Journal of clinical and diagnostic research

Monoblastic Sarcoma- A Rare Case Report of Myeloid Sarcoma Variant

Nupur Kaushik, Lalit Kumar, Pooja Agarwal, Harendra Kumar, Brijesh Sharma

Myeloid sarcoma also known as chloroma, granulocytic sarcoma, extramedullary Acute Myeloid Leukaemia (AML), myeloblastoma or extramedullary myeloid tumour is a rare manifestation, characterised by the proliferation of immature myeloid cells, myeloblasts or monoblasts occurring as one or more tumour at an extramedullary site. It is associated with disruption of normal architecture of tissue in which it is found. Monoblastic sarcoma is a rare variant of myeloid sarcoma. Hereby, the authors report a case of primary monoblastic sarcoma in a 64-year-old male patient presented with complaint of swelling over right side lower cervical region. He had no history of AML. On physical examination, the swelling was over medial one-third of right clavicle measuring 6×5.8×3 cm. The swelling was excised and sent for histopathological examination, which was diagnosed as monoblastic sarcoma, and confirmed on immunohistochemistry

Successful Management of Renal Fusion Anomaly of Kidney with Nephrolithiasis and Urinary Incontinence

Sunirmal Choudhury, Ankit Sandhu, Dilip Kumar Pal

The presence of an ectopic ureter may be indicated by continuous wetting, seen especially in girls. In majority of such cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. A 32-year-old female presented with urinary incontinence with normal voiding episodes and right flank pain. On investigation, she was found to have duplex moiety on the right-side with partially duplicated ureter and quadruple moiety on the left-side with partially duplicated quadruple ureter with ectopic opening of ureters. The patient also had right upper calyceal stone. It was successfully managed with totally minimal invasive technique with retrograde intrarenal surgery for right nephrolithiasis and left laparoscopic ureteric reimplantation for ectopic ureter. Patient was continent during the follow-up period of nine months with no significant complications. Developmental anomalies of kidney and ureter though rare, can be managed with total minimal invasive techniques, requires proper planning, instruments and its implementation.

Mass Forming Chronic Pancreatitis Mimicking a Pancreatic Neoplasm: A Case Report

Sarang Gosavi

Chronic pancreatitis can present as a focal inflammatory mass mimicking pancreatic neoplasm and also it has increased risk of developing pancreatic cancer. Even with the help of multiple new imaging modalities, convincing differentiating points between these two entities is not available. Hereby, the author present a case of 50-year-old female with epigastric pain since one month. No significant past history or any history of addictions was present. On clinical examination, there was tenderness in epigastric region, however no lump could be felt. Her laboratory parameters revealed, raised bilirubin levels. Amylase and lipase levels were slightly raised. Computed Tomography (CT) revealed heterogeneously enhancing mass involving head and uncinate process of pancreas with loss of fat planes between lesion and superior mesenteric vessels, atrophic pancreas with dilated pancreatic duct and multiple ductal calculi. CT guided biopsy of pancreatic mass was performed. Histopathology revealed pancreatic tissue with fibrocollagenous and fibroadipose tissue with dense and diffuse infiltration by mononuclear cells, histiocytes and a few foamy macrophages suggestive of acute on chronic inflammation with no evidence of any malignant cells.

T2 Weighted Hypointense Subcortical White Matter- A Rare Imaging Feature in Ketotic Hyperglycaemia

Rudresh Hiremath, Vinyasa Nagesh, Divya Vishwanatha Kini

Diabetic ketoacidosis is a hyperglycaemic state in which serum glucose level is more than 250 mg/dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq/L, and serum ketone level is raised and dehydration is present. Insulin deficiency is the main precipitating factor. Rarely, they present with neurological complications such as focal/generalised motor seizures, hemiparesis and sensory deficits which may be associated with various imaging features. With increasing prevalence of diabetes in the last decade, it is vital to familiarise with various hyperglycaemia induced imaging abnormalities in brain in order to provide accurate diagnosis for providing prompt treatment and preventing complications. T2 Weighted (T2W)/ Fluid-Attenuated Inversion Recovery (FLAIR) subcortical hypointensity in ketotic patients presenting with focal seizures had been reported rarely. Here, authors presented the imaging findings of a 27-year-old female patient with newly diagnosed type II diabetes mellitus and diabetic ketoacidosis with new onset seizures. T2 subcortical white matter hypointensity was noted in the right post-central gyrus. Though non specific, this imaging finding was of importance in such cases of hyperglycaemia in order to formulate further patient care.

Leiomyoma of the Breast- A Rare Case Report

Leiomyoma though a common entity encountered in our daily practise, its occurrence in breast is extremely uncommon. There are a very few reported cases of leiomyomas occurring in breast parenchyma. This tumour clinically simulate commonly occurring tumours of breast. Hereby, authors report a case of a mesenchymal neoplasm occurring in breast of a 33-year-old female of child bearing age. The histopathological diagnosis requires careful differentiation from lesions that have smooth muscle proliferation, especially leiomyosarcoma. The most commonly performed treatment is resection of the lesion with free margins. Although breast leiomyoma is rare, it should be considered among the differential diagnosis for breast nodules of benign appearance.

Myelomatous Pleural Effusion in a Relapse Plasmablastic Myeloma

Prachi Tripathi, Amit Tripathi, Nidhi Shukla, Raj Narain Srivastava

Multiple myeloma is characterised by malignant proliferation of plasma cells in bone marrow with rare involvement of peripheral blood (plasma cell leukaemia). Sometimes tissue involvement (plasmacytoma) is also seen. However, pleural effusion is very rare in myeloma patients. Pleural effusion in myeloma is usually secondary and reactive in nature. Malignant Myelomatous Pleural Effusion (MPE) is usually associated with poor prognosis. Hereby, the author report a case of a 46-year-old male who presented with groin pain with ureteric calculus. The patient was diagnosed with multiple myeloma with 42% plasma cells in the marrow. On treatment, patient went into remission, however he relapsed twice. On second relapse, the marrow examination showed plasma cells with plasmablastic morphology (24%). Plasmablastic morphology is associated with poor prognosis. The patient also developed pleural effusion. The cytospin smears of the pleural fluid showed clusters of atypical plasma cells (positive for CD38, CD138 and kappa light chain restriction). Thus, the present case report an extremely rare presentation of multiple myeloma with plasmablastic morphology and MPE.

Giant Malignant Phyllodes Tumour of Breast- A Clinical Dilemma and Surgical Challenge

Raghav Yelamanchi, Nikhil Gupta, Dhruv Gupta, CK Durga

Phyllodes tumour is an uncommon tumour of the breast. It is fibroepithelial in origin and mostly benign. Giant phyllodes tumours are described as tumours with size more than 10 cm and are extremely rare. Differentiating malignant and benign tumours pathologically is difficult and needs clinical judgement and high index of suspicion. A 50-year-old female presented with complaint of swelling in the left breast. On further evaluation, it was diagnosed as phyllodes tumour on biopsy. She underwent left mastectomy and excision of pectoralis major muscle due to clinical and radiological suspicion of malignancy. Postoperative histopathology report revealed malignant phyllodes tumour. Cases of giant phyllodes tumour should undergo adequate imaging and image guided biopsy with high index for suspicion for malignancy. They should be operated as per the principles of oncosurgery as there is a high probability of such huge tumours harboring malignancy.

A Rare Case of a Radicular Dens Invaginatus Associated with an Inflammatory Periapical Cyst

Radicular Dens Invaginatus (RDI) represent a rare form of dens invaginatus which develops in the root of the tooth after the crown development is completed that can sometimes cause complex pathological conditions that are difficult to diagnose. This case report describes a case of a RDI associated with an inflammatory periapical cyst. A 17-year-old female complained of mobility in tooth 22. The tooth showed gyroversion and colour change and no evidence of caries or root fracture. Axial slices and tridimensional reconstruction of the cone-beam computed tomography revealed the presence of a RDI on the distal surface of the root that extended from cervical to the apical third. The diagnostic hypothesis was symptomatic infectious apical periodontitis, and conventional root canal treatment was performed. Subsequently, it was opted for a complementary surgical approach, which involved an aspiration puncture bulletin with a collection of yellow-citrus liquid, periapical curettage, apicectomy, retro-preparation and retrofilling with Mineral Trioxide Aggregate (MTA). Histopathological examination revealed inflammatory periapical cyst. After 3-years, repair of the area was evident. Surgical management of this rare condition can be favourable for resolving endodontic infection related to this dental anomoly.

Incidental Finding of Distal Ulnar Giant Cell Tumour Treated with Preoperative Short Course of Denosumab and Extended Curettage

Mohit Singh, Sudip Deb, Nungdilong, Pranay Gupta, Ajay Kumar Yadav

Giant Cell Tumour (GCT) forms 5% of all primary bone tumours. GCT of distal ulna is an extremely uncommon entity being more common in the distal femur, proximal tibia and distal radius, respectively. Wide excision is one of the modalities of treatment, but this creates a bony defect that have to be reconstructed. The case report discusses a 30-year-old Indian male who was diagnosed incidentally with GCT of distal ulna after an alleged history of injury following road traffic accident. It was extremely difficult to perform excision and extended curettage initially due to extensive thinning of the cortex. Denosumab was administered subcutaneously for three months. Daily supplements of calcium 500 mg and vitamin D 400 IU were given. The short course of preoperative Denosumab lead to marked intralesional sclerosis facilitating the less morbid procedure of extended curettage and bone grafting and thus, salvaging the wrist. The functional outcome at one year postoperatively was excellent without any complications. Denosumab has the potential to regress the tumour, thereby preventing the need for complex reconstructive surgeries of the wrist.

A Rare Case of Giant Dacryocystomucopyocele

Pooja R Jain, Rohit P Tiwari, Rakesh K Barot, Arun Mane, Vaidehi D Bhatt

Chronic dacryocystitis is frequently caused by Nasolacrimal Duct (NLD) infection or obstruction. Mucocele is formed when chronic stagnation of tears occurs in the lacrimal sac. When mucocoele gets infected with pyogenic organisms, pyocele is formed. Proximal obstruction in mucopyocele causing encysted dacryocystomucopyocele presenting as an enormous swelling is very uncommon. Very few cases of giant encysted dacryocystomucopyocele are reported in literature. Hereby, authors report a case of 42-year-old male with an acquired, enormous dacryocystomucopyocele, which developed over only one and half years and produced upward displacement of the lower lid and mechanical obstruction for eye closure. Computed Tomography (CT) of orbit and paranasal sinuses was done to confirm the diagnosis and find out the extent of cyst. Complete surgical excision of the cyst was performed. There was no recurrence of the swelling at one year follow-up.

Bilateral Central Serous Retinopathy in Patient with Chronic Kidney Disease on Haemodialysis: A Case Report

Heena Dharamdasani, Shankar Chokkalingam, Siddharam Janti, Stephen Sudhakar

Central Serous Chorioretinopathy (CSCR) is the detachment of the neurosensory retina and/or Retinal Pigment Epithelium (RPE) due to accumulation of fluid in the subretinal space, mostly confined to the macula. Hereby, presenting a rare case of a 32-year-old patient with defective vision in both eyes, she was a known case of Chronic Kidney Disease (CKD) on haemodialysis. On examination best corrected visual acuity was 6/9 on dilated fundus examination with ring reflex in both eyes, Optical Coherence Tomography (OCT) macula showed detachment of the neurosensory retina from RPE with the subretinal fluid. This case is considered to be rare due to the unusual association noted between CSCR and End Stage Renal Disease (ESRD), in a female patient with no history of usage of corticosteroids or known identifiable risk factors. Hence, it is essential to screen patients with ESRD for CSCR to prevent vision threatening complications.

Poncet’s Disease Revisited

Mini Bhatnagar, Bimal K Agrawal, C Srivatsa, Dil Preet Reehal, Jaskaran Bazad

Tuberculosis (TB) is one of the most dreaded diseases prevalent in developing countries. Though primarily affecting the lungs, TB can affect almost any part of the body. The musculoskeletal system is the fourth most common extra-pulmonary target, after pleural, lymphatic and genitourinary system. Poncet's Disease aka Tuberculous Rheumatism is a rare rheumatologic association of active Extra Pulmonary TB (EPTB) which may be easily missed/misdiagnosed even though TB is frequently encountered in medical practice. The authors present the case of an adolescent 18-year-old male who presented with subacute symmetrical inflammatory arthritis of lower extremities. Investigations ruled out other rheumatological conditions. He recovered completely after receiving Antitubercular Treatment (ATT) for abdominal TB, which was diagnosed during workup.

Boxing Match Gone Awry- A Punch over the Head Leading to Eccentric Proptosis in a Child

The most common ocular pathologic conditions in amateur boxing are sub conjunctival haemorrhage, lid injuries, cataract, pupil deformation, angle abnormalities and retinal tear. Proptosis due to frontoethmoidal mucocele in young is one of the least common complications seen in boxers. Here, we discuss a rare case of unilateral eccentric proptosis of right eye in a nine-year-old child after he was punched on the right side of the head during a boxing match. He came with complaint of swelling of upper eyelid. Examination revealed right sided eccentric proptosis with restricted ocular movements and defective vision. Computed Tomography (CT) of orbit showed a well-defined isodense lesion with smooth margins arising from the frontal sinus, extending inferiorly to anterior ethmoidal sinus which caused mass effect over right eye and ocular muscles which resulted in displacement of the eye ball. Otolaryngologist’s opinion was obtained. Functional Endoscopic Sinus Surgery (FESS) was done. Postoperatively vision improved with no proptosis and eyeball returned to its normal position.

Chlorpromazine and Trifluperazine Induced Parkinsonism in a Patient with Insomnia

S Girija , N Naresh Kumar , N Natis Prasannaa , S Sarumathy , R Nanda Kumar

Drug Induced Parkinsonism (DIP) can be described as reversible development of Parkinsonian syndrome in patients treated with drugs which impair dopamine function. It includes symptoms such as tremor, muscular rigidity and bradykinesia. Gastrointestinal prokinetics, calcium channel blockers, modern atypical antipsychotics, and antiepileptic drugs may cause DIP. This report is about a 40-year-old female patient who developed a DIP after taking the antipsychotic medication combination (chlorpromazine and trifluperazine) for insomnia after being prescribed from a psychiatric clinic. After four weeks of initiation of treatment, she developed tremors, muscular rigidity and slowness in movements. The patient was admitted with the following complaints and then the drugs chlorpromazine and trifluperazine were stopped. The patient was then treated with tablet levodopa and carbidopa 110 mg, trihexiphenidyl 2 mg and tablet alprazolam 0.25 mg after which she gradually improved and was feeling better after a week. Atypical antipsychotics indicated for psychiatric disorders have high potential to cause extrapyramidal symptoms. Hence, for the treatment of insomnia newer drugs such as zolpidem and zaleplon can be used to minimise the chances of occurrence of DIP.

Anaesthetic Management of a Patient with Myasthenia Gravis Posted for Tonsillectomy- A Case Report

Dinesh K Chauhan, Vibhakar Vasudeva, Pooja Shah, Priya Kishnani

Myasthenia gravis is a chronic autoimmune disease of neuromuscular junction which causes skeletal muscle weakness and fatigability, characterised by decrement in postsynaptic acetylcholine receptor at neuromuscular junction caused by auto-antibodies destruction. There are three types of myasthenia gravis in children- transient neonatal, congenital and juvenile. Juvenile Myasthenia Gravis (JMG) is an autoimmune disorder that can affect all the skeletal muscles including extraocular muscles, which may lead to fatigability and generalised weakness. This report is about a case of seven-year-old patient weighing 25 kg presented with throat pain since one and half month. Patient was a known case of congenital myasthenia gravis and diagnosis was confirmed by Edrophonium test. He underwent tonsillectomy and was successfully managed under general anaesthesia with no muscle relaxant technique. Tonsillectomy in paediatric patients is not an uncommon surgical procedure. In spite of being a common surgery, it is still challenging to the surgeon as well as the anaesthesiologist as there is a shared airway between the two. Also, in the postoperative period there are chances of post-tonsillectomy bleeding causing airway obstruction, if not diagnosed and treated early could risk the life of the patient. Therefore, this surgery poses an increased risk of mortality and morbidity.

Tubercular Empyema Thoracic: An Acute Presentation with COVID-19 Co-infection

Sachin Gautam, Sanjay Pandit, Dharam Pal Bhadoria, Rahul Kumar

COVID-19 (Coronavirus Disease 2019) pandemic is caused by a novel Coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which has received worldwide attention and most COVID-19 patients have respiratory symptoms and develop a mild disease. In addition, co-infection of SARS-CoV-2 with other respiratory infections of bacterial, other viral and fungal origin needs to be validated. The clinical features, course and treatment of tuberculosis (TB) patients with COVID-19 are unclear and understudied. There is paucity of literature on this co-infection. Here, authors present a case report of a 35-year-old diabetic Asian male patient who presented to the emergency department as COVID-19 positive with acute exacerbation of symptoms, who later developed respiratory distress and was eventually found to have a lung abscess with subsequent tubercular empyema thoracic on contrary to a severe COVID-19 pneumonia or a fungal infection. Contrast Enhanced Computed Tomography (CECT) chest along with Cartridge-Based Nuclei Acid Amplification Test (CBNAAT) of pleural fluid pus confirmed the tubercular lesion timely to aid the diagnosis and further course of management.

A Case of Large Bowel Obstruction- An Unusual Cause in a Middle Aged Female

Endometriosis is a disease seen among women in reproductive age group. It is characterised by deposition of endometrial tissue outside the uterus. It commonly involves the pelvic organs like ovary, fallopian tube and pelvic ligaments. Involvement of gastrointestinal tract by endometriosis is uncommon and the incidence varies widely among different studies. Colonic endometriosis can be confused with malignancy both clinically and radiologically. In these instances, histopathology is essential for a correct diagnosis. Here, the authors report a case of colonic endometriosis presenting with features of large bowel obstruction in a 49-yearold female with previous history of laparoscopic hysterectomy. Radiological scanning of abdomen and colonoscopic examination were suspicious of sigmoid malignancy. Although colonic biopsy was inconclusive and tumour markers were normal, she underwent sigmoidectomy with lymph node clearance as per oncological principles with primary anastomosis. The final histopathological examination revealed features of colonic endometriosis without any evidence of malignancy. Detailed evaluation of the patient did not reveal endometriosis at any other site. Patient was discharged after full surgical recovery and was doing well till the last followup.

Chronic Lymphocytic Leukaemia Unmasked by COVID-19 Infection: A Case Report

Bhumika Gupta, Gyanendra Singh, Vivek Gupta, Tushar Kalonia, Shivani Kalhan

Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome (SARS) CoV-2 is an Ribonucleic Acid (RNA) virus which spreads through respiratory route. It was first detected in Wuhan, China in December 2019. World Health Organisation (WHO) declared it as worldwide pandemic in March 2020. Clinically, it can present as a mild flu like disease to severe respiratory illness. Reverse Transcription Polymerase Chain Reaction (RT-PCR) is the method for confirmation. Chronic lymphocytic leukaemia is a lymphoproliferative disorder that presents as absolute lymphocytosis with proliferation of monoclonal mature B lymphocytes, unlike other causes of reactive lymphocytosis. Patients with chronic lymphocytic leukaemia often have defects in humoral and cellular immune system. Therefore, these patients have a strong predisposition to recurrent infections and in this case for COVID-19. The relationship between chronic lymphocytic leukaemic and COVID-19 is not very clearly understood. A 77-year-old male with no significant co-morbidities presented with cough, fever and shortness of breath. His High-Resolution Computed Tomography (HRCT) chest revealed non-specific interstitial pneumonia and was tested positive for COVID-19 infection on RT-PCR. A Complete Blood Count (CBC) showed a high Total Leukocyte Count (TLC) with absolute lymphocytosis. There was absence of lymphadenopathy or splenomegaly. Flow cytometry confirmed the diagnosis of Chronic lymphocytic leukaemia. He was offered convalescent plasma therapy and later had to be intubated because of multiorgan failure. His Absolute Lymphocyte Counts (ALC) more than doubled in a week’s time. COVID-19 infection usually presents with lymphopenia, lymphocytosis should always raise a suspicion of underlying haematological malignancy or secondary infection.

Partial Molar Caesarean Scar Pregnancy- A Case Report

Usha Justa, Geetika Gupta Syal, Rita Mittal, Shruti Jha, Jyotika Bala

Caesarean Scar Pregnancy (CSP) is a rare entity. Gestational Trophoblastic Disease (GTD) in a CSP is exceedingly rare. This can lead to complications like rupture uterus, severe haemorrhage, hypovolemia which may require hysterectomy, endangering a woman’s life, her future fertility and death. As no therapeutic protocols have been established about this rare condition, it is difficult to diagnose and manage. The case report describes a patient, 26-year-old gravida 2 para 1, diagnosed with a CSP with partial mole. She was treated with systemic Methotrexate (MTX) followed by surgery-wedge resection of ectopic mass and repair of uterus. Patient remained on β-hCG follow-up. The management of CSP requires high clinical suspicion and immediate action with combination of various treatment modalities. Primary caesarean section rate must be reduced by performing caesareans only for justified reasons, so as to decrease the incidence of scar pregnancies.

Anaesthetic Management of Non Traumatic Diaphragmatic Hernia as a Co-existing Disease: Combined Spinal Epidural to Rescue

Divya Gahlot, Kirti Nath Saxena, Bharti Wadhwa

Diaphragmatic hernia is a congenital or acquired defect in diaphragm, resulting in herniation of abdominal viscera into thoracic cavity. Acquired diaphragmatic hernia are seen mostly in patients with blunt or penetrating abdominal injuries. Non traumatic acquired diaphragmatic hernias have been reported in literature but are extremely rare. Anaesthetic management of a patient presenting with Non traumatic diaphragmatic hernia as a co-existing disease offer unique challenges and considerations. This report was about the successful anaesthetic management of a 66-year-old male having Osteoarthritis (OA) of left knee with long standing massive right diaphragmatic hernia as a co-existing disease. The patient was scheduled for left Total Knee Replacement (TKR). Combined Spinal Epidural (CSE) with low dose Subarachnoid Block (SAB) was the anaesthetic technique of choice. Femoral sciatic block is an alternate technique of anaesthesia for such patients.

Split Hand/Foot Malformation with Long Bone Deficiency: A Report of Two Female Siblings

Spilt Hand/Foot Malformation with Long bone Deficiency (SHFMLD) is a rare heterogeneous group of limb malformations characterised by absence/hypoplasia and/or median cleft of hands and/or feet associated with long bone abnormalities, most frequently tibia. This case report described two sisters with congenital limb defects born to healthy consanguineous parents. The six-year-old girl did not had both radii and the left fibula. There was a cleft in the left hand and the right foot. She had one digit in her right upper limb, but did not have the left foot. The four-year-old girl had four short limbs, bilateral tibial aplasia with single digit in all limbs. Both parents were normal, and no other similar cases were reported in the family. According to the authors’ best knowledge, these two cases are the first published cases in Yemen with SHFMLD, but they need a genetic study to determine their genetic profile.

Combined Effects of Thermotherapy along with Scapular Muscles Strengthening in Cervical Radiculopathy: A Case Report

Shaikh Mohammad Aeraj, Tajuddin Chitapure

Cervical radiculopathy is a syndrome in which the patient complains of pain on the right scapular border along with sensorimotor deficits. This syndrome commonly develops due to compression of the cervical nerve roots. This report describes the case of 52-year-old histopathology laboratory technician who developed cervical radiculopathy due to prolonged cervical forward flexion while working on his table. The patient also complained of pain on the right scapular border. Radiographic analysis showed cervical spondylosis having osteophyte formation on spinous process of C2, C3, C4, C5 and C6 vertebras. Neural tissue tension test was positive for median nerve. He was treated consecutively with strengthening for shoulder abductors, shoulder adductors, scapula elevators and scapular protractors along with thermotherapy. His right medial border scapular pain and symptoms of cervical radiculopathy decreased in severity after the seventh day of treatment. Although the authors cannot suggest a cause and effect relationship, this report allows for initial hypothesis development that thermotherapy approach may have clinical merit. Future studies in the form of well-designed, randomised clinical trials should be performed to evaluate the effectiveness of this approach in patients with cervical radiculopathy.

Oral Plasmablastic Lymphoma: A Case Report of a HIV Negative Patient with an Unusual Clinical Signature

Plasmablastic Lymphoma (PBL) is an aggressive variant of diffuse large B-cell lymphoma with a low survival rate. It is associated with Human Immunodeficiency Virus (HIV) infection but also affects patients with autoimmune diseases as chronic lymphocytic leukaemia, systemic lupus erythematosus, with long-term immunosuppression for heart and kidney transplants and, ulcerative colitis. It has been reported in immunocompetent and HIV negative patients, determining the diagnosis more challenging. A rare case of bleeding gingival hyperplastic PBL in the left posterior mandibular area in a 61-year-old HIV negative male patient is reported. Histological assessment showed that oral mucosa was infiltrated by a monomorphic population of large lymphoid elements with morphological characteristics similar to immunoblasts with a “starry sky” appearance. Immunohistochemical markers were positive for CD138, Kappa and Lambda light chains, and negative for CKAE1/3, Synaptophysine, Chromogranin, CD56, and CD20. The detection of the primary oral manifestation of PBL remains challenging in immunocompetent patients and this case report aims to broaden the knowledge of the possible oral clinical aspects of PBL.

Irreducible Hernia in Female Children with Ovary, Uterus or Uterine Adnexa: A Case Series

Joseph Francis, Suhitha Gajanthody, Ashraf Ahamed, Divya Syam

Inguinal hernias are the most frequent hernias of childhood. They are relatively uncommon in females as compared to males. Congenital inguinal hernias are due to the failure of closure of processus vaginalis. In females, this usually obliterates around the eighth month of foetal life. When these remain patent, a rare but possible herniation of contents can occur through this, like the genito-urinary system, including the ovaries and sometimes the fallopian tubes. However, the occurrence of uterus as one of the contents is a rare entity. This is a case series of six such cases with various genital tract entities as contents in paediatric female inguinal hernia. In conclusion, the rare entity of uterus, uterine adnexae and ovaries being a content of inguinal hernia has to be kept in mind when treating female children.

Diagnosis of Spinal Tuberculosis in Retrovirus Negative Cases: A Case Series

Spinal Tuberculosis (TB) is the most common destructive form of extrapulmonary TB. The diagnosis of spinal TB is challenging involving combined approach of clinical diagnosis, imaging techniques, detection of Acid-Fast Bacilli (AFB) in microscopy, histopathology, and culture. This case series reports four patients of spinal TB diagnosed clinically, radiologically and microbiologically that were treated appropriately with standard anti-TB treatment according to Category I daily regimen.

Cefepime Induced Neurotoxicity: A Case Series

Sukanto Kishore Das, Subodh Kumar Das, Akhila Panda, Laxmidhar Parhi

Cefepime is a broad-spectrum antimicrobial which is widely used for the treatment of both gram positive and gram negative pathogens, mainly in hospital setup for critically ill patients. Its half-life is around two hours and is primarily excreted via kidneys. However, in patients with renal impairment the half-life increases upto 13 hours. This may cause drug accumulation leading to several toxicities, of which neurotoxicity is of prime concern. Missing the diagnosis of these symptoms related to cefepime it may lead to increase in mortality or central nervous system dysfunction. Dose adjustment is recommended in such cases; however, several reports of neurological manifestations have been documented despite such modification. Here, authors reported six cases of cefepime induced neurotoxicity. The symptoms that the patients reported with were drowsiness, disorientation, non convulsive epilepsy, slurred speech, tremors and myoclonic jerks. In all patients, cefepime was withdrawn and symptomatic management with antiepileptic drug and monitoring with repeat Electroencephalogram (EEG) were done.

A Case Series on Epiploic Appendagitis: An Underdog in Acute Abdomen

Epiploic appendagitis is an uncommon yet a significant surgical diagnosis that every surgeon should be aware. It occurs due to the torsion of the epiploic appendage which gives rise to acute abdominal pain that can mimic other common causes of acute abdominal pain like appendicitis or cholecystitis. The treatment of epiploic appendagitis depend on clinical presentation, severity and it varies from conservative management to surgical excision. This case series is about eight patients presented with complaints of lower abdominal pain. After clinical examination they were initially diagnosed to have appendicitis or diverticulitis. The Computed Tomography (CT) based diagnoses were appendicitis, omental infarct, diverticulitis or epiploic appendagitis. All of them were subjected to diagnostic laparoscopy and found to have an inflammed epiploic appendage which was excised laparoscopically.

Bone Marrow Clot Section a Useful Tool for Diagnosis of Haematological Diseases- A Case Series

Parul Garg, Harjot Kaur, Ishwer Tayal, Aradhana Singh Hada

Bone marrow examination is required for diagnosis of various haematological disorders. It includes both neoplastic and nonneoplastic disorders. Usually, bone marrow examination includes Bone Marrow Aspiration (BMA), bone marrow biopsy and bone marrow imprints. Bone marrow clot sections can also be an adjuvant of bone marrow examination and these sections are prepared from the left-over blood after aspirate smears. An adequate bone marrow clot section can be valuable for diagnosis of various diseases, especially in cases in which the aspirate and core biopsy material are inadequate or non contributory or it can be an adjuvant procedure. Little has been published about usefulness of bone marrow clot section. Studies are going on to evaluate the role of bone marrow clot section as an adjuvant or a diagnostic tool. This study includes a series of three cases in which bone marrow clot section was a diagnostic tool.

Subareolar Abscess in an Adult Male Mimicking Carcinoma Breast

Uma Kumar, Annu Nanda, Udita Singhal, Pooja Jain

Elevation of Serum Cystatin C Levels as a Predictor of Cardiovascular Risk in Type 2 Diabetes Mellitus Patients: A Case-control Study

NS Sumantara, MR Anusuya

Introduction: Patients with type 2 Diabetes Mellitus (DM) exhibit atherogenic lipid profile, increasing the risk for atherosclerosis, compared to people without diabetes. Cystatin C, a naturally occurring protease inhibitor has a key role in pathogenesis of atherosclerosis in type 2 DM patients by inhibiting the elastolytic activity of arterial extracellular matrix by cysteine protease cathepsins. Increased concentration of cystatin C in serum reflects a counterbalance of the damaging elastolytic activity which is involved in the pathogenesis of atherosclerosis in type 2 DM patients. Aim: To determine the serum levels of cystatin C and lipid profile in type 2 DM patients with good and poor glycaemic control and to find out the correlation between serum cystatin C with HbA1c levels and cardiovascular risk markers (non-HighDensity Lipoprotein Cholesterol (HDLc), Total Cholesterol (TC)/ HDLc, Low-Density Liporotein (LDLc)/HDLc). Materials and Methods: The present case-control study included 60 diabetic patients of 35-75 years of age including both the genders. They were divided into Group A (n=30) with HbA1c ≤6.5% and Group B (n=30) with HbA1c >6.5%. Blood samples were collected in fasting state and analysed for Fasting Blood Sugar (FBS), TC, HDLc, LDLc. FBS was analysed by Hexokinase method, HbA1c by turbidimetric inhibition immunoassay and cystatin C by Immunoturbidimetric method. Other parameters like Non-HDLc and cardiovascular risk ratios TC/HDLc and LDLc/HDLc were calculated. Statistical analysis was done by student’s t-test and statistical significance was established at p-value <0.0001. Pearson’s correlation coefficient was used to examine various parameters. Results: In the present study, it was found that diabetic patients with HbA1c >6.5% showed increased levels of serum cystatin C (1.20±0.73 mg/L), TC (182±46.48 mg/dL), LDLc (137±13.86 mg/ dL) and low levels of HDLc (34.7±12.43 mg/dL) compared to diabetic patients with HbA1c ≤6.5%. Increase in serum cystatin C levels correlated well with the increased levels of HbA1c (r=0.92), non-HDLc (r=0.87) and cardiovascular risk ratios like TC/HDLc (r=0.95) and LDLc/HDLc (r=0.97). Conclusion: The elevated serum levels of cystatin C levels correlated well with increased HbA1c and lipid profile indicating the dyslipidemia and proatherogenic status in type 2 diabetic patients with poor glycaemic control. Thus, cystatin C can be considered as the predictive marker for cardiovascular disease in type 2 diabetic patients.

Digital Gaming and Psychological Well-being among Adolescent College Going Students in Puducherry, India

A Praveen, P Stalin

Introduction: Adolescents are vulnerable to addictions such as tobacco, alcohol, pornography, internet use etc. Due to high exposure to internet and gadgets, the involvement of adolescents in digital gaming has increased significantly in recent years. Excessive digital gaming may affect the mental health status. Aim: To measure the prevalence of digital gaming and to assess the relationship between digital gaming and psychological wellbeing among college going adolescents. Materials and Methods: A college based cross-sectional study was conducted among 415 adolescents (=19 years of age) studying in arts, engineering and medical colleges located in Puducherry. The study participants were recruited using stratified multistage sampling technique. After obtaining written informed consent, study participants were interviewed using a structured questionnaire consisting of variables such as socio-demography, usage and pattern of digital gaming. Gaming Addiction Scale was used to assess the level of addiction to digital gaming. Psychological well-being score was assessed using 42 items Ryff’s scale with six domains such as autonomy, environmental mastery, personal growth, positive relations with others, purpose in life and self-acceptance. Data was analysed in IBM SPSS Statistics for windows, Version 21.0 (IBM Corp, Armonk, New York). Chisquare test and one-way ANOVA tests were used to measure the p-value, p<0.05 was considered as statistically significant. Results: Out of 415 study participants, 83.1% were current or past players of digital games. Females (93%) ever played more than males (74%) (p<0.001). The proportion of current/past gamers was lowest in the participants aged 17 years (49.1%) (p<0.001). All engineering and arts students (100%) played the digital games either currently or in past, however it was only 48.9% among medical students (p<0.001). Majority (53.6%) played in both online and offline mode. About three-fourth (76.2%) of the study participants were playing digital games at their homes. The proportion of daily playing digital gamers was higher in females (28.6%) than males (23.4%) but statistically not significant (p=0.215). Total 29% of the study participants felt bad when they were unable to play games. The prevalence of addictive and problematic users among those who were playing digital games was 4.3% and 33.6%, respectively. The mean score of self-acceptance dimension of psychological well-being was lowest among current users than past and never users with statistical significance (p=0.046). However, the dimension of personal growth was higher among current and never users than past users (p<0.001). Conclusion: Most of the college going adolescents had ever played digital games. There was no significant relationship between psychological well-being and digital gaming except for personal growth and self-acceptance dimensions.

Impact of Smartphone Addiction on Neck Pain and Disability in University Students

Anjali Suresh, SG Sudhan, Prasanna Mohan, A Thangamani Ramalingam

Introduction: In the present era, the use of smartphones for teaching learning and communication in education in India has raised manyfold. The increasing use of smartphones in our daily life has brought about numerous musculoskeletal problems. Impairments in the neck is the most common when compared to other parts of the body. Aim: To find out the impact of smartphone addiction on neck pain and disability. Materials and Methods: This cross-sectional study was conducted on students from Garden City University aged between 18-25 years through non probability sampling technique. The data was collected from August to September 2019. The addiction level to a smartphone was measured using Smartphone Addiction Scale Short Version (SAS-SV) and the Neck disability was measured using the Neck Disability Index (NDI) and were circulated. The questionnaires were shared to the students through electronic media and 108 subjects participated in it. The data were analysed using IBM SPSS 20.0 statistical software to correlate smartphone addiction scale and NDI. Spearman’s correlation test was performed to analyse the relationship between smartphone assessment scale-short version and NDI Results: The Spearman correlation analysis clearly showed that there was a moderate positive correlation (r=0.682) between smartphone addiction and neck pain and neck disability in university students and the level of significance was (p<0.01). Conclusion: This study concluded that longer the use of smartphones would result in significant neck pain and disability. The students who were under the category of addiction to smartphone would require ergonomic advice and education about the ill-effects of smartphone and the various musculoskeletal problems that may arise due to overuse.

Acute Urticaria in Children in a Tertiary Care Hospital: A Cross-sectional Study

Kannu Priya, Anupama Vinayak Mauskar

Introduction: Urticaria is a highly prevalent condition resulting in a large number of medical consultancies worldwide. Urticaria is derived from the Latin word “urere” meaning “to burn”. Urticaria usually manifests as a transient, itchy, polymorphic skin eruption. It can occur in any age group. Aim: To study the prevalence and possible triggers of acute urticaria in children. Materials and Methods: All children of age group six months to 12 years visiting the Institute from June 2018 to April 2019, with the complaint of acute urticaria with or without angioedema were included in the study while those with chronic urticaria and only angioedema were excluded. Sixty five children presented with acute urticaria with or without angioedema. Patients were diagnosed based on history and clinical examination. All patients were subjected to a detailed history, general physical examination and, necessary investigations like Complete Blood Count (CBC), absolute eosinophil count, Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), Skin Prick test as indicated. They received appropriate treatment and their clinical outcome was studied. Results: Prevalence of acute urticaria was found to be 0.23. It was more commonly seen in males (63.08%) and more in the age group of 1 to 5 years (56.92%). The focus of infection was found in 44.6% of children, while 21% of children had a history of consumption of some form of medications leading to urticaria. Conclusion: Urticaria can be prevented in children by preventing them from infection and avoiding the use of amoxicillin-clavulanic acid unless very necessary. Those children with a family history of acute urticaria should be prevented from exposure to excessive heat, cold, pressure, vibration, etc. Investigations are also recommended as an important diagnostic tool to find out the aetiology of acute urticaria.

Effectiveness of Self-instructional Modules on Knowledge Regarding Side-effects of Self-medication among Adolescents

Introduction: Self-medication is an old practice and may be defined as drug acquisition and consumption without physician’s advice for diagnosis, prescription, or treatment monitoring. Aim: To evaluate the effectiveness of self-instructional module on knowledge of side-effects regarding self-medication among adolescents. Materials and Methods: The present study with pre and posttest design was conducted on 70 adolescents selected from Wardha, Maharashtra, India. The adolescents were selected based on non probability convenient sampling technique. Descriptive statistics were used to analyse the data. Paired t-test was used to compute the mean, Standard Deviation (SD) and mean percentages. The unpaired t-test and one-way ANOVA were used to associate the demographic variables with level of knowledge. Results: Majority of the subjects were in the age group of 17 years and were females. Pre-test mean score was 10.91 and post-test mean score was 19.03. The effectiveness of the selfinstructional modules on the knowledge regarding side-effects of self-medication was statistically significant (p=0.034). Conclusion: The current study revealed that a self-instructional module as a mode of teaching on side-effects of self-medication effectively improved the knowledge level of adolescents.

Association between Serum Albumin and Hypothyroidism in Pre-eclampsia: A Case-control Study

Nineetha Muraleedharan, M Saboora Beegum

Introduction: Pre-eclampsia is a cause of high morbidity and mortality in pregnant women. Serum albumin is found to be low in pre-eclampsia. Few recent studies have shown a state of hypothyroidism in pre-eclampsia. Aim: To find the association between serum albumin and thyroid hormone levels in pre-eclampsia and seek to find if hypoalbuminemia increases the risk of hypothyroidism. Materials and Methods: A case-control study was done at Department of Biochemistry and the Department of Obstetrics and Gynaecology of Government Medical College, Thiruvananthapuram, Kerala, with 40 pre-eclampsia cases and 40 normal pregnant controls, in 30-38 week gestation. Serum albumin and thyroid profile-Total T3, Total T4, Thyroid Stimulating Hormone (TSH), freeT3 (fT3), freeT4 (fT4) were tested. Statistical analysis was done with Student's t-test, Chi-square, Fischer's t-test and Pearson’s correlation coefficients. Results: The mean serum albumin was significantly lesser in preeclampsia (3.11±0.39) than in controls (3.7±0.14 g/dL). Thyroid hormones were significantly decreased in pre-eclampsia. TSH was significantly raised (3.76±1.55 mIU/L) in pre-eclampsia compared to normal pregnant ladies (2.3±0.94 mIU/L). In cases with hypoalbuminemia, risk for hypothyroidism was 2.85 times compared to those with normal albumin but was not statistically significant. In severe pre-eclampsia, there was a two times increased risk. There was a negative correlation of TSH and positive correlation for fT4 with serum albumin. However, this was statistically not significant. Conclusion: Hypothyroidism in pre-eclampsia was not significantly correlated with hypoalbuminemia in this study. Thus, hypoalbuminemia did not significantly increase the risk for hypothyroidism in present study. Further studies are needed to determine the risk factors affecting thyroid function in preeclampsia.

Incidence and Predictors of Post-catheterisation Femoral Artery Access Vascular Complication in North Indian Population

Anil Gupta, Sarita Choudhary, Vijay Pathak, Pooja Pathak

Introduction: Coronary Artery Disease (CAD) has been considered one of the major causes of morbidity and mortality in developed countries. Vascular access-site complications following percutaneous interventions done using femoral approach, are an important cause of mortality, morbidity, prolonged stay and greater cost burden. Aim: To study the incidence and the factors which predict femoral artery access vascular complication after catheterisation in North Indian population. Materials and Methods: This was a prospective longitudinal observational study conducted at Department of Cardiology SMS Medical College at Jaipur, Rajasthan, India between April 2016 to November 2017. All patients (n=11200) who underwent catheterisation from the femoral approach from April 2016 till November 2017 in the study institute were included. Duplex ultrasound was performed in cases with clinical suspicion of vascular complications. Clinical data and procedural variables were compared with a control group of 100 randomly selected patients. Univariate analysis and a logistic regression model for multivariate analysis for predicting independent variable was performed. Results: Femoral artery access vascular complication incidence rate was 2.05% (230). Complications rate was higher for interventional procedures (3.6%) than diagnostic procedures (1.25%). The most common vascular complication was haematoma which was seen in 1.29% (145) patients, other complication were femoral artery venous fistula seen in 0.37% (42) patients, pseudo-aneurysm in 0.41% (46) patients, acute limb ischemia in 0.1% (12) and infection in 0.09% (11) patients. It was found that advanced age (>60 years), female gender, obesity and hypertension were predictors of complication. Patients who received thrombolytic agent or low molecular weight heparin prior to procedure, use of large sheath size (7F vs 6F) and multiple puncture to achieve femoral artery access were also independent predictors of vascular complication. Diabetes mellitus and duration of manual compression had no impact on vascular complication. Conclusion: Femoral artery access vascular complication is not uncommon following diagnostic or interventional cardiac catheterisation. The strongest predictors of vascular complication were advanced age (>60 year), female gender, overweight and obesity, hypertension, use of thrombolytic agent or anticoagulant prior to procedure, large size sheath 7F, and multiple puncture. Use of smaller sheaths, improved access techniques, safer antithrombotic therapy and use of vascular closure devices may be helpful for prevention of these vascular complications.

Effect of White and Yellow Background Colour on Short Term Memory: A Cross-over Study

Mithun S Acharya, Narayana Keertish, Harsha T Gowda, SS Krithishree

Introduction: Colour has a potential influence on learning by improving Short Term Memory (STM) in different settings. Background colours of study materials can have an impact on STM in healthy student population. Enhanced memory can improve academic performance in students. In this study background colour between chromatic/yellow and achromatic/ white colours were compared. Aim: To compare the effect of white background black text with yellow (preferential colour chosen via voting by students) background black text of study materials on STM. Materials and Methods: A cross-over study design was conducted in a tertiary care hospital of southern India with an interval of two weeks in October 2018. Two groups of 27 students each were assessed for visual STM using word list recall in a cross-over design study with an interval of two weeks duration. Data was collected as number of words and correct number of words recalled, from the word list. The obtained data was then put to statistical analysis using statistical software IBM Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Out of total sample of 54 students, 13 were males and 41 were females. The males and females were comparable with age with p-value of 0.25 which was not statistically significant. The analysis showed that there was no statistically significant difference in the number of words and number of correct words recalled between white and yellow colour backgrounds in both the sessions. There was an overall improvement in the recall of words in both test materials from first session to second session. Conclusion: Chromatic/yellow background colour was no better than the standard achromatic/white background colour. Improvement in the number of words recalled from first session to second session with both colours appeared to be due to carry over effects.

Effectiveness of Modified Plank vs Conventional Plank on Core Muscle Endurance and Stability in Recreational Athletes: A Quasi-experimental Study

Introduction: The core muscle plays a major role in providing stability. Several studies have been conducted to identify the activation of core muscle in variety of planking methods but the effects of modified planking in core strengthening program is vaguely studied. Aim: To compare the modified plank with conventional plank and to identify which mode of planking was more superior in training for endurance and dynamic stability of core muscle. Materials and Methods: A quasi-experimental, pre-test and posttest study design was conducted for a total duration of 6 weeks and 32 subjects were assigned into two groups: Experimental group (Body Saw Plank) and Control group (conventional plank). A pretest and post-test of core endurance and dynamic stability were measured by using McGill Torso Muscular Endurance Test and Star Excursion Balance Test (SEBT). A paired sample t-test was used to identify a significant difference between pre-test result and posttest result within the same group. Furthermore, an independent t-test was used to determine the significant difference between the post-test on the subject’s core endurance and dynamic stability between the control group and experimental group. Results: A total of 32 subjects were selected, with a mean age of 20.63±1.6, of which 14 were males and 18 were females, with mean height, mean weight and mean Body Mass Index (BMI) were 164.70±7.74, 57.26±8.57 and 21.02±2.36 respectively. After 6 weeks of intervention, there was a significant difference between the pre-test and post-test of McGill Torso Muscular Endurance Test. However, comparison of post-test between groups of the McGill Torso Muscular Endurance Test shows no significant difference. On the other hand, both groups also show significant differences between the pre-test and posttest on SEBT. However, comparison between the post-test of the control group and experimental group has no significant differences in normalised reach distance and composite score. Conclusion: The findings proved that both body saw plank and conventional plank effectively enhances core muscle endurance and also dynamic stability equally

Medical Waste Management during Conflict: A Cross-sectional Study in Yemen

Samira Hameed Hanash, Lutfi A Al-Maktari, Redhwan A Al-Naggar

Introduction: Proper handling and disposal of medical waste is an important issue, and a lack of awareness of medical waste management is a dangerous hazard for humans and the environment. Aim: To determine the knowledge and practices of Healthcare Workers (HCWs) about medical waste management in Yemen. Materials and Methods: A cross-sectional study was conducted among 337 HCWs in four main hospitals in Ibb city, Yemen, from November 2019 to May 2020. Knowledge and practice of medical waste disposal were assessed using a selfadministered questionnaire to gather data from the respondents in Arabic language. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) v. 25.0. Mann-Whitney, Chi-square, and Spearman and correlation tests. Results: Most of the participants had a diploma (47.8%), occupation was nursing (41.2%), with less than five years of experience (50.7%). The study showed that respondents demonstrated good knowledge and practice about medical waste management. There was a moderate positive correlation between knowledge and practice domains. Occupation significantly influenced knowledge (p=0.001) and practice (p=0.002) of the participants. Type of hospital showed a statistically significant relation to knowledge (p=0.001). Education significantly influenced the knowledge (p=0.030) of the study participants. Conclusion: Occupation, type of hospital and education level are the factors which significantly influenced the knowledge of Yemeni nurses. The contents of education should be focused on medical waste management among HCWs.

A Study on Phenotypic Association between Biofilm and Drug Resistant Klebsiella Species Isolated from Urinary Tract Infections

Introduction: Urinary Tract Infections (UTI’s) are considered to be one of the most prominent infections, worldwide. Klebsiella species are the commonest cause of community and hospital acquired UTIs. Biofilm production and hypermucous production are the important virulence factors among the pathogenic strains of Klebsiella species. Biofilmassociated and Hyper-Mucoviscosity (HMV) variants of Kiebsiella spp. is potent enough to easily colonise the urinary tract, develop the invasiveness of infection and mainly contribute in higher resistance to most classes of antibiotics. Understanding the virulence factors associated with Multi Drug Resistant (MDR) Klebsiella spp. would aid in estimating the resistance related mortality. Aim: To identify and comparatively analyse the HMV, biofilmproducing capacity and drug resistance pattern of archived Klebsiella spp. isolates from UTI. Materials and Methods: The present retrospective analysis was done from January to March 2020 on 207 archived Klebsiella spp. isolates collected between December 2017 to January 2019. The presumptive identification of Klebsiella spp. was done using standard microbiological techniques. Antimicrobial susceptibility test was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Klebsiella spp. were tested for biofilm production using microtiter plate method and HMV phenotype by string test. Descriptive statistics and Student’s t-test were performed to analyse the data. Results: A total of 207 Klebsiella isolates were used in this study and majority (94.6%) of the isolates were identified as Klebsiella pneumoniae subspecies pneumoniae. Out of 207 isolates, 14 isolates (6.8%) were Extensively Drug Resistant (XDR); 141 isolates (68.1%) were MDR; 43 isolates (20.8%) were resistant to one or two class of antibiotics. Biofilm detection assay showed 201 (97.1) out of 207 were strong biofilm producers and 6 (2.9%) were moderate biofilm producers. String test for HMV detection showed only 2 (1%) isolates were positive HMV producers. Among the biofilm producers, majority of the Klebsiella isolates were found to be MDR. Conclusion: Resistance in Klebsiella spp. is an evolving problem. Majority of the drug resistant Klebsiella isolates used in present study were strong biofilm producers. This study emphasises on the sensible use of last resort drugs to cut down the evolution of resistant strains.

An Analytical Study of Short-term Morbidities in Large for Gestational Age Infants- A Single Centre Experience from South India

Keerthana Menon, Bhavani Deepthi Perumalla, Vignesh Kumar, Giridhar Sethuraman

Introduction: Globally, Large for Gestational Age (LGA) infants constitute a significant proportion of live births, with Gestational Diabetes Mellitus (GDM) being a primary contributor. Infants born to GDM mothers are more prone for morbidity and mortality and if born large, the incidence of morbidities could increase. The clinicodemographical profile of LGA infants has not been well analysed, especially in Lower Middle Income Countries (LMIC) like India, where gestational diabetes is very common. Aim: To analyse the incidence, demographic profile and shortterm neonatal outcomes of LGA births, stratified for GDM. Materials and Methods: This was an analytical retrospective cohort study conducted in a tertiary care hospital in South India. Medical records of LGA infants =35 weeks born between December 2018 and May 2020 were reviewed (in December 2020 and January 2021), after Institutional Human Ethics committee approval (No:296/ IHEC/JAN 2021). The LGA infants were grouped as GDM induced Large Infants born to gestational and pregestational Diabetes Mellitus mothers (LIDM) and large infants born to non gestational diabetes mellitus mothers (LnIDM). Case records with incomplete data were excluded. Demographic profile of the two groups at birth and their clinical morbidities during hospitalisation were recorded. The primary outcome was requirement of respiratory support in the two groups. The categorical outcomes were compared using Chi-square test/Fishers exact test, while numerical variables were compared using Mann-Whitney U test. Odds ratio and their 95% Confidence Intervals (CI) were obtained as appropriate. Multivariate logistic regression, controlling for potential confounders, was done to derive the adjusted odds ratio. The p-value <0.05 was taken as significant. All analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: Out of 2653 live births, 268 were LGA infants ≥35 weeks (9.72%). The LIDM were 126 (48.8%) and LnIDM were 132 (51.2%). Ten case records were excluded due to incomplete data hence, 258 infants were included in the final analysis. The median (Interquartile range) birth weight was significantly higher in the LIDM's {3.92 (3.86, 4.08) kg} compared to LnIDM≥s {3.89 (3.75, 3.96) kg}. The primary outcome of need for respiratory support was not significantly different between the two groups {Adjusted odd’s ratio (aOR) 1.62; 95% CI 0.92 -2.83; p-value=0.08)}. Multivariate logistic regression, controlling for confounders, showed higher neonatal intensive care admission rates (aOR 2.15; 95% CI 1.17-4, p=0.01), neonatal hyperbilirubinemia (aOR 1.70; 95% CI: 1.01- 2.84, p=0.04) and Persistent Pulmonary Hypertension (PPHN) (aOR 4.43; 95% CI: 1.41-13.82, p=0.004) in the LIDM infants. Conclusion: GDM contributes significantly to LGA births in India, and is associated with higher Neonatal Intensive Care Unit (NICU) admissions, neonatal hyperbilirubinemia and PPHN, compared to non GDM causes.

Impact of Socio-demographic and Anthropometric Variables on Eruption Time of Permanent Teeth among Kurds Aged 5-15 Years in Duhok Governorate-Kurdistan Region, Iraq

Hoger Mustafa Najman, Samim Ahmad Aldabbagh, Zana Qadir Omer

Introduction: Many variables affect tooth eruption time. Eruption time and sequence of teeth is important as part of dental treatment planning in paediatric dentistry, orthodontics treatment, and forensic dentistry to estimate age of the child. Aim: The aim was to study the effect of different sociodemographic and anthropometric variables on eruption time of permanent teeth among Kurds aged 5-15 years in Duhok governorate-Kurdistan Region-Iraq. Materials and Methods: A cross-sectional study was conducted on 1418 randomly selected healthy Kurdish students aged 5-15 years of both genders in Duhok governorate. All were clinically examined for tooth emerging through the oral mucosa. Normally and delayed teeth eruption time was correlated to different variables such as gender, residency, socio-economic status, Body Mass Index (BMI), parents’ job, smoking habits, education, consanguinity, nutritional details, feeding pattern, birth weight, and pregnancy outcomes. Data were analysed using the Statistical Package for Social Sciences (SPSS, version 22.0). Numerical variables were presented and summarised as means and Standard Deviation (SD). Categorical variables were presented as frequencies and percentages. Chi-square test was used to test association between categorical variables. A p-value of =0.05 was considered statistically significant. Results: There were a statistically significant differences with p-value<0.05 between permanent teeth eruption time in relation to gender, BMI, second year nursing pattern variables, while there were no statistically significant association (p>0.05) among eruption time and socio-economic status, residence, parents (education, job, smoking habit), several nutritional details, pregnancy outcome, birth weight, nursing at first year, and finally the introduction of supplementary food for the child. Conclusion: Normal and delayed eruption time and factors affecting it will be useful in treatment planning in paediatric and orthodontic dentistry as well as in forensic dentistry

Causal Relationship Model of Factors Affecting Workplace Happiness among Head Nurses’ of Secondary Hospital at Northern Region, Thailand

Jirarat Ruetrakul

Introduction: There is a growing recognition for workplace happiness worldwide. If employees work in an unfavorable atmosphere, this may lead to boredom, discouragement and disengagement as well as alienation from colleagues; thereby becoming unhealthy for both employees and organisations. Aim: To develop a causal relationship model of factors affecting workplace happiness among head nurses and test the model with empirical data collected with the chosen research sample. Materials and Methods: This research uses the causal relationship research method. A five point Likert scale questionnaire about factors affecting workplace happiness was administered to 196 head nurses at secondary hospitals, northern Thailand. It included six latent variables: 1) leader characteristics; 2) work satisfaction; 3) awareness of the professional values; 4) organisational climate; 5) social support; and 6) workplace happiness. Analysis instruments were descriptive statistics i.e., frequency, percentage, average, standard deviation, Pearson product moment correlation, and linear structural relationship model. Results: Based on the causal relationship model, the following factors were identified as influencing workplace happiness among the head nurses: social support, work satisfaction, organisational climate, leader characteristics and awareness of the professional values, respectively. After adjustment as alternative model, the causal relationship model of workplace happiness fit the empirical data, with Chi-square (?2 )= 238.098, df=205, Comparative Fit Index (CFI)=0.99, Root Mean Squares Error of Approximation (RMSEA)=0.02, Tucker-Lewis Index (TLI)=0.98, Standardised Root Mean Square Residual (SRMR)=0.04. This means that the variables in the model can explain the variance of workplace happiness by 46.6%. Conclusion: Drawn from the causal relationship model of factors influencing happiness at work among the head nurses, the factors with the most influencing overall impact on happiness at work are: work satisfaction, organisational climate, social support, and leadership characteristics.

Clinicopathological Spectrum of Surface Epithelial Ovarian Carcinoma and its Association with Serum CA-125 Levels: A Cohort Study

Nisha Singla, Sarita Nibhoria, Kanwardeep Kaur Tiwana, Prince Gupta

Introduction: The ovaries are the primary female reproductive organs and endocrine glands. Ovarian carcinoma has often been called as a silent killer because the symptoms may develop so late that the chances of cure are very poor. According to World Health Organisation (WHO) ovarian tumours are classified based on their most probable tissue of origin: surface epithelial (65%), germ cell (15%), sex cord-stromal (10%), metastases (5%) and miscellaneous. The malignant surface epithelial tumours are further classified by cell type into serous, mucinous, endometrioid, clear cell, brenner, seromucinous and undifferentiated carcinoma. The most widely used tumour marker in ovarian carcinoma is CA125 which is considered as gold standard. Aim : To find the utility of serum CA-125 levels in histopathological variants of malignant surface epithelial tumours, degree of differentiation and their distribution according to clinical data pertaining to age, parity, history of use of oral contraceptive pills/ovulation inducing drugs and family history of carcinoma ovary/breast or colon. Materials and Methods: A prospective study (cohort study) was done at Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India over a period of 1.5 year (April 2017- October 2018) on 50 ovarian masses which were diagnosed as ovarian carcinoma. Data was represented as frequencies and percentages for categorical variables and as means and standard deviations for continuous variables. Analysis was done using Statistical Package for Social Sciences (SPSS) v 20.0.0. Results: Serous carcinoma (80%) topped among all the histological variants. Serous high grade carcinoma was more common than serous low grade carcinoma. Maximum rise of serum CA-125 levels were seen in serous carcinoma. Among serous carcinomas, mean serum CA-125 levels were more in high grade serous carcinoma than low grade serous carcinoma and the results were statistically significant. Conclusion: Serum CA-125 level is a great tool for diagnosis, follow-up and prognosis of ovarian carcinomas

Co-infection of COVID-19 and Tuberculosis in a Tertiary Care Hospital

Introduction: The burden of Tuberculosis (TB) has managed to remain an age old menace to our society, especially India. The potential impact of Coronavirus Disease-2019 (COVID-19) on TB patients continues to be worrisome due to the disruption of the national program and its services. Aim: To compare the TB infection in COVID-19 vs non COVID19 patients. Materials and Methods: This retrospective study was undertaken at Department of Microbiology, ABVIMS, Dr. RML Hospital Delhi, India. The data was collected, retrospectively from 15th September 2020 to 15th January 2021 from admitted 1094 non COVID-19 and 150 COVID-19 patients, >18 years of age, either sex. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was done to diagnose COVID-19 and GeneXpert was used to detect Mycobacterium tuberculosis. The data entry was done in the Microsoft Excel spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0. Two by two contingency table was used for calculating the Odd’s ratio. Results: During the study period, 1094 samples were received from non COVID-19 ward and 150 from COVID-19 ward. Out of 150 COVID-19 positive patients, 30 (20%) were also positive for Mycobacterium tuberculosis Complex (MTBC) and 120 (80%) were negative for MTBC. Out of 1094 COVID-19 negative patients, 98 (8.96%) were positive for MTBC and 996 (91.04%) were negative for MTBC. The Odd’s ratio/Risk Ratio (RR) of TB infection in COVID-19 infected patients was 3.08 {Confidence Interval (CI) 95%}. The mortality was 10% in the COVID-19 positive group. Conclusion: It was observed that the chances of contracting TB are thrice in COVID-19 patients and thus TB diagnosis should be equally emphasised and further strengthened in this ongoing pandemic.

Looking into Array of Clinical Presentations of Patients with Leprosy and their Clinico-epidemiological Profile: A Retrospective Study

Seema Goel, Dimple Chopra, Geetika Gera

Introduction: The prevalence of leprosy in India has decreased to <1 per 10,000 population by 2016 after the introduction of Multidrug Therapy (MDT) in 1982; still wide variations in Prevalence Rates (PR) continue to exist across the states and regions in the country. Aim: To determine the current clinical profile of leprosy and study various presenting features of patients with leprosy at a tertiary care hospital in Northern India. Materials and Methods: A retrospective study, based on seven years data, was conducted on patients diagnosed and registered in the leprosy clinic of a tertiary care hospital in Northern India, from January 2013 to December 2019. Data regarding their demographic details, presenting complaints, clinical features, associated complications and treatment administered was analysed and was entered into Microsoft Excel and presented as tables. Results: A total of 181 patients of leprosy were registered over a period of seven years. There were 133 males and 48 females with male to female ratio of 2.77:1. Of the total patients registered, 3.86% were children (≤14 years) and 97.8% patients were immigrants from the adjoining states. The most common clinical type was Multibacillary (MB) leprosy in 88.95% patients whereas most frequent morphological type was Borderline Tuberculoid (BT) leprosy (72.93%). Thirty-three (18.23%) patients presented with leprosy reaction (Type 1 reaction in 16.6% and Type 2 reaction in 1.66%). World Health Organisation (WHO) grade 2 deformities (G2D) were diagnosed in 3 (1.66%) patients, with claw hand being the most common deformity (1.10%). Anaesthetic to hypoaesthetic patches were the most common presenting feature (64.1%). Conclusion: Despite statistical elimination, MB disease and leprosy reactions are commonly seen as presenting manifestations. It highlights the need for high quality leprosy services including good referral system for an active case detection. Varied clinical presentations of leprosy should be contemplated while examining patients that can assist in an early and better case detection that will prevent delay in therapy and associated deformities and also decrease the transmission of disease in the community.

Reporting Risk of Malignancy in Salivary Gland Cytopathology and Histopathology: A Cross-sectional Study

Introduction: For preoperative evaluation of patient with salivary gland lesion Fine Needle Aspiration Cytology (FNAC) is an effective technique, but due to lack of uniform system for reporting and also because of morphological heterogeneity and overlap between different lesions there are limitations, in its use. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced which divides salivary gland lesions into six categories, guides in diagnosis and further management of Risk Of Malignancy (ROM) in different categories. Aim: To classify salivary gland lesions according to MSRSGC and also evaluate for ROM in each category. Materials and Methods: This was a cross-sectional study looking at the data over a period of three years (January 2017 to December 2019) in the Department of Pathology Chirayu Medical College and Hospital, Bhopal. In this study salivary gland FNAC cases were categorised according to Milan system on cytopathology. Results: A total of 63 cases of salivary gland system FNAC were evaluated on cytology and classified according to MILAN system. Histopathological follow-up (association) was available in 45 cases. The ROM in different categories was calculated. Category I non diagnostic constituted 25%, Category II nonneoplastic comprised 0%, Category III Atypia of Undetermined Significance (AUS) showed 50% Category IV: (a) Benign showed 5% IV; (b) Salivary gland neoplasm of Uncertain Malignant Potential (SUMP) comprised 100%, Category V Suspicious for Malignancy (SM) comprised 100% and Category VI Malignant constituted 90%. Conclusion: The MSRSGC is an evidence based effective system for salivary gland FNAC. It provides better communication with clinicians and improves over all patient care.

Role of Neutrophil Lymphocyte Ratio as a Prognostic Biomarker in COVID-19 Infection in Indian Patients: A Single Centre Observational Study from South India

Introduction: Early identification of severe disease in Coronavirus Disease-2019 (COVID-19) infection is important to reduce mortality and for the efficient allocation of medical resources. Several studies have established that severe cases of COVID-19 infections tend to have a higher Neutrophil Lymphocyte Ratio (NLR) and is an independent predictor of mortality. Aim: This study aimed to determine whether NLR can serve as a predictor of the prognosis of COVID-19 infections in Indian patients. Materials and Methods: This study was an ambispective observational single centre study conducted in Tirunelveli Medical, Tirunelveli, Tamil Nadu, India. from March 2020 to July 2020. Clinical and laboratory data of 1100 laboratory-confirmed COVID-19 infected patients were reviewed in this study. The patients were categorised as, asymptomatic, mild, moderate, and severe cases based on their clinical presentation. The demographic, clinical characteristics and laboratory data on the day of admission were analysed and compared by tertiles of the NLR. The Reciever Operating Characteristic (ROC) curve was applied to determine the threshold of NLR and the prognostic value was assessed via the Kaplan-Meier curve and regression models. Results: A total of 1100 cases were included in the study and were subdivided based on the clinical presentation into mild (n=226), moderate (n=27), severe (n=67), and asymptomatic (n=780) cases. The overall mortality rate was 4.9%. The ROC curve indicated that NLR is a better predictor of severe disease than other haematological parameters, with 89.3% Area Under the Curve (AUC) at the cut-off value of 2.81 with 80.6% sensitivity and 87.1% specificity. Multivariate analysis established that patients with NLR >2.8 had higher odds (OR=19.809, 95% CI-10.159-38.622) of severe infection and mortality (HR=1.110, 95% CI-1.088-1.113). Kaplan-Meier curve showed a significant difference (p-value <0.001) in the duration of hospital stay between patients with NLR <2.8 (mean=10.4 days) and NLR >2.8 (13.1 days). Conclusion: Early identification of COVID-19 patients with severe disease is important to reduce mortality. Elevated NLR is associated with severe disease in Severe Acute Resiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The NLR >2.8 in Indian population, may aid in identification of severe illness necessitating early access to intensive care unit and requirement of respiratory support.

Effect of Diluted Vasopressin vs Saline on Intraoperative Blood Loss during Vaginal Hysterectomy- A Randomised Controlled Trial

Vinika Nimodia, Sandhya Jain, Shalini Rajaram, Asha Tyagi, Bindiya Gupta

Introduction: Vasopressin has been used to control blood loss in gynaecological surgeries such as in myomectomy, abdominal hysterectomy etc. Only few studies have demonstrated its efficacy in Vaginal Hysterectomy (VH) in reducing intraoperative blood loss. VH is frequently performed gynaecological surgery in safe lower dose of vasopressin. There is no consensus on dose of infiltration. Aim: To compare submucosal vasopressin vs saline infiltration during VH and assess surgical parameters i.e., intraoperative blood loss, postinfiltration vitals, ease of dissection, use of electrocautery, need of blood transfusion and complications. Materials and Methods: This randomised controlled trial was done in department of Obstetrics and Gynaecology in collaboration with Department of Anaesthesia from November 2017 to April 2019. Low risk women aged <65 years with Pelvic Organ Prolapse Quantification-Stage (POP-Q stage) III/IV prolapse were recruited from Outpatient Department (OPD). They were randomised into two groups. Group I (n=35) patients received submucosal infiltration with diluted vasopressin (40 mL vasopressin of 0.1U/mL, total 4U), prior to the incision. Group II (n=35) patients received 40cc of normal saline. Vitals were checked at one and five minutes postinfiltration. All the qualitative parameters were compared between the two groups by chi-square test and quantitative parameters by unpaired t-test. Inter and intragroup comparison was done by Repetitive Measure ANOVA followed by Tukey’s test. For the parameters, which did not follow the Gaussian distribution, were compared by non-parametric Mann-Whitney test between the two groups. A p-value <0.05 was considered as significant. All the data analysis was carried out in Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The mean estimated blood loss from incision till creation of flaps was half in vasopressin group as compared to saline group (21.33 mL vs 49.67 mL, p-value=0.001). Vasopressin group had less use of electrocautery, whereas ease of dissection was more in saline group. There was no significant difference in duration of surgery till flap creation and need of blood transfusion. There was fall in pulse rate and Blood Pressure (BP) in both groups which did not require medical intervention and was likely due to neuraxial anaesthesia. Conclusion: Vasopressin appears to be safe and effective in VH at infiltration dose of four units in dilution. However further studies on larger sample size are recommended to gather more evidence in this regard.

Co-circulation of all the Four Serotypes of Dengue Virus in Endemic Region of Saurashtra, Gujarat during 2019-2020 Season

Introduction: Dengue has rapidly emerged as a vector-borne viral disease in recent years and also endemic in all continents. The agent of dengue, i.e., dengue viruses, are categorised under the genus Flavivirus, with the four dengue virus serotypes: designated as Dengue Virus-1 (DENV-1), DENV-2, DENV-3 and DENV-4. These all four serotypes are in circulation either singly, or more than one at the same time. Aim: To study the epidemiological update of dengue with circulating serotype and co-infection in Saurashtra region, Gujarat, India. Materials and Methods: A cross-sectional study was conducted during January 2019 to December 2020 and total samples received were 12,563 which were clinically suspected dengue samples case. After receiving blood samples, serum was separated and proceeded for Dengue NS1Ag (non structural protein 1 antigen), and Dengue IgM Ab (Immunoglobulin M antibody). After serological confirmation, 151 samples from different geographical area were selected for Dengue specific Reverse Transcriptase- Polymerase Chain Reaction (RT-PCR) for serotyping. Results: Total 4069 (32.3%) had confirmed dengue positive by Enzyme Linked Immunosorbent Assay (ELISA). The ratio of male cases was higher than female, and in age group 21- 35 year (47%). Seasonal trend showed a gradual increase in positivity from June with high peak in October. Circulation of all the four serotypes in area, higher monotypic infection by DENV-1 serotype (41.2%), followed by DENV-4, DENV-2 and DENV-3. Co-infection of different serotypes were also found. Conclusion: The present study concluded that all four serotypes circulate with predominant being DENV-1 type and co-infection of different serotypes in the Saurashtra region. Dengue mainly affected adult male population, and seasonal peak during monsoon and post-monsoon period.

Mental Well-being of Students of Health Section Pedagogy at Ho Chi Minh City: A Cross-sectional Study

Son Van Huynh, Thien-Thu Truong-Thi, Nhu-Thuyen Dang-Thi, Vinh-Long Tran-Chi

Introduction: The well-being of students refers to the psychological, cognitive, and social functioning of the life of students. The Vietnamese undergraduate students are under a great deal of burden and pressure, that makes examining their well-being more necessary than ever. Aim: To examine the Vietnamese Pedagogy students' well-being. Materials and Methods: This was a cross-sectional study from April 2018 to September 2018, on Four hundred and seventy-six students (128 males and 348 females) at the Ho Chi Minh City University of Education on completed paper-based questionnaires that included demographic items. Our research utilised the Mental Health Continuum Short Form in Vietnamese, which surveyed Vietnamese pedagogy undergraduates. The scale was developed with an aim of creating a brief self-rating assessment tool which accesses three components of well-being: emotional, social, and psychological. The emotional well-being subscale including 3 items is defined as positive effects/satisfaction with life. Social well-being includes social contribution, social integration, social actualisation, social acceptance, and social coherence. Finally, six items represent psychological well-being: self-acceptance, environmental mastery, positive relations with others, personal growth, autonomy, and purpose in life. To achieve this goal, descriptive statistics were used for describing the sample statistics and conclusion. The Statistical Package for the Social Sciences version 16.0 was used for data analysis. Frequency, percentage, mean score, and standard deviation were used to analyse descriptive and inferential statistics. Results: A convenience sample of 476 (response rate of 600 questionnaires distributed at 79.3%) Vietnamese students from the Ho Chi Minh City University of Education was studied which included 128 males (26.9%) and 348 females (73.1%). The majority of the participants (78.6%; n=372) were born in Ho Chi Minh City, and 21.4% (n=102) were born in other provinces of Vietnam. Regarding their academic year, 50.4% (n=240), 18.9% (n=90), 13.2% (n=63) and 17.5% (n=83) were respectively represents, sophomore, junior, and senior, respectively. The results indicated that Vietnamese Pedagogy students had a high level of psychological well-being (M=2.99, SD=1.12) and emotional well-being (M=2.96, SD=1.26), while their social well-being (M=2.40, SD=1.12) was medium. Conclusion: Pedagogy students in Vietnam had a high level of psychological well-being, emotional well-being, and medium level of social well-being. All results obtained after this research are indispensable to understand the pedagogy undergraduates’ well-being. This research was conducted with the notion that it would act as a stimulant in extending related work to improve pedagogy students' well-being.

Study on the Effect of Intermittent Fasting on Body Mass Index, Physical Activity and Sleep in Adults

Maha H Alhussain, Dawa M Almarri, Shaista Arzoo

Introduction: Recently, Intermittent Fasting (IF) has gained popularity as an effective approach for obesity management. Many types of IF have been practiced for either religious or health purposes. Muslims, for example, are encouraged by Islam to voluntarily fast two days/week (Monday and Thursday) from sunrise to sunset. Aim: This study investigated the association between Muslims’ voluntary fasting (two days/week) with Body Mass Index (BMI), Physical Activity (PA), and sleep pattern. Materials and Methods: The present survey-based study was conducted for three months on 1242 adults (245 males and 997 females) who completed the completed selfadministeredstudyquestionnaire. The questionnaire comprised questions on sociodemographic and anthropometric variables, fasting-related questions, PA, and sleep pattern. Participants were classified into fasting and non-fasting groups according to their responses to the question “Do you fast two days (i.e., Monday and Thursday) every week? The differences between the two groups were tested using Chi-square test, an exact probability test and unpaired t-test. Results: A total of 1,242 valid responses (age 18 years and above) were collected. Among those participants, only 18.4% (n=229) reported fasting Monday and Thursday every week. The BMI of those who used to fast two days/week was significantly higher (p < 0.05) than those who did not fast. The desire to lose weight (47.59%), followed by religious views (44.54%) were the main reasons for fasting. A significant difference (p < 0.05) in PA was observed between the two groups, but overall, the participants were involved in low PA only. No significant differences (p ≥ 0.05) in sleep pattern, such as sleepiness during the day, and sleep duration were observed between the two groups. However, significant differences in the time required to sleep and waking up during sleep were found between the two groups. Conclusion: This study indicated that fasting two days/week does not affect BMI when meal timings are restrained to early evening and pre-dawn periods, with adequate night sleep. It may be an appropriate beginning point to further develop strategies to sustain any beneficial effects of the voluntary IF on obesity.

Prevelance of Hepatitis B, Hepatitis C and HIV Infections among People Who Inject Drugs- A Study from Tertiary Care Centre of Kashmir Valley, India

Sanam Rasool Wani, Anjum Farhana, Danish Zahoor Pandith, Mohammad Maqbool Dar

Introduction: Drug addiction one of the greatest challenges face across the glob. The parenterally transmitted viruses like Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) occur more frequently in this high-risk group of population as compared with the general population. Aim: To find the prevalence of HBV, HCV and HIV in People Who Inject Drugs (PWIDs) attending a tertiary care hospital in Kashmir valley, India. Materials and Methods: A prospective descriptional study was conducted from October 2017 to October 2020 in the Department of Microbiology of a tertiary care hospital in Kashmir. Subjects included 200 (PWIDs) who voluntarily presented themselves at the drug clinic. Participants were tested for HBV, HCV and HIV infections. For HBV, surface antigen was detected using Enzymelinked Immunosorbent Assay (ELISA), HCV was detected by HCV antibody test using ELISA and HIV was detected using combination of three rapid kits, COMBAIDS-RS ADVANTAGE ST, MERISCREEN HIV 1-2 WB and TREDRO HIV 1-2 Ab. Demographic data was collected from all the PWIDs. Results: Among 200 PWIDs,138 (69%) were in the age group of 16-25 years and none of them was more than 35 years of age. The mean age of PWIDs was 22.9 years. Out of 200, 20 (10%) PWIDS had HCV antibodies, 7 (3.5%) were positive for HBV, and 1 (0.5%) had anti-HIV antibodies. A 73.5% of PWIDs belonged to urban Kashmir and majority of them (62.5%) were college going students. Conclusion: From present study, authors report a high prevalence of hepatitis C and B in PWIDs of Kashmir. It is also the fact that these figures are just the tip of the iceberg. Targeted intervention programs should make HBV/HCV testing, prevention and care more accessible for PWIDs

Overexpression of Stathmin in Oral Squamous Cell Carcinoma, its Association with Histomorphological Features and Pathological Staging

Nabanita Barma, Gopinath Barui, Anadi Roy Chowdhury

Introduction: Stathmin, one of the most important intracellular phosphoprotein that plays the vital role in the regulation of cell cycle and cell proliferation. It acts by disassembly of Microtubules (MT) that helps in the formation of mitotic spindle. It is overexpressed in various human cancers. Aim: To investigate the expression status of stathmin and its relation with clinicopathologic significance in Oral Squamous Cell Carcinoma (OSCC) and its association with age, sex, tobacco chewing, histomorphological features and pathological staging. Materials and Methods: A descriptive and observational study in cross-sectional design was conducted in a tertiary care centre of Kolkata, West Bengal, India, from January to March 2020 in the Department of Pathology of RG Kar Medical College and Hospital in collaboration with Department of Oto-Rhino-Laryngology of the same institute. Stathmin expression was assessed by immunohistochemistry (IHC) in 28 OSCC cases. The association between stathmin expression and clinicopathological parameters like age, sex, tobacco chewing, tumour site, histomorphological type, Tumour Nodes Metastases (TNM) stage and Worst Pattern Of Invasion (WPOI) were evaluated on the basis of Chi-square test and Fisher’s-exact test (software Statistical Package for the Social Sciences (SPSS) version 25.0). Results: Stathmin was overexpressed in 18 cases out of 28 cases of OSCC. In this study a positive association was observed between stathmin expression and age group, history of tobacco chewing, advanced T stage, advanced pTNM staging and WPOI of OSCC. bConclusion: The study suggests that overexpression of stathmin could contribute to cancer progression. There is a higher likelihood that stathmin may be used as a potential biomarker as well as therapeutic target for OSCC.

Deciding the Appropriate Route and Method of Hysterectomy for Women with Benign Diseases: A Cross-sectional Study at a Tertiary Care Hospital, India

Hiralal Konar, Madhutandra Sarkar, Dorothy Dessa

Introduction: Different factors may influence the route of hysterectomy for benign indications. Each of the three main approaches of hysterectomy has its own set of risks and benefits. A rational and evidence-based decision to select a right method for a particular patient is necessary to bring about the best possible outcome with least complications. Aim: To compare three groups of hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH), Non-descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH), with regard to the patient and clinical factors, surgical outcomes and complications, in order to decide the optimum route and method of hysterectomy in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, one hundred and twenty women, with 40 patients each in the TAH, NDVH and TLH groups, were admitted due to benign gynaecological conditions in a tertiary care hospital in Kolkata, India from May 2013 to April 2014. They were operated, and then followed up at 6 to 12 weeks after surgery. All the relevant information, e.g., clinical diagnosis, operating time, intraoperative blood loss, length of stay in hospital, postoperative pain score, intraoperative and postoperative complications, etc., was recorded. Data were analysed statistically by simple proportions and statistical tests, i.e., chi-square test and F-test. Results: The most common indication for hysterectomy was benign diseases in all the groups, 47.5%, 40% and 37.5% respectively in the TAH, NDVH and TLH groups. The mean operating time (minutes) was significantly higher in the TLH group (163.5) as compared to the TAH (75.03) and NDVH groups (84.88) (p=0.039). A significantly lesser mean intraoperative blood loss (ml) was observed in the NDVH (85.67) and TLH groups (98.63) as compared to the TAH group (168.47) (p=0.021). The observations in regard to other surgical outcome parameters, i.e., postoperative pain score, hospital stay, were also favourable in the NDVH or TLH group. The complication rate was higher in the TAH group (22/40 or 55%) as compared to the NDVH (14/40 or 35%) and TLH (17/40 or 42.5%) groups. Conclusion: NDVH or TLH is the preferred method over TAH in case of benign uterine disease due to lesser operative morbidity and faster recovery.

Food Consumption Pattern of Adolescents in Delhi-NCR Born Full-term with Low Birth Weight with Reference to the New Estimated Average Requirement

Anku Malik, Yamini Gusain, Renuka Pathak, Geeta Trilok Kumar

Introduction: Nutrition and lifestyle transition in India have attributed to the burden of malnutrition in early life. Evidence suggests that children born Low Birth Weight (LBW) are at increased risk of later life diseases. Aim: The study aims to describe the nutrient intake of term LBW children with reference to the new estimated average requirement. Materials and Methods: This questionnaire based crosssectional study was conducted in the premises of Institute of Home Economics, Delhi, India. Dietary intake data for 139 full-term LBW children (9-12 years) was collected using 24- hour recall. Nutrient and food group intake was analysed using DietCal software (version 10). Gender differences in dietary intake were assessed using Mann-Whitney U test. Proportion of children with micronutrient intake below Estimated Average Requirement (EAR) was also estimated. Data was analysed using Mann-Whitney U test and Chi-square test. Results: The protein intake of more than 50% children provided 10-15% of energy. Carbohydrate contributed to less than 55% of day’s energy while energy from fat was more than 30% for majority of children. Percentage of children with inadequate micronutrient intake ranged from 44.6% for Vitamin C to 100% for Vitamin B12 and Vitamin D. A high proportion of children had low consumption of green leafy vegetables, nuts, oilseeds, and fleshy foods. The intake of milk and milk products were significantly higher in boys as compared to girls (p=0.02). Conclusion: There is a transition from carbohydrate dense foods to high fat processed foods that are inadequate in micronutrients. Findings highlight the need for an intensive public health approach to improve the diet quality of the Indian population.

Effect of Benson’s Relaxation Therapy on Post Caesarean Section Pain and Stress: A Pilot Study

Riddhi Parmar, Anjali Tiwari

Introduction: Many mothers face some discomfort after caesarean section like pain, mood changes, postpartum depression and stress. Non pharmacological methods can be utilised to relieve these discomforts as they are simple to use, inexpensive and do not have any side effects. Benson’s Relaxation Therapy (BRT) is a form of breathing exercise to be done by postcaesarean section mothers, breathing in and out in sitting position with closed eyes, Saying to oneself the word “one” while breathing out. Aim: To evaluate the effect of BRT on level of pain and stress among postcaesarean section mothers. Materials and Methods: Quantitative research approach with quasi experimental: pre test post-test control group design was used. By using convenient sampling technique, total 10 samples {experimental group (5) and control group (5)} were recruited. The intervention was given to the experimental group twice a day for three consecutive days. BRT was not done in control group. Post interventional pain and stress was assessed on 3rd day by using numerical pain rating scale for pain assessment and Modified Hung's postpartum stress scale for stress assessment. Data were collected by using SPSS version 20. The t-test was used to analyse the data. The p-value less than 0.05 was considered as significant. Results: The study showed that BRT was effective in reducing pain level in experimental as well as in reducing stress level. The mean pain score for experimental group reduced from 7 to 2.2 while in control group it was 7.60 at pre-intervention and 4.6 at follow-up. The mean stress score for the experimental group reduced from 90.60 to 57.60 while in control group it was 92.00 at pre-intervention and 75.20 at follow-up. Conclusion: This study reflected the positive effect of BRT in reducing pain and stress level among postcaesarean section mothers.

Aluminium Induced Neurodegeneration in Rat Cerebrum in Presence of Ethanol Co-exposure

Buddhadeb Ghosh, Suman Yadav, Ravi Kant Sharma

Introduction: Aluminium (AL) exposure leads to neurotoxicity and many problems in the body. AL role in Alzheimer’s Disease (AD) is unknown and controversial to the scientists. According to World Health Organisation (WHO) provisional tolerable weekly intake of AL is 2 mg/kg body weight. Moderate intake of alcohol may favour body in Coronary Heart Disease (CHD) and diabetes mellitus, etc. Aluminium being cheaper along with increased consumption of alcohol, mixed with each other may induce neurotoxicity. Aim: To identify the effects of AL in cerebrum of rats in presence of ethanol co-exposure. Materials and Methods: An experimental study was carried out at Dr. RP Government Medical College, Kangra and Government Medical College, Amritsar, India after due approval from the Institute Animal Ethics Committee. Thirty-two wistar rats were divided into one vehicle control and three experimental groups. Group I received the normal saline water as vehicle control group. Group II received AL chloride 4.2 mg/kg body weight as experimental group. Group III received ethanol 1 gm/kg body weight as experimental group. Group IV received both AL chloride 4.2 mg/kg body weight and ethanol 1 gm/kg body weight as experimental group. After treatment, brain cortex was processed for histopathological observation under microscope. Results: Cerebral cortex showed normal architecture of the brain with Haematoxylin and Eosin (H&E) staining and cresyl violet staining and modified Bielschowsky’s silver staining in low and high magnification in vehicle control group. Experimental group treated with AL and ethanol separately showed reduction in the count of pyramidal cells with moderate neuronal degeneration with pyknotic nuclei. Vacuolar changes and pericellular spaces around the necrotic neurons were also seen. Combined AL and ethanol treated group showed acute neurodegeneration and necrosis of cortex indicating chromatolysis and loss of substances and Neurofibrillary Tangle (NFT) and plaque. Conclusion: It has been concluded that the ethanol induced the effects of AL on the cerebrum and plays a significant role in AD pathogenesis.

The Role of Cytogenetic Methods in the Diagnosis of Haematological Diseases

Introduction: Conventional cytogenetics, by the use of standard karyotyping, allows the study of numerical and structural chromosomal aberrations. Haematological malignancies include a number of cancer types that originate in the blood cells of the bone marrow or of the lymphatic system. Cytogenetic methods are traditionally used for diagnosis and prognosis of these diseases. However, with the increasingly frequent use of molecular methods in the diagnostic laboratories, the importance of the conventional cytogenetic analysis in the diagnosis of haematological diseases needs to be reassessed. Aim: To evaluate the role of cytogenetic methods in the diagnosis of haematological malignancies. Materials and Methods: A retrospective analysis of cytogenetic findings of 146 patients with various haematological malignancies was performed. All of the findings were made over a period of three years at the Centre for Genetics by the Medical Faculty of the University of Sarajevo in Bosnia and Herzegovina. Microsoft Excel 2019 was used for the analysis and presentation of data in the form of tables and graphs. Results: The results of the present study showed that the use of conventional cytogenetic analysis is a good diagnostic method for 50.68% (74) of patients in whom chromosomal aberrations were detected. Conclusion: Cytogenetics remains the most comprehensive method for assessing chromosomal abnormalities due to its ability to detect clinically relevant aneuploidies and additional cytogenetic abnormalities that cannot be detected by locusspecific assays.

Awareness and Perspective of Nursing Tutee on Proof Relied Enactment at Selected Nursing Colleges of Central Gujarat, India

Arpan Pandya

Introduction: Nursing tutee are traditionally following the set benchmarks of nursing care. Several researchers have observed a wide gap between present awareness and perspective of nursing tutee in relation to recent healthcare developmental proofs and their day-to-day nursing activity. In the present study researcher has made an attempt to assess the Proof Relied Enactment (PRE) skills to find out their status. Aim: To assess the possessed awareness and perspective of final year Bachelor of Science (BSc) Nursing tutee regarding PRE. Materials and Methods: This descriptive survey was conducted among the fourth year BSc Nursing students in selected Nursing colleges of central Gujarat, India from January 2020 to December 2020. Purposive sampling technique was used and a sample of 120 students was included in the study. Descriptive and inferential statistics including mean, Chisquare and Karl Pearson coefficient of correlation was used to analyse the results. Results: The study showed that learning of fundamentals of PRE has significant correlation with utilisation status of PRE whereas rest of variables displayed negative correlation. The mean awareness score was 20.1 and SD was 2.91, whereas mean score for use of evidence resources was 28.24 and SD was 2.95, mean score for utilisation status for PRE was 6.15 whereas SD was 1.47, mean perspective score was 107.94 and SD was 10.93. None of the demographic showed statistically significant association with perspectives of tutee on PRE. There was positive correlation between awareness and perspective of nursing tutee on PRE. Conclusion: Nursing tutee who learned PRE in their curriculum consciously improved their PRE skills and were more productive during study

Fosfomycin Sensitivity Pattern among Uropathogens Isolated from Patients Visiting Day Care Facility of Sushila Tiwari Hospital in Kumaun Region, Uttarakhand, India

Shraddha Sharma, Pankaj Kumar Verma, Vinita Rawat, Umesh, Vikrant Negi

Introduction: Urinary Tract Infections (UTI) are one of the most common infections responsible for antibiotic resistance. There are limited antibiotics options for treating the cases due to Multi Drug Resistant (MDR) bacteria. Fosfomycin is being used for treating UTIs and has shown promising results even against MDR pathogens. Aim: To determine the fosfomycin sensitivity pattern along with Minimum Inhibitory Concentration (MIC) against uropathogens by agar dilution method. Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Government Medical College Haldwani, Uttarakhand, India, between August 2017 to September 2019. Clean catch, mid stream urine samples were inoculated on Cystine Lactose Electrolyte Deficient (CLED) agar and incubated. The significant growths of pathogenic bacteria were subjected to antibiotic susceptibility testing. Fosfomycin (30 mg) disc was used in Kirby-Bauer disc diffusion testing. Fosfomycin trometamol MIC was determined by agar dilution method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The data collected in the study were analysed by using Statistical Package for the Social Science (SPSS) software version 20.0. Results: Significant growth of pathogenic bacteria was observed in 365 out of total 2725 urine samples. E.coli (72.32%) was the leading isolate followed by Enterococcus species (10.41%). Fosfomycin was recorded as the most active antibiotic against all the bacterial pathogen with 85-100% susceptibility except Proteus species (40%) in disc diffusion method. The MIC of fosfomycin was recorded between 4-64 against most of the isolates by agar dilution method. Conclusion: Fosfomycin is the most active antibiotic against all the uropathogens in the study setup and can be included in empirical treatment of day care patients along with nitrofurantoin.

Comparison of Staining Characteristics of Papanicolaou Stain and May-Grünwald-Giemsa Stain in Tzanck Smear Cytology

BN Kumarguru, HN Shruthi, AS Ramaswamy, V Shiva Kumar

Introduction: Although the skin is more readily accessible to the cytological examination than any other organ, cytodiagnosis is much less frequently used in dermatology. Tzanck smears are routinely stained with May-Grünwald-Giemsa (MGG) stain. But, Papanicolaou (PAP) stain is known to yield polychromatic transparent staining with crisp nuclear and cytoplasmic features. Aim: To compare the staining characteristics of PAP stained and MGG stained Tzanck smears by using a scoring system. Materials and Methods: The present study was a cross-sectional study on Tzanck smears, conducted at a tertiary care referral Institute, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam, Andhra Pradesh, India, from March 2016 to April 2017. In each case, two Tzanck smears were prepared. One smear was wet-fixed in isoproplyl alcohol and stained by PAP method. The other smear was air-dried and stained by MGG stain. Both the smears were evaluated for the staining characteristics by using a scoring system. The scoring system was indigenously designed for evaluating the stained sections. All the staining parameters such as contrast, cytoplasmic features, nuclear features and background were evaluated in the scoring system employed in the present study. Chi-square test and two sample t-test were used for statistical analysis. Results: Forty cases of Tzanck smears were analysed. Most common diagnostic entity was cutaneous infections in 18 cases (45%). The average scores of all the parameters of staining characteristics and the overall score were better in PAP stained smears than MGG stained smears. The p-values were statistically significant. Conclusion: PAP stain may be considered as a behooveful stain for the evaluation of Tzanck smear. It may be suggested that, although the PAP stained smears scored better than MGG statistically, both the stains may be used as complementary to each other.

Pervasiveness and Epidemiological Profile of SARS-CoV-2 Infection among the Population of Majha Region of Punjab,India

Introduction: There are many types of coronaviruses that causes respiratory and intestinal infection in humans. Among these coronaviruses, is a group of Severe Acute Respiratory Syndrome (SARS)-like bat coronavirus, including both SARS-CoV and Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) that comprise a unique clade under the subgenus Sarbecovirus. The SARS-CoV-2 strains in India are more closely related to bat-CoVRaTG13 (93% homology) than pangolin CoV (83.5% homology). India reported its first case of Coronavirus Disease 19 (COVID-19) on January 30, 2020. Punjab, a state in northwestern India comprises of 22 districts which are classified into three major distinct regions viz. Majha, Malwa and Doaba. Four districts of Majha region of Indian state of Punjab are Amritsar, Tarn Taran, Gurdaspur and Pathankot. Aim: The present study describes the SARS-CoV-2 epidemiology based on samples tested for Coronavirus; received at Viral Research and Diagnostic Laboratory (VRDL), Government Medical College, Amritsar, Punjab, India. Materials and Methods: This epidemiological study was designed taking into consideration three main factors i.e. the gender, the age groups and the factor whether the individual has any symptoms or not. To study their context of applicability and its interpretation, a total of 3,47,418 samples from period of 01st April 2020 to 31st October 2020 were included in this study. Ribonucleic Acid (RNA) amplification by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of SARS-CoV-2 from nasopharyngeal/ oropharyngeal swabs of all individuals revealed confirmation of 17,920 positive samples. Total 2,29,310 males and 1,18,108 females were tested for the COVID-19 infection. Social science statistics online tool (https://www.socscistatistics.com/tests/) was used for Chi-square (χ² ) test to analyse different parameters. Results: Maximum number of COVID-19 positive patients was detected in 21 to 30 years age group (p<0.05). Highest positivity ratio of samples was observed in individuals exceeding the age of 50 years. Number of asymptomatic individuals was found to be quite higher than symptomatic individuals in total population. Overall percent positivity of asymptomatic individuals was 4.81% (p<0.00001), which accounts to 4.71% of total number of tested individuals in this study. Conclusion: COVID-19 is an evolving disease and data from this study elucidates the epidemiological profile of the SARSCoV-2 infection among population of Majha region of Punjab state of Indian subcontinent.

Evaluation of Change in Aceclofenac Usage Pattern in Knee Osteoarthritis Following Viscosupplementation: A Prospective Interventional Study

Introduction: Osteoarthritis (OA) of knee is one of the most common musculoskeletal disorders affecting the elderly population in Asia-Pacific region. Array of diverse treatment options exist including analgesics, Non Steroidal AntiInflammatory Drugs (NSAIDs), opioids, physical therapy, orthotic devices, structure modifying drugs, Intra-articular viscosupplementation, corticosteroids or Platelet Rich Plasma (PRP) and surgery. Viscosupplementation {Hyaluronic Acid (HA)} is said to exert an anti-inflammatory effect and has remained a modality under investigation for a longtime. Aim: To evaluate the change in aceclofenac usage pattern in knee OA following viscosupplementation as a surrogate for efficacy of viscosupplementation related pain relief. Materials and Methods: This study was a prospective interventional study on 60 subjects over duration of 18 months (October 2015 to March 2017). The subjects who were prescribed viscosupplementation (single dose of Intra-articular Hyaluronic Acid (IAHA) High Molecular Weight (HMW) 90 mg/3 mL in the affected knee) were included after satisfying inclusion and exclusion criteria. All the patients were assessed at the baseline, 4, 8 and 12 weeks in terms of Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and quantity of aceclofenac intake post viscosupplementation. Data were entered and analysed in Statistical Package of the Social Science (SPSS) version 21. Categorical variables were presented in number and percentage while continuous variables were presented as mean±SD and compared using paired t-test across follow-ups. A p-value ≤0.05 was considered statistically significant. Results: Total 60 subjects were enrolled in the study, of which 38 (63.33%) were females and 22 (36.67%) were males. After viscosupplementation there was significant reduction in aceclofenac intake from 3.88±1.46 gm to 1.72±0.75 gm and p-value was <0.0001. There was also improvement in pain as VAS decreased from 6.88±0.98 to 3.97±0.86 (p-value <0.0001) over 12 weeks. Similarly there was functional improvement as WOMAC total score reduced from 46.2±8.45 to 27.53±5.67 after 12 weeks. The p-value was <0.0001 at all the follow-ups. Conclusion: Aceclofenac requirement is decreased and there is improvement in pain and function after viscosupplementation. Viscosupplementation reduces NSAIDs (aceclofenac) usage in OA knee while at the same time reducing pain and improving function.

Detection of Endometrial Nerve Fibres in the Diagnosis of Endometriosis: A Case-control Study

Introduction: Due to non-availability of a good non-invasive or semi-invasive test for diagnosing endometriosis, there is a substantial time delay between the onset of symptoms and surgically confirmed endometriosis. Development of a simple non-invasive or semi-invasive diagnostic method can greatly help to reduce this delay and prevent severe morbidity in minimal to mild endometriosis which cannot be diagnosed clinically or by ultrasonography. Aim: To evaluate the role of nerve fibre detection in endometrial biopsy for diagnosing endometriosis Materials and Methods: In this observational study, detection of endometrial nerve fibres in endometrial biopsy in women undergoing laparoscopy/laparotomy for pelvic pain or infertility was done using polyclonal rabbit anti-protein gene product 9.5 (Dako, Australia). The results were compared between women who has laparoscopic/laparotomy visualisation of endometriotic lesions with those who don’t have endometriotic lesions. Women with visual evidence of endometriosis in laparoscopy/laparotomy were taken as cases (n=32). Women without evidence of endometriosis in laparoscopy/laparotomy were taken as controls (n=29). Presence of endometrial nerve fibre was compared between women with and without evidence of endometriosis. Presence of endometrial nerve fibres and its association with painful symptoms, history of hormonal therapy, endometrial histopathology and stages of endometriosis was analysed. Results: Endometrial nerve fibres were detected in the functional layer in 21.8% of the endometriosis patients and no nerve fibres were detected in the control group. There was no significant association between endometrial nerve fibres in endometriosis and presentation of painful symptoms, history of hormonal therapy, endometrial histopathology and stages of endometriosis. Sensitivity of detecting endometriosis by the presence of nerve fibres in endometrial nerve biopsy specimen was 21.8% and specificity was 100%. Conclusion:Endometrial nerve fibre assessment for identifying endometriosis in women undergoing laparoscopy/laparotomy using routine endometrial sampling and immunohistochemical analysis was found not to be sensitive for the diagnosis of endometriosis.

Comparison of Magnetic Resonance Imaging and Mammography in the Evaluation of Carcinoma Breast- A Longitudinal Observational Study

Introduction: Breast cancer is the most common malignancy in females worldwide. Mammography is a useful tool to diagnose breast cancer. Magnetic Resonance Imaging (MRI) has similar sensitivity like mammography to diagnose breast cancer, however MRI is more sensitive in diagnosing breast cancer in young females and patients with family history of breast cancer. Aim: To compare the sensitivity and specificity of MRI and mammography in the diagnosis of breast cancer. Materials and Methods: This was a longitudinal observational study done in the General Surgery Department of the study institute, from April 2018 to January 2020. Total 228 patients participated in the study. All patients, suspected to have breast cancer clinically, underwent mammography and MRI. The diagnosis was later confirmed by histopathological examination. The sensitivity and specificity of both MRI and mammography were determined by comparing with the results of histopathological examination using student’s t-test. Results: All 228 patients were females. In the study, it was found out that the sensitivity of mammography and MRI was 95% and 95.83%, respectively, in detecting breast cancer. The specificity of mammography and MRI was 89.28% and 83.33%, respectively. However, the differences were statistically non significant. Conclusion: From the study, it was found out that the sensitivity and specificity of MRI and mammography is similar in detecting breast cancer.

A Cadaveric Study of Radial Nerve Course and its Clinical Implications on Radial Nerve Block at Elbow

Srimathi Ramasamy, Muthu Kumar Thyagarajan, Chandrasekar Raju

Introduction: Upper limb nerve blocks are done commonly by brachial plexus (C5-T1) blocks via supraclavicular, infraclavicular approaches. Sometimes a single peripheral nerve needs additional block with local anaesthetic to achieve adequate block. Peripheral nerve blocks are useful for minor surgical procedures in a single nerve distribution. Aim: To study the course and clinical significance of the radial nerve in 50 cadaveric upper limbs. Materials and Methods: A cross-sectional study was conducted on 50 intact dissected upper limbs. The upper limbs were obtained from the Department of Anatomy, Sri Ramachandra Medical College from August 2020 to December 2020. Radial nerve was exposed by routine dissection in all the upper limbs and its entire course was studied and observed for any variation. The distance from the biceps tendon to the radial nerve at the elbow, distance of the radial nerve in the Lateral Intermuscular Septum (LIS) from the epicondyles at the elbow were measured. The results obtained were statistically analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Results: In present study, the mean distance of the radial nerve in the LIS to the medial epicondyle was 12.4±0.31 cm and to the lateral epicondyle was 12.1±0.28 cm. The mean distance from the biceps tendon to the radial nerve at the elbow was 1.75±0.22 cm. Conclusion: From the present study, it can be inferred that effective peripheral radial nerve block can be achieved by blocking the nerve 1.75 cm lateral to the biceps tendon at the elbow 3 cm above the elbow crease. This can be made comfortable to the patient and more precise by ultrasound localisation of the radial nerve.

Low-fibre Diet as an Option for Bowel Preparation Prior to Colonoscopy: A Randomised Controlled Clinical Trial

Introduction: Bowel preparation for colonoscopy plays an important role in the evaluation of the colon. Many methods for preparing the colon for colonoscopy do not work well. Aim: To use a low-fibre diet as a standard and applicable method for bowel preparation in performing colonoscopy and increasing patients’ adherence to colonoscopy. Materials and Methods: Clinical control trial design was used to compare bowel preparation in people receiving a low-fibre diet with those who did not receive food {Nil Per Os (NPO)} for bowel preparation. The participants included 477 patients who were randomly divided into two groups including 223 patients having a low-fibre diet (for dinner) and 254 patients having nothing for dinner (NPO). Data were recorded including age, sex, weight, height, level of education, bowel preparation score, colonoscopy diagnosis and sedative dose. Both groups were given a solution of 3 L of ethylene glycol and 60 mg of bisacodyl at three occasions: 3 pm and 7 pm the day before colonoscopy and 6 am on the colonoscopy day. Scoring criteria for colonoscopy preparation included excellent (clean and free of any liquids), very good (clean with clear fluid, underlying mucus visible in clear fluid), good (clean with dirty liquid), poor (with particles including stools, but can be assessed at 80% mucus), and very poor (containing stool particles, and mucosal evaluation below 80%, colonoscopy was cancelled in this group). The data were analysed by SPSS version 21.0 using Chi-square and Independent Samples Test. Results: About 82% of patients who consumed a low-fibre diet for bowel preparation the night before colonoscopy had an excellent and very good quality of bowel preparation compared with 74.9% of patients not receiving any diet. The number of patients who cancelled the colonoscopy were more in the group not receiving any diet (4.7% versus 2.6%). The data indicated that the quality of colon preparation decreased by age (p=0.0001), whereas Body Mass Index (BMI) did not differ on colon cleansing. When having dinner, patients with Irritable Bowel Syndrome (IBS) had significantly more secretion of air bubble and foam formation than patients not eating dinner (p=0.002). The results showed that the difference in bowel preparation quality between the two groups was not significant (p=0.169), and increased patient adherence to colonoscopy in the first group. Conclusion: Implementing a proper bowel preparation method is very important in improving the quality of colonoscopy and increasing the patient’s adherence to colonoscopy. Using a low-fibre diet on the day before colonoscopy can help achieve this goal.

Direct Detection of Extended Spectrum β-Lactamases from Positive Blood Cultures by using Aztreonam and Clavulanate

Introduction: Bacterial Sepsis by Multidrug Resistant Gram Negative Bacilli (MDRGNB) producing Extended Spectrum ß-Lactamases (ESBL) is one of the major causes of mortality and morbidity in hospitals. Early detection of ESBLs directly from positive blood cultures can reduce mortality. The phenotypic detection of ESBLs is difficult as they may be masked by the co-production of additional enzymes like AmpC. This can be overcome by using an Aztreonam Discs With and Without Clavulanate (AO/CL) method. Aim: To identify ESBLs directly from the positive blood cultures by using AO/CL disc diffusion method and to detect the genes coding for ESBL enzymes by conventional Polymerase Chain Reaction (PCR). Materials and Methods: A prospective study was conducted over a period of five months (October 2020-February 2021). A total of 100 positive blood cultures showing Gram-negative bacilli on Gram stain was subjected to direct detection of ESBLs by using Cefotaxime (CTX), Ceftazidime (CAZ) discs with and without clavulanate and AO/CL. Isolates from positive blood culture were identified to genus and species level by VITEK-2 compact. Isolates were tested for ESBL production by CAZ/ CTX with and without clavulanate disc diffusion method as recommended by CLSI. PCR was carried out to detect target genes responsible for ESBL production such as CTX–M, TEM, SHV genes. Statistical analysis was done by using MS Excel sheet. Descriptive statistics like percentage calculation was done in the study. Results: Out of 100 positive blood cultures showing Gram Negative Bacteria (GNB) on Gram stain, 33 were positive for ESBL production by direct disc diffusion method. Out of these, 27 ESBL producers were detected by CAZ/CTX with and without clavulanate disc diffusion method and AO/CL method whereas six ESBL producers were detected by AO/ CL disc diffusion method only. A 27 culture isolates were found positive for ESBL production by CAZ/CTX with and without clavulanate disc diffusion method as recommended by Clinical and Laboratory Standards Institute (CLSI). Out of 33, 28 (85%) isolates possessed one of the target genes for ESBL production such as 10TEM (36%), 10CTX-M (36%), 07TEM+CTX M (25%), 01SHV (3%). Conclusion: Direct detection of ESBLs plays a significant role in management of sepsis. It helps the clinician in escalation and de-escalation of antibiotics and prevents the development of antimicrobial resistance. It contributes towards antibiotic stewardship and better compliance to infection prevention and control protocols. AO/CL method is preferred to detect ESBL producers directly from positive blood culture bottles.

Evaluation of IgG Antibody Response to Severe Acute Respiratory Syndrome Coronavirus-2 in Healthcare Workers in a Tertiary Care Centre, Chennai, India

Introduction: Globally, the Coronavirus Disease-2019 (COVID19) pandemic poses a high risk for Healthcare Workers (HCWs) who are among the population that is most vulnerable of being infected with Severe Acute Respiratory SyndromeCoronavirus-2 (SARS-CoV-2). With a prevailing pandemic such as COVID-19, it becomes important to understand the presence and persistence of antibodies in the serum of HCW, testing positive for COVID-19 on Reverse transcriptase Polymerase Chain Reaction (RT-PCR). An understanding of the prevalence of IgG antibodies against COVID-19 and the duration for which they are present in the serum will help in predicting the immune response of individuals against the disease. Aim: To study the prevalence of COVID-19 IgG antibodies in laboratory confirmed COVID-19 RT-PCR positive symptomatic, asymptomatic and RT-PCR negative subjects. Materials and Methods: The present longitudinal study was conducted from April to December 2020 with a sample size of 90 participants based on a pilot study. Blood sample was collected and serum was separated. Enzyme Linked Immunosorbent Assay (ELISA) was done to detect the presence of COVID-19 IgG antibody in serum. Chi-square test and Pearson correlation were used to find out the statistical significance of COVID19 IgG antibodies in COVID-19 positive and negative HCWs and the relationship between Cycle threshold values (Ct) and antibody levels, respectively. Results: Fever with sore throat was the most common (33%) symptom. Chi-square test done to compare IgG among RTPCR positive and negative subjects showed p-value of <0.0001 which was significant. However, statistical significance was not found (p-value 0.9973) with respect to COVID-19 IgG antibodies in RT-PCR positive COVID-19 asymptomatic and symptomatic subjects. Mean antibody index in symptomatic and asymptomatic was 3.7743±1.9834 and 3.571±1.7961, respectively. Average number of days, the antibodies persisted was 25 days-266 days. Conclusion: The prevalence of COVID-19 antibodies among RTPCR positive symptomatic, asymptomatic and RT-PCR negative subjects was 87.8%, 66.7% and 26.7%, respectively. The maximum number of days antibodies persisted was 266 days. Further studie will elucidate whether these antibodies prevent re-infection.

Prevalence of Hamstring Tightness in Young Orthopaedic Surgeons

Atul Sareen, Jatin Prakash, Vikas

Introduction: Hamstring is a group of muscles that form an important part of core muscles (lumbo-pelvic and hip complex) and their tightness may reduce the lumbar lordosis thereby potentially decreasing the absorption of force, affecting posture, range of motion of lower limbs and increasing the possibility of developing Low Back Pain (LBP). The study was planned to test hamstring tightness in group of Orthopaedic Surgeons as this group has been shown to be prone to develop back pain. Aim: To find prevalence of hamstring tightness in young Orthopaedic Surgeons who do not suffer from back pain. Materials and Methods: This was a cross-sectional observational study conducted at a tertiary care centre. Eighty two Orthopaedic Surgeons, between ages 24-35 years, were enrolled in the study. The height and weight of the subjects were recorded using a standardised medical scale. Age and medical history were recorded using a questionnaire. Knee extension angle were measured by active knee extension test. Measure less than than 20 degree was considered normal. A 21-30 degree was regarded as mild tightness, 31-40 degree as moderate tightness and >40 degree as severe tightness. Results: Prevalence of hamstring tightness among Orthopaedic Surgeons in the series was 86.6%. Eleven surgeons (13.4%) did not have any hamstring tightness on either side. Rest all had some degree of hamstring tightness. There was no side predominance for hamstring tightness and both sides were equally involved (p=0.67). The mean tightness on right side was 30.83 degree and left side was 31.11 degree. Further, there was no relation of Body Mass Index (BMI) and hamstring tightness. Conclusion: Prevalence of hamstring tightness is very high among young Orthopaedic Surgeons. Hence, they should be made aware of the condition and further preventive measures should be encouraged.

Microbiological Profile of Pin Tract Infections due to External Fixators

Introduction: Pin tract infections are complications associated with external fixators. Proper diagnosis and treatment can prevent further complications related to the infection. There are limited numbers of studies on this infection and thus treatment is usually based on individual’s experience. Therefore, this study was undertaken to have a better understanding of pin tract infections and to help us establish a treatment protocol in the hospital. Aim: To determine the incidence of pin tract infections among all patients who have external fixators, to identify the causative agents and study their antibiotic sensitivity pattern. Materials and Methods: The present study was a cross-sectional study which was conducted in a tertiary hospital for patients who had external fixators. After obtaining ethical clearance and informed consent from the patient, all patients were monitored and if there was clinical suspicion of infection, discharge/pus was collected from the infection site and processed in the microbiology laboratory as per standard laboratory protocol to isolate and identify the causative agent. Antimicrobial susceptibility using Kirby Bauer’s disc diffusion method. Statistical analysis was done by using Microsoft excel 2010. Results: It was found that out of the 30 patients included in the study, six patients showed clinical evidence of pin tract infections with male preponderance. The most common isolate was Acinetobacter baumanii followed by Pseudomonas aeruginosa, Citrobacter koseri with variable antibiotic susceptibility pattern. Conclusion: Pin tract infection occurred in 20% of the patients. Early diagnosis and treatment prevents complications which further reduces the cost of treatment and the number of days of hospital stay.

Reliability of Thrombocytopenia in Sepsis as a Predicting Tool for ICU Mortality

Akash Shridharani, Labani Ghosh, Jyoti Mannari

Introduction: There are many easy reproducible scores used in Intensive Care Unit (ICU) to predict mortality. But these need to be reassessed on a regular basis. There are many variables used to calculate these scores. But there can be some loss of data as the scores are repeated 24-48 hours apart and have many parameters which may make the process less user friendly. Aim: To study the predictive value of new onset thrombocytopenia as an effective tool in predicting mortality in septic patients. Materials and Methods: In this prospective observational study, 200 patients with thrombocytopenia at admission or at any time during ICU hospitalisation between 1st February 2015 to 1^st November 2016 were selected; patients hospitalised for less than 24 hours were excluded. Thrombocytopenia is defined as a platelet count lower than 150,000/mm³ , and recovery is defined as returning to levels above 150,000/mm³ after showing thrombocytopenia. Admission prognosis variables Acute Physiology, Age and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) Score and platelet counts during the hospitalisation and outcomes were assessed using descriptive statistics, Chi-square test and One-way Analysis of Variance (ANOVA). Results: Out of 200 patients included, overall incidence of thrombocytopenia was 29.83%. The mean age was 49 (SD 18.24) years and mean duration of stay was 8.85 (SD 6.58) days. Maximum patients belonged to the age group of 18-30 years and 51-60 years. Total 89 (44.5%) of the 200 had sepsis and out of them 24 patients died, therefore, mortality rate among those in sepsis with thrombocytopenia was 27%. Mean SOFA score and APACHE II scores were 6.32 (SD 3.44) and 14 (SD 7.89), respectively. In the patients with thrombocytopenia and poor outcomes in the form of death or Discharge Against Medical Advice (DAMA), the SOFA scores were 9.04 and 6.96, respectively (p=0.0438). Similarly, patients with sepsis and thrombocytopenia who had either died or given DAMA the mean APACHE II scores were 18.66 and 17.96, respectively (p-value 0.0492). Conclusion: There was a significant association between, APACHE II and SOFA scores with new onset thrombocytopenia. Therefore, it can be used as an independent individual variable to predict mortality in patients of sepsis with thrombocytopenia.

Intravascular Administration of Isotonic Saline versus Polymerised Gelatin in the Prevention of Spinal Induced Hypotension: A Randomised Clinical Trial

C Sreekanth, T Gurumurthy

Introduction:Hypotension remains one of the most common problems associated with subarachnoid blockade. A number of strategies have been developed for its prevention, of which administration of fluids prior to subarachnoid block holds the importance. Gelatin is a colloidal plasma volume expander obtained from degraded gelatine. It is as effective as albumin solution in the treatment of spinal induced hypotension. Aim: To compare the incidence and frequency of hypotension after subarachnoid block in patients receiving colloid (polymerised gelatin) or crystalloid (0.9% normal saline) as prehydration and compare side-effects of colloid and crystalloid prehydration. Materials and Methods: A total of 60 patients scheduled for elective Transurethral Resection of Prostate (TURP) surgery were selected to participate in this prospective randomised double-blind study for a period of two years from April 2006 to April 2008. Patients were randomly allocated into two groups of 30 patients each. Group H received 500 mL of polymerised gelatine (Haemaccel) solution and group N received 1000 mL of 0.9% normal saline 15 minutes prior to subarachnoid block. Intraoperative monitoring includes Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR) for 30 minutes. Incidence of hypotension and number of mephentermine boluses were noted. Statistical analysis of data was determined with Mann-Whitney U test and Analysis of Variance for Repeated Measures (ANOVA). Chi-square test was used to find out possible associations. Results: After spinal anaesthesia mean systolic blood pressure decreased in both the groups and was lower in group N compared to group H (97±18.9 vs 102±9.26 mmHg). There was fall in diastolic blood pressure in both the groups and was maximum at 20th minute in group N and group H (66.37±5.47 vs 64.67±10.30). There was highly significant (p<0.01) fall in mean arterial pressure in group N. The change in the heart rate was highly significant (p<0.01) at different time interval in both the groups. Vasopressor was required in 90% and 60% patients in group N and group H, respectively. No statistical difference in the incidence of nausea and vomiting in both the groups. Conclusion: The present study showed that preloading of fluids either with colloids or crystalloids prior to subarachnoid block reduces the incidence of hypotension but not completely eliminating it, also showed that colloids offset hypovolemia and hypotension more effectively than crystalloids in patients undergoing TURP surgery.

Association of Interleukin-6-174G/C Gene Promoter Polymorphism with Rheumatoid Arthritis in Adolescence: A Case-control Study

Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune disease with unknown pathogenesis. The disease is multifactorial, however, the exact causes of the occurrence, as well as the targets of the autoimmune process, are unknown. Genes candidate for a predisposition to RA are cytokine genes. Of the cytokines, IL-6 is considered a key mediator of systemic and localised inflammation in RA. Aim: The comparative analysis of the frequency distribution of alleles and genotypes IL-6-174G/C polymorphism in patients with RA and in the control group to determine the genotype most characteristic of this disease. Materials and Methods: This case-control study was conducted in a group of 136 children with RA aged 14 to 18 years. In the control group, there were 143 practically healthy children of similar age without RA and orthopaedic pathology. Both groups were tested for polymorphism IL-6-174G/C using real-time Polymerase Chain Reaction (real-time PCR). The results were statistically processed using the Pearson’s Chi-square test. Results: The distribution of 174G/C genotypes in the IL-6 gene was significantly different in patients with RA when compared with the control group. In patients with RA, heterozygous carriers of 174G/C (52.94%) prevailed, while in the control group the most numerous group were homozygous carriers of -174G/G (40.56%). Conclusion: As a result of this study, it was possible to identify significant differences in distribution of genotypes 174G/C polymorphism in IL-6 gene between patients with RA and subjects of the control group. In relation to the European population of the Russian Federation, this polymorphism can serve as a diagnostic marker in the study of the pathogenesis of RA.

Phenotypic Variation of Insulin Resistance among Polycystic Ovarian Syndrome Patients in Semiurban North Indian Population

Chaitali Maitra, Ramesh Chandra Gupta, Rishika Raj

Introduction: Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder in the women of reproductive age. Studies show that there is an intensive relationship between insulin and gonadal function. As per Rotterdam Criteria, there are four major phenotypes of PCOS with different presentation. Early detection of Insulin Resistance (IR) and consequential prevention of Metabolic Syndrome (MS) associated with PCOS may lead to better prospect for the disease. Aim: To find the pattern of IR in all the phenotypes of PCOS in relation to Waist Hip Ratio (WHR), Body Mass Index (BMI) and Testosterone and thereby, providing data for designing phenotype specific treatment of the disease. Materials and Methods: In this cross-sectional observational study, fasting insulin and fasting glucose were analysed to calculate Homeostasis Model Assessment (HOMA-IR) and Testosterone for total 144 female subjects of reproductive age group (18-40 years). Subjects were classified in to four groups as per Rotterdam Criteria. Complete PCOS (PCOCOM), PCO with Oligo/Anovulation (PCO-O), Anovulation with Hyperandrogenism (O-HA), and PCO with Hyperandrogenism (PCO-HA). Regression analysis was done to find the relation among the study variables. Analysis of Variance (ANOVA) was used to analyse the significant variance among the groups. Results: IR was found to be maximum among O-HA phenotype (2.4±0.37) and lowest among PCO-HA phenotypes (1.3±0.22). Regression analysis shows that there exist significant associations between IR and BMI (t=4.96, p=0.001) as well as between IR and WHR (t=2.97, p=0.003). No independent association between testosterone and IR was observed. Conclusion: Significant difference of IR, WHR, and BMI was observed among the four phenotypes of PCOS. Due to increased IR, O-HA and PCO-COM phenotypes are more predisposed to Cardiometabolic consequences of PCOS.

Comparative Evaluation of Vitamin E and Glutathione Peroxidase Levels in Salivary Samples of Children with and without Dental Caries

Introduction: Multiple factors influence the initiation and progression of caries. Recent research has revealed that free radicals can be a prime cause of several inflammatory oral pathologies, including dental caries by direct or indirect influence on the salivary constituents like disease mediated free radicals and antioxidants. Aim: The aim of the present study was comparative evaluation of Vitamin E and Glutathione Peroxidase levels with the prevalence of dental caries in a group of school-going children. Materials and Methods: The present cross-sectional clinical study was conducted in Department of Pedodontics and Preventive Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India from November 2016 to November 2018. Hundred children aged between 6-12 years were selected and divided into two groups i.e., caries active group (n=50) and caries-free group (n=50). Children having atleast five decayed teeth were considered as caries active and children with DMFT/deft score 0 were considered as caries-free group. A 2 mL of unstimulated saliva was collected from all the subjects and the levels of Glutathione Peroxidase (GPx) and Vitamin E were evaluated by spectrophotometric assay. Obtained imbibing values were subjected to statistical analysis using unpaired t-test and Statistical Package for the Social Science (SPSS) Version 21.0 software. The p-value <0.05 was considered statistically significant. Results: Of the 100 participants, 52 were males and 48 were females. The mean age of the study participants was 10.21±1.4 years. Significant reduction in GPx (p<0.001) and Vitamin E (p<0.05) were noticed in caries active group when compared to the caries-free group. Conclusion: GPx and Vitamin E levels showed an inverse relationship with the presence of dental caries. Thus these antioxidant levels can be used as biomarkers to assess the oral as well as general health. Caries activity can also be measured by these salivary factors which might be helpful in preventive dentistry.

Interplay among the Variants of One Carbon Metabolism, Methylenetetrahydrofolate Reductase Polymorphisms and Lung Cancer

Mandeep Kaur Sodhi, Varinder Saini, Vishal Sharma, Jasbinder Kaur, Jagdeep Kaur

Introduction: Folates perform an integral task in Deoxyribonucleic Acid (DNA) synthesis, methylation and repair. Methylenetetrahydrofolate Reductase (MTHFR) potrays a key part in the metabolism of folate and regulates the equilibrium between the various forms of folate for DNA synthesis and DNA methylation. The MTHFR irrevocably transforms 5,10 methylenetetrahydrofolate to 5-methyltetrahydrofolate, the principal circulating folate and the carbon donor for remethylation processes. It is vastly polymorphic in the general population. Aim: To study the association, if any, between the variants of one carbon metabolism, MTHFR polymorphisms and risk of lung cancer. Materials and Methods: It was a case-control study conducted during March 2010 to September 2011 in the Department of Pulmonary Medicine in collaboration with the Department of Biochemistry at Government Medical College and Hospital, Chandigarh, to see whether any association exists between the variants of one carbon metabolism, MTHFR polymorphisms (C677T and A1298C), and lung cancer. Twenty biopsy proven lung cancer patients and 20 age and sex matched cancer-free controls were selected. Results: The mean serum folate in cases was higher (12.84 ng/ mL±7.527 ng/mL) as compared to controls (4.46 ng/mL±1.346 ng/mL), suggesting that high levels of serum folate are associated with lung cancer. There was no significant variance in the levels of vitamin B12 and plasma homocysteine between cases and controls. No MTHFR polymorphism C677T was seen in the blood and the bronchial biopsy samples of all cases as well as blood samples of all the controls. The MTHFR polymorphism A1298C was present in the blood as well as bronchial biopsy samples of cases as well as blood of controls. Thus, in the present study, there was no relation of this polymorphism with lung cancer. Conclusion: Polymorphisms in MTHFR may contribute to lung cancer. More research on the basis of cellular and molecular mechanisms of lung cancer is urgently needed to aid in understanding of pathogenesis of the disease.

Seasonal Variation in Epistaxis in Districts of Upper Assam: A Cross-sectional Study

Introduction: Epistaxis whether spontaneous or acquired is one of the most common Ear, Nose, Throat (ENT) emergencies. Its management can be challenging depending on the origin of bleeding and presence of precipitating factors. Aim: To find out the seasonal variation in epistaxis according to age, gender, region and aetiological factor. Materials and Methods: This cross-sectional study was conducted from June 2019 to June 2020 in a tertiary care centre in Upper Assam, India. In this study, the seasons were divided according to weather atlas as follows: Winter- December, January, and February; Spring- March and April; Summer- May and June; Monsoon- July, August and September; and AutumnOctober and November. The data collected was tabulated in Microsoft Excel worksheet and the categorical variables were summarised as proportions and percentages. Results: Out of 313 patients, 221 (70.6%) were males and 92 (29.4%) were females. High male preponderance with male to female ratio of 2.4:1 was noticed. Maximum number of patients were seen in month of October, 66 cases (21%). Minimum male patients were seen in month of June 2020 2 cases (0.6%) and minimum number of female patients were seen in the month of February and April (0.3%). Conclusion: The major cause of epistaxis in this region is hypertension, therefore peripheral health facility should be ready for treatment.

Effect of Body Mass Index on Occupational Health of Clinicians: A Descriptive Study

Harpreet Singh Gulati, Upendra Kumar Gupta, Ambica Wadhwa

Introduction: Clinicians in the present scenario are always exposed to constant and sustained levels of physical and mental stress. As they form the backbone of healthcare setup, the health of clinicians themselves is a very significant factor towards providing good health to all. Aim: To determine the effect of Body Mass Index (BMI) on Work Related Musculoskeletal Discomfort (WMSD) and Occupational Stress (OS) in clinicians. Materials and Methods: The descriptive study with inferential design was conducted on 200 clinicians working in Outpatient Departments (OPDs) of National Institute of Medical Sciences and Research, Jaipur, Rajasthan and Punjab Institute of Medical Sciences, Jalandhar, Punjab, India and various private hospitals in Jalandhar from July 2019 onwards till December 2020. The BMI was calculated as ratio of weight (kg) to the square of height (m). The WMSD and OS were determined through reliable and valid questionnaires and their values were associated with demographic variables via statistical tests of Chi-square, ANOVA and student t-test to infer their inter-relational significance. Results: High BMI was reported more in above 40-yearold clinicians with higher incidence in surgical doctors than medical doctors. Majority (n=115) 57.5% of the clinicians were found to have mild musculoskeletal discomfort followed by no discomfort (23%) while 19.5% of them exhibited moderate to severe discomfort. Female clinicians showed more level of discomfort than male clinicians. The BMI has high significance in relation to the questionnaire score. Clinicians with BMI >25 also showed high percentage (57.1%) of moderate and severe levels of OS. Conclusion: The BMI is positively related to physical as well as mental well-being of clinicians, especially in the middle age group. This information serves as an awareness and warning signal for the clinicians to safeguard their own health.

Assessment of Salivary Lipid Profile Parameters in Healthy and Type 2 Diabetes Mellitus Patients

Introduction: Recent studies suggest that saliva could be functionally equivalent to serum in reflecting the physiological state of the body. Studies are being conducted to develop saliva as a tool for the screening and monitoring of chronic systemic diseases like Diabetes mellitus. Dyslipidaemia is most commonly assessed by laboratory lipid profile analysis in serum sample. This study is a step towards validation of saliva as a tool for the screening and monitoring of dyslipidaemia. Aim: To measure, compare and correlate the serum and salivary lipid profile parameters {Total Cholesterol (TC), High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL)} in Type 2 Diabetes mellitus patients and healthy individuals. Materials and Methods: The case control study was carried out for a period of one year i.e., from March 2019 to February 2020. The study comprised of 200 participants between the ages 31-70 years. The participants included 100 diabetic subjects with a history of diabetes for at least three years and 100 age matched subjects as controls. TC, HDL and LDL was estimated by using kits based on spectrophotometric principle. Statistical analysis was done on Statistical Package for Social Sciences (SPSS) Version 16.0. Mean, Standard deviation, Pearson’s correlation coefficient, along with regression analysis was carried out and compared between the groups. Results: There is a significant difference between the salivary TC, HDL and LDL levels in healthy individuals and diabetics. A strong and significant positive correlation of serum TC (Pearson correlation coefficient ‘r’=0.87 for controls, 0.66 for diabetics, p<0.01), HDL (Pearson correlation coefficient ‘r’=0.78 for controls, 0.88 for diabetics, p-value <0.01) and LDL (Pearson correlation coefficient ‘r’= 0.81 for controls, 0.87 for diabetics, p-value <0.01) levels with its respective salivary levels was obtained in all the participants (controls and diabetics) of the study. The regression coefficient was calculated and a formula was derived for prediction of serum lipid profile parameters using their respective salivary levels. Conclusion: Standardisation of the techniques for the estimation of salivary lipid profile parameters, including triglycerides and Very LDL (VLDL) and setting up a reference range will also make it useful in clinical practice.

Evaluation of Ropivacaine versus Ropivacaine with Fentanyl for Postoperative Epidural Analgesia in Patients Undergoing Elective Lower Abdominal Oncosurgeries- A Randomised Clinical Study

SS Srihari, Ks Henjarappa, BH Arathi, NR Rashmi, VB Gowda, Namrata Ranganath

Introduction: Epidural analgesia has emerged as one of the preferred and convenient modes of intraoperative and postoperative management owing to advantage of not interfering with metabolic functions, better tolerability and decrease in reflex activity, similar analgesic properties, less motor blockade and decreased propensity of cardiotoxicity. Neuraxial opioids like fentanyl used in epidural analgesia offer advantage of augmenting local anaesthetic effect and reducing the anaesthetic and analgesic requirement. Aim: To compare the adequacy of analgesia, requirement of rescue analgesics between 0.2% ropivacaine and 0.2% ropivacaine with 2 mcg/cc fentanyl. Materials and Methods: The randomised clinical study was carried out from September 2016 to May 2018 in 70 patients (35 in each group) of American Society of Anaesthesiologists (ASA) I and II scheduled for elective lower abdominal oncological surgeries. The anaesthetic intervention in group R was 0.2% ropivacaine and group RF was 0.2% ropivacaine with 2 mcg/cc fentanyl. All data was statistically analyzed and compared using Student t-test, Chi-square/Fisher-Exact test. The p-value <0.05 was considered to be significant. Results: Both the groups were compatible with regard to demographic data and haemodynamic variables. The mean Visual Analogue Scale (VAS) were higher in group R compared to group RF at 0, 2, 4, 12, 18 and 24 hours but the observed difference in both the groups was not statistically significant except at 1 and 6 hours. Number of rescue analgesics as epidural boluses (p-value=0.007) and paracetamol (p-value=0.022) requirement were more in group R compared to group RF respectively. Conclusion: On account of adequate postoperative analgesia, haemodynamic stability, ropivacaine with fentanyl is a better option than ropivacaine alone for epidural infusion.

Indian Sandbur (Bhurut) as a Foreign Body in Upper Aerodigestive Tract- A Cross-sectional Study from Western Rajasthan

Vikas Devra, Ruchi lakhawat, Bhikham Chand, Rajesh Kumar Singh

Introduction: Indian sandbur is an unusual foreign body which is accidentally ingested or inhaled in aerodigestive tract and can cause drastic complication. Indian sandbur (known as bhurut in the local language) is the seed of the grass Cenchrus biflorus. It is an important annual grass species in drought-prone areas of arid and semi-arid ecosystems. In India, it is predominantly found in western Rajasthan. Aim: To describe a case series of unusual foreign body Bhurut in the upper aerodigestive tract in western Rajasthan, India. Materials and Methods: The cross-sectional (retrospective) study was conducted on 21 patients, that presented to the study institute with accidental ingestion of Indian sandbur. The data belonged to a period from January 2020 to December 2020. The medical records of the patients were analysed and data were collected using a structured questionnaire. The questionnaire included information such as age, sex, anatomical lodgement of foreign body, signs, and symptoms, duration of lodgement before confirmation and removal. Results: The mean (SD) age of patients was 33.47 (17.41) years. Majority of the patients were males (66.66%). The most common site of impaction was vocal cords of the larynx, seen in seven (33.33%) patients. The most common presenting symptom was foreign body sensation. In all cases, the foreign body was successfully removed either under local (11 cases) or General Anaesthesia (GA) (10 cases). In the postoperative period, persistence of hoarseness of voice was observed in three patients. Conclusion: Bhurut should be suspected in patients presenting with foreign body ingestion, associated with a desert region. Removal of the bhurut under local or GA achieves good results.

Characterisation of Plasmids in Multidrug Resistant Uropathogenic Gram-negative Bacterial Isolates

Manish Ranjan, Mahadevan Kumar, Sourav Sen, Parijat Das, Kunal Kanti Lahiri

Introduction: Urinary Tract Infections (UTI) are one of the commonest conditions for which people seek medical care with an estimated 150 million episodes per annum worldwide. An unprecedented upsurge in the rate of development of antimicrobial resistance has reduced the therapeutic options leading to increased morbidity, prolonged hospital stays, development of complications. Majority of these infections are attributable to Gram negative bacteria which have now acquired resistance to almost all classes of antibiotics. Aim: To analyse the plasmid-mediated drug resistance and characterise the major plasmid families that are in circulation. Materials and Methods: A cross-sectional study comprising of a total of 95 non consecutive multidrug-resistant gram-negative bacterial isolates were subjected to Plasmid based replicon typing from January 2017 to June 2018. The 18 major replicons were divided in five multiplex and three uniplex Polymerase Chain Reaction (PCR) formats and the samples were subjected for plasmid characterisation and further sequencing of the plasmid Deoxyribonucleic Acid (DNA). The data obtained was analysed by Microsoft Excel software. Results: Escherichia coli, accounted for maximum n=51 (53.7%), Klebsiella pneumoniae n=19 (20%), Citrobacter sp n=11 (11.6%), miscellaneous gram negative n=14 (14.7%) The isolates exhibited a high degree of resistance to almost all tested antibiotics, sparing a few like Fosfomycin, Chloramphenicol, Imipenem, Amikacin. A total of 154 different plasmid families were detected from the 95 isolates. FIB replicon (24%), FIA (21%), F, W (20%), FIC, B/O (14%), Y (12%), I1 replicon (10.5%) were the major plasmid families detected in the present study. Conclusion: Many isolates exhibited the presence of more than one Incompatibility (Inc.) group plasmids, conferring multidrug resistance to the isolates. The study highlights the need for further research to study the association between plasmid families and their respective antibiotic resistance profiles for a given geographical niche and the need to devise further methods to target these epidemic plasmids.

Association of C-Reactive Protein with Mild and Severe Depression

Soni Singh, Sunita Tiwari, Wahid Ali, Shraddha Singh

Introduction: Depression is associated with increased serum C-Reactive Protein (CRP) levels in circulation. Inflammatory response is established as an important factor in the pathophysiology of depressive disorders. Increased levels of CRP are associated with Cardiovascular diseases. Aim: The objective of the present study was to assess the changes in circulating CRP level according to severity of depression. Materials and Methods: A cross-sectional study was conducted in Physiology Department of KGMU, Lucknow, Uttar Pradesh, India, with time duration of one year. Study group comprised of 40 drug naïve depressive patients between the age group of 18-40 years enrolled in the study. Diagnosis of depression was based on International Classification of Diseases (ICD-10). Patients were divided into two groups (mild depression and severe depression) on the basis of severity of depression accessed via Hamilton Depression Rating Scale (Ham-D). Serum CRP levels were accessed on both groups by commercially available ELISA kit. Results: Statistically insignificant relationship was seen when age (p=0.14), Blood Pressure (BP) {Systolic Blood Pressure (SBP) (p=0.102) and Diastolic Blood Presure (DBP) (p=0.270)}, Body Mass Index (BMI) (p=0.539) were compared with both mild and severe depression group. Serum CRP levels and both the depression group (mild depression and severe depression) showed statistically significant relationship (p=0.015). Conclusion: It can be concluded that there exist a significant association of serum CRP levels with severity of depression. Patients with severe depression have lower levels of CRP as compared to patients with mild depressive symptoms.

Effects of Ketamine Gargle for Postoperative Sore Throat, Hoarseness of Voice and Cough Under General AnaesthesiaA Randomised Control Study

Dinesh Chauhan, Ankit Mankad, Jigisha Mehta, Tejash H Sharma

Introduction: Majority of the patient undergo endotracheal intubation for various time duration, when given general anaesthesia. Injury in airway mucosa or vocal cords due to endotracheal intubation can be a contributing factor. Ketamine without affecting local healing process has an anti-proinflammatory effect as it limits exacerbation of systemic inflammation. Aim: To study the role of ketamine gargles as a pharmacological measure in order to attenuate Postoperative Sore Throat (POST), Hoarseness of Voice (HOV) and cough followed by endotracheal intubation during surgeries under general anaesthesia. Materials and Methods: A randomised controlled study was carried out for a duration of 22 months on 50 patients of American Society of Anaesthesiologists (ASA) grade I and II. They were allocated into two groups of 25 patients. Group (K): ketamine 50 mg in 29 mL 0.9% normal saline and Group (C): 30 mL 0.9% normal saline. Patients were advised to gargle for 30 seconds just 5 minutes prior to induction of anaesthesia. Patients were intubated with appropriate size of the endotracheal tube and were extubated when fully awake and conscious. Patients were shifted to postoperative ward and were kept in propped up position with oxygen. Patients were assessed at 1,2,4,24 hours for incidence of POST, HOV and cough. Assessment was made as per the four point scale grading system. The statistical analysis was performed using unpaired t-test, p<0.05 considered statistically significant. Results: In terms of POST grading in both K and C groups p-value was statistically significant (p<0.05) at 1 and at 2 hours postoperatively. In terms of HOV, in group K voice quality issues were reduced till 24 hours, (p<0.05). In terms of cough, in group K there was a significant reduction in complaints of cough till four hours postoperatively, (p<0.05). Conclusion: Ketamine gargles is effective in attenuating POST and cough till 2 hours and HOV till 4 hours postoperatively in patients following endotracheal intubation.

Study of Effect of Nd:YAG Laser Capsulotomy on Corneal Endothelium: A Teaching Hospital Based Prospective Study

Amit Hemant Pathak, Ajit Kamalakar Joshi, Sai Divya Nellutla

Introduction: Posterior Capsular Opacification (PCO) is a condition which develops months or years after cataract surgery. The Neodymium Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy is the procedure of choice for PCO and its adverse effects include intraocular pressure elevation, cystoid macular oedema, corneal endothelial cell damage, retinal detachment and Intraocular Lens (IOL) pitting. Aim: To assess the corneal endothelial structure and function before and after Nd:YAG laser capsulotomy in patients with PCO using specular microscopy. Materials and Methods: This was a prospective observational study carried out in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India on 50 eyes of 50 patients having PCO. This study was conducted in the time period between October 2020 to February 2021 for four months. Patients were subjected to Nd:YAG laser capsulotomy in the affected eye and were followed-up at one week and one month postprocedure. Specular Microscopy was used to evaluate the Endothelial Cell Density (ECD), Coefficient of Variation (CV) and Hexagonality of endothelial cells before and after laser capsulotomy. Statistical Package for Social Sciences (SPSS) version 26.0 was used for the statistical analysis. Chisquare test and Analysis of Variance (ANOVA) test are the tests of significance applied in this study. Results: Forty-five patients (90%) gained Best Corrected Visual Acuity (BCVA) of >6/18 after one week and 47 patients (94%) gained BCVA of =6/18 after one month postprocedure. Mean ECD prelaser was 2356.76 cells/mm² , which decreased to 2231.8 cells/mm² at one week and 2199.2 cells/mm² at one month follow-up. The difference between prelaser ECD and at one week and one month was 124.96 cells/mm² and 157.56 cells/ mm² , respectively, which was statistically significant at one month (p<0.0001). The mean CV prelaser was 33.74, at one week was 35.58 and at one month it was 37.22. The difference in CV from prelaser status to one month was statistically significant (p<0.0001). The mean hexagonality at baseline was 65.34% which decreased to 62.02% at one week and 60.42% at one month follow-up. The difference in hexagonality between one month and baseline was statistically significant (p<0.0001). Conclusion: The Nd:YAG laser capsulotomy is a safe, effective and non invasive method for the treatment of PCO. However, it causes structural and functional corneal endothelial cell damage.

Comparison of Manual, Semi-automated and Fully-automated Enzymatic Methods for High Density Lipoprotein Estimation- A Cross-sectional Study

Nagraj A Hosmani, Vanishree S Bubanale

Introduction: Spherical particles with nonpolar neutral lipids at the center and more polar amphipathic lipids at their surface are called Lipoproteins. High Density Lipoprotein (HDL) aids in cholesterol homeostasis by removing it from cells by several different mechanisms. The results of HDL Cholesterol (HDL-C) should be accurate and reliable, especially for the patients with borderline values, where the variation resulting from the methodology used may interfere with the interpretation of clinical scenario by the doctors. Aim: To compare the results of HDL values obtained by using three different technical methods. Materials and Methods: The present study was conducted using 30 serum samples from the Biochemistry laboratory of KLE Society’s Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi, Karnataka, India for HDL values, each for the three different technical methods (fully-automated, semi-automated and manual method). The data obtained was analysed statistically by computing descriptive statistics the mean, standard deviation and correlation coefficient. Results: Results of serum samples analysed for HDL-C values ranged from 31-79 mg/dL (mean 43.1) in fully-automated analyser, 28.06-75.18 (mean 39.6) in semi-automated and 27.06-62.7 mg/dL (mean 39.7) using manual method. There was significant difference in the mean values of HDL-C values obtained using the three different methods and positive correlation was established on comparing semi-automated and manual method (Semi-automated v/s manual method, r=0.827) and found to be statistically significant. Conclusion: As HDL estimation is routinely done in many of the clinical laboratories, a sound knowledge of the HDL values obtained using different techniques can help the clinicians while ordering for the test and also for diagnosing and monitoring of the cases with various lipid abnormalities.

An In-vitro Evaluation of Microbial Adhesion on Different Types of Orthodontic Brackets

Vedant Patni, Kuldeep Dmello, Jitesh Wadhwa, Mora Sathi Rami Reddy, Atul Singh

Introduction: Information regarding the adhesion of bacterial species and plaque accumulation to bracket material is limited. Adequate information is needed in order to offer patients orthodontic treatment without significantly increasing their risk of developing white spots, caries, or gingival inflammation. Aim: To determine the levels of the caries inducing Streptococcus mutans species on metallic, self-ligating and ceramic brackets and to compare the total bacterial counts and counts of species present on these bracket materials. Materials and Methods: In this in-vitro study, six commercially available bracket systems {3M Gemini (A), American Orthodontics (B), Ormco (C), Begg (D), Ceramic (E) and Self-ligating (F)} were compared. The brackets were bonded in the cell well culture plate and the agar plates were prepared. Brain heart infusion medium including bacteria and artificial saliva was introduced to each bracket system containing 10 premolar brackets and were incubated. After 72 hours, the adherent bacteria were then detached by sonication and the Colony-Forming Units (CFU) of Streptococcus mutans were calculated on each bracket and were analysed using Statistical Package for the Social Sciences (SPSS) software version 17.0 for Windows. Results: Between the different bracket types, significant differences were found in terms of biofilm formation. The Begg brackets showed the least bacterial adhesion and the selfligating brackets showed the highest bacterial adhesion and was statistically significant among all the groups (p<0.05). Ceramic brackets also showed a higher bacterial adhesion after the self-ligating brackets. Among the three groups of metallic brackets, 3M brackets showed the least bacterial adhesion but was statistically insignificant (p>0.05). Conclusion: Different orthodontic brackets serve as different loci for biofilm formation showing that the Begg brackets are the most hygienic among all the brackets taken in this study.

Assessment of Dermatology Life Quality Index in Vitiligo Patients Treated with Narrow Band Ultraviolet B Therapy: A Prospective Interventional Study

AS Sanjana, Rajendra Okade

Introduction: Vitiligo is a disorder of skin pigmentation that is associated with tremendous psychological impact on the affected patients. The prevalence of vitiligo range from 0.1% to 8%. Narrow Band Ultraviolet B (NBUVB) therapy has been reported to be effective and a safe tool in vitiligo. Aim: To determine the effect of NBUVB treatment on vitiligo patients and to assess the impact on Dermatology Life Quality Index (DLQI) of patients after the therapy. Materials and Methods: This was a prospective study conducted pre and post intervention (NBUVB) on all the vitiligo patients attending Dermatology Outpatient Department (OPD) at our Institute from January 2019 to June 2019. The estimated sample size was 80 patients. The patients who met the inclusion criteria underwent whole body NBUVB irradiation. The treatment was started with an initial dose of 300 mJ/cm₂ in all the cases. It was administered two days per week on non consecutive days. The irradiation dose was increased by 50 mJ/cm₂ on each subsequent visit until the optimal dose was obtained to have a minimal erythema in the lesion. The DLQI questionnaire designed by Finlay and Khan was used to determine the quality of life impairment in the study patients. The DLQI scoring was done twice, the first scoring at the start of therapy and the second scoring at the end of therapy. The data was analysed using Statistical Package for the Social Sciences (SPSS) 20.0 version software for determining statistical significance. Chi-square test, Fisher-exact test and odds ratio were used to check for the associated factors, p-value <0.05 was considered to be statistically significant. Results: A total of 79 patients were included in the study. Age ranged from 18 to 72 years, with a mean age of 43.2±15.14 years. The sex distribution among study patients was almost equal, with 39 females and 40 males. The duration of NBUVB irradiation ranged from two months to six months. The cumulative number of NBUVB irradiation sessions ranged from 14 to 48, with an average of 22.65±7.42 sessions. The grade of repigmentation in the study group was excellent in 2 (2.5%), good in 52 (65.8%), average in 25 (31.7%) and poor in none. The baseline DLQI score distribution ranged from 6 to 28, with mean score of 11.76±3.69. The end of therapy DLQI score ranged from 0-7, with mean score of 2.58±2.32. The difference between the mean baseline DLQI score and end of therapy DLQI score was statistically significant. Conclusion: The NBUVB treatment is effective on vitiligo patients in achieving repigmentation of depigmented patches. The baseline DLQI score of vitiligo patients were high, and it significantly decreased after the NBUVB therapy

Environmental Impact of Food, Fruit and Vegetable Waste during COVID-19 Pandemic: A Review

Mahd Zia, Sirajuddin Ahmed, Anil Kumar

Apart from the major health impact, Coronavirus Disease-2019 (COVID-19) has impacted almost all sectors across the world. One of them is food, Fruit and Vegetable Markets (FVM). Lockdown implementation had different impacts in different countries, like Canada and the United Kingdom (UK) where they have logistics and supply chain of food, fruits and vegetable items and noted a shift in supply from food service to the retail channel, although the fresh food supply remains unaffected. A similar trend was seen in the metro cities of India, where online shopping has increased. In the food supply sector, both retailers and farmers had to face difficulty in storing, transporting, and selling of the goods and had to bear losses due to increased wastage. Although with an increased demand, organic farming has increased but still increased expenditure, less yield, and selling of the products are the major challenges in front of them. Food, fruit and vegetable wastes have considerably reduced at the food supply due to the obvious impact of lockdown on food supplies, however, a shortage of cold storages and supply chain at the farmer level in developing countries has resulted in more wastage. Developed countries reported increased illegal dumping of wastes in the rural areas and the stoppage of the recycling services due to the lockdown. Also, a shift in the habits of the consumer due to health and food-related issues has been seen throughout the world resulting in reduced waste generation at the consumer level. Despite all this, agricultural producer and the retail industry appears to be best placed to weather the storm. The major challenges related to the industry are sustainability in the food chain and maintaining smooth logistics and necessary precautionary measures in the event of health crises in the future.

Plasmid Derived AmpC Genotypes among the Multidrug Resistant Enterobacteriaceae Strains Isolated from Urine Samples in Southern India

P Ronni Mol, Ganesan Shanthi, Khalid Bindayna

Introduction: The most common pathogens causing Urinary Tract Infections (UTI) in community and hospital settings are Enterobacteriaceae. Antibiotic resistance is a major problem worldwide because of an increase in the use of antibiotics. Production of Extended Spectrum Beta-Lactamases (ESBLs) and AmpC beta-lactamases is the most common cause of resistance among Enterobacteriaceae (AmpC). Initially, AmpC b-lactamases received less attention globally, but now it has become a rising problem. Detection of AmpC ß-lactamases expressing microbes is a requirement for addressing surveillance, for problems of hospital infection control, and for choosing optimal antimicrobial therapy. Aim: To study the genotype distribution of plasmid mediated AmpC ß-lactamase produced in Enterobacteriaceae strains isolated from urine samples. Materials and Methods: A cross-sectional study based on clinical laboratory surveillance was conducted from July 2019 to February 2020. Sixty Enterobacteriaceae isolates were identified by standard biochemical reactions. AmpC screening were done by cefoxitin disk diffusion and confirmed by an inhibitor-based assay using boronic acid. The presence of six plasmid mediated AmpC genes was determined by multiplex Polymerase Chain Reaction (PCR). Statistical Package for the Social Science (SPSS) version 20.0 was used to obtain descriptive data. Results: Among 60 Enterobacteriaceae isolates, 23 (38.3%) were cefoxitin-resistant isolates which contain Escherichia coli strain (n=17) while the remaining samples consist of Klebsiella pneumoniae (n=5) and Proteus mirabilis strains (n=1). AmpC ß-lactamase production was phenotypically confirmed in 12 (20%) isolates and genotypically confirmed by PCR analysis in 16 (26.6%) of all the urine isolates. In the present study, 3 (13%), 2 (8.6%) of cefoxitin resistant isolates harboured the DHA, EBC gene and 1 (4.3%) each harboured FOX and CIT gene, and 9 (39.1%) harboured a combination of the genes. Conclusion: The present study suggested the predominant existence of plasmid mediated AmpC producers in Multi-Drug Resistant (MDR) Escherichia coli and Klebsiella pneumoniae. We suggest continuous surveillance is important to effectively control the spread of these strains and for optimal clinical outcome.

Impact of COVID-19 on Maternal and Neonatal Outcomes in Pregnancy: A Prospective Study

Introduction: The Coronavirus Disease-2019 (COVID19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global public health crisis. Pregnant women are known to be disproportionately affected by respiratory illnesses, which are associated with increased infectious morbidity and high maternal mortality rates. Aim: To study the management of COVID-19 in pregnancy and its perinatal outcome. Materials and Methods: This prospective observational study was conducted in the Obstetrics and Gynaecology Department in Government Medical College and Rajindra Hospital, Patiala from March 2020 to September 2020, to evaluate the effects of COVID-19 in pregnancy and to determine the maternal and foetal outcomes in COVID-19 positive patients. In order to evaluate the pattern of caesarean and vaginal deliveries in COVID-19 and non COVID-19 patients, Chi-square test was done. Results: A total of 150 COVID-19 positive patients were admitted to the COVID-19 labour room and out of them 142 (94.67%) were antenatal and 8 (5.33%) were postnatal. Total number of the deliveries in this period was 80 (53.33%) and out of them vaginal deliveries were 35 (23.33%) and caesarean section were 45 (30%). Out of 80, 6 (7.50%) babies with poor Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score were admitted to the Neonatal Intensive Care Unit (NICU) and 70 (87.50%) had good APGAR after delivery, four had Intrauterine Death (IUD). Conclusion: The pregnant women with suspected COVID19 who needed medical care were transferred to a hospital equipped with sufficient health facilities and fully trained clinicians to take proper care of critically ill obstetric patients for effective management.

Assessment of Nutritional Status and its Determinants among Under-five Children in Urban Slum Areas of Gwalior City, Central India

Feeding, Prevalence, Stunting, Underweight, Wasting

Persistence of Symptoms after Acute COVID-19 Infection- An Experience from a Tertiary Care Centre in South India

Introduction: Coronavirus Disease-19 (COVID-19) pandemic is posing a challenge not only with sheer number of people infected but also with the large number of patients with persistent symptoms of COVID-19 infection. A proper understanding of the magnitude and associated factors of persistent COVID-19 symptoms will go a long way in planning treatment and control strategies. Aim: To determine the proportion of patients who have persistent symptoms post acute COVID-19 infection and to determine the factors associated with it, among those who have been discharged from Government Medical College, Thrissur, Kerala, India. Materials and Methods: The current cross-sectional study was conducted among 335 patients who were admitted and discharged with COVID-19 infection in Government Medical College, Thrissur, Kerala, a tertiary care institution in southern India between December 2020 and February 2021. They were contacted through a telephonic interview 28 days from symptom onset through a semi-structured interview schedule. The questions included basic demographic details, symptomatology at admission, persistent symptoms at 28 days after onset and other clinical details including comorbidities. For defining post COVID-19 symptom persistence National Institute for Health and Care (NICE) guidelines were used. Association between persistent symptoms and selected factors was done by Chi-square test. Results: Out of the 335 patients, the persistence of symptoms of COVID-19 infection after 28 days of symptom onset was 221 (66%) (CI 60.7-79.8). Persistence of two or more COVID-19 symptoms after 28 days of onset was seen in 120 (35.8%). The most common persistent symptoms among the patients were fatigue in 109 (32.5%) of people followed by dyspnoea in 77 (23%), cough in 45 (13.4%) and myalgia in 37 (11%) patients. Highest persistence was seen in Category C patients where symptoms were persisting in 75%. Persistence was also higher in those with Diabetes Mellitus (DM), those who received oxygen support and those who were in Intensive Care Unit (ICU) or on ventilator and the association was statistically significant (p-value <0.05). Conclusion: The study shows that two-third of patients still continues to have persistent symptoms even after 28 days of symptom onset. Health systems should be prepared to face the consequences of morbidities caused by post COVID-19 syndrome.

Association of Islet Amyloid Polypeptide and Inflammatory Markers in Type 2 Diabetes Mellitus

Introduction: Islet Amyloid Polypeptide (IAPP) is co-synthesised and co-secreted with insulin by islets of pancreatic β-cells, its increased concentration in individuals with Type 2 Diabetes Mellitus (T2DM), may involve in inflammatory processes. Aim: To study and find the association of IAPP with inflammatory markers including high-sensitivity C-reactive protein (hsCRP), Tumour Necrosis Factor (TNF)-a and Interleukin (IL)-6 in patients with T2DM. Materials and Methods: This was a cross-sectional study, conducted from, December 2015 to December 2019, on 262 subjects (30-60 years, 147 males and 115 females), including 131 healthy controls and 131 known cases of T2DM, Fasting blood glucose and glycated haemoglobin (HbA1c) was estimated by commercially available kit, and serum fasting insulin, IAPP, hsCRP, TNF-α, and IL-6 were analysed by ELISA. Insulin Resistance (IR) and insulin sensitivity were calculated. Statistical analysis was done with Statistical Package Social Sciences (SPSS) version 24. The descriptive statistics were expressed as Mean±SD, Student t-test was applied, and p≤0.05 was considered as statistically significant and highly significant at =0.01 at 95% CI. The relationship between IAPP and other variables were done by using Spearman Rank correlation (r). Results: Circulatory level of IAPP was positively associated with serum hsCRP (r=0.312, p≤0.05) in T2DM. The elevated levels of IAPP (21.3±10.54 pmol/L), insulin (11.74±3.91 µU/mL), Homeostatic Model Assessment for Insulin Resistance (HOMAIR) (5.11±2.01) and inflammatory markers including hsCRP (3.44±1.77 mg/L), TNF-a (29.5±4.7 pg/mL) and IL-6 (20.2±5.2 pg/ mL) p≤0.05 with poor glycaemic control (HbA1c 8.78±2.30%, p<0.001), and reduced insulin sensitivity {Quantitative Insulin Sensitivity Check Index (QUICKI) 0.31±0.02, p≤0.05} were compared with healthy control; indicates that hyperamylinemia may induce inflammation in individuals with T2DM. Conclusion: Elevated degree of IAPP can be an important predictor and indicator of inflammatory processes and IR in uncontrolled diabetes.

Is DTPA the Gold Standard for Glomerular Filtration Rate Estimation in Voluntary Kidney Donors before and after Donor Nephrectomy?

Introduction: Precise assessment of renal function of voluntary kidney donors has important implications for both donor and recipient health outcome. The ideal test for assessment of overall renal function is measurement of Glomerular Filtration Rate (GFR). Various centres use different creatinine based formulae to calculate the GFR, however when compared to GFR measurements by 99mTc-diethylenetriaminepentaacetic acid (DTPA) isotope clearance, their performance remain inconclusive. Aim: To assess the efficacy of creatinine-based GFR estimating equations in comparison to DTPA scan in voluntary kidney donors before and after donor nephrectomy. Materials and Methods: This study was conducted on 50 voluntary kidney donors who underwent donor nephrectomy at Army Hospital (R&R), New Delhi, India. It was conducted from November 2016 to March 2018 as a single centre, prospective, longitudinal cohort study on living related kidney donors with follow-up at 1 and 3 months after kidney donation. The predictive capabilities of GFR estimation by Cockroft Gault (CG) equation, corrected for GFR and 24-hour urine Creatinine Clearance (CrCl) corrected for Body Surface Area (BSA), for both pre and postdonor nephrectomy at 90 days, were assessed and further compared with DTPA-GFR as reference GFR. Individual quantitative parameters were compared using Student t-test. For the normally distributed GFR data, Pearson’s correlation coefficient was also calculated. Statistical Package for the Social Sciences (SPSS), version 24.0, software and MS Excel were used for analysis. Results: Out of 50 subjects studied, 38 (76%) were females and 12 (24%) were males. Majority of donors were spouses. The mean GFR measured by 99mTc-DTPA scan was 99.47±14.4 mL/min/ 1.73 m² and 62.1±11.5 mL/min/1.73 m² pre and postdonation respectively. All the equations being evaluated in this study underestimated the GFR as measured by 99mTc DTPA renal scan prior to kidney donation whereas GFR estimation postdonor nephrectomy by CG CrCl and CG GFR overestimated the GFR values while urine-CrCl underestimated it. Conclusion: All the equations performed unsatisfactorily. Even the best performing equation urine-CrCl was also found to be suboptimal for donor evaluation. More accurate methods of GFR estimation, should, thus be used keeping the potential risks of living kidney donation in perspective.

Audit of Computed Tomography (Brain) Referrals from the Accident and Emergency Department in a Tertiary Care Hospital

Ravinder Sahdev, Yashasvi Shukla, Akhilesh Rao

Introduction: Non-Contrast Computed Tomography (NCCT) brain is a common referral made from the Accident and Emergency (A&E) Department both for traumatic and non traumatic causes. Aim: To evaluate the veracity of the referrals made by the Accident and Emergency Department clinicians for NCCT Head. Materials and Methods: This was the Retrospective evaluation of diagnostic yield of head Computed Tomography (CT) referrals made from A&E Department of a tertiary care hospital located in northern-central India over three year period between January 2015 to December 2017. CT reports were first grouped into two major group’s trauma and non trauma referrals with further subdivision into positive and negative scan on the basis of presence of abnormality. Subsequently, the positive trauma reports were classified into major findings (three subgroups extra-axial haemorrhage, brain contusions and depressed skull fractures) and minor findings like undisplaced fractures of the skull or facial bones with or without subgaleal haematoma. Distribution of trauma cases as per National Institute for Health and Care Excellence (NICE) guidelines was then tabulated. Non trauma reports were also further classified into the two major clinically important findings of haemorrhage and infarct as well as non-specific minor findings. Results: Of the total data of 2185 head CT (980 trauma cases and 1205 in non trauma cases) referrals done by A&E Department during the study period. Out of total, 144 (58.5%) of trauma cases and 328 (27.2%) of non trauma cases were with major findings. Trauma 788 cases and non trauma 965 cases were referred by Medical Officer (MO)/ Resident as revealed from the audit. Positivity percentages for traumatic and non traumatic causes were 25.1% and 27.2%, respectively. Conclusion: Due to non adherence to existing guidelines or due to poor clinical knowledge, there is poor diagnostic yield of CT referrals made from A&E Department. Thus clinical audit is essential at Department of Radiodiagnosis to streamline the referring protocols and improves the overall efficiency of the healthcare system.

Concordance of Bronchoalveolar Lavage Cytology with Transbronchial Lung Biopsies in Non-neoplastic Pulmonary Diseases

Nischita Jayaraj, Kusuma Venkatesh

Introduction: In many pulmonary diseases, despite radiological and clinical investigations, laboratory tests and function studies, the diagnosis becomes difficult. Bronchoalveolar Lavage (BAL) is a minimally invasive method in which cells are collected from bronchial and alveolar spaces for cytology. This is facilitated by using a flexible bronchoscope with which a biopsy is taken following BAL. Bronchoscopy with BAL when used appropriately can offer correct diagnosis which in turn aids in proper management of the patient. Aim: To find the concordance of BAL findings with the histopathological features of Transbronchial Lung Biopsy (TBLB) in non-neoplastic lung diseases. Materials and Methods: It was a retrospective study conducted in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka. A total of 40 patients presenting with clinicoradiological findings, suggesting a non-neoplastic lung disease in the year 2019, undergoing bronchoscopy with BAL and concurrent TBLB were chosen. The BAL fluid was processed and differential count of cells was done to classify according to the American Thoracic Society Guidelines. Concordance was checked between the diagnoses made on TBLB and BAL analysis. Results: In the present study, a total of 40 cases were included of which 13 (32.5%) cases showed neutrophilic, 16 (40%) cases showed lymphocytic, 5 (12.5%) cases showed eosinophilic and 6 (15%) cases showed normal cellular distribution on BAL cytology. Diagnoses on studying TBLB included nine cases of Nonspecific Interstitial Pneumonia (NSIP), seven cases of Usual Interstitial Pneumonia (UIP), six cases of Bronchiolitis Obliterans Organising Pneumonia (BOOP), three cases of Bronchiolitis, two cases each of pulmonary tuberculosis and granulomatous inflammation. There was one case each of actinomycosis, sarcoidosis, lung abscess and mucor mycosis. Normal histology was noted in seven cases. The sensitivity of BAL fluid analysis was found to be 84.84% and the concordance was 80%. The Kappa value obtained was 0.71 indicating good agreement/concordance between BAL cytology and TBLB. Conclusion: The data from the current study suggest that differential cell counts in BAL provide diagnostic information of fundamental importance in frequently occurring non-neoplastic lung diseases in the community.

Radiological and Functional Outcome of Medial Tibial Reduction Osteotomy for Severe Varus Deformity in Patients Undergoing Total Knee Arthroplasty- A Prospective Cohort Study

Amal Mathew, AS Arun Kumar, Murukan Babu, TC Ranjith, Susan John

Introduction: The deformity and imbalance in an osteoarthritic knee undergoing Total Knee Arthroplasty (TKA) are the result of a combination of bony and soft tissue changes locally. Proper and ideal balancing of ligaments is considered essential to the success of a TKA. There are numerous techniques to achieve soft tissue balance in varus knee. More recently, Medial Tibial Reduction Osteotomy (MTRO) has been described as an adjuvant to soft tissue release. Limited data exists on the outcomes of patients requiring a MTRO. There are not many Indian studies available regarding the radiographic and clinical outcomes of medial reduction osteotomy in severe varus deformity in TKA. Aim: To find out the radiological and functional outcome of MTRO for severe varus deformity in patients undergoing TKA. Materials and Methods: This study was prospective Cohort study conducted at the Department of Orthopaedics, Rajagiri Hospital, Chunangamveli, Aluva, Kerala from December 2018 to November 2019. Twenty patients 15 females and 5 males (30 knees), in the age group 55-80 years with osteoarthritis of knee with severe varus deformity, were enrolled in the study. Preoperative and postoperative standing leg Antero-posterior radiographs were taken for all patients and hip-knee-ankle angle was measured and amount of deformity correction was calculated. Postoperatively, radiographs were taken on the 5th day and 3rd month. Knee society scores were also recorded preoperatively and on the 5th postoperative day, postoperative visits on 6 weeks, 3 months and clinical outcome was assessed. The statistical analysis was performed by Statistical Package for Social Sciences (SPSS) version 25.0 using Analysis of Variance (ANOVA) and Wilcoxon Signed Rank test. Results: The median knee score improved from 47±9 to 93±3 postoperatively. Similarly, median function score improved from 50±5 to 80±0. The improvement in function score and knee score were statistically significant (p-value 0.001). The correction of varus between preoperative, postoperative (p-value 0.001) day 5 and 3 months postoperatively was statistically significant. No patient required a release of the superficial Medial Collateral Ligament (MCL). The MTRO was associated with statistically significantly improved Knee Society scores and varus deformity correction. Conclusion: In patients with fixed varus deformity of the knee, the MTRO is found to be safe and adequate to achieve coronal alignment.

Dexmedetomidine and Fentanyl for Postoperative Analgesia in Patients Undergoing Abdominal Surgery: A Randomised Controlled Trial

Prashant Sachan, Prem Raj Singh, Sateesh Verma, Brij Bihari Kushwaha

Introduction: Pain control is an important factor for postoperative recovery. Many drugs have been studied for effectiveness of postoperative analgesia. Fentanyl is a conventional drug and dexmedetomidine is one of the emerging drugs used for analgesia and postoperative pain control. Aim: To compare the effect of fentanyl and dexmedetomidine on pain control and haemodynamic stability. Materials and Methods: A randomised controlled trial was conducted on 60 patients (30 each group) undergoing for abdominal surgery, between January 2019 to January 2020. Group A received fentanyl loading dose 2 μg/kg I.V. followed by 0.5 μg/kg/hr infusion and group B received dexmedetomidine loading 1 μg/kg over 10 minutes followed by maintenance 0.5 μg/ kg/hr infusion. Infusion was continued up to four hours during surgery and till eight hours of postoperative in both groups. Haemodynamic parameters {Heart Rate (HR), Mean Arterial Pressure (MAP)} were recorded after start of study drug infusion, after intubation, then every 15 minutes till 1 hour, then every 30 minutes till end of surgery and after extubation. In postoperative period, HR and MAP were recorded at interval of one hour till eight hours after extubation and postoperative analgesia was assessed by Visual Analogue Scale (VAS) at interval of one hour till eight hours. Present study used descriptive statistical analysis for data analysis. Analysis of Variance (ANOVA) was used to compare data between two groups. Chi-square test was used to find the significance of difference on categorical scale between two groups. Results: This study showed that group B had significantly less VAS score most of time in recovery period as compared to group A (1.97±0.18 vs 2.10±0.31 at eight hours postoperative). HR, MAP was found significantly less all the time during surgery and most of the time postoperatively in group B (p-value <0.05). Conclusion: Intravenous infusion of dexmedetomidine can be better for controlling postoperative pain and perioperative haemodynamic stability as compared to infusion of fentanyl in patients undergoing abdominal surgeries.

Factors Predicting the Outcome of Non invasive Ventilation in Acute Respiratory Failure Secondary to Chronic Obstructive Pulmonary Disease Exacerbation

Introduction: Non invasive Mechanical Ventilation (NIV) is a better alternative for treating respiratory failures of any cause compared to invasive ventilation. Various factors influence the outcomes of patients treated with NIV in acute respiratory failure secondary to Chronic Obstructive Pulmonary Disease (COPD). Aim: To determine the possible early predictors and associated factors influencing the outcome of NIV in acute respiratory failure due to COPD patients. Materials and Methods: This was hospital-based observational study undertaken at SRM Medical Hospital and Research Centre in the Respiratory Medicine Department, after obtaining ethical clearance and informed patient consent. All patients with COPD exacerbation were admitted to the respiratory medicine ward. An Arterial Blood Gas (ABG) analysis was carried out, and those patients with type 2 respiratory failure were included in the study. This study included 42 patients with acute respiratory failure secondary to COPD requiring NIV. Data of patient’s ABG parameter, heart rate, blood pressure, and respiratory rate baseline values at an interval of one hour, six hours, and every 24 hours were recorded. The outcome was divided into two categories depending upon whether patients improved or required invasive ventilation. Data were entered in Microsoft Excel datasheet and was analysed using Statistical Package for Social Sciences (SPSS) 22.0 version software. Results: Of 42 patients, 30 (71.42%) were treated successfully with NIV, while 12 (28.57%) required invasive ventilation and were declared NIV failure (requiring invasive ventilation). Among the patients, it was observed that patients with mean age >60 years, BMI >26.5, baseline pH <7.2, PaCO₂ >78, heart rate >120, respiratory rate >40, co-morbidities and infective exacerbation were requiring invasive ventilation. It was also observed that among the failure category patients treated with conventional Spontaneous and Timed (S/T) mode showed more failure rates than Average Volume Assured Pressure Support (AVAPS) S/T mode. Conclusion: Patients with acute respiratory failure secondary to COPD responds well to NIV. The baseline pH, PaCO₂ , HR and Respiratory Rate (RR) before initiation of NIV predicts outcome. Also, age, BMI, associated comorbidities and mode of NIV predicts the outcome.

Short-term Prognostic Value of Admission Cardiac Troponin T, C-Reactive Protein and Echocardiographic Regional Wall Motion Abnormalities in Patients with Acute ST Elevation Myocardial Infarction

Pooja Dhaon , Dharmendra Uraiya , Neeraj Tripathi

Introduction: With increasing burden of Coronary Artery Disease (CAD) and ST-Elevation Myocardial Infarction (STEMI) in India, early risk stratification of patients is as important as making a correct diagnosis. Cardiac Troponin T (cTnT), C-Reactive Protein (CRP) and echocardiographic Regional Wall Motion Abnormalities (RWMA) are used to assess the patients of STEMI at presentation. The short term prognostic importance of these parameters also need to be known. Aim: To study the prognostic values of admission cTnT, CRP and echocardiographic RWMA in patients with acute STEMI. Materials and Methods: Fifty patients of STEMI were evaluated from January 2017 to July 2017 by Troponin-T (positive >0.18 ng/ mL), CRP (positive >3 mg/L) and echocardiography (positive with presence of RWMA) on day one. The patients were divided into three groups: Group 1: patients with all the three parameters positive, Group 2: patients with all three parameters negative, Group 3: patients with one or two parameters positive. The end points observed were heart failure Left Ventricular Ejection Fraction (LVEF) <40%) assessed by Echocardiography (ECG) at day 28, significant ventricular ectopics (>class II by Lown’s classification) and mortality at day 30 in the groups. Chi-square test for equality of proportions was used to analyse the difference in outcome in the groups. Results: The mean age of patients was 54 years. There were 25 (50%) patients in group 1, 14 (28%) patients in group 2 and 11 (22%) patients in group 3. Twelve (24%) patients had heart failure with 9 (18%) in group 1 and 3 (6%) in group 3 (p<0.05). The 9 (18%) patients had significant ventricular ectopics with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Mortality was found in 9 (18%) patients with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Conclusion: Acute STEMI with high cTnT, CRP and presence of RWMA on ECG at admission need more aggressive management and close follow-up.

Investigation of Different Commercially Available Real Time-Polymerase Chain Reaction Kits for SARS-CoV-2 Diagnosis

Introduction: The whole world is facing an ongoing global health emergency of COVID-19 disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) is a gold standard in the detection of SARS-CoV-2 infection. Presently, many single tube multiple gene target RTPCR kits have been developed and are commercially available for Coronavirus Disease 2019 (COVID-19) diagnosis. Aim: To evaluate the performance of seven COVID-19 RT-PCR kits (DiagSure, Meril, VIRALDTECT II, TruPCR, Q-line, Allplex and TaqPath) which are commercially available for COVID-19 RT-PCR diagnosis. Materials and Methods: This observational study was conducted at the State Virology Laboratory (SVL), Gandhi Medical College, Bhopal, Madhya Pradesh, India. Seven commercially available kits have been evaluated on the basis of: (i) number of SARS-CoV-2 specific gene target; (ii) human housekeeping genes as internal control; (iii) RT-PCR run time; and (iv) kit performances to correctly detect SARS-CoV-2 positive and negative RNA samples. A total of 50 RNA samples (left over RNA) were included, master mix preparation, template addition and RT-PCR test has been performed according to kits literature. At the end of PCR run, mean and standard deviation of obtained cut-off of all kits were calculated using Microsoft Excel. Results: All seven RT-PCR kits performed satisfactory regarding the reproducibility and they could correctly identify 30 positive and 20 negative RNA samples. RNA samples (group C) having low viral loads with a high Cycle threshold (Ct) value (>30) were also detected by all these seven kits. Obtained Ct values of each group was in parallel range in comparison with the initial testing Ct values. Kits were found to be superior which contains primers and probes for three SARS-CoV-2 specific gene targets, have human housekeeping gene as internal control and taking less time to complete RT-PCR. Conclusion: All seven COVID-19 RT-PCR kits included in this study demonstrated satisfactory performance and can be used for the routine molecular diagnosis of COVID-19 disease.

Spinal Dysraphism- A Histopathological Study of 45 Cases

Bangaru Sandhya, SS Sabitharani, Yandapally Niharikareddy

Introduction: Dysraphic conditions of spine resulting from non closure of the neural groove, consists of different types of malformations and they are called spina bifida, which have been classified into several types. Myelomeningocele (MMC) and Meningocele (MC) come under spina bifida cystica. Aim: To review the clinical and pathological findings of congenital spinal dysraphism and discuss the pathological diagnosis Materials and Methods: A descriptive cross-sectional type of study was conducted in 45 cases of spinal dysraphism during the period from October 2012 to February 2016, in the Department of Pathology of a tertiary care hospital, Hyderabad, India. Cases which were diagnosed as spinal dysraphism by clinical and radiological examination, tissue specimens were sent to the department of pathology along with clinical and radiological findings. Haematoxylin and Eosin (H&E) staining was done in all cases, followed by detailed microscopic study of slides. Histopathological findings such as epithelial, mesodermal, neuroectodermal changes were elucidated in detail and findings were compared with literature. Results: In a total of 45 cases there were 30 cases of MMC, nine cases of MC and six cases of encephalocele. Loss of epidermal appendages were seen in 91% of cases and neuropil like matrix was present in 76% cases. Conclusion: The embryogenesis of spina bifida involves ectoderm, neuroectoderm and mesoderm. A detailed definition of histopathological aspects will help in understanding these anomalies and should be a part of a detailed histopathology report.

Selection Approach for Indian Medical Residency Program: Perspective of Interns and Residents

Puja Dulloo

Introduction: Indian Postgraduate (PG) selection process has undergone various modifications since the past decade including the recent single nationalised entrance test initiated from April 2016. The perception of graduates and PGs for the type and process of selection test is not known. Aim: To study the perception of interns and residents regarding the process of the National Eligibility Cum Entrance Test for Postgraduates (NEET-PG) selection test. Materials and Methods: An exploratory qualitative thematic analytic study was conducted using purposive sampling with Semi-Structured Interviews (SSI), as per gender and academic grading, interns, and residents were selected. Eleven interns and ten first year residents took part. Braun and Clarke's six-phase thematic analysis framework was used for data analysis. Results: Three themes emerged; "building validity", "Proposed modifications" and "learning by the assessment". Validity building was related in terms of framing the multiple-choice questions, the format of the examination, and single attempt made per year. Different modifications were suggested by graduates and residents, in terms of assessment tools and strategies. Significant variations were observed in terms of learning by present assessment. Conclusion: The NEET-PG, a single nationalised assessment, appears to be well accepted with questioning for its validity in terms of assessment tool used, leading to restricted learning for the applicants. Participants widely proposed various assessment tools and methods for conducting a PG selection test for medical specialties. The NEET-PG assessment requires modification in terms of domains being assessed for the applicant so that it would improve patient care and safety. Selection authorities should pay weightage to the applicant's voice before framing the policies.

Pattern of Magnetic Resonance Imaging Findings in Lumbar Spine Pathologies and its Correlation with Demographic Variables in Rivers State

Introduction: Magnetic Resonance Imaging (MRI) currently is an excellent imaging modality of choice for the demonstration of pathologies of the lumbar spine and the intervertebral disc. A sound knowledge of the common pathologies of the lumbar spine in our setting will assist clinicians and radiologists in making accurate diagnosis. Aim: To determine the type and distribution of MRI findings in lumbar spine pathologies and its demographic correlation in Rivers State. Materials and Methods: This was an observational crosssectional study carried out among all symptomatic and asymptomatic patients who were referred for lumbar spine MRI at two selected Imaging Diagnostics Centres in Rivers State, from May 2020 to November 2020. The lumbar spine MRI examinations were performed using 0.35 Tesla MRI machines with both planar surface and multicoil phased array. The patients were evaluated for disabilities using the Nurick grading classifications. Data obtained were analysed using both descriptive (mean, deviation, frequency and percentage) and inferential (Pearson's Correlation) statistical tools. The level of statistically significance was set at p<0.05. Results: Out of 151 patients that were included in this study, majority 78 (51.7%) of the patients were within the age group of 40-59 years with an overall mean age of 52.51±14 years. The majority 114 (75.50%) of the patients had single pathology. Among those that had single pathology, a greater proportion had spondylosis 65 (43.05%). A greater proportion 73 (48.34%) of the patients had single level of spinal involvement with lumbar vertebra four (L4) commonly affected in 26 (17.22%). Out of 151 patients, majority 49 (32.45%) had Nurick grade II and the least 7 (4.64%) had Nurick grade V. Conclusion: Lumbar spine pathologies frequently involve the fourth lumbar vertebra and middle-aged males are commonly affected.

Sexual Maturity in Adolescents Suffering from Sickle Cell Disease: A Cross-sectional Study

Vijay Shah, Akash Patel, Praful Bambharoliya, Jigisha Patadia

Introduction: Sickle Cell Disease (SCD) is an inherited chronic haemolytic anaemia. The diseased person suffers from various complications such as anaemia, frequent infection, fever, hand-foot syndrome, stroke, etc. Puberty changes includes the appearance of the secondary sexual characteristics, increase in height, change in body composition and development of reproductive capacity. Aim: To study the sexual maturity and effect of multiple blood transfusions in adolescents suffering from SCD. Materials and Methods: It was a cross-sectional study conducted on 35 adolescents of age group 11 to 15 years, suffering from SCD. Study was conducted over a period of six months from March 2018 to September 2018 at Department of Paediatrics, Government Medical College, Surat, Gujarat, India. The SCD was diagnosed by Haemoglobin (Hb) electrophoresis. Weight and height of all the participants were measured. For assessing the sexual maturity, Tanners staging was used, also known as Sexual Maturity Rating (SMR). Unpaired t-test was done for data analysis. Results: The mean age of the patients was 13.03±1.7 years. There were 25 males and 10 females. The mean age of male patients between Tanner stage 2 (14.63±0.52 years) and Tanner stage 3 (14.75±0.5 years) was significantly higher than the Indian data for males (11.3 and 12.8 years, respectively). The mean age of female patients between Tanner stage 2 (13.5±2.12 years) and Tanner stage 3 (14.33±1.16 years) was higher than the Indian reference data for girls (10.2 and 11.6 years respectively). Conclusion: This study concluded that adolescents with SCD were significantly shorter in height and weight than the standard reference population. Sexual maturity is delayed in adolescents with sickle cell anaemia.

Oxidative Stress Markers (8-Isoprostane and 8-Hydroxy-2-Deoxyguanosine) in Major Depression: A Case-control Study

Parul Chopra, Rajesh Sagar, Asok Kumar Mukhopadhyay

Introduction: Depression is associated with activation of innate immune response leading to oxidative damage. The 8-isoprostanes and 8-hydroxy-2-deoxyguanosine (8-OHdG) are biomarkers of oxidative damage to lipids and Deoxyribonucleic Acid (DNA), respectively. They have been independently linked to depression. Aim: To study the oxidative stress markers (8-Isoprostanes and 8-OHdG) in subjects with major depression. Materials and Methods: In this observational case-control study 42 cases of depression, 13-25 years of age were recruited from Psychiatry Out Patient Department (OPD) at a tertiary-care hospital in Delhi, India, along with 42 healthy controls. They were assessed clinically and using psychometric evaluation scores, Beck’s Depression Inventory-II (BDI-II) and Hamilton Depression Rating Scale (HAM-D). All 42 subjects were on medication with antidepressants {33/42 with Selective Serotonin Reuptake Inhibitors (SSRI) 8/42 with Tricyclic Antidepressants (TCA) and 1/42 on a combination of both}. Routine laboratory investigations were done. Plasma 8-Isoprostane and serum 8-OHdG concentrations were measured in both cases and controls. The results obtained were analysed using relevant statistical tests on STATA version 11 (StataCorp, 2009). Results: Clinically, all patients had moderate to severe depression. BDI-II and HAM-D scores were raised in all cases as compared to the controls (28.81±5.60 vs 1.62±1.59 for BDI and 20.88±4.67 vs 1.33±1.43 for HAM-D, respectively). The concentration (in depressed vs controls) of plasma 8-Isoprostane (107.70±54.48 pg/mL vs 77.78±60.15 pg/mL) and serum 8-OHdG (2103.03±154 pg/mL vs 2017±164.69 pg/mL) were significantly elevated (p-value <0.05). Though elevated in patients belonging to both genders, showed significant increase of 8-Isoprostane only in females and 8-OHdG only in males as compared to their healthy controls. No correlation of the levels of any of two markers was seen with clinical severity of depression of patients as assessed by BDI. Conclusion: Evidence of oxidative stress to lipids and DNA are present in the peripheral blood. These can be explored further in establishing the biomarkers for diagnosis and prognosis of depression.

Characterisation of Candida Colonisation in Neonates

Abhilasha Dalal, GR Jagannatha Babu, K Anuradha

Introduction: The occurrence of invasive fungal infections has increased significantly worldwide, premature infants in Neonatal Intensive Care Unit (NICU) along with other risk factors are at particular risk of these invasive fungal infections which lead to fungal septicaemia in newborns. Candidaemia is the most common form of invasive candidiasis associated with an unacceptably high mortality rates. Candida colonisation in neonates is considered the first step towards developing neonatal sepsis. Aim: To determine the prevalence of Candida colonisation and its characterisation among neonates admitted in NICU. Materials and Methods: The present study was a prospective cross-sectional study with 150 neonates included in the study. Swabs were taken from four different sites of each neonate and inoculated on Chocolate agar and Sabouraud’s Dextrose Agar (SDA) and incubated at 37°C for seven days. Candida species isolated were confirmed by gram stain, germ tube test, growth on Chromogenic (CHROM) agar and cornmeal agar. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 11.0. Results: A total of 32 (21.3%) neonates had Candida colonisation. Twenty two (68.7%) were low birth weight and 24 (75%) were born premature. Perineum was the most common (56%) site of colonisation. Among Candida isolates, Candida tropicalis (63%) was the commonest followed by Candida parapsilosis (25%) and Candida glabrata and Candida albicans (6%). The risk factors identified were low birth weight, premature birth, use of antibiotics. Conclusion: Colonisation of preterm and low birth weight neonates by Candida species is a major risk factor and needs attention to avoid dissemination and life threatening infection.

Systematic Review on Relation Between Surface Treatment and Outcome of Delayed Replantation of Permanent Anterior Avulsed Teeth

Shaili Mehta, Jayeeta Verma

Introduction: One of the most severe dental injury is Tooth Avulsion or exarticulation. Tooth avulsion is the complete displacement of tooth out of the socket. The common treatment employed for avulsed teeth is replantation, the prognosis of which depends on the handling of the tooth specimen and time lag between avulsion and replantation of the teeth. Surface treatment of root surface of avulsed teeth prior to delayed replantation is a common practice and a variety of agents and methods have been used for the same. The literature lacks evidence that establishes a definitive relation between surface treatment and prognosis of delayed replantation of avulsed teeth. Aim: To understand the effect of surface treatment and outcome after replantation of avulsed anterior permanent teeth with an extraoral dry time of more than 60 minutes. Materials and Methods: The protocol for systematic review was registered on PROSPERO, registration number was CRD42020222919. A search was performed on case reports and case series available on delayed replantation of avulsed anterior permanent teeth on databases like Medline/PubMed, Google Scholar, and Cochrane from the year 2000 to 2018. The MeSH terms and keywords like tooth avulsion*, tooth fractures*, tooth injuries*, traumatology*, delayed replantation methods and delayed replantation standards with Boolean operators were used for data identification and screening. After applying inclusion and exclusion criteria, total five articles were included. Results: The duration of storage of the teeth were variable with cases reported from 24 hours to 72 hours of extraoral dry time. All five reports used different methods for surface treatments. No complications were reported after 12 months in three cases. No complication was reported after 24 months in one case. After 12 weeks, one article reported ankylosis and infraocclusion after replantation. Conclusion: As a result of data heterogenicity and a short follow-up period of the articles, a clear relation between surface treatment and delayed replantation of an avulsed teeth could not be established. However, it can be safely concluded that surface treatment of avulsed teeth prior to delayed replantation results in a better prognosis and predictable outcomes.

Non Computerised Circadian Interventions for Improving Working Memory Performance among Children

Rameshwari Zala, Anil Sharma

Working memory provides a mental workspace for tasks requiring both processing and storage. Working memory is a cognitive system whose essential function is to facilitate and beautify the potential of encoding, storage, and retrieval functions that are imperative for gaining knowledge and processing of facts. It has been prompted that various mediations applied within day-today contexts of children have the potential to improve working memory and generate transfer to real-world skills, anyway little is known about the effectiveness of these interventions among children. This review focuses to detect deliberately the adequacy of intervention or interventional package on working memory performance of children to identify their effects on Working memory, advantages extended to near-and far-transfer capability of interventions, and gains sustained overtime and dosage of it. Literature searches were conducted across 10 electronic data bases using consistent keywords. Papers were screened by title and abstract (n=964) and judged against predefined eligibility criteria (n=63). Eighteen papers were included in the appraisal. Different working memory interventional approaches were included such as adapting the surroundings to decrease working memory loads; direct working memory training with and without tactics mandate and coaching competencies which circuitously effect on working memory (athletics, lexical apprehension, astonishing man-made play, and self-possession). Both direct training on working memory undertakings and rehearsing certain abilities that may likewise affect randomly on working memory which delivered refinement on working memory errands. Hardly, any research articulated dosage impact, estimated outlying shift of outcomes (n=4), or tried the solidness of valid statements after added time (n=4). The absence of an unmistakable hypothetical structure brought about uncertain forecasts about instructing and switch impacts. Methodological difficulties likewise compel the intensity of the proof, including: small-scale sample sizes; oversight of blinding of members and result assessors; and shortfall of active control group.

Cardiac Troponins: Analytical Characteristics and Diagnostic Capabilities of Modern (High-sensitive) Determination Methods

Aleksey Michailovich Chaulin, Duplyakov V Dmitry

Cardiovascular diseases have a leading role in terms of morbidity, mortality, and disability of the population, causing significant socioeconomic damage to all countries of the world. This circumstance requires researchers to constantly seek for new biomarkers and improve methods for determining existing biomarkers, and search for new therapeutic targets to improve diagnostic and treatment strategies. Recently, there have been some important changes in laboratory diagnostics of patients with acute coronary syndrome, due to the introduction into the routine practice of new high and ultrasensitive methods for the determination of biomarkers of injury, specific to cardiac muscle tissue, namely cardiac troponins. A key advantage of highly sensitive immunochemical assays is the ability to detect cardiac troponins in the early stages of myocardial infarction. This allows making the optimal decision on the early choice and conduct of reperfusion therapy, which significantly improves the further prognosis of patients. Among the most significant generally recognised disadvantages of highly sensitive determination methods are low specificity and a huge variety of troponin immunoassays. The decrease in specificity is reflected in the fact that cardiac troponins are no longer considered the “gold standard” of diagnosis related to Acute Myocardial Infarction (AMI) (irreversible ischaemic damage to cardiomyocytes). As a result, any damage to the myocardium, even insignificant and reversible under physiological state (physical activity, stress) and several pathological conditions, can lead to an increase in serum levels of cardiac troponins and affect the accuracy of the diagnosis. Each method for the determination of cardiac troponins, among the existing wide variety of troponin immunoassays, possesses different analytical characteristics, and detects different concentrations of troponins in the same patient. This article provides a view of current data on the biology of cardiac troponins, and defines the analytical characteristics of new high-sensitive methods for the determination of cardiac troponins.

Teaching and Learning Principles of the Ancient Indian Education System and its Relevance with the National Education Policy 2020

Tirath Das Dogra, Astha Chaudhry

The teaching and learning principles followed in the ancient Indian education system were largely based on the student centric teaching and learning principles as advocated in the modern system of education. The overall development of the student including the inner and outer self was largely practiced in Indian ancient education system. Also, the principles and practices discussed in Andragogy bears striking similitude with the practices followed in the ancient system. The relevance of understanding these traditional Indian teaching and learning principles increases with the introduction of National Education Policy (NEP) 2020 by Ministry of Human Resource and Development, Government of India as it highlights that all these principles are required to be adopted by the Higher Educational Institutions. This article aims to discuss some of the teaching and learning principles of the ancient Indian education system and their relevance in contemporary times along its coherence with NEP.

Vitamin D Binding Protein: A Fidelity Molecule in Spectra of Diseases

Bhuneshwar Yadav, Kurpad Nagraj Shashidhar, Harish Reddy, R Sai Deepika

Vitamin D Binding Protein (VDBP), also well-known as Gc-globulin, is a plasma protein which acts as a carrier molecule for vitamin D and its metabolites. This multifunctional glycoprotein is a member of the albumin superfamily of binding proteins. It is predominantly synthesised as a single long chain glycoprotein in the liver. VDBP helps in vitamin D metabolites transport, control bone development, binds actin monomers and fatty acids and prevents their polymerisation; which might be harmful in circulatory system. A less defined role in modulating immune and inflammatory response is also known. VDBP plays an important role in protection of microcirculation, inflammation, infection and also known to have antiviral and antitumoral activity. Recent studies documented its use as a early marker for diagnosis of Chronic Kidney Disease (CKD). This review discusses the multifunctional characters of VDBP in spectra of diseases with emphasis on its use as marker for diabetic nephropathy.

Physiotherapeutic Intervention for Cervicobrachial Pain Syndrome: A Scoping Review

Shubhrendu Sekhar Pandey, Ashish Ashish, Royana Singh

Introduction: Cervicobrachial Pain Syndrome (CBPS) is a disorder of enhanced mechanosensitivity to the neural structure, also known as lower cervical pain syndrome. Cervicobrachial pain is managed by manual and traditional therapy, besides medical management. Aim: The aim of this scoping analysis was to determine the efficacy of the protocols for cervicobrachial syndrome treatment. Materials and Methods: Until March 2020, initial literature searches were performed through robust online electronic databases such as "Scopus" "MEDLINE via PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Sciences and Cochrane Controlled Trials Register in Cochrane Library, Physiotherapy Evidence Database (PEDro), ProQuest 5000 International, ProQuest Health and Medical Complete, and following keywords were used "Neck Disability Index, "Upper Limb Tension test, "Goniometry "Neck pain," "Cervicobrachial Pain Syndrome," Thirty six studies were included in this scoping study using PRISMA guidelines. Results: There is little evidence of manual and conventional physiotherapy treatment of cervicobrachial pain and its efficacy. Key advantages have been reported in manual therapy and exercises methods for pain relief and rehabilitation. Electrotherapeutic modalities, neck strengthening exercises, traction and methods for handling soft tissue are considered to be less effective in managing cervicobrachial pain syndrome relative to manual therapy. Lateral cervical glide and median nerve slider technique (neurodynamic) have useful effects as a treatment intervention in multiple cases of cervicobrachial pain syndrome, such as the median nerve slider technique and contra-lateral cervical glide technique. Recommendations for the management of cervicobrachial syndrome in practice should be encouraged in additional trials of innovative treatment methods. Conclusion: Studies should identify which cervicobrachial pain respond to specific interventions for immediate and effective response so as to increase the quality of life of the patients. Further research with innovative techniques of therapeutic approach would facilitate practice guidelines for the management of cervicobrachial syndrome.

Psychological Impact of COVID-19 Pandemic on Frontline Healthcare Physicians

Prateek Jain, Tejal Mehta, Monika Pathania

The Coronavirus Disease 2019 (COVID-19) pandemic began in December 2019 in Wuhan, China. Such sudden infectious outbreaks take a toll on the psychological health of our brave frontline healthcare physicians. Frontline healthcare physicians become vulnerable to psychological problems like depression, anxiety, stress, and insomnia. Long working hours, increased patient load, and risk of spread of contagion to family members are a few of the major contributing factors. Such factors, coupled with chronic stress and emotional exhaustion predispose doctors to experience burnout which has also been reported to increase the risk of mental morbidities. Early counselling, pandemic preparedness, self-care efforts, and stress management can help to cope in these adverse times. Various online portals have also been developed as an intervention strategy in mitigating the negative impact of this pandemic. The purpose of this viewpoint is to highlight the need to address such issues in physicians, find possible root causes, and suggest relevant measures to curb the incidence of these problems.

Vitamin D as a Substitute of Catheter Ablation in a Paediatric Patient with High Burden Premature Ventricular Contractions: A Case Report

Gabriel Cismaru , Cecilia Lazea , Simona Cainap , Daniela Iacob

Catheter ablation is established as a treatment option for patients with high number Premature Ventricular Contractions (PVCs). However, complications can occur like cardiac tamponade, coronary artery injury or infectious endocarditis. Reversible causes such as hypocalcaemia, hypomagnesaemia and hypokalemia can be responsible for PVCs. Here, a case of nine-years-old boy, with vitamin D deficiency that presented high number PVCs which corrected using vitamin D dietary supplementation was described. Patient was hospitalised in the Cardiology Department for catheter ablation of PVCs. He presented with shortness of breath during football matches and asthenia. Electrocardiography (ECG) and Holter ECG demonstrated high number PVCs with a morphology consistent of Right Ventricular Outflow Tract (RVOT) origin. Catheter ablation was postponed until Vitamin D came to normal values. Dietary supplementation was performed, together with Holter ECG monitoring. After vitamin D normalisation, PVC burden reduced significantly without the need of catheter ablation or antiarrhythmic drugs. Catheter ablation and antiarrhythmic drugs can be avoided in patients with frequent PVCs and vitamin D deficiency.

Aesthetic Rehabilitation of Discoloured Anterior Teeth with Facial Talon’s Cusp: A Case Report

Talon's cusp is described as a process of horn-like shape curving from the base downwards to the cutting edge. Ripa and Mellor later described this phenomenon as talon cusp resemblance to talon of eagle. Talon cusp is a well-defined extra addition cusp like structure which extends from half of the Cementoenamel Junction (CEJ) to the incisal edge on the surface of an anterior tooth. The aetiology is unknown for the formation of the talon cusp. A talon cusp is often diagnosed during routine dental examination as an incidental finding and usually does not show any symptoms. In such cases, careful clinical and radiographic examination is mandatory for correct diagnosis and treatment planning. Due to limitation of 2-D (two dimensional) radiographs, these images are unable to recognise the complicated anatomy of the tooth. Use of Cone-Beam Computed Tomography (CBCT) has become common in dentistry. CBCT has been useful in producing a three-dimensional (3-D) image without distortion of the teeth, maxillofacial skeleton and related tissues. Scan of CBCT help to plan treatment and also provide valuable information about dental anatomy. This paper describes a case of 23-year-old female patient with a facial talon cusp on the permanent maxillary left central incisor, which was endodontically managed and followed by aesthetics rehabilitation with a follow-up for a period of one year.

Multilocular Thymic Cyst in a Patient with Diffuse Infiltrative Lymphocytosis Syndrome

Nitin Gupta, Anivita Aggarwal, Madhavi Tripathi, Sundeep Malla, Neeraj Nischal

Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a multisystem disorder characterised by bilateral salivary gland enlargement and/or xerostomia in patients with Human Immunodeficiency Virus (HIV) infection. A 16-year-old young male patient, presented with bilateral painless parotid swelling since five years. On evaluation, patient was found to have oral thrush and bilateral cervical lymphadenopathy. He turned out to be positive for HIV with a cluster of differentiation 4 (CD4) count of 237/mcl. On Positron Emission Tomography- Contrast Tomography (PET-CT), a multiloculated thymic cyst (13×9×6 cm) was noted. He was diagnosed to have DILS with a large multiloculated thymic cyst. The patient was managed with tenofovir, lamivudine and efavirenz along with cotrimoxazole prophylaxis and fluconazole and was followed uptil nine months for the regress of the conditions. The case highlights the rare association between DILS and thymic cyst.

Aesthetic Repair of Zirconia Supported Porcelain Prosthesis with Ceramic Veneer: A Case Report with Three-Year Follow-up

Tugce Merve Ordueri, Asena KaptaTAnoglu, Mehmet Muzaffer Ates

Chipping is the most common complication in zirconia-supported porcelain prosthesis. If the prosthesis has ideal adaptation and there is no problem other than chipping, intraoral repair is the most practical solution for such failures. Composite resins are often preferred for intraoral porcelain repair. However, the wear and unstable colour of composite resins negatively affect aesthetics. This complication could be restored intraorally and aesthetically with ceramic veneer. This case report presents the intraoral repair of a zirconia supported Fixed Partial Denture (FPD) consisting of four units. The cohesive fracture of the ceramic material in the incisal part of maxillary right central incisor was restored with ceramic veneers. Preparation was done with a tapered, round end diamond bur under water-cooling. The impression was taken with elastomeric impression material. Ceramic veneer was manufactured with a leucite-reinforced glass-ceramic and cemented with light cure resin cement. Based on the three-year follow-up of the performed intraoral repair, ceramic veneers have shown an alternative treatment for fractured FPD.

Experiences of a Postgraduate Resident during COVID-19: The Trials and Tribulations in the Unique Setting of Obstetrics and Gynaecology

Suma Shet, Payal Patwa, Charu Sharma, Manisha Jhirwal

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) will be remembered as a life changing landmark in the medical history. The changes it brought forth in the life of medical students resemble the two sides of a coin. It made them unlearn the conventional methods of education, patient care and research and learn the newer ways of patient interaction through telemedicine, online classes through web-based platforms and completing their thesis and dissertation through different online modes. This commentary is based on such experiences of a postgraduate resident.

Clinical Presentation and Diagnostic Dilemma in Management of Unicornuate Uterus with Canalised Rudimentary Horn- A Case Series

C Sathyavani, HS Shruthi

A unicornuate uterus is the result of abnormal or failed development of one Mullerian duct. Partial development of one Mullerian duct leads to a rudimentary uterine horn. This can lead to various gynaecological and obstetric problems and diagnostic dilemma. Over the past ten years, the authors have witnessed about eight cases of unicornuate uterus with canalised rudimentary horn presenting as a wide spectrum of obstetric and gynaecological problems. Two cases presented as dysmenorrhoea, one was diagnosed as a part of infertility work-up and the rest presented with varied obstetric complications. Most of the cases underwent excision of the rudimentary horn with unilateral salpingectomy. High clinical suspicion and knowledge about varied presentation is important for early diagnosis in such cases and to avert the clinical complications.