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

Rehabilitation of a Rare Combined Radial, Median, and Ulnar Nerve Injuries following Handcuff Compression: A Case Report

Abhishek Mandal, Manisha Mondal, Akanksha Saxena, Mandeep Kumar Jangra, Ruchika Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Prolonged compression and abnormal stretch is the cause of many types of Peripheral Nerve Injuries (PNI), but injury due to overtightened handcuffs is a rare occurrence. These neuropathies have a poor prognosis if not treated promptly. A 24-yearold man with combined radial, median, and ulnar nerve injury following handcuff restraint received a 40-day physiotherapy protocol intervention (30-40 min/session). Interventions included proprioceptive neuromuscular facilitation, functional electrical stimulation, and functional activities administered each day for 10 days and then five days/week for the remaining 30 days. Measurements were taken at baseline (T0), then at every 10 sessions (T1, T2, T3, T4). Progress was evaluated on a 10-session interval using the Quick Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), pinch and hand grip strength using hand dynamometer. Grip and pinch strength improved from 0-10 kg and 0-5 kg, respectively whereas disability score on QuickDASH changed from 59.09% to 13.63% and PRWE improved from 48.5 to 4.5 point. An individually tailored advanced physiotherapy regime was effective in improving gross motor, fine motor skills and functional recovery of an individual with a rare handcuff injury. Significant improvements were also observed in elbow, wrist, and metacarpophalangeal joint range of motion. Thus, a structured, phase-wise physiotherapy approach can be the first line of effective treatment in functional recovery of individuals with a rare handcuff injury.

Adult-onset Still’s Disease Masquerading as Pyrexia of Unknown Origin with Severe Hyponatremia and Pleural Effusion: A Case Report

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Mittal Sindhav Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Adult-onset Still’s Disease (AOSD) is a rare autoinflammatory disorder marked by quotidian fever, evanescent rash, and inflammatory arthritis, often requiring exclusion of infectious and autoimmune causes before diagnosis. Hereby, the authors present a case report of 45-year-old female with a two-and-a-half–month history of daily high-grade fever, salmon-coloured maculopapular rash exacerbated during fever spikes, severe sore throat, and pro-gressive polyarthralgia. Her illness later progressed to bilateral flank pain, vomiting, dysapnoea, and hypotension. Laboratory evaluation revealed marked leukocytosis (27,000/cumm), anaemia, hyponatremia, elevated Serum Glutamic Oxaloacetic Transaminase (SGOT), hypertriglyceridemia, and significantly raised inflammatory markers, including C-reactive Protein (CRP) (162 mg/dL), Lactate Dehydrogenase (LDH) (1612 U/L), and ferritin (1200 ng/mL). Infectious and autoimmune studies were negative. High Resolution Computed Tomography (HRCT) of the thorax showed bilateral pleural effusions and ground-glass opacities, while Contrast-enhanced Computed Tomog-raphy (CECT) abdomen demonstrated hepatosplenomegaly and ascites. Despite broad-spectrum intravenous antibiotics, fever and systemic symptoms persisted. Given the prolonged fever, typical rash, sore throat, neutro-philic leukocytosis, abnormal liver function tests, and negative Anti-nuclear Antibodies (ANA) and Rheumatoid Fac-tor (RF), a diagnosis of AOSD was strongly supported, fulfilling Yamaguchi criteria with three major and multiple minor criteria. The patient was treated with indomethacin and intravenous methylprednisolone 1 mg/kg for five days, later transitioned to tapering oral steroids. Within 48 hours, she demonstrated marked clinical improvement with resolution of fever and rapid decline in ferritin, CRP, and White Blood Cells (WBC) count. She was discharged after stabilisation and remained asymptomatic at her 15-day follow-up while continuing a tapering steroid regimen. The present case highlights the importance of early consideration of AOSD in patients with prolonged fever and multisystem involvement, particularly when infections and autoimmune diseases have been excluded. Rapid re-sponse to corticosteroids further supports the diagnosis and underscores their central role in initial management.

Mammary Hamartoma of the Right Breast: A Case Report

Gopu Sowmya, Alexander Mecheri Anthony, T Raghupathy, Ramalakshmi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Mammary hamartoma is an uncommon benign breast lesion composed of disorganised but mature mammary ducts, lobules, fibrous stroma, and adipose tissue. Despite its characteristic pathological identity, it is often under-recognised clinically because it can mimic other benign breast masses, such as fibroadenoma and lipoma. A 50-year-old woman presented with a longstanding lump (approximately 35 years) in the right breast that had been first noticed around puberty (approximately at 15 years of age) and had gradually increased in size over time, with associated cyclical mastalgia. There was no history of nipple discharge, skin changes, constitutional symptoms, or family history of breast malignancy. Ultrasonography and mammography demonstrated a well-circumscribed lesion with mixed echogenicity and the classical ‘breast within a breast’ appearance, with minimal internal vascularity, and the lesion was categorised as Breast Imaging-Reporting and Data System (BI-RADS) III. Trucut biopsy showed benign breast tissue without malignancy. Owing to the persistent and sizeable nature of the lesion, wide local excision was performed. Histopathological examination showed mature adipocytes, ducts, lobules, dense fibrocollagenous tissue, and congested blood vessels arranged in a disorganised pattern, confirming mammary hamartoma. This case highlights that mammary hamartoma should be considered in the differential diagnosis of long-standing, well-circumscribed breast lumps, and that imaging combined with histopathology is essential for definitive diagnosis.

Anaesthetic Management of Subtrochanteric Femur Fracture in a Morbidly Obese Patient with Multiple Co-morbidities: A Case Report

Charmi Hitenbhai Shah, Sara Mary Thomas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Morbid obesity, defined as Body Mass Index (BMI) greater than 40 kg/m², poses significant challenges for anaesthetic management, particularly in emergency orthopaedic procedures. The authors present the case of a 62-year-old morbidly obese female (BMI-58.76 kg/m²) with multiple co-morbidities including hyper-tension, diabetes mellitus, hypothyroidism, chronic kidney disease, and bronchial asthma, who presented with left closed displaced subtrochanteric femur fracture following a fall at home. The patient underwent Proximal Femoral Nailing (PFN) with Tension Band Wiring (TBW) under Combined Spinal-Epidural (CSE) anaesthesia after compre-hensive preoperative optimisation for ten days. Preoperative management included correction of anaemia, elec-trolyte imbalances, glycaemic control, and respiratory optimisation. Intraoperatively, invasive arterial and central venous monitoring were established under ultrasound guidance. Low-dose spinal anaesthesia with 0.5% heavy bupivacaine (2 mL) was administered, supplemented by epidural catheter placement for postoperative analgesia. Sensory block was achieved to T10 dermatome with Bromage grade 2 motor block. The surgery was completed successfully in 125 minutes with stable haemodynamics maintained throughout. Postoperative pain management was achieved through multimodal analgesia including epidural tramadol administration. The present case high-lights the importance of meticulous preoperative optimisation, appropriate selection of regional anaesthesia tech-nique, and intensive perioperative monitoring in managing morbidly obese patients with multiple co-morbidities undergoing major orthopaedic surgery.

Physiotherapeutic Rehabilitation in a Patient with Right Cerebellar Haemorrhage with Ventricular Extension and Mild Hydrocephalus: A Case Report

M Jayakrishnan, Jayesh Chandran Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Cerebellar haemorrhage can result in impaired coordination, balance disturbances, and reduced functional independence. This case report describes the physiotherapy rehabilitation of a 55-year-old female diagnosed with right cerebellar haemorrhage with ventricular extension and mild hydrocephalus. After medical stabilisation, physiotherapy was initiated focused on balance training, coordination exercises, gait training and functional retraining for a period of 10 days. During rehabilitation, improvement was observed in balance, coordination and independence in activities of daily living, which was supported by changes in the outcome measure scores. This case suggests that early physiotherapy intervention may support functional recovery in patients with cerebellar involvement.

Mixed Germ Cell Tumour of the Suprasellar Region: A Case Report

Rushali Patel, Keyuri Bharat Patel, Zalak Parmar, Shyama Chag Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Intracranial Germ Cell Tumours (GCTs) represent a rare and heterogeneous group of CNS malignancies that commonly arise in the second decade of life. They account for 0.5-11% of all intracranial neoplasms, with a male:female ratio of 2-2.5:1. Authors report a rare case of a 12-year-old female in paediatric outpatient department who presented with symptoms of raised intracranial pressure, vomiting (3-4 episodes/day), seizure and severe headache for three days associated with altered sensorium. Non-contrast MRI brain was suggestive of a suprasellar lesion causing obstructive hydrocephalus with differential diagnosis of craniopharyngioma and germinoma. Craniotomy was performed, and tissue was sent for Histopathological Examination (HPE). On gross examination, multiple greyish-white soft-tissue bits were received, measuring 3.0×2.5×2.0 cm. The HPE revealed a mixture of mature benign tissues of ectodermal, mesodermal, and endodermal origin, with discretely arranged pleomorphic cells, foci of lymphocytic infiltrate, and a few syncytiotrophic giant cells, favouring mixed GCT. Immunohistochemistry (IHC) showed positivity for OCT3/4, CD117, and ß-HCG in the germinoma component, as well as positivity for Glypican 3 and AFP in the yolk sac tumour component, and positivity for Cytokeratin (CK) in the mature teratoma component. CD30 and GFAP were negative. The diagnosis was confirmed through histopathological evaluation and a comprehensive IHC panel, which identified a mixed GCTs complex composition of mature teratoma (75%), germinoma (20%), and yolk sac tumour (5%). This case emphasises the necessity of meticulous subtyping, as the presence of even minor non-germinomatous components significantly alters the prognosis and necessitates a multimodal therapeutic approach. Precise histopathological diagnosis of GCTs is crucial, as it determines prognosis and guides treatment planning. These tumours generally have a favourable prognosis, with 5-year survival rates ranging from 65% to 95%. Mixed GCTs in the suprasellar region represent a rare form of malignancy. In the diagnostic setting, accurate histopathological evaluation supplemented with IHC is essential for subtyping GCTs and planning appropriate management, including surgical resection, chemotherapy, and conventional radiotherapy.

Holistic Ayurvedic Approach Along with Viddha Karma in Carpal Tunnel Syndrome: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Trupti Thakre, Rohit Waskar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Carpal Tunnel Syndrome (CTS) is a common neuropathy caused by compression of the median nerve within the carpal tunnel. It manifests as pain, numbness, tingling, and weakness in the affected hand. CTS can be correlated with Vata Pradhana Vyadhi in Ayurveda, where aggravated Vata and Pitta Dosha lead to nerve dys-function and inflammation. This case report describes a 50-year-old female with a 6-month history of progressive numbness, tingling, pain, and swelling in both hands, predominantly affecting the thumb, index, and middle fin-gers, with nocturnal aggravation. Clinical examination revealed positive Tinel’s and Phalen’s tests. She was diag-nosed with CTS and managed with an Ayurvedic treatment along with Viddha karma. After 1 month of con-servative treatment, the patient experienced significant symptom relief, improved grip strength, and enhanced functionality. This case highlights the importance of Ayurvedic treatment along with Viddha karma and early intervention in preventing disease progression.

Appendicitis with Calcified Schistosome Eggs in a 73-year-old Female: A Case Report

Yuliya Mazo, Kurtis A Hinton, Timothy W Boorady, Robert A Jesinger Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Schistosomal appendicitis is an uncommon manifestation of chronic schistosomiasis, typically resulting from egg-induced granulomatous inflammation and luminal obstruction. Although most cases are reported in endemic areas, delayed presentations in non endemic settings are increasingly recognised due to global migration. Hereby, the authors present a rare case of appendicitis with calcified schistosome eggs identified in the appendix of a 73-year-old female residing in the USA. While schistosomiasis more commonly affects younger males in endemic regions, the present case highlights a delayed presentation of appendicitis decades after suspected exposure in the Philippines. The present case underscores the importance of considering atypical causes of appendicitis in non endemic regions, particularly in older patients with relevant travel history. It also highlights how global migration may contribute to the delayed identification of prior parasitic infections, emphasising the role of multidisciplinary collaboration in accurate diagnosis and management.

Long-retained Tracheostomy Tube as an Unusual Endobronchial Foreign Body: A Case Report

Komal Rathod, Ajay Chavhan, Pratap Singh Parihar, Saraswathula Bharadwaj Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Foreign bodies in the tracheobronchial tree are uncommon in adults and typically involve aspirated debris. Re-tained or neglected tracheostomy tubes as airway foreign bodies are extremely unusual. Imaging is essential for detecting, localising, and assessing problems. Here, we present a 60-year-old female who presented with persis-tent cough, worsening dyspnoea, and repeated episodes of lower respiratory tract infection over the last few weeks. The patient had past history of tracheostomy approximately 20-25 years ago (exact indication and duration unknown). A radio-opaque tubular structure was visible on a chest radiograph along the right main bronchus. A metallic foreign body, identified as a long-retained tracheostomy tube, was successfully removed after bronchos-copy verified its presence. A normal carina was then restored. This case involves an unusual endobronchial for-eign body in an adult. This neglected tracheostomy tube requires a radiological scan, namely X-ray, to detect air-way dysfunction and parenchymal changes, thereby averting long-term morbidity.

Combined Effect of Static Openers and Sciatic Nerve Mobilisation on Pain, Range of Motion and Lower Extremity Functions in an Individual with Piriformis Syndrome: A Case Report

Apoorva Saini, Mandeep Kumar Jangra, Kanupriya, Akanksha Saxena Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Piriformis Syndrome (PS) is defined as an impingement of the sciatic nerve by the piriformis muscle, resulting in buttock pain, sciatica-like symptoms, or both. Various physiotherapeutic interventions are used for its management, such as sciatic nerve mobilisation, strengthening of the hip abductors, extensors, and external rotators, and electrotherapy modalities including Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Therapy (IFT), however, none have been proven to provide long-term effects. Static openers are novel techniques that facilitate canal opening and create space for compressed nerves. A 24-year-old female presented to the Outpatient Department (OPD) with complaints of pain in gluteal region radiating till right posterior side of knee from past six days. On assessment, special tests such as Straight Leg Raise (SLR) test, Beatty, and Flexion, Adduction, Internal Rotation (FAIR) test of right-side were positive with restriction in Hip Internal and External Range Of Motion (ROM) making a diagnosis of PS. Sciatic nerve mobilisation was performed for three sets of 30-40 repetitions (2 minutes/set) with a one-minute rest between sets, while static openers were given for 30 seconds to one minute, four days/week. Baseline and postintervention, improvements were observed on pain by Visual Analogue Scale (VAS) (8 to 5), Pain pressure threshold of piriformis muscle reduced (2.20 to 2.10), Hip IR (32° to 36°), ER (43° to 48°), and Lower Extremity Functional Scale (LEFS) (25 to 35). This case report concludes that combining static openers with sciatic nerve mobilisation might serve as an effective intervention in managing PS.

Pleomorphic Rhabdomyosarcoma in the Deltoid Muscle with Pulmonary Spread: Radiologic and Histopathologic Insights

Nillohit Saha, Jenikar Paulraj, Sai Shankar Mankuzhy Gopalakrishnan, Harshavardhan Balaganesan, R Remya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumour primarily affecting children, but it is comparatively rare in adults. This case study outlines the clinical presentation, imaging characteristics, and histopathological findings of pleomorphic RMS in a 56-year-old male patient with a painless, progressively enlarging mass in the left deltoid region. Imaging techniques, including ultrasound and Contrast-Enhanced Magnetic Resonance Imaging (CEMRI), revealed a large, lobulated intramuscular lesion with significant vascularity, diffusion restriction, and features suggestive of haemorrhage. Histopathological Examination (HPE) confirmed the diagnosis of undifferentiated pleomorphic RMS, supported by positive immunohistochemical staining for myogenin. Following imaging for metastatic evaluation, multiple cannonball metastases were identified in the lungs. These findings underscore the necessity for early diagnosis and the importance of imaging in evaluating the extent of the disease and guiding therapeutic decisions in this aggressive tumour.

Management of Resistant Anovulation with Uttara Basti Therapy: A Case Report

Varsha P Jadhao, Pooja Shrivastav Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Resistant anovulation represents a challenging subset of ovulatory dysfunction in women with primary infertility, particularly when conventional pharmacological interventions fail. The present case report describes a 29-year-old female presenting with treatment-resistant anovulation in the context of polycystic ovarian morphology who achieved successful ovulation and conception following an integrated treatment protocol combining evidence-based traditional medicine with contemporary reproductive endocrinology principles. The patient presented with a four-year history of infertility despite multiple cycles of conventional ovulation-inducing agents, including clomiphene citrate, letrozole and human Menopausal Gonadotropin (hMG). Implementation of a multimodal management strategy including Ayurvedic therapeutic interventions, metabolic optimisation and hormonal monitoring resulted in spontaneous ovulation during the fourth treatment cycle, culminating in uncomplicated pregnancy and continuation to term. This case illustrates the potential therapeutic value of integrating complementary medical approaches with conventional diagnostic monitoring in the management of resistant ovulatory dysfunction.

Cervical Adenosarcoma with Sarcomatous Overgrowth Presenting as a Gangrenous Polyp: A Rare Case Report

Reshmi Arumugam, Manjiri Dhilip Phansalkar, Sampath Karl, Moses Ambroise Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Cervical Müllerian adenosarcoma is a rare biphasic neoplasm, representing 2-10% of all Müllerian adenosarcomas and only 0.16% of cervical malignancies. It is characterised by benign epithelial glands embedded within a malignant stromal component with Sarcomatous Overgrowth (SO) signifying an aggressive variant associated with poorer outcomes. Owing to its frequent clinical resemblance to benign cervical polyps, timely diagnosis depends on careful histopathological and immunohistochemical evaluation. The authors hereby report a case involving a 39-year-old unmarried nulliparous woman who presented with one-week history of a mass per vaginum. Perspeculum examination showed a gangrenous polyp arising from the cervix. Grossly, the excised specimen consisted of a greybrown polypoidal tissue (4.0×3.5×1.8 cm) with a smooth, ulcerated and congested surface and a cut surface demonstrating a central greywhite zone surrounded by a peripheral greybrown area. Microscopy revealed a highly cellular malignant spindlecell neoplasm with marked pleomorphism, brisk mitotic activity {50/10 High-Power Fields (HPF)}, haemorrhage, necrosis and periglandular cuffing of entrapped benign endocervical or endometrialtype glands- features diagnostic of adenosarcoma with SO. Immunohistochemistry (IHC) demonstrated stromal CD10 and Cyclin D1 positivity, diffuse p16 expression, a p53 null pattern and negativity for Oestrogen Receptor (ER), Progesterone Receptor (PR), Smooth Muscle Actin (SMA), desmin and myogenin, effectively excluding other mesenchymal tumours. No residual tumour was identified on completion hysterectomy. The novelty of the present report lies in its unusual presentation as a gangrenous cervical polyp and the diagnostic challenge posed by its close mimicry of a benign lesion. The present case highlights the essential role of comprehensive histopathology and immunohistochemistry in distinguishing cervical adenosarcoma from more common benign entities.

Severe Warm Autoimmune Haemolytic Anaemia with Concurrent Adnexal Cyst: A Case Report on Transfusion Strategy in a Complex Clinical Scenario

Kirupanantha Rajan Poobalan, Radhakrishnan Krishnamoorthy, Anandan Ashwin, R Niranj Rathan, M Sampat Kumar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Warm Autoimmune Haemolytic Anaemia (AIHA) is a rare immune-mediated disorder in which IgG autoantibodies destroy Red Blood Cells (RBCs) at body temperature. The presence of panreactive autoantibodies complicates compatibility testing and transfusion support. Coincidental gynaecologic pathology such as an adnexal cyst is rarely documented and may increase clinical complexity. A 43-year-old woman presented with severe anaemia (Hb 3.2 g/dL), tachycardia, and pallor. Laboratory evaluation revealed macrocytosis, reticulocytosis, elevated Lactate Dehydrogenase (LDH), indirect hyperbilirubinaemia, and a strongly positive direct Coombs test (4+). ABO grouping showed autoagglutination that required resolution by conventional tube testing. Antibody screening demonstrated panagglutinating warm autoantibodies with Coombs-phase incompatibility in all crossmatches. Two least-incompatible packed red cell units were transfused safely, with appropriate haematologic response. High-dose methylprednisolone followed by oral prednisolone achieved remission. Ultrasonography revealed a left adnexal cyst (O-RADS 3) with normal tumour markers. After one month of immunosuppressive therapy, antibody reactivity subsided and all crossmatches became compatible. The patient underwent laparoscopic cystectomy with minimal blood loss; histopathology confirmed a benign serous cyst with a paratubal cyst. This case underscores the effectiveness of judicious transfusion using least-incompatible units and early corticosteroid therapy in warm AIHA. The incidental adnexal cyst highlights the need for multidisciplinary coordination between transfusion medicine and gynaecology teams in complex perioperative scenarios.

MRCP-based Diagnosis of Todani Type IVa Choledochal Cyst with Associated Hepatic Duct Anatomical Variant in a Young Adult Female: A Case Report

Samarth Shah, Meet Gami, Kunal Solanki, Rajesh Rathore, Ashutosh Patel Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Choledochal cysts are rare congenital anomalies of the biliary system, with Todani type IVa involving both intrahepatic and extrahepatic bile ducts. Accurate classification and identification of associated biliary anatomical variants are essential for appropriate management and surgical planning. We report the case of a 20-year-old female who presented with postprandial abdominal pain and was referred for Magnetic Resonance Cholangiopancreatography (MRCP) following a suspicious ultrasound examination. MRCP demonstrated fusiform dilatation of the extrahepatic bile duct with multifocal dilatation of the intrahepatic biliary radicles, consistent with a Todani type IVa choledochal cyst. An associated hepatic duct anatomical variant (type II) was also identified. Laboratory parameters were within normal limits, and no surgical intervention had been undertaken at the time of presentation. This case highlights the pivotal role of MRCP in the non-invasive diagnosis, classification, and comprehensive biliary mapping of choledochal cysts. The co-existence of a choledochal cyst with a hepatic duct anatomical variant makes this case unique and has significant implications for surgical planning.

Intricate Tibial Plateau Pivot Fracture with PCL Avulsion: A Case Report

A Robin, Vijayanand, S Karthikeyan, Sai Preeth Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X This case report presents an unusual type of tibial plateau fracture, referred to as a “pivot fracture,” resulting from a high-velocity trauma along with a Posterior Cruciate Ligament (PCL) avulsion, a pattern not covered under standard classification systems. The patient was managed with open reduction of both the pivot fracture and the PCL avulsion fragment through the Burks and Schaffer approach. Postoperative care included a structured rehabilitation protocol. Although there was a delayed union of the femur fracture sustained in the same incident, the patient regained full knee Range of Motion (ROM) by the eighth month. This case highlights the challenging nature of tibial plateau fractures, the need for tailored surgical approaches, and the importance of meticulous preoperative planning, underscoring the necessity for flexible and case-specific treatment strategies.

Managing Fournier’s Gangrene with Bilateral Orchidectomy While Preserving the Scrotum: A Case Report

Pankaj Gharde, Chahat Singh, Harshal Tayade, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Fournier’s Gangrene (FG) is a fast-progressing, life-threatening necrotising fasciitis of the perineal and genital areas, which is common in individuals who have uncontrolled diabetes or other immunocompromised state. The present case is about a 45-year-old diabetic male, who presented with rapidly progressive bilateral swelling of scrotal region, foul discharge, and septic shock. Aggressive resuscitation, intravenous antibiotics, vasopressor support and urgent surgical exploration were all part of emergency management. Intraoperatively, extensive necrosis of scrotal fascia along with non-viable testes was found, thus requiring bilateral orchidectomy with wide excision of necrotic tissue. Surgical, chemical and enzymatic debridement was done to the patient postoperatively, and daily dressings were meticulously done. Interestingly, the scrotectomy was not done, and the wound healed by secondary intention, giving a good contour thus eliminating the need for grafting or flap reconstruction. The present case highlights the need of timely diagnosis, multidisciplinary and aggressive management, and customised wound care in achieving positive results in such cases, even in bilateral testicular involvement.

A Case Report of Myxoedema Psychosis in a 25-year-old Female

Adithya Biswas, Kailash Sureshkumar, Shabeeba Z Kailash, Aravindh Manogaran, S Nivedita Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Hypothyroidism is a medical disorder of thyroid hormone deficiency which can manifest with a range of somatic and psychological disturbances. This case highlights the rarer manifestation of psychotic symptoms in a patient with hypothyroidism which is known to typically manifest with depressive and/or anxious psychiatric symptomatology. The following report discusses a case of a young adult married house-wife from a semiurban setting presented with history of irritability, aggressive and odd behaviours, hearing voices, suspiciousness with irregular sleep in an on/off manner for 10 days duration coinciding with a period of irregularity in her hypothyroid medication use. Upon mental status examination signs of poor self-care, gaze avoidance, increased psychomotor activity and speech rates were noted alongside referential and persecutory delusions and beckoning secondary auditory hallucinations. Insight of grade 3 and poor judgement. The patient was assessed by serial applications of the Brief Psychiatric Rating Scale (BPRS) showing an improvement from across the span of four days of re-initiation of long-term thyroid medication under the cover of short-term antipsychotics and psychotherapy. This case exemplifies the acute nature of psychotic symptoms that can manifest in hypothyroidism, with some instances having psychotic features as the presenting complaints. Maintaining a high index of suspicion to enable early identification is important. An improvement in patient’s condition was noted in response to thyroid level assessment and reinforcement of medication use. Appropriate psychopharmacological and psychotherapeutic interventions contributed to the patient’s acute improvement which highlights the need for discussing such cases.

Left Atrial Myxoma Presenting as Acute Cardioembolic Stroke in Young Female: A Rare Case Report

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Mittal Sindhav Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Left atrial myxoma is the most common primary cardiac tumour and a rare but important cause of cardioembolic stroke. This is a case report of a 22-year-old married female who presented with history of sudden-onset right-sided weakness and difficulty in speech. Brain imaging confirmed acute ischaemic stroke in the left frontoparietal and left gangliocapsular region with haemorrhagic transformation. Further evaluation with echocardiography revealed a large, mobile left atrial mass attached to the interatrial septum, consistent with atrial myxoma. Patient was started on single antiplatelet, statin with anticoagulation. Patient was referred for cardiac Magnetic Resonance Imaging (MRI) and Cardiothoracic and Vascular Surgeon opinion to higher centre. This case highlights the importance of considering cardiac sources such as left atrial myxoma in young or atypical stroke patients without conventional risk factors. Early echocardiographic evaluation can be lifesaving, enabling timely surgical intervention to prevent recurrent embolic events.

Comprehensive Postoperative Physiotherapy for Pulmonary Function, Functional Recovery and Quality of Life in a Patient with Pancreatopleural Fistula: A Rare Case Report

Dinkey A Mankad, G Palani Kumar, Kalpesh Satani Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Pancreatopleural Fistula (PPF) is a rare complication of pancreatitis that occurs approximately in 0.4% of patients characterised by an abnormal communication between the pancreatic duct and the pleural cavity. Surgical intervention is often required in severe or necrotising cases. Comprehensive physiotherapeutic rehabilitation plays a vital role in PPF. A 25-year-old male patient presented to the hospital with complaints of lower abdominal pain, fever, nausea, vomiting, cough with whitish expectoration left-sided chest pain and breathlessness {Grade 4 modified Medical Research Council (mMRC)}. He had a history of alcohol consumption for the last ten years. Based on abdominal Computed Tomography (CT) scan findings, he was diagnosed with a left PPF along with left pleural effusion. The patient subsequently underwent a pancreatic necrosectomy. After obtaining informed consent, a detailed physiotherapy evaluation was conducted and a tailor-made pulmonary rehabilitation program included early mobilisation in the Intensive Care Unit (ICU), active breathing exercises, incentive spirometry, exercise training (aerobic and resisted exercises), positioning, and airway clearance techniques. mMRC Dyspnoea Scale showed improvement from Grade 4 to Grade 2. The Six-Minute Walk Distance increased from 120 meters to 350 meters and SF-36 (36-Item Short Form Survey) score improved from 20 to 36. Findings of this case report indicate that comprehensive postoperative physiotherapeutic rehabilitation is both feasible and effective and demonstrated significant improvement in pulmonary function, functional recovery, and better quality of life in the postoperative period in patients with PPF. A structured rehabilitation program can effectively prevent postsurgical complications, and improve functional recovery in such rare and complex thoraco-abdominal conditions.

Aromatase Inhibitor induced Carpal Tunnel Syndrome: A Rare Case of Under-reported Side Effect in Indian Population

Vasundhra Bhatia, Saquib Zaffar Banday, Chetan Ram Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Carpal Tunnel Syndrome (CTS) has been increasingly identified in hormone receptor-positive Breast Cancer (BC) patients treated with Aromatase Inhibitors (AIs). While CTS is common in the general population, its association with AIs is underexplored. Recognition is important as such adverse events may compromise adherence to life-prolonging therapy. We report a case of a hormone receptor-positive BC 30-year-old married female patient who developed symptomatic CTS during AI therapy. The patient presented with classic symptoms of numbness, tingling, and pain in the hand, confirmed through clinical evaluation and diagnostic testing. The temporal relationship between AI initiation and symptom onset suggested a drug-related cause. Although AI-induced CTS has been described globally, reports remain rare in India. This case highlights the need for heightened clinical awareness, timely recognition, and management of CTS in patients receiving AIs to prevent treatment discontinuation and ensure optimal therapeutic outcomes.

Mixed Type of Median Raphe Cyst Presenting as Canaliform Variant: A Rare Case Report

Reshma Karishetti, Shahina Shaikh, Santosh Baburao Kurbet, Hema Bannur, Simran Shantanu Tendulkar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Median raphe cysts are benign congenital developmental anomalies that can occur at any site along the midline of the ventral aspect of external genital region. Their pathogenesis is unclear. They are thought to be arising from defective closure or epithelial trapping during embryological development of urethral folds. They are rare with less than 15 cases being reported in the Indian subcontinent. Here is a report of one such case in a three-year-old child presenting with difficulty in passing urine and also difficulty in passing stools. On examination, there were multiple cystic lesions arranged in linear fashion along the median raphe from perineum to penile shaft since birth. Ultrasonography showed multiple isoechoic cystic lesions from the middle of shaft of the penis to perineum, very well separate from urethra, lying entirely within the mucosa without any evidence of solid components, septations or vascularity. Surgical excision was performed. Histopathological examination showed multiple, canaliform median raphe cysts with mixed type. Differential diagnosis on histopathology includes apocrine cystadenoma, mucinous cysts, epidermal cysts and dermoid cysts. These cysts are best treated by complete surgical excision to prevent recurrence. Canaliform variant of median raphe cysts are uncommon and rarely reported. They have bimodal age distribution. Histopathological confirmation is essential for accurate diagnosis. Complete excision remains the treatment of choice. Timely diagnosis and surgical excision prevent further complications.

Myelin Oligodendrocyte Glycoprotein Antibody Associated Acute Disseminated Encephalomyelitis Post Varicella Infection in a Child: A Case Report

Shikha Yadav, Jyoti Kadian, Hardik Soni, Ritika Singh, Kapil Bhalla Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Myelin Oligodendrocyte Glycoprotein Antibody associated Disease (MOGAD), an autoimmune demyelinating disorder, often overlaps with features of Acute Disseminated Encephalomyelitis (ADEM), optic neuritis and transverse myelitis in paediatric population. Recent advances have identified Myelin Oligodendrocyte Glycoprotein (MOG) antibody as a marker in a subset of paediatric demyelinating diseases. MOGAD is increasingly being recognised as a distinct entity among paediatric demyelinating disorders. Identification of MOG antibodies is important as it has diagnostic, therapeutic and prognostic implications particularly in post-infectious demyelination. Herein, the authors report a case of 10-year-old male who presented with fever and vesicular lesions for 10 days, suggesting chickenpox infection (varicella), which was followed by paraparesis. Neurological examination suggested hypotonia of lower limbs and absent deep tendon reflexes with rest of central nervous examination within normal limits. Radiological and biochemical investigations (serum MOG positive) confirmed the diagnosis of ADEM likely to be post varicella infection. He was managed successfully with intravenous immunoglobulin, high dose steroids and is currently doing well on follow-up. This case highlights the importance of early detection, diagnosis and testing for anti-MOG in children presenting with ADEM like features. Early recognition of MOG antibody associated ADEM and timely initiation of immunotherapy are crucial for improving neurological outcomes in affected children. This case emphasises the need to consider MOGAD in children presenting with acute demyelination after varicella.

Comprehensive Ayurvedic Management of Ekakushtha (Chronic Plaque Psoriasis) Using Multimodal Therapy and Dietary Regulation: A Case Report

Neha Singh, Shweta Parwe, Milind Nisargandha Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Psoriasis is a common dermatological disorder that affects up to 1% of the global population. The age of onset shows bimodality, with peaks at 16-22 and 57-60 years. Males are affected twice as much as fe-males. Plaque psoriasis causes extreme physical and psychological distress because of chronicity, flares, and visible lesions. According to Ayurveda, it is classified as Ekakushtha (Vata-Kapha Kshudrakushtha) and therefore requires a multimodal approach to Shodhana, Shamana, and Pathya. A 72-year-old postmenopausal female presented after eight years of silvery scales, red-ness, and burning with intense itching over elbows, forearms, hands, and lower limbs despite seven to eight years of allopathic treatment with temporary relief and frequent relapses. Chronic plaque psoria-sis (Ekakushtha) was diagnosed based on Psoriasis Area Severity Index (PASI) and Dermatology Life Quali-ty Index (DLQI) scores, along with positive Auspitz and candle grease signs. The patient was treated with Nitya Virechana (20 mL HS), Panchatikta Ghrita Guggul (250 mg twice daily), Panchatikta Ghrita (20 mL once daily), Krimikuthar Rasa (125 mg twice daily), Marichyadi Taila (topical), soothing powder (Rasmanikya, Yashtimadhu, and Ashwagandha), and Ashtyoga Lepa, along with strict Pathya (Shashtika Shali, Mudga; avoidance of sour, oily, and salty foods). There was a significant reduction in PASI score and improvement in DLQI (from 13 to 5). Clinical symptoms, including silvery scales, burning sensation, and itching (Kandu, Matsyashakalopamam, Daha, Mahavastu), were markedly reduced. In the present case, the treatment response was noted signifi-cantly earlier compared to the previous allopathic treatment, because here the treatment regimen was implemented in accordance with Ayurvedic Samprapti. After the end of active treatment, no recur-rence was found. It also emphasises the importance of a balanced diet as a crucial factor in promoting overall health.

Anaesthetic Challenges in a Parturient with Interatrial Septal Aneurysm Posted for Emergency Caesarean Section under Subarachnoid Block: A Case Report

S Gowtham, G Nevetha Priyadarshini, P Nandhini Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Interatrial Septal (IAS) aneurysm is a rare cardiac anomaly characterised by a localised outpouching of the atrial septum protruding into either atrium. During pregnancy, physiological cardiovascular changes may unmask or exacerbate the haemodynamic consequences of this condition, posing anaesthetic challenges during delivery. IAS aneurysm may be associated with Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO) and increases the risk of atrial arrhythmias, thromboembolism, and myocardial dysfunction. We report the anaesthetic management of a 32-year-old gravida 2 abortus one woman at 39 weeks of gestation with an incidental echocardiographic diagnosis of fenestrated IAS aneurysm, posted for emergency caesarean section due to foetal distress. The patient had a history of hypothyroidism on treatment and a resolved antiphospholipid antibody syndrome. Preoperative evaluation revealed stable haemodynamics with no evidence of active cardiac dysfunction or arrhythmias. Subarachnoid block was administered using low-dose hyperbaric bupivacaine, with prophylactic low-dose noradrenaline infusion initiated to prevent hypotension. Intraoperative haemodynamics remained stable, with no arrhythmias or embolic events. Both maternal and neonatal outcomes were favourable. This case highlights the importance of meticulous preoperative assessment, vigilant intraoperative monitoring, and proactive haemodynamic management in parturients with IAS aneurysm. Neuraxial anaesthesia can be safely administered in asymptomatic patients when haemodynamic goals are carefully maintained. Early recognition and tailored anaesthetic planning contribute significantly to optimal maternal and foetal outcomes.

Cytodiagnosis of Angiosarcoma Following Radical Mastectomy: A Rare Case Report of Stewart-Treves Syndrome

Sandhya Biswal, Ranjana Giri, Mouli Mishra, Subrat Kumar Sahu, Prajna Das Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Stewart-Treves Syndrome (STS) is a rare, highly aggressive cutaneous angiosarcoma with poor prognosis. It develops in a background of chronic lymphoedema, most commonly following mastectomy and adjuvant radiotherapy for carcinoma of the breast. The condition is uncommon, with the literature largely limited to isolated case reports and small case series. Radiotherapy is believed to increase the risk of STS by inducing tissue fibrosis, lymphatic obstruction, and persistent lymphoedema. Chronic lymphoedema results in local immune dysfunction, creating a microenvironment conducive to malignant transformation and oncogenesis. We report the case of a 52-year-old woman who developed STS involving the right upper limb seven years after undergoing radical mastectomy followed by postoperative adjuvant chemoradiotherapy for breast carcinoma, right-side. She presented with progressive swelling of the affected limb followed by multiple purplish cutaneous nodules two months later. On clinical examination, the nodules were immobile, firm to hard in consistency, tender, and measured between 0.5 cm and 2 cm in diameter. Positron Emission Tomography-Computed Tomography (PET-CT) scan showed post Modified Radical Mastectomy (MRM) status with multiple subcutaneous nodules on right limb and no other distant metastasis. Fine-Needle Aspiration Cytology (FNAC) revealed features suggestive of a malignant neoplasm. Subsequent histopathological examination, supported by Immunohistochemical (IHC) analysis, confirmed the diagnosis of high-grade angiosarcoma overlying lymphoedema. This case highlights the diagnostic value of FNAC as a rapid and minimally invasive initial investigative tool in post-mastectomy patients with chronic lymphoedema who develop suspicious cutaneous lesions. Early recognition and prompt diagnosis are crucial to improving clinical outcomes in this rare but fatal condition.

Neuro-reproductive Malformations and Hypogonadism in a Young Adult with Type 1 Diabetes: A Case Report of Partial Dysgenesis of the Corpus Callosum

Yuganshu Tirtharaj Bisen, Arush Pareek Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X The coexistence of partial dysgenesis of the corpus callosum, reproductive tract anomalies, and endocrine disorders in the patient presents unique diagnostic and management challenges. This case report contributes to the limited literature on complex multisystem presentations that require coordinated multidisciplinary care. This case is about a phenotypically female patient who presented to the Department of General Medicine with chief complaints of poorly controlled Type 1 Diabetes Mellitus (diagnosed eight years ago) and acute systemic symptoms, which included fever, non-bilious vomiting (2-3 episodes), decreased appetite for three days, and a history of primary amenorrhoea that had never been previously evaluated. Patient’s vitals were normal except for a temperature of 101°F. Physical examination revealed dysmorphic facies, with hypertelorism, rudimentary breast, a left-sided unilateral complete cleft lip and a unilateral cleft palate. Neurological assessment indicated global developmental delay with a clinically estimated IQ of 70, while bedside olfactory testing with standard odours (coffee, peppermint) confirmed normal olfaction. A detailed genital examination revealed a normal vaginal canal. Pelvic ultrasonography identified a rudimentary uterus. Neuroimaging demonstrated partial corpus callosum dysgenesis, in which the rostrum, genu, and body were not seen. The patient responded favourably to supportive care, including intravenous fluids, antiemetics, empiric antibiotics, and a basal-bolus insulin regimen, achieving clinical improvement. Genetic testing was initiated to evaluate this complex presentation comprehensively. The patient’s chromosomes were 46, XX. The patient was then referred to higher centres for hormone replacement therapy. This case underscores the necessity of investigating “silent” neurological and reproductive anomalies in adolescents with uncontrolled metabolic disease and developmental delay. It highlights a multidisciplinary approach involving endocrinology, neurology, and gynaecology to address the multifaceted health needs of these patients.

Persistent Hypoglycaemia and Pigmentary Mosaicism: A Case Report of Beckwith-Wiedemann Syndrome

Kulandaivel Murugaiah, Gauthaman Balu, Hamsavahini Mohan, Thambiprabagarane Kalaimani, Pradhap Krishnamoorthy Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Beckwith–Wiedemann Syndrome (BWS), a rare human genomic imprinting disorder, is characterised by variable phenotypes that include overgrowth, macroglossia, abdominal wall defects, persistent or transient hypoglycaemia, lateralised overgrowth, and predisposition to embryonal tumours. Here, a large-for-gestational-age neonate presented with macrosomia, macroglossia, hemihypertrophy, persistent hypoglycaemia, and structural heart defects. Due to persistent hypoglycaemia, requiring Glucose Infusion Rate (GIR) for more than seven days, the baby was started on oral diazoxide, following which blood glucose levels stabilised. Clinical diagnosis of classic BWS was made, and samples were sent for Methylation-Specific Multiple Ligation-Dependent Probe Amplification (MS-MLPA) analysis, which showed gain of methylation in Imprinting Control (IC) one and loss of methylation in IC2 of the 11p15 locus, suggestive of BWS caused by paternal uniparental disomy. Though the diagnosis is currently based on a clinical scoring system, molecular and genetic testing will confirm the diagnosis and predict the familial recurrence risks and the risk of embryonal tumour. Despite recent advances in knowledge, there is marked heterogeneity in clinical diagnostic criteria and care. This case has been reported to emphasise the wide variations in the clinical presentations and the need for comprehensive protocols for the molecular investigation, care, and management of BWS and also to establish rigorous surveillance protocols for early identification and treatment of various malignancies that these infants are predisposed to.

Asymptomatic Orbital Metastasis from Rectal Adenocarcinoma: A Case Report

Raju Shinde, Pooja Batra, Ashish Jivani, Khushbu Vaidya, Somya Goel Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Orbital metastasis from colorectal carcinoma is an extremely rare presentation, especially in the absence of ocular symptoms and without involvement of more common metastatic sites such as the liver and lungs. We report a 54-year-old male presenting with chronic difficulty in defecation, occasional bleeding per rectum, and significant weight loss. On evaluation, he was found to have signet cell adenocarcinoma of the rectum with metastasis involvement of cervical lymph node and an incidentally detected asymptomatic intraconal orbital lesion with no evidence of hepatic or pulmonary metastases. The patient underwent a diverting loop ileostomy due to subacute intestinal obstruction caused by luminal narrowing caused by the rectum extending into the sigmoid colon. The patient was initiated on palliative chemotherapy but succumbed to the disease within four months of diagnosis. This case underscores the importance of thorough systemic evaluation and highlights the possibility of atypical metastatic sites even without localising symptoms.

Airway Challenge in a Neonate with Pulmonary Atresia and Patent Ductus Arteriosus: Anaesthetic Implications During Planned Stenting

Meenal Rajput, Karuna Taksande, Kattula Leela Krishna, Payodhi Modi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Neonates with duct dependent pulmonary circulation and complex conotruncal anomalies pose significant anaesthetic challenges, particularly during interventions such as Patent Ductus Arteriosus (PDA) stenting where even minor physiological or airway disturbances may precipitate rapid decompensation. We present the case of a seven-day-old male neonate weighing 2.7 kg, diagnosed with complex congenital cardiopulmonary disease in the form of pulmonary atresia, large misaligned Ventricular Septal Defect (VSD), and PDA arising between the Left Common Carotid Artery (LCCA) and the Left Subclavian Artery (LSCA), who was planned for PDA stenting. The infant had a baseline Oxygen Saturation (SpO2) of 86% on room air and a normal systemic examination, with stable haematological and biochemical investigations, except for mildly deranged coagulation parameters and neonatal hyperbilirubinaemia. Echocardiography revealed confluent branch Pulmonary Arteries (PA) supplied exclusively through a 3 mm PDA. After adequate fasting and optimisation, general anaesthesia was induced with fentanyl and ketamine, and muscle relaxation with rocuronium was administered after confirmed mask ventilation, and gentle ventilation was maintained with oxygen and sevoflurane. Despite repeated attempts, tracheal intubation was not possible, suspecting an associated airway anomaly. The procedure was abandoned to prevent hypoxia and haemodynamic instability in this duct-dependent circulation, and neuromuscular blockade was immediately reversed with sugammadex, allowing rapid return of spontaneous ventilation and recovery. The child was then referred for high-resolution Computed Tomography (CT) of the airway and great vessels to define the cause of intubation failure, which could not be done locally due to the unavailability of advanced imaging facilities. This case highlights the importance of anticipating airway anomalies in neonates with conotruncal defects and complex ductal anatomy, the utility of sugammadex as a rescue agent in neonatal airway emergencies, and the necessity of multidisciplinary referral to specialised centers for the safe completion of PDA stenting.

A Case Report of Open Globe Injury with Iris Prolapse in a Geriatric Patient

Mohammed Arif Kaderi, Sachin Vishwanath Daigavane Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X To maintain the visual potential of individuals with open globe injuries, anatomical integrity must be restored. Preventing further tissue damage and preserving corneal shape to reduce the resulting postoperative astigmatism are the major goals of initial repair surgery. We present a case of 70-year-old male patient reporting to the OPD of Department of Ophthalmology, with the chief complaint of pain, diminution of vision in left eye and dropping of the left eyelid since two days, due to trauma from bull’s horn. The patient was diagnosed with aphakia/open globe injury and underwent three surgical procedures for the rectification of complaint. First procedure was globe injury tear repair, second was scleral tuck lens implantation and finally scleral tuck lens explantation with reimplantation. The three surgeries took place till two months after reporting of the chief complaint.

Raoultella ornithinolytica causing Lung Abscess Complicated by Pyopneumothorax in an Immunocompetent Young Girl: A Rare Case Report

Charu Nayyar, Piyush Pareek, Varsha Chalavarya, Dimple Kapoor, Neelam Gulati Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Raoultella ornithinolytica is a Gram-negative, non motile, aerobic, encapsulated bacterium belong-ing to the family Enterobacteriaceae that resembles Klebsiella. This bacterium is present in soil and aquatic environments and seldom causes Healthcare-Associated Infections (HAIs). However, clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases. Present case is of 19-year-old female, presented with fever, productive cough, and right-sided chest pain since one year, which was earlier treated with oral antibiotics but symptoms did not completely resolve. Chest X-ray showed right-sided air-fluid level suggestive of hydro-pneumothorax, for which an Intercostal Chest Tube (ICDT) was inserted in the right pleural cavity which drained about one litre of thick pus initially. Pus sample was sent for microbiological analysis. The results confirmed a Raoultella ornithinolytica (R. ornithinolytica) infection, which was treated with intravenous piperacillin-tazobactam and gentamicin according to the sensitivity pattern. Contrast-Enhanced Computed Tomography (CECT) chest revealed large thick walled abscess, requiring surgi-cal intervention. The patient’s condition improved after oral trimethoprim-sulphamethoxazole therapy and surgery. R. ornithinolytica can cause serious community-acquired infections even in healthy individuals, as demonstrated by this rare case of lung abscess with pyopneumothorax. Accurate diagnosis, antimicrobial susceptibility testing, and timely surgical management are critical for favourable out-comes. Increased awareness and reporting are essential to better understand its clinical impact.

Juvenile Phyllodes Tumour of the Breast in an Adolescent Female: A Rare Case Report

LG Prabanchan, S Karthikeyan, Kambala Prasanna Kumar, Balakrishnan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Phyllodes tumour is a rare fibroepithelial neoplasm of the breast, accounting for less than 1% of all breast tumours. Its occurrence in the paediatric and adolescent age group is extremely uncommon and often poses a diagnostic challenge due to its close resemblance to fibroadenoma. Early diagnosis is crucial, as incomplete excision is associated with a high-risk of recurrence. A 13-year-old premenarchal girl presented with a rapidly enlarging, lump in the left breast of one month duration. Clinical examination revealed a firm, non-mobile, tender mass measuring 7.0×6.0 cm. Ultrasonography suggested a left breast fibroadenoma and differential as phyllodes and Trucut showed features of a benign fibroepithelial lesion. The patient underwent wide local excision with adequate margins. Histopathological examination confirmed as boderline phyllodes tumour. The postoperative period was uneventful, and no recurrence was observed during six months of follow-up. Juvenile phyllodes tumour, though rare, should be considered in adolescents presenting with rapidly enlarging breast masses. Wide local excision with clear margins remains the treatment of choice to prevent recurrence while preserving breast development.

Steroid-refractory Bilateral Optic Neuritis as a Presentation of Paediatric MOG Antibody- associated Disease: A Case Report

Shamli Durgesh Zalke, Siddharam S Janti, Niraj Kumar, T Ashok Vardhan Reddy, Srividya Kalluri Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD) commonly presents in children as bilateral optic neuritis with disc oedema and favourable steroid responsiveness. The MOGAD is an immune-mediated demyelinating disorder of the central nervous system, increasingly recognised as distinct from multiple sclerosis and neuromyelitis optica spectrum disorder. In children, optic neuritis is the most common manifestation and is frequently bilateral, associated with optic disc oedema and good visual recovery following corticosteroid therapy. However, emerging evidence suggests that MOGAD encompasses a broader clinical spectrum, including atypical neurological features and variable treatment response. Hereby, the authors present a paediatric case of a 13-year-old girl with severe bilateral visual loss, early neurological symptoms, papilledema-like fundus appearance, and poor response to intravenous corticosteroids, requiring Intravenous Immunoglobulin (IVIg) for visual recovery. The present case highlights important deviations from typical MOGAD presentations and underscores the need for early recognition of steroid-refractory disease. The deviations from typical MOGAD presentations include poor initial response to steroids, whereas most cases show rapid steroid responsiveness. In addition, the paediatric onset of disease with aggressive course and need for second-line immunotherapy is less commonly reported in classic MOGAD. The paediatric case described herein diverges from the classical phenotype, emphasising diagnostic and therapeutic challenges.

Perioperative Anaesthetic Challenges in a Patient with a Giant Gastrointestinal Stromal Tumour: A Case Report

Vishnu Panwar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Giant GISTs weighing more than 10 kg are exceedingly rare. Such tumours pose formidable anaesthetic challenges owing to marked mass effect, raised intra-abdominal pressure, impaired respiratory mechanics, increased aspiration risk, and the potential for major haemodynamic instability and blood loss. Anaesthesia-focused reports on giant GISTs remain limited. We report the perioperative anaesthetic management of a 67-year-old female with a symptomatic giant intra-abdominal GIST weighing 10.6 kg. The patient presented with progressive abdominal distension and exertional dyspnoea secondary to diaphragmatic splinting. Anticipated challenges included difficult ventilation in the supine position, inferior vena cava compression, aspiration risk, and sudden circulatory changes following tumour decompression. A multidisciplinary plan was formulated. Anaesthesia was conducted using combined general anaesthesia and thoracic epidural analgesia. Modified rapid sequence induction was performed after aspiration prophylaxis. Invasive arterial and central venous monitoring, pressure-controlled ventilation, goal-directed fluid therapy, active temperature management, and preparedness for massive transfusion were employed. Gradual tumour manipulation was ensured to minimise decompression-related complications. Despite significant intraoperative blood loss, haemodynamic stability was maintained. The patient was extubated uneventfully and monitored postoperatively in the Intensive Care Unit (ICU). Recovery was uncomplicated, with marked improvement in respiratory symptoms at follow-up. This case highlights the importance of anticipating physiological derangements, individualising airway and ventilation strategies, and employing meticulous haemodynamic management to achieve favourable outcomes during resection of giant GISTs.

Sarcoidosis Presenting as Abdominal Pain with Generalised Lymphadenopathy: A Diagnostic Challenge

K Hari Vignesh, S Karthikeyan, Prasanna Kumar Kambala, Sasikumar Patabi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Sarcoidosis is a chronic multisystem granulomatous disorder of unknown aetiology, characterised by the formation of non-caseating epithelioid granulomas in affected organs. Although pulmonary and intrathoracic lymph node involvement is observed in approximately 90% of cases, extrapulmonary manifestations are increasingly recognised and may affect virtually any organ system, including the liver, spleen, skin, eyes, and heart. Abdominal involvement is present in 10-30% of patients, frequently remaining subclinical or manifesting with non-specific symptoms. Atypical presentations, such as isolated abdominal pain in the absence of respiratory symptoms, create substantial diagnostic challenges and often result in delayed diagnosis or misdiagnosis. Establishing the diagnosis necessitates a high index of clinical suspicion, thorough systemic evaluation and meticulous exclusion of alternative granulomatous conditions, particularly tuberculosis and malignancy. This is a case of 62-year-old female presenting with abdominal pain for last two months and a long history of hypothyroidism and diabetes mellitus. Further, radiological assessment and laboratory findings concluded a diagnosis of multisystem sarcoidosis, which was later managed by corticosteroids for symptomatic systemic sarcoidosis with extensive lymphadenopathy. This case highlights the importance of considering Sarcoidosis as a differential diagnosis in patients presenting with non-specific symptoms and clinical suspicion of granulomatous disease.

Verrucous Carcinoma of the Scalp: A Rare Case Report

Harini Venkatesan, Magesh Chandran, Kuberan Krishnan, Ajay Gokul, J Thanka Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Verrucous carcinoma is a rare tumour with locally aggressive behaviour. These tumours are composed of well-differentiated squamous cells with minimal metastatic potential. These tumours are commonly reported in the oral cavity and anogenital region. Involvement of the scalp in verrucous carcinoma is uncommon. Verrucous carcinoma might appear benign on histopathological assessment and result in delayed or misdiagnosis, which in turn might result in unfavourable outcomes. This 31-year-old male presented with a long-standing ulcero-proliferative lesion over the posterior scalp. It was associated with cervical lymphadenopathy. Initial biopsy suggested verrucous hyperplasia without any malignancy. The Contrast Enhanced Computed Tomography (CECT) of the brain and neck was carried out to understand the extent of the lesion followed by wedge biopsy done to confirm the diagnosis along with Fine Needle Aspiration Cytology (FNAC) of the lymph node. The patient underwent a wide local excision, and the histopathological analysis confirmed the diagnosis of verrucous squamous cell carcinoma. He was surgically managed by negative margins and flap reconstruction with favourable postoperative outcomes. This case report underscores the uncommon presentation of the verrucous carcinoma over the scalp which is commonly observed over oral and ano-genital regions. This clinical presentation underscores the importance of complete surgical excision and histopathological analysis for diagnosis confirmation, with long-term follow-up to keep a check on recurrence.

An Unusual Presentation of an Abdominal Wall Abscess Masquerading as Malignancy: A Case Report

D Karishmayadav, Ganesh Guru, Alexander Mecheri Antony, T Ragupathy, Ramalakshmi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Intramuscular abscesses involving the anterior abdominal wall are distinctly uncommon. A chronic course is usually characterised by the presence of firm masses with minimal inflammatory signs, closely resembling soft-tissue tumours on clinical examination and imaging. These features can pose a diagnostic challenge and complicate their management. A 45-year-old female presented with localised abdominal pain for one month, accompanied by intermittent low-grade fever. She had been on antidiabetic therapy for the past seven years and had undergone a lower segment caesarean section 23 years earlier. Examination revealed a firm, non-fluctuant mass in the left anterior abdominal wall. Radiological evaluation demonstrated an ill-defined enhancing lesion involving the left rectus abdominis muscle, raising concern for a neoplastic process. Surgical exploration revealed a hard mass adherent to the posterior rectus sheath, grossly suggestive of a desmoid tumour. In the absence of intraoperative frozen section analysis, wide local excision with abdominal wall reconstruction was undertaken. Histopathological assessment of the excised mass confirmed the diagnosis of a non-malignant chronic intramuscular abscess. Chronic intramuscular abscesses of the abdominal wall are rare and may closely mimic soft-tissue malignancies. Histopathological evaluation and surgical exploration may be needed in patients with equivocal imaging findings.

Primary Malignant Rhabdoid Tumour of the Urinary Bladder Presenting in an Adolescent: A Case Report

Kaustubh Vilasrao Kharche, Gwendolyn Fernandes Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Primary Malignant Rhabdoid Tumour (PMRT) of the urinary bladder is an extremely rare, undifferentiated malignant tumour. Most cases of rhabdoid tumours present below three years of age and presentation during adolescence is extremely unusual. The common sites of occurrence for PMRTs are kidneys and the central nervous system. PMRTs are highly aggressive tumours with poor prognosis and a propensity for metastasis. A 15-year-old female presented with haematuria and Lower Urinary Tract Symptoms (LUTS) since one year. She developed severe anaemia for which two units of packed red cells were recently transfused. Contrast Enhanced Computed Tomography (CECT) showed a large, enhancing, exophytic mass arising from the right lateral wall of the urinary bladder, measuring 8.8×6.3×6.1 cm. A Transurethral Resection of Urinary Bladder Tumour (TURBT) was done which showed a high-grade malignant tumour with large, non-cohesive cells with a rhabdoid morphology. Immunohistochemistry (IHC) was positive for EMA, vimentin and pancytokeratin. The tumour was negative for LCA, CD20, CD3, MPO, CD34, myogenin, desmin, GATA3 and uroplakin III. INI1 showed complete loss of nuclear expression in the tumour cells and a diagnosis of PMRT was given. A month later, a radical cystectomy with urethrectomy and lymph node dissection was received. A large fungating mass was seen on the right lateral wall of the urinary bladder. Histopathology showed similar features of malignant rhabdoid tumour similar to the TURBT, with invasion into lamina propria as well as the muscularis propria. No lymph node metastasis was seen. No CNS or renal tumour was seen. A positive vimentin and loss of INI1 (SMARCB1) is diagnostic of rhabdoid tumour. Differential diagnosis of PMRT includes rhabdoid variant of urothelial carcinoma, plasmacytoid variant of urothelial carcinoma, rhabdomyosarcoma, and haematolymphoid malignancies. Loss of INI1 establishes the diagnosis. Although rare in adolescents and rare in location, PMRTs of the urinary bladder should not be overlooked and an early, accurate diagnosis is warranted in view of its aggressive nature.

Giant Malignant Phyllodes Tumour of Breast with Rapid Progression: A Case Report

Jigna Prakashbhai Patel, Mansi Dipak Rupani, Anushree H Doshi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X A Phyllodes Tumour (PT) is a fibroepithelial neoplasm that normally does not include lymph nodes and usually develops in the third or fourth decade of life. Recurrent phyllodes tumour has the potential to develop into a more aggressive form of the original tumour. PT is a challenging diagnosis as it is very uncommon with a prevalence rate of <1% and due to histological and radiological overlapping with other lesion. They are typically seen in women aged 40-50 years. With patient specific treatment, adequate margins are crucial for a favourable outcome, and surgical excision is still the gold standard of care. Regarding the guidelines for systemic chemotherapy, hormone therapy and radiation therapy, there is currently no agreement. This case involves a 25-year-old woman who discovered a huge palpable mass about 13×12×11 cm with axillary lymph-node. The breast skin showed dilated blood vessels and ulceration. She gave history of similar type of mass before eight months for which surgery was done outside in some hospital. She had a negative family history of breast cancer, was nulliparous with normal menstrual cycles and had no record of trauma. She was anaemic with haemoglobin level of 5 g/dL. No distant metastasis was found on clinical and radiological examination. The patient had a left breast mastectomy, along with partial muscular adhesion to the tumour being removed and axillary lymph node dissection. Pathological confirmation of the malignant phyllodes tumour diagnosis was obtained. She passed away three days after surgery because of cardiopulmonary arrest and severe anaemia with sepsis. Our case serves to emphasise the need of promptly identifying and treating this uncommon breast tumour.

Anaesthetic Management of Adult Unilateral Pulmonary Hypoplasia with Post-tuberculosis Sequelae and Cervical Vertebral Anomalies: A Case Report

Shubham Rahane, Neeta Verma, Amreesh Paul Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Pulmonary hypoplasia is a rare congenital anomaly associated with underdeveloped lungs with incomplete lung volume. It can be unilateral or bilateral and often occurs in people with other anomalies. Contributing factors include oligohydramnios, congenital diaphragmatic hernia, and genetic syndromes. In addition, sequelae from Pulmonary Tuberculosis (PTB) may further exacerbate the cases of pulmonary hypoplasia, causing fibrosis and lung damage. The present case report, presents an account of a 20-year-old female with congenital pulmonary hypoplasia with exertional dyspnoea and upper limb paresthesia. On imaging, she had hypoplastic right lung and cervical rib anomalies with vertebral segmentation defects. A multidisciplinary team assessment of her condition was done, and she underwent general anaesthesia for surgical intervention. Preoperative pulmonary function tests were Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) at 60% and 58% of predicted values, and thus, bronchodilator therapy with nebulised albuterol was initiated. Rapid sequence induction was done using propofol, followed by rocuronium. Maintenance was done using sevoflurane, oxygen, and nitrous oxide. She was then transferred to the Surgical Intensive Care Unit (SICU) for close monitoring. A multimodal analgesia strategy with fentanyl and ketorolac was initiated, along with careful fluid management to avoid overload. Tailored pulmonary rehabilitation and optimised nutritional support were given for her recovery. The present case underscores the difficulties of managing pulmonary hypoplasia in adulthood and the benefits one could reap from a multidisciplinary approach.

Joubert Syndrome: A Rare Case Highlighting the Significance of the Molar Tooth Sign

Prerna Jain, Rajesh Kumar Rathore, Parth Nikhil Doshi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Joubert Syndrome (JS) is a rare autosomal recessive neurodevelopmental disorder characterised by malformation of the cerebellar vermis and brainstem, leading to a wide spectrum of neurological manifestations. Early recognition can be challenging in infancy because the presenting features are often subtle and may overlap with other causes of developmental delay. We report a case of a one-year-old male child who presented with delayed developmental milestones, particularly delayed sitting and poor truncal stability. The parents also described intermittent episodes of rapid breathing followed by brief pauses since early infancy. The child was born at term with an uneventful antenatal and perinatal history and was the first child of non-consanguineous parents. On examination, the child had generalised hypotonia and mild global developmental delay. Growth parameters showed a weight of 8.2 kg, length of 73 cm, and an increased head circumference of 51 cm. Routine laboratory investigations, including complete blood count, serum electrolytes, and liver and renal function tests, were within normal limits. Visual and hearing screening were unremarkable, and abdominal ultrasonography did not reveal renal or hepatic abnormalities. Neuroimaging was performed to further evaluate the developmental delay. Non-contrast computed tomography suggested a posterior fossa malformation, and subsequent Magnetic Resonance Imaging (MRI) demonstrated hypoplasia of the cerebellar vermis, thickened and elongated superior cerebellar peduncles, and a deepened interpeduncular fossa forming the characteristic molar tooth sign, along with mild ventriculomegaly. These findings established the diagnosis of JS. This case highlights the critical role of MRI in diagnosing JS, particularly in resource-limited settings where advanced genetic testing may not be readily available. Careful recognition of characteristic neuroimaging findings can enable timely diagnosis, appropriate counselling, and early initiation of supportive management.

Squamous Cell Carcinoma of Tongue in a Patient with Immune Thrombocytopenia: A Case Report

Jagrati Yadav, Saloni Kanabar, Ram Pukar Bharat, Kanchan Devde, Aman Sondule Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Oral Tongue Squamous Cell Carcinoma (OTSCC) is among the most aggressive forms of oral cancer, particularly prevalent in South Asian populations. Immune Thrombocytopenia (ITP), an autoimmune haematological condition that destroys peripheral platelets via antibody, rarely occurs with solid epithelial tumours. The simultaneous occurrence of OTSCC and ITP creates diagnostic and therapeutic challenges. Hereby, the authors present a case report of a 45-year-old Indian male with a six-month-old chronic, non healing ulcer on the left lateral border of the tongue. A 4.7×1.7×3.2 cm ulcer proliferative lesion with nodal spread was seen on Magnetic Resonance Imaging (MRI), while histological investigation revealed a well-differentiated squamous cell carcinoma. Results showed severe thrombocytopenia (38,000/mm³) and significant megakaryocytic activity in the bone marrow, supporting immune-mediated platelet degradation. A combination of high dose corticosteroids, rituximab, and Intravenous Immunoglobulin (IVIg) led to haematological restitution with platelet counts reaching 300,000/mm³, allowing for safe chemoradiotherapy. After follow-up, the patient showed partial tumour shrinkage and good tolerance without haemorrhagic sequelae. This remarkable concurrence highlights the importance of early detection, careful exclusion of mimic reasons, and a precisely coordinated multidisciplinary approach that relies on haematologic stabilisation for curative oncological therapy.

Conus Medullaris Syndrome Following a L1 Burst Fracture: A Rare Case Report

RS Monish Anand, B Vijay Anand, S Devi Prasad, Robert Sebastian Dias, Ashwin Mathew Kadavil Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Thoracolumbar burst fractures are common injuries related to high-energy trauma and often lead to loss of the spinal canal and neurologic loss. Among such injuries, one rare but severe complication is Conus Medullaris Syndrome (CMS), which causes bowel and bladder dysfunction, loss of perianal sensation, and may cause motor deficits. The present case report presents an uncommon presentation of pure CMS in a 34-year-old male following an L1 burst fracture. The trauma occurred while the patient was seated in a bus, during which axial loading led to lower back pain followed by delayed onset neurological symptoms. Neurological examination revealed a deficit in reflexes and perianal sensory loss, with preserved lower-limb motor weakness. Radiological examination revealed an L1 burst fracture with severe spinal canal injury and injury to anterior ligamentous complex. The patient underwent pedicle screw fixation and posterior decompression, after which neurological recovery was gradual. Bowel control returned on Postoperative Day (POD) 8, and bladder control was regained on POD 40. The present case highlights the role of early diagnosis, advanced imaging, and customised surgical treatment in achieving the best results in thoracolumbar fracture patients on CMS. The abnormal pathogenesis and delayed development of symptoms emphasise the significance of focusing on the diagnosis and treatment of spinal trauma cases.

Bilateral Pleural Effusion in Advanced Acute Silicosis Presenting with Acute Hypercapnic Respiratory Failure: A Rare Clinical Presentation

Gyanendra Kumar Nanda, Manoranjan Dash, Swetapadma Pradhan, Jyoti Patnaik, Sonali Das Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Silicosis is a preventable occupational lung disease caused by inhalation of crystalline silica and remains a significant cause of morbidity among young working populations in developing countries. It is characterised by progressive pulmonary fibrosis and irreversible respiratory impairment. While parenchymal lung involvement is well recognised, pleural manifestations are distinctly uncommon, and pleural effusion is rarely reported. The current case describes a 30-year-old male with a history of sandblasting exposure who presented with progressive dyspnoea and acute hypoxaemic respiratory failure. High-resolution computed tomography of the thorax demonstrated reticulonodular opacities with progressive massive fibrosis and bilateral pleural effusion, consistent with advanced silicosis. Diagnostic thoracentesis revealed a haemorrhagic exudative pleural effusion with low adenosine deaminase levels, normal glucose, and absence of malignant cells or granulomas. Microbiological studies were negative, and cardiac, hepatic, renal, and systemic causes of pleural effusion were excluded. Owing to severe respiratory failure, invasive procedures such as thoracoscopy or bronchoscopy could not be performed. The patient was treated with oxygen therapy, broad-spectrum antibiotics, systemic corticosteroids, and bronchodilators. Despite clinical stabilisation, persistent hypoxaemia necessitated Long-Term Oxygen Therapy (LTOT) and consideration for lung transplantation. After exclusion of common aetiologies, the pleural effusion was attributed to silica-induced pleural inflammation. This case highlights an unusual and under-recognised pleural manifestation of silicosis. In patients with relevant occupational exposure and unexplained exudative pleural effusion, silica-related pleural disease should be considered after excluding tuberculosis and malignancy. Early recognition is essential for appropriate management and prognostic assessment.

Probable Nivolumab-induced Myocarditis Presenting as Fulminant Heart Failure in an Elderly Patient with Advanced Hodgkin’s Lymphoma: A Case Report

Harisritha Paladagu, Steve Thomas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Immune checkpoint inhibitors have revolutionised the management and treatment of various malignancies, including advanced-stage Hodgkin’s lymphoma. Here is a case of a 76-year-old female patient who presented with a history of fatigue, generalised weakness and pedal oedema for the past two months. The patient was initially found to have severe pancytopenia. On further evaluation, the patient was diagnosed with Stage IV Hodgkin’s lymphoma. The patient was initiated on chemotherapy with a Nivolumab-containing regimen. After two weeks, the patient developed breathlessness, hypoxia and pulmonary oedema. Cardiac evaluation revealed global left ventricular hypokinesia with an ejection fraction of 35% on echocardiography, and serial biomarkers were found to be elevated. Despite maximum care and management, the patient died of cardiogenic shock. Nivolumab, though rare, has been found to cause myocarditis. This highlights the need for vigilant use of Immune checkpoint inhibitors, considering the risk of serious complications, particularly among elderly patients.

Post-traumatic Dorsal Wrist Epidermal Inclusion Cyst with Retained Foreign Body Mimicking a Ganglion: A Case Report

M Ezhilbharathi, KG Mahesh, R Manimaran, Kanchana Koppolu Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Post-traumatic epidermal inclusion cysts of the wrist are uncommon lesions that can closely mimic a dorsal wrist ganglion clinically. A 63-year-old woman presented with two painless, progressively enlarging swellings over the dorsal aspect of the left wrist for three months, associated with restriction of wrist flexion. She reported a penetrating injury four months earlier due to accidental bangle-spiral intrusion at the wrist, followed by native treatment. There were no constitutional symptoms, discharge, ulceration, or features suggestive of infection. She was a known case of type 2 diabetes mellitus for eight years on regular medication, with no other co-morbidities. Examination revealed two firm, non tender, non pulsatile dorsal wrist swellings with normal overlying skin and mobility along the tendinous plane. A clinical diagnosis of dorsal wrist ganglion with retained foreign body was considered, given the antecedent trauma. Plain radiography demonstrated two radiopaque foreign bodies closely related to the swelling. Owing to delayed presentation and patient preference, exploration was performed under local anaesthesia with intraoperative fluoroscopic (C-arm) guidance. A well-defined cystic lesion at the level of the joint space containing the foreign body and thick pultaceous material was identified. The foreign body was removed and the cyst excised en bloc, with fluoroscopic confirmation of complete removal. Histopathology established the diagnosis of an epidermal inclusion cyst. This case highlights that post-traumatic epidermal inclusion cysts with retained foreign bodies can closely mimic dorsal wrist ganglia, and underscores the importance of eliciting penetrating injury history, using appropriate imaging, and performing complete excision for definitive diagnosis and cure.

Healing against the Odds by Prompt Recognition and Management of Chemotherapy Extravasation Injury: A Case Report

Ayush Gandhi, Firoz Borle, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Chemotherapeutic agent extravasation is an acute complication which may lead to tissue necrosis, ulceration, and functional deficits specifically amongst immunocompromised patients. Managing such cases, especially in the paediatric age group is challenging, given the risk of spreading infection and long-term functional deformity of tissues surrounding the intravenous cannulation site. Emergency prompt management of such injury is of paramount importance to get good functional results. This case report demonstrates how a progressive, necrotic ulcer of an intravenous site in a five-year-old girl with B-cell ALL and sickle cell disease was successfully managed through multidisciplinary collaboration using debridement, negative-pressure wound therapy, and split-thickness skin grafting to heal the wound and restore the hand function in otherwise severely immunocompromised paediatric patient.

Persistent Diarrhoea due to Salmonella Serotype Agona in a Child with Inflammatory Bowel Disease: A Case Report

Chetan Patare, Swapna Mali, Sushma Save, Vishal Sawant, Reena Set Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X This case report describes the presentation, diagnosis and review of Salmonella serotype Agona in a patient with Inflammatory Bowel Disease (IBD). Salmonella serotype Agona is a non typhoidal Salmonella, reported globally as a common cause of food-borne outbreaks; however, in India, it is not commonly reported either in outbreak studies or sporadic case reports. A six-year-old male child, known case of IBD, presented with complaints of loose stools along with blood for the past two months. Parents gave a history of intermittent fever, loose stools, abdominal pain, and vomiting for the last one year. Stool sample received in Microbiology Laboratory for routine microscopy, culture and sensitiv-ity. On microscopy, motile Gram-negative bacilli and pus cells were seen; stool was positive for occult blood and negative for parasites. Salmonella group B was grown on culture, which was later con-firmed by Multi Locus Sequence Typing (MLST) as Salmonella serotype Agona. Patient responded to azithromycin and ceftriaxone. It is difficult to distinguish between chronic infective diarrhoea and IBD, as clinically, both can appear the same. Emphasis must be given to the detection of enteropathogens from the stool sample of IBD patients, which will direct the correct management of the patient. Salmonella Agona has outbreak potential; hence, vigilant efforts are required for its identifica-tion and confirmation.

Clinical Application of Injectable Platelet-rich Fibrin-based Sticky Bone in Immediate and Delayed Dental Implant Placement: A Report of Two Cases

Sheryl Dolly, L Vishalatchi, R Kadhiresan, Abdul Miran, U Arunmozhi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Sticky bone, formed by combining Injectable Platelet-Rich Fibrin (I-PRF) with bone graft material, represents a significant advancement in regenerative implant dentistry. Its cohesive and mouldable nature facilitates superior handling, adaptation to defect morphology, and enhanced stability at the graft site. This case report describes two female patients aged 23 and 41 years who presented with posterior mandibular tooth loss and underwent implant placement using I-PRF- based sticky bone in delayed and immediate protocols, respectively. Although adequate bone volume was present in both cases, sticky bone was used as an adjunctive regenerative measure to enhance peri-implant bone stability, manage minor peri-implant defects, preserve ridge contour, and promote favourable soft-tissue healing. Sticky bone was prepared by thoroughly mixing I-PRF with either Demineralised Bone Matrix (DMBM) or xenograft materials until a cohesive, sticky consistency was achieved. The prepared graft was placed in the defect sites following implant placement, without the use of additional membranes. Clinical and radiographic evaluations were performed periodically over a six-month healing period using qualitative outcome parameters, including peri-implant soft-tissue health, graft integration, peri-implant bone fill, ridge contour preservation, and implant stability. All cases demonstrated uneventful healing with minimal postoperative complications. Radiographic assessments revealed satisfactory bone regeneration and excellent ridge contour maintenance, while clinical observations showed stable soft-tissue coverage with healthy keratinised mucosa and preserved interdental papillae. Functional loading was achieved with optimal implant stability, and none of the cases required secondary augmentation procedures. The combined effect of the biological activity of I-PRF and the structural support of the graft material contributed to accelerated healing and predictable regenerative outcomes. Within the limitations of this case report, sticky bone can be considered a reliable and biologically favourable grafting material for enhancing osseous and soft-tissue regeneration in both immediate and delayed implant placement protocols.

Congenital Defect in Primary Bile Acid Biosynthesis: A Case Study of Clinical Spectrum and Long-term Prognosis

Ishwarya Mahendran, Sumathi Krishnan, A Mary Chandrika, Vidhya Vishwanathan, B Shanthi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Congenital Bile Acid Synthesis defect type 1 (CBAS1), caused by pathogenic variants in HSD3B7 gene, is the most common inborn error of primary bile acid synthesis. Deficiency of 3β-hydroxy-?-C-steroid oxidoreductase results in accumulation of hepatotoxic intermediates and near absence of Cholic Acid (CA) and Chenodeoxycholic Acid (CDCA). Clinically, infants typically present with cholestasis, fat-soluble vitamin deficiency, coagulopathy, and developmental delay. Importantly, CBAS1 is a treatable disorder; early initiation of oral bile acid therapy can restore bile flow and prevent progression to end-stage liver disease. A six-year-old boy with genetically confirmed CBAS1 (homozygous exon 7 HSD3B7 deletion), presented with limb swellings, mucosal bleeding, ecchymoses, and profound pallor. The clinical spectrum included global developmental delay, seizure disorder, and multiple hospitalisations for complications associated with cholestasis. His laboratory evaluation showed hyperbilirubinaemia, hypoalbuminaemia, prolonged coagulation profile, and severe microcytic hypochromic anaemia (haemoglobin ~1.6 g/dL), a finding rarely reported in CBAS1. Child was managed with blood transfusion, vitamin K, fat-soluble vitamin supplementation, antibiotics, and supportive care. CBAS1 is a rare but treatable disorder. Early recognition, newborn screening in high-risk families, and timely CA therapy are essential to improve survival, preserve native liver function, and reduce transplant burden.

Endometriosis at the Vaginal Scar: A Case Report

Dhayalan Arunachalam, Aparna Baliga Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Endometriosis is a chronic disease defined as the ectopic growth of functional endometrial glands and stroma outside the uterine cavity. Vaginal scar endometriosis is a rare form of extra-pelvic endometriosis following obstetric or gynaecological vaginal surgeries. Here, we present a case of a 50-year-old P2L2 (Normal Vaginal Delivery), status postvaginal hysterectomy, with complaints of mass/growth at introitus 4 years with cyclical nodular swelling and spotting per vagina every month. Local examination revealed a 2×3 cm nodule at the fourchette region. Wide local excision of the nodule with a free margin of 1 cm of the surrounding healthy tissue was done. The postoperative course was uneventful, and the patient remained asymptomatic during follow-up visits. It is necessary to create awareness and high suspicion among doctors for early diagnosis and treatment of such a rare form of extra-pelvic endometriosis to provide relief and a good quality of life for patients.

Prenatal Diagnosis of Posterior Urethral Valve Presenting with the Keyhole Sign: A Case Report

Kohila Kalimuthu, GR Nivashini, Preethi John Kennedy, M Vignesh Kumar, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X The most common cause of Lower Urinary Tract Obstruction (LUTO) in the male foetus is the Posterior Urethral Valve (PUV). It can cause severe complications such as renal dysfunction and dysplasia of the lung. Early prenatal diagnosis is vital for assessing prognosis, providing parental counselling, and planning additional care. This is a case report of a 22-year-old primigravida in whom characteristics of foetal bladder outlet obstruction were identified on a routine scan of the second trimester. Ultrasonography showed a significantly distended foetal bladder at gestational week 21, indicative of megacystis. Moreover, the classical keyhole sign was also seen due to dilatation of the proximal urethra. Despite these anomalies, amniotic fluid was within the normal range, suggesting that renal function was not yet severely impaired. The patient decided to have the pregnancy terminated. Foetal autopsy revealed the existence of megacystis and bilateral hydroureter with hydronephrosis, which were in line with the prenatal imaging findings. This case highlights the importance of identifying sonographic signs, in particular the keyhole appearance and related urinary tract dilatation. Early identification of the above findings is crucial in appropriate clinical decision-making.

Adult Ileo-ileal Intussusception by Meckel’s Diverticulum with Heterotopic Pancreatic Tissue: A Case Report

Karthik Krishna Ramakrishnan, M Vignesh Kumar, GR Nivashini, Praveen K Sharma, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Adult intussusception is a clinically significant but uncommon cause of acute abdomen, and it tends to cause non-specific symptoms, which lead to late diagnosis. In adults, an organic lead point is the underlying cause in most cases, unlike in paediatric intussusception, where an idiopathic cause is predominant. Meckel's diverticulum with heterotopic pancreatic tissue is a very uncommon cause of intussusception. A 21-year-old male presenting with acute abdominal pain without associated other gastrointestinal or systemic symptoms was evaluated. Baseline laboratory investigations were within normal limits. Ultrasonography demonstrated a classical target sign suggestive of intussusception. Contrast-Enhanced CT (CECT) demonstrated an antegrade ileo-ileal intussusception containing invaginated mesenteric fat and vessels, along with a heterogeneously enhancing intraluminal polypoid lesion acting as a lead point. Laparoscopy verified a viable intussusception containing a Meckel’s diverticulum with a polypoid mass at its tip. The intussusception was reduced, and resection of the lead point was performed. Histological examination demonstrated pancreatic acini, ducts, and islet cells consistent with Type I heterotopic pancreas. The postoperative phase was uneventful. This case demonstrates the diagnostic value of CECT in evaluating adult intussusception, particularly for detecting uncommon lead points, such as heterotopic pancreatic tissue in Meckel's diverticulum.

Negative Pressure Wound Therapy with Instillation and Dwell Time using Vacuum Assisted Closure Novel Foam Dressing as a Limb Salvaging Strategy in a Complex Diabetic Plantar Ulcer: A Case Report

Bhavyal Sinha, R Manimaran, K Kanchana Batra Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Diabetic foot ulcers remain a major cause of morbidity and lower limb amputation worldwide, particularly in patients with neuropathy, ischaemia, and infection where conventional wound care often fails. Complex plantar ulcers are especially difficult to manage due to persistent pressure loading, deep tissue involvement, and biofilm formation, necessitating advanced wound management strategies. The present case is of a 70-year-old male with poorly controlled type 2 diabetes mellitus who presented with a chronic non healing infected plantar ulcer of six months duration following prior vascular intervention and partial toe amputation. Clinical evaluation revealed a large full-thickness ulcer with exposed musculature and significant slough without systemic sepsis. Following radical surgical debridement, Negative Pressure Wound Therapy with Instillation and Dwell time (NPWTi-d) using a novel foam dressing was initiated with normal saline instillation at -125 mmHg. Rapid wound improvement was observed, with significant reduction in slough after the first cycle, approximately 70% granulation tissue formation after the second cycle, and complete healthy wound bed preparation after the third cycle. Definitive split skin grafting was performed with complete graft uptake and successful limb salvage. This case highlights that early use of negative pressure wound therapy with instillation and dwell time after adequate debridement can accelerate wound bed preparation, reduce infection burden, and improve outcomes in complex diabetic plantar ulcers, supporting its role as an effective limb-salvaging modality in high-risk patients.

Scimitar Syndrome Presenting as Recurrent Pneumonia: A Paediatric Case Report

Ganavi Ramagopal, Sivaani Udhayakumar, Lavanya Basava, Sharumathi Shanmugam, Akbar Ali Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Recurrent pneumonia in children is frequently associated with congenital heart disease, developmental delay, anatomic abnormalities and cystic fibrosis. The challenge for physicians managing recurrent pneumonia lies in identifying underlying cause which if treated early will reduce further consequences. The identification of risk factors and adherence to immunisation schedules are essential to reduce disease burden and the mortality. Presenting a two year six-month-old male child, with history of recurrent admissions for pneumonia, the cause for which was not identified and now diagnosed as Scimitar syndrome, which is found to be as a rare congenital heart disease, described as a variant of Partial anomalous pulmonary venous return, in turn leading to left to right shunt. The condition ideally requires an very efficient interdisciplinary professional team approach which involves a Pediatrician, trained Pediatric cardiologist, experienced cardiothoracic surgeon and a radiologist. Early intervention can significantly reduce morbidity and improve outcomes.

Central Venous Catheterisation of the Internal Jugular Vein in the Sitting Position: A Case Report on Overcoming the Challenges of Severe Kyphosis

S Sreya Sri, Yashvi Patwa, Tejas H Sharma Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Securing central venous access is a fundamental requirement for high-risk surgical interventions, yet severe skeletal deformities such as kyphosis can render conventional supine or Trendelenburg positioning impossible. This case report describes a 67-year-old female with a complex history of peripheral vascular disease and prior femoral popliteal bypass grafting who presented for emergency bilateral below-knee amputation. The patient’s severe thoracic kyphosis prevented supine positioning and was complicated by difficult peripheral intravenous (i.v.) access and fused spinal spaces. Consequently, Internal Jugular Vein (IJV) catheterisation was performed with the patient in a 60° sitting position. Due to the lack of ultrasound guidance and the effects of gravity on venous filling, a significant challenge occurred when the guidewire met resistance at the 10 cm mark, likely due to anatomical kinking or postural decrease in venous cross-sectional area. This was successfully navigated by employing a coordinated Valsalva manoeuvre, which increased intrathoracic pressure to distend the vein and facilitate smooth guidewire advancement. Following successful central access, spinal anaesthesia was administered via a paramedian approach in the sitting position. Despite intraoperative blood loss and the need for vasopressor support, she was discharged without complications. This case highlights the clinical novelty of performing IJV cannulation in an upright position and emphasises the utility of the Valsalva manoeuvre as a rescue technique when severe anatomical distortion and postural constraints hinder standard technique.

3D Printing Assisted Autotransplantation of Impacted Maxillary Canine: A Case Report

Lalita Girish Nanjannawar, Sanjay Satyappa Byakodi, Ankita Manik Mohite, Simran Neeraj Budhraja Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X This case report highlights successful management of a horizontally impacted maxillary canine by surgical autotransplantation technique using three-dimensional (3D) printed replicas of the donor tooth. An 18-year-old male patient reported for orthodontic treatment with a chief complaint of irregularly placed teeth. On clinical and radiographic examination, he was diagnosed as having skeletal Class I jaw relation, Angle’s Class I malocclusion with horizontally impacted 23 causing root resorption of 22, over-retained 63, scissors bite in relation to 15 and 45, reduced overjet and deep bite. Fixed orthodontic treatment was planned for leveling and alignment of teeth followed by autotransplantation of the impacted 23 as it was not favourable for orthodontic alignment. After alignment of all teeth, adequate space was created for accommodating permanent canine using open coil spring. A preoperative Cone-beam Computed Tomography (CBCT) scan was recorded for digital planning of surgical autotransplantation procedure. Based on CBCT data, a surgical template was designed that replicated the exact root dimensions of impacted maxillary canine. This template was subsequently 3D printed in resin and utilised intraoperatively to aid in socket preparation during surgical autotransplantation. Extraction and surgical repositioning was extremely challenging due to the close proximity of canine to the nasal floor, following which grafting was done and splint was placed. Following the initial stabilisation phase, orthodontic traction was applied to align the transplanted tooth in its ideal position. Accurate timing of interventional procedures like endodontic treatment and initiation of orthodontic traction helped in successful alignment of the transplanted canine. A 3D printing assisted autotransplantation procedure in this case successfully replaced the requirement of tooth removal followed by prosthetic restorations.

Guided Endodontic Management of a Calcified Maxillary Central Incisor with Previous Iatrogenic Access using CBCT and Three-dimensional Printing: A Case Report

Lalit Pawar, Aditya Singh Patel, Manoj Chandak, Shweta Sedani, Nishigandha Pawar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Pulp canal obliteration presents a major clinical difficulty because the usual anatomical landmarks are lost, making conventional access preparation unpredictable and prone to iatrogenic errors. Recent advances in static guided endodontics, based on Cone-Beam Computed Tomography (CBCT) and digital planning, allow a more precise and conservative approach to canal localisation. A 24-year-old female patient presented with discolouration of the maxillary right central incisor with an unsuccessful attempt at root canal treatment. Clinical and radiographic findings revealed pulp canal obliteration along with an improperly directed access cavity and dentinal gouging, without any evidence of periapical disease. A CBCT-based guided endodontic workflow was adopted by merging CBCT data with a digital surface scan to design a virtual drill path and fabricate a Three-Dimensionally (3D) printed guide. The guide allowed controlled and accurate access to the residual canal while preserving surrounding dentin, after which conventional root canal treatment was completed. Intracoronal bleaching was then performed to improve the tooth shade. At the 6-month follow-up, the tooth remained asymptomatic and functional, with healthy periodontal and periapical status and a satisfactory aesthetic and functional outcome. Static guided endodontics provided a predictable conservative means of locating and treating a severely calcified canal in a tooth with a previously misdirected access. CBCT-based digital planning combined with three-dimensional printed guides allows precise and minimally invasive canal localisation in teeth affected by pulp canal obliteration. This digital workflow minimises the likelihood of procedural errors and excessive removal of dentin while ensuring safe and effective endodontic and aesthetic treatment.

Acute Necrotising Pancreatitis with Walled-off Necrosis Complicated by Left Renal Vein Thrombosis: A Case Report

Jaypradha Saravanan, Sakthi Ganesh Subramonian, Hitha Almengada Ravi, Karthik Krishna Ramakrishnan, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Acute necrotising pancreatitis represents a severe form of pancreatic inflammation associated with substantial morbidity and mortality, particularly when complicated by walled-off necrosis and vascular thrombosis. We report a case of a middle-aged male with acute-on-chronic pancreatitis who presented with acute epigastric pain. Contrast-Enhanced Computed Tomography (CECT) demonstrated extensive pancreatic necrosis with a large haemorrhagic walled-off necrotic collection, severe ascites, and a focal eccentric thrombus involving the left renal vein, causing partial luminal narrowing with preserved renal enhancement. The Modified CT Severity Index (MCTSI) score was 10/10, indicating severe disease. Clinical deterioration necessitated intensive care management, following which ultrasound-guided percutaneous drainage was performed as part of a step-up approach. The patient improved with conservative management, including anticoagulation, antibiotics, and metabolic optimisation. This case highlights the importance of comprehensive CT evaluation in severe pancreatitis, early recognition of rare vascular complications, and the effectiveness of minimally invasive management strategies.

Ocular Toxoplasmosis in the Real World: A Case Series with Serological Correlation and Treatment Outcomes

Vaigandla Lasya, Deepashri Mutalik, Mounesh Patil, Zarafshan Jamadar, Vivek Wani Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Ocular toxoplasmosis is recognised as the most common cause of posterior uveitis worldwide, which leads to substantial visual impairment when clinicians fail to identify and treat the condition adequately. This case series presents the clinical symptoms, serological profiles and treatment results of eight patients who had ocular toxoplasmosis and received treatment. The study subjects displayed ocular symptoms and they showed multiple eye conditions which included anterior segment involvement, vitritis, focal retinitis and retinochoroiditis. Optical Coherence Tomography (OCT) was performed to detect structural defects which appeared in the retinal tissue. All participants in the study showed positive results for Toxoplasma gondii IgG antibodies. The subjects in the study showed positive results for multiple co-infections which included Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV), rubella and tuberculosis. The treatment plan included a course of oral co-trimoxazole which continued into maintenance therapy while some patients received oral prednisolone together with intravitreal clindamycin treatment. The study participants achieved better visual acuity after the treatment. The subject group showed visual acuity results between 6/6 and 6/36. There were no side-effects which affected the study participants. The study presents different clinical symptoms which ocular toxoplasmosis causes and shows how co-infections can complicate the diagnosis of ocular toxoplasmosis and demonstrates how treatment methods work against ocular toxoplasmosis.

Pseudohyponatraemia and Pseudohypokalaemia Due to Lipaemic Samples: A Series of Seven Cases

Swati Digambar Sawant, Kamalakar Mane, Tamilvendhan Arumugam, Atul Patil Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Pseudohyponatraemia and pseudohypokalaemia are laboratory artifacts caused by analytical interference rather than true electrolyte deficiency. Lipaemia, most commonly due to hypertriglyceridaemia, can result in falsely low sodium and potassium values when measured using indirect Ion-Selective Electrode (ISE) methods, leading to potential misinterpretation and inappropriate clinical management. This case series included seven patients whose lipaemic serum samples showed spuriously low sodium and potassium levels on indirect ISE analysers. Clinical history, biochemical findings, and triglyceride concentrations were reviewed. Electrolyte measurements were repeated using direct ISE methodology and/or after ultracentrifugation to confirm analytical interference. All seven cases demonstrated falsely low sodium and potassium values when analysed using indirect ISE, while repeat testing by direct ISE showed values within the reference range. None of the patients exhibited clinical symptoms consistent with hyponatraemia or hypokalaemia. Increasing severity of lipaemia was associated with greater underestimation of electrolyte concentrations. A notable finding in the present series was the consistent discrepancy between indirect and direct ISE measurements across all patients, highlighting the significant impact of lipaemia on electrolyte estimation. This observation emphasises the importance of correlating laboratory results with clinical findings and confirming abnormal values before initiating treatment. Lipaemia is a significant cause of pseudohyponatraemia and pseudohypokalaemia in routine biochemical analysis. Awareness of this interference is essential to prevent diagnostic errors and unnecessary treatment. Confirmation using direct ISE or ultracentrifugation should be performed before reporting abnormal electrolyte values in lipemic samples.

Exploring Rare Off-label Applications of Gabapentin in Palliative Care: A Series of Five Cases

Chaitanya Patil, Nilesh Dhamne, Yogesh Anap Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Gabapentin, a structural analogue of γ-aminobutyric acid, is conventionally used for neuropathic pain; however, its broader role in symptom modulation within palliative care remains insufficiently characterised. Patients with advanced illness frequently experience distressing, non-pain symptoms - such as persistent hiccups, refractory cough, uraemic pruritus, vasomotor hot flashes, and Restless Legs Syndrome (RLS) - that are often resistant to standard therapies or limited by adverse effects. Although emerging evidence suggests a wider neuromodulatory potential of gabapentin, its off-label use for these indications is rarely reported in real-world palliative care practice. We describe a case series of five patients receiving specialist palliative care in whom gabapentin was employed specifically for refractory non-neuropathic symptoms after failure or intolerance of conventional treatments. Notably, gabapentin led to complete resolution of intractable hiccups in a patient with advanced gastroesophageal carcinoma, significant relief of refractory cough in metastatic lung cancer, marked improvement of chronic uraemic pruritus in End-Stage Renal Disease (ESRD), clinically meaningful reduction of tamoxifen-associated hot flashes in a breast cancer survivor, and alleviation of severe RLS impairing sleep in advanced pancreatic cancer. Symptom control was achieved within days to weeks of initiation, and treatment was well tolerated, with only mild, transient somnolence or dizziness observed. This case series underscores the underrecognised versatility of gabapentin as a single-agent strategy for managing multiple refractory symptoms in palliative care. Beyond pain control, gabapentin may offer a pragmatic approach to symptom palliation, reduction of polypharmacy, and improvement in quality of life in patients with advanced disease.

Machine-cut Upper Limb Vascular Injuries in Agricultural Workers: A Case Series

M Hemachandren, Nembian Raja Rajan, Sirmela Ananthan, Rajeev Thilak Chellasamy Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Agricultural machinery-related vascular injuries represent a severe occupational hazard with potential for permanent disability and limb loss. A case series of seven consecutive patients with upper limb vascular injuries from agricultural machinery was included. All seven patients (100% male, mean age 42±8 years) presented with combined neurovascular injuries. Brachial artery involvement occurred in 85.7% (6/7) of cases with universal median nerve injury. Hay balers were the most common causative machinery (42.9%), followed by rice harvesters (28.6%). Interpositional vein grafting was required in 71.4% (5/7) of cases. Despite delayed presentation and injury severity (71.4% with sensorimotor deficits), 100% limb salvage was achieved with restoration of arterial flow in all patients. Complex agricultural machine-cut injuries involving major upper limb vessels demonstrate excellent limb salvage outcomes when managed at specialised vascular centres, even with delayed presentation up to 24 hours. The high prevalence of preventable human and mechanical factors underscores the urgent need for mandatory safety training and equipment modification in agricultural settings.

Langerhans Cell Histiocytosis in Children: A Case Series

Himabindu Thirumani, Vishal Toka, Srilekha Palle, Vijaya Lakshmi Ambati, Venkatesh Pandi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Langerhans Cell Histiocytosis (LCH) is a rare haematological disorder with prominent proliferation or accumulation of cells of macrophages, dendritic cells and their haematopoietic precursors. Early diagnosis by the common histologic finding of Birbeck granules on electron microscopy is essential for optimal outcomes. A series of eight LCH cases who presented with skin, skeletal, lymph node involvement, hepatosplenomegaly are reported here. The age of the patients ranged from four months to twelve years. Two patients presented with skin involvement, two patients had disseminated lymphadenopathy, four patients had skeletal involvement. Tissue biopsy and immunohistochemistry of either the skin or bone lesions was done for confirmation of the diagnosis. It is challenging to diagnose LCH in children as it mimics common disorders in children. Diagnosis is mainly clinical. Evaluation of a child with persistent dermatitis for LCH is necessary to prevent delay in diagnosis till systemic involvement occurs.

Post-surgical Infections Caused by Non-tuberculous Mycobacteria: A Case Series

Thushara Ushakumari Bhuvanendran, Renu Mathew, Reena Anie Jose, Marshlin Joseph Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Non-Tuberculous Mycobacteria (NTM) are increasingly recognised as causes of chronic post-surgical infec-tions, particularly following procedures involving prosthetic materials. Delayed diagnosis is common due to sterile routine bacterial cultures and negative routine Tuberculosis (TB) molecular tests. Three cas-es of postsurgical NTM infections were reported. The first case involved a 53-year-old diabetic male with chronic synovitis of the knee, necrotising myofasciitis of the thigh and osteomyelitis of the femur caused by Mycobacterium intracellulare. Diagnosis was established by automated Acid Fast Bacilli (AFB) culture BACTEC Mycobacteria Growth Indicator Tube (BACTEC MGIT) and species identification by MAL-DI-TOF. The patient was treated with clarithromycin, rifampicin, and ethambutol for one year with clini-cal improvement. The second case was a mesh infection following laparoscopic Trans-Abdominal Pre-Peritoneal (TAPP) hernia repair in a 46-year-old male. Mycolicibacterium fortuitum was grown in AFB culture. Management included mesh removal and combination therapy with amikacin, doxycycline, and levofloxacin for three months, resulting in complete recovery. The third case involved a 63-year-old diabetic female with mesh infection after laparoscopic hernioplasty. The bacterial isolate was identi-fied as Mycobacteroides abscessus. Surgical mesh removal followed by multidrug therapy with clar-ithromycin, doxycycline and levofloxacin for four months led to successful resolution. NTM should be suspected in persistent postsurgical infections unresponsive to conventional antibiotics, especially when routine bacterial cultures are sterile. AFB culture, NTM species identification, and susceptibil-ity-guided multidrug therapy combined with surgical removal of infected prosthetic material are essen-tial for favorable outcomes. Strengthening infection control practices and appropriate sterilisation techniques for surgical instruments are crucial to prevent healthcare-associated NTM infections.

Expanding the Role of Erector Spinae Plane Block in Robotic Cholecystectomy: A Case Series of Multimodal Analgesia in High-risk Surgical Patients

Prachi Siddharth Kamble, Neeta Verma, Amreesh Paul Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Robotic cholecystectomy offers the benefits of minimal invasive surgery, but presents with anaesthetic complications like altered respiratory mechanics, haemodynamic disturbance, and severe postoperative pain. Adequate perioperative pain management is warranted to minimise the usage of opioids and ensure early recovery. Erector Spinae Plane Block (ESPB) is a regional block with multi-dermatomal somatic and visceral analgesic effects and can be used as an adjuvant to General Anaesthesia (GA). Three patients with various associated diseases undergoing robotic cholecystectomy were administered GA in the form of sevoflurane, fentanyl, vecuronium, and propofol with ultrasound-guided ESPB at corresponding levels of the thorax. This included a 65-year-old male patient with ischaemic heart disease who was administered a unilateral block provided to him with the intention of avoiding sympathetic stimulation, a 56-year-old obese man with a challenging airway was administered bilateral ESPB for bilateral analgesic cover, and a 62-year-old female patient with history of prior upper abdominal surgery and chronic pain was administered unilateral block with addition of dexamethasone for extension of duration of analgesia. ESPB provided adequate perioperative analgesia in all patients as demonstrated by low visual analogue scores, reduced postoperative opioid consumption, and intraoperative haemodynamic stability. No block side-effect was observed. The technique was especially useful for patients with cardiovascular comorbidities, obesity, or chronic pain and resulted in early mobilisation and rehabilitation. The case series illustrates the efficacy, simplicity, and safety of ESPB as an adjuvant to GA for robotic cholecystectomy. Its use in multimodal anaesthetic practice would enhance postoperative comfort, minimise opioid use, and enable quicker recovery, especially for patients at high risk of receiving minimally invasive upper abdominal surgery.

Solid Papillary Carcinoma of the Breast with Dual Neuroendocrine and Mucinous Differentiation: A Series of Seven Cases

Takahiro Mase, Takeshi Hasegawa, Midori Nomura, Hideki Mori Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Solid Papillary Carcinoma (SPC) is a rare neoplasm of the breast. SPC was first reported by Maluf HM and Koerner FC in 1995. Other groups also described histological and cytological features of SPC. Recent World Health Organisation (WHO) classification (4th and 5th Editions) made definition of this disease. However, classification and definition of SPC has been still obscure, particularly on dealing with mucinous carcinoma. Present series prompted to create further properties of SPC using seven cases distinctly having both neuroendocrine and mucinous differentiation. Clinicopathological features of seven SPC cases of Japanese women diagnosed and underwent surgery in our hospital were examined. Clinical features were evaluated for age, site of tumours, initial symptoms, surgical treatment, lymph node metastasis and prognosis. Pathological features were evaluated for type of tumour, nuclear grade, Ki-67 index, loss of myoepithelial cell layer, type of mucin accumulation, Neuroendocrine Differentiation (NED) and hormone receptor status. Incidence of the SPC among all breast cancers (620 cases in last 11 years) was 1.13% and the mean patient age was 73.9±7.8 years. SPCs consisted of four cases (in situ) and three cases (invasive). All cases were characterised by nodules with a solid growth pattern with delicate fibrovascular cores. SPC in situ was diagnosed when the nodules had well-circumscribed contours and distribution pattern consistent with an in situ process. SPC invasive type was identified by the carcinoma with areas featuring strands or clusters of tumour cells. They had loss of myoepithelial cell layer at periphery of the tumour nodule confirmed by p63 staining. NED was confirmed by expression of synaptophysin and chromogranin A. The mucin accumulation was classified into three types (extracellular production, mucinous carcinoma and intracellular production). Intracellular mucin production was ascertained by Alcian blue mucin staining. Clinicopathological features of invasive SPC considerably resembled those of neuroendocrine carcinoma, mucinous carcinoma and Invasive Breast Carcinoma of No Special Type (IBC-NST). It is reasonable to regard SPC as a precursor lesion for neuroendocrine carcinoma, mucinous carcinoma and IBC-NST. No recurrence or distant metastasis was found in all cases suggesting a good prognosis of this disease.

Self-Myofascial Release as an Adjunct to Conventional Treatment for Sacroiliac Dysfunction in Chronic Low Back Pain Patients: A Series of Fifteen Cases

Rama Taneja, Amita Aggarwal, Shiwangi Garg Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Foam Rolling (FR) is a Self-Myofascial Release (SMR) technique in which individuals use a roller or similar device to apply controlled pressure to specific muscle groups. Recent research indicates that using foam rollers and related tools improves pain, Range Of Motion (ROM), recovery, and functional performance. But its role in sacroiliac dysfunction has not been reported. The present case series of 15 cases (10 Females, 5 Males) emphasises the effect of FR, in combination with conventional treatment, on pain and functional outcomes in patients with chronic Low Back Pain (LBP) associated with probable sacroiliac dysfunction. The results were recorded over two weeks, and the ability to maintain improvement at the fourth week was assessed. Fifteen patients (mean age 29.13 years) were assessed using the Numeric Pain Rating Scale (NPRS), Pain Pressure Threshold (PPT), and Oswestry Disability Index (ODI). A foam roller was applied to the hamstring, iliopsoas, and quadratus lumborum for anterior (n=7), posterior (n=5), and upslip (n=3) dysfunction, respectively, along with conventional therapy. The findings demonstrate a mean reduction of 3.53 and 12.3 points in pain and functional status, respectively, measured using NPRS and ODI after two weeks of intervention. Also, the mean improvement in PPT was 1.78 from baseline to the 2^nd week of treatment. At the 4^th week, two cases, Case 7 and 8, showed an increase in pain with disability at follow-up.

Ochrobactrum anthropi as an Emerging Nosocomial Pathogen: A Case Series from the Neurosurgery ICU of a Tertiary Care Centre in Northern Kerala, India

C Fathima Shereen, Smrithi Surendranath, Amritha Sabitha Kurup, Jensina E Salahudheen, Beena Philomina Jose Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Ochrobactrum anthropi is a non lactose fermenting, Gram-negative bacillus increasingly recognised as a cause of healthcare-associated infections, particularly in critically-ill or immunocompromised pa-tients. While traditionally considered of low virulence, recent reports revealed its potential for caus-ing outbreaks, especially in intensive care settings. This case series reports an outbreak of O. an-thropi bacteraemia in a neurosurgical Intensive Care Unit (ICU), emphasising its clinical impact, source identification, and infection control implications. In November 2022, four patients admitted to the neurosurgical ICU of a tertiary care centre in Northern Kerala were diagnosed with O. anthropi bacteraemia. Two were elderly individuals with co-morbidities (diabetes, chronic kidney disease), while the other two were young, immunocompetent patients. Presenting symptoms included fever, altered sensorium, seizures, and pneumonia. Blood cultures in all cases grew O. anthropi, confirmed via biochemical tests and VITEK-2 identification. All O. anthropi isolates showed resistance to ceftazidime but susceptibility to meropenem, piperacillin-tazobactam, ciprofloxacin, gentamicin, and amikacin. Environmental surveillance identified O. anthropi on ICU bed surfaces previously occu-pied by infected patients, suggesting dry surface contamination and possible contact transmission. No growth was observed from i.v. fluids, water sources, or other wet surfaces. After implementing enhanced infection control measures and terminal cleaning, no further cases were reported. This case series high-lights O. anthropi as an emerging nosocomial pathogen capable of causing outbreaks even among im-munocompetent individuals. Environmental contamination, particularly of dry surfaces, may act as a res-ervoir. Early recognition, appropriate antimicrobial therapy, and stringent infection control practices are critical to prevent future outbreaks in ICU settings.

Clinical Spectrum and Therapeutic Approaches in Lymphangioma Circumscriptum: A Case Series of Nine Patients

RG Sharada, E Ragadharshini, Sukesh Gautam Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Lymphangioma Circumscriptum (LC) is a rare hamartomatous condition affecting the lymphatic system. It is also referred to as microcystic lymphatic malformation. Treating this condition is both intriguing and challenging. The present case series is about nine patients (7 males, 2 females) with LC presenting at different locations, highlighting their clinical, dermoscopic, histopathological and different management strategies. The patients ranged in age from seven to 58 years and included both congenital and acquired forms of LC. Clinically, the lesions were slow growing, asymptomatic, and grouped, involves sites such as the beard area, vulva, neck, abdomen, gluteal region, and distal extremities. On Dermoscopy examination, pale yellow or translucent lacunae separated by septa, with occasional hypopyon like features due to blood sedimentation were noted. Histopathological examination revealed characteristic thin walled lymphatic channels in superficial dermis. To rule out deeper involvement Imaging was utilised selectively. Various treatment modalities were employed, including Carbon dioxide (CO₂) laser, Radiofrequency Ablation (RFA), cryotherapy Pulsed Dye Laser (PDL), intralesional bleomycin, and combination therapies, tailored according to lesion morphology and depth. Most patients achieved satisfactory clearance with minimal adverse effects, and no recurrence were noted during follow-up. LC, though benign, poses aesthetic, psychological, and therapeutic concerns, especially when occurring at atypical sites. Even though surgical excision of deep lymphatic system is the mainstay treatment according to Whimster’s hypothesis, this may not be feasible in patients with atypical sites and extensive involvement. In such cases minimally invasive modalities provide effective alternatives to surgery.

A Clinical Technique for Separating Implant-supported Restoration from Titanium Abutment

Paranjay Prajapati, Rajesh Sethuraman, Sameer Chauhan, Pritha Negi, Jay Gohil Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X A patient reported to the Department of Prosthodontics with a fractured dental prosthesis. The implant prosthesis was Porcelainfused-to-metal (PFM) type which was fractured. It was a cementretained implant prosthesis. The abutment along with the prosthesis is unscrewed and separated from the implant fixture (Table/Fig 1).

Clinical Image of Ulcerated Defect on Left Cheek with Orocutaneous Fistula in a Patient with Recurrent Oral Cancer

Ram Pukar Bharat, Vijay Jeyachandran, Yogesh Dagar, Amol Shankar Dongre Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X A 37-year-old male, a chronic gutkha chewer, presented with a non-healing ulcer measuring 3×3 cm in the left lower gingivobuccal sulcus [Table/Fig-1a,b]. He reported sticky, ropy saliva and increased salivation for one month, along with limited mouth opening of 15 mm and difficulty in chewing for four months. The lesion was initially painless but later became associated with severe pain on the left side of the face. There was no history of dysphagia or oral burning. Intraoral examination revealed a 3×3 cm ulceroproliferative growth arising from the left lower gingivobuccal sulcus, extending from teeth 33 to 37 (Table/Fig 2). The tongue, palate, uvula and floor of mouth were uninvolved. Incisional biopsy confirmed moderately differentiated squamous cell carcinoma. Contrast-Enhanced Computed Tomography (CECT) of the face, neck, and thorax demonstrated a 3×3 cm mass arising from the left buccal mucosa with invasion of the masticator space and a 1×2 cm ipsilateral level IB lymph node, without pulmonary metastasis (Table/Fig 3). The patient underwent wide local excision, segmental mandibulectomy, maxillary alveolectomy and left-sided type II modified radical neck dissection. Reconstruction of the composite intraoral and cheek defect was performed using a Pectoralis Major Myocutaneous (PMMC) flap. The PMMC flap was chosen because it provides a reliable, well-vascularised pedicle flap with adequate soft-tissue bulk for intraoral and cheek coverage, while avoiding the need for microvascular anastomosis and reducing operative time an important consideration in our resource-limited setting.

Linear Verrucous Epidermal Nevus along Linea Nigra: A Rare Presentation

K Desingh, M Aishwarya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X A 30-year-old primigravida, at seven months of gestation, presented to the Department of Dermatology, Venereology, and Leprosy with complaints of black, raised, warty skin lesions over her abdomen since birth. These lesions had grown over the past three months. She was asymptomatic with no relevant past medical or family history.

Striking Whiplash Lesions: A Rare and Classic Case of Severe Manifestation of Paederus Dermatitis

Omprakash Patel, Sonali Chalakh Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X A 26-year-old male patient reported to the outpatient department of Ayurveda in a tertiary care institute of Western Maharashtra with a prominent linear skin lesion on the ventral right mid-forearm with redness, burning, itching, pain, and blistering. The lesion appeared three days ago, 12-24 hours after accidental contact with an insect. On further questioning, the patient recalled that an insect had been crushed or brushed against the ventral aspect of his right forearm around three days prior. He did not report fever, malaise, or other systemic symptoms. Initially, erythematous and itchy, later developed blisters, pain, and greyish necrotic appearance. No chronic illnesses, medications, or allergies were reported. No relevant family history was noted. The patient worked outdoors and resided in a rural area, with a history of increased insect exposure during the monsoon season. The patient did not give any history of smoking, alcohol consumption, or substance use. On general examination, the patient was afebrile with stable vital parameters. No lymphadenopathy was present, and systemic examination was within normal limits. On local examination, a well-defined linear erythematous lesion with vesicles and greyish necrotic areas was observed on the ventral surface of the right mid-forearm. The lesion was tender, with mild surrounding inflammation. No laboratory investigations were performed as the diagnosis was clinically evident based on the characteristic lesion morphology and absence of systemic involvement. Based on the typical linear “whiplash” lesion, history of insect exposure, and clinical findings, a diagnosis of Paederus dermatitis was established (Table/Fig 1).

Pulmonary Mucormycosis with Chest Wall Involvement: An Uncommon Presentation

SR Gopika, Nisha Shaji, Yuvashree Suresh, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X A 47-year-old female, presented with chief complaints of left-sided chest pain for the last 15 days, with pain radiating to the left shoulder, accompanied by shoulder numbness. The patient also reported cough with brown-coloured expectoration, shortness of breath, and unilateral sweating of the left side of the face for one week. There was a history of fever without chills or evening rise of temperature for two days and an unintentional weight loss of 15 kg in the past six months. There was no loss of appetite and no prior history of tuberculosis, chronic respiratory disease or anti-tubercular treatment. The patient gave a history of biomass exposure for five years and is a known case of uncontrolled type 2 diabetes mellitus. On general examination, patient was conscious and oriented. The pulse rate was 110 per minute, blood pressure measured 120/80 mmHg, respiratory rate was 20 per minute, and oxygen saturation was 98% on room air. The patient was afebrile at presentation. Systemic examination revealed bilateral air entry with normal vesicular breath sounds. Cardiovascular, abdominal and neurological examinations were unremarkable. On laboratory evaluation, the patient’s random blood glucose was 558 mg/dL, Glycosylated Haemoglobin (HbA1c) was 14.4%, and the total white blood cell count was 11,500/ cu.mm, International Normalised Ratio (INR) was 0.94, and Erythrocyte Sedimentation Rate (ESR) was 47 mm/hour. The patient had undergone an MRI of the cervical spine at an outside hospital for shoulder pain and numbness. Incidentally, a large mass measuring 4.7×4.8 cm was noted in the left upper lobe close to the lateral chest wall. Further evaluation with contrast-enhanced CT chest at our institute was done. CT topogram showed a mass in the left upper zone (Table/Fig 1). Contrast enhanced CT showed a lesion measuring 6.2×4.5×4.3 cm in the apicoposterior segment of the left upper lobe with a central area of ground-glass opacity and surrounding consolidation, which is called the reverse halo sign [Table/Fig-2a,b]. The lesion showed a broad-based attachment to the pleura with extension across the left first and second intercostal spaces into the chest wall. No definite rib erosion was noted [Table/Fig-2c,d]. Possibility of an atypical fungal infection was considered, although neoplastic aetiology was a differential diagnosis in view of chest wall involvement. A CT-guided biopsy (Table/Fig 3) from the lesion was performed, which revealed skeletal muscle necrosis with granulation tissue and fungal organisms morphologically compatible with mucormycosis. Bacterial and mycobacterial cultures were negative. With these findings, a diagnosis of pulmonary mucormycosis of the left upper lobe with chest wall extension was established in the background of uncontrolled diabetes mellitus. The patient was admitted under the pulmonology department and started on supportive management with intravenous antibiotics, analgesics, and diabetic control. Antifungal therapy with liposomal amphotericin B was strongly advised; however, the patient’s attendants declined initiation of therapy due to logistic reasons. Surgical management with left upper lobectomy was also suggested by cardiothoracic surgical consultation, but was refused by the patient’s family. The patient was therefore discharged at the patient’s request for further management at a government hospital after detailed counselling regarding the risks and potential complications.

Probable Aripiprazole Induced Erythema Multiforme in an Elderly Patient: A Case Report

Pragya Bharadwaj, Monisha Seralathan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Dear Editor, Erythema Multiforme (EM) is an immune mediated dermatological condition involving both mucosal and cutaneous sites. The most commonly involved mucous membranes are lips, tongue and buccal mucosa (1). The authors report an unusual case of mucosal EM induced by aripiprazole in an elderly patient with very late-onset psychosis, which warrants clinical attention given the increasing use of this agent in older adults.

Spectrum of Clinical Presentation, Risk Factors and Severity of Myocardial Infarction in Female Patients: A Hospital-based Cross-sectional Study

Mahendra Pauskar, Kishan Balgi, Prashanth Nadekar, Mahesh Managooli Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Myocardial Infarction (MI) in women is often underdiagnosed and undertreated owing to atypical presentations and distinct risk factor profiles. Evaluating the clinical spectrum, risk factors and angiographic severity of MI in female patients is crucial for improving diagnostic ac-curacy and optimising management. Aim: To evaluate the clinical presentation, risk factors and severity of MI in female patients. Materials and Methods: This was a cross-sectional observational study conducted in the De-partment of General Medicine at Goa Medical College and Hospital, Bambolim, Goa, India, over a period of 24 months January 2021 to December 2022 on 60 female patients with clinical features and Electrocardio-gram (ECG) changes of Acute Myocardial Infarction (AMI), elevated cardiac enzymes (fulfilling definitive diagnostic criteria for AMI) and willing to give consent for coronary angiography were enrolled for the study. Data was collected on patient’s demographics, clinical features, risk factors, laboratory param-eters {Se.Trop I, lipid profile, Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS), Glycated haemoglobin (HbA1c)}, electrocardiography, 2D Echocardiography, coronary angiography and analysed using Statistical Package for Social Sciences (SPSS) software. Descriptive statistics such as mean, standard deviation, frequencies and percentages were calculated for variables. Results: Among the study group of 60, 27 patients (45%) in the age group of 51 to 60 years were the most commonly affected with a mean age of occurrence of MI being 63.72 years. Among the study par-ticipants, 44 patients (73.3%) had typical symptoms of AMI at the time of presentation to the hospital constituting the largest subgroup. A 36 patients (60%) had Hypertension, which was the most common risk factor followed by DM seen in 30 patients (50%) and Dyslipidaemia seen in 27 patients (45%). Among the patients, non ST Elevation Myocardial infarction (NSTEMI) and Anterior Wall MI (AWMI) were the most com-mon ECG presentation with 16 (26.7%) patients in each group followed by anterolateral wall MI and Infe-rior wall MI (IWMI) with 12 (20%) patients in each group. Angiographic evaluation revealed that Single-Vessel Disease (SVD) was the most common finding, observed in 32 patients (53.3%). Conclusion: The MI in women is characterised by a distinct clinical and angiographic profile, with a predominance of traditional cardiovascular risk factors and single-vessel coronary artery dis-ease. These observations emphasises the need for heightened clinical vigilance and gender-sensitive di-agnostic strategies, particularly in postmenopausal women with multiple risk factors. Regular and timely cardiovascular evaluation in this high-risk population may facilitate early detection of CAD and improve clinical outcomes.

Radiographic Evaluation of Gender-related Differences in the Morphology and Dimensions of the Nasopalatine Canal using Cone Beam Computed Tomography: A Retrospective Cross-sectional Study

Yashika Jain, Renita Lorina Castelino, G Subhas Babu, Vidya Ajila, K Smrithy Sivadas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The Nasopalatine Canal (NPC) is a vital structure in the anterior maxilla that contains the neurovascular bundle for the blood and nerve supply. It shows considerable anatomical vari-ation, which influences the surgical and implant procedures in the anterior maxilla. Thus, with the help of Cone Beam Computed Tomography (CBCT), these variations can be evaluated more precisely to enhance treatment planning and for positive clinical outcomes. Aim: To evaluate the morphology and dimensions of NPC using CBCT and to determine the variabil-ity in relation to gender. Materials and Methods: The present retrospective cross-sectional study was conducted in the Department of Oral Medicine and Radiology AB Shetty Memorial Institute of Dental Sciences for a period of one year from January 2024 to December 2024. A total of 200 CBCT scans in which complete NPC was vis-ible were included in the study. The reconstructed sagittal sections were assessed for the shape, length, width at nasal and oral end, angulation and volume of NPC. Out of 200 scans, 100 were of females and 100 males with the age range of 20-70 years. The statistical analysis between the groups was done using unpaired t-test and One-way Analysis of Variance (ANOVA) test. The categorical data was compared using Chi-square test. The p-value less than 0.05 was considered significant. Results: The most common shape was found to be cylindrical with no variation in relation to gender. The mean length of the canal was 13.56±2.3 mm in males and 11.6±2 mm in females, showing a statistically significant difference (p=0.001). Also, with advancement in age the length of the canal increased significantly (p=0.032). The width of the canal at oral end was greater with increase in age (p=0.001) and more in males than females (p=0.001) which was statistically significant. There was no significant difference in angulation and volume of canal in relation to age and gender. Conclusion: The present study highlights the variation in the morphology and dimensions of the NPC. The cylindrical shape was the most common. With increasing age, the length and width of the canal tends to increase, being greater in males than in females. The canal volume is greater in males than in females and increases with age. The angulation of the canal, however, demonstrates no significant varia-tion with either age or gender.

Effects of Mechanical Vibrations on Stress Distribution and Displacement in Bone and Teeth Surrounding Infrazygomatic Screws: An In-vitro Finite Element Analysis Study

Rishika Singla, Aravind Kumar Subramanian, Sruthi Harikrishnan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Infrazygomatic Crest (IZC) Mini-Implants (MI) is widely used in orthodontics for stable anchorage. However, the impact of mechanical vibrations on bone stress distribution and implant stability remains poorly understood. The rationale for this study stems from the need to understand how combined mechanical stimuli affect the local biological environment, which is critical for ensuring the safe and effective use of IZC screws. The study seeks to offer insights into the potential implications of vibration-assisted accelerated orthodontics on skeletal anchorage stability. Finite Element Analysis (FEA) provides a valuable non-invasive tool to simulate and analyse these complex interactions. Aim: To evaluate and compare the stress distribution and displacement in bone and adjacent teeth surrounding IZC screws under static orthodontic loading and under mechanical vibration. Materials and Methods: An in-vitro FEA was conducted at a Saveetha Dental College, Chennai, from January to March 2024. A digital 3D model of the maxilla with teeth and an infrazygomatic screw was developed using SolidWorks 2021, meshed in HyperMesh 14, and analysed in Abaqus 6.14. Stress and displacement values were compared under static load (250 g) and vibratory conditions (30-120 Hz). No inferential statistical tests were applied, as this was a simulation-based study. Results: Under static loading (250 g), minimal stress and displacement were observed. Modal analysis revealed natural frequencies beginning at 1048 Hz, ruling out resonance. Frequency response analysis showed a reduction in bone stress (0.43 MPa) and minor increases in tooth displacement compared to static conditions, suggesting safe vibratory effects. Conclusion: Mechanical vibrations within safe frequency ranges do not induce resonance and may enhance tooth displacement without compromising structural stability. These findings provide insights for optimising IZC screw applications in orthodontics.

Electron Microscopy in Phacolytic Glaucoma: A Cross-sectional Study

BT Reetha, R Arathi Simha, Anna Pulimood, Thomas Kuriakose Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Cataracts when allowed to progress become hypermature. In patients with hyperma-ture cataracts the liquified lens cortex tends to leak through the micropores of lens capsule. It is this leaked material which causes blockage of trabecular meshwork and thus an acute rise in Intraocular Pressure (IOP) leading to phacolytic glaucoma. Though the incidence of phacolytic glaucoma has reduced, it is still common in developing countries, in patients with limited access to healthcare. Aim: To analyse the aqueous humour cells and study the characteristics of the macrophages in phacolytic glaucoma using electron microscopy. Materials and Methods: This was a cross- sectional observational study conducted in the De-partment of Ophthalmology at Schell eye hospital (Christian Medical College) Vellore, Tamil Nadu, India from December 2012 to November 2013. Patients presenting with gradual progressive loss of vision, acute onset of eye pain, redness, vision less than or equal to 3/60, IOP of ≥ 21 mm Hg, hypermature cataract, macroscopically intact anterior capsule and flare of 2+ were included in the study. Patients were admit-ted and paracentesis was done. A 0.1-0.2 mL of aqueous was aspirated using a 26 gauge customised cannula and collected in Eppendorf tubes. This was then sent for Electron Microscopic (EM) analysis where the aqueous humour was studied for the cellular content and its characteristics. Categorical variables were expressed as n (%). The statistical software Statistical Package for the Social Sciences (SPSS) version 16.0 was used for analysis wherever applicable. Results: A total of 10 phacolytic glaucoma patients were recruited as a part of a larger study in whom the aqueous was sent for histopathological analysis. Amongst them four patients had enough sam-ple and these were studied by electron microscopy. From the sample obtained, blocks were prepared by the pathologist. The pathologist picked 10 consecutive macrophages from each block to study. Numerous macro-phages were identified in the first two cases. In addition to this the second case demonstrated four neutrophils. Majority of the macrophages showed distension of the cytoplasm with phagosomes containing lens proteins. Many membrane bound granules containing uniformly electron dense material, ranging in size from 100 nm to >1000 nm were also seen in the macrophages. These were consistent with melanin pig-ment granules. Only one monocyte with no engulfed material was seen. The 3rd sample showed no cells which were confirmed on light microscopy as well and the 4th sample showed cell lysis. Conclusion: Macrophage was the predominant cell in patients with phacolytic glaucoma though occasional neutrophils and one monocyte were found. All the macrophages were overwhelmed with lens pro-tein and melanin pigments.

Reliability and Measurement Precision of a Low-cost Head-mounted Laser Device for Cervical Joint Position Error Assessment: A Reproducibility Study

Prashant Kumar, Anshika Gupta, Sanskriti Srivastava, Sharon Charles, Shikha Mishra, Deepika Shukla, Himanshu Jaiswal, Kanika Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Sensorimotor control and postural stability heavily rely on cervical propriocep-tion. A head-mounted laser pointer is often used in a clinical practice as it is a simple and inexpen-sive head-to-neutral Joint Position Error (JPE) test. Its test-retest reliability and measurement preci-sion need to be established. Aim: To find out the test-retest reliability and measurement error of an indigenously developed low-cost head-mounted laser pointer instrument to measure cervical JPE in healthy adults. Materials and Methods: This was an observational repeated-measures reliability test conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilita-tion, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from November 2025 to December 2025. This study employed a test-retest reliability design with repeated measures in-volving 51 healthy adults aged 18-45 years of age. Cervical JPE was measured in flexion, right rotation, left rotation and right lateral flexion and left lateral flexion using a laser device mounted on the head placed 90 cm away against a board. The protocol was repeated again after 72 hours under the same conditions. The Intraclass Correlation Coefficient (ICC 2,1) was used to assess test-retest reliability. The measure of absolute reliability was determined by computing the Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) at the 95% confidence level (MDC95). Intersession comparison was analysed through Bland Altman analysis. Results: High reliability of all movements with ICC values of between 0.98 and 0.99 were exhib-ited. The range of SEM was between 0.03° and 0.04°, and the range of MDC was between 0.08° and 0.12°. Bland Altman analysis revealed that there were small mean bias and close Limits of Agreement (LoA). Conclusion: The test-retest reliability of the device showed excellent performance and low measurement error among the healthy adults. The findings support its potential utility as a low-cost clinical assessment tool on cervical proprioception.

Mothers’ Knowledge and Attitudes Regarding Newborn Heel-prick Screening Tests: A Cross-sectional Study

Rachita Lakhumna, Prasad Dnyandeo Pore, Saurabh Kumar Wadhwa Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Newborn Screening (NBS) is a crucial preventive health strategy for early detec-tion of metabolic, endocrine and genetic disorders. In India, despite its potential to reduce infant morbidity and mortality, implementation remains limited. Awareness and acceptance among mothers are keys to the success of such programs. Aim: To assess the knowledge and attitude of postpartum mothers regarding the Heel-Prick Screen-ing Test (HPST) and to determine their association with sociodemographic factors. Materials and Methods: A cross-sectional study was conducted among 122 postpartum mothers at the Department of Community Medicine, Bharati Vidyapeeth (DU) Medical College, Pune, Maharashtra, India, between July 2023 to September 2023. Mothers who had delivered a live newborn at Bharati Hospital were included in the study. Data were collected using a structured, pretested questionnaire consisting of 13 knowledge items and nine attitude statements. The Chi-square test was applied to examine any association between mother’s knowledge and various sociodemographic variables. The p<0.05 was considered signifi-cant. Results: The mean age of participants was 27.3±3.4 years. The majority were aged 25-30 years 75 (61.47%), Hindu 111 (90.98%), educated up to high school or above 109 (89.34%) and homemakers 120 (98.36%). The mean knowledge score was 2.01±2.56 (18; 15.44% correct responses). Only 61 (50%) mothers knew that HPST is a simple procedure, 3 (2.46%) knew the correct timing (3-7 days after birth). The mean attitude score was 17.86±0.90 (66.15%), reflecting a favourable attitude. A total of 38 (31.15%) agreed that HPST prevents disease and 36 (29.50%) believed it benefits newborns. Maternal age was significantly associated with attitude (p=0.010). Conclusion: Although 80 (66.15%) mothers exhibited favourable attitudes toward HPST, their awareness remained inadequate. The results highlight the need for structured antenatal and postnatal education, training of healthcare providers and community-level awareness programs to improve knowledge and ensure early participation in NBS initiatives in India.

A Cross-sectional Study on Patient Participation in Stroke Rehabilitation: Exploring the Influence of Client-centred Care on Patient Satisfaction and Clinic-based Adherence

Jignasha Navinbhai Gohil, Mansi Soni Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Stroke rehabilitation, based on individual limitations and needs, necessitates significant knowledge. To obtain all of this, individuals’ continued involvement in therapeutic inter-ventions is vital. Yet previous studies show inconsistent levels of patient involvement and limited un-derstanding of its influence on satisfaction and adherence. Aim: To determine patient participation in rehabilitation and its association with satisfaction and clinic adherence in stroke rehabilitation in individuals with stroke. Materials and Methods: A cross-sectional study was conducted, with 82 stroke patients, under the affiliation of the Ashok & Rita Patel Institute of Physiotherapy, Anand, Gujarat, India, getting physiotherapy services from January 2022 to June 2022. To evaluate patient participation in rehabilita-tion, the Client-Centred Rehabilitation Questionnaire (CCRQ) has been used. Patient satisfaction and clinic-based adherence were assessed using the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) and the Index of Adherence, respectively. The data were analysed using descriptive statistics. Demographic differences were tested using the Mann-Whitney U and Kruskal-Wallis tests, while Spearman’s correlation used to check association between patient involvement, satisfac-tion, and adherence. The statistical significance level was considered to be p-value <0.05. Results: The study recruited 82 participants, out of whom 65 (79.3%) were males and 17 (20.7%) were females. The subjects varied in age from 27 to 75-year-old (54.52±11.98). The CCRQ comprised seven domains, among which physical comfort demonstrated the highest mean score (1.39±0.36), while client-centred education was the lowest rated (2.63±0.96). Spearman’s correlation analysis showed that all CCRQ domains were significantly associated with patient satisfaction, whereas only emotional support (p=0.015) and client-centred education (p=0.014) demonstrated low to moderate but statistically signifi-cant correlation with adherence, highlighting their key role in sustaining patient involvement. Conclusion: The findings revealed that stroke patients’ responses to participation in their rehabilitation have substantial variation. All CCRQ domains were strongly linked to patient satisfac-tion, but only emotional support and client-centred education were associated with clinic adherence. Future studies can be carried out to check patient participation in different healthcare settings with the same objective involving different populations.

Clinical Profile, Laboratory Findings and Radiological Evaluation of Sheehan’s Syndrome: A Retrospective Observational Study from a Tertiary Centre from North-Western India

Hardeva Ram Nehara, Sanjay Saran, Narendra Kumar Dara, Ketan Bhatnagar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Sheehan’s Syndrome (SS) is postpartum hypopituitarism which occurs due to is-chaemic necrosis of pituitary because of shock or severe hypotension secondary to massive Postpartum Haemorrhage (PPH). Few studies on SS originate from Northwest India. Aim: To characterise the clinical profile, laboratory findings, and radiological features of SS. Materials and Methods: The present retrospective observational study reviewed 46 SS patients admitted over 30 months (July 2022-December 2024) at Sardar Patel Medical College, Bikaner, Rajasthan in Northwest India. Women diagnosed with SS based on PPH history with amenorrhoea and/or lactation failure, hypopituitarism, and/or empty sella syndrome were enrolled, excluding those with pre-existing endocrine disorders, alternative hypopituitarism aetiologies, or incomplete records. Demographic and anthropometric parameters, clinical presentation, history of PPH, duration of amenorrhoea, failure of lactation, laboratory and endocrine profile, and imaging characteristics were recorded and analysed. Continuous variables were expressed as mean±Standard Deviation (SD); categorical variables as counts and percent-ages. Results: The mean age at diagnosis was 38.2±12.5 years, and the mean diagnostic delay was 12.1±5.5 years. Secondary amenorrhoea and agalactia were the most common clinical findings. History of home delivery, PPH, and blood transfusion were present in 30 (65.2%), 40 (87%), and 22 (47.8%) patients, respectively. Out of 46 patients, 14 (30.4%), 14 (30.4%), and 15 (32.6%) patients presented with altered sensorium, shock, and hypoglycaemia, respectively. Loss of Axillary or Pubic hair, asthenia, and psycho-sis were present in 41 (89.1%), 41 (89.1%), and 5 (10.9%) patients, respectively. Anaemia and hypo-natraemia were present in 43 (93.5%) and 31 (67.4%) patients, respectively. Total and partial empty sella were recorded in 36 (78.3%) and 10 (21.7%) patients, respectively. On anterior pituitary hormonal analysis, all 46 (100%) patients had low-normal gonadotropins, 41 (89.1%) had adrenal insufficiency, 42 (91.3%) had secondary hypothyroidism, and 37 (80.4%) had low prolactin levels. Bone Mineral Density (BMD) assessment (n=11) was suggestive of osteopenia. Conclusion: The SS resulted in combined pituitary hormone deficiencies in most patients. Secondary amenorrhoea and agalactia were the most common presenting features, serving as early clues to suspect SS and initiate appropriate diagnostic workup.

Distribution of CEM BI-RADS Recombined Image Descriptors in Malignant and Non-malignant Breast Lesions: A Prospective Observational Study

Porkodi Dharmalingam, Devimeenal Jagannathan, Vijay Sathish Kumar Irulappan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Contrast-Enhanced Mammography (CEM) is an emerging functional breast imaging technique that integrates digital mammography with intravenous iodinated contrast administration. Following the introduction of a dedicated Breast Imaging-Reporting and Data System (BI-RADS) lexicon for CEM in 2022, validation of individual Recombined (RC) image descriptors has become essential for standardised interpretation. Aim: To evaluate the distribution of CEM BI-RADS recombined image descriptors in malignant and non-malignant breast lesions. Materials and Methods: The present prospective observational study was conducted between July 2019 and March 2023 at the Institute of Radiodiagnosis, Government Kilpauk Medical College and hospital, Chennai, Tamil Nadu, India, and evaluated 802 breast lesions (327 malignant and 475 non-malignant) from 769 participants using CEM. RC image descriptors- including enhancement presence, morphology, margins, internal enhancement characteristics, distribution patterns, lesion conspicuity, and contrast kinetics- were assessed according to the 2022 American College of Radiology Breast Imaging-Reporting and Data System (ACR CEM BI-RADS) lexicon. Statistical analysis was performed using the Chi-square test, with p<0.05 considered statistically significant. Results: The study population comprised women, with malignant lesions predominantly observed in patients aged over 40 years (mean age: 52.68±10.61 years), while non-malignant lesions were more common in younger patients (mean age: 48.78±9.64 years). Absent enhancement was identified exclusively in non-malignant lesions (57.9%). A higher frequency of mass enhancement was observed in malignant lesions (83.5%) compared with non-malignant lesions (36.2%). With respect to mass enhancement patterns, non-circumscribed margins (86.4% vs. 12.2%), heterogeneous internal enhancement (74.7% vs. 25.6%) were observed in a significantly higher proportion of malignant lesions than non-malignant lesions. Similarly, malignant lesions demonstrated higher lesion conspicuity and predominantly washout (82.4%) or plateau (16%) contrast kinetics. Conclusion: According to the findings of the present study, distinct CEM BI-RADS recombined image descriptors demonstrate significant associations with malignant and non-malignant breast lesions.

Ketamine-propofol versus Ketamine- dexmedetomidine Infusion for Minimally Invasive Short Gynaecological Surgical Procedures: A Randomised Clinical Study

Karthickvel Murugavel, Bhagyavardhan Botta, Kala Balasubramanian, Emmima Praisy Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Total Intravenous Anaesthesia (TIVA) is increasingly preferred for minimally invasive short gynaecological procedures due to its predictable pharmacokinetics, rapid recovery pro-file, and avoidance of inhalational agents. Among commonly used regimens, Ketamine-Propofol (KP) and Ketamine-Dexmedetomidine (KD) combinations are widely utilised; however, their comparative effects on haemodynamic stability, recovery characteristics, and postoperative analgesia remain under ongoing clin-ical evaluation. Aim: To compare the clinical effects of KP and KD infusion in minimally invasive short gynaeco-logical surgical procedures. Materials and Methods: This randomised, open-label clinical study included 100 adult female patients aged 20-50 years with American Society of Anaesthesiologists (ASA) physical status I or II un-dergoing elective minimally invasive short gynaecological procedures. Participants were randomly allo-cated into two groups (n=50 each). The KD group received intravenous ketamine 1 mg/kg and dexmedetomi-dine 1 μg/kg over 10 minutes, followed by maintenance infusion of ketamine 0.1 mg/kg/hour and dexme-detomidine 0.1 μg/kg/hour. The KP group received ketamine 1 mg/kg and propofol 2 mg/kg over 10 minutes, followed by maintenance infusion of ketamine 0.1 mg/kg/hour and propofol 0.1 mg/kg/hour. Haemodynamic parameters, Ramsay Sedation Score (RSS), Modified Aldrete Score, Visual Analogue Scale (VAS), and ad-verse events were recorded. Statistical analysis was performed using independent student’s t-test and Chi-square test, with p-value <0.05 considered statistically significant. Results: The mean age of participants in the KP and KD groups was 41.43±11.8 years and 43.65±9.05 years, respectively, with comparable baseline haemodynamic parameters (p-value >0.05). In-traoperative heart rate remained stable with no significant intergroup difference. The KD group demon-strated significantly lower Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Ar-terial Pressures (MAP) from the third minute onward (p-value <0.001), without clinically significant hypotension. Recovery was significantly faster in the KP group (RSS <3: 14.66±2.27 minutes vs 17.36±3.02 minutes; p-value <0.001). Postoperative pain scores were significantly lower in the KD group at all measured time points (p-value <0.001 to 0.012), with delayed requirement for rescue analgesia. Adverse effects were minimal and comparable between groups. Conclusion: Both KP and KD combinations provide safe and effective intravenous anaesthesia for minimally invasive short gynaecological procedures. KD offers superior haemodynamic stability and pro-longed postoperative analgesia, whereas KP facilitates faster recovery. Selection of the anaesthetic regimen should be individualised based on procedural requirements and recovery priorities.

Comparison between Ultrasound-guided Supraclavicular and Infraclavicular Approach to Brachial Plexus Block for Upper Limb Surgery: A Randomised Controlled Study

M Anis Fathima, Nagalakshmi Palanisamy, RV Ranjan, Rajalakshmi Mahendran Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Brachial plexus block is a widely used regional anaesthesia technique for upper limb surgeries, providing effective perioperative analgesia and reduced opioid requirements. Among the various approaches, supraclavicular and infraclavicular blocks are commonly performed under ultrasound guidance to improve accuracy and safety. However, differences in onset time, duration of blockade, and complication rates between these two techniques remain areas of clinical interest. Aim: To compare the efficacy of ultrasound-guided supraclavicular and infraclavicular approaches to brachial plexus block in patients undergoing forearm and hand surgeries. Materials and Methods: The present randomised controlled study was conducted at a tertiary care teaching hospital, Pondicherry Institute of Medical Science (PIMS) in Puducherry, India, from No-vember 2018 to April 2020 on 64 American Society of Anaesthesiologists (ASA) grade I and II patients above 18 years undergoing upper limb surgeries. Patients were randomly assigned into two groups. Group A received ultrasound-guided infraclavicular block and Group B received ultrasound-guided supraclavicular block. The primary outcome was comparison of sensory and motor block onset, while secondary outcomes included duration of blocks and associated complications. The data were analysed using Student’s t-test, Fisher’s-exact test, Chi-square test, and Mann-Whitney U test. Results: Both groups were comparable with respect to demographic characteristics including age, weight, gender distribution, ASA physical status, type and site of surgery (p>0.05). The onset of senso-ry blockade was quicker in infraclavicular group (5.59±2.53 min) than supraclavicular group (7.59±3.49 min). The timing of motor block onset showed no statistically significant differences between the groups. (11.81±6.17 vs 11.22±5.96 mins). Mean duration of sensory blockade (12.06±3.18 vs 13.25±3.34 hours) and motor blockade (9.97±2.68 vs 11.09±2.44 hours) were same in both groups. Conclusion: Ultrasound-guided infraclavicular block provides a significantly faster onset of sensory analgesia compared to the supraclavicular approach, while both techniques offer comparable dura-tion of sensory and motor blockade. Given the similar safety profile and effectiveness, either approach may be chosen based on clinician expertise and surgical requirements. The infraclavicular approach may be preferred when rapid onset of analgesia is desired.

Antimicrobial Utilisation and Resistance Patterns in Critically-ill ICU Patients with Multidrug-resistant Infections: A Retrospective Study

Akhila Chagalamari, Debabrata Dash, Uppara Kadiyala Rakesh, Madhav Rao, Sushil Sharma, Gaurav M Rangari, Hemanth Kumar, Mohammed Sibgatullah Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Multidrug-resistant (MDR) infections are increasingly prevalent in critically-ill patients in Intensive Care units (ICUs), complicating empirical antimicrobial choices. Antimicrobial Resistance (AMR) surveillance through antibiograms and outcome analysis is vital to guide stewardship. Aim: To analyse empirical antimicrobial utilisation patterns and AMR patterns in ICU patients with MDR infections and to assess concordance with department-level antibiogram data. Materials and Methods: A single-centre retrospective observational analysis was conducted at Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, between January 2021 and December 2023, including 92 ICU patients with culture-confirmed MDR infections. A total of 683 urine, 92 blood, 185 respiratory and 50 pyogenic isolates were analysed. Antimicrobial utilisation, resistance patterns and recorded clinical outcomes were evaluated. Descriptive statistics were used; categorical variables were expressed as percentages and continuous variables as mean±SD or median {Interquartile Range (IQR)}. A p-value <0.05 was considered statistically significant. Results: Among ICU isolates, Methicillin-Resistant Staphylococcus Aureus (MRSA) consti-tuted 7/15 (46.7%) of pyogenic S. aureus isolates, while Vancomycin-Resistant Enterococcus (VRE) was identified in 3/48 (6.3%) isolates. Among Bloodstream Enterobacterales, carbapenem susceptibility was observed in 79/92 (86.5%) isolates and piperacillin-tazobactam susceptibility in 71/92 (76.9%) isolates. Respiratory isolates (Acinetobacter baumannii and Klebsiella pneu-moniae, n=185) demonstrated susceptibility rates below 70% for most tested agents, with colistin sus-ceptibility preserved in the majority of isolates. In respiratory isolates of A. baumannii and K. pneumoniae, carbapenem showed modest activity, with susceptibility observed in 79/185 isolates (42.8%). Clinical outcomes were assessed descriptively, with variability observed according to organism type and empirical antimicrobial coverage. Conclusion: Empirical antibiotic strategies informed by local antibiogram trends improve out-comes in critically-ill MDR-infected patients. Continuous resistance surveillance and stewardship-driven de-escalation are critical to optimising ICU antimicrobial protocols and combating AMR.

Evaluation of Posterior Tibial Slope and Anterior Cruciate Ligament Integrity as Risk Factors for Knee Osteoarthritis: A Retrospective Study

Chockalingham Kasi, KV Arun Kumar, Pradeep Elangovan, Shivaani Venkatramanan, MD Sugale Ram, K Sudharsanan, Steve Merwyn Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Knee Osteoarthritis (OA) is a multifactorial degenerative joint disease with both biomechanical and anatomical risk factors. Posterior Tibial Slope (PTS) and Anterior Cruciate Ligament (ACL) integrity have been individually implicated in joint instability and degeneration. Aim: To evaluate the association of PTS and ACL status with the radiographic severity of knee OA and investigate their potential synergistic effects. Materials and Methods: This retrospective study included 334 patients presenting with chronic knee pain, evaluated using lateral radiographs and Magnetic Resonance Imaging (MRI) at a Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India between March 2021 and March 2024. PTS was measured using the Hudek method, and ACL integrity was categorised as intact, partially torn, or completely torn. OA severity was graded using the Kellgren-Lawrence (KL) system. Multivariable linear regression assessed the predictive value of PTS, ACL status, age, and Body Mass Index (BMI) on OA severi-ty. Results: Mean PTS increased significantly with OA severity, ranging from 7.9° in KL Grade 0 to 12.1° in Grade 4. ACL integrity declined progressively across KL grades, with 91.1% intact ACLs in KL 0 compared to only 15% in KL 4. A synergistic effect was observed: knees with high PTS (≥10°) and ACL tears had the highest OA severity (mean KL grade=3.3). PTS and ACL status were independent predictors of KL grade (p-value <0.001), along with age and BMI (p-value <0.001). Conclusion: Increased PTS and ACL deficiency are independent and synergistic risk factors for radiographic knee OA. Early identification of these parameters may inform prognosis and preventive strategies.

Precision Redefined: A Scoping Review on OccluSense and the Changing Face of Occlusal Equilibration

Shriyaa Abhay Shinde, Sunila B Sangappa, Christy Thomas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Occlusal analysis is an integral component of prosthodontic diagnosis and treat-ment planning and has traditionally relied on articulating paper for identifying occlusal contacts. How-ever, its subjective nature and inability to quantify occlusal force and timing limit clinical accuracy. Recent advancements in digital dentistry have introduced systems such as OccluSense and T-scan, which provide objective assessment of occlusal contact dynamics. Aim: To evaluate and compare conventional and digital occlusal analysis methods- articulating paper, OccluSense, and T-scan- with respect to their validity, reliability, and digital integration in occlusal equilibration for Fixed Dental Prostheses (FDP). Materials and Methods: A scoping review was conducted using PubMed and Scopus database to include articles published between 2010 and 2025 and written in English. The review was conducted till 16 June, 2025. The included studies assessed the effectiveness of T-scan, OccluSense, and articulating paper in occlusal equilibration during prosthodontic practice. A total of 22 articles including reviews, clinical trials, comparative studies, and in-vitro research results, met the inclusion criteria Result: Of the 22 studies that were reviewed, nine looked at digital integration, twelve at reliability, and nine at validity. For occlusal equilibration in FDPs, digital technologies such as T-scan and OccluSense demonstrated better accuracy, repeatability and workflow compatibility, providing more clinical utility than articulating paper. Conclusion: Digital occlusal analysis systems such as T-scan and OccluSense demonstrate superi-or accuracy, reliability, and repeatability compared to conventional articulating paper. They provide objective, quantifiable data on occlusal contacts and timing, improving clinical decision-making and workflow in occlusal equilibration for fixed dental prostheses.

Formulation and Evaluation of Antimicrobial, Anti-inflammatory, and Physicochemical Properties of Herbal Oral Gel Prepared from Jasminum grandiflorum Leaf Extract: An In-vitro Study

G Supraja, M Sankari Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Periodontitis is a chronic inflammatory disease that requires effective management, often involving adjunct therapies like chlorhexidine, but it comes with its own set of side-effects, creating a need for alternatives. Jasminum grandiflorum (jasmine), rich in bioactive com-pounds with anti-inflammatory, antioxidant, and antimicrobial properties, holds potential for periodontal therapy. Given the limitations of chlorhexidine-based adjuncts, exploring safer, plant-derived for-mulations is essential. Aim: To formulate a gel containing Jasminum grandiflorum leaf extract and evaluate its anti-inflammatory, antimicrobial, and physicochemical properties in comparison to chlorhexidine gel. Materials and Methods: The present in-vitro study was carried out in Saveetha Dental College, SIMATS University (Chennai, Tamil Nadu, India) from January 2024 to March 2024. A Jasminum grandiflo-rum leaf extract gel was formulated by combining bioactive compounds from dried leaves with Carbopol and carboxymethyl cellulose and evaluated its anti-inflammatory and antimicrobial properties compared to chlorhexidine gluconate gel (Hexigel). Anti-inflammatory activity was tested using the egg albumin denaturation assay, while antimicrobial activity was assessed against anaerobic bacteria using the agar well diffusion method, along with evaluations of wettability to assess the contact angle, and temperature stability. Statistical comparisons were performed using one-way Analysis of Variance (ANOVA), and p-values<0.05 were interpreted as statistically significant. Results: The Jasmine gel showed 77% anti-inflammatory activity at 50 μg/L, comparable to chlorhexidine (81%) and diclofenac sodium (80%), but its antimicrobial activity was weaker, with a 9 mm zone of inhibition compared to chlorhexidine’s 24 mm. It demonstrated excellent stability across various temperatures. Jasmine gel shows good anti-inflammatory and stability profiles but no antimicrobial action, requiring further optimisation before it can be considered alongside chlorhexidine. Conclusion: Jasmine grandiflorum demonstrated potent anti-inflammatory activity, combined with its superior physicochemical properties, it can be a useful adjunct in non-surgical periodontal therapy.

Prognostic Value of Admission NT-proBNP for Stroke Severity and 90-Day Functional Outcome in Acute Ischaemic Stroke: A Hospital-based Cohort Study

Bommidi Loak Sai Vallisree, Siva Ranganathan Green, Shayilendranath Venkatesan, T Arun Prakash, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Acute Ischaemic Stroke (AIS) is a leading cause of morbidity and mortality worldwide. Accurate prognostic markers are essential for early risk stratification. N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), a cardiac biomarker, has been proposed as a predictor of stroke severi-ty and outcome, but its clinical utility remains incompletely defined. Aim: To assess whether admission NT-proBNP is associated with stroke severity and 90-day func-tional outcome in AIS and to explore its relationship with Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes. Materials and Methods: This hospital-based prospective cohort study conducted in the Depart-ment of General Medicine, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Puducherry, India, over a two-year period (June 2023 - July 2025) and included 90 consecutive patients with AIS. Baseline demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores and TOAST classifications were recorded. Serum NT-proBNP levels were measured at admission. Functional outcome was assessed using modified Rankin Scale (mRS). Statistical analysis done using Statistical package for So-cial Sciences (SPSS) (v_24.0), where inferential statistics were applied based on the type of the varia-ble and their normality. Diagnostic utility assessed by Receiver Operating Characteristic (ROC) analy-sis. Results: The mean age of the patients was 61.3±12.5 years with 59/90 (65.6%) males. The mean NT-proBNP was 173.6±220.1pg/mL. Elevated NT-proBNP (>125 pg/mL) was observed in 32/90 (35.6%) of pa-tients. NT-proBNP levels correlated significantly with NIHSS (ρ=0.43, p<0.001) and mRS (ρ=0.21, p=0.048), but not with TOAST subtypes. Logistic regression identified NT-proBNP as an independent pre-dictor of unfavourable outcome {Odds Ratio (OR)=1.00, 95% Confidence Interval (CI) 1.00–1.01, p=0.049}. ROC analysis showed NIHSS had superior predictive accuracy (AUC-0.78, cut-off-6, sensitivity-0.73, spec-ificity=0.71) compared with NT-proBNP {Area Under Curve (AUC-0.69, cut-off=113 pg/mL, sensitivity-0.68, specificity=0.71}. Conclusion: NT-proBNP is significantly associated with stroke severity and functional outcomes in AIS, though NIHSS remains the stronger predictor. NT-proBNP, with its high NPV, serves as a valuable adjunct biomarker to enhance prognostication. Further large-scale studies are warranted to validate its integration into routine stroke assessment.

Interobserver Agreement in Histopathological Assessment of the Operative Link on Gastritis Assessment and the Operative Link on Gastric Intestinal Metaplasia Staging: A Cross-sectional Study

R Srinidhi, Padma Priya Kasukurti, N Gowthami, Sulata M Kamath Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Gastric Cancer (GC) is a major health concern in India, with Intestinal Metaplasia (IM) and atrophy being key risk factors. Early detection requires endoscopic surveillance and histopathological examination. After decades of utilising the Sydney System, the Operative Link on Gastritis Assessment (OLGA) and the Operative Link on Gastric Intestinal Metaplasia (OLGIM) were introduced. These systems classify gastritis histologically from stage 0 (lowest risk) to stage IV (highest-risk). Aim: To assess interobserver agreement in the utility of OLGIM and OLGA. Materials and Methods: The present cross-sectional study was done on 147 dyspeptic patients’ biopsies. Two observers independently scored the samples using the two systems in the Department of Pathology at a tertiary care center and Medical College, Bengaluru, Karnataka, India, using archived cases from January 2025 to April 2025. Each biopsy on a single level was scored on a Visual Analogue Scale (VAS) of 0-3 for Gastric Atrophy (GA) and Intestinal Metaplasia (IM). Antral and corpus scores were grouped into stages I-IV. Kappa value was used to assess the interobserver agreement between the two scorers with respect to the final stage. Categorical variables were expressed as percentages. Interobserver agreement between the OLGA and OLGIM classification systems was assessed using the kappa statistic, with statistical significance evaluated by the Chi-square distribution and Statistical Package for the Social Sciences (SPSS) 22.0 software. A p-value <0.05 was considered statistically significant. Results: The interobserver agreement was excellent, with kappa values of 0.958 for OLGIM and 0.937 for OLGA (p<0.05). There is no significant difference in the interobserver reproducibility of the two staging systems, though OLGIM shows better agreement. Conclusion: A combined grading system offers improved risk stratification and can potentially be adopted in daily practice. Routine use of these systems will aid in early detection and surveillance of GCs.

Validation and Test-retest Reliability of Hindi Version of Istanbul Low Back Pain Disability Index in Patients with Chronic Mechanical Low Back Pain: A Cross-sectional Study

Renu Burathi, Shivangi Palsra, Riya Kalra, Paras Saini, Ridhi Vatsa, Shweta Sharma, Mahavir Singh, Aditi Popli Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Globally, Chronic Mechanical Low Back Pain (CMLBP) is a significant cause of disability. Patient-reported outcome measures are essential for assessing functional limitations, however majority of tools now in use were created in Western contexts and might not accurately represent the culturally distinctive daily activities of Hindi-speaking individuals. There is currently no validated Hindi version of the multidimensional Istanbul Low Back Pain Disability Index (ILBPDI), despite its proven psychometric qualities. Aim: To evaluate the content validity and test-retest reliability following linguistic translation and cultural adaptation of ILBPDI in Hindi for CMLBP patients. Materials and Methods: This cross-sectional study was conducted at Maharishi Markandeshwar (MM) Superspeciality Tertiary Care Hospital, Mullana-Ambala, Haryana, India from March 2025 to January 2026. In accordance with Beaton’s recommendations, the ILBPDI underwent forward translation, synthesis, backward translation, expert committee evaluation, and pilot testing. The participants included 51 Hindi-speaking patients with CMLBP aged between 25-60 years. The Delphi method, which provided Item-Level and Scale-Level Content Validity Indices {I-CVI, S-CVI Universal Agreement Average (S-CVI/Ave) and S-CVI Universal Agreement (S-CVI/UA)}, was employed by 10 experts to determine content validity. Test-retest reliability was evaluated after 72 hours by Intraclass Correlation Coefficients (ICC), and Internal Consistency (IC) was evaluated by Cronbach’s alpha. Results: Excellent comprehensibility was shown in pilot testing (96-100%). S-CVI/Ave=0.98 and S-CVI/UA=0.88 indicated strong content validity. The H-ILBPDI demonstrated exceptional test-retest reliability (ICC=0.989) and great IC (Cronbach’s α=0.994). Conclusion: For evaluating functional impairment in Hindi-speaking patients with persistent mechanical Low Back Pain (LBP), the H-ILBPDI is a viable, dependable, and culturally relevant instrument.

Knowledge, Attitudes and Practices of Yoga in the Management of Diabetic Neuropathy amongst the General Population: A Cross-sectional Study

Dipali Khade, Chaitali Shah, Sandesh Sakpal, Dhvani Shah Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Diabetic Neuropathy (DN) is a chronic consequence of Diabetes Mellitus (DM) that impacts physical function and quality of life. Yoga has shown benefits for controlling blood sugar, lowering stress and improving neuromuscular function. Aim: To assess the Knowledge, Attitudes and Practices (KAP) of yoga in the management of DN amongst the general population. Materials and Methods: A cross-sectional study was conducted between September to December 2025 among individuals from the general population in the Sion, suburb of Mumbai, Maharashtra, India where 316 individuals within the general population were interviewed. A self-made, content-validated questionnaire was utilised to evaluate KAPs concerning yoga and DN. Descriptive statistics were used to analyse the data. Results: Out of 316 people, 296 (93.67%) were aware of what is diabetes and 247 (78.16%) did know that nerves can be affected in diabetes, 28 (8.9%) were already diagnosed as DM, but 16 (57.1%) of the diabetic people were not aware if they had or not DN. Many people knew about yoga, only 5 (1.58%) didn’t know what is yoga. Most people who took part had good attitudes towards yoga, 265 (83.86%) of them thought that yoga could help with diabetes and 210 (66.45%) felt it is beneficial for DN in addition to medical care. However, only 122 (38.6%) of these people did yoga. People who practiced yoga often said that it helped them become more flexible, mentally better, have more energy and deal with stress better. Two subjects indicated no change whereas none reported negative effects. Conclusion: Although awareness and attitudes toward yoga were positive, the levels of actual practice were low, suggesting a gap between knowledge and practice. Hence, there is necessity for accessible, organised yoga-based programs to facilitate the integration of yoga in diabetes care.

The Effect of Contamination in Different Stages of Composite Resin Restoration Adhesion and Decontamination Methods on Leakage, Bond Strength and Marginal Adaptation: A Scoping Review

Ghaida Raja Althebeti Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Composite resin restorations require isolation and precise adhesive procedures to achieve durable bonding. Contamination may affect the bond strength and marginal integrity. However, effective decontamination protocols under different contamination conditions remains unclear. Aim: To explore the effect of contamination at different stages of adhesion, and decontamination on the bond strength, leakage, and marginal adaptation of direct composite resin restorations. Materials and Methods: A literature search was conducted in two databases (PubMed and Scopus) to include studies published between January 1, 2015, and December 31, 2025. The search was conducted at Umm Al-Qura University, Saudi Arabia, to identify relevant studies. Original English-language studies investigating the effect of contamination with saliva, blood, or haemostatic agent on direct composite resin restorations bonded to enamel, dentin, or between composite layers, with reported outcomes of bond strength, marginal/internal adaptation, or microleakage, were included. Results: A total of 1,041 articles were initially identified, and 36 studies were finally in-cluded. Saliva, blood, or haemostatic agents adversely affected the bonding performance of direct compo-site resin restorations. Evidence regarding microleakage and marginal adaptation was limited. Decontami-nation strategies demonstrated variable effectiveness in restoring bond strength, depending on the type of contaminant. Conclusion: The stage at which contamination occurs and the adhesive system may affect the bond strength of composite resin restorations. Blood contamination showed a more negative effect on bond strength when it occurred after adhesive curing, whereas the effect of saliva at different adhesive stages remains variable. Decontamination of saliva through water rinsing, followed by air drying and reapplication of adhesive, demonstrated favorable outcomes with Self-Etch (SE) adhesives.

HALP Score as a Composite Immunonutritional Marker in Chronic Kidney Disease: A Cross-sectional Analysis Across Albuminuria Stages

J Johnsi Priya, Aliya Nusrath, Nandeesh Venkatappa, S Inchara, HS Pavan, NH Veena Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Chronic Kidney Disease (CKD) contributes to inflammation and malnutrition there-by increasing the risk of mortality. The Haemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score is a novel and comprehensive immunonutritional marker offering complete picture on both inflammation and nutrition. The HALP score is explored in various malignancies, but its novelty in CKD is least assessed. Aim: The present study was aimed to evaluate HALP scores across albuminuria-based CKD groups and assess its correlations with established inflammatory markers like Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR), thereby assessing the disease severity and guide therapeutic interventions. Materials and Methods: The present cross-sectional study was conducted between June 2024 to June 2025 at the Adichunchanagiri Hospital and research centre, a tertiary care teaching hospital in Karnataka, India. Study included 150 CKD subjects in three Urine Albumin-Creatinine Ratio (UACR)-based groups (n=50 each): G1 (<30 mg/g), G2 (30-300 mg/g), G3 (>300 mg/g). HALP score was calculated using haemoglobin, albumin, lymphocyte and platelet counts. eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. Data was analysed using Analysis of Variance (ANO-VA), Pearsons’s correlation and Receiver Operating Characteristic (ROC) curve analysis. The p-value of <0.05 was considered statistically significant. Results: The present study subjects showed a mean age of 44.44±16.82 years in group 1, 43.65±12.51 years in group 2 and 55.46±16.96 years in group 3 which was significant at p-value 0.000353. The gender distribution was 27 (54%) males and 23 (46%) females in group 1, 31 (62%) males and 19 (38%) females in group 2, and 39 (78%) males and 11 (22%) females in group 3. HALP correlated nega-tively with NLR (G1 r=- 0.6125, p<0.00001), G2 (r=- 0.5277, p=0.000084), and G3 (r=- 0.5898, p<0.00001) and PLR in G1 (r=- 0.770, p<0.00001), G2 (r=- 0.7221, p<0.00001) and G3 (r=- 0.3119, p=0.0279). ROC of HALP showed AUC=0.816, cut-off=28.79, sensitivity=86.7%, specificity=67.6%. Conclusion: The immunonutritional status of CKD patients decreases as the stage advances. HALP score being a straightforward and composite marker can be incorporated in routine clinical practice for early risk assessment, monitoring and also for therapeutic and nutritional interventions.

Prevalence of Musculoskeletal Disorders, Stress and their Associated Risk Factors among Medical Representatives in Chennai, Tamil Nadu, India: A Cross-sectional Study

Meena Priya Srinivasan, T Stephen, Krishna Prasanth Baalann, Hariharan Surathkumaar, Saranya Kumaran Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Medical Representatives (MRs) serve as the major interface between pharmaceutical companies and clinicians. Individuals in such positions typically work long hours, have to travel often, and face high-performance pressures. In addition to these challenges, they have to stand for ex-tended periods, and they often adopt poor body postures, thus raising the probability of Musculoskeletal Disorders (MSD) and stress. The present study estimated the prevalence of MSDs and stress among MRs in Chennai and identified associated occupational and lifestyle risk factors. Aim: To estimate the prevalence of musculoskeletal disorders and stress among MRs along with their associated risk factors. Materials and Methods: A cross-sectional study was conducted among 290 MRs aged 18 years and above working in Chennai, Tamil Nadu, India from May 2025 to August 2025. Participants were selected from May 2025-August 2025, selected by two-stage cluster sampling from 20 pharmaceutical companies. Data were collected using a pretested semi-structured questionnaire incorporating the Standardised Nordic Musculoskeletal Questionnaire and Perceived Stress Scale-10. Descriptive statistics, Chi-square test, and multiple logistic regression were used to identify factors associated with MSDs and stress. Results: The prevalence of MSDs and moderate stress were 78.6% and 72.4%, respectively. Lower back (42.5%) and neck (19.3%) were the most affected regions. MSDs showed associations with commuting by bike {Adjusted Odds Ratio (AOR) 4; p=0.023}, commuting by bus (AOR 2.62; p=0.007), working more than 10 hours/day (AOR 15.89; p=0.004), exercising only 1-3 days/week (AOR 9.39; p<0.001) and travelling more than 4 hours/day (AOR 1.84; p<0.001). Moderate stress was associated with married marital status (AOR 6.36; p<0.001) and working more than 10 hours/day (AOR 1.93; p=0.044). MRs with MSDs had 11.68 times higher odds of moderate stress than those without MSDs (p<0.001). Conclusion: A high prevalence of MSDs and stress was observed among MRs, showed significant associations with prolonged working hours, travel duration, physical activity patterns, and marital status. Enforcing standard working hours, optimising travel schedules, promoting regular exercise, and instituting periodic screening with ergonomic and mental health interventions are recommended for this vulnerable workforce.

Dexamethasone versus Dexmedetomidine as Adjuvants to Ropivacaine in Ultrasound-guided Rectus Sheath Block for Postoperative Analgesia in Patients Undergoing Exploratory Laparotomy: A Randomised Controlled Trial

Akshi Manoher, Abhimanyu Singh Pokhriyal, Arti Rajput Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Midline laparotomies cause significant postoperative pain, which adds to high morbidity associated with them. Rectus Sheath Block (RSB), has emerged as a reliable technique for post-operative analgesia in abdominal surgeries and has been shown to significantly prolong postoperative analgesia and decrease pain scores in patients undergoing midline laparotomies. Aim: To compare the duration and quality of postoperative analgesia with dexamethasone vs dexmedetomidine as adjuvants to 0.25% ropivacaine in Ultrasound (USG)-guided bilateral RSB for midline laparotomy patients. Materials and Methods: This single centre double-blinded, randomised controlled trial was conducted over a period of 12 months at the Department of Anaesthesiology and Pain Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India between year 2023 to 2024 and included 70 American Society of Anaesthesiologists (ASA) physical status I/II patients scheduled for midline laparotomy. They were randomly assigned to receive Ultrasound (USG)-guided, bilateral RSB with a total dose of 40 mL of 0.25% ropivacaine with 8 mg dexamethasone (Group-A), 40 mL of 0.25% ropivacaine with 1 μg/kg dexmedetomidine (Group-B) and 40 mL of 0.25% ropivacaine alone (Group-C). Postoperatively, tramadol was administered via Patient-Controlled Analgesia (PCA) by demand-only mode. The primary outcome was time to PCA activation, while secondary outcomes included 24-hour tramadol consumption, pain scores (at 30 minutes and at 1, 3, 6, 12, 18 and 24 hours), patient satisfaction and block-related complications. Unpaired t-tests were used for continuous variables, while the Chi-square test was applied to categorical data. Analysis of Variance (ANOVA) was performed to assess vital parameters and to compare differences across the three groups. Results: All three groups were comparable in terms of demographic variables like age, weight and gender distribution. PCA activation time was longest in Group-A (102.27±32.79 min) vs. Group-B (73.18±24.08 min) and Group-C (39.77±21.84 min) (p<0.001). Tramadol consumption was lowest in Group-A (279.54±100.31 mg) (p=0.002). Pain scores and patient satisfaction favoured Group-A (p=0.001, p=0.031, respectively). Conclusion: Dexamethasone with ropivacaine in RSB demonstrated superior analgesic efficacy in terms of better pain scores, longer time to activate PCA pump and overall lowest 24-hour tramadol consumption than ropivacaine alone. The overall patient satisfaction in terms of pain management was better in dexamethasone group as compared to dexmedetomidine with ropivacaine and ropivacaine alone.

Effects of Tamoxifen, Ormeloxifene and Evening Primrose Oil in the Management of Breast Fibroadenoma: A Prospective Observational Study

Shesh Nath, Probal Neogi, Raj Kumar, Varsha Kumar, Sanjay Singh, Santosh Singh Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Breast fibroadenoma, a common benign tumour in young women, is often managed conservatively. Selective Oestrogen Receptor Modulators (SERMs), such as tamoxifen and ormeloxifene, have shown therapeutic potential, while Evening Primrose Oil (EPO) is used as an alternative remedy. Aim: To compare the efficacy of tamoxifen, ormeloxifene, and EPO in the management of breast fibroadenoma. Materials and Methods: A prospective observational study was conducted in the Department of Surgery, Moti Lal Nehru Medical College (tertiary care centre), in collaboration with the Departments of Pathology and Radiodiagnosis, Medical College, Prayagraj, Uttar Pradesh, India from September 2020 to September 2021. A total of 142 female patients (15-40 years) with fibroadenoma (2-10 cm), confirmed by clinical examination, ultrasound, and FNAC/Tru-Cut biopsy, were included. Participants were allocated into four groups: Ormeloxifene (n=39), Tamoxifen (n=40), Evening Primrose Oil (n=33), and Placebo (n=30). Tumour volume was assessed using ultrasound, as determined by the formula. V = axbxcx0.52 and diagnosis was confirmed by Tru-cut biopsy or Fine-needle Aspiration Cytology (FNAC). Patients were fol-lowed up at weeks 12 and 24 to assess adverse effects and therapeutic response. Clinical examinations and repeat ultrasound assessments were performed at 12 and 24 weeks to evaluate changes in tumour size and consistency. Results: Among 142 women, fibroadenoma was most common in the 26-30-year age group. Ormeloxi-fene showed the greatest regression, with 76.9% achieving ≤1.9 cm lesions at 24 weeks, followed by ta-moxifen (60.0%). EPO showed a limited effect, and the placebo showed none. The differences were statis-tically significant (p-value <0.001). Ormeloxifene proved to be the most effective therapy in reducing fibroadenoma size. Conclusion: Ormeloxifene demonstrated the highest efficacy in fibroadenoma regression, followed by Tamoxifen. SERMs, particularly Ormeloxifene, should be considered for conservative fibroadenoma management.

Efficacy and Safety of Ayurvedic Interventions in the Management of Rheumatoid Arthritis: A Systematic Review

Deepa Chawla, Preeti Borkar, Renu Singh, Aparna Manathottathil Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Ayurveda offers a wide range of therapeutic approaches for Rheumatoid Arthritis (RA), including Panchakarma and oral medications. Although many studies are available on Ayurvedic approaches to RA, the efficacy and safety of oral medications haven’t been thoroughly reviewed. This gap highlights the necessity of a comprehensive assessment of these interventions. Aim: The present review evaluates the efficacy and safety of Ayurveda interventions for the management of RA. Materials and Methods: In the present systematic review, Databases like PubMed, Science direct, Web of Science, Cochrane, Google Scholar, Ayush Research Portal, DHARA (Digital Helpline for Ayurveda Research Abstracts), Shodhganga@INFLIBNET, and The Clinical Trial Registry of India (CTRI) were searched. All comparative clinical trials on RA (Amavata) published in English, from 2010 to 2024, were considered for the review. Studies administering Ayurvedic interventions involving Shamana Chikitsa intended for oral use for any duration in patients diagnosed with RA- clinically, or confirmed through laboratory and radiological investigations, or based on American College of Rheumatology Diagnostic Criteria- or with Amavata as defined in Ayurveda, were included regardless of age or gender. Data were analysed qualitatively including the Risk of Bias (RoB) assessment. Meta analysis was not possible due to heterogeneity in studies. Results: A total of 448 articles were identified, with 21 studies meeting inclusion criteria, 15 randomised and six non-randomised trials. None compared Ayurvedic interventions with placebo. Most studies had a high Risk of Bias (RoB) due to weak methodology; randomisation, allocation concealment, and, blinding were poorly described or missing. Even though some studies employed standardised outcome measures, the subjective parameters used by the most studies lacked validated scoring tools. The major concern regarding the studies was selective reporting, with underreporting of adverse events and safety markers. Conclusion: Despite Ayurvedic medications are widely used in the management of RA, the supporting evidence remains limited due to lack of methodological rigor and inadequate safety assessments. This review highlights the critical need for well-designed randomised controlled trials using standardised outcome measures and safety parameters.

Efficacy of Simvastatin versus Hydroxyapatite in the Regeneration of Periapical Bone Defects When used in Conjunction with PRF: A Prospective Interventional Study

Kavya Pinnamaneni, Anita D Parushetti, CN Srinivas, Aishwarya Venkat, Sunny Priyatham Tirupathi, Sneha M Nair Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The complete healing process for periapical bone defects involves a focused regenerative approach. Simvastatin (SIM), and Hydroxyapatite (HA) saturated PRF scaffold provides osteopromotive and anti-inflammatory properties, creating a predictable osteoconductive environment. Plate-let-Rich Fibrin (PRF) also aids in regeneration through the sustained release of growth factors. Aim: To evaluate and compare SIM and HA efficacy in bone regeneration of periapical defects when used in conjunction with PRF. Materials and Methods: This 18-month prospective interventional study was conducted on 20 patients requiring apicoectomy (15-50 years of age) who reported to the Outpatient Department of Oral and Maxillofacial Surgery, Malla Reddy Institute of Dental Sciences, Hyderabad Telangana, India, from June 2022 to February 2024. Eligible subjects were randomised to Group-I (SIM+PRF; n=10) or Group-II (HA+PRF; n=10). The graft materials were placed into the defects after apicoectomy prior to suturing. The clinical parameters (pain, extraoral swelling, and signs of infection) were assessed on postoperative days 1, 3, 7, 15, and 30. Radiographic healing was monitored with Cone Beam Computed Tomography (CBCT) Periapical Index (PAI) scores at baseline, six months, and 12 months. Statistical analysis was performed using Analysis of Variance (ANOVA) (p<0.05). Results: The study group comprised 10 males and 10 females, with an average age of 33.6 years in Group-I and 29.2 years in Group-II. No statistically significant differences were noted for any interval as measured by inter-group clinical parameters for pain, extraoral swelling, or evidence of infection such as pus discharge and sinus opening where, p>0.05. The average Visual Analogue Scale (VAS) scores on the 7th postoperative day were 0.6±0.69 for Group-I, and 0.8±0.78 for Group-II. Although Group-I showed more diminished infection markers and swelling, the differences were not statistically significant. Conversely, the findings of a radiographic analysis showed that for the 12-month CBCT-PAI, Group-I had a significantly better score than Group-II (p=0.005). There were seven cases classified as “healed” during final evaluations compared with six in Group-II. Conclusion: The findings of the present study demonstrated that when compared to HA-augmented PRF, SIM-augmented PRF achieves significantly better and faster bone formation. SIM appears a novel and advantageous potential medicine for restoring bone healing within periapical defects.

Effectiveness of Socratic Circles versus Traditional Self-directed Learning in Physiology among First Year MBBS Students: A Mixed Methods Study

Nirmala Anand, Rajesh Shenoy, Sofia Anjum Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: In phase I MBBS, for conceptual intensive subjects like physiology, Socratic Circles (SCs) offer a dialogue-based inquiry driven teaching learning strategy. They contrast the tradi-tional didactic faculty-driven approaches followed for Self-Directed Learning (SDL). While evidence from western universities support the effectiveness of Socratic Circles (SC) in enhancing critical thinking and student engagement, its utility in Indian medical curricula is unexplored. Aim: To compare the effectiveness of SCs versus the traditional didactic SDL in Physiology among first year MBBS students. Materials and Methods: This mixed methods study was conducted in Department of Physiology, Kaher’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, India, from August to December 2024 among 200 Phase I MBBS students. Students were randomly allocated to Group A (SC, n=100) and Group B (SDL n=100) using odd and even roll numbers. A pretest for all 200 students assessed their baseline knowledge. Group A (SC) underwent a structured preparatory phase for three weeks where, students gener-ated their own learning objectives as well as learning resources. This was followed by three sessions, each session of three hours long SC session. This was followed by reflection, debriefing, and feedback. Group B underwent conventional faculty led SDL with assigned tasks. Identical post-tests were adminis-tered after the sessions. The quantitative data were statistically analysed using Student test which measured the learning gains. The qualitative data obtained from reflective journals were analysed the-matically. Results: The study cohort consisted of Phase-I MBBS (Batch 2023-24) students with a mean age of (19.1±0.7) years, comprising 98 females (49%) and 102 males (51%). Group A (SC) showed a significant improvement in post-test scores (7.1±1.91) compared to pretest (4.2±1.27; p-value=0.001), whereas Group B (Traditional SDL) did not showed a statistically significant improvement (pretest: 4±1.20; post-test: 5.5±1.12; p-value=0.80). Quality assessment scores were also significantly higher in the SC group (6.2±0.67) than in the traditional SDL group (3±0.71; p-value=0.004). Conclusion: Socratic circles greatly improved learning outcomes, critical thinking quality, and student engagement. Positive student feedback strongly supported the approach, which promoted deeper understanding and enhanced student responses’ clarity, accuracy, depth, and precision.

Effect of Cervical Isometric Strengthening Exercises with Electromyographic Biofeedback on Neck Proprioception and Postural Control among Prolonged Computer Users: A Pilot Study

Amrita Preetam, Aditi Gautam, Pramod Kumar Sahu, Sachin Gupta, Shahiduz Zafar, Shagun Agarwal, Mohammad Sidiq, Aksh Chahal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The use of computers, often referred to as Visual Display Terminals (VDTs), for large-scale data processing and maintaining worldwide databases is growing in popularity. Excessive com-puter use can cause VDT syndrome, which includes a direct effect on neck proprioception and postural control. Aim: The present pilot study aimed to compare the outcomes of the groups-one undergoing cervical isometric strengthening exercise with Electromyographic (EMG) biofeedback (experimental group) and the other performing neck isometric exercises only (control group)-to assess the effectiveness of the inter-vention. Materials and Methods: The present pilot study randomised 40 subjects (20 in the experimental group and 20 in the control group), aged 18-35 years. The study was conducted at the Physiotherapy De-partment of Galgotias University, Uttar Pradesh, India, over four months (August 2023-November 2023). A total of forty computer users were recruited from colleges and universities and were allocated into two groups based on inclusion criteria: Group A (Experimental) and Group B (Control). The experimental group performed cervical isometric strengthening Exercise with EMG biofeedback, while the control group under-went a neck isometric exercise. The study measured various outcome variables, including neck propriocep-tion, Forward Head Posture (FHP), static balance, and dynamic balance. Student’s t-test: Paired t-test (within-group) and independent t-test (between-group) were used and assessed the significance of the differences. Results: A total of 40 computer users were divided equally into two groups. Group A (interven-tion) showed statistically significant improvements in all outcome measures compared to Group B (con-trol). Within Group A, HRA Cervical Range of Motion (CROM) improved in all directions—flexion, exten-sion, right and left lateral flexion, and right and left rotation (all p<0.001). In contrast, Group B showed no significant within-group improvements in any variable (p>0.05). Between-group analysis using unpaired t-tests revealed significantly better post-intervention outcomes in Group A for NDI (p<0.001), CROM flexion (p<0.001), extension (p<0.001), right and left lateral flexion (p<0.001), and right and left rotation (p<0.001). These findings support the effectiveness of the ergonomic and exercise inter-vention in reducing disability and improving cervical mobility. Conclusion: The findings of the present study indicate that cervical isometric strengthening exercises combined with EMG biofeedback result in significant improvements in neck proprioception, FHP, and both static and dynamic balance. These improvements were evidenced by statistically significant dif-ferences between the experimental and control groups, with the experimental group demonstrating greater overall gains.

Mucoscopic Features of Oral Mucosal Lesions at a Tertiary Care Centre in Central India: A Cross-sectional Study

Rochit Singhal, Prerna Sharma, Krupa Kapadia, Shyam Govind Rathoriya, Isha Khandelwal, Rumana Khan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Patients with Oral Mucosal Lesions (OMLs) form a significant number in the daily routine dermatology OPD. Also, many times OMLs pose a diagnostic challenge due to similar-looking mor-phologies. Every time mucosal biopsy is not feasible for confirmation of diagnosis. Aim: To study the mucoscopic features of various mucosal lesions affecting the oral cavity. Materials and Methods: The present cross-sectional study was conducted in the Dermatology outpatient department at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India, from Octo-ber 2024 to September 2025. A total of 258 patients were enrolled in the study after obtaining approval from the Institutional Ethics Committee. All patients presenting with lesions of the oral mucosa, who were willing to give written informed consent, were included in the study. A detailed history and clini-cal examination were done, followed by mucoscopic examination. The findings were recorded in a prede-signed proforma. The data was then statistically analysed. Results: A total of 258 patients were enrolled for the study, out of which 149 (57.7%) were males and 109 (42.3%) were females, with a ratio of 1.3:1. The mean age of patients was 33.4±7 years. Inflammatory OMLs 116 (44.9%) was most commonly found, followed by infectious OMLs 56 (21.7%) and premalignant and malignant OMLs 35 (13.5%). Recurrent Aphthous Stomatitis (RAS) 63 (24.4%) was the most common OML studied, followed by Oral Lichen Planus (OLP) 35 (13.5%) and herpes labialis 23 (8.9%). Fordyce spot showed white yellow discrete ovoid structures on mucoscopy and geographic tongue showed atrophic filiform papillae surrounded by whitish yellow irregular serpiginous borders. Conclusion: According to the findings of the present study mucoscopy helps in aiding the subtle features of various OML and thus assists in diagnosis where mucosal biopsy is not feasible.

Assessment of Caregiving Burden, Quality of Life, and Psychological Distress Among Caregivers of Patients with Bipolar Affective Disorder and Schizophrenia: A Hospital-based Observational Study

Aakriti Sood, Ashwani Saini, Avisha Mahla, Ved Pal Mahla, Ashutosh Tripathi, Pradeep Kumar Sharma, Debopam Das Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Severe mental illnesses like Schizophrenia and Bipolar Affective Disorder (BPAD) significantly affect an individual’s ability to function effectively. These are chronic conditions with a prevalence of around 1% and 2.4%, respectively. They are a significant contributor to global disabil-ity, ranking among the top causes worldwide. Family members endure substantial hardship while delivering necessary care and assistance. The nature of these illnesses progressively undermines psychological health of caregivers, leading to declining mental functioning of the caregivers over time and increasing their burden of care. This deterioration affects both the diagnosed individual and the family system supporting them, creating increasingly complex challenges for the caregivers. Aim: To determine the burden of care, Quality of Life (QoL), and mental distress among caregiv-ers of patients with schizophrenia and BPAD. Materials and Methods: The present hospital-based observational study was conducted at Facul-ty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India, from June 2023 to June 2024 over one year. Caregivers of diagnosed patients were enrolled. The patients were diagnosed accord-ing to International Classification of Diseases, 10th Revision (ICD-10). They were further allotted into 2 groups: Group 1 consisted of caregivers of 50 patients diagnosed with BPAD, and Group 2 consisted of caregivers of 50 patients diagnosed with schizophrenia. The semi-structured sociodemographic data sheet was used to obtain the details. Burden Assessment Schedule (BAS), World Health Organisation Quality of Life-Brief Version (WHOQoL-BREF), and Depression, Anxiety and Stress Scale-21 (DASS-21) were applied to note the relevant parameters. The Wilcoxon-Mann-Whitney U test was applied to compare caregiver burden and the quality of life between groups. The Chi-square test and Fisher’s exact test were applied to determine depression, anxiety, and stress among the caregivers. A p-value<0.05 was considered statisti-cally significant. Results: The mean age of caregivers was 45.65±12.49 years. Caregivers of patients diagnosed with schizophrenia experienced a considerably greater burden than those caring for patients with BPAD, with mean BAS scores of 76.94 and 62.36, respectively (p<0.001). A statistically significant difference was noted between the QoL scores of both groups across all the domains (p<0.05). The caregivers of pa-tients with schizophrenia exhibited higher levels of depression, anxiety, and stress compared to care-givers of patients with BPAD, with the mean scores of depression (22.20±10.34 and 13.64±7.93), anxiety (21.32±9.02 and 11.96±7.42), and stress (21.64±9.22 and 11.84±6.78) respectively. Conclusion: Individuals providing care for patients with schizophrenia faced a notably greater burden on their physical and mental health compared to the caregivers of patients with BPAD. The QoL of the caregivers of schizophrenia patients was lower in the physical, psychological, and social domains, whereas the QoL of caregivers of BPAD patients was poorer in the environmental domain. The levels of stress, anxiety, and depression were more significant in the people caring for the patients with schizo-phrenia.

Intraoperative Advantages and Clinico-radiological Outcomes of Total Open Nailing versus Closed Nailing in Diaphyseal Femur Fractures: A Prospective Observational Study

Udit Kumar Biswal, Nabin Kumar Sahu, Gopal Kumar Agarwal, Santosh Kumar Sahu, Pooja Priyadarsini Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Intramedullary interlocked nailing is the preferred surgical treatment of femo-ral diaphyseal fractures. Although Closed Nailing (CN) is popular due to its non invasiveness and excel-lent union rates, Total Open Nailing (TON) utilises direct retrograde access from the fracture site, resulting in less intraoperative imaging and potential benefits in certain situations. Aim: To compare TON in the lateral decubitus position to CN on a traction table for femoral shaft fractures with regards to intraoperative parameters, and clinical and radiological outcomes. Materials and Methods: This prospective observational study conducted at the Department of Orthopaedics, IMS and Sum Hospital, Bhubaneswar, India, over a period of 3 years from January 2020 to December 2022. It comprised 122 operated patients. aged 16–75 years with closed femoral shaft fractures. Intraoperative parameters (operative time, blood loss, radiation exposure), radiographic outcome, align-ment, time to union {The Radiographic Union Score for Tibial fractures (RUST) score ≥9} and complica-tions were evaluated. All patients were followed-up for a minimum period of 24 months. The Statistical Package for Social Sciences (SPSS) software version 25.0 was used for statistical analysis and p-value <0.05 was considered significant. Results: Of the 122 patients, six patients were lost to follow-up or withdrew from the study. A total of 116 patients (75 CN, 41 TON) completed the minimum 2-year follow-up. TON exhibited considerably lower operative time (68.2±12.4 vs 82.7±14.1 min; p<0.001) and radiation dose (61.1±26.3 vs 208.5±29.2 s; p<0.001) than CN, but with increased intraoperative blood loss (522.2±87.1 vs 164.3±37.9 ml; p<0.001). Union rates were comparable between groups (TON: 97.5%, CN: 97.3%; p=0.64), although time to union was slightly longer in TON (p=0.06). TON exhibited fewer malalignments and more precise nail placement (p=0.049), with no deep infections in either group. Conclusion: TON provides operative efficiency, lower radiation exposure, and improved alignment with similar union and complication rates, and is thus a useful choice in certain clinical situations.

Cardiorespiratory Fitness and Quality of Life among Handloom Workers of Sualkuchi, Assam: A Cross-sectional Study

Khetra Pratim Baruah, Somyata Chitaranjan Satpathy Sarma, Sonia Lakhotia Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Cardiorespiratory Fitness (CRF) measures how efficiently the heart, lungs, and muscles supply oxygen during exercise. Quality of Life (QoL) encompasses an individual’s perceived well-being and satisfaction across multiple domains, including physical, psychological, social, and en-vironmental aspects. Handloom workers are exposed to various occupational health hazards due to the na-ture of their work, which often leads to altered postural mechanisms, musculoskeletal injuries, respira-tory problems, etc. However, there has been limited research specifically addressing the CRF and overall QoL of handloom workers in Assam. This knowledge may aid in better healthcare resource allocation in the future based on their specific health needs. Aim: The aim of the study is to analyse the CRF and understanding of the health challenges faced by handloom workers due to their occupational condition and how it is affecting the QoL of Handloom Workers of Sualkuchi, Assam, India. Materials and Methods: The present cross-sectional study was conducted from January 2024 to June 2024 at Sualkuchi, Assam, India, where 74 handloom workers were assessed for CRF by the Modified Harvard Step Test. WHOQoL-BREF (World Health Organization Quality of Life - BREF (or Brief) assessment) was used to interpret the QoL across four domains: physical fitness, psychological well-being, relation-ships in society, and the effect of the environment. The Wilcoxon rank-sum test was used for the analy-sis of CRF and QoL. Correlational analysis was done between Physical Fitness Index (PFI) and Body Mass Index (BMI) using Spearman’s rank test, p<0.05 is considered significant. Results: The mean age of the participants was 36.5(±4.4) and the duration they worked for was 7(±7), respectively. The BMI of 91% of participants was in the normal range, and only 9.5% were over-weight. Modified Harvard Step Test indicated that a significant number of handloom workers had a low PFI. In terms of QoL, the handloom workers rate their social relationships the highest among the quali-ty-of-life domains, while psychological well-being is the lowest-rated domain. Conclusion: The present study underscores significant occupational health concerns among hand-loom workers, particularly in terms of CRF. Addressing these issues requires a multi-faceted approach, involving improvements in workplace conditions, health interventions, and psychological support.

Evaluating the Awareness and Knowledge of Cataract among Digitally Connected Adults in Northern Saudi Arabia: A Cross-sectional Study

Mohamed M Abd El-Mawgod, Mujeeb Ur Rehman Parrey, Asseel Farhan K Alanazi, Abdulelah Raka A Alanazi, Abdulrahman Bader N Alenezi, Rashed Satam B Alshammari, Ahmad Yousef A Alenezi, Abdulaziz Hussain A Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Cataract is one of the most common causes of vision loss, particularly in older adults, due to clouding of the eye lens. It is a complex illness that can develop from genetic, environmental, behavioural, and medical conditions. Aim: To assess awareness of cataract among a convenience sample of digitally connected adults. Materials and Methods: A cross-sectional study was conducted among a convenience sample of digitally connected adults in Arar City, Northern Saudi Arabia, the field practice area of the Medical College of Northern Border University, between May and December 2024. An online survey using a structured self-administered questionnaire was used as a data collection tool to assess awareness and knowledge of Cataract among the study population. Chi-square (χ2) and Fisher’s exact tests were used as the primary significance tests. A p-value<0.05 was considered significant. Results: The survey included 372 participants with a mean age of 32.5±11.8; the majority, 303 (81.5%), accurately identified cataract disease. Almost all respondents were aware that cataract causes visual impairment, 339 (91.1%). The most often stated risk factors for cataract were Diabetes Mellitus (DM), 287 (77.2%), and ageing, 278 (74.7%). The majority of participants agreed that cataract is curable, with surgery being the most often mentioned treatment option 335 (90.1%). Conclusion: Cataract awareness was generally high. Compared to female participants, male participants exhibited a significantly higher level of awareness regarding cataract inheritance and the congenital origin of the condition.

Drug Utilisation Pattern in the Inpatient Management of Psoriasis: A Retrospective Study from a Tertiary Care Centre in Karnataka, India

D Karthik, Anil Pandhrinath Hogade Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Psoriasis is a chronic immune-mediated inflammatory disorder that often requires multidrug therapy during hospitalisation. Evaluation of drug utilisation patterns helps assess rational prescribing practices and adherence to treatment guidelines, especially in inpatient settings where polypharmacy is common. Aim: To analyse the prescription pattern of drugs used in hospitalised psoriasis patients using World Health Organisation (WHO) prescribing indicators and to assess adherence to standard treatment guidelines. Materials and Methods: The present retrospective study was conducted over a period of two years from October 2023 to October 2025 in the Dermatology Inpatient Department of a tertiary care teaching hospital in Karnataka, India. Medical records of 82 psoriasis patients admitted during the study period were reviewed. Demographic details, type of psoriasis, co-morbidities, drug classes, route of drugs, WHO core prescribing indicators and adherence to National Institute for Health and Care Excel-lence (NICE) guidelines were analysed using descriptive statistics. Results: The mean age of patients was 51.9±16.4 years, with male predominance (44 patients, 53.66%). Plaque psoriasis was the most common clinical type observed among the study population. The mean duration of hospital stay was 5.8±4.0 days. A total of 640 drugs were prescribed across 82 pre-scriptions with an average of 7.80±3.52 drugs per prescription. Antibiotics were prescribed in 32 pre-scriptions (39.02%). At the drug level, 192 drugs (30.00%) were prescribed by generic name and 277 drugs (43.28%) were from the essential medicines list. Fixed-dose combinations constituted 130 drugs (20.31%) of the total prescribed drugs. Corticosteroids were the most frequently prescribed class of drugs, pre-dominantly in topical formulations. Adherence to NICE treatment guidelines was observed in 50 prescrip-tions (60.98%). Immunosuppressive agents were used in 35 patients (42.68%), most commonly Cyclosporine in 17 patients (20.73%) and Methotrexate in 16 patients (19.51%). No adverse drug reactions were docu-mented during the study period. Conclusion: Polypharmacy was common among hospitalised psoriasis patients, with corticosteroids and immunosuppressive agents forming the mainstay of therapy. Moderate adherence to NICE guidelines and low generic prescribing indicate the need for regular prescription audits and reinforcement of guide-line-based prescribing to promote rational drug use.

Utility of Bone Marrow Cell Block in the Diagnosis of Haematological Disorders: A Cross-sectional Study

Hafsa Shabeer, Shankaran Rukmini Niveditha, Thejasvi Krishnamurthy, Gayathri Bilagali Ramdas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The examination of Bone Marrow Aspirate (BMA) smears and Biopsies (BMBx) are well established in the diagnosis of various haematological and non-haematological disorders. While both techniques have unique advantages over the other, they also have limitations that warrant the need for a method that integrates the benefits of both approaches but maximises sample utility. The examination of Bone Marrow Cell blocks (BMCB), akin to cell blocks from fine needle aspirates, may fulfil this need. Aim: To evaluate the utility of the bone marrow cell block technique in various haematological disorders and to compare it with BMA smears and BMBx sections. Materials and Methods: The present cross sectional study was conducted over a period of one year and six months (December 2017 and June 2019) in the Department of Pathology at Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India. There were 60 study subjects for whom bone marrow ex-amination was advised by the clinicians. Bone marrow samples were procured from these 60 patients from whom 60 BMA smears, 51 BMCBs and 31 biopsies were obtained. Results from comparison of BMCB against BMA was divided into four categories based on the contribution of BMCB to the final diagnosis. With BMBx being the gold standard, BMCB was also evaluated against BMBx primarily based on Morphology with special stains for iron, reticulin as well as immunohistochemistry (CD3, CD20 and CD138). Data was tabulated and descriptive statistics, including means and percentages, were calculated. Cohen’s kappa was employed to assess the strength of agreement between BMA/BMCB and BMCB/BMBx. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software (version 23.0). Results: A male to female ratio of 1:1 with a mean age of 47.3 years. A majority of the cases were non-neoplastic (46/51, 90.19%) of which 26/51 (50.98%) were anaemia of varying etiology; neoplastic disorders comprised of 9.8% (5/51), and a diagnosis could not be made in ten cases due to specimen inadequacy. BMCBs were comparable with BMA in 39.21%, improved the diagnosis in 27.45%, non-contributory in 33.33%. Overall, the BMCB was in agreement with 50% of the BMA smears (p<0.001), and with 54.8% of the BMBx (p<0.001). It was noted that utilising part of the first pull and adjusting the volume of the fixative improved the quality of BMCB. Conclusion: The BMCB combines the morphologic clarity of an aspirate with the architectural details of a biopsy thereby maximising corroborative and diagnostic information. It is a resource effective, time-conscious technique that does not require special expertise and would be an invaluable addition to the examination of the bone marrow.

Cortactin Immunoexpression and its Association with Clinicopathological Parameters in Head and Neck Squamous Cell Carcinoma: A Cross-sectional Study

I Deepika, J Johnsy Merla, S Gurusamy, K Swaminathan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) is a group of malignancies, in-volving oral cavity, pharynx, hypopharynx, larynx. HNSCC are aggressive tumours having high invasive capacity which is due to phenotypic alterations between neoplastic cells and surrounding environment. Invadopodia are actin rich protrusions on the surface of invasive neoplastic cells that promotes degra-dation of extracellular matrix. Cortactin (CTTN), a cytoplasmic protein, promotes polymerisation and rearrangement of actin cytoskeleton plays an important role in predicting tumour progression. It’s been suggested that increased expression of cortactin in tumours will help in identifying cell migration, invasion and metastasis thereby predicting tumour progression in HNSCC. Aim: To evaluate the Immunohistochemical (IHC) expression of cortactin in biopsies and resected specimens of histologically proven HNSCC and to assess its association with tumour grade, Depth of Inva-sion (DOI), Perineural Invasion (PNI) and Tumour, Nodal, Metastasis (TNM) staging. Materials and Methods: This cross-sectional study was conducted at the Department of Patholo-gy, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, for a period of 18 months, December 2022 to May 2024, on 35 patients of histologically proven HNSCC Cortactin immunoexpression was assessed using Intensity Response Score (IRS) in biopsies and resected specimens of HNSCC. The IRS was calculated as intensity of the staining reaction multiplied by the percentage of positive cells. Based on the IRS, cortactin expression was categorised as negative (weak) immunoexpression, positive (medium and strong) immunoexpression. Positive immunoexpression was correlated with maximum depth of invasion, presence of PNI and higher TNM staging. Results: In the present study of 35 cases, the most commonly affected age group was 60-69 years. Males constituted the majority of cases 23 cases (65.71%), while females accounted for 12 cases (34.28%). Out of 10 cases (28.57%) with DOI >10 mm, positive cortactin expression was observed in 9 cas-es (90%). Among the 13 cases exhibiting PNI, cortactin positivity was observed in 12 cases (92.30%). With respect to tumour stage, cortactin positivity was identified in 7 out of 8 cases (87.50%) with the stage T3 disease and in 5 out of 6 cases (83.33%) with the stage T4 disease. Furthermore, cortactin pos-itivity was observed in all cases with nodal involvement, being present in 4 cases (100%) with stage N1 and 6 cases (100%) with stage N2. All associations were statistically significant with p-value <0.05. Conclusion: Cortactin expression was significantly observed in HNSCC cases with maximum DOI, presence of PNI and higher TNM staging. Thus, cortactin may serve as a relevant prognostic marker in assessing tumour behaviour and prognosis.

Comparison of Video Laryngoscopy and Direct Laryngoscopy during Endotracheal Intubation: A Randomised Controlled Trial

Harika Gangi, Taiyenjam Kennedy Singh, Tongbram Yashobanta Singh Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Intubating the trachea and securing the airway always remains an unavoidable challenge for the anaesthesiologist. For Direct Laryngoscopy (DL) and tracheal intubation, the Macintosh laryngoscope has been the gold standard device. With the advent of Video Laryngoscope (VL) in the recent times, it has been one of the major advances in anaesthesia practice. Aim: To compare the VL {Tuoren (TVL)} versus the Direct Laryngoscope (DL) (Macintosh) for rou-tine airway management. Materials and Methods: This single-blinded, randomised controlled trial was conducted at Shi-ja Hospitals and Research Institute, Imphal, Manipur, India from April 2021 to March 2022. A total of 100 patients of American Society of Anaesthesiologists (ASA) grades I and II, aged between 18 to 60 years, posted for planned elective surgery under General Anaesthesia (GA), were randomly allocated into two groups (n = 50 each): Group VL and Group DL. Various airway parameters, haemodynamic parameters and airway related complications were assessed and compared using Unpaired t-test for quantitative variables and Chi-square test for qualitative variables. A p-value of <0.05 was considered statistically signifi-cant. Results: Both groups were comparable in demographic characteristics (age group: in Group VL 34.36±11.49 years vs in Group DL 33.52±11.11 years, p-value=0.98, gender: p-value=0.54, ASA grading: p-value=0.76). The duration of intubation was more in Group VL (25.81±6.29 seconds) as compared to Group DL (11.96±3.96 seconds). There was a statistically significant better Modified Cormack and Lehane (MCL) grading view obtained in Group VL as compared to Group DL (p-value=0.01). The Intubation Difficul-ty Score (IDS) was significantly lower in Group VL as compared to Group DL (p-value=0.04). Conclusion: Tuoren VL provided a better glottic view and a lower IDS compared to the Macintosh laryngoscope, despite requiring a longer time for intubation. While haemodynamic parameters were compa-rable overall, the use of the Tuoren VL was associated with a statistically significant increase in Sys-tolic Blood Pressure (SBP) and Mean Arterial Pressure (MAP) at one minute after intubation. Airway re-lated complications were not encountered in either group.

Prevalence of Metabolic Syndrome in Patients with Bronchial Asthma in Kurdish Patients: A Cross-sectional Study

Subhi Yousif Farman, Baheej Yasin Mohammed Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The Metabolic Syndrome (MetS) is a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular diseases and type 2 diabetes. It may also increase the risk of bronchial asthma, a chronic inflammatory disorder. In Iraq and the Middle East, both MetS and asthma conditions are rising due to urbanisation and lifestyle changes. Specific data concerning the burden and characteristics of MetS among asthma patients attending tertiary care centres in this region remains limited. Aim: To assess the MetS prevalence among bronchial asthma patients. Materials and Methods: The present cross-sectional study was conducted at Azadi General Teaching Hospital in Duhok, Kurdistan Region of Iraq, from June 2023 to February 2024. A total of 100 patients with bronchial asthma were recruited through convenience sampling. General and medical information was collected, including age, gender, place of residence, asthma medication, adherence to regular asthma treatment, smoking status, personal history of co-morbidities, obesity, and Waist Circumference (WC). Biomedical measurements comprised Blood Pressure (BP), Fasting Blood Sugar (FBS), Triglycerides (TG), High-Density Lipoprotein (HDL), Low-Density Lipoprotein (LDL), and Total Cholesterol (TChol). In addition, physical activity levels and asthma diagnosis were assessed. Contributing factors to MetS were analysed using independent t-tests and Chi-square tests, with statistical significance set at p<0.05. Results: Among 100 asthma patients, 27% were diagnosed with MetS. Compared with non-MetS patients, those with MetS were more likely to receive regular therapy (p<0.0001), had higher rates of persistent asthma (p=0.009), and longer disease duration (p=0.0004). Hypertension (p=0.0001) and diabetes (p<0.0001) were significantly more prevalent in MetS patients. They also demonstrated worse metabolic profiles, including lower HDL, higher BMI, greater WC, elevated TGs, increased fasting glucose, and higher smoking prevalence (all p<0.05). Conclusion: The present study confirms that MetS is a common and clinically relevant Co-morbidity in patients with bronchial asthma in Duhok, Iraq. The significant association between MetS and factors indicative of greater asthma severity and significantly worse metabolic profiles necessitates a multidisciplinary approach.

Comparing the Results of Nine Laboratory Analytes Using Internal Quality Control and Patient-based Real-time Quality Control: A Retrospective Observational Study

Subhasish Nayak, Vanishree Bubanale Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Internal Quality Control (IQC) strategies, which form the basis of most Quality Control (QC) procedures, rely on routinely analysing commercially available QC materials with known ana-lyte concentrations. These materials, however, may not accurately reflect patient samples, causing po-tential issues with sensitivity (failure to detect errors) or specificity (incorrectly rejecting valid results). Aim: To evaluate the efficiency of Patient-Based Real-Time Quality Control (PBRTQC) and IQC for nine clinical chemistry analytes. Materials and Methods: The present retrospective observational study was conducted at Dr. Prabhakar Kore Hospital, Belagavi, Karnataka, India, from January 2025 to December 2025. Nine clinical chemistry analytes, whose results were within predefined truncation limits, were chosen, which include albumin, aspartate transaminase, alanine transaminase, alkaline phosphatase, creatinine, chloride, po-tassium, sodium and total protein. The efficiency was evaluated using moving average analysis with simu-lated systematic errors. Using Statistical Package for Social Sciences (SPSS) 29.0, non-normally dis-tributed variables were compared using the Mann-Whitney U test (p <0.05), with continuous data reported as frequencies. Results: The PBRTQC system demonstrated a superior 89% error detection rate for positive biases compared to 0% for IQC, identifying clinically significant biases within 4-5 patient samples N-S-D (Num-ber of Samples to Detect). Despite this high sensitivity, the system maintained exceptional specificity with a false alarm rate of <1.5%. These findings indicate that PBRTQC, utilising the native patient ma-trix, provides a highly efficient and reliable real-time alternative to traditional batch-based QC. Conclusion: The present study concludes that PBRTQC significantly outperforms traditional IQC by detecting systematic errors more effectively than IQC. The results highlight that PBRTQC offers supe-rior sensitivity to matrix-related biases that commercial QC materials often miss, particularly in de-tecting shifts that IQC failed to flag. Ultimately, it is recommended to use a hybrid QC model that lev-erages PBRTQC for continuous, real-time monitoring alongside IQC to ensure comprehensive detection of both systematic and random errors.

Outcome Analysis of Minimally Invasive Single Level Microdiscectomy in Awake Spine Surgery: A Prospective Interventional Study

Harsh Manojkumar Thesia, Sohael M Khan, Kashyap Kanani, Shailly Rajnish Tiwari, Samarth Kashyap Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Lumbar Prolapsed Intervertebral Disc (PIVD) is a common cause of low back pain with radiculopathy, frequently affecting the economically productive age group and leading to signifi-cant functional disability. When conservative management fails, surgical intervention is indicated, with minimally invasive microdiscectomy increasingly preferred due to reduced tissue trauma, blood loss, and faster recovery. Awake spine surgery performed under Spinal Anaesthesia (SA) has emerged as an alterna-tive to General Anaesthesia (GA), offering potential advantages such as early mobilisation, shorter hos-pital stay, and fewer anaesthesia-related complications. However, limited evidence exists regarding clinical and functional outcomes of minimally invasive single-level microdiscectomy performed under awake conditions, particularly in the Indian setting, justifying the present study. Aim: To analyse outcome of minimally invasive single level microdiscectomy in awake spine sur-gery. Materials and Methods: The present prospective interventional study was conducted in the De-partment of Orthopaedics, AVBRH, Sawangi, Wardha, Maharashtra, India from February 2023 to August 2025 among 40 patients undergoing minimally invasive micro-discectomy using awake spine surgery technique in for single level lumbar PIVD. Pre and postsurgery; every patient had a neurological examination as part of their clinical evaluation and Visual Analogue Scale (VAS) was used to measure pain; Oswestry Disabil-ity Index (ODI) was used for functional evaluation, Roland-Morris Disability Questionnaire (RMDQ) was used to measure physical disabilities. The Short Form-36 Health Survey (SF-36) was used to measure health-related quality of life. Means and standard deviations of the measurements for each group were employed using Statistical Package for Social Sciences (SPSS) software version 25. The t-test and Chi-square test were used to statistically analyse the data for each assessment point. Results: The study participants’ preoperative mean VAS score was 5.45±1.08. After surgery, the mean VAS continued to drop on days 7, 30, and 90. The study participants’ preoperative mean ODI was 50.925±8.13. After surgery, the mean ODI continues to improve on days 7, 30, and 90. The study partici-pants’ preoperative mean RMDQ was 17.05±2.99. On days 7, 30, and 90 after surgery, the mean RMDQ was 10.725, 7.50, and 4.65, respectively. When compared to baseline, the mean RMDQ continues to improve con-siderably (p<0.01) at days 7, 30, and 90 after surgery. When compared to baseline, the mean SF-36 con-tinued to improve considerably (p<0.01) at days 7, 30, and 90 after surgery. Conclusion: Minimally Invasive Spine Surgery (MISS) performed under SA was associated with low blood loss, efficient operative timing, significant pain and functional improvement, enhanced quality of life, and acceptable complication rates.

Standardisation of a Semi-nested PCR for Early Identification of Candida auris: A Cross-sectional Study from Southern India

K Vichitra, Rajyoganandh Subramanian Vijayaraman, Thayanidhi Premamalini, Anupma Jyoti Kindo Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Candida auris has drawn more clinical attention due to its multidrug re-sistance. More than 90% of C. auris isolates are known to be resistant to all the antifungal drugs. Conventionally, the identification of C. auris has not been described precisely yet but one such ability of this yeast is that they can grow at an elevated temperature and fail to grow in the presence of cycloheximide and in automated approaches like VITEK 2, Matrix-assisted Laser Desorp-tion/ionisation Time-of-flight (MALDI-TOF), Analytical Profile Index 20C AUX yeast (APIC20C-AUX) they can be misidentified as other species, which can lead to errors in the choice of antifungals. Aim: To standardise a simple in-house semi-nested colony Polymerase Chain Reaction (PCR) for accurate identification of C. auris. Materials and Methods: A cross-sectional study was conducted at the Department of Microbiolo-gy at Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India, from March 2017 to February 2018. All the Candida isolates obtained from blood samples over a period of one year were considered for this study. All the isolates underwent conventional phenotypic identification, such as microscopy, sub-culturing on Sabouraud Dextrose Agar (SDA) with antibiotics and chromogenic me-dium and carbohydrate fermentation. Further genotypic identification was performed for all the isolates. Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR-RFLP) was initially performed, and the isolates that were unidentified by this method were sent for gene sequencing. C. auris-specific primers were designed manually. A semi-nested colony PCR was performed using the self-designed primers for all the isolates. Results: A total of 87 Candida sp. were isolated and considered for this study. Phenotyp-ic and genotypic identification was performed for the isolates. In the study, it was observed that C. auris was misidentified by commonly used phenotypic methods as Candida haemulonii and Candida parapsilosis and hence, further PCR-RFLP was performed to confirm the species. The iso-lates that still couldn’t be identified by PCR-RFLP were sent for gene sequencing. All the isolates were subjected to C. auris-specific semi-nested PCR for identification. A 22 (25.3%) out of the 87 isolates produced amplicons of size 400 bp. The rest 65 (74.7%) isolates did not produce bands. All 22 isolates that produced bands were confirmed as C. auris by gene sequencing. Conclusion: To conclude, an in-house, semi-nested colony PCR (2-hour) method for differentiat-ing C. auris from Candida haemulonii was standardised. This method not only differentiates C. auris from Candida haemulonii but also other Candida species. This test will be useful in the early identification of C. auris in any microbiological laboratory set-up.

Risk of Root Resorption between Clear Aligners and Fixed Orthodontic Appliances: A Retrospective Cohort Study

Hanadi Sabban, Suwarna Dangore Khasbage, Salma Hossameldin Ghoneim, Amal Mohammed Said Abushal, Ghadir Al-Sakkaf, Linah Al-Labban, Nouf Baeshen, Khadija Turkistani Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: External Root Resorption (ERR) is a recognised complication of orthodontic treatment, and its severity may vary with appliance type. Clear aligners are often perceived as a more biologically gentle alternative to conventional fixed appliances; however, evidence directly comparing ERR between these modalities remains limited. Most studies focus on specific teeth or use small, hetero-geneous samples, making it difficult to draw definitive clinical conclusions. The present study address-es this gap by comprehensively evaluating ERR patterns at the patient level, including severity, distri-bution, and tooth-specific involvement, in a single Institutional cohort. Aim: To evaluate and compare the prevalence and severity of ERR in patients treated with clear aligners and conventional fixed orthodontic appliances. Materials and Methods: A retrospective cohort study was conducted at King Abdulaziz Universi-ty Dental Hospital, Jeddah, Saudi Arabia between November 2022 and September 2025 on 100 patients. The sample comprised 57 patients treated with fixed appliances and 43 patients treated with clear aligners. Pretreatment and post-treatment panoramic radiographs were extracted from the Radiology Department ar-chive and reviewed to assess ERR. Parameters evaluated included the prevalence of ERR, its severity, number of teeth affected, unilateral or bilateral involvement, tooth-specific involvement, and treatment duration. Mann-Whitney U test, Chisquare test, Fisher’s-exact test were used for statistical analysis. Results: Of 100 patients, 57.0% were treated with fixed appliances and 43.0% with clear align-ers. The aligner group was older ( 26.8±19.5 years, p<0.001) and included more females {35 (81.4%) vs 29 (50.9%), p=0.003}, while malocclusion type did not differ (p=0.215). Extractions were significantly more frequent with fixed appliances (p<0.001), and treatment duration was longer (p=0.005). ERR preva-lence (p=0.002), severity (p<0.001), bilateral involvement (p=0.008), and multi tooth involvement (p=0.033) were all higher in the fixed appliance group. Multivariable regression confirmed fixed appli-ance therapy as the significant predictor of ERR (p=0.034). Conclusion: Although both fixed appliances and clear aligners are associated with a risk of ERR, fixed appliances demonstrated significantly higher prevalence, greater severity, and wider distri-bution of resorption. Clear aligners showed a biological advantage in limiting ERR, particularly in max-illary incisors, though careful radiographic monitoring remains essential with both modalities.

Changing Patterns of Tobacco use and Psychological Barriers to Tobacco Use Cessation Among Those in Early Remission of Alcohol Dependence: A Cross-sectional Study

Adithya Biswas, Kailash Sureshkumar, Shabeeba Z Kailash, Aravindh Manogaran, S Nivedita Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Tobacco and alcohol are the most common combination of substances of abuse. Studies show that tobacco use patterns change when alcohol dependent patients abstain with readiness to change and smoker’s risk perception forming the major psychological barriers to quitting tobacco use in this period. This represents an under-studied aspect of nicotine dependence that the present study aimed to explore. Aim: To study changing patterns of tobacco use and the association between perceived health risks, readiness to change, and nicotine severity among patients of alcohol dependence in early remis-sion who are current tobacco smokers. Materials and Methods: The present cross-sectional study was conducted in the outpatient ser-vices of the Department of Psychiatry at a tertiary healthcare centre in Tamil Nadu, India over a period of two months between June to July of 2025. Ethical clearance was obtained and a sample of 100 patients of alcohol dependence in early remission who smoke were selected. They were evaluated for the severity of their nicotine dependence, addiction and health risk perceptions towards self and others and willing-ness to quit smoking. Statistical Package for Social Sciences (SPSS) version 27 was used for the statis-tical analysis involving analysis of variance, Pearson’s correlation and paired t-test. Results: There was a significant difference between means of willingness to change and smok-ers’ perceived health risk (p=0.021), addiction risk (p=0.026) as well as severity of nicotine depend-ence (p=0.008). The test also showed that those who had lower stages of readiness to change had lower perceived risk scores (statistically significant for perceived health and addiction risk domains) and higher severity of nicotine dependence. Pearson’s correlation shows a significant inverse correlation between severity of nicotine dependence and perceived health risk, addiction risk and harm to others (p<0.001). Conclusion: Patients in poorer motivation stages of readiness to change tended to have higher severity of nicotine dependence and perceived risk towards their health and addiction status. Those who had more severe dependence also had poorer perceived risk. Targeted interventions towards improving mo-tivation to quit and improving risk awareness will aid in tobacco use cessation.

Effects of Ozonated Water and Sodium Hypochlorite as an Irrigant on Postoperative Pain in Patients with Symptomatic Apical Periodontitis: A Split Mouth Randomised Clinical Trial

Aayush Paresh Bhatt, Roshan Samuel Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Even after prompt administration of local anaesthesia during root ca-nal/endodontic treatment procedures, postoperative pain resulting from improper irrigation techniques remains a major issue in endodontics. Nonetheless, serious efforts were made for incorporating effective irrigation protocols using conventional irrigation methods such as Sodium Hypochlorite (NaOCl) and aque-ous ozone. Even though they have demonstrated strong bactericidal properties and numerous other ad-vantages, the effects of these methods on patients with symptomatic apical periodontitis undergoing sin-gle-visit root canal therapy are not well understood. Aim: To determine the effects of ozonated water and NaOCl as an irrigant on postoperative pain in patients with symptomatic apical periodontitis undergoing single-visit root canal therapy using the Visual Analogue Scale (VAS). Materials and Methods: The present single-centre, prospective, double-blinded, parallel-group, equivalency, split-mouth, randomised clinical trial was conducted during the period of June 2022-May 2025 at Department of Conservative Dentistry and Endodontics, SDS, KVV, Karad, Maharashtra, India, on a total of 25 patients (n=25) and 50 teeth (n=50) that were randomly assigned to two groups by com-puter-generated Sequentially Numbered, Opaque Sealed Envelopes (SNOSE) method. Following the convention-al procedure for biomechanical tooth preparation, one arch irrigated with 5.25% NaOCl was designated as “Group A” and opposite arch irrigated with ozone water and then subjected to 20 seconds of Ultrasonic Activation (UA) was designated as “Group B”. To assess the precision of the root canal obturation, a periapical radiograph was obtained after the procedure. Finally, the level of postoperative discomfort was measured at 6 hour, 12 hour, 24 hour, 48 hour, 72 hour, and 7-day period using a VAS. Statistical Package for Social Sciences {Statistical Package for Social Sciences (SPSS), Version 21.0} was used to analyse the data. The Kolmogorov-Smirnov test and Pearson’s chi-square test were used to compare means and analyse categorical data. Results: A mean pain score of 3.64 (SD±0.95), 2.68 (SD±0.90), 1.44 (SD±0.58), 0.76 (SD±0.52), 0.56 (SD±0.51) and 0.00 (SD±0) for Group A and 4.12 (SD±0.97), 3.08 (SD±0.81), 1.68 (SD±0.69), 0.72 (SD±0.54), 0.52 (SD±0.51) and 0.00 (SD±0) for Group B was obtained at 6 hr, 12 hr, 24 hr, 48 hr, 72 hr and 7-day period respectively. Group B showed a slightly higher mean pain score than Group A but the difference was non-significant (p>0.05). Conclusion: Intracanal irrigation with 5.25% NaOCl or aqueous ozone, ultrasonically triggered, reduced postoperative discomfort during a 7-day period. However, there was no significant difference in pain reduction between the two groups.

Acute Oral Toxicity of Aqueous Alcoholic Extract of Punica granatum Fruit Pulp in Female Swiss Albino Mice: An Experimental Study

C Reddy Prasad, D Santoshi Roopa, C Senthil Kumar Sivanesan, M Yuvaraj, AK Afzal Khan, J Thirunavukkarsu Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Punica granatum L. (pomegranate) is broadly consumed as a dietary fruit and has a long history of use in traditional health practices. The edible fruit pulp, comprising the fleshy arils, has been incorporated into diets across regions for its taste and nutritional value. Aim: To assess the acute oral toxicity of an aqueous-alcoholic extract of Punica granatum fruit pulp in female Swiss albino mice in accordance with Organisation for Economic Cooperation and Development (OECD) Guideline 423. Materials and Methods: An experimental study was carried out in centre for Laboratory Animal Research (CLAR) Saveetha Medical College and University, Chennai, Tamil Nadu, India. The animals were procured from Biogen laboratory, animal facility, Bangalore, Karnataka, India. The study was conducted from 8th to 23rd April 2025. Healthy, adult female Swiss albino mice aged 8 to 12 weeks were included in the study. A limit test at one dose level of 2000 mg/kg body weight was carried out with six animals (3 animals per step). According to OECD 423, mortality and toxicity, clinical signs for exclusively initial few hours. Body mass, food and water intake, psychological behavioural changes were assessed and later for a period of 14 days. At study termination, haematological indices, serum biochemical parameters and urine profiles were assessed. Histopathological examination of major organs was performed to evaluate tissue architecture. Statistical analysis was done to analyse significance level in the study. Results: No mortality or treatment-related clinical signs were noticed throughout the observa-tion period. Body weight progression, food and water intake remained comparable to controls. Haematolog-ical parameters, serum liver enzymes {Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP), Gamma-glutamyl Transferase (GGT)}, renal markers {urea, creatinine, Blood Urea Nitrogen (BUN), uric acid} and lipid profile values showed no significant differences between treated and control groups (p-value >0.05). Urinalysis and histopathology revealed normal structural features without evidence of cellular degeneration, inflammation, or organ-specific toxicity. Conclusion: The aqueous-alcoholic extract of Punica granatum fruit pulp did not elicit acute toxic effects at a limit dose of 2000 mg/kg in mice, indicating a high margin of safety. These results provide baseline toxicological support for the safe practice of pulp-derived preparations; how-ever, additionally subchronic and chronic studies are required to establish long-term safety thresholds.

Comparison of Proposed Drilling Technique with Osseodensification and Standard Drilling for Enhancing Primary Stability of Implants in Low Density Bone: A Randomised Clinical Trial

Mamatha Nanjappa Siddalingappa, Madhumati Singh, Soundharya Meyyappan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Primary implant stability is a critical factor in successful osseointegration. It is influenced by several variables such as bone density, implant design, and the surgical technique employed. The surgical technique plays a particularly crucial role in low-density bone. Aim: To evaluate the primary stability of implants placed using the proposed drilling technique, the osseodensification technique, and the standard drilling technique in low-density bone. Materials and Methods: This randomised clinical study was conducted in the Department of Im-plantology, Rajarajeswari Dental College and Hospital, Bengaluru Karnataka, India, from March 2022 to February 2023. A total of 57 participants (75 dental implants - 40 in maxilla and 35 in mandible) were enrolled and randomly assigned to one of the three drilling protocol groups, group I- Proposed drilling protocol (n=25 implants) were placed and group II- Osseodensification technique (n=25 implants) and group III- Standard drilling technique (n=25 implants). Insertion Torque (IT) and Implant Stability Quo-tient (ISQ) were measured as a measure of primary stability. Descriptive statistics were used to measure IT, Resonance Frequency Analysis (RFA) value in terms of mean and standard deviation for each group. One-way Analysis of Variance (ANOVA) test followed Tukey’s post-hoc test was used to compare the mean IT and RFA between the three groups. The level of significance was set at p-value <0.05. Results: This study included 57 patients, of whom 34 were females and 23 were males, with an age range of 20–62 years and a mean age of 41 years. The mean Insertion Torque (IT) value in group I was 46.75±4.94 Ncm, in group II was 43.25±3.73 Ncm, and in group III was 31.50±4.01 Ncm. Group I demon-strated a significantly higher mean IT compared to group II (p=0.03) and group III (p<0.001). Addition-ally, group II showed a significantly higher mean IT compared to group III (p<0.001). The mean Implant Stability Quotient (ISQ) in group I was 65.90±3.74, in group II was 60.83±3.29, and in group III was 56.78±3.25. Group I demonstrated a significantly higher mean ISQ compared to both group II and group III (p<0.001). Conclusion: Primary stability of implants placed in low-density bone was enhanced with the pro-posed drilling and osseodensification techniques when compared to the conventional drilling technique.

Histopathological Spectrum of Brain Autopsies: A Cross-sectional Study

Pallavi Mishra, Swatismita Sahoo, Yugosmita Patra, Goutami Dasnayak, Ranjan Kumar Mallick, Kalyani Prava Gouda Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Brain autopsy unveils diverse manifestations that enthrall the pathologists. These are often undiagnosed, sometimes misdiagnosed or may show progression during a person’s lifetime. Due to paucity of literature on pathological spectrum of Central Nervous System (CNS) lesions on autopsy present study was conducted to broaden the horizon in this aspect. Aim: To identify and document the histopathological findings incidentally detected in brain au-topsies. Materials and Methods: A retrospective cross-sectional study of medicolegal autopsies was performed in the conducted at the Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India for a period of one year from January 2024 to December 2024. A total of 103 CNS autopsy cases were documented. The histopathological findings in each case were noted. Age, gender, incidence, nature of lesions and histopathological findings were recorded in each case. Descriptive statistics was used for quantitative data described as frequency and percentage. Results: This study consisted of a total of 103 cases. Among them, 81 cases (78.64%) of the lesions were non neoplastic while 22 cases (21.36%) were neoplastic. A total of 15 cases (14.56%) did not show any remarkable CNS pathology. Infection was the most common aetiology comprising of 35 cases (33.9%) followed by primary brain neoplasms 15 cases (14.56%). Traumatic causes 14 cases (13.6), degen-erative causes including neurodegenerative diseases 12 cases (11.6%), secondaries in brain 7 cases (6.8%) and the vascular causes 5 cases (4.85%) summed up the spectrum of histopathological spectrum of CNS autopsies. Conclusion: The incidental and interesting observations are essential for research and epidemi-ological studies. They have also diagnostic significance as they help to determine the natural evolution of diseases, treatment outcome and prognosis.

Ultrasound-based Quantification of Anterior Neck Soft-tissue Thickness for Early Prediction of Difficult Laryngoscopy in Obese Individuals: A Cross-sectional Study

Aboobakkar Kanchikatta Shanfer, Jaseem Baliyambra, Sunil Rajan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Ultrasound has emerged as a simple, portable, non invasive, and reliable tool for airway assessment. It is safe, readily available, repeatable, and provides real-time dynamic images, making it particularly useful when combined with airway procedures. Aim: To evaluate the role of bedside airway ultrasonography in identifying predictors of diffi-cult laryngoscopy in patients with Body Mass Index (BMI) between 30 and 34.9 kg/m². Materials and Methods: This cross-sectional study was conducted at Lisie Hospital, Ernakulam, Kerala, India, over six months (July-December 2015). A total of 50 obese patients (BMI 30-34.9 kg/m²) were included. Clinical predictors such as Neck Circumference (NC) at the level of the thyroid cartilage were assessed, along with ultrasound-guided measurements of anterior neck soft-tissue thickness at the thyrohyoid membrane, hyoid bone, and vocal cords. Laryngoscopic view was graded using the Cormack-Lehane classification and categorised as easy or difficult. Statistical analysis was performed using Statisti-cal Package for the Social Sciences (SPSS) version 22.0. Continuous variables were expressed as mean±standard deviation. Appropriate statistical tests were applied, and a p-value <0.05 was considered significant. Results: The study population included 22 males (44%) and 28 females (56%), with a mean age of 42.92±7.63 years and mean BMI of 31.70±1.13 kg/m². Easy laryngoscopy was observed in 35 patients (70%), while 15 patients (30%) had difficult laryngoscopy. Age, gender, and BMI showed no significant association with laryngoscopy difficulty (p-value >0.05). Thyromental Distance (TMD) and Inter-Incisor Gap (IIG) were comparable between groups. NC was significantly greater in the difficult laryngoscopy group (46.60±2.90 cm) compared to the easy group (39.97±2.08 cm) (p-value <0.001). Ultrasound measure-ments revealed significantly increased anterior neck soft-tissue thickness at all three levels in pa-tients with difficult laryngoscopy (p-value <0.001). Conclusion: Difficult airway remains a major contributor to anaesthesia-related morbidity and mortality. Incorporating ultrasonography into preoperative airway assessment provides a reliable, inex-pensive, and real-time method for predicting difficult laryngoscopy, enabling better airway planning.

Comparison of USG-guided with Anatomical Landmark-guided TAP Block following Total Abdominal Hysterectomy: A Randomised Controlled Trial

Angan Ghosh, Sanjot Ninave Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Ideal postoperative pain management after Total Abdominal Hysterectomy (TAH) is linked with patient comfort, earlier recovery, and opioid consumption reduction. The Transversus Abdomi-nis Plane (TAP) block provides somatic analgesia for the anterior abdominal wall, which can be achieved using either anatomical landmarks or Ultrasound (USG). USG-guided TAP blocks offer real-time imaging, accurate local anaesthetic deposition, and potentially superior analgesic outcomes. Aim: To compare the efficacy of USG-guided and anatomical landmark-guided TAP block with 0.25% bupivacaine with 10 mg nalbuphine in patients undergoing TAH under subarachnoid block. Materials and Methods: This randomised controlled trial was conducted in the Department of Anaesthesiology at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Wardha, Maharashtra, India from August 2023 to March 2024. Total of 60 female patients scheduled for elective TAH under spinal anaesthesia were randomly assigned to receive USG-guided, group U (n=30) or landmark-guided, group A (n=30) TAP block. Bilateral TAP blocks were administered following the completion of surgery with 20 mL of study drug on each side. Postoperative pain using the Visual Analogue Scale (VAS), block duration, number of block failures, complications, sedation scores, and patient satisfaction were assessed. Statistical inference was performed using Independent t-tests and Chi-square tests, where p-value<0.05 was considered significant. Results: The mean age (44.67±7.00 vs 45.53±6.01 years), weight (58.37±3.75 vs 59.47±4.07 kg), height (157.87±3.79 vs 158.77±3.23 cm), Body Mass Index (BMI) (23.42±1.18 vs 23.58±1.23 kg/m²), and distribution of American Society of Anaesthesiologists Physical Status Classification grades I/II (17/13 vs 18/12) were comparable between the two groups, with no statistically significant differences. USG-guided TAP block provided much longer sensory blockade (629.16±19.67 min vs. 593.96±28.45 min, p<0.01), total analgesia time (666.63±35.80 min vs. 618.97±51.32 min, p<0.01), and rescue analgesia time (676.37±36.16 min vs. 630.20±47.37 min, p<0.01) compared to landmark-guided blocks. Group U had decreased VAS scores and sedation scores, with statistical significance. Group U had two cases of block failure, whereas group A had three cases of block failure. Adverse events were few and statistically non significant. Patient satisfaction was slightly better in group U, although the difference was not sta-tistically significant. Conclusion: USG-guided TAP block is associated with superior postoperative pain relief, fewer block failures, lower pain scores, and fewer rescue analgesics administered compared to the landmark-guided method for patients undergoing TAH under spinal anaesthesia. Both techniques were haemodynamical-ly stable and well-tolerated. USG guidance enables precise needle placement and optimum local anaesthet-ic deposition and should thus be employed for TAP blocks in TAH.

Hepatoprotective and Hypolipidaemic Effects of Bacopa monnieri in High-fructose Corn Syrup-induced Non Alcoholic Fatty Liver Disease in Male Wistar Rats: An Experimental Study

G Balavigneshwaran, Urmila Kagal, Ranjit Kangle Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is a global health concern strongly linked to excessive dietary fructose intake. High-Fructose Corn Syrup (HFCS) contributes significantly to metabolic dysregulation, hepatic steatosis and inflammation. Bacopa monnieri, a traditional Ayurvedic herb with antioxidant properties, was investigated for its potential protective effects against HFCS-induced hepatic injury and dyslipidaemia. Aim: To evaluate the hepatoprotective and hypolipidaemic potential of an alcoholic extract of Bacopa monnieri against HFCS-induced NAFLD in Wistar albino rats. Materials and Methods: This 12-week experimental study was conducted at the Department of Pharmacology, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India, from March 2024 to February 2025 and included 18 Wistar albino rats divided into three groups (n = 6): Group I (Normal Control), Group II (HFCS Control) and Group III (HFCS + Bacopa monnieri 40 mg/kg, per os). Hepatic injury was assessed using serum markers: Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Gamma-Glutamyl Transferase (GGT). Lipid profile parameters such as Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C) were analysed. Liver sections were subjected to histopathological examination {Haematoxylin and Eosin (H&E) staining}. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) followed by Tukey’s post-hoc test (p<0.05). Results: Chronic HFCS administration caused significant hepatocellular injury, evidenced by elevated serum AST, ALT and GGT levels compared to the normal control group (p<0.05). The HFCS group also exhibited profound dyslipidaemia, characterised by increased TC, TG and LDL-C levels, along with reduced HDL-C levels. Treatment with Bacopa monnieri significantly attenuated these enzymatic elevations and reversed lipid profile alterations (p<0.05). Histopathological findings corroborated the biochemical results, showing reduced macrovesicular steatosis, hepatocyte ballooning and inflammatory infiltration, with restoration of near-normal hepatic architecture. Conclusion: Bacopa monnieri demonstrates significant hepatoprotective and hypolipidaemic activity against HFCS-induced liver injury, as evidenced by attenuation of serum liver enzymes, improvement in lipid profile parameters and reduction in histopathological alterations. These findings suggest its potential utility as a therapeutic adjunct in the management of NAFLD.

Quantifying Tumour Stroma Ratio and Desmoplastic Stroma in Colorectal Cancer: A Cross-sectional Study

Ramya Chitturi, Muni Bhavani Itha, Sandhya Krupal Variganji, Aparna Chinnam, Satya Saikumar Laxmi Prasanna Kantubhukta, Gonji Suma Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Tumour microenvironment plays an important role in the progression and invasion of cancer. There has been search for newer prognostic markers in colorectal cancers. Tumour Stroma Ratio (TSR) is an estimate of proportion of epithelial and stromal cells. Desmoplastic Reaction (DR) is the growth of fibrous tissue around tumour cells. DR and TSR have been found to have prognostic significance in colorectal cancers. Aim: To evaluate TSR and DR and determine their association with clinicopathological features in colorectal carcinoma. Materials and Methods: This was a retrospective cross-sectional study conducted in the De-partment of Pathology, Guntur Medical College, Kanna Vari Thota, Guntur, Andhra Pradesh, India, from June 2021 to May 2024. The study included all consecutive resected cases of histopathologically con-firmed colorectal adenocarcinoma received in the Department of Pathology during the study period. TSR and DR were characterised by two independent pathologists. Chi-square test was used to assess the asso-ciation of TSR, types of desmoplastic response with clinicopathological parameters evaluated included age, gender, tumour location, histological grade, pathological T stage, lymphovascular invasion, peri-neural invasion, lymph node metastasis, TSR, and DR. Results: A total of 53 cases of colorectal carcinomas were identified with the median age being 60 years. Stroma High (SH) tumours were seen in 19 (35.8%) cases and Stroma Low (SL) tumours in 34 (64.2%) cases. SH tumours were associated with advanced pathological stage, suggesting a potentially poorer prognosis. SL tumours were associated with mature stroma and favourable outcomes. Mature type of DR was seen in 31 (58.5%) cases, intermediate type in 18 (34%) cases and immature type in 4 (7.5%) cas-es. Chi-square test was used to assess the association between TSR, DR, and clinicopathological parame-ters. A statistically significant association was observed between TSR and pathological T stage (p=0.03) as well as DR (p=0.023). Conclusion: TSR showed statistically significant association with T stage and DR, suggesting its potential as a supportive histomorphological parameter. Incorporation of these newer parameters in pathology reports may aid in treatment decisions.

Evaluating the Role of TGF Beta and TGF Beta Type 2 Receptor Along with p53 in Breast Cancer: A Cross-sectional Study from a Tertiary Care Centre of Eastern India

Palash K Mandal, Anindya Adhikari, Subrata Pal, Kaushik Dey, Subir Biswas, Aditi Sarkar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Immunohistochemical study of different markers is crucial now-a-days for molecu-lar classification and study prognosis of breast cancer cases. A remarkable relationship is observed between immune-markers like Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor (HER) 2, p53 and Transforming Growth Factor β (TGF) and its type 2 receptor. Aim: To evaluate the role of TGF β and TGF β type 2 receptor along with p53 for molecular classification of breast carcinoma. Materials and Methods: The present cross-sectional study was conducted over a period of one year on 98 cases of breast carcinoma, which was evaluated by immunohistochemical analysis of ER, PR, HER 2, p53, TGF β and TGF β type 2 receptor biomarkers. Estrogen, progesterone and HER 2 expressions were used for molecular typing (Luminal A, Luminal B, Her 2 enriched and Triple negative) of cases. Subse-quently, the results of different molecular types were correlated with expression of p53, TGF and its type2 receptor. Results: In the present study of molecular typing, the authors found 33 cases of Luminal A, 32 cases of Luminal B, 20 cases of Her2 enriched and 13 cases were triple negative. TGF β and its type 2 receptor positivity were found in 50 and 36 cases, respectively. Conclusion: Increased positivity of TGF and its receptor TGF beta 2 in the luminal B subtype indicates its possible dual role of tumour suppressor and tumour promoter. Highest p53 expression in Luminal A type may indicate P53 mutations are not always present in all cases of breast cancer of this region.

Comparative Evaluation of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio as Prognostic and Mortality Predictor in COVID-19 Patients: A Retrospective Study from a Tertiary Care Centre in Southern India

Hrudya Venugopal, Smitha Kiran, Regi Jose Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Coronavirus Disease-2019 (COVID-19) demonstrates marked heterogeneity in clini-cal outcomes, ranging from mild illness to severe disease and death. Early identification of patients at risk of deterioration is essential for timely intervention. Inflammatory haematological indices such as Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) have emerged as potential prognos-tic markers, but comparative evidence from Indian tertiary care settings remains limited. Aim: To evaluate and compare the prognostic value of admission-day NLR and PLR for predicting mortality and Intensive Care Unit (ICU) admission among hospitalised COVID-19 patients. Materials and Methods: This retrospective study included 521 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 patients admitted between January and December 2021 in Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, a tertiary care hospital in Southern India. Demographic details, co-morbidities, and baseline haematological parameters were ana-lysed. NLR and PLR were calculated from admission complete blood counts. Receiver Operating Characteris-tic (ROC) curve analysis, logistic regression, and linear regression models were used to assess prognos-tic performance. Results: The median NLR was 7.17 (IQR 3.71-11.25), and the median PLR was 200.22 (IQR 128.8-268.4). An NLR cut-off of 4.875 predicted mortality with an AUC of 0.832, sensitivity of 67.1%, and specificity of 83.1% (p-value <0.0001). PLR showed lower discriminative ability (AUC 0.694). Admission-day NLR independently predicted ICU admission (OR 1.257; 95% CI 1.181-1.339). Both NLR and PLR were as-sociated with longer hospital and ICU stay. Conclusion: Admission-day NLR is a superior predictor of mortality, ICU admission and duration of ICU/hospital stay duration compared to PLR. Its low cost, ease of calculation, and strong prognostic value make it a practical tool for early risk stratification.

Development and Evaluation of a Teleconsultation Training Module for Indian Medical Undergraduates: A Pilot Mixed-methods Study

SH Lavanya, Donna T Weiss, L Kalpana, Medha A Joshi, Seema Deepak Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Online video teleconsultation requires skills that are currently not included in the Indian Undergraduate (UG) medical curriculum. Medical students lack competence related to telecon-sultation. Despite proposed national telemedicine guidelines and an increasing use of teleconsultations, there is a paucity of literature related to the training of UG medical students. Aim: To develop, implement, and evaluate a structured teleconsultation training module for UG medical students. Materials and Methods: An exploratory sequential mixed-method pilot study with a pre-post design was conducted in the Department of Pharmacology, BGS Global Institute of Medical Sciences, Benga-luru, Karnataka, India from July 2023 to March 2024 among 30 second-year medical students. A total of 34 students were enrolled and 30 completed the study. The study developed and implemented a teleconsulta-tion module consisting of synchronous and asynchronous teaching sessions. The curriculum focused on technical proficiency and ethical aspects, including communication, informed consent, and e-prescription. Active learning techniques, such as role-plays and interactive lectures, were utilised. With informed consent, student competence was evaluated through pre-validated Multiple Choice Questions (MCQs) knowledge questionnaires and checklist-based simulated-patient encounters. Results: The study achieved its defined threshold for educational impact, which required at least 80% of students to demonstrate a >50% increase in post-intervention scores. Following training, 93% of students showed significant improvement in the knowledge questionnaire, and 96.7% demonstrated enhanced proficiency in simulated-patient encounters. Furthermore, all students and faculty reported improved confidence in “web-side” etiquette and proficiency in module delivery, respectively. Signifi-cant improvements were observed in knowledge and skills (p<0.05). Conclusion: With the changing healthcare landscape, it is imperative to integrate structured teleconsultation training into the Indian UG curriculum. Equipping students with formal virtual care skills is essential for meeting modern healthcare demands and ensuring adherence to national guidelines.

Correlation between Forward Head Posture, Reaction Time and Eye-hand Coordination among College-going Students: A Cross-sectional Study

Mritunjay Kumar, Subhasish Chatterjee, Mousumi Saha, Muskan, Isha, Shanvi, Shivi Bajpai, Anushka Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Forward Head Posture (FHP) is prevalent among college students, potentially im-pairing sensorimotor function via disrupted proprioceptive feedback, though evidence in asymptomatic populations remains limited. Aim: To investigate correlations between Craniovertebral Angle (CVA), eye-hand coordination Al-ternate Hand Wall Toss Test (AHWTT) and reaction time {Ruler Drop Test (RDT)} in asymptomatic students with FHP. Materials and Methods: A cross-sectional study of 100 college students (aged 18-26 years, CVA <53°) was conducted between December 2024 to February 2026 at the Department of Physiotherapy, Mahari-shi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India. CVA was measured using photogrammetry with Kinovea software, AHWTT was recorded as the number of successful catches in 30 seconds. Reaction time was calculated by RDT. Normality was confirmed (Shapiro-Wilk); Pearson’s correlation was used to assess correlation between the variables. Results: Mean CVA was 38.16±5.26°. A moderate positive correlation was found between CVA and AHWTT performance (r=0.518, p<0.001). Small negative correlations existed between CVA and left-hand re-action time measures (r=-0.268, p=0.007; r=-0.265, p=0.008), while no significant correlation was ob-served with right-hand reaction time (r=-0.142, p=0.158). Conclusion: Less severe FHP correlates with better eye-hand coordination and faster hand reac-tion time in asymptomatic students, supporting postural screening for early sensorimotor optimisation.

Understanding Resilience among Migrant Construction Labourers: A Qualitative Study on Social Support and Biopsychosocial-spiritual Challenges

Aron Antony Raj, Alex Joseph, Dhasarathi Kumar, Roshni Mary Peter Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Interstate migrant construction workers in India face severe psychosocial and health challenges characterised by high psychological distress, financial instability, and inadequate healthcare access. Aim: The present study aimed to explore and understand the Biopsychosocial-Spiritual (BPSS) re-silience of interstate migrant construction workers in the Chengalpattu district, Tamil Nadu, India. Materials and Methods: A qualitative In-Depth Interview (IDI) based study was conducted at SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chengalpattu district, Tamil Nadu, India from March 2025 to August 2025. The primary units of study in the current research were individual interstate migrant construction workers employed in the construction sector in Chengalpattu district, Tamil Nadu, India. Workers’ of either gender (male or female), age range of 18-50 years who had Job roles within the construction sector (e.g., bricklayer, construction worker, assistant, manager) and duration of migration (ranging from 1 to 10 years) were included in the present study. Data were col-lected using a semi-structured interview guide, which was developed based on the BPSS framework. Each interview lasted approximately 30 to 45 minutes. Data collection was carried out over a defined time period and continued until thematic sufficiency was achieved. Data analysis was conducted using thematic analysis Results: Seven IDIs were conducted with interstate migrant construction workers (five males, two females) aged 18-50 years from six states (Bihar, Odisha, Andhra Pradesh, West Bengal, Jharkhand, Chhattisgarh), with one local worker for contextual comparison (Tamil Nadu). Themes were finalised and organised into four major thematic areas: employment and lifestyle issues, physical and emotional well-being, assistance from friends and family, and faith, beliefs, and traditions as coping mechanisms. The present study found that interstate migrant construction labourers demonstrate resilience through social networks and spiritual beliefs within a BPSS framework. Conclusion: Enhancing working conditions and formal healthcare access would address core vul-nerabilities and lower long-term health hazards for interstate construction workers. The current study findings therefore support calls for mental-health approaches that integrate economic and relational realities rather than treating distress as an isolated clinical phenomenon.

Caesarean Risk Prediction using Newton-Raphson Model: A Retrospective Cohort Study

Prachi Saoji, Lakshmi Madireddy, Ajeet Saoji, Kartik Khurana Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The global rise in Caesarean section (C-section) rates is a pressing public health concern. A logistic regression model refined through the Newton-Raphson algorithm enhances preci-sion and stability in predicting Caesarean Section (CS) risk. Aim: To develop an optimised predictive model for predicting CS risk using logistic regression enhanced by the Newton-Raphson method. Materials and Methods: The present retrospective cohort study was conducted at Lata Mangeshkar Hospital, a tertiary care institute in Nagpur, India, from July 2024 to February 2025. The study included 190 participants, categorised into case CS and control (vaginal delivery) groups. Varia-bles included maternal age, residence, height, prepregnancy Body Mass Index (BMI), weight gain, birth weight, parity, antenatal visits, and co-morbidities. Logistic regression was applied, and coefficients were optimised using the Newton-Raphson method. Results: Mean age of cases and controls was 29.7 years and 27.2 years, respectively. Birth weight showed the strongest association with CS (Odds Ratio (OR) 3.39, 95% Confidence Interval (CI): 1.92-5.98). Conclusion: The present study confirms the performance of an optimised logistic regression mod-el to predict the CS requirement. The findings highlight the necessity of anticipating risk based on crucial maternal and obstetric characteristics.

Evaluation of Two Doses of Dexamethasone on Postoperative Pain in Patients Undergoing Surgeries under Spinal Anaesthesia: A Randomised Clinical Study

Shaily Dutt, Reema Aggarwal, Roma Sharma, Chandrashekhar Debnath Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Postoperative pain is a significant cause of delayed discharge and unanticipated hospital admission following day care anaesthesia. Dexamethasone has shown promising result in postoper-ative pain relief and prevention of postoperative nausea and vomiting, but there are discrepancies in the doses used to elucidate this effect. Aim: To compare the effect of preoperative intravenous (i.v.) administration of 0.1 mg/kg and 0.2 mg/kg of dexamethasone on postoperative pain in patients undergoing surgery under spinal anaesthe-sia. Materials and Methods: This randomised double blind clinical study was conducted in Depart-ment of Anaesthesia at Mata Chanan Devi Hospital, New Delhi, India from March 2017 to September 2018. A total of 105 patients of aged 18-60 years American Society of Anaesthesiology (ASA) physical status I/II 1 or 2 of either gender undergoing elective surgeries under subarachnoid block were allocated in three groups. Group C (n=35) received preoperative i.v. injection of 5 mL of normal saline. Group DI (n=35) received preoperative i.v. dexamethasone 0.1 mg/kg and Group DII (n=35) received preoperative i.v. dexa-methasone 0.2 mg/kg. The primary objective was to evaluate postoperative pain on motion and rest. The secondary objective was to evaluate the effect of postoperative nausea and vomiting and need of rescue. Statistical Analysis was performed using Chi-square test and Independent sample t-test with p<0.05 con-sidered significant. Results: Demographic variables and baseline characteristics were comparable among the groups. The age range was 18-60 years of each gender with Body Mass Index (BMI) < 30 kg/m2, ASA grade I/II. Vis-ual Analogue Scale (VAS) score at rest and at motion was statistically significant in 3rd, 6th and 12th hour (p<0.05) after surgery. At 24 hours after surgery, VAS score of pain at rest was insignificant but at motion was statistically significant (1.89±0.40 in Group C 1.11±0.40 in Group DI 1.29±0.52 in Group DII) (p<0.001). The mean total postoperative rescue analgesic and ondansetron consumption over 24 hours was found to be statistically lower in groups DI (1.23±0.84) and DII (0.86±0.73) as compared to Group C (1.89±0.90), also there was statistically significant difference between Group DI and DII (p=0.015). Conclusion: Preoperative administration of single dose of i.v. dexamethasone at a dose of 0.2 mg/kg 60 minutes prior to the surgical incision reduced the VAS score, improves postoperative analgesia, reduces Postoperative Nausea and Vomiting.(PONV), and decreases rescue analgesic requirement in patients undergoing surgery under spinal anaesthesia with benefits lasting upto 24 hours.

Evaluation of Plantar Fasciitis using Ultrasonography and its Clinical Correlation: A Prospective Observational Study

RS Monish Anand, E Dilip Kumar Naidu, B Vijay Anand, C Rishab, R Sabari Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Heel pain is a frequent musculoskeletal complaint that impairs daily functioning and quality of life. Plantar Fasciitis (PF) is the most common cause, particularly among adults. Despite its prevalence, the utility of Ultrasonography (USG) for diagnosis and its correlation with clinical and demographic features remain underexplored in the South Indian population. Aim: To evaluate ultrasonographic features of the plantar fascia in patients with PF and correlate these findings with clinical symptoms and demographic factors. Materials and Methods: The present prospective observational study was performed in the Department of Orthopaedics at SRM Medical College Hospital & Research Centre, Chennai, Tamil Nadu, India, from August 2024 to October 2024. About 42 patients between the ages of 26 and 58 years who had unilateral heel pain and a PF diagnosis were included. Radiological assessment included weight-bearing anteroposterior and lateral X-rays of both feet to measure the Angle of the Medial Arch (AMA) and the First Metatarsophalangeal Angle (FMTPA). Demographic data, duration of symptoms, or pain severity utilising Visual Analog Scale (VAS) was recorded. Ultrasonographic parameters, encompassing plantar fascia or heel pad thickness, were assessed. Statistical analysis was conducted utilising Statistical Package for Social Sciences (SPSS) version 21.0. Pearson's correlation or Receiver Operating Characteristic (ROC) curve analysis was utilised, with p<0.05 being statistically significant Results: The mean age of participants was 42.3 years, with 57.1% being female. The average plantar fascia thickness in the affected foot was 6±0.6 mm, significantly higher than 3±0.6 mm in the unaffected foot. A significant correlation was found between plantar fascia thickness and VAS pain scores (r=0.316, p=0.041). The ROC analysis of heel pad thickness showed an Area under the Curve (AUC) of 0.895 (p<0.001), with a cut-off value of 17.9 mm yielding 91.3% sensitivity and 68.4% specificity. Conclusion: USG is an effective, non-invasive modality for diagnosing PF, with strong correlation to clinical symptom severity. It holds promise as a primary imaging tool in early diagnosis and symptom monitoring. Further longitudinal studies are warranted to confirm its role in prognostication and treatment follow-up.

Comparative Evaluation of Single Buccal Infiltration of 4% Articaine versus Buccal and Palatal Infiltration of 2% Lignocaine in Patients with Symptomatic Irreversible Pulpitis in Maxillary Molars: A Randomised Controlled Trial

Nimisha Shah, Rohan Jiteshkumar Doshi, Meetkumar Dedania, Nidhi Bharti, Manalee Mapara, Srishti Jaiswal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: For pain management during dental treatment procedure, Local Anaesthesia (LA) is essential. In cases of maxillary teeth buccal and palatal infiltration of 2% lignocaine is commonly used anaesthetic technique. Palatal injection is usually painful due to thick palatal mucosa which often causes discomfort to the patient. Buccal infiltration of 4% articaine can be used as a solution to the above problem due to its higher diffusion ability and thus additional palatal injection can be avoided. Aim: To evaluate and compare the pulpal anaesthesia with buccal infiltration of 4% articaine and buccal and palatal infiltration of 2% lignocaine in patients with Symptomatic Irreversible Pulpitis (SIP) in maxillary molars. Materials and Methods: This single-blinded, parallel-arm randomised controlled trial was conducted in the Department of Conservative Dentistry and Endodontics, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Pipariya, Vadodara, Gujarat, India, from January 2024 to June 2024. Healthy male and female patients aged 18-60 years who provided informed consent and presented with moderate to severe preoperative pain were included. All selected patients were diagnosed with SIP in maxillary molars and had a Visual Analogue Scale (VAS) score of ≥4 on a 1-10 scale. A total of 182 patients were enrolled and randomly allocated into two groups: Group-A (n=91) received buccal infiltration with 4% articaine, and Group-B (n=91) received combined buccal and palatal infiltration with 2% lignocaine. Patients were instructed on the use of the VAS and trained on how to record their pain levels accurately, after which the preoperative VAS scores were obtained. LA was administered, followed by pulp sensibility testing at three and five minutes using an Electric Pulp Tester (EPT) to assess anaesthetic efficacy. The need for supplemental anaesthesia was also documented. Statistical analysis was performed using the Chi-square test to compare EPT responses and additional anaesthesia requirements, with a significance threshold of p<0.05. Results: When assessing VAS scores after access, the majority of participants in both groups reported no pain (VAS score of 0), in 85/91 patients (93.4%) in Group-A and 80/91 patients (87.9%) in Group-B and mean VAS Score in Group-A is (0.22±0.85) and in group B is 0.38±1.07. There was no significant association between VAS scores after access preparation (p=0.253). At three minutes, 49/91 patients in Group-A and 50/91 in Group-B showed no EPT response, increasing to 81/91 and 75/91, respectively, at five minutes at highest value of EPT at 10 points. No statistically significant difference was observed between the groups at either three minutes (p=0.882) or five minutes (p=0.204). The number of additional anaesthesia doses required showed no significant association in both groups. (p=0.183). Conclusion: Single buccal infiltration of 4% articaine is equally effective as buccal and palatal infiltration of 2% Lignocaine in cases of SIP in maxillary molars.

Phytochemical Characterisation and Pharmacological Evaluation of Vedanasthapana Gana in Multiple Dosage Forms using HPTLC and GC-MS: An In-vitro Experimental Study

Nirmala Ramesh Sonawane, Sangeeta Hemant Toshikhane, Prasanna Ramesh Mathad Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Vedanasthapana Gana is a classical Ayurvedic multiherbal formulation described by Acharya Charaka for relieving pain. It has been traditionally used in different painful conditions for many years. However, scientific data comparing its chemical composition in different dosage forms is limited. Modern analytical studies are needed to ensure its quality, consistency, and pharmacological applicability when prepared in various forms. Aim: To analyse the phytochemical composition and pharmacological applicability of Vedanasthapana Gana prepared as oil, methanolic extract, and rectal suppository using physicochemical tests, High Performance Thin Layer Chromatography (HPTLC), and Gas Chromatography-Mass Spectrometry (GC-MS). Materials and Methods: An in-vitro experimental laboratory-based study was carried out at the Centre of Research for Development Parul University, Vadodara, Gujarat, India and CARE KERALAM, Kerala, India from May 2023 to March 2025. Vedanasthapana Gana was prepared in three dosage forms: medicated oil, methanolic extract, and rectal suppository. Physicochemical parameters were assessed according to Ayurvedic Pharmacopoeia of India guidelines. HPTLC analysis was performed for all three forms using silica gel plates and scanned at 254 nm and 366 nm. GC-MS analysis was carried out for the methanolic extract using an Agilent GC-MS system to identify volatile and semivolatile compounds. Results: Vedanasthapana oil showed prominent lipid-specific constants with slightly acidic pH (4.8), while the suppository was near basic (7.8) with higher ash content (1.13) and lower moisture (0.15%). The methanolic extract had greater viscosity, specific gravity, and total solids (1.70%) with acidic pH (4.5). Both oil and suppository tested negative for rancidity. HPTLC analysis revealed bioactive phytochemicals including gallic acid, ferulic acid, quercetin, kaempferol, luteolin, apigenin, β sitosterol, and lupeol, with the extract showing the widest profile. GC MS profiling of the extract identified sesquiterpenes, chalcone derivatives, and a steroidal compound associated with anti-inflammatory, analgesic, and antimicrobial activities. Conclusion: The study confirms that Vedanasthapana Gana contains multiple pharmacologically active compounds in all three dosage forms. Differences in phytochemical profiles were observed due to variation in the method of preparation and dosage form. The use of HPTLC and GC-MS provided reliable scientific evidence for the presence of bioactive constituents, supporting the traditional use of Vedanasthapana Gana and its further development and standardisation in different dosage forms.

Homicide Trends and Patterns in a Hilly State of Northern India: A Five-year Retrospective Observational Autopsy-based Study

Abhishek Sharma, Kirti Parmar, Manoj Kumar Sharma Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Homicide represents the most severe form of interpersonal violence and consti-tutes a major public health and medico-legal concern worldwide. Patterns of homicide vary considerably across regions depending on socio-demographic, cultural, and geographical factors. Aim: To analyse the trends and patterns of homicide cases in a hilly state of North India over a five-year period. Materials and Methods: This retrospective observational study was conducted in the Department of Forensic Medicine and Toxicology, Shri Lal Bahadur Shastri Government Medical College and Hospital, Nerchowk, Mandi, Himachal Pradesh., India. The data were collected for homicidal autopsy cases examined over a period of five years from January 2020 to December 2024. The study was planned, data were ana-lysed, and interpretations were carried out between January 2025 and March 2025. Data regarding demo-graphic variables, manner and cause of death, weapon used, anatomical distribution of injuries, and cir-cumstances of death were extracted from post-mortem records and police inquest reports. Descriptive sta-tistical analysis was performed using Microsoft Excel, and results were expressed as frequencies and percentages. Results: Out of 707 cases autopsied, 31 (4.38%) cases belonged to homicide. Among the homicidal cases 20 (64.52%) cases belonged to males and 11 (35.48%) belonged to females, the most common age group was 21-30, 12 (38.71%) years, the commonest body part which sustained the fatal injury was head in 17 (54.84%) cases, the most common type of weapon used to inflict fatal injuries was blunt in 23 (74.2%) cases, ethyl alcohol was detected in 17 (54.84%) cases, cyanide was detected in 1 (3.23%) case. Conclusion: Homicides in the studied hilly region predominantly involved young adult males and were largely the result of interpersonal conflicts using readily available weapons. Understanding re-gional homicide patterns can assist forensic experts and policymakers in formulating targeted preventive strategies.

Development, Reliability and Validity Testing of a Novel To and Fro Agility Test in School-going Children: A Cross-sectional Study

Kanu Goyal, Subhasish Chatterjee Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: For children to participate in sports, physical education, and everyday func-tional tasks, agility is a crucial feature of motor fitness. Even though there are many agility evalua-tion methods available, many are constrained by space needs, complicated procedures, or decreased via-bility for school-age children. Thus, a straightforward, valid, and reliable field-based agility test that is appropriate for school-age children is required. Aim: To develop a novel To and Fro Agility Test (TFAT) and to evaluate its content validity, test-retest reliability and criterion validity in school-going children aged 10 to 16 years. Materials and Methods: A cross-sectional methodological study was conducted at MM Interna-tional School Mullana, Ambala, Haryana, India between June 2025 to November 2025. The study consisted of 51 participants of which 25 were boys and 26 girls. Study followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. Six experts evaluated the content validi-ty of the newly developed novel TFAT using a four-point Likert scale, and the Item Content Validity In-dex (I-CVI) was then calculated. By comparing TFAT performance with the 5-0-5 agility test, criterion validity was analysed. Intraclass Correlation Coefficient (ICC), Cronbach alpha, Standard Error mean (SEM), coefficient of variation, Smallest Worthwhile Change (SWC), Minimal Detectable Change (MDC), Bland-Altman analysis, regression analysis, Receiver Operating Characteristic (ROC) curve, sensitivity, specificity, and Area Under the Curve (AUC) were all included in the statistical analysis. Results: The mean age of the participants was 13.1±1.8 years. The TFAT demonstrated high test-retest reliability with an ICC of 0.99 (95% CI:0.98-0.99) and Cronbach alpha of 0.99, as well as excel-lent content validity (I-CVI=1). Absolute reliability showed low SEM (0.25 sec) indicating good measure-ment precision, however the CV (28.7%) indicates relatively high variability; thus, absolute reliability should be interpreted cautiously despite excellent ICC. Validity criteria analysis demonstrated good discriminative capacity having an AUC of 0.74, high sensitivity (0.91), and moderate specificity (0.47). Bland-Altman analysis found little bias (0.082 s) with limited limits of agreement as well as no system-atic error criteria. The high ICC indicates that TFAT provides consistent and reproducible agility meas-urements in school-going children supporting its use for monitoring performance changes. Conclusion: The novel TFAT is a reliable, valid and practical tool for assessing agility in school-going children. Its simplicity, minimal equipment requirements and strong psychometric properties support its use in school based physical education and youth sports settings.

Prevalence and Predictors of Peripheral Arterial Disease in Type 2 Diabetes Mellitus Patients at a Tertiary Care Centre in West Bengal, India: A Cross-sectional Study

Tapendu Manna, Rahin Mahata, Bikas Chandra Seth, Umakanta Mahapatra, Debjyoti Halder Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Peripheral Arterial Disease (PAD) is characterised by the obstruction of arter-ies in the extremities. PAD in diabetes is often asymptomatic and underdiagnosed, posing a significant risk of morbidity and mortality due to associated cardiovascular events. Aim: To assess the prevalence and predictors of PAD in patients with Type 2 Diabetes Mellitus (T2DM). Materials and Methods: It was a single-centre, cross-sectional, hospital-based study conduct-ed in the Department of General Medicine, Midnapore Medical College and Hospital, West Bengal, India, over a period of 12 months (January 2019 -December 2019. A total of 100 patients with T2DM aged 18-65 years were included. Data collection included demographic details, clinical history, anthropometric measurements {Body Mass Index (BMI), waist circumference, waist-hip ratio}, blood pressure and relevant laboratory investigations. Ankle-Brachial Index (ABI) was measured for PAD screening and duplex ultra-sound was used to confirm diagnosis. Factors assessed as potential predictors of PAD included age, dura-tion of diabetes, glycaemic status, blood pressure, lipid profile, renal function, Coronary Artery Dis-ease (CAD) and microvascular complications. Chi-square test for categorical variables and ANOVA for mul-tiple group comparisons. Regression analysis was performed to identify independent predictors for PAD. A p-value <0.05 was considered statistically significant. Results: Of the 100 participants, 54% were male and 46% female, with a mean age of 48.3±8.5 years. The mean duration of diabetes was 5.7±3.2 years. The prevalence of PAD, defined as ABI ≤ 0.90, was 19% (n=19). Compared to non PAD patients, those with PAD had significantly higher mean Fasting Plas-ma Glucose (FPG) (155.4±18.6 vs. 113.4±18.9 mg/dL, p<0.001), Postprandial Plasma Glucose (PPPG) (247.1±47.6 vs. 152.1±44.3 mg/dL, p<0.001), duration of diabetes (9.4±3.8 vs. 4.8±2.4 years, p<0.001), Systolic Blood Pressure (SBP) (139.6±17.0 vs. 122.6±15.4 mmHg, p<0.001), Total Cholesterol (TC) (191.4±50.8 vs. 155.7±30.4 mg/dL, p<0.001), triglycerides (161.0±93.0 vs. 107.7±40.3 mg/dL, p<0.001) and LDL cholesterol (115.5±50.1 vs. 90.0±26.3 mg/dL, p=0.002). Conversely, estimated Glomeru-lar Filtration Rate (eGFR) was significantly lower in PAD patients (58.7±27.7 vs. 103.2±36.4 mL/min/1.73 m², p<0.001). Conclusion: PAD is a common but underdiagnosed complication among Indian patients with T2DM. Emphasis on early screening using simple tools like ABI, along with timely intervention for modifiable risk factors, may help reduce cardiovascular morbidity, prevent diabetic foot complications and improve overall outcomes.

Real World use of Tolvaptan and Hypertonic Saline in Hyponatraemia: A Prospective Observational Study at a Tertiary Care Centre in India

Nagesh Murthy, Ajay K Khobragade, A Meenu Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The most common electrolyte imbalance among the hospitalised patients and mainly the elderly patients is hyponatraemia (serum sodium below 135 mmol/L), which has high morbidity due to prolonged hospitalisation and mortality. Aim: To evaluate the clinical and biochemical profile of hyponatraemia and compare the real world usage of oral tolvaptan with the standard of care in normalising the serum sodium levels within inpatients. Materials and Methods: This prospective observational study included 200 adults with serum sodium below 130 mmol/L in the Department of Medicine of Jagjivan Ram Hospital, Mumbai, Maharashtra, India (November 2020- June 2022). Treatment allocation was based on clinical judgment and aetiology (eu-volemic/hypervolemic status). Serial serum sodium levels were monitored daily for seven days. Data anal-ysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0, utilising Chi-square and independent t-tests to identify significant differences between treatment groups. Results: The average age was 64.6±16.2 years; 50.5% of the population was female. Majority of euvolemic patients had Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) (38.5%). Tolvaptan group (n=22) demonstrated that the baseline sodium was lower (114.1±7.3 mmol/L vs 123.5±6.2 mmol/L other treatments), and that correction of this treatment was better (12.27±3.45 vs 5.0±2.18 mmol/L, p-value <0.001). Conclusion: In the real-world setting, Tolvaptan is effectively utilised for profound hypo-natraemia achieving faster recovery compared to conventional standard care. Optimisation of dosing of SIADH and heart failure required larger randomised trials.

Role of Diagnostic Hysteroscopy and Hysteroscopic-guided Biopsy in Cases of Abnormal Uterine Bleeding: An Observational Study

Mamta Singh, Vandana Gupta, Soniya Vishwakarma, Neelam Swaroop, Kalpana Kumari, Nupur Mittal, Pragya Shree, Pragati Divedi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Abnormal Uterine Bleeding (AUB) is one of the most common gynaecological com-plaints which affects the physical, social health of the patient. Around 33% of women referred to gynae-cological outpatient clinics have AUB. Hysteroscopy is a minimally invasive intervention that usually offers an opportunity for simultaneous treatment and guided biopsy. Aim: To evaluate the role of diagnostic hysteroscopy in evaluating uterine cavity in cases of AUB and its correlation with histopathological findings. Materials and Methods: This observational study was conducted at Department of Obstetrics and Gynaecology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India, from July 2021 to June 2023 and included a total of 60 patients, aged 20-70 years, with AUB on prede-fined inclusion and exclusion criteria. Hysteroscopy was done in all cases and attempts were made to diagnose the underlying causes by direct visualisation of different endometrial pattern and many undiag-nosed intrauterine pathologies. The samples were taken for Histopathology Examination (HPE) and HPE re-ports were correlated with the findings of hysteroscopy. The sensitivity, specificity, diagnostic accu-racy were also calculated. Results: Most of patients were in age group 41-50 years and the most common clinical presenta-tion was Heavy Menstrual Bleeding (HMB). Hysteroscopy has high sensitivity and specificity for diagnosis of all intrauterine pathologies. It has low sensitivity but high specificity for diagnosis of normal proliferative endometrium and secretory endometrium. The overall sensitivity, specificity Positive Pre-dictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy of endometrial pathology was 93.1%, 80%, 81.8% 92.3% and 86.4%, respectively. Conclusion: The present study concludes that hysteroscopy is a reliable diagnostic tool for the assessment of intrauterine pathologies, especially focal ones such as endometrial and endocervical polyps and submucous myomas, as these are often missed by blind endometrial curettage.

Comparison of Enhanced Recovery after C-section versus Traditional Protocol in Elective Caesarean Section: A Randomised Clinical Trial

Khatija Yakubbhai Dalvani, Khyati Chandrakantbhai Jethva, Jigisha Prahladray Badheka, Aditya Singh, Anand Pankajbhai Bhalodiya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Caesarean delivery is a common obstetric procedure associated with complications such as pain, nausea, infection and thromboembolic events. Enhanced Recovery After Caesarean (ERAC) is a multimodal strategy designed to minimise these complications facilitate faster recovery and enhance pa-tient satisfaction. Aim: To compare the effectiveness of ERAC versus traditional protocols in elective caesarean sections. Materials and Methods: This randomised, single-blind clinical trial was conducted at Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India, from December 2022 to March 2024 involved 150 American Society of Anaesthesiologists Physical Status (ASA-PS) grade II and III patients undergoing elective lower-segment caesarean sections under spinal anaesthesia, divided into two haemodynamics: Hae-modynamic T (Traditional protocol, n=75) and Haemodynamic E (ERAC protocol, n=75). The parameters as-sessed were mobilisation time, time to first oral intake, pain scores, and complications. Data were ana-lysed using Statistical Package for Social Sciences (SPSS) software version 22.0 and EpiInfo 7. Statis-tical tests included student’s t-test for continuous variables and Chi-square test for categorical var-iables. A p-value ≤0.05 was considered statistically significant. Results: Demographic data were comparable in both haemodynamics. Haemodynamic E had signifi-cantly earlier mobilisation (11.32±2.45 vs. 24.02±4.13 hours, p<0.0001) and oral intake (6.8±0.98 vs. 9.4±1.5 hours, p=0.02). Readiness for discharge was faster in Haemodynamic E (1.7±0.71 vs. 2.9±0.79 days, p<0.0001). ERAC also resulted in lower Intraoperative Nausea and Vomiting (IONV) (28% vs. 57.3%, p=0.0005) and reduced postoperative pain (p<0.01). Conclusion: ERAC protocol significantly enhances recovery, improving pain management, mobilisa-tion, oral intake, and mother-newborn bonding, leading to higher patient satisfaction and earlier dis-charge readiness compared to traditional approaches. These findings support its widespread implementa-tion in caesarean deliveries.

Effects of Intestinal Parasitic Infections on Haematological Profiles of Patients attending a Tertiary Care Hospital in Eastern India: A Retrospective Cross-sectional Study

Shalini Bhaumik, Nonika Rajkumari, Aditya Kundu, Ujjala Ghoshal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Intestinal parasites, commonly Soil-Transmitted Helminths (STH), are widespread in tropical regions and cause major illness, disability, malnutrition, and anaemia. They disrupt growth, development, micronutrient balance, cognition, and increase susceptibility to other infections. Protozo-an diseases such as amoebiasis, giardiasis, and cryptosporidiosis also significantly affect. Aim: To evaluate the impact of Intestinal Parasitic Infections (IPIs) on haematological parame-ters. Materials and Methods: A retrospective cross-sectional study was conducted in the Microbiolo-gy Department of a tertiary care hospital in Kalyani, Nadia district, West Bengal, India. A total of 133 stool samples received in the parasitology laboratory for diagnostic screening between August 2022 and July 2024 were included in the study. Haematological parameters such as Haemoglobin (Hb), Haematocrit (HCT), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglo-bin Concentration (MCHC), along with Total Leukocyte Counts (TLC) and Absolute Eosinophil Counts (AEC), were measured using automated Complete Blood Count (CBC) analysers. The data were analysed using statis-tical software (e.g., Statistical Package for the Social Sciences (SPSS), version 25.0). A p-value of <0.05 was considered statistically significant. Results: Out of 133 patients, the prevalence of IPIs in males and females was 16/78 (20.5%) and 9/55 (16.4%), respectively. Out of 44 parasites identified, predominant ones were Entamoeba spp 29 (66%), Strongyloides stercoralis 6 (13.6%), Giardia lamblia 5 (11.4%), Hookworm 2 (4.5%), and Blastocystis hominis and Cryptosporidium 1 each (2.3%). Infected patients’ haemoglobin levels were lower (mean Hb 9.43 g/dL) than controls (mean Hb 12.08 g/dL). Eosinophilia, raised haemato-crit, and decreased MCV levels were noted in the infected patients. Maximum anaemia (9.3 g/dL) was seen with hookworm infection, and eosinophilia (15.2%) was seen in mixed infection. Conclusion: The prevalence of Entamoeba spp., Strongyloides stercoralis, and Giardia spp. indicates continuing transmission within the community. The concomitant haematologi-cal abnormalities suggest that these infections have systemic implications beyond the gastrointestinal tract. These findings highlight the importance of early diagnosis, frequent screening, and targeted therapies such as deworming programs.

Association of Timed Up and Down Stairs Test with Anthropometric and Physiological Parameters in Children Aged 6-14 Years: A Cross-sectional Study

Ahana Sah, Nandni Goel, Payal Saini, Shivani, Amit Kumar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Timed Up and Down Stairs (TUDS) test is a functional movement performance as-sessment which evaluates the time consumed in order to ascend and descend a set of stairs. However, the normative reference value for the TUDS test remains limited in the Indian paediatric population. Addi-tionally, the relationship between anthropometric and physiological parameters and TUDS performance has not been adequately explored in developing countries. Aim: To establish the reference score for TUDS performance in school-aged children of six to 14 years, as well as examine the correlation between anthropometric and physiological factors with TUDS. Materials and Methods: This cross-sectional study was conducted at a sports complex located within the Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, India from March 2025 to January 2026. A total of 500 healthy school-going children were recruited through purposive sam-pling. Anthropometric (age, gender, height, weight, body mass index, and bilateral limb length) and physiological measurements {Heart Rate (HR), blood pressure and Oxygen Saturation (SpO2)} were recorded, followed by TUDS testing. Statistical analysis was performed using Spearman correlation and multiple linear regression, with p-value <0.05 considered statistically significant. Results: The sample included 224 girls (44.8%) and 276 boys (55.2%) with a median age of nine years. Multiple regression analysis demonstrated a significant relation with age, gender and body weight of TUDS test performance, showing (25.7%) of the variance (R2=0.257, F (14,485)=11.9, p-value <0.001). Age of the children demonstrated the strongest association, whereas height, lower limb length and physi-ological parameters showed minimal independent influence. Conclusion: TUDS test performance was primarily determined by anthropometric factors with neg-ligible impact from physiological variables in school-aged children. Age and body size were the primary determinants of TUDS performance, highlighting the importance of maturational factors when interpreting paediatric functional mobility tests.

Viral Load Pattern and other Non Invasive Serological Investigations among Hepatitis B Surface Antigen Positive Patients attending Tertiary Care Centre: A Retrospective Study

Sujala Chandraiah Kurut, Supriya Madhavrao Emekar, Sanjaykumar Rajaram More Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: In patients with Chronic Hepatitis B (CHB), assessing the presence of liver com-plications is crucial for both managing and assessing treatment response. Aim: To study viral load levels, Non invasive Tests (NITs), and their association with disease progression in patients (CHB) attending tertiary care centre. Materials and Methods: This retrospective study was conducted at a tertiary care centre in Maharashtra under the National Viral Hepatitis Control Program (NVHCP) from October 2021 to October 2024. Patients aged 15-70 years, including preoperative cases, blood donors, and individuals with or without liver disease, who tested positive for Hepatitis B Surface Antigen (HBsAg) were included. A to-tal of 44,596 samples were analysed. Demographic and clinical data were retrieved from the NVHCP data-base. All patients were evaluated using hepatitis B viral load (quantitative Polymerase Chain Reaction (PCR)), Aspartate Aminotransferase (AST)-to-Platelet Ratio Index (APRI), and Fibrosis-4 (FIB-4) scores to assess correlations with liver complications. Age, gender, and relevant clinical history were record-ed. Statistical analysis was performed using standard software; Chi-square tests were used to compare viral load with APRI and FIB-4 scores. A p-value <0.05 was considered statistically significant. Results: A total of 44,596 screened patients, 892 (2%) were HBsAg positive. Among these, 120 (13.4%) with viral load >20,000 IU/mL started treatment. The highest viral loads (6–>7 log 10 IU/mL) were observed mainly in the 40-60-year age group. Conclusion: Viral load strongly correlated with non invasive markers. APRI and FIB-4 scores are valuable prognostic tools for assessing liver disease progression and transmission risk in HBV-positive patients.

Developmental Patterns of Visual Perception, Motor Coordination and Visual-motor Integration in Typically Developing Children in West Bengal, India: A Cross-sectional Study

Thulasikanthan Mugesh, NR Seran Nappinnai, Anjan Bhattacharya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Visual-Motor Integration (VMI) reflects the coordinated functioning of perceptual and motor systems and is fundamental for academic and everyday activities. Developmental data especially from non Western populations remain limited. Aim: To examine age-related developmental trajectories of Visual Perception (VP), Motor Coordination (MC), and VMI in typically developing Indian children aged 7-15 years, and to analyse associated gender differences. Materials and Methods: This cross-sectional study examined VP, MC, and VMI in 224 typically developing Indian children aged 7-15 years from West Bengal using the Beery-Buktenica developmental test of VMI, Sixth Edition. The study was conducted with the approval of MAHER Doctoral and Ethical Committee. Age effects were analysed using One-way Analysis of Variance (ANOVA) and gender differences using independent-samples t-tests. Results: Age had a statistically significant effect on VP, MC, and VMI (p-value <0.001), with moderate-to-large effect sizes. VP showed a general age-related increase, whereas MC and VMI exhibited non linear developmental patterns with peak performance in middle childhood and greater variability during adolescence. No significant gender differences were observed. Conclusion: Visual-motor and perceptual-motor skills continue to change dynamically across school age, with particularly sensitive transitions during early adolescence. These findings extend existing developmental models to a non Western population and highlight the importance of age-sensitive interpretation of VMI-related performance.

Effect of Muscle Energy Technique versus Conventional Exercise on Pain and Functional Outcome in Subjects with Plantar Fasciitis: A Quasi-experimental Study

AK Varshini, K Kotteeswaran Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Plantar Fasciitis (PF) is a prevalent degenerative disorder of the plantar fas-cia, responsible for 11% to 15% of foot-related medical consultations and estimated to affect roughly 10% of the population particularly individuals aged 40-60 years. Frequently attributed to repetitive microtrauma and biomechanical overload, its high prevalence paired with substantial impacts on mobility and quality of life emphasise the need for deeper study into its pathogenesis and improved treatment approaches. Aim: The aim of the present study is to find out the effect of Muscle Energy Technique (MET) versus conventional exercise on pain and functional outcome in subjects with PF. Materials and Methods: The present quasi-experimental study was conducted in the Department of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India from January 2023 to July 2023. A total of 60 subjects with PF fulfilling the selection criteria were includ-ed. The Plantar Fasciitis Pain/Disability Scale (PFPS) was used for pre and post-test assessment. Sub-jects were randomly allocated into two groups: the MET group (n=30), who received post-isometric relaxa-tion and Reciprocal Inhibition (RI) techniques; and the conventional exercise group (n=30), who received calf and plantar fascia stretching, intrinsic foot muscle strengthening, and both group received ultra-sound for 15 minutes. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 25.0 Within-group comparisons were performed using the paired t-test, while between-group comparisons were analysed using the independent t-test. A p-value <0.05 was considered statisti-cally significant. Results were presented as mean ± Standard Deviation (SD) and percentage distribution in tables and graphs. Results: According to the statistical analysis, both groups had a statistically significant improvement between their pre and post values (p<0.0001). There was no statistically significant differ-ence between the two groups in post-exercise outcomes (p=0.3404), indicating that both interventions were similarly effective. Conclusion: MET and conventional exercise both are effective at relieving pain and improving functional outcome. It can be incorporated as a routine physiotherapy intervention to enhance recovery and mobility.

Effectiveness of Vestibular Exercise as an Adjunct with Pharmacotherapy in the Management of Cognitive Functions and Postural Control in Patients with Parkinson’s Disease: A Randomised Controlled Trial

Annaiah Edagottu, Deepika Chandrasekaran, Sai Sailesh Kumar Goothy, PK Jabir, D Sendilkumaran, S Suma Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Parkinson’s disease is the most common presenting neurological disorder world-wide. Vestibular exercises have been used in the clinical setting in the management of multiple condi-tions, like Down syndrome. However, studies regarding the application of exercises stimulating the ves-tibular apparatus in the symptomatic management of Parkinson’s disease are sparse. Aim: To evaluate the effectiveness of vestibular exercises as an adjunctive intervention to standard pharmacological treatment (L-DOPA) for enhancing cognitive function and postural control in individuals diagnosed with Parkinson’s disease. Materials and Methods: The present randomised controlled trial was conducted at the Depart-ment of Physiology, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, Kar-nataka, India from 05-08-2024 to 18-09-2025. Total 80 participants were randomly assigned into two sepa-rate groups, that is, control (n=41) and experimental groups (n=39). A structured 25-minute vestibular exercise program was implemented in the study. Spatial memory, verbal memory and 100-pin dexterity test were assessed in the participants before and after intervention and compared. Data was collected during baseline setting and after 12 weeks of intervention in both groups and compared. The data were compared using Kruskal-Wallis, One-way Analysis of Variance (ANOVA) on ranks with Dunn’s post-hoc multiple com-parisons test for between-group and within-group analysis. A p-value <0.05 was considered statistically significant. Results: The mean age among control and experimental group was 57.2±1.4 years and 56.3±1.4 years, mean body mass index in control and experimental group was 20.3±0.2 kg/m2 and 21.1±0.2 kg/m2. Substantial improvement was observed in verbal memory, visual reaction time for green and red light, and auditory reaction time for high and low pitch sounds, 100 pin test, TUG in the experimental group in comparison to the control group (p-value <0.001). Conclusion: Significant improvement was observed in the cognitive functions and postural con-trol in the experimental group participants followed by vestibular exercises. The study recommends fur-ther large-scale, multicentric investigations to validate these outcomes and to explore the potential integration of vestibular exercises into the primary management strategies for Parkinson’s disease.

Comparative Evaluation of Antimicrobial Efficacy of Leukocyte Platelet-rich Fibrin and Advanced Platelet-rich Fibrin against Streptococcus Intermedius: An In-vitro Study

T Mogana Preya, V Vineet, BB Bhuvaneswari, Iyanar Kannan, LS Makesh Raj, T Parthasarathi, Juala Catherine, Thanigaimalai Abirami Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Platelet-rich Fibrin (PRF) has emerged as a valuable biomaterial in oral and maxillofacial regenerative procedures. While its regenerative properties are well-documented, the anti-microbial potential of different PRF preparations remains incompletely understood, particularly against oral pathogens like Streptococcus intermedius. Aim: To evaluate and compare the antimicrobial efficacy of Leukocyte Platelet-rich Fibrin (L-PRF) and Advanced Platelet-rich Fibrin (A-PRF) against Streptococcus intermedius in-vitro. Materials and Methods: This in-vitro study design was conducted in the Department of Perio-dontics, Tagore Dental College and Hospital, Rathinamangalam, Tamil Nadu, India, from January 2025 to June 2025. A total of five participants were selected based on inclusion and exclusion criteria. A total of 5 blood samples (10 mL of blood samples were collected from each patient) were collected from five systemically healthy individuals diagnosed with chronic periodontitis. L-PRF and A-PRF were prepared using standardised centrifugation protocols (L-PRF: 3000 rpm/10 minutes; A-PRF: 1500 rpm/14 minutes). Antimicrobial activity against S.intermedius was assessed using the agar diffusion method. Zones Of Inhibition (ZOI) for L-PRF and A-PRF against S.intermedius were measured after 24-hour incuba-tion at 37°C under microaerophilic conditions. Statistical analysis as applied on the data obtained, statistically significant. Results: Vancomycin consistently demonstrated antimicrobial activity against S. intermedius with a mean inhibition zone of 18.76±1.32 mm. However, neither L-PRF nor A-PRF exhibited detectable ZOI against S. intermedius across all five samples, indicating absence of antimicrobial activity under the experimental conditions employed. Conclusion: Within the limitations of the present in-vitro study, neither L-PRF nor A-PRF demonstrated antimicrobial activity against S. intermedius using the agar diffusion method. These findings suggest that the anticipated antimicrobial benefits of PRF may be species-specific and limited against certain oral pathogens. The clinical selection of PRF should therefore primarily consider its well-established regenerative properties rather than potential antimicrobial effects against S. in-termedius.

Comparative Evaluation of Tell-Show-Do, Music of Choice and Traditional Music Therapy as Audio Distraction Techniques on Anxiety Levels in Children Undergoing Restorative Treatment: A Randomised Clinical Trial

Shweta Kajjari, Shivayogi M Hugar, Vidyavathi H Patil, Akanksha Prakash Dumbare, Niraj Gokhale, Chaitanya Uppin Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Fear and anxiety are the most prevalent concerns among young children, often leading to uncooperative behaviour that poses challenges in providing effective dental care. Hence, im-plementing appropriate strategies can significantly improve a child’s dental experience. Music therapy as audio distraction technique is one such promising non-pharmacological methods to reduce the anxiety in children. Different kinds of music influence human brain waves, leading to deep relaxation and calm-ness, and thereby reducing pain and anxiety. Aim: To evaluate and compare the Tell-Show-Do (TSD), Music of Choice and traditional music ther-apy as audio distraction techniques on anxiety levels in children undergoing restorative treatment. Materials and Methods: The present randomised three arm controlled clinical trial was carried out in the Department of Paediatric and Preventive Dentistry, KAHER’S KLE VK. Institute of Dental Sci-ences, Belagavi, Karnataka, India from May 2024 to November 2024. A total of 66 children aged 6-10 years were included in the study and allocated into three groups: Group I TSD, Group II Music of Choice and Group III Traditional Music Therapy. All Children by single operator received class I restorative proce-dure in primary/permanent molars. Anxiety was evaluated with pulse rate and Venham’s Picture Test at pre and post interventions. The child’s behaviour was also determined by the Frankl’s behaviour rating scale before and after the restorative procedure. The pre and post intervention scores of all the as-sessed parameters were recorded. Descriptive statistics were used to summarise the demographic data. For inferential analysis, the Kruskal-Wallis test was used to compare anxiety-score changes between the three groups (inter-comparison), the Wilcoxon matched-pairs test for intra-group comparison, and the Mann-Whitney U test was used for pair-wise comparison among the groups. The level of significance was set at p<0.05. Results: 66 patients were recruited for the study in which females were 36 (54.55%) and males were 30 (45.46%) with the mean age of 8.20 years. The results revealed no significant differences in pre intervention scores among the three groups, confirming comparable baseline levels. For Venham’s Picture Test, post intervention, significant differences were observed between TSD and Music of Choice (p=0.003*) and between TSD and traditional music (p=0.001*). However, Music of Choice and traditional music exhibited no significant difference (p=0.1490). Pulse rate mean scores differed significantly be-tween the groups TSD (97.00), Music of Choice (91.05), and traditional music (89.35) with p=0.0370*. Intra-group comparison of pre and post intervention scores illustrated that Group II (Music of Choice) showed statistically significant reduction in both Venham’s Picture Test (p=0.001*) and pulse rate (p=0.0016*). Group III (traditional music) showed statistically significant changes for both measures with the p-value of 0.001*. In contrast, Group I (TSD) there were no statistically significant changes. Overall, all three groups showed a significant reduction in anxiety. Among them, traditional music yielded the lowest anxiety scores followed by Music of Choice group and highest with the TSD group. Ad-ditionally, there was a significant improvement in patients’ behaviour measured by Frankl’s behaviour rating scale from negative to positive and definitely positive across the three groups. Conclusion: Traditional music therapy and Music of Choice showed statistical significant chang-es in anxiety reduction over TSD group. Traditional music therapy had a significant impact over Music of Choice. Both the audio distraction techniques are promising, safer, non-invasive and effective behaviour guidance techniques in children.

Immunohistochemical Analysis of Matrix Metalloproteinase-1 as a Diagnostic and Prognostic Biomarker in Breast Cancer: A Retrospective Cross-sectional Study

Naglaa Ahmed Bayomy, Anshoo Agarwal, Marwa Badawi, Naglaa Mokhtar, Saad Elshafey, Mohammed M Mosaed, Mohammed M Ismail, Nawal Gouda Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Matrix Metalloproteinase-1 (MMP1) plays a crucial role in Extracellular Matrix (ECM) remodelling and has been implicated in cancer invasion and metastasis. However, its utility as a diagnostic and prognostic biomarker in breast cancer remains incompletely characterised. Aim: To evaluate the diagnostic utility of MMP-1 expression in distinguishing malignant breast carcinoma from benign breast lesions through Immunohistochemical (IHC) analysis and the associations between MMP1 expression levels and clinicopathological parameters to determine its potential prognostic value in predicting tumour aggressiveness and patient outcomes. Materials and Methods: This retrospective cross-sectional study was conducted at Tanta Central Laboratory, Tanta University, Egypt, spanning January 2021 to December 2023. A comprehensive immunohistochemical analysis of MMP1 expression in 200 breast tissue specimens (100 malignant and 100 benign controls) was performed using validated antibodies and standardised scoring protocols. Expression levels were assessed for associations with clinicopathological parameters using Pearson’s Chi-square test and Fisher’s exact test. Diagnostic performance metrics including sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated with 95% confidence intervals. Results were presented as frequencies and percentages, with p-value <0.05 considered statistically significant. Results: MMP1 expression demonstrated significant upregulation in malignant tissues compared to benign controls. Strong overexpression was observed in 38 cases (38%) of malignant cases versus four cases (4%) in benign tissues (p=0.0006). Complete absence of weak expression in benign tissues contrasted with 26 cases (26%) prevalence in malignant cases (p<0.0001). The marker demonstrated sensitivity of 74%, specificity of 64%, PPV of 67.27% and NPV of 71.11% for distinguishing malignant from benign lesions. Conclusion: MMP1 overexpression strongly correlates with breast malignancy and demonstrates moderate diagnostic utility. Higher MMP1 expression correlated with adverse clinicopathological parameters including larger tumour size and lymph node positivity, suggesting potential prognostic significance. These findings support MMP1’s potential integration into multi-biomarker diagnostic panels and suggest its value in understanding breast cancer pathobiology.

Patterns of Reaction in Non Metastatic Lymph Nodes of Breast Carcinoma: A Cross-sectional Study

Katta Teja, A Hemalatha, PN Sreeramulu, DVS Priyanka Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Lymph nodes draining breast carcinoma exhibit reactive patterns reflecting tu-mour-immune interactions. While lymph node metastasis is a well-established prognostic factor, the clin-ical significance of reactive patterns in non metastatic nodes remains underexplored. Understanding these patterns may provide insights into host immune response and potential prognostic implications. Aim: To evaluate the patterns of reaction in non metastatic lymph nodes in breast carcinoma and analyse their association with tumour size, grade, stage, and receptor status {Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor 2 (HER2/neu), Ki67}. Materials and Methods: A cross-sectional study was conducted at the Department of Pathology in RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. Patients diagnosed with invasive ductal carcinoma (no special type) who underwent mastectomy between January 2022 and December 2024 were included. A total of 80 patients meeting inclusion criteria were enrolled. Histopathological examination of 1,063 non metastatic lymph nodes was performed. Data were analysed using Chi-square test, Fisher's-exact test for small samples, and Generalised Estimating Equations (GEE) to account for patient-level clustering. Bonferroni correction for multiple comparisons was applied (adjusted α=0.00625). Results: Among 1,063 non metastatic lymph nodes examined, 111 (10.4%) showed reactive changes, predominantly Sinus Histiocytosis (SH) (85.6%), followed by Germinal Centre Predominance (GCP) (9.9%) and Lymphocyte Predominance (LP) (4.5%). Tumour size showed significant association with reactive pat-terns (p=0.001, remains significant after Bonferroni correction). Molecular subtype also correlated sig-nificantly (p=0.002, remains significant after correction). Ki67 proliferation index showed association (p=0.009) but did not remain significant after Bonferroni correction (α=0.00625). Luminal A tumours showed exclusively SH, while other subtypes displayed varied patterns. ER, PR, and HER2 status showed no significant association. Conclusion: Non metastatic lymph nodes exhibit diverse reactive patterns that correlate signif-icantly with tumour size and molecular subtype after rigorous statistical correction. These findings highlight the complex interplay between tumour biology and nodal immunity, with potential prognostic implications.

Morin-Mediated Silver Nanoparticles: In-vitro Synthesis, Antimicrobial Activity and Characterisation using Fourier Transform Infrared, Ultraviolet-visible, X-ray Diffraction

R Sukanth, PT Priyangha Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Nanotechnology enables precise molecular manipulation, providing nanoparticles as versatile tools for medicine and other fields. Green synthesis methods for nanoparticles utilise nat-ural sources, such as plant extracts and flavonoids. Silver nanoparticles, known for their antimicrobial and anti-inflammatory properties, have significant potential in biomedical applications. Despite these advances, studies utilising morin as a green reducing and stabilising agent remain limited. Owing to its intrinsic antimicrobial and anti-inflammatory potential, morin offers a promising approach for nanopar-ticle synthesis. Aim: To synthesise Morin-mediated Silver Nanoparticles (M-AgNPs) and evaluate their in-vitro properties, such as Fourier Transform Infrared Spectroscopy (FTIR), Ultraviolet-Visible (UV-Vis) spec-trum, X-ray Diffraction (XRD), antibiofilm, and antimicrobial activities. Materials and Methods: This in-vitro experimental study was conducted in Green Lab, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India, between August 2024 and September 2024 to synthesise and evalu-ate morin-mediated silver nanoparticles (M-AgNPs). Morin flavonoid was used as a reducing and stabilis-ing agent for nanoparticle synthesis by reacting with a 1 mM silver nitrate (AgNO3) solution under con-trolled alkaline conditions. The formation of M-AgNPs was confirmed through colour change and subse-quently characterised using Fourier Transform Infrared Spectroscopy (FTIR), Ultraviolet–Visible (UV-Vis) spectroscopy, and X-ray Diffraction (XRD) analysis to determine functional groups, optical properties, and crystalline structure. The antibacterial and antibiofilm activities of the synthesised nanoparticles were evaluated against oral biofilm-forming microorganisms using standard agar well diffusion and biofilm inhibition assays. All experiments were performed in triplicate. International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) Statistics version 21.0 was used to perform one-way Analysis of Variance (ANO-VA), with a p-value of less than 0.05 considered statistically significant. Results: The FTIR results revealed a broad peak around 3300 cm-1 corresponding to O-H stretching from hydroxyl groups in Morin, while the peak near 2900 cm-1 indicates C-H stretching from its organic components. Peaks below 1000 cm1 suggest specific interactions between silver nanoparticles and Morin’s functional groups, confirming successful surface functionalisation. UV-Vis spectrum showed a Surface Plasmon Resonance (SPR) peak at 400-450 nm. The XRD analysis revealed a strong peak at 2θ=32°, along with additional peaks at 38°, 44°, and 64°. The sharp peak at 32° indicates a high degree of crys-tallinity, while slight peak broadening suggests a small crystallite size. The antibiofilm assay re-vealed that the control sample, an untreated mixed biofilm grown for three days, showed 100% live bacte-ria, indicating no antibacterial effect. The test sample was treated with M-AgNPs for 24 hours, result-ing in significant antibiofilm activity. After treatment, only 0.5% of the bacteria remained alive, while 99.5% were dead. M-AgNPs demonstrated antibacterial activity comparable to standard antibiotics, showing Zones Of Inhibition (ZOI) of 14 mm for Staphylococcus aureus (Gentamycin: 14 mm), 16 mm for Streptococcus mutans (Amikacin: 16 mm), and 13 mm for Escherichia coli (Chloramphenicol: 14 mm) and the results were statistically significant for the test group (p-value<0.05). In contrast, Morin-mediated yttrium nanoparticles (M-YtNPs) showed less effective antibacterial activity. Conclusion: Thus, M-AgNPs showed effective antibiofilm and antibacterial properties, offering a promising, eco-friendly advancement for enhancing periodontal disease treatments.

Reliability and Psychometric Properties of the Hand Behind Back Test in Young Healthy Adults: A Cross-sectional Study

Chhaya, Manu Goyal, Muskan Bathla, Aditi Nagpal, Ritika Kashyap, Kanu Goyal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The Hand Behind Back (HBB) test is often used in clinical practice to evaluate shoulder internal rotation; yet, additional clarification regarding its measurement reliability using a tape measure is required. Aim: To identify the HBB test’s intra-rater and inter-rater reliability and its psychometric qualities such as Standard Error of Measurement (SEM), Minimum Detectable Changes (MDC) at the 95% Con-fidence level (MDC95), Coefficient of Variation (CV%) and Smallest Worthwhile Change (SWC) using tape measurement in healthy adults. Materials and Methods: A prospective observational cross-sectional test-retest study was con-ducted at the Outpatient Physiotherapy Department of Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India, between March 2025 to November 2025 on total of 60 healthy individuals which were evaluated by two physiotherapists. Each rater completed two measurement sessions under uniform con-ditions. The inter-rater and intra-rater reliability were assessed by analysing Cronbach’s alpha and interclass correlation coefficients. Cohen’s Kappa was used to assess agreement for the categorical variable of gender. SEM, MDC95, CV%, and SWC were analysed for evaluation of absolute reliability and psychometric qualities. Bland-Altman analysis was further used to investigate the agreement. Results: Both raters showed excellent intra-rater reliability, with ICC values of 0.988 and 0.953, respectively. With an ICC of 0.967, it showed excellent inter-rater reliability. Cohen’s Kappa showed excellent agreement for gender classification with a value of κ=1.00, while Cronbach’s alpha values revealed high internal consistency (≥0.97). The MDC95 value was 0.69 cm, and the SEM values were low (0.25 cm). The SWC (0.46 cm) was higher than the SEM, and the CV% was 5.92%. There was no indication of proportional bias, and Bland-Altman plots showed narrow Limits of Agreement (LoA) and small mean bi-ases. Conclusion: In healthy adults, the tape measure hand behind the back test showed good psycho-metric qualities with low measurement error, and excellent intra-rater and inter-rater reliability. The results obtained indicate that it can be applied as a sensitive and trustworthy clinical outcome measure for evaluating internal rotation of the shoulder joint.

Comparison of Normal Saline Solution and Manual Liquid-based Cytology Solution in Fine Needle Aspiration Cytology of Neoplastic Lesions: A Cross-sectional Study

R Vishnupriya, BN Kumarguru, AS Ramaswamy, P Janakiraman Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, simple, safe and relatively pain-free procedure having high sensitivity and specificity in various lesions . Liquid Based Cytology (LBC) is a technique that enables cells to be suspended in a monolayer, through which better morphological assessment is possible. Aim: To compare the efficacy of LBC techniques using processing solutions namely Manual Liquid Based Cytology (MLBC) solution and Normal Saline (NS) solution with that of Conventional Cytology (CS) in the evaluation of FNAC of neoplastic lesions. Materials and Methods: This was a cross-sectional study conducted at the Department of Pa-thology, PES Institute of Medical Sciences and Research, a rural tertiary care referral Institute at Kuppam, Andhra Pradesh, India. The study was conducted prospectively for a period of 18 months from May 2023 to October 2024. A total of 102 neoplastic cases diagnosed by FNAC were analysed. For each case, LBC techniques were performed using manual LBC solution and NS. The quality of smears stained by Haema-toxylin and Eosin (H&E) and Papanicolaou (PAP) and May-Grunwald Giemsa (MGG) was evaluated for various cytopathological parameters like background, cellularity, cell morphology and cell distribution by using a scoring system. The quality of smears prepared using manual LBC solution and NS was compared with that of conventional smears. The data was subjected to statistical analysis using STATA 17.0 software. The data derived from ordinal scoring (Mair scoring system) were analysed using the two sample t test. Cate-gorical variables were analysed using Chi-square test. Results: The most common site of aspiration was the breast tissue 41 cases (40.2%). The most common cytopathological diagnosis was invasive breast carcinoma {20 cases (19.61%)}. NS showed better overall performance in comparison with manual LBC solution in H&E stained smears (Mean=4.28), Pap stained smears (Mean=4.05) and MGG stained smears (Mean=4.27). The values were statistically highly sig-nificant (p-value <0.0001). NS showed a better quality index in comparison with manual LBC solution in H&E stained smears, Pap stained smears and MGG stained smears. Conclusion: The NS is an effective novel liquid based cytology fluid for processing FNAC mate-rial. The NS processing technique not only improves the quality of smear preparation but also ensures laboratory safety.

GraphMAE-based Embedding of 3' UTR ClinVar Variants Reveals MicroRNA-gene Regulatory Disruption in Periodontitis Pathogenesis: An In-silico Computational Modelling Study

Debleena Biswas, Deepavalli Arumuganainar, Pradeep Kumar Yadalam Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Periodontitis is a widespread chronic inflammatory disease, and aberrant mi-croRNA (miRNA)- gene regulation is implicated in its pathogenesis. DeepUTR and miRAW are deep learning models used to predict messengerRNA (mRNA) half-life and miRNA–mRNA interactions. While effective, they depend on large feature sets and lack integration of gene, variant, and miRNA relationships. A self-supervised graph embedding approach, Graph Masked Autoencoder (GraphMAE), was developed to analyse 3' untranslated regions (3' UTR) variants affecting microRNA binding in a multimodal context. Aim: To construct a graph-based multimodal model integrating genes, miRNAs, and UTR3 variants to predict regulatory disruptions relevant to periodontitis. Materials and Methods: This was an in-silico computational modelling study using consisted of publicly available ClinVar 3' UTR variants linked to inflammatory and periodontitis-associated genes. The dataset contained 533 (169 genes+147 miRNAs+217 variants) variant-gene-miRNA triplets corresponding to 1,599 graph edges. Nodes were annotated with compact features, including genes (chromosomal location and gene length and graph degree), miRNAs (GC content and seed-family flags), and variants (effect and length change). The The GraphMAE encoder consists of a Graph Convolutional Network (GCN) layers followed by Rectified Linear Unit (ReLU) activation functions (GCN?ReLU?GCN?ReLU?Linear on a 22-dimensional input) is trained to reconstruct masked node attributes (mask ratio of 0.3) using an Adam optimiser (learning rate 1×10-3) for 50 epochs. Model performance was evaluated using Area Under Receiver Operat-ing Characteristics (AUROC) Curve, Average Precision (AP), accuracy, reconstruction loss, and link-prediction performance. Results: GraphMAE achieved an AUROC˜0.718 (AP˜0.68), distinguishing gain vs. loss edges, far above a gene-only baseline (AUROC˜0.608). It also generalises to unseen miRNA-gene pairs (AUROC˜0.678). The inferred gene-miRNA network reveals clusters of inflammation and tissue remodelling genes (e.g., I#IIL1BI?I, I#ITP53I?I, I#IFOXP3I?I) under miRNA control. Notably, GraphMAE predicts novel high-confidence interactions (e.g., involving I#IIQSEC2I?I). These results demonstrate that integrating gene, variant, and miRNA features in a graph model uncovers regulatory disruptions in periodontitis. Conclusion: GraphMAE’s compact, interpretable embeddings outperform feature-rich CNN/RNN mod-els, such as DeepUTR and miRAW, and suggest testable new miRNA–gene links in periodontal disease. The framework also provides a foundation for extending non coding variant analysis to larger datasets and additional omics layers, which may further enhance biological interpretation. With refinement and vali-dation, GraphMAE has the potential to support deeper insights into gene regulatory mechanisms underlying periodontal and other chronic inflammatory diseases. These findings highlight the value of graph-based computational models in advancing precision genomics research.

Clinical Profile and Predictors of Outcomes in Patients with Acute Abdomen Presenting in the Emergency Department: A Prospective Cohort Study from a Tertiary Care Centre

Himanshi Baid, Mukta Singh, Komal Thakur, Saachi Goel, Vaibhav Gupta Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Acute abdomen is a common emergency presentation with variable causes and out-comes. The clinical profile, aetiologies, and outcome predictors vary from region to region. Understand-ing regional patterns of disease enables protocolised care and improves efficiency and decision-making in Emergency Departments (ED). Aim: To study the clinical profile and predictors of outcomes in acute abdomen in the emergency department. Materials and Methods: This prospective cohort study was conducted over three months (June 2024- August 2024) in a tertiary-care ED in Northern India. Consecutive adults (>18 years) with acute abdominal pain were enrolled. Demographic, clinical, laboratory, and imaging data were collected in a structured proforma. Outcomes were classified as favourable (ED discharge or hospital stay ≤7 days) or unfavourable (surgical intervention, hospital stay >7 days, High Dependency Units (HDU) /Intensive Care Units (ICU) admission, or death). Data were analysed using appropriate parametric and non parametric tests, and multivariable logistic regression was used to identify independent predictors of various out-comes (p-value <0.05). Results: Of 499 screened patients, 198 were analysed (mean age 43.3±17.2 years; 54% male). Co-morbidities were present in 26.3%, most commonly hypertension (9.6%) and diabetes (8.1%); 33.8% reported substance use. The most frequent provisional ED diagnosis was non specific “acute abdomen” (39.9%). Common definitive diagnoses were ureteric colic (13.2%), pancreatitis (8.8%), and acid peptic disorders (10%). Favourable outcomes occurred in 44.4%. Unfavourable outcomes included prolonged hospital stay (19.7%), HDU admission (17.7%), ICU admission (6.1%), surgical intervention (9.1%), and in-hospital mor-tality (1%). Hypoalbuminaemia was independently associated with reduced odds of ED discharge (OR 0.03, 95% CI 0.00-0.45; p-value=0.012), prolonged stay (OR 0.34, 95% CI 0.17-0.67; p-value=0.002), and HDU/ICU admission (OR 0.33, 95% CI 0.16-0.67; p-value=0.002). Abnormal abdominal examination predicted prolonged stay (OR 1.07, 95% CI 1.01-1.13; p-value=0.021) and HDU/ICU admission (OR 1.07, 95% CI 1.01-1.14; p-value=0.033). Fluid resuscitation predicted HDU/ICU admission (OR 3.71, 95% CI 1.15-11.94; p-value=0.028). Conclusion: Hypoalbuminaemia independently predicted unfavourable outcomes in adults presenting with acute abdominal pain and may represent a simple, low-cost marker for early risk stratification in the ED.

Evaluating Preoperative Systemic Inflammatory Markers as Predictors of Cervical Metastasis in Oral Squamous Cell Carcinoma: A Cross-sectional Study

Sanjana Narendra Wadewale, Nitin Bhola, Anchal Agarwal, Rozina Vishnani Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Oral Squamous Cell Carcinoma (OSCC) is a leading malignancy in India, contrib-uting to nearly one-third of global cases. Cervical lymph node metastasis is the most critical prognos-tic factor; however, reliable preoperative predictors remain limited. C-Reactive Protein (CRP) is a di-rect inflammatory marker, whereas Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) are inflammation based haematological indices that have shown prognostic relevance in various ma-lignancies. Aim: To evaluate and correlate preoperative serum CRP, NLR, and PLR with cervical lymph node metastasis in patients with primary OSCC. Materials and Methods: This cross-sectional observational study was conducted in the Depart-ment of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe) Maharashtra, India, from October 2020 to May 2022. Forty patients with histopathologically confirmed OSCC undergoing surgical excision with modified radi-cal neck dissection were included. Preoperative CRP and Complete Blood Counts (CBC) were obtained within one week prior to surgery. NLR and PLR were calculated from haematological parameters. Cervical metasta-sis was confirmed by final histopathology. Statistical analysis was performed using Pearson’s correla-tion coefficient (r-value). Association between inflammatory markers (CRP, NLR, PLR) and cervical lymph node metastasis was assessed using Chi-square test. A p-value <0.05 was considered statistically signif-icant. Results: The age of the patients ranged from 35 to 74 years, with a mean age of 54.5 years. There was a marked male predominance, with 31 males (77.5%) and 9 females (22.5%), resulting in a male-to- female ratio of approximately 3.4:1. of whom 13 (32.5%) had cervical metastasis. Elevated CRP, PLR, and NLR were observed in 18 (45%), 21 (52.5%), and 31 (77.5%) patients, respectively. No statistically significant association was observed between CRP (r=-0.14, p=0.37), PLR (r=-0.02, p=0.92), or NLR (r=-0.04, p=0.81) and cervical metastasis. Conclusion: Preoperative CRP, NLR, and PLR did not show a significant association with cervical metastasis in OSCC. Although these markers are inexpensive and readily available, their standalone pre-dictive value appears limited. Larger multicentric studies are warranted to validate their prognostic role.

Visual-motor Integration and Academic Achievement in Children with Specific Learning Disabilities: A Cross-sectional Study

Thulasikanthan Mugesh, NR Nappinnai Seran, Anjan Bhattacharya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Children with Specific Learning Disabilities (SLD) often exhibit difficulties beyond academic skills, particularly in Visual Perception (VP), Motor Coordination (MC), and Visual-motor Integration (VMI), which can adversely affect classroom performance. Aim: To examine the influence of demographic variables on VP, MC, and VMI, and to explore their relationship with academic achievement in children with SLD. Materials and Methods: This cross-sectional study included 120 children aged 8-15 years diagnosed with SLD, recruited from schools and clinical settings in Kolkata, West Bengal, India. Standardised assessments were used to evaluate VP, MC, and VMI. Academic performance in English and Mathematics was obtained from school records. Independent samples t-tests, One-way Analysis of Variance (ANOVA), and Pearson correlation analyses were performed using Statistical Package for the Social Sciences (SPSS) Statistical significance was set at p-value <0.05 with p-value <0.01 and 0.001 indicating higher levels of significance. Results: Age showed a statistically significant association with VMI (F=2.43, p-value=0.002), but not with VP or MC. Gender and family type did not significantly influence any visuomotor domain. Geographical location showed a significant difference only for MC, with rural children performing better than urban children (t=-2.34, p-value=0.002). Significant positive correlations were observed between visuomotor abilities and academic achievement in English and Mathematics, with VP showing the strongest association with English performance (r-value=0.74, p-value <0.001). Conclusion: Visuomotor abilities are strongly associated with academic achievement in children with SLD. Assessment of VP, MC, and VMI should be included in routine evaluation, and early targeted intervention may support better classroom participation and learning outcomes.

A Comparative Evaluation of Sealing Efficiency in Two MTA Placement Techniques Using Rhodamine B Dye and Confocal Laser Scanning Microscopy: An In-vitro Study

K Madhu Varma, Dasari Lokesh, Jagapathi Babu Mavidi, R Kalyan Satish, D Praveen, J Krishnaveni, A Katyayani, P Mounika Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: A reliable apical seal is essential for the long-term success of endodontic sur-gery. Mineral Trioxide Aggregate (MTA) is well known for its excellent sealing properties and is fre-quently employed as a root-end filling material. The technique of MTA placement-either orthograde through the root canal or retrograde during surgical access-may influence its sealing effectiveness and consequently, the clinical outcome of endodontic procedures. Reported variations in the sealing ability of MTA are primarily attributed to differences in placement techniques and evaluation methodologies. The absence of standardised guidelines continues to limit the establishment of definitive conclusions. Therefore, a direct comparative assessment of orthograde and retrograde MTA placement using Confocal Laser Scanning Microscopy (CLSM) is warranted. Aim: The present in-vitro study aimed to compare the sealing ability of orthograde and retro-grade MTA placement techniques using CLSM. Materials and Methods: The present in-vitro study was conducted at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, over a period of four months (January 2025 to April 2025). A total of 24 extracted single-rooted human mandibular teeth with single canals, obtained for periodontal reasons, were randomly allocated into three groups (n=8 per group): Group I (Control): No root-end preparation or filling. Group II (Orthograde): A 6 mm apical MTA plug placed orthogradely using a Disposable Apical Carrier (DAC). Group III (Retrograde): Retrograde root-end preparation followed by MTA filling. All specimens underwent apical resection at 3 mm from the apex. To assess microleakage, samples were im-mersed in 1% Rhodamine B dye for 24 hours and subsequently examined under CLSM. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp.). Inter-group comparison of apical microleakage (in mm) was conducted using one-way Analysis of Variance (ANO-VA). Pairwise comparisons were performed using Tukey’s post-hoc test. The level of significance was set at p<0.001. Results: One-way ANOVA revealed statistically significant differences in mean dye penetration among the groups (p<0.001), indicating a significant variation in apical microleakage (F=5.5, p<0.001). Pairwise post-hoc analysis using Tukey’s test showed that Group III (Retrograde: 3.2±0.6 mm) exhibited significantly less dye penetration compared to Group I (Control: 9.8±1.6 mm) and Group II (Orthograde: 5.8±1.1 mm) (p<0.001). A statistically significant difference was also observed between Group II and Group III (p<0.001). Conclusion: Retrograde placement of MTA demonstrated superior sealing ability compared to the orthograde technique, suggesting that it may be more effective in minimising apical microleakage in en-dodontic surgery.

Aspiration Risk Assessment in Alcohol-intoxicated Mild Traumatic Brain Injury Patients: A Prospective Cross-sectional Study using the Simple Swallowing Assessment

Abhinov Thamminaina, T Abhilash, Chinju Raja Punnen, Mario Antony, SS Rahul, C Harikrishnan, Deepack S Kottarathil, Amal Raja Punnen Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Mild Traumatic Brain Injury (TBI) is prevalent in Emergency Departments, yet the aspiration risk in alcohol-intoxicated patients remains understudied. Aspiration can precipitate life-threatening pneumonia, particularly in patients with impaired protective reflexes. Aim: To determine the prevalence of aspiration risk and identify clinical predictors in alcohol-intoxicated mild TBI patients using the Simple Swallowing Assessment (SSA) in a tertiary care Emergency Department. Materials and Methods: A prospective cross-sectional study was conducted over 18 months from January 2022 to June 2023 in the Emergency Department, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India India. A total of 250 patients with TBI were screened; 187 patients with mild TBI {Glasgow Coma Scale (GCS): 13-15} and confirmed alcohol intoxication {Blood Alco-hol Concentration (BAC) ≥0.08%} were included. Aspiration risk was assessed using the SSA. Demographic characteristics, injury mechanism, BAC, and clinical outcomes were recorded. Statistical analysis in-cluded descriptive statistics, Chi-square tests for categorical associations, and logistic regression to identify independent predictors. Statistical significance was set at p<0.05. Statistical Package of So-cial Sciences (SPSS) version 25.0 was used. Results: The mean age of the patients was 35.4±10.2 with 134 males. Overall aspiration preva-lence was 15.7% {95% Confidence Interval (CI), 11.2%-20.2%}. Age >40 years {Odds Ratio (OR) 2.1, 95% CI 1.3–3.4}, BAC >150 mg/dL (OR 1.8, 95% CI 1.1-2.9), and Road Traffic Accidents (RTA) (OR 1.6, 95% CI 1.0-2.5) emerged as independent risk factors. Patients with aspiration signs developed pneumonia within 72 hours more frequently (p=0.01) and had longer hospital stays (mean 7 days vs. 4 days, p-value=0.03). Conclusion: Aspiration is a clinically significant finding in alcohol-intoxicated mild TBI pa-tients, particularly in older adults and those with high blood alcohol levels. Early identification us-ing bedside screening tools such as the SSA enables timely intervention and improves patient outcomes.

Effectiveness of Manual Therapy on Pain, Range of Motion and Functional Performance among Patients with Myofascial Trigger Point Pain of Upper Trapezius Muscle: A Systematic Review

Rubi Yadav, Abhishek Sharma, Nidhi Sharma, Mohammad Sidiq, Jyoti Sharma, V Krishna Reddy, Aksh Chahal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: A prominent cause of pain that manifests in the Musculoskeletal System is Myo-fascial Trigger Points (MTrPs). MTrPs Points provide a clear basis for evaluation, often resulting in neck pain that can lead to occupational disability. In recent years, effective manual therapeutic strat-egies have been implemented to manage MTrPs. These strategies include myofascial release, positional release, muscle energy techniques, Ischaemic Compression (IC) therapy, transverse friction massage, man-ual pressure release, trigger point therapy, and exercise therapy. Aim: The present review aimed to determine the effect of various Manual Therapy (MT) techniques on pain, Range Of Motion (ROM), and functional performance among patients with Myofascial trigger point pain of the upper trapezius muscle and extract promising techniques from evidence-based practice in man-aging them. Materials and Methods: The present review has been registered under International Prospective Register of Systematic Reviews (PROSPERO) with a unique no. CRD42023427359. Databases of PubMed, Google Scholar, and Cochrane were searched. The search was conducted between March 2023 and October 2023. Meth-odological quality was assessed independently by two authors using the Physiotherapy Evidence Database (PEDro) scale. Four main outcome parameters were evaluated in the short and medium term: pain, pressure threshold, cervical ROM, and disability, including muscle stiffness. Results: After fulfilling the inclusion and exclusion criteria, 15 articles were incorporated in the systematic review. Two independent authors verified and screened data and the third author dou-ble-checked and searched for additional articles. The findings reveal that MT influences the clinical presentation in patients with upper trapezius trigger points by reducing pain intensity and duration, while also accelerating cervical ROM and decreasing the incidence of neck disability, indicating a sig-nificant role of MT in enhancing the health-related quality of life for those with upper trapezius MTrPs. Conclusion: The current study comes to the conclusion that giving patients with upper trapezius trigger points an efficient protocol based on MT therapy and exercise reduces the incidence of adhesion formation, improving neck pain and thereby, greatly enhancing the overall quality of life.

Comparison of Ropivacaine and Levobupivacaine in Supraclavicular Brachial Plexus Block for Fast-track Recovery in Arteriovenous Fistula Creation: A Randomised Double-blind Clinical Study

Amrita Singh, Noopur Jani, Kalpana Vora, Beena Parikh, Anjali Chothajni Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Arteriovenous Fistula (AVF) creation surgery is the standard procedure for es-tablishing durable vascular access in patients with End Stage Kidney Disease (ESKD). Brachial Plexus Blocks (BPB) improve surgical outcomes of AVF by producing sympathetic blockade and vasodilatation. For ambulatory AVF surgery, early motor recovery from regional blocks is desirable to enable early dis-charge. Aim: The present study was aimed to compare recovery profile of Ropivacaine and Levobupivacaine in supraclavicular BPB for AVF creation. Materials and Methods: The present randomised double-blind clinical study was conducted in the department of Anaesthesia at a tertiary care superspeciality teaching hospital, (Institute of Kidney Disease and Research Centre-Institute of Transplantation sciences) Ahmedabad, Gujarat ,between September 2022 and July 2024 by enrolling sixty American Society of Anesthesiologists (ASA) III-IV patients with ESKD undergoing AVF creation. Patients received Supraclavicular BPB with either 20 mL of 0.5% Levobupi-vacaine (Group L) or 20 mL of 0.5% Ropivacaine (Group R). Motor and sensory block characteristics, post-operative analgesia duration and complications were assessed. Data were analysed using Statistical Pack-age for Social Sciences (SPSS) version 20. Independent t-test and Mann-Whitney U test were applied for continuous variables while Chi-square test for categorical variables. Results: Both groups were comparable in terms of demographic characteristic. Motor block re-gression time and total motor block durations were shorter in Group R (225±14.7 minutes; 425.67±82.28 minutes) than Group L (268±14.7 minutes; 606.67±54.73 minutes, p=0.001); whereas motor block onset was faster in Group L (14.27±1.01 minutes) than Group R (19.77±1.59 minutes, p=0.001). Conclusion: Levobupivacaine provides prolonged motor and sensory blockade whereas Ropivacaine offers short duration motor block with adequate analgesia. Thus, Ropivacaine is more suitable Local An-aesthetic (LA) to hasten Regional Anaesthesia (RA) recovery in Arterio-Venous Fistula (AVF) creation surgery.

Establishing Normative Values for Single Leg Hop Test in School-going Children Aged 8-15 years: A Cross-sectional Study from Haryana, India

Jasmeet Kaur, Manu Goyal, Aradhana Chhabra, Kanu Goyal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The Single Leg Hop Test (SLHT) is a functional tool used to evaluate unilateral lower limb power and dynamic stability in paediatric populations. Although, it is widely used in clini-cal and research settings, standardised reference ranges for school-going children are not well-established, limiting the ability of consistent interpretation of performance results. Aim: To establish normative values for the SLHT among school going children aged 8-15 years. Materials and Methods: A cross-sectional study was conducted at MM International School, Mul-lana, Ambala, Haryana, India from January 2025 to December 2025. This study included 330 school-going children aged between 8-15 years. Participants were stratified by age and gender. The test was conducted using standardised procedures, and hop distance was recorded as the primary outcome measure. Age and gender-specific reference ranges were established using descriptive statistics, including mean values, standard deviations, and percentile distributions to measure the changes in functional performance. Results: A total of 330 school-going children aged 8-15 years were analysed. The mean distances of the single leg hop were 85.04±28.46 cm for the right leg and 81.83±29.66 cm for the left leg. Hop performance improved gradually with age (p<0.001). Females demonstrated slightly longer hop distances than males; however, the difference was not statistically significant, while higher Body Mass Index (BMI) showed lower hop performance outcomes (p<0.05). The children showed age-related improvements in lower-limb strength, balance, and functional ability. In addition, for the reliability testing of SLHT, another sample of 166 school-going children across different BMI categories was analysed. Excellent re-liability was observed for both limbs, with Intraclass Correlation Coefficients (ICC) of 0.99 for right and left leg hop distances (95% CI: 0.987-0.996, p<0.001). Conclusion: The present study provides age and gender-specific normative values for the SLHT in school-going children, reporting age-related improvements, slightly higher performance in females, and a mild negative influence of higher BMI, thus supporting its standardised use in paediatric functional assessment.

Evaluation of Serum Cystatin C levels in Type 2 Diabetes Mellitus Patients with and without Diabetic Nephropathy: A Cross-sectional Study

Sangeeta Chongtham, Ngangom Arunkumar Singh, Takhellambam Brojen Singh, Niketa Ashem, Okram Reshmi, Moirangthem Sinorita Devi, Soibam Pritam Singh, RK Vallentina Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Diabetes Mellitus (DM) is a metabolic disorder characterised by insufficient in-sulin secretion or action that raises blood glucose levels. One of DM’s major chronic complications is Diabetic Nephropathy (DN), a leading cause of End-Stage Renal Disease (ESRD). Early diagnosis of renal dysfunction is a major clinical challenge. Cystatin C is a low molecular weight protein, proposed for the evaluation of renal function. Aim: To estimate the level of serum Cystatin C in Type 2 DM (T2DM) with and without DN. Materials and Methods: The present cross-sectional study was done in the Department of Bio-chemistry and Nephrology, Regional Institute of Medical Sciences, Imphal, Manipur, India, from March 2023 to March 2025. A total of 153 diabetic individuals ≥18 years were included in the study, classified into three groups based on Urinary Albumin Excretion (UAE): Normoalbuminuria, Microalbuminuria, and Macroalbuminuria. Serum Cystatin C level was measured using a sandwich Enzyme-Linked Immunosorbent Assay (ELISA). Age, gender, Body Mass Index (BMI), and weight were analysed to identify associations with DN. The Pearson’s correlation coefficient was used to determine the association of Cystatin C levels with albuminuria. The p-value of <0.05 was considered significant. Results: Age differed significantly (p<0.001), being highest in the normoalbuminuria group. Body weight (p=0.24), height (p=0.51), and BMI (p=0.24) showed no significant group differences in all three groups. Serum Cystatin C levels were much higher in microalbuminuria and macroalbuminuria compared to normoalbuminuria, and the difference was statistically significant (p<0.001). A significant positive correlation was noted between serum Cystatin C and UAE (r=0.686, p<0.001). Conclusion: The study found significant differences in Serum cystatin C in normoalbuminuria, microalbuminuria, and macroalbuminuria DM patients. So, Serum cystatin may exhibit great promise for DN risk assessment and early identification.

Comparative Evaluation of Microleakage in Class V Cavities Restored with Glass Ionomer Cement Modified with Chicken Eggshell Powder and Cention N: An In-vitro Study

Snehal Madhukar Wamane, Sarita Vikram Singh, Aniket Kakasaheb Jadhav, Mrunal Manohar Shinde, Ruchira Bhamare Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Glass Ionomer Cements (GIC) have been valued for their ease of use, fluoride release, and bonding. However, their microleakage can cause sensitivity and secondary caries. Adding Chicken Eggshell Powder (CESP) improves GIC's properties, while Cention N, an alkasite material, enhances wear resistance and sealing with fluoride and calcium release. The present study compares the microleakage of CESP-modified GIC and Cention N. Aim: To evaluate and compare the microleakage of GIC modified with CESP and Cention N. Materials and Methods: This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be) University Dental College and Hospital, Pune, Maharashtra, India and was carried out over three months from August 2024 to October 2024. For the present study, 14 healthy maxillary first premolar teeth that were extracted for orthodontic treatment, intact, had no carious lesions or restorations and were free of pulpal abnormalities were selected. Class V cavities were prepared on the buccal and palatal surfaces of premolars and divided into two groups. Group I where Cavities on the buccal surface were restored using GIC modified with 3% by weight CESP (GIC+CESP), and those on the palatal surface with Cention N being group II. After immersion of the teeth in 0.5% methylene blue dye and buccolingual sectioning, the microleakage assessment was done under a stereomicroscope. Intergroup comparison of microleakage between the two groups was performed using an Independent samples t-test, and the p-value less than 0.05 was considered statistically significant. Results: The comparison showed statistically significant differences (p-value=0.029) between the two groups. Group I (GIC+CESP) and group II (Cention N) showed differences in the microleakage scores, and group I showed the lowest micro-leakage in comparison to group II. Conclusion: GIC modified with CESP (GIC+CESP) exhibited significantly lower microleakage compared to Cention N in Class V cavities. This suggests that incorporating CESP into GIC enhances its sealing ability, making it a promising alternative for reducing microleakage in restorative dentistry.

Effect of Subcutaneous Closed-tube Drainage on Wound Complications following Elective Abdominal Surgery in Morbidly Obese Patients: A Prospective Interventional Study

Shriya Himmat Thacker, Sagar Jaware, Avinash Dhumal, Bhushan Shah, Amey Doke, Jayant Gadekar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Obesity is a recognised risk factor for complications in abdominal surgery wounds. The “dead space” formed by inadequately vascularised subcutaneous adipose tissue permits the accumulation of serous fluid and blood. Bacteria proliferate in this environment, heightening the risk of Surgical Site Infections (SSI) and wound dehiscence. Aim: To determine the efficacy of prophylactic subcutaneous closed-tube drainage in reducing local wound complications following elective abdominal surgery in morbidly obese individuals. Materials and Methods: This prospective interventional study was conducted in the Department of General Surgery, Dr. Vithalrao Vikhe Patil Medical College and Hospital, Maharashtra, India, between April 2025 and December 2025. The study included 200 patients with a Body Mass Index (BMI) exceeding 30 kg/m² and subcutaneous fat thickness greater than 3 cm. The study group (n=100) received a subcutaneous closed-tube suction drain, whereas the control group (n=100) underwent standard closure without drainage. The principal outcomes were seroma, haematoma, and SSI within 30 days postoperatively. The secondary outcomes encompassed the duration of hospital stay and the necessity for supplementary interventions. Results: The baseline demographic and clinical characteristics, including mean age (p-value=0.34), BMI (p-value=0.58), and subcutaneous fat thickness (p-value=0.67), showed no statistically significant differences be-tween the drain and nodrain groups. Use of subcutaneous suction drains significantly reduced wound complications. Seroma formation was 6% in the drain group and 24% in the control group (p-value <0.001). Also, there were fewer haematomas (2% vs 8%, p-value=0.048). Most significantly, the SSI rate was significantly lower in the study group (5% vs 18%, p-value=0.004). Consequently, the drain group had a markedly lower need for secondary interventions such as needle aspiration or re-suturing (4% vs 22%) and a shorter hospital stay (4.2±1.1 vs 6.8±2.5 days). Conclusion: Prophylactic subcutaneous closed-tube suction drainage is an effective, low-risk intervention that reduces wound morbidity in morbidly obese individuals and optimises hospital resource utilisation by reducing fluid accumulation and bacterial proliferation.

Management and Outcomes of Vascular Complications in Lower Limb due to Diabetes: A Prospective Observational Study

Akanksha Yachmaneni, Suhas Jajoo, Chandrashekhar Mahakalkar, Samyukth Katam Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Diabetes mellitus is a metabolic disorder characterised by hyperglycaemia, leading to vascu-lar complications, including Peripheral Artery Disease (PAD) and gangrene. Aim: To assess the vascular complications in the lower limbs of diabetic patients by evaluating clinical and radiological findings and analysing treatment outcomes. Materials and Methods: The present prospective observational study was conducted among 60 diabetic patients with signs of diabetes-related vascular problems in their lower limbs at the Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India from July 2022 and concluding in March 2024. Angiography or Doppler ultrasonography combined with patient data collection and clinical evaluation were used to diagnose and assess patients. The collected data were analysed to identify patterns and trends in the patient population. Descrip-tive statistics were used to summarise the data, means and standard deviations, frequencies and percentages were calculated for categorical variables by employing Statistical Package for Social Sciences(SPSS)-22 (SPSS 22.00 for Windows; SPSS Inc., Chicago, USA). Results: The majority of patients were male subjects 52 (86.7%) and only 8 (13.3%) patients were fe-males. Mean age of male subjects included in study was 59.73±11.9 years and 59.5±15.7 years for females. An 81.7% of the study population received their diagnosis through doppler ultrasonography. Glycated Haemoglobin (HBA1c) >7 was present in 66.7% of subjects. Gangrenous changes were identified in 60% of subjects as doppler ultrasonography revealed the presence of ischaemia in all subjects. Interventional treatment was the primary ap-proach, with 90% of subjects receiving procedures like Intraarterial Thrombolysis (IAT) and stenting. However, 36.7% showed progression, requiring further intervention. Conclusion: In conclusion, the present study emphasises the significance of clinical and radiological as-sessment in managing vascular complications in the lower limbs of diabetic patients. The findings suggest that interventional treatment approaches, such as IAT and stenting, are effective in managing the condition. However, a considerable proportion of patients may require further intervention, highlighting the need for close monitoring and follow-up care. The study’s results can inform clinical practice and guide treatment decisions for diabetic patients with vascular complications.

Molecular Genetic Spectrum and Clinical Correlates of Congenital Hyperinsulinism in India: A Multicentric Cross-sectional Study

Jaikumar B Contractor, Somashekhar Nimbalkar, Praveen Singh, Ruchi Shah, Shalmi Mehta, Riddhi Patel, Pavithra Nagraj, Santhosh Olety Sathyanarayana, Sudha Rao, Viswanathan Mohan, Venkatesan Radha, Pratik Shah Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Congenital Hyperinsulinism (CHI) is a rare genetic disorder of pancreatic β-cells character-ised by persistent hypoglycaemia resulting from inappropriate insulin secretion. Such recurrent hypoglycaemic episodes are often associated with irreversible neurological injury and long-term developmental impairment, un-derscoring the importance of timely diagnosis and initiation of targeted therapy to improve neurodevelopmental outcomes and quality of life. In India, the true burden of CHI remains uncertain due to limited awareness, diagnos-tic delays, fragmented care pathways and restricted access specialised centers compounded by the absence of a national surveillance system. Consequently, many infants undergo prolonged empirical medical therapy or de-layed surgical intervention, leading to preventable complications and adverse outcomes. Aim: The present study was undertaken to evaluate the molecular genetic spectrum and clinical correlates of CHI, determine the frequency and distribution of pathogenic variants, assess genotype-phenotype associations, and interpret their implications for management. Materials and Methods: The current multi-centric crosssectional study was conducted from July 2022 to December 2025 at Pramukhswami Medical College and Shri Krishna Hospital, Karamsad, Gujarat, India. Eighteen (n =18) children with biochemically confirmed CHI were recruited through coordinated CHI India Association-linked clinics and outreach programs across India. Clinical, biochemical, and treatment details were recorded. Genetic testing was performed using Next-Generation Sequencing (NGS) panels at accredited laboratories including the Madras Diabetes Research Foundation. Variants were classified according to American College of Medical Genet-ics and Genomics (ACMG) criteria. Clinical and genetic data were summarised using descriptive statistics, and genotype-phenotype associations were assessed using the Kruskal-Wallis test. Results: Pathogenic or likely pathogenic variants were detected in all 18 children (100%). Mutations in-volved ABCC8 (n=11), KCNJ11 (n=3), HNF4α (n=2), GLUD1 (n=1), and PMM2 (n=1). Eight (44%) were diazoxide-responsive, seven (39%) unresponsive, and three (17%) partially responsive. Five children (27.8%) underwent surgery; focal lesions were confirmed in those with paternally inherited ABCC8/KCNJ11 mutations. Median birth-weight SDS differed significantly across genotypes (Kruskal-Wallis H=13.04, p=0.023). Neurodevelopmental delay was present in 27.77% of patients. Conclusion: Genetic testing provides high diagnostic yield in Indian children, with ABCC8 and KCNJ11 mutations predominating. Paternal KATP mutations predict focal disease and potential surgical cure. Early molecu-lar diagnosis and optimised therapy are crucial for improved outcomes.

Determinants of Treatment Response in Schizophrenia: Insights from a Cross-sectional Observational Study

Aanchal Miglani, Sathyanarayanan Gopinath, Priya Sivashankar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Schizophrenia is a complex mental health disorder characterised by variable treatment responses. Previous research has explored factors influencing patient experiences; however, the understanding of how modifiable and non-modifiable factors relate to treatment effectiveness remains limited and, at times, inconsistent. Aim: To explore how the sociodemographic and clinical factors influence illness severity, treatment outcomes, and functional adjustment in work and social domains in patients with Schizophrenia. Materials and Methods: The present cross-sectional observational study was conducted at Sree Balaji Medical College and Hospital, Chennai, India, from July 2022 to July 2023, on 74 schizophrenia patients with at least six months of follow-up. The study assessed sociodemographic factors, treatment adherence, and illness severity in relation to therapeutic outcomes and social adaptation. Data were analysed using Epi Info software version 7, applying Mann-Whitney, Chi-square, and Wilcoxon signed-rank tests, with a significance level set at p <0.05. Results: The current study included individuals diagnosed with schizophrenia spectrum disorders (mean age: 36.1 years), with balanced gender distribution. Most participants were unemployed (71.6%) and married (59.5%). A significant reduction in illness severity was observed post-intervention (p <0.001). Demographic variables such as age, sex, and marital status showed no significant differences; however, marked and severe illness was associated with lower treatment efficacy (p<0.001) and poor resilience (p=0.001). Treatment response assessed via effectiveness index and global improvement categories. Treatment effectiveness was significantly associated with factors such as employment status (p=0.028), illness severity (p<0.001), age of illness onset (p=0.021), Higher Mental Function (HMF) (p=0.002), insight (p=0.007), resilience (p=0.019), and antipsychotic dose (p=0.041). Global improvement was significantly associated with factors such as employment status (p=0.012), illness severity (p<0.001), age of illness onset (p=0.035), HMF (p=0.003), insight (p=0.037), resilience (p<0.001), and treatment adherence (p=0.023). Individuals with milder illness, better insight, preserved HMF, higher resilience scores, and active treatment adherence showed more favourable outcomes. Functional impairment was significantly greater among those with inadequate treatment response and higher illness severity, particularly affecting work, home management, leisure, and interpersonal relationships (p<0.001). Despite overall improvement, a subset of patients continued to experience residual functional limitations, highlighting the link between treatment effectiveness and real-world functioning. Conclusion: According to the present study results, higher resilience, good insight, employment and strong family support are the key factors associated with better outcomes. The study also supports the role of early intervention, sustained treatment engagement and a recovery oriented approach for better clinical and psychosocial care.

Risk Factors for Post-PCNL Systemic Inflammatory Response Syndrome in Patients with Negative Preoperative Urine Culture: A Prospective Observational Study

Sanjay Singh, Souvik Chatterjee, Debansu Sarkar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Percutaneous Nephrolithotomy (PCNL) is the standard treatment for large renal stones. De-spite sterile preoperative urine cultures, Systemic Inflammatory Response Syndrome (SIRS) continues to be a common and potentially serious postoperative complication, occurring in up to 30% of cases. This suggests that conventional urine culture alone may not identify all patients at risk. Clinical co-morbidities such as diabetes mellitus, stone burden, operative duration, and inflammatory biomarkers, including C-reactive Protein (CRP), Neutrophil-to-lymphocyte Ratio (NLR), and Plateletto- lymphocyte Ratio (PLR), have been proposed as potential predictors. Identification of these factors may aid in early recognition and prevention of SIRS. Aim: To evaluate the proportion of SIRS following PCNL in patients with sterile preoperative urine cultures and to identify associated clinical, biochemical, and intraoperative risk factors. Materials and Methods: This prospective observational study was conducted at the Department of Urolo-gy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India, a tertiary care urology centre, between April 2023 and May 2025. A total of 197 patients undergoing PCNL with sterile preoperative urine cultures were included. Patients were categorised into two groups based on the presence or absence of postoperative SIRS. Preoperative, intraoperative, and postoperative variables were analysed using univariate and multivariate logistic regression analyses. Results: SIRS developed in 28.9% (57/197) of patients following PCNL. The mean age of patients in the SIRS group was 51.89±9.54 years, compared with 48.75±11.27 years in the non SIRS group (p-value=0.049). The proportion of male patients was comparable between the two groups 54.4% vs. 49.3%, (p-value=0.516). On univariate logistic regression analysis, diabetes mellitus showed a strong association with postoperative SIRS (odds ratio 13.29, p-value <0.001). Other significant predictors included stone size (odds ratio 5.14 per cm², p-value <0.001), operative duration (odds ratio 1.09 per minute, p-value <0.001), CRP (odds ratio 1.56 per mg/L, p-value <0.001), and PLR (odds ratio 1.05 per unit, p-value <0.001). On multivariate logistic regression analysis, diabetes mellitus, elevated CRP levels, increased PLR, and multiple access tracts remained independent predictors of postoperative SIRS. Conclusion: SIRS is a common complication following PCNL, even in patients with sterile preoperative urine cultures. Diabetes mellitus, inflammatory biomarkers, and procedural complexity significantly influence postoperative inflammatory risk. Incorporating these parameters into preoperative risk stratification may facilitate early identification of high-risk patients and improve perioperative outcomes.

Knowledge and Attitude of Eye Care Practitioners on Legal Provisions and Social Issues of Visually Impaired Individuals in and around Mangalore: A Cross-sectional Study

Shilka Chellath, Liba Sara Varghese Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Blind and visually impaired individuals continue to face significant legal and social issues, even though the Government of India has been ensuring comprehensive support through framing specialised legal measures. It is crucial for professionals who deal with blind and visually impaired individuals to know their legal rights and understand the everyday social challenges they face. Aim: To assess the knowledge and attitude of eye care practitioners in and around Mangalore regarding legal provisions and social issues faced by visually impaired individuals. Materials and Methods: A cross-sectional study was conducted among practitioners from various hospitals in Mangalore between May 2024 and January 2025. Participants were recruited based on predefined inclusion and exclusion criteria, after obtaining written informed consent. Data were collected using a researcher-developed questionnaire comprising three sections, including socio-demographic characteristics, knowledge, and attitude. Descriptive statistics were applied, and inferential analysis was conducted using one-way Analysis of Variance (ANOVA). A p-value <0.05 was considered statistically significant. Results: Among the 96 participants, 58 (60.4%) were aged 25-35 years, 75 (78.1%) were female, and 60 (62.5%) were optometrists. The majority, 58 (60.4%), had 1-10 years of professional experience. The mean total knowledge score was 13.78±4.52, while the mean total attitude score was 16.77±2.4, reflecting a generally favourable attitude. One-way ANOVA revealed a statistically significant difference in total knowledge scores across experience groups (p-value=0.018). Knowledge scores were significantly higher among practitioners with more than 15 years of experience. Conclusion: Although eye care practitioners exhibit a favourable attitude towards supporting visually impaired individuals, they demonstrate only a moderate level of knowledge, with notable gaps in legal provision and social issues. These findings highlight the need for structured educational and training initiatives to enhance practitioners’ knowledge and improve comprehensive patient care.

Clinico-epidemiological Profile, Risk Factors, and Outcomes of Elizabethkingia Infections: A Retrospective Observational Study

Nidhi Yaduvanshi, Chinmoy Sahu, Kanchan Kumari, Sangram Singh Patel Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Elizabethkingia spp. is an emerging nosocomial pathogen that primarily causes bloodstream infections, pneumonia, and sepsis, particularly in critically-ill individuals. This organism is typically resistant to commonly used antibiotics for Gram-negative infections and is associated with significant morbidity, mortality, and prolonged hospital stays. Aim: To evaluate the clinicoepidemiological profile, risk factors, species identification, antimicrobial susceptibility pattern, and outcome of infections caused by Elizabethkingia species. Materials and Methods: This was a retrospective laboratory-based observational study conducted in the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India, over a one-year period from June 2024 to June 2025. All clinical samples {blood, Cerebrospinal Fluid (CSF), Endotracheal (ET) aspirate, Bronchoalveolar Lavage (BAL) and urine} showing pure growth of Elizabethkingia species were included. A total of 48 non duplicate Elizabethkingia isolates obtained from individual patients were included. Identification was initially performed using the VITEK-2 automated system and subsequently confirmed by Matrix-Assisted Laser Desorption/Ionisation Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility testing was carried out by–Kirby-Bauer disk diffusion method. Demographic and clinical data (age, sex, diagnosis, co-morbidities, risk factors, and outcome) were retrieved from patient records. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 14.0; results were expressed as n (%), and Chi-square test was applied, considering p-value<0.05 significant. Results: A total of 48 patients were positive for Elizabethkingia spp., comprising 39 adults (81.3%) and nine neonates (18.7%). Respiratory infections predominated among adults, 64.1% (25/39), whereas meningitis and sepsis were the main presentations in neonates, 88.9% (8/9), including five cases of meningitis (55.6%) and three cases of meningitis with sepsis (33.3%). Both E. meningoseptica and E. anophelis isolates showed 100% susceptibility to minocycline and piperacillin–tazobactam. Overall, favourable outcomes were observed in 83.3% of patients, with mortality in 16.7%, primarily due to meningitis and sepsis. Conclusion: The present study highlights the emergence of E. meningoseptica and E. anophelis as significant multidrug-resistant pathogens causing severe infections in both adult and neonatal patients. The findings emphasise the importance of rapid and accurate species identification using MALDI-TOF MS to guide appropriate therapy. Early diagnosis and targeted treatment were associated with improved patient outcomes. Strengthening infection control practices and continuous antimicrobial surveillance are vital to prevent hospital transmission and ensure optimal management of these multi-drug-resistant pathogens.

Prevalence of Dry Eye Disease among Patients with Glaucoma using Topical Antiglaucoma Medications: A Cross-sectional Study from a Tertiary Care Hospital of Eastern India

A Ardra, Debajyoti Nanda, Krittika Palchoudhury, Manisha Sarkar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Dry Eye Disease (DED) is a common, chronic, multifactorial disorder of the tear film and ocular surface that significantly affects quality of life and treatment adherence in patients with glaucoma. Long-term use of the topical antiglaucoma medications, especially those containing preservatives, has been implicated in ocular surface damage. Aim: To determine the prevalence and severity of DED among patients with glaucoma using topical antiglaucoma medications. Materials and Methods: This hospital-based, cross-sectional study was conducted in the Department of Ophthalmology of a tertiary care teaching Institute in Kolkata, West Bengal, India, over 18 months (June 2023-December 2024). Glaucoma patients, aged more than 40 years, on topical antiglaucoma therapy for ≥6 months, were included. DED was evaluated using the Ocular Surface Disease Index (OSDI), Schirmer’s I test, Tear Film Break-up Time (TBUT) and corneal fluorescein staining. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23.0. Association of glaucoma with various background-related study parameters of patients were analysed by using the Chi-square test and binary logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: A total of 206 patients with glaucoma were included in the study among them 78 (37.9%) were male and 128 (62.1%) were female with the mean age of 64.38±10.288 years. The prevalence of DED was 68.9%. Increasing age (p-value=0.04), longer duration of topical antiglaucoma therapy (p-value <0.001), and higher number of topical medications (p-value=0.027) were significantly associated with DED. A Receiver Operating Characteristics (ROC) curve analysis demonstrated that duration of topical therapy was a strong predictor of DED {Area Under Curve (AUC=0.965)}, with a cut-off value of 10.5 months showing 97.2% sensitivity and 81.2% specificity. Conclusions: DED is highly prevalent among patients with glaucoma using topical antiglaucoma medications. Duration of therapy is a strong predictor of DED development. Early screening and appropriate management of ocular surface disease are essential to improve quality of life and treatment adherence.

Effectiveness of Video-based versus Live Demonstration Methods in Infection Control Training of Phase II MBBS Students: A Quasi-experimental Study

Ardra R Menon, Jasmine K Abdulkader, Rejitha Kurukkanari, Anitha P Moorkoth Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Infection Prevention and Control (IPC) training is a critical component of undergraduate medical education to ensure patient safety and protect Healthcare Workers (HCW). During the Coronavirus Disease 2019 (COVID-19) pandemic, disruption of conventional face-to-face teaching necessitated the adoption of alternative instructional strategies, including structured video-based training. However, evidence comparing the effectiveness of video-based methods with traditional live demonstrations for IPC skill acquisition among medical undergraduates remains limited. Aim: To compare the effectiveness of structured video-based training versus live demonstration methods in teaching infection control practices to Phase II Bachelor of Medicine and Bachelor of Surgery (MBBS) students and to assess students’ perceptions of these teaching modalities. Materials and Methods: This quasi-experimental study was conducted in the Department of Microbiology at Government Medical College, Manjeri, Kerala, India, from December 2021 to January 2022. A total of 100 Phase II MBBS students were allocated into two non randomised groups based on existing practical batches: live demonstration (n=50) and video-based training (n=50). Training focused on three selected IPC practices: hand hygiene and donning and doffing of Personal Protective Equipment (PPE). Cognitive knowledge was assessed using structured pre- and post-test questionnaires, while psychomotor skills were evaluated using an Objective Structured Practical Examination (OSPE). Student feedback was recorded using a 5-point Likert scale. Statistical analysis included calculation of mean, standard deviation, median, and interquartile range. As the data were non normally distributed, non parametric tests, namely the Wilcoxon signed-rank test and Mann-Whitney U test, were applied. A p-value <0.05 was considered statistically significant. Results: The study cohort comprised 54 females (58.7%), and 38 males (41.3%). Among the 92 students who completed the training, there was a statistically significant post-test improvement in cognitive knowledge using both training methods (p-value <0.001). The absolute gain in knowledge ranged from 29% for PPE video-based training to 37% for PPE live demonstration. While both live and video-based methods were equally effective in improving the cognitive domain of hand hygiene (Mann-Whitney U test, p-value=0.56), live demonstrations were significantly superior for skill acquisition in hand hygiene and PPE donning/doffing, as well as for cognitive improvement in PPE training (Mann-Whitney U test, p-value <0.001). Student feedback indicated a strong preference for live demonstrations 45/46 (97.8%), although video-based training was also perceived as useful by a majority of participants 28/46 (60.9%). Conclusion: Live demonstrations are superior to video-based training for acquisition of psychomotor IPC skills, particularly for PPE use, while structured video-based modules effectively enhance cognitive knowledge. Video-based training can serve as a valuable adjunct to traditional teaching, particularly during faculty shortages or logistical constraints, supporting a blended approach to IPC education in undergraduate medical curricula.

Impact of Surgical Antimicrobial Prophylaxis Protocol Implementation on Surgical Site Infection Rates and Microbial Epidemiology: A Prospective Observational Study

Kalaivani Ramakrishnan, Ramya Ramamurthi, Sindhuja Thangaraj, Vanitha Vaithilingam Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Surgical Site Infections (SSIs) are a leading cause of postoperative morbidity, contributing to prolonged hospital stays and increased healthcare costs. Institutional strategies, including surveillance and adherence to Surgical Antimicrobial Prophylaxis (SAP) guidelines, remain essential in combating SSIs. Aim: To determine the distribution, microbial profile, and antimicrobial resistance patterns of SSIs, and to assess adherence to SAP protocols in a tertiary care teaching hospital. Materials and Methods: This prospective observational study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, from January 2022 to December 2024. As this was a prospective, period-based surveillance study, all eligible SSI cases detected during the study period were included. The parameters assessed were SSI incidence, clinical classification of infections, patient demographics, microbial distribution, antimicrobial resistance patterns, and SAP adherence indicators. SSI surveillance followed the Centres for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) criteria with 30- or 90-day follow-up. SAP adherence was monitored across eight surgical departments. Results: A total of 15,650 clean and clean-contaminated surgeries were performed, among which 125 patients developed SSIs. Females constituted 82 (65.6%) of the SSI cases, with the 31-50 years age group most affected, 56 (44.8%). The overall SSI rate was 125 (0.79%), with the highest burden observed in post-Lower Segment Caesarean Section (LSCS) cases, 82 (65.6%). Gram-negative organisms predominated 88 (70.4%), primarily Escherichia coli and Klebsiella pneumoniae. Resistance to third-generation cephalosporins was notably high at 61 (71.8%). Conclusion: The present study showed that SSIs in this tertiary care setting were largely associated with Gram-negative organisms, many of which exhibited multidrug resistance. An important observation was the higher proportion of SSIs among post-LSCS cases, suggesting that obstetric surgeries may represent a vulnerable group within the overall SSI burden. Strengthening perioperative infection control measures, ensuring appropriate postoperative antibiotic discontinuation, and reinforcing patient education and follow-up may support sustained reduction in SSI.

Evaluation of Biochemistry Laboratory Services for Compliance with ISO 15189:2022 Standards in a Tertiary Care Teaching Hospital in Southern India: A Cross-sectional Study

Mohammed Zeeshanuddin, Syed Salman Ahmed, KV Krishna Reddy, Nimma Satyanarayana Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Medical laboratories play a vital role in delivering accurate diagnostic results essential for effective patient care. Errors in laboratory processes can lead to misdiagnoses, treatment delays and increased healthcare costs. The International Organisation for Standardisation (ISO) 15189:2022 standard outlines requirements for quality and competence in medical laboratories, promoting a robust Quality Management System (QMS). Aim: To assess the compliance of the Biochemistry laboratory at a tertiary care teaching hospital in Southern India with ISO 15189:2022 standards in order to enhance diagnostic quality and patient safety. Materials and Methods: The present observational cross-sectional study was conducted from July 2023 to June 2024 in the Clinical Biochemistry Laboratory of a tertiary care teaching hospital in Southern India to evaluate current practices against ISO 15189:2022 standards. Thirty-three parameters across the pre-analytical (14), analytical (10) and post-analytical (9) phases were assessed. Data were collected through direct observation of sample collection, processing and reporting. Compliance was recorded as “YES” or “NO” for each parameter across Outpatient Department (OPD, n=165), Inpatient Department (IPD, n=132) and Emergency Department (EMD, n=99) samples. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 29 and Microsoft Excel to determine p-values. Results: Overall compliance was 72.27%, with OPD showing 75.54%, IPD 74.15% and EMD 67.09%. The analytical phase demonstrated the highest compliance (78.05%), followed by the post-analytical phase (73.59%) and the pre-analytical phase (65.14%). Key gaps included inconsistent temperature monitoring, irregular safety drills and poor sample handling. Chi-square tests confirmed statistically significant differences across departments (p<0.05). Conclusion: Recommendations include improved temperature monitoring, enhanced safety training, barcode labelling and strengthened quality control measures. These findings highlight the laboratory’s strengths and provide a roadmap toward full ISO 15189:2022 compliance, ultimately enhancing diagnostic accuracy and patient outcomes. The present study emphasises the critical role of systematic quality management in medical laboratories.

Development of Comprehensive Movement Screening Tool in Competitive Swimmers: A Modified Delphi Study

Dnyanesh Pramod Patil, Ajit Surendra Dabholkar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Competitive swimmers are subjected to repeated, high volume of training loads which predispose them to overuse injuries, primarily involving the shoulder, knee and low-back. Current screening tools are generic and isolated screening tests may not adequately identify swimming specific injury risk; therefore, developing an evidence-based screening tool will help to identify injury risk and guide injury prevention. Aim: To develop a sports-specific comprehensive movement screening tool for competitive swimmers. Materials and Methods: A 3-round modified Delphi conducted at School of Physiotherapy, D Y Patil deemed to be University, Navi Mumbai, Maharashtra, India online between January 2024 and September 2024. A total of 13 experts (7 academicians and 6 clinicians) participated In Round-1, 29 pre-identified tests comprising of six domains were rated on a 2-point Likert scale with consensus set at ≥70%. In rounds 2 and 3, experts reappraised their agreement in view of group consensus and threshold was stepped up at ≥80% on 5-point Likert scale. Results: In Round-1, 13 tests achieved ≥70% threshold and four tests nearing threshold were retained for the next round. In Round-2, a total of 23 tests (including six newly suggested tests) were evaluated, of which 10 achieved ≥80% consensus and were included in the final screening tool. Instead of eliminating 13 tests in Round-2 they were re-evaluated again in Round-3. In Round-3, from 13 tests below 80% consensus were evaluated again, from those seven tests which achieved the required consensus agreement and were included in the final tool. However, all tests in the category of balance domain did not achieve expert consensus were eliminated. A total of 17 tests achieved consensus and included in the final screening tool which comprised of 5 domains- functional movements, mobility, muscle strength and endurance, muscle length and core stability. Conclusion: The comprehensive movement screening tool for competitive swimmers developed using a modified delphi process achieved consensus on 17 tests comprising of 5 domains. This tool can assist in early identification of injury risk and guide prevention strategies based on the identified risk.

Analgesic Efficacy of Ultrasound Guided Peri Capsular Nerve Group Block versus Femoral Block for Facilitating Spinal Anaesthesia Positioning in Proximal Femoral Fractures: A Prospective Observational Study

Shiril Ashraf, Roshin Reeba Joseph, Susan Suku Ninan, Elizabeth Lovely Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Positioning patients with proximal femoral fractures for spinal anaesthesia is often associat-ed with severe pain. Femoral nerve block has been traditionally used for analgesia but may cause quadriceps weakness. The Pericapsular Nerve Group (PENG) block is a novel technique designed to provide effective analge-sia while preserving motor function. Aim: To compare the analgesic efficacy and the Ease Of Spinal Positioning (EOSP) between ultrasound-guided PENG block and Femoral Nerve Block (FNB) in patients undergoing surgery for proximal femoral fractures. Materials and Methods: The present prospective observational study was conducted in the Department of Anaesthesiology at Government Medical College, Kottayam, Kerala,India, from January 2025 to December 2025, included 52 patients undergoing surgery for proximal femoral fractures under spinal anaesthesia. Patients were enrolled using consecutive sampling to PENG block group (n=26) and FNB group (n=26). Pain scores at rest (VAS-R) and during movement (VAS-D) were recorded before block and at 10, 20, and 30 minutes after block. EOSP was assessed on a 0-3 scale during sitting for spinal anaesthesia. Statistical analysis was performed using appropriate tests, with p<0.05 considered statistically significant. Results: A total of 52 patients were included in the study, with 26 patients in each group. The mean age was 65.2±8.4 years in the PENG group and 66.1±7.9 years in the FNB group, with no significant difference in demographic characteristics between the groups (p>0.05). Baseline pain scores were comparable between groups (7.24±0.66 vs 7.35±0.69; p=0.578). Post-block Visual Analogue Scale (VAS) scores at rest were significantly lower in the PENG group at 10 minutes (3.92±0.79 vs 4.65±0.74; p=0.001), 20 minutes (2.46±0.65 vs 3.50±0.76; p<0.001), and 30 minutes (2.04±0.45 vs 2.69±0.68; p<0.001). EOSP scores were significantly higher in the PENG group (2.46±0.51) compared with the FNB group (2.12±0.59; p=0.028). No block-related complications were ob-served. Conclusion: Both PENG block group and femoral block group showed significant reduction in VAS scores. But it was noted that Ultrasound-guided PENG block provide better reduction in pain scores compared to FNB and provides superior analgesia. PENG block was associated with better EOSP compared to FNB in patients with proximal femoral fractures undergoing spinal anaesthesia.

Effects of Intravenous Dexmedetomidine and 2% Lignocaine on Perioperative Haemodynamic Stability and Postoperative Recovery Profile in Laparoscopic Cholecystectomy: A Randomised Double-blind Controlled Trial

Yuvaraj Ponnambalam, Pushparani Anand, Karthik Kanthan Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Laryngoscopy and endotracheal intubation induces significant sympathetic stress response, leading to tachycardia and hypertension which can be often deleterious, particularly in laparoscopic surgeries. Several pharmacological agents have been evaluated in order to reduce this response. Dexmedetomidine, a selective alpha 2-adrenergic agonist, and intravenous lignocaine have been shown to have some effects on the haemodynamic responses during surgery. Aim: To compare the effectiveness of intravenous dexmedetomidine and intravenous lignocaine on perioperative haemodynamic stability and postoperative recovery profile in laparoscopic cholecystectomy. Materials and Methods: This randomised double-blind controlled trial, was conducted in the Department of Anaesthesia, in SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, over a period of eight months, from April 2025 to December 2025. which included 90 patients undergoing elective Laparoscopic cholecystectomy under general anaesthesia and randomly allocated into three groups- Group D-Dexmedetomidine, Group L-Lignocaine (2%), Group P-Placebo (0.9% Normal saline) of 30 patients in each group. Haemodynamic parameters were taken at baseline, induction, intubation, intraoperatively and shortly after intubation. The intubation response was assessed as the change from baseline {changes in Heart Rate (?HR), Systolic BP (SBP), Diastolic BP (DBP), Mean Arterial Pressure (MAP)}. Factors evaluated after surgery were extubation time, Visual Analogue Scale (VAS) pain scores and Richmond Agitation-Sedation Scale (RASS). Statistical analysis was performed using One-way Analysis of Variance (ANOVA) for intergroup comparison. Non parametric variables were analysed using the Kruskal-Wallis test and categorical variables were compared using Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Baseline characteristics were similar with mean age was 43.7±4.3 years in dexmedetomidine group, 41.1±3.8 years in lignocaine group and 43.0±5.1 years in placebo group (p=0.06). During laryngoscopy and intubation, the HR was significantly less in the dexmedetomidine group (84.7±4.7 beats/min) than in the lignocaine (90.3±6.2) and placebo groups (91.2±6.1) (p<0.01). MAP also was lower with dexmedetomidine 96.9±5.6 mmHg than lignocaine 99.1±5.2 mmHg and placebo 100.6±6.0 mmHg (p=0.04). Early postoperative sedation (RASS at 0 minutes) was significantly higher in dexmedetomidine group (p=0.02). Conclusion: Intravenous dexmedetomidine was better than lignocaine and placebo in blunting the hae-modynamic response due to laryngoscopy and endotracheal intubation. Dexmedetomidine was also associated with better perioperative haemodynamic stability with acceptable postoperative recovery profile.

Impact of Erythrocyte Indices on Glycated Haemoglobin and Plasma Glucose Discordance in Non-diabetics: A Retrospective Study

AK Roopa, M Hema, Mamta Singh, M Rakchna, Praveen Kumar, K Sowmya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Glycated Haemoglobin (HbA1c) has evolved into one of the most essential tools for the diag-nosis and followup of Diabetes Mellitus (DM). Discordance between plasma glucose and HbA1c is being ob-served, especially in individuals diagnosed with prediabetes. Different types of anaemia, such as iron deficiency, haemolytic, and megaloblastic anaemia, can affect HbA1c results. Aim: To study the effect of erythrocyte indices on the levels of HbA1c, particularly in situations where HbA1c levels are discordant with plasma glucose. Also, to derive the cut-off value of Red Blood Cells (RBC) indi-ces below or above which the HbA1c results will be affected. Materials and Methods: The present retrospective analytical study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from March to August 2023. Out of 495 non-diabetic individuals recruited, those whose HbA1c value matched their plasma glucose value were catego-rised under the concordant group (n=285), and the rest under the discordant group (n=210). Retrospective data, including Fasting Plasma Glucose (FPG), HbA1c, Haemoglobin (Hb), Packed Cell Volume (PCV), Erythrocyte Sed-imentation Rate (ESR), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpus-cular Haemoglobin Concentration (MCHC) were collected and compared between the groups. Statistical analysis was performed using the Mann- Whitney U test and Spearman’s rho correlation via Statistical Package for Social Sciences (SPSS) Version 20. Results: The study population had a mean age of 43.2±11.3 years, comprising 319 males (64.4%) and 176 females (35.5%). For identical FPG ranges in both groups, the discordant group had higher median HbA1c values compared to the concordant group (p<0.001). Discordance was more frequently observed when HbA1c was in the range of 5.8-6.2%. RBC indices such as MCV and MCH were significantly lower in the female discord-ant group, whereas MCHC was considerably lower, especially in the male discordant group. ROC curve analysis showed that the cutoff value derived for the RBC indices had approximately 60% sensitivity and 60% specificity for all indices except MCHC. Conclusion: In the present study, HbA1c showed significant discordance with FPG in the 5.8-6.2% range, increasing the risk of misclassification around the prediabetes threshold.

Unveiling the Therapeutic Potential of Khadira (Acacia Catechu) Against Vitiligo: A Computational Study

Priyanka Nyamti, Rajendraswami Hiremath, Rashmi Motnali Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Vitiligo is characterised by a loss of skin pigmentation, resulting in white patches or spots. It happens when the cells called melanocytes, the cells responsible for producing skin pigment, are harmed or killed. Although it is not communicable or fatal, vitiligo can be emotionally taxing for people who have it. Although Khadira is the most well-known traditional remedy for treating skin conditions, its underlying Protein Protein Interaction (PPI) and signalling pathway remain unknown. The network pharmacology approach was used to investigate the molecular basis of action of Khadira. Aim: To explore the molecular mechanisms of Acacia Catechu in the treatment of vitiligo using network pharmacology analysis. Materials and Methods: This study was a computational network pharmacology analysis conducted in the Department of RSBK, KLE Shri B M Kankanawadi Ayurveda Mahavidyalaya, Belagavi, Karnataka, India between May 2025 and June 2025. Phytochemicals were obtained from earlier research works from PubMed and Google Scholar, Dr. Dukes, and the Indian Medicinal Plants, Phytochemistry and Therapeutics (IMPPAT) databases. Swiss Absorption, Distribution, Metabolism and Excretion (ADME) was used to assess the drug-likeness of phytochemicals linked to PubChem Criminal Investigation Department (CID) based on Lipinski’s criteria. Binding Database (BindingDB) was used to predict targets, and Gene Identifier (Gene ID) was obtained using the Uni Prot database. The String database was used to analyse Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and Cytoscape 3.7.2 was used to construct the networks. Results: A total of 125 phytochemicals were identified from Acacia Catechu, of which 31 fulfilled the drug-likeness criteria. Target prediction analysis yielded 111 potential protein targets, and 42 overlapping genes associated with vitiligo were identified. PPI network analysis highlighted key hub genes, including Xanthine Oxidoreductase (XDH), Mitogen-Activated Protein Kinase 14 (MAPK14) and Janus Kinase 1 (JAK1). Pathway enrichment analysis revealed significant involvement in immune and inflammation-related pathways, such as insulin resistance and prolactin signalling, suggesting multi-target mechanisms underlying the therapeutic potential of Khadira. Conclusion: The present study suggests that Acacia Catechu (Khadira) may exert therapeutic effects in vitiligo through multi-target interactions involving quercetin and kaempferol, particularly with proteins such as XDH, MAPK14, and JAK1 that are linked-to immune and inflammatory pathways. These computational findings support its traditional use; however, experimental and clinical validation is required.

Comparison of 0.75% Hyperbaric Ropivacaine Alone versus 0.75% Hyperbaric Ropivacaine with Fentanyl in Spinal Anaesthesia for Infraumbilical Surgeries: A Double-blinded Randomised Controlled Study

Dinesh K Chauhan, Shirin Jain, Tejash Sharma, Mahendi Mehta, Sara Mary Thomas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Spinal anaesthesia is preferred for infraumbilical surgeries due to its rapid onset and effec-tive postoperative analgesia. Ropivacaine, a long-acting local anaesthetic with reduced cardiotoxicity, is increas-ingly used with adjuvants to enhance block characteristics. Intrathecal adjuvants like fentanyl are being increasing-ly used to improve or prolong the anaesthetic and analgesic effects. Aim: To compare the effects of 0.75% hyperbaric ropivacaine alone versus 0.75% hyperbaric ropivacaine with fentanyl (25 μg) as an adjuvant in spinal anaesthesia for infraumbilical surgeries. Materials and Methods: This randomised controlled study was conducted at tertiary care facility at the Op-eration Theatre (OT) complex in the Department of Anaesthesiology at Dhiraj Hospital, Smt. Bhikhibhen Kanjibhai Shah Medical Institute and Research Centre Vadodara, Gujarat, India from January 2023 to June 2024. Eighty pa-tients undergoing elective infraumbilical surgeries were divided into two equal groups of 40 patients each. Group R (Ropivacaine only) received intrathecal 0.75% hyperbaric ropivacaine 2.5 mL+normal saline 0.5 mL, while group RF (Ropivacaine+Fentanyl) received intrathecal 0.75% hyperbaric ropivacaine 2.5 mL+fentanyl 25 μg. The param-eters studied were onset and duration of sensory and motor blockade, haemodynamic changes, sedation scores, two-segment regression time, duration of analgesia, and sideeffects. Statistical analysis was performed using Stu-dent’s t-test and Chi-square test with p-value <0.05 considered significant. Results: The mean age in group R was 64.5±7.2 years and group RF was 67.8±6.9 years. The time to S2 regression was significantly longer in group RF (118.8±12.8 min) compared to group R (104.5±11.2 min) (p-value <0.001). group RF achieved higher sensory block level (T8 vs T10, p-value <0.001) with shorter motor block dura-tion (208±59 vs 282±56 minutes, p-value <0.001). VAS scores were lower in group RF (3.0±1.5 vs 4.5±1.8, p-value=0.01). Time to rescue analgesia was significantly prolonged in group RF (320±55 vs 210±45 minutes, p-value <0.001). Sedation was higher in group RF (7.5% vs 0%, p-value=0.04) with no significant haemodynamic differences. Conclusion: Addition of intrathecal fentanyl 25 μg as an adjunct to 0.75% hyperbaric ropivacaine provides superior analgesia, shorter motor blockade, and prolonged postoperative pain relief while maintaining haemodynamic stability in comparison to intrathecal 0.75% hyperbaric ropivacaine alone.

Prognostic Relevance of the Modified DECAF Score for Predicting In-hospital Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Anjaly Anoopkumar, Supriya Adiody, Unni R Baby Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Chronic Obstructive Pulmonary Disease (COPD) remains the third leading cause of death globally, with a particularly high burden in Low and Middle-Income Countries (LMIC). Accurate risk stratification during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is crucial for optimising treatment and resource allocation. The modified DECAF score can be used as a simple bedside tool designed to predict in-hospital mortality and guide clinical decision making. Aim: The present study aimed to evaluate the prognostic utility of the Modified DECAF (Dyspnoea, Eosinopenia, Consolidation on CXR, Acidaemia, and atrial Fibrillation) score in predicting in-hospital mortality among patients admitted with AECOPD. Additionally, it seeks to identify clinical variables associated with prolonged hospital stay and overall patient outcomes during AECOPD admissions. Materials and Methods: A prospective observational study was conducted from November 2022 to May 2024 in the Department of Respiratory Medicine at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, Eighty-eight patients with COPD, diagnosed as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and supported by spirometric evidence of airflow obstruction during clinical stability and coming with an acute exacerbation were included. The modified DECAF score cut-off was determined using a Receiver Operating Curve (ROC) curve. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated. Variables influencing prolonged hospital stay and outcomes were analysed using the Chi-square test. Results: The modified DECAF score showed excellent accuracy in predicting in-hospital mortality in AECOPD (AUC=0.963). A cutoff score of 3.5 achieved 100% sensitivity, 89.04% specificity, and a 65.22% PPV. Given its high sensitivity and reliability, the modified DECAF score is a valuable tool for risk stratification in AECOPD patients. Patients with higher modified DECAF scores had longer hospital stays and poorer outcomes. The mean duration of hospitalisation was 8.2±3.6 days. Requirement for oxygen therapy, non-invasive, or invasive ventilation was associated with increased mortality (p<0.005). Although females, current smokers, and those with comorbidities showed a trend toward prolonged hospitalisation, these differences were not statistically significant. Conclusion: The modified DECAF score achieved maximum sensitivity at a cut-off of 3.5, proving its utility in guiding care decisions. It aids in determining the appropriate level of care, suitability for early discharge, and end-of-life considerations, ultimately reducing morbidity and mortality while optimising resource utilisation.

Evaluating the Efficacy of Recreational Activities to Conventional Physiotherapy to Restore Hand Grip in Geriatrics: A Randomised Controlled Study

Pooja Saikia, Manabendra Nayak Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Ageing is a complex biological process associated with a gradual decline in physical and mental wellbeing. Hands are one of the vital upper limb parts of the body, and their functional reduction affects people’s environmental interaction. However, the studies related to the practices to improve Handgrip Strength (HGS) and function among the geriatric population are very limited. Aim: To evaluate the HGS and hand function among adults using hand dynamometer test and the Jebsen Hand Function Test (JHFT), following conventional physiotherapy and recreational activities. Materials and Methods: This single-blind randomised clinical trial was undertaken in Elderly Care Centres (ECCs) in Assam, India, during the period from February 2025 to June 2025. A total of 92 geriatric people were screened, of whom 80 eligible participants were randomly allocated into two groups. Group A received conven-tional physiotherapy, whereas Group B participated in recreational activities for six weeks (five sessions per week). Handgrip strength and hand function were assessed using a hand dynamometer and the Jebsen Hand Function Test at baseline, third week, and sixth week. Paired t-tests were used to analyse within-group differences, and the effect size was calculated using Cohen’s d. A p-value of <0.05 is regarded as statistically significant. Results: The research outcomes proved that the conventional physiotherapy improved handgrip strength from 9.75±1.81 to 12.13±1.73, while recreational activities improved hand function, with JHFT completion time reducing from 44.53±8.26 seconds at baseline to 31.0±8.74 seconds at post-intervention in group B. Conclusion: Both interventions improved handgrip strength and hand function in older adults. Convention-al physiotherapy showed greater improvement in handgrip strength, whereas recreational activities produced greater improvement in hand function. Therefore, proprioceptive training is a valuable intervention for promoting the overall well-being as well as Quality of Life (QoL) in the elderly.

Branched-chain Amino Acid Metabolomics for Assessing Liver Cirrhosis Severity: A Cross-sectional Study

Pooja SK Rai, Pramod Ingale, Neelam Patil, Vaishnavi Pawar, Manoj Lokhande, Nandan Valavaikar, Sarvabhavi Kumavat, Sneha Yadav Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Liver cirrhosis is a chronic, progressive disorder marked by extensive hepatic fibrosis and profound metabolic disturbances. Among these alterations, Branched-chain Amino Acids (BCAAs)—leucine, iso-leucine and valine—undergo significant dysregulation, reflecting compromised hepatic function, altered nitrogen metabolism and muscle catabolism. Advances in metabolomic technologies have facilitated the accurate quantifi-cation of BCAA levels, highlighting their potential as sensitive biomarkers for evaluating disease severity and pro-gression in cirrhotic patients. Aim: To study the levels of branched-chain amino acids in different grades of liver cirrhosis and to evaluate their utility over Child-Pugh score as a biomarker for liver cirrhosis. Materials and Methods: This cross-sectional study was carried out at Department of Biochemistry, Lok-manya Tilak Municipal Medical College and Sion Hospital (LTMMC & GH), Sion, Mumbai, Maharashtra, India, from January 2023 to December 2024 and including 250 patients with liver cirrhosis. Plasma samples from patients with clinically and histologically confirmed cirrhosis were analysed using tandem Mass Spectrometry (MS/ MS). BCAA levels (leucine, isoleucine and valine) were assessed across Child-Pugh classes (A, B and C) and correlat-ed with liver function parameters and disease severity indices. Chi-square test was applied to statistical analysis. Results: Out of 250 patients, 78% were males and 22% were females, between age group of 18-70 years. A progressive decline in BCAA concentrations was observed with increasing severity of cirrhosis (p<0.001). Pa-tients in Child-Pugh classes B and C demonstrated significantly lower BCAA levels compared with controls. Conclusion: The BCAA profiling through metabolomics provides a sensitive and non invasive approach to assessing liver cirrhosis severity. Incorporating BCAA measurements into routine clinical practice may improve risk stratification and support personalised nutritional and therapeutic strategies in cirrhotic patients.

Comparison of Opioid Free General Anaesthesia to Conventional General Anaesthesia for Haemodynamic Stability in Mastoid Surgery: A Randomised Clinical Study

Nirali Jitendrabhai Godhani, Kumud S Ganvit, Dixita Vaghela, Jinal Prajapati, Nimisha Nayani, Girish Vadhel, Reena Gameti, Palak Modi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Opioids are traditionally used in balanced anaesthesia to provide analgesia and haemodynamic stability; however, opioid related adverse effects such as respiratory depression, postop-erative nausea and vomiting, delayed recovery, and opioid induced hyperalgesia have prompted the search for alternative strategies. Opioid Free Anaesthesia (OFA), based on multimodal non opioid analgesia, has emerged as a promising technique to maintain perioperative stability while minimising opioid exposure. Aim: To compare opioid free general anaesthesia with conventional fentanyl based general anaes-thesia for perioperative haemodynamic stability in patients undergoing mastoid surgery. Materials and Methods: This randomised parallel-arm clinical study was conducted in the De-partment of Anaesthesiology at Government Medical College and SSG Hospital, Vadodara, in collaboration with the ENT department, from September 2023 to July 2024. Patients were randomised into two groups: Group OF received magnesium sulphate and dexmedetomidine with a greater auricular nerve block, while Group O received fentanyl based anaesthesia. Haemodynamic parameters, Oxygen Saturation (SpO2), postop-erative analgesia duration, and adverse events were assessed and statistically analysed. Data were ana-lysed using Statistical Package for the Social Sciences (SPSS) software. Normally distributed quantita-tive variables were analysed using independent samples student t-test between the groups. Results: The two groups had similar age, gender distribution, ASA physical status, Mallampati grade, body weight, height, and surgical time (p-value >0.05). After induction, Group OF had a signifi-cantly lower Heart Rate (HR) (78.98±11.16 bpm) than Group O (89.25±6.52 bpm) (p-value <0.001). In Group OF, Mean Arterial Pressure (MAP) values were continuously lower compared to Group O with signifi-cant differences observed at after intubation and various time intervals with significant differences observed at 30 minutes, 120 minutes, and 12 hours postoperatively (p-value <0.001). Both Group OF (329±86.58 minutes) and Group O (330±43.44 minutes) had comparable postoperative analgesia duration, which was not statistically significant (p-value >0.05). Conclusion: OFA using magnesium sulphate and dexmedetomidine with regional nerve block provides superior haemodynamic stability and comparable postoperative analgesia compared to conventional opi-oid based anaesthesia in mastoid surgery.

Optimisation of Preprocessing Protocol to Enhance Yield and Purity of Exosomes in Buffalo Milk: An In-vitro Study

Krutika Lolsure, Vijay M Kumbar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Milk-Derived Exosomes (MDEs) are nano-sized Extracellular Vesicles (EV) with significant potential as natural drug delivery systems due to their biocompatibility, stability, and ability to cross biological barriers. However, efficient isolation of high-purity exosomes from buffalo milk is challenging because of its high fat and casein content. Optimising preprocessing strategies for casein removal is therefore critical. Aim: To compare acetic acid precipitation and Ethylenediaminetetraacetic acid (EDTA) precipitation as pre treatment strategies for casein removal and to evaluate their effectiveness in isolating high-purity buffalo MDEs. Materials and Methods: This in-vitro study was conducted at the Department of Biochemistry, Dr. Prabhakar Kore Basic Science Research Centre (Dr PK BSRC), KAHER, Belagavi, Karnataka, India, from December 2024 to March 2025. Here, fresh buffalo milk was defatted using differential centrifugation, followed by casein removal through either acetic acid precipitation or EDTA precipitation. Exosomes were subsequently isolated from the whey fraction using the ExoEnrich™ (Serum/Plasma) exosome isolation kit. Particle size, size distribution, and zeta potential were analysed using Dynamic Light Scattering (DLS). Morphological characterisation was performed by Transmission Electron Microscopy (TEM), and the exosomal surface marker CD81 was confirmed using flow cytometry. Results: Both isolation methods yielded nanosized vesicles within the expected exosomal range. Acetic acid-treated samples showed a mean particle size of 146 nm and a zeta potential of -20.55 mV, whereas EDTA-treated samples exhibited a slightly larger size of 154 nm with a zeta potential of -17.07 mV. TEM analysis revealed characteristic spherical, cup-shaped vesicles in both groups. Flow cytometry confirmed CD81-positive exosomal populations. Overall, acetic acid precipitation resulted in higher exosome purity compared to EDTA precipitation. Conclusion: The present study demonstrates that both acetic acid- and EDTA-mediated precipitation enable successful isolation of buffalo milk–derived exosomes. Acetic acid precipitation showed comparatively improved purity and favourable physicochemical properties in the current experimental setting. However, rather than establishing definitive methodological superiority, these findings emphasise the role of casein removal chemistry in influencing vesicle characteristics and enrichment efficiency. Further studies are required to confirm these observations across broader conditions.

Effect of High-intensity Functional Training on Visuospatial Working Memory in Middle-aged Adults: A Pilot Study

Abhishek Aaryan, Nidhi Sharma, Prashant Kumar, Sandhya Saini, Abhay Sharma Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Visuospatial working memory is a key cognitive domain that shows subtle decline with age. While aerobic exercise has demonstrated cognitive benefits, evidence on the effects of High-intensity Functional Training (HIFT) on Visuospatial Working Memory (VSWM) in middle-aged adults remains limited. Aim: To evaluate the effect of a 6-week HIFT program on VSWM storage and executive updating in healthy middle-aged adults. Materials and Methods: The present single-arm pre-post pilot study was conducted at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be Uni-versity), Mullana-Ambala, Haryana, India, between August and December 2025. Seventy-two healthy adults (36 males, 36 females), aged 35-50 years, underwent a supervised HIFT (5 sessions/week for 6 weeks). VSWM was assessed at baseline and post-intervention using the Corsi Block-Tapping Task (memory span) and a Visuospatial 2-back task (updating), with sensitivity index (d') and Reaction Time (RT) as outcome measures. Data were analysed using paired t-test and Wilcoxon signed-rank test with effect size estima-tion. Results: The median Corsi span increased from 4.0 to 5.0 (p<0.001; r=0.86). On the 2-back task, sensitivity (d') improved from 2.36±0.52 to 2.84±0.48 (p<0.001; d=0.68), and RT decreased from 612±95 ms to 558±82 ms (p<0.001; d=0.61). Conclusion: A 6-week HIFT program was associated with improvements in both storage and execu-tive components of VSWM in middle-aged adults. These findings are preliminary and should be interpreted cautiously due to the single-arm design. HIFT may represent a time-efficient exercise strategy with po-tential cognitive benefits in middle adulthood.

Comparative Effectiveness of Russian Current and High-voltage Pulsed Galvanic Stimulation on Quadriceps Muscle Atrophy and Functional Recovery Following Total Knee Replacement: A Research Protocol

Nikita Dhanraj Warkad, Soumik Basu Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Total Knee Replacement (TKR) improves joint function and relieves pain, but postoperative quadriceps atrophy impedes recovery. Neuromuscular Electrical Stimulation (NMES), including Russian Current (RC) and High-Voltage Pulsed Galvanic Stimulation (HVPGS), may counteract atrophy. The present prospective study will compare how well they help quadriceps strength and functional recovery in the early stages of post-TKR rehabilitation. Need of the study: Quadriceps atrophy following TKR significantly delays functional recovery, limits mobili-ty, and increases fall risk. Conventional rehabilitation is often insufficient in the early postoperative phase due to pain and Arthrogenic Muscle Inhibition (AMI). The NMES, particularly RC and HVPGS, offers potential benefits in enhancing muscle strength and reducing atrophy. However, limited evidence exists comparing their effectiveness. In order to guide clinical rehabilitation strategies and improve early post-TKR outcomes, the present study is nec-essary. Aim: To compare the efficacy of RC and HVPGS in reducing quadriceps muscle atrophy and enhancing functional outcomes following TKR. Materials and Methods: The present research protocol is for a prospective, single-blinded, randomised controlled trial that will be conducted from Feb 2025 to Feb 2026 to evaluate and compare the effectiveness of RC and HVPGS in managing quadriceps muscle atrophy and enhancing functional recovery after unilateral TKR. The study will be conducted at Tertiary health care centre i.e., Acharya Vinoba Bhave Rural Hospital (AVBRH) Sawangi, Wardha, Maharashtra, India. The study commenced from Feb 2025 and will be completed in Feb 2026, including recruitment, intervention, and follow-up assessments. A total of 40 participants will be enrolled and randomly allo-cated into two equal groups (n=20 in each group) using a block randomisation method with allocation concealment via the SNOSE (Sequentially Numbered, Opaque, Sealed Envelopes) technique. After screening for eligibility and obtaining consent, participants will be randomised into: • Group A: Received RC stimulation (2500 Hz, 50 Hz burst frequency) • Group B: Received HVPGS (100-150 V, 50 Hz) Both groups will undergo standard physiotherapy (Range of Motion (ROM) exercises, strengthening, gait training) for four weeks, five sessions per week. Each NMES session lasted 20 minutes, supervised by a physiotherapist. Pre and post-intervention assessments will be recorded for each outcome measure. Demographic details such as age, gender, Body Mass Index (BMI), limb dominance, and surgical side will be recorded and analysed to ensure baseline comparability between groups. In Statistical Package for Social Sciences (SPSS), using mean ± Standard Deviation (SD) for baseline descriptive, groups will be compared with independent t-tests or Mann-Whitney U (and paired t-tests or Wilcoxon for pre-post), considering p<0.05 significant, and report the effect sizes via Cohen’s d for parametric tests (0.2=small, 0.5=medium, 0.8=large) or r=Z/vN for non-parametric ones.

Pharmaceutico-analytical Evaluation of Drakshadi Gutika and a Novel Polyherbal Tablet with Comparative Assessment of Antioxidant Activity and Acid-neutralising Capacity: A Research Protocol

Rashmi Dilip Zade, Mujahid Khan, Aditi Telrandhe Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Polyherbal formulations are an essential element of traditional medicine sys-tems, particularly Ayurveda, due to the synergistic effects produced by the combination of multiple plant-derived ingredients. Drakshadi Gutika is a well-known Ayurvedic formulation primarily used to enhance digestion and address gastrointestinal disorders. In contrast, the Novel Polyherbal Tablet (NPT) will be a contemporary multi-herb-based formulation designed to address similar therapeutic indi-cations. Both formulations are believed to possess antioxidant and acid-neutralising properties, which will be crucial for managing oxidative stress and gastric acidity, respectively.The study intends to provide a scientific basis for their quality control and therapeutic potential. Need of the study: Stress is a major cause of hyperacidity, affecting 60–70% of individuals. This study introduces a Novel Polyherbal Tablet formulated with proven antioxidant and antiulcer herbs to evaluate its synergistic antioxidant and acid-neutralising effects compared to Drakshadi Gutika. Due to the impracticality of Drakshadi Gutika’s classical 12 g dosage, a modified, formulation is proposed. Aim: To evaluate and compare the pharmaceutico-analytical properties, antioxidant activity and acid-neutralising capacity of Drakshadi Gutika and the Novel Polyherbal Tablet. The study intends to provide a scientific basis for their quality control and therapeutic potential. Materials and Methods:This experimental analytical study will take place from July 2025 to November 2025 at the Biocyte Research and Development Pvt Ltd., Sangli. Both Drakshadi Gutika and NPT will be procured from authenticated sources and their ingredients will be identified and analysed for Standardisation. The pharmaceutico-analytical assessment included evaluations of organoleptic properties (colour, taste, odour), moisture content, total ash and loss on drying, as well as dissolution profiles. For antioxidant activity, the 2, 2-diphenyl-1- picrylhydrazyl (DPPH) free radical scavenging assay will be employed to determine the antioxidant potential of both formulations. The acid-neutralising capacity of each formulation will be measured through titration with a standardised acid solution, calculating the buffering capacity against simulated gastric acid. Statistical analysis will be performed to compare the results of both formulations with respect to antioxidant activity and acid-neutralising capacity will be compared by using statistical analysis by applying Unpaired t-test.

Evaluation of Hepatoprotective Activity of Erycibe Paniculata Roxb. Leaf in Wistar Rats: Research Protocol for a Comparative Experimental Study

Jaydeep Kumar Sahu, Sneha Vidhate Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Liver disease is the cause of two million deaths annually. Herbal medicine gained popularity due to its effectiveness and fewer side-effects. About majority of the world’s popu-lation relies on traditional medicine predominantly based on plant material. The species of genus Erycibe possesses hepato-protective activity, and E. paniculata has been used by ethnic groups for ailments of the liver. This could be adjuvant or alternative therapy for the management and avoidance of liver-related illnesses. Need for the study: Given the high global and national burden of liver disease, the ethnome-dicinal use and reported hepatoprotective potential of Erycibe paniculata necessitate its scien-tific validation as a safe, effective, and affordable herbal alternative. Aim: To evaluate the hepatoprotective activity of E. paniculata Roxb. leaf in Wistar rats. Materials and Methods: The experimental study will be conducted at Central Preclinical Re-search Facility, Datta Meghe College of Pharmacy, Sawangi (Meghe), Wardha, Maharashtra, India. The dura-tion of the study will be three years, which will be from January 2025 and it will be completed on or before December 2028. The present study is an experimental study in which an acute and sub-acute toxici-ty study as per (Organisation for Economic Co-operation and Development Test Guidelines) (OECD) guide-line 423 and 407, respectively will be performed, followed by a hepatoprotective study. As mentioned below total number of animals will be 82, which will be further divided into acute toxicity study having two groups with 3 animals in each (6), sub-acute toxicity of four groups consisting of 10 animal each (40), 36 for hepatoprotective study consisting of six groups. Groups 1 to 6 will receive water, aceta-minophen, silymarin, silymarin with acetaminophen, Erycibe paniculata leaf powder, Erycibe pa-niculata leaf powder with acetaminophen, respectively. All the groups will receive the drug orally, only acetaminophen will be given intraperitoneally. The assessment of hepatic damage will be evaluated based on the liver function markers like Aspartateaminotransferases (AST), Aminotransferases (ALT), Al-kaline Phosphatase (ALP), Lactate dehydrogenase (LDH), Metabolic byproducts such as creatinine, biliru-bin, cholesterol, triglycerides, urea, proteins and glucose and histopathological study. The comparison of biochemical parameters among different treatment groups by One-way Analysis of Variance (ANOVA) Tuk-ey’s Honest Significant Difference (HSD) as post-hoc and p<0.05 will be considered significant.

Assessment of Digital Dermatoglyphic Pattern Variation between Children Exhibiting Cooperative and Uncooperative Behaviour in the Dental Operatory: A Research Protocol

Shepali Hule, Ramakrishna Yeluri Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Understanding a child’s behaviour features in different situations can assist in the treatment planning and can create an effective treatment for the child, especially during their first visit. Fingerprints are unique and constant over a lifetime. Research indicates a relationship between fingerprint type and behaviour mode of children during dental treatment Therefore, fingerprint patterns might assist to predict the extent of cooperation by children during dental procedures. Aim: To assess the relationship between fingerprint patterns, children's behaviour, and their cooperation during dental operatory in children of Wardha region of Maharashtra. Materials and Methods: A cross-sectional study will be conducted in the Department of Paedi-atric and Preventive Dentistry of Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha be-tween November 2025 to August 2026. In this study, 84 children will be divided into two groups with 42 in each group. In the first visit, oral examination will be done in the dental operatory and behaviour will be assessed by Frankl’s behaviour rating scale. Based on the behaviour, children will be catego-rised as cooperative and uncooperative. Finger prints will be collected on a digital scanner and will be classified based on Cummin’s classification into loop, whorl and arch as dermatoglyphic patterns. The Chi-square test will be used to assess the association between fingerprint patterns and behavioural re-sponses. A p-value of <0.05 will be considered statistically significant. Hence, this study aims to as-sess the correlation between fingerprint patterns, behaviour, and cooperation of children during dental procedures in the Wardha region, Maharashtra.

Efficacy of Kettlebell Exercise Regimen to Improve Strength and Cardiorespiratory Function among 200-metre Sprinters: A Research Protocol

Bhagyashree Panda, Aksh Chahal Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: A kettlebell is a cast-iron or cast-steel weight with a handle, resembling a cannonball. It gained popularity in 2015 and is now widely used in fitness routines. Dumbbell training is also beneficial for strength training in sprinters. Dumbbell exercises are used for specific muscles, but kettlebell exercises provide overall body strength, which is beneficial for sprinters. The present study will compare a dumbbell exercise with a kettlebell exercise. Need of the study: Kettlebell exercises provide several benefits by engaging multiple muscle groups simultaneously, whereas dumbbell exercises typically target specific muscles. While previous studies have highlighted the advantages of kettlebell training, limited research has compared its effectiveness to dumbbell exercises in sprinters. Aim: This study focuses on kettlebell exercises and their effects on improving the strength and cardiorespiratory function of 200-metre sprinters, compared with dumbbell workouts. Materials and Methods: This study will be a randomised controlled trial conducted in the sports premises of Subharti University, Meerut, India from March 2025 to September 2026. Participants will be randomly assigned to two groups: Group-A and Group-B. Group-A will engage in a series of kettle-bell exercises, while Group-B will continue their regular exercise regimen, which consists of dumbbell exercises. To assess strength, the investigators will utilise the bench press test and the sit-up test. Additionally, the home step test will be employed to evaluate cardiorespiratory function. The Shapiro-Wilk test will be used for data normality. The paired t-test will be employed for comparisons within groups, while the independent t-test will be applied to compare between groups. A p-value will be considered statistically significant if it is less than 0.05.

Comparative Evaluation of Variability in Torque Expression in Maxillary Central Incisors with Different Column Angles using Brackets Placed at Different Levels in Class II Division 2 Malocclusion: A FEM Study

Digvijay Shashank Pradhan, Ranjit Haridas Kamble Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Torque in the maxillary central incisors plays a critical role in determining the final treatment outcome for an orthodontic treatment of a malocclusion. The column angle of maxillary central incisors in Class II Division 2 malocclusion is increased as compared to individuals with other malocclusions. Variations in the column angle paired with bracket positioning can affect torque expression during orthodontic treatment. With variable column angles with brackets placed at different occlusogingival heights using Finite Element Model (FEM) analysis. The study will invariably provide a better understanding and clinical judgement of initial bracket positioning to consider the torque ex-pression within the confines of alveolar complex whilst taking into account the altered crown root angle. Aim: To evaluate and compare the expression of torque in maxillary central incisors with variable column angles by placing the brackets at different occlusogingival heights using FEM analysis. Need of the study: The relationship between column angle morphology and torque mechanics has been poorly quantified, leaving clinicians without objective guidelines for bracket height selection in Class II Division two cases. Existing clinical observations suggest variability in torque response but lack controlled biomechanical evidence explaining how anatomical variations influence root behaviour. Treatment planning currently relies on empirical judgement, which can lead to inconsistent root positioning and prolonged finishing phases. FEM offers a way to generate predictable, reproducible biomechanical data that can help standardise torque mechanics for anatomically complex incisors. A systematic evaluation is required to establish evidence-based parameters for optimising torque expression when dealing with increased column angles. Materials and Methods: This will be an observational, analytical finite element study con-ducted at the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIER), Wardha, Maharashtra, India. The study will be carried out over a period from 2^nd July 2025 to 7^th Febrauary 2027. A total of 9 FEMs were constructed, representing three column angles combined with three bracket positions. Three separate anatomic 3D FEMs of a maxillary central incisor with varying column angles will be constructed using Creo 10 software. An MBT prescription bracket with a slot size of 0.022×0.028 and a stainless-steel arch wire measuring 0.019×0.025 in cross-section will be placed in the bracket slot and secured using a stainless-steel ligature. A palatal root torque will be applied. A total of nine Simulations i.e., three simulations each for three different column angles (+9°, +12°, and +15°), with the brackets positioned at the incisal, middle, and gingival thirds of the clinical crown will be performed separately. The mod-el will be discretised using a structured tetrahedral mesh, and the material properties will be assigned from well-established literature. Hyper Mesh software will be utilised for finite element analysis and biomechanical responses will be statistically analysed across the various simulation scenarios. Statistical significance will be evaluated using two-way Analysis of Variance (ANOVA).

Evaluation of the Comparative Efficacy of Dugdhika (Euphorbia prostrata W. Aiton) Inhalation versus Salbutamol in the Management of Tamaka Shwasa (Bronchial Asthma): A Research Protocol

Bhavesh Dangore, Sadhana Misar Wajpeyi Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Tamaka Shwasa is an Ayurvedic respiratory disorder caused by vitiated Prana Vayu and aggravated Kapha, often worsened by dust, smoke, cold, and exertion. It re-sembles bronchial asthma, which affects around 300 million people globally and 15-20 million in India. Modern treatment includes bronchodilators like Salbutamol, while Ayurveda herbs like Dugdhika (Euphorbia prostrata), known for its Shwasahara and Kaphahara effects in respirato-ry conditions. Aim: Evaluation of comparative efficacy of inhalation of Dugdhika (Euphorbia prostrata w.Ait) versus Salbutamol in the management of Tamaka Shwasa (Bronchial asthma). Need of the study: Salbutamol provides rapid bronchodilation in bronchial asthma, but its repeated use is associated with undesirable adverse effects and limited long-term acceptability. Dugdhika (Euphorbia prostrata), described in Ayurvedic literature as Shwasahara and Kaphashamaka, exhibits bronchodilator and smooth muscle relaxant actions in experimental studies. Hence, the present study is required to evaluate Dugdhika as a potentially safe, cost-effective, and evidence-based alternative for the immediate management of Tamaka Shwasa (bronchial asthma). Materials and Methods: The Mahatma Gandhi Ayurved College Hospital and Research Centre in Salod (H), Wardha, Maharashtra, India, will host an eight-month randomised single blind standard con-trolled equivalency clinical trial study from October 2025 to May 2026. The present study consists of 110 patients who fit the requirements for inclusion, divided into two groups of 55 at random. Group 2 will get an inhalation stat of Salbutamol, whereas Group 1 will receive an inhalation stat of Dugdhika. Assessments will be conducted before and after 20 minutes of giving inhalation. Outcomes will be measured using peak expiratory flow rate, spirometry, breathlessness (Dyspnoea).

Effectiveness of CBME Electives for Undergraduates in a Government Medical College, West Bengal, India: A Research Protocol

Prerana Aggarwal, Adarshlata Singh Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: The Competency-Based Medical Education (CBME) curriculum, introduced by the Na-tional Medical Commission (NMC), represents a transformative approach to undergraduate medical training in India. Within this framework, the incorporation of Electives enables students to explore areas of personal interest, enhance clinical and research competencies and foster professional development. Need of the study: Although electives have been well-received, effective implementation re-quires active engagement from all stakeholders. Despite the completion of Electives postings by a few Bachelor of Medicine and Bachelor of Surgery (MBBS) batches, challenges persist in ensuring their opti-mal execution and efficacy. Previous studies have mainly employed observational methods, focusing on student or faculty perceptions. However, these evaluations have overlooked the perspectives of the Plan-ning and Implementation Committee (PIC) members who play a vital role in shaping curriculum design, re-source allocation and policy development. Aim: This study aims to systematically evaluate stakeholder perceptions (students, faculty and PIC members) and implement targeted changes based on these insights. Materials and Methods: This quasi-experimental study will be conducted at the Burdwan Medical College, Kolkata, West Bengal, India from March 2025 to December 2025, using three distinct self-administered semi-structured questionnaires including MBBS students from two consecutive batches (2020-21 and 2021-22), their preceptors and PIC members regarding the Elective module. An intervention involv-ing the design of operational guidelines and induction sessions for students and faculty will precede Electives for the 2021-22 batch of students. Descriptive statistics (frequency, percentage, mean, medi-an, standard deviation) will summarise responses to closed-ended questions. Inferential statistics such as paired t-tests and Chi-squared tests will be used for comparative analysis of responses from both participant groups. The p-value <0.05 will be considered significant. Open-ended responses will undergo thematic analysis to extract core insights and patterns.

Equity in Clinical Trial Participation in India (2020-2024) across Oncology and Vaccination Trials: A Systematic Review and Meta-analysis Research Protocol

Arijita Manna, Rovena Yazhini, S Tejesh, Hotha Sai Srinivas Karpuram Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Clinical trials in India have historically struggled to reflect the lived reali-ties of disadvantaged communities. The inclusion of individuals in research continues to be shaped by gender, geography, and social position. Evidence shows that women, rural residents, and tribal groups are often missing from trials; even in national priority areas such as cancer and vaccination, narrowing the evidence base and deepening structural gaps in participation. Need of the study: While clinical trials are expanding in India, there is a lack of systemat-ic evidence regarding the representation of marginalised groups. Assessing reporting gaps using a struc-tured framework like the Equity Transparency Index (ETI) is essential to identify systemic biases and ensure that clinical evidence in oncology and vaccination is generalisable to India’s diverse popula-tion. Aim: To examine equity-relevant participation and reporting, specifically related to women, ru-ral populations, and Scheduled Tribe inclusion, in oncology and vaccination clinical trials registered in India. Materials and Methods: This systematic review Protocol complies with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines, covering trials regis-tered between 1st January 2020 and 31st December 2024. The primary source will be the Clinical Trials Reg-istry–India (CTRI). The World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP) will be consulted where registry entries are unclear. India-site oncology or vaccination trials registered 2020–2024 will be included. The following data will be extracted: trial identifiers, year, design, sponsor, sample size, recruitment setting, sex numerators, rural reach, tribal inclusion, and linked publication status. Transparency will be graded using a six-domain ETI adapted from the REP-EQUITY toolkit. Proportions will be meta-analysed under random effects (REML) with Hartung–Knapp confi-dence intervals; heterogeneity assessed by I². Planned subgroups include trial type, domain, and spon-sor.

Hepatoprotective Effect of Centella asiatica Extract Against High-fat Diet-induced NAFLD in Wistar Rats: A Research Protocol

Madhu Rani, Gaurav R Sawarkar, Ujwal Vyas Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is a rapidly increasing global health problem characterised by excessive fat accumulation in hepatocytes, leading to oxidative stress, inflammation, and hepatocellular injury. The growing prevalence of NAFLD is strongly associated with unhealthy dietary habits, sedentary lifestyles, obesity, and metabolic disorders. If left untreated, NAFLD may progress to advanced liver diseases such as Non-Alcoholic Steatohepatitis (NASH), fibrosis, and cirrho-sis. Need of the study: The NAFLD affects a significant proportion of the global population, and currently available pharmacological options remain limited. Plant-based therapeutic agents with antioxidant and anti-inflammatory properties have gained attention as potential alternatives. Centella asiatica has demonstrated antioxidant, anti-inflammatory, and hepatoprotective activities in experimental studies, suggesting its possible role in the management of NAFLD. Aim: To evaluate and compare the hepatoprotective efficacy of the hydroalcoholic extract of Centella asiatica with vitamin C, vitamin E, caffeine, and metformin in High-fat Diet (HFD) -induced NAFLD in male Wistar rats. Materials and Methods: The present preclinical experimental study will be conducted at the Central Preclinical Research Facility, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Salod, Wardha, Maharashtra, India, from December 2025 to February 2026. Seven groups of male Wistar rats (n=6 per group), aged 10-12 weeks and weighing 150-200 g, will be included. Group I will receive a standard pellet diet, while Groups-II to VII will receive a HFD alone or in combination with Centella asiatica extract, vitamin E, vitamin C, metformin, or caffeine, respectively. Hepatoprotective activity will be assessed using Liver Function Tests (LFT), lipid profile analysis, estimation of oxidative stress markers such as Superoxide Dismutase (SOD) and Glutathione (GSH), and histopathological examination of liver tissue. Statistical analysis will be performed using statistical software Statistical Package for Social Sciences (SPSS) version 17 and the differences between multiple groups will be analysed by One-way Analysis of Variance (ANOVA) followed by Tukey’s post-hoc test, with a p-value <0.05 considered statistically significant.

Diagnostic Challenges, Histopathological Insights, and Emerging Clinical Strategies in Primary Pleural Angiosarcoma: A Narrative Review

Vaishnavi Hatwar, Umesh A Vaidya Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X The Primary Pleural Angiosarcoma (PPA) is a highly aggressive and rare endothelial cell malignancy of the pleura. The non-specific presenting features, coupled with its tendency to mimic mesothelioma, metastatic carcinomas, or benign pleural diseases, make its diagnosis particularly challenging. Delayed diagnosis, often till late in the course of the disease, and poor outcomes are common. The hallmark clinical presentations are haemorrhagic pleural effusion, chest pain, and progressive dyspnoea-all non-diagnostic. The present narrative review aimed to synthesise and critically evaluate the literature on PPA, focusing on diagnostic strategies, histopathological features, therapeutic modalities, and outcome patterns. From a qualitative analysis of published case reports and review articles published between 1988 and 2025, which were chosen for their extensive clinical, pathological, and Immunohistochemical (IHC) documentation pertinent to PPA, it is found that PPA arises almost exclusively in older men, characterised by rapidly progressive respiratory symptoms and a high frequency of haemothorax. Again, imaging studies are non-diagnostic, and cytology is of low sensitivity. The differential diagnosis is established by pleural biopsy, confirmed by IHC analysis with endothelial markers such as CD31, ERG, and FLI-1. Despite aggressive multimodal therapy comprising surgical resection, chemotherapy, and radiotherapy, median survival is woeful, less than six months from presentation in most series. In conclusion, PPA represents a frontier in both diagnosis and therapy within thoracic oncology. Early biopsy, accurate immunophenotyping, and multidisciplinary input are essential in maximising patient outcomes. Due to its rarity and dismal prognosis, more comprehensive and focused molecular studies are urgently needed to enhance diagnostic precision and therapeutic outcomes.

Impact of Mentorship, Peer-learning, and Student Organisations on Academic Performance and Research Engagement: A Review

Hetal Rathod, Mahavirsingh H Rajput Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Mentoring, peer learning and student organisation creation are becoming effective pedagogical approaches to improve academic success, retention, engagement of students and early research exposure at the collegiate level of education. In a variety of academic disciplines and institutional settings, the use of formalised mentoring activities and peer-learning programmes have shown to have positive effects on students’ academic achievement, psychosocial adjustment, motivation, and retention- especially among underrepresented or academically underserved student populations. This review draws on recent empirical work to provide an overview of the unique and overlapping contributions of mentorship, peer-learning, and student organisations in fostering academic performance and research involvement. The paper also considers theoretical models, implementation strategies, significant contextual moderators and promising directions for the integration of mentoring ecosystems in higher education.

Anaesthetic Approach in Intrauterine Foetal Surgery: A Narrative Review

Snehal Venkatesh Kabra, Sanjot Ninave Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Intrauterine foetal Surgery (IFS) has evolved from an experimental approach to an established treatment for certain life-threatening or disabling foetal conditions. It has witnessed remarkable advances in survival as well as long-term results. This has been due to advancements in high-resolution prenatal imaging, improved operative techniques, and a deeper understanding of foetal physiology. Anaesthesia in these procedures poses numerous unique challenges. These challenges require the anaesthesiologist to balance the complex and often competing physiological demands of the mother and the fetus while working under conditions that are high-risk and time-critical. This review integrates current anaesthetic methods and highlights emerging indications, such as fetoscopic laser photocoagulation for Twin-to-Twin Transfusion Syndrome (TTTS), foetal endoscopic tracheal occlusion for Congenital Diaphragmatic Hernia (CDH), and open or fetoscopic myelomeningocele repair. It covers key aspects of maternal-foetal physiology, concentrated foetal analgesia, ethical considerations, advances in foetal monitoring, and the integration of newly emerging technologies such as closed-loop anaesthesia systems, machine learning, and simulation-based training. Procedure-specific anaesthetic challenges associated with fetoscopic and ex utero intrapartum treatment procedures are discussed, along with the principles of postoperative care and their impact on long-term outcomes. Finally, the review identifies current knowledge deficits and directions forward that can lead to the standardisation of practice, enhanced patient safety, and evidence-based research to inform safer and more efficient anaesthetic care for foetal surgery. By incorporating technology and interdisciplinary approaches, anaesthesiologists can further advance the art and science of caring for two patients simultaneously during such remarkable procedures.

Liquid Ventilation in Respiratory Care: Physiological Principles, Clinical Applications, and Emerging Engineering Innovations

Pranav Ashok Gurrapu, Sheetal Madavi, Amreesh Paul, Pardhasaradhi Kapusetti, Diip Sanka Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Liquid Ventilation (LV) is a respiratory assistance technique that utilises oxygenated perfluorochemical liquids for pulmonary gas exchange, representing a novel approach compared to conventional gas ventilation. Utilising the high gas solubility, low surface tension, and biologic inertness of perfluorochemicals, it can potentially supplement oxygenation, increase alveolar recruitment, reduce ventilator-induced lung injury, and serve as a vehicle for targeted pulmonary delivery of drugs. Partial and whole LV have shown promising results in preclinical models of respiratory distress in neonates, acute lung injury, and aspiration syndromes, and initial clinical trials in neonates have documented feasibility and physiological benefit. Technical problems hinder large-scale implementation, including the need for specialised ventilator design, precise temperature and volume control of the liquid, and the requirement for complex monitoring equipment. In addition to respiratory therapy, LV will likely have therapeutic hypothermia, pulmonary lavage, and image enhancement applications. Enhanced biomedical engineering, closed-loop control of ventilation, and integration with modern anaesthetic technology can overcome current limitations and yield new horizons for its application in critical illness and perioperative care. The present review combines information regarding physiological mechanisms, clinical and experimental findings, and future directions for LV in anaesthetic and respiratory practice. The current review also highlights the novelty of LV by focusing on innovative physiological mechanisms, under-explored engineering advancements, and emerging clinical applications.

Erdheim-Chester Disease: Therapeutic Challenges, Multidisciplinary Management, and Emerging Targeted Treatment Strategies in Rare Histiocytosis

Nitika Senger, Sourabh Deshmukh Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Erdheim-Chester Disease (ECD) is an uncommon non-Langerhans Cell Histiocytosis (LCH) characterised by histiocytic organ infiltration and subsequent multisystemic fibrosis and chronic inflammation. The disease primarily affects the skeleton, cardiovascular system, Central Nervous System (CNS), kidneys, and lungs, and is extremely hard to diagnose and treat. Though the treatment modalities have been reformed in the last few years, the disease is still complex due to resistance to standard treatments and its heterogeneity. This review explains the therapeutic challenge of ECD and the latest developments with targeted therapies. We conducted a comprehensive review of recent clinical guidelines, case reports, and literature on the treatment modalities, such as targeted therapies, immunomodulators, and the role of multidisciplinary therapy. Identification of the BRAF V600E mutation in more than 50% of cases of ECD has been the primary reason for the activity of BRAF and MEK inhibitors, which were capable of enhancing survival. However, the challenges are still there, such as resistance to drugs, side effects, and the unavailability of standardised therapeutic regimens. For BRAF-negative ECD, other therapeutic agents such as PI3K inhibitors, JAK inhibitors, and immunomodulatory treatments are being studied. The management of ECD with multidisciplinary therapy, with the assistance of oncologists, neurologists, radiologists, and pathologists, is needed to provide optimal patient care. Though the targeted therapies have been optimised, ECD treatment remains non-standardised. Further studies should be conducted to formulate standardised treatment algorithms and provide optimal long-term treatment with the assistance of a collaborative, multidisciplinary centre.

A Review of Chylous Ascites in Systemic Disease and Postoperative States: Diagnostic Challenges and Evolving Surgical Strategies

Sakshi D Ghugul, Sheetal Asutkar Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Chylous Ascites (CA) is a rare, but important, clinical entity in which there is deposition of triglyceride-rich lymphatic fluid within the peritoneal cavity. It may result secondarily from a wide variety of aetiologies, including systemic inflammatory disease, neoplasms, traumatic disruption of lymphatics, and as a postoperative complication of extensive abdominal or retroperitoneal surgery. Although it is a rare condition, growing clinical interest exists in its diagnostic and therapeutic challenge, especially with new imaging and microsurgical treatment development. This narrative review aims to incorporate available evidence regarding presentation and diagnostic evaluation and new surgical treatments of CA. A systematic search of recent peer-reviewed literature between 2000 and 2025 was performed, emphasising publications that addressed systemic disease-related and iatrogenic causes, new developments in lymphatic imaging such as MR lymphangiography, and interventional treatments including Lymphovenous Anastomosis (LVA) and peritoneovenous shunting. In conclusion, this paper has highlighted major advances in the ability to localise lymphatic leaks and thus allow less invasive and more targeted surgical therapy. Furthermore, integrating biochemical, radiologic, and histopathological modalities facilitated early diagnosis of the underlying pathologies. While still reserved for expert centres, microsurgical treatment has yielded encouraging outcomes with reduced morbidity compared to conventional reoperations. Although CA remains a diagnostic and surgical challenge, novel imaging and lymphatic surgery tools are transforming its treatment. General surgeons, oncology teams, and multidisciplinary units should remain cognizant of traditional and innovative strategies to maximise outcomes in this rare but sinister syndrome.

Hypereosinophilic Syndrome: A Narrative Review of Pathogenesis, Clinical Spectrum and Evolving Therapeutic Strategies

Khushi Soni, Kishor Hiwale, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Hypereosinophilic Syndrome (HES) represents a heterogeneous group of disorders, which are characterised by the persistent eosinophilia and progressive, multisystemic damage of organs. This narrative review article synthesises current-evidence on aetiopathogenesis, clinical features, diagnosis, along with various novel therapeutic options for HES management. Pathogenesis of HES usually involves two mechanisms: First one is sustained eosinophil overproduction driven by clonal, lymphocytic, or reactive pathways. Another mechanism is eosinophil-mediated tissue injury which is resulted through cytotoxic granule proteins, cytokines and pro-inflammatory cascades. Advances in molecular diagnostic methods such as detection of Factor Interacting with PAPOLA and CPSF1-Platelet-Derived Growth Factor Receptor Alpha (PDGFRA), Platelet-Derived Growth Factor Receptor Beta (PDGFRB) and Fibroblast Growth Factor Receptor 1 (FGFR1) and Janus Kinase 2 (JAK2) rearrangements also refined classification of HES into myeloid, lymphocytic, idiopathic and secondary variants, thus it further helps enabling more targeted management. Histopathological findings usually demonstrate dense eosinophilic infiltrates having tissue necrosis and fibrosis, while microbiological studies also proved to be helpful in excluding parasitic as well as infectious triggers. Management of HES got evolved from broad immunosuppression along with corticosteroids to the mutation-directed therapy, biologics targeting Interleukin-5 (IL-5)/ Interleukin-5 Receptor (IL-5R), as well as experimental agents like Siglec-8 inhibitors, JAK-pathway modulators. Despite having such therapeutic progress, challenges remain in early diagnosis, predicting disease trajectory, as well as preventing irreversible organ dysfunction. Future directions should focus further on single-cell multi-omics, development of non invasive biomarkers, as well as Artificial Intelligence (AI)-based risk prediction models for HES. The present review thus highlights the need for an integrated multidisciplinary care and continued research for optimisation of outcomes for patients with HES. The present narrative review article aimed to highlight about current understanding of pathogenesis, clinical features, diagnosis as well as evolving targeted management strategies for HES along with emphasis on precision medicine, future research directions.

Anaesthetic and Resuscitation Challenges in Austere, Remote or Hyperbaric Environments: A Narrative Review

Dilip Venkata Naga Sai Krishna Sanka, Nikhil Bhalerao Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Resuscitation and anaesthesia in austere, remote and hyperbaric environments present unique challenges due to extreme physiological stresses, limited resources and environmental limitations. High-altitude, deep-sea, hyperbaric and space-analogue environments each introduce unique physiological responses that alter oxygen availability, pressure shifts and fluid displacement. These changes significantly affect pharmacokinetics, haemodynamics and patient stability, adding complexity to care. Physiological responses such as altered gas exchange and changes in circulatory dynamics require careful monitoring and management. The lack of adequate hardware and monitoring equipment often forces clinicians to adapt with creative workarounds or rely on transportable technology. Limited diagnostic tools and the inability to constantly monitor vital signs pose additional risks, requiring adaptability and resourcefulness. Resource, staff and isolation constraints complicate airway management, ventilation, fluid resuscitation and emergency procedures. Clinicians must often make quick, high-stakes decisions without immediate backup or access to advanced equipment. Given these constraints, simulation training, telemedicine support and rapid decision-making drills are crucial for enhancing clinicians’ preparedness to perform under pressure. Pharmacologic adaptation, monitoring modifications and development of customised anaesthetic and resuscitation protocols are essential to mitigate risks. Anaesthetic agents and fluid resuscitation strategies must be carefully tailored to ensure stability in environments with altered pressures or oxygen levels. The present review analyses the physiological effects and limitations of anaesthesia and resuscitation in extreme conditions, focusing on all phases of care, from initial resuscitation to postoperative recovery. The strategies discussed provide critical insight into how to optimise care and enhance patient safety under extreme conditions.

The CRISPR Diagnostic Revolution: A Narrative Review of Technologies, Applications and Future Directions in Infectious Disease Management

Elantamilan Durairaj, Jyotismita Rajbongshi, Mangayarkarasi Vincent Babu Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X The timely and accurate diagnosis of infectious diseases remains a cornerstone of clinical medicine. However, conventional diagnostics face significant limitations by being slow, lacking sensitivity or requiring sophisticated laboratory infrastructure. This restricts their accessibility, particularly in resource-limited settings. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and CRISPR-associated (Cas) protein systems have emerged as a significant technology that can bridge this diagnostic gap. This review synthesises findings from primary research, systematic reviews, and meta-analyses pertaining to the development, validation, and application of CRISPR-based diagnostic technologies for infectious diseases. Originally developed for gene editing, CRISPR technology has been ingeniously repurposed for diagnostics by harnessing the programmable nucleic acid recognition of Cas enzymes. The discovery of target-activated, non specific “collateral cleavage” activity in Cas12 and Cas13 enzymes enabled the development of highly sensitive detection platforms, including DETECTR and SHERLOCK, which can achieve attomolar sensitivity. These platforms have been successfully validated for a vast range of pathogens, demonstrating performance comparable to the gold-standard Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) for detecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), influenza, Human Immunodeficiency Virus (HIV), hepatitis viruses, Mycobacterium tuberculosis, and malaria parasites, among others. CRISPR-based diagnostics represent a shift in molecular detection techniques, offering the potential to democratise access to high-precision testing. While challenges for widespread implementation remain, ongoing research into novel Cas enzymes, microfluidic integration, and amplification-free methods promises to overcome these hurdles. This narrative review consolidates the current state-of-the-art, highlights key research gaps, and provides recommendations for researchers, clinicians, and policymakers to guide the translation of this revolutionary technology from the laboratory to global health applications. This review uniquely puts together the technical mechanisms of novel Cas effectors against real-world clinical performance data across viral, bacterial and fungal pathogens to highlight the gap between laboratory innovation and Point-Of-Care (POC) implementation.

A Narrative Review on AI-assisted Clinical Decision Support System in Physiotherapy Practice: Computer Vision-based Posture Assessment and its Clinical Validation

Geeta Gill, Sajjan Pal, Ruchi, Preeti Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Artificial Intelligence (AI)-assisted Computer Vision (CV) systems are applied in physiotherapy for objective, markerless assessment of posture and movement. The conventional clinical evaluation relies on visual inspection and manual goniometry; therefore, it is subject to inter-rater variability and measurement discrepancy. The CV frameworks employ Red, Green, Blue (RGB) cameras, depth sensors, and hybrid optical-inertial configurations to detect skeletal landmarks and calculate joint angles, range of motion, symmetry indices, and temporal kinematic variables. The pose estimation models such as MediaPipe, OpenPose, and YOLO-Pose permit real-time landmark detection. The Machine Learning (ML) and Deep Learning (DL) algorithms classify movement quality and generate structured feedback for rehabilitation sessions. The incorporation of CV into physiotherapy therefore, provides quantitative assessment of posture and movement that corresponds with conventional clinical measurement methods and supports systematic rehabilitation monitoring. The review examines the technological architecture, validation standards, and clinical applicability of AI-assisted CV systems in physiotherapy practice and evaluates their role in clinical decision support and movement assessment within structured rehabilitation programmes.

Awake Craniotomy in Drug-resistant Epilepsy: A Narrative Review of Clinical Principles, Perioperative Management, and Emerging Advances

Chitra Kolla, Sheetal Madavi, Souvik Banik, Dhwani Sheth, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Drug-Resistant Epilepsy (DRE) affects usually one-third of patients having epilepsy who fail to achieve seizure freedom despite trials of two or more appropriately chosen and tolerated Antiseizure Medications (ASM). Persistent seizures in DRE further contribute to significant neurological, cognitive, psychosocial morbidity, thereby emphasising need for timely identification as well as alternative therapeutic strategies. Surgical intervention, which is done in cases where epileptogenic foci are located near eloquent cortical regions, has emerged as a critical management option. Awake Craniotomy (AC) has also gained prominence into its application for DRE surgery because of its ability to combine maximal resection of epileptogenic zones along with real-time functional mapping, thereby preserving essential neurological functions inclusive of language, motor control and cognition. This narrative review explores clinical and neurodiagnostic determinants guiding candidacy for AC, perioperative anaesthetic strategies, intraoperative monitoring, selection of patients also postoperative care of patients. Asleep-Awake-Asleep (SAS) and Awake-Awake-Awake (AAA) protocols are discussed in brief highlighting their advantages, limitations along with their anaesthetic implications. Special emphasis is placed on preoperative psychological preparation of patients usually in paediatric populations, and role of multidisciplinary teams for optimising intraoperative cooperation with improvement of outcomes. The narrative review article also highlights emerging innovations like high-density Electrocorticography (ECoG) grids, Real-Time Functional brain Mapping (RTFM), as well as Corticocortical Evoked Potentials (CCEP), which helps to enhance the accuracy of intraoperative mapping and reduce postoperative deficits. Through integration of established evidence with novel techniques, AC can prove as a precision-based, function-preserving surgical approach which can help in maximising seizure control while minimising neurological deficit in patients. This narrative review underscores evolving role of AC in management of DRE thus emphasising its potential for improving patient outcomes and quality of life in complex type of clinical cases.

Advances in Corneal Cross-linking: A Narrative Review of Iontophoresis-assisted Approaches for the Management of Keratoconus

Ashish Sharma, Sachin Daigavane, Shashank Banait Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Keratoconus (KCN) is a gradual ectatic corneal condition that, if not treated, can result in severe vision impairment. Corneal Collagen Cross-Linking (CCXL) is still the gold standard for stopping disease development, with the traditional epithelium-off (“Dresden protocol”) technique showing long-term success. However, constraints such as postoperative discomfort, delayed epithelial healing, and infection have prompted the development of alternate approaches. Iontophoresis-Assisted Corneal Cross-Linking (I-CXL) has emerged as a potential method for increasing riboflavin penetration through the intact epithelium with a modest electrical current, hence improving patient comfort and lowering complications. This review critically examines the available data comparing I-CXL to traditional CXL in terms of effectiveness, safety, visual and topographic results, and long-term stability. While I-CXL has advantages such as faster recovery, greater patient acceptability, and lower complication rates, most studies show that its biomechanical stiffening impact and long-term effectiveness are inferior to traditional CXL. Recent improvements, such as expedited and customised iontophoresis techniques, show promise for closing this gap. Understanding the comparative merits and limitations of each strategy is critical for developing effective KCN treatment regimens.

Enhanced Recovery after Bowel Surgery: A Narrative Review of Current Concepts, Implementation Challenges, and Future Directions

Yashasvi Trivedi, Rajesh Gattani, Amit Bose, Shailabh, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Enhanced Recovery After Surgery (ERAS) is a transformative, evidence-based multimodal approach which is aimed at minimising surgical stress, optimising perioperative physiology, and accelerating recovery in bowel surgery. This narrative review article highlights current evidence on the core components, physiological foundations, implementation patterns, along with outcome benefits of ERAS protocol in various bowel surgical procedures. Preoperative strategies such as patient counselling, risk optimisation and carbohydrate loading can help to reduce anxiety, insulin resistance, as well as postoperative catabolism. Intraoperative elements like minimally invasive surgery, Goal-Directed Fluid Therapy (GDFT), multimodal analgesia, regulation of temperature, and avoidance of routine tubes and drains can help further to prevent inflammatory and neuroendocrine stress responses. Postoperative measures, including early feeding, early mobilisation, opioid-sparing analgesia and meticulous fluid and glycaemic management, facilitate faster functional bowel recovery and reduced morbidity. The narrative review also highlights adaptation of ERAS across specific surgical procedures like Low Anterior Resection (LAR), emergency bowel surgery, Inflammatory Bowel Disease (IBD), as well as geriatric populations. Despite available robust evidence, some barriers like compliance variability, resource limitations, along with cultural factors can disturb overall widespread implementation of ERAS, particularly in low and middle-income countries such as India. Emerging technologies, namely robotic surgery, digital ERAS tracking, artificial intelligence-guided perioperative surgical procedures, and personalised recovery pathways can offer promising results thus enhancing adherence and outcomes. Overall, ERAS protocols can further improve recovery of patient, reduce complications, and enhance the quality and efficiency of various bowel surgeries.

Low Dye Taping as a Conservative Intervention for Flat Foot: A Literature Review

Mayur Das, Swapnav Borthakur Journal of clinical and diagnostic research : 2026 - June - 20:0973-709X Flat foot, also known as pes planus is a very common foot deformity which presents itself through the collapse of the medial longitudinal arch. There is an increase in plantar pressure and biomechanical changes due to the collapse of the medial longitudinal arch. The navicular height is found to decrease due to the collapse of medial longitudinal height. Low Dye Taping (LDT) is used to decrease the plantar pressure and correct the biomechanical changes. The purpose of the review was to examine the effects of LDT in individuals with flat feet, which were assessed using a variety of outcome tools. A total of nine studies were found through extensive literature search related to treatment of flat foot with LDT. The search keywords were flat foot, pes planus, medial longitudinal arch, foot deformity and LDT. The study was completed using electronic databases including Google Scholar, Web of Science, PubMed, Scopus, and Cochrane Library. The result shows that LDT contributes to biomechanical changes in patients with flat feet, decreasing the dynamic baropodometric parameters. LDT thus increases and maintains the collapsed medial longitudinal arch.