Journal of clinical and diagnostic research

Bartsocas-Papas Syndrome: A Lethal Multiple Pterygium Syndrome

Sumita Mehta, Ekta Kale, Tarun Kumar Ravi, Ankita Mann, Pratibha Nanda

Bartsocas-Papas Syndrome (BPS) is a very rare autosomal recessive syndrome characterised by marked craniofacial deformities, multiple pterygia of various joints, limb and genital abnormalities. It is mostly associated with mutation in the gene encoding Receptor Interacting Serine/Threonine Kinase 4 (RIPK4) required for keratinocyte differentiation. The syndrome is generally lethal and majority of babies die in-utero or in the early neonatal period. This is a report about a neonate born with characteristic clinical features of BPS including severe craniofacial and ophthalmic abnormalities, limb deformities and multiple pterygia at popliteal, axillary and inguinal region. The baby had respiratory distress at birth and was managed conservatively on Continuous Positive Airway Pressure (CPAP)/Oxygen hood and injectable antibiotics for two weeks and then referred for further work-up to a tertiary hospital. The parents took the baby home against the advice of the treating doctors and she subsequently died after 10 days. BPS is associated with high mortality and so all efforts should be directed towards diagnosing it early antenatally when termination of pregnancy is a viable option. This is possible by having a high index of suspicion in couples with consanguineous marriages or with a positive family history.

Heterotopic Ossification in Guillain-Barré Syndrome- A Dual Case Report

Rachit Gulati, Shashank Yeshwant Kothari, Sandeep Kumar Gupt

Heterotopic Ossification (HO) is formation of atypical, lamellar bone within a soft tissue surrounding major joints. It is well documented as a complication following spinal cord injury and traumatic brain injury; however, it is quite rarely seen in lower motor neuron conditions like Guillain-Barre Syndrome (GBS). Here, we present two cases of GBS (both young males) with Bilateral hip pain who were diagnosed HO on the basis of radiological study while still admitted in the Intensive Care Unit (ICU). Both of them had history of mechanical ventilation, tetraparesis and prolonged immobilisation. There are very few reports of HO in GBS and if detected early, it improves the functional outcome.

Intra-abdominal Solitary Myofibroma in a Child: A Rare Case Report

Smita Singh, Jyoti Garg, Kusha Sharma, Kiran Agarwal

Intra-abdominal masses in children are usually malignant. Benign tumours at this location are not seen frequently. It is even rarer to find solitary myofibromas intra-abdominally as these tumours are known to have predilection for the head and neck region. We present an unusual case of solitary myofibroma with abdominal localisation in a six-year-old male child who presented with abdominal distension since six months. Computed Tomography (CT) abdomen revealed a complex solid-cystic mass extending from umbilicus to right iliac fossa and measuring 9×6×4 cm. Histopathological examination revealed a tumour displaying biphasic nodular pattern with the presence of lighter staining fascicles of mature myoid cells along with darker staining and more cellular areas of smaller primitive cells. On Immunohistochemistry (IHC), tumour cells were positive for vimentin and Smooth Muscle Actin (SMA) with variable reactivity for desmin while these were negative for CD34 and Anaplastic Lymphoma Kinase 1 (ALK). Based on the histopathological and immunohistochemical findings, final diagnosis of myofibroma was made. Recognition of these lesions is extremely challenging owing to their rare presentation intra-abdominally and also because of their close morphological overlap with other spindle cell tumours commonly found at this site. This case highlights the combined role played by histopathology and IHC in making a clear distinction between different entities. It is imperative for both clinicians and histopathologists to establish the correct diagnosis as excision of the solitary myofibroma is curative in most cases and offers better clinical course than the more commonly found malignant tumours at this site.

Metastatic Carcinoma Breast Presenting as Appendicular Abscess

Breast cancer is the most common cancer in females worldwide and presents mostly as a hard painless lump in breast. Authors report a case of a 59-year-old female who presented to emergency department with complaints of pain and lump in right iliac fossa, high grade fever with chills and rigor, multiple episodes of vomiting. She was febrile having tachycardia with normal blood pressure. Examination revealed a firm tender lump in right iliac fossa with guarding of abdomen. Incidental finding of a large left sided breast lump was noted. Radiological investigations revealed appendicular abscess. She was undertaken for emergency diagnostic laparoscopy followed by appendectomy. Surprisingly, histopathology revealed deposits of ductal carcinoma in appendix. She developed faecal fistula at incision site. On further evaluation of left breast lump it was diagnosed as locally advanced breast carcinoma. Patient was managed with neo-adjuvant chemotherapy followed by left sided Modified Radical Mastectomy (MRM) and adjuvant chemotherapy. She was on regular follow-up since then. Appendicular metastasis is one of the rare sites of metastasis of breast malignancy and presentation as appendicular abscess made the diagnosis and management challenging.

Video Laryngoscope Assisted Awake Nasal Intubation with Restricted Mouth Opening in an Operated Radical Neck Dissection Patient

Naso-Endotracheal Intubation (NEI) for anaesthesia in oral and maxillofacial surgeries are difficult in case of oral mass, micrognathia, restricted mouth opening, pathological anatomy of upper airway and restricted neck extension. This case report presents the clinical and anaesthetic management for a 46-year-old male patient recently operated for left buccal mucosa squamous cell carcinoma with restricted mouth opening of 1.5 cm, a big rent of 4×5 cm on left cheek and restricted neck extension and flexion scheduled for forehead flap surgery. Patient was intubated with non-channeled Video Laryngoscope (VLS) assisted awake nasal intubation.

Sino Cranial Aspergillosis Mimicking Skull Base Meningioma- A Case Report and Review of Literature

Vishwanath Joshi, Saumya Rao, Neemish Kamat, Mitusha Verma, Deepak Patkar

Fungal infections of the nose and paranasal sinuses can be categorised into invasive and noninvasive forms. Central Nervous System (CNS) Aspergillosis is extremely rare in immunocompetent individuals. Invasive fungal sinusitis affecting CNS commonly poses a diagnostic dilemma on imaging, often confused with neoplastic processes. Here, Authors report a case of invasive sino cranial aspergillosis in immunocompetent individual mimicking a meningioma on imaging. A 46-year-old male patient presented with history of seizure like episode and right eye proptosis to Neurology Department. On Magnetic Resonance Imaging (MRI), there was enhancing T2 weighted hypointense extra-axial mass lesion along right frontal convexity with associated osseous erosion, intraorbital extension and associated sinus disease. Based on clinical presentation and imaging features, initial diagnosis of a aggressive neoplastic lesion was made. Patient subsequently underwent biopsy which showed fungal elements of Aspergillus Fumigatus species. Patient underwent endoscopic sinus surgery and along intravenous and oral antifungal therapy with good response to treatment. This case highlights the key role of imaging including MRI and CT in making accurate diagnosis of fungal sinusitis especially in immunocompetent individuals and differentiate from other entities like meningioma.

A Case Report of Beckwith-Weidemann Syndrome: An Overgrowth Anomaly

Monika Jindal, Santosh Minhas, Monika Sharma, Jaspreet Singh

Beckwith-Wiedemann Syndrome (BWS) is an overgrowth anomaly of congenital origin that has low prevalence. However, among the congenital anomalies of overgrowth, it has high prevalence. Typical features are macroglossia, macrosomia, omphalocele and anterior abdominal wall defects. Though Genetic, but it’s mechanism of occurrence is not clear. Many researchers have found correlation between methodology of Assisted Reproductive Techniques and BWS. Future research for the improvement of the prenatal diagnostic techniques would help the multidisciplinary team to treat these congenital diseases. In the present case, the diagnosis of BWS was made by ultrasound conducted in Radiology Department after filling Preconception and Prenatal Diagnostic Techniques (PCPNDT) form in the institute at gestation of 29+6 weeks and after two days of diagnosis, unfortunately patient reported to our hospital emergency with intrauterine foetal demise.

Orofacial Findings and Dental Management of Noonan Syndrome: A Case Report

Razeem Khalid Alhassoun

Noonan Syndrome (NS) is an autosomal dominant condition caused by mutations in multiple genes in the RAS-MAP (MitogenActivated Protein) Kinase pathway. It is typically characterised by short stature, broad webbed neck, abnormal chest shape, congenital heart defects and developmental delay. Oral manifestations include high arched palate, micrognathia, malocclusion, impacted teeth and jaw bones. Presented here is a case of NS in a 26-year-old female, reported to the dental clinic in College of Dentistry, Princess Nourah Bint Abdulrahman University. The cranio-dentofacial features of this syndrome can be diagnosed by the dentist and these features can be unrecognised by the physician. The dentofacial features of the patient included a broad forehead, down slanting palpebral fissure, flat base of the nose and low junction of the ears, prominent nasolabial folds, Class III molar malocclusion, edge-to-edge bite, high arched palate, and congenitally missing teeth. The present patient was first diagnosed by a dental professional and hence, this case report aims to present this syndrome from a dental viewpoint. The treatment plan was to improve her oral hygiene, retain the deciduous tooth and space maintainer in the congenitally missing tooth to preserve space for the future prosthodontic treatment.

Non-immunological Contact Urticaria (NICU) due to Ethanol Containing Hand Sanitiser: A Case Report

Shashank Bansod , Bhushan Madke

Contact Urticaria (CU) is a wheal and flare reaction, occurring within few minutes to hours of contact to an external agent over skin or mucosa. Depending on underlying pathophysiology, CU is of two types: immunological CU and nonimmunological CU. Use of hand sanitisers has increased multifold in this COVID-19 pandemic, due to increased awareness regarding maintaining a good hygiene to reduce the transmission of infection. Our present case is a 24-year-old man, who overzealously added ethanol-based hand sanitiser to his bathing water on the advice of a general physician and after bathing developed redness, swelling and itching on various body parts. A diagnosis of Nonimmunological CU (NICU) due to ethanol in sanitiser was made, based on history and clinical examination.

Rare Case of Intestinal-Type Adenocarcinoma Arising in Cervical Oesophageal Heterotopic Gastric Mucosa

Heterotopic Gastric Mucosa (HGM) also termed gastric inlet patch or inlet patch, is a rare and benign phenomenon in cervical oesophagus and can be missed during endoscopy. It has an average incidence of 2.5%. Adenocarcinoma arising in the background of gastric heterotopia is very rare and uncommon in the upper oesophagus. A 46-year-old male presented with hoarseness and progressive dysphagia for solids for the past one month. Upper Gastrointestinal Endoscopy (UGIE) revealed a tight stricture at 19-20 cm from the incisors. Initial mucosal biopsies were not conclusive. With high clinical suspicion of malignancy, patient underwent bougie dilation of oesophageal stricture followed by repeat biopsy. Histology revealed an intestinal type of adenocarcinoma, arising in a background of gastric heterotopia of the cervical oesophagus. Alcian Blue/Periodic Acid Schiff (AB/PAS) staining was positive in both the heterotopic glands and in the cancer, indicating the presence of intestinal metaplasia. Tumour cells were immunopositive for cytokeratin-7. A Positron Emission Tomography – Computed Tomography scan revealed a metabolically active lesion located in the upper third of the oesophagus along with uptake in right supraclavicular node. This case report describes a patient with primary intestinal type adenocarcinoma of the cervical oesophagus in the background of HGM not related to Barrett’s oesophagus.

Emergency LSCS in a Parturient with Pre-eclampsia and HELLP Syndrome with Altered Renal Functions Managed with Regional Anaesthesia

Pooja Arpan Shah, Mehul Mehta, Jatin Patel

Haemolysis, Elevated Liver enzyme levels, and Low Platelet (HELLP) syndrome is characterised by haemolysis (abnormal peripheral blood smear, increased unconjugated bilirubin), elevated liver enzyme and decreased platelet count. It is an advanced stage of pre-eclampsia. Pre-eclampsia is defined as blood pressure >140/90 mmHg with proteinuria with or without pedal oedema. HELLP syndrome account for 24% of maternal mortality and 40% of perinatal mortality. Anaesthetic management of such parturient is also challenging. This report is about a 35-year-old female patient with HELLP syndrome and altered renal function requiring LSCS. She was managed with regional anaesthesia.

CT Imaging in Gastrointestinal Stromal Tumour: A Case Series

Arjun H Kamath, Satish Danappa Patil, Shivanand V Patil, Ravi Kumar

Gastrointestinal Stromal Tumours (GISTs) being most common non-epithelial tumours comprise a bunch of non-epithelial smooth muscle, mesenchymal alimentary tract tumours, appearing from the interstitial cells of Cajal of varying malignancy which specify KIT protein-CD117, a stem cell factor receptor. The mutations seen in GIST’s are most common in the proto-oncogene c-KIT; seen only in GIST. This gene is not seen in the other mesenchyamal tumours. Here, the mutated c-KIT helps in the growth and survival of this tumour by activation of the KIT receptor tyrosine kinase. The incident of GISTs is increasing in recognition and the increased rate of survival has made imaging seemingly important, not only for diagnosis, but also for monitoring the effects of treatment and detecting progression of the tumour. The clinical symtoms in this case series include pain abdomen, nausea, vomiting and constipation. Some cases can present as abdominal distension. The investigation of choice for these spectrum of diseases is currently Computed Tomography (CT), however many imaging techniques, such as Positron Emission Tomography (PET), fluorine 18 Fluorode-Oxyglucose (FDG), Magnetic Resonance (MR) imaging, and Ultrasonography (US) can also be used. This article describes the typical imaging findings of GISTs at initial presentation. Many cases present late and at a stage where surgery will not be of much use. However, Imatinib has showed a drastic response in prognosis and helps increasing the survival changes leading a normal life. This study helps us in identifying the pattern of the lesion and its enhancement patterns leading to early detection, thus aiding the surgeon or the oncologist to plan for treatment.

Delayed Infection of an Autopolymerising Acrylic Resin Implanted for Orbital Floor Reconstruction

Satomi Sugiyama, Toshinori Iwai, Taro Mikami, Jiro Maegawa

Osteogenesis Imperfecta: Dreadful Infantile Dysplasia

Bhushita Guru, Bhushan N Lakhkar, Bhavana B Lakhkar

Value of Triggering Receptor Expressed on Myeloid Cells-1 (TREM-1) as a Diagnostic Marker for Neonatal Sepsis

Introduction: Neonatal Sepsis (NS) is a serious clinical condition caused by a dysregulated immune response to an infection. Neonatal period is the most vulnerable time in the child’s life. Globally, approximately 7000 newborns die everyday. Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) is an important receptor for the inflammatory response regulated by neutrophils. Aim: To explore the role of TREM-1 as a potential early diagnostic marker of NS compared to the conventional blood culture technique. The prognostic utility and relation of TREM-1 expression level to the clinical disease severity in septic neonates were also evaluated. Materials and Methods: The study enrolled 75 neonates with NS admitted to the Neonatal Intensive Care Unit (NICU). The studied neonates were categorised into three groups; group I: 25 neonates with an Early Onset Sepsis (EOS), group II: 25 neonates with a Late Onset Sepsis (LOS), group III: 25 neonates with septic shock. In addition, 25 age and sex-matched healthy neonates with no evidence of sepsis or any other medical illness were studied as a control group. Blood samples for conventional blood cultures and estimation of TREM-1 gene expression level in Polymorph Nuclear Neutrophils (PMNs) using quantitative Real-Time Polymerase Chain Reaction (RT-PCR) assay were synchronously collected. Data regarding clinical and laboratory findings, and risk factors of NS were also analysed. Statistical Package for the Social Sciences (SPSS) software version 20 was used to analyse the data obtained from the study. Results: The total culture-proven cases represented 24% (18/75) of all the studied neonates with NS. Klebsiella spp. was the most frequently isolated Gram-negative bacteria (4/18; 22.2%) followed by Pseudomonas spp. (3/18; 16.7%) and Acinetobacter spp. (1/18; 5.5%). Coagulase- Negative Staphylococci (CoNs), S. aureus and Candida spp. accounted for 22.2% (4/18), 16.7% (3/18) and 16.7% (3/18) of the isolated organisms respectively. No statistically significant difference was detected between the three studied groups as regards blood culture results. Significant statistical differences were detected between groups I, II and III in relation to the control group (p=0.048, p=0.049 and p<0.001) regarding TREM-1 mRNA expression level. Low Birth Weight (LBW) and prematurity were the most significant risk factors for NS. At a cut-off point of ≥0.631 TREM-1 mRNA could be considered as a potential marker for diagnosis of NS with sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 65.33%, 96.0%, 98.0% and 48.0%, respectively. The prognostic utility of TREM-1 gene expression proved a sensitivity of 87.8% at a cut-off point >0.369. Conclusion: TREM-1 gene expression has a potential value in prognostic assessment of NS and could be considered as an early diagnostic marker.

Effect of Plyometrics and Pilates Training on Dynamic Balance and Core Strength of Karate Players

Sajjan Pal, Joginder Yadav, Bijender Sindhu, Sheetal Kalra

Introduction: The success of the karate player mainly depends on the balance and core strength. Improvement in these physical variables depends upon the type of exercise training used by the athletes. In the Indian context, there is lack of literature that supports the use of Pilates and Plyometric Training (PT) programme in training of Karate players. Therefore, to achieve success in the sport, best training method should be chosen by athletes or coaches. Aim: To compare and evaluate the effectiveness of two training programs Pilates and Plyometric on balance and core strength of National level male Karate athletes. Materials and Methods: The design of this study was experimental and sampling technique was simple random sampling. This study was conducted on a sample of 120 with 40 subjects in each group i.e., Experimental group A (Plyometric, N=40), Experimental group B (Pilates, N=40) and Control group C (N=40). The data was collected during 20th May 2018 to 10th February 2020. The national level male karate players in the age group of 18 to 24 years with playing experience of five years were included in the study. The plyometric and pilates training were carried out in experimental groups for three days per week for eight weeks and no training method was implemented in the control group. Three reading were recorded, at the baseline, at the end of 4th and 8th week. Dynamic balance and core strength were the outcome measurements which were measured by modified Star Excursion Balance Test (mSEBT) and isometric core strength tests respectively. All the data was analysed by SPSS version 2.0 and the descriptive stats noted as mean±SD. ANOVA post-hoc analysis were calculated with p-value significance set at <0.05. Results: After eight weeks of intervention, both experimental groups showed significant improvement in dynamic balance and core strength comparisons between the groups. When the pre-test and post-test values of the experimental groups have been compared at the 4th week and 8th week of the study showed significant improvement (p-value <0.001) in the mSEBT and Core strength of the plyometric group compared to pilates and control group. Conclusion: The findings of the present study revealed that plyometrics and pilates both can improve balance and core strength of karate players but the PT method had more positive and statistically better effects on core strength and dynamic balance than pilates group in the view of sports performance.

Dexmedetomidine vs Fentanyl for Awake Fiberoptic Intubation in Paediatric Patients with Temporomandibular Joint Ankylosis: A Retrospective Analysis

Introduction: For successful management of difficult paediatric airway intubation, proper preparation of airway along with a calm and sedated child with titrated doses of sedative agents is paramount. Aim: To compare two different classes of sedative agents (Dexmedetomidine vs Fentanyl) regarding intubating conditions and comfort score of paediatric population at the time of awake fiberoptic intubation. Materials and Methods: This retrospective study was carried out among 40 paediatric patients, aged between 5-14 years those who underwent surgery for Temporo-Mandibular Joint (TMJ) ankylosis. Clinical data relevant for this study was collected from the pre-format sheets of anaesthesia technique, attached with case files of the patients. Inj. dexmetedomidine bolus of 1 mcg/kg for 10 minutes followed by infusion at the rate 0.6 mcg/kg/hr in group A and Inj. fentanyl bolus dose of 2 mcg/ kg followed by infusion 1 mcg/kg/hr in group B were compared in terms of intubating conditions and patient co-operation. For data analysis Statistical Package for the Social Sciences (SPSS) version 20 (IBM Inc.) was used. Patient characteristics in the two groups were compared using mean±SD and chi-square test. Results: All the patients had successful intubation in first attempt in both the groups. In terms of airway preparation, out of total, 14 (35%) patients in group A had no secretions as compare to 4 (10%) patients of group B (p-value was 0.002). In terms of cough score, 13 (32.5%) patients in group A had no cough as compared to 3 (7.5%) patients in group B. Patients in group A were more comfortable at the time of insertion of Flexible Fiberoptic Bronchoscopy (FOB) with no or less resistance to FOB insertion (p-value was 0.043). Vocal cord conditions were favourable in both the groups and there was no difference. Conclusion: Fiberoptic nasal intubation was found to be easier and safe in terms of patient comfort and preservation of patent airway with the use of dexmedetomidine, in paediatric TMJ ankylosis.

Extraoral Halitosis due to Exhaled Acetone in Patients Undergoing Sleeve Gastrectomy

Introduction: Bariatric surgery is widely used and considered as one of the most effective treatments for morbid obesity, but it can be associated with medical and dental adverse side-effects. It is frequently associated with major metabolic changes that may lead to extraoral halitosis. Aim: To assess the role of exhaled acetone produced as a result of weight loss in the production of extra-oral halitosis in patients undergoing bariatric surgery. Materials and Methods: A prospective longitudinal cohort study was designed from October 2018 to November 2019 and monitored for six months postsurgery. The subjects were patients undergoing sleeve gastrectomy surgery with a Body Mass Index (BMI) of 35-50 kg/m² . Subjects were divided into two groups of low BMI loss (<5 Kg/m² ) and high BMI loss (≥5 Kg/m² ) postsurgery, Breath samples were collected with a portable breath ketone analyser for measurement of acetone concentrations, and blood samples were taken for measurement of 3-hydroxybutyrate levels. Breath and blood samples were taken at baseline then at one month, three months, and six months postsurgery. All statistical analysis were performed using the SPSS version 22.0 with a significance value of p-value set at p<0.05. Results: Out of 43 patients enrolled initially, eventually 39 patients completed the study. The mean level of breath acetone was 4.1, 3.4, and 3.8 ppm at one month, three months, and six months, respectively (p=0.018). There was a statistically significant increase in breath acetone at one month in patients with a high rate of BMI loss. At one month, the mean blood level of 3-hydroxybutyrate was higher in patients with a high rate of BMI loss than in those with a low rate of BMI loss (1.9 vs. 1.2 mmol/L; p=0.049). The levels of breath acetone and blood 3-hydroxybutyrate were significantly correlated at one month (r=0.6, p<0.05). Conclusion: Rapid weight loss one month after gastric sleeve surgery resulted in high acetone levels suggestive of increased extraoral halitosis in such patients. Increased Acetone levels in breath and 3-hydroxybutyrate in blood are suggestive of increased extraoral halitosis in patients undergoing gastric sleeve surgery particularly within a month after surgery.

Malaria Severity Score in Malaria Patients Admitted in Critical Care Wards

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (>18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and nonsurvivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value <0.05 was considered as significant. Results: Out of 60 patients, 41 survived and 19 died due to malaria. Mean age of survivors was 38.56±2.27 and of nonsurvivors 40.21±5.6 years (p=0.718). There were 27 patients of P.vivax, 30 of P. falciparum and three patients of mixed infection; mortality was in 09, 08, 02 patients, respectively. On admission, out of total 60 patients, 10 (16.67%) had 1+, 20 (33.33%) had 2+, 24 (40%) had 3+ and 6 (10%) had 4+ parasite count. There were no patients in 1+ parasite count group, two (10%) in 2+, eleven (45.8%) in 3+ and six (100%) in 4+ parasite count group. Mean MSS was not significantly different on day 0 and day 2 but was higher on day 7 in non-survivor group than in survivors group (p=0.005). Mortality prediction score cut-off was ≥9, which was obtained by plotting Receiver Operating Characteristic (ROC) curve. Mean MSS in non-survivor group was 7.37 on day 0, 6.58 on day 2 and 9.11 on day 7. Thus, MSS score of day 7 gave `prediction reaching cut-off value of ≥9. Conclusion: MSS was found to be a useful prognostic score in severe falciparum/vivax malaria who needs intensive care treatment as sequential score gives significant difference in survivors and non-survivors on seventh day

Effects of Dexmedetomidine and Fentanyl Premedication on Quality of Extubation in Children undergoing Tonsillectomy: A Prospective Cohort Study

Chathoth Anjana, Suseela Indu, Prabhakaran Vineetha

Introduction: Smooth extubation in children is a challenging task, especially those undergoing tonsillectomy. Dexmedetomidine, an alpha-2 receptor agonist has been found to be beneficial in paediatric anaesthesia due to its anxiolytic, sedative and analgesic properties. It also attenuates haemodynamic stress response and airway reflexes to intubation and extubation. Fentanyl, a synthetic opioid is also extensively used in paediatric anaesthesia. Aim: To compare the effects of dexmedetomidine and fentanyl premedication on quality of extubation and extubation haemodynamics. Materials and Methods: The prospective cohort study was conducted in 120 children divided into two groups of 60 each, aged 5-12 years, belonging to American Society of Anaesthesiologists’ (ASA) physical status I and II, posted for elective tonsillectomy under general anaesthesia. Group F received fentanyl 2 µg/ kg intravenously and group D, dexmedetomidine 0.5 µg/kg as intravenous infusion over 10 minutes as premedication. The time from discontinuation of anaesthetics to extubation and to opening the eyes in response to verbal stimuli were noted. The quality of extubation was evaluated according to the 5 point extubation score and postoperative sedation assessed using Ramsay sedation score. The haemodynamic parameters were monitored immediately after discontinuation of anaesthetics and at 1, 3, 5 and 10 minutes postextubation. Any complications like airway obstruction, bradycardia, and hypotension were noted and treated appropriately. Statistical Package for Social Sciences (SPSS) software version 22 was used for statistical analysis and categorical outcomes compared with Chi-square test/Fisher’s-Exact test. Results: Extubation was smoother in group receiving dexmedetomidine. The median time from discontinuation of anaesthetics to extubation and eye opening was significantly shorter in dexmedetomidine group compared to fentanyl group (p<0.001). Postoperative sedation score was comparable between the two groups. Heart Rate (HR) and Mean Arterial Pressure (MAP) monitored showed significantly stable values in the dexmedetomidine group (p<0.001) when compared to fentanyl soon after discontinuation of anaesthetics and 1, 3, 5 and 10 minutes postextubation. Conclusion: Premedication with dexmedetomidine 0.5 µg/kg intravenously provides better quality and haemodynamics of extubation compared to fentanyl 2 µg/kg in children undergoing tonsillectomy, without causing significant sedation.

Effect of Animation Distraction on Pain Response during Venepuncture among Children

Divya, Deepa Danieal

Introduction: Children are the most valuable resource, and childhood is the world of a miracle. Every child in a lifetime may face many illnesses and hospitalisation. Pain is a common problem faced by a hospitalised child. Venepuncture is an invasive procedure followed in the hospital, which may produce pain, fear, anxiety, and discomfort in children. The animation distraction is one of the cost-effective non-pharmacological methods which may distract the child during any procedure and reduce the pain stimuli. Aim: To find the effect of animation distraction on pain response during venepuncture. Materials and Methods: An evaluative research approach with a quasi-experimental (post-test only control group) design was adopted in the study. The sample comprised of 40 children (20 each in the control and experimental group) aged 4-12 years undergoing venepuncture was selected by using a nonprobability purposive sampling technique. A small 5-20 minutes of animated videos based on the children’s age and choice were displayed to the experimental group during the venepuncture procedure. Wong–Baker Faces Pain Rating Scale was used to assess the pain response after venepuncture in both the control and experimental group. Results: The data was collected, recorded systematically, and analysed with descriptive and inferential statistics. The experimental group’s mean post-test pain score (3.4±1.68) was lower than the control group (8.2±1.53) with p<0.001. Threefourths of the control group (75%) had severe pain, whereas in the experimental group, none of the samples experienced severe pain, and 55% of the samples had moderate pain. Notably, 5% of the samples from the experimental group reported no pain during venepuncture. The calculated t-value t(38)=9.79 is greater than the table value t(38)=2.02 at 0.05 level of significance. Conclusion: The animation distraction was highly effective in reducing the pain response in children during venepuncture.

Pattern of Sexually Transmitted Infections: A Retrospective Study from a Tertiary Care Hospital in Central India

Introduction: Sexually Transmitted Infections (STIs) pose a major health, social and economic problem worldwide, predominantly in developing countries like India. It is essential to understand the current patterns of STIs in the various regions of the country in order to plan and implement strategies to control the spread of infection. Aim: To study the pattern of STIs among patients attending the STI clinic. Materials and Methods: This was a cross-sectional study of data obtained retrospectively from case records over last 7 years (January 2013-December 2019) from STI clinic at a tertiary care hospital at Nagpur. The demographic details, detailed history, clinical findings were noted and relevant investigations were performed. The patients were diagnosed as per syndromic approach and subjected to serologic tests for syphilis and Human Immunodeficiency Virus (HIV). The data was analysed by using MS Excel and Epi Info software, and percentage, mean, standard deviation and proportions were calculated. Results: Out of the total 4471 cases, 2807 (62.8%) were males and 1664 (37.2%) were females. The most commonly observed STI was balanoposthitis, followed by cervico-vaginal discharge, Genital Ulcerative Disease- Herpetic (GUD-H), anogenital warts, molluscum contagiosum, GUD-nonherpetic, urethral discharge, lower abdominal pain and inguinal bubo. The proportion of viral STIs was 33.5% (1495 cases) and bacterial STIs were 4.3% (191 cases). The most commonly observed STI was balanoposthitis in males and cervico-vaginal discharge in females. Newly diagnosed cases of HIV were 1.4% (61 cases) of total cases. Conclusion: The proportion of viral STIs was higher compared to bacterial STIs. The prevalence of HIV among study population was 3.9%. Since STIs are indicators of high risk sexual behaviour in the community and a major health burden with risk of development of HIV, prompt diagnosis and adequate treatment of STIs is necessary.

High Sensitive C-reactive Protein Level in Relation to Increased Body Mass Index among Non-diabetic Non-hypertensive Women

Ghada A Elfadil, Abdelgadir Elmugadam, Rasheeda A Saied, Salah Omar Hussein

Introduction: An increased Body Mass Index (BMI) has an adverse effect on the socio-economic and healthcare sectors and may influence metabolic status. High sensitivity C-reactive Protein (hs-CRP) is an emerging biomarker. The association between dyslipidaemia and obesity is well established, and has been found to be the risk factors for CVD. Aim: To study the relationship of hs-CRP with BMI, lipid profile and magnesium among obese and overweight non-diabetic non-hypertensive Sudanese women. Materials and Methods: A cross-sectional study was conducted on 90 women in Khartoum state (Sudan), aged between 20 and 43 years, from June to November 2019. The study included three groups of women based on BMI. hs-CRP was measured by using latex immunoturbidimetric method, lipid profile was evaluated using Biosystems colourimetric methods and magnesium by a chemical method. Results were computed using Statistical Package for the Social Sciences (SPSS) version 20. Results: There was significant increase in the mean values of hs-CRP, Total Cholesterol (TC), Triglyceride (TG), Low Density Lipoprotein Cholesterol (LDL-C), and a significant decrease in the mean values of High Density Lipoprotein Cholesterol (HDL-C) and magnesium in obese and overweight women, when compared to normal body weight women. Pearson’s correlation coefficient revealed a positive correlation between hs-CRP, and BMI, Waist-To-Hip Ratio (WHR), TC, TG, and LDL-C (p-value <0.01). Conclusion: Overweight and obese women have increased hs-CRP and atherogenic lipid profile, suggesting obesity to be a state of chronic inflammation. hs-CRP can be used to assess the risk of obesity-related disorders for early intervention.

Relation between Mode of Delivery and Findings of Oto-Acoustic Emission Test Results

Introduction: Hearing loss, since birth, is an important public health issue round the globe with a prevalence ranging from 2-3/1000 live births. Neonates born by Caesarean Delivery (CD) refer for Oto-Acoustic Emissions (OAE) test more frequently compared to Vaginal Delivery (VD) soon after birth. During this study, the effects of the modes of delivery on the OAE test results were investigated. Aim: To study the effects of modes of delivery on the OAE test results. Materials and Methods: During this study 500 neonates, born beyond 37 weeks of gestation, at Dhiraj Hospital, Gujarat, India between January 2019-July 2019 without any associated risk factors were enrolled and divided on basis of their mode of delivery-vaginal or caesarean section. Before their discharge from hospital, OAE test was performed on the patients. Modes of delivery and OAE test results were collected and analysed. Results: Results reviled that there was a significant difference in OAE test failure rates between the two delivery mode groups. CD was significantly related to failed OAE. CD infants had a three-fold higher failure rate as compared to VD infants in OAE test (4.12% vs 1.3%). Conclusion: Neonates born by CD had significantly higher failure rates on first OAE as compared to VD. This shows that the mode of delivery contains a significant effect on the results of the hearing screening tests.

Evaluation of Prophylactic Diacerein Treatment on Anti-Arthritic Activity in Freund’s Complete Adjuvant-Induced Arthritis in Rat Model

Rajlaxmi Upadhyay, Trupti Rekha Swain, Sabita Mohapatra, Manas Ranjan Upadhyay

Introduction: Osteoarthritis (OA) is commonly prevalent disorder seen in Indian population. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) are used as primary drugs for its symptomatic treatment. However, its use is limited by its long-term adverse effects. Many clinical studies have shown that diacerein reduces clinical symptoms of OA. Aim: To evaluate whether diacerein has beneficial anti-arthritic property when used prophylactically in Freund’s Complete Adjuvant (FCA) induced arthritis in rats. Materials and Methods: An experimental study was conducted over a period of about two months in the Department of Pharmacology, SCBMC, Cuttack. Thirty albino rats of Wistar strain was divided into 5 groups with 6 animals in each group. The basal body weight and the hind paw volumes of both right and left paw of all the animals was noted in day 0 and then on 4^th, 8^th, 14^th and 21^st day. Arthritis was induced in all animals by injecting FCA on day 0 into the plantar surface of right hind paw. Normal saline, diclofenac 5 mg/kg, three doses of diacerein (50 mg/kg, 100 mg/kg, 200 mg/kg), was administered orally once daily to groups I, II, III, IV and V respectively. Paw volumes and body weight was measured for arthritic parameters. On day 22 radiological and histopathologic evaluation was done. Results: Maximum inhibition of Freund’s adjuvant induced arthritic paw volume was on the 21^st day with 100 mg/kg of diacerein and with diclofenac 5 mg/kg was from 8^th to 14^th day. There was a decrease in body weight due to freund’s adjuvant in normal saline group from 4^th to 21^st day, still greater decline with diclofenac 5 mg/kg group, but in diacerein treated group there was an increase in body weight from 4^th to 21^st day in all the three doses. Radiologically and histopathology maximum benefit was noted with 100 mg/kg of diacerein. Conclusion: Three weeks treatment of oral diacerein can significantly inhibit arthritic swelling of the injected paw at all the 3 doses in adjuvant induced arthritis model in rats and can be a promising disease modifying drug for OA.

Predictive Value of Serum Vitamin D3 Level for Forearm Fractures among Children in a Tropical Country: A Case Control Study

Introduction: Orthopaedic emergency department commonly receives paediatric fractures, of which forearm fractures constitute a larger proportion with the burden greatest in low-middle income countries. Studies done in the temperate region found an association between forearm fractures in children and low serum vitamin D3. Some studies in our environment have shown low levels of 25-hydroxy vitamin D3 {25(OH)D} in normal Nigerian children, but the association with forearm fractures has not been studied. Aim: To determine if serum vitamin D3 level can predict the occurrence of forearm fractures in children. Materials and Methods: This was a cross-sectional case control study conducted over a year from January 2018 to December 2018 at a tertiary health facility in South-West Nigeria among paediatric patients. Thirty children with forearm fractures and thirty children with no forearm fractures were recruited for the study. Socio-demographic data, mechanisms of fracture, anthropometric measurements and serum 25(OH)D levels were determined. Univariate and multivariate analyses were done for the variables concerning the presence or absence of forearm fractures (dependent variable is the presence or absence of forearm fractures; independent variables include the age, sex, mechanism of injury, outdoor playing time, serum vitamin D3 level). Results: The mean serum 25(OH)D levels in the study group were significantly lower than the controls; (60.751±15.041 ng/mL and 95.506±19.489 ng/mL, respectively). There was a statistically significant relationship between the serum level of 25(OH)D and the presence of forearm fracture in children (p=0.002 and OR of 0.838). Conclusion: Children with forearm fracture have relatively lower serum vitamin D3 compared with age matched ones without fracture and they have correspondingly increased odd risks of sustaining fore arm fracture.

Proportion of Psychiatry Outpatients with Borderline Personality and Associated Clinical Syndromes using the Millon Clinical Multiaxial Inventory-III: A Retrospective Study

Shaunak Ajit Ajinkya, Pranita Shantanu Sharma, Aparna Ramakrishnan

Introduction: Personality disorders are a group of behavioural patterns associated with significant personal and socio-occupational disturbances. Numerous studies have demonstrated borderline personality to be one of the most common personality disorders. It’s less often diagnosed with just a clinical assessment. Aim: To examine the proportion of patients with Borderline Personality Disorder (BPD), and its associated personality types and clinical syndromes, using the Millon Clinical Multiaxial Inventory version-III (MCMI-III). Materials and Methods: A retrospective observational study was carried out on 450 adult patients who attended the psychiatry outpatient department of an urban tertiary care hospital. They had been administered the MCMI-III, a selfrating questionnaire commonly used to provide information on personality types and associated clinical syndromes. Statistical Package for the Social Sciences (IBM SPSS, Windows) version 20.0 was used for statistical analyses. Data was expressed in terms of actual number, mean and percentages. Chi-Square or Fisher`s-exact test, as appropriate, was used for categorical data to test for associations. Odds ratio was estimated to measure strength of the association. Results: Borderline was the most common personality type comprising nearly half (46.63%) of the study population. 25.5% had borderline traits while 21.1% had Borderline Personality Disorder (BPD). BPD was significantly higher in females (p<0.001), younger age group below the age of 40 years (p<0.001) and unmarried persons (p<0.001). It was comorbid most with Anxiety (90.91%; OR=4.05; p<0.001), Major Depression (85.23%; OR=18.39; p<0.001), Post Traumatic Stress Disorder (PTSD) (46.59%; OR=6.30; p<0.001) and Thought disorders (56.82%; OR=18.15; p<0.001). Alcohol (22.73%; OR=3.54; p<0.001) and Drug dependence (13.64%; OR=11.52; p<0.001) were also seen significantly higher in patients with BPD. Personality types significantly comorbid with BPD were Sadistic, Depressive, Masochistic, Negativistic, Schizotypal, Avoidant, Dependent, Antisocial and Paranoid types, with odds being most for Sadistic personality (OR=9.44). Conclusion: It is recommended that mental health professionals and clinicians should start to look for underlying symptoms of BPD in patients of anxiety and mood syndromes. If found these patients should be directed for psychotherapy as early as possible. The MCMI psychological test would be an important contribution to this area, given the need for systematic, quick, and objective testing methods that facilitate the diagnosis.

Neonatal Outcomes in Meconium Stained Amniotic Fluid Delivery: A Rural Perspective

Gajanan Venkatrao Surewad, Khyathi Ambatipudi, Nageswara Rao Kalavakuri

Introduction: Presence of meconium in amniotic fluid is a potentially serious sign of foetal compromise and has demonstrated that the incidence of MSAF rises with gestational age. The incidences of admission to Neonatal Intensive Care Unit (NICU) with various neonatal disorders were higher in pregnancies complicated by MSAF. Aim: To study clinical profile and outcomes in neonates born through MSAF at tertiary care hospital in rural area of Andhra Pradesh. Materials and Methods: This cross-sectional, descriptive study included a total of 4462 infants who were admitted in the NICU of Nimra Institute of Medical Sciences and Hospital, Andhra Pradesh from December 2017 to January 2020. All pre-term, term and post-term infants, delivered normally or by caesarean section or instrumental delivery, with MSAF, were included in the study. A detailed ante-natal, natal and postnatal history was taken for the neonates to detect the aetiology of MSAF, type and duration of delivery and any complications Post delivery. All the clinical assessment and lab investigations, X-ray assessments were done for the subjects as and when required. The observations were noted along with the treatment given. Results: Out of 4462 infants admitted in study period, 436(9.78%) had MSAF and 96 (22.01%) developed Meconium Aspiration Syndrome (MAS). MSAF infants born by Normal Vaginal Delivery (NVD) formed 220 (50.46%), Lower Segment Caesarean Section (LSCS) 176 (40.37%) and 40 (9.17%) instrumental delivery. MAS infants born by LSCS formed 38 (21.59%), NVD 52 (23.63%) and instrumental delivery 6 (15%). The mean gestational age was 38-40 weeks. MAS developed in 18 (50%) infants with gestational age >42 weeks, 12 (12%) between 40-42 weeks and 50 (23.36%) between 38-40 weeks (significant relationship, p-value 0.012). The mean birth weight was 2.599±441 kg. MAS developed more in infants of birth weight 2-2.499 kg and least were of birth weight between 1.5-1.999 kg. Male to female ratio was 1.27:1. Thick MSAF was seen in 160 (36.69%) and thin MSAF in 276 (63.31%) infants (p-value 0.001). In MAS infants, 82 had thick and 14 thin MSAF. Among MSAF alone infants (n=340), 142 (41.75%) were associated with birth asphyxia. Among MAS infants, incidence of birth asphyxia was 66 (68.75%). Thirty eight MAS infants developed complications. Pneumothorax was the most common complication. Overall, mortality was 160 (36.69%). MAS contributed to 22.5% of these deaths. A 60 (62.5%) MAS infants were discharged and 36 (37.5%) died. Conclusion: MAS was most consistently associated with thick MSAF. Preventive measures like timely evaluation of high risk factors, preparedness for untoward intrapartum events and close monitoring of MSAF infants can be taken to minimise the mortality and morbidity rates, because it is a global problem especially in under-developed countries.

Comparison between the Techniques of Radiocephalic Arteriovenous Fistulas for Haemodialysis: A Retrospective Analytical Study

R Anil, Prabhu Avinash, Kumar Niranjan, Naik Nagraj

Introduction: Chronic Kidney Disease (CKD) has become a major health issue worldwide. CKD patients require Renal Replacement Therapy (RRT) throughout their life. Haemodialysis is one of the options for RRT. Arterio-Venous Fistula (AVF) creation is required for haemodialysis. The radio-cephalic fistula is the initial option for creating vascular access. Fistula can be created by anastomosing cephalic vein to radial artery either by End-To-Side (ETS) or Side-To-Side (STS) techniques. Aim: To compare the efficacy rate of radiocephalic AVF using ETS or STS anastomotic methods. Materials and Methods: This was a retrospective analytical study conducted at SDM college of medical sciences and hospital, Dharwad from March 2017 to February 2020. A total of 43 CKD patients were enlisted for the above duration from the hospital records. These patients were included in the study since they underwent radio-cephalic AVF creation. AVF creation at other anatomical sites for rest of the CKD patients was excluded. Out of 43 patients, 24 of them underwent ETS technique and 19 STS technique; 15 patients from the former group and 17 from the latter were followed-up for a period of three months. Eleven patients were lost to follow-up. Demographic variables were analysed with frequency, mean and standard deviation. Its association with two different operative techniques was analysed using Fisher’s-exact test. Outcome of the two operative procedures was analysed using student’s t-test. Results: Effectively 15 patients from ETS group and 17 from STS group were compared. Three (20%) in ETS group and 5 (29.41%) in STS group had primary failure. Mean of maturation time in weeks in ETS group was 4.73±2.73 weeks and in STS group was 5.29±3.75 weeks. Three months patency rate in ETS group was 12 (80%) and in STS group was 12 (70.58%). Student’s t-test was performed comparing the above parameters and no statistical significance was noted. Conclusion: Comparison of two techniques of radio-cephalic AVF creation proves that both the techniques are beneficial with no superiority of one over other.

Perception of Pain, Attitude and Satisfaction of Pain Management among Postoperative Patients

Uma Venkatesan, Sruthi Kamal, Jasmine Viswanathan

Introduction: Pain is considered as a fifth vital sign. Pain management and patients satisfaction with the treatment decreases early postoperative recovery. Aim: The study aim was to assess the satisfaction of pain management among postoperative patients. Materials and Methods: A cross-sectional study was used to conduct a study among 180 postoperative patients’ undergone surgeries (General surgery patients, ortho-paedic surgery and urological surgery patients) at selected hospitals, Puducherry. The purpose of the study was to associate the pain level with satisfaction. The patients were selected based on purposive sampling technique. After obtaining consent, the researcher used numerical pain scale to assess the pain perception of the patient, closed ended questionnaire to assess attitude level and modified short assessment questionnaire for patient satisfaction towards pain management. The study was analysed using Statistical Package for the Social Science (SPSS) software version 20.0. The descriptive statistics was used to assess the level of pain and attitude and inferential statistics like Pearson correlation coefficient were carried out to find the correlation between pain and satisfaction. Results: Severe pain was felt by nearly all (70%) among general surgery patients, 60% in orthopaedic surgery patients and 50% had moderate pain in urological surgery patients respectively. Regarding attitude, majority (78%, 88% and 83%) of the patients had positive attitude towards pain management in General surgery, Orthopaedic and Urology surgery patients. Most (74%) of them were satisfied with their pain management in general surgery patients, whereas in orthopaedic and urological patients, nearly all 90%, 96% of the clients were very satisfied towards pain management. Conclusion: The study concluded, optimal satisfaction toward pain management will increase quality of early postoperative recovery.

Handgrip Strength as a Predictor of Muscular Strength and Endurance: A Cross-sectional Study

Shlesha Maulik Vaidya, Darshana M Nariya

Introduction: Reliable muscle strength measurement of individual muscle groups is time-consuming and so it would be convenient to have a single, quick and simple tool as an indicator of the general muscle strength. Handgrip strength might be an adequate measurement for generalised muscle strength. It has a low cost and may be used in a time-efficient manner in clinical setting. Aim: To determine if a handgrip dynamometer test is a valid predictor of both muscular strength and endurance and to provide a gender specific reference charts for handgrip and establish correlation between BMI and handgrip. Materials and Methods: It was a cross-sectional study, conducted from October 2017 to March 2018. Participants included 30 college students, 10 males and 20 females of 18 to 25 year age group. BMI of all subjects were measured. Handgrip strength was measured by adjustable handgrip dynamometer. Horizontal Jump Test (HJT) and Vertical Jump Test (VJT) were used to measure lower limb muscle strength. To evaluate the strength of the trunk, one minute curl-ups test was used. Aerobic power was measured by VO₂ max Cooper’s test. Results: Significant correlation found between handgrip strength and HJT (r=0.8226, r² =0.6767, p<0.05), handgrip strength and VJT (r=0.6917, r² =0.4764, p<0.05), handgrip strength and VO₂ max (r=0.7204, r² =0.519, p<0.05), handgrip strength and BMI (r=-0.1341, r² =0.018, p<0.05), handgrip strength and one minute curls-up test (r=0.4368, r² =0.1908, p<0.05). Although there was weak correlation of handgrip strength with BMI and one minute curls-up test. Conclusion: Handgrip strength can be an effective tool for predicting muscular strength and endurance.

C-MAC D-Blade vs Airtraq for Intubation with Manual Inline Axial Stabilisation- A Randomised Clinical Trial

Introduction: One of the most important skills in anaesthesia is securing the airway with an endotracheal tube. Difficult tracheal intubation however is considered one of the major contributors of anaesthesia related morbidity and mortality. Video laryngoscopy offers several advantages during endotracheal intubation. The view of the glottis provided by Videolaryngoscopes is better compared to the Macintosh laryngoscope in difficult airways which makes it more attractive for routine difficult airway intubations. Aim: To compare the time taken for intubation between two Videolaryngoscopes, namely C-MAC D-blade and Airtraq and to assess the quality of laryngoscopy view between the two groups. Materials and Methods: This was a randomised clinical trial conducted in 116 American Society of Anesthesiologists 1 (ASA1) and ASA2 patients undergoing elective surgeries in Pondicherry Institute of Medical Sciences. Patients are randomised into two groups, Group C-MAC D-blade and Group Airtraq by computer randomisation. Statistical analysis was performed using t-test, Repeated measures of ANOVA was used to find the significance from preinduction to 10 mins period for each group and Bonferoni’s correction for intergroup comparison. Results: The time taken for intubation was comparable in two study groups (Group C-MAC D-blade 41.88 secs) and (Group Airtraq -40.78 sec) with p-value of 0.734. Laryngoscopic view was not statistically significant with p-value of 0.083. Optimisation maneuvers were required in 63.8% in Group Airtraq on comparison with 44.8% in Group C-MAC D-blade. In both Group C-MAC D-blade and Group Airtraq, there was a significant rise in the heart rate and BP at 0 minute compared to preinduction. But after 5 minutes, the heart rate and BP were back to preinduction values. Conclusion: Both the Videolaryngoscopes, C-MAC D-blade and Airtraq performed equally, with respect to time taken for intubation and laryngoscopic view. However, External Laryngeal Manipulation (ELM) was required more in Group Airtraq and was statistically significant.

Effect of 6-12 Weeks of Systemic Glucocorticoids on Bone Mineral Density in Children

Kalpana Panda, Soumya Dey, Namrita Sachdev, Tribhuvan Pal Yadav

Introduction: Prolonged use of systemic steroids in children is associated with many side-effects including effect on Bone Mineral Density (BMD). Effect of more than three months of systemic steroids on BMD has been studied in children but not the effect of 6-12 weeks duration of steroid. Aim: To evaluate the effect of 6-12 weeks of systemic glucocorticoids on BMD in children. Materials and Methods: A longitudinal observational study was conducted at a Tertiary Care Hospital. Dual Energy X-ray Absorptiometry (DEXA) of Whole Body (WB), Lumbar Spine (LS) and Distal Radius (DR) were done at baseline, end of steroid therapy or third month whichever was earlier and end of six months, on 30 patients receiving systemic steroid (Nephrotic Syndrome (NS)-7, Systemic Onset Juvenile Idiopathic Arthritis (SOJIA)-12, Tubercular Meningitis-11). Age and sex adjusted values of Bone Mineral Content (BMC), BMD and Z scores were analysed. Bone densitometric parameters of Total Body Less the Head (TBLH) were derived from WB values. X-rays of whole spine (antero-posterior and lateral view) were done at baseline and follow-up. Equal number of age and sex matched healthy controls were subjected to biochemical and DEXA scans at baseline. Continuous and categorical variables were compared using Student’s t-test and Fisher-exact test, respectively. Pairwise comparison over period of time was done using Bonferroni correction. Results: Bone densitometric parameters of cases and controls were comparable at baseline. At follow-up statistically significant decrease in BMD was found at all three sites. A statistically significant negative correlation was found between cumulative dose of steroid and duration of steroid treatment with Z score of TBLH. No vertebral fractures were detected at baseline or follow-up. Conclusion: Use of systemic glucocorticoids for 6-12 weeks negatively affects bone mineralisation, not only during therapy but even three months after stopping it.

Shade Preference of Artificial Teeth in Denture Wearing Local Population- A Cross-sectional Study

Neerja Mahajan, Simrat Kaur, Neelam Suman

Introduction: No existing local literature and guidance is currently available regarding shade selection by the patients for artificial teeth set of complete denture. Results of studies done in other countries cannot be generalised in our local population; hence there is a need to know the desires of our population. Keeping this research question in mind, this study reflects the behavioural aspects and wishes of patients towards artificial teeth shades. Aim: To observe and compare the shade preferences of artificial teeth during complete denture fabrication in diverse sample of both male and female patients in two different dental colleges. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics and Crown and Bridge, KM Shah Dental College and Hospital, Vadodara and Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar during the time period of May 2016 to September 2019. A total of 824 participants with complete denture treatment needs, participated from two different dental colleges. Upper anterior molds of Acry Rock (Ruthinium Dental Products Pvt., Ltd.,) acrylic teeth in 18 different shades of A1, A2, A3 A3.5, A4, B1, B2, B3, B4, C1, C2, C3, C4, D2, D3, D4, E1and F1 were used and participants were asked to choose aesthetically pleasing shades for themselves in both the colleges. The frequency distribution was recorded and compared using the Chi-square test for statistical analysis for preference of shades between male and female participants of two colleges. Results: The most preferred shades were A1, B1, D2 and E1 by both male and female participants in both the colleges and the shade selection was statistically significant (p-value=0.0018), while no statistically significant difference was seen in preference of shades between male and female participants at both the colleges. Conclusion: Patients primarily preferred the lighter shades with high values. This should be kept in mind during treatment planning to increase the psychological acceptance of aged patients towards artificial dentures.

Detection of Helicobacter pylori in Patients with Oral Squamous Cell Carcinoma and Oral Potentially Malignant Disorders at a Tertiary Care Centre in Gujarat: A Case-Control Study

Introduction: Oral squamous cell carcinoma (OSCC) contribute to 90% of cancer cases in head and neck region and entails remarkable morbidity and mortality inspite of immense research and advances. Amongst other causes, infection with Helicobacter pylori is an emerging cause of OSCC. There is still perplexity in the exact etiopathogenesis of H. pylori related oral cancer. Aim: In order to explore this much unattended area, present study was aimed to find out the association between H. pylori in premalignant disorders and OSCC. Materials and methods: A Prospective case-control Pilot study of 35 patients (11 confirmed cases of Oral squamous cell carcinoma and 24 with oral potentially malignant disorders along with 15 age and sex matched healthy control) from June 2018 - September 2018 was conducted in the Department of Microbiology, Smt. B. K. Shah Medical Institute, Piparia, Gujarat. H. pylori was detected by methods like Rapid urease test, Gram’s staining and Serology. Results: H. pylori was detected in five cases with OSCC with male predominance and mean age 45.6 yrs. All the five positive patients were severely addicted to tobacco and betel quid since decades. Tobacco was found to be the major risk of OSCC with the OD of 16.19, followed by betel quid (OD-4.56) and H. pylori infection (OD-0.83). Conclusion: The results of this pilot study do not establish a definite causal relationship between H. pylori and OSCC due to the low sample size. Study definitely offers an avenue for further work on larger populations to confirm this possible association.

Role of MRI in Evaluation of Focal Liver Lesions: A Cross-sectional Study

Sanket Manoj Kotnis, Roopa Hosahalli Nagaraj, Prakash Jain Rajanna Brahma

Introduction: The non-invasive diagnosis of liver lesions is usually achieved with contrast material-enhanced computed tomography and Magnetic Resonance (MR) imaging. Dynamic three dimensional gradient-recalled-echo MR imaging provides dynamic contrast-enhanced thin-section images with fat saturation and a high signal-to-noise ratio and is excellent for the evaluation of various focal hepatic lesions. Aim: To explore the effectiveness and hence the clinical utility of plain and contrast MR characterisation of focal hepatic lesions in patients and their correlation with the histopathological findings. Materials and Methods: The present study was a multicenteric study done on both Inpatients and Outpatients of Department of Radiology of Tertiary care hospitals in Bengaluru, from January 2020 to August 2020. A total of 42 patients diagnosed with focal liver lesions by Ultrasonography were included in this study. Plain MRI study was done by using spin echo technique and contrast MRI study was done after rapid bolus injection (0.1 mmol/kg body weight) of gadolinium dimeglumine. Pathological and post-operative histopathological findings were noted. Microsoft excel software was used for data analysis and tables were prepared for comparison of collected data. Specificity and sensitivity were calculated for diagnostic accuracy of MRI. Results: This study included forty-two patients in total, twenty-five male and seventeen female patients, in age group of 15 to 84 years with a mean age of 48 years. Metastasis and Hepatocellular Carcinoma (HCC) were most common malignant lesions in liver while Hemangiomas were most common benign lesions followed by simple and complex cysts and hepatic adenoma. The present study calculated the specificity and sensitivity of MRI of focal hepatic lesions and correlated the findings clinically, pathologically and histopathologically. The specificity of MRI for characterisation of focal liver disease was high (90.4%). Specificity of MRI for HCC was found to be 96.7 % and that for metastasis was 97% while sensitivity for Haemangiomas is found to be 100%.MRI is superior compared to other modalities like ultrasound and CT in having high spatial resolution. Multiple sequences like T1, T2 and fat suppression techniques like IN PHASE, OUT OF PHASE helps in demonstrating lesion characters like architecture, margin, haemorrhage, fat component and vascular invasion of the lesions. Conclusion: MRI is valuable for the characterization of focal liver lesions detected on Ultrasonography. Basic MRI sequences along with chemical shift imaging sequences and dynamic contrast imaging has significant role in characterising the focal liver lesions. Despite that, It should be the modality choice for the lesions which are undetected or doubtful on ultrasound and CT examinations.

Alteration in Steroid Hormone and HER2/ neu Receptor Status Following Neoadjuvant Chemotherapy in Triple Negative Breast Cancer. Is There Any Hope?

Rama Das, Parna Basu, Suman Ghosh, Debasish Guha

Introduction: Breast cancer continues to be the most common cancers among women in India. The Triple Negative Breast Cancer (TNBC) is a heterogeneous group of malignancy which is often aggressive and has a worse prognosis. Aim: The aim of this study was to assess the hormone receptor and HER2/neu status with platinum based chemotherapy in TNBC. Materials and Methods: The study was analysed retrospectively in a tertiary care centre of West Bengal from Januay 2017 to December 2019. Forty TNBC patients of Locally Advanced Breast Cancer (LABC) cases who received carboplatin along with neoadjuvant chemotherapy (study group) were compared with other group of 64 TNBC patients (control group) who did not receive any chemotherapy making a total of 104 cases of TNBC patients who were selected for the study. All the patients in both the groups had modified radical mastectomy. The study group of 40 TNBC patients who received chemotherapy also showed pathological partial response. Masterchart was prepared comprising patient's age, menopausal status, family history, therapy history, histo-morphological features, hormone receptor and HER2/ neu status after platinum added chemotherapy. Oestrogen Receptor (ER)/Progesterone Receptor (PR) were considered positive, if >1% tumour cell nuclei were immunoreactive and negative, if it was otherwise. HER-2/neu score of 3+ was taken as positive by Immunohistochemistry (IHC) method. Statistical analysis for descriptive purposes, percentages and mean were calculated. Comparison of both the groups was done by Pearson’s Chi-squared and Fisher's-exact test. Significance level was considered at p-value <0.05. Results: TNBC patients (NACT group) showed hormone receptor positivity of 21 cases (52.50%) after chemotherapy along with carboplatin. HER2/neu positivity was detected in 9 (22.5%) cases. Non-NACT (64) cases were considered as control group for comparison. The effect of NACT in TNBC patients was found to be statistically significant with respect to change in HER2/ neu (p=0.033, p<0.05) and ER status (p<0.05) while change in PR status was found to be statistically insignificant. Conclusion: The study showed significant alteration in hormonal and HER2/neu receptor status in TNBC patients receiving platinum added neoadjuvant chemotherapy. This study found statistical significance and justifies re-evaluation of these Hormone Receptor (HR) and HER2/neu markers in residual tumour after chemotherapy.

Self-perception of Body Weight and Physical Activity with its Relationship to Actual Body Weight among Students in a Medical College: An Analytical Cross-sectional Study

T Prathiba, G Rajkumar, M Anbarasi

Introduction: Obesity and sedentary life style are becoming more prevalent among the student generation. Every human being has a very good insight about the outlook. But many are not able to maintain what they perceive. During this survey, the students get a vivid picture of their real body weight and their perception of their body structure. Aim: To compare the self-perceived body weight with actual body weight among medical students and to analyse the perceptions and practice of medical student’s related to physical activity. Materials and Methods: This analytical cross-sectional study included 400 medical students. Self-perceived body image was assessed using Silhouette matching technique. Students represented the figure how they currently look (Feel) and how they actually wanted to look (Ideal). The Feel minus Ideal Discrepancy (FID) score was noted. Actual body weight and height were measured. Body Mass Index (BMI) was calculated using the Quetelet formula- weight(Kg)/height(metres)² . Perceptions and practice of physical activity were assessed using Exercise Benefits/Barrier Scale (EBBS). Comparison of perceived and actual body weight was done by Student’s Independent t-test and Pearson correlation test using Statistical Package for the Social Sciences (SPSS) version 17.0. Results: The actual BMI and perceived BMI showed strong positive correlation (r= 0.726; p=0.0001). Males had high exercise benefit scores (92) when compared with females (86) (p=0.0002). The students had high total score (benefit score plus barrier score); males had 127 and females had 124 (p=0.003) and high benefit/barrier ratio. Conclusion: Actual BMI and self-perceived BMI were well correlated indicating participant’s awareness of their body image. Male participants were more actively involved in physical activity and more concerned about maintaining their body weight. All students had higher benefit scores which is a favourable sign towards a healthy and active physical life.

Assessment of DNA Damage in Chick Embryo Brains Exposed to 2G and 3G Cell Phone Radiation using Alkaline Comet Assay Technique

Introduction: The cellular phones/mobile phones have emerged as the fastest growing man-made phenomenon ever discovered in the history. Controversies still exist among the scientific community regarding the ill-effects of Radiofrequency Radiation (RFR) exposure from cell phones on biological tissues. The present study will provide an insight into the basic mechanisms by which RF fields interact with developing brain in an embryo. Aim: To assess the possible Deoxyribonucleic Acid (DNA) damage in developing brain of chick embryo following chronic exposure to Ultra-High Frequency/Radiofrequency Radiation (UHF/RFR) emitted from 2G and 3G cell phone. Materials and Methods: Fertilised hen eggs were divided into three groups. Experimental Group A (exposed to 2G radiation, 24 eggs), Experimental Group B (exposed to 3G radiation, 24 eggs) and Group C sham exposed control group (24 eggs). After the completion of scheduled duration of exposure (72 minutes per day), the chick embryos were sacrificed from 9th-12th day and the brains were dissected out. The chick embryo brains were then subjected to alkaline comet assay technique to assess the DNA damage. The results were statistically compared using one-way Analysis of Variance (ANOVA). Results: In the present study, the exposure of chick embryo brains to 2G and 3G cell phone radiation caused increased mean comet length (p<0.001), mean tail length (p<0.001), mean percentage of DNA in the tail (p<0.001) and mean tail moment (p<0.01) suggestive of increased DNA damage. Conclusion: The present study concludes that the RFR exposure caused significant increase in DNA damage in developing brain of chick embryos with changes more pronounced in 3G exposure group.

Susceptibility of Clinical Isolates of Staphylococcus aureus to Ceftaroline

Harsha Sreedharan, KB Asha Pai

Introduction: Urosepsis is a serious, life-threatening consequence of a complicated Urinary Tract Infection (UTI). It is caused by bacterial infection of the urinary tract or prostate that spreads into the bloodstream. Since urosepsis is associated with a very high mortality rate (20-40%), an early diagnosis and identification of the causative bacteria is important so as to facilitate a prompt treatment with appropriate antibiotics. Nearly 50% cases of urosepsis are caused by the Gram Negative Bacterial (GNB) pathogen, Escherichia coli (E. coli). Aim: To determine the bacteriological profile, antimicrobial susceptibility pattern, phenotypic resistance of the organisms associated with urosepsis and to correlate the levels of proinflammatory markers with the clinical outcome of the patient associated with urosepsis. Materials and Methods: This was a prospective observational study including all patients with simultaneously positive urine and blood cultures, with identical bacterial isolate(s). The details of clinical presentation, antibiotic therapy and other relevant information such as C-Reactive Protein (CRP) and Procalcitonin (PCT) values were recorded and analysed using Microsoft office excel 2013. Results: E. coli was the commonest isolate (43/53, 81.1%). Of the total 43 E. coli isolates, 4/43 (9.3%) were Extended Spectrum Beta Lactamase (ESBL) producers and 23/43 (53.49%) were Carbapenemase producers. Significant rise of the proinflammatory markers (PCT>10 ng/mL) and (CRP>100 mg/l) were associated with high mortality (49%). Out of the 53 patients, 43.4% (23/53) patients had more than one risk factor associated with severe sepsis and poor prognosis. Conclusion: Early recognition of symptoms followed by accurate diagnosis and early goal directed therapy is essential to decrease morbidity and mortality from urosepsis.

Clinicolaboratory Profile and Outcome of Patients with Urosepsis at a Tertiary Care Centre in Southern India

Airway Challenges in a Preterm Neonate with Undiagnosed Complete Tracheal Rings Posted for Surgery

Pratika Pradeep Bhokare, Sayli Rajendra Kulkarni

Preterm neonates are defined as those born before 37 weeks. The anatomical features of preterm neonates vary from that of an adult, such that they have a large tongue, an anterior funnel shaped larynx, angled vocal cords and an omega shaped epiglottis. Their physiological development also differ as they have a greater risk for apnoea of prematurity, airflow obstruction, bronchopulmonary dysplasia, low functional residual capacity and decreased transient oxygen tension. Congenital airway anomalies have a prevalence rate of 0.2-1 in 10,000 live births. Congenital Tracheal Stenosis (CTS) caused by complete tracheal rings is one of the rarest forms of all the airway anomalies that occur, which is characterised by presence of complete ‘O’ shaped cartilaginous rings of trachea devoid of a membranous part. The case discussed in the article is that of a day 26 preterm neonate with increasing abdominal distension and failure to thrive. The neonate was posted for an urgent exploratory laparotomy for abdominal decompression and ileostomy. Patient was kept on Continuous Positive Airway Pressure (CPAP) support for four days immediately after birth; however, intubation was never attempted nor required. With a history of respiratory depression and lack of history of previous intubation, difficult airway cart was kept ready prior to surgery. Supraglottic Airway (SGA) devices were at the core of airway rescue in this case of undiagnosed CTS. This case report shows how and why a preparation for difficult airway in preterm neonates is a necessity. It will provide as a guide if a similar case is encountered by the anaesthetist.

A Randomised Control Trial Comparing the Efficacy of LMA-Supreme and I-Gel as Rescue Ventilatory Device in Patients with Simulated Difficult Airway Undergoing Anaesthesia with Controlled Ventilation

Sadia Rahman, Nidhi Agarwal, Sushil Guria, Swati Jain, Mona Swain

Introduction: In an unanticipated difficult airway or in an emergency situation of cannot-intubate-cannot-ventilate scenario, Supraglottic Airway Devices (SGD) are recommended as rescue devices for establishing airway quickly to prevent hypoxia. Aim: To compare efficacy of i-gel airway and Laryngeal Mask Airway supreme (LMA supreme) as ventilatory devices and the time taken for their insertion in anaesthetised and paralysed patients with simulated difficult airway. Materials and Methods: One hundred and eighty adult patients with simulated difficult airway were randomly allocated to two groups of 90 patients each. In group I: i-gel and in group S: LMA supreme was inserted. Primary outcome studied was time taken for insertion of SGD. Secondary outcomes were the number of attempts taken for insertion of device, oropharyngeal leak pressure, ease of gastric catheter insertion, fibreoptic bronchoscopic view of anatomical alignment of device with glottic opening. Quantitative variables were compared using unpaired t-test/Mann-Whitney Test, between the two groups. Qualitative variable were compared using Chi-Square test/ Fisher's-exact test. Results: Total time taken for successful insertion was significantly shorter with group i-gel as compared to group LMA supreme {median (IQR) {19 (18.25-21)} versus {24 (23-24)} with p-value =0.0001. Overall success rate of insertion (96.67% vs 97.78%, p=1.000) and oropharyngeal leak pressure (p-value=0.555) of i-gel and LMA-S were comparable. i-gel has better anatomic alignment with glottic opening as compared to LMA-S (p-value ≤0.0001). Gastric tube insertion was easy in all patients in both the groups. Conclusion: Shorter time for the insertion of i-gel was observed due to absence of inflatable cuff, although both LMA-S and i-gel are equally efficacious as ventilatory devices in patients with simulated difficult airway under general anaesthesia with controlled ventilation.

Anti-Inflammatory Activity of Oxycarotenoid Extracts Isolated from Coriander Leaves (Coriandrum Sativum) and Curry Leaves (Murraya koenigii) on Carrageenan Induced Acute Inflammation in Rats

AM ANUSHA, PA SHERENA, PT ANNAMALA, JK Mukkadan

Introduction: Green leafy vegetables are important sources of polyphenols and carotenoids which possess both antioxidant and anti-inflammatory activities. Aim: To study the anti-inflammatory activity of oxycarotenoid extracts isolated from coriander leaves (Coriandrumsativum) and curry leaves (Murraya koenigii) in carrageenan induced acute paw oedema in rats. Materials and Methods: Oxycarotenoid extracts were isolated from the coriander leaves (Coriandrum sativum) and curry leaves (Murraya koenigii) and they were assessed for antiinflammatory activities by in-vivo methods. The in-vivo antiinflammatory activity was evaluated in carrageenan induced acute paw oedema model. Indomethacin at a dose of 20 mg/Kg body weight was used as standard anti-inflammatory drug. Results: The results revealed that oxycarotenoids extracted from coriander leaves administered at a dose of 40 mg/ kg body weight showed an inhibition of 53.33% whereas the oxycarotenoids extracted from curry leaves showed an inhibition of 60% at the sixth hour after carrageenan injection. The results are comparable with those of indomethacin (20 mg/ Kg body weight) administered group which showed an inhibition of 55.53% Conclusion: These findings suggest that oxycarotenoid extracts isolated from leafy vegetables (coriander leaves and curry leaves) have significant anti-inflammatory activities.

A Morphometric and Morphological Study on Dry Adult Cuboid Bones

SREYA MOITRA

Introduction: Precise biometric data of cuboid and calcaneocuboid joint are not discussed very distinctly in the text books of Anatomy. A better knowledge of the joint surfaces of cuboid and biometric data would generate a three dimensional modeling of the calcaneocuboid joint and would help in the management of Cuboid Syndrome. Aim: To study about morphological and morphometric analysis in adult dry cuboid bone. Materials and Methods: This study was conducted in the Department of Anatomy of a Medical College using 60 dry cuboid bones from museum. Each bone was observed for its morphometric analysis as well as its pattern of calcaneal and metatarsal articular facets. Results were statistically analysed using the Statistical Package for the Social Sciences (SPSS) software, version 19. Students t-test was applied to find the difference between the mean values of the parameters. Results: Mean medial length of cuboid was 33.41 mm, lateral length was 19.73 mm, height was 26.17 mm, length index was 169.33, vertical and transverse diameters of calcaneal articular facet were 24.24 mm and 16.45 mm respectively, vertical and transverse diameters of metatarsal articular facet were 21.32 mm and 13.85 mm respectively, depth of peroneal groove was 0.63mm. Concavo-convex facet with posteromedial projection and oval or reniform in shape (Type 1A) was the most common calcaneal articular facet and convex pattern was the most common metatarsal articular facet of cuboid. Conclusion: Morphological characterisation of articular facet of cuboid and its morphometric analysis help to understand the degree of movement at calcaneocuboid joint, its associated pathologies and instabilities.

Clinicopathological Analysis of Whipple’s Pancreaticoduodenectomy Specimens in a Tertiary Care Hospital with Special Emphasis on Grossing

Ashima Nagesh Amin, Christol Blanch Moras, T Umashankar

Introduction: Pancreaticoduodenectomy (PD) is done for a myriad of tumours as well as inflammatory condition affecting the duodenum, common bile duct, ampulla of vater and the head of pancreas. The diagnostic accuracy of the histopathology report is largely determined by the preliminary meticulous gross examination of the specimen. Aim: To comprehensively analyse the clinicopathological parameters of Whipple’s specimen and thus evaluate the trends in indication of Whipple’s procedure in Southern India. Materials and Methods: This was an observational time bound descriptive study done in the Department of Pathology, Father Muller Medical College Hospital, Mangalore, Karnataka from May 2014 to April 2019 wherein histopathological and clinical data of all the patients who underwent Whipple’s procedure were retrieved and analysed. The gross specimens were retrieved from the museum and records were assessed for the type of grossing method employed. The H&E slides were reassessed for the tumour type, grade, margins, perineural and angioinvasion, lymph node status and staging. Immunohistochemical marker (CD 117) and cytochemical like Mucicarmine and Alcian blue were employed wherever required. Descriptive analysis of the data involved calculating percentage, mean, median and range. The p-value was calculated using Fischer-Exact test with statistical significance level at <0.05. Results: Total of 45 patients underwent Whipple’s procedure, of which 28 (62.2%) were males and 17 (37.8%) were females with a ratio of 1.6:1. The most common symptom was jaundice (33 cases-73.3%) followed by pain abdomen (7 cases-15.6%). The mean age was 56.2 years. The mean tumour size was 2.8 cm. Malignancy was seen in (43 cases- 95.6%). The others being, inflammatory lesions (2 cases-2.2%). The most common site of localisation of tumours was periampullary (16 cases37.2%) followed by pancreatic head (15 cases-34.9%).The most common histological subtype was adenocarcinoma (40 cases93%). There were two cases of grade 2 neuroendocrine tumours (2 cases-4.7%) and one case (2.3%) of malignant Gastrointestinal Stromal Tumour (GIST). Lymph node positivity was most commonly seen in pancreatic cancers (7 cases46.7%) with a significant p-value of 0.001. Lymphovascular invasion were seen in 16 cases (37.2%) and perineural invasion in 23 cases (53.5%). The most common tumour stage was T2 (16 cases-37.2%) followed by T3 (12 cases-27.9%). Margins were free in most of the malignant tumours (37 cases-86.04%). Conclusion: Thorough gross inspection of the Whipple's specimen along with sound knowledge of the anatomy of the region is of utmost importance. The present analysis showed that periampullary adenocarcinoma was the most common subtype, many of the cases being diagnosed at an advanced stage, emphasising on early diagnosis through clinicoradiological modalities and guided biopsies. A meticulous and careful evaluation of the Whipple's specimen is a pre-requisite for accurate histopathological differentiation of tumours originating in this anatomical region. Subtyping the tumor,reporting margin clearance, lymphovascular and perineural invasion, also has prognostic implications. Whipple's PD may rarely be done for non-neoplastic conditions like chronic pancreatitis.

Celiac Disease in Children with Chronic Diarrhoea: A Cross-sectional Study

YM Bhavika, DG Prasanna Kumar, HN Harish

Introduction: Celiac disease is a chronic gastrointestinal disorder, very often underdiagnosed due to lack of awareness among the general practitioners. Aim: To study the prevalence of celiac disease among children with chronic diarrhoea. Materials and Methods: A cross-sectional study was conducted in which, 890 children between the age group of 1-18 years with history of chronic diarrhoea (loose stools or increased frequency for more than two weeks) were enrolled, between November 2015 and January 2018 in a tertiary care centre in India. The children were screened with serological tests for celiac disease and among those who were tested positive; the diagnosis was confirmed by intestinal biopsy. Results: Of the 890 patients with chronic diarrhoea, 252 (28.3%) were tested positive for anti-tissue Transglutaminase (tTG) antibodies with levels more than 10 times the upper normal limit. Among the 252 patients with positive serology, 144 patients had intestinal biopsy findings suggestive of celiac disease (Marsh stage 3b and 3c) while the rest had normal or mild (marsh grade 1, 2 and 3a) histological changes. Conclusion: Celiac disease is one of the most important causes of chronic diarrhoea and hence should be actively looked for in children presenting with chronic diarrhoea.

Unusual Thoracic Tumours- A Concise Imaging Approach

Introduction: There are certain uncommon large thoracic masses sharing overlapping radiological features with commoner ones except few salient characteristic features. Diagnosing these uncommon tumours has practical implications for patient management and prognosis including obviating unnecessary surgeries. Aim: To demonstrate characteristic Computed Tomography (CT) features of large common and certain uncommon intrathoracic masses Materials and Methods: A retrospective cross-sectional search was done in January 2020, from the archives of patients record in Radiology Department from December 2017 to January 2019 for intra-thoracic tumours. Those tumors or masses meeting inclusion criteria were analysed by two radiologists who were blinded about the histopathologic reports. A probable radiological diagnosis was made and it was later matchedup with the histopathologic reports to reach to a confirmed diagnosis. The unique CT features were separately tabulated and their p-value for a particular diagnosis was calculated using Fisher's-exact test. Results: Out of total 23 cases studied, 12 bronchogenic carcinomas and 11 uncommon diagnoses including Solitary fibrous tumour, Synovial sarcoma, Pulmonary blastoma, Askin's tumour, Schwannoma and Metastasis were found. Subtle rib erosion in Askin's tumour (p-value=0.004), intra-tumoural vessels in Synovial sarcomas (p-value=0.0006) and intense enhancement in some non-bronchogenic tumours (p-value=0.0137) were found to be significantly associated features. Conclusion: When encountering an opaque hemithorax on chest radiograph and a large mass on CT, one should look for certain peculiar features of these unusual lung masses to suggest them as a differential diagnosis, as "Our eyes see only what our mind knows".

Smartphone Vision Syndrome Associated with Prolonged Use of Digital Screen for Attending Online Classes during COVID-19 Pandemic among Medical Students: A Cross-sectional Study

Jagdish Hundekari, Rishendra Sisodiya, Lokendra Kot

Introduction: Smartphone vision disorder is a complex of eye and vision related problems associated with close work during use of digital screen. It is one of the rising wellbeing concerns identified with innovation (phones and tablets) because of constant utilisation of Smartphones among medical undergraduates particularly during the last five months due to COVID-19 pandemic for attending online classes. Aim: To investigate the impact of online classes on development of Digital Vision Syndrome (DVS) among undergraduate medical students. Materials and Methods: A cross-sectional study was conducted in 280 undergraduate medical students from 1st and 2nd professional MBBS course attending online classes regularly from the last five months. The authors evaluated the student’s perception based on the symptoms experienced in the last five months through a pre-tested questionnaire related to DVS which are caused due to two mechanisms: (i) accommodative mechanism; (ii) ocular surface mechanism by using 5-point Likert scale. The association between development of DVS symptoms and risk factors like distance of eyes from the screen, refractive errors, duration of exposure and size of screen was analysed by factor analysis and ANOVA through EpiInfoTM for windows version 7.2.4. Results: In the present study, 78.2% of students were using smartphones and 21.8% were using large screen for reading and attending online classes during the lockdown period. It was observed that the descriptive statistics elaborates the overall mean of approximately score 3 in all 280 students on Likert scale. In regard to distance at which digital screen was kept, students who kept less distance (> arm and forearm length) are at higher risk of DVS development (p<0.001). In case of refractive error, the negative correlation shows that impact with spectacles is less compared to emmetropic eye (p<0.01 and p<0.001). About 75% of the total students score range between occasionally to always which indicates that the majority of the students got DVS. Authors assess the impact of duration of digital screen used and revealed that accommodative and ocular mechanisms responsible for development of DVS were significantly affected as duration of exposure to digital screen increases (p<0.001). We analysed the impact of digital screen size on DVS symptoms and found that participants using small screen are at higher risk (p<0.001) for development of smartphone vision syndrome as compared to large screen digital devices. Conclusion: The students attending online classes are more prone to development of smartphone vision syndrome. This study had shown association between DVS and the risk factors associated with it: duration of exposure, distance from the screen and size of screen used.

A Randomised Controlled Trial on the Efficacy and Safety of Oral Ketamine in Neonatal Circumcision

Introduction: Procedural analgesia use in neonatal circumcision is not widespread in the developing world. An easy-to-administer, adequate and safe analgesia will encourage usage in neonatal circumcision. Orally administered ketamine may prove effective and safe, and may encourage procedural analgesia use in neonatal circumcision. Aim: To determine the analgesic efficacy of oral ketamine in Plastibell® neonatal circumcision. Materials and Methods: A hospital based randomised double blind controlled study was conducted at the paediatric surgery unit of the hospital, from March 2015 to December 2015. Total 121 neonates were sequentially recruited, and randomised into two groups. Group A received oral ketamine, and Group B received plain syrup (placebo) as procedural analgesia. Continuous pulse oximeter monitoring was done before, during and immediately after the procedure. The pre-procedural and intra-procedural peripheral oxygen saturation (SpO₂ ) and Pulse Rate (PR) were determined at the various stages. Also, the Neonatal Infant Pain Scale (NIPS) scores were assessed during the stages of the procedure. Differences in mean scores were analysed. Mann-Whitney U test and Independent t-test were used to compare means of continuous variable, while Fisher's exact test was used to compare categorical variables. Significance was set at p<0.05. Results: Sixty-one neonates received oral ketamine, while 60 received placebo. The intraoperative mean SpO₂ were lower in the placebo group and significant at the tying stage with p=0.022. The mean intraoperative PR was higher in the placebo group and significant at dorsal-slit, tying and excision stages (p<0.05). The mean intraoperative NIPS scores were significantly higher in the placebo group. Conclusion: Oral ketamine provides effective and safe analgesia for neonatal Plastibell® circumcision in comparison to placebo.

Venous Thromboembolism Prophylaxis in Medical Intensive Care Unit: An Audit

Basant Kumar Pathak, P Harikrishnan, Manish Manrai

Introduction: Venous Thromboembolism (VTE) is a major cause of morbidity and mortality in patients admitted to healthcare facilities. This can be prevented by giving thromboprophylaxis to patients after assessing the risk for VTE. This however is not being routinely done leading to underuse of thromboprophylaxis due to inadequate practice of risk assessment. Aim: To conduct an audit of VTE prophylaxis in Intensive Care Unit (ICU) based on Padua score and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Risk Assessment Model (VTE RAM). Materials and Methods: This was a cross-sectional observational study and the data was collected from medical records of patients retrospectively who were admitted to medical ICU between October 2019 and December 2019. Based on medical records risk assessment was done using the Padua score and IMPROVE VTE RAM. The prophylaxis given to patients was scrutinised for appropriateness based on American Society of Haematology (ASH) guidelines. The two validated scores Padua score and IMPROVE VTE RAM were compared with each other for any significant difference in the risk assessment made using Chi-square test and p-value <0.05 were considered significant. Results: Out of the 176 patients risk assessment was not done in any patient. On calculating the Padua score, 149 patients (84.66%) were in high risk for VTE (Padua Score ≥4) and amongst them only 76 (51%) patients received thromboprophylaxis. On calculating the IMPROVE VTE RAM score, 137 patients (77.84%) were in moderate or high risk for VTE requiring prophylaxis and amongst them only 76 (55.47%) patients received thromboprophylaxis. The accuracy of clinician’s judgement without risk assessment was 58.52% (95% CI: 65.80%-51.24%) and 64.20% (95% CI: 71.28%-57.12%) as compared to risk assessment by Padua score and IMPROVE VTE RAM, respectively. There was no significant difference between IMPROVE VTE RAM and Padua score with respect to risk assessment for VTE (p-value of 0.10). Conclusion: The practice of VTE prophylaxis is grossly inadequate and there is a requirement to sensitise the healthcare providers about the importance of risk assessment for VTE.

Apelin 13 and Blood Pressure, Is there any Association in Pre-eclampsia? A Case-control Study

Rajeev Gandham, CD Dayanand, SR Sheela

Introduction: Pre-eclampsia is a pregnancy specific disorder, characterised by the onset of hypertension and proteinuria. Preeclampsia is the leading cause of maternal, perinatal morbidity and mortality. The exact cause of pre-eclampsia is not known clearly and needs to be explored. Aim: To evaluate the maternal serum apelin 13 levels among pre-eclampsia and healthy pregnant women and also, to find the association between apelin 13 and blood pressure. Materials and Methods: A case-control study was conducted between Department of Biochemistry and Department of Obstetrics and Gynaecology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. After approval from the Institutional Ethics Committee and written informed consent from study subjects, a total of 270 pregnant women were recruited for this study. Among them, 135 pre-eclamptic women were considered as cases and 135 normotensive healthy pregnant women served as controls. According to the pre-eclampsia severity, cases were grouped into mild (n=47) and severe preeclampsia (n=88). Blood samples were collected from all the study subjects and was analysed for apelin 13 by Enzyme Linked Immunosorbent Assay (ELISA) method. Maternal and foetal adverse outcomes were recorded. Results were expressed as mean±Standard Deviation (SD). Categorical variables were expressed in percentages. Spearman’s correlation was applied and p<0.05 was considered significant. Results: The mean gestational age was 36.66±3.69 weeks which was, significantly low in pre-eclamptic women compared with healthy pregnant women. BMI (26.94±3.81 kg/m2 ), systolic (157.82±15.14 mmHg), diastolic (101.68±11.02 mmHg) and Mean Arterial Pressure (MAP) (120.20±11.12 mmHg), pulse rate (88.14±5.82 bpm), Aspartate Transaminase (AST) (25.25±12.49 IU/L) and Alanine Transaminase (ALT) (19.01±10.95 IU/L) were significantly increased in pre-eclamptic women when compared with control group. Mean maternal serum apelin 13 (341.44±218.63 pg/mL) concentrations were significantly lower in pre-eclampsia compared with healthy pregnant women. Maternal serum apelin 13 concentrations were negatively correlated with Systolic Blood Pressure (SBP) (r=-0.196), Diastolic Blood Pressure (DBP) (r=-0.172) and MAP (r=-0.204). Adverse maternal outcomes such as epigastric pain 75 (55.55%), oedema 62 (45.92%) and persistent headache 35 (25.92%) were higher in pre-eclamptic group. Additionally, adverse foetal outcomes were more in preeclamptic cases including significantly decreased birth weight (2.40±0.65), babies requiring Neonatal Intensive Care Unit (NICU) admission were 54 (40%), preterm birth (≤37 wks) in 50 (37.03%), Respiratory Distress Syndrome (RDS) 31 (22.96%), Small for Gestational Age (SGA) in 4 (2.96%) and Intra Uterine Death (IUD) in 11 (8.14%) neonates. Conclusion: It was concluded from the present study that there was low maternal serum apelin 13 concentrations in pre-eclampsia and had negative correlation with blood pressure, suggesting its potential role in the pathophysiology of pre-eclampsia.

Risk Factors for Pneumonia in Patients with Acute Ischaemic Stroke-A Retrospective Study

Roy Thomas

Introduction: The most common non-neurological complication of stroke is infection. Stroke, associated with pneumonia is one among them. A few studies have identified prognostic predictors of pneumonia in stroke. Aim: To identify the risk factors of pneumonia in acute ischaemic stroke patients. Materials and Methods: This retrospective cohort study included medical records of 470 adult patients with acute ischaemic stroke between June 2015 to June 2020 (five years) in a Tertiary Care Medical College and Hospital. Among them, 173 had stroke associated with pneumonia. The clinical parametersage, gender, lesion location, stroke severity (Glasgow Coma Scale (GCS)) , National Institute of Health Stroke Scale (NIHSS), Modified Barthel Activities of Daily Living (ADL) index, water swallow test, vascular risk factors and co-existing conditions (pre-existent Chronic Obstructive Pulmonary Disease (COPD), atrial fibrillation, renal electrolyte dysfunction, hypoproteinaemia) were compared. Chi-square test and logistic regression analysis were used for statistical analysis. Results: In this study, the following factors were associated with increased risk of developing pneumonia-age >70 years, bed ridden status, GCS ≤13, NIHSS ≥5, water swallow test score ≤2. Among them, multivariate analysis identified bed ridden status and water swallow test as independent predictors. Conclusion: Bed ridden status and water swallow test score were significant risk factors of ischaemic stroke associated with pneumonia. Hence, an early identification of these factors and a better knowledge of them may help in better care and prevention of pneumonia in acute ischaemic stroke.

A Single Surgeon's Experience of Total Extra Peritoneal Repair Vs Transabdominal Preperitoneal Repair- A Prospective Cohort Study

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of <0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.

Effect of Phacoemulsification on Intraocular Pressure in Cataract Patients Attending a Tertiary Care Centre in Kerala-A Retrospective Cohort Study

Introduction: Cataract is the leading cause of preventable blindness worldwide. It is caused by the degeneration and opacification of the lens fibres. Phacoemulsification is the current treatment modality available for cataract. However, there is a possibility of an increase in the anterior chamber depth after phacoemulsification. This occurs as a result of the removal of the bulky lens matter and implantation of a thin intraocular lens, thereby reducing the intraocular pressure. Aim: To compare the preoperative and postoperative Intraocular Pressure (IOP) changes and the factors associated with intraocular pressure changes among patients who underwent phacoemulsification in a Tertiary Care Centre in Kerala. Materials and Methods: A retrospective cohort study was carried out among 610 patients, who underwent phacoemulsification surgery from January 1st, 2017 to December 31st, 2017. Using a checklist, the following data such as age, sex, Date of Surgery, Last recorded preoperative intraocular pressure of both eyes, First recorded Postoperative intraocular pressure of both eyes any time after 3 months, Axial length, Grade of cataract and comorbidities like diabetes, hypertension, dyslipidaemia, glaucoma and Coronary Artery Disease (CAD) was obtained from the hospital Information System. Data collected was entered into an MS Excel and was analysed using SPSS version 20. Frequency and percentages were calculated and association assessed using Chi-square test. Paired t-test was applied to find the mean changes in the IOP levels and p-value was =0.05, thus significant. Results: It was observed that there was a mean reduction of 7.907 mmHg in ocular hypertensives when compared to ocular normotensives following phacoemulsification. This finding was found to be statistically significant (p-value <0.001). There was association between grade of cataract and change in IOP which was significant with a p-value of 0.031. Conclusion: Phacoemulsification is the treatment of choice in patients with cataract. In the study, it was found that ocular hypertensives who underwent phacoemulsification had a significant drop in intraocular pressure post-surgery. Phacoemulsification can be employed in patients who have both ocular hypertension and cataract. This procedure can improve vision and in addition to having a positive effect on IOP reduction.

Prevalence of Obesity and Predictive Value of Central Obesity among Medical Doctors to Diagnose Hypertension

Tamaraemumoemi Emmanuella Okoro, Emmanuel Auchi Edafe

Introduction: Central obesity has been shown to have worse health outcomes than general obesity and plays a greater role in the causation of cardiovascular diseases. Prevalence of central obesity is high in Nigeria and is associated with increased cardiovascular risk. Aim: To assess the prevalence of central obesity in medical doctors in Bayelsa state using four obesity indices and to determine the association between these indices and compare the ability of these indices to predict cardiovascular risk. Materials and Methods: This was a descriptive crosssectional study conducted between August 2018 and January 2019. Using a structured self-administered questionnaire, data was collected from 244 randomly selected medical doctors. Data included socio-demographic information, work duration and professional cadre, Blood Pressure (BP) was taken. Anthropometric measures which included weight (in Kg), height (in metres), Waist Circumference (WC) and Hip Circumference (HC) in centimeters was taken. From the different measures: Waist-Hip Ratio (WHpR), Waist-Height Ratio (WHtR), Body Mass Index (BMI) was calculated. Based on WHO recommended thresholds, WC, WHpR, WHtR and BMI were used in categorising participants as obese and nonobese. Correlation analysis was done and Receiver Operating Characteristic (ROC) curve was constructed. Statistical significance was set at p-value <0.05. Results: Most doctors in the study were less than 30-year-old (40.2%), married (54.9%) and female doctors made up a third of the respondents (29.9%). The mean age of study participants was 37.4 years (SD-11.3 years) and mean duration of medical practice was 9 years (SD-11.1 years). The prevalence of elevated BP was 26.6% using a BP threshold of ≥140/90 mmHg. The prevalence of obesity was 18.4% using BMI ≥30 kg/m² . Based on WC, WHtR, and WHpR categorisations, the prevalence of obesity was 44.3%, 58.2%, and 63.1%, respectively. The weakest relationship existed between BMI and BP (r=0.15; p=0.019); while the correlation coefficient (r) between WC and WHtR showed a very strong positive relationship (r=0.88; p=0.001). ROC curve analysis revealed all anthropometric indices obtained modest performances in predicting Cardiovascular Diseases (CVD) risk as indicated by AUC values that were equal to or higher than 0.60. WC performed best in predicting hypertension in study participants (0.69) while BMI was the worst performer (0.60). Conclusion: A high prevalence of central obesity in medical doctors is worrisome given the associated cardiovascular risks. This study shows all four anthropometric indices (WC, WHtR, WHpR and BMI) are useful in predicting cardiovascular risk, with the best and worst predictors being WC and BMI, respectively

Effect of Flavone Derivatives on Vincristine and Oxaliplatin Induced Peripheral Neuropathy in Mice

Introduction: Therapy with anticancer drugs like paclitaxel, platinum complexes and vincristine result in severe peripheral neuropathy. Very few treatment options are available to overcome this debilitating side effect. Flavone and its monohydroxy derivatives have been proved to possess anti-nociceptive and anti-inflammatory effects in animal models. Aim: To investigate flavone, 5-hydroxy flavone, 6-hydroxy flavone and 7-hydroxy flavone for their effect on neuropathy induced by vincristine and oxaliplatin in mice. Materials and Methods: In this experimental animal study, neuropathy was induced in mice by multiple doses of vincristine or a single dose of oxaliplatin. The manifestations of mechanical allodynia, cold allodynia and thermal hyperalgesia were measured by von Frey’s hair aesthesiometer, acetone spray test and hot water tail immersion test. The data was subjected to ANOVA followed by Dunnett’s test for multiple comparison and paired t-test at appropriate places. Results: Flavone and monohydroxy flavones significantly reduced the paw withdrawal response scores due to mechanical allodynia and cold allodynia resulting from vincristine or oxaliplatin administration (p<0.05). The tail withdrawal latency due to thermal hyperalgesia was also significantly increased by different flavone derivatives (p<0.05). However, 7-hydroxy flavone was ineffective in oxaliplatin-induced mechanical allodynia and vincristine induced thermal hyperalgesia. Analysis of the results indicated that the manifestations of neuropathy induced by vincristine or oxaliplatin were amenable to treatment with flavone derivatives in the following order; cold allodynia>thermal hyperalgesia>mechanical allodynia. Opioid mediated antinociceptive effect, interaction with cation channels and anti-inflammatory effect of the investigated flavones may be suggested as possible mechanisms for their beneficial effects in neuropathy due to chemotherapeutic agents. Conclusion: Various neuropathic manifestations induced by vincristine and oxaliplatin were effectively attenuated by flavone and monohydroxy flavones.

Colour Preferences of Elastic Ligatures among Orthodontic Patients

Introduction: Elastic modules are an integral part of fixed appliances. The availability of different colours is important to patients and their compliance during treatment. Knowledge about the most popular colours is important to orthodontists when ordering their materials. Aim: This study aimed to determine the elastic ligature colour preferences of patients undergoing fixed orthodontic treatment and the influences of age and gender on these preferences. Materials and Methods: This cross-sectional study was done on a total of 319 patients (88 males and 231 females) aged 18- 36 years of age participated in this study. The patients’ elastic ligature colour preferences were recoded using a colour guide and a self-administered questionnaire. The questionnaire contained questions about the patients’ preferences regarding coloured or transparent ligatures, light or dark shades, and changing the ligatures for specific occasions. The data were analysed using SPSS version 25. The descriptive statistics were calculated, and a Pearson’s chi-squared analysis was performed to determine the influence of age and gender effects on colour preferences (p-value <0.05). Results: Most of the participants were excited about changing their elastic ligatures colours (44.5%), and they liked to change the colours at each visit (45.5%). Most participants did not like having multicoloured elastic ligatures in their mouths (77.4%) or changing the elastic colours before certain occasions (49.8%). There was no statistically significant difference in the elastic ligature colour preferences between the genders (p-value=0.0552), but there were statistically significant differences among the age groups (p-value <0.001). Conclusion: Most of the patients undergoing orthodontic treatment with fixed appliances preferred less noticeable elastic ligature colours. A significant difference was found between age groups: younger patients preferred coloured elastics, while older patients preferred less noticeable and transparent elastics. No difference was found between the colour preferences among both the gender.

Lipoprotein (a) as a Predictor of Steroid Dependence in Paediatric Steroid Sensitive Nephrotic Syndrome

Surupa Basu, Sushmita Banerjee, Pranab Roy, Apurba Ghosh

Introduction: Lipoprotein a {Lp(a)} increases in Nephrotic Syndrome (NS). Although the majority of paediatric NS are steroid sensitive, relpase and steroid dependence are commonly seen in this cases. Lp(a) is an LDL-like lipoprotein that consists of an LDL particle to which the glycoprotein apolipoprotein(a) {apo(a)} is attached. Aim: To evaluate the potential of Lp(a), measured on admission, for the prediction of relapse/steroid dependency. Materials and Methods: Children (n=36) with first episode NS were recruited in this prospective observational case-control study and followed up for one year. They were tested at presentation for Lp(a) (mg/dL) and standard tests such as haemoglobin, albumin, protein, cholesterol, triglyceride, and urine protein. Children received standard therapy for NS, and were followed for a period of one year from diagnosis to record days to initial remission, relapse episodes, steroid dependence etc. Patients were categorised as: no relapse (NR), Infrequent Relapse (IFR), frequent relapse (FR) and Steroid Dependent (SD) as per standard definitions. Fifteen healthy volunteers were also tested for lipid profile and Lp(a) levels. Results: Of 36 cases (median age 3 years, 19 males), there were 15NR, 7IFR, 2FR and 12SD. The mean Lp(a) of the NS group (165.2±120.4 mg/dL) was higher than controls (30.52±21.9 mg/ dL) (p<0.0001). All the lipid parameters except HDL-cholesterol were significantly higher in the NS group. Within the NS group, Lp(a) showed significant correlation (Spearman-rho) with albumin (p=0.0062,r=0.47), but no correlation with lipid parameters or urine protein. Comparison of Lp(a)levels in the NS groups revealed that the SD patients had a high Lp(a)(222.0±115.7 mg/ dL) compared to NR (129.7±120.1 mg/dL) (p=0.02). Conclusion: Concentration of plasma Lp(a) in patients with SDNS was higher compared to patients who did not suffer any relapse, and this concentration may serve as a marker for prediction of SDNS.

Prevalence, Severity and Determinants of Depression in Patients with Type 2 Diabetes Mellitus

Shilpa Pal, Anita Sharma, Sagar Modi

Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at higher risk to develop depression. Depression in turn adversely affects glycaemic control and increases the risk of diabetes-related complications and mortality. There is a large variation among Indian studies on prevalence of depression in T2DM and associated risk factors. Aim: To assess the prevalence, severity, and determinants of depression among patients with T2DM. Materials and Methods: The study was conducted at a Tertiary Care Hospital during February 2018-February 2019, in North-Indian state of Uttarakhand. Study subjects were patients with T2DM, age >18 years. Based on exclusion and inclusion criterias, a total sample of 290 patients were studied. Presence of depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Hamilton Depression Rating Scale (HAM-D) was used to estimate the severity of depression. Unpaired t-test and Mann-Whitney U test were used to compare continuous variables between subjects with and without depression. Chi-Square test was used to analyse categorical data. Binary logistic regression analysis was used to study the association between likelihood of depression and predictor variables. Results: Among 290 (155 males and 135 females, mean age of all subjects 58.2±11.08 years) study subjects with T2DM, 64 (22.1%) were found to have depression using DSM-5 criteria. Out of these 64 patients with depression, 46 were detected to have mild depression, 14 moderate depression and 4 severe depression using HAM-D scale. Subjects with T2DM and depression had: higher proportion of females (62.5% vs. 42.0%; p-value 0.004); lower literacy level (53.1% vs. 67.3%; p-value 0.037); higher frequency of diabetic retinopathy (85.9% vs. 62.8%; p-value <0.001) and diabetic kidney disease (43.8% vs. 27.4%; p-value 0.013); higher Fasting Plasma Glucose (FPG) (217.7±94.62 vs. 190.0±76.45 mg/dL; p-value 0.040); and lower haemoglobin (10.8±2.49 vs. 11.7±2.37 gm/dL; p-value 0.010) compared to the subjects without depression. On binary logistic regression analysis, female gender (OR 2.457, 95% CI 1.368-4.413, p-value 0.003) and diabetic retinopathy (OR 3.842, 95% CI 1.788- 8.255, p-value 0.001) remained significantly associated with likelihood of depression. Conclusion: Depression was present in one-fifth of the study subjects with T2DM. Majority of them had mild depression. Female gender and diabetic retinopathy were associated with increased likelihood of depression.

Evaluation of the Apical Sealing Ability of Resin and Silicon Based Sealers by Dye Extraction Method: An In Vitro Study

Introduction: Thorough, chemo-mechanical preparation of the root canal is required to completely eliminate microorganisms from the dentinal tubules. Faulty obturation in the apical area is the pathway from which bacteria and their toxins pass on to the periapical area and this leakage can be studied by sealability studies. Aim: To evaluate the apical sealing ability of three sealers i.e., AH Plus, Roekoseal and Adseal using passive dye penetration test and a dye extraction test with Methylene blue dye to evaluate the apical leakage. Materials and Methods: The present study was an experimental in-vitro study, carried out at MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India over a period of 10 months (from August 2013 to May 2014). Eighty freshly extracted human permanent maxillary central incisor teeth were obtained. The crowns of the teeth were sectioned at/below cemento-enamel junction and divided into five groups: Groups I, II and III were obturated with gutta-percha and three different sealers, and groups IV and V were the two control groups. Passive dye penetration test was performed to evaluate penetration of the dye by means of capillarity followed by dye extraction test. At the end of dye extraction procedure, the supernatant solution obtained was analysed using an Ultraviolet spectrophotometer. Significance was set at 5%. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences (SPSS) statistical software version 20 (Armonk, New York, United States). The normality of data in each group was tested using Shapiro-Wilk test. The mean absorbance values of the five groups were compared using one-way ANOVA. Further to compare the level of absorbance of dye among various groups, Tukey’s post-hoc test was applied. Results: The mean values of dye absorbance of all groups were as follows, AH Plus (0.02638), Roekoseal (0.06713), Adseal (0.03575), positive control group (1.36250) and negative control group (0.01894). One-way ANOVA showed p<0.001, thus indicating there was a significant difference between the dye absorbance values of all the groups. Tukey’s post-hoc test showed statistically significant difference in dye absorbance of the experimental groups when compared to positive control group. There was no significant difference in dye absorbance when experimental groups were compared to each other. When AH Plus was compared with Roekoseal, the p-value was 0.568 and 0.997 with Adseal whereas when Roekoseal was compared with Adseal the p-value was 0.778. Conclusion: The mean dye absorbance value of AH Plus was found to be least and that of Roekoseal was highest in the experimental groups. AH Plus gave the best results, as least dye was extracted from this group, indicating least dye penetration and minimum microleakage followed by Adseal and Roekoseal.

Role of Calretinin Immunohistochemical Stain in Evaluation of Hirschsprung’s Disease

Pranati Pradhan, Bipin Chandra Pal, Gayatri Rath

Introduction: Hirschsprung's Disease (HD) is a common congenital disorder characterised by absence of enteric neurons along a variable length of large bowel involving a segment of the rectum and the adjacent proximal bowel. The definitive diagnosis is based on histopathological study of rectal seromuscular biopsies. Calretinin Immunohistochemistry (IHC) staining adds to the diagnostic yield as it allows better appreciation of the mature and immature ganglion cells including the segments with paucity of ganglion cells. Aim: To assess the usefulness of calretinin IHC in the diagnosis of HD as an add-on technique to routine Haematoxylin and Eosin staining. Materials and Methods: This was a prospective study carried out in the Department of Pathology, SCB Medical College, Cuttack during the period from August 2016 to July 2018. Full thickness rectal biopsy specimens were processed and subjected to routine Hematoxylin and Eosin Stain (H&E) staining and Calretinin IHC staining. A thorough search of ganglion cells was made in both types of stained slides. The observations were tabulated and compared for diagnostic accuracy. Statistical analysis was done using Statistical Packages for Social Sciences (SPSS) Inc, Chicago IL version 15.0 windows. Through, ANOVA and Chisquare test. Results: Calretinin IHC provided superior diagnostic yield compared to routine H&E staining. A total number of 45 cases were studied. Sensitivity of 95.4% and specificity of 55.5% were obtained. It also presented higher accuracy values, than H&E (p=0.49). Conclusion: Calretinin is a superior immunohistochemical staining method that serves as a reliable additional diagnostic tool for better morphological appreciation of ganglion cells and thereby helps in establishing the diagnosis of HD.

A Cross-sectional Study of Serum Levels of Zinc, Copper and Magnesium in Type 2 Diabetes Mellitus in South Indian Urban Population

HU Hemanth Gowda, Harish Rangareddy

Introduction: Variability in the levels of these trace elements may reflect altered insulin metabolism and poor glycaemic control in the background of elevated oxidative stress. Mineral metabolism is another entity that may be disrupted by diabetes mellitus. Conversely, there are studies implicating early imbalances of trace elements in upsetting glucose homeostasis and insulin metabolism. Aim: To estimate and compare serum zinc, copper and magnesium in Type 2 Diabetes Mellitus (DM) patients with non diabetic controls and to correlate the serum zinc, copper and magnesium with Glycated Haemoglobin levels in Type 2 DM. Materials and Methods: This cross-sectional study was conducted at the Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India. The study included 30 Type 2 DM patients and 30 healthy, age and gender matched controls without Type 2 DM. Their serum levels of zinc, copper and magnesium were measured and compared. Statistical Package for the Social Sciences (SPSS) version 16 software was used to perform the statistical analysis. The data obtained was subjected to descriptive statistical analysis. Results: Mean±SD of serum zinc in Type 2 DM and controls was 93.44±46.99 µg/dL and 121.74±37.15 µg/dL, respectively. Serum zinc was significantly decreased in Type 2 DM. However, there was no significant alteration with respect to serum copper and magnesium. Pearson's correlation analysis showed that the association between HbA1c with zinc (r=0.069, p=0.718), copper (r= -0.094, p=0.622) and magnesium (r=0.116, p=0.543) was random. Conclusion: Zinc deficiency noticed in Type 2 DM patients may be due to increased excretion in urine. Zinc oral preparations are cheap and easily available. Considering these, it can be further explored if micronutrient supplementation would help to improve the glycaemic variability in Type 2 DM.

Effects of Oral N-Acetylcysteine on the Haemato-Biochemical and Histopathological Changes on the Liver of Albino Rats

Ervilla Dass

Introduction: N-Acetylcysteine (NAC) is a direct precursor in the synthesis of intracellular Glutathione (GSH). NAC protects the liver by restoring the GSH levels or by acting as an alternate substrate for conjugation and hence, detoxification of the reactive metabolite of hepatotoxic drug. Aim: To evaluate the effects of oral NAC on the haematobiochemical and histopathological changes on the liver of albino rats. Materials and Methods: The study was carried out in animal house located at Sumandeep Vidyapeeth, Piparia. The healthy albino rats of either sex weighing 150-400 gm body weight were grouped into two for the experimental study and were housed in animal house for duration of 24 hours. Before initiation of any procedures; after overnight fasting; the albino rats belonging to Group I Control Group (n=6) were administered distilled water 10 mL/kg orally; Group II NAC treated (n=6) were administered NAC 450 mg/kg as a single oral dose. Blood samples were collected after 24 hours of treatment, to evaluate the effect of NAC on the haematobiochemical and histopathological changes on the liver. All results were expressed as Mean±SEM. Results: NAC as a single oral dose of 450 mg/kg does not caused statistically significant changes in the serum enzymes levels. Moreover, histopathology showed normal appearance of the liver was similar to that of the control treated rats, with no change in the texture and liver tissue showed normal morphology. Conclusion: NAC as a single oral dose of 450 mg/kg body weight has no toxic effect on the liver in albino rats.

Evaluation of Truenat MTB/RIF Test in Comparison with Microscopy and Culture for Diagnosis of Extrapulmonary Tuberculosis in a Tertiary Care Centre

Introduction: Worldwide, Extrapulmonary Tuberculosis (EPTB) accounts for 15-20% of all cases of TB. The diagnosis of EPTB is a big challenge, as the number of Mycobacterium tuberculosis (MTB) bacilli in the tissues and other organs is often very low. Truenat MTB/RIF (rifampicin) is a novel method, which is battery operated, point-of-care and chip-based Real Time Polymerase Chain Reaction (RT-PCR) micro device. Aim: To evaluate Truenat as a screening test in the diagnosis of EPTB in comparison with microscopy and culture. Materials and Methods: A prospective cross-sectional study was carried out over a year in which samples from suspected cases of EPTB fitting in the inclusion criteria were subjected to Ziehl-Neelsen (ZN) staining for smear microscopy, culture on Lowenstein Jensen (LJ) medium and PCR for MTB by Truenat. Comparisons were made between the tests and the data was presented using summary statistics with 95% Confidence Interval (CI). Results: A total of 248 samples were received from suspected cases of EPTB. Out of the different samples tested, 9 (3.6%) were positive with Truenat MTB. The predominant type of EPTB observed in the study was lymph node Tuberculosis (TB) (66.6%) followed by intestinal, pleural and skeletal TB. Out of the 106 samples tested for culture, four were culture positive for MTB and out of 178 samples tested for microscopy, three were positive for acid fast bacilli. Sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), observed agreement of Truenat with culture and microscopy were 100%, 95.1%, 100%, 44.4%, 95.3% and 100%, 96.6%, 100%, 33.3%, 96.6%, respectively. Conclusion: Truenat MTB test is a cost-effective rapid molecular test with good sensitivity and specificity for the diagnosis of EPTB in low resource settings.

A Study on the Effect of N-Acetylcysteine on Acute Kidney Injury due to Falciparum Malaria

Gurupada Das, Bibhu Prasad Behera, Purna Chandra Karua, Rama Chandra Sethy

Introduction: Acute Kidney Injury (AKI) occurs most commonly in Plasmodium falciparum infection. Next to cerebral malaria and anaemia, AKI is the third most common complication of falciparum malaria. N-Acetylcysteine (NAC) has been shown to decrease serum creatinine without affecting the Glomerular Filtration Rate (GFR) by activating creatinine kinase and possibly by increasing tubular secretion. Aim: To study the effect of NAC on improvement and deterioration of falciparum malarial AKI. Materials and Methods: This prospective observational study was undertaken on 100 patients of falciparum malaria with AKI who were admitted to the Department of General Medicine ward, VSSIMSAR, Burla, Odisha from November 2014 to October 2016. Patients who were treated with NAC were considered as NAC group (n=50) and those who were not given were considered as Non N-Acetylcysteine (NNAC) group (n=50). In both the groups serum creatinine level and urine output were compared on day 1, day 3 and on day 5 of the study. Graph pad instat version-3 for windows was used for various statistical analyses. The numerical value was compared by Chi-square test. The comparison of mean values among the NAC and NNAC groups was performed by student t-test. The p-value less than 0.05 was considered statistically significant. Results: A total of 63 males and 37 females were included in the study. Most of the cases were present in 15-34 years age group in both NAC and NNAC groups. The mean age of the patients for NAC group was 33.3±12.8 years and for NNAC group was 33.2±12.1 years with majority being males in both the groups. Out of 50 cases who were given NAC 600 mg twice daily for five days, 28 (56%) cases improved in AKI on day 5 as compared to day 1 of the study in NAC group. Similarly, out of 50 cases who were not given NAC, 26 (52%) cases improved in AKI on day 5 as compared to day 1 of the study in NNAC group. There was no difference in patients showing improvement in AKI after NAC therapy compared to patients with NNAC (χ² , 0.04; p=0.841). Conclusion: In NAC group, improvement of falciparum malarial AKI after five days was found to be little bit more as compared to the NNAC group, though it did not reach statistically significant difference.

Intratympanic Steroid Therapy for Advanced Ménière’s Disease: Are There Effects on the Vestibular System?

Introduction: Méniére's Disease (MD) is associated with rotatory vertigo, unstable levels of hearing, tinnitus, along with vegetative symptoms and postural instability. Progressive hearing loss can be treated in part successfully with Intratympanic Steroid (ITS) (dexamethasone) injection. Aim: To investigate the effects of ITS treatment on vestibular system in MD. Materials and Methods: This retrospective case-control study, was conducted at Semmelweis University, Department of Otolaryngology and Head and Neck Surgery during the period of January 2018 to March 2020. Study involved 120 patients data suffering from advanced MD. Thirty-eight patients suffering from advanced stage of MD received ITS treatment along with 82 patients with advanced MD that were treated with conservative treatment based on international guidelines. The results of vestibular function tests using ultrasound-computercraniocorpography (US-COMP-CCG) before and after administration of ITS injection were compared, using MannWhitney U test and Logistic Regression. To analyse the baseline characteristic of the control and treated groups, Mann-Whitney U test and Chi-square test were applied. Results: Based on the comparison between the baseline characteristic of the control and ITS groups, there was no significant difference detected in case of the US-COMP-CCG parameters, nor was it when the distribution of age groups and gender were contrasted. When the distribution of US-COMPCCG parameters before and after the steroid treatment were contrasted using boxplots, there was no obvious difference between the parameters, which was also strengthened by the non-significant statistical difference. In case of the parameters of stepping test the same outcome was detected. Comparing the boxplots of the parameters of both tests after the treatment and of the control group, no significant difference was detected. Long-term follow-up data analysis was carried out using Kaplan-Meier curve and Logistic Regression, and there was no statistically significant difference between the treated and nontreated groups {p=0.445; Odds ratio: 1.654 (95% CI: 0.166- 0.197)}. Conclusion: Based on US-COMP-CCG, the ITS injection seems to have no impact on the vestibular system, although seems to be efficient in the management of some cases of MD.

Serum and Salivary Sialic Acid and Nitric Oxide Levels Estimation and Comparison after Nonsurgical Periodontal Therapy in Generalised Chronic Periodontitis Patients

Introduction: An exigency for a biomarker arises to expeditiously detect the periodontal disease evolution and to advocate more robust therapy efficacy measurements. Nitric oxide and sialic acid have been proved to be potential inflammatory markers. Hence, the evaluation of the involvement of nitric oxide and sialic acid in periodontal disease will enable us to assimilate the aspect of the complex process of periodontal disease progression. Aim: To estimate and compare the effect of nonsurgical periodontal therapy on serum and salivary sialic acid and nitric oxide levels in generalised chronic periodontitis patients. Materials and Methods: This study was a case-control as well as an interventional study. The subjects for this study were recruited from the Meenakshi Ammal Dental College and Hospital, Chennai from April 2017 to October 2018. Hundred patients were selected for this study. Control group consisted of 50 periodontally healthy subjects and test group consisted of 50 generalised chronic periodontitis subjects. After blood and saliva sample collection for determination of salivary and serum sialic acid and nitric oxide levels, evaluation of periodontal parameters like plaque index, probing pocket depth and Clinical Attachment Level (CAL) was done. Then the test group subjects underwent nonsurgical periodontal therapy and on 90th day post SRP parameters were re-evaluated. The collected data were analysed with IBM SPSS Statistics software, Version 23.0. In the above statistical tool the probability value 0.05 was considered as significant level. Results: The mean difference of plaque index, probing pocket depth, CAL, serum sialic acid, salivary sialic acid, serum Nitric Oxide (NO) and salivary nitric oxide: between the control and test group at baseline was -2.05, -5.01 mm, -5.56 mm, -12.515 mg/dL, -11.97 mg/dL, -129.762 µMol/L and -78.978 µMol/L respectively; for the test group at baseline and 90 days after nonsurgical periodontal therapy was 1.332, 3.15 mm, 3.285 mm,14.206 mg/dL, 12.76 mg/dL, 130.082 µMol/L, 82.004 µMol/L, respectively. All the values were statistically significant with p-value <0.001. Conclusion: Nonsurgical periodontal therapy led to a decrease in the serum and salivary sialic acid and nitric oxide levels in subjects with generalised chronic periodontitis. A decrease in biochemical parameters was associated with a reduction in probing pocket depth and gain in attachment level.

Postoperative Hypoparathyroidism: Presentation, Clinical Features and Long-term Follow-up from Tertiary Care Hospital

Shrikrishna V Acharya

Introduction: Hypoparathyroidism is commonly seen after total thyroidectomy. Though most of the time it is transient in nature but permanent decrease in function of the parathyroid function is also possible. Aim: A retrospective analysis of clinical presentation, treatment, prevalence of complications of hypoparathyroidism and its treatment with active vitamin D analogues was conducted. Materials and Methods: A retrospective cohort study followed by location and duration of study of all patients who developed Permanent Hypoparathyroidism (PH) and who were regular in follow-up for at least three years. Any patient with intact Parathyroid Hormone (iPTH) levels <13 pg/mL and was on replacement therapy with calcium and/ or vitamin D for at least one year after surgery is labelled as PH. Data of their treatment, serum calcium, phosphorous, creatinine, urine calcium/creatinine ratio and renal ultrasound was recorded. Data was represented as percentage, mean and standard deviation. Statistical analysis was conducted using SPSS version 19. Results: Out of the 23 patients enrolled, three were male and 20 were female with a mean age of 41.2±15.2 years. The mean duration of follow-up was 48±28 months. Clinical complications in 12 patients were observed. Two patients developed renal colic due to renal stone on follow-up. None of the patients developed renal failure. Conclusion: PH causes considerable morbidity and economic burden to family due to its lifelong treatment and monitoring. It requires regular follow-up and monitoring to prevent complications of disease as well as its treatment with active calcium salts. Around 50% of the patients suffered few relevant clinical events requiring hospitalisation.

Study of Parasitic Infection in Immunosuppressive Patients and its Association with the Socio-demographic Status

J Lakhani Sucheta, Dhruba Hari Chandi, J Lakhani Som

Introduction: In developing countries, immunosuppressive patients are at greater risk of parasitic infection which may cause morbidity and mortality. Socio-economic and environmental factors including lack of health hygiene in close contact with infected reservoir animal which plays an important role. Aim: To determine the prevalence of parasitic infections and their association with socio-demographic status. Materials and Methods: This was a cross-sectional study which was carried out at tertiary care hospital located in Central East India. Total 120 stool samples were collected from the immunosuppressive patients and were processed using direct wet mount preparation with saline and Lugol, formalin-ether concentration and Modified Ziehl-Neelsen stain. Different socio-demographic parameters were recorded. Statistical analysis was done using Graph Pad Prism version 8 Chi-square test. The p-value ≤0.05 was considered as statistically significant Results: Out of total 120 patients, 20 (16.7%) were found to be infected. Majority of the population were males (66.7%). Among the total positive samples, 75% (15) showed the presence of Protozoa in which 10 samples had Entamoeba histolytica. The presence of Helminths was found in 25% (5), in which three samples showed Ascaris lumbricoides and two had Taenia species (10%). Conclusion: The prevalence of parasitic infection among immunosuppressive patients in the present study was 16.7%. Entamoeba histolytica was the most commonly observed parasite. There was no significant association between prevalence of parasitic infections and socio-demographic data variables.

Assessment of Perception of Family Planning among Mothers in an Urban Slum Area in Kolkata, India

Introduction: Women in India are not fully educated on contraception usage. In 2017, a central family planning initiative called Mission Pariwar Vikas was launched by the Ministry of Health and Family Welfare (MoHFW). Aim: This study was conducted among mothers in an urban slum in Kolkata to establish their unmet family planning needs, as well as different factors associated with it. Materials and Methods: A cross-sectional community-based study was conducted from February 2019 to May 2019 among mothers residing at an urban field practice area (Dhapa UHTC, Kolkata). All mothers of under-five children present in the slum were included in the study (n=246). Pre-designed, pre-tested, semi-structured schedule with both open and closed-ended questions were used. Results: The majority of the mothers were Muslim, of whom 37.8% were below 18 years of age. Among the mothers, 46.3% were adolescent mothers (<18 years). Around 78% mothers desired two children. Around 70.7% mothers were using some form of contraceptives at the time of the study. Out of 246 subjects, unmet family planning needs were found in 72 (29.3%) subjects. Significant association was found between unmet family planning needs and age, education level, socioeconomic status, knowledge of the ideal age of marriage, and the number of children desired. Conclusion: The study revealed the unmet needs for contraception in an urban slum. However, the practice assessed by the study was actually reported practice and therefore, recall bias might be present. Further studies are recommended in other areas and different settings in order to extrapolate the study findings.

Association between Intimate Partner Violence with Quality of Life

NV Roopesh Gopal, SV Sathish Kumar, Kiran S Bhat

Introduction: An intimate relationship is an interpersonal relationship that involves physical or emotional intimacy. Those who are in such a relationship may experience violence from partners which may affect their day-to-day quality of life and thus cause a burden on the family. Aim:To assess the relationship between Intimate Partner Violence (IPV) with Quality of life and to provide early interventions. Materials and Methods: Hospital-based, cross-sectional study was conducted at the Department of Psychiatry, Kodagu Institute of Medical Sciences (KoIMS) teaching hospital Madikeri, Karnataka. The subjects were recruited by purposive sampling method. A total of 5810 consecutive subjects who visited the psychiatry OPD from March 2017 to June 2019 were assessed and among them, 82 subjects both men and women in the age group of 18 to 60 years were recruited. All of them reported IPV on the Hurt, Insulted, Threatened, and Screamed (HITS) scale and were further assessed for Quality of life using the World Health Organisation Quality of Life BREF (WHOQOL-BREF) scale. Descriptive statistics were used for continuous variables. A Nonparametric Chi-square test was applied for categorical variables and Mann-Whitney U scores were used for quality of life variables. The correlation was done using Pearson's correlation. Results: Mean age was 36.04 in years (SD±11.28) having a mean of 7.5 years of schooling (SD±4.5). The majority belonged to the rural background and lower socioeconomic status. Out of 82 subjects, 21 subjects reported IPV score less than 10 (25.60%) and among the rest of the 61 (74.39%) subjects, 80.32% were females and 19.67% were males who had IPV scores of more than 10. The study subjects reported poor and very poor scores in their overall quality of life and very dissatisfied and dissatisfied in their health domain. IPV also correlated with reduced quality of life, which was statistically significant. Conclusion: People that experience IPV has an overall reduced quality of life. Routine clinical assessment needs to be done to provide early interventions.

Effectiveness of Video Assisted Teaching on Knowledge among ASHA Workers Regarding HPV Infection in a Selected Rural Community of Mangaluru, India

Philomena Fernandes, Sabitha Nayak

Introduction: Human Papilloma Virus (HPV) is a major aetiological agent for cervical cancer, the second most common cancer in the world. The main role of Accredited Social Health Activist (ASHA) includes, motivating women to give birth in hospitals, bringing children to immunisation clinics, encouraging family planning, treating minor ailments, keeping demographic records, and improving village sanitation. In the community, ASHA create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services. Aim: To evaluate the effectiveness of video-assisted teaching on knowledge regarding HPV infection among ASHA workers. Materials and Methods: A pre-test post-test design was adapted for this study. Fifty-eight ASHA workers were selected using a convenience sampling method. A pre-test was conducted to assess the existing knowledge on HPV infection with the help of structured knowledge questionnaire, followed by Video-Assisted Teaching on HPV infection and seven days later a post-test was done. Interpretation of score of knowledge questionnaire between 1-5 was considered as poor knowledge, 6-10 an average knowledge, 11-15 good knowledge and 16- 20 excellent knowledge. Data were analysed using descriptive statistics and inferential statistics. The p-value less than 0.05 were considered to be significant by Z-test. Results: The knowledge of HPV infection was improved noticeably after the video-assisted teaching program as the pre-test mean knowledge score was 7.19±2.55, and the post-test score was 13.10±1.95 at p<0.05. Statistically significant effectiveness of the video-assisted teaching program was established using Willcoxon signed-rank test (Z-value=-6.56 with p<0.05); however, no significant association was found between the pre-test level knowledge and demographic variables. Conclusion: Knowledge of HPV infection among peripheral community workers is vital as it can influence the broader population and avoid this preventable disease condition at the grass root level. The current study revealed that a video-assisted teaching program on HPV infection effectively improved the knowledge level of ASHA workers.

Self Directed Learning Behaviour- Impact of E-Learning Activity on Students

Mangesh Anandrao Bankar

Introduction: Self-Directed Learning (SDL) skills are essential for medical graduates for enabling them to engage in continuous learning during their medical practice. Aim: To assess the impact of E-learning activity on SDL readiness among second year MBBS students. Materials and Methods: The single group pre-test/post-test experimental study was conducted at Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair. The SelfDirected Learning Readiness Scale (SDLRS) was administered to 87 fifth semester MBBS students, after obtaining informed consent. The Google website- www.sites.google.com/view/elearningpharmacology was created and an interactive Power Point presentation along with practice set was uploaded daily for six days. The students were instructed to visit the site daily and complete the practice questionnaire. Post-test and E-learning perception questionnaire was administered after completion of E-learning activity. The data analysed using Statistical Package for Social Sciences (SPSS) version 20 software. Results: Total 87students (60% female and 40% male) participated. There was a statistically significant difference between total SDLRS scores (p<0.05) and other subscales i.e., Critical Self Evaluation (CSE) (0.007), Learning Self Efficacy (LSE) (0.003) and Effective Organisation of Learning (0.001) of the pre and post-test scores. For E-learning activity perception questionnaire, mode was observed to be 4 for 5 out of six items. Conclusion:The results of the study showed that E-learning activity influences SDL readiness among students. The E-learning activity was well perceived by study participants.

Knowledge, Awareness and Anxiety towards Coronavirus Pandemic among Indian Parents: A Web-Based Survey

Rakesh Kumar, Neha Agarwal, Alpa Gupta

Introduction: Nation-wide lockdown imposed to curtail the COVID-19 infection spread is possibly, a source of anxiety among general public. Effectiveness of these measures depends upon people’s knowledge and awareness. Aim: To determine knowledge, awareness and anxiety towards coronavirus pandemic among Indian parents of children aged less than eighteen years, and behavioural changes in the children. Materials and Methods: A cross-sectional online survey was conducted from 4th May to 16th May 2020. Online questionnaire consisted of demographic details, items on knowledge and awareness, Generalised Anxiety Disorder (GAD 7) score, parental reporting of behaviour changes in children. Descriptive statistics, analysis of variance (ANOVA) was conducted. The p-value less than 0.05 was considered as significant. Results: Of the 121 individuals accessing the survey, 85 (54 males; mean age 38.1±5.9 years) and 31 females; mean age 37.9±7.4 years consented to participate. The mean age of their children was 7.5±4.7 years. The major source of information was internet (84.7%). Mild anxiety was observed in a significant proportion of the participants 76.5% while severe anxiety in 8.2%. Around 41.2% parents noticed behavioural changes in their children; with addiction to mobile and video games (61.2%) being the most common change. Among the various coping methods, finding preventive ways to getting infected was opted by the majority (83.5%). The mean GAD 7 score was 7.4±4.0. Statistically significant difference in the GAD was observed among parents differing in the gender {F(2, 82)=3.275, p- value 0.043} and their opinion on behavioural changes observed in their children {F(2, 82)=4.697, p-value 0.012}. Conclusion:High level of increased awareness among general public towards the current pandemic and the ways to tackle the situation calmly is crucial in preventing both the short- and long-term mental health complications anxiety among Indian parent’s influences child’s mental health.

Continuous Epidural Analgesia and Continuous Femoral Nerve Block for Postoperative Pain after Unilateral Total Knee Arthroplasty: A Prospective Cohort Study

TG Anupama, MV Bindu, Rashmi Ravindran

Introduction: Total Knee Arthroplasty (TKA) surgeries are associated with moderate to severe postoperative pain. Inadequate analgesia leads to patient distress, suboptimal knee mobilisation and complications due to delayed rehabilitation. Peripheral nerve blocks and central neuraxial techniques are in the vanguard of various analgesic strategies to minimise pain after TKA. Aim: To compare the effects of Continuous Epidural Analgesia (CEA) and Continuous Femoral Nerve Block (CFNB) on postoperative analgesia, knee rehabilitation and adverse effects after TKA surgeries. Materials and Methods: A prospective cohort study was conducted among 90 patients undergoing unilateral TKA at the Government Medical College, Kozhikode, Kerala, India. They were divided into two groups of 45 each. CEA (Group E) and CFNB (Group F) were given for postoperative pain management. Effectiveness of postoperative analgesia was measured by Numerical Rating Scale (NRS) scores at 6, 12, 24, 48 and 72 hours and also by need for rescue analgesics during the first 48 hours. Postoperative knee rehabilitation indices were measured on 1st, 2nd and 3rd Postoperative Days (POD). Incidence of adverse effects in each group was also noted. Continuous variables were analysed using students t-test, categorical variables using Chi-square test and NRS scores using Mann Whitney U test. Results: NRS scores were similar in both CEA (E) and CFNB (F) groups. On POD 1, 75.6% of group E and 71.1% of group F (p=0.630), on POD 2, 71.1% of group E and 68.9% of group F (p=0.818) and on POD 3, 62.2% of group E and 66.7% of group F (p=0.66) achieved specific rehabilitation indices. There was no statistically significant difference in pain scores, rescue analgesic requirement and rehabilitation indices between the two groups. No significant adverse effects were noted in either group. Conclusion: CFNB is as effective as continuous epidural block for postoperative analgesia and knee rehabilitation after TKA without any significant side-effects.

Effectiveness of Structured Teaching Programme on Knowledge Regarding Therapeutic Intervention among Chronic Kidney Disease Patients in a Selected Hospital of Nadiad City, Gujarat: A Quasi-Experimental Study

Vedanti Subhashbhai Patel, Arpita J Vaidya

Introduction: Chronic Kidney Disease (CKD) is a severe clinical problem which has a significant socioeconomic impact worldwide. Diet, exercise, haemodialysis, Kidney Transplantation are some of the treatment modalities used to maintain patient's health. It is necessary to create awareness regarding the therapeutic interventions that are available among these patients to improve their knowledge. Aim: To assess the effectiveness of Structured Teaching Programme (STP) on knowledge regarding therapeutic intervention among CKD Patient. Materials and Methods: A quantitative study with quasi experimental pre-test and post-test, two-group design was conducted at Muljibhai Patel Urological Hospital. A total of 60 CKD patients were enrolled into the study. A structured questionnaire in Gujarati language was built that contained information regarding CKD, lifestyle modifications such as diet and exercise; knowledge on haemodialysis and kidney transplantation. The structured questionnaire was used to assess the knowledge regarding the interventions. A pilot study was conducted and was found to be feasible. The study duration was of seven days with the pre-test conducted on day one of the study followed by a structured training for three consecutive days, and the perception of the participants were evaluated on day seven using a standard questionnaire. The effect of STP was analysed by student's t-test and Chisquare test was used to find the association with selected demographic variables. Results: The study included CKD patients. The mean age of study population is above 49 years with 65% males and their data were analysed systematically. The post-test mean knowledge score of patients in the experimental and control group was 27.36±2.63 and 17.73±2.37, respectively. The result implies that there was an inadequate knowledge among patients with CKD. Conclusion: The structured teaching Programme was effective in increasing knowledge regarding therapeutic intervention among CKD patients.

Osteoporotic Intertrochanteric Fractures in the Elderly Managed with Proximal Femoral Nail Antirotation-The Functional Outcome

SPS Gill, Ankit Mittal, Manish Raj, Satosh Singh, Ajay Rajpoot, Akashdeep Singh

Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results with Proximal Femoral Nail Antirotation (PFNA). Aim: To evaluate the functional and radiological outcome of reduction and fixation of these fractures with PFNA. Materials and Methods: This prospective interventional study was conducted from december 2015 to november 2018. A total of 62 patients of more than 50 years of age with intertrochanteric fracture were managed with internal fixation using PFNA. All the pateints were evaluated with respect to the mean operative time, blood loss. Fluoroscopy exposure, time to union and development of any complication. The statistical analysis involved calculation of the mean and Standard Deviations (SD) of above parameters which was done using the Microsoft excel chart sheet. Functional evaluation was done using the Harris Hip Score (HHS). Results: A total of 62 patients with age ranging from 54 to 94 years (mean 78.2, SD 09.11) were evaluated. The mean duration of follow-up was 14.3 months. The average operative time, the mean blood loss and the average fluoroscopy time were 61.4 (range 45-90 minutes, SD 11.6) minutes, 103.9 (range 60-200 mL, SD 36.4) mL and 74.0 (range 41 to 98, SD 13.5) seconds respectively. About 100% union rate with the average time to union being 16.1 (SD 3.3) weeks and ranging from 12 weeks to 24 weeks was reported. Varus collapse and limb shortening >1cm were observed in 3 patients. The average HHS at the end of study showed a mean value of 82.8 (SD 8.6) and ranged from 65 to 94 with 46 (74.2%) patients having excellent to good outcome. Conclusion: Owing to easy insertion, reduced operative time and blood loss, stable fixation, less complications and good functional and radiological outcome, PFNA can prove to be an implant of choice for the management of intertrochantric fractures of the femur.

Impact on Dental Treatment Procedures in Dental OPD Attendance and Emergency Care of Non-COVID-19 Patients during COVID-19 Pandemic: A Study from Meghalaya, India

Lomtu Ronrang

Introduction: Dental emergency situations such as trauma of oral and maxillofacial region due to road traffic accident might require immediate intervention. But due to an outbreak of COVID-19 pandemic and a phase-I lockdown all the private dental clinics were temporarily closed the only hope for dental emergency patient’s care was a Government run hospital dental set-up during this time of pandemic. Aim: To find out the impact of COVID-19 pandemic on the dental OPD attendance and its emergencies in dental care to non-COVID-19 patient by comparing a three months data of recent past, pre and COVID-19 pandemic. Materials and Methods: It's a comparative study where number of patients attending the daily dental OPD patient services comprising of new cases, follow-up cases, in-patient case services for three months from March 2020-May 2020 and also compare with the previous years' (2019 and 2018) of three months (March to May). Results: The data shows that there was a tremendous decrease in total number of patients in the dental OPD services during this pandemic and phase-I lockdown. The statistical analysis of the data shows that the overall changes in flow of the patients during the pandemic were 39.35***, 33.52*** and 39.07*** for a new patient/week, follow-up patient/week and total no. of patient/week respectively with an ANOVA, where 'p' is significant at <0.01, <0.001. Conclusion: The study shows that COVID-19 pandemic and phase-I lockdown had impacted overall patient flow in the daily routine dental OPD services within these three months (March to May) of 2020 as compared to three months (March to May) from the previous year of 2019 and 2018.

Resumption to Swimming Post COVID-19 Lockdown

COVID-19 pandemic has severely affected sports worldwide. Usual practice can’t be done due to high viral transmission, yet prolonged inactivity leads to detraining and deconditioning and threatens ending of sporting career. Depending on the present guidelines of the government, a safe and evidence based gradual resumption of training and sports is essential. The cardiorespiratoryneuromuscular system involvement among others in COVID-19 directly affects exercise-sports performance and health, and the possibility of sub-clinical transmission poses immense challenge. Like other games, swimming is also heavily affected. Although COVID-19 is transmitted by droplets, the prolonged presence of virus in the air currents, commonly-touched surfaces and in stool of those infected should be kept in mind. Importance of hand hygiene, cough and sneeze etiquette, social distancing, use of mask while not exercising hard, other good public hygiene practices, staying home if sick, frequent cleaning and disinfection of pool and frequently touched surfaces, early detection, isolation and adequate treatment for the positive cases and strictly following government guideline should be compulsory. Awareness program and continued education for athletes, parents, coaches, support staff and other management team should be done. This review is intended to understand the course of COVID-19 and to formulate guidelines for resumption of swimming in India, based on recommendations by various organisations like WHO, CDC etc. The aim being to act as a key support for safely resuming swimming yet reducing the risk of COVID-19 infection.

It is Time to Revise the Ventilation Strategy in COVID-19 Affected Patients

Shagufta Naaz, Erum Ozair, Adil Asghar, Nishant Sahay, Rajnish Kumar

COVID-19 infection has emerged as a pandemic. This infection is new to the world, and the management strategy is evolving daily. As per the current guidelines, the patients of COVID-19 infection requiring mechanical ventilation should be treated on the lines of management of Acute Respiratory Distress Syndrome (ARDS). However, it seems that the management of ventilation in the case of COVID-19 needs to be modified. With growing experience, many hospitals have turned to Non-invasive Ventilation (NIV) to ward-off severe respiratory failure and in keeping with the inadequate resources. The controversy in using NIV is whether the benefits of using such interventions are more than the potential risks of aerosolisation of the virus. There is a hope that helmet-based ventilation may help reduce the risk of nosocomial infection. Autopsy findings demonstrated that besides ARDS, the alveolar capillaries were clearly thickened, with fibrin thrombi within the capillaries and small vessels and surrounding oedema present in COVID-19 affected lungs. This virus attacks the beta chain of haemoglobin, dissociates heme, removing iron converting it to porphyrin. The cause of desaturation is the failure of the blood to carry oxygen leading to multiorgan failure and mortality. The cause of lung damage seen on Computerised Tomography (CT) scans is the release of oxidative iron, which in turn overcomes the natural defenses against pulmonary oxidative stress and causes what is known as the Cytokine Storm. The question is whether mechanical ventilation is harming the patient by traumatising their lungs leading to increased mortality. Prone ventilation is the next preferred step for COVID-19 patients who fail to achieve adequate oxygenation with low tidal volume ventilation. Hyperbaric oxygen therapy can help the leftover functioning haemoglobin to carry more oxygen. Blood transfusion and plasmapheresis provide symptomatic relief. Thrombolytic therapy is also being tried with some benefits. These may be promising in treating patients with COVID-19 infection. Researches are required on the other probability and to test newly emerging treatment modalities.

Discriminant Red Cell Indices for Microcytic Hypochromic Anaemia in Distinguishing Beta Thalassaemia Trait and Iron Deficiency Anaemia: A Systematic Review

Ankita Sain, Arvind Bhake, Anil Agrawal, Sophia Thomas

Introduction: Numerous red cell indices are in practice for surveillance of Microcytic Hypochromic (MCHC) anaemia in determination of their aetiology to the Iron Deficiency Anaemia (IDA) and Beta Thalassaemia Trait (BTT). The studies have revealed that there exists the discrepancies for Sensitivity (SN) and Specificity (SP) for any single index conclusive to classify them to the categories of IDA and BTT. A comparative review is needed as to know which index is suitable to discriminate between above two major entities under MCHC anaemia, which can be put to the practice in resource poor laboratories. Aim: A systematic review was planned for diagnostic reliability of red cell indices that segregates IDA from BTT in a morphological classification of MCHC anaemia. Materials and Methods: A systematic literature search was conducted in a database that yielded 36 studies dealing with one or more of the five included indices (Mentzer index, Bessman index, Green and King index, Srivastava index and Sirdah index) in the present analysis. The data for SN and SP of these indices were collected and compared from their performance at discrimination between IDA and BTT and Youden index was calculated to compare the performance of individual index. Results: Of these five indices, the comparative statistics has shown Green and King index works well at the SN of 79.37% and SP of 82.54% as compared to the rest of the indices. The second closest index that is practicable at discriminating IDA from BTT is Mentzer index. Conclusion: None of the indices can be completely relied upon to achieve a conclusive segregation. However, Green and King and Mentzer indices can be used for screening the suspected population to identify patients which may need the specialised tests to confirm the diagnosis to bring this population under proper treatment either for IDA or BTT.

Endocrine Causes of Secondary Osteoporosis in Adults: Mechanisms and Evaluation

Osteoporosis and fragility fractures are a major public health issue. Secondary osteoporosis is characterised by the presence of an underlying disease, deficiency, or use of a drug. Conditions that increase speculation for secondary osteoporosis include fragility fractures amongst the younger men or premenopausal women, markedly decreased Bone Mineral Density (BMD) values, and fractures despite conforming to anti-osteoporotic therapy. Since the emphasis is on the treatment of the primary disorder, a diagnosis of osteoporosis and thus the opportunity of preventive intervention can be missed. With this review, the authors objective is to emphasise the importance of secondary osteoporosis, discuss the causes and their mechanism and summarise treatment options.

Endocrinopathy Causing Skeletal Decalcification and Ectopic Calcification Highlighted by Imaging Tour

PRK Bhargav, Sunil Kumar Kota, M Sabaretnam

Primary Hyperparathyroidism (PHPT) is an endocrine disorder which is caused by increased production of Parathyroid Hormone (PTH). Hypercalcemia leads to a number of symptoms and may cause patient's morbidity and even mortality if left untreated. In the present case, a 21-year-old female presenting with frequent attacks of urinary tract infection, diffuse bone pain and episodic pain abdomen since 15 months. On clinical, biochemical and radiological evaluation, the case was diagnosed as PHPT due to left superior parathyroid adenoma. Patient underwent uneventful surgical parathyroidectomy following preoperative optimisation. She achieved normocalcaemia without any surgical complications. This case is presented to highlight the impact of hyperparathyroidism on calcium metabolism leading to extensive skeletal decalcification and ectopic deposition of calcium leading to end organ damage. Various images are used to highlight this phenomenon of decalcification and calcification.

Correction :2020 Oct: 14(10): OC10-OC14

Ravi K Anadure, Vinny Wilson, Ragini, Rajeev Saxena, Aneesh Mohimen, Rajeev Sivasankar, Kumar Abhisheka, A Multicentric Study on the Clinical Profile, Serology, Neuroimaging and Treatment of Neurocysticercosis (Published in Journal of Clinical and Diagnostic Research. 2020 Oct: 14(10)). In this article the authors have showen two neuroimaging photographs (MRI and CT scan) (Figure 5, c and d), which are sourced from a publication by Prof Arturo Carpio in the chapter named "Novel aspects on cysticercosis and neurocysticercosis." in the book "Clinical Diagnoses of Neurocysticercosis", Edited by Humberto Foyaca Sibat. The authors are thankful to Prof Arturo for granting permission to show these images from his chapter.