Table of Contents : Journal of clinical and diagnostic research : 2024 - April - 18

Ectopia Lentis with Retinal Detachment in a Patient with Marfan Syndrome: A Case Report

Devwrath Suneet Upasani, Sachin Daigavane, Swapneel Mathurkar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Marfan syndrome is an autosomal dominant hereditary connective tissue disease caused by mutations in the Fibrillin-1 gene located on chromosome 15q15-21. Fibrillin is a specific type of glycoprotein widely distributed throughout the body, contributing to the elasticity and load-bearing capacity of connective tissue. Marfan syndrome is a multisystem disorder that affects the cardiovascular system, musculoskeletal system, and the eyes. Patients with Marfan syndrome can experience life-threatening complications such as aortic aneurysms, aortic dissection, and mitral valve prolapse. However, most patients initially present to an ophthalmologist with ocular symptoms, necessitating the ophthalmologist to diagnose and counsel the patient about the disease and its complications. A 23-year-old female patient presented to the Ophthalmology Outpatient Department (OPD) with complaints of diminished visual acuity in both eyes since birth. The patient exhibited cataractous changes in the lens with dislocation in the superotemporal quadrant in both eyes. Furthermore, the patient experienced rhegmatogenous retinal detachment in her left eye. The patient underwent scleral belt buckling and pars plana vitrectomy with silicone oil insertion in the left eye, as well as cataract extraction with Posterior Chamber Intraocular Lens (PCIOL) implantation in the right eye. Marfan syndrome can impact visual function in various ways. The present case report underscores the ocular manifestations of Marfan syndrome and the management of patients with developmental cataracts, subluxation, and retinal detachment due to high myopia.

Allergic Reaction to Aminophylline in a Case of Lower Respiratory Tract Infection with Measles: A Rare Case Report

Anuja Satish Handargule, Amar Taksande, Revat Meshram, Poonam Uke Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Measles is an acute respiratory infectious disease caused by the measles virus. It leads to respiratory involvement with manifestations such as pneumonia, laryngobronchitis, pneumonitis, etc. It can also cause secondary bacterial and fungal infections. Aminophylline is a methylxanthine bronchodilator composed of theophylline and ethylenediamine. Airway blockage is reversed by bronchial smooth muscle relaxation, increased myosin light chain kinase activity, and decreased intracellular calcium concentration. It relaxes the smooth muscle of the bronchial airways and pulmonary blood vessels, reducing airway responsiveness to histamine, methacholine, adenosine, and allergens. Allergic skin reactions secondary to aminophylline administration have been rarely seen. Aminophylline can be given orally as well as intravenously. A seven-month-old male infant presented with a lower respiratory tract infection and a maculopapular rash involving the face and trunk. A history of contact with measles was present. Intravenous aminophylline was administered for persistent wheezing. The infant developed a generalised erythematous papular rash with a more widespread distribution than before within one hour of administration. The child was treated with antihistamines for the same. After a detailed physical examination, looking at the pattern of the rash and excluding other causes like environmental factors and drug history, the diagnosis of an allergic reaction to aminophylline was made. Early identification of allergic reactions is paramount, as prompt cessation of the offending agent and initiation of appropriate medical interventions can significantly mitigate the severity of the reaction and prevent potential life-threatening complications.

Acute Dystonia Associated with Low-Dose Aripiprazole in a Male Child: A Case Report

Bharat Udey, Jawahar Singh, Jagriti Bhatia Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Aripiprazole is a newer anti-psychotic agent with low liability for Extrapyramidal Symptoms (EPS). Acute dystonia develops due to a lack of dopamine, resulting in a relative overactivity of cholinergic neurons. In the past, cases of Aripiprazole-induced acute dystonia have been reported more frequently among adults than children. Here, the authors present a case in which acute dystonia developed at a very low dose (2 mg) of Aripiprazole. The case involves a 10-year-old boy diagnosed with Oppositional Defiant Disorder (ODD) who exhibited aggressive behaviour and irritability. Aripiprazole (2 mg) was initiated for treatment, but after five days, the patient developed excessive sleepiness, slurred speech, oculogyric crisis, and torticollis, indicative of acute dystonia. To rule out any organic causes, a detailed assessment and investigations were conducted, including complete blood counts, liver and kidney function tests, serum calcium, electrolytes, ceruloplasmin, blood copper levels, slit-lamp examination for Kayser-Fleischer ring, and electroencephalography, which did not reveal any significant organic conditions. Aripiprazole was discontinued, and Promethazine was administered. The dystonia score on the Unified Dystonia Rating Scale (UDRS) decreased from 10 to 0 in 5 days, indicating complete resolution of dystonia. Naranjo’s causality assessment score was seven, reflecting the probable association of aripiprazole with acute dystonia. This case emphasises the importance of monitoring for adverse reactions to anti-psychotic medications, particularly in paediatric patients, and the need for prompt recognition and management of adverse effects to ensure patient safety and treatment efficacy. To the best of our knowledge, this is the first case report of acute dystonia in a child at such a low dose of Aripiprazole. Clinicians should be vigilant for the emergence of such significant adverse effects of commonly used drugs.

Intraductal Papilloma of the Breast: A Case Report

Sudhir Ramchandra Jayakar, Virendra Sudhakar Athavale, Prachi Virendra Athavale, Sheetal Sudhir Jayakar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Intraductal papilloma of the breast is a rare benign tumour. The polypoid lesions arising from the nipple surface include papillomas and fibroepithelial stromal polyps. These lesions must be distinguished from malignant nipple lesions, such as Paget’s disease of the nipple or malignant breast conditions involving the nipple. Solitary papillomas (solitary intraductal papillomas) are single tumours that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast, and can be felt as a small lump behind or next to the nipple. Papillomas may also be found in small ducts in areas of the breast farther from the nipple. Multiple papillomas, which are growths that are less prone to generate nipple discharge, were present in this case. In papillomatosis, there are very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are. In order to distinguish between these disorders, a thorough clinical examination and imaging are essential. This case report describes a 36-year-old female who presented with swelling from the left nipple. Sonography of the left breast revealed a dilated duct in the left retro-areolar region with a focal isoechoic component within the duct {American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS 4B)}. The patient underwent core excision of the duct, and histopathological analysis confirmed the diagnosis of papilloma with changes of adenosis without atypia.

Recurrent Spontaneous Perforation of Urinary Bladder due to Tuberculosis: A Case Report

Veracious Cornerstone Wann, Laltanpuii Sailo, Stephen Lalfakzuala Sailo, Donboklang Lynser, Nagha Danal Marak Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Although tuberculosis most commonly causes thickening and contracture of the urinary bladder, rarely, inflammatory infiltration with central necrosis and perforation may occur. Hereby, the authors present a case report of a 24-year-old man with recurrent spontaneous perforation of the urinary bladder due to tuberculosis. In the first presentation, he recovered well with conservative treatment. In the second presentation, he underwent ileal augmentation cystoplasty, and he did well after the definitive surgery. To the best of authors’ knowledge, this is the first report of recurrent perforation of tuberculous urinary bladder. Perforation of the urinary bladder due to tuberculosis is a rarity, and a high index of clinical suspicion and appropriate investigation is needed for timely diagnosis and treatment.

Blockbuster Laryngeal Mask Airway as a Rescue Device in Paediatric Patient with Retrognathia Posted for Microtia Reconstruction Surgery: A Case Report

Madhu, Monika, Roopa, Himadri Chanda, Nitu Yadav Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X The first and second branchial arches, along with the first branchial cleft, contribute to the development of ear and mandible. Children with microtia can have retrognathia or micrognathia and have challenging airway management. Managing the airway in these patients presents a significant challenge for anaesthesiologists as they have the potential for upper airway obstruction and challenging tracheal intubation because of facial deformities. Although awake fiberoptic intubation is a well-accepted method for handling difficult intubations, it can be uncomfortable and stressful for paediatric patients. Moreover, it demands expertise and is unsuitable for patients unwilling to undergo awake intubation. This case report highlights the use of the blockbuster Laryngeal Mask Airway (LMA) in an 11-year-old retrognathic child with microtia with anterior larynx scheduled for auricular reconstruction surgery. There was a failure to secure the airway with multiple attempts at traditional intubation and the supraglottic airway device i-gel, as the child had an anterior larynx and Cormack Lehane (CL) grading of 4 on direct laryngoscopy. The blockbuster LMA, distinguished by its innovative design facilitating both ventilation and intubation through an integrated channel, emerged as a pivotal alternative. The supraglottic device is not the technique of choice, but it can definitely be an alternative and could be life-saving in situations where fiberoptic bronchoscopy and tracheostomy are not available.

Gracilis Flap Restoring Quality of Life in a Patient with Non Functional Anal Sphincter

Simran Dhole, Firoz Borle, Suhas Jajoo, Chandrashekhar Mahakalkar, Shivani Kshirsagar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X An excellent technique for reconstructing the perineum following extensive perineal resection for restoration of a traumatised anal sphincter is the Gracilis myocutaneous flap. Direct anal trauma or pelvic injuries can separate the anal sphincters. An overlapping sphincteroplasty has a fair possibility of regaining acceptable fecal continence if roughly half of the sphincter ring is still functional. A case of a 22-year-old male who underwent Gracilis myocutaneous flap reconstruction after being diagnosed with a non functioning anal sphincter is reported. A free muscle transplant was done to repair the sphincter, utilising denervated muscle with an intact blood supply. New muscle was attached to those sphincter muscles which were still functional. The transplanted muscle receives new muscular fibers, enabling the repaired sphincter to contract voluntarily in addition to reflexively. The surgical approach is determined based on the presented sphincter defect. Free muscle transplantation can be preferred in cases where the external sphincter has some degree of functionality.

Multiple Cranial Nerve Involvement in a Complex Case of MISME Syndrome in a Paediatric Patient: A Case Report

Afwaan Faizal, Michael Antony Vikram, Ajay Lucas Rubben Prabhu, Dinesh Babu Jawahar, Sam Raja Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Neurofibromatosis 2 (NF2) is characterised by numerous tumours in the central and peripheral nervous systems due to NF2 gene abnormalities that cause the tumour suppressor protein, Merlin, to disappear. Often referred to as Multiple Inherited Schwannomas, Meningiomas, and Ependymomas (MISME), a distinctive characteristic of NF2 is bilateral vestibular schwannomas manifesting in late adolescence with symptoms such as sensorineural hearing loss, tinnitus, and balance issues. Two distinct phenotypes, Wishart and Feiling-Gardner, characterise NF2. This case report discusses the case of a paediatric patient who presented with bilateral hearing loss, giddiness, and blurring of vision and sought a Magnetic Resonance Imaging (MRI) examination which revealed bilateral vestibular schwannomas, non vestibular schwannomas, left sphenoid wing meningiomas, multidirectional spinal schwannomas, spinal nerve sheath tumours, and lesions in the retroperitoneal region. Despite an absent family history, significant involvement of cranial nerves strongly indicates classical NF2. Management focuses on preserving function, and surgery is contemplated for symptomatic lesions and tumours causing cord compression. Gamma Knife radiosurgery and targeted therapies have been investigated.

Chondroid Lipoma: A Rare Variant of Lipoma

Samadrita Paul, Balaji Pachipulusu, VK Varsha, Poornima Chandra Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Lipoma is a benign, growing tumour of mesenchymal origin composed of mature fat cells and adipocytes. They can occur in the subcutaneous layer or at intramuscular or intermuscular sites. Oral lipoma, a benign tumour of mesenchymal origin composed of mature adipocytes and usually surrounded by a thin fibrous connective tissue capsule, is rare and mostly found on the buccal mucosa and tongue. Hereby, the authors present a case of Chondroid Lipoma (CL), a very rare subtype of lipoma involving the ventral surface of the tongue in a 50-year-old female patient. The Chondroid Lipoma, a variant of lipoma, is extremely rare in the oral and maxillofacial region containing both embryonal fat and cartilage.

Pericardial Effusion and Superficial Abdominal Abscess as Complications of Malposed PICC Line in a Preterm Neonate: A Case Report

Asritha Komandla, Aditi Rawat, Sagar Karotkar, Bhavana Lakhakhar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X In neonatal critical care units, peripherally inserted central catheter lines are frequently used to provide venous access for continuous parenteral nutrition and medications in newborns. In this case report, a male neonate weighing 1270 grams was on Continuous Positive Airway Pressure (CPAP) for hyaline membrane disease and initially received Total Parenteral Nutrition (TPN) through a Peripherally Inserted Central Catheter (PICC) in the left long saphenous vein on the second day. The baby developed tachycardia, respiratory distress requiring mechanical ventilation, and erythematous swelling over the paraumbilical region. A diagnosis of pericardial effusion and superficial abdominal abscess secondary to a malposed PICC line in a preterm, very low birth weight neonate was made. Suspecting a misplaced line, it was immediately removed, and the patient showed improvement over the next 24 hours. Within the next 48 hours, the patient was extubated to CPAP. Therefore, daily inspection by an expert, as well as confirmation of the central line tip, will aid in preventing delays in detecting complications.

Airway Challenges in a Child with Treacher Collins Syndrome having Ventricular Septal Defect, Oculofacial Malformations and Oesophageal Atresia: A Case Report

Janhavi Dahake, Neeta Verma Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Treacher Collins Syndrome (TCS), also known as Franceschetti syndrome, is an autosomal dominant condition marked by various developmental anomalies confined to the head and face. It primarily affects craniofacial structures derived from the first and second branchial arches. Patients usually present with down-slanting palpebral fissures, mandibular hypoplasia, lower eyelid colobomas, external ear malformations, and hearing loss. Congenital heart defects and cryptorchidism are two other unusual anomalies. It is typically a bilateral condition. The symptoms and physical features of TCS can vary greatly from person to person. Some individuals may be affected so mildly that their condition goes undiagnosed, whereas others may develop serious, life-threatening complications. Individuals with TCS may require specialised airway management due to a narrow mouth aperture and micrognathia. They are best served by an interprofessional team that can coordinate all aspects of their care. Timely detection and management can improve the quality of life for these patients. The present case report presents the airway challenges in an eight-year-old child with TCS who has congenital malformations and presented with swallowing difficulty, which was later diagnosed as oesophageal atresia.

Ultrasound-guided Brachial Plexus Block as a Sole Anaesthetic Technique in a Child for Fixation of Humerus Fracture: A Case Report

S Parthasarathy, Thalangara Mukhthar Abdulla Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Managing supracondylar fractures provides distinct problems in the complex setting of paediatric trauma. A 36-month-old male child was admitted with accidental injury and supracondylar fracture of left humerus. There were no other injuries. The child was planned open reduction and internal fixation in the right lateral position. The plan was to administer nerve block. To satisfactorily transfer the baby, the authors administered 5 mg of oral diazepam to the mother after explanation. The patient was smoothly transferred inside with syrup promethazine 5 mL. After securing an intravenous access, and an intravenous pethidine of 10 mg, he was administered ultrasound guided brachial plexus block with a supraclavicular approach with 5 mL of 0.5% bupivacaine. The pain subsided and the patient slept well. The surgery and the postoperative period were uneventful. The authors concluded that sedating the mother prior will help in separation and nerve blocks can be administered in children in precise sites with the help of ultrasound but without supplemental general anaesthesia. This report is the first case report to do without the use of any intravenous anaesthetic drugs.

Desmoid Fibromatosis Presenting with Gastrointestinal Manifestations in a Patient with Ehlers-Danlos Syndrome: A Case Report

Elias Lugo-Fagundo, Edmund M Weisberg, Ryan C Rizk, Elliot K Fishman Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Ehlers-Danlos syndrome comprises 13 hereditary connective tissue disorders associated with skin hyperelasticity, joint hypermobility, atrophic scarring, and blood vessel fragility. Hypermobile EDS, the most common subtype, has no clear genetic or molecular source. When presented with wide-ranging clinical symptoms, it requires effective clinical diagnosis. A 31-year-old female with hypermobile EDS underwent an abdominal Computed Tomography (CT) scan displaying a 2.9 cm soft-tissue mass possibly arising from the terminal ileum, which was revealed to be a desmoid fibromatosis. It is believed that Gastrointestinal (GI) manifestations may be associated with EDS, specifically the hypermobile subtype. The patient demonstrated manifestations commonly seen throughout the literature on hypermobile EDS, including abdominal pain, nausea, and diarrhoea. With symptoms worsening, a follow-up CT disclosed an enlargement of the ileocecal desmoid tumour, measuring 5.1 cm. Because all the subtypes of EDS share features such as tissue fragility, joint hypermobility, and skin hyperextensibility, and many of the manifestations are insufficient to establish a diagnosis, imaging modalities are essential for proper identification and patient management. Given the patient’s medical history and the involvement of EDS and desmoid tumours with connective tissue, there is a strong linkage between desmoid fibromatosis and the patient’s hypermobile Ehlers-Danlos diagnosis. The available literature does not clearly attribute such a tumour to the syndrome. This patient’s symptoms represent a possible association between hypermobile EDS and desmoid fibromatosis, warranting future research in this area. The patient is now stable and was recently discharged.

Diagnosis of Cardiac Metastasis on Pericardial Fluid Cytology in a Patient of Urothelial Carcinoma of Bladder: A Case Report

Ramnik Singh, Sonam Billawaria, Neha Desai, Rutuja Khawale, Gauri Patil Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Bladder cancer ranks as the 9th most common malignancy worldwide within the urinary system. Urothelial carcinoma stands as the predominant histologic type in the United States and Western Europe, constituting approximately 90% of bladder cancer cases. While common sites of metastasis for urothelial carcinoma typically involve regional and distinct lymph nodes, the liver, lungs, and bones, instances of metastasis to the pericardium are rare. Roughly 10% of urothelial carcinoma cases exhibit cardiac metastasis, often remaining clinically asymptomatic. Hereby, the authors present a rare case of symptomatic pericardial infiltration originating from urothelial carcinoma in a 32-year-old male. The patient initially presented with a two-week history of progressive dyspnoea on exertion and had been previously diagnosed with high-grade transitional cell carcinoma with squamous differentiation upon histopathological examination and urothelial carcinoma on a Positron Emission Tomography (PET) scan 12 months earlier. Following neoadjuvant chemotherapy and radiotherapy, the patient exhibited a partial response to the treatment. However, despite the effectiveness of the therapies, he developed dyspnoea and pericardial effusion. Although pericardial involvement in advanced malignancies is not uncommon, symptomatic cardiac metastasis from urothelial carcinoma remains rare. Radiographic studies revealed right-sided pleural effusion, while a Computed Tomography (CT) scan of the thorax and upper abdomen (plain and contrast) displayed severe bilateral pleural effusion, pericardial effusion, and metastatic deposits in the mediastinal lymph nodes. Electrocardiography indicated sinus tachycardia, inverted T-waves in leads V1 to V5, and flattening of the T-wave in V6. The patient underwent pericardial tapping, yielding approximately 50 cc of pericardial fluid. A 10 cc of the pericardial fluid was subsequently sent for examination in the Pathology Department, with fluid cytology results indicating the presence of malignant cells.

Implementation of Ayurvedic Treatment Principles in Hepatocellular Jaundice: A Case Report

Pankaj Yadav, Vaishali Kuchewar, Tanika Yadav, Annya Gautam Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Jaundice is a yellow colouring of the skin, mucous membranes, and the conjunctival membrane surrounding the sclera. It is a clinical indication of underlying hepatocellular dysfunction, biliary obstruction, or anomalies in bilirubin metabolism. Kamala might be linked to jaundice based on shared traits. Ayurveda has been well known for treating liver disorders for centuries. In this case report, a 29-year-old male patient, visited the Kayachikitsa outpatient department with primary complaints of pricking pain in the abdomen, loss of appetite, yellow discolouration of urine, nausea, vomiting, generalised weakness, and constipation for 10 days. Based on clinical examination and Liver Function Tests (LFT), he was diagnosed with jaundice. The patient was effectively treated with Shodhan (bio-purification) with sadya virechan (purgation therapy) followed by medicinal treatment for 45 days. Within 7-8 days, there was a significant improvement in abdominal pain with mild tenderness, frequency of vomiting, complaints of anorexia, nausea, constipation, and yellow discolouration of urine, along with substantial improvement in liver function. After 45 days of Ayurvedic treatment, all symptoms and liver functions showed highly significant results. The treatment was given by considering the vitiation of Pitta and Rakta. It can be concluded that by implementing Ayurvedic treatment principles, liver function can be improved in cases of jaundice in a short duration without causing any adverse effects.

Gastric Tuberculosis Accompanied by Cutaneous Fistula: A Case Report

Thulasikumar Ganapathy, Rathnaganpathi Thulasikumar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Gastric Tuberculosis (TB) is a rare presentation. Posterior gastric perforation with tuberculosis complications is extremely unusual. The authors herewith present a case of a 32-year-old male, with complaints of fever for two months and discharge from the left-side of the back for 15 days, through which ingested food particles were drained. The patient was a known case of Type 2 Diabetes Mellitus (T2DM) and was recently diagnosed with pulmonary TB. He was evaluated with an upper Gastrointestinal (GI) endoscopic biopsy, Contrast-enhanced Computed Tomography (CECT), and Gastrografin (GGF) studies to confirm the diagnosis. He presumably developed gastric ulceration with posterior perforation, tracking through the retroperitoneum and presenting as a subcostal abscess that was inadvertently incised and converted into a fistula. He was treated both medically and surgically. He recovered completely and discharged with full course of Antitubercular Treatment (ATT) drugs and didactic medications. The presence of a cutaneous fistula in association with gastric TB underscores the diverse clinical presentations of this infectious disease, emphasising the importance of early detection and tailored management approaches.

Atypical Presentation of Lobular Capillary Haemangioma of the Maxillary Alveolus: A Case Report

Divya Raja, Rabin Chacko, Saurabh Kumar, Arun Paul Charlu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Pyogenic Granuloma (PG) is a benign vascular lesion that rapidly grows, is painless, and presents as a friable, smooth, or lobulated exophytic lesion, manifesting as small, red, erythematous papules with a pedunculated or sessile base. The most common site is the gingiva, followed by the tongue and buccal mucosa. Hereby, the authors present a case of a five-year-old girl who reported for an oral and maxillofacial consultation with a swelling in her left upper gum region, associated with multiple episodes of intermittent bleeding. On presentation, a bluish-red, sessile lesion was observed on the gingiva of the left upper 1st molar. Magnetic Resonance Imaging (MRI) and Angiography provided a provisional diagnosis of a vascular tumour, following which embolisation and excision of the lesion were performed by Interventional Radiologists (IR) and Maxillofacial Surgeons. The patient’s recovery was uneventful, and histopathology{Haematoxylin and Eosin (H&E)} was reported as Lobular Capillary Haemangioma (LCH).

Insight into the Role of Optical Coherence Tomography in Acute Coronary Syndrome following Scrub Typhus: A Case Report

Prasanna Subbaraju, Abilasha Munisingh, Vasundhara Ponnanganti, CS Aravind Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Scrub typhus, an illness stemming from the Orientia tsutsugamushi bacterium within the Rickettsiaceae family, is recognised for its febrile nature and frequently linked to vasculitis-induced complications. The challenges faced in the management of scrub typhus complicated by Acute Coronary Syndrome (ACS) and Multiple Organ Dysfunction Syndrome (MODS) is presented in this case report. Of particular significance, this report introduces a novel approach of employing Optical Coherence Tomography (OCT) to identify the underlying pathology, which guided us in making the treatment decision-a novel application of OCT in infectious disease management yet to be documented in the existing medical literature. In present case, OCT was used and the lesion was characterised to be vasculitic and not atherosclerotic, thereby changing the entire treatment course, benefiting the patient. This innovative utilisation of OCT throws light over vasculitic pathology of present case and emphasises the need for intracoronary imaging in the management of this rare complication of a fairly common tropical disease.

Rehabilitation of Post-COVID-19 Mucormycosis Surgical Defect Using an Unconventional Obturator with Precision Attachments: A Case Report

Supriya Shukla, Preethi Kusugal, Ajay Kumar Nayak, Saurabh Balaso Patil Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Mucormycosis, also known as black fungus, is a rare fungal disease caused by a filamentous fungus that primarily affects the nose, paranasal sinuses, and brain. A significant number of mucormycosis cases were reported during the COVID-19 pandemic, many of which required surgical intervention. Parts of orofacial structures such as the alveolar process of the maxilla, palate, contents of the orbit, and nasal cavity were often removed to prevent a fatalities. The extent of hard tissue structures removed depended on the degree of involvement. Following surgical procedures, individuals were left with a variety of defects, ranging from lost alveolar processes and teeth to partial or total maxillectomy, and oronasal communication due to a missing palate. In such situations, Prosthodontists play a critical role in rehabilitating patients prosthetically. They analyse the defects in each case and design a prosthesis to replace the missing structures, aiding in the restoration of function and aesthetics. Hereby, the authors present a case report of 36-year-old-male with missing teeth in the upper left posterior and anterior regions and this clinical report aimed to describe an innovative aesthetic alternative to conventional cast partial obturators using OT attachments to achieve retention.

A Case Report of Periodontal Regeneration in Failing Tooth by Single Flap Approach Using Sticky Bone and Platelet-rich Fibrin Membrane

Lekha Alanija, Raaja Sreepathy Chandran Selvaraj, Kadhiresan Rathinasamy, Arunmozhi Ulaganathan, Arockiya Antony Praveen Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Periodontal regeneration aims to regenerate the diseased or lost periodontium. Regenerative periodontal therapy utilises growth factors, autogenous soft and hard tissue grafts for the purpose of regeneration. Platelet-rich Fibrin (PRF) is an autologous biomaterial which works on the principle of centrifugation. The injectable PRF (i-PRF) that is formed when centrifuged at low Revolutions Per Minute (RPM) produces an excellent matrix when mixed with bone graft called “sticky bone”. Sticky bone possesses the property of mouldability along with its inherent potential of bone formation. The PRF matrix also enhances the wound healing through the release of various growth factors. PRF membranes which are obtained at higher centrifugation levels also act as a substitute to augment the soft-tissues. The present case is that of a 45-year-old male, who underwent a one-year follow-up for the management of endodontic periodontal lesion in the lower left first molar with sticky bone and PRF membrane by single flap approach. The patient was periodically reviewed clinically and radiographically and prosthetic restoration was given on accessing the radiographic bone fill after six months. After six months there was a significant difference in the radiographic bone fill, along with the reduction in the probing pocket depth from 7 mm to 4 mm and clinical attachment from 9 mm to 7 mm. The results indicate that sticky bone and PRF membrane serves as a predictable source for the management of intrabony defects.

Shining a Light on Hidden Thyroids: A Case Exploring the Potential of Technetium Imaging for Lingual Thyroid Diagnosis

Anbarasi Madoure, MS Vishak, Lokesh Kumar Penubarthi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Ectopic thyroid, the presence of thyroid tissue in locations other than the normal anterior neck region between the second and fourth tracheal cartilages, is the most common form of thyroid dysgenesis. A 32-year-old female patient sought medical attention at the Otolaryngology Department with a foreign body sensation in her throat. To ensure an accurate diagnosis, hereby, the authors conducted a comprehensive diagnostic work-up, which included Technetium-99 (Tc-99m) scanning. Remarkably, the scanning results revealed radiotracer uptake in the base of the tongue while indicating an absence of uptake in the thyroid bed. By shedding light on present captivating case, the present report offers valuable insights into the usage of Technetium imaging in diagnosing doubtful Lingual Thyroid (LT) cases.

Foreign Body Causing Diagnostic Dilemma in Koch’s Abdomen Patient Presenting with Acute Intestinal Obstruction: A Case Report

Ranendra Hajong, Kamthamuon Neihsial, Arup J Baruah, Dathiadiam Tongper, Pinky Rabha Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X The ileocaecal region is the most commonly affected region in Koch’s abdomen; however, it can involve any part of the Gastrointestinal Tract (GIT). Patients usually present late with either features of acute or subacute intestinal obstruction or with features of perforation peritonitis. Early diagnosis of abdominal Tuberculosis (TB) is still challenging due to the vague and non specific symptomatology of the disease. Hereby, the authors present a case report of 11-year-old boy who was on Antitubercular Treatment (ATT) for suspected abdominal TB, presented with features of subacute intestinal obstruction which subsequently had to be operated for acute obstruction. However, the cause of obstruction was not due to the complications of abdominal TB but due to the mechanical obstruction caused by the seeds of bayberry, which got obstructed in the relatively narrowed part of the ileocaecal region due to thickening of the bowel wall. No similar case reports have been found in the literature earlier. Hence, the present case is being reported.

Anaesthetic Considerations in the Video-assisted Thoracoscopic Excision of Pulmonary Aspergilloma: A Case Report

Vipul Krishen Sharma, Chandi Priya Singh Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Video-assisted Thoracoscopy (VATS) is often used for diverse chest and lung ailments, which requires one-lung ventilation utilising a double-lumen tube. It involves small incisions and real-time imaging, resulting in enhanced postoperative recovery. A dry field allows the surgeon better visualisation of the thoracic cavity. To ensure that the patient is fit for prolonged single-lung ventilation, preoperative assessment is vital. While there are advantages and disadvantages to minimally invasive procedures, anaesthesia management and single-lung ventilation are key steps in a successful VATS procedure. Care must be taken to avoid elevated peak pressures intraoperatively. Hereby, the authors present a case report of a 49-year-old smoker with cough, fever, a known treated case of pulmonary Koch’s, and chronic lung disease. After a thorough clinical examination and imaging, he was diagnosed to have a cavitary lesion in the lung, suggestive of Aspergilloma. Authors performed thorough preoperative evaluation prior to surgery, which included pulmonary function tests to help identify the performance of the residual lung. For this patient, VATS was employed to resect the cavitary lesion along with the fungal ball. Single-lung ventilation with a double-lumen endotracheal tube was utilised to collapse the right lung and provide a better operative field. The surgery was uneventful with minimal blood loss, and histopathology confirmed the diagnosis. Due to the minimal access route, the duration of ventilation and recovery is hastened. Appropriate antibiotic/antifungal support, along with aggressive chest physiotherapy and incentive spirometry, is initiated early in such patients, as the pain following VATS is bearable.

Meropenem-induced Haematological Abnormalities in the Elderly: A Series of Three Cases

Sharadashri Rao, Kuladeepa Ananda Vaidya Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Meropenem is a broad-spectrum antibacterial agent given empirically for diseases caused by single or multiple susceptible bacteria in both adults and children with a wide range of serious infections. Several studies have reported an association between meropenem and haematological abnormalities such as leukopenia, thrombocytopenia, neutropenia, and haemolytic anaemia. In this case series, the authors present three cases - one with meropenem-induced leukopenia and the other two with meropenem-induced thrombocytopenia. In the first case, leukopenia was observed on the third day of administration. The leukocyte count dropped to 3,500 cells/mcL but recovered upon discharge. In the other two cases, the platelet count dropped below 1.3 lac/cu.mm on the fourth day of administration but started to recover once the antibiotic was discontinued. This underscores the importance of being vigilant and conducting regular laboratory blood counts when administering antibiotics like meropenem to prevent life-threatening complications.

Clinical Image of Varicose Veins of Upper Extremity

Shubham Bobade, Sheetal Asutkar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X

A Bizarre Presentation of Vulvar Nevus Lipomatosis Superficialis

Priyadarshan Anand Jategaonkar, Sudeep Pradeep Yadav, Gayatri Khatri Yadav, Smita Priyadarshan Jategaonkar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X

Navigating Complex Pulmonary Hypertension: A Case of Post-tubercular Lung Disease and Atrial Septal Defect

Kundan Mehta, RS Lekshmi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Authors present a case involving a 47-year-old male farmer who sought medical attention at the Outpatient Department (OPD) due to a persistent cough and progressive dyspnoea over the past year. Additionally, he reported experiencing intermittent low-grade fever for the last 10 days, managed with 500 mg of paracetamol prescribed by a local doctor. The patient had a history of being diagnosed with drug-sensitive, sputum-positive pulmonary tuberculosis four years ago and had undergone treatment with HRZE (Isoniazid-300 mg, Rifampicin-450 mg, Pyrazinamide-1500 mg, Ethambutol-1200 mg) for a duration of six months. Upon admission, the patient was afebrile but had tachycardia (120/min), tachypnoea (28/min), a blood pressure reading of 80/50 mmHg, and an oxygen saturation level of 88% on room air. Clinical examination revealed tracheal deviation to the right and drooping of the right shoulder. Impaired percussion notes were observed in the right supra and infra-scapular, infra-axillary, and mammary areas. Auscultation revealed bronchial breath sounds with coarse crepitations in these areas. The cardiovascular system revealed a wider fixed splitting of S2 and a systolic murmur at the upper left sternal border. Chest radiography revealed scarring and cavities in the right lung (Table/Fig 1). Contrast-enhanced Computed Tomography (CECT) confirmed these findings and additionally identified areas of bronchiectasis. Multiple acinar nodules with alveolar consolidation were noted in the basal segment of the right lower lobe, alongside dilatation (32 mm) of the main pulmonary artery (Table/Fig 2). Staining, culture studies, and Gene Xpert testing for Mycobacterium tuberculosis in sputum and bronchoalveolar lavage yielded negative results. Mild leucocytosis was managed with parenteral antibiotics. A 2D echocardiogram provided insights into the patient’s cardiac status, revealing an ejection fraction of 50%. It also highlighted a large ostium secundum Atrial Septal Defect (ASD) with a left-to-right shunt, dilated right atrium, right ventricle, mild tricuspid regurgitation, and moderate pulmonary artery hypertension, with a right ventricular systolic pressure of 55 mmHg (Table/Fig 3). Transoesophageal echocardiography confirmed the size of the ASD (30 mm) and rim measurements, thus solidifying the diagnosis of Pulmonary Hypertension (PH) secondary to Post-tubercular Lung Disease (PTLD) and ASD, classifying it under both World Health Organisation (WHO) Groups 2 and 3. Navigating complex PH involves a multidisciplinary approach with specialists like pulmonologists and cardiologists. Treatment includes medications, lifestyle changes, and in severe cases, surgery or lung transplantation. The World Symposium on Pulmonary Hypertension (WSPH) defines PH as a mean Pulmonary Artery Pressure (mPAP) greater than 20 mmHg measured by Right Heart Catheterisation (RHC). Respiratory causes of PH are obstructive lung disease, restrictive lung disease, other lung diseases with a mixed restrictive/obstructive pattern, hypoxia without lung disease, and developmental lung disorders (1). Group 2 PH includes PH due to left heart failure. Cardiac causes of PH are heart failure with preserved left ventricular ejection fraction, heart failure with reduced left ventricular ejection fraction, valvular heart disease, and congenital/acquired cardiovascular conditions (2). Group 3 PH is due to lung disease and/or hypoxia. Causes include obstructive lung disease, restrictive lung disease, other lung diseases with a mixed restrictive/obstructive pattern, hypoxia without lung disease, and developmental lung disorders (3). PTLD encompasses a range of disorders affecting the airways, lung parenchyma, pulmonary vasculature, and pleura. It significantly reduces life expectancy and increases the risk of recurrent tuberculosis (4). Managing present complex case necessitated consideration of early ASD closure and medical therapy. Current guidelines recommend ASD closure when there is still a net left-to-right shunt and the Pulmonary Vascular Resistance (PVR) is less than two-thirds of systemic vascular resistance, to prevent sustained PH and right heart failure (5). To address the patient’s condition, authors devised a therapeutic plan that included Endothelin Receptor Antagonists (ERA), Phosphodiesterase type 5 Inhibitors (PDE5), and home oxygen therapy. These interventions aimed to improve haemodynamics, enhance exercise capacity, boost functional status, elevate overall quality of life, and potentially extend survival (6). The elevated occurrence of PH in post-tuberculosis pulmonary sequelae underscores the imperative for early detection, appropriate treatment, and strict adherence to pulmonary tuberculosis treatment regimens. National and international tuberculosis programs should incorporate guidelines for long-term follow-up to mitigate the morbidity and mortality linked to PH (7).

An Unusual Presentation of Multiple Myeloma

Ashwin Karnan, Babaji Ghewade Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X

Undiagnosed Endometriosis: A Rare Case of Frozen Pelvis

Minal A Kalambe, Priya P Nair, Saunitra Inamdar, Ankit K Badge Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X

An Image of Hutch Diverticulum with Ureteric Insertion

Bandari Kaavya, Senthil Kumar Aiyappan, Yeshwanth Raju Narayanan, Yatham Rama Rao Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X

Perception of Faculty Regarding Competency-based Medical Education

Amita Aditya Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X

Expression of GATA3, p63, E-cadherin and Her2Neu Immunohistochemical Stains in Urothelial Carcinoma and their Relationship with Histological Grading and Prognosis- A Cross-sectional Study

Debarghya Mukherjee, Soumya Dey, Souvik Chatterjee, Madhumita Mondal, Deepali Singh, Mamata Guha Mallick Sinha Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Urinary bladder cancer is the 10th most common cancer worldwide. Cystoscopy and biopsy/Transurethral Resection of Bladder Tumour (TURBT) are the best techniques for diagnosing and staging urinary bladder cancers. Urothelial Carcinomas (UC), particularly in transurethral resection biopsies, can pose diagnostic difficulties due to limited material. Immunohistochemistry (IHC) plays a valuable role in these settings, and many immunostains are being utilised for diagnostic evaluation. However, the relationship of these immunomarkers with histological grade and their prognostic utility has not been adequately explored. Aim: To analyse expression of Her2Neu, E-cadherin, p63, and GATA3 in UC and its relation with histological grading and prognosis. Materials and Methods: This was an observational cross-sectional study conducted in the Pathology Department of IPGMER and SSKM Hospital, Kolkata, West Bengal, India over two years (November 2020-October 2022). Samples of 100 bladder carcinoma patients with predominant TURBT specimens were included in the study. The histopathological reports and tumour grading were done according to the World Health Organisation (WHO) classification of urinary bladder tumours. The Formalin Fixed Paraffin-embedded (FFPE) sections of the tumour blocks were subjected to IHC staining, and the results were interpreted accordingly. Statistical analysis was performed with the help of the Statistical Package for Social Sciences (SPSS), IBM (version 25.0). Unpaired t-test and Z-test (Standard Normal Deviate) were used to test the significant difference between two proportions. Results: The mean age of the study population was 59.69±14.53 years, and there was a male preponderance (male: female=3.54:1). Histopathological examination revealed 55% to be of low-grade morphology. Overall, 53% of cases were in T1 stage, and the rest were in T2 stage. On IHC analysis, E-cadherin showed a statistically significant decrease in intensity with increasing grade (p-value <0.001) and T stage of UC (p-value <0.001), but there was no statistically significant relationship between Her2Neu expression and tumour grade/stage (p-value 0.5764 and 0.5663, respectively). A statistically significant relationship was observed between GATA3 and p63 scores with the grade and T stage of the tumour, i.e., GATA3 positivity increased with increasing grade and T stage of the tumour (p-value <0.001 in both), and there was a loss of p63 with advancing grade and stage of the tumour (p-value <0.001 in both). Conclusion: GATA3, p63, and E-cadherin can be used as prognostic markers in UCs. No significant relationship was found between Her2Neu expression and tumour grade in UC.

Spectrum of Cutaneous Metastasis in Visceral and Haematolymphoid Malignancies: A Cross-sectional Study at a Tertiary Care Centre in Kolkata, West Bengal, India

Kanwaljeet Singh, Devika Gupta, Ankita Kumari, Prasanta Sengupta, Mohul Chandra Prakash Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Cutaneous Metastasis (CM) is the spread of malignant cells from a primary site of malignancy to the skin. The incidence of CM ranges from 0.5% to 9% of all patients with cancer. CM may be the first sign of clinically silent visceral cancer or can even be a clue to tumour recurrence and heralds a poor prognosis requiring intense chemoradiotherapy. Aim: To study the spectrum of CM of internal malignancies, including haematolymphoid neoplasms. Materials and Methods: This cross-sectional study was conducted at Department of Pathology, Command Hospital Kolkata, West Bengal, India, over a period of two years from April 2020 to March 2022 and data was analysed over the next six months. A total of 16 patients who developed CM secondary to underlying solid organ or haematological malignancy were analysed. Categorical variables were summarised as percentages. Data in tables were presented as the frequency of variables (categories) or as absolute numbers. Results: The parameters studied included the primary site of malignancies, the frequency of various histological types at the primary site, and the common cutaneous metastatic regions. The mean patient age was 55.25 years (ranges 24-72 years) with no gender predilection (M:F=1:1). The most common primary cancer site was the kidney and the oral cavity 4 each (25%), followed by breast, lung, and haematolymphoid malignancy, 2 each (12.5%), and 1 each of thyroid and gallbladder (6.25%). The most common site of CM was the head, abdomen, and epigastric wall 07/16 each (43.75%). The majority of the CM were identified as adenocarcinoma on histopathology. Conclusion: The CM occurs rarely and can be the initial presentation of an occult internal malignancy or may suggest recurrence if diagnosed later. Renal cell carcinomas and squamous cell carcinomas of the oral cavity are the tumours that have a high predisposition for CM, and hence these patients require close follow-up and surveillance.

Comparison of qSOFA, MEDS, and APACHE II Scores in Early Identification of Sepsis for Patients with 28 days Mortality and ICU Admission: A cross-sectional Study

PD Shiv Ranjit, Akilan Elangovan, TV Ramakrishnan, Tamilanbu Panneerselvam, J Janifer Jasmine Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Sepsis is a life-threatening infection that results in organ dysfunction due to an increased pathogen load, necessitating urgent intervention. There is a gap in clinicians’ ability to identify septic patients at high-risk with poor outcomes, highlighting the need for validated predictive scores for early intervention, favourable outcomes, and prompt recovery. Aim: To validate the predictive capacity of the Sequential Organ Failure Assessment (qSOFA), Mortality in Emergency Department Sepsis (MEDS), and Acute Physiology and Chronic Health Evaluation (APACHE 2) scores in patients with 28-day mortality and in Intensive Care Unit (ICU) patients due to sepsis. Materials and Methods: This cross-sectional study was conducted on 150 septic patients at the Department of Emergency Medicine, Sri Ramachandra Institute of Higher Education and Research in Chennai, India, between June and December 2022. Parameters assessed included Respiratory Rate (RR), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP), temperature, White Blood Cell (WBC) count, platelet count, bilirubin, and creatinine. Descriptive analysis of age, gender, source, RR, GCS, SBP, qSOFA, MEDS, APACHE 2 in 28-day mortality, and ICU patients. Positive correlation and good predictivity of predictive scores (qSOFA, MEDS, APACHE 2) were analysed using Spearman’s Rank Correlation Coefficient (SRCCRs) statistical test in 28-day mortality and ICU patients. Results: A total of 150 septic patients (male: female-93:57) with an average age of 57.07±14.4 years were included. Urosepsis was the most common (n=51), followed by respiratory sepsis (n=48). Of these, 96 patients were admitted to the ICU, and 54 patients experienced 28-day mortality. The average and median values of RR were 27.1±7.64 breaths/minute (b/m) and 26 b/m, respectively. SBP values were 106.13±30.47 mmHg and 110 mmHg, respectively. Diastolic Blood Pressure (DBP) values were 66±16.51 mmHg and 60 mmHg, respectively. The average and median values of GCS were 12.75±3.92 and 15, respectively. The average for qSOFA was 29.1±0.025, with a median of 28; for MEDS, the average was 7.99±5.89, with a median of 7; and for APACHE 2, the average was 16.74±9.64, with a median of 15. Spearman’s Rank Correlation Coefficient (SRCCRs) demonstrated a strong positive correlation and good predictive validity between qSOFA, MEDS, and APACHE 2 scores in 28-day mortality and ICU patients (<0.001). Receiver Operating Characteristic Curve (ROC) analysis indicated good predictive validity for qSOFA in 28-day mortality and ICU patients. Conclusion: qSOFA exhibited a positive correlation and good predictive validity compared to MEDS and APACHE 2 in both 28-day mortality and ICU patients (<0.001). This study highlights the utility and applicability of qSOFA at the bedside for initial triage, as it can be quickly employed with minimal information.

Comparison of Enhanced Recovery After Surgery (ERAS) protocol versus Conventional Approach for Laparoscopic Cholecystectomy: An Interventional Study

B Praveen Kumar, S Vinoth Kumar, S Sendhil Sudarsan, CP Ganesh Babu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Laparoscopic cholecystectomy is considered the gold standard for benign gallbladder disease due to its minimal invasiveness, reduced bleeding, and rapid recovery. Enhanced Recovery After Surgery (ERAS) protocols, recognised for lowering surgical stress and complications, are increasingly adopted for their postoperative benefits. Aim: To assess and compare postoperative outcomes in laparoscopic cholecystectomy patients undergoing ERAS versus conventional approaches. Materials and Methods: This prospective interventional study was conducted at the Surgery Department of Mahatama Gandhi Medical College and Research Institute, Puducherry, India from January 2021 to June 2022. All patients above 18 years of age undergoing laparoscopic cholecystectomy with American Soceity of Anaesthesiologists (ASA) I and II were included. A total of 90 subjects, 45 subjects in the Group A (ERAS protocol) and 45 subjects in the Group B (Conventional approach), were included based on computer-generated random numbers with concealment of allocation. Key parameters, including length of hospital stay, morbidity, postoperative pain, and protocol compliance, were evaluated between both groups. Continuous variables were presented as means with standard deviations and analysed using unpaired t-tests. Categorical variables were expressed as percentages and compared using chi-square tests. Results: The mean age of the study population in ERAS and conventional was 41.3±7.9 years and 41.6±9.6 years, respectively. Similarly, 17 male participants were from the ERAS group and 15 were from the conventional group, whereas among female participants 28 were from the ERAS group and 30 were from the conventional group. The ERAS group demonstrated significant advantages: shorter hospital stays (91.2% vs. 73.4%, p=0.0274), lower Grade 1 morbidity (p=0.0213), and reduced postoperative pain (p=0.0001). Conclusion: The ERAS group exhibited notable benefits, including a shorter hospital stay, reduced morbidity, and lower postoperative pain. These findings suggest the potential for enhanced recovery outcomes with ERAS protocol implementation in laparoscopic cholecystectomy patients.

Colour Stability of Two Different Denture Base Resins and the Efficacy of Two Denture Cleansing Agents after Tea and Coffee Staining: An In-vitro Study

Sonam S Agrawal, Monal M Kukde, Krishna Kumar S Lahoti, Jaykumar R Gade, Nandkishor J Bankar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: In dentistry, colour is one of the most important dimensions of aesthetics. Due to the diverse food habits in India, stains accumulate on dentures. Various denture cleansing agents such as Fittydent and Clinsodent are widely used, emphasising the importance of patient oral hygiene. Aim: To evaluate the colour stability of heat-cure activated acrylic denture base resins {Dental Products of India (DPI) and Trevalon} after staining with tea and coffee, subsequently treated with Clinsodent, Fittydent, and distilled water (control group) as cleansing agents. Materials and Methods: This in-vitro study was conducted at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, in the Department of Prosthodontics, Crown and Bridge, and Implantology in collaboration with Indorama, Nagpur, Maharashtra, India, over a period of approximately 90 days (August-October 2017). Total 120 samples were prepared in-vitro study using custom-made brass metal discs measuring 10 mm by 2 mm. Trevalon and DPI heat-cure acrylic denture base resins were used for sample preparation. Baseline colour stability values were established after immersing the samples in distilled water at 37°C for 24 hours. The samples were then stained for eight hours, followed by immersion in different cleansing agents and distilled water for 12 hours. This process was repeated every 24 hours for 60 days, with the staining and cleansing agents replenished daily. Colour measurements were taken at baseline, 15th, 30th, 45th, and 60th days. Statistical analysis involved t-tests and one-way Analysis of Variance (ANOVA). Results: The DPI denture base resin exhibited a highly significant ΔE (change in energy) at 45 days (p=0.0001), while Trevalon showed significance at 60 days (p=0.0079). The difference in means was statistically significant using t-tests for independent samples, and the variance-measure analysis indicated statistical significance in the means of ΔE. The comparison of the three cleansing agents at 60 days was statistically obtained using one-way ANOVA. Conclusion: Dental Products of India (DPI) showed more colour variation than Trevalon. Tea showed a higher staining than coffee. Staining intensity increased over time, peaking at 45 days and stabilising thereafter. Clinsodent is better than Fittydent in removing stains.

CBCT Comparison of the Remaining Dentin Thickness Following Biomechanical Teeth Preparation using Edge Endo X7, Hero Gold, and Neo Endo Flex Rotary File Systems: An In-vitro Study

Banavathu Priyanka, Parvathaneni Krishna Prasad, TBVG Raju, Seshadri Abitha, Nadimpalli Mahendra Varma, Dondapati Gowtam Dev Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Success in endodontics depends on canal preparation, disinfection, and obturation. Cleaning and shaping play a pivotal role in successful endodontic therapy. An important factor in preventing procedural mishaps and further complications is the quantity of dentine removed during instrumentation because the fracture resistance of the root is directly influenced by the amount of dentine that remains after instrumentation. Aim: To evaluate and compare the remaining dentine thickness of the root canal after instrumentation with three different rotary file systems using Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: Thirty permanent extracted, single-rooted teeth were collected. The samples were decoronated at the level of the Cementoenamel Junction (CEJ). A pre-instrumentation CBCT scan was taken. Access opening and working length were determined. The samples were randomly assigned to three groups: Group I - Edge Endo X7, Group II- Hero Gold, Group III - Neo-endo flex files. Biomechanical preparation was carried out using the respective files. To evaluate the remaining dentine thickness, a comparison was made with the pre-instrumentation CBCT scan. Statistical analysis was performed using One-way ANOVA. Results: Upon inter-group comparison of the pre-instrumentation group, no significant difference (p≥0.05) was observed. Post-instrumentation, it was noted that the remaining dentine thickness in Group I (p≤0.05) at the apical third was significantly less than in Group II (p=0.007) and Group III (p=0.042). Maximum preservation of dentine was seen with Hero gold files, whereas the minimum preservation of dentine was seen with Edge Endo X7. Conclusion: Hero gold files exhibited less removal of dentine apically, whereas Edge Endo X7 showed more removal of dentine apically.

Choice of Antiarrythmics Used in Different Arrhythmias Encountered in Patients Undergoing PTCA and Clinical Outcome: A Retrospective Observational Study

Rashmi Singla, Minali Raja, Yoginder Singh Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Percutaneous Transluminal Coronary Angioplasty (PTCA), is a minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the heart muscle. It is indicated in angina patients unresponsive to maximal medical therapy and in ST elevated Myocardial Infarction (MI). A variety of arrhythmias and conduction disturbances can occur during and after Percutaneous Coronary Interventions (PCI), which can be risk factors for increased morbidity and mortality. Aim: To evaluate the choice of antiarrhythmics use in different arrhythmias encountered in patients undergoing PTCA and to assess the outcome. Materials and Methods: This retrospective observational study was conducted by analysing the data of 139 patients aged between 40 to 70 years who underwent PTCA in the year 2023. The study was carried out over eight months from January 2023 to August 2023 at the Cardiology Department of Max Hospital, Dehradun, Uttarakhand, India, located in Jakhan. All patients who underwent PTCA at Max Hospital, Dehradun (including stable and unstable angina patients not responding to medical therapy and Myocardial infarction cases), were included in the study. The sample size consisted of 139 patients aged 40 to 70 years who underwent PTCA. Age and gender ratios were considered as demographic factors. Computer records were reviewed for data collection. Additionally, the attending cardiologist was consulted for observations and the treatment plan followed. The outcomes were assessed at admission, after 10 days, and one and a half months, for all drugs. The collected data results were analysed in terms of percentage and mean. Results: In the present study, the most common arrhythmias were ventricular premature complexes, occurring in all patients who underwent coronary angioplasty. The second most common arrhythmia was atrial fibrillation, present in 111 (80%) cases. The remainder consisted of atrial flutter 7 (5%), atrial tachycardia 1 (1%), Ventricular tachycardia 7 (5%), and ventricular fibrillation 0.6 (1%), as well as bradyarrhythmia/conduction defects in 69 (50%) cases. Drugs such as Amiodarone, Mexiletine, Lidocaine, Sotalol/Metoprolol, Flecainide, magnesium supplements, and Atropine were used based on the type of arrhythmias. The incidence of complications decreased at admission, after 10 days, one and half month, and the mortality rate decreased after the administration of all the drugs in the present study. Quality of life showed improvement. Conclusion: The most common arrhythmias occurring after PTCA were reperfusion arrhythmias, which were mostly self-limiting and resolved without treatment. Amiodarone was the most commonly used drug for both atrial and ventricular arrhythmias. Mexiletine was used for Ventricular Tachycardia, Flecainide for supraventricular arrhythmias, and Lidocaine for ventricular tachycardia not responsive to Cordarone. β-blockers were well-tolerated drugs used concomitantly with other antiarrhythmic drugs. The use of antiarrhythmic reduced morbidity and mortality after PTCA and improved the quality of life score.

Assessment of Impact of Malocclusion on Oral Health Status and Oral Health-related Quality of Life among School and College Students of Chennai, Tamil Nadu, India: A Cross-sectional Study

Vinita Mary Abraham, Jaideep Mahendra, Prabhu Manikam Natarajan, R Kesavan, U Vidhyarekha, Bhuminathan Swamikannu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Malocclusion is multifactorial in origin, caused by the interaction of various general and local factors. The consequences of malocclusion include dental caries, periodontitis, impaction of teeth, and compromised chewing abilities. Thus, if left untreated, malocclusion can not only lead to oral health problems like periodontal problems and dental caries but also psychological problems, causing a loss of self-esteem and confidence in the individual. Aim: To assess the potential relationship between malocclusion with orthodontic treatment needs and dental caries, periodontal diseases, dental traumatic injuries, oral hygiene, and Oral Health-related Quality of Life (OHRQoL). Materials and Methods: A cross-sectional study was conducted among 1800 school-going and college students at their respective Institutions in Chennai, Tamil Nadu, India from December 2021 to June 2022 with and without orthodontic treatment needs, to identify malocclusion and various oral conditions/diseases associated with it, in addition to the effect of malocclusion on OHRQoL. Oral health status was assessed using the World Health Organisation (WHO) Basic Oral Health Survey (2013); malocclusion was assessed using the Index of Orthodontic Treatment Needs (IOTN) index, and OHRQoL was measured using OHIP-14. Data were analysed using Statistical Packages for Social Sciences (SPSS) version 23.0 software, and statistical significance was assessed using Pearson’s Chi-square test and Mann-Whitney U Test. Results: The study was conducted among 1800 subjects aged between 14 and 21 years (mean 17.47±1.58 years) from various schools and colleges in Chennai. Among the study subjects, 1066 (59.2%) were males, and 734 (40.8%) were females. About 46.7% of the study subjects had malocclusion. The binomial logistic regression analysis suggested that study subjects with orthodontic treatment needs had greater odds of experiencing dental caries, gingival bleeding, and traumatic dental injuries compared to study subjects without orthodontic treatment needs. Conclusion: There is a definite relationship between malocclusion, orthodontic treatment needs, dental caries, periodontal diseases, dental traumatic injuries, oral hygiene, and OHRQoL.

Correlation of Serum Neutrophil Gelatinase-associated Lipocalin with Clinical Severity Score in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Sunanda Dalai, Nirupama Devi, Jhulana Kumar Jena, Jyoti Prakash Panda, Bijaya Lakshmi Nanda, Saswati Satpathy Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Acute Coronary Syndrome (ACS) is a term that encompasses various clinical presentations such as ST-Segment Elevation Myocardial Infarction (STEMI), Non STEMI (NSTEMI), or unstable angina. Neutrophil Gelatinase-associated Lipocalin (NGAL), also known as lipocalin-2, belongs to the lipocalin category of extracellular proteins. Recent research indicates that NGAL levels are increased in different cardiac situations, regardless of the presence of acute renal injury. Aim: To compare the levels of serum NGAL and Global Registry of Acute Coronary Events (GRACE) scores between cases with ACS and Angio-negative cases, and to study the correlation of serum NGAL with the GRACE score (clinical severity score) in ACS patients. Materials and Methods: A cross-sectional study was conducted with 128 patients at the Department of Biochemistry, MKCG Medical College and Hospital, Berhampur, Odisha, India, presenting to the Cardiac Emergency Department from November 2020 to August 2021. Coronary Angiograms (CAG) were done to confirm the presence of Coronary Artery Disease (CAD), and patients were grouped accordingly as Group-1 with ACS patients and Group-2 with angiogram-negative cases. Apart from the routine work-up, including serum urea and creatinine, serum electrolytes, fasting blood sugar, lipid profile, and management, all patients underwent determination of serum NGAL levels and GRACE score at admission. The data were analysis using student’s t-test and Pearson’s correlation test. Results: Among the 128 participants (64 cases in Group-1 and 64 cases in Group-2), Group-1 comprised 37 cases of STEMI, 26 cases of NSTEMI, and one case of unstable angina. Serum NGAL levels were significantly elevated in patients with CAG-proven ACS (140.89±56.47 ng/mL) without any renal dysfunction, sepsis, or overt infection compared to patients without CAD on CAG (52.01±18.39 ng/mL) (p<0.0001). The serum NGAL level exhibited a positive correlation of 0.359 (p=0.004) with the severity of ACS, as measured by the GRACE score. Conclusion: The present study suggests that serum NGAL in patients with ACS may serve as a potential novel biomarker for risk stratification and predicting the severity of the disease.

Screening of High and Low-risk Human Papillomavirus Variants in Cervical Cancer Patients by Polymerase Chain Reaction: A Cross-sectional Study

Ritu Yadav, Lokesh Kadian, Smiti Nanda, Shalu Ranga, Parul Ahuja, Chetna Yadav, Preeti Chauhan Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Cervical cancer is the second most common gynaecological malignancy worldwide. Persistent Human Papillomavirus (HPV) infection is the principal risk factor leading to cervical carcinogenesis and causes a large number of casualties. Aim: To estimate the risk factors and symptoms related to cervical carcinoma and to check for mono-infection or co-infections of low-risk and high-risk HPVs in Northern Indian females. Materials and Methods: This cross-sectional study was conducted from January 2019 to January 2021 on 110 confirmed cervical cancer tissue samples collected from the Department of Obstetrics and Gynaecology at Pandit BD Sharma University of Health Sciences, Rohtak, Haryana, India. Information about risk factors and symptoms was collected using a semistructured proforma. Detection of HPV infection and HPV genotyping (16, 18, 33, 58, 6, and 11) was done by using type-specific Polymerase Chain Reaction (PCR). Fisher’s exact test was applied to determine the association of high-risk HPV infection with other risk factors using GraphPad Prism Version 6 (La Jolla, California, USA). A p-value of ≤0.05 was considered significant. Results: Of all the studied cases, 68 (62%) were above 55 years old, 67 (61%) were in a postmenopausal state, and 86 (78%) were from a rural background. Irregular menstruation was observed in 99 (90%) cases, bleeding after menopause in 59 (54%) cases, and early age at first intercourse in 57 (52%) cases were the most common symptoms. HPV infection was found in all cases of cervical carcinoma. The incidence of high-risk-HPV16 (84%) and HPV18 (73%) was the most prominent, while the incidence of low-risk-HPV6 (7.2%) and HPV11 (6%) was the lowest. Co-infection of HPV16/18 was the Highest in 60 (54.5%) cases, followed by HPV16/33 in 13 (11.8%) cases. Multi-infection of HPV types 16/18/33 was found in 10 (9.1%) cases, and multi-infection of HPV types 16/18/33/6/11, except HPV58, was found in one patient. Conclusion: Higher age, postmenopausal status, early age at intercourse, and poor menstrual hygiene were significantly associated with high-risk HPV co-infection. Educating women about the risk factors and symptoms of cervical cancer and screening for high-risk HPVs in rural women are required to reduce the prevalence of cervical cancer in Northern India.

Pathological Complete Response with Platinum Containing Neoadjuvant Chemotherapy in Triple-negative Breast Cancer: An Interventional Study

Binila Mary Jose, VR Ajith Kumar, Suma Susan Meloot Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Triple-negative Breast Cancer (TNBC) accounts for 20% of all breast cancer cases globally and responds well to cytotoxic chemotherapy. The standard Neoadjuvant Chemotherapy (NAC) regimen for TNBC includes 4+4 cycles of anthracycline, cyclophosphamide, and taxane. Integrating platinum agents into the NAC has gained attention as an effective treatment for TNBC. Aim: To estimate the proportion of pathological Complete Response (pCR) in TNBC patients receiving platinum-based NAC. Materials and Methods: This interventional study enrolled 73 non metastatic TNBC patients who attended the radiotherapy Outpatient Department (OPD) of Government Medical College Thiruvananthapuram Kerala, India from April 2022 to April 2023. All patients underwent a complete history, physical examination, and tumour histopathology with Oestrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor 2 (HER2) receptor status assessment. Patients were treated with the NAC regimen: Epirubicin 90 mg/m2, Cyclophosphamide 600 mg/m2 intravenously every three weeks for four cycles followed by Paclitaxel 175 mg/m2, Carboplatin according to Area Under Curve (AUC)-5 by intravenous administration every three weeks for four cycles. Clinical response was evaluated after the completion of NAC using Response Evaluation Criteria in Solid Tumours (RECIST) criteria. pCR assessment was conducted postsurgery. Study variables were entered into Microsoft Excel, and the analysis was performed using Statistical Packages for Social Sciences (SPSS) version 24.0. Results: Out of 73 patients with a mean age of 54.4 years, 33 (45.2%) patients showed complete response on clinical examination after eight cycles of Carboplatin-containing NAC, and 23 (31.5%) patients achieved pCR. Total 30 (41.1%) patients experienced complications during chemotherapy, with neutropenia and peripheral neuropathy being the most common, each occurring in 22 (30.1%) patients. Conclusion: In present study, one-third of the patients achieved pCR with platinum-based NAC with an acceptable side-effect profile. It represents a beneficial treatment option for TNBC patients; however, the impact of pCR on survival requires further validation through long-term studies. Given the poor prognosis and limited treatment options for TNBC, the addition of affordable and available agents to the existing chemotherapy regimen could potentially revolutionize the treatment of these patients.

Comparison of Shear Bond Strength, Adhesive Remnant and Precision Fit between Conventional Lingual Retainers and Customised CAD/CAM Fabricated Lingual Retainers: An In-vitro Study

B Mohamed Sohail, Poornima R Jnaneshwar, Dilip Srinivasan, Ravi Kannan Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Fixed lingual bonded retainers offer the comfort of aesthetics and reduced tissue irritation after orthodontic treatment but are wrought with frequent bond failures. Numerous techniques have been used to adapt the retainer to the lingual surface of the lower anterior teeth, but research on customised lower lingual retainers is scarce. Aim: To evaluate and compare the Shear Bond Strength (SBS), Adhesive Remnant Index scores (ARI), and precision fit of a novel Computer-aided Designing-Computer-aided Machining/Manufacturing (CAD-CAM) fabricated retainer and conventional retainers. Materials and Methods: This invitro study was conducted at the Department of Orthodontics, and Dentofacial Orthopaedics, SRM Dental College, Ramapuram, Chennai-89 from June 2022 to February 2023. It included a total of 360 human mandibular anterior teeth were collected and embedded in acrylic blocks in groups of six to simulate the mandibular anterior arch form. A total of 60 retainers made of braided Stainless Steel (SS) wires, co-axial wires, customised through CAD/CAM technology were evaluated. The retainers were bonded to the lingual aspect of the teeth using composite resin. A universal testing machine was used for testing SBS. Precision fit was observed using Exocad software. Statistical analysis included one-way Analysis of Variance (ANOVA) for SBS, Kruskal-Wallis for ARI score, and Mann-Whitney U test for precision fit. Results: The CAD-CAM retainers had a more precise fit when compared to conventional retainers (p=0.009). SBS was highest for CAD-CAM fabricated retainer and lowest in the co-axial retainer, and this finding was statistically significant (p<0.001). The CAD-CAM retainer had the highest mean rank in ARI scores (33.90) when compared to braided SS and co-axial wire. Conclusion: The CAD-CAM fabricated retainers would be more effective clinically, as higher bond strength due to precise fit would reduce the failure rate, thus preventing relapse and minimising chairside time.

Histological Evaluation of the Effectiveness of Four Decalcifying Solutions on Teeth and Bone in Rats: An In-vitro Study

Rusul J Hadi, Areej Salim Al-Azzawi, Nawar Bahjet Kamil, Suraj Arora, Nada MH AL-Ghaban, Dina H Obaid Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Intense histological research has been conducted on human bone and teeth for a long period of time. Histological evaluation of these highly mineralised tissues demands a thorough decalcification process using different chemical agents, which might alter some aspects of tissue architecture and staining properties. Aim: To assess the impact of four decalcifying agents on rat teeth and bone, focusing on the rate of decalcification, staining effectiveness, and tissue structure preservation. Materials and Methods: An in-vitro animal study was conducted in the Department of Oral Diagnosis at the College of Dentistry, University of Baghdad, Bab Almoaadim, Baghdad, Iraq from October 2022 to March 2023. Four decalcification agents, namely 10% Neutral Ethylenediaminetetraacetic Acid (EDTA), 10% formic acid, 3% nitric acid, and 5% nitric acid, were used to decalcify 24 molar teeth with their surrounding alveolar bone obtained from healthy male rats, which were randomly divided into four groups, each group consisting of six teeth. The decalcified sections underwent regular processing, and staining was performed using Haematoxylin and Eosin (H&E). Grading was conducted after two separate observers examined the stained sections under a light microscope. Data were presented using Mean±Standard Deviation (SD), number, and percentage. A one-way Analysis of Variance (ANOVA) (F-test) was used to compare the decalcification times within groups. Several group comparisons, including categorical data, were examined using the Chi-square test. Results: Nitric acids (3% and 5%) exhibited the fastest decalcification with a mean value of (2±0.89) days, while Formic acid required (3.5±0.54) days, and EDTA was the slowest, with (19±1.09) days. These differences in decalcification time were found to be statistically significant (p<0.00001). Formic acid 10% demonstrated superior tissue preservation and staining quality, with excellent staining results, minimal dentin-pulp separation, and preservation of pulp zones, cementum, and osteoblasts. In contrast, nitric acid 5% resulted in severe dentin-pulp separation, absence of pulp zones, absence of osteoblast, and significant osteocyte retraction. Statistical significance was observed across all agents for dentin-pulp separation, pulp organisation, cementum destruction, Periodontal Ligament (PDL) separation, and osteocyte retraction (p-values of 0.004, 0.02, 0.02, 0.04, and 0.03, respectively). Conclusion: Consequently, 10% formic acid emerged as the most efficient decalcifying solution, ensuring rapid decalcification with favourable staining intensity and tissue architecture.

Clinical Efficacy of Ambu AuraGain^TM and i-gel® in Patients Undergoing Elective Gynaecological Laparoscopic Surgeries Under General Anaesthesia: A Randomised Clinical Study

Shiny Priyadarshini Aarumulla, Vijetha Devaram, N Jayanth Medithala, Hrudayesh Adini, Prabhavathi Ravipati, Krishna Chaitanya Kandukuri Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Second-generation supraglottic airway devices that provide high seal pressures are found to be suitable for patients undergoing laparoscopic surgery, as they have a separate port for gastric tube insertion, effectively separating the airway and the oesophagus. The present study compares the usage of two such second-generation supraglottic devices-AuraGain™ and i-gel® in patients undergoing gynaecological laparoscopic surgeries. Aim: To compare the Oropharyngeal Leak Pressure (OLP) and airway pressures achieved by the i-gel® and Ambu AuraGain™ after insertion in the supine position and during laparoscopic carbon dioxide peritoneum in the Trendelenburg position. Materials and Methods: This randomised clinical, single-blinded study conducted at the Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra pradesh, India involved 100 female patients undergoing elective gynaecological laparoscopic surgeries under general anaesthesia with controlled ventilation. The primary objective was to compare the clinical performance of Ambu AuraGain™ (Group-A) and i-gel® (Group-I) concerning their oropharyngeal seal pressures and airway pressures in gynaecological laparoscopic surgeries. The secondary outcomes measured included the time taken for insertion, ease of insertion of the device, effects on postinsertion haemodynamic parameters like heart rate, blood pressure, oxygen saturation, ease of gastric tube insertion, and fibreoptic bronchoscopic grading of the visualised glottic structures after device placement, as well as postoperative side effects like blood staining upon removal of the device and sore throat. Data were analysed using Student’s t-test and chi-square test. Results: The mean age in Group-A was 39.62±4.085 years, and in Group-I, it was 39.48±2.468 years. The mean peak inspiratory pressures after device insertion were 14.34 mmHg in Group-A and 16.66 mmHg in Group-I. Haemodynamic parameters postinsertion were similar in both groups {Group-A: Mean Heart Rate (HR) 87.22 bpm, Mean Arterial Pressure (MAP) 89.72 mmHg, Oxygen Saturation (SpO2) 99.58%; Group-I: Mean HR 87.50 bpm, MAP 89.72 mmHg, SpO2 99.72%). Fibreoptic bronchoscopic grading in Group-A was 0/0/9/41, and in Group-I, it was 0/0/11/39. Blood staining upon removal was noted in four patients (8%) in Group-A and in 3 patients (6%) in Group-I. Sore throat in the postoperative period was noted in 14% of patients in Group-A and 8% in Group-I. Conclusion: Ambu AuraGain™ was found to provide a better seal and higher OLP compared to the i-gel® in gynaecological laparoscopic surgeries and therefore provide safer and more effective ventilation for patients undergoing such surgeries. I-gel® was found to be easier and quicker to insert than the AuraGain™.

Causation, Types and Outcome of Road Traffic-related Ocular Injury in University of Llorin, Kwara, Nigeria

Olawale Job Oladejo, Dupe Serifat Ademola-Popoola, Amase Nyamngee, Folu Owoeye Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Despite transportation liberating man and making him mobile, his increasing reliance on vehicular movement has conferred great facilities on him and his activities. The most profound culprit of all modes of transport is the road, of which traffic accidents are the most disturbing consequence of its use. Road traffic-related ocular injuries often have severe consequences and form a significant part of ophthalmic emergencies. These injuries may be missed and are therefore often underreported. Aim: To determine the causation, types, and outcomes of road traffic-related ocular injuries at the University of Ilorin Teaching Hospital, Kwara, Nigeria. Materials and Methods: This was a cross-sectional study conducted on 78 eyes of consecutive patients with road traffic-related ocular injuries who presented at the Accident and Emergency unit of the University of Ilorin Teaching Hospital, Kwara, Algeria, between September 2012 and August 2013. The materials included the HOTV chart for vision assessment, which is a standardised, easy-to-use assessment method for both literate and illiterate individuals, a pen torch, direct ophthalmoscope, binocular indirect ophthalmoscope, slit lamp biomicroscope, Perkins tonometer, 2% fluorescein strip, 0.5% GuttTetracaine, and a handheld portable slit lamp ophthalmoscope. Patients’ demographics, duration of ocular injury before presentation, Visual Acuity (VA) at presentation, type of vehicle, place of injury, classification of ocular injury, treatment, and outcome on follow-up were recorded. Results: There were 78 eyes (72 patients) with road traffic-related ocular injuries. The age range of the subjects was 3-55 years with a mean of 31.10 years. Forty-four (61.1%) patients were young men between 20-39 years. Fifty-one (70.8%) patients were males, and 21 (29.2%) were females, with a male-to-female ratio of 2.4:1. Most of the victims were traders (22, 30.6%), and fifty-two eyes (72.2%) presented within 12 hours of ocular injury. Motorcycles were associated with ocular injury in 37 (51.4%) patients. The most common injuries were of closed globe type (contusion, lamellar laceration, superficial foreign body) in 70 patients (89.7%). Conclusion: Road traffic-related injuries have increased over the past eight years in Nigeria. Males are more commonly injured in Road Traffic Injury (RTI), and motorcycles were the most common cause of injury to road users. Three out of 36 people injured in a vehicle at the time of injury used seat belts, while none of the riders and passengers on motorcycles wore helmets. The importance of prevention, the use of safety devices, and the avoidance of risk behaviors on the road need to be emphasised.

Factors Affecting Attitude Towards Research among Nursing Students: A Cross-sectional Survey from Taif, Saudi Arabia

Mysara Alfaki Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Research skills are an essential part of what it takes to be a professional nurse. While the research attitudes of nursing students in other countries have been extensively studied, research on nursing students’ attitude towards nursing research in Saudi Arabia is limited. Aim: To examine the factors affecting nursing students’ Attitude Towards Research (ATR). Materials and Methods: A cross-sectional study was conducted in the Department of Nursing, Faculty of Applied Medical Sciences at Taif University, Taif, Saudi Arabia, over a duration of five months from March 2023 to August 2023. 60 fourth-year nursing students from a single Saudi University (Taif University) participated in the present cross-sectional research. The English version of the ATR questionnaire scale was the main instrument for data collection. The scale consists of 32 items, each with a corresponding Likert scale answer option ranging from “1-strongly disagree” to “5-strongly agree.” Those who scored higher exhibited a more positive attitude toward research. Differences in research attitudes were analysed using the t-test and one-way Analysis of Variance (ANOVA). Results: The mean age of the study population was 21.7±1.4 years. All 60 (100%) participants were males, and 44 (73.3%) of the study subjects were in the age group of 21 to 23 years. A total of 32 (53.3%) of the participants had high school research experience. The research attitude among nursing students had a composite mean score of 106.6±18.4. There was a statistically significant difference (p<0.05) in mean attitude toward research scores among different age groups, types of secondary and high school graduates, and those with high school research experience. Conclusion: The present study found a significant difference in ATR among nursing undergraduates concerning age, types of secondary and high school graduates, and high school research experience. Qualitative research might provide additional insights into the topic of attitude toward research among undergraduates.

Efficacy of Thoracic Segmental Spinal Anaesthesia in Percutaneous Nephrolithotomy: A Retrospective Observational Study

Prajnananda Haloi, Rahul Biswas, Ananta Bora, Santana Devi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Percutaneous Nephrolithotomy (PCNL) is a minimally invasive procedure for the treatment of renal stone disease, usually performed under General Anaesthesia (GA). Regional anaesthesia, specifically Thoracic Segmental Spinal Anaesthesia (TSSA), offers a suitable alternative to mitigate complications associated with GA. TSSA in PCNL has an advantage over conventional lumbar spinal anaesthesia in terms of better haemodynamic stability, attributed to the lesser amount of local anaesthetic drug required. However, its clinical utility is yet to be fully explored. Aim: To investigate the feasibility and efficacy of TSSA in patients undergoing PCNL by analysing their medical records. Materials and Methods: A retrospective observational study was conducted on 250 patients from January 2022 to July 2023 at GNRC Medical, Guwahati, India. Patients aged 20-70 years with American Society of Anaesthesiology (ASA) I and II classification, undergoing PCNL with renal stones ≤40 mm, were included. TSSA was administered at the T9-T10 intervertebral space. Intraoperative parameters, degree of motor and sensory block, post-operative analgesia, patient and surgeon satisfaction were recorded. Descriptive statistics of the study were analysed in Microsoft excel and presented as mean with standard deviation or as numbers and percentages. Results: The patients in the study had a mean age of 41.08 years, Body Mass Index (BMI) of 25.52 kg/m2, stone size of 25.73 mm, and surgical duration of 74.92 minutes. TSSA was associated with minimal intraoperative hypotension (6%) and bradycardia (8.9%), zero incidences of neurological complications, and did not require conversion to GA. Complete stone clearance was achieved in 89.6% of cases. Post-operative analgesia was excellent in 179 (71.6%) patients as they did not require any rescue analgesia within the first 24 hours. Patient and surgeon satisfaction were notably high. Conclusion: TSSA emerges as a safe and efficient alternative to GA in selected cases of PCNL. Patient and surgeon satisfaction, along with minimal post-operative complications, support its consideration and usage. However, the choice of anaesthesia should be individualised based on procedural complexities and patient characteristics.

Comparison of Pneumonia-specific Scores, Sepsis Score and Generic Score in Predicting the Severity of Community-acquired Pneumonia: A Cross-sectional Study

DV Pratapa Reddy, V Vijayakumari, R Sunil Kumar, CH RN Bhushana Rao, S Gowtham, Shalini Perumal Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Pneumonia is defined as inflammation of the pulmonary parenchyma caused by an infectious agent. Community-acquired Pneumonia (CAP) is a heterogeneous disease with a significant disease burden, morbidity, and mortality. Severe Community-acquired Pneumonia (SCAP) has been proven to be associated with increased Intensive Care Unit (ICU) admission, mechanical ventilation, and mortality. Although several severity assessment tools are available, there is a lack of evidence to support one tool over another in patients with pneumonia. Aim: To compare the ability of pneumonia-specific scores {{Confusion, Urea, Respiratory rate, Blood pressure (CURB)-65 and Expanded CURB-65)}, Sepsis score {quick Sepsis-related Organ Failure Assessment (qSOFA)}, and Generic score {National Early Warning Score (NEWS)} in predicting SCAP patients at the time of hospital admission. Materials and Methods: This was a hospital-based cross-sectional study conducted in the Department of Pulmonary Medicine, Government Hospital for Chest and Communicable Diseases, Andhra Medical College, Visakhapatnam, India, on 100 patients with clinically and radiologically diagnosed CAP over a period of six months from April 2023 to September 2023 after obtaining Institutional ethics clearance and informed consent. All four severity scores (CURB-65, eCURB-65, qSOFA, NEWS) were documented in each patient at the time of admission. Outcomes such as 30-day mortality and ICU admission were measured. Receiver Operating Characteristic (ROC) curve analysis was performed for mortality prediction and ICU admission for all four scoring systems, and statistical analysis was carried out using Statistical Packages for Social Sciences (SPSS) version 24.0. Results: Out of 100 patients, 62 (62%) were males, and the remaining 38 (38%) were females with a mean age of 56±15 years. The number of patients with co-morbidities was 48 (48%). Regarding addictive habits, smoking and alcohol played a significant role at 38% and 33%, respectively. A 30-day mortality was observed in 18 (18%) patients, and 20 (20%) patients received ICU treatment. The frequency of patients with co-morbidities such as Diabetes Mellitus (DM), Hypertension (HTN), Ischaemic Heart Disease (IHD), and Chronic Obstructive Pulmonary Disease (COPD) was 21%, 33%, 5%, and 3%, respectively. For ICU admission as an outcome measure, the Area Under Receiver Operating Characteristics (AUROC) values were as follows: CURB-65: 0.977 (95% CI: 0.949-1.00, p-value <0.001); Expanded CURB-65: 0.966 (95% CI: 0.931-1.00, p-value <0.001); qSOFA: 0.935 (95% CI: 0.881-0.989, p-value <0.001); NEWS score: 0.967 (95% CI: 0.934-1.00, p-value <0.001). Conclusion: In the present study, all four scoring systems were equally effective in detecting the need for ICU admission and predicting 30-day mortality among CAP patients at the time of admission. However, organ-specific tools (CURB-65 (2-3) moderate) have demonstrated valid and effective means of assessing severity compared to sepsis scores and generic tools.

Association of Meal Irregularity and Chronotypes with Dietary and Sleep Patterns: A Cross-sectional Study

Maha H Alhussain, Fatimah R Al-Ramadhan, Manal Abdulaziz Binobead, Shaista Arzoo Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: The circadian clock is a homeostatic regulation system comprising clock genes in the body that regulate various physiological and behavioural processes. Diet determines our health and the timing and periodicity of feeding, in addition to nutritional quality, influence circadian rhythms and metabolism significantly. Aim: To assess the association of meal irregularity and chronotypes with dietary and sleep patterns. Materials and Methods: This cross-sectional study was conducted on 375 female adults using the convenience sampling method. Information on socio-demographic characteristics, dietary patterns, sleep patterns, chronotypes, and physical activity was collected through a self-administered questionnaire consisting of 26 questions. Participants aged 18-40 years and who completed the study questionnaire were enrolled. Pregnant or lactating mothers and users of tranquilisers and psychotropic drugs were excluded. T-tests and one-way Analysis of Variance (ANOVA) were used for continuous variables, and the Chi-square test was used for categorical variables. Results: A total of 197 (52.5%) participants reported consuming their meals at a regular time every day, while 178 (47.5%) did not. Concerning eating meals at a regular time every day, a significant association was found between eating meals at a regular time every day and the number of meals per day (Chi-squared, p-value<0.001). The data indicated that most participants were of the intermediate type (190, 50.7%), followed by the morning type (111, 29.6%), and then the evening type (74, 19.7%). Regarding the Morning-Evening Questionnaire (MEQ), there were significant associations between MEQ and the time of the last meal (Chi-squared, p-value=0.001), eating a meal after 9 pm (Chi-squared, p-value<0.001), and the need for a nap in the middle of the day (Chi-squared, p-value<0.001). Conclusion: The present study suggests that the regular timing of eating is associated with the number of meals per day. Dietary and sleep patterns, including the time of the last meal, eating a meal after 9 pm, and the need for a nap in the middle of the day, were also associated with chronotype.

Evaluation of Cervico-vertebral Dimensions and Cranio-cervical Angulations in Adults with Different Vertical Growth Patterns: A Cross-sectional Cephalometric Study

Dipjyoti Baruah, BC Karunakara, Sumitra Reddy, Shweta Nagesh Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: The measurement of cervical vertebrae is a valuable diagnostic aid since it provides data on skeletal maturity and potential for growth. Research suggests the existence of a relationship between dentofacial characteristics and cranio-cervical morphology and posture. This relationship can provide insights into the development and treatment of malocclusions, particularly malocclusions in the vertical dimension. Aim: To compare cervico-vertebral dimensions, morphology, and cranio-cervical postures in subjects with different skeletal growth patterns such as average, horizontal and vertical. Materials and Methods: The study was cross-sectional in design and was conducted for a period of two years between January 2014 and December 2016 at KLE Society’s Institute of Dental Science and Research, Bengaluru, Karnataka, India. A total of 102 lateral cephalograms were taken for the study and classified into three groups according to Frankfurt Mandibular Plane Angle (FMA angle) and Jarabak ratio as Horizontal (HR), Vertical (VR), and Average (AV) groups. Each group comprised 34 subjects (17 males, 17 females). A total of 28 morphological parameters of C3, C4, and C5 in the lateral cephalogram were measured and analysed. Each lateral cephalogram was scanned with a Konica Minolta Bighub Laser printer, and the area measurement was made with IMAGE J software to measure the area of cervical vertebrae. One-way Analysis of Variance (ANOVA) was used to compare the various parameters between the three groups, and pair-wise comparisons were done using the Least Significant Difference (LSD) test. Student's t-test was done to assess the differences between males and females. A p-value less than 0.05 was considered statistically significant. Results: The mean chronological age of subjects was 21.2±3.14 years for the HR group, 21.3±3.78 years for the VR group, and 21±3.76 years for the AV group. There was a statistically significant difference between the three groups in the measurements of the anterior body height of C3 (ABHC3) (p=0.023), posterior Body Height of C3 (PBHC3) (p=0.007), vertical measurements of C3 (H3) (p=0.010) and (W3) (p=0.013), anterior body height of C4 (ABHC4) (p=0.010), Posterior Body Height of C4 (PBHC4) (p=0.005); H4 (p=0.002); Ratio of H4 and W4 (H4/W4) (p=0.048); area of the third cervical vertebrae (C3) (p=0.039) and area C4 (p=0.024). For cranio-cervical angulation, there were statistically significant differences found for the angle between the Nasion Sella Line (NSL) and the tangent to the Odontoid Process (NSL/OPT) (p<0.001), where the VR group had significantly larger values than the HR and AV groups. There was no significant difference found in fusion anomalies of cervical vertebrae among all three (HR, VR, and AV) groups. Conclusion: The study found that individuals with a horizontal growth pattern tend to have larger cervical vertebral dimensions compared to average and vertical growers. Individuals with a vertical growth pattern exhibited a large cranio-cervical angulation. Overall, males had larger cervical vertebral dimensions compared to females. The studied population did not exhibit any fusion anomalies.

Assessment of Minimum Inhibitory Concentration and Anti-biofilm Activity of Plectranthus Amboinicus Solvent Extract against Pure Strains of Putative Periodontal Pathogens: An In-vitro Study

S Lavanya, T Jessica Christella, Nizar Ahmed, SK Balaji, Vamsi Lavu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Antiseptic agents used in periodontics as anti-plaque and anti-gingivitis agents are primarily chemical substances such as Bis-biguanide derivatives (chlorhexidine) or essential oils. Herbal derivatives have gained prominence in the recent past due to their activity against putative periodontal pathogens; however, only a few have achieved commercialisation. This study focusses on determining the efficacy of an extract from a widely available herb, Indian mint-Plectranthus Amboinicus Methanolic extract (PAM), which has known anti-microbial and anti-inflammatory properties against periodontal pathogens in-vitro. Aim: To assess the Minimum Inhibitory Concentration (MIC) and anti-biofilm property of PAM solvent extract against pure strains of putative periodontal pathogens, namely Porphyromonas gingivalis (American Type Culture Collection-ATCC 33277), Fusobacterium nucleatum (ATCC 25586), and Aggregatibacter actinomycetemcomitans (ATCC 43718). Materials and Methods: The extract of PA was prepared using methanol and a Soxhlet extractor. An in-vitro analysis of the MIC and anti-biofilm efficacy of the extract was performed against standard strains of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum using the broth dilution method and microtitre-crystal violet assay, respectively. The MIC activity of the PAM extracts was compared with Chlorhexidine as a standard. Results: The MIC value of P. amboinicus extract was nearly similar to Chlorhexidine as assessed by the broth dilution method. The MIC of P. amboinicus extract for A.a and P.g was 0.4 ug/mL, F.n was 0.8 ug/mL, and the Chlorhexidine values against all three periodontal pathogens were 0.2 ug/mL. The anti-biofilm activity of The extract of PAMwas evaluated using the microtitre-crystal violet assay, and the Optical Density (OD) values were reduced after exposure to the extract, with a significant reduction (p<0.001) of the biofilm-forming bacteria observed. Conclusion: The methanol extract of PAM demonstrated a noteworthy MIC, exhibiting effectiveness at a low concentration of 0.4 μg/mL against Aggregatibacter actinomycetemcomitans in three repeated trials. Moreover, this extract displayed significant inhibitory effects on the biofilm formation of periodontal pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum (Pg, Aa, Fn), suggesting its potential as an alternative to conventional chemical anti-microbials.

Genomic Characterisation and Epidemiology of XBB Recombinant Variant of Severe Acute Respiratory Syndrome Coronavirus 2 in Uttarakhand using Next Generation Sequencing: A Retrospective Cross-sectional Study

Shekhar Pal, Geetika Rana, Minakshi Singh, Shweta Thaledi, Shweta Singhal, Manish Kumar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Following the surge of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in late 2019, there was an 11-month period of relative evolutionary stability. However, since late 2020, SARS-CoV-2 evolution has been characterised by the emergence of mutation sets impacting virus characteristics like transmissibility and antigenicity, termed “variants of concern.” This shift likely responds to changing immune profiles within the human population. There is mounting evidence suggesting that post-vaccination serum is less effective in neutralising certain SARS-CoV-2 genotypes. XBB is a recombinant variant comprising sublineages BA.2.10.1 and BA.2.75 of the Omicron variant. Aim: To investigate the genomic characterisation and epidemiology of the XBB recombinant variant of SARS-CoV-2 in Uttarakhand, India. Materials and Methods: A retrospective cross-sectional study was conducted at the Viral Research Diagnostic Laboratory (VRDL Lab), Government Doon Medical College (GDMC), Dehradun, Uttarakhand, India. A total of 1,162 nasopharyngeal swabs received between September 2022 and February 2023 from various healthcare facilities were included for Next Generation Sequencing (NGS) of coronavirus. NGS was performed and all results were forwarded to the Indian SARS-CoV-2 Genomics Consortium (INSACOG) and the Indian Biological Data Centre (IBDC) for variant determination. Data collection occurred from March to April 2023, with data analysis following from May to June 2023. Statistical analysis was conducted using Microsoft Excel and Omnicalculator. Results: Among the 1,162 processed samples, 41 (3.53%) were identified as the XBB variant of Omicron. Within the XBB variants, XBB.2 was predominant 22 (53.7%). Maximum XBB samples (38, 92.7%) originated from District Dehradun, Uttarakhand, India. Conclusion: SARS-CoV-2 has been evolving and advancing with each new variant coming across. As XBB is impacting both previously infected individuals and those vaccinated, there is an imperative to develop new and efficacious vaccines against circulating variants to reduce associated risks of morbidity and mortality.

Diagnostic Utility of Bone Marrow Aspiration, Trephine Biopsy, and Flow Cytometry in the Evaluation of Various Haematological and Non Haematological Disorders: A Cross-sectional Study from Northern India

Renuka Verma, Rajnish Kalra, Veena Gupta, Sumiti Gupta, Monika Gupta, Sunita Singh Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: The spectrum of haematological and non haematological disorders is vast in various age groups. Complete blood counts and other routine laboratory tests are not always sufficient to diagnose these diseases. Bone marrow examination plays an important role in diagnosing their underlying causes. Aim: To analyse the spectrum of various haematological and non haematological disorders reported in Bone Marrow Aspiration (BMA) and compare them with Bone Marrow Trephine Biopsy (BMB) and Flow Cytometry (FCM) findings where applicable. Materials and Methods: A one-year cross-sectional study was conducted in the Department of Clinical Pathology, PGIMS, Rohtak, Haryana, India from April 2022 to March 2023. A total of 518 consecutive BMA samples were morphologically analysed. Comparative evaluations were performed among BMA, BMB, and FCM where applicable. Diagnostic accuracy was calculated, and the findings of discordant cases were tabulated. Definitive diagnosis of lymphoma/leukaemia and Paroxysmal Nocturnal Haemoglobinuria (PNH) cases were made using FCM. Results: The patients’ ages ranged from three months to 86 years, with a mean age of 38.4 years. The male to female ratio was 1.3:1, with a slight male predominance. The highest number of cases were of anaemia {183 (35.3%) and 164 (31.7%), respectively} and leukaemia {128 (24.7%) and 134 (25.9%), respectively}, followed by normal marrow studies {39 (7.5%) and 32 (6.2%), respectively} and megakaryocytic thrombocytopenia {24 (4.6% in each} in both BMA and biopsy. Among anaemia cases {183 and 164 cases in BMA and BMB}, the majority were of the megaloblastic type {62 (33.8%) and 54 (32.9%), respectively}, followed by hypoplastic/aplastic type {40 (21.8%) and 50 (30.5%), respectively}. In cases of leukaemia (128 and 134 cases in BMA and BMB), acute leukaemia cases (76 (59.4%) and 82 (61.2%), respectively} outnumbered chronic leukaemia cases {52 (40.6%) and 52 (38.8%), respectively} in both BMA and BMB. The concordance and discordance rate between BMA and BMB were 87.6% (419 cases) and 12.4% (59 cases), respectively. Diagnosis was exclusively made by BMB in cases of myelofibrosis, granulomatous disease, and Hodgkin’s lymphoma. Conclusion: BMA cytology is a relatively safe and mildly invasive technique for evaluating various haematological and non haematological disorders with better preservation of cellular morphology. However, in cases with dry/blood taps and focal marrow involvement, BMB should be performed, as it shows well-preserved marrow architecture with all its cellular and stromal components. FCM is a definitive diagnostic modality for further categorisation of acute leukaemia and Chronic Lymphoproliferative Disorders (CLPD).

Comparison of BPL™ Video Laryngoscope and Macintosh Laryngoscope Guided Throat Packing for Head and Neck Surgeries: A Randomised Controlled Study

Milon Vasant Mitragotri, Madhuri Kurdi, Dharmesh Arvind Ladhad, Prema Raddi, Mahesh D Kurugodiyavar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Evidence regarding throat packing for head and neck surgeries is limited. A video laryngoscope, an airway adjunct used for various diagnostic and therapeutic purposes, can also effectively pack the throat. Aim: To compare the Time Taken for Throat Packing (TTTP) using a non-channeled video laryngoscope BPL™ versus the conventional Macintosh larynogoscope direct laryngoscope. Materials and Methods: In this non-inferiority, randomised controlled, single-blind study, 72 patients undergoing head and neck surgeries requiring throat packing were recruited. The non-inferiority margin was set at 10 seconds between the two groups (n=36 each). Throat packing in Group-M and Group-V was performed using the Macintosh and video laryngoscopes with the assistance of Magill’s forceps. The TTTP was recorded from the blade insertion to complete blade removal. A one-sided two-sample unpaired t-test was used to test non-inferiority hypothesis considered in this study. Results: The mean age of patients in Group-M was 37.39 years and in Group-V was 33.65 years, with mean weights of 60.89 kg and 56.32 kg, respectively. The mean TTTP difference between Group-M and Group-V was found to be -12.6 seconds with a lower limit of the one-sided 95% Confidence Interval (CI) of -20.6s. The null hypothesis was accepted, concluding that video laryngoscope-guided throat packing took a longer duration. The ease of throat packing, haemodynamic stress response, and Postoperative Sore Throat (POST) were comparable between both groups. Conclusion: Video laryngoscope-guided throat packing is inferior to conventional Macintosh throat packing in terms of TTTP. However, it is equivocal regarding the ease of throat packing and the stress response induced. POST was the same whether throat packing was performed using a video laryngoscope or a Macintosh laryngoscope.

Effect of Smartphone Usage during Night Time on Sleep Patterns of Young Adults: A Cross-sectional Observational Study

Safa Hyder, Sudhir Shankar Mane, Mohammed Abdul Hannan Hazari, Mehnaaz Sameera Arifuddin Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Excessive smartphone usage among adolescents and young adults has been consistently linked to poor sleep. Moreover, smartphone overuse has been associated with daytime tiredness, longer sleeps latency, and reduced sleep duration. The significance of addressing poor sleep among adolescents and young adults is underscored by recent research linking it to adverse physical and psychological health outcomes, such as mood disturbances, impaired cognitive function, and increased risk incidence of hypertension and diabetes. Aim: To evaluate the effects of smartphone usage on sleep quality among individuals using Pittsburgh Sleep Quality Index (PSQI) and hypnogram data. Materials and Methods: In this cross-sectional observational study, sleep patterns were assessed using the PSQI questionnaire and Prime Nap sleep tracker app (version 1.1.4). The study was conducted by Deccan College of Medical Sciences, Hyderabad, Telangana, India. The data was collected in the form of a hypnogram and the study was conducted in the participants’ homes (under domicile conditions) in the city of Hyderabad, Telangana, India from March 2020 to April 2020. A total of 60 participants (both male and female) in the age group of 15-25 years were recruited and divided into two groups: one comprising 30 individuals with regular prolonged exposure to smartphone screens at night, and the other consisting of 30 individuals who experienced minimal or no smartphone exposure once they prepared to sleep. Descriptive statistics were applied to the collected data using Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS) for Windows version 25.0. Results: Adding up the average scores of the seven factors gives a global PSQI score from 0 to 21, with 0-4 indicating good sleep and 5-21 indicating poor sleep. Among those who used smartphones regularly at night time, 20 participants (66.67%) had PSQI score >5 and poor sleep quality, 24 participants (80%) had prolonged sleep latency, 18 participants (60%) had poor sleep duration, 27 participants (90%) had sleep disturbances, and 22 participants (73.33%) had increased daytime dysfunction. Hypnogram abnormalities were seen in >15 participants (50%) of subjects. Conclusion: The prevalence of smartphone addiction is widely acknowledged in the medical literature, highlighting the need for its assessment, especially among adolescents and young adults. The study reveals that poor sleeping habits among participants were attributable either to a lack of awareness or neglect. By recognising the importance of adequate sleep, improvement in the quality of daily activities can be made by reducing daily screen time, consequently alleviating both physical and mental stress. Furthermore, the findings have implications for individuals whose work involves prolonged exposure to computer screens, especially during night time.

Clinico-bacteriological Study and Molecular Detection of Campylobacter in Childhood Diarrhoea: A Cross-sectional Study

Visakha Kadiyala, Madhuri Kulkarni, Prathyusha Kadiyala, Anshu Kumar Yadav Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Campylobacter infections cause diarrhoeal diseases as frequently as Salmonella and Shigella infections. The prevalence of Campylobacter infection among children with acute diarrhoea in developing countries ranges from 5-35%. Diagnosing Campylobacter infections is challenging as the organism is difficult to isolate, grow, and identify. Currently, no best-practice clinical or public health laboratory guidelines exist for laboratory diagnosis of Campylobacter infections. Aim: To explore the clinical and bacterial aspects of childhood diarrhoea, emphasising the prevalence and molecular detection of Campylobacter. Materials and Methods: A hospital-based cross-sectional descriptive study was conducted with 55 stool samples of children under five with diarrhoea or dysentery at the Department of Microbiology, JSS Medical College, Mysuru, Karnataka, India, from October 2016 to September 2017. All stool samples were inoculated onto Campylobacter selective and non selective media with filtration and incubated in microaerophilic conditions. The culture isolates were identified by standard phenotypic tests. Molecular characterisation of Campylobacter was performed targeting the Campylobacter adhesion to fibronectin F (cadF) gene. The presence of a phylogenetically conserved 16S ribosomal Ribonucleic Acid (16SrRNA) domain was studied, followed by specific detection of pathogenic Campylobacter species. The Statistical Package for Social Sciences (SPSS) version 22.0 was used for statistical analysis. Descriptive statistics like percentage, mean, and Standard Deviation (SD) were applied. Results: Campylobacter was isolated by culture in one out of 55 stool samples. The isolate was confirmed to be Campylobacter jejuni by phenotypic tests. Campylobacter genus-level Polymerase Chain Reaction (PCR) was positive for 6 samples (10.9%). Six positive samples were subjected to species-level PCR; all were positive for C. jejuni. Out of 55 stool samples, two diarrheagenic Escherichia coli, two Shigella sonnei, one Shigella dysenteriae, and one Salmonella enterica serovar Typhi were also identified. Conclusion: Culture is insufficiently sensitive for diagnosing Campylobacter infection compared with nucleic acid-based diagnostics. Nucleic acid-based diagnostics offer increased sensitivity, can determine both the presence and burden of infection, and can distinguish between Campylobacter infections at the species level. Therefore, PCR is recommended, if feasible, as the preferred diagnostic modality for detecting Campylobacter infection.

Ocular Manifestations of Leukaemia: A Cross-sectional Study from Tertiary Care Hospital of South Gujarat, India

Umeshaben Ishvarbhai Padvi, Trupti Mahesh Solu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Leukaemic ophthalmopathy can be either symptomatic or asymptomatic. Several factors can cause leukaemic ophthalmopathy, including opportunistic infections, direct ocular infiltration by leukaemic cells, indirect ocular involvement from subsequent haematologic alterations, and consequences from different treatment modalities. Patients with leukaemia who develop leukaemic infiltrates must undergo urgent systemic and neurological re-evaluation. Aim: To evaluate the prevalence and spectrum of leukaemic ophthalmopathy among leukaemic patients and to identify and analyse the common ocular manifestations of leukaemia in different age and gender groups. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in South Gujarat, India. A total of 48 patients diagnosed with leukaemia were included in the study. Detailed histories regarding their systemic illness, present systemic complaints, ocular complaints, and history of treatment were noted. Detailed ophthalmoscopic examinations like slit lamp examinations, fundoscopic examinations, visual acuity, and intraocular pressure were performed on each participant. Statistical analysis was conducted using descriptive data analysis methods in Microsoft Excel sheets. Results: Out of the total 48 leukaemia patients recruited, 16 (33.33%) had ocular manifestations. Among the 25 acute leukaemia patients and 23 chronic leukaemia patients, 8 (32%) and 8 (34.78%) had ocular manifestations, respectively. Among all ocular manifestations, venous tortuosity was the most common, followed by deep and superficial retinal haemorrhage, dry eye, and Roth’s spot. Conclusion: The prevalence of ocular manifestations in leukaemia was reported to be 33.33%. Although an ophthalmologist's involvement in leukaemia treatment is secondary, it is nonetheless crucial to promptly recognise any ocular signs due to the worse prognosis associated with ocular involvement and to rule out extramedullary disease.

Correlation Between Portal Vein Diameter and Clinical Prognostic Scores in Patients with Liver Cirrhosis: A Cross-sectional Study

Aman Garg, Kamal Singh, Nidhi Bhardwaj, Narinder Kaur Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Patients with liver cirrhosis develop portal hypertension, which leads to complications like splenomegaly, ascites, and oesophageal varices. Hepatic Venous Pressure Gradient (HVPG) measurement, the best available method to measure portal hypertension, is invasive and difficult to perform. Some studies suggest that an increased Portal Vein Diameter (PVD) on ultrasonography indicates portal hypertension and correlates with oesophageal varices. Studies correlating PVD with other complications of portal hypertension, like ascites and spleen size, are scarce. Aim: To correlate ultrasonographically measured PVD with clinical prognostic models: Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD), as well as with platelet count, in patients with liver cirrhosis. Materials and Methods: This was a cross-sectional study conducted in the Department of General Medicine in collaboration with the Department of Radiodiagnosis at Government Medical Collge, Chandigarh, India, from February 2021 to September 2021 over an eight-month period in a tertiary healthcare centre in North India. A total of 97 patients with cirrhosis, identified based on clinical features supported by laboratory tests and ultrasonography, were included in the study. A 6 mL of blood sample was collected from each patient for haemogram, biochemical tests (liver function tests and renal function tests), and coagulogram. Ultrasonography assessment of PVD, spleen size, and ascites was performed in a supine position using a right subcostal approach, after overnight fasting. The collected data were analysed using relevant statistical tests. Results: The mean age of the study population was 47.39 ± 12.64 years, with 73 (75.3%) males and 24 (24.7%) females. The most common aetiological factor for liver cirrhosis was alcohol, present in 52 (53.6%) patients. The mean PVD was found to be 12.31±2.71 mm. The correlation coefficient of PVD with spleen size was 0.3 with a p-value of 0.004, suggesting a positive correlation. The correlation coefficient of parameters like thrombocytopenia, CTP score, and MELD score was -0.2 (p-value=0.066), 0.1 (p-value=0.463), and 0.0 (p-value=0.725), respectively. Conclusion: Sonographically measured PVD cannot be used as a substitute for the clinical grading and staging of cirrhosis. Only a weak positive correlation was found between PVD and spleen size.

Evaluation of Induced Sputum against Gastric Juice Aspirate in the Diagnosis of Tuberculosis in Children: A Cross-sectional Study

Baker Ninan Fenn, Joy S Michael, Prasanna Samuel, DJ Christopher, Valsan Philip Verghese, Anila Chacko, Urmi Ghosh, Winsley Rose Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Diagnosing Tuberculosis (TB) in children is difficult as they do not expectorate sputum on their own, and the sample is usually paucibacillary. Hence, alternative sampling methods like Gastric juice Aspiration (GA), which is the widely accepted method, and Induced Sputum (IS) collection, a more novel approach, are used. The IS method has several advantages, such as being less invasive, not requiring inpatient admission, causing less discomfort, and not necessitating overnight fasting, compared to the GA method. Aim: To evaluate IS against GA for diagnosing TB using XpertMTB/RIF assay, as well as mycobacterial culture, in children aged between 2 and 15 years. Materials and Methods: This cross-sectional study was conducted in the Department of Paediatrics at Christian Medical College and Hospital, Vellore, Tamil Nadu, India from June 2019 to March 2020, involving 138 children aged between 2 and 15 years who were being evaluated for TB. GA samples were collected after an overnight fast, and on the same day, atleast two hours later, IS samples were collected by trained staff. Both samples underwent mycobacterial smear and culture using the Mycobacteria Growth Indicator Tube (MGIT) method and Xpert MTB/RIF assay. Confirmation of pulmonary TB was based on atleast one of these tests being positive. The ‘Wong-Baker’ Visual Analogue Scale (VAS) was individually administered to each patient to compare the discomfort associated with GA and IS procedures. The differences in yield between IS and GA were tested for significance using the Two-sample test of proportions with a significance level set at 5%. McNemar's ?2 test was employed to compare matched observations. The Mann-Whitney test was used for comparing continuous variables, and the Chi-Square test for categorical variables. Cohen’s Kappa (?) was used to assess interobserver agreement between the sampling methods using the different tests. Results: Out of the 138 cases recruited with suspected pulmonary TB, the diagnosis was microbiologically confirmed in 13 cases (9.4%). The overall diagnostic yield was 12/138 (8.7%) for GA and 10/138 (7.2%) for IS. In children under 10 years, GA outperformed IS with all three cases being positive by GA and none by IS. For those aged 10 years and above, 10 children (100%) tested positive with IS, while nine children (90%) were positive with GA. According to the Wong-Baker VAS measuring discomfort during the procedure, IS was favoured over GA (p-value<0.0001). Conclusion: IS performs similarly or better than GA in children over 10 years, while GA performs better than IS in children under 10 years of age. IS is reported to cause less discomfort than GA on the Wong-Baker VAS.

Indications for Intervention in Patients Undergoing Ureteroscopic Therapy for Ureteric Calculus: A Cross-sectional Study

Muralidhar Achar, Raj Ahemed Mulla, Hasit Mehta, Prashanth Kulkarni, Saurabh Bhargava Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Urolithiasis is one of the most common urological problems worldwide. The fastest treatment modality to achieve stone clearance of ureteral stones is Ureteroscopic Lithotripsy (URSL). However, it is negated by both the cost burden and potential risk to the patient. Medical Expulsive Therapy (MET) is a treatment option for upto 10 mm stones but has failure rates of 40-60% in the literature. Aim: To analyse the various indications for surgery, whether MET was used or not, if used-its details, operative findings at ureteroscopy including the reason for the failure of MET. Materials and Methods: A cross-sectional study consisting of 72 patients with ureteric calculi undergoing URSL was analysed from June 2017 to December 2018 at Mazumdar Shaw Medical Centre, Bangalore, Karnataka, India. Indications were assessed at the time of admission. During ureteroscopy, factors like impaction, distal obstruction, and unusual findings were studied, which could have contributed to the failure of MET. The Chi-square test was used as a test of significance for categorical data. The Analysis of Variance (ANOVA) test was used as a test of significance to identify the mean difference between continuous variables. The p-value of <0.05 was considered statistically significant. Results: The mean age in the study was 41.65±13.4 years (range 20-69 years), and the mean stone size was 10.03±3.34 mm. Large stone was the most common indication (41, 56.9%, p=0.004), followed by failed MET (35, 48.6%). Even though MET could have been continued for four weeks in 17 patients (23.6%), they were taken up for surgery. The impaction rate was 70.8% (51), with 48.6% (35) being large impacted stones and 22.2% (16) being small impacted stones. The overall stone clearance rate was 68 out of 72 (94.4%). Conclusion: Large stone size (≥10 mm) and failed MET were the main indications for surgery. One reason for the failure of MET was not waiting for a duration of four weeks. During ureteroscopy, impaction of the stone, irrespective of size, was the most common finding and was the reason for the failure of MET. Ureteric stones on MET should not be neglected as there are reasons for the failure of MET, and they will require URSL after four weeks.

Evaluation of Efficacy and Safety of 2 mg vs 4 mg Dienogest in Endometriosis: A Randomised Single-blind Dose-ranging Trial

Suparna Biswas, Raghunath Bhattacharyya, Sumit Ranjan Pramanik, Neha Jain, Subhash Chandra Biswas Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Endometriosis is a recurring chronic inflammatory condition that affects females of reproductive age. Endometriosis-associated Pelvic Pain (EAPP) adversely impacts physical, mental, and social well-being. Currently, there is no ideal treatment option. Dienogest, a selective progestin, shows a pronounced effect on endometriosis. Aim: To compare the efficacy and safety of Dienogest at doses of 2 mg and 4 mg/day orally in the treatment of endometriosis. Materials and Methods: An observer-blind, parallel-group, randomised clinical trial was conducted in the Department of Obstetrics and Gynaecology at IPGME&R, SSKM Hospital, Kolkata, West Bengal, India, from April 2016 to December 2017. A total of 190 women aged 20-45 years suffering from endometriosis were recruited and divided into two treatment groups, A and B, receiving daily doses of 2 mg and 4 mg, respectively, for 24 weeks. Relief of EAPP was assessed using the Visual Analogue Scale (VAS) score, and improvement in Quality of Life (QoL) was measured. Treatment-related adverse events were also recorded. Numerical variables were compared using Student’s t-test or the Mann-Whitney U Test, and categorical variables were compared using the Chi-square test or Fisher’s-exact test. Results: The absolute reduction in pelvic pain VAS score was 39.71±8.60 at 24 weeks from the initial score of 70.88 (Mean VAS score before treatment with Dienogest) in Group A, compared to 34.80±6.45 from 69.34 (Mean VAS score before treatment with Dienogest) in Group B (p=0.0001). The difference in mean VAS at 24 weeks between the two groups was statistically significant (p=0.0002). At 24 weeks, 18 (24.66%) patients in Group A experienced an irregular bleeding pattern compared to 27 (40.30%) in Group B, with spotting being the most common issue. Adverse effects such as weight gain, acne, alopecia, depression, and decreased libido were observed in both groups, but they were more pronounced in the 4 mg group. Conclusion: The efficacy and safety results from this dose-ranging study of Dienogest indicate that 2 mg/day is the effective dose for treating endometriosis and offers better tolerability compared to the 4 mg dose.

The Spectrum of Deletion Pattern in the Dystrophin Gene in Duchenne Muscular Dystrophy Patients: A Cross-sectional Study from Northeast India

Anjanjyoti Rajkonwar, Jenita Baruah, Binod Sarmah, Giriraj Kusre, Gautam Shyam, Abhijit Dutta Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Duchenne Muscular Dystrophy (DMD) is an X-linked recessive neuromuscular disorder characterised by progressive, irreversible muscle weakness. It is caused by a mutation in the dystrophin or DMD gene, leading to the absence of the essential muscle protein Dystrophin in DMD. Muscle strength continually diminishes, and death usually occurs from chronic respiratory insufficiency and/or cardiac failure. Due to the high mortality rate, early diagnosis is crucial to allow appropriate planning for patient care and treatment. In India, the traditional multiplex Polymerase Chain Reaction (PCR) assay is the most common method to detect Dystrophin gene deletion mutations. Aim: To describe the spectrum of deletion patterns in the dystrophin gene in muscular dystrophy patients attending a tertiary care hospital in Northeast India. Materials and Methods: A hospital-based cross-sectional study was conducted on a total of 53 suspected DMD patients attending the Department of Neurology and Department of Paediatrics at Assam Medical College, Dibrugarh, Assam, India from January 2016 to December 2022. Multiplex PCR was performed to study the deletion patterns for the 25 most common exons of the DMD gene for all patients at the Genetic lab, Department of Anatomy. Deletion mutations at different multiple exons were found, and the results were statistically analysed using Statistical Package for Social Sciences (SPSS) to calculate the mean and standard deviation. The results were presented in tabular form as percentages. Results: Out of the 53 cases suspected to have DMD on the basis of clinical presentation and high serum Creatine Kinase (CK) levels, 34 patients (64.2%) showing deletion mutations in the 25 most common exons of the DMD gene were included in the study. Deletions were most common in 15 (44.1%) patients in the distal hotspot region of exons 44-55. The most common gene deleted was exon 50 in 11 (32.4%) patients. The age at which symptoms were noticed was 4.7±2.01 years. The mean age at diagnosis was 8.4±2.4 years. Conclusion: In the present study, most patients suspected of DMD based on clinical and laboratory findings had deletions in the DMD gene, with the most common region for deletion in the dystrophin gene being the distal hotspot region, and exon 50 being the most commonly deleted.

The Attitudes of Emergency Department Nurses towards Patient Safety in Alqassim Region, Saudi Arabia: A Questionnaire-based Cross-sectional Study

Bander Saad Albagawi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Patient safety is a crucial aspect of healthcare delivery, and nurses play a critical role in ensuring that patients receive safe and high-quality care. As healthcare systems continue to evolve, it is essential to understand the attitudes and perceptions of nurses towards patient safety. Aim: To explore emergency department nurses’ attitudes toward patient safety in the Alqassim region, Saudi Arabia. Materials and Methods: This was a cross-sectional study involving 420 emergency department nurses from the hospitals of the Alqassim region, Saudi Arabia. The World Health Organisation (WHO) patient safety questionnaire, specifically tailored for nurses, was employed. Data analysis was conducted using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Total of 139 nurses out 420 completed the research. Most participants were males aged between 22 and 30 years, married, and held a Bachelor of Science in Nursing (BSN) degree. The overall average score for patient safety reached a moderate level, with a mean of 118.66±23.33. The component on workplace safety had the highest average score of 32.33±7.40, while the section on personal attitudes towards patient safety had the lowest average score of 15.02±3.72. Conclusion: Nurses exhibited moderate attitudes towards various aspects of patient safety, including error and patient safety, healthcare system safety, and personal attitudes towards patient safety. Enhancing patient safety measures is crucial for fostering a resilient safety culture in the healthcare sector.

Longitudinal Study on the Rare Entity of Acromial Apophysitis in Paediatric and Adolescent Ages

Devendra Lakhotia, Utkarsh Agrawal Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Acromial apophysitis is a traction apophysitis caused by repetitive stress to the distal acromion. Although it is a common non-traumatic cause of shoulder pain in adolescence, data is scarce in the literature. There is a need for a better understanding of acromial apophysitis regarding its cause, diagnosis and management. Aim: To determine the cause, clinical features, radiological findings, management, and outcome of the patients diagnosed with acromial apophysitis. Materials and Methods: A longitudinal descriptive study was carried out at Jaipur National University Institute for Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India, from August 2018 to August 2022. A total of 30 patients aged 10-20 years with shoulder pain, diagnosed with acromial apophysitis based on history, clinical, and radiological examination, were included in the study. The treatment given, duration of disease, and outcome were noted. Descriptive statistics were performed using Microsoft Office Excel. Results: Out of 30 patients diagnosed with acromial apophysitis, 24 (80%) were male, and 6 (20%) were female, with a mean age of 13.47 (range 10-18) years. The cause was repetitive micro-trauma following chronic overuse during athletic and sports activities in 24 patients (80%). Among these patients, 13 played cricket, three played basketball, three played volleyball, two did weightlifting, one was a wrestler, one was a tennis player, and one was a judo player. Six patients (20%) did not give a history of playing any kind of sports. All patients had anterior shoulder pain with tenderness at the antero-lateral acromion. Radiographs showed fragmentation, sclerosis, and irregularity of the acromial apophysis. Conservative treatment included rest and restriction of sporting activities. The duration for the analgesics taken by patients was 8.9 days (range 3-21). The duration from the onset of symptoms to recovery was 5.8±1.61 weeks. None of the patients showed a recurrence of symptoms after complete recovery. Conclusion: Acromial apophysitis is a common cause of shoulder pain in paediatric and adolescent age. It occurs due to repeated overhead abduction, overuse, and throwing activities, mostly in sports persons. It is diagnosed clinically and confirmed with plain radiographs. It is a self-limiting disease with a short benign course. It is treated conservatively with rest and analgesics and has an excellent outcome. This diagnosis should be kept in mind for shoulder pain in young patients to prevent undue investigations and surgery.

Assessment of the Need for Training in Clinical Pharmacology Research on Traditional Medicine among Modern Medicine Practitioners: A Questionnaire-based Study

Sandhya K Kamat, Padmaja A Marathe, Harshad V Kesari, Merin Eldhose, Yashoda Aithal, Nirmala N Rege, Nilima A Kshirsagar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Training young doctors is essential for carrying out need-based research. The field of Traditional Medicine (TM) has made significant contributions to modern medicine, and there is unlimited scope for exploring it further in search of improved treatment options. However, there is a lack of systematic research studies on traditional medicines. It was, therefore, considered necessary to assess the interest and awareness among modern medicine practitioners regarding Traditional Medicine Research (TMR). Aim: To assess the need for training in TMR among modern medicine practitioners. Materials and Methods: A cross-sectional questionnaire-based study was conducted in the Department of Pharmacology and Therapeutics at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India, from March 2020 to September 2020 among modern medicine practitioners from the Western region of India. A validated questionnaire was used to collect data regarding the level of training in research methodology, research experience including TMR, areas for training, attitude towards training in TMR, challenges in TMR, and therapeutic areas to focus TMR efforts. The data were analysed using descriptive statistics. Results: Out of 109 participants, 96 (88.1%) were trained in research methodology. At least one research project was undertaken by 91 (83.5%) participants. Ninety-seven percent of participants felt that TMR was necessary. TMR was conducted by 19 (17.4%) participants. Approximately 65 (59.6%) participants felt that conducting TMR poses challenges such as lack of funds, infrastructure, lack of belief in TM, unavailability of literature pertaining to TM, lack of expertise, and lack of corporate attention and marketing. Therapeutic areas identified to focus research efforts included lifestyle-related disorders, diabetes mellitus, cancer, ageing, allergic disorders, osteoarthritis, and obesity. Conclusion: All the participants expressed the need to undergo training in TMR. However, the experience of conducting TMR was limited. Lack of funds, infrastructure, and expertise were mentioned as the main hurdles in undertaking TMR. It is essential to conduct systematic and need-based training programs for modern medicine practitioners in basic research methodology and TMR.

Evaluation of Failure Rate for Cortical Dental Implants Placed in the Mandibular Anterior Region: A Systematic Review

Srishty Goyal, Dhirendra Kumar Singh, Kumari Lucy Bhola, Jalaluddin Mohammad Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: To enhance the success of dental implants, it is crucial to understand the factors contributing to implant failure. Practitioners should carefully evaluate the relevance and impact of critical risk factors associated with the mandibular anterior region to gauge the potential for implant failure. Aim: To assess the rates of implant failure for implants placed in the mandibular anterior region. Materials and Methods: For this systematic review, the eligibility criteria for present study included randomised and non randomised clinical trials, prospective cohort studies, and retrospective studies published in the English language between 2000 and 2022. These studies specifically documented dental implant failure rates in the anterior mandible, excluding reviews, in-vitro, cadaveric, and animal studies, as well as case series studies. The participants considered were systemically and mentally healthy individuals aged 18-90 years who had undergone oral restoration using dental implants in the anterior mandibular area. Exclusion criteria involved patients who did not undergo oral restoration with dental implants in the anterior mandibular region, those with systemic diseases affecting implant success, serious cardiac diseases, deficient homeostasis, blood dyscrasias, and psychological diseases. The intervention focused on patients rehabilitated with cortical dental implants in the mandibular anterior region, without a specific comparator or control. Based on the mentioned criteria, nine studies were included. The main outcome of interest was the dental implant failure rate. Results: The review's included studies indicated the placement of 3,718 implants in the mandibular anterior region, with 86 failures, resulting in a 2.31% failure rate, suggesting an approximate 3% failure rate for implants in this area. Conclusion: Given the multifactorial nature of implant failure, the available literature does not support the designation of the mandibular anterior region as a specific risk factor for such failures.

Single versus Two Implants-assisted Mandibular Overdentures: A Finite Element Analysis Study

Mohamed Ahmed Alkhodary Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Single-implant Overdentures (1IODs) have gained popularity as a more economical protocol than Two-implant Overdentures (2IODs). However, concerns have existed about the longevity of using a single implant compared to two implants. Aim: To investigate the marginal bone loss and stress distribution around dental implants assisting 1IODs compared to 2IODs within five years of clinical service. Materials and Methods: This randomised clinical trial was conducted at the Department of Prosthetic Dental Sciences, College of Dentistry of Qassim University in the Kingdom of Saudi Arabia from June 2018 to September 2023. Total 40 completely edentulous male patients, aged 50 to 60 years, were blindly allocated to two groups. Group I included 20 patients who received two implants at the canines’ regions, and Group II included 20 patients who received one implant under their mandibular overdentures at the midline of the mandible. The implants in both groups were followed up immediately after loading, at six and 12 months, three years, and five years for probing depth, mobility, and vertical bone loss. Finite Element Analysis (FEA) was used for stress analysis around the implants. One-way Analysis of Variance (ANOVA) and Mann-Whitney tests were used for statistical analysis at a significance level of p<0.05. Results: Group II had significantly more fractures and required more new dentures than Group I. Specifically, 6 (37.5%) patients at three years and 8 (80%) patients at five years, compared to 2 (13%) patients at three years and 3 (20%) patients at five years in Group I. Additionally, Group II had more fractures at the metal housings in the denture base: 6 (37.5%) patients at the first year, followed by 11 (69%) patients at three years follow-up and 12 (75%) patients at five years, whereas in Group I, 2 (13%) patients in the first year, then at three years, 3 (20%) patients, and at five years, 5 (55%) patients. Regarding reattaching the O-ring to their metal housing, in Group II, 12 (75%) patients required this procedure at three years, and 15 (94%) patients at five years, whereas in Group I, 5 (33%) patients needed this procedure at three years, and 8 (53%) patients at five years. Comparison of the crestal bone loss showed that Group II had significantly more marginal bone loss than Group I. At three years, Group II had vertical bone loss of (3.97±0.16 mm) compared to (2.76±0.15 mm) of Group I, and at 5 years, Group II had (5.01±0.12 mm) compared to (3.41±0.14 mm) in Group I. FEA results revealed statistically significantly less stress concentration around implants in Group I (n=15, 100%) compared to implants in Group II (n=16, 100%), with maximum Von Mises values of 63.30 MPa and 129.94 MPa for vertical and inclined loading in Group I, respectively, and 89.32 MPa and 213.93 MPa for vertical and inclined loading in Group II, respectively. Conclusion: Single implants exhibited more vertical bone loss than two implants, starting three years into service, and their dentures required more repairs and replacements than two-implant dentures, making their long-term use less economical.

Impact of Melamine on the Weight of Specimens in Different Stages of Plastination: A Cross-sectional Cadaveric Study

Kalpana Makhija, Shweta Asthana, Aarushi Jain, Sandhya Mehra Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Due to the lack of cadavers, anatomists across the nation are facing trouble in teaching. Plastinated specimens can be used to get around this deficiency and reliance. Aim: To assess the change in weight during plastination using melamine. Materials and Methods: A cross-sectional cadaveric study was conducted in the Department of Anatomy at GMC Kota, Rajasthan, India, using nine specimens from cadavers obtained between June 2016 and June 2017. Freshly dissected specimens from a fresh cadaver were used for plastination. The weight reduction after dehydration using acetone (three changes of seven days each), degreasing using xylene (three changes of seven days each), impregnation with a melamine-xylene mixture (10 days in a vacuum), and curing was recorded. Weight was measured using a digital weighing balance and recorded after each step. All statistical analyses were performed using Analysis of Variance (ANOVA) in MedCalc software version 22.009. Results: There was a gradual weight loss after each step except for impregnation. The percentage of mean weight after dehydration was 58.59±4.03%, after degreasing was 56.21±2.55%, after impregnation was 66.06±4.69%, and after curing was 48.26±5.39% and p-value was highly significant (<0.05). Conclusion: Continuous reduction in weight without distortion of anatomy resulted in lightweight plastinates which were odor-free and aesthetically pleasing.

Flow Cytometry in Mature T- and NK-cell Neoplasms: A Retrospective Descriptive Study from a Tertiary Care Cancer Centre in Kerala, India

Jayasudha Arundhathi Vasudevan, Rekha A Nair, Priya Mary Jacob, CM Simi, Geetha Narayanan, Aleyamma Mathew Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Mature T- and NK-cell Neoplasms (MTNKN) constitute around 12% of all non-Hodgkin lymphomas. They have a variable clinical course, ranging from indolent to highly aggressive tumours. Flow cytometry immunophenotyping is crucial for the diagnosis, staging, and classification of MTNKN. Aim: To determine the frequency, morphologic, and immunophenotypic profile of various subtypes of MTNKN diagnosed by flow cytometry. Materials and Methods: This was a retrospective descriptive study conducted at the Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India. All cases of MTNKN diagnosed by flow cytometry in peripheral blood, bone marrow aspirates, or body fluids from January 1, 2010 to June 30, 2020 (10.5 years duration) at the cancer centre were studied. The morphology of tumour cells and immunophenotype by flow cytometry were analysed. Clinical parameters (lymphadenopathy, hepatosplenomegaly, skin lesions, effusions, B symptoms) and follow-up details, including Progression-free Survival (PFS) and Overall Survival (OS), were also noted. Descriptive statistics for continuous variables and frequencies and percentages for categorical variables were obtained. The Kaplan-Meier method for survival plots was used. Results: Mature T- and NK-cell neoplasms constituted 83 cases. The median age of patients was 56 years. The majority of patients were males (n=49). Adult T-cell Leukaemia/Lymphoma (ATLL) (n=50) constituted the most common subtype, followed by Mycosis fungoides/Sezary syndrome (MF/SS) (n=14), T-cell Large Granular Lymphocytic Leukaemia (T-LGLL) (n=7), T-cell Prolymphocytic Leukaemia (T-PLL) (n=4), Aggressive NK-cell Leukaemia (ANKL) (n=3), Hepatosplenic T-cell Lymphoma (HSTL) (n=3), and Anaplastic Large Cell Lymphoma (ALCL) (n=2). OS and PFS at three years were 22.3% and 16.6%, respectively. Conclusion: Mature T- and NK-cell neoplasms presenting as leukaemia is rare. ATLL was the most common subtype of MTNKN. Flower cells, Sezary cells, and prolymphocytes are useful morphological clues for diagnosis. Immunophenotyping by flow cytometry, along with clinicopathologic correlation, is crucial for the diagnosis and subclassification of MTNKN. All subtypes except T-LGLL show inferior PFS and OS.

Surgical Outcomes of Tympanoplasty with Various Graft Materials in Chronic Otitis Media: A Retrospective Cohort Study

Prasad Trimbakrao Deshmukh, Farhat Qamruddin Khan, Sagar Shankarrao Gaurkar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Clinical Spectrum of Aspergillosis in Children with Severe Asthma: A Retrospective Observational Study

Payal Agrawal, Nidhi Bedi, Pankaj Abrol, Neha Gupta, Kirtika Balhara Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Aspergillus species can affect the respiratory system of genetically predisposed asthma patients. Allergic Broncho-Pulmonary Aspergillosis (ABPA) is one of the manifestations of aspergillosis. Most research on ABPA has been conducted in the adult population, with very few studies including paediatric patients. Aim: To examine the clinical spectrum of aspergillosis in severely asthmatic children aged between 2 and 18 years admitted to the Paediatric Intensive Care Unit (PICU). Materials and Methods: This retrospective observational study was conducted from September 2021 to August 2022. Out of 76 children aged between 2 and 18 years who presented with asthma over one year, 24 children fulfilling the inclusion criteria (severe asthma requiring PICU admission) were included in the study by convenient sampling. Children were diagnosed with ABPA and Severe Asthma with Fungal Sensitisation (SAFS) based on the ISHAM (International Society for Human and Animal Mycology) work group criteria (history of asthma, raised Aspergillus-specific and total Immunoglobulin E (IgE), presence of Aspergillus-specific IgG, eosinophilia, and positive radiological findings). Descriptive statistics elaborated in the form of mean and standard deviation. Results: A total of 24 patients with acute severe asthma were admitted to the PICU over one year. Nearly 60% (15/24) of the patients fulfilled the criteria for subgroup A (comprising poorly controlled asthma, eosinophilia, or positive radiological findings). Among them, six (25%) patients had total serum IgE levels > 1000 IU/mL, three (12.5%) had levels between 500-1000 IU/mL, and six (25%) had levels <500 IU/mL. Among these patients, 60% (9/15) had elevated Aspergillus-specific IgE and IgG levels. As per the ISHAM work group criteria, 6/24 (25%) patients were diagnosed with S-ABPA (Serological ABPA) and 3/24 (12.5%) patients were diagnosed with SAFS. Conclusion: Aspergillus sensitivity is increasingly being detected in asthmatic children, requiring further work-up, especially in patients with poorly controlled asthma.

Carotid Artery Ultrasonography as a Screening Tool for Predicting Coronary Artery Disease: A Cross-sectional Study from Hilly State of Northern India

Drishti Srikrishnan, Vijay Thakur, Sushma Makhaik, Sumala Kapila, Shruti Thakur, Anupam Jhobta, Neeti Aggarwal, Charu S Thakur Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Coronary Artery Disease (CAD) is a major cause of morbidity and mortality worldwide; therefore, early diagnosis plays a crucial role in managing patients with CAD. Multidetector Computed Tomography (MDCT) allows non invasive visualisation of coronary arteries but has limited availability, involves radiation, and is costly. Carotid artery atherosclerosis can be assessed by Ultrasound (USG) in terms of Carotid Intima-media Thickness (CIMT) and carotid plaque assessment. These carotid USG parameters are associated with CAD and can be used to predict CAD in high-risk patients. Aim: To study the association and correlation between carotid artery atherosclerosis USG parameters (CIMT and carotid plaque) and CAD, using Computed Tomography Coronary Angiography (CTCA) as a reference. Materials and Methods: A cross-sectional study was conducted from January 2020 to October 2021 in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. In the present study, 31 patients with suspected CAD were enrolled. All patients underwent CTCA followed by carotid artery USG within two weeks. The association and correlation between carotid artery atherosclerosis on USG and CAD on CTCA were examined. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy were calculated using CTCA as the reference standard. Categorical data were analysed using the Chi-square test, with a p-value of <0.05 considered statistically significant. Results: The mean age of the patients was 54.06±10.79 years. The CAD was observed in 14 (45.1%) cases, of which 13 (92.8%) had significant CAD. Nine patients had raised CIMT, of which eight had CAD. Raised CIMT and CAD showed a significant association with sensitivity, specificity, PPV, NPV, and accuracy of 57.14%, 94.12%, 88.89%, 72.73%, and 77.42%, respectively. A positive correlation was found between CIMT values and the number of vessels with significant CAD (r= +0.67). A total of 7 patients (22.5%) had the presence of carotid plaque, of which 6 (88.57%) had significant CAD. A significant association was found between CAD and the presence of carotid plaque. Carotid plaque had sensitivity, specificity, PPV, NPV, and accuracy of 50%, 100%, 100%, 70.83%, and 77.42%, respectively, in predicting CAD. A positive correlation was observed between carotid plaque burden and the number of vessels with significant CAD (r= +0.56). Conclusion: There is a significant association between carotid ultrasonography parameters (i.e., CIMT, carotid plaque) and CAD. CIMT is a more sensitive parameter than carotid plaque in predicting CAD. However, carotid plaque is more specific for predicting CAD. Carotid artery ultrasonography can be used as a screening tool for predicting CAD and should be included in the work-up of patients with suspected CAD.

Precision in Practice: A Cross-sectional Study Involving MRI T2 Dixon and Conventional Sequence in Detecting Focal Multiple Myeloma Lesions

SP Rajesh, Seetharaman Cannane, Gopinath Periasamy, Vijayakumaran Ethiraju, Haleema Sherene Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Multiple Myeloma (MM) represents a malignant proliferation of plasma cells derived from a single clone. Imaging of the skeleton beyond symptomatic areas is useful for myeloma staging and subsequent follow-up for treatment response and disease relapse. Despite research comparing the Dixon sequence to conventional sequences in a variety of musculoskeletal disorders, there is a lack of studies regarding the Dixon sequence’s application in MM. Aim: To compare the contrast of MM focal lesions in all four T2-weighted Dixon and Conventional T1-weighted spin-echo and Short Tau Inversion Recovery (STIR) images. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology at Kovai Medical Centre and Hospitals (KMCH), Coimbatore, Tamil Nadu, India. All newly diagnosed and known cases of MM, either biopsy-proven or strongly suspected based on other diagnostic testing conforming to International Myeloma Working Group (IMWG) criteria from December 2020 to July 2022, were included in the study. A total of 43 patients with 142 focal MM lesions were included. Contrast between focal MM lesions and surrounding bone marrow was calculated on T1-weighted spin-echo, STIR, and T2-weighted Dixon (all four) images. Statistical analysis was done using repeated measures of Analysis of Variance (ANOVA) with Bonferroni correction to control the type I error on multiple comparisons to find the significant difference between multivariate analyses. A probability value of 0.05 was considered a significant level for all statistical tools. Results: The study population consisted of 21 men and 22 women with a mean age of 65.3±8.6 years {Mean±Standard Deviation (SD)}. Contrast values in all four T2 Dixon images, STIR, and T1-weighted images were as follows: T2 Dixon Fat-only (FO) images (0.86.±0.09) (SD); range: (0.46-0.99), T2-weighted Dixon Water-only (WO) images (0.54±0.14) (SD); range: (0.14-0.82), T2 Dixon In-phase (IP) images (0.20±0.13) (SD); range: (0.02-0.41), T2-weighted Dixon Out-phase (OP) images (0.53±0.19) (SD); range: (0.12-0.87), STIR images (0.47±0.12) (SD); range: (0.12-0.73), and T1 images (0.23±0.12) (SD); range: (0.01-0.55). The mean contrast was highest on T2 Dixon fat-only images (p<0.0005) compared to T1 images, with the lowest contrast seen in IP images and intermediate values in OP images. Conclusion: In conclusion, fat-only images of the T2 multipoint Dixon sequence provide significant contrast compared to conventional T1-weighted imaging. Dixon water-only images provide fat suppression that is not inferior to STIR images. While Dixon techniques in the diagnosis of MM did not significantly differ from the conventional sequence, Dixon stands out from conventional sequences when considering the study duration and contrast between the lesion and normal bone marrow.

Assessment of Knowledge and Compliance with Hand Hygiene among Health Personnel to Reduce Methicillin Resistant Staphylococcus aureus Nosocomial Infections: A Prospective Observational Study from a Tertiary Care Hospital in Southern India

Kalangari Swathi, SankaraRaman Kandasamy, V Sangamithra, Kandasamy Chitresh Shankar, Dudekula Kushbu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Following a significant recovery from Coronavirus Disease-2019 (COVID-19) pandemic, the world has recognised that Hand Hygiene (HH) and facial masks are key preventive measures against various cross infections, particularly in hospital settings. Studying the incidence of Methicillin Resistant Staphylococcus aureus (MRSA) as a part of Healthcare Associated Infections (HAI) surveillance is crucial, as MRSA transmission can be effectively prevented through HH. Aim: To assess the knowledge and compliance of HH among health personnel using the World Health Organisation (WHO) HH questionnaire. Materials and Methods: A prospective observational study was conducted at Bhaarath Medical College and Hospital, Chennai, Tamil Nadu, India, over one year, from December 2020 to November 2021. The Hospital Infection Control Committee (HICC) team carried out an HH survey using the WHO HH questionnaire to evaluate knowledge and attitudes among 115 Healthcare Workers (HCWs), including doctors and nursing staff, in a tertiary care hospital in Kanchipuram, Southern India. The study also involved monitoring monthly MRSA incidence density rates in Intensive Care Unit (ICU) settings as part of HAI surveillance, followed by regular HH audits. MRSA infectivity rates were statistically analysed using paired t-tests with Statistical Package for Social Sciences (SPSS) software version 21.0 to determine p-values and address standard deviations. Results: In this study, 26 (65%) of doctors had undergone training, while 57 (76%) of nurses reported recent formal HH training. Only 16 (40%) of doctors and 21 (28%) of nurses used alcohol-based handrub. Doctors exhibited knowledge ranging from 60-77.5% on germ transmission and hand rub-related questions, while nurses demonstrated better knowledge ranging from 72-93.3%. HH adherence was 30% among doctors and 72% among nurses. The MRSA infectivity rate varied over the year, starting at 1.33 per 1000 resident days before HH audits and decreasing to 0.3. Each HH audit led to a significant improvement in MRSA rates, with a p-value <0.0001, indicating statistical significance. Conclusion: Present study evaluated HCWs knowledge and attitudes toward HH, along with the impact of HH audits on reducing MRSA rates, has proven to be beneficial for hospital infection control practices, particularly during the COVID-19 pandemic and its aftermath, when vigilance tends to decrease over time.

Efficacy of Cis-Atracurium vs Atracurium in Patients undergoing Abdominal Procedures: A Randomised Clinical Study

Vrinda P Oza, Vandana S Parmar, Mayur B Patel, Feny C Thakkar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Cis-atracurium has a neuromuscular blocking capacity approximately three times that of atracurium besylate. The Effective Dose (ED) 95 of cis-atracurium is 0.04 mg/kg, while that of atracurium is 0.2 mg/kg. Cis-atracurium is preferred over atracurium due to the lack of histamine release, providing better cardiovascular stability. This study compares these two drugs in terms of haemodynamic parameters, neuromuscular blocking properties, intubating conditions, and safety profiles. Aim: To assess the efficacy of atracurium and cis-atracurium from various perspectives, including neuromuscular blockade, haemodynamic stability, and safety profiles. Materials and Methods: A double-blinded, randomised clinical study was conducted from January 2019 to October 2019 in Rajkot, Gujarat, India. Sixty patients undergoing abdominal surgeries under general anaesthesia were allocated to two groups. Group A received a loading dose of atracurium 0.5 mg/kg followed by a maintenance dose of 0.1 mg/kg, while Group B received a loading dose of cis-atracurium 0.2 mg/kg followed by a maintenance dose of 0.03 mg/kg. During the surgical procedure, parameters studied included neuromuscular blockade, hemodynamic changes, intubating conditions, and safety profiles in terms of complications. Student’s t-test was used to analyse normally distributed continuous variables, and the chi-square test was used for qualitative variables. Results: The demographic profiles were comparable in both groups in terms of age (p-value=0.800), sex (p-value=0.393), weight (p-value=0.101), and American Society of Anaesthesiologists (ASA) grading (p-value=0.509). A significant increase in heart rate (99.46±8.06 (/minute) vs. 91.66±9.11 (/minute)) and mean arterial blood pressure (104.44±10.16 (mm of Hg) vs. 93.4±12.77 (mm of Hg)) was noted post-intubation in Group A compared to Group B. Patients in Group A (3.5±0.62 minutes) had a faster onset of neuromuscular blockade compared to Group B (4.6±0.49 (minutes)), while the duration of action of the first loading dose and the 25% recovery time from the last supplemental dose was longer in Group B (52.86±5.18 minutes and 41.66±3.60 minutes) than in Group A (31.2±4.82 minutes and 20.86±4.37 minutes). Fewer patients experienced complications (hypotension, erythema of the skin) in Group A compared to Group B. Conclusion: Cis-atracurium releases less histamine compared to atracurium and has a longer duration of action. Cis-atracurium can be a better alternative to atracurium as it offers better haemodynamic, neuromuscular, and safety profiles with similar intubating conditions.

Effectiveness of Hamstring Release and Neural Mobilisation in Improving Walking Capability and Physical Activity Associated with Intermittent Neurogenic Claudication in Patients with Lumbar Spinal Stenosis: A Quasi-experimental Study

Geeta Yadav, Saurabh Kumar, Vinika Choudhary, Priyanka Rishi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: In India, one of the most prevalent spinal pathologies is Lumbar Spinal Stenosis (LSS). It is characterised by the compression of neural structures in the spinal canal, resulting in symptoms such as neurogenic claudication, lower extremity radiculopathy, and gait impairment. Treatment involves various therapeutic modalities, with present study focusing on an integrated exercise method. Aim: To evaluate the potential efficacy of hamstring release and neural mobilisation in LSS patients. Materials and Methods: This quasi-experimental study was conducted at SGT Medical College Hospital and Research Institute, Gurugram, Haryana, India from September 2021 to May 2022. Total of 30 patients diagnosed with LSS were divided into two groups based on inclusion criteria: group A (experimental) and group B (control). Pain, neural flexibility, walking capacity, disability, and physical activity were assessed at baseline and after the 3rd week of the intervention. Treatment sessions were administered for 30 minutes per day, three times per week (on alternate days), for a duration of three weeks in both groups. Data analysis was done using the Windows version of Statistical Package for Social Sciences version 26.0 (SPSS, Chicago, IL, USA). The paired t-test was used to compare mean data within each group before and after the intervention. The Independent t-test formula was applied to compare pre and postintervention changes between group A and group B. Group B. A significance level of p-value <0.05 was considered statistically significant. Results: Group A and group B had respective mean ages of 37.07±8.66 years and 41.07±8.66 years. Total of 30 LSS patients were treated. Significant differences were observed in the Numeric Pain Rating Scale (NPRS) (p-value<0.0001), Straight Leg Raise (SLR) (p < 0.001), Slump Test (p-value<0.0001), and Self-paced Walking Test (SPWT) (p-value <0.0001). Minimal significance was noted in the Modified Oswestry Disability Index (MODI) (p-value=0.027) and Swiss Spinal Stenosis Questionnaire (SSSQ) (p-value=0.029). Conclusion: Hamstring release and neural mobilisation improve pain, neural flexibility, walking capacity, disability, and physical activity in LSS patients.

Comparative Evaluation of Depression, Anxiety and Quality of Life between Clinical and other than Clinical Branch Postgraduate Medical Students: A Cross-sectional Study

Jyoti Prakash, Achyut Kumar Pandey, Pankaj Kumar Gupta, Pradeep Kumar, Abhinav Kumar Pandey, Sanjay Gupta Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Medical training has been reported to be stressful. Clinical branch residents were found to be more anxious when compared to other than clinical branch residents. Heavy workloads and long working hours usually contribute to stress, resulting in fatigue, depression, and anxiety. Aim: To compare depression, anxiety, and Quality of Life (QoL) between clinical and other than clinical branch postgraduate medical students. Materials and Methods: The present cross-sectional study was conducted in the Department of Psychiatry at the Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), in Varanasi, Uttar Pradesh, India. The data were collected from 150 residents through face-to-face interviews and by applying the Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HDRS), and World Health Organisation Quality of Life Brief Version (WHOQOL-BREF). The data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics 23.0 software. Results: The present study found that the majority of residents were male 108 (72%), belonged to the Hindu religion (134, 89.33%), were unmarried (150, 83.33%), and resided in the hostel (118, 78.67%) during their residency tenure. The prevalence of depression among clinical branch residents was 52 (50.0%), and in other than clinical branch residents, it was 17 (36.96%) (p=0.633). The prevalence of anxiety among clinical branch residents was 65 (62.5%), and in other than clinical branch residents, it was 18 (39.14%) (p=0.002). QoL was better in other than clinical branch residents compared to clinical branch residents in physical health, social, and environmental domains (p<0.04). Conclusion: The study concluded that clinical branch residents were experiencing significantly higher levels of anxiety. Overall, the QoL of residents in other than clinical branches was better than their counterparts in clinical branches.

Clinical Profile of Post-COVID-19 Patients with Persistent Chest Pain: A Cross-sectional Study

Sibaram Panda, Sunil Kumar Sharma, Jagannath Hati, Braja Bihari Panda Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Chest pain in post-COVID-19 patients can be due to serious alarming post-COVID-19 sequelae, such as Coronary Artery Disease (CAD), pulmonary embolism, myocarditis, etc. Approximately one-fifth of patients attending clinical Outpatient Department (OPD) following COVID-19 recovery present with persistent chest pain. There is limited knowledge about the clinical profile of patients experiencing persistent post-COVID-19 chest pain. Aim: To describe the clinical profile of such patients to fill the knowledge gap and acquire new insights into patients with post-COVID-19 persistent chest pain. Materials and Methods: A cross-sectional study was conducted, enrolling a total of 259 patients with persistent chest pain (i.e., chest pain lasting more than 24 weeks after COVID-19 diagnosis). After detailed history-taking and clinical and laboratory examinations, observed data were collected, compiled, evaluated, and analysed to achieve the study objectives. Results: Out of 259 patients, 133 (51.4%) had cardiac {85 (32.8%)} or pulmonary {48 (18.5%)} abnormalities. Among patients with cardiac abnormalities, CAD, arrhythmia, myocarditis/cardiomyopathy, pericarditis, and PAH were detected in 38 (14.6%), 18 (6.9%), 7 (2.7%), 11 (4.2%), and 11 (4.2%), respectively. Meanwhile, among patients with pulmonary abnormalities, 36 (13.9%) patients had organic residual lesions in the lung parenchyma, 7 (2.7%) had pleuritis, and 28 (10.8%) had pulmonary function abnormalities. The remaining 126 (48.6%) patients experienced chest pain due to non cardiopulmonary aetiologies like gastrointestinal {45 (17.3%)}, musculoskeletal {38 (14.6%)}, psychomotor {35 (13.5%)}, autonomic {8 (3.3%)}, etc. Conclusion: This study found that chest pain in post-COVID-19 patients arises due to multisystemic aetiologies such as cardiac, pulmonary, visceral, autonomic, psychomotor, musculoskeletal, etc. A wide spectrum of serious cardiac abnormalities (such as CAD, arrhythmia, myocarditis, pericarditis, PAH, etc.) contributes to about 1/3rd of cases of persistent chest pain in post-COVID-19 patients.

Effect of Internal Quality Planning using Sigma Metrics in Lean Management of a Clinical Chemistry Laboratory: An Analytical Study

S Rohit, R Ramesh Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Across the globe, quality control systems serve as the foundation for providing accurate and precise results, and also immediate error detection. However, many laboratories adhere to uniform Quality Control (QC) rules for all parameters, which may result in unnecessary overspending. The present study aimed to establish individual control rules and determine the number of control measurements for each of the 10 parameters using Westgard EZ Rules 3 software. The cost-effectiveness and benefits of applying these new rules were evaluated, alongside the lot-to-date, lot-to-lot, and company-to-company Coefficient of Variation (CV) for quality control materials. Aim: To assess the impact of sigma-metrics-based internal quality planning on lean management in a clinical chemistry laboratory. Materials and Methods: This cost-effective analysis study was conducted using commercially available quality control materials. It was done in the Department of Biochemistry in the Super Specialty Block (SSB) Biochemistry laboratory at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, from June 2020 to June 2022. Initially, the existing practices were scored. Using Westgard EZ Rules 3 software, OPSpecs charts and power function graphs were plotted using Westgard EZ Rules 3 software, and control rules and the number of control measurements for 10 parameters (Urea, Creatinine, Calcium, Phosphorus, Magnesium, Uric acid, Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP), and Total protein) were determined. Cost-effective and cost-benefit analyses were conducted using quality cost worksheets. A comparison of lot-to-date (month to month), lot-to-lot, and company-to-company CV was performed using Statistical Package for Social Sciences (SPSS) Software version 19.0. Results: In the present study, it was found that ALP, calcium, and magnesium followed the 1_3S rule, whereas the remaining 7 parameters followed the 1_3S/2_2S/R_4S/4_1S/10_X rule with two control materials. The study revealed a decrease in cost by 95.8%, 92.3%, and 81.5% for ALT, AST, and creatinine, respectively, and by 71.1%, 68.8%, 59.8%, and 54.9% for uric acid, phosphorus, total protein, and urea, respectively, if the new control rules were followed instead of the existing ones. ALP, magnesium, and calcium showed no cost difference, indicating that the current control rules were similar to the newly framed ones. Furthermore, there was no significant difference in lot-to-date (month to month), lot-to-lot, and company-to-company CV on QC rules for most parameters despite changing reagent lots. Conclusion: In conclusion, the study demonstrated that the control rules for each of the 10 parameters (Urea, Creatinine, Calcium, phosphorus, magnesium, uric acid, AST, ALT, ALP, and total protein), as well as the comparison of QC material CV, proved to be cost-effective.

Exploring the Risk Factors Associated with Video Game Addiction among Adolescent School Children in Chennai District, Tamil Nadu, India: A Cross-sectional Study

BN Surya, VM Anantha Eashwar, Pragadeesh Palaniappan, S Madhush Kumar, A Hari Narayanan, BN Venkatesh, Krishnaprasanth Baalann, U Sarath Kumar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Video game addiction has emerged as a significant concern among adolescent children in recent years. With the widespread availability of technology and the increasing popularity of video games, a substantial number of adolescents are displaying addictive behaviours. Aim: To estimate the prevalence of video game addiction among adolescent school children in Chennai, Tamilnadu, India and find out the various risk factors associated with it. Materials and Methods: A cross-sectional study was conducted at the Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu, Chennai, Tamil Nadu, India among 300 school children aged 10-17 years from four private schools in Chennai, Tamil Nadu, India from February 2023 to June 2023. Data collection involved the Gaming Addiction Scale for Adolescents (GASA) and a pretested semistructured questionnaire. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The study revealed that approximately 31.7% of the participants had video game addiction. Categorical variables were analysed using the Chi-square test, with a significance level of p <0.05. Bivariate logistic regression was utilised to determine unadjusted odds ratios, and variables with p <0.05 were included in the multivariate model to calculate adjusted odds ratios and construct 95% confidence intervals. Conclusion: Video game addiction among adolescent school children is a significant issue with multiple associated risk factors. By promoting awareness, encouraging healthy coping mechanisms, and fostering balanced lifestyles, we can effectively address video game addiction and enhance the well-being of adolescent school children.

Comparison of Clinicopathological Characteristics of Patients with Early and Late-onset Colorectal Adenocarcinoma: A Cross-sectional Study

Bodhisattva Bose, Sunil Kumar Singh, H Sunil, Amit Gupta, Deepak Sundriyal, Rajkumar Kottayasamy Seenivasagam, Itish Patnaik, Deepa Joseph Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Colorectal Cancer (CRC) has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has also been suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. Aim: To assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed at ages over and below 45 years. Materials and Method: This prospective cross-sectional study was conducted between January 2020 and August 2022 in the Departments of Surgical, Medical, Radiation Oncology, Surgical Gastroenterology, and General Surgery at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakand, India. All patients underwent a biopsy from the representative site for histological documentation of the disease. They then underwent treatment (surgery/chemotherapy/radiotherapy) as required. All the data were categorised into two groups: an early-onset group (age <45 years) and a late-onset group (≥45 years). A comparison of the clinicopathological characteristics (age, gender, co-morbidities, tumour subsite, clinical presentation, clinical stage, etc.), pathological data (grade and differentiation of tumour, as per World Health Organisation (WHO) grading system), and serum Carcinoembryonic Antigen (CEA) levels between the two groups was performed. The association between categorical variables was investigated using the Chi-square test. The mean difference was assessed using an independent t-test. A p-value of 0.05 or below was considered statistically significant. Results: A total of 51 patients with rectal cancer, 35 males and 16 females, were included in the study. The mean age was 44.73±16.47 years. Out of the total of 51 (100%) patients, lower rectum involvement was seen in 22 (43.1%) patients, followed by 7 (13.7%) patients each with ascending colon and sigmoid involvement resepectively. However, the Chi-square test showed no statistically significant association of location involved with age groups (?2=9.09; p=0.16). Out of 51 (100%) adenocarcinoma patients in total, three patients each under 45 years of age had signet cell adenocarcinoma and mucinous adenocarcinoma (?2=7.07; p=0.029). Among the total of 51 (100%) patients, moderately differentiated lesions were seen in 17 (33.3%) patients, poorly differentiated lesions were seen in 15 (29.4%) patients, and well-differentiated lesions were seen in 10 (19.6%) patients (?2=13.01; p=0.005). Conclusion: Younger patients tended to have larger tumours that were of a higher grade and had signet ring or mucinous histopathology. The social and clinical implications of these findings are to be explored.

Awareness Regarding the use of Clear Aligners as an Orthodontic Treatment Modality among the General Population of Maharashtra, India: A Cross-sectional Survey

Renuka Pawar, Tanya Prasad, Chanamallapa R Ganiger, Sandesh Phaphe, Yusuf Ahammed, Pratap Mane, Seema Patil Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Fixed orthodontic treatment has been the standard method to treat malocclusions for decades; however, the number of adults seeking more inconspicuous ways to enhance their smiles has significantly increased. This trend has led to the rising popularity of clear aligners among the general population, hailed as the 'invisible treatment' for correcting misaligned teeth. Aim: To assess the level of awareness among residents of Maharashtra regarding clear aligners. Materials and Methods: A cross-sectional study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (KVV) Karad, Maharashtra, India with a sample size of 423 participants. An online survey on awareness and perceptions of clear aligners among the general population of Maharashtra was carried out for one month through the dissemination of an online questionnaire. The questionnaire was administered using Google Forms and consisted of 12 closed-ended questions. The online data was collected and analysed while assessing its content validity. Results: The mean age of the study participants was 28.4±5.88 years. According to the survey, 203 (47.99%) participants had visited an orthodontist, with 87 (43.03%) receiving clear aligner recommendations as a treatment option. Notably, 266 (62.88%) were already familiar with clear aligners, and 268 (63.36%) considered them to be an effective treatment. Conclusion: The study findings indicated that 62.88% of participants had prior knowledge of clear aligners, while only 47.99% had visited an orthodontist.

Vitronectin Levels in Leukocyte-platelet Rich Fibrin, Injectable-platelet Rich Fibrin, and Serum: A Cross-sectional Study

Anirudh B Acharya, Aditi Lokhande, Swetha Acharya, Mihir Kulkarni, Srinath Thakur Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Platelet-rich Fibrin (PRF) is an autologous platelet concentrate preparation containing several proteins that aid in healing. Vitronectin is one of these proteins that has not been quantified in all types of PRF. Various protocols have been suggested to alter the yield of different components of PRF to enhance wound healing. Hence, it is beneficial to know the vitronectin levels in PRF. Aim: To detect, estimate, and compare the levels of vitronectin in two PRF protocols and serum. Materials and Methods: The present cross-sectional study conducted in the Department of Periodontics at the SDM College of Dental Sciences and Hospital. Dharwad, Karnataka, India from January 2019 to June 2020 involved 12 systemically and periodontally healthy volunteers. Blood was obtained from each volunteer to collect and prepare serum, Leukocyte-PRF (L-PRF), and injectable-PRF (i-PRF), respectively. Three distinct samples-supernatant, exudate, and clot-were collected and categorised into seven groups (L-PRF supernatant, L-PRF exudate, L-PRF clot, i-PRF supernatant, i-PRF exudate, i-PRF clot, blood serum) that were assayed for levels of vitronectin. The data were statistically analysed using the independent t-test, one-way Analysis of Variance (ANOVA), and Newman-Keuls Post-hoc procedures. Results: The mean age was 24.92±2.57 years. Vitronectin was detected and estimated in all the samples. Vitronectin levels ranged from 64.09±0.04 ng/mL to 64.20±0.21 ng/mL. One-way ANOVA applied to test between and within groups was significant (p=0.049). A statistically significant difference was observed only between L-PRF exudate and serum (p=0.05). Conclusion: The comparable levels of vitronectin in L-PRF and i-PRF observed in present study suggest that vitronectin in these two PRF protocols may aid wound healing.

Analysis of Informed Consent Forms Submitted to Institutional Ethics Committee of a Medical Institute in Southern India: A Cross-sectional Observational Study

Vedavathi Hanumaiah, Shreenivas Prabhakar Revankar, Nagaraja Prasad Sai, Mohammad Arif Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Informed consent is an essential component in research involving human participants. However, the informed consent obtained may be incomplete and not fulfill the essential criteria of Informed Consent Forms (ICFs). Although the guidelines for developing ICFs have been clearly spelled out by various research bodies, these guidelines are not followed completely. Aim: To analyse the ICFs submitted to the Institutional Ethics Committee (IEC) of a Medical Institute in Southern India. Materials and Methods: The present study was a cross-sectional observational study analysing ICFs submitted to the IEC of McGann District Teaching Hospital, Shimoga Institute of Medical Sciences (SIMS), Shivamogga, Karnataka, India, for the period 2014 to January 2023. All research projects containing ICFs during the study period were included in the study. Of the research projects submitted, only 70 had ICFs, and these were subjected to analysis as per Indian Council of Medical Research (ICMR) guidelines criteria. The criteria for ICFs were: statement of research, purpose/methods of the study, duration/frequency of the study, benefits to participants/community, foreseeable risks, discomfort/inconvenience, confidentiality, payment/reimbursement for participation. In addition to these, ICFs were also analysed for additional elements as per ICMR criteria for tissue and blood samples. The results were then subjected to descriptive statistical analysis and presented as mean and percentages. Results: Many of the required essential elements were present in nearly 50% of ICFs submitted to the IEC, which include information on the basic purpose/methods of the study 70 (100%), identity of the principal investigator/research team 57 (81.42%), freedom to participate/withdraw from the study 55 (78.57%), confidentiality of records 54 (77.14%), and foreseeable risks, discomfort, and inconvenience to participants 35 (50%). Other essential elements like benefits were present to participants/community 28 (40%), payment/reimbursement for participation 28 (40%), duration and frequency 12 (17.14%), statement of research 9 (12.85%), treatment/compensation for injury 4 (5.71%). Regarding additional elements of ICFs for biological samples, ICFs adhered to the ICMR requirements except none of the submitted forms had any information on the period of storage of biological samples. Conclusion: The ICF is an essential requirement for conducting research. Ensuring adherence of ICF to guidelines is important from a research perspective. The present study concludes that the majority of the essential elements were present in ICFs with a few exceptions like study as research and information on the storage of biological samples, which was nil.

A Prospective Analysis of Sustained Immunity Following Covishield Vaccination

P John Solomon, VS Kalaiselvi, A Priya Margaret, Juwain Shehzad Nehil, WMS Johnson, Chitralekha Saikumar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: The outbreak of Coronavirus Disease 2019 (COVID-19) affected a large number of people worldwide within a short period of time. The mortality rate was high, and there was no specific medicine available to cure it. Therefore, the situation demanded the rapid development of a vaccine. When the vaccines were introduced, there was limited knowledge about their efficacy, side-effects, and duration of protection. Hence, a detailed study was conducted in these areas. Aim: To study the immunological responses following Covishield vaccination and determine the duration of protection offered by the vaccine. Materials and Methods: The present study is a prospective observational study conducted at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from March 2021 to May 2023, involving the staff members of the hospital and college who were above 18-year-old. Individuals with immunodeficiency, those on immunosuppressive medication, or anyone with proof of COVID-19 were excluded. The total sample size was 56. Blood samples were collected before administering the vaccine, at 0, 3, and 12 months, and tested for Complete Blood Count (CBC), COVID-19-specific Immunoglobulin G (IgG), Cluster of Differentiation (CD) 45, CD3, CD4, CD8, etc. The findings were statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0 and STATA software version 10. Results: A total of 154 volunteers initially provided the first blood samples. However, only 129 of them provided blood samples 2nd time and received two doses of the vaccine. Out of these, only 56 participants completed the fourth time blood test. The results consistently demonstrated a rise in IgG levels over time, with consistently higher levels observed in females. Participants above 45 years exhibited higher IgG levels. Individuals with co-morbidities also showed an increase in IgG levels. The research revealed that individuals who were initially IgG negative experienced a greater fold increase in IgG levels after the first dose of vaccination. The incidence and duration of side-effects post-vaccination reduced with each successive vaccine dose. Conclusion: All the volunteers developed adequate IgG antibodies. Two doses of Covishield effectively resulted in lasting immunity in 94.64% of cases, and three doses achieved 100% immunity. Females and participants above 45 years consistently exhibited higher antibody levels. Individuals with co-morbidities also developed antibodies, albeit at slightly lower levels. The side-effects were mild and short-lived. No long-term after effects were detected even after two years and two months following vaccination.

Vitamin D and Vitamin D Receptor FokI, ApaI, and BsmI Gene Polymorphisms and their Relation with the Risk of Breast Carcinoma: A Case-control Study

Ashok Kumar Dogra, Archana Prakash, Sanjay Gupta, Meenu Gupta Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Breast cancer stands as the leading cause of mortality among women in developing nations. The potential role of Vitamin D in mitigating the incidence of breast cancer is thought to stem from its ability to impede cell proliferation by interacting with the Vitamin D Receptor (VDR). The VDR gene is responsible for encoding the VDR, which plays a pivotal role in mediating the effects of vitamin D. Aim: To analyse vitamin D levels and the association of VDR FokI, ApaI, and BsmI genotypic distribution frequency with the risk of breast cancer. Materials and Methods: The case-control study included 220 samples, including 110 breast cancer patients and 110 age-matched control women aged 30-70 years. The Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) genotyping was performed using Deoxyribonucleic acid (DNA) extracted from blood, and the circulating levels of 25-hydroxyvitamin D by case/control were estimated by chemiluminescence immunoassay. Results: The 3’ VDR polymorphism BsmI sequence showed minimal association with breast cancer risk. The bb genotype had a significantly lower odds ratio of 0.056 (p-value<0.05). Conversely, the BB and Bb genotypes exhibited no statistically significant associations with odds ratios of 1.76 (95% CI: 0.36-8.54; p-value>0.05) and 1.30 (95% CI: 0.27- 6.25; p-value>0.05), respectively. Isolated analysis of the FokI variant revealed a significant association with increased breast cancer risk, with odds ratios of 5.49 (FF) and 6.00 (Ff), both demonstrating statistical significance (p-value<0.05), and a Chi-square value of 0.006. Additionally, the p-value for serum Vitamin D levels was found to be highly significant at p-value<0.001, indicating that the levels were significantly lower in individuals newly diagnosed with breast cancer compared to those in the healthy control group. Conclusion: The study found a significant link between breast cancer susceptibility and VDR (FokI) polymorphism FF and Ff genotypes, with minimal impact observed for (BsmI) polymorphism bb genotype. This implies that certain genetic variations, especially in the FokI polymorphism of the VDR gene, are associated with an elevated risk of breast cancer.

Molecular Docking Study on Phytochemicals of Alpinia galanga and Their Derivatives as Inhibitors of β-Ketoacyl Reductase (MabA) of Mycobacterium Tuberculosis: An In-silico Study

Palaneswamy Savetha, Ethirajulu Premalatha, Tanjavur Kaderesan Veerappan Sharavanan, Belukurichi Sadasivam Sangeetha, Iyanar Kannan Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Tuberculosis (TB), an infectious disease caused by the bacterium Mycobacterium Tuberculosis (MTB), continues to be a global health problem. Alpinia galanga (Linn.) of the Zingiberaceae family has antitubercular properties, and their mode of action in in-vitro as well as in-vivo conditions is well established. This knowledge of the active phytochemicals of Alpinia galanga has been utilised to identify new potent drugs for MTB. Aim: To perform molecular docking studies of various phytochemicals of Alpinia galanga and their derivatives with β-ketoacyl reductase (MabA) of MTB. Materials and Methods: The present study is an in-silico study conducted in the Bioinformatics facility of the Central Research Laboratory of Tagore Medical College and Hospital, Chennai, Tamil Nadu, India from November 2022 to April 2023. The receptor protein was downloaded from the Research Collaboratory for Structural Bioinformatics (RCSB) database. The phytochemicals in. sdf format were downloaded from the PubChem database. The derivatives were prepared by Chemsketch software. Docking was performed using AutoDock Vina with PyRx as the GUI (Graphical User Interface). Post-docking analysis was performed in LigPlot+. Results: Phytochemicals from Alpinia galanga were obtained from the PubChem database and docked with MabA of MTB. The derivatives were further subjected to docking analyses. From the docking study, two molecules, namely, (1E,6Z)-2,4-diamino-6-fluoro-1,7-bis(4-hydroxyphenyl)-1-sulfanylhepta-1,6-diene-3,5-dione and (2E,6Z,10E)-2,6,9,9-tetrakis(hydroxymethyl)cycloundeca-2,6,10-trien-1-one-ethane (1/1), were found to have good binding energy values. Conclusion: The present study helped us find drug-like molecules that can inhibit the MabA of MTB. Two compounds derived from the phytochemicals of A. galanga were found to have an effective binding capacity to the drug target in-silico. Hence, the outcome of present study has provided a therapeutic strategy for TB, especially for strains of MTB that are drug-resistant.

Clinical Profile and Outcome of Moderate to Severe Acute Respiratory Distress Syndrome in a Paediatric Intensive Care Unit of Eastern India: A Prospective Cohort Study

Gobinda Mondal, Manoj Kumar Sahoo, Anjan Kumar Das, Banasree Roy, Asok Kumar Mandal Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Paediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of mortality and morbidity in Paediatric Intensive Care Units (PICU) despite various advanced management strategies. The management and outcome of PARDS depend on the severity of the disease. Aim: To study the clinical profile in terms of aetiology and outcome of paediatric patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS) in the PICU. Materials and Methods: A prospective cohort study was conducted at the PICU in Dr. BC Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, India, from July 2018 to June 2019. A total of 120 children aged between two months and 12 years who developed moderate to severe ARDS according to Paediatric Acute Lung Injury Consensus Conference (PALICC) criteria were included. Demographic details, different risk factors, morbidity patterns, and outcomes were recorded. Patients were categorised into three groups based on Positive End Expiratory Pressure (PEEP): 5-8 cm of H₂O, 9-12 cm of H₂O, and >12 cm of H₂O. Based on Peak Inspiratory Pressure (PIP), patients were divided into two groups: <30 cm of H₂O and 30-35 cm of H₂O. Data were statistically analysed using the Chi-square test, Fisher’s test, and t-tests where applicable. Results: Out of a total of 120 children with moderate to severe ARDS, there were 75 males and 45 females. Direct lung injury accounted for 79 cases (65.5%), while indirect lung injury occurred in 41 cases (34.5%). Pneumonia and sepsis were the most common causes of direct and indirect lung injury, respectively. Among 75 cases of pneumonia, 40 deaths were reported (53.3%), and out of 37 cases of sepsis, 31 resulted in death (83%). On the day of admission, 38.3% of cases were classified as moderate ARDS and 61.7% as severe ARDS. The mortality rate for severe ARDS was 77%, compared to 43.5% for moderate ARDS. The mortality rate was 100% in the PEEP max >12 cm of H₂O group and 84.4% in the PIP 30-35 cm of H₂O group. Conclusion: The majority of ARDS cases are due to direct lung injury caused by pneumonia, and the outcome is better than in cases of indirect lung injury. Mortality is nearly twice as high in severe ARDS as in moderate ARDS.

Diagnostic Validity of Urinalysis in Comparison with Urine Culture Prior to Micturating Cystourethrogram in Children: A Retrospective Observational Study at a Tertiary Care Centre in Kerala, India

Jagadeesh Nelluvayil Puthenvariath, Sarath Kumar Narayanan Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Micturating Cystourethrogram (MCUG)-triggered Urinary Tract Infections (UTIs) are well-known, but the risk factors that trigger infections are not well studied. Even though MCUG being invasive, there is no general consensus regarding the use of peri-procedural antibiotic coverage and screening for sub-clinical UTIs just before MCUG. Aim: To determine the diagnostic validity of Urinalysis (UA) when compared with the gold standard, Urine Culture and Sensitivity (UCS), to exclude pre-procedure infections. Materials and Methods: This retrospective observational study involved paediatric patients who underwent MCUG from January 2021 to December 2022, at Kozhikode Government Medical College (Kerala) to exclude urological anomalies. All children were tested with UA and UCS before MCUG, which was done under antibiotic coverage. A positive UCS was defined as a significant growth of a single organism (>100,000 for mid-stream urine or >50,000 for catheterised sample), while a positive UA was defined as pus cells >5/high power field on microscopy. After exclusions, the authors analysed 300 patients. The diagnostic validity of UA was assessed using the Pearson Chi-square test, by Statistical Package for Social Sciences (SPSS) version 16.0. and a p-value less than 0.05 was considered significant. Results: The median age was nine months (IQR 13 months) with 68% being male. The most common indication for MCUG was evaluation for recurrent/febrile UTIs (n=171, 56.6%). Both Pre-MCUG, UA and UCS were documented as positive in eight patients (2.6%), and pre-MCUG, UCS alone was positive in two patients. The diagnostic validity of UA when compared with UCS showed high specificity and positive predictive values at 100% (p<0.05). Conclusion: A simple UA, when compared with UCS (the gold standard investigation for UTIs), has high specificity and positive predictive value in excluding sub-clinical UTIs prior to MCUGs. It may be preferable as it yields quick and reliable results.

Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Block and Three-in-one Block in Elderly Patients Undergoing Hip Surgeries: A Randomised Double-blinded Clinical Trial

Urvashi Yadav, Usman Ghani, Jaybrijesh Singh Yadav, Shuchi Nigam, Amit Kumar Singh Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Hip surgery is a common surgical procedure in the elderly population, leading to significant pain. Ultrasound (USG) guided regional nerve blocks are a newer, safe, and effective postoperative pain control modality for elderly patients. Aim: To compare the analgesic efficacy of Fascia Iliaca Compartment Block (FICB) with the three-in-one block for postoperative analgesia in elderly patients after lower limb orthopaedic surgeries. Materials and Methods: It was a randomised double- blinded study performed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India on 60 elderly patients of Americian Soceity of Anaesthesiologists (ASA) class I-II scheduled for elective hip and femur shaft surgery under spinal anaesthesia.All patients were randomly allocated into two groups. Group A received ultrasound-guided FICB with 35-40 mL of 0.25% bupivacaine, and group B received ultrasound-guided three-in-one block with 35-40 mL of 0.25% bupivacaine after completion of surgery. In the postoperative period, pain was assessed using the Visual Analogue Scale (VAS), and inj. diclofenac sodium 1.5 mg/kg intravenous (i.v.) was given as rescue analgesic whenever VAS was ≥4. The primary outcome was changes in VAS scores at rest and during passive leg elevation between the two groups at various time intervals within 24 hours. Secondary outcomes measured were the duration of analgesia and total rescue analgesic required in 24 hours. Qualitative variables were compared between groups using the Chi-square test. A p-value<0.05 was considered statistically significant. Results: Demographic data were comparable in both groups, with a mean age of 65.11±1.89 years in Group A and 65.57±1.46 years in Group B. The VAS score at rest was significantly lower in Group A compared to Group B at the 6th hour (1.21±1.17 vs. 1.61±0.78) and 12th hour (2.80±0.12 vs. 3.33±0.92), respectively. The VAS score during passive movement was significantly lower in Group A at the 6th hour and 12th hour compared to Group B. The mean time for the first demand of rescue analgesic was 9.27±2.16 hours in the Fascia Iliaca Compartment Block (FICB) group and 6.67±1.45 hours in the three-in-one group. The difference was significant, with a p-value of 0.006. The mean requirement of total rescue analgesia was 133.33±33.27 mg in Group A and 198.53±29.16 mg in Group B, which was statistically significant. Conclusion: The fascia iliaca block had lower pain scores both at rest and during passive movement compared to the three-in-one block. Total analgesic requirement was lower in the fascia iliaca group compared to the three-in-one block group.

Effect of Sacral Erector Spinae Plane Block on Postoperative Analgesia in Perianal Surgeries: A Randomised Controlled Trial

Sanjaya Kumar Behera, Sunil Kumar Pattnaik, Mousumi Das, Partha Sarathi Mohapatra, Krishna Mishra, Lingaraj Sahu Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Sacral nerves emerge through sacral foramina and traverse below the multifidus muscle. Hence, blocking this myofascial plane can provide postoperative analgesia in the perianal region by blocking the sacral nerves supplying it. Aim: To study the effect of Sacral Erector Spinae Plane Block (SESPB) on postoperative pain and postoperative analgesic requirement in perianal surgeries. Materials and Methods: A randomised controlled trial was done with 60 patients who were randomly allocated into two groups (30 in each group). Group 1 patients received no intervention, whereas Group 2 received bilateral SESPB. The Visual Analogue Scale (VAS), opioid requirement, first analgesic demand, and additional analgesic requirement were compared between the two groups. The qualitative data was analysed by Student’s t-test, whereas the quantitative data was analysed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Around 18 (60%) of the participants in group 1 were males, whereas group 2 consisted of 15 (50%) males. The mean age in group 1 was 40.7±11.5 years, whereas it was 43.6±12.7 years in group 2. The means of BMI were similar in both groups. The mean VAS score of group 1 was 3.19±0.23, whereas it was 2.37±0.25 in group 2. The first analgesic requirement was significantly delayed, and total tramadol requirement was lower in group 2 compared to group 1. Four patients from group 1 (control group) required inj. diclofenac sodium additionally. Conclusion: Bilateral SESPB provided good postoperative analgesia in patients who underwent perianal surgery. The total analgesic requirement was also found to be lower with this block. Hence, it can be considered a modality for perianal surgeries.

Perioperative Dysrhythmias in Adult Patients for Non Cardiac Surgery: A Prospective Cohort Study

Amruta Vinod Hippalgaonkar, Amala Gurunath Kudalkar, Bharati Anil Tendolkar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: The vulnerable perioperative period is prone to the development of a heterogeneous group of conditions characterised by abnormal electrical activity in the heart, termed as cardiac dysrhythmias. Aim: To determine the incidence of dysrhythmias in the perioperative period, identify predisposing factors, evaluate the effect of anaesthesia, analyse haemodynamic consequences, and document the treatment provided. Materials and Methods: A prospective cohort study involving 9666 adult patients undergoing non cardiac surgery was conducted in the Department of Anaesthesiology at Lokmanya Tilak Municipal College and General Hospital, Sion, Mumbai, Maharsahtra, India from January 2012 to December 2013. Parameters studied included preoperative clinical data (history, examination, and relevant investigations), type of anaesthesia, occurrence of dysrhythmias, and clinical outcomes of persistent dysrhythmias or those requiring treatment. Data was collected prospectively and analysed using Statistical Package for Social Sciences (SPSS) software version 15.0. Results: The overall incidence of dysrhythmias was 1.2%. Consistent factors included age over 40 years (68.1%), male gender (52.59%), gastrointestinal and orthopaedic procedures (65.5%), preoperative hypertension (25%), and patients receiving general anaesthesia (61.2%). Most patients were classified as American Soceity of Anesthesiologists (ASA) Class-I and II (93.97%) and underwent elective surgery (61.21%). The majority (81.89%) of dysrhythmias occurred intraoperatively and were ventricular in origin (68.97%). Unstable haemodynamic conditions [Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) <50 /min and/or Ventricular Premature Contraction (VPCs) >5/min or multifocal VPCs)] were observed in 56.9% of patients. Of patients with ventricular dysrhythmias, 57% exhibited unstable haemodynamics. Treatment was provided to 84.48% of patients, with 74.14% responding positively, leading to the termination of dysrhythmias. Anticholinergics were used in 40.52% of treatment modalities. The majority of dysrhythmias were transient 80 (68.9%) patients, and 83 of patients had a favourable outcome. Unfortunately, 5 (6.9%) of patients could not be revived, with three patients 3 (2.5%) succumbing in the operating room. Mortality was not directly linked to the dysrhythmia but was due to underlying causes. Conclusion: Transient intraoperative ventricular cardiac dysrhythmias are common in adult patients undergoing noncardiac surgeries. Therefore, it is crucial to identify high-risk patients, analyse contributing factors, and promptly correct issues under expert medical guidance.

Morphological Changes of Corneal Keratocytes following Surface Ablation Laser Surgery: An Observational Study from the United Kingdom

Daphné Gunness, Indrajit Banerjee, Jared Robinson, Teeluck Kumar Gunness Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Laser Subepithelial Keratomileusis (LASEK) is a type of surface ablation laser surgery that offers a solution to patients for correcting their ametropia. In rare instances, LASEK has been associated with complications such as the development of postoperative haze, infection, and poor visual outcomes. Imaging features detected within the patient’s cornea using In-Vivo Confocal Microscopy (IVCM) have aided in identifying the cellular basis of complications like these. Aim: To observe and describe the morphological changes seen on IVCM in patients following LASEK surgery. Materials and Methods: This observational study aimed to assess the quantity and morphology of anterior and posterior keratocytes in adults aged 18 years and older. Five participants (9 eyes) who presented for follow-up appointments following LASEK surgery at Manchester Royal Eye Hospital (MREH), United Kingdom, from July to December 2018 were recruited for the study. The cell counts of the anterior and posterior keratocytes were calculated using the Heidelberg Eye Explorer software. The images were analysed with the Image J program (National Institutes of Health, Bethesda, USA). Nerve fibers were assessed using the ACCMetrics program (University of Manchester, UK). The t-test was used to establish the statistical association between variables. Results: Morphological changes, such as zones of hyper-reflectivity beneath the epithelium, were observed in all the recruited participants. Immune cells and sub-basal nerve abnormalities were detected in several participants. The number of keratocytes in the anterior stroma of all the participants was found to be much lower compared to that of the control. Only participant number 3 had a greater number of keratocytes in the anterior stromal layer (454 and 514 cells/mm²) compared to the other participants, who had a cell count ranging between 156 to 262 cells/mm². Conclusion: It is evident that visible changes are noted both quantitatively and morphologically in both the anterior and posterior keratocytes postoperatively. More research is required with larger controlled studies to investigate the IVCM imaging biomarkers and morphological features that represent the wound healing process and the factors influencing visual outcomes, ensuring that postoperative complications can be minimised.

Risk Assessment of Obstructive Sleep Apnoea Symptoms and Its Correlation with Oral Manifestations: A Cross-sectional Study

TR Yathish, CG Manjula Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Obstructive Sleep Apnoea (OSA) is the most common sleep-related breathing disorder seen in all age groups. The aetiology is multifactorial, including factors such as obesity, aging, stress, and a sedentary lifestyle. Poor knowledge about diagnostic options, management, and consequences of improper treatment may contribute to morbidity and mortality. Berlin Questionnaires (BQ) are simple, low-cost, non-invasive tools that can be used to assess the risk of OSA. Screening subjects using questionnaires and oral examinations for a multi-disciplinary approach to treat OSA is essential. Aim: To assess the risk of OSA symptoms and their association with oral manifestations among students. Materials and Methods: This cross-sectional study was conducted among medical students aged between 18 and 24 years. Three hundred medical students (171 males, 129 females) willing to participate in the study were included. Responses to the Berlin and oral health questionnaires were collected, and oral examinations were performed. Statistical analysis was conducted using Epi Info software. Kruskal-Wallis H test and one-way Analysis Of Variance (ANOVA) were carried out to evaluate significance in different groups and to examine associations between OSA, oral health, and other variables. Results: The collected data were statistically analysed. In the present study, 35 subjects (11.67%) were classified as high-risk and 265 subjects (88.33%) as low-risk by the BQ. The prevalence of OSA in the present study was 12.87% in males and 10.08% in females. High-risk subjects were educated, motivated, and referred for confirmatory diagnostic tests and early treatment. Conclusion: The prevalence of OSA in the present study was 12.87% in males and 10.08% in females. Emphasis should be placed on highlighting the clinical aspects related to OSA and its relation to oral health. There is a great need to educate and motivate dental and medical students and professionals about OSA by conducting health education programs.

Comparison of Blood Biomarkers in Systemic Blood and Varicose Veins: A Cross-sectional Study

Kinjal P Patel, Nishant B Patel, Silky A Patel, Hely Bhaveshkumar Patel Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers’ instructions. An Independent samples t-test was used to compare group difference, and p-value ≤0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/dL, p<0.001), hsCRP (1.34±1.01 mg/L vs. 3.78±1.67 mg/L, p<0.001), IL-6 (2.65±1.07 pg/mL vs. 4.17±1.51 pg/mL, p<0.001), vWF (90.73±16.72% vs. 127.30±19.92, p<0.001). D-dimer was also substantially higher in samples extracted from leg VV than in systemic blood (105.87±17.72 ng/mL vs. 85.61±18.18 ng/mL, p<0.001). Conclusion: Blood from VV has shown a higher level of several inflammatory markers and signs of endothelial dysfunction. This is most likely the result of worsening venous pressure and dilated, convoluted superficial veins that restrict blood flow. The procoagulant qualities of the local blood and damage to the venous wall, leading to a chronic inflammatory response, may accelerate the disease’s progression and thrombotic consequences.

A Retrospective Observational Study to Assess the Quality Management System in a Molecular Diagnostic Laboratory of a COVID-19 Dedicated Hospital in Delhi, India

Sonali Bhattar, Sukriti Sabharwal, Shikhar Saxena Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: A molecular diagnostic laboratory is the cornerstone of Coronavirus Disease-2019 (COVID-19) disease diagnosis, as the patient’s treatment and management protocol depend on molecular results. Therefore, the laboratory conducting these tests must adhere to quality management process to increase the accuracy and validity of the generated reports. Rajiv Gandhi Super Speciality Hospital established its molecular diagnostic set-up at the beginning of the pandemic. Hence, this study aims to generate quality management data to help improve weak points. Aim: To assess the quality management system for COVID-19 diagnosis. Materials and Methods: This retrospective observational study was conducted at Rajiv Gandhi Super Speciality Hospital in Delhi, India. A total of 14,561 samples were collected over six months, from February 2021 to July 2021. Data from all samples received during this period for COVID-19 Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) testing were included. Data were retrospectively collected from the electronic Laboratory Information Management System (LIMS). Quality variables were analysed over six months from July to December 2021 and classified into preanalytical, analytical, and postanalytical variables. Quality Indicators (QIs) were selected from a common model of QIs set by the International Federation of Clinical Chemistry and Laboratory Medicine. The results were presented in percentages, and descriptive statistics were analysed using Statistical Package for Social Sciences (SPSS) software. Results: During the six-month study period, the molecular laboratory received 14,561 samples. Among the preanalytical variables, sample leakage was the most common cause of sample rejection (134 samples, 0.92%), followed by the non generation of Specimen Referral Form (SRF) identification (76 samples, 0.52%), and non compliance with triple packaging (44 samples, 0.3%). Other preanalytical aspects assessed included incomplete patient identification (17 samples, 0.11%), insufficient sample quantity (12 samples, 0.08%), missing forms/samples (7 samples, 0.04%), samples in the wrong vials/empty Viral Transport Media (VTM) tubes (5 samples, 0.03%), and incomplete LIMS entry (2 samples, 0.01%). Internal Quality Control (QC) was not obtained in 55 samples (0.37%), and two incidents of cross-contamination resulted in false-positive results. Among the postanalytical factors, 11 samples (0.07%) could not be dispatched within the stipulated time frame. Conclusion: The assessment of the quality management system revealed some areas for improvement, emphasising the importance of adhering to QC processes for the smooth operation of diagnostic laboratories, especially those involved in critical reporting. The assessment of QIs helped monitor laboratory parameters effectively.

Declining Trend of HIV Seroprevalence in Pregnant Women: A Retrospective Observational Analysis of 12 Years’ Experience at a Tertiary Care Hospital in Central India

Meena Mishra, Varsha Wanjare, Seema Agrawal, Ms Qazi, Sunanda Shrikhande, Arvind Kurhade, Suresh Ughade, Soumyabrata Nag Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Human Immunodeficiency Virus (HIV) infection among antenatal women has been reported throughout the country, with a relatively high prevalence in the state of Maharashtra. Data on HIV seroprevalence in antenatal women serve as an indirect indicator of the HIV epidemic's burden in the general population and aid in predicting the same in young children. Diagnostic and treatment services for HIV are concentrated in selected states and districts with high seroprevalence, making it necessary to accurately calculate the prevalence of HIV. Aim: To assess the effectiveness of Prevention of Parent-to-Child Transmission (PPTCT) services and to study the effectiveness of the National Acquired Immunodeficiency Syndrome (AIDS) Control Programme (NACP) in the functioning of PPTCT services. Materials and Methods: A retrospective observational analysis of 12-year data, from January 2007 to December 2018, was conducted in the Department of Microbiology at the Government Medical College and Hospital, Nagpur, Maharashtra, representing Central India. Data collection took place from June 2019 to December 2019, and analysis occurred over the subsequent two months (January 2020 to February 2020). The total sample size was 101,865 patients. All pregnant women registered in the Antenatal Clinic (ANC) under the PPTCT Program were included in the present study, and Strategy III of the National HIV testing algorithm was followed. The women's ages, their partners' serostatus, and records of babies born to HIV seropositive mothers were obtained and analysed. The statistical analysis of the data was performed using Stata (version 10.4.2009, STATA Corp., Texas, USA) and Epi Info 7 (version 7.1.06, 2012, CDC, Atlanta, USA), employing the Chi-square test for linear trend (Extended Mantel-Haenszel). A p-value <0.05 was considered significant. Results: The seroprevalence of HIV infection among pregnant women was 1.04% in 2007, decreasing to 0.23% by 2017. In 2009, 88.9% of women were counselled, and 100% were tested for HIV, with pretest counselling steadily increasing to 100% by 2012. The trend in HIV testing, however, remained at 100% over the span of 10 years. Post-test counselling varied from 89.6% to 99.9%, whereas the trend of HIV testing among partners fluctuated from 50% to 94.44%. The overall HIV positivity among babies, after 18 months of follow-up, was 4.77%. Conclusion: The HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing themselves of the facilities at Integrated Counselling and Testing Centre (ICTC). Intensive health education and the availability of diagnostic and therapeutic services across the country have reduced the burden of the HIV/AIDS problem in the country.

Effectiveness of a Standardised Educational Package for Mothers of Children with Severe Acute Malnutrition: A Hospital-based Randomised Controlled Trial

Pushpendra Singh, Ghanshyam Das, Ajay Kumar Gaur, Satvik Chaitanya Bansal Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Malnutrition is a major public health problem, especially in Low- and Middle-Income Countries (LMICs), contributing significantly to under-five mortality. New strategies are needed to enhance outcomes for childhood malnutrition. Aim: To evaluate the impact of an educational package on mothers of children hospitalised with Severe Acute Malnutrition (SAM). Materials and Methods: This was a hospital-based randomised controlled trial conducted in the Department of Paediatrics at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. Only children hospitalised between 6 months and 59 months of age with SAM were included and randomised into an Intervention group and a Control group. In the intervention group, verbal, pictorial, and demonstration techniques were used to educate the mothers. Anthropometric measurements of malnourished children and maternal knowledge scores were compared at baseline, 15 days, and two months postdischarge. Frequency and percentage were calculated for qualitative data analysis, while mean values with standard deviations were calculated for quantitative data. Independent t-tests and paired t-tests were applied, and paired t-tests were used for within-group comparisons at different time points. Data was entered into Microsoft Excel software, and analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean age of children was 1.4±0.9 years, with the majority below two years of age (86.4%). The male-to-female ratio was 1.04 (n=154 versus n=148). Most subjects belonged to lower or upper-lower socio-economic classes (75%). Mothers were commonly educated up to the primary school level (48%). Both study groups had similar socio-demographic profiles. There was a significant weight gain (p-value <0.01) and height gain (p-value <0.01) in the intervention group at the end of the follow-up period. Maternal knowledge gain in the intervention group was also significantly higher than in the control group (p-value <0.01). Conclusion: This study supports maternal educational strategies as a low-cost intervention to address early childhood malnutrition in resource-limited settings. Further research is needed to standardise the intervention and assess long-term impact.

Impact of Albumin Therapy in Critically Ill COVID-19 Patients: A Retrospective Cohort Study

Bonchanpalli Mohan Kumar, Mustahsin Malik, Rajesh Kumar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Due to the limited understanding of this disease, research has quickly extended towards identifying biomarkers to predict its prognosis and progression. Aim: To explore the impact of albumin infusion on critically ill COVID-19 patients. Materials and Methods: In this retrospective cohort study, a total of 150 severe COVID-19 patients aged 18 to 65 years were enrolled. These patients were categorised into the no albumin infusion group (n=61), consisting of those who did not undergo albumin transfusion during their treatment, and the albumin infusion group (n=89), comprising patients who received albumin transfusion as part of their treatment protocol. Assessments of hospitalisation included the Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE-II) scores obtained at baseline and day 5. Unpaired t-tests, Chi-square tests, and paired t-tests were used for analysis. Results: The mean values of Haemoglobin (Hb), eosinophils, Random Blood Sugar (RBS), Mean Corpuscular Volume (MCV), total protein, serum urea, serum bilirubin, Prothrombin Time (PT), International Normalised Ratio (INR), Interleukin 6 (IL-6), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and D-dimer exhibited significant differences between the two groups. The average duration of vasopressor usage and Intensive Care Unit (ICU) stay were significantly reduced in the albumin infusion group (3.50±1.55 days and 8.70±4.20 days, respectively) compared to no albumin infusion group (4.33±1.05 days and 12.80±3.43 days, respectively). The albumin infusion group also displayed a lower incidence of Renal Replacement Therapy (RRT) and poorer ICU outcomes. Conclusion: The intravenous administration of albumin did not exhibit a significant impact on mortality. However, albumin transfusion in patients with severe COVID-19 who initially had albumin levels <3 g/dL demonstrated a notable reduction in the requirement for vasopressors, RRT, and the length of ICU stay.

A Prospective Interventional Study on Modified One-minute Preceptor Model: An Effective Teaching-learning Tool for Early Clinical Exposure in Biochemistry

Trupti Diwan Ramteke, Anita Shivaji Chalak, Tejaswini Dashrath Sonawane Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Early Clinical Exposure (ECE) was incorporated into the Competency-based Medical Education (CBME) curriculum in 2019. ECE in a classroom setting is conducted through Clinical Case Discussion (CCD) using paper-based clinical case scenarios. The assessment pattern of CBME and Maharashtra University of Health Sciences (MUHS) includes clinical case-based questions. Therefore, assessing and developing clinical reasoning skills and critical thinking has become the need of the hour. Aim: To measure the effectiveness of the modified One-minute Preceptor (OMP) model as a teaching-learning tool for CCD to enhance the knowledge and reasoning skills of Phase I Bachelor of Medicine Bachelor of Surgery (MBBS) students and to assess the perception of students and faculty towards the modified OMP model. Materials and Methods: This prospective interventional study was conducted in the Department of Biochemistry at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India from February 2020 to May 2020. Out of 250 Phase I MBBS students, 180 who had given consent and participated in all the sessions were included. Eight faculty members voluntarily participated in the study. The faculty involved in CCD for the control and study groups were different and selected through randomisation. After a didactic lecture, a pretest was administered, and then students were divided into Control group A (n=90) and Study group B (n=90). For CCD, the modified OMP model was used for the study group and the traditional unstructured method for the control group. A post-test was given after CCD, and feedback was collected from faculty and students. Quantitative analysis of the feedback was done using a 5-point Likert scale, and open-ended questions were qualitatively assessed. Pretest and post-test scores were analysed using an unpaired t-test. Learning gain was measured, and program evaluation was conducted using Kirkpatrick’s model. Results: There was a statistically significant difference in the post-test scores obtained by the control group and study group (p-value <0.001). A higher normalised learning gain (0.83) was observed in the study group. The modified OMP model was perceived as an effective, interactive teaching-learning tool for CCD by both students and faculty. Conclusion: CCD using the modified OMP model significantly improved knowledge, critical thinking, and reasoning skills of students. Even after modifications to the original OMP model, the effectiveness of this model for preclinical subjects remains unaffected.

Relationship between Sleep Deprivation and Daytime Sleepiness in different Groups of Population: A Cross-sectional Study

Madeeha Akhlad, Hammad Ahmed Siddiqui, Muhammad Azharuddin Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Research consistently indicates that insufficient sleep, whether it is a persistent or short-term issue, can result in daytime sleepiness among the general population. Contributing factors include demanding work schedules, social commitments, and the habit of using electronic devices before bedtime. Aim: To find the relationship between sleep deprivation, daytime sleepiness, and socio-economic status, and their association among teachers, bachelor’s and master’s students, and medical practitioners. Materials and Methods: This cross-sectional study included the assessment of daytime sleepiness and quality of sleep among different populations using the Eppworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI), respectively. The socio-economic status was assessed using the modified Kuppuswamy Scale (mKS). The participants were categorised into three groups: teachers, students, and medical professionals according to their profession. In the analysis, to find the linear relationship between age, Body Mass Index (BMI), and the other three outcomes, Pearson’s correlation was used. Results: There were 65 (38.5%) males and 104 (61.5%) females among the respondents. On analysis, considering the overall results, it was found that there was a moderate positive correlation between age and BMI (r-value=0.232, p-value<0.05) and no significant correlation between age and ESS, PSQI, mKS. There was a moderately negative correlation between mKS and ESS (r-value=-0.205, p-value=0.016), suggesting that the lower the SES, the more the chances of daytime sleepiness in students’ group. In the teacher’s group, there was no significant correlation between age and BMI, ESS, PSQI, and mKS in any of the groups. Conclusion: It can be concluded that daytime sleepiness was related to socio-economic status in students, such that they are inversely proportional to each other. Medical practitioners experienced the most daytime sleepiness compared to other population groups.

Cross-sectional Study on the Pattern of Skull Fractures in Fatal Two-wheeler Road Traffic Accidents at a Tertiary Care Hospital in Northeastern India

Nabajit Barman, Gobil Thapa, Swagata Dowerah Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Death due to Road Traffic Accidents (RTA) is one of the leading causes of mortality and morbidity in a developing country like India. As there is a paucity of literature on the nature and type of injuries in RTAs in the locality of Upper Assam, a retrospective study on postmortem cases of fatal two-wheeler accidents was conducted to address the magnitude of the problem. Aim: To analyse different types of skull fractures and causes of death among two-wheeler RTAs at tertiary care Hospital in Northeast India. Materials and Methods: The present cross-sectional study was conducted in the mortuary of Assam Medical College, Dibrugarh, Assam, India, for a period of one year from August 2020 to July 2021. The records of all RTA cases involving two-wheeler motorcycles brought for postmortem examination during this period were studied for parameters including age, gender distribution, cause of death, type of skull fracture, intracranial haemorrhage, and time of occurrence, and analysed using descriptive statistics. Results: There were 532 fatal RTA cases recorded, out of which 292 involved two-wheelers (54.89%). Males (87.67%) outnumbered females (12.33%). The most affected age group was between 21-30 years with a total of 98 cases (33.56%), followed by 31-40 years with 68 cases (23.29%). Skull fracture was present in 103 cases (35.27%). Fissured fracture was the most common type seen in 64 cases (62.14%) followed by depressed fracture in 19 (18.45%). The most common single bone fracture was of the Temporal bone in 44 cases (42.72%), followed by frontal bone in 18 (17.48%). Coma was the most common cause of death, seen in 214 cases (73.29%), followed by haemorrhagic shock in 42 (14.38%). Subdural Haemorrhage (SDH) alone was the most common intracranial haemorrhage found in 159 cases (74.30%), followed by Extradural Haemorrhage (EDH) alone in 7 cases (3.27%). Conclusion: Injuries to the skull and brain are the leading cause of death in RTAs. Adequate measures should be taken to prevent mortality and morbidity, achievable through strict enforcement of road safety measures, awareness among the people, and improving road infrastructure along with emergency medical services.

Comparison of Dexmedetomidine and Fentanyl Added to Levobupivacaine in USG-guided Axillary Block for Upper Limb Surgeries: A Randomised Double-blinded Controlled Study

Kala Balasubramanian, Bhagya Vardhan Botta, Chandhinie, Geetha Soundarya Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Apart from general anaesthesia, brachial plexus block by the axillary approach is one of the reliable sole anaesthetic techniques for patients undergoing upper limb surgeries. In this study, levobupivacaine was chosen due to fewer adverse effects compared to Bupivacaine, and fewer studies were available for the axillary approach to brachial plexus block. Adjuvants were added to hasten the onset and also to prolong their analgesic effect. Aim: To compare the effect of Dexmedetomidine (D) 0.5 mcg/kg and Fentanyl (F) 0.5 mcg/kg when added to 0.5% Levobupivacaine (L) as an adjuvant in brachial plexus block by the axillary approach for upper limb surgeries. Materials and Methods: A randomised double-blind controlled study was carried out at the Department of Anaesthesiology, Sree Balaji Medical College, BIHER, Chennai, Tamil Nadu, India from January 2020 to October 2021 on 60 American Society of Anaesthesiologists (ASA) I and II patients of either sex posted for various types of upper limb surgeries. Subjects were divided into two equal groups by computer-generated randomisation. Group A received 0.5% levobupivacaine and dexmedetomidine 0.5 mcg/kg, and Group B received 0.5% levobupivacaine and Fentanyl 0.5 mcg/kg. Both patients and the evaluator were unaware of the type of adjuvants added to the local anaesthetic. The onset time, duration of sensory and Motor blockade were recorded. Haemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. The Mann-Whitney U test demonstrated variations in the onset and duration of sensory and motor blocks. Adverse effects, including nausea, vomiting, and hypotension, exhibited significant differences according to Fisher’s-exact test. Results: Age and weight distributions were comparable between groups (mean age: Group A=45.20 years, Group B=44.80 years; mean weight: Group A=74.13 kg, Group B=74.43 kg). Group A exhibited faster sensory and motor block onset times (sensory: Group A=6.20 minutes, Group B=8.63 minutes; motor: Group A=8.27 minutes, Group B=10.00 minutes), longer block durations (sensory: Group A=11.63 hours, Group B=9.53 hours; motor: Group A=9.67 hours, Group B=8.20 hours), and required the first rescue analgesic (Group A=12.57 hours, Group B=10.27 hours) compared to Group B (p<0.05). Similarly, the mean time for the first rescue analgesia for patients among these two groups was also statistically significant (p<0.05). Conclusion: The addition of 0.5 mcg/kg dexmedetomidine to 0.5% levobupivacaine in axillary block was more effective in prolonging the duration of blockade and providing adequate intraoperative analgesia when compared to 0.5 mcg/kg fentanyl with 0.5% levobupivacaine, without producing any adverse events.

Prevalence of Exercise-induced Desaturation in Survivors of Severe COVID-19 Pneumonia and the Predictive Value of Lung Ultrasound: A Cross-sectional Study

GS Praveen, KP Suraj, N Safreena Mohamed Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Survivors of severe Coronavirus Disease-2019 (COVID-19) pneumonia may experience Exercise-Induced Desaturation (EID), which can remain undiagnosed at discharge, as most exhibit normal resting Arterial Blood Gases (ABGs). This undiagnosed condition may lead to unexpected hospital readmissions, causing additional burden to the health system. However, the prevalence of EID among this population, especially in developing countries, is not well documented. Aim: To estimate the prevalence of EID among survivors of severe COVID-19 pneumonia and to explore the predictive role of Lung Ultrasound Scan (LUS) in detecting EID. Materials and Methods: This hospital-based, observational, cross-sectional study was conducted at the Institute of Chest Diseases in Kozhikode, Kerala, India from October 2021 to September 2022. It involved 153 COVID-19 patients aged 18 years and above who had recovered from severe pneumonia, were otherwise fit for hospital discharge, and had normal resting ABGs. The study examined the prevalence of EID using the 6-Minute Walk Test (6MWT). Additionally, it investigated the predictive ability of a LUS for EID. A LUS was performed on all patients and scoring was conducted according to the established protocol. Results: The mean age of the study subjects was 53.50±14.13 years, with 119 (77.8%) being male. During the 6MWT, 96 patients (62.7%) showed significant desaturation. A total of 83 (95.4%) subjects in the desaturated group required Non-Invasive Ventilation (NIV) compared to 4 (4.6%) in the non-desaturated group (p<0.001). All 24 (100%) subjects in the desaturated group required Invasive Mechanical Ventilation (IMV), while none in the non-desaturated group did. The mean Length Of Stay (LOS) in the hospital was 35.50±13.35 days for the desaturated group, compared to 23.32±16.25 days for the non-desaturated group (p<0.001). The LUS score was significantly higher in the desaturated group (16.61±5.92) than in the non-desaturated group (5.54±4.62). The Receiver Operating Characteristic (ROC) curve for the LUS score indicated a cut-off value of 8.5 for identifying significant EID. Conclusion: Survivors of COVID-19 who recovered from Acute Respiratory Failure (ARF) and have normal resting ABGs may still have significant EID. A protocol-based LUS score can potentially identify individuals at risk for EID.

Navigating Tissue Microarray Construction: A Guide for Avoiding Pitfalls and Mastering Key Technical Aspects

Tanvi Jha, Somnath Mahapatra, Preeti Diwaker, Vinod Kumar Arora, Sonal Sharma Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Tissue Microarray (TMA) is a novel technique that is now integral in pre-clinical and translational research. In resource-limited settings, automated microarrayers and molds are out of reach, and manual TMA construction may be done instead. Aim: To explore the pitfalls encountered while constructing manual TMAs and to troubleshoot these problems using the available resources. Materials and Methods: A cross-sectional study was done between September 2019 and March 2021 in the Department of Pathology at a tertiary healthcare center in New Delhi using 60 mastectomy specimens. Five manual TMAs were constructed using simple, cheap, and readily available resources. Problems encountered during the construction were identified and documented. Solutions attempted to troubleshoot the common problems were documented, and their outcomes were evaluated. Results: Difficulty in core extraction, cracking of TMAs during core insertion, loss of cores, misalignment of cores, bulging of blocks, difficulty in sectioning due to non-uniform cores, and loss of cores during sectioning were major problems identified. Simple measures such as prior warming of both donor and recipient blocks, use of punch biopsy needles with a plunger, maintaining a margin around the cores, using wax cores to align cores, and adequate cooling prior to sectioning helped in overcoming these problems. Other solutions that were attempted but did not yield satisfying results included the use of agarose in paraffin blocks and the use of liquid wax to seal cracks and gaps. Conclusion: Manual TMA is not only feasible, it is easy to construct once the technique is learned and the problems that commonly arise in its construction are tackled. The modifications suggested in the present study can aid in constructing these microarrays faster and avoid both wastage of time and resources. TMAs can thus be used as an alternative to traditional paraffin-based techniques for research applications in resource-limited centers with high patient loads.

Effectiveness of Photobiomodulation Alone and 0.5% Nanocurcumin Gel with Photobiomodulation in Treating Myogenous Temporomandibular Disorders: Protocol for a Randomised Clinical Trial

Sourabh B Shinde, Vidya K Lohe Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Temporomandibular Disorders (TMD) encompass a variety of clinical dysfunctions affecting the Temporomandibular Joint (TMJ), masticatory muscles, and nearby tissues. Pain typically originates from the muscles associated with the functional movements of these structures. Low-level Laser Therapy (LLLT) has been used in TMD patients to control inflammation and disrupt the stress-pain-stress cycle. Curcuma longa is a significant plant in Asia used for medicinal purposes. Curcumin (diferuloylmethane) is a hydrophobic bioactive compound commonly found in the rhizome of C. longa. Considerable attention has been given in recent years to its various pharmacological actions. The available research has shown significant potential in inflammation control, with nano-range preparations of curcumin (Nanocurcumin) enhancing the pharmacological actions and benefits of curcumin, which were not markedly achievable before. Need for the study: The TMDs are among the most common types of disorders associated with orofacial pain. Conditions originating from stress related to the joint often impact the associated muscles, initiating the stress-pain-stress cycle. As TMDs do not have a definitive treatment plan, further research is needed regarding the treatment associated with TMDs. Aim: To assess the effectiveness of photobiomodulation alone and 0.5% nanocurcumin gel with photobiomodulation in treating myogenous TMDs. Methodology: In the present randomised clinical trial, 44 patients with myogenous TMDs will be included. The patients will be divided into two groups: Group A will receive laser applications at the trigger zones, and Group B will receive the application of 0.5% nanocurcumin gel along with laser at the trigger zones. Patients will be assessed for jaw opening, Beck’s Anxiety Inventory, and Visual Analogue Score after four weeks.

Comparing the Combination of Banana Consumption and Deep Breathing Exercises with Banana Consumption Alone and Deep Breathing Exercises Alone in the Management of Sleep Deprivation, Anxiety, and Depression among Postmenopausal Women: A Research Protocol

Sheetal Namdeorao Sakharkar, Raju Kamlakar Shinde, Ruchira Shrikant Ankar, Aarti Rajendra Raut, Dinesh Vilasrao Mude, Samruddhi Subhashrao Gujar Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Introduction: Sleep disturbances are associated with increased healthcare costs and negative health outcomes. Oestrogen levels decrease after menopause, which may also be accompanied by deterioration in cognitive function along with the symptoms of depression and depressive disorders. Need for the study: The need of the study is evident in postmenopausal women, where physiological changes lead to a decline in vital hormones such as oestrogen and melatonin, contributing to anxiety, depression, and obstructive sleep apnoea. Consuming fruits rich in tryptophan which is a precursor of melatonin and serotonin can reduce sleep disorders and enhance sleep quality. Fruits containing tryptophan and melatonin can improve the sleep quality of healthy adults when consumed for seven days. Bananas are the prime example of nutritious food which enhances the mood-boosting benefits of serotonin. Deep breathing exercises are effective in reducing menopausal symptoms and help to manage stress related to life and menopause. Aim: To evaluate and compare the efficacy of a combination of banana consumption and deep breathing exercises with banana consumption alone and deep breathing exercises alone for managing sleep deprivation, anxiety, and depression among post-menopausal women. Materials and Methods: A random 3-arm parallel intervention study will be carried out at Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe Wardha, and Near Mai Hospital, Gandhi Nagar Arvi Naka Wardha, Maharashtra, India. The study will be conducted from May 2023 to May 2026. A random sampling technique will be used to select the sample. A total of 135 post-menopausal women, meeting the inclusion criteria will be chosen for the study. The Pittsburgh Sleep Quality Index (PSQI) will be used to evaluate sleep deprivation, the self-rating anxiety and depression scale will be used to assess depression and anxiety, and serum magnesium tests along with demographic variables will be recorded. Statistical analysis will be performed using Analysis of Variance (ANOVA), among the outcome variables between the three groups. A p-value less than 0.05 will be considered as statistically significant.

Review of Structural and Functional Anatomy of Kidney in Ayurvedic Literature with Special Reference to Diseases of the Kidney

Abhay Narayan Kulkarni, Rajashree Abhay Kulkarni Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Description of organs and their treatment in Ayurvedic texts is very brief. In today’s world when the diseases of organs like kidneys, heart, liver, and brain etc., are becoming very common, Ayurvedic practitioners find these descriptions inadequate to treat patients with such diseases. An effort was made to assess whether critical analysis of references related to kidneys in classical Ayurvedic texts provide inputs to an Ayurvedic Practitioner to understand the pathogenesis of Chronic Kidney Disease (CKD). Tantrayukti based interpretation of references of kidneys in classical Ayurvedic texts establishes that kidneys were known to, and are elaborately described in Ayurveda, with their anatomical details such as embryological origin, name, number, relation with other abdominal organs, location etc. They are known by the name of Vrukka, which are the abdominal organs that are two in number and are described as Basti Marma (which includes the kidneys, ureter, and Bladder) for the purpose of diagnosis, prognosis, and treatment of all urine related diseases. Basti Marma is one of the three Maha Marmas i.e., most important vital organs of the body viz., Shiro (~brain), Hridaya (~heart) and Basti (~bladders). Vrukka (kidney) is formed from the nutritious part of Kapha, Meda and Rakta, gives the inputs to the practitioner to consider the metabolism of these factors in diagnosis and treatment of CKD. Physiology of formation of urine is also elaborately described in Ayurveda. The reference of Sushruta which discusses about Sahastrshaha Sukshma mukhani (~ thousands of minute openings invisible to naked eye) where urine is formed resembles the description of glomerular filtration. Formation and processing by Samaana, role of Jathar Agni, Dhatvagni and Bhutagni in formation of Mutra (~urine), storage and excretion at the level of Bladder, by Apaana is defined clearly, and this description is of immense value for practitioners. Relation of Basti Marma to Kleda (~body fluids) and its pathological connection with specific diseases is also evident. Understanding of various factors viz., Kleda (~body fluids), Marma (~vital organs), Prana (~life force), Oja (~vitality), Kalaa (~Internal membranes) Jathar Agni, Dhatvagni, Bhutagni etc., and their role in pathogenesis of CKD provides Vaidyas with inputs to devise the line of treatment of patients suffering from CKD, taking into consideration the individual condition of each patient.

Role of Prakruti (Constitution)-wise Pathya (Wholesome Diet) in Disease Prevention for Children: A Narrative Review

Prakash Dwivedi, Renu Bharat Rathi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Ayurveda, the Science of Life, not only utilises medications to cure diseases but also employs Anupana, Ahara (diet), and other techniques to preserve a person’s health and manage diseases. Ayurveda places strong emphasis on fundamental dietary principles such as suitable food, combinations of food, cooking techniques, storage, dining environment, hygiene, and manners. Pathya Ahara (Wholesome diet) Kalpana (Ayurvedic Dietetics) is a unique concept. Pathya (Wholesome) refers to that which provides relief to individuals through the use of diet and regimen. The primary goal of discussing Pathya (Wholesome) Ahara Kalpana (Ayurvedic Dietetics) is to highlight the importance of providing proper nutrition based on one’s constitution in preserving physical health and in balancing Dosha, Dhatu, Mala, and Agni to aid in curing various ailments. The term “Pathya” (Wholesome) refers to the diet and lifestyle that are compatible with a person’s channels, constitution, and strength, respectively. The key idea behind Pathya (Wholesome) Ahara (diet) serves as the foundation for both the preventive and therapeutic components of Ayurveda. According to Ashtavidha Ahara Vidhi Visesha Ayatana (Rules regarding Diet), there are various methods for the prevention, diagnosis, and treatment of paediatric disorders as described in Ayurveda. Therefore, utilising preventive measures can help in maintaining a disciplined lifestyle and promoting a healthy existence.

Clinical Care Pathways in Paediatric Nursing: A Narrative Review

Archana Taksande (Lohave), Bibin Kurian Kurian, Khushbu Manohar Meshram Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Paediatric Clinical Care Pathways (CCPs) are developed for specific health conditions or patient populations and are designed to standardise care across different healthcare settings, including hospitals, clinics, and outpatient settings. These care pathways outline the clinical guidelines for diagnosis, treatment, and follow-up of specific medical conditions. They provide a framework for the delivery of care based on the best available evidence and tailored to each patient's individual needs. This overview is aimed at identifying the available evidence for the effective use of CCPs in paediatric patients with Lower Respiratory Tract Infection (LRTI). It reviews the nature of CCPs of LRTI, their benefits, strategies to implement them, steps involved in development of CCPs and the disease condition in paediatric population for whom the CCPs are used so far. The article also gives an account of limitations of using CCPs.

An Update on 3D-printed Orthodontic Aligners

Nazleen Valerie Vas, Ravindra Kumar Jain Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Clear Aligner Treatment (CAT) is an orthodontic technique used to align teeth with removable and scarcely visible appliances. Conventionally, these are produced through the process of thermoforming. The inherent disadvantages of thermoforming include increased surface roughness leading to plaque accumulation, compromised biomechanics due to a reduction in force delivered and flexure of the aligner, and altered mechanical properties, such as increased opacity, water sorption, and hardness. Direct Three-dimensional (3D)-printed aligners, or Direct Printed Aligners (DPA), introduce a new frontier to aligner technology and are a recent addition to the ever-improving field of orthodontics. Through 3D printing, the various disadvantages of thermoformed aligners like surface roughness, extent and definition of aligner borders, undercuts, and differential thickness of the aligner can be controlled to enhance the accuracy of aligner fit with lesser reliance on attachments. 3D printing of aligners is more environmentally friendly since there is no subtractive process for thermoforming or post-processing of the TA. Various methods of 3D printing, such as selective laser melting, selective laser sintering, Stereolithography (SLA), and Digital Light Processing (DLP), can be applied to the printing of clear aligners. Challenges in printing primarily involve maintaining transparency and designing support during the printing process. The present review aimed to include a detailed description of all aspects of direct 3D-printed aligners.

Efficacy of Advanced Allied Interventions for Dyspnoea, Exercise Capacity, and Quality of Life among the Geriatric Population: A Literature Review

Urvashi Bhattacharya, Abhijit Dutta Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Ageing is a gradual and irreversible pathophysiological process that results in the decline of function in all the body's systems, including the respiratory system. With age, the respiratory muscles lose their strength and become tight, thus affecting lung function. Exercise has been seen to have a positive influence on delaying the ageing process, reducing its ill effects on all systems. Apart from conventional physiotherapy, studies show that other allied therapies, such as the Buteyko breathing technique, respiratory muscle stretch gymnastics, fan therapy, Tai Chi exercise, and many others, have an influence on the cardiorespiratory system. These allied therapies help improve breath control, increase the strength and flexibility of respiratory muscles, stimulate the trigeminal nerve, and contribute differently to reducing symptoms of dyspnoea and fatigue, increasing exercise capacity, and improving Quality of Life (QoL). The purpose of present literature review is to identify various allied therapies that decrease dyspnoea associated with ageing and increase exercise capacity and QoL in the elderly population. A literature search was conducted to find relevant guidelines on interventions for dyspnoea, exercise capacity, and improving QoL in the geriatric population. Total 13 studies related to treatments for dyspnoea and exercise capacity among the geriatric population, aimed at decreasing symptoms and improving QoL, were included in present review article. The number of new and advanced allied methods developed was limited, so more articles could not be added as they did not serve the purpose. The search keywords used were geriatric, dyspnoea, exercise capacity, QoL, and allied therapies. Electronic databases such as PubMed, Google Scholar, Medline, and ResearchGate were used to complete the study. The findings reveal that advanced allied therapies, including fan therapy, Tai Chi exercise, respiratory muscle stretch exercises, pranayama, and video-assisted exercises, are easier and more entertaining ways to engage in regular physical activity, increase exercise capacity, decrease dyspnoea, and improve QoL among the geriatric population.

Connecting the Threads: A Descriptive Review of Social, Cultural and Spiritual Influences on Physiotherapy Practice

Gurjeet Kaur, Ganesh Kumar Subudhi, Srikanta Padhan, Avilash Mohapatra Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X In the 21st century, there have been significant indigenous advancements in the field of physiotherapy. However, there still exist certain sociocultural and spiritual beliefs among practitioners. Through meticulous examination, evaluation, diagnosis, prognosis, and physical intervention, physiotherapists utilise mechanical movements and force to treat impairments and help improve function, mobility, and quality of life. The cultural framework plays a crucial role in how individuals experience health, illness, and disability. Simultaneously, sociocultural factors are pivotal in the physical function, health, and illness of individuals. This paper explores the social, cultural and spiritual influences on physiotherapy across different societal and professional contexts. While there have been several recent studies providing snapshots of advancements in technologies in the healthcare system, there are not as many focusing on these three aspects in the clinical practice of physiotherapists. Due to the different eras in the history of physiotherapy, the present article demonstrates how physiotherapists are influenced by social, cultural, and spiritual domains. It is challenging to generalise the results in every situation and geographical area. Therefore, physiotherapists should be proactive in addressing these healthy beliefs at the grassroots level within the healthcare society. To create a personalised treatment plan, goal-setting, and care plan for the patient, the physiotherapist finds great value in understanding the patient’s sociocultural and spiritual history.

Narrative Review on Osteoporosis: A Silent Killer

Shrihari L Kulkarni, Harpreet Kour Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Osteoporosis is a common condition affecting the elderly population. Most of the time, it is diagnosed only after an individual suffers from a fracture. In addition to the fracture and its complications, the patients and their families must also bear the psychological and financial consequences of the disease. There are multiple risk factors associated with osteoporosis, hence it requires a multimodal approach in management as well. This narrative review aims to provide a comprehensive insight into the classification, prevalence, pathophysiology, signs and symptoms, risk factors, screening tools, management, differential diagnosis, prognosis, complications, and recent advances in osteoporosis.

Utilising Artificial Intelligence (AI) in the Diagnosis of Psychiatric Disorders: A Narrative Review

Mansi Khare, Sourya Acharya, Samarth Shukla, Harshita, Ankita Sachdev Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X In the era of machinery, Artificial Intelligence (AI) has become the new tool for managing patients in psychiatry. Nowadays, many psychiatric disorders are being diagnosed and treated with the help of AI. New technologies like Machine Learning (ML), robots, Deep Learning (DL), and sensor-based systems provide a different perspective on psychiatric disorders. The present narrative review article summarised the use of AI in diagnosing and treating psychiatric disorders. AI can assist a patients with a psychiatric diseases in prognosis, clinical diagnosis, management therapy, and addressing clinical and technological issues. It highlights various AI methods used in mental healthcare, with a focus on multiple ML perspectives. Additionally, AI has the potential to address several factors, including privacy, transparency, bias, and other social and ethical considerations. The aim of the present review was to redefine mental disorders more objectively, personalise treatments, facilitate early diagnosis, and provide patients with more choices in their care. Through the present article, author aimed to highlight the use of AI in the diagnosis of various psychiatric disorders such as depression, schizophrenia, bipolar disorder, Autism Spectrum Disorder (ASD), and Alzheimer’s Disease (AD).

Role of Panchakarma Chikitsa in the Management of Katigraha (Lumbar Spondylosis): A Literature Review

Anup Jain, Punam Sawarkar, Seema Jain Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Katigraha is a disease in which Vata gets imbalanced in its sthana (seat), causing pain to originate in the joints of sphika and prishtha-vanshasthi. According to Gadanigraha, when Vata is affected by Ama and is located in Kati Pradesh, it exhibits the symptoms of Katigraha, namely Graha (stiffness) and Ruja (pain) in Kati Pradesh (lower back). Compared with modern science, the authors can correlate this disease to lumbar spondylosis. Chronic low-back pain affects 4.2% of the population and accounts for almost 50% of total low-back pain related costs. The treatment involves various approaches, including anti-inflammatories, analgesics, muscle relaxants, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), exercises, traction, and invasive procedures like surgeries. Panchakarma, a specialised facet of Ayurveda, not only focuses on bringing the body to a state of Samadosha, thereby targeting to achieve normal health. With literary evidence supporting its efficacy, Panchakarma offers a comprehensive approach in managing such conditions, encompassing curative, preventive, and promotive aspects of health. Databases such as PubMed, Google Scholars, Shodhaganga, etc., were searched, and a total of 12 articles were shortlisted based on various Panchakarma interventions being used for the management of Katigraha. Panchakarma provides a promising avenue for the effective management of Katigraha, paving the way for enhanced well-being and improved quality of life for individuals suffering from this condition.

Parasagittal Meningioma in a Middle-aged Female Harbouring Metastatic Ductal Carcinoma: A Rare Case of Incidentally Detected Tumour-to-tumour Metastasis

Nadia Shirazi, Sanjeev Pandey, Meena Harsh, Siddhartha Tyagi Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Metastasis of a tumour particularly coming from breast into an intracranial meningioma is a rare phenomenon. Several factors related to tumour microenvironment have been suggested in the pathophysiology of these lesions, particularly the rich vascular network of meningiomas, expression of common hormonal receptors like Oestrogen Receptor (ER) and Progesterone Receptor (PR), local immunosuppression, and presence of cell adhesion molecules. Here, we present a clinicoradiologically unsuspecting case of intracranial, parasagittal meningioma who was operated for relief of symptoms of mass effect and was incidentally detected with tumour metastasis within the meningioma. A 50-year-old female presented with seizures, headache and visual disturbances since last one month. Radiology revealed a parasagittal mass which was likely to be meningioma. The patient was operated. On histopathology, a low-grade meningioma was seen with areas of metastatic adenocarcinoma. The metastatic foci were surrounded by fibroblastic meningioma cells. On Immunohistochemistry (IHC), the metastatic tumour cells were strongly positive for PR and Cytokeratin 7 (CK7) and a diagnosis of fibroblastic meningioma with intratumoural metastasis of ductal carcinoma was rendered. The patient was given radiotherapy for brain tumour and also started on chemotherapy for breast carcinoma with brain metastasis. Since the entity of “Tumour-to-tumour Metastasis (TTM)” is uncommonly thought of and its detection is not easy, it is important that both clinicians and pathologists should adequately examine tissue samples of excised meningioma, as detecting the presence of any metastatic foci within the main mass will alter the prognosis and treatment plan considerably.

A Rare Case of Sheehan’s Syndrome Presenting as Depression and Dyselectrolytaemia in a Multiparous Woman

M Maneesha, KS Chenthil, Vignessh Raveekumaran, J Jenifer Florence Mary Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Sheehan’s Syndrome (SS) is a rare endocrine condition that presents with complex features in women with intrapartum or Postpartum Haemorrhage (PPH) seen in clinical practice. The spectrum of symptoms is diverse, and early detection with prompt treatment of this endocrinopathy is facilitated by a high index of suspicion, sound clinical acumen, and an appropriate diagnostic strategy by an astute physician. SS, which manifests as a major depressive disorder, but not accompanied with dyselectrolytaemia, is an interesting finding in the present case study. In fact, most of the time, it presents with non specific symptoms that delays the diagnosis and management. Hereby, the authors present the case of a 39-year-old multiparous woman who was diagnosed with depression for two months by the psychiatrist. Later, she developed symptoms including anorexia, for which she presented to the Medicine Department. On detailed examination, her vitals were poor. Again, she was evaluated in detail for her obstetric history presented as a history of agalactia and early amenorrhoea two years ago. Followed by the history, laboratory investigation and imaging techniques were done, and found to have thinned pituitary gland and flattened against the sella floor. With this prompt examination, diagnosed with SS due to PPH. Yet, her laboratory investigation resulted in abnormal electrolytes made the final diagnosis as SS with dyselectrolytaemia and depression as neuropsychiatric manifestations. She was treated with Hormone Replacement Therapy (HRT). Due to her financial constraints, her treatment switched to oral drugs and discharged Against Medical Advice (AMA) with follow-up advice.

Crossed Fused Ectopic Kidney with Stone Disease and Bifid Renal Pelvis: A Case Report

Vikram Satav, Ashish Gavade, Vilas Sabale, Sunil Mhaske, Shashikant Asabe Journal of clinical and diagnostic research : 2024 - April - 18:0973-709X Crossed fused ectopic kidney is a rare congenital anomaly wherein the kidneys are present on the same side due to fusion. It is a rare disease that may remain undiagnosed throughout life. Its rarity and anatomical abnormality make any intervention challenging. A 32-year-old male patient presented with symptoms of pain in the abdomen and burning micturition for a year. Serum creatinine, along with other blood tests, was normal. X-ray KUB showed renal calculi in the region of the right kidney. However, a Computed Tomography (CT) scan showed that the left kidney was malrotated and fused with the lower pole of the right kidney, suggestive of crossed fused renal ectopia. A cystoscopy and retrograde pyelography were performed, followed by open pyelolithotomy, wherein calculi were removed, and a stent was placed. Through this case report, it is suggested that adequate presurgery evaluation is necessary for patients with such malformations.