low troponin levels. Each patient underwent coronary angiography revealing significant LAD stenosis, followed by successful PCI and secondary prevention strategies. These cases highlight the importance of recognising Wellens’ syndrome and the urgency of diagnosis and treatment to prevent major adverse cardiac events.

A Rare Clinical Image of Malodorous Vulvar Cellulitis in Pregnancy

Pradnya Sakle, Sarika Khadase Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X A 29-year-old gravida 2, para 1 woman at 34 weeks gestation presented with complaints of vulvar swelling, erythema, foul-smelling discharge and pain for one month. Initial examination revealed localised tenderness and a malodorous discharge around the vulvar region (Table/Fig 1). The patient reported no recent trauma or history of sexually transmitted infections. Ultrasound imaging was performed to rule out any deep-seated abscess or involvement of adjacent structures. Laboratory investigations, including a complete blood count and cultures, were conducted to identify the causative agent. Results indicated an elevated white blood cell count, and cultures confirmed the presence of a polymicrobial infection, including Streptococcus agalactiae and Escherichia coli.

A Clinical Image of Basal Cell Carcinoma in Universal Vitiligo

Asharbh Raman, Kshitiz Lakhey, Akanksha Jakhar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X A 53-year-old woman presented to dermatology OPD with an abnormal growth under her right eye since one year. The patient first developed white patches on the fingertips at the age of 13. Similar lesions appeared over her toes and perioral region and then progressed to involve approximately 90% of the body surface area over the next 15 years, which was consistent with universal vitiligo. She did not undergo any treatment for vitiligo during this time. She denied prior use of phototherapy, topical corticosteroids, calcineurin inhibitors and systemic immunosuppressive agents. The disease remained stable for over a decade prior to the onset of the current lesion.

Imaging Findings of Pituitary Stalk Interruption Syndrome

Yatham Rama Rao, Senthil Kumar Aiyappan, Jaya Selin Praveena Joseph, Ramya Sai Dachepalli Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X An 11-year-old male child presented with inadequate height and weight gain compared to peers. His social, familial, and peer interactions were normal, with no behavioural concerns. He was born at term via caesarean section (birth weight: 2.7 kg) to non consanguineous parents. His medical history included poor academic performance-resulting in a one-year school interruption-and developmental delay, including delayed tooth eruption. There was no history of chronic diarrhoea, vomiting, respiratory distress, recurrent hospitalisation, seizures, or bowel/bladder incontinence.

Epiglottic Chondroma: Diagnostic Challenges and Management Strategies

Tanmay L Chaudhari, Mohak Kumar, Apurva Jarandikar, Mayur Ingale Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Dear Editor, Chondromas are benign neoplasms arising from cartilaginous tissue, predominantly found in bones; with soft-tissue occurrences are rare (1). Among the infrequent sites of occurrence, chondromas of the upper aerodigestive tract are exceptionally uncommon (2). Diagnosing epiglottic chondroma presents a challenge due to its rarity and non specific clinical presentation. Limited cases in the literature highlight the importance of considering chondromas in the differential diagnosis, especially in patients with chronic symptoms such as dysphagia or globus sensation [3-5].

School Dental Nurse: Role in the Indian Primary School Education System

K Venugopal Reddy Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Dear Editor, Nursing care is a crucial component of any healthcare delivery system. The services offered by these paramedical staff are commendable, making them an inseparable part of healthcare delivery systems worldwide. The concept of incorporating nurses into oral healthcare delivery systems originated in New Zealand when Richmond Dunn, a member of the New Zealand Dental Association, proposed the creation of the dental nurse profession in 1917. The New Zealand School Dental Service (SDS) was subsequently formed in 1921. The SDS’s success is evident in the decrease in extractions per 100 fillings due to dental caries: from 114.5 during 1921-22 to 25.5 in 1930-31 (1).

Precision versus Protocol: A Cross-sectional Analysis of Gastric Biopsy Techniques in Detecting Premalignant Lesions

Mrunal Kesari, Yoganand Patil, V Kalaivanan, Indranil Bhattacharya Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Patients with Chronic Atrophic Gastritis (CAG) and Gastric Intestinal Metaplasia (GIM) are at risk of developing gastric adenocarcinoma. The early and accurate detection of these lesions is critical for effective intervention and improved patient outcomes. Aim: To study the Sydney protocol and targeted single-site biopsy in detecting premalignant gastric lesions, identifying the most reliable method for early diagnosis. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology and Laboratory Medicine at Jagjivan Ram Hospital, Western Railway, Mumbai, Maharashtra, India from June 2023 to February 2024. A total of 100 gastric biopsies were included, comprising 50 cases of targeted single-site biopsy and 50 cases following the Sydney protocol. The Sydney protocol recommends obtaining biopsies from five specific sites in the stomach: two from the antrum, two from the body and one from the incisura angularis. The parameters studied were atrophy and intestinal metaplasia, which were assessed using histopathological evaluation of gastric biopsy specimens. The results were analysed by calculating interobserver agreement using kappa statistics to evaluate the reproducibility and reliability of the diagnostic criteria. Results: Out of 50 targeted single-site biopsies, urease was positive in 14 (28%) cases. A total of 14 (28%) patients had CAG, of which 12 were stage I and 2 were stage II. A total of 4 (8%) patients had intestinal metaplasia, out of which three were stage I and one was stage II. Out of 50 Sydney protocol-compliant biopsies, 20 (40%) patients’ urease tests were positive in at least one biopsy site. A total of 30 (60%) patients had CAG, of which 15 (30%) had CAG in all three sites (corpus, antrum and incisura), 4 (8%) had CAG only in the corpus, 4 (8%) had CAG only in the antrum, 3 (6%) had CAG in both the antrum and incisura, 2 (4%) had CAG in both the corpus and incisura, and 2 (4%) had CAG only in the corpus. Out of these 30 patients with CAG, 18 (36%) were classified as stage I, 9 (18%) as stage II, and 3 (6%) as stage III. A total of 10 (20%) patients had GIM, of which 6 (12%) had GIM only in the antrum, 2 (4%) had intestinal metaplasia in both the corpus and antrum, 1 (2%) had intestinal metaplasia in both the antrum and incisura and 1 (2%) had intestinal metaplasia only in the incisura. Out of these 10 patients with intestinal metaplasia, 5 (10%) were classified as stage I, 3 (6%) as stage II, 1 (2%) as stage III, and 1 (2%) as stage IV. Additionally, 3 (6%) patients had low-grade dysplasia. Conclusion: The Sydney protocol outperforms targeted single-site biopsy in detecting premalignant gastric lesions due to its comprehensive sampling from multiple sites, thereby reducing the risk of missed lesions. This thorough approach ensures accurate diagnosis and highlights the importance of endoscopic follow-up for ongoing patient management.

Comparison of Haemodynamic Changes and Intubation Conditions during Awake Fiberoptic Oral Intubation using Conscious Sedation with Either Dexmedetomidine or Fentanyl: A Prospective Interventional Study

N Pallavi, Ahmedi Fathima, Rajeev Ratna Suresh Naik, V Swathi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Awake Fiberoptic Intubation (AFOI) is the preferred intubation technique in cases of anticipated difficult airway or unstable cervical spine injury. The patient will not be comfortable if it is performed without the appropriate sedative. AFOI achieves a better safety profile and a higher success rate due to preserved muscle tone and minimal risk of desaturation. Aim: To compare the effects of fentanyl and dexmedetomidine on haemodynamic changes and intubating conditions during AFOI in patients scheduled for elective cervical spine surgery. Materials and Methods: In this prospective interventional study conducted at Fortis Hospitals, Bengaluru, Karnataka, India, 84 patients aged 18 to 60 years with American Society of Anaesthesiologists (ASA) grade I or II, scheduled for elective cervical spine surgery requiring AFOI, were randomly assigned to two groups. Group A received dexmedetomidine at a dose of 1 μg/kg intravenously over 10 minutes, while Group B received fentanyl at a dose of 2 μg/kg intravenously over 10 minutes. Sedation levels were assessed using the Ramsay Sedation Score (RSS), and intubation was performed when the score reached 2 or higher. Intubation conditions were evaluated based on the cough score during bronchoscopy and the postintubation score. Statistical analysis, including appropriate tests such as t-tests or Chi-square tests, was conducted to assess differences in changes in pulse rate, Mean Arterial Pressure (MAP), and oxygen saturation during AFOI between the two groups and to evaluate the occurrence and significance of any adverse effects. Results: The mean age of the patients was 41.12±3.73 years in Group A and 40.21±3.03 years in Group B. Group A showed superior RSSs compared to Group B. Additionally, Group A demonstrated more favourable cough and postintubation scores in comparison to Group B. During the intubation and postintubation phases, Group B experienced a notable increase in pulse rate and MAP, whereas these haemodynamic parameters remained stable in Group A. Furthermore, Group A exhibited no significant desaturation events in contrast to Group B. Conclusion: Dexmedetomidine proved to be more effective than fentanyl for AFOI, providing superior intubating conditions by ensuring better patient comfort, which was assessed and confirmed through favourable scores on RSS (score of 2), cough score (score of 1), and postintubation score (score of 1). These advantages make dexmedetomidine the preferred choice for AFOI, offering a more favourable balance of sedation, haemodynamic stability and oxygenation.

Synergistic Formulation of Lactobacillus Probiotics, Vitamin C and Lavender Oil in Mouthwash: An In-vitro Study

R Bharath, PT Priyangha Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Mouthwashes enhance oral hygiene by reducing plaque and refreshing breath. Probiotic mouthwashes containing Lactobacillus bacteria offer antimicrobial benefits and reduce oral pathogens. Aim: To develop a mouthwash containing Lactobacillus bacteria, Vitamin C, and lavender oil, and to evaluate its in-vitro properties, such as antimicrobial, anti-inflammatory, and cytotoxic properties. Materials and Methods: This is an in-vitro study conducted in Green Lab, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India between August 2024 and September 2024. To prepare the mouthwash, distilled water was heated to 40-45°C for ingredient dissolution of ingredients. Vitamin C was added in powdered form to achieve a final concentration of 0.1-1%, and glycerin (5%) was added. Lavender oil (0.1-0.5%) was incorporated with Polysorbate 20 as an emulsifier. The mixture was cooled below 40°C before adding Lactobacillus plantarum MTCC 5690. The pH was adjusted to 5.5-7.0, followed by adding xylitol and sodium benzoate as a preservative, and the final product was filtered for purity. The mouthwash was evaluated in-vitro for its antimicrobial, anti-inflammatory, and cytotoxic properties. International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) Statistics version 21.0 was used to perform one-way Analysis of Variance (ANOVA), with a p-value of less than 0.05 considered statistically significant. Results: The antimicrobial activity assay revealed that the mouthwash showed the largest inhibition zones for Streptococcus mutans, with a mean of 17±1.5 mm for High Concentration (HC) formulation and 16±1.5 mm for Low Concentration (LC) formulation. This confirming that the HC mouthwash produced larger inhibition zones than the LC formulation. The results were statistically significant (p<0.05) for Staphylococcus aureus, Streptococcus mutans, and Escherichia coli, indicating meaningful differences among different concentration groups for these microorganisms. The anti-inflammatory assay revealed that at a concentration of 50 μL/mL, the mouthwash significantly reduced protein denaturation, showing an absorbance of 3.9 at 570 nm. For the cytotoxic effects, the highest values were observed at 50 μL/mL, with an absorbance of 0.22, demonstrating a dose-dependent increase. Fluorescence microscopy showed increased cell viability at 50 μL/mL (Grade 0), indicating the highest level of protection for the cells. Conclusion: In conclusion, the formulated mouthwash that combines probiotics, Vitamin C, and lavender oil shows effective antimicrobial and anti-inflammatory effects, thus presenting a promising alternative for enhancing periodontal health.

Assessment of Knowledge, Awareness and Attitudes about the Risk of Periodontal Disease among Polycystic Ovarian Disease Patients Residing in Chennai, India: A Questionnaire based Cross-sectional Study

S Varsha, Jai Santhosh Manikandan, Makesh Raj, Sai Krishna, Hemalatha, Nanda Kumar, Pravina Fernando Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Polycystic Ovarian Disease (PCOD) has become one of the most prevalent conditions among females of reproductive age. Women with PCOD are at an increased risk of developing Periodontal Disease (PD). As PD may potentially lead to tooth loss, it is essential to create active awareness. Understanding the current levels of awareness among the public would help in formulating appropriate awareness protocols. Aim: To assess the knowledge, awareness and attitudes about the risk of PD among PCOD patients residing in Chennai. Materials and Methods: A descriptive cross-sectional survey was conducted in the Department of Oral Pathology at Tagore Dental College, Chennai, Tamil Nadu, India, from December 2022 to March 2023 with 375 female participants diagnosed with PCOD and living in Chennai. Purposive sampling was employed to select participants. Data were collected using both online and offline questionnaires over a study duration of five months after obtaining informed consent. The questions assessed the knowledge, awareness and attitudes regarding the risk of PD among PCOD patients. Data were collected using Excel and transferred to the Statistical Package for the Social Sciences (SPSS) version 24.0 for analysis. Categorical data were expressed in frequencies and percentages. Results: The study revealed that PCOD patients aged from 15 to 46 years, with a mean age of 22.25±5.03 years. Of the participants, 82.9% brushed their teeth once a day and 78.6% never flossed their teeth, indicating poor oral hygiene practices. Out of the 53 (14.1%) of participants who were aware that PCOD can affect oral health, about 29.3% received this information from their dentists and 26.8% received it from the internet. Approximately 93.6% of PCOD patients were not aware of the increased risk of PD due to PCOD and the majority (90.7%) did not believe they needed more frequent dental visits than non PCOD females, indicating relatively limited knowledge about the potential oral complications of PCOD. However, 97.1% of participants demonstrated a positive attitude toward adopting preventive measures to prevent PD/gum disease related to PCOD in the future. Conclusion: The results of the present study highlight significant gaps in the knowledge, awareness and attitudes regarding the risk of PD among women with PCOD in Chennai. The key findings indicate that while there is a general lack of awareness about the association between PCOD and PD, there is a notable positive attitude toward adopting preventive measures for oral health. There is a critical need to create awareness among women with PCOD regarding the risk of PD to improve their quality of life.

Ultrasonographic Evaluation of Uterine LSCS Scar and its Impact on Maternal Outcomes: A Cross-sectional Study

Hemant Deshpande, Rohit Dimbar, Shriraj Katakdhond, Saba Chaudhary Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The evaluation of uterine scars following Caesarean Section (CS) is essential for predicting delivery outcomes, particularly in patients considering Vaginal Birth After Caesarean (VBAC) or those undergoing repeat Lower Segment Caesarean Section (LSCS). Ultrasonography has emerged as a valuable tool for assessing caesarean scars, providing insights into critical scar features such as thickness, shape, continuity, and echogenicity. These factors play a significant role in determining the risk of complications, including uterine rupture and scar dehiscence, and influencing the decision-making process for VBAC or repeat LSCS. Aim: The study focused on identifying critical scar features, including thickness, continuity, and echogenicity, and their impact on delivery outcomes, specifically VBAC success rates and complications during repeat LSCS. Materials and Methods: This hospital-based, cross-sectional study was conducted from February 2022 to January 2025 at a tertiary care hospital. A sample of 284 pregnant women, at a gestational age of over 35 weeks with a history of previous CS, was recruited. Participants underwent clinical evaluation, including a detailed history, physical examination, and ultrasonographic assessment of the LSCS scar. Scar parameters were measured transabdominally, including thickness, shape (triangular/ballooning), continuity, and echogenicity using transvaginal ultrasound imaging. Categorical variables were summarised as percentages, while continuous variables were expressed as mean±standard deviation. Results: The majority of patients (201, 70.77%) were in the 26-30 age group, with 249 (87.68%) patients falling between 150-160 cm in height and 139 (48.94%) patients weighing 56-60 kg. A high proportion (236, 83.1%) resided in rural areas, and 227 (79.93%) patients belonged to the lower socioeconomic class. Scar patterns indicated that 55 (98.21%) cases of vaginal deliveries had a triangular scar, with only 1 (1.79%) had ballooning pattern, while 180 (78.95%) cases of LSCS had a triangular scar and 48 (21.05%) cases exhibiting a ballooning pattern. Thinner scars (<3 mm) were associated with a higher incidence of repeat LSCS (195, 85.09%). Continuous scars were linked to successful VBAC outcomes in 52 (92.86%) cases. Hyperechoic scars were found in 56 (100%) of vaginal deliveries, whereas hypoechoic (46, 20.18%) and isoechoic scars (12, 5.25%) were more common in LSCS cases. Conclusion: Ultrasonographic evaluation of the LSCS scar plays a critical role in predicting delivery outcomes. Triangular scars and thicker scar measurements (>3 mm) were associated with higher success rates for VBAC, while ballooning patterns and thinner scars (<3 mm) were linked to higher rates of repeat CS.

Analgesic Effects of Intravenous Paracetamol versus Intravenous Magnesium Sulphate in Patients undergoing Major Abdominal and Upper Limb Surgeries under General Anaesthesia: A Randomised Clinical Study

Raj Bahadur Singh, Saurav Shekhar, Shivani Sinha, Siddharth Singh, Anand Dev, Mohd Asim Rasheed Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Effective postoperative pain management is essential for patient recovery and satisfaction. Intravenous (i.v.) paracetamol and magnesium sulfate are two options that have shown promise in reducing pain and opioid use. Aim: To compare the efficacy of intraoperative i.v. magnesium sulfate versus i.v. paracetamol on postoperative analgesic requirements in major surgeries under general anaesthesia. Materials and Methods: This prospective randomised clinical study was conducted in the Department of Trauma and Emergency at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, and included 100 patients classified as American Society of Anaesthesiologists (ASA) grade I and II. The patients were assigned to two groups: Group P received 20 mg/kg i.v. paracetamol, and Group M received 20 mg/kg i.v. magnesium sulfate in 100 mL of normal saline. Written consent was obtained from all the participants. Baseline parameters were monitored and a standardised general anaesthesia protocol was followed. Postoperatively, pain was assessed using the Visual Analog Scale (VAS) and analgesic requirements and adverse effects were recorded. Statistical analysis was conducted using the t-test via GraphPad Prism (Dotmatics, GraphPad Software, San Diego, California). Results: A comparison of pain scores revealed similar levels immediately after surgery (Group P: 7.1, Group M: 7.2) and at six hours postsurgery (Group P: 2.1, Group M: 2.0). At 12 hours, Group M reported higher pain (6.8) compared to Group P (6.2), but pain levels were comparable at 18 hours (Group P: 3.0, Group M: 3.1). There was no significant difference in the number of rescue analgesia injections used (Group P: 2.0, Group M: 1.9, p-value=0.348). Diclofenac consumption was higher in Group P (300 mg) compared to Group M (290 mg, p-value=0.00526). The time to the first rescue analgesic was longer in Group M (5.2 hours) compared to Group P (4.6 hours, p-value=0.023). Adverse effects such as nausea, vomiting, sedation and respiratory depression were similar between groups, with no significant differences. Conclusion: The i.v. paracetamol and magnesium sulfate provided comparable postoperative pain relief. Group P had lower pain levels at 12 hours, while Group M required less diclofenac and had a longer time to the first rescue analgesic. Adverse effects were similar, making both drugs effective options for pain management.

Long-term Efficacy of Aquatic Therapy on Balance and Gait in Older Adults: A Randomised Clinical Trial

Purnima Singh, Pratap Chandra Sarma Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Balance and gait issues significantly contribute to fall-related injuries in older adults. Aquatic therapy interventions, such as Clinical Ai Chi (CAC), Water-Specific Therapy (WST) and the Bad Ragaz Ring Method (BRRM), have shown short-term benefits in enhancing balance and gait. Nevertheless, it is uncertain whether these improvements can be maintained over a longer duration. Aim: To assess the long-term effectiveness of CAC, WST and BRRM in preserving balance and gait improvements 12 months after the intervention, with an emphasis on functional outcomes and the reduction of falls. Materials and Methods: This randomised clinical study was conducted at Bangalore, Karnataka, India which involved 69 participants who completed an initial eight weeks of intervention. The sustainability of the eight-week intervention’s impact on balance and gait was evaluated over 12 months, with periodic assessments using the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), Timed Up and Go (TUG) test and Balance Confidence Scale (BCS). Data were gathered through clinical assessments, self-reported fall records and mobility diaries. Statistical analysis involved repeated measures Analysis of Variance (ANOVA) and post-hoc comparisons to investigate temporal trends and differences between groups. Results: A 12-month follow-up revealed that the CAC group maintained clinically significant improvements in BBS (p-value <0.01) and DGI (p-value <0.012) scores. The WST group exhibited a delayed but progressive improvement in FRT and TUG scores, indicating sustained long-term benefits. However, the BRRM group showed only marginal improvements, which diminished over time. Furthermore, the CAC group reported significantly fewer self-reported falls compared to both the WST and BRRM groups (p-value <0.05), and participants in the CAC group also expressed increased confidence and improved mobility in their daily activities. Conclusion: The study confirms the long-term efficacy of CAC in sustaining balance and gait improvements, reducing fall risk and enhancing confidence among older adults. WST showed delayed but beneficial effects, while BRRM exhibited limited long-term impact. Future research should explore tailored aquatic therapy protocols to maximise long-term benefits for diverse populations.

The Impact of a Novel Postural Supporting Device on Neuromotor and Behavioural Development of Premature Neonates: A Pilot Study

Dhwani Chanpura, Neha Mukkamala, Nalina Gupta Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Preterm neonates face significant challenges in neurobehavioural development compared to full-term neonates, as they often experience delayed motor coordination and cognitive development. Therapeutic positioning is an essential neurodevelopmental intervention in the Neonatal Intensive Care Units (NICU), as it supports the infant’s posture and movement. Aim: To develop a new postural supporting device and evaluate its impact on the neuromotor development of premature neonates. Materials and Method: This pilot study was conducted at level III NICU at Dhiraj Hospital, Vadodara, Gujarat, India, from April 2024 to July 2024. Nine medically stable preterm neonates, within the first 72 hours of life and with a gestational age between 30 weeks 0/7 days and 36 weeks 6/7 days, who were referred for physiotherapy, were included in the study. Conventional physiotherapy intervention, along with positioning in a novel postural supporting device, was administered. After one week, their neuromotor behaviour was assessed using the neuromotor behavioural assessment scale. Results: All nine preterm neonates demonstrated significant improvement when comparing pre- and post-outcomes, with p-values of 0.007 for neurological components, 0.007 for behavioural components, 0.011 for autonomic components and 0.016 for motor components. Conclusion: The present study shows that the “New Postural Supporting Device” has a positive impact on neuromotor and behavioural organisation in premature neonates.

Status of Oxidants and Antioxidants in Acne Vulgaris: A Cross-sectional Study

Astha Goyal, Sanjiv Kumar Bansal, Shikhar Ganjoo, Busi Karunanand Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Acne vulgaris is a multifactorial dermatological disease. The role of oxygen free radicals and antioxidant enzymes has been implicated in the pathophysiology of several skin diseases, including acne. However, the relationship between acne vulgaris and oxidative stress biomarkers lacks a clear consensus. Aim: To investigate the existence of oxidative stress in patients with acne vulgaris by measuring the levels of an oxidant, Malondialdehyde (MDA), and antioxidants such as Superoxide Dismutase (SOD), Catalase (CAT), and Glutathione (GSH). Materials and Methods: This cross-sectional study was carried out in the Department of Biochemistry in association with the Department of Dermatology and Venereology at the Faculty of Medicine and Health Sciences, SGT University, Budhera, Gurugram, India over a period of 12 months from July 2023 to June 2024. The study involved 200 patients with acne vulgaris and 50 healthy adults in the control group, aged 18-45 years. Five millilitres of venous blood was taken into gel separator tubes for the parameters such as SOD, CAT, GSH, and MDA, which were measured using Enzyme-linked Immunosorbent Assay (ELISA) kits. The values were compared with those of the control group. Student’s t-test was applied, and a p-value of <0.05 was considered statistically significant. Results: The mean age of the cases was 26.24±6.56 years, with 121 females and 79 males, while the healthy controls had a mean age of 25.80±5.45 years, with 29 females and 21 males. The serum levels of SOD (8.75±2.92 U/mL), CAT (0.22±0.08 ng/mL), and GSH (0.61±0.25 ng/mL) were found to be statistically decreased in patients with acne vulgaris compared to healthy controls, who had mean±SD values of 89.39±9.91 U/mL, 8.99±4.02 ng/mL, and 18.77±6.50 ng/mL, with a p-value of <0.001, respectively. Additionally, the serum MDA levels were found to be statistically increased in patients with acne vulgaris (7.72±2.11 nmol/mL) compared to healthy controls (2.51±0.97 nmol/mL), with a p-value of ≤0.001. Conclusion: The present study clearly demonstrated the existence of oxidative stress in patients with acne vulgaris, indicating its crucial role in the pathophysiology of acne alongside inflammation. Additionally, incorporating atleast one antioxidant-based medication into the combined acne treatment regimen may prove beneficial.

Cytological Profile of Solid and Cystic Lesions Arising from Various Sites in the Body: A Cross-sectional Study

Palaniappan Vellai, Pushpalatha Dharmarajan, Vamitha Panneerselvam Sampathkumar, Prathipa Krishnamurthy, Ravi Sivaraman, Reji Manjunathan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, cost-effective, and efficient technique for obtaining diagnostic cellular material with minimal discomfort and a low patient complication rate. Aim: To study various solid and cystic lesions in the body using FNAC, followed by histopathological examination for definitive diagnosis. Materials and Methods: The present cross-sectional Study was conducted on 383 patients who underwent surgery for cystic and solid lesions in the Department of Pathology at Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India. over a period of one year from June 2022 to June 2023. Patients with various solid lesions (breast, thyroid, salivary gland lesions, lymphoma, etc.) and cystic lesions (epidermal cysts, ganglionic cysts, fibro-cystic breast disease, etc.) referred for cytopathological analysis were included. FNAC results were tabulated, and histopathological examination of surgically removed tissues was performed for definitive diagnosis. Results: The study shows that FNAC is useful for diagnosing solid and cystic lesions, with a concordance rate of 83.66% for solid lesions and 90.90% for cystic lesions when compared to histopathology. However, it also highlights difficulties in distinguishing between benign and malignant thyroid and breast lesions, emphasising the need for further testing in uncertain cases. Conclusion: The FNAC is a simple, non traumatic, safe, cost-effective outpatient procedure. It provides high diagnostic accuracy for many conditions related to both solid and cystic lesions, especially when combined with imaging guidance and expert cytological interpretation.

Rubber Band Ligation versus Injection Sclerotherapy for the Management of Grade I and Grade II Haemorrhoids: A Prospective Interventional Study

Kanika Sharma, Ramachandran Ponniah Iyyappan, Ponmani Agasthiya Manimaran, Sanniyasi Saravanan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Several approaches are available for treating haemorrhoids, ranging from conservative in-office procedures to more invasive surgeries. Rubber Band Ligation (RBL) and Injection Sclerotherapy (SCL) are two widely used, minimally invasive techniques that can be performed in an office setting. While both methods relieve symptoms and enhance patients’ quality of life, they vary in mechanisms, techniques, and outcomes. Despite their popularity, there is limited comparative research on their efficacy, safety, and patient satisfaction. Aim: To compare RBL and SCL regarding post-procedural pain, bleeding, relief of symptoms, and recurrence. Materials and Methods: A prospective interventional study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, from July 2019 to July 2021. A total of 60 patients over the age of 18 years, with grade I or II haemorrhoids, undergoing RBL or injection SCL were included. Patients were recruited by convenience sampling and allocated alternately, i.e., RBL (n=30) or SCL (n=30), and systematically compared in terms of post procedural pain, bleeding, relief of symptoms, and recurrence. Data was analysed using IBM SPSS version 23.0 statistics software. The t-tests and Chi-square tests were applied and p-value of <0.05 was considered significant. Results: The mean pain score immediately post-procedure (30 minutes) was 2.6 and 1.7 in the RBL and SCL groups, respectively, p=0.024. The same trend was reported on day zero and mean pain score was significantly lower in the SCL group (0.37) as compared to the RBL group (0.93), p=0.008. In the first week, 53.3% of the RBL group presented with bleeding as compared to 20% of the SCL group, p=0.007. Patients in the RBL group reported better relief of symptoms (i.e., pain, bleeding, pruritus, sensation of mass per rectum) than patients in the SCL group, 93.3%, and 83.3%, respectively, though this data was not statistically significant. The RBL group had one recurrence (3.3%) and the SCL group had three recurrences (10%). Conclusion: The SCL group outperformed the RBL group regarding pain and bleeding in the first week post-procedure. However, clinically the pain experience was similar for both groups. While data beyond the first week was not statistically significant, SCL remains a safe and effective treatment for early haemorrhoids.

Evaluation of Micronucleus in Buccal Mucosa Samples as a Potential Biomarker for Early Diagnosis of Parkinson’s Disease: A Cross-sectional Study

Disha K Davis, Rajila Hannah Sugirthabai Rajendran Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Parkinson's Disease (PD) is the second most prevalent neurodegenerative disease as of 2024, with a global prevalence of 1.51 per 1,000 people in 2023. Micronuclei are small structures formed when chromosome fragments or whole chromosomes are not properly incorporated into the daughter nuclei during cell division. Their presence can signal genomic instability, which may be linked to neurodegenerative diseases such as PD. The buccal micronucleus assay is a cytogenetic test that examines micronuclei in cells from the buccal mucosa, offering insights into genetic damage or chromosomal instability, and it has been explored as a potential diagnostic tool for PD. Aim: To compare the presence of micronuclei in the buccal mucosa samples between individuals with PD and healthy controls, as a potential non invasive indicator for early PD detection. Materials and Methods: This cross-sectional study was conducted in the Department of Neurology at NIMHANS Hospital, Bengaluru, Karnataka, India from March 2023 to February 2024. A total of 170 participants, including both individuals with PD and healthy controls, were recruited from the Outpatient Department (OPD) and PD wards of NIMHANS Hospital. Buccal mucosa samples were collected using a moistened wooden tongue spatula, fixed onto glass slides with biofix spray and stained using the Papanicolaou (PAP) method. Microscopic images of these slides were then analysed quantitatively using an image analyser, focusing on the presence of micronuclei in the buccal epithelial cells. Results: The mean age of the healthy group was 66 years, while the mean age of the Parkinson’s group was 60 years, with an overall mean age of 63.14 years. The gender distribution in the healthy group included 38 males and 47 females, whereas the Parkinson’s group consisted of 55 males and 30 females. Among the study participants, the frequency of micronuclei occurrence was higher in Parkinson’s patients (69.4%) compared to healthy controls (11.8%). Conclusion: The occurrence of micronuclei was notably greater in individuals with PD when compared to healthy controls, suggesting a higher rate of genomic instability in PD patients. This observation reinforces the potential of micronucleus frequency as a useful biomarker for PD.

Effect of Acute Exercise on Pulmonary Function in Young Adults with Anaemia: A Quasi-experimental Study

K Roopashree, AN Jubin John, KC Devina Dilip, Prithika Shree Ragothaman, Aadhi Krishna Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Anaemia is a condition in which the Haemoglobin (Hb) level in the blood is below the reference range for age and gender. In India, mild anaemia is commonly found among medical students. Exercise capacity is limited by the ability to deliver oxygen to the muscles, and anaemia can impair this process by weakening the respiratory muscles, thus reducing pulmonary function. Pulmonary Function Tests (PFTs), combined with bicycle exercise testing, are useful for detecting occult cardiorespiratory limitations. Aim: To estimate the prevalence of anaemia among first-year medical students and to study the effect of exercise on pulmonary function in individuals with anaemia. Materials and Methods: This was a quasi-experimental study conducted in the Research laboratory of the Physiology Department, at Eastpoint College of Medical Sciences and Research Centre (EPCMSRC), Bengaluru, Karnataka, India between December 2023 and April 2024. The sample size was 136 with male and female, aged 18-23 years. Based on the level of Hb concentration, the participants were divided into a Normal group and an Anaemia group. After 10 minutes, PFT parameters, including Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), the FEV1/FVC ratio, and Peak Expiratory Flow Rate (PEFR) were recorded using a spirometer. Following this, exercise testing was performed using a bicycle ergometer (INCO). PFT was recorded again immediately after exercise and compared. An independent sample t-test was used to find differences between the groups, while a paired t-test was used to compare pre- and post-exercise values within each group. A p-value of <0.05 was considered significant. Results: The prevalence of anaemia was found to be 22.1%, with significantly lower PFT parameters observed in the anaemic group compared to the normal group before exercise (p<0.05). However, no significant changes in the parameters were noted after exercise in either group (p>0.05). Conclusion: Approximately, 22.1% of participants had anaemia. There was no significant change in pulmonary function after exercise in either the normal or anaemic group.

Journals’ Characteristics and Factors Associated with Retraction among Pharmacology, Toxicology and Pharmaceutics Journals: An Observational Study Based on Scimago Journal and Country Rank and Retraction Watch Databases

Ahmed Ibrahim Fathelrahman Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Retraction is a corrective practice intended to address serious research mistakes and violations of research ethics. Most studies on retraction describe the characteristics of retracted papers, the attributes of retraction notices, the reasons for retraction, and/or the rates/patterns of retraction geographically or chronologically. Some studies have addressed postretraction issues, such as how retracted papers are cited after being retracted. To our knowledge, no study has focused specifically on the characteristics of the journals that issue retractions. Aim: To describe the characteristics of journals and patterns of retraction, as well as to determine the factors associated with retraction occurrences among pharmacology, toxicology and pharmaceutics journals. Materials and Methods: This was an observational study examining the metrics and retraction history of journals based on the Scimago Journal and Country Rank and the Retraction Watch databases. Descriptive and comparative analyses were conducted. Student’s t-test, One-way Analysis of Variance (ANOVA) and the Chi-square test or Fisher’s exact test were used, when appropriate, to test for significant differences. Logistic regression analysis was performed, and adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were computed. A p-value of <0.05 was considered as statistical significance. Results: Out of 116 journals in the subject category “Pharmacology, Toxicology and Pharmaceutics (Miscellaneous)”, 50 journals (43.1%) were indexed in Web of Science (WoS), 61 (52.6%) were open access and 106 (91.4%) were still classified as “active” under Scopus as of January 2025. Overall, there were retractions in 29 journals (25%), including 192 retracted articles. The maximum number of retracted articles was 110, with an average of 1.66 retracted articles per journal. Journals that were WoS-indexed and those in quartiles Q1 and Q2 were significantly more likely than their counterparts to have at least one retraction. Journals from Western Europe, North America, and the Pacific region were significantly more likely to have at least one retraction compared to other geographic regions. In this context, journals with at least one retraction had higher metrics than those without any retractions, including the H-index, total number of documents (2023), total number of documents (3 years), total number of references, total citations (3 years), and number of citable documents. Being WoS-indexed and the H-index were found to be significant independent predictors of retraction in the logistic regression model. Conclusion: The findings of the present study revealed that higher-quality journals (Q1 and Q2 journals, those with higher metrics and those indexed in WoS) experienced more occasions of retraction.

Immununohistochemical Analysis of Progesterone Receptor and Ki-67 in Meningioma: A Cross-sectional Study

Rathin Hazra, Saurabh Dash, Prasenjit Kumar Bar, Sarbari Kar Rakshit Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The most common primary intracranial tumour is meningioma. It occurs mostly in middle-aged to elderly individuals. Differentiating meningiomas from other intracranial lesions and properly grading them is often a challenging task for pathologists. Meningiomas can cause significant morbidity, mortality, and recurrence, even after complete excision, which may lead to repeat operations and ultimately reduced survival rates. Meningiomas are categorised by the World Health Organisation (WHO) into three grades, primarily based on subjective methods that consider morphology, mitotic figures, and necrosis. Proliferative activity can also be assessed to some extent using these parameters. To minimise subjective biases, it is advisable to use Progesterone Receptor (PR) expression and Ki-67 Labelling Index (LI)-when feasible-as predictive markers for understanding tumour behaviour, which can also be useful for individualised management. Aim: To investigate the status of PR expression and the Ki-67 index in meningioma, along with their associations with age, gender, risk factors, histological types, and grading of meningiomas. Materials and Methods: The present study was a Institution-based retrospective cross-sectional analysis conducted in the Department of Pathology in collaboration with the Department of Neurosurgery at Nil Ratan Sircar Medical College and Hospital (NRSMCH), Kolkata, West Bengal, India. The study examined the correlation of PR expression with Ki-67 LI in 50 diagnosed cases of meningiomas following a retrospective review of all cases from March 2022 to February 2023. Primary ready-to-use antibodies were employed immunohistochemically to assess the immunostatus of these markers for prognostication of meningiomas. For statistical analysis, Statistical Package for Social Sciences (SPSS) version 27.0 was utilised, applying mean, Standard Deviation (SD), Analysis of Variance (ANOVA), and Chi-square testing. A p-value of less than 0.05 was considered statistically significant. Results: Among the 50 cases, there were 30 Females (F) and 20 Males (M), resulting in a ratio of M:F=1:1.5. The percentage distribution of grade I, grade II, and grade III cases was 37 (74%), 10 (20%), and 3 (6%), respectively. Meningothelial tumours were the predominant histomorphological subtype, accounting for 14 cases (37.83%). PR positivity was observed in 35 cases (70%). Most of the grade I cases demonstrated PR positivity (26 out of 37 cases, or 70.27%) and a low mean Ki-67 value of 4.16%. In contrast, the grade III cases primarily exhibited absent to weakly positive PR status (3 out of 3, or 100%) with a high Ki-67 value of 11%. The mean Ki-67 value was higher in PR-negative cases (n=15), at 7.18% with an SD of 4.26, while it was lower in PR-positive cases (n=35), with a mean of 3.64% and an SD of 4.17. Both PR expression and Ki-67 index showed a significant reduction and increase, respectively, with increasing WHO grades. The association of grade with PR and Ki-67 was significant (p-value=0.003 and p-value=0.004, respectively). An inverse correlation was observed between the Ki-67 index and PR score (R=-0.7561). The combined PR status and Ki-67 expression had a sensitivity of 96.67%, specificity of 100%, and an overall accuracy of 97.78%. Conclusion: The results indicate that middle-aged females are more likely to develop meningiomas, with the most common site being intracranial. Grade I tumours were the most prevalent, particularly the meninogothelial subtype. PR expression decreased, and Ki-67 index increased with higher grades. The mean Ki-67 value was greater in grade III meningiomas and PR-negative cases. The association between tumour grade and PR and Ki-67 was significant. The study of PR and Ki-67 immunohistochemical staining proved to be valuable supplements to routine histopathological assessments; thus, management strategies should be individualised.

Knowledge, Attitude and Acceptability of Human Papilloma Virus Vaccine among Undergraduate Medical Students in a Teaching Hospital of North Karnataka: A Cross-sectional Study

Apoorva R Deshpande, Sukanya V Badami, Vasundara S Gayakwad, Mahesh C Baragundi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Human Papilloma Virus (HPV) is associated with a wide range of diseases and cancers globally, affecting both the genders, and can be effectively prevented by the HPV vaccine. As the literature on the knowledge, attitude, and acceptability of the HPV vaccine is limited, the present study was undertaken. Aim: To assess the knowledge, attitude, acceptability, and recommendations regarding the HPV vaccine among undergraduate medical students at Gadag Institute of Medical Sciences (GIMS) Gadag, and to suggest the appropriate recommendations as an effective measure to reduce the burden and mortality due to HPV-related cancers. Materials and Methods: present cross-sectional study was conducted from September to October 2024 among undergraduate medical students from first year to final year, as well as interns at GIMS, Gadag. A total of 620 students responded to the study.Informed consents were obtained, data was collected using a pre-validated, semistructured questionnaire about knowledge (Cronbach’s Alpha value-0.854), attitude, acceptability, and recommendations (Cronbach’s Alpha value-0.82) regarding HPV infection and the v accine. Assessment of knowledge of HPV infection and HPV vaccines was conducted by scoring 1 point for correct answers and 0 points for incorrect answers. The score of 50% or more was considered to indicate a good knowledge score, while those with less than 50% indicated a poor knowledge score. Assessment of attitude, acceptability, and recommendation-related questions was done using a 5-point Likert scale. The Chi-square test and Fisher’s exact test were used to assess the associations. Results: Amongst the participants, 435 (70.2%) students had good knowledge, and 505 (81.5%) demonstrated a positive attitude, believing that receiving the HPV vaccine would be beneficial for a teenage girl or boy’s future health. Additionally, 425 (68.6%) were willing to receive the vaccine. Students with a good knowledge score showed the significant association with vaccine acceptability (p=0.001) and recommendations to others (p=0.001). Conclusion: Our study revealed the knowledge and attitude gaps even among medical students that need to be addressed at the earliest. Therefore, we suggest Conducting more educational and awareness programmes on HPV infection and the vaccine, not only for medical students but also for those in primary and secondary schools, colleges, and public places by the experts can work as an effective tool to fill the gaps. Both government and non-governmental organisations should take the necessary steps to customise the cost and availability of the vaccine in health centers.

Association of Platelet Indices with Cardiac Enzymes and Left Ventricular Function in Patients with Acute Myocardial Infarction: A Cross-sectional Study

P Kireeti, Rajesh Singh Laishram, Mayanglambam Bijoy, Sunil Kumar Leishangthem, Rajkumar Ajaykumar, Keisham Jaya Chanu, Ningthoukhongjam Reema, Dhanaraj Singh Chongtham Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Myocardial Infarction (MI) is a leading cause of mortality worldwide. Platelet activation has been implicated in its pathogenesis, and platelet indices, which measure platelet hyperactivity, have been suggested as biomarkers of Coronary Artery Disease (CAD). However, the association of platelet indices with cardiac enzymes and Left Ventricular (LV) function in patients with Acute Myocardial Infarction (AMI) remains unexplored. Aim: To determine the association between platelet indices, cardiac enzymes, and LV function in patients with AMI. Materials and Methods: This hospital-based cross-sectional study was conducted at the Department of Medicine, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India from May 2022 to July 2024. The study included 55 patients with AMI, aged 18 years and above, who were admitted to the medicine ward and Intensive Cardiac Care Unit (ICCU) of RIMS. Data were collected on demographics, clinical history, vital parameters, lipid profiles, Electrocardiogram (ECG) findings, cardiac enzymes (Creatine Kinase Myocardial Band (CK-MB), hs Troponin I), and 2D echocardiographic findings. The platelet indices measured included Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet-large Cell Ratio (P-LCR). The data were analysed using the Statistical Package for Social Sciences (SPSS) version 26.0 and expressed as descriptive and inferential statistics. Results: The study population had a mean age of 65.14±13.38 years, with a male-to-female ratio of 1.8:1. The most common complaints were chest pain (90.3%) and shortness of breath (56.4%). The risk factors included smoking (78.2%) and hypertension (50.9%). The mean and standard deviation of MPV (fL) was 10.995±1.592, PDW was 16.107±0.436, PCT (%) was 0.255±0.082, and P-LCR (%) was 32.836±10.920, respectively. Key correlations observed included PDW, which was negatively correlated with the LV internal diameter in diastole (r-value=-0.286, p-value=0.034) and the LV internal diameter in systole (r-value=-0.314, p-value=0.020). Furthermore, MPV showed a possible negative correlation with Left Ventricular Ejection Fraction (LVEF) (r-value=-0.247, p-value=0.069). No significant correlation was observed between platelet indices and cardiac enzymes. Conclusion: The findings from present study highlight that elevated platelet indices, particularly MPV and PDW, play a crucial role in the prothrombotic environment seen in AMI and are linked to LV dysfunction and remodeling. These indices, when integrated into routine diagnostics, could improve the assessment of AMI severity, predict outcomes, and provide insights into post-AMI LV changes.

Outcome of Different Surgical Interventions in Management of Emphysematous Pyelonephritis: A Retrospective Cohort Study from Dharwad, India

Revanasiddappa Kanagali, Muralidhar Achar, Pramod Makannavar, Srinivas Kalabhavi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Emphysematous Pyelonephritis (EPN) is a rare, life-threatening infection of the renal parenchyma characterised by gas formation within the kidney and surrounding tissues. When not promptly diagnosed and treated, this condition presents with a mortality rate ranging from 20% to 80%. Aim: This study aimed to evaluate the outcomes of different surgical interventions in managing EPN, focusing on minimally invasive interventions {Double J Stent (DJS), Percutaneous Nephrostomy (PCN), Percutaneous Drainage (PCD)} and nephrectomy. Materials and Methods: A retrospective cohort study was conducted at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, examining 80 cases of EPN over a 54-month period from January 2017 to June 2023. Data were collected from hospital records, including clinical notes, laboratory results, imaging studies, and surgical reports. The study assessed demographics, clinical presentation, laboratory investigations, imaging studies, treatment details, and patient outcomes. Descriptive statistics were used for demographic and clinical characteristics and Chi-square test was applied for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The study included 80 patients with a gender distribution of 48.8% female and 51.2% male, with a mean age of 57.9±12.2 years. Flank pain (91.3%), fever (86.3%), and dysuria (36.3%) were the predominant clinical manifestations. Laboratory evaluation revealed significant findings, including anaemia (52.5%), renal dysfunction (56.3%), and sepsis (61.3%). Escherichia coli were the primary causative organism, identified in 34 patients (42.5%). Class 2 EPN was the most prevalent classification, occurring in 25 patients (31.3%). Hypotension (p-value=0.015), elevated Glycated haemoglobi (HbA1c) levels (p-value=0.018), and the need for dialysis (p-value=0.008) were significantly associated with mortality. Minimally invasive interventions were predominantly successful, with various drainage procedures employed: unilateral DJS (48.8%), bilateral DJS (27.5%), PCN (3.8%), and PCD (18.8%). Nephrectomy was required in only 5% of cases. Conclusion: This study supports the efficacy of minimally invasive intervention approaches for EPN, thereby reducing the necessity for nephrectomy. Prognostic indicators, including hypotension, elevated HbA1c, and the requirement for dialysis, warrant careful monitoring. Minimally invasive interventions, coupled with targeted antibiotic therapy, are validated as a preferred treatment for EPN.

Utility of Cell Blocks from Lymph Node Aspirates to Improve the Diagnostic Accuracy of Fine Needle Aspiration Cytology: A Cross-sectional Observational Study from Eastern India

Upajna Pal, Abhinandan Bayen, Debajyoti Nanda, Manisha Sarkar, Dipanwita Nag Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Fine Needle Aspiration Cytology (FNAC) has been the primary modality for diagnosing lymph node enlargement, although it comes with its own share of fallacies and pitfalls. Cell blocks can be prepared from material obtained in the same sitting as FNAC, providing morphological details and preserving architectural patterns such as cell balls, three-dimensional clusters, excellent cytoplasmic and nuclear details, and individual cell characteristics. Aim: To determine the utility of cell blocks in improving the diagnostic accuracy of lymph node aspirates. Materials and Methods: This cross-sectional observational study was conducted with 50 patients who presented with visible or palpable lymph node enlargement over a period of one year (January 2021 to December 2021) at the Medical College and Hospital, Kolkata, West Bengal, India. Patients underwent Fine Needle Aspiration (FNA) from the lymph nodes, followed by cell block preparation in the same sitting. Material for the cell block was obtained by an additional pass with a 16-18G needle and was prepared using the plasma thrombin method, followed by formalin fixation, routine processing, Haematoxylin and Eosin (H&E) staining, and immunohistochemical staining. Patients were subsequently followed-up for tru-cut and excision biopsies. FNAC and cell block slides were examined by two expert pathologists to reach a final diagnosis. The diagnostic validity of the cell block was reported in terms of sensitivity, specificity, and accuracy. The Cohen’s kappa statistical coefficient test was performed to represent diagnostic accuracy. A p-value of less than 0.05 was considered significant. Results: Out of the total 50 cases, 21 (42%) were diagnosed as infective or reactive lymphadenopathy, 9 (18%) cases were lymphoproliferative disorders, and 20 (40%) cases were metastatic deposits based on cytology and cell block morphology. One case of reactive lymphadenopathy underwent lymph node excision biopsy and was ultimately diagnosed as Non-Hodgkin’s lymphoma. Three cases (6%) were diagnosed as classical Hodgkin’s lymphoma (positive for CD15 and CD30) based on the cell block, 6 (12%) cases were Non-Hodgkin’s lymphoma and 20 (40%) cases were metastatic deposits identified on FNA cytology and cell block. The overall sensitivity of the cell block in diagnosing lymph node aspirates was 97.87%, with a specificity of 80% and an accuracy rate of 96.15%. Cohen’s kappa calculated for FNAC and cell block was 0.724, indicating substantial agreement (95.5% agreement). Conclusion: Cell blocks can be efficiently utilised from lymph node aspirates to improve the diagnostic accuracy of lymph node FNAC, even before an excision biopsy is performed in patients who are unfit for invasive surgical procedures. Immunohistochemistry (IHC) in cell blocks can also be effectively implemented to differentiate between lymphoma and metastatic deposits.

Prevalence and Associated Risk Factors of Visual Impairment among Children at Ibn Al-Haitham Eye Hospital in Baghdad,Iraq: A Cross-sectional Study

Baydaa Jaber Shamran, Zainora Mohammed, Hassenien Shuber, Mohd Harimi Abd Rahman, Norliza Mohamad Fadzil Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Childhood Visual Impairment (VI) extends beyond poor vision, affecting psychological wellbeing, educational progress and social development. These challenges can persist into adulthood, significantly influencing overall quality of life. However, data on childhood VI in Iraq remain limited. Filling this gap is essential for developing effective health interventions that can enhance outcomes for affected children. Aim: To determine the prevalence, causes and associated risk factors of VI among children aged 6 to 15 years. Materials and Methods: A cross-sectional study was conducted at the Ibn Al-Haitham Teaching Eye Hospital in Baghdad, Iraq from October 2023 to May 2024, which included children aged 6 to 15 years. The participants underwent a comprehensive vision assessment to determine visual status and refractive error. Those who had Best-Corrected Visual Acuity (BCVA) worse than 6/12 were referred to an ophthalmologist to determine the cause of reduced vision. Data on socio-demographic factors and risk factors for VI were collected using a structured questionnaire. These include age, gender, residential area, family income and family history (parents’ age, educational backgrounds and history of refractive error). Results: A total of 508 children, with a mean age of 9.31±2.69 years, were included in the analysis. VI was determined based on presenting visual acuity, with a prevalence of 95 (18.7%). The main causes of vision impairment were uncorrected refractive errors, cataracts and amblyopia. Multivariate analysis showed a high risk of VI among children living in urban areas (adj. OR: 2.50; 95% CI: 1.43-4.40; p-value=0.001). Meanwhile, lesser odds of VI were found among those whose fathers had a secondary education (adj. OR: 0.27; 95% CI: 0.14-0.53; p-value <0.001), tertiary education (adj. OR: 0.10; 95% CI: 0.04-0.21; p-value <0.001), or were myopic (adj. OR: 0.30; 95% CI: 0.17-0.52; p-value <0.001). Conclusion: This study revealed that uncorrected refractive error was the leading cause of VI among children in Iraq. The analysis of risk factors associated with VI underscores the significant impact of socio-demographic characteristics, particularly area of residence and parental education. Therefore, enhancing access to eye care services and implementing awareness programmes to encourage health-seeking behaviours are essential for improving visual health outcomes among children in Baghdad, Iraq.

Correlation between Pre-procedural Ultrasound-estimated and Actual Procedural Epidural Depth in Lumbar Epidural Anaesthesia Taking BMI into Consideration: An Observational Study

Minu Thomas, Derlin Thomas, John Varghese Thoppil, Paul Ovungal Raphael, Deo Mathew Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Ultrasound guidance has become a popular tool for regional anaesthesia due to its ease of use and ability to accurately identify anatomical landmarks. This technique has been shown to improve safety and reduce complications. In recent years, there has been growing interest in using ultrasound for lumbosacral regional anaesthesia, even as a preoperative assessment tool. However, the variability in the distance between the skin and the epidural space can make it difficult to accurately locate the space, thereby increasing the risk of complications such as nerve injuries, paresthesia, haematoma formation, and post-dural puncture headache. Aim: To evaluate the skin-to-epidural space distance using Ultrasound-derived (UD) measurements compared to the conventional Needle Depth (ND) using the Loss of Resistance (LOR) technique, and to investigate their correlation with Body Mass Index (BMI). Materials and Methods: This observational study was conducted in the Amala Institute of Medical Sciences, Kerala, India from November 2020 to November 2021 with 60 patients aged 18-70 years, classified as American Society of Anaesthesiologists (ASA) class 1-2 and having a BMI between 18-30 kg/m2, who were undergoing elective lumbar epidural anaesthesia. The epidural space depth was assessed using transverse axial plane UD, and the actual ND was measured using a sterile linear scale. The correlation with BMI was studied. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0, and the agreement between UD and ND was evaluated using the Intraclass Correlation Coefficient (ICC). Results: The mean age of the patients was 50.77±9.12 years. The study revealed a strong agreement between UD and ND in assessing the epidural space, with an ICC of 0.963 (p-value=0.0001) and a Pearson’s correlation coefficient (r) of 0.960 (p-value=0.0001). A high correlation was observed between UD and ND in patients with a BMI of 18-22.9 kg/m² (ICC=0.983, p-value <0.0001) and 23-24.9 kg/m² (ICC=0.953, p-value=0.0001), while a moderate correlation was found in the BMI group of 25-29.9 kg/m² (ICC=0.627, p-value=0.008). Conclusion: The present study demonstrated a strong correlation between ultrasound-estimated and actual needle depths in patients with a BMI under 30 kg/m2. This correlation was associated with more accurate puncture site identification, higher success rates, fewer attempts for lumbar epidurals, and a reduced rate of complications.

Comparative Assessment of Efficiency and Patient Tolerance of Hybrid Arch Bar, Erich’s Arch Bar and Maxillomandibular Fixation Screw Placement in Treatment of Jaw Fractures: A Prospective, Single Blinded, Parallel Group, Controlled, Clinical Study

Sherwin Samuel, Kalyani Bhate, Akash Muralidharan, Manoj Bafna, Rushab Chordia Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Intermaxillary fixation, otherwise known as Maxillomandibular Fixation (MMF), is a time-tested technique used to stabilise occlusion when one or both of the jaws are fractured. There are different methods available for MMF, among which Erich’s arch bar, MMF screws, and hybrid arch bars are the most commonly used. The presence of these different methods warrants a study to evaluate the efficiency, advantages, and disadvantages of each method. Aim: To assess the efficiency and patient tolerance of hybrid arch bars, Erich’s arch bars, and MMF screw placement in the treatment of jaw fractures. Materials and Methods: This prospective, single-blinded, parallel-group, controlled clinical study was carried out in the Department of Oral and Maxillofacial Surgery at Dr. DY Patil Dental College and Hospital, Pimpri, Pune, from April 2023 to December 2023. Three parallel groups were designed with 15 participants who had mandibular fractures requiring MMF in each group. Patients in Group A were treated with Erich arch bars, patients in Group B with MMF screws, and patients in Group C with hybrid arch bars. Factors assessed included gingival inflammation on the day of removal and seven days post-removal of the MMF appliance using the modified gingival index, time taken for placement and removal in minutes, and patient discomfort using a visual analog scale. The observed values were subjected to statistical analysis using ANOVA for comparison of means and the Bonferroni test for intergroup comparison, with the significance level set at p<0.001. Results: This was a prospective, single-blinded, parallel-group, controlled clinical study conducted on 45 patients, of which 37 were male and eight were female. All patients were within the age group of 22 to 62 years. The mean value for gingival inflammation on the day of removal of MMF was highest for the hybrid arch (3.14±0.0770) and lowest for MMF screws (0.57±0.6), with a p-value <0.001. The mean value for gingival inflammation seven days post-removal of MMF was highest for Erich’s arch bar (1.57±0.732) and lowest for MMF screws (0.29±0.4), with a p-value <0.001. The mean application time was highest for Erich’s arch bar (42.36±5.2 minutes) and lowest for MMF screws (20.57±2.8 minutes), with a p-value <0.001. The mean removal time was highest for the hybrid arch bar (18.14±1.5 minutes) and lowest for MMF screws (6.93±1.4 minutes), with a p-value <0.001. The mean patient discomfort was observed to be highest with Erich’s arch bar (6.21±1.4) and lowest for MMF screws (5.00±1.4), with a p-value <0.001. Conclusion: In terms of time efficiency during the placement of appliances, gingival inflammation, and patient comfort, the best choice would be MMF screws. Although Erich arch bars consumed more time during placement, they caused less severe gingival inflammation compared to the hybrid arch bar, making them the second-best option for dentulous or partially dentulous patients whose dental arches allow for their placement.

Understanding the Paradigm of Treatment Dropouts in Diabetic Retinopathy Care: A Prospective Cohort Study

Alisha Elizabeth Alex, Inchara Nagraj, Sangeetha, BS Narendran Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Diabetes Mellitus is a lifelong condition that demands continuous management. Inadequate glycaemic control raises the risk of complications such as cardiovascular and cerebrovascular diseases, nephropathy, retinopathy and neuropathy. Diabetic Retinopathy (DR) if left untreated can pose a serious risk to one’s vision and treatment dropouts pose a significant challenge. Adherence to prescribed treatment regimens is crucial in preventing the progression of these complications. Therefore, addressing this issue of treatment dropouts is the need of the hour. Aim: To explore the factors associated with compliance among DR patients receiving Intra Vitreal Injections (IVI) (Anti-VEGF injections) and multiple laser sittings. Materials and Methods: A prospective cohort study was conducted at a tertiary healthcare hospital, Kolar, Karnataka, India which involved 112 diabetic patients and factors associated with Loss To Follow-Up (LTFU) were assessed using questionnaires from July 2022 to October 2023 in a tertiary care hospital in Kolar, Karnataka. Data was analysed using Statistical Package for the Social Sciences (SPSS) 22.0 version software. Categorical data was represented as frequencies and proportions. The Chi-square test or Fischer’s exact test (for 2×2 tables only) was used as a significance test for qualitative data with a p-value of <0.05, which was considered statistically significant. Results: Age ranged from 22-81 years with a mean of 57.4±11.3 years. Out of the 112 patients, 34 (30.4%) were LTFU, and 78 (69.6%) were followed-up as recommended or had delays of less than six months. Significant difference was found between LTFU and the type of treatment given (p-value=0.012). Specifically, 17 (21.8%) Pan Retinal Photocoagulation (PRP) laser patients were LTFU as compared to 11 (50%) patients who received IVI Anti-VEGF injections and 6 (50%) patients who received both PRP laser and IVI (Anti-VEGF injections). The cardinal causes of LTFU were limited affordability (35.3%), lack of satisfaction with treatment (14.7%), and job obligations (23.5%). Conclusion: Present study emphasised the socio-economic burden on the patient in terms of affordability and loss of daily income, which in turn affects their compliance with frequent follow-ups, demanding the need for newer strategies to improve compliance.

Effectiveness of Therapeutic Plasma Exchange in Paediatric Atypical Haemolytic Uremic Syndrome: A Cohort Study in a Transplant Institute of Gujarat, India

Pooja Yuvraj Modi, Amitkumar Vishnubhai Prajapati, Kamal V Kanodia, Anshuman Saha, Kinnari B Vala Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Atypical Haemolytic Uremic Syndrome (aHUS) is a rare but serious condition that primarily affects the kidneys, leading to kidney failure, anaemia, and low platelet counts (thrombocytopenia). Therapeutic Plasma Exchange (TPE) is the first-line treatment for aHUS, as stated in the American Society of Apheresis Guidelines (ASFA 2023), and is classified as a Category 1 indication. Aim: To determine whether TPE can be regarded as an effective treatment modality alongside conservative management in paediatric aHUS. Materials and Methods: This retrospective observational cohort study was conducted in the Department of Transfusion Medicine at the Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India, between October 2023 and April 2024, involving paediatric patients with aHUS. Anti-Factor H antibody testing was performed to confirm the diagnosis; for some patients, the diagnosis was corroborated through clinical correlation by the treating paediatric nephrologists. The patients were then advised to undergo TPE in conjunction with conservative management. TPE was performed on the Com Tec, Fresenius Kabi, continuous cell separator apheresis machine after obtaining informed consent from the patients’ parents or guardians. Pre and post procedural haematological and renal parameters were recorded and analysed to study the recovery profile in each patient. The mean and standard deviation were calculated for all parameters using Microsoft Excel 2010, and certain data were analysed as percentages. A paired t-test was employed to assess the statistical significance of changes in pre and post exchange haemoglobin levels, platelet counts, and serum creatinine levels. Results: In the present study, 12 paediatric aHUS patients were evaluated for their response to TPE. Of these, the majority showed a positive response to TPE therapy, with 75% of patients (9 out of 12) achieving a complete response. Additionally, 16.66% (2 out of 12) exhibited a partial response to TPE therapy, while 8.33% (only 1 out of 12) showed no response to TPE therapy. Each patient underwent a minimum of eight and a maximum of 16 TPE procedures, culminating in a total of 133 procedures performed on the 12 patients. Adverse events were observed in 25.56% (34 out of 133) of the total TPE procedures. The most common adverse event was chills and rigors, which accounted for 47.05% (16 out of 34 events) of the total number of adverse events. Conclusion: In the present study, the clinical triad of the disease (haemoglobin levels, platelet count, serum creatinine) improved post-TPE in the majority of patients with aHUS. The adverse events were few and manageable with conservative treatment. It was observed that TPE can be regarded as an effective and safe therapeutic modality for treating paediatric aHUS patients. However, given the small sample size and retrospective nature of the study, more robust prospective studies and clinical trials are needed to draw general conclusions.

Association between Preanaesthetic Check-up Parameters and Postoperative Recovery Score: A Cross-sectional Study

Sneha Henry, Moona Abdul Kadiru, R Shyam Krishnan, Harris Mohammed Paravengal, Keshav Anand, Mazhar Zulfikar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Elective surgeries are typically preceded by a thorough health assessment conducted by an anaesthetist during the Preanaesthesia Check-Up (PAC). This process involves evaluating the patient’s medical history, conducting a physical examination and reviewing laboratory test results. The PAC not only focuses on the clinical utility and cost-effectiveness of tests, but also aims to optimise the patient’s outcome by addressing any unidentified health issues before the procedure. Aim: To analyse laboratory reports associated with the PAC and evaluate their impact on postoperative recovery. Materials and Methods: This observational, cross-sectional study was conducted at Malabar Medical College Hospital and Research Centre a tertiary care hospital in North Kerala, India, from August to October 2023. A total of 102 postoperative patients were enrolled in the study over a two-month period. Demographic and laboratory data were collected using a structured questionnaire. Statistical analysis was performed using the Chi-square test with Jamovi software, and a p-value of <0.05 was considered statistically significant. Results: Among the 102 patients studied, male participants accounted for a higher proportion (59.8%) compared to females. Co-morbidities were present in 51/102 (50%) of the study population, with Hypertension (HTN) being the most prevalent {(n=32/102), which accounted for 32/51 (62%) of those with co-morbidities}, followed by Diabetes Mellitus (DM) (n=16/51). General Anaesthesia (GA) was administered to 64/102 (62.7%) of the participants, and 93 (91.2%) underwent procedures lasting longer than one hour. Random Blood Sugar (RBS) levels were deranged in 23.5% of the patients, while Renal Function Tests (RFT) were within normal limits for 98.04% of the cohort. A poor Quality of Recovery (QoR) score (<70) was observed in 15.7% of the patients. Conclusion: The present study demonstrated a significant association between co-morbidities and postoperative recovery. The preanaesthesia check-up is a useful and cost-effective tool for preventing perioperative morbidity.

Evolving Resistance Patterns: A Retrospective Five-year Study of Urinary Pathogens and Antibiotic Efficacy

A Mohan Kumar, J Jaison Jayakaran, R Alice Peace Selvabai, Ambujavalli Balakrishnan Thayikkannu, Priyadarshini Shanmugam Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The rising incidence of antimicrobial resistance is a major source of concern, particularly in the absence of new antimicrobial agents. This infection arises when microorganisms (predominantly bacteria) infiltrate and multiply within the urinary tract. Aim: To we present the changing antibiotic sensitivity patterns of urinary pathogens over the past five years (2019-2023) in a hospital located on the northeast coast of Tamil Nadu, India. Materials and Methods: This retrospective study was performed at the Department of Microbiology, Chettinad Hospital and Research Institute, Tamil Nadu, India, from January 2019 to October 2023. Out of 39,592 urine samples, 9,940 samples with bacterial growth were included in the study, considering only those with positive bacterial growth. Exclusion criteria included samples with no bacterial growth, samples from patients who had received antibiotics before sample collection, and duplicate samples. The demographic parameters considered were age, gender and co-morbidities. Bacterial identification was performed using conventional microbiological methods, including Gram staining, catalase testing, oxidase testing and biochemical tests. Antibiotic resistance testing was conducted using the Kirby-Bauer disk diffusion technique, following the protocols established by the Clinical and Laboratory Standards Institute (CLSI). Statistical analysis was performed using the Chi-square test, with a p-value under <0.05 regarded as statistically significant. Results: The study processed 39,592 urine samples, from which 9,940 (25.1%) pathogens were isolated. Escherichia coli (4,406; 44%) and Klebsiella pneumoniae (1,730; 17%) were the most common Gram-Negative Bacteria (GNB), while Enterococcus spp. (1,305; 13%) dominated among Gram-Positive Cocci (GPC). Notably, the efficacy of Amikacin (AK) against E. coli, Citrobacter koseri and Pseudomonas aeruginosa has declined over the last five years, as has the penicillin class of antibiotics, such as penicillin against Staphylococcus aureus. However, certain antibiotic classes like cephalosporins, aminoglycosides, Cotrimoxazole (COT), and Ciprofloxacin (CIP) exhibited improved efficacy against GNB. COT and Clindamycin (CD) also demonstrated notable effectiveness against Staphylococcus aureus, highlighting evolving antibiotic susceptibility patterns. Conclusion: From 2019 to 2023, there was a noticeable decrease in the efficacy of amikacin against E. coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, as well as a decrease in penicillin effectiveness against S. aureus. However, Imipenem (IMP), Meropenem (MRP), and Gentamicin (GEN) remained effective against GNB. Oxazolidinones, glycopeptides and sulfonamide antibiotics showed positive efficacy against GPC, highlighting their continued reliability in treating GPC infections.

Salbutamol Nebulisation in Normal Saline versus Salbutamol Nebulisation in Hypertonic Saline (3%) in Children with Acute Asthma Exacerbation: An Open-labelled Randomised Controlled Trial

Mohanlal Kundu, Kapil Bhalla, Dinkar Yadav, Hunny Verma, Neeraj Kumar, Mukesh Saini, Mohit Yadav, Neha Yadav Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Asthma has a significant impact and is the leading cause of morbidity and mortality in children. Salbutamol has been the cornerstone of treatment for bronchial constriction in asthma. Conventionally, salbutamol is diluted in Normal Saline Solution (NSS) and used for nebulisation. Studies conducted on bronchiolitis have demonstrated that using hypertonic saline instead of Normal Saline (NS) can decrease the viscosity of secretions and thus clear the airways. Aim: To compare the efficacy of salbutamol nebulisation in NS versus salbutamol nebulisation in hypertonic (3%) saline in children with acute asthma exacerbation. Materials and Methods: This open-labelled randomised controlled trial was conducted in the Department of Paediatrics at Pandit BD Sharma Post Graduate Institute of Medical Science, Rohtak, Haryana, India. The study involved 200 children between the ages of 5 and 14 years who presented with acute asthma exacerbation at the same institute from November 2022 to October 2023. A scoring system, the Becker asthma severity score, was used to classify the children as having mild/moderate or acute severe asthma. The study sample was divided into two groups: Group A (Control group: Salbutamol nebulised with NS) and Group B {(Study group: Salbutamol nebulised with Hypertonic Saline (HS))}. Both groups were compared in terms of improvement in symptoms using the Paediatrics Respiratory Assessment Measure (PRAM) score, duration of hospital stay and the requirement for admission to the Paediatrics Intensive Care Unit (PICU). An unpaired t-test and Chi-square test were performed, and the p-value was calculated, with a significance level set at <0.05. Results: In the present study, both groups were comparable in terms of age, gender (p=0.039), socioeconomic status, and residence. The Paediatric Respiratory Assessment Measure (PRAM) score was comparable in the hypertonic saline and NS groups at the beginning. However, the PRAM score was significantly lower in the hypertonic saline group compared to the NS group at 20 minutes (6.12±1.26 versus 6.84±1.13), 40 minutes (4.85±0.83 versus 5.14±1.00), and 60 minutes (3.14±0.64 versus 3.87±0.65). The PICU admission rate was significantly lower in the hypertonic saline group (24.6%) compared to the NS group (75.4%). A higher number of patients in the hypertonic saline group were discharged within 24 hours compared to the NS group. Conclusion: The 3% hypertonic saline group, in comparison with the 0.9% NS group, showed greater efficacy in relieving symptoms and reducing the length of hospital stay in children with acute exacerbation of asthma.

Evaluation of Foetal Modified Myocardial Performance Index as a Predictor of Perinatal Outcome in Intrauterine Growth Restriction Foetuses: A Prospective Cohort Study

Sinddhu Mani, Ramachandran Palanisamy, Veeraraghavan Gunasekaran, Subhashree Chandrasekaran, Murali Nanjundan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Functional cardiovascular assessment is gaining significance as a key tool in understanding foetal pathology. The foetal Modified Myocardial Performance Index (Mod-MPI) is a non invasive, pulsed-wave Doppler-derived measure of global cardiac function. Mod-MPI is independent of ventricular size, geometry and heart rate. Despite advances in the diagnosis and management of Intrauterine Growth-Restricted foetuses (IUGR), there remains a small proportion of cases that face severe adverse perinatal outcomes despite normal conventional Doppler studies. This highlights the need for new indices such as Mod-MPI for improved perinatal outcomes. Aim: To assess foetal cardiac function using Mod-MPI in IUGR foetuses in the third trimester and to compare Mod-MPI values with those of normal controls. Materials and Methods: The prospective cohort study was conducted in the Department of Radiology at Government Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India, from May 2024 to December 2024. A total of 43 singleton pregnancies in the third trimester with IUGR (cases) and 43 gestational age-matched normal singleton pregnancies in the third trimester (controls) were included in the study and were followed until delivery. The Mod-MPI was calculated in the foetal left ventricle by placing the Doppler sample in the internal leaflet of the mitral valve and estimating three time periods: Isovolumetric Contraction Time (ICT), Isovolumetric Relaxation Time (IRT) and Ejection Time (ET). The Mod-MPI was calculated as (ICT+IRT)/ET. Independent sample t-tests and Chi-squared tests were used for comparison between cases and controls. Results: The mean Mod-MPI value in the control group was found to be 0.41, with a Standard Deviation (SD) of 0.05. In IUGR cases, the mean Mod-MPI value was found to be 0.56±0.06. The p-value was <0.001. Based on the results, a value of 0.4950 was taken as a cut-off in the present study for the occurrence of adverse perinatal outcomes. Moreover, IUGR foetuses with higher left Mod-MPI values were associated with significantly worse perinatal outcomes and increased morbidity compared to the control group and IUGR foetuses with normal Mod-MPI values. Conclusion: The Mod-MPI is a simple and sensitive parameter for early foetal cardiac adaptation and higher MPI values were significantly associated with adverse perinatal outcomes, even in the presence of normal conventional Doppler findings.

Comparative Evaluation of Enamel Surface Roughness after Minimally Invasive Treatment of White Spot Lesions: An In-vitro Experimental Study

I'Udzuri Bin Md Jazam, Azwatee Abdul Aziz, Maria Angela Garcia Gonzalez, Prema Sukumaran Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: White Spot Lesions (WSLs) represent the initial demineralisation of enamel. In the past, invasive treatment methods required the removal of marginal tissue, which weakened the residual tooth structure. A further understanding of caries development, coupled with technological advancements, has led to a change in the paradigm, with non invasive or microinvasive treatments favoured over traditional restorative methods. Aim: To evaluate the surface roughness of resin-infiltrated proximal WSLs with ICON^® subjected to a pH cycling challenge and to compare its surface roughness with that of WSLs treated with Duraphat^®. Materials and Methods: An in-vitro experimental study was conducted at the Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia, between September 2019 and July 2021. A total of 60 extracted sound premolars were included in the research and the teeth were randomly divided into four groups of 15 specimens each. The groups were assigned as Sound (negative control), Demineralised (positive control), ICON^® and Duraphat^®. All specimens, except for the sound group, were subjected to initial demineralisation in a standard acid buffer demineralisation solution without fluoride at pH 4.5 for seven days and enamel changes were confirmed using Optical Coherence Tomography (OCT). Resin infiltration (ICON^®) and fluoride varnish (Duraphat^®) were applied to their corresponding groups. A non contact profilometer (3D Alicona) was used to measure surface roughness (Ra) at baseline and after pH cycling; initial and post-cycling mean differences were recorded. Statistical data were analysed using one-way repeated measures Analysis of Variance (ANOVA). A p-value of <0.05 was considered statistically significant. Results: The R_a at baseline revealed significant differences across the groups, except for ICON^® (0.31 μm±0.01), compared to sound enamel (0.31 μm±0.03) with a p-value <0.05. After pH cycling, the enamel surfaces treated with ICON^® (0.42 μm±0.01) were significantly smoother than those treated with Duraphat^® (0.58 μm±0.01), with p-values <0.001. After seven days of acidic challenge, ICON^® exhibited the least R_a change (0.11 μm). Conclusion: The WSLs treated with ICON^® showed approximately the same surface roughness as sound enamel, suggesting that the risk of developing caries around WSLs treated with ICON^® is comparable to that around sound enamel.

Immunohistochemical Expression of Paired Box 2 (PAX2) in Normal Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and its Association with Clinicopathological Parameters: A Cross-sectional Study

HG Sowjanya, Vijaya V Mysorekar, BK Sujani Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Endometrial Carcinoma (EC) is an increasingly problematic gynaecological cancer. Endometrial Hyperplasia (EH), particularly with atypia, is known to precede endometrial adenocarcinoma. Paired box 2 (PAX2) is a member of the paired box gene family that is involved in transcriptional regulation during embryogenesis and has been found to mutate early during endometrial carcinogenesis. Studies regarding PAX2 expression in endometrial lesions are limited. Aim: To determine the expression of PAX2 in proliferative endometrium, non atypical hyperplasia, atypical EH, and EC, and its association with other clinicopathological parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India, on endometrial specimens received for routine histopathological evaluation from the Department of Obstetrics and Gynaecology (OBG) between March 2021 and October 2022. A total of 78 endometrial biopsy specimens and 30 total abdominal hysterectomy specimens were received. All specimens underwent Haematoxylin and Eosin staining (H&E) and Immunohistochemistry (IHC) with a PAX2 antibody. All H&E-stained slides were screened for histological type; in the case of carcinoma, slides were also screened for tumour grade, stage, myometrial invasion, angiolymphatic invasion, lymph node metastasis, and parametrial involvement. Data were analysed using Statistical Packages of Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Somers, NY, USA) software. The Chi-square test, Fisher’s-exact test, and Analysis of Variance (ANOVA) test were primarily applied. A p-value of <0.05 was considered statistically significant. Results: A statistically significant difference was found between histological diagnosis and PAX2 intensity (p<0.001). During progression from normal to malignancy, PAX2 expression decreases in both distribution and intensity of staining. There was no association between PAX2 expression and clinicopathological parameters like tumour size, grade, angiolymphatic invasion, and lymph node metastasis, except for the stage of carcinoma (p=0.04). Conclusion: PAX2 staining is lost with the progression of lesions to atypical hyperplasia and endometrioid adenocarcinoma. Follow-up studies correlating PAX2 expression with cancer-specific 5-year survival statistics need to be conducted to assess the prognostic value of PAX2 in EC.

Assessment of Blood pH and pCO₂ as Predictors of Febrile Seizures in Paediatric Patients: A Cross-sectional Study

Suhit Banerjee, Tapan Kumar Biswas, Gobinda Mondal, Banasree Roy, Anish Chatterjee Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Febrile seizures commonly occur in the age group of six months to five years. Hypocarbia and alkalosis are known to enhance neuronal excitability and promote epileptiform activity. Neuronal excitability and seizure activity are strongly suppressed by various manoeuvre that lead to a decrease in brain pH, including exposure to elevated Carbon Dioxide (CO₂) levels, which results in hypercapnia. Aim: To study blood pH and partial pressure of Carbon Dioxide (pCO₂) levels in febrile children and to correlate these parameters with the occurrence of febrile seizures. Materials and Methods: This cross-sectional study was conducted in the Department of Paediatrics at Dr. BC Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, India, from January 2019 to December 2019. Infants and children aged six months to five years with clinical features compatible with the diagnosis of febrile seizures were enrolled as cases, while children with fever but without convulsions were included as controls. A total of 50 children were selected as cases and 50 as controls. Venous blood gas analysis was performed within one hour and 24 hours after the onset of seizures in cases and one hour after the febrile episode in controls. Data were statistically analysed using t-tests, one-way analysis of variance, Chi-square tests, or Fisher’s exact test. A p-value ≤0.05 was considered statistically significant. Results: The mean age of the febrile seizure cases was 24±16 months, while that of the controls was 31±23 months. Of the cases, 40 (80%) were male and 33 (66%) of the controls were male. The blood pH of cases within one hour of the febrile seizure was (mean±SD) 7.43±0.03 (indicative of respiratory alkalosis) and 24 hours after the febrile seizure, it was 7.41±0.05, showing a significant difference (p=0.017). The blood pCO₂ of cases measured within one hour of the febrile seizure was (mean±SD) 30±5 (indicative of hypocapnia), while the pCO₂ of controls measured one hour after the febrile episode was 36.5±6.5 mmHg. A significant difference (p<0.0001) was found between these two pCO₂ values. Conclusion: Respiratory alkalosis and hypocapnia are associated with febrile seizures. Medical carbogen may be used as treatment or prophylaxis for febrile seizures; however, further studies are required to establish this.

Evaluating the Co-relationship between Patient Mindfulness and Dental Treatment Satisfaction: A Cross-sectional Study

Seema Sathe, Khushbu Nimish Doshi, Anjali Bhoyar, Tanvi Jaiswal, Mithilesh M Dhamande, Rajanikanth Kambala, Ashika Singhania Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: There is a longstanding belief that the quality of mindfulness contributes to a person’s enhanced well-being. The concept of mindfulness has gained increasing attention in healthcare settings, including dentistry, as a potential factor influencing patient experiences and outcomes. The present study aimed to explore how mindfulness influences dental treatment satisfaction, as psychological factors such as anxiety significantly impact patient experiences. Understanding this correlation could lead to better strategies for reducing dental anxiety, improving patient satisfaction and enhancing overall treatment outcomes in dental care. Aim: To evaluate the correlation between patient mindfulness and dental treatment satisfaction. Materials and Methods: This research was a cross-sectional, questionnaire-based study with a sample size of 303 patients selected from the Outpatient Department (OPD) of the Department of Prosthodontics and Crown and Bridge at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from June 2023 to November 2023. A questionnaire was used to assess patient mindfulness as well as their satisfaction with various aspects of treatment. The Mindful Attention Awareness Scale (MAAS) questionnaire was distributed and completed by the patients prior to treatment and a single evaluator assessed the responses without knowing the treatment status of the patients. The patients then underwent the treatment for which they had visited the hospital. Upon completion of the treatment, the Patient Satisfaction Questionnaire (PSQ) was distributed and filled out by the patients. This was assessed using the Likert scale. A correlative evaluation was then conducted after assessing the individual scores on the questionnaires using Pearson’s Correlation Coefficient. Results: Using Pearson’s correlation coefficient, a positive correlation was found between the scores of the MAAS and the PSQ (r=0.347, p<0.01). This indicates that as the MAAS score of the patient increases, the PSQ score also increases. Conclusion: The evaluation of the correlation between patient mindfulness and dental treatment satisfaction indicates that higher levels of mindfulness are associated with increased satisfaction during dental procedures. This relationship suggests that mindfulness may enhance patients’ overall experiences.

Long- and Short-term Effects of Corticosteroids on the Rate of Orthodontic Tooth Movement and Associated Histological Changes in Animal Model: A Systematic Review

Ashish Agrawal, Aparajita Pandey Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Orthodontic Tooth Movement (OTM) involves a multifaceted process intricately linked to the remodelling of bone and tissue subsequent to the application of orthodontic forces on teeth. Various factors, such as age, gender, root morphology and the administration of medications like Corticosteroids (CS), can affect the remodelling of alveolar bone and the pace of OTM. The influence of CS on the rate of OTM has been reviewed in animal studies with conflicting results. Aim: To systematically investigate the effect of CS (duration) on the rate of OTM in animal models (rats). Materials and Methods: A sytematic review was conducted at the Department of Dentistry, Faculty of Dental Sciences, IMS BHU, Varanasi, Uttar Pradesh, India. A total of five databases (PubMed, Google Scholar, Wiley Library, Cochrane Library, Scopus) were searched without restrictions until March 5, 2024, using the following keywords: CS, orthodontic, tooth movement and bone remodelling. All in-vivo experimental animal studies assessing the rate of OTM following the administration of CS were included. The Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias tools were utilised. The reporting of the present review was based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The protocol was registered with the number CRD42024441077 in the Prospective Register of Systematic Reviews (PROSPERO) database (http://www.crd.york.ac.uk/PROSPERO). Results: The results of all five studies (all five studies being in-vivo experimental animal studies) concluded that CS causes suppression of osteoclastic activity histologically. The dosage and duration of steroids used in the studies showed a significant influence on the extent of OTM. Nevertheless, histological examinations revealed changes indicating suppression of osteoclastic activity, as evidenced by reduced activity of Tartrate Resistant Acid Phosphatase (TRAP), a major cytochemical marker of osteoclasts and a decrease in the length of root resorption. Conclusion: The CS induces alterations in the rate of tooth movement. However, intervention studies have concluded that the effect on OTM depends on both the dose and duration (≤3 weeks=short-term and ≥7 weeks=long-term) of administration.

Effect of Rhythmic Auditory Stimulation and Nordic Walking on Arm Swing and Spatiotemporal Gait Parameters in Parkinson’s Patients: A Quasi-experimental Study

Nivruti Khanna, Kalidasan Varathan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Parkinson’s Disease (PD) is a neurological illness characterised by impairments in movement, balance, coordination and gait caused by the absence or deficiency of dopamine and it is progressive in nature. The absence or decreased arm swing is a prodromal sign that may lead to gait impairments. Aim: To assess and analyse the effect of Rhythmic Auditory Stimulation (RAS) on arm swing and spatiotemporal gait parameters in conjunction with Cura Swing and Nordic Walking (NW). Materials and Methods: A quasi-experimental study was conducted at the Krupanidhi Group of Institutions, Bengaluru, Karnataka, India, which recruited 30 subjects based on specific inclusion criteria; the study duration was six months, from June 2022 to December 2022. After obtaining informed consent, participants were randomly divided into two groups, groups A and B, each consisting of 15 subjects, with interventions provided for five days each week over three weeks. The pre- and post-treatment evaluation included a 3D analysis using Kinovea and the Functional Gait Assessment (FGA). Group A, the control group, received 20 minutes of NW along with conventional physiotherapy, whilst group B received 20 minutes of RAS training through Cura Swing, followed by 20 minutes of NW. Results: After analysing the data using an Independent t-test, the results for Kinovea post forward swing and Kinovea post backward swing for both the right and left sides revealed a substantial difference between the two groups. Additional variables such as Timed Up and Go (TUG), cadence, stride length and FGA indicated significant differences between groups, with p-values of 0.01, 0.03, 0.009 and 0.02, respectively. Based on intergroup comparison analysis using a Paired t-test, there was a significant improvement in both groups independently regarding the measures of Kinovea forward and backward swing for both the right and left arms, TUG, cadence, stride length and FGA. Conclusion: RAS and NW programmes have shown beneficial effects on arm swing and balance. The lack of research in the literature concerning the therapeutic advantages of NW in conjunction with RAS as a holistic treatment contributes to the uniqueness of this study.

Assessment of the Effectiveness of Xylene-free Haematoxylin and Eosin Staining versus the Conventional Approach: A Comparative Observational Study

Swetha Muralidharan, Sangeetha Nagalingam, Shimi Sunder Raja Kumar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Xylene, a commonly used hydrocarbon in histopathological laboratories, poses significant risks, including carcinogenicity. Identifying safer alternatives is essential for laboratory safety and environmental sustainability. Aim: To evaluate the feasibility and effectiveness of xylene-free Haematoxylin and Eosin (H&E) staining as a safer and more environmentally friendly alternative to conventional xylene-based staining methods. Materials and Methods: A comparative observational study was conducted in the Department of Pathology at Karpaga Vinayaga Institute of Medical Sciences and Research Centre (KIMS & RC), Chengalpattu, Tamil Nadu, India, over a duration of three months (January 2024 to March 2024). The study included 50 specimen blocks (100 slides), with two sections taken from each block: group A (conventional staining) and group B (xylene-free staining). The 1.7% dishwashing liquid solution used in the xylene-free method was prepared by mixing 25 mL of commercially available dishwashing solution with 1,500 mL of distilled water. The staining quality, cellular architecture and overall staining effectiveness were analysed statistically using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The analysis shows that 49 (98%) of the slides in group A and 36 (72%) of the slides in group B had distinct nuclei and cytoplasm. The analysis of staining quality indicated that 45 (90%) of group A slides had good quality, whereas only 25 (50%) of group B slides achieved this standard. Overall quality was satisfactory in 49 (98%) of group A slides and only 36 (72%) of group B slides. Conclusion: Xylene-free H&E staining is a viable alternative with comparable diagnostic quality and improved safety and environmental benefits. However, slight reductions in staining clarity suggest a need for further optimisation. Future research should focus on improving deparaffinisation efficiency and refining methodologies to enhance nuclear and cytoplasmic clarity while maintaining safety and sustainability benefits.

Relationship between Happiness Index and Physical Activity Level among Physiotherapy Students: A Cross-sectional Study from Dakshina Kannada, Karnataka, India

Deena D Souza, Saumya Srivastava, Bhoomika Bhat Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The happiness and Physical Activity (PA) play an important role in human life to promote healthy lifestyle. Aim: To find out the connection between PA and happiness students, which helps in overall wellbeing and academic success. Materials and Methods: A cross-sectional observational study was conducted among Department of Physiotherapy students of NITTE Institute of Physiotherapy, Yenepoya Physiotherapy College, Kanachur College of Physiotherapy and Alvas College of Physiotherapy in Dakshina Kannada, Mangaluru, Karnataka, India. A total of 118 students aged 18-25 years participated over a period of six months from October 2023 to March 2024. The study utilised the Oxford Happiness Questionnaire and the International Physical Activity Questionnaire (IPAQ) to assess the happiness index and PA levels. Descriptive statistics, using frequency, percentage, mean±Standard Deviation (SD) of the data. The Pearson correlation coefficient (“r”) was to find out relation between happiness index and PA leave. The p-value <0.05 was considered significant. Results: All 118 participants (mean age, 20.31±1.43 years) completed the survey. A significant relationship was found between happiness and age, with 26 (41.3%) of students aged 18-20 years feeling happy and 37 (58.7%) are not happy as compared to 35 (63.6%) of 21-24-years students are happy and 20 (36.4%) are not happy (p-value <0.05). In analysis by gender, 35 (48.6%) of females and 26 (56.5%) of males underlined their happiness levels as high and 37 (51.4%) of females and 20 (43.5%) of male underlined low happiness level. PA was positively correlated with happiness, since only 3 (8.1%) among low PA participants were happy, with 10 (45.5%) among moderate PA and 48 (81.4%) among high PA participants. Thus, age and PA had a positive effect on happiness. Conclusion: The study’s results underscore the importance of promoting PA among students to enhance their overall wellbeing. These findings align with previous research highlighting the positive correlation between exercise and mental health. However, to pinpoint the precise exercise variables, more research is necessary such as type, intensity and duration that most significantly influence happiness levels in physiotherapy students.

Diagnostic Utility of Infratemporal Fossa Sign in Patients with Laryngeal and Oesophageal Reflux Diseases: A Prospective Observational Study

Abdul Saleem, Vivekanand Ashok, Prathap Ramalingam Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The Infratemporal Fossa (ITF) sign is defined as the patient’s localisation of pain to the posterior infra-auricular or retromandibular area. This pain is attributed to oedema of the pharyngeal end of the Eustachian Tube (ET), which can be observed using Diagnostic Nasal Endoscopy (DNE). Reflux disease is one of the various causes of ET salpingitis. Aim: To determine the incidence of the ITF sign in patients with Laryngopharyngeal Reflux (LPR) and to identify the percentage of patients presenting with the sign who also have underlying LPR. Materials and Methods: This prospective observational study was conducted at a tertiary care centre in the Department of Ear, Nose and Throat (ENT) and General Surgery at Karuna Medical College, Palakkad, Kerala, India from February 2024 to July 2024. Patients exhibiting the ITF sign, as well as those diagnosed with gastroesophageal conditions who also presented with the ITF sign, were evaluated for the presence of LPR using the Reflux Symptom Index (RSI). DNE and video laryngoscopy were performed, and the medial ET changes and LPR changes were graded using the 3ET score and Reflux Finding Score (RFS), respectively, in all patients with the ITF sign. Patients underwent a six-week course of Proton Pump Inhibitor (PPI) therapy and were subsequently re-evaluated using the RFS and 3ET score. The pre- and post-treatment scores were statistically analysed using a paired t-test. Results: A total of 68 patients were included. Of these, 47 presented with the ITF sign as their initial complaint, and 21 patients with Gastroesophageal Reflux Disease (GERD) also displayed the ITF sign. The mean RFS value was 15.15 before treatment, and after six weeks of PPI treatment, the mean value was 6.66. The mean 3ET DNE scores were 4.47 and 1.82 before and after treatment, respectively. Conclusion: The ITF sign can be considered one of the indicators of LPR disease.

Comparison of the Lever Sign, Lachman Test, and Lateral Pivot Shift Test for Assessing Diagnostic Accuracy in Complete Anterior Cruciate Ligament Tears: A Cross-sectional Study

C Vineesh Mohan, KM Siju, KS Jayakrishnan, K Gopikrishnan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Clinical examination remains fundamental in diagnosing Anterior Cruciate Ligament (ACL) tears, with various tests available. The main tests include the anterior drawer test, Lachman test, and lateral pivot shift test. Lelli’s test (lever sign) is a relatively new clinical test for diagnosing complete ACL tears. Each test shows variable sensitivity, specificity, and accuracy in different studies, and literature on the lever sign is limited. Aim: To evaluate and compare the diagnostic accuracy of three clinical tests-the Lachman test, lever sign test, and lateral pivot shift test-in diagnosing complete ACL tears. Materials and Methods: This analytical cross-sectional study was conducted at Government Medical College Palakkad and Government District Hospital, Palakkad, Kerala, India, from March 2024 to December 2024. A total of 61 patients with suspected ACL injuries underwent all three clinical tests, with results compared against Magnetic Resonance Imaging (MRI) and arthroscopic findings. The data were entered into a Microsoft Excel spreadsheet, and analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 29.0. Sensitivity, specificity, and diagnostic accuracy were calculated for individual tests and their combinations. The agreement between clinical tests and the final diagnosis was assessed using Cohen’s kappa coefficient. A p-value of less than 0.05 was considered statistically significant. Results: The study population had a mean age of 28.4±7.2 years. The study included 33 confirmed ACL tears and 28 cases without tears. The Lachman test showed high sensitivity (90.9%) but moderate specificity (67.9%). The lever sign demonstrated balanced sensitivity (84.8%) and specificity (85.7%). The lateral pivot shift test exhibited perfect specificity (100%) but lower sensitivity (45.5%). The combination of all three tests achieved the highest diagnostic accuracy (96.7%, p-value <0.001), significantly outperforming individual tests. The Lachman test showed great agreement (kappa coefficient 0.82), the lever sign showed substantial agreement (kappa coefficient 0.7), and the lateral pivot shift test showed low agreement (kappa coefficient 0.43) with the final diagnosis. Conclusion: While each test has unique diagnostic strengths, the combination of all three tests provides optimal diagnostic accuracy. The present study supports a comprehensive clinical examination approach using the Lachman test, lever sign test, and lateral pivot shift test for accurate ACL tear diagnosis.

The Influence of Yoga on HbA1c Levels in Patients with Type 2 Diabetes Mellitus: A Systematic Review

Sumedha, Subhasish Chatterjee Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disease characterised by insulin resistance and hyperglycaemia due to insulin deficiency. Despite advances in traditional treatment approaches, achieving and maintaining optimal glycaemic control remains a clinical challenge. Aim: To thoroughly evaluate and summarise the available evidence on the effects of yoga on HbA1c levels in patients with T2DM. Materials and Methods: The present review was a systematic review in which five electronic databases were searched: PubMed/MedLine, SCOPUS, the Cochrane Library (including ICTRP and EMBASE), and the Physiotherapy Evidence Database (PEDro). The keywords used were “yoga”, “HbA1c”, “diabetes” and “T2DM”. Google Scholar was also searched for supplementary information and manually reviewed references from identified publications. After removing duplicates and making the full text available, 24 articles were included in the systematic review. Results: This systematic review demonstrates the benefits of various yoga techniques for patients with T2DM. The review primarily focused on fasting blood glucose, postprandial blood glucose, hormone levels, lipid profiles, blood pressure, cardiac function, vitamin C and E levels, anthropometric measurements, quality of life and psychological factors. This review aids in predicting the benefits of various yoga techniques as an integrated approach and assesses the cumulative benefits of medication among patients with diabetes. Out of the 24 included studies, numerous yogic practices were employed; seven studies used Suryanamaskar, eight studies used Trikonasana and the remainder utilised Padmasana, Paschimottasana, Tadasana, Mandukasana, Ardh Matsyendrasana, Sukhasana and others. The studies also incorporated various Pranayamas, including Sudarshan Kriya, Bhastrika, Bhramari, Kapalbhati, Nadi Shuddhi, Viparitakarani, Sitkari, Anuloma-Viloma, and Om chanting. Conclusion: This review highlights the benefits of various yoga techniques as an integrated approach and underlines the cumulative benefits of pharmacological treatment in patients with diabetes.

Widespread Grey and White Matter Abnormalities in 15-year-old Female: A Case Report on a Rare Radiological Presentation of Wilson Disease

Ashutosh Kumar Mishra, Ruchi Shukla, Harshil Patel, Kushal Singh, Archana Verma Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Wilson disease is a genetic disorder affecting copper metabolism, characterised by the accumulation of excess copper, primarily in the liver and brain, and the liver’s inability to excrete copper into the bile. The putamen, lentiform nucleus, thalamus, and brainstem are prominently involved in Magnetic Resonance Imaging (MRI) of the brain in Wilson disease, while lesions affecting grey and white matter are rare. Hereby, the authors present a case of a 15-year-old female patient who presented with postural tremor, dystonia, rigidity, dysarthria, and gait instability, along with bilateral Kayser-Fleischer rings and symmetric grey and white matter T2 hyperintensities in the fronto-temporo-parietal region. Therefore, patients exhibiting clinical signs of neurological involvement and abnormal MRI findings should be thoroughly evaluated for Wilson disease, as it is a disabling yet treatable disorder.

Body Mass Index and its Association with Active Ankle Proprioception in Healthy Young Individuals: A Cross-sectional Study

Purvi Patel, Riya Gadara Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Proprioception plays an important role in generating movements that are free and coordinated, aiding in the maintenance of normal body posture, regulating balance and postural control, and facilitating motor learning. Body Mass Index (BMI), a measure of weight adjusted for height, is commonly used to assess obesity in adults. Aim: To explore the association of ankle proprioception with BMI in healthy young individuals. Materials and Methods: This cross-sectional study was conducted on students of Sumandeep Vidyapeeth University between May 2023 and December 2023. Students aged between 18 and 40 years, without any known pathology, were approached, and a total of 112 individuals were screened. Out of these, 108 subjects were included in the study, consisting of 96 females and 12 males. The outcome measures used were Joint Position Sense (JPS) and BMI. JPS was assessed at three different angles: 30%, 60%, and 90% of the total range of active ankle inversion and eversion, specifically at 42° of plantar flexion, as measured by a pedal goniometer. The Chi-square test was used to establish the association between categorical variables. BMI was calculated by measuring the weight and height of the subjects, using the formula BMI=kg/m². Data were analysed at a 5% level of significance, with a Confidence Interval (CI) of 95%. Results: No significant association was found between BMI and active ankle proprioception at 30%, 60%, and 90% angles (p-value >0.05). Conclusion: According to this study, BMI was not found to be associated with ankle proprioception in healthy individuals, particularly regarding the active range of motion in a non weight-bearing position. The study also suggests that the pedal goniometer is a cost-effective tool that can be used to measure the proprioception of the ankle joint effectively.

Assessment of Adequacy of Informed Consent Process before Caesarean Section: A Cross-sectional Study

Kalpna Kulshrestha, Varun Kulshreshtha, Barakha Gupta, Kalpana Verma Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Caesarean section is the most common surgery performed in obstetrics. Legitimate informed consent should be obtained from the patient or her guardian before a caesarean section. Aim: To assess the adequacy of the informed consent process and to understand the reasons for any inadequacy in obtaining informed consent. Materials and Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India from January 2022 to December 2022. The study included all patients undergoing caesarean sections. A total of 460 patients were included after obtaining prior legitimate consent. A pretested and pre-validated questionnaire was adopted for the study, consisting of 16 questions related to details of the informed consent process for the surgery performed and the anaesthesia. The responses were recorded on a five-point Likert scale. Responses of “strongly agree” (1) and “agree” (2) were considered adequate, while responses of “neutral” (3), “disagree” (4), and “strongly disagree” (5) were regarded as inadequate. Data from the questionnaires were collected and entered into a Microsoft Excel sheet and analysed using Statistical Packages of Social Sciences (SPSS) software. Results: Out of 460 patients, 242 (52.6%) were aged 18 to 25 years. Most of the women, 424 (92.2%), were literate. Additionally, 263 (57.2%) had undergone repeat caesarean sections, and 364 (79.1%) had emergency caesarean sections. A majority of the women, 414 (90%), were aware of the benefits of caesarean sections, and 394 (85.7%) were informed about the major risks involved in the surgery. Most respondents, 395 (85.9%), also received information regarding possible complications during their surgery. Information about the need for blood transfusion was provided to most respondents, 402 (87.4%). Furthermore, 388 (84.3%) of them were aware of the type of anaesthesia, but only a few patients, 27 (5.9%), were explained about the risks associated with anaesthesia. The effect of caesarean section on future pregnancy was not explained to 368 (80%) of the respondents. Conclusion: Although most patients were well informed about the procedure and the associated risks and complications, some elements of the consent process were inadequately addressed, indicating a need for improvement.

Clinicopathological Evaluation of Rhabdomyosarcoma with Emphasis on Myogenin Expression and FOXO1 Gene Fusion in Various Morphological Subtypes: A Cohort Study

Sindhu Ramamurthy, Ashwini Nargund, Geeta V Patil Okaly, Usha Amirtham, Arun Kumar, Ashok Kumar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Rhabdomyosarcoma (RMS) is a prevalent paediatric soft-tissue sarcoma. Among the four histomorphological subtypes of RMS, distinguishing the dense pattern of Embryonal RMS (ERMS) from the solid pattern of Alveolar RMS (ARMS) solely based on morphology is challenging and necessitates ancillary techniques. Aim: To study the demographics, classify the histomorphological subtypes and reclassify the morphologically overlapping embryonal and ARMS cases into specific subtypes based on the intensity of myogenin expression and the FOXO1 gene fusion status. Materials and Methods: This cohort study was conducted at the Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India, from January 2019 to December 2022. The study included 71 cases of RMS. Clinical data such as age, gender, tumour site, size and clinical stage, along with histomorphological types, were analysed. A panel of immunomarkers was performed based on morphological differentials, which included desmin, myogenin, MyoD1, CD99, synaptophysin, chromogranin, PanCK, NKX2.2, INI1, CD56, S100, CD34 and SMA. Myogenin expression was scored based on the extent of tumour cell positivity. Interphase Fluorescence In Situ Hybridization (FISH) analysis was conducted on all ARMS and morphologically unclassified cases using the CytoTest Break Apart Probe for the FOXO1 gene. One hundred tumour cells were analysed and split signals, with or without amplification signals in at least 15 cells, were considered positive. Results: A male preponderance was noted (43/71, 60.6%), with a higher incidence among children under 14 years (42/71, 59.2%). ERMS was the most common histological subtype (26/71, 36.6%), followed by ARMS (13/71, 18.3%) and Spindle Cell RMS (SCRMS) (7 cases, 9.9%). The head and neck regions were frequently involved (24 cases, 33%). Twenty-three cases of unclassified RMS were reclassified into ARMS (fusion-positive) (43.4%, n=10) and reclassified ERMS (fusion-negative) (34.7%, n=8). Notably, the correlation between myogenin expression and FOXO1 fusion showed that 94.7% of fusion-positive cases exhibited 4+ myogenin expression (p-value <0.001). Overall, ARMS had the worst overall survival (OS) rate (26.1%). The reclassified ERMS and the classic ERMS cases showed almost similar survival rates (62.5% vs 64.2%, respectively) (p-value=0.025). Conclusion: The study highlights that the myogenin immunomarker is useful in differentiating between ERMS and ARMS in resource-constrained settings and emphasises the need for fusion testing in ARMS and unclassified RMS cases for accurate risk assessment and tailored treatment strategies.

Evaluation of Maternal and Foetal Outcome in Patients with Incidentally Diagnosed Müllerian Anomaly during Caesarean Section: A Retrospective Descriptive Study

Deepali Raina, Niharika Aggarwal, Geeta Katheit Rai, Anubhuti Singh, Vaishali Vijan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Congenital uterine anomalies, also known as Müllerian anomalies, have an overall prevalence rate of 0.06% to 38%, depending on the type of study population and diagnostic techniques used in various studies. Müllerian anomalies develop due to defective organogenesis of the genital tract. These anomalies can remain asymptomatic or present with a varied range of symptoms, including perinatal, maternal and foetal morbidities. Aim: To study the maternal and foetal outcomes in patients with incidentally diagnosed Müllerian anomalies during caesarean section and to compare the perinatal outcomes with the type of Müllerian anomaly diagnosed. Materials and Methods: A retrospective descriptive study was conducted in the Department of Obstetrics and Gynaecology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India. A retrospective review of the records of all patients who underwent Lower Segment Caesarean Section (LSCS) in the hospital from October 2017 to December 2022 was performed. The patients with intraoperatively documented incidental findings of Müllerian anomalies were selected. Results: The mean age of study participants was 25.6 years. Among a total of 2186 patients, 40 women were found to have Müllerian anomalies intraoperatively, resulting in a prevalence of 1.83%. A septate uterus was present in 14 (35%) patients, making it the most common Müllerian anomaly. Malpresentation was noted in 22 (55%) patients and was the most common indication for caesarean section. Foetal complications, such as preterm birth, were observed in 10 (25%) patients and low birth weight was seen in 15 (37.5%) patients. On a positive note, no baby was born at extremely premature gestation (<28 weeks) and 75% of women were able to carry their pregnancies to term successfully. A total of 80% of the babies born did not require any Neonatal Intensive Care Unit (NICU) and no baby had an extremely low birth weight (<1000 grams). Conclusion: Patients with known Müllerian anomalies can have an acceptable maternal and foetal outcome with vigilant obstetrical care.

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

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

Efficacy of Repetitive Transcranial Magnetic Stimulation (Ipsilateral Cortex) along with Physiotherapy to Contralateral Side on Tone and Function of Subacute Stroke Survivors: Protocol for a Randomised Controlled Trial

Pallavi Lalchand Harjpal, Raghuveer Raghumahanti, Mohammed Irshad Qureshi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Following a stroke, the resultant injury causes hyperexcitability of the contralesional hemisphere, leading to an interhemispheric imbalance and contralateral motor dysfunction. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non invasive brain stimulation technique that has been investigated for its ability to hasten stroke recovery by stimulating the ipsilesional motor cortex or inhibiting the contralesional hemisphere. Need of the study: Stroke is a major cause of impairment, with a significant number of survivors experiencing motor impairments that affect their quality of life and independence. rTMS modulates cortical excitability and plasticity and has been shown to improve motor recovery after stroke. However, the exact parameters, timing and targets of rTMS remain undefined, which contributes to its variable clinical evidence. Some research focusing on the unaffected hemisphere suggests that ipsilateral cortical stimulation may be one means to decrease interhemispheric inhibition and promote recovery. A better understanding of the mechanisms underlying these phenomena might be useful in improving stroke treatment and intervention strategies. Aim: The present research aims to determine the effectiveness of a standard physiotherapy protocol for the contralateral side combined with rTMS of the ipsilateral (contralesional) cortex in improving tone and function in subacute stroke survivors. Materials and Methods: A randomised controlled trial involving 60 subacute stroke patients will be conducted, in which the patients will be divided into two groups: Group A (experimental) and Group B (control), using a random number sequence with a 1:1 allocation ratio. The experimental group will receive rTMS along with standard physiotherapy, while the control group will receive placebo rTMS alongside standard physiotherapy. This study will take place in the outpatient department of Ravi Nair Physiotherapy College and Acharya Vinobha Bhave Rural Hospital from April 2024 to March 2025. Each group will receive five intervention sessions per week for four weeks. The Modified Ashworth Scale (MAS), Stroke Rehabilitation Assessment of Movement (STREAM), Functional Reach Test (FRT) and 10-Metre Walk Test (10-MWT) will be used to assess each patient before and after therapy. The paired t-test will be employed to test the outcome variables for the pre-post results. The Kolmogorov-Smirnov test will be used to assess the normality of the data. If the data are normally distributed, a parametric test will be performed; if normality is violated, a non parametric test will be carried out, with a significance level set at p-value <0.05.

Impact of Spiral Stretch Technique on Range of Motion, Pain, and Disability in Patients with Adhesive Capsulitis: A Study Protocol for a Randomised Clinical Trial

Krishna Gopal Mondal, Sunita Sharma, Subhasish Chatterjee Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Adhesive Capsulitis (AC) of the shoulder is a progressively painful condition that gradually limits both passive and active movement in the glenohumeral joint. It affects 3% to 5% of the general population annually, but in individuals with diabetes, the rate can reach up to 40%. The Spiral Stretch technique is a unique method that incorporates Proprioceptive Neuromuscular Facilitation (PNF) into an assessment and treatment sequence, modified to include Muscle Energy Technique (MET) principles. Although preliminary research suggests a potential role for managing AC, further research is needed to confirm its effectiveness as a standalone or adjunctive therapy. Need of the study: The spiral stretch technique shows promise for managing AC, but its benefits, best use, and long-term effects are not yet clear. More research is needed to understand it better and improve patient outcomes. Aim: To develop a protocol to evaluate the efficacy of the spiral stretch technique in treating pain, Range of Motion (ROM), and disability in patients with AC. Materials and Methods: This is a pre-test post-test Randomised Controlled Trial (RCT) that will be conducted at MM Super-specialty Hospital, Mullana from August 2024 to February 2025. Patients will be recruited based on specific inclusion and exclusion criteria. Subjects will be randomly allocated into two groups through computer-based random allocation techniques. Group 1 will receive spiral stretch and conventional physiotherapy treatment, whereas Group 2 will receive only conventional physiotherapy treatment. Pre-test and post-test assessment will be done using the Numerical Pain Rating Scale (NPRS), shoulder ROM measurements, and the Shoulder Pain and Disability Index (SPADI). The physiotherapy treatment will be given for 40 minutes each session, three times a week for four weeks.

Impact of Early Proprioceptive Training on Pain, Range of Motion, Muscle Strength, and Gait Post in Patients following Total Knee Replacement: A Research Protocol for Randomised Controlled Trial

Anjali Vikas Nawkhare, Pratik Phansopkar, Aishwarya Borhade Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: In cases of Osteoarthritis (OA) affecting knee compartments, Total Knee Replacement (TKR) is highly effective but often leads to postsurgery challenges such as reduced knee flexion, strength, and Range of Motion (ROM). The purpose of this study is to fill in the information gaps regarding the best proprioceptive training settings for patients undergoing TKR. Although there is some discussion about the optimal method, early proprioceptive training is essential for enhancing gait, neuromuscular control, balance, and recovery outcomes. This study aims to improve customised rehabilitation techniques by examining the influence of important variables such as muscular strength and knee ROM. The ultimate goals are to improve recovery, prevent falls, and enhance the long-term quality of life for TKR patients. Need of the study: While traditional TKR rehabilitation has been widely studied, research on early-stage proprioceptive rehabilitation is scarce, highlighting the need for more effective post-TKR rehabilitation techniques. Aim: To investigate the effect of early intervention using proprioceptive training along with Combined Kinematic Chain Exercise (CCE) in subjects who have undergone TKR. Materials and Methods: A Randomised Controlled Trial (RCT) will be conducted in the orthopaedic ward (IPD no. 33) of Acharya Vinoba Bhave Rural Hospital, Ravi Nair Physiotherapy College, Sawangi Wardha, with a total sample size of 52. The duration of the study is from February 2024 to June 2025. Twenty-six participants will be allocated to each group. The patients will be divided into two groups: the control group (Group A), which will receive CCE, and the experimental group (Group B), which will receive proprioceptive exercises along with CCE. Both groups will undergo interventions six days a week for four weeks, with outcome measures assessed at baseline and after four weeks. Primary outcomes will include pain {Numeric Pain Rating Scale (NPRS)}, ROM, gait parameters (X-sens), muscle strength, and gait (balance and functional mobility). These parameters will be assessed using frequency and percentage for categorical data, and mean and standard deviation for continuous data. Continuous outcome variables will be analysed using normality tests and summarised with descriptive statistics; significance will be tested using t-tests for normally distributed data and Mann-Whitney tests for non-normally distributed data. Categorical variables will be summarised by frequency and percentage, with efficacy analysed using Chi-square tests.

Audits and Ethics in Ayurvedic Practice: A Narrative Review

Abhishek Dattatray Mavale, Devyani Dasar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X An audit is a systematic process of evaluating or examining a particular area, process, or set of data to ensure compliance with established standards, policies, or regulations. The goal of an audit is to assess the effectiveness, accuracy and efficiency of the processes involved, identify areas for improvement and ensure accountability. Audits can be conducted in various domains, such as finance, operations and healthcare, among others. Ethics are the foundation of professionalism. In addition to being able to do surgery as it is commonly understood, a skillful surgeon is seen as morally and ethically reliable. The surgical ethics conversation might be guided by the principles and the four-box model approaches to clinical ethics. An audit’s objective is to determine if the results of the audit match current standards and if what you believe to be happening actually is. A surgical audit is a critical, methodical and objective evaluation of the surgical treatment provided, assessed by one or more peers in comparison to established benchmarks or specific criteria. A clinical audit’s objective is to ascertain what modifications are necessary to improve the quality of treatment by contrasting a process or clinical outcome with pre-established standards grounded on evidence-based medicine. Even while these studies have shown encouraging results that demonstrate the potential efficacy of auditing, overall, the findings do not substantially support clinical audit methods. These findings demonstrate the need for more study to verify this method in different operating settings. Present review defines the field of ethics and audits, then go over the primary ethical dilemmas that surgeons encounter and how they resolve them.

A Narrative Review on the Use of Magnetic Mallets as an Aid in Dental Implantology and Atraumatic Extractions

Prajakta Prashant Kothiwan, Hasti Kankariya, Shreya Srivastava Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X The primary focus of Oral and Maxillofacial Surgery is exodontia, followed by the replacement of teeth with implants, along with the management of various pathologies in the orofacial region. Patients often find dental extractions frightening due to potential complications such as dry socket, delayed healing, paraesthesia and bleeding at the site. Furthermore, extensive rehabilitation, such as replacing a full arch with implants, was previously only possible for patients in good oral health due to the lengthy and traumatic procedures involved. The utilisation of equipment like the magnetic mallet enables more efficient and minimally invasive operations. The use of the magnetic mallet in oral surgery and oral implantology has gained immense popularity in recent years, emerging as an effective instrument for atraumatic extraction, implant osteotomy, sinus floor elevation and bone condensation techniques. The magnetic mallet is based on the principles of electromagnetism. Magneto-dynamic technology applies controlled forces to a body in a time-sensitive manner. As a result, the consistent and controlled application of pressure makes the procedure more comfortable for both the patient and the surgeon. The magnetic mallet is an innovative tool that provides the clinician with excellent visibility of the surgical site without the need for saline irrigation during the procedures. The present review focuses on the magnetic mallet, a unique and inventive magneto-dynamical patented device used for extractions, implant placements and sinus lift procedures. It also discusses the advantages of the magnetic mallet over conventional surgical hammers and procedures where bone osteotomy is required.

Optimising Cervical Cancer Screening: A Critical Review of Quality Control, Assurance, and Process Improvement Strategies in Pap Smear Cytology

Gracy Jeba Rani, S Sowmya, ES Keerthika Sri Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Cervical cancer is a significant global health concern, with the Pap smear serving as a crucial tool for early detection. However, the effectiveness of Pap smear screening is compromised by false positives and negatives, necessitating robust Quality Control (QC) and Quality Assurance (QA) measures. This review examines the preanalytical, analytical, and post-analytical phases of Pap smear cytology, focusing on quality indicators that enhance diagnostic accuracy. The 2014 refinement of the Bethesda System for Reporting Cervical Cytology (BSRCC) provides a standardised framework for classifying cytological abnormalities. Key quality indicators, such as the ASCUS/SIL ratio and Cytology-Histology Concordance (CHC), are highlighted, along with the importance of Six Sigma metrics and Lean principles for evaluating and improving Pap smear procedures. The review emphasises the implementation of QC, QA, Six Sigma, and Lean principles in healthcare systems to ensure high diagnostic standards, operational efficiency, and patient safety.

Osteogenesis Imperfecta: A Narrative Review of Pathogenesis, Clinical Manifestations and Emerging Therapies

Prashanth Balusani, Harish Madrekar, Nalluri Akhil, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Osteogenesis Imperfecta (OI) is a genetic disorder that causes “brittle bone disease” due to defects in type I collagen and other genes that control collagen synthesis and osteoblast activity, resulting in fragile bones, as well as skeletal problems and connective tissue disorders. Individuals with this condition exhibit symptoms ranging from mild intermittent fractures to life-threatening cases, with varying degrees of severity. The genetic condition OI includes primary types (I-IV), which exhibit autosomal dominant traits, whereas newer versions (V-VIII) demonstrate autosomal recessive or unique dominant characteristics. The characteristics of OI include brittleness, which leads to easy fractures, shortened body length, spinal curvature, a bluish ring around the eyes, ear problems, weak teeth and sensitive skin. Diagnosis relies on clinical assessments, imaging tests and genetic testing, as these methods aid in subtype identification and genetic counselling. Physical therapy, along with assistive technology, helps patients manage OI. Bisphosphonates are the primary drugs used for treating OI, accompanied by calcium supplements and vitamin D, which constitute the pharmacological therapy. Surgical interventions, such as intramedullary rodding and spinal fusion, become necessary when severe deformities develop. Future treatments for OI’s inherited nature include three promising therapies that combine gene therapy, stem cell therapy and antisclerostin antibody protocols. Advances in genetic testing, alongside new therapeutic developments, unlock new medical possibilities to enhance patient healthcare and increase the need for research into the management of this complex condition.

Case of Dengue Myocarditis Mimicking as Acute Myocardial Infarction: A Diagnostic Dilemma

Priya Baluni, Shubhangi A Kanitkar, Prasad Chandrakant Bagare, Vanshaj Sharma Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Atypical manifestations of dengue, also known as expanded dengue syndrome, causing isolated single organopathy (including acute fulminant liver failure, acute kidney injury, Disseminated Intravascular Coagulation (DIC), aplastic anaemia and myocarditis) are less reported and poorly characterised. Hereby, authors present a case of an elderly woman who presented with acute febrile illness and symptomatic myocarditis, mimicking Acute Myocardial Infarction (AMI), posing a diagnostic challenge. A 73-year-old female presented with recurrent fever (up to 102°F) over three days, accompanied by weakness, dizziness and syncope. Clinical examination revealed bilateral wheezing. During hospitalisation, she experienced further syncopal episodes and bradycardia without hypotension. Continuous Electrocardiogram (ECG) monitoring demonstrated intermittent bradycardia and tachycardia, along with a Left Bundle Branch Block (LBBB). Elevated cardiac biomarkers, including Creatine Kinase-Myocardial Band (CK-MB) (31.70 U/L) and troponin I (117.6 pg/mL, rising to 125.50 pg/mL), suggested myocardial injury. Laboratory tests showed leucopenia and thrombocytopenia. Initial dengue serology {Immunoglobulin M (IgM) Antibody Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA) and Reverse Transcription-polymerase Chain Reaction (RT-PCR)} was negative. A 2D echocardiogram revealed mild left atrial dilation, preserved systolic function {Left Ventricular Ejection Fraction (LVEF) 55-60%} and paradoxical interventricular septal motion. Given the LBBB, elevated biomarkers and echocardiographic findings, cardiac Magnetic Resonance Imaging (MRI) was performed, revealing no myocardial infarction but delayed mid-myocardial enhancement in the basal anteroseptum and anterior wall, indicative of subacute myocarditis. Holter monitoring showed sinus rhythm with premature atrial contractions, tachycardia and Ventricular Premature Contractions (VPCs). Repeated dengue IgM testing was positive, confirming dengue myocarditis. The patient was managed with antipyretics, intravenous fluids, nebulisation and hydrocortisone, leading to symptomatic improvement. She was discharged on day 13 in a stable condition with normal sinus rhythm and made a full recovery at follow-up.

Comprehensive Physiotherapeutic Approach in Managing Lumbar Schmorl’s Node: A Case Report

Prince Rohilla, Rajeev Kumar Singh, Shazia Mattu, Nitika Roy Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Schmorl’s nodes are indicative of Intervertebral Disc (IVD) protrusion into the vertebral body, with epidemiological predominance of 76% amongst males. The condition is usually asymptomatic with rare presentation of pain in few cases, making Non steroidal Anti-inflammatory Drugs (NSAIDs) and physiotherapeutic management as typical line of treatment. Although physiotherapy is helpful in this condition, studies are scarce with set physiotherapeutic interventions lacking. This case report presents a 30-year-old male having lower back ache (LBA) with Schmorl’s nodes at the superior endplate of L3 vertebral disc. Therefore, this case report highlights the importance of a comprehensive physiotherapeutic approach including a combination of electrotherapy, manual therapy, exercise therapy, and education on posture as well as ergonomics. Significant improvement in Low Back Pain (LBP) {Numerical Pain Rating Scale (NPRS)}, strength of core and lower extremity {Manual Muscle Testing (MMT)}, functional outcome {Oswestry Disability Index (ODI)} and Quality of Life (QoL) {Short Form Health Survey (SF-36)} were noted after six weeks of intervention. Further research is warranted to validate the effectiveness of this approach in a larger patient population.

Single-staged Islanded Forehead Flap for Cheek Defect in Recurrent Buccal Mucosa Cancer: A Case Report

Nidhi Vijay Kumar Bodiwala, Nitin D Bhola, Chetan S Gupta, Hema S Anukula Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Facial defect reconstruction restores function and aesthetics following trauma, malignancy, or other anomalies. Among various techniques, the pedicled forehead flap offers superior outcomes due to its robust vascularity and ability to incorporate multiple tissue types. The present case presents a 54-year-old male with recurrent oral squamous cell carcinoma and a full-thickness cheek defect following tumour excision. Given his history of multiple surgeries and radiation, conventional flap options had already been used or were limited due to compromised vascularity after treatment. A single-staged islanded pedicled forehead flap was innovatively used as a reliable backup reconstructive approach. Preoperative workup included Contrast-Enhanced Computed Tomography (CECT) to assess tumour extent and Doppler sonography for temporal vessel patency. Following wide local excision, the forehead flap was designed, islanded and transposed in a single stage, ensuring adequate tissue coverage, functional restoration and aesthetic symmetry without the need for multiple surgeries. The patient achieved acceptable oral competence, facial contour and minimal donor site morbidity. The novelty of the present case lies in the successful application of a single-staged islanded forehead flap in a previously treated, surgically complex field, avoiding the need for free tissue transfer or staged procedures. The technique’s ability to provide reliable vascularity and optimal cosmetic and functional results with minimal complications highlights its significance as a valuable option in challenging oncologic reconstructions. The present case underscores the enduring role of the forehead flap as a salvage option, particularly in patients with limited reconstructive choices due to prior surgeries or radiation, reinforcing its versatility in modern facial reconstructive surgery.

Metastasis of Head and Neck Malignancies to Liver: A Report of Two Cases

Archana Menon, A Hemalatha, MS Supreetha, Vajja Nagaraju Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X The liver is a premetastatic niche due to its high vascularity and dual blood supply and metastasis to the liver is associated with a poor prognosis. It is a common organ for metastasis, second only to lymph nodes, for malignancies like gastrointestinal cancers, breast and prostate carcinomas, uveal melanoma, neuroendocrine tumours and sarcomas. Distant metastasis from head and neck squamous cell carcinomas and Adenoid Cystic Carcinoma (ACC) is infrequent and also associated with poor prognosis. The common sites of distant metastasis from head and neck cancers are the lungs, followed by bone and then the liver. Secondary metastases to the liver from Oral Squamous Cell Carcinoma (OSCC) and ACC are extremely rare. This report presents a case of a 53-year-old male who was operated on for left submandibular gland ACC. Seven months later, he presented with icterus, generalised weakness and loss of appetite, along with increased levels of Alkaline Phosphatase and Gamma-Glutamyl Transferase. Another case involved a 61-year-old female who was diagnosed with SCC of the buccal mucosa and presented with elevated levels of Alkaline Phosphatase and Gamma-Glutamyl Transferase. Fine Needle Aspiration Cytology (FNAC) was performed on both cases, and metastasis of ACC and SCC was confirmed, respectively, by FNAC. Although the liver is a common site of metastasis, it is rare for uncommon malignant cells to be aspirated during FNAC, demonstrating its utility as a minimally invasive and rapid diagnostic tool in the management of head and neck cancers. Early detection of distant metastasis plays a significant role in the prognosis and management of affected individuals.

Segmental Epidural Anaesthesia with Ropivacaine for Umbilical Hernia Repair in a Patient with Severe Cardiac Dysfunction: A Case Report

Sandip Baheti, Vaibhavi Singh, Priya Singh Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Ischaemic Heart Disease (IHD) remains a leading cause of morbidity and mortality, particularly among elderly patients with reduced Left Ventricular Ejection Fraction (LVEF). Managing these patients during non cardiac surgeries presents significant challenges due to heightened risks of intraoperative myocardial ischaemia, arrhythmias and heart failure. The present case report presents the anaesthetic management of a high-risk 77-year-old male with a severely reduced LVEF of 25%, hypokinesia of the inferolateral and inferoseptal walls, grade 2 diastolic dysfunction, moderate calcific aortic stenosis and mild aortic regurgitation, who underwent elective umbilical hernia repair. Non cardiac surgeries in such patients are particularly challenging due to the increased risks of intraoperative myocardial ischaemia, arrhythmias and heart failure. Segmental epidural anaesthesia with 0.2% ropivacaine was chosen to minimise cardiovascular stress while avoiding the risks associated with general or spinal anaesthesia. The primary goals included optimising myocardial oxygen supply, maintaining haemodynamic stability and preventing spinal hypotension and cardiac complications. The patient remained haemodynamically stable throughout the procedure without any perioperative cardiac events. The present case underscores the effectiveness and safety of segmental epidural anaesthesia with low-concentration ropivacaine for high-risk cardiac patients undergoing non cardiac surgery. It highlights the importance of tailored anaesthetic strategies to ensure successful outcomes in this vulnerable population.

Efficacy of Thumari (Securinega leucopyrus) Ointment and Betadine Ointment in Managing Shastrakruta Vrana: A Randomised Controlled Trial Research Protocol

Devesh Hetram Nagpure, Sheetal Gajanan Asutkar Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Acharya Sushruta highlighted the enduring significance of wounds in surgery, addressing various types caused by trauma and imbalances in Vata, Pitta, and Kapha (the fundamental energies governing physiological and psychological functions). Thumari, or Katupila (Securinega leucopyrus), a traditional remedy from India and Sri Lanka, is renowned for its exceptional wound-healing properties, including purification, healing, and skin restoration. Need of the study: Surgical site infections are a significant concern in India (23-38% incidence), and Betadine ointment’s potential side effects (skin irritation, redness, itching) underscore the need for improved wound healing options. Thumari-based products (gel, oil, kalka) have demonstrated effective wound healing, anti-inflammatory, analgesic, antibacterial, and antifungal properties, attributed to their tannin and flavonoid content. While small-scale studies show positive results, larger comparative trials are needed to confirm Thumari’s efficacy. Aim: To evaluate the comparative efficacy of Thumari ointment and Betadine ointment in managing Shastrakruta Vrana (surgical wounds). Materials and Methods: This randomised controlled trial (CTRI/2023/02/049990) will be conducted at Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salod Hirapur, Maharashtra, India (March 2023-October 2024). Seventy patients (aged 18-60 years) will receive either Betadine or Thumari ointment for local application on their surgical wounds. Assessment parameters include pain, tenderness, colour, margin, discharge, inflammation, and healing time. Data analysis will use Mann-Whitney U test, Chi-square test, and Independent t-test (SPSS 27.0; p<0.05 for significance).