Journal of clinical and diagnostic research

Pulmonary Candidiasis in an Immunocompetent Patient

Yogesh Kakde, Divit Shah, Sourya Acharya, Samarth Shukla, Sunil Kumar

Clinically, fungi infections of the respiratory system are uncommon. The pathogen culture and the clinical characteristics are frequently used in the clinical diagnosis of fungi. Two different patterns of invasive pulmonary candidiasis have been described: primary candida bronchopneumonia and secondary pulmonary disease arising from haematogenous dissemination or rarely primary bronchopneumonia. Primary candida bronchopneumonia is limited largely to immunocompromised patients and is thought to occur by aspiration of candida into the upper respiratory tract. This is a case of a 55-year-old male who presented with the chief complaint of dyspnoea on exertion, intermittent fever, and cough associated with expectoration of 1-month duration. The fever was moderate grade and intermittent without chills, rigours or night sweats. Respiratory system examination revealed bilateral scattered course crackles in both lung fields. Chest X-ray revealed heterogeneous opacities in bilateral upper lobes and hyperinflation of the lung. Biopsy specimens from para hilar (centrilobular nodules) were obtained and stained with Haematoxylin and Eosin (H&E), periodic acid Schiff, and Gram stain. Clusters of pseudohyphae and budding yeasts were detected in the nodules, indicating candida infection. Sputum microscopy confirmed pulmonary candidiasis. The patient’s bronchoscopy was done and bronchoalveolar lavage was sent for investigations and the growth of candidiasis came positive.

Diabetes and Fungal Infection- A Didactic Relationship

Ishita Singhal, Manpreet Arora, Aparna Dave, Pulin Saluja

Oral fungal infections are frequently encountered in clinical practice, and with the advent of the Coronavirus Disease-2019 (COVID-19) pandemic, their incidence has quite increased. Increased emergence of oral candidal and non candidal infections is evident in patients with uncontrolled diabetes, patients on steroids or antibiotic therapies, immunocompromised and immunosuppressed individuals. Also, habits of smoking and alcohol consumption, intake of carbohydrate-rich food, and salivary dysfunction have many times influenced the colonisation of fungal infections in the oral cavity. Aspergillosis once considered exotic is now more prevalent than before and presents itself in two forms: non invasive or invasive form, which has led to the rapid dissemination of the disease. Hence, a timely diagnosis of such lesions is important to prevent their invasion into other parts of the body. This article discusses a rare case of Aspergillosis occurring in the oral cavity at the site of the extraction socket in a 50-year-old woman, who is a known diabetic without any history of COVID-19 infection. Aspergillosis unlike other fungal infections of the oral cavity has been reported more in immunocompetent individuals. Here, authors report a unique case limited to the oral cavity in an immunocompromised patient.

Anaesthetic Management for Excision of Right Apical Carcinoma of Lung Encroaching in Thoracic Spine

Jui Ashok Jadhav, Shrilekh Gajanan Mankhair, Vivek Chakole

Airway management in thoracic surgeries is usually more difficult compared to in any other surgery. One Lung Ventilation (OLV) can be achieved for thoracic surgeries using various approaches like Double Lumen Tube (DLT), Bronchial Blockers (BB) and endobronchial tube. In BB, the procedure needs more precaution because of proneness to movement and displacement than DLT. In case of endobronchial tube, it is impossible to perform bronchoscopy, suction and Continuous Positive Airway Pressure (CPAP) for isolated lung. The present case report is of a 40-year-old male patient, who presented with right intrathoracic tumour encroaching thoracic segment of spinal cord and underwent excision of tumour through thoracotomy and laminectomy approach. Left-sided 37 French DLT was used to achieve OLV. After placing DLT the proper placement was evaluated by bronchoscope.

Facial Diplegia as an Initial Presentation of Guillain-Barré Syndrome

Guillain-Barré Syndrome (GBS) is an acquired immune mediated inflammatory and demyelinating disorder of the peripheral nervous system. This case report is about a 30-year-old female who presented with unilateral facial palsy which progressed to bilateral facial nerve palsy without motor weakness of limbs. Cerebrospinal Fluid (CSF) analysis showed albuminocytological disassociation and Nerve Conduction Studies (NCS) of face showed decreased conduction velocity of nasalis and orbicularis oculi nerves. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for five days and showed complete recovery. The present case is reported due to its rarity in presentation i.e. bilateral facial nerve palsy in the initial days of presentation.

Nevus Lipomatosus Cutaneous Superficialis Masquerading as Giant Lipoma- A Rare Case Report

Paridhi, Shalini Bahadur, Madhuvan Gupta, Shivani Kalhan, Deeksha Singh

Nevus Lipomatosus Cutaneous Superficialis (NLCS) is an idiopathic, rare skin hamartoma. It occurs due to ectopic deposition of adipocytes in dermis. There are two main clinical forms of NLCS- classic and solitary. Both have different clinical presentations but histologically they show similar morphology characterised by bundles of mature adipocytes in the superficial and deep dermis separated by bundles of collagen. The hallmark of this lesion is absence of connection between subcutaneous fat and adipocyte clusters in dermis.Though NLCS is benign developmental disorder and remains static for a long time, it can be cosmetically unpleasant if it grows to a large size. Herein, authors report a case of a 21-year-old male with a solitary painless pedunculated lump in right thigh for 10 years that clinically presented as giant lipoma due to its soft consistency, cut surface of the mass was yellow and fibrofatty. There was no connection of these adipocytes seen with the subcutaneous fat. Focal collections of adipocytes were also seen around the blood vessels. Sparse perivascular mononuclear inflammatory infiltrate were also noted. Final diagnosis of NLCS was made.

Multifactorial Intraoperative Uterine Scar Dehiscence: A Case Report

Thacker Shriya Himmat, Sadhana Prasad Kaware

Now-a-days, the number of Caesarean section (C-section) has increased, also the complications of C-section has increased. Obstetricians often encounter uterine scar dehiscence during delivery by c-section. However, it is rare to find a uterine scar dehiscence which is extending over one-third of the anterior uterine wall and it is yet to build the best surgical approach for repairing this rare complication of c-section or a torn anterior wall during delivery. Herein, a 23-year-old female who is Rhesus factor (Rh) negative G2P1L1 with seven months of amenorrhea came with chief complaint of pain in the abdomen since morning. On ultrasonography, severe oligohydramnios was diagnosed as Amniotic Fluid Index (AFI) was >5 cm. Hence, the patient was taken for emergency Lower Segment Caesarean Section (LSCS), Lower Uterine Section (LUS) was papery thin, uterovaginal fold of peritoneum was opened and the bladder was pushed down. One-third of the anterior uterine wall was involved. LUS was sutured using vicryl no. 1 and complete haemostasis was achieved. As uterine scar dehiscence is not preventable, efforts should be made to manage it efficiently and repair the myometrium safely.

Omental Herniation through Uterine Perforation due to Unsafe Abortion: A Case Report

Imran Ahmed Khan, Veena Shahi, Najma Malik, MD Abu Bashar, Rajeev Shahi

Post-abortion complications are a significant cause of maternal morbidity and mortality when conducted by untrained persons in sub-standard settings, which are commonly seen in Low and Middle-Income Countries (LMICs). The presentation depends on the type and extent of the injury but at times may be misleading and delayed recognition resulting in fatal complications. Uterine perforation is one of the uncommon complications of unsafe abortion. The authors report a case of 26-year-old female patient, gravida 2, para 1 admitted with a history of bleeding per vaginum for the past five days. A detailed Ultrasonography (USG) was done by an ultrasonologist who confirmed the presence of a small rent in the uterine wall and the intrauterine product as a continuation of the omentum. An emergency laparotomy was performed and intraoperative findings showed uterine perforation located at the scar line of the previous uterine incision, through which omentum has entered the uterine cavity and traversed through the cervical canal into the vagina. That part of the omentum which had come into the uterine cavity was removed after ligating all feeding vessels, and the rest of the omentum was placed back into the peritoneal cavity. The uterus was preserved and the patient was discharged in stable condition. Uterine perforation sometimes may present with minimal symptoms and a thorough history and physical examination is key in diagnosing it. Unsafe abortions in hands of quacks and unqualified practitioners leading to life-threatening complications still remain a major problem in developing countries like India and require the immediate attention of policymakers.

Management of Scrotal Aggressive Angiomyxoma: A Case Report

R Lakshmana, Jayakumar, N Snigdha, Neethish K Paul, PA Sethu Raman

Aggressive Angiomyxoma is most commonly identified as a slow growing mesenchymal neoplasm most commonly seen in women than in men. It has a marked tendency for local recurrence but with low instances of metastasis. Radiological investigations may assist in arriving at a provisional diagnosis and provide an arbitrary idea about the margins of the tumour but the gold standard diagnosis is always be histopathological examination. Surgery is the first line and the most reliable form of treatment. However, around 40-70% of patients came with complaints of recurrence. This is a case of a 61-year-old male patient who came with complaints of scrotal swelling which increased in size over a period of six months. The swelling was firm in consistency without warmth or tenderness. Contrast-enhanced Magnetic Resonance Imaging (CE-MRI) was taken to discern the borders of the mass and it was suspected to be a soft tissue sarcoma. Mass was excised in toto and a confirmatory diagnosis of aggressive angiomyxoma was made only after postoperative histopathological examination. The patient was on regular follow-up for eight months to date and no evidence of local recurrence was detected. This case report presents to be a curious case as aggressive angiomyxomas are usually tumours seen in females. It also describes the management of scrotal swelling without a preoperative diagnosis.

Dengue Fever Presenting as Ischaemic Stroke: A Case Report

Rajasekhar Putta, K Vali Basha, K Newton Issac Praneeth Perumalla

Several neurological manifestations are common in dengue fever. They are encephalitis, encephalopathy, Guillain Barre Syndrome (GBS), Intracranial haemorrhage, but, ischaemic stroke is a rare complication. This is a case report of ischaemic stroke in a patient with dengue fever. A 39-year-old female patient presented to the emergency department with the chief complaints of fever, retro orbital pain since four days, and one episode of seizure on the day of presentation. Examination revealed left homonymous hemianopia. Diagnosis of dengue was made based on Immunoglobulin M (IgM) Enzyme-Linked Immunosorbent Assay (ELISA) positive for dengue. Magnetic Resonance Imaging (MRI) brain showed acute infarcts in right temporal, right occipital and right hippocampal region. Severity of hemianopia decreased as the days progressed and platelet count gradually improved to normal limits within five days. Adequate fluid management was given and the patient was discharged once stable. Anti-platelets were started after two weeks during the follow-up. Examination during follow-up showed decrease in hemianopia to just mild blurring of vision on left gaze. Ischaemic stroke is rarer entity and clinicians should be made aware of this complication.

Focal Nodular Hyperplasia of the Liver without a Central Scar: A Rare Case Report

Gyanendra Singh, Anurag Singh, Manoj Jain, Tushar Kalonia

Focal Nodular Hyperplasia (FNH) is most frequent benign tumour of liver just after the haemangioma, which makes about 3-5% of all primary hepatic tumours. It occurs frequently in females during their middle age group. This is case report of 48-year-old female patient having complaints of upper abdominal pain since last one year. Using abdominal ultrasonography and a CT scan, it was discovered that segment four of the liver contained a tumour measuring 11 cm in maximum diameter without a central scar, which made preoperative imaging scans for FNH difficult to diagnose. Lobectomy of left lobe was done. The gross specimen on cut section revealed a lesion with nodular appearance and absence of any central stellate scar. On the basis of histopathological finding the diagnosis of FNH without central stellet scar was made. To ensure adequate therapy, it is essential to differentiate between FNH and other hyper vascular liver lesions and metastases. Therefore, it is difficult to diagnose FNH before surgery if there are no typical radiological findings. This case report focused on FNH without the usual radiological findings and emphasised its importance to distinguish it from other malignant hyper vascular liver entities.

Idiopathic Gastric Fundal Perforation in a Young Male

Rajguru Siwach, Shivani B Paruthy, Sajith K Mohan, Tulsi Appat, Anirban Das

Gastric perforation is a life-threatening condition encountered in surgical emergency. Common conditions that cause gastric perforation requiring emergency exploration include peptic ulcers, trauma, iatrogenic injuries and corrosive burns. Gastroduodenal region is the most common site of perforation but perforation in fundus of stomach is unusual. Acute Gastric Dilation (AGD) is a rarely encountered condition that leads to vascular compromise of stomach wall causing ischaemia and necrosis. Hereby reporting the case of a 26-year-old male, who presented with complaint of abdominal pain following heavy meal. Erect skiagram of chest was diagnostic of hollow viscous perforation peritonitis and the patient underwent emergency exploratory laparotomy. A perforation was noted over the posterior aspect of fundus of dilated stomach. Gastric fundectomy and feeding jejunostomy was done. The surgeon should be aware of such cases of AGD, with fundal perforation for active and appropriate management.

Warfarin-Induced Limb Contusion and Haematoma

Soumya, Dnyanesh Morkar, Anushree Deshpande

Warfarin is a narrow therapeutic index drug with high potential to cause adverse effects. It is generally a preferred drug for the management of venous thrombosis. This case is an unusual presentation of left arm contusion and limb haematoma secondary to long-term warfarin use. A 32-year-old male patient was admitted with the complaints of left lower limb oedema and left upper arm oedema. He was on warfarin for dural sinus thrombosis for two years. The integrative analysis of patient clinical presentation, medication history, International Normalised Ratio (INR) level, Ultrasonography (USG) scan and Naranjo assessment showed the probable case of warfarin-induced left arm contusion and limb haematoma. The patient was successively managed with the administration of vitamin K, injection heparin, packed red blood cell and other supportive therapy after the withdrawal of the culprit drug. Thus, patients prescribed with warfarin should be looked at for this typical adverse event. Monitoring of anticoagulant therapy is vital for the positive clinical outcome and minimisation of adverse events. Clinical pharmacists have a key role to play in the patient safety and their inputs can fertilise the concept of pharmacist led anticoagulation clinic in India.

Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type: A Rare Neoplasm Masquerading as Squamous Cell Carcinoma

UMA Kumar, Natasha Gulati, Pooja Khari, Madhu Sinha

Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type (PCDLBCL, LT) comprises 4% of all cutaneous lymphomas, and it presents as an aggressive form of lymphoma. Rarely do pathologist/cytologists find specimens of PCDLBCL, LT on Fine Needle Aspiration Cytology (FNAC). The mimickers on FNAC are metastatic small cell carcinoma, Merkel Cell Carcinoma (MCC), Malignant Melanoma (MM), Cutaneous Alveolar Rhabdomyosarcoma and Primary Cutaneous Ewing’s Sarcoma (PCES). A 75-year-old female patient presented in the Department of Surgery with multiple nodules on the leg for three months. On cytology small round cell tumour with possibility of non hodgkin lymphoma was given and biopsy was advised. The confirmation of PCDLBCL, LT on cytology is not recommended however, it is emphasised that it can be picked up on FNAC and distinguished from its mimickers. Because of the aggressive nature and poor prognosis with the frequent relapses and tendency for extracutaneous spread, it is considered to be a distinct type of cutaneous lymphoma which needs to be diagnosed and treated as early as possible.

One Injury, Two Tracks and Two Weapons with Two Thoughts: An Exhumation Case Report

Exhumation is authorised digging out of already buried body from his legitimate graveyard. The autopsy in exhumed dead body require extreme attention and thorough examination of the corpse to determine the exact cause and manner of death. Exhumation also helps to evaluate and rule out any disease responsible for death. In the present case, authors discuss and report an unusual case of decomposed young adult male of 24-year-old, who was killed/stabbed by his younger brother. Body of deceased was buried by the perpetrator of crime without police information and medicolegal autopsy. The stab wound was altered by accused to misguide or create confusion in identifying the type of injury and weapon of offence. Later, this scenario was solved by autopsy surgeons after visiting incident scene, complete postmortem examination of the corpse and examinations of belongings.

Neurological Complications after Deceased Donor Liver Transplant: A Case Series from a Public Sector Hospital

This is a case series of neurological complications which occurred after Deceased Donor Liver Transplant (DDLT) in a public sector hospital. The clinical presentations were bizarre. This is because patients with End Stage Liver Disease (ESLD) commonly have hepatic encephalopathy and postoperatively can present with similar clinical picture, like tremors and altered mentation. The first patient in the series presented with tremors due to Calcineurin Inhibitor (CNI) toxicity, second had Posterior Reversible Encephalopathy Syndrome (PRES), third with Osmotic Demyelination Syndrome (ODS) with coma and fourth with Extrapyramidal Syndrome (EPS). Patients 1 and 4 had involuntary movements and other clinical manifestations which interfered with recuperation in the postoperative period. So, the dosages of the immunosuppressants were adjusted and serum tacrolimus assay were serially monitored on alternate days. Case 3 developed PRES due to hypertension, as a result of high serum tacrolimus levels. The patient presented with headache and seizures, which if uncontrolled would have been lethal. In Case 4 clinical features and management of a patient who suffered prolonged coma due to ODS for about three months has been discussed. Also, the same patient had a cerebral infarct due to embolic phenomenon inspite of thromboprophylaxis. From this case series, it needs to be emphasised that postoperative occurrence of neurological complications are likely. So careful selection of the recipients, steady titration of immunosuppressants and watchful monitoring of the neurological signs are essential to improve the outcome of the transplant. Imaging of the brain, preferably Magnetic Resonance Imaging (MRI) should not be delayed to rule out other differential diagnosis.

Granulomatous Mastitis Masquerading as Breast Neoplasms- An Enigmatic Series of 14 Cases

Meghadipa Mandal, Anadi Roy Chowdhury

Granulomatous Mastitis (GM) is a rare entity encountered in day-to-day practice. Aetiologies range from infections like tuberculosis, lactation, certain medications to being idiopathic. Clinical and radiological pictures in these cases often mimic breast carcinoma that poses diagnostic dilemmas to the treating physician. However, sometimes they may be asymptomatic. Definitive diagnosis is made using cytology followed by histomorphology by demonstration of granulomas, which are collections of histiocytes along with giant cells and inflammatory cells. Ancillary studies like Ziehl-Neelsen (ZN) stain, Periodic Acid Schiff (PAS) stain, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) are used to detect or rule out certain aetiologies of granulomatous inflammation. Idiopathic Granulomatous Mastitis (IGM) is mainly a diagnosis of exclusion, where all the possible aetiologies have been ruled out by detailed history and investigations. Treatment approaches are mainly conservative, depending on the cause or may be anti-inflammatory and steroids in case of IGM. Appropriate and timed diagnosis of such cases is essential to prevent over diagnosis of carcinoma and unnecessary mastectomies. This is a series of 14 such cases which were diagnosed using cytology or histology and ancillary tools. They belonged to four categories (namely-Tuberculous mastitis, IGM, Post-chemotherapy GM and sarcoid granuloma of breast). Tuberculous cases shared majority of the series, whereas, sarcoid granuloma was a single isolated entity. All these cases presented with lump in breast with other associated presentations. Immediate tissue diagnosis helped in ruling out malignancy and adopting a conservative approach for management.

Limberg Transposition Flap in Primary Pilonidal Sinus- A Case Series

T Jeyalaksmi, E Shenbaga Seetha Priya

Sacrococcygeal Pilonidal Sinus (PS) is common among the young male adult population. There are multiple treatment options available ranging from non medical and surgical procedures. Medical management is not in vogue. This case series is about 10 patients with a common manifestation of serous discharge from the sinus in the sacrococcygeal region. The patients warranted a definitive cure for their condition. Though not life-threatening, it is socially embarrassing and adversely affects the quality of life in terms of education and livelihood among the young. The Limberg flap technique was advocated in all these patients, only one out of 10 patients showed wound infection. All the patients were satisfied with the surgical outcome. The surgical choices varied from simple excision to flap procedures. Overall the Limberg (rhomboid) flap technique has fewer postoperative complications and low recurrence rate and has a shorter learning curve, and is emerging as the standard of care.

Applications of Arterial Spin Labelling Sequence in Neuroimaging, Case Depictions with Examples: A Case Series

Since many neurological diseases are associated with altered regional cerebral flow, Arterial Spin Labelling (ASL) image being a non invasive non contrast sequence, is increasingly being used and incorporated in routine protocols as an adjuvant sequence to study the regional alterations in cerebral perfusion or Cerebral Blood Flow (CBF). It demonstrates increased or decreased regional CBF in various brain pathologies reliably without the use of intravenous contrast material. In this case series (seven cases), ASL is increased (increased CBF) in cases of high-grade tumour, highly cellular tumours, encephalitis, tumour recurrence, acute phase of Posterior Reversible Encephalopathy Syndrome (PRES), and decreased in cerebral infarct, periinfarct ischaemic penumbra, thereby making an effort to emphasise the significance and utilisation of ASL in adjunct to the other routine Magnetic Resonance Imaging (MRI) sequences.

Dengue Fever with Myositis- An Uncommon Complication of a Common Disease

Priyank Rastogi, Rajesh Chetiwal, Sandeep Choudhary

Dengue has a high prevalence in tropical countries including India. Although myalgias are a common musculoskeletal manifestation in dengue but myositis is unusual. The present case series describes three cases of female patients with dengue fever (35-year-old, 30-year-old and 37-year-old), who developed severe pain and tenderness in muscles and were diagnosed with myositis. The present case series emphasises the fact that, although the condition is usually self-limiting, but it has the potential to aggravate into life threatening conditions like acute respiratory and renal failure, if left unattended.

Deciphering Deep Neck Space Infections and its Management: A Case Series

Nitha, Ajitha Tavvala, M Swarnapriya, Reshma Radhakrishnan Nair, PA Famida

Deep Neck Space Infections (DNSI), which affect the potential deep cervical spaces often have a rapid onset and given their life-threatening complications, pose a significant challenge. For the most part, these infections arise from local extension of infections from a septic foci which is mostly of odontogenic and periodontal origin. A case series of neck space infections, their presentation, management and recovery is presented here. Although Contrast-Enhanced Computed Tomography (CECT) scan has been touted as a routine investigation of deep neck infections, it is found that imaging by ultrasound saves time and resources and is of immense diagnostic value in localising and delineating the exact space involved and detecting impending complications so as to pre-empt it. Also, true to the maxim, “…never let the sun set on an undrained abscess”, surgical drainage on the first day even in stable cases followed by an empiric course of high dose broad spectrum antibiotics resulted in faster recovery.

Lung to Lung Cannon Ball Metastases: A Case Series on Primary Lung Malignancy

Cannon ball metastases refer to large, well circumscribed, round pulmonary nodules like cannon balls that are scattered over both lungs, being a classical presentation of haematogenous tumour spread.Cannon ball pulmonary metastases are typically seen in the patients with choriocarcinoma or renal cell carcinoma. Rarely, pulmonary metastases with the same appearance may be secondary from prostate cancer, synovial sarcoma, endometrial carcinoma or haepatocellular carcinoma.The present case series is about six patients diagnosed with cannon ball metastases which occurred from primary lung carcinoma. Out of these six cases, three were of small cell carcinoma, two of squamous cell carcinoma and one of adenocarcinoma.The histopathology of all the cases was established by biopsy from the tumour site and appropriate treatment was started in the form of chemotherapy and radiotherapy as needed. Clinicians must investigate thoroughly for primary origin of cannon ball metastasis, though rare but lung cancer can present as this kind of metastasis.

A Ritual for Initiation of Medical Students to the Profession-White Coat Ceremony

Vishnu Bhat Ballambattu, Ravikumar Sambandam

Medical practice over the years has changed from a final ritual before death to a skill that can reverse the process from illness to good health. The knowledge regarding the cause of illness, role of antisepsis and asepsis, newer diagnostic facilities availability of medications for controlling the disease and treating infections has resulted in better outcomes. Medical knowledge and skills have evolved over the years. Before the late 19th century, seeking medical advice was often considered a last resort before death. Encounters with physicians rarely benefitted the patients, since most of the therapies were worthless and more of quackery or palliative in nature. People consulted medical practitioners more as a ritual without any benefit. Doctors/medical practitioners were often identified with black dress indicating their ultimate role in soothing a process that could not be reversed. Dr. Samuel D. Gross and his assistants were shown amputating a young man’s leg in a black dress in a painting created by Thomas Eakins at Jefferson Medical College in Philadelphia. This picture was labeled as “The Gross Clinic”. It is not clear whether the patient survived or not. Over the years, medical knowledge has tremendously improved beyond counselling, giving some hope to terminally ill patients (1). Dr. Joseph Lister described antisepsis in the year 1889. The painting, “Agnew Clinic” by Thomas Eakins at the University of Pennsylvania shows the anatomist and surgeon, Dr. David Hayes Agnew in a white coat. The spread of malaria by mosquitoes was known in 1892. Medicine became more scientific in the late 19th century. The concept of illness and management of patients gradually changed. Doctors and nurses started wearing “white dress” to indicate the purity of the profession and some hope for the sick patients (2). The white coat originated in the late 19th century. At the Pritzker School of Medicine, University of Chicago, Illinois, United States of America (USA), matriculating students taking paths to become doctors were honored with white coat in 1989. The credit of conducting the first white coat ceremony goes to Dr. Arnold P. Gold, who was a Professor of Clinical Neurology and Paediatrics, College of Physicians and Surgeons, Columbia University, New York, USA. It was conducted in the year 1993 and was seen as a great event for students getting initiated into the medical profession. Deans, Presidents of colleges and other distinguished professionals participate in this induction function. The white coat indicates a projection of love for self, one’s coat, friends and family and above all patients. Usually, an oath is administered during this ceremony highlighting doctors’ role in abiding to the universal principles of ethics, while discharging their duty. Some 90% of American and nearly 50% of British medical students swore some kind of oath either on entry to medical school or at graduation during the year 2001 (3). This makes them give a lifelong commitment to the profession, individual patients and society at large. In the present day scenario, the white coat ceremony marks the welcoming of medical students into the profession. White coat is placed on the student’s shoulder and a stethoscope around their neck during the program. The students are addressed by a notable person in the field along with institute authorities like the Director, Dean etc. Students’ family members and friends may also join the function. Students should be initiated into the profession and should be guided through universal principles of ethics. Autonomy, beneficence, non maleficence along with equality and justice form the universal principles of ethics. One should weigh the benefits versus risk while advising treatment and patients’ autonomy should always be respected. A doctor can counsel and advise but should not make the final decision on the course of treatment without a patient’s consent. Every patient should receive quality care irrespective of race, religion or socio-economic status. It is also necessary that confidentiality is always maintained with regard to information provided by the patient. White colour indicates goodness and purity. It makes the medical students feel a sense of honour, inclusiveness and respect (4). White coat wearing is not compulsory in England and Denmark but is part of the uniform in Sweden, Finland and Norway. The white coat gives the doctor an identity, confidence and respect. Simultaneously, it gives challenges and responsibilities. The medical profession demands a lot of work, but the financial returns may not be always good. It is a noble profession which requires hard work, dedication, commitment, compassion and empathy. “Medical schooling is a marathon” and the student has to keep pace with the time (4),(5). The Medical College of Kolkata was the first medical college to function in India in the year 1835. But the first white coat ceremony was conducted in the year 2017 at Guru Gobind Singh Medical College, a constituent college of Baba Farid University of Health Sciences at Faridkot, India. Professor Russell D’souza, Head of Asia Pacific division, United Nations Educational, Scientific and Cultural Organisation (UNESCO) chair of Bioethics was the chief guest. During the next year, many medical colleges across the country initiated this program. A white coat ceremony was usually conducted when the student entered the Clinical Departments, i.e., after completing the preclinical subjects. The National Medical Council has introduced early clinical exposure in the first year now and the white coat ceremony being conducted now during the first year itself. It is essential to make the medical students affirm their position as they enter the medical school and not after graduation. Feedback from students, parents and the medical fraternity are also highly positive towards this initial induction programme (1). It has been observed that, 72% of doctors wear a white coat during 75% of their working time. Usually, paediatricians and psychiatrists do not wear a white coat. They often like to be seen by their patients in casual dress. A white coat not only helps in recognising the doctor by colleagues, co-workers and patients, but also protects their dress from getting dirty. It also helps in carrying examination items in large pockets. However, White coat usage is not restricted to doctors now. It is also used by nurses, physiotherapists, technicians and others. All professionals dealing with illness of human beings wear white overcoats. A laboratory coat or wear coat is typically worn by healthcare professionals who work in laboratory settings or who handle chemicals or other hazardous materials. It is designed to protect the wearer and their clothing from spills and splashes. While a laboratory coat may not be as closely associated with the medical profession as a white coat, it is still an important piece of protective clothing for healthcare professionals in certain settings. Wearing a white coat not only makes the medical professional more easily identifiable but also provides hope for sick patients and their relatives. The hippocratic oath and universal principles of ethics should guide the professional in the right direction for betterment of the society.

Dental Screening at 35,000 Feet-Why Not!

Rahul Mohandas, Subhashree Mohapatra

Dear Editor, Aviation dentistry refers to the evaluation, prevention, and management of oral and maxillofacial diseases in air travel passengers and crew members (1). Cruising at a height of 35,000 feet, flight journeys are long, and often spent on non productive tasks. This duration of the flight journey can be put to optimal healthcare use, by conducting in-flight dental screening of all the passengers. In-flight dental screening can prove beneficial for passengers who are ignorant of their oral hygiene status, thereby motivating them to seek dental treatment at the earliest, if necessary. The incipient soft tissue lesions, which are often missed by the patient, can be caught at an early stage, proving beneficial for the patient. It can also promote dental tourism, especially in the case of international passengers seeking dental treatment in a foreign land (2). The society is spending a lot of time travelling at high altitudes. However, there is a lack of literature surrounding the complications associated with uncompensated alterations of pressure at higher altitudes (3). Barotrauma can occur as a result of the pressure difference between the body fluids and atmospheric pressure (4). Barodontalgia is the manifestation of dental pain due to barometric pressure changes in the external environment (5). Tooth fractures caused by a high-altitude environment, due to gas entrapment beneath faulty restorations have been termed odontecrexis (6). Dental emergencies like head and face barotrauma, barodontalgia, and odontecrexis have been underreported during commercial air travel, due to lack of awareness among the cabin crew and general public (7). In a study by Phillips M et al., 24.4% patients with brain tumour reported of worsened symptoms during an air flight (8). Such dental emergencies can be addressed by onboarding an in-flight dental surgeon. Additionally, in-cabin dental professionals can also be trained to handle in-flight medical emergencies like syncope, seizures and respiratory distress (9). However, certain potential problems may be encountered during the practical application of this hypothesis. Firstly, there is a space constraint in the aircraft cabin (10). A separate dental operatory section will have to be created, which would be at the expense of certain seats. Moreover, the operatory would have to be designed in a way to provide adequate space for the dental chair, and the operator. A separate laboratory area will also have to be incorporated. Secondly, in-flight turbulences may act as hindrances during operative dental procedures (11). While turbulence is sometimes unavoidable, its effect can be dampened. One way could be to setup the dental operatory over the wings of the aircraft, which helps the aircraft to remain balanced. Lastly, in domestic flights with shorter duration, dental procedures may not be carried out due to time constraint. However, dental screening can be performed in such flights. The dental institutions and regulatory bodies across the globe, in collaboration with their civil aviation authority board should plan and implement in-flight dental screening programs. Aviation dentistry-based guidelines have to be formulated for the smooth functioning of dental screening. Several dental practitioners can be recruited and trained for conducting in-flight dental screening, which would further improve the employment of dentists. Installation of a dental unit with basic diagnostic instruments should suffice for preliminary screening of the passengers. Emergency medical kits and drugs can be maintained on board. Portable radiographic units can be used, provided they do not interfere with the flight’s wireless system. Initially, the presence of barometric pressure changes may hinder the initiation of operative and restorative dental procedures. However, the construction of a dental operatory with an optimal cabin pressure control system may eventually facilitate operative dental procedures in the air. This could prove to be revolutionary in converting the vision of an aviation dental clinic into a reality. Aviators and dental practitioners should embrace all available opportunities for incorporating and promoting oral and dental health and wellness.

Comparative Effect of Niel-Asher Technique and Positional Release Technique on Pain, Active ROM and Functional Disability in Adhesive Capsulitis: An Experimental Study

Prabhu Ram Kishnapandian , Deepak Raghav , Amit Dwivedi

Introduction: Adhesive Capsulitis of Shoulder (ACS) is a common self-limiting disorder characterised by painful, progressive loss of active and passive shoulder motion due to fibrosis and rigidity of the joint capsule. ACS occurs in 2-5% of the population overall and up to 20% of those with diabetes. Women between the ages of 40 and 60 are at increased risk, and one in four patients may have bilateral illness. Several studies have been done to prove the effectiveness of electro-therapeutic modalities and manual mobilisation techniques on Adhesive Capsulitis, but very few studies have been done to find out and compare the effectiveness of Niel-Asher technique and Positional Release Technique (PRT) on adhesive capsulitis. Aim: To compare effect of Niel-Asher technique and positional release technique on pain, active Range of Motion (ROM) and functional disability in patients with adhesive capsulitis. Materials and Methods: This was a pre and post-experimental design conducted at Santosh Medical College and Hospital, Ghaziabad, India, for a duration of two years conducted on 110 patients with a diagnosis of stage II primary adhesive capsulitis. The patients were divided into group A and group B using a systematic random sampling procedure. Conventional physiotherapy and the Niel-Asher technique were used on patients in group A. Patients in group B received conventional physiotherapy and PRT. The therapy was given to patients, three times weekly for a total of six weeks. The Shoulder Pain and Disability Index (SPADI), Range of Motion (ROM) and Visual Analogue Scale (VAS) were measured in both groups in pre, mid and post-therapy. The analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) software version 17.0. Results: A total of 110 patients with adhesive capsulitis patients, 55 in each group A (mean age: 51.78±7.810 years) and group B (mean age: 52.33±7.794 years) were included in the study and the mean age of total study subjects was 52.05±7.80 years. On analysis of the collected data, statistically significant outcomes across all three measures (VAS, SPADI, and ROM) were observed with a p-value of less than 0.001. In pain, functional impairment and restricted ROM, group A, outperformed group B in this comparison. Conclusion: Both conventional physiotherapy along with Niel-Asher technique group and conventional physiotherapy along with PRT group were individually effective in relieving pain and improving Range of Motion and Functional ability in patients with Adhesive capsulitis, but among these two groups, the group that received Niel-Asher technique in addition to conventional physiotherapy reported more significant improvements when compared to PRT group, in pain, range of motion and functional ability.

Anticancer Activity of the Amide-Imidazole Compound on Cancer Cell Lines: An In-Vitro Study

Pramit Kumar, Amresh Kumar, Sude Kumar Singh, Preeti Sharma

Introduction: The leading cause of morbidity and mortality in the world is cancer. Promising anticancer compounds include small heterocyclic chemicals. In many malignancies, cancer cells’ resistance to therapy leads the recurrence and mortality after treatment. Drug resistance that develops during therapy encourages researchers to create compounds that are more useful and less harmful. Derivatives of amido-imidazole conjugates induce apoptosis in breast cancer cell line. Aim: To investigate the effect of anticancer activity of amide-imidazole on various signalling and apoptotic protein in cancer cell lines. Materials and Methods: This in-vitro study was designed in the Department of Biochemistry, Santosh Medical College, Ghaziabad, Uttar Pradesh, and AIIMS Patna from February 2021 to January 2022. The normal as well as cancer cell lines were cultured and grown in the medium, and the antiproliferative activity of compounds was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, while various signalling proteins that regulate the proliferation and migration of cancer cell were assessed using the western blotting method. Statistical analysis of antiproliferative activity was estimated using graphical methods. Results: The results showed that the amide-imidazole compound had variable antiproliferative potency in a variety of cancer cell lines. When HT-29, MDA-MB 231 and MCF-7 cancer cell lines were treated with the amide-imidazole compound at different concentrations (5, 10, 15, and 20 μM). Cell proliferation was inhibited, which is measured by MTT {3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide} assays. The growth in different cancer cells is HT-29 (94.16, 85.19, 77.54, and 77.86), Malondialdehyde (MDA)-MB 231 (100, 91.10, 86.82, and 79.96), and MCF-7 (74.01, 65.26, 60.42, and 36.99) at different concentrations, respectively. The western blot results of the Michigan Cancer Foundation-7 (MCF-7) cancer cell line showed a decrease in the concentration of various signalling pathways such as AKT, Extracellular signal-regulated Kinase (ERK), and Signal Transducer and Activator of Transcription-3 (STAT 3) and an increase in the cleavage of Poly (ADP-ribose) Polymerase (PARP) and Caspase-8, while also decreasing the antiapoptotic protein B-cell Leukaemia (BCL)-2. Conclusion: In present study, amide-imidazole derivatives triggered the apoptosis and lowered the antiapoptotic cell protein in breast cancer cell lines (MCF-7). Hence, breast cancer, can be treated with amide-imidazole derivatives.

Wrist Spanning versus Non Spanning Technique of External Fixation in Distal Radius Fractures: A Randomised Clinical Trial

Saikat Sarkar, Subhankar Mukherjee, Kaushik Mandal, Prasun Mandal

Introduction: External fixation is one of the treatment options for unstable Distal Radius Fractures (DRF). Extra-articular variety of DRF can be managed by both wrist joint spanning and non spanning types of external fixators. Literature comparing the outcome of these two techniques is scarce. Aim: To compare and evaluate the results of treatment of DRF with wrist spanning and non spanning techniques. Materials and Methods: A randomised clinical trial study was carried out at Medical College and Hospital, Kolkata, India from November 2017 to January 2019. It included 30 patients, 15 had been treated by spanning and 15 by non spanning external fixators. They were evaluated during the immediate postoperative period, six weeks, nine weeks, and 12 weeks after surgery using digital roentgenography, Disability of Arm, Shoulder, and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and clinical assessment. A radiological assessment of volar tilt, radial height, and radial inclination was done and the data was normally distributed and analysed by unpaired t-test. Results: The DASH score was better at 12 weeks in the non spanning group, with a mean of 21.89 in spanning vs 19.3 in the non spanning group (p-value 0.0412). At 12 weeks, the mean and p-value for the spanning and non spanning group: range of flexion (61.87 and 70.46), extension (66.13 and 71.13, p-value=0.0053), supination (73.2 and 74.9) and pronation (77.20 and 79.8). For spanning and non spanning groups, the volar tilt mean was 2.33 and 0.60 with a p-value of 0.0042 and the radial length mean was 1.27 and 0.33 with p-value 0.0013, in favour of the non spanning technique. Conclusion: According to the present study, non spanning external fixation is a better operative technique than spanning external fixation. Unstable DRFs can be treated better by a non spanning external fixator.

Association of Melasma in Patients with Thyroid Dysfunction and their Clinical Profile: A Cross-sectional Observational Study

Nishtha Hitendrabhai Patel, Narendra Gangaiah, Veena Thimmappa

Introduction: Melasma may occur in thyroid diseases, and its manifestations may be the first presenting sign or even precede the diagnosis by many years. Melasma is difficult to treat. An initial screening of thyroid dysfunction will help in better management of both thyroid disorders and melasma. Aim: To detect the proportion of thyroid dysfunction in patients with melasma and describe the clinical profile of such patients. Materials and Methods: This was a cross-sectional, observational study carried out in the Department of Dermatology, Venereology and Leprosy, of a tertiary care teaching hospital of Karnataka, India, from September 2020 to February 2022. Patient above or equal to 18 years of age with newly diagnosed melasma alone and no history of thyroid dysfunction were included in the study. A detailed history, using a preformed questionnaire, was taken. Wood’s lamp examination was done to know the depth of pigmentation, along with thyroid dysfunction test, and antiThyroid Peroxidase (TPO) antibody was evaluated. Descriptive statistics data were analysed using a Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: There were 100 patients with a mean age of 35.9 years, with a predominance of female (86%) and the majority (48%) of population were housewives. The distribution of lesion was either dermal (55%) or epidermal (44%). There were 65 patients with positive antiTPO; with men (85.7%) being significantly more than women (61.6%). The distribution of pigmentations was higher for the dermal pattern (55%), among females (46) and males (9), while only one mixed pattern was seen in males. Conclusion: Male melasma patients had higher positivity of antiTPO positivity than females, with significant antiTPO positivity. These patients showed more dermal pigmentations on Wood’s lamp examination.

Interpregnancy Interval Effect on Perinatal Outcome- A Prospective Observational Study

Moumita Bera, Nilanjana Chaudhury, Subrata Samanta

Introduction: Spacing of birth is an important parameter affecting maternal and foetal health. Optimal birth spacing provides multiple benefits for both mother and her child. Both short and long Interpregnancy Intervals (IPI) is associated with multiple adverse perinatal outcomes. Therefore, IPI is viewed as a potential modifiable risk factor for adverse foetal-maternal outcome. Aim: To study the association of IPIs with adverse maternal and foetal outcomes. Materials and Methods: This prospective observational study was conducted in R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India for a period of 18 months from January 2019 to June 2020. All multigravida women with atleast three antenatal checkups were included in the study. The subjects were divided in two groups: group A consisted of 86 subjects, who had <2 year IPI and group B consisted of 87 subjects, who had ≥2 year IPI. These were compared on the basis of following socio-demographic characteristics: maternal age, Body Mass Index (BMI), contraceptive use, socio-economic status. Foetal outcome was assessed by gestational age at delivery, birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, need for Neonatal Intensive Care Unit/Sick Neonatal Care Unit (NICU/SNCU) admission and perinatal morbidity and mortality. Data were collected and statistically analysed using Statistical Package for Social Science (SPSS) version 19.0 (SPSS Inc, Chicago, IL, USA). Chi-square test was used for categorical data and students t-test was used for continuous data. Statistical significance in all evaluations was defined as p-value <0.05. Results: Contraception use were significantly less in women with short IPI (p=0.001). The incidence of anaemia (p=0.026), scar dehiscence in postcaesarean pregnancies (p=0.031) and Postpartum Haemorrhage (PPH) (p=0.041) were also higher in mothers with short IPI. In this group incidence of low-birth-weight baby (p=0.039), preterm birth (p=0.041) and need for care of babies in NICU (p=0.043) were also higher and was statistically significant. Conclusion: Lack of contraceptive use significantly increases the risk of short IPI which increases the risk of preterm delivery, maternal anaemia PPH and scar rupture in post-CS pregnancy and therefore, has a serious impact on maternal morbidity. Low birth weight and NICU/SNCU admission being more in group A was a drain on the health expenditure.

Internal Quality Control Indicators in Cervical Smear Screening- Report from a Tertiary Care Centre, India

Poongodi Rajagopal, Arundhathi Shankaralingappa, Sharmila Vijayan

Introduction: Quality indicators are one of the tools to monitor the Quality Control (QC) system and have revolutionised the field of laboratory medicine. Internal QC helps in identifying the non conformities in lab from the moment sample reaches the lab and till the report is being despatched. This study was performed to evaluate the internal QC indicators of cervical smears with an intent to know where we stand, identify the lacunae and to improve performance of lab services. Aim: To evaluate the internal QC indicators of cervical smears in an effort to improve performance of lab services. Materials and Methods: This was a retrospective cross-sectional study conducted in the year 2021. Archived reports of females >18 years of age who had undergone Papanicolaou (Pap) smears between August 2019 and August 2021 were collated from the Department of Pathology, AIIMS, Mangalagiri. Based on these reports, various internal quality indicators, including positivity rate, percentage of Atypical Squamous Cells (ASC) among satisfactory tests, percentage of ASC among abnormal tests {includes Atypical Squamous Cells of Undetermined Significance (ASCUS), ASC-H, Low-grade Squamous Intraepithelial Lesion (LSIL), High-grade Squamous Intraepithelial Lesion (HSIL), carcinoma} ASC/SIL ratio, ASCUS/SIL ratio, percentage of LSIL, percentage of HSIL, percentage of false negatives, percentage of unsatisfactory smears were calculated. Data was analysed by using the Statistical Package for the Social Sciences (SPSS, version 15.0; IBM, USA) and descriptive statistical analysis was calculated for the quality indicators. Results: A total of 1227 Pap smear cases were analysed in two-year duration, out of which 41 cases were unsatisfactory (3.34%). The annual smear positivity rate ranged from 1.19-1.31%, ASC percentage among the abnormal tests- 40%, ASC percentage among the satisfactory tests- 0.50%, percentage of tests with LSIL- 0.08%, percentage of tests with HSIL- 0.25% and false negative rate- 0.16%. ASC/SIL ratio and ASCUS/SIL ratio were 1.50% and 1.25%, respectively. Conclusion: The internal QC indicators obtained in the present study were lower than the recommended values by CAP/Bethesda. Thus, achieving benchmark in internal quality indicators is still far from reality as it depends on population, screened incidence of cervical lesions and expertise of sampling team and cytopathologists. Regular audit improves screening ability of the test. Thus, every lab should try to achieve the internal quality indicator goals, which will ultimately result in building a good cervical screening system.

Comparative Evaluation of Flexural Strength of Heat Polymerised Polymethyl Methacrylate Provisional Fixed Restorative Resin Reinforced with Different Percentages of Silanised Zirconium Oxide Nanoparticles: An In-vitro Study

Priya Gupta, Saee Deshpande, Vaishnavi Banode

Introduction: The purpose of providing a provisional restoration includes immediate replacement of missing teeth, for protection of pulp and maintenance of periodontal health, to maintain occlusal stability, to preserve the position of the teeth and for masticatory efficiency. Provisional restorations fabricated from heat processed acrylic resin have been used successfully. Incorporation of inorganic nanoparticles into Polymethyl Methacrylates (PMMA) resin has been shown to improve its physical properties. Aim: To evaluate and compare the flexural strength of heat polymerised PMMA provisional restorative resin reinforced with different percentages of silanised zirconium oxide nanoparticles. Materials and Methods: This is an in-vitro study performed in the Department of Prosthodontics, VSPM’s Dental College and Research Centre, Nagpur, Maharashtra, India, from June 2018 to February 2020. A die was used to create sixty heat-cured PMMA resin specimens, which were then divided into four groups: group A includes controls with conventional heat Polymerised Provisional Restorative Resin (PMMA) and groups B, C and D conventional heat polymerised provisional restorative resin reinforced with different percentages of silanised zirconium oxide nanoparticles (1 wt%, 2.5 wt%, 5 wt%, respectively), having 15 specimens in each group. Three point bending tests were conducted on all samples using a universal testing machine. The flexural strength of each specimen was calculated. Mean value of flexural strength of each group was used for statistical analysis. One-way analysis of variance test was used to find out the mean value of flexural strength of each group. Results: The mean flexural strength for control group was 53.76±2.97 MPa. For group B (1% Zirconium oxide) it was 58.14±4.86 MPa, for group C (2.5% Zirconium oxide) was 63.29±4.22 and for group D (5% Zirconium oxide) it was 59.02±3.99 MPa. Statistical analysis showed that maximum strength was obtained by reinforcement with 2.5% silanised zirconium oxide nanoparticles. Conclusion: Polymethyl methacrylate reinforced with silanised 2.5% of zirconium oxide nanoparticles promises to be better material in terms of flexural strength.

Perception of Undergraduate Medical Students and Faculty towards Team Based Learning as a Teaching Tool- A Cross-sectional Study

Amit Kumar Jain, Naveen Jain, Seema Jain

Introduction: In India, the fast-changing medical education scenario needs to differentiate the meaningful learning from rote learning into the medical practice. Team Based Learning (TBL) is a dialectic form of learning where students learn in small groups or teams. Aim: The present study was conducted to introduce TBL methodology in ophthalmology subject as learning strategy among undergraduate medical students and to evaluate the perceptions of students and faculties towards TBL methodology. Materials and Methods: This cross-sectional study was conducted in a tertiary care teaching hospital of Uttar Pradesh, India, from December 2019 to February 2020. Total 120 Bachelor of Medicine and Bachelor of Surgery (MBBS) students of 3rd year part 1 participated in the study. Main TBL sessions were conducted in two phases, wherein during preclass preparation the topic glaucoma was assigned to the students. In phase 1 individual Readiness Assurance Test (iRAT) and team Readiness Assurance Test (tRAT) were conducted using MCQs. In phase 2, tRAT was conducted for real-life clinical situations on glaucoma. Data were analysed using Statistical Package for Social Sciences (SPSS) 20.0 software version. Results: In all 120 participants with the 100% response rate, mean score of iRAT, tRAT in phase 1 and tRAT in phase 2 was 18.9±5.24, 26.16±3.89 and 27.91±4.56, respectively. Majority of students perceived that TBL helped in understanding the glaucoma well and improved teacher student relationship. Almost all faculty members agreed that TBL was an innovative teaching method to develop critical thinking and imbibe subject knowledge in students. Conclusion: The TBL as an innovative Teaching Learning (TL) method was well implemented and accepted among medical students and teaching faculty because TBL established rationale thinking and problem-solving skills.

Effect of Heartfulness Meditation on Cortisol Levels and Vital Parameters in Healthy Female Medical Students- A Prospective Longitudinal Study

Pujitha Kunati, M Sharan B Singh, Vanajakshamma, N Sharvani, VS Kiranmayi

Introduction: Medical education has been reported to be one of the most stressful academic curriculum worldwide, with a potential of negatively affecting the physical and mental health of medical students. Meditation is a self-produced relaxation technique which restores the mental peace by relieving emotional and physiological stress and is an accepted therapy to reduce stress. Aim: To study the effect of heartfulness meditation on cortisol levels and vital parameters in healthy female medical students. Materials and Methods: This study was a prospective longitudinal study conducted in the Department of Physiology at Sri Padmavathi Medical College for women, SVIMS, Andhra Pradesh, India. Sixty female medical students of age group 18-25 years were undergone heartfulness meditation training for a period of six months from September 2021 to February 2022 Baseline measurements of cortisol, heart rate, Respiratory Rate (RR) and Blood Pressure (BP) were taken at the beginning of the session and after six months of intervention program i.e., from September 2021 to February 2022. Later pre and postvalues were compared and analysed statistically by using paired sample t-test and the p-value <0.05 or 5% was used as level of significance for comparison. For data analysis Statistical Package for Social Sciences (SPSS) version 19 was used. Results: The vital signs and cortisol levels in female medical students were significantly changed after practicing heartfulness meditation for six months. There was a significant decrease in Pulse Rate (PR) (p<0.001), RR (p<0.001), Systolic Blood Pressure (SBP) (p<0.001) and Diastolic Blood Pressure (DBP) (p<0.001) and cortisol levels (p<0.001) after 6 months practice of heartfulness meditation. Conclusion: The study concluded that heartfulness meditation had a positive effect on sympathovagal balance and also it was effective in reducing stress levels in medical students.

WhatsApp’ening in Orthopaedic Training- A Cross-sectional Survey Assessing the Effectiveness in Communication between Orthopaedic Trainees in North-west United Kingdom Deanery

Neelam Patel, Richard Unsworth, Sanil Ajwani

Introduction: The North-west Orthopaedic Trainees Association (NWOTA) WhatsApp group is a group setup by the orthopaedic trainees and has been running for a number of years, distributing a wide range of information to orthopaedic residents within the North-west of England region. Aim: To look at the aspects of multimedia communication within the WhatsApp group in Orthopaedic training. Materials and Methods: This cross-sectional survey was Knowledge, Attitude and Behaviour (KAB) study, which assessed the various aspects of information posted within the NWOTA group via a questionnaire over a one month period in April 2020. The questionnaire was split into different domains of information posted within the group, and the residents were asked to rate the usefulness of this type of information from 1-10, with 10 being the most useful. The data collected was anonymised. A Mann-whitney U test was used to statistically analyse the results for significance. Microsoft Excel version 16.16.27 was used to calculate the results. Results: Fifty-five trainees, out of a total of 63, within the deanery responded, with an average experience of 3.4 years working as a specialist registrar. The highest scoring topics were updates on unofficial announcements such as social events (mean score of 8.27), journal club advertising (8.24), and updates on deanery teaching (7.98). The topics scoring lowest were updates from more official announcements such as updates from the Training Programme Director (TPD) (6.24), updates on training (6.55) and finding out on-call registrars in different hospitals (7.16). Statistical analysis using the Mann-whitney U-test confirmed a significant difference (p-value <0.05) in responses, when assessing the association between each combination of variables, the significant differences were seen in the extreme scoring variables that scored particularly high or low. Conclusion: The results showed that the orthopaedic trainees find WhatsApp to be a useful channel for communication of more unofficial announcements rather than official updates. With the advancements within social media and the increasing use of mobile phones, this may be an area for potential improvements within residency communications to improve speciality training.

Correlation of Sagittal Abdominal Diameter and Other Anthropometric Parameters with Serum Leptin Levels in Young Adults- A Cross-sectional Study

Introduction: Leptin is secreted in concentrations proportional to body fat mass. The anthropometric parameter among Sagittal Abdominal Diameter (SAD), Body Mass Index (BMI), Hip Circumference (HC), Waist Circumference (WC), Waist-Hip Ratio (WHR), and Waist-Height Ratio (WHtR) that correlates maximally with serum leptin levels could be used preferably to assess adiposity. Aim: The present study aims to correlate serum leptin levels with SAD, BMI, HC, WC, WHR and WHtR in young and healthy North Indian adults. Materials and Methods: The present cross-sectional study was conducted jointly in the Department of Physiology and Biochemistry at the King George’s Medical University, Lucknow, Uttar Pradesh, India from September 2015 to August 2016 and it included apparently healthy individuals, aged 18-25 years, native to North India, after obtaining an informed consent. A convenient sample size of 100 was taken. One investigator took all anthropometric measurements. (SAD, BMI, HC, WC, WHR and WHtR) RayBio human leptin ELISA kit was used for the estimation of leptin level. For statistical analysis, Pearson’s correlation coefficient was used. P<0.05 was considered significant. Results: The study involved 55 males and 45 females aged 21.4±1.5 years with BMI 22.7±2.7 kg/m2, HC 91.5±6.9 cm, WC 81.9±7.9 cm, WHR 0.9±0.1, WHtR 0.50±0.04, SAD 20.8±3.1 cm and serum leptin level 389.6±102.7 pg. Serum leptin level correlated significantly with HC (r=0.23, p=0.02), WC (r=0.29, p=0.003), WHtR (r=0.36, p<0.001), and SAD (r=0.56, p<0.001). A non significant correlation was obtained with BMI (r=0.15, p=0.12) and WHR (r=0.11, p=0.26). Conclusion: The SAD is a better predictor of body fat and cardiometabolic health than other anthropometric parameters in the present study, as it correlated most strongly with serum leptin levels.

Clinical Profile of Ocular Chemical Injuries in a Tertiary Care Centre of Kolar, Karnataka, India: A Retrospective Study

Poojitha Madala, T Sangeetha, S Kruthika

Introduction: Ocular chemical injury is a true ophthalmic emergency which needs immediate assessment and management. They cause extensive damage to the ocular surface resulting in permanent visual impairment. The majority of victims are young and the exposure occurs at home, work place and with assaults. Aim: To analyse the clinical characteristics, grade and visual outcome in patients with ocular chemical injuries. Materials and Methods: This retrospective study was conducted on patients with chemical eye injuries who presented at Ophthalmology Department in Kolar tertiary care centre in the past five years. Medical records of 127 patients who presented from January 2017 to December 2021 with chemical eye injuries were assessed for age, gender, history of the mode of injury, pattern and grade of damage, visual outcome and treatment methods during the acute phase and at one month follow-up. Paired t-test and one-way Analysis of Variance (ANOVA) with posthoc test was the statistical method used for analysis. Results: Out of 127 chemical injury cases, 104 (81.9%) were males and 23 (18.1%) were females. The incidence of chemical injury was found to be 51 (40.2%) in the age group of 31-45 years and 38 (29.9%) in 15-30 years with 74 (58.3%) cases affected by alkali and 27 (21.3%) cases by acids and 26 (20.4%) unknown injury. A total of 43 (34%) cases had grade I, 75 (59%) had grade II and 9 (7%) had grade III injury and the common clinical finding was conjunctival congestion in 147 eyes and epithelial defect in 107 eyes. Significant improvement in the visual acuity was observed after the initial management and subsequently at one month follow-up (p-value <0.001). Conclusion: Male dominance and fields and workplace injuries were most common in the study. Initiation of immediate irrigation with tap water and early reporting to the hospital can reduce serious complications with early restoration of vision. It also emphasises the promotion of necessary protective measures to avoid workplace based accidental injuries.

Comparative Study between ELISA and TrueNat for Hepatitis B Virus and Hepatitis C Virus among Antenatal Women Attending Tertiary Care Medical Institute in Manipur, India

Preety Samom, Supriya Laifangbam, Smeeta Huidrom

Introduction: Viral hepatitis is one of the leading causes of death and disability. Nearly 1.5 million people die every year from Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) related liver diseases. Reported consequences of HBV and HCV infection in pregnancy include an increased likelihood of occurrence of preterm delivery and low birth weight and perinatal transmission. Aim: To compare Enzyme-Linked Immunosorbent Assay (ELISA) and closed system Polymerase Chain Reaction (PCR) TrueNat for the detection of HBV and HCV among antenatal women attending a tertiary care medical institute. Materials and Methods: This was a hospital-based cross-sectional study conducted at the Department of Microbiology, JNIMS, Imphal, Manipur, India, during the period from December 2020 to January 2022. Serum samples were tested using ELISA as well as on the TrueNat PCR. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Out of 60 samples, using ELISA (QUALISA), 24 were found to be positive for HBV surface antigen (HBsAg) and 14 were found to be positive for HCV antibodies (HCV Ab). On further testing using TrueNat chip-based closed system Real Time-PCR (RT-PCR) Test, 12 were found to be positive for HBV Deoxyribonucleic Acid (DNA) and five were found to be positive for HCV Ribonucleic Acid (RNA). Conclusion: TrueNat PCR could eliminate the problem of false positivity in the detection of HBV and HCV. It is useful to make clinical decisions on starting antiviral therapy and also in documenting the efficacy of the antiviral therapy.

Level of Serum Selenium in Bronchial Asthma Patients in a Tertiary Care Center: A Cross-sectional Study

Reena Renjit, George Marius, CP Muraly, V Ramnath, VV Unnikrishnan

Introduction: Selenium (Se) is a trace element that has role as an antioxidant in acute stress like; systemic inflammatory responses or trauma. Literature shows positive correlation between low serum Se levels and bronchial asthma. Aim: To determine the level of serum Selenium (Se) in bronchial asthma and to compare the Se levels with the age-matched control group without asthma. Materials and Methods: This cross-sectional study was conducted at the Departments of Physiology and Pulmonary Medicine of a Government Tertiary-care Hospital in Kerala, from November 2021 to March 2022. A total of 24 patients of Bronchial Asthma, between 20-55 years of age and 24 age-matched controls were selected. Serum Se levels were estimated in cases and controls, using Atomic Absorption Spectrometer (AAS). Statistical analysis of the data was done using unpaired sample t-test and correlation was tested with Chi-square test, using Statistical Package for Social Sciences (SPSS) version 27.0. Results: Serum Se levels of 24 patients with Bronchial asthma, aged between 25-55 years and the Se levels in the age-matched controls were obtained. The mean Se level in the study group was (67.21±39.57 ngm/L) significantly lower (p-value was 0.0001) than that of the control (108.38±19.22 ngm/L). The mean age was 39 years±10.8 years. Out of them, 40% were females and the remaining 60% were males. The severity of asthma ranged between mild persistent asthma to moderate asthma. And the mean duration of asthma was 5.59 years. Conclusion: Serum Se in adult bronchial asthma patients aged between 20-55 years, with mild to moderate severity was significantly lower than that in the control group.

Split Night versus Full Night Polysomnography in Obstructive Sleep Apnoea Syndrome: A Retrospective Study

Introduction: Obstructive Sleep Apnoea (OSA) is traditionally evaluated using a diagnostic Polysomnography (PSG) which is then followed by a PSG with Continuous Positive Airway Pressure (CPAP) titration. Split Night PSG (SN-PSG) includes the diagnostic and titration study in a single night. Split Night PSG is a better technique however, the requirements for CPAP titration are too strict. Aim: To assess the accuracy of different duration of split night compared to a Full Night PSG (FN-PSG) in OSA Syndrome. Materials and Methods: A retrospective observational study was performed in the Department of Pulmonary Medicine at VMMC and Safdarjung Hospital, New Delhi, India, from January 2019 to May 2019. Apnoea-Hypopnea Index (AHI) was assessed at the 1 hour, 2 hour, 3 hour and 4 hour from analysis of SN-PSG data obtained from FN-PSG. Using the Area Under Receiver Operating Characteristic (AUROC) curve, it was compared to the FN-PSG. Calculations were made to validate the diagnosis by a 2 hour PSG using different AHI cut-off points (5/hour to 15/hour). Results: Data from 20 PSG recordings were processed. A stronger correlation of FN-AHI was demonstrated with AHI at 2 hour (p-value <0.0001) (r value=0.902). At 2 hours of study, with an AHI cut-off of 5 hour, the sensitivity and specificity was 92.9% and 83.3%, respectively. The Positive Predictive Value (PPV) was 92.9% and Negative Predictive Value (NPV) was 83.3% (AUROC=0.976; p-value=0.001). At 2 hours, AHI cut-off of 15 hour, the sensitivity and specificity was 71.4% and 100%, respectively. The PPV was 100% and NPV was 86.7% (AUROC=1.000; p-value <0.0001). Conclusion: Split night PSG is effective for diagnosing severe OSA. A lower cut-off of AHI may be used to qualify patients for CPAP titration.

Role of Multidetector Computed Tomography in the Detection and Characterisation of Benign and Malignant Non Lymphoid Masses of the Neck and its Concordance with Fine Needle Aspiration Cytology

Introduction: Computed Tomography (CT) enables the evaluation of both osseous and soft tissue details and has become an important imaging modality in the evaluation of patients presenting with a neck mass. The study was conducted to justify the usefulness of Multidetector CT (MDCT) in patients presenting with neck lesions. Aim: To detect benign and malignant non lymphoid lesions of the neck using MDCT imaging features and compare it with Fine Needle Aspiration Cytology (FNAC). Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis at Government Stanley Medical College, Chennai, India, from June 2021 to May 2022. Contrast Enhanced CT (CECT) was performed with a 16 slice MDCT scanner pre and postcontrast administration. The benign and malignant lesions were evaluated by their enhancement patterns, necrosis, bony and vascular invasion and extension to adjacent neck space. The results were compared with FNAC being considered the gold standard, sensitivity and accuracy of CT was determined. The collected data was analysed with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Version 23.0. Results: A total of 95 patients who were enrolled in to the study, 38 patients were females and 57 patients were males, the mean age of the subjects studied were 45.1±17.4 years. A total of 67 cases were benign lesions and 28 cases were malignant lesions by FNAC. The sensitivity and specificity of MDCT was found to be 78.6% and 95.5%, respectively with a Positive Predictive Value (PPV) of 88.0% and Negative Predictive Value (NPV) of 91.4%. Conclusion: MDCT is precise in differentiating malignant from benign lesions of the neck and defining the extent of the lesions and involvement of adjacent structures.

Effectiveness of Ultrasonic, F-File, and NaviTip FX Needle Agitation Techniques on Removal of Root Canal Debris and Smear Layer Using Two Different Irrigants: A Scanning Electron Microscopy Study

Introduction: For successful endodontics, there should be proper cleaning and shaping of the canal before the obturation. Various agitation techniques help in the removal of the debris and smear layer. With the removal of this debris and smear layer, there will be a better opening of dentinal tubules and penetration of sealer in the tubule. Aim: To evaluate the effectiveness of removal of debris and smear layer from prepared root canals by comparing ultrasonic agitation, F-file agitation, and NaviTip FX needle agitation using Sodium hypochlorite (NaOCl) and SmearClear as irrigants. Materials and Methods: The present in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Devanagere, Bangalore, India, from June 2011 to September 2014 included 60 bilaterally matched pairs of extracted human premolar teeth with single canal and mature apices, were collected. All teeth were decoronated at the cementoenamel junction. The teeth were grooved longitudinally on the buccal and lingual surfaces. Instrumentation was done using K3 rotary files up to #40 and irrigation was carried out using 2 mL syringes mounted with Max-i-probe needles. Agitation procedure (n=10 for each group) was done as follows: Group 1: Ultrasonic agitation of 2.5% NaOCl for 30 seconds; Group 2: F-file agitation of 2.5% NaOCl for 30 seconds; Group 3: NaviTip FX agitation of 2.5% NaOCl for one minute continuously; Group 4: Ultrasonic agitation of SmearClear for 30 seconds; Group 5: F-file agitation of SmearClear for 30 seconds; Group 6: NaviTip FX agitation of SmearClear for one minute continuously. The roots were split into two halves using a chisel and mallet. The amount of debris and smear layer was assessed using SEM at 1000X magnification at each root canal’s coronal, middle, and apical areas. Statistical analysis was done using Kruskal-Wallis and Mann-Whitney U test. Results: Statistically significant difference was obtained in the reduction of debris and smear layer between 2.5% NaOCl and SmearClear. Ultrasonic agitation of SmearClear was better than F-file agitation and NaviTip FX. In both debris and smear layer removal (p-value <0.05). Conclusion: Ultrasonic agitation of SmearClear was better than F-file agitation and NaviTip FX agitation. SmearClear produced better removal of debris and smear layer than 2.5% NaOCl.

Prediction of Coronary Artery Disease using Ankle Brachial Pressure Index in Patients with Diabetes Mellitus: A Cross-sectional Study

Manvi Sharma, Mini Bhatnagar, Abhinav Meelu, Ronak Patel, Sanchit Uppal

Introduction: Diabetes mellitus confers a tenfold risk of cardiovascular disease due to atherosclerosis. Screening a large number of patients for Coronary Artery Disease (CAD) in susceptible population groups are required. Ankle Brachial Pressure Index (ABPI) is a non invasive tool for identifying atherosclerosis and peripheral artery disease and can be used in large population studies. Hence the present study attempted to assess the applicability of ABPI as a tool for prediction of CAD in diabetic patients. Aim: To calculate the ABPI in patients of diabetes mellitus and to assess the association of ABPI value with presence of CAD, duration of CAD and with the microvascular complications of diabetes mellitus. Materials and Methods: This cross-sectional study was conducted at MMIMSR, Mullana, Haryana, India from December 2019 to July 2021. Total 100 patients suffering from type 2 diabetes mellitus for more than five years duration were included. Patients were divided into two groups based on the presence or absence of CAD. ABPI was calculated in each patients and its correlation was assessed with CAD and association with microvascular complications of diabetes mellitus. The correlation assessed using Pearson correlation test. The mean was compared in with respect to Independent t-test (for two groups). Results: Out of 100 patients, there were 78 males and 22 females of mean age 60.64±10.97 years. Microvascular complications were present in 35% cases. Past history of CAD was present in 58%, stroke in 9%, hypertension in 15% and chronic kidney disease in 8% cases. Electrocardiogram (ECG) changes suggestive of CAD were observed in 62% while 2D-ECHO showed Regional Wall Motion Abnormality (RWMA) in 57 cases while 18 had angiographic evidence. Mean ABPI was 0.79 and 1.17 in the CAD and non CAD group respectively which was significant (p-value <0.001). A negative correlation was observed with ABPI and duration of CAD in years with Pearson correlation value of -0.260 (p-value 0.049). Conclusion: ABPI was also found to be negatively correlated with the duration of CAD and was significantly lower in diabetic patients with microvascular complications of diabetes. ABPI had a senstivity of 84.5% and specificity of 90.5% in prediction of CAD in patients suffering from diabetes.

A Fully Replicate, Cross-over, Bioequivalence Study to Compare Two Prolonged Release, Multi-matrix Tablet Formulations of Budesonide in Healthy Indian Adults

Introduction: Budesonide is a synthetic, non halogenated corticosteroid, structurally related to 16α-hydroxyprednisolone, which is approved as first-line therapy for various gastrointestinal disorders. Budesonide prolonged-release tablets incorporating multi-matrix technology {Cortiment® 9 mg: Reference product (R)} were approved in India for induction of remission in adult patients with mild-to-moderate active ulcerative colitis. Aim: To assess the bioavailability, safety and tolerability of a single dose of generic budesonide prolonged-release tablets 9 mg {CortirowaTM OD; Test product (T)} and demonstrate their bioequivalence to Reference product (R) in healthy Indian adults under fasting conditions. Materials and Methods: In this randomised, open-label, single-dose, balanced, 2-treatment, 2-sequence, 4-period, fully replicate, cross-over bioequivalence study was conducted from 12th July 2021 to 8th August 2021 at Ecron Acunova Limited, Manipal, India. Total 56 participants were randomly allocated (1:1) to treatment sequences Test-Reference-Test-Reference (TRTR) or Reference-Test-Reference-Test (RTRT). After a 10-hour overnight fasting, participants were administered a single oral dose of T or R along with 240 mL of water. After each dose, a total of 26 venous blood samples (each 4 mL) were collected from each participant, at hourly intervals until 20 hours, and at 24, 30, 36, 48, and 72 hours. Plasma budesonide concentrations were analysed using a validated Liquid Chromatography-Tandem-Mass Spectrometry (LC-MS/MS) method. Based on the randomisation sequences, the treatment periods were defined as test product treatment Period-1 (T1), test product treatment Period-2 (T2), reference product treatment Period-1 (R1), and reference product treatment Period-2 (R2). The primary pharmacokinetic parameters were peak plasma concentration (Cmax) and area under the concentration-time curve from time zero to the last sample with quantifiable concentration (AUC0-t). Results: Test and reference products were comparable in terms of mean (standard deviation) Cmax {pg/mL: T1=2163.0 (1423.9) and T2=2456.25 (1346.035) vs R1=2301.59 (1582.995) and R2=2437.62 (1437.665)} and AUC0-t {hr.pg/mL: T1=27938.0 (16431.23) and T2=33629.58 (18407.253) vs R1=25882.41 (17250.267) and R2=33146.25 (19350.222)}. As the within-subject Standard Deviation (SD) of R (SWR) for Cmax and AUC0-t was ≥0.294, the reference-Scaled Average Bioequivalence (SABE) approach was used. The bioequivalence criteria prespecified using the Scaled Average Bioequivalence (SABE) approach was met as the 95% upper confidence bound for (μT-μR)2- θs2WR of Cmax (-0.255371831) and AUC0-t (-0.445865013) were both ≤0, and the point estimate (T/R) geometric mean ratio of Cmax (0.97) and AUC0-t (1.06) were both within 0.80 and 1.25. While 10 Adverse Events (AEs) were reported in the study, all were of mild intensity. Conclusion: CortirowaTM OD was bioequivalent to Cortiment® 9 mg in healthy Indian adults under fasting conditions. Both the products were found to be well-tolerated.

Air Versus Distilled Water Cuff Inflation using Cuffill (Digital Cuff) in Adult Patients Undergoing General Anaesthesia

Pooja Arunkumar Giriyapur, Ravi Madhusudhana

Introduction: An essential part of anaesthesia is endotracheal intubation. The Endotracheal Tube (ETT) cuff pressure must not be higher than the predicted 22-30 mmHg tracheal perfusion pressure. If the ETT’s cuff is inflated with air while under nitrous oxide+oxygen anaesthesia, the cuff pressure may increase dangerously and result in ischaemia of the tracheal mucosa. Hence, distilled water as an alternative agent to air for inflation of cuffs of ETTs was used in the present study. Aim: To determine whether inflating the ETT cuff with distilled water, instead of air changes the pressure over time. To evaluate changes in cuff pressure over time, and to assess the knowledge about endotracheal cuff pressure monitoring with cuffill. Materials and Methods: This randomised clinical study was conducted in the Department of Anaesthesiology at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, from February 2022 to April 2022. The study included 50 patients undergoing elective surgery under general anaesthesia who were randomly divided into two groups. In group A, distilled water was used and in group B, air was used to inflate the cuffs of ETTs. General anaesthesia was given with nitrous oxide, oxygen and relaxant technique. The intracuff pressures of ETT cuffs were recorded by AG cuffill. Increase of pressures with time were recorded and analysed. Results: Mean ET cuff pressure by cuffill with air (group B) was 26±2.43 mmH2O after 0 minutes of intubation. After 15 minutes of intubation mean ET cuff pressure was 31.80±3.39 mmH2O. Mean ET cuff pressure by cuffill with distilled water (group A) was 25.56±2.02 mmHg after zero minutes of intubation. After 15 minutes of intubation, mean ET cuff pressure was 28.5±2.26 cmH2O. There was a pressure difference observed between the groups with a mean difference of 3.217, t-value of 4.743 and a p-value=0.001. Conclusion: For the purpose of inflating the cuffs of ETTs when the patient is under general anaesthesia with the use of nitrous oxide, oxygen, and relaxant method, distilled water may be considered a more desirable agent than air.

Establishing Reference Interval for Fasting Blood Glucose in Healthy Adults of Ambalapuzha, Kerala, India: A Cross-sectional Study

Introduction: Fasting blood glucose is one of the major tests in the diagnosis, treatment and prognosis of Diabetes Mellitus. Researchers have found the racial/ethnic differences in reference interval of common biochemical and haematological laboratory tests. Reference Intervals denotes normative values related to laboratory parameters/analytes used by diagnostic centres for clinical diagnosis. An appropriate reference value is essential for effective clinical decision making. Aim: To establish reference intervals for fasting blood glucose in healthy adult population of Ambalapuzha, North Grama Panchayath, Kerala, India. Materials and Methods: The present cross-sectional study was conducted in the Department of Biochemistry, Government T.D. Medical College, Ambalapuzha, Alappuzha, Kerala, India, from February 2018 to August 2018. A total of 420 healthy individuals were included in the study. After random selection of subjects, fasting blood samples were collected and all the samples were analysed for fasting blood glucose levels. Data was analysed statistically by using Analysis of Variance (ANOVA) test. Mean, standard deviation, reference interval and comparison between both sexes and different age groups were done. Results: Out of 420 individuals, 166 (39.5%) were males and 254 (60.5%) were females. The mean level of glucose was 80.97±10.113 mg% and the standard error of means was 0.493. The study population was categorised into 20-29 years, 30-39 years, 40-49 years and 50-59 years age groups. When compared those age groups, the mean blood glucose level was highest (83.81 mg%) for the age group 50-59 years. Significant difference in mean was seen when 30-39 years and 40-49 years was compared with 50-59 years age category. Conclusion: The study concluded that there was no difference in the reference range established between males and females. There was a significant difference in the mean fasting blood glucose among different age groups.

Morbidity and Mortality Profile of Neonates Admitted in Special Newborn Care Unit in a Tertiary Care Hospital: A Retrospective Study

Mahibur Rahman, Gayatri Bezboruah, Monalisa Bhoktiari

Introduction: Newborn period is the most vulnerable phase of life and deaths during first 28 days of life account for 70% of all infant deaths and 56% of all deaths of under-5 year in children. Children who die within the first 28 days of birth suffer from conditions and diseases associated with lack of quality care at or immediately after birth and in the first few days of life. Aim: To study the morbidity and mortality profile of neonates admitted in Special Newborn Care Unit (SNCU) in a tertiary care hospital. Materials and Methods: This hospital-based retrospective study was carried out in SNCU, Department of Paediatrics, Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India. The study period was from 1st July 2021 to 30th June 2022. A total of 7439 neonates (both inborn and outborn) from birth to 28 days of life admitted in SNCU during the study period were included in the study. Morbidity and mortality data of admitted neonates were collected from the monthly reporting format and patient records and compiled in MS Excel sheet and analysed using arithmetic mean and also expressed in percentages. Results: During the study period, 7439 neonates were admitted in SNCU, of which, inborn were 4854 (65.3%) and outborn were 2585 (34.7%). Male and female in the study population were 4305 (57.9%) vs 3134 (42.1%) respectively. Normal birth weight and Low Birth Weight (LBW) babies were 4200 (56.5%) vs 3239 (43.5%). Term and Preterm (PT) babies 4424 (59.5%) vs 3015 (40.5%). Neonatal jaundice, birth asphyxia and neonatal sepsis were common morbidities requiring admission. Mortality was 12.1% which was higher in outborn (21.5%) than inborn (7.1%). Birth asphyxia (45.3%) was the most common cause of mortality followed by Respiratory Distress Syndrome (RDS) with prematurity (20.4%) and neonatal sepsis (15.1%). Birth asphyxia was higher in outborn (47.5%) than inborn (41.9%). Neonatal sepsis was higher in outborn (18.3%) than inborn (9.9%). Highest number of death occured within seven days of birth (70.2%) and among LBW babies (61%). Conclusion: Birth asphyxia, RDS with prematurity and neonatal sepsis are common causes of neonatal mortality. Outcomes of this study can be used for improving the existing healthcare services to reduce neonatal mortality.

Admission Pattern of Burn Patients of Various Aetiologies in the Burn Unit of a Tertiary Care Hospital in COVID-19 and Pre-COVID-19 Period: A Retrospective Study

Sandip Basu, Sharon Alex

Introduction: Worldwide the Coronavirus Disease-2019 (COVID-19) pandemic has brought with it many changes and challenges in the healthcare scenario. While restricted movement during the lockdown period had its effect in the reduction of outdoor burn incident such as industrial burn, overcrowding at residential units led to an increase in domestic burns. Aim: To evaluate various changes in acute burns reflected in the admission pattern in a tertiary care hospital during pre-COVID-19 and COVID-19 period. Materials and Methods: The present study was a retrospective observational study conducted in the burn unit of a tertiary care teaching hospital in Kolkata, West Bengal, India, from September 2018 to February 2020 (Pre-COVID-19) and March 2020 to August 2021 (COVID-19). Data of burns patients such as age, sex, aetiology of burn, mode of burn injury, percentage of body surface area involved, duration of hospital stay, number of patients undergoing surgical management, discharge, and death were reviewed and analysed using MS Excel and Z-test. Results: There was a decrease in the admission rates in the COVID-19 period (462 v/s 317). Flame burn 43.51% v/s 48.26% (p=0.67); scald burn 38.10% v/s 41.01% (p=0.19); electric burn 15.8% v/s 4.73% (p=0.001); chemical burn 2.59% v/s 5.99% (p=0.0173) for pre-COVID-19 v/s COVID-19 periods, respectively. The proportion of accidental burn injuries remained the same because of overcrowding at home (50.22% v/s 47.63%) (p=0.477) which was compensated by a decrease in workplace accidental burns during the lockdown period. The percentage of suicidal injuries had increased during the COVID-19 period (35.06% v/s 48.27%) (p=0.00022). The percentage of homicidal burn injuries had significantly reduced during COVID-19 time (14.72% v/s 4.1%) (p=0.00001). There was a statistically significant increase in the paediatric population of burn injuries during COVID-19 (35% v/s 62.7%) (p=0.00001). Conclusion: The present study observations indicated a decrease in admission rates and comparable accidental flame and scald burn injuries and a drop in workplace burn injuries with women and children being the most vulnerable population.

Characteristics of Neuropathic, Ischaemic and Neuroischaemic Diabetic Foot Ulcers- A Prospective Cohort Study

Chabungbam Gyan Singh, Abhik Sil, Debopam Sanyal, Arup Mandal

Introduction: Diabetic Foot Ulcers (DFU) can be divided into neuropathic, ischaemic and neuroischaemic types. Since the pathophysiology is different, it is important to ascertain the outcome data on the three subgroups of DFU. Aim: To compare and assess the differences in the characteristics and healing process of the three types (Neuropathic, Ischaemic, and Neuroischaemic) of DFU. Materials and Methods: A prospective cohort study was conducted from April 2019 to July 2021 in the Department of Surgery, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur, India. Age, gender, duration of diabetes mellitus, smoking, hypertension, Glycosylated Haemoglobin (HbA1c), aetiology of DFU, osteomyelitis, gangrene, estimated Glomerular Filtration Rate (eGFR), and presence of multiple ulcer were recorded. Healing time and outcome (healed, non healed and amputation) of ulcer were the dependent variable. Data collected were analysed using SPSS-version-21. Fisher’s-exact test was used for proportions. Analysis of the time needed for healing was performed using the Kaplan-Meier method. A p-value of <0.05 was taken as significant. Results: A total of 42 patients were recruited for the study and 29 (69%) were males. Patients in neuropathic, ischaemic and neuroischaemic DFUs were 18,14 and 10, respectively. Hypertension (100%) and smoking history (100%) were present in the ischaemic group. Maximum healing (88.9%) was seen in patient with neuropathic ulcers and maximum non healing (28.6%) and amputation (21.4%) occurred in ischaemic group. Mean (SD) heal time in days were 165.5 (4.62), 141.1 (9.17) and 86.4 (8.02) for ischaemic, neuroischaemic and neuropathic, respectively (p<0.001). The average time in which 50% of patients (median) had healed wounds was 75, 136, and 171 days for neuropathic, ischaemic, and neuroischaemic ulcers, respectively. Conclusion: Neuropathic DFU has better healing than the other DFUs. Ischaemic DFU have maximum non heal ulcers and amputation.

Evaluation of Postoperative Analgesia on Addition of Dexmedetomidine to Ropivacaine 0.2% in Femoral Nerve Block in Patients undergoing Open Knee Surgery-A Randomised Single Blinded Study

Neha M Shah, Jayesh Katakiya, Afroza N Syed, Pinal Bumiya, Neha Cheraya

Introduction: Femoral Nerve Block (FNB) renders marked postoperative analgesia in patients undergoing knee surgery and use of adjuvant to Local Anaesthetic (LA) agent is more advantageous in lengthening duration of sensory effect of block. Aim: To evaluate the effect of addition of dexmedetomidine to 0.2% Ropivacaine in FNB. Materials and Methods: The randomised clinical trial was conducted in the Department of Anaesthesiology, Medical College and SSG Hospital, Vadodara, Gujarat, India. The trial included 60 patients of either sex, American Society of Anaesthesiologists (ASA) Grade-I,II,III posted for open knee surgery. Patients were randomly allocated to two groups-group RD patients received 0.2% ropivacaine 20 milliliter (mL) with dexmedetomidine 2 mL (50 μg) and Group R received 0.2% ropivacaine 20 mL with normal saline 2 mL for FNB. Duration of postoperative analgesia, total requirement of systemic rescue analgesic in 24 hours, vital parameters and complications were observed. Statistical analysis was done with Medcalc 14.8.1 statistical software. A p<0.05 considered as significant. Results: Duration of analgesia was significantly longer in group RD (484±26.98 min) than in group R (338±29.40 min), p<0.0001. Mean postoperative cumulative requirement of analgesic (Tramadol) was lesser in group RD (207±25 milligram (mg)) than in group R (290±30 mg), p<0.0001. Conclusion: Dexmedetomidine to ropivacaine 0.2% for FNB significantly augments duration of analgesia and reduces requirement of systemic analgesic declining its unfavourable effect.

Mandibular Buccal Shelf Characteristics of South Indian Population with Different Skeletal Patterns- A Retrospective Cone Beam Computed Tomographic Study

Reshma Mohan, Ravindra Kumar Jain

Introduction: The morphology of the Mandibular Buccal Shelf area (MBS) which is one of the ideal extra-alveolar locations for Mini-Implants (MI) may vary depending on the population and growth patterns. The success or failure of MIs placed in MBS could be affected by these morphological variations. Aim: The present study aimed to evaluate the angulation, bone width, and bone depth of the MBS area in South Indian population and the effect of age, gender, and skeletal patterns (both sagittal and vertical) on MBS dimensions using Cone Beam Computed Tomography (CBCT). Materials and Methods: This retrospective study was conducted at Saveetha Dental college, Chennai, India, from January 2022 to June 2022. Forty-five CBCTs of participants with various sagittal skeletal patterns were equally divided into three groups- Group A: Class-I malocclusion; Group B: Class-II malocclusion; and Group C: Class-III malocclusion. Using the OSIRIX Lite software (version 12.0.3), the angulation, buccal bone width {4 and 6 mm from the Cementoenamel Junction (CEJ)} and buccal bone depth (6 and 11 mm from the CEJ) of the MBS were determined on CBCTs. The statistical analysis was performed by utilising Statistical Package for the Social Science (SPSS) software (version 23.0). Descriptive statistics were performed for all the parameters, Mann-Whitney U test was performed to compare the measurements in gender and each side of the arches, and the Kruskal-Wallis one-way analysis was performed to compare the measurements at different locations and different skeletal patterns. A p-value of <0.05 was considered statistically significant. Results: No significant difference was found between genders for the angulation, bone width and bone depth of the MBS (p-value >0.05). A significant difference in the angulation and width at 11 mm from the CEJ was noted between the age groups (p-value=0.01). The MBS posterior region had higher values for all parameters. Significant difference was noted for the different sagittal and vertical growth patterns (p-value <0.01) except bone width in vertical skeletal pattern. Conclusion: South Indian adults exhibited higher bone width in the MBS area. Sagittal skeletal Class-III subjects exhibited larger bone dimensions and hypodivergent patients reported greater apico-coronal bone depth than other growth patterns. The placement of MI in the MBS region must be done with caution considering the variations in different skeletal patterns.

Ultrasonographic Evaluation and Clinico-biochemical Association in Patients with Polycystic Ovarian Disease in a Tertiary Care Hospital: A Cross-sectional Study

Sindhu Reddy Dwarampudi, Gitanjali Satapathy, Kamal Kumar Sen, Sangram Panda

Introduction: Polycystic Ovarian Syndrome (PCOS) is an endocrinological disorder characterised by a combination of polycystic ovarian morphology, diverse clinical features, and abnormal biochemical indices that affects women of reproductive age. Aim: To assess the sonographic appearance of ovaries and endometrium in clinically suspected cases of PCOS and to determine the association between the sonographic appearance of ovaries and endometrium with the clinical and hormonal profile of the patient. Materials and Methods: This cross-sectional study included 53 female patients in the reproductive age group (18-35 years) who were referred to the Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India for pelvic ultrasonography in clinical suspicion of PCOS from September 2020 to September 2022. All patients underwent transabdominal sonography, only married individuals with abdominal obesity underwent transvaginal ultrasonography. Complete biochemical hormonal analysis was performed. Association between volume, size of the ovary, number of follicles, and stromal thickness with hormones like Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), testosterone, prolactin, Thyroid Stimulating Hormone (TSH) were analysed. All continuous variables were expressed as mean±standard deviation and categorical variables as percentages. Chi-square test was used for statistical analysis. Results: The mean age was 25.60±4.09 years and the majority 26 (49.1%) were between 18 to 25 years and presented with menstrual abnormalities. Volume of ovary was ≥10 cc in 41 (93.18%) patients with LH >6.7 IU/mL which was statistically significant (p=0.03) and LH/FSH ratio was >2:1 in 30 patients of which 28 (93.3%) had ovarian volume ≥10 cc which was statistically significant (p=0.03). A number of follicles >12 showed a significant association with LH (p=0.04), LH/FSH (p=0.01), testosterone (p=0.002). Stromal thickness also showed significant association with LH (p=0.018), LH/FSH (p=0.001), testosterone (p=0.04). Conclusion: Predominant patients with PCOS had enlarged ovaries with multiple (>12), small-sized (<9 mm) peripherally arranged follicles and low FSH and elevated LH, LH/FSH ratio, testosterone, TSH, and prolactin levels.

Outcomes of Decompressive Craniectomy in Patients with Supratentorial Ischaemic Stroke: A Longitudinal Study

Jitendra Nagar, Yash Madnani, Anand Sharma, Avinash Sharma, Ankit Meena

Introduction: Decompressive Craniectomy (DC) is a surgical procedure that entails removing a section of the skull with the aim of preventing neuronal damage and improving the patient’s prognosis. The goal was to determine if DC is associated with reduced risk of death and improved outcomes. Aim: To study the outcome, morbidity and mortality associated with DC in patients with intracranial ischaemic infarct. Materials and Methods: A longitudinal single-centre study was carried in the Department of Neurosurgery, GR Medical College and JA Group of Hospitals, Gwalior, Madhya Pradesh, India, from January 2019 to June 2020. A total of 25 cases were operated and subsequently followed-up. Patients who were admitted with life-threatening supratentorial infarction and deemed eligible for DC based on clinical assessment {National Institute of Health Stroke Scale, Glasgow Coma Scale (GCS)} and neuroimaging with computed tomography head or Magnetic Resonance Imaging (MRI) brain were prospectively included in the study. The outcomes of the study were evaluated based on the functional impairment experienced by patients after a stroke. This was assessed using the modified Rankin Scale (mRS), which is a seven-point scale that ranges from 0 (no symptoms) to 6 (death). The assessments were conducted at discharge, three months and six months. Paired t-test was used to analyse the functional outcomes of patients at admission, discharge, 3-month, and 6-month follow-up, using the mRS as the tool of evaluation. The relationship between patient characteristics and neurological outcome was analysed using the Chi-square test. Results: In the study, 25 patients were analysed, with 76% being males. The right hemisphere was affected in 13 (52%) patients, while 12 (48%) patients had left hemisphere involvement. At admission, 23 (92%) patients had a mRS score of five and only 2 (8%) patients had mRS score of 4. During hospitalisation, 8 (32%) patients died. After discharge, 7 (28%) patients had a mRS score of 4 or less, which increased to 9 (36%) patients at three months follow-up and 12 (48%) patients at six months follow-up. Conclusion: The present study concluded that decompressive hemicraniectomy improved neurological outcomes of patients with supratentorial ischaemic infarcts, with patient characteristics playing a significant role.

Assessing Resilience among Medical Teachers: A Necessary Step in Building More Equipped Medical Teaching: A Cross-sectional Study

Introduction: Resilience among medical teachers is not only a subject of academic inquiry but also a growing body of literature. It encompasses perceiving the way of adaption of strategies in times of adversity or change as well as enable people carry on their jobs and lives. Aim: To assess overall scores and scores of seven domains of resilience-assessment like vision, determination, interaction, relationships, problem solving, organisation and self-confidence. Materials and Methods: This observational cross-sectional institution-based study was carried out in the Department of Physiology BSMCH, Bankura on 60 medical educators for the period starting in April, 2021 and ending in February, 2022. The Resilience Assessment Questionnaire (RAQ) in Google form was sent to the subjects through email for participating in the study. The responses of RAQ were recorded and analysed by Microsoft excel- 2019. Results were represented in the form of descriptive statistics. Results: The data was obtained from 60 medical educators of the institute having mean age 49.63 years and comprising of both sexes with atleast 10 years of experience of teaching. With respect to overall scores, 83.3% of the subjects (n=50) had scores between 35-140 (low score) while only 16.7% (n=10) were found to be pretty resilient. Regarding determination scores 51.7% (n=31) subjects had scores between 5-15 (low level of determination and 33.3% (n=20) had considerable determination (score 16-20) while only 15% (n=9) were determined persons (score 21-25). A total of 50% (n=30) subjects were not very good in problems solving score, 28.4% (n=17) liked and succeeded in solving problems. About 30% (n=18) scored 16-25 and had considerable self-confidence whereas 5% (n=3) scored poorly. In less than 15% of the subjects, the Score of Vision (n=10), Interaction (n=6), Relationship (n=14) and Organisational (n=5) skill were found to be in the higher range (score 21-25) whereas 85% (n=50, 54, 46 and 55, respectively) subjects scored poorly (score 5-20) in these categories. Conclusion: In the present study, resilience of ≥50% participants were found to be at a lower level. It draws attention of medical educators to reconsider the multidimensional factors that influenced their resilience. It may be proposed that brave decisions and actions aiming to improve resilience must be made by medical educators to help making medical students responsible doctors of tomorrow.

An Evaluation of the Colour Stability and Surface Roughness of High Translucency Zirconia Dental Ceramic after Immersion in Different Acidic Media: An In-vitro Study

Introduction: Demand for increasingly appealing metal-free ceramic restorations drives research. With its exceptional mechanical and biological properties, zirconia crown outperforms other traditional ceramic materials. With outstanding mechanical and biological qualities, zirconia has several therapeutic applications. Temperature, environment, diet, and smoking habits all affect colour and surface roughness of dental restorations. Aim: To investigate the colour stability and surface roughness of high translucency monolithic zirconia following immersion in various acidic solutions. Materials and Methods: This in-vitro study was conducted at Yenepoya Dental College, Mangalore, Karnataka, India, from December 2019 to June 2020. Thirty rectangular samples from a Computer-Aided Design (CAD)/Computer Aided Manufacturing (CAM) machined Zirconia blank with 10×8×1 mm dimensions were sintered at 1350°C, tested for colour stability (E) and surface roughness prior to immersion (R). Groups were classified into CO (coffee), TO (tobacco) and CA (citric acid medium). Colour stability and surface roughness were re-evaluated postimmersion on all samples using spectrophotometers and profilometer, respectively. A significant difference in surface roughness and colour stability between the test groups were assessed using the paired-t test. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Results: Colour stability and surface roughness variations between the baseline value and three groups were found to be unaltered by different acidic media. The intergroup comparison of spectrophotometric analysis between the three groups had a standard deviation of 0.422 for citric acid medium, 0.316 for Coffee medium and 0.422 for Tobacco medium with an overall p-value of 0.804. The intergroup comparison of profilometric analysis had a standard deviation of 0.316 for Citric acid medium, 0 for Coffee medium and 0 for Tobacco medium with an overall p-value of 0.381. The paired t-test study showed that immersion in different acidic media had little effect on surface roughness of samples with a p-value of 0.343 but it was under clinically acceptable range. Conclusion: According to the present study, high translucency monolithic zirconia had greater colour stability when treated with citric acid, followed by tobacco and then with coffee media, whereas, zirconia in coffee media had greater surface roughness, followed by tobacco, and then with citric acid media. However, both the results were clinically acceptable, indicating a 10 year lifespan when properly glazed.

Skin and Soft Tissue Infections due to Aeromonas spp.: An Emerging Pathogen

Mousumi Kilikdar, Jampala Srinivas, Pallavi Chitrans, Safiya Siraj, Aman Ansari

Introduction: Aeromonas species the emerging human pathogens, can cause various diseases like gastrointestinal infections, Skin and Soft-Tissue Infections (SSTIs), respiratory tract infections, urinary tract infection, hepatobiliary tract infection, blood stream infections etc. Aeromonas consists of important pathogenic species like Aeromonas hydrophila being the most common one followed by A. sobria, A. veronii, A. caviae and A. salmonicida. SSTIs due to Aeromonads are most often associated with pre-existing ulcer, traumatic wound and exposure to water. Aim: To analyse socio-epidemiological factors, clinical features, risk factors and antibiotic resistance potential of Aeromonas spp., SSTIs. Materials and Methods: This prospective study was performed in Microbiology Department of Rajshree Medical Research Institute, Bareilly, Utter Pradesh, India. A total of 39 patients with Aeromonas spp., SSTIs were identified during the period from 2020 to 2022. All Gram-negative fermenting motile isolates which are positive for oxidase, H2S production, indole reaction, lysine decarboxylase were further identified by Vitek 2 compact system (Biomerieux, France). Patient demographics were presented as mean±standard deviation. Results: Majority of patients hailed from urban areas, were in middle age group and were farmers. A. hydrophila 24 (62%) was the predominant isolate. Majority of the infections were superinfection of wound 16 (41%) and chronic non healing ulcer 13 (33.3%). A total of 33.3% of infections were polymicrobial, common concomitant pathogens being, Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA). Trauma and water exposure were main risk factors with co-morbidities like diabetes, hypertension and liver cirrhosis. A 20.5% of patients were immunocompromised. There was one case of Necrotising Fasciitis (NF) which resulted in patient’s death. Co-trimoxazole, 3rd and 4th generation cephalosporins. Aztreonam and Tigecycline were the most effective antibiotics while eight of the isolates were Multidrug Resistant (MDR). A 33 patients recovered completely and three patients died of complications. Conclusion: Aeromonas hydrophila must be regarded as an emerging pathogen of SSTIs mainly in patients with pre-existing ulcers and can be MDR. Such infections have a good prognosis if prompt medical, surgical and supportive treatment is given.

Recovery Period for Attaining Baseline Haematological Parameters after Plateletpheresis Donation- A Cohort Study

Keyuri B Patel, Kailash Inaniya, Dharti Pravin Padharia

Introduction: Plateletpheresis provides the advantage of collecting a large volume of platelets, equivalent to a platelet count of 20-40×109 in a single unit. The risk of postdonation anaemia is reduced as the red cells are reinfused into the donor. Plateletpheresis affects the donors, haematological parameters and their period for reaching the baseline is important. Aim: To analyse the recovery of haematological parameters to baseline among apheresis platelet donors. Materials and Methods: A cohort study was conducted at the Department of Pathology, Pramukh Swami Medical College, Gujarat, India from April 2020 to September 2021. The study included 40 plateletpheresis procedures, which were performed according to manufacturer’s manual and standard operating procedure. The donor’s samples were assessed on immediate postdonation, on second, seventh, and 14th postdonation day. The age, weight, height of patient, Haemoglobin (Hb) concentration, Total Leucocyte Count (TLC), and platelet were also noted. Paired t-test was applied for the comparison of pre and post plateletpheresis values of haematological parameters. The p-value <0.05 was considered statistically significant. Data analysis was done with the help of Statistical Package for Social Sciences (SPSS) Version 15. Results: All donors selected for plateletpheresis were males (100%) with mean age of 32.3 years. Post plateletpheresis, the platelet count reached the baseline on the 14th day whereas, the total White Blood Cells (WBC) count and Hb reached the baseline on the seventh day. The donors who were preobese were maximum in number and the duration of procedure was comparatively lower in them. Conclusion: The platelet count reached the baseline by the 14th day while the other haematological parameters reached the baseline by the seventh day. Therefore, a minimum interval of seven days would suffice to ensure the baseline return of the haematological parameters in the best interest of the donor’s health.

Evaluation of the Effects of Doses of Dexmedetomidine as Adjuvants to Hyperbaric Bupivacaine in Subarachnoid Blocks for Elective Caesarean Sections: A Prospective, Randomised, Triple-blind Controlled Study

Introduction: Since single-shot spinal anaesthesia for caesarean section operations provides limited postoperative analgesia, several adjuvants are employed to obtain the prolonged duration of sensory block. Dexmedetomidine (DMT) used as an adjuvant to 0.5% hyperbaric bupivacaine is found to provide a longer duration of analgesia. Aim: To evaluate the block characteristics and neonatal effects of three doses of DMT 2.5 μg, 5 μg and 7.5 μg used as adjuvants to 0.5% hyperbaric bupivacaine (10 mg). Materials and Methods: A prospective randomised multi arm triple-blind controlled study was conducted at the Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Andhra Pradesh, India from May 2020 to May 2022 on parturients who were assigned to four groups of 20 each. Parturients of Groups A, B and C were given 0.5% hyperbaric bupivacaine (10 mg) with DMT 2.5 μg (0.1), 5 μg (0.2 ) or 7.5 μg (0.3 ) mL, respectively as adjuvant and those in Group D were given 2 mL of 0.5% hyperbaric bupivacaine alone and the final volume was made 2.5 in all four groups by adding sterile normal saline (0.9% NaCl). Characteristics of the mother and neonate like age, height, body weight, Body Mass Index (BMI), gravida status etc., were recorded, the duration of analgesia, the total quantity of the analgesic medicine consumed during the 1st 24 hours of the postoperative period, duration of the motor and sensory blocks, changes in haemodynamic variables were also noted. Ramsay Sedation Scores (RSS), surgeon and patient satisfaction scores were recorded for statistical analysis. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 20.0 and a p-value of ≤0.05 was considered statistically significant. Results: Parturients of Groups A, B and C had an earlier onset of sensory block 4.3±0.8, 3.6±0.5, 2.7±0.5 minutes, respectively compared to control 5.7±0.6 minutes (p-value <0.001). They also had a longer duration of analgesia 203.6±14.4, 320.2±24.0, 340.0±14.4 minutes, respectively compared to those in control 150.1±7.1 minutes (p-value <0.0001) and consumed a lesser amount of analgesic medication; 165.0±14.4, 110.0±30.7, 100.0±0.0 mg, respectively compared to control 190.0±30.7 mg (p-value <0.001). Surgeon scores regarding the anaesthetic technique were satisfactory in a greater proportion/percentage of parturients in Groups A, B and C; 13 (65%), 16 (80%) and 18 (90%), respectively vs 9 (45%) in control p-value <0.01198. Patient scores regarding the anaesthetic technique were satisfactory in a greater proportion/percentage of parturients in Groups A, B and C; 14 (70%), 17 (85%), 19 (95%), respectively vs 10 (50%) in control p-value <0.00652. Conclusion: On the basis of the results of the present study, it was concluded that 5 μg DMT added as an adjuvant to 10 mg of 0.5% hyperbaric bupivacaine intrathecally was the optimal drug combination to be used for spinal anaesthesia for caesarean section cases, whereas a higher dose of 7.5 μg DMT had resulted in greater fluctuations in Pulse Rate (PR) and Mean Arterial Pressure (MAP) and a lower dose of 2.5 μg DMT had resulted in a shorter duration of analgesia.

Prevalence of Deep Vein Thrombosis among COVID-19 Patients using Colour Doppler Ultrasound in a Tertiary Care Centre of Central India: A Prospective Cohort Study

Amit Shankhwar, Alka Agrawal, Aksha Tanwani, Vasudev Lodhi

Introduction: Acute respiratory disease, Coronavirus Disease 2019 (COVID-19) is an infectious and potentially fatal respiratory disease. Increase in the inflammatory response, hypoxia, immobilisation are suggested mechanisms of procoagulant state. Deep Vein Thrombosis (DVT) and pulmonary emboli are common and often silent. Venous duplex ultrasound help in determination of the presence, extent, age of the thrombus and its attachment to venous wall. Aim: To evaluate the prevalence of DVT by colour doppler ultrasound in lower limbs of mild to severe clinical categories of COVID-19 patients. Materials and Methods: A time-bound, hospital-based prospective cohort study was conducted in the Department of Radiodiagnosis, MY Hospital, Indore, Madhya Pradesh, India, between March 2021 and February 2022. Study comprised 2200 cases of COVID-19 positive patients with elevated D-dimer levels i.e., >0.5 ng/mL and colour doppler imaging for lower limb. The clinical (co-morbidities, clinical severity) and radiological data (compressibility, colour flow) were studied and analysed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Results: In the present study, there were 1144 (52%) males and 1056 (48%) females. Out of 2200 patients, 792 (36%) patients showed presence of DVT. The most prevalent age group was 36-55 years having 506 (63.9%) patients. Majority of DVT positive patients were suffering with hypertension and diabetes i.e., 261 (33%) and 372 (47%) patients, respectively. Most commonly affected vein in DVT was Common Femoral Vein (CFV) in 704 (88.9%) patients. Superficial veins thrombosis was also associated with DVT affecting Short Saphenous Vein (SSV) in 439 (55.4%) patients and Great Saphenous Vein (GSV) in 221 (27.9%) patients. Conclusion: There was a high prevalence of DVT among COVID-19 positive patients. Colour doppler ultrasound has provided an excellent aid in the diagnosis of DVT.

Unravelling the Gaps in Anaemia Control among Pregnant Women- A Qualitative Study from an Urban Setting

Timsi Jain, B Charumathi, Yogesh Mohan, Hmangaih Sangzuali, M Jayasurya, P Heera

Introduction: Nutritional anaemia is one of the biggest public health problems of our country. Inspite of anaemia control being one of the oldest National Health Programmes, the prevalence of anaemia among the pregnant women has practically remained the same since the last five decades. This implies that something critical is being missed in the entire chain of operations of the programme. Aim: To explore the missing links and real factors impacting the success of anaemia control among pregnant women. Materials and Methods: A qualitative study was conducted among currently pregnant women attending the antenatal clinic of a Tertiary Care Hospital in urban Chennai, India from June 2022 to August 2022. In-depth interviews were conducted with the pregnant women to discover the pregnant mothers’ perspectives and challenges in compliance with the anaemia control initiatives. Results: A total of 25 pregnant mothers were interviewed in the study. The mean age was 28.3±4.07 years. Eight mothers were primiparous, and 17 multiparous. 12 mothers were anaemic as per their last Haemoglobin (Hb) estimation. Though there was reasonably good knowledge among the pregnant mothers regarding anaemia and its treatment, there was a significant gap in compliance to the anaemia prophylaxis/treatment. Several common critical issues surfaced in the study which was related to the social norms, family dynamics, health system and support related to management of side-effects. Conclusion: It is essential to address the operational gaps and the unique issues of treatment compliance in our society. Behavioural change communication needs to be specific and targeted, mothers need a better health and social support system to manage the side-effects of Iron-Folic Acid (IFA) and the healthcare system needs to involve other key decision makers in the household like husbands, mother in laws to provide a supportive environment.

Prevalence and Risk Factors of Pulmonary Arterial Hypertension in Interstitial Lung Diseases: A Cross-sectional Study

Introduction: Interstitial Lung Diseases (ILD) is associated with inflammatory and/or fibrotic changes in the lungs. Pulmonary Arterial Hypertension (PAH) is a complication of many end-stage lung diseases due to the remodelling of pulmonary vasculature associated with hypoxia leading to pulmonary vascular resistance. The Association of PAH in ILD contributes significantly to high morbidity and mortality. ILD being a progressive disease it is difficult to predict when the PAH will set in. Aim: To assess the clinical and radiological profiles of patients with ILD and to associate these with the severity of PAH. Materials and Methods: The present cross-sectional study was conducted in the Department of Respiratory Medicine at GSL Medical College on 23 patients with ILD from 1st October 2019 to 31st August 2021, in GSL Medical College and Hospital, Andhra Pradesh. Each patient was subjected to Chest X-ray (CXR), Electrocardiogram (ECG), and 2-Dimensional Echocardiogram (2D ECHO). Evidence of PAH in any one investigation was considered. In ECG reports evidence of right ventricular enlargement (R>S in V1/V2 and right axis deviation >110 degrees, R=11 mm) was considered as PAH. CXR showing dilatation of the pulmonary artery with an increased cardiothoracic ratio was considered as PAH. A 2-D ECHO was performed to estimate the right arterial pressure and evidence of pulmonary arterial systemic pressure of >40 mmHg was considered as PAH. All the data were statistically analysed by using IBM Statistical Package for Social Sciences (SPSS) version 20.0. Results: Fifty-two percent of the population constituted females, and the mean age of the whole population was 59.7±14.4 years and the majority of them (65%) belonged to upper lower socio-economic class. Usual Interstitial Pneumonia (UIP) was the most common pattern observed accounting for 57%. Prevalence of PAH was 65% with a longer duration of symptoms, 57% of the population had grade 3 of Modified Medical Research Council (MMRC) dyspnoea and 52.17% covered less than 200 metres in the 6-Minute Walk Test (6-MWT). Oxygen desaturation after 6-MWT was observed to be the contributing factor for the development of severe pulmonary hypertension in ILD patients. Conclusion: Factors like delayed seeking of medical care, co-morbidity like hypertension, higher grades of dyspnoea at the time of presentation, shorter 6MWD, and postwalk oxygen saturation were found to be predictors of pulmonary artery hypertension in patients with ILD. Early recognition of these risk factors in patients with ILD and the prompt treatment of the disease can reduce the development of severe PAH.

Comparison of Analgesic Effect of Clonidine as an Adjuvant with Different Concentration of Ropivacaine (0.35% and 0.2%) in Thoracic Paravertebral Block among Modified Radical Mastectomy Patients: A Randomised Double Blinded Clinical Study

Lalit Kumar Raiger, Pooja Jain, Sandeep Sharma

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 μg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020. After obtaining written informed consent, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groups- RP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 mL+Clonidine (1 μg/kg) and 0.2% Ropivacaine 19 mL+Clonidine (1 μg/kg) diluted upto total 20 mL with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p<0.05 was considered statistically significant. Results: Mean duration of analgesia was prolonged in clonidine groups RC and LDRC (811.5±110.99 and 753±119.76 min, respectively) as compared to group RP (400.125±108.13 min), although no statistically significant difference was noted between group RC and LDRC. Similar observations were noted when total dose of rescue analgesic in group RC (82.50±7.21 mg) and LDRC (99.38±35.57 mg) was compared to group RP (142.50±53.169 mg) as well as when total number of rescue analgesic doses in group RC (1.10±0.496) and group LDRC (1.32±0.474) were compared to group RP (1.92±0.694). Visual Analogue Scale (VAS) was noted at rest, cough, movement at 0, 4, 8, 12, 24 hours and showed a statistically significant difference between ropivacaine group RP and ropivacaine clonidine groups. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in lower pain scores, prolong duration of analgesia and reduce postoperative requirement of rescue analgesics. Both lower (0.2%) and higher (0.35%) concentrations of ropivacaine provide equally effective postoperative analgesia.

Evaluation of Human Leukocyte Antigen-B27 Expression in Patients with Spondylopathy/Spondylitis by Flowcytometry

Deepali Saxena, Pankaj Arora, Seema Acharya, Sana Ahuja

Introduction: The role of immune mediated injury in pathogenesis of Ankylosing Spondylitis (AS) is well established. HLA B27, a Major Histocompatibility Complex (MHC) class I molecule is one of the major genetic risk factors associated with the disease. Various techniques are used for testing HLA-B27 which includes Polymerase Chain Reaction (PCR) based tests, Enzyme Linked Immunosorbent Assay (ELISA) and flowcytometry. Flowcytometry has gained popularity due to ease of procedure, shortened turnaround time and cost-effectiveness. Aim: To assess the sensitivity and specificity of flowcytometry for HLA-B27 detection, taking PCR assay as the gold standard along with its association with demographic, clinicopathological and radiological parameters. Materials and Methods: This was a prospective study conducted in Department at Pathology of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India, for a period of 18 months from January 2020 to June 2021. The study included 51 patients for which HLA-B27 typing was done cases by flowcytometry and Sequence Specific Allele (SSA) PCR/Real time PCR on peripheral blood samples. The association of HLA-B27 with clinical features {Inflammatory Back Pain (IBP), arthritis, psoriasis, uveitis, dactylitis, Inflammatory Bowel Disease (IBD), cervicitis, urethritis, diarrhoea) along with MRI findings (sacroilitis)}, laboratory findings {C-reactive protein and Erythrocyte Sedimentation Rate (ESR)} was evaluated. The performance analysis parameters of flowcytometry were evaluated both by excluding and including the cases in grey zone taking PCR as gold standard. Statistical testing was conducted with SPSS 20.0. Chi-square test or Fisher’s-exact test were used and a p-value of less than 0.05 was taken as significant. Results: A significant association of HLA-B27 was seen only with IBP (p-value=0.001) and sacroilitis (p-value=0.03). Of the 22 (43.1%) patients positive for HLA-B27 by PCR, 18 (81.8%) patients were positive while the remaining 4 (18.1%) were in grey zone by flowcytometry. Of the 29 (56.9%) patients testing negative by PCR, 27 (93.1%) patients were negative, 1 (3.4%) was in grey zone and 1 (3.4%- false positive) tested positive for HLA-B27 by flowcytometry. Sensitivity and specificity of flowcytometry for detection of HLA-B27 was found to be 100% and 96.4%, respectively when grey zone cases were excluded. Conclusion: The study brings to light that flowcytometry is a fairly specific and sensitive method for HLA-B27 detection with a high Negative Predictive Value (NPV) (100%) and Positive Predictive Value (PPV) (94.7%). In the Coronavirus Disease-2019 (COVID-19) era, it reiterates the importance of flowcytometry for HLA-B27 especially when PCR is overburdened.

Role of Cerebro-Placental Ratio in Predicting Adverse Outcomes in Low-Risk Pregnancies- A Prospective Cohort Study

C Kavyarani, Ravi N Patil, C Sathyavani, Shiny Varghese

Introduction: Abnormal Cerebro-Placental Ratio (CPR) is associated with a substantial risk of adverse perinatal outcomes and the test seems to be particularly useful for follow-up of foetuses with sonographically diagnosed Foetal Growth Restriction (FGR). Aim: To determine the usefulness of doppler velocimetry, especially CPR at 35 weeks of gestation or later, in predicting intrapartum foetal heart rate abnormalities and adverse neonatal outcomes in low-risk term pregnancies. Materials and Methods: The present prospective cohort study was conducted at the Department of Obstetrics and Gynaecology in Bangalore Baptist Hospital, Bangalore, India from September 2019 to September 2020. A total of 60 pregnant women between the age group of 18 to 35 years with low-risk pregnancies, who present for the obstetrical ultrasound at 35 weeks of gestation or later with planned delivery at the hospital were included. All low-risk pregnant women with Estimated Foetal Weight (EFW) >10th centile and abnormal Cerebro-Placental Ratio (CPR) <10th centile were compared with those of normal CPR i.e., >10th centile. An adverse obstetric outcome like foetal distress, meconium aspiration syndrome or respiratory distress syndrome, mode of delivery, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality was analysed in the study population using Chi-square test or Fisher’s-exact test. Results: In this study, there was a significant association between foetal distress and CPR with Odds Ratio (OR) of 4.21 i.e., foetal distress was 4.21 times higher in the abnormal group compared to the normal group. Among 20 cases with abnormal CPR, 11 had foetal distress i.e., 55% and among 40 cases with normal CPR, nine had foetal distress i.e., 22.5%. Among those with abnormal CPR, 15% had Amniotic Fluid Index (AFI) <8 and among those with normal CPR, 0 had AFI <8, showing a significant association. Conclusion: In low-risk patients with EFW >10th centile and abnormal CPR, there was a significant association with adverse obstetric outcomes, requiring vigilant intrapartum monitoring.

Sepscore- An Improved Armament in the Diagnosis of Neonatal Sepsis

Introduction: Neonatal sepsis is the third most frequent cause of neonatal mortality. Early diagnosis and treatment are very crucial for successful outcome. Blood culture, which is the gold standard for diagnosis, will not be available early for appropriate management. Haematological Sepsis Scoring (HSS) is a rapid, low-cost sensitive lab tool for diagnosing neonatal sepsis. Modification of HSS (Sepscore) done by removal of repetitive parameters and addition of Nucleated Red Blood Cells (nRBC) which are elevated in sepsis, have higher specificity. Aim: To compare the diagnostic utility of the modified HSS (Sepscore) with Rodwell’s HSS. Materials and Methods: The prospective analytical study was conducted over 18 months in a tertiary care hospital in South India blood samples of 350 neonates admitted to Neonatal Intensive Care Unit (NICU) with signs of sepsis were evaluated by HSS and Sepscore. The sensitivity, specificity, predictive values and likelihood ratios of Sepscore and cut-off value of the Sepscore using the Receiver Operating Characteristic (ROC) curve for diagnosis of neonatal sepsis was determined. Results: A total of 146 (41.7%) of 350 had neonatal sepsis and rest served as controls. A total of 188 (53.7%) of the subjects were preterm. The cut-off was determined as three for both HSS and Sepscore. The sensitivity and specificity of HSS were 71% and 54% whereas that of Sepscore was 68% and 61%, respectively. The diagnostic ability of Sepscore was found to be significantly higher than that of HSS (p=0.0094). Conclusion: According to the observation of the present study sepscore has a higher specificity and marginally lower sensitivity compared to the HSS in neonatal sepsis.

Clinico-epidemiological Profile of Incidentally Detected Gastrointestinal Neuroendocrine Tumours on Gastrointestinal Endoscopy: A Retrospective Study

AK Koushik, J Sai Harish Reddy, P Ganesh, S Shanmuganathan

Introduction: Neuroendocrine tumours (NETs) are rare tumours, with the Gastrointestinal (GI) tract and the lung as the most common sites with indolent course. Endoscopists play a pivotal role in the diagnosis of GI-NETS because the majority of patients with NETs are asymptomatic and NETs are discovered during screening examinations. Since GI-NETs are less common than other cancers, their natural history, diagnosis, and treatment may not be completely understood. Aim: To estimate the prevalence and to characterise the clinical, endoscopic, and histological features of incidentally detected GI-NETs in nodular/polypoidal/ulcerated lesions on GI endoscopy. Materials and Methods: This hospital-based retrospective study was conducted at the Department of Medical Gastroenterology of a tertiary care facility, Chennai, Tamil Nadu, India. The data belonged to the period between January 2018 to December 2020. Data belonged to the patients that underwent Oesophago-gastro Duodenoscopy (OGD)/Colonoscopy and were found to have nodular/polypoidal lesions. Records on serum chromogranin, serum gastrin and radiological tests such as Ultrasonography (USG) or Computed Tomography (CT) scan were recorded. The histopathological with immunohistochemistry staining report was used to diagnose NETs. Continuous variables were analysed for normality by the Kolmogorov Smirnov test. Results: A total of 59 eligible patients were studied. The prevalence of GI-NET tumours in 2018 was 17 (0.32%), 19 (0.33%) in 2019, and 23 (0.41%) in 2020 with an overall rate of 59 (0.36%) for all the three years. Total male participants were 35 (59.32%), and the mean age of the patients was 56.13±12.44 years. Majority had abdominal pain 32 (54.24%) and 35 (59.32%) had tumours in the duodenum, 15 (25.42 %) in the stomach. The most common site was duodenum 35 (59.32%). As per World Health Organisation (WHO) NET, most tumours were Grade I (50, 45.76%). Majority of tumours had Synaptophysin (57, 96.61%), Chromogranin (49, 83.05%), and a Ki67 (Kiel-clone no. 67) index less than equal to 2 (49, 83.05%), while 27 (84.75%) tumours were of size of <1 cm. Conclusion: The GI-NETs are uncommon, and their biology, histopathology, and clinical behaviour are distinct. Typically, they are slow-growing tumours, but their growth rate can fluctuate depending on the location, size, and grade of the tumour.

Assessment of Awareness on Drug Delivery System among Oral Healthcare Professionals: A Cross-sectional Study

KP Mahesh, S Viveka

Introduction: The technique or approach used to provide pharmaceutical drugs to achieve a therapeutic effect in people or animals is known as drug delivery. Local anaesthetics, Non Steroidal Anti-inflammatory Drugs (NSAIDs), and antibiotics are the most generally recommended medicines in dentistry. Dentists must be upto date on dosage formulations and various drug delivery methods. Aim: To evaluate the knowledge about the Drug Delivery System (DDS) among oral healthcare professionals. Materials and Methods: This was a cross-sectional questionnaire survey was conducted on 75 dental students and oral healthcare professionals of both genders, in population, Mysore, India. A questionnaire consisting of 12 dichotomous ‘Yes’ or ‘No’ questions were used in the study. The study population was obtained by convenient random sampling. The questionnaire was created and verified by healthcare professionals with extensive teaching and clinical experience. The responses received during the period from August 2022 to September 2022 were subjected to statistical analysis. The study was analysed by descriptive statistics such as frequency and percentage. Results: All the 75 participants responded to the questionnaire and the response rate was 100%. The mean age of the participants in the present study was 22±2.3 years. A 92.00% (n=69) participants knew about various drug interactions. The participants had less knowledge about recent nano-based drug delivery. Only 42.66% (n=32) were acquainted with microneedle based transdermal delivery system, 33.33% (n=25) about nanocrystals and 21.33% (n=16) about 3D printing technology in DDS. A 97.33% (n=73) of the participated subjects thought that selection of appropriate DDS plays a role in its therapeutic efficacy. Conclusion: The recent advances in drug delivery methods are of little interest among the participants in the present study. Participants in the present survey demonstrated a lack of basic and fundamental understanding of nanotechnologies, highlighting the critical need for increased awareness. This article has highlighted the importance of knowing various drug delivery methods and the current trends in approaches.

Success and Acceptability of Stainless Steel Crowns placed using Hall Technique with Modifications: A Randomised Clinical Trial

Dhigvijay Arepogu, SVSG Nirmala, Inthihas Shaik, Sivakumar Nuvvula

Introduction: High frequency of caries in primary teeth and its inadequate treatment is major public health problem, that significantly affects children’s lives. The Hall Technique (HT) is a novel method of caries management for treating primary molars compared to conventional treatment techniques used in primary healthcare settings. It is one of the methods used for biological sealing in carious primary molars, in which bacteria will be sealed from the oral environment thereby inactivating the carious lesion. This technique also increases the child’s compliance and operator comfort as the local anaesthetic administration is eliminated. Aim: To prospectively evaluate the clinical success and failure rate, and acceptability of Stainless Steel Crowns (SSC) placed using Hall Technique (HT) and with Modified Hall Technique (MHT) in rural school children aged 6-9 years. Materials and Methods: In a school-based setting, a randomised clinical trial was done with a total of 60 children (60 teeth) aged 6-9 years, who were randomly divided into two groups, 30 in each. In Group A (HT)- crowns were placed using the HT and in Group B (MHT)- MHT and follow-up were done at 3, 6, and 12 months. The acceptability of the technique for both the parents and children was evaluated with the questionnaire. The data analysis was carried out using a Statistical Package for Social Sciences (SPSS Version 21). Statistical significance was set at p<0.05. Results: In the HT group, the majority of crowns 26 (86.7%) were successful with 2 (6.6%) minor failures and 2 (6.6%) major failures, whereas the MHT group showed 100% success with no failures. On comparing Group A with Group B no significant differences were observed with respect to gender, arch and tooth type (p>0.05). Children’s acceptability and preference were more towards the MHT. Conclusion: According to the present study the MHT was well accepted by children and the parents showed preference towards both the techniques.

Utility of Prognostic Scoring System Based on Histomorphological Parameters in Low-grade Colorectal Carcinoma

Introduction: Colorectal Carcinoma (CRC) is the third most common cancer worldwide. Percentage of gland formation is the only valid parameter for histologic grading of CRC. Tumour budding and Tumour-infiltrating Lymphocytes (TILs) are emerging prognostic factors in CRC. In recent years high grade CRC has become subject to more precise molecular grading strategies. However low grade cases show in homogenous outcome due to still insufficient categorisation. The focus of this study is to determine whether the combination of amount of gland formation, budding, and TILs will allow us to further characterise large in homogenous group of WHO low-grade cases into prognostically significant subgroups. Aim: To estimate the significance of tumour budding and TILs in low-grade CRC and to categorise low-grade CRC into prognostic subgroups taking into account three histologic parameters-gland formation, tumour budding and TIL. Materials and Methods: This was a descriptive cross-sectional study done in the Department of Pathology, MES Medical College, Malappuram, Kerala, India. It was an ambispective study (retrospective from January 2015 to December 2021 and prospective from December 2021 to March 2022) which analysed 105 World Health Organisation (WHO) low-grade CRC cases. The demographic data of the patients was collected and histopathological assessment of tumour grade, pT, pN, Lymphovascular Invasion (LVI), Tumour-infiltrating Lymphocytes (TIL) and Tumour Budding (TB) was done on Haematoxylin and Eosin (H&E) stained sections. A morphology-based risk score was developed taking into account three parameters- percentage of gland formation, budding, and TIL. For each parameter, 1 to 2 points were given, resulting in a sum score, dividing the CRC cases into a low-, an intermediate-, and a high-risk group. Statistical analysis was performed using SPSS 25.0. The results were expressed as numbers and percentage. Pearson Chi-square test was used to test the relationship. Results: In the present study degree of budding significantly associated with pT stage (p=0.02), pN stage (p=0.042) and LVI (p=0.038). TIL also differed significantly with pT (p=0.001) pN (p=0.042) and LVI (p=0.004). Applying the prognostic scoring to 105 cases, 33 (31.4%) cases showed high score, 30 (28.6%) cases were of intermediate score and 42 (40%) cases showed low score. The three groups differs significantly with pT (p=0.027), pN (p=0.035) and LVI (p=0.015). Conclusion: The present study showed combining different morphological parameters of tumour and tumour environment can help to further subdivide CRC into prognostically significant subgroups.

A Comparative Study to Assess Parathyroid Hormone Status in Different Age Groups of b-Thalassaemia Major Individuals from Eastern India

Susmita Banerjee, Anindya Dasgupta

Introduction: β-thalassaemia major, due to imbalance, missing or deficiency of β-globin chain synthesis pathway, is marked as a hereditary disorder. Homozygous state presents with severe anaemia. Regular blood transfusions and chelation therapy increase the life expectancy in thalassaemia patients. Due to recent advances in the treatment paradigm of β-thalassaemia major patients, there has been a significant increase in their lifespan but, due to the treatment related iron overload, endocrine defects like hypogonadism, diabetes mellitus, hypothyroidism and Hypoparathyroidism (HPT) have been seen to progress. Diverse studies state the occurrence of HPT to be from none upto almost 22.5% in patients. It has also been recognised that asymptomatic hypocalcaemia is much more common and can be overlooked unless precisely viewed. Aim: To estimate and compare the biochemical parameters related to bone turnover in regularly transfused thalassaemia patients in different age groups and to find out significant correlation among the biochemical markers. Materials and Methods: In this cross-sectional study conducted at Calcutta National Medical College, Kolkata, West Bengal, India, from January 2017 till January 2018, 100 β-thalassaemia major patients were enrolled. Serum Parathyroid Hormone (PTH), serum ferritin, ionic calcium (Ca2+), Alkaline Phosphatase (ALP), phosphorus (P) and 25-Hydroxy vitamin D (25-OHD) levels were estimated in these patients. Statistical evaluation was done by the Statistical Package for the Social Sciences (SPSS), version 12.0. Result was reported as mean±SD. Pearson correlation coefficient was used to determine the association of serum ferritin levels and parathormone levels. The p-value of <0.05 was considered as statistically significant. Results: Out of 100 patients, 19 patients had HPT. The mean age was found to be 12.6 years on diagnosis, mean ionised calcium was 0.95 mmol/L, mean serum ferritin was 3045 μg/L (range 1209-10,000 μg/L) and mean serum phosphate was 1.88 mmol/L (range 1.50-2.73 mmol/L). Serum PTH values of 7.04 pg/mL was found to be low. Negative correlation serum PTH and ferritin levels were found. Significant higher values of mean serum ferritin (2789 μg/L) and lower values of parathormone (17.13 pg/mL) was found in the age group of 11-18 years as compared to the other age group of ≤10 years with serum ferritin and parathormones values being 1648 μg/L and 23.44 pg/mL, respectively. Conclusion: Regularly transfused β-thalassaemia major patients, inspite of receiving chelation therapy tend to develop altered calcium and vitamin D homeostasis once they enter second decade of life. Thereby, biochemical parameters related to bone profile which includes ionic calcium, vitamin D, phosphate and parathyroid hormones levels should be stringently monitored once the patient crosses first decade of life to prevent any development of hypocalcaemia or overt HPT.

Comparing the Timbre of Different Musical Sounds used in Music Therapy and its Effect on the Quality of Sleep in Medical Students with Insomnia- A Prospective Interventional Study

Amritha Varshini Ragavan, AS Kaniethapriya, P Premananth, S Anu, J Vijay Anto

Introduction: Stress and the pressure to perform in a competitive world has led to a rise in insomnia cases, especially in medical students. Music serves as a great alternative or additional therapy and hence, specifying the details of the type of music and creating a standard set of musical parameters, e.g., a specific value for tempo that sleep music should have. This will make it a more viable and clear option. One of these important but minimally explored aspects is timbre of music. Aim: To assess and compare the effect of timbre of different musical sounds on an individual’s quality of sleep, duration and day time sleepiness. Materials and Methods: This prospective interventional (community trial) study was done in the Department of Physiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India for three weeks. Hundred medical students having insomnia were chosen and split into five groups: Group A-sitar, B-violin, C-vocal, D-flute and E-control. Groups A-D had to listen to tracks with an assigned timbre for 20 minutes before going to sleep daily for three weeks. Pittsburg Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were used to assess sleep quality, duration and day time sleepiness. Kruskal-Wallis test was used to analyse the results. Results: Sleep quality improved with sitar being the one that improved the quality the most, followed by violin, then flute and finally, vocal (p-value=0.001). Sleep duration improved with sitar being the one that showed the most improvement, followed by flute, then violin and finally, vocal (p-value=0.001). Daytime sleepiness decreased with sitar being the one that decreased it the most, followed by violin, then flute and lastly, vocal (p-value=0.021). Conclusion: The most effective timbre in improving sleep quality, duration and reducing day time sleepiness was sitar and the least effective was vocal.

Microbiological Profile of Osteomyelitis and Antibiotic Resistance Pattern of Bacterial Isolates with Special Reference to MDR Strains at a Tertiary Care Hospital, Kanpur, Uttar Pradesh, India

Rohan Nigam, Suneet Kumar Yadav, R Sujatha, Deepak Sameer Bind, Nashra Afaq

Introduction: Osteomyelitis is an inflammatory process that affects bone due to the contiguous infection, direct inoculation, or haematogenous spread of microorganisms. It is an infectious disease that is difficult to diagnose and treatment is complex because of its heterogeneity, pathophysiology, clinical presentation and management. Aim: To determine microbiological profile osteomyelitis and antibiotic resistance pattern of bacterial isolates with special reference to Multidrug Resistance (MDR) strains. Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology and Department of Orthopaedics, Rama Medical College Hospital and Research Centre, Kanpur, Uttar Pradesh, India. A total of 100 samples from osteomyelitis cases were aerobically cultured and isolates from culture positives were identified by standard procedures. Antimicrobial Susceptibility Testing (AST) was done following Clinical and Laboratory Standards Institute (CLSI) guidelines. Staphylococcal isolates were screened for methicillin resistance and Gram-negative bacilli were screened for MDR production. The data was entered in Microsoft excel. Results: Out of 100 samples, 76% were culture positive and 24% were culture negative. Males were more affected than females. Staphylococcal spp. (47.4%) was predominant, E. coli (14.4%) and Klebsiella spp. (11.8%), Pseudomonas spp. (9.2%), Proteus spp. (5.2%), Coagulase-Negative Staphylococci (CoNS) (4%). Among the MDR strains, Methicillin-resistant Staphylococcus aureus (MRSA) was 44.4%. All the MDR Staphylococcal isolates were 100% sensitive for linezolid. Among the MDR Gram-negative bacilli were Extended Spectrum Beta Lactamases (ESBL) (50%), AmpC (17.6%) and Metallo-beta-lactamases (MBL) (14.7%) and they were 100% sensitive for polymixin B and colistin. Conclusion: The microbiological profile of osteomyelitis in the present study showed high prevalence of MRSA 44% as the commonest agent, sensitive only to linezolid. E. coli ESBL (50%) and MBL 14.7% were sensitive only to colistin and polymixin B, therefore proper infection control practices and antibiotic policy has to be followed to reduce the incidence of MDR strains.

Comparison of 3% Hypertonic Saline and Mannitol in the Management of Children with Raised Intracranial Tension: A Research Protocol

Lavanya Ramakrishnan, Revatdham Meshram

Introduction: Raised Intracranial Tension (ICT) is a common medical emergency with varied aetiology. Immediate medical or surgical intervention is mandated in most cases. Conservatively, osmotherapy with 3% Hypertonic Saline (HTS) or mannitol is the mainstay to reduce raised ICT. Additionally, the patient may also need surgical intervention along with osmotherapy. Need of the study: Cerebral oedema and raised ICT in children and its treatment protocol are under-estimated and need further research and study in terms of identification of the condition and the choice of osmotherapy, which is the cornerstone in treating raised ICT among others. Aim: To analyse the role of 3% HTS and mannitol and their individual efficacy in reducing intracranial pressure in children. Materials and Methods: This open-labelled protocol for prospective study will be conducted in the Department of Paediatric Intensive Care Unit (PICU) of Acharya Vinoba Bhave Rural Hospital associated with Jawaharlal Nehru Medical College, a tertiary care center situated in the state of Maharashtra, in India, from November 2020 to October 2022. Patients between the age group of one month to 16 years will be taken alternatively and admitted to the Paediatric Intensive Care Unit (PICU) of a designated tertiary care hospital situated in the state of Maharashtra, in India diagnosed to have or showing signs and symptoms of raised ICT. They will be given 3% HTS or mannitol after considering the exclusion criteria for each if any will be conducted. The patient will be treated with a fixed dose of either drug as pre-decided by the principal investigator and the secondary investigator and the patient will be monitored within the next hour for immediate effects and improvement in the clinical state of the patient as well as the immediate general outcome in terms of vitals and sensorium and final outcome in terms of discharge rate with neuromorbidity, if any, or resulting death in patients treated with either drug will be noted. The Chi-square test, Fischer’s-exact test for categorical data, and independent t-test for continuous data with normal distribution will be used to assess the relationship between various demographic, clinical, and aetiological characteristics and outcomes. The parameters that will be compared are sensorium, heart rate, respiratory rate and pattern, and Blood Pressure (BP) at admission. The above parameters will be monitored immediately after infusion of osmotherapy and the final outcome, as mentioned above, of patients on either of the drugs will be noted. The p-value <0.05 will be considered significant.

Management Strategies and Outcomes of Paediatric Blunt Abdominal Trauma at a Tertiary Care Centre in South Kerala: A Retrospective Observational Study

Liya Joseph

Introduction: Blunt abdominal trauma is a leading cause of injury in paediatric population. The management of paediatric abdominal injury has shifted from Operative Management (OM) to Non Operative Management (NOM) over years. NOM is the standard treatment for clinically stable patients with blunt trauma abdomen. Aim: To describe retrospectively the management strategies and outcomes of paediatric patients with blunt abdominal trauma in a tertiary care centre. Materials and Methods: This was a retrospective observational record-based study that included 96 medical records of children admitted in Government Medical College, Thiruvananthapuram, Kerala, India, with blunt trauma abdomen from January 2018 to December 2022. Patients were characterised according to the treatment they received as- NOM and OM. Ultrasound Focused Assessment with Sonography in Trauma (USG FAST) and Contrast Enhanced Computed Tomography (CECT) abdomen were done in all the patients. The factors recorded were- age, gender, mechanism of injury, concomitant injury, tachycardia, hypotension, respiratory rate, blood transfusion requirement, injuries (American Association of Surgery of Trauma (AAST) organ injury scale), length of Intensive Care Unit (ICU) and hospital stay and mortality. Univariate analysis of the clinical features were done using Chi-square test using Statistical Package for the Social Sciences (SPSS) 27.0 statistical software. The p-value <0.05 was considered statistically significant. Results: About 83 patients (86.46%) were in NOM group while 13 patients (13.54%) were in OM group. The most common age group involved was 6-12 years with male predominance. Median age was 9.2 years. The most common mechanism of injury was road traffic accident 31 (32.29%). Among 84 patients with isolated solid organ injury, only 5 (5.9%) required surgical intervention. Among nine patients with isolated hollow viscous injury, 5 (55.5%) required surgical intervention. All 3 (100%) patients with both hollow viscous and solid organ injury required surgery. Hypotension and blood transfusion requirement were statistically significant factors in the OM group p<0.05. Complications, length of hospital and ICU stay were more in operatively managed group with mortality rate of 1.04%. Conclusion: The success of NOM of blunt trauma abdomen depends on proper selection of the patient. Patients who are haemodynamically stable can be safely managed non operatively with adequate monitoring in a tertiary care centre.

Evaluation of Awareness, Attitude, Practice and Barriers of Adverse Events Associated with Medical Devices among Medical Doctors of Gujarat, India: A Cross-sectional Study

Krishna Modi, Vipul Prajapati, Yash Mehta, Himani Modi, Supriya Malhotra

Introduction: In this era of technology, the use of medical devices for betterment of patients is rapidly rising. Along with the usage, adverse events also tend to occur more with these devices. Materiovigilance Program of India (MvPI) refers to close observation of medical device-related adverse events by a well-coordinated surveillance system of detection, collection, assessment, reporting, and prevention of those events. Aim: To evaluate the awareness, attitude, practice and barriers of adverse events associated with medical devices among doctors. Materials and Methods: A cross-sectional study was conducted all over Gujarat, India, among 174 doctors which included medical consultants, resident doctors and intern doctors for a duration of two months from 5th November 2022 to 5th January 2023. The questionnaire was administered containing 26 questions related to awareness, attitude, practice and barriers of materiovigilance. The responses were collected via social media platform. Analysis was done in percentages and numbers and using Statistical Package for the Social Sciences (SPSS) software, version 26.0. The p-value <0.05 was considered as statistically significant. Results: Out of 174 responders, 106 (60.9%) were males, while 68 (39.1%) were females. Mean age in present study was 27±5.3 years. There were 54 consultants, 61 residents and 59 interns. Most of the participants (98.27%) were having positive attitude, whereas, 72.98% participants had knowledge about materiovigilance and 63.21% participants have reported adverse events related to devices. Overall Knowledge, Attitude and Practice (KAP) of resident doctors was better, as compared to consultants and interns in the present study. Conclusion: Even though there was inadequate awareness and practice, optimism in attitude was found in participants. There is a need to conduct regular workshops and training sessions for doctors to make reporting feasible and easy to reduce mishaps due to medical devices in future.

Self-assertiveness and Perceived Parenting Style among Medical Students in Southern India: A Cross-sectional Study

Meera George, Neethu George, Dharmaraj Rock Britto

Introduction: The youth population particularly medical students should have the ability to express their feelings without hurting others and thus develop proper communication with the patients. The way they express and take decision shows their self-assertiveness. The communication potential and the assertivenss skill is developed mainly during the childhood partially through parental guidance. Aim: To assess self-assertiveness and perceived parenting style among medical students and to assess any association between the variables. Materials and Methods: The study was conducted as a cross-sectional study among 400 prefinal and final-year medical students (MBBS) from Travancore Medical College, Kollam district Kerala, India for a period of two months from January-February 2020. The data was collected using a self-reported questionnaire method which includes- sociodemographic details, Rathus Assertiveness Scale to assess self-assertiveness, and parenting bond instrument to assess perceived parenting style. The association was assessed using Chi-square and Fisher’s exact test. The data was collected in Microsoft excel and analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: The mean age of the study population was 21.34±1.71 years, and there were 132 (33%) males, and 268 (67%) females. The study showed that 206 subjects (51.5%) had low assertiveness scores. Among subjects, most of the subjects {236 (59%) in the father and 252 (63%) in the mother} perceived their parents to have optimal parenting style. The male gender perceived the parents to be affectionless and high protection from the parents showed a significant reduction in the assertiveness scores. The study did not found any significant association between perceived parenting styles and the self-assertiveness score of medical students. In case of father, the Chi-square value was 7.27, and p-value was 0.20 and for mother the Chi-square value was 4.93 and the p-value was 0.08. Conclusion: Most of the medical students have low self-assertiveness score and perceived their parents to have optimal parenting styles. Even though the study showed an absence of association between the perceived parenting style and self-assertiveness, the importance of being assertive should be established among students and measures can be adopted to make a family consultation.

Immunohistochemical Expression of Alpha Smooth Muscle Actin in Infiltrating Ductal Carcinoma of Breast and its Association with Histopathological and Hormonal Status: A Cross-sectional Study

Introduction: Breast carcinoma is the second most common cancer and cause of death worldwide, with a mortality rate of 15%. Among various theories regarding the pathogenesis of cancer, the tumour microenvironment is known to play an essential role in cancer development and progression. Aim: To determine the expression of alpha Smooth Muscle Actin (α-SMA) in infiltrating ductal carcinoma of breast carcinoma and its association with histopathological parameters and hormonal receptors status. Materials and Methods: This was a cross-sectional observational study done in Department of Pathology, RL Jalappa Hospital, a tertiary care centre, Karnataka, India from January 2018 to December 2022. A total of 100 cases of Infiltrating Ductal Carcinoma confirmed by histopathological examination were included in the study. All the Haematoxylin and Eosin (H&E)-stained slides were screened for histological type, tumour grade, and nodal metastasis and Immunohistochemistry (IHC) markers like Oestrogen Receptor (ER), Progestrone Receptor (PR), Ki67, Human Epidermal growth factor 2 neu (HER2/neu) and α-SMA were performed. The p-value (Probability that the result is accurate) of <0.05 was considered stastically significant after assuming all the rules of stastistical tests. Results: The majority (33%) of the subjects belonged to the age group 51-60 years. 54% of the subjects were positive for ER, 52% of the subject was positive for PR, and 30% of the subjects were HER2/neu. 53% of the subjects had >14% Ki67 and 47% of the subjects had <14% Ki67. According to molecular typing, 38% was luminal A, 20% was luminal B, Triple-Negative Breast Cancer (TNBC) was present in 30%, and HER2/neu positivity was seen in 12%. According to Nottingham Prognostics Index (NPI), patients were grouped into four categories according to the NPI score: I (excellent) was 15%; II (good) was 36%, III (moderate) was 32%; and IV (poor) was 17%. Conclusion: SMA positivity can be used as an important prognostic factor in infiltrating ductal carcinoma as its stromal expression is associated with grade of the tumour and lymph node status.

Outcome Analysis of En-bloc Excision and Endoprosthetic Replacement among the Cases Operated for Distal Femoral and Proximal Tibial Giant Cell Tumour around the Knee: A Retrospective Study

Introduction: Giant Cell Tumour (GCT) around the knee joint is the most common site for this locally malignant bone tumour and, in advanced stages, requires excision of the tumour mass. Current recommendations promote joint salvage procedures in allograft or mega prosthetic replacement. Patients undergoing this surgery need massive changes in their lifestyle to cope with their activities of daily living. The psychological and social impact following these procedures has not been extensively studied. Aim: To observe the long term functional results as well as the impact on quality of life in patients undergoing endoprosthetic replacements in GCT around the knee with emphasis on any difference in results among the cases operated for distal femoral and proximal tibial GCT. Materials and Methods: This retrospective study was conducted in the Department of Orthopaedic Surgery at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow from June 2015 to June 2019 with a total sample size of 21 cases. The two groups formed were; one having GCT of distal end femur and the other group with GCT of proximal end tibia. The evaluation was done for outcome measures by Oxford Knee Score (OKS) and Musculoskeletal Tumour Society score (MSTS) for their functional outcome and Short Form Health Survey (SF-12) for their quality of life effect at two years postoperatively. Students unpaired t-test was performed for intergroup analysis and Analysis of Variance (ANOVA) was done for within the group analysis for subsequent follow-up visits. Data was analysed using Statistical Package for Social Sciences (SPSS) version 21. Results: The mean age of study population was 33.67±8.674 years. The male-female distribution was insignificant (p=0.673), providing with a homogenous study group. Recurrent GCT was found significantly more commonly in the proximal tibia group than in the distal femur group (p=0.031). Comparison of OKS and MSTS preoperatively, at six months, at one year, and two years showed statistically significant improvement in successive follow-ups in both the distal femur and proximal tibia groups (p<0.001 in both groups). Intergroup analysis also showed significantly better scores in the distal femur group compared to the proximal tibia group in the preoperative period and all successive follow-ups. On intergroup analysis at 2 years, both the OKS (p=0.0206) and MSTS score (p<0.0001) were found to be statistically significant. SF-12 mental and physical scores preoperatively also showed statistically significant improvement in all cases (p<0.001) for mental and physical components. Conclusion: Early functional outcomes of en-bloc excision and reconstruction with modular endoprosthesis are good in terms of joint function and the patient’s overall mental and physical well-being.

Protective Antibody Titer against Hepatitis B in Healthcare Workers: A Cross-sectional Study from Tertiary Care Hospital of Kashmir

Reyaz Nasir, Anjum Farhana, Danish Zahoor, Tawhida Fazili, Sanam Rasool Wani

Introduction: Hepatitis B is not only the most transmissible blood borne viral infection, but also the only one that is preventable by vaccination. In developing countries, Hepatitis B vaccination coverage among Healthcare Workers (HCWs) is very low for various reasons. Aim: To evaluate Hepatitis B Virus (HBV) immunisation status and Hepatitis B surface antibody (anti-HBs) titer among HCWs in a tertiary care hospital in Kashmir. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology, Government Medical College, Srinagar, India from April 2019 to June 2019. Serum samples were collected from 196 HCWs and their vaccination history was collected. Those who had taken all three doses of hepatitis B were considered to be fully vaccinated those that had taken two doses as partially vaccinated. Triple serology was done for all which included testing for HBV, Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) infection, one HCW turned out to be Hepatitis B Surface Antigen (HBsAg) positive and was dropped out of study. Those negative (195/196) were further tested for anti-HBs titer by enzyme immunoassay method. Parametric data were expressed as mean±Standard Deviation (SD) and categorical values as percentages. Results: Out of 195 HCWs selected for the study, 104 were males and 84 (43%) were females with mean age 38.4±6.9 years. Among them fully vaccinated were 46 (23.5%), partially vaccinated were 91 and not vaccinated were 65 (33.33%). Anti-HBs titers were protective in 54 (27.7%) which belonged 81.5% (44/54) to vaccinated category and 18.5% (10/54) to partially vaccinated category. Conclusion: Fully vaccinated HCWs (95.6%) had a protective antibody titer but unfortunately there are low vaccination rates among HCWs. There is a need for well-planned and clear policies for HBV screening and vaccination in HCWs, especially those who are at a greater risk of exposure to blood or other potentially infectious material.

Effectiveness of Oral Health Education Using Child Model Video vs Conventional Education by Dentist among Orphanage Children of Puducherry, India: A Prospective Interventional Study

M Kavitha, T Seema Devi, GS Prathima, Shiva Shankar, Divvi Anusha, Eldo Babu

Introduction: Orphan children are usually abandoned by their parents and these children are more vulnerable to oral health problems due to lack of knowledge and psychological support. These children do not receive adequate preventive health care and often suffer from oral health diseases. Oral Health Education (OHE) is the paramount of health promotion and prevention of oral health disease and also, it throws some light on unattended oral health problems. Aim: To assess the knowledge, attitude and oral hygiene practices among 10 to 15 year-old orphanage children and to compare the effectiveness of OHE using video (child model) vs conventional method (dentist) on knowledge, attitude and oral hygiene practices. Materials and Methods: This prospective interventional study was conducted among 120 orphanage children of 10-15 years in Puducherry, India. OHE using dentist and child model OHE video intervention was given to group I and group II, respectively. Knowledge, attitude and practice scores of both the groups was assessed at pretest, post-test and 15 days follow-up using a prevalidated questionnaire. The data thus collected were statistically evaluated using repeated measures of Analysis of Variance (ANOVA), independent t-test, percentage. Results: A total of 120 children were selected for the study out of which 70 (58.33%) were females and 50 (41.7%) were males. The mean age of the study participants was 12.5 years. When compared with baseline, a significant increase in knowledge, attitude and practice scores were seen in post-test and follow-up of child model video group when compared to conventional dentist led OHE group (p≤0.001). The results of the present study indicate that Knowledge, Attitude and Practice (KAP) regarding oral health were improved in OHE using child model video group. Conclusion: From the results of this study it was found that incorporation of video in imparting OHE using child model can be an effective tool in improving oral health knowledge and it is evident that these children will be more confident and comfortable receiving instructions from children of their age group.

Effect of Introduction of ‘Research Orientation Module’ in Ayurveda Undergraduates

Introduction: Health research is necessary to address community health issues and needs even in enhancing health care. Anyone involved in medical science must understand research. A long-term approach for the promotion of health research is to target undergraduates. Aim: The present study is an effort to develop a time bound ‘Research orientation module’ with the aim to orient Ayurveda undergraduates about the basics of research and providing them hands-on training to develop primary proposal writing skills. Materials and Methods: It was an educational interventional study. It was conducted in two phases. In phase I and II, 160 and 56 students of II, III, and IV years Bachelor of Ayurvedic Medicine and Surgery (BAMS) respectively were enrolled. The students were exposed to research orientation module. The pretest, posttest, and feedback was taken and students were asked to prepare a research proposal on their topic of interest. The data is represented in mean and standard deviation. As the data followed normal distribution, parametric tests were used to analyse the data. Intergroup comparison was done with one-way ANOVA test. The paired t-test was used to check mean differences between groups. Result: In all batches, the mean posttest score (15.02±2.63) was significantly higher than pretest score (1.44±0.65) which showed improvement in knowledge. The mean proposal evaluation score was increased in all batches after students participated in workshops, but the IV year students score (12.83) was significantly increased in comparison with II year (9.92)and III year (10.53)students’ score. With the aid of the students’ feedback, the workshop evaluation was completed. Positive feedback and an interest in learning about the fundamentals of research were apparent. Conclusion: It can be concluded that ‘Research orientation module’ is effective in educating Ayurveda undergraduates about the basics of research and it is helpful in developing proposal writing skills in Ayurveda undergraduates.

Factors Affecting Intraoperative Blood Loss in Scoliosis Surgery: An Observational Cross-sectional Study

V Rajanigandha, S Saranya, P Anoop

Introduction: Significant intraoperative blood loss may be associated with scoliosis surgery. To know about the quantity of blood loss and risk factors associated is imperative in limiting the blood loss as well as to plan transfusion strategies like blood conservation techniques. Aim: To evaluate the quantity of intraoperative blood loss in scoliosis surgery and to study the various factors contributing to blood loss. Materials and Methods: This was a cross-sectional prospective observational study conducted at Government Medical College, Thiruvananthapuram, India, from January 2019 to January 2020. Thirty-five (ASA I and II) consecutive patients were scheduled to undergo surgery for correction of scoliosis, and consecutive sampling was done. Age, gender, weight, height and body mass index were noted. During surgery, intraoperative blood loss was measured by gravimetric method from the suction drain and by numerically assessing the quality of the surgical field by the operating surgeon using fromme’s ordinal scale. All these data were entered into structured proforma and analysed by using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of subjects was 13.69±1.43 years. The mean intraoperative blood loss was 645.60±143.26 mL {20.11±11.7 % of Estimated blood volume (EBV)}. Mean duration of surgery (r=0.890, p<0.001), Cobb’s angle (r=0.829, p<0.001), number of fused vertebra (r=0.694, p<0.001) correlated with intraoperative blood loss, expressed as a percentage of EBV. The quality of the surgical field, using Fromme’s ordinal scale by visual assessment, correlated with the mean intraoperative blood loss (p=0.001). Conclusion: Duration of surgery, number of fused vertebrae, and preoperative Cobb’s angle are the most important factors predicting intraoperative blood loss in patients undergoing scoliosis surgery.

CTLA4 Methylation and its Expression as a Prognostic Biomarker in Tobacco Users with and without Oral Squamous Cell Carcinoma- A Protocol for Cross-sectional Study

Introduction: Oral Squamous Cell Carcinoma (OSCC) is characterised by immunosuppression mediated by evasion of ‘immune checkpoints’ by tumour cells. Cytotoxic T Lymphocyte Associated Protein 4 (CTLA4) is one of the immune checkpoint molecule whose role in oral carcinogenesis remains to be elucidated. Deoxyribonucleic Acid (DNA) methylation of CTLA4 promoter region holds potential as a biomarker for diagnosis and assessment of individuals at risk of developing OSCC. Need of the study: Immunotherapy is an emerging treatment modality in some cancers. Thus, better understanding of CTLA4 methylation role in OSCC paves a way for newer strategies in immunotherapeutic. Aim: To assess the DNA methylation pattern of promoter region of CTLA4 gene and evaluate its expression in tobacco users with and without OSCC so that it can contribute as biomarker for diagnosis and prognosis of OSCC. Materials and Methods: The proposed longitudinal cross-sectional study will be conducted at Sharad Pawar Dental College and Hospital, Maharashtra, India. It will evaluate promoter methylation and protein expression of CTLA4 gene in Smokeless Tobacco (SLT) users. There will be three groups: group A OSCC patients; group B normal individuals with SLT habit without any oral lesion; and group C normal individuals without SLT habit. Formalin Fixed Paraffin Embedded (FFPE) tissue blocks will be prepared from the biopsy obtained from total thirty nine participants. DNA methylation of CTLA4 promoter will be assessed using Methylation-Specific PCR (MS-PCR). In addition, the quantitative expression of CTLA4 will also be assessed using Immunohistochemistry (IHC).

Autologous Whole Blood Therapy in Chronic Spontaneous Urticaria: A Comparative Study Between Autologous Serum Skin Test Positive and Negative Patients

Introduction: Chronic Spontaneous Urticaria (CSU) is frequently encountered in our day to day practice. Patients are often reluctant to take medicines for prolonged durations and seek interventions for rapid and prolonged remission. Autologous Whole Blood Therapy (AWBT) has been used with varied results in CSU and Autologous Serum Skin Test (ASST) reactivity has shown to influence the therapeutic response in some studies. Aim: To compare the efficacy of AWBT in ASST positive versus negative CSU. Materials and Methods: The present prospective, interventional, parallel group study was conducted in the Department of Dermatology, Command Hospital Air Force (tertiary care centre), Bangalore, India, from January 2014 to December 2015. Eight weekly injections of AWB (5 mL) were administered to 30 ASST positive and 30 age and sex matched ASST negative patients of CSU and followed-up for four weeks. Modified Urticaria Severity Score (MUSS) was recorded at baseline, 4th, 8th and 12th weeks to assess objective response to AWBT. Subjective response was documented as poor, satisfactory, good and excellent based on patient’s feedback at the end of 12 weeks. Independent two-sample t-test, Chi-square (χ2) test and cross tabulations were used to analyse the data through Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of <0.05 was considered statistically significant. Results: A total of 102 consenting patients were subjected to ASST, out of which 38 patients were ASST positive. After excluding those who were lost to follow-up, data from 30 ASST positive patients and corresponding age and sex matched ASST negative controls were analysed. Baseline MUSS of ASST positive group was significantly higher, indicating more severe nature of CSU. With AWBT, improvement in MUSS of ASST positive group (68.49±10.32%) was significantly higher than the ASST negative group (p-value <0.001) and ASST positive group required significantly lesser doses of rescue antihistamines (p-value <0.001) at the end of 12 weeks. Subjective response to AWBT was either good or excellent in both groups. Conclusion: Although AWBT resulted in significant reduction of MUSS in ASST positive patients, it benefited patients in both groups irrespective of their ASST reactivity status. AWBT can be used as an effective adjuvant in the treatment of CSU.

Do Arterial and Venous Diameter Predict the Success of Wrist Radiocephalic Arteriovenous Fistula for Haemodialysis?: A Prospective Interventional Study

Introduction: Native or autogenous Arteriovenous Fistula (AVFs) placed for Chronic Kidney Disease (CKD) is the gold standard. Radiocephalic Arteriovenous Fistula (RCAVF) just proximal to the wrist is preferred, as it provides a larger proximal area for cannulation and can be created using End-to-Side (E-S) and Side-to-Side (S-S) techniques with good patency. Diameters of the radial artery and cephalic vein have been shown to produce predictable results in RCAVF. The distance between the radial artery and the cephalic vein at wrist or even more proximal has not been studied previously and may be instrumental in choosing either of the two surgical techniques for RCAVF. Aim: To find the optimum diameters of radial artery and cephalic vein, evaluated by Colour Doppler Ultrasound (CDU) that predicted the success of wrist RCAVF in E-S and S-S RCAVF placement techniques for Haemodialysis (HD). Materials and Methods: This prospective interventional study was carried out in the Departments of Plastic Surgery and Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Eastern Uttar Pradesh, India, from January 2019 to June 2021, to study 62 fistula in 52 patients of CKD in whom wrist RCAVF, as vascular access for HD, was constructed. The variables studied were calibre of radial artery and cephalic vein and their bearing on the surgical outcome in E-S and S-S surgical techniques. Further distance between radial artery and cephalic vein (in mm) at the wrist were meticulously studied to find its significance in both E-S and S-S surgical techniques. The outcomes measured were fistula usability (time from AVF placement to fistula maturation and subsequent functional use for HD) and AVF patency three months postoperatively. Significance of comparative variables was studied by two-tailed t-test. Results: In the present study, average age was 46.86±14.85 years and 37 patients were males while 15 were females. Mean diameter of radial artery was 2.14±0.48 mm while it was 2.12±0.49 mm in E-S and 2.16±0.45 mm in S-S technique (p-value=0.309). Mean diameter of cephalic vein was 2.24±0.64 mm, 2.26±0.67 mm in E-S and 2.22±0.61 mm in S-S technique (p-value=0.734). The distance between the both artery and vein was 5.77±4.06 mm. Thirteen Radiocephalic Fistula (RCF) failed to mature (25%), 10 of these underwent secondary surgery for AVF. RCAVF became usable for HD after 7.70±1.12 weeks in E-S group and 7.59±1.19 weeks in S-S group (p-value=0.592). Primary AVF patency was 90.9% in E-S and 92.6% in S-S procedures at three months after surgery when the radial artery and cephalic vein were both larger than 2 mm. If the arteriovenous distance is less than 3 mm, the fistula can be treated using the S-S approach, and if it is greater than 3 mm, the E-S technique. Conclusion: This study demonstrated association between cephalic vein and Radial Artery Diameter (RAD) (>2 mm) with good three months RCAVF patency. It was shown that the distance between the radial artery and cephalic vein at the wrist serves as a criterion for using either the S-S or E-S surgical procedures.

Influence of Proportions of the Nose on Aesthetic Score of an Individual- A Pilot Study

L Harsha, Sri Rengalakhmi

Introduction: Achieving an ideal dental, skeletal and appealing soft tissue adaptation and profile of the patient is of utmost importance postorthodontic treatment. The soft tissue profile is the key determinant of the aesthetics of the individual. Nose, being the centre of the face, plays a major role in determining the aesthetics. But, do morphological changes of the nose influence the perception of aesthetics? Aim: To assess if the proportions of the nose influence the aesthetics/aesthetic score of an individual. Materials and Methods: The present pilot cross-sectional study was conducted on 50 patients reporting to the Outpatient Department (OPD) at Saveetha Dental College and Hospitals, Chennai, India, who were randomly selected to participate in this study. Calibrated anterior and right lateral profile view photographs as black and white images were taken. The basal alar width, length of the nose and the nasal index were calculated using software. Each photograph was also scored on a scale of 0-10 by 4 individuals on the basis of their perception of aesthetics to determine the aesthetic score. The obtained data was tabulated and statistically analysed using Pearson’s correlation method. Results: Mesorrhine type of nose was the most prevalent type of nose in the selected population. A negative correlation was observed between nasal index and aesthetic score (-0.047) that was statistically non significant (p-value>0.05). Patients with leptorhinne type of nose have an increased aesthetic score than mesorrhine and platyrrhine type of nose. Conclusion: The type of nose does not influence the aesthetics of an individual. The divine or golden proportions are not the actual determinants of facial attractiveness and aesthetics. The golden proportions are one of the determinants of facial attractiveness and aesthetics.

Comparative Evaluation of Various Root Canal Irrigants on the Marginal Integrity of Furcal Perforation Repair Material: An In-vitro Study

Introduction: Furcal perforations can occur during access cavity preparation while locating the canal orifices. This must be sealed immediately. After the repair of furcal perforation, endodontic treatment should be performed with various irrigants to clean the root canal system. This procedure causes unavoidable contact of endodontic irrigants with the site of furcal repair. Aim: To evaluate the effect of root canal irrigants on the marginal integrity of furcal perforation repair material using protein leakage assessment. Materials and Methods: This in-vitro study was conducted from June 2021 to September 2021 at Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India. A total of 90 extracted mandibular molars with intact furcation were used. Access cavities were prepared. Based on the repair materials, samples were randomly divided into two groups. An artificial perforation of diameter 2 mm was made in the furcation area. The specimens were divided according to the furcation perforation repair materials used: Biodentine, Endosequence (n=45 each). Perforations were filled with Biodentine, Endosequence. They were then subdivided into three subgroups, each containing samples of (n=15) according to the irrigating solutions used. Each group was irrigated with 0.2% Chitosan, Chloroquick, and 5.25% Sodium Hypochlorite (NaOCl) for two minutes, respectively. Protein {Bovine Serum Albumin (BSA)} microleakage was checked by preparing apparatus having upper and lower chamber. Protein leakage through the furcation repair material into the lower chamber was assessed by Ultraviolet (UV) visible spectrophotometry. The microleakage was assessed with a reagent Coomassie Brilliant BlueG-250 daily for 60 days. Intergroup comparisons were made using one way Analysis of Variance (ANOVA) test. The multi group comparisons were made using Tukey Honestly Significant Difference (HSD) tests. Results: A 0.2% Chitosan showed more protein leakage than Chloroquick over a period of 60 days (p<0.001), as compared to the baseline, 30 days values with both the furcation repair materials. A 5.25% NaOCl irrigated samples exhibited highest protein leakage among all the irrigants. Conclusion: Biodentine has a better sealing ability than Endosequence BC sealer. Chloroquick proved to be the better irrigant as compared to Chitosan and Sodium Hypochlorite (NaOCl) in terms of affecting sealing of furcation repair materials.

Effect of Educational Video on Maternal Nutrition, Hygiene and Sanitation Among Maternal Age Group Women: A Prospective Interventional Study from Prayagraj, Uttar Pradesh, India

Tripti Verma, Alka Gupta

Introduction: Interventions that try to alter behaviour in order to promote health and disease management are typically time and resource-consuming. At the moment, boosting maternal and child nutrition is the main focus of nutrition programme in India. This paper discusses the most effective methods to change eating habits, hygiene, and sanitisation particularly the significance of contemporary Information Technology (IT) in health education. Aim: To determine the pre education knowledge level and create awareness regarding maternal nutrition, hygiene and sanitation through the developed education video on personal hygiene and sanitation among maternal-aged group women. Materials and Methods: The community-based prospective interventional study was conducted in the Department of Food, Nutrition and Public Health, Ethelind College of Home Science, Sam Higginbottom University of Agriculture, Technology and Sciences, (SHUATS) Prayagraj, Uttar Pradesh, India, from October 2019 to April 2021 by using the prospective intervention study design. Based on the Socio-demographic profile, anthropometric measurement, and clinical assessment, specific questions regarding dietary knowledge and personal hygiene were recorded by using the questionnaire. By using the recorded data through a questionnaire, 100 respondents were selected through stratified random sampling and divided into the control group (n=50) and experimental group (n=50) involved in the intervention study. The experimental group which consisted of 50 respondents was grouped into two groups E1 (n=25) and E2 (n=25) and educated separately {due to Coronavirus Disease (COVID-19) restriction on mass gatherings} three times a month at 15 days intervals. The nutrition education intervention was given through an educational video in the hindi language. The effects of the intervention were studied among the participants of the experimental group. The control group did not receive any nutritional awareness sessions. Knowledge level before and after the education intervention was recorded by using the self-structured questionnaire consisting of 15 multiple questions. The data was analysed by using Analysis of variance (ANOVA) technique. Results: The mean age of maternal age group women was 22 years. Analysis was done for the complete data collected from 100 participants (15-35 years of age, 50 in each control and experimental group) included in the present study. No significant difference was found between the knowledge of the control and experimental group at baseline (p-value >0.05). However, the post-intervention, there was significant gain in knowledge in the experimental group (p-value <0.001). Conclusion: It was found that providing the nutrition education through the developed information and communication technology proved effective by increasing knowledge level among the maternal aged group women.

Profile of Skin Diseases among Patients Attending a Dermatology Outpatient Clinic: A Record-based Cross-sectional Study from a Tertiary Care Centre in Northern Kerala, India

Anita Sanker, Sandhya George, Sindhu C Bhaskaramenon, R Sivaprasad

Introduction: Epidemiological studies to determine the pattern of skin diseases among patients attending a hospital are important for proper healthcare planning and management. They give insight to the epidemiology of diseases. Similar studies have not been conducted in Northern Kerala recently. Aim: To identify the pattern of diseases among patients who attended the Outpatient (OP) section of the Department of Dermatology in our hospital. Materials and Methods: The present study was retrospective, record-based cross-sectional study in which OP registers of the Department of Dermatology from December 2018 to November 2019 were analysed retrospectively. Skin diseases were grouped into different groups and the frequency of cases in each group was studied. These were also categorised according to different age groups, gender and month of their OP visit. Descriptive statistics were used to analyse the data. Data analysis was performed using Microsoft Excel and R software (R version 3.6.1 (2019-07-05)). Results: Out of the 17,907 new patients, 42.7% of them had infections, of which fungal infections were the most common. Eczema (27.7%) was the common group. Significant difference in male: female ratio was seen in melasma (14:95), leprosy (13:2), drug reaction (1:28), connective tissue diseases (0:18) and Vesiculobullous (VB) (0:4). Monthly split-up of cases showed increased frequency of some groups of diseases during some months, these include Sexually Transmitted Infections (STI) in February-9/20 (45%), leprosy in May-4/15 (26.7%), drug reaction in December- 9/29 (31%), connective tissue diseases in April- 6/18 (33.3%) and VB diseases in February 4/4 (100%). Conclusion: Infections and eczemas which could be managed in primary healthcare set-up contributed to majority of the OP attendance of our tertiary care centre. The peripheral institutions should be strengthened in manpower and the level of knowledge and skills. More focused and effective training of medical students, continuing medical education for general practitioners and the implementation of family physician system should gain more importance in our country. Increased frequency of some diseases was seen during some months these findings have to be confirmed by longer duration studies.

A Comprehensive Cross-sectional Analysis on the Diagnostic Predictors of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Introduction: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a relatively new and minimally invasive procedure for sampling mediastinal and hilar lymph nodes. Various factors can influence the diagnostic yield of EBUS-TBNA and comprehensive studies evaluating them together are scarce. Aim: To evaluate the factors predicting the diagnostic yield of EBUS-TBNA in sampling mediastinal and hilar lymph nodes. Materials and Methods: A cross-sectional study was conducted at Institute of Chest Diseases, Government Medical College, Kozhikode , Kerala, India, from June 2019 to May 2020. The patients with enlarged mediastinal and hilar lymph nodes on Computed Tomography (CT) thorax underwent Fibre Optic Bronchoscopy (FOB) followed by EBUS-TBNA under conscious sedation. Patient and procedure related factors and ultrasonological features of lymph nodes were noted. Their relationships with EBUS-TBNA histopathological results were assessed. Statistical methods like Fisher’s exact test with significant p-value as <0.05 were used for analysis. Results: The mean age was 60.78±13.664 years with 59 (81%) males. Out of 73 lymph node stations sampled, 49.3% were subcarinal, followed by right lower paratracheal (30.1%), left hilar (8.2%), left upper paratracheal (6.9%) and left lower paratracheal (5.5%). EBUS-TBNA Histopathology Report (HPR) came as positive in 68.5% (50/73) cases with squamous cell carcinoma found in 34%, adenocarcinoma in 32%, poorly differentiated carcinoma in 16%, tuberculosis in 14%, and non specific inflammation in 4% cases. Significant association was found with factors like moderate sedation, duration of procedure taking >30 minutes, lymph node size >1 cm and absence of hilar sign, more number of passes per node and use of suction while sampling lymph nodes and diagnostic yield by EBUS-TBNA (p-value <0.05). There was no significant association with lymph node stations, lymph node features like shape, margin, echogenicity, necrosis and Rapid On-Site Evaluation (ROSE) and diagnostic yield; so also is the case with patient related factors like age, sex, co-morbidities, FOB and CT findings. Conclusion: The duration of the procedure, type of sedation, lymph node size and absence of hilar sign, number of passes per node and use of suction while sampling the node are the main factors predicting the diagnostic yield of EBUS-TBNA in sampling mediastinal and hilar lymph nodes.

Diagnostic Accuracy of Lung Ultrasound versus Chest Radiograph for Early Diagnosis of Ventilator-associated Pneumonia: An Observational Study

Ekta Dixit, Ravi Kant Dogra, Sumala Kapil, Jyoti Pathania

Introduction: Ventilator-associated Pneumonia (VAP) is one of the leading causes of morbidity and mortality in Intensive Care Unit (ICU) and is diagnosed by clinical symptoms, Chest X-ray (CXR), Computerised Tomography (CT) and microbiology test in routine practice. Aim: To compare the diagnostic accuracy of Lung Ultrasound (LUS) with gold standard CXR, with or without modified Clinical Pulmonary Infection Score (CPIS) score, for the diagnosis of VAP in ICU. Materials and Methods: This prospective observational study was carried out on 40 mechanically ventilated patients in Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India over the duration of one year from November 2018-October 2019. The study was continued till VAP was diagnosed by all three modalities (CXR, LUS and microbiology) or to the maximum of 10 days postintubation whichever was less. Data was analysed with appropriate statistical tools “MedCalc”. Results: The mean age of patients was 45.78±15.99 years and there were 28 male and 12 females. The diagnosis of VAP was earliest with LUS (3.1±0.81 days) and (4.22±1.23 days) with CXR when studied alone (p<0.0001). However, when LUS was incorporated in CPIS score instead of CXR the diagnostic accuracy were statistically similar (p>0.05). During the early days (3 and 4 day) the diagnostic accuracy (AUC), sensitivity and specificity of LUS was better and was (0.70-0.74, 57-90%) than (0.5; 16.7-83%) with CXR. Fifth day onwards AUC was better with CXR (0.79-0.81) as compared to (0.54-0.70) with LUS. Total leucocyte count (TLC), fever, P/F ratio and sputum quantity were observed individually between the VAP and non VAP group patients and were found to be similar (p>0.05). Conclusion: According to the present observational study, LUS can accurately diagnose VAP when other objective tools like CPIS, CXR and microbiology are inconclusive.

Evaluating the Effectiveness of Escalating Intravenous Infusions of Lignocaine and Ketamine in Reducing Pain and Disability for Fibromyalgia Syndrome: A Prospective Observational Study

GS Ashwini, RS Deepak, Mruthyunjaya Nagaraj, K Bhavyashree

Introduction: Fibromyalgia is a chronic syndrome characterised by widespread musculoskeletal pain accompanied by fatigue, disability, sleep, memory and mood issues. The pain of fibromyalgia is difficult to manage and has no complete remission. While there is no cure for fibromyalgia, a variety of medications have been tried to minimise symptoms and improve general health. Hence, a trial was conducted to evaluate lignocaine and ketamine as pharmacological modalities to treat fibromyalgia. Aim: To evaluate effectiveness of intravenous (i.v.) lignocaine-ketamine infusions in reducing pain and disability in fibromyalgia syndrome. Materials and Methods: A prospective observational study was conducted at Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India, between March 2021 and March 2022, on patients aged between 18-60 years diagnosed with fibromyalgia syndrome. Sixty patients were included in the study. Escalating doses of i.v. lignocaine of 5 mg/kg, 6 mg/kg and 7 mg/kg followed by escalating doses of i.v. ketamine of 0.4 mg/kg, 0.5 mg/kg and 0.6 mg/kg were administered on alternate days over a period of 12 days. Infusions were given in 50 mL normal saline through syringe pump over a period of 45 minutes. Pre and postinfusion 11 point Numerical Rating Scale (NRS) score was used to assess pain and World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 score to assess disability. Data are presented as mean and standard deviation. Statistical analysis was done by using the t-test for pre and post-treatment score, with a p-value <0.05 was considered statistically significant. Results: The present study showed female predominance of 42 out of 60 patients (70%) compared to males 18 out of 60 (30%). Pretreatment average baseline NRS score was 8.8. The mean reduction in NRS scores after lignocaine-ketamine infusions at the end of one month was 1.40 and at sixth month 1.25 which was statistically significant (p-value=0.001). Pretreatment mean average disability score was 2.70 and at the end of sixth month it was 0.59 which was statistically significant (p-value=0.001). Three patients did not show reduction in NRS scores and reported mild to moderate side-effects in the form of dizziness, headache and raised blood pressure. Conclusion: Combined infusions of lignocaine-ketamine resulted in significant reduction in pain and disability in patients with fibromyalgia. Higher and repeated doses seem to be more effective and resulted in longer pain relief. Long-term follow-up periods are needed to determine the effectiveness, dose response and safety of these infusions as a therapeutic modality for fibromyalgia.

Prevalence of Stillbirths during COVID-19 Pandemic at a Tertiary Referral Centre in Central Kerala, India: A Cross-sectional Study

KK Ajini, S Jyotsna, JS Ajith Prasad

Introduction: Stillbirth is defined as a baby born with no signs of life after a given threshold. It is a sensitive indicator of quality of care received by the mother during antepartum and intrapartum period. There has been a renewed focus on stillbirth in the backdrop of COVID-19 pandemic, as pregnant women are at an increased risk for severe form of COVID-19 and are associated with adverse perinatal outcomes. Aim: To estimate the prevalence of stillbirths and its characteristics during the pandemic and also, to classify the causes of stillbirths according to the International Classification of Diseases for use in Perinatal Mortality (ICD-PM) classification. Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College, Thrissur, Kerala, India, during the COVID-19 pandemic from 1st August 2021 to 30th July 2022. A total of 106 mothers, who gave birth to stillbirths after 28 weeks of gestation were included in the study. When gestational age was not sure, stillbirth weighing more than 500 grams was considered as the inclusion criteria. Foetus, placenta, cord and membranes were examined after the delivery. The parameters studied were age, domicile, income, gestational age, order of pregnancy, mode of delivery, timing of foetal death, baby weight, gender, presence of anomalies and maternal medical complications. The causes were classified according to ICD-PM classification system. Categorical variables were assessed by Chi-square test and continuous variables were assessed by unpaired Student’s t-test. Results: There were 106 stillbirths with a Stillbirth Rate (SBR) of 38.78 per 1000 births. Major proportions of stillbirths were antepartum. Mean maternal age was 28.7±4.7 years. There were 73 (68.86) rural women and 33 (31.1%) urban women with stillbirths. A total of 90 (84.9%) cases were referral, while 16 (15.1%) were registered in the Institute for antenatal care. A total of 67 (63.2%) stillborns were male babies, but there was no significant difference in SBR, according to the order of pregnancy. Causes were classified according to the ICD-PM classification system. Hypertensive disorders in pregnancy (36.79%) and the foetal growth restriction (39.62%) were the common maternal and foetal condition identified among the cases. There were 22 COVID-19 positive cases, but they were also having hypertension as co-morbidity. Conclusion: In present study, antepartum stillbirth was the commonest type and occurred mostly in referral cases from periphery. Hypertensive diseases in pregnancy and foetal growth restriction were the leading causes. Early detection of high-risk conditions and timely referral, may reduce the rate of stillbirth.

Clinical Presentations and Operative Management of Non Traumatic Acute Pain Abdomen- A Prospective Interventional Study from Jorhat, Assam, India

Introduction: Non traumatic acute abdominal pain is a very common reason for patients’ visit to the Emergency Department and remains a challenging task for general surgeons in terms of appropriate diagnosis as well as management in a timely manner. Aim: To evaluate the clinical presentations, the operative management and the postoperative outcome of patients presented with non traumatic acute pain abdomen. Materials and Methods: A hospital-based prospective interventional study was done in 250 patients presenting with non traumatic acute pain abdomen to the Emergency Department of General Surgery, Jorhat Medical College and Hospital, Jorhat, Assam, India, from June 2021 to May 2022. Demographic profile, detailed history physical examination, operative managements and the outcome were noted. The data was tabulated on Microsoft excel 2021 and analysed with relevant tables and graphs. Results: Out of 250 patients with non traumatic acute pain abdomen who underwent operative intervention, most affected age group was 2nd-4th decade of life, comprising 165 (66%) patients. A total of 167 (66.80%) were males. Most common presenting symptom besides pain abdomen was nausea, seen in 172 (68.80%) cases. Most common clinical sign besides tenderness was abdominal muscle guarding, seen in 220 (88%) cases. Acute appendicitis was the most common aetiology with 129 (51.60%) patients and emergency open appendicectomy was the most common surgical procedure performed. Most common postoperative complication was surgical site infection, seen in 57 (22.80%) cases. Mortality rate was 3.60% (9 deaths). Conclusion: As most acute pain abdomen invariably present with surgical emergency and varied aetiology, the complexity for imparting the most appropriate treatment is increased. Hence, surgeons in the emergency department need to be well-versed in assessing the patients right from taking of proper history, clinical correlation of symptoms to elicitation of signs, assisted with most readily available investigations, to arrive at a prompt diagnosis to provide appropriate surgical intervention at the earliest.

Comparative Analysis between Reid’s Colposcopic Index and Swede’s Score for Detection of Premalignant Lesions of Cervix: A Prospective Study

Smriti Pandey, Vandana Saini, Keya Kalra

Introduction: Colposcopy is an effective tool to detect premalignant lesions of the cervix. It is an observer-dependent technique; hence, various colposcopic-based scoring systems have been employed to minimise interobserver variations. Aim: To compare Reid’s Colposcopic Index (RCI) and Swede’s score for the detection of premalignant lesions of the cervix and compare it with colposcopic directed biopsy and histopathology. Materials and Methods: In this prospective observational study conducted at a tertiary care hospital in Delhi, India, between August 2019 to April 2020, 100 women of the reproductive age group were recruited. Pap (Papanicolaou) smear and colposcopy were done for all the patients. Scoring of colposcopic lesions was done according to Reid’s and Swede’s scoring system. In women with RCI or Swede’s score ≥3, biopsy of the cervix for histopathology was carried out. Data was recorded and statistically analysed using Statistical Package for the Social Sciences (SPSS) software. Pearson and spearmen correlation coefficient was used for correlation of RCI and Swede’s score. Results: Mean age of women was 43.89±8.2 years. A positive correlation was found between RCI and Swede’s score as the correlation coefficient was 0.995 and p-value <0.001. Sensitivity was better with Swede’s scoring system as compared to RCI for predicting Cervical Intraepithelial Neoplasia (CIN)-I lesions. However, for predicting CIN-II and CIN-III lesions sensitivity with both the scoring system was comparable. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of RCI at a cut-off score of 5 was 54.54%, 87.17%, 54.54%, and 87.1% for CIN-I, for CIN-II was 100%, 86.67%, 45.45%, and 100%. CIN-III was 100%, 82.1%, 22.7%, and 100%. Similarly, the sensitivity, specificity, PPV, and NPV of Swede’s score at a cut-off score of 5 was 59%, 84.6%, 52%, and 88% for CIN-I, for CIN-II was 100%, 83.33%, 40%, and 100%. And that for CIN-III was 100%, 78.94%, 20% and 100%. Conclusion: According to the present study, both scoring systems performed well in predicting CIN lesions.

Evaluation of Oral Health Status and Temporomandibular Joint in Patients with Various Psychiatric Disorders in a Tertiary Care Center of Maharashtra, India

Introduction: Living a physically and mentally healthy lifestyle is equally vital. It occurs at all socio-economic levels and affects individuals of all backgrounds. It is estimated that 450 million people are suffering from mental problems worldwide. Irrespective of the cause, everyone should be aware that poor dental health impacts overall health. Aim: To assess the level of oral health for people with different psychiatric illnesses and to determine whether these people’s level of oral health correlates with other characteristics and also to determine the extent of the issue with dental health and the best way to address it. Materials and Methods: In this cross-sectional study, ninety-eight patients receiving care at the Psychiatric Department of Maharashtra, India, between April and May 2022 were included. A case history performa was prepared to gather detailed information on all aspects. The oral examination was done by examining lymph nodes, lips, tongue, gums and tissue, saliva, natural teeth, oral cleanliness, and dental pain with a sterile mouth mirror and probe using Oral Health Assessment Tool (OHAT) for dental screening modified from Kayser-Jones. Dental caries was reported using the Decayed, Missing, and Filled Teeth (DMFT) index. Furthermore, Helkimo’s TMJ Index was used to assess Temporomandibular Joint (TMJ). Descriptive statistics were used to observe frequency variation. Results: The participant patients mean age were 41.33±13.58 years, and their range of age was 21-65 years. The female:male ratio of the study population was 1.1:1. Sleep disorders (24.50%) and anxiety (22.40%) were the most prevalent psychiatric conditions impacting the research population. The oral health examination of the patients described changes in the oral cavity and associated factors, including lips, tongue, gums and tissues, saliva, natural teeth, oral cleanliness, and dental pain. Total 59.10% of the participants had moderate to severe TMJ dysfunction. The range of the DMFT score was 3 to 17 (mean 7.89±3.21). The participants’ TMJ Index score ranged from 0 to 17 (mean 5.51±4.48). More than half of the participants (59.10%) had moderate to severe TMJ dysfunction. Conclusion: Maharashtra’s psychiatric patients have poor oral health conditions, highlighting the need for oral health education and expanding access to dental care for these patients.

Myoinositol and Metformin versus Only Metformin in the Management of Gestational Diabetes Mellitus: A Randomised Open-label Clinical Trial

Introduction: The incidence of Gestational Diabetes Mellitus (GDM) is rising globally with India no exception. The overall prevalence of GDM in our country is 16.55%. Insulin is the gold standard for the treatment of diabetes. Metformin, an Oral Hypoglycaemic Agent (OHA) is promisingly used in place of or along with Insulin. Myoinositol an insulin sensitiser may have some role in the treatment of GDM. Aim: To assess whether myoinositol in addition to metformin provides any better glycaemic control in GDM patients than those receiving metformin only. Materials and Methods: An open-label randomised clinical trial was conducted in the Department of Obstetrics and Gynaecology of Medical College and Hospital, Kolkata, West Bengal, India, in which mothers with a singleton pregnancy with 2-hour Postprandial Blood Sugar (PPBS) ≥140 mg/dL after 75 gm oral glucose {Diabetes in Pregnancy Study Group of India (DIPSI) criteria} were included and those with pregestational diabetes, on any form of antidiabetic treatment and with other co-morbidities like renal pathology, hypertension were excluded. A total of 150 patients with GDM were given Medical Nutrition Therapy (MNT) and after two weeks, 66 patients were selected and randomly allocated into two groups. Group 1 was given Myoinositol along with metformin (n=33) and group 2 was given metformin only (n=33). Dropouts were three in each group. So, a net of 30 patients from each group was taken for the final analysis. A p-value ≤0.05 was considered statistically significant. Results: The mean change in fasting glucose levels in group 1 was 19.30±9.713 mg/dL whereas in group 2 was 20.76±13.70 mg/dL (p=0.6343). The mean change in postprandial blood glucose was 59.4667±16.8026 mg/dL in group 1 and 54.7667±18.8674 mg/dL in group 2. Both these results were statistically not significant. Two (6.7%) patients required insulin in group 1 and 5 (16.7%) patients had insulin added in group 2. Association was not statistically significant (p=0.2276). Conclusion: Myoinositol supplementation with metformin achieves good glycaemic control through its insulin-sensitising action and reduces the complications of GDM to a certain extent but it does not provide any extra benefits over metformin alone.

Clinical Profile of Dengue Fever and its Utility in Early Prediction of Severe Dengue Among Children Less than 18 Years at a Tertiary Care Hospital in Northern India

Rohit Chib, Sudesh Singh, Manju Devi, Najmus Saqib

Introduction: Dengue is the emerging mosquito-borne infectious disease in India. Dengue is endemic in many countries across the world. Dengue is one of the major causes of paediatric morbidity and mortality and clinical profile of dengue patients change from time to time and region to region. The elucidation of the clinical profile is very important for patient management and saving lives. Aim: To assess the clinical profile of Dengue Fever (DF) and its utility in early prediction of severe dengue among children 0 to 18 years according to National Guidelines for Clinical Management of DF 2014 at a tertiary care hospital, in Northern India. Materials and Methods: The present observational study was conducted in Department of Paediatrics at GMC, Kathua, Jammu and Kashmir, India, from 1st June 2021 to 30th November 2021. All the clinically suspected patients of dengue in the age group 0 to 18 years were subjected to NS1 antigen and Immunoglobulin M (IgM), Immunoglobulin G (IgG) antibody tests, all patients positive for these were considered as confirmed dengue patients and were included into the study. Parameters studied were the clinical profile of DF and its utility in prediction of severe dengue. Data was analysed by Statistical Package for the Social Sciences (SPSS) software version 28.0.1.0 (142) and different groups were compared by using the Chi-square test and multivariate logistic regression. The p-value <0.05 was considered significant. Results: Out of the total 640 febrile patients, 71 (11.1%) were positive for dengue and were enrolled in the study. NS1 was positive in 67.6%, IgM in 56.33% and IgG (along with NS1 or IgM or both) in 32.4%. Flushed facies at 81.6% was the most common clinical finding followed by myalgia 74.6%, headache 73.2%, facial puffiness 66.2%, vomiting 54.9%, rash 50.7%, arthralgia 33.8% and retro-orbital pain in 16.9%. The total number of patients with co-morbidities was 7 (9.9%). Patients with warning signs having hepatomegaly ≥2 cm Below Costal Margin (BCM) were 49.3%, followed by recurrent vomiting 38%, pain abdomen 38%, restlessness 33.8%, minor bleeding 28.2% and lethargy 23%. Signs of cardiovascular collapse were cold calamities 26.7% followed by shock 23.9% and narrow pulse pressure <20 mmHg 12.6%. The metabolic disturbance was seen in 12 (16.9%) patients and severe organ involvement in 11 (15.5%). The tourniquet test was positive for 52.1%. A whole blood transfusion was given to eight patients. Only one patient expired with total mortality of 1.4%. Conclusion: Vomiting and myalgia were found to be statistically significant for early prediction of severe dengue, which may help in early initiation of treatment and decrease both morbidity and mortality. Patients presenting with atypical manifestations of severe organ involvement were also included under the severe dengue category, which was not possible according to previous guidelines.

Type of Refractive Errors among School Going Children from District Kathua, Jammu, India

Maneesha Sethi, Priyanka Sodani, Vabita Bhagat

Introduction: Worldwide refractive error remains one of the most common causes of visual impairment in children. Uncorrected refractive error can lead to long term effect on academic progression and employment opportunities. The study was conducted in remote area of district of Kathua, Jammu, India. Aim: To estimate type of refractive error among children and its association with demographic characters. Materials and Methods: The descriptive, cross-sectional, observational, hospital-based study was carried out in Out Patient Department (OPD) of Ophthalmology, Government Medical College, Kathua, Jammu, India. The study of population included 351 children of age 5-16 years with complaint of diminution of vision. Examination included visual acuity recording, slit lamp, fundus examination and dilated retinoscopy. Inferential statistics was calculated using Open Epi version 3.01. Results: Out of 1582 children, 351(22.18%) children had refractive error. Their mean age was 12.52±2.87 years. The refractive errors were more common in the age group 13-16 years (61.5%), followed by 9-12 years (29.9%), and 5-8 years (8.51%). Refractive errors were more in males (56.12%) as compared to females (43.87%); 247 (70.37%) children had refractive error in both the eyes, whereas 104 (29.6%) had it in one eye. Astigmatism was most common (50.14%) followed by myopia (40.45%), hypermetropia (7.4%) and amblyopia (1.99%). Maximum astigmatism was seen in 13-16 years (56.25%) followed by 9-12 years (34.09%) and least in 5-8 years (9.65%). Conclusion: A high percentage of refractive errors in the study indicate that school health services should be strengthened and implemented effectively.

Reckoning the Status of HER2/neu Protein and Oncogene in Breast Cancer Specimens: Comparison of IHC Assay with FISH Assay at a Tertiary Care Centre, West India

Ranjana Solanki, Sarla Saini, Utkarsh Sharma, Nidhi V. Shihora, Pratibha Maan

Introduction: Breast carcinoma is the most prevalent malignant neoplasm among women with more than one million new cases per year. The benefit of humanised anti-Human Epidermal growth factor Receptor 2 (HER2)/neu monoclonal antibody trastuzumab (Herceptin) in HER2/neu-positive breast cancers has been well documented. Immunohistochemistry (IHC) for protein overexpression and Fluorescence In Situ Hybridisation (FISH) for detecting HER2/neu gene amplification is widely used. Some laboratories use IHC as primary test with FISH for subset of cases while using FISH as primary investigation followed by IHC if needed is done by others. Aim: To evaluate IHC assay in breast carcinoma cases for HER2/neu as screening test before FISH. Materials and Methods: A cross-sectional descriptive type of observational study was conducted in the Department of Pathology and Multidisciplinary Research Unit, SMS Medical College and attached hospitals Jaipur, India, between April 2020 and December 2021. A total 122 samples of invasive breast carcinoma were included in study for IHC and FISH analysis. On paraffin embedded breast tumour tissue sections, IHC was performed using mouse monoclonal antibody targeting the intracellular domain of HER2/neu protein and FISH was implemented by dual colour probes targeting the HER2/neu gene on chromosome 17. Cases were classified according to HER2/neu status on IHC interpretation and FISH interpretation as per American Society of Clinical Oncology/the College of American Pathologists (ASCO/CAP) HER2/neu-2018 testing guidelines. Chi-square test, kappa coefficient and Z-test were applied for statistical analysis. The p-value <0.05 was considered significant. Results: Of the 122 patients of Invasive Duct Carcinoma (IDC), the mean age was 50.3±12.7 years with a age range of 25-70 years. HER2/neu IHC score 3+ (overexpression) was seen in 19 (15.6%) cases while 2+ (equivocal) result was obtained in 84 (68.8%) cases and 19 (15.6%) cases showed negative (1+/0) HER2/neu expression. Out of 19 IHC positive cases, all cases were amplified by FISH and all 19 IHC negative cases, were non amplified by FISH. There were 84 IHC equivocal cases of which 37 (44%) cases were amplified, 45 (53.6%) non amplified and 2 (2.4%) cases were equivocal when analysed by FISH. Also, 11 (9%) cases were found Centromere Enumeration Probe (CEP) amplified in the study, they were negative or equivocal on IHC and none was IHC positive. Conclusion: The study concluded that combined FISH and IHC methodologies could optimise information on HER2/neu status in breast cancer patients. Also, testing algorithm is emphasised where laboratories may use IHC as a screening method and FISH can be used as accurate and specific method in IHC (2+) equivocal cases. Thus, patients with HER2/neu status positive of IHC (3+) or FISH (gene amplified) can be proposed to be treated with herceptin (trastuzumab).

Predictive Utility of Visual Evoked Potentials in Detection of Ocular Changes in Paediatric Sickle Cell Patients: A Cross-sectional Analytical Study

Arunita Tushar Jagzape, VK Deshpande, Tushar B Jagzape

Introduction: Ocular manifestations are one of the complications of Sickle Cell Disease (SCD) that may occur in various segments of the eye. Optic nerve involvement is underdiagnosed though it can be involved as a sequela to ischaemia. Prediction of disease at an early age aids in better diagnosis. Visual Evoked Potentials (VEP) helps to detect abnormalities (silent lesions) in patients with visual complaints who do not present with visible pathological ophthalmological changes. In literature search, no study has been undertaken to assess the predictive utility of VEP regarding subclinical ocular changes in paediatric age group of SCD patients. Aim: To evaluate predictive utility of VEP to identify subclinical ocular changes in paediatric patients of SCD and to record associated Visual Reaction Time (VRT). Materials and Methods: In this cross-sectional analytical study, 30 cases (SCD patients) and 30 normal children in age group 3-15 years were evaluated by ophthalmic examination followed by VRT and VEP using Light-emitting diode (LED) goggles (Flash). Statistical analysis included descriptive (percentages) and inferential statistics presented as unpaired t-test, linear regression curve, Pearson’s correlation coefficient, coefficient of determination (R2) and β (regression) coefficient. The analysis was done at 99% confidence interval with significance at p<0.01. Results: There was statistically significant prolongation of P100 latency in both eyes in paediatric cases when compared to normal children (p<0.01). N75-P100 amplitude, interocular difference showed no significant changes. When P100 latency was correlated with VRT, there was weak positive correlation (r=0.207, p=0.1278 for right eye, r=0.238, p=0.0801 for left eye). Though sensitivity of flash LED goggle VEP was 70%, specificity was high (96.66%). Positive predictive value was 95.45%. Conclusion: These findings show that VEP can be used as a predictive measure (tool) to detect subclinical changes in absence of ocular complaints and normal ophthalmological findings.

Management of Acute Anal Fissure at a Tertiary Care Hospital in West Bengal, India- A Longitudinal Study

Farhan MD Rahbar, Pradip Kumar Mohanta, Sabuj Pal

Introduction: Anal fissure is a tear in the lining of the anus and is a common problem throughout the world. It is one of the most common painful and benign conditions of the anal region, which leads to morbidity and decrease in quality of life. Aim: To prospectively observe the outcomes of management of acute anal fissure, both surgically and conservative modalities of treatment. Materials and Methods: This longitudinal study constituted 102 patients clinically presenting with features of acute anal fissure such as pain, bleeding, constipation attending Out Patient Department (OPD) in College of Medicine and JNM Hospital, West Bengal, India, from January 2020 to June 2021. Patients were grouped according to modalities of treatment given (surgical/conservative), after that regular follow-up was done at regular intervals to find out outcome of treatment, with respect to relief of pain, bleeding, healing rate, fissure relapse and incontinence. Chi-square test was used to compare the proportions and independent t-test was used to compare means. The p-value of <0.05 was considered to be statistically significant. All the analysis was done in IBM Statistical Package for the Social Sciences (SPSS) version 22.0. Results: In the current study, 9 (8.8%) patients had anterior anal fissure and 93 (91.2%) patients had posterior anal fissure. Fifty one patients (50.0%) underwent medical management {(nifedipine 2% gel locally, diltiazem (2%) locally)} and 51 patients (50.0%) were treated with surgical management (lateral internal sphincterectomy). Significant difference was noted at 15th, and 30th and 45th days post-treatment when surgically managed patients were compared with medically managed patients p-value <0.05*. Four patients in the medically managed group, had bleeding during the entire period. Association of bleeding at 15th day, 30th day, 45th day and 6th month with mode of management was statistically significant (p<0.05*) healing was achieved for 90 patients (88.2%) at the end of 6th month follow-up. In medical management, 9 (17.6%) patients had fissure relapse. In surgical management, 3 (5.9%) patients had fissure relapse p>0.05. Conclusion: In the present study, though patients in both surgical and medical groups had pain relief, those who underwent surgery had better result. Majority of the patients in the study achieved remission, at the end of sixth month follow-up, irrespective of the type of management. Relapse of the disease was slightly more in medically managed group, compared to those, who underwent surgical management.

Effects of Royal Jelly Supplementation on Dry Mouth Sensation in Patients with Normal Saliva Function: A Randomised Clinical Study

Yumi Mochizuki, Fumihiko Tushima, Yuji Kabasawa, Hiroyuki Harada

Introduction: In several cases, dry mouth sensation with normal salivary function is not diagnosed as an abnormality and this condition has no standardised treatments. Moreover, it is significantly associated with psychological disorders such as depression, trait anxiety and perceived stress. Based on recent studies, daily oral royal jelly supplementation (1000 mg) for eight weeks has beneficial effects on menopausal symptoms such as anxiety. However, there are no studies on the effects of royal jelly supplementation on dry mouth sensation in patients with normal salivary function. Further, only few clinical trials have long-term follow-up greater than eight weeks. Aim: To evaluate the effects of royal jelly tablets on dry mouth sensation in patients with normal salivary function. Materials and Methods: This randomised, double-blind, crossover clinical trial included 15 adults with an unstimulated salivary flow of >0.1 mL/min who had a chief complaint of dry mouth sensation and those without any salivary gland disease. This study was performed at Tokyo Medical and Dental University Hospital, Tokyo, Japan, between November 2019 to April 2020. The royal jelly tablet contained 400 mg of enzyme-treated royal jelly powder and each participant received either two tablets of enzyme-treated royal jelly (800 mg) or placebo daily for 12 weeks. The Visual Analogue Scale (VAS) was used to evaluate dry mouth sensation and the Japanese version of the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-12 (GHQ-12) were applied to assess psychological status and social dysfunction. The differences in VAS, HADS and GHQ-12 scores over time between the enzyme-treated royal jelly and placebo groups were analysed using repeated-measure Analysis of Variance (ANOVA) and the posthoc paired t-test. Results: The 4 and 12-week VAS scores between the enzyme-treated royal jelly and placebo groups significantly differed (p-value=0.041 and 0.043, respectively). The 12-week HADS and GHQ-12 scores between the enzyme-treated royal jelly tablet and placebo groups differed significantly (p-value=0.040 and 0.046, respectively). Moreover, the HADS scores of the enzyme-treated royal jelly tablet group significantly decreased. Conclusion: Daily supplementation with enzyme-treated royal jelly (800 mg) for 12 weeks was effective against dry mouth sensation in patients with normal saliva function.

Effect of Azadirachta indica against Sodium Benzoate Induced Hepatorenal Toxicity in Wistar Rats- An Experimental Interventional Study

Introduction: Azadirachta indica (Neem) is one of the widely used plants which has various medicinal properties like antipyretic, antimicrobial, antitumour, anti-inflammatory, antiulcer and antidiabetic effects. Silymarin-a milk thistle derivative has its own clinical significance. Sodium Benzoate (SB) is a versatile food preservative used in packaged food and drink industries which is consumed by the people unknowingly above World Health Organisation (WHO) standards which causes potential cytotoxicity. Aim: To evaluate the effect of Azadirachta indica leaf extract and the combination effect of Azadirachta indica leaf extract (Neem) with Silymarin against SB induced hepatorenal toxicity in adult male albino wistar rats. Materials and Methods: This experimental interventional animal study was conducted at Central Animal House at Aarupadai Veedu Medical College and Hospital, Puducherry, India from July 2021 to August 2021 for a period of 14 days. Total 30 male wistar rats were randomised into five groups with six rats into each group. The groups were: group 1 Control received only distilled water, group 2 SB 200 mg/kg bw (SB) alone, group 3 SB+Silymarin 100 mg/kg bw, group 4 SB+ Azadirachta indica aqueous extract 400 mg/kg bw, group 5 SB+Silymarin 100 mg/kg bw+Azadirachta indica aqueous extract 400 mg/kg bw for 14 days through oral gavage. Doses and duration were determined based on previous studies. Blood was drawn from a retro-orbital puncture, animals were sacrificed by euthanasia, a part of liver and kidney samples were sent for histopathological examination-cell structure, integrity and inflammation. Biochemical parameters of liver function tests-Serum Alanine Transaminase (ALT), Serum Aspartate Aminotransferase (AST), Serum Alkaline Phosphatase (ALP) and Kidney function tests: urea, creatinine and uric acid were measured in serum. Statistical analysis was done by one-way Analysis of Variance (ANOVA) followed by Dunnet’s posthoc test used for intergroup comparison, p-value <0.05 considered to be significant. Results: There was a significant increase in the activities of liver enzymes ALT, AST, ALP and kidney function (creatinine, uric acid) in the SB alone treated group when compared with the control group. Hepatorenal protection of neem extract was shown by significant decrease in liver and renal parameters which was comparable to that of control and Silymarin standard drug. Combination of silymarin and neem showed significant protection in liver (ALT, AST, ALP) and kidney function (urea, creatinine, uric acid) when compared to neem alone treated group. All the results were substantiated by histopathological examination of liver and kidney tissues. Conclusion: This study suggests the effect of Azadirachta indica leaf extract with Silymarin possess hepatorenoprotective effect against SB induced damage in rats. Combination effect of Azadirachta indica leaf extract with Silymarin significantly proved the hepatorenal protectivity when compared with Neem alone treated group.

Foetal Cardiac Dimensions in 18-40 Weeks of Gestation from Tamil Nadu, India: A Cross-sectional Study

Sundara Raja Perumal, Laura Rosario, Senthil Kumar

Introduction: Foetal echocardiography helps in the identification of congenital anomalies of the heart and arrhythmias. It is usually done from 18-22 weeks of gestation but it can also be done as early as 12-13 weeks of gestation through transvaginal ultrasound. Measurement of cardiac dimensions in the foetus plays a major role in the early detection of cardiac defects including hypoplastic right and left heart. In addition, the measurement of foetal cardiac dimensions is useful in the evaluation of foetuses with heart failure due to foetal anaemia, which is secondary to Rh alloimmunisation or Bart’s disease. Aim: To construct a reference centile curve for foetal cardiac dimensions from 18-40 weeks of gestation for the Indian population residing in Tamil Nadu state. Materials and Methods: This was a cross-sectional study performed between January 2020 and July 2021. A total of 345 antenatal mothers, who came to the Department of Radiology, SRM Medical College and Research Centre, Chennai, India, for for routine anomaly and growth scans were included in the study. Cardiac longitudinal and transverse diameters were measured on 2D images, when the heart was maximally distended in a four-chamber view at the end of the diastole. Left atrial longitudinal and transverse diameters, right atrial longitudinal and transverse diameters, left ventricular longitudinal and transverse diameters, right ventricular longitudinal and transverse diameters interatrial septum thickness interventricular septum thickness cardiac longitudinal and transverse diameters were measured. Results: The mean values at 18 and 40 weeks of gestation for left atrial longitudinal and transverse diameters, right atrial longitudinal and transverse diameters, left ventricular longitudinal and transverse diameters, right ventricular longitudinal and transverse diameters, interatrial septum thickness, interventricular septum thickness, cardiac longitudinal, and transverse diameters were 0.73, 0.65, 0.72, 0.66, 0.83, 0.62, 0.75, 0.62, 0.1, 0.1, 1.71, 1.72 cm and 2.22, 1.71, 2.31, 1.9, 3.21, 1.71, 3.3, 1.84, 0.3, 0.3, 5.02, 3.84 cm, respectively. Conclusion: The normal reference ranges for foetal cardiac dimensions can be a useful tool in the early identification of cardiac remodelling in congenital heart disease.

Effect of COVID-19 Pandemic on Awareness on Prevention of Spread of Infective Respiratory Secretions among Resident Doctors

Narayanan Preethi, Sridevi A Naaraayan, Krishnaswamy Devimeenakshi

Introduction: Respiratory infections including Coronavirus Disease-2019 (COVID-19) infection spread through droplet infections. Hence standard precautionary measures like handwashing and use of masks are essential to prevent transmission of these infections in healthcare setting. Aim: To determine the effect of COVID-19 pandemic on awareness level of resident doctors on prevention of spread of infective respiratory secretions. Materials and Methods: This cross-sectional study was conducted among two subsequent batches (year 2019-20 and 2020-21) of resident doctors at a medical college hospital, from February 2020 to September 2020. The 2019-2020 batch of resident doctors worked as residents from March 2019 to March 2020 and were considered as pre COVID-19 batch. The 2020-2021 batch of resident doctors had their training period from April 2020 to April 2021 and were considered the COVID-19 batch. A pretested semi-structured questionnaire consisting of 14 questions to evaluate the awareness on prevention of spread of infective respiratory secretions was administered. The responses were evaluated, marks awarded and summated. Results: There were 121 respondents in the pre COVID-19 batch making the response rate 85%. There were 112 respondents in the COVID19 batch, with a response rate of 86%. The mean (standard deviation) score obtained by the COVID-19 batch was 9.91±3.42 which was significant higher than that obtained by the pre COVID-19 batch which was 7.1±1.83. The score obtained by COVID-19 batch for 11/14 questions was significantly higher compared to the pre COVID-19 batch. Conclusion: A significant improvement was seen in the knowledge level in prevention of spread of infective respiratory secretions among resident doctors after the onset of the COVID-19 pandemic.

Burden of Rotavirus Diarrhoea among Children Less than Five Years of Age Attending a Tertiary Care Institute with Acute Gastroenteritis: A Cross-sectional Study

Anjum Ara Mir, Bashir Ahmad Fomda, Nargis Bali, Mushtaq Bhat

Introduction: Diarrhoea due to rotavirus continues to cause significant morbidity in children less than five years of age especially in developing countries. Prior to the incorporation of rotavirus vaccine in the national immunisation program the prevalence of rotavirus in stool samples of children in India has been reported to vary from 4.6-33.7%. However, there is not much data regarding the burden of rotavirus diarrhoea after the widespread use of rotavirus vaccine. Aim: To find out the extent to which rotavirus is responsible for causing infection in children under five years of age. Materials and Methods: This was a cross-sectional study carried out in the Department of Microbiology, in collaboration with the Department of Paediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India, among children who presented with acute gastroenteritis to the biggest tertiary care institute of the region. After seeking written consent from the parents/caretakers stool samples were collected and subjected to Enzyme Linked Immunosorbent Assay (ELISA). Demographic variables including vaccination status and seasonality were recorded for all the cases. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 23.0 and p-value of <0.05 was taken as significant. Results: Of the 279 stool samples received during the study period, a rotavirus positivity of 17.2% was seen with 31 (63.8%) patients affected being males. A total of 37 (77.1%) children belonged to the age group of 0-12 months and 27 (56.3%) of those affected were from rural areas. Diarrhoea was the most common symptom in 28 (58.3%) patients. Most of the rotavirus positive children, that is, 26 (54.2%) were not vaccinated. Majority of the cases, 34 (70.8%), were seen in winter season. Conclusion: Majority of the children who visited the hospital were not vaccinated and were rotavirus positive despite a robust vaccination program. This puts an emphasis on the need to improve the vaccination rates in order to fight this illness.

Mask Associated Dry Eye (MADE) in Healthcare Workers: A Cross-sectional Study

Sudeshna Roy, Kesha Shah, Shafaque Sahar, Sunandan Modak

Introduction: The Coronavirus disease-19 (COVID-19) pandemic mediated by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), made the use of face masks mandatory to check the spread of the disease. With the increased use of face masks, more people started presenting to the ophthalmologist with symptoms of dry eye. The proposed mechanism of dry eye was attributed to air blowing upwards from behind the mask into the eyes, especially in loose fitting masks. This air leads to rapid evaporation of tears and disturbance of homeostasis of the tear film. Aim: To measure self-reported symptoms of dry eye and to establish mask use as a risk factor for the development of Dry Eye Disease (DED) in healthcare workers in a Tertiary Care Hospital. Materials and Methods: This cross-sectional, observational study was conducted at Nilratan Sircar (NRS) Medical College and Hospital, Kolkata, West Bengal, India, for a duration of three months from December 2021 to February 2022. The study was conducted on 146 participants. An online survey was conducted using Google Forms, sent via email to hospital employees working in different departments of the hospital. All healthcare workers employed at NRS Medical College and Hospital who wore a face mask during duty hours and were willing to participate in the study were included. The Ocular Surface Disease Index (OSDI) questionnaire was used and modified by adding “while wearing a facemask” to the end of each question. To establish face mask use as a causative agent for development of DED, a few other questions related to face mask usage were included in the survey. The data was tabulated in Microsoft excel and analysed with Statistical Package for Social Sciences (SPSS) version 24. Results: The mean age of the study population was 27.4±8.28 years. The mean hours of wearing a mask was 6.38±3.04 hours. N95 face mask was the most common type of mask used. The study population included 100 doctors, 14 nursing staff, 18 optometrists, eight group D staff (sweepers and ward attendants), and six dieticians. The mean OSDI score was 14.24. Increased usage of face masks, in particular surgical, more hours of reading significantly correlated with higher incidence of DED. Conclusion: This study showed that increased hours of face mask use in particular surgical was associated with development of DED. To encourage more people to wear face masks, all possible problems arising from face mask use should be promptly identified and dealt with.

Postoperative Pain Management and Patient Satisfaction in an Indian Tertiary Care Centre-A Prospective Observational Study

Anwesha Banerjee, Ashok K Saxena, Neha Bhardwaj, Mohit K Srivastava

Introduction: Despite various advancements over last two decades in pain medicine, postoperative pain remains inadequately addressed, even in a tertiary medical centre. There are very limited studies addressing postoperative pain management in India. Few published studies have assessed postoperative pain, but only at 24 hours intervals, and utilising tools focusing on any one parameter of pain. Hence, a holistic assessment using four different pain assessment tools should be done to get a wider overview of the condition. Aim: To assess the intensity and severity of postoperative pain at 6, 12, 24 and 48 hours postoperatively for patients undergoing surgery for orthopaedics, gastrointestinal, general surgery, obstetrics and gynaecological ailments and patient satisfaction at 24 hours postoperatively. Materials and Methods: A prospective observational survey was conducted at a tertiary care centre of New Delhi, India from October 2020 to October 2021. Three scales were used to determine the status of postoperative pain at 6,12,24 and 48 hours follow-up. The three different pain scales were Numerical Pain Rating Scale (NRS-pain) static and dynamic, Global Perceived Effect (GPE) and Neuropathic Pain System Inventory (NPSI). Results: Total of 400 patients, with mean age of the study population was 43.26±4.98 years. Majority were males, 250 (60%) and of American Society of Anaesthesiologist (ASA) Grade I, 208 (52%). Significant improvement was observed in the NRS pain score at each follow-up among those undergoing orthopaedic surgery, general surgery, and gynaecological procedures. Improvement in the mean GPE scale was only seen for orthopaedic surgeries. There was a significant neuropathic pain component observed in all the surgeries except gynaecological surgeries. Majority 321 (80.25%) had received information about their pain treatment but only 174 (43.5%) were satisfied with their pain treatment. Conclusion: A majority of the patients undergoing orthopaedic or general surgery, and gynaecological procedures had improvement in pain. This survey highlights the need for investigating future postoperative pain management protocols so that the intensity of postoperative pain, incidence of chronic persistent pain and resulting suffering, as well as disability, can be minimised to a large extent.

Short-Term Outcomes of Fibrin Glue Versus Absorbable Tackers for Mesh Fixation in Laparoscopic TAPP Inguinal Hernia Repair: A Randomised Clinical Trial

Introduction: Hernia is defined as the protrusion of all or part of a viscus through the wall that contains it. Laparoscopic and tension-free open repairs are the two procedures that are being performed globally in inguinal hernia surgery. Aim: To compare the benefits of fibrin glue versus absorbable tackers in laparoscopic Transabdominal Preperitoneal (TAPP) inguinal hernia repair and to appraise their outcomes. Materials and Methods: A randomised clinical trial was conducted at a tertiary hospital of SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India for 18 months, from March 2021 to August 2022. Total of 54 patients who had laparoscopic TAPP hernia repairs were divided into two groups each with 27 participants, group A mesh fixed using fibrin glue and group B mesh fixed using absorbable tackers. All the patients were followed-up for atleast three months postsurgery. Operating time, postoperative pain and complications data were collected. The Chi-square and Unpaired t-test determined the statistical significance of the data. Results: Total of 54 patients aged 18-60 years were included in the study with no significant differences (p-value=0.696). The same was true for gender (11 males and 43 females), with no significant differences (p-value=0.735) in group A and group B between male and female patients. In current study, there was a statistically significant difference in pain levels between groups after 24 hours, (group B: 5.33±1.30 and group A: 6.56±0.51) however, after 48 hours (group B: 4.07±0.87 and group A: 4.63±0.49) and 72 hours (group B: 2.74±0.76 and group A: 2.63±0.49), there was no significant difference in the severity of the pain between the groups. At one week follow-up the level of pain score was significantly different. There was also a significant difference in haematoma between groups (p-value=0.038). In addition, there was a significant difference in return to normal activities in one week (p-value=0.033), two weeks (p-value=0.022), and four weeks between groups (p-value=0.019). Conclusion: The use of fibrin sealant for mesh fixation in TAPP surgery has superior short-term outcomes when compared to tackers in terms of postoperative pain, return to normal activities and reduced incidence of haematomas.

Knowledge, Attitude and Practice of Rational Use of Medicine among Interns and Resident Doctors in Tertiary Care Teaching Hospital of Western City of Gujarat: A Cross-sectional Study

Samprada Y Tank, Jimmy M Kagathara

Introduction: According to the definition of Rational Use of Medicine (RUM), patients must receive pharmaceuticals that are “suitable to their clinical needs, in doses that fit their own specific requirements, for an adequate period of time, and at the lowest cost to them and their community”. By prescribing the proper medications in the proper dosages, doctors can influence the health and well-being of their patients. Aim: To evaluate the knowledge, attitudes, and practices of interns and resident doctors towards RUM in tertiary care center, Jamnagar, Gujarat. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in August 2022 in Guru Gobind Singh Government Hospital, Jamnagar, Gujarat. Total 149 first year postgraduate students (residents doctors) from different specialties and 205 intern students of a tertiary care teaching hospital were included in the study. A questionnaire was administered, which included the questions regarding socio-demographic profile, use of Essential Medicines (EM), RUM, concept of Personal drugs (P-drug) and source of drug information. Data were statistically analysed using Chi-square test. Results: Mean age of resident doctors was 24.55±1.74 years while of interns was 22.86±1.27 years. Around 18 (12.08%) residents and 9 (4.39%) interns knew what the phrase RUM meant. At their place of employment, the National Model Essential Drug List was accessible to 12 (5.85%) interns and 16 (10.73%) residents. Out of total, 190 (92.68%) interns and 143 (95.97%) residents were able to identify the components of the prescription slip accurately. The word P-drug was known to roughly 74 (36.09%) interns and 34 (22.81%) residents, of which 45 (21.95%) interns and 27 (18.12%) residents were aware of the Safety, Tolerability, Efficacy, Price (STEP) criteria for P-drug selection. Conclusion: Majority of the responders seem to be aware of the concept of EM and RUM, while the word P-drug seems to be quite unknown to the responders. However, majority of responders prescribed EM which are old drugs. Since, the awareness of RUM among interns and residents was found to be inadequate, it has critical importance to hold educational activities with the co-operation of physicians, health organisations, universities to avoid negative consequences of irrational drug use.

Prevalence of Anxiety amongst Interns while Performing Treatments in Dental Colleges of Navi Mumbai: A Cross-sectional Study

Sanika Samir Gokhale, Karishma Dattatray Jadhav, Jayeeta Verma

Introduction: Anxiety is one of the most commonly experienced disorders across gender and all ages. Dental anxiety seen in patients prior to or during treatment is a well-researched topic. However, anxiety experienced by interns while treating patients in the dental college is a lesser explored side of the same coin. Aim: To evaluate and understand the prevalence of anxiety experienced by dental interns while performing treatments in a college clinical set-up and studies the various factors precipitating anxiety. Materials and Methods: This cross-sectional study was conducted using google forms, amongst interns of five dental colleges in Navi Mumbai, Maharashtra, India, from July 2021 to October 2021. A sample size of 350 was derived by convenient sampling method. The parameters assessed via questionnaire through a Likert-type response scale included various factors precipitating anxiety amongst interns such as performing invasive dental treatments, lack of in-depth knowledge of procedures, age, attitude and medical conditions of patients, encountering complications while treating patients, presence of supervision and working with anxious peers. Chi-square test was performed to analyse collected data, extract results and draw a conclusion. Results: The mean age of the participants was 23±2 years. A total of 350 participants, out of which 332 showed symptoms of anxiety while treating patients in clinics. No significant gender predilection was noted for anxiety (p=0.544). Factors precipitating anxiety included performing invasive dental treatments (p=0.0004), lack of in-depth knowledge of certain procedures (p=0.020), patient’s attitude (p=0.017), treating patients with certain medical conditions (p=0.035) as well as encountering complications while treating patients (p=0.022). A significant number of participants thought that anxiety leads to more procedural errors (p=0.010). The need to incorporate anxiety management in the dental curriculum was observed (p=0.023). Conclusion: The results of the present study showed prevalence of anxiety amongst dental students and highlighted the need to incorporate anxiety management programmes in the curriculum. Preparing interns to cope with anxiety resulting from treating patients seems to be of importance for their future clinical practice.

Clinical and Laboratory Profile of Patients with Newly Diagnosed Juvenile Idiopathic Arthritis: An Observational Study from a Tertiary Care Centre, Karnataka, India

Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic condition of childhood. It represents a heterogeneous group of childhood arthritis. Aim: To study the clinical profile and laboratory characteristics of all newly diagnosed JIA patients. Materials and Methods: This hospital-based prospective observational study was conducted in the Department of Paediatric Rheumatology at Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India between December 2017 to May 2019. All children who fulfilled International League of Associations for Rheumatology (ILAR) criteria for the diagnosis of JIA were enrolled in the study, and their clinical and laboratory parameters were evaluated. The analysis between matched-pairs data like the comparison between age of onset and age of presentation in males and females were done by paired t-test. Results: The mean age of the study participants was 9.67±3.96 years. A total of 51 children were included in the study with Male:Female (M:F) of 1:1.12. Mean age at onset was 8.71±4.02 years and median duration of disease was 13 months (2-96 months). The most common subgroup was polyarticular JIA 18 (35.3%) followed by Systemic Onset Juvenile Idiopathic Arthritis (SOJIA) 14 (27.5%), enthesitis-related arthritis 13 (25.5%) and oligoarticular JIA 4 (7.8%). Knee (94%) was the most common joint involved followed by the ankle (70.5%). Fever was the most common extra-articular feature present in 73% of cases. Hepatomegaly, splenomegaly and lymphadenopathy was present in 33.3%, 9.8% and 21.6% children, respectively. Anaemia, leukocytosis, thrombocytosis and elevated Erythrocyte Sedimentation Rate (ESR) were more common in SOJIA. Macrophage Activation Syndrome (MAS) was diagnosed in two cases of SOJIA (14.3%) with no mortality. Conclusion: Polyarticular JIA was the common subtype in the study, followed by SOJIA. Most common joint involved was knee, followed by ankle and fever is the most common extraarticular manifestation.

Non Linear Relationship between BMI and Sepsis among ICU Patients: Analysis of the MIMIC-III Real World Database

MK Lintu, Amitha Puranik, Kalesh M Karun, David Raj Micheal, Asha Kamath

Introduction: The relationship between occurrence of sepsis and Body Mass Index (BMI) has been studied by treating BMI as a categorical variable based on the standard categories developed by the World Health Organisation (WHO). This technique masks the actual form of the relationship that exist between BMI and sepsis. Aim: To determine the shape of the association between BMI and probability of sepsis after adjusting the effect of gender, age, ethnicity and co-morbidities among critically-ill patients and to identify an appropriate technique to elucidate this association. Materials and Methods: The study was based on the data extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database, a real-world dataset. Study includes all the patients admitted to the ICU at the Beth Israel Deaconess Medical Center in Boston, Massachusetts from 2001 to 2012. A robust Poisson regression model and a Restricted Cubic Spline (RCS) regression model were applied to model the data. Results: The study revealed a non linear relationship between BMI and occurrence of sepsis. From the RCS plot, an increased risk of sepsis was observed among underweight and obese males and a similar pattern was observed among those with hypertension. BMI, age, and hypertension were found to be significant in the robust Poisson model (RR 1.01, 95% CI 1.00-1.02, RR 1.01, 95% CI 1.00-1.02, and RR 0.76, 95% CI 0.69-0.84, p<0.05, respectively). Conclusion: A non linear relationship was observed between BMI and occurrence of sepsis after adjusting for other factors in the critically-ill patients. Female patients in both underweight and obese category had lower occurrence of sepsis as compared to those with normal BMI. It is also worth noting that the status of diabetes did not display any association with BMI.

Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus and its Association with Age, Gender, Duration and Glycosylated Haemoglobin: A Cross-sectional Study

Sawan Kumar Shukla, Mahendra Tilkar, Karan Saran Kapur

Introduction: Diabetes Mellitus (DM) is a group of metabolic disorders resulting in hyperglycaemia with disturbances in carbohydrate, fat, and protein metabolism. Hyperglycaemia when present for a long period of time leads to a host of metabolic abnormalities and also results in end organ damage. Diastolic dysfunction is an early sign of diabetic heart muscle disease preceding systolic and diastolic damage. Only a few studies have been conducted in central India to establish this prevalence and association in diabetic patients. Aim: To assess Left Ventricular Diastolic Dysfunction (LVDD) in diabetic patients and its association with age, gender, duration, and glycosylated haemoglobin (HbA1c). Materials and Methods: In this cross-sectional study, 150 normotensive patients with type 2 DM and no clinical evidence of cardiovascular disease were enrolled by simple random selection in the Department of General Medicine, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. The sample size was calculated by standard formula with a confidence interval of 95% and an error margin of less than 5%. A semi-structured proforma was used to record the demographic profiles with full medication history, as well as, anthropometric measurements like height, weight, and waist circumference. Blood pressure was measured and blood was drawn for complete blood count, liver function test, renal function test, fasting and postprandial blood sugar, HbA1c, and lipid profile. Electrocardiographic and Echocardiographic studies were performed to assess LVDD. Data obtained by various methods was analysed statistically using Statistical Package for the Social Sciences (SPSS), version 20.0 and Chi-square test. Results: The present study showed that 85 out of 150 type 2 diabetic patients had diastolic dysfunction, out of which 80 had grade I diastolic dysfunction and, five of them had grade II diastolic dysfunction. The prevalence of diastolic dysfunction was increased with age, duration, and HbA1c (≥7%) and was not affected by gender. Conclusion: The study concluded that asymptomatic normotensive patients of type 2 DM have Heart Failure with preserved Ejection Fraction (HFpEF). LVDD were associated with age, gender, duration of diabetes, and HbA1c.

Clonidine as an Adjuvant to Local Anaesthetic in Infraclavicular Brachial Plexus Block: A Randomised Clinical Trial

Anupama Gill, Namita Saraswat, Jyoti Singh, Nitin Choudhary, Preeti S Govind

Introduction: Brachial plexus blocks are routinely performed to provide anaesthesia and analgesia for upper limb orthopaedic surgeries. Various adjuvants are being added to local anaesthetic solution to prolong the duration of sensory and motor blockade to ensure successful completion of long duration surgeries with adequate postoperative analgesia. Clonidine is used in varying dosages as adjuvant for peripheral nerve block. Aim: To study different dosages of clonidine when used as an adjuvant in infraclavicular approach to brachial plexus block. Materials and Methods: The randomised double-blind clinical study enrolled 60 American Society of Anaesthesiologists (ASA) I and II patients, between ages of 18-60 years, undergoing elective forearm orthopaedic surgery, lasting more than one hour. Based on the dose of clonidine added, the patients were distributed to group I (75 μg); group II (100 μg) and group III (150 μg). They were compared with regard to onset and duration of sensory and motor blockade, haemodynamic parameters, quality of sedation and side-effects. The results were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Demographic profile was comparable between the study groups. The onset of sensory and motor duration was faster in group III (5.8±1.65 minutes; 10.08±0.98 minutes). Also, the duration of sensory and motor blockade was highest in group III (11.02±2.33 hours; 10.44±1.45 hours). Patients in group III had significantly higher level of sedation in comparison to other groups. Conclusion: Clonidine in a dose of 150 μg provides significantly longer duration of sensory and motor blockade without any adverse haemodynamic outcomes.

Comparative Evaluation of Rate of Intrusion and Amount of Periapical Root Resorption with Temporary Anchorage Devices and Connecticut Intrusion Arch in Adult Population- A Prospective Interventional Study

Introduction: Deep bite is a complaint where, an increase in the vertical overlap between the upper and lower arch front teeth is seen. Deep bite is a relatively short face with a square gonial angle and flat mandibular plane are related to the skeletal dimensions that influence this condition. An untreated, deep overbite leads to the problems such as: abnormally increased wear and harm to the teeth, periodontal complains issues with occluding and chewing food, headaches and Temporomandibular Disorders (TMD), painful sores or ulcers, loss of tooth structure and tooth itself. There are various treatment modalities which aid in correction of these anomalies, such as mini screw implants {Temporary Anchorage Devices (TADs)} and various intrusion arches. Need of the study: Due to the paucity of evidence regarding rate of intrusion and the correlation of root resorption with use of bilateral TADs and Connecticut Intrusion Arch (CIA), with the aid of Cone Beam Computed Tomography (CBCT), the present study will be conducted to provide an insight into the efficacy of both treatment modalities to correct deep bite and identify which of the two modalities provide less damage to the root and surrounding structure. Materials and Methods: This prospective interventional study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College, Sawangi, Meghe, Wardha, Maharashtra, India. The duration of study will be two years. A sample of 20 patients will be split into two groups to perform the study. Bilateral TADs will be implanted in group A, while CIA will be placed in group B to allow for the intrusion of front teeth. All the patients will be started with initial levelling and alignment using MBT 0.022” bracket prescription. After leveling and alignment, miniscrew implants (TADs) will be placed in the labial cortical plates in between the lateral and canine bilaterally in group A and CIA will be placed in patients allotted to group B. CBCT records will be collected in the following time intervals: Before applying intrusion mechanics (T0), after one month of applying intrusion mechanics (T1), three months after applying intrusion mechanics; (T2) and six months after applying intrusion mechanics (T3). Rate of intrusion and amount of root resorption will be assessed and compared between these time intervals. Expected outcome: The rate of intrusion using different intrusion mechanics have been assessed by other studies, however, they have not been correlated with the amount of root resorption caused by these technique. Therefore, the present study intends to evaluate and compare the rate of intrusion and the amount of root resorption of maxillary anterior teeth using TADs and CIA, thereby assessing better modality in correction of deep bite.

Comparison of Intermediate Fidelity Simulation with PowerPoint Presentation and Video Lectures for Imparting the Skills of Normal Delivery to Undergraduate Students-A Research Protocol

Sandhya Pajai, Swanand Pathak, KS Uplabdh Gopal

Introduction: In the modern era, which is heavily driven by multimedia, traditional ways of teaching medical students are insufficient. Techniques based on simulations might be crucial in closing this educational gap that exists. A curriculum built on the cognitive, psychomotor, and emotional learning domains, which were first introduced about 50-year-ago, is receiving more and more attention in medical education. The highest standards of care, patient safety and error prevention, patient autonomy, and resource allocation are the main goals of these reforms. Experiential (or “hands-on”) learning is becoming more and more popular in medical education, however, using real patients to conduct this type of learning raises ethical and legal issues and is less socially acceptable. With the help of simulation, learning possibilities like immersion, reflection, practice, and feedback can be offered without the hazards associated with a similar real-life experience. The precise artificial recreation of a difficult real-world process is called simulation. Need of the study: Despite the many benefits of fidelity-based learning, it is not widely incorporated as an excellent learning tool in many institutions and Obstetrics and Gynaecology Departments. Hence, authors plan to study the effectiveness of an intermediate fidelity simulator in improving the skills of normal delivery in medical students. Aim: To assess skill development and teaching for normal delivery through PowerPoint presentation and video lectures, then compare it with skill development through Intermediate fidelity simulation in undergraduate medical students. Materials and Methods: The cross-sectional, observational study after due ethical approval will be conducted in Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India from September 2022 to August 2023. An introductory lecture will be taken for a batch of 160 students of 3rd year. Pre-Objective Structured Clinical Examination (pre-OSCE) will be conducted and then two groups of students will be formed. Group A will be taught with video PowerPoint presentation-based lectures meanwhile intermediate fidelity will be used as a method for teaching normal delivery for Group B. Post-OSCE will be conducted for both groups. Results will be analysed using student’s paired t-test for statistical significance.

Efficacy of Arm Ergometer Exercise on Glycaemic Control in Type 2 Diabetes Mellitus- An Interventional Study

Shubhada Ravindra Dhait, Vishnu Vardhan, Rashmi Walke

Introduction: Type-2 diabetes develops when the body’s natural metabolism is disrupted, which is marked by a decline in glucose tolerance over time. Diabetes mellitus is a dreadful condition specified by an increase in the concentration of glucose that influences the cardiovascular system, veins, arteries, vision, renal system, and ganglion over time. Arm ergometer is an upper body exercise apparatus that quantifies and standardises physical activity in terms of work output. Thus, it is well recognised as an essential component in the treatment of Type 2 Diabetes Mellitus (T2DM). Need of the study: Exercise has been demonstrated to aid glycaemic management in those at high risk of diabetes. The symptoms of peripheral artery disease, peripheral neuropathy, vision disturbances, renal disease, heart disease, cognitive impairment, and metabolic dysfunction are likely to worsen due to poor glycaemic control. Limited evidences on arm ergometer have shown its effectiveness on glycaemic control. Aim: To find the efficacy of arm ergometer exercise on glycaemic control in patients with T2DM. Materials and Methods: This interventional study will be conducted in the Diabetes Out Patient Department (OPD) of Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India from April 2022 to March 2023 after obtaining the ethical clearance. A total of 40 participants with T2DM will be recruited, and after baseline health parameter assessment like postprandial blood glucose, Haemoglobin A1c (HbA1c), and 6-minute walk test, the participant will perform arm ergometer exercise for 30 minutes for 5 days/week. All the parameters will be assessed again after 6 weeks. Frequency distribution will be calculated using Chi-square and pre and post data will be compared using student’s paired t-test. Expected outcome: Arm ergometer exercise will be effective on glycaemic control in T2DM individual.

Efficacy of Lignocaine Hydrochloride with Adrenaline, Clonidine and Dexmedetomidine for Surgical Removal of Impacted Mandibular Third Molar: A Research Protocol for a Randomised Clinical Trial

Akash Yogesh Doshi, Nitin Dharmpal Bhola

Introduction: In human dentition, the most common impacted teeth are Mandibular Third Molars (M3M). Removal or extraction of these teeth leads to anxiety in the patients oweing to the perception of pain. Thus, pain control mechanism like anaesthesia needs to be executed appropriately. Using newer local anaesthetic drugs minimises side-effects and drug interactions. Adrenaline is traditionally used vasoconstrictor along with Lignocaine. Dexmedetomidine and Clonidine are alpha agonists which in combination with Lignocaine provide a prolonged duration of anaesthesia thus decreasing the need for rescue analgesics. Need of the study: This research will assist in assessing and establishing the duration of anaesthesia and postoperative analgesia after the administration of lignocaine hydrochloride with adrenaline, clonidine and dexmedetomidine in third molar surgery. This will eventually lead to less consumption of analgesics owing to the delay in ingestion of rescue analgesics. Aim: To evaluate and compare the safety and efficacy of adrenaline, clonidine and dexmedetomidine as an adjuvant to lignocaine hydrochloride for perineural inferior alveolar nerve block in cases of Impacted Mandibular Third Molars (IM3M) surgeries. Materials and Methods: This is a prospective, triple-blind, randomised, controlled, parallel arm study. The study will be conducted at the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha, India, from February 2023 to June 2024. A total of 45 consecutive systemically healthy patients requiring unilateral surgical extraction of impacted M3M with similar orientations will be divided into three groups randomly. The first group will receive lignocaine with adrenaline, the second group will receive lignocaine with clonidine and third group will receive lignocaine with dexmedetomidine during the extraction procedure which will be compared on following parameters like the onset of anaesthesia, depth of anaesthesia, haemodynamic parameters and duration of postoperative analgesia. ‘One-way Analysis of Variance (ANOVA)’ will be used to analyse and evaluate.

Evaluation of Correlation between Cognitive Impairment and Tooth Loss- Research Protocol

Jahnavi Purna Gorripati, Surekha Dubey Godbole

Introduction: Cognitive impairment has been linked with aging, neurobiological, psychological, and social factors. Studies have generally quoted “that older adults usually present with some form of cognitive impairment. Mild cognitive impairment is a state representing the intermediate phase between normal aging dementia and is also termed predementia syndrome. Recent evidence also shows correlation between teeth loss and Alzheimer’s disease, which can cause cognitive impairment. Need of the Study: As there is very little research in the literature regarding the correlation of cognitive impairment with loss of teeth in dentistry, there is a need to check and evaluate the correlation. Thus, this study will assess the correlation between cognitive impairment and tooth loss using a MMSE. Aim: To evaluate the correlation between cognitive impairment and tooth loss using a Mini-Mental State Examination (MMSE). Materials and Methods: The current study is a cross-sectional observational study that will be conducted at Sharad Pawar Dental College and Hospital. Following approval of the Ethical institutional Committee (IEC) and Ethical Approval No: DMIMS (DU)/IEC/2022/779. All the 300 participants between 30-60 years of age who visited the OPD of Department of Prosthodontics, will be included in the study. The inclusion criteria for this study were patients aged between 30-60 years with number tooth loss 2-4, 6-8, partially edentulous, and completely edentulous. Participants suffering from neurological disorders that may lead to cognitive impairments will be excluded from the study. Descriptive statistics will be performed for frequency percentage. Association will be tested using Chi-square analysis to find the significance p-value.

Comparative Evaluation of Effectiveness of Triphala and Chlorhexidine in One Stage Full Mouth Disinfection Treatment of Stage-II and III Periodontitis in Type-II Diabetes Mellitus Patients- A Research Protocol

Introduction: The idea of Full-Mouth Disinfection (FMD) was presented in the early 1990s, the traditional method of treating periodontal disease, quadrant by quadrant over several visits. The FMD method has been recommended with a number of changes over time. Triphala, Ayurvedic medicinal herbal formulations is also useful in dentistry as antiplaque, antimicrobial, antioxidant, analgesic, antipyretic and anti-inflammatory agent. As Chlorhexidine (CHX) is used from past years for full mouth disinfection, there is need to evaluate the efficacy of CHX as well as Triphala in diabetic mellitus patients. Need of the study: As CHX has been used for years to disinfect the entire mouth, a study comparing the effectiveness of CHX and Triphala in individuals with Diabetes Mellitus (DM) for full mouth disinfection will be done. Aim: To evaluate and compare the efficacy of triphala and CHX in the treatment of Stage-II and III periodontitis with one stage complete mouth disinfection in Type-II DM patients. Materials and Methods: This experimental study will be done in Sharad Pawar dental College, Department of Periodontics after obtaining the ethical clearance during September 2021 to September 2022. About 24 type 2 diabetic subjects with Stage-II and Stage-III periodontitis, will be randomly divided into test Group-And control group with 12 in each group. In Group-A, full mouth disinfection will be done using CHX and in Group-B full mouth disinfection will be done using Triphala. After full mouth subgingival scaling and root planing, patient will brush the dorsum of the tongue for one minute with gel, the mouth will be rinsed two times with mouthwash for one minute, the pharynx will be cleaned with a spray, and all periodontal pockets will be irrigated (thrice within 10 minutes) with a gel. Clinical parameters will be evaluated at baseline and six months. The clinical parameters are Probing Pocket Depth (PPD), Plaque Index (PI), Clinical Attachment Level (CAL), Papillary Bleeding Index (PBI). Paired t-test will be used to compare data within group for before and after treatment and unpaired t-test will be used to compare between the groups.

Comparative Evaluation of Novel Calcium Hydroxide-hydrogel with Calcium Hydroxide-iodoform as Obturating Material: A Protocol for an In-vitro Study

Dhruvi Raj Solanki, Punit Fulzele, Nilima Thosar

Introduction: Pulpectomy is one of the extensively done procedures in clinical practice, in which the pulp is extirpated, and the canal is filled with an obturating material. Modalities of pulp therapy in primary teeth are subtly different from that of permanent teeth, and so are the obturating materials. Calcium hydroxide has an optimum antimicrobial effect on the root canal of teeth. The success rate for Ca(OH)2-iodoform paste ranges from 84% to 100%. A mixture of calcium hydroxide with iodoform is conventionally used due to its strong antibacterial property, but, high resorptive activity leads to increased periapical radiolucency in the long term. Chitosan, a hydrogel, is antimicrobial, antioxidant and anti-inflammatory. Need of the study: Calcium hydroxide-hydrogel can be potential alternative to the available calcium hydroxide iodoform obturating material for primary teeth by increasing its longetivity in the canal and giving a uniform ion release. Aim: To prepare, optimise and characterise novel calcium hydroxide-hydrogel as an obturating material and compare it with conventional calcium hydroxide-iodoform. Materials and Methods: The present in-vitro study will be carried out at Sharad Pawar Dental College, Wardha, Maharashtra, India. Chitosan-calcium hydroxide hydrogel will be formulated by soaking commercially available chitosan in 2% acetic acid solution. Calcium hydroxide will be added to this base in different concentrations for each sample and mixed in a magnetic stirrer. Twenty samples of calcium hydroxide-hydrogel will be formulated and divided into three groups with concentration of 0.1, 0.55 and 1% w/v, respectively and a control group with calcium hydroxide-iodoform will also be evaluated. Calcium ion release shall be checked through infrared spectroscopy techniques and pH through pH meter at 7, 14, 21, and 28 days. To evaluate, an Analysis of Variance (ANOVA) followed by post- a hog test will be used.

A Review on Therapeutic Potential of Cold Atmospheric Plasma Therapy in Oral Cancer: Emerging Trends and Amelioration

Monika Srivastav, Elizabeth C Dony

Oral Squamous Cell Carcinoma (OSCC) is a life-threatening disease. Many patients are in advanced stages at the time of diagnosis, resulting in high mortality, morbidity and clinical problems that make clinical management challenging. Due to advancements in early diagnostic procedures of cancer and its treatment, the number of patients suffering from OSCC has decreased. Still, the number of death due to cancer has not been reduced. In many circumstances, chemotherapy has major side-effects. Cold Atmospheric pressure Plasma (CAP) is a new therapy option that seems to be used mostly as part of a palliative cancer treatment program to provide comfort to these patients. Using a gas that is ionised partially, known as CAP therapy, researchers are now able to treat cancer. The identification of the anticancer properties of CAP, and clinical efficacy, can open up the door for the development of a wide range of synergistic and individualised plasma-enabled therapies. These drugs can potentially enhance current therapies in the direction of safer, more efficient treatment modalities and provide a gentle but efficacious cancer single-agent therapy with a wide therapeutic window and good selectivity.

Physiotherapy Interventions as an Adjunct Approach in Patients with Primary Dysmenorrhea: A Narrative Review

Sunita Sharma, Aksh Chahal, Harneet Narula, Vandana Esht

Primary Dysmenorrhea (PD) is a major contributor in teenage and young female absenteeism following menstrual cramps and abdomen pain before and during their menstrual cycle. Prostaglandin secretion causes uterine muscles and blood arteries to contract. The discomfort is usually modest, but in some cases, it is so terrible that it prevents them from going to work for many days in a month without any social, psychological and physical activity. The purpose of this review was to assess impact of physiotherapy on psychological, social and physical wellbeing in patients with PD. Physiotherapy intervention without surgical management can improve psychological, physical and social well-being of PD patients. All articles incorporated in this review were reported to reduce the pain intensity and the frequency in PD. A healthier and more appropriate eating style, as well as more frequent physical activity can help school and college going females to avoid dysmenorrhea. Educational activities can help in raising awareness among young women about the importance of a healthy diet and physical activity. The present review concluded that physiotherapy treatment strategies are effective treatments for reducing pain and psychological effects on PD females. Conservative management by physiotherapy reduces intensity and frequency of pain, anxiety, depression, stress, poor sleep quality and improved quality of life in PD.

Impact of Monsoon on the Pattern of Infectious Diseases in the Indian Setting- A Review

Marie Victor Pravin Charles, Arunava Kali, Santhanam Vidyalakshmi

The survival of life on earth depends on equilibrium between the organisms and the environment. The monsoon is a seasonal variation prevailing in the Indian sub-continent. Monsoon has two seasons which are separated by a transition. The infectious diseases epidemiology is affected by both climatic and societal influences. An interaction of climatic and societal influence favours the infectious disease exposure in a population. The infectious diseases affecting the population can be broadly classified as vector borne diseases, food borne diseases, water borne diseases, and respiratory diseases. The rainfall associated change in temperature and floods favours the survival of infectious diseases and their transmitting vectors. The changing global climatic trends including the EL nino Southern oscillation bring undue rainfall during other seasons. The drastic events associated with these climatic changes affect the health and sanitation infrastructure. India being a developing country has more vulnerability to such infections. A better strengthening of the infrastructure and health policies is the need of the hour to curb the infections.

Variation of Acid Phosphatase Activity in the Fallopian Tube of Rabbits: A Semiquantitative Histochemical Assessment

Introduction: The fallopian tube is a tubular muscular organ connecting the uterus to the ovary. It is important for the passage of gametes, zygotes, and early embryos. Fallopian tube undergoes histochemical variations with ovarian cycles. Aim: To study the phasial and segmental variation of Acid Phosphatase (ACP) activity in the fallopian tube of rabbits. Materials and Methods: A cross-sectional observational study was done on 50 female rabbits at Sarojini Naidu (SN) Medical College, Agra, Uttar Pradesh, India from June 1976 to June 1979. The fallopian tubes of both sides were taken out by dissection and cut into anatomical segments, from medial to lateral ends viz., intramural, isthmus, ampulla and infundibulum. The phases of the oestrus cycle i.e., pro-oestrus, oestrus, meta-oestrus, and di-oestrus were decided by cytological observation of a papaniculous stained vaginal smear. ACP activity was observed in various phases of sexual cycle and in different segments of the fallopian tube by the modified lead nitrate staining method i.e Takeuchi and Tanoue. One-way Analysis of Variance (ANOVA) was applied for the analysis of the data. Results: The ACP activity was higher in pro-oestrus (2.25±0.24), oestrus (2.00±0.24) and low in meta-oestrus (1.33±0.24) and di-oestrus phases (1.08±0.24) of sexual cycle. The activity was seen higher in infundibulum (2.50±0.22), ampullary (1.83±0.22) and low in intramural (1.08±0.22) and isthmus segments (1.25±0.22) of the fallopian tube. The maximum difference (1.42) was noticed between the infundibulum and intramural segments (p<0.001). A maximum difference (1.16) was noticed between pro-oestrous and di-oestrus the (p<0.001). Conclusion: Oestrogenic phase of the sexual cycle has higher enzymatic activity whereas in the luteal phase it was low. The infundibulum and ampulla show higher activity which suggests these segments are more functionally active as compared to intramural and isthmus segments.

Impact of Social Media on Eating Disorders in Adolescents and Emerging Therapies: A Review

Shaini Suraj, Rohit Dhoke, Brij Raj Singh, Nandkishor Bankar

The saying goes ‘You are what you eat’. This is in reference to a healthy and balanced diet which gives a boost to one’s mental and physical health. But in recent times, Eating Disorders (EDs) are seen to increase among adolescents. These result from several factors, including prevalence of unhealthy dieting behaviours and unrealistic beauty images. Advertising has popularised a thin body ideal. Social media is influencing the young minds in their food choices. Constant use of pictures, advertisements, videos by celebrities and other social media influencers have caused an increase in body dissatisfaction especially among adolescents. The ideal body portrayed by media for women is a very thin body, perfect in shape, and for men it is a muscular and tall body image. The adolescent brain has increased levels of ‘neuroplasticity’ and hence is malleable that is it is highly responsive to being shaped and re-wired by the environment- which also includes diet and body images. Hence, the need of the hour is to set in place healthy dietary habits and exercise routine along with will power for lifelong healthy living.

Immunomodulators and SARS-CoV-2: Management of the Dysregulated Immune Response

Chandramouli Mandya Thimmaiah, Giridhar Belur Hosmane, Debasis Behera

The Coronavirus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) resulted in millions of deaths worldwide. In adults, it can lead to serious complications such as Acute Respiratory Distress Syndrome (ARDS), renal failure, encephalitis, acute cardiac illness, thromboembolism, and multiorgan failure. However, in infants and children, it causes mild illness. The current evidence showed hyperinflammatory syndrome is the reason for most of the deaths in patients with severe COVID-19. There are increasing research activities around immunomodulatory drugs to manage SARS-CoV-2 induced dysregulated immune response. However, these immunomodulatory drugs are currently approved by FDA for the prevention and treatment of certain inflammatory disorders, such as rheumatoid arthritis, gout, recurrent pericarditis, and multiple sclerosis. Here, we summarise the drugs studied in several randomised clinical trials to demonstrate the efficacy and safety in treating the uncontrolled immune response of COVID-19 patients.

Monkeypox: An Uncommon Re-emerging Virus- Threat to Mankind

Ashwini Arun Mankar, Suvarna Vaibhav Sande, Priyanka Purushottam Chaubey

Monkeypox Virus (MPV) causes rare zoonotic illness. The Central African (or Congo Basin) clade and the West African clade are its two genetic subgroups, of which Central African subgroup is more lethal. To distinguish between the lineages, sequencing is crucial. As it was first isolated from captive monkeys that is why it is named as MPV. Its clinical features are similar to small pox. Undiagnosed acute rash with one or more symptoms, such as headache, fever, lymphadenopathy, myalgia, back pain, or asthenia, are considered common clinical findings. Real-Time Polymerase Chain Reaction (RT-PCR) is used in the laboratory diagnosis. There are various complications of monkeypox disease that includes bacterial infection of skin, skin scarring, hyper or hypopigmentation, permanent corneal scarring (vision loss), pneumonia, dehydration, sepsis, encephalitis and death. The drug of choice includes Tecovirimat, Cidofovir, Vaccinia Immune Globulin Intravenous (VIGIV), Brincidofovir. ACAM2000, LC16m8 and modified vaccinia Ankara are few options for vaccines but still under investigation. Though the disease is self-limiting but may complicate and has morbidity as well as mortality. So, it’s better to prevent the spread of the disease by early identification, contact tracing, isolation with stringent hospital infection control practices with early initiation of treatment.

Recent Advances of Aesthetic Gynaecology: A Narrative Review

Dhruva Piyush Halani, Arpita Jaiswal

In the vast field of gynaecology, Female Cosmetic Genital Surgery (FCGS) is the newest and fastest growing sub specialty due to sexual distress and vaginal laxity. It includes operations intended to alter the genitalia of women in terms of function and/or aesthetics. Using electronic databases including MEDLINE/PubMed, Embase, and Scopus, a literature review search with current advancements was carried out without regard to dates or research designs. The search was based on 40 different cosmetic gynaecological terms, including “surgical vaginoplasty,” “labiaplasty,” “vaginal rejuvenation,” “vaginismus,” and “energy based devices,” amongst others. All english full-text prospective, retrospective, and interventional studies describing cosmetic gynaecological procedures that included atleast five participants were considered. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. This review provides an overview of the developing field of cosmetic gynaecology as well as the opinions of the authors and current developments in the study of this therapeutic area. Vaginal laxity is common and may impact sexual function and quality of life. Expanding aesthetic gynaecology may benefit the patients in their Female Sexual Function Inventory (FSFI) scores, intimate wellness, and psychosocial function.

Exploring the Profile of the Gut Microbiome in Differentiating Type 2 Diabetes Mellitus and Non Alcoholic Fatty Liver Disease

Yashasvi Anand, Shiv Joshi

Type 2 Diabetes Mellitus (T2DM) and Non Alcoholic Fatty Liver Disease (NAFLD) are emerging global pandemics and carry a significant burden of co-morbidity and mortality. Asian Indians have the highest prevalence of T2DM, leading to 2.54 million deaths yearly. In India, it is 11.6%, and 30-50% of patients with NAFLD have diabetes. Patients with worsening T2DM tend to have increased progression of NAFLD to cirrhosis. NAFLD leads to end-stage liver disease causing 2.59 million deaths annually. Therefore, the relationship between T2DM and NAFLD needs to be disclosed, and the gut microbiome shows significant characteristics for the same. The gut microbiome is a collection of trillions of bacteria, archaea and fungi that resides in the digestive tract of humans. It plays a significant role in health by helping control digestion and benefits for human body immune system. Progression of metabolic health disorders shows changes in the quality and heterogeneity of the gut microbiome. It has been established that metabolic and immunological disorders are mainly influenced by the gut microbiome and not by the type of diet. Butyrate-producing bacteria benefit insulin resistance leading to more chances of T2DM. Since, the liver is close to the gut microbiome, the influence of the gut microbiome and its metabolites affecting liver function is great. But, gut microbiome being specific in both cases can assist in exploring the relationship and differentiating one from the other. Therefore, further analysis and studies are required to understand the role of the gut microbiome and its significance in better diagnosis.

Chances and Challenges of Mobile Health in Public Health Dentistry

The future of healthcare delivery keeps evolving and mobile phone technology may have a huge role to play. Mobile Health (mHealth) is a facet of Electronic Health (eHealth) that involves the use of mobile phones and other wireless devices in medical practice. The effectiveness of mHealth has been proven in different studies, as well as, in different aspects of medicine and dentistry. Text messaging has made significant progress in delivering health education for maintaining oral hygiene, especially for orthodontic patients as well as tobacco cessation counseling. Mobile phone applications incorporate various features like gaming, audio, and video messages to engage smokers in several behavioural change strategies. mHealth technology has made an immense contribution to contact tracing, screening, and teleconsultation during the Novel Coronavirus Disease-2019 (COVID-19) pandemic. Given that mHealth is a low cost, easily accessible, and widely available means of communication, it has the potential to play a significant role in public health dentistry.

Role of Cross-sectional Imaging in Evaluation of Parotid Gland Tumours: A Pictorial Review

Radiological evaluation of the parotid gland neoplasms is a major challenge for radiologists, due to the wide variety of imaging features and differential diagnosis. Though Ultrasonography (USG) combined with guided Fine Needle Aspiration Cytology (FNAC) is the primary diagnostic modality, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in the evaluation of patients presenting with suspected neoplastic lesions of the parotid gland. Cross-sectional imaging data of seven patients were selected and reviewed in detail. CT and MRI imaging had been done on patients referred to Radiology Department for clinically suspected parotid tumours. All of them underwent surgical excision and histopathological examination postimaging. Benign tumours usually arise from superficial lobe and exhibit strong signal intensity on T2 weighted images with well-defined margins. Lobulated margins with T2 dark rim are characteristic of pleomorphic adenoma. Hyperdense lesion with cystic changes with occasional bilateralism favour Warthin’s tumour. Most of the malignant parotid tumours involve deep lobe and appear as low signal lesion on T2 weighted imaging with ill-defined margins. Locally aggressive features like subcutaneous/deep infiltration strongly suggests malignancy. Cross-sectional imaging feature of carcinoma ex-pleomorphic adenoma is variable from focally aggressive to totally aggressive tumourigenesis. Few malignant tumours like high-grade Mucoepidermoid Carcinoma (MEC) and Adenoid Cystic Carcinoma (AdCC) can show tendency towards perineural spread. Although histopathological examination is required for definitive diagnosis, few pathology-specific imaging findings on cross-sectional imaging can help in localising and characterising the parotid lesions and categorising innocuous benign from sinister malignant lesions and thus narrow down the differential diagnosis.

Implications of Nicotinamide Adenine Dinucleotide Reductive Stress in Health and Diseases- A Narrative Review

Sanjukta Mishra, Rajlaxmi Sarangi, Swarnalata Das

Nicotinamide Adenine Dinucleotide (NAD+) takes part in cellular energy metabolism by accepting hydride equivalents to form reduced NADH, which furnishes reducing equivalents to mitochondrial Electron Transport Chain (ETC). Usually, NADH (H for hydrogen)/NAD+, redox couple is crucial for cellular redox homeostasis and healthy physiological condition. Reductive Stress (RS) denotes a stable alteration of redox homeostasis due to overexpression of the antioxidant enzyme system, which could deplete Reactive Oxygen Species (ROS). This might potentially switch the redox couple from an oxidative state to a reduced state. Notably, it navigates the cell to RS. Emerging evidence recommends that RS might be even more detrimental than its counterpart oxidative stress. Contemporary perception on fundamental mechanisms of RS, due to perturbation of redox couple, is limited. This review is based on recent comprehension on the biochemical and metabolic role of NADH/NAD+ redox couple and its title role in promoting diseases like cancer, cardiovascular disease, Diabetes Mellitus (DM), neurodegenerative diseases. Besides, insight into the evolution of NAD+ redox signaling will augment the perspective on cellular redox homeostasis. Upcoming coveted analyses are desired to establish and explore metabolic transformation to RS. Moreover, the antireductant approach to hinder RS will be noteworthy.

Extranodal Rosai-Dorfman Disease of the Nasal Septum: A Case Report

Santosh Prasad Kesari, Kartikeya Ojha, Piyush, HR Sohan Rao

Rosai-Dorfman Disease (RDD) is a rare, benign histiocytic proliferative disorder mostly involving the lymph nodes. Extranodal disease can occur in the skin and soft tissue including the mucosal surface, central nervous system, gastrointestinal tract and breast. Here, a case of a 17-year-old Indo-asian girl is presented, who came to the Ear, Nose and Throat (ENT) Outpatient Department (OPD) with a mass in her left nostril for the past two years. A sessile globular mass from the left nasal septum was seen during diagnostic visual endoscopy. A Computerised Tomography (CT) scan of the paranasal sinus revealed a rather large right maxillary sinus with a soft tissue density lesion filling it and obliterating the osteomeatal complex, while blood tests revealed an increased eosinophilic count. The nasal tumour was removed, and its histological analysis revealed characteristics of RDD. This is typically sporadic histiocytosis with emperipolesis in the cells. Clinically, the condition is benign, and all that is required is conservative therapy and periodic monitoring of its progression. Surgical excision is rarely advised until the disease has grown to an unmanageable size and is causing respiratory impairment or a cosmetic deformity. Currently, therapy revolves around surgical and immunosuppressive treatments, but the optimal diagnostic and therapeutic management of RDD remains to be defined.

Restoring Teeth Aids in Restoring Identity- Role of Restorative Dentistry in Forensic Odontology

Forensic odontology is a relatively new branch in the field of dentistry that has opened a new horizon for many dentists. With a surge of crime rates and lawsuits in the world, the need for specialists to help in identification of postmortem remains has increased. The reason for forensic odontology as an up-and-coming field in recent times is because teeth and the surrounding orofacial structures, similar to fingerprints, are unique features and can be used for definitive identification. This uniqueness can be attributed to variations in morphology, size and different treatment history of every individual. Teeth are a good source of data for postmortem studies as they are durable structures and are able to resist decomposition. For this reason, forensic odontology has become a promising field in recent times. Materials used to restore teeth have also shown durability in adverse conditions and increase the variations that can help in identification as restorations can be considered as unique features. The aim of this review article is to describe the various ways restorative materials can aid in identification of individuals.

Clomipramine Induced Extrapyramidal Symptoms: A Case Series

Disha Mukherjee, Madhurima Khasnobis, Anirban Ray

Extra Pyramidal Symptoms (EPS) are a group of symptoms that include dystonia, bradykinesia, tremor, akathisia, and tardive dyskinesia. They are caused by the blockage of D2 receptors in the nigro-striatal pathway and the imbalanced acetyl choline activity that results in the basal ganglia. It most likely happens when first-generation antipsychotics taken in large doses and some second-generation antipsychotics. A few tricyclic antidepressants, including amitriptyline and clomipramine, Monoamine Oxidase (MAO) inhibitors, such as phenelzine, and SSRI (fluoxetine), such as fluoxetine, may also cause EPS. Antiemetics (domperidone), antiepileptic medications like phenytoin and carbamazepine, and anti-migraine medications like sumatriptan are a few additional causes of EPS. Schizophrenia patients who have never been prescribed medication may also exhibit similar movement problems. The Tricyclic Antidepressant (TCA) clomipramine is a tertiary amine that has potent D2 blocking and serotonin and norepinephrine reuptake inhibitor characteristics. Constipation, dry mouth, nausea, dizziness, drowsiness, tachycardia, sweating, arrhythmia, and seizures at high doses are common side effects associated with clomipramine. In this case series, three patients from different age groups are presented, the first one being a 38-year-old female with a diagnosis of paranoid schizophrenia, the second one was a 26-year-old male with the Obsessive Compulsive Disorder (OCD)- washer type, and the third one was a 62-year-old female with dementia, all of whom developed signs of EPS like dystonia, bradykinesia and tremors following the introduction of clomipramine. In all the patients, the drug was stopped and the patients were cured. This case series stresses that a clinician should be cautious about the possibility of extrapyramidal side effects while using the TCA Clomipramine which is commonly known for its anticholinergic side effects.