Journal of clinical and diagnostic research

Trichinellosis: A Case of Life-threatening Myositis and Myocarditis in Garhwal Hill Region

Human Trichinellosis is now a rare zoonotic disease. Although the disease is not uncommon, rather non specific symptoms make the disease, a rare thought differential in acute febrile gastroenteritis. Incidence has decreased owing to healthy eating habits. The infection usually manifests with subclinical disease presentation, and acute gastroenteritis; however occasionally leading to life-threatening myocarditis, myositis and seizure. Diagnosis requires a low threshold for suspicion and evaluation. Muscle biopsy serves as the definitive diagnostic method. Most often it resolves without any treatment whereas severe cases require high dose intravenous glucocorticoid and antihelminthic. Here, authors report a case of a 23-year-old female patient, who presented with lifethreatening acute onset, progressive pure motor quadriparesis with myocarditis. After detailed clinical and laboratory investigations, the possibility of acute infectious aetiology with eosinophilia, myocarditis, and myositis was diagnosed, and a muscle biopsy was performed. The patient was diagnosed with Trichinellosis after ruling out other causes of acute motor paralysis. The patient improved after albendazole and glucocorticoid therapy. The case represents an uncommon cause of myositis and myocarditis. Detailed review of the history and epidemiology of the infectious disease should always be given priority for early diagnosis. The case also gives the importance of timely treatment which was life-saving.

Cardiac Sarcoidosis in an Adult Male: An Autopsy Finding

Ruchi Agarwal, Surbhi Jain, Anjali Sindhu, Kulwant Singh

Sarcoidosis is an inflammatory disease of unknown cause which results in the formation of non caseating granulomatous lesion. Lung and lymph nodes are most frequently involved, however any organ of the body can be affected. Although, it has been observed that approximately one fourth of cases of sarcoidosis develop cardiac involvement, only 5% show clinical manifestations and most cases are diagnosed in autopsy studies. Here, an uncommon case of cardiac sarcoidosis presented, diagnosed on autopsy. A 68-year-old male was brought dead to the hospital to conduct an autopsy. On dissection, in the coronal cut of the heart specimen, multiple small greyish white nodules were seen in left ventricular wall. Special stains like Ziehl Neelsen (ZN) stain for tubercular bacilli and Periodic Acid Schiff (PAS) stain and Grocott’s Methenamine Silver (GMS) stain for fungal aetiology were non contributory. Histopathological examination revealed multiple non caseating granulomas with numerous giant cells rimmed by few scattered lymphocytes along with areas of fibrosis. A diagnosis of granulomatous carditis-sarcoidosis was given. This case report highlights that in all cases revealing non caseating granulomatous inflammation negative for acid fast bacilli and fungus, sarcoidosis should be suspected.

Spontaneous Rupture of Urinary Bladder with Vesicocutaneous Fistula in a HIV Positive Female: Case Report

Spontaneous rupture of urinary bladder is a rare presentation with high morbidity and mortality. Symptoms resemble acute peritonitis in most cases. Rarely, urine circumvents via vesicocutaneous fistula. A 60-year-old bed ridden female, seropositive for Human Immunodeficiency Virus (HIV), presented to the emergency department with complaints of suprapubic ulcer and urine leak from the ulcer site for 15 days. On clinical examination, there was Spontaneous Rupture of Bladder (SRUB) secondary to chronic retention of urine was found. Computed Tomography (CT) cystogram revealed vesicocutaneous fistula. She was managed using foley’s catheter insertion. Percutaneous Nephrostomy (PCN) insertion failed due to technical reasons. She soon succumbed due to Acute Kidney Injury (AKI), respiratory acidosis. This case is studied because of its rarity and importance of early diagnosis and management. Till date, no case of SRUB depicting clinical presentation in HIV patient has been reported.

Non Parasitic Chyluria and Nephrotic Range Proteinuria: A Case Report

Girish P Vakrani, Kumar KY Yashavantha, M Dileep, Mehra Kunal, Parachuri Sanjay

Chyluria is excreting chyle in urine leading to white urine. It can cause mild proteinuria. It could be parasitic or non parasitic in origin. It is often mistaken as nephrotic syndrome or urinary tract infection. Normal renal biopsy should prompt for further investigation. Lymphangiography or retrograde pyelogram can establish the diagnosis. Non parasitic chyluria is rare, but do occur like the one reported in this case. Hereby, authors discuss a case of chyluria associated with proteinuria in a 49-year-old male patient, due to non parasitic cause which was successfully treated. Treatment was done with installation of povidone iodine into renal pelvis. The resolution of chyluria and proteinuria suggest that abnormal lymphatic-urinary communications was causing chyluria.

Carvedilol Induced Toxic Epidermal Necrolysis: A Rare Case Report

Roma Dhande, Bhushan Madke, Adarsh Singh, Sugat Jawade

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life threatening immunologically mediated, mucocutaneous, Adverse Drug Reactions (ADR) associated with high mortality which requires immediate medical care. Carvedilol is a non selective adrenergic blocker used for the therapy of heart failure with hypertension and left ventricular dysfunction following Myocardial Infarction (MI) in clinically stable patients. Hereby, authors report of a 69-year-old male, with a history of MI and hypertension, who received Carvedilol at a dose of 75 mg daily and four days after the first dose of carvedilol, patient presented with erythematous maculopapular rash on face, trunk and limbs with fever up to 38°C. Skin biopsy from one of the fresh lesions showed apoptotic keratinoctyes, subepidermal cleft and monocytic infiltrate in the dermis and the findings were compatible with the diagnosis of TEN. Early recognition and cessation of the drug is of prime importance along with apt treatment and supportive care.

Ureteral Entanglement in Ring Inferior Venacava- A Rare Presentation

Dhansagar Uttamrao Wakle1 , Krishnendu Maiti, Dilip Kumar Pal

Ureteral entanglement in ring Inferior Venacava (IVC) also called Periureteric venous ring is a rare developmental anomaly, where right ureter passes through a slit like opening in a partially duplicated infrarenal IVC, this results in a dilated upper urinary tract. Authors hereby report a case of a 25-year-old married female presented with flank pain of right side of abdomen for seven months. On Contrast Enhanced Computed Tomography of Kidney, Ureters and Bladder (CECT KUB) with urography diagnosed as retrocaval ureter with right hydronephrosis. The patient was planned for right ureteroureterostomy. During surgery, it was found that right ureter was entangled in between slit like opening of inferior venacaval ring. Preureteral venacava with ring IVC is a rare phenomenon. Clinically it is very difficult to distinguish between the causes of ureteric obstruction. There is scarcity of such cases in the literature. The index case was also diagnosed intraoperatively and managed successfully.

Primary Cutaneous Mucormycosis in a Patient with Severe COVID-19 Infection

A 47-year-old male was brought to the hospital with the chief complaints of fever, breathlessness and cough since one week. He was a known case of Type 2 Diabetes Mellitus (T2DM) for five years and was on oral hypoglycaemic drugs. On presentation, he was hypoxemic with a SpO2 of 91% at 13 LO2 and his sugar level was 286 mg/dL. Further, chest imaging and Reverse TranscriptasePolymerase Chain Reaction (RT-PCR) was suggestive of severe COVID-19 pneumonia and his hypoxemic respiratory failure required Intensive Care Unit (ICU) stay. He was started on high flow oxygen therapy and due to further worsening of his condition, he required endotracheal intubation and mechanical ventilation. On 18th day after admission, he developed blackish blister lesion, insidious on onset and gradually spreading over right forearm over a week. Skin lesions have grown Mucor spp. in microbiological culture. It was diagnosed as primary cutaneous mucormycosis with no involvement of rhinocerebal region and pulmonary region. Immediately antifungal therapy was started and the lesion started resolving. The patient developed secondary bacterial infection, multiorgan dysfunction, the patient could not be revived. This case report demonstrates cutaneous mucormycosis as a rare possible complication of Coronavirus Disease 2019 (COVID-19) infection and emphasises the risk factors and diagnostic measures which helped to arrive at the diagnosis.

Russell Body Cervicitis Presenting with Contact Bleeding: A Case Report

Nimi Shabeer, Nandakumar Gopinath

Russell bodies are large (2-3 µm diameter) homogenous hyaline immunoglobulin inclusions, often single, seen in plasma cells displacing the nucleus to a side. When a plasma cell contains multiple vacuoles or inclusions, they are called mott cells. Russell body cervicitis is a rare inflammatory pathology in cervix, characterised by marked infiltration of plasma cells and mott cells. Very little is known about the aetiology, pathogenesis and natural course of this condition. Hereby, authors report an unusual case of a 41-year-old female, who presented with complaints of postcoital bleeding for two weeks. On clinical examination, a small cervical polyp was found and biopsied. Microscopy showed an endocervical polyp with stroma showing dense intense infiltration with plasma cells and multiple mott cells with russell bodies. The cells showed positive immunoreactivity for CD138, kappa and lambda. The histological changes in chronic cervicitis are non specific with a mixed inflammation composed of lymphocytes, plasma cells, histiocytes and stromal fibrosis. However a presentation of sheet like plasmacytic inflammatory infiltrate in the cervix accompanied by numerous russell bodies is a rare histologic finding with very few published literature. A similar histological pattern has been recorded in other sites, including russell body gastritis, a recently recognised pseudotumoral lesion of stomach. Authors have presented this case to contribute to the few articles of russell body cervicitis in literature.

Live Pregnancy with Chronic Abruption-oligohydramnios Sequence: A Case Report

Pragati Jain, Reena Yadav, Nishtha Jaiswal, Kiran Agarwal

Chronic Abruption-Oligohydramnios Sequence (CAOS) is a diagnosis during pregnancy, which is characterised by chronic antepartum haemorrhage and oligohydramnios. The CAOS affects foetal outcome as it is associated with preterm delivery and high chances of foetal mortality. Chronic abruption should be judiciously differentiated from other acute cause of antepartum haemorrhage and bleeding in early trimester. Here, a very rare entity of CAOS was reported, in which a 22-year-old primigravida presented at 29 weeks of gestation with a live pregnancy. Ultrasound was done which showed a live foetus of 27 weeks gestation, with reduced liquor (Amniotic Fluid Index (AFI)=2-3) with intra-placental collection of depth (7cm) and a large retroplacental collection (9.2×6.7 cm). In the present case, timely intervention and decision for termination, lead to favourable foetal and maternal outcomes. As CAOS is related with high foetal mortality, interventions to expedite foetal lung maturity should be planned and weighing upon the maternal and foetal outcomes, termination should be considered.

Moyamoya Syndrome with Recurrent Stroke in a Splenectomised Patient with Beta-Thalassaemia Major: A Case Report

Moyamoya Syndrome (MMS) is a progressive disease with typical angiographic ‘moyamoya’ alterations. Here, the authors discuss a case of 16-year-old male patient who developed MMS after being diagnosed with ß-thalassaemia major. This patient was detected with heterozygous mutations in the ß-globin gene and underwent splenectomy at the age of 12 years. Four years postsplenectomy he presented with paresis of the right upper limb. Magnetic Resonance Imaging (MRI) showed infarction and stenosis of the internal carotid artery with the collateral vessel’s formation. Recurrence of stroke and progression of the vasculopathy were seen. Till now, only a few cases of MMS have been linked to thalassaemia major.

Uterocutaneous Fistula- A Case Series

Nishi Choudhary, Monika Gupta, Sunita Malik

Uterocutaneous Fistula (UCF) is an uncommon condition, which usually occurs as a postoperative complication. Authors, hereby presented three cases of UCF. First case was of 40-year-old multigravida who presented with pus discharge from anterior abdominal wall for three months duration following an open uterine myomectomy. Her UCF was confirmed after methylene blue dye test and Magnetic Resonance Imaging (MRI). She had unsuccessful closure of UCF after three months of Gonadotropin-Releasing Hormone (GnRH) analogue therapy and complete excision of the fistulous tract was achieved later. She was asymptomatic after 24 months of follow-up. Second and third case was primigravida patients who developed UCF after caesarean section and were managed conservatively. Uterocutaneous fistula is a rare clinical entity, and its prevention is the best strategy with avoidance of postoperative infection and better surgical technique. Authors reviewed here the cases of UCF after abdominal myomectomy and caesarean section and its management.

Simulating the Nature: Case-Specific Clinical Techniques to Create Biomimetic Direct Posterior Composite Restorations- A Case Series

Ajay Singh Rao, Suwidhi Ranka, Nimisha C Shah, Jaimini Patel, Dipen Bhatt

This article describes various clinical techniques of direct posterior composite restoration to compensate for the polymerisation shrinkage stress and at the same time to create biomimetic (Life-like) restorations. Selection of the technique depends upon the amount of intact tooth structure, extent and depth of the caries. If caries was limited to pit and fissures only then horizontal or oblique layering technique can be used and if occlusal anatomy was intact the tooth can be restored by using occlusal stamp technique. Use of appropriate techniques of restoration govern the success of direct composite restoration and can improve the durability of the restoration.

Fish Bone Impaction in Upper Digestive Tract with Life Threatening Complications- A Case Series

SP Cibhi, A Murugan, Ramanjaneyulu Kantu, KV Rajan

Unintentional fish bone ingestion is a common perception in emergency surgery department especially in coastal areas. Authors present a case series of three patients with ingested fish bones, successfully removed from the upper digestive tract in two patients who presented immediately after ingestion. Another patient who had similar history with late presentation, had various complications and was managed conservatively. Computed Tomography (CT) scan is an important diagnostic tool in locating the foreign body and its associated complications. Contrast Enhanced Computed Tomography (CECT) carries a vital role in identifying the associated vascular injury in patients with delayed presentation with hematemesis or malena, which can be missed in plain CT. Most of the foreign bodies following ingestion pass spontaneously through the oesophagus without any complications, whereas sharp foreign body like fish bones may get stuck in the oesophagus or penetrate the oesophageal wall causing life threatening complications such as aorto-oesophageal fistula, trachea-oesophageal fistula mediastinitis, mediastinal abscess and pneumothorax. Hence, early endoscopy and intervention is the key to treatment of foreign body ingestion in upper digestive tract.

Impressions for Multiunit Implant Supported Prosthesis: A Simple and Innovative Technique

Raghavendra Adaki, Banashree Sankeshwari, Dayanand Huddar, Tanisha Misquitta

Making of impression is an integral part of fabrication of prosthesis. Quality of impression material and technique used to fabricate will influence fit of prosthesis. The precise transfer of the spatial relationships of implants from the mouth to the master cast with an impression is the first and crucial step to ensure passive fit of implant framework. As passivity of prosthesis is mandatory for implant supported fixed prosthesis, failure to achieve the same will lead to considerable stresses to screw retained prosthesis which leads to loosening of prostheses and screw fracture. Making of impression in multiple unit implant cases becomes even more crucial. To achieve accurate impression in previous study has emphasised on the importance of splinting impression copings together for multiunit implant impression. Various researches have been done regarding use of different splinting materials and impression materials. Use of die stone has never been attempted as impression material for implant impressions. In this article, authors have put forth an innovative technique of using rigid and non rigid impression material without any splinting technique or rather using die stone impression material itself as a splinting material to make impression in an implant supported prosthesis.

Full Mouth Rehabilitation of a Patient with Amelogenesis Imperfecta using Twin Stage Procedure

Vineet Sharma, Jyoti Paliwal, Kamal Kumar Meena, Ashish Dadarwal, Amit Singla

Complete Management of Maxillary Impacted and Dilacerated Central Incisor

Ruby Shah

Importance of Maternal Red Cell Antibody Screening: A Spectrum of Two Neonatal Cases with a Positive Direct Antiglobulin Test

Sirat Kaur, Ashish Jain, Praveen Kumar, Ratti Ram Sharma

Opportunistic Oesophageal Candidiasis in a Patient with COVID-19 Infection

Abhijit Wadekar, Sanyukta Hepat, Anamika Giri, Samarth Shukla, Sourya Acharya

Dear Editor, Currently, the world is dealing with the catastrophic global pandemic of Coronavrus Disease-2019 (COVID-19). With new mutant strains arising, the complications of COVID-19 are increasing and adding to our anxieties and concerns. The COVID-19 era is also giving rise to new opportunistic infections in the patients. Amongst these opportunistic infections the most common are fungal infections like mucormycosis, candidiasis, aspergillosis [1,2]. Candidiasis is commonly encountered in the oral cavity in the form of oral thrush. Invasive candidiasis, like oesophageal candidiasis, is a rare occurrence in immunocompetent individuals (2). The mechanism of such severe infections post COVID-19 can be attributed to the severe immune dysregulation which is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. These fungal infections can occur in similar way of fever, cough and shortness of breath thus making the diagnosis even more challenging. COVID-19 patients who are admitted in intensive care unit are more vulnerable to such infections (3). The pathogens causing secondary infections in a SARS COV-2 can be either bacterial or fungal, candida being one of them (4). Early diagnosis and prompt treatment of these life threatening opportunistic infections are mandatory (4). Inadequate investigations, missing clinical clues, overuse of antibiotics leading to resistance are the underlying reasons for such simple infections to become life threatening (5). In the current scenario while the treatment of COVID-19 remains a challenge in itself. Thus, it is in the best interest of the patients, that as clinicians we rely on the early diagnosis and prompt treatment to reduce mortality (6). A 59-year-old male was admitted in hospital with diagnosis of moderate COVID-19 infection. He was treated with intravenous (i.v.) antibiotics, injection remdesivir for five days, steroids and anticoagulants and was discharged after seven days in a stable condition. This patient again presented three weeks later with chief complaints of dysphagia and odynophagia, which was more for solids than liquids. There was no history of hoarseness of voice, swelling of neck, stridor, no history of diabetes mellitus. On examination, the patient was stable, respiratory rate 16/min with saturation on room air 95%, blood pressure 120/70 mmhg. Cardiovascular system, respiratory system, central nervous system and per abdomen examination revealed no abnormalities, no cervical lymphadenopathy and goiter. Oral cavity examination revealed no oral thrush, glossitis or ulcers. His COVID-19 panel blood investigations showed raised C-Reactive Protein (CRP) and D-dimer. In view of dysphagia, upper gastrointestinal endoscopy was done, which showed candidiasis growth in oesophagus as shown in (Table/Fig 1). Sample was sent for histopathology which was suggestive of candidiasis spores shown in (Table/Fig 2). The patient was treated with injection fluconazole 100 mg twice a day for 15 days post-treatment he clinically improved and his symptom of dysphagia and odynophagia were resolved. Repeat endoscopy was done which was found to be normal. Candidiasis is a simple fungal infections affecting mankind since hundreds of years. These infections can be in the form of skin infections, oral thrush, vaginosis or affect the gastrointestinal system. These simple conditions become life threatening when they present as secondary infections in post COVID-19 patients (1). Fungal yeast species belonging to the Candida genus, range from Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, are the most prevalent fungal species inhabiting various mucosal surfaces, such as the skin and the respiratory, digestive, and urinary tracts (2). Although being commensal within the human host, Candida species are equipped with virulence attributes, enabling them to invade when opportunities arise and causes various infections in humans, especially when the immune system is impaired (7). Similar cases of opportunistic fungal infections in COVID-19 patients have been reported since the COVID-19 pandemic, few of which have been summarised below in (Table/Fig 3) [8-11]. Diagnosis of invasive candidiasis remain challenging. Various investigatory tools like blood culture, non-culture entities like β-DGlucan (BDG) and mannan antigen testing, molecular methods like Polymerase Chain Reaction (PCR) or even Enzyme-Linked Immunosorbent Assay (ELISA) kits can be used for detection (7). Imaging techniques like MRI, endoscopy can also be used for diagnosis (4). Invasive candidiasis has a higher mortality rate if treatment not started at the right time. ss. The management of invasive candidiasis in patients with COVID-19 is similar to that of non COVID-19 patients (5). Echinocandins are the treatment of choice for invasive Candida infections. Second line alternatives are fluconazole, liposomal amphotericin B, voriconazole, posaconazole and isavuconazole. Other preventive measures include hygiene, source control and even prophylaxis in a prolonged hospitalised patient (6). As the world fights a battle in the dark, we as clinicians should we well aware of these secondary infections which can be treated rather easily than losing the patient to post COVID-19 complications. Such cases of mortality should be reported, so that the medical fraternity is made well aware of the scenario.

Is there a Relationship between Quality of Life, Anxiety, Physical Activity and Physical Performance among Maintenance Haemodialysis Patients?

Nevin Adel Amer, Ahmed S Alkarani, Atallah Alenezi, Rahma Abdelgawad Elkalshy

Introduction: The Maintenance Haemodialysis (MHD) patients often experience poor Quality Of Life (QOL), low physical activity and performance, increased anxiety level. The overlapping between these factors and its effect in life quality is incomprehensible. Aim: To determine the relationship between QOL, anxiety, physical activity and performance in MHD Patients. Materials and Methods: A cross-sectional, descriptive study was conducted on 68 patients selected from four Haemodialysis (HD) Unit at Shebin El-Koom city Menoufia Governorate, Egypt from February 2020 to April 2020. Total 68 MHD patients were taken according to the selected criteria. Tools of the study were demographic data sheet, Kidney Disease and Quality Of Life (KDQOL ™-36), Beck Anxiety Inventory (BAI), 6 Minute Walk Test (6-MWT) and the 30 seconds Sit to Stand Test. Pearson’s correlation co-efficient was used. The level of significance for all statistical tests was set at p-value <0.05. Results: The mean±SD age of the MHD patients was 59.73±11.45 years. A 58.8% of the participants were males. Total 67.7% of patients experienced severe anxiety. The mean and standard deviation of (6-MWT) and the 30 seconds Sit to Stand Test were 191.74±97.05 meters and 7.74±2.34 cycles, respectively. The BAI was negatively correlated with KDQOL, physical activity and Physical Performance (PP) where the r and p-values were (r=-0.36, p-value= 0.03; r=-0.87, p-value=0.001; r=-0.73, p-value=0.001, respectively). There was a positive correlation between KDQOL score and physical activity (r=0.40, p-value=0.01). Conclusion: The study concluded that there were associations between the variables and recommended that greater attention should be paid to regular evaluations of QOL, anxiety, and physical activity. It also recommended treating anxiety effectively to help improve QOL, physical activity, and performance.

Assessment of Vaccine Wastage in an Immunisation Clinic of a Tertiary Care Centre in Western Odisha- A Cross-sectional Study

Aliva Patra, Sasmita Pradhan, Smita Kumari Panda

Introduction: Vaccine wastage is an expected component of any immunisation program. Wastage is defined as “loss by use, decay, erosion or leakage or through wastefulness”. Vaccine wastage in unopened vial is mostly attributed by cold chain and stock management problem. Vaccine wastage in opened vial is mostly due to discarding of remaining dose at the end of the session, not being able to draw the number of doses in a vial, submergence of opened vials in water and poor vaccine administration practices. Aim: To assess the vaccine wastage in an immunisation clinic of a tertiary care centre in western Odisha, India. Materials and Methods: A record based descriptive cross-sectional study was carried out at Immunisation Clinic, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India. The information regarding children and pregnant women vaccinated were retrieved from immunisation register for the study period 1st October 2019 to 30th September 2020. Vaccine wastage rate at the immunisation clinic was calculated by taking into account the number of doses of vaccines wasted divided by the total number of the doses of vaccines issued multiplied by 100. Results: Vaccine wastage rate and wastage factor was found to be highest in case of Measles-Rubella (MR) vaccine (wastage rate 65% and wastage factor 2.85) and lowest in Hepatitis B vaccine (wastage rate 1.67% and wastage factor 1.01). Wastage rate for 10 dose vial was 28.37% followed by 19.72% for 25 dose vial and 10.11% for 20 dose vial. Wastage rate and wastage factor was found to be higher in lyophilised vaccines when compared to liquid vaccines and the difference was statistically significant. Wastage rate and wastage factor was found to be higher for oral vaccines when compared to injectable vaccines and the difference was statistically significant. Conclusion: It was seen that in case of MR vaccine (supplied as 10 dose/vial), vaccine wastage was more as it didn’t follow open vial policy and less number of beneficiary came for MR vaccine per immunisation session. The vaccine wastage can be reduced in lyophilised vaccines if they are supplied in less doses per vial.

Association of Vitamin B12 with Atherogenic Index of Plasma- A Cross-sectional Study

Vidya Bhakta, Said Khader, Rubeena Quadri

Introduction: Vitamin B12 has a pivotal role in several metabolic processes and it’s inadequacy can pose serious health implications. Aim: To assess if vitamin B12 inadequacy is associated with increased risk of Cardiovascular Disease (CVD) based on the Atherogenic Index of Plasma (AIP). Materials and Methods: A cross-sectional, retrospective study was conducted in a tertiary care hospital, Riyadh, Saudi Arabia from December 2019 to January 2021. Data of apparently 569 healthy individuals within the age range of 18-60 years, who were screened for vitamin B12 deficiency was collected. The variables were analysed by ANOVA under categories of vitamin B12 level; Deficient (<148 pmol/L), Marginal (148-221 pmol/L) and Sufficient (>221 pmol/L). Correlation and regression analysis were done to find the correlation of vitamin B12 with lipid profile and AIP. The level of significance was set at p-value <0.05. Results: The prevalence of B12 deficiency was found to be 7.2%. B12 was negatively correlated with Triglycerides (TG) (r=-0.161, p-value <0.05). Total Cholesterol (TC) (r=-0.169, p-value<0.05) and AIP (r=-0.15, p-value <0.05). According to regression analysis for every unit increase in B12, the TG and AIP decreased by 0.001 unit and TC reduced by 0.002 unit even after model adjustment for age, gender and BMI. Conclusion: Vitamin B12 is inversely related to AIP. The lower level of vitamin B12 is related to increased cardiovascular risk and poor lipid profile.

Dose Effect Response of Melatonin Premedication in Oncosurgical Patients: A Randomised Controlled Trial

HM Ravikiran, Kavitha Lakshman, Namrata Ranganath

Introduction: Cancer patients experience higher levels of pathological anxiety than other patients. Though several studies have reported perioperative use of melatonin in alleviating preoperative anxiety with minimal side effects, research on the perioperative use of melatonin in oncology patients is scarce. Aim: To analyse the preoperative anxiolysis, sedation, sleepiness and hemodynamic response to intubation after premedication with oral melatonin at two different doses of 0.3 mg/kg and 0.5 mg/kg body weight and comparing them with placebo. Materials and Methods: This was randomised controlled trial on a total of 90 cancer patients aged 18-60 years undergoing elective surgeries under general anaesthesia were randomised into three groups of 30 patients each. Oral melatonin 0.3 mg/kg, oral melatonin 0.5 mg/kg, and placebo were given to patients in Groups A, B, and C, respectively. The Visual Analogue Score (VAS), Ramsay Sedation Scale (RSS), and Stanford Sleepiness Scale (SSS) were used to assess anxiety, sedation, and sleepiness before and 90 minutes after premedication. Heart rate (HR), systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressures were also measured. For intragroup comparison, a paired t-test and for intergroup comparison, ANOVA (Analysis of Variance) and difference-in-differences regression analysis were performed. Results: The three groups (group A: oral melatonin 0.3 mg/kg, group B: oral melatonin 0.5 mg/kg, group C: placebo) each having 30 patients were comparable with regard to demographic profiles with insignificant p-value. Melatonin had no significant anxiolytic impact when compared to placebo (p>0.05). However, melatonin offered considerable sedation and haemodynamic stability in a dose-dependent manner. Melatonin 0.5 mg/kg (group B) gave better sedation (RSS score: 3.30±0.11) and haemodynamic stability (fall in Mean Heart Rate: by 7.4 after premedication) than melatonin 0.3 mg/kg) (RSS score: 2.77±0.12; fall in mean Heart rate after premedication: by 7.76) than the placebo (RSS score: 2.17±0.07; fall in mean Heart Rate: by 0.2). Conclusion: Oral melatonin provides better sedation and haemodynamic stability during endotracheal intubation in a dose-dependent manner when compared to placebo. But when required for sole anxiolysis melatonin was similar to placebo. Further studies are warranted to explore the safe dose for the anxiolytic effect of oral melatonin in cancer patients.

Effect of Two Different Doses of Dexmedetomidine on Extubation Quality Score during Tracheal Extubation in Adult Patients- A Randomised Controlled Trial

Monu Chaudhary, Pramod Gupta, Shipra Aggarwal

Introduction: Extubation of the trachea is the process of discontinuing the artificial airway when the need for ventilation and protection of the airway are absent. Extubation most of the time is associated with haemodynamic changes like hypertension, tachycardia and dysrhythmias. Extubation during lighter planes of anaesthesia can stimulate reflexes by laryngeal and tracheal irritation which may lead to laryngospasm and bronchospasm. Aim: To study the effect of two different doses of dexmedetomidine on extubation quality score during tracheal extubation in adult patients undergoing Ear, Nose and Throat (ENT) surgeries. Materials and Methods: The present study was a randomised controlled trial in which 120 patients with American Society of Anesthesiologists (ASA) grade I and II, aged 18-60 years, were randomised into two groups, D1 and D2, to receive dexmedetomidine 0.3 µg/kg and 0.5 µg/kg, respectively. The drug was infused over 10 minutes before skin closure. Extubation quality score was assessed on a 5-point scale and sedationagitation scale was recorded during tracheal extubation. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP), Oxygen Saturation (SpO2), Electrocardiography (ECG) were noted at two, five and ten minutes interval during endotracheal extubation, and after that every 10 minutes till one hour. Mann-Whitney U test was used for quantitative data and Chi-square test, Fisher's-exact test were used for qualitative data. Results: Quality of extubation was better in D2 as compared to D1. There was no severe coughing in D2 as compared to D1 {0/60 (0) vs 4/60 (6.67%), p-value 0.027}. Lesser number had minimal coughing in group D2 as compared to D1 {9/60 (15%) vs 13/60 (21.67%), p-value 0.047}, 15/60 (25%) of patients were found sedated in group D2 and 5/60 (8.33%) were found sedated in group D1 (p-value 0.039). Patients in group D2 were more haemodynamically stable than D1 during extubation. Conclusion: Present study concluded that dexmedetomidine 0.5 µg/kg administered before tracheal extubation, had a better extubation quality score, better sedation–agitation scale and was more effective in maintaining the haemodynamic stability as compared to dexmedetomidine 0.3 µg/kg.

Thromboelastography Parameters Suggestive of Hypercoagulability and its Correlation with Thrombotic Complications in Liver Transplantation- A Retrospective Study

Satish Logidasan, Kanimozhi Rathinasamy, Gowrishankar Anjeneyan

Introduction: Conventional coagulation parameters like, Prothrombin Time (PT), International Normalised Ratio (INR) reflects only the synthesis or status of procoagulant factor levels. Whereas, Thromboelastograph (TEG) reflects ongoing coagulation process and helps in identifying hypocoagulable or hypercoagulable status. The hypercoagulable TEG parameters in the perioperative period can guide the physicians to prevent adverse thrombotic complications, instead of depending on the Conventional Coagulation Tests (CCTs), which has the potential to mislead and may delay appropriate clinical interventions. Aim: To establish, if correlation exists between TEG parameters suggestive of hypercoagulability and the occurrence of perioperative thrombotic complications and also to see if CCT correlates with hypercoagulable TEG parameters in liver transplantation. Materials and Methods: This was a retrospective analysis which was done in 32 patients of Diseased Donor Liver Transplantion (DDLT), from August 2018 to September 2019 at tertiary care centre in Chennai, Tamil Nadu, India. Data were analysed for correlation with hypercoagulable TEG parameters and perioperative thrombotic events. Thromboelastograph parameters were also compared with CCT like INR, platelet count. The Mann-Whitney U-test was considered significant if p-value <0.05, at 95% confidence interval. Results: Amongst the aetiology of the transplanted patients (32), the highest number of patients in the present study had alcoholic liver disease {n=11 (34.37%}. A comparison of paired G values with International Normalised Ratio (INR) showed that there was no significant correlation between G value and INR {r=-0.2, p-value=0.47 (Spearman’s rank correlation)}. The G values were compared with platelet counts and a moderate correlation was found (r=0.62, p-value <0.001). The patients with high G traces had platelet counts of normal reference range. There was no correlation between the R time and INR (r-value=0.04), (p-value=0.32). Conclusion: Thromboelastograph parameters suggestive of hypercoagulability can be useful to predict the occurrence of thrombotic complications in liver transplant surgery. The present study found a moderate correlation was seen between the G value in TEG and platelet counts. No correlation was present between r value and INR value. There is always a possibility of aggravating the thrombotic potential, if the management is solely based upon the PT, INR, platelet count values.

Impact of Functional Disability on Quality of Life in Patients with Haemophilia: An Observational Study

Ashish Kavia, Mrinal Joshi, Surbhi Mittal, Poonam Banthia

Introduction: Haemophilia is a disease characterised by multiple episodes of spontaneous as well as traumatic bleeding leading to joint pains, joint damage. As a result, there may be disability ultimately leading to a compromised Health Related Quality of Life (HRQoL). This impairment is related to the severity of the clotting factor defect, bleeding frequency and orthopaedic problems. Aim: To find out the correlation of quality of life with functional disability in patients with haemophilia A and B. Materials and Methods: This observational study was conducted from April 2012 to November 2013 on 88 patients with haemophilia A and B, aged between 11 to 50 years. The Physical Component Summary (PCS) and Mental Component Summary (MCS) score was calculated using the short form health survey (SF-36) questionnaire, which is used to assess HRQoL. Gilbert score was used for assessing functional disability. The patients were analysed at initial presentation and then at six months follow-up. All scores were calculated at both times, and comparison was done according to different age groups as well severity of haemophilia. Correlation between SF-36 and Gilbert score was evaluated using various statistical methods. Results: All 88 patients were males with the mean age was 21±9.9 years, with 90.91% being type A haemophilia and 9.09% being type B haemophilia. Clinical presentation of haemophilia patients included bleeding into joints and muscles, gum bleed and epistaxis. Mean scores for PCS and MCS at the initial evaluation were 26.34 and 28.53 and after six months the scores were 29.79 and 29.87, respectively. The overall mean Gilbert score for different age group at initial evaluation and six months were 4.46 and 3.20, respectively. Gilbert score increased with age as well increasing severity of haemophilia. In comparison, PCS and MCS scores decreased with age as well as with increasing severity. Using linear regression and correlation, a negative correlation between functional disability and HRQoL was found. Conclusion: Negative correlation between functional disability and quality of life suggested that when there is increase in functional disability there is a decrease in quality of life. Also, as severity of haemophilia increases the functional disability and quality of life decreases. Therefore, an early intervention in haemophilia patients is important to reduce functional disability. The quality of life can be improved by limiting the functional disability. These findings should aid in improving healthcare delivery to the patients of haemophilia.

Comparison of Menstrual Hygiene Awareness and Practices among School going Adolescent Girls of Government and Private Schools

Alka Modi Asati, Sandeep Singh, Chakresh Jain, Anshuman Sharma

Introduction: Menstruation is an important milestone in a girl’s life, which marks the beginning of her reproductive life. Awareness about menstrual hygiene is a vital aspect of health education among menstruating girls to avoid insufficient and incorrect information regarding menstruation. Aim: To find the awareness and their hygiene practices about menstruation among adolescent girls in government and private schools. Materials and Methods: A descriptive cross-sectional study was conducted among 200 adolescent girls of 9th to 12th standard of government and private schools of Rewa, Madhya Pradesh, India for four months from June 2019 to September 2019, after obtaining informed consent from their parents and principals of respective schools, with the help of a pretested and semi-structured questionnaire. Data were analysed statistically by simple proportions. Chi-square test was applied to find the association between the variables. Results: Mean age of the participant girls was 15.82±1.34 years. An 84.88% of girls of private schools had heard about menstruation before menarche, 96.5% girls of private schools and 87.7% girls of government schools knew menstruation is a normal phenomenon. Hygienic practices are better in private school’s girls than government school. Study participants of government schools experienced more restrictions than private school girls. Conclusion: Awareness about menstrual health among adolescent girls was less, so it is essential that health professionals and officials of health must give family education and trained teachers about factors affecting the reproductive health of girls.

Comparison of Two Doses of Intravenous Dexmedetomidine as Premedication for Laryngeal Mask Airway Insertion in Adults: A Randomised Clinical Trial

Introduction: The Laryngeal Mask Airway (LMA) has gained popularity in recent years for both rescue ventilation as well as airway management device for General Anaesthesia (GA). Adequate jaw relaxation and blunting of airway reflexes prevents haemodynamic changes during LMA insertion. Several drugs have been used as adjuncts to Intravenous (IV) Propofol, of which Dexmedetomidine in a dose of 1 μ/kg is now gaining popularity. But at this dose significant bradycardia has been observed. Hence, the study aimed at comparing 1 µ/kg of Dexmedetomidine, with a lower dose of 0.8µ/kg to assess the same. Aim: To compare two different doses of intravenous dexmedetomidine 0.8 µg/kg and 1 µg/kg as premedication with propofol 2 mg/kg for ease of insertion of LMA, attempts at LMA insertion and secondary objectives included, additional propofol requirements, adverse effects. Materials and Methods: The present study was a randomised double blind clinical trial in which a total of 180 American Society of Anesthesiologists (ASA) grade I and II patients undergoing short procedures under GA not exceeding more than two hours were included. Those with Heart Rate (HR) <60 bpm (beats per minute), on beta blockers, restricted mouth opening were excluded. The patients were randomly divided into group 1 and 2 who received dexmedetomidine at 0.8 µg/kg and 1 µg/kg as an infusion over 10 minutes, respectively. HR, Respiratory Rate (RR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) were noted before dexmedetomidine administration, after administration, 30 seconds after induction and 1, 3, 5 ,10, 15, 20 and 25 min after LMA insertion, conditions for LMA insertion were assessed using Muzi M et al., score which includes (Jaw mobility was graded as: 1-fully relaxed; 2-mild resistance; 3-tight but opens; 4-close. Coughing/movement were graded as: 1-none; 2-one or two coughs; 3-three or more coughs; 4-bucking/movement), number of attempts at LMA insertion, additional doses of propofol if administered, adverse effects. Statistical analysis was done using Independent t-test, Chi-square test and p-value <0.05 was considered statistically significant. Results: The conditions for LMA insertion were adequate and comparable in both groups with 94.4% of patients in group 1 and 91.1% patients in group 2 having a Muzi M et al., score of 2 (jaw mobility graded as- fully relaxed and coughing/movement graded as- none). Five patients in group 1 and eight patients in group 2 had more than one attempt at LMA insertion (p-value of 0.303). There was statistically significant drop in HR in group 2 compared to group 1 (p-value <0.001). Also, a statistically significant drop in SBP, DBP, MAP in group 2 compared to group 1 was observed. There was no statistically significant difference in the requirement for additional propofol bolus in the two groups. Conclusion: IV dexmedetomidine 0.8 µg/kg used as premedication, administered as an infusion over 10 min provides smooth LMA insertion conditions and can be used as a safer alternative to IV dexmedetomidine 1 µg/kg.

Sleep Quality and Psychological Parameters: A Cross-sectional Study on Medical Students during Second Wave of COVID-19 Pandemic

Introduction: Stressors are defined as any event or conditions in the surroundings that may trigger stress. Medical students have immense stress of academics already and to this, second wave of Coronavirus Disease 2019 (COVID-19) pandemic worsened the scenario by having deleterious effect on the sleep quality, sleep duration and psychological parameters. Aim: To investigate the association between mental health and sleep health among medical students during second wave of COVID-19 pandemic. Materials and Methods: The present study was a crosssectional study, done on 180 medical students during first week of April 2021 within 10 days, after the Institutional Ethical clearance. The survey form was given in six groups of 30 students each with first description of the study and getting the informed consent. The study was done by using three widely used and validated tools, Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS) and General Anxiety Disorder-7 (GAD-7). All the students voluntarily participated in the survey. Descriptive statistics and correlation test were applied using Statistical Package for the Social Sciences (SPSS) version 26.0. The Correlation coefficient between three parameters was assessed using r-value. Results: The study results show that 72.22% of the students were having moderate stress and 29.44% of the students were having poor quality of sleep. An 18.89% of participants were moderately anxious for several days during this second wave of pandemic. Conclusion: Increased level of stress and anxiety had a direct impact on the quality of sleep due to second wave of COVID19 pandemic.

Association between Thyroid Stimulating Hormone with Components of Metabolic Syndrome in Postmenopausal Women

D Namitha, Paul Mathew, YD Shilpashree

Introduction: Metabolic Syndrome (MS) identifies a group of metabolic disorders that includes glucose intolerance, central obesity, hypertension and dyslipidaemia that place the affected individual at exaggerated risk for developing disorder, in addition as exaggerated mortality from all causes. Aim: To evaluate serum Thyroid Stimulating Hormone (TSH) levels and to determine the correlation between serum concentrations of TSH with components of MS among postmenopausal women with MS. Materials and Methods: A cross-sectional observational study was conducted for the period of four months on 100 postmenopausal women between 45-65 years who attended Outpatient Department (OPD) of Obstetrics and Gynaecology, Adichunchanagiri Institute of Medical Sciences (AIMS), Mandya, Karnataka, India. A fasting blood sample was collected from all the subjects, serum was used for estimating Fasting Plasma Glucose (FPG), Lipid profile, and Serum TSH. Results were presented on Mean±SD (Standard Deviation) (Min-Max) and in Number (%). For the comparison of means, Analysis of Variance (ANOVA) test was used. Correlation was examined by determining Pearson correlation coefficient (r-value). A p-value <0.05 was taken as statistically significant. Results: Among the study population, the dysfunction in thyroid gland was found in 35 (35%). The major thyroid dysfunction was found to be hypothyroidism (32%) and only three had hyperthyroidism (3%). Waist Circumference (WC), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were 98.2±12 cm, 128.84±13.65 mmHg and 79.2±9.2 mmHg, respectively. Fasting Blood Glucose (FBS), Triglyceride (TAG), High Density Lipoprotein (HDL) cholesterol (HDL-C) and TSH were 166.7±71 mg/dL, 125.94±90.67mg/ dL, 45.46± 13.13 mg/dL and 3.35±2.01 mIU/L, respectively. Statistically significant positive correlation was observed between FPG (p=0.049) and both SBP (p=0.0008) and DBP (p=0.001) and negative correlation was observed between TAG, HDL and TSH but not statistically significant in women with hypothyroidism when compared to euthyroid. A statistically negative correlation was found with WC (p=0.001) and positive correlation was found with TAG (p=0.008) and TSH among women with euthyroid condition. Conclusion: Hypothyroidism alters lipid levels and increases blood pressure leading to increased risk for cardiovascular disease (CVD). Together hypothyroidism and metabolic syndrome could increase the risk for CVD in postmenopausal women. Thus, assessing thyroid function in postmenopausal women with metabolic syndrome may aid in early detection of CVD risk and better clinical management among these patients and reduces the already existing high incidence of CVDs.

Surgical Outcome and Complications of Lateral Internal Sphincterotomy in Chronic Anal Fissure- A Cross-sectional Study

Ramin Azhough, Sahar Taher, Zahra Mosaddeghi Kheyavi, Pooya Jalali

Introduction: Despite the advent of new methods in the conservative treatment of Chronic Anal Fissure (CAF), such as nitric oxide donors, they often require surgical treatment. The gold standard surgical option for the CAF is Lateral Internal Sphincterotomy (LIS). This procedure usually involves dividing the Internal Anal Sphincter (IAS) from the distal end to the fissure or dentate line (whichever comes first). Aim: To evaluate the surgical outcome and complications of LIS in CAF. Materials and Methods: This cross-sectional descriptive study was conducted on 60 patients with CAFs who underwent LIS in Imam Reza Hospital, Tabriz, Iran. The study was approved by the Ethical Committee of Tabriz University of Medical Sciences and was done from February 2017 to March 2019. The following data were recorded: age, sex, history of constipation, constipation duration, history of prolonged diarrhoea, child birth history, type of delivery, history of receiving pharmacological treatment for fissure, history of past fissure surgery, postoperative pain, postoperative complications and recurrence rates. The results were analysed using statistical methods (mean±Standard Deviation (SD)) for quantitative variables and frequencies and percentages for categorical variables. Results: The mean age of the patients was 36.6±12 years (18- 70 years). During surgery, haemorrhoids, anal polyps, perianal fistulas, and anal masses were observed in 27 (45%), 7 (11.66%), 1 (1.6%), and 1 (1.6%) patients, respectively. After surgery, the patients’ symptoms decreased. Anal pain, bleeding and constipation decreased in 52 (86.67%), 50 (88.33%) and 43 (71.67%) patients respectively. Urinary retention, anal itching, and flatus incontinence were observed in 3 (5%), 1 (1.67%), and 9 (15%) patients, respectively. None of the patients had faecal incontinence and none had a recurrence. Complete healing was observed in all patients. Conclusion: The LIS is an effective and safe option in the surgical treatment of patients with anal fissure.

Clinical Characteristics and Outcome Predictors in Microbiologically Proven Mycotic Keratitis

Bini Sukumaran Thulasi, Mini Mathew

Introduction: Mycotic keratitis is a major cause of monocular blindness in tropical and subtropical climates. The difficulty to differentiate mycotic keratitis (fungal keratitis) from other causes, limited availability of antifungal agents, their poor ocular penetration and indolent course of the disease lead to significant ocular complications and vision loss. Aim: To analyse the typical presenting clinical characteristics which predict the final visual outcome in microbiologically proven mycotic keratitis over two years in a tertiary eye care centre of South Kerala, India. Materials and Methods: The present study was a retrospective study, conducted on 165 eyes of 165 patients treated for culture proven mycotic keratitis in the Regional Institute of Ophthalmology, South Kerala, India, from August 2018 to July 2020. Best Corrected Visual Acuity (BCVA), detailed history including history of injury and systemic diseases were noted. Treatment outcome was measured as BCVA at the end of three months. The association between age, sex, presenting features like size, depth, margins and colour of the keratitis and the final BCVA were assessed by linear regression analysis. Results: Among 165 eyes, 90 (54.6%) had a history of injury in the affected eye. The majority of the keratitis had a size of 2-6 mm in 150 (90.9%), peripheral in location in 107 (64.8%) and involvement up to anterior 2/3rd of the stroma in 93 (56.4%). Of 165, 112 (67.9%) of the ulcers had a greyish white or pigmented colour, 118 (71.5%) had dry texture and 115 (69.7%) had feathery margins. Raised exudates were present in 99 (60%) patients, satellite lesions in 29 (17.6%), immune ring in 6 (3.6%), endothelial plaque in 20 (12.1%) and hypopyon in 40 (24.2%) at the time of diagnosis. The important predictors of final BCVA at three months were the larger size of the ulcer, increase in depth, central location, presence of hypopyon and poor vision at presentation. Conclusion: Small superficial keratitis with good vision at presentation had a better final BCVA. Dry texture and feathery edges were seen more frequently in fungal keratitis. Large, deep, central keratitis and poor vision at presentation are associated with worse final visual outcome after treatment.

Association of Epithelial Changes in Fallopian Tube and Epithelial Neoplasms of Ovary using p53 Tumour Marker- A Cross-sectional Study in a Tertiary Care Centre

Vandana Maroo, Suchismita Chakrabarti, Anadi Roy Chowdhury

Introduction: Ovarian cancer is one of the major reasons of mortality in women due to gynaecological malignancies. The origin of ovarian carcinomas was considered to be de novo previously. But recent studies have shown that the type II ovarian carcinomas, majority constituting of High Grade Serous Carcinomas (HGSCs) originate from the fimbrial end of the fallopian tubes. Aim: To establish an association of epithelial changes of fallopian tube with epithelial neoplasms of ovary in light of p53 expression. Materials and Methods: An observational, descriptive, crosssectional study was done in the Department of Pathology in a tertiary care centre of Eastern India for a period of 18 months from July 2019 to December 2020. Informed written consent was taken from all patients prior to the study. The epithelial ovarian neoplasms and fimbrial ends of the fallopian tubes using Sectioning and Extensively Examining the FIMbrial (SEE-FIM) end technique were submitted in 51 cases. The sections were stained with Haematoxylin and Eosin (H&E) and p53 tumour marker. The obtained results were tabulated and data analysis was done using Chi-square test and Fisher’s-exact test with the help of statistical software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 25.0. A p-value of <0.05 was considered statistically significant. Results: On histopathological examination, 84.31% (43/51) cases were found to be serous tumours of the ovary, out of which 54.9% (28/51) cases showed histological features of HGSCs, 100% of these HGSCs were p53 positive. Thirteen cases (46.42%) of fimbrial ends of HGSCs showed nuclear atypia, pleomorphism and stratification and p53 positivity were categorised as Serous Tubal Intra Epithelial Carcinomas (STIC). Total 10 cases (10/28=35.71%) of fimbrial ends which showed p53 positive in minimum of 12 cells in the fimbrial ends were labelled as ‘p53 signatures’. The remaining five cases did not show any significant finding. Conclusion: Overall, the fimbrial end of the fallopian tube could be considered as the origin of these HGSCs and these lesions are precancerous in nature.

Clinicoepidemiological Profile of Glaucoma in 18-45 Years of Age- A Descriptive Study

Vinokali Achumi, Susan Thomas, Neeta Sidhan

Introduction: Glaucoma is a group of disorders characterised by chronic progressive optic neuropathy. The consequences of glaucoma are more severe in the young individuals because of late diagnosis and longer life expectancy. Therefore, this study was conducted to assess the clinicoepidemiological profile of glaucoma in the age group 18-45 years. Aim: To study the demographic characteristics, clinical profile and types of glaucoma among patients in the age group of 18- 45 years. Materials and Methods: This descriptive study was conducted in Regional Institute of Ophthalmology, Glaucoma Clinic, Thiruvananthapuram, Kerala, India. Among 75 patients who presented with various types of glaucoma, in the age group 18-45 years during a period of one year from January 2018 to January 2019, after obtaining ethical clearance were included. The subjects had an Intraocular Pressure (IOP) >21 mmHg and glaucomatous optic nerve changes with corresponding visual field defects. Relevant history and comprehensive eye examination was done in all patients after obtaining consent. Results: Majority of the patients were in the age group 26- 35 years (40%, n=30). Among these patients, 41 (54.7%) were males, and 34 (45.3%) were females. The types of glaucoma seen in the present study were: 26 cases of Juvenile Open Angle Glaucoma (JOAG), 14 cases of Primary Open Angle Glaucoma (POAG), 12 cases of Primary Angle Closure Glaucoma (PACG), two cases of angle closure glaucoma in retinitis pigmentosa, five Secondary Angle Closure Glaucoma (SACG) which includes two neovasular glaucoma, one case each of iridocorneal endothelial syndrome, iris meloncytoma suspect and microspherophakia, six cases of Pigmentary Glaucoma (PG), six cases of traumatic glaucoma and four cases of inflammatory open angle glaucoma. The most common symptom reported by these patients was defective vision (50%) but 16 (21.3%) patients were asymptomatic at presentation. Family history of glaucoma was positive in 22 (29.3%) of the patients and majority was found in JOAG. Out of 133 eyes, 79 eyes had Best Corrected Visual Acutity (BCVA) >6/18, in between 6/18-6/60 in 36 eyes 16 eyes, had <6/60 and two eyes had no perception of light. Conclusion: Periodic eye examination is warranted among the young population with positive family history of glaucoma to prevent severe visual loss and blindness.

Otoendoscopy and Audiometry Findings as Predictors of Ossicular Dysfunction in Mucosal Chronic Suppurative Otitis Media: A Cohort Study

Introduction: Chronic Suppurative Otitis Media (CSOM) is chronic inflammation of epithelial lining of the middle ear cleft. Ossicular discontinuity and/or erosion is known in CSOM with cholesteatoma but at times it can be associated with tubotympanic CSOM which surprises the operating surgeon. This study to determine the relationship between preoperative and otoendoscopic findings in cases of CSOM was undertaken to facilitate the surgeon in planning about dealing the disease before rather than having surprise at exploration. Aim: To study predictors of ossicular dysfunction in cases of mucosal CSOM. Materials and Methods: This prospective cohort study of 64 cases was undertaken at Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from November 2018 to April 2020. All cases were subjected to detailed clinical, otoscopic, and microscopic examination to assess the size of perforation, granulation tissue, tympanosclerosis, exposure of incudostapedeal joint, and condition of middle ear mucosa. A pure tone audiogram was also done. All cases underwent tympanoplasty with or without cortical mastoidectomy and the intraoperative findings of ossicular erosion were noted. All cases with granulation or polypoidal mucosa on otoscopic examination as well as mastoid exploration were subjected to histopathological examination for confirmation of disease pathology. Using Chi-square test with Yates continuity correction the variables data was processed and results were analysed. Results: Out of the 64 cases, 15 (23.4%) had ossicular erosion. Bivariate analysis showed a positive association for middle age group between 31-40 years (p-value <0.001), long-duration of disease (p-value <0.004), polypoidal middle ear mucosa (p-value <0.002), granulations in the middle ear (p-value <0.001), and also when the incudostapedeal joint was exposed (p-value <0.005) through the subtotal perforation (p-value <0.022). On audiological evaluation moderate to moderately severe hearing loss (41-70 dB HL) (p-value <0.0015), and air-bone gap >40 dB (p-value <0.001) were associated with incus erosion. Intraoperative findings like aditus block (p-value <0.001) and mastoid granulations (p-value <0.001) were also found to be significant risk factors associated with incus erosion. Conclusion: Preoperatively identifying the predictors of ossicular dysfunction like granulation tissue in the middle ear and raised pure tone audiometric average threshold can help the surgeon to better understand pathology of the disease and helpful too while counselling the patients to meet the realistic expected outcome of surgery

Comparison of CT Scan and Cystoscopy findings of Bladder Involvement in Patients of Carcinoma Cervix in View of Revised FIGO Staging: A Cross-sectional Study

Manjit Kaur Mohi, Harjinder Singh, Divya Sharda, Sangeeta Aggarwal, Manoj Mathur

Introduction: Cervical cancer is the 5th most common cancer in humans and the second most common cancer in women worldwide. Bladder invasion is an important prognostic factor and adversely affects the clinical outcome and detecting true bladder invasion is extremely important for prognostication and treatment in patients of cervical cancer. Cystoscopy was the approved method for assessing involvement of the bladder according to International Federation of Gynaecology and Obstetrics (FIGO) staging until the revised FIGO staging 2009 which encourages the use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scan and does not recommend cystoscopy as mandatory investigation. Aim: To compare the role of CT scan of pelvis and cystoscopy for bladder involvement in carcinoma cervix. Materials and Methods: This cross-sectional study was conducted on 100 patients of carcinoma cervix admitted in the Gynaecology wards of Government Medical College, Patiala, Punjab, India, from January 2015 to December 2015. The study involved cystoscopy and CT scan pelvis which were done for pretreatment assessment of all patients who were histopathologically proven to have carcinoma cervix. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of CT scan were calculated. Results: The majority (33%) of patients belonged to 51-60 years age group with mean age of 50.86±10.75 years. True positives were six cases, where bladder involvement on cystoscopy was histopathologically proven. True negatives were 72 cases where bladder was not involved on CT and cystoscopy. False positive were cases which were involved on CT scan but negative on cystoscopy for bladder involvement which came out to be 22. No false negatives were observed in which bladder was not involved on CT scan but showed involvement on cystoscopy in the present study. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT scan came out to be 100%, 76.60%, 21.43%, 100% and 78%, respectively. Conclusion: The positive findings of CT scan for bladder involvement can be used to select patients who need to undergo cystoscopy as CT scan is a moderately accurate modality for assessing bladder involvement in patients of carcinoma cervix. The 100% NPV observed in our study is encouraging to suggest that it can be used as primary modality to avoid invasive procedure like cystoscopy in women with carcinoma cervix specially with CT negative findings for bladder involvement.

Expression of Poly(A)-Specific Ribonuclease in Solid Tumours and Haematopoietic Malignancies

Introduction: Ribonucleases (RNases) are enzymes involved in degradation of excess messenger Ribonucleic Acid (mRNA) and deadenylation of the poly(A) tail is the most common mechanism involved in mRNA degradation. Among the various RNases involved in deadenylation-dependent mRNA decay, Poly(A)-Specific Ribonuclease (PARN) plays the major role in the deadenylation-mediated mRNA decay. Although PARN is primarily involved in mRNA stability, recent studies suggest other functions of PARN including a role in telomere maintenance, DNA-damage response, and p53 regulation. Altered expression of PARN was also observed in cancers including acute leukaemia, lung squamous cell carcinoma and gastric cancer. Aim: To determine the levels of PARN transcripts in solid tumours and haematopoietic malignancies. Materials and Methods: This study was conducted on a cohort obtained from the Department of Oncology at Justice KS Hegde Charitable hospital in Mangaluru, Karnataka, India during January 2017 to June 2017. A total of 26 clinical samples and 14 controls were included. The expression level of PARN in plasma and tissue samples obtained from patients with solid organ tumours and haematopoietic malignancies were analysed by quantitative real-time Polymerase Chain Reaction (PCR) by calculating relative expression using Microsoft excel 2010. Results: A consistent down regulation of PARN in 88.23% (15 out of 17) of the samples were observed. All the plasma samples (100%, 10 out of 10) obtained from the lung cancer cases, showed down regulation of PARN at statistically significant level, regardless of the subtype of the cancer. In case of haematopoietic malignancies, PARN transcript level was down regulated in five out of seven samples analysed (71.42%), with statistically significant decrease in three of them. Conclusion: Despite a small sample size, the data presented here show that PARN is down regulated in solid organ cancers, suggesting a tumour-suppressive function of PARN. Screening of a large number of samples would be required to evaluate the true potential of PARN as a novel biomarker in solid organ and haematopoietic cancer.

Does Shoulder Girdle Strengthening Exercises have an Effect on Grip Strength in Adolescent Recreational Tennis Players? A Randomised Controlled Tria

Introduction: There is a correlation of shoulder girdle strength on grip strength but its effect remains unobserved in adolescent recreational tennis players due to insufficient training time received by recreational players. Aim: To evaluate the effect of shoulder girdle strengthening exercises on grip strength and to find correlation between shoulder strength and grip strength in recreational adolescent tennis players. Materials and Methods: The present study was randomised controlled trial, in which 50 adolescent lawn tennis players meeting the inclusion criteria of age range between 9-19 years were selected and randomised into two groups. Group A received shoulder girdle strengthening exercises for three alternate days per week for four weeks whereas no exercises were performed by group B participants. The assessment was done for grip strength and shoulder strength at the baseline, by the end of the 2nd week and by the end of the 4th week for both the groups using hand-held dynamometer and seated medicine ball throw test to see the effect of shoulder girdle strengthening exercises on grip strength. The data was analysed in software MedCalc using repeated measure Analysis of Variance (ANOVA). Results: The analysis showed statistical significance of p-value <0.001 for both shoulder strength and grip strength in group A in comparison to group B. The correlation between shoulder girdle strengthening on grip strength was found to be r=0.4090, thus revealing a moderate positive correlation between shoulder strength and grip strength after four weeks. Conclusion: The shoulder girdle strengthening exercises can be incorporated in the training program to improve grip strength as they have a positive moderate correlation

Effectiveness of Jigsaw Active Learning Method in Promoting Knowledge Gain and Retention among Medical Students: A Quasi-experimental Study

Divya G Krishnan, Anukesh Vasu Keloth, Shaikh Ubedulla, PG Mohandas

Introduction: The jigsaw method is one of the learning methods that has great potential to make students learn a large amount of information in a short period of time. It is a classroom technique where students act as blocks of jigsaw puzzle and learn cooperatively with all the participating students acting as teachers as well as learners. Aim: To assess the effectiveness of jigsaw active learning method in comparison to conventional didactic method in promoting knowledge gain and retention among final year medical students. Materials and Methods: This quasi-experimental crossover pretest post-test study was conducted among final year medical students of a tertiary care teaching hospital in North Kerala from June 2021 to July 2021 during the integrated sessions by Surgery and Pharmacology Departments. Students were randomly divided into two groups A and B of 28 students each. They were taught two topics i.e., hyperthyroidism and hypothyroidism, as two sessions by either a jigsaw (experimental) or didactic (control) method. The first topic was taught by the two methods and then the same groups were later crossed over for the second topic. Knowledge gain and retention were assessed by immediate and delayed post-tests consisting of 20 multiple choice questions with a single correct response. Each correct response was given one mark and incorrect responses were given no negative marks. All data collected was analysed statistically. Statistical significance was considered at p-value <0.05. Results: The mean age of students was 22.321±0.734 years. Mean scores of immediate post-test were significantly higher in the jigsaw group for the first session (16.64 vs 14.21, p=0.001) and the crossover session (17.61 vs 15.14, p=0.001). Mean scores of delayed post-test were significantly higher in the jigsaw group for the first session (14.32 vs 11.03, p=0.001) and the crossover session (14.85 vs 11.28, p=0.001). Conclusion: Jigsaw method was found to be more effective than didactic method in promoting knowledge gain and retention among medical students.

Critical Analysis of Perceived Stress among Medical Students Studying in Government Medical Colleges at Srinagar, Anantnag and Baramulla, Union Territory Jammu and Kashmir, India- A Cross-sectional Study

Introduction: Stress is one of the most important issues among medical students, often defined as the “wear and tear” the body experiences and multiple factors contribute to its prevalence. It can exert a negative impact on the emotional/psychological well-being of an individual, if not treated at the proper time. Proper management and timely interventions will lessen the negative effects of stress, thereby enhancing their academic performance and skill development as medical graduates. Aim: To measure and compare the perceived stress level among medical students studying in three main medical colleges located at Srinagar, Anantnag, and Baramulla (in the government sector), Jammu and Kashmir, India. Materials and Methods: This cross-sectional study was multiinstitutional, conducted in the first and second year medical students of Government Medical College (GMC)-Srinagar/GMC-Anantnag and GMC- Baramulla, Jammu and Kashmir, India in the age group of 18-25 years who voluntarily consented to participate. A total of 264 students were taken for the study. Data as per structured/standard questionnaire was collected on Google form in a password-protected electronic format. The already validated and reliable Perceived Stress Scale (PSS)- Cohen et al., 1983, was used to analyse the stress levels. Categorical data were analysed using the Pearson Chi-square test. Results: Overall maximum students, 145 (54.9%) had moderate stress, followed by 83 (31.5%) who had high or perceived stress and 36 (13.6%) had low stress levels. College analysis indicated that perceived high stress was highest in GMC-Srinagar students with 38.1%, followed by 31.6% from GMC-Baramulla and 22.22% from GMC-Anantnag. Conclusion: Present study indicate an overall high prevalence of moderate stress followed by perceived high stress among the medical students of three medical colleges located in Kashmir, India. Interestingly, the location of the medical colleges had little impact on the stress level among such undergraduate students.

Trends of Blood Transfusion Services before and during COVID-19 Pandemic- A Retrospective Study from Maharashtra, India

Shweta Wasudeo Dhote, Abhiniti Rahul Srivastava

Introduction: Coronavirus Disease 2019 (COVID-19) affected the usual number of blood donations as well as the component utilisation in routine use severely. Directions by government to maintain social distancing and avoidance of social gatherings resulted in lesser number of voluntary blood donation camps. This resulted in blood scarcity. Aim: To assess the impact on pattern of usage of blood components previously and during COVID-19 pandemic. Materials and Methods: This was a retrospective study, conducted in Department of Immunohaematology and Transfusion Medicine (Blood Centre) of a tertiary care hospital, Navi Mumbai, Maharashtra, India. The study was carried out for a period of two years i.e., from April 2019 to March 2021. The study was divided into two phases. Phase I- April 2019 to March 2020, Phase II- April 2020 to March 2021. Data was collected retrospectively from the donor registers and camp reports. Blood components utilisation data was collected from issue registers. Microsoft Excel and Microsoft Word were used to compile the data. Basic descriptive statistics and graphs were prepared using Statistical Package for the Social Sciences (SPSS). Independent t-test was applied to assess the difference in mean and Standard Deviation (SD) between two phases. The p-value p<0.05 was considered as significant. Results: A total of 6,060 units were collected during the phase I whereas 3,433 units were collected during the phase II. Mean number of units received during phase I were significantly higher (505±127.2) as compared to phase II (286.1±73.9) (p<0.05). Overall, utilisation of Packed Red Blood Cell (PRBC), Random Donor Platelet/Single Donor Platelet (RDP/SDP) and Fresh Frozen Plasma (FFP) was significantly higher in phase I as compared to phase II (p<0.05). Conclusion: Every day, our understanding of the COVID-19 epidemic grows. An effective communication strategy with voluntary blood donors to urge them to donate, as well as networking with neighbouring blood centres, will go a long

Impact of COVID-19 on Academic Activities of Ophthalmology Postgraduates: A Cross-sectional Survey

Introduction: Academics amid the lockdown in Coronavirus Disease-19 (COVID-19) outbreak have experienced massive reforms worldwide. This survey was conducted after the lockdown to evaluate its effect on academic activities in ophthalmology. Aim: To assess the effect of lockdown and related restrictions on ophthalmology Postgraduate (PG) training programmes. Materials and Methods: An online cross-sectional survey using google forms was designed and sent to postgraduates of ophthalmology Department across India through various social media platforms for one week. A total of 45 questions were included related to ophthalmology practice, clinical opportunities, surgical training and online teaching. Data was entered in Microsoft Excel software and descriptive statistics was used to describe the results. Results:A total of 84 postgraduates were surveyed, out of which majority were from Karnataka (n=41) followed by Kerala (n=35). Total 38 (45.2%) participants observed a reduction in Outpatient Department (OPD) patients and 78.6% decline in Operation Theatre (OT) procedures, 74 (88.10%) trainees required almost a month to restart OT and most of them 81 (96.43%) wore an N95 mask while operating. Nearly, 72 (85.7%) got Reverse Transcription-Polymerase Chain Reaction (RTPCR) test as an additional investigation for all of their patients. Majority of the responders, 81 (96.4%) felt that the webinars were helpful. Conclusion: This survey shows that majority of the ophthalmology postgraduates (mainly in Karnataka and Kerala) felt that the COVID-19 lockdown adversely affected their curriculum learning, especially the surgical training. Most of them benefited from the webinars and other online teaching programmes. Regulatory bodies should take a note of the issue and appropriate guidelines should be setup to optimise the training loss due to this pandemic.

Accessory Head of the Flexor Pollicis Longus: A Cadaveric Study on the Gantzer’s Muscle

Aarabhy Jayan, JS Krishnaraj, Jipin Gopi

Introduction: The anterior interosseus nerve syndrome is a compression neuropathy affecting the anterior interosseus nerve, resulting in motor weakness of the long tendons to the index finger and thumb. Of the many conditions leading to this syndrome, one of the more common yet most overlooked aetiologies is the presence of accessory head of the flexor pollicis longus muscle, also called the Gantzer's muscle. Even though numerous studies have been done in both Indian and international populations regarding the frequency of the Gantzer’s muscle, there are hardly any studies involving the South Indian population. Aim: To analyse the frequency and morphology of the Gantzer's muscle in the sub-population of Malabar region, Kerala. Materials and Methods: This descriptive observational study was performed in Department of Anatomy at Malabar Medical College, Atholi, Kerala, India, from July 2021 to August 2021. Study included 60 upper limbs from the cadavers provided for undergraduate medical education. In the limbs where the muscle was identified, parameters such as proximal and distal attachments, shape and length of muscle and tendon, relation to adjacent median and anterior interosseus nerves were studied. Frequencies of each of these parameters were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Percentages obtained were compared with existing studies. Results: The Gantzer's muscle was found in 28 of the 60 limbs dissected. It was more common on the right side (17 limbs), and the most common origin was the medial epicondyle (53.6%). All the cases identified were inserted onto the ulnar aspect of the Flexor Pollicis Longus tendon, mostly in the upper third. In all cases, the Median Nerve was superficial and the Anterior Interosseus Nerve was deep to the accessory head. In majority of the cases, the Anterior Interosseus Nerve was related to the posterior aspect of the belly of the Gantzer’s muscle (82.1%). Conclusion: Clinicians and surgeons should be conscious of the possibility of the Gantzer's muscle being the aetiology, in cases of isolated Anterior Interosseus nerve palsies.

Antiangiogenic Biomarker Soluble Fms-like Tyrosine Kinase-1 in Pregnancy Complicated with Preeclampsia: A Cohort Study

Introduction: Preeclampsia (PE) is one of the leading obstetric diseases with significant morbidity and mortality in both mother and foetus. The etiology of preeclampsia is unknown. It may result from several reasons with imbalance between angiogenic regulatory factors in maternal circulation as one of the factor. High circulatory levels of Soluble Fms-like Tyrosine Kinase-1 (sFlt-1) are detectable several weeks before clinical presentation of preeclampsia. Aim: To determine association of serum levels of sFlt-1 with preeclampsia in second and third trimester of pregnancy. Materials and Methods: A prospective cohort study was conducted in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology in a tertiary care hospital (Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India), from November 2018 to March 2021. The study participants were divided into two groups i.e, normotensive (group 1) and preeclamptic (group 2). The enrollment of participants was done during second trimester. Serum sFlt-1 concentration was measured in second trimester (24-28 weeks) and in third trimester (beyond 28 weeks) using Enzyme Linked Immunoassay (ELISA) kits. Receiver Operating Characteristics (ROC) curve analysis was done for evaluation of Area Under Curve (AUC), sensitivity and specificity using software defined cut-off values. Results: Total 60 participants were there in each group with maternal mean age of 25.8±3.2 years in group 1 and 30.6±5.5 years in group 2 (p-value <0.001). sFlt-1 levels were significantly higher in preeclampsia group both in second and third trimesters when compared with normotensive group with median 313.07 versus 65.150 (p-value <0.001) and 337.875 versus 76.925 (p-value <0.001), respectively. The ROC curve analysis using 190.5 ng/mL as cut-off point in second trimester showed sensitivity 90%, specificity 85%, AUC was 0.832, 95% CI (0.745-0.918) and in third trimester at cut-off point 271.5 ng/mL showed sensitivity 90%, specificity 90%, AUC was 0.884, 95% CI (0.817-0.951). Conclusion: The soluble Fms-Like Tyrosine Kinase-1-1 (sFlt-1), may serve as biomarker for early diagnosis and can improve prediction of preeclampsia.

A Comparative Evaluation of Effect of Different Ferrule Heights on Stress Distribution in Endodontically Treated Teeth Restored with Zirconia Post and Core System using 3D-Finite Element Analysis

Introduction: Customised Zirconia postcore exhibits high strength, toughness and superior aesthetics. The stress distribution in the root of endodontically treated teeth has been found to improve with use of ferrule. Aim: To evaluate the effect of different ferrule heights on stress distribution in endodontically treated maxillary central incisor restored with zirconia postcore system using three-dimensional (3D) finite element analysis. Materials and Methods: The in-vitro experimental study was conducted at Maharashtra Institute of Dental Sciences and Research, Latur, Maharashtra, India, from December 2014 to July 2016. The external shape of the right maxillary central incisor was obtained by the micro computed tomography scan of previously extracted maxillary central incisor. The scanned profiles were then assembled and a 3D-finite element model of five dentin ferrule heights was designed with customised zirconia postcore (1.2 mm diameter) and all ceramic crown. Total five models of different ferrule heights (0 mm, 0.5 mm, 1 mm, 1.5 mm, 2 mm) were made. Von mises stress was determined by applying a load of 100 N at 45° and at a distance of 2 mm from the incisal edge on the palatal surface of crown. Descriptive statistical methods and Pearson correlation test were used to analyse the data. Results: The maximum von Mises stress at the postdentin interface decreased from 2.808 MPa to 0.512 MPa and that of zirconia post reduced from 57.163 MPa to 48.29 MPa when the ferrule height increased from 0 to 2 mm. The maximum von Mises stress in the radicular dentin decreased from 15.219 MPa to 11.321 MPa. Conclusion: There was association between increased height of ferrule and reduced von Mises stress in the zirconia post, postdentin interface and in remaining radicular dentin. Also, with increase in height of ferrule there was an evident shift of von mises stress to the cervical end of root from midroot and apical end of root.

Macular Thickness Evaluation in Parkinson's Disease using Spectral Domain Optical Coherence Tomography: A Case-control Study

Srinivas Phani Nakkella, Shashwati Bhushan

Introduction: Parkinson's Disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease. Its incidence is increasing worldwide, along with population aging and a longer life span. Since the retina is part of the Central Nervous System, the dopaminergic cells are present in the retina too. Aim: To evaluate central macular thickness, average macular thickness, and macular volume changes in Parkinson's cases and compare them with age and gender matched healthy control group using Spectral Domain Optical Coherence Tomography (SD-OCT). Materials and Methods: This was a case-control study, conducted from January 2019 to October 2020 in the Department of Ophthalmology and the Department of Neurology Outpatient Department (OPD) of Government Regional Eye Hospital, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Total 50 diagnosed cases of PD using the United Kingdom Parkinson's Disease Society Brain Bank criteria were included in the study. Fifty age and the gender matched healthy group were included as controls. Both groups underwent retinal imaging with SD-OCT using Macular scans with 6 mm in diameter, centered at the foveola measuring macular thickness and macular volume averages for each of the nine map areas and data was incorporated into a logistic regression model to predict changes. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0 (released 2013 Armonk, NY: IBM Corp.). Results: There were 24 male and 26 female in both the groups, with maximum in the age group of 51-60 years. There was no significant difference between the various groups in terms of the age and gender. There was a significant difference between the two groups in terms of central macular thickness (W=549.0, p-value <0.001), with the median central macular thickness (μm) being highest in the control group. There was a significant difference between the two groups in terms of macular volume (cumm) (t=-5.193, p-value <0.001), with the mean macular volume (cumm) being highest in the control group. There was no significant difference between the groups in terms of average macular thickness (μm) (W=1534.000, p-value=0.050). However, for every one unit increase in duration of disease (years), the average macular thickness (μm) decreases by 2.70 units (rho=-0.64, p-value <0.001). Conclusion: The macular thickness decreases with increasing disease duration in patients with PD patients compared to age and gender matched.

2D:4D Ratio as a Predictor for Swimming Learning- A Pilot Study

Introduction: Competitive swimming is one of the popular sports, where physical conditioning and skill have a large contribution in achieving high-level performances. In males, the second to fourth digit ratio (2D:4D) have lower values than females but the mean digit ratio remains the same with age. This ratio is considered to be a biomarker of the balance between Foetal Testosterone (FT) and Foetal Oestrogen in a nearly embryonic stage. Aim: To determine the correlation of 2D:4D ratio in swimming beginners. Materials and Methods: This cross-sectional pilot study was conducted in the swimming pool facility of Banaras Hindu University Varanasi, Uttar Pradesh, India from March 2019 to June 2019. A total of 118 (59 females and 59 males), swimming beginners participants having age between 18 to 27 years were selected and cross-sectional samples were taken for the study. Participants passed all the stages of swimming learning under a well-trained coach for six weeks. In the last week of swimming learning, final performance assessment tests were conducted. For which six minutes was given to each participant and the total distance covered during swimming was measured in meters. Body Mass Index (BMI) was calculated from measured height and weight. The left and right 2D:4D ratio, height and length of participants were recorded and analysed for correlation. The collected data were analysed using a Statistical Package for the Social Sciences (SPSS),16.0 version. Results: A total of 118 participants, 59 males and 59 females, with mean age of the male participants was 21.37±3.52 years and the mean age of the female participants was 20.64±2.63 years. The mean 2D:4D ratio of both right and left hand digits in both sexes was <1. In males, the right hand 2D:4D ratio was negatively correlated (r=-0.444) with swimming learning performance and it was found significant (p-value=0.004) but the left hand 2D:4D ratio was negatively correlated (r=-0.176) which was not significant with swimming learning performance. In female's right hand, the 2D:4D ratio and BMI were negatively correlated which was not significant with swimming learning performance (r=-0.095, r=-0.018, respectively). Conclusion: The study shows a significant 2D:4D ratio correlation with swimming learning performance in males right hand. So, 2D:4D ratios can be used as reliable criteria as a predictor of swimming learning and swimmer's competitive performance however, it needs further extensive study.

Impact of Online Learning during COVID-19 Pandemic and its Comparison with Conventional Teaching: A Cross-sectional Study

Shipra Jain, Ruchika Kalra, Prerna Goswami, Pushkar Mani

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic has made a huge impact on medical education resulting in adoption of online methods of teaching in order to continue with the process of teaching and learning so as to complete the syllabus. In addition, online education methods also helped to provide psychological support to the students in this time of crisis. Aim: To evaluate the perception of students for online learning and to compare it with conventional classroom teaching. Materials and Methods: This cross-sectional study was conducted in the Department of Pharmacology at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, on fifth semester 148 medical undergraduates, in April, 2021. All the participants were randomly divided into two groups, with each group consisting of 74 students. Group I was taught antitubercular drugs through online method while, group II was taught the same topic in classroom and then a cross-over was done among the two groups for antimalarial drugs on the second day. The perception of students towards online learning and the preferred method of teaching were evaluated using a predesigned standardised questionnaire. The collected data was analysed using Z-test and p-value <0.05 was considered significant. Results: Out of 148 students, 62.84% were females. Mobile phones (86.48%) were the most commonly used gadgets for online learning. Majority of students preferred conventional classroom teaching with regard to convenience (75.67%), acquisition of knowledge (83.78%), practical skills (89.86%), interactive (84.45%), doubt clearance and the preferred method of teaching (81.08%). However, most of the students agreed that online learning saves time (62.83%) and was better suited for submission of assignments (68.9%). A statistically significant difference (p-value <0.05) was observed when online learning was compared with classroom teaching. Conclusion: The study concluded that online learning is not a substitute for classroom teaching but might supplement conventional classroom teaching. However, it helps in completion of syllabus and boosts the morale of the students during this pandemic.

In-vitro Comparative Evaluation of Enamel Microhardness Remineralised with Diode and Er,Cr:YSGG Lasers along with CPP-ACP Remineralising Agent

Prem Vishva Natarajan, Ravindra Kumar Jain

Introduction: Enamel demineralisation is a common consequence of orthodontic treatment and has been treated with a variety of methods and recent use of lasers has been investigated. Aim: To assess and compare the efficacy of diode laser, Erbium, Chromium-Doped: Yttrium, Scandium, Gallium and Garnet (Er,Cr:YSGG) with Casein Phosphopeptide Amorphous Calcium Phosphate (CPP-ACP) and CPP-ACP alone for remineralisation of the demineralised enamel surfaces. Materials and Methods: This in-vitro experimental study was conducted at Blue Lab, SIMATS, Chennai, Tamil Nadu, India, from February 2021 to March 2021. A total of 40 extracted sound human teeth were obtained and subjected to demineralisation (T0) and divided into three experimental groups of 10 teeth each and one control group with 10 teeth. The study groups were as follows: Group 1- artificial saliva, group 2- CPP-ACP, group 3- Er,Cr:YSGG+CPP-ACP, group 4- diode laser+CPP-ACP. Vickers Microhardness test was done after demineralisation (T0) and after remineralisation (T1). Descriptive statistics, paired t-test and one-way Analysis of Variance (ANOVA) followed by Posthoc Tukey’s test were done to evaluate intragroup and intergroup differences. Results: On intragroup comparison between T0 and T1 significant differences in microhardness were noted for all groups (p-value <0.05). At T1 the lowest mean microhardness value was noted in group 1 (210.13±41.20) and the highest mean value was noted in group 3 (255.86±41.53). Intergroup comparison revealed no significant difference in microhardness among the all four groups at T0 and T1 (p-value=1.0 and p-value=0.12 respectively). Conclusion: It can be concluded that both diode laser and Er,Cr:YSGG when used along with CPP-ACP are eq

Efficacy of a Combination of b-Tricalcium Phosphate with Hyaluronic Acid in the Management of Intrabony Periodontal Defects: A Prospective Clinical Study

Introduction: Numerous bioactive grafts have been studied for periodontal defect regeneration of which, b-Tricalcium Phospate (β-TCP) is a very promising bone graft. Hyaluronic Acid (HA), an essential component of periodontal ligament matrix plays a pivotal role in tissue growth, repair and remodeling. Aim: To evaluate the efficacy of 0.8% HA as an adjunct to β-TCP in the treatment of isolated human intrabony defects. Materials and Methods: This prospective clinical study was conducted at the Department of Periodontics, SRM Dental College, Chennai, Tamil Nadu, India, from January 2017 and December 2017 (followed-up to June 2018). The study included 30 intrabony defects from 16 chronic periodontitis patients, 15 of each were randomly assigned into either test/control groups and were reviewed till six months. After phase I therapy regenerative osseous surgery was performed at all the sites. Control sites received β-TCP bone graft alone and test group received β-TCP with 0.8% HA. Postsurgical clinical evaluation of Probing Pocket depth (PPD) and Clinical Attachment level (CAL) was done at three and six months, radiographs were repeated at six months to assess the bone fill. Statistical analysis using Statistical Package for the Social Sciences (SPSS) version 22.0 was done, Mann-Whitney U test and Wilcoxon-Signed Rank test were used to compare the intergroup and intragroup values respectively. Results: The mean age of the control and test groups were 45.7 and 48.5 years respectively. The PPD was reduced, CAL and bone fill were increased in both groups from baseline, indicating clinical effectiveness. From baseline to six months, the PPD reduction and gain in CAL in the test and control groups were 3.27±0.18 mm, 3.20±0.18 mm and 3.07±0.03 mm, 3.07±0.08 mm, respectively, which was statistically significant (p-value <0.001). However, intergroup comparison revealed no statistical significance (p>0.05) in both clinical and radiographic parameters. Conclusion: Hyaluronic acid as an adjunct to β-TCP demonstrated only comparable outcomes despite obtaining substantial bone fill and attachment gain.

Ocular Manifestations among Newly Diagnosed Tuberculosis Patients Receiving Anti-Tubercular Therapy under Revised National Tuberculosis Control Programme: A Prospective Cohort Study

Introduction: Ocular tuberculosis has diverse presentations. As microbiological confirmation is difficult, a high index of suspicion is required. The present study replenishes the gap of existing knowledge regarding ocular tuberculosis and facts related to antitubercular drug related toxicity. Aim: To evaluate the magnitude and outcome of ocular tuberculosis along with antitubercular drug related ocular toxicity, with special reference to ethambutol toxicity. Materials and Methods: This cohort study was conducted from May 2018 to April 2019 at Outpatient Department of Ophthalmology, Burdwan Medical College and Hospital, West Bengal, India. Total 170 newly diagnosed tuberculosis patients underwent comprehensive ophthalmic examination for any signs of ocular tuberculosis or development of antitubercular drug related ocular toxicity. They were treated and followed up to the completion of Anti-Tubercular Therapy (ATT). The statistical software Statistical Package for the Social Sciences (SPSS) version 20.0 was used for the analysis. Results: Out of total 170 study participants, 110 (64.7%) were male, mean age was 35.65±15.49 years. Ocular tuberculosis was found in 12 (7.05%) patients. Four patients had choroidal tuberculoma, two had Eales disease, four had choroiditis, two had anterior and intermediate uveitis. All the ocular tubercular lesions responded to ATT. Total 7 (4.1%) patients developed ethambutol-induced ocular toxicity. Following stoppage of ethambutol and treatment with corticosteroids there was significant improvement in colour vision, perimetry and Visual Evoked Potential (VEP) findings in 3 (42.9%) patients. Unfortunately, 4 (57.1%) patients developed optic atrophy. Conclusion: Comprehensive ophthalmic examination should to be done in all tuberculosis patients to detect and treat co-existing ocular tuberculosis as well as early detection of antitubercular drug toxicity. Withholding of the offender can result in visual recovery.

Evaluation and Correlation of Serum C-Reactive Protein and Procalcitonin Levels in Acute Exacerbation and Stable Phase of Chronic Obstructive Pulmonary Disease Patients: An Observational Study

Manisha Bhardwaj, Varinder Saini, Jasbinder Kaur

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterised by limitation of airflow that is not fully reversible. Acute exacerbations lead to worsening of respiratory symptoms which results in increased hospitalisation incurring high socio-economic costs. Timely diagnosis and early treatment of exacerbation can avoid unnecessary hospitalisation and mortality. Biomarkers which may function as diagnostic and prognostication aids are of great help in resource constrained countries like India. Indian literature on the role of biomarkers in such context are scarce. Aim: To evaluate serum levels of C-Reactive Protein (CRP) and Procalcitonin (PCT) in COPD patients admitted in respiratory ward with acute exacerbation and assess their correlation with course of disease. Materials and Methods: The present study was an observational study in which a total of 103 COPD patients, diagnosed as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines admitted with acute exacerbation, were included in the study. All patients were subjected to routine investigations at admission. The serum CRP and PCT levels were assessed at the time of admission, discharge and at four weeks after discharge as well. Normality of quantitative data was checked by measures of Kolmogorov-Smirnov tests of normality. For normally distributed data means were compared using unpaired t-test. For skewed data or scores Mann-Whitney Test was applied. For categorical variables, numbers and percentages were calculated. The data observed at various points of time was compared using Wilcoxon Signed-Rank test or paired t-test whichever was applicable depending on its normality. Correlation analysis was performed using Spearman’s Rank Test. All calculations were two-sided and were performed using Statistical Package for the Social Sciences (SPSS) trial version 17.0 (SPSS, Chicago, IL). A p-value of <0.05 was considered to indicate statistical significance. Results: Serum levels of CRP and PCT measured were as follows; 10.80±21.1 mg/L, 7.40±8.9 mg/L and 3.50±6.20 mg/L (mean±standard deviation) and 0.08±0.11 mg/L, 0.05±0.70 mg/L, and 0.01±0.04 mg/L (mean±standard deviation) at admission, discharge and follow-up, respectively. The CRP and PCT levels were significantly higher at the time of admission than at discharge and follow-up (p-value ≤0.001, p-value ≤0.001) which correlated with severity of breathlessness as per Modified Medical Research Council (mMRC) dyspnoea scale. A significant correlation between CRP and PCT values was found at the time of admission (r=0.423, p-value ≤0.001) and at discharge (r=0.310, p-value ≤0.001) but not at follow-up (r=0.049, p-value=0.622). Conclusion: The serum levels of CRP and PCT dropped significantly from admission to discharge and then follow-up after one month. The change in these parameters correlated well with exacerbation and stable phases of COPD. Further research is required to validate their role as biomarkers of acute exacerbation of COPD.

CD64 Expression by Neutrophils as a Diagnostic Marker for Sepsis: A Critical Evaluation

Seema Acharya, Divyata Chanyal, Pooja Sharma Kala

Introduction: The increasing incidence of sepsis and its associated mortality has urged the search for rapid and reliable diagnostic test. Flow cytometry offers rapid assessment of change in antigen expression by neutrophils in blood in suspected sepsis cases. An increased expression of CD64, a high affinity opsonic surface receptor, by neutrophils is seen in sepsis. Aim: To critically analyse the role of neutrophilic CD64 expression by different possible flow cytometric parameters in sepsis. Materials and Methods: This case-control study was conducted in Department of Pathology of a Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India from February 2017 to July 2019. It included peripheral blood samples from 43 cases of sepsis and their corresponding age matched controls. Flow cytometric analysis of blood samples for CD64 expression by neutrophils was done. The statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 18.0, Chicago, IL. Results: Flow cytometric analysis revealed a statistically significant increased expression of CD64 by neutrophils in sepsis patients, in terms of all four parameters analysedincreased expression of CD64 as compared to controls, in terms of percentage of neutrophils expressing CD64 (63.88±34.12 in cases), mean Fluorescent Intensity (FI) (2137.19±2319.71), Median Fluorescent Intensity (MFI), (2011.28±2261.89) as well as Neutrophil:Lymphocyte (N:L) CD64 index (7.29±9.66). Sensitivity and specificity of each parameter evaluated in present study varied from 60.4-67.4% and 81.4-83.7%, respectively. Conclusion: Quantitative expression of neutrophil CD64 (nCD64), by flow cytometry, in terms of percentage expression, MFI, mean fluorescent intensity and Neutrophils:Lymphocytes CD64 index is helpful in diagnosing sepsis patients even after 72 hours of onset. This is a rapid, reliable and cost-effective investigation. Hence, enabling prompt and judicious treatment of sepsis.

Anatomical Variants of the Sciatic Nerve Division in the Pelvis, the Gluteal Region and the Thigh: A Cadaveric Study

Azza I Farag, Rasha M Salama

Introduction: Anatomical dissimilarities can be found in any part of the body and is pertinent to identify patients who are not treated successfully with standard medical care. Anatomical variants of the Sciatic Nerve (SN) were defined many years ago, and may have consequences in certain diseases, as sciatica. Specialised care may be required to these patients due to their unique anatomy. Aim: To study the cadaveric anatomical variants of the SN divisions in the pelvis, the gluteal region and the thigh and also to describe its linkage to the Piriformis Muscle (PM). Materials and Methods: This descriptive study was conducted from June 2021 to September 2021 in the Department of Anatomy of Qassim University, Saudi Arabia. Total 30 lower limbs and gluteal regions of formalin fixed male cadavers were used to study the anatomical variants of the SN division into its terminal branches and its relation to the PM. Numbers and percentages of the specimens falling in the groups were calculated and tabulated. Results: Out of 30, 3 specimens (10%), showed division of the SN in the pelvis, where both Tibial Nerve (TN) and Common Fibular Nerve (CFN) course separately below the piriformis muscle. While, 8 specimens (26.66%) showed division of the SN in the pelvis, where CFN pierces the piriformis muscle, and tibial nerve lies below it. About 5 specimens (16.66%), showed division of the sciatic nerve into tibial nerve and CFN in the gluteal region at the level of the obturator internus muscle. Additionally, 9 specimens (30%) showed division of the sciatic nerve into tibial nerve and CFN occurred in the upper of the posterior aspect of the thigh. Lastly, 5 specimens (16.66%), revealed division of the sciatic nerve into tibial nerve and CFN in the middle of the posterior aspect of the thigh. Conclusion: The most prevalent level of bifurcation of the SN in the present study was the upper part of the posterior aspect of the thigh (30%), while the least common level of the SN bifurcation was in the pelvis, before its exits in the gluteal region, where TN and CFN course separately below PM (10%).

Awareness, Attitude and Practices Regarding Eye Health and Common Eye Problems in Urban Indian Population: A Community-based Cross-sectional Study

NC Shwetha, Ratnapriya Srivastava, Kaushal Kumar

Introduction: India has large share of global blindness and visual impairment. Major factor reported is lack of awareness about eye conditions associated with poorer outcomes in terms of seeking medical help, treatment and prevention. Therefore, increase in awareness and knowledge about eye health will result in improved practices towards eye health and decrease in burden of visual impairment. Aim: To assess Knowledge, Attitude and Practice (KAP) about eye health and common eye problems in urban Indian population. Materials and Methods: A cross-sectional community based online survey was done for six months, from July 2020 till December 2020. A self-designed questionnaire was sent via Google forms to people aged 18 years and above. Knowledge, attitude and practice towards eye health and eye diseases i.e., cataract, glaucoma, Diabetic Retinopathy (DR) and dry eye, were assessed with respect to age, gender, education, and spectacle usage. Statistical analysis was done using descriptive statistics to summarise the data and inferential statistics Chi-square test was used to find association by Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Of the total 417 participants, 177 (42.4%) were males and 240 (57.6%) females. Mean age was 32.49 years. All the participants were literates, 226 (54.1%) were graduates and 161 (38.6%) were postgraduates. A total of 370 (88.7%) of them believed eye diseases can be prevented by regular check-ups from ophthalmologists but only 15 (16.48%) of the population aged above 40 years underwent glaucoma screening. A total of 10 diabetic patients underwent DR screening. Conclusion: Most participants were aware and had good knowledge about common eye diseases. This does not correlate with their self-care practices. There is a need for robust health education to increase the level of awareness and to understand the importance of routine eye examinations which help in early detection and treatment, thereby reducing visual impairment in the public.

Efficacy of Ketamine as an Adjuvant to Antidepressants in the Treatment of Depression

Hrishikesh Solunke, Ajay Solanki, NR Anup, Rajesh Raman, Shivananda Manohar

Introduction: Depression is the second leading cause of morbidity worldwide. Currently, available antidepressants mostly target the monoamine system. The onset of action and response rates for these antidepressants are varied. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist has shown rapid onset of action in the treatment of depression. The available literature about intravenous (i.v.) ketamine as an adjuvant to oral antidepressants is limited. Aim: To study if ketamine is beneficial as an adjuvant to antidepressants in the treatment of depression. Materials and Methods: This study was a prospective interventional study conducted at JSS Medical College and Hospital, Mysuru, Karnataka, India, between January 2019 to January 2021. Total 60 patients diagnosed with depression and receiving 20 mg per day of the Selective Serotonin Reuptake Inhibitor (SSRI) escitalopram were recruited. The patients were divided into two groups of 30. Group I was continued only on the oral antidepressant antidepressant and the group II in addition to the oral antidepressant received 3 doses of i.v. infusion of ketamine hydrochloride, on alternate days. All the patients were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Scale for Suicidal Ideation (BSSI) at baseline and after 14 days. Statistical measures like Cramer’s V, Independent samples t-test (to match both groups for age) and repeated measure Analysis of Variance (ANOVA) was employed and data collected were analysed through the IBM Statistical Package for the Social Sciences (SPSS) statistics for windows, version 20.0. Results: The mean age of the sample population was 37.883±8.128 years. There was statistically significant improvement in depressive symptoms in group II when compared to group I. There was a decrease in mean MADRS scores by 6.07 in Group I and by 8.10 in Group II (p-value=0.011). The improvement was statistically significant in four items on the MADRS scale, namely, reported sadness (p-value=0.015), inner tension (p-value=0.021), pessimistic thoughts (p-value=0.00034) and suicidal thoughts (p-value=0.001), as well as the total MADRS score (p-value=0.011). The mean change in BSSI scores from baseline to final reading improved in both the groups (p-value=0.740). Conclusion: Intravenous ketamine as an adjuvant to oral antidepressant medications, showed greater and more rapid improvement than that seen with oral antidepressants alone. It can be considered as an effective adjuvant to other antidepressants and future studies are required to establish this.

Comparison of Inhaler Device Techniques Before and After Training in Patients with Chronic Obstructive Pulmonary Disease

S Rajesh Kumar Jain

Introduction: In the treatment of Chronic Obstructive Pulmonary Disease (COPD), the administration of drugs with an inhaler is often used. Improper usage of inhaler devices can result in suboptimal therapeutic effects which inturn can lead to the prescription of additional dose or drug with a higher tendency of developing side-effects. Very often patients are prescribed inhaler medications without adequate education on device usage. Aim: To compare the techniques of inhaler devices usage, before and after training in patients with COPD. Materials and Methods: An institutional-based, prospective study was conducted among COPD patients attending the Department of Pulmonary Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from March 2020 to September 2020. A total of 250 patients who met the diagnostic criteria recommended by Global initiative for chronic Obstructive Lung Disease (GOLD), previously on inhaler medications using pressurised Meter Dose Inhaler (pMDI), pMDI with spacer, Rotahaler® or Revolizer®, were included in the present study. The investigator employed a device-specific checklist to evaluate inhaler device usage by the participants. This checklist was scored, while the patient was observed utilising the inhaler device. Following which, each patient was educated regarding inhaler device usage by a doctor or nurse. For each correct and incorrect step, the patient received a score of “1” and “0” respectively. For each patient, the total score for all the steps was calculated and was compared with the total score of post-training visit. The maximum score for pMDI was 11, for pMDI with spacer was 13 and for both Rotahaler®, and Revolizer® was 8. The minimum score for all the inhalation devices was 0. The R software was used for statistical analysis and descriptive statistics were represented in the form of tables, percentages, and frequencies. A p-value of <0.05 was considered statistically significant. Results: A total of 250 patients using various inhalers (pMDI=54; pMDI with Spacer=80; Rotahaler®=67, Revolizer®=49) with mild to very severe COPD.The mean age of the participants was found to be 58.26 years (SD 6.48). Before training, only 1.25% (1/80) patients using pMDI with spacer were able to complete all the steps whereas none of the patients using pMDI, Rotahaler®, and Revolizer® were able to complete all the steps accurately. After training, 31.25% (25/80) of patients using pMDI with spacer, 11.94% (8/67) patients using Rotahaler®, and 44.89% (22/49) of patients using Revolizer® were able to accurately complete all the steps whereas none of the patients using pMDI were able of complete all the steps. Conclusion: The majority of patients committed errors, both handling, and inhalational steps. When trained, the error percentage was reduced significantly among patients using all types of inhalers. Patients using Revolizer® conducted the least of handling errors, whereas those using pMDI committed the maximum handling errors. Patients using Revolizer® had erred the least with inhalation errors, whereas those using Rotahaler® had erred the most with the inhalational errors.

Knowledge and Practice of Personal Protective Equipment among Students of Different Healthcare Specialties during COVID-19 Pandemic

Introduction: Healthcare professionals who are constantly working to treat the patients of Coronavirus Disease-2019 (COVID-19) are at great risk. So the only method they can prevent themselves while working is the use of Personal Protective Equipment (PPE). The use of PPE has increased with the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Aim: To evaluate the knowledge and practice of students of different healthcare specialties regarding the use of PPE. Materials and Methods: The present cross-sectional study was conducted from October 2020 to December 2020 on healthcare students of different healthcare specialties of Najran University, Saudi Arabia. Participants were asked questions about the practice and knowledge of PPE via an electronic link of a questionnaire. Collected data were statistically analysed for frequency and association of responses by using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Total of 606 students (females were 122, males were 484) from different health specialities i.e., Medical (25.4%), Dental (42.1%), Pharmacy (11.2%), Nursing (13.4%) and Physiotherapy (7.9%) participated in this survey. Most of the participants (110 from the medical field, 142 from dental, 42 from pharmacy and 63 from nursing and 28 from physiotherapy) were familiar with the word PPE before this pandemic. There was a significant relationship (p-value <0.0001) between the specialty and practice of PPE. The majority of the participants (52%) did not know the Occupational Safety and Health Administration (OSHA) guideline and 55.9% were not aware of donning and doffing. Only 44.7% of professionals used N95 before the pandemic and 41.9% did not use N95 before COVID-19. While using the N95 mask 58.2% felt comfortable and 11.4% didn’t feel comfortable and the remaining participants were not sure. Conclusion: Although most participants practiced and had knowledge about the use and handling of PPE, but still there is a need to improve their knowledge and train them about its importance during COVID-19. Their knowledge can be improved by different training programs and health education.

Clinicopathological Study of Spectrum of Muscle Disorders in a Tertiary Care Hospital

Mayank Sharma, Sanjay R Bijwe, Snehal V Chavhan, Arvind E Rathod

Introduction: The diagnostic approach to muscle disorders is often challenging due to paucity of literature, unavailability of ancillary facilities, affordability and improper sample collection. The role of pathologist in terms of categorising the muscle biopsy interpretation with limited resources plays an imminent role in guiding clinicians for further therapeutic approach. Aim: To analyse spectrum of various muscle disorders and to relate their clinical and histopathological findings. Materials and Methods: This was observational retrospective as well as prospective study of 63 muscle biopsies received during 10 years period from June 2009 to June 2019, at Department of Pathology in Grant Government Medical College, Mumbai, India. Slides of muscle biopsies received prior to June 2017 were restained and reviewed while muscle biopsies after this period were studied prospectively. Various histomorphological and histopathological (fascicular architecture, variation in size and shape of fibers, necrosis and degenerative/regenerative changes, nuclear characteristics, type and distribution of inflammatory cells along with interstitial changes) features were studied in detail and the findings were compared with similar previous studies. These findings when clubbed together with clinical, biochemical and Electromyography (EMG) findings, to guide the path towards appropriate diagnosis. Results: The present study evaluated and analysed 63 muscle biopsies, clinically, histopathologically and histomorphologically. Mean age was 30.6 years, 43 (68.25%) patients were males and 20 (31.75%) patients were females. A number of 12 (19.04%) patients were clinically diagnosed as having limbgirdle muscular dystrophy, followed by 9 (14.28%) patients as inflammatory myositis. Eight patients (12.69%) were diagnosed as Polymyositis (PM), five (7.93%) as Dermatomyositis (DM), one (1.58%) patient each of juvenile DM and inclusion body myositis. Histopathologically, the cases diagnosed were PM14 cases (22.22%) followed by muscular dystrophy (excluding limb-girdle muscular dystrophy)- 12 cases (19.04%) and limbgirdle muscular dystrophy- 9 cases (14.28%). Conclusion: Although molecular and genetic studies are need of hour, histomorphological features helps in proper categorisation of cases, however close liaison between pathologist and clinicians is essential and histopathological findings should only be interpreted in light of clinical manifestations and laboratory findings.

Midterm Clinical Outcome of Minimally Invasive Latarjet Procedure for Recurrent Anterior Shoulder Instability- A Prospective Cohort Study

Iftikhar H Wani, Asif Sultan, Mohammad Ashraf Khan, Munir Farooq

Introduction: Latarjet coracoid bone block is an effective treatment for the management of recurrent anterior shoulder instability. Minimally invasive technique modified by Saragaglia helps in preservation of subscapularis, leaves a minimal scar and helps in early rehabilitation and recovery. Aim: To assess the midterm clinical outcome of minimally invasive Latarjet procedure for recurrent anterior shoulder instability. Materials and Methods: This was a prospective cohort study conducted from April 2013 to March 2019 at a tertiary care Orthopaedic and Trauma Hospital in patients above 20 years of age of either sex with instability severity score index of >6 were included. A detailed history and clinical examination was done with special reference to hand dominance and number of episodes. Special tests like shift and load test, sulcus test, anterior apprehension test shoulder anterior drawer test and Jobe’s relocation test were done and found to be positive. Preoperative Rowe score was assessed in all the patients. Mean follow-up in present study was 60±18 months. Quantitative variables were analysed using Student’s t-test and qualitative variables using Fisher’s-exact test or Chi-square test. A p-value of <0.05 was considered as significant. Results: There were 40 men and seven female patients (49 shoulders, two patients with bilateral pathology) with an average age of 33.5±9 years. No recurrent dislocation was reported in the study. None of the patients had a positive apprehension test at final follow-up. Rowe score at final follow-up was excellent in 39 (79.6%) patients, good in 7 (14.3%) patients, fair in 3 (6.1%) patients and no patient reported poor result (score below 50). All special tests like shift and load test, sulcus test, anterior apprehension test, shoulder anterior drawer test and Jobe’s relocation test became negative at final follow-up. Three patients developed superficial infection and one patient developed pseudoarthrosis of the graft. Conclusion: Minimally invasive Latarjet procedure is simple, easy and reproducible method of treating anterior shoulder instability. It provides good cosmesis and functional results with low recurrence rate at a midterm follow-up.

Primitive Neuroectodermal Tumour of Uterine Cervix: A Rare Case Report and Review of Literature

Pallavi Srivastava, Saumya Shukla, Nuzhat Husain

Primitive Neuroectodermal Tumour (PNET) of the uterine cervix is a rare entity. Till date, less than 25 cases have been reported from 1987-2021. Histopathologically, tumour is composed of small round blue cells, developing from neuroectodermal cells. Awareness of this rare entity is important from clinical, radiological and pathological aspect for prompt management. A 67-year-old female presented with abnormal vaginal bleeding and lower abdominal pain since two months. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the abdomen revealed the presence of a large mass measuring 71×63×47 mm in size along with, enlarged inguinal lymph nodes. Pathological examination of the tumour revealed a small round cell neoplasm, immunohistochemically positive for CD99 (Cluster of Differentiation) and Friend Leukaemia Intergration-1 (FLI-1). Diagnosis of PNET uterine cervix was rendered. Molecular testing for (Ewing Sarcoma breakpoint region 1) EWS/FLI-1 fusion transcripts could not be performed. Despite administration of the first cycle of adjuvant chemotherapy, the patient died from disease due to pulmonary metastasis. Due to unusual site and small round cell morphology, this entity may present as a diagnostic challenge to the pathologist.

Gastrointestinal Stromal Tumour with Intratumoural Endometriosis

Md Ali Osama , Vibhuti Mittal , Suresh Singhvi , Seema Rao

Analysis of Magnetic Resonance Imaging of Brain Tumour using Fuzzy Set Rules

Manini Singh, Vineeta Saxena Nigam

Introduction: Cancer becomes life threatening once the expansion of tissues in human brain turns into an uncontrolled growth. In detection of brain tumours, Magnetic Resonance Imaging (MRI) images give better results when compared to Computerised Tomography (CT) scan and X-ray. Malignant tumours can be detected with the help of image processing and machine learning techniques. These techniques detect even a small abnormality in the human brain following a four-stage process which includes preprocessing, segmentation, feature extraction and optimisation. Aim: To predict a brain tumour using Fuzzy minimum-maximum rule in MRI. Materials and Methods: The medical challenge is how can we rapidly and precisely diagnose brain lesions. It is difficult when using standard image analysis to differentiate the benign and malignant lesions. Hereby, authors have used a Fuzzy imaging algorithm in data set of 253 brain tumour images of high grade tumour colllected from kaggle.com.This paper proposes a fuzzy min-max image processing algorithm. Image processing includes four stages- preprocessing, segmentation, feature extraction and accuracy detection. Brain tumours are located using various algorithms at each of these stages. Results: There were more than 20 features which can be taken into consideration when using the Fuzzy image algorithm. The proposed method in its current form achieves an accuracy of about 95% by considering seven features. Conclusion: The study revealed that age, shape, contour, blood supply, capsule of tumour, oedema, post contrast enhancement, cyst generation signal intensity of T-1 weighted image etc. were the important investigation parameters. Location and size are important to the domain experts, but due to their complexity these parameters are not considered here.

Efficacy of Three Enamel Protecting Agents on Shear Bond Strength of Orthodontic Brackets Bonded to Demineralised Enamel with Conventional Adhesive

Smita Nimbalkar, Li Huey Lim, Zi Thung Lee, Ken Horng Lim, Sze Ying Sia

Introduction: Enamel demineralisation is common in the patients undergoing orthodontic treatment with fixed appliance and bonding of the orthodontic brackets on demineralised enamel surfaces compromises clinical outcome. Aim: To compare the effect of flouride varnish, Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP-ACPF) and resin infiltrant on Shear Bond Strength (SBS) of adhesives used to bond orthodontic brackets on demineralised enamel. Materials and Methods: This comparative in-vitro study was conducted in the Faculty of Dentistry, MAHSA University, Kuala Lumpur, Selangor, Malaysia, from September 2017 to March 2018. A total of 60 premolars were exposed to three cycles of demineralisation-remineralisation for 18 days and were grouped equally into four groups. Group I was without any enamel pretreatment while group II was treated with Fluoride varnish (Duraphat), group III with CPP-ACPF (GC Tooth Mousse Plus) and group IV with resin infiltrant (Icon). The orthodontic brackets were bonded to buccal surface of premolars with Transbond XT, conventional orthodontic light cure adhesive system and SBS (MPa) was measured following mechanical shearing of bracket under universal testing machine. Statistical comparisons were done using Welch Analysis of Variance (ANOVA) and Games Howell Post-hoc Test. Results: The highest SBS values were found in group IV (16±5.2 MPa) followed by group I (13.5±6.6 MPa), group III (9.8±2.8 MPa) and group II (3.4±2.7 MPa). Pairwise comparison of SBS scores between following groups were found statistically significant i.e., Group I and group II (p-value <0.001), group II and group III (p-value <0.001), group II and group IV (p-value <0.001), and between group III and group IV (p-value=0.004). The SBS scores between group I and group III (p-value=0.212) and between group I and group IV (p-value=0.671) were not significantly different from each other. Conclusion: Demineralised enamel pretreated with resin infiltrant (Icon) showed highest SBS among all the groups while fluoride varnish application showed lowest SBS. To prevent remineralisation during orthodontic treatment, Icon can be used as prophylaxis agent before brackets are bonded to teeth with enamel lesion.

A Cross-sectional Study on Nomophobia among Undergraduate Medical Students in Chennai, India

Introduction: Nomophobia is the fear of being away from mobile phone contact or in other words nomophobia is the irrational fear of being without mobile phone. Nomophobia is an emerging psychological public health problem. Aim: To determine the prevalence of nomophobia and pattern of mobile phone usage among medical students in Chennai. Materials and Methods: This cross-sectional study was done among 400 undergraduate medical students of Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, studying from 1st year to 4th year, over a period of two months (July 2019 and August 2019). A structured questionnaire, developed by Yildirim C and Correia AP, was used to determine the prevalence of nomophobia among the study population. Stratified simple random sampling technique was used, where 100 students from each study year were selected. Descriptive statistics and chi-square test were done to compare the severity of nomophobia with various variables. Results: Out of 400 students, 50% (200) were males and 50% (200) were female students. Overall, 85% (340) used mobile internet. The top three reasons for using mobile internet were WhatsApp (95%), YouTube (81.3%) and Instagram (74.3%). The overall prevalence of nomophobia was 99% (396); 17.5% (70) showed severe nomophobia, 56.3% (225) moderate nomophobia, and 25.3% (101) had mild nomophobia. Severe nomophobia was associated with mobile usage >5 hours in a day (p-value=0.013). Conclusion: Health education and health awareness campaigns regarding nomophobia should be created among the undergraduate medical students.

Perception of Phase 1 MBBS Students Regarding the Foundation Course: A Cross-sectional Study

Manish Goyal, Kavita, Ravi Kant Tiwari, Pravin Gunderao Dhone

Introduction: A one-month Foundation Course (FC) was introduced by Medical Council of India (MCI) in its Competency Based Medical Education (CBME), from the academic session 2019 onwards. The course was introduced with the purpose to orient fresh MBBS students about the challenging academic environment of medical colleges, apart from giving them the opportunity to early assimilation, peer-communication, group-interaction and introducing them to some basic skills. Aim: To obtain the perception of the students about their experience on the foundation course, and to collect feedback for further improvements in the next sessions. Materials and Methods: A questionnaire-based observational cross-sectional study was conducted at the end of FC from April 2021 to July 2021. The participants were 92 newly joined phase 1 MBBS students at Rajmata Shrimati Devendra Kumari Singhdeo Government Medical College, Ambikapur, Chhattisgarh, India. The experience and the perception of students about the FC was taken as feedback, obtained on a prestructured and validated questionnaire consisting of 33 closed-ended questions and distributed over five modules. The feedback to these questions was to be answered as a single response based on the fivepoint Likert scale with decreasing order of agreement. Data analysis was done by using the Statistical Package for the Social Sciences (SPSS) version 16.0 software. Results: The mean age of study participants was 19.05±1.21 years. Thirty four (36.9)% of the study participants graded the overall experience to FC as highly satisfactory. Among them 14 were males and 20 were females. The feedback on the orientation module and field visit module scored the average mean (4.2) on a 5-point Likert scale. While the feedback on the module on computer, language, learning and extra-curricular activities obtained the lowest average mean score (3.6). Conclusion: The FC is a welcome change in the curriculum according to the newly introduced CBME. The topics such as 'cadaver as first teacher', 'visit to dissection hall', 'visit to blood bank', 'role of doctors in society' and 'Basic Life Support (BLS)' scored the higher mean value, while 'substance abuse and cyber-addiction' and 'sports and hobbies' scored the lower mean values on a five-point Likert scale. The FC helped to assimilate and acclimatise the newly joined phase 1 MBBS students with the main stream of medical course.

Implementation of Good Clinical Practice in Early COVID-19 Pandemic

Introduction: The novel Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has spread across the globe generating a pandemic. Every affected country has tried its best to mitigate the virus’s effects. Aim: This study was designed to implement the good clinical practice in the Institute of Cardiovascular Diseases Timis¸ oara (ICDT) for Coronavirus Disease-2019 (COVID-19) infection by a retrospective search for patients with a possible COVID-19 infection before widespread testing was available in our country. Materials and Methods: The retrospective study was conducted on selected group of 19 patients admitted to the ICDT, who displayed radiological signs of possible SARS-CoV-2 infection, between September 2019 and May 2020 in collaboration with the Radiology Department. Patients have been followed-up regarding their clinical status and asked to participate in Immunoglobulin G (IgG) antibody testing at a local laboratory. The patients were divided based on the period they were admitted to the hospital into four groups: September-December 2019, January-February 2020, March-April 2020 and May 2020. The patients tested for coronavirus came from all four timeframes. Results: Only 13 patients (male: female ratio was 10:3 ; mean age was 71.69 years) from the initial group were available and willing to answer a short interview and only five agreed to be tested for SARS-CoV-2 IgG antibodies. Most of the patients admitted to the hospital were suffering from acute myocardial infarction (30.7%), as well as heart failure (30.7%), followed by coronary heart disease (15.38%). A 30.7% of the patients had atrial fibrillation, 23% were also diagnosed with pneumonia during their hospital admission, 23% were also being treated for arterial hypertension, 7.69% had diabetes mellitus and Chronic Obstructive Pulmonary Diseases (COPD). Out of the five patients tested for IgG antibodies, two tested positive, with a titre above 1.4. Conclusion: The patients who have gone through the SARS-CoV-2 infection without being previously diagnosed were identified and followed-up on their health status. By conceiving and performing this study, the authors have strived to establish a new set of rules to advance and improve good clinical practice in unprecedented times.

Retained Trophoblastic Tissue: A Clinicopathological Study

Introduction: Remnants of Conception (ROC) are routinely submitted for Histopathological Examination (HPE) to confirm the presence of trophoblastic tissue, to rule out gestational trophoblastic diseases, for ascertaining the aetiology of recurrent abortions as well as diagnosing foetal pathologies apart from medicolegal purposes. However, there is a lot of debate about the usefulness of routine HPE of all ROC. Aim: To assess the usefulness of routine histopathological examination for remnants of conception. Materials and Methods: This retrospective study was conducted between January 2021 to May 2021at Department of Pathology, Guntur Medical College (Government General Hospital) Guntur, Andhra Pradesh, India. The data of cases were collected between June 2017 to July 2019. There were a total of 104 cases during the study period. The cases were retrieved by retrospective search of pathology records and patient details and other relevant clinical information was obtained from patient requisition form and clinical case sheet. The Haematoxylin and Eosin (H&E) slides were reviewed. Statistical analysis was performed using percentages and frequencies. Results: Gestational age was known in 54 cases out of which cases presenting in first trimester were 41 (75.93%) cases, second trimester were 11 (20.37%) cases, and third trimester or postdelivery were 2 (3.70%) cases. Out of 41 first trimester cases, 22 (40.7%) cases were below eight weeks of gestation. The indication of surgical uterine evacuation was incomplete miscarriage in 50 cases, missed miscarriage in 19 cases, suspected molar pregnancy in 17 cases and anembryonic miscarriage in two cases, and suspected ectopic in five cases. On HPE, ROC was confirmed in 77 (74.04%) cases, 12 (11.5%) cases showed only decidual tissue with arias stella reaction and no villi. There was choriocarcinoma in 1 (0.9%) case and molar pregnancy in 13 (12.5%) cases. On HPE, there was no evidence of trophoblastic tissue in 1 (0.9%) case. Conclusion: Remnants of conception was most common in first pregnancy, and during the first trimester in the study. Histopathological examination is required for confirmation of trophoblastic tissue and in diagnosis of molar pregnancy and other trophoblastic diseases.

Comparison of Pritchard and Dhaka Regimen in Outcome of Patients with Severe Preeclampsia and Eclampsia in Eastern Part of India: A Prospective Observational Study

Anjali Rani, Madhu Jain, Debbrata Das, Kamlesh Kumar, Milad Mohammadzadehasl

Introduction: Preeclampsia and eclampsia are one of the leading causes of maternal mortality. Magnesium sulphate is the drug of choice to prevent and avoid recurrences of convulsions. Pritchard is the standard regimen of Magnesium sulfate (MgSO₄ ). But keeping in view the small stature and low Body Mass Index (BMI) of Indian women low dose regimen of MgSO₄ (Dhaka regimen) is also effective. Aim: To compare the efficacy of Pritchard and Dhaka regimen in control of convulsions in severe preeclampsia and eclampsia. Materials and Methods: A prospective observational study was done at Institute Of Medical Sciences-Banaras Hindu University, Varanasi, Uttar Pradesh, India, in Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry from January 2019 to December 2020. Two groups were made. In group I standard Pritchard regimen (n=48) and in group II Dhaka regimen (n=36) was given. Outcome was measured in terms of recurrence of convulsions, MgSO4 toxicity. Various parameters age, BMI, APGAR score, mode of delivery, birth weight were also measured. Student t-test was used to compare two groups. Results: The mean age in group I was 26.48±4.677 years and in group II was 24.64±3.743 years. Incidence of preeclampsia and eclampsia was 8.92%. The maternal mortality due to preeclampsia and eclampsia was 30.05%. Recurrence of convulsion was seen in two cases in group II and one case in group I. Serum magnesium level was statistically significant at 30 minute and at 4 hours. Various parameters like age, (p-value=0.056) duration of stay in hospital, (p-value=0.110) BMI, (p-value=0.304) mode of delivery (p-value=0.186) was not statistically significant. Conclusion: The low dose Dhaka is as effective as Standard Pritchard regimen. Magnesium sulphate toxicity was seen in three cases in Pritchard and not in single case in Dhaka regimen. It is a better choice for women of short stature of Asian women as it is less toxic.

Prevalence of exoT Gene in Pseudomonas aeruginosa Isolated from Various Clinical Samples: A Cross-sectional Study

Jagannath Dnyanoba Andhale, M Anjaneya Swamy, RN Misra

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is one of the most frequently co-infecting bacteria reported. Development of drug resistance, biofilm formation, cell associated factors make the P. aeruginosa more virulent. Type III secretion system controls expression of genes. P. aeruginosa chromosome harbours exoT, exoS, exoU, and exoY virulent genes. Gene exoT plays an important role in causation of infection. The identification of virulent markers of pathogens for identification of acute and chronic infections at early stage remains a critical area and still need large research. Aim: To study the prevalence of exoT gene encoding exotoxin T in P. aeruginosa from clinical samples. Materials and Methods: A descriptive cross-sectional research was conducted during January 2015 to March 2016 at the Department of Microbiology in Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India. Various clinical samples were processed using standard laboratory methods. The statistical analysis was done by using Chi-square test. Strains of P. aeruginosa isolated from various clinical samples were identified using standard laboratory methods, and exoT gene was detected by Polymerase Chain Reaction (PCR) and gel electrophoresis technique. Results: Out of 30 strains of P. aeruginosa, 20 (66.67%) were isolated from male and 10 (33.33%) from female patients. Most of them belonged to the age group 41-60 years (46.67%). The exoT gene occurred in 20 (66.67%) isolates of P. aeruginosa, while 10 (33.33%) showed negative amplification results. Out of 20 exoT genes in P. aeruginosa, 17/20 (85%) were detected from male and 3/10 (15%) from female patients. Conclusion: Gene exoT of P. aeruginosa plays the crucial role in causation of disease. It is concluded that exoT gene can be a notable virulent element expressed by 66.67% of P. aeruginosa clinical isolates. The proven role of exoT virulence gene in the pathogenicity of P. aeruginosa would help in understanding the prognosis of Pseudomonas infection and designing an effective treatment and vaccine against the Pseudomonas infections to prevent them.

Neutrophil to Lymphocyte Ratio as an Early Predictive Marker for Adverse Outcomes in Patients with Acute Pancreatitis

Introduction: Acute pancreatitis is associated with various complications leading to morbidity and mortality. In inflammation it is common that number and proportion of inflammatory cells vary. In acute pancreatitis it has been observed in various studies that Neutrophil to Lymphocyte Ratio (NLR) can predict prognosis of the disease. Hence, a prospective study was conducted with an aim to determine the clinical significance of NLR in predicting adverse outcomes in acute pancreatitis. Aim: To compare the NLR at 0 hour, 24 hours and 48 hours between mild and Severe Acute Pancreatitis (SAP) and set an optimal NLR in predicting severity of acute pancreatitis and development of organ failure in acute pancreatitis. Materials and Methods: A prospective observational study was conducted between September 2017 to August 2019 in a tertiary care teaching institute at Kasturba Medical College and Hospital, Manipal, Karnataka, India. After obtaining Institutional Ethical Committee (IEC) clearance and fulfilling the inclusion and exclusion criteria, 180 patients with age 18 years and above with acute pancreatitis were evaluated. Patient’s clinical characteristics, imaging features, biochemical, pathological, microbiological and laboratory parameters were noted. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) software version 20.0. Unpaired student’s t-test was used to compare the mean differences of the two groups. A p-value <0.05 was considered as statistically significant. Results: In present study, 31-40 years age group was commonly affected with acute pancreatitis. Males were predominantly affected (84%). Among 180 patients, 49 had SAP. Alcohol was the most common cause for acute pancreatitis (69.4%). Mean NLR in Mild Acute Pancreatitis (MAP) at 0, 24, 48 hours of admission to hospital were 9.38, 6.88, 5.15, respectively. In SAP, NLR were 16.27, 12.43, 9.72 at 0, 24, 48 hours, respectively. In MAP, NLR was highest on the day of admission and rapidly came down towards normal value. In SAP, NLR was highest on day 1 and remained higher for a longer duration indicating severe ongoing inflammation. Conclusion: The NLR at the time of admission has an ability to differentiate between mild and SAP. Patients with NLR >10.80 should be considered as having severe pancreatitis and managed aggressively to treat any potential complications.

Age at Menarche as a Navigator of Gallbladder Cancer: A Case-control Study

Durgesh Shukla, Akash Mishra, Mallika Tewari, Nisha Tiwari, RN Mishra

Introduction: Age at menarche is said to be a risk factor for Gallbladder Cancer (GBC). The available research about the association of age at menarche with GBC, by taking a cut-off age of 13 years, is neither uniform nor consistent and at best inconclusive. Aim: To evaluate the association between age at menarche and the risk of GBC, based on cut-off age of 13 years and treating age at menarche as a continuous variable. Materials and Methods: A hospital based case-control study was conducted on 92 female patients and 92 female controls. The data was collected from the Department of Surgical Oncology, Sir Sunderlal (SS) Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India during the period of October 2018 to June 2019. Logistic regression analysis was performed and Adjusted Odds Ratio (AOR) with its 95% CI (Confidence Interval) was obtained. Results: In the present study, the mean age of GBC cases and control were 56.84±8.74 years and 51.21±6.37 years, respectively. With the reference category of menarche age, the females with menarche age >13 years were insignificantly at lower risk of incidence of GBC (AOR=0.569; 95% CI: 0.263-1.233). But when age at menarche was considered as a continuous variable; the AOR was significantly lower among females found decreasing with increasing age at menarche (AOR=0.798; 95% CI: 0.666-0.955). Conclusion: This exercise indicates, using a reference category of continuous measurements obtained result may be inconclusive with an influence of subjective decision making so it is suggested to prefer the recorded discrete continuous value for the analysis procedure.

Bochdalek Hernia in an Adult Presenting as Hydropneumothorax due to Gastric Volvulus Perforation: A Case Report

Congenital Diaphragmatic Hernia (CDH) occurs due to herniation of abdominal contents into the thorax through a defect in the diaphragm caused by incompletely fused pleuro-peritoneal folds. It is classified into three types, of which Bochdalek hernia is the most common type. Here the authors report a case of a 24-year-old male patient who presented with sudden onset of abdominal and chest pain with multiple episodes of non bilious vomiting since two days. Computerised Tomography (CT) suggested the possibility of a Bochdalek hernia with mesentroaxial gastric volvulus and intrathoracic gastric perforation causing hydropneumothorax which was confirmed on surgery. The gastric perforation was closed and the herniated abdominal contents were reduced and the diaphragmatic rent was repaired. His postoperative recovery was unremarkable. Bochdalek hernias may infrequently remain asymptomatic till adulthood, where they may manifest suddenly with serious chest or abdominal complaints. Computerised tomography is a rapid imaging tool that can provide a precise preoperative diagnosis and a road map for the operating surgeon.

A Scanning Electron Microscopy and Energy Diffraction X-Ray Spectroscopy Study to Evaluate the Effect of Firing Temperature at the Ceramic-Noble Metal Alloy Interface in Porcelain Fused to Metal Restorations

Introduction: Porcelain Fused to Metal (PFM) restorations offer aesthetics of ceramics and the strength of metal hence are the gold standards of fixed partial dentures. However, the fracture of porcelain-metal interface still remains a matter of concern. Aim: To study the porcelain-noble metal alloy interface of PFM restorations at different firing temperatures, using Scanning Electron Microscopy (SEM) and Energy Diffraction X-ray Spectroscopy (EDS). Materials and Methods: This in-vitro study was conducted between November 2018 to October 2019 at Prosthodontics Department of Saraswati Dental College and Hospital and King George’s Medical University Lucknow, Uttar Pradesh, India. A total of 75 strips of noble metal alloy were prepared and layered with 1 mm of porcelain on one surface, conforming to American National Standard/American Dental Association Specifications (ANSI/ADA) specification no. 38 for Metal-Ceramic Dental Restorative Systems: 2015. These were randomly divided equally into three groups. Specimens of each group (n=25) were fired at different temperatures that is 850° C, 900° C and 960° C, respectively. Scanning electron microscopy and Energy diffraction X-ray spectroscopy were performed at the noble metal alloy and ceramic interface of all specimens. Data was recorded and statistically analysed using one-way Analysis of Variance (ANOVA) and post-hoc Tukey HSD test. Results: Irregularities/Coarseness (50 µm) was seen on the noble metal alloy surface adjacent to ceramic layer in SEM images at all the three chosen temperatures. The EDS study revealed intermingled zones of partial oxygen depletion at the interface region with formation of intermetallic compound, lead zirconate titanate and complete oxygen depletion zone near metal alloy end of interface. The mean value of Shear Bond Strength (SBS) was 16.31 MPa at 850° C, 24.33 MPa at 900° C and 19.41 MPa at 960° C (p-value <0.05). Conclusion: Difference in properties and location of the intermetallic compound formed at the interface, as well as the location of the oxygen depletion zone could account for the weaker bond formed between noble alloy-porcelain interface compared to base metal-porcelain interface.

Detailed Morphometry and Morphology of Bicipital Groove of Humerus among North Indian Population

Paras Kumar, Susmita Saha, Gaurav Arora, Prachi Saffar Aneja

Introduction: Bicipital Groove (BG) represents an indentation on the proximal humerus which lodges tendon of Long Head of Biceps (LHB) brachii with synovial sheath. It’s medial and lateral walls are formed by lesser and greater tubercles respectively and the transverse humeral ligament converts it into a tunnel. Aim: To find a detailed morphometry attributing to morphological classification of BG among North Indian population. Materials and Methods: The present observational study was conducted over a period of one year on 100 adult intact dry humerii of unknown sexes obtained from Osteology Museum, Department of Anatomy, Shree Guru Gobind Singh Tricentenary (SGT) University, Gurugram, Haryana, India for several morphometric parameters like length, width, depth, length of medial and lateral walls as per descriptive statistics using Statistical Package for the Social Sciences (SPSS) version 21.0. The BG was classified according to the depth, opening angle and medial wall angles. Morphological features like Supratubercular Ridge (STR) of Meyer’s, bony spur on the floor of the groove or thickening of the walls were also observed and the frequency distribution was presented and Independent t-test was applied to compare the parameters on both sides. Results: Out of 100 sample, the mean of each parameter was length 72.98±7.54 mm, width 9.12±2.18.mm, depth 5.49±1.56 mm, medial wall and lateral wall length 54.83±8.62 mm and 60.82±8.01 mm respectively, opening angle 72.27±18.12° and medial angle 65.27±10.71°. Mostly BG had a depth of 4-6 mm with an incidence of 48%. Opening angle of BG was small (<95°) in 84% of humerus and maximum belonged to type 1 (90° to 75°) variety. Around 34% bones were showing morphological changes, out of which STR was 47.05%, bony spur on the floor of BG was 20.58% with wall thickening in 32.35% of total humerus. Conclusion: The detailed morphometry and classification of BG will serve as a reference base for North Indian population. It will be also useful for the clinicians as they should be well verged with the various morphological appearances of BG among dry bones and radiographs for proper diagnosis and treatment.

A Study on Clinicomicrobiological Profile of Infections in Febrile Neutropenic Children with Haematological Malignancies in a Tertiary Care Hospital at Chennai, Tamil Nadu, India

P Dhanaleha, MR Anand, G Jayalakshmi

DIntroduction: Febrile neutropenia is common with chemotherapy regimens in 25-40% of patient, especially in children and the severity which depends on the chemotherapy regimens. Neutropenic fever is an oncologic emergency that requires immediate treatment with antibiotics. Aim: To isolate and identify bacterial, fungal, parasitic and viral aetiological agents causing infections in febrile neutropenic children with haematological malignancy and to identify the comorbid conditions. Materials and Methods: This cross-sectional study was conducted at the Institute of Microbiology, Madras Medical College Chennai, Tamil Nadu, India, for a period of one year from November 2012 to October 2013. A total of 112 paediatric patients with 129 febrile episodes were included in the study satisfying the inclusion and exclusion criteria. Under strict aseptic precautions samples were collected from patients with signs of infections after obtaining informed consent and were subjected to microbiological detection and identification by conventional culture methods. The data was expressed in terms of frequency and percentages and statistical results were analysed with Microsoft Excel. Results: Among the 129 febrile episodes microbiologically documented infections were 39.5% (51 out of 129 febrile episodes). Bacterial infections were predominant constituting 36.4% followed by 3.1% fungal infection. Bacteremia constituted to about 19.4% of febrile episodes, followed by urinary tract infection about 11.6%, respiratory tract infection 6.2% and oral infection 2.3%. Most of the gram negative isolates were sensitive to amikacin, cefaperazone sulbactam and piperacillin tazozobactam. Gram positive isolates were sensitive to vancomycin, cotrimoxazole and erythromycin. Out of the four fungal isolates three Candida spp. were isolated from oral thrush and one Aspergillus flavus from respiratory tract. All the fungal isolates were 100% sensitive to antifungal agents. Overall mortality due to infection was 18%. Conclusion: In this study, the spectrum of bacteremia among febrile neutropenic patients, appear to be shifting towards gram positive microorganisms with multidrug resistant organisms being common. Emergence of multidrug resistance can be prevented by reviewing periodical modification of empiric antibiotic policy. Therefore, surveillance of antibiotic resistance pattern would be useful for deciding empiric therapy in them.

Type 2 Diabetes Mellitus- Better Associated with BMI, Abdominal Obesity or Insulin Resistance?

Sreelakshmi Mohanan, Geetha Nair, Jean Maliekkal

Introduction: Type 2 Diabetes Mellitus (T2DM) has emerged as a major public health concern globally and it is associated with a multitude of complications leading to mortality and morbidity. A close association has been observed with T2DM and obesity in various studies, which has been closely associated with intraabdominal or central obesity rather than to overall adiposity. Aim: To evaluate the association of T2DM with anthropometric parameters, abdominal obesity parameters and Insulin Resistance (IR). Material and Methods: A case-control study was conducted amongst 64 normal healthy individuals and 64 diabetic patients attending the diabetic clinic of a tertiary care centre over a period of one year. Participants aged between 30 to 75 years were recruited. The abdominal obesity anthropometric parameters which included Body Mass Index (BMI), Waist Circumference (WC), Waist Hip Ratio (WHR), Waist Height Ratio (WHtR) were recorded. IR was estimated using Homeostasis Model Assessment (HOMA)-IR method. Data was entered in Microsoft Excel software and data was analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. Results: A 64 T2DM patients and 64 normal healthy controls were included in the study. The mean BMI was 23.1±2.3 and 21.3±1.2 for cases and controls, respectively (p-value <0.001). The mean WC was 84.0±4.8 and 80.5±2.8 (p-value=0.003), and mean WHR was 0.9±0.3 and 0.8±0.02 (p-value <0.001) for cases and controls, respectively. The mean WHtR was 0.5±0.1 and 0.5±0.03 (p-value=0.330), and mean IR was 3.8±1.1 and 1.3±0.2 (p-value <0.001) for cases and controls, respectively. A statistically significant positive correlation was observed between IR and WC of T2DM patients (p-value=0.025). A statistically insignificant positive correlation was observed between IR and BMI (p-value=0.105). Conclusion: Body Mass Index (BMI), abdominal obesity parameters and IR values were elevated in T2DM. Among the anthropometric parameters studied, WHtR was observed to be a better parameter and it can be used routinely in a clinical setting as it has a constant parameter (height).

Analysis of Histopathological Parameters of Oral Squamous Cell Carcinoma by Bryne’s Grading in Different Age Groups

Introduction: Oral Squamous Cell Carcinoma (OSCC) commonly seen in 6th to 8th decades of life, when occurring in younger age group under 45 years its prediction and aggression is questioned due to subjective data in literature. Various histopathological grading systems of OSCC have been discussed in the literature, but the reability of such grading systems is controversial. However, Bryne’s invasive tumour front grading system has a high prognostic value since it provides diagnostic and predictive information of OSCC. Aim: To compare the histopathological parameters of OSCC by Bryne’s grading in different age groups. Materials and Methods: This was a retrospective archive study conducted in the Department of Oral Pathology and Microbiology, MIDSR Dental College, Latur, Maharashtra, India, from June 2010 to December 2020. Total 90 histopathologically diagnosed cases with OSCC were included in the study. These patients were divided into three groups: Group I included 30 patients below 40 years of age; Group II included 30 patients who were between 41 to 60 years of age; and Group III included 30 patients who were above 60 years of age. Formalin fixed paraffin embedded blocks of OSCC were used to prepare Haematoxylin and Eosin (H&E) stained section and graded based on Bryne’s invasive tumour front grading system. Chisquare test was applied to evaluate the significant difference among different age groups. Results: Out of 90 cases of OSCC included in the study among different age groups, 70 (77.77%) were males and 20 (22.22%) were females. This study found 93.33% (28 patients) in group III followed by 76.66% (23 patients) in group I and 63.33% (19 patients) in group II had score 2 nuclear polymorphism. When the three groups were compared using chi-square test, a p-value of 0.024 was obtained which was found to be a statistically significant in the nuclear polymorphism among different age groups by Bryne’s grading. The comparison between other histological parameters of Bryne’s grading degree of keratinisation (p-value=0.169), pattern of invasion (p-value=0.422), number of mitosis (p-value=0.107), and lymphoplasmacytic infiltration (p-value=0.252) revealed no significant differences. Conclusion: Outcomes of the study result showed differences in nuclear polymorphism were more obvious among old p

Study of Factors Affecting the Yield of Plateletpheresis by Intermittent Flow Cell Separator

Chada Tejaswi, Venkateshwar Reddy

Introduction: Rational use of platelet transfusions is one of the important treatment options available. Due to advances in apheresis technology, collection of Single Donor Platelets (SDP) with high yield is achieved. Platelet yield in the transfused SDP product influences the platelet recovery in the patient thus decreasing repeated transfusions and economic burden. Aim: To analyse donor laboratory and clinical factors influencing the quality of SDP. Materials and Methods: A retrospective study on plateletpheresis procedures was conducted in the Department of Transfusion Medicine, at Kamineni Institute of Medical Sciences Telangana, India, from January 2017 to January 2019. A total of 168 procedures were studied which were done on intermittent flow cell separator (Haemonetics MCS+, USA). Donor variables such as age, gender, predonation platelet count, haemoglobin, Haematocrit, Total Leukocyte Count (TLC), Mean Platelet Volume (MPV), and Platelet Distribution Width (PDW) were studied for their effect on platelet yield of SDP. Statistical analysis was done for study of relationship between platelet yield and donor variables using Pearson correlation. Results: The mean age was 26.8±5.81 years with maximum in age group 21-30 years. The mean platelet yield was 3.1±0.79×1011 per unit. Statistically significant direct correlation was observed between predonation platelet count and platelet yield (r=0.327, p<0.0001). No such correlation was observed with predonation haemoglobin (r=0.098, p=0.204). There was a negative correlation between the platelet yield and MPV (r=-0.051, p=0.512) which was not significant. There was negative correlation between platelet yield and PDW (r=-0.166, p=0.032) which was found to be statistically significant. Also no statistical significance was found between platelet yield and age of the donor (r=0.118, p=0.125), total leukocyte count of the donor (r=0.112, p=0.147), haematocrit of the donor (r=0.005, p=0.944). Conclusion: Donors with higher platelet counts results in a better yield and derives a better clinical response. This helps in decreasing the number of transfusions per patient and exposure to the donors thus lessening the economic burden.

Evaluation of Medial Meniscal Thickness, Tear and Extrusion in Patients with and without Osteoarthritis of Knee: A Cross-sectional Study

Introduction: Loss of articular cartilage is the primary change occurring in osteoarthritis. However, due to combination of several cellular changes and biomechanics stresses, several secondary changes like formation of osteophytes, development of bone osteophytes, synovial and capsular changes, meniscal tears and extrusion also occur. A meniscal lesion in a healthy knee joint may eventually lead to the development of knee osteoarthritis, but an osteoarthritic knee may also lead to meniscal damage which in turn can further accelerate the disease process. It is often concluded to be a two-way relationship. Aim: To assess medial meniscal thickness and incidence of medial meniscal tear, extrusion in patients with knee osteoarthritis and also to assess cartilage damage in knee osteoarthritis patients in comparison to normal patients. Materials and Methods: A cross-sectional study was in the Department of Radiodiagnosis, SRM Medical College, Hospital and Research Centre, Tamil Nadu, India, in 180 subjects, out of which 90 had osteoarthritis and 90 were controls. Patients were evaluated radiographically using anteroposterior and lateral projections in plain X-ray following which patient’s knees were imaged using routine Magnetic Resonance Imaging (MRI) protocols. The thickness of anterior horn, posterior horn and body of medial meniscus was assessed manually in sagittal Proton Density Fat Saturation (PDFS) sequence images. The signal intensity changes within the menisci was assessed and graded accordingly. Meniscal tear associated with meniscal extrusion was also assessed. The articular cartilage thickness was measured in coronal PDFS images. Data was analysed using Chi-square test for qualitative analysis and unpaired t-test for quantitative analysis. Results: The mean medial meniscal thickness of anterior horn, body and posterior horn was 3.95 mm, 3.57 mm, 3.53 mm in patients with osteoarthritis; while those for patients without osteoarthritis was 5.65 mm, 6.05 mm, 6.56 mm (p-value of 0.021, 0.032, 0.029, respectively). The medial meniscal tear was seen in 46 patients with osteoarthritis and 40 without osteoarthritis (p-value=0.018). The meniscal extrusion was nil, less than 50% and more than 50% in 39, 34 and 17 patients with osteoarthritis; while those for the other group was 72, 14 and four (p-value <0.001, 0.001 and 0.003, respectively). The mean medial tibial articular cartilage thickness was 1.86 mm in patients with osteoarthritis and 2.04 mm in patients without osteoarthritis (p-value=0.009), and the mean femoral articular cartilage thickness was 1.84 mm in patients with osteoarthritis and 2.02 mm in patients without osteoarthritis (p-value=0.010). Conclusion: The study concludes that the incidence of meniscal tear, extrusion, and cartilage damage is more common in patients with knee osteoarthritis. Further research is needed to provide proficient knowledge and to improve the quality of life in patients suffering from knee osteoarthritis.

Smartphone Addiction and its Impact on Insomnia among the Undergraduate Medical Students of a Teaching Hospital of Maharashtra, IndiaA Cross-sectional Study

Introduction: Smartphone addiction is a type of behavioural addiction. Because of their alluring and exciting features, they have become favourite among young adults. Medical students are also prone to develop smartphone addiction. Excessive use of these devices has produced detrimental effect on physical and psychological well-being of an individual. Continuous exposure to screen has reduced sleep duration, delayed sleep onset and poor sleep quality. Aim: To assess the prevalence of smartphone addiction and its impact on insomnia among undergraduate medical students. Materials and Methods: Present online cross-sectional study was conducted by the Department of Psychiatry of Government Medical College, Akola, Maharashtra, India, over a period of three days from October 3, 2021 to October 5, 2021 on undergraduate MBBS (Bachelor of Medicine and Bachelor of Surgery) students of the selected college. This study was an online survey by using Smartphone Addiction Short Version Scale (SAS-SV) and Insomnia Severity Index (ISI) scale to assess smartphone addiction and insomnia respectively. A total of 275 complete responses were included in the study. Statistical analysis was carried out by using Chi-square test and Pearson’s correlation test. Results: A total of 275 complete responses of the undergraduate medical (MBBS) students, age 18-25 years ,143 males and 132 females,were included. Smartphone addiction was found to be present among 181 (65.8%) medical students. It was significantly associated with factors such as spending more than three hours per day on smartphone, having perceived bad impact of increased smartphone use over academic performance and facing criticism regarding increased smartphone use. Insomnia was present among 143 (52%) medical students, of which 82 (29.8%) had mild, 47 (17.1%) had moderate, and 14 (5.1%) had severe insomnia. Significant correlation (r-value 0.35; p-value <0.001) existed between the smartphone addiction and the severity of insomnia among study participants. Conclusion: This study reveals alarming rise in smartphone addiction and its impact on insomnia among medical undergraduates. There is a need of continuous supervision and intervention program for early detection of addiction and safeguarding the well-being of medical students.

A Cohort Study of Toxicities of Intensity Modulated Radiotherapy in Postoperative Patients of Carcinoma Cervix and Endometrium

Introduction: Conventional Whole Pelvic Radiotherapy (WPRT) is associated with significant morbidity, especially haematological and Gastrointestinal (GI), which increases further with concurrent chemotherapy. Various studies have shown a clinical benefit of pelvic Intensity Modulated Radiotherapy (IMRT) but included a significant number of patients with intact cervix and uterus. Aim: The primary aim of the study was to record the toxicities of IMRT and the secondary aim was to detect its tolerance. Materials and Methods: This was a phase 2, single arm cohort study, conducted from August 2015 to October 2018 at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, including a total of 30 patients (23 cervical and seven endometrial cancer) who had undergone a total hysterectomy and required adjuvant pelvic irradiation. These patients were treated with pelvic IMRT using a dose of 45-50.4 Gray (Gy) at 1.8-2 Gy per fraction given as five fractions per week with/without concurrent chemotherapy (using injection cisplatin 35-40 mg/m2 per week) as per indications. Acute toxicities were recorded at weekly intervals during the treatment followed by the assessment of late toxicities at the time of each follow-up visits using Radiation Therapy Oncology Group (RTOG) radiation morbidity criteria. All outcomes were measured from the time of the start of radiotherapy to the time of acute event. Acute and late toxicities were assessed according to RTOG radiation morbidity criteria. Survival analysis was done using the Kaplan-Meier method. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) (IBM Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Results: Out of 30 patients, the highest grades of acute toxicities for skin, Lower Gastrointestinal (LGI), Genitourinary (GU), and haematological toxicities were grade 1, 2, 2 and 2, occurring in 11 (36.7%), 9 (30%), 4 (13.4%), and 1 (3.4%) of the cases, respectively. No late skin and GU toxicities were observed. Maximum late LGI toxicity was grade 1, occurring in 6.67% of the cases. Five (out of 30) patients developed treatment failures (two distant and three local). At a median follow-up of 35 months, the three year Progression Free Survival (PFS) and Overall Survival (OS) were 83.3% (all stages included). Conclusion: Considering acute and late adverse events in the form of skin, LGI, GU, and haematological toxicities, IMRT is well tolerated and has an acceptable toxicity profile even in the setting of an aggressive trimodality approach.

Seroprevalence of Neurocysticercosis among Epilepsy Patients in Chennai, Southern India- A Cross-sectional Study

Elumalai Arthi, R Selvi

Introduction: Neurocysticercosis (NCC) is the leading cause of epilepsy in the developing world and is also the most common parasitic infection of the Central Nervous System (CNS). The disease is one of the “major neglected diseases” as per World Health Organisation (WHO). There is an immense burden of epilepsy in the developing countries like India, but little is known about its cause. Data regarding the prevalence of epilepsy due to NCC is unavailable in many regions in India though in some areas it is reported more frequently. Aim: To estimate the seroprevalence of NCC among epilepsy patients in Southern India. Materials and Methods: This prospective cross-sectional study was conducted at Stanley Medical College, Chennai, Tamil Nadu, India, among epilepsy patients attending neurology clinic for a period of one year (August 2011-September 2012). All the participants were evaluated for NCC by Magnetic Resonance Imaging (MRI) and detection of Taenia solium (T. solium) anticysticercal antibody by Enzyme Immuno Transfer Blot (EITB) and Enzyme Linked Immuno Sorbent Assay (ELISA). The statistical analysis was done by Chi-square test using Statistical Package for the Social Sciences (SPSS) software (version 19.0). Results: In the present study, of the 100 epilepsy cases studied, about 20% of the participants had MRI findings suggestive of NCC and colloidal vesicular stage was the most common stage (11%). Anti-cysticercal antibodies were detected in 27% by EITB and 16% by ELISA. However, there was no statistical significant association between seropositivity type of epilepsy and MRI findings. In comparison to EITB, the sensitivity and specificity of ELISA were 59.3% and 90.4%, respectively. Conclusion: The findings of this study suggests that there has been an exposure of NCC in this population and hence this disease should be considered in all epilepsy cases for appropriate treatment.

Biochemical Estimation in an Acute Toxicity Study of Narayana Chenduram- A Siddha Formulation

PM Sukala, R Muthusamy, V Tamilalagan, S Baskaran, Arbind Kumar Choudhary

Introduction:/b> Chendurams are more potent and its potency is further increased when combined with herbal juices. Chenduram is known to be effective when it is given at low concentration. Narayana Chenduram (NC) is a metal based siddha formulation that contains heavy metals like mercury, cinnabar, arsenic along with sulphur/sulphides. NC is used to treat Parkinson’s disease along with the polyherbal formulation Athimathura Gritham (AG). Aim: To evaluate the health status of the animals under acute oral toxicity study of NC. Biochemical estimation of heavy metals in liver, kidney, brain and serum was carried out. Histopathological study was also performed in liver and kidney. Materials and Methods: The present experimental study was conducted in Department of Anatomy, University of Madras, Chennai, India from October 2009 to December 2009. The heavy metals present in NC was analysed by Inductively Coupled Plasma Optical Emission Spectrophotometry (ICP-OES) using acid digestion method. A single oral dose acute toxicity study of NC was conducted using acute toxic class method as per Organisation for Economic Cooperation and Development (OECD) Guidelines for the testing of chemicals. It was done using limit test method. The study was conducted by giving NC at a single dose of 2000 mg/kg body weight mixed in 10 mL of honey/kg body weight and rats were observed for 14 days for toxic signs. Total five animals were tested under this method to determine Lethal Dose 50 (LD50). On day 15, the distribution of heavy metals in liver, kidney, brain and serum was determined by ICP-OES using acid digestion method and was compared with control. Food and water intake, body weight were recorded before and after drug administration as per the guidelines. Histopathological examination of liver and kidney was performed in the same animals and compared with control. To find the effect of given adjuvant (honey) under acute oral toxicity study, NC at a single dose of 1000 mg mixed with 10 mL of honey/kg body weight was administered to one group of animals and NC at a single dose of 1000 mg mixed with 10 mL of sesame oil/kg body weight was given orally to another group of animals. After administration of test drug, the rats were observed for 14 days for toxic signs and on 15th day they were sacrificed to study histological changes in kidney and liver among these two groups. Adjuvant treated control group of animals were administered only with 10 mL of honey at a single dose and observed for 14 days and sacrificed on day 15 to study histology of liver and kidney and compared with control. Results: No mortality was observed at a single dose of 2000 mg/ kg under acute toxicity study. Hence, LD50 was greater than 2000 mg/kg body weight. ICP-OES analysis showed that the mean concentration of mercury was five times more than that of mean concentration of arsenic in the given sample weight of NC. Under acute toxicity study, after oral administration of NC at a single dose of 2000 mg/kg body weight, serum showed more significant accumulation of mercury than arsenic when compared to control groups. A single dose of 2000 mg NC produced hepatotoxicity and renal toxicity. At a single dose of NC at 1000 mg mixed with 10 mL honey showed less histopathological changes when compared with NC mixed with sesame oil. Adjuvant (honey) treated group did not show any histopathological toxicity in liver and kidney when compared with control. Conclusion: Though there was no mortality at a single dose of 2000 mg/kg body weight, serum showed marked accumulation of mercury that indicates toxicity. It produced signs of histopathological toxicity in liver and kidney. Dose dependent change was observed. Hence, it is recommended to use Chenduram at low doses.

Effect of Oral 12% Carbohydrate Containing Clear Fluid in Children on Post-anaesthesia Recovery Profile- A Randomised Clinical Trial

Archana Anilkumar Bharadwaj, Ishwar Bhukal, Preethy Joseph Mathew
Introduction: The perioperative fast is an unpleasant experience, especially for children, as prolonged fasting leads to dehydration, hunger and anxiety. American Society of Anaesthesiology (ASA) recommends the 6-4-2 regimen for preoperative fasting. Preoperative carbohydrate containing clear fluids have been included in the Enhanced Recovery After Surgery (ERAS) protocol due to benefits in adult surgical patients, but very little has been studied about postanaesthesia recovery, especially in children. Aim: To study the effect of oral 12% clear carbohydrate fluid on postanaesthesia recovery profile in children. Materials and Methods: The randomised clincial trial was done on 101 children belonging to ASA physical status I and II, aged 2 to 8 years, scheduled for elective procedures, who were randomly allocated to two groups. The study children received 5 mL/Kg of body weight of clear apple juice two hours prior to anaesthetic induction, and those in the control group were advised to follow the standard 6-4-2 fasting regimen (solid, breast milk, clear fluid). A Random Blood Sugar (RBS) value was measured intraoperatively. The time taken to achieve a Modified Aldrete Score (MAS) of >9 was noted from the time of extubation. The time taken for the children to ask for oral intake and the time taken to attain the recommended discharge criteria were noted in the recovery room. Independent t-test and Mann-Whitney U-test were applied for comparing the various parameters assessed, with a significance level of α=0.05. Results: Mean age of the population in the study group and the control group were 4.520±1.9 years and 4.775±2.02 years (p-value=0.548), respectively. It was found that the children in the study group took a longer time to attain MAS of >9 (study group 18.70±10.19 minutes and control group 16.86±6.85 minutes, p-value=0.007) and had lower intraoperative blood sugar levels compared to the control group {the median (IQR) values of study group 70 (60-79) mg/dL and control group 90 (85-98) mg/dL, p-value=0.005}. Time to ask for oral intake was longer in the study group indicating decreased thirst (study group 49.40±31.08 (minutes) and control group 25.88±16.93 (minutes), p-value=0.0001). None of the children had complications like vomiting or pulmonary aspiration in the perioperative period. Conclusion:Oral clear 12% carbohydrate fluid as part of preoperative fasting regime is safe for post-anaesthesia recovery

A Prospective Cohort Study Analysing 3-Dimensional Conformal Radiotherapy and Salivary Glands Preserving Intensity Modulated Radiotherapy with/without Concomitant Cisplatin Chemotherapy in Head and Neck Malignancies

M Santosh Krishna, Bhaskar Vishwanathan, B Naveen, Geeta S Narayanan
Introduction: Most common toxicity of radiotherapy in head and neck malignancy patients is xerostomia. Xerostomia can be prevented by using salivary gland sparing Intensity Modulated Radiation Therapy (IMRT) technique. Aim: To compare Dose Volume Histogram (DVH) of salivary glands in IMRT and 3-Dimensional Conformal Radiation Therapy (3DCRT) and evaluation of xerostomia, mucositis and dysphagia in both groups. Materials and Methods: The present study was a prospective cohort study in which 30 patients were selected. Patients of head and neck cancer reporting to Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India were included. Duration of study was one year (January 2013 to December 2013). Fifteen patients treated with IMRT and 15 patients with 3DCRT to a dose of 60-70 Gy in 30-35 fractions, with or without concomitant cisplatin. The DVH of salivary glands and incidence of xerostomia, mucositis and dysphagia was compared in both the groups. Patients were assessed during the course of radiotherapy and three months postradiotherapy. Results: Mean dose to contralateral parotid was 19.48 Gy in IMRT when compared to 47.31 Gy in 3DCRT. Mean dose to contralateral submandibular was 44.06 Gy in IMRT when compared to 67.63 Gy in 3DCRT. At three, six and seven weeks there was a difference in number of patients having reduced severity of mucositis in IMRT when compared to 3DCRT. There was no significant difference in dysphagia between both groups at three, six and seven weeks and one month after the treatment. No significant difference in xerostomia between both the groups at seven week and one month after treatment. At three months after treatment the difference in xerostomia was significant between both groups (p<0.05) favouring IMRT. No tumour response benefit was seen with IMRT. Conclusion: Radiation dose received by salivary glands by IMRT was significantly less when compared to 3DCRT, thereby reducing the incidence, severity and duration of xerostomia. IMRT helps in reducing the severity and duration of dysphagia and mucositis in comparison to 3DCRT during radiotherapy of head and neck cancer.

Psychological Distress among Family Members of Inpatients in General Medicine Wards at a Tertiary Care Hospital: A Cross-sectional Study

Darsh Aggarwal, Frederick Satiro Vaz
Introduction: It is now being increasingly recognised that even family members of the patients face emotional and cognitive challenges. Several studies have studied the distress experienced by family members of patients admitted in the Intensive Care Unit (ICU) setting and have identified anxiety and depression, stress, confusion, uncertainty among the family members. There is however, sparse literature available on the psychological distress experienced by family members of inpatients in general wards, globally as well as in India. Aim: To estimate psychological distress among the family members of inpatients in General Medicine wards at a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted in General Medicine wards at a tertiary care hospital in Goa, India. Family member caregivers of the patients admitted in these wards constituted the study sample. The data was collected in predesigned format. The psychological distress was studied by using the Hospital Anxiety and Depression Scale (HADS) questionnaire and the Caregiver Self-Assessment Questionnaire (CSAQ). Statistical analysis was conducted using Statistical Package for the Social Sciences version 24.0. Chi-square was the test of significance used. Odds ratios and 95% Confidence Interval (CI) were calculated wherever the association between the variable of interest and outcome variable was statistically significant with p-value =0.05. Results: Out of 150 family member caregivers, 84 were males and 66 were females with mean age of 38.87±13.08 years. Majority (43.3%) were children of the admitted patients. The most common ailments were cardiovascular (24%) followed by infectious diseases (17.3%) and neurological (16.6%) problems. The prevalence of anxiety was 42% among the family members whereas that of depression was 23.3%, on HADS scoring system. Relationship of the family member with the inpatient and marital status of the patient were the factors significantly associated with anxiety in the family member. Around 66% of the family members were experiencing high degree of distress, as measured by the CSAQ. Relationship of family member with the inpatient and the gender of the caregiver were the only factors significantly associated with psychological distress, measured by CSAQ. Conclusion: Since family members of patients experience significant psychological distress even in general ward setting there may be a need to more actively involve family members in the hospital care of the admitted patients. This departure from the traditional patient centered care wherein a family member’s role was minimal may lead to a more holistic healthcare benefiting both the patient and his family.

Role of Saroglitazar in Non Diabetic Non Alcoholic Fatty Liver Disease Patients: A Retrospective Observational Study

Akash Jaiswal, Kavita Jain, Amit Kumar Singh
Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is a commonly encountered problem which affects one third of the general population. Saroglitazar, a Peroxisome Proliferator Activated Receptor (PPAR) alpha α and gamma γ agonist has been recently approved for treatment of NAFLD. Aim: To assess the efficacy of saroglitazar in non diabetic NAFLD patients. Materials and Methods: It was a retrospective observational study, conducted from October 2020 to March 2021 on 45 non diabetic NAFLD patients, at a tertiary care centre in northeastern India. Liver enzymes, liver fibrosis and liver fat content were compared before and after receiving saroglitazar for 24 weeks. Multiple regression analysis was used to assess percent change in Alanine Transaminase (ALT), Aspartate Transaminase (AST), ALP, bilirubin, Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP). The p-values <0.05 were considered as statistically significant. Results: Mean age of the study population was 46±8.20 years, and there were 24 males and 21 females. Reduction in liver enzymes like Alanine Transaminase (ALT) and Aspartate Transaminase (AST) and fibroscan parameters like Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) were seen. Mean values of ALT and AST at pretreatment status were 85.52±17.12 U/L and 70.02±19.10 U/L, and after treatment were 40.20±12.11 U/L and 37.32±8.31 U/L, respectively (p-value <0.0001 for both ALT and AST). Pretreatment and post-treatment mean values for LSM and CAP were 8.11±2.18 kPa (kilopascal), 365.84±56.22 d/m (decibel/ metre) and 7.20±1.80 kPa, 345.21±35.22 d/m, respectively (p-value=0.021 for LSM and 0.036 for CAP). Conclusion: Twenty four weeks saroglitazar was effective in treatment of non diabetic NAFLD. It not only reduces hepatocellular inflammation, but also liver fibrosis and liver fat.

Assessment of Coronary Artery Disease and Lipoprotein Lipase Gene Polymorphism in Bengali Population by PCR based RFLP Analysis- A Retrospective Study

Jayanta Kumar Rout, Sayari Banerjee, Subhankar Kayal, Rajshekhar Dutta
Introduction: Coronary Artery Disease (CAD) is a leading cause of death in most countries as well as developing countries like India and incidence of susceptibility to CAD is associated with increased frequencies of particular Single Nucleotide Polymorphisms (SNPs) located in Lipoprotein Lipase (LPL) gene. Aim: To evaluate the association of LPL gene polymorphisms variation namely LPL-HindIII, LPL-PvuII and LPL-Ser447Ter with CAD in Bengali population by Polymerase Chain Reaction (PCR) based Restriction Fragment Length Polymorphism (RFLP). Materials and Methods: A retrospective case-control study was conducted at RG Kar Medical College and Hospital, Kolkata, West Bengal, India from April 2016 to October 2016. The study included 100 patients suffering from CAD and 100 controls from healthy populations were taken and Deoxyribonucleic Acid (DNA) extraction followed by genotyping was done by PCR based RFLP study. Hardy-Weinberg equilibrium for genotypic frequencies were analysed followed by goodness-of-fit Chisquare (χ2 ) test to check the equilibrium of the SNP alleles. Results: Total 100 patients, 57 males and 43 females with mean age 61.42±9.34 years suffering from CAD were cases and 100 patients were controls, 61 males and 39 females with mean age 49.37±10.21 years. It was found that genotypic frequencies for HindIII, PvuII and MnlI polymorphism of LPL gene were not deviated from the Hardy-Weinberg expectations in both control and cases groups. We could not find any significant association of the HindIII, PvuII and Ser447Ter polymorphisms of the LPL gene with occurrence of CAD in target population after appropriate data analysis using SPSS and MedCalc software. Conclusion: Association and prediction of susceptibility patterns in ethnic population may require a prospective study involving higher number of cases which subsequently leads to possible pharmacogenomic utility on a broader perspective. Although authors did not get any statistically significant association between CAD and the genes of interest but these findings would lead to a better understanding of the condition and open up more avenues for study, treatment and prevention of CAD.

Minimally Invasive Transpedicular Screw Fixation for Thoracolumbar Fractures- A Retrospective Analysis in a Basic Neurosurgery Unit

Anand Prabhavathy Raghavan, Satheesh Chandra Sugatha Rao, Thomas Cyriac
Introduction: Thoracic and lumbar fractures are among the most common type of traumatic spine fractures. With advanced surgical technique and instrumentation the use of minimally invasive pedicle screw fixation for thoracolumbar fractures has increased. Minimally invasive spine procedures avoid excessive muscle dissection and decreases trauma to tissues during surgery. Aim: To study the outcome with minimally invasive spine surgery for thoracolumbar fractures. Materials and Methods: This study was designed as a retrospective descriptive study. All patients with thoracic and lumbar fractures who had undergone minimally invasive percutaneous pedicle screw fixations from June 2016 to May 2019, in the Department of Neurosurgery were included. Cases requiring laminectomy were excluded. A total of 25 patients were included in this study. Mean blood loss, operative time, hospital stay, postoperative pain and complications were assessed. Data was entered in excel sheet and statistically analysed using charts and graphs. Results: Nineteen males (76%) and six females (24) were included in this study. Mean age of the study population was 41.45 years. Mean blood loss was 125 mL and no patient required blood transfusion. Average duration of the procedure was 104±34.9 minutes. Improved pain score was noted during postoperative period. No patient developed Cerebrospinal Fluid (CSF) leak, new onset neurological deficits and bowel or bladder involvement during the postoperative period. Conclusion: Minimally invasive spine fixation surgery is safe and less destructive procedure which is fast and is associated with minimal morbidity. Percutaneous techniques are associated with less blood loss, shorter hospital stay and improved perioperative pain scores. From the present study it was noticed that there was an increased risk for radiation associated with minimally invasive pedicle screw fixation.

Interleukin-6: A Versatile Biomarker in the Clinical Chemistry Laboratory in the COVID-19 Era

Surupa Basu
Introduction: Interleukin-6 (IL-6) is a proinflammatory cytokine released during the cytokine storm of sepsis and Coronavirus Disease-2019 (COVID-19). IL-6 has been extensively used as a biomarker in Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) and in the emerging novel paediatric disease called Paediatric Inflammatory Multisystem Syndrometemporarily associated with SARS-CoV-2 (PIMS-TS) or Multisystem Inflammatory Syndrome in Children (MIS-C). Additionally, IL-6 measurement is necessary to decide for several cytokine-blocking and cytokine-removal therapies and to determine treatment adequacy. Aim: Evaluation of the performance of IL-6 in COVID-19, PIMSTS/MIS-C and in CytoSorb cytokine removal therapy in sepsis as a versatile biomarker in clinical chemistry laboratory. Materials and Methods: The study was an exploratory descriptive study carried out between March 2019 and February 2021 for a period of 24 months. IL-6 (pg/mL) was measured on Roche e411 immunoassay platform using Electrochemiluminiscence Assays (ECLIA) in 15 adult patients. Biological reference interval of the parameter was <7 pg/mL. Results: The results showed that IL-6 was increased significantly in non survivors compared to survivors with COVID-19 (p-value=0.0043). IL-6 levels (normal <7 pg/mL) were highly elevated in children with PIMS-TS {median 75.9 pg/mL (IQR: 47.3-223.4)} reflecting the intense inflammatory state of the novel paediatric condition. All PIMS-TS cases (n=13) survived. IL-6 levels were increased post CytoSorb therapy in sepsis patients who did not survive and declined in survivors. IL-6 serially measured during treatment helped to monitor therapeutic adequacy in prolonged sepsis case. Conclusion: The various applications of automated IL-6 testing in the clinical chemistry laboratory reflects the versatility of the trending biomarker.

Screening for Carcinoma Cervix by Comparing Pap Smear Cytology, Histopathology with Colposcopy in Unhealthy Cervix

Chaithanya Chandru, SR Sheela
Introduction: Cervical cancer is one of the most frequent genital tract cancers and accounts for 80% of all female cancers worldwide. Annually, the incidence is about five lacs and 2,80,000 people die due to carcinoma cervix yearly. In India, 1,26,000 new cases are detected and 71,000 deaths occur annually. Cervical cancer is a preventable condition, since it is associated with prolonged preinvasive stage, so that early screening and appropriate treatment can be undertaken to prevent the progression into invasive stage. Aim: To compare Papanicolaou (Pap) smear cytology, colposcopy and colposcopy guided biopsy (histopathology) in detecting premalignant and malignant lesions of the cervix. Materials and Methods: A cross-sectional study was carried out in Department of Obstetrics and Gynaecology at RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. The study period was from October 2018 to June 2020 and 90 study subjects were included in the study. All the study subjects enrolled were subjected to Papanicolaou (Pap) smear, colposcopy and colposcopy directed biopsy. The data was statistically analysed for sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear and colposcopy, with considering colposcopy directed biopsy as the gold standard for diagnosis. Results: Maximum number of women was found in the age group of more than 50 years (44.4%), mean age was 52±11 years. Majority of the women were multipara accounting for 95.6%. Pap smear had a sensitivity and specificity of 69.2% and 88.2%, respectively. The colposcopy had sensitivity of 97.37% specificity of 88.46 as Pap smear. Conclusion: Colposcopy has a good association with Pap smear and histopathology in diagnosis of premalignant and malignant lesion in unhealthy cervix. Hence, its satisfactory diagnostic efficacy makes it a realiable for diagnosis of malignant and pre malignant lesion.

Prognostic Significance of ABPM in Comparison to Clinical Blood Pressure Monitoring and their Association with Various Risk Factors Involved in CKD Predisposition in North Indian Patients

Seema Singh, Syed Tahseen Raza, Nitin Ranjan Gupta, Rahul Singh
Introduction: Ambulatory Blood Pressure Monitoring (ABPM) has been found to be a more reliable method for diagnosing Hypertension (HTN) and stratifying cardiovascular risk than Continuous Blood Pressure (CBP) monitoring. Aim: To evaluate prognostic significance of ABPM in comparison to clinical Blood Pressure (BP) Monitoring and their association with various risk factors involved in Chronic Kidney Disease (CKD) patients. Materials and Methods: This was a prospective study done in Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India. Routine laboratory tests were conducted for all patients. Casual Blood Pressure (BP) was obtained by a trained staff through a digital BP monitor (CITIZEN-CH-432) and Meditech ABPM-05 device was used for ABPM. Pearson 's correlation method was used to analyse the relationship between the two continuous variables. Results: Present study included 400 patients of which 225 (56.25%) were male subjects, and mean age was 62 (Range21-76) years. Of the study population, 90 (22.5%) were CKD G1-2, 79 (19.75%) were CKD G3a, 96 (24%) were CKD G3b, and 135 (33.75%) were CKD G4. Among all the patients included in the study, the most common was normal BP (33.75%), sustained HTN (26.25%), White Coat Hypertension (WCH) (6.5%), and masked HTN (33.5%). When multiple logistic regression analyses were done, estimated Glomerular Filtration Rate (eGFR), and BP data, night-time Systolic Blood Pressure (SBP) (OR, 1.043; 95% CI, 1.025-1.067; p<0.001), and night-time Diastolic Blood Pressure (DBP) was found (OR, 1.050; 95% CI, 1.013-1.075) to have an independent association with non/reverse-dippers. Conclusion: The ABPM has more prognostic significance when compared to office BP measurements in all kind of normotensive, hypertensive and CKD patients at all stages. ABPM measurements are often abnormal in CKD, with CKD patients frequently showing an altered circadian rhythm with an increased rate of non dipping and reverse dipping.

Association of ABO and Rhesus Blood Groups with the Severity of SARS-CoV-2 Infection: A Cross-sectional Analytical Study
Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a new strain of RNA viruses causes coronavirus disease in human. Though some studies suggested different blood group types as risk factors for Coronavirus Disease 2019 (COVID-19) infection, the association between blood groups and the COVID-19 infection may not be the same in various societies with different genetic statuses. Also, no studies so far have investigated the relationship between COVID-19 severity and ABO blood groups in Iran and developing countries according to the World Health Organisation (WHO) criteria. Aim: To evaluate the association between blood types and the severity of COVID-19 infection. Materials and Methods: This cross-sectional study enrolled 171 patients infected with SARS-CoV-2 {49 severe (severe or critical) and 122 non severe (mild to moderate)}, who were admitted to hospitals of Mazandaran University of Medical Sciences, Sari, Iran from April 2020 to June 2020. To evaluate the distribution of the blood group, 171 COVID-19 patients were compared with the reported data of Iranian population blood groups. The severity of COVID-19 infection was determined based on WHO criteria including clinical symptoms, radiological findings, and signs of organ dysfunction. The associations between ABO blood groups and the severity of COVID-19, were evaluated using Pearson’s Chi-square. Results: The distribution of the blood group in 171 patients with COVID-19 was not different compared to the reported general Iranian population blood group (p-value=0.344). Evaluation of the association between ABO blood groups and the severity of COVID-19 showed that patients with blood group type B developed severe COVID-19 infection compared to other blood types who showed mild or moderate conditions (p-value=0.048). Mortality due to COVID-19 was not statistically different between the ABO blood group and Rh (p-value=0.96, p-value=0.27 respectively), but the frequency of patients with Rh-negative that needed intubation and mechanical ventilation was higher compared to Rh-positive patients (p-value=0.003). Conclusion: A positive correlation was found between blood type B and COVID-19 severity. Also, mechanical ventilation was significantly more in Rh-negative patients.

Diagnostic Value of Medical Thoracoscopy- A Retrospective Analysis

Binu Krishnan, Sonish Krishnan, Priya Shanmugharaj
Introduction: Clinical and radiological parameters might not be sufficient to diagnose the aetiology of exudative pleural effusions accurately. Often, thoracoscopy serve as an important added tool in the correct diagnosis. Aim: To analyse the diagnostic accuracy of initial diagnosis (clinical and radiological) compared with thoracoscopic biopsy. Materials and Methods: This was the retrospective study done on all the consecutive medical thoracoscopic procedures conducted in tertiary care centre (pulmonology wing), Trivandrum, India from May 2010 to April 2016. All thoracoscopic procedures were conducted in adult patients above the age of 18 years. Kappa statistics was performed to find the diagnostic accuracy. Results: During this period, 94 diagnostic medical thoracoscopic procedures were performed. Majority of them were males (68.1%) and mean age was 54.8±13.53 years. Main diagnostic indications were undiagnosed exudative effusions (85.4%) and emphysema (7.1%). Tuberculosis was the most common initial diagnosis prior to the procedure (70.2%). Histopathology reports showed tuberculosis as the most common final diagnosis (45.7%), followed by malignancy (38%) and chronic inflammation (6.4%). Four patients who were not biopsied were excluded from diagnostic accuracy analysis. When thoracoscopic biopsy was taken as the gold standard, sensitivity was found to be 67.4% for initial diagnosis of tuberculosis and only 13.9% for malignancy. But specificity was found to be more for malignancy (81.5%) than tuberculosis (27.7%). Overall diagnostic accuracy of initial diagnosis was found to be 46.7% for tuberculosis and 54.4% for malignancy. There was minimal or no correlation (R=-0.173) between the diagnostic outcome and type of anaesthesia (local or general anaesthesia). There was no significant difference in occurrence of complications between local and general anaesthesia (p-value=0.717). Conclusion: Medical thoracoscopy had an important additional diagnostic value in management of pleural diseases as evidenced by slight agreement between initial and final diagnosis

Ponseti Method versus Posteromedial Soft Tissue Release for the Management of Clubfoot: A Prospective Interventional Study
Introduction: Idiopathic clubfoot is a common complex deformity of newborns that can be managed either by manipulation, serial casting or by surgery with individualised success of treatment rated differently. Aim: To determine functional outcome, health status of clubfoot patients and the percentage of recurrence that needs additional surgery at the end of three years of treatment by using both Ponseti method and posteromedial soft tissue release method. Materials and Methods: A prospective interventional study was conducted in which two groups of idiopathic clubfoot patients were treated as per the two modalities of treatment (ponseti versus posteromedial release) at the Orthopaedic Department of Veer Surendra Sai Institute of Medical Science and Research, Odisha, India between March 2017 to February 2021, with regular followup for a period of three years. Forty patients with 63 feet were taken in the study. Out of which, 20 patients with 32 feet were managed by ponseti method in one group whereas another group containing 20 patients with 31 feet were treated by posteromedial soft tissue release. During follow-up foot function was assessed by Laaveg-Ponseti score, general well-being of the children was assessed by paediatric outcomes data collection instrument and any complications were recorded in terms of recurrence. Results: Mean age of presentation in Ponseti group is 4.73 month, whereas mean age of presentation in surgical group is 7.85 month. Though recurrence was the major complication in both the groups, significant difference was seen in severity of recurrence (p-value=0.049). More numbers of major recurrence were seen in posteromedial surgical group (5,16.13%) which subsequently required major surgical procedures for correction. Pretreatment pirani score of ponseti and surgical group (4.9±1.0, 5.1±0.90) was statistically improved (0.34±0.38, 0.20±0.33). Foot function was evaluated using Functional Rating System (FRS) total score showing higher in ponseti group 95.25±5.68 with good to excellent outcome. Health status of the patients was assessed by Paediatric Outcomes Data Collection Instrument (PODCI) score, showed no significant difference in result in both the groups (p-value=0.3562) in view of global function subscale. Conclusion: This study have documented a favourable outcome towards ponseti group in terms of higher rate of excellent to good outcome, better parental satisfaction and better passive mobility of clubfeet with less number of revision surgery required for recurrence.

Role of Neutrophil-lymphocyte Ratio as Short-term Outcome Prognostic Indicator Following an Acute ST Segment Elevation Myocardial Infarction-A Prospective Observational Study

Catherine T Paul, Vijayashree Thyagaraj, Swati Hegde
Introduction: The ratio of Neutrophils to Lymphocytes (NLR) has recently arisen as a likely biomarker to forecast clinical outcomes in Ischaemic Heart Disease (IHD). The NLR in cases of ST Elevation Myocardial Infarction (STEMI) with respect to survival outcomes and complications is not well established in literature and was evaluated in the present study. Aim: To study the association of NLR with complications and mortality following acute STEMI. Materials and Methods: A short-term prospective observational study was conducted in 102 participants diagnosed with STEMI. The study was conducted at tertiary care hospital from October 2015 to September 2017. Haematological, serological and radiographical findings were obtained and compared between survivors and non survivors. Receiver Operator Curve (ROC) and Area Under the Curve (AUC) analysis were performed to analyse the utility of NLR in predicting mortality and major complications. Results: The mean age of patients was 64.12±14.82 years and 75.5% of them were male. Non survivors (9.8%) had a greater incidence of cardiogenic shock (p-value <0.00049), pulmonary oedema (p-value <0.01199) and tachyarrhythmia (p-value <0.00049) compared to survivors. The ROC and AUC analysis showed that a higher NLR had a sensitivity of 80% in detecting mortality, 77.78% in detecting cardiogenic shock and 80% in detecting pulmonary oedema. Conclusion: Higher NLR can be a useful prognostic marker for predicting short-term mortality and acute complications following an acute STEMI.

Non Pharmacological Management Strategies for Sleep Quality in Adults- A Narrative Review

Atchaya Nanth, Suvarna Jyothi Kantipudi
Sleep problems are prevalent among adults and is a matter of public health concern. They not only impair the quality of life but are associated with various medical and neuropsychiatric consequences. There is a need for increased awareness regarding various treatments available, especially safer options, and more acceptable management options for sleep problems among medical fraternity. The aim of this article was to give a narrative overview of sleep assessment in adults and existing evidence for various non pharmacological management strategies for enhancement of sleep quality. Authors had manual search strategy of PubMed, Google Scholar engines for relevant research publications and reviewed them along with cross references from the retrieved articles. A comprehensive review on the evidence outlines, the effectiveness and usefulness of the non pharmacological management options in sleep problems. This review showed that the cognitive behavioural therapies and mindfulness based therapies are highly effective in enhancing sleep quality. Considering the safety profile of non pharmacological management strategies when compared to commonly prescribed pharmacological agents such as sedative hypnotics, there is a need to improve availability of services for non pharmacological treatment options. This can be achieved by brief systematised training in the psychotherapeutic interventions for sleep to healthcare professionals, which in turn will improve the quality of life of people suffering with sleep problems across medical conditions.

Oral Health Needs Including Unmet Dental Needs among Transgender Population- A Review

Ipseeta Menon, Hari Parkash, Ritu Gupta, Lavanya Rohatgi, Dipshikha Das
Healthcare is a fundamental human right irrespective of gender, race, religion, caste, social status or the community in which they live. But transgender people are mostly victims of such barriers which eventually lead to compromised oral health. This narrative review emphasise on the oral health needs including unmet dental needs among transgender population. Search strategies were devised for each database for easy identification of the studies to be included in this review. The search strategy used a combination of controlled vocabulary and free text terms. The main electronic database used to access the studies were PubMed, PubMed Central, Cochrane Review, Embase and Google Scholar using keywords such as transgender, eunuch, dental health, oral health, etc., were used as the main electronic databases to access the studies. Exact 20 articles fulfilled this criteria and were selected for review. A high prevalence of oromucosal lesions were seen among the transgenders. High prevalence of gutkha chewing habit might be a reason for an increase in number of oral mucosal lesions. Furthermore, the review also showed that Oral Submucous Fibrosis (OSMF), leukoplakia and lichen planus were the commonly found oral mucosal lesions in the surveyed population. Awareness of brushing habits among transgenders and care towards their oral hygiene was found to be low. In the present review, it has been observed that the dental health is poor among the studied population. There is a need for oral hygiene and health awareness among transgenders as well as improvement and participation by policy makers for better delivery of health and dental facilities to them. Thus, more emphasis should be laid on research in this population group.

Rapidly Growing Mycobacterium in Postsurgical Wounds: A Systematic Review and Meta-analysis

Ashok Mhaske , Shubhangi Mhaske , Sanjay Harke , Arti Jain , Jaswant Patel
Introduction: Rapidly Growing Mycobacteria (RGM) are extensively found in nature and is isolated as an environmental saprophyte from water sources and soil. The incidence of these opportunistic pathogens has increased in the recent years as nosocomial outbreaks, with an exaggerated outcome of morbidity and resistant antibiotic intervention. Aim: To assess the occurrence of rapidly growing mycobacteria in postsurgical wounds. Materials and Methods: Literature search in PubMed, Google Scholar and Scopus of published articles in English language from March 2010 to December 2020 were anlaysed for the predetermined outcomes. Keywords used for the literature search were "atypical mycobacteria"; "non tuberculous mycobacteria"; "rapidly progressing mycobacteria"; "RGM"; "postsurgical wounds"; "surgical site infection"; "wound site"; "port hole infections". A total of 10 studies adhering to Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines were included for statistical analysis. OpenMeta-Analyst software was used. Results: A prevalence of 56.4% (95% CI: 33.0; 79.8) was noted in 592 patients evaluated postsurgically. The articles included were of fair quality when assessed on Ottawa scale. M.Chelonae, M.Abscessus, M.fortuitum and M.massiliense were the most commonly isolated organisms. Clarithromycin, Amikacin, Ciprofloxacin, Imepenem and Linezolids were administered as antibiotic intervention. Conclusion: Considering the higher prevalence of RGM infection (56.40%), every surgeon must consider the possibility of this opportunistic infection. It is vital

Airway from an Orthodontic Perspective
With the change in concepts of orthodontics over the years, the focus today has slowly shifted to airway-centered orthodontics. Several pathological conditions of the craniofacial region both genetic and epigenetic in origin can contribute to nasal and airway resistance and airway collapse, all of which could sooner or later predispose the patients to sleep-related breathing disorders. These have serious implications on the lifestyle, body homeostasis, and cardiovascular system. On the other hand increased resistance to airflow through the upper respiratory tract can lead to mouth breathing tendency or snoring at a young age which ultimately hinders the normal transverse, sagittal and vertical development of the craniofacial complex especially of the stomatognathic system. This review focuses on the two-way relationship between the airway and craniofacial region. It also attempts to point out the need to consider the various goals of airway-centered orthodontics as various orthodontic treatment modalities impact the airway in a significant manner both positively and negatively.

Enhancement of Manpower for Management of COVID-19 Crisis in India

Swati Jain, Bhavya Krishna, Divya Gautam, Mahesh Chandra, Harish Sachdeva
The Coronavirus Disease 2019 (COVID-19) pandemic overwhelmed not just the resources in terms of infrastructure but also manpower. With many healthcare workers turning COVID-19 positive themselves, and the healthcare system being overburdened, we were short-staffed in most health Institutions across India. In anticipation of a similar crisis, at our tertiary care centre, we came up with certain measures to enhance the manpower should the need arise for not just hospitals, but also the society at large.