Journal of clinical and diagnostic research

Anaesthetic Management of Multivalvular Surgery Complicated by Submitral Aneurysm and Pulmonary Hypertension: A Case Report

Abhigna Gummalla, Vivek Chakole, Amreesh Paul Francis

Submitral Aneurysm (SMA) is a rare cardiac condition that presents with perioperative anaesthetic complications, especially with comorbidities such as Pulmonary Hypertension (PH) and severe valvular disease. The case reported is a 21-year-old female with a medical illness history of rheumatic heart disease, severe mitral and Tricuspid Regurgitation (TR), PH, and basal SMA. She was admitted with palpitations, dyspnoea, and cough. Preoperative assessment revealed ventricular dysfunction and pulmonary disease. She was to undergo general anaesthesia for Mitral Valve Replacement (MVR), tricuspid valve repair, and SMA repair. Anaesthesia management included maintaining cardiac output, preserving right ventricular function, and controlling pulmonary pressures. Invasive monitoring and intraoperative echocardiography were used. Postoperative intensive care unit management was carried out, and ventilatory support was weaned on the 2^nd postoperative day. The postoperative course was uneventful, with enhanced functional capacity and satisfactory echocardiographic parameters at follow-up. The case highlights the complexity of anaesthetic care for multivalvular heart disease with SMA and PH. It underscores the need for personalised treatment, precise monitoring, and multidisciplinary care for successful management.

Bone Marrow Metastasis as an Initial Manifestation of Gastric Carcinoma: A Rare Case Report

Gastric adenocarcinomas, despite being a leading contributor of cancer-related mortality, presentation directly with Bone Marrow (BM) infiltration sans prior Gastrointestinal (GI) symptoms holds sparse documentation in existing literature. Though a rare phenomenon, BM studies play a pivotal role in the presentation and management of such cases. This case report describes a 36-year-old female with worsening generalised body pain accompanied by fever. Radiologic evaluation revealed multiple lytic lucencies in the vertebral bodies and pelvic bones. A subsequent BM aspiration yielded suspicious looking cells in clusters and BM biopsy suggestive of metastatic deposits. These findings prompted a workup for unknown primary malignancy. Immunohistochemistry (IHC) on trephine BM biopsy suggested a tumour that is CK7+, CK20-, CDX2-, TTF1-, ER – and CA125-; suggesting upper GI primary. A Positron Emission Tomography-Computed Tomography (PET-CT) and upper GI endoscopy revealed a mass in the proximal part of body of stomach which showed a poorly differentiated adenocarcinoma. Thus, a final diagnosis of gastric carcinoma with bone marrow metastasis was confirmed and the patient was planned for palliative care.

Hereditary Diffuse Transgradient Palmoplantar Keratoderma in a 57-year-old Male: A Case Report

Swathi Ganesh Shenoy, K Suresh Kumar, TS Rajashekar, Yerragonda Susmitha

Palmoplantar keratoderma refers to a heterogeneous group of disorders characterised by abnormal thickening of the stratum corneum of the palms and soles. Transgradient palmoplantar keratoderma is a distinctive subtype in which the hyperkeratosis extends beyond the palmar and plantar margins onto the adjoining dorsal surfaces of hands and feet, wrists, ankles, or adjacent skin. Present case is that of a 57-year-old male farmer who presented with thickening of the skin over both palms and soles, associated with fissuring and pruritus. The lesions were first noted in early childhood, initially involving the soles and gradually progressing to the palms over a few years. A positive family history was noted, with similar complaints in his elder brother, suggesting a hereditary pattern. On examination, diffuse palmoplantar hyperkeratosis with transgradient extension onto the dorsal surfaces was observed. Histopathology revealed compact orthokeratotic hyperkeratosis, prominent hypergranulosis, and acanthosis with elongated rete ridges. Transgradient palmoplantar keratoderma should be suspected in patients presenting with early-onset diffuse palmoplantar hyperkeratosis extending onto the dorsal surfaces, especially with a positive family history.

Magnetic Resonance Imaging and Ultrasound Evaluation of Chronic Lateral Malleolar Bursitis: A Case Report

Chronic lateral malleolar bursitis is an unusual cause of lateral ankle swelling that can mimic tendon, joint, or soft-tissue disorders. Present case report is of a 48-year-old male farmer with a 7-month history of painless, fluctuant swelling over the right lateral malleolus. High-frequency Ultrasonography (USG) of the right ankle revealed a focal, well-defined effusion/cystic lesion in the subcutaneous plane/ lateral malleolar bursa, characterised by multiple mobile echogenic lenticular structures (rice bodies) with minimal internal vascularity. Magnetic Resonance Imaging (MRI) of the right ankle revealed T2 weighted (T2W) and Proton Density Fat Saturation (PDFS)- a focal hyperintense fluid collection (effusion)/cystic lesion in the subcutaneous plane/lateral malleolar bursa containing multiple T2W and PD FS hypointense rice bodies, with no involvement of the peroneus tendons, bone marrow, or adjacent neurovascular structures. Aspiration and histopathology revealed fibrinous rice bodies with chronic inflammatory cells with no evidence of granulomatous infection, confirming the diagnosis of chronic lateral malleolar bursitis. This case demonstrates the simultaneous use of USG and MRI to describe the superficial bursae in real time, assess the extent of involvement, and rule out deeper extension.

Nephrolithiasis in a Second Renal Allograft Recipient: A RaNephrolithiasis in a Second Renal Allograft Recipient: A Rare Cause of Graft Dysfunctionre Cause of Graft Dysfunction

Renal allograft nephrolithiasis is an uncommon but clinically significant complication which may compromise graft function. While structural and infective factors are well recognised, metabolic abnormalities such as hyperoxaluria and hypocitraturia are increasingly being recognised as contributors to post renal transplant nephrolithiasis. This case describes a 49-year-old male, a second renal transplant recipient who developed de novo nephrolithiasis with ureteric obstruction in the transplanted kidney, complicated by a urinary tract infection and graft dysfunction. His first transplanted renal graft failure was due to chronic active Antibody mediated rejection and recurrent chronic pyelonephritis, which required a graft nephrectomy. He subsequently underwent a deceased donor renal transplantation. He had episodes of urinary tract infection and was treated with antibiotics. One month later he was presented with graft dysfunction, imaging revealed multiple renal calculi with proximal ureteric calculi with mild hydroureteronephrosis. He underwent ureteroscopy lithotripsy with double-J stenting, after which there was stabilisation of graft function. Metabolic evaluation showed hyperoxaluria, 24-hour urine oxalate level was 77.5 mg/day (normal range 7-44), along with significant hypocitraturia with urinary citrate excretion of 50 mg/day (normal range 116-924). Serum calcium, phosphorous and uric acid were within normal range, while parathyroid hormone was elevated, with vitamin D deficiency. This suggested an oxalate driven lithogenic mechanism. Associated hypocitraturia may have further promoted calcium oxalate crystal stone formation. This case highlights hyperoxaluria and hypocitraturia as an important metabolic contributor to post renal transplant nephrolithiasis and emphasises the need for metabolic evaluation. Early imaging, timely urology intervention, prevention of urinary tract infections, correcting metabolic and mineral bone abnormalities and optimisation of immunosuppressive therapy are essential to maintain graft function.

Multiple Myeloma Presenting as Digital Ischaemia Mimicking Rheumatoid Vasculitis: A Diagnostic Challenge

Multiple myeloma commonly presents with anaemia, bone pain, renal dysfunction, hypercalcaemia, and lytic bone lesions. However, digital ischaemia and gangrenous ulceration as an initial manifestation are exceedingly rare and may mimic rheumatologic or vasculitic disorders, leading to diagnostic delay. A 45-year-old female with a history of type 2 diabetes mellitus and previously treated as seronegative rheumatoid arthritis presented with progressive blackish discolouration and ulceration of the right ring finger associated with whitish discharge for one month. She also complained of bilateral pedal oedema, difficulty in walking, low-grade fever, and melaena. Initial evaluation raised suspicion for rheumatoid vasculitis, Raynaud phenomenon, or peripheral vascular disease. Rheumatologic workup including rheumatoid factor, anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies, Antinuclear Antibody (ANA) immunoblot, Antineutrophil Cytoplasmic Antibody (ANCA) profile, and nail fold capillaroscopy was negative. Arterial Doppler of the right upper limb demonstrated normal triphasic flow. Laboratory investigations revealed severe anaemia (haemoglobin 4.3 g/dL), thrombocytopenia, leucocytosis, markedly elevated inflammatory markers, and poorly controlled diabetes mellitus. Computed tomography of the thorax and abdomen demonstrated multiple extensive lytic lesions involving the axial and appendicular skeleton with associated soft tissue components, pathological destruction involving the humeral head, diffuse osteopenia, and hepatosplenomegaly. Bone marrow biopsy revealed hypercellular marrow largely replaced by sheets of plasmacytoid cells with suppression of normal haematopoietic elements. Immunohistochemistry showed diffuse CD138 positivity, confirming plasma cell neoplasm favouring multiple myeloma. The patient was initiated on bortezomib, lenalidomide, and dexamethasone-based chemotherapy. This case highlights an unusual presentation of multiple myeloma presenting as digital ischaemic ulceration mimicking rheumatologic vasculitis. In patients with atypical digital ischaemia associated with cytopenias, elevated inflammatory markers, and systemic manifestations, haematological malignancies including multiple myeloma should be considered in the differential diagnosis to avoid delay in diagnosis and management.

Extreme Hyperferritinaemia in Adult-onset Still’s Disease Mimicking Infection and Malignancy: A Case Report

Ankit Notwani, Ramachandran Viswanathan, Kishore Hemanth Kumar

Adult-Onset Still’s Disease (AOSD) is a rare systemic inflammatory disorder characterised by quotidian fever, evanescent rash, and inflammatory arthralgia. It often presents as a diagnosis of exclusion due to its clinical heterogeneity and lack of specific diagnostic markers, particularly in patients presenting with Fever of Unknown Origin (FUO). Hyperferritinaemia is a well-recognised laboratory feature, with markedly elevated levels reflecting severe systemic inflammation. However, extreme hyperferritinaemia is not specific to AOSD and may also be observed in infections, malignancies, and hyperinflammatory conditions such as Macrophage Activation Syndrome (MAS), making diagnosis challenging. Hereby, the authors present a case of a 35-year-old male presenting with high-grade fever, migratory polyarthralgia, transient erythematous rash, generalised lymphadenopathy, and significant weight loss, accompanied by markedly elevated serum ferritin levels. Extensive evaluation excluded infectious, malignant, and autoimmune causes. Imaging studies demonstrated reactive lymphadenopathy, splenomegaly, and bone marrow activation, supporting a systemic inflammatory process. The patient showed rapid clinical improvement following corticosteroid therapy. This case is notable for extreme hyperferritinaemia with multisystem involvement in the absence of MAS, along with a presentation mimicking infection and malignancy. It underscores the importance of considering AOSD in patients with FUO and markedly elevated ferritin levels to facilitate timely diagnosis and management.

Anaesthetic Management of a Patient with Severe Thoracolumbar Kyphoscoliosis Undergoing Exploratory Laparotomy for a Large Ovarian Cyst: A Case Report

Charmi Hitenbhai Shah, Tejash H Sharma, Dinesh K Chauhan

Severe thoracolumbar kyphoscoliosis usually makes anaesthesia difficult. The chest is deformed, the lungs work poorly, and the twisted spine is hard to reach for a neuraxial block. A 30-year-old woman with this deformity presented with a large ovarian cyst and was listed for open abdominal surgery. Before this illness she could carry out her routine household work (about four metabolic equivalents) but became breathless on climbing one flight of stairs (modified Medical Research Council dyspnoea grade 2). Her chest radiograph showed a double curve, with the thoracic spine bent to the right at a Cobb’s angle of 74 degrees and the lumbar spine to the left at 64 degrees. Lung function testing showed a severe restrictive pattern, and her breathing did not improve after a bronchodilator. The heart scan and the rest of the workup were normal. General anaesthesia in a patient with such poor lung reserve carries a real risk of breathing trouble after surgery, so a spinal block was chosen instead, even though the distorted anatomy made it harder. The landmarks were felt for patiently, and the block was placed in the sitting position at the L3-L4 space. A dose of 3.8 mL of 0.5 percent heavy bupivacaine with 10 micrograms of dexmedetomidine was given. A sensory level of T6 was reached. She stayed stable through the whole operation, with no drop in oxygen and no swings in blood pressure, and her recovery was smooth. This case shows that a spinal block, planned with care and placed with patience, can be a safe option for major abdominal surgery in a patient with severe kyphoscoliosis and weak lungs.

An Atypical Presentation of Congenital Syphilis with Pseudoparalysis and Nephrotic Syndrome in a 45-day-old Infant: A Case Report

Kshitij Sharma, MG Ravanagomagan

Congenital syphilis is a preventable infection transmitted from mother to foetus through the placenta by Treponema pallidum and continues to contribute to considerable neonatal illness and death. The disease can affect multiple organs, including the skin, bones, liver, kidneys, and central nervous system, and may present with diverse and unusual clinical features. Prompt identification is crucial, as delayed diagnosis can result in serious complications even when appropriate treatment is given. A 45-day-old male infant presented with reduced limb movements, irritability, and fever. Examination revealed hepatosplenomegaly, desquamation of palms and soles, and radiographic findings including metaphyseal destruction (Wimberger sign) and ‘celery-stalk’ appearance of the distal femur. The infant subsequently developed congenital nephrotic syndrome. Although the mother’s antenatal Venereal Disease Research Laboratory (VDRL) screening was reported negative, the combination of clinical, radiological, and serological findings established the diagnosis of congenital syphilis. Despite prompt treatment with crystalline penicillin and supportive therapy, the infant succumbed to sepsis during the third week of illness. This case highlights an unusual presentation of congenital syphilis masquerading as neuromuscular weakness, later complicated by nephrosis, emphasising the importance of high clinical suspicion and multidisciplinary evaluation in atypical neonatal presentations.

Autosomal Dominant Hyper-IgE (Job) Syndrome Presenting with Recurrent Pulmonary Infections and Empyema in a Child: A Case Report

Shashank Mishra, Santosh Dey, Kamal Kishore, Amit Pandey

Hyper-IgE syndrome (HIES), also known as Job syndrome, is a rare primary immunodeficiency characterised by recurrent cutaneous and pulmonary infections, chronic eczematous dermatitis, and markedly elevated serum immunoglobulin E levels. The Autosomal Dominant (AD) form, resulting from mutations in the Signal Transducer and Activator of Transcription 3 (STAT3) gene, is the most frequently encountered variant and is associated with significant infectious morbidity, particularly involving the respiratory system. The present case report describes a three-year-old male child who presented with a 10-day history of cough, tachypnoea, and right upper abdominal pain. He had a history of recurrent bilateral pneumonia, eczema, oral candidiasis, and abscess formation. Radiological evaluation revealed a right sided pleural empyema with substantial loss of lung volume. Laboratory investigations showed a markedly elevated serum IgE level of 2872 IU/mL, and genetic testing confirmed a STAT3 mutation, establishing the diagnosis of AD-HIES. Despite initial conservative management, the patient developed organising empyema and subsequently underwent Video-Assisted Thoracoscopic Surgical (VATS) decortication. The postoperative course was uneventful, with significant clinical and radiological improvement. Long-term antimicrobial prophylaxis was initiated. Follow-up was advised; however, the patient did not return for follow-up due to relocation. The present case underscores the importance of considering HIES in children with recurrent pulmonary infections and severe pleural complications, and highlights the role of early diagnosis, genetic confirmation, and timely surgical intervention in improving clinical outcomes.

Cystitis Cystica with Prominent Vascular Channels Mimicking a Perineal Mass: A Paediatric Case Report

Narala Sai Akankssha, Sree Divya Mohan, Ramya Ramanathan, Sundari Subramanian

Cystitis cystica is a benign reactive urothelial lesion characterised by cystic dilatation of von Brunn nests within the lamina propria, usually secondary to chronic mucosal irritation. Although commonly encountered incidentally in adults, it is uncommon in children and may present with atypical clinical features, often mimicking neoplastic or vascular lesions. Hereby, the authors present a case report of an eight-year-old female child who was brought to Paediatric Outpatient Department (OPD) by her mother with perineal itching, bleeding and dysuria for the past two to three days. Clinical examination revealed an exophytic periurethral mass. Contrast -enhanced Computed Tomography (CECT) of abdomen demonstrated a well-defined lesion with increased vascularity, raising suspicion of a vascular malformation or neoplasm. Cystoscopy revealed no intravesical pathology and a biopsy was obtained from the periurethral mass. Histopathological examination showed cystically dilated von Brunn nests with prominent vascular channels, consistent with cystitis cystica, without evidence of dysplasia or malignancy. The postoperative course was uneventful. The present case highlights the diagnostic challenge posed by atypical presentations of cystitis cystica in children and underscores the importance of histopathological confirmation to avoid overtreatment. Early recognition and appropriate evaluation are essential in paediatric practice to ensure optimal management and follow-up.

Anaesthetic Management in a Patient with Severe Left Ventricular Dysfunction Undergoing Lumbar Laminectomy and Spinal Fixation: A Case Report

Severe Left Ventricular Systolic Dysfunction (LVSD), in addition to serious valve heart disease, presents a daunting challenge for anaesthesiologists in non-cardiac surgery. We present the case of a 75-year-old woman scheduled for L3 laminectomy and spinal fixation due to lumbar canal stenosis. She had an Ejection Fraction (EF) of 20%. On pre-operative assessment, severe LVSD with valvular lesions was noted. Anaesthesia was induced with etomidate, fentanyl, and vecuronium to minimise cardiac stress and maintain stable blood flow. Arterial and central venous lines were placed for continuous monitoring. Anaesthesia was maintained with a mixture of oxygen, air, and sevoflurane. Infusions of noradrenaline and dobutamine were adjusted to maintain stable blood pressure. The patient was positioned with care to avoid venous compression and to maintain preload. Fluid administration was performed very cautiously to avoid overload. She remained stable throughout the procedure and was extubated uneventfully. Later, she was transferred to the intensive care unit for close monitoring during recovery. This case illustrates that careful anaesthetic planning, close monitoring, appropriate fluid management, and proactive support are of paramount importance in high-risk cardiac patients for spine surgery, since even slight changes in blood flow can lead to major complications.

Redefining Immediate Implant Aesthetics with Socket-shield Technique: A Case Report

A Lubna Firdose, D Preetha, KJ Nagasurthi, R Kadhiresan, U Arunmozhi

Tooth loss has been a longstanding issue, prompting the exploration of various treatment modalities. Dental Implants have emerged as one such biocompatible treatment modality for replacement of missing teeth. Following tooth extraction preservation of facial alveolar bone and soft-tissue architecture is critical for achieving optimal aesthetic outcomes in the anterior maxilla. Physiologic post-extraction remodelling, particularly resorption of the buccal plate, often compromises aesthetic results even with immediate implant placement. Conventional extraction and implant protocols may not completely prevent these dimensional changes. The Socket-shield Technique (SST) is a biologically driven approach that aims to preserve the periodontal ligament-bundle bone complex through intentional retention of the buccal root fragment, thereby limiting post-extraction hard and soft-tissue collapse. Hereby, the authors described the clinical application of SST with immediate implant placement in a 27-year-old male patient presenting with repeated fracture of a composite restoration in a previously endodontically treated maxillary left central incisor (21). Clinical and radiographic follow-up demonstrated preservation of the facial bone contour, stable peri-implant soft-tissues and favourable aesthetic outcomes. Within the limitations of a single case, SST appears to be a viable option for managing aesthetically demanding anterior maxillary implant sites when performed with careful case selection and surgical precision.

A Case of Tuberculous Myocarditis Presenting as Monomorphic Ventricular Tachycardia: Multimodality Imaging-guided Diagnosis and Management

DR Nivetha, Preetam Krishnamurthy, V Tamil Mani, K Ranjith, TR Muralidharan

Myocardial involvement in tuberculosis is extremely uncommon and is often diagnosed only at autopsy. Ventricular arrhythmias as the presenting manifestation of tuberculous myocarditis are rare and pose important diagnostic and therapeutic challenges. A 36-year-old female presented with palpitations and sustained monomorphic ventricular tachycardia requiring electrical cardioversion. Baseline electrocardiography showed sinus rhythm with right bundle branch block, and transthoracic echocardiography demonstrated a structurally normal heart. Electrophysiological study revealed three distinct ventricular tachycardia morphologies, suggesting a diffuse arrhythmogenic substrate. Cardiac magnetic resonance imaging demonstrated myocardial oedema and late gadolinium enhancement involving the interventricular septum and lateral wall. Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) showed patchy myocardial uptake and multiple hypermetabolic cervical and mediastinal lymph nodes. Computed Tomography (CT)-guided lymph node biopsy revealed necrotising granulomatous lymphadenitis consistent with tuberculosis, and the tuberculin skin test was strongly positive. Given the high risk of recurrent malignant arrhythmias during the inflammatory phase, an implantable cardioverter-defibrillator was implanted prior to initiation of antitubercular therapy. The patient received antitubercular therapy with adjunctive corticosteroids and completed nine months of treatment. She remains asymptomatic on follow-up with no recurrence of ventricular tachycardia. The present case highlights the importance of considering tuberculosis in patients presenting with inflammatory ventricular arrhythmias in endemic regions and demonstrates the complementary role of cardiac magnetic resonance imaging and fluorine-18 FDG PET-CT in establishing the diagnosis and guiding management.

Inflammatory Facial Swelling in an Elderly Male: A Rare Case of Cheek Carbuncle

Mohith Reddy, Samir Ahmed, Guru Prasad, Kuppusamy Barathiraja

Facial carbuncles are uncommon deep skin and Soft-Tissue Infections (SSTI) characterised by coalescent furuncles, extensive tissue necrosis, and multiple draining sinuses. Their occurrence on the face is clinically important because of the potential risk of spread to intracranial structures through the facial venous system. A 61-year-old male presented with a progressively enlarging painful swelling over the left cheek associated with erythema, tenderness, necrotic slough, and multiple discharging sinuses. Clinical examination and ultrasonography revealed a deep infective lesion with internal septations and surrounding soft-tissue oedema. Differential diagnoses including pyogenic abscess, infected sebaceous cyst, odontogenic infection, and soft-tissue malignancy were considered. The diagnosis of cheek carbuncle was established based on characteristic clinical features, imaging findings, intraoperative observations, and microbiological confirmation. The patient underwent surgical debridement with drainage of multiple interconnected purulent cavities followed by intravenous antibiotic therapy guided by microbiological culture findings and regular wound care. Microbiological culture demonstrated Staphylococcus aureus infection. Progressive wound healing with healthy granulation tissue formation was observed during follow-up, and no local or systemic complications developed. The present case highlights the importance of considering carbuncle in the differential diagnosis of inflammatory facial swellings, particularly in elderly patients. Early recognition, appropriate imaging, prompt surgical intervention, and targeted antimicrobial therapy are essential to achieve favourable outcomes and prevent potentially serious complications associated with facial infections.

Dengue Fever Complicated by Intracerebral Haemorrhage, Acute Respiratory Failure and Nosocomial Pneumonia: A Case Report

Ronak Shah, Parth Shah, Mittal Sindhav

Dengue fever is a mosquito-borne viral illness caused by the dengue virus. Majority of cases have self-limiting course, rarely severe dengue causes fatal neurological complications like encephalitis and haemorrhage. This is case report of a 38-year-old male who presented with three days of high-grade fever, one day of altered sensorium, headache, and generalised weakness. Serological testing confirmed dengue IgM positivity. The clinical course was complicated by a rapid decline in Glasgow Coma Scale (GCS) from 15 to 11, necessitating endotracheal intubation on day two in the setting of blood-stained pulmonary secretions. High-resolution Computed Tomography (CT) of the thorax suggested consolidation with pulmonary oedema. CT of the brain revealed a 3.9×3.8×3.5 cm Intracerebral Parenchymal Haemorrhage (IPH) with surrounding oedema causing significant mass effect. Laboratory parameters documented severe thrombocytopaenia (nadir 0.6 lac/cumm), coagulopathy, hepatocellular injury with peak SGOT/SGPT of 227/276 IU/L, and elevated C-reactive protein at 85.6 mg/L. Endotracheal aspirate cultures grew extensively drug-resistant Acinetobacter baumannii on day five, requiring escalation of antimicrobial therapy to meropenem and polymyxin. Supportive management included platelet and Fresh Frozen Plasma (FFP) transfusion. The patient was successfully extubated on day nine and discharged home on day twelve. Notably, the simultaneous occurrence of dengue-associated Intracerebral Haemorrhage (ICH), acute hypoxaemic respiratory failure, and Multi-Drug Resistant (MDR) nosocomial pneumonia in a young immunocompetent adult represents a triad that is rarely documented in the published literature. Early recognition of neurological deterioration, timely neuroimaging, aggressive blood product support, and targeted antimicrobial therapy with conservative management of ICH remains critical determinants of a favourable outcome.

Status Epilepticus as the Initial Presentation of Neurofibromatosis Type 1 in a Three-Year-Old Male: A Case Report

M Swetha, Smita Dey, Jayakaviyah

Neurofibromatosis Type 1 (NF1) is a common autosomal dominant neurocutaneous disorder, occurring in approximately one in 2,500-3,000 live births. It results from mutations in the NF1 gene and is characterised by diverse cutaneous, ophthalmologic, and neurological manifestations. Although seizures occur in 4-10% of affected children, status epilepticus as the initial presentation in early childhood is uncommon. In present case, a three-year-old boy presented with continuous abnormal body movements and unresponsiveness lasting seven minutes. There was a history of developmental delay without prior seizures. Clinical examination revealed multiple café-au-lait macules, and ophthalmologic evaluation demonstrated bilateral Lisch nodules. Magnetic Resonance Imaging (MRI) of the brain showed multiple non-enhancing T2/FLAIR hyperintense lesions in the cerebellar hemispheres, thalami, and gangliocapsular regions, consistent with Focal Areas of Signal Intensity (FASI). Electroencephalography revealed bilateral epileptiform discharges with right-sided predominance. Based on established diagnostic criteria, NF1 presenting with focal epilepsy was diagnosed. The child responded well to antiepileptic therapy and remained seizure-free on follow-up. The distinct feature of this case is status epilepticus as the first neurological manifestation of NF1 in early childhood, supported by characteristic radiological findings. Subtle cutaneous signs played a pivotal role in establishing the diagnosis. This case highlights the importance of multidisciplinary evaluation and structured long-term follow-up to monitor neurological and systemic complications. Early recognition ensures timely intervention, appropriate counseling, and improved long-term outcomes.

Schwartz-Jampel Syndrome: A Case Report with Clinical and Phenotypic Insights

Komal Rathod, Pratap Singh Parihar, Ramesh Chaple, Ajay Chavan, Amit Tosniwal

Schwartz-Jampel Syndrome (SJS) is a rare autosomal recessive disorder characterised by myotonia, craniofacial dysmorphism and skeletal dysplasia, resulting from pathogenic variants in Heparan Sulfate Proteoglycan 2 (HSPG2). Pathogenic variants disrupt perlecan function, resulting in abnormal cartilage development and impaired neuromuscular transmission. A three-year and five-month-old male presented with blepharophimosis, generalised muscle stiffness, delayed motor milestones and gait abnormality. Electromyography demonstrated continuous spontaneous myotonic discharges. Radiographs revealed metaphyseal dysplasia with epiphyseal abnormalities. Molecular testing identified three heterozygous HSPG2 variants with parental carrier status, consistent with compound heterozygosity. Carbamazepine and structured rehabilitation were administered. Follow-up demonstrated reduction in myotonia, improved gait parameters and decreased fall frequency. In early-onset myotonic disorders, SJS should be considered with characteristic craniofacial and skeletal features. Symptomatic treatment with sodium-channel–blocking agents and multidisciplinary rehabilitation may confer functional benefit.

Pancreatic Neuroendocrine Tumour Co-existing with Crohn’s Disease: A Case Report

Virendra Kumar Meena, Aman Khandelwal, Ravinder Kumar Kundu

Pancreatic Neuroendocrine Tumours (PNETs) are rare pancreatic neoplasms, while Crohn’s disease is a chronic inflammatory bowel disorder characterised by transmural inflammation and skip lesions. The co-existence of these two conditions is exceedingly uncommon. We report the case of a 62-year-old female presenting with non-specific abdominal symptoms, in whom Contrast-Enhanced Computed Tomography (CECT) revealed a hypervascular lesion in the neck of the pancreas with arterial enhancement and venous washout, consistent with a PNET, along with discontinuous small-bowel wall thickening suggestive of Crohn’s disease. Histopathological examination of resected ileocolonic specimens confirmed Crohn’s disease by demonstrating transmural inflammation and non-caseating granulomas. This case highlights the diagnostic value of contrast-enhanced imaging in detecting concurrent pancreatic and bowel pathology and underscores the importance of histopathology in confirming inflammatory bowel disease.

Histopathological and Immunohistochemical Evaluation of Endometrial Polyp with Endometrial Intraepithelial Neoplasia in a Postmenopausal Woman: A Case Report

Aslima Banu, Mary Lilly

Endometrial Intraepithelial Neoplasia (EIN) is a premalignant lesion recognised as a precursor to endometrioid endometrial carcinoma. Although endometrial polyps are predominantly benign, they may rarely harbour atypical or premalignant lesions, particularly in postmenopausal women presenting with abnormal uterine bleeding. A 60-year-old postmenopausal woman presented with postmenopausal bleeding. Pelvic ultrasonography demonstrated a bulky retroverted uterus with a diffusely thickened endometrium measuring 3 cm and no focal myometrial lesion. Magnetic Resonance Imaging (MRI) confirmed diffuse endometrial thickening and additionally revealed an intramural fibroid. Owing to persistent endometrial thickening and clinical suspicion of endometrial pathology, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Gross examination revealed a 2.5×1.5 cm endometrial polyp within a diffusely thickened endometrium. Histopathological examination demonstrated focal EIN involving both the endometrium and the endometrial polyp, confirming the lesion originated within the polyp. The myometrium showed adenomyosis without evidence of myometrial invasion or concurrent malignancy. The cervix exhibited chronic cervicitis, while both fallopian tubes and ovaries were histologically unremarkable. Immunohistochemical analysis for Bcl-2 (B-cell lymphoma 2) demonstrated intense staining in the endometrial glands and stroma with focal loss of expression, supporting the diagnosis. The final diagnosis was focal EIN arising within an endometrial polyp in a background of adenomyosis without associated endometrial carcinoma. No clinical evidence of recurrent disease was observed during the six-month follow-up. This case highlights the importance of meticulous histopathological evaluation of endometrial polyps in postmenopausal women with abnormal uterine bleeding, as premalignant lesions such as EIN may occur within polyps despite the absence of invasive carcinoma, thereby improving early detection, risk assessment, and optimal patient management.

A Rare Association of Atrial Septal Defect with Retinitis Pigmentosa in an Adult: Coincidence or Syndromic Link

Sumedh Krishna, Vignessh Raveekumaran

Atrial Septal Defect (ASD) and Retinitis Pigmentosa (RP) are individually well-recognised clinical entities, but their co-occurrence in an adult patient without a defined syndromic diagnosis is exceptionally uncommon. A 52-year-old female with Type 2 Diabetes Mellitus (T2DM) who presented with acute gastroenteritis complicated by septic and hypovolemic shock. During evaluation, she was incidentally found to have an ostium secundum ASD measuring 1.07 cm with left-to-right shunt, dilated right-sided cardiac chambers, dilated main pulmonary artery and Pulmonary Arterial Systolic Pressure (PASP) of 43 mmHg. Ophthalmological assessment revealed bilateral advanced RP, with Visual Acuity (VA) limited to light perception in both eyes and fundus findings of peripheral bone-spicule pigmentation, attenuated retinal vessels and optic disc pallor. The family history was strongly suggestive of inherited retinal disease, with multiple siblings affected by progressive visual loss and a background of consanguinity. During admission, the patient developed a transient episode of left upper limb weakness, clinically consistent with Transient Ischaemic Attack (TIA); neuroimaging showed no acute infarct. Usher syndrome was excluded by audiometry (normal bilateral hearing) and that Bardet-Biedl syndrome and Refsum disease were excluded on separate clinical grounds. The present case is reported because the non syndromic co-existence of ASD and RP may represent a coincidental association or an unrecognised shared genetic/developmental pathway. The case emphasises the need for multidisciplinary evaluation, genetic counselling and consideration of whole-exome sequencing in adults with congenital cardiac anomalies and familial retinal dystrophy.

Young-onset Ischaemic Stroke Secondary to Antiphospholipid Syndrome Associated with Mitral Valvular Lesion: A Case Report

Sadhurnaa Venkatesan, Vignessh Raveekumaran

Young-onset ischaemic stroke warrants evaluation for uncommon aetiologies, particularly autoimmune and hypercoagulable disorders. Antiphospholipid Syndrome (APS) is an important cause of ischaemic stroke in young adults and is frequently associated with recurrent pregnancy loss and cardiac valvular lesions. A 32-year-old hypertensive female presented with weakness of the left lower limb for three days. Neurological examination revealed monoparesis with exaggerated reflexes and bilateral extensor plantar responses. Magnetic Resonance Imaging (MRI) of the brain demonstrated multiple acute non haemorrhagic infarcts in the right frontoparietal region, along with evidence of previous infarction. Echocardiography revealed a highly mobile echogenic mass attached to the posterior mitral leaflet associated with mitral regurgitation, suggestive of a cardioembolic source. Laboratory investigations demonstrated prolonged activated Partial Thromboplastin Time (aPTT), positive lupus anticoagulant, elevated anticardiolipin Immunoglobulin G (IgG) antibodies, and positive Antinuclear Antibody (ANA) titre. A history of recurrent pregnancy loss further supported the diagnosis of secondary APS with probable cardioembolic stroke. Young stroke associated with adverse obstetric history should raise suspicion for APS. Cardiac valvular lesions in APS may act as embolic sources and contribute to recurrent ischaemic events. Early diagnosis and multidisciplinary management are essential to prevent recurrent thrombotic complications and improve long-term neurological outcomes.

Gastric Adenocarcinoma and Thyroid Follicular Adenoma with Oncocytic Features: A Rare Synchronous Presentation Managed with Single-stage Surgery

Anjana Naga Jampala, Suganya Palanivel, Rajendran Shanmugasundaram

Synchronous tumours involving anatomically and histologically distinct organs are uncommon and present considerable diagnostic and therapeutic challenges. The co-existence of gastric adenocarcinoma and a thyroid neoplasm is particularly rare. A 74-year-old male presented with vomiting, progressive abdominal fullness, anorexia, and significant unintentional weight loss. Upper gastrointestinal endoscopy revealed partial gastric outlet obstruction with a suspicious pyloric lesion. Contrast-Enhanced Computed Tomography (CECT) of the abdomen demonstrated circumferential wall thickening involving the pyloric region of the stomach causing significant luminal narrowing. During staging evaluation, Computed Tomography (CT) of the thorax incidentally detected a well-defined soft tissue lesion in the right lobe of the thyroid gland. Whole-body Positron Emission Tomography-Computed Tomography (PET-CT) demonstrated a heterogeneously enhancing metabolically active thyroid lesion with central necrosis and tracheal displacement, raising suspicion for malignancy. Core needle biopsy of the thyroid lesion suggested a follicular-patterned oncocytic neoplasm suspicious for Hurthle cell neoplasm. Following multidisciplinary tumour board discussion, the patient underwent D2 subtotal gastrectomy with regional lymphadenectomy followed by total thyroidectomy with preservation of three parathyroid glands in a single operative session. Histopathological examination of the gastric specimen revealed well-differentiated adenocarcinoma of the stomach pT3N1M0 {T3 (primary tumour), N1 (regional lymph node involvement), M0 (no distant metastasis)}. Histopathological examination of the thyroid lesion demonstrated follicular adenoma with oncocytic features without evidence of capsular or vascular invasion. Postoperatively, serum calcium and parathyroid hormone levels were monitored, and calcium supplementation was initiated. The patient subsequently received adjuvant chemotherapy for gastric carcinoma. The present case highlights the importance of comprehensive staging, histopathological confirmation, and multidisciplinary management in patients with suspected synchronous neoplastic lesions. Accurate differentiation between metastatic disease and a second primary or benign lesion is essential for appropriate therapeutic planning and prognostic assessment.

Cystic Artery Originating from Hepatic Capsular Artery: A Case Report

Mohammad Bukhetan Alharbi

The Cystic Artery (CA) is a crucial structure that is dissected and ligated during Laparoscopic Cholecystectomy (LC). While several studies have explored the varying anatomy of the CA, there are no case reports discussing the hepatic capsular artery as a potential source of the CA. This case report involves a 52-year male who underwent a planned LC using blunt dissection to separate the connective tissue surrounding the gallbladder. Remarkably, the CA in this case originated from the hepatic capsular artery, which may be the first instance of such an observation recorded. Precise surgery with careful dissection of the gallbladder can help minimise the risk of bleeding from an injury to the CA, especially when faced with atypical anatomical variations. Continuous awareness and updates on these variations are essential for achieving a safe surgical outcome.

A Rare Case Report of Neonatal Pneumoperitoneum Leading to Pneumoscrotum

The collection of air in the scrotal area is known as a pneumoscrotum. It is uncommon for pneumoperitoneum and pneumoscrotum to coexist, which presents challenges for diagnosis and treatment. Air in the scrotum as a concurrent sign is rare and patient typically exhibits symptoms of intraperitoneal sepsis. An unusual and serious ailment is in which a newborn has acute swelling of the scrotum that usually includes testicular torsion, trauma, inguinal hernia, hydrocele and, rarely, intestinal perforation or adrenal haemorrhage. Acute scrotum in an emergency needs attention. Neonates undergoing rigorous resuscitation or mechanical ventilation, as well as those with significant respiratory distress, may also exhibit this condition. The simultaneous occurrence of pneumoperitoneum and pneumoscrotum in a newborn is even more uncommon. Hereby, the authors present a case of one-day-old male neonate born by normal vaginal delivery who cried immediately after birth. The baby initially presented with respiratory distress and mild scrotal swelling. The antenatal scan had shown enlarged genitals with echogenic debris and calcifications. Evaluation for increasing scrotal swelling and progressive abdominal distension revealed gas under diaphragm and pneumoscrotum. Surgical exploration showed a wide perforation in transverse colon. The postoperative course was uneventful. A properly done radiological examination can help detect and identify the pathology and determine the source of an acute scrotum. The purpose of the present study is to present and assess the authors approach to treating pneumoperitoneum and provide insight into its presence in newborns and infants.

Gallbladder Perforation Secondary to Salmonella Typhi Infection in a Child: A Rare Case Report

Subasri Saravanan, Revathi Varadarajan, S Jagadeeswari

Acute Acalculous Cholecystitis (AAC) is an uncommon inflammatory disorder of the gallbladder occurring in the absence of gallstones and is typically seen in critically ill patients. In the paediatric population, AAC is rare but has been reported in association with systemic infections, dehydration, and inflammatory states. Enteric fever caused by Salmonella typh remains endemic in developing countries and may involve the hepatobiliary system, leading to complications such as cholecystitis and, rarely, gallbladder perforation. Due to nonspecific clinical features, diagnosis is often delayed, increasing the risk of morbidity. This report describes an unusual case of Salmonella typhi–induced AAC complicated by concealed gallbladder perforation in an eight-year-old child, successfully managed with subtotal cholecystectomy. An eight-year-old girl presented with high grade fever, abdominal pain and non bilious vomiting. Investigative work-up revealed acalculous cholecystitis due to Salmonella typhi, resulting in gallbladder perforation. The child recovered due to timely surgical intervention and appropriate antibiotic therapy. The present case highlights the importance of maintaining a high index of suspicion for hepatobiliary complications in children with enteric fever presenting with acute abdomen.

Salvage Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy for Radiorecurrent Laryngeal Carcinoma: A Case Report

Recurrent or residual Laryngeal Squamous Cell Carcinoma (LSCC) after chemoradiotherapy often requires surgical salvage. Salvage total laryngectomy is effective but results in significant long-term functional loss. In selected cases without cartilage invasion, supracricoid laryngectomy with Cricohyoidoepiglottopexy (CHEP) can achieve oncologic clearance while preserving the larynx and reducing aspiration-related morbidity. A 77-year-old male presented with progressive hoarseness for one month. He had been treated three years previously with radiotherapy (25/35 planned cycles; defaulter) and chemotherapy (6 cycles) for LSCC. A Contrast-Enhanced Computed Tomography (CECT) of skull base to thorax showed an enhancing polypoidal lesion involving the anterior 2/3^rd of the right true vocal cord (posterior 1/3^rd free), no thyroid cartilage, arytenoid, or paraglottic space involvement, and no supraglottic/subglottic extension. No significant cervical lymphadenopathy was noted. Biopsy revealed sarcomatoid carcinoma with spindle cell morphology. The patient underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Histopathology confirmed spindle cell squamous carcinoma with all margins free of tumour. Tumour size was 0.5×0.5×0.3 cm with staging pT1a pNx pMx. Supra cricoid laryngectomy with cricohyoidoepiglottopexy is an effective organ-preserving option in selected cases of radiorecurrent laryngeal carcinoma without cartilage invasion, helping to avoid total laryngectomy while maintaining oncological safety.

Resolving an Unexpected Blood Grouping Discrepancy and a False-positive Compatibility Test in Pretransfusion Workup: A Case Report

Vidhi Jain, Devanshi Gosai

Column Agglutination Technology (CAT), commonly known as the gel card method, is widely used in transfusion medicine for its sensitivity, standardisation, and reproducibility, but its heightened sensitivity can occasionally generate false-positive cross match results that pose a diagnostic challenge in urgent settings. This report describes a 76-year-old man with symptomatic severe anaemia (haemoglobin 5.2 g/dL), cholelithiasis, and Acute Kidney Injury on Chronic Kidney Disease (AKI on CKD), who had been transfused approximately one month earlier and was referred for pretransfusion workup. Forward grouping identified the blood group as O, Rh-D positive, while reverse grouping by CAT initially showed mixed-field agglutination; a strongly positive anti-H lectin reaction excluded the Bombay (Oh) phenotype. CAT cross matching demonstrated persistent 4+ incompatibility against two separate O Rh-D positive units across two independent samples. All recognised causes of grouping discrepancy and cross match incompatibility were systematically evaluated, and the Direct Antiglobulin Test (DAT) was negative. Conventional Tube Technique (CTT) resolved the apparent grouping discrepancy, confirmed blood group O Rh-D positive without ABO discrepancy, and demonstrated full serological compatibility, thereby establishing a gel-specific false-positive result. One unit of O Rh-D positive Packed Red Blood Cells (PRBC) was transfused uneventfully; the patient subsequently died of his underlying illness during the same admission. This case underscores the importance of recognising false-positive CAT cross match results and the continued value of conventional tube testing as a confirmatory method, and highlights the need for clear standard operating procedures to prevent unnecessary withholding of serologically compatible blood from patients who urgently require transfusion.

Long-term Outcome in Neuroendocrine Tumour of the Prostate: A Rare Case Report with Literature Review

Neuroendocrine (NE) prostate cancer is a rare and aggressive variant of prostate carcinoma, often presenting in advanced stages with widespread metastases and is associated with poor prognosis and limited treatment options. Hereby, the authors present the case of a 66-year-old male initially diagnosed with metastatic adenocarcinoma of the prostate with NE differentiation. Despite a normal Prostate-Specific Antigen (PSA) level, extensive metastatic disease involving lymph nodes, liver and bones was identified. The patient was treated with systemic chemotherapy (cisplatin and etoposide) and palliative radiotherapy. Subsequent progression led to brain metastases and bony metastasis, which were managed with whole brain radiotherapy and systemic second line chemotherapy. The patient tolerated treatment well and remains asymptomatic on follow-up. NE prostate cancer is a rare and aggressive entity with limited therapeutic options. Normal PSA levels in the setting of advanced disease should raise suspicion for NE differentiation. Early diagnosis and aggressive multimodal therapy, including high-dose radiotherapy, may improve symptom control and prolong survival in selected patients.

Tubercular Cold Abscess Mimicking Baker’s Cyst: A Rare Case of Posterior Knee Swelling

VS Ambrish, J Lionel John, Arivoli

Musculoskeletal tuberculosis is usually not a common form of extrapulmonary tuberculosis which often presents with an atypical clinical features, resulting in delayed or missed diagnosis. Tubercular cold abscesses typically lack classical signs of inflammation and may clinically mimic benign cystic conditions. Posterior knee swelling is most commonly attributed to Baker’s cyst; however, in tuberculosis-endemic regions, infective aetiologies should be considered when the presentation is atypical or fails to respond to conventional treatment. Hereby, the authors report a case of a 67-year-old female who presented with a chief complaints of swelling over the posterior aspect of the knee since two years which was gradually progressive, associated with pain and restriction of knee normal range of movements. She was initially managed as a Baker’s cyst with repeated aspirations and intra-articular steroid injections, which provided only temporary relief. Magnetic Resonance Imaging (MRI) report showing a well-defined cystic lesion suggestive of a Baker’s cyst. Due to persistent symptoms and progressive enlargement, surgical excision was performed. Histopathological examination demonstrated granulomatous inflammation, and microbiological examination such as GeneXpert confirmed Mycobacterium tuberculosis with rifampicin resistance. The patient was initiated on appropriate antitubercular therapy and showed significant clinical improvement with no recurrence in six-month follow-up. The present case highlights the importance of considering tuberculosis in the differential diagnosis of persistent or atypical posterior knee swellings. Imaging alone will not be enough in arriving clinical diagnosis, may be misleading, and definitive diagnosis requires histopathological and microbiological confirmation. Early surgical intervention combined with appropriate therapy ensures favourable outcomes and prevents complications.

Cannabis-associated Spontaneous Bilateral Basal Ganglia Haemorrhage: A Case Report

Spontaneous Bilateral Basal Ganglia Haemorrhage (SBBGH) is an exceptionally rare entity, with fewer than sixty cases reported worldwide. Although cannabis use is a recognised risk factor for ischemic stroke, its association with Intracerebral Haemorrhage (ICH) remains uncommon and poorly characterised. A 23-year-old male with no vascular risk factors presented with acute onset right-sided hemiparesis, dysarthria, and dysphonia. Symptoms developed a few hours after cannabis ingestion. Neurological examination revealed right facial nerve palsy, vocal cord palsy, and reduced motor strength in the right upper and lower limbs. Non-contrast computed tomography of the brain demonstrated acute bilateral basal ganglia haematomas. Comprehensive evaluation, including autoimmune, infectious, coagulation, and genetic work-up, was unremarkable. Magnetic resonance angiography and venography excluded vascular malformations, aneurysms, and cerebral venous thrombosis. Urine toxicology was positive for cannabis, identifying it as the probable aetiological factor. This case represents a rare presentation of SBBGH associated with cannabis use. It expands the spectrum of cannabinoid-related cerebrovascular complications and highlights the importance of considering substance-related aetiologies in young patients with atypical ICH.

Herpes Simplex Virus Encephalitis Presenting as Acute Hemiplegia and Altered Sensorium: A Case Report

Deepak Raj, R Umashankar, Razook Fareedh, MV Aishwarya Lakshmi, Saketh Ramineni

Herpes Simplex Virus Encephalitis (HSVE) is the most common cause of sporadic fatal viral encephalitis worldwide and carries substantial morbidity and mortality when antiviral therapy is delayed. The disease typically involves the temporal lobes and presents with fever, altered mental status, seizures, and focal neurological deficits. However, early clinical and radiological features may closely resemble acute ischemic stroke, leading to diagnostic uncertainty. We report a 46-year-old male patient who presented with an acute onset of fever, global aphasia, right-sided hemiplegia, and altered sensorium. Magnetic Resonance Imaging (MRI) demonstrated unilateral cortical T2/FLAIR hyperintensity with diffusion restriction predominantly involving the left temporal and fronto-parietal regions, without conformity to a specific vascular territory. Electroencephalography (EEG) revealed Periodic Lateralised Epileptiform Discharges (PLED) over the left hemisphere. Normal opening pressure, slight lymphocytic pleocytosis (68 cells/mm³), normal protein and glucose, and negative Gram stain, AFB smear, and fungal investigations were all observed in the CSF study. A normal first CSF does not rule out the diagnosis because early HSVE might appear with little or normal CSF abnormalities. Empirical intravenous acyclovir was initiated promptly. The patient demonstrated neurological stabilisation following antiviral therapy. This case highlights the importance of considering HSVE in patients presenting with acute febrile focal neurological deficits mimicking stroke. Early recognition and timely antiviral therapy significantly reduce mortality and improve neurological outcomes.

Marsupialisation of Giant Bronchogenic Cyst through Right Anterior Mini-thoracotomy: A Case Report

Nembian Raja Rajan, Sujith Velayudhan Indira, D Srinath, Anand Alwan

Bronchogenic cysts are common mediastinal lesions; however, intrapericardial occurrence is exceedingly rare. The authors report the case of a 50-year-old female who presented with persistent cough and right shoulder pain of three months’ duration. The patient is a known case of systemic hypertension and diabetic type 2 for 5 years and patient was taking medication for the same for 5 years, bronchial asthma, or pulmonary tuberculosis. Clinical examination was unremarkable. Contrast-Enhanced Computed Tomography (CECT) of the chest revealed a large, well-defined intrapericardial cyst causing significant compression of the Left Atrium (LA) and displacement of adjacent mediastinal structures without evidence of invasion. Given the symptomatic presentation and anatomical complexity, surgical management was undertaken. The patient underwent marsupialisation through a minimally invasive right anterior mini-thoracotomy. Intraoperatively, the cyst was found to be densely adherent to surrounding vital structures, including the pulmonary artery and LA, precluding safe complete excision. Approximately, 200 mL of thick mucinous fluid was aspirated, and the cyst wall was opened, everted, and plicated. The postoperative course was uneventful. The patient was extubated early, remained haemodynamically stable, and was discharged on Postoperative Day (POD) 4. Histopathological examination confirmed the diagnosis of a bronchogenic cyst. At the six-month follow-up, the patient remained asymptomatic, with no evidence of recurrence. The present case highlights marsupialisation as a safe and effective alternative in selected complex cases where complete excision carries significant risk.

Leptomeningeal Carcinomatosis with Brain and Spinal Metastasis from Triple-negative Breast Cancer: A Case Report

Prateek Chauhan, Amogh Biradar, Rahul Dev

Leptomeningeal Carcinomatosis (LMC) is an uncommon but devastating complication of metastatic breast cancer, particularly associated with Triple-Negative Breast Cancer (TNBC). The authors report a 46-year-old female with previously treated TNBC and a parenchymal brain metastasis who presented with subacute, progressive bilateral lower-limb weakness and gait impairment. Contrast-Enhanced Magnetic Resonance Imaging (CE-MRI) of the brain and spine demonstrated diffuse leptomeningeal enhancement over the cerebellar hemispheres, spinal cord, and cauda equina, along with post-radiotherapy white-matter changes and hydrocephalus. Cerebrospinal Fluid (CSF) cytology confirmed the presence of malignant cells, establishing the diagnosis of LMC. Given her poor performance status and extensive intracranial and spinal disease burden, she was managed with palliative intent, including corticosteroids, analgesics, antiemetics, and best supportive care, but experienced progressive neurological decline. The present case highlights the close temporal relationship between brain metastases and LMC in TNBC, underscores the diagnostic value of CE-MRI with post-contrast Fluid Attenuated Inversion Recovery (FLAIR) and Three-Dimensional (3D) T1-weighted sequences combined with CSF cytology, and emphasises the need for heightened clinical suspicion and optimised palliative strategies in patients with advanced TNBC who develop new neurological symptoms.

Pure Red Cell Aplasia with Triple Pulmonary Co-infection and Shock-induced Organ Injury: An Autopsy-based Case Report

Nivetha Ambalavanan, Siddharthan Manimuthu, Aravind Sekar, Pulkit Rastogi

Pure Red Cell Aplasia (PRCA) is a rare haematological disorder characterised by profound anaemia, reticulocytopaenia, and selective erythroid precursor depletion. While immunosuppressive treatment is a cornerstone of management, it significantly increases patient susceptibility to life-threatening opportunistic pathogens. The authors present the case of a 26-year-old male with PRCA and hypogammaglobulinaemia who presented with rapidly progressive respiratory failure. Despite intensive care, the patient succumbed within five days of admission. Bone marrow examination revealed marked erythroblastopenia and moderate hypocellularity. Post-mortem examination identified Diffuse Alveolar Damage (DAD) resulting from a concurrent pulmonary triple co-infection: Pneumocystis jirovecii (P. jirovecii), Mycobacterium tuberculosis (M. tuberculosis), and Cytomegalovirus (CMV). These findings were confirmed via specialised stains and Immunohistochemistry (IHC). Systemic findings included centrilobular hepatic necrosis and acute tubular injury, consistent with terminal cardiovascular collapse. The present case underscores the extreme vulnerability of immunocompromised individuals and highlights the necessity of aggressive surveillance, the consideration of polymicrobial involvement in deteriorating patients, and the potential role of expanded prophylaxis to reduce mortality in this high-risk population.

Appendicular Diverticulum Mimicking Acute Appendicitis: A Case Report

Acute appendicitis is one of the most common surgical emergencies encountered in clinical practice. It typically presents with right iliac fossa pain, nausea, vomiting and leukocytosis and is often managed surgically with appendicectomy. Despite a well-established clinical presentation, several rare pathological entities can mimic acute appendicitis, posing diagnostic challenges for clinicians. Appendicular diverticulum is an uncommon condition characterised by sac-like protrusions of the appendiceal wall. The authors report a 44-year-old male who presented to the surgical Outpatient Department with abdominal pain for 20 days, associated with episodes of vomiting and intermittent fever. The pain was predominantly localised to the right iliac fossa and was described as intermittent rather than acute in onset. There was no history of similar episodes. The patient had no known co-morbidities such as diabetes mellitus or hypertension. The laboratory profile was within normal limits. The appendicular diverticulum was confirmed by histopathological and immunohistochemical tests without any evidence of neoplasia. The patient was advised to undergo periodic clinical surveillance, given the known association between appendicular diverticulum and appendiceal neoplasms. There was no evidence of any postoperative complication or recurrence. The present case highlights a rare presentation of appendicular diverticulum mimicking acute appendicitis. It emphasises the importance of histopathological evaluation and immunohistochemistry in all appendicectomy specimens.

Goblet Cell Adenocarcinoma of Appendix with Ovarian Metastasis: A Case Report

P Archana, Priyathersini Nagarajan, R Priya Dharshini, S Jagadesh Chandra Bose

Goblet Cell Adenocarcinoma (GCA) is a rare neoplasm of the appendix composed of goblet like mucinous cells, classified as adenocarcinoma. High-grade GCA of appendix with large aggregates of mucin containing goblet shaped cells, secondarily involving the ovary with signet ring cells is very rare. Such cases pose a significant diagnostic challenge, as the pelvic mass may clinically mimic as a primary ovarian malignancy, thereby delaying identification of the true appendiceal origin. This is a case of 50-year-old postmenopausal female who presented with complaints of significant weight loss (5 kg) since one month and recurrent vomiting since one month. Clinical examination revealed a large pelvic mass. Ultrasonography of abdomen and pelvis revealed malignant neoplasm in pelvis with involvement of uterine stump and vagina. Biopsy of the pelvic mass showed malignancy, however, the primary site remained inconclusive, necessitating further workup to exclude a gastrointestinal/gynaecological primary. The patient underwent surgical exploration. Histopathological examination of appendix demonstrated tumour cells arranged in anastomosing trabeculae, irregular nests, glands and cords with singled out goblet-shaped mucin-secreting cells and areas of high-grade transformation showing signet ring cell morphology. Histopathological examination of ovarian mass showed mucin filled signet ring cells. Individual tumour cells showed abundant intracytoplasmic (cellular) mucin with basally displaced, mildly to moderately pleomorphic nuclei. Immunohistochemistry showed positivity for CK20, CDX2, SATB2, CK19, synaptophysin; CK7 and PAX8 were negative, confirming primary appendiceal origin. This immunophenotype excludes primary ovarian mucinous carcinoma and confirms ovarian metastasis consistent with Krukenberg tumour. This case highlights the diagnostic pitfall of misinterpreting appendiceal GCA as a primary ovarian malignancy when the patient presents with a pelvic mass. High-grade transformation with signet ring cell features carries a poor prognosis requiring immediate management. This case is unique because of a grossly normal-appearing appendix despite underlying malignancy, presenting as a primary ovarian mass. The diagnostic difficulty due to high-grade transformation with signet ring cell morphology highlights the need for broad spectrum immunohistochemistry panel before labelling a pelvic mass as primary ovarian in origin.

Giant Non-traumatic Splenic Pseudocyst Mimicking a Pancreatic Pseudocyst: A Case Report

Splenic pseudocysts are rare non-parasitic cystic lesions of the spleen characterised by the absence of an epithelial lining. Most occur following trauma, whereas non-traumatic splenic pseudocysts are uncommon. A 45-year-old woman presented with a one-year history of chronic postprandial vomiting, early satiety, abdominal fullness, weight loss (6-7 kg), and recent-onset breathlessness. Initial ultrasonography suggested a pancreatic pseudocyst because of the apparent proximity of the lesion to the pancreatic tail and poor visualisation of the spleen. However, normal serum amylase and lipase levels together with unexplained cytopenias prompted further evaluation. Contrast-Enhanced Computed Tomography (CECT) revealed a large splenic cystic lesion with peripheral calcifications and internal septations, establishing its splenic origin and prompting revision of the initial diagnosis of pancreatic pseudocyst. The patient subsequently underwent open splenectomy. Histopathological examination confirmed a splenic pseudocyst. This case highlights that a presumed pancreatic pseudocyst in the absence of pancreatitis and with normal serum amylase and lipase levels should prompt consideration of alternative diagnoses, including splenic pseudocyst.

Aberrant Origin of the Ilioinguinal Nerve from L1-L3: A Case Report

The Ilioinguinal Nerve (IIN) has a crucial role in providing sensory innervation to the groin region. The literature has extensively documented variability in IIN formation, particularly in relation to the iliohypogastric nerve. However, there is a scarcity of cadaveric studies that specifically document variations in the origin of the IIN. Herein, we report a case of an aberrant variation in the origin of the IIN. Instead of following the usual origin from the first lumbar (L1) nerve root, the right IIN was observed to arise from a broader contribution spanning the L1-L3 nerve roots, indicating an atypical, more extensive segmental origin. In contrast, the contralateral IIN followed the conventional anatomical pattern, originating solely from the L1 spinal nerve without additional contributions. Thorough knowledge of any variation concerning the IIN is crucial for surgeons, Orthopaedics, and anaesthetists, as it enables them to prevent iatrogenic injuries.

Pulmonary Cavitation Following Acute Pulmonary Infarction: A Rare Case of Complication of Pulmonary Embolism

Sushant Dilip Muley, Sushant Hiraman Meshram, Ashish Kendre, Pranav Atigre

Pulmonary infarction is a rare complication of Pulmonary Embolism (PE) due to dual blood supply of the lung. Pulmonary cavity formation following PE is a very rare but a recognised complication, typically resulting from ischaemic infarction of lung parenchyma. The majority of reported cases involve patients managed conservatively with anticoagulation or thrombolytic therapy, without surgical or invasive intervention. Cavity formation occurs due to occlusion of distal pulmonary arteries, leading to haemorrhage, necrosis and subsequent parenchymal breakdown. The authors report a rare case of a 35-year-old male patient with no known co-morbidities presented with acute PE with pulmonary infarction leading to cavitation with possible secondary infection following a thrombolysis and anticoagulation therapy. Chest radiography showed prominent descending right pulmonary artery-(Palla sign). As patient was haemodynamically unstable, he was immediately thrombolysed with intravenous Streptokinase (STK) followed by systemic anticoagulation with unfractionated heparin. Patient discharged on tab dabigatran 150 mg twice daily in a stable condition. This case highlights the importance of vigilance for post-embolism complications such as cavitation and infection, even after appropriate anticoagulant management and need for prompt management to prevent associated morbidity and mortality thereby improving the quality of life of the patient.

One Lung Ventilation and Erector Spinae Plane Block in a Child with Posterior Mediastinal Tumour: A Case Report

Neeta Verma, Prachi Siddharth Kamble

Tumours located in the posterior mediastinum of children present unique anaesthetic challenges because they are in proximity to large vessels and the airway, which puts the child at risk for airway compression, difficulty breathing, and loss of haemodynamic stability during surgery. This case describes the perioperative anaesthetic management of this eight-year-old girl, weighing 23 kg, with a large ganglioneuroma that extended from D1 to D7 in the posterior mediastinum. Because of the risk of airway compromise, an Awake Fibreoptic Intubation (AFOI) was performed while allowing the child to breathe on her own before General Anaesthesia (GA) was induced. To achieve lung isolation and enable One-Lung Ventilation (OLV), a 5 Fr paediatric bronchial blocker was used under fibreoptic guidance. During OLV, lung-protective ventilatory strategies were used, and oxygenation and haemodynamic stability were maintained throughout. Postoperatively, she received analgesia with an Erector Spinae Plane Block (ESPB) using 0.25% bupivacaine under ultrasound guidance. Her intraoperative and postoperative courses were uncomplicated. This case stresses the need for careful preoperative assessments, maintenance of spontaneous ventilation until airway control has been established, appropriate techniques for lung isolation, and multimodal analgesic therapy for safe anaesthetic management of posterior mediastinal tumours in children.

Management of Complex Zygomaticomaxillary Fracture with Frontal and Orbital Wall Involvement Associated with a Crushed Globe: A Case Report

Krishna Balaji Pampatwar, Bhushan Mundada, Nitin Bhola

Zygomaticomaxillary Complex (ZMC) fractures are among the most common midfacial injuries and are frequently caused by high-velocity trauma, particularly road traffic accidents. These fractures frequently affect nearby structures including the orbit, maxilla, and frontal bone, leading to serious problems with function, appearance, and vision. To restore orbital integrity, facial symmetry, and functional outcomes, prompt diagnosis and appropriate surgical intervention are essential. A 17-year-old male presented with severe facial trauma following a road traffic accident. Significant facial asymmetry, periorbital oedema, flattening of the right malar prominence, limited jaw opening, and total loss of vision in the right eye were found during the clinical examination. An ophthalmological examination revealed a crushed globe that could not be saved. A complicated right-sided ZMC fracture involving the orbital floor, lateral orbital wall, maxillary sinus walls, along with frontal bone was identified on Computed Tomography (CT) imaging of the facial bones. Significant orbital damage and fracture fragment displacement were observed. Under general anaesthesia, the patient underwent a surgical procedure. Titanium miniplates and screws were used for open reduction and internal fixation of the frontal and zygomaticomaxillary bone fractures. In order to prevent enophthalmos and restore orbital support, titanium mesh was used for orbital floor repair. Because of the permanent ocular lesion, the injured globe was eviscerated. The face contour was well restored, the mouth opening was better, the occlusion was stable, with wounds healing appropriately. The postoperative recovery was uncomplicated. In order to manage difficult midfacial fractures for the best possible functional and cosmetic rehabilitation, this case highlights the significance of thorough clinical examination, radiographic assessment, and a multidisciplinary approach.

Exophytic Major Recurrent Aphthous Stomatitis (Fuchs Syndrome) Triggered by Pregnancy and Lactation: A Case Report

Mittal Sindhav, Bharat Chaudhary, Ronak Shah, Parth Shah

Fuchs syndrome, the most severe form of major Recurrent Aphthous Stomatitis (RAS), is characterised by large, deeply penetrating oral ulcers that cause significant morbidity. While its pathogenesis involves immune dysregulation, nutritional deficiency, and hormonal influences, pregnancy and lactation-associated exacerbations remain poorly documented, and atypical exophytic presentations are exceptionally rare. Hereby, the authors report the case of a 32-year-old lifelong lacto-vegetarian female, actively breastfeeding, who presented with a third episode of severe oral ulceration over 18 months each episode temporally associated with late pregnancy, early postpartum or active lactation. On this occasion, a 6 mm ulcer progressed to a 6 cm exuberant flower-like exophytic inflammatory mass covering the entire lower lip despite seven days of oral acyclovir therapy, initiated on the basis of incidental Herpes Simplex Virus Type 1-Immunoglobulin G (HSV-1 IgG) seropositivity. Negative Herpes Simplex Virus-Immunoglobulin M (HSV-IgM) and absence of vesicular lesions excluded active herpetic infection. Borderline vitamin B12 at the lower end of the reference range (234 pg/mL) and low-normal ferritin (30 ng/mL) were identified as contributory nutritional factors in a vegetarian patient with increased lactational demands. Systemic prednisolone (20 mg daily tapered over 13 days) produced dramatic clinical improvement within 72 hours and complete epithelialisation by day 21, with no recurrence at three months. The present case illustrates the diagnostic pitfall of equating isolated HSV-1 IgG positivity with active infection, highlights the role of hormonal immunomodulation in precipitating major RAS, and reinforces the primacy of systemic corticosteroids in managing severe immune-mediated oral ulceration.

Malignant Proliferating Trichilemmal Tumour of the Deltoid Region in an Adolescent: A Rare Presentation at an Unusual Site and Young Age

Aditya Chadalawada, A Naveen Kumar

Proliferating Trichilemmal Tumour (PTT) is a rare benign adnexal neoplasm arising from the outer root sheath of the hair follicle. Malignant transformation to Malignant PTT (MPTT) is exceptionally uncommon and is frequently mistaken for squamous cell carcinoma, as the two share overlapping clinical and microscopic features. MPTT classically affects the scalp of women in the sixth-to-seventh decade of life; presentation in adolescence and at an extra-scalp site is rare. The authors report a 16-year-old girl with a painless swelling over the left deltoid region present for one year, with rapid enlargement over the preceding five months. There was no history of trauma or intramuscular injection. An outside incisional biopsy reported MPTT and she was referred for definitive management. Magnetic Resonance Imaging (MRI) showed a 3.1×2.5 cm subcutaneous mass superficial to the deltoid without muscular invasion and a few small left-axillary nodes. After tumour board discussion she underwent wide local excision with 1 cm margins and sentinel lymph node biopsy localised with methylene blue dye; the sentinel node was negative on frozen section and definitive histopathology and all resected margins were free of tumour. Histopathology confirmed MPTT with abrupt keratinisation, nuclear atypia, infiltrative margins and eight mitoses per 10 high-power fields, without lymphovascular invasion. She recovered well, did not require adjuvant radiotherapy and showed no recurrence at follow-up. The present case highlights that MPTT can occur in adolescents and at unusual sites. It must be distinguished from squamous cell carcinoma and complete surgical excision with margin assessment is the cornerstone of management.

Improving Diagnostic and Treatment Precision for Negative Symptoms of Schizophrenia using Quantitative Electroencephalography and Transcranial Direct Current Stimulation: A Case Report

Deepan Raj, Srinivas Rajkumar, Priya Sivashankar

Schizophrenia is a major mental illness associated with significant disability. Negative symptoms represent a key determinant of long-term morbidity and poor functional outcomes. This is a case report of a 22-year-old male presenting with poor functional recovery despite apparent resolution of psychotic symptoms (hallucinations and delusions) on antipsychotics. In follow-up his antipsychotic dose was up titrated along addition of anti-depressants with suspicion of primary negative vs depressive symptoms. He did not show any improvement in his negative symptoms such as avolition, anhedonia, apathy, alogia, asociality. Comprehensive reassessment, including clinical evaluation and Quantitative Electroencephalography (qEEG), showed findings such as frontal dysfunction and raised the possibility of secondary negative symptoms related to antipsychotic treatment rather than a primary deficit state. Based on this, pharmacotherapy was optimised by switching from high-dose risperidone to amisulpride and augmenting with transcranial Direct Current Stimulation (tDCS) targeting the left dorsolateral prefrontal cortex. Significant improvement was observed in affect, speech output, social interaction, and Cognitive Performance (CPT), supported by normalisation of electrophysiological markers. This case highlights the importance of distinguishing primary and secondary negative symptoms and suggests a potential role for qEEG in guiding pharmacological and other interventions. This case study challenges the conventional wisdom that uptitrating antipsychotics in incomplete remission of psychotic illness can be counterproductive leading to secondary negative symptoms. In such cases adequacy of dopamine blockade can be assessed by qEEG.

Surgical Repositioning and Adjunctive Injectable Platelet-rich Fibrin for Severe Intrusive Luxation of Permanent Maxillary Incisors: A One-year Follow-up Case Report

V Jeevitha, S Manoj, Pooja Prabhu, R Vaishnavi, Cherry Biyani

Intrusive Luxation (IL) is one of the most severe forms of traumatic dental injuries, causing extensive damage to the Periodontal Ligament (PDL), pulp, and supporting alveolar bone. Management of severe intrusion in mature permanent teeth remains challenging because of complications such as pulp necrosis, inflammatory root resorption, replacement resorption, and ankylosis. Injectable Platelet-Rich Fibrin (I-PRF), an autologous platelet concentrate, has gained attention because of its regenerative potential and ability to promote soft and hard-tissue healing. The present case report describes the multidisciplinary management of severe traumatic intrusion of the maxillary incisors in a 36-year-old male patient following an accidental fall. Clinical and radiographic examination revealed severe intrusion (>7 mm) of teeth 12 and 21, accompanied by uncomplicated crown fractures and subluxation of tooth 11. Owing to the severity of intrusion and complete root development, immediate surgical repositioning was performed and stabilised using a flexible fibre splint. Root canal treatment was initiated one week after surgical repositioning as a preventive (prophylactic) intervention in accordance with the International Association of Dental Traumatology (IADT) 2020 guidelines for mature intruded teeth, owing to the high-risk of pulp necrosis and inflammatory external root resorption. Calcium hydroxide was used as an intracanal medicament. To enhance periodontal healing and PDL regeneration, freshly prepared I-PRF was aspirated immediately after centrifugation into a sterile syringe and slowly administered through the gingival sulcus surrounding the affected teeth under aseptic conditions using 30 Gauge needle. The injections were performed once weekly for four consecutive weeks. At the one-year follow-up, clinical and radiographic evaluation demonstrated satisfactory periodontal and periapical healing without evidence of root resorption or ankylosis. The patient remained asymptomatic with satisfactory functional and aesthetic outcomes. This case highlights the potential role of I-PRF as an adjunctive regenerative therapy in the management of severe IL.

Management of Post-traumatic Arthritis (Chronic Foot Pain) with Ayurvedic Intervention: A Case Report

Sneha Santosh Banchhade, Manisha Mukesh Thakare, Sheetal Uttam Roman

Post-traumatic arthritis accounts for 12% of osteoarthritis cases, with conventional management focusing primarily on symptomatic relief. The present case demonstrates significant effectiveness of integrated Ayurvedic management in chronic post-traumatic foot pain with the combination of internal medications and Jalaukavacharana (leech therapy) addressing both local and systemic aspects, offering a promising alternative for managing chronic post-traumatic arthritis. A 35-year-old male presented with chronic left foot pain, stiffness, and cold sensitivity persisting for 2.5 years following an accidental fall. Conventional treatments provided only temporary relief. Clinical examination revealed plantar tenderness, restricted foot movements, morning stiffness, and Visual Analogue Scale (VAS) pain rating of 8/10 with dorsiflexion limited to 10°. Based on Ayurvedic diagnosis of vatarakta, the patient received oral medications (Kaishor Guggulu, Amrutadi Guggulu, Eranda Taila, and Guduchi decoction) and Jalaukavacharana (leech therapy) on the ankle joint. After 1.5 months of treatment, complete symptom resolution was achieved with VAS decreasing to 0/10, elimination of morning stiffness, improved dorsiflexion to 20°, normal walking without pain, and no cold sensitivity. The successful outcomes highlight the potential of traditional Ayurvedic approaches in addressing complex musculoskeletal conditions.

Mixed Cryoglobulinaemic Glomerulonephritis Type II in the Setting of Rheumatoid Arthritis and Chronic Hepatitis B: A Case Report

Vijay Jeyachandran, Ram Pukar Bharat, Kapil Sejpal, Manish Balwani

Mixed (Type II) cryoglobulinaemia is a systemic immune-complex vasculitis often linked to chronic infections especially Hepatitis C Virus (HCV) or autoimmune disease. Chronic Hepatitis B Virus (HBV) associated cryoglobulinaemic is rare, and its coexistence with Rheumatoid Arthritis (RA) is especially unusual. The authors report a 45-year-old female with long-standing seropositive RA on methotrexate and chronic HBV presented with fatigue, arthralgias, palpable purpura on her legs, and new-onset oedema. Laboratory workup showed elevated serum creatinine, nephrotic-range proteinuria, hypoalbuminaemia, haematuria, and a positive Rheumatoid Factor (RF). Antinuclear Antibody (ANA) and Anti-double-stranded deoxyribonucleic acid (anti-dsDNA) were negative. Complement levels i.e., Component 3 (C3) moderately reduced, Component 4 (C4) severely low, and positive mixed cryoglobulins with a high Immunoglobulin M (IgM) cryocrit. HCV and Human Immunodeficiency Virus (HIV) serologies were negative. Renal biopsy showed a diffuse endocapillary proliferative, Membranoproliferative Glomerulonephritis (MPGN) with hyaline “pseudothrombi.” Immunofluorescence disclosed granular capillary wall deposits of IgM, Immunoglobulin G (IgG) (both kappa and lambda), C3, and C1q, consistent with Type II cryoglobulinaemic GN. Treatment included high-dose corticosteroids and HBV antiviral drugs. Despite antiviral therapy and plasmapheresis, renal failure progressed requiring haemodialysis, and the patient died within three weeks due to disease-related complications and nosocomial infection. The present case highlights that RA and HBV can together underlie cryoglobulinaemic GN. Early recognition using RF, complement, and cryocrit testing and biopsy-guided therapy are critical. Purpura, positive RF, and low C4/C3 should prompt consideration of mixed cryoglobulinaemic vasculitis.

Real time Imaging (Intraoperative Doppler) in Median Arcuate Ligament Syndrome Management: A Case Report

Prem Shah, Haryax Pathak, Bhasha Vaidya

Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to coeliac trunk compression, typically affecting middle-aged women. Surgical decompression is the gold standard, but technical failure or recurrence poses a significant challenge. The authors report a rare case of recurrent MALS in a 31-year-old male who presented with severe, persistent abdominal pain 1.5 years after an initial laparoscopic ligament release. Preoperative Computed Tomography (CT) and Doppler Ultrasound (DUS) confirmed the recurrence, showing coeliac trunk kinking and a markedly elevated Peak Systolic Velocity (PSV) of 235 cm/sec. Due to dense adhesions from the previous procedure, the patient underwent a re-do surgery via open laparotomy. The key to successful re-operation was the use of intraoperative DUS to precisely localise the coeliac trunk amidst fibrotic tissue. Following complete surgical decompression of the artery, the intraoperative PSV immediately dropped to 80 cm/sec, confirming adequate flow restoration. The patient experienced complete, sustained symptom resolution at the 6-month follow-up. The present case highlights that intraoperative DUS is a vital tool for ensuring the completeness of coeliac axis decompression, especially in complex, re-operative settings where persistent adhesions obscure anatomical planes.

Spontaneous Endometrial Cast Expulsion in Membranous Dysmenorrhoea: A Case Report

Swapnali Sansare, Aneesha Nallapati

Membranous dysmenorrhoea is a rare gynaecological condition characterised by the expulsion of the endometrium as a single intact cast that retains the shape of the uterine cavity. The authors report the case of a 36-year-old multiparous female who presented with a history of heavy and prolonged menstrual bleeding associated with the passage of tissue per vaginum for 7-8 months. She had a preceding history of amenorrhoea for six months and pregnancy was excluded. Clinical examination revealed expulsion of a membranous structure through the cervix; it was removed, resulting in immediate symptomatic relief. Ultrasonography (USG) demonstrated a thickened endometrium with no focal uterine or adnexal pathology. Histopathological examination confirmed the diagnosis, showing pre-decidualised endometrial tissue with dilated, congested vessels. The patient remained asymptomatic on follow-up over three menstrual cycles. Membranous dysmenorrhoea remains a poorly understood entity with limited reported cases, often associated with hormonal influences, though spontaneous occurrences, as seen in the present case, are uncommon. Recognition of this condition is important to differentiate it from other causes of abnormal uterine bleeding and to avoid unnecessary interventions.

Ultrasound-guided Transversus Abdominis Plane Block as Rescue Analgesia following Failed Spinal Anaesthesia in a High Risk Patient: A Case Report

Karuna Taksande, Pardhasaradhi Kapusetti

Opioid-free perioperative analgesia plays a crucial role in patients with significant co-morbidities and a prior history of opioid-related respiratory depression. Achieving adequate analgesia using regional anaesthesia techniques is of importance in such cases. The present case report details the anaesthetic management of a 58-year-old male with a history of obesity, Obstructive Sleep Apnoea (OSA), stage 4 Chronic Kidney Disease (CKD), hypertension and opioid-induced respiratory depression who was scheduled to have a laparoscopic hernia repair. Spinal anaesthesia was chosen as the anaesthetic modality to avoid opioid usage. Inadequate neuraxial blockade necessitated General Anaesthesia (GA). The goal of an opioid-free anaesthetic technique was accomplished by using dexmedetomidine infusion and an ultrasound-guided bilateral Transversus Abdominis Plane Block (TAPB) for perioperative analgesia. The patient remained haemodynamically stable throughout the surgery without requiring vasopressors or opioids. Pain scores remained low in the recovery room with analgesia provided by paracetamol. There were no episodes of respiratory depression, sedation, nausea, or vomiting. The present case evidences the efficiency of ultrasound-guided TAPB plus dexmedetomidine as a safe opioid-sparing strategy after failed Neuraxial Anaesthesia (NA) in high risk patients undergoing laparoscopic abdominal surgery.

Synergistic Approach to Diastema Closure using Frenectomy and Restorative Procedures: A Case Report

Varshini Raman, Deepak Moses Ravindran, Divya Kumar, Lekha Ashokumar, SK Balaji

Midline diastema, the space between maxillary central incisors, is a common aesthetic concern with multifactorial aetiology. A 24-year-old female presented with a midline diastema caused by a high papillary frenum, contributing to multifactorial aesthetic disharmony. This created aesthetic concerns and anterior asymmetry. Digital diagnostics, including intraoral scanning and virtual smile design, supported accurate assessment and planning. Treatment involved a diode laser frenectomy to remove the high frenal attachment and restore gingival zenith harmony. This was followed by diastema closure using a digitally guided injectable resin composite technique. A 3D-printed mock-up and customised injection template helped achieve precise morphology, controlled resin placement, and strong aesthetic results while preserving tooth structure. Postoperative review at three months showed smooth healing, high patient satisfaction, and stable functional and aesthetic outcomes with no relapse. This case highlights the combined benefits of laser-assisted surgery and digitally guided restorative methods. The approach offers a minimally invasive, predictable, and refined solution for treating diastema linked to high frenal attachment.

Perioperative Anaesthetic Considerations in Neurofibromatosis Type 1 with Periampullary Neuroendocrine Tumour Undergoing Whipple’s Procedure: A Case Report

Abhigna Gummalla, Vivek Chakole, Bhagyesh Sapkale

Neurofibromatosis type 1 (NF1) is an autosomal dominant multisystem disorder which is associated with benign and malignant tumours, skeletal deformities, airway lesions as well as endocrine abnormalities such as phaeochromocytoma posing significant anaesthetic challenges. Gastrointestinal involvement usually manifesting as periampullary Neuroendocrine Tumours (NETs), although uncommon may also require major surgical intervention. The present case report describes a 65-year-old male having known NF1 diagnosed with a well-differentiated periampullary NET scheduled for elective pancreaticoduodenectomy. Preoperative evaluation further showed multiple cutaneous, intraoral neurofibromas without any clinical evidence of difficult airway or carcinoid syndrome. Cardiovascular assessment was also unremarkable as well as biochemical parameters were within acceptable limits. Anticipating potential airway and haemodynamic concerns, invasive arterial and central venous monitoring were instituted and combined general anaesthesia along with epidural analgesia was administered. The intraoperative course of the patient remained haemodynamically stable also recovery was uneventful. The case highlights the importance of meticulous preoperative assessment, vigilance for occult endocrine pathology as well as individualised perioperative planning to ensure safe anaesthetic management in NF1 patients who are undergoing major abdominal surgery.

Bilateral Punctal Stenosis Following Netarsudil Therapy in Fuchs Endothelial Dystrophy: A Case Report

Netarsudil, a Rho-Associated Protein Kinase (ROCK) inhibitor, is being increasingly used in the management of glaucoma and corneal endothelial disorders. Although conjunctival hyperaemia and corneal verticillata are well-recognised adverse effects, lacrimal drainage abnormalities have rarely been reported. The authors described a 52-year-old male with Fuchs endothelial dystrophy who developed progressive bilateral epiphora and punctal stenosis following initiation of topical Netarsudil 0.02% eye drops. The patient developed worsening watering and redness approximately four months after initiation of therapy. Slit-lamp examination revealed bilateral conjunctival congestion, corneal guttae with stromal oedema and cicatricial narrowing of both upper and lower puncta. Specular microscopy demonstrated reduced endothelial cell density bilaterally, while anterior segment optical coherence tomography showed increased central corneal thickness. Other causes of acquired punctal stenosis including trauma, autoimmune disease, cicatrising conjunctivitis, Stevens-Johnson syndrome and alternative medication-induced aetiologies were excluded clinically. Despite discontinuation of Netarsudil and initiation of preservative-free lubricants, punctal fibrosis persisted, necessitating bilateral punctoplasty with symptomatic improvement on follow-up. The temporal relationship with drug initiation, exclusion of alternate aetiologies and stabilisation after discontinuation supported a probable adverse drug reaction according to World Health Organisation – Uppsala Monitoring Centre (WHO-UMC) causality assessment criteria. The present case highlights a rare but clinically significant adverse effect associated with Netarsudil therapy and emphasises the importance of early recognition and punctal evaluation in patients receiving prolonged ROCK inhibitor therapy.

Integrated Approach of Physiotherapy with Ayurveda in Management of Tethered Cord Syndrome: A Case Report

Tethered Cord Syndrome (TCS) is a rare neurological condition caused by pathological anchoring of the spinal cord, resulting in abnormal stretching and progressive neurological deficits. Although TCS is commonly diagnosed in childhood, adult-onset cases present diagnostic and therapeutic challenges due to delayed recognition and varied clinical manifestations. The present case report describes a 38-year-old male presenting with chronic low back pain, progressive lower limb weakness and bilateral lower limb tremors, leading to impaired functional mobility and reduced quality of life. Magnetic Resonance Imaging (MRI) revealed thickening of the filum terminale, confirming the diagnosis of adult TCS. As the patient preferred conservative care, a 4-week integrated treatment program combining structured physiotherapy and Ayurveda interventions was implemented. Physiotherapy focused on pain relief, muscle strengthening, flexibility and functional rehabilitation, while Ayurveda therapies aimed to enhance neuromuscular balance and provide symptomatic relief. Clinical progress was monitored through periodic neurological and functional assessments. Following the intervention, the patient demonstrated significant improvements in pain intensity, muscle strength, lower limb tremors and overall functional performance, with no adverse effects reported. The present case suggests that integrative, non surgical management may be beneficial in adult TCS patients opting for conservative treatment and highlights the need for further controlled studies.

Low-dose Mirtazapine Induced Hyponatraemia with Probable Syndrome of Inappropriate Antidiuretic Hormone Secretion in an Elderly Male: A Case Report

Hyponatraemia is a common and potentially serious condition in elderly patients. It is associated with significant morbidity including delirium, falls and prolonged hospitalisation. Antidepressant induced hyponatraemia is a recognised adverse effect, most commonly attributed to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Although Mirtazapine is often considered a safer alternative to other antidepressant-induced hyponatraemia, reports of SIADH related to its use remain limited. We report the case of a 72-year-old male with dementia and Behavioural and Psychological Symptoms of Dementia (BPSD) who developed symptomatic hyponatraemia 15 days after initiation of mirtazapine (3.75 mg/day). Evaluation revealed hypotonic hyponatraemia with a serum sodium level of 122 mEq/L, serum osmolality of 253 mOsm/kg, urine spot sodium of 31.1 mEq/L and clinical euvolaemia. Alternative causes of hyponatraemia and SIADH including adrenal insufficiency, hypothyroidism, renal dysfunction, cardiac failure, malignancy, respiratory disease, HIV infection and acute intracranial pathology were excluded. Mirtazapine was stopped while concomitant medications were continued unchanged along with fluid restriction and high-salt diet which resulted in improvement of serum sodium levels and resolution of hyponatraemia associated delirium within three days. The likelihood of Mirtazapine use causing hyponatraemia was probable (score 7) as per the Naranjo Adverse drug reaction probability scale. This case describes probable mirtazapine-associated SIADH occurring at a low dose of 3.75 mg/day in an elderly male and highlights the importance of baseline evaluation and regular monitoring of serum sodium along with vigilance for clinical signs of hyponatraemia in elderly patients and those with risk factors receiving mirtazapine although mirtazapine is considered a safer alternative for other antidepressant-induced hyponatraemia.

Atypical Presentations of Paediatric Tuberculosis: A Series of Seven Cases from a Tertiary Care Centre in South India

Paediatric Tuberculosis (TB) remains one of the leading infectious causes of illness and death among children globally, with diverse clinical manifestations that often complicate diagnosis and management. This case series describes seven children aged nine months to 13 years who presented with atypical or extrapulmonary manifestations of TB at a tertiary care centre in South India. Diagnosis was based on a combination of clinical features, radiological findings, microbiological evidence (CBNAAT/GeneXpert, histopathology), and therapeutic response to Anti-Tubercular Therapy (ATT). The spectrum included Central Nervous System (CNS) tuberculoma presenting with seizures, calvarial TB with epidural extension, endobronchial TB mimicking acute severe asthma, tuberculous pleural effusion, pulmonary TB associated with Severe Acute Malnutrition (SAM), Pott’s disease with paravertebral abscess, and disseminated TB with hepatic abscesses in infancy. Microbiological confirmation was obtained in selected cases, while others required clinicoradiological correlation. All children showed clinical improvement following initiation of ATT, supported by nutritional rehabilitation, corticosteroids, or surgical intervention when indicated. This series highlights the broad clinical spectrum of paediatric TB and underscores the importance of high clinical suspicion and early imaging to prevent diagnostic delays and long-term sequelae.

Clinical Outcomes and Technical Considerations in the Surgical and Endovascular Management of Ascending Aortic and Aortic Arch Aneurysms: A Case Series

Aneurysms of the ascending aorta and aortic arch represent one of the most surgically challenging domains in cardiothoracic practice. Contemporary management requires a hybrid strategy integrating conventional open surgery, staged procedures, and Thoracic Endovascular Aortic Repair (TEVAR). This case series presents the institutional experience with six patients who underwent diverse surgical and endovascular interventions for aortic aneurysmal disease, highlighting surgical technique, perioperative complexity, and clinical outcomes. Six patients (age range 30-65 years; four males, two females) presented with aortic pathologies including ascending aortic aneurysm, aortic arch aneurysm, descending thoracic aortic aneurysm, and chronic Type B aortic dissection. Procedures included Aortic Valve Replacement (AVR) with ascending aorta replacement (Dacron graft), total arch replacement with the elephant trunk technique followed by staged TEVAR, carotid artery debranching with staged TEVAR, hemiarch replacement with innominate artery re-implantation, and emergency aortic debranching with TEVAR for complicated dissection. Five of six patients were discharged in haemodynamically stable condition with satisfactory postoperative recovery and continued well-being confirmed at outpatient follow-up. One patient died due to retrograde Type A aortic dissection with coronary extension and cardiac tamponade on postoperative day 10. A multidisciplinary, heart-team-based approach with careful patient selection, staged procedural planning, and individualised intraoperative strategy achieves acceptable outcomes even in complex aortic pathologies. TEVAR combined with surgical debranching provides a viable hybrid alternative in high-risk patients. Mortality risk persists in retrograde dissection, underscoring the need for vigilant surveillance.

Clinical Spectrum and Severity of Mycoplasma pneumoniae Infection in Children From a Rural Tertiary Centre: A Case Series

Mycoplasma pneumoniae, a common cause of Community Acquired Pneumonia (CAP) in children is traditionally considered a mild illness. Increasing evidence suggests broader clinical spectrum with significant respiratory and extrapulmonary involvement. This case series consists of 20 hospitalised children with laboratory-confirmed M. pneumoniae infection at rural tertiary care centre. Diagnosis was confirmed using respiratory Real-time Polymerase Chain Reaction (RT-PCR) in all patients, with serology performed in four children, all of whom tested positive. The median age observed was six years (IQR 2.5-9 years) with 12 males and 8 females. Six children (30%) were aged between six months-five years, 10 (50%) were 6-10 years and four above 10 years. RT-PCR for Mycoplasma pneumoniae was positive in all patients (100%). Fever (19/20) and cough (20/20) were the most common presenting symptoms. Extrapulmonary manifestations included dermatological and haematological involvement in 3/20 children each, and musculoskeletal involvement in 1/20. Disease severity was mild in 7/20 children, moderate in 6/20, severe in 6/20, and critical in 1/20. Eighteen children received macrolide therapy, of whom 6/18 required escalation to doxycycline. Respiratory support was required in 13/20 children, including oxygen therapy (6/20), non-invasive ventilation (6/20), and mechanical ventilation (1/20). Inflammatory markers were elevated, with a median C-reactive Protein (CRP) of 29 mg/L (IQR 5-40), while low-to-normal leukocyte counts were commonly observed. Nineteen children recovered and were discharged, while one child died due to refractory shock and respiratory failure. In resource limited settings where access to rapid molecular diagnostics may be constrained, recognition of indirect clinical and laboratory clues may aid early suspicion and management.

Motorcycle Chain Entrapment Injuries to the Hand during Routine Maintenance: A Case Series

Motorcycle-related hand injuries are commonly associated with road traffic collisions; however, injuries sustained during routine chain cleaning and lubrication remain underreported despite being entirely preventable. This case series included 14 consecutive patients treated between April 2025 and December 2025. All patients were male, with a mean age of 29.6 ± 10.8 years (range 17-55 years). The dominant hand was involved in 9 (64.3%) patients, while injury laterality showed right-hand involvement in 10 (71.4%) and left-hand involvement in 4 (28.6%) patients. The index finger was most commonly affected in 5 (35.7%) cases, followed by the middle finger in 4 (28.6%) cases. All 14 (100%) patients presented with contaminated wounds. Definitive management included primary closure in 4 (28.6%) patients, local flap reconstruction in 3 (21.4%), split-thickness skin grafting in 1 (7.1%), tendon repair in 2 (14.3%), Kirschner wire fixation in 2 (14.3%), and revision amputation in 2 (14.3%). Postoperatively, superficial wound infection occurred in 2 (14.3%) patients and resolved with conservative management, while mild residual stiffness was observed in 3 (21.4%) patients. No cases of deep infection, osteomyelitis, flap or graft failure, or major limb compromise were noted. Complete wound healing was achieved in all patients. Motorcycle chain entrapment injuries represent a preventable yet clinically significant cause of hand trauma in young males. Early irrigation, prompt debridement, and defect- specific reconstruction are associated with favourable outcomes and minimal complications.

The Role of High-resolution Nerve Ultrasonography in Atypical Presentations of Hansen’s Disease: A Case Series

Hansen disease is a chronic infectious disease with a predilection for peripheral nerves. Clinical examination may underestimate the extent of nerve involvement, particularly in patients with suspected mononeuropathy or atypical presentations. This case series describes five cases of Hansen disease in which high-frequency ultrasonography contributed to diagnosis and disease mapping. Patients were referred for ultrasound evaluation either with suspected involvement of a single peripheral nerve or with an alternative clinical diagnosis. High-Resolution Ultrasound (HRUS) was performed using a Philips EPIQ machine with an 18 MHz linear transducer, assessing the symptomatic nerve and additional accessible peripheral nerves bilaterally. Sonographic features including nerve thickening, altered fascicular pattern, hypoechogenicity, focal or diffuse enlargement were recorded. Assessment of the nerves was done on long and short axis imaging of each nerve and single measurements of Cross-sectional Area (CSA) were taken at the point of maximum nerve thickening by a single observer. Ultrasound revealed additional clinically unsuspected nerve thickening in three cases and redirected clinical suspicion toward Hansen disease in two cases initially thought to have other pathology. This series highlights high-frequency ultrasonography as a useful, non-invasive adjunct for mapping peripheral nerve involvement in Hansen disease and for raising diagnostic suspicion in atypical or clinically underestimated presentation. Although the World Health Organisation (WHO) has prescribed three diagnostic cardinal signs which include definitive loss of sensation in a pale or reddish skin patch, thickened or enlarged peripheral nerves with associated sensory or motor loss, and microscopic identification of Acid-Fast Bacilli (AFB) in a slit-skin smear, in tertiary and specialised medical settings, the absolute confirmation of Hansen’s Disease (HD) relies on histopathological examination of a skin biopsy. A significant advantage of HRUS is its non-invasive nature. It is also useful in cases of Pure Neural Leprosy (PNL) where patients do not have skin lesions and negative skin smears, HRUS allows for diagnosis by documenting absolute nerve asymmetry and thickening especially in cases where an invasive nerve biopsy could cause permanent nerve damage. HRUS is also useful to identify early subclinical structural nerve abnormalities, asymmetrical cross-sectional enlargement, and internal fascicular changes before nerve damage translates into sensory or motor loss which can be identified during a routine clinical exam. Ultrasound also helps visualise the exact location of nerve thickening and can differentiate it from other aetiologies such as entrapment neuropathy.

Concomitant Presentation of Central Giant Cell Granulomas in the Anterior Mandible and Palate of a Male Patient: A Clinical Image

Radhika Sasikumar, Amita Aditya, Vrinda Rajagopal, Sunil Mishra

Image of Bifid Uvula in an Asymptomatic Patient

Khushbu Prasad, Shraddha Jain, Megha Kawale, Chandraveer Singh, Pragati Shikha

Advanced Double-headed Pterygium with Visual Axis Involvement: A Rare Clinical Presentation

Mohammed Arif Kaderi, Sachin Vishwanath Daigavane

Facial Angiofibromas as a Diagnostic Clue to Tuberous Sclerosis in a Child: Images in Medicine

Prachi Vijay Warukar, Trupti Thakre

Unmasking Hidden Pathology of Odontoma, Supernumerary Teeth and Cyst through the Lens of CBCT in a Young Child with Delayed Eruption: A Clinical Image

Umapathy Thimmegowda, Nidhi S Shetty, Sanveed Sunil Marathe

Fournier’s Gangrene in a Case of Cirrhosis

A 42-year-old male, chronic alcoholic , diagnosed case of alcoholic cirrhosis at the age of 34 years with small oesophageal varices on medical management with beta blocker (tablet carvedilol 3.125 mg twice a day) and diuretics (tablet lasilactone 20/50 one tablet once a day) since eight years, with last intake of alcohol eight years back, presented to this hospital with complaints of severe pain with swelling over both testis as shown in [Table/Fig-1a,b]. Patient was also complaining of fever since seven days which was acute in onset and progressive in nature, continuous type of fever which was associated with generalised weakness.

Letter to the Editor: Role of Early Imaging in a Case of Ludwig’s Angina

Ankita Swarnkar, Barathi Raja Kuppusami

Dear Editor, Ludwig’s angina is a rapidly progressive deep neck space infection with a high risk of airway compromise (1).

Correspondence on Alterations in Electrolyte and Renal Profile in Chronic Kidney Disease Patients with Co-existing Cardiovascular Complications: A cross-sectional Study

Arti Mihir Hajarnavis, Vrushali Anupkumar Rawool

The Adaptation Paradox Beyond NEET-UG Scores: A Cross-sectional Study of Post-admission Adaptation and Academic Performance among Medical Undergraduates in North India

Neeraj Raizada, Mudit Sharma, Monika Gupta, Vishal Bankwar, Shubham Sharma

Introduction: National Eligibility-cum-Entrance Test for Undergraduates (NEET-UG) score provides an entry-level marker of academic preparedness for Bachelor of Medicine and Bachelor of Surgery (MBBS) students, but academic performance after admission may also depend on study behaviour, peer context and self-regulation within the medical-college environment. Aim: To assess factors associated with satisfactory academic performance among MBBS students, with particular focus on NEET-UG category, study pattern, academic peer orientation and peer-related academic resilience. Materials and Methods: This cross-sectional study was conducted among 358 MBBS students from second year onward at the Department of Community Medicine, Jaipur National University Institute of Medical Sciences and Research Centre, Jaipur, Rajasthan, India between January 2025 and March 2025. Data were collected using an anonymous, structured, self-administered online questionnaire assessing NEET-UG category, most recent university examination performance, study pattern, residence, alcohol/smoking status, psychological distress indicators, academic peer orientation and peer-related academic resilience. Satisfactory academic performance was defined as a self-reported score of ≥60% in the most recent university examination. Associations were assessed using a Chi-square test and multivariable logistic regression. Adjusted Odds Ratios (aOR) with 95% Confidence Intervals (CI) were reported. Results: Overall, 243 students (67.9%) reported satisfactory academic performance. On adjusted analysis, NEET-UG category, gender, study pattern and peer-related academic resilience remained independently associated with satisfactory performance. Compared with the <250/not disclosed NEET-UG category, higher odds were observed among students scoring 250-349 (aOR=2.14; 95% CI: 1.21–3.78; p=0.009) and ≥350 (aOR=2.22; 95% CI: 1.19-4.16; p=0.012). Female students had higher odds of satisfactory performance than male students (aOR=2.05; 95% CI: 1.26–3.33; p=0.004). Students reporting ≥3 hours/day or a need-based variable study pattern had higher odds than those reporting <3 hours/day (aOR=1.71; 95% CI: 1.04-2.80; p=0.033). Peer-related academic resilience was independently associated with satisfactory performance (aOR=1.83; 95% CI: 1.13-2.97; p=0.015), while academic peer orientation alone was not. Conclusion: Academic performance among MBBS students was associated with both entry-level academic profile and post-admission adaptation factors. Study pattern and peer-related academic resilience appear important beyond NEET-UG category alone.

Association of Posterior Capsular Opacification with Different Type of Intraocular Lenses: A Retrospective Study from Gujarat, India

Shriya Ashish Kotak, Jane Manishkumar Mehta, Samir Bhavsar, Rashi Kochar

Introduction: Posterior Capsular Opacification (PCO) is the most common complication following cataract surgery, caused by the proliferation and migration of Lens Epithelial Cells (LECs). Though surgical techniques aim to minimise cortical remnants, the physical and chemical properties of Implanted Intraocular Lenses (IOLs), are increasingly recognised as the primary determinants of capsular clarity. Consequently, identifying specific lens configurations that actively inhibit the cellular mechanisms driving PCO is crucial for minimising secondary laser interventions. Aim: To find the prevalence of PCO in patients coming to eye OPD at a tertiary care hospital and to compare and associate the prevalence of PCO with the type of IOL implanted and other ocular parameters. Materials and Methods: A retrospective study was conducted at Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat, India analysing the records of 270 patients who underwent cataract surgery with IOL implantation followed by an Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy. Operative and clinical data such as type of cataract surgery, design and material of IOL and co-morbidities were retrieved from medical records. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26.0, using descriptive statistics and the Chi-square test to evaluate associations between categorical variables. Result: The overall prevalence of PCO in this study was 44.4% (n=120/270). The analysis revealed a statistically significant association between the occurrence of PCO and both the material composition and optic design of the implanted IOL. Patients implanted with hydrophilic IOLs exhibited a significantly higher likelihood of developing PCO compared to those receiving hydrophobic IOLs {71.4% (n=60/84) vs 32.3% (n=60/186)}. Similarly, the occurrence of PCO in eyes with round-edged IOLs was markedly greater than in those with square-edged designs {86.7% (n=104/120) vs 13.3% (n=16/120)}. Conclusion: The study revealed a strong association between PCO, material, and IOL design. Specifically, hydrophilic IOLs and those with round-edged were more likely to result in PCO compared to hydrophobic and square-edged IOLs. On the other hand, factors such as patient age, presence of diabetes mellitus, and the type of cataract surgery (phacoemulsification versus manual small incision cataract surgery) showed no significant influence on PCO development.

Pattern of Thyroid Disorders: A Cross-sectional Study in a Tertiary Care Hospital of Coastal Odisha, India

Ikhita Misra, Lalit Mohan Sika, Itishree Prusty, Ishani Rath

Introduction: Thyroid disorders have been reported to be highly prevalent in India, particularly in coastal regions where iodine excess may contribute to structural and functional abnormalities. Data from Ear, Nose and Throat (ENT) outpatient settings in eastern India remain limited. Aim: To evaluate the demographic profile, clinical spectrum, and biochemical patterns of thyroid dysfunction among patients presenting to the Otorhinolaryngology outpatient department of a tertiary care hospital in coastal Odisha, India. Materials and Methods: This cross-sectional study was conducted in the Department of Otorhinolaryngology of Sri Jagannatha Medical College and Hospital (SJMCH), Puri, Odisha, India. The study enrolled 213 consecutive patients with clinical or biochemical evidence of thyroid dysfunction over one year. Detailed history, examination, serum Thyroid Stimulating Hormone (TSH), free Triiodothyronine (T3), Tetraiodothyronine (T4) {Chemiluminescence Immunoassay (CLIA)}, Ultrasonography (USG), and Fine Needle Aspiration Cytology (FNAC) (where indicated) were performed. Patients were classified as euthyroid, overt/subclinical hypo- or hyperthyroid using standard reference ranges. Statistical analysis used Python 3.12 (Python Software Foundation) with the SciPy (version 1.11). Results: The cohort was 88.7% female (mean age 35.14±13.54 years). Euthyroid status predominated (n=139, 65.3%), followed by hypothyroidism (n=50, 23.5%) and hyperthyroidism (n=24, 11.3%). Goitre was present in 158 (74.2%) patients including diffuse goitre (n=44, 20.7%), colloid cyst (n=38, 17.8%), and solitary thyroid nodule (n=30, 14.1%). Hormone levels differed significantly across groups (p-value <0.0001). A significant difference in age group was observed across the three thyroid function groups (p-value=0.0415); no significant differences were found by gender (p-value= 0.630). Conclusion: Euthyroid structural thyroid disorders constituted the majority of ENT referrals in coastal Odisha. Female predominance and high goitre rates highlight the need for integrated ENT-endocrine evaluation and region-specific screening strategies.

Prevalence and Predictors of Patent Ductus Arteriosus on Day 3 and Day 7 in Preterm Neonates: A Prospective Observational Study

Avinash Shukla, Amar Taksande

Introduction: Patent Ductus Arteriosus (PDA) refers to a persistent vascular connection between the pulmonary artery and the aorta. In a healthy newborn, this foetal vessel typically undergoes functional closure shortly after birth, followed by anatomical sealing. If the shunting is substantial, it can lead to significant haemodynamic instability. PDA is a common cardiovascular condition seen in neonates, particularly in preterm infants. As preterm birth is a significant contributor to neonatal mortality in India and other low-middle-income countries, understanding how PDA contributes to this burden is essential. By limiting the study to one specific rural hospital, the findings are highly relevant for similar settings and may serve as a baseline for future larger-scale or multicentric studies. Aim: To determine the prevalence of PDA on day 3 and day 7 of life in preterm neonates admitted to a rural neonatal intensive care unit and to assess its determinants, particularly gestational age and birth weight. Materials and Methods: The present prospective observational study was conducted in a rural tertiary care hospital, Neonatal Intensive Care Unit (NICU), Department of Paediatrics, at JNMC and AVBRH, Sawangi (Meghe), Wardha, Maharashtra, India from January 2023 to September 2024. A total of 100 preterm neonates with gestational age up to 34 weeks admitted to the neonatal intensive care unit were included. Echocardiographic assessment was performed on day 3 of life and repeated on day 7 in neonates with PDA. Determinants such as gestational age and birth weight were analysed. Data were analysed using statistical software, and Chi-square test was used to find association of gestational age and birth weight with PDA. A p-value less than 0.05 was considered statistically significant. Results: On day 3 of life, PDA was detected in 76% of preterm neonates. On repeat echocardiography on day 7, persistence of PDA was observed in 27% of neonates. Lower gestational age and lower birth weight were significantly associated with persistence of PDA, indicating prematurity as a major determinant. Conclusion: The present study highlights PDA as a prevalent condition contributing significantly to early complications and death. The most affected infants were those born before 30 weeks of gestation and those with extremely low birth weights.

CBCT Analysis of Maxillary and Sphenoidal Sinuses for Forensic Age and Gender Estimation: A Retrospective Study

Amruta J Potekar, Rashmi Venkatesh, Chandramani B More, Deepa J Patil

Introduction: Age and gender estimation are fundamental in forensic identification, especially in crime investigation, cases of mass disasters and unidentified body remains. Paranasal sinuses, especially maxillary and sphenoidal, are unique, durable, and sexually dimorphic and well-protected within skull, resistant to trauma and decomposition. Cone Beam Computed Tomography (CBCT) enables precise Three-dimensional (3D) morphometric analysis of these anatomical structures, making them valuable markers for forensic age and gender determination. Aim: To evaluate the morphological (volumetric) characteristics of the maxillary and sphenoidal sinuses using CBCT to assess their potential in forensic age and gender estimation. Materials and Methods: The present Institutional-based retrospective study was conducted between September 2025 to November 2025 on CBCT archives from Department of Oral Medicine and Radiology, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India. CBCT Digital Imaging and Communications in Medicine (DICOM) files of maxilla/both arches covering maxillary and sphenoidal sinus was selected for analysis. Total CBCT scans of 142 individuals aged 21-75 years were analysed and volumetric measurements of bilateral maxillary and sphenoidal sinus were recorded by semi-automatic segmentation method using 3D Slicer software and statistically analysed to determine correlations with age and gender. Inclusion and exclusion criteria were strictly applied to ensure sample consistency. For statistical analysis Chi-square test, Mann-Whitney, Kruskal-Wallis tests and Logistic regression analysis were done, p-values less than 0.05 were regarded as statistically significant. Results: Significant variations in sinus dimensions were observed between different genders and age groups. The median volumes of the maxillary sinus (males: 13,574.75 mm³; females: 11,210.30 mm³) and the sphenoidal sinus (males: 4,918.71 mm³; females: 4,017.23 mm³) were significantly greater in males than in females, with p-values of 0.023 and 0.02, respectively. Correlation analysis revealed a statistically significant (p-value <0.05) negative association between age and sinus volume, with advancing age linked to reduced volumes in the bilateral maxillary sinuses and the right sphenoidal sinus. Conclusion: The CBCT imaging of the maxillary and sphenoidal sinuses provides valuable morphometric data that can aid in forensic identification. These anatomical structures demonstrate measurable differences across age and gender, supporting their utility as supplementary tools in forensic profiling.

Effect of 2% Chlorhexidine Gel Medicament on Push-out Bond Strength of Epoxy Resin and Bioceramic Sealers in teeth extracted from Diabetics: An In-vitro Study

Introduction: Diabetes Mellitus (DM) impairs healing, immune function and dentin metabolism, potentially affecting adhesion. Chlorhexidine (CHX) gel is widely used as an intracanal medicament due to its sustained antimicrobial action; however, its influence on sealer bonding in diabetes-altered dentin is unclear. AH Plus® and BioRoot Root Canal Sealer (RCS) sealers are commonly used, yet their adhesion following 2% CHX application requires evaluation. Aim: To evaluate the effect of 2% CHX gel on the Push-Out Bond Strength (POBS) of AH Plus® and BioRoot RCS in teeth from diabetics. Materials and Methods: This in-vitro study was conducted at the Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. The study duration was three months, from June 2024 to August 2024. A total of 52 single-rooted teeth were prepared up to size 35/06 using Sodium Hypochlorite (NaOCl), sonic activation and Ethylenediaminetetraacetic Acid (EDTA). Specimens were divided into two groups: without 2% CHX (Group-1) and with 2% CHX (Group-2) gel applied for two weeks, followed by obturation using AH Plus® and BioRoot RCS. After two weeks, 2-mm mid-root slices were subjected to POBS testing and bond failure mode analysis. Results: One-way Analysis of Variance (ANOVA) showed a significant difference in POBS among the groups (F value 9.36, p-value <0.001). AH Plus® with 2% CHX showed the highest mean POBS (2.44±0.59 MPa), followed by AH Plus® without CHX (1.81±0.80 MPa). BioRoot RCS without CHX showed 1.27±0.59 MPa, while BioRoot RCS with 2% CHX showed 1.41±0.44 MPa. CHX increased Bond Strength (BS) for AH Plus®, while only a minimal increase was observed for BioRoot RCS. Post-hoc test illustrated that AH Plus® with 2% CHX (Group-2A: 2.44±0.58) demonstrated a significantly greater POBS compared to BioRoot RCS with 2% CHX (Group-2B: 1.41±0.44) (p-value <0.05). Conclusion: The AH Plus® showed higher POBS than BioRoot RCS, with 2% CHX significantly enhancing AH Plus® adhesion but not BioRoot RCS.

Design, Physicochemical Characterisation, and Printability Optimisation of a Novel Composite Biomaterial Ink for Extrusion-based 3D Bioprinting: An In-vitro Study

Parkavi Arumugam, R Srivarsan, Kaarthikeyan Gurumoorthy

Introduction: Three-Dimensional (3D) bioprinting enables patient-specific regenerative strategies for improved oral health and quality of life, with rational Biomaterial Ink (BI) design being critical for extrusion-based printing as composition governs printability, structural fidelity, and biological relevance. Systematic optimisation is essential for developing BI suitable for oral and craniofacial tissue defects. Aim: To develop a Polyethylene Glycol (PEG) - Polyethylene Glycol Diacrylate (PEGDA) -hydroxyapatite-collagen composite BI and to evaluate its feasibility for extrusion-based bioprinting through phase-wise printability assessment, followed by rheological and surface wettability characterisation. Materials and Methods: The present in-vitro study was conducted at the Department of Biomaterials, Saveetha Dental College, Chennai, Tamil Nadu, India, from February 2023 to March 2023. BI formulations were sequentially developed by varying PEG, PEGDA, hydroxyapatite, and collagen concentrations. Phase-wise printability screening identified formulations with stable extrusion and shape retention. Selected formulations underwent rheological evaluation, printability assessment and surface wettability by contact angle analysis. Contact angle data were analysed using One-way Analysis of Variance (ANOVA)and Tukey's post-hoc test (p<0.05). Rheological analysis was performed qualitatively. Results: Phase-wise optimisation identified BI-3 as exhibiting stable filament formation and favourable low-strain viscoelastic behaviour, supporting smooth extrusion and shape fidelity. Contact angle analysis revealed significant formulation-dependent differences in surface wettability (p<0.001). Conclusion: The study successfully developed and optimised a composite BI for extrusion-based bone bioprinting, with BI-3 demonstrating the most favourable printability, rheological, and wettability characteristics, supporting its potential for alveolar bone bioprinting applications.

Molecular Epidemiology of Emerging Subvariants of the SARS-CoV-2 Omicron Lineage: A Cross-sectional Study from Himachal Pradesh, India

Priyanka Rao, Sunite A Ganju, Lata R Chandel

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) shows continuous genetic variation, resulting in the emergence of multiple viral lineages worldwide. These mutations can influence viral transmissibility, pathogenic potential, and immune escape, resulting in changed disease pattern. Genomic surveillance allows systematic tracking of viral evolution and circulating variants; thus, monitoring is essential for informed public health planning and clinical preparedness. Aim: To detect the emergence of variants of Omicron lineage in the hilly state of Himachal Pradesh, India. Materials and Methods: This cross-sectional study was conducted at the Shri Lal Bahadur Shastri Medical College, Mandi, Himachal Pradesh, India from January 2024 to June 2024. All the SARS-CoV-2 positive samples with Ct value ≤30 received across the state from the four Virus Research and Diagnostic Laboratories (VRDLs) of the state were included. Ribonucleic acid (RNA) extraction was performed using the Q-Line Molecular Viral RNA Extraction Kit, and Whole Genome Sequencing (WGS) was carried out on the Oxford Nanopore MinION platform. Consensus sequences were generated using Medaka and Nanopolish for variant identification and phylogenetic analysis. All demographic and clinical data, like age, sex, clinical presentation, and vaccination status, were recorded and tabulated in Microsoft Excel 2021. The study focused on genomic sequences generated, and the data were presented as numbers and percentages. Results: A total of 30 SARS-CoV-2 positive samples were received. Among SARS-CoV-2 positive cases, adult females constituted the highest proportion, 17 (56.7%), with most patients aged 19-60 years, 17 (56.7%), and the majority of samples originating from Shimla, 11 (36.7%). The study identified JN.1 sublineages in 19 (63.3%) as the predominant cause of infection. Most cases, 20 (66.7%) reported to the outpatient department. Mild symptoms such as fever and cough were seen in 7 (35%) cases. Even though 23 (76.7%) of cases were vaccinated with the COVID-19 vaccine, 10 (33.3%) required admissions. However, no mortality was reported. Conclusion: Tracking SARS-CoV-2 variants revealed the predominance of the JN.1 sublineage of Omicron with generally mild symptoms. Continuous genetic evolution of SARS CoV-2 highlights the need for robust, ongoing genomic surveillance integrated with epidemiological data to enable early detection of emerging variants and strengthen control strategies.

Atorvastatin as an Add-on Therapy in Episodic Migraine Prophylaxis: A Randomised Controlled Study

V Arun Kumar, CD Jaypriya, G Chenthamarai, R Praveena

Introduction: Migraine is a primary headache disorder with an estimated frequency of 12% in the world population, ranked fifth among causes of disability worldwide in both sexes under 50 years. Conventional prophylactic agents are limited by adverse effects and poor tolerability. Atorvastatin, a HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitor with pleiotropic anti-inflammatory and endothelial-protective properties, has been proposed as a potential prophylactic agent in migraine. Aim: To assess the efficacy and tolerability of Atorvastatin 20 mg/day as add-on therapy on frequency, intensity and duration of migraine attacks over a 3-month treatment period compared with standard therapy alone. Materials and Methods: The present prospective, parallel group, open-labelled, randomised controlled study was conducted at the Outpatient Department of Neurology, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India, over eight months from November 2020 to June 2021. A total of 63 participants with episodic migraine (4-15 attacks/month for ≥1 year) were randomised into a control group (n=32, standard prophylaxis alone) and an atorvastatin group (n=31, standard prophylaxis + Atorvastatin 20 mg Once Daily (OD) for 3 months). Primary outcome was ≥50% responder rate in frequency of attacks at end of treatment. Secondary outcomes included 50% responder rate in pain intensity (Numerical Rating Scale) and mean headache duration. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 28. A p-value of <0.05 was considered statistically significant. Results: The mean age of participants was 39.65±8.56 years in Atorvastatin group and 40.06±8.61 years in Control group. Out of 63 participants 56 (88.9%) were female. At the end of the third month, 50% responder rate in frequency of attacks was 58.06% in Atorvastatin group vs 18.75% in the control group (p<0.001). Mean frequency of attacks declined significantly from baseline 5.77±1.18 to 2.58±1.09 in the Atorvastatin group versus 5.81±1.12 to 3.75±1.22 in the control group (p<0.001). Significant reduction was also observed in pain intensity (p=0.004) and headache duration (p<0.001) at the end of the third month. No serious adverse events were reported; statin-induced myalgia was the most common Adverse Drug Reaction (12.9%). Conclusion: Atorvastatin 20 mg/day as add-on therapy significantly reduces the frequency, intensity and duration of migraine attacks with good tolerability. It offers added cardiovascular protection in a population at elevated vascular risk, making it a promising option for migraine prophylaxis.

Comparison of Bilateral V-Y Rotation Advancement Flap, Homodigital Island Flap and Cross Finger Flap for Reconstruction of Fingertip Amputations: A Prospective Interventional Study

Archana Sinha, Suvashis Dash, Deepti Gupta, Harish Kumar Sharma

Introduction: The aim of reconstruction for fingertip amputations is to provide stable soft-tissue coverage while preserving length, preventing joint stiffness, minimising neuromas, restoring normal sensation and achieving an acceptable cosmetic outcome. Cross-Finger (CRF) flaps and Homodigital Island (HDI) flaps have been workhorse flaps for fingertip amputation reconstruction for decades. Aim: To assess the long-term functional and aesthetic outcomes of the Bilateral V-Y Rotation Advancement (BV-YRA) flap compared to CRF and HDI flaps. Materials and Methods: This was a prospective interventional study conducted over a period of two years in the Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospitals, New Delhi, India, involving patients presenting with fingertip amputations. A total of 39 patients presenting with Allen zone II and III amputations were included in the study. A total of 13 patients underwent BV-YRA Flap, 13 patients underwent HDI Flap and 13 patients had CRF Flap for fingertip amputation reconstruction. The authors compared the BV-YRA Flap, the HDI Flap and the CRF Flap for fingertip reconstruction. The final outcome was assessed at 12 months. Assessments were done for sensory recovery by the 2-Point Discrimination (2-PD), cold intolerance by Cold Intolerance Symptom Severity (CISS), Range Of Motion (ROM) of the Distal Interphalangeal (DIP) joint by goniometer, aesthetic outcome by self-evaluation score and time-off work in days. Comparisons were performed using appropriate statistical parametric or non parametric tests. After four patients lost to follow-up postsurgery, 35 patients presenting with Allen zone II and III amputations were included in the study. A total of 13 patients underwent BV-YRA Flap, 12 patients underwent HDI Flap and 10 patients had CRF Flap for fingertip amputation reconstruction. Results: The demographics of patients in the three groups were comparable. All the flaps survived. The 2-PD was significantly lower in the BV-YRA group than in the other two groups (p<0.05). Only two patients in the BV-YRA flap group reported cold intolerance, whereas all patients in the HDI and CRF groups reported mild cold intolerance. The BV-YRA flap group demonstrated significantly greater DIP and PIP joint mobility than the HDI and CRF flap groups (p<0.05). The aesthetic satisfaction score was significantly better in the BV-YRA group (3.6±0.6) compared to the HDI (1.9±0.79) and CRF (1.0±0.82) groups (p<0.05). The mean time-off work for patients in the BV-YRA, HDI and CRF groups was 20, 33.5 and 51.5 days, the difference was statistically significant (p<0.05). Conclusion: The authors found that fingertip amputations treated with the BV-YRA flap had significantly better functional and aesthetic outcomes than those treated with HDI and CRF flaps.

Efficacy of Dexmedetomidine as an Adjuvant to Ropivacaine plus Lignocaine-adrenaline Combination for Ultrasound-guided Popliteal Sciatic and Femoral Nerve Blocks in Lower Limb Surgeries: A Double-blinded Randomised Clinical Study

Neha Manoj Kushe, Naseema V Kanase, Mouna Rao, Namrata Mandirwala

Introduction: Single-injection peripheral nerve blocks provide effective perioperative analgesia for lower limb surgery, but the duration of local anaesthetic action may be insufficient for the early postoperative painful period. Dexmedetomidine may improve block quality when used as a perineural adjuvant. Aim: To evaluate the efficacy of dexmedetomidine as an adjuvant to a ropivacaine plus lignocaine-adrenaline mixture for ultrasound-guided popliteal sciatic and femoral nerve blocks in patients undergoing below-knee lower limb surgeries. Materials and Methods: This double-blinded randomised clinical study included 86 adults aged 18-60 years with American Society of Anesthesiologists Physical Status I-III. Patients were allocated into two equal groups. Group-RL received 20 mL of 0.5% ropivacaine and 10 mL of 2% lignocaine with adrenaline. Group-RLD received the same mixture with dexmedetomidine 5 microgram, with total volume maintained at 30 mL. Twenty millilitres was used for popliteal sciatic block and 10 mL for femoral nerve block. Sensory and motor onset and duration, time to first analgesic request, Visual Analogue Scale (VAS) scores, haemodynamic variables, sedation, satisfaction and adverse events were recorded. Continuous variables were expressed as mean±standard deviation and compared using independent t-test or appropriate non-parametric tests. Categorical variables were analysed using Chi-square test. A p-value <0.05 was considered statistically significant. Results: Baseline characteristics were comparable between Group-RL and Group-RLD. Dexmedetomidine significantly shortened sensory onset (6.5±2.1 vs 9.8±2.6 minutes, p <0.001) and prolonged sensory duration (478.6±31.2 vs 332.7±24.5 minutes, p<0.001). Motor onset was faster in Group-RLD (8.3±2.8 vs 11.4±3.2 minutes, p<0.001), while motor duration was longer (289.4±34.7 vs 254.9±29.8 minutes, p<0.001). Time to first analgesic request was delayed with dexmedetomidine (528.3±33.5 vs 348.5±30.9 minutes, p<0.001). VAS scores were lower from two to 12 hours. Satisfaction rate was higher in Group-RLD (88.4% vs 55.8%, p<0.001). Bradycardia, hypotension and sedation were more frequent with dexmedetomidine, but no respiratory depression, local anaesthetic systemic toxicity, nerve injury or infection occurred. Conclusion: Dexmedetomidine added to ropivacaine plus lignocaine-adrenaline for ultrasound-guided popliteal sciatic and femoral nerve blocks improved onset, prolonged sensory and motor block and enhanced postoperative analgesia, with a higher but manageable incidence of bradycardia, hypotension and sedation.

Hepatoprotective Effects of Cassia fistula L.: A Systematic Review of Preclinical Animal Studies

Premadevi Ramdasji Kalmegh, Bharat Rathi, Swapnali Khabade

Introduction: Cassia fistula Linn., commonly known as the Indian Laburnum or “Aargwadh” in Ayurveda, is traditionally valued for its antiseptic and therapeutic properties. Liver diseases, exacerbated by environmental toxins and viral infections, remain a significant global health burden. Medicinal plants, especially those rich in antioxidants, have gained attention for their hepatoprotective potential. Numerous preclinical studies have indicated that Cassia fistula exhibits protective effects against liver damage, making it a promising candidate for liver therapy. Aim: To systematically analyse and synthesise available evidence on the hepatoprotective activity of Cassia fistula, evaluating its efficacy across experimental models and identifying its active phytoconstituents. Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was carried out using databases including PubMed, Scopus, Web of Science, Ayush, Shodhganga and Google Scholar, employing predefined search terms such as “Cassia fistula”, “Aargwadh”, “Hepatoprotective” and “liver injury”. Studies were screened based on predefined inclusion and exclusion criteria, focusing on in-vivo, in-vitro and clinical studies assessing hepatoprotective outcomes. The Population (or Patient), Intervention, Comparison, Outcome and Study (PICOS) framework was used to define eligibility criteria. Data were independently extracted by two reviewers and included details on the part of the plant used, type of extract, hepatotoxins employed (e.g., Carbon Tetrachloride (CCl₄), paracetamol, Diethylnitrosamine (DEN)}, biomarkers measured and phytochemicals identified. The SYstematic Review Centre for Laboratory animal Experimentations (SYRCLE's) Risk of Bias tool was used to assess methodological quality of animal studies. Results: The review included a total of nine studies, demonstrating consistent hepatoprotective effects of Cassia fistula across various experimental models of liver injury. Extracts from different plant parts (pods, leaves, bark, fruit pulp) significantly reduced levels of liver enzymes {Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP)}, improved histopathological profiles and enhanced antioxidant defences. Bioactive compounds such as flavonoids, polyphenols, anthraquinones and glycosides were frequently associated with the observed protective effects. Conclusion: Cassia fistula exhibits significant hepatoprotective activity across multiple models of chemically induced liver damage, likely due to its rich phytochemical profile. It holds promise as a complementary herbal therapy for managing liver disorders.

Thrombocytopaenia in Alcohol Withdrawal: A Retrospective Study on its Prevalence and Role as a Low-cost Predictor of Delirium Tremens

Sabitha Venkateswaran, Priya Subhashini, Priya Dharshini, Vijeyta Naresh

Introduction: Delirium Tremens (DT) is a life-threatening alcohol withdrawal complication, requiring early identification to improve outcomes. Alcohol-induced Thrombocytopaenia (TP) may serve as a cost-effective predictor of DT. Although several biochemical markers have been studied for predicting DT, reliable, simple and cost-effective early predictors remain limited, especially in resource-limited settings. Since platelet count is routinely available and inexpensive, evaluating TP as a potential predictor of DT may provide a practical tool for early risk stratification. Aim: To study the prevalence of TP in alcohol withdrawal and its predictive role in DT. Materials and Methods: The present retrospective observational study reviewed case records of adult patients (≥18 years) admitted with an International Classification of Disease-10 (ICD-10) diagnosis of alcohol withdrawal between September 2022 and March 2025 at the Department of Psychiatry, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India. Only records with platelet counts available at admission were included, yielding a total sample of 409 patients. Data on demographic characteristics, along with relevant clinical and laboratory findings, were collected. The prevalence of TP and its predictive value for DTs were evaluated using sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Statistical associations were determined using appropriate tests and multiple logistic regression with a significance level set at p<0.05. Results: The prevalence of TP was 93 patients (22.7%). DT incidence was 12.5% (51 patients). DT occurred in 39.8% of thrombocytopenic patients, showing a strong association (p<0.001). Regression analysis identified previous history of DT and TP as strong predictors of DT. TP demonstrated 72.5% sensitivity, 84.4% specificity, moderate PPV (39.8%) and high NPV (95.6%). Conclusion: The TP is a cost-effective, highly specific predictor of DT in Alcohol Withdrawal Syndrome (AWS), making it useful for risk stratification in resource-limited settings. Further research is needed to evaluate its clinical utility.

Effect of Pressure Biofeedback Training on Quadriceps Muscle Strength and Knee Range of Motion among Normal BMI Patients with Total Knee Replacement: A Quasi-experimental Study

Molvika Mohan, Nityal Kumar Alagingi

Introduction: Total Knee Replacement (TKR) is a common treatment for knee OA, but rehabilitation can be challenging due to postoperative quadriceps weakness and limited knee Range Of Motion (ROM). Pressure Biofeedback (PBF) training is presented as a viable method to potentially enhances ROM recovery and quadriceps activation. Aim: This study aimed to determine the effectiveness of PBF training on quadriceps muscle strength and knee ROM in people with TKR. Materials and Methods: A quasi-experimental study was conducted at KS Hegde Hospital, Mangaluru, between May 2024 and May 2025. The study included twenty patients with normal BMI who had undergone TKR. From Postoperative Day (POD) 1 to POD 7, participants received PBF training in addition to standard physiotherapy. Knee ROM was measured using a goniometer, while quadriceps strength was assessed with a PBF device. The effectiveness of PBF training on muscle strength and functional outcomes was evaluated using the paired t-test, with statistical significance set at p<0.05 Results: A total of 20 patients were enrolled in the study, comprising seven males and 13 females, with ages ranging from 45 to 74 years. Significant functional improvements were observed over the postoperative period. Knee flexion increased from 23.10° on POD 1 to 67.73° on POD 7, while knee extension improved from 6.03° to 2.20°. Quadriceps strength also rose markedly, from 55.25 mmHg to 94.88 mmHg. All changes were statistically significant (p<0.001) Conclusion: The study demonstrates that PBF training significantly improves knee ROM and quadriceps strength during the early postoperative phase of TKR. Early incorporation of PBF training into routine TKR rehabilitation can accelerate recovery, optimise quadriceps strength, and improve knee mobility, offering patients a more effective pathway to regain function and independence.

Short-term Effect of Kinesio Taping on Arterial Blood Gas and Oxygen Saturation in Individuals with Chronic Obstructive Pulmonary Disease: A Randomised Controlled Trial

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is associated with impaired respiratory mechanics, postural abnormalities, and reduced oxygenation. A forward shoulder posture contributes to inefficient ventilation. Kinesio Taping (KT) has been proposed as a postural correction strategy to enhance respiratory efficiency in individuals with COPD. Aim: To evaluate the short-term effect of KT on Arterial Blood Gas (ABG) parameters and Oxygen Saturation (SpO₂) in individuals with COPD. Materials and Methods: The present Randomised Controlled Trial (RCT) was conducted at the Department of Physiotherapy and Department of Pulmonology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, from September 2024 to August 2025 and included 40 participants aged 40-70 years with mild-to-moderate COPD. Participants were allocated to two groups using the concealed envelope method. Group A received KT along with conventional physiotherapy, whereas Group B received conventional physiotherapy alone. The intervention was administered over three to five days. The outcome measures included ABG parameters (Potential of Hydrogen (pH), Partial pressure of oxygen (PaO₂), Partial pressure of carbon dioxide (PaCO₂), and Bicarbonate (HCO₃) and SpO₂. Statistical analysis was performed using paired and independent t-tests and non-parametric tests, where appropriate. Statistical significance was set at p<0.05. Results: Significant improvement in SpO2 was observed in the experimental group (p<0.0001). No significant between-group differences were observed in the change scores of ABG parameters. (p>0.05) Conclusion: KT, as an adjunct to conventional physiotherapy, improved SpO₂, while no significant treatment-related changes were observed in ABG parameters.

Comparison of Ultrasonographic and Radiographic Findings in Knee Osteoarthritis: A Cross-sectional Study

Rohit Raj Rajkumar, E Dilip Kumar Naidu, Gowthaman Nambiraj, Sabarish

Introduction: Knee Osteoarthritis (OA) is a prevalent degenerative joint disorder and a major cause of pain and disability among the elderly population. Conventional radiography remains the standard imaging modality for diagnosis and grading; however, it has limited sensitivity in detecting early and soft-tissue changes. Ultrasonography (USG) has emerged as a useful, cost-effective adjunct for evaluating both osseous and periarticular soft-tissue abnormalities. Hence, there is a need to assess its diagnostic efficacy in comparison with radiography. Aim: To compare the ultrasonographic features with radiographic grading (Kellgren-Lawrence) in patients with knee OA. Materials and Methods: The present cross-sectional observational study was conducted in the Department of Orthopaedics at SRM Medical College Hospital and Research Institute, Kattankulathur, Chennai, Tamil Nadu, India. from May 2024 to August 2024. A total of 48 patients aged above 50 years fulfilling the American College of Rheumatology (ACR) criteria for knee OA were included. All patients underwent standing anteroposterior and lateral radiographs, graded using the Kellgren-Lawrence (KL) classification, followed by ultrasonographic evaluation using a high-frequency linear probe. Parameters studied included osteophytes, Joint Space Narrowing (JSN), cartilage thickness, joint effusion, Baker’s cyst, and meniscal protrusion. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software (version 22.0). McNemar’s test, Chi-square test, and paired t-test were applied. A p-value of <0.05 was considered statistically significant. Results: The majority of patients were aged 60-69 years 20 (41.7%) with a female predominance 26 (54.2%). Most cases belonged to Kellgren-Lawrence (KL) Grade 2 18 (37.5%) and Grade 3 16 (33.3%). USG detected osteophytes in 44 (91.7%) of patients compared to 34 (70.8%) on radiography (p=0.004). JSN was observed in 38 (79.2%) by USG and 36 (75.0%) by radiography (p=0.62), showing no significant difference. Ultrasonographic findings such as reduced cartilage thickness 32 (66.7%), joint effusion 20 (41.7%), and meniscal protrusion 12 (25.0%) increased significantly with higher KL grades (p<0.05). Mean medial joint space measurements were comparable between modalities (p=0.48), whereas USG detected significantly reduced lateral joint space compared to radiography (p=0.03). Conclusion: USG provides improved detection of osteophytes and offers additional information on soft-tissue and early structural changes in knee OA. It associates well with radiographic severity and serves as a valuable, accessible adjunct to conventional radiography for comprehensive evaluation and early diagnosis of knee OA.

Comparative Evaluation of Hydraulic Calcium Silicate-based Cements RS+, ProRoot MTA and Biodentine in Apexification: An In-vitro Study

Harshvardhan Abhijit Mohite, Sachin Gugawad

Introduction: Apexification in immature permanent teeth with necrotic pulps using calcium hydroxide root canal treatment approach is quite challenging with several notable limitations and disadvantages that can compromise the apical seal and make the tooth more susceptible to infections and other pulp-related diseases. To address this issue, suitable alternatives utilising Mineral Trioxide Aggregate (MTA), Biodentine, and bioceramic root canal material RS+ cement have recently been introduced. Aim: To assess and compare ProRoot MTA, Biodentine, and Resin-bonded Sealer (RS+) cement in apexification in terms of marginal adaptation, calcium release and fracture resistance. Materials and Methods: The present in-vitro study was conducted at Department of Paediatrics and Preventive Dentistry, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Deemed University, Karad, Maharashtra, India, during the period of August 2023 to October 2024. A total of 72 (N=72) samples of sound premolar tooth extracted for orthodontic purposes were included that were randomly divided into three groups as Group-A (ProRoot MTA), Group-B (Biodentine) and Group-C (RS+ Cement). Balanced equivalence sampling with 24 samples (n=24) each was done for Group-A to Group-C. Each group was further divided into subgroups (Group-A1-A3 to Group-C1-C3) with eight samples (n=8) each for assessing three specific parameters: marginal adaptation, calcium release and fracture resistance. The teeth were decoronated at the Cementoenamel Junction (CEJ) using a diamond disc and the apexification process was carried out in all the three groups. After evaluating the apexification procedure using Radiovisiography (RVG), marginal adaptability was assessed by measuring the micro gap width in the dentin-material boundary area with Scanning Electron Microscopy (SEM) at 1000x magnification. Calcium release was detected at seven day and 14-day interval using Energy-Dispersive X-ray (EDX) analysis. Finally, the fracture resistance for each group was evaluated using Universal Test Machine (UTM) in Newtons. Data was subjected to IBM Statistical Package for Social Sciences (SPSS) version 21.0. Mean, Standard Deviation (SD) and unpaired t-test were applied to compare variables between the groups. Intergroup comparison was done using Analysis of Variance (ANOVA) followed by Post-hoc Tukey’s test. A p-value of <0.05 was considered significant. Results: Group-A had the highest marginal gap values (1.75±0.10), followed by Group-B (1.25±0.03), and Group-C had the lowest (0.97±0.09) (p<0.001). The results of pairwise comparisons between groups indicated that MTA had the worst marginal adaptation and RS+ the best (p<0.001). Group-B documented the greatest reduction of calcium release from day 7 (13.24±0.26) to day 14 (11.29±0.63) (p<0.001) as compared to other groups. However, intergroup variability revealed that RS+ exhibited a steady and gradual release of calcium over time (0.69, p=0.02). Fracture resistance was highest among Group-C (72.63±2.98) followed by Group-B (57.68±1.98) and Group-A (51.66±2.06) with statistically significant p-value (p<0.001). Intergroup comparisons with Tukey's test revealed significant differences between all groups (p<0.001). Conclusion: RS+ showed good marginal adaptation and high fracture resistance, followed by Biodentine and ProRoot MTA. With respect to calcium ion release, Biodentine showed the greatest reduction in calcium ion release over time, while RS+ and MTA showed comparable, statistically non significant differences.

Dentoalveolar and Smile Aesthetic Changes Following Fixed Orthodontic Treatment in Adults with Varying Anterior Overjet: A Retrospective Study

Introduction: Anterior overjet is a key determinant of dentofacial aesthetics and occlusal function, and its correction is a primary objective of fixed orthodontic therapy. It is still unclear how baseline overjet magnitude affects dentoalveolar adaptation during orthodontic treatment in adults. Although fixed appliance therapy routinely addresses excessive overjet, no single study has directly compared whether patients grouped by initial overjet category respond differently- or whether any such differences carry through to smile aesthetic parameters. Aim: To compare skeletal, dental, and smile aesthetic changes after comprehensive fixed orthodontic treatment in 30 adult patients, divided into three groups by baseline anterior overjet (OJ): normal (0-4 mm), excessive (>4 mm), and negative/reverse (<0 mm). Materials and Methods: This retrospective observational study was conducted at the Department of Orthodontics at Dr DY Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India using treatment records of patients treated between 2018 and 2024; the study itself was planned, executed, and analysed between January 2024 and February 2025 Thirty patients satisfied all inclusion criteria and were assigned to three groups of 10 on the basis of baseline anterior overjet: Group 1 (normal overjet, 0-4 mm), Group 2 (excessive overjet, >4 mm), and Group 3 (negative/reverse overjet, <0 mm). Pre- and post-treatment lateral cephalograms and standardised frontal smile photographs were assessed across 21 parameters - 7 skeletal, 7 dental, and 7 smile-related. Within-group changes were tested with paired-samples t-tests; between-group treatment change scores were compared using One-way Analysis of Variance (ANOVA) with Tukey HSD post-hoc testing (α=0.05). Results: Group 2 (excessive overjet) showed the greatest and most consistent dentoalveolar response: U1-NA (mm) reduced by 4.00 mm (p=0.004), U1-NA° by 11.80° (p=0.004), L1-NB° by 4.00° (p=0.034), and U1-PP° increased by 16.90° (p = 0.003), with concurrent SNA reduction of 2.20° (p=0.002) and ANB reduction of 1.40° (p=0.039). Group 1 (normal overjet) showed significant retroclination of U1-NA° (6.70°; p=0.016), U1-NA (mm) reduction (p = 0.041), U1-PP° change (p=0.020), and a significant decrease in interlabial gap (p=0.035). Group 3 (negative overjet) showed no statistically significant change in any parameter. Between-group ANOVA confirmed significant differences for U1-NA° (F=3.665; p=0.042) and U1-PP° (F=4.938 p=0.016). Smile Index increased significantly within Group 2 (p=0.043); all other smile parameters were non significant across all groups. Conclusion: Fixed orthodontic treatment produced dentoalveolar changes that scaled with baseline overjet severity. Adults with excessive overjet showed the most pronounced skeletal and dental changes, particularly in upper incisor inclination. Larger prospective trials are required to determine treatment sensitivity for these indices because smile aesthetic measures were mostly insensitive to tooth movement in study design.

Assessing the Brain Activity of Oral Sedation versus Nitrous Oxide Sedation in Paediatric Patients: A Randomised, Cross-over, Clinical Trial

Neha Ravindra Ghongade, Namrata Gaonkar

Introduction: Managing Dental Fear and Anxiety (DFA) using pharmacological approaches including oral and Nitrous Oxide (N₂O) sedation techniques is a major challenge in paediatric dentistry. Although management of DFA using pharmacological approaches is considered safe, it is necessary to monitor vital indicators like Oxygen Saturation (SpO₂) and pulse rate levels to avoid unpredictable adverse events. Aim: To compare and evaluate the differences in brain activity patterns, monitoring of pulse rate and SpO₂ levels during oral sedation and N₂O sedation in paediatric patients undergoing pulp therapy for primary mandibular molars. Materials and Methods: The present randomised, cross-over, clinical trial study was conducted in the Department of Paediatrics and Preventive Dentistry, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Deemed University, Karad, Maharashtra, India during the period of August 2023 to October 2025. A total of 14 (N=14) primary mandibular molars indicated for pulp therapy were included in the study. Midazolam oral sedation was administered to one primary molar at first visit (Group A) and N₂O inhalation was administered to another primary molar (Group B) in the same participant in the second visit in a cross over manner. Vital indicators, including SpO₂and pulse rate were tracked at three different intervals (baseline, mid-treatment, after withdrawal of the drug). Clark’s formula was applied for oral sedation and patient’s flow rate was checked for N₂O sedation. Electroencephalogram (EEG) was used for interpretation. Statistical Package for Social Sciences (SPSS) statistical software (version 25; IBM, Armonk, NY, USA) was used to statistically analyse the data. Tukey’s post-hoc and Chi-square test were used to compare mean and categorical variables. Results: The mean pulse rate values obtained with oral sedation vs N2O sedation at baseline, mid-treatment and post-treatment were 85.8±0.6; 85.7±0.5; 85.2±0.5(p=0.720) vs 85.8±0.6; 85.6±0.5; 85.3±0.5 (p=1.000; p=0.728; p=0.720), respectively. The mean SpO2 levels with oral sedation vs N2O sedation at baseline, mid-treatment and post-treatment were 97.7±0.02; 96.8±0.19; 97.07±0.17 vs 97.78±0.22; 97.2±0.19; 97.1±0.14, respectively (p=1.000; p<0.001; p=0.392). However, the intergroup differences were not statistically significant (mid-treatment vs post-treatment) (p=0.142 vs p=0.506) and the EEG displayed no notable deviations, indicating that there had been no appreciable changes in brain activity in both the groups. Conclusion: According to the findings of the present study, both the groups resulted in acceptable, efficient and safe outcomes with no much difference in the brain activity levels.

Comparative Evaluation of Bone Ring versus Particulate Bone Graft using CBCT in Buccal Bone Augmentation with Simultaneous Implant Placement: A Randomised Controlled Trial

Introduction: Dental implant placement in defective sockets often compromises its predictability and long-term success. Although various techniques have been suggested for augmentation of defects around implants, the most recent advanced three-dimensional reconstruction technique is the Bone Ring Technique (BRT). Aim: To compare and evaluate the buccal bone regenerative capacity of bone ring and particulate bone graft. Materials and Methods: This randomised controlled parallel group trial was conducted at the Department of Periodontology, Karpaga Vinayaga Institute of Dental Sciences, Kancheepuram, Tamil Nadu, India, for a duration of six months, from August 2025 to February 2026. In the present study, among 24 edentulous sites, 12 were included in the Bone ring group (Group A), and 12 were included in the particulate graft group (Group B). Buccal height, palatal height and ridge width were assessed between baseline and six months. Wilcoxon Signed Ranks Test and Mann-Whitney U Test were used for intra- and intergroup comparison, respectively. The Statistical Package for Social Sciences (SPSS) software, version 21.0 was used, and p<0.05 was considered significant. Results: The CBCT analysis before and after six months of implant placement showed that both group A and group B demonstrated significant height and width augmentation of buccal bone. While comparing the augmentation between group A and group B, group A showed significantly higher bone gain than group B, in both buccal height and width, with p-values of 0.037 and < 0.001, respectively. Conclusion: The Bone Ring Technique (BRT) is a newer viable option for restoring complex defects around dental implants with three-dimensional bone augmentation.

Quality and Content Analysis of YouTube Videos Regarding Antibiotic use in Dentistry: A Cross-sectional Study

Balajee Venkatesh, Prethipa Roland, S Lokesh Kumar

Introduction: Antibiotic misuse is a major global public health problem that contributes to antimicrobial resistance. India is among the largest consumers of antibiotics worldwide.YouTube, widely used for accessing health-related information, hosts content on antibiotic use that includes misinformation, which may mislead patients who bypass professional consultations. Despite the growing use of YouTube as a source of health information, limited evidence exists about the accuracy and reliability of content related to antibiotics in dentistry. Aim: To assess YouTube videos related to the use of antibiotics in dentistry for their content and overall quality, including clarity, accuracy, technical quality, overall flow, completeness of information, and usefulness to patients. Materials and Methods: This was a cross-sectional study conducted via YouTube between January 2024 and March 2024 at the Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. Of the 300 videos initially identified across all predefined search terms, 29 met the primary inclusion criteria: English-language videos related to the study topic, with clear audio-visual quality and relevant educational content. Video demographics, source, length, and viewer interaction indices were recorded. Content analysis was performed using a 10-point rating system. The Global Quality Scale (GQS) and Video Information and Quality Index (VIQI) were applied to assess the overall quality of the videos. Statistical analysis was performed using descriptive and inferential statistics, including the Mann–Whitney U test, Spearman’s rank correlation, Cohen’s kappa, and intraclass correlation coefficient (ICC), as appropriate. A p-value <0.05 was considered statistically significant. Results: The mean content score was 3.51±2.13 out of 10, (p=0.0004) between rich and poor content videos, while the mean GQS value was 2.64/5 (p=0.0203), showing statistical significance. VIQI scores averaged 10.08/20, with no significant differences (p=0.853). Among the 29 videos analysed, the major contributors were general channels (n=11; 37.93%), followed by health care professionals (27.59%), educational series 5 (17.24%), and health care centres 4 (13.79%). Only one video (3.45%) was uploaded by a dental association (such as the American Dental Association). Regarding geographic origin, the majority were uploaded from India, 8 (28%) and from the USA 7 (24%), while the remaining videos were from other countries. Conclusion: YouTube videos on antibiotics in dentistry generally exhibited poor content and moderate quality. Addressing antimicrobial resistance requires responsible prescription practices and patient education on appropriate antibiotic use.

Comparative Evaluation of the Disinfection Efficacy of Herbal Formulation, 2% Glutaraldehyde, and Electrolysed Oxidising Water on Clinically Derived Polyvinyl Siloxane Impressions: An In-vivo Experimental Study

Introduction: Dental impressions are frequently contaminated with saliva, blood and microorganisms, posing a risk of cross-infection. Polyvinyl Siloxane (PVS) impressions require effective disinfection without compromising material properties. Although glutaraldehyde is widely used, concerns regarding toxicity and environmental impact have encouraged the exploration of safer alternatives such as Electrolysed Oxidising Water (EOW) and herbal formulations. However, limited comparative evidence exists regarding their antimicrobial efficacy on clinically derived PVS impressions. Aim: To compare the antimicrobial efficacy of herbal formulation (HiOra™), 2% glutaraldehyde, and EOW on clinically derived PVS impressions. Materials and Methods: This in-vivo experimental study was conducted in the Department of Prosthodontics, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from December 2023 to April 2025. Eleven dentate subjects were included, yielding a total of 44 samples. The inclusion criteria were healthy dentulous subjects aged 18-45 years with no active oral lesions. Four samples from each impression were allocated to Group A (control), Group B (HiOra™), Group C (2% glutaraldehyde), and Group D (EOW). Samples were immersed for 10 minutes. Aerobic and anaerobic Colony Forming Units (CFUs) were quantified. Demographic parameters such as age and gender of the participants were recorded. Statistical analysis was performed using the Kruskal-Wallis test followed by post-hoc Bonferroni test, with significance set at p<0.05. Results: Significant intergroup differences were observed (aerobic: p=0.003; anaerobic: p<0.001). Mean aerobic log CFU/mL values were 1.02±0.73 (control), 0.80±0.81 (HiOra™), 0.36±0.51 (glutaraldehyde), and 0.00±0.00 (EOW). EOW showed significantly lower aerobic counts compared to control (p=0.003) and HiOra™ (p=0.046), and was comparable to glutaraldehyde (p=1.000). Mean anaerobic log CFU/mL values were 2.67±1.09, 1.26±1.27, 0.72±1.40, and 0.09±0.30, respectively, with EOW demonstrating near-complete reduction. Conclusion: EOW demonstrated the highest antimicrobial efficacy, followed by 2% glutaraldehyde, while the herbal formulation showed the least effectiveness. EOW may serve as a promising eco-friendly alternative for routine prosthodontic disinfection.

Association of Platelet Volume Indices with HbA1c Levels in Type 2 Diabetes Mellitus and Non-diabetic Individuals: A Cross-sectional Analytical Study

Introduction: Platelets play a significant role in the pathophysiology of diabetes-related vascular complications. Chronic hyperglycaemia contributes to endothelial dysfunction, oxidative stress and increased platelet activation, which all together promote a prothrombotic state. Platelet Volume Indices (PVI), including Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW), are considered markers of platelet activation and reactivity, early estimation of which can help in early detection of diabetes related complications. Aim: To study association of PVI (MPV and PDW) with HbA1c in diabetes mellitus type 2 patients and non diabetics. Materials and Methods: This cross-sectional comparative study was conducted in the Department of Pathology and the Department of Immunohaematology and blood transfusion in a tertiary care hospital of Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India on 300 subjects: 200 Type 2 Diabetes Mellitus (T2DM) patients and 100 healthy controls (blood donors) from 1st November 2018 to 31st January 2020. Diabetics were sub-divided based on HbA1c: Group A (HbA1c ≥7.5%), Group B (HbA1c 6.5-7.4%) and Group C was of controls (HbA1c ≤6.4%). Platelet indices (MPV and PDW) and HbA1c were measured and statistically analysed using Statistical Packages of Social Sciences (SPSS) version 26.0 Quantitative variables were expressed as mean±standard deviation. Chi-square test, Mann-Whitney U/Z-score test and Pearson’s/Spearman correlation were applied considering p-value <0.05 statistically significant. Results: Mean MPV of Group A was 10.83±1.69 fL, Group B was 10.53±1.51 fl and Group C was 10.00±1.36 fL. Mean PDW of Group A was 16.43±0.68 fL, Group B was 16.38±0.50 fL and Group C was 16.17±0.37 fL. MPV and PDW were significantly higher in both diabetic sub groups compared to controls (p <0.001). Group A showed the highest values, suggesting greater platelet activation. However, correlation between HbA1c and platelet indices was not statistically significant within two diabetic sub-groups (Group A and B). Conclusion: Elevated MPV and PDW in T2DM patients suggest their potential as markers for vascular risk may serve as a practical tool for early identification of complications in T2DM. MPV may be considered a simple supportive marker for glycaemic control in T2DM patients, though validated clinical cut-off values require further studies.

Role of Serum Ferritin, Vitamin D Status, and C-Reactive Protein in Nonalcoholic Fatty Liver Disease: A Case-control Study

Mary Chandrika Anton, B Shanthi, Vasudevan Elumalai, K Sumathi

Introduction: Nonalcoholic Fatty Liver Disease (NAFLD) is an increasingly prevalent metabolic liver disorder associated with chronic low-grade inflammation. Altered iron metabolism, Vitamin D deficiency, and systemic inflammatory markers have been implicated in its pathogenesis; however, their relationship with disease severity remains incompletely understood. Aim: To evaluate the association of serum ferritin, Vitamin D status, and C-Reactive Protein (CRP) with the presence and severity of NAFLD. Materials and Methods: This hospital-based case-control study was conducted at the Department of Biochemistry, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from January 2023 to December 2023. A total of 200 participants were enrolled, including 100 NAFLD patients diagnosed by clinical, biochemical, and ultrasonographic criteria and 100 age- and gender-matched healthy controls. Serum ferritin, 25-hydroxyvitamin D, and CRP levels were estimated using standard laboratory methods. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Normality was assessed using the Shapiro-Wilk test. Mann-Whitney U test and Chi-square/Fisher’s-exact tests were used for group comparisons, while Spearman’s rank correlation was used to assess associations with NAFLD severity. Results: The mean age of NAFLD patients was 32.27±3.99 years, and that of controls was 31.46±4.19 years, with equal gender distribution in both groups (50 males and 50 females). NAFLD patients had significantly higher median serum ferritin [183.0 (148.0-254.75) vs 145.0 (97.75-236.25) ng/mL; p=0.0001] and CRP levels [6.5 (5.0-9.5) vs 1.5 (0.8-2.0) mg/L; p<0.0001], and significantly lower Vitamin D levels [13.0 (8.57-17.0) vs 24.0 (22.0-30.5) ng/mL; p<0.0001] than controls. Vitamin D deficiency was present in 79% of NAFLD patients. Serum ferritin (r=-0.024, p=0.813) and Vitamin D (r=0.149, p=0.139) showed no significant correlation with NAFLD severity, whereas CRP demonstrated a significant positive correlation (r=0.604, p<0.001). Conclusion: NAFLD is associated with elevated serum ferritin and CRP levels and reduced Vitamin D concentrations. While ferritin and Vitamin D were associated with the presence of NAFLD, CRP correlated significantly with disease severity, suggesting its potential utility as a marker of disease progression and inflammatory burden.

Assessment of Oral and Periodontal Health Literacy among Medical Students and Faculty: A Cross-sectional Study

Tabassum, Anil Kumar, Renu Singh, Rajesh Kumar Thakur, Bipin Kumar Yadav

Introduction: Oral and periodontal diseases are highly prevalent and contribute substantially to systemic inflammation, impaired daily functioning, and reduced quality of life. Because oral health is closely interconnected with general health, medical practitioners play a crucial role in early detection, initial management, and timely referral of dental and periodontal conditions. Aim: To evaluate the knowledge, awareness, and attitudes regarding oral and periodontal health among undergraduate and postgraduate medical students and teaching faculty members. Materials and Methods: This cross-sectional questionnaire-based study was conducted in the Department of Periodontology at the UPUMS, Saifai, Etawah, Uttar Pradesh, India, from January 2023 to June 2023. The sample size calculated was 1000, out of which 992 completed the questionnaire. Medical students and faculty were included, which were further categorised into three groups: undergraduate medical students (Group I), postgraduate medical students (Group II), and medical faculty members with senior residents (Group III). A structured, pre-tested and validated closed-ended 20 questionnaire assessed knowledge (Q1-5), awareness (Q6-14), and attitudes (Q15-20) toward oral and periodontal health. Demographic parameters such as age, gender, and level of education were recorded and considered during analysis. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0, and group comparisons were made using the Chi-square test (p<0.05 considered significant). Results: Significant differences were found across all groups (p<0.001). Faculty members demonstrated the highest levels of knowledge and awareness, followed by undergraduate and postgraduate students. Most participants (Group I: 77.6%, Group II: 70%, Group III: 98.9%) recognised dental plaque and calculus as primary aetiological factors, though only a minority of undergraduates (31.7%) had received professional brushing instruction. Awareness of systemic implications, such as the link between periodontal diseases and cardiovascular or diabetic conditions, increased with professional level. Attitude scores indicated that faculty exhibited the most positive outlook toward oral health promotion (91.3%) and referral practices (86.9%). Conclusion: The study revealed substantial gaps in knowledge and awareness about oral and periodontal health among medical undergraduates, emphasising the need for integrating oral health education into the medical curriculum. Enhanced interdisciplinary collaboration and targeted educational initiatives could improve early identification, preventive counselling, and referral practices for oral health care.

Dexmedetomidine versus Clonidine as Intrathecal Adjuvants to Hyperbaric Ropivacaine for Subarachnoid Block in Patients with History of Scorpion Bite undergoing Infraumbilical Surgery: A Double-blinded Randomised Clinical Study

Mouna Rao, Naseema V Kanase, Namrata Mandirwala, Neha Manoj Kushe

Introduction: Patients with previous scorpion sting may show variable response to spinal local anaesthetics because scorpion toxins can alter voltage-gated sodium-channel behaviour. Ropivacaine and intrathecal alpha-2 agonists may improve block reliability in this subgroup. Aim: To compare intrathecal dexmedetomidine and clonidine as adjuvants to 0.75% hyperbaric ropivacaine for Subarachnoid Block (SAB) in patients with history of scorpion bite undergoing infraumbilical surgery. Materials and Methods: This double-blinded randomised clinical study was conducted in the Department of Anaesthesiology, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, India. The study included 78 American Society of Anaesthesiologists (ASA) I-II adults aged 18-60 years with documented scorpion bite history scheduled for elective infraumbilical surgery. Patients were allocated equally. Group RD received 3 mL 0.75% hyperbaric ropivacaine with dexmedetomidine 5 μg intrathecally, while Group RC received 3 mL 0.75% hyperbaric ropivacaine with clonidine 30 μg. Block characteristics, block success and haemodynamic variables were recorded. Normality was assessed using the Shapiro-Wilk test. Continuous variables were compared using the independent-samples t-test, and categorical variables using the Chi-square or Fisher’s exact test. A p-value <0.05 was considered significant. Results: A total of 78 patients were randomised, with 39 patients allocated to each group. Baseline characteristics were comparable between Group RD and Group RC, including age (42.6±9.8 vs 43.9±10.2 years), sex distribution (21/18 vs 23/16 male/female), weight (63.4±8.1 vs 64.1±7.6 kg), height (162.8±6.9 vs 163.2±7.1 cm), baseline heart rate (78.4±7.0 vs 79.5±6.8 beats/min), baseline mean arterial pressure (94.8±5.9 vs 93.7±6.1 mmHg), and duration of surgery (73.4±15.2 vs 75.1±14.8 minutes). Among patients with successful measurable block, sensory onset was significantly faster in Group RD than in Group RC (3.5±0.9 vs 5.3±1.3 minutes; p-value <0.001), and motor onset was also earlier (4.3±0.9 vs 5.7±1.2 minutes; p-value <0.001). Group RD demonstrated a longer duration of sensory block (274.2±24.9 vs 228.8±23.7 minutes; p-value <0.001) and motor block (245.8±28.0 vs 196.7±23.4 minutes; p-value <0.001). Successful spinal block was achieved in 38/39 (97.4%) patients in Group RD and 36/39 (92.3%) patients in Group RC; however, the difference was not statistically significant (p-value=0.615). Conclusion: Intrathecal dexmedetomidine added to 0.75% hyperbaric ropivacaine produced faster sensory and motor onset and prolonged block duration compared with clonidine in patients with previous scorpion bite. Both regimens were haemodynamically acceptable, but dexmedetomidine showed superior overall block characteristics and reliability.

Ultrasound-guided Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Prospective Observational Study

Introduction: Postoperative pain following laparoscopic cholecystectomy is multifactorial and requires effective management to enhance recovery and reduce opioid consumption. Ultrasound-guided regional techniques like Erector Spinae Plane Block (ESPB) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) block are increasingly used for postoperative analgesia. Aim: To compare the analgesic efficacy of ESPB and OSTAP block in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The present prospective observational study was conducted in the Department of Anaesthesia at SKIMS Medical College and Hospital, Srinagar, Jammu and Kashmir, India, from June 2024 to December 2025. A total of 56 patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were enrolled into two equal groups: Group O received bilateral OSTAP block, and Group E received bilateral ESPB. Postoperative pain was assessed using the Numerical Rating Scale (NRS) at predefined intervals up to 24 hours. Time to first rescue analgesia, total analgesic consumption, haemodynamic parameters and complications were also evaluated. The p-value <0.05 was considered statistically significant. Results: The mean age was 41.89±12.50 years in the OSTAP group and 38.86±12.75 years in the ESPB group (p-value >0.05). OSTAP group had four males and 24 females while ESPB group which had 10 males and 18 females (p-value >0.05). Mean Body Mass Index (BMI) was 22.58±1.20 kg/m² in the OSTAP group and 22.69±1.00 kg/m² in the ESPB group (p-value >0.05). OSTAP group had 11 American Society of Anaesthesiologists (ASA) I and 17 ASA II patients whereas ESPB group had 12 ASA I and 16 ASA II patients (p-value >0.05). The ESPB group demonstrated significantly lower NRS scores after extubation, in the recovery, at one hour, nine hours, 12 hours, and 24 hours postoperatively (p-value <0.05). The time to first rescue analgesia was significantly longer in the ESPB group than OSTAP group (p-value <0.001). Total analgesic consumption was significantly lower in the ESPB group (p-value <0.001). Mean heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Oxygen Saturation (SpO₂) were comparable between groups (p-value >0.05). No complications were observed. Conclusion: ESPB provides superior and prolonged postoperative analgesia with reduced opioid requirement compared to OSTAP block, making it a more effective component of multimodal analgesia for laparoscopic cholecystectomy.

Community-based Photogrammetric Assessment of Nasal Angles among Adults in the Garhwal Himalayas, Uttarakhand, India

Niyati Airan, Anil Kumar Dwivedi, Ananya Sharma, Viyom Agarwal

Introduction: The nose has long been known to hold an important place in the medical sphere, owing to its important functions in olfaction and respiration. Its normal morphology and morphometry are also crucial for determining facial aesthetics. Different types of nasal deformities are also seen to be associated with various congenital anomalies. Anthropometry of the nose varies with age, gender and ethnicity. Aim: To explore region-, ethnic-, and gender-specific nasal angulations of the adult population of Garhwal, Himalayas, Uttarakhand, India. Materials and Methods: This community-based cross-sectional observational study was conducted at the Department of Anatomy, Veer Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar Garhwal, Uttarakhand, India, from July 2024 to June 2025. Multistage sampling was applied to measure 141 males and 105 females residing in the Garhwal Himalayas, using the photogrammetric method. Nasofrontal, nasofacial, nasolabial, nasal-tip and inter-alar angles were measured employing the Magnus Analytics MagVision application. Descriptive (Mean and Standard deviation) and inferential (Independent t-test and Welch’s t-test) statistics were done by Statistical Package for Social Sciences (SPSS) software, with p<0.05 as significant. Results: Means of nasofrontal angle was 123.79°±13.28° in males and 133.59°±6.72° in females, nasofacial angle was 33.94°±4.74° in males and 32.08°±3.47° in females, nasolabial angle was 93.49°±13.61° in males and 96.07°±12.20° in females, nasal-tip angle was 82.03°±5.05° in males and 82.69°±6.09° in females, inter-alar angle was 77.73°±10.58° in males and 79.14°±10.16° in females. Nasofrontal angle was found to be significantly higher in females, whereas nasofacial angle was higher in males. All angles also showed significant differences with those found by other authors in various ethnicities. Conclusion: Normal values of nasal angular parameters of the Garhwal Himalayan population have been established in this study. This will prove its worth during plastic surgeries of the face, diagnosing genetic diseases, manufacturing facial accessories and criminal investigation procedures.

Effect of Extraction of Mesioangularly Impacted Mandibular Third Molars on the Periodontal Status of Adjacent Second Molars: A Retrospective Observational Study

Yang Liu, Jiuqing Lu, Yichao Shen, Lei Zhen, Jiapeng Wang

Introduction: The Mandibular Third Molar (M3M), often the last tooth to erupt, is commonly impacted due to insufficient space in the dental arch, leading to various oral health complications such as pericoronitis, infections, root resorption, cysts, and tumours. Notably, mesioangular impaction is the most prevalent type and is closely associated with the caries and periodontal issues of the Mandibular Second Molar (M2M). Periodontal diseases are significant contributors to tooth loss in adults, and the absence of M2M poses challenges for restoration while increasing the burden on remaining teeth. Aim: To evaluate the effect of extracting mesioangularly impacted M3M on the periodontal status of M2M. Materials and Methods: A retrospective observational study with pre- and post-comparisons was conducted at Tongji Hospital, affiliated with Tongji University, Shanghai, China, from October 2024 to February 2025. A total of 56 patients were included. Periodontal parameters, including Probing Depth (PD) and Bleeding On Probing (BOP), were evaluated before and after tooth extraction. Statistical analyses were performed using paired comparisons with the Wilcoxon signed-rank test, group comparisons with the Mann-Whitney U test and the Kruskal-Wallis test, and unpaired t-test and Welch’s Analysis of Variance (ANOVA) where appropriate. A p-value of <0.05 was considered statistically significant. Results: There were 32 males and 24 females. The age of patients ranged from 16 to 45 years. Results showed a significant reduction in PD from 4.2±1.1 mm pre-extraction to 2.8±0.9 mm post-extraction (p<0.01). Additionally, factors such as the angulation and depth of impaction were identified as significant risk factors for bone loss around M2M. Conclusion: The extraction of mesioangularly impacted M3M significantly improves the periodontal health of M2M, supporting the need for timely intervention in similar clinical scenarios. Future studies with larger sample sizes and long-term follow-ups are warranted to further elucidate the relationship between third molar management and periodontal health outcomes in adjacent teeth.

Antibacterial Evaluation of Plectranthus amboinicus-infused Glass Ionomer Cement Against Streptococcus mutans: An In-vitro Study

Shambavi V Kadam, Vignesh Ravindran

Introduction: Dental caries remains one of the most prevalent oral diseases worldwide and is strongly associated with Streptococcus mutans, while conventional Glass Ionomer Cement (GIC) has limited intrinsic antibacterial activity. Therefore, there is a need to develop modified restorative materials with enhanced antimicrobial properties to reduce bacterial colonisation and improve clinical outcomes. Aim: The present preliminary in-vitro study aimed to evaluate and compare the antibacterial efficacy of Plectranthus amboinicus aqueous extract-modified GIC with that of conventional GIC against Streptococcus mutans using Colony-Forming Unit (CFU) enumeration and crystal violet assay. Materials and Methods: This preliminary in-vitro study was conducted in the Department of Microbiology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from December 2025 to January 2026. An aqueous extract of Plectranthus amboinicus was prepared and incorporated into Type II GIC (GC Corporation, Tokyo, Japan) to form the test group. At the same time, conventional GIC served as the control group. A total of six cylindrical specimens (5 mm × 2 mm) were fabricated, with three specimens in each group (n=3). Each specimen was incubated with a standardised Streptococcus mutans suspension. Antibacterial activity was evaluated using serial dilution and CFU enumeration. Biofilm biomass was assessed using a crystal violet assay with absorbance measured at 592 nm. All experiments were performed in triplicate for each group. Statistical analysis was carried out using an Independent samples t-test (Welch’s correction), with a p-value <0.05 considered statistically significant. Results: The I#IPI?I. amboinicus modified GIC demonstrated consistently lower colony counts and optical density values than the control at all tested dilutions, indicating enhanced antibacterial performance. Mean CFU values in the modified group were reduced from 222.33 to 198.00 CFU/mL at 10-6 dilution, from 205.33 to 147.67 CFU/mL at 10-5, and from 143.67 to 95.33 CFU/mL at 10-4, with all differences statistically significant (p<0.001). Similarly, mean OD values decreased from 2.137 in the control to approximately 1.48 in the modified GIC group (p<0.001), reflecting reduced biofilm biomass. Conclusion: Incorporation of Plectranthus amboinicus aqueous extract into glass ionomer cement significantly enhances its antibacterial efficacy against Streptococcus mutans in-vitro. This modification may represent a promising approach to improving the antimicrobial profile of restorative materials and potentially reducing the risk of secondary caries. However, further studies are required to evaluate its physicochemical properties, biocompatibility, and long-term clinical performance.

Comparative Effectiveness of Interactive Panel Board and Chalkboard Teaching Aids among Second-year MBBS Students: A Quasi-experimental Study

Krishna Singh, Rahul Vaish, Dheeraj Kumar Mulchandani, Ashish Kumar Dixit

Introduction: The Competency-Based Medical Education (CBME) stresses practicality, reasoning, and engagement. Many consider pharmacology challenging, and hence, there is a need for an efficient way to teach the course. There is a paucity of literature comparing the effectiveness of interactive smart panel boards and chalkboard teaching based on objective parameters in India. Aim: To evaluate and to compare interactive smart panel board and chalkboard teaching in undergraduate pharmacology. Materials and Methods: The present quasi-experiment was performed on 103 second-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students in the Department of Pharmacology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India, from February 2025 to March 2025. Six topics related to the Central Nervous System (CNS) were covered by either the interactive panel board method (3 topics) or the chalkboard (3 topics) in random order. Change in knowledge was evaluated using pre-test and post-test Multiple-Choice Questions (MCQs). Perception was measured by a 17-item Likert scale questionnaire. Paired and independent sample Student’s t-test was used to analyse data. Statistical significance was set at p<0.05. Results: Both instructional methods demonstrated a significant improvement in post-test scores (p<0.001). The mean knowledge gain was notably higher with the smart panel board (3.74±1.02) compared to the chalkboard (2.73±0.96) (p<0.001). A majority of the students expressed a preference for the smart interactive panel board 48 students (46.6%) and mixed teaching techniques (30.1%), whereas only 16 (15.5%) indicated a preference for the chalkboard as the sole instructional method. Conclusion: Smart teaching was more effective in terms of instant learning and engagement, whereas chalkboard was superior for note-taking purposes. A combined method of teaching could yield the best results.

Awareness and Knowledge of Vestibular Dysfunction among Individuals with Diabetes Mellitus: A Cross-sectional Study

Uzma Abdul Wahid Shaikh, Kiran Yatin Pawar

Introduction: Vestibular dysfunction is a debilitating yet under-recognised complication of Diabetes Mellitus (DM) that significantly elevates fall risk and diminishes quality of life. Clinical studies demonstrate a significant prevalence of vestibular impairment in diabetic populations; however, there is a notable deficiency of data concerning patient awareness of this relationship. Understanding this awareness gap is essential to justify the integration of vestibular screening into standard diabetes care and to develop targeted educational interventions that promote early diagnosis. Aim: To assess awareness and knowledge regarding vestibular dysfunction among individuals with chronic Diabetes Mellitus (DM) Type 1 (T1DM) and Type 2 DM (T2DM) using a validated questionnaire. Materials and Methods: This community-based cross-sectional observational study, was conducted in association with KJ Somaiya College of Physiotherapy, Mumbai, Maharashtra, India, from March 2025 to August 2025, involving 150 individuals aged 30 to 60 years. Participants were recruited using convenience sampling from KJ Somaiya Hospital (OPD and IPD) and residential communities in East Mumbai, Maharashtra, India. A validated questionnaire was used to collect data on the levels of awareness and knowledge of vestibular dysfunction in patients with DM. Microsoft Excel was used to perform descriptive statistics, and results were represented using tables and bar graphs. Results: Only 23 of the 150 participants (15.3%) were aware that diabetes may contribute to vestibular impairment. While 79 (52.7%) participants understood that dizziness is not solely attributable to hypotension or hypoglycaemia, familiarity with specific vestibular terminology was limited. Vertigo was recognised by 92 (61.3%) participants, whereas nystagmus was recognised by only 17 (11.3%). While 108 (72.0%) recognised that glycaemic control could alleviate symptoms, only 54 (36.0%) were aware of physiotherapy-based Vestibular Rehabilitation (VR). A higher level of education was significantly associated with increased awareness and knowledge scores. Conclusion: There is a substantial gap in patient awareness regarding the vestibular complications of diabetes. Awareness and knowledge levels were associated with educational status. Early screening, physiotherapy-based interventions and the integration of vestibular health education into diabetes care may reduce fall risk and improve quality of life.

Association of Residual Stromal Tumour Infiltrating Lymphocytes with Pathological Response Following Neoadjuvant Chemotherapy in Breast Carcinoma: A Retrospective Cohort Study

K Hari Krishna, MS Supreetha, A Hemalatha, PN Sreeramulu

Introduction: Tumour Infiltrating Lymphocytes (TILs) are important indicators of the host immune response and established predictive biomarkers primarily in Triple-Negative Breast Cancers (TNBC) and Human Epidermal Growth Factor Receptor 2 (HER2) - positive Breast Cancers (BC), but not across all BC subtypes. However, the biological and clinical significance of residual stromal TILs following Neoadjuvant Chemotherapy (NACT) remains incompletely understood. Unlike pre-treatment TILs, residual stromal TILs reflect the post-treatment tumour immune microenvironment and may provide additional information on pathological response and residual disease burden. Evaluating residual stromal TILs on routine Haematoxylin and Eosin (H&E)-stained sections offers a simple, reproducible, and cost-effective approach that could enhance routine pathological assessment. Aim: To evaluate the distribution of residual stromal TILs in post-neoadjuvant surgical resection specimens and its association with pathological response. Materials and Methods: This retrospective cohort study was conducted at the Department of Pathology, Sri Deveraj URS Medical College, Kolar, Karnataka, India, from January 2021 to January 2025. A total of 47 patients with histopathologically confirmed BC treated with NACT followed by surgery. Residual stromal TILs were evaluated in residual invasive tumour on post-treatment resection specimens using H&E sections, in accordance with International Immuno-oncology Biomarker Working Group recommendations, and categorised as low (<10%), intermediate (10-50%), or high (>50%). Pathological response was assessed using the Miller-Payne Grading System (MPGS) and Residual Cancer Burden (RCB) classification. Associations between residual stromal TIL categories and treatment response were analysed using Fisher’s-exact test and Spearman’s rank correlation coefficient. Results: Among the 47 patients, low residual stromal TILs were identified in 17 (36.2%), intermediate residual stromal TILs in 17 (36.2%), and high residual stromal TILs in 13 (27.6%). Pathological Complete Response (pCR) was achieved in 4 (8.5%) patients. No statistically significant association was observed between residual stromal TIL category and pCR (Fisher’s-exact test, p=0.36). Residual stromal TIL category demonstrated a moderate positive correlation with MPGS (Spearman’s ρ=0.56, p<0.001) and a moderate negative correlation with RCB class (Spearman’s ρ=-0.48, p=0.002). Notably, higher residual stromal TIL levels were observed more frequently among patients demonstrating better pathological response. Conclusion: Residual stromal TILs demonstrated significant associations with graded pathological response following NACT but not with pCR. Routine assessment of residual stromal TILs may complement pathological response evaluation, although larger prospective studies are needed to establish their clinical utility.

Evaluation of Traditional and Pictorial Symptom Scores among Indian Men with Lower Urinary Tract Symptoms: A Retrospective Observational Study

Eeshansh Khare

Introduction: The traditional questionnaire for Lower Urinary Tract Symptoms (LUTS) in males is the International Prostate Symptom Score (IPSS). To minimise its limitations, a picture-based Visual Prostate Symptom Score (VPSS) was developed as an alternative. Aim: To compare the ease of use, applicability, and clinical correlation of the Traditional Symptom Score (TSS) and Pictorial Symptom Score (PSS) among Indian men presenting with LUTS. Materials and Methods: This was a retrospective, record-based observational study conducted on 100 male patients with LUTS in the Outpatient Department (OPD) of the Urology Department at Vivanta Critical Care and Multispeciality Hospital, Chhindwara, Madhya Pradesh, India, from January 2024 to December 2024. The first 50 patients were given the IPSS questionnaire to complete, followed by the VPSS, and were considered Group I; the next consecutive 50 patients who completed the VPSS first and the IPSS later were considered Group II. Evaluation parameters were age, education status, time taken for filling symptom scores, help needed for filling symptom scores, prostate-specific antigen, prostate size, and uroflowmetry parameters. Unpaired t-test, Chi-square test, and Pearson’s correlation test were used in statistical analysis. Results: The majority of patients, 16 (32%) in Group I and 20 (40%) in Group II, were aged 61-70 years. 29 (58%) in group I and 16 (32%) in group II had an average educational status of primary education and below. Thirty-two patients in group I completed the PSS without help, but only 15 in group II completed the TSS without help. 12 patients had difficulty completing the PSS, compared with 38 for the TSS. Difficulty faced by patients was understanding the scoring systems of each question and the questions asked in questionnaires. Mean Prostate-specific antigen (PSA) in group I and II was 2.46±1.5 ng/mL and 2.17±1.35 ng/mL, respectively. Patients with increased prostate size had a higher total score in group I (r=0.91) and group II as well (r=0.90). PSA also showed a positive correlation with both scores (r=0.83 and r=0.76, respectively). Both TSS and PSS showed a negative correlation with maximum flow rate (r = -0.60 and r = -0.76, respectively). Conclusion: The PSS was easier for patients to complete than the traditional symptom score. The severity of LUTS was strongly correlated with both symptom scores. Maximum urinary flow rate inversely correlated with both symptom scores.

Clinicopathological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Cross-sectional Study from Tertiary Care Centre in Kerala, India

Introduction: Thrombotic Microangiopathy (TMA) is a clinicopathological syndrome characterised by endothelial injury, microvascular thrombosis, and organ dysfunction. Renal involvement is common and may result from diverse primary and secondary aetiologies. The aetiological spectrum and histopathological manifestations of renal TMA vary considerably among different populations and clinical settings. Renal biopsy not only confirms the diagnosis but also provides valuable information regarding the pattern and chronicity of vascular and glomerular injury, which may have prognostic significance. Studies evaluating the spectrum of biopsy-proven renal TMA are limited, particularly from the Indian population, making such analyses important for improving diagnostic accuracy and patient management. Aim: To evaluate the clinicopathological features and aetiological spectrum of TMA in renal biopsies. Materials and Methods: This retrospective cross-sectional observational study was conducted in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India and included all native and graft renal biopsies diagnosed with TMA between January 2020 and December 2024. Cases of Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and biopsies lacking definitive histological features of TMA were excluded. Clinical parameters (age, sex, blood pressure, proteinuria, haematuria, renal function), laboratory parameters (haemoglobin, platelet count, serum creatinine, serum albumin, complement levels), and histopathological features were evaluated. Acute and chronic TMA lesions were assessed, and cases were categorised according to underlying aetiology. Data were entered into Microsoft Excel and analysed using descriptive statistics. Continuous variables were expressed as mean±standard deviation, while categorical variables were presented as frequencies and percentages. Results: Among 2,302 renal biopsies examined during the study period, 55 (2.4%) showed histological evidence of TMA. Forty-seven cases involved native kidneys and eight involved renal allografts. The mean age at presentation was 41.6±13.3 years, and 32.7% of patients were female. Hypertension-associated TMA was the most common aetiology, accounting for 30 (54.55%) of cases, followed by transplant-associated TMA 8 (14.55%), IgA Nephropathy 7 (12.73%) autoimmune diseases 5 (9.09%), infection-related TMA 3 (5.45%), atypical haemolytic uraemic syndrome 1 (1.82%) and snake bite 1 (1.82%). All infection-related cases were associated with Coronavirus Disease-2019 (COVID-19). Proteinuria (89%) and microscopic haematuria (61.8%) were common clinical findings. Histologically, vascular lesions predominated, with fibrointimal hyperplasia and arteriolar thrombi being the most frequent abnormalities. Chronic vascular changes were more common than acute thrombotic lesions. Only two (3.64%) patients had thrombocytopenia, including the single case of complement-mediated atypical Haemolytic Uraemic Syndrome (aHUS). Conclusion: Secondary causes predominate in renal TMA, with hypertension-associated TMA being the leading aetiology. Chronic vascular lesions are common and may reflect delayed presentation and sustained endothelial injury. Renal biopsy remains essential for diagnosis, aetiological classification, and identification of uncommon causes of TMA.

Correlation of Lumbar Spine MRI Signal Alterations with DEXA-derived Bone Mineral Density and T-scores: A Cross-sectional Analytical Study

Amit Sarma, Mrinal Kanti Singha

Introduction: Osteoporosis is a systemic skeletal disorder that increases the risk of fragility fracture and constitutes a major global health burden. Dual-Energy X-Ray Absorptiometry (DEXA) is the clinical reference standard for Bone Mineral Density (BMD) assessment but, as a two-dimensional projection technique, does not directly evaluate trabecular microarchitecture or marrow composition. Magnetic Resonance Imaging (MRI) signal characteristics of vertebral marrow have been proposed as opportunistic markers of Vertebral Bone Quality (VBQ). Aim: To evaluate the correlation between lumbar spine MRI signal alterations (T1- and T2-weighted) and DEXA-derived BMD parameters, including BMD, T-score and Z-score, in patients undergoing lumbar spine imaging. Materials and Methods: A cross-sectional analytical study was conducted at Assam Down Town University, Guwahati, Assam, India, from October 2023 to April 2024. A total of 100 adults of either sex who underwent both lumbar spine MRI (1.5 Tesla) and DEXA were evaluated. A circular Region Of Interest (ROI) of 1 cm² was placed in the central trabecular portion of the L3 vertebral body on T1- and T2- weighted sagittal images, avoiding cortical bone, end-plate changes and focal lesions. DEXA-derived BMD was classified according to World Health Organisation (WHO) T-score criteria. Pearson’s correlation coefficient with 95% Confidence Intervals (CI) was used to assess associations; a two-tailed p-value <0.05 was considered significant. Results: The cohort comprised 52 females (52%) and 48 males (48%). Based on lumbar (L1-L4) T-scores, 42 (42%) participants had normal BMD, 31 (31%) osteopenia and 27 (27%) osteoporosis. Reduced BMD was more frequent among females and older participants. The T-score showed weak but statistically significant negative correlations with T1-weighted (r=-0.214; 95% CI -0.394 to -0.018; p-value=0.033) and T2-weighted (r=-0.208; 95% CI -0.389 to -0.012; p-value=0.038) signal values. The Z-score correlated strongly with mean BMD (r=0.685; 95% CI 0.565 to 0.777; p-value <0.001); as the Z-score is derived from BMD, this served as an internal consistency check. Conclusion: Lumbar vertebral MRI signal alterations showed weak but statistically significant associations with DEXA-derived BMD, suggesting that routinely acquired lumbar MRI may provide supplementary, opportunistic information on VBQ. The modest strength of these correlations indicates that MRI signal cannot currently replace DEXA for the diagnosis of osteoporosis.

Efficacy of Dexmedetomidine as an Adjuvant in Subarachnoid Block versus Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy under Spinal Anaesthesia: A Double-blinded Randomised Clinical Study

Rachana S Kori, J Vasantha Kumar, Shilpa Nijalingappa Bingi, Sharmila Somayaji

Introduction: Postoperative pain continues to be a major concern in patients undergoing abdominal surgeries despite advances in regional anaesthesia. Dexmedetomidine is found to have analgesic properties, hence used as an adjuvant for enhancing postoperative analgesia in both central neuraxial and peripheral nerve block. Aim: To compare the efficacy of dexmedetomidine as an adjuvant in subarachnoid block versus Transversus Abdominis Plane (TAP) block in patients posted for total abdominal hysterectomy under spinal anaesthesia. Materials and Methods: This double-blinded randomised clinical study was conducted at Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India. A total of 70 patients undergoing elective total abdominal hysterectomy under subarachnoid and TAP block. Patients were randomly allocated into two groups (n=35 each). Patients were administered intrathecal 2.8 mL of 0.5% hyperbaric bupivacaine. At the end of surgery, an ultrasound-guided bilateral TAP block was administered using 20 mL of 0.25% bupivacaine on each side (total volume made up to 22 mL). Group SD (Spinal Dexmedetomidine group) received 5 μg (0.05 mL) of dexmedetomidine intrathecally and Group TD (TAP Dexmedetomidine group) received 25 μg dexmedetomidine in TAP block. Haemodynamic parameters, postoperative Visual Analogue Scale (VAS) pain score, time to first rescue analgesia, total rescue analgesic consumption in 24 hours, and sedation scores were noted. Data were analysed using an independent samples t-test and a Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Demographic parameters were comparable between the groups (age, weight, American Society of Anaesthesiologists (ASA) status). Postoperative VAS scores at 0 hour were significantly lower in Group SD (0.8±1.5) compared to Group TD (1.9±2.1) (p-value <0.05). The time to first rescue analgesia was significantly prolonged in Group SD (396.0±200.7 minutes) compared to Group TD (195.4±92.4 minutes) (p-value <0.001). The total postoperative rescue analgesic requirement within 24 hours was significantly lower in Group SD (144.3±45 mg) compared to Group TD (182.9±45.3 mg) (p-value=0.001) haemodynamic parameters remained stable in both groups. Conclusion: Intrathecal dexmedetomidine as an adjuvant to spinal anaesthesia provides superior early postoperative analgesia, prolonged duration of analgesia, and reduced postoperative analgesic requirement compared to dexmedetomidine administered in TAP block. Both techniques maintained satisfactory haemodynamic stability with minimal adverse effects.

Dexmedetomidine-bupivacaine versus Ketamine-bupivacaine for Ultrasound-guided Axillary Brachial Plexus Block in Forearm and Hand Surgeries: A Triple-blind Randomised Clinical Study

Introduction: Single-injection ultrasound-guided axillary brachial plexus block provides effective anaesthesia for forearm and hand surgery, but analgesia is limited by local anaesthetic duration. Dexmedetomidine and ketamine are used as adjuvants, though their comparative axillary-block efficacy remains inadequately defined in clinical studies. Aim: To compare dexmedetomidine and ketamine as adjuvants to bupivacaine for ultrasound-guided axillary block in adult patients undergoing elective forearm and hand surgeries. Materials and Methods: This triple-blind randomised parallel-group clinical study was conducted in the Department of Anaesthesiology, Krishna Hospital and Medical Centre, Karad, Maharashtra, India. The study included 60 American Society of Anesthesiologists Physical Status (ASA-PS) I-II adults aged more than 18 years undergoing elective forearm and hand surgeries under ultrasound-guided axillary block. Participants were randomised into two equal groups. Group D received 30 mL of 0.25% bupivacaine with dexmedetomidine 100 μg diluted in 2 mL, while Group K received 30 mL of 0.25% bupivacaine with ketamine 100 mg in 2 mL. Sensory and motor onset, sensory, and motor duration, duration of analgesia, rescue analgesic requirement, Visual Analogue Scale (VAS) scores, sedation, satisfaction, haemodynamic variables and adverse events were recorded. Continuous variables were expressed as mean±standard deviation and compared using Student’s unpaired t-test or appropriate parametric tests. Categorical variables were expressed as number and percentage and compared using Chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Results: Demographic characteristics were comparable between the groups. Sensory onset was similar in Group D and Group K (11.6±2.6 versus 12.1±2.4 minutes; p-value=0.442), whereas motor onset was significantly earlier in Group D (13.46±3.31 versus 16.83±1.37 minutes; p-value<0.001). Group D had longer sensory block duration (413.97±87.31 versus 227.00±48.36 minutes), motor block duration (472.24±90.06 versus 292.67±59.13 minutes), and duration of analgesia (440.2±121.2 versus 251.7±57.1 minutes) (all p-value<0.001). The proportion of patients requiring rescue analgesia was lower in Group D than in Group K (53.3% versus 86.7%; p-value=0.010). Group D also demonstrated lower VAS scores at 6, 12, and 18 hours, with clinically acceptable haemodynamic changes. Conclusion: Dexmedetomidine added to bupivacaine for ultrasound-guided axillary block produced faster motor onset, prolonged sensory-motor blockade and better postoperative analgesia than ketamine, with manageable sedation and infrequent bradycardia.

A Five-year Antimicrobial Susceptibility Trend among Bacterial Isolates from Blood Culture at a Tertiary Health Care Facility: A Retrospective Study

Introduction: Antimicrobial Agents (AMA) frequently used to treat Bloodstream Infections (BSI) when inappropriately used give rise to Antimicrobial Drug Resistance (AMR). Monitoring blood culture isolates with Antimicrobial Susceptibility Testing (AST) determines pattern of antibiotic resistance can help to promote its rational use. Aim: To estimate clinicodemographic associates and trend of Antimicrobial Susceptibility among bacterial blood culture isolates over five-years (2019-2024). Materials and Methods: This study was a retrospective record-based design done in the Department of Pharmacology in collaboration with the Department of Microbiology in Maharaja Krushna Chandra Gajapati, Medical College and Hospital, Berhampur, Odisha, India. All consecutive laboratory confirmed cases reported for blood culture AST using Clinical and Laboratory Standards Institute (CLSI) guidelines from December 2022 to December 2024 over five-year 2019-2024 were analysed for resistance and sensitivity pattern. All consecutive samples were taken and 1572 cases adhering to inclusion criteria were included. Percentage of AMA resistant and sensitive to different clinico-demographic associates was computed using Jamovi version 2.7.14. Results: There was a rising trend of Antimicrobial Resistance (AMR) from 12.5% to 14.5% from 2019-2024. Statistically significant association p<0.05 were obtained for AMR patterns Ampicillin-Sulbactam-Cefepime-Ceftriaxone-Cefexime-Piperacillin-Tazobactam (AMS-CEP-CTR-CIX-PIT) with different clinicodemographic associates with A.baumannii being the predominant bacterial isolate in neonatal sepsis with a male gender preponderance. Association of sensitivity to Cotrimoxazole-Gentamycin-levofloxacin-linezolid-meropenem-teicoplanin-vancomycin (COT-GEN-LEV-LIN-MER-TEI-VAN) to different associates was also found to be statistically significant p<0.05. Conclusion: Multidrug Resistance (MDR) being a potential matter of concern can be overcome with rational use of antibiotics and standardised timely susceptibility surveillance. Hence, AMAs which are sensitive in bacterial isolates have to be utilised judiciously to prevent further development of AMR to the existing antibiotics in future.

Cultivating Emotional Intelligence among Indian Medical Students: Perceptions and Experiences

Introduction: Emotional Intelligence (EI) is a critical attribute for medical professionals, encompassing self-awareness, self-regulation, motivation, empathy, and social skills. Indian medical students face exceptional stress due to intense academic competition, hierarchical structures, and limited mental health resources. Although structured EI interventions have demonstrated promise internationally in reducing burnout and improving clinical performance, systematic EI training remains largely absent from Indian medical curricula. Aim: To explore the perceptions and experiences of Indian medical graduates regarding the application of EI skills in their clinical and academic lives after completing a structured Value Added Course (VAC). Materials and Methods: This qualitative study was conducted at the Department of Psychiatry, Pramukhswami Medical College, Karamsad, affiliated with Shree Krishna Hospital, a tertiary care Institute in Gujarat, India, between September 2024 and April 2025. The study involved medical students who had participated in a three-month VAC titled “Developing Emotional Competencies,” based on Goleman’s EI model. The course addressed self-awareness, self-management, social awareness, and relationship management through interactive learning and reflective activities. The primary inclusion criterion was participation in the VAC on EI. A total of 10 students were eligible, of whom five students participated in the Group Interview (GI). The interview, conducted approximately one year after course completion, was audio-recorded and transcribed. Thematic analysis was performed following Braun and Clarke’s framework to identify patterns across the data. Results: Seven overarching themes emerged: EI in clinical practice, self-awareness management, social awareness and relationships, professional development, stress and burnout management, EI educational programs, and personal benefits. Students demonstrated concrete applications of EI in patient interactions, emphasising empathetic care while maintaining professional boundaries. Self-awareness emerged as foundational to all EI domains. Participants reported enhanced confidence in navigating emotionally charged interactions, improved recognition and management of stress, and normalised emotional experiences. Cross-cutting patterns revealed an evolution from theoretical understanding to practical application. Conclusion: Medical students perceive structured EI training as beneficial for fostering emotional awareness, interpersonal sensitivity, and adaptive coping during medical education. Embedding EI within medical curricula may offer a meaningful avenue to support the holistic development and emotional well-being of future healthcare professionals.

Association of Vessel Wall MRI Findings with Clinical Outcomes in Atherosclerotic Ischaemic Stroke: A Systematic Review

Amrit Arun Bansod, Tushar Patil, Lalit Nirwan

Introduction: Vessel wall Magnetic Resonance Imaging (MRI) is a promising modality for identifying and characterising the atherosclerotic plaque and the vascular pathology. However, the prognostic value of vessel wall characteristics has not been established and is undefined. Aim: To assess the association between plaque characteristics on vessel wall MRI with clinical outcomes in patients with ischaemic stroke. Materials and Methods: The present systematic review was conducted at the Department of Neurology, Super Speciality Hospital and Government Medical College, Nagpur, and Datta Meghe Institute of Higher Education and Research,Wardha,Maharashtra,India between January 2026 and April 2026. The present systematic review was registered in Prospective Register of Systematic REviews (PROSPERO) (Reg no. CRD420261357174) and was conducted according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Studies involving adult patients (>18 years) with atherosclerotic ischaemic stroke who underwent 3-Tesla vessel wall MRI were included. Prospective and retrospective cohort studies with more than 20 participants and full-text articles published in English from 2016 onwards were included, while case reports, case series, reviews, randomised controlled trials, and studies involving non atherosclerotic stroke aetiologies were excluded. A comprehensive literature search was performed in PubMed, Embase, ScienceDirect, Cochrane Library, and Google Scholar upto January 2026 using predefined MeSH terms and Boolean operators. A total of seven studies meeting the inclusion and exclusion criteria were included in the review including 766 patients. Risk of bias in included studies was assessed independently by two reviewers using the Newcastle Ottawa Scale (NOS), and the strength of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Results: The included studies were of high methodological quality; however, the certainty of evidence ranged from very low to moderate as per GRADE assessment due to observational nature of studies and heterogeneity in outcome definitions. The plaque characteristics included Intraplaque Haemorrhage (IPH), plaque enhancement and permeability, plaque burden and plaque composition showed significant association with poor functional outcomes. Plaque enhancement also independently predicted stroke recurrence (Hazard ratio: 2.17, 95% Confidence interval: 1.27-3.70). These were also associated with high National Institutes of Health Stroke Scale (NIHSS) score at admission. Conclusion: Plaque characteristics on vessel wall MRI, particularly IPH and plaque enhancement, show consistent associations with adverse functional outcomes and recurrence of stroke. These findings suggest a potential role of vessel wall MRI in risk stratification and prognostic assessment in patients with ischaemic stroke; however, larger multicentric prospective studies are required to establish generalisability and prognostic utility.

Tamponade Dressing versus Regular Dressing Following Incision and Drainage of Perianal Abscess: A Prospective Observational Study

Bhavya, S Jayakanthan

Introduction: Perianal abscess is a common anorectal emergency typically managed by Incision and Drainage (I&D). However, the optimal postoperative dressing method remains controversial, with limited evidence comparing tamponade dressing and regular dressing regarding wound healing and fistula formation. Aim: To compare tamponade dressing and regular dressing following I&D of perianal abscess with respect to postoperative pain severity, wound healing, healing duration, postoperative complications, and fistula-in-ano formation. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery of Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from November 2024 to April 2026. A total of 62 adult patients with primary perianal abscesses were included and equally categorised into tamponade dressing (n=31) and regular dressing (n=31) groups. All patients underwent I&D under appropriate anaesthesia. Outcomes assessed included postoperative pain severity, wound healing status, healing duration, postoperative complications, and fistula-in-ano during follow-up. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent samples t-test, Pearson’s Chi-square test, and Fisher’s-exact test were applied as appropriate. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 42.60±15.65 years and 36 (58.1%) were males. Baseline demographic and clinical characteristics were comparable between the groups. Mild postoperative pain was observed in 15 (48.4%) patients in the tamponade group and 9 (29.0%) in the regular dressing group, while severe pain occurred in 4 (12.9%) and 8 (25.8%) patients, respectively (p=0.225). Healthy wound healing was noted in 24 (77.4%) patients receiving tamponade dressing compared with 17 (54.8%) receiving regular dressing (p=0.163). Healing within two weeks occurred in 14 (45.2%) and 8 (25.8%) patients, respectively, whereas healing beyond four weeks occurred in 5 (16.1%) and 12 (38.7%) patients. Healing duration showed a significant trend favouring tamponade dressing (p=0.038). The overall postoperative complication rate was significantly lower in the tamponade dressing group than in the regular dressing group (3.2% vs. 29.0%, p=0.006). Fistula-in-ano developed in 3 (9.7%) patients receiving tamponade dressing compared with 8 (25.8%) patients receiving regular dressing (p=0.096). Conclusion: Tamponade dressing demonstrated a lower numerical incidence of fistula formation; however, the difference was not statistically significant.

Dry Eye Disease in Psychiatric Disorders: A Cross-sectional Study on Prevalence and its Impact on Sleep Quality and Quality of Life

Introduction: A bidirectional relationship exists between Dry Eye Disease (DED) and mental health. Approximately, 23% of patients with mild DED have psychiatric co-morbidities, with higher risks in moderate and severe cases. DED also impacts sleep patterns and productivity, affecting Quality of Life (QoL). Aim: To estimate the prevalence of DED among patients with mental disorders and its impact on sleep quality and QoL. Materials and Methods: The present cross-sectional study was conducted at the Department of Psychiatry and the Department of Ophthalmology in a tertiary care centre, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India from February 2021 to February 2022, involved four groups namely Group A1 {Patients with mental disorders and DED from Psychiatry Outpatient Department (OPD)} (n=61), Group A2 (DED patients with Mental disorders from ophthalmology OPD) (n=68), Group B (Patients with Mental disorders alone) (n=44) and Group C (patients with DED alone) (n=48). Assessments included the Clinical Global Impression Severity scale (CGI-S), Sleep Condition Index (SCI), QoL Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), and clinical ocular tests like Tear Film Break-up Time (TBUT) and Schirmer’s test. Independent t-test was used to compare continuous variables with normal distribution whereas Mann-Whitney U test was used to compare continuous variables with non-normal distribution. Chi-square test was used to compare categorical variables. Spearman correlation was carried out to assess correlation between variables and predictive analysis was carried out using multiple logistic regression. Results: The prevalence of DED among patients with psychiatric disorder was found to be 58.09%. Participants with comorbid psychiatric and DED (A1) had significantly lower QoL (Q-LES-Q-SF) and poorer sleep (SCI) compared to those with only psychiatric disorders (B), with most reporting poor or fair QoL (p<0.001). Though participants in A2 had more instances of eye disorders in family (p=0.002) compared to DED only participants (C), the TBUT and Schirmer’s test severity did not vary significantly between any of the groups. Conclusion: DED is increasingly prevalent among patients with severe mental disorders, significantly affecting sleep quality and QoL. A multidisciplinary management approach involving timely screening and referral by ophthalmologists and psychiatrists could improve outcomes.

Cyberchondria and its Correlation with Depression among Parents of Under-five Children in an Urban Community of Tamil Nadu, India: A Cross-sectional Study

SU Bhavan Kumar, K Bincy, R Diwakar, P Kaveri, MVM Pradeep

Introduction: Cyberchondria is characterised by an increase in health-related distress or anxiety, reassurance-seeking behaviour and frequent excessive online health searches. Parents are more vulnerable to this habit because they are likely to look up not just their own illness, but also their children’s. Aim: To determine how common depression and cyberchondria are among urban parents of under-five children in Tamil Nadu, as well as the factors associated with these conditions. Materials and Methods: A community-based cross-sectional study was conducted over three months in a selected Primary Health Centre (PHC) of Kattankulathur block, Chengalpattu district, Tamil Nadu, India among parents of under-five children aged (≥21 years). The minimum required sample size was calculated as 215; A total of 230 households was approached, of which 228 participants completed the questionnaire and were included in the final analysis. Participants were selected using a multistage sampling technique. Structured questionnaires - the Cyberchondria Severity Scale-12 (CSS-12) and the Patient Health Questionnaire-9 (PHQ-9) were used to measure cyberchondria and depression severity, respectively. Pearson’s correlation (between continuous CSS-12 and PHQ-9 scale scores) and multivariable linear and logistic regression analyses were employed for statistical analysis. Results: The mean age of the study population was 32.5±8.6 years, including females 101 (44.3%), graduates 161 (70.6%), and employed 207 (90.8%). The majority of .them belonged to the upper middle or middle socioeconomic class 178 (78.1%). High levels of cyberchondria severity were observed in 145 (63.6%) of participants, and severe depression in 141 (61.8%) of the participants, with a strong positive correlation between cyberchondria and depression (r=0.869, p<0.001). Conclusion: This community-based cross-sectional study among urban parents of under-five children in Tamil Nadu revealed a high prevalence of cyberchondria (63.6%) and severe depressive symptoms (61.8%), with a significant positive correlation between the two conditions. Female gender and higher socio-economic status were significant independent predictors of high cyberchondria severity. These findings underscore the need for targeted digital health literacy interventions and routine mental health screening for parents of young children in rapidly urbanising communities.

Association of Pancreatic Pseudocysts and Walled-off Necrosis with Clinical Characteristics and Management in Acute Pancreatitis: A Prospective Analytical Study

Introduction: Acute Pancreatitis (AP) is a common inflammatory condition with a clinical spectrum ranging from mild self-limiting disease to severe necrotising pancreatitis associated with significant morbidity and mortality. Early assessment of disease severity is essential for appropriate management and prognostication. Contrast-Enhanced Computed Tomography (CECT) plays a crucial role in evaluating pancreatic necrosis, peripancreatic changes, and local complications. Aim: To evaluate the association of pancreatic pseudocysts and Walled-off Necrosis (WON) with clinical characteristics and management in patients with AP using CECT. Materials and Methods: A hospital-based prospective analytical study was conducted in the Department of Radiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Andhra Pradesh, India, from April 2024 to January 2026. A total of 50 consecutive patients with AP who underwent CECT were included. Pancreatic and peripancreatic fluid collections were classified according to the 2012 Revised Atlanta Classification. Demographic, and outcome data were collected, and associations between the type of fluid collection and clinical characteristics, management, hospital stay, organ failure, and mortality were analysed using appropriate statistical tests. Results: Among 50 patients with AP, 41 (82%) were males, and the 41-50 years age group constituted the largest proportion (32%). Alcohol was the most common aetiology (58%). Pseudocyst was the most frequent fluid collection (58%), while WON was observed in 42% of patients. Moderate and severe pancreatitis was present in 52% and 48% of patients, respectively. A significant association was observed between the type of pancreatic fluid collection and management approach (p-value=0.0449). However, no significant association was found between the type of fluid collection and hospital stay, organ failure, mortality, Modified Computed Tomography Severity Index (MCTSI) score, infection, gender, or aetiology (p-value >0.05). Conclusion: CECT-based assessment using the Revised Atlanta Classification demonstrated a significant association between the type of pancreatic fluid collection and the management approach in the current study.

Student Perceptions of a Non-digital Gamified Student-generated MCQ Strategy in Undergraduate Physiotherapy Education: An Exploratory Mixed-methods Study

Veena Anil Bembalgi, Mrunali Kerkar, Pooja Motar Sublok

Introduction: Traditional lecture-based teaching methods often struggle to maintain student engagement, especially in the context of decreasing student attention spans. Innovative, active-learning strategies are needed to address these challenges. Gamification is one such strategy that can enhance student engagement. Limited evidence exists in physiotherapy education regarding gamified student-generated Multiple Choice Question (MCQ) strategies. Aim: To evaluate undergraduate physiotherapy students’ perception of a non digital gamified MCQ-based teaching-learning strategy. Materials and Methods: The present exploratory mixed-method study was conducted at KLE College of Physiotherapy, Hubballi, Karnataka, India, from July 2025 to November 2025. Fifty undergraduate third-year physiotherapy students participated voluntarily through convenience sampling in a single classroom session. The session began with a traditional lecture, followed by an assignment where students generated MCQs based on the taught topic. Students were divided into two groups of twenty-five each to facilitate participation in the gamified, competitive MCQ quiz session, moderated by the subject expert. Quantitative feedback was collected using a five-point Likert scale and analysed using descriptive statistics and the Mann-Whitney U test. Qualitative data from open-ended questions were analysed thematically. Statistical analysis was performed using Statistical Package for Social Sciences version 30. Results: A total of 85-95% of students reported improved engagement and perceived learning. No objective learning outcomes were measured. While 65% felt confident about the topic post-session, only 50% agreed that referencing textbooks improved learning. Qualitative feedback highlighted increased critical thinking, collaboration, and enjoyment, though some students noted challenges in time management and MCQ quality. No significant differences were found between groups for any of the ten items, indicating broad applicability. Conclusion: The present study shows that a non digital, student-generated MCQ gamification approach is feasible and well accepted, with high engagement and perceived learning. However, its effect on knowledge gain and retention remains unclear due to the absence of objective measures and a controlled design. Future studies should include MCQ training, objective assessments, and longitudinal designs to confirm its impact.

Post-COVID-19 Three-year Trends of Clinical Profile and Outcome of Infants (1-12 months) Hospitalised at the Paediatric Department of a Tertiary Care Teaching Hospital of Gujarat, Western India: A Retrospective Study

Introduction: The post-neonatal period (1-12 months) also represents a critical vulnerability window in child health. Despite substantial global progress in reducing under-five mortality, infant hospitalisations beyond the neonatal period continue to pose considerable challenges, particularly in developing countries where 10-15% of hospitalised infants succumb to preventable conditions. Understanding the clinical profile, temporal trends, and outcomes of hospitalised infants is essential for both, clinicians as well as administrators or policymakers. Aim: To study the 3-year trends of clinical profile and outcome of infants (beyond Neonatal Period) hospitalised at tertiary care teaching hospital after the end of the “Coronavirus Disease-2019 (COVID-19) pandemic”. Materials and Methods: This retrospective study was conducted at the Department of Paediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Gujarat, India over three years (July 2022 to June 2025). All consecutive indoor infants aged 1-12 months during the study period were included. The demographic details and clinical details including outcome were retrieved from medical records and pertinent information collected using a predesigned, structured proforma. Data were analysed using appropriate descriptive and inferential statistical methods. Results: A total of 177 infants were enrolled (Year-wise n=78, 76 and 23, respectively). The overall study cohort showed male predominance of 114 (64.4%). Respiratory infections emerged as the leading diagnosis in 60 (33.9%), followed by cardiovascular disorders 30 (16.9%). About 64 (36.2%) required Paediatric Intensive Care Unit (PICU) admission with critical illnesses. Successful discharge in 151 (85.3%) and mean±SD length of stay was 6.7±8.7 days. Significant relationship was found in trends for increasing prematurity (1.3% to 17.4%, p-value=0.002), declining immunisation completion (65.4% to 26.1%, p-value <0.001). Socio-economic status showed highly significant associations with both outcomes (p-value=0.003) and PICU admission (p-value <0.001). Conclusion: Post-COVID-19 epidemic, 3-year trends showed the temporal trends of rising prematurity rates, declining immunisation rates, and persistent high Discharge Against Medical Advice (DAMA) rates. This study provides essential baseline data for designing evidence-based interventions at tertiary care settings that serve vulnerable populations.

Impact of Virtual Reality on Pain and Fear among Hospitalised Children Undergoing Venipuncture: A Quasi-experimental Study

Renita Prathima Tauro, Priya Reshma Aranha, Renita Priya Dsouza

Introduction: Pain and worry during painful procedures like needle pricks are normal among children admitted in hospitals and can make their overall treatment harder. Virtual Reality (VR) is rapidly becoming a potent new tool that employs immersive play to divert youngsters from their pain and anxiety, while tried-and-true psychological techniques assist alleviate this suffering. Aim: To assess the effectiveness of VR in mitigating pain and fear in children during venipuncture. Materials and Methods: The present quasi-experimental study was conducted in the Paediatric Wards of Yenepoya Medical College Hospital, a tertiary care centre, from September 2024 to August 2025, with main data collection in January and March 2025. The children aged 8-12 years undergoing their first venipuncture after admission was included in the study. The study involved 82 school-age children, 41 each in intervention and control groups. The intervention group received VR during venipuncture and the control group received routine hospital care. Parameters assessed were pain and fear during venipuncture using the Numerical Pain Rating Scale (NPRS) and child fear scale. Statistical analysis was performed using frequencies, percentages, Mann-Whitney U, and Wilcoxon signed-rank tests for score comparisons. Karl Pearson’s correlation was used to relate post-procedure pain and fear, while the chi-square test determined associations with demographic variables. Results: The mean age of children was 10.05±1.57 years; majority was males (51.2% in the intervention group and 63.4% in the control group). The mean post-test pain score was less in the intervention group (2.05±0.74) compared to the control group (6.37±1.69). At the same time the mean post-test fear scores were less in the intervention group (0.20±0.40) compared to the control group (2.07±0.34). The study also found a very highly significant difference (p<0.001) in the mean post-test pain and fear scores between the groups. A strong positive correlation was found between pain and fear scores in children undergoing venipuncture (r=0.82; p<0.001). Conclusion: The VR is found effective in reducing the pain and fear among children undergoing venipuncture.

In-vitro Assessment of Cytotoxicity, Antioxidant Potential and Anti-inflammatory Activity of a Novel Ginseng Gel Formulation

Neha Jain, Arvina Rajasekar

Introduction: Plant-derived bioactive compounds, particularly Panax ginseng, have attracted considerable interest owing to their antioxidant, anti-inflammatory, and cytoprotective properties relevant to human wellbeing and health. Such phytoconstituents are increasingly explored in medicine for addressing inflammation-associated disease and oxidative stress-related illness. Incorporation of these compounds into biocompatible gel formulations may enhance localised therapeutic efficacy when applied to oral mucosal or periodontal tissues while minimising systemic adverse effects, thereby supporting human wellbeing and broader public health outcomes. Aim: To formulate a novel ginseng-based gel and evaluate its cytotoxicity, antioxidant potential, and anti-inflammatory activity using standardised in-vitro assays. Materials and Methods: The present in-vitro experimental study was conducted at the Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, between July 2025 and October 2025. A 2% ginseng gel was prepared using a carbopol-based matrix. Cytotoxicity was assessed using the brine shrimp lethality assay. Antioxidant activity was evaluated using 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) radical scavenging and Ferric Reducing Antioxidant Power (FRAP) assays. Anti-inflammatory activity was determined through Human Red Blood Cell (HRBC) membrane stabilisation and Bovine Serum Albumin (BSA) protein denaturation assays. All experiments were performed in triplicate. Statistical analysis was carried out using one-way Analysis of Variance (ANOVA) and independent samples t-tests, with significance set at p<0.05. Results: The ginseng gel demonstrated a concentration-dependent response in the brine shrimp lethality assay (p<0.001); however, mortality values remained within acceptable limits and did not differ significantly from the standard control (p>0.05). Antioxidant activity increased significantly with concentration in both DPPH and FRAP assays (p<0.001), with activity comparable to reference antioxidants (p>0.05). The formulation also exhibited significant, dose-dependent inhibition of protein denaturation and enhanced membrane stabilisation (p<0.001), comparable to diclofenac sodium (p>0.05). Conclusion: The novel ginseng gel demonstrated acceptable biocompatibility along with significant antioxidant and anti-inflammatory activity under In-vitro conditions, supporting its potential as a localised therapeutic formulation and warranting further in-vivo and clinical evaluation.

Assessing the Impact of Educational Intervention on Staff Nurses’ Knowledge, Attitude and Practice in Urine and Blood Sample Collection for Culture: A Quasi-experimental Study

Rashmi Belodu, TS Kiran, Vijay Gangannagari

Introduction: Urinary Tract Infection (UTI) remains a common infection, with the most common Hospital-Acquired Infection (HAI) being Catheter-Associated Urinary Tract Infection (CAUTI), with overdiagnosis and overtreatment of CAUTIs and unnecessary antibiotic use. Blood Culture Contamination (BCC) is a significant quality and safety issue in hospitals, as it leads to an increase in unnecessary testing, admissions, antibiotic exposure, and cost. Aim: To assess the Knowledge, Attitude, and Practice (KAP) of staff nurses regarding urine and blood sample collection for culture in a tertiary health care centre. Materials and Methods: This quasi-experimental study was conducted between April 2023 and May 2023 at Siddaganga Medical College and Research Institute, Tumakuru, Southern India. A total of 148 staff nurses, all employees of the hospital, who consented to be included in the study with varied age groups and background experience, were included. Self-administered questionnaires consisting of 10 multiple-choice questions each were prepared, validated and subsequently distributed to nurses both before and after participating in an educational intervention of the microbiology department. Results: Of the 148 participants, 129 females and 19 males, nurses demonstrated good knowledge regarding urine container use both before and after training (148; 100%), while knowledge of urine sampling during catheter change improved from 132 (89%) to 141 (95%). Knowledge regarding refrigeration of urine samples improved from 67 (45%) to 126 (85%), and disinfectant use increased from 33 (22%) to 123 (83%). In blood collection practices, knowledge of skin disinfectant use improved from 110 (74%) to 148 (100%), preferred sampling site awareness increased from 121 (82%) to 141 (95%), and knowledge regarding order of blood collection and blood draw volume improved from 38 (26%) to 126 (85%) and from 73 (49%) to 126 (85%), respectively. Conclusion: In this study, it was found that there were gaps in the knowledge and attitude of nurses regarding urine and blood sample collection. The study identified these gaps and helped design a comprehensive ongoing educational programme for nursing staff to address these gaps. It was found that these interventions should be ongoing and inclusive of all nurses for obtaining better results on patient samples in microbiology.

Etiological Spectrum of Acute Febrile Illness in a Tertiary Care Hospital in Assam, India: A Cross-Sectional Study

Introduction: Acute Febrile Illness (AFI) encompasses a spectrum of conditions marked by fever, often caused by various infectious agents. The aetiological diversity poses challenges in diagnosis and treatment, particularly in regions with limited diagnostic resources. Aim: To evaluate the spectrum of pathogens causing AFI with or without rash in patients. Materials and Methods: A hospital-based cross-sectional study was conducted from January 2024 to December 2024 on 1,544 patients who had attended Lakhimpur Medical College and Hospital, North Lakhimpur, Assam, India. Patients with fever (≥ 37.5°C) with or without rash were enrolled. Serological investigations for Measles, Rubella, Dengue, Varicella-zoster, Chikungunya viruses, Japanese Encephalitis (JE), Orientia tsutsugamushi, Leptospira, and Hepatitis viruses were performed using Enzyme-linked Immunosorbent assay (ELISA) and Rapid Detection Testing (RDT) kits. Data analysis was performed using both descriptive and inferential methods. A p-value of <0.05 was considered significant. Results: Fever was prevalent in all 1,544 (100%) cases, followed by 856 (55.44%) cases of headache, 636 (41.19%) with cough, 476 (30.83%) with vomiting, 347 (22.47%) with abdominal pain, 59 (3.82%) cases with dysentery, 52 (3.37%) with diarrhoea, 46 (2.98%) cases with unconsciousness, and 21 (1.36%) cases presented with rash. Fever was observed in combination with headache in 856 (55.44%), with cough in 636 (41.19%), with bodyache in 481 (31.15%), and with vomiting in 476 (30.83%) cases. The study identified seasonal variations in infection rates, with peaks during the monsoon months. The majority of positive cases were attributed to Scrub Typhus 133/817 (16.28%), followed by Leptospirosis 129/473 (27.27%), Dengue 84/1273 (6.59%), and JE 20/87 (22.99%), while some had co-infection. Conclusion: The study underscores the importance of integrated clinical and laboratory approaches in diagnosing AFI. Scrub typhus, leptospirosis, and dengue were identified as major causes, emphasising the need for enhanced surveillance and diagnostic capabilities.

Differentiating Psoriasis from Psoriasiform Dermatitis using Proliferation Markers Ki-67 and Cyclin D1: A Cross-sectional Study

Shagun Pragya Gupta, Bhavna Sharma, Anand Kumar Verma, Paschal D Souza

Introduction: Psoriasis shares several clinical and histopathological features with other psoriasiform dermatoses. Differentiating it from other psoriasiform dermatitis is a diagnostic challenge which holds therapeutic as well as prognostic significance. Aim: To compare the immunohistochemical expression of proliferative markers Ki-67 and Cyclin D1 in psoriasis and other psoriasiform dermatitis and to determine if these markers can help differentiate them. Material and Methods: A cross-sectional study was conducted at the Department of Pathology, ESI-Post Graduate Institute of Medical Sciences and Research (ESI-PGIMSR), a tertiary care hospital in Basaidarapur, New Delhi, India, from April 2023 to August 2024, where 27 biopsies each of psoriasis and psoriasiform dermatitis were included. Immunohistochemistry (IHC) was performed using Ki-67 and Cyclin D1 antibodies, and their expression was evaluated. Three parameters—total epidermal cell count, suprabasal epidermal cell count, and the suprabasal-to-total epidermal cell count ratio—were compared between the two groups. Receiver Operating Characteristic (ROC) curve analysis was used to determine optimal cut-off values for these parameters. An Independent t-test was used to analyse the results using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The total epidermal cell count was significantly higher in psoriasis than in psoriasiform dermatitis for both markers. For Ki-67, the mean count was 386 vs 356 cells/mm² (p<0.001), while for Cyclin D1 it was 360 vs 329 cells/mm²(p<0.001). Similarly, the suprabasal epidermal cell count was also higher in psoriasis for both Ki-67 (343 vs 298 cells/mm²; p<0.001) and Cyclin D1 (333 vs 305 cells/mm² - p=0.036). The suprabasal-to-total epidermal cell count ratio was significantly higher in psoriasis, with values of 89% vs 84% for Ki-67 (p=0.001). ROC curve analysis yielded cut-off values of 370 and 318 cells/mm² for the total and suprabasal Ki-67 counts, respectively and 396 and 325 cells/mm² for the total and suprabasal Cyclin D1 counts, respectively. Conclusion: Ki-67 and Cyclin D1 exhibit significantly different immunohistochemical expression patterns in psoriasis and psoriasiform dermatitis. Quantitative assessment of these markers, along with objective cut-off values, may serve as an objective adjunctive diagnostic tool. IHC can therefore be a valuable tool in challenging diagnostic cases.

Morphological Variations of the Coronoid Process of Dry Adult Human Mandibles: A Cross-sectional Study from the Vadodara Region of Gujarat, India

Jahnavi Nath, Hetal Vaishnani, Bhoopesh N Raja, Aditya A Musale

Introduction: The mandible bears two superior projections from its ramus- the coronoid and condylar processes. The coronoid process gives insertion to the temporalis muscle and shows considerable morphological diversity. Knowledge of its shape and morphometry is important for maxillofacial surgeons, radiologists, anthropologists and forensic experts, particularly as the process serves as a donor site for autogenous bone grafts in orbital floor reconstruction, alveolar defect repair and sinus augmentation. Aim: To study the morphological variations of the coronoid process in dry adult human mandibles of the Vadodara region of Gujarat, India, with morphometric measurements and gender-wise comparison. Materials and Methods: A cross-sectional study was carried out in the Department of Anatomy, Smt. BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat, India, over a period of six months, from October 2025 to March 2026. Thirty dry adult human mandibles (60 sides; 16 male, 14 female by non metric sexing) were examined. Coronoid shape was classified as triangular, hook-shaped or rounded. The base (AB), anterior arm (AC), posterior arm (BC) and height (CD), together with the inter-coronoid distance, were measured bilaterally using Vernier callipers. Data were analysed with the unpaired Student’s t-test or Mann-Whitney U test; Chi-square was used for shape-gender association. A p-value <0.05 was considered significant. Results: The triangular variant was the most common (32/60 sides, 53.33%), followed by hook-shaped (17 sides, 28.33%) and rounded (11 sides, 18.33%). The mean inter-coronoid distance was greater in males (85.93±3.92 mm) than in females (79.26±4.96 mm; p=0.0005). Male mandibles showed higher means for all linear parameters on both sides, reaching statistical significance for the right base (31.80±1.91 vs 29.49±2.36 mm; p=0.003), left base (32.00±2.37 vs 29.09±1.41 mm; p<0.001) and left posterior arm (p=0.037). A significant gender-shape association was observed (χ2=8.98, p=0.011), with hook-shaped predominant in males (43.8%) and triangular in females (71.4%). Conclusion: The coronoid process in the Vadodara region exhibits significant morphological diversity and sexual dimorphism, with the triangular shape predominating overall. Gender-related differences in shape and base dimensions may assist maxillofacial surgeons in graft harvesting and forensic experts in sex determination.

Effectiveness of a Nutrition Promotion Intervention on Glycaemic Control among Patients with Type 2 Diabetes Mellitus: A Quasi-experimental Study

A Farida Fahhima, I Praveen Kumar, B Nisha

Introduction: Type 2 Diabetes Mellitus (T2DM) is one of the global health concerns that needs effective management of blood glucose levels to avoid the complications. Nutritional interventions for the control of diabetes mellitus have been promising, yet studies assessing their effectiveness are few. Aim: To assess the effectiveness of nutrition promotion intervention in controlling blood glucose levels in T2DM patients Materials and Methods: The present quasi-experimental study was conducted from November 2025 to April 2026 among patients with T2DM enrolled from the Non-communicable Disease (NCD) clinic of an Urban Health Centre. A total of 104 T2DM patients were enrolled on the quasi-experimental study. A semi-structured questionnaire was used to collect the baseline data. Sociodemographic information, such as age, gender, and socioeconomic status, was comprehensively gathered. Nutritional health education and a novel nutrition promotion intervention were given to the patients and followed up for 24 weeks. The blood glucose levels and Glycated Haemoglobin (HbA1c) were evaluated at baseline and after the intervention period of 24 weeks. Data analysis was performed on Statistical Package for the Social Sciences (SPSS) software version 25. Significance test for the difference between the pre- and post-intervention values was conducted using a paired t-test. Results: According to the study, males accounted for 80.77% of the study population, with most of them being employed. The intervention was associated with significant reductions in Fasting Blood Glucose (FBS) (p=0.001), Postprandial Blood Glucose (PPBS) (p=0.001) and Glycated Haemoglobin (HbA1c) (p=0.001) of the participants significantly improved following the nutritional intervention. Conclusion: The study observed reductions in glycaemic parameters after a nutrition promotion intervention in regulating the blood glucose levels among T2DM patients. The study also supported the importance and effect of customised nutrition counselling and health education in diabetes management to improve glycaemic control.

Continuous Rectus Sheath Block versus Epidural Analgesia for Postoperative Haemodynamic Stability after Elective Midline Laparotomy: A Randomised Controlled Trial

Lakshme Sanjana Karthik, Gayathri Balasubramaniyan, Amirdath Prakash

Introduction: Effective postoperative pain management is essential for optimal recovery after elective midline laparotomy. While epidural analgesia is widely used, it may cause sympathetic blockade, leading to hypotension and bradycardia. Continuous Rectus Sheath Block (CRSB) is a potential alternative that provides effective analgesia without compromising haemodynamic stability. Aim: To compare postoperative haemodynamic stability between CRSB and epidural analgesia in patients undergoing elective midline laparotomy. Materials and Methods: This single-blinded randomised controlled trial was conducted at the Department of Anaesthesiology, SRM Medical College, Hospital and Research Centre, Tamil Nadu, India, from August 2024 to February 2026. A total of 64 adult patients, American Society of Anaesthesiology Physical Status (ASA I-III), scheduled for elective midline laparotomy, were enrolled and randomly assigned to two groups: Group CRSB (n=32) receiving continuous bilateral RSB and Group Epidural (n=32) receiving standard epidural analgesia. Demographic data, including age, gender, and Body Mass Index (BMI), were recorded at baseline. Postoperative haemodynamic parameters, Mean Arterial Pressure (MAP) and heart rate, were measured at predetermined intervals. Pain was assessed using the Visual Analogue Scale (VAS), and the time to return of bowel sounds was recorded. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered statistically significant. Results: Both groups were comparable in baseline demographics (mean age 48.5±10.2 years). The CRSB group experienced faster return of bowel function (p=0.027). Conclusion: The CRSB provides analgesia equivalent to epidural analgesia, with improved haemodynamic stability and accelerated gastrointestinal recovery. It represents a safe and effective alternative, particularly for patients at risk of haemodynamic compromise.

Role of Perfusion Index as an Early Predictor of Successful Ultrasound-guided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Gedela Sai Sravani, Pramod B Jamale, Naseema V Kanase

Introduction: Supraclavicular brachial plexus block is commonly used for upper limb surgeries, providing effective anaesthesia and postoperative analgesia. Sensory and motor assessment is subjective and may delay decisions. Perfusion Index (PI) may provide an early objective indicator of sympathetic blockade and block success. Aim: To evaluate pulse oximetry-derived PI as an early objective predictor of successful ultrasound-guided supraclavicular brachial plexus block and to compare it with routine clinical assessment. Materials and Methods: This was a hospital-based prospective observational study conducted in the Department of Anaesthesiology, Krishna Hospital and Medical Research Centre, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India, over 18 months from June 2024 to November 2025. It included 70 adults aged 18-60 years with American Society of Anaesthesiologists (ASA) physical status I or II who underwent upper limb surgery under ultrasound-guided supraclavicular brachial plexus block. PI was measured in the blocked and contralateral limbs at baseline, 10 minutes and 20 minutes after block administration. The PI ratio was calculated by dividing the PI value at 10 minutes after block administration by the baseline PI value. Standard sensory and motor testing was used to assess block success. Independent t-test, Pearson’s correlation, and receiver operating characteristic analysis were used. Results: A total of 70 patients were included in the final analysis. The mean age was 45.2±5.4 years, mean weight was 70.0±3.3 kg, mean height was 166.3±3.5 cm, and mean body mass index was 25.3±0.3 kg/m². Successful surgical block was achieved in 54 patients (77.1%), while 16 patients (22.9%) had failed/inadequate block requiring fentanyl supplementation. Among successful blocks, mean sensory onset time was 12.4±0.5 minutes and mean motor onset time was 15.8±0.5 minutes. Baseline PI was comparable between successful and failed/inadequate blocks (1.39±0.07 versus 1.41±0.06; p=0.121). PI at 10 minutes, PI at 20 minutes and the 10-minute PI ratio were significantly higher in successful blocks than in failed/inadequate blocks (p<0.001). The 10-minute PI ratio showed a significant negative correlation with sensory and motor onset times (r=-0.71 and r=-0.70, respectively; p<0.001). ROC analysis demonstrated excellent discriminatory performance within the present dataset. However, the observed estimates should be interpreted cautiously because they were derived from a single-centre observational cohort and require external validation. Conclusion: PI is a simple, non invasive, and reliable adjunct for early prediction of supraclavicular block success. PI demonstrated excellent diagnostic performance and may serve as an objective adjunct to routine sensory and motor assessment.

Comparison of Sugammadex and Neostigmine on Speed and Quality of Recovery after Vecuronium Neuromuscular Blockade in Adult Patients Undergoing Spine Surgery under General Anaesthesia: A Randomised Clinical Study

Ishani Abhyankar, Naseema V Kanase, VS Kapurkar

Introduction: Residual neuromuscular blockade after non depolarising muscle relaxants is an important concern during recovery from anaesthesia. Incomplete reversal may affect ventilation, airway protection, and safe extubation. This problem is more relevant in spine surgery, where prolonged anaesthesia, prone positioning, and the need for early neurological assessment make reliable recovery essential. Aim: To compare sugammadex with neostigmine plus glycopyrrolate for reversal of vecuronium-induced neuromuscular blockade in adult patients undergoing elective spine surgery under general anaesthesia. Materials and Methods: This single-blinded randomised clinical study was conducted in the Department of Anaesthesiology, Krishna Hospital and Medical Centre, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from July 2024 to December 2025. The study included 60 adult patients aged 18-60 years with American Society of Anaesthesiologists (ASA) physical status I or II who were posted for elective spine surgery. Eligible participants were randomly distributed into two groups of 30 patients each. Patients in Group S were administered intravenous sugammadex 2 mg/kg, whereas patients in Group N received intravenous neostigmine 0.05 mg/kg along with glycopyrrolate 0.01 mg/kg following the return of the second twitch on quantitative Train-Of-Four (TOF) monitoring. The main outcome assessed was the duration required to attain a TOF ratio of ≥0.9. Additional outcomes included extubation time, haemodynamic variables, post-anaesthesia care unit duration, total hospital stay, and treatment-related adverse events. Data were analysed using independent-samples t-test, Chi-square test, and Fisher's-exact test as appropriate, with p<0.05 considered statistically significant. Results: Baseline characteristics were comparable between group S and group N: age 44.8±9.2 versus 46.1±8.7 years; gender 18/12 versus 17/13 (M/F); Body Mass Index (BMI) 24.6±2.8 versus 24.9±2.6 kg/m²; and ASA I/II 19/11 versus 20/10. Time to TOF ratio ≥0.9 was significantly shorter in group S than group N (2.8±0.9 versus 14.6±3.8 minutes; p<0.001). Time to extubation was also reduced with sugammadex (5.9±1.4 versus 17.8±4.6 minutes; p<0.001). Post-anaesthesia care unit stay was shorter in group S (42±10 versus 58±14 minutes; p<0.001), while hospital stay was comparable (4.1±0.9 versus 4.4±1.0 days; p=0.19). Haemodynamic parameters were similar between groups. Bradycardia was significantly more frequent in group N (1/30 versus 6/30; p=0.04). No serious adverse event was observed. Conclusion: In adult patients undergoing elective spine surgery, sugammadex enabled quicker and more reliable reversal of vecuronium-induced neuromuscular blockade than the conventional neostigmine–glycopyrrolate regimen. It shortened the time to extubation and post-anaesthesia care unit stay without compromising haemodynamic stability. Its main benefit was seen during immediate postoperative recovery.

Development of a Screening Tool for Analysing the Risk of Acquiring Cognitive Decline in Middle-aged Adults using the Modified Delphi Technique

Agrima Aggarwal, Neha Jain

Introduction: In India, cognitive decline is increasingly recognised as a midlife concern; one in ten individuals exhibits signs of cognitive decline after age 45 years. Demographic variations, lifestyle behaviours, and physical and mental capacities influence heterogeneous trajectories of cognitive function. Declines in cognition adversely affect task performance and daily functioning, undermining occupational capacity and overall health and wellbeing. Early identification of at-risk middle-aged adults may enable targeted prevention and health promotion interventions. Aim: To achieve expert consensus on a novel screening tool for identifying the risk of cognitive decline in middle-aged adults using the modified Delphi technique. Materials and Methods: A consensus study using the modified Delphi technique was conducted from July 2024 to March 2025 at Mahatma Gandhi Occupational Therapy College, Jaipur, Rajasthan, India. Three rounds of the modified Delphi method were utilised. A panel of multidisciplinary experts was selected, comprising individuals with at least a Master’s degree in their respective disciplines and at least 10 years of experience in the field. In Rounds 1 and 2, experts rated item relevance on a 5-point Likert scale; Round 3 focused on establishing the Content Validity Index (CVI). Statistical analysis was conducted using the median and Interquartile Range (IQR), along with item- and scale-level CVI, to compute universal agreement. Results: An initial pool of 30 items was designed, from which the panel reached consensus on 18 (60%) and 20 (83.3%) items in the first two rounds, respectively. Three items were removed after achieving >75% consensus for disagreement, with a wider IQR and higher variability. Using an I CVI threshold of ≥0.79 in the final round, 20 items met content validity criteria and were retained in the final instrument. The CVR and CVI values on the scale were 0.78 and 0.89, demonstrating good content validity of the tool, with a 65.2% rate of universal agreement. Conclusion: The 20-item screening tool was developed through structured expert consensus and demonstrates strong content validity. This tool could facilitate the identification of middle-aged adults at risk of cognitive decline and inform preventive and health promotion strategies.

Role of Contrast Enhanced Computed Tomography in Assessing Tumour Spread Patterns and Staging of Buccal Carcinoma: A Retrospective Observational Study

Introduction: Buccal mucosa is one of the common subsites of oral cavity cancers. Buccal carcinoma usually shows contiguous extension, involving adjoining anatomical structures; accurate assessment of its extent is necessary for appropriate patient management. Contrast Enhanced Computed Tomography (CECT) is an important imaging modality that helps with disease staging, assessment of preoperative surgical resectability, and radiation planning. Aim: To evaluate the anatomical pathways of tumour spread and staging characteristics of buccal carcinoma using CECT. Materials and Methods: This retrospective study was conducted at the Department of Radiodiagnosis and Interventional Radiology, Bhopal Memorial Hospital & Research Center, Bhopal, Madhya Pradesh (MP), India, from November 2023 to October 2024. Total of 100 patients of all age groups with clinically suspected cases of buccal carcinoma were evaluated by a 256-slice multislice CECT machine. The abnormal manifestations measured included involvement of adjacent anatomical structures such as the gingivobuccal sulcus, alveolar ridge, retromolar trigone, masticator space, mandible, skin, floor of mouth, tongue, and regional lymph nodes, were systematically documented on CECT. The imaging findings were subsequently confirmed by histopathological examination of the surgical specimen and/or biopsy samples wherever available. All continuous variables were measured using the mean and SD, and categorical variables using frequencies and percentages. Results: A total of 100 patients (85 histopathologically confirmed) with clinically suspected buccal mucosal lesions were evaluated. The patient ages ranged from 20 to 70 years, with a mean of 48.6 years. There were 72 males and 28 females (male:female ratio 2.6:1). Histopathological examination confirmed squamous cell carcinoma in 85 patients, while the remaining 15 patients had premalignant conditions. The most common site involved was the parotid duct orifice, seen in 65.4% (56/85) of cases, followed by the gingivobuccal sulcus, 60.2% (51/85). Other sites showing contiguous infiltration included the overlying subcutaneous fat and skin 45.3% (39/85), lips and angle of the mouth 21.2% (18/85), retromolar trigone 25.6% (22/85), mandibular alveolus 43.5% (37/85), maxillary alveolus 38.7% (33/85), muscles of the masticator space 48.2% (41/85), floor of the mouth 30.2% (26/85), oropharynx 30.6% (26/85), maxillary sinus/pterygomaxillary fissure 29.2% (25/85), pterygoid plates 25.4% (22/85), high infratemporal fossa (i.e., above the mandibular notch) 30.6% (26/85), and the base of the skull with intracranial extension 15.7% (13/85) Conclusion: In this study, CECT effectively demonstrated the extent of buccal carcinoma and the various anatomical pathways of locoregional tumour spread.

Effectiveness of Leg Cycle Ergometry Exercise on Functional Capacity, Muscle Strength and Quality of Life in Post-CABG Patients: A Systematic Review

Deepali Dattaram Vinerkar, Vishnu Vardhan

Introduction: Coronary Artery Bypass Grafting (CABG) is performed to restore myocardial perfusion and reduce morbidity in patients with coronary artery disease. Postoperative patients commonly experience reduced functional capacity, respiratory muscle weakness and limited exercise tolerance, necessitating structured rehabilitation. Leg cycle ergometry has gained increasing interest as an early rehabilitation. Aim: To systematically review Randomised Controlled Trials (RCT) evaluating the effectiveness of leg cycle ergometry in postoperative rehabilitation following CABG surgery. This systematic review was registered in PROSPERO. The review was structured according to the PICOTS framework: Population - adult CABG patients; Intervention - leg cycle ergometry; Comparator - standard physiotherapy, walking, or resistance training; Outcomes - functional capacity, muscle strength, pulmonary function and quality of life; Timing - immediate postoperative period; Study design - RCTs. Materials and Methods: The present review was conducted in the Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was registered in International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search was conducted in PubMed, Scopus and Nested Knowledge (2015-2025). Eligible studies were RCTs involving adult patients undergoing CABG who were also undergoing postoperative leg cycle ergometry. Data extraction followed a standardised format and the Cochrane RoB-2 tool was used to assess risk of bias. The review followed the Population, Intervention, Comparison, Outcome and Time (PICOTS) framework. The search strategy included combinations of keywords using Boolean operators (“CABG”, “coronary artery bypass”, “leg cycle ergometry”, “aerobic training”, “early mobilisation”) across PubMed, Scopus and Nested Knowledge. Only RCTs involving adult CABG patients who received leg cycle ergometry were included. Studies involving other cardiac surgeries or non randomised designs were excluded. Results: From 223 records, five RCTs met the inclusion criteria. Overall, the included RCTs demonstrated consistent improvements across major postoperative outcomes. Leg cycle ergometry performed for 1-3 weeks resulted in significantly greater gains in functional capacity and lower-limb strength compared with standard physiotherapy alone. Respiratory muscle strength was better preserved in studies measuring Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP), and additional benefits were noted in psychological outcomes {Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)}, sleep quality {Pittsburgh Sleep Quality Index (PSQI)} and overall quality of life {36-Item Short Form Survey (SF-36)}. However, heterogeneity in intervention duration, exercise intensity and outcome tools limited direct comparison of effect sizes. Three studies were rated as low-risk of bias, while two presented some concerns. Conclusion: Leg cycle ergometry is an effective and safe adjunct in early post-CABG rehabilitation. Further standardised RCTs are warranted to strengthen evidence for widespread clinical implementation.

Prevalence of Hamstring Tightness and Shortness in Individuals with Prolapsed Intervertebral Disc: A Cross-sectional Study

Sayani Das, Mandeep Kumar Jangra, Kanupriya, Mritunjay Kumar, Akanksha Saxena

Introduction: Prolapsed Intervertebral Disc (PIVD) is one of the most typical musculoskeletal conditions affecting the lumbosacral spine and is considered a leading primary reason for low back pain and sciatica. Altered spinal biomechanics, neural tension, and muscle spasm, which are considered to be the primary factors in PIVD, may result in hamstring tightness and shortness. Hamstring tightness is defined as the reduction in the extensibility of the hamstring muscle group, which includes the biceps femoris, semitendinosus, and semimembranosus muscles. This hamstring tightness leads to hamstring shortness due to inactivation for prolonged time. However, shortening of the hamstring muscles would affect the flexibility of the pelvis and the lumbar region during any physical activity, thereby changing the mechanical forces and causing unnecessary stress, leading to pain. The secondary effects on the musculature need to be considered while evaluating the prevalence in patients with PIVD. Aim: To assess the prevalence of hamstring tightness and hamstring shortness among individuals diagnosed with PIVD. Materials and Methods: The present cross-sectional study was undertaken among 120 participants aged between 18 to 80 years with lumber PIVD was conducted from September 2025 to February 2026 at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India. Participants were asked for their consent before undergoing the Finger to Toe Touch Test (FTTT) and Active Knee Extension Test (AKET) for measuring hamstring flexibility. Visual Analogue Scale (VAS) was used for measuring pain intensity. Participants were considered to have hamstring shortness if the AKET was >23.4° for females and >33.0° for males. Participants were considered to be tight if AKET was >20° and FTTT was >10 cm. Descriptive statistics were used for calculating prevalence. Results: Among the participants, 61 were males and 59 females with a median age of 41 years {Interquartile Range (IQR) 32-52}. Hamstring tightness was more prevalent in males 31 (50.82), while hamstring shortness was higher in females 45 (76.27). Overall prevalence of hamstring shortness and tightness was 60% and 36.66%, respectively. Conclusion: According to the findings of the present study hamstring tightness and shortness are common in individuals with PIVD and may contribute to associated musculoskeletal dysfunction.

Sacral Morphometry in Sacralised and Non Sacralised Dry Human Sacra: A Cross-sectional Study from Northern India

Nidhi Lal, Ankita Saha, Prachi Saffar Aneja, Susmita Saha

Introduction: Lower back pain is a very common problem among the younger generation today. One congenital cause is a Lumbosacral Transitional Vertebra (LSTV), which occurs at the lumbosacral junction. Variations in the morphology of the sacrum and lumbar vertebrae have clinical relevance because they alter biomechanics. Accurate morphometric data on sacralisation are necessary for orthopaedic, radiological, anatomical, and forensic applications. Despite the recognised prevalence and clinical relevance of LSTVs, limited osteological data comparing morphometric parameters between sacralised and non sacralised sacra are available in the Indian population. Aim: To evaluate morphometric variations of the sacrum in relation to lumbosacral assimilation and compare measurements between male and female sacra and also between sacralised and non sacralised specimens. Materials and Methods: The present observational cross-sectional study included 80 dry human sacra (50 male, 30 female) collected from the Department of Anatomy, FMHS, SGT Medical College, Gurugram, Haryana, India, between January 2025 and December 2025. Morphometric parameters measured included mid-Ventral Straight Length (VSL), Ventral Base Width (VBW), Superior Base Width (SBW), Sacral Auricular Lengths (SAL) and Sacral Auricular Widths (SAW). Based on these measurements, Ventral Base Index (VBI) and Sacral Body Index (SBDI) were calculated. Statistical analysis using independent samples t-test and Fisher’s exact test was performed with significance set at p<0.05. Data are presented as mean±Standard Deviation (SD). Results: Sacralisation was observed in 13 (16.3%) specimens, with complete sacralisation in 9 (69.2%) and partial fusion in 4 (30.8%). Significant sexual dimorphism was observed in VSL (p<0.001), both right and left auricular lengths (p<0.05) and SBDI (p<0.0001). Regarding morphometric comparison between groups, the mean SBDI was significantly lower in sacralised bones than in non sacralised bones (p=0.003). Deep sacral hiatus with dorsal wall defects was found in 9 (11.3%) cases. Conclusion: According to the findings of the present study sacralised sacra demonstrated larger morphometric dimensions, which were not found to be statistically significant except for SBDI.

Impact of COPD Phenotype on Disease Specific HR-QoL using CAT and SGRQ-C Score: A Hospital-based Observational Study

Naresh Bhagora, Sher Singh Meena, Pushpendra Bairwa, Hitendra Jatav

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of morbidity and mortality worldwide. The chronic and progressive nature of the disease significantly affects patients’ Quality of Life (QoL). Tools like the COPD Assessment Test (CAT) and St. George’s Respiratory Questionnaire (SGRQ-C) are widely used to assess Health-Related Quality of Life (HR-QoL) in these patients. Aim: To determine the impact of COPD phenotypes on disease-specific HR-QoL using CAT and SGRQ-C score. Materials and Methods: This hospital based observational study was conducted at RNT Medical College, Udaipur, Rajasthan, between the period of July 2024 to February 2025. All Diagnosed cases of COPD, as per GOLD guideline, with age above 40 years were included for the study. Patients with significant medical condition and pregnant or lactating women were excluded from the study. The total number of patients included were 160. The modified Medical Research Council (mMRC) Questionnaire was used to quantify the severity of breathlessness along with CAT score. The CAT and SGRQ-C, patient-administered questionnaire was used for HR-QoL assessment. Independent sample t-test and ANOVA test were used to compare the variables. Statistical analysis was done using MS excel and JAMOVI software version 6.2. Results: A total of 40 patients in each phenotype were enrolled in the study. Majorities of patients were male (118, 73.75%) and mean age was 62.56±10.71 years. Highest CAT score for cough and phlegm were observed in AE-CB phenotype ((2.60±0.96 and 2.93±0.94, respectively). Highest CAT score for chest tightness and breathlessness were observed in AE Non CB phenotype (1.88±1.18 and 3.03±0.95, respectively). AE non CB phenotype shows higher physical activity limitation (2.55±0.98) and sleep disturbance (1.85±1.36) while AE-CB phenotype shows poor confidence in leaving home (1.98±1.45) and low energy (1.29±0.20) while performing the routine work. Highest SGRQ-C score were observed in AE-CB (44.53±13.94) and AE Non CB (46.77±9.45), respectively. Conclusion: The AE non CB and AE-CB phenotypes were found to have the most significant impact on HR-QoL among COPD patients. This suggests that individuals with the AE-CB phenotype notably require a tailored treatment approach that specifically addresses both the frequent exacerbations and the chronic bronchitis component to improve their overall QoL.

Perceptions of First-year MBBS Students towards Kahoot! as a Formative Assessment Tool in Medical Education: A Quasi-experimental Study from Howrah, India

Ananya Kundu, Satyaki Basu, Mahenoor Anwar, Indranil Chakraborty

Introduction: Kahoot! is a gamified, real-time student response system that leverages game-design elements such as leaderboards, instant feedback, and time-based quizzes to enhance student engagement and formative assessment in educational settings. With the implementation of Competency-Based Medical Education (CBME) in India — which emphasises active learning and continuous formative feedback-evaluating the acceptability and perceived utility of such tools among preclinical medical students is important. Aim: To assess the perceptions of first-year MBBS students regarding Kahoot! as a formative assessment tool, with respect to engagement, enjoyment, learning impact, ease of use, and gender differences in perception. Materials and Methods: A quasi-experimental single-group post-test study was conducted among 115 first-year MBBS students of Biochemistry at JIS School of Medical Science and Research, Howrah, West Bengal, India, during November-December 2025. Consecutive sampling was used. A 12-item, five-point Likert scale questionnaire adapted from the validated instrument of Ismail and Mohammad was administered online. One open-ended question was also added. Descriptive statistics, one-sample t-tests, Chi-square goodness-of-fit tests, and Mann-Whitney U tests were used for analysis. Results: Of 115 respondents, 97 (84.3%) agreed or strongly agreed that they enjoyed Kahoot! sessions; 95 (82.6%) perceived improved class interactivity; 88 (76.5%) reported improved subject understanding; 99 (86.1%) found the platform easy to use; and 94 (81.7%) recommended Kahoot! for future classes. Technical issues were reported by only 22 (19.1%) students. Time-pressure anxiety was mixed: 38 (33.0%) agreed, 20 (17.4%) were neutral and 57 (49.6%) disagreed. No significant gender differences were observed (Mann-Whitney U, p-value>0.05 for all items). Two types of opinions emerged from the open-ended question: engagement/motivation and technical/stress concerns. Conclusion: First-year MBBS students perceived Kahoot! as an engaging, user-friendly, and educationally beneficial formative assessment tool. Contextually judicious integration into CBME-oriented undergraduate medical teaching is supported. Multicentric studies examining objective learning outcomes are warranted.

Pharmaco-analytical Characterisation and Quality Control of Rasapachak Vati: An Experimental Study

Varun Gupta, Dnyanesh Joshi

Introduction: In Ayurveda, Agni (digestive fire) is fundamental to health and its impairment is considered a primary cause of many gastrointestinal and hepatobiliary disorders. Classical formulations like Kwatha (herbal decoction) are effective but face limitations in shelf life, palatability and convenience. To address these challenges, Rasapachak Vati, a tablet formulation modified from a classical decoction, was developed to improve patient compliance while retaining therapeutic efficacy. Aim: To evaluate the Rasapachak Vati through comprehensive analytical characterisation using modern techniques. Materials and Methods: A pharmaceutico-analytical experimental study was conducted in Department of Samhita Siddhanta, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, Maharashtra, India, with analysis performed at Cotex Laxmi Healthcare Private Limited, MGACHRC, Salod (H), Wardha, from July 2024 to July 2025. The formulation contains Kalinga (Holarrhena pubescens), Patola (Trichosanthes dioica) and Katukrohini (Picrorhiza kurroa) , each known for Deepana (digestive stimulant), Pachana (carminative), Yakrituttejaka (liver stimulant) and Krimighna (anthelmintic) properties. Analytical evaluation included organoleptic, physicochemical (loss on drying, ash values, pH, extractive values, disintegration time, hardness, friability) and microbiological parameters. Results: The tablets exhibited a brownish colour, characteristic odour and bitter taste. Physicochemical analysis showed acceptable limits for moisture content (0.52%), total ash (2.44%), acid-insoluble ash (0.05%), alcohol extractive value (28.36%), water extractive value (42.57%) and pH (5.1). The tablets had a disintegration time of four minutes, a hardness of 3.5 kg/cm2 and friability of 0.5%, indicating good mechanical integrity. Microbiological tests confirmed the absence of pathogenic contaminants, ensuring safety for internal use. Conclusion: Rasapachak Vati is pharmaceutically stable, safe and suitable for therapeutic use. The transformation from decoction to tablet form enhances its shelf life, dosage accuracy and patient acceptability. Analytical validation supports its potential as a standardised, evidence-based Ayurvedic digestive formulation, warranting further pharmacological and clinical investigations.

Utility of Bland-Altman Plot in the Assessment of Inter-observer Variability for Internal Quality Control in Semen Analysis: A Cross-sectional Study

Prabhavati Jothilingam, Dharmishtha Kapadiya, Sweta Kulkarni

Introduction: Assessment of inter-observer variability is an essential component of quality control in semen analysis. The authors compared Bland-Altman (BA) plot, Intraclass correlation coefficient and Student’s paired t-test to determine which was the most feasible method for statistical analysis of internal quality control in their laboratory and the reason for the same. Aim: To assess inter-observer variability in sperm concentration and motility in fresh samples using Bland-Altman plot, Student’s paired t-test and Intraclass Correlation Coefficient (ICC), as a part of internal quality control. Materials and Methods: A cross-sectional observational study was conducted in the South of India, Puducherry, over a period of six months from 1^st January 2020 to 30^th June 2020. As a part of internal quality control two assessors independently analysed sperm concentration, progressive and non progressive motility and immotile spermson two aliquots of the samples tested by the manual method. Inter-observer variability was analysed using Bland-Altman plot, Students paired t-test and ICC. Data was analysed using Microsoft Excel® (2016), GraphPad Prism version 9, Mangold ICC calculator software and online ICC calculator at the website http://vassarstats.net/index.html Results: Nineteen men were included in the study. The ICC coefficient showed good correlation for sperm concentration, progressive motility, immotile sperms with values of 0.77, 0.84, 0.95 respectively and moderate correlation for non progressive motility with ICC=0.72. The p-value of Student’s paired t-test was above 0.05 for all parameters. There was no significant difference between the assessors for sperm concentration and motility using ICC and Student’s paired t-test, although the Student’s paired t-test does not measure agreement. Bland-Altman plot showed an occasional outlier for both parameters. The authors attributed different pockets of sampling as the reason for outlier in sperm concentration. In motility testing, the two outliers were a result of delayed reporting by one of the assessors resulting in decline in the progressive motile and an increase in the non progressive motile and immotile sperms. Conclusion: In a low throughout laboratory, fresh semen is a useful sample for daily quality control. Bland-Altman plot is an easy and effective tool for monitoring internal quality control when there are two assessors, obviating the need for complex statistical tests. Adopting simple yet effective methods for internal quality control, would encourage more laboratories to come into the ambit of quality assurance.

Effect of Sonic versus Ultrasonic Irrigant Activation on Dentinal Tubule Penetration of AH Plus Bioceramic Sealer and ReGen Bioactive Endosealer: An In-vitro Confocal Laser Scanning Microscopy Study

Introduction: Successful root canal therapy relies on thorough canal disinfection and the ability of sealers to penetrate the dentinal tubules effectively. Although mechanical shaping and irrigation lower bacterial presence, irrigant activation, especially using sonic or ultrasonic devices, boosts smear layer elimination and overall cleaning. The clinical success of Bioceramic Sealers (BCS) depends on their deep penetration into dentinal tubules for a fluid-tight seal. However, there is limited comparative evidence on whether sonic or ultrasonic activation better enhances intratubular adaptation of newer sealers like AH Plus Bioceramic and ReGen Bioactive Endosealer. This study uses Confocal Laser Scanning Microscopy (CLSM) to evaluate and compare these methods and aims to provide a standardised basis for selecting optimal irrigation activation protocols. Aim: To evaluate and compare the maximum depth of penetration of AH Plus BCS (AHPB) and ReGen Bioactive Endosealer sealer after sonic and ultrasonic activation. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences in Guntur, Andhra Pradesh, India, from July 2023 to September 2024. A total of 60 extracted human mandibular premolars with single roots were extracted for reasons related to periodontal or orthodontic reasons. Standard access cavities were prepared, followed by Working Length (WL) determination, and shaping was done with ProTaper Gold files up to size F3. Samples were randomly assigned to four experimental groups (n=15) depending on the combination of sealer and activation method: Group-1 (SLP-EA + AHPB), Group-2 (SLP-EA + ReGen Bioactive Endosealer), Group-3 (Ultra X + AHPB), and Group-4 (Ultra X + ReGen Bioactive Endosealer). Post-irrigation and activation, root canals were filled using Rhodamine B-stained sealers along with gutta-percha. Samples were then sliced at the middle and apical thirds and examined using Confocal Laser Scanning Microscopy (CLSM). Statistical analysis was performed using One-way Analysis of Variance (ANOVA), significant value was set at p<0.05, followed by Tukey’s post-hoc test. Results: A statistically significant difference (p<0.05) in maximum sealer penetration was identified in the middle third, with Group 3 (Ultra X + AHPB) showing the greatest depth, followed by Groups 1, 4 and 2. No significant differences were found at the apical third, though AHPB-based groups showed marginally deeper penetration. Conclusion: AH Plus Bioceramic Sealer demonstrated greater dentinal tubule penetration than ReGen Bioactive Endosealer, particularly when used with ultrasonic activation. These findings indicate that both the sealer type and the irrigant activation technique influence dentinal tubule penetration under the experimental conditions of this in-vitro study.

Comparative Analysis of SLA and SLActive Implant Surfaces on Peri-implant Clinical, Radiographic, and MMP-8 Parameters after One Year of Functional Loading: A Cross-sectional Study

Neha Jain, Arvina Rajasekar

Introduction: The longevity of dental implants depends on stable osseointegration and controlled host response. Surface modifications such as Sandblasted, Large-grit, Acid-etched (SLA), and chemically modified SLActive implants aim to enhance osseointegration; however, their long-term influence on peri-implant health remains unclear. This study compared clinical and biochemical parameters of SLA and SLActive implants after a minimum of one year of functional loading. Aim: To comparatively evaluate peri-implant clinical parameters, radiographic Crestal Bone Levels (CBL), and Peri-Implant Crevicular Fluid (PICF), Matrix Metalloproteinase-8 (MMP-8) concentrations in SLA and SLActive implant surfaces after a minimum of one year of functional loading. Materials and Methods: This cross-sectional study was conducted at the Department of Periodontology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from December 2024 to December 2025. A total of 70 systemically healthy patients aged 30-60 years with single-tooth implants placed in healed mandibular posterior sites and functionally loaded for at least 12 months were included. Participants were divided into two groups: Group 1-SLA (n=35) and Group 2-SLActive (n=35). Baseline characteristics, including age, gender, Plaque Index (PI), and Gingival Index (GI), were recorded. Peri-Implant Probing Depth (PPD), CBL, and PICF, MMP-8 concentrations were assessed. PICF samples were collected using microcapillary pipettes and analysed via ELISA. Continuous variables were compared using Independent t-tests, and categorical variables (gender) were analysed using the Chi-square test; p<0.05 was considered statistically significant. Results: Baseline characteristics, including age, gender, PI, and GI, were comparable between groups (p>0.05). The mean PPD was 4.50±0.45 mm in SLA and 4.48±0.50 mm in SLActive implants (p=0.86). CBL values were 0.84±0.18 mm and 0.82±0.20 mm, respectively (p=0.66). MMP-8 concentrations showed no significant difference (3.21±0.40 ng/mL for SLA vs. 3.18±0.38 ng/mL for SLActive; p=0.75). Conclusion: SLA and SLActive implants demonstrated comparable peri-implant clinical, radiographic, and biochemical parameters after one year of functional loading, suggesting similar tissue response under clinically stable peri-implant conditions.

Comparison of Different Dosage of Intrathecal Morphine as an Adjuvant to Hyperbaric Ropivacaine in Lower Limb Orthopaedic Surgeries: A Double-blinded Randomised Controlled Study

Shivani Meena, Sarvesh, Prateek, Meena Singh, Kirti Ahuja, Pranav Bansal

Introduction: Spinal anaesthesia with hyperbaric bupivacaine is the cornerstone of lower limb surgeries. With introduction of commercially prepared hyperbaric ropivacaine, its use has increased considerably as an effective alternate. Aim: To evaluate the analgesic and blockade characteristics of different dosages of morphine when used intrathecally as an adjuvant with hyperbaric ropivacaine in lower limb orthopaedic surgeries. Materials and Methods: The present double-blinded randomised controlled study was conducted on 114 patients undergoing lower limb orthopaedic surgery under spinal blockade, Patients were divided into three groups. Group R received 3 mL of 0.75% hyperbaric ropivacaine, Group RM1 received 3 mL of hyperbaric ropivacaine with 100 μg morphine, and Group RM2 received 3 mL of 0.75% hyperbaric ropivacaine with 200 μg morphine, respectively. The onset and duration of sensorimotor blockade, duration of analgesia, visual analogue scale for pain and incidence of adverse effects were compared in three groups. Analysis of Variance (ANOVA) test was used for quantitative data while Chi-square test was used for qualitative data. Results: Demographic data was comparable in all the groups. Group RM2 has significantly prolonged postoperative analgesia {11.59±0.60 hours (p<0.001)}. Analgesic requirement was lower in groups RM1 (1.58±0.37) and RM2 (1.26±0.45) as compared to Group R (1.58±0.50) (p<0.001). A statistically significant difference was observed between the total duration of sensory blockade in Group R (201.95±7.12 min), Group RM1 (232. 21±7.48 min) and Group RM2 (467±21.04 min) (p<0.001). The duration of motor blockade was also increased in Group RM2 (424±25.78 min). Conclusion: Addition of 200 μg morphine to hyperbaric ropivacaine provides haemodynamically stable anaesthesia with prolonged duration of analgesia and sensory blockade. This dosage does not have any additional adverse effects.

Aetiological Classification of Abnormal Uterine Bleeding using the FIGO PALM-COEIN System: A Retrospective Observational Study

Introduction: Abnormal Uterine Bleeding (AUB) has a profound impact on the reproductive health and overall quality of life of women. Although many causes have been identified, the role of regional, sociodemographic, and clinical factors is still not thoroughly examined in India. Aim: To assess the aetiological classification of AUB by employing the FIGO PALM-COEIN system. Materials and Methods: The present retrospective observational study investigated 384 cases of AUB at the Department of Obstetrics and Gynaecology, Government General Hospital, Guntur, Andhra Pradesh, from September 2024 to February 2025. The analysis involved data extracted from electronic and physical medical records, encompassing demographic, clinical, and diagnostic information. The causes were classified according to the FIGO PALM-COEIN criteria. Descriptive statistics were employed to encapsulate the demographic and clinical attributes of the study cohort. Categorical variables were represented as frequencies and percentages. Results: Among 384 women with AUB, the mean age was 38.9±7.6 years, with most patients aged 36-45 years (198, 51.6%). Overweight or obesity was observed in 245 subjects (63.8% of participants). The most frequent co-morbidities were hypothyroidism in 103 subjects (26.8%) and Polycystic Ovary Syndrome (PCOS) in 66 subjects (17.2%). AUB-L (Leiomyoma) in 119 subjects (31.0%), AUB-O in 97 subjects (Ovulatory dysfunction) (25.3%), and AUB-A (Adenomyosis) in 55 subjects (14.3%) were the predominant aetiologies. Significant associations were noted between AUB subtypes and age, early marriage, endocrine disorders, and nulliparity (p<0.05). Conclusion: According to the findings of the present study AUB in Indian women arises from multiple factors shaped by both structural and hormonal influences.

Integrating Team-based Learning into the Microbiology Curriculum: Impact on Students’ Performance and Feedback in a Quasi-experimental Framework

Introduction: With the implementation of Competency-Based Medical Education (CBME), the need for interactive, learner-centred teaching strategies has increased. Team-Based Learning (TBL) fulfils this need by fostering active engagement and collaborative problem-solving. Aim: To evaluate the effectiveness of TBL with conventional didactic lectures among second-year MBBS students in Microbiology. Materials and Methods: This quasi-experimental study was conducted in the Department of Microbiology at Smt BK Shah Medical Institute and Research Centre, Vadodara, Gujarat, India over three months (March 5, 2025, to June 5, 2025), after Institutional Ethics Committee approval. A total of 182 second-year MBBS students who attended all TBL sessions on selected infectious disease topics were included. Learning outcomes were assessed using the Individual Readiness Assurance Test (iRAT), Team Readiness Assurance Test (tRAT), and post-session formative assessments. Student and faculty perceptions were collected using structured feedback questionnaires. Data were analysed using a paired t-test and descriptive statistics. Results: Mean post-test scores were significantly higher after TBL (18.94±1.60) than after didactic lectures (13.13±2.68; p-value <0.0001). Post-test scores across all TBL sessions were higher than baseline iRAT scores, demonstrating significant improvement in immediate learning outcomes. Mean post-test scores were 19.02±1.45 for Urinary Tract Infections (UTI), 18.92±1.64 for skin and soft-tissue infections, and 18.88±1.63 for anaerobic infections/gas gangrene. Students reported that TBL enhanced engagement, motivation, conceptual clarity, and collaborative learning. Faculty also perceived TBL as a highly interactive and effective instructional strategy that improved participation and clinical reasoning. Conclusion: TBL is an effective pedagogical approach that enhances learning outcomes and active engagement in undergraduate medical students. Integrating TBL into routine microbiology teaching can further support the successful implementation of CBME.

Hindi Translation and Validation of the Manchester COPD Fatigue Scale: A Cross-sectional Study

Introduction: The most common yet under-evaluated symptom in patients with Chronic Obstructive Pulmonary Disease (COPD) is fatigue which has significant implications for quality of life and functional status. To assess this multidimensional construct accurately a disease specific tool is essential. The Manchester COPD Fatigue Scale (MCFS) is a validated tool to measure fatigue but due to its unavailability in Hindi it cannot be put to use in the Indian population with COPD. So for that reason, the aim of the study is to translate it into Hindi language and validate it to ensure correct assessment of fatigue in Hindi speaking patients with COPD. Aim: To systematically translate the MCFS into the Hindi language and evaluate its content validity in patients with COPD. Materials and Methods: The present cross-sectional study was conducted at the Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, Haryana, India, from September 2025 to February 2026. The study was conducted by using a methodological design which included forward-backward translation and expert review by Delphi method to appropriately assess the clarity and conception of the translated version of the scale. The statistical analysis was done using the Item level Content Validity Index (I-CVI). The purpose of the current study is to create a Hindi version of this scale so, after the approval from the original developer, the authors created the Hindi version of the scale using a forwardbackward translation process. Eight experts then evaluated the content validity of the scale. Results: The Hindi version of the MCFS demonstrated excellent content validity with high item-level and scale-level content validity indices i.e., 0.97. Conclusion: The Hindi version of the MCFS was successfully translated and demonstrated excellent content validity in Hindi speaking patients with COPD.

Immunohistochemical Expression of FOXP3 and CD8 in Oral Squamous Cell Carcinoma: A Cross-sectional Study

Sharjubala Khumanthem, TN Suresh, D Aswathappa

Introduction: In India, Oral Squamous Cell Carcinoma (OSCC) is among the top three malignancies. Tumour-Infiltrating Immune Cells (TIIC), as key elements of tumour microenvironment have recently been demonstrated to be crucial to the development and spread of cancer. The immune infiltrates of tumours is predominantly lymphocytes with T cells being major cell type. Aim: To determine FOXP3 and CD8 immunohistochemical expression in OSCC and its correlation with Tumour -NodeMetastasis (TNM) staging and lymph node metastases. Materials and Methods: The present cross-sectional laboratory based study was conducted in the Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India from April 2023 to April 2025. A total of 86 histologically confirmed cases of OSCC were screened for lymph node metastases, graded and TNM staged using the current American Joint Committee on Cancer (AJCC) staging criteria. The cases were then immunohistochemically stained using FOXP3 and CD8. Data analysis was done using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 22 (IBM SPSS Statistics, Somers, NY, USA). Chi-square test/Fischer’s exact test was employed as the test of significance. The Pearson’s correlation coefficient was used to perform correlations. A p-value <0.05 was deemed statistically significant. Results: The study patients were predominantly females and the mean age of the patients was 52 years. Nodal metastases were present in 37 (43%) of patients. Among the cases studied, 3 (3.5%), 18 (20.9%), 23 (26.7%),30 (34.9%) and 12 (14%) belonged to stage I, II, III, IVA and IVB, respectively. High CD8+IM (invasive margin) was associated with node negative cases (p=0.0074). Low CD8+IM (invasive margin) was associated with higher TNM stages (p=0.0092). Increased CD8+IM/FOXP3+ ratio was associated with lower TNM stages (p=0.023). Conclusion: The quantity, location and roles of Tumour Infiltrating Lymphocytes (TIL) are dynamic in nature. CD8+ IM (invasive margin)/FOXP3+ ratio is a promising biomarker in cancer research. Modulating this ratio could enhance antitumour immunity and improve treatment outcomes.

Effect of Liquorice Extract on Oral Health: A Systematic Review and Meta-analysis

Kiruppashini Thiagarajan, Indrapriyadharshini Karthikeyan

Introduction: Oral diseases continue to be a significant global public health challenge. Chlorhexidine (CHX) is widely regarded as the gold standard for chemical plaque control; however, its prolonged use is linked to adverse effects. Herbal alternatives such as Glycyrrhiza glabra (liquorice) have gained attention due to their antimicrobial and anti-inflammatory properties. Aim: To systematically evaluate the clinical effectiveness of liquorice extract on dental caries, plaque, gingivitis, Recurrent Aphthous Stomatitis (RAS), and oral mucositis through systematic review and meta-analysis. Materials and Methods: This systematic review and metaanalysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) guidelines and registered in International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023476073). Electronic databases, including PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar, were searched from 2017 to 2023. Only RCTs published in English were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Collaboration tool. Meta-analysis was performed using Review Manager (RevMan) version 5.4.1 software. Results: Out of 1,677 records identified, seven RCTs met the inclusion criteria for qualitative synthesis, and six were included in quantitative meta-analysis. Liquorice extract demonstrated significant reduction in Streptococcus mutans levels, DMFT scores, pain scores in RAS, and mucositis severity compared with placebo/control. However, in plaque and gingivitis reduction, chlorhexidine showed greater clinical improvement than liquorice. Substantial heterogeneity was observed in pooled analyses (I2 =98%). Conclusion: Liquorice extract exhibits promising antimicrobial and anti-inflammatory properties in the management of dental caries, aphthous ulcers, and mucositis. However, current evidence does not conclusively support its superiority over chlorhexidine for plaque and gingivitis control. High-quality, adequately powered RCTs with standardised concentrations and longer follow-up are required before recommending liquorice as a definitive alternative to chlorhexidine.

Evaluation of the Coefficient of Friction between Natural Teeth and Restorative Crown Materials: An In-vitro Study

Introduction: The use of aesthetic restorative materials, particularly zirconia, has increased in modern dentistry due to their strength and aesthetics. Their frictional behaviour against opposing surfaces is a key factor influencing clinical performance and wear. However, comparative data on friction among enamel, metal-ceramic, and zirconia under standardised conditions is limited. Aim: To evaluate and compare the Coefficient of Friction (COF) of natural teeth, metal-ceramic crowns, and zirconia crowns against different opposing materials under standardised in-vitro conditions. Materials and Methods: The present in-vitro study was conducted in the Department of Prosthodontics, CKS Theja Institute of Dental Sciences, Tirupati, Andhra Pradesh, India, from July 2018 to December 2018. Ninety extracted human premolars meeting the inclusion criteria (caries-free, intact structure) were selected and randomly allocated into three groups (n=30): Group A (Natural teeth) Group B (Metal- ceramic) Group C (Zirconia). Each group was further subdivided based on opposing materials (metal, metal-ceramic, zirconia; n=10). Specimens were mounted in acrylic blocks and subjected to friction testing using a pin-on-disc tribometer under a constant load of 20 N for one hour at 37°C with continuous lubrication. The COF was calculated. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) with significance set at p<0.05 Results: Natural teeth showed the lowest COF against metal discs (0.073±0.011) and highest against metal-ceramic discs (0.402±0.028). Zirconia discs showed intermediate values (0.343±0.021). Metal-ceramic crowns demonstrated lowest COF against metal (0.124±0.018) and highest against zirconia (0.338±0.027). Zirconia crowns showed lowest COF against metal (0.266±0.020) and highest against metal-ceramic (0.470±0.035). Conclusion: Frictional behaviour varied significantly among materials. Metal surfaces demonstrated the most favourable performance, while zirconia provided a balance between aesthetics and acceptable properties.

Comparison of Acromio-Axillo-Suprasternal Notch Index with Upper Lip Bite Test to Predict Difficult Visualisation of Larynx: A Prospective Observational Study

Introduction: Preoperative prediction of Difficult Visualisation of Larynx (DVL) remains a critical aspect of safe anaesthetic practice. Failure to anticipate airway difficulty leads to serious complications. Various bedside airway assessment tests like the Upper Lip Bite Test (ULBT) are widely used, but none provide complete reliability. The Acromio-Axillo-Suprasternal Notch Index (AASI) is a newer anatomical parameter proposed to improve predictive accuracy. Aim: To compare the diagnostic performance of AASI and ULBT to predict DVL in adult patients undergoing elective surgery under general anaesthesia. Materials and Methods: This single-blinded prospective observational study was conducted in the Department of Anaesthesiology at Smt. BKS Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India. The study included 166 patients aged 18-60 years, classified as American Society of Anaesthesiologists (ASA) I-III, scheduled for elective surgeries. Patients with Body Mass Index (BMI) ≥35 kg/m^², airway deformities, or emergency conditions were excluded. Preoperative airway assessment was performed using ULBT and AASI (cut-off ≥0.49). Following induction of anaesthesia, direct laryngoscopy was performed and graded using the Cormack-Lehane (CL) classification. Grades I-II were considered easy and Grades III-IV as DVL. Quantitative data were analysed using the independent student’s t-test, qualitative data using the Chi-square test, and the diagnostic validity of AASI and ULBT was assessed by sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive value (NPV), and accuracy. Results: Out of 166 patients, 23 (13.86%) had DVL. Mean age and gender distribution was comparable between two groups (38.44±10.89 vs 40.53±11.09, p=0.24), (p-value=0.25). There were no significant differences in mean weight, height, or BMI between groups (p-value >0.05). Distribution of ASA grades also did not differ significantly (p-value=0.08). AASI demonstrated sensitivity of 60.87%, specificity of 91.61%, PPV of 53.85%, NPV of 93.57%, and accuracy of 87.35%. ULBT showed sensitivity of 47.83%, specificity of 90.21%, PPV of 44.00%, NPV of 91.49%, and accuracy of 84.34%. Conclusion: AASI is a superior predictor of DVL compared to ULBT, with higher sensitivity, specificity, and overall diagnostic accuracy. Its high negative predictive value makes it a useful screening tool in clinical practice. However, as no single test is completely reliable, combining AASI with other airway assessment methods may further enhance prediction and improve patient safety.

A Cross-sectional Study of Antiglaucoma Drug Utilisation and Prescribing Patterns in a Tertiary Care Hospital, Udaipur, Rajasthan, India

Swati Jangir, Bipa Mazumdar, (Col) Avinash Mishra

Introduction: Glaucoma is one of the leading causes of irreversible blindness worldwide and requires long-term pharmacological management. Drug utilisation studies help evaluate prescribing patterns, rational drug use, treatment adherence, and cost-related factors in glaucoma management. Aim: To evaluate the utilisation pattern of antiglaucoma medications and prescribing trends in a tertiary care hospital, Udaipur, Rajasthan, India. Materials and Methods: The present cross-sectional study was conducted in the Ophthalmology Outpatient Department (OPD) at American International Institute of Medical Sciences, a Tertiary Care Institution, Udaipur, Rajasthan, India, from December 2024 to December 2025. A total of 127 patients diagnosed with glaucoma were included in the study. Data regarding demographic characteristics, clinical profile, prescribed medications, treatment patterns, dosing frequency, duration of therapy, and generic versus branded prescribing were collected using patient interviews and prescription records. Statistical analysis was performed using descriptive statistics and the Chi-square test. A p-value<0.05 was considered statistically significant. Results: Topical therapy was prescribed in all patients. Monotherapy was the most common treatment pattern (38.6%), followed by polytherapy (31.5%) and Fixed Dose Combinations (FDCs) (29.9%). Prostaglandin analogues were the most frequently prescribed drug class. Generic medications accounted for 55.9% of prescriptions. No statistically significant association was observed between income level and type of drug prescribed (χ²=3.46, p=0.326). Conclusion: The prescribing pattern of antiglaucoma medications in the present study demonstrated predominant use of prostaglandin analogues, monotherapy, FDCs, and generic medications within the study setting. Use of prostaglandin analogues, generic medications, and simplified treatment regimens may contribute to effective and cost-conscious glaucoma management.

Efficacy of Salmusta Yoga versus Tablet Metformin in Type 2 Diabetes Mellitus (Madhumeha): A Research Protocol for Randomised Controlled Trial

Diksha J Gaikwad, Sadhana Misar Wajpeyi, EAA Gamulea Andrei Florin

Introduction: Diabetes mellitus is a metabolic disorder that can be correlated with Madhumeha, a type of Prameha in Ayurveda. This is a Santarpanajanya Vyadhi (Diseases caused by overnutrition), caused by Medo Dushti (disruption in fat metabolism) affecting Medovaha Strotas. Salmusta yoga, containing Sal (Shorea robusta) , Musta (Cyperus rotundus) , and Kampillaka (Mallotus philippensis) in Yogratnakar for the management of Prameha (Diabetes mellitus). Need of the study: Type 2 Diabetes Mellitus (T2DM) is a rapidly increasing metabolic disorder with significant complications. Although modern treatments like insulin and metformin are effective, long-term use may cause adverse effects and does not fully address underlying metabolic disturbances. In Ayurveda, Madhumeha involves Kapha predominance, Medo Dushti, and Agnimandya, requiring a holistic approach. Shamana Chikitsa is preferred when Shodhana is not feasible. Salmusta yoga, described in Yogaratnakara, has Kapha-Medohara and Pramehaghna properties reported to have antihyperglycaemic effects. However, limited clinical evidence exists, highlighting the need to evaluate its efficacy in managing Madhumeha. Aim: Evaluation of comparative efficacy of Salmusta yoga Versus tablet metformin in the management of diabetes mellitus type 2. Materials and Methods: A single-blind (accessor blind) parallel randomised controlled trial will be conducted at the Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H) Wardha, Maharashtra, India, from September 2025 to March 2027. The study involves 64 patients meeting the inclusion criteria, randomly assigned into two groups of 32 each. Group 1 will receive Salmusta yoga, while Group 2 will receive tablet metformin twice a day for two months. Assessments of fasting and postprandial blood sugar level will be conducted on days 0, 30 and 60. Chi-square test, Student’s unpaired, and paired t-test will be used for both descriptive and inferential statistics. A significance level of p<0.05 will be applied.

Effectiveness of the PACT Protocol for Caregivers of Children with Cerebral Palsy: A Research Protocol for Randomised Controlled Trial

Introduction: Cerebral Palsy (CP) is a lifelong condition that affects a person’s movement, posture, and ability to perform daily self-care tasks, often making them dependent on caregivers. The newly developed PACT is a structured caregiver training protocol designed to support families by improving caregiving skills, encouraging greater independence in self-care, and enhancing overall care for individuals with CP in community settings. Need of the study: Families often experience considerable emotional stress, social isolation, and physical fatigue while caring for individuals with CP. Therefore, there is a need for a structured caregiving protocol that can help reduce caregiver burden and improve their overall mental wellbeing. Aim: To evaluate the effectiveness of a structured training programme, the Parent/Caregiver-Assisted Care and Training (PACT) protocol, in improving Activities of Daily Living (ADL) among caregivers of children with CP. Materials and Methods: This randomised controlled trial will be conducted from June 2025 to September 2026 in selected community areas of Wardha district, Maharashtra, India. Caregivers of children with a confirmed CP diagnosis will be enrolled with Group A (control) receiving routine care, while Group B (intervention) will undergo a four-session evidence-based PACT programme focusing on daily care, home exercises, safe drug administration, communication, and stress management. Baseline and two-month postintervention assessments will be conducted using the Paediatric Evaluation of Disability Inventory (PEDI) and the Gross Motor Function Measure (GMFM). Data will be analysed using descriptive statistics, paired t-tests/Wilcoxon signed-rank tests for within-group changes, independent t-tests/Mann-Whitney U tests for between-group differences, and ANCOVA for adjusted comparisons, with significance at p-value <0.05.

Proportion of Tuberculosis Patients Incurring Catastrophic Health Expenditure in India: A Systematic Review and Meta-analysis Research Protocol

Janmejaya Samal, Shraddha Bhatia

Introduction: Globally and at the national level in India, Tuberculosis (TB) programs aim to achieve zero Catastrophic Health Expenditure (CHE) on TB. However, there is evidence through the observational studies reporting CHE incurred by Indian families on TB. Furthermore, the contribution of India to the global TB burden is high both in morbidity and mortality. Need of the study: A systematic review and meta-analysis will be conducted to estimate the proportion of Indian patients who incur the CHE among Indian TB patients. Aim: This study aimed to determine the proportion of Indian TB patients incurring CHE, identify factors contributing to CHE among these patients and estimate the mean/median CHE amounts nationally and regionally due to TB in India. Materials and Methods: Three databases, PubMed, Embase and Scopus, will be used to search for English-language studies reporting the proportion, determinants and mean/median CHE among Indian TB patients. Grey literature will be identified through Google searches and reference screening. Two independent reviewers will screen studies, with disagreements resolved by a senior researcher. Risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS) and the Mixed Methods Appraisal Tool. The review will estimate CHE proportions with 95% confidence intervals and examine predictors, with subgroup, sensitivity and publication bias analyses (I², Egger’s, Begg’s, trim-and-fill). Results will be presented using forest, funnel, Galbraith and leave-one-out plots. Evidence quality will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Comparative Efficacy of Ventilator Nursing Clinical Pathway versus Paediatric Ventilation Guidelines in Paediatric Intensive Care Unit: A Research Protocol

Khushbu Manohar Meshram, Bibin Kurian, Archana Taksande, Shalini Lokhande

Introduction: Many critically ill children in the Paediatric Intensive Care Unit (PICU) require mechanical ventilation. Despite lung-protective strategies, ventilation-related complications remain common, emphasising the need for effective management and prevention. Need of the study: Through constant observation and intervention, nurses are essential to the care of children on mechanical ventilation. However, organised, nurse-led care is not given much attention in the current paediatric ventilation recommendations, and inconsistent nursing practice, expertise, and protocol execution may result in less-than-ideal patient outcomes. Aim: To compare the efficacy of the Ventilator Nursing Clinical Pathway (VNCP) versus paediatric ventilation guidelines for children on mechanical ventilators at the PICU for improvement in clinical outcomes. Materials and Methods: The present two-arm parallel superiority randomised controlled trial will be conducted at Smt Radhikabai Meghe Memorial College of Nursing, Sawangi (Meghe), Wardha, Maharashtra, India, from June 2026 to June 2027. There will be two stages to the study: In Phase I, the VNCP will be developed and validated by experts; in Phase II, the VNCP’s efficacy will be compared with standard nursing care for children on mechanical ventilation between the ages of one month and twelve. Random assignment will be used to place eligible individuals in either the intervention group (VNCP) or the control group (routine care). Continuous variables will be compared using the independent t-test or Mann-Whitney U test, categorical data using the Chi-square test, and longitudinal data using repeated measures Analysis of Variance (ANOVA). A p-value of <0.05 will be deemed statistically significant.

Effect of Blood Flow Restriction Training on Cardiorespiratory Endurance, Quality of Life, and Muscle Strength among Postmenopausal Women: A Research Protocol for a Randomised Clinical Trial

Kashish Maggu, Mandeep Kumar Jangra, Akanksha Saxena

Introduction: Postmenopause is a physiological phase that occurs after 45-55 years of age, associated with musculoskeletal, cardiovascular, metabolic and functional changes. Blood Flow Restriction Training (BFRT) is an emerging low-intensity exercise technique that can yield gains in strength and endurance comparable to high-load Resistance Training (RT). Need of the study: Menopause-related hormonal changes contribute to reduced muscle strength, decline in cardiorespiratory endurance, and impaired Quality of Life (QoL). BFRT has shown positive effects on muscular outcomes; however, evidence regarding its impact on cardiorespiratory endurance and QoL in postmenopausal women remains limited. Aim: To investigate the effect of BFRT on cardiorespiratory endurance, QoL and muscle strength among postmenopausal women. Materials and Methods: A randomised clinical trial will be conducted at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to), Mullana-Ambala, Haryana, India, from May 2026 to March 2027. A total of 70 postmenopausal women aged 45-55 years, will be allocated to the experimental group and control group. The experimental group will receive BFRT with elastic band exercises. In contrast, the control group will receive resistance exercises through an elastic band three times a week for four weeks. Outcomes, including cardiorespiratory endurance, QoL, and muscle strength, will be assessed using the Queen’s College step test, a Handheld Dynamometer (HHD), the 5-times sit-to-stand test, and the Menopause-Specific Quality of Life (MENQOL) Questionnaire at baseline and after the intervention period. Shapiro-Wilk test, Parametric tests (paired and independent t-tests) and non parametric tests (Wilcoxon Signed-Rank and Mann-Whitney) will be applied. The p-value <0.05 will be considered statistically significant.

Effectiveness of Proprioception versus Craniocervical Flexion Training Exercises in Forward Head Posture Patients: A Research Protocol for a Randomised Controlled Trial

Pranali Suryawanshi, Deepak Anap

Introduction: Forward Head Posture (FHP) is a forward inclination with increased flexion of the lower cervical and the upper thoracic regions, increased extension of the upper cervical vertebra and extension of the occiput on C1. Commonest impairments in subjects with FHP are neck pain, reduced cervical joint position sense, reduced strength of Deep Cervical Flexor (DCF) muscles and scapular muscle weakness. Need of the study: Proprioception training improves cervical joint position sense and Craniovertebral Angle (CVA) by activating suboccipital muscles and enhancing head–eye coordination. Craniocervical flexion training strengthens DCFs, reduces overactivity of superficial neck muscles and improves posture. Although both treatments show benefits in FHP, there is limited literature directly comparing their effectiveness. This gap highlights the need for present study to evaluate and contrast these interventions for evidence-based clinical practice. Aim: This study aims to compare the effectiveness of proprioception vs. craniocervical flexion training exercises in patients with FHP. Materials and Methods: A single-blinded randomised three-arm parallel trial will be conducted at YMT College of Physiotherapy Kharghar, Navi Mumbai, Maharashtra, India from January 2023 to June 2026. Total 114 subjects will be randomly allotted to three groups with a 1:1:1 ratio. The first group will receive Proprioception training exercises along with conventional exercises, the second group will receive Craniocervical flexion training exercises along with conventional exercises and the third group will receive conventional exercises. Effect on pain, CVA, DCF activation and on cervical proprioception will be assessed after six weeks of intervention and statistical evaluation will be conducted using repeated measures of Analysis of Variance (ANOVA) or Friedman’s test. A p<0.05 will be considered statistically significant.

Enamel Remineralisation and Antimicrobial Efficacy of a Withania somnifera, Ficus religiosa, Salvia rosmarinus-based Polyherbal Gel: A Research Protocol

Rijuta Gujar, Punit Fulzele, Nilima Thosar, Anjori Raut

Introduction: Dental caries is a multifactorial and chronic disease. Streptococcus mutans and Lactobacillus species are the primary microorganisms responsible for dental caries and enamel demineralisation. Caries can be prevented by fluoridated products like Casein Phosphopeptide- Amorphous Calcium Phosphate (CPP-ACP) or non fluoridated products. CPP-ACP can be used as a remineralising agent. Fluoride can also be used only as a remineralising agent. This article focuses on Withania somnifera, Ficus religiosa, and Salvia rosmarinus, which have all the three properties- antibiofilm, antimicrobial and remineralising. Need of the study: Dental caries is a significant oral disease due to bacterial biofilms and enamel demineralisation. Traditional chemical medicaments such as fluoride have drawbacks of toxicity and resistance. Therefore, safer natural substitutes are desired. Withania somnifera, Ficus religiosa, and Salvia rosmarinus have antimicrobial, antioxidant, and remineralising activities. But they have to be studied in combination as a polyherbal gel for enamel. Therefore, the present study aims to assess the antimicrobial, antibiofilm, and remineralisation capability of this plant formulation, providing a biocompatible and effective means to prevent dental caries. Aim: To evaluate the antimicrobial, antibiofilm and remineralisation efficacy of Withania somnifera, Ficus religiosa and Salvia rosmarinus-based polyherbal gel on enamel. Materials and Methods: An in-vitro study will be conducted in the Department of Paediatric and Preventive Dentistry, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India, from December 2025 to December 2026. In the present study, teeth extracted for orthodontic purposes or teeth samples with non cavitated lesions suitable for remineralisation assessment will be selected. Total teeth will be 70, with two groups each containing 35 teeth, n=35. Group 1: Withania somnifera, Ficus religiosa, Salvia rosmarinus. Group 2: Control group CPP-ACP. Antimicrobial efficacy will be determined against oral pathogens with the agar diffusion and broth microdilution techniques. Antibiofilm activity will be evaluated using biofilm inhibition and disruption assays. The remineralisation ability will be examined by scanning electron microscopy. A paired t-test will be applied to compare biofilm reduction before and after treatment within the same group. An independent t-test will be used to compare outcomes between two independent groups (polyherbal gel and control-CPP-ACP). The p-value of ≤0.05 will be considered statistically significant.

From Placentation to Prediction: Modern Perspective on Emerging Biomarkers in Preeclampsia Prediction

R Saroash Zulfishaan, R Anusha, Preet Agarwal, Leena Chand

Preeclampsia (PE), a multisystem hypertensive disorder complicating 3-8% of pregnancies worldwide, drives substantial maternal and perinatal morbidity and mortality, necessitating early predictive strategies to enable timely interventions. This narrative review synthesises evidence on galectin-7, galectin-3, galectin-13 (PP13), galectin-1, galectin-9, Carbonic Anhydrase IX (CAIX), and soluble fms-like tyrosine kinase-1 (sFlt-1)/Placental Growth Factor (PlGF) ratio. Gal-7 and Gal-13 modulate trophoblast invasion, immune tolerance, and spiral artery remodelling at the maternal foetal interface; CAIX, regulates pH under conditions of placental ischaemia; sFlt-1 antagonises proangiogenic Vascular Endothelial Growth Factor (VEGF)/PIGF, precipitating endothelial dysfunction - a PE hallmark; and Gal 3 promotes inflammation and trophoblast migration while linking to fibrosis. Prospective cohorts demonstrated presymptomatic alterations highlighting diagnostic accuracy over traditional. By elucidating these biomarkers' mechanistic roles in defective placentation, angiogenic imbalance, and hypoxic stress, this analysis underscores their potential in multi-marker panels for precision risk stratification facilitating aspirin prophylaxis and surveillance to avert preterm delivery and organ injury.

Salivary Biomarkers for Early Detection of Oral Diseases: A Narrative Review of Diagnostic Technologies and Clinical Applications with a Su-Field Systems Analysis

Saliva has emerged as a promising non invasive diagnostic biofluid containing a diverse range of biological molecules, including cytokines, nucleic acids, enzymes, metabolites, extracellular vesicles, and microbial components that reflect physiological and pathological processes within the oral cavity. Owing to its ease of collection, cost-effectiveness, and suitability for repeated sampling, saliva has gained increasing attention as a diagnostic medium for the early detection, monitoring of oral diseases, particularly oral squamous cell carcinoma and periodontal disease. Recent advances in nanotechnology have significantly enhanced the sensitivity and specificity of biosensor platforms, enabling the detection of low-abundance salivary biomarkers with improved analytical performance. Artificial Intelligence (AI) and machine-learning approaches further strengthen diagnostic capabilities by facilitating the interpretation of complex biomarker datasets and supporting clinical decision making. In addition, digital health technologies and teledentistry platforms offer opportunities for real-time data management, remote monitoring, and integration of diagnostic information into routine clinical workflows. This narrative review summarises the biological basis of salivary biomarkers and examines emerging diagnostic technologies relevant to oral disease detection. Furthermore, Substance-Field (Su-Field) analysis, a core Teoriya Resheniya Izobretatelskikh Zadach {TRIZ (in Russian)}, which means Theory of Inventive Problem Solving methodology, is employed as a conceptual systems-engineering framework to identify system-level limitations and guide optimisation of salivary diagnostic systems. The analysis identifies key challenges, including biological variability, signal instability, limited clinical validation, and interoperability barriers, while highlighting potential optimisation strategies. Integration of salivary biomarker science with biosensing technologies, Artificial Intelligence (AI), digital health systems, and Su-Field-guided system optimisation may facilitate the development of reliable chair-side diagnostic platforms for early detection, disease monitoring, and precision oral healthcare.

Skeletal Anchorage Systems: A Narrative Review of Biomechanical Considerations for Predictable Orthodontic Tooth Movement with Maxillary and Mandibular Distalisation

Ramesh Carmel, Vincy Antony, Muhammed Shaloob, Sinjimol Thomas, Indu Nambiar

In recent years, skeletal anchorage systems have become an integral component of orthodontic biomechanics. They provide a reliable source of anchorage that is independent of the dentition, thereby improving the efficiency of distalisation with better control and reduced dependence on patient compliance. The present narrative review focuses on the biomechanical principles underlying skeletal anchorage-assisted distalisation. In particular, it examines the relationship between force vectors and the centre of resistance of the dental arches. Tooth movement depends largely on the point of force application relative to this centre, which determines whether the movement is primarily translational or accompanied by rotational changes, such as clockwise or counterclockwise rotation of the occlusal plane. Several skeletal anchorage options are available, including infrazygomatic crest mini-implants, buccal shelf screws, interradicular mini-implants, and palatal mini-implants. Each provides specific biomechanical advantages depending on the clinical situation. Maxillary and mandibular distalisation present distinct anatomical and biomechanical challenges, often requiring individualised force system design. Careful control of force magnitude, direction, and vector position allows predictable en masse distalisation. This approach also helps maintain incisor torque, vertical dimension, and occlusal stability. With appropriate planning, skeletal anchorage systems can be used to manage sagittal discrepancies in both camouflage and presurgical orthodontic treatment, offering better control and greater efficiency than conventional anchorage methods.

Wandering Spleen: A Narrative Review of Clinical Spectrum, Pathogenesis, Emerging Diagnostics, and Management Approaches

Wandering Spleen (WS) is an uncommon clinical disorder in which the spleen is abnormally mobile as a result of either congenital ligamentous anomalies or acquired laxity and thus put at risk of torsion, infarction and variable abdominal symptoms. WS has a bimodal distribution in the age group, which includes children and women of reproductive age and is characterised by non specific symptoms, such as a mobile mass in the abdomen or pelvis, intermittent pain, in few severe cases, an acute abdomen. Diagnosis is not easily done and is dependent much on imaging methods like ultrasound with Doppler, Contrast-Enhanced Computed Tomography (CECT), nuclear scintigraphy, dynamic Magnetic Resonance Imaging (MRI) and newer modalities like Contrast-Enhanced Ultrasound (CEUS). Spleen preservation through splenopexy which is laparoscopic, open, or robotically done is prioritised in the management and splenectomy is used in case of non viable spleen or infarction or sepsis complications. It is important to prevent severe complications by recognising them early and applying proper intervention. The present review will outline the pathogenesis, clinical manifestation, emerging diagnostic methods and the modern management of WS including the most minimal invasive and spleen-sparing techniques.

Kyasanur Forest Disease: A Narrative Review of Clinical Features, Transmission, Diagnosis and Public Health Strategies

Amartya Aaruhya, Anupama Sawal, Bhagyesh Sapkale

Kyasanur Forest Disease (KFD) is an emerging tick-borne viral haemorrhagic illness which is endemic to the Western Ghats of southern India, caused by the Kyasanur Forest Disease Virus (KFDV), a Flavivirus transmitted primarily by haemaphysalis ticks. KFD presents after a 3-8 day incubation with abrupt fever, headache, myalgia and gastrointestinal symptoms and may progress to haemorrhagic and neurological complications. Spread of KFD to other neighbouring states underscores challenges to control the disease. Diagnosis of KFD depends upon Reverse Transcription Polymerase Chain Reaction (RT-PCR) during early viremia, which is then followed by Immunoglobulin M (IgM) Enzyme-Linked Immunosorbent Assay (ELISA), with emerging isothermal amplification techniques showing promise for field use. Measures for prevention of KFD are vaccination, carcass disposal, avoidance of ticks, along with community education. Treatment is mainly supportive, which focuses on intensive care for severe cases. Strengthening of surveillance methods, vaccinations and integrated one health strategies are essential for reducing burden of the disease.

Anaesthetic Management of Cerebellopontine Angle Tumours: A Narrative Review of Neuroanatomy, Perioperative Strategies and Contemporary Advances

Repalli Leela Rajeswari, Sanjot Ninave, Kola Kavya Praneetha, Bhagyesh Sapkale

Cerebellopontine Angle (CPA) tumours represent complicated lesions in the posterior fossa, which have significant anaesthetic complications as they are closely adjacent to cranial nerves, brainstem nuclei, and Cerebrospinal Fluid (CSF) pathways. Vestibular schwannomas are the most common, followed by meningiomas and epidermoid cysts. Progressive tumour growth usually leads to cranial nerve dysfunction, compression of the brainstem, and hydrocephalus; thus, careful perioperative planning is crucial for achieving the best results. This narrative review is a comprehensive assessment of CPA neuroanatomy that is relevant to anaesthesia and its implications for perioperative management. It outlines preoperative neurological and airway assessment, including a focus on lower cranial nerve involvement and risk of aspiration. Intraoperative strategies are critically discussed, with Total Intravenous Anaesthesia (TIVA) being the method of choice to maintain the integrity of intraoperative neuromonitoring such as Brainstem Auditory Evoked Potentials (BAEP) and cranial nerve Electromyography (EMG). Other factors such as patient positioning, haemodynamic stability, brain relaxation techniques and the prevention of neuromuscular blockage are additional considerations to facilitate reliable monitoring conditions. The approaches to postoperative care emphasise airway protection, delayed extubation, neurological monitoring, and the prevention of complications such as aspiration, cranial nerve deficits, and increased intracranial pressure. The novelty of this review lies in its integrated anaesthesia-centric synthesis of CPA tumour management, combining detailed neuroanatomical correlations with contemporary perioperative strategies. It also highlights the potential of emergent innovations like multimodal neuromonitoring, Enhanced Recovery After Surgery (ERAS) protocol and evolving potential of Artificial Intelligence (AI) in intraoperative decision support and postoperative critical care. In conclusion, a structured, anatomy-guided, patient-specific anaesthetic approach incorporating advanced monitoring and emerging technologies is essential to improve safety and neurological outcomes in CPA tumour surgery.

ACL Reconstruction with Enhanced Physiotherapy Interventions and Early Rehabilitation: A Narrative Review

Faiyazuddeen Kuthbudeen, Muthukumaran Jothilingam

Anterior Cruciate Ligament Reconstruction (ACLR) is a common surgical knee procedure that requires intensive postoperative rehabilitation by the patient. Although ACLR restores the knee’s mechanical stability, patients often experience postoperative limitations. This study aimed to examine the supplementary physiotherapy interventions incorporated into standard rehabilitation programs that enhance early-stage ACLR rehabilitation. In October 2025, a literature review was performed utilising electronic databases. The primary outcomes assessed included pain, oedema, muscle strength, Range Of Motion (ROM), and knee function. For this review, 10 studies were selected that fulfilled the inclusion criteria (total n=210). The studies analysed the efficacy of Kinesio Taping (KT), Whole-Body Vibration (WBV), local vibration training, Trigger Point Dry Needling (TrP-DN), high tone power therapy, alternating magnetic field, and an App-based active muscle training program. The majority of the additional physiotherapy interventions demonstrated improvements in pain, oedema, ROM, knee muscle strength, or knee function during the early stages of postoperative ACL rehabilitation. With the exception of one study, no adverse events were reported in the included studies, indicating the safety of the physiotherapy interventions discussed. Further comprehensive research is warranted in this domain.

Nipah Virus Infection: A Narrative Review of Clinical Spectrum, Pathogenesis, and Emerging Preventive and Therapeutic Strategies

Pankaj Jambholkar, Swarupa Chakole, Bhagyesh Sapkale

Nipah virus (NiV) is known to be an emerging zoonotic pathogen of the Paramyxoviridae family, which was first identified in 1998, and is also associated with high morbidity and mortality due to severe encephalitis and respiratory illness. Transmission occurs through direct contact with infected animals, contaminated food, and human-to-human transmission , thereby further highlighting its epidemic potential. Despite significant advances in understanding its virology, pathogenesis, as well as clinical manifestations, NiV outbreaks continue to pose substantial public health challenges, usually in endemic regions. Current management of NiV remains largely supportive with no licensed antivirals or vaccines available, thus emphasising the need for effective medical countermeasures. Recent therapeutic developments must focus on monoclonal antibodies and antiviral agents, including Remdesivir, which have shown promising efficacy in preclinical studies. Vaccine candidates, including recombinant protein, viral vector, and mRNA-based platforms, are being examined in their early phases of clinical evaluation, showing potential for robust protection of immunity. Future research priorities must include the development of rapid point-of-care diagnosis, strengthening genomic surveillance while also implementing One Health approaches integrating human, animal and environmental data for the prevention of spillover events. Refining animal models and elucidating immune correlates of protection are very important aspects for translating preclinical successes into adequately licensed interventions for management approaches for NiV. Collaborative international frameworks as well as structured R&D roadmaps are critical options for the acceleration of vaccine and therapeutic development, thereby further ensuring rapid deployment during outbreaks. This narrative review article highlights current knowledge on the epidemiology of NiV, pathogenesis, clinical management, as well as emerging preventive-therapeutic strategies while also identifying critical research gaps. It underscores the need for a proactive, integrated approach which combines medical, public health and scientific efforts for the mitigation of the threat of NiV globally.

Perioperative Anaesthetic Management in Emery-dreifuss Muscular Dystrophy: A Narrative Review

Abhigna Gummalla, Vivek Chakole, Bhagyesh Sapkale

Emery-Dreifuss Muscular Dystrophy (EDMD) is a very rare but also clinically important laminopathy that is accompanied by early contractures, weakness of the humeroperoneal muscles and progressive cardiac involvement such as conduction abnormalities, atrial arrhythmias, and dilated cardiomyopathy. These multisystem characteristics present special perioperative problems in EDMD, and thus, EDMD is a high-risk condition for anaesthesiologists. This is a narrative review summarising the existing evidence, also highlighting the overall picture of perioperative considerations in EDMD in the light of preoperative optimisation, intraoperative monitoring, anaesthetic pharmacology and postoperative care. Preoperative evaluation of EDMD requires meticulous cardiac assessment with the help of ECG, echocardiography, Holter monitoring, as well as pacemaker/Implantable Cardioverter-Defibrillator (ICD) interrogation, alongside respiratory evaluation, which proves beneficial for restrictive physiology. Intraoperatively, it is necessary to have rhythm surveillance, invasive haemodynamic surveillance, quantitative neuromuscular surveillance, and the presence of external pacing. Succinylcholine should not be used because of the risks of hyperkalemia and rhabdomyolysis, and the non depolarising agents also require careful titration. Total Intravenous Anaesthesia (TIVA) may be preferred over volatile anaesthetic agents in selected patients, and multimodal analgesia, which is safe. Despite the advantages of the regional and neuraxial practices like opioid sparing and cardiac stability, their implementation needs a thorough selection of patients and cardiac preparedness. In the postoperative period, the EDMD patients should be monitored at the ICU level to identify the arrhythmias, respiratory dysfunction, and delayed neuromuscular recovery. The present review highlights the need for adequately standardised protocols and future research to improve perioperative safety related to the management of EDMD patients.

Artificial Intelligence in Spinal Cord Stimulation and Neuromodulation: A Narrative Review of Clinical Applications, Emerging Evidence, and Future Directions

Chitra Kolla, Sheetal Madavi, Souvik Banik, Dhwani Sheth, Bhagyesh Sapkale

Spinal Cord Stimulation (SCS) is known as an established neuromodulatory therapy which is used for refractory chronic pain; however, its clinical outcomes remain heterogeneous due to limitations in patient selection, subjective outcome assessment, and trial-and-error programming strategies. Recent advances into Artificial Intelligence (AI) as well as Machine Learning (ML) have further introduced data-driven approaches for addressing such challenges through leveraging high-dimensional clinical, electrophysiological, imaging, and patient-reported datasets. The present narrative review article summarises emerging role of AI into SCS and neuromodulation, which is focused on AI-assisted selection of patients, intelligent programming, closed-loop adaptive systems, as well as clinical evidence. AI techniques which are inclusive of supervised and unsupervised learning, Deep Learning (DL), and Reinforcement Learning (RL), enable improved prediction of responders, phenotyping of chronic pain populations, and real-time optimisation of stimulation parameters. Early clinical and pilot studies suggest promising improvements into personalisation, therapeutic consistency; however, evidence still remains limited by small sample sizes, heterogeneity, also lack of large prospective trials. Ethical, regulatory, data-governance challenges like privacy, algorithmic bias, transparency, accountability further act as additional barriers for widespread adoption of AI into SCS as well as neuromodulation. Future research must focus on validation at multicenter-level, standardised-type of data frameworks, explainable AI along with adaptive regulatory pathways. AI-based SCS thus holds very significant potential into advancement of precision neuromodulation, provided responsible integration, rigorous clinical validation are adequately achieved. The current narrative review article uniquely integrates current and emerging applications of AI across full SCS pathway while also further critically highlighting evidence gaps, future directions for precision neuromodulation.

Factors Influencing Prosthodontic Complications in Metal Acrylic Resin Full Arch Implant-supported Fixed Prostheses: A Narrative Review

Anshul Trivedi, Sumit Aggarwal, Sweta Teotia

Fixed full-arch implant-supported metal-acrylic resin prostheses are a well-established solution to rehabilitate fully edentulous patients due to their retrievability/repairability, versatility and cost. However, the prosthesis and biomechanical complications can significantly impact the long-term performance of the prosthesis. The objective of this narrative review was to identify key biomechanical and prosthetic factors that influence the complication rates and clinical outcomes for fixed full-arch metal-acrylic resin implant-supported prostheses. Prosthodontic-related complications occurred from multifactorial sources; identified factors that influence prosthodontic complications included the number and distribution of implants; cantilever length; anteroposterior spread; type of material used to manufacture framework; how metal and acrylic are bonded; occlusal design; and parafunctional habits. Long-term success of fixed full-arch implant-supported metal-acrylic resin prostheses are dependent upon the following biomechanically favourable conditions: implant distribution and number, controlled cantilever length, accurate fit of framework, strong metal-acrylic bond, appropriate occlusal schemes and regular maintenance protocols. Additionally, the use of digital workflow methods, Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) frameworks and new high-performing polymer materials may improve both the fit and stress distribution in the prosthesis, but there is still a lack of strong long-term clinical evidence to support these claims.