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

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

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

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

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

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

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