Table of Contents : Journal of clinical and diagnostic research : 2024 - March - 18 https://www.jcdr.net/current_issues.asp Table of Contents : Journal of clinical and diagnostic research : 2024 - March - 18 Glandular Odontogenic Cyst of Maxillary Anterior Region: Report of a Rare Case Amita Aditya, Antara Kore, Shruti Patil, Daisy Happy, Vaishnawi Sawant Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Glandular Odontogenic Cyst (GOC) is a rare odontogenic cyst that indicates the pluripotency of the oral epithelium due to the exhibition of glandular characteristics. It is more prevalent in the mandibular anterior region and shows a predilection in males. The cyst was first described by Padayachee and van Wyk in 1987. It has non distinct clinical and radiographic features but very characteristic histopathological features. Here, the authors report a rare case of GOC occurring in a 36-year-old male patient in the maxillary anterior region. An intraoral periapical radiograph revealed a large unilocular radiolucency from the apex of 11 to the mesial aspect of 15. The cyst was enucleated under local anaesthesia, and endodontic treatment was performed for the associated teeth. No recurrence was seen at the two-month follow-up. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD01-ZD04&id=19093 Interdisciplinary Management of an Adolescent Cleft Patient with Skeletal Class III Malocclusion: A Case Report Harsh Ashok Mishra, Parit Kumar Ladani, Rajkumar Maurya, Hitesh Ramdas Sawant, Waseem Khan Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Cleft lip and palate are the most frequently observed congenital abnormalities affecting the maxillofacial region. They can occur isolated or together in various combinations. These deformities are also associated with features found in over 300 recognised syndromes. Additionally, there are several problems, including social limitations, such as difficulties in breastfeeding resulting in failure to grow properly, speech abnormalities, hearing loss, misalignment of teeth, significant facial abnormalities, and serious aesthetic, psychological, and psychosocial challenges. Treatment modalities involve a number of specialists, such as Maxillofacial and Plastic surgeons, Anaesthetists, Orthodontists, Restorative dentists, Paediatric dentists and Prosthodontists, who collaborate to determine the best treatment plan based on the site of the defect and the patient&#39;s age. The present case report discusses the treatment and management of a 16-year-old female patient who presented with cleft lip and palate, along with skeletal class III malocclusion, hypodontia, multiple decayed teeth and dental malformation. The patient had missing lateral incisors and canines in the maxillary arch, along with carious maxillary central incisors. The purpose of this article is to report the multidisciplinary management of a unilateral cleft lip and palate patient with class III malocclusion, utilising orthognathic surgery, as well as, incorporating endodontic and prosthodontic corrections. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD05-ZD07&id=19094 Intra-axial Hepatic Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt Placement Ashikh Chandran, Ramakrishna Narayanan, Seema Reddy Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TD01-TD04&id=19091 Cystic Extrafollicular Adenomatoid Odontogenic Tumour: A Case Report and Pictorial Update Deepak Pandiar, P Anbumani, Reshma Poothakulath Krishnan, S Dharini Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Adenomatoid Odontogenic Tumour (AOT) constitutes about 5% of all odontogenic tumours and is most commonly seen in young females, in association with impacted maxillary canines in a Dentigerous Cyst (DC) like relationship. Extrafollicular AOT is an uncommon variant seen unassociated with impacted teeth. Rare cystic presentation is reported with most cases seen arising from or in association with DC. Here, the authors present a case of extrafollicular AOT in a 29-year-old Dravidian male, who reported with a chief complaint of swelling of lower anterior jaw region. Radiographically, a well-defined radiolucent lesion was noted extending from mesial aspect of the roots of right mandibular second molar, crossing the midline to involve the body of mandible till mesial aspect of lower left canine. There was evidence of cortical perforation. The lesion was excised and sent for histopathological evaluation. Histopathologically, the lesion was diagnosed as cystic AOT-extrafollicular variant. There was adequate healing and no signs of recurrence or residual disease were noted 18 months after the surgery. The present case is a unique presentation of cystic extrafollicular AOT with pictorial demonstration and detailed explanation of its pathogenesis. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD08-ZD11&id=19119 Orthodontic Treatment and Mini Wing Osteotomy: A Case Report of Changes in Facial Aesthetic Fernanda Ramos de Faria, Sergio Luiz Mota-Júnior, Leonardo Metropolo Moreira, Aluan Costa Ungierowicz, Marco Abdo Gravina Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X For correction of dentofacial deformities, orthosurgical treatment is recommended and often involves bi-maxillary orthognathic surgery. The chin area is an important key for a harmonious facial profile and plays an important role. The present case (of a 38-year-old female) describes one successful surgical-orthodontic treatment. The treatment consisted of the use of an Edgewise fixed appliance (0.022&#8221;&#215;0.028&#8221;), mini Wing osteotomy (mWo), correction of the deviated nasal septum, and rhinoplasty. The treatment resulted in a better facial harmony and aesthetic with greater definition and lengthening of the submental region, adipose tissue elimination, and an upturned nose due to the correction of the deviated nasal septum associated with rhinoplasty. The Class I canine and molar relationship, the upper and lower midlines coincident with the facial midline, and the compensatory projection of the lower incisors were maintained. A satisfactory overbite and overjet, and leveled curve of Spee were obtained. In conclusion, the orthodontic treatment associated with mWo, correction of the deviated nasal septum, and rhinoplasty surgery provided satisfactory functional and aesthetic results. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD12-ZD14&id=19120 MDA5 Juvenile Dermatomyositis Misdiagnosed as Childhood Psoriasis: A Case Report Dinkar Yadav, Renu Sharma, Neha Yadav, Kapil Bhalla Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Juvenile Dermatomyositis (JDM) is a rare autoimmune disorder which mainly affects the skin and skeletal muscles. Characteristic features of this rare disorder include Gottron papules, heliotrope rashes and proximal muscle weakness. MDA5 positive JDM is usually associated with interstitial lung disease in later part of life. The authors report a case of an 11-year-old male child who presented to the Paediatric Department with complaints of rashes over extensor surfaces, Gottron papules and pain and weakness in all limbs. The child was on treatment from the Dermatology Department as a case of psoriasis for last six months. During hospital stay after detailed work-up, the child was diagnosed to have JDM. Anti-melanoma Differentiation-Associated gene 5 (Anti-MDA5) antibodies were positive in the present case. The child was treated with immunosuppressive drugs with supportive care and is currently on treatment for the last one and a half years and is largely asymptomatic. JDM requires meticulous clinical examination and specific investigations so that timely diagnosis can be made to ensure appropriate treatment. In the present index case, the authors describe the typical clinical presentation, newer investigative modalities like myositis specific antibody and treatment outcomes of this rare condition. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SD01-SD03&id=19121 An Unusual Case of Anaemic Retinopathy Secondary to Iron Deficiency Anaemia Vignessh Raveekumaran, Ananya Balaji, Sethuraj Selvaraj, J Jenifer Florence Mary Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Anaemia has varied ocular presentations, ranging from simple conjunctival pallor to retinal abnormalities. Anaemic Retinopathy (AR) is a secondary retinal pathological symptom that can range from asymptomatic to developing retinal abnormalities. The increase in the severity of anaemia will ultimately increase the risk of retinopathy. While the outcomes might be similar to hypertensive or diabetic retinopathy, further comprehensive systemic and clinical evaluation is warranted. The incidence of AR, its associations with varying degrees of anaemia severity, and other haematological variables is still debated. Visual loss due to retinal abnormalities in anaemia is a rare clinical entity, despite its long-standing existence. Hereby, the authors present a case of a patient presenting with AR. A 19-year-old woman with a history of heavy menstrual bleeding was admitted for a sudden, painless, non progressive loss of vision in her left eye. Upon examination, her fundus revealed several Roth spots affecting all four quadrants and the macula, alongside a large and small preretinal haemorrhage in the nasal region and in the macula. Blood investigations revealed a Haemoglobin (Hb) of 2.4 g/dL and other reports suggestive of iron deficiency. She was diagnosed with iron-deficiency anaemia, with retinopathy as the most remarkable feature. She was treated with blood transfusion and Iron-folic Acid (IFA) supplementation, which showed a prompt response in the resolution of haemorrhage. She was discharged on IFA supplementation with planned follow-up for Ophthalmology and Gynaecology visits along with dietary advice. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD03-OD05&id=19122 A Case of Sepsis-induced MODS in Disseminated Filariasis: Cause or Co-incidence Arun Bargali, Rashmi Mishra, Sharon T Mathews, Naresh Kumar, Ishan Rohatgi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Filariasis, an affliction caused by thread-like filarial worms, poses a formidable health challenge in India, with diverse regional endemicities. It manifests in two distinct forms: lymphatic and extralymphatic. The former induces agonising limb swelling, while the latter, often overlooked due to its atypical presentation, can affect various organs. The present a noteworthy case involving a 25-year-old woman who succumbed to septic shock, displaying Multiple Organ Dysfunction Syndrome (MODS). The patient exhibited bicytopaenia, leukocytosis, and progressively deteriorating liver and kidney functions, culminating in Acute Respiratory Distress Syndrome (ARDS). Postmortem examinations, conducted with proper consent, revealed sheathed microfilaria in liver and bone marrow tissues. This rare multisystem involvement in filariasis, leading to a fulminant course, raises questions about potential immunosuppression triggered by disseminated filarial dissemination. The hypothesis centres on the notion that the systemic spread of filaria might underlie the severe and rapid deterioration observed in this unique case, shedding light on the intricate dynamics of this parasitic disease and its implications for immune function. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD06-OD08&id=19124 Primary Splenic Hodgkin Lymphoma and its Prognosis: A Report of Two Cases Sayantan De, Moumita Sengupta, Debashis Bhattacharya, Madhumita Mondal, Mamata Guhamallick Sinha Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Primary Splenic Lymphomas (PSL) constitute an extremely uncommon variety of splenic neoplasm and can present with grave complications such as splenic rupture. Hodgkin Lymphomas (HL), a type of hematopoietic neoplasm, are typically diagnosed between the ages of 20 and 30 years and present with supra-diaphragmatic lymphadenopathy, often accompanied by systemic B symptoms. A histopathological diagnosis involving Reed-Sternberg (RS) cells in an inflammatory background is crucial. However, other differentials such as reactive hyperplasia, infectious mononucleosis, anaplastic large cell lymphoma, or various other lymphomas may mimic Hodgkin disease both clinically and histologically. Therefore, accurate diagnostic evaluation of Hodgkin lymphoma is crucial, especially as it is highly curable with combination chemotherapy, even in higher stage disease. In this report, the authors present two cases of primary splenic HL diagnosed through histopathological and immunohistochemical examination of splenectomy specimens from January 2020 to December 2021 at the Department of Pathology, IPGME&R, Kolkata, India. While reporting the histopathological sections, the authors also considered other differentials such as reactive changes, tuberculosis, and other non-Hodgkin lymphomas. Both patients were male, aged 10 years and 18 years, and presented with abdominal distension and fever, without any palpable peripheral lymph nodes, for the last six months to one year. After chemotherapy, the patients were regularly monitored to identify any signs of recurrence or relapse. Therefore, the initial recognition and proper diagnosis of Hodgkin lymphoma presenting in the spleen may vary in clinical presentation and morphology, but early accurate diagnosis carries a good prognosis, as survival is best determined by its histopathological type. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ED01-ED03&id=19126 Chondromyxoid Fibroma of the Metatarsal Head: A Rare Case Report Pradheer Gupta, N Vishnu Vardhan, Biju Ravindran, Kharidehal Durga, Sahaj Marthathi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Chondromyxoid Fibroma (CMF) is an uncommon non malignant cartilage tumour with a greater predilection for the legs, with about a quarter of cases involving the metatarsals. It accounts for less than 0.5% of all bone tumours and mostly occurs in patients aged 10 to 30 years old. Patients typically present with complaints of pain and swelling in the affected region. Radiologically, a lytic lesion with well-defined margins is observed in the metaphysis. The present case is about an 11-year-old male who presented to the Orthopaedic Outpatient Department (OPD) with a history of pain and swelling over his left foot. Upon examination, a discrete swelling was noted over the lateral aspect of the foot, extending from the head to the shaft of the 4th metatarsal. Upon palpation, the swelling was found to be tender and firm in consistency, accompanied by restricted foot movement. Initially, a giant cell tumour of the 4th metatarsal bone in the left foot was suspected based on radiography. However, histopathological examination led to the diagnosis of CMF. The lesion was curetted, and a below-knee Plaster of Paris (POP) was applied for one month. No recurrence of the lesion has been observed after five months of follow-up. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=RD01-RD03&id=19128 Shoulder and Elbow Synergy for Lateral Epicondylalgia Management: A Case Report Maheshkumar Baladaniya, Purva Gulrandhe Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Lateral epicondylalgia, commonly known as tennis elbow, is a chronic overuse injury characterised by acute inflammation at the common wrist extensor origin, resulting in pain. Scapular muscle weakness has been linked to lateral epicondylalgia, as weakness or instability in proximal muscles can trigger distal issues. Non-operative interventions, such as activity adjustments, physiotherapy, and various therapeutic methods, have been effective in managing symptoms. This case report demonstrates the effectiveness of scapular muscle strengthening in improving lateral epicondylalgia, along with extensor strengthening. The patient, a 36-year-old male construction manager, underwent a comprehensive course of physical therapy, including scapular muscle strengthening exercises. Comprehensive follow-up using outcome measures such as the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and handheld dynamometer was done. The treatment resulted in improvements in daily function, physical activity, and sports performance, indicating the potential benefits of incorporating scapular muscle strengthening in the management of lateral epicondylalgia. This case emphasizes the need for a tailored approach, suggesting scapular muscle strengthening exercises as a more targeted intervention for lateral epicondylalgia. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=KD01-KD03&id=19129 A Case Report on the Rare Presentation of Brucellosis-induced Spondylitis Nivetha Manivannan Raj, Priya Periaiah, Senita Samuel, Vengadakrishnan Krishnamoorthy Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Human brucellosis is a zoonosis with a global distribution that can affect several organs and tissues. The most frequent brucellosis consequence, osteoarticular arthritis, has been reported in 10-85% of patients. Arthritis (most common), bursitis, tenosynovitis, sacroiliitis, spondylitis, and osteomyelitis are among the range of bone and joint disorders. The age of the patient and the Brucella species involved both have an impact on the type of skeletal involvement. The most common and significant clinical type of osteoarticular involvement in adults with Brucella species infection is spondylitis. The diagnosis of spondylitis may be challenging, and it may be made more difficult by potentially fatal neurological or vascular problems. In most cases, spinal arthritis is the most common presentation which emerges a few weeks following the initial Brucella infection and can impact any segment of the spine (especially lumbar region). Unlike in this case, a 54-year-old male with a history of remittent fever presented with complications where uncommon complication of sacroiliac joints are involved. Managing the infection involves a combination of antibiotics and stabilising the affected joints. Nonetheless, the therapeutic process could extend over several months, and there&#39;s a possibility of infection recurrence if not treated appropriately. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DD01-DD04&id=19138 Bilateral Renal Cortical Necrosis and Reversible Cerebral Vasoconstriction Syndrome in a Case of Severe Postpartum Haemorrhage JTV Krishna Pavan Kumar, MA Uma Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys&#8217; cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient&#8217;s condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD09-OD11&id=19139 Complete Mouth Rehabilitation in a Patient with Fanconi Anaemia: A Rare Genetic Disorder Maha Mahmoud, Saad Abdulmohsen Alqabbani, Sumit Rajinder Bedi, Sonali Vedraj Sharma Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Fanconi anaemia is a rare, progressive congenital bone marrow failure syndrome characterised by autosomal recessive inheritance and clinical manifestations, including growth retardation, bone marrow failure leading to pancytopenia, an elevated risk of malignancy, skin pigmentation, and skeletal malformations. Patients who have undergone bone marrow transplantation can be treated comprehensively in the dental clinic like other routine patients, provided their blood indices are within normal limits. Its complications include aplastic anaemia, malignancies like acute myeloid leukaemia, liver tumours, and squamous cell carcinoma, often developing post-bone marrow transplantation. Dental anomalies, altered salivary flow, and increased susceptibility to cancer necessitate early diagnosis and specialised dental care. Hereby, the authors present a case of 15-year-old male with Fanconi Anaemia who had undergone bone marrow transplantation and was treated comprehensively in a hospital setting. The present case report aimed to equip healthcare practitioners, especially dentists, with the knowledge needed for accurate diagnosis and effective management. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SD04-SD06&id=19141 Low-grade Appendiceal Mucinous Neoplasm in a Middle-aged Female: A Case Report Virendra Athavale, Saili Kelshikar, Rushabh Parekh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Mucinous Appendiceal Neoplasms (MANs) are rare tumours where more than 50% of the tumour volume is composed of extracellular mucin. Low-grade Appendiceal Mucinous Neoplasm (LAMN) is a rare condition with symptoms that vary depending on clinical manifestations. It can manifest as an unruptured mucin-filled appendix, transmural invasion of the primary tumour, or present with peritoneal metastases post-rupture. The prognosis of LAMN depends on the presence or absence of neoplastic epithelium outside the appendix. Here, the authors describe a case of 35-year-old female who visited the OPD of Emergency Medicine with only complain of pain in abdomen for three days. She exhibited right iliac fossa tenderness with no guarding during the abdominal examination. She underwent an open appendectomy and was diagnosed with LAMN upon histopathological examination. She was advised to follow up after six months post-discharge to monitor for any metastatic spread. Due to its malignant potential, mucinous lesions of the appendix are uncommon yet significant entities. They are more prevalent in women and can range from mucinous adenocarcinomas to straightforward retention cysts. This case illustrates the need for extreme caution when dealing with appendiceal tumours and the importance of selecting the appropriate course of action, be it surgical or medical. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PD01-PD03&id=19142 Acute Cerebrovascular Accident in Pregnancy Due to Hyperhomocysteinaemia Secondary to Vitamin B12 Deficiency: A Case Report Sudeeptha Raghuveer, K Sowmya, KT Chaitanya, CS Vidya Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Stroke in pregnancy is rare but is one of the leading causes of morbidity and mortality in developed countries. Pregnancy, as a prothrombotic state, acts as a precursor for stroke. Preeclampsia, eclampsia, amniotic fluid embolism, hypertension, diabetes, and many other factors predispose to the development of stroke. Endothelial cell injury leading to arteriosclerosis, causing a stroke, has been associated with raised homocysteine levels. Hereby, the authors present a case of a 26-year-old Gravida 3 Pregnancy 1 Live 1 Abortion 1 (G3P1L1A1) at 35 weeks gestation with a cephalic presentation who complained of a headache for two days, sudden onset of weakness in the right upper limb and lower limb with an inability to walk without support and inability to speak since 12 hours, associated with one episode of vomiting. Magnetic Resonance Imaging (MRI) brain showed acute infarcts in the left fronto-parietal lobes and capsule region with haemorrhagic transformation in the left frontal lobe. Serum vitamin B12 measured by Electroluminescence Assay (ECLA) was found to be low at 113pg/mL (normal range -191-771pg/mL). Serum homocysteine levels measured by enzymatic method were elevated at 46 umol/L (normal range 3-18 umol/L). A diagnosis at 34 weeks of pregnancy with acute cerebrovascular accident with right hemiparesis with Broca&#8217;s aphasia due to hyperhomocysteinaemia secondary to vitamin B12 deficiency was made. Prompt diagnosis and treatment are known to decrease morbidity in women with cerebrovascular accidents. MRI brain with venogram is known to be the gold standard procedure in diagnosing stroke. Thrombolytic therapy has proven beneficial in the treatment of the disease and in preventing its progression. Prenatal and natal supplementation with folic acid/vitamin B12 in the first trimester of pregnancy prevents Vitamin B12 deficiency and raised homocysteine levels in the maternal serum, thereby decreasing the incidence of stroke. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QD01-QD03&id=19143 Emergency Bilateral Internal Iliac Artery Ligation in Antepartum Haemorrhage with Complete Placenta Previa and Placenta Accreta at Previous Caesarean Scar Site: A Case Report Pankaj Salvi, Sanjay Ponde, Vidya Gaikwad, Sneha Aramandla Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QD04-QD06&id=19144 Immediate Effect of Dry Cupping along side Breathing Exercises on Chest Wall Mobility in a Patient with COPD: A Case Report Yukti Jobanputtra, Vaishnavi Yadav Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Chronic Obstructive Pulmonary Disease (COPD) is one of the most prevalent respiratory disorders, caused by the obstruction of the respiratory pathway. It is a progressive disease that worsens with time, but it is treatable. Physiotherapists are widely acknowledged to have a significant role in the care of patients suffering from respiratory disease. They employ a number of tactics targeted at reducing the labour of breathing, enhancing ventilation, promoting function, and providing dyspnoea alleviation. Chest physical therapy may include postural corrections to promote ventilation, secretory retention control, breathing and whole-body exercises to increase strength and function, and the use of adjuncts to improve lung function. Cupping therapy is one of the ancient healing methods. It is used on the skin by creating a negative pressure inside the cup through various devices. Many studies have shown that cupping therapy has promising preventive and therapeutic effects in a variety of pathological conditions, such as high fever due to upper respiratory tract infection, pulmonary dysfunctions in asthmatic children, type 2 diabetes mellitus, autoimmune diseases such as rheumatoid arthritis, hypertension, myocardial infarction, and cardiac arrhythmias, and chronic fatigue syndrome. Here, the authors reported a case of a 74-year-old male patient demonstrating the positive effect of cupping therapy, particularly dry dynamic cupping, along with physical exercise to improve chest expansion or thoracic expansion and improve well-being in a patient suffering from COPD. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=KD04-KD06&id=19145 Lateral Medullary Syndrome Presenting as Persistent Singultus and Upper Motor Neuron Facial Palsy in a young Adult: A Rare Case Suprit Malali, Nishtha Manuja, Sunil Kumar, Vineet Rajkumar Karwa, Suhail Shaikh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Lateral Medullary Syndrome (LMS) is a collection of different neurologic symptoms after cerebral haemorrhage/infarction. The areas most frequently afflicted are the cerebellum and the posterolateral portion of the brain stem&#8217;s medulla oblongata; the Posterior Inferior Cerebellar Artery (PICA) supplies blood. Dizziness, vertigo, nystagmus, nausea, ataxia, dysphagia, vomiting, hiccups, hoarseness, sensation impaired on half of the face, impaired thermal sensation and pain on the contralateral side of the limbs, trunk, ipsilateral face, along with Horner&#8217;s syndrome are amongst the typical symptoms of lateral medullary infarction. Hiccups are among the signs that are simple to ignore, although they can also result in oesophagitis, and respiratory depression, as Wallenberg&#8217;s syndrome is the most frequently reported. The authors discuss the case of a 30-year-old male who complained of recurrent, uncontrollable hiccups as an LMS-presenting symptom and was brought to our hospital. He arrived at our emergency room complaining of persistent, intractable hiccups and cerebellar symptoms on the left-side. In addition to being hypertensive, he had a long history of tobacco (chewing) and alcohol addictions dating back six years. He had 7, 9 and 10th cranial nerve involvement. The authors are reporting this case because the patient had Upper Motor Neuron (UMN)-type facial palsy, a rare presentation in LMS. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD12-OD14&id=19147 Rectovaginal Fistula Complicated by Retained Vaginal Foreign Body: A Case Report Sharma Nalini, Kothuni Christina Chakre, Donkupar Khongwar, Donboklang Lynser, Ahanthem Santa Singh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Foreign bodies in the genital tract are rare but can be found in females of all ages. Objects inserted vaginally may be for therapeutic purposes, accidental placement, and sometimes even for sexual gratification. Non therapeutic objects commonly seen include tampons, bottle caps, sex toys, and, rarely, metallic objects of various shapes and sizes. The authors report a case of a 40-year-old widowed woman, with no living children, presenting with foul-smelling vaginal discharge and passage of stool per vagina. Upon examination, a retained vaginal foreign body was noted intravaginally, complicating as a rectovaginal fistula, necessitating emergency laparotomy and requiring a colostomy. Long-retained objects are known to cause excessive foul-smelling discharge and can lead to serious complications such as lacerations, pelvic inflammatory disease, fistulas, fibrosis, and even death. Therefore, patients should seek medical attention and be treated promptly to prevent any complications. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QD07-QD09&id=19148 Case of Unicystic Ameloblastoma with Features of Ameloblastic Fibro-dentinoma Bhavani Sangala Nagendra, Sanjeevareddygari Shailaja, Ritesh Ranjan, Eppalapalli Sharath Kumar Reddy, Vishwakarma Raghu Vamshi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Hybrid odontogenic tumours occur rarely in the oral cavity. The basic histogenesis of these lesions is not clear. Hybrid odontogenic tumours characteristically exhibit two or more distinct morphological features that may lead to a diagnostic dilemma. Unicystic Ameloblastomas (UA) are the second most common odontogenic tumour. Ameloblastic Fibro-dentinoma (AFD) is a rare mixed odontogenic tumour. Both UA and AFD commonly occur in the second decade of life, may be asymptomatic with a slight female predilection, and predominantly occur in the mandibular posterior region. Herein, the authors report a rare case of a 15-year-old female patient complaining of swelling in the right lower posterior jaw region in the last two months. The lesion was surgically enucleated and sent for histopathological examination. On histopathological examination, the lesion exhibits areas of both UA and AFD, representing a rare occurrence of a hybrid odontogenic tumour. The present case report highlights the unique combination of two odontogenic tumours of different origins. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD15-ZD17&id=19150 Successful Resolution of Messianic Delusion following Bi-temporal Modified Electroconvulsive Therapy in a Patient with Treatment-resistant Schizophrenia Aakanksha Kharb, Sunny Garg, Priti Singh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Messianic delusion comprises a delusional system centered on the patient&#8217;s conviction that he has been selected by God for a special task or mission and has unique abilities to carry it out. The present case report describes a case of Treatment-Resistant Schizophrenia (TRS) with Messianic delusion in a 23-year-old unmarried male who presented to the Emergency Department with complaints of muttering to himself, decreased sleep, suspiciousness, socio-occupational dysfunction, aggressive behaviour, and a recent suicide attempt. Key interventions offered during the ward stay included rapid tranquilisation, antipsychotics, and benzodiazepines. The patient completely recovered with the concurrent use of clozapine and Modified Electroconvulsive Therapy (MECT). The patient received 16 sessions of MECT. He achieved both short-term and long-term remission with the therapy, as observed during regular follow-ups in the next six months. The present case emphasises the need for a multidisciplinary approach to the management, early detection, and adequate treatment of this challenging illness. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=VD01-VD03&id=19167 Incisional Hernia with Rare Finding of Liver as Content: A Case Report Mogekar Smitha, Sudhir Jayakar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Lumbar incisional hernia is an uncommon complication that affects the abdominal wall integrity, accounting for approximately 3.5% of all cases. It typically occurs following open nephrectomy or aortic aneurysm repair surgeries. Although rare, lumbar hernias can lead to discomfort, aesthetic issues, or even intestinal obstruction. In extremely rare cases, lumbar herniation of the liver can occur. Here, the authors present a case of a 60-year-old female patient with liver herniation through a lumbar incisional hernia and a history of pyelolithotomy for renal calculi. The authors performed an open hernia repair with meshplasty. Lumbar incisional hernias are rare and still difficult to manage. Computed tomography is the diagnostic method of choice in the evaluation of the parietal wall defect to choose the appropriate therapeutic management. Surgical management modalities are still poorly codified, with no precise recommendations, and this is probably due to the relative rarity of the cases. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PD04-PD06&id=19168 Uterine Perforation with Intra-abdominal Extrusion of Foetus and Intrauterine Bowel Herniation and Strangulation: A Case Report Asish Anand Subrata Sahu, Ajay Vare, Ravishankar V Patil, Varsha Rote-Kaginalkar, Nikhil Jain Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Uterine perforation is a major but rare complication of surgical abortion. Some of the dreaded complications are bowel herniation, strangulation, gangrene, and sepsis. With the legalisation of medical termination of pregnancy, such life-threatening complications have become a rarity in recent times. Usually, the patient presents with lower abdominal pain. A history of surgical abortion may not be forthcoming if an unsafe abortion is performed. A high index of suspicion should be kept while imaging such patients in an emergency setting, since early diagnosis is the key to survival. Hereby, the authors present a case of a 30-year-old female patient presenting with non specific complaints of abdominal pain. Upon vaginal examination, a structure protruding out of the internal os (admitting the tip of a finger) was noted, and a boggy mass was felt in the pouch of Douglas. Ultrasonography and Contrast-enhanced Computed Tomography scan (CECT) performed in an emergency setting revealed uterine rupture with a rent, intra-abdominal foetal extrusion, and bowel loop herniation through the vagina. A delayed CT scan provided additional information about right ureteral injury, which was helpful in proper urological preoperative planning. In conclusion, ultrasonography and CECT imaging are useful in cases with lower abdominal pain having recent history of abortion to rule out uterine perforation and other obvious and occult associated complications for proper patient management. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TD05-TD08&id=19169 Management of <i>Shambukavarta Bhagandara</i> (Horseshoe Fistula in Ano) by Using Interception of Fistulous Tract with Application of Ksharsutra (IFTAK) Technique: A Case Report Abhishek Dattatray Mavale, Devyani Dasar, Akshay Kumar, Pavitra Jayvarsha, Naveen Singh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <i>Bhagandara </i>is a well known ailment due to its high recurrence rate and complexity in management. <i>Sambukavarta Bhagandara </i>classifies it as an <i>Asadhyaya </i>ailment and describes it as a <i>Tridoshaj Bhagandara</i>. In present terminology, it is a synonym for Fistula in Ano. Here, the authors present a 45-year-old female with an anal fistula who had never received therapy or undergone surgery. In her case, an innovative technique called &#8216;Interception of Fistulous Tract with Application of Ksharsutra (IFTAK)&#8217; was used for the <i>Ksharasutra </i>application. Five mL of <i>Chandanbalalakshadi </i>Tail Basti was administered every day. The patient was completely cured four to six weeks after the procedure. In situations with a horseshoe-shaped anal fistula, <i>Ksharasutra </i>therapy utilising the Windows (IFTAK) technique is exceptionally successful, resulting in less scar development, a shorter hospital stay, allowing patients to return to work sooner, causing fewer complications following surgery, and <i>reducing</i> the risk of recurrence. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PD07-PD09&id=19172 Congenital Bilateral Aniridia with Ectopia Lentis: A Case Report Vijaya Mallareddy, Sachin Daigavane, Pranaykumar Shinde Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Aniridia is characterised by variable degrees of hypoplastic iris or complete absence of iris tissue and is a rare congenital disorder. Mutation in the PAX6 gene is mostly responsible for aniridia. It is associated with various ocular manifestations involving both anterior and posterior segments of the eye. A 14-year-old male patient, presented to the ophthalmology outpatient department with complaints of a gradual decrease in vision in his left eye. Upon examination, photophobia and bilateral aniridia associated with nystagmus were present in both eyes, along with a sclerally fixated intraocular lens in the right eye and a superiorly subluxated mature cataract in the left eye. Intraocular pressure was elevated in the left eye. Gonioscopy revealed rudimentary iris tissue in both eyes. Upon systemic examination, the patient was diagnosed with hydro-ureteronephrosis of the right-side, which was asymptomatic, and borderline intellectual functioning. This case highlights the unique features of WAGR syndrome (Wilm&#8217;s tumour, Aniridia, Genito-urinary anomalies, Range of developmental delay) presenting with aniridia and genito-urinary conditions, along with borderline intellectual functioning without the presentation of Wilm&#8217;s tumour. Cataract extraction by lens aspiration with scleral fixation of intraocular lens implantation was performed in the left eye. This study adds to the broader knowledge of the disease entity&#8217;s spectrum, exploring the diagnostic challenges associated with the case and potentially influencing diagnostic criteria. It may guide future studies exploring the diverse clinical presentations of WAGR syndrome. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ND01-ND03&id=19177 Alien Hand Syndrome: A Case Report Decoding the Enigmatic Limb Akshaya Rathin Sivaji, Tony Kizhakkemuriyil Scaria Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Alien Hand Syndrome (AHS) is a rare condition characterised by involuntary hand movements occurring without the patient&#8217;s intention. While AHS has various causes, it is frequently associated with ischemic stroke, post-corpus callosotomy, degenerative conditions, and has more recently been observed in cortico-basal degeneration. This case report highlights a 62-year-old male patient experiencing involuntary movement in his right hand three days after admission with an ischemic stroke involving the left fronto-parietal lobe and corpus callosum. The predominant symptoms included compulsive groping, inter-manual conflict, and hemi-anaesthesia in his right hand. The callosal subtype arises from corpus callosum damage and often involves inter-manual conflict. However, callosal infarction is uncommon due to the abundant blood supply. This case report describes a case of AHS caused by callosal infarction, confirmed through magnetic resonance imaging, specifically showing infarction in the left corpus callosum. The patient exhibited symptoms consistent with the anterior variant based on radiographic findings. However, features of the posterior variant were also observed. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD15-OD17&id=19178 Late onset Darier&#8217;s Disease with Palmoplantar Keratoderma: A Case Report Noshin N Abdu, Shaheela Backar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Darier&#8217;s disease is an infrequently encountered autosomal dominant condition characterised by complete penetrance but variable expression. It is characterised by abnormal keratinisation and epidermal adhesion deficiency, clinically presenting as greasy keratotic or warty papules and plaques, primarily affecting seborrheic regions and flexures. Additional manifestations include palmar pits, nail abnormalities, cobble-stoning of the oral mucosa, and even neuro-psychiatric issues. In extremely rare cases, mucosal involvement can occur in the oral, laryngeal, Oesophageal, or rectal areas. Familial Darier&#8217;s disease typically emerges during puberty. Here, the authors present a unique case of 55 years old male patient of Darier&#8217;s disease with delayed onset, despite a significant family history of the condition. The clinico-pathological aspects, highlighting the presence of palmo-plantar keratoderma are also discussed. Treatment included the application of topical hydrocortisone 1% cream twice daily for two weeks, then once daily for two weeks along with dexpanthenol once daily for eight weeks. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=WD01-WD03&id=19182 A Rare Case of Diffuse Neurofibroma Mimicking as Hairy Naevus or Vascular Malformation: A Surgeon&#8217;s Perspective Dakshayani Nirhale, Romi Gaudani, Mahendra Gurupal Wante, Pushkar Galam Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Nevi are areas of melanocytic hyperplasia or neoplasia. These collections can be found in the epidermis, partially in the dermis, or completely within the dermis. They commonly develop in childhood and young adulthood and sometimes spontaneously regress. Exposure to Ultraviolet (UV) radiation is associated with increased density of these lesions. In contrast, neurofibromas are benign proliferations made up of all nerve elements and arise as fleshy and non tender, sessile, or pedunculated masses on the skin. They can arise sporadically or in association with type 1 Neurofibromatosis (NF), and in these cases, are associated with caf&#233;-au-lait spots and Lisch nodules. In the present report, authors present a case diagnosed clinically as a giant naevus on the dorsum of the right hand in an adult patient (26-year-old female) with no other associated secondary swellings elsewhere in the body. However, further radiological investigations revealed a case of vascular malformation. Postoperatively, histopathological examination showed features of diffuse neurofibroma. The present case report enables the surgeon to consider various rare differential diagnosis for swelling in the extremities, even when it is not reflected in the clinical or radiological findings. Thus, a detailed history, physical examination, and various diagnostic tests, keeping in mind all possible differential diagnosis, should be performed. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PD10-PD11&id=19193 Myocysticercosis Presenting as Incomplete Claw Hand: A Rare Presentation of Cysticercus Jyoti Gulati, Nidhi Bedi, Payal Agrawal, Pankaj Abrol Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Human cysticercosis is an infection with the larval form of <i> Taenia solium </i> that commonly involves the central nervous system. Due to the infection, isolated muscular involvement is rare, and very few cases have been reported in the literature. Hereby, the authors present a rare instance of isolated muscular cysticercosis in a 15-year-old girl, resulting in an incomplete claw hand due to the compression of both the ulnar and median nerves. The patient had been experiencing swelling on the anterior aspect of her left forearm for eight months, with recent aggravation. The swelling was gradually followed by an inability to fully extend the middle and ring fingers for the past six months. The patient&#8217;s laboratory results were within normal limits, and ultrasound and Magnetic Resonance Imaging (MRI) of the forearm confirmed the presence of cysticercosis. The treatment plan included a course of oral steroids and antihelminthic drugs, along with physiotherapy. In present case, the patient&#8217;s condition significantly improved with conservative management. The present case illustrates the diagnostic challenges due to the vague clinical presentation and unfamiliarity of clinicians with present entity, making it difficult to diagnose when seen as an isolated cyst. The unique manifestations of muscular cysticercosis emphasise the importance of early detection and proper management. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SD07-SD09&id=19198 Giant Pseudocyst of the Pancreas: A Rare Case Report Yogesh Bhagwan Manek, Darshana Tote, SN Jajoo, Sanjeev Gianchandani Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X A Pancreatic Pseudocyst (PP) is a fluid-filled collection often found near the pancreas. It is characterised by its contained structure and homogeneous fluid composition, with little to no necrotic tissue. Individuals with a history of chronic pancreatitis, and to a lesser extent acute pancreatitis, may exhibit non specific symptoms. To minimise related morbidity and mortality, any potential complications must be identified. The authors present a case of a rare giant PP in a 28-year-old man who presented with abdominal pain and distention, severe backache, fever, frequent vomiting, loss of appetite, weight loss, and firm, sticky stools. Initially measuring 25&#215;19.2&#215;11.2 cm on a Computed Tomography (CT) scan, this PP was unusually large for its type. Due to the patient&#8217;s condition not being suitable, a direct cystojejunostomy was performed. Three drains were placed: an anastomotic drain near the anastomosis site, a Morrison&#8217;s drain in the Morrison pouch, and a pelvic drain. Later, a complication arose in the form of a faecal fistula, which was managed conservatively with a suction drain. The patient&#8217;s only primary complaint was non specific stomach pain, despite the size of the pseudocyst. Therefore, individuals with a history of chronic alcoholism and symptoms such as abdominal pain and distension should be evaluated for PP. A CT scan is recommended to investigate this condition, despite its rarity. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PD12-PD14&id=19199 Complete Heart Block Secondary to Concomitant Use of Metoprolol and Fluoxetine in a Case of Chronic Depression and Systemic Hypertension: A Case Report Kashish Khurana, Sourya Acharya, Kamaldeep Sadh, Nikhil Pantbalekundri, Saket Toshniwal Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Bradyarrhythmia can be brought on by intrinsic or extrinsic causes that disrupt the cardiac conduction system, with iatrogenic drug usage being the most common extrinsic cause. Atrioventricular (AV) block is frequently brought on by beta-blockers, calcium channel blockers, anti-arrhythmics, and digoxin. The first course of treatment for heart block involves stopping the problematic medications. Psychotropic medications have the potential to cause cardiotoxic adverse effects that affect the heart. In a patient with a pre-existing cardiac disorder, psychotropic drugs can manifest with dangerous arrhythmias. It is yet unknown what intricate processes cause these effects. A variety of arrhythmias may be brought on by or made worse by many commonly used drugs. Hereby, the authors present a case report of 56-year-old hypertensive male, a known case of chronic depression with chest heaviness. The Electrocardiogram (ECG) revealed Complete Heart Block (CHB) with Right Bundle Branch Block (RBBB). The patient was on fluoxetine and beta-blockers for his mental illness and hypertension. Three days after withholding the drugs, the CHB resolved, and his baseline ECG remained as RBBB. The present case highlights the interaction of drugs leading to CHB in present patient. Therefore, the importance of a detailed drug history in such cases becomes imperative. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD18-OD20&id=19205 Macrodactyly Lipomatosa in the Left Index Finger and Thumb: A Radiological and Clinical Perspective Shreyosi Santra, Vivek Khanna, Shishir Chumber, Kavita Vani Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Macrodystrophia Lipomatosis (MDL) is a rare congenital, non-hereditary, and benign form of gigantism characterised by the overgrowth of adipose tissue in a specific area of the body, usually affecting the hand or foot in the distribution of the median and plantar nerves, respectively. Here, the authors present a case of a 21-year-old male patient, who presented to the Surgical Outpatient Department (OPD) with the gradual, progressive enlargement of the left index finger and thumb over the last six months, experiencing difficulty in holding objects and maintaining grip. This case highlights the importance of radiological imaging in diagnosis and treatment planning. Macrodystrophia lipomatosis should be considered as a differential diagnosis for hypertrophic digits, even in adult patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TD09-TD10&id=19206 Total Knee Arthroplasty in a Patient with Bilateral Fused Hip due to Seronegative Arthritis: A Case Report Tushar Chaudhari, Swaroop Solunke, Abhishek Nair, Pratik Gundecha Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Degenerative changes in other joints secondary to hip fusion occur due to changes in the relative biomechanical forces acting on those joints. At present, there are no standard protocols to aid the decision-making process of joint replacement surgery in patients with hip fusion due to secondary arthritis causes. Each patient requires tailored management planned by the surgeon to optimise treatment plan and achieve the highest degree of functional improvement. Total Knee Arthroplasty (TKA) is a well-documented, common, and cost-effective procedure in the management of morbidities associated with joint degeneration due to wear and tear of the cartilage. TKA in patients with hip fusion is relatively rare, and there are few case reports and studies indicating a standardised approach and treatment protocols for the same. In this case report, TKA due to symptomatic knee arthritis in a patient with a 15-year history of spontaneous bilateral hip fusion due to seronegative arthritis is discussed. Postoperatively, the patient&#8217;s condition was stable, with good Range Of Motion (ROM) at the knee and without aseptic features as determined by recent radiologic investigations. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=RD04-RD06&id=19212 Spectrum of Unusual Cytomorphology of Axillary Swellings: A Series of Four Cases Paridhi, Bhuvan Adhlakha, Shivani Kalhan, Shalini Shukla, Vivek Gupta Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X The axilla is a triangular area situated anatomically beneath the shoulder joint, between the upper arm and thorax. It contains lymph nodes and numerous non lymphatic tissues such as neurovascular structures, muscle, and fat. Axillary swellings can arise from any of these mesenchymal soft tissues. Fine Needle Aspiration Cytology (FNAC) is the first-line investigative technique widely used in evaluating axillary swellings, as it is a simple outpatient procedure that causes minimal complications, unlike core biopsy, which is invasive and carries a high-risk of bleeding. Hereby, the authors present a case series of four unusual cases: bilateral accessory breast tissue (32-year-old female), bilateral galactocele (28-year-old female), unilateral galactocele (24-year-old female), and fibroadenoma (35-year-old female) in the axilla, all of which were cytomorphologically diagnosed with the aid of FNAC. Axillary lumps can present with a variety of unusual lesions and can pose a significant diagnostic challenge to a clinicians. Although histopathology of the biopsy of the lesion remains the gold standard, clinical features along with imaging can aid in the diagnosis with better patient compliance. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ER09-ER11&id=19210 Unusual Presentations of Epilepsy: A Series of Paediatric Cases with Abdominal Epilepsy and Epileptic Angina Rita Panyang Kataki, Bhaskar Borah Sonowal, Komal Agarwal, Chow Nifaseng Chiring, Luhit Dhungel Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Epilepsy, a common neurological disorder characterised by recurrent seizures, can manifest in unusual clinical presentations such as abdominal pain, nausea, vomiting, and bloating associated with diverse Central Nervous System (CNS) symptoms like confusion, fatigue, headache, dizziness, and syncope. The importance of recognising and documenting such unusual presentations lies in their potential to be misdiagnosed or overlooked, delaying appropriate treatment and causing undue distress to both the patients and their families. In the present case series, patients presented with gastrointestinal or chest pain for a prolonged period. As the symptoms did not subside with treatment, an Electroencephalogram (EEG) was performed to rule out epilepsy. In all three cases (10-year and 10-month-old female, 11-year-old male, seven-year-old male), EEG revealed a generalised seizure disorder. The present case series highlights unusual presentations of epilepsy in paediatric patients, including Abdominal Epilepsy (AE) and epileptic angina. These cases underscore the importance of considering epilepsy as a potential aetiology in patients with recurrent and atypical symptoms. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SR01-SR03&id=19207 Clinical Presentation, Approach and Outcome of Gliosarcoma: A Series of 12 Cases Shreya Singh, Ritusha Mishra, Bitan Naik, Manav Shah, Himanshu Mishra Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Gliosarcoma (GSM) is a rare and aggressive type of brain tumour with limited treatment options and a poor prognosis. The present case series aimed to provide further insights into the clinical features, treatment outcomes, and prognosis of GSM. Medical records of 12 histologically confirmed cases of GSM were analysed from 2018 to 2022, revealing a male predominance and a median age of 54 years. The most common symptoms were headache and vomiting due to raised intracranial pressure. All patients underwent maximal safe resection followed by concurrent chemoradiation and adjuvant chemotherapy with Temozolomide (TMZ). Kaplan-Meier analysis showed a median Progression-free Survival (PFS) and overall survival of 8 and 12 months, respectively. The study revealed that the optimal treatment for primary GSM remains a therapeutic dilemma due to the rarity of the disease and the heterogeneity of the patient population and treatment regimens employed. The present study provides valuable insights into the clinical presentation and management of primary GSM in India and highlights the need for further research to improve outcomes for these patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=XR01-XR03&id=19188 Immunoglobulin G4-related Disease: A Series of Four Cases Chandni Thomas, S Divya, Joy Augustine Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Immunoglobulin G4-related Disease (IgG4-RD) is an immune-mediated fibroinflammatory disease that affects multiple organs, resulting in tumefactive lesions and/or organ dysfunction. This chronic, multiorgan inflammatory process is characterised by the infiltration of IgG4-positive plasma cells and has a variable clinical presentation depending on the organ involved. The present case series discusses four cases (two males and two females) of IgG4-RD involving different sites in patients presented to present Institution. The authors reviewed four cases of IgG4-RD, including clinical details, biochemical, radiological, and histopathological features. The case series includes IgG4-RD masquerading as meningioma, IgG4-related sclerosing cholangitis, IgG4-RD of the thyroid gland, and IgG4-RD of the lacrimal gland. Since IgG4-RD has non specific clinical features, histopathological analysis and immunohistochemistry play a pivotal role in diagnosis. Despite its diagnostic difficulties, earlier recognition is crucial to prevent significant morbidity and extensive fibrosis leading to organ failure. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ER05-ER08&id=19190 Layered and Thoracic Segmental Spinal Anaesthesia in Patients with Kyphoscoliosis for Various Surgeries: A Case Series Prashanth Gowtham Raj, Lagadapati Madhav Avinash, Amingad Basavaraj Bhagyashree, Kaggathi Ramesh Vasantha Kumar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Kyphoscoliosis involves exaggerated anterior and lateral curvatures of the spine, affecting the dorsolumbar spine. Associated multiple organ system dysfunctions cause difficulties with both general and regional anaesthetic techniques. Co-existing neuromuscular disorders, pulmonary infections, difficulties in securing the airway, postoperative pulmonary morbidities, and the need for mechanical ventilation associated with general anaesthesia make neuraxial anaesthesia the most widely used technique in these cases. Continuous neuraxial techniques in these patients offer advantages over single-shot spinal anaesthesia in achieving the desired level of anaesthesia, managing patchy blocks, extending the duration of anaesthesia, and providing postoperative analgesia, but they are technically more challenging. Single-shot spinal anaesthesia can be a simple, safer, and effective alternative for surgical procedures of shorter duration. Performing thoracic segmental spinal anaesthesia in these patients is very challenging due to the complete distortion of anatomy and possible obliteration of neuraxial spaces. Layered spinal anaesthesia involves combining multiple local anaesthetics with different baricities to produce a successful subarachnoid block. Present series is reported with successful and uneventful use of the layered and thoracic segmental spinal anaesthetic technique in patients with kyphoscoliosis for various surgeries, including laparoscopic procedures. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UR01-UR05&id=19154 Cytological Diagnosis of Malignant Pleural Effusion Caused by Metastatic Squamous Cell Carcinoma: A Series of Four Cases Resmi Rajeev, MT Suma, Jini L Valooran Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X The majority of malignant pleural effusions are caused by adenocarcinomas, with the most common primary sites being the lung and breast in men and women, respectively. Metastatic squamous cell carcinoma in serous effusions is rare, accounting for less than 3% of all malignant effusions. The most common primary site of origin for metastatic squamous cell carcinoma involving serous effusions is the lung, followed by the head and neck, oesophagus, and cervix. Well-differentiated squamous cell carcinoma in pleural effusion, characterised by keratinised cells with hyperchromatic nuclei, tadpole cells, and fiber cells, is exceedingly rare. Poorly differentiated squamous cell carcinomas often present a diagnostic challenge and can be mistaken for poorly differentiated adenocarcinoma, malignant mesothelioma, or reactive mesothelial hyperplasia. Immunohistochemistry is often required for a definitive diagnosis. Making an accurate diagnosis is crucial for providing optimal treatment to the patient. In this series, four cases (56 years old male,69 years old male, 60 years old female and 81 years old male) of malignant pleural effusion caused by metastatic squamous cell carcinoma arising from the lung, oropharynx, cervix, and oesophagus were examined. While one of the cases involved a well-differentiated squamous cell carcinoma with characteristic cellular morphology that allowed for a straightforward diagnosis, the other three cases were poorly differentiated squamous cell carcinomas that required cell block preparation and immunohistochemistry for confirmation. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ER01-ER04&id=19127 Dental Management of a Rare Case of Cornelia de Lange Syndrome Joby Peter, R Krishna Kumar, John Joseph Methippara, Reshma A Joseph, Amina Sherafudeen Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZJ03-ZJ04&id=19170 Bizarre Deformity of Pinna Jasleen Kaur, Prasad Deshmukh, Sagar Gaurkar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=MJ01-MJ02&id=19118 Imaging Features of Mucinous Carcinoma of the Breast Kondampally Varsha Reddy, Mandadapu Sri Padma, Bandari Kaavya, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TJ01-TJ02&id=19197 Correspondence: Post-stroke Psychosis Following Lesions in the Basal Ganglia Shweta Kedia, Sarvesh Goyal Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=VL01-&id=19196 Comparison of 16S rRNA Sequencing and VITEK 2 Analysis for the Identification of <i>Acinetobacter baumannii</i> Clinical Isolates: A Study from Southwestern Province of Saudi Arabia Vinod Kumar Basode, Ahmed Abdulhaq, Nader Kameli, Mohammed Uthman A Alamoudi, A Abu Alsayl Zuhair Hussain Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DL01-DL02&id=19152 Complete Hydatidiform Mole with Theca Lutein Cysts: Classic USG and MR Imaging Spectrum Sagar Vitthal Gund, Suresh Vasant Phatak, Kajal Mitra, Deepali Mohan Trimukhe Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TL01-TL02&id=19153 Vancomycin Anaphylaxis under Anaesthesia: Expeditious Diagnosis and Management Aparna A Bagle, Sandeep D Veer Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UL01-UL02&id=19116 Assessing Profile and Outcomes of Monoclonal Immunoglobulin-depositing Proliferative Glomerulonephritis: A Retrospective Observational Study V Leelavathi, Bhushan C Shetty Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition Disease (PGNMIDD) is characterised by the absence of established therapeutic modalities. Glomerular diseases have diverse aetiologies and are generally influenced by age, sex, and race. The aetiology of PGNMIDD is not fully understood, and a uniform management protocol is lacking for this cohort. <b>Aim: </b>To comprehensively investigate the clinicopathological features of PGNMIDD and evaluate the effectiveness of different treatment regimens. <b>Materials and Methods: </b>This retrospective observational study was carried at the Department of Nephrology, Institute of Nephrology, RGUHS, Bengaluru, Karnataka, India from January 1, 2018, to August 31, 2022, following standard protocols and methodology. A total of 13 cases of PGNMIDD, diagnosed using kidney biopsy, were included and analysed in present study. The diagnosis was made using available standard tests, and descriptive analysis was performed based on parameters such as age, gender, major clinical presentations, serum protein electrophoresis response, Antinuclear Antibody (ANA) and AN, renal biopsy outcomes, and treatment remission status. <b>Results: </b>A total of 13 patients (10 males, 3 females) were diagnosed with PGNMIDD. Clinical presentations included two patients with acute nephritic syndromes, eight patients with chronic kidney disease, a single patient with nephrotic syndrome, and two patients with Rapidly Progressive Glomerulonephritis (RPGN). Follow-up after six months and one year showed further deviations and remission results, which are described in detail in present study. <b>Conclusion: </b>In the present study, PGNMIDD primarily affected males and presented diverse renal manifestations. M-spike in serum protein electrophoresis was rarely observed. The majority of patients required maintenance haemodialysis. Moderate-to-severe interstitial fibrosis and tubular atrophy were common in renal biopsies of patients, highlighting the need to delay Renal Replacement Therapy (RRT). ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OC14-OC17&id=19117 Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=-&id=19051 Evaluation of Surface Roughness in Clear Silicon Fabricated Using Three Different Techniques: An In-vitro Study Vrushti Bharat Ramanuj, Ankit Ved Arora, Sonali Vinod Kapoor, Neha Sudhakar Chawda, Maulee Dharmesh Sheth, Kavina Satish Desai Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Anterior composite restorations present many aesthetic challenges for clinicians. Direct veneers provide chairside advantages such as evaluating tooth anatomy, shade selection, and correcting tooth morphology according to the patient&#8217;s desire. In today&#8217;s world, the use of digitalisation and 3D-printed models has grown. However, limitations of these are unknown and a research gap exists, with surface roughness being a major issue. <b>Aim: </b>To evaluate the surface roughness of clear silicon templates fabricated over 3D-printed models, blue inlay wax and dental stone. <b>Materials and Methods: </b>This in-vitro study utilised both quantitative and qualitative approaches. The study was conducted at the Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India. The study was completed over three months. A total of 36 surfaces of clear silicone template (Exaclear) were obtained from two blocks each of 3D-printed model, blue inlay wax, and dental stone, measuring 30&#215;10&#215;10 mm. These blocks were divided into six units of 10&#215;5 mm (N=36) and were divided into three groups: 1) 3D-printed model; 2) Blue inlay wax; 3) Dental stone. Surface roughness was evaluated using a surface roughness tester and Scanning Electron Microscope (SEM). Quantitative analysis of surface roughness was done using the surface roughness tester, and qualitative analysis was done using SEM. Statistical analysis was done using the posthoc Tukey Honest Significant Difference (HSD) test and statistical software SPSS Version 20.0. <b>Results: </b>The quantitative analysis showed the highest Roughness average (Ra) value mean&#177;Standard Deviation (SD) for Group 1 (11.97&#177;4.43 &#956;m), followed by Group 3 (2.42&#177;1.07 &#956;m) and Group 2 (0.63&#177;0.86 &#956;m). SEM showed the presence of voids only in Group 1. <b>Conclusion: </b>Surface roughness of clear silicon template fabricated on wax surface is less as compared to templates fabricated on 3-D printed models. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZC12-ZC15&id=19136 Knowledge and Awareness of Various Physical Restraints and Protective Stabilisation Methods: Parent&#8217;s Perception towards their Use in Children: A Multimedia Pre- and Post-test Quasi-experimental Study Umapathy Thimmegowda, Adarsh Narayana Geetha, Suraj Sathyendra, Mohammed Nahyan Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Physical restraints are often a debatable and misunderstood aspect of dental healthcare practice. They are frequently used in dental care settings to immobilise children and reduce the risk of injury during procedures. It is essential to assess parents&#39; knowledge, awareness, and attitudes towards physical restraints and provide accurate information about them. This is important to ensure that they are used appropriately and ethically. <b>Aim:</b> To assess parents&#8217; knowledge, awareness, and attitudes towards physical restraints in dental care settings before and after a multimedia intervention, and to provide precise information about the same. <b>Materials and Methods:</b> The study was conducted at the Department of Paediatric and Preventive Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India using a pretest and post-test quasi-experimental study design on 400 parents whose children were between 3 and 16 years of age. The survey was conducted between December 2022 and March 2023. The data collection methods used in the present study consisted of a pre-education questionnaire and a post-education questionnaire administered after a multimedia educational intervention. The collected data were subjected to statistical analysis, including measures such as mean, Standard Deviation (SD), Chi-square goodness of fit test, Wilcoxon&#39;s signed-rank test, and Kruskal-Wallis tests. <b>Results:</b> When questioned about various stabilisation methods like direct and indirect methods, 379 (94.8%) of the study parents were unaware of them. However, after education, the majority of parents, 393 (98.3%), became aware that there were two types of stabilisation methods. Initially, 294 (73.5%) of parents refused to provide permission for doctors to treat their children using various stabilisation techniques. However, after being thoroughly educated about the various methods and their benefits, 383 (95.8%) agreed to let the dentist employ different stabilisation techniques when treating their children. This assurance helped alleviate concerns about potential harm to the child caused by using these stabilisation methods. <b>Conclusion:</b> The study suggests that there is a significant knowledge gap among parents. However, the implementation of multimedia educational intervention methods during dental visits by dentists played a crucial role in increasing their knowledge and resulted in a significant improvement in their attitude towards stabilisation methods. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZC16-ZC20&id=19137 Comparison of Arterial Stiffness among Prehypertensive and Normotensive Subjects using Photo Pulse Plethysmography: A Pilot Study P Jeyashree, K Dilara, KN Maruthy, KS Dhamodhini Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Increased arterial stiffness is a marker of Cardiovascular Disease (CVD), even before clinical signs and symptoms become evident. Hypertension is an established risk factor for CVD. However, recent studies have revealed increased arterial stiffness even among prehypertensives. Photo Pulse Plethysmography (PPG) is an efficient non-invasive, and cost-effective technique to measure arterial stiffness. Studying arterial stiffness using PPG can serve as a surrogate marker of Cardiovascular (CV) risk among prehypertensives. <b>Aim: </b>To compare arterial wall stiffness among prehypertensives and normotensives using PPG. <b>Materials and Methods: </b>This pilot study was conducted at the Sri Ramachandra Institute of Higher Education and Research, Chennai, TamilNadu, India from December 2022 to February 2023. The study population included 10 non diabetic prehypertensives and 10 normotensives, aged between 30-50 years, with normal lipid profiles. The peripheral pulse was recorded using a PPG module and digitised using AUDACITY software. The Arterial Stiffness Index (SI) was calculated and compared between the two groups. The correlation between anthropometry and arterial SI was also determined. Pearson&#8217;s correlation test was used to assess the association using Statistical Package for Social Sciences (SPSS) version 24.0. <b>Results: </b>The SI was found to be higher in prehypertensives compared to normotensives, and this difference was statistically significant (p-value=0.04). SI showed a positive correlation with increasing Blood Pressure (BP) and anthropometric variables (Body Mass Index [BMI] and Waist-Hip Ratio [WHR]; r=0.2 and r=0.15, respectively); however, no significant relationship was observed among these variables. <b>Conclusion: </b>This study concludes that the SI, an important CV risk marker, shows a significant increase in prehypertensive subjects compared to normotensive subjects. However, SI showed mild positive correlation with BP and other anthropometric measurements, though not statistically significant. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=CC01-CC04&id=19131 Awareness on Recent Guidelines for Rabies Prophylaxis among Healthcare Professionals in Rewa District, Madhya Pradesh, India: A Questionnaire-based Cross-sectional Study Murchhana Pradhan, Sandeep Singh, Chakresh Jain, Neera Marathe, Anshuman Sharma, Priyanshi Namdeo Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Rabies is a zoonotic disease that can be fatal and continues to impose a significant financial burden on developing countries. Recently, there have been advancements in the introduction of cell culture vaccines and immunoglobulin, as well as the approval of Intradermal (ID) schedules for vaccine administration. <b>Aim:</b> To assess the knowledge of doctors in Rewa District regarding the National Guidelines for Rabies Prophylaxis in 2019. <b>Materials and Methods:</b> A cross-sectional study was conducted, involving doctors from tertiary healthcare centres, district hospitals, and private practices. Data were collected over a period of one month from 206 doctors using a Google form, which included information about their field of practice and their knowledge of recent guidelines on Rabies prophylaxis. Data analysis was performed using the Chi-square test. <b>Results:</b> Out of the 206 doctors surveyed, 92 (44.7%) were male. A 56.7% of the doctors were aware of the regimen and dosage for ID administration of the Anti Rabies Vaccine, (ARV) and 44.6% were knowledgeable about the modification of Post-Exposure Prophylaxis (PEP) to Pre-Exposure Prophylaxis (PrEP) in the Essen regimen. Furthermore, 70.9% of the doctors were familiar with the dosage of Human Rabies Immunoglobulin (HRIG), while 42.7% knew how to manage animal bites in immunocompromised patients. <b>Conclusion:</b> The study revealed a lack of sufficient knowledge on various aspects of rabies management among the doctors surveyed. This underscores the need for reorientation programs and Continuing Medical Education (CMEs) training to be provided to doctors to enhance their knowledge of rabies and improve the effective management of animal bites. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=LC01-LC05&id=19132 Outcomes of Aortoiliac Occlusive Disease Treated by Aorto-femoro-popliteal and Distal Bypass Surgeries: A Prospective Cohort Study Mohan Lakshmidharan, R Shivali Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Aortoiliac occlusive disease can contribute to lower extremity ischaemic symptoms requiring intervention. Though proximal aorto-femoral bypass surgery has been the mainstay of intervention, the delayed healing in many patients necessitates exploration of other techniques, including sequential revascularisation. <b>Aim:</b> To estimate the outcomes of aortoiliac occlusive disease treated by aorto-femoro-popliteal and distal bypass surgeries. <b>Materials and Methods: </b>A prospective cohort study was conducted to determine the treatment outcomes of 25 patients with aortoiliac occlusive disease visiting a tertiary care centre of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India from October 2012 to December 2014. Data regarding the aetiology of the disease, co-morbidities including substance use, degree of disease involvement, and treatment modalities were collected. Data was analysed by Statistical Package for Social Sciences (SPSS) software version 22.0. The Chi-square test was used to compare outcomes with different treatment modalities, and a p-value <0.05 was considered statistically significant. <b>Results: </b>The mean age of the study participants was 58.3&#177;2 years (range 40 to 70 years). The study noted that the most common aetiology for aortoiliac occlusive disease was atherosclerosis in 18 (72%) cases. The most common associated co-morbidity was smoking in 18 (72%) cases. Abnormal profunda patency was noted in 15 (60%) cases and synthetic Polytetrafluoroethylene (PTFE) was used in 80% of sequential bypass cases. A significantly higher proportion (86.7% vs 30%) of people treated by the sequential procedure achieved relief from claudication pain (p-value<0.05). The complication noted after the proximal bypass was pseudoaneurysm (20%), and the only complication noted after the sequential bypass was graft thrombosis (13.33%). The mean Ankle-brachial Index (ABI) score and ulcer healing time were also significantly higher in the sequential bypass procedure (p-value<0.05). <b>Conclusion: </b>Sequential bypass offers better advantages than proximal bypass for treating aortoiliac occlusive disease. It was found to be a safe and effective method for successful limb salvage, ensuring successful limb revascularisation and sufficient outflow to maintain graft patency. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PC01-PC06&id=19133 dsdsfdf ccbhfh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=-&id=19092 Clinicopathological Features of Primary Renal Mesenchymal Neoplasms in Adults: A Cross-sectional Study Arman Z Chacko, Vikram Raj Gopinathan, Sanjeet Roy, G Kiruthiga Kala, MT Prashanthy Annie, Manojkumar Ramani, Antony Devasia, Santosh Kumar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Renal mesenchymal tumours are a subset of primary renal tumours arising from the mesenchymal tissue in the kidney. They are a heterogeneous group of mostly benign tumours that exhibit varied behaviours and molecular characteristics. <b>Aim:</b> To analyse the wide spectrum of histological subtypes, their unique clinical presentation, and pathological features of primary renal mesenchymal neoplasms. <b>Materials and Methods:</b> This was a retrospective cross- sectional observational clinicopathological study conducted in Department of General Pathology, Christian Medical College, tertiary care hospital, Vellore, Tamil Nadu, India, looking at data of adult Primary Renal Mesenchymal Tumours (PRMT) for a 15-year period between January 2006 and March 2021. Clinical details such as age, presenting symptoms, and tumour size were obtained from the hospital information system. Histopathology and immunohistochemical slides were reviewed for all the cases. Additional Immunohistochemistry (IHC) and molecular studies were performed for the undifferentiated sarcomas. The tumours were categorised into three groups as recommended by the World Health Organisation (WHO) 2020 classification of soft-tissue tumours based on biological behaviour: benign, intermediate, and malignant. Continuous variables are expressed as mean and Standard Deviation (SD). Comparison of categorical variables between groups was performed using the Chi-squared test. Continuous variables between groups were compared using the Student&#8217;s t-test for significance. A p-value of less than 0.05 was considered statistically significant. <b>Results: </b>Of the 2164 nephrectomies performed for neoplastic conditions, 97 (4.5%) were diagnosed as renal mesenchymal tumours. There were 59 (60.8%) benign, 10 (10.3%) with intermediate biologic behaviour and 28 (28.9%) malignant tumours. The mean ages at presentation were 40.5 years for benign, 43.4 years for intermediate, and 41 years for malignant tumours, respectively. Haematuria was seen in 11 of 38 (29%) intermediate grade and malignant tumours and in only 6 of 59 (10%) benign tumours, a difference that was statistically significant (p-value=0.017). Malignant tumours 24 of 28 (86%) were more likely to be larger (>7 cm) when compared to benign tumours 28 of 59 (47%) at the time of presentation (p-value=0.027). Classical angiomyolipomas constituted 53/59 (90%) of the benign tumours. Of the 10 intermediate grade tumours, epithelioid angiomyolipomas and solitary fibrous tumours were the most common, accounting for 50% and 30% of the intermediate group, respectively. Undifferentiated small round cell sarcoma was the most common malignant neoplasm, making up 12/28 (43%) of the malignant tumours. <b>Conclusion:</b> The present study found that renal mesenchymal tumours constitute a small but unique group of renal tumours. They are predominantly benign, but up to a quarter are malignant. Malignant tumours tend to be larger and more often present with haematuria. The present study highlights the importance of IHC in the diagnosis of intermediate and malignant mesenchymal tumours and the requirement of exhaustive molecular studies individually tailored to the immuno-profile of malignant tumours. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC01-EC07&id=19101 Effects of Transcutaneous Electrical Nerve Stimulation, Laser Therapy, and Ultrasound in Managing Temporomandibular Disorders: A Randomised Clinical Study Mounika Yeladandi, Sunanda Chavva, Swetha Bindu Padala, Shugufta Khanam, Harika Vemula, Himapriya Moparthi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Temporomandibular Joint Disorders (TMDs) are considered multifactorial, and several treatment approaches have been proposed for their effective management. The use of non invasive treatment modalities is recommended, which includes Transcutaneous Electric Nerve Stimulation (TENS), Low-Level Laser Therapy (LLLT), acupuncture, ultrasound, and manual therapies. <b>Aim:</b> To evaluate the effectiveness of TENS, LLLT, and ultrasound therapy in patients suffering from TMDs. <b>Materials and Methods:</b> This prospective, randomised clinical trial was conducted on thirty patients (11 males, 19 females) clinically diagnosed with TMD associated with Temporomandibular Joint (TMJ) pain, clicking joint sound, pain in the muscles of mastication, and limited mouth opening. Patients were sequentially randomised into three groups to be treated with TENS, laser beam, and ultrasound therapies, respectively. The Visual Analog Scale (VAS) Score and pain-free mouth opening were recorded before, during, and after treatment. Data were analysed using Statistical Package for Social Sciences(SPSS) version 16.0 statistical software. Statistical tests such as the paired sample t-test, Analysis of Variance (ANOVA), and post-hoc Tukey test were performed. <b>Results:</b> There was a significant reduction in the VAS score in the TENS group (3.15), LLLT group (5.75), and ultrasound group (5.50) post-treatment (p<0.001). In addition, improvements in Mean Mouth Opening (MMO) levels were observed with TENS (7.80 mm), LLLT (9.09 mm), and ultrasound therapy (7.15 mm). These differences were found to be statistically significant (p<0.05). The laser and ultrasound groups fared better than the TENS group in the reduction of VAS scores (p<0.05), and there was no significant difference in MMO among the three therapies. <b>Conclusion:</b> Reductions in VAS scores and improvements in mouth opening were noticed in all three groups post-treatment. The laser and ultrasound therapies were more effective in reducing pain compared to TENS therapy. Comparing pre-treatment and mid-treatment values, laser beam therapy proved to be more effective in reducing pain scores compared to TENS and ultrasound therapy. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZC01-ZC06&id=19096 Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study Bidyut Bhuyan, Jayanta Das, Monigopa Das, DK Bhattacharya, Chandan Nath Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Serum cystatin C has been proposed as a sensitive marker for detecting renal impairment. Renal impairment can often co-exist with liver cirrhosis, as decreased blood flow through the cirrhotic liver can lead to kidney dysfunction. However, its role in patients with liver cirrhosis has not been extensively studied, especially in the detection of early renal impairment. <b>Aim:</b> To investigate whether serum cystatin C could serve as a potential marker for detecting early renal dysfunction in patients with liver cirrhosis. <b>Materials and Methods:</b> This hospital-based cross-sectional study was conducted on 60 patients with liver cirrhosis at Assam Medical College and Hospital, Dibrugarh, Assam, India, from June 2019 to May 2020. All patients were assessed for clinical symptoms and laboratory parameters, focusing on renal function tests, measurement of serum cystatin C levels, and Glomerular Filtration Rate (GFR). A two-tailed p-value <0.05 was considered statistically significant in all calculations. <b>Results:</b> In total, 60 consecutive patients with liver cirrhosis were evaluated during the study period, 85% of whom were males. The mean age was 47.4&#177;9.3 years. The mean values of GFR calculated from the mean values of serum creatinine and serum cystatin C were 59.57&#177;31.48 and 31.25&#177;18.32, respectively, both showing a negative correlation (r=-0.802 and r=-0.817, respectively), indicating that cystatin C has a superior correlation with GFR when compared to serum creatinine. Regression analysis showed a tighter distribution of results around the regression line for cystatin C, as indicated by an R2 value of 0.67, compared to 0.64 for creatinine. It was also observed that for every unit rise in serum creatinine and cystatin C value, GFR decreased by 29.89 and 14.67, respectively. <b>Conclusion:</b> Serum cystatin C is a better predictor of GFR than serum creatinine and can therefore be used as an early marker of renal dysfunction in the course of liver cirrhosis. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=BC01-BC04&id=19097 Predictors of Response to Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer: A Prospective Cohort Study Arjun Kumar, Deepak Aggarwal, Kranti Garg, Varinder Saini Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Lung cancer carries the highest cancer-related mortality rates worldwide. Despite all recent advances, the mortality from lung cancer is still rising. A better understanding of the risk factors may help us predict responses to chemotherapy for better management. <b>Aim:</b> To evaluate predictors of response to chemotherapy in advanced Non-Small Cell Lung Cancer (NSCLC) patients. <b>Materials and Methods:</b> This was a prospective cohort study conducted in the Department of Pulmonary Medicine at Government Medical College and Hospital, Chandigarh, India. A total of 60 confirmed cases of advanced (stage IIIB and IV) NSCLC patients were enrolled consecutively for a duration of two years. Baseline clinical parameters, routine blood tests, spirometry, exercise capacity using the 6 Minute Walk Test Distance (6MWTD), and Computed Tomography (CT)-based tumour size were recorded. Certain pre-defined patient, disease, and therapy-related factors (age, gender, dyspnoea, baseline blood tests, tumour size, histology, etc.) were evaluated for their possible role as predictors of treatment response in advanced NSCLC patients. A positive response was defined if the response to chemotherapy was Complete Response (CR) or Partial Response (PR), and a negative response if the response was Progressive Disease (PD) or Stable Disease (SD) as per revised RECIST (Response evaluation criteria in solid tumors) 1.1 criteria. Variables between the two groups were compared using the Mann-Whitney U test and Chi-square test. To find out the factors that may predict response to treatment, univariate and multivariate logistic regression analysis were used. <b>Results:</b> Out of a total of 60 confirmed cases of NSCLC patients, only 40 patients were able to complete the four cycles of chemotherapy. The mean age of the patients was 58.5&#177;9.6 years. There were a total of 35 males (87.5%) and five females (12.5%) in the study. Out of 40 patients, 27 (67.5%) had squamous cell carcinoma and 13 (32.5%) had adenocarcinoma. On univariate analysis, Neutrophil-Lymphocyte Ratio (NLR) had a statistically significant association with tumour response (p<0.001). On multivariate analysis, advanced age (p=0.05) and high (>3.81) NLR (p=0.002) were found as independent predictors of poor response to chemotherapy. <b>Conclusion:</b> Pre-treatment high NLR and advanced age are significant factors for a poor response to chemotherapy treatment in advanced NSCLC patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OC01-OC05&id=19098 Association between Iron Indices and Dyslipidemia among Patients with Iron Deficiency Anaemia: A Cross-sectional Study Mukti J Patel, Nivedita Priya Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Iron Deficiency Anaemia (IDA) is a major public health problem in India. Iron plays a role in hepatic lipogenesis, being an integral part of some enzymes and transporters involved in lipid metabolism. Since information on the association between iron metabolism and dyslipidemia in adults is limited, it is important to assess the lipid status in iron-deficient patients. <b>Aim:</b> To study the association of iron indices with the lipid profile among patients with iron deficiency anaemia. <b>Materials and Methods:</b> This hospital-based cross-sectional study was conducted at the Department of Paramedical and Health Sciences, Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat, India, from December 2022 to May 2023. In the present study, 100 IDA patients aged between 25-45 years were included. All the participants underwent different tests including Total Cholesterol (TC), Triglyceride (TG), High Density Lipoprotein-Cholesterol (HDL-C), and Low Density Lipoprotein-Cholesterol (LDL-C). Furthermore, the association between IDA patients and lipid levels was analysed. The data were statistically analysed using Pearson&#8217;s correlation test and Chi-square test. <b>Results:</b> In the present study, out of a total of 100 patients, 38 were males and 62 were females. The majority of IDA patients had lower levels of TC, TG, and LDL-C. Low levels of TC and LDL were found in 52 (83.87%) of females and 30 (78.94%) of males. A total of 28 (73.68%) of males and 52 (83.87%) of females had lower values for TG levels. In contrast to TC and TG, a substantial correlation between Haemoglobin (Hb) levels and HDL-C and LDL-C was found. However, Hb had a positive association with TG, HDL-C, and LDL-C and a negative correlation with TC. These results also suggest a substantial correlation between Serum Iron (SI) and TC, TG, and HDL-C, but not a significant correlation with LDL-C. <b>Conclusion:</b> When observed for dyslipidemia, IDA patients showed significantly lower levels of TC, TG, and HDL-C with respect to their SI levels. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=BC05-BC09&id=19099 A Serological Study on Hydatid Disease from a Tertiary Care Hospital in Southern India: A Retrospective Observational Study Mahalakshmi Kumaresan, Anitha Gunalan, Gayathri Pandy, R Harshita Agarwal, Nonika Rajkumari Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Echinococcus species are zoonotic parasites that cause hydatid disease, affecting humans and animals. The seroprevalence of hydatid disease reflects the level of exposure to this parasite and can be used as an indicator of the burden of the disease in a population. <b>Aim: </b>To determine the seroprevalence of hydatid disease. <b>Materials and Methods: </b>The study was a retrospective observational study conducted at JIPMER hospital, a tertiary care centre located in Puducherry, Southern India. In this study, hydatid serological data from January 2019 to December 2022 were collected in March 2023 and retrospectively analysed in April 2023. All the serum samples that tested positive for Enzyme Linked Immuno Sorbent Assay (ELISA) for echinococcosis during the period from January 2019 to December 2022 were included. The demographic details such as age, gender, place of residence, etc., of the patients whose samples were included were collected from their case records. These samples were then analysed using Microsoft Excel for proportions and percentages. <b>Results: </b>The study showed that the seroprevalence of hydatid disease was 70 (34%) out of 206 samples tested. The seroprevalence was higher in the older age group (>45 years), with 41 (58.6%) cases. It was observed that males and females were almost equally infected, with minor differences in the prevalence of 37 (52.9%) males and 33 (47.1%) females. <b>Conclusion: </b>As the prevalence of hydatid disease in Southern India was unknown, it was observed to be lower when compared to other states of India. This study has provided valuable information on the level of exposure of hydatid disease in the population and will help formulate disease control and prevention strategies. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DC01-DC04&id=19107 Efficacy and Safety of Oral Eplerenone in Acute Central Serous Chorioretinopathy: A Randomised Controlled Study Avik Dey Sarkar, Sanjay Kumar Daulat Thakur, Smaranjit Biswas, Ajoy Dey Sarkar, Sanchari Sarkar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Acute Central Serous Chorioretinopathy (CSCR) is an important form of acquired maculopathy that usually presents as localised serous detachment of the neurosensory retina. Although, the disease is typically self limiting over a period of 2-3months, a percentage of patients ultimately develop chronic RPE changes. Eplerenone, a potential Mineralocorticoid Receptor (MR) antagonist, may play a role in regulating choroidal vascularity and modifying the disease in chronic CSCR. <b>Aim:</b> To assess the safety and efficacy of oral eplerenone medication in acute CSCR. <b>Materials and Methods:</b> This was a randomised controlled trial that included 162 eyes of 162 patients with acute CSCR. Patients were divided into two groups&#8211; Group-A, which received oral Eplerenone, and Group-B, which received Placebo therapy. Each group comprised 81 eyes. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT), and serum potassium (K+) levels were measured at baseline and monthly intervals for three consecutive months. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) Statistics version 20 software (IBM Corp., Armonk, NY, USA). A p-value less than 0.05 was considered statistically significant. <b>Results:</b> The differences in CMT in Group-A and Group-B were 279&#177;56.41&#956;m and 207&#177;68.88 &#956;m (p<0.01) at the end of the first month and 361&#177;33.56 &#956;m and 278&#177;46.27 &#956;m at three months (p<0.01), respectively. The average BCVA improvement in Group-A and Group-B was 6.05 lines and 4.21 LogMAR lines, respectively, at the conclusion (p=0.002). Deterioration to chronicity was seen in 3.7% of the eyes in Group A and 17.3% of the eyes in Group B. The increase in Serum K+ at three months was 0.61&#177;0.27 mg/dL in Group-A and 0.1&#177;0.21 mg/dL in Group-B (p=0.03). <b>Conclusion:</b> Eplerenone is a safe and effective first-line treatment option for acute CSCR, leading to faster and higher resolution with protection from progression to chronicity. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=NC01-NC04&id=19108 Diagnostic Stability of Single Spirometry Compared to Repeat Spirometry for Airway Obstruction in Suspected COPD Patients: A Cross-sectional Study Hima Beenakumari, Ronaldwin Benedict, Praveen Gopinathan Sudharma Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Obstructive airway diseases are a leading cause of respiratory morbidity and mortality worldwide, particularly Chronic Obstructive Lung Disease (COPD). The diagnosis of COPD is confirmed by a post-bronchodilator ratio of Forced Expiratory Volume in the first second (FEV1) to Forced Vital Capacity (FVC), i.e., FEV1/FVC <0.7. A repeat spirometry shows variability in a significant population. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommends repeating spirometry on a separate occasion if the post-bronchodilator FEV1/FVC is between 0.6 and 0.8. <b>Aim: </b>To determine the proportion of patients with diagnostic stability in the FEV1/FVC ratio after two weeks. <b>Materials and Methods: </b>This study was a cross-sectional study conducted in the Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, Kerala, India from January 2019 to December 2019. in which 155 clinically suspected COPD patients with an FEV1/FVC ratio between 0.6 and 0.8 were recruited. A repeat spirometry was conducted two weeks later. The two post-bronchodilator FEV1/FVC ratios were compared, and the proportion of patients with diagnostic stability was determined. Fisher&#8217;s-exact test and Pearson&#39;s Chi-square test were used to compare categorical variables between groups. The statistical significance of differences between means of variables among different independent groups was analysed using independent sample t-tests. A p-value <0.05 was considered statistically significant. <b>Results: </b>The mean age of the study population was 63.02&#177;9.80 years. In present study, 118 (76.13%) out of 155 patients had stability in diagnosis, while 37 (23.87%) patients experienced a change in their diagnosis after repeat spirometry. The use of Inhaled Corticosteroids (ICS) and a history of Coronary Artery Disease (CAD) were associated with diagnostic instability (p<0.05). <b>Conclusion: </b>In present study, 23.87% experienced a change in their diagnosis after repeat spirometry. Hence, repeat spirometry should be done on a separate occasion as suggested by GOLD guidelines in patients with FEV1/FVC ratios between 0.6 and 0.8. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OC06-OC08&id=19109 Comparative Assessment of Flexural Strength in Heat-cured Polymethyl Methacrylate Resin Reinforced with Silver Nanoparticles, Siwak, and Fluconazole: An In-vitro Study Rupali Choure, Naveen S Yadav, Kirti Somkuwar, Vrinda Saxena, Riddhi Tiwari, Ramnik Bhatia Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> For crafting complete dentures, Polymethylmethacrylate (PMMA) has long been the material of choice. Various reinforcements are being used to enhance the properties of PMMA and minimise denture fracture. <b>Aim: </b>The present in-vitro study compared the flexural strength of PMMA resin samples reinforced with Silver Nanoparticles (Ag NP), siwak, and fluconazole. <b>Materials and Methods: </b>The present in-vitro experiment was conducted from July to August 2017 at the Prosthodontics Department of a Dental College with technical support from the Centre for Scientific Research and Development (CSRD), affiliated with People&#8217;s University in Bhopal, Madhya Pradesh, India. Flexural testing was conducted at the Central Institute of Plastic Engineering and Technology (CIPET), Bhopal. A total of 120 acrylic resin samples, each measuring 65 mm in length, 10 mm in width, and 2.5 mm in thickness, were fabricated in accordance with American Dental Association (ADA) Specification No. 12. These specimens were categorised into four distinct groups. The first group consisted of only PMMA resin (Group A), while the remaining three groups comprised PMMA resin enhanced with AgNP (Group B), Siwak (Group C), and Fluconazole (Group D), respectively, with each group containing 30 samples. Subsequently, these specimens underwent a flexural strength assessment through a 3-point flexural test. The statistical analysis to assess and compare the mean flexural strength of the samples was conducted. The present analysis was performed first by applying an Analysis of Variance (ANOVA) test, followed by pairwise comparisons with Tukey&#8217;s Post-hoc test. A p-value less than 0.05 was used to determine statistical significance. <b>Results: </b>The mean flexural strength (&#177;Standard Deviation) in N/mm<sup>2</sup> for PMMA; PMMA+AgNP; PMMA+Siwak and PMMA+ Fluconazole was 82.33&#177;5.18; 80.55&#177;5.67; 71.50&#177;10.15; and 74.03&#177;10.84, respectively. The mean flexural strengths of the PMMA and PMMA+AgNP groups were similar (p=0.842). However, the flexural strength of the Siwak+PMMA and Fluconazole+PMMA groups was significantly less than that of the other two groups. <b>Conclusion: </b>The flexural strength of PMMA is unaffected by the inclusion of AgNP at a concentration of 1%, and its incorporation would allow the benefit from its antibacterial qualities. It is not advised to add fluconazole or siwak because doing so reduces the flexural strength. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZC07-ZC11&id=19110 N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) as a Marker for Risk Stratification and Prediction of Functional Outcome in Acute Ischaemic Stroke AG Manoj, K Prabhakar, KN Shashidhar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Stroke is the second leading cause of mortality and disability worldwide. A large proportion of stroke survivors are left with significant disability. Assessing stroke severity and predicting morbidity and mortality is essential for treatment decisions and counseling. Traditionally used tools like the National Institutes of Health Stroke Scale (NIHSS) are not reliable in predicting mortality. Studies have shown that B-type Natriuretic Peptide (BNP) and N-terminal pro Brain Natriuretic Peptide (NT-proBNP) are elevated in acute stroke. <b>Aim:</b> To assess the prognostic importance of NT-proBNP in stroke. <b>Materials and Methods:</b> A prospective cohort study was conducted at Sri Devaraj URS Medical College (SDUMC), SDUAHER, Kolar, Karnataka, India involving 64 consecutive stroke patients from July 2018 to September 2019. Serum NT-proBNP levels were measured on both the day of admission and on day 7. Stroke severity was assessed using the NIHSS on admission day, and functional disability was determined using the Barthel Index (BI) at the 3-month mark. Data were entered into MS Excel for statistical analysis, where a p-value of <0.05 was considered statistically significant. <b>Results:</b> The average age of the subjects was 62.36 years with a standard deviation of 12.15 years. The average NIHSS on the day of admission was 12.81 (7), and it was 20.2 (5.882) among deceased patients. The mean NT-proBNP on admission was 776.70 (1023.6) pg/mL, significantly elevated in deceased patients at 2014.65 (1320.546) compared to survivors at 328.94 (239.353). NT-proBNP is strongly associated with stroke severity (NIHSS) (R2=0.522; Spearman&#8217;s correlation coefficient=0.843, p-value <0.001) and functional outcome (BI) (R2=0.824; Spearman&#8217;s correlation coefficient -0.923, p-value <0.001) at three months.On Receiver Operating Characteristic (ROC) analysis, a serum NT-proBNP level of 960 pg/mL had a sensitivity and specificity of 94.1% and 97.9% in predicting mortality, and a value of 435.1 pg/mL had a sensitivity and specificity of 90% and 81% in predicting disability. <b>Conclusion:</b> Serum NT-proBNP was significantly elevated in patients after stroke and was strongly associated with stroke severity and functional outcome at three months. Measuring serum NT-proBNP on the day of admission can predict mortality and functional dependence after acute ischaemic stroke. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OC09-OC13&id=19111 Efficacy of Magnesium Sulfate and Dexmedetomidine as Adjuvants to Ropivacaine in Supraclavicular Brachial Plexus Block: A Randomised Clinical Study Poonam Singh, Nidhi Gupta, Rajesh Kumar, Apoorva Jaiswal, Sahil Jaggi, Raydhi Sharma Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Peripheral nerve blocks have recently proven to be extremely promising in terms of patient satisfaction. In upper limb procedures, rapid and deep anaesthesia can be achieved with supraclavicular ultrasound-guided access to the brachial plexus. To improve the quality of local anaesthesia, adjuvants such as magnesium sulfate and dexmedetomidine have been added to the local anaesthetic. <b>Aim:</b> To evaluate the efficacy of magnesium sulfate and dexmedetomidine as adjuvants to ropivacaine in supraclavicular Brachial Plexus Blockade (BPB). <b>Materials and Methods: </b>A prospective randomised double-blind study was conducted in the Department of Anaesthesiology from June 2016 to November 2017 ( 1 year and 6 months) at King George&#39;s Medical University, Lucknow, Uttar Pradesh, India. A total of 60 patients were divided into two groups using a computer-generated random number for upper limb surgeries (below the mid-humerus) under supraclavicular brachial plexus block. Group A (n=30) received ropivacaine 0.5% (30 mL) plus dexmedetomidine 50 &#956;g for the supraclavicular block, and Group B received ropivacaine 0.5% (30 mL) plus magnesium sulfate 150 mg in 1 mL Normal Saline (NS) 0.9% for the same block. A comparison of these two groups was conducted for the time of onset, duration of sensory and motor block, haemodynamic stability, postoperative analgesia, and complications. Statistical analyses such as Student&#8217;s t-test, Chi-square test, and Mann-Whitney U-test were used. <b>Results:</b> The mean age of Group A was 28.03&#177;5.86 years and Group B was 31.07&#177;7.06 years. The sensory block and motor block onset were significantly faster among patients of Group A (6.47&#177;1.43 min and 8.50&#177;1.46 min) compared to Group B (9.57&#177;1.22 min and 11.77&#177;1.19 min). The mean duration of analgesia was significantly longer (p<0.001) in Group A (1034.10&#177;61.07 min) compared to Group B (460.00&#177;35.82 min). The duration of sensory block and motor block was also significantly higher (p<0.001) in Group A compared to Group B. Both groups were haemodynamically stable, but sedation was significantly higher in Group A. <b>Conclusion:</b> Dexmedetomidine 50 &#956;g is a superior adjuvant compared to magnesium sulfate 150 mg with ropivacaine 0.5% in supraclavicular brachial plexus block as it significantly hastens onset time and prolongs the duration of sensory and motor blocks and the duration of analgesia. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UC01-UC05&id=19112 Effects of Galvanic Skin Resistance Biofeedback on Perceived Stress in Individuals with High Blood Pressure: A Quasi-experimental Study Krima Tanna, Subhash Khatri Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> According to the World Health Organisation (WHO), hypertension is one of the leading causes of premature morbidity and mortality, both in industrialised and developing countries. Patients with arterial hypertension are advised to make lifestyle adjustments, such as increasing physical activity and reducing stress. Nowadays, a variety of relaxation techniques are used to reduce stress and tension. The practise of Biofeedback (BF) is regarded as a successful treatment for this purpose. <b>Aim: </b>To investigate the effect of Galvanic Skin Resistance Biofeedback (GSRBF) on perceived stress. <b>Materials and Methods: </b>In present quasi-experimental study, 53 individuals with high blood pressure, including prehypertensive and hypertensive individuals {Blood Pressure (BP)> 120/80 mmHg}, were included. Participants were recruited from various Medical and Physiotherapy Outpatient Departments (OPD) of private and Government hospitals and clinics in Veraval, Gujarat, India, from March 2022 to September 2022. Basic demographic data was collected, Blood Pressure (BP) was measured, and the Perceived Stress Scale (PSS) was administered. Participants were then connected to the GSRBF instrument and instructed to relax using a relaxation response technique. After 12 sessions, BP was measured again, and the PSS was administered. As the data were not normally distributed, a t-test was performed at a significance level of 95% (p<0.05). <b>Results: </b>The analysis revealed a significant decrease in PSS scores following GSRBF sessions, with a p-value of <0.05. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) also showed a significant reduction, with a p-value of <0.05. <b>Conclusion: </b>The GSRBF demonstrated a significant reduction in perceived stress among individuals with high blood pressure, and it also showed a significant reduction in SBP and DBP. The present study provides valuable insights into the potential of GSRBF as an adjunct therapy for managing hypertension and promoting overall well-being. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=YC01-YC05&id=19113 Immunohistochemical Expression of PD-L1 in Core Biopsy Samples of Non Small Cell Lung Cancer and its Association with Histopathological and Clinicoradiological Parameters Swagata Karan, Prajna Das, Ranjita Panigrahi, C Mohan Rao Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Lung cancer is one of the most common causes of cancer-related mortality worldwide. In addition to chemotherapy, immunotherapy has yielded favourable outcomes in advanced, surgically non resectable Non Small Cell Lung Carcinoma (NSCLC). The inhibition of immune checkpoints by monoclonal antibodies targeting Programmed Death 1 (PD-1) and Programmed Death Ligand 1 (PD-L1) plays a pivotal role in preventing the downregulation of antitumour immunity. <b>Aim: </b>To study the expression of PD-L1 in NSCLC cases from core biopsy specimens and its association with histological types, grades of tumour along with clinicoradiological parameters (age, sex, smoking status, and radiological location of the tumour). <b>Materials and Methods: </b>This ambispective study was done in the Pathology Department of Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India, over two years from October 2020 to August 2022. The authors studied 35 cases of histopathologically and Immunohistochemically (IHC) diagnosed NSCLC. Partial or complete membranous staining of any intensity in &#8805;1% of tumour cells was considered positive in IHC. The Tumour Proportion Scoring (TPS) used for PD-L1 reporting was as follows: TPS <1%: negative, TPS 1-49%: low positive expression, and TPS &#8805;50%: high positive expression. Microsoft excel and Statistical Package for Social Sciences (SPSS) version 25.0 software were used for statistical analysis. <b>Results: </b>The most common age group was 61-70 years (12 cases; 34.29%), with a male predominance 24 (68.60). Chronic smokers (16 cases; 45.71%) were commonly affected. Squamous Cell Carcinoma (SCC) was the common histological type (21 cases; 60%). Overall, 14 cases (40.0%) showed low (1-49%) and 5 cases (14.30%) showed high (&#8805;50%) positive TPS of PD-L1 expression, respectively. Three cases (27.3%) of Grade 2 SCC and one case (10%) of Grade 3 SCC expressed high positivity. There was a statistical association between PD-L1 expression and male sex (p-value 0.01), positive smoking history (p-value 0.048), and SCC (p-value 0.032). <b>Conclusion: </b>The PD-L1 expression is associated with increased tumour proliferation, aggressiveness, as well as shorter survival period in advanced NSCLC. The present study showed a significant association of PD-L1 expression in males, chronic smokers, and SCC. As per the existing literature, its association with clinicoradiological parameters is not clear. Future research with a larger cohort study, along with other predictive biomarkers, is highly desired to reach conclusive evidence. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC08-EC12&id=19114 Antibody Screening, Identification and Red Cell Alloimmunisation Analysis in Multi-Transfused Patients at a Tertiary Care Hospital, Amritsar, India Akashdeep Singh, Harjot Kaur, Parul Garg, Shabad Preet Kaur, Bikramjit Singh Khurana, Japneet Kaur, Karamjit Singh Gill, Deepak Verma Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Alloimmunisation to red blood cell antigens, resulting from genetic disparities between donors and recipients, is one of the risks associated with blood transfusions. Antibody screening cells are used to detect unexpected antibodies. The risk of alloimmunisation is higher in patients who have undergone multiple blood transfusions. <b>Aim:</b> To estimate the frequency of various Red Blood Cell (RBC) alloantibodies and to determine the types of antibodies present in repeatedly transfused patients. <b>Materials and Methods:</b> This cross-sectional study was conducted on 200 patients with a history of multiple blood transfusions from October 1, 2019, to April 30, 2021, at the blood centre of Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSR), Amritsar, Punjab, India. Antibody detection and identification were performed, and the results were recorded. The data was statistically analysed using the Statistical Package for Social Sciences (SPSS) version 26.0 to draw relevant conclusions. The observations were tabulated in the form of numbers and percentages. Categorical data was analysed using the Chi-square test. The level of significance was determined as p&#8804;0.05. <b>Results:</b> The study included 200 patients who were on multiple transfusions. The most common blood group among the patients was B positive (39%), followed by O positive (26%). The majority of patients (73.50%) had solid malignancies, followed by 28 (14%) thalassemia patients and 25 (12.50%) patients with chronic kidney disease. Solid malignancies included patients with breast cancer, cervical cancer, ovarian cancer, prostate cancer, and liver cancer. Alloantibodies were found in 15 patients (7.50%), of which 11 had solid malignancies and 4 had thalassemia. The most frequent antibody detected was the anti-K antibody (40%). Alloantibody formation was observed in both males and females. However, no statistical significance was found between gender and alloimmunisation (p=0.940). <b>Conclusion:</b> The effect of alloimmunisation can be avoided by routine RBC antibody screening before blood transfusion, especially in patients with a history of multiple blood transfusions. These measures decrease the incidence of red blood cell alloimmunisation and delayed hemolytic transfusion reactions in multi-transfused patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC13-EC17&id=19115 Saliva as a Non Invasive Specimen for Assessment of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study Vraj Rangrej, Achal B Parekh, Anand K Patel, Mayur H Adalja Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. Impaired mucociliary clearance due to altered respiratory physiology in COPD presents an exceptional opportunity for bacterial proliferation. Sampling the respiratory tract using sputum or Bronchoalveolar Lavage (BAL) can be labourious and inconvenient, particularly in chronically debilitated patients. Saliva offers an interesting and non invasive method for assessing COPD patients and preventing exacerbations. <b>Aim:</b> To use saliva to analyse the association between the frequency of positive Potentially Pathological Bacterial Isolates (PPBI) and COPD exacerbations in relation to the frequency of exacerbations and the severity of the disease. <b>Materials and Methods:</b> This cross-sectional study was conducted over a period of one year (July 2022 to June 2023) among COPD patients attending the outpatient department at the Department of Respiratory Medicine, GMERS Medical College, Gotri, Vadodara, Gujarat, India. A total of 60 patients with COPD, diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 guidelines, were included. The patients were categorised based on the severity of airflow limitation, GOLD &#8220;ABCD&#8221; assessment tool, and number of exacerbations. Salivary samples were collected and subjected to microbiological analysis using laboratory conventional culture techniques. Analysis of Variance (ANOVA) and t-tests were applied. <b>Results:</b> The mean age was 64&#177;5.1 years. <i>S. pneumoniae</i> and <i>H. influenza</i> were common bacterial findings in all stages of COPD, while <i>E. coli</i> and <i>A. baumannii</i> were isolated in GOLD Group D patients. Disease severity also showed a significant association with oral bacterial composition (p=0.010) and the frequency of exacerbations (p=0.03). <b>Conclusion:</b> The current study demonstrates an association between oral bacteria and COPD, especially in patients with severe symptoms (GOLD Group D). Additionally, patients with repeated exacerbations exhibited a different oral bacterial composition, thus supporting the use of saliva as a non invasive specimen for assessing heterogeneous diseases like COPD and designing an empiric antibiotic regimen for those PPBI. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OC14-OC18&id=19179 Glycated Haemoglobin and TIMI Score as Risk Predictor in Patients with Acute Myocardial Infarction: A Cross-sectional Study Agot Garang Ayur, M Vasanthan, VM Vinodhini, P Renuka, Sriram Veerar Aghavan Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Cardiovascular Disease (CVD) is the leading cause of death and disability globally. The Thrombolysis in Myocardial Infarction (TIMI) score is calculated to assess the risk outcome among myocardial infarction patients. Researchers found that diabetic patients with myocardial infarction have relatively unfavourable outcomes when compared to myocardial infarction patients without diabetes. <b>Aim:</b> To evaluate Glycated Haemoglobin (HbA1c) levels, the TIMI score in Acute Myocardial Infarction (AMI) patients and compare them between ST Elevation Myocardial Infarction (STEMI) and non STEMI (NSTEMI) patients. <b>Materials and Methods:</b> This cross-sectional study was conducted at the Intensive Care Unit (ICU) of the Department of Cardiology at SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India, from July 2022 to June 2023. A total of 100 myocardial infarction patients were included and divided into two groups based on Electrocardiogram (ECG) findings and Creatine Phosphokinase-MB (CK-MB) values, with 50 STEMI and 50 NSTEMI. Patients blood samples were evaluated for HbA1c, total cholesterol, Triglycerides (TGL), High-density Lipoprotein Cholesterol (HDL-C), Low-density Lipoprotein Cholesterol (LDL-C), Very High-density Lipoprotein Cholesterol (VLDL-C), and CK-MB parameters. The TIMI score was calculated to evaluate the risk of developing complications among myocardial infarction patients. Pearson&#8217;s correlation was used to correlate biochemical parameters with the TIMI score. <b>Results:</b> A total of 100 myocardial infarction patients were analysed in the present study, with 50 being STEMI (mean HbA1c%: 8.0&#177;0.2.8) and 50 being NSTEMI (mean HbA1c%: 7.2&#177;2.0) with a p-value of <0.01*, a high TIMI score in STEMI patients (means 5.38&#177;2.76) and 50 NSTEMI (mean 3.24&#177;1.20) with a p-value of <0.0001*. Also, HbA1c was strongly positively correlated with the TIMI score in both the STEMI and NSTEMI groups, with r-value of 0.6 (p=0.0001*) and 0.7 (p=0.0001*), respectively. CK-MB was correlated with the TIMI score in both STEMI and NSTEMI, with r-value of 0.308 (0.03) and 0.375 (0.007). There was no correlation between the TIMI score and the lipid profile. <b>Conclusion:</b> The study concluded that HbA1c, along with the TIMI score, is a significant predictor of risk outcome in AMI patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=BC10-BC15&id=19180 The Effect of Vitamin D Supplementation as Adjuvant to Phototherapy versus Phototherapy Alone on Neonatal Jaundice: A Randomised Controlled Trial Ghanshyam Das, Abhinay Jain, Vijay Gupta, Durgesh Shukla Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Neonatal jaundice, or neonatal hyperbilirubinaemia, is a common and significant concern among newborns globally. Given that phototherapy is the primary treatment for neonatal jaundice, exploring alternative adjunctive treatments is beneficial. <b>Aim:</b> To observe the impact of vitamin D supplementation as an adjuvant therapy alongside phototherapy in managing neonatal jaundice. <b>Materials and Methods:</b> A hospital-based double-blinded randomised controlled trial was conducted at the Special Newborn Care Unit (SNCU) in Department of Paediatrics, G.R. Medical College, Gwalior, Madhya Pradesh, a tertiary care neonatal centre in North India, over a two-year period (April 2020 to March 2022). The study included 70 newborns with neonatal jaundice, divided into two groups: one receiving phototherapy and vitamin D (Group 1), and the other receiving phototherapy alone (Group 2). The average levels of bilirubin were compared at baseline, 48 hours, 96 hours, and 120 hours in the two groups. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 22.0, calculating frequency, percentage, mean, Standard Deviation (SD), and applying the independent t-test for comparison. A p-value less than 0.05 was considered statistically significant. <b>Results:</b> The mean total serum bilirubin at admission in Group 1 was 18.58&#177;1.76 mg/dL, and in Group 2 was 17.77&#177;2.01 mg/dL, with a p-value of 0.077. At 48 hours, the levels in Group 1 were 15.11&#177;1.99 mg/dL, and in Group 2 were 14.69&#177;1.53 mg/dL, with a p-value of 0.339. At 96 hours, the levels in Group 1 were 14.75&#177;5.62 mg/dL, and in Group 2 were 13.16&#177;1.49 mg/dL, with a p-value of 0.237. At 120 hours, the levels in Group 1 were 8.90&#177;4.66 mg/dL, and no patients were observed in Group 2. The study found that vitamin D as an adjuvant to phototherapy did not significantly impact the rate of decline of serum bilirubin, and the duration of phototherapy was not affected significantly. <b>Conclusion:</b> The study concludes that vitamin D, as an adjuvant to phototherapy, does not significantly affect the rate of decline of serum bilirubin, and it does not alter the duration of phototherapy when comparing both groups. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SC09-SC12&id=19181 Efficacy of Natural Coconut Water, Pre-packaged Coconut Water, and Hank&#8217;s Balanced Salt Solution as Storage Media in Maintaining Periodontal Ligament Cell Viability: An In-vitro Study Sara Samreen, Rituraj Kesri, Ankita Ukey, Pratik Surana, Anshuta Sahu, Pankaj Agrawal, Owais Rahman Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Avulsion of teeth is one of the most complex forms of dental injury, and the selection of an appropriate storage medium greatly influences the preservation of Periodontal Ligament (PDL) cell viability, which is crucial for the successful re-implantation of avulsed teeth. Therefore, identifying effective storage options such as natural coconut water and pre-packaged coconut water holds significant promise in improving outcomes for this challenging dental injury. <b>Aim:</b> To evaluate the efficacy of natural coconut water, pre-packaged coconut water, and Hank&#8217;s Balanced Salt Solution (HBSS) as storage media in maintaining PDL cell viability. <b>Materials and Methods:</b> A total of 32 non-carious freshly extracted human premolars were randomly divided into four study groups (n=8) and stored in the following storage media respectively: Group I-Natural coconut water group, Group II-Pre-packaged coconut water group, Group III-Bench dry group, and Group IV-HBSS groups for 30 minutes. The PDL cells were collected and incubated in phosphate buffer saline for 30 minutes and then centrifuged at 800 rpm for five minutes. Following this, the cells were stained with trypan blue to observe their viability. The Analysis of Variance (ANOVA) with Tukey&#8217;s post-hoc test was used for analysing the data. <b>Results:</b> The mean percentage of viable cells in natural coconut water (80.6250) was higher than in HBSS (79.8750), pre-packaged coconut water (79.2500), and the bench dry group (6.1250). Meanwhile, the mean percentage of non-viable cells was highest in the bench dry group (93.8750), followed by the pre-packaged coconut water (20.7500), HBSS (20.1250), and natural coconut water (19.3750). <b>Conclusion:</b> Natural coconut water and pre-packaged coconut water are equally effective in maintaining the viability of PDL cells. Therefore, pre-packaged coconut water can be used as a substitute for natural coconut water for tooth storage, depending upon availability. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD21-ZD24&id=19171 Immunity against COVID-19 in Vaccinated and Unvaccinated Individuals: A Prospective Cohort Study John Solomon, Juwain Shehzad Nehil, VS Kalaiselvi, WMS Johnson, Chitraleka Saikumar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Three years into the Coronavirus Disease-2019 (COVID-19) pandemic, questions linger regarding long-term vaccine efficacy, potential side effects, and the risk of future viral waves. Despite vaccinations, no existing vaccine offers complete protection, contributing to ongoing fears and vaccine hesitancy. Asymptomatic carriers and unattained herd immunity add layers of complexity. This study seeks to examine the status of immunity in vaccinated and unvaccinated individuals amidst the shifting landscape of different Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) variants. <b>Aim: </b>To determine the percentage of unvaccinated individuals who have developed COVID-19 specific antibodies and to compare the factors influencing immunity in both unvaccinated and vaccinated individuals. <b>Materials and Methods: </b>This prospective cohort study was conducted at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from March 2021 to May 2023. Participants, aged 18-82 of both sexes, were divided into two groups. Group-1 comprised our college and hospital staff who were vaccinated, and Group-2 consisted of members from the local community in the Chromepet, Chennai area who remained unvaccinated. Blood samples were collected from both groups to assess immunity status. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 22.0). The tests used included the Chi-square test, p-value, mean, and standard deviation. <b>Results: </b>Blood group &#8220;B&#8221; was more commonly observed in Group-2. The prevalence of co-morbidities was higher in Group-2. Immunological markers CD4 and CD8 were below normal in some individuals in Group-2. By April 2022, 53 (95%) out of 56 persons in Group-1 and by December 2022, 24 (96%) out of 25 persons in Group-2 tested positive for COVID-specific IgG antibodies. By May 2023, 100% of the volunteers in both groups were found to be positive. <b>Conclusion: </b>This study suggests that natural immunity may be effective in protecting against COVID-19. Whether vaccinated or not, by the end of the two-year study, all individuals in the study group had developed COVID antibodies. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DC05-DC10&id=19155 Comparison of Equivalent Doses of Intrathecal Hyperbaric Levo-bupivacaine and Hyperbaric Bupivacaine for Caesarean Section: A Prospective Randomised Double-Blind Study Noyomi Saring, Animesh Namdeo, Millo Apo, Ramapati Sanyal Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Subarachnoid Block (SAB) with Hyperbaric Bupivacaine (HB) is the most common anaesthetic technique for Lower Segment Caesarean Section (LSCS). Levo-bupivacaine, an enantiomer of racemic bupivacaine, has been developed to provide anaesthesia with the same effectiveness but with better haemodynamic stability. <b>Aim: </b>To compare the effectiveness of hyperbaric levo-bupivacaine to HB in achieving sensory and motor blocks in Caesarean Section(CS) using equivalent doses. <b>Materials and Methods: </b>Eighty parturients aged 18-38 years with no co-morbidities were randomly divided into two groups receiving equivalent doses of HB and hyperbaric levo-bupivacaine for SAB. The effectiveness of the two drugs was compared in terms of the time taken to achieve sensory and motor blocks, as well as the time for block regression for two segments for sensory block and the return of motor block assessed by the ability to flex the ankle joint. Adverse events such as a fall in Systolic Blood Pressure (SBP) and the dose of vasopressor were noted for the two groups. <b>Results: </b>The time taken to attain a T6 dermatomal block level was 2.43&#177;1.00 and 2.80&#177;1.51 (p-value 0.08) for the bupivacaine and levo-bupivacaine groups, respectively. Complete motor block of the lower limb was achieved in 4.85&#177;1.67 and 5.15&#177;1.82 (p-value 0.53). However, the time to 2-segment regression for sensory block was significantly faster in the levo-bupivacaine group than in the bupivacaine group (125.9&#177;28.56 minutes and 109.13&#177;28.84 minutes, respectively, p-value 0.009). Regression from motor block was also found to be highly statistically significant (158.38&#177;34.92 minutes for bupivacaine and 138.75&#177;25.71 minutes for the levo-bupivacaine group, p-value 0.006). Spinal-induced hypotension was comparable in both groups, but the bupivacaine group needed a much higher repetition of dose of vasopressor than the levo-bupivacaine group. <b>Conclusion: </b>Levo-bupivacaine is comparable to its racemic isomer bupivacaine in achieving anaesthesia when administered Intrathecally (IT) for CS. However, with equivalent doses, the duration of action is significantly shorter with hyperbaric levo-bupivacaine. Dose adjustment might be required with hyperbaric levo-bupivacaine based on the duration of the surgery. Haemodynamic stability is also similar with both drugs. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UC06-UC09&id=19156 Foetomaternal Outcomes in Pregnant Women with Corrected vs Non corrected Heart Disease: A Cross-sectional Analysis at a Tertiary Care Institute of Eastern India Kaberi Debbarma, Sambhunath Bandyopadhyay, Bidisha Roychoudhury, Saroj Mondal, Nita Singh, Rajib Roy Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Cardiac disease in pregnancy remains a major concern, particularly in developing countries like India. Pregnancy in women with heart disease increases the risk of maternal and foetal complications. Approximately 1% to 4% of pregnant women have concomitant cardiac disease. <b>Aim: </b>To examine the foetomaternal outcomes of pregnant women in the corrected vs. non corrected heart disease groups. <b>Materials and Methods: </b>This was a cross-sectional study conducted in the Department of Obstetrics and Gynaecology at IPGME&R, Kolkata, West Bengal, India, from February 2020 to July 2021. A total of 50 pregnant women were included in the present study, with 25 in the corrected heart disease group and 25 in the non corrected heart disease group. Foetomaternal outcomes, including intrapartum complications, maternal intensive care unit admission, mode of delivery, and foetal complications, were observed. Comparative analyses were conducted using the Student&#8217;s t-test and Chi-square test. The p-values <0.05 was considered statistically significant. <b>Results: </b>Data from the present study showed that out of a total of 50 pregnant women with heart disease, the majority (60%) were young (&#8804;25 years). Approximately 48% of women were in their second pregnancy. The most common cardiac lesion in the corrected group was closure of Atrial Septal Defect (ASD) in 8 (16%) cases, while in the non corrected group, the most common was mitral regurgitation in 11 (22%) cases. In the corrected heart disease group, 15 (30%) had a caesarean section and 10 (20%) delivered vaginally, whereas in the non corrected group, 17 (34%) had a caesarean section and 8 (16%) delivered vaginally. Adverse cardiac events occurred in 2 (4%) of the corrected group, whereas 11 (22%) were observed in the non corrected group (p-value=0.0088, significant). Preterm birth and low birth weight babies were more common in the non corrected heart disease group (p-value=0.0449, significant). <b>Conclusion: </b>The study concludes that most women with cardiac disease are young. Compared to the Corrected Group of Heart Disease (CGHD), the non corrected group of pregnant women are more likely to experience severe cardiac complications and require admission to the intensive care unit. The foetomaternal outcome is better in the corrected group. Successful management of pregnant women with heart disease requires a comprehensive multidisciplinary approach to optimise foetomaternal outcomes. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QC01-QC04&id=19157 Multimodal Sensory Stimulation among Very Low Birth Weight Preterm Newborns: A Quasi-experimental Study at a Tertiary Care Hospital in Agartala, Tripura, India Abishek Gowda, Sujit Kumar Chakrabarti, Sribas Das, Tapas Ghosh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> There is a continuous search for an effective intervention to help preterm low birth weight neonates overcome their poor growth and developmental outcomes. Most researchers have examined the effect of Oromotor Stimulation (OMS) on feeding performance. Studies exploring Multimodal Sensory Stimulation (MSS) on various outcome parameters are sparse and reveal inconsistent results. <b>Aim: </b>To analyse the effectiveness of MSS in improving weight gain, length of hospitalisation, and feeding performance in preterm Very Low Birth Weight (VLBW) neonates. <b>Materials and Methods: </b>This quasi-experimental study was conducted between June 2021 and December 2022 in the Paediatrics Department of Agartala Government Medical College, Agartala, Tripura, India. A total of 104 hospitalised neonates with gestational age from 28 to less than 37 weeks and birth weight from 1000 to less than 1500 grams (VLBW) were included in the study. All neonates received standard care and Kangaroo Mother Care (KMC). On the advice of some faculties, several of them also received MSS. All neonates were divided into two groups: those who received MSS and those who did not, and they were monitored until discharge. Mean hospitalisation length, weight gain, and transition time were derived and statistically analysed using Chi-square and Mann-Whitney U tests. <b>Results: </b>In the present study, the mean gestational age was 32.04&#177;1.75 and 32.679&#177;1.19 weeks, and the M:F ratio was 1.43:1 and 1.30:1 in the MSS-given and MSS-not given groups, respectively. Mean weight gain was significantly higher in the MSS-given group (97.00&#177;123.09 g versus- 23.42&#177;43.96 g). Mean hospitalisation length was longer in the MSS-given group, but transition time did not differ significantly across the groups. <b>Conclusion: </b>Multimodal sensory stimulation is effective in promoting weight gain in preterm VLBW neonates. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SC01-SC05&id=19158 Prevalence of Sarcopenia in Liver Cirrhosis Patients and Determinants of Survival in Cirrhotic Population: A Prospective Cohort Study Bini Balakrishnan, B Vijayalakshmi, KT Shenoy, KB Leena, P Jayakumar, JK Mukkadan Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Chronic liver diseases are the leading cause of mortality and are associated with a significant reduction in health-related quality of life, as well as being a major complication in cirrhosis. There is a high risk of reduced muscle mass, muscle strength, or function, known as sarcopenia, in patients with liver cirrhosis. Sarcopenia is a major determinant of survival in cirrhosis patients, along with the Child-Turcotte Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) scores. <b>Aim:</b> To study the prevalence of sarcopenia in patients with liver cirrhosis by assessing skeletal muscle mass using the third lumbar level Skeletal Muscle Index (SMI) through Computed Tomography (CT) and to determine the survival analysis of the cohort using a Cox regression model. <b>Materials and Methods:</b> The present study was a prospective cohort study conducted in the Department of Gastroenterology and Hepatology at Sree Gokulam Medical College and Research Foundation in Thiruvananthapuram, Kerala, India South India, from October 2018 to October 2022. A total of 209 patients with cirrhosis were evaluated. Liver biochemical parameters, CTP score, and the MELD score were studied. Age, gender, and aetiology were noted. All subjects were assessed for sarcopenia using CT at the third lumbar vertebrae level SMI, and all subjects were followed up every six months for survival. Survival curves and survival probability were evaluated for all the subjects recruited in the present study. Cumulative survival rates were estimated by the Kaplan-Meier method for sarcopenia, CTP score, and the MELD scores after categorisation into the aetiology of cirrhosis, and the groups were compared using the Log-rank test. Independent factors associated with mortality were identified using Cox proportional hazards models. A p-value <0.05 was considered statistically significant. <b>Results:</b> The mean age&#177;Standard Deviation of the subjects was 58.24&#177;9.9 years. Among the subjects, males accounted for 161 (77%), while 48 (23%) were females. In subjects with sarcopenia (n=77), the survival rate was 53 (68.8%), and in subjects without sarcopenia (n=132), the survival rate was significantly higher at 110 (83.3%) with a p-value <0.05 (p=0.027). Univariate Cox regression analysis indicated that sarcopenia was a statistically significant predictor of survival. The mortality risk was higher in individuals with sarcopenia, with a Hazard Ratio (HR) of 1.9 and a 95% Confidence Interval (CI) ranging from 1.1-1.4. In the Cox regression model, CTP class B/C had a 2.4 times higher risk for mortality than CTP class A (p<0.05). Individuals with sarcopenia had a 1.76 times higher risk of mortality compared to those without (HR=1.765, 95% CI: 0.983-3.17) in the multivariate Cox regression analysis. Aetiology and CTP class scores were independently associated with mortality (p<0.05) after adjusting for multiple prognostic factors in the multivariate Cox regression analysis. <b>Conclusion:</b> Univariate Cox regression analysis indicated that sarcopenia was a statistically significant predictor of survival, with a higher mortality risk in individuals with sarcopenia. The multivariate Cox regression model for survival concluded that CTP class B/C posed a higher risk for mortality compared to CTP class A. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=CC09-CC14&id=19159 Insight into <i> Stenotrophomonas maltophilia </i> Infections in a Tertiary Care Teaching Hospital in Western India and Review of Literature: A Retrospective Observational Study Daisy Bacchani, Ekadashi Rajni, Shaveta Kataria, Chinkle Sharma, Richa Sharma, Vishnu Kumar Garg Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> <i>Stenotrophomonas maltophilia (S. maltophilia)</i> is a ubiquitous and opportunistic pathogen of growing importance. This gram-negative, non fermenter is widely distributed in moist hospital environments. It is intrinsically resistant to a number of antibiotics, making it a challenge both for the clinician and the microbiologist. Very sparse data is available from Western India regarding this emerging pathogen. <b>Aim: </b>To determine the prevalence and spectrum of infections caused by <i>S. maltophili</i>a and to provide an overview of associated co-morbidities, antibiotic susceptibility pattern of these isolates, and clinical outcomes. <b>Materials and Methods: </b>This retrospective observational study was carried out in a tertiary care private hospital (Mahatma Gandhi Hospital) in Jaipur, Rajasthan, India over a period of one year (July 2021-June 2022). A total of 11,170 samples were received in the microbiology laboratory for bacterial culture and susceptibility testing during the study period and processed as per standard protocols. Only one isolate per patient was included for the purpose of the study. Culture identification and antibiotic susceptibility testing was done using the VITEK-2 automated system. Data regarding patients&#8217; demographic profile, epidemiological profile, baseline characteristics, co-morbidities, laboratory findings, and clinical outcome were tabulated in an Excel worksheet and analysed. All statistical analysis was done using the Software Statistical Package for the Social Sciences (SPSS) version 20.0. <b>Results: </b>Fourteen patients were found to have <i>S. maltophili</i>a infection during the study period. The majority of patients had respiratory tract infection and bacteraemia. All isolates were from inpatients, more than two-thirds being from the Intensive Care Unit (ICU). A high level of susceptibility was seen to routinely recommended drugs, with 100%, 93% and 79% being susceptible to minocycline, levofloxacin and co-trimoxazole, respectively. All patients (except one) were successfully managed and discharged. <b>Conclusion: </b><i>S. maltophili</i>a is an emerging opportunistic pathogen and is associated with a plethora of clinical conditions. Early and accurate diagnosis by embracing automation in microbiology laboratories is essential to identify this pathogen. <i>S. maltophili</i>a infections have a favourable outcome when diagnosed and treated timely. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DC11-DC15&id=19160 The Gamut of Renal Lesions on Autopsy: A Two-year Cross-sectional Study from North Eastern Odisha, India Kalyani Prava Gouda, Upasana Das, Rashmi Rekha Mahapatra, Pragyan Lisha Panda, Lity Mohanty Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Kidney diseases have shown a rising upward trend in the last few decades due to the increase in incidence of associated chronic diseases like diabetes, hypertension. However the frequency and spectrum of renal pathology in autopsy specimens is not well documented or overlooked by physicians as well as pathologists. <b>Aim: </b>To analyse the spectrum of various types of renal pathologies, based on the histopathological analysis of renal tissue where autopsies were performed routinely with no history of renal diseases. <b>Materials and Methods: </b>This cross-sectional study was carried out over a period of two years from June 2021 to June 2023 in the Department of Pathology of SCB Medical College and Hospital, Cuttack, Odisha, India, and consisted of 84 cases of well-preserved renal autopsies. The autopsy samples were routinely processed and stained by Haematoxylin and Eosin (H&E) and then reported. Special stain of Periodic Acid Schiff (PAS) was done. Gross and microscopic findings were studied. The study was compared with other relevant studies. The data was analysed using Microsoft Excel 2019. <b>Results: </b>A total of 84 cases were included in the study. The male:female ratio was 1.27:1. The age group with the highest number of cases (35 cases) was 21-40 years. Among the 84 cases the commonest pathology was seen in tubules (40 cases, 47.62%) and glomeruli (7 cases, 8.33%), followed by vascular pathologies (5 cases, 5.95%) and interstitial lesions (4 cases, 4.76%). Renal cell carcinoma was incidentally detected in two cases and Wilms tumour in one case. Five cases had normal histology. <b>Conclusion: </b>The study illuminates the various renal lesions on autopsy and showed tubular lesions were more common than glomerular lesions in renal autopsy. Renal lesions are more common in males. The focus should be to develop more effective diagnostic methods for renal lesions so that intervention can be fast and sharp resulting in less mortality. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC18-EC22&id=19161 Navigating the Haematological Maze: Unraveling the Role of NLR and PLR as Predictors of Dengue Severity- A Cross-sectional Study from Southern India PT Navya, Rameejan Begum, Ayeesha Sithika Thajudeen, Mohammed Althaf Hussain, R Vijayashree Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Dengue Fever (DF) poses a critical public health threat in tropical regions, displaying a spectrum of manifestations without distinct diagnostic hallmarks. Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) are useful biomarkers of inflammation and prognostic markers in various diseases. The inflammation that occurs in dengue is due to the exaggerated response of the immune system. <b>Aim:</b> To assess the utility value of NLR and PLR as prognostic markers for dengue severity. <b>Materials and Methods:</b> A cross-sectional study was conducted on 99 admitted Dengue patients. Patients were grouped into three categories: DF, Dengue Haemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS). Various parameters of Complete Blood Count (CBC), NLR, and PLR were compared among the groups using Analysis of Variance (ANOVA) test (p-value <0.05 considered significant). Sensitivity, specificity, and accuracy were calculated using Receiver Operating Characteristic (ROC) curve. <b>Results:</b> Among the 99 patients, 63.6% exhibited thrombocytopenia (platelet count <1.5 lac/dL), and 7% of patients had a platelet count <20,000/dL. All DHF and DSS patients had thrombocytopenia. Leucopenia was evident in 45.45% of patients, with 6% having a Total Leukocyte Count (TLC) <2000/dL. TLC remained stable across these stages. The mean NLR in DF was 2.47 (range 0.1-15.4), in DHF it was 1.013 (range 0.2-3.2), and in DSS it was 0.41 (range 0.08-0.65.17) with a p-value of 0.02. The PLR displayed substantial differences, with mean values of 134.4 (range 10.1-273.8) for DF, 50.57 (range 7.1-96.1) for DHF, and 10.39 (range 3.1-38.8) for DSS with a p-value of 0.003. NLR had 63% accuracy, 77.8% sensitivity, and 94.4% specificity. PLR had 81.5% accuracy, 93.3% sensitivity and 33.3% specificity. <b>Conclusion:</b> The specificity of NLR was higher, while PLR exhibited superior accuracy and sensitivity in detecting severe cases. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC23-EC26&id=19162 Unraveling the Unusual Pathological Findings of Appendiceal Lesions: A Cross-sectional Study from Tertiary Care Centre in Chengalpattu, Tamil Nadu, India Sangeetha Nagalingam, Fathima Rehana, Karthik Sigamani, Kazzali Ahamed Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> The appendix, once considered a vestigial structure, is now recognised as a site of diverse pathologies beyond simple appendicitis through a systematic analysis of published literature and case studies. The diagnosis of appendiceal lesions is still a clinical phenomenon and a constant struggle. The gold standard for diagnosing appendiceal lesions, however, is meticulous histopathological examination. <b>Aim: </b>To determine the histopathological distribution of all the appendiceal lesions and to identify the rare and unusual histopathological findings in appendectomy specimens received at a tertiary care Centre. <b>Materials and Methods: </b>A cross-sectional study was conducted in the Department of Pathology at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India for a duration of 10 years, from August 2013 to August 2023. From the histopathological records of 832 appendectomies, 40 specimens with unusual histopathological findings were identified and analysed in this study. Relevant recorded data from all the appendiceal specimens reported during the study period, with special reference to age, sex, and histopathological findings, were retrieved and evaluated retrospectively. Corresponding slides and specimens were reviewed. The data were presented in the form of frequency tables and percentages. The analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. <b>Results: </b>Out of 832 appendectomy specimens, there were 485 (58.29%) cases of acute appendicitis, 244 (29.33%) cases of chronic appendicitis, 59 (7.09%) cases of subacute appendicitis, and 4 (0.48%) cases of gangrenous appendicitis. Unusual histopathology findings were noted in 40 cases (4.81%). These include 17 cases of appendiceal neuroma, eight cases of Xanthogranulomatous appendicitis, seven cases of <i> Enterobius vermicularis </i>, three cases of Low-grade Appendiceal Mucinous Neoplasm (LAMN), one case of appendiceal Neuroendocrine Tumour (NET), one case of Goblet Cell Adenocarcinoma (GCA), one case of metastatic squamous cell carcinomatous deposit in the appendix, one case of urothelial rests in the appendix, and one case of appendiceal lipoma. <b>Conclusion: </b>In this study, 4.81% of patients had atypical appendiceal lesions. A complete histopathological examination of appendectomy specimens increases the chances of discovering unusual lesions of the appendix. Ultimately, this comprehensive analysis will contribute to future improvements in clinical management and prognostication, fostering better patient outcomes. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC27-EC31&id=19163 Role of Blood Lactate Clearance in Predicting Outcomes among Septic Patients Admitted to the PICU: A Prospective Cohort Study Akanksha Rana, Mangla Sood, Arvind Sood Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> A crucial metric for evaluating the effectiveness of microcirculation in septic shock is serum lactate. Lactate clearance within the first 24 hours of admission has predictive value for death in Paediatric Intensive Care Unit (PICU) admissions. Higher mortality was observed in septic patients who were unable to clear elevated admission lactate. <b>Aim: </b>To determine the admission lactate level and to investigate whether failure to clear elevated lactate in septic patients can prognosticate high PICU mortality. <b>Materials and Methods: </b>This prospective cohort study was conducted from August 2021 to July 2022 at PICU, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. A total of 75 children, aged two months to 18 years, admitted to the PICU for sepsis or septic shock, were enrolled in the study. The authors measured blood lactate at Intensive Care Unit (ICU) admission, at 6, 12, and 24 hours. Lactate clearance was calculated, and its association with mortality after 24 hours of PICU stay was measured using the Chi-square test. <b>Results: </b>Out of the total, 55 survived, comprising 31 males (41.3%) and 44 females (58.7%). When comparing admission blood lactate to lactate clearance >10% at 6, 12, and 24 hours, there was no correlation between the two variables and mortality in PICU patients with sepsis. <b>Conclusion: </b>Lactate clearance in the first 24 hours of PICU stay was recommended as a parameter associated with the mortality rate among septic patients. However, the authors did not find any correlation. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SC06-SC08&id=19164 Pubertal Development in Girls with Beta Thalassaemia and Assessment of the Adequacy of Chelation Therapy: A Quasi-experimental Study Rupali Modak, Amitava Pal, Shuvendu Das, Dilip Kumar Biswas Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Beta thalassaemia is the most prevalent hereditary autosomal disorder, significantly impacting endocrine function during pubertal development. The pathology is rooted in the excessive deposition of iron in vital organs. If left untreated, this condition leads to serious morbidity and mortality. Hypogonadism stands as the most common endocrine complication. <b>Aim: </b>To observe pubertal development in girls with thalassaemia and evaluate the adequacy of chelation therapy in such patients by measuring levels of Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), oestrogen, and serum ferritin. <b>Materials and Methods: </b>A quasi-experimental study was conducted at the Thalassaemia Clinic at the Department of Obstetrics and Gynaecology, Burdwan Medical College, Purba Bardhaman, West Bengal, India involving 300 diagnosed Beta Thalassaemia Major (BTM) (case) patients aged 13 to 17 years over a period of one and a half years (January 2020 to June 2021). The girls in the study groups were sequentially enrolled from the Outpatient Department of the Thalassaemia Clinic after meeting inclusion and exclusion criteria. Demographic data, anthropometric measurements, and Sexual Maturity Rating (SMR) were recorded. Hormonal assays of serum FSH, LH, oestrogen, and serum ferritin levels were conducted. Thalassaemic girls with serum ferritin levels exceeding 500 ng/mL received chelation therapy. Serum ferritin levels were measured at two-month intervals for up to six months, with reassessment of serum FSH, LH, oestrogen, and ferritin levels at the end of the six-month period. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 27.0, Microsoft excel spreadsheet, and Epi Info 7. <b>Results: </b>A total of 190 (63.3%) of the thalassaemic girls were aged 13 to 15 years, with a mean Body Mass Index (BMI) of 22.5000&#177;2.6100 kg/m2, and 74 of them (38.94%) experienced menarche in this age group. Out of 300 cases, 269 thalassaemic girls (89.6%) received chelation therapy, and 89 cases (33.09%) reached menarche after chelation therapy. A significant (p<0.0001) increase in mean LH and FSH levels was observed after chelation therapy. The mean ferritin level decreased from 3168.85 ng/mL to 2227.24 ng/mL following chelation therapy. <b>Conclusion: </b>Pubertal development failure is common in beta thalassaemic girls. Intervention in the form of adequate chelation therapy in girls with high serum ferritin levels yielded favourable outcomes, as evident from serum gonadotropin and oestrogen levels. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QC05-QC09&id=19165 Effect of the Shoulder Symptom Modification Procedure on Pain and Kinesiophobia in Patients with Shoulder Pain: A Quasi-experimental Study KU Dhanesh Kumar, R Pruthviraj, Stephiya Davis, Anusha Shenai, VK Paul Daniel, Sriraghunath, Pavana Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Shoulder pain, ranking third among musculoskeletal issues, hampers diagnostics due to test limitations. The present study explores the potential of the Shoulder Symptom Modification Procedure (SSMP) as an intervention. Influential factors in physiotherapy outcomes, including kinesiophobia, are linked to shoulder pain. A knowledge gap remains on the impact of SSMP on pain and kinesiophobia in individuals with shoulder pain, contributing insights to musculoskeletal interventions. <b>Aim:</b> To investigate the effect of SSMP on pain and kinesiophobia in patients with shoulder pain. <b>Materials and Methods: </b>A single-blinded quasi-experimental study was conducted in the Department of Musculoskeletal Physiotherapy on 35 participants aged 40-60 years experiencing shoulder pain, recruited from R.V. College of Physiotherapy, Bengaluru, Karnataka, India, over a six month period from February 2022 to July 2022. Pain was measured using the Numerical Pain Rating Scale (NPRS), and kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK). The researcher, blinded to pre- and post-test results of TSK-11 and NPRS, conducted a shoulder symptom modification assessment. The procedure&#8217;s response-guided treatment was administered twice a week for three weeks, with each session lasting 30 minutes. Pre-assessment of TSK-11 and NPRS was performed by an assessor, with the same assessor re-evaluating outcomes after three weeks. Data underwent statistical analysis using a paired t-test in R Software version 4.1.0, with significance attributed to results having a p-value <0.05. <b>Results: </b>The mean age of the study participants was 52&#177;7.74 years. There was a significant reduction in NPRS from 7.54&#177;1.146 to 3.74&#177;1.70 post-intervention and TSK-11 scores from 27.20&#177;5.12 to 23.17&#177;4.83 in subjects with shoulder pain after three weeks of intervention. The study showed a significant improvement in pain (p<0.001*) and kinesiophobia (p<0.001*) in patients with shoulder pain. <b>Conclusion: </b>The SSMP was found to be effective in reducing pain and kinesiophobia in patients with shoulder pain. Further research should be conducted in the future, taking large samples and varied techniques into account for the identification of optimal strategies in improving health-related outcomes. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=KC01-KC04&id=19166 Effect of Anaemia on Cognitive Ability in Female Dental Undergraduate Students: A Cross-sectional Study S Qairunnisa, Thilip Kumar Gnanadurai, MV Muralidhar, I Devasena, TG Pragathi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Anaemia not only impairs physical growth but also affects behavioral and cognitive abilities. Past studies have proved that increased haemoglobin levels result in improved Central Nervous System (CNS) functions. However, there is a significant lacuna between cognition and anaemia among young adults, especially females. <b>Aim: </b>To assess the cognitive ability of female undergraduate dental students with and without anaemia. <b>Materials and Methods: </b>This cross-sectional study included 100 young female dental students, aged between 18 and 23 years, who presented in the Department of Physiology, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India, from February to July 2019. Haemoglobin levels were analysed using the colourimetric cyanmethemoglobin method with Drabkin&#8217;s solution, and based on this, the students were divided into anaemic and non anaemic groups. Cognitive status was assessed using the Digit Symbol Substitution Test (DSST), letter cancellation test, and Stroop test. The Student&#8217;s t-test and Pearson&#8217;s correlation were used to examine the association between haemoglobin levels and cognition. <b>Results: </b>The mean age in the anaemic group and non anaemic group was 19.95&#177;1.80 years and 19.64&#177;1.60 years, and the Body Mass Index (BMI) was 19.54&#177;1.62 kg/m2 and 19.32&#177;1.43 kg/m2, respectively. Haemoglobin levels were significantly lower in the anaemic subjects at 10.408 gm/dL compared to the non anaemic subjects (p-value<0.001). A statistically significant difference was observed between the two groups on DSST scores (21.10&#177;2.99 versus 32.60&#177;14.69), letter cancellation test (25.80&#177;4.63 versus 35.80&#177;4.56), and Stroop test (132.10&#177;8.15 versus 123.56&#177;10.52). <b>Conclusion: </b>The present study reported a significant association between anaemia and cognitive function. Therefore, early screening and prompt treatment of anaemia are crucial for improving both physical as well as mental health. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=CC05-CC08&id=19146 Estimation of Microalbuminuria in Children with Beta Thalassaemia Major: A Cross-sectional Study YB Arun, G Aruna, GR Rajashekaramurthy, KS Sanjay Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Improvement in the standard of care of Thalassaemia by regular blood transfusion increases life expectancy. Multiple transfusions with concurrent iron overload and chronic anaemia, leading to tissue-level hypoxemia, cause significant renal dysfunction. Microalbuminuria is a sensitive marker of glomerular damage, and studies in thalassemic children have demonstrated variable prevalence rates of microalbuminuria. <b>Aim: </b>To study the prevalence of microalbuminuria and its association with clinical and laboratory parameters in children with Beta Thalassaemia Major (BTM). <b>Materials and Methods: </b>A cross-sectional study was conducted from January 2018 to June 2019 at Indira Gandhi Institute of Child Health, Bangaluru, Karnataka,India. A total of 155 children with Beta Thalassaemia Major (BTM) aged 2-18 years, attending the Thalassaemia Day Care Centre, were included in the study. Their demographic details such as age, gender, clinical parameters like frequency of transfusions, type of chelation therapy, height, weight, Body Mass Index (BMI), organomegaly, and laboratory parameters like serum creatinine, ferritin, pretransfusion Hb%, and Urinary Microalbumin Creatinine Ratio (UMCR) were studied as per a predesigned proforma. The association between microalbuminuria with clinical and laboratory parameters was evaluated using the independent sample T-test or Mann-Whitney U test and Chi-square/Fischer&#8217;s-exact test. <b>Results: </b>A total of 155 children with BTM were studied. In the present study, out of a total of 155 patients, microalbuminuria was found in 66 (42.6%). A significant increase in the prevalence of microalbuminuria was observed as the age advanced, as the frequency of blood transfusions increased, with low pretranfusion haemoglobin (g%), and with elevated serum ferritin. <b>Conclusion: </b>In the present study, the prevalence of microalbuminuria was found to be 42.6%. Screening for microalbuminuria is recommended in all children with beta thalassaemia major for the early detection of renal dysfunction, prevention of disease progression, and improvement in the quality of their lives. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=SC13-SC18&id=19211 Comparison of the Efficacy of Labetalol and Nifedipine in Preeclampsia: A Prospective Interventional Study Neha Nimbark, Rohinee Sharma, Sneha Jain Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Hypertensive disorders of pregnancy constitute the most widely analysed conditions in pregnancy. Previously, methyldopa was the most commonly used drug, which nowadays has been largely replaced by T. labetalol and T. nifedipine due to the slower onset of action of methyldopa. Chronic hypertension is associated with more maternal and perinatal adverse events, so it is important to determine the optimal antihypertensive therapy. <b>Aim: </b>To compare drug side effects, obstetric complications, and mode of delivery between Group A (T. labetalol administered) and Group B (T. nifedipine administered). <b>Materials and Methods: </b>A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology, Dhiraj Hospital and SBKS Medical Institute and Research Centre, Vadodara, Gujrat, India from December 2022 to May 2023 at Dhiraj Hospital, involving 200 pregnant women with hypertension or Blood Pressure (BP) readings &#8805;140 mmHg Systolic Blood Pressure (SBP) or &#8805;90 mmHg Diastolic Blood Pressure (DBP) after 20 weeks gestation. They were randomly divided into two groups: Group A (n=100) with T. labetalol administered and Group B (n=100) with T. nifedipine. The two groups were compared with variables like age, side effects of respective drugs, pregnancy complications, and outcomes, including vaginal or caesarean delivery. The Chi-square and t-test were used to compare variables between the two groups. <b>Results: </b>The mean age in Group A was 25.52&#177;4.10 years, and in Group B, it was 25.95&#177;4.47 years. In Group A (T. labetalol), the majority of cases, i.e., 34 (34%), required a 200 mg dose, followed by 300 mg in 26 (26%) of cases. In Group B (T. nifedipine), the majority of cases, i.e., 48 (48%), required a 30 mg dose, followed by 20 mg in 28 (28%) and 40 mg in 24 (24%) of cases. In Group A (T. labetalol), 2 (1%) cases had Intrauterine Growth Restriction (IUGR), 4 (2%) had oligohydramnios, and 2 (1%) had Intrauterine Demise (IUD). In Group B (T. nifedipine), 6 (3%) cases had IUGR, 6 (3%) had oligohydramnios, and 0 (0%) mmHg had IUD. No significant difference was found between Group A and B (p=0.213). In Group A (T. labetalol), 76 (38%) cases had vaginal delivery, 14 (7%) had emergency caesarean sections, and 10 (5%) had elective caesarean sections. In Group B (T. nifedipine), 70 (35%) cases had vaginal delivery, 18 (9%) had emergency caesarean sections, and 12 (6%) had elective caesarean sections. No significant difference was found between groups A and B (p=0.628). Post-intervention SBP in Group A was 126.06&#177;6.6 mmHg, and in Group B, it was 126.96&#177;8.17 mmHg with no statistically significant difference (p=0.3925). Post-intervention DBP in Group A was 80.6&#177;2.38 mmHg, and in Group B, it was 80.2&#177;1.40 mmHg with no statistically significant difference (p=0.14). <b>Conclusion: </b>Both T. labetalol and T. nifedipine were found to be equally effective. However, with respect to drug side effects and tolerability, T. labetalol was found to be significantly better compared to T. nifedipine. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QC14-QC17&id=19213 Crown Lengthening by Conventional Diode Laser and Blue Laser: A Randomised Clinical Trial Gautami Subhadra Penmetsa, Inti Srividya, MAKV Raju, Karuturi Lahari, Alluri V Ramaraju, Kondapally Mohana Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Crown lengthening is a reliable procedure that enables the restoration of teeth with a short clinical crown, extensive subgingival caries, and correction of excessive gingival display for aesthetic purposes. Blue laser, a recent technology in dentistry, has shown significant effectiveness at low power settings, promoting favourable wound healing effects. <b>Aim:</b> To compare the Visual Analogue Scale (VAS) scores and wound healing outcomes between blue laser and denlase in performing crown lengthening procedures. <b>Materials and Methods:</b> A randomised clinical trial was conducted in the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, involving 14 patients who were divided into two groups. Participants were recruited from September 2021 to April 2022.Ethical clearance was obtained from the Institutional Ethics and Review Board. Group-A underwent crown lengthening using blue laser (445 nm), while Group-B received treatment with denlase (980 nm). VAS scores and the wound healing index were recorded and compared between the two groups at baseline, 10 days, and one month after the surgery. Statistical tests such as the Mann-Whitney U test, unpaired t-test, and repeated measures ANOVA were used for analysis. <b>Results:</b> The study revealed a statistically significant difference (p-value=0.006) in VAS scores between the blue laser group (mean value of 0.5) and the denlase group (mean value of 1.3). However, statistically significant differences in Wachtel&#8217;s early wound healing index were not observed in either of the groups. <b>Conclusion:</b> Blue laser treatment was found to be more comfortable for patients, as indicated by the lower VAS scores. Both groups demonstrated good wound healing properties based on Wachtel&#8217;s early wound healing index, with no significant difference between them. It is important to note that literature on blue laser technology is still in its early stages and requires further comprehensive investigation. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZC25-ZC28&id=19214 Serum Vitamin D Levels and Vascular Endothelial Growth Factor in Patients with Type 2 Diabetes Mellitus: A Cross-sectional Study Shilpa K Shet, Aruna Gowdra, HL Vishwanath, K Ravi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Diabetes Mellitus (DM) is the most common noncommunicable disease and the fifth leading cause of death worldwide. Recent research has demonstrated that low Vitamin D levels and high Vascular Endothelial Growth Factor (VEGF) in middle-aged and elderly populations represent a risk factor for Type 2 Diabetes Mellitus (T2DM). <b>Aim: </b>To estimate the Vitamin D and VEGF levels in study subjects with T2DM and healthy controls and to correlate the Vitamin D level and VEGF with HbA1c % in study subjects with T2DM. <b>Materials and Methods: </b>A cross-sectional study was undertaken from October 2014 to November 2016 at the Department of Medicine in collaboration with the Department of Biochemistry, Bangalore Medical College and Research Institute, Bangalore. The study included 50 T2DM subjects on oral hypoglycaemic agents for five years and 50 age and sex-matched healthy controls selected randomly from the general population. In all the study subjects, Random Blood Glucose (RBG), LFT, Renal Function Test (RFT), HBA1c, serum Vitamin D, and serum VEGF were estimated. Student t-test and Chi-square/Fisher-Exact test were used to find the significance of study parameters between cases and controls. Multivariate logistic regression analysis was done to assess the risk factors for DM. <b>Results: </b>The mean age of the cases was 50.9&#177;9.7 years and of controls was 49.76&#177;7.7 years. Among the 50 cases, 19 (38%) were men and 31 (62%) were women. Among the 50 controls, 27 (54%) were men and 23 (46%) were women. The mean Body Mass Index (BMI) among cases was 27.21&#177;4.59 and in controls was 24.82&#177;2.63 (p-value=0.0016). The mean serum 25(OH) Vitamin D levels in cases were 11.39&#177;3.32 ng/mL and in controls were 28.06&#177;11.14 ng/mL (p-value <0.001). The mean serum VEGF levels in cases were 97.52&#177;16.96 pg/mL and in controls were 56.37&#177;17.74 pg/mL (p-value <0.001). <b>Conclusion: </b>The present study found that subjects with T2DM have lower serum 25(OH) Vitamin D levels and higher serum VEGF levels than those without T2DM. Serum Vitamin D decreases and serum VEGF-A levels increase with increasing HbA1c%, correlating with vascular complications. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=BC16-BC20&id=19215 Clinicopathological Study of CD34 Antigen Expression in Benign and Malignant Breast Lesions: A Cross-sectional Study Raghavendra Singh, Tarun Mishra, Pooja Agarwal, Shikha Prakash, Lalit Kumar, Surendra Pathak, Nupur Kaushik, Rajdeep Singh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Breast cancer is the most frequent cancer among women. The CD34 immunohistochemical antigen serves as a tool in differentiating between benign and malignant breast lesions. It has been suggested that CD34 may be related to invasive potential. <b>Aim: </b>To evaluate the expression of the CD34 antigen in the stroma of benign and malignant breast lesions using the Immunohistochemistry (IHC) method. <b>Materials and Methods: </b>This cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Surgery at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India over a period of 18 months (from January 2021 to June 2022), involving a total of 50 histopathologically confirmed cases of benign and malignant breast lesions. Postsurgical specimens, including biopsies and mastectomies, were fixed in 10% neutral buffered formalin. The initial diagnosis was made by Haematoxylin and Eosin (H&E)-stained tissue sections. Sections from the same block were subjected to IHC staining using a monoclonal antibody to the CD34 antigen, and the intensity of expression in stromal cells was graded from 0 to 3+ based on nuclear positivity: up to 5% stromal cells immunoreactive (grade-0), >5% and up to 25% (grade-1), >25% and up to 50% (grade-2), and > 50% (grade-3). The data was entered into Microsoft Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) statistical software version 19.0. The inferential statistics included the use of the Chi-square test. <b>Results: </b>Out of the total 50 cases evaluated, 25 (50%) were categorised as benign, and rest 25 (50%) were categorised as malignant lesions. Among the benign lesions, the most common lesion was fibroadenoma, accounting for 9 (36%) cases, followed by benign phyllode tumour, with 6 (24%) cases. Among malignant lesions, the most common lesion was Invasive Ductal Carcinoma (IDC), accounting for 23 (92%) cases. The intensity of CD34 expression was found to be significantly higher in benign as compared to malignant breast lesions. Out of the 25 benign breast cases, the maximum number of cases (19) showed Grade-3+ positivity, 5 cases showed Grade-2+, and 1 case showed Grade-0 positivity. However, among malignant lesions, maximum cases (23, 92%) showed Grade-0 on CD34 immunostaining. <b>Conclusion: </b>This study was undertaken to evaluate the CD34 expression in benign and malignant breast lesions which might be able to distinguish between the benign and malignant breast lesions. The most benign breast lesions express CD34 in the stroma, while it is almost totally lost in all malignant neoplasms. Loss of CD34 is associated with the tumour&#8217;s capacity for invasion. However, to determine its function as a therapeutic target in cases of breast cancer, additional research can also be done. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC41-EC47&id=19208 Association of the 24-hour Pregnancy Unique Quantification of Emesis Index with Self-Rated Wellbeing Score: A Cross-Sectional Study Nisha Bhatia, Krishna Kumari Meka, Fozia Jeelani Wani Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Nausea and Vomiting of Pregnancy (NVP) are common symptoms of pregnancy. Often, treatment is guided by subjective symptoms, leading to hospitalisation of these patients and unnecessary health costs. The 24-hour Pregnancy-Unique Quantification of Emesis (PUQE) index helps objectively quantify these symptoms and guide the management of these patients. <b>Aim:</b> To assess the association of the 24-hour PUQE index with the self-rated well-being score in evaluating the severity of NVP. <b>Materials and Methods:</b> In this cross-sectional study, a total of 207 women at 5 to 12 weeks of singleton pregnancy were recruited after obtaining informed consent. They were interviewed regarding their symptoms of nausea and vomiting based on a 24-hour PUQE index questionnaire, and a score was assigned to them. They were stratified as mild, moderate, or severe based on the score. The association of these symptoms with a self-rated well-being score and subjective symptoms such as the ability to take multivitamins, sleep pattern, liquid intake, and the need for hospitalisation was assessed. They were followed-up after four weeks, and a repeat score was obtained. Chi-square test was performed to compare the severity of PUQE-24. <b>Results:</b> The mean well-being score at the first visit was 3.381&#177;1.650, and at the follow-up visit, it was 7&#177;1.763. At the first visit, 46 out of 207 had a mild 24-hour PUQE score, 140 out of 207 had a moderate score, and 21 out of 207 had a severe score. During the follow-up visit, 123 out of 207 had a mild score, 77 out of 207 had a moderate score, and seven out of 207 had a severe score. There was a significant association between the mean self-rated well-being score and the 24-hour PUQE score at the first and follow-up visits (p-value=0.0001). Among the patients hospitalised at the first visit (21 out of 28), 75% belonged to the severe PUQE category. The mean liquid intake at the first visit was 24.363&#177;10.357 mL/kg/hr, and at the follow-up visit was 29.972&#177;10.691, showing a significant association with the severity of the 24-hour PUQE score (p-value=0.0001). A significant association was observed between the 24-hour PUQE scores of the first and follow-up visits (p-value=0.002). <b>Conclusion:</b> In this study, there was a significant association between the 24-hour PUQE score and the well-being score at both visits. Stratifying the severity of NVP objectively will guide us to choose the appropriate treatment and reduce the need for hospitalisation. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QC10-QC13&id=19209 An Outbreak of Ralstonia <i>mannitolilytica Septicaemia</i> at a Tertiary Care Hospital: An Observational Cross-sectional Study Nidhi Bhatnagar, Shruthi Vasanth, Nidhi Tejan, Chinmoy Sahu Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Ralstonia spp. is an emerging non fermenting Gram negative bacillus implicated in cases of bloodstream infections in immunocompromised individuals. It is commonly found as an environmental contaminant in hospital settings. Several sporadic outbreaks have been reported from different parts of the world due to Ralstonia spp. This study reports a similar outbreak at a tertiary care hospital in Northern India. <b>Aim: </b>To determine the source of Ralstonia septicaemia in affected patients at a tertiary care centre. <b>Materials and Methods: </b>The present observational cross-sectional study was conducted at the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India from February 2020 until the end of March 2020 (two months). A total of 2,650 blood cultures were received during the study period; of these, 53 (2%) patients were found to have Ralstonia mannitolilytica infection over a two month period. All patients from various wards whose blood cultures showed growth of Ralstonia species were included in this study. The organism was identified using both biochemical tests and Matrix-Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS). Antibiotic sensitivity testing was conducted using the Kirby-Bauer disk diffusion assay. Environmental surveillance was conducted to detect the source of origin. Patients&#8217; age, sex, duration of hospital stay, co-morbidities, and other clinical parameters were recorded. Statistical analysis was performed using Microsoft Excel. <b>Results: </b>There were 52 cases of septicaemia due to Ralstonia mannitolilytica, and one Ralstonia isolate was obtained from intraoperative pus. Most of the Ralstonia isolates obtained were Multidrug-Resistant (MDR), showing resistance to imipenem, meropenem, amikacin, aztreonam, and sensitivity to first-line drugs such as ceftazidime, piperacillin-tazobactam, cefoperazone-sulbactam, levofloxacin, and trimethoprim-sulfamethoxazole, resulting in successful treatment. Out of 53 cases, one patient succumbed to death due to surgical complications. Environmental sampling did not yield any organisms resembling Ralstonia spp. <b>Conclusion: </b>The environmental source of the Ralstonia bacteraemia outbreak could not be identified in this study. All patients except one were successfully treated with antibiotics. Clinicians and microbiologists should remain vigilant in case any such case arises to prevent further outbreaks. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DC16-DC19&id=19200 Clinicopathological Assessment of Modified Activity and Chronicity Indices in Lupus Nephritis at a Teaching Hospital in Mysore, India Pallavi Deka, Suchitha Satish, Manoj Chandrashekar, Manjunath Sanjeev Shetty Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> In 20-49% of patients with Systemic Lupus Erythematosus (SLE), Lupus Nephritis (LN) is a major complication and, therefore, an important prognostic determinant of SLE. The Activity and Chronicity Indices (AI and CI), used as adjuncts to the histological classification of LN, assist in identifying patients who will benefit from immuno-suppressive therapy. <b>Aim: </b>To investigate the correlation of AI and CI in patients with biopsy-proven LN with clinical and laboratory findings. <b>Materials and Methods: </b>A cross-sectional study was conducted as the Departments of Pathology and Nephrology, JSS Medical College and Hospital Mysore, India from January 2023 to March 2023, by retrieving the data of 56 patients with biopsy proven LN. AI and CI were assessed and classified. Data from multiple groups were compared using Pearson&#8217;s chi-square test, and between two groups using independent samples t-test with Statistical Package for Social Sciences (SPSS) version 21.0. Pearson&#8217;s correlation coefficient (r-value) was calculated using Microsoft excel 2021. <b>Results: </b>Renal biopsies from 56 cases with biopsy-proven LN were studied, with a mean age of 28&#177;10.30 years and a M:F ratio of 1:10.2. Of the 56 biopsies studied, active lesions were seen in 47 (83.9%) and chronic lesions in 21 (37.5%). AI showed statistical significance with hypertension (p=0.049) and haematuria (p=0.005), with proteinuria (p=0.001, r=0.72), serum creatinine (p=0.037, r=0.62), and blood urea nitrogen (p=0.003, r=0.55) showing a statistically significant positive correlation. CI showed a statistically significant positive correlation with proteinuria (p=0.028, r=0.039) and serum creatinine (p=0.010, r=0.58). Both AI and CI showed statistical significance with the degree of renal insufficiency, with CI (p=0.008) displaying a stronger statistical significance than AI (p=0.012). <b>Conclusion: </b>In conclusion, the management and prognosis of patients with suspected LN are greatly facilitated through information obtained from renal biopsy, especially AI and CI, which are useful guides to treatment. It is important to study renal biopsy for the constellation of features in LN for better patient management. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC36-EC40&id=19201 Safety and Efficacy of Nebulised Dexmedetomidine as an Adjuvant to Topical Anaesthesia in Patients Undergoing Endobronchial Ultrasound under Moderate Sedation: A Randomised Double-blinded Controlled Study Afreen Rashid, Mohammad Akbar Shah, Shafat A Mir, Khalid Sofi, Majid Jehangir, Nazia Mehfooz Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Anaesthetic sedatives are widely used for bronchoscopy and Endobronchial Ultrasound (EBUS) to ensure patient cooperation and minimise patient discomfort. Dexmedetomidine is an ?2 adrenergic agonist used for sedation. <b>Aim: </b>To evaluate the safety and efficacy of nebulised dexmedetomidine in EBUS. <b>Materials and Methods: </b>In this randomised double-blinded controlled study, conducted in the Department of Anaesthesiology and Pulmonary Medicine at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India from 2020 to 2022, 52 patients aged between 18 and 70 years undergoing EBUS were included. Patients were randomly assigned to the study group (S) and the control group (C). Group C received nebulised lidocaine (2%) 10 mL for 10-15 minutes in a sitting position. Group S received nebulised lidocaine (2%) 8 mL + Dexmedetomidine 2 mL (1 mcg/kg) for 10-15 minutes in a sitting position. Haemodynamic parameters, cough severity scores, patient and operator satisfaction scores, Midazolam requirements, and any complications were recorded and compared. The data were analysed statistically using the Student&#8217;s t-test and Chi-square test, whichever was feasible. A p-value of <0.05 was considered statistically significant. <b>Results: </b>The demographic parameters including the mean age (years) of 46.3&#177;14.01 in Group C vs. 44.5&#177;14.35 in Group S, mean weight (kg) of 61.6&#177;8.27 in Group C vs. 63.5&#177;10.06 in Group S, and male/female ratio of 12/14 in Group C vs. 9/17 in Group S were comparable. Haemodynamic parameters were better postnebulisation in Group S compared to Group C. The authors observed that the incidence of coughing was significantly higher in Group C compared to Group S (73.1% vs. 46.2%). It was found that Group C had a significantly higher requirement for midazolam doses compared to Group S (53.8% vs. 19.2%). When the patient satisfaction score assessed on the Numerical Rating Scale (NRS) was analysed, it was found that Group S patients were highly satisfied compared to Group C patients, and the difference was highly significant (p-value <0.05). No drug or procedure-related complications were observed in the two groups. <b>Conclusion: </b>The present study demonstrated that nebulised dexmedetomidine-lidocaine was well-tolerated during bronchoscopies under moderated sedation and was associated with stable Haemodynamics, decreased incidence of severe coughing, and a lower consumption of sedation drugs. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UC14-UC18&id=19202 Effect of Carbon Dioxide Pneumo-peritoneum in Coagulation Profile of Patients undergoing Laparoscopic Cholecystectomy: A Prospective Cohort Study Chabungbam Gyan Singh, Keisham Lokendra Singh, Arambam Nejoobala Chanu, Arup Mandal, Kshetrimayum Raju Singh, Rongsenneken, Mohd Aquilur Rahman Khan, Mohamad Shahjuddin Shah Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Laparoscopic Cholecystectomy (LC) is done under general anaesthesia with the patient in a reverse Trendelenburg position and with pressurised carbon dioxide in the peritoneum. This can induce venous stasis in the lower extremities and may affect the balance in the coagulation and fibrinolysis system, thereby thrombo-embolic complications. <b>Aim: </b>To investigate the effects of carbon dioxide pneumo-peritoneum on the coagulation system of patients undergoing LC. <b>Materials and Methods: </b>A prospective longitudinal study was carried out from January 2021 to June 2021 among patients aged 18 to 60 years who attended the Surgery Department at Regional Institute of Medical Sciences, Imphal, Manipur, India and were diagnosed with gallstone disease and subsequently underwent LC. Independent variables like age, sex, religion, pre-operative prothrombin time, platelet count, activated Partial Thromboplastin Time (aPTT), and International Normalised Ratio (INR). Outcome variables comprised complications, post-operative prothrombin time, platelet count, aPTT, and INR. Data collected were analysed using Statistical Package for Social Sciences(SPSS) version 21.0. Paired t-tests were employed to test the association between mean values of post-operative and pre-operative PT, aPTT, INR, etc. A p-value of less than 0.05 was considered statistically significant. <b>Results: </b>The study enrolled 71 patients who encountered LC with carbon dioxide pneumo-peritoneum, including 18 male and 54 female patients. Maximum number of patients (28, 38.9%) fell into the 41 to 50 years age group. There was no significant difference in the mean value of prothrombin time (p=0.150) and INR (p=0.437) measured between the pre-operative and post-operative periods. <b>Conclusion: </b>LC is a safe procedure without clinically significant changes in the coagulation profile. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PC07-PC10&id=19203 Perceptions and Experiences Regarding Personal Protective Equipment Usage and Menstrual Health and Hygiene among Female Healthcare Workers during COVID-19: A Cross-sectional Study at a Tertiary Care Hospital, Maharashtra, India Rajiv Yeravdekar, Manisha Gore Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Female Healthcare Workers (FHCWs) played a crucial role during the Coronavirus Diseases-2019 (COVID-19) pandemic, diligently donning Personal Protective Equipment (PPE) to deliver essential care to patients. While PPE effectively shielded FHCWs from infections, it simultaneously imposed limitations on their ability to perform fundamental human activities, including using restrooms and managing menstruation. During menstruation, the restricted access to sanitary pads, combined with the challenges of working in PPE, heightened vulnerability among FHCWs, resulting in discomfort, distress, and a decline in work efficiency. <b>Aim: </b>To assess the perceptions, experiences, and challenges of FHCWs regarding PPE usage while providing healthcare services during the COVID-19 pandemic. Additionally, it aimed to explore the challenges experienced in managing Menstrual Health and Hygiene (MHH) during the COVID-19. <b>Materials and Methods: </b>A cross-sectional study was conducted in the western region of India at a tertiary care hospital of the medical college of Symbiosis International (Deemed to be University) in Pune, Maharashtra, India from September 2020 to November 2020. A total of 300 FHCWs who were assigned COVID-19 duties and utilised PPE were included. Data was collected through a semistructured proforma, covering topics on PPE usage, challenges encountered, personal experiences, and the management of menstruation. The collected data underwent analysis using Statistical Package for Social Sciences (SPSS) software version 21.0, with a primary emphasis on descriptive statistics. <b>Results: </b>A total of 194 (64.7%) perceived that PPE imparted protection, and 267 (89.1%) believed that work efficiency was compromised. Challenges reported by FHCWs while working in PPE included sweating, difficulty in making eye contact, triggers of headaches, nausea, and earaches. A total of 161 (53.9%) reported experiencing a menstrual cycle while on duty with COVID-19 patients, out of which 40 (24.8%) experienced irregular periods, 23 (14.2%) experienced premenstrual stress, and 98 (60.8%) suffered from dysmenorrhoea during menstruation. Additionally, 155 (96.4%) were unable to change sanitary pads, 18 (11%) had stained PPE suits, and 146 (99.9%) experienced challenges in the disposal of sanitary napkins. <b>Conclusion: </b>Many FHCWs felt that PPE offered protection but also compromised work efficiency. Sweating, discomfort, and managing menstrual hygiene within PPE were common challenges encountered. Providing training on PPE usage, adjusting shift durations, implementing policies for the supply of sanitary pads, permitting breaks for changing, ensuring proper disposal arrangements, providing necessary medications and additional PPE if required, leaves, or creating alternative duty arrangements would be beneficial for FHCWs. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=LC06-LC11&id=19204 Flexural Strength of Recently Advanced Lithium Disilicate Glass-ceramic CEREC Tessera: An In-vitro Study Abdullah S Alayad, Dalal S AlDabeeb, Ghayda M Algoblan, Maha H Aldawsari, Rahaf A Alghamdi, Shahd M Alqahtani Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Ceramic materials are quickly becoming the preferred materials for indirect restorations. The improvements in digital impression technology and manufacturing processes have led to the broad spectrum use of Computer-aided Design/Computer-aided Manufacturing (CAD/CAM) in the fabrication of indirect restorations. <b>Aim: </b>To assess the biaxial flexural strength of the CAD/CAM Advanced Lithium Disilicate (ALDS) glass-ceramic CEREC Tessera and compare it with that of LDS IPS e.max CAD. <b>Materials and Methods: </b>An in-vitro study was conducted at the Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia from September 2022 to September 2023 to assess the flexural strength of advanced LDS (CEREC Tessera; Dentsply Sirona) in comparison with LDS (IPS e.max CAD; Ivoclar Vivadent). A total of 10 specimens of each material were tested for flexural strength using an Instron universal machine. The data were analysed using a t-test with a significance level of ?=0.05. <b>Results: </b>A significantly lower mean flexural strength was observed in the ALDS group compared to the LDS group, with a p-value of 0.00008. <b>Conclusion: </b>The LDS exhibited greater flexural strength than advanced LDS. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZC21-ZC24&id=19189 Sequential Oxygen Therapy in COVID-19 Diabetic Patients: A Retrospective Cohort Study Chhaya M Suryawanshi, Dipanjali Mahanta Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Acute respiratory failure is the most common clinical feature in patients with severe Coronavirus Disease -2019 (COVID-19) who are admitted to an Intensive Care Unit (ICU) and may require invasive mechanical ventilation, which is generally linked with a high fatality rate. Patients with established co-morbidities, such as diabetes, invariably fall into the category of patients with severe disease presentation and rapid disease progression. <b>Aim:</b> To study the clinical outcomes of COVID-19 diabetic patients after sequential oxygen therapy using a reservoir bag mask, High Frequency Nasal Oxygen (HFNO), and Non-invasive Ventilation (NIV). <b>Materials and Methods:</b> In this retrospective cohort study, adhering to the STROBE statement criteria, the authors included 150 patients suffering from COVID-19 acute respiratory failure, who were known diabetics, divided into three groups based on admission oxygen saturation and Respiratory Rate (RR) for Non-Rebreather Bag-Mask (NRBM) therapy, HFNO, and NIV. For two weeks, all patients were monitored, and measures such as Saturation of peripheral Oxygen (SpO<sub>2</sub>), Respiratory Rate (RR) escalation of oxygen requirement, glycaemic management, compliance and problems with continued oxygen therapy, the need for invasive mechanical ventilation, and mortality were recorded. The recorded parameters among the three groups were compared using Analysis of Variance (ANOVA) test. <b>Results:</b> Among the demographic parameters recorded, the authors noted that individuals older than 50-55 years of either sex were admitted for HFNO (56.02&#177;11.71 years) and NIV (54.28&#177;14.67 years) therapy, whereas no such preponderance was noted among the two genders. Significant results were noted in all three groups in terms of the escalation of oxygen fraction (FiO2) requirements on the 10<sup>th</sup> day of observation (NRBM 12.63&#177;2.48%, HFNO 37.74&#177;13.56%, NIV 82.44&#177;11.11%). The need for tracheal intubation was higher in patients in the NIV group (10) compared to the HFNO (9) and NRBM (1) groups. Patients whose blood sugar levels remained uncontrolled throughout the course of observation in the study were disparagingly seen to have been a part of the HFNO and NIV groups, and hence the subsequent mortality. <b>Conclusion:</b> There was a steady escalation of mean oxygen requirements in all three groups of oxygen therapy over the course of two weeks, coinciding with the ensuing &#8216;cytokine storm&#8217; associated with Severe Acute Respiratory Syndrome- Coronavirus- 2 (SARS-CoV-2) infection. This trend of escalation of oxygen requirement also in turn coincided with the raised glycaemic charting trends of the patients over the same course of two weeks, delineating those individuals with diabetes mellitus, in view of their compromised immunity and innate pro -inflammatory state, are more prone to develop severe form of the disease with more serious complications, which may even lead to mortality. With regards to the compliance, NRBM & HFNO provided best results in comparison to NIV. The rates of complications were also noted to be higher with the use of NIV in this instance. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UC10-UC13&id=19183 A Knowledge, Attitude, and Practice Survey on Oncology Healthcare Professionals&#8217; Awareness of Cancer Cachexia Diagnosis and its Management: A Cross-sectional Study Bindya Sharma, Twinkle Dabholkar, Saloni Purav Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> As per the new classification of Cancer Cachexia (CC), the clear distinct precachexia stage can be identified, enabling early interventional strategies to retard the progression of CC. Given its recent classification and potential to prevent the onset of CC, it is imperative to study its awareness among Oncology Health Care Providers in India. <b>Aim:</b> To assess the Knowledge, Attitude, and Practices (KAP) of diagnosing and managing CC in a group of oncologists and Onco-physiotherapists in India. <b>Materials and Methods:</b> This was a survey-based cross-sectional study. The surveys were disseminated through various Indian Oncology professional organisation bodies in the country via emails from May 2020 to April 2021. Two survey questionnaires were formulated and validated based on a literature review and input from experts in the field. A total of 64 oncologists with an average of 11.96&#177;8.49 years of experience and 53 physiotherapists with an average of 3.86&#177;4.89 years of experience participated in the survey. Data was analysed using descriptive statistics. <b>Results:</b> In the knowledge domain, oncologists considered muscle wasting (37, 58%), weight loss (36, 57%), and loss of appetite (18, 14%) as the most accurate determinants of CC, and Onco-physiotherapists considered weight loss (18, 34%), muscle wasting (16, 30%), and loss of appetite (11, 21%) as the most accurate determinants. In the attitude domain of both surveys, nutritional therapy was considered an extremely important treatment. In the practice domain, the results showed that the majority of Oncologists (25, 39%) would initiate treatment at a weight loss of >5% when the stage of cachexia or refractory cachexia may have set in, while Onco-physiotherapists (23, 43%) would do so at 5%. <b>Conclusion:</b> These surveys suggest a knowledge-to-action gap and highlight the need for increased awareness about CC among cancer healthcare providers for optimal patient care. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=YC06-YC11&id=19184 Assessing the Role of MAPH Score in Predicting Acute Coronary Syndrome: A Cross-sectional Study KP Athira, Madukara Devadiga, Sharadashri Rao, Kuladeepa Ananda Vaidya Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Incorporating the concepts of hyperviscosity, platelet hyperactivity, and age-related risk of Acute Coronary Syndrome (ACS), a new score has been put forward-the Mean platelet volume-Age-total Protein-Haematocrit (MAPH) score, which can determine the increased thrombotic tendency associated with ST-Segment Elevation Myocardial Infarction (STEMI). The MAPH score includes parameters such as Mean Platelet Volume (MPV), age, total protein, and haematocrit. Researchers have found that a high MAPH score is associated with a high thrombus burden in cases with STEMI and Non ST-Elevation Myocardial Infarction (NSTEMI). However, the association between MAPH score and ACS is undefined. <b>Aim: </b>To assess the role of MAPH score in predicting ACS. <b>Materials and Methods: </b>This cross-sectional study was conducted in the Department of Pathology, Srinivas Institute of Medical Sciences and Research Centre Mangalore, Karnataka, India for six months. The study included 100 clinically diagnosed cases of ACS and 100 healthy controls. The demographic data, MPV, total protein, and haematocrit values of all cases and controls were collected and tabulated, and statistical analysis was performed. Receiver Operating Characteristic (ROC) curve analysis was performed on each MAPH score parameter, and cut-off values for each parameter were obtained based on the Youden index. After calculating the MAPH score of cases and controls, multivariate logistic regression analysis was performed to evaluate the role of the MAPH score as an independent predictor of ACS. <b>Results: </b>A statistically significant increase in MPV (p-value =0.017) and total protein (p-value<0.001) was noted among the cases. The calculated cut-off values for MPV, age, total protein, and haematocrit were 8.4 fL, 54 years, 6.8 g/dL, and 49.1%, respectively. A statistically significant increase in the MAPH score was noted among the cases compared to the controls. Finally, multivariate logistic regression analysis identified the MAPH score as an independent predictor of ACS. <b>Conclusion: </b>This was the first study investigating the association between MAPH scores in patients with ACS. The MAPH score was identified as an independent predictor of ACS and can be used as a screening tool to predict and diagnose the condition in primary healthcare settings. This helps to ensure early coronary revascularisation and reduce Coronary Artery Disease (CAD)-related mortality and morbidity to a greater extent. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=EC32-EC35&id=19174 Prediction of Pathological Risk Stratification using Computed Tomography Features in Gastrointestinal Stromal Tumours: A Retrospective observational Study Manali Arora, Aditya Abhishek, Nitesh Singh, Vishal Thakker, Sheenam Azad, Aakash Gupta, Navdeep Singh Sidhu, Rajiv Azad Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours of gastrointestinal tract. A high postsurgical recurrence and metastatic rate have created a need for a presurgical risk profile identification system. <b>Aim: </b>To assess the association between morphological Computed Tomography (CT) parameters with the pathological risk profile and analyse which CT features can predict the risk grading of GISTs. <b>Materials and Methods: </b>This was a retrospective cohort study based on imaging and histopathological data of 26 patients with pathologically proven GISTs presenting to the Department of Radiodiagnosis of a tertiary hospital in the northern Indian Himalayan foothills over a period of five years from July 2018 to June 2023. CT imaging features including size, growth pattern, margins, enhancement, calcifications, necrosis, intralesional haemorrhage, enlarged feeding vessels, direct organ invasion, and associations such as ascites and lymphadenopathy were studied. All lesions were classified as per Miettinen risk classification into no risk, very low-risk, low, moderate, and high-risk lesions. Analysis was done by the Chi-square test. Predictive analysis was carried out by computing the odds ratio and performing regression analysis on significantly associated imaging features. <b>Results: </b>Out of 26 patients, the study group comprised 16 males (61.54%) and 10 females (38.46%). The most common decade of presentation was the 6th decade with the mean age of presentation being 55.81&#177;4.23 years. Twelve patients were grouped under intermediate to high-risk grading. Lesion size >5 cm (p-value=0.0171, OR=19.12), ill-defined margins (p-value=0.0048, OR=18.33), intralesional necrosis (p-value=0.0053, OR=19.8), and enlarged feeding vessels (p-value=0.012, OR=21.27) were identified as imaging features with significant association and predictive ability for high-risk lesions. The strongest predictive ability for a high-risk profile was shown by ill-defined margins (R2=0.381) and intralesional necrosis (R2=0.3287). <b>Conclusion: </b>A preoperative Contrast Enhanced Computed Tomography (CECT) assessment provides a comprehensive imaging profile for GISTs as well as a fair accuracy of risk profile prediction via various singular and clustered morphological parameters. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TC01-TC04&id=19175 Comparison of CT-Determined Pulmonary Artery Diameter among Smokers and Non-smokers: A Cross-sectional Study Renisha Divina Dsouza, U Raghuraj, Shashi Kumar Shetty Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction:</b> Tobacco smoking is a common addiction in our society. The toxic chemical compounds present in tobacco smoke cause epithelial damage and inflammation of the airways. Chronic smoking results in the thickening of the pulmonary arterial wall and vasoconstriction, leading to the development of pulmonary arterial hypertension. Hence, measurement of pulmonary artery diameter using Contrast Enhanced Computed Tomography (CECT) may be helpful in the early detection of pulmonary arterial hypertension. <b>Aim:</b> To compare the diameters of the Main Pulmonary Artery (MPA), Right Pulmonary Artery (RPA), and Left Pulmonary Artery (LPA) using CECT thorax in smokers and non-smokers. <b>Materials and Methods:</b> A cross-sectional study was conducted from April 2021 to March 2022 in the department of radio-diagnosis, KS Hegde Hospital, Karnataka, India, consisting of 100 patients referred for CECT thorax in the age group of 18-85 years. They were divided into two groups: smokers and non-smokers, with 50 patients in each group. They were further categorised into three age groups: < 50 years, 50-60 years, and >60 years. The widest diameters of the MPA were measured at the level of bifurcation of the artery and perpendicular to the long axis of the artery. At this level, RPA and LPA diameters were measured at the widest portion on 1.25 mm axial images of the arterial phase. Variation in the pulmonary artery diameter was compared between smokers and non-smokers with respect to age and analysed by unpaired t-test and Pearson correlation. <b>Results:</b> Diameters of MPA, RPA, and LPA were statistically significant (p<0.05) in smokers compared to non-smokers. In smokers, MPA and RPA diameters correlated with age, which was statistically significant (p<0.05). No significant correlation (p>0.05) was shown between age and MPA, RPA, and LPA diameter in non-smokers. The mean MPA diameter showed a significant difference (p<0.05) in all three age groups. <b>Conclusion:</b> The diameter of the pulmonary artery is statistically significant in smokers compared to non-smokers. Hence, assessment of pulmonary artery diameters among smokers using CECT thorax will help to diagnose Pulmonary Hypertension (PH) at an early stage. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=TC05-TC08&id=19186 Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique with other Tunneling Techniques: Protocol for a Systematic Review and Meta-analysis Shrishti Satish Salian, Prasad V Dhadse, Pavan Bajaj, Ranu R Oza Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Gingival recession is defined as the displacement of the gingival margin apical to the Cementoenamel Junction (CEJ). The aim is to achieve complete root coverage. The increasing demand for aesthetics by patients has led dentists to adopt newer and more novel techniques. Since Allen first introduced the tunneling technique in 1994, several procedural adjustments have been suggested. The &#8220;Vestibular Incision Subperiosteal-Periosteal Tunnel Access (VISTA)&#8221; technique was introduced by Zadeh HH and offers the benefit of being minimally invasive. <b>Need for the study: </b>This systematic review aims to guide clinicians in selecting the best possible root coverage procedure for better patient-centered outcomes. <b>Aim: </b>The aim is to compare the &#8220;VISTA technique&#8221; with other tunneling techniques in the treatment of multiple gingival recession defects. <b>Materials and Methods: </b>Up until December 2023, the authors will search PubMed, the Cochrane Library, and Embase without any language constraints. Additionally, reviewers will hand-search and examine the bibliographies of relevant publications, search trial registries for active trials, and look for potentially relevant research. The keywords to be used for the search include VISTA technique, tunneling technique, root coverage procedure, and multiple gingival recession. Randomised Controlled Trials (RCTs) using an open or blinded assessment of outcomes will be included. Full journal publications will also be included. Exclusions will be made for brief abstracts (typically meeting reports), non randomised studies, research on experimental pain, studies based on animal models, and observational studies. The eligibility of each study will be independently determined by three review authors (SS, PD, RO). They will then extract the data and independently assess the Risk of Bias (RoB) for each study using the established Cochrane methodology. The evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE), and a summary of findings will be tabulated. The Preferred Reporting Items for Synthematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed for present review. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZK01-ZK03&id=19103 Diagnostic findings in Various Cutaneous Hypopigmented Disorders: A Scoping Review Sabiha Quazi, Adarshlata Singh, Bhushan Madke, Khalid Khan Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Medical conditions can cause the skin to become hypopigmented or depigmented, mainly due to decreased production of melanin. Hypomelanosis is mainly benign and rarely malignant. Depigmentation refers to a complete lack of melanin, with the most common cause being vitiligo. Differentiating between these conditions can be difficult. Diagnosis of the condition is primarily based on the patient&#8217;s detailed history, clinical signs and symptoms, accurate evaluation, and dermoscopy. Repigmentation can occur following early diagnosis and appropriate management. <b>Aim:</b> To highlight diagnostic findings of various cutaneous hypopigmented macular lesions and patches. <b>Materials and Methods:</b> PubMed and Google Scholar databases were searched using a mix of terms, including &#8220;cutaneous disorders&#8221;, &#8220;dermoscopy&#8221;, &#8220;skin biopsy&#8221;, and &#8220;hypopigmented disorders&#8221; for this scoping review, which followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. Boolean operators &#8220;AND&#8221; and &#8220;OR&#8221; were used between the keywords. The inclusion criteria consisted of articles with full text availability, articles describing various cutaneous disorders with characteristic morphology, diagnosis, types and subtypes, conditions associated with systemic diseases, histological examination findings, and prognosis of the condition, peer-reviewed papers with a comprehensive diagnosis of cutaneous hypopigmented diseases, histological biopsies. Randomised Controlled Trials (RCTs), review articles, case reports, and articles in the English language were included in this review. <b>Results:</b> Based on the selection criteria, a total of 12 studies were included in the review, describing various cutaneous disorders with characteristic morphology, diagnosis, types and subtypes, conditions associated with systemic diseases, histological examination findings, and prognosis of the condition. <b>Conclusion:</b> Knowledge regarding various outcomes from the studies related to diagnostic findings in various cutaneous hypopigmented disorders is essential for dermatologists for awareness, appropriate examination, and adequate treatment. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=WE01-WE06&id=19134 Design, Materials and Biomechanics of Orthopaedic Implants: A Narrative Review Melrose Barreto, Saumya Srivastava, Harramb Mittal Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Millions of patients&#8217; lives have been improved by orthopaedic implants. Joint replacement surgery has helped to relieve pain and improve function, while fracture fixation implants promote faster bone healing, resulting in a quicker return to daily activities. The use of more wear-resistant bearing surfaces has increased the longevity of artificial joints. As with any implant, special attention must be paid to the material and design used to create the implants; otherwise, bone fractures or defects may occur, and bone healing may not occur at all. This review highlights the parameters of implant design, the different biomaterials used in implants, and the types of implants, along with their biomechanics. The review provides a brief explanation of the factors involved in designing an implant, the materials used to manufacture it, and the biomechanical principles behind the most common types of implants. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=RE01-RE07&id=19135 Advancement in Understanding and Treating Diabetic Foot Ulcer in Indian Scenario: A Comprehensive Review Mohd Shahid Khan, Noor Jahan, Razia Khatoon, Faisal Moin Ansari, Siraj Ahmad Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X This advanced review focuses on preventing and managing Diabetic Foot Ulcers (DFUs), with a particular emphasis on the Indian context. It explores a range of strategies, including patient education, empirical therapeutics, advanced diagnostics like Polymerase Chain Reaction (PCR), and innovative treatments such as maggot therapy, Negative Pressure Wound Therapy (NPWT), Proximal Tibial Cortex Transverse Distraction (PTCTD), Platelet-rich Plasma (PRP), Leukocyte-Platelet-rich Fibrin (L-PRF), regenerative stem cell interventions, and novel applications like sucrose octasulfate dressings. The study underscores the critical role of patient education and timely interventions in preventing DFU complications. Advanced therapies, including maggot therapy, NPWT, PTCTD, PRP, and L-PRF, show promising results in expediting wound healing and reducing recurrence rates. Innovative approaches like antibiotic-loaded nano fibres and electrical stimulation offer new avenues for inhibiting bacterial growth and promoting wound healing. In summary, the prevention of DFU infections hinges on the trifecta of patient education, empirical therapeutics, and scrupulous wound management. Advanced therapeutic modalities offer a frontier of exciting possibilities for refining outcomes, particularly in regions like India with its unique infection profiles. This multidisciplinary tapestry, interwoven with emerging technologies, holds great potential for elevating the management of DFUs and ultimately enhancing the quality of life for those afflicted by this ailment. This advanced study represents the vanguard of DFU research, offering insights into pioneering strategies that warrant further exploration through rigorous research and large-scale clinical trials, thereby guiding the evolution of DFU management practices. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DE01-DE08&id=19100 H3N2 Influenza Virus Pathogenesis, Transmission and Complications: A Narrative Review Vaishnavi Uttam Goradwar, Ashish Prakash Anjankar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X The recent outbreak of the influenza virus has grown to be a significant issue and a matter of great concern in terms of controlling the impending influenza pandemic. The influenza virus poses a serious threat as it directly infects and impairs the immune system reaction and the respiratory tract. The virus effectively produces infectious viral particles when haemagglutinin molecules are properly cleaved at the respiratory epithelium. The mode of transmission is via droplets from an affected case. The lungs, responsible for the vital exchange of gases, can fail due to various mechanisms, including the destruction of epithelial cells, significant degradation of the extracellular matrix, and airway obstruction. Influenza is a primary cause of severe pneumonia, but it can be accompanied by further bacterial infections, commonly involving bacteria such as <i> Streptococcus pneumoniae </i> and <i> S. aureus </i>. Influenza infection increases the susceptibility to developing Acute Respiratory Distress Syndrome (ARDS) and bacterial sepsis. Both adults and children have a 30-50% chance of experiencing viral infections along with bacterial pneumonia. Notably, Influenza A virus (H3N2) influenza has been associated with a significant increase in admissions to intensive care units. Among the factors contributing to the development of ARDS, individuals between the ages of 36 and 55 years, pregnant women, and obese individuals are at a higher risk. However, infection with influenza viruses A (H3N2) or B, female sex, and influenza vaccination have been identified as protective factors against ARDS. Influenza infection increases the susceptibility to developing ARDS and bacterial sepsis. Disease progression can be limited by spreading awareness among the people about the factors responsible for transmission, clinical manifestations, and preventive methodologies. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=LE01-LE04&id=19149 Mechanochemical Ablation: Current Status in the Management of Varicose Veins: A Comprehensive Review Dheer Singh Kalwaniya, Yogendra Singh, Jyoti, Venkata Bharath Kumar Reddy Lakkireddy Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Varicose veins, a common venous disorder, often lead to significant discomfort and a reduced quality of life. Over the years, numerous treatment approaches have been explored to alleviate the associated symptoms. Surgical interventions such as saphenofemoral junction ligation and Great Saphenous Vein (GSV) stripping were transformative in their time, but the emergence of endovenous techniques like Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) marked a significant shift. While these endovenous techniques have shown exceptional clinical outcomes and cost-effectiveness, they do come with the drawback of pain due to the application of heat for ablation and the necessity of infiltrating tumescent anaesthesia around the vein. In recent years, non thermal, non tumescent methods have arisen as effective alternatives that reduce patient discomfort. These methods encompass procedures such as Mechanochemical Ablation (MOCA) and endovenous cyanoacrylate glue, which minimise heat generation and eliminate the need for tumescent anaesthesia. This article provides a comprehensive overview of the current status of MOCA. It covers its mechanism of action, clinical outcomes, cost-effectiveness, and safety profiles in managing varicose veins. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=PE01-PE04&id=19173 Simulation-based Training for Anaesthesiology Residents: A Boon Amol Singham, Amreesh Paul Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Training in anaesthesiology necessitates exposure to diverse clinical situations, demanding quick thinking, decision-making, and intervention. Achieving expertise in this field traditionally requires years of clinical practice and exposure to various scenarios. Simulation-Based Medical Education (SBME) revolutionises anaesthesiology training by providing a controlled environment where trainees can acquire knowledge, refine clinical skills, and develop clinical and non clinical competencies. This approach includes training in soft skills, critical analysis of clinical scenarios, and receiving constructive feedback from qualified instructors. In alignment with industries like aviation and the military, various countries have incorporated SBME into medical curricula. The present scoping review explores the benefits, limitations, and diverse applications of SBME for anaesthesiology trainees. The historical progression of SBME, from basic procedural models to advanced simulations and virtual reality, underscores its transformative impact on medical education. Standards and accreditation for simulation laboratories ensure quality maintenance in training programs. SBME in anaesthesiology focuses on technical skill development and cultivating crucial non technical skills essential for patient safety. The review emphasises the need for a comprehensive curriculum, qualified instructors, reliable equipment, and ethical considerations to establish standards for simulation in anaesthesia. The versatility of simulation types, including low-fidelity task trainers, high-fidelity mannequins, and virtual simulations, enhances training opportunities. Anaesthesia simulation encompasses a spectrum of scenarios, from cardiothoracic anaesthesia to airway management, addressing technical and soft skills. While SBME offers advantages such as enhanced teamwork, regulated skill development, and exposure to rare situations, drawbacks include costs, ethical concerns, and replicating real-world complexity. Ongoing research is crucial to assess the effectiveness of SBME and its impact on patient outcomes. The evolving significance of SBME in anaesthesiology suggests its continued promise for breakthroughs in medical education. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=UE01-UE05&id=19187 Comprehensive Analysis of Chest Wall Resection: Indications, Reconstruction, and Results: A Systematic Review Sourabh Nandi, Madiwalesh Chhebbi, Sunil Saini Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X <b>Introduction: </b> Chest wall neoplasms encompass primary, locally invasive, and metastatic tumours. Malignant chest wall tumours are typically uncommon, comprising roughly 5% of all thoracic neoplasms and 1 to 2% of all primary tumours. This systematic review addresses the imperative need for a comprehensive analysis of chest wall resection, focusing on indications, reconstruction techniques, and outcomes, to provide clinicians with evidence-based guidelines for optimal patient management. <b>Aim: </b>To comprehensively review indications for chest wall resection, explore reconstruction techniques, and analyse complications and outcomes associated with the procedure. <b>Materials and Methods:</b> A thorough electronic database search was performed on PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED utilising the search terms &#8220;Chest wall,&#8221; &#8220;Chest wall Resection,&#8221; and &#8220;Chest wall Reconstruction.&#8221; Full-text articles published in English within a 20-year period (from 1999 to 2020) were selected based on pre-defined inclusion and exclusion criteria and subjected to analysis as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. <b>Results: </b>In total, 24 full-text records met the inclusion and exclusion criteria and underwent critical analysis for this systematic review. Chest wall sarcomas emerged as the primary indication for chest wall resection in the present study, with recurrent or locally advanced breast carcinoma also noted as significant causes. Various artificial soft meshes, notably Marlex or Goretex, were commonly employed for reconstruction, while soft-tissue coverage was achieved through various myocutaneous flaps, both pedicled and free. Respiratory complications predominated among the observed complications, with wound-related issues also documented. <b>Conclusion: </b>Patient selection is paramount in chest wall reconstruction, with the ideal method still under debate. However, prioritising minimal patient morbidity during reconstruction is crucial. Adherence to these principles can lead to better outcomes in terms of complications, survival, and quality of life, especially in appropriately selected patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=XE01-XE06&id=19176 Respectful Maternity Care: A Narrative Review Pragyna Parmita, Neema Acharya, Ketav Joshi Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Respectful Maternity Care (RMC) is a fundamental right of every childbearing woman. It is aimed at lessening disparities in medical care and assists in achieving an optimal outcome for both mothers and newborns. However, studies have shown that Disrespect and Abuse (D&A) are extremely widespread in low socio-economic countries and that care quality has been neglected at all levels. To minimise disrespectful Maternity Care, we must create situation-specific, proof-based interventions as well as strategies and plans of action. RMC needs a lot more than the ending of misconduct. Care should be provided to all women in a way that safeguards their respect, privacy, and confidentiality. They should not be ill-treated and constant support should be provided at the time of labour and childbirth. Respectful treatment should not be dependent on the social status of the mother. The implementation of RMC through the labour and delivery process is a complicated procedure that demands that healthcare providers possess both interpersonal and scientific abilities. In this regard, it is crucial to recognise the probable hurdles and execute efficient approaches for implementing RMC into action. The present review aimed to further focus the discussion around the creation of RMC policies for various healthcare settings. The authors emphasise the value of RMC and highlight that poor treatment and disrespectful care are issues that are essential to be addressed across all research fields, including community health, quality assurance, administration, and human rights. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=QE01-QE07&id=19185 Malondialdehyde: A Toxic Stress Marker for Periodontitis Afshan Bey, Arthy Arrvind, Pramod Kumar Yadav, Shubham Sareen Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Recently, it has been discovered that one of the primary causes of a variety of inflammatory illnesses, including periodontitis, is an excess of Reactive Oxygen Species (ROS). It is recognised that the host&#8217;s response to pathogens plays an equal or even bigger part in determining how connective tissue breaks down. The process of Polymorphonuclear (PMN) phagocytosis greatly increases ROS formation through the metabolic pathway known as the &#8220;respiratory burst.&#8221; Because the antioxidant defense system is unable to neutralise these high levels or activities of ROS, Oxidative Stress (OS) and tissue damage ensue. ROS can directly affect tissue through Lipid Peroxidation (LPO), Deoxyribonucleic Acid (DNA) damage, protein breakdown, and the oxidation of essential enzymes. Numerous aldehydes can be produced as byproducts of LPO, including Malondialdehyde (MDA), propanal, hexanal, and 4-Hydroxynonenal (4-HNE). They can be detected in bodily fluids and suggest a pro-oxidant state. MDA is a by-product created by the enzymatic or non enzymatic breakdown of Arachidonic Acid (AA) and larger Polyunsaturated Fatty Acids (PUFAs). MDA is the most studied OS tissue damage indicator. After it is formed, MDA can either be broken down by enzymes or combine with DNA or proteins in cells and tissues to form adducts that can cause harm to biological molecules. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZE01-ZE05&id=19195 Ayurvedic Management of <i> Vicharchika </i> vis-&#224;-vis Atopic Dermatitis: A Case Report Vaibhavi Chitmulwar, Sourabh Deshmukh Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X In this fast-paced developing world, regular day-to-day activities like diet and sleep are neglected, leading to various skin disorders <i>(Kushtha). Kushtha </i>is a generalised term used for all skin diseases in Ayurveda. It is mainly divided into two types: <i>Maha kushtha </i>and <i>Kshudra kushtha. Vicharchika </i>is a type of <i>Kshudra kushtha </i>characterised by symptoms like blackish discolouration <i>(Shyava varnata), </i>vesicles <i>(Pidika), </i>discharge <i>(Strava), </i>and itching <i>(Kandu), </i>which can be correlated to atopic dermatitis/eczema. There is no adequate treatment to cure the root cause in contemporary medicine other than topical steroids and antihistaminic agents. The main treatment protocol according to Ayurveda involves the use of both purification <i>(Shodhana) </i>and palliative treatment <i>(Shaman chikitsa)</i>. A 21-year-old female patient presented with small blackish papules on both upper limbs, oosing, and itching on the lesions. She was given medication for both internal use and external application, resulting in significant improvement in symptoms. The patches resolved, and the discharge, itching, and vesicles disappeared. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=VD04-VD07&id=19194 A Case Report of Axenfeld-Rieger Anomaly Prachi Singh, Rika Singh, Supreet Ballur Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Axenfeld-Rieger (AR) syndrome is an inherited Autosomal Dominant (AD) disorder with ocular, dental, and craniofacial defects, whereas AR anomaly presents only with ocular changes. Hereby, the authors present a case report of 40-year-old male patient who reported to the Outpatient Department (OPD) with complaints of diminution of vision in Both Eyes (BE) for three years. There was a significant family history. Visual acuity was limited to hand movements in both eyes. Both eyes showed prominent Schwalbe&#8217;s line, iris atrophic patches, and ectropion uvea. Intraocular Pressure (IOP) was high in the Right Eye (RE) and within normal limits in the Left Eye (LE). No craniofacial or dental anomalies were detected. Gonioscopy revealed a closed angle with broad peripheral anterior synechiae in both eyes. Fundus examination revealed a Cup Disc Ratio (CDR) of 0.5 in the RE and 0.9 in the LE. AR anomaly is a rare case. Long-term follow-up of these cases is as important as early diagnosis and treatment to prevent blindness. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ND04-ND05&id=19191 Fabrication of Distal Extension Removable Partial Denture with Surveyed Crown and Altered Cast Technique: A Case Report Ayman AL-Oulabi, Azirrawani Ariffin, Yanti Johari Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Support and stability for a Removable Partial Denture (RPD) are difficult to achieve in a distal extension edentulous ridge and are even more compromised in reduced dentition. The combination of the altered cast technique and milled crown in removable partial denture fabrication would greatly enhance support by redistributing the load more effectively. However, it is not routinely practiced due to the complexity of the treatment and the lack of emphasis in dental curriculum. In the present case of a 54-year-old male, despite several attempts at wearing the denture, the patient was unable to tolerate it. The atrophic mandibular ridge and poor inclination of the abutment tooth seemed to be complicating factors. Therefore, the prosthesis required some modifications. The present case report highlights the Applegate altered cast technique, which can be deployed with a milled crown, including the clinical and laboratory stages involved. This might help to overcome the problems encountered with distal end saddle dentures, making them more tolerable to patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD25-ZD30&id=19216 Histopathological Features of Shell Teeth: A Case Report Shrijha Ganesan, Surabhi Srivastava, Tabita Joy Chettiankandy, Manisha Ahire Sardar, Nivedhitha Maraimalai Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Shell Teeth are a type of radiographic appearance of teeth seen in Dentinogenesis Imperfecta type II (DGI II). Radiographically, they are characterised by an enlarged pulp chamber enclosed by a thin layer of dentin. The clinical appearance of these teeth ranges from yellow to bluish-grey in colour. The histological features of shell teeth have not been updated in the literature, unlike clinical and radiographic appearance. These features are not available in the literature compared to other dental anomalies. Here, the authors present a case of an 18-year-old female who came with the complaint of poor aesthetic dentition. The dentition aligned with the clinical and radiographic features of shell teeth. Histopathological features of the present case included an irregular arrangement of the dentinal matrix and a few cellular inclusions. The final diagnosis was given as DGI type II. This developmental disorder requires prevention and early intervention of its dental implications, such as dental caries and attrition. The treatment usually requires a well-planned multidisciplinary protocol involving endodontic and prosthodontic approaches. Histopathological features of shell teeth are required to aid in the identification of the precise pathogenesis and genetic mechanism behind this structural disorder of dentin. It also helps in the modification of certain treatment procedures to accommodate the structural abnormality. The case report aimed to bridge the literature gap on the histopathological features of shell teeth. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZD18-ZD20&id=19151 Rifampicin-induced Pancytopenia in Pulmonary Tuberculosis Patient: A Rare Presentation Yashika Bansal, Nitin Tangri Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X Tuberculosis (TB) is prevalent throughout the world and is a major public health problem in most developing countries. In India, standardised and Directly Observed Treatment (DOT) under National Tuberculosis Elimination Programme (NTEP) is being recommended currently for drug-sensitive pulmonary TB. TB being a major health issue in developing nations like India, causes enormous death and morbidity every year. Anti-Tuberculosis Treatment (ATT) given for TB has been highly effective in fighting the disease and is generally well tolerated, with few minor side-effects. We report a 76-year-old male who was diagnosed with pulmonary TB and was on first-line four-drug anti-tubercular therapy ATT since seven days. He presented to the emergency department with loss of weight and appetite, chest tightness and vomiting. Liver Function Tests (LFT) was deranged, suggesting ATT-induced hepatitis. After normalisation of LFT, rifampicin reintroduction was initiated. Complete Blood Count (CBC) revealed pancytopenia. In bone marrow biopsy, normoblastic maturation with few micronormoblasts and megaloblast picture was seen that did not reveal any granuloma, thereby ruling out the presence of <i> Mycobacterium tuberculosis </i> (MTB). Iron profile and vitamin B12 levels were within normal limits. Rifampicin-induced pancytopenia is rare but its possibility should always be kept in mind while treating with ATT. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=OD01-OD02&id=19102 A Rare Occurrence of Fibrolipoma in Oral Buccal Vestibule C Seethalakshmi, N Aravindha Babu, P Sri Neeraja Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=ZJ01-ZJ02&id=19130 <i>Raoultella ornithinolytica </i>: A Case Series of Clinical Presentations and its Role in Various Infections from a Tertiary Care Centre in Tumkur, Karnataka, India Rashmi Belodu, BV Renushri, TS Kiran, G Vijayakumar Journal of clinical and diagnostic research : 2024 - March - 18:0973-709X #iRaoultella ornithinolytica (R. ornithinolytica)</i>, a Gram-negative bacillus, has characteristics resembling those of <i>Klebsiella</i> spp. This bacterium is present in soil and aquatic environments and seldom causes Healthcare-Associated Infections (HAIs). However, clinical features and outcomes of human infections caused by <i>R. ornithinolytica</i> have been reported for only a limited number of cases. Here, multiple cases of adult patients with clinical features of community-acquired infections at different body sites are presented. <i>R. ornithinolytica</i> was identified in the laboratory from respective samples sent for culture and sensitivity. These patients were treated with good outcomes. <i>R. ornithinolytica</i> is a saprophyte known to cause secondary infections in patients with risk factors and sometimes exhibits antibiotic resistance. However, all the patients presented to the institution recovered fully from the infections and were discharged. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2024&month=March&volume=18&issue=3&page=DR01-DR04&id=19192