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

Isolated Partial Sternal Agenesis in a Newborn: A Case Report

RS Sushma, T Hariharasudhan, MG Ravanagomagan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Anterior chest wall skeletal anomalies such as sternal cleft or agenesis are rare congenital defects resulting from incomplete fusion of the paired sternal bars during embryogenesis. They may occur as complete or partial defects and can be associated with intracardiac, diaphragmatic, or midline anomalies. The estimated incidence is less than 0.15% of chest wall malformations. Early recognition in the neonatal period is important due to implications for respiratory mechanics, risk of mediastinal injury, and timing of surgical repair. We report a case of isolated partial sternal agenesis in a 35-week preterm male neonate, born small for gestational age (1.9 kg), who developed respiratory distress within the first hour of life. Examination revealed a soft midline depression over the upper chest without pulsation or skin changes. Imaging demonstrated absence of the manubrium and upper sternebrae without mediastinal herniation. Echocardiography, cranial ultrasonography, and chromosomal microarray were normal. The respiratory distress resolved within 24 hours, consistent with transient tachypnoea of the newborn. The infant was managed conservatively with favourable outcome.

Congenital Adrenal Hyperplasia Characterised by Electrolyte Imbalance in a Male Neonate: A Case Report

Sri Sai Saran Nimmakayala, Revathi Varadarajan, S Jagadeeswari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive disorders of adrenal steroidogenesis, most commonly caused by 21-hydroxylase deficiency. The salt-wasting form of CAH represents a neonatal endocrine emergency. This is a case report of a four-day-old male neonate, who presented on day four of life with lethargy and poor feeding and the systemic examination revealed marked hyper pigmentation especially over the scrotal region but otherwise unremarkable. Investigations revealed hypoglycaemia, hyponatraemia, and hyperkalaemia and hyperpigmentation, however, the septic screen was negative. In view of persistent hypoglycaemia, hypotension and dyselectrolytemia together with hyperpigmentation and diagnosis of CAH was suspected and the baby was worked-up for the same. Biochemical evaluation revealed markedly elevated serum 17-hydroxyprogesterone levels, confirming the diagnosis of classical salt-wasting CAH. This condition is often mistaken for sepsis and the diagnosis is usually delayed. Prompt recognition and initiation of glucocorticoid and mineralocorticoid therapy led to rapid clinical stabilisation. This case highlights the diagnostic challenge of CAH in male neonates and emphasises the importance of early suspicion, timely biochemical testing, and urgent management to prevent mortality.

Congenital Bronchogenic Cyst Causing Obstructive Emphysema in a Two-Month-Old Infant: A Case Report

Kezia Tyagi, Pramod Vajnath Nagure, Vasudha Ravindra Nikam, Jeetendra Kuber Patil Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Congenital bronchogenic cysts are rare developmental anomalies of the embryonic foregut. We present a case of a two-month-old infant with a congenital bronchogenic cyst causing obstructive emphysema and respiratory distress. The infant was born full-term with mild respiratory distress at birth, which resolved spontaneously. However, recurrent episodes of respiratory distress led to admission. Initial X-rays showed no abnormalities, but subsequent imaging revealed a hyperlucent left lung with mild mediastinal shift. A Computed Tomography (CT) scan demonstrated a hypodense lesion in the subcarinal region, compressing the left main bronchus and resulting in obstructive emphysema. The infant underwent surgical excision, with histopathology confirming a bronchogenic cyst. This case highlights the importance of considering congenital bronchogenic cysts in infants presenting with respiratory distress and emphasises the role of advanced imaging techniques in diagnosis.

Papillary Carcinoma of Thyroglossal Duct Cyst with Ectopic Thyroid: A Case Report

Dileep Reddy Ayapaneni, Jitender Reddy Kothapalli, Tejaswini Buthpur, Nikita Srilalitha Addepalli Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Papillary carcinoma arising from a Thyroglossal Duct Cyst (TGDC) is an uncommon malignancy, accounting for less than 1% of all TGDCs. Imaging plays a crucial role in early detection, characterisation, and guiding surgical management. We report a case of papillary carcinoma developing in a TGDC in a 27-year-old male who presented with a gradually enlarging anterior midline neck swelling, recently associated with pain. There were no symptoms of dysphagia, hoarseness, or thyroid dysfunction. Ultrasonography revealed a well-defined predominantly cystic lesion with internal septations and echogenic components showing vascularity on colour Doppler. Contrast-Enhanced Computed Tomography (CECT) of the neck demonstrated a thick-walled cystic lesion below the hyoid bone with enhancing internal septa and solid nodular areas, suggesting malignant transformation. Incidentally, a separate enhancing nodule was observed at the base of the tongue, consistent with ectopic (lingual) thyroid tissue, along with a small orthotopic thyroid gland. No cervical lymphadenopathy was noted. The patient underwent Sistrunk’s procedure, and histopathological evaluation confirmed papillary carcinoma arising within the TGDC. The postoperative period was uneventful. This case highlights the significance of meticulous preoperative imaging in identifying both malignant features within a TGDC and the presence of additional thyroid tissue along the thyroglossal tract.

Haemophilus Influenzae Meningoencephalitis with Multifocal Haemorrhagic Cerebral Infarction and Lobar Pneumonia in an Immunocompetent Young Adult: A Diagnostic and Therapeutic Challenge

Ronak Shah, Parth Shah, Mittal Sindhav Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Haemophilus influenzae meningoencephalitis complicated by multifocal haemorrhagic cerebral infarction is exceedingly rare in immunocompetent adults and presents a formidable diagnostic challenge. This case report is of a 20-year-old unvaccinated male who presented with high-grade fever, altered sensorium, generalised tonic-clonic seizures, and dysarthria of seven days' duration. Neurological examination disclosed meningeal signs and a Glasgow Coma Scale (GCS) of 12/15. Magnetic Resonance Imaging (MRI) brain with contrast revealed multiple acute haemorrhagic infarcts involving the left fronto-temporo-parietal cortex, basal ganglia, insular cortex, and periventricular white matter, with extension to the right cerebellum on Day 3 imaging. Concurrent left lower lobe consolidation was confirmed on High-Resolution Computed Tomography (HRCT) thorax, and echocardiography demonstrated mildly reduced ejection fraction (45%) with inferoseptal hypokinesia without vegetations. CSF analysis revealed a normal cell count (2 cells/μL, lymphocyte predominant), with normal protein and glucose levels; conventional culture was negative. Pathogen identification was achieved exclusively via the CSF BioFire FilmArray Meningitis/Encephalitis (ME) panel, which returned positive for H. influenzae. Following clinical deterioration and rising inflammatory markers on ceftriaxone-based empirical therapy, treatment was escalated to meropenem (2 g every 8 hours) with adjunctive dexamethasone, resulting in progressive clinical improvement by Day 7. This case illustrates the diagnostic utility of multiplex molecular panels in culture-negative bacterial meningitis and underscores the potential for H. influenzae to cause extensive cerebrovascular injury through septic arteritis and vasculitis. Timely carbapenem escalation may be life-saving when cephalosporin therapy fails.

Synchronous Occurrence of Metastatic Prostate Adenocarcinoma and Plasma Cell Myeloma in the Bone Marrow: A Rare Case Report

Aruna Vijayakumar, Renu Sukumaran, Jayasudha Arundhathi Vasudevan, Sugeeth Mangalapilly Thambi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Simultaneous occurrence of plasma cell myeloma and prostate adenocarcinoma is rare, with only a few cases reported in the literature. The mechanism of co-occurrence of these malignancies is poorly understood. It has been suggested by some studies that Bone Marrow Microenvironment (BMME) plays a crucial role. We describe a rare case of synchronous occurrence of metastatic prostate cancer and plasma cell myeloma in bone marrow biopsy. A 73-year-old male presented with complaints of fatigue, low back ache and weight loss. Routine haematological and biochemical investigations showed anaemia with increased Erythrocyte Sedimentation Rate (ESR), raised creatinine and reversal of Albumin/Globulin ratio. Serum Protein Electrophoresis (SPE) showed M peak in the gamma fraction (2.30 g/dL). Serum Immunofixation Electrophoresis (IFE) showed two bands in the IgA region corresponding to the two bands in the kappa region. With clinical diagnosis of plasma cell myeloma, bone marrow study was done. Bone marrow aspirate showed around 20% plasma cells. Bone marrow biopsy showed clonal expansion of plasma cells with kappa light chain restriction. Same biopsy also showed tiny foci of metastatic carcinoma with surrounding fibrosis. Further evaluation revealed enlarged hard prostate with raised serum Prostate Specific Antigen (PSA) level, concerning for concomitant prostate carcinoma. On immunohistochemical study, carcinoma cells in bone marrow biopsy showed strong nuclear positivity for NKX3.1, confirming prostatic origin of metastatic carcinoma. The association between these two disorders is poorly understood. It has been suggested that BMME may play a crucial role.

Rare Adult Presentation of Embryonal Rhabdomyosarcoma: A Case Report

Harsh Manojkumar Thesia, Sohael M Khan, Shailly Tiwari, Samarth Kashyap, Kaustav Datta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Embryonal Rhabdomyosarcoma (ERMS) is a malignant mesenchymal tumour showing skeletal muscle differentiation and represents the most common histological subtype of Rhabdomyosarcoma (RMS). It predominantly affects the paediatric population, typically arising in the head and neck, genitourinary tract, and retroperitoneum. Occurrence in adults is exceedingly rare and is associated with aggressive biological behaviour, advanced stage at presentation, limited therapeutic options, and poor prognosis. Hereby, the authors report the case of a 56-year-old male who presented with a rapidly enlarging, painful right abdominal mass of two months duration. Imaging revealed a large heterogeneous soft tissue mass with evidence of distant metastases. Histopathological examination showed pleomorphic round-to-ovoid tumour cells with rhabdomyoblastic differentiation and prominent anaplastic features. Immunohistochemistry demonstrated positivity for Myogenic Differentiation 1 (MyoD1), cytokeratin, Cytokeratin 8/18 (CK8/18) and Desmin, confirming the diagnosis of ERMS. Genomic profiling done using foundation one heme revealed amplification Mouse Double Minute 2 homolog (MDM2), Cyclin-Dependent Kinase 4 (CDK4) and Fibroblast Growth Factor Receptor Substrate 2 (FRS2). Suggesting aggressive tumour biology and potential therapeutic targets. The patient underwent surgical excision followed by multiple lines of chemotherapy and molecularly guided targeted therapy. Despite transient clinical responses, the disease showed repeated relapses with progressive metastatic spread. The patient ultimately succumbed to the illness. The present case highlights the extreme rarity of adult-onset ERMS, its aggressive clinical course, and dismal outcome despite multimodal treatment. Accurate histopathological and molecular diagnosis, along with reporting of such cases, is essential to improve understanding of this uncommon and highly aggressive malignancy.

Glycogen Storage Disease Type IIIa Presenting as Progressive Hepatomegaly and Abdominal Distension in a Three-year-old Child: A Case Report

Uday Kumar Vangala, Samruddhi Patil, Vijendra Kirnake, Ameya Vaidya, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Glycogen Storage Disease type IIIa (GSD IIIa) is known to be a rare autosomal recessive metabolic disorder which results due to deficiency of the Glycogen Debranching Enzyme (GDE), that further leads to abnormal glycogen accumulation in liver and muscles. The current case report describes a three-year-old female child who presented with progressive abdominal distension, hepatomegaly since last one year. Clinical evaluation of patient showed short stature for age, overweight build also markedly enlarged liver. Laboratory investigations of patient reported persistently elevated levels of transaminases, dyslipidaemia while imaging showed hepatomegaly along with presence of a characteristic beaver’s tail appearance. Liver biopsy revealed intra-hepatocytic accumulation of glycogen having plant cell-like morphology. Whole exome sequencing was done which helped to identify a homozygous frameshift mutation in the amylo-alpha-1,6-glucosidase and 4-alpha-glucanotransferase (AGL) gene (c.53_54insTCCT), thus confirming the diagnosis of GSD IIIa. The patient was then managed conservatively, who also remained under close follow-up. The present case highlights about importance of early recognition, histopathological correlation as well as molecular confirmation of GSD IIIa to facilitate timely management and long-term surveillance for potential progressive complications.

Pulmonary Artery Intimal Sarcoma: Unmasking a Rare and Lethal Mesenchymal Malignancy Mimicking Thrombus

Nayana Babu, Sheima R Das, TB Noufal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Pulmonary Artery Intimal Sarcoma (PAIS) is an aggressive, rare, and lethal malignant tumour arising from pluripotent mesenchymal cells in the pulmonary artery intima. It is an uncommon neoplasm that is frequently misdiagnosed because of its clinical and radiological resemblance to pulmonary thromboembolism. We report the case of a 29-year-old male who presented with right-sided chest pain, cough, and exertional dyspnoea of two weeks’ duration, with stable vital signs at presentation. Imaging studies such as roentgenography and CT thorax favour the diagnosis of pulmonary embolism. Patient underwent thrombolysis and failed. Further investigations, including anti-thrombin III, protein C, protein S, lupus anticoagulant, D-dimer, and bilateral lower limb venous Doppler studies, were performed to evaluate the cause of pulmonary embolism; however, all results were unremarkable. As the symptoms persist patient underwent pulmonary endarterectomy. Histopathological examination revealed an undifferentiated malignant mesenchymal neoplasm arising from the pulmonary artery intema. Immunohistochemical analysis demonstrated diffuse vimentin positivity, confirming mesenchymal origin, along with strong nuclear MDM2 positivity, supporting the diagnosis of PAIS. Negative staining for endothelial markers helped exclude vascular neoplasms.

A Case of Lupus Erythematosus Panniculitis of the Abdominal Wall: Imaging-cytopathological Association

Karthik Krishna Ramakrishnan, Priya Dharshini Rajaram, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Lupus Erythematosus Panniculitis (LEP), is an uncommon inflammatory manifestation of Systemic Lupus Erythematosus (SLE) characterised by immune-mediated inflammation of the subcutaneous adipose tissue. Abdominal wall involvement is uncommon and may mimic other inflammatory or neoplastic conditions, creating diagnostic difficulty. A 43-year-old female with long-standing SLE complicated by lupus nephritis presented with acute diffuse abdominal wall pain. Physical examination revealed ill-defined subcutaneous nodules with erythema and indurations. Ultrasound demonstrated heterogeneous subcutaneous tissue with poorly defined hypoechoic nodular foci. Ultrasound-guided Fine-Needle Aspiration Cytology (FNAC) showed lymphocytic panniculitis and degeneration of adipocytes and foamy macrophages. Non contrast Computed Tomography (CT) of the abdomen showed diffuse nodular stranding of fat within abdominal anterior wall and bilateral flanks with diffuse dystrophic calcifications in subcutaneous tissue. These imaging findings, in conjunction with the clinical and cytological features, were highly suggestive of LEP. The patient responded positively to corticosteroid pulse therapy followed by oral steroids. The present case emphasises diagnostic value of multimodality imaging and invasive cytological sampling in determination of panniculitis in patients with SLE.

Case Report of a Rare Anatomical Variation of Vertucci Type II Canal Configuration in Maxillary First Molar

Aradhana N Kibe, Akshayprasad P Thote, Rutuja S Gawarle, Joyeeta Mahapatra, Aayushi Pakhale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Different root morphologies and canal configurations have been associated with the first maxillary molar. It has significant clinical importance in endodontics. There are extensive studies documented in literature about additional roots and canals however, the occurrence of fewer roots or canals is comparatively rare and the clinicians must be aware about it. Such anatomical deviations lead to challenges during diagnosis, treatment planning and prognosis. If improperly identified it may lead to mishaps like leading to missed canals, perforations, instrument separation inadequate debridement of the root canal system and obturation etc. The case report describes the endodontic management of a maxillary first molar which had a single root in a 45-year-old female patient. For accurate radiographic assessment of the internal anatomy, Digital Volumetric Tomography (DVT) was used. It enabled identification of the root canal morphology which was Vertucci Type II (2-1) canal configuration. After access opening, one buccal orifice and one palatal orifice were located. These two canals merged into a single canal apically. Biomechanical preparation was performed using Protaper file system. Standard irrigation protocols were followed to ensure effective cleaning and disinfection. The canals were later obturated with calcium-hydroxide based sealer and single cone obturation technique. The patient was asymptomatic in the one-month review indicating the favourable treatment outcome and no complication. This case highlights the importance of careful clinical evaluation and using advanced imaging systems for such uncommon root canal anatomies.

Challenging Anaesthetic Management of a Child with Hunter Syndrome Undergoing Adenotonsillectomy and Hernia Repair: A Case Report

Anupama Kumari, Sara Mary Thomas, Jigisha Mehta, Pooja Arpan Shah Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Hunter syndrome, also known as Mucopolysaccharidosis type II (MPS II), is a rare X-linked lysosomal storage disorder caused by a deficiency in iduronate-2-sulfatase. This deficiency leads to the accumulation of Glycosaminoglycans (GAG) which affects multiple organ systems in the body, presenting significant challenges in conduct of anaesthesia. The present report presents a case of four-year-old male child with MPS II who required two surgical procedures six months apart-adenotonsillar resection and hernia repair (umbilical and inguinal). The uniqueness of the present case lies in the use of two different anaesthetic approaches for the same patient: general anaesthesia with challenging airway management for the first surgery and spinal anaesthesia with sedation for the second, thus avoiding repeated airway instrumentation. Preoperative evaluation revealed characteristic features such as coarse facial features, an enlarged head, macrocephaly, macroglossia, a short neck, a Mallampati grade III airway, an enlarged liver and mild mitral valve prolapse with regurgitation. Anticipating airway difficulties, spontaneous ventilation was maintained during induction of general anaesthesia; direct laryngoscopy revealed a Cormack-Lehane grade III view and intubation was successfully performed on the first attempt using a paediatric bougie and a flexometallic endotracheal tube. For the subsequent hernia repair, regional anaesthesia was deliberately chosen to circumvent the known airway risks and the procedure proceeded uneventfully. Both surgeries resulted in smooth recoveries. The present case highlights the importance of comprehensive preoperative assessment, careful airway management and adaptable anaesthetic planning, including the strategic use of regional techniques, to ensure safety in children with MPS II who require multiple surgeries during childhood.

An Unusual Presentation of Colonic Adenocarcinoma: A Case Report

R Kavin Shanmugavel, P Harshwanth Chandar, Mahalakshmi, Mohana Priya, D Balaji Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Colorectal cancer possesses a significant global health burden. Adenocarcinoma typically arises from a sequence of mucosal changes, and hence early screening and recognition are crucial for patient prognosis. However, varied clinical presentations and non-specific symptoms pose a diagnostic challenge. This case report will highlight the key clinical and pathological features of the colonic malignancy. A 45-year-old male presented with abdominal pain, melaena, and significant weight loss for a period of two months. On examination patient appears to be cachexic. On per abdomen examination, tenderness was present in the right iliac fossa, and per rectal examination showed black colored stools staining gloves and no Blumer’s shelf deposits. After colonoscopy, imaging and histopathological confirmation, Patient was diagnosed to be a case of locally advanced adenocarcinoma of the right colon with local spread to gluteal muscles. Patient was started on neoadjuvant chemotherapy for downstaging and resection which later formed gluteal abscess right-side. It was managed with regular dressing and paraentral supplement which showed healing on later stage and further chemotherapy was continued. This case report highlights the rarity of presentation of adenocarcinoma colon with local infiltration which later form local abscess and deposited in skin and subcutaneous region. Postsurgical management, patient developed enterocutaneous fistula which was managed conservatively with supportive measures. Fistula got closed spontaneously and the wound healed. Patient was started on chemotherapy; further tumour response is being assessed. The purpose of this case report is to review the nature of colonic malignancy and its presentation. The advanced cases are usually challenging and require multi-disciplinary approach and proper pre-operative planning.

Integrative Ayurvedic Management of Recurrent Gluteocutaneous Pyogenic Granuloma: A Case Report

Kamal Sahu, Pooja Shrivastav, Magesh Kirubakaran, Sampada Ghatbandhe Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Pyogenic granuloma is a rapidly proliferative vascular lesion marked by lobular capillary growth and fragile hypergranulation. While commonly small and responsive to excision, recurrent gluteocutaneous pyogenic granuloma is exceptionally rare. Recurrence after multiple debridements indicates dysregulated angiogenesis, excessive Vascular Endothelial Growth Factor (VEGF) expression, heightened inflammation, or aberrant wound remodeling. Ayurvedic evidence supports the use of anti-angiogenic, anti-proliferative and cytomodulatory interventions. This case presents a rare treatment-resistant pyogenic granuloma that responded to an integrative Ayurvedic protocol. A 38-year-old female presented with a large exophytic hypergranulated lesion on the right gluteal region that recurred despite three prior debridements. Post-debridement, an integrative Ayurvedic protocol was initiated: Apamarga Kshara and Tamra Bhasma dusting, followed by Yashtimadhu Ghrita dressings, oral Yashtimadhu tablets, and short-term intravenous antibiotics. Healing parameters including pain, discharge, granulation tissue coverage, and wound appearance were graded using established wound-assessment scales. Significant improvement appeared by Day 7, with reduction in pain and discharge and formation of healthy granulation tissue. By Day 14, pain and discharge resolved completely, and full granulation coverage was achieved. Complete healing with a healthy scar occurred by Day 45. Follow-up at 1, 3, and 6 months showed stable healing with no recurrence, a rare outcome given the lesion’s prior aggressive behaviour. The observed clinical response is biologically plausible based on contemporary experimental studies suggesting anti-proliferative and angiogenesis-modulating properties of certain constituents; however, these mechanisms are not directly described in classical Ayurvedic texts and remain interpretative correlations. This rare case demonstrates that an integrative Ayurvedic protocol can successfully treat recurrent, angiogenesis-driven pyogenic granulomas unresponsive to conventional management. The outcome is supported by classical principles and modern pharmacological evidence.

Incidentally Detected Dual-feeder Pulmonary Arteriovenous Malformation Mimicking a Pulmonary Mass on CT: A Case Report

Praveen K Sharma, Priya Dharshini Rajaram, Vinoth Pandian, Arun Kumar, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Pulmonary Arteriovenous Malformations (PAVMs) are uncommon abnormal vascular communications between pulmonary arteries and pulmonary veins, resulting in right-to-left shunting. Although many lesions are asymptomatic and incidentally detected, PAVMs are clinically important because they may cause hypoxaemia, paradoxical embolism, stroke, or cerebral abscess. A 56-year-old female presented with fever, cough, and breathlessness of one week’s duration. She was a known case of type 2 diabetes mellitus and systemic hypertension on regular medical treatment. On examination, the patient was febrile, with a reduced resting Oxygen Saturation (SpO2 82% on room air), requiring supplemental oxygen. Initial chest radiograph demonstrated a focal, lobulated opacity in the right mid- and lower-lung zones. Non contrast chest Computed Tomography (CT) revealed a well-defined, multilobulated, soft-tissue density lesion in the right middle lobe abutting the pleura and pericardium, raising suspicion for a pulmonary neoplasm. Further evaluation with contrast-enhanced CT pulmonary angiography demonstrated intense, homogeneous enhancement of the lesion, with two feeding arteries arising from the right middle lobar pulmonary artery and drainage into the left atrium via a large accessory pulmonary vein, consistent with a complex aneurysmal PAVM. The diagnosis was subsequently confirmed on catheter digital subtraction angiography. The patient was managed conservatively with supportive care and optimisation of associated co-morbid conditions and close clinical follow-up. This case highlights the importance of contrast-enhanced CT angiography in differentiating PAVMs from pulmonary mass lesions and in accurately delineating angioarchitecture anatomy for management planning.

Papillary Thyroid Carcinoma in a Toxic Retrosternal Goitre: A Case Report

Manali Jain, Rajan Vaithianathan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Thyroid nodules are common worldwide, with Multinodular Goitre (MNG) accounting for the majority of benign thyroid disease. Although hyperfunctioning (“toxic”) nodules have traditionally been considered at low-risk for malignancy because of chronic Thyroid Stimulating Hormone (TSH) suppression, emerging evidence suggests a clinically significant incidence of occult carcinoma, particularly in the presence of underlying molecular alterations. Retrosternal extension further complicates evaluation. A 64-year-old woman presented with a five-year history of painless anterior neck swelling and a recent onset of difficulty in breathing when lying down. Clinical and biochemical evaluation revealed hyperthyroidism, and imaging demonstrated a large, heterogeneous thyroid mass with retrosternal extension and compressive features. Due to concerning clinical and imaging findings, she underwent total thyroidectomy. Histopathology confirmed a follicular variant of papillary thyroid carcinoma arising within a toxic MNG. The patient recovered well postoperatively with levothyroxine replacement and remained asymptomatic at follow-up. This case highlights the rare occurrence of malignancy within a hyperfunctioning thyroid nodule and underscores the importance of thorough evaluation and multidisciplinary management in patients with atypical thyroid swellings, especially when retrosternal extension or suspicious imaging features are present.

Stump Appendicitis after Previous Appendicectomy: A Case Report

Prashant Hombal, Anupama Gudadappanavar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Acute appendicitis remains one of the most common causes of attendance to the Emergency Department that culminates in urgent surgery. Stump appendicitis is a rare but important delayed complication of appendectomy, characterised by inflammation of residual appendiceal tissue. Even more unusual is its presentation as a cutaneous swelling, which can lead to diagnostic delays. The present case report describes a 26-year-old male patient who presented with swelling at the previously operated site three months after an open appendectomy. Computed Tomography (CT) imaging showed an air pocket in the subcutaneous plane with an adherent stump of the appendix to the parietal peritoneum, and operative findings confirm the presence of a remnant appendix adherent to the parietal peritoneum with an overlying cutaneous sinus tract. The patient was re-explored with a diagnostic laparoscopy, wherein the remnant appendix was identified and excised completely. The postoperative period was uneventful, and the patient made a complete recovery. The current case highlights the importance of maintaining a high-index of suspicion in patients with post-appendectomy right lower quadrant symptoms. Awareness of this condition among clinicians and careful radiological evaluation are essential for timely diagnosis. Early recognition and prompt surgical management are crucial to prevent serious complications and ensure favourable patient outcomes.

Chronic Occupationally Exacerbated Vipadika (Palmar Psoriasis): A Case Report

Rutuja Satish Ighare, Shital Rahul Rasane, Kirti Bhausaheb Gaikwad, Aishwarya Ramesh Takawane Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Palmar psoriasis is a chronic, immune-mediated inflammatory dermatosis characterised by erythematous, hyperkeratotic, scaly lesions associated with pruritus and considerable impairment in quality of life. In Ayurveda, skin disorders are broadly classified under Kushtha, and based on its clinical manifestations, palmar psoriasis can be correlated with Vipadika. This case report describes the Ayurvedic management of a 29-year-old male shopkeeper who presented with persistent scaly plaques, severe itching, marked erythema, and hyperpigmentation involving both palms and the dorsum of the hands for the past four years. The diagnosis of palmar psoriasis was made on the basis of clinical presentation. Auspitz sign was negative, and the baseline Psoriasis Area and Severity Index (PASI) score was 15, indicating moderate disease severity. This reduced to three after treatment. The patient was treated with Arogyavardhini Vati (500 mg twice daily), Patoladi Kashaya (20 mL twice daily), Panchatikta Ghrita (20 mL on an empty stomach), Gandhaka Rasayana (125 mg twice daily), Kaishor Guggulu (500 mg twice daily), and Bruhat Manjishtadi Kwatha (20 mL twice daily). External applications included Kushtarakshasa Taila and Tankan Bhasma (purified borax pow-der), along with prescribed dietary and lifestyle modifications. Clinical assessment at the end of 57 days of active internal treatment, with a total observation and follow-up period of 144 days (~20 weeks), showed marked reduction in scaling, pruritus, erythema, and hyperpigmentation. The PASI score decreased significantly from fifteen to three. The findings suggest that a structured Ayurvedic poly-herbal regimen combined with appropriate dietary and lifestyle interventions may offer an effective therapeutic approach for the management of psoriasis.

Functional Outcome of Distal Biceps Tendon Repair using Suture Bridging with Endobutton and Suture Anchor: A Case Report

T Mari Saravanan, B Vijay Anand, S Devi Prasad, J Kevin Dhas Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Distal biceps tendon rupture is a rare injury, accounting for less than 10% of all biceps injuries, often resulting in significant loss of elbow flexion and supination strength. This reports a 40-year-old male who sustained a complete rupture of the right distal biceps tendon during heavy lifting. Surgical repair was performed using a suture bridging construct with Endobutton and suture anchor fixation. At three months postoperatively, the patient achieved near-normal range of motion (flexion 130°, supination 80°) and full muscle strength (5/5). No complications including stiffness, infection, or re-rupture, were observed, and the patient returned to work with full functional recovery. Suture bridging with Endobutton and suture anchor fixation is a reliable and reproducible technique for distal biceps tendon repair, providing excellent functional outcomes, allowing early rehabilitation, and being particularly suitable for active individuals.

Anaesthetic Management of a Child with Poland Syndrome undergoing Left Inguinal Herniotomy: A Case Report

Poongani Nagarajan, Aruna Parameswari, Soma Ganesh Raja Neethirajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Poland syndrome is a rare congenital disorder characterised by unilateral absence or hypoplasia of the pectoralis major muscle, often associated with ipsilateral chest wall deformities, rib anomalies, and upper limb abnormalities. The severity of presentation varies widely, ranging from mild cosmetic deformities to significant thoracic asymmetry and respiratory compromise. Anaesthetic management in such patients can be challenging because of altered respiratory mechanics, associated musculoskeletal anomalies, difficult airway considerations, and the possible association with Malignant Hyperthermia (MH). Careful perioperative evaluation and individualised anaesthetic planning are therefore essential to ensure patient safety. Authors report the anaesthetic management of a six-year-old child with Poland syndrome posted for elective left inguinal herniotomy. The child had left-sided chest wall hypoplasia, thoracic hemivertebrae, mild kyphosis, and right thumb dysplasia, with preserved cardiopulmonary function. Considering the possible risk of MH, a trigger-free anaesthetic technique was planned. The anaesthesia workstation was prepared by removal of vaporisers and high-flow oxygen flushing before induction. Total Intravenous Anaesthesia (TIVA) using propofol with atracurium was administered, and airway management was successfully achieved using an i-gel supraglottic airway device. An ultrasound-guided Quadratus Lumborum (QL) block provided effective perioperative analgesia and minimised opioid requirement. Intraoperative haemodynamics and ventilation remained stable, and recovery was uneventful. This case highlights the importance of meticulous preoperative assessment, avoidance of triggering agents, and the role of multimodal anaesthetic techniques in ensuring safe perioperative management of children with Poland syndrome.

Auxiliary-assisted Torque Correction for Three-dimensional Finishing of Labially Impacted Maxillary Canine: A Case Report

Aishwarya Rajesh Atey, Rizwan Gilani, Shefali Singh, Abhijeet Kadam, Gauri Wagh Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Impaction of the tooth often requires combined surgical and orthodontic management and presents a significant clinical challenge due to functional and aesthetic importance. Successful treatment depends not only on eruption and alignment of the impacted tooth, but also on precise control of root position and torque to achieve functional, aesthetic, and periodontal stability. A 14-year-old female patient presented with spacing in the maxillary anterior region and a clinically missing maxillary right canine. Clinical examination revealed a labial bulge in maxillary right region. Orthopantomogram (OPG), lateral cephalogram, and CBCT revealed a labially impacted maxillary right canine with mesial crown displacement. Treatment was carried out using pre-adjusted edgewise MBT 0.018-inch slot appliance. The impacted canine was surgically exposed using an open surgical exposure technique, and orthodontic traction was initiated simultaneously with space creation. The canine was gradually guided into the arch and subsequently refined using piggyback mechanics. Although satisfactory crown alignment was achieved, residual torque discrepancy necessitated the use of Begg-type torquing auxiliary. To improve three-dimensional root positioning.The total treatment duration was 18 months. Post-treatment CBCT confirmed favourable crown positioning, improved root angulation, and appropriate positioning within the alveolar housing. This case highlights that successful management of impacted maxillary canines extends beyond crown alignment alone. Coordinated biomechanics, auxiliary-assisted torque correction, and radiographic verification of root position can significantly improve three-dimensional finishing and contribute to stable, functionally and periodontally favourable outcomes with improved long-term stability.

Elusive Nature of Schizotypal Personality Disorder: A Case Report on Diagnostic and Treatment Challenges

Amit Dattatraya Khune, Srinivas Rajkumar, Anoop Jose Alappat, Priya Sivashankar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Schizotypal Personality Disorder (SPD) is characterised by pervasive social and interpersonal deficits, cognitive–perceptual distortions, and eccentric behaviour, and is frequently misdiagnosed due to symptom overlap with schizophrenia, anxiety, and obsessive-compulsive symptoms. It occupies a distinct position across diagnostic systems, being placed within schizophrenia spectrum disorders in the International Classification of Diseases, 11^th Revision (ICD-11), while the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies it under Cluster A personality disorders. This case describes a 25-year-old male who initially presented with social anxiety and ritualistic behaviours and was diagnosed with social anxiety disorder with obsessive-compulsive features. In subsequent visits, additional diagnoses of depression and psychosis were considered based on the evolving symptom profile. He responded poorly to treatment despite multiple trials of medications and inpatient care. On his fourth admission, a comprehensive evaluation with diagnostic psychometry was undertaken, incorporating birth and developmental history and thorough tracking of the longitudinal course of symptoms, which revealed an enduring pattern of eccentric behaviour, persistent odd beliefs, impaired interpersonal functioning, constricted affect, transient stress-related suspiciousness, and poor treatment adherence, leading to significant occupational and social impairment. The diagnosis was revised to SPD, and he was treated with psychotherapy and pharmacotherapy. The case highlights the importance of a Kraepelinian longitudinal approach to evaluation in psychiatry, which is often neglected in contemporary practice.

Intravenous Nimodipine Associated Severe Metabolic Acidosis and Haemodynamic Collapse in patient with Aneurysmal Subarachnoid Haemorrhage: A Case Report

Rolly Malhotra, Karthavya Sasuveghatta Lingappa, Somnath Chatterjee Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Nimodipine is a dihydropyridine Calcium Channel Blocker (CCB) routinely used in the management of aneurysmal Subarachnoid Haemorrhage (aSAH) to prevent Delayed Cerebral Ischemia (DCI). While oral route of administration is the standard of care, intravenous (i.v.) nimodipine is occasionally used in critically ill patients. However, i.v. administration may lead to profound hypotension and uncommon metabolic derangements. A 54-year-old hypertensive female presented with aSAH secondary to ruptured left anterior communicating artery aneurysm. Following aneurysm clipping, the patient was monitored in ICU with standard neurocritical care and oral nimodipine. The patient was transitioned to i.v. nimodipine due to high clinical suspicion of cerebral vasospasm and DCI. Within 48 hours of i.v. nimodipine, the patient developed severe hypotension requiring high-dose vasopressor support, mixed metabolic acidosis, hyperchloremia, ketonemia, and hyperglycaemia. Workup for sepsis, postsurgical meningoencephalitis, and other causes was inconclusive. An adverse drug reaction related to i.v. nimodipine was suspected. Discontinuation of nimodipine and targeted metabolic support led to improvement of clinical symptoms. This case highlights the rare but potentially life-threatening adverse effects of i.v. nimodipine, including refractory hypotension and severe metabolic acidosis. Clinicians should exercise caution, maintain close monitoring, and consider drug-induced toxicity when unexplained metabolic and haemodynamic instability occurs. The present case emphasises that vigilant haemodynamic and metabolic monitoring during i.v. nimodipine therapy is essential.

Reconstruction of a Marjolin’s Ulcer Arising in a Chronic Diabetic Foot Ulcer Using an Anterolateral Thigh Flap: A Case Report

Kyatham Shishir, Firoz Borle, Chandrashekhar Mahakalkar, Suresh Chandak, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Marjolin’s ulcer is known as the malignant transformation of long-standing chronic wounds, which usually develops into a well-differentiated Squamous Cell Carcinoma (SCC). These lesions are frequently seen over non-healing ulcers of the foot. Management of such cases of malignancy poses a great challenge due to the limited reconstructive options available, particularly in resource-constrained and rural healthcare settings. Consequently, below-knee amputation also remains the most adopted treatment approach, resulting in considerable morbidity and loss of function. However, with the availability of reconstructive techniques as well as microsurgical expertise, limb salvage is increasingly feasible and a better option in patient care. Microvascular free flap reconstruction allows adequate excision of the malignancy, coverage of exposed bone, and restoration of ambulation, thereby reducing morbidity and improving the patient’s quality of life. The present case report highlights a case of an elderly 76-year-old male with diabetes and a history of Hansen’s disease, having a non-healing ulcer over right foot for the past two years. Biopsy in the present case suggested well-differentiated SCC. The lesion was treated by wide local excision followed by Anterolateral Thigh (ALT) free flap reconstruction for achieving oncologic clearance as well as functional restoration. The current case highlights the role and effectiveness of ALT flap reconstruction for accomplishing durable as well as functional limb salvage.

Unexpected Airway Obstruction Following Tracheostomy in a Patient Undergoing Head and Neck Surgery: A Case Report

Pranav Ashok Gurrapu, Sheetal Madavi, Nikhil Balerao, Amreesh Paul Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Airway management in patients with previous head and neck surgery poses significant challenges owing to anatomical distortion, limited mouth opening, and postoperative tissue changes. We report a case of a 43-year-old male with hypertension, diabetes, and recently diagnosed hypothyroidism who had undergone Wide Local Excision (WLE) with partial mandibulectomy and Pectoralis Major Myocutaneous (PMMC) flap reconstruction three months earlier. Scheduled for resection and Anterolateral Thigh (ALT) flap reconstruction for an ulcer in the buccal region, with a planned tracheostomy, awake fibreoptic nasal intubation was done under dexmedetomidine sedation and lignocaine topicalisation due to restricted temporomandibular joint movement and altered airway anatomy. General Anaesthesia (GA) was maintained with sevoflurane, fentanyl, and rocuronium. At the end of an uneventful surgery, a tracheostomy was performed to protect the airway during the postoperative period. Within minutes, the anaesthesia team detected a sudden loss of capnography, increased airway pressures, and absent chest rise indicative of total airway obstruction. A circuit check revealed no issues, and suctioning the tube did not resolve the issue. Fibreoptic bronchoscopy was done through the tracheostomy tube, which revealed a mucosal fold obstructing the distal end of the tracheostomy tube. The tracheostomy tube was immediately removed, and the patient was reintubated nasally under fibreoptic guidance. Postoperatively, the patient was administered dexamethasone to decrease airway oedema and was shifted to the Intensive Care Unit (ICU) for observation and elective ventilation. Two days later, fibreoptic bronchoscopy indicated a clear airway, and the patient was successfully extubated. This case highlights the importance of vigilant monitoring, prompt recognition, and management of airway obstruction, as well as the critical role of fibreoptic bronchoscopy in managing such complex situations in head and neck reconstructive surgery.

Localised Tenosynovial Giant Cell Tumour of the Great Toe: A Case Report

Anurag Choudhary, Dharun Kumar, G Pugazhendhi, C Vasanthkumar, Yogeshwar Agharkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Tenosynovial Giant Cell Tumour (TGCT) is a benign proliferative lesion arising from the synovium of tendon sheaths, bursae, or joints. Although localised TGCT is usually described in the digits of the hand, involvement of the foot and isolated great toe lesions remain uncommon. We report a 20-year-old female with no known medical comorbidities who presented with a four-year history of gradually progressive swelling over the plantar aspect of the left great toe, associated with intermittent dull aching pain. Clinical examination revealed a firm, well-circumscribed soft-tissue mass with preserved first metatarsophalangeal joint motion and intact distal neurovascular status. Magnetic Resonance Imaging (MRI) demonstrated a well-defined lesion along the plantar aspect of the first metatarsal and proximal phalanx, encasing the flexor hallucis longus tendon, while Fine-Needle Aspiration Cytology (FNAC) suggested a benign tenosynovial lesion. The tumour was excised en bloc with preservation of the flexor hallucis longus tendon, and histopathological examination confirmed localised TGCT. The lesion was classified as Al-Qattan type I because it was a solitary encapsulated nodule without satellite lesions. The postoperative course was uneventful, and no clinical recurrence was noted at four weeks. This case emphasises the importance of considering TGCT in the differential diagnosis of persistent toe swellings and highlights the role of meticulous complete excision in reducing recurrence risk.

Neglected Posterior Hip Dislocation with Grade II Avascular Necrosis of Femoral Head Managed with Open Reduction and Staged Soft-tissue Release: A Case Report

Dhairya Vijay Veragiwala, Suhas Landge, Ulhas Dudhekar, Mandeep Mangla Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Neglected traumatic dislocation of the hip in adults is uncommon and presents significant challenges because of soft-tissue contracture and intra-articular changes. A 33-year-old male presented with persistent right hip pain and difficulty walking for eight months following a trivial fall that was initially neglected. Clinical examination revealed limb shortening with fixed deformity, while imaging confirmed chronic posterior hip dislocation with secondary changes in the femoral head. Management included open reduction, excision of intra-articular fibrofatty tissue, and core decompression. Persistent residual flexion deformity required staged sartorius tenotomy. Postoperative rehabilitation resulted in significant pain relief, improved range of motion, and satisfactory functional recovery. This case demonstrates that even delayed presentations of neglected posterior hip dislocation can be managed successfully with careful surgical planning, adequate soft-tissue release, and staged intervention when required.

Behavioural Disturbances and Cognitive Impairment in an Elderly Male with Multiple Co-morbidities: A Case Report Highlighting Diagnostic Challenges

VM Niranjana, Suvarna Jyothi Kantipudi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X The mental health burden of ageing population has increased due to various factors including elder abuse, multiple medical co-morbidities, loss of functional and economic independence, social restrictions with age despite developments in healthcare. Depression and dementia are common yet frequently underrecognised conditions because of atypical presentations, symptom overlap, ageism in the culture, low mental health literacy, and limited rural access to specialist care especially in low- and middle-income countries such as India. The present case report aimed to highlight diagnostic challenges at the interface of depression and baseline cognitive impairment in an older adult with predisposing psychosocial vulnerability. A 60-year-old male with diabetes mellitus, coronary artery disease previously treated pulmonary tuberculosis, who underwent recent surgeries, with intellectual disability, and unassessed bilateral, hearing loss progressive social withdrawal, reduced oral intake, irritability, poor sleep, and behavioural disturbances. Although he initially denied low mood, anhedonia, suicidal ideation and presented with prominent somatic preoccupation, subsequent interviews elicited moderate to severe depressive symptoms and suicidal intent linked to family conflict in the context of bereavement and functional decline. A final diagnosis of severe depression was made, with Hamilton depression rating scale score of 26. Medical investigations (blood counts, hepatic/renal function, electrolytes, glucose, thyroid function, urinalysis) and Magnetic Resonance Imaging (MRI) brain were unremarkable. Cognitive evaluation using the Addenbrooke’s Cognitive Examination showed global impairment (37/100), but interpretation was complicated by low education and pre-existing intellectual disability. Audiometry confirmed bilateral mixed hearing loss, but financial barriers limited access to hearing aids. Treatment with sertraline, psychoeducation, and cognitive retraining led to clinical and functional improvement. The present case underscores the need for comprehensive biopsychosocial assessment, careful longitudinal differentiation of depression from dementia in the presence of baseline cognitive impairment, and multidisciplinary care addressing sensory deficits and social determinants.

Isolated Primary Tuberculous Osteomyelitis of the Distal Tibia in Early Childhood: A Case Report

Krishna D Sambare, Nareshkumar Dhaniwala, Ansh Khanduja, Shashank Yadav, Harsh Patel Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Tuberculous osteomyelitis is an uncommon manifestation of extrapulmonary tuberculosis, accounting for 1-3% of all tuberculosis cases and 10-15% of musculoskeletal tuberculosis. Isolated involvement of the distal tibia in early childhood is rare and often mimics other chronic infective or neoplastic bone conditions, making diagnosis challenging. A two-year-old female child presented with a six-week history of swelling and dull, progressive pain over the distal left leg. Radiography and Magnetic Resonance Imaging (MRI) revealed a well-defined lytic lesion in the metaphyseal-diaphyseal region of the distal tibia suggestive of osteomyelitis. Surgical decompression and curettage were performed and histopathological examination showed epithelioid granulomas, Langhans-type giant cells and caseous necrosis, confirming tuberculous osteomyelitis. The patient was treated with a fixed-dose anti-tubercular drug regimen- two months of intensive phase followed by 12 months of continuation phase. Follow-up radiographs at four weeks and 12 months demonstrated progressive cavity healing and cortical remodelling, with the patient achieving full, pain-free mobility. Early diagnosis and prompt management of tuberculous osteomyelitis are crucial to prevent deformity and growth disturbances. Combined surgical curettage and Anti-Tubercular Therapy (ATT) provide excellent outcomes, as demonstrated in this rare case of distal tibial involvement in a young child.

Anaesthetic Management of Post-intubation Tracheal Stenosis using a Supraglottic Airway: A Case Report

Abhigna Gummalla, Vivek Chakole, Amreesh Paul Francis Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Patients who have undergone prolonged intubation may develop Tracheal Stenosis (TS). Patients with TS may experience a range of symptoms, including shortness of breath, noisy breathing, and changes in voice. This case reports on the anaesthetic management of a 21-year-old male who presented with these symptoms and was confirmed to have stenosis at the levels of C7 and C8. The patient’s condition was probably related to a long intubation period because of respiratory failure, and he had an airway obstruction risk due to the TS. Anaesthesia was induced with propofol, and the patient was not given any muscle relaxants. The patient’s ventilation was facilitated through a Laryngeal Mask Airway (LMA) during stenting of the tracheal lesion by interventional radiology. The patient’s haemodynamics and oxygenation remained stable, and the airway was managed with a guidewire placed in the larynx and balloon dilation of the tracheal lumens, followed by successful deployment of the stents without interruption of ventilation. The patient tolerated the procedure well and recovered smoothly without any signs of airway complications. The novelty of this case lies in the successful maintenance of spontaneous ventilation without neuromuscular blockade during tracheal stenting, ensuring airway safety in a high-risk stenotic lesion. This case illustrates the critical role of good anaesthetic planning and intra- and interdisciplinary coordination in caring for patients with critical TS undergoing interventional procedures.

Buccal Cyst with Respiratory Epithelium: A Diagnostic Dilemma: A Case Report

Prajakta Ravindra Patil, Sunil Surendraprasad Mishra, Mamatha Puroshotam Reddy, Anupama Anand Chavan, Parag Uday Wankhede Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Teratoid, dermoid and epidermoid cysts are rare, developmental, non odontogenic lesions that are derivatives of germinative epithelium. Epidermoid cysts are most frequently reported in the floor of the mouth, with uncommon occurrence in the buccal mucosa. Dermoid cysts in this location have not been documented and the evidence of respiratory epithelium within such cysts and location is exceedingly rare. A 55-year-old female presented with a painless and slowly enlarging swelling in the left buccal mucosa. Imaging suggested a mucous retention cyst because of its cystic appearance and well-defined margins, but after surgical excision, histopathology revealed a cystic wall partly lined by ciliated pseudostratified columnar epithelium of respiratory type. Such lining is extremely rare in oral cysts and has not been reported in the buccal mucosa. The postoperative phase was uneventful and no recurrence was reported during follow-up. This case is noteworthy as respiratory-type epithelial lining has rare occurrence in oral cysts and that too within the buccal mucosa. This case emphasises the importance of histopathology in confirming unusual variants and highlights the limitations of clinic-radiographic diagnosis and adds to the limited literature on oral cysts with respiratory epithelium.

Histopathological Diagnosis of an Intramuscular Ganglion Cyst: A Rare Case Report with Clinicopathological Correlation

Bhagyashri R Hungund, Shrishail Metgud, Tanvi Chaubey Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Ganglion cysts are benign soft-tissue lesions with no true epithelial lining containing gelatinous fluid like material composed of hyaluronic acid and mucopolysaccharides. They usually arise from joint capsule and rarely from the tendon sheath, cartilage, cruciate ligaments, nerves. Hand and wrists are the common sites of occurrence. Intramuscular ganglion cyst arising within the muscle of lower limb is a rare entity with limited number of cases reported in the literature. These deep-tissue lesions present significant diagnostic challenges frequently mimicking other soft-tissue masses or tumours. This case report describes a 28-year-old male who presented with a tender, slow growing swelling on the anterolateral aspect of his left lower limb. It was painful on walking and straining which had persisted for past one month. On physical examination, the swelling measured 10×4 cm on anterolateral aspect of left lower limb, tender, cystic in consistency, non-mobile and fixed deep in the muscle. Skin over the swelling appeared normal. Notably, the patient reported no prior history of trauma or any other surgeries. Radiological investigations like Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) suggested the swelling to be a cystic lesion. Involvement of extensor digitorum longus muscle was suspected. The swelling was excised and sent for histopathological evaluation. The diagnosis of intramuscular ganglion cyst was made. The patient showed recovery postsurgery and there was no recurrence of the swelling seen in the subsequent follow-up. This case demonstrates the necessity of a comprehensive diagnostic workup when evaluating cystic lesions in atypical locations.

Traumatic Rupture of the Left Hemidiaphragm with Intrathoracic Herniation of the Stomach, Hydropneumothorax and Gastric Perforation: A Case Report

Mohammed Azeem Khan, Chandrashekhar Mahakalkar, Ashutosh Babhulkar, Akansha Hatewar, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Traumatic Diaphragmatic Rupture (TDR) is a rare but also serious sequela of high-energy blunt thoracoabdominal trauma, which is frequently associated with concomitant thoracic as well as intra-abdominal injuries. Delayed or missed diagnosis can result in life-threatening complications because of visceral herniation and strangulation. A 28-year-old male from India presented after a motorcycle-related fall with chest pain, dysponea and left hypochondrial tenderness. Initial imaging of the patient showed left-sided diaphragmatic rupture with herniation of the entire stomach into the thoracic cavity, which was associated with hydropneumothorax, near-complete lung collapse, multiple rib fractures, and a grade III splenic injury. Contrast-Enhanced Computed Tomography (CECT) of the patient further confirmed a large posterior diaphragmatic defect measuring approximately 7 cm. Emergency exploratory laparotomy showed a left diaphragmatic rupture, also having herniated stomach and bowel, gastric perforation, and significant splenic laceration. Surgical management included reduction of herniated viscera, primary diaphragmatic repair, splenectomy, and closure of the gastric perforation, along with intercostal drainage. The present case underscores the importance of early recognition, comprehensive imaging, and adequate surgical management of TDR to prevent severe morbidity and mortality.

Intraoperative Ventricular Tachycardia during Neonatal Tracheoesophageal Fistula Repair: An Anaesthetic Challenge

Kola Kavya Praneetha, Jayashree Sen, Amreesh Paul, Pardhasaradhi Kapusetti Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X The anaesthetic risk for neonate Tracheoesophageal Fistula (TEF) repair is high due to immature physiology, airway abnormalities, frequent congenital anomalies, limited cardiovascular reserve in the early neonatal period, and the emergency nature of the surgical intervention, which usually allows only a short time for complete preoperative optimisation. This case is a report of a four-day-old male neonate weighing 2.5 kg posted for emergency TEF repair who developed sudden intraoperative ventricular tachycardia and cardiac arrest with successful resuscitation. The neonate was brought to the hospital exhibiting excessive salivation and feeding intolerance since birth. Along with dextrocardia, thrombocytopenia, indirect hyperbilirubinaemia, and periventricular hyper-echogenicity, other abnormalities were also found during the preoperative workup. Being a physical status IV E patient according to the American Society of Anaesthesiologists classification, the child was put under general anaesthesia with ketamine, fentanyl, propofol, and atracurium. Intubation was performed with a 2.5 mm uncuffed endotracheal tube. About an hour into the operation, close to the end of the procedure, the patient suddenly experienced cardiovascular collapse with ventricular tachycardia, which eventually led to intermittent asystole. Immediate Cardiopulmonary Resuscitation (CPR), including defibrillation and adrenaline administration, led to the return of spontaneous circulation after one cycle. The neonate was stabilised with a noradrenaline infusion and is currently under the care of the Neonatal Intensive Care Unit (NICU) following the surgery. Additional investigations revealed alterations in cardiac conduction and transient metabolic derangements, which were assumed to be the cause of the incident. Such scenarios underscore the critical importance of patient safety during neonatal TEF repair. This includes vigilant perioperative monitoring, thorough preparedness for the potential development of malignant arrhythmias, and the availability of advanced resuscitation equipment at all times.

Uncommon Variant of Ossifying Fibroma (Psammomatoid Type) in an Adult Patient: A Case Report

Rathinasamy Kadhiresan, Kumar Nalin, Ekambaram Deepika, Cynthia Jenifer, Praveen Arokia Antony Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Ossifying Fibroma (OF) is a fibrous neoplasm lesion characterised by various amounts of calcified tissue, such as bone or cementum within a cellular fibrous stroma. Juvenile Ossifying Fibroma (JOF) is a rare benign fibro-osseous neoplasm seen in children and also young adults. The most frequent sites involved sinonasal, orbital, and jaw bones. Based on clinicopathological features, JOF is classified into two distinct variants: Trabecular JOF (TrJOF) and Psammomatoid JOF (PsJOF). The trabecular variant is more commonly seen in the jaw bones and is characterised histologically by trabeculae of immature woven bone within a cellular stroma. In contrast, the psammomatoid variant also referred to as Psammomatoid OF (POF), typically affects the paranasal sinuses, orbit, and craniofacial bones. It is characterised histopathologically by the presence of numerous small, round, psammoma-like ossicles embedded in a densely cellular fibrous stroma. POF is a rare, benign, fibro-osseous variant of OF exhibiting short-term rapid growth and has a high recurrence rate. The diagnosis is based on radiographic and histopathological findings, hereby, the authors present a case report of a psammomatoid variant of OF in right maxillary region in a 26-year-old male patient presented with a mild swelling and pain in the right upper tooth region for past one week. After clinical, radiological, and histological examinations, the diagnosis was confirmed as POF. Surgical excision was performed. There were no signs of recurrence or complications.

Morquio Syndrome Type IVA, an Autosomal Recessive Lysosomal Storage Disorder in a 7-year-old Female: A Case Report

M Sherin Fathima, Vijayalakshmi Samudi, Sundari Subramanian, S Mohamed Ibrahim Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Mucopolysaccharidosis Type IV (Morquio syndrome) is a rare autosomal recessive lysosomal storage disorder caused by deficiency of N-acetylgalactosamine-6-sulfatase, resulting in progressive accumulation of Glycosaminoglycans (GAG) in multiple tissues. The disorder primarily affects skeletal development and is characterised by short stature, skeletal dysplasia, kyphoscoliosis, pectus carinatum and genu valgum, while intelligence is usually preserved. Diagnosis is established through biochemical and genetic investigations demonstrating elevated levels of keratan sulfate and chondroitin-6-sulfate along with reduced enzyme activity. Management is mainly supportive and involves Enzyme Replacement Therapy (ERT), orthopaedic interventions and multidisciplinary monitoring to improve functional capacity and quality of life. A seven-year-old female child presented with progressive lower limb deformities and inability to walk. Clinical evaluation revealed characteristic skeletal abnormalities with normal cognitive function. A history of third-degree consanguinity and sibling mortality with similar complaints raised suspicion of an inherited metabolic disorder. Enzyme assay confirmed Morquio syndrome Type A. Although ERT was advised, logistic and financial constraints limited its availability. The present case emphasises the importance of early diagnosis, genetic counselling and family screening, particularly in populations with high prevalence of consanguineous marriages, to facilitate timely intervention and improve long-term outcomes.

Posterior Tibial Artery Pseudoaneurysm Mimicking an Abscess after Tibial Interlocking Nailing: A Case Report

Yogeshwar Atul Agharkar, Rathina Easwar V Ra, Nimish Manoj Mehta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Postoperative swelling following fracture fixation is commonly attributed to infection, seroma, or haematoma. However, rare vascular complications such as pseudoaneurysm can closely mimic an abscess and pose a diagnostic challenge. We report a case of posterior tibial artery pseudoaneurysm presenting as a suspected abscess in a 45-year-old male following intramedullary interlocking nailing for a distal third tibia-fibula fracture sustained in a road traffic accident. Three weeks postoperatively, the patient presented with a painful, progressively enlarging swelling with local warmth and erythema. Laboratory parameters showed mildly elevated inflammatory markers. Clinical suspicion of abscess was reconsidered due to the presence of an expansile, mildly pulsatile swelling with reduced distal pulses. Colour Doppler ultrasonography demonstrated a characteristic Yin-Yang sign, and CT angiography subsequently confirmed a pseudoaneurysm arising from the posterior tibial artery. The patient was successfully treated with endovascular embolisation, with complete resolution of symptoms and preserved limb perfusion. This case highlights the importance of considering vascular injuries in atypical post-operative swellings.

Pleomorphic Adenoma of Submandibular Gland: A Rare Case Report

Mohak Kumar, Priyanka Singla, Vinod Shinde, Manu S Babu, Mayur Ingle Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X A benign mixed tumour, or Pleomorphic Adenoma (PA), is the most prevalent form of salivary gland neoplasm. Submandibular gland involvement is rather rare, accounting for 8-10% of all salivary gland tumours, but the parotid gland is the site of most occurrences. The present case report describes a rare case of PA that originated from the right submandibular gland. Here, the authors present a case of a 38-year-old female who presented with the main complaint of right side cervical swelling (located inferior to angle of mandible) since two years, insidious in onset and gradually progressive in nature. On examination the swelling was firm, well defined, mobile, measuring approximately 2×2 cm. Rest of the Ear, Nose and Throat (ENT) examination was normal. Ultrasonography (USG) of local region was done which demonstrated a well-defined hypoechoic lesion in the right submandibular gland measuring 18×12 mm showing posterior acoustic enhancement and mild internal vascularity on colour Doppler. PA needs consideration. Fine Needle Aspiration Cytology (FNAC) and Computed Tomography (CT) scan were done further to confirm the diagnosis. Histopathological examination of the excised specimen confirmed the lesion as a PA. The postoperative period was uneventful, and no signs of recurrence were noted during a six-month follow-up. The current case underscores the importance of considering PA in the differential diagnosis of persistent neck swellings and illustrates the diagnostic complexity posed by submandibular gland tumours. It highlights the critical role of histopathological confirmation in establishing a definitive diagnosis and emphasises the need for early surgical intervention to ensure optimal outcomes and minimise the risk of recurrence.

A Case of Intraoperative Bullous Corneal Epithelial Detachment: An Unusual Presentation of Keratopathy During Cataract Surgery

Genickson Jeyaraj, Bijnya Birajitha Panda, Sandra Sagar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Cataract surgery has evolved as a promising surgery in the field of ophthalmology with newer advancements and faster recovery. The present case report highlights an unusual presentation of bullous corneal epithelial detachment in a 58-year-old male patient who underwent cataract surgery by phacoemulsification. The intraoperative changes that occurred subsided in the postoperative phase, and there was no significant change noted in slit lamp examination and Anterior Segment Optical Coherence Tomography (AS-OCT). A detailed evaluation of the patient in the pre-operative period can prevent many mishaps during the intra and postoperative periods and aid in improving the patient’s visual quality. However, at times, the findings might be so subtle that a proper correlation during the pre-operative period is not possible regarding the expected outcome. The present case report is one of its kind, necessitating the importance of appropriate preoperative history, examination and meticulous surgical technique of the patient posted for surgery.

Carcinoma en Cuirasse: A Rare Entity in Young Women

Mahe Falak Naz, Kewecho Akami, Neikhrietsonuo Kesiezie, Visar Linyu, Shikha Prabhu Lawande Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Carcinoma en Cuirasse is a rare form of cutaneous metastasis most commonly associated with advanced breast carcinoma. It is characterised by diffuse dermal infiltration resulting in indurated, sclerodermoid thickening of the skin, because of its rarity and its resemblance to benign dermatological conditions, diagnosis is often delayed, particularly in young patients. Hereby, the authors report the case of a 24-year-old female who presented with progressive skin thickening over the left breast and was initially managed as a dermatological condition. Due to the atypical presentation and young age of the patient, an underlying malignancy was not suspected at presentation. Further evaluation with imaging and histopathological examination revealed breast carcinoma with extensive cutaneous metastatic involvement consistent with Carcinoma en Cuirasse. The patient was subsequently referred for oncological management. The present case highlights an unusual presentation of metastatic breast cancer in a very young woman and emphasises the importance of considering underlying malignancy in patients with persistent sclerodermoid skin lesions. Early recognition of Carcinoma en Cuirasse is important as it usually indicates advanced disease and poor prognosis. The present case highlights the aggressive biological behaviour of carcinoma en cuirasse, its occurrence in a young woman, and the diagnostic difficulties posed by its resemblance to benign inflammatory and dermatological disorders. Early biopsy of persistent breast skin lesions and multidisciplinary evaluation are essential for timely diagnosis and management.PD17-PD19

Clinical, Radiographic and Histopathological Evaluation of Cleidocranial Dysplasia in a Child: A Case Report

Kojagori Chaudhuri, Shabnam Zahir, Piyali Datta, Arkya Pratim Chakraborty, Shreya Batabyal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Cleidocranial Dysplasia (CCD) is a rare autosomal dominant skeletal disorder characterised by clavicular hypoplasia, delayed closure of cranial sutures and multiple supernumerary unerupted teeth. A 12-year-old girl presented with a chief complaint of multiple mobile lower anterior teeth and delayed eruption of permanent teeth. General examination revealed short stature, partial shoulder approximation and genu valgum. Extraoral findings included frontal bossing and depressed nasal bridge. Intraoral examination showed multiple retained deciduous teeth with only one erupted permanent tooth. Radiographic evaluation {Orthopantomogram (OPG), lateral cephalogram, chest and skull radiographs} demonstrated approximately 49 impacted and supernumerary teeth, clavicular hypoplasia, nasal bone hypoplasia and delayed fontanelle closure. Based on characteristic clinico-radiographic features, a diagnosis of CCD was established. The patient was referred for paediatric evaluation and genetic testing; however, molecular confirmation could not be obtained. Oral prophylaxis and extraction of mobile deciduous teeth were performed and comparative histopathological analysis was undertaken. Early recognition of such characteristic dental findings facilitates timely diagnosis and interdisciplinary management.

Management of an Infected Total Knee Replacement with Implant Removal, Antibiotic Cement Spacer, and Revision Total Knee Arthroplasty: A Case Report

Aditya Sudhir Dalvi, Nitin Narendra Samal, Dhairya Vijay Veragiwala, Amit Narendra Gaurkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Periprosthetic joint infection is one of the most serious complications following total knee replacement and may result in implant failure, persistent pain and functional disability. This is a case report of a 65-year-old male who presented with persistent discharge from the left knee, severe pain while walking and inability to squat or sit cross-legged 15 months after undergoing bilateral total knee replacement. Clinical examination revealed a discharging sinus over the left knee with painful restriction of movement. Radiographs demonstrated loosening of both femoral and tibial components, raising suspicion of chronic periprosthetic joint infection. The patient underwent implant removal, thorough debridement, synovectomy and placement of an antibiotic-loaded gentamicin cement spacer. Intraoperative cultures grew Methicillin-Sensitive Staphylococcus Aureus (MSSA). Based on the culture sensitivity report, intravenous vancomycin was administered for 10 days, followed by oral doxycycline for three weeks. After clinical and laboratory evidence of infection control, a second-stage revision total knee arthroplasty was performed. The postoperative recovery was uneventful, with marked improvement in pain, knee function and walking ability during follow-up. This case highlights the importance of early recognition of chronic periprosthetic joint infection, meticulous surgical debridement, staged revision arthroplasty and culture-guided antimicrobial therapy in achieving favourable clinical outcomes.

Non surgical Orthodontic Camouflage of Skeletal Class III Subdivision Malocclusion with Functional Mandibular Shift Secondary to Occlusal Interference in a Post-pubertal Patient: A Case Report

Abhijeet Sahebrao Kadam, Rizwan Aziz Gilani, Shefali Singh, Aishwarya Rajesh Atey, Gauri Wagh Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Skeletal Class III malocclusion is one of the most challenging conditions in orthodontics owing to the complexity of the skeletal, dentoalveolar, and soft-tissue components involved. It could be caused by maxillary hypoplasia, mandibular prognathism, or both, and will commonly be associated with anterior crossbite, facial asymmetries, and occlusal disharmonies. Class III malocclusion management in post-pubertal patients becomes more complicated since skeletal development would already be completed. Orthognathic surgery is often regarded as the ideal treatment modality for post-pubertal skeletal Class III malocclusion however, in carefully selected borderline cases with acceptable facial profile and moderate skeletal discrepancy, orthodontic camouflage can provide satisfactory functional and esthetic outcomes. This particular case presents a non surgical management of Class III subdivision malocclusion in a 17-year-old male patient which is characterised by functional facial asymmetry, anterior crossbite, crowding, and mandibular deviation secondary to occlusal prematurities. Clinical findings show that the patient had a straight profile, asymmetric non consonant smile, reverse overjet, deep bite, and lower midline deviation. Cephalometric analysis shows skeletal Class III with vertical growth pattern as well as retroclined maxillary and upright mandibular incisors. Given the patient’s refusal to undergo orthognathic surgical procedures, orthodontic camouflage treatment was indicated and a fixed mechanotherapy utilising 0.022-inch McLaughlin, Bennett, and Trevisi (MBT) appliance system. Treatment included extraction of over-retained deciduous teeth, alignment and leveling with sequential archwire progression, extraction of the lingually erupted mandibular right lateral incisor was carried out as part of the camouflage strategy to relieve lower anterior crowding, and the use of class III elastics to establish a functional occlusion and positive overjet. Following active treatment for 22 months, marked changes were noted in the patient’s facial profile, aesthetics of the smile, overjet, overbite, and tooth alignment. A favourable functional and aesthetic outcome was achieved with establishment of class I molar and canine relationships, positive overjet and overbite, and improvement in the soft-tissue profile. Six-months follow-up records demonstrated maintenance of the treatment results. This case highlights the potential of orthodontic camouflage as a non surgical treatment alternative in carefully selected borderline skeletal class III patients.

Gingival Enlargement as a Rare Manifestation of Acute Myeloid Leukaemia in a Patient with Cardiovascular Compromise: A Case Report

Prachiti Chaulkar, Bela Dave, Khushboo Desai, Chandni Patel, Vrunda Patel Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Gingival enlargement may be an early oral indicator of haematologic malignancy, particularly Acute Myeloid Leukaemia (AML). In case of AML, the malignant immature white blood cells increase in number at the expense of the bone marrow cells. This results in a decrease in the number of erythrocytes and platelets. This manifests clinically as anaemia, weakness, fatigue, and pallor along with spontaneous bleeding and petechiae. Early recognition by dental clinicians is critical, as oral signs may precede systemic manifestations. Oral signs such as gingival enlargement, spontaneous bleeding, ulcerations, and secondary infections may serve as the first diagnostic feature for unsuspected leukaemia. In present case report, a 50-year-old medically compromised male patient presented with generalised gingival enlargement, spontaneous bleeding, pseudomembranous candidiasis, fever, malaise, and recent weight loss. The severity of enlargement was disproportionate to local irritants and radiographic findings, prompting haematologic evaluation. Investigations revealed leukocytosis with 82% blast cells, anaemia, thrombocytopenia, uncontrolled diabetes, indicating AML. The patient was referred urgently for oncologic management and initiated on chemotherapy after multidisciplinary clearance. Despite timely diagnosis and supportive care, the patient’s condition deteriorated rapidly due to pneumonitis and immunosuppression. He succumbed to respiratory failure only 15 days after AML diagnosis due to the nature of the disease. Atypical or generalised gingival enlargement especially when inconsistent with local aetiologic factors should raise suspicion of underlying systemic disease, including leukaemia. Dental practitioners especially periodontist play a pivotal role in early detection, timely referral, and multidisciplinary management which may significantly influence prognosis.

Concurrent Dengue, Tuberculosis and Secondary Haemophagocytic Lymphohistiocytosis in a Patient with Chronic Kidney Disease: A Case Report

Sreyas Gautam, Aiswarya Rajalaxmi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X The co-existence of multiple infections in an immunocompromised patient makes it challenging to make a diagnosis, especially when there are overlapping clinical features. The present case report describes a 65-year-old female with longstanding chronic kidney disease who presented with prolonged fever, progressive breathlessness, and right supraclavicular lymphadenopathy. Three of the four co-existing conditions were definitively diagnosed: dengue infection was confirmed by positive serum Non-Structural Protein 1 (NS1) antigen and dengue Immunoglobulin M (IgM), tuberculous lymphadenitis by Fine Needle Aspiration Cytology (FNAC) and secondary Haemophagocytic Lymphohistiocytosis (HLH) using the H-score and HLH-2024 diagnostic criteria. Community-acquired pneumonia was strongly suspected based on clinical and radiological findings. Cutaneous lesions over the anterior chest wall and upper back were consistent with scrofuloderma but were not histologically confirmed. The patient received multidisciplinary care, including Anti-Tubercular Therapy (ATT), broad-spectrum antibiotics, dexamethasone and Intravenous Immunoglobulin (IVIG) (for HLH), blood product transfusions and dialysis. The literature search identified reports of concurrent dengue and HLH, tuberculosis and HLH, and dengue with tuberculosis. However, there was no published case describing the simultaneous occurrence of dengue, tuberculosis, and secondary HLH in a single patient.

Hepatic Encephalopathy Precipitated by Sickle Cell Crisis in a Patient with Chronic Hepatitis C Undergoing Automated Exchange Transfusion: A Rare Case Report

Sanket Mahajan, Priyanka Mahajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Hepatic involvement in Sickle Cell Disease (SCD) encompasses a broad spectrum known as sickle cell hepatopathy, ranging from self-limiting acute hepatic crisis to fatal Sickle Cell Intrahepatic Cholestasis (SCIC). In patients with co-existing Hepatitis C (HCV), chronic liver damage significantly reduces hepatic reserve, predisposing them to Acute-on-Chronic Liver Failure (ACLF) during a Vaso-Occlusive Crisis (VOC). This case highlights a scarcely reported and an exceptionally rare presentation of Hepatic Encephalopathy (HE) triggered by sickle cell crisis in patient with known HCV, requiring emergent intervention. An 18-year-old male patient with known history of Homozygous Sickle Cell Anaemia (HbSS) and chronic Hepatitis C presented with severe VOC, progressive jaundice and altered mental status. Clinical evaluation revealed features of overt HE, acute liver decompensation and sickle cell crisis. Laboratory findings revealed marked hyperbilirubinaemia, elevated transaminases, prolonged Prothrombin Time /International Normalised Ratio (PT/INR). Imaging confirmed hepatomegaly without biliary obstruction, while the high Haemoglobin (Hb) S pointed toward sinusoidal sickling as acute driver of hepatic failure. Due to severity of hepatic failure and life-threatening nature of illness, the patient underwent Automated Red Cell Exchange (A-RCE) which rapidly reduced HbS, alleviating sinusoidal obstruction and improving hepatic perfusion. Standard medical management for encephalopathy was concurrently administered. Following A-RCE, the patient showed dramatic clinical and neurological improvement within 48 hours and liver enzymes showed a steady downtrend. This case underscores that A-RCE is a critical, life-saving modality for managing acute hepatic failure in SCD, particularly when compounded by chronic viral hepatitis and thus should be considered first-line to prevent irreversible multi-organ failure.

Management of Bilateral Fallopian Tubal Block with Shodhan and Shaman Chikitsa: A Case Report

Gaurav Rajendra Sawarkar, Pawan Banduji Itankar, Punam Gaurav Sawarkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Female infertility, a growing concern often linked to hormonal imbalances, frequently stems from the obstruction of fallopian tubes, which prevents fertilisation. While conventional medicine offers surgical intervention, this method has notable drawbacks, including the potential for reblockage caused by inflammatory or autoimmune processes. A 27-year-old female married for five years was diagnosed with secondary infertility, struggling to conceive for four years. She had irregular and scanty menses, along with chronic constipation. She underwent Shodhan Chikitsa (Virechana after Abhyantara Snehana, Swedana and Sasneha Niruha Basti, followed by Uttar Basti with Kshara Taila and Sahacharadi oil). Concurrently, for five months, she was given Shaman Chikitsa (Chandraprabha Vati, Sukshma Triphala Guggulu, Sahacharadi Kwatha), along with lifestyle modifications. After five months, Hysterosalpingography (HSG) reports confirmed patent fallopian tubes and all symptoms improved. She conceived successfully after six months. The tubal block was resolved due to the Vata-Kaphahara and Lekhana properties of Shodhana and Shamana Chikitsa, showing Ayurveda’s effectiveness in treating fallopian tube blockages safely, avoiding surgical intervention.

Ayurvedic Management of Vandhyatwa with Special Reference to Thin Endometrium: A Case Report

Gayatri Hubli, Shama Sarmokadam, Shivani Diddi, Pankaj Sharma Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Infertility is defined as the inability to conceive even after one year of regular unprotected sex. Conception requires four essential elements: Rutu (Timing), Kshetra (Uterus), Ambu (Nutrition) and Beeja (Gametes). Although significant advancements have been made in human reproduction, the implantation process remains poorly understood. Among these, the receptive endometrium plays an important role. Thin Endometrium (TE) is a known cause of infertility, contributing to implantation failure and early miscarriages. A 22-year-old married female patient presented with an inability to conceive for 2.5 years, with a history of two early pregnancy losses. On Ultrasonography (USG), it was noted that the endometrium was thin (4 mm). The diagnosis of TE was based on transvaginal USG findings and clinical correlation alone, as the patient refused invasive diagnostic evaluation. The patient was treated with internal ayurvedic medicine and local therapies for a duration of four months. Endometrial Thickness (ET) increased from 4-4.9 mm to 8-10 mm with evidence of ovulation and successful conception. A healthy female infant was delivered at term. Ayurvedic therapy enhanced endometrial quality and receptivity, promoting implantation and a successful pregnancy. This approach shows promise for infertility occurring due to a TE.

Metastatic Mixed Germ Cell Tumour Diagnosed on Cytology with an Occult Primary: A Case Report

HB Rakshitha, Shashwat Singh Bhadoria, K Amita, D Pruthvy Kartheek, Apoorva Pandit Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Metastatic Germ Cell Tumours (GCTs) with occult primaries are rare presentations that pose significant diagnostic challenges, particularly on cytology. In the present case, a 27-year-old male presented with fever, abdominal pain, and weight loss, in whom ultrasound revealed para-aortic and inguinal lymphadenopathy without detectable testicular mass. Ultrasound-guided Fine-Needle Aspiration Cytology (FNAC) from para-aortic lymph nodes demonstrated highly atypical pleomorphic cells arranged in clusters and dispersed patterns, with high nuclear-to-cytoplasmic ratio, prominent nucleoli, multinucleation, and necrotic background, suggestive of metastatic high-grade malignancy with suspicion of GCT. Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography (FDG PET-CT) showed metabolically active supraclavicular and abdominopelvic lymph nodes but no primary lesion. Excision of a supraclavicular lymph node revealed near-complete nodal replacement by tumour. Immunohistochemistry demonstrated positivity for SALL-4, CD30, and OCT3/4, with syncytiotrophoblastic cells positive for human Chorionic Gonadotropin (hCG) and Glypican-3, confirming metastatic mixed GCT comprising embryonal carcinoma and choriocarcinoma components. The patient received Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy and achieved remission but developed lung metastases after one year. This case highlights the diagnostic importance of FNAC in young males presenting with unexplained lymphadenopathy, even in the absence of an identifiable testicular mass. Mixed GCTs may mimic poorly differentiated carcinoma on cytology, and accurate diagnosis requires integration of morphology with immunohistochemistry and clinical-radiologic correlation. Early recognition is crucial, as metastatic GCTs remain potentially curable despite disseminated disease, and prompt therapy significantly impacts outcomes.

Early Aseptic Loosening following Uncemented Total Hip Arthroplasty Managed with Extended Trochanteric Osteotomy: A Case Report

Neelaksh, Gajanan Pisulkar, Sanjay Deshpande, Harrshit Salhan, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Early aseptic loosening following Total Hip Arthroplasty (THA) is an uncommon complication that may indicate implant-related, technical or biomechanical factors when it occurs within a short interval after primary arthroplasty. Early diagnosis along with timely revision surgery are important aspects in preserving bone stock while improving functional outcomes. Early aseptic loosening following THA is known as an uncommon but very significant cause of postoperative hip pain and functional limitation. The present case reports a 56-year-old male having progressive right hip pain, difficulty in ambulation two years following uncemented THA which was performed for avascular necrosis of femoral head. Clinical evaluation of patient showed no signs of infection and inflammatory markers were normal. Radiographs demonstrated progressive periprosthetic radiolucent lines around the femoral stem, suggestive of aseptic loosening. A diagnosis of aseptic implant loosening was established after excluding infective as well as other causes. The patient underwent revision THA during which acetabular component was found stable while the femoral stem was well fixed distally thus necessitating an Extended Trochanteric Osteotomy (ETO) for safe removal. A long uncemented revision stem was implanted showing satisfactory stability and osteotomy was fixed with cerclage wiring. Postoperative recovery was uneventful with good functional outcome. This case highlights the importance of early recognition of aseptic loosening and demonstrates the role of ETO in facilitating safe femoral stem removal and successful revision arthroplasty.

Complex Challenges in Perioperative Care of a Preterm Neonate with Perforated Appendix in an Incarcerated Inguinoscrotal Hernia: A Case Report

Agathiyan Anbarasu, Anand Kuppusamy, N Mohammed Arshad Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Perioperative management of extremely preterm neonates is challenging because of their immature respiratory, cardiovascular and metabolic systems, which make them highly vulnerable to perioperative instability. Hereby, the authors report the perioperative management of a 22-day-old male neonate, born at 27 weeks of gestation with a birth weight of 1.225 kg, who presented with an incarcerated right inguinoscrotal hernia at a post-conceptional age of 30 weeks. His initial neonatal course was complicated by respiratory distress syndrome requiring mechanical ventilation and surfactant therapy, followed by Continuous Positive Airway Pressure (CPAP) and gradual weaning to room air. For herniotomy, the authors planned an individualised, opioid-free multimodal anaesthetic technique to minimise the risk of postoperative apnoea. Intraoperative management focused on maintaining stable oxygenation, normothermia, normoglycaemia and haemodynamic stability in a very preterm neonate with limited physiological reserve. Intraoperatively, the authors encountered a rare finding of a perforated appendix within the hernial sac (Amyand’s hernia), for which appendectomy along with hernia repair was done. Ultrasound-guided caudal analgesia using bupivacaine provided effective perioperative analgesia and supported the opioid-sparing anaesthetic technique. Postoperatively, the neonate was electively ventilated in Synchronised Intermittent Mandatory Ventilation (SIMV) mode, then weaned to nasal CPAP and finally to room air without any apnoeic episodes or major complications. The present case highlights the importance of proper planning, multidisciplinary coordination and the use of opioid-free anaesthesia with ultrasound-guided regional techniques in extremely preterm neonates. It also strengthens the limited literature on perforated appendix inside an incarcerated inguinoscrotal hernia in neonatal population.

A Classical Sign with Uncommon Symptoms: Joubert Syndrome Presenting with Retinal Dystrophy and Keratoconus

Yeddula Pranay Raja, Shivam Gupta, Anupama K George, N Kamala, Nirmala Devi Chandrasekaran Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Joubert Syndrome and Related Disorders (JSRD) are a rare group of autosomal recessive ciliopathies characterised by the pathognomonic molar-tooth sign on Magnetic Resonance Imaging (MRI) of the brain. The clinical manifestations are usually multisystemic and may involve multiple organs. Early diagnosis is warranted, as neurological, renal, and ocular symptoms may remain latent that require multidisciplinary management. A 20-year-old male born to third-degree consanguineous parents, with a known history of global developmental delay and stage V chronic kidney disease on regular maintenance haemodialysis, presented with acute-onset high-grade fever and cough, along with a recent history of severe lower respiratory tract infection requiring mechanical ventilation. On examination, cerebellar signs including broad-based gait, dysmetria, dysdiadochokinesia, and intention tremors were noted, along with bilateral retinal dystrophy and keratoconus of the left eye. Laboratory investigations revealed anaemia and deranged renal function tests. MRI of the brain demonstrated the characteristic molar-tooth sign, with elongated superior cerebellar peduncles, agenesis of the cerebellar vermis, and a characteristic bat-wing appearance of the fourth ventricle. Ultrasonography of the kidneys showed bilaterally atrophied kidneys. A diagnosis of Joubert Syndrome with oculorenal involvement was made based on the neurological, renal, and ocular manifestations. This case highlights the typical clinical and neuroimaging features of JSRD, along with the additional finding of keratoconus, an uncommon ocular manifestation. Early diagnosis is essential for appropriate prognostication, genetic counselling, and timely intervention of organ-specific screening and surveillance, particularly in consanguineous families since the pattern of inheritance is recessive.

Drug Rechallenge in Adverse Cutaneous Drug Reactions to Antitubercular Therapy: A Case Series

Hariharasubramony Ambika, Priyadharsini Jeyaprakash, Vatsan Vivekanandan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Adverse Cutaneous Drug Reactions (CADRs) to Anti-Tubercular Therapy (ATT) range from mild pruritus to severe reactions such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), often leading to treatment interruption. Rechallenge is particularly challenging as reactions commonly occur during the intensive phase involving multiple drugs. In this case series of seven patients, structured inpatient rechallenge protocols enabled the identification of culprit drugs and the successful completion of ATT in all cases. Rifampicin was tolerated in all patients, while isoniazid and pyrazinamide were most frequently implicated. All patients were followed for 6-12 months without recurrence. This series highlights that supervised rechallenge, with careful monitoring, can optimise treatment completion while ensuring patient safety.

Diagnostic Utility of Megakaryocytic Morphology and Fibrosis Grading in Myeloproliferative Neoplasms: A Series of Five Cases

VB Santhakumari, Paul Ittoop Alappatt, M Kalaiyazhagan, P Rajkumar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Myeloproliferative Neoplasms (MPNs) comprise a heterogeneous group of clonal haematopoietic stem cell disorders characterised by excessive proliferation of one or more myeloid lineages. Despite advances in molecular diagnostics, these entities frequently exhibit overlapping clinical and haematologic features, making accurate classification a diagnostic challenge for pathologists and clinicians alike. This descriptive and educational case series highlights the diagnostic utility of detailed morphologic evaluation, focusing particularly on megakaryocytic morphology and grading of bone marrow fibrosis, in five representative patients encompassing essential thrombocythaemia, prefibrotic primary myelofibrosis, overt primary myelofibrosis, post-polycythaemia vera myelofibrosis, and chronic myeloid leukaemia with secondary fibrosis. Each case underwent a comprehensive diagnostic workup, including complete blood count, peripheral blood smear examination, bone marrow aspiration, and trephine biopsy. Histopathologic evaluation was performed using haematoxylin and eosin, reticulin, and Masson’s trichrome stains to assess megakaryocytic clustering, nuclear features, and stromal alterations. Molecular testing for JAK2 V617F, CALR, and MPL mutations, along with cytogenetic studies, was conducted wherever feasible to provide a complementary molecular profile. Detailed morphologic integration allowed precise classification and staging according to both the WHO 2022 and International Consensus Classification (ICC) criteria, correlating histologic patterns with clinical and molecular data. Particular emphasis was placed on distinguishing clonal fibrosis of primary myelofibrosis from secondary, reactive fibrosis seen in chronic myeloid leukaemia, a distinction with significant therapeutic and prognostic implications. This case series underscores the indispensable role of an integrated, multidisciplinary diagnostic approach where morphology, molecular markers, and clinical context converge to achieve accurate diagnosis, refine prognostication, and guide risk-adapted management of MPNs.

Peripartum Anaesthetic Management of Newly Diagnosed Pulmonary Hypertension: A Case Series

Chitra Kolla, Sheetal Madavi, Souvik Banik, Amreesh Paul Francis Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Newly diagnosed Pulmonary Hypertension (PH) in pregnancy can result in significant health concerns and complications in anaesthesia management for caesarean section delivery. Here, the authors, describe the cases of three pregnant patients who were scheduled for emergency caesarean sections with a new diagnosis of PH. These patients presented with nonspecific symptoms of dyspnoea on exertion and lower extremity swelling, which initially were believed to be due to changes occurring during normal pregnancy. Further evaluation, including echocardiography, revealed different degrees of PH with preserved Left Ventricular Ejection Fraction (LVEF). All patients underwent combined spinal and epidural anaesthesia for their surgical procedure. A low-dose spinal anaesthetic was administered with epidural boluses to achieve analgesia. The sympathetic blockade was managed judiciously to maintain stable blood pressure. Norepinephrine was administered to all patients in order to support right ventricular function, and supplemental oxygen was administered as needed. Blood pressure was closely monitored throughout. In the postoperative period, all three patients were transferred to the intensive care unit for close monitoring. The postoperative course for all patients was uneventful, and they were discharged without complications. This experience emphasises the importance of early recognition of unusual symptoms in pregnancy, early echocardiography, neuraxial anaesthesia, and vigilant monitoring and collaboration in order to achieve a successful outcome for women newly diagnosed with PH.

Wide Awake Local Anaesthesia No Tourniquet for Clavicle Fracture Fixation: A Case Series

Pardhasaradhi Kapusetti, Karuna Taksande, Amreesh Paul, Kavya Praneetha Kola Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X The conventional management of clavicle fractures involves repositioning fractured segments into anatomic alignment, usually under General Anaesthesia (GA) or Regional Anaesthesia (RA). However, both techniques carry the risk of adverse outcomes. Wide Awake Local Anaesthesia No Tourniquet (WALANT) offers an alternative and can be used as a conservative approach for treating clavicle fractures. WALANT was developed to relieve pain and discomfort and reduce patient- and procedure-related complications associated with anaesthesia or sedation while maintaining the same standard of care as procedures performed under anaesthesia. This case series describes the use of the WALANT technique in three patients (2 males, 1 female) with displaced midshaft and distal-third clavicle fractures. Pain, patient satisfaction and surgeon satisfaction were evaluated. All three procedures were completed without complications, with minimal blood loss, low pain levels and stable vital signs throughout surgery. High levels of patient and surgeon satisfaction were reported postoperatively and no anaesthesia-related complications occurred. Pain relief was assessed from the time patients entered the operating room until discharge, with ongoing postoperative evaluation using standardised scoring systems for both patient and surgeon satisfaction. WALANT is considered an effective and safe technique and may serve as an alternative to conventional anaesthetic methods for procedures involving the shoulder and shoulder girdle, including clavicle fractures. This case series also provides useful information regarding postoperative outcomes and recovery time in patients treated with the WALANT technique.

Enterolithiasis Presenting as Small Bowel Obstruction: A Case Series of Three Cases

Shailabh, Imran Ali Khan, MD Jawed Akther, Jay Dharamshi, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Enterolithiasis is a very rare condition characterised by the formation of intraluminal stones within the small bowel, often occurring in segments with stasis, strictures, or chronic inflammation. It can also further lead to small bowel obstruction, thereby posing diagnostic and therapeutic challenges. The present series reports about three cases of elderly Indian females presenting with small bowel obstruction of variable duration and severity. Presented case 1 involved a 68-year-old female having a post-tubercular ileal stricture and a 4×3×2 cm enterolith, managed by segmental ileal resection and primary anastomosis. Presented case 2 involved a 65-year-old female having adhesions, inflammatory mesentery, a submucosal lipoma, and a 4×2×2 cm enterolith, managed via adhesiolysis, resection, and lipoma excision. Presented case 3 was of a 60-year-old female, having vague abdominal pain and a radiodense shadow initially mistaken for a vesical calculus; exploratory laparotomy later revealed a mobile ileal enterolith measuring 7×5×2 cm, which was removed through enterotomy without requiring bowel resection. All of these patients had uneventful postoperative recoveries. Thus, enterolithiasis must be considered in patients having small bowel obstruction, especially in the presence of strictures, adhesions, prior inflammatory conditions or when imaging findings are misleading and suggest alternative pathologies.

Unusual Paediatric Nasal Masses Presenting with Nasal Obstruction: A Case Series Emphasising the Diagnostic Value of Radiological Imaging

Sneha Sarah Regi, Soumya Susan Regi, Madhavi Kandagaddala, Aparna Irodi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X The most frequent causes of nasal obstruction in children are inflammatory conditions such as sinusitis and nasal polyps. Masses in the paediatric nasal cavity or nasopharynx may be identified incidentally during imaging or present with overt clinical signs. Because their initial symptoms often mimic common upper respiratory conditions, these lesions frequently go undiagnosed for extended periods. Given this non-specific clinical presentation, radiological evaluation is typically essential for a comprehensive diagnostic assessment. The present series reports five cases, first case was of Primitive Neuroectodermal Tumour (PNET), the imaging finding on Computed Tomography (CT) was that of a heterogeneously enhancing mass seen in the right maxillary sinus with destruction of the walls of the sinus and associated extension into the right nasal cavity and right orbit. Second case, child with pleomorphic Rhabdomyosarcoma (RMS) showed findings of an aggressive mass involving the bilateral nasal cavities, nasopharynx, and left orbit, with heterogeneous post-contrast enhancement. In the third case of sinonasal meningioma, Magnetic Resonance Imaging (MRI) showed a T2 isohyperintense mass in the nasal cavity, with destruction of the nasal septum and turbinates, extending into the maxillary sinuses and orbits, resulting in optic nerve displacement, and adjacent dural enhancement without brain parenchymal involvement. In fourth case of Syringocystadenoma Papilliferum (SCAP), there was malignant transformation into a heterogeneously enhancing soft-tissue mass centred in the right nasal cavity with destruction of the right nasal bone and mild erosion of the anterior wall of the right maxillary sinus, proven to be an adenoid cystic carcinoma on biopsy. Fifth case was of sinonasal yolk sac carcinoma presented on MRI as a lobulated T2 heterogeneously hyperintense, T1 hypointense mass with focal haemorrhagic areas displacing the nasal septum to the right and causing obstruction of the contralateral nasal cavity with mild heterogeneous post-contrast enhancement.

Transfusion Approaches in Liver Transplantation: A Case Series from a Tertiary Care Hospital

Aishwarya Ajith, R Krishnamoorthy, A Ashwin, Jonahs Betsy, R Niranj Rathan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Orthotopic liver transplantation is a complex procedure associated with significant haemostatic disturbances and variable transfusion requirements. Optimal perioperative blood management is essential to reduce morbidity and improve graft outcomes. The present case series describes transfusion strategies and outcomes in three patients (two males and one female) with end-stage liver disease of varying aetiologies undergoing deceased donor liver transplantation at a tertiary care centre. Preoperative evaluation included clinical assessment, blood grouping and typing, antibody screening, crossmatching, and reservation of blood components. Intraoperative and postoperative transfusion requirements were guided by serial monitoring of haemoglobin, platelet count, coagulation profile, fibrinogen levels, liver function tests, and overall clinical status. Intraoperative blood loss ranged from 440 mL to 5100 mL. Two patients required minimal transfusion support, whereas one patient developed major perioperative haemorrhage requiring massive transfusion support. Transfusion therapy included leukoreduced packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate administered in a targeted and individualised manner. Progressive improvement in coagulation parameters and liver function was observed in all patients following transplantation. No transfusion-related adverse events occurred, and all patients achieved satisfactory graft function and were discharged in stable condition. An individualised, goal-directed transfusion strategy combined with meticulous preoperative planning, judicious blood component utilisation, and multidisciplinary coordination can effectively manage diverse transfusion requirements during liver transplantation. Patient blood management principles and targeted correction of coagulopathy may optimise outcomes while minimising unnecessary exposure to blood products.

Functional Outcome Following Surgical Management of Bimalleolar Ankle Fractures: A Case Series

Sukesh M Kaveeshwar, MuraliKrishnan, J Venkadesh, S Aishwarya Mirnalni Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Bimalleolar ankle fractures are unstable injuries that frequently result in significant functional impairment. Open Reduction and Internal Fixation (ORIF) is the standard surgical approach aimed at restoring ankle anatomy and stability. The present case series was conducted from January 2023 to July 2024 at the Department of Orthopaedics, Sree Balaji Medical College and Hospital, a tertiary care teaching hospital, included 27 adult patients with closed bimalleolar ankle fractures. All patients underwent ORIF with plate osteosynthesis of the fibula and cannulated cancellous screws of the medial malleolus. Functional outcomes were assessed using the Olerud-Molander Ankle Score (OMAS) preoperatively and at a mean follow-up of six months. The mean preoperative OMAS was 3.7±4.7 (range 0-15), indicating severe functional limitation. At six months, the mean postoperative OMAS improved to 78.5±16.0 (range 40-100). Excellent outcomes were observed in 12 patients (44%), good in 10 (37%), fair in 4 (15%), and poor in 1 (4%). ORIF of closed bimalleolar ankle fractures results in significant short-term functional improvement. Early surgical intervention with accurate anatomical reduction and stable fixation is associated with favourable recovery.

Clinical Spectrum and Outcomes of Deep Cerebral Venous Sinus Thrombosis: A Case Series

Pankaj Kumar Saini, Awni Kothari, Sanjiv Maheshwari, Kamlesh Kumar Beniwal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Cerebral Venous Sinus Thrombosis (CVST) is a rare disorder that can lead to significant morbidity and mortality. Thrombosis can occur in superficial veins, the deep venous system or the cortical veins of the brain. The diagnosis of CVST is often missed because of its heterogeneous presentation. Headache is the most common presenting symptom. Hemiparesis, seizures, and impaired level of consciousness can occur in many cases. Herein, the authors present four cases of CVST with distinct clinical presentations. One of our patients presented with fever and altered sensorium, which initially misled the diagnosis as viral encephalitis. All these cases were diagnosed to have Deep CVST (DCVST), having bilateral thalamic involvement on Magnetic Resonance Imaging (MRI) brain. The risk factors for provoked CVST include pregnancy, early postpartum period, use of oral contraceptive drugs, infections and dehydration. Use of oral contraceptives was identified as the underlying risk factor in one of the four cases described in this case series. In unprovoked CVST, underlying procoagulant conditions (Factor VIII, Protein C/Protein S, and Antithrombin III deficiency) are the aetiological factors. MRI of the brain with Magnetic Resonance Venogram (MRV) of the Brain is the current diagnostic modality of choice for CVST, with very high sensitivity and specificity. All of our patients had favourable outcome with conservative management, so early diagnosis and prompt management is helpful in reducing morbidity and mortality in DCVST.

Clinicopathological Spectrum and Histopathological Concordance in Parotid Gland Tumours: A Series of Ten Cases

Preethika Murugesan, Ganesh Guru, Ramalakshmi, T Ragupathy Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Parotid gland swellings represent a heterogeneous group of benign and malignant lesions with overlapping clinical and radiological characteristics, often creating diagnostic challenges during preoperative evaluation. The present case series presents ten patients with parotid gland tumours managed surgically at a tertiary care center between January 2024 and July 2025. Patients presented predominantly with slowly enlarging painless preauricular swellings, while a minority demonstrated pain, rapid enlargement, or nodal disease suggestive of malignancy. Preoperative assessment included clinical examination, Ultrasonography (USG), selective cross-sectional imaging, and Fine-Needle Aspiration Cytology (FNAC) reported using the Milan System for Reporting Salivary Gland Cytopathology. Definitive management consisted of superficial or total conservative parotidectomy with emphasis on facial nerve preservation. Histopathological examination revealed a broad spectrum of lesions including pleomorphic adenoma, basal cell adenoma, nodular oncocytic hyperplasia, keratinous lymphoepithelial cyst, intraparotid lipoma, salivary duct carcinoma, mucoepidermoid carcinoma, and metastatic cutaneous squamous cell carcinoma. FNAC demonstrated concordance with final histopathology in the majority of cases, particularly in malignant lesions. However, diagnostic disconcordance was observed in selected oncocytic and cystic lesions, highlighting the known limitations of FNAC in certain salivary gland pathologies. Postoperative outcomes were generally favourable, with preservation of major facial nerve function in most cases. The current case series highlights the marked clinicopathological diversity of parotid gland tumours and emphasises the importance of correlating clinical, radiological, cytological, and histopathological findings for accurate diagnosis and optimal surgical management.

Dermatitis Linearis: A Clinical Snapshot of Paederus Beetle Infestation in a Child

Akuthota Arun Kumar, Ramya Ramanathan, S Sundari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X

Clinical Image of Anteverted Concha: A Rare Auricular Variant

Pragati Shikha, Sagar Gaurkar, Prasad Deshmukh Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X A 55-year-old male presented to the Otorhinolaryngology Department complaining of left aural fullness. Patient gives a history of frequent episodes of aural fullness followed by cerumen removal since two years. His primary concern was his frequent impaction of wax.

Multinodular Uterine Fibroids Managed by Total Hysterectomy

Sheetal Asutkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X A 44-year-old multiparous woman (G3P3L3A0) presented to the Outpatient Department with complaints of menorrhagia for several menstrual cycles and mild, intermittent lower abdominal pain for one year. Her menstrual cycles had turned increasingly heavy and prolonged over a period of time, hence interfering with her daily activities. There was no history of passage of clots or post-coital bleeding. General examination revealed that the patient was moderately built and nourished; vital parameters were stable. There was no history of hypertension, diabetes mellitus, hypothyroidism, or previous surgical interventions.

Squamous Papilloma Associated with Uterine Prolapse: A Clinical Image

Sampada Narayan Ghatbandhe, Pooja Shrivastav, Magesh Kirubakaran Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X An 88-year-old multiparous female (G3P3L3) with an obstetric history of three full-term normal vaginal deliveries conducted at home with no history of obstetric complications, presented with complaints of a mass protruding per vagina for one year, associated with dragging pain, difficulty in walking, discomfort during daily activities, and itching. There was no history of bleeding per vaginum or urinary and bowel disturbances. There was no significant past medical, surgical, or family history. On local examination, a complete uterine prolapse was noted. Over the exposed vaginal surface of the prolapsed uterus, a whitish, cauliflower-like exophytic growth measuring approximately 3×3 cm was observed. The lesion was sessile, firm, non tender, and showed no ulceration or bleeding. The surrounding vaginal mucosa appeared normal (Table/Fig 1).

Letter to the Editor on Addressing Burnout and Mental Health in Surgeons

Harini Krishnan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Dear Editor, Surgery is a very demanding branch of medicine in which many surgeons sacrifice their health, peace of mind, and family life for work, often without personal satisfaction (1). Surgeons play a crucial role in the healthcare workforce, and their job demands mental wellbeing, as it directly influences patient safety, sustainability, and the quality of medical services (2). Compromised mental health among surgeons has been associated with higher rates of medical errors and poorer patient outcomes (3).

A Case of Right Parotid Mass with Difficult Airway Management and Surgical Challenges

Subha Vazhakalayil Jose, Sakshi Gupta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X

Brexting: A Modern Distraction During Breastfeeding

Venkata Kruthi Tellakula, Akshay Jagtap Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X To the Editor, Breastfeeding is the recommended method of infant feeding because of its well-established nutritional, immunological, and health benefits for both infants and mothers (1). With the widespread use of smartphones, the term “brexting” has emerged to describe maternal engagement with mobile devices while breastfeeding. At present, however, brexting has no universally accepted definition. For the purpose of this discussion, brexting refers to maternal use of a smartphone or other handheld digital device during breastfeeding that diverts attention away from the infant. Importantly, there is currently no validated instrument to measure brexting.

Haematological Parameters and Serum Osmolality in Patients with Bipolar Affective Disorder and Schizophrenia: A Cross-sectional Study

Ritu Meena, Deepa Meena, Tushar jagawat, Gargi Kukareja, Preet Kamal, Pushpendra Bairwa Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Schizophrenia (SCZ) and Bipolar Affective Disorder (BPAD) are psychiatric disorders affecting an estimated 1-2% of the population worldwide. Inflammatory reactions such as cytokine cascades, cellular immune responses and increased levels of acute phase proteins and complement factors are associated with many psychiatric disorders, including SCZ and BPAD. Aim: To compare peripheral inflammatory indices in patients with SCZ and BPAD. Materials and Methods: This hospital-based, cross-sectional study was conducted during the period of October 2023 to August 2024 at the Department of Psychiatry, Balvir Singh Tomar Institute of Medical Science, Research and Hospital, Jaipur, Rajasthan, India which included 162 participants comprising 72 patients with BPAD, 90 patients with SCZ, aged 18-60 years. A semi-structured proforma was used to assess clinical characteristics. Blood samples were collected for various haematological and serum osmolality parameters. Statistical significance was set at p<0.05. Results: All groups were matched for gender, age, caste, religion and residence. The majority of patients were married. There was no significant difference in neutrophils, lymphocytes, platelets, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Haemoglobin (Hb), haematocrit, Mean Platelet Volume (MPV), or Erythrocyte Sedimentation Rate (ESR) (p>0.05). However, monocyte percentage was significantly higher (p-value <0.001) in BPAD patients (8.60±1.22) compared to SCZ patients (7.59±2.41). Although BPAD patients had slightly higher mean blood urea nitrogen and serum osmolality values, these differences were not significant. Conclusion: The present study found that most haematological, biochemical, inflammatory and serum osmolality parameters were similar in both groups. These suggest that these laboratory parameters alone may not be useful in differentiating BPAD from SCZ.

Effect of Four Weeks of Mat Pilates versus Swiss Ball Pilates on Blood Profile and Body Composition Elements in Sedentary Type 2 Diabetes Mellitus Population: A Randomised Clinical Trial

Aarohi Sanjay Shaligram, Varun Chandrakant Naik, BR Ganesh Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is a common metabolic disorder among mid-aged adults. Physical fitness is a measure approach for maintaining Blood Glucose Levels (BGL) within the ranges. Pilates is a low-impact exercise and easy to perform. Mat Pilates (MP) and Swiss Ball Pilates (SBP) were the two interventions used in the current study. Aim: To determine and compare the effect of four weeks of MP and SBP on blood profile and body composition elements in sedentary T2DM. Materials and Methods: The present randomised controlled trial was conducted over a period of 12 months at Karnataka Lingayat Education Society’s (KLES) Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India. A total of 30 participants were enrolled and randomly assigned into two groups during the study period with each group of 15 participants; Group A received MP, while Group B received SBP. Outcome measures included Blood Lactate (BL) levels, body composition elements, and BGLs were recorded on day 1 and after four weeks of intervention. Results: Statistical analysis was done using Statistical Package for the Social Sciences (SPSS). Within-group analysis demonstrated significant improvement in BL with Group A (p-value <0.001) and for Group B (p-value <0.001), blood glucose both the groups p-value being <0.001 and body composition elements like fat (Group A, p-value=0.003) (Group B, p-value <0.001), skeletal muscle mass, water content, Waist to Hip Ratio (WHR), physical age, and overall Health Assessment Score (HAS). Conclusion: Both MP and SBP led to significant improvements in body composition, metabolic function, and overall physical health. By successfully reducing BL, blood glucose, and body fat while raising skeletal muscle mass, water content, and HAS, both strategies showed their effectiveness in fostering fitness and well-being.

Three-weekly Cisplatin versus Weekly Cisplatin Concurrently with Accelerated Radiotherapy Fractionation in Head and Neck Cancers: A Prospective Interventional Study

Deepika Malik, Kartik Kadia, Rajeev K Seam, Laxman Pandey, Jameel Sherrif, SVS Bala Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Concurrent chemoradiation is the standard of care for locally advanced head and neck squamous cell carcinoma. Cisplatin remains the primary radiosensitiser, enhancing tumour cell kill through multiple mechanisms. Altered fractionation, combined with concurrent chemotherapy, has demonstrated superior outcomes compared with conventional schedules. Accelerated fractionation is increasingly adopted; however, the optimal concurrent cisplatin schedule remains uncertain. Aim: To compare acute toxicity and early treatment response between three-weekly and weekly cisplatin concurrently with accelerated fractionation in Head and Neck Cancers (HNC). Materials and Methods: The present prospective interventional feasibility study was conducted in the Department of Radiation Oncology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala, Haryana, India. between 1st July 2021 and 30th June 2022. A total of 43 non-metastatic, histopathologically confirmed squamous cell carcinoma patients of the oropharynx, hypopharynx, and larynx (Stage II-IVB) were randomised using computer-based block randomisation into two arms. The three-weekly arm received accelerated radiotherapy (70 Gy in 35 fractions, six fractions per week) with cisplatin 100 mg/m² on days 1 and 22. The weekly arm received the same radiotherapy with cisplatin 40 mg/m² on days 1, 8, 15, 22, 29, and 36. Forty patients were analysed (20 per arm); Toxicities (dermatitis, mucositis, dysphagia, xerostomia, haematologic (using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0), renal parameters (using Kidney Disease: Improving Global Outcomes (KDIGO) criteria) and vomiting (using a predefined subjective clinical classification) were assessed and compared between the two arms. Response assessment was done and compared using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. For Quality of Life (QoL) assessment and comparisons, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Head and Neck Module (35 items) (EORTC QLQ-H&N35) questionnaires were used. For comparison, 3-month outcomes were considered. Pearson’s chi-square test was used to compare categorical variables. Continuous variables were compared using the unpaired Student’s t-test. A p-value of <0.05 was considered statistically significant. Results: The mean age of the study population was 54.50±8.4 years (42-70 years), 95% (38 out of 40) of patients were males. All patients in the three-weekly arm received 200 mg/m² cumulative cisplatin, whereas 90% in the weekly arm received >200 mg/m² (p=0.001). Radiotherapy interruptions occurred in 15% versus 5%, respectively. Median Overall Treatment Time (OTT) was similar (40.5 vs 41.5 days; p=0.98). At three months, complete response rates were 65% (three-weekly) and 50% (weekly) (p=0.66). Grade ≥3-mucositis was higher in the three-weekly arm (40% vs 25%; p=0.040). Xerostomia was significantly greater in the three-weekly arm at treatment completion and three months (p<0.05). Conclusion: Both regimens were effective. Weekly cisplatin arm achieved higher cumulative dosing with a more favourable toxicity profile. Although response rates numerically favoured the three-weekly arm, differences were not statistically significant.

Assessment of Dermoscopic Characteristics of Molluscum Contagiosum: A Cross-sectional Study

Manjeet Naresh Ramteke Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Molluscum Contagiosum (MC) is a cutaneous viral infection caused by molluscipoxvirus, affecting children, sexually active adults and immunosuppressed individual. Although it is easily diagnosed clinically, it can be confused with other clinical entities. In addition, the diagnosis becomes difficult when it has a single lesion or associated with inflammation. Thus, dermoscopy which is a non invasive and inexpensive tool helps to determine the diagnosis of MC. Aim: To evaluate the dermoscopic characteristics of MC and compare them with clinical presentation. Materials and Methods: The present cross-sectional observational study was conducted at the Outpatient Department (OPD) in the department of Dermatology, Venereology and Leprosy at a tertiary care center at a Grant Government Medical College, Mumbai, Maharashtra, India, for a period of 6 months from July 2025 to December 2025. Patients presenting with pearly white umbilicated papules and clinically suggestive of MC were included in the study. The patients’ history was recorded and examination done thoroughly and data such as the gender and age of the patient, the size of the lesions, the presence or absence of an orifice, vessels, inflammation and/or excoriation and perilesional eczema were recorded. A total of 33 patients with 161 lesions were included in the study. Dermoscopy was performed in 161 lesions from 33 patients where non vascular and vascular structures were noted in each lesion. Results were expressed in terms of frequency and percentage. Descriptive statistical analysis was done using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 17.0. Results: A total of 33 patients with 161 lesions were included in the study. Of the 33 patients, 20 were males and 13 were females with mean age of 14.45±9.32 (range from 2 years to 32 years). The MC lesions were most frequently found on the face, trunk and upper extremities. The structures evaluated on dermoscopy included non vascular structures (whitish or yellowish structure) and vascular structures (crown, punctate, radial). On clinical and dermoscopy examination of 161 lesions, orifices were visualised in 100 and 161 of the lesions, and vessels in four and 72, respectively. The vascular patterns found in the 72 lesions on dermoscopy were the crown (23.60%), radial (11.18%) and punctiform patterns (9.93%). Conclusion: The dermoscopic findings of MC were non vascular and vascular. Rounded structures were common (70.80%) in the non vascular structure. Crown vessels (23.60%) were the most common vascular pattern observed; however, no vascular structures were seen in 55.28% of the lesions. Dermoscopy in lesions of MC was found to be superior as compared to clinical examination and aids in diagnosis of unusual presentations of these lesions.

Effect of Preheating on the Flexural Strength and Microhardness of Giomer and Nanohybrid Composite Resin: An In-vitro Study

Aditi Sanjay Joshi, Sarita Singh, Aishwarya Handa, Vinaya Ingale, Aishwarya Patil Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Although composite restorations have become very common in restorative dentistry, inadequate polymerisation results in clinically unsuccessful restoration due to fracturing and wear. Preheating is a technique adopted in clinical practice to decrease the viscosity and increase monomers’ mobility, hence optimising the mechanical properties. Aim: To compare the flexural strength and microhardness of a giomer and nanohybrid composite following preheating to 50°C. Materials and Methods: This in-vitro experimental comparative study was conducted in the Department of Conservative Dentistry and Endodontics in collaboration with the Dental Materials/Mechanical Testing Laboratory, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, over a period of six months from August 2025 to January 2026. A total of 96 samples were fabricated, then equally subdivided into two groups of four subgroups each: preheated (at 50°C for 5 mins) and control groups. The flexural strength was determined using the three point bend test on Universal testing machine, while surface durability was measured by a Vickers microhardness tester applying a load of 200 g. Statistical analysis was carried out using independent and paired sample t-tests (p<0.05). Results: Preheating resulted in significant improvements in flexural strength of 19.67% and 29.02% for giomer and Nanohybrid composite respectively. Preheating significantly improved microhardness for 11.96% and 15.94% in Giomer and Nanohybrid composite respectively. Giomer showed significantly higher absolute values than the Nanohybrid composite (p<0.001) in all parameters. Conclusion: Within the study’s limitations, preheating at 50°C significantly enhances the mechanical and surface properties of both tested materials.

Phenotypic Characterisation of Resistant Profiles of the Isolates in Orthopaedic Implant Associated Infections: A Cross-sectional Study

Shailja Gautam, Manjula Vagarali, Ravi S Jatti Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Orthopaedic Implant Associated Infections (OIAIs) are serious complications associated with prolonged morbidity, implant failure, repeated surgical interventions, and increased healthcare burden. The emergence of antimicrobial-resistant pathogens further complicates treatment out-comes. Aim: To study the phenotypic characterisation of resistant profiles of isolates in OIAIs and to detect the bacteriological profile and antibiogram of these isolates. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College (JNMC), KAHER, Belagavi, Karnataka, India over one year (April 2024-March 2025). A total of 66 aspirated pus samples from patients with confirmed OIAIs were included. Samples were processed using standard microbiological techniques. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method according to CLSI M100, 34th edition (2024) guidelines. Phenotypic detection of resistance mechanisms including Methicillin-Resistant Staphylococcus aureus (MRSA), Extended-Spectrum β-Lactamase (ESBL), AmpC, and Metallo-Beta-Lactamase (MBL) production was carried out. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0, and p-value<0.05 was considered statistically significant. Results: Out of 66 samples processed, 60/66 (90.9%) showed culture positivity. The highest proportion of patients belonged to the 31-40 years age group {18/66 (27.3%)}, and males accounted for 55/66 (83%) cases. Gram-negative organisms predominated {39/60 (65%)}, while Staphylococcus aureus was the most common individual isolate {21/60 (35%)}. Among S. aureus isolates, MRSA constituted 12/21 (57.1%). ESBL + AmpC co-production was the predominant resistance mechanism among Gram-negative isolates {23/39 (59%)}, followed by ESBL production alone {11/39 (28%)}. All S. aureus isolates remained susceptible to vancomycin and linezolid. Conclusion: OIAIs predominantly affected younger males and were more commonly associated with external implants. Gram-negative organisms showed a high burden of Multidrug Resistance (MDR), including ESBL and AmpC production. Routine antimicrobial susceptibility testing, continuous resistance surveil-lance, and antibiogram-guided therapy are essential for effective management and antimicrobial steward-ship.

Tumour-infiltrating Lymphocyte Score and its Association with Histopathological Parameters in Gastrointestinal Tumours: A Cross-sectional Study from a Tertiary Care Centre in Chengalpattu, Tamil Nadu, India

Anushankari Pandian, Sangeetha Nagalingam Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Gastrointestinal malignancies are biologically heterogeneous and show variable immune responses across anatomical sites. Tumour-Infiltrating Lymphocytes (TIL) reflects host immune response within the tumour microenvironment and can be assessed on routine haematoxylin and eosin-stained sections. Aim: To evaluate stromal TIL score in primary gastrointestinal malignancies and assess its association with histopathological parameters. Materials and Methods: This single-centre cross-sectional study included 45 primary gastrointestinal malignant tumours diagnosed between January 2024 and December 2025 at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India. Tumours from the stomach, colon, rectum, duodenum, and oesophagus/gastro-oesophageal junction were included. Histopathological parameters including tumour site, histological subtype, tumour grade, lymphovascular invasion, perineural invasion, lymph node status, pathological tumour stage, and TNM stage were recorded. Stromal TIL score was assessed as the percentage of stromal area occupied by mononuclear inflammatory cells. For dichotomised analysis, cases with stromal TIL score >50% were classified as high-TIL, whereas cases with stromal TIL score ≤50% were grouped as low-TIL. Statistical Analysis: Data were analysed using SPSS software version 29.0. Fisher’s-exact test was used for categorical variables, and Mann-Whitney U test was used for continuous non-parametric variables. A p-value <0.05 was considered statistically significant. Results: Among 45 cases, 27 (60.00%) were High-TIL and 18 (40.00%) were Low-TIL. Low-TIL status showed significant association with poor differentiation, lymphovascular invasion, perineural invasion, nodal positivity, advanced pT stage, and advanced TNM stage. Positive lymph node count and exploratory composite adverse-feature score were significantly lower in the high-TIL group. Conclusion: Low stromal TIL status was associated with adverse histopathological features. However, because stromal TIL distribution was uneven across tumour sites and histological subtypes, the findings should be interpreted as exploratory pooled associations rather than site-independent conclusions.

Incidence, Clinical Features and Risk Factors for Cystoid Macular Oedema following Cataract Surgery: A Prospective Cohort Study

Shetty Niharika Krishna, Supreet S Kelagar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Pseudophakic Cystoid Macular Oedema (PCME) remains an important cause of delayed visual recovery after cataract surgery. The use of Optical Coherence Tomography (OCT) has increased the detection of milder and subclinical postoperative macular oedema, making local incidence estimates and risk profiling clinically relevant. Aim: To estimate the incidence of PCME within 3 months after cataract surgery and to evaluate the clinical and operative risk factors associated with its occurrence. Materials and Methods: The present prospective cohort study was conducted in the Department of Ophthalmology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Karnataka, India, during a 12-month study period from January 2025 to January 2026. A total of 155 eyes of 155 patients aged 40 years and above undergoing small-incision cataract surgery or phacoemulsification were analysed. Baseline systemic and ocular variables, operative details, postoperative anterior chamber reaction, Best-Corrected Visual Acuity (BCVA), and OCT-derived central macular thickness were recorded. PCME was defined on OCT by intraretinal cystic changes with increased central macular thickness. Categorical variables were analysed by Chi-square test or Fisher’s exact test, continuous variables by Student’s t-test, and within-group CMT change by paired t-test after assessment of distribution. Exploratory multivariable logistic regression was used to identify associated predictors. A p-value of <0.05 was considered statistically significant. Results: PCME was identified in 18 of 155 eyes (11.6%). Diabetes mellitus, hypertension, operative duration >20 minutes, intraoperative complications, and anterior chamber inflammation grade ≥2 at one week were more frequent in the PCME group. Mean central macular thickness increased from 252±22 μm preoperatively to 320±25 μm at six weeks in eyes with PCME (p<0.001), whereas the change in non-PCME eyes was not statistically significant (250±20 μm to 240±18 μm, p=0.052). 3-month BCVA remained poorer in the PCME group (LogMAR 0.5±0.2 vs 0.3±0.1, p=0.008). In exploratory multivariable analysis, diabetes mellitus, operative duration >20 minutes, and intraoperative complications remained associated with PCME. Conclusion: OCT-detected PCME occurred in approximately one in nine operated eyes in this cohort. Diabetes mellitus, greater operative stress, and intraoperative complications were the strongest associated predictors. Early OCT surveillance may therefore be justified in eyes with a higher postoperative inflammatory or metabolic risk profile.

Optimising Medication Adherence in Drug-resistant Tuberculosis through Pharmacist-Led Counselling: A Prospective Interventional Study

Vishwa Rajakumar Byakod, Madiwalayya Shivakantayya Ganachari, Vivek Patil Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Medication adherence describes how well patients follow their prescribed treatment in terms of dose, timing and frequency. The present study evaluated adherence patterns to identify areas where focused interventions such as patient education, counselling and improved support systems may be needed. Aim: To assess medication adherence among patients with Drug-Resistant Tuberculosis (DR-TB) using a validated adherence assessment tool and to evaluate the impact of patient counselling through Patient Information Leaflets (PIL) on adherence-related outcomes. Materials and Methods: A prospective interventional multicentre study was carried out among 133 patients diagnosed with DR-TB from April 2025 to March 2026 at the District Tuberculosis Centre, Belagavi, Karnataka, India. along with four associated centres in North Karnataka under the National Tuberculosis Elimination Programme (NTEP). Medication adherence was evaluated using a validated and structured adherence assessment tool. In addition, patient counselling was provided through specially designed PIL and adherence-related parameters were assessed and compared throughout the study period. The data were analysed using descriptive statistics, paired t-test, Wilcoxon’s signed-rank test, correlation analysis and multiple linear regression. Results: Among 136 patients screened, 133 eligible patients with DR-TB were enrolled and completed the study. Following individualised medication-adherence counselling, significant improvements were observed across all medication adherence domains (p<0.001). The greatest improvement was observed in the medical condition-related domain (mean difference=3.02; Cohen’s dz=2.40), followed by the therapy-related domain (mean difference=1.92; Cohen’s dz=1.37). Wilcoxon’s signed-rank analysis demonstrated significant positive changes in 20 of 21 questionnaire items, with effect sizes ranging from 0.295 to 0.833. No significant change was observed for the item assessing delays in medication refilling due to financial constraints (p=1.000). Overall, the intervention resulted in a substantial improvement in medication adherence among DR-TB patients. Conclusion: The intervention significantly improved adherence-related outcomes across multiple domains, independent of demographic factors. Pharmacist-led, patient-centred strategies may enhance DR-TB management and support effective Tuberculosis (TB) control.

Red Cell Distribution Width and Serum Electrolyte Disturbances as Predictors of Length of Hospital Stay in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

N Shrilakshmi, CC Deepu, Chittin N Swamy Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a frequent cause of hospital admission, and early identification of patients likely to have prolonged in-patient stay is clinically useful. Red Cell Distribution Width (RDW) and serum electrolyte disturbances are routinely available at admission, but their combined relationship with length of hospital stay is not consistently described. Aim: To assess admission RDW and serum electrolyte levels in patients admitted with AECOPD and to examine their association with length of hospital stay. Materials and Methods: This hospital-based prospective observational study was conducted in the Department of Respiratory Medicine, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Karnataka, India, over three months from June 2025 to August 2025. A total of 50 consecutive patients aged 40 years or older admitted with AECOPD were analysed. RDW and serum electrolyte levels were measured at admission, and length of hospital stay was calculated from admission to discharge. Correlation analysis and multivariate linear regression were performed using IBM Statistical Package for Social Sciences (SPSS), version 30.0. A p-value<0.05 was considered statistically significant. Results: The mean age was 65.4±8.2 years, and the mean length of hospital stay was 10.6±2.8 days. Elevated RDW (>14.3%) was present in 41 (82%) patients, while hyponatraemia, hypokalaemia, hypocalcaemia, and hypomagnesaemia were observed in 38 (76%), 32 (64%), 29 (58%), and 18 (36%) patients, respectively. RDW showed a significant positive correlation with length of stay (r=+0.47, p=0.001). Serum sodium (r=-0.39, p=0.005) and potassium (r=-0.32, p=0.028) showed significant inverse correlations. In multivariate analysis, RDW (beta=+0.42, p=0.001), serum sodium (beta=-0.32, p=0.008), and serum potassium (beta=-0.25, p=0.038) remained independent predictors of length of hospital stay. Conclusion: Higher RDW and lower serum sodium and potassium at admission were independently associated with longer length of hospital stay among patients admitted with AECOPD. These routinely available admission parameters may support early risk stratification and inpatient management planning.

Low-cost Distraction Technique to Reduce Pain Perception among Infants and Improve Parents’ Satisfaction during the Immunisation Procedure: An Interventional Study from Assam, India

Deepanshu Sharma, Rahul Sharma, Jyoti Sharma Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Immunisation serves as a critical key indicator of community child health and plays a crucial role in reducing infant mortality. The Sample Registration System (SRS) 2021, Assam continues to report a higher Infant Mortality Rate (IMR-30) compared with the national average (IMR: 25). The aspirational district Programme emphasises strengthening maternal and child health outcomes through evidence-based interventions and local innovations. Aim: To explore the effect of oral sucrose and the 4S technique on infant pain perception and parent satisfaction during immunisation. Materials and Methods: The present facility-based experimental comparative study was conducted at the Immunisation Clinic of the Civil Hospital, Mangaldoi, Darrang (aspirational district), and Civil Hospital Karimganj (non-aspirational district) of Assam, India, The study is affiliated with Poornima University, Jaipur, and the University provided ethical approval through the JSPH Institutional Review Board (IRB) in Jodhpur and Ethics Committee No. JSPH/23/08/0, dated 29/08/2023. The duration of the study was from October 2023 to April 2024. The total sample size was 400, equally distributed between two study sites (200 each site), with participants at each site further divided into four groups of 50 participants each (Group A,B,C and the Control group). The 4S technique and oral sucrose were also used. The modified Riley pain scale was utilised to measure pain, and a 5-point Likert scale was used to measure parent satisfaction. Statistical analysis was performed using t-test, chi-square value and p-value <0.05 was considered statistically significant. Results: The study found that mothers in non-aspirational districts were more aware of Universal Immunisation Programme (UIP) Programmes compared to aspirational districts since infant immunisation begins at 1.5 months of age. Intervention Group C, which combined the 4S technique with oral sucrose, had the highest proportion of infants reported no pain in both aspirational 39 (78%) and non-aspirational 33 (66%) districts. Lower pain scores were positively associated with parental satisfaction, with Group C showing the highest level of satisfaction {32 (64%) in AD and 30 (60%) in non AD}. All intervention groups showed statistically significant improvement compared to the control group (p=0.001). Conclusion: Improving immunisation is crucial for reducing vaccine hesitancy and needle fear in aspirational and non-aspirational districts. Improving vaccination awareness can improve neonatal health and reduce the infant mortality rate. The results suggest the use of pharmaceutical and non pharmacological therapies, such as sucrose administration, to lessen vaccination-related pain, especially in children’s populations.

Intraocular Pressure and Optic Nerve Sheath Diameter during Prone-position Thoracolumbar Spine Surgery: A Prospective Observational Study

Navneeta Bisht, Somsubhra Pal, Sarita Kumari, Sumit Sachan, Ram Badan Singh, Ravi Shankar Prasad Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Patients undergoing prone-position spine surgery risk raised Intraocular Pressure (IOP) and, rarely, Postoperative Visual Loss (POVL). The temporal behaviour of IOP, Ocular Perfusion Pressure (OPP) and Optic Nerve Sheath Diameter (ONSD), a non-invasive surrogate of Intracranial Pressure (ICP), and the relationship between these ocular and intracranial parameters, remain incompletely characterised. Aim: To evaluate the magnitude and temporal pattern of changes in IOP, OPP, ONSD and Mean Arterial Pressure (MAP) during prone-position thoracolumbar spine surgery, to identify factors associated with IOP elevation, and to examine the correlation between IOP and ONSD. Materials and Methods: This prospective observational study was conducted in the Department of Anaesthesiology and Critical Care Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. A total of 37 American Society of Anaesthesiologists (ASA) I-II patients undergoing thoracolumbar spine fixation were enrolled. Bilateral IOP, OPP, ONSD and MAP were measured at eight time points: postintubation (baseline), hourly for up to six hours, and before extubation. Data were analysed with the Friedman test, paired t-tests and Spearman rank correlation. Results: Thirty-seven patients completed the study. IOP rose significantly from baseline (right eye 13.46±1.95 mmHg) to 22.65±2.50 mmHg at 5 hours and 23.40±1.52 mmHg at 6 hours, p-value <0.001, and remained elevated before extubation (16.06±2.82 mmHg, p-value <0.001). ONSD increased during prone positioning and returned towards baseline by extubation. IOP and ONSD correlated positively across intraoperative measurements (pooled Spearman ρ=0.299, p-value <0.001, n=486). Age (ρ=0.543) and baseline MAP (ρ=0.533) correlated with baseline IOP (both p-value=0.001). OPP remained above 50 mmHg in every patient. No patient developed visual impairment postoperatively or at 48 hours. Conclusion: Prone-position spine surgery causes significant, progressive IOP elevation that persists until extubation. The parallel rise in ONSD and its correlation with IOP suggest a concurrent increase in ICP, an eye-brain axis response. OPP was nonetheless preserved and no POVL occurred, indicating that surgery of this duration was tolerated by ASA I-II patients. Advanced age and higher baseline MAP confer greater risk, supporting perioperative IOP monitoring in high-risk patients.

Evaluation of Hand Files and Two Rotary Systems for Pulpectomy in Children Aged 4-9 Years: A Randomised Clinical Trial

Shivayogi M Hugar, Snehal S Kumthekar, Akanksha Dumbare, Vedika Pitta, Aishwarya Patil, Chandrashekhar Badakar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Hand instrumentation has long been used for pulpectomy procedures; however, it is often associated with prolonged treatment time. In comparison, Nickel-Titanium (NiTi) rotary files used for root canal preparation in primary teeth are more efficient and economical, enabling quicker procedures with consistent and predictable outcomes. Aim: To evaluate and compare hand files and two rotary systems for pulpectomy in children aged 4-9 years. Materials and Methods: The present prospective, in-vivo, three-arm, parallel-group, randomised clinical trial was conducted in Department of Paediatric and Preventive Dentistry at KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India, from 6th January 2026 to 31st January 2026. A total of 75 healthy children aged 4-9 years meeting primary inclusion criteria (positive/definitely positive behaviour on Frankl’s scale, primary molars with spontaneous pain/irreversible pulpitis and at least two-thirds root length remaining) were randomly allocated into three groups (n=25 each). Group I was instrumented using hand K-files, Group II using Kedo Nano Plus rotary files and Group III using Neoendo Pedoflex rotary files. Instrumentation time was recorded using a stopwatch. Obturation quality was evaluated using Modified Coll and Sadrian criteria and postoperative pain was assessed using Wong-Baker Faces Pain Rating Scale at 24, 48 and 72 hours. Inferential analysis used chi-square test for categorical associations; Analysis of Variance (ANOVA)/Kruskal-Wallis for multiple group comparisons; independent t-test/Mann-Whitney U for two-group comparisons. p-value<0.05 is considered statistically significant. Results: Participants (mean age 6.01±1.45 years) showed no significant intergroup differences in age or gender (p>0.05). Obturation quality differed significantly (χ²=22.419, p<0.001), with optimal fills highest in Group II with 21 (84%) canals and Group III with 19 (76%) canals versus Group I with 6 (24%)canals. Instrumentation time was significantly lower with 6.88 min for Group II and 8.85 min for Group III compared to 16.35 min with Group I (ANOVA, p<0.001). Postoperative pain showed significant differences at 24 h (p<0.001) and 72 h (p<0.05), with higher pain in hand file group. Conclusion: Kedo Nano Plus rotary system demonstrated enhanced obturation quality, followed by Neoendo Pedoflex rotary files, making it viable alternative to conventional hand K-files for pulpectomy in primary molars.

Immunohistochemical Expression of CD57 in Oral Squamous Cell Carcinoma: A Cross-sectional Study

R Ranjith Kumar, TN Suresh, D Aswathappa Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Over 90% of oral malignancies in India are squamous cell carcinomas, with oral cancer accounting for about 30% of the total number of cancers in this country. Tumour microenvironment is a critical factor in tumour progression and immunomodulation. The anti-tumour immune response and good prognosis of various cancers have been linked to the presence of CD57, which is a marker of migrated differentiated Natural Killer (NK) cells. Aim: To evaluate the association between CD57 expression and TNM staging in Oral Squamous Cell Carcinoma (OSCC). Materials and Methods: The present observational cross-sectional study conducted in Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India, involving OSCC found in 60 histologically confirmed cases between January 2024 and December 2024. The immunohistochemical staining of the CD57 was done on the positive control of tonsil tissue using primary mouse monoclonal antibody. Stromal lymphocytes that were stained in cytoplasm were regarded as positive. The five stromal hotspots were assessed and the average result was considered to be the CD57 labelling index. Quartile-based cut-off values were used as a categorisation of CD57 expression. Parameters studied were tumour grade, T stage, Lymph node positive and negative cases and overall Tumour-Node-Metastasis (TNM) stage. Descriptive statistics were used to report the 25^th, 50^th (median), and 75^th percentiles. Associations between categorical variables were assessed using the Chi-square test. A p-value <0.05 was considered statistically significant. The statistical analysis was done in Statistical Package for Social Sciences (SPSS) version 22. Results: The male-to-female ratio was 1:1.8. Buccal mucosa was the most common site 41 (68.3%) cases. TNM staging revealed 5 (8.3%) cases in stage I, 21 (35%) in stage II, 16 (26.7%) in stage III, and 18 (30%) in stage IV. Lymph node metastasis was present in 18 cases (30%). High CD57 expression showed a statistically significant association with nodal-negative status (p=0.0001). Lymph node metastasis was identified in 18 of 60 (30.00%) cases, whereas 42 (70.00%) cases showed no nodal involvement. Conclusion: The potential of CD57 as an immunological marker concerning tumour behaviour was demonstrated by a significant association of the nodal status with the expression of the CD57 in OSCC.

Compliance of Lifestyle Modifications among Overweight and Obese School Children Aged 7 to 12 Years: A Prospective Interventional Study

Jayalakshmi Pabbati, Banothu Ravi Kumar, Manisha Reddy Mogulla Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The recognition of obese and overweight children and their treatment is an important aspect of preventive paediatrics and public health, as a drastic increase in prevalence was observed globally in the past decade. The recommended initial step in the management of childhood obesity is lifestyle modification. Children spend most of their time in school; it is evident that the school environment is the ideal setting for childhood obesity intervention programmes. Aim: To estimate the prevalence of obesity and overweight in school children aged 7-12 years, as well as their compliance with lifestyle modifications. Materials and Methods: A prospective interventional study was conducted among 640 school children of five schools located in the five-kilometre radius of the Gandhi Medical College, Telangana, India over a period of 18 months from September 2022 to March 2024. The Student's paired t-test was used to compare the inter group variation in the mean value of Body Mass Index (BMI), time spent on physical activity and sedentary behaviour per day. The Chi-square test was used to assess the categorical variables, such as number of episodes of the skipping of the breakfast and intake of junk/excess caloric intake in a week. Statistical significance was taken with a p-value of <0.05. Results: Out of the 640 students screened, 148 (23.13%) were identified as obese and overweight. Among 148 students, 72 were overweight (11.25%), while 76 (11.88%) students were obese. The majority of overweight children were within the age category of seven to eight years, whereas children with obesity were predominantly observed in the 11 to 12 years age group. The present study revealed a higher female predominance, accounting for 86 (58.11%) in overweight and obese children. Following the lifestyle modifications, the average BMI for these children was reduced from 25.98 kg/m² to 20.67 kg/m², with the p-value of <0.001. Compliance to the lifestyle modification was observed in 123 (83.11%) overweight and obese children, while the dropout rate was seen in 25 (16.89%) children. Conclusion: Lifestyle modifications effectively reduced obesity rates in children. High compliance rates indicate the potential for successful long-term lifestyle changes in children.

Efficacy of Pericapsular Nerve Group Block in Combination with Suprainguinal Fascia Iliaca Block in Comparison to PENG Block Alone for Postoperative Analgesia after Total Hip Arthroplasty: A Randomised Double-blind Controlled Study

Devyani Desai, Neha Shah, Ashpalya Dhote, Mittal Bhuriya, Pinal Bumiya Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The complex innervation of the hip joint may require a combined regional analgesia technique to achieve effective perioperative analgesia. The Pericapsular Nerve Group (PENG) and Suprainguinal Fascia Iliaca Compartment Blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and Lateral Femoral Cutaneous Nerves (LFCN), essentially innervating the hip joint. Aim: To evaluate the efficacy of the PENG block and SIFICB compared with the PENG block alone for postoperative analgesia and functional recovery in patients undergoing Total Hip Arthroplasty (THA). Materials and Methods: This double-blind, randomised controlled study was conducted at Sir Sayajirao General Hospital, Baroda Medical College, Vadodara, Gujarat, India. The study analysed 60 patients aged 18-65 years with American Society of Anaesthesiologists (ASA) status I-III who were posted for THA. Postoperatively, the PSB group received SIFICB (20 mL) and a PENG block (10 mL), while the PB group received only a PENG block (10 mL) with 0.5% bupivacaine and 8 mg dexamethasone. The Visual Analogue Scale (VAS) scores at rest and with 15° hip flexion, the duration of analgesia, the cumulative dose of rescue analgesic required, motor blockade, ability to perform quadriceps exercises, early ambulation, patient satisfaction, and complications over the first 6, 12, 24, and 48 hours were assessed. Statistical analysis was performed using the student’s t-test, Chi-square test, and Mann-Whitney U test in MedCalc version 20.0.10. Results: The two groups were comparable in terms of demographics. The patients belonging to the PSB group had significantly lower median pain scores {1 (0-2) vs 2 (2-3), p-value <0.001; 0 (0-0) vs 1 (0-2), p-value <0.001, respectively} at rest and {3 (2-4) vs 4 (3-5), p-value=0.007, and 2 (1-3) vs 3 (2-4), p-value <0.001, respectively} with 15° hip flexion at 24 and 48 postoperative time points with longer median duration of analgesia {40 (18-42) vs 8 (6.5-19.5) hours, p-value<0.0001} and reduction in median cumulative requirement of rescue analgesic {0 (0-1) vs 1 (1-2), p-value=0.002} compared to the patients with group PB. Group PSB patients walked a higher mean number of steps than group PB (137.1±30.97 vs 75.9±19.55, p-value<0.0001) after 48 hours. Conclusion: A combination of the PENG and SIFICB provides lower VAS scores at rest and with 15° hip flexion, a longer duration of analgesia, and a reduced requirement for rescue analgesics in the first 48 hours postoperatively, in comparison to the PENG block alone after THA. It also preserves motor function, enabling more quadriceps exercises, and supports early mobilisation, ultimately leading to greater patient satisfaction.

Comparison of Microleakage of Resin-based Composite Restoration on Pretreating Dentin with Chlorhexidine and Grape Seed Extract by Dye Penetration Technique: An In-vitro Study

Elsy P Simon, VK Vibin, MV Veena, Nimmy Kurian, Kavya Belaram Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Durability of dentin-resin adhesion relies on the integrity of the collagen network within the hybrid layer. However, this collagen is susceptible to degradation by Matrix Metalloproteinases (MMPs) and cysteine cathepsins, particularly in areas insufficiently infiltrated with resin. To enhance collagen stability and reduce degradation, various cross-linking agents such as Chlorhexidine (CHX) and Grape Seed Extract (GSE) have been explored. This study investigates whether these agents, when applied to etched dentin, can reduce microleakage in composite restorations. Aim: To evaluate and compare the effect of 2% CHX and 6.5% GSE as dentin pretreatment on microleakage in composite restorations. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics, KMCT Dental College, Manassery, Mukkam, Kozhikode, Kerala, India in January 2025. Twenty-four extracted, non carious human premolars extracted for therapeutic or periodontal reasons were randomly divided into two groups (n=12 each). Standardised Class V cavities were prepared with cervical margins in dentin. Group 1 was pretreated with 2% CHX, and Group 2 with 6.5% GSE after acid etching. Cavities were then restored using a 5th generation bonding agent and composite resin. Samples underwent 1500 thermocycles, followed by immersion in 2% methylene blue dye for 24 hours. Longitudinal sections were evaluated for microleakage under a stereomicroscope and scored from 0 (no leakage) to 4 (penetration including pulpal floor). Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0, using an Independent t-test with p<0.05 considered statistically significant. Results: Both groups exhibited varying degrees of microleakage. The GSE group showed a lower mean score (1.83±1.33) compared to the CHX group (2.66±1.30), with three GSE samples showing no leakage. However, the difference between the groups was not statistically significant (p=0.13). Conclusion: Within the limitations of this in-vitro study, pre-treatment of etched dentin with CHX or GSE did not significantly eliminate microleakage in composite restorations, despite some specimens in the GSE group showing zero leakage.

Functional Outcomes of Arthroscopic ACL Reconstruction with a Bone-patellar Tendon-bone Graft using the Femoral Press-fit Fixation Technique: A Prospective Observational Study

NM Manjesh Kumar, MB Dileep, Mayur Rai, Vinay Vasu Bangera, Chavan Pramod Babu Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Anterior Cruciate Ligament (ACL) injuries are common, particularly among athletes, and require surgical intervention to restore knee stability and function. The Bone-Patellar Tendon-Bone (BPTB) graft is a widely used graft for ACL reconstruction, known for its biomechanical strength and favourable outcomes. The femoral press fit fixation technique was developed to avoid disadvantages related to hardware and other fixation devices. Aim: To evaluate the functional outcomes of arthroscopic ACL reconstruction using the BPTB graft with the femoral press-fit fixation technique, and to review the associated complications and rehabilitation protocols. Materials and Methods: A prospective observational study was conducted at A J Institute of Medical Sciences, Mangalore, India, from July 2022 to March 2024. It was conducted among 21 patients who underwent arthroscopic ACL reconstruction with a BPTB graft and femoral press-fit fixation. Clinical outcomes such as range of motion, postoperative complications, and graft failure were assessed using the IKDC (International Knee Documentation Committee) and Lysholm scoring systems. Repeated Measures ANOVA was utilised to compare mean IKDC scores and Lysholm’s scores across time points. A p-value of <0.05 was considered significant. Results: All patients included belonged to class III modified Kuppuswamy scale. The use of BPTB grafts in ACL reconstruction produced positive functional outcomes, including significant improvements in (p<0.01) knee stability and patient-reported outcomes. However, the study identifies potential problems, such as donor site morbidity in one patient among 21 (4.8%) and anterior knee pain in 9 (42.9%) patients out of 21. Conclusion: Arthroscopic ACL reconstruction using BPTB grafts with the femoral press-fit technique is an effective method for restoring knee function. Despite certain risks, the advantages of bone-to-bone healing, cost-effectiveness, avoiding hardware-associated complications and clinical outcomes make it a preferred choice for ACL reconstruction.

Quantitative Analysis of CD34+ Haematopoietic Stem Cells using Flow Cytometry: A Cross-sectional Study

Rupali Kumari, Satish Arakeri Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: For a successful transplant, it is significant to precisely count haematopoietic stem and progenitor cells (CD34⁺) to make sure the graft is big enough. Standardised protocols are essential for consistent results across biological samples. Accurate enumeration of CD34⁺ Haematopoietic Stem Cells (HSC) is essential for successful transplantation, but variability in flow cytometric methods and lack of standardisation can affect reliability. Standardised protocols are therefore necessary to ensure reproducible and clinically meaningful results. Aim: To standardise the method of enumeration of CD34 counting in flow cytometry and its correlation with quality controls. Materials and Methods: The present cross-sectional study was done in the Pathology Department, Flow Cytometry Section, at BLDE (Deemed to be University), Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from March 2024 to October 2025. Total 30 samples (10 from each source i.e., bone marrow, cord blood as well as peripheral blood samples) were analysed using a bead-based, single-platform flow cytometric assay (BD Stem Cell Enumeration Kit) on a BD FACSCanto™ II. The primary outcome was the absolute count of viable CD34⁺ cells/μL measured by single-platform bead-based flow cytometry. Secondary parameters included CD34⁺ percentage, precision (CV), linearity, bead recovery and acquisition quality indices. Statistical analysis was accomplished by Statistical Package for Social Sciences (SPSS) version 20. Continuous variables were summarised as mean±SD or median (IQR) based on distribution assessed by the Shapiro-Wilk test. Group comparisons (PB, CB, BM) used ANOVA with appropriate post-hoc analysis. Results: Cord blood showed the highest CD34⁺ viability (94.73%), followed by bone marrow (73.20%) and peripheral blood (57.28%). CD34⁺ counts were highest in bone marrow (509.05 cells/μL), followed by peripheral blood (231.5 cells/μL) and cord blood (46.84 cells/μL). CD34 count showed a negative correlation with viability (r=-0.351, p=0.047) and a positive correlation with CD45% (r=0.466, p=0.009). Conclusion: Mono-platform flow cytometry is reliable in the enumeration of CD34⁺ in various biological specimens. The analysis of a counts, viability and CD45 simultaneously increases the accuracy of the test, as it aids in making correct clinical decisions in the transplant of stem cells.

Morphology and Proportion of Testicular and Epididymal Appendices: A Cadaveric Study

Smitha S Nair, R Rajeev, Jenish Joy, KB Usha Devi, A Mini, SS Athira Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The testicular and epididymal appendages are small, vestigial remnants of embryonic duct systems which are clinically significant, as the torsion of these appendages represent one of the most common causes of acute scrotum. A precise knowledge of the morphological features of these appendages would be highly beneficial for the diagnosis and treatment of acute scrotum. Aim: To estimate the proportion and to describe the morphology of testicular and epididymal appendices. Materials and Methods: A cross-sectional study was conducted in the Department of Anatomy, Government Medical College, Thiruvananthapuram, Kerala, India, from February 2026 to April 2026. A total of 112 testicular specimens available in the Department were used to study the testicular and epididymal appendages. The specimens were analysed for the following situations: (i) Absence of both testicular and epididymal appendages; (ii) Presence of appendix of testis alone; (iii) Presence of appendix of epididymis alone; (iv) Presence of both testicular and epididymal appendages; (v) Presence of more than one testicular or epididymal appendices in one testis. The morphology of these appendages were also evaluated. The data obtained were analysed, qualitative variables were presented in percentages and the quantitative variables in mean and Standard Deviation (SD). Results: Some type of testicular or epididymal appendices were found in 83 (74.1%) specimens. In 54 (48.2%) appendix was present in testis alone, in 19 (17%) appendix was present in epididymis alone, and in 10 (8.9%) it was present in both testis and epididymis. Out of 83 specimens, there were no specimens with more than one epididymal or testicular appendages. Among the appendix of testis, it was found in both sides in 93.8% and majority of them were sessile (79.7%). Among the appendix of epididymis, in 96.6% they were present on both sides and majority were pedunculated (79.3%). The mean length, width and thickness of testicular appendices were 1.67±0.70 mm, 1.23±0.25 mm and 0.30±0.25 mm respectively. The mean length, width and thickness of epididymal appendices were 2.90±1.39 mm, 1.57±1.00 mm and 0.55±0.18 mm, respectively. Conclusion: In the present study, appendix of testis was found on both sides in most of the specimens and majority of them were sessile. Epididymal appendix were found on both sides in most of the cases and majority were pedunculated. So, if the acute scrotum is due to torsion of these appendages, the surgeon should carefully examine the opposite side also to prevent its torsion in future. A detailed anatomical knowledge of these appendages would be vital in the diagnosis and treatment of acute scrotum. The study findings would be promising for the clinical practice and research.

Effects of Jaffe and Enzymatic Creatinine Assays on eGFR Classification and Analytical Acute Kidney Injury Threshold Crossing: A Cross-sectional Method-comparison Study

Biswajit Das, Radhakrishnan Narayanaswamy, Wilma Delphine Silvia Chickballapur Rayappa, Arbind Kumar Choudhary Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Serum creatinine remains the routine marker for kidney-function assessment, but Jaffe and enzymatic assays can yield systematically different values. Such differences may alter estimated Glomerular Filtration Rate (eGFR) category assignment and may cross creatinine-based analytical thresholds used in Acute Kidney Injury (AKI) surveillance. Aim: To compare Jaffe and enzymatic creatinine methods and determine their effect on serum creatinine, urine creatinine, creatinine clearance, Estimated Glomerular Filtration Rate (eGFR), Kidney Disease: Improving Global Outcomes (KDIGO), eGFR G-category (G1-G5) assignment, same-sample analytical Acute Kidney Injury (AKI)-threshold crossing, and exploratory calibration of Jaffe-derived eGFR. Materials and Methods: This cross-sectional laboratory method-comparison study was conducted at the Department of Biochemistry in the clinical laboratory setting of NU Hospitals Pvt., Ltd., Bangalore, India, from January 2026 to March 2026. A total of 105 participants had paired serum Jaffe and enzymatic creatinine measurements; paired urine creatinine measurements were available for 98 participants. Correlation, regression, Bland-Altman agreement, eGFR G-category agreement, analytical AKI-threshold crossing, and exploratory calibration modelling were evaluated using Python and R. Results: Mean age of the participants was 49.2±16.4 years, and 75 (71.4%) were male. Jaffe serum creatinine was higher than enzymatic serum creatinine by a mean±SD of 0.12±0.13 mg/dL, and Jaffe-derived eGFR was lower by a mean±SD of -9.0±11.0 mL/min per 1.73 m2. Correlation was excellent for serum creatinine (Pearson’s r=0.997), urine creatinine (r=0.998), creatinine clearance (r=0.977), and eGFR (r=0.973). eGFR G-category agreement was 70.5% (Cohen’s kappa=0.63), with most discordance reflecting higher-risk categorisation by the Jaffe method. Nine participants (8.6%) crossed the same-sample analytical 0.3 mg/dL serum creatinine difference threshold. Exploratory calibration improved apparent eGFR category agreement to 74.3%, while 5-fold cross-validated agreement was 72.4%. Conclusion: Jaffe and enzymatic creatinine measurements were highly correlated but not fully interchangeable. This analysis shows potentially clinically relevant shifts in eGFR category assignment and same-sample analytical AKI-threshold crossing when assay methods differ. Urine creatinine agreement was also strong but showed a positive Jaffe-minus-enzymatic bias. The creatinine assay method should therefore be documented during reporting, interpretation, method transition, and longitudinal follow-up.

Green-mediated Silver-Carbon-Chitosan Nanocomposite Wound Healing Gel using Musa paradisiaca: An In-vitro Study against Wound-assosciated Pathogens

Banuppriya Palani, Steffy Dominic, Santhoshkumar Jayakodi, Rajeshkumar Shanmugam, Elumalai Perumal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The rise of antibiotic-resistant wound infections highlights the need for alter-native antimicrobial agents. Green synthesis using plant extracts provides an eco-friendly approach, and Musa paradisiaca leaves contain phytochemicals that aid nanoparticle synthesis and stabilisation. Aim: To synthesise a green-mediated silver–carbon–chitosan nanocomposite (C-AgNCs) using aqueous leaf extract of Musa paradisiaca leaf extract and evaluate its physicochemical characteristics, antimicrobial, antibiofilm, and time-kill activities against selected wound-associated pathogens. Materials and Methods: This in-vitro experimental study was conducted at the Department of Microbiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Scienc-es, Chennai, Tamil Nadu, India, over a period of three months from January 2026 to March 2026. C-AgNCs were synthesised using a green method, aqueous leaf extract. Nanoparticles were confirmed by visible colour change and UV-visible spectroscopy, showing a Surface Plasmon Resonance (SPR) peak at 440 nm, indicating spherical morphology. Antimicrobial activity was assessed using the agar well diffusion meth-od against Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecium, Escherichia coli, and Staphylococcus aureus. Time-kill kinetics was evaluated through opti-cal density measurements over four hours. Antibiofilm activity was analysed at varying concentrations. Results: Synthesised C-AgNCs exhibited significant antimicrobial activity, with a maximum inhi-bition zone of 18 mm against Pseudomonas sp. at 100 μL. Time-kill assays demonstrated dose- and time-dependent bactericidal effects, particularly against E. coli and I#ISI?I. aureus, with substantial reduction in viable cells within 2-4 hours. Antibiofilm showed concentration-dependent inhi-bition, with E. coli being highly sensitive. Conclusion: Green-synthesised C-AgNCs demonstrate strong antimicrobial and antibiofilm proper-ties and show promising potential as a sustained-release therapeutic agent for managing chronic wound infections.

PD-L1 Expression in Cervical Intraepithelial Neoplasia and Carcinoma: A Cross-sectional Observational Study

S Divya, V Eswari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Programmed Death-Ligand 1 (PD-L1) contributes to immune escape in cervical lesions and may have clinical relevance for risk stratification and immunotherapy. The present study addresses the need for a uniform revaluation of PD-L1 expression across the pre-invasive to invasive cervical neoplasia spectrum using a combined intensity-and-proportion scoring approach. Aim: To evaluate PD-L1 expression in Cervical Intraepithelial Neoplasia (CIN) and invasive carcinoma using a predefined, uniform immunohistochemical scoring protocol. Material and Methods: The present cross-sectional observational study was conducted at Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu, India. from May 2024 to December 2025. Sixty cervical biopsy specimens were analysed, comprising 10 cases each of CIN-1, CIN-2 and CIN-3, and 30 cases of invasive carcinoma. PD-L1 staining intensity and the proportion of positive lesion cells were scored from 0 to 3, and a composite score (0-6) was obtained by adding the two scores. Expression was categorised as negative (0), low (1-2), intermediate (3) or strong (4-6). Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0 with Pearson’s chi-square tests, Cochran-Armitage trend tests, Kruskal-Wallis tests, Mann-Whitney U-tests and multivariable binary logistic regression. Results: The study included 60 cases; based on grouped age mid-points, the estimated mean age was 43.5 years. Overall, 21/60 (35%) cases were PD-L1 positive. Positivity was 0/10 (0%) in CIN-1, 3/10 (30.0%) in CIN-2, 5/10 (50.0%) in CIN-3 and 13/30 (43.3%) in invasive carcinoma. The association between diagnosis and PD-L1 positivity approached significance (Pearson’s chi-square=7.40, p=0.060), while a significant increasing trend was observed across CIN grades (Cochran-Armitage-Z=2.53, p=0.011). PD-L1 positivity also differed across age groups (chi-square=8.71, p=0.033), with a significant age-related trend (Z=2.70, p=0.005). Multivariable logistic regression showed that each one-level increase in diagnostic severity was associated with higher odds of PD-L1 positivity (Odds Ratio (OR)=1.91; 95% Confidence Interval (CI): 1.07-3.41; p=0.029). Composite scores differed significantly across diagnostic categories (Kruskal-Wallis H=8.32, p=0.040). Conclusion: PD-L1 expression increased from low-grade to high-grade CIN and remained frequent in invasive carcinoma. These findings support the role of PD-L1 as an immune related biomarker in cervical neoplasia and justify further evaluation of standardised PD-L1 assessment for risk stratification and treatment planning.

Arterial Blood Gas Acid-base Disturbances and their Association with ICU Admission in Emergency Patients with Acute Dyspnoea: A Cross-sectional Study

Mittal Sindhav, S Surendhar, Parth Shah, Ronak Shah Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Arterial Blood Gas (ABG) analysis simultaneously assesses oxygenation, ventilation, and acid-base status. Acid-base disturbances are common in Emergency Department (ED) patients with acute dyspnoea, yet their predictive value for Intensive Care Unit (ICU) admission across heterogeneous multi aetiology presentations remains poorly characterised in the Indian emergency medicine setting. Aim: To characterise ABG-derived acid-base disturbance patterns and evaluate their association with ICU admission among adult ED patients presenting with acute dyspnoea. Materials and Methods: A cross-sectional study was conducted in the ED and Critical Care Unit, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India, from June to November 2025. Eighty-nine consecutive adults (≥18 years) with acute dyspnoea presenting to the ED were enrolled. All patients underwent ABG analysis as part of routine emergency care. ABG parameters including pH (Potential of Hydrogen), PaCO2 (Partial Pressure of Arterial Carbon Dioxide), PaO2 (Partial Pressure of Arterial Oxygen), HCO3 - (Bicarbonate), lactate, A-a gradient (Alveolar-Arterial Oxygen Gradient), and S/F ratio (SpO2/FiO2) were assessed. Patients were classified into five mutually exclusive acid-base categories based on standard criteria: respiratory acidosis (pH <7.35 and PaCO2 >45 mmHg), metabolic acidosis (pH <7.35, PaCO2 <35 mmHg, and HCO3- <22 mEq/L), mixed acidosis (pH <7.35, PaCO2 >45 mmHg, and HCO3- <22 mEq/L), alkalosis (pH >7.45), and normal pH (7.35-7.45). ICU admission criteria were based on standard clinical indicators: haemodynamic instability, need for ventilatory support, or multi-organ dysfunction - not on ABG parameters alone. Statistical analysis included the Mann-Whitney U test, Kruskal-Wallis test, Spearman rank correlation, Chi-square test, and Receiver Operating Characteristic (ROC) curve analysis with Youden index. ROC analysis was performed for arterial pH, PaCO2, HCO3-, lactate, and S/F ratio. Exact p-values are reported; p-value <0.05 was considered statistically significant. Results: A total of 89 patients were enrolled (mean age 54.3±12.1 years; 64 males (71.9%), 25 females (28.1%). Mean Respiratory Rate (RR) was 27.2±5.4 breaths/min and mean SpO2 was 88.3±7.6%. ICU admission rate was 80.9% (n=72); 17 (19.1%) were managed in the general ward. Acidaemia was observed in 47 patients (52.8%): respiratory acidosis 18 (20.2%), metabolic acidosis 13 (14.6%), mixed acidosis 16 (18.0%); alkalosis 10 (11.2%); normal pH 32 (36.0%). ICU admission rates differed significantly by acid-base category (Chi-square p-value=0.001): mixed acidosis 100%, respiratory acidosis 94.4%, metabolic acidosis 92.3%, normal pH 71.9%, alkalosis 40.0%. Arterial pH was significantly lower in ICU patients versus ward patients 7.283±0.153 vs 7.428±0.066; p-value <0.001). ROC analysis demonstrated that arterial pH was the strongest predictor of ICU admission (AUROC=0.830; sensitivity 71%, specificity 82%, Positive Predictive Value (PPV) 94.4%, Negative Predictive Value (NPV) 31.0% at cutoff pH ≤7.36). Compared to arterial pH, the S/F ratio showed lower discriminatory performance (AUROC=0.657). Conclusion: Arterial pH ≤7.36 identifies high-risk patients with greater discriminative accuracy than oxygenation-based indices, and ABG acid-base pattern assessment may be incorporated as an important triage parameter in the management of emergency dyspnoea.

Cord Blood Predictive Markers of Haemolytic Jaundice in ABO Incompatible Neonates: A Cross-sectional Study

Gayathri Elavarasan, Aparna Jayaraman, Ramya Rajamanickam, Shobhana Sivathanu Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The ABO incompatibility occurs when the mother has blood group O and the baby has A/B/AB group. This occurs in 15-25% of pregnancies and is currently the most common cause of neonatal haemolytic jaundice and re-admission. If a test can predict those infants who are likely to develop haemolytic jaundice, such high-risk infants can be monitored more closely, while the others may be planned for early discharge. Aim: To compare the Cord Blood (CB) markers of haemolysis in ABO incompatibility between neonates who develop haemolytic jaundice and those who do not, and derive predictors for haemolytic jaundice. Materials and Methods: This cross-sectional study was conducted at the Department of Paediatrics, ESICMC and Hospital, Chennai, Tamil Nadu, India, from December 2020 to June 2022. Total 200 newborns who were ABO incompatible and Rh compatible with their mothers were enrolled in the study and CB samples were collected for all. These neonates were followed-up and laboratory investigations were done at the onset of clinically significant jaundice. CB haemolytic markers such as Direct Coombs test (DCT), Haemoglobin (Hb), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC), Reticulocyte Count (RC), Total Serum Bilirubin (TSB) and peripheral smear study, were compared between the newborns who developed haemolytic jaundice and those who did not. Data were statistically analysed by using Student’s t-test, Fisher’s exact test and ROC curve analysis. Results: A total of 200 term newborns were included in the study; among them 96 (48%) were male and 104 were female (52%). Among them, 86 had A+ (43%), 1 had B-(0.5%), and 113 had B+ (56.5%). Out of 200 newborn babies included in the study, 164 were found to develop clinically significant jaundice. Postnatal samples for TSB, Complete Blood Count (CBC), RC and smear for evidence of haemolysis were sent for each of these neonates. 28 neonates had haemolytic jaundice and were included in Group I, and the remaining 172 (no jaundice/no evidence of haemolytic jaundice-non haemolytic group) were included in Group II. On retrospective analysis of their CB parameters, group I had higher cord TSB and lower Hb levels when compared to group II (p<0.001). The ROC cut-off value for CB TSB for predicting haemolytic jaundice was 2.9 mg/dL, and that of CB Hb was 15. 3g/dL. Conclusion: In ABO incompatibility, mean CB bilirubin was significantly higher, and Hb concentrations were significantly lower in neonates who developed haemolytic jaundice compared to those who did not.

Role of Paternal Support in Breastfeeding Initiation and Duration: A Cross-sectional Study from Chennai, Tamil Nadu, India

Shikha Mishra, Vidya Selvam Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Breastfeeding is widely recognised for its benefits to both infant and maternal health. Although maternal factors have been extensively studied, recent evidence indicates that paternal involvement may significantly influence breastfeeding initiation and duration. Aim: To evaluate the impact of paternal involvement on the initiation and duration of breastfeeding and to identify the key barriers and facilitators influencing fathers’ support. Materials and Methods: The present cross-sectional observational study was conducted from October to December 2024 at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. A total of 92 fathers whose partners had recently given birth completed a structured 25-item questionnaire assessing demographics, dimensions of paternal support (emotional, practical, and prenatal education), and breastfeeding outcomes. Data were analysed using descriptive statistics, Pearson’s correlation, and hierarchical regression models. Results: Most fathers were aged 26-35 years (60.9%), followed by 36-45 years (26.1%), with 8.7% <25 years and 4.3% >45 years. A total of 89.1% reported that their partners were breastfeeding. Emotional support was reported as often by 32.6% and always by 29.3%, while practical support was often by 33.7% and always by 25.0%, with mean scores of 3.7 and 3.6, respectively. The mean breastfeeding initiation time was 2.3±1.0 hours, with 81.5% planned initiation, and the mean breastfeeding duration was 20.5±5.8 weeks (54.3% for 12-24 weeks, 29.3% >24 weeks, 16.3% <12 weeks). Emotional support showed a negative correlation with initiation time (r=–0.48, p<0.001). Regression analysis identified emotional support as the strongest predictor of breastfeeding duration (β=0.38, p<0.001). Conclusion: Enhanced paternal involvement, particularly through emotional support and participation in prenatal education, is associated with earlier initiation and prolonged breastfeeding.

Ethnobotanical Survey of Medicinal Plants Used by the Tribal Population of Ashti Taluka, Wardha District, Maharashtra, India

Mrunalini Paturkar, Pramod Khobragade, Akshay Pargaonkar, Vijay Gajananrao Thakare Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: India has a rich heritage of medicinal plants, which constitute a central pillar of its traditional healing systems. An ethnobotanical survey of medicinal plants provides extensive knowledge about plant species and their efficacy in local communities, thereby helping to strengthen and enhance the Ayurvedic healthcare system, particularly in the management of rare diseases. This study focuses on conducting an ethnobotanical survey. Aim: To collect information on herbs used for medicinal purposes by the tribal population of Ashti taluka in Wardha District, Maharashtra, India. Materials and Methods: A descriptive, observational survey was conducted in remote villages of Ashti tahsil, Wardha district, Maharashtra, India. Traditional healers and elderly community members were identified with the help of leaders and local people. Interviews were conducted in the local language from November 2020 to November 2021 using a structured questionnaire covering plant common names, habits, useful parts, method of preparation, mode of application, dosage, and medicinal uses. Photographs of wild plants were taken, and taxonomic identification and verification were carried out using Indian medicinal plant literature and international botanical databases. The age and experience of informants were taken into consideration during data collection. Results: Twelve plant species belonging to ten different plant families were documented. These plant species were used by folk practitioners for the management of acute and chronic conditions such as hypertension, diabetes mellitus, cancer, asthma, and skin diseases, including eczema, psoriasis, and leukoderma. Conclusion: Plants utilised by tribal communities appear to play an important role in the management of acute and chronic conditions, including hypertension, diabetes mellitus, asthma, and skin disorders such as eczema, psoriasis, and leukoderma. Traditional therapeutic practices reflect a deep integration of folk and classic Ayurvedic knowledge systems.

Efficacy of Carbetocin and Oxytocin in Reducing Blood Loss during the Third Stage of Labour: A Prospective Observational Study

Anoj Kattukaran, Prameela Menon, Hridya Prasad, Jitha Sukumaran, Sreenija M Menon Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Postpartum Haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Prophylactic uterotonics like oxytocin are widely used; however, newer agents such as carbetocin have emerged as potential alternatives with longer half-lives and reduced need for repeated administration. Aim: To compare the efficacy and safety of carbetocin versus oxytocin in preventing PPH during vaginal delivery. Materials and Methods: The present prospective observational study was conducted in the Department of Obstetrics and Gynaecology of Amala Institute of Medical Sciences in Kerala, India from December 2022 to December 2023, including 260 women undergoing vaginal delivery. A total of 130 women were administered carbetocin (100 μg) as a single intravenous dose and 130 women were given oxytocin according to Kerala Federation of Obstetrics & Gynaecology (KFOG) guidelines i.e., five units oxytocin diluted in 5 mL Normal Saline (NS) slow Intravenous (i.v.) over five seconds+10 units Intramuscular (IM)+20 units infusion in 500 mL NS at one drop/sec. Primary outcomes included incidence of PPH, estimated blood loss, and the need for additional uterotonics. The Estimated Blood Loss (EBL) was assessed using gravimetric analysis. Haemodynamic parameters were also recorded at five minutes and 30 minutes. Any adverse events and requirement of blood transfusion were also noted. Associations between categorical variables were tested using Chi-square or Fisher’s exact test, while associations between continuous variables were evaluated using the independent t-test, with statistical significance set at the 5% level. Results: In the present study, mean age was 26.08±3.32 years in the oxytocin group and 27.07±3.85 years in the carbetocin group, with predominantly primigravida women (69, 53.1% vs 73, 56.2%) Also, 13 (10%) of the carbetocin patients experienced >500mL blood loss versus 9 (6.9%) in the oxytocin group. Mean estimated blood loss was similar (carbetocin: 316.28 mL; oxytocin: 311.77 mL, p=0.871), as was the need for additional oxytocics (carbetocin: 16 (12.3%); oxytocin: 15 (11.5%), p=0.848). Only one oxytocin patient (0.8%) required transfusion. Vomiting occurred in 2.3% of carbetocin patients, with none in oxytocin. Carbetocin showed a statistically significant slight increase in Systolic Blood Pressure (SBP) at five minutes was +0.892±10.23 mmHg (oxytocin) versus +1.354±6.32 mmHg (carbetocin), p=0.034. Conclusion: Carbetocin demonstrates comparable efficacy to oxytocin in reducing blood loss and preventing PPH during vaginal delivery.

Clinical and Haematological Characteristics of Chronic Myeloid Leukaemia in Adults and Paediatric Patients: A Cross-sectional Study from a Tertiary Care Centre in Bengaluru, India

Joseph Latha Fathima, Ajmal Islam Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Chronic Myeloid Leukaemia (CML) is the most common myeloproliferative neoplasm and is characterised by presence of Philadelphia chromosome which results from a reciprocal balanced translocation between the chromosome 9 and 22(t9;22) resulting in the formation of Breakpoint Cluster Region - Abelson gene (BCR-ABL) fusion gene. Worldwide, the incidence of Chronic Myeloid Leukaemia (CML) is 1-2 per 100,000 population with a male predominance. The incidence increases with age. The median age of onset in middle-income groups is low. The age incidence is low in Asian countries. The present study was conducted to study the incidence and clinico-haematological profile of CML in South Indian population. Aim: To evaluate the haematological parameters of CML and to classify the phases of CML. Materials and Methods: The present 10-year descriptive cross-sectional study from January 2014 to December 2023 was done at the Department of Transfusion Medicine & Immunohaematology in a tertiary care hospital in Bengaluru, Karnataka, India. Data were collected from the laboratory registers and Laboratory information system. Demographic data of patients across all age groups (1 to 100 years), along with findings from peripheral smear, bone marrow and molecular investigations were collected. Flow cytometry was done in cases with Blastic Phase (BP). Data was entered using Microsoft Excel and expressed as percentages and frequencies. Results: A total of 170 cases diagnosed with CML were included in the present study, with 155 adults and 15 children. Among the adult cases, male female ratio was 1.7:1. Highest incidence was observed in 31-40 age group (45.8%) with a male predominance (64.7%). The majority of adult patients presented in Chronic Phase (CP) (89.6%; 139/155), while 5.1% (8/155) were in High-Risk Chronic Phase (HRCP) and 5.1% (8/155) in BP. Among the 8 blast-phase cases, six were classified as myeloid blast crisis with MPO, CD 34, CD 13 and CD 117 positivity and two were B lymphoid blast crisis which are positive for CD 34, CD10, and CD 19. Of the 15 paediatric cases (0-18 years), five cases were below 10 years, and 10 cases were between 10 to 18 years. The male: female ratio in the paediatric age group was 1:1.5. Two children were in BP. Immunophenotyping confirmed lymphoid blast crisis Conclusion: The current study demonstrates that the age of presentation of CML in Indian population is one to two decades earlier than that reported in Western population although the aetiology remains unclear. A mild male predominance was observed. CML was also encountered in paediatric age group, with two cases progressing to BP. Myeloid blast crisis constituted the majority of BP.

A Convolutional Neural Network (CNN)-based Approach for Lung Cancer Detection Leveraging Classical Edge Detection Techniques: An AI-based Retrospective Study

Saurav Mali, Ankur Mukherjee, Biren P Parikh, Sanjiban Patra, Samrat Bordoloi, Sanchaita Rajkhowa, Subrata Sinha Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. Despite advances in diagnostic imaging, histopathological assessment continues to be the gold standard for accurate classification of lung cancer subtypes. However, manual interpretation of histopathological slides is time-consuming and susceptible to inter-observer variability, underscoring the need for efficient Computer-Aided Diagnostic (CAD) systems. Aim: To develop a Convolutional Neural Network (CNN)-based model for automated classification of lung carcinoma histopathological images by integrating classical gradient-based edge detection techniques to enhance image quality and improve classification performance. Materials and Methods: This retrospective analytical study was conducted in the ICMR-funded laboratory at Brainware University, Kolkata, West Bengal, India. The project commenced in February 2024 and is proposed to conclude in February 2027. To date, it has yielded a dataset of 11,580 histopathological images of lung tissue, categorised as Lung Adenocarcinoma (LUAD), Lung Squamous Cell Carcinoma (LSCC), and Non Malignant (BNM). The present work represents a split study and forms part of a larger ICMR-funded project spanning three years. This component focuses on LUAD, LSCC, and non-malignant lung tissue, thereby encompassing the two most common Non Small Cell Lung Cancer (NSCLC) subtypes (which together account for approximately 85% of lung cancers) along with a normal reference class. Edge enhancement was performed using Sobel and Scharr operators to emphasise structural boundaries. The processed images were used to train a custom-designed CNN architecture comprising three convolutional blocks, each followed by pooling layers, and fully connected layers for classification. The model was trained for 100 epochs with a batch size of 32 and evaluated using accuracy, precision, sensitivity, specificity, and F1-score as performance metrics. Results: Sobel-based preprocessing yielded superior model performance compared with the Scharr method. The proposed CNN trained on Sobel-enhanced images achieved an overall classification accuracy of 93.55%, outperforming the 81.33% accuracy obtained with Scharr-based preprocessing. The Sobel-enhanced model also demonstrated stronger generalisation, with AUC values of 0.98, 1.00, and 0.98 for the LUAD, BNM, and LSCC classes, respectively. Conclusion: The integration of edge detection with CNN-based analysis effectively enhances the classification of lung cancer histopathological images. The Sobel operator notably improved model accuracy, precision, and generalisation, suggesting its potential suitability for highlighting morphological boundaries in tissue sections. Future work will extend this framework by exploring additional edge detection methods, implementing stain normalisation, and validating performance on external datasets to further optimise model robustness and clinical applicability.

Effect of 3-Dimensional Myofascial Release Therapy on Pain and Range of Motion in Subjects with Non Specific Low Back Pain: A Randomised Controlled Trial

Rani Hubli, Apeksha Hungund Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Non Specific Low Back Pain (NSLBP) is the most common form of LBP and is often associated with mechanical and postural factors. Disrupted soft-tissue tension, particularly in the hamstrings and lumbar myofascial system, affects lumbar mechanics. Myofascial Release Therapy (MFRT) has shown improvement in pain and disability; however, evidence for three-dimensional MFRT (3D MFRT), which addresses fascial restrictions across multiple planes, remains scarce. Aim: To determine the effect of 3D MFRT on pain, lumbar Range Of Motion (ROM), lumbar spinal curvature and functional disability in individuals with NSLBP. Materials and Methods: This randomised controlled trial was conducted at the Department of Orthopaedic Manual Therapy, KLE Institute of Physiotherapy, Belagavi, Karnataka, India, from October 2024 to March 2025. A total of 36 participants with NSLBP were randomly assigned to an intervention group (Group-A) that received 3D MFRT plus conventional therapy (n=18) or a control group (Group-B) that received conventional therapy alone (n=18). Both groups underwent six treatment sessions over two weeks, on alternate days. Pain intensity {Visual Analogue Scale (VAS)}, lumbar ROM {Modified-Modified Schober’s Test (MMST)}, lumbar lordosis angle (flexicurve) and disability (Oswestry Disability Index) were recorded at baseline and after the sixth session. Between-group comparisons were used to determine treatment effects. Results: Baseline comparisons showed no significant differences in demographics or outcome measures between groups. Post-intervention, the intervention group demonstrated significant improvements (p<0.05) in spinal curvature (Flexicurve), lumbar ROM, pain intensity and disability index compared to the control group. Effect sizes ranged from moderate to large. Conclusion: The present study supports 3D MFRT as an effective adjunct to conventional therapy for NSLBP in improving pain, mobility and function.

Utilisation of Antenatal Care Services and Associated Factors among Tribal Women in Sambalpur District, Odisha, India: A Prospective longitudinal Study

Asit Kumar Majhi, Bharati Panda, Udayana Nayak, Smita Kumari Panda, Anurag Choudhury Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Antenatal Care (ANC) is a crucial component for maternal and foetal healthcare, yet utilisation among tribal populations remains suboptimal due to socio-cultural, geographical, and economic barriers. The study focuses on three tribal blocks in the Sambalpur district, Odisha, namely Jamankira, Kuchinda, and Bamra, which have a significant tribal population. Aim: To estimate the utilisation of ANC services among the tribal women and to describe the factors associated with the utilisation of ANC services. Materials and Methods: A community-based prospective longitudinal study was conducted under the Department of Community Medicine in tribal villages, which are part of the blocks of Jamankira, Kuchinda, and Bamra of Sambalpur district, Odisha, India, from March 2023 to May 2025. A community-based sample of postpartum mothers (within one month of normal vaginal and caesarean delivery) was taken using the World Health Organisation (WHO) 30-cluster sampling technique. Data were collected using a pre-tested structured questionnaire, which included parameters like socio-economic data, pregnancy history, timing of ANC registration, ANC services (laboratory tests, prophylactic measures like Iron and Folic acid (IFA) tablets, Calcium, deworming, Tetanus toxoid administration, and contraceptive use), and counselling regarding pregnancy. Chi-square test, Fisher’s-exact test was used to analyse the data in Statistical Package for Social Sciences (SPSS) version 30.0, and a p-value<0.05 was considered significant. Results: Out of 210 study participants (postpartum mothers), the majority of mothers were aged 25-29 years, 92 (43.8%), Hindu,189 (90%), and lived in three-generation families, 83 (39.5%). Most mothers had a high-school education, 129 (61.4%) and were unemployed, 127 (60.5%). Only 82 (39%) of mothers received comprehensive ANC (≥4 visits with IFA tablets, calcium, deworming, and counselling). Core investigations like blood sugar, urine routine and microscopy test, Human Immunodeficiency Virus (HIV) screening, and blood grouping were universally performed, but prophylactic measures like IFA, 139 (66.2%) and calcium supplementation, 119 (56.7%) had lower coverage. All participants, 210 (100%) received counselling on danger signs, breastfeeding, family planning, and postnatal care. Education, occupation, and parity significantly influenced ANC uptake (p<0.001). Early ANC registration (≤12 weeks) was significantly associated with higher education levels (p=0.027). Multiparous women and those with adverse obstetric histories (abortions, stillbirths) were less likely to receive comprehensive ANC. Conclusion: Despite high diagnostic and counselling coverage, comprehensive ANC utilisation remains low among tribal women in Sambalpur, Odisha. Socio-demographic factors like education and occupation, along with obstetric history, significantly influence ANC uptake. Targeted interventions are needed to improve awareness, accessibility, and adherence to ANC protocols.

Mandibular Ramus as an Indicator of Chronological Age Estimation and Gender Determination using Cone Beam Computed Tomography: A Retrospective Cross-sectional Study

D Bhairavi, Mahendra Raj, T Saravanan, Raghupathy, Aravindhswamy, J Nithya Devi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Age and gender estimation from skeletal remains is vital in forensic identification. The mandible, being strong, durable and sexually dimorphic, provides reliable information. Cone Beam Computed Tomography (CBCT) enables accurate Three-Dimensional (3D) evaluation of mandibular structures. Existing two-dimensional (2D) imaging methods are affected by image distortion, while population-specific variations influence mandibular morphology; therefore, CBCT-based reference standards are warranted. The present study focuses on establishing population-specific reference values for forensic age and gender determination. Aim: To evaluate mandibular ramus dimensions using CBCT for forensic age estimation and gender determination. Materials and Methods: This retrospective cross-sectional study was conducted in the Department of Oral Medicine and Radiology at Karpaga Vinayaga Institute of Dental Sciences from March 2025 to June 2025. A total of 100 CBCT scans that clearly visualised the mandible and met the primary inclusion criteria of individuals aged 7-58 years were selected using consecutive retrospective sampling. CBCT images (CS 9600, Carestream Dental LLC) were reviewed using Digital Imaging and Communications in Medicine (DICOM) software, and five mandibular ramus parameters-coronoid height, condylar height, ramus height, maximum ramus breadth, and minimum ramus breadth-were measured in millimetres (mm). Age and gender were recorded as demographic variables. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 27.0. Student’s t-test/Welch’s t-test and Analysis of Variance (ANOVA) were used for group comparisons; Pearson correlation and linear regression were used for age association, and discriminant function analysis (Wilks’ Lambda) was applied for gender prediction. A significance level of p≤0.05 was considered statistically significant. Results: Males showed higher mean coronoid height (61.51±4.42 mm) and condylar height (70.48±6.00 mm) compared to females (55.78±4.19 mm and 64.70±4.28 mm, respectively). Discriminant function analysis correctly classified 78% of individuals, with 34/40 females (85%) and 44/60 males (73.3%) correctly identified. Mandibular ramus height showed a weak and statistically non significant association with chronological age (R=0.206, p=0.121), indicating limited predictive value for age estimation in the studied population. Conclusion: CBCT-derived mandibular ramus measurements showed significant sexual dimorphism with 78% accuracy for gender determination. However, ramus height demonstrated a weak, non significant association with age, limiting its value for age estimation. Further large-scale studies are warranted.

Impact of Diet and Occupation on Kidney Stone Formation: A Cross-sectional Study

Mohankumar Appadurai, Priyadarshini Shanmugam, Periasamy Ponnusamy Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Nephrolithiasis is a growing global health concern influenced by genetic, dietary and lifestyle factors. Excessive meat intake, genetic predisposition and occupational conditions contribute significantly to stone formation and recurrence. However, few studies in India have examined their combined impact. Aim: To evaluate the role of dietary patterns and occupational activity in renal stone formation. Materials and Methods: This cross-sectional study was conducted Department of Microbiology at Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India, from October 2023 to February 2025. A total of 90 patients with renal stones, including both first-time stone formers (n=46) and recurrent cases (n=44), were enrolled. A structured questionnaire was used to gather dietary information. Fourier Transform Infrared Spectroscopy (FTIR) analysis was performed on 50 stone samples to determine their mineral composition. To determine associations among variables, Pearson’s Chi-square test was performed and results with p<0.05 were deemed statistically significant. Results: Of the 90 patients included, 56% were males and the majority were aged 31-45 years. Recurrent stone formers exhibited significantly higher meat consumption (χ²=11.9, p≤0.05) and a stronger family history of renal calculi (χ²=6.62, p≤0.01). Sedentary occupations were more prevalent among first-time stone formers, whereas physically demanding jobs were more common among recurrent cases (χ²=12.64, p≤0.001). Conclusion: The findings highlight that dietary habits and both sedentary and physically demanding occupations play crucial roles in renal stone occurrence.

Complete Blood Count Variations and Haematological Patterns in Patients with Non Haematological Malignancies: A Retrospective Cross-sectional Study

R Ruthemmimal, R Suresh, V Eswari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Haemotological abnormalities, especially anaemia, are frequent in patients with solid tumours and may affect performance status, treatment tolerance and overall clinical outcome. A Complete Blood Count (CBC) is a low-cost baseline investigation that can identify anaemia, leukocyte abnormalities and platelet changes at the time of diagnosis. Aim: To assess the spectrum of CBC abnormalities among patients with non haemotological malignancies and to evaluate their association with anaemia status and the cancer site. Materials and Methods: This retrospective cross-sectional study was conducted in the Department of Pathology, Meenakshi Medical College and Hospital and Research Institute, Kanchipuram, Tamil Nadu, India, from October 2025 to March 2026. Retrospective analysis was done from January 2023 to September 2025. Records of 200 patients with histopathologically confirmed non haemotological malignancies were reviewed. Demographic details, cancer site, baseline Haemoglobin (Hb) level, total White Blood Cell (WBC) count, Differential Leukocyte Count (DLC) and platelet count were collected before initiation of treatment. Anaemia was defined according to World Health Organisation (WHO) criteria (males: Hb<13 g/dL; females: Hb<12 g/dL). Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent samples t-test and Kruskal-Wallis test were used as appropriate, and p<0.05 was considered statistically significant. Results: The mean age was 57.72±12.56 years. Among 200 patients, 104 (52.0%) were female, and 96 (48.0%) were male. Gastrointestinal tract malignancies were most frequent, 73/200 (36.5%), followed by breast 37/200 (18.5%) and head and neck cancers 31/200 (15.5%). Using WHO gender-specific criteria, anaemia was present in 121/200 patients (60.5%); it was observed in 52/104 females (50.0%) and 69/96 (71.88%). Moderate anaemia was the most common severity group, seen in 84/121 anaemic patients (69.4%). After multiple-test adjustment, none of the evaluated leukocyte or platelet parameters was significantly affected by anaemia status. Across cancer sites, no statistically significant differences were observed in Hb, DLC, total WBC or platelet count. In contrast, blood-picture categories showed significant differences in Hb, neutrophils, lymphocytes, monocytes, eosinophils, total WBC and platelet count. Conclusion: Baseline CBC testing identified a substantial burden of anaemia and selected leukocyte-pattern differences in patients with non haematological malignancies. Correct application of gender-specific WHO criteria is essential for accurate anaemia classification. Routine haematological screening at diagnosis can support early risk assessment, correction of anaemia and treatment planning.

Predictors of Corrected Count Increment after Pooled Platelet Concentrate Transfusion in Thrombocytopenic Patients: A Cohort Study

Sushree Sumedha Dash, Prajna Das, Biswajit Bhuyan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Platelet transfusion is essential in managing thrombocytopenic patients to prevent or control bleeding. Corrected Count Increment (CCI) is a key measure of transfusion efficacy. Although apheresis Platelet Concentrates (PCs) from Single Donor Platelet (SDP) offers the highest platelet yield, they require more time, higher costs, specialised equipment, trained personnel and extensive donor counselling. In contrast, pooled PCs prepared by the Platelet-Rich Plasma (PRP) method serve as a practical and feasible alternative for blood centres with component separation facilities. The present study explores predictors influencing CCI following pooled PCs transfusion prepared by the PRP method. Aim: To assess the CCI after pooled RDP transfusion. Materials and Methods: A prospective observational cohort study was conducted in the Department of Immunohaematology and Blood Transfusion, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, for a period of two years (January 2023 to January 2025). A total of 205 thrombocytopenic patients were included in the study who received pooled Random Donor Platelet (RDP) prepared by the PRP method. Patient demographics, diagnosis, transfusion history and platelet component characteristics were recorded. Pre-transfusion Total Platelet Counts (TPC) of the patients and the TPC of pooled RDP bags was analysed using calibrated Sysmex seven part analyser (XN3100 model) in the Department of IHBT, KIMS. Pre and post-transfusion platelet counts were measured to calculate CCI at one hour and 24 hours. Results: Out of total 205 thrombocytopenic patients only 69 (33.65%) patients developed refractoriness. Logistic regression analysis revealed significant influence of active bleeding (p<0.001), drugs (p=0.011), days of storage of platelets (p<0.001) and ABO non identical platelet transfusions (p=0.001) on refractoriness. Conclusion: Identifying the predictors can optimise transfusion strategies and improve patient outcomes. A modest yet potentially clinically significant benefit was noted with the transfusion of pooled platelets concentrate by PRP method in thrombocytopenic patients.

Role of Spectral CT Imaging in the Evaluation of the Chemical Composition of Urinary Calculi: A Cross-sectional Study

Mohini Gupta, Karthik Gadabanahalli, Prashanth Kulkarni, Venkatraman Bhat Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Characterising the composition of urinary calculi is valuable for managing patients with urolithiasis. Prior to Dual-Energy Computed Tomography (DECT), there were limited direct options for precisely evaluating the composition of calculi. This technique by interrogating the tissues with two energy levels can analyse the composition of calculi. Aim: To assess the diagnostic accuracy of Dual-Energy spectral Computed Tomography (CT) in determining stone composition, using Fourier Transform Infrared (FTIR) spectroscopy as the gold standard. Materials and Methods: The present cross-sectional study was conducted at Department of Radiology, Narayana Health City Hospital, Bengaluru, Karnataka, India between June 2023 and February 2024. A total of 41 patients with urolithiasis who subsequently were managed by Percutaneous Nephrolithotomy (PCNL) underwent Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB) imaging using a 256-slice General Electric (GE) Revolution dual-energy CT scanner following a standardised protocol, and were included. The acquired imaging data were post-processed on the GE Advantage Workstation to assess the chemical composition of urinary stones. Postoperative stone specimens were subjected to Fourier Transform Infrared (FTIR) spectroscopy analysis, and the laboratory findings were compared with the radiological results. Results: The study included 41 patients aged 24-78 years, with a mean age of 43.6±7.98 years, predominantly males (28/41). Abdominal pain was the commonest symptom (72.3%), and 10.6% were asymptomatic. Multiple stones were more frequent, with 14.9% having more than five calculi. In the present study, the composition of urinary calculi was accurately determined in 32 of 41 cases (78%). Of the 35 calcium oxalate calculi, DECT accurately identified 20, while the remainder were categorised as other compositions. DECT identified all the uric acid stones. Conclusion: Spectral CT with advanced post-processing software demonstrates strong potential for accurately determining the primary composition of urinary stones.

Psychological Distress, Quality of Life and Burden among Caregivers of Patients with Traumatic Central Nervous System Injuries: A Cross-sectional Study

Sanjana Manoj Mohata, Raghavendrasingh Dharwadkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Caregivers of individuals with traumatic Central Nervous System (CNS) conditions face significant physical, emotional, and psychological challenges. These demands often compromise their well-being and disrupt the caregiving process, leading to adverse outcomes. Aim: To assess the levels of burden, Quality of Life (QoL), anxiety, depression, and stress among primary caregivers of patients with traumatic CNS conditions. Materials and Methods: The present cross-sectional study was conducted at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, from October 2024 to March 2025. A total of 42 primary caregivers were recruited using a convenience sampling method based on a pre-calculated sample size. Eligible participants were required to be aged ≥18 years and caring for patients with acute traumatic CNS conditions without financial compensation. Anxiety, depression, and stress were measured using the Depression, Anxiety, and Stress Scale (DASS-21); caregiver burden with Zarit Burden Interview (ZBI); and QoL with Family Caregiver Specific Quality of Life Scale (FAMQOL). Demographic data (age, gender, caregiver-patient relationship) were collected. Statistical analysis was performed in Statistical Package for Social Sciences (SPSS) v 29.0.10 using descriptive statistics and Pearson’s correlation, with p<0.05 considered significant. Results: The sample included more male than female caregivers. The majority exhibited extremely severe levels of depression and anxiety, while 7 (16.7%) reported extremely severe stress. Higher DASS-21 scores were significantly associated with lower FAMQOL scores and higher ZBI scores (p<0.001), indicating that increased psychological distress was correlated with a decrease in QoL and increased burden. Conclusion: Caregivers of patients with traumatic CNS conditions experience substantial psychological distress, diminished QoL, and heightened burdens. These findings emphasise the importance of recognising and responding to the psychological challenges and unmet needs of this vulnerable population.

Urban-rural Comparative Assessment of Cognitive Impairment and its Determinants among Elderly Residents of Southern India: A Cross-sectional Study

VG Heera Shrivarika, M Vijayakarthikeyan, S Raju Kannan, S Sangeetha Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Cognitive impairment in older adults includes subjective memory complaints, Mild Cognitive Impairment (MCI) and major neurocognitive disorders. Cognitive impairment among older adults is an emerging public health challenge globally and in India. Aim: To estimate the prevalence of cognitive impairment and identify its associated factors among elderly residents in rural and urban area. Materials and Methods: A comparative community-based analytical cross-sectional study was done among elderly subjects (≥60 years) in Poolavari (rural) and Attayampatti (urban) field practice areas of the institution ensuring feasibility, accessibility and representativeness of typical rural and urban populations in the Salem district of Tamil Nadu, India from 1st November 2025 to 31st January 2026. Simple random sampling was used to select participants. A structured questionnaire was used to collect data. Cognition was evaluated using the Brief Interview for Mental Status (BIMS) and function was characterised with the KATZ Index of Activities of Daily Living (ADL). Data were analysed through Statistical Packages of Social Sciences (SPSS) version 22.0. A Chi-square test and a multivariable logistic regression were conducted. Results: Mean age was 65±4.7 years, majority were females 231 (57.7%) and 169 (42.3%) were males. The majority 235 (58.7%) were from lower class. Forgetting things often 228 (57%) was the most common dementia-related symptom and as per KATZ ADL scale 52 (13%) were dependent. Nearly 82 (20.5%) had moderate cognitive impairment and 11% had severe cognitive impairment. Multivariable analysis showed independent predictors of cognitive impairment were residence in rural area (AOR: 1.67), dependence in KATZ ADL scale {Adjusted Odds Ratios (AOR): 1.55}, and presence of dementia-related symptoms (AOR: 1.87). Conclusion: Cognitive impairment is highly prevalent in South India elderly population. Immediate steps for reducing the future burden of dementia include community-based screening, early detection and integration of geriatric cognitive care into primary healthcare services.

Evaluation of Gapseal^® as a Sealing Material at the Implant-abutment Interface in Type II Diabetes Patients: A Split-mouth Randomised Clinical Trial

Priyadharshini Kumaravel, Shanmuganathan Natarajan, Parthasarathy Natarajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Peri-implantitis is a prevalent complication in implant dentistry, particularly among patients with Type II Diabetes Mellitus (T2DM). It is characterised by impaired wound healing and a high susceptibility to infectious processes, as interfacial microleakage between the implant and abutment creates a channel for bacterial ingress. Porphyromonas gingivalis is a key pathogen whose colonisation triggers peri-implant inflammatory cascades that ultimately lead to osteolytic sequelae. Given the heightened risk of peri-implantitis in T2DM patients, the rationale for the present study is that evaluating GapSeal^® as a sealing material at the Implant Abutment Interface (IAI) may provide a preventive strategy to reduce bacterial colonisation and improve implant outcomes. Aim: To evaluate the efficacy of GapSeal^® as a sealing material at the IAI in patients with T2DM. Materials and Methods: This single-blinded, split-mouth randomised clinical trial was conducted at the Department of Prosthodontics, Crown and Bridge, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India, over a period of six months, from January 2025 to June 2025. The study included 12 partially edentulous patients with T2DM requiring implant-supported prostheses. A total of 24 implants were placed following a split-mouth design, with GapSeal^® applied at the IAI in the test group, while the control group received no sealing material. Submucosal plaque samples were collected from the IAI at baseline and at 2, 4, and 12 weeks following abutment connection. The samples were analysed for Porphyromonas gingivalis using quantitative real-time Polymerase Chain Reaction (qPCR) to assess microbial colonisation. Statistical analysis was performed using an Independent t-test, and for within-group comparison over a period of time, repeated measures Analysis of Variance (ANOVA) followed by a Bonferroni post-hoc test was used. The p-value <0.05 was considered statistically significant. Results: The GapSeal^® group demonstrated significantly lower P. gingivalis colonisation compared to the control group at all post-baseline time points (p<0.001), with the most pronounced reduction observed at 12 weeks. P. gingivalis counts were significantly lower in the GapSeal^® group at two weeks (2.18±0.35 vs. 4.30±0.85; p<0.001), four weeks (2.39±0.39 vs. 4.68±0.77; p<0.001) and 12 weeks (2.59±0.36 vs. 5.57±0.86; p<0.001). Conclusion: GapSeal^® significantly reduces P. gingivalis colonisation at the IAI in patients with T2DM, indicating its potential to minimise microleakage and reduce bacterial colonisation associated with peri-implant inflammatory risk. These findings support the use of GapSeal^® as an adjunctive prophylactic measure in implant therapy in patients for systematically compromised patients to improve oral healthcare outcomes.

Burden of Depression among Patients with Type 2 Diabetes Mellitus in India: A Cross-sectional Study

Anushankari Pandian, Sangeetha Nagalingam Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Depression, a leading global cause of disability, shares a bidirectional relationship with Type 2 Diabetes Mellitus (T2DM). Though regional studies exist, pan-India evidence on depression in T2DM is still limited. Considering this unmet need, the current study was designed to determine the prevalence and various components of depression associated as co-morbidity in T2DM patients in India. Aim: To analyse various components of depression associated as co-morbidity in T2DM patients. Materials and Methods: A cross-sectional, questionnaire-based survey was conducted between August and December 2024 across 725 private clinics in India. A total of 10,655 patients were enrolled, of whom 10,638 were included in the final analysis. Male and female patients aged 18-year-old and above, diagnosed with type 2 diabetes for over a duration of one year or longer were included in this study. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9), and associations with demographics, clinical, and lifestyle factors. Chi-square test was used to find out significance on categorical scales between groups, univariate analysis was applied to investigate the association between symptoms and risks, and two-sided test was used to assess the level of significance. Results: Overall, 46.4% (n=4931) of patients exhibited depression, while 53.6% (n=5707) had no clinically significant depression based on PHQ-9 score. Subgroup analysis through univariate revealed that depression was significantly associated with age and diabetes duration (p-value <0.001 each). Notably higher prevalence was observed in 18-40 years age group. Conversely, no statistically significant association found between haemoglobin-A1c levels and depression (p-value=0.512). Symptoms of moderate to severe depression in men was minimally higher than women, with no statistically significant difference (p-value=0.345). Additionally, smoking and exercise independently contributed to depression prevalence among diabetic patients (p-value <0.001). On multivariate regression analysis, independent predictors of greater depression severity included younger age, smoking, and longer diabetes duration (p-value <0.001 for all). Conclusion: This large, pan-India study highlights a substantial burden of depression among patients with T2DM. Younger age, long-standing diabetes, and smoking were independently associated with higher depression rates. Routine depression screening and integrated management should be prioritised as part of comprehensive diabetes care.

Comparison of Maternal Echocardiographic Findings in Women with Early Onset Preeclampsia and Late Onset Preeclampsia: A Prospective Observational Study

Goter Doke, Dina Pabi, Rinchin Dorjee Megeji, EK Shehna Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Significant cardiovascular adaptations occur in preeclampsia, with Early Onset Preeclampsia (EOPE, onset before 34 weeks of gestation) associated with a more complex and severe haemodynamic profile compared to Late Onset Preeclampsia (LOPE, onset at or after 34 weeks). Recent evidence indicates that EOPE and LOPE represent distinct pathophysiological entities characterised by different haemodynamic states, necessitating subtype-specific cardiovascular risk assessment during the antenatal period. Aim: To compare echocardiographic findings in women with EOPE versus those with LOPE and to characterise differences in biventricular systolic and diastolic function between the two subtypes. Materials and Methods: A prospective observational study was conducted in 80 antenatal women (40 with EOPE and 40 with LOPE) at a tertiary care centre in Arunachal Pradesh from June 2021 to September 2022. Standard two-dimensional, M-mode, and Doppler transthoracic echocardiography was performed for all participants. Biventricular systolic function, Left Ventricular (LV) diastolic function, LV geometry, and Right Ventricular (RV) systolic function were assessed according to American and European Society of Echocardiography guidelines. Results: Impairment in LV Ejection Fraction (LVEF) was significantly more prevalent in EOPE compared with LOPE (42.5% versus 20%, p-value=0.03). Indices of LV diastolic dysfunction, including mitral E/A ratio, septal E/E’, and lateral E/E’, were significantly higher in EOPE (p-value=0.005, 0.015, and 0.011, respectively). Overall diastolic dysfunction was more frequent in EOPE than in LOPE (80% versus 55%, p=0.017). Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in EOPE compared with LOPE (2.11±0.286 cm versus 2.45±0.523 cm, p-value <0.001), indicating RV longitudinal systolic dysfunction in EOPE. Relative LV wall thickness was significantly higher in EOPE (0.53±0.18 versus 0.45±0.12, p-value=0.026). Conclusion: Women with EOPE demonstrate significantly greater LV diastolic dysfunction and biventricular myocardial contractility impairment compared with LOPE. Echocardiography performed during the antenatal period can identify preeclamptic women at higher cardiovascular risk, particularly those with early onset disease, enabling patient-specific management and long-term cardiovascular surveillance.

A Cross-sectional Study on Digital Health Approaches to Maternal Nutrition: Assessing the Role of mHealth Applications among Pregnant Women in Tamil Nadu, India

K Saraswathy, R Vijayalakshmi, Nesa Sathya Satchi, K Vijayalakshmi, D Sasikala, V Dhanalakshmi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Maternal nutrition is a key determinant of pregnancy outcomes and child health. Mobile health (mHealth) applications have emerged as supportive tools for improving nutritional awareness and dietary practices among pregnant women. However, evidence on their utilisation and association with nutritional outcomes in Tamil Nadu remains limited. Aim: To assess the utilisation of mHealth applications and examine their association with nutritional awareness and dietary practices among pregnant women in a selected community in Chennai, Tamil Nadu. Materials and Methods: A cross-sectional study was conducted among 158 pregnant women at Apollo College of Nursing maintains a formal collaboration with Kollumedu Primary Health Centre (PHC), Chennai, Tamil Nadu, from October 2023 to November 2023 using consecutive sampling. Data were collected using structured questionnaires and dietary checklists. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (Chi-square test) were applied using Statistical Package for the Social Sciences (SPSS), with statistical significance set at p<0.05. Results: Among the participants, 108 (68.4%) possessed cell phones, whereas 56 (35.4%) indicated consistent utilisation of mHealth applications. Frequently utilised applications comprised mMitra 22 (13.9%), Pregnancy+ 18 (11.4%) and My Diet Coach 12 (7.6%). App users exhibited markedly greater nutritional awareness than non-users (40 (71.4%) vs 38 (37.2%), p<0.001), with a mean awareness score of 10.48±6.09 (out of 25). App users exhibited improved dietary patterns, characterised by increased consumption of protein-rich meals, fruits, vegetables and iodised salt. The average dietary practice score was 9.0±0.72 for individuals with healthy habits, compared to 6.4±0.88 for those with unhealthy practices. Nutritional parameters, including Body Mass Index (BMI) and haemoglobin levels, were markedly associated with mHealth utilisation. The educational status, number of antenatal visits and residential location were strongly associated with awareness and dietary habits (p<0.05). Conclusion: Use of mHealth applications was significantly associated with higher nutritional awareness and enhanced dietary practices among pregnant women. Antenatal care services, combined with digital health tools, may serve as effective platforms for reinforcing maternal nutrition education.

Effect of Mat Pilates on Blood Pressure and Heart Rate Recovery in Prehypertensive College-going Students: A Randomised Controlled Trial

Anushka, Mousumi Saha, Subhasish Chatterjee, Shivi Bajpai, Shanvi Priya, Tai Yayum, Mritunjay Kumar, Ridhi Vatsa Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Prehypertension, which is believed to be a primary cardiovascular risk indicator, can develop into hypertension in case of no treatment. Exercise and lifestyle change are proposed to be the major preventive measures. In the recent past, there has been a concern over the possible cardiovascular benefits of mat Pilates, which is a mind-body practice that concentrates on breathing, core stability, and controlled movement. Aim: To evaluate the effect of a 4-week mat Pilates programme on the Blood Pressure (BP) and Heart Rate Recovery (HRR) in prehypertensive college-going students. Materials and Methods: This study was a parallel-group randomised control trial, 1:1 allocation ratio, conducted from July 2024 to December 2025, at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation (MMIPR) Mullana, Ambala, Haryana, India. Total 34 prehypertensive students, aged 18 to 25 years were selected for this study, they were randomised into two groups: the Pilates group (PG) and control group (CG). Pilates group received mat Pilates along with conventional exercises and control group received only conventional exercises. The session was done for 30 minutes for four weeks. The Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Heart Rate Recovery (HRR) at one minute (HRR1) and two minutes (HRR2) were primary outcomes. The secondary outcomes were maximal heart rate (HRmax) and resting heart rate (HRrest). The statistical significance was set at p-value <0.05. Results: Following intervention, both groups demonstrated improvement. In Pilates group, SBP dropped from 128.8±4.5 to 125.2±4.1 mmHg, while, DBP dropped from 84.6±2.3 to 83.5±1.9 mmHg, HRR1 and HRR2 also improved from 23±5.3 to 29.4±4.2 bpm and 34±5.2 to 43.2±4.5 bpm (p-value <0.05). In control group, all variables showed improvement but more in SBP 128±4.7 to 127.4±4.4 mmHg (p-value=0.004) and HRR2 (p-value=0.002). The between group analysis showed that, there were more improvement SBP (p-value <0.001), HRR1 (p-value <0.001), and HRR (p-value <0.001). Conclusion: Mat Pilates is a more effective in improving BP and recovery of heart rate in prehypertensive students compared to conventional exercises.

Effect of Mucuna Pruriens Seed Extract on Glycaemic Control, Inflammation and Lipid Profile in Type 2 Diabetes-induced Rats: An Experimental Study

Gampa Sai Preetish, Urmila Kagal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) represents a major global health challenge, with rapidly increasing prevalence and significant morbidity due to associated metabolic and inflammatory complications. India bears a substantial share of this burden, with a large and growing population affected by the disease. In addition to persistent hyperglycaemia, type 2 diabetes is characterised by chronic low-grade inflammation and dyslipidaemia, which contribute to insulin resistance and disease progression. Therapeutic agents capable of targeting multiple metabolic abnormalities simultaneously may offer improved disease management. Mucuna pruriens, a medicinal plant containing bioactive compounds such as L-3,4-Dihydroxyphenylalanine (L-DOPA), flavonoids and polyphenols, has been reported to possess antioxidant and anti-inflammatory properties. Aim: To evaluate the effect of Mucuna pruriens seed extract on body weight, blood glucose levels, inflammatory markers and lipid profile in High-Fat Diet (HFD) and low-dose streptozotocin-induced T2DM in male Wistar rats. Materials and Methods: The present experimental animal study was conducted at the Department of Pharmacology, KAHER’s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India, from March 2024 to March 2025. Adult male Wistar rats (200±20 g) were used. Type 2 diabetes was induced by feeding a HFD for four weeks followed by intraperitoneal administration of streptozotocin (30 mg/kg). Animals with fasting blood glucose ≥200 mg/dL were included. Rats were divided into four groups (Normal control n=6; Diabetic control n=8; Metformin 180 mg/kg n=8; Mucuna pruriens 200 mg/kg n=8). Treatments were administered orally for seven weeks. Body weight and fasting blood glucose were monitored periodically. Serum inflammatory markers {Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-6 (IL-6)} and lipid parameters were estimated at the end of the study. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) followed by Tukey’s post-hoc test. Results: Diabetic control animals developed marked hyperglycaemia (311.1±3.8 mg/dL). Treatment with Mucuna pruriens (200 mg/kg) significantly reduced fasting blood glucose levels to 167.5±15.4 mg/dL compared with diabetic control (311.1±3.8 mg/dL; p<0.001) and metformin (240.8±19.8 mg/dL; p<0.001). Significant reductions in inflammatory markers were observed, with IL-6 showing significant improvement compared with metformin (p=0.004), while TNF-α reduction was comparable between groups. Improvement in lipid parameters, including increased HDL and reduced LDL cholesterol and triglycerides, was also observed. Conclusion: Mucuna pruriens seed extract demonstrated significant improvement in glycaemic control, inflammatory cytokines and lipid abnormalities in experimental T2DM. The extract showed greater reduction in blood glucose and inflammatory markers compared with metformin, suggesting potential adjunct therapeutic value in managing metabolic disturbances associated with type 2 diabetes.

Demographic Profile and Clinicopathological Characteristics of Odontogenic Cysts and Tumours: A 10-Year Retrospective Cross-sectional Study

MP Rajalekshmi, R Franklin, Beena George, D Angelin, Jeslin Mary Samraj, RK Asika Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Epidemiological studies on Odontogenic Cysts (OC) and Odontogenic Tumours (OT) were conducted in different parts of the world, and much less are reported in the literature from the Kanyakumari population in Tamil Nadu. The present study may serve as baseline data for future multicentric longitudinal research. Aim: To evaluate the demographic and clinicopathological characteristics of OCs and OTs diagnosed over a 10-year period and compare the findings with previously published reports in the literature from other parts of India and worldwide. Materials and Methods: The current demographic retrospective cross-sectional study was conducted in the Department of Oral Pathology and Microbiology, Sree Mookambika Institute of Dental Sciences, Kulasekharam, Kanyakumari, Tamil Nadu, India. It was based on the epidemiologic and clinicopathological data of all patients reported with a histopathologic diagnosis of OC and 7 tumours, retrieved from the archives of the Department of Oral and Maxillofacial Pathology over a period of 10 years from January 2015 to December 2024. All cases with definitive histopathological diagnosis of OC and OT with complete demographic and clinical data and histologic slides were included in the study. The microscopic slides were examined, and the diagnosis was modified according to the 2022 World Health Organisation (WHO) classification of odontogenic and maxillofacial bone tumours. Patient’s age, gender, site of lesion, clinical and pathological data were analysed using descriptive statistics. Results: Among 82 cases, a total of 49 (59.75%) cases were males, and male-to-female ratio was 1.44:1. Data from 540 samples of oral biopsies was retrieved. Of these, 82 cases of OCs (15%) and 35 cases of Odontogenic Tumours (OTs) (6.5%) were used in the present study after reassessing the diagnosis. Radicular Cyst (RC) was the most common OCs, 40 cases (49%) with a mean age of 35 years and male predilection and anterior maxillary predominance. Among the OTs, Ameloblastoma (AME) constituted 17 cases (48.5%) followed by six cases of Odontoma (OD) and Cement-Ossifying Fibroma (COF) each. AME showed a strong male predilection, and the most favoured anatomical site is mandibular posteriors (76.47%). Conclusion: The current study reflects not only differences in the distribution of odontogenic lesions but also similarities among the varied population samples assessed both in India and around the world, which contribute significantly to enhancing the concepts of treatment and prognosis.

Bioactive Bilayered Chitosan-zinc Oxide/Polycaprolactone Scaffold with Controlled Barrier Function for Guided Bone Regeneration in Implant-related Diseases: An In-vitro Evaluation

Supraja Govindarajan, Arvina Rajasekar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Peri-implant infectious diseases remain a significant challenge affecting implant success, human health, and oral well-being. Effective regeneration around dental implants requires restoration of peri-implant bone while limiting undesirable soft-tissue infiltration. Conventional single-layered barrier membranes provide mechanical occlusion but lack bioactivity to promote osteogenesis. Therefore, multifunctional scaffolds with regenerative potential and effective barrier function are needed to improve implant therapy and enhance regenerative outcomes in implant-related diseases. Aim: To design, characterise, and assess the in-vitro regenerative potential of a bilayered Chitosan–Zinc Oxide/Polycaprolactone (CS–ZnO/PCL) scaffold integrating bioactivity with barrier function for implant-related disease regeneration. Materials and Methods: The present in-vitro study was conducted in Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from September 2024 to January 2025. A bilayer scaffold was fabricated by combining a solvent-cast PCL layer with a porous CS-ZnO top layer. Morphology was analysed by Field Emission Scanning Electron Microscopy (FESEM). Functional group integration was confirmed via Fourier Transform Infrared (FTIR) spectroscopy. Surface wettability was measured by contact angle analysis. Haemocompatibility was assessed through an ASTM F756-compliant haemolysis assay. In-vitro fibroblast migration across the bilayer scaffold was evaluated over 14 days. Results: The FESEM revealed a porous, interconnected CS-ZnO top layer suitable for tissue infiltration and a smooth, dense PCL base layer providing effective barrier characteristics. FTIR confirmed the incorporation of CS, ZnO, and PCL, with O-H stretching shifts indicative of hydrogen bonding. The scaffold exhibited enhanced hydrophilicity and haemolysis values <5%, meeting biocompatibility standards. Migration assays showed restricted fibroblast migration at day 7 and minimal penetration by day 14, indicating controlled cellular infiltration across the bilayer structure. Conclusion: The CS-ZnO/PCL bilayer scaffold provides bioactivity with controlled barrier function, representing a promising material for guided bone regeneration and peri-implant tissue healing. This approach may improve implant outcomes, reduce the risk of peri-implant disease, and enhance patient well-being. The bilayered scaffold exhibited favourable physicochemical characteristics, indicating its potential as a candidate for implant-related bone regeneration.

Comparative Evaluation of Local Anaesthesia with and without Adrenaline on Haemodynamic and Metabolic Responses during Tooth Extraction: A Prospective Study

Harshawardhan Kadam, CV Pattanshetti, Swapnil Shinde, Shrutika Salunkhe, Shweta Sagare Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Local Anaesthetic (LA) solutions often incorporate vasoconstrictors to delay the systemic absorption of the drug. This prolongs the duration of anaesthesia, reduces toxicity by slowing systemic uptake, lowers the total required dose of LA and enhances anaesthetic efficacy by localising the drug at the injection site. Despite extensive published literature, the systemic metabolic effects of these agents in diabetic dental patients remain underexplored. Aim: To evaluate the effect of local anaesthesia with and without adrenaline on blood glucose levels and haemodynamic parameters in patients undergoing routine tooth extractions. Materials and Methods: This prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College, and Hospital, Sangli, Maharashtra, India, from January 2017 to December 2019. The study included 120 patients aged 17 to 65 years requiring multiple tooth extractions, comprising both medically stable non-diabetic individuals and patients with controlled Type 2 Diabetes Mellitus (T2DM) as the primary inclusion criteria. Each participant received two anaesthetic regimens in separate appointments in randomised order. Haemodynamic parameters (systolic and diastolic blood pressure, heart rate) and random blood glucose levels were recorded before injection (R0), immediately after (R1), and at 10 (R2) and 20 minutes (R3) post-injection. Data were analysed using repeated-measures Analysis of Variance (ANOVA) with Bonferroni post-hoc tests for intragroup comparisons, Independent t-tests for intergroup change scores, and Chi-square tests for categorical variables (p≤0.05). Results: Lignocaine with adrenaline produced significant transient increases in systolic blood pressure, heart rate, and blood glucose levels in diabetic subjects compared with plain lignocaine (p<0.001). Non diabetic patients exhibited smaller, but statistically significant increases in haemodynamic parameters with adrenaline (p<0.05). Blood glucose changes were also statistically significant with adrenaline in non diabetic patients as well (+11.8 mg/dL, p<0.001), although less pronounced than in diabetic subjects. Diastolic blood pressure showed statistically significant but clinically modest increases with adrenaline in both groups (p<0.001), whereas plain lignocaine produced minimal diastolic pressure. Conclusion: LA solutions can elicit systemic metabolic responses, and caution is warranted when using lignocaine containing adrenaline in patients with T2DM patients. Clinicians should consider plain LA alternatives for diabetic patients when prolonged anaesthesia or enhanced haemostasis is not essential. Patient specific risk assessment is recommended preoperatively, particularly for those with suboptimal glycaemic control despite HbA1c ≤7%. Future studies should evaluate longer term impact on glycaemic control and incorporate non invasive cardiac output monitoring.

In-vitro Evaluation of the Integrity of RFID Tags Incorporated in Denture Bases Following Simulated Physical and Chemical Assaults

Neeru Gaba, Nidhi Mangtani, Sandeep Kalra, Sandeep Garg, Sanjeev Mittal, Urvashi Sukhija Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Radiofrequency Identification (RFID) tags can be used for denture identification during war, natural catastrophes like tsunamis, fire hazards or while looking for suspects in cases of violence. It is important that these tags are readable even after the assault to retrieve the stored information. Exposure to various chemicals like strong acids or physical assaults like fire must not damage the tags. Aim: To study the effect of various physical and chemical assaults on RFID tags incorporated in both heat cure and self-cure acrylic denture base. Materials and Methods: The present in-vitro experimental study was carried out in Department of Prosthodontics of Maharishi Markandeshwar Institute of Dental sciences and Research, Ambala, Haryana, India from July 2024 to December 2024. For the study total of 150 denture bases; 75 heat cured denture base (Group A) and 75 cold cured denture bases (Group B) were fabricated. RFID tags (Rapid radio Solutions Pvt., Ltd., Mumbai) of dimension 18 mm×18 mm were incorporated during fabrication into the heat cure denture bases and post fabrication in cold cure denture bases. Information was recorded into all RFID tags (example denture base material used, sample number and assault exposure) with help of Apple iPhone 11. The samples of both Group A and B were randomly divided into five subgroups of 15 samples each (n=15) according to exposure to various physical and chemical assaults. Assaults were 98% sulphuric acid for 24 hours (Subgroup A), 20% nitric acid for 24 hours (Subgroup B), liquid Nitrogen for three hours (Subgroup C), direct flaming with butane torch for three minutes (Subgroup D) and Incineration at 200°C for 20 minutes (Subgroup E). Post assault RFID tags were scanned to retrieve information from them. The number and percentage of RFID tags that were readable in each subgroup of both groups were noted. Only descriptive statistics were done in the study. Results: In Subgroup A of both heat cured (Group A) and cold cured denture bases (Group B) RFID tags incorporated, were not readable after assault 0 (0%) and all the denture bases showed severe surface deterioration. All RFID Tags of Subgroup B 15 /15 (100%) and Subgroup C 15 /15 (100%) of both Group A and Group B were readable after assault and denture bases did not show any surface deterioration. In Subgroup D and Subgroup E some RFID tags were readable after assault. 9/15 (60%) samples of Subgroup D in Group A and 14/15 (93.33%) of Subgroup D in Group B were readable post-assault whereas in Subgroup E, 8/15 (53.33%) in Group A and 7/15 (46.66%) in Group B RFID tags could be read post-assault. Conclusion: RFID tags are resistant to assaults of dil. nitric acid and liquid nitrogen. Exposure to heat by direct flaming or incineration may render them unreadable. With conc. sulphuric acid there is complete damage to RFID tags.

Correlation of Salivary and Serum Calprotectin Levels in Patients with Periodontitis - Stage II and III, before and after Non Surgical Periodontal Therapy: A Clinicobiochemical Case Control Study

Subramani Varshini, Krishnamurthy Malathi, Gnanasambandam Sandhya, Paul Jemima Ajitha Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Calprotectin (CPT), a major cytoplasmic protein in neutrophils, is released from myeloid cells during inflammation. It exerts pro-inflammatory effects on various cell types and plays a prominent role in tissue breakdown. CPT levels in Gingival Crevicular Fluid (GCF) have been proposed as a sensitive biomarker for monitoring the effects of periodontal therapy at the site level. The present study aimed to evaluate the diagnostic and prognostic utility of salivary CPT as a biomarker in periodontitis. Aim: To compare CPT levels in the saliva and serum of patients with Stage II and III periodontitis, before and after Non Surgical Periodontal Therapy (NSPT). Materials and Methods: This preliminary case-control study was conducted at the Outpatient Department (OPD) of Periodontology at Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India, from July 2022 to May 2023. A total of 20 subjects were assigned to two groups: Group I-10 subjects with a healthy periodontium, and Group II-10 subjects with periodontitis (Stages II and III) according to the 2017 World Workshop Classification of Periodontal and Peri-Implant Diseases and Conditions. Clinical parameters were recorded, and saliva and serum samples were collected at baseline (T0), one month (T1) and three months (T2) after NSPT for the estimation of CPT levels using an Enzyme Linked Immunosorbent Assay (ELISA). Correlations between salivary and serum CPT levels and clinical parameters were assessed before and after NSPT. Repeated-measures Analysis of Variance (ANOVA) was employed for intra-group comparison. The correlation between salivary and serum CPT levels was evaluated using the Pearson’s correlation coefficient. For all statistical analyses, p<0.05 was considered statistically significant. Results: Intergroup comparisons of clinical and biochemical parameters at T0 demonstrated statistically significant differences in all parameters (p<0.001) except serum CPT. Salivary CPT levels were higher in periodontitis than in healthy individuals (p-value=0.018); and the levels decreased following NSPT. There was a negligible positive correlation between salivary and serum CPT levels at T0 (r=0.017); and a weak negative correlation at T1 (r=-0.242) and T2 (r=-0.203), indicating no significant linear relationship at any time point assessed. Conclusion: Salivary CPT levels showed a clear reduction in patients with periodontitis at one and three months after non surgical therapy. Within the confines of this study, it could be presumed that salivary CPT may be considered a potential diagnostic and prognostic biomarker for periodontitis.

Comparison of Two Remineralising Agents on the Microshear Bond Strength of Composite Resin to Artificially Demineralised Dentin: An In-vitro Study

Anita Kale, Suraj Shyamkumar Malu, Ramchandra Kabir, Amol Badgire, Abhishek Badade, Praveen Dhore Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Bonding efficacy depends on the structural integrity of dentin, which is compromised by demineralisation. Remineralising agents like Nanobioactive Glass (NBG) and Theobromine (TH) can enhance dentin hardness and bonding performance. NBG promotes Hydroxyapatite (Hap) formation, while TH, a cocoa-derived compound, increases microhardness and tubule occlusion. However, their comparative effects on bond strength are not well established. Aim: To evaluate and compare the effect of TH and NBG on the microshear Bond Strength (μSBS) of nanohybrid composite resin bonded to artificially demineralised dentin after one and seven days of application testing. Materials and Methods: This was an in-vitro study conducted in Department of Conservative Dentistry and Endodontics of MIDSR Dental College, Latur Maharashtra, India in the month of February 2024. A total of 32 non carious extracted human molars were used for this in-vitro study and randomly allotted in four groups (n=8). Group-1 sound dentin, Group-2 demineralised dentin. Group-3 consisted of demineralised dentin with NBG application and Group-4 of demineralised dentin with TH application, which were further divided into two subgroups (A and B) each for one day and seven days application, respectively (n=4 for subgroups). Remineralising agents were applied for one day and seven days according to groups allocated with samples stored in artificial saliva between applications. All specimens were prepared by bonding using a self-etch adhesive and nanohybrid composite resin. The μSBS was tested with the help of a universal testing machine at day 1 and day 7. Statistical analysis was done with Statistical Package for Social Sciences (IBM SPSS Statistic for window, version 21.0. Armonk, NY: IBM Corp.) at 95% Confidence Interval (CI) and 80% power to the study. Analysis of Variance followed by Tukey’s Honestly Significant Difference (HSD) test was applied to check statistically significant difference between groups (p<0.05). Results: Demineralisation significantly reduced dentin strength compared to sound dentin (p<0.001). At seven days, NBG significantly increased stress at maximum load (20.34±1.03 MPa) compared to demineralised dentin and TH groups (p<0.001), with a significant time-dependent improvement (p<0.0001). TH showed significantly higher values than demineralised dentin (p<0.001) but no significant change between one and seven days (p>0.05). NBG demonstrated strength comparable to sound dentin at seven days (p>0.05). Conclusion: The TH and NBG agents enhanced bond strength of composite resin to demineralised dentin. TH performed better at Day 1, while NBG exhibited greater efficacy over time at Day 7.

Comparative Efficacy of Intralesional Platelet-rich Plasma Plus Methotrexate, Methotrexate Monotherapy, and Conventional Topical Therapy in Localised Chronic Plaque Psoriasis: A Randomised Controlled Trial

B Yuvapriya, Rajkumar Kannan, M Vairaprabha Devi, Parimalam Kumar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Psoriasis is associated with a significant negative impact on patients’ physical and mental health. Patients are at a higher risk of developing cardiovascular disorders, which are in turn associated with a range of psychological impairments. Combinational modality of treatment and intralesional routes of drug delivery may ehhance the treatment outcomes and reduce systemic toxicity and hepatic adverse effects in psoriasis patients. Aim: To compare the clinical efficacy of intralesional Platelet-Rich Plasma (PRP) combined with methotrexate, intralesional methotrexate monotherapy and conventional topical therapy in the treatment of chronic plaque psoriasis and to determine the post-treatment recurrence rate. Materials and Methods: This randomised controlled trial was conducted in the Department of Dermatology at a Tertiary Care Centre, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India from November 2019 to April 2021. A total of 66 patients with localised chronic plaque psoriasis were enrolled into the study and randomised into three groups. Group A patients were treated with a single dose of intralesional PRP followed by intralesional methotrexate for four weeks, and this regimen was repeated every month for four months or untill complete resolution of lesions. Group B patients were treated with methotrexate monotherapy. Group C patients were treated with conventional topical treatment with corticosteroids and emollients. After completion of treatment, patients were followed-up for three months and digital photographs, Psoriasis Area Severity Index (PASI) score, clinical effectiveness, relapse and adverse effects were recorded. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23.0 and a p-value<0.05 was considered statistically significant. Results: Group A demonstrated the greatest reduction in mean PASI score, followed by group C (topical therapy), whereas group B (methotrexate alone) showed comparatively lesser improvement. The overall improvement rate in group A was 72.7%, indicating a significantly better therapeutic response compared with groups B and C (p<0.05). Adverse effects were more frequently reported in group A. Conclusion: In the present study, a significant proportion of participants showed clinical improvement with both intralesional PRP combined with methotrexate and topical corticosteroids therapy with emollients. Intralesional methotrexate monotherapy as a single treatment modality in psoriasis was less effective compared with the other groups. Earlier presentation in the course of the disease, was associated with a better treatment response.

Prognostic Value of the Monocyte-to-HDL Ratio in Acute Ischaemic Stroke: A Prospective Cohort Study

Bishal Swain, Ranjan Kumar Sen, Abinash Swain Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The Monocyte-to-High-density lipoprotein cholesterol Ratio (MHR) has recently been identified as a novel inflammatory biomarker linked to atherosclerotic cardiovascular disease. Nonetheless, its predictive significance in Acute Ischaemic Stroke (AIS) remains insufficiently investigated. Aim: To evaluate the correlation between MHR and stroke severity and prognosis in individuals with AIS. Materials and Methods: This prospective observational cohort study was conducted at the Department of Medicine, Srirama Chandra Bhanja Medical College and Hospital (SCB) in Cuttack, Odisha, India, from 2023 to 2024. The study was designed and reported in accordance with STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. A total of 200 consecutive patients aged 45 years or older with radiologically confirmed AIS who presented within 72 hours after onset were included. The monocyte count (five-part differential cell counter) and HDL-C level (fasting lipid profile) taken upon admission were used to calculate MHR. The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) were used to assess stroke severity and outcome (3 months). Statistical analyses were done by the Statistical Package for Social Sciences (SPSS) version 27.0, encompassing Spearman correlation, the Mann-Whitney U test, and ROC curve analysis Results: The study included 200 patients (95 males and 105 females) with a mean age of 65.16±10.39 years. The median MHR was markedly elevated in patients with severe stroke {17.02 (IQR 3.26)} in contrast to those with moderate stroke {5.04 (IQR 1.55)}. There was a considerable positive relationship between MHR and both NIHSS (ρ=0.87, 95% CI: 0.80-0.92; p<0.001) and mRS (ρ=0.78, 95% CI: 0.70-0.85; p<0.001). The best MHR threshold for predicting a poor outcome was 9.24 (AUC 0.92, 95% CI: 0.88-0.96; sensitivity 80.2%, specificity 94.9%). In multivariable linear regression, MHR remained independently associated with admission NIHSS (B=1.38, p<0.001). In logistic regression analysis, MHR independently predicted poor 3-month functional outcome (OR=2.17, p<0.001). Conclusion: An elevated MHR is independently correlated with heightened stroke severity and unfavourable functional outcomes. MHR could serve as an affordable and reliable predictor of prognosis in AIS.

Comparison of Dexmedetomidine as an Adjuvant to Propofol and Propofol as a Sole Agent in Induction of General Anaesthesia: A Randomised Clinical Trial

Jayakrishna Vijayakumar, Tania Jose, Rajan Babu, Gayathri G Yemuna Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Agents used for induction of anaesthesia often cause vasodilation and suppression of the sympathetic nervous system, leading to a drop in blood pressure. Additionally, laryngoscopy and endotracheal intubation can cause hypertension and tachycardia. So, maintaining haemodynamic stability during induction, intubation and maintenance of anaesthesia is important. Induction of anaesthesia needs sufficient depth of anaesthesia while preventing haemodynamic derangement. Aim: To study the haemodynamic effects of dexmedetomidine when used as an adjuvant to propofol as compared to propofol as a sole agent in the induction of General Anaesthesia (GA) in patients undergoing elective surgeries under GA. Materials and Methods: This double-blinded randomised clinical study was conducted at the Department of Anaesthesiology, SUT Academy of Medical Sciences, Trivandrum, Kerala, India, from October 2025 to April 2026. A total of 38 patients were enrolled and randomly assigned to two groups. Group A patients were induced with propofol and vecuronium as muscle relaxants, and in Group B patients were initially given dexmedetomidine before induction with propofol and vecuronium. Heart Rate (HR), Non Invasive Blood Pressure (NIBP) Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Oxygen Saturation (SpO2) were recorded in each group at pre op, before induction, one minute, five minutes, 10 minutes and 15 minutes post induction. An Independent t-test was used to compare quantitative parameters, Chi-square test for categorical variables and a Mann-Whitney U Test for comparing ordinal parameters. Results: A total of 38 patients assessed showed no significant demographic differences. Post induction tachycardia (group A-91.11±5.78; group B-79.00±13.25) was significant in group A. There was significant hypotension (MAP, DBP) post induction in group A {MAP 5 min post induction (group A-84.1±11.0, group B-93.1±9.6), DBP 5 min post induction (group A-70.6±9.8; group B-77.8±10)}. Group A required a significantly higher mean dose of propofol (134.2±25.2 mg) compared to group B (101.1±18.8 mg) Conclusion: Dexmedetomidine as an adjuvant to propofol provides better haemodynamic stability than propofol alone during induction of GA. The total propofol requirement is also significantly lower in the patients when induced along with Dexmedetomidine.

Healing Through Movement: A Comparative Study of Yoga and Aerobic Exercise on Physical and Endocrine Outcomes in Women with Polycystic Ovary Syndrome

Dimple Choudhry, Kirti Bhardwaj, Minakshi Chauhan, Malika Jhandai, Nikita Choudhry, Sudha Yadav, Bhawna Saini, Nandini Bhatia Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, characterised by hormonal imbalance, ovulatory dysfunction, and metabolic disturbances. Lifestyle interventions such as aerobic exercise and yoga have emerged as promising non-pharmacological treatments to address both physical and psychological symptoms of PCOS. Aim: To compare the effects of aerobic exercise and yoga on flexibility, fatigue, quality of life, and endocrine parameters in women diagnosed with PCOS. Materials and Methods: The present study was an experimental study conducted on women with PCOS at Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India, between August 2023 and July 2024. Written informed consent was obtained from all participants. A total of 60 women aged 18-25 years with a confirmed diagnosis of PCOS were recruited using a random sampling (chit) method, while those with a history of smoking, pregnancy, diabetes mellitus, congenital adrenal hyperplasia, thyroid disorders, or musculoskeletal conditions were excluded from the study. Participants were randomly allocated into two groups of 30 each. Group 1 received a structured aerobic exercise program, and Group 2 followed a yoga-based intervention, both performed for 30 minutes per day, five days per week for six weeks. Outcome measures were assessed at baseline, post-intervention (6 weeks), and at one-month follow-up, including flexibility, fatigue, quality of life (SF-36), Waist-To-Hip Ratio (WHR), and endocrine markers {anti-Müllerian hormone (AMH), Luteinising Hormone (LH), Follicle-Stimulating Hormone (FSH), testosterone, and prolactin}. The independent t-test was used to compare demographic characteristics between the two groups. For outcome measures, the Mann-Whitney U test was applied to compare differences between groups, and the Wilcoxon signed-rank test was used for within-group comparisons. A p-value of ≤0.05 was considered statistically significant for all analyses. Results: Both groups exhibited significant improvements across all parameters. Group 1 demonstrated greater gains in musculoskeletal flexibility (8.1% improvement at follow-up), emotional well-being, and WHR reduction (11.4%), with statistically significant differences in flexibility and WHR between groups (p<0.05). Endocrine markers improved significantly in both groups, with no significant between-group differences, although Group 1 showed slightly better outcomes in AMH and LH, while Group 2 had greater reductions in prolactin and testosterone. Conclusion: Aerobic exercise and yoga are both effective in improving quality of life, reducing fatigue, enhancing musculoskeletal fitness, and regulating endocrine function in women with PCOS. However, aerobic exercise demonstrated superior benefits in specific domains, suggesting its potential as a preferred modality in managing PCOS related symptoms.

Effect of Deep Breathing Exercise on Stress among Haemodialysis Patients: A Pre-experimental One-group Pretest Post-test Design

Jayesh Jain, Vijesh Patel, Sadhana Adhyapak, Sucheta Yangad, Khurshid Jamadar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Patients undergoing haemodialysis often experience stress which can affect their appearance and body’s functioning. Deep breathing exercise plays an important role in alleviating stress and enhancing quality of life. Aim: To assess the efficacy of deep breathing exercise on stress among haemodialysis patients. Materials and Methods: This pre-experimental one-group pretest post-test design was conducted among 50 haemodialysis patients from May 2021 to July 2021, at the GCS Medical College Hospital and Research Centre, Ahmedabad, Gujarat, India. Participants were selected through purposive sampling from selected hospitals Stress was assessed using the standard Perceived Stress Scale (PSS-10). The specific breathing technique used in the study was Structured Deep Diaphragmatic Breathing Exercise. Participants were instructed to perform slow, controlled nasal inhalation with abdominal (diaphragmatic) expansion, followed by slow oral exhalation maintaining an inhalation-exhalation ratio of 1:2. The breathing rate was maintained at approximately 14-16 breaths per minute. Each session lasted 10 minutes, resulting in approximately 140-160 breathing cycles (repetitions) per session. Descriptive and inferential statistics were used for data analysis. The paired t-test was applied to compare pretest and post-test stress scores. Results: In the pretest, 38 (76%) of patients had high stress and 12 (24%) had moderate stress. Following the intervention, 47 (94%) of patients had low stress and 3 (6%) had moderate stress. The mean pretest stress score was 29.0±2.9, which reduced to 9.9±2.8 in the post-test. The reduction in stress level was statistically highly significant (t=37.4, df=49, p-value<0.001). Conclusion: This indicates that the stress among haemodialysis patients improved remarkably after deep breathing exercises. Incorporating this technique into routine dialysis care may improve the psychological wellbeing of patients.

Magnesium Sulphate versus Fentanyl as an Adjuvant to Levobupivacaine in Ultrasound- guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Study

Riya P Solanki, Aditi A Dhimar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Ultrasonography (US)-guided Supraclavicular Brachial (SCB) plexus block, alone or as an adjunct to general anaesthesia, provides reliable and safe anaesthesia and analgesia for upper limb surgeries. Adjuvants improve the quality of peripheral nerve blocks by prolonging the duration of sensorimotor blocks and postoperative analgesia. Aim: To compare Magnesium Sulphate vs Fentanyl as an adjuvant to Levobupivacaine in Ultrasound (US) guided SCB plexus block. Materials and Methods: The present randomised controlled study was conducted at BJ Medical College and Civil Hospital, Ahmedabad, from November 2024 to July 2025, involved 62 patients aged 18-60 years, American Society of Anaesthesiologists (ASA) I-III, of either gender, posted for upper limb surgery were randomly divided into two groups: Group F and Group M. In Group F, patients received Levobupivacaine 0.5% 25 mL plus Fentanyl 50μg diluted in 5 mL Normal Saline (NS), while Group M patients received Levobupivacaine 0.5% 25 mL plus Magnesium Sulphate 250 mg diluted in 5 mL NS for US-guided SCB. The primary objective was to assess sensory and motor blockades; secondary objectives included haemodynamic parameters, postoperative analgesia, and complications, if any. Statistical analysis was done using the student t-test and chi-square test using MedCalc version 12.4.3.0. Results: Both groups were comparable in terms of age, gender, and ASA. The onset of sensory block were early in group F (7.24±0.86) compared to group M (15.24±1.85), p<0.0001. The duration of sensory blockade was prolonged in Group M, i.e., 13.93+1.27 hours, as compared to Group F, i.e., 11.26±2.14 hours (p<0.0001), 95% CI -3.56 to -1.77, DF 60). The onset of motor block was earlier in Group F than in Group M (7.24±0.86 vs 8.20±0.82, p=0.25, 95% CI -0.99 to 0.27, DF 60). The duration of postoperative analgesia was longer in Group M as compared to Group F (15.02±1.57 vs 13.32±2.64 hours, p=0.003, 95% CI -2.80 to 0.59). No complications were observed in our study. Conclusion: Magnesium sulphate was a better adjuvant to levobupivacaine with prolonged duration of postoperative analgesia and decreased requirements of rescue analgesia, longer duration of sensory blockade with stable haemodynamics while Fentanyl had early onset of sensory and motor block, for US-guided SCB.

Evaluation of Mobile Augmented Reality in Orthodontic Training using the Technology Acceptance Model: A Multicentre Quasi-experimental Study

Ziqan Zhou, Norehan Mokhtar, Gururajaprasad Kaggal Lakshmana Rao, Anis Farhan Kamaruddin, Nguyen Tran, Syaidatul Salmah Nurbalqis Saiful, Hasnah Hashim, Maryati Md Dasor Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Mobile Augmented Reality (MAR) has shown potential in orthodontic education, yet evidence within orthodontic training specifically remains scarce. Understanding student acceptance is critical to guiding its curriculum integration. Aim: To evaluate undergraduate dental students’ acceptance of a Machine Learning-Enabled Mobile Augmented Reality System (MAR-ORTHO-EDU 2.0) based on the Technology Acceptance Model (TAM). Materials and Methods: This multicentre quasi-experimental study was conducted across four Malaysian public universities (Universiti Sains Malaysia, Universiti Islam Antarabangsa Malaysia, Universiti Kebangsaan Malaysia, and Universiti Teknologi MARA) from November 2022 to June 2023. A total of 227 undergraduate dental students (years 3 and 4) were enrolled: 105 in the control group and 122 in the intervention group. The present paper reports the TAM component of this larger study, administered exclusively to the intervention group (n=122) following a didactic lecture, system demonstration, and one-week access to the MAR-ORTHO-EDU 2.0 application. The TAM questionnaire assessed Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Attitude toward Use (AT), and Behavioural Intention (BI) via convenience sampling. Demographic variables, including gender, year of study, and Emotional Intelligence (EQ), were recorded. Pearson’s correlation and multivariable linear regression were used for analysis (p<0.05). Results: The TAM questionnaire demonstrated robust internal consistency (Cronbach’s α=0.88-0.91). Participants reported favourable acceptance across all domains. The strongest correlation was observed between AT and PU (r=0.791), followed by AT and BI (r=0.780). Multivariable regression indicated that PEOU (p=0.029) and AT (p<0.001) were significant predictors of BI, collectively explaining 69.1% of the variance. PU was not significant in the multivariable model, suggesting mediation through AT. Conclusion: These findings indicate that dental students showed favourable acceptance of MAR-ORTHO-EDU 2.0, with ease of use and attitude, rather than PU, emerging as the primary drivers of adoption intention in orthodontic training.

Periodontal Disease and Its Impact on Migraine-specific Quality of Life: A Cross-sectional Study using MSQ v2.1 Questionnaire

Sarvesh Ganapathy, Deepa Ponnaiyan, CM Anitha, Dhayanand John Victor Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Migraine is a prevalent and disabling neurovascular disorder that significantly impairs Quality of Life (QoL). Identifying modifiable systemic factors that influence migraine burden is essential for improving patient outcomes. Periodontal Disease (PD), a chronic inflammatory condition, contributes to systemic inflammation through persistent immune activation and elevated pro-inflammatory mediators, which are also implicated in migraine pathophysiology. However, the impact of PD on migraine-specific QoL has not been adequately investigated. Aim: To evaluate the impact of PD on migraine-specific QoL using the Migraine-specific QoL Questionnaire version 2.1 (MSQ v2.1). Materials and Methods: A cross-sectional study was conducted at the Outpatient Department of Periodontics, SRM Dental College, in collaboration with SRM General Hospital, Chennai, Tamil Nadu, India, from January 2025 to June 2025. A total of 110 migraine patients aged 18-65 years were enrolled. Group I (n=55) consisted of periodontally healthy individuals with migraine, while Group II (n=55) consisted of individuals with PD and migraine. Migraine was diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), and periodontal status was classified using the 2017 World Workshop Classification. Participants with systemic conditions affecting periodontal or neurological health or those unable to complete the questionnaire were excluded. Periodontal parameters {Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL) and Plaque Indices (PI)] were recorded, and migraine-specific QoL was assessed using the MSQv2.1 across the Role Function Restrictive (RFR), Role Function Preventive (RFP), and Emotional Function (EF) domains. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0, with normality testing and appropriate parametric and categorical comparisons; p<0.05 was considered statistically significant. Results: Significantly lower MSQ v2.1 domain scores were observed in all participants with PD compared to those without PD (p<0.001 for all). Notably, the PD group demonstrated a markedly reduced mean total MSQ v2.1 score (17.26±3.09), indicating severe impairment of migraine-specific QoL. These findings indicate a strong negative association between PD and the functional and emotional well-being of migraine patients. Conclusion: The PD appears to negatively influence migraine-specific QoL. These findings underscore the importance of interdisciplinary management for individuals with co-existing PD and migraine. Further research is warranted to elucidate the underlying mechanisms and to explore potential therapeutic interventions.

Completeness and Accessibility of Oral Cancer Discharge Summaries: A Retrospective Clinical Audit

Akshara Modak, Pratibha Ramani, Deepak Nallaswamy Veeraiyan, Murugesan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Oral cancer discharge summaries are crucial for delivering high-quality care and guiding future treatment planning after surgical management. They summarise essential clinical information required for follow-up, adjuvant therapy decisions, and multidisciplinary coordination. However, incomplete or inaccurate documentation can compromise patient safety and continuity of care. While several studies have evaluated the quality of clinical records, limited evidence specifically assesses the completeness and accessibility of oral cancer discharge summaries, highlighting the need for systematic evaluation. Aim: To assess the completeness of oral cancer discharge summaries using a standardised approach. Materials and Methods: A retrospective clinical audit was conducted on discharge summary reports of 93 oral cancer patients who underwent surgical management between January 2023 and December 2023 at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, using total enumerative sampling of all eligible cases. Discharge summaries prepared in the Department of Oral and Maxillofacial Surgery were evaluated by investigators from the Department of Oral Pathology. A scoring system was used to evaluate 28 parameters covering key aspects of documentation, including patient identification details, clinical history, treatment details, discharge information, and Tumour Node Metastasis (TNM) staging. Each parameter was assessed using a binary scoring system (1=documented, 0=missing) with a maximum score of 28. The availability of discharge summaries in the Dental Information Archival System (DIAS), the Institutional electronic health record system, was also recorded to identify cases where discharge reports were not uploaded to the online database. Descriptive statistics were used for statistical analysis. Results: Of the 93 patients who underwent surgical management for oral cancer, 54 (58%) of discharge summaries were available in the Institutional online DIAS, whereas 39 (42%) were not uploaded to the online database and were analysed separately as a measure of documentation availability. Among the available discharge summaries (n=54), 19 cases (35.2%) achieved complete documentation with a score of 28/28, while 17 cases (31.5%) scored 27/28, indicating near-complete documentation. The documentation completeness score among available summaries ranged from 4-28, with a mean score of 24.83±5.85 and a median (interquartile range) score of 27 (25.75-28). The most frequently omitted parameter was the departmental stamp of the Institution, 23 cases (42.6%), followed by TNM staging, which was missing in 22 cases (40.7%). Conclusion: Complete and accessible documentation in oral cancer discharge summaries is essential for ensuring patient safety and effective healthcare delivery. Implementation of standardised discharge summary templates, regular documentation audits, and improved digital record management may enhance the quality and availability of discharge documentation.

Bacteriological Profile of Lower Segment Caesarean Section Wound Infection: A Cross-sectional Observational Study

Shilpa H Ningaraddi, Manjula Vagarali, Samra Sahu Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Postoperative Lower Segment Caesarean Section (LSCS) wounds are among the most common Surgical Site Infections (SSIs) in the department of obstetrics and gynaecology, leading to increased treatment costs and prolonged hospital stays. Microbiological examination is essential to identify the causative organisms and determine their antimicrobial susceptibility to commonly used antibiotics. Aim: To determine the bacteriological profile and antibiotic susceptibility pattern of pathogens isolated from LSCS wound infections. Materials and Methods: The study was a cross-sectional observational study conducted from March 2025 to February 2026. The study was conducted at the Department of Microbiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India and included 85 LSCS wound infection pus samples. The collected pus swabs were inoculated onto blood agar and MacConkey agar for isolation of aerobic bacteria, while aspirates were inoculated onto blood agar enriched with haemin and vitamin K for anaerobic culture. The isolates were identified based on colony morphology and standard biochemical tests. Antibiotic susceptibility testing was performed for both aerobic and anaerobic bacterial isolates. Demographic details, including age, were recorded and analysed. Frequencies were calculated for categorical variables, and quantitative variables were expressed as mean±Standard Deviation (SD). Results: A total of 85 patients were included in the study, with ages ranging from 19 to 36 years and a mean age of 26.22±3.54 years. In the present study, Klebsiella pneumoniae 7 (25%) was the most commonly isolated pathogen, followed by Citrobacter freundii 4 (14.3%). Methicillin-Resistant Staphylococcus aureus (MRSA) demonstrated 3 (100%) sensitivity to linezolid. Among the Gram-negative isolates (n=20), 15 (75%) belonged to the Enterobacteriaceae family and showed 15 (100%) resistance to ceftriaxone. Pseudomonas aeruginosa showed 1 (33.3%) resistance to cefepime, ceftazidime, and aztreonam, while Acinetobacter baumannii showed 2 (100%) resistance to all the antibiotics tested. Conclusion: LSCS wound infections were predominantly caused by Gram-negative bacteria, including non fermenting organisms. The observed antimicrobial resistance patterns emphasise the need for continuous surveillance and rational antibiotic use. Early identification of pathogens and appropriate antimicrobial therapy are essential for effective management. Implementation of targeted prophylactic strategies may help reduce the incidence of LSCS wound infections.

Morphometric Study of the Supratrochlear Foramen of Humerus: A Cross-sectional Study from Gujarat, India

Aditya A Musale, Kinjal Jethva, Hetal Vaishnani, Bhoopesh Raja, Jahnavi Nath Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The Supratrochlear Foramen (STF) is a developmental perforation of the thin bony septum separating the coronoid and olecranon fossae of the distal humerus. Its prevalence varies widely between populations and it is clinically relevant because it may narrow the medullary canal, mimic a lytic lesion on radiographs, and act as a population-specific anthropological marker. Aim: To determine the incidence and morphometric characteristics of the STF in dry adult human humeri from a Gujarati cadaveric collection. Materials and Methods: A cross-sectional study was conducted on dry adult human humeri from a Gujarati cadaveric collection in the Department of Anatomy, SBKS Medical Institute and Research Centre, Vadodara, over six months (May-October 2025), after ethics approval from the Sumandeep Vidyapeeth Institutional Ethics Committee (SVIEC). Fifty-five dry adult humeri with intact epicondyles were examined. Transverse Diameters (TD) and Vertical Diameters (VD) of STF were measured with vernier calipers, Epicondylar Breadth (EB) on an osteometric board, and distances from Medial Epicondyle (ME) and Lateral Epicondyles (LE) to STF borders (MB, LB) with sliding calipers; each measurement was averaged from three readings. Data were analysed using descriptive statistics, paired t-tests and Pearson correlation, with p<0.05 considered significant. Results: STF was identified in 13 of 55 humeri (23.64%), with a slight right-side predominance (7/13, 53.85%). Oval was the commonest shape (6/13, 46.15%), followed by round (5/13, 38.46%), triangular (1/13, 7.69%) and irregular (1/13, 7.69%). Mean TD (5.00±3.19 mm) was significantly greater than mean VD (3.80±2.11 mm; t=2.747, p=0.018), confirming an elliptical configuration. Mean LB (26.21±3.58 mm) significantly exceeded mean MB (24.32±3.30 mm; t=-2.435, p=0.031), indicating that the foramen lies closer to the ME. Mean EB was 55.54±6.65 mm. Conclusion: STF is a frequent variant with predominantly oval morphology and medial displacement. Awareness of these values is important for preventing complications during intramedullary nailing, avoiding radiological misinterpretation, and supporting population-specific anthropological data.

Expression of E-cadherin in Endometrial Hyperplasia and Endometrioid Endometrial Carcinoma: A Cross-sectional Immunohistochemical Study

Eyeshwarya S Raj, M Shanmugapriya, V Eswari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Endometrial carcinoma is one of the most common gynaecological malignancies and is often preceded by endometrial hyperplasia, representing a spectrum of disease progression. The transition from hyperplasia to carcinoma involves complex molecular mechanisms, among which Epithelial-Mesenchymal Transition (EMT) plays a critical role. E-cadherin, a key cell adhesion molecule, is essential for maintaining epithelial integrity, and its loss has been strongly associated with tumour invasion, metastasis, and dedifferentiation. However, its expression pattern across premalignant and malignant endometrial lesions and its clinicopathological significance remain incompletely understood. Aim: To evaluate E-cadherin expression in endometrial hyperplasia and endometrioid endometrial carcinoma and to assess its association with histopathological parameters. Materials and Methods: The present cross-sectional descriptive observational study with retrospective and prospective components was conducted over a period of 19 months from April 2024 to November 2025 in the Department of Pathology at Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu, India. A total of 38 paraffin-embedded tissue samples were analysed, including endometrial hyperplasia (n=15) and endometrioid endometrial carcinoma (n=23). The clinicopathological parameters studied included age, type of surgical procedure, histological type (hyperplasia with/without atypia and carcinoma), tumour grade, International Federation of Gynecology and Obstetrics (FIGO) stage, Tumour, Node, and Metastasis (TNM) stage, depth of myometrial invasion, and Lymphovascular Invasion (LVI). Immunohistochemical evaluation of E-cadherin expression was performed using a semi-quantitative scoring system based on staining intensity and proportion of positively stained cells. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 22, applying Student’s t-test and Chi-square/Fisher’s exact test, with p<0.05 considered statistically significant. Results: The mean age of patients with endometrial carcinoma was significantly higher than that of patients with endometrial hyperplasia (57.09±10.04 years vs 45.47±8.34 years; p=0.005). Among carcinoma cases (n=23), FIGO Grade 2 was the most common (11/23, 47.83%), with Stage IB predominance (11/23, 47.83%). E-cadherin expression was preserved in all cases of endometrial hyperplasia (15/15, 100%), whereas only three of 23 carcinoma cases (13.04%) showed positive expression. Loss of E-cadherin expression demonstrated significant association with higher tumour grade (p=0.0394), deeper myometrial invasion (p=0.0383), and presence of LVI (p=0.0129). Conclusion: Loss of E-cadherin expression is significantly associated with adverse pathological features in endometrioid endometrial carcinoma and may serve as a potential indicator of tumour aggressiveness; however, its definitive prognostic role requires validation in larger studies with survival analysis.

Clinicopathological Features and Implications of PD-L1 Expression in Colorectal Carcinoma and the Associated CD68-Positive Macrophages: An Analytical Cross-sectional Study

NR Rajesh Kanna, Surajit Pathak, S Manigandan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Colorectal carcinoma exhibits marked heterogeneity in its tumour immune microenvironment, and immune escape through PD-L1 expression may interact with macrophage infiltration. However, the relationship between PD-L1 expression and CD68-positive tumour-associated macrophage density in colorectal carcinoma remains incompletely defined, particularly in relation to routine clinicopathological features. Therefore, evaluating this association may help improve the biological interpretation of the tumour microenvironment in colorectal carcinoma Aim: To evaluate the association between PD-L1 expression with macrophage infiltration in colorectal carcinoma and their clinicopathological correlation. Materials and Methods: This single-centre, hospital-based analytical cross-sectional study conducted in the Department of Pathology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India included 30 cases of Stage-I-IV colorectal carcinoma evaluated using archival blocks and prospective specimens reported between February 2024 and January 2026 (24 months). Clinicopathological parameters (age, sex, tumour site, histological type, histological grade, depth of tumour invasion, lymph node status, overall TNM stage, lymph node metastasis and tumour-infiltrating lymphocyte status) were recorded, and immunohistochemistry for PD-L1 and CD68 was performed on formalin-fixed paraffin-embedded tissue sections, with PD-L1 assessed by Tumour Proportion Score (TPS) and Combined Positive Score (CPS). Associations between PD-L1 expression, CD68-positive tumour-associated macrophage density and clinicopathological variables were analysed using the chi-square test or Fisher’s-exact test, as appropriate, with p<0.05 considered statistically significant Results: The mean age was 56.5±9.9 years, and 13/30 patients (43.3%) were aged ≥60 years. Males constituted 17/30 cases (56.7%). Conventional adenocarcinoma was the commonest histological type, seen in 24/30 cases (80.0%), while 16/30 tumours (53.3%) were moderately differentiated, 15/30 (50.0%) were T3, and 12/30 (40.0%) were Stage-III. PD-L1 positivity by TPS was observed in 13/30 cases (43.3%), while high CD68-positive TAM density was noted in 10/30 cases (33.3%). Among PD-L1-positive tumours, 8/13 cases (61.5%) showed high CD68-positive TAM density, compared with 2/17 PD-L1-negative cases (11.8%) (p=0.009). PD-L1 positivity was significantly associated with right-sided tumour location {8/13 (61.5%); p=0.011}, poor differentiation {6/13 (46.2%); p=0.004}, brisk TILs {7/13 (53.8%); p=0.011}, T4 stage {9/13 (69.2%); p=0.002}, N2 stage {5/13 (38.5%); p=0.004}, Stage-IV disease {6/13 (46.2%); p=0.013}, and lymph node metastasis {%); p=0.009}. Conclusion: PD-L1 expression was significantly associated with CD68-positive macrophage infiltration and adverse clinicopathological features in colorectal carcinoma, supporting its potential role as a prognostic biomarker and therapeutic target.

Nutritional Adequacy, Body Composition, and Functional Recovery in ICU Survivors: A Prospective Observational Study from Mumbai, India

Sanjith Saseedharan, Mansi Gada Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Critical illness is associated with rapid skeletal muscle wasting and impaired functional recovery. Adequate nutritional intake during critical illness and the post-Intensive Care Unit (ICU) recovery period may influence preservation of lean body mass and restoration of muscle strength. Evidence from Indian ICU cohorts remains limited, particularly for studies combining serial body composition, hand grip strength, and nutrition-delivery assessment. Aim: To evaluate longitudinal changes in body composition and muscle strength among ICU survivors and to estimate minimum nutritional adequacy in an Indian ICU cohort receiving standardised nutrition therapy. Materials and Methods: This prospective observational study included 150 adult ICU survivors treated at a tertiary care hospital in Mumbai, India. Participants were assessed at ICU admission, ICU discharge, and three months after hospital discharge using Bioelectrical Impedance Analysis (BIA) and hand grip dynamometry. All patients received a standardised nutrition prescription of 25 kcal/kg/day with oral nutritional supplementation. Minimum energy adequacy was estimated using a conservative intake model. Statistical analysis included descriptive statistics, longitudinal comparison of repeated measurements using repeated-measures Analysis of Variance (ANOVA) and multivariable linear regression for predictors of grip-strength recovery. Results: A total of 150 ICU patients were included. Mean age was 63.6±15.2 years and 85 (56.7%) were male. Skeletal Muscle Mass (SMM) declined from 23.04±5.66 kg at ICU admission to 21.99±5.12 kg at ICU discharge and remained reduced at 22.00±4.74 kg at three-month follow-up. Mean right-hand grip strength improved from 8.79±8.01 kg at admission to 12.43±6.15 kg at three months. Estimated minimum nutrition adequacy during hospitalisation was 60.5% of the prescribed energy target. Multivariable regression analysis demonstrated that duration of ICU stay (β=-0.94, p-value<0.001), baseline right-hand grip strength (β=-0.63, p-value<0.001), and admission phase angle (β=0.81, p-value=0.013) were independently associated with grip-strength recovery. Age, sex, and estimated nutrition adequacy were not significant predictors. Conclusion: ICU survivors demonstrated persistent skeletal muscle loss despite progressive improvement in muscle strength during recovery. Estimated minimum nutrition adequacy was approximately 60% of the prescribed target, highlighting the challenges of achieving optimal nutrition delivery in critically-ill patients.

Reactive Thrombocytosis and Changes in Platelet Parameters in Children with Iron Deficiency Anaemia: A Cross-sectional Study

Payal Agrawal, Priyamvada Singh, Nitesh Singla, Ankit Agrawal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Iron Deficiency Anaemia (IDA) is the most common type of anaemia in paediatric age group. IDA has reported to be associated with thrombotic complications such as fatal cerebrovascular thrombosis, central retinal vein thrombosis, suggesting the correlation between various platelet parameters and IDA. Aim: To observe changes in platelet parameters: platelet count, Mean Platelet Volume (MPV), Plateletcrit (PCT), and Platelet Distribution Width (PDW) in children with IDA. Also, to observe the severity of changes in platelet parameters with the increasing severity of IDA. Materials and Methods: The present cross-sectional study was conducted in SGT Medical College, Hospital and Research Institute, Gurugram, India, over a period of 18 months from October 2022 to March 2024. A total of 141 Children aged between 6 months to 18 years with clinical and laboratory findings suggestive of IDA were enrolled. Children having anaemia other than IDA and any chronic illness were excluded. Platelet parameters {Platelet counts, MPV, PCT, and PDW} of enrolled patients were recorded. Data were statistically analysed by using Pearson correlation, Independent t-test and paired t-test. The p-value <0.05 was considered significant. Results: Among 141 enrolled IDA patients, 75 (53.1%) belonged to moderate while 33 (23.4%) belonged to each mild and severe IDA category. Almost two-thirds patients 86 (61%), have shown thrombocytosis with nearly 68 (80%) mild and rest moderate thrombocytosis. An inverse correlation (r) (p<0.05) was observed between few platelet parameters and iron parameters i.e., haemoglobin (Platelet counts: r=-0.693, MPV: r=-0.759, PDW: r=-0.776), serum ferritin (Platelet counts: r=-0.405, MPV: r=-0.398, PDW: r=-0.572), and serum iron (Platelet counts: r=-0.244, MPV: r=-0.226, PCT: r=-0.166, PDW: r=-0.296). The incidence of thrombocytosis increased with the severity of iron deficiency {mild=06 (18.1%), moderate=47 (62.5%), severe=33 (100%)}. Conclusion: Nearly two third of IDA children had Reactive Thrombocytosis (RT) with significant inverse correlation between other platelet indices and iron parameters. The severity of changes in platelet parameters increases with the increasing severity of iron deficiency with serum iron being the most reliable indicator.

Dunn’s Graph versus Modified Shukla’s Formula in Estimating the Correct Depth of Neonatal Umbilical Venous Catheter Insertion: A Cross-sectional Study

Pooja Devang Patel, Rakshant Jain, Mukund Vaja, Kena Shah, Harshvardhan Sahu, Shiva Kumar Gundrathi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Accurate placement of Umbilical Venous Catheters (UVC) is critical in neonatal intensive care. The Dunn Method (anatomical estimation) and Modified Shukla Formula (length-based estimation) are two commonly used techniques for determining catheter insertion depth. Comparing these two methods is essential to identify which provides more precise and reliable catheter positioning, thereby minimising complications and improving outcomes. Aim: To compare the efficacy, safety, and clinical outcomes associated with the Dunn Method and Modified Shukla Formula for UVC placement in neonates. Materials and Methods: This cross-sectional study was conducted in Neonatal Intensive Care Unit (NICU) of Department of Paediatrics, Dhiraj Hospital, Sumandeep Vidyapeeth Vadodara, Gujarat, India from October 2023 to March 2025. Study included 121 neonates requiring UVC placement within first seven days of life. They were allocated to either the Dunn method group (n=64) or the Shukla method group (n=57). Variables assessed included insertion depth, tip position, success rate, complications, clinical outcomes, and demographic characteristics. Categorical variables were compared using Chi-square test while normal distributed continuous variables by unpaired t-test. Mann-Whitney test was used for not normally distributed variables. Data were considered statistically significant when p-value <0.05. Results: No significant difference was found in demographic characteristics including gender, gestational age, birth weight, mode of delivery and nutritional status. The Dunn method demonstrated no significant difference in placing correct tip positions (64.1% vs. 54.4%), with fewer high-tip placements (9.4% vs 22.8%, p-value=0.046) compared to Shukla method. Both methods had similar first-attempt success rates (96.9% vs 96.5%). Complications, including Late Onset Sepsis (LOS) and line migration, were slightly lower in the Dunn group, though not statistically significant. Clinical outcome such as discharge rate (60.9% vs 42.1%) favoured the Dunn group. Conclusion: The Dunn method offers more precise catheter placement, fewer high-tip malpositions, and trends toward better clinical outcomes compared to the modified Shukla formula. It may be preferred for UVC insertion in neonates, particularly in preterm and low birth weight infants.

Psychosocial Impact of Acne Vulgaris on Quality of Life and Self-esteem: A Cross-sectional Study

Neha Purohit, Devashish Palkar, Rashmi Mahajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Acne vulgaris is a common inflammatory dermatological condition that may affect psychological well-being as well as physical appearance. Despite increasing recognition of the psychosocial burden associated with acne, quality-of-life and self-esteem assessment is not routinely incorporated into dermatology practice. Aim: To assess quality of life and self-esteem among patients with acne vulgaris attending a tertiary care hospital. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Dermatology Outpatient Department of Dhiraj General Hospital (affiliated with Sumandeep Vidyapeeth Deemed to be University), a tertiary-care teaching hospital in Vadodara, Gujarat, India, from June 2023 to September 2023. A total of 108 patients aged 15-45 years with clinically diagnosed acne vulgaris were included. Acne severity was graded using a simple clinical grading system. Quality of life was assessed using the Dermatology Life Quality Index (DLQI), while self-esteem was evaluated using Rosenberg’s Self-Esteem Scale (RSES). Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 25. Results: The mean age of participants was 22.24±4.47 years. The study included 56 (51.9%) females and 52 (48.1%) males. Grade II acne was the most common clinical presentation and was observed in 50% of participants. The mean DLQI score was 5.79±5.62, suggesting mild to moderate impairment in quality of life. Overall, 82 (75.9%) participants demonstrated some degree of quality-of-life impairment, while 20 (18.6%) participants experienced very large to extremely large impairment. The mean RSES score was 19.74±4.87, and low self-esteem was observed in 13 (12.03%) participants. Female participants demonstrated slightly lower mean RSES scores compared to males (19.31±4.41 vs. 20.19±5.34, respectively); however, the difference was not statistically significant (p=0.62). Conclusion: Acne vulgaris was associated with impairment in quality of life and self-esteem among affected individuals. Recognising the psychosocial burden associated with acne may help clinicians adopt a more holistic and patient-centred approach to acne management.

Knowledge, Attitude and Practice of Electronic Waste among Medical Undergraduates in Belagavi, Karnataka, India: A Cross-sectional Study

Ahamed Muqthar, Asha Anil Bellad, TR Sriram Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: India is currently at a rapid pace of technological advancement and increasing electronic device consumption, thereby increasing e-waste, especially after the Coronavirus Disease -2019 (COVID-19) pandemic. E-wastes contain a multitude of hazardous materials having a detrimental effect on both environmental and human health. Aim: To evaluate the knowledge, attitude and practice of e-waste management among medical students, the future healthcare professionals who will influence public health and environmental sustainability initiatives. Materials and Methods: The present cross-sectional study was conducted among 522 undergraduate medical students of Jawaharlal Nehru Medical College Hospital in Belagavi, Karnataka, India, from 1^st September to 30^th September 2024. Data was collected with a pre-designed, pretested, structured questionnaire. All enrolled students were included. Mann-Whitney U test and Kruskal-Wallis H test were used for statistical analysis. Results: The majority of participants 341 (65.3%) were aged between 18 and 20 years. Around 83 (54.2%) were female. Most were in their second year of medical college 179 (34.3%). Around 477 (91.4%) of students were familiar with the concept of e-waste. Most 466 (89.2%) were aware of the harmful effects of e-waste; 477 (91.4%) recognised its negative impact on environment. Only 277 (53.1%) has the knowledge of existing government policies, rules, or regulations concerning e-waste management. Mobile phones were the frequently used devices 496 (95%). Most of them 375 (71.8%) had purchased less than two new devices in the past five years. The most common reason for purchasing new electronics was loss of function 233 (44.6%). Around 231 (44.3%) reported keeping unused electronics at home. Conclusion: According to the results of the present study medical students demonstrate good knowledge of e-waste hazards. However, significant gaps remain in policy knowledge. Proper disposal practices were not followed, most of the students kept the unused devices at home.

Evaluation of Immunohistochemical Expression of CD68 and CD163 in Oral Squamous Cell Carcinoma and Oral Squamous Cell Carcinoma Arising from Oral Submucous Fibrosis: A Cross-sectional Study

Divya Shree Sankar, Sandhya Sundar, Deepak Pandiar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Oral Squamous Cell Carcinoma (OSCC) is a common malignancy with poor prognosis, the development of which is affected by the Tumour Microenvironment (TME). Tumour-Associated Macrophages (TAMs), particularly the M2 phenotype marked by CD 163, play a key role in tumour progression. Oral Sub-mucous Fibrosis (OSMF)-induced OSCC shows distinct biological behaviour due to fibrosis-related alterations in macrophage polarisation. Aim: To evaluate and compare the immunohistochemical expression of CD 68 and CD 163 and the CD 68/CD 163 macrophage ratio, in conventional OSCC and OSMF-induced OSCC. Materials and Methods: This cross-sectional study was conducted between January 2020 and February 2025 in the Department of Oral Pathology and Microbiology at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. The study included 34 histopathologically confirmed OSCC cases (20 conventional OSCC and 14 OSMF-induced OSCC). Immunohistochemical expression of CD 68 and CD 163 was evaluated using percentage positivity, staining intensity and Immunoreactive Score (IRS). The CD 68/CD 163 ratio was calculated to assess macrophage subtype distribution. As data was non normally distributed (Shapiro-Wilk test), comparisons were performed using the Mann-Whitney U test and results were expressed as median {Interquartile Range (IQR)}. Results: Conventional OSCC demonstrated significantly higher median CD 68 IRS {4.00 (2.00)} than OSMF-induced OSCC {3.50 (2.00)} (p=0.004). CD 163 IRS was also higher in conventional OSCC {6.00 (4.50)} compared to OSMF-induced OSCC {3.00 (2.00)} (p<0.001). Percentage positivity and staining intensity differed significantly for both markers (p<0.05). However, the CD 68/CD 163 ratio did not differ significantly between the groups (median IRS ratio: 1.00 vs 1.00; p=0.570). Conclusion: Differential macrophage expression between conventional and OSMF-associated OSCC indicates variations in TME characteristics. However, the balance of macrophage subtypes remained comparable, warranting further investigation of their biological and prognostic relevance.

Anti-streptolysin O Titers in Patients with Post-streptococcal Complications: A Retrospective Observational Study

Saurabh Chhotalal Norris, Binda Prakashbhai Pipaliya, Nidhi Mihirkuamar Bhalodia Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Anti-streptolysin O (ASO) antibodies serve as an important marker of recent Group A Streptococcus (GAS) infection and are crucial in diagnosing immune-mediated post streptococcal complications, such as Acute Rheumatic Fever (ARF) and Post Streptococcal Glomerulonephritis (PSGN). Aim: To evaluate ASO titers in patients with suspected post-streptococcal immune-mediated complications. Materials and Methods: A retrospective observational study was conducted in the Department of Microbiology, Dhiraj Hospital, Smt. B.K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, over a period of two years from January 2023 to December 2024. A total of 67 serum samples with ASO titers ≥200 IU/mL were included. Patients presenting with clinical features suggestive of post streptococcal sequelae such as fever, joint pain, haematuria, facial puffiness, or a recent history of sore throat (within 2–3 weeks) were included in the study. Demographic data, clinical presentation, ASO titers, and provisional diagnoses were recorded and analysed. Data were expressed as frequency and percentage {n (%)}. Results: The majority of ASO-positive cases were children aged 6–15 years, 38/67 (56.7%), with a male predominance 41/67 (61.2%). The most common clinical features included joint pain 33/67 (49.2%), fever 25/67 (37.3%), and haematuria or facial puffiness 17/67 (25.4%). The highest recorded ASO titer was 1100 IU/mL. The most common provisional diagnoses were PSGN 21/67 (31.3%) and suspected acute rheumatic fever 19/67 (28.3%). Conclusion: Quantitative ASO measurement using MISPA i3 nephelometry provides reliable and rapid detection of recent streptococcal infections. These findings reinforce its value in diagnosing post-streptococcal immune-mediated complications, particularly among paediatric populations, supporting timely clinical intervention and management.

Clinical Profile of Paediatric Ocular and Adnexal Trauma at a Tertiary Healthcare Centre in Southern India: A Prospective Observational Study

BV Vinutha, CG Shylaja, L Kiran Kumar, MS Smithagowda, A Aishwarya Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Paediatric ocular trauma is a leading cause of uniocular blindness in children, with significant physical, psychological and socioeconomic implications. Understanding its epidemiology, clinical spectrum and outcomes is essential for effective management and prevention. Aims: To evaluate the aetiology, clinical presentation and visual outcomes of paediatric ocular trauma Materials and Methods: The present prospective observational study was conducted over one year (June 2024 to May 2025) in the Department of Ophthalmology in association with Paediatric Department at a tertiary care centre in Bengaluru, Karnataka, India. Thirty two children aged 2-16 years presenting with ocular trauma were included. Data was collected using a standardised proforma. Injuries were classified using the Birmingham Eye Trauma Terminology System (BETTS) and visual outcomes were recorded. The Ocular Trauma Score (OTS) was calculated and patients were followed up based on severity of injury. Descriptive statistics were used to report frequencies, percentages and means. Results: The mean age was 9.8±4.5 years, with a male predominance. Closed globe injuries 15 (46.87%) and adnexal injuries 16 (50%) were more common than open globe injuries (n=1, 3.13%). The most frequent causes were blunt trauma and road traffic accidents 8 (25%) each, followed by dog bites 6 (18.75%). Common injuries included lid tear, orbital fractures, corneal abrasion and traumatic uveitis. Surgical management was required in 53.12% of cases. Visual outcomes were favourable in most children after treatment. Conclusion: Paediatric ocular trauma remains significant but largely preventable cause of visual impairment. Early diagnosis, timely intervention and long-term follow-up are essential to favourable visual outcomes. Public awareness, safety education and access to emergency eye care are essential to reduce the incidence and burden of ocular injuries in children.

Pattern of Lipid Profile among Asthmatic versus Non-asthmatic Children Aged 5-12 years: A Cross-sectional Study from Coastal Kerala, India

B Bhavya, Mary James, KN Poornima Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Hypercholesterolemia and asthma are associated with skewing of adaptive immune system towards a TH2 (T Helper cell 2). Literature has examined the relationship between blood lipid profile and asthma with ambiguous results. Hence, it is important to look for pattern of lipid profile in asthmatic children. Aim: To compare the Total Cholesterol (TC), Low Density Lipoprotein-Cholesterol (LDL-C) and High Density Lipoprotein-Cholesterol (HDL-C), triglyceride in asthmatic and non-asthmatic children. Materials and Method: A total of 180 children aged 5–12 years were enrolled in this cross-sectional study, including 90 children with asthma attending the asthma clinic and 90 non-asthmatic children serving as controls. The study was conducted at Government TD Medical College, Alappuzha, in the paediatric asthma clinic and paediatric ward from April 2021 to April 2022. Data was collected using questionnaire and anthropometric measurement. Fasting lipid profile was done in the hospital laboratory by enzymatic colorimetric method. Data was analysed and compared using Statistical Package of Social Sciences (SPSS) software version 20. Results: Mean Total Cholesterol (TC)- 172.73 mg/dL, LDL-C- 104.11 mg/dL, HDL-C- 47.98 mg/dL, triglyceride- 77.63 mg/dL (5-9.9 years) and 81.20 mg/dL (10-12 years). Girls with asthma had significantly higher TC than control group with p-value 0.022. TC, LDL-C and HDL-C were high compared to studies in general paediatric population of India. Prevalence of dyslipidemia among the whole study population was as high as 51.1%. Conclusion: There was no statistically significant difference in TC, LDL-C, HDL-C or Triglycerides among asthmatic and non-asthmatic children. However, girls with asthma had significantly higher TC than control group.

Comparison of sFlt-1/PlGF Ratio in Gestational Diabetes and Normoglycaemic Pregnancies with Early-onset Preeclampsia: A Cross-sectional Study

Ojas Kumar Aggarwal, Gulnar Azaz, Sparsh Gupta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Preeclampsia involves disrupted angiogenic balance, marked by elevated soluble Fms-Like Tyrosine kinase-1(sFlt-1) and reduced Placental Growth Factor (PlGF) levels. Preeclampsia is associated with angiogenic imbalance, and Gestational Diabetes Mellitus (GDM) may further influence this disruption, necessitating evaluation of combined diabetic and angiogenic effects. Aim: To compare the maternal sFlt-1/PlGF ratio between GDM and normoglycaemic pregnancies with Early-Onset Preeclampsia (EO-PE). Materials and Methods: The present cross-sectional study was conducted at the Department of Biochemistry at KAHER’s Jawaharlal Nehru Medical College and KLE Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, Karnataka, India from July 2024 to July 2025 study included 100 pregnant women {50 GDM and 50 normoglycaemic (non GDM)} with preeclampsia between 20 and 33 weeks of gestation. Serum sFlt-1 and PlGF levels were measured, and their ratio was calculated. Data normality was assessed using the Shapiro-Wilk test. Group comparisons were performed using the Mann-Whitney U test, and correlations were analysed using Spearman’s correlation test. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, Version 25.0. Results: The mean age of participants was comparable between the groups, with the GDM group having a mean age of (29.92±3.26) years and the non GDM group having a mean age of (29.26±2.81) years. The newborn gender distribution in the GDM group included 28 (56%) males and 22 (44%) females, while the normoglycaemic group included 26 (52%) males and 24 (48%) females. The sFlt-1/PlGF ratio was significantly higher in the GDM group {median: 109.8; Interquartile Range (IQR): 96.7-132.9} compared to normoglycaemic pregnancies (median: 56.8; IQR: 52.9-62.5) (p<0.001). Significant differences were also observed in Body Mass Index (BMI), fasting glucose, Glycated Haemoglobin (HbA1c), sFlt-1, and PlGF levels (p<0.001). The ratio showed strong positive correlations with fasting glucose (r=0.807) and HbA1c (r=0.838). Conclusion: Elevated sFlt-1/ PlGF ratio in GDM compared to normoglycaemic pregnancies reflects early angiogenic imbalance and suggests greater angiogenic imbalance in GDM-associated EO-PE.

Prevalence of Self-reported ADHD Symptoms and Associated Factors among College Students in Kolar District, Southern India: A Cross-sectional Study

Vivek Jayan, C Muninarayana, UC Samudyatha Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Attention Deficit Hyperactivity Disorder (ADHD) in adults remains under-recognised in India, particularly among college students, despite its significant impact on academic performance and psychosocial functioning. However, there is limited epidemiological evidence from southern India regarding the prevalence and socio-demographic correlates of ADHD symptom burden in undergraduate populations, creating a gap in context-specific data necessary for targeted screening and intervention strategies. Aim: To estimate the prevalence and symptom patterns of self-reported ADHD and identify socio-demographic correlates of symptom burden in undergraduate students using the Adult ADHD Self-Report Scale (ASRS v1.1). Materials and Methods: The current cross-sectional study was conducted from January 2023 to June 2023 among 1,913 undergraduate students from degree colleges affiliated to Bengaluru North University, Kolar District, Karnataka, India. ADHD symptoms were assessed using the World Health Organisation (WHO)-endorsed ASRS v1.1. Socio-demographic data were collected using a structured questionnaire. Descriptive statistics were expressed as frequency and percentage {n (%)}. Associations were analysed using Chi-square or Fisher’s exact test, and factors independently associated with ADHD symptom burden were identified using binary logistic regression. Results: Overall, 257 students (13.4%) screened positive for ADHD-related symptoms. Inattentive presentation was the most common (182; 70.8%), followed by hyperactive-impulsive (45; 17.5%) and combined presentation (30; 11.7%). Female gender {Adjusted Odds Ratio (AOR) 1.42; 95% CI: 1.05-1.93}, having more than two siblings (AOR 1.36; 95% CI: 1.01-1.85), and being firstborn (AOR 1.29; 95% CI: 1.01-1.65) were independently associated with higher symptom burden. Conclusion: A considerable proportion of undergraduate students reported ADHD-related symptoms, highlighting the need for targeted screening and early support strategies within higher-education Institutions, particularly for identified at-risk groups.

Domestic Accidents among the Tribal Adults: A Cross-sectional Study from a Block of Murshidabad District, West Bengal, India

Rajarshi Das, Mrinmoy Adhikary, Malay Kumar Das, Dilip Kumar Das Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Domestic accidents are a significant yet often overlooked public health issue, particularly among tribal communities. Aim: To estimate the magnitude and pattern of domestic accidents among rural tribal adults and to assess the health care-seeking behaviour among the victims. Materials and Methods: A community-based cross-sectional study was conducted over a period of five months (15th July- 15th November 2025) in Nabagram block, Murshidabad district, West Bengal, India among a calculated sample of 220 tribal adults selected through multistage random sampling. The participants were interviewed using a predesigned schedule on domestic accidents; care-seeking behaviour was assessed for the most recent accident. Multivariable logistic regression was used to identify correlates of domestic accidents. Statistical Package for the Social Sciences (SPSS) version 23.0 was used for analysis. Results: A total of 33 domestic accidents occurred among 28 participants, with a period prevalence of 12.7% (28/220) and an accident load of 1.2/person. Incised wound 16 (48.5%), insect bite 6 (18.2%), animal bite 6 (18.2%) and fall 5 (15.2%) were the types of accidents; most commonly affected site being head/neck 10 (30.3%) and 17 (51.5%) accidents occurred in the morning. Significant correlates of domestic accidents were found to be alcohol consumption (aOR 6.58, 95% CI: 2.21-19.56) and family type (aOR 3.07; 95% CI: 1.17-7.98). The majority of accident-victims received first-aid at home 17 (60.7%); attended public health facility 15 (53.6%); received medical treatment 27 (96.4%). Conclusion: Domestic accidents still remain as a substantial health burden among rural tribal adults in the area and underscore the need for targeted public health interventions.

Comparative Evaluation of Compressive and Impact Strength of Cold-polymerised and Heat-polymerised Acrylic Resins Reinforced with Different Additives: An In-vitro Study

N Suresh Babu, Paturu Mano Kumar, Naru Phaneeswar, LJ Priyanka, V Chandana, M Naga Ratna Priya Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Polymethyl Methacrylate (PMMA) is widely used for denture base fabrication; however, its limited mechanical properties may predispose it to fracture. Fibre reinforcement has been proposed to improve its strength and durability. Despite this, there is limited comparative evidence evaluating the effect of different fibre reinforcement on both self-cure and heat-cure acrylic resins. Aim: To assess and compare the compressive and impact strength of self-cure and heat-cure acrylic resins reinforced with glass and polypropylene fibres. Materials and Methods: The present in-vitro study was conducted at the Department of Prosthodontics, CKS Theja Institute of Dental Sciences and Research, India from August to November 2024. A total of 120 specimens were divided into six groups (n=20) (Group I-Group VI) based on resin type (self-cure, heat-cure) and reinforcement (control, glass fibre, polypropylene fibre). The inclusion criteria comprised standardised acrylic resin specimens fabricated according to the specified dimensions and specimens free from visible defects such as porosity, cracks, or surface irregularities. Standardised specimens were prepared for compressive and impact strength testing. Fibres (2 wt%) were incorporated during the dough stage. Compressive and impact strength were evaluated using a universal testing machine and Charpy impact tester, respectively. Data were analysed using one-way Analysis of Variance (ANOVA) and Tukey’s post-hoc test (p<0.05). Results: All reinforced groups showed significantly higher compressive and impact strength than controls (p<0.001). Glass fibre-reinforced heat-cure resin demonstrated the highest compressive strength (219.22±7.47 MPa) and impact strength (14.23±2.73 kJ/m2), followed by polypropylene-reinforced heat-cure resin. Among self-cure groups, glass fibre reinforcement showed superior compressive (126.35±3.79 MPa) and impact strength (6.05±0.67 kJ/m2) compared to polypropylene fibres. One-way ANOVA revealed significant intergroup differences for compressive strength (F(5,114)=977.33, p<0.001) and impact strength (F(5,114)=194.68, p<0.001). Tukey’s post-hoc test confirmed significantly greater mechanical performance in glass fibre -reinforced and heat-cure groups compared to other groups (p<0.001). Conclusion: According to the findings of the present study glass fibre reinforcement, particularly in heat-cure PMMA, significantly enhances mechanical properties and may improve denture durability.

Histopathological Evaluation of Tumour Infiltrating Lymphocytes in Head and Neck Squamous Cell Carcinoma: A Cross-sectional Study

MS Sahana, Padma Priya Kasukurti, N Gowthami, Sulata M Kamath Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) is a significant public health concern in India, constituting nearly 30% of all cancer cases. Tumour Infiltrating Lymphocytes (TILs) are an essential component of the tumour microenvironment, influencing tumour progression and limiting tumour invasion, particularly within the tumour stroma. Tumours evade the immune system through the expression of immune checkpoint molecules such as CTLA-4 and PD-L1 on both tumour cells and infiltrating cells. Targeted checkpoint inhibitors can reverse this suppression. HNSCC shows variable prognosis and treatment response. TILs play an important role in the tumour immune response, but their significance in HNSCC is not clearly established. Hence, the present study aimed to evaluate TILs in a cost-effective and routinely used manner in a tertiary care setting. Aim: To histopathologically evaluate stromal and intratumoural TIL in HNSCC and assess their association with clinicopathological parameters. Materials and Methods: A retrospective, cross-sectional study was conducted at the Department of Pathology, Ramaiah Medical College, Bengaluru, Karnataka, India, from May 2024 to May 2025. A total of 95 cases of HNSCC were assessed using a standardised method from the International Immuno-Oncology Biomarkers Working group (IBWG). TILs grading for both intratumoural and stromal TILs was given as low (<10%), intermediate (11-50%) and high (>51%). Chi-square tests were used to study the association with prognostic variables like age, gender, tumour site, tumour differentiation, tumour staging, Lymphovascular Invasion (LVI) and Perineural Invasion (PNI) in HNSCC. Results: Out of 95 cases examined, stromal TILs were low in 62 (65.26%) cases, intermediate in 32 (33.68%) cases and high in 1 (1.05%) case. Intratumoural TILs were high in 45 (47.36%) cases, intermediate in 46 (48.42%) and low in 4 (4.21%) cases. The stromal TILs had a significant association with tumour site (p-value 0.009) and tumour differentiation (p-value <0.001), and the intratumoural TILs had a significant association with tumour differentiation (p-value <0.001) and LVI (p-value 0.036). Conclusion: The present study demonstrated significant associations with selected clinicopathological parameters and concluded that TILs may serve as a potential prognostic marker. Further longitudinal studies evaluating treatment response and survival outcomes are required. Their evaluation helps in risk stratification and clinical decision-making. TILs’ assessment may also identify patients who could benefit from immunotherapy. Routine evaluation of TILs s may contribute to future personalised treatment planning and the development of new therapies.

Comparison of Change in Endotracheal Tube Cuff Pressure during Laparoscopic Abdominal Surgeries in Different Positions: A Prospective Observational Study

Poorvi Jain, Bharat Choudhary, Anisha Banu, Moksha Kanwar Sisodiya, Sarita Janweja Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Laparoscopic abdominal surgeries involve the creation of pneumoperitoneum along with specific patient positioning, both of which can significantly affect respiratory mechanics and airway pressures. These changes may alter Endotracheal Tube (ETT) cuff pressure, potentially increasing the risk of postoperative airway-related complications such as sore throat and tracheal mucosal injury. Aim: To assess variations in ETT cuff and airway pressures in patients undergoing surgery in Trendelenburg and Reverse Trendelenburg positions. Materials and Methods: The present hospital-based prospective observational study was conducted in the Department of Anaesthesiology, Dr. SN Medical College and Associated Group of Hospitals, Jodhpur, Rajasthan, India, on 50 adult patients {American Society of Anaesthesiologists (ASA) I-II, aged 20-60 years} scheduled for elective laparoscopic procedures under general anaesthesia from February 2024 to December 2024. Participants were allocated into two groups based on surgical positioning: Trendelenburg (n=25) and Reverse Trendelenburg (n=25). After tracheal intubation, ETT cuff pressure was initially set between 25-30 cm H2O and measured at baseline, after pneumoperitoneum, after positioning, and at regular intraoperative intervals. Airway pressures were also recorded. Postoperative sore throat and hoarseness were assessed at two and 24 hours. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22, unpaired t-test and chi-square test were used, with p<0.05 considered significant. Results: The demographic characteristics of patients were comparable between the two groups (p>0.05). Pneumoperitoneum caused a significant rise in cuff pressure in both groups, with a greater increase in the Trendelenburg group (baseline 25 to peak 46.50±4.43 cm H2O) compared to Reverse Trendelenburg (from baseline 25 to peak 38.60±4.88 cm H2O; p<0.05). Airway pressures increased significantly from baseline after pneumoperitoneum in both groups, but intergroup differences were not statistically significant. Postoperative sore throat (36% vs. 8%) and hoarseness (16% vs. 8%) were significantly higher in Trendelenburg (p<0.05). Conclusion: Trendelenburg positioning during laparoscopic surgery results in a greater increase in ETT cuff pressure than Reverse Trendelenburg, correlating with a higher incidence of postoperative airway symptoms. Continuous intraoperative cuff pressure monitoring is recommended.

Relationship between Core Muscle Endurance, Hamstring Flexibility and Pelvic Tilt with Low Back Pain-related Functional Limitation in Road Cyclists: A Cross-sectional Study

Rasilia Marlien Mascarenhas, Dhaval Chivate, Basavaraj Motimath, Sanjana Pammannavar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Low Back Pain (LBP) is one of the most common musculoskeletal injuries among both recreational and competitive cyclists, with reported prevalence rates ranging from 30% to 60%. Biomechanical factors such as insufficient trunk muscle endurance, limited hamstring extensibility, and abnormal pelvic positioning have been identified as potential contributors to cycling-related LBP; however, their combined impact on functional disability in this athletic population has not been thoroughly investigated. Aim: To examine the relationships between core muscle endurance, hamstring flexibility, and pelvic tilt with LBP related functional disability in amateur road cyclists. Materials and Methods: The present cross-sectional study was conducted at KLE Institute of Physiotherapy, Belagavi, Karnataka, India, between 10 January 2026 and 12 April 2026, included 41 (n=41) road cyclists with non specific LBP. McGill’s trunk endurance test battery was used to assess core muscle endurance, the active knee extension test was used to measure hamstring extensibility, and the Artificial Intelligence (AI) Posture Evaluation and Correction System (APECS) smartphone application was used to quantify anterior pelvic tilt in both standing and on-cycle positions. The Oswestry Disability Index (ODI) was used to quantify functional limitation. Following confirmation of data normality via the Shapiro-Wilk test, bivariate associations were analysed using Pearson’s correlation coefficient, followed by simple and multiple linear regression analyses. Results: All trunk endurance parameters exhibited strong inverse correlations with ODI scores (r=-0.745 to -0.847). Hamstring restriction, indicated by increased Active Knee Extension angles, demonstrated significant direct correlations with disability (right r=0.823, left r=0.779). Pelvic tilt while standing (r=0.627) and while cycling (r=0.733) exhibited significant correlations with ODI scores. Multiple regression analysis revealed core endurance (β=-0.053) and pelvic tilt (β=0.243) as independent predictors of functional limitation, collectively explaining 82.6% of the variance in ODI scores. Conclusion: Reduced core muscle endurance, limited hamstring extensibility, and increased anterior pelvic tilt in the cycling position correlated with greater functional disability. Core muscle endurance and pelvic tilt emerged as independent predictors of disability, underscoring their relevance in physiotherapy assessment and rehabilitation for this population.

Surgical Innovations in Terrible Triad Injuries of the Elbow: A Novel and Innovative FibreWire and Endobutton Method

Indrajit Das Bhoumik, Nishant Chaudhary, Ashutosh Bhardwaj, Aditya Kumar Singh Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Terrible triad injury, characterised by posterior dislocation of the elbow, radial head fracture, and coronoid fracture, poses significant challenges due to its complex anatomy and the necessity for precise surgical intervention. These injuries are often associated with elbow instability, stiffness, chronic pain, and poor functional outcomes if not managed appropriately. Advances in surgical techniques and fixation methods have improved the prognosis; however, achieving stable joint reconstruction and early mobilisation remains a major challenge for orthopaedic surgeons. Therefore, careful evaluation and timely intervention are essential to restore elbow stability and function. Aim: This study introduces a novel surgical technique utilising FibreWire and Endobutton in patients with terrible triad injuries of the elbow. Materials and Methods: This prospective interventional study included 20 patients with terrible triad injuries treated at Department of Orthopaedics, Government Doon Medical College and Hospital, Dehradun, Uttarakhand, India. Surgical management involved anterior capsular augmentation and Lateral Collateral Ligament (LCL) repair using FibreWire, Endobutton, and radial head fixation. Exclusion criteria included patients aged <18 years, severely comminuted radial head fractures, open fractures, polytrauma or associated injuries affecting the treatment protocol or functional outcome assessment, and Medial Collateral Ligament (MCL) injuries. Functional outcomes were assessed at two weeks, three months, and six months postoperatively using the Mayo Elbow Performance Score (MEPS) and Visual Analog Scale (VAS) for pain. The normality of continuous variables was assessed using the Shapiro-Wilk test. Repeated measures analysis of variance (Repeated Measures ANOVA) was used to compare serial postoperative values of MEPS, Visual Analogue Scale (VAS) scores, and Range of Motion (ROM) over different follow-up intervals. In cases where assumptions for parametric testing were not met, the Friedman test was utilised. Results: The mean age of participants was 26.8±3.3 years, with a male predominance (18 males, 2 females). Injuries were primarily caused by falls (80%) and sports-related trauma (20%). The average time to surgery was 5±1.8 days. At the final follow-up, significant improvements were observed, with mean ROM (flexion-extension) of 135.4°±20.7°, mean rotation of 95°±25.1°, MEPS of 92.4±8.8, and mean VAS score of 0.3±0.5. Outcomes were excellent in 75% of patients, good in 15%, and fair in 10%. No significant complications, such as infections, non-union or heterotopic ossification were reported. Conclusion: The integration of FibreWire and Endobutton offers a minimally invasive, biomechanically robust approach in managing terrible triad injuries, facilitating early mobilisation and reducing the risk of postoperative stiffness. This technique simplifies surgical complexity by avoiding the need for dual tunnels in the ulna while enhancing joint stability and function.

Role of Subcutaneous Negative Suction Drainage in Surgical Site Infection and its Relation with Subcutaneous Fat Thickness: A Prospective Interventional Study

Amandeep Singh, Parampreet Singh Sandhu, Ashutosh Talwar, Jaskaran Singh, Haramritpal Kaur, Rajvir Kandhola Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Wound complications are a major concern for surgeons after surgery. Surgical Site Infection (SSI) is the second most common complication. Many factors in a patient’s journey through surgery have been identified as contributing to the risk of SSI. Therefore, preventing these infections is complex and requires integrating a range of preventive measures before, during, and after surgery. In countries like India, where the risk of wound infection is high due to multiple factors, the importance of novel wound care techniques is essential. Aim: To study the role of negative suction drain in reducing SSI in exploratory Laparotomies and to study the relation of Subcutaneous Fat Thickness (SFT) with SSI. Materials and Methods: This prospective interventional study was conducted in Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India, from July 2021 to January 2023. A total of 80 patients who underwent emergency exploratory laparotomy were included in the study. SFT was measured at the mid-point between the umbilicus and pubic symphysis from skin up to the rectus sheath using a sterile scale. Subcutaneous negative suction drain (16 Fr) was placed between the skin and rectus sheath and labelled as Group-A (D). In Group-B (ND), the skin was closed without placing a suction drain. Signs of SSI were identified, and a comparison was done using the Chi-square test. Results: The overall incidence of SSI in the present study was 38.75%. In 31 SSI cases, the most common were males 24 cases (77.4%) and >50 years of age 11 cases (35.5%). The incidence of SSI in the drain group (Group-A) was 17.5%, significantly lower than in the non drain group (Group-B), i.e., 60%. In Group-A (with subcutaneous negative suction drain), SSI rates remained consistently low across all higher SFT categories, with minimal variation. In contrast, Group-B (without drain) showed a sharp and progressive increase in SSI incidence with increasing SFT, reaching 91.7% in the 3.1-3.5 cm group and 100% in patients with SFT ≥3.6 cm. Conclusion: Use of negative suction drain in emergency exploratory laparotomy cases reduces SSI or morbidity. We recommend using a subcutaneous negative-suction drain in emergency exploratory laparotomy cases with high SFT.

Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to 0.5% Heavy Ropivacaine for Lower Limb Surgeries: A Randomised Controlled Study

Akansha Singhal, Karuna Taksande Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Spinal Anaesthesia (SA) is a suitable Regional Anaesthesia (RA) for lower limb surgery, but is limited by its comparatively short analgesic duration. Adjuvants like fentanyl and dexmedetomidine can be administered intrathecally with local anaesthetics like ropivacaine to assist in modulating block parameters, extend the duration of analgesia and decrease systemic administration of opioids. Aim: To compare and evaluate the safety and efficacy of intrathecal fentanyl and dexmedetomidine as adjuvants to ropivacaine in lower limb orthopaedic surgery. Materials and Methods: This double-blinded, randomised controlled study was carried out at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. It was performed in 60 American Society of Anaesthesiologists (ASA) I-II patients aged 18-50 years undergoing elective lower limb operations. The patients were divided into two groups: Group-RD was administered 15 mg 0.5% hyperbaric ropivacaine with 10 μg dexmedetomidine and Group-RF was administered 15 mg 0.5% hyperbaric ropivacaine with 20 μg fentanyl. Haemodynamic parameters, sensory and motor block characteristics, sedation {as measured by the Ramsay Sedation Score (RSS)}. Duration of analgesia and side-effects were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v22.0 and GraphPad Prism v6.0 and p<0.05 was considered statistically significant. Results: The mean age was 38.43±8.31 years in Group-RF and 37.27±8.75 years in Group-RD. Group-RD showed a significantly earlier onset of sensory block (4.33±0.64 min vs 5.58±0.59 min). Motor block onset was also earlier in Group-RD (5.04±0.75 min) than in Group-RF (7.57±0.60 min), with a longer motor block duration (207.26±6.58 min vs 148.9±8.22 min). Postoperative analgesia lasted significantly longer in Group-RD (391.86±9.89 min) compared with Group-RF (213.3±3.79 min). Haemodynamic parameters remained clinically stable in both groups, with only slight transient decreases in PR and blood pressure and no significant bradycardia or hypotension. Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine compared to fentanyl in SA. It provides better onset, longer sensory and motor block duration and increased analgesia without inducing further haemodynamic instability or respiratory depression.

Effect of Cervical Motor Control Exercises on Cranio-vertebral Angle in Asymptomatic individuals with Forward Head Posture: A Randomised Controlled Trial

Nandini Chandrakant Naik, Twinkle Yogesh Dabholkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Forward Head Posture (FHP) is a common musculoskeletal condition characterised by the displacement of the head anterior to the body’s centre of gravity. FHP although asymptomatic, can lead to various structural and functional impairments. Motor control exercises focus on addressing habitual and incorrect motion patterns, thereby preventing the destabilisation of the cervical spine and the progression of FHP. Aim: To assess the effectiveness of adding cervical motor control exercises to conventional exercises on Craniovertebral Angle (CVA), cervical range of motion, deep neck flexor strength and endurance, Joint Position Error (JPE), and motor control of cervical spine in asymptomatic individuals with FHP. Materials and Methods: The present Randomised Controlled Trial (RCT) was conducted at DY Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India from October 2024 to March 2025 involving young adults (18-26 years) with asymptomatic FHP. Participants were randomly assigned to an experimental group (n=15) that received motor control exercises in addition to conventional physiotherapy treatment and a control group (n=15) that received conventional physiotherapy treatment. Intra-group Comparison and Inter-group comparison of pre and post-intervention outcomes including CVA, cervical range of motion, Cranio-Cervical Flexion Test (CCFT) activation score and performance index, JPE, and cervical motor control test were performed using paired t-tests and independent t-tests. The data was analysed using Statistical Package for the Social Sciences (SPSS) software, version 30.0. A p-value of <0.05 was considered statistically significant. Results: A total of 30 participants completed the study and were included in the final analysis (n=15 per group). Significant within-group differences were observed between pre and post-intervention assessments for all outcome measures in both the conventional and experimental groups (p<0.05), except for JPE during extension in the conventional group. Inter-group comparison demonstrated a significantly greater improvement only in cervical spine motor control (p=0.003) in the experimental group compared with the conventional group. Although the experimental group demonstrated greater numerical improvements in CVA, CCFT activation score, and performance index, these between-group differences were not statistically significant (CVA: p=0.356; CCFT activation: p=0.154; Performance Index: p=0.194). Cervical Range of Motion (ROM) and cervical joint position error demonstrated differences only in selected movement directions. Conclusion: These findings suggest that adding cervical motor control exercises to a conventional treatment protocol was more effective than conventional treatment alone in improving cervical motor control in individuals with asymptomatic forward head posture. Although greater numerical improvements were observed in postural alignment, deep cervical flexor strength, and endurance in the experimental group, these between-group differences were not statistically significant. Improvements in cervical range of motion and joint position error were evident only in selected movement directions.

Psychiatric Co-morbidities and Their Association with Quality of Life in Patients Undergoing Haemodialysis: A Cross-sectional Study

Shijoy P Kunjumon, UV Ahmed Finoz, T Vidun Vinod Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Haemodialysis, the primary treatment for End-Stage Renal Disease (ESRD), is essential for sustaining life but has significant negative impacts on patients’ psychological and physical well-being. Psychiatric disorders, particularly depression and anxiety, are prevalent among these patients and severely affect their Quality of Life (QoL). Aim: To evaluate the prevalence of psychiatric comorbidities, assess the quality of life, and examine their association with selected biochemical parameters among patients undergoing maintenance hemodialysis. Materials and Methods: This hospital-based cross-sectional study was conducted at the haemodialysis unit of Kannur Medical College, Kannur, Kerala, India, from March 2017 to September 2018. A total of 45 patients aged 18 years and older undergoing maintenance haemodialysis for at least two months were included. Socio-demographic variables such as age, gender, marital status, education, occupation, and duration of dialysis were recorded. Psychiatric co-morbidities were assessed using the Mini International Neuropsychiatric Interview Plus (MINI PLUS) version 5.0.0, and QoL was evaluated using the World Health Organisation Quality of Life – Brief Version (WHOQoL-BREF) scale. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0, with appropriate statistical tests applied; a p-value <0.05 was considered statistically significant. Results: Among 45 patients (mean age: 59.07±9.69 years), psychiatric morbidity was present in 36 (80.0%). Major Depressive Episode (MDE) was most common in 24 patients (53.3%), followed by dysthymia in 6 patients (13.3%) and Generalised Anxiety Disorder (GAD) in 6 patients (13.3%); however, 9 patients (20.0%) had no psychiatric diagnosis. Psychiatric morbidity showed no significant association with age (p=0.928), gender (p=0.234), duration of dialysis (p=0.733), duration of renal disease (p=0.384), or Diabetes Mellitus (DM) (p=0.852). QoL scores were significantly lower in patients with psychiatric morbidity across all WHOQOL-BREF domains (all p<0.001). No significant association was observed between psychiatric morbidity and the biochemical parameters evaluated, including haemoglobin, blood urea, serum creatinine, sodium, potassium, calcium, and phosphorus levels (all p>0.05). Conclusion: Psychiatric disorders such as depression and anxiety are prevalent among haemodialysis patients and are strongly linked to impaired QoL. Early screening and management of these conditions could enhance patient well-being. Further studies should explore the psychological dynamics in haemodialysis patients and develop tailored interventions to improve coping strategies and QoL.

Efficacy of Bacillus Coagulans Supplementation on Metabolic Parameters and Inflammation in Prediabetic Obese South Indian Adults: A Double-blinded, Placebo-controlled, Randomised Clinical Trial

Arunkumar Ramaraj, Jerin James, Sathyanarayanan Varadarajan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Prediabetes and obesity are major public health concerns contributing to the growing global burden of Type 2 Diabetes Mellitus (T2DM) and cardiometabolic disorders. Metabolic inflammation and gut microbiota dysbiosis are key mechanisms linking these conditions, highlighting the potential therapeutic role of probiotics. While probiotic supplementation has been studied for glycaemic control and metabolic inflammation, data on its efficacy in prediabetic obese populations, particularly in the Indian context, remain limited. Aim: To evaluate the effect of Bacillus coagulans supplementation on glycaemic parameters and metabolic inflammation in prediabetic obese patients compared to placebo. Materials and Methods: This was a prospective, double-blinded, placebo-controlled, randomised clinical trial conducted at the General Medicine and Diabetology Outpatient Department of SRM Medical College Hospital and Research Centre (SRM MCH&RC), Kattankulathur, Chengalpattu District, Tamil Nadu, India, a tertiary care hospital in South India the period of 10 months (July 2024 to April 2025). A total of 72 prediabetic obese individuals aged 18-65 years were randomly assigned to two groups: Group-I (n=36, 50%) received Bacillus coagulans, commercially available as Lactic Acid Bacillus (120 million spores) once daily for 12 weeks, while Group-II (n=36, 50%) received an identical placebo. Glycaemic parameters Glycated haemoglobin (HbA1c), Fasting Plasma Glucose (FPG), Postprandial Blood Glucose (PPBG), insulin resistance markers {Triglyceride-Glucose (TyG) index, TG/High-Density Lipoprotein Cholesterol (HDL-C) ratio}, anthropometric measures {Body Mass Index (BMI)}, metabolic inflammation markers, Tumour Necrosis Factor-alpha (TNF-α) and oxidative stress marker, Malondialdehyde (MDA) were measured at baseline and after 12 weeks. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 29.0. Results: A significant reduction in FPG (p<0.05) and HbA1c (p<0.05) was observed in the probiotic group n=36 (50%) compared to the placebo group n=36 (50%). TNF-α levels significantly decreased (p<0.05) in Group-I, suggesting reduced metabolic inflammation. The TyG index showed a significant reduction, suggesting improved insulin sensitivity, while TG/HDL-C ratio remained unchanged. Among lipid parameters, total cholesterol and Low-Density Lipoprotein Cholesterol (LDL-C) showed significant reductions. No significant changes were observed in oxidative stress markers (MDA levels). The probiotic supplementation was well-tolerated, with only minor gastrointestinal symptoms reported. Conclusion: Probiotic supplementation with Bacillus coagulans significantly improved glycaemic control, reduced metabolic inflammation and enhanced lipid metabolism in prediabetic obese individuals. Favourable effects were also observed in insulin resistance (TyG index), while oxidative stress markers were unchanged. While probiotics offer a promising adjunctive approach, integrating them with lifestyle and dietary modifications is crucial for optimal metabolic health. Further long-term studies with diverse probiotic strains and extended follow-up periods are recommended to validate these findings.

Cervical Cytological Abnormalities in Symptomatic Women: A Retrospective Cross-sectional Analysis of 945 Pap Smears at a Rural Tertiary Care Centre in Puducherry, India

Saravanakumari Vijayakumar, Rajeshwari Randive Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Cancer of the uterine cervix remains a leading cause of mortality among rural Indian women, due to limited screening access and health illiteracy. Rural regions face a stable, high burden of disease, which is often complicated by a high prevalence of reproductive tract infections. Aim: To delineate the cytological spectrum of conventional Papanicolaou (Pap) smears in a rural tertiary care centre in Southern India. Materials and Methods: In this retrospective cross-sectional study, 945 conventional pap smears (between 01 April 2024-31 December 2025) performed in a rural tertiary care hospital at Pondicherry, India were analysed using the 2014 the Bethesda System for reporting cervical cytology. Demographic data, symptoms, clinical findings, adequacy of smears, Negative for Intraepithelial Lesion/Malignancy (NILM), Epithelial Cell Abnormality (ECA), and glandular cells were studied. Statistical Package for the Social Sciences (SPSS) version 23.0 for Windows was used for statistical analysis. Associations between cytological findings such as inflammation, NILM and infections were obtained using Chi-square and Fisher’s exact tests. Results: This cohort comprised 945 women with a mean age of 44.5±11.0 years (reproductive age group: 36.7±6.6 years; postmenopausal: 53.1±8.4 years). Specimen adequacy was 85.8%. About 907 (96%) were NILM, women in their reproductive years had a significantly higher infectious burden of Bacterial Vaginosis (BV) 78 (15%), Candida 47 (9.1%), and Trichomonas vaginalis 20 (3.9%). Postmenopausal women showed higher rates of reactive cellular changes and atrophic changes (p-value=0.03). The ECA rate was 4%, with an Atypical Squamous Cells of Undetermined Significance (ASC-US)/ Squamous Intraepithelial Lesion (SIL) ratio of 2.1:1. One invasive Squamous Cell Carcinoma (SCC) was identified in the postmenopausal group. Conclusion: This study revealed a predominance of infectious lesions among NILM smears, in which inflammatory atypia may complicate the diagnosis. The persistence of high-grade lesions and SCC in postmenopausal women underlines the importance of continued screening beyond the reproductive years in rural settings.

Comparison of Low-fluence Q-Switched Nd:YAG Laser Combined with Topical Triple Combination Therapy versus Topical Triple Combination Therapy Alone in the Treatment of Melasma: A Prospective Interventional Study

Sweta S Kumar, Nisha Yadav, Monika Srivastava, Shubham Kushwah, Sanjay Kannaujia, Atul Saxena, Santosh Kumar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Melasma is a common acquired hyperpigmentation disorder that predominantly affects individuals with darker skin types and is associated with significant cosmetic concern and frequent relapse. The low-fluence Q-Switched Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) Laser (QSNYL) has emerged as a promising adjunct to conventional topical therapy. Aim: To compare the efficacy and safety of low-fluence QSNYL combined with topical triple combination therapy versus topical therapy alone in patients with melasma. Materials and Methods: This prospective interventional study was conducted in the Department of Dermatology at Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India, from December 2024 to October 2025. A total of 50 patients with clinically diagnosed melasma were enrolled via consecutive sampling and randomly assigned to two groups (n=25 each). Group-A received a low-fluence QSNYL along with topical triple combination cream and sunscreen, while Group-B received topical therapy and sunscreen alone. Change in Melasma Area and Severity Index (MASI) score from baseline to 12 weeks was the primary outcome to be measured. Statistical analysis was performed using an independent-samples Student’s t-test and Chi-square test, with p<0.05 considered significant. Results: Among 50 participants, 43 (86%) were females and 7 (14%) were males. Group-A demonstrated significantly greater reduction in MASI score 86.7% compared with Group-B (55.3%) at 12 weeks (p<0.001). Patient satisfaction scores were higher in Group-A (3.08±0.676) than in Group-B (2.24±1.137; p=0.006). Adverse effects were mild and transient, with erythema being most common. Recurrence was observed in 8% of Group-A and 16% of Group-B. Conclusion: Low-fluence Q-switched Nd:YAG laser combined with topical triple combination therapy significantly improves melasma with minimal adverse effects and higher patient satisfaction.

Effects of Task-oriented Training and Arm Ability Training with Rhythmic Auditory Stimulation on Upper Extremity Function and Quality of Life After Stroke: A Randomised Clinical Study

D Mythili, K Kotteeswaran, V Balchandar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Stroke is the most common cause of disability, and about 70%-80% of patients present with upper limb impairments affecting daily activities, which are associated with reduced Quality of Life (QoL). The haemorrhagic strokes account for 10-15%, and the ischaemic strokes for about 85%. The most challenging consequences for stroke patients are the loss of upper-limb function, often accompanied by cognitive deterioration. This existing dysfunction is not only about weakness but also about a complex interaction between impaired fine motor control and diminished muscle strength, and it is widely accepted that these deficits have the greatest impact on a stroke survivor’s ability to achieve functional independence. Aim: To find the effects of task-oriented and arm-ability training with Rhythmic Auditory Stimulation (RAS) on enhancing upper extremity dexterity and health-related well-being among post-stroke survivors. Materials and Methods: This randomised clinical study was conducted at the Outpatient Department of Jaya College of Physiotherapy, Thiruninravur, Tamil Nadu, India, from November 2025 to January 2026. A total of 50 stroke subjects were randomly allocated to two groups using a lottery method. Group A (n=25) received task-oriented training with RAS, and Group B (n=25) received arm ability training with RAS. Both groups received treatment for three weeks, five days/week. Outcome measures were the Modified Standardised Nine Hole Peg Test (mS-NHPT), Fugl-Meyer Assessment Upper Extremity (FMA-UE), and Stroke Specific QoL Scale (SS-QoL). The Statistical Package for Social Sciences (SPSS) software version 26.0 was used. The paired-sample t-test, the unpaired-sample t-test and the Chi-square test of independence for gender variance. A p-value<0.01 was considered statistically significant. Results: Significantly greater enhancements in outcomes were observed in both groups. There were pronounced enhancements in group B compared to group A, with a p-value<0.001. Both interventions were individually effective on mS-NHPT, FMA-UE, and SS-QoL among subacute stroke subjects. Conclusion: Arm ability training with RAS shows significantly marked gains compared to task-oriented training with RAS and has a considerable effect on upper extremity function and life quality among stroke survivors.

Antimicrobial Susceptibility Profile of Salvage Antibiotics against WHO Priority Carbapenem-resistant KAPE Pathogens using CLSI Recommended Reference Methods: A Laboratory-based Cross-sectional Study

Prerna S Salian, Aruna Poojary, Anurag Kumar Bari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Increasing reliance on salvage antibiotics for Carbapenem-Resistant Gram-Negative (CR-GNB) infections necessitates updated, locally generated in-vitro susceptibility data using standardised laboratory methods to guide rational antimicrobial therapy. Aim: To evaluate the in-vitro antimicrobial susceptibility profile of salvage antibiotics against carbapenem-resistant Klebsiella pneumoniae (CRKP), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA) and Escherichia coli (CREC), collectively termed CR-KAPE. Materials and Methods: This laboratory-based cross-sectional study was conducted at the Department of Microbiology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India from January 2022 to December 2024. A total of 366 consecutive, non-duplicate CR-KAPE isolates from various clinical specimens (blood, Lower-Respiratory Tract (LRT), Intra-abdominal Infection (IAI), skin and soft-tissue, urine) were included as per predefined inclusion criteria. Identification and confirmation of CR were performed using conventional methods and the VITEK 2 system. Antimicrobial Susceptibility Testing (AST) of salvage antibiotics was carried out using broth microdilution, agar dilution, and E-test-Disk diffusion assay, interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Demographic details were recorded, and data were analysed as descriptive statistics. Results: Among 366 CR-KAPE isolates, 138 (37.7%) were CRKP, 88 (24.0%) CRAB, 57 (15.6%) CRPA, and 83 (22.7%) CREC. Tigecycline susceptibility was observed in 52/72 (72.2%) CRAB and 81/83 (97.5%) CREC isolates. Colistin intermediate susceptibility ranged from 88% to 98% across CR-KAPE isolates, while polymyxin B demonstrated higher intermediate susceptibility rates (93% in CRKP and 98%-100% in other isolates). In 45.1% (165/366) of isolates, the MIC of polymyxin B was lower than that of colistin, while in 39.6% (145/366) it was similar. CRAB demonstrated 100% (88/88) susceptibility to CSE at a fixed EDTA concentration of 4740 μg/mL. Fosfomycin susceptibility among CREC urine isolates was 38/42 (90%). Ceftazidime-Avibactam (CZA)-aztreonam synergy was observed in 108/137 (78.8%) CRKP and 45/75 (60.0%) CREC isolates. Conclusion: The findings highlight the declining efficacy of available salvage antibiotics against CR-KAPE pathogens and emphasise the need for new antimicrobial agents targeting GNB infections. Rapid standardised methods and continuous surveillance are essential to preserve last-resort drugs and guide effective treatment strategies.

Colour Vision Screening Training Module for School Counsellors: Module Development, Validity and Feasibility Study

Belina-Anne William M Thomas, Sharanjeet Sharanjeet-Kaur, Mahadir Ahmad, Lei Hum Wee, Mohd Izzuddin Hairol Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Congenital Colour Vision Deficiency (CCVD) is often undetected in school children due to the absence of colour vision testing in routine school health programmes. Early detection allows timely counselling and career guidance, potentially minimising emotional, behavioural and academic challenges. Training school counsellors to perform colour vision screening may offer a cost-effective and sustainable solution. Aim: To develop, validate, and assess the feasibility of a Colour Vision Screening Training Module (CVS-T Module) for school counsellors. Materials and Methods: A three-phase, mixed-methods study was conducted in Kuala Lumpur, Malaysia, between January 2021 and December 2022. The study was guided by Sidek’s Module Development Mod-el, which comprised three phases: (I) formulation of the module concept, design, and content; (II) development of the module through literature review and input from subject matter experts (n=4), followed by validation from a multidisciplinary expert panel (n=7); and (III) pilot feasibility testing, in which secondary school counsellors (n=2) applied the module to screen school children (N=44). Results: Content validation showed excellent agreement (I-CVI=1.0, S-CVI/Ave=1.0, S-CVI/UA=1.0), though such perfect scores are rare and may reflect the expert panel’s recruitment. Experts supported the finalised module and the pocket handbook for screening procedures. Feasibility testing revealed 100% agreement (AC1=1.0) for both counsellor and optometrist methods, despite a small, homogeneous male-only sample from one school. Counsellors provided positive feedback on the module’s clarity, relevance, and ease of use. Conclusion: The CVS-T Module is a valid, feasible and practical training resource for school counsellors to conduct in-school colour vision screening. Its integration into school health programs could facilitate the early detection and referral of CCVD, potentially reducing the negative psychological and educational impact of delayed diagnosis. Further studies should evaluate its effectiveness on a larger scale.

Effectiveness of Delorme versus Oxford Technique on Grip and Forearm Muscle Strength in Distal Forearm Fractures: An Experimental Study

Manju Chordiya, Shivani Jain Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Distal forearm fractures are among the most common musculoskeletal injuries, and are frequently associated with significant loss of hand function and impaired forearm muscle strength. Progressive Resistance Exercises (PRE) techniques, such as the Delorme and Oxford protocols, are established rehabilitation approaches for improving muscle function; their contrasting principles and comparative effectiveness remain understudied, thereby warranting this investigation. Aim: To compare the effectiveness of the Delorme and Oxford techniques on grip strength and forearm muscle strength in patients with postoperative distal forearm fractures. Materials and Methods: This experimental study was conducted at the Outpatient Department (OPD) of Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India from May 2024 to May 2025, after obtaining Institutional Ethics Committee approval. A total of 30 participants aged 18-40 years with distal forearm fractures, at least 6 weeks postoperative and with ≥80% normal range of motion, were included. Participants were randomly allocated into two groups: Group A followed the Delorme protocol (ascending resistance), and Group B followed the Oxford protocol (descending resistance). Both groups underwent a four-week intervention comprising supervised sessions three times per week along with a home exercise program. Outcome measures included grip strength and forearm muscle strength (wrist flexors, extensors, supinators, and pronators), assessed using the Lafayette Hand-Held Dynamometer. Statistical analysis was performed using SPSS version 23.0, with paired t-tests for within-group comparisons and unpaired t-tests for between-group comparisons. A p-value<0.05 was considered statistically significant. Results: Baseline characteristics were comparable between the two groups (p>0.05). Within-group analysis showed significant improvements in both groups (p<0.01) across all the outcome measures. Between-group comparison revealed significantly greater post-intervention improvements in group A compared to group B. Grip strength was significantly higher in Group A than in group B, p<0.05. Similarly, wrist flexor strength, wrist extensor strength, supinator strength, and pronator strength were significantly higher in group A compared to group B, p<0.05. Conclusion: Both the Delorme and Oxford training protocols were seen to be effective in improving the grip strength and forearm muscle strength in patients with postoperative distal forearm fractures. However, the Delorme technique was more effective than the Oxford technique in enhancing the forearm muscle strength and hand grip in this population.

Role of Computed Tomography Pulmonary Angiography in Predicting Short-term Outcome in Patients with Pulmonary Embolism: A Retrospective Observational Study

Jyothi Gunturu, Naga Narasimha Raju Jukuri, Kanna Sri Hari Hanuman, Praneetha Buridi, Mahathi Thotakura Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Pulmonary Embolism (PE) despite advances in diagnosis and management continues to be associated with significant morbidity and mortality. Early identification of prognostic indicators is essential for risk stratification and guiding therapeutic decisions. Computed Tomography Pulmonary Angiography (CTPA), the current gold standard for PE diagnosis, also provides valuable prognostic information by quantifying embolic burden and assessing Right Ventricular Dysfunction (RVD). Aim: To assess the role of CTPA in predicting short-term outcomes in patients with PE. Materials and Methods: A retrospective observational study was conducted at Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India, between January 2023 and June 2025. Patients diagnosed with PE on CTPA and followed for at least 30 days were included in the study. Pulmonary Artery Obstruction Index (PAOI) was calculated using the Qanadli scoring system. RVD was assessed using four CTPA parameters: Right Ventricle/Left Ventricle (RV/LV) diameter ratio, Main Pulmonary Artery (MPA) diameter, interventricular septal deviation, and contrast reflux into the Inferior Vena Cava (IVC). Outcomes at 30 days were categorised as good prognosis (discharge), Intensive Care Unit (ICU) admission, or death. Results: A total of 85 patients were included in the study. The mean age was 54.6 years, with 51 males and 34 females. Fifty-two patients had a good prognosis, 23 required ICU admission, and 10 died within 30 days. Mean PAOI increased progressively across outcome groups (21.88±8.7, 38.91±6.3, and 45.75±14.0, respectively). MPA diameter demonstrated moderate sensitivity (78.8%) and specificity (71.2%) for predicting adverse outcomes. RV/LV ratio showed moderate sensitivity (75.8%) but low specificity (42.3%). Interventricular septal deviation and IVC contrast reflux demonstrated low sensitivity (54.5% and 42.4%, respectively) but high specificity for mortality (75.0% and 90.4%, respectively). Conclusion: PAOI is the strongest overall predictor of adverse short-term outcome, while CT signs of RVD- particularly IVC contrast reflux and septal deviation- are highly specific markers of mortality.

Hepatoprotective Effects of Aqueous Extract of Tagetes patula Flowers Against Paracetamol-induced Hepatotoxicity in Rats

Abhishek Bhattacharjee, Pritama Paul, Sumana Majumder, Ngangom Gunindro, Chandan Chatterjee Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Paracetamol (PCM) overdose is a major contributor to acute liver failure, mainly resulting from oxidative stress and the depletion of Glutathione (GSH) triggered by its toxic byproduct, N-Acetyl-P-Benzoquinone Imine (NAPQI). Conventional hepatoprotective agents have limitations, prompting interest in medicinal plants. Tagetes patula (French marigold), traditionally used for hepatic disorders, contains flavonoids and terpenoids with potential antioxidant activity, but its hepatoprotective effects remain underexplored. Aim: To evaluate the hepatoprotective effect of Aqueous Extract of Tagetes patula flowers (AETP) against PCM-induced hepatotoxicity in rats. Materials and Methods: This an experimental animal study was conducted at the Departments of Pharmacology and Pathology, Regional Institute of Medical Sciences (RIMS), Imphal, India from November 2021 to May 2022. A total of 25 adult male Wistar albino rats were divided into five groups (n=5). Group I received vehicle (control), Group II received PCM (2 g/kg; toxic control), Group III received PCM + silymarin (25 mg/kg; standard), and Groups IV and V received PCM + AETP (200 mg/kg and 400 mg/kg, respectively) for seven days. Serum AST, ALT, and ALP levels were measured, and liver histology was examined. Data were analysed using one-way Analysis of variance (ANOVA) with Bonferroni post-hoc test. Results: The PCM caused significant elevation of AST, ALT, and ALP (p<0.001) and severe histopathological damage. Silymarin markedly reduced enzyme levels and preserved hepatic architecture. AETP treatment produced a dose-dependent hepatoprotective effect: 200 mg/kg partially improved biochemical and histological parameters, while 400 mg/kg significantly reduced enzyme levels (p<0.05 vs toxic) and showed improved hepatic architecture. Conclusion: The AETP flower extract demonstrates dose-dependent protective effects on the liver against PCM-induced liver injury, likely attributed to its antioxidant and anti-inflammatory phytochemicals. Additional research is required to elucidate its underlying mechanisms and validate its therapeutic efficacy.

Evaluation and Standardisation of Tripurabhairava Rasa: A Laboratory-based Pharmaceutical Analytical Experimental Study

Sukeshini Julme, Mujahid Khan, Rashmi Zade Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Tripurabhairava Rasa (TBR) is a classical herbo-mineral formulation described in the Bharat Bhaishajya Ratnakara, traditionally used in managing various types of Jwara (fever). It contains Shuddha Vatsanabha (Aconitum ferox), Shunthi (Zingiber officinale), Maricha (Piper nigrum), and Shuddha Tankana (Borax). The presence of toxic substances like Vatsanabha necessitates thorough pharmaceutical and toxicity evaluation. The formulation is indicated in conditions such as Sannipatik Jwara (severe condition of any disease), Vataroga (disorders caused by vata), Shleshmaroga (disorders caused by kapha), Maha Jwara (long duration of pyrexia), mastakasya roga (disorders of meninges), and pida of Udara (pain in the lower abdomen). Aim: To evaluate and standardise TBR using validated pharmaceutical and analytical parameters. Materials and Methods: The present study is a laboratory-based pharmaceutical-analytical experimental study conducted at the Department of Rasashastra evam Bhaishajya Kalpana, Mahatma Gandhi Ayurved College and Research Centre (MGACH & RC), Salod (H), Wardha, Maharashtra, India, from January 2024 to February 2024. The formulation was prepared using classical Ayurvedic methods, including Shodhana (purification), Churna Nirmana (powdering), Bhavana (levigation), and Vati (tablet preparation). Physicochemical analyses, including loss on drying, total ash, water and alcohol-soluble extractives, acid-insoluble ash, extractive values, and pH, were carried out at Cotex Laxmi Health Care Pvt., Ltd., Wardha, and MGACH & RC, Salod (H), Maharashtra, India. Chemical profiling of the formulation was performed using High-Performance Thin Layer Chromatography (HPTLC). As this was a pharmaceutical-analytical study, demographic parameters were not applicable. Data were analysed descriptively and the results were expressed as mean values, with no inferential statistical analysis performed. Results: The formulation showed the following analytical values: Loss on drying- 1.59%, Total ash- 32.5%, Water-soluble ash- 0.32%, Acid-insoluble ash-0.01%, Alcohol-soluble extractive- 9.88%, Water-soluble extractive- 52.94%, and pH-10.3. HPTLC analysis revealed five distinct spots with Rf values of 0.32, 0.72, 0.77, 0.82, and 0.90. Conclusion: The present study presents the first pharmaceutical and analytical evaluation of TBR prepared strictly according to classical references. The findings suggest the formulation maintains acceptable pharmaceutical standards. Further research on pharmacological activity and toxicity is warranted to support its safe therapeutic application.

Comparison of Single-handed Mask Ventilation by Conventional E/C Grip, Thenar Eminence technique and Hook Methods: A Randomised Clinical Study

Asrith Reddy Arakatla, Nirmala Devi Kagalkar, Santoshkumar Alalamath Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Facemask ventilation is a fundamental skill in anaesthetic and emergency airway management. However, comparative evidence on single-handed techniques remains limited. The conventional E/C grip, Thenar Eminence (T/E) technique, and the novel hook method differ biomechanically and may influence ventilation efficiency. In single-operator resuscitation scenarios, optimal technique selection is critical. Aim: To compare the efficacy of single-handed bag-mask ventilation using E/C, T/E, and hook techniques in adult patients under general anaesthesia assessed by End-Tidal Carbon Dioxide (ETCO2) and chest rise. Materials and Methods: The present randomised clinical study was conducted at the Department of Anaesthesiology, BLDE (Deemed to be University), Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India, from July 2024 to November 2025. A total of 177 adult patients American Society of Anaesthesiologists (ASA) I-II, 18-65 years, Body Mass Index (BMI) <35 kg/m², Mallampati I-II undergoing elective surgery was equally allocated to three groups: E/C (Group C), T/E (Group T), and hook technique (Group H). Following induction with propofol (2 mg/kg) and suxamethonium chloride (succinylcholine) (2 mg/kg), apnoeic patients were ventilated with 100% oxygen at 12 breaths/minute. ETCO2 was measured via side stream capnography at baseline and after the 2^nd, 4^th, 6^th, 8^th, and 10^th breaths. Chest expansion was assessed using a four-point scale. Data were analysed using Analysis of Variance (ANOVA), Kruskal-Wallis, and Chi-square tests with Bonferroni correction. Results: Baseline characteristics were comparable (mean age: 33.42±11.15, 32.98±11.42, and 31.67±10.95 years for E/C, T/E, and hook groups; p=0.697). The hook technique demonstrated the highest success rate (93.2%) compared with E/C (88.1%) and T/E (86.4%) (p=0.048). Optimal chest rise (Score 4) was more frequent with the hook method (67.8%) versus E/C (61.0%) and T/E (55.9%) (p=0.045). ETCO2 increased in all groups without significant differences at individual time points. Conversion to two-handed ventilation was lowest with the hook technique (6.8%) compared to E/C (11.9%) and T/E (13.6%). Adverse events were least frequent in the hook group (8.5% vs 18.6% and 23.7%; p=0.032). Conclusion: The hook technique offers superior single-handed mask ventilation success, improved chest rise, and more consistent ETCO2 trends compared to E/C and T/E methods. It may be particularly beneficial in prolonged resuscitation and for operators with smaller hands, supporting its inclusion in airway management training.

Comparison of the Efficacy of Intralesional Triamcinolone Acetonide Alone versus Triamcinolone Acetonide Combined with Hyaluronidase in the Treatment of Keloids: A Prospective Interventional Study

P Mangaiyarkkarasi, R Sudha, B Jayalakshmi Dhevi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The management of keloids remains a significant therapeutic challenge due to their chronic nature, resistance to treatment, and tendency to recur. Various modalities of management include surgery, laser therapy, cryotherapy, silicone sheets, radiation and intralesional injections. First-line therapy is intralesional Triamcinolone Acetonide (TAC), but it often causes dermal atrophy and hypopigmentation. Combination therapies are increasingly explored to enhance the efficacy, reduce the adverse effects, and minimise recurrence. Aim: To compare the efficacy of intralesional injection of triamcinolone alone vs intralesional injection of triamcinolone combined with hyaluronidase in the treatment of keloids. Materials and Methods: The present open-label prospective interventional study conducted at the Dermatology Outpatient Department (OPD) of Government Rajaji Hospital, Madurai, Tamil Nadu, India, from June 2023 to August 2024, involving 36 patients with keloids. Patients were randomly assigned to two groups (n=18 each): Group 1 received intralesional TAC alone; Group 2 received TAC plus hyaluronidase. Intralesional injections were administered every three weeks for up to maximum of six sessions. Efficacy was evaluated by assessing the vascularity, pigmentation, pliability, height, pain/itching by modified Vancouver Scar Scale (mVSS). Data were entered in Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) software. Chi-square test was applied, with p<0.05 considered statistically significant. Clinical photographs were taken at baseline and before each injection session. Results: The mean age of the study population was 31.64 year (range 20-50 years). Among the participants, 26 (72.22%) were male and 10 (27.78%) were female, giving a male-to-female ratio of approximately 2.6:1. The onset of the lesion was spontaneous in 16 cases, preceded by trauma 10 cases and surgery six cases. Analysis of substance use revealed that 4 (11.11%) were alcoholic, 4 (11.11%) were smokers and 2 (5.56%) were both alcoholic and smoker. The mean VSS score decreased from 13.66 at baseline to 2.7 at 18 weeks in Group 2, compared with 13.5 to 4.1 in Group 1. Group 2 demonstrated significantly greater improvement in VSS scores from week six through week 15 (significant p-value for Group 2-p<0.05). Complete resolution of keloid was achieved in 16 of 18 patients (88.9%) in Group 2 versus 12 of 18 patients (66.7%) in Group 1 at 18 weeks with the remaining patients in each group achieving partial resolution. Conclusion: Combination TAC with hyaluronidase yielded superior efficacy (89% complete resolution) over TAC alone (67%). Though both treatments were efficacious, combination therapy is recommended for faster results, lower relapse and minimal side-effects.

Development and Psychometric Evaluation of the Menopausal Symptom Bothersomeness Questionnaire: A Cross-sectional Study

Priyasingh Bhagirathsingh Rangey, Nehal Shah Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Menopausal females experience a diversity of symptoms related to various organ systems, which significantly affect their daily function and Quality of Life (QoL). Bothersomeness depends on each individual’s tolerance level; hence, bothersomeness due to menopausal symptoms is subjective and varies with each woman. Aim: To develop a valid and reliable questionnaire to assess the bothersomeness of menopausal symptoms. Materials and Methods: A cross-sectional study was conducted among menopausal women from multiple states of India (New Delhi, Haryana, Uttar Pradesh, Gujarat, Rajasthan, Madhya Pradesh, Maharashtra, and Karnataka), India from May 2023 to April 2025. A mixed-methods approach was used to determine the content domain and generate items, and a preliminary questionnaire of 46 items was created. A nine-member expert panel was formed to review and validate the content. Factor analysis was performed to reduce items. Reliability and construct validity were assessed. Content validity was determined using Content Validity Index (CVI), Content Validity Ratio (CVR) and Kappa values. Results: Among a total of 106 menopausal women, 52 females were peri-menopausal, and 54 were post-menopausal. Mean age of the sample was 51.13±5.067 years. Mean ages of peri-menopausal and post-menopausal women were 47.83±2.185 years and 54.31±5.024 years, respectively. The questionnaire’s validity was assessed using multiple methods. Content validity indices (I-CVI: 0.67-1.00; S-CVI/Ave: 0.95) guided item selection, resulting in a draft of 33 questions. Exploratory factor analysis conducted with 106 participants identified a nine-factor structure comprising 33 questions. Internal consistency was acceptable to excellent (Cronbach’s α range: 0.635-0.921). Test-retest reliability was moderate to excellent, with Spearman’s rho and ICC values exceeding 0.5 in a subsample of 22 participants. Construct validity was established through comparison with the Greene Climacteric Scale and the Menopausal QoL questionnaire in a different sample of 107 participants. Item 24 was removed due to insufficient loading, leading to 32 items in the final questionnaire. Conclusion: The Menopausal Symptom Bothersomeness Questionnaire (MSBQ), containing 32 items divided into nine domains, was developed to assess the bothersomeness due to menopausal symptoms in menopausal females. The questionnaire has acceptable internal consistency and moderate to excellent test-retest reliability and has established construct and content validity. It is a valid and reliable comprehensive Patient-Reported Outcome Measure (PROM) that can be used in the community setting.

Flexibility and Anthropometric Characteristics as Predictors of Agility Performance in Recreational Basketball Athletes: A Cross-sectional Study

Rishita, Amit Kumar, Prachi Sharma, Mohit Bansal, Suruchi Garg Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Due to the dynamic nature of basketball, agility, flexibility and physical characteristics have a higher importance in the performance of an athlete, so understanding their association and influence of different factors will help in predicting injury risk, designing training regimes and athlete profiling at the recreational level. This study is intended to explore interaction between and predict outcomes of performance of recreational basketball athletes’ agility based on their level of flexibility and anthropometric characteristics. Aim: To identify if either flexibility or anthropometric characteristics can predict an individual’s ability to execute agility in athletic skills by both correlation and regression analysis. Materials and Methods: A cross-sectional study was conducted in the sports complex of Maharishi Markandeshwar (Deemed to be University), Mullana- Ambala, Haryana, India from January 2025-December 2025. The study included 62 healthy recreational basketball athletes of age 18-30 years who participated with each of their heights, weights and Body Mass Index (BMI) recorded as anthropometric measurements. Both agility and flexibility were assessed via t-test for agility and the Sit and Reach Test (SRT) for flexibility. Pearson’s correlation coefficient and regression analysis were conducted to assess associations and to identify agility predictions. Statistical significance was set at p-value <0.05. Results: In terms of agility, F (4,57) =0.778, p-value=0.544, R2=0.052, the regression model was non significant. However, anthropometric variables had significant moderate relationship with flexibility F (4,57)= 6.113, p-value <0.001, R2=0.300). For flexibility and agility (F (1,59)= 0.36, p-value=0.543, R2=0.006), the model was not statistically significant. BMI had very small correlations with agility, while age, height and weight weren’t related. Gender showed a weak negative association with agility (r=-0.266, p-value <0.05). Flexibility showed a negative relationship with age (r=-0.323, p-value <0.05), weight (r=-0.296, p-value <0.01), and BMI (r=-0.359, p-value <0.01) but not with height or gender. No statistically significant link between agility and flexibility was found. Conclusion: In summary, flexibility along with anthropometric characteristics exhibited limited ability to predict an athlete’s agility indicating recreational basketball athletes should be evaluated and develop agility as a distinct physical trait apart from all other variables.

Surface Morphology and Microbial Profile of Failed Peri-implantitis Affected and Clinically Healthy Dental Implants: A Comparative Cross-sectional Study

Neha Jain, Arvina Rajasekar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Dental implants are widely used for tooth replacement, but peri-implantitis remains a major cause of failure due to biofilm accumulation and destructive inflammation. Structural changes on implant surfaces may further enhance bacterial adhesion and compromise osseointegration. Despite the established role of surface characteristics and microbial factors in peri-implant disease, limited clinical evidence is available on their combined evaluation in failed implants compared with healthy implants, providing the rationale for the present study. Aim: To compare the surface morphology and microbial load of failed peri-implantitis affected implants with clinically healthy implants using Scanning Electron Microscopy (SEM) and culture-based microbiological analysis. Materials and Methods: This comparative cross-sectional study was conducted at the Department of Periodontology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, Tamil Nadu, India, from January 2025 to September 2025. A total of 20 participants were included, comprising 10 clinically healthy single-implant cases in Group 1 (control group) and 10 failed implants diagnosed with peri-implantitis in Group 2 (test group), selected based on defined clinical and radiographic inclusion criteria. Retrieved failed implants were subjected to SEM to evaluate surface alterations, with an unused implant of the same system examined as a structural reference for baseline surface morphology. Plaque samples collected from healthy and failed peri-implant sites were analysed using aerobic and anaerobic culture to quantify colony forming units (CFU/mL). Demographic parameters, including age and gender, were recorded for both groups. Intergroup comparisons were performed using the Independent t-test, while gender distribution was assessed using the Chi-square test, with the level of significance set at p-value <0.05. Results: SEM evaluation using an unused implant as a qualitative structural reference demonstrated the baseline surface morphology of the implant system, including loss of micro-roughness, cracks, and adherent debris. Microbiological analysis comparing the clinical patient groups revealed significantly higher aerobic bacterial counts in the failed implant group (group 2: 6.61±1.02×106 CFU/mL) than in the clinically healthy implant group (group 1: 2.23±0.06×106 CFU/mL; p<0.001). Similarly, anaerobic counts were elevated in group 2 (3.96±0.91×106 CFU/mL) compared with group 1 (1.02±0.03×106 CFU/mL; p<0.001). Conclusion: Failed peri-implantitis-affected implants exhibited substantial surface deterioration and significantly increased microbial load compared with healthy implants.

Serum 25-Hydroxyvitamin D Status among Vegetarian, Partial Vegetarian, and Non Vegetarian Medical Students: A Cross-Sectional Study

Sudha Ambiger, Sushma Kulkarni, PH Chetana, Arun V Dhangi, AB Fareeda Banu, Shivlingappa Javali Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Beyond calcium homeostasis, vitamin D’s impact on health is becoming more significant. Although dietary habits may influence vitamin D status, studies comparing vitamin D levels among vegetarian, partially vegetarian, and non vegetarian in medical students are scarce. Aim: To evaluate the association between dietary patterns and vitamin D status among healthy Indian and Malaysian medical students. Materials and Methods: This was a cross-sectional study which was conducted in the Department of Biochemistry, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India. Apparently, healthy medical students of Indian and Malaysian ethnicity studying in medical colleges of Belagavi were included in the study. Data on age, height, weight, socio-economic status, and exposure to sunlight were collected. After analysis of the diet questionnaire, study participants were divided into three groups. Group 1: Vegetarian, Group 2: Partial vegetarian, and Group 3: Non vegetarian. Vitamin D, calcium, phosphorus, and alkaline phosphatase levels were estimated. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of 200, 100 Indian and 100 Malaysian medical students were included in the study. In Malaysian group, 8 (8%) were vegetarian,12 (12%) were partial vegetarian, and 80 (80%) were non vegetarian. In Indian group 22 (22%) were vegetarian, 46 (46%) were partial vegetarians, and 32 (32%) were non vegetarians. The study shows Indian students were more vitamin D deficient, 78%, compared to Malaysian students, 66%. In both Indian and Malaysian medical students, mean levels of vitamin D and calcium were lower in the vegetarian and partial vegetarian groups as compared to in the non vegetarian group (p-value <0.05). Alkaline phosphatase was found to be normal in both Indian and Malaysian medical students in all three dietary habit groups. A statistically significant correlation of vitamin D with sunlight exposure was found in both Indian and Malaysian medical students (p-value <0.05). Conclusion: The markedly higher prevalence of low vitamin D in medical students of India (78%) and Malaysia (66%) shows that vitamin D level depends on dietary habits in addition to ethnicity and sun exposure. In both Indian and Malaysian medical students, the mean level of vitamin D was lower in vegetarian and partial vegetarian groups compared to the non vegetarian group. The best way to prevent deficiencies and insufficiencies in vegetarians and partial vegetarians is to take a vitamin D supplement in the recommended dosage.

Ultrasound-guided Greater Auricular Nerve Block versus Intravenous Diclofenac for Postoperative Analgesia in Tympanomastoid Surgery under General Anaesthesia: A Randomised Controlled Trial

Bhavini Shah, Niveditha Kishore Srinivasan, Ibrahim Saleem Mainaparambil, Sakshi Gupta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Tympanomastoid surgery is associated with significant postoperative pain due to extensive soft-tissue and periosteal manipulation. Effective analgesia is needed to enhance recovery and reduce complications. Materials and Methods: This randomised controlled study included 70 patients undergoing tympanomastoid surgery under general anaesthesia. Patients were allocated into two groups: Group G received an ultrasound-guided Greater Auricular Nerve Block (GANB) with 5 mL of 0.25% bupivacaine, and Group C received intravenous diclofenac 75 mg, both interventions were administered before extubation. Postoperative haemodynamic parameters, Visual Analogue Scale (VAS) scores, rescue analgesia requirements, total analgesic consumption, and adverse effects were assessed and compared between groups. Data were analysed using mean±standard deviation, paired and unpaired t-tests for quantitative variables, Chi-square test for qualitative variables, and p<0.05 was considered statistically significant. Results: A total of 70 patients were enrolled, with 35 patients in each group. Demographic variables, including age, gender, Body Mass Index (BMI), and American Society of Anaesthesiologists (ASA) status, were comparable between the groups (p>0.05). Mean postoperative VAS scores were significantly lower in group G compared to group C at all intervals (0 min: 0.40±0.55 vs 1.71±1.20; 30 min: 0.97±1.04 vs 4.20±1.38; 1 h: 1.34±1.10 vs 3.51±1.42; p<0.001). Total rescue analgesia requirement was lower in group G (1.60±1.00 vs 2.94±0.48; p<0.001). Mean MAP at extubation was lower in group G (98.94±3.02 vs 102.14±2.87; p<0.001), indicating better haemodynamic stability. Nausea, vomiting, and headache were more frequent in group C, whereas transient tingling sensations and soreness at the injection site were observed only in group G. Conclusion: Group G demonstrated superior postoperative analgesia, better haemodynamic stability, and lower rescue analgesic requirement compared to group C in patients undergoing tympanomastoid surgery under general anaesthesia. Ultrasound-guided GANB was found to be a safe and effective component of multimodal analgesia with minimal adverse effects.

Impact of an Educational Intervention on Awareness, Knowledge, Preventive Practices, and Risk Perception Regarding Mobile Phone Radiation among Allied Health Sciences Students: A Quasi-experimental Study

Jay Lande, Abhay Saraf, Amita Digambar Dabholkar, Pratap Kaushik Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Mobile phones are in widespread use among students and are therefore an exposure source of Radiofrequency Electromagnetic Radiation (RF-EMR) which has raised concerns about health effects and safety procedures. Although students use cell phones extensively, little or no knowledge exists about radiation exposure, Specific Absorption Rate (SAR), and preventive measures. Educational activities can be used to increase awareness, perceptions and safe mobile phone usage practices. Aim: To assess the impact of an educational intervention on the levels of awareness, knowledge, and risk perception regarding mobile phone radiation among allied health sciences students. Materials and Methods: The present Institutional-based quasi-experimental (pre-post) study design was adopted with a sample of 213 students from Dr. D. Y. Patil School of Allied Health Sciences, Pune, Maharashtra, India between June-July 2025. A validated, self-administered questionnaire of 64 items was used with the aim of assessing awareness, knowledge, perceptions of risk, and preventive practices regarding the hazards of mobile phone radiation. The questionnaire was given pre-intervention and post-intervention. The intervention included an awareness and educational session on mobile phone radiation, its potential health effects, myths and misconceptions, and safety practices. The data collected was analysed using the chi-square statistical test. A p-value of less than 0.05 was considered statistically significant. Results: Improvements in various areas of radiation awareness and safety practices were statistically significant. These areas include an increase in awareness of preventive practices from 132 (62%) to 176 (82.6%), knowledge of methods to check SAR levels from 70 (32.9%) to 165 (77.5%), improvement in the practice of checking their phone’s SAR levels among the students from 62 (29.1%) to 164 (77%), awareness of safe sleeping distance from 119 (55.9%) to 170 (79.8%), and awareness of radiation warning symbols from 91 (42.7%) to 144 (67.6%) (all p<0.001). Improvement in the perception of risks was observed, but belief in the impact of radiation on health did not change (p=0.613). Conclusion: Results show improvements in knowledge, awareness of preventative measures and perception of risk concerning mobile phone radiation following educational intervention among students. While things have certainly gotten better in each area, health effects data appear stagnant for some audiences, reinforcing the need to maintain awareness and educational efforts.

Pattern of Medical Inventory and Methods of Procurement: A Retrospective Study at a Tertiary Care Hospital of Kolkata, West Bengal, India

Manika Pal, M Shashi Kumar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Procurement of medical inventory is a crucial function with its implications on operational efficiency of a healthcare facility. Different modes of procurement are employed for drugs and disposables having diverse demand characteristics in a large hospital to ensure uninterrupted supply to the end-user departments for continuum of care. Aim: To explore the different categories of medical inventories and their modes of procurement at the central medical store in a Government Hospital and Medical College. Materials and Methods: The present retrospective study was conducted on medical inventory in a Medical College located in Kolkata, West Bengal, India. Data abstraction form was formulated and variety of data sources were utilised including those retrieved from the records available on the Hospital Information System for a period of one financial year (April 2025 to March 2026). Data were analysed employing Statistical Package for Social Sciences (SPSS) Version 22 and summarised with descriptive statistics. Results: The study revealed that there were six categories of medical supplies at the central medical store. It was also evident that majority (85.76% of annual pharmaceutical expenditure) of the drugs were procured through Central Rate Contract (CRC). Government e-marketplace was the main mode of procurement for surgical disposables and laboratory consumables. Total procurement on Government e-marketplace was 13.36% of annual pharmaceutical expenditure. A small portion was procured through local purchase from the empaneled vendors in exigency. Conclusion: The stock of drugs and disposables were categorised depending on the inventory regulation technique in central medical store for a meaningful control over the material supplies. While there were four modes of procurement, CRC was the main mode of procurement for the drugs and Government e-marketplace served the principal mode of procurement for surgical disposables and laboratory consumables. This evaluation offers an in-depth perspective on current procurement practices of medical inventory that can design efficiency-enhancing strategies.

Autism Spectrum Disorder among Children Attending a Tertiary Care Centre in Tripura, India: A Cross-sectional Observational Study

Chandana Sundaresh, Sujit Kumar Chakrabarti, Sribas Das, Anita Deb Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by impaired social communication, restricted interests, and repetitive behaviours. Data from low- and middle-income countries, particularly from North East India, remains sparse. Aim: To estimate the burden of ASD and also to describe the sociodemographic and clinical profile of the children with ASD attending a tertiary care hospital in Tripura, India. Materials and Methods: A cross-sectional observational study was conducted in the Outpatient Department (OPD) of Paediatrics at Agartala Government Medical College and GB Panth Hospital, Agartala, Tripura, India, from November 2022 to May 2024. The study included 32 children aged 2-12 years who visited the Paediatrician for social and communication deficits, repetitive behaviours, or developmental delays. Such children were initially screened using the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R) and subsequently confirmed with the INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD). Sociodemographic characteristics, perinatal factors, co-morbid conditions, and lifestyle histories were systematically recorded. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0. Results: Out of 28,252 children attending OPD, 32 (0.11%) were diagnosed with ASD. Male-to-female ratio was 4.3:1. The mean age at diagnosis was 3.59±1.38 years. The majority belonged to Hindu Bengali families and the upper-middle socioeconomic class of the modified Kuppuswamy scale. Common presenting complaints were poor social communication, 19 (59.4%), language delay, 6 (18.8%), repetitive behaviours, 4 (12.5%) and hyperactivity, 3 (9.4%). Antenatal risk factors included Pregnancy Induced Hypertension (PIH), 3 (9.4%), hypothyroidism, 3 (9.4%), and gestational diabetes, 2 (6.3%). Co-morbidities included ADHD in 24 (75.0%), intellectual impairment in 20 (62.5%), sleep disorders in 7 (21.9%), and seizures in 6 (18.8%) cases. Conclusion: The observed burden of ASD was 0.11% among Paediatric OPD attendees of the Department of Paediatrics, with a clear male predominance, and ADHD was the most frequent comorbidity. Integration of routine screening during OPD visits may improve early recognition and intervention.

Comparative Evaluation of Kang and Lee MRI Grading Systems in Cervical Spinal Canal Stenosis with Clinical and Morphometric Correlation: A Cross-sectional Study

Jyotsna Gangera, KV Rajasekhar, S Saravana Kumar, BI Navinkumar, V Yakaiah Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Cervical spinal canal stenosis is a common cause of neurological deficit, and Magnetic Resonance Imaging (MRI) plays a key role in assessing its severity. Qualitative grading systems, such as the Kang and Lee classifications, are widely used, while morphometric indices, such as the Torg-Pavlov ratio, provide objective assessment. However, direct comparative evaluation of these systems with clinical correlation remains limited. Aim: To compare Kang and Lee’s MRI grading systems and evaluate the association of Kang grade with clinical symptoms and the Torg-Pavlov ratio. Materials and Methods: This cross-sectional study included 150 patients who underwent cervical spine MRI at the Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2023 to October 2024. Stenosis severity was graded using the Kang and Lee grading systems. Clinical symptoms, including neck pain, radiculopathy, and myelopathy, were recorded. Canal and vertebral body diameters were measured to calculate the Torg-Pavlov ratio. Agreement between grading systems was assessed using weighted kappa statistics. Associations with clinical symptoms were analysed using the Chi-square test, and correlations with the Torg-Pavlov ratio were assessed using Spearman’s correlation. Results: The mean age of the study population was 54.53±11.46 years, with equal gender distribution. Neck pain was present in 99 patients (66.0%) radiculopathy in 63 (42.0%), and myelopathy in 42 (28.0%). According to Kang grading, Grade 0, 1, 2, and 3 were observed in 19.3%, 27.3%, 25.3%, and 28.0%, respectively, while Lee grading showed 24.7%, 32.0%, 18.0%, and 25.3%. Clinically significant stenosis (Grade ≥2) was present in 53.3% by Kang and 44.0% by Lee grading. Agreement between grading systems was excellent (κ=0.867). Severe stenosis showed significant association with myelopathy (p-value <0.001). The mean Torg-Pavlov demonstrated strong negative correlation with stenosis severity (Kang rho=-0.95, p-value <0.001; Lee rho=-0.92, p-value <0.001). Conclusion: Kang and Lee grading systems demonstrate excellent agreement and significant clinical correlation with myelopathy. The Torg-Pavlov ratio provides a reliable quantitative measure that correlates inversely with stenosis severity, supporting the combined use of qualitative and quantitative MRI assessment in evaluating cervical spinal canal stenosis.

Rapid Diagnosis of Rhino-Orbito-cerebral Mucormycosis by Double-concentration Method using Cytospin: A Cross-sectional Study

Akanksha Agrawal, Tanvi Jha, Preeti Diwaker, Vinod Kumar Arora Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Rhino-Orbito-Cerebral Mucormycosis (ROCM) is an opportunistic, aggressive and rapidly progressive infection requiring early diagnosis and treatment. Potassium Hydroxide (KOH)-mount preparations aid in this, however, sometimes diagnosis is elusive. Biopsy and culture are gold-standards but time consuming. Cytology may, thus, be an important alternative for rapid and definitive diagnosis. The present study proposes a double concentration technique for the same. Aim: The study was aimed to assess diagnostic accuracy of cytopathology, compare it with KOH mount and characterise tissue reactions in ROCM. Materials and Methods: The current cross-sectional study was done in the Cytopathology section of Department of Pathology, UCMS and GTB Hospital, a tertiary care and dedicated Coronavirus Disease 2019 (COVID-19) hospital in New Delhi, India from May to July 2021. Samples (nasal crusts/ scrapings, orbital tissue aspirates and drained pus) from 47 cases of suspected ROCM sent for cytology were included. Double-concentration method was used to prepare the smears from all samples; however, an additional step of crushing was used for nasal crust/scrapings prior to concentration. Smears were stained with May-Grünwald Giemsa (MGG) and Papanicolaou (PAP) stains. Periodic Acid-Schiff (PAS) stain was used for confirmation of mucormycosis. The parameters studied included identification of fungal hyphae and associated tissue reaction patterns. A comparison with KOH mount and histopathology was done. Histopathology was taken as gold standard for the calculations diagnostic accuracy parameters. Results: Among 47 suspected ROCM cases, the double-concentration cytospin technique yielded cytological evidence of mucormycosis in 11/47 (23.4%) cases (broad, pauciseptate hyphae with right-angle branching). Two of 11 (18.2%) cytology-positive cases were inconclusive on KOH mount. Tissue reaction patterns such as acute inflammatory exudate, foreign-body giant-cell reaction and fat necrosis were noted. With histopathology as the gold standard, the double-concentration cytology technique showed sensitivity of 50%. Conclusion: Double-concentration method can be used as a fast effective method for detection of mucormycosis on cytology especially in cases of doubt where cross confirmation is required. It is a rapid and diagnostically method, providing same day results with high specificity and optimal sample utilisation for identifying fungal hyphae and the type of tissue reactions associated with ROCM.

Association between CTLA-4 Immunohistochemical Expression and Histopathological Parameters in Colorectal Carcinoma: An Ambispective Cross-sectional Study

Sahad Saleena Suhaib, M Shanmugapriya, V Eswari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Colorectal cancer is one of the most common invasive malignancies worldwide and contributes significantly to cancer-related morbidity and mortality. Recent advances in cancer immunology have highlighted the importance of immune checkpoint molecules in tumour progression and immune evasion. Cytotoxic T-Lymphocyte–associated Antigen-4 (CTLA-4) is an important immune regulatory molecule that inhibits T-cell activation by binding to B7 ligands and suppressing cytokine production. Its expression has been investigated as a potential biomarker for tumour-immunosurveillance and as a therapeutic target in several malignancies. However, limited data are available on CTLA-4 expression in colorectal carcinoma in the Indian population. Aim: To evaluate the immunohistochemical expression of CTLA-4 in colorectal carcinoma and analyse its association with histopathological grade and clinicopathological characteristics. Materials and Methods: This ambispective study was conducted at the Department of Pathology, Tertiary Care Centre of Meenakshi Medical College, Hospital and Research Institute, Kanchipuram, Tamil Nadu, India, over one year, from January 2023 to January 2024. A total of 50 histologically confirmed cases of colorectal carcinoma were included, comprising 12 biopsy specimens and 38 resected specimens. Formalin-fixed, paraffin-embedded tissue blocks were processed and stained with Haematoxylin and Eosin (H&E) for histopathological evaluation. Immunohistochemistry was performed using a mouse monoclonal anti-CTLA-4 antibody, and staining intensity was graded from 1+ (negative) to 4+ (strong positive). Statistical analysis was carried out using IBM Statistical Package for Social Sciences (SPSS) version 22.0, and associations between CTLA-4 expression and tumour grade were assessed using the chi-square test with a significance level of p-value<0.05. Results: Most patients belonged to the 50–59 years (14/50, 28%) and 60–69 years (14/50, 28%) age groups, with a male predominance (31/50, 62%). Adenocarcinoma was the most common histopathological subtype (47/50, 94%), and the majority of tumours were well-differentiated (32/50, 64%). Among resected specimens, T3 stage tumours were the most frequent (21/38, 55.3%). CTLA-4 expression demonstrated 1+ intensity in 33/50 cases (66%), 2+ intensity in 8/50 cases (16%), and 3+ intensity in 9/50 cases (18%), while no cases showed 4+ intensity. The association between histopathological grading of colorectal carcinoma and CTLA-4 expression intensity was found to be statistically significant (χ²=32.36, p <0.001), with increased expression observed in higher-grade tumours. Increased CTLA-4 expression (2+ and 3+ intensity) was more frequently observed in moderately and poorly differentiated tumours compared to well-differentiated tumours. Conclusion: The study demonstrates that CTLA-4 expression increases with higher tumour grade in colorectal carcinoma, suggesting its potential role as a prognostic immunological marker. These findings also support the possible therapeutic relevance of CTLA-4–targeted immunotherapy in colorectal cancer, although further large-scale studies are required to validate its clinical utility.

Knowledge, Attitude and Perception of Medical Students about Consanguineous Marriages and Associated Patterns of Genetic Diseases in Arar, Saudi Arabia: A Descriptive Cross-sectional Survey

Mohamed M Abd El Mawgod, Naglaa Mokhtar, Anshoo Agarwal, Faisal Saud M Alanazi, Rashed Atha M Alruwaili, Abdulrahman Radhi H Alruwaili, Nasser Hamoud K Alanazi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Consanguineous Marriage (CONM) is a well-recognised contributor to Genetic Diseases (GD) and adverse reproductive outcomes, particularly in Saudi Arabia where CONM prevalence is high. Understanding medical students’ knowledge, attitudes, and perceptions toward CONM and GD is critical for shaping future clinical practice in this context. Aim: To evaluate the knowledge, attitudes, and perceptions regarding CONM and GD among medical students at Northern Border University (NBU), Arar, Saudi Arabia. Materials and Methods: The present descriptive cross-sectional survey was conducted between January and July 2024 among medical students at the College of Medicine, Northern Border University (NBU). A structured, self-administered questionnaire comprising 23 items across four domains (sociodemographic data, consanguinity and family history, knowledge of CONM-related consequences, and knowledge of GD risk factors) was used. Results: A total of 233 students participated {mean age 21.6±1.8 years; 132/233 (56.7%) males}. Two-thirds reported CONM as prevalent in Saudi Arabia 153/233 (65.7%). Nearly, all recognised its association with GD 224/233, (96.1%) and were aware of Premarital Screening (PMS) services 222/233 (95.3%). Fewer than half had received formal information about CONM 112/233 (48.1%), while more than half expressed a need for further training in genetic counselling 128/233 (54.9%). Conclusion: Medical students at NBU demonstrated strong awareness of CONM prevalence and its link to GD, alongside widespread recognition of Premarital Screening (PMS) services. Nonetheless, critical gaps remain in quantitative genetic risk assessment, particularly in recurrence-risk estimation and distinguishing chromosomal from monogenic disorders. The findings highlight an urgent need for targeted curricular revision integrating Mendelian inheritance, recurrence-risk calculation, and genetic counselling skills to better prepare future clinicians for practice in high-consanguinity populations.

Correlation of Serum Surfactant Protein-B with Lung Function and Diffusion Abnormalities in Chronic Obstructive Pulmonary Disease: A Case-control Study

Saurav Suresh, Keertivardhan D Kulkarni Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Spirometry remains the cornerstone for the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD). However, it may not fully reflect the underlying structural lung injury, particularly in early disease and in older individuals. Surfactant Protein-B (SP-B) is a lung-specific molecule of particular interest, although its relationship with pulmonary function impairment in COPD is not well established. Aim: To evaluate the correlation of serum SP-B levels with pulmonary function parameters and diffusion abnormalities in patients with COPD and to compare these findings with age-matched healthy controls. Materials and Methods: This case-control study conducted in the Department of Respiratory Medicine, Shri B. M. Patil Medical College, Vijayapura, Karnataka, India. The study included 70 participants- 35 COPD patients and 35 age-matched healthy controls. Individuals over 50 years of age with either a smoking index greater than 10 pack-years or biomass exposure index above 30 were enrolled in the study. All participants underwent spirometry with Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) assessment as per American Thoracic Society (ATS) and European Respiratory Society (ERS) 2022 standards. Venous blood samples were collected, centrifuged and stored at -80°C and plasma SP-B levels were measured using a Human SP-B Sandwich ELISA Kit (AQTE01771, Aliquot Biotech). Parameters studied included COPD Assessment Test (CAT), modified Medical Research Council (mMRC) score, Forced Expiratory Volume in 1 second (FEV1%) predicted, post-bronchodilator FEV1/FVC ratio, FEV1 and FVC z-scores, DLCO, KCO (Carbon Monoxide Transfer Coefficient) and plasma SP-B levels. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0, with p-value <0.05 considered statistically significant. Results: A total of 70 participants were included in the study, comprising 35 COPD cases and 35 age-matched controls. The COPD group consisted of 26 males and nine females with a mean age of 66.31±6.45 years, while controls included 23 males and 12 females with a mean age of 64.34±7.03 years. Mean serum SP-B levels were significantly higher in COPD cases compared to controls (3.00±0.58 ng/mL vs 1.79±0.63 ng/mL). COPD patients demonstrated significantly lower mean FEV1% predicted (42.97±12.18 vs 75.55±15.35), FVC % predicted (59.57±11.41 vs 74.31±14.18), post-bronchodilator FEV1/FVC ratio (54.28±10.60 vs 78.14±6.11), and DLCO values (13.47±4.99 vs 16.13±5.79) compared to controls. Serum SP-B levels showed significant inverse correlations with FEV1 % predicted, FVC % predicted, corresponding z-scores, and FEV1/FVC ratio. Conclusion: Serum SP-B is significantly elevated in COPD patients and demonstrated an inverse relationship with lung function parameters. SP-B shows considerable promise as a biomarker reflecting physiological impairment and alveolar injury in COPD patients.

Evaluation of Electromagnetic Interference from Smartphones on Working Length Determination using an Electronic Apex Locator: An In-vitro Study

Pooja Atul Kulkarni, Ashwini Gaikwad, Rajlaxmi Patil, Aishwarya Handa, Mrunal Shinde Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: With advancements in technology, in endodontics, the adoption of Electronic Apex Locators (EALs) has risen as they provide greater accuracy while lowering radiation exposure. Many devices, including smartphones, emit Radiofrequency (RF) waves through fixed antennas, creating Electromagnetic Fields (EMF) that may cause Electromagnetic Interference (EMI). Such interference has the potential to affect circuits within EALs, possibly impacting their accuracy during Working Length (WL) determination. Evaluating this interference in an in-vitro model helps determine whether routine smartphone use can affect WL determination and potentially influence endodontic treatment outcomes. Aim: To assess the effect of smartphones on performance of EALs in determining WL. Materials and Methods: The present in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics in the Bharati Vidyapeeth Dental College, Pune, Maharashtra, India, through the span of three months from July to September 2024. Extracted intact single canal single rooted mandibular premolars with mature apex were primarily included. A total of 180 teeth were decoronated to standardise a length of 14 mm and provide a stable reference point. Actual Working Length (AWL) was established with a K-file of size 10 into each canal. Each tooth was mounted in a plastic bottle filled with normal saline to simulate periodontium-like conductivity, and to complete the circuit EAL’s lip clip was inserted into the bottle as well. Samples were partitioned into five groups: Group 1: Control (no smartphone present), Group 2: Smartphone in close proximity, no mode activated, Group 3: Smartphone at 35 cm, no mode activated, Group 4: Smartphone in close proximity with bluetooth, mobile data, Wi-Fi, and calling modes activated, Group 5: Smartphone at 35 cm with all modes activated. Data normality was confirmed using the Shapiro-Wilk test (p>0.05). For intergroup comparisons, One-way Analysis of Variance (ANOVA) was utilised. Results with p-values below 0.05 were deemed statistically significant. Results: Descriptive analysis of WL measured using a fifth-generation EAL revealed the lowest mean values in Group 3 (12.98±0.60), followed by Group 4 (13.05±0.58) and Group 5 (13.06±0.58), while the highest mean WL was observed in Group 1 (13.26±0.49) and Group 2 (13.18±0.49). Intergroup comparison using one-way ANOVA showed no statistically significant differences in WL among the five groups (p>0.05). Tukey’s post-hoc analysis further confirmed the absence of significant pairwise differences between groups. Conclusion: The results of the present in-vitro study suggests that smartphones, whether active or inactive and regardless of distance, do not interfere with EAL performance. Thus, smartphones may be safely used in dental operatories without concern for EMI affecting WL accuracy.

Evaluating Elevated D-Dimer Levels Associated Clinical Conditions in Hospitalised Patients: A Cross-sectional Study

Chitrawati Gargade, Prakash Jadhav, Siddhi Shirdhankar, Vijay Dombale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: D-dimer is widely used to exclude Venous Thromboembolism (VTE) and to support the diagnosis of Disseminated Intravascular Coagulation (DIC). However, Elevated plasma D-dimer levels are not specific to thromboembolic disorders and may be observed in several non-thrombotic conditions such as infections, malignancies, inflammatory disorders, trauma, and postoperative states. This broad range of associated conditions complicates the interpretation of D-dimer results, particularly in resource-limited rural settings where the burden of infectious and inflammatory diseases is relatively high. Aim: To study the clinical conditions associated with elevated plasma D-dimer levels in hospitalised patients. Materials and Methods: The present cross-sectional, retrospective, laboratory database-based study was conducted in the Department of Pathology at a rural tertiary-care medical college in Western Maharashtra, India, from 1^st October 2023 to 30?Sup?th September 2024. Patients were selected from the Laboratory Information System (LIS) database based on records of quantitative plasma D-dimer testing performed during the study period. All consecutive hospitalised patients with at least one D-dimer value greater than 250 μg/L D-dimer Units (DDU), which represents the upper reference limit in the study laboratory, were included in the study. Demographic details, final clinical diagnosis, and selected laboratory parameters including Haemoglobin (Hb), Total Leukocyte Count (TLC), platelet count, Prothrombin Time/International Normalised Ratio (PT/INR), Activated Partial Thromboplastin Time (APTT), C-Reactive Protein (CRP), and other available laboratory investigations were retrieved from hospital records. Data were analysed using descriptive statistics. Results: Among 349 D-dimer tests, 247 were >250 μg/L DDU. After excluding duplicate tests (n=6) and cases with insufficient clinical information (n=6), 235 patients were analysed (139 males, 59.1%; 96 females, 40.9%). D-dimer values ranged from 255 to 75,860 μg/L DDU (mean 2,604.3 μg/L). The commonest cause was dengue (133/235, 56.6%), comprising 129 NS1 antigen-positive and 4 IgM-positive cases. Cardiovascular disorders {Myocardial infarction, Atrial Fibrillation, post Coronary artery bypass graft surgery (CABG)} constituted 28/235 (11.9%), followed by sepsis (16/235, 6.8%) and thromboembolic conditions (12/235, 5.1%). Other causes included Acute Respiratory Distress Syndrome (ARDS), fracture/osteomyelitis, pregnancy-related conditions, malignancy, snakebite and acute febrile illness. Overall mortality was 35/235 (14.9%) and was predominantly seen in patients with moderate-to-severe D-dimer elevation. Conclusion: In the current rural hospital cohort, elevated D-dimer levels were most frequently associated with infectious conditions particularly dengue followed by cardiovascular disorders and sepsis, whereas confirmed thromboembolic events represented a small proportion of cases. Extremely high values were observed in severe systemic illnesses such as sepsis and snakebite and were associated with poorer outcomes. These findings suggest that, in tropical rural settings, elevated D-dimer often reflects infection-related coagulation activation rather than isolated thromboembolism. Clinical interpretation should therefore be guided by the underlying disease context.

Antipsychotic-induced Side-effects among Indian Patients: A Prospective Observational Study

Nisheet Patel, Lakhan Kataria, Akansha Jain, Dhatri Sarvaiya, Prajesh Kalathiya, Devashish Palkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Antipsychotic drugs are an effective treatment for most psychotic disorders. Nevertheless, patients’ quality of life, adherence, and clinical results may be negatively impacted by these medications’ incapacitating side-effects. Aim: To assess the prevalence, severity, and progression of antipsychotic side-effects in treatment-naive Indian patients using standard scales. Materials and Methods: The present prospective observational study was conducted in the Psychiatry Department of Dhiraj hospital, Vadodara, Gujarat, India, from October 2023 to March 2025 included 332 treatment-naive patients Glasgow Antipsychotic Side-effect Scale (GASS), Modified Simpson Angus Scale (MSAS), Abnormal Involuntary Movement Scale (AIMS), and Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) were applied to measure side-effects at baseline, one month, and three months. Serial measurements were also made of weight, Body Mass Index (BMI), glucose, and lipid profile. Statistical tests such as Analysis of Variance (ANOVA) and Kruskal-Wallis with Dunn post hoc analysis were used, and p<0.05 was considered statistically significant. Results: Among the 332 treatment-naive patients {197 (59.3%) females; 135 (40.7%) males} with a mean age of 34.7±10.2 years, 194 (58.5%), 101 (30.4 %), and 37 (11.2%) were treated with monotherapy, two and three-drug combinations, respectively. A total of 199 (60%) patients had weight gain, 166 (50%) sedation, and 149 (45%) Extrapyramidal Symptoms (EPS). At three months, GASS score significantly increased from 0.0 to 13.0 (p<0.0001). Cholesterol levels rose from 150.2 mg/dL to 173.5 mg/dL (p<0.0001). The clozapine-amisulpride combination demonstrated the most profound movement abnormalities and metabolic issues. Older age (r=0.34, p=0.001) and long duration of illness (r=0.28, p=0.003) showed a weak positive correlation with GASS scores. Conclusion: Antipsychotic medications appear to have very significant side-effects, which underline the importance of frequent individualised monitoring and routine tailored strategies to decrease risks while maintaining efficacy. The most frequently observed side-effects were sexual dysfunction, weight gain, sedation, and EPSs. These findings highlight the need for early, structured monitoring of side-effects and cautious use of antipsychotic polypharmacy in routine clinical practice.

Evaluation of Huperzine A Concentration-dependent Antimicrobial and Antibiofilm Activity against Streptococcus mutans and Candida glabrata: An In-vitro Study

M Tejas, S Ramya, Nidarsan Viswanathan, Kavitha Ramasamy Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Antimicrobial Resistance (AMR) is a growing global public health crisis, with biofilmforming microorganisms demonstrating significantly enhanced resistance to conventional antimicrobial agents. Biofilm-associated infections are notoriously difficult to eradicate and contribute to persistent, recurrent, and chronic infectious diseases. Repurposing drugs with established safety pro-files represents a viable and cost-effective strategy for developing novel antimicrobial therapies. Hu-perzine A, a natural alkaloid derived from Huperzia serrata, is primarily known for its Acetylcholinesterase (AChE) inhibitory activity but has been increasingly investigated for repurposed antimicrobial applications. Aim: To evaluate the concentration-dependent antimicrobial and antibiofilm activity of Huperzine A against selected bacterial and fungal pathogens, with particular focus on Streptococcus mutans and Candida glabrata. Materials and Methods: This in-vitro experimental study was conducted at the Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from June 2025 to November 2025. Six standard microbial strains were included as the study sample: Escherichia coli, Streptococcus mutans, Candida glabrata, Candida albicans, Pseudomonas aeruginosa, and Staphylococcus aureus. Antimicrobial activity was assessed using the agar well diffusion method to determine the Zone Of Inhibition (ZOI) and the broth microdilution method to determine the Minimum Inhibitory Concentration (MIC). Biofilm inhibition was evaluated using Crystal Violet (CV) staining for biomass quantification and the MTT assay to measure metabolic activity of biofilm cells. Structural and viability changes in biofilms were further examined using Confocal Laser Scanning Microscopy (CLSM) and Colony-Forming Unit (CFU) enumeration. Statistical analysis was per-formed using One-way Analysis of Variance (ANOVA) followed by Tukey’s multiple comparisons test; a p-value of <0.05 was considered statistically significant. Results: Huperzine A demonstrated measurable antimicrobial activity against all tested microorganisms. The highest inhibition was observed for Candida glabrata (17±1.2 mm) and Streptococcus mutans (13±0.8 mm) at 100 μg/mL. Corresponding MIC values were 145 μg/mL and 190 μg/mL, respectively. Biofilm assays revealed strong concentration-dependent inhibition, with up to 97% reduction in biofilm biomass for S. mutans and 96% for C. glabrata at 5× MIC. MTT assays demonstrated a marked decrease in metabolic activity, reducing cell viability to less than 10% compared to untreated controls. Conclusion: Huperzine A demonstrated notable antimicrobial and antibiofilm activity against Streptococcus mutans and Candida glabrata. The compound effectively disrupts biofilm structure and reduces microbial viability in a concentration-dependent manner.

Outcomes of Post-pancreatic Enzyme Replacement Therapy in Patients of Pancreatic Exocrine Insufficiency: A Prospective Observational Study

Somya Goel, Raju K Shinde, Pooja Batra, Khusbu Vaidya, Ashish Jivani Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Exocrine pancreatic insufficiency is a significant clinical condition with underlying multifactorial aetiologies. Pancreatic Enzyme Replacement Therapy (PERT) is helpful in improving certain clinical conditions such as chronic pancreatitis, exocrine pancreatic insufficiency and others. Aim: To analyse post-PERT outcomes in exocrine pancreatic insufficiency. Materials and Methods: The present prospective observational study was conducted in the Department of Surgery at Datta Meghe Institute of Higher Education and Research Centre, Wardha, Maharashtra, India from July 2023 to May 2025. Patients of >18 years, diagnosed with exocrine pancreatic insufficiency with acute exacerbation via clinical assessment and Modified Computed Tomography Severity Index (MCTSI) score were included. Quality of Life (QoL) was recorded along with VAS for pain and weight when on medication. The PERT was initiated 3 times/day for 15 days. The patients were evaluated for symptomatic and QoL improvements based on weight, pain scale at baseline, day 7 and day 15. Results: A total of 53 patients were enrolled in the study. The mean age of the study cohort was 36±10.187 years with 52.8% patients between 31 to 40 years and predominantly males. The results showed statistically significant improvement in pre-versus post-treatment in QoL (32.92±11.662 vs 52.58±12.073), vomiting (22/41.5% vs 6/11.3%), pain (53/100% vs 19/35.8%), sticky stools (33/62.3% vs 11/20.8%) and bloating sensation (30/56.6% vs 13/24.5%). Conclusion: The PERT can effectively improve the symptoms in patients of exocrine pancreatic insufficiency.

Examining the Efficacy of Pilates in Women with Breast Cancer Undergoing Hormonal Treatment: A Systematic Review

Jasleen Kaur Grover, Nitin Bhardwaj, Kriti Arya, Akshat Sehgal, Shashank Malhotra, Sandeep Pattnaik Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Approximately 70% to 80% of breast cancers are hormone receptor-positive, and hormonal therapy is an important pillar in their treatment. Nevertheless, any cancer itself as well as the treatment with hormonal therapy is frequently related to physical and psychological side-effects that compromise quality of life. Pilates, a mind-body exercise therapy, has emerged as a possible supportive intervention to counteract these complications. Aim: To assess the efficacy of Pilates in enhancing physical function, symptom control, and psychological well-being in breast cancer patients treated with hormonal therapy. Materials and Methods: A systematic review was conducted based on the recommendations by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Moreover, the pro-tocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024568245). Scholarly databases and search engine; PubMed, Cochraine library, Physiotherapy evidence database (PEDro) and Google Scholar were extensively searched for Randomised Controlled/Clinical Trials (RCTs) published between January 2018 and December 2024. Studies that enrolled women (≥18 years) with stage 0-III breast cancer receiving hormonal therapy and undergoing a Pilates-based intervention were included. Data extraction and quality assessment were independently done by two reviewers. The PEDro scale and Cochrane Risk of Bias tool (RoB 2) were employed to evaluate methodological quality. Results: Five RCTs were found to meet the inclusion criteria among the 2,852 articles identified. Pilates interventions differed in format and duration across the included studies. Methodological quality was fair to good, with PEDro scores of 5 to 7. Most of the studies demonstrated a low RoB; however, a few presented some concerns related to outcome measurement and participant adherence. Conclusion: Pilates seems to be a useful adjunctive intervention for enhancing physical outcomes and managing fatigue in patients with breast cancer receiving hormonal therapy. Its psychological benefits, however, continue to lack conclusive evidence.

Comparative Evaluation of Surface Roughness and Gloss of Nanohybrid Composite Resins after Tooth Brushing: An In-vitro Study

Poulomi Guha, Nishitha Arun, Pradeep Solete Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The clinical longevity and aesthetics of composite restorations depend on surface smoothness and gloss, properties influenced by filler characteristics and altered by routine tooth brushing. Comparative data on how contemporary nanohybrid composites resist toothbrush abrasion are limited. Aim: To compare surface roughness and gloss before and after simulated tooth brushing among Ivoclar Tetric N-Ceram, Dentsply Spectrum, and 3M Filtek Z250. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, from August 2024 to September 2024. Thirty standardised nanohybrid composite discs (n=10 per material) were fabricated using prefabricated moulds (10 mm diameter×2 mm thickness). The samples were divided into three groups of 10 samples each as Group A (n=10): Ivoclar Tetric N Ceram (Ivoclar Vivadent, Switzerland) Group B (n=10): Dentsply Spectrum (Dentsply, India), Group C (n=10): 3M Filtek Z250 (3M, India). Only defect-free specimens without voids, cracks, or surface irregularities were included. Specimens were finished and polished using the Shofu Super-Snap polishing system following the manufacturer’s protocol. Baseline surface roughness (Ra, μm) was measured using a Mitutoyo SJ-310 profilometer, and gloss (GU) was assessed using a 60° glossmeter. Specimens were subjected to 20,000 brushing cycles in a motorised tooth brushing simulator under a constant load of 2 N, using a toothpaste-water slurry (1:2). Post-abrasion surface roughness and gloss measurements were recorded. Paired t-tests were used for intra-group comparisons, and One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test was applied for intergroup comparisons. Statistical significance was set at p<0.05. Results: All materials showed increased surface roughness and reduced gloss after simulated tooth brushing (p<0.001). Significant intergroup differences were observed in post-brushing roughness and gloss (ANOVA, p<0.001). Dentsply Spectrum exhibited significantly lower surface roughness than Ivoclar Tetric N Ceram and 3M Filtek Z250, while 3M Filtek Z250 showed significantly lower gloss values than Ivoclar Tetric N Ceram and Dentsply Spectrum. No significant differences were observed between Ivoclar Tetric N Ceram and 3M Filtek Z250 for roughness or between Ivoclar Tetric N Ceram and Dentsply Spectrum for gloss. Conclusion: Simulated tooth brushing adversely affected the surface and optical properties of all tested nanohybrid composites. Dentsply Spectrum demonstrated superior resistance to surface roughening, whereas 3M Filtek Z250 showed lower gloss retention than Dentsply Spectrum and Ivoclar Tetric N-Ceram. These differences may influence material selection when long-term esthetic performance is a priority.

Association of Serum Uric Acid Levels with Severity of Knee Osteoarthritis: A Cross-sectional Study

Sandeep Singh Jaura, Paarth Gautam, Punit Tiwari, Abhishek Pathania Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Osteoarthritis (OA) of the knee is a common degenerative joint disorder and a leading cause of chronic pain, stiffness and disability among middle-aged and elderly individuals. Serum Uric Acid (SUA) has been suggested as a potential metabolic factor associated with OA severity. Aim: To evaluate the association between SUA levels and the severity of knee OA and to assess their relationship with pain intensity and functional status. Materials and Methods: This cross-sectional observational study was conducted in the Department of Orthopaedics, Maharishi Markandeshwar (MM) Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India, over a period of 18 months (January 2023 to June 2024). A total of 100 patients aged 40-70 years with clinically and radiologically confirmed OA of the knee were included. SUA levels were categorised as normal (<6 mg/dL), moderately elevated (6-8 mg/dL) and high (>8 mg/dL). Pain severity was assessed using the Visual Analogue Scale (VAS), functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiological severity using the Kellgren-Lawrence (KL) grading system. Statistical analysis was performed using Stata version 17.0. Associations between variables were assessed using the Pearson’s Chi-square test, Analysis of Variance (ANOVA), while correlation analysis was performed to evaluate the relationship between SUA levels and WOMAC scores. A p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 57.65±5.65 years, with an age range of 48-68 years. Among the 100 participants, 37% had normal SUA levels, 35% had moderately elevated levels and 28% had high SUA levels. A significant association was observed between SUA levels and radiological severity of OA based on KL grading (χ2=26.21, p=0.006). Higher SUA levels were also significantly associated with greater pain severity on the VAS scale (χ2=16.15, p=0.013). Mean WOMAC scores increased progressively with rising SUA levels and a strong positive correlation was observed between SUA levels and total WOMAC score (r=0.67, p<0.001). Conclusion: Elevated SUA levels are significantly associated with greater radiological severity, increased pain intensity and poorer functional status in patients with knee OA.

Blood Glucose Level and Risk Factor Affecting Glucose Homeostasis in Premature Newborns: A Retrospective Study

Jwan Ibrahim Jawzali, Amanj Zrar Hassan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Neonatal blood glucose levels are affected by pregnancy outcomes. Preterm infants are more prone to hypo- and hyperglycaemia compared to full-term newborns. Understanding glucose fluctuation in these infants is important for improving early diagnostic accuracy and neonatal survival rate. Aim: To explore the glucose levels and risk factors affecting glucose homeostasis among premature neonates. Materials and Methods: A retrospective study was conducted from January 1 to March 31, 2017, at the Maternity Teaching Hospital affiliated with Hawler Medical University in Erbil city, Iraq. A total of 212 preterm newborns treated in the Neonatal Intensive Care Unit (NICU) were included. Information concerning premature neonates (glucose status, birth weight, and health status) of 24-hour-old newborns and maternal data (ages and gestation) were collected. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) software; methods used are descriptive statistics and inferential tests. Results: Mean maternal age was 26.7±6.9 years and 113 (53.3%) of women were in young age (20-29 years). A total of 179 (84.4%) of the neonates had normal random blood glucose levels. Highest percentage of maternal 139 (65.6%) were in the group of 33 to 36 weeks of Gestational Age (GA). More than half 135 of premature newborns (63.7%), were in Low Birth Weight (LBW) group. Negative significant correlation found between random blood glucose with GA (unstandardised coefficient β= -1.3; 95% CI: -2.5 to -0.196) and with birth weight of newborns unstandardised coefficient β=-8.5; 95% CI: -14.3 to -2.7). Apgar moderate scores of 4-6 at five minutes increased with increase random blood glucose levels. While Apgar good 7-10 scores group at 10 minutes inversely associated with random blood glucose, (r=-0.196, p-value=0.021). Conclusion: Most neonates demonstrated normal blood glucose levels. However, lower GA and birth weight were associated with a higher level of glucose, likely due to physiological stress and metabolic immaturity. This may be reflected in Apgar scores, as these infants require more time to adapt to extrauterine life.

Significance of Systemic Inflammation and Inflammation Response Index in Oral Squamous Cell Carcinoma: A Cross-sectional Study

Dheeraj Kumar, Kalyani Raju Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Among novel markers, the most recently developed are the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI). SII and SIRI are composite inflammatory indices derived from different blood cell populations: SII incorporates platelets, neutrophils, and lymphocytes, while SIRI incorporates neutrophils, monocytes, and lymphocytes , and were shown to be independent predictors of overall survival in patients with lung, breast, oesophageal and urologic cancers. The objective was to determine the utility of common inflammatory markers such as SII and SIRI in Oral Squamous Cell Carcinoma (OSCC). Aim: To establish role of SII and SIRI in OSCC and its significance as prognostic marker in OSCC taking into consideration of grade and stage of disease. Materials and Methods: The current cross-sectional analytical study was conducted in a tertiary health centre, R L Jalappa Hospital, Department of Pathology at Devaraj Urs Medical College, Tamaka, Karnataka, India utilising case files of OSCC patients received between January 2023 and December 2023 with data included from same period of time to estimate the SII and SIRI in OSCC and its association with grade and stage of disease. The data was compiled and results were analysed using Microsoft Statistical Package for the Social Sciences (SPSS) software 2022 after entering all the data on a spread sheet in October 2024. Descriptive statistics and Fisher’s exact test were applied as appropriate. Results: With age group of 30 years to 90 years, with a mean age group of 60 years± comprising males 33 (66%) and females 17(34%). The SII showed statistically significant association with grade (p=0.0013), of OSCC. The association of SII with stage (p=0.586) and SIRI with grade (p=1.001) and stage (p=0.79) respectively did not show statistically significant association. Majority of OSCC showed high SII and SIRI values. Conclusion: The SII and SIRI as prognostic markers have not been established in OSCC. Although SII has shown a significance with grade of disease in the present study which can be used as a prognostic marker and outcome of the disease. But its significance with stage of disease was not stabilised. On other hand SIRI showed no significance with either grade or stage of the disease. Minimal cut-off value of SII and SIRI also needs to be validated so both parameters can be used as prognostic factors in OSCC.

Comparative Evaluation of Healing Outcomes, Surgical Time and Scar Tissue Formation in Paralleling versus Conventional Frenectomy Techniques: A Randomised Controlled Trial

Netra Shah, Monali Shah, Jinal Patil, Ruchi Raval, Jasuma Rai Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: High Maxillary Labial Frenum (HMLF) attachment is associated with midline diastema, gingival recession, compromised oral hygiene, and aesthetic concerns. Frenectomy is the treatment of choice, and various techniques have been proposed to improve outcomes. The conventional method involves substantial tissue excision, resulting in scar formation and patient discomfort. Therefore, there is a need to explore and evaluate alternative surgical techniques that minimise tissue trauma while improving healing outcomes and reducing postoperative morbidity. Aim: To evaluate and compare the healing response, surgical time and scar formation between the paralleling and Conventional frenectomy techniques. Materials and Methods: The present randomised controlled clinical trial with a parallel-group study design was conducted in the Department of Periodontology at KM Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara over 10 months from June 2024 to March 2025 on 52 patients presenting with papillary or papilla-penetrating frenum attachments. The participants were randomly allocated into two equal groups: Group A, treated using the paralleling technique, and Group B, treated using the conventional technique. Total procedural time from incision to completion of suturing was recorded intraoperatively using a stopwatch. Clinical outcomes, including the Healing Index (HI) and Mucosal Scarring Index (MSI) were assessed at one week and one month, postoperatively. The data on clinical parameters collected at one week and one month were analysed using the statistical software IBM Statistical Package for the Social Sciences (SPSS) 16.0 (IBM Inc., Chicago). Wilcoxon signed-rank test were used for intragroup comparison intergroup comparison p-value of <0.05 is considered statistically significant. Results: Group A demonstrated significantly superior healing outcomes, lower scarring, and shorter operative times compared to Group B (p<0.001). At one month, the paralleling technique achieved higher HI scores (4.76±0.44) and lower MSI values than the Conventional method (0.53±0.51). The mean surgical duration was shorter in Group A (17.88±2.11 minutes) compared to Group B (22.69±2.19 minutes). Conclusion: The paralleling technique provides enhanced healing, minimal scar formation, and reduced surgical time, making it a more efficient and aesthetically favourable option for managing aberrant maxillary labial frenum attachments.

Impact of Caesarean Audit on Caesarean Section Rates using Robson classification: A Retrospective Observational Study

Azhini Arjunan, S Swathi, KP Mohana Sundari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The World Health Organisation (WHO) recommends an optimal caesarean section rate of no more than 15%. A caesarean audit can identify the changing trends in caesarean section indications and reduce the rates by improving obstetric care. Aim: To evaluate the impact of a caesarean section audit on the caesarean section rate by comparing pre-audit and post-audit periods. Materials and Methods: The present retrospective observational study analysed 2698 pregnant women who gave birth between October 2023 and February 2024 at Government Medical College, Tiruppur. Pregnant women who delivered from 1^st October 2023 to 31^st December 2023 were enrolled as the pre-audit group (n=1698), and those who delivered from 1^st January 2024 to 29^th February 2024 were enrolled as the post-audit group (n=1000) as we started doing caesarean audit from 1^st January 2024. The caesarean section rate was compared between groups by using Robson’s 10 group classification system. Results: The overall caesarean section rate (872 (51.4%) vs 429 (42.9%), p-value <0.001) showed a significant reduction in the post-audit period. The caesarean section rate in group 2a, which represents primary caesarean section {298 (34.2%) vs 98 (22.8%)} was also significantly lower in the post- audit group compared to the pre-audit group. There was one maternal death in the pre-audit group and one in the post-audit group {1(0.0005% vs 1(0.001%) p=1.0}. Neonatal deaths were 10 in the pre-audit period and three in the post-audit period {10(0.005% vs 3 (0.003%) p=0.39}. Conclusion: Caesarean audit appears to be an effective strategy for reducing the overall caesarean section rate and primary caesarean section rates.

Effectiveness of Buerger-Allen Exercise on Lower Extremity Perfusion and Peripheral Neuropathy Symptoms among Patients with Type 2 Diabetes Mellitus: A Quasi-experimental Study from Puducherry, India

Sangavi Govindarajan, Punitha Josephine Santhanasamy Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic condition frequently associated with poor circulation and peripheral neuropathy, leading to complications such as foot ulcers and amputations. Non pharmacological interventions, including Buerger-Allen Exercises (BAE), have demonstrated efficacy in enhancing blood flow and alleviating neuropathic symptoms. Aim: To assess the effectiveness of BAE in improving lower extremity perfusion and mitigating peripheral neuropathy symptoms among patients with T2DM. Materials and Methods: The present study used a quasi-experimental design (two-group pre-test and post-test) and was conducted from April 2025 to June 2025 at the Diabetic Outpatient wards of Mahatma Gandhi Medical College and Research Institute, Puducherry, India. A total of 110 subjects were purposively sampled, with 55 participants allocated to each group: the study group received BAE alongside routine care for 14 days, and the comparison group received routine care exclusively. Data collection involved a structured interview schedule, Ankle-Brachial Index (ABI) for perfusion assessment, and the Michigan Neuropathy Screening Instrument (MNSI) for neuropathy evaluation. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 19.0, employing descriptive statistics and Mann-Whitney U test, with p<0.05 considered statistically significant. Results: The mean age±Standard Deviation (SD) of the study group was 50.52±5.77 years, and of the comparison group was 50.66±6.42 years. In the study group, mean right ABI scores improved from 0.71±0.12 to 0.87±0.08, while mean MNSI scores decreased significantly from 4.49±1.27 to 2.02±0.85 (p<0.001). In contrast, the comparison group showed no significant change in ABI (0.71±0.11 to 0.71±0.12) and only minimal improvement in MNSI scores (4.69±1.26 to 4.49±1.43). Post-test comparisons demonstrated significantly better perfusion and reduced neuropathy symptoms in the study group compared to the comparison group (p<0.001). Conclusion: The BAE is an effective, non pharmacological intervention for improving lower-extremity perfusion and reducing peripheral neuropathy symptoms among patients with T2DM.

Prevalence of Counter-clockwise Superior Mesenteric Vein Rotation around the Superior Mesenteric Artery on Contrast-enhanced Computed Tomography Abdomen: A Retrospective Observational Study

Udaya Bhaskarini Vakamudi, Shubangi Gupta, Shivani Dhaka, CM Sreedhar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The counter-clockwise swirl of the Superior Mesenteric Vein (SMV) around the Superior Mesenteric Artery (SMA) is a normal anatomical variant. Aim: To observe the normal variant anatomy of a counter-clockwise swirl of the SMV around the SMA using a contrast-enhanced Computed Tomography (CT) scan of the abdomen. Materials and Methods: A retrospective observational study was performed in the radiology department of SGT Medical College, Gurugram, Haryana, India from 2023 November to 2024 November. Abdominal CT scans from 200 consecutive patients, performed for various clinical indications, were included. The CT scans were evaluated for the absence or presence of a counter- clockwise swirl of the mesenteric vessels. The degree of vessel rotation was also calculated based on the criteria proposed by the authors of the present study. The results were analysed, and the numbers of patients in different groups and subgroups were expressed as percentages. Results: Of the 200 patients, 114 (57%) showed counter-clockwise rotation of mesenteric vessels. Out of these, 114 patients, 84 (42%) patients had >90° to <180° degrees, 19 (9.5%) patients had >180° to <270° degrees, and 11 (5.5%) patients had >270° degrees of counter-clockwise swirl of the SMV around the SMA. Conclusion: Awareness of this normal branching pattern of mesenteric vessels is important to avoid an inadvertent laparotomy.

Efficacy of Mobilisation with Movement and Class IV LASER in Non Diabetic Adults with Adhesive Capsulitis: A Research Protocol

Mansi Jain, Aksh Chahal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Adhesive Capsulitis (AC) is a common idiopathic and self-limiting condition, characterised by painful shoulder stiffness and progressive limitations of both active and passive shoulder motion following rigidity and fibrosis of the joint capsule. Exercise therapy intervention with electrotherapy is performed as part of the conventional and ongoing rehabilitation. Need of the study: Mobilisation With Movement (MWM) and Class IV Light Amplification by Stimulated Emission of Radiation (LASER) therapy are commonly used physiotherapy interventions, but comparative evidence on their effects on Pressure Pain Threshold (PPT), disability, and quality of life is lacking. Evaluating PPT offers an objective assessment of pain sensitivity, disability, and quality of life, which reflect functional outcomes. Aim: The proposed study aims to evaluate the comparative effect of MWM and Class IV LASER therapy among patients with AC on reducing pain, decreasing disability, and improving quality of life. Materials and Methods: The present study is a three-arm randomised clinical trial that will be conducted at Physiogenix Rehabilitation, Jyoti Hospital, Gurugram, Haryana, India, from February 2025 to February 2026. Total 84 individuals (male and female), between 45-75 years, will be recruited based on the designed inclusion and exclusion criteria. Patients will be randomly allocated into three groups. Group A will receive MWM along with conventional physiotherapy, Group B will receive Class IV LASER Therapy along with conventional physiotherapy, and Group C will receive only Conventional Physiotherapy. All three groups will receive the intervention for five times a week for four weeks. Primary outcome measure to be used will be the Numeric Pain Rating Scale (NPRS) for assessment of pain, and the secondary outcome measure will be Shoulder Pain and Disability Index (SPADI), Range of Motion (ROM) and PPT. Analysis of Variance (ANOVA) test will be used for the between-group comparisons, and a p-value <0.05 will be considered significant.

Evaluation of Demineralised Freeze-dried Bone Allograft and Autologous Dentin Graft with Advanced Platelet-rich Fibrin in Socket Preservation: A Research Protocol

Mahima Kothekar, Pavan Bajaj, Sneha Dare, Shivani Thakre Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Alveolar ridge resorption is initiated rapidly within weeks following tooth extraction, therefore successful implant outcomes depend upon preservation of alveolar ridge. Techniques like atraumatic extraction and socket grafting helps in reduction of bone loss. Demineralised Freeze-dried Bone Allograft (DFDBA) is a commonly used due to its osteo-inductive properties which are enhanced when combined with Advanced Platelet Rich Fibrin (A-PRF). A-PRF enhances healing and regeneration of both soft and hard-tissues. Autologous Dentin Graft (ADG), derived from extracted teeth, mimics natural bone and offers osteoinductive and osteoconductive benefits. Radiographic and histological analysis along with clinical evaluation are reliable methods to assess outcomes. Need of the study: The ADG eliminates the need for a second surgical site and reduces patient morbidity. Furthermore, the combined effect of ADG with A-PRF has not yet been evaluated, highlighting the need for this study. Aim: To assess and compare the effectiveness of DFDBA with A-PRF and ADG with A-PRF in socket preservation using clinical, radiographical, and histological analysis. Materials and Methods: This randomised controlled clinical trial compares DFDBA with A-PRF and ADG with A-PRF in socket preservation. The trial will be conducted at the Department of Periodontics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, from May 2025 to June 2026, which will involve 10 participants in each group. Participants will be randomly assigned to one of two groups: (a) Socket preservation performed using DFDBA with A-PRF; (b) Socket preservation performed using ADG with A-PRF. Cone Beam Computed Tomography (CBCT) will be performed postoperatively and at four months, along with clinical evaluation and implant placement. Bone biopsies obtained during implant placement will be analysed histomorphometrically in a blinded manner. Statistical analysis will be performed using paired and unpaired Student’s t-tests, with a p-value <0.05 will be considered statistically significant.

High- versus Low-intensity Functional Training on Cognition, Balance, and Functional Ability in Individuals with Cognitive Impairment: A Protocol for a Randomised Clinical Trial

Gagan Deep Singh, Akanksha Saxena Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Cognitive impairment significantly reduces functional independence in older adults, increasing the risk of falls, disability, and poor quality of life. Cognitive and motor functions are closely linked, with deficits in attention, executive function, and memory adversely affecting balance, gait, and physical performance. Exercise interventions, particularly functional training approaches like High-Intensity Functional Training (HIFT) and Low-Intensity Functional Training (LIFT), have shown promise in addressing both cognitive and motor impairments. Need of the study: Although exercise is beneficial for cognitive impairment, comparative evidence on training intensity remains limited. LIFT is commonly used for its safety and feasibility, but may yield modest cognitive-motor improvements. HIFT, involving higher-intensity, multi-joint movements may offer greater neuromuscular and cognitive benefits. However, direct comparisons between HIFT and LIFT in cognitively impaired individuals are lacking. Therefore, this study aims to determine the most effective intervention for improving cognitive-motor performance and functional outcomes. Aim: To evaluate and compare the effectiveness of HIFT and LIFT in improving cognition, balance, and functional ability in individuals with cognitive impairment. Materials and Methods: A randomised clinical trial will be conducted at TDTR DAV Institute of Physiotherapy and Rehabilitation, Yamunanagar, from January 2026 to December 2027. 28 individuals with cognitive impairments according to Montreal Cognitive Assessment (MoCA) scores: 17-24, both male and female, aged 55-75 years, Borg Rating of Perceived Exertion ≤13, Resting Blood Pressure <160/100 mmHg will be recruited via criterion-based purposive sampling. Participants will be randomly allocated into two groups: Group-A will receive HIFT, whereas Group-B will receive LIFT for eight weeks, three times/week. Cognition, balance, and functional ability will be evaluated at baseline, at the end of the 4th week and post-intervention by the MoCA, Berg Balance Scale, and the Functional Independence Measure (FIM), respectively. For normally distributed data, repeated measures ANOVA will be used for within-group analysis and the independent t-test for between-group analysis and for non-normally distributed, the Friedman test will be used for within-group analysis and the Mann-Whitney U test for between-group analysis. The p-value of <0.05 is considered statistically significant.

Pharmaceutical Development and Quality Control Assessment of Novel Syrup (Ojolyte) and Evaluation of its Antioxidant Effect: A Research Protocol for an In-vitro Study

Sakshi Yashwant Khapre, Anita Santoshrao Wanjari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Ayurveda, an ancient holistic medical system, emphasises achieving balance for overall well-being. The efficacy, safety, stability and palatability of drug dosage forms are crucial in both traditional and modern pharmaceutics. In ayurveda, this is addressed by Bhaishajya Kalpana, which focuses on drug formulation and preparation. The concept of polyherbal medicine is highly valued, as combining multiple herbs can enhance therapeutic effects and reduce toxicity. Nutraceuticals, which are made from food or plants, are becoming more and more popular since they provide health advantages beyond simple nourishment. Modern pharmaceutical advancements aim to improve dosage forms for better shelf life, patient compliance and market acceptance. Mantha is a traditional ayurvedic cold infusion, offers a liquid form that is easy to ingest and acts quickly due to rapid absorption. Building on this, Sharkara Kalpana (syrups) were introduced to ayurveda, offering improved palatability, masked undesirable tastes, and extended shelf life due to their high sugar concentration and osmotic pressure, which inhibits microbial growth. Need of the study: Ojolyte syrup, an emerging formulation, is a mineral-rich, antioxidant, fruity energy drink that replenishes electrolytes and quenches thirst. It is suitable for all age groups, pregnancy, morning sickness, post-chemotherapy care and hangover management, offering a palatable alternative to conventional supplements. Aim: To assess the pharmaceutical development and quality control Assessment of novel syrup (Ojolyte) and evaluation for anti-oxidant effect Materials and Methods: The experimental study will be conducted at MGACH&RC, Salod (H), Wardha, Maharashtra, India from January 2025 to December 2025. Nine ingredients including Phoenix dactylifera, Punica granatum, Vitis vinifera, Garcinia cambogia, Tamarindus indica, Emblica officinalis, Cyperus scariosus, rock salt and rock sugar are used in specified proportions. Initially, Mantha is prepared by soaking and churning the ingredients in cold water, followed by filtration. This filtrate is then processed into syrup by adding 70% sugar and heating to attain one-to-two-thread consistency. Analytical parameters include organoleptic evaluation, physicochemical tests (pH, viscosity, specific gravity, total ash, loss on drying) and microbial load assessment. Advanced analysis involves High-Performance Liquid Chromatography (HPLC) for phytochemical profiling, 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay for antioxidant potential, and nutritional analysis for protein, fat, fibre, carbohydrates, minerals and vitamin C. Shelf-life studies will be conducted under varying temperatures to ensure stability.

Effect of Buteyko versus Diaphragmatic Breathing on Balance and Spatiotemporal Gait Parameters in Individuals with Motion Sickness: A Research Protocol for a Randomised Clinical Trial

Kanupriya, Mandeep Kumar Jangra, Apoorva Saini, Akanksha Saxena Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Motion sickness arises from a conflict between visual and vestibular sensory inputs and provokes autonomic symptoms such as nausea and dizziness. Because these symptoms can cause functional impairment, pharmacological treatment options—often associated with adverse effects—are limited, increasing interest in non pharmacological interventions such as controlled breathing. Need of the study: The Buteyko Breathing Technique (BBT) reduces minute ventilation through controlled nasal breathing and breath-holding, potentially influencing physiological responses related to motion sickness. However, existing studies have primarily examined these breathing techniques in isolation and have focused on autonomic or respiratory outcomes rather than functional measures. Furthermore, their relative effects on clinically important outcomes such as balance and spatiotemporal gait parameters remain unclear. Aim: To evaluate the effectiveness of diaphragmatic breathing and Buteyko breathing on balance and spatiotemporal gait parameters in individuals with motion sickness. Materials and Methods: This randomised, single-blind, single-centre clinical trial will be conducted at the Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana-Ambala, Haryana, India, from May 2025 to July 2026. A total of 40 participants with a history of motion sickness and a Motion Sickness Susceptibility Questionnaire (MSSQ) score ≥ 15 will be recruited and randomly allocated to two groups: Buteyko Breathing (BBT) and Diaphragmatic Breathing (DB). The intervention will be administered four times per week for four weeks. The primary outcomes will be motion sickness susceptibility and balance performance, assessed using the Motion Sickness Susceptibility Questionnaire-Short (MSSQ-Short) and the Mini Balance Evaluation Systems Test (Mini-BESTest), respectively. Secondary outcomes will include sensory integration for balance, evaluated using the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), and spatiotemporal gait parameters. Data normality will be assessed using the Shapiro–Wilk test. Non normally distributed data will be analysed using the Wilcoxon signed-rank test or Mann–Whitney U test. A p-value <0.05 will be considered statistically significant.

Comparative Evaluation of Efficacy of Gomutra Haritaki versus Atorvastatin in the Management of Obesity: A Randomised Single-blind Standard Control Clinical Trial Protocol

Sakshi Mute, Shweta Parwe, Milind Nisargandha, Garima Gupta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Obesity is a significant global health concern and is often associated with various complications, including cardiovascular diseases and metabolic disorders. Although drugs such as Atorvastatin are routinely employed to control lipid disturbances, they have unwanted side effects. Gomutra Haritaki, a traditional Ayurvedic remedy, offers a potential natural and holistic alternative. Need of the study: The present research may shape integrative treatment strategies for obesity, a condition whose prevalence has more than doubled globally since 1990, affecting 16% of adults by 2022 {World Health Organisation (WHO)}. Gomutra Haritaki, as mentioned in Charaka and Sushruta Samhita, enhances digestion, metabolism, and fat reduction through its Ushna Virya, thereby balancing Kapha and Meda. In contrast, statins, though effective, can cause myalgia (1-10%), rare rhabdomyolysis (<0.1%), and occasionally affect liver function (˜1%) or increase diabetes risk. Risk factors include alcohol use, polypharmacy, and hypothyroidism. Aim: To evaluate and compare the efficacy of Gomutra Haritaki and Atorvastatin in reducing obesity-related parameters such as weight, Body Mass Index (BMI), lipid profile, and waist-hip ratio in adult patients Materials and Methods: The present research will be a single-blind, randomised, standard-controlled trial with 40 participants who have newly diagnosed cases of obesity in the age group 20-40 years and a BMI>30 kg/m². Group A participants will be administered Gomutra Haritaki-3 g/day (3 tab twice daily), and Group B participants will be given Atorvastatin (10 mg daily). Both Gomutra Haritaki and Atorvastatin will be administered for a period of 60 consecutive days. The trial will be conducted at Mahatma Gandhi Ayurved College and Hospital and Research Centre, Salod, Wardha, Maharashtra, India, between March 2025 and January 2026. Objective parameters, weight, BMI, lipid profile, and hip to waist ratio will be assessed on 0, 15^th, 30^th, and 60^th days. Paired and unpaired t-tests will analyse data, with p<0.05 considered significant. Statistical analysis will be performed using Statistical Package for Social Sciences (SPSS) version 17.0.

Immunohistochemical Evaluation of Oestrogen and Progesterone Receptors in Colorectal Carcinoma and their Association with Tumour Grade and Stage: A Research Protocol

Sneha Sukumar, Samarth Shukla, Sourya Acharya, Shailly Tiwari Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Colorectal cancer is one of the major contributors to the global cancer burden, accounting for a predominant proportion of cancer-related deaths and diagnoses. In India, the rising incidence is often linked to dietary habits and lifestyle changes. While Oestrogen Receptors (ER) and Progesterone Receptors (PR) are well established in hormone-based malignancies, their role in Colorectal Carcinoma (CRC) remains sparse. Need of the study: With little biomarker-based categorisation, colorectal cancer is becoming a greater health concern in India. Although ER and PR are known to exist in hormone-sensitive tumours, it is yet unknown how they relate to prognosis in colorectal cancer. Since there is a dearth of information on ER/PR expression in colorectal cancer in India, the present study aims to assess its correlation with tumour grade and stage and to investigate its possible use in individualised treatment. Aim: To assess the immunohistochemical expression of ER and PR in CRC and their correlation with tumour grade and stage. Materials and Methods: An ambispective observational study will be conducted in Department of Pathology at Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India, from June 2024 to June 2026. Fifty-five patients from the surgery and oncosurgery units who match the inclusion criteria will be enrolled. Histopathological analysis will be conducted on surgically resected colorectal cancer specimens, accompanied by immunohistochemistry labelling to assess the expression of ER and PR. The standard procedures will be followed for processing tissue, staining with Haematoxylin and Eosin (H&E) and immunohistochemistry. The outcomes will be evaluated against histological criteria and Tumour, Node, Metastasis (TNM) staging. The Chi-square test will be used for statistical analysis. A p-value of <0.05 will be considered statistically significant.

Comparative Effects of Neuromuscular Joint Facilitation and Conventional Physiotherapy on Pain, Balance, and Functional Performance in patients with Knee Osteoarthritis: A Randomised Controlled Trial Protocol

Anchal, Sandeep Pattnaik, Nikita Vaid, Kanika Bhatia Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Globally, Knee Osteoarthritis (KOA) is a major contributor to pain, impairment, and decreased mobility. While traditional physical therapy emphasises mobility, strengthening, pain management, and function, it cannot adequately address neuromuscular deficiencies that impact joint stability. Neuromuscular Joint Facilitation (NJF) is a movement-based method that improves muscle activation, coordination, and proprioception. Need of the study: KOA is commonly associated with pain, impaired balance, and reduced functional ability. While conventional physiotherapy has been shown to improve pain and functional outcomes, it may not sufficiently address underlying neuromuscular and proprioceptive deficits. Additionally, there is limited comparative evidence regarding the effectiveness of NJF, particularly in improving balance among individuals with KOA. Therefore, this study is needed to compare the effectiveness of NJF and conventional physiotherapy in enhancing balance, reducing pain, and improving functional ability in this population. Aim: To compare the effectiveness of NJF and conventional physiotherapy techniques in reducing pain, improving balance, and function in Grade 2 and 3 KOA patients. Materials and Methods: A single-blinded, randomised controlled trial will be conducted at the tertiary care multispeciality hospital in Mullana, Ambala, Haryana, from January 2025 to December 2026. A total of 60 participants will be enrolled. The study will recruit patients aged 40-70 years, both male and female, with KOA, who meet the inclusion criteria. Numeric Pain Rating Scale (NPRS) for pain, Western Ontario and McMaster Universities OA index (WOMAC) for function, and Single Leg Stance test (SLS) for balance will be the outcome measures. The experimental group will receive NJF, including PNF diagonal patterns, PNF stretching, and joint composition movements; the control group will receive conventional physiotherapy exercises, three times a week for four weeks. Paired t-test and independent t-test will be used for intra-group and inter-group comparisons, respectively. If data are not normally distributed, the Wilcoxon signed rank test and the Mann-Whitney U test will be applied, and the chi-square test will be used for categorical variables with significance set at p<0.05.

Supervised Tele-rehabilitation versus Unsupervised Home-based Pulmonary Rehabilitation in Individuals with COPD: A Randomised Controlled Trial Protocol

Ridhi Vatsa, Akanksha Saxena, Mandeep Kumar Jangra, Sameer Singhal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern characterised by irreversible airflow limitation due to airway and alveolar abnormalities. Many individuals diagnosed with mild to moderate COPD often experience reduced independence and functional capacity, for which Pulmonary Rehabilitation (PR), the evidence-based program, is the only primary non pharmacological treatment approach for the treatment of COPD, which reduces progression of the disease and improves overall Quality of Life (QoL) of the patient. Need of the study: However, access to centre-based PR programs is frequently limited by distance, cost, and resources. Tele-rehabilitation offers a feasible and accessible alternative for delivering PR remotely. Despite its potential benefits, further research is needed to establish its effects on functional outcomes in patients with COPD. Aim: To evaluate the effectiveness of supervised tele-PR versus home-based PR on pulmonary function, balance, cognition, and functional performance in individuals with mild to moderate COPD. Materials and Methods: A randomised controlled trial will be conducted at MM Super Speciality Hospital, Mullana, Ambala, Haryana, India, from August 2025 to June 2026. A total of 60 participants (Forced Expiratory Volume in one second/Forced Vital Capacity (FEV1/FVC) <0.7 and FEV1 >50%), aged 45-85 years, will be included and randomly allocated to supervised Tele-PR (Group 1) and unsupervised home-based PR (Group 2). The six-week tele-rehabilitation program will include supervised exercise, breathing techniques, and educational sessions via video conferencing. Pre and post intervention assessments will include pulmonary function tests (FEV1 and FVC), the Berg Balance Scale (BBS) for balance, the Montreal Cognitive Assessment (MoCA) for cognitive function, and the Londrina Activities of Daily Living (ADL) Protocol for functional performance. Within-group and between-group comparisons will be performed using paired and unpaired t-tests, respectively. For non-normally distributed data, the Wilcoxon signed-rank test and Mann-Whitney U test will be used. Statistical significance will be set at p<0.05.d-rank test and Mann-Whitney U test will be used. Statistical significance will be set at p<0.05.

Evaluation of Comparative Efficacy of Trivritadi Ointment versus Jatyadi Ointment in Bhagandara Vrana Ropana Karma (Post-partial Fistulectomy Wound Healing): A Randomised Controlled Clinical Trial Research Protocol

Manoj Kumar Gupta, Sheetal Asutkar Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Bhagandara (fistula-in-ANO) is a chronic anorectal disease that develops from an abnormally positioned tract between perianal skin and the anal canal and is routinely found to develop as a sequela of incompletely healed or untreated anal abscesses. Partial fistulectomy is the treatment of choice, yet slow or imperfect wound coverage is a serious issue. In traditional Indian medicine (Ayurveda), Jatyadi ointment has been a traditional remedy for wound management after surgery for years. At the same time, Trivritadi ointment is classically listed for Bhagandara but is less studied. Need of the study: Although Jatyadi ointment has adequate documentation for the general cure of wounds, no trial has comparatively studied it vis-à-vis Trivritadi ointment, indicated for the coverage of fistula wounds as per the literature from Ayurveda. This research bridges that gap for determining a superior treatment option. Aim: To compare the efficacies of Trivritadi ointment and Jatyadi ointment for early coverage of wounds after partial fistulectomy for patients of Bhagandara. Materials and Methods: A double-blind, randomised controlled trial shall be undertaken at Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACH), Salod (H), Wardha, Maharashtra, India. The trial will be planned for April 2025 commencement until December 2025 and each patient will be monitored for one month, including a 30-day postoperative evaluation. The duration of the study will depend on the inclusion rate of patients and the completion of follow-up visits. Based on the sample size calculation, a total of 144 participants will be enrolled and randomly allocated to receive wound dressing with either Trivritadi ointment (Group A) or Jatyadi ointment (Group B), with 72 participants in each group for a treatment period of 14 days. Wound cure shall be analysed at Day 7, Day 14 and Day 30 by both objective and subjective parameters like quality of wound bed, granulopan formation, dis-charge, foul odour and intensity of pain, the latter being graded through a Visual Analogue Scale (VAS). Student’s t-test will be used for continuous variables and Chi-square test for categorical variables. Paired t-test will assess outcome changes over time, with significance at p<0.05.

Evaluating the Association of Karshya (Emaciated) Individuals with Grahani Roga (IBS): A Research Protocol for a Cross-sectional Study

Mahima Sahu, Preeti Borkar, Dnyanesh Joshi, Varun Gupta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Ayurveda identifies Grahani Roga and Karshya as two interconnected pathological conditions that arise due to the impaired functioning of Agni or the digestive fire. The condition of Karshya is marked with emaciation, at times also accompanied by diminished Agni, and is often associated with chronic malabsorption syndromes, which in turn Grahani Roga. While the Ayurvedic texts have elaborated on this relationship, modern research validating it clinically is quite limited. Need of the study: Grahani Roga impairs the absorption of nutrients in the intestine, and Karshya is an ailment associated with chronic under-nourishment, along with weakened digestive capacity and health. Emaciated patients suffering from this association may help pinpoint the early signs of digestive disorders, thereby providing timely treatment and avoiding complications. Understanding their connections may clarify the interrelationship between malnutrition and a dysfunctional digestive system. Aim: To evaluate the association of Karshya (emaciated individuals) with Grahani Roga. Materials and Methods: The study is designed as an cross-sectional investigation involving 382 patients recruited from the Outpatient Department (OPD) and Inpatient Department (IPD) at the Department of Samhita and Siddhant, MGACH and RC, Salod (H), Wardha, Maharashtra, India, from November 2024 to May 2026. Patients will be selected based on inclusion criteria aligning with both Ayurvedic and contemporary diagnostic parameters of Karshya and Grahani Roga. Subjective and objective assessments, including anthropometric measurements and symptom gradation, will be utilised to establish the association. Statistical analysis will be applied to interpret the collected data. A Chi-square test of independence will be applied, and a p-value less than 0.05 will be considered statistically significant.

Determination of the Levels of Estradiol (E2) in Urine and the Optimum Time Frame for Nasal Cartilage Moulding in Infants with Cleft Lip and Palate: A Research Protocol for a Prospective Observational Study

Pallavi Daigavane, Priyanka Niranjane, Bhagyashri Chimote, Ruchi Chandankhede Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Cleft lip and palate are among the most common congenital craniofacial anomalies, which result from incomplete fusion of the facial processes when the fetus develops. After performing non surgical methods like nasoalveolar moulding, which is crucial to improve the nasal symmetry, the length of the columella and aesthetics of the face, before the surgical procedures are performed. In infants, the ability of the nasal cartilage is very much influenced by maternal hormones like Estradiol (E2), which is usually elevated in newborns for a short period of postnatal growth due to the placental transfer. Thus, understanding urinary estradiol levels will help us establish an effective time frame for initiating the presurgical procedures. Need of the study: The effectiveness of PNAM depends on the malleability of nasal cartilage in early infancy, which is influenced by maternal hormones such as estradiol. However, the optimal biologically driven time frame for initiating PNAM has not been clearly established. Assessing urinary estradiol levels in infants may help identify the most favourable period for initiating PNAM to improve treatment outcomes in cleft lip and palate patients. Aim: To assess urinary estradiol levels in infants with cleft lip and palate to identify the optimal time frame for initiating Presurgical Nasoalveolar Moulding (PNAM) based on hormonally influenced nasal cartilage malleability. Materials and Methods: This will be a prospective observational study conducted in the Department of Orthodontics and Dentofacial Orthopaedics, in collaboration with the research house, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. The study will include convenience sampling, a total sample of 25 infants per group (cleft and non cleft) will be included, based on Lamorte power calculations and feasibility with infants registered under the Smile Train visiting the Departmental OPD. The study will be carried out over 12 months from January 2026 to December 2026. The primary inclusion criteria of age ≤3 months at initiation of PNAM, absence of systemic illness, and no prior orthopaedic intervention. Demographic parameters including age, gender, birth weight, and cleft type, were recorded. After obtaining parental consent, urine samples shall be collected from infants in labelled sterile vials and stored at -80°C until analysis. Estradiol levels were estimated using a standard ELISA technique. Samples were collected at four time points: V1 (0-15 days), V2 (30 days), V3 (60 days), and V4 (90 days) from birth. Intragroup comparisons were performed across visits, and intergroup comparisons were made between infants with cleft lip and palate, non-cleft infants, and standard textbook reference values to determine the optimum estradiol level and time frame for nasal cartilage moulding. Data were statistically analysed using repeated-measures Analysis of Variance (ANOVA), with p<0.05 considered statistically significant.

Tumour-infiltrating Lymphocytes and its Association with Prognostic Pathological Parameters in Resectable Oral Squamous Cell Carcinoma: An Observational Ambispective Study Research Protocol

Saoni Debroy, Arvind Shridhar Bhake Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Tumour-infiltrating Lymphocytes (TILs) have emerged as important components of the tumour microenvironment and are recognised as significant prognostic indicators in several human malignancies. In Oral Squamous Cell Carcinoma (OSCC), increasing evidence suggests that the density, distribution and immune phenotype of infiltrating lymphocytes may influence tumour progression, nodal metastasis and overall biological behaviour. However, limited structured data are available from the Indian population correlating specific lymphocyte subsets with established pathological prognostic parameters in resectable OSCC. Need of the study: Despite the high burden of OSCC, prognostication continues to rely mainly on conventional parameters such as tumour grade, tumour size, nodal status and Tumour-Node-Metastasis (TNM) staging. The tumour immune microenvironment represents a potentially valuable adjunct prognostic marker that may refine risk stratification and improve therapeutic planning. Evaluating the density and localisation of CD4+, CD8+ and CD57+ lymphocytes within the tumour parenchyma and at the invasive front may provide additional insight into tumour-host immune interactions and disease behaviour. Aim: To evaluate the immune profile of TILs identified by CD4, CD8 and CD57 expression in resectable OSCC and to determine their association with pathological prognostic parameters. Materials and Methods: The present study will be an observational ambispective cross-sectional study and will take place in the Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Acharya Vinoba Bhave Rural Hospital, Wardha, Maharashtra, India. Patients with a resectable OSCC scheduled for surgical excision will be included based on predefined inclusion and exclusion criteria. Demographic and clinical information e.g., age, sex, occupation, risk habits, tumour site, tumour size and nodal status will be recorded. Histopathological parameters such as grade of tumour, T stage, N stage and TNM stage will be documented. Tissue sections fixed in paraffin blocks (formalin) will be subjected to histological immuno-enzymatic tests (antibodies against CD4, CD8, CD57) for determination of tumour infiltrating lymphocytes in the intratumoural region and at the invasive front. Data will be analysed by using Statistical Package for Social Science (SPSS). Associations between TIL subsets and pathological prognostic parameters will be assessed by the use of appropriate statistical tests at p<0.05 as threshold for statistical significance.

Validity and Reliability of EuroQol 5-Dimension 5-Levels Questionnaire (EQ-5D-5L) in Assessing Health-related Quality of Life in Sacroiliac Joint Dysfunction: A Research Protocol for a Prospective Observational Study

Sunaina Gupta, Aarunee Srivastava, Vaishali Rai, Sandeep Pattnaik Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: The EuroQol-5 Dimension-5 Level (EQ-5D-5L) is a commonly used, standardised tool for measuring Health-Related Quality of Life (HRQoL) across five areas: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Sacroiliac Joint (SIJ) dysfunction is a significant contributor to low back pain and adversely affects the functional ability and quality of life. Despite its widespread use, evidence regarding the reliability and validity of the EQ-5D-5L in this population remains limited. Need of the study: There is a lack of validated instruments designed to evaluate HRQoL in individuals with SIJ dysfunction. Determining the reliability and validity of EQ-5D-5L in this population will support its clinical and research application. However, in the context of SIJ dysfunction, there is no universally accepted SIJ specific questionnaire that fully captures all relevant constructs, particularly those aligned with the domains assessed in our study. Aim: To determine the reliability and validity of the EQ-5D-5L questionnaire in patients with SIJ dysfunction. Materials and Methods: A prospective observational study will be conducted at the Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, from May 2025 to March 2026, in patients with SIJ dysfunction. A minimum of 50 participants will be included for reliability analysis, while approximately 100 participants will be included for concurrent validity assessment. Participants will be asked to complete the EQ-5D-5L at baseline, again within 30 minutes by two independent trained raters to assess inter-rater reliability, and after seven days to determine test-retest reliability. Concurrent validity will be assessed by having participants complete the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RMDQ) at baseline and correlating their scores with those of the EQ-5D-5L. Descriptive statistics will summarise demographic data. Reliability will be assessed using the Intraclass Correlation Coefficient (ICC), and concurrent validity using Pearson or Spearman correlation coefficients. Floor and ceiling effects will also be evaluated. Statistical significance will be set at p<0.05.

Hindi Translation, Validation and Reliability Testing of the Dynamic Gait Index in Stroke Patients with Residual Weakness: A Research Protocol for a Psychometric Validation Study

Anmol, Subhasish Chatterjee, Mousumi Saha, Ruchika, Tai Yayum Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Stroke is one of the primary causes of lifelong disability, and typically an individual will experience some type of walking/gait impairment, a decreased ability to shift their weight, and altered balance. Since walking is one of the most critical aspects of performing everyday tasks, gait assessment must be performed accurately so rehabilitation can occur appropriately. Need of the study: The Dynamic Gait Index (DGI) is a well-established measure to assess dynamic balance among stroke survivors, and has been translated into several languages, including Brazilian, Portuguese, Turkish, Arabic, Icelandic, and Urdu. There is presently no published version of the DGI in Hindi, restricting its use among the vast number of Hindi- speaking individuals in India and elsewhere. Aim: To translate the DGI into Hindi and assess its validity and reliability for use in stroke rehabilitation. Materials and Methods: A psychometric validation study involving 51 stroke patients will be conducted at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, from January 2026 to December 2026. The Translation and cultural adaptation procedure will be performed according to Beaton’s Guidelines (forward translation, synthesis, back translation, expert committee review, pretest, and finalization) to ensure linguistic clarity and cultural appropriateness. Content Validity will be evaluated by using the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI/AVE). Reliability analysis will be performed using the intraclass correlation coefficient (ICC) and Cronbach’s alpha to determine the internal consistency. Agreement between measurements will be assessed using Bland-Altman plots. Statistical analysis will be conducted to evaluate the psychometric properties of the translated scale, including internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficient), with significance set at p<0.05.

Evaluating Postoperative Healing of Skin Grafts With and Without Platelet Rich Fibrin at Free Flap Donor Sites in Oral Squamous Cell Carcinoma: A Research Protocol for a Randomised Controlled Trial

Mahendrakumar P Padsala, Nitin Bhola Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Reconstruction of donor sites after harvesting radial forearm, fibula, and Anterolateral Thigh (ALT) flaps typically involves split-thickness free skin grafts. However, challenges such as necrosis and partial graft loss can arise. Studies show that optimising the wound bed with methods like negative-pressure wound therapy can improve outcomes, though these methods can be costly and time-consuming. A simpler, cost-effective alternative is the use of Platelet-Rich Fibrin (PRF) membranes, which enhance wound conditions and improve graft survival by releasing growth factors that promote angiogenesis and fibroblast migration. Additionally, PRF membranes act as a protective barrier for the skin graft, aiding in donor-site reconstruction. Need of the study: Donor site closure is done with Split-Thickness Skin Graft (STSG) that requires proper regeneration for the best possible outcome after surgery. It is imperative to comprehend the relative effectiveness of STSG alone and in combination with PRF to assist clinicians in determining the most effective reconstruction method following microvascular surgery in oral cancer patients. Both STSG and PRF have shown promise in enhancing wound healing and tissue regeneration; however, to develop evidence-based guidelines for clinical practice, a direct comparison through a rigorous comparative study is essential. Aim: To evaluate and compare the postoperative healing of skin grafts with and without PRF at free flap donor sites in oral squamous cell carcinoma. Materials and Methods: The present Randomised Controlled Trial (RCT) will be conducted on 40 patients in the Department of Oral and Maxillofacial Surgery at Siddharth Gupta Memorial Cancer Hospital (SGMCH), DMIHER, Sawangi, Wardha, Maharashtra, India, from August 2025 to January 2027. A detailed history of the patient with written informed consent will be obtained from patients in their language before enrolment. The present single-blinded RCT with a parallel group design will randomly assign patients using an odd-even method into two groups: Group A (STSG without PRF) and Group B (STSG with PRF). The study population includes oral cancer patients undergoing surgical resection followed by microvascular free flap reconstruction, like anterolateral thigh, free fibula, and radial forearm. A Southampton Wound Assessment Scale (SWAS) will be utilised for assessing the healing. Patients will be monitored for graft survival, re-epithelialisation, and complications such as necrosis, infection, or tendon exposure over a structured follow-up period. Statistical analysis will be done by using descriptive and inferential statistics, specifically the Chi-square test, Student’s paired and unpaired t-test, with p-value <0.05 considered significant.

Methodological Framework for Predictive Modelling using Metabolic, Mechanical and Radiographic Parameters in Knee Osteoarthritis Diagnosis: A Research Protocol for Cross-sectional Study

Sahil Kalra, Manu Goyal Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Osteoarthritis (OA) is a very common chronic musculoskeletal disorder, which is often diagnosed with the help of clinical and radiographic techniques; nevertheless, these traditional methods might not be capable of detecting the disease during its initial stages or explaining the underlying molecular pathogenesis. Need of the study: Knee OA is a multifactorial disease driven by metabolic, biomechanical and structural factors, yet diagnosis relies on late radiographic changes after irreversible damage. Current predictive models incorporate isolated radiographic features and clinical data, but omit integrated biomarkers or biomechanical factors. A unified model that integrates these domains is essential for proactive diagnosis and personalised OA management. Aim: To develop and validate a predictive model based on metabolic and mechanical markers for knee OA and evaluate its concurrent validity with radiographic grading. Materials and Methods: A cross-sectional study will be conducted at the Outpatient Department of Maharishi Markandeshwar Super Speciality Hospital, Haryana, India, from September 2025 to September 2027. Adults aged 45-70 years with symptomatic unilateral or bilateral knee OA confirmed by radiographic evaluation will be recruited using purposive sampling. Metabolic markers {lipid profile and glycated Haemoglobin (HbA1c)}, mechanical parameters (tibial torsion and Q-angle) and radiographic severity, based on the Kellgren-Lawrence (KL) grading system, will be assessed using standardised measurement procedures. Pearson’s correlation coefficient (r) or Spearman (ρ) will be used to determine the relationship between various variables. Step-wise multiple regression will be used to determine the most significant predictors of the clinical outcome. A p-value of <0.05 is considered statistically significant.

Efficacy of Gonadotropin with Clomiphene versus Letrozole in Women with Ovulatory Dysfunction Undergoing Intrauterine Insemination: A Research Protocol for a Randomised Controlled Trial

Sana Aafreen, Kamlesh Chaudhari, Ekramul Haque Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Globally, infertility poses a significant problem for young couples. In cases of mild male factor infertility, unexplained infertility, and ovulatory dysfunction, Intrauterine Insemination (IUI) is often used as a first-line treatment. Clomiphene Citrate (CC) is a selective oestrogen receptor modulator that is often used to help women ovulate. However, it can have anti-oestrogenic effects on the endometrium and cervical mucus, which could make pregnancy less likely to go well. Letrozole, a third-generation aromatase inhibitor, offers advantages such as mono-ovulation, a shorter half-life, and minimal anti-oestrogenic activity, making it a promising alternative. Need of the study: Women with ovulatory dysfunction commonly undergo IUI, but the optimal ovulation-induction agent remains unclear. CC may impair endometrial receptivity, while letrozole offers more favourable physiological effects. Comparative evidence is needed to determine which regimen improves pregnancy outcomes in this population. Aim: The present study aims to compare the efficacy of letrozole with Human Menopausal Gonadotropin (HMG) and CC with HMG in infertile women with ovulatory dysfunction undergoing IUI. Materials and Methods: The current study is a Randomised Controlled Trial (RCT) that will be conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, from June 2024 to May 2026. A total of 142 women aged 20-38 years with ovulatory dysfunction will be enrolled and randomly assigned to two groups: Group A will receive CC 50 mg twice daily from Day 2 to 6; Group B will receive Letrozole 2.5 mg twice daily from Day 2 to 6. Both groups will receive IM HMG 75 IU from Day 6 to Day 10. Ovulation will be monitored by transvaginal ultrasonography and triggered with Human Chorionic Gonadotropin (hCG) once dominant follicles reach 18-20 mm, followed by IUI. The primary outcomes are the clinical pregnancy rate (confirmed by ultrasound) and biochemical pregnancy rate (positive β-hCG test). Secondary outcomes include endometrial thickness, number of dominant follicles, perifollicular blood flow, and incidence of Ovarian Hyperstimulation Syndrome (OHSS). Numerical data will be presented as mean±Standard Deviation (SD) or proportions. Continuous variables will be tested for normality using the Shapiro-Wilk test. Normally distributed data will be compared using the independent samples t-test; non-normally distributed data will be compared using the Mann-Whitney U test. A p-value of <0.05 will be considered statistically significant.

Efficacy of Fortified Finger Millet Cookies with and Without Trikatrayadi Lauha versus Pearl Millet Cookies for Iron Deficiency Anaemia in Preschool Children: A Randomised Controlled Trial Research Protocol

Sameer Suresh Muratkar, Renu Rathi, Bharat Rathi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Introduction: Iron Deficiency Anaemia (IDA) is widely prevalent among preschool children in India and poses a major health concern. Ayurveda describes Pandu as analogous to IDA, emphasising the importance of nutritional interventions. Need of the study: Millets have been selected as the primary food-based intervention due to their beneficial properties, including Tikta, Madhura and Kashaya rasa (bitter, sweet and astringent tastes), Shita virya (cold potency), Snigdha guna (unctuousness) and Balya (strength-promoting qualities). Pandu is considered a Pitta-dominant disorder and millets are known to help in pacifying Pitta. Furthermore, the Snigdha and Balya properties may help reduce dryness, tissue weakness, emaciation and degeneration as described in the pathogenesis of Pandu. Cookies have been chosen as a convenient delivery form to improve acceptability and compliance. The incorporation of Pippali, Anjir and Kismish (PAK), along with Trikatrayadi Lauha Kalpa, is intended to enhance the nutritional and therapeutic value of the formulation. Thus, there is a need to explore effective food-based interventions for the management of Pandu and this study aims to contribute to this area. Aim: To compare the efficacy of PAK (Pippali, Anjir, Kismish)-fortified finger millet cookies with and without Trikatrayadi Lauha and PAK-fortified pearl millet cookies in children with IDA. Materials and Methods: A triple-arm, randomised, double-blind, superiority-controlled clinical trial will be conducted at Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACH and RC), Sawangi (Wardha), Maharashtra, India, along with nearby Government Anganwadi centres and Government Vaccination Centres in Wardha district from March 2026 to September 2026. A total of 180 children aged 3-6 years diagnosed with mild to moderate anaemia will be enrolled. Participants will be randomised into three equal groups using computer-generated block randomisation. Group-X: Finger millet cookies fortified with Trikatrayadi Lauha, Group-Y: Finger millet cookies only, Group-Z: Pearl millet cookies. Each child will receive two cookies daily for 90 days. Haemoglobin levels and clinical parameters will be assessed at baseline and at the end of the intervention period. Continuous variables will be expressed as Mean±Standard Deviation (SD) and compared using Analysis of Variance (ANOVA). Categorical variables will be analysed using the Chi-square test. A p-value <0.05 will be considered statistically significant.

Novel Lipid Indices and Lipoprotein(a) in Cardiovascular Risk Stratification for Chronic Kidney Disease: A Narrative Review

TM Shiva Ganesh, Vignessh Raveekumaran, Chandrasekar Kulli Thirugnanam, Sathiya Sai Kiruba Kennedy Babu Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Chronic Kidney Disease (CKD) is a major and growing global health challenge affecting millions of individuals worldwide. Cardiovascular Disease (CVD) remains the leading cause of morbidity and mortality in patients with CKD, with atherosclerotic CVD contributing substantially to adverse outcomes. Traditional lipid parameters often fail to adequately capture the complex dyslipidaemia associated with CKD, resulting in underestimation of cardiovascular risk. In addition to elevated Triglycerides (TG) and reduced High-Density Lipoprotein Cholesterol (HDL-C), patients with CKD frequently exhibit increased levels of Lipoprotein(a) {Lp(a)}, an established independent risk factor for atherosclerosis and thrombosis. In recent years, several novel lipid indices derived from conventional lipid parameters and Lp(a) have emerged as potentially superior markers of atherogenic risk. These include the Atherogenic Index of Plasma (AIP), Castelli Risk Indices (CRI), Atherogenic Coefficient (AC), and Lipid Tetrad Index (LTI). Unlike isolated lipid measurements, these composite indices provide a more comprehensive assessment of the balance between atherogenic and protective lipoproteins and may better reflect the unique lipid abnormalities seen in CKD. Although growing evidence suggests that these indices are associated with cardiovascular risk and disease progression in CKD, the available literature remains fragmented, and their clinical utility has not been comprehensively synthesised. The novelty of the present review lies in its integrated evaluation of both Lp(a) and emerging lipid indices as cardiovascular risk assessment tools in CKD. By consolidating current evidence, highlighting pathophysiological links, and identifying existing research gaps, the present review aimed to provide a contemporary perspective on their potential role in improving cardiovascular risk stratification and guiding future research in CKD populations.

The Galectin-3 Paradox: A Review Stating Perspectives from the Standpoint of Inflammatory Processes in Insulin Resistance

K Elakiya, AR Srinivasan, R Jayanthi, Bhargav Kiran Gaddam Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Insulin resistance (IR) forms the core of a wide spectrum of metabolic disorders, including Type 2 Diabetes Mellitus (T2DM), Non Alcoholic Fatty Liver Disease (NAFLD; presently known as Metabolic Dysfunction-Associated Steatotic Liver Disease or MASLD), and cardiovascular complications. Despite the inroads made in comprehending IR, the underlying role of chronic low-grade inflammation in the pathogenesis remains to be unequivocally established. Galectin-3 (Gal-3), is a β-galactoside-binding lectin with documented roles in fibrosis and immune regulation. Gal-3 has recently been figuring in worldwide studies as a key inflammatory mediator associated with IR. Paradoxically, while elevated Galectin-3 levels associate with IR and metabolic dysfunction, experimental evidence suggests a protective role depending on the tissue context and the phase or degree of disease progression. The present review succinctly examines the paradoxical behaviour of Galectin-3 in IR and is based on the documented literature available in established databases, including PubMed, Scopus and Web of Science. The review endeavours earnestly to evaluate the impact of Gal-3 on organ dysfunction and hepatic insulin signalling disruption. Its influence on adipose tissue remodelling, skeletal and cardiac muscle resistance, retinal complications, and peripheral neuropathy was also explored. The article further highlights current challenges in IR diagnosis and strives to discuss the role of emerging biochemical markers. Understanding the dualistic role of Galectin-3 could herald the arrival of novel therapeutic strategies targeting inflammation-driven IR.

Role of Lactate-to-Albumin Ratio and SOFA Score in Predicting Clinical Outcomes in Sepsis and Septic Shock: A Narrative Review

AT Rajasekhar, Chandrasekar Kulli Thirugnanam, Vignessh Raveekumaran, TM Shiva Ganesh Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Infection-associated organ dysfunction or sepsis, was responsible for about 166 million sepsis cases and 21.4 million all-cause sepsis-related deaths globally, representing 31.5% of total global deaths in 2025. Heterogeneous pathophysiology (proinflammatory cytokine storm, microvascular dysfunction, metabolic derangements) makes prognosis difficult. This review assesses how well the LAR predicts clinical outcomes in sepsis and septic shock when compared to the Sequential Organ Failure Assessment (SOFA) score. With a focus on mortality prediction and comparative performance, studies evaluating lactate, albumin, LAR, and SOFA score in adult sepsis populations were considered. Tissue hypoperfusion is reflected in serum lactate, but systemic inflammation and low physiological reserve are indicated by hypoalbuminaemia. By combining these factors, LAR provides better predictive accuracy than any marker by itself. LAR is an independent predictor of 28-day death, with area under the curve values ranging from 0.70 to 0.90, according to many cohort studies. The suggested cut-offs range from 0.96 to 1.5, and higher levels are always linked to greater mortality. The SOFA score is still a reliable method for evaluating organ failure and forecasting results. According to new research, LAR may provide incremental or even better prognostic value in some situations and correlates with SOFA. LAR is an accessible and promising biomarker for early sepsis risk assessment. It may improve prognosis accuracy when combined with the SOFA score. However, prior to widespread clinical use, cut-off standardisation and validation via prospective multicentre trials are required.

Advanced Bioengineered and Molecularly Targeted Strategies in Diabetic Wound Healing: A Literature Review

Mansour Alanazi, Dhaifallah Alenizi, Shereen Mohamed Olama, Raed AlRuwaili, Anshoo Agarwal, Bader Alanazi Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Diabetic Foot Ulcers (DFUs) represent a major complication of Diabetes Mellitus (DM), associated with significant morbidity, elevated risk of lower limb amputation and substantial healthcare costs. Conventional wound management strategies frequently prove inadequate given the complex pathophysiology of diabetes-associated impaired tissue repair, driving a paradigm shift towards advanced bioengineered, molecular and nanotechnology-based therapeutic approaches. The present literature review comprehensively evaluates the evidence for six major therapeutic domains: bioengineered skin substitutes, growth factor therapies, nanotechnology-based drug delivery systems, regenerative medicine modalities {Mesenchymal Stem Cell (MSC) therapy, exosome therapy, Platelet-Rich Plasma (PRP) and gene therapy}, Hyperbaric Oxygen Therapy (HBOT) and emerging multimodal smart platforms. Bioengineered skin substitutes- including Apligraf, Dermagraft and EpiFix- demonstrated superior wound closure rates compared to conventional dressings across multiple Randomised Controlled Trials (RCTs) and meta-analyses. Becaplermin {recombinant Platelet-Derived Growth Factor (PDGF) –BB}, the sole Food and Drug Administration (FDA)-approved molecularly targeted agent for DFUs, achieved complete wound healing in 48% of patients versus 25% in the placebo group (p=0.007). Nanotechnology platforms demonstrated transformative antibacterial, antioxidant and sustained drug delivery potential, although a significant translational gap between preclinical and clinical evidence persists. Regenerative medicine modalities- including MSC therapy, exosome-based therapies, PRP and HBOT- each demonstrated clinically meaningful benefits in refractory or high-risk DFUs. No single therapeutic modality fully addresses the multifactorial pathological deficiencies of diabetic wound healing. An evidence-based, patient-stratified, multimodal approach- integrating bioengineering, molecular biology, nanotechnology and regenerative medicine- represents the optimal strategy for improving clinical outcomes in DFUs. A Wagner-grade-stratified treatment algorithm is proposed to facilitate evidence-based clinical decision-making.

Prognostic Significance of Human Spermine Oxidase Expression in Oral Squamous Cell Carcinoma: A Literature Review

Akash Shegaonkar, Minal Chaudhary, Smita Chaware, Aayushi Pakhale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Oral Squamous Cell Carcinoma (OSCC) is one of the most prevalent malignancies of the head and neck region and is characterised by its aggressive nature, which significantly impacts diagnosis and prognosis. Early detection and the identification of reliable prognostic biomarkers are therefore crucial for improving patient outcomes and guiding treatment strategies. The complex involvement of polyamine metabolism in carcinogenesis is a recent development in molecular oncology, highlighting the role of Spermine Oxidase (SMOX) in various cellular functions such as Deoxyribonucleic Acid (DNA) synthesis, cellular proliferation, modulation of ion channel function, cellular signalling, nitric oxide synthesis, and inhibition of immune responses. These functions underline its role in various cancer types. Elevated polyamine levels observed in OSCC are associated with tumour initiation and progression; however, their detailed expression profile and potential value as diagnostic and prognostic markers in OSCC are not yet well-defined. This review seeks to consolidate evidence regarding the expression of human SMOX in OSCC biology, elucidating its prognostic significance and therapeutic potential by addressing current knowledge gaps.

Use of Artificial Intelligence in Analysing Recent Trents in Sleep Disorder: A Comprehensive Review

Bingu Shiv Kiran Reddy, Babaji Ghewade, Ulhas Jadhav, Sameer Adwani, Vivek Alone Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Sleep disorders affect a large proportion of the population and are traditionally diagnosed using nocturnal polysomnography; however, they are laborious and expensive. Emerging Artificial Intelligence (AI) has modified the diagnosis and disease management strategies for sleep disorders. Moreover, machine learning and deep learning algorithms may precisely recognise disorders including narcolepsy, insomnia, and Obstructive Sleep Apnoea (OSA) utilising intricate electrophysiological information. These modalities aid in evaluating sleep patterns, thereby facilitating earlier diagnosis and tailored management. Integration of the Internet of Medical Things (IoMT) with peripheral devices enables real-time monitoring of past clinical settings. AI-driven tools optimise clinical workflows, minimise healthcare costs, and reduce dependency on manual assessment. Moreover, AI improves clinical outcomes and treatment adherence by enabling accurate phenotyping and personalised treatment modifications. Despite requiring specific procedures, unpredictable sensor information, data privacy issues, algorithm robustness and regulatory compliance are under investigation. The current comprehensive review emphasises the transformative role of AI in sleep medicine, highlighting its capacity to enhance patient quality of life, optimise management strategies and improve diagnostic accuracy.

Leveraging Artificial Intelligence for the Diagnosis and Management of Obstructive Sleep Apnoea: A Narrative Review

Saurav Rajnish Shah, Dhwani Sheth, Ajay Ramchandra Kamble, Harshil Dobariya, Viraj Gupta Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Recurrent upper airway blockage during sleep, sleep architecture disruption, intermittent hypoxaemia, and increased cardiovascular and neurocognitive morbidity are all symptoms of Obstructive Sleep Apnoea (OSA), a prevalent disease. The gold-standard diagnostic method, Polysomnography (PSG), is limited by patient discomfort, infrastructure requirements, and cost. At the same time, within the frameworks of Machine Learning (ML) and Deep Learning (DL) architectures, Artificial Intelligence (AI) has become a paradigm for change. These can retrieve predictive and diagnostic information from a variety of signals and images. The present review provides an overview of recent AI techniques, including Support Vector Machines (SVM), Random Forests (RF), neural networks, Convolutional Neural Networks (CNN), transformers, and hybrid expert systems, and discusses their applications in OSA screening, event detection, severity estimation, therapy planning, and compliance prediction. Technologies incorporated into wearables or contactless platforms, such as radar sensors, pulse oximeter rings, and AI-enabled household appliances, as well as ENT (Otorhinolaryngology) applications in anatomical phenotyping and surgical outcome prediction, are of particular interest. Thereby, the present review aimed to provide Ear, Nose and Throat (ENT) practitioners with a thorough overview of AI's capabilities, limitations, and potential applications in precision sleep medicine.

Burnout among Dialysis Nurses and Technicians: A Narrative Review

Aksa Shibu, Biplab Bera, Keziah John Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Burnout is a chronic occupational psychological strain or stress. Haemodialysis nurses and technicians are healthcare professionals dealing with End-Stage Renal Disease (ESRD) patients. Sociodemographic characteristics, work environment and stress are some of the factors causing burnout in haemodialysis nurses and technicians. And also, the burnout is influenced by high workload, low salary, and poor professional relationships. The most commonly used burnout measurement tools are the Maslach Burnout Inventory, Burnout Measure, Oldenburg Burnout Inventory (OLBI), Copenhagen Burnout Inventory, Shirom-Melamed Burnout Measure (SMBM) and Burnout Assessment Tool (BAT). Burnout in this population is typically characterised by three key dimensions. They are emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment, which are highly prevalent among haemodialysis nurses. The impact of burnout extends beyond individual well-being, affecting patient care quality, workforce stability, and the overall healthcare system.

Leptospiral Sphingomyelinase 2 (Sph2): A Multifunctional Virulence Factor in Pathogenesis and Diagnostics

Mushrraf Yusuf Khan, Aditi Warghade, Jaishriram Rathored Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Leptospiral Sphingomyelinase 2 (Sph2) is identified as one of the important virulence determinants and it is a potential biomarker in detecting leptospirosis at its initial stages. Empirical studies have proved that Sph2 is actively released in infection and its activity may be detected in serum and urine of patients. The presence of Sph2 in such biological fluids is an important diagnostic parameter that can be used to differentiate between leptospirosis and other febrile diseases that can have similar clinical features. Furthermore, clinical studies have shown that the levels of Sph2 in the urine of patients with a concurrent infection of dengue and leptospirosis double, which suggests its possible use in the endemic areas with both of these pathogens. The Sph2-based assays have demonstrated sensitivity ranging from 80.6% to 91% and specificities ranging from 67% to 100%, high and as compared to the traditional antibody-based assays, especially in the early stages of infection when humoral responses are yet to be developed. However, there are a few issues, such as strain-dependent fluctuations in the expression of Sph2 and the need to standardise detection protocols. Even with these limitations, integrating Sph2 detection into rapid and easy-to-use diagnostic tools- like lateral flow or biosensor-based assays- could significantly improve the early and accurate diagnosis of leptospirosis, particularly in resource-limited healthcare settings.

Tumour Treating Fields in Solid Tumours: Integrating Physics with Cancer Treatment

Ram Pukar Bharat, Ravi Kanodia, Amol Shankar Dongre Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Tumour Treating Fields (TTFields) are non-invasive cancer treatment modality. They disrupt mitotic spindle formation and cytokinesis, inducing mitotic arrest and apoptosis, while also affecting Deoxyribonucleic Acid (DNA) repair, membrane permeability, and anti-tumour immunity. TTFields are clinically approved for the treatment of Glioblastoma Multiforme (GBM) and Malignant Pleural Mesothelioma (MPM). When combined with standard therapies, TTFields have been shown to significantly improve Progression-Free Survival (PFS) and Overall Survival (OS). Ongoing clinical trials are evaluating their efficacy in advanced ovarian cancer, Pancreatic Adenocarcinoma (PAC), and Non-Small Cell Lung Cancer (NSCLC) in combination with systemic therapies. Treatment is generally well tolerated, with mild, localised skin reactions being the most common adverse effect, supporting TTFields as a safe and effective adjunctive therapy for aggressive tumours.

A Narrative Review on Biomarkers of Diabetic Nephropathy: Critical Assessment of Conventional and Emerging Indicators

R Selva Balaji, N Vishnu Prasath, R Kannan, Ramadurai Murugan, Pachaiyappan Murugan Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Diabetic Nephropathy (DN) is the leading cause of Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) worldwide, posing a major clinical and socioeconomic burden. Early diagnosis remains difficult, as conventional biomarkers such as albuminuria and estimated Glomerular Filtration Rate (eGFR) often indicate renal injury only after irreversible damage has occurred. Recent research has identified promising biomarkers linked to inflammation, tubular damage, fibrosis, metabolic imbalance, and molecular alterations, underscoring the need for updated insights into their clinical value. The present review critically examines both established and emerging biomarkers of DN, highlighting their biological relevance, diagnostic utility, and limitations. Emphasis is placed on the shortcomings of single biomarkers and the potential of multi-marker approaches that integrate clinical parameters to improve risk assessment and support personalised treatment. Emerging indicators reflecting inflammation, tubular injury, fibrosis, and metabolic dysregulation show improved sensitivity for early and normoalbuminuric stages of disease. Despite these advances, challenges in standardisation, validation, and clinical implementation persist. Addressing these gaps is essential to advance precision nephrology and improve patient outcomes in DN.

Long-term Outcomes of Corneal Involvement in Thyroid Eye Disease: A Narrative Review

Suyash Singh, Sachin Daigavane Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Thyroid Eye Disease (TED), an autoimmune inflammatory condition of the orbit, can result in a variety of ocular surface issues, including corneal breakdown. Although corneal involvement is less common than other manifestations such as proptosis or diplopia, it can result in significant morbidity and visual impairment if not promptly managed. The present narrative review explores the long-term clinical outcomes associated with corneal involvement in TED. Literature reporting ocular conditions, including exposure keratopathy, epithelial defects, and corneal ulceration in patients with TED, was considered. Although relatively rare, corneal complications in TED carry a risk of serious visual sequelae. Long-term prognosis depends largely on the severity at presentation and timeliness of intervention. Routine corneal monitoring and a proactive management approach are essential for preserving ocular integrity and vision in affected individuals. Therefore, the aim of the present review was to evaluate the long-term visual and corneal outcomes in patients with TED presenting with corneal involvement, and to assess the extent of residual ocular surface morbidity over time.

Recent Advances in Therapeutic Management of Invasive Ductal Carcinoma: A Narrative Review

Abhishek Ghose Biswas, Kishore Hiwale Journal of clinical and diagnostic research : 2026 - August - 20:0973-709X Invasive Ductal Carcinoma (IDC), a frequently reported subtype of Breast Cancer (BC), is affected by complex pathogenic processes, including Hormone Receptors (HR) signaling and growth factors. For initiation and development of IDC, deregulating Oestrogen Receptor (ER) signaling pathways plays a critical role by affecting cell growth, variation, and survival. Moreover, diverse Progesterone Receptor (PR) signaling mechanism modified ER-driven transcription factors, leading to endocrine resistance. Interestingly, tumour signaling mechanisms are strengthened by interaction between ER or PR and human Epidermal Growth Factor Receptor 2 (HER2/neu). Over-expression of HER2 allows proliferation via Protein Kinase B or Phosphoinositide3-kinase, and Mitogen-Activated Protein Kinase (MAPK) pathways, thereby leading to ER-independent mechanisms as well as resistance to Endocrine Therapy (ET). Emergent multi-omics interventions including single-cell and next-generation sequencing, and mass-spectrometry imaging, have unraveled molecular heterogeneity in IDC, thereby offering insights into Ductal Carcinoma In Situ (DCIS) progression to IDC and facilitate novel biomarker identification treatment prognostication. In a similar context, advancements of targeted therapies, including dual HER2 inhibition, antibody-drug conjugates, and combination treatments with endocrine agents, have enhanced personalised treatment strategies, although needs further clinical investigation. Thus, the present review aims to elucidate the role of molecular diagnostics and targeted therapeutics in IDC management, integrating existing literature to improve clinical management in IDC and tailored future research.