Journal of clinical and diagnostic research

Plexiform Fibrohistiocytic Tumour at a Rare Site: Frontal Region of Head with underlying Frontal Bone Invasion

Sarita Nibhoria, Ekta Rani, Aradhana Singh Hada, Bikramjit Singh, Ruth Prakash

Plexiform Fibrohistiocytic Tumour (PFHT) is an intermediate malignant tumour of soft tissue. It is a rarely metastasising dermal subcutaneous neoplasm. It affects children and young adults. The age range of presentation is from birth to age 77 years. The tumour is most commonly located on the upper extremities, whereas the involvement of the frontal region is rare. The differential diagnosis includes benign fibrous histiocytoma, fibromatosis, giant cell tumour and neurofibroma. Plexiform fibrohistiocytic tumour is a slow-growing mass and which is considered a low grade malignant tumour. Treatment is simple excision. It can exhibit aggressive behaviour and rate of local recurrence is 12-38%. A 45-year-old female was presented with a solid mass on the frontal region of the head which was diagnosed as a plexiform fibrohistiocytic tumour with underlying frontal bone invasion on histopathological examination of an excised mass in the Pathology Department. Plexiform Fibrohistiocytic Tumour (PFHT) is a mesenchymal neoplasm that shows a multinodular growth pattern and which is composed of fibroblasts, histiocyte like cells and multinucleated osteoclast like giant cells. Clinically, it is usually a slow-growing mass with frequent local recurrence and rare regional lymphatic and systemic metastasis.

Dealing with Dual Challenges Posed by an Uncorrected Atrial Septal Defect with Poliomyelitis- Anaesthetic Considerations for a Non Cardiac Surgery

R Chandhinie, M Raj, R Purushotham

Atrial Septal Defect (ASD) is one of the most common congenital heart diseases. This is one such disease where patients largely remain asymptomatic throughout childhood and begin showing symptoms during adulthood. Here, the authors present a case of a 44-year-old male patient, with an uncorrected ASD and poliomyelitis, who presented with fracture femur. He was posted for Open Reduction Internal Fixation (ORIF) with plating of femur. The anaesthetic management was successfully done with general anaesthesia through endotracheal intubation along with fascia iliaca block. After the procedure and extubation, the patient was conscious, oriented, responded to commands, and had normal vital parameters. He was shifted to the Intensive Care Unit (ICU)for further observation and monitoring in view of his pre-existing co-morbid conditions. Postoperatively, cardiovascular surgeon advised a correction surgery for his ASD at a later date. The patient was discharged on Postoperative Day (POD) 12. Dealing with these two vastly different disease entities in the same patient certainly posed a unique aspect to the present case considering the fact that there was no prior literature regarding the same.

Serositis as a Presenting Feature of Dengue Fever in a Young Female: Forecast of Upcoming Dengue Shock Syndrome

Ruchita Kabra, Dhruv Talwar, Sunil Kumar, Sourya Acharya, Praraj Jaiswal

Dengue fever is a prominent challenge in the developing countries throughout the world, with dengue shock syndrome as a leading cause of morbidity and mortality during the seasonal dengue epidemics. Most common presenting features of dengue fever are high grade fever with chills, headache, rash, nausea and vomiting. With the increasing challenges of treating dengue shock syndrome to prevent mortality in the young, it is important to determine factors which can be used to predict dengue shock syndrome. This report showcases a case of 20-year-old young female who presented with the chief complaint of pedal oedema, pain in abdomen along with breathlessness. Upon investigations it was found to be dengue fever with pleural effusion and ascites. The patient later developed dengue shock syndrome, which was managed successfully with the help of intravenous fluids, inotropic support and platelet transfusion. Hence, this case report highlights the importance of detection of serositis in the form of ascites, pleural effusion and pedal oedema in dengue fever as a tell-tale sign of upcoming dengue shock syndrome and the pathophysiology behind it.

Dasatinib causing Intracerebral Bleeding in a Patient with Chronic Myeloid Leukaemia

Dasatinib is a potent inhibitor of BCR-ABL (break point cluster-Abelson) kinase, Src family of kinases, C-kit, and Platelet Derived Growth Factor Receptor beta (PDGFR-beta), and used in the treatment of Chronic Myeloid Leukaemia (CML), Ph-positive acute lymphoblastic leukaemia, and Acute Myeloid Leukaemia (AML). The most common side effects of dasatinib are myelosuppression, gastrointestinal disturbance, fluid retention, cutaneous eruption, and bleeding diathesis. This report is about a recently diagnosed, 45-year-old female with CML, BCR-ABL positive. After six-month therapy with imatinib, the patient developed resistance to imatinib. The treatment was changed to dasatinib 70 mg, once a day. Three months after starting the therapy, the patient showed a cytological response. While receiving dasatinib, she complained of headaches, nausea, and vomiting. Her complete blood count was within the normal limit. Coagulogram was within the normal limit. Non Contrast Computerised Tomography (NCCT) of the head showed intracerebral bleed in the right frontal area of the brain. The patient was then treated with mannitol and put on artificial ventilation. She succumbed on day fourth of the Intensive Care Unit (ICU). Dasatinib has been associated with impaired platelet aggregation, and can show fatal bleeding manifestations.

A Rare Case of Conjunctival Squamous Cell Carcinoma in a Patient on Long-term Azathioprine Therapy: Cause or Coincidence

Stephen Sudhakar , Gayatri Sundareswaran , Neha Arora , Lawrence Dcruze

Autoimmune Polyglandular Syndrome (APS) is a cluster of endocrine abnormalities that occur in discreet patterns in subjects with immune dysregulation and that permit treatment and anticipation of associated systemic or other hormonal deficiencies. It is classified into four subtypes based on the extent of autoimmune manifestations. APS type 3 is characterised by the presence of an autoimmune thyroid disease and another autoimmune illness, excluding Addison’s disease. Ocular manifestations of APS include keratoconjunctivitis, dry eye, corneal scarring, cataract, retinopathy and optic atrophy. Here, a case of a 23-year-old male patient with APS has been presented with a growth in the left eye for four months, with no other associated symptoms. The patient was a known case of APS type 3 with Autoimmune Haemolytic Anaemia (AIHA) since the age of five years. The patient was treated with long-term oral steroids and Azathioprine for 18 years. His visual acuity was 6/6; N6 in both eyes. A gelatinous lesion measuring 8×4 mm was located on the nasal bulbar conjunctiva of left eye, extending 3 mm onto the cornea. The lesion demonstrated intrinsic vascularity, feeder vessels and pigmentation, clinically suggestive of Ocular Surface Squamous Neoplasia (OSSN). Ultrasonography defined the extension of the lesion to involve the episclera, sclera and posterior cornea. Incisional biopsy established the diagnosis of conjunctival squamous cell carcinoma in-situ. Surgical excision was deferred in view of good visual acuity and deep scleral and corneal involvement. The patient was treated with topical Mitomycin C 0.04%, and remained on close follow-up for six months. A possible contribution of long-term intake of systemic azathioprine to the occurrence of conjunctival neoplasia can be considered.

Biodentine and Amniotic Membrane to Treat the Hidden Villain- A Rare Case of Labiocervical Vertical Groove

This case report signifies the importance of complications and early diagnosis of radicular groove and to discuss the treatment of combined endo-perio lesion using bone graft mixed with Platelet Rich Fibrin (PRF), amniotic membrane and biodentine. Labiocervical Vertical Groove (LCVG) presents various complications to the patients, especially if it extends to the pulpal space. Labiocervical vertical groove originating near the cervical area of tooth can extend to the radicular surface. These grooves can be mild, moderate or deep based on its extent and depth. This case report deals with the complications, degree of destruction and treatment of an intrabony defect associated with LCVG in maxillary central incisor in a 35-year-old male patient, who reported to the Department of Periodontics and Implantology with the chief complaint of mobility of teeth over a period of past 2 months. In this case report, authors have highlighted the advantages of saucerization, PRF, Amniotic membrane and biodentine to treat the bone loss along with restoration of the groove.

Tropical Pulmonary Eosinophilia Masquerading as Interstitial Lung Disease: An Interesting Case Report with Review of Literature

Tropical Pulmonary Eosinophilia (TPE) is a form of occult filariasis characterised clinically by paroxysms of nocturnal cough, wheezing and dyspnoea . It is due to hyper-responsive pulmonary reaction to trapped microfilaria inside the lung tissue. Though, it is common in endemic areas, it is frequently misdiagnosed mostly as bronchial asthma or tuberculosis and the patient continues to suffer without being treated appropriately. A 36-year-old male, who presented with fever, cough and shortness of breath for a period of six months was misdiagnosed as Interstitial Lung Disease (ILD) and was put on antifibrotic agents without any relief of symptoms. He was thoroughly investigated with routine haematological tests, Absolute Eosinophil Count (AEC), X-ray of chest, High Resolution Computed Tomography (HRCT) thorax including bronchoalveolar lavage and was diagnosed as Tropical Pulmonary Eosinophilia (TPE). Diethyl Carbamazine citrate (DEC) was initiated and patient had satisfactory recovery. So, in endemic areas the possibility of TPE should always be kept in mind while evaluating cases presenting with chronic cough, dyspnoea and wheezing, even if the radiological imaging may mimic ILD.

Large Mediastinal Mass Managed Conservatively in an Elderly Woman

Dheeraj, Nitin Gupta, Ravi Kant, Monika Pathania

Mediastinal masses have been eluding clinicians for a long time, owing to their common symptoms that are attributable to common infective and non infective aetiologies and their rare incidence. They are generally diagnosed in the anterior mediastinum and include a variety of different entities demonstrating a range of clinicopathologic features. Chest computed tomography is important for the diagnosis, to know the extent of disease and helps in the prognosis. The prognosis of mature teratoma is excellent, surgical removal is curative. This case report was of a 58-year-old female, an unusual age of presentation, diagnosed as benign mature teratoma and was managed conservatively with periodic assessment for symptomatology. A conservative rather than surgical approach was chosen keeping in mind the socio-economic profile of the patient, surgical complications and benign nature of the disease. The uniqueness of present case is hidden behind the unusual presentation of the disease coupled with belonging to an eastern world where surgical modalities are not as accessible and affordable. Hence, a conservative approach might be an equally effective solution, especially considering the age of presentation.

Organic Manic Episode: A Case Report on an Uncommon Presentation of Neurocysticercosis

Aswin Sasidharan, Iniyan Selvamani, Dheeptha Shrine

Neurocysticercosis is the most commonly encountered helminthic infection of central nervous system caused by the larval stage of Taenia solium. The most common psychiatric manifestations seen in neurocysticercosis are depression, anxiety and psychosis. However, mania as a neuropsychiatric presentation is uncommon. The index case is a 34-year-old married female who presented to a tertiary medical centre with symptoms of fever, headache and dizziness for a period of two months. She was subjected to detailed evaluation by the Neurology Department of the institution. Magnetic Resonance Imaging (MRI) images showed cystic lesions in the right occipital lobe and in the intraventricular areas, demonstrating vesicular stage of cysticerci. She was treated with albendazole, antiepileptics and a short course of steroids and was discharged following resolution of symptoms after two weeks. Within days following discharge, patient started exhibiting behavioural changes suggestive of mania and was brought to the Psychiatry Outpatient Department and managed as a case of organic manic episode with mood stabilisers and antipsychotics. Patient improved symptomatically within two weeks and is presently being monitored on an outpatient basis. The present case shows a rare presentation of neurocysticercosis and the significance of early recognition and treatment of the psychiatric manifestations.

An Unusual Presentation of Tuberculosis at Atypical Anatomical Location: Rectus Abdominis Muscle

Abhishek Kumar, Ajay Shankar Prasad, Neel Kanth Issar, Harsh Pandey, Prateek

Unusual presentation of Tuberculosis (TB) in anatomical locations like skeletal muscle which are atypical and not favourable for survival and multiplication of Mycobacterium tuberculosis. Commonly, muscle involvement is secondary. A direct inoculation (abdominal lymph node) or extension from underlying tubercular synovitis and osteomyelitis may involve an abdominal muscle. The case report is about a 43-year-old female who presented with an abdominal lump for past one month. There was no history of cough, weight loss, pain abdomen, recurrent vomiting, breathlessness and no history of TB or close contact with TB patient. Ultrasound (USG) and Contrast Enhanced Computed Tomography (CECT) of the abdomen revealed loculated collection in right rectusabdominis muscle, and USG-guided aspiration for cytology, culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) confirmed tubercular abscess. The patient was managed as per National Tuberculosis Elimination Programme and responded well with antitubercular drug therapy for six months. The present case throws light on to the possibility of tubercular infection in atypical anatomical locations as primary foci, especially in those areas where tuberculosis is endemic.

Anaesthetic Management of a Patient with Dilated Cardiomyopathy and Acute Decompensated Heart Failure

Dilated Cardiomyopathy (DCM) is a non ischaemic heart muscle disease with left or biventricular dilatation and systolic dysfunction in the absence of other heart disease. DCM can lead to substantial morbidity and mortality due to complications like heart failure and arrhythmias. Intraoperative management of a patient with acute decompensated heart failure due to DCM is a challenge for anaesthesiologist. This case report is about a 58-year-old male patient, who was a known case of DCM with low left ventricular ejection fraction (10-15%), chronic kidney disease, chronic pancreatitis and hypertension. He came to the emergency department with acute decompensated heart failure and subacute intestinal obstruction. After initial stabilisation, he was scheduled to undergo emergency exploratory laparotomy for obstruction. Intraoperative management of the patient was done successfully by ensuring normovolemia, avoiding ventricular afterload, avoiding myocardial depression and providing adequate pain relief through multimodal analgesia. The article mentions various anaesthetic concerns, risks involved and preparations required in such a case.

A Case of Acute Breathlessness in Systemic Lupus Erythematosus: A Devastating Complication

Varsha Bhatt, Kavya Koneru, Abhishek Zanwar, Manaswini Edara, Anusha Vattikuti

Diffuse Alveolar Haemorrhage (DAH) is a severe respiratory complication of Systemic Lupus Erythematosus (SLE) and is associated with high mortality. A drop in blood haemoglobin, dyspnoea, haemoptysis, diffuse infiltrates on chest imaging indicate this devastating diagnosis. The DAH is rare in SLE, even rarer in the early months in an undiagnosed patient. Defective phagocytosis, immune complexes, depletion of complement, and autoantibodies are the aetiologies. Immune complex induced alveolar capillaritis is the cause of DAH. This report was about a 28-year-old female, who presented with acute worsening dyspnoea on a background history of inflammatory joint pain, digital gangrene, alopecia, oral ulcers, and Raynaud’s phenomenon. She was subsequently diagnosed as SLE with DAH. This case was rare as she presented with DAH in the early months of her disease. The patient was started on high dose steroid, cyclophosphamide, and plasmapheresis, but succumbed on day 14 of admission due to high disease activity and respiratory failure. DAH carries very high mortality rate even in the best centres, even when diagnosed early.

Hypertension Secondary to COVID-19 Leading to Posterior Reversible Encephalopathy Syndrome in a 13-year-old Male

Saranya Sai Satya Nelabhotla, Pradnya Diggikar, Prashant Gopal

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological condition defined by white matter vasogenic oedema predominantly affecting the posterior occipital and parietal lobes. A 13-year-old male presented with complaints of fever for four days. Upon evaluation, he turned out positive for COVID-19 with a Computed Tomography (CT) severity score of 5/25. Three days post admission (day 7 of illness), patient developed sudden onset of painless, diminution of vision in both eyes followed by two episodes of generalised tonic clonic seizures. Examination revealed a blood pressure of 180/110 mmHg. Characteristic Magnetic Resonance Imaging (MRI) findings led to a diagnosis of PRES. Patient was treated with antiepileptics, antihypertensives and intravenous mannitol and made a complete recovery. Early identification, treatment of symptomatology and correction of the underlying cause are all key aspects of management.

Correction of Unilateral Cleft Lip, Palate and Alveolus by Presurgical Nasoalveolar Molding using Modified Nasal Stent- A Case Report

T Noufal, Shoaib Ulla Khan, B Goutham, Sunil Muddaiah, Sanju Somaiah

Cleft deformities may lead to psychological problems, dental problems, and aesthetic problems, if left untreated. Hence, the management of cleft patients is quite challenging and controversial which involves a multidisciplinary approach including members of various specialities. The Presurgical Nasoalveolar Molding (PNAM) method is an innovative therapy for mitigating the impact of craniofacial deformities. The use of PNAM therapy in a 2-day-old male infant is described in this case report. Impressions were taken during the first visit and on the same day lip tape therapy (lip taping) was started using 3M™ Steri Strip™. The Nasoalveolar Molding (NAM) plate was delivered to approximate the cleft alveolus. A modified nasal stent appliance was administered until the cleft gap was decreased to around 4 mm and the cleft lip was repaired through surgery. The use of PNAM with the modified nasal stent appliance showed promise in lowering the amount of the cleft deformity of the lip, palate, and alveolus, with improving nasal aesthetics. When comparing pre-NAM to post-NAM, there was also a considerable reduction in the alveolar defect. In cleft patients, the PNAM-assisted primary reconstruction employing a nasal stent appliance resulted in an overall improvement of the nasolabial complex, enhanced aesthetics, and a reduction in the extent of surgery and surgical operations.

A Rare Case Report of Pythium insidiosum keratitis in an Immunocompetent Patient

Beena, Rama Soujanya Betu

Corneal ulcers are one of the major causes of monocular blindness after cataracts in developing nations and have a varied aetiology. One of the emerging causes of corneal ulcers closely resembling fungi in its morphology is the Pythium insidiosum which is known to infect a variety of animals, but in humans, only a few cases have been reported causing ocular, cutaneous/subcutaneous, vascular, and disseminated infections. This was a case of a 29-year-old male, non agriculturist by occupation who presented to the Ophthalmology Outpatient Department with a history of diminution of vision, redness and watering of the left eye in the last five days. On further investigations, he was diagnosed to have a corneal ulcer with P. insidiosum being the aetiological agent. The patient was managed surgically by penetrating keratoplasty and medically by combination therapy consisting of moxifloxacin eyedrops every 4^th hour, voriconazole eye drops 2 hourly, natamycin eye drops 2^nd hourly, oral fluconazole 150 mg thrice daily for one week..

Lemierre’s Syndrome Presenting with Pleural Effusion

Hrishikesh Barui, Anirban Das, Preetam Goswami, Rathindra Nath Biswas

Lemierre’s syndrome is a condition characterised by septic thrombophlebitis of internal jugular vein following an oropharyngeal infection along with septic embolisation to other organs, mainly lungs. This report is about a 14-year-old girl who presented with complaint of high-grade fever, progressive shortness of breath and painful swelling of throat for seven days. Chest radiograph showed left hemithorax homogeneous opacity with contralateral mediastinal shift. Complete haemogram and other blood investigations revealed neutrophilic leucocytosis and raised C-reactive protein (CRP). Gram stain and aerobic culture of sputum, pleural fluid and blood were inconclusive. As there was no relief of symptoms even after empirical treatment with antibiotics, Contrast Enhanced Computed Tomography (CECT) scan of neck and thorax was done, and it showed bilateral ectatic internal jugular veins with intravascular thrombus and consolidation of left lung with ipsilateral pleural effusion. Ultrasonography (USG) of neck confirmed the presence of thrombus in internal jugular vein on both sides. She was started on intravenous clindamycin and subcutaneous anticoagulants. Gradually the symptoms of the patient resolved. To conclude, despite being called a “forgotten disease”, Lemierre’s syndrome requires strong clinical suspicion and prompt management to prevent mortality.

Non Indigenous Rhinoscleroma

Prabakaran Somu, RB Namasivaya Navin, S Rajasekaran, Raghvi Anand

Rhinoscleroma (RS) is a granulomatous illness of the upper respiratory tract caused by Klebsiella rhinoscleromatis. It is a rare, chronic, granulomatous disease. RS develops in the nasal mucosa subepithelium and can spread to the eustachian tube, maxillary antrum, oral cavity, larynx, orbit, trachea, and bronchi. The present case is of a 29-year-old female who came to the Ear, Nose and Throat (ENT) Outpatient Department (OPD) with chief complaints of bilateral nose block for six months. Examination by anterior rhinoscopy revealed pink nasal mucosa and a swelling arising from both sides of nasal septum, that was soft, non tender, did not bleed on touch. Diagnostic nasal endoscopy showed a midline septal mass which was present just posterior to mucocutaneous junction and a second septal mass was present posterior to first mass at level of posterior part of inferior turbinate. The patient underwent submucosal resection of septal mass and the same was sent for histopathological examination and it was diagnosed as features suggestive of RS. The patient was treated with a course of tablet ciprofloxacin, analgesics, antihistamines. There has been no recurrence during the one year follow-up period. Patient improved symptomatically and had no further complaints.

An Undiagnosed Case of Mucous Retention Cyst of Maxillary Sinus- A Case Report of a 10-year-old Lesion

CJ Sanjay, HS Sreeshyla, Nagabhushana Doggalli, Karthikeya Patil, Namrata Suresh

Mucous Retention Cyst of paranasal sinuses is rare. In comparison with the other paranasal sinuses, its incidence in the maxillary antrum is very less. Anatomically the maxillary sinus is in close vicinity to the maxillary alveolus and dentition of the oral cavity. Pathologies involving these anatomical regions can manifest in both the sites or either of the site leading to diagnostic dilemmas. Maxillary sinus pathologies most often produce oral symptoms and hence may be misdiagnosed initially thereby causing delayed treatment. Hence, careful evaluation and management are highly essential. This article reports a case of mucous retention cyst of maxillary sinus mimicking maxillary tooth pathology leading to delayed management. The described case is a 38-year-old male patient having well-defined firm swelling on the middle 1/3^rd of the face, with obliteration of buccal vestibule in the region of missing left maxillary first molar (26) mimicking residual cyst. The left maxillary first molar tooth had been extracted 10 years back due to its misdiagnosis as tooth pathology. Orthopantomograph showed loss of floor of the maxillary sinus with well-defined dome-shaped radiolucency with sclerotic borders extending into the sinus. Histopathology confirmed the diagnosis of maxillary sinus pathology.

Nevus Lipomatosus Cutaneous Superficialis with Spindle Cell Lipoma-like Areas: A Case Report

AR Piyush, Neelima Bahal, Pooja Sharma Kala, Richa Mittal

Nevus Lipomatosus Cutaneous Superficialis (NLCS) is a rare occurring cutaneous hamartoma with presence of mature adipocytes in dermis. Though first reported in 1921 by Haffman and Zurhelle, fewer cases have been documented in literature since then. Authors, hereby, report a case of nevus lipomatosus cutaneous superficialis in an unusual age of 55-year-old male with multiple painless ill defined sessile nodules of 1.5 to 3 cm on lower back. Surgical excision was performed and histopathology revealed characteristic features as that of NLCS along with intervening areas of spindle cell lipoma. Co-existence of other lesion along with NLCS, both clinically or on histopathology is further an infrequent occurrence. No such case has been reported in literature so far.

A Rare Cause of Recurrent Pleural Effusion- Pancreaticopleural Fistula

Nafees Ahmad Khan, Huma Firdaus, Arushiverma, Mehtab Ahmad, Mohammad Shameem

Pancreaticopleural fistula is one of the rarest complication of acute pancreatitis, chronic pancreatitis and pancreatic pseudocyst. Diagnosis requires a high index of clinical suspicion in alcoholic patients presenting with pancreatitis and associated recurrent pleural effusion. Diagnosis is delayed as patients usually present with predominant pulmonary symptoms of dyspnea and chest pain. Hereby authors presented a case, where a 50-year-old chronic alcoholic male presented with chief complains of shortness of breath and chest pain. Based on the chest radiograph, Computed Tomography (CT) scan and pleural fluid analysis diagnosis of pancreaticopleural fistula was made. The patient was managed with intercoastal tube drainage and symptomatic treatment for other complains. Medical management, endoscopic and surgical interventions bring out a good prognosis in pancreaticopleural fistula.

CA 19-9 in Ovarian Immature Teratoma- A Potential Tumour Marker or A Masquerade?

Julie H John, R Sanghamita, Ajay Halder, Sramana Mukhopadhyay, Shweta Patel

Carbohydrate antigen 19-9, also known as Cancer Antigen (CA 19-9) is a tumour marker found elevated in certain ovarian tumours. Although, reports of its association with mature teratoma are considerable, little is mentioned about its association with immature teratoma. This could be attributed to immature teratoma being a rare tumour with only a few studies on its tumour markers. Authors present the case of a 24-year-old female presenting with ovarian immature teratoma who also showed unusually high serum levels of CA 19-9 which reduced drastically after surgery. This association therefore may warrant further investigations to establish the clinical relevance and its importance in future.

Pulmonary Cystic Lesions in Patients with COVID-19 Infection: A Case Series

Neema Agarwal, Payal Jain, Tooba Naved Khan, Aakash Raja

Computed Tomography has played a vital role in Coronavirus Disease 2019 (COVID-19) infection, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) over the last two years. The typical features of COVID-19 on High Resolution Computed Tomography (HRCT) of chest including ground glass opacities and consolidation with a peripheral and lower lobar predilection have been very well documented in literature worldwide. However, thin-walled lucencies in the lung parenchyma called cysts is not very well documented. Authors, thus, present a case series comprising six SARS-CoV-2 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) positive patients admitted to the hospital during the period 1^st April 2021 to 31^st May 2021 with lung cysts on HRCT. It was a retrospective study, wherein, details of the patients were drawn from the case record sheets and the clinical parameters along with HRCT chest findings were analysed, and correlations were drawn to study the cause, timing and significance of these cysts. In this study, the cysts were found to be thin-walled, varying in size from 5-20 mm in diameter and subpleural in distribution with no obvious lobar predilection. The immediately surrounding lung parenchyma showed features of maximal involvement by the atypical pneumonitis. All six cases had moderate to severe lung involvement entailing oxygen therapy. The high flow oxygen therapy and its duration along with degree of lung involvement, are important determinants of cystic degeneration. In the present case series, cystic changes were observed somewhere between day 15 to day 40 of the disease and thus, a part of postacute fibrosis in COVID-19 infection.

Antibody Cocktail in Moderate to Severe COVID-19 Infection: A Series of 10 Cases

Rohit Hanmanta Bhandari, Sonali Gupta

In the wake of the Coronavirus Disease-2019 (COVID-19) pandemic, scientists all over the world are in a relentless search for a cure. None of the therapies advised till date have shown significant benefit in treating COVID-19 infection. An antibody cocktail consisting of a combination of casirivimab and imdevimab is the newest weapon in the armamentarium against the disease. Currently, it has shown great promise in treating mild non hospitalised cases. The authors present the results of a series of 10 cases aged 31-76 years that demonstrate the efficacy of this cocktail in treating moderate to severe cases as well. All the patients received Roche’s Antibody cocktail© on admission and standard treatment protocol comprising of remdesivir, methylprednisolone and low molecular weight heparin was given. Oxygen supplementation was titrated to achieve a target oxygen saturation (SpO₂) of 88-92%. Majority (70%) of the patients demonstrated an improvement in SpO₂/Fraction of Inspired Oxygen (FiO₂) ratio and a decline in the inflammatory marker levels 3-5 days after receiving the cocktail. Eight out of the 10 patients could be discharged home after 10-14 days of admission. The remaining two had severe disease with Computed Tomography Severity Index (CTSI) >17/25 and died despite receiving all the available therapies. Antibody cocktail is an effective adjuvant therapy against moderate to severe COVID-19 pneumonitis, demonstrating rapid improvement in SpO₂/FiO₂ ratio, inflammatory markers and a shortened duration of hospital stay.

Uncommon Pathological Presentations of Mature Cystic Teratoma: A Case Series

Suchita Pant, Usha Joshi, Kriti Joshi

Mature cystic teratomas are benign tumours of the ovary but rarely certain unusual gross and microscopic findings might complicate their diagnosis or may have an impact on their clinical outcome. Here, we are presenting a case series of five unusual pathological presentations of mature cystic teratomas of ovary. Out of five cases, three cases were of collision tumours, in which combination of mature cystic teratoma is seen with mucinous cystadenoma in two cases, and with serous cystadenoma in one case. True collision tumours are defined as histologically distinct neoplasms in the same tissue or organ without any histologic admixture or intermediate cell population zone between two components. These tumours are located in various organs but ovarian location is rare. Mature cystic teratoma is the most common component of collision combinations in the ovary. All classes of ovarian tumours, benign, borderline and malignant may collide and therefore, clinical outcomes in collision tumours depend on individual tumour characteristics. The fourth case was of a mature cystic teratoma associated with a distinct haemangiomatous component. Mature cystic teratoma associated with prominent haemangiomatous component is a very rare finding with only few case reports in the literature and it should be differentiated from true ovarian haemangioma, lymphangioma, and angiosarcoma. The fifth case was of bilateral mature cystic teratomas associated with a well-defined lipomatous lesion in right sided mature cystic teratoma mimicking lipoma. Lipomatous ovarian lesions are very rare and mature cystic teratoma with prominent adipocytic proliferation is also an exceedingly uncommon finding and it should be differentiated from true ovarian lipoma and other atypical lipomatous proliferations. Most of these tumours remain clinically and radiologically unrecognised, therefore their histological recognition is essential for adequate patient management.

Minimally Invasive Restoration of Fractured Maxillary Central Incisors with Partial Laminate Veneers- A Case Series

Asena Kaptanoglu, Tugce Merve Ordueri, Alaaddin Kilicaslan, Haluk Baris Kara

Porcelain laminate veneers are one of the most preferred treatment methods today, due to the increasing interest in minimally invasive approach and their superior aesthetic properties. With the appreciation of the minimally invasive approach and the developing adhesive procedures, the partial laminate veneers have become more popular in the dental field. In this case series including three cases, the teeth were restored with partial laminate veneers by only intervening in the fractured area. In this case series, the teeth that were restored with partial laminate veneers were prepared with different techniques. Preparation was performed without bevel in enamel margin in case 1, with incisal overlap and bevel to create more natural transition on tooth surface in case 2. In case 3, preparation with incisal overlap was performed with preparation of the palatal surface of the tooth. The optical impression was made with the digital camera of the Chairside Economical Restoration of Esthetic Ceramic (CEREC) acquisition unit (Omnicam CEREC Sirona, Bensheim, Germany), in the first case. In the other cases, impression was taken with elastomeric impression materials. In addition, restorations were fabricated from feldspathic porcelain and lithium disilicate porcelain. In all the cases, restoration was cemented with resin cements. The following cases present the minimally invasive treatment of maxillary central incisors with partial laminate veneers fabricated from different ceramic materials. New materials, procedures, and techniques provide patients an improved quality of life and a greater self-esteem with creating a confident aesthetic smile.

Biochemical Investigation of Multisystem Inflammatory Syndrome in Children (MIS-C) with SARS-CoV-2 Infection: A Series of Seven Cases

Kamalakar Bhagwat Mane, Swati Digambar Sawant

In children, Coronavirus Disease 2019 (COVID-19) is typically mild. However, in rare cases, children are severely affected, and clinical manifestations are differed from adults. The consequence of COVID-19; Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication that seems like toxic shock syndrome or Kawasaki Disease (KD). The MIS-C is characterised by an inflammatory response in the body that occurs four weeks after infection with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Fever, rashes, diarrhoea, red eyes, and vomiting are common early symptoms that can worsen over time. The inflammation can affect the blood vessels, heart, and other organs, leaving children critically ill and in need of immediate medical attention. Many of the children with MIS-C show positive SARS-CoV-2 serology but negative Polymerase Chain Reaction (PCR), supporting the concept that MIS-C is linked to immunological dysregulation that develops after the acute infection has passed. However, some children do have positive PCR testing. A case series of seven critically ill (5 females and 2 males) with MIS-C in sequential order of admission in the Paediatric Intensive Care Unit (PICU) of tertiary care hospital is illustrated. Key findings of this syndrome include fever, epilepsy, diarrhoea, shock and variable presence of rash. In the present case series, the clinical features, laboratory findings and therapies for a cohort of seven children with MIS-C are presented. Laboratory investigations carried out at early stage of disease can be of vital importance to diagnosis of MIS-C.

Usefulness of Simulation Based Learning in First Year Medical Students: A Quasi-experimental Study

Vinod Shende, Sachin Pawar, Suvarna Sande

Introduction: Auscultation of chest is an important part of clinical patient assessment and the skills required to interpret it are traditionally learned by listening the heart and lung sounds of many different patients. It may be difficult for the students to compare actual heart and lung sounds with similar findings. Therefore, use of simulated heart and lung sounds in teaching and training of medical students may be helpful in such scenario as it allows the repetitive and individualised oriented training in support of learning in real scenarios. Aim: To evaluate the usefulness of simulation in understanding various respiratory and cardiovascular sounds, to assess the learning gain of students by pretest and post-test and to evaluate the perception of students towards simulation based learning. Materials and Methods: The present quasi-experimental study was carried out on 100 first year MBBS students at Clinical Skills Laboratory and Department of Physiology, at Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India, from April 2018 to September 2018. Pretest was taken before intervention from all participants. Students were randomly divided into two groups. Group I had undergone clinical examination of Cardiovascular System (CVS) and Respiratory System (RS), where as, group II had undergone clinical examination of CVS and RS as well simulation based learning. Objective Structured Clinical Examination (OSCE), post-test and feedback was obtained from all participants. Data was analysed using Microsoft excel and Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Both groups had 50 subjects each, with age group of 18-20 years and mean age 18.3±1.9 years . There were 21 male and 29 female subjects in both groups. Mean scores of OSCE in group I and II were 7 and 8.18 respectively. Mean score of pretest in group I and II were 5.04 and 5.02 respectively, whereas mean score of post-test in group I and II were 6.66 and 7.54 respectively. Comparison of OSCE and post-test scores in two groups was found to be statistically significant (p-value <0.0001). Conclusion: Understanding of cardiovascular and respiratory sounds was better in group II where simulation based learning was used compared to other group. Hence, it was concluded that simulation based learning is useful additional tool to learn clinical examination of cardiovascular and respiratory physiology. It helps first MBBS students to enhance their clinical knowledge, skills and attitude.

Triple Assessment for the Diagnosis of Carcinoma Breast in a Tertiary Care Hospital of Tripura: A Cross-sectional Study

Tamal Sarkar, Damodar Chatterjee, Diptendu Chowdhury, Pradip Sarkar

Introduction: A combination of invasive and non invasive procedures, clinical examination, radiological imaging {mammography/ultrasonography/Magnetic Resonance Imaging (MRI)} and Fine Needle Aspiration Cytology (FNAC) called the triple assessment test is being increasingly used in place of the more invasive core needle biopsy and histopathology. Aim: To evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma and to determine sensitivity and specificity with regards to histopathology in the diagnosis of the disease. Materials and Methods: A cross-sectional study was conducted among 61 women of more than 25 years of age having palpable breast lump, attending the surgery Outpatient Department (OPD) and breast clinic of a tertiary care hospital from January 2017 to February 2019. Data on socio-demographic status, menstrual and obstetric information, clinical examination performed, mammography, FNAC, high resolution sonography breast and histopathology were recorded into predesigned and pretested proforma and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of total 61 patients participated in the present study, most patients were of 41-50 years of age, with a mean age of 44.23±7.4 years. Majority of patients were married, non vegetarian and without any past history of alcohol consumption. Sensitivity and specificity of triple assessment was 98.3% and 100%, respectively. The positive predictive value of triple assessment was 100% while the negative predictive value was 66.7%. All values were significantly better than both clinical breast examination and FNAC in detecting malignancies. Conclusion: The triple test was also found to be accurate in diagnosing breast carcinoma in this geographical region. A patient with a negative triple test report can be safely followed-up without the need for biopsy.

Retinal Nerve Fibre Layer and Ganglion Cell Complex Measurement and their Correlation with Visual Field Changes among Glaucoma Patients

Kanika Yadav, Rakesh Porwal, Praveena

Introduction: Glaucoma is an optic neuropathy that causes loss of Retinal Ganglion Cell (RGC) and changes in the visual field. The loss in RGC is determined by Optical Coherence Tomography (OCT), and visual field defects are evaluated with perimetry. A study of RGC loss and visual field defects together might help to detect glaucoma earlier. Aim: To determine the relationship between Retinal Nerve Fibre Layer (RNFL) and Ganglion Cell Complex (GCC) thickness measured with OCT, and visual field sensitivity evaluated with Standard Automated Perimetry (SAP) in glaucoma patients of varying severity. Materials and Methods: This was a cross-sectional study, conducted in a tertiary care hospital, Ajmer, Rajasthan from October 2018 to January 2020. Sixty glaucoma patients were recruited for ophthalmic evaluation. The two test SAP and SD-OCT were performed on all patients. Patients were categorised into three groups i.e., early, moderate and severe, based on severity. The RNFL, Mean Deviation (MD) and Pattern Standard Deviation (PSD) were compared among these three groups. One way Analysis of Variance (ANOVA) was used to compare the mean values of RNFL, GCC, MD and PSD across the three glaucoma groups. Post hoc analysis was done by Tukey’s range test. Correlation was assessed using Spearman’s correlation coefficient. Results: The mean (SD) age of participants were 54.43 (10.07) years. Total 15% of patients belonged to early stage glaucoma, 40% to moderate and 45% to severe glaucoma. The difference in mean RNFL (both superior and inferior) was found significant among the three groups. In bivariate analysis, MD was found significantly correlated with superior and inferior RNFL (r=0.70, p-value <0.01 and r=0.47, p-value <0.01, respectively). The MD was not found to correlate with superior and inferior GCC whereas, PSD was found weakly correlated with GCC superior and inferior (r=-0.26, p-value=0.04 and r=-0.27, p-value=0.03, respectively), though there was inverse correlation with both GCC superior and GCC inferior. PSD was not found to correlate with superior and inferior RNFL. Conclusion: Superior and inferior RFNL were associated with MD, an indicator of the severity of glaucoma. The RNFL thickness was the best indicator to differentiate the severity of glaucoma. Further exploration is needed to develop specific indications of RNFL and GCC measurement in the management of glaucoma.

A Systematic Approach to Optimise the Number of Beams for Intensity Modulated Radiotherapy in Pituitary Adenoma using Radiobiological Parameters

Richa Sharma, Sunil Dutt Sharma, Devesh Kumar Avasthi, Rohit Verma

Introduction: The number of beams used in a Radiotherapy (RT) plan effects the overall quality of the plan and hence the treatment. The inclusion of radiobiological concepts in finding the optimum number of beams for a particular planning technique has the potential to provide a step ahead of the routine clinical practice where clinical decisions are more dependent on the physical dose parameters. Aim: To optimise the number of beams for Intensity Modulated Radiotherapy (IMRT) plan based on Tumour Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) biological parameters. Materials and Methods: This retrospective study was done on 30 patients with pituitary macro-adenoma who underwent radiotherapy with a prescribed dose of 50.4 Gy in 28 fractions in Delhi State Cancer Institutes, Delhi, India from December 2012 to August 2018. The study data was collected and analysed between June 2018 and April 2020. These patients were treated with step and shoot IMRT technique on ONCOR?SUP?TM#SUP# Expression linear accelerator (Siemens Healthineers, USA). But, the number of beams used to deliver IMRT plans were different as decided by the medical physicist and hence planner dependent rather than the disease. Being a centrally located disease, a symmetric beam arrangement was adopted for IMRT planning. For dosimetric comparison, three IMRT plans with five, seven, and nine equispaced beams were generated in Monaco treatment planning system for each patient and thus, a total of 90 IMRT plans were created and evaluated. For fair comparison, same IMRT planning parameters were utilised in all three plans of each patient. Monte Carlo (MC) dose calculation algorithm was used for all the plans. Resulting Cumulative Dose Volume Histograms (CDVHs) were exported to MATLAB, where these cDVHs were processed as per Niemierko’s radiobiological model to calculate the values of TCP and NTCP based on the Equivalent Uniform Dose (EUD). After this, the analysis of variance, ANOVA test was conducted over the resulting values of EUD, TCP, and NTCP to assess the difference of quality among plans having different beam arrangements at 0.05 level of significance. Results: The mean tumour control probability (TCP) for IMRT plans with seven and nine beams were found to be 89.0±0.8% and 89.1±0.9% respectively for planning target volume (PTV). These values were not significantly different from each other. However, the mean TCP value for IMRT plans with five beams was found to be 88.4±1.1% for PTV. Further, this TCP value was proved to be significantly lower as compared to IMRT plans with seven and nine beams with a p-value of 0.008 and 0.004, respectively. On the other hand, the mean Normal Tissue Complication Probability (NTCP) was assessed to be less than 1% for all critical organs irrespective of the beam arrangement, indicating almost no probability of radiation induced toxicity in any of the organ. Conclusion: This study concludes that the plan efficiency can be improved by using optimum number of beams for IMRT planning of pituitary adenoma.

Prevalence of Arrhythmic Events in Paediatric Patients with Congenital Heart Disease-A Retrospective Study

Asish Banerjee, Meenakshi Mitra

Introduction: Various types of arrhythmias occur in patients with Congenital Heart Disease (CHD) and are the leading cause of morbidity and mortality. Knowledge regarding arrhythmias in CHD is important for safe and effective management of arrhythmia and in reduction of sudden cardiac deaths. Aim: To assess the profile of various arrhythmic events in children with CHD. Materials and Methods: A retrospective study was conducted from January 2018 to December 2020. Data were collected from the Department of Paediatrics of a tertiary care hospital in Durgapur, West Bengal, India. A total of 232 children of the age group 0-18 years, diagnosed with CHD were included in this study. Children who underwent cardiac intervention were excluded from the study. Age, sex, age at diagnosis, nature of CHD, clinical findings, Electrocardiogram (ECG) findings were recorded. Data analysis was performed using Fisher’s-Exact test on Statistical Package for the Social Sciences (SPSS), version 27.0. A p-value <0.05 was considered as statistically significant. Results: A 20.3% children of 0-18 years of age with CHD had conduction abnormalities. Statistically significant association was found between atrial septal defect with Atrial Fibrillation (AF) (p-value <0.001) and atrial flutter (p-value=0.008), Ventricular Septal Defect (VSD) with Premature Ventricular Contractions (PVC) (p-value=0.0001), Atrioventricular (AV) canal defect with first degree AV block with (p-value=0.0004), Tetralogy Of Fallot (TOF) with Ventricular Tachycardia (VT) (p-value=0.021), L-Transposition of Great Vessels (L-TGA) with complete AV block (p-value=0.012), Ebstein’s anomaly with Supraventricular Tachycardia (SVT) (p-value <0.001). Conclusion: Specific conduction abnormalities are significantly associated with specific CHD. These results demand attention for effective management of arrhythmia and reduction of sudden cardiac death in children with CHD.

Clinico-pathological Evaluation of Chronic Diarrhea with Microscopic Colitis: A Cross-sectional Study

Girija, CS Sheeladevi, HV Aradhya

Introduction: Chronic diarrhoea is common in the older population accounting for 7-9% which often markedly affects their quality of life. The causes are many and include infectious, endocrine, metabolic, neoplastic, functional, drugs. Microscopic Colitis (MC) has emerged as a distinct diagnostic entity, where the colon appears endoscopically normal, but the biopsy reveals characteristic features in the mucosa. It has two histological forms i.e, Collagenous Colitis (CC) and Lymphocytic Colitis (LC). Aim: To study the clinicopathological spectrum of lesions in random colonic biopsies of patients with chronic diarrhoea having normal colonoscopy. Materials and Methods: This hospital-based cross-sectional study was conducted in Department of Pathology at JSS Hospital, Mysuru, Karnataka, India, from October 2017 to September 2019. Multiple random biopsies were taken from 80 patients with chronic diarrhoea who had normal colonoscopy. The slides were stained with Haematoxylin and Eosin (H&E) and Masson’s Trichrome Stain (MTS). The histological features were studied under light microscopy and using computer-assisted image analysis. The Chi-square test was used to statistically analyse the data. Results: The age of patients ranged from 11-82 years with a mean age of 43 years. Out of total 80 patients, 65 (81.25%) of the cases had non specific inflammation, 14 (17.4%) had microscopic colitis and 1 patient (1.25%) had probable eosinophilic colitis. The histological features were observed in computer-assisted image analysis using morphometry and interpreted by two pathologists with agreement. Conclusion: Random biopsies are required for the diagnosis of microscopic colitis in the absence of macroscopic abnormalities on colonoscopy, which may affect the treatment strategy. A histologic examination combined with histochemical stain MTS and interpretation utilising computerised image analysis program with morphometry is more effective in cases with diagnostic uncertainty.

Comparison between the Reverse Sellick’s and SORT Manoeuvres of Nasogastric Tube Insertion in Anaesthetised, Intubated, Adult Patients- A Randomised Clinical Study

Debdeep Chakraborty, Sanjay Maitra, Jayanta Chakraborty , Mohanchandra Mandal

Introduction: In the perioperative period and critical care unit, Nasogastric Tube (NGT) placement is a simple procedure which turns in to a difficult one in anaesthetised, intubated patient. The SORT manoeuvre (a combination of Sniffing position, Orientation of nasogastric tube, Rotating the patient’s head to the contralateral side and Twisting movements of operator’s hand) has been studied sparingly. Reverse Sellick’s manoeuvre is a commonly applied method for NGT placement where cricoid cartilage is lifted by the performer with non dominant hand during placement of NGT. Aim: To ascertain the success rate of SORT manoeuvre in comparison with the reverse Sellick’s manoeuvre for NGT placement in anaesthetised and intubated adults. Materials and Methods: This single-blinded, randomised study was conducted in N.R.S. Medical College and Hospital (tertiary care centre), Kolkata, West Bengal, India, from March 2020 to August 2021. Total 102 adults patients, scheduled for abdominal surgeries under general anaesthesia with intubation, were included. The patients received NGT placement either by applying reverse Sellick’s manoeuvre (group A, n=51) or using SORT manoeuvre (group B, n=51), following a random allocation method. The number and percentage of patients having successful NGT placement within first attempt in each group was recorded. The time to perform the procedure and any incidence of adverse event were recorded. Quantitative variables were compared using Independent t-test between the two groups. Qualitative variables were compared using Chi-square test/Fisher’s exact test, as appropriate. A p-value ≤0.05 was considered statistically significant. Results: Successful placement of NGT within single attempt was feasible in 48 (94.1%) patients using the SORT manoeuvre in contrast with 38 (74.5%) applying the reverse Sellick’s manoeuvre (p-value=0.006). Longer procedure time was observed with the SORT manoeuvre compared to the reverse Sellick’s manoeuvre (22.3±4.4 vs 20.1±3.8 seconds), respectively; p-value=0.008). Use of SORT manoeuvre in comparison with reverse Sellick’s manoeuvre resulted in apparently lower incidence of adverse events (coiling 1.96% vs 19.6%; kinking 1.96% vs 3.92%, respectively); however, found statistically not significant (p-value=0.305). However, overall incidence of adverse events was considerably more in reverse Sellick’s manoeuvre compared with the SORT manoeuvre (25.5% and 5.8%, respectively, p-value=0.006). Conclusion: The SORT manoeuvre appears to be advantageous over the reverse Sellick’s manoeuvre for NGT placement in adult patients undergoing surgery under general anaesthesia with intubation, in terms of higher success rate and lower incidence of adverse events.

Comparison of Effect of Clonidine and Magnesium Sulphate on Attenuation of Haemodynamic Response to CO₂ Pneumoperitoneum in Patients undergoing Laparoscopic Surgeries- A Randomised Clinical Study

Aparna Bagle, Krusha Suresh Shah, Spoorti Pujari, Tanya Gulia, Chandrakala Singh

Introduction: Laparoscopy, a minimally invasive technique causes several physiological fluctuations. There can be deleterious sympathetic responses during Carbon Dioxide (CO₂) insufflation, which is done to create a pneumoperitoneum. Aim: To assess the impact of clonidine and magnesium sulphate on sympathetic response to carbon dioxide insufflation in patients undergoing laparoscopic surgeries. Materials and Methods: A double-blinded randomised clinical study was conducted in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharshtra, India, from June 2020 to September 2021, included 52 patients, posted for elective laparoscopic surgeries. Patients were randomised into two groups i.e, group M (n=26) received 30 mg/kg of magnesium sulphate and group C (n=26) received 1 μg/kg of clonidine after premedication. The vital parameters like heart rate, systolic, diastolic and mean arterial pressure, end tidal carbon dioxide, saturation were observed and noted at predetermined interval in perioperative period. Also, Visual Analogue Score (VAS) and sedation score were recorded in the recovery room. The statistical software SPSS version 16.0 was used. The p-value <0.05 was considered as significant. Results: The mean age in group C and group M was 35.46±8.5 years and 35.38±9.02 years (p-value=0.751). Both groups were compared for change in heart rate, systolic, diastolic and mean blood pressure changes after pneumoperitoneum and showed no significant variations in both groups at different time intervals (p-value >0.05). Also, both groups showed less than 20% variation from the baseline parameters, thus, effectively attenuating the pressor response. The VAS and sedation score were comparable in both the groups and showed no significant variations in both groups at different time intervals. Conclusion: Intravenous administration of clonidine 1 μg/kg, or magnesium sulfate 30 mg/kg prior to pneumoperitoneum was effective in suppressing the pressor response during laparoscopic procedures. At the above used dosages, groups C and M showed insignificant difference in the measured parameters, thus, proving to be equally effective in blunting the pressor response.

Comparative Analysis of Line Immunoassay with Immunofluorescence Assay for the Identification of Autoantibodies in Patients with Suspected Systemic Autoimmune Disorders: A Cross-sectional Study

Jaspreet Kaur, Jaswinder Singh

Introduction: Systemic Autoimmune Diseases (SAD) are the diseases, including Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Sjogren’s syndrome, polymyositis, dermatomyositis, etc. where multiple organs are involved in the presence of a large variety of autoantibodies directed against one’s own immune system at various levels. They are one of the major causes of death and disability in all age groups and are characterised by the presence of Antinuclear Antibodies (ANA) in the blood of patients. Aim: To comparatively evaluate the utility of Line Immunoassay (LIA) with Indirect Immunofluorescence Assay (IIFA) for the detection and identification of ANA in suspected SAD patients. Materials and Methods: The present observational, cross-sectional study was conducted on the collected samples of 560 clinically suspected SAD patients attending the Outpatient and Inpatient Departments (Medicine, Paediatrics, Orthopaedics, Dermatology and General Surgery) at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India (tertiary care hospital), from March 2016 to March 2020. Samples were subjected to ANA testing by IIFA and LIA. All variables anti-dsDNA, anti-Smd1, SSA/Ro and U1 SnRNP, SSA/Ro, anti Proliferating Cell Nuclear Antigen (PCNA) and PO/RPP, SSB/La, anti CENP-B, Scl70, AMA-M2 and Mi-2 included in the study were presented in the form of percentages. Performance of LIA was reported in terms of sensitivity and specificity at 95% confidence interval. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 22.0 (Chicago, IL, USA) for windows. Results: Samples of both male (n=229) and female (n=331) patient of age group ranging from 0-90 years with mean age of 38.2 years were studied. Out of 560 samples, 197 (35.17%) patients were found to be ANA positive by IIFA. The LIA was positive in 175 (31.25%) patients. Of these 175 positive patients, 92 (52.57%) had a recognised autoimmune disease with the most common diagnosis was SLE, found in 38 (41.30%). In comparison to IIFA the sensitivity and specificity of LIA was found to be 82.13% and 98.62% respectively with 92.63% accuracy. Conclusion: The combined analysis of IIFA and LIA can be very useful for rapid identification of ANA which strengthen the initiation of treatment at the earliest to reduce disease morbidity and mortality.

Knowledge and Anxiety of Pregnant Women towards COVID-19 Pandemic in the Prevaccination Phase

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic has led to devastating and unprecedented health crises especially in the vulnerable population, ever since its origin in 2019. COVID-19 management in pregnant women had been a matter of controversy before the introduction of the standard protocols by the various international bodies. A lot of concern still prevails around the adverse foeto-maternal outcomes such as preterm birth, stillbirth, increased caesarean rates, maternal morbidity and mortality. Furthermore, uncertainty about the duration of the COVID-19 pandemic had also increased anxiety among pregnant women, particularly during the first wave. Aim: To find out the knowledge and beliefs of pregnant women towards the COVID-19 infection in first wave and to know whether it had increased anxiety among non infected pregnant women before the advent of the COVID-19 vaccination. Materials and Methods: A cross-sectional observational study was conducted on the 280 asymptomatic pregnant women attending the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, over four months (10^th October 2020 to 10^th February 2021). These women were provided with a questionnaire and a Generalised Anxiety Disorder Score-7 (GAD-7) chart. Statistical analysis was performed using the Pearson’s Chi-square analyses with p<0.05 considered statistically significant. Results: The total number of participants were 280. Majority of them were in their 20’s and were primigravida. The mean GAD-7 score for the study population was 4.642 and the overall prevalence of anxiety in the present study was 34.3% (n=96). GAD-7 score chart showed 65.7% (n=184) had 0-4 levels (minimal) while severe scores ≥15 were noted in 2.9% (n=8). In the current study, greater anxiety scores were found in the homemakers. A high prevalence of anxiety was seen in primigravida and during the third trimester. About 37.5% of the participants believed that COVID-19 could transmit to the foetus-in-utero, if infected and 50.36% felt being pregnant could increase the risk of contracting COVID-19 infection. Conclusion: The present findings suggest that pregnant women showed a lot of concerns and significant anxiety due to COVID-19 during the study period.

Early Cataract and Surgical Recovery in Young Type 1 Diabetics: Experiences from a Single Centre in Northern India

Rishi Shukla, Sangeeta Shukla, Neha Agarwal, Anurag Bajpai, Mohit Khattri

Introduction: Cataract, a non retinal ophthalmic complication, is the leading cause of visual impairment in adults living with Type 1 Diabetes (T1D). Unfortunately, there is a dearth of data on diabetic cataract in the paediatric population, particularly from developing countries. To the best of authors’ knowledge, the current study is the first and the largest observational study reporting the characteristics, and surgical recovery of early cataract among Indian children and adolescents living with T1D. Aim: To report the patient characteristics and surgical outcome of early cataract in young type 1 diabetics. Materials and Methods: The present study was a retrospective observational study (January 2005-December 2020), conducted at Regency Hospital Pvt. Ltd., Kanpur, Uttar Pradesh, India. Medical records of children and adolescents (n=150) aged 1-18 years with T1D in the last 15 years, and who developed cataract during follow-up were included in the study and reviewed from January 2021 to March 2021, for the socio-demographic details, age at which diabetes was diagnosed, presence or absence of ketoacidosis at the time of diagnosis of diabetes, age at which cataract was diagnosed, glycaemic control, morphology and laterality of cataract, history of retinopathy before cataract surgery, presence or absence of concomitant nephropathy, visual acuity at the time of cataract diagnosis, type of surgical intervention done and visual acuity following surgery. Results: Out of 150 T1D patients, a total of 10 patients (five boys; 19 eyes) were diagnosed with cataract, before the age of 18 years. The mean age at diagnosis of T1D was 8.6±3.2 years (range 3-12 years) and cataract was 13.2±4.1 years (range, 6-18 years). Mean HbA1c at the time of cataract diagnosis was 7.99±0.98%. The past history of diabetic ketoacidosis was documented in patients (60%). Nearly 70% (n=7) patients belonged to the lower socio-economic strata. Cortical cataract (12/19 eyes; 63%) was the most common morphology identified. These patients were operated after a mean duration of 0.5±0.7 years of cataract diagnosis. The corrected visual acuity remained good after a mean follow-up duration of 3.2±2.7 years (range 0-8 years), post cataract extraction. Conclusion: The experiences gained from the present study reinforce the need for early cataract screening in the paediatric diabetic population, especially in those, belonging to lower socio-economic strata, and/or with history of diabetic ketoacidosis. Cortical cataract was the most common form identified. Vision can be preserved with timely surgical intervention.

Prevalence of HIV Infection among Blood Donors in a Tertiary Care Hospital of Haryana: A Retrospective Study

Inderjeet Singh, Bharti Chawla, Sneh Kumari, RB Jain, Sumit Chawla

Introduction: Blood is a scarce, but life saving resource. At the same time, unsafe transfusion practice also puts millions of people at risk of Transfusion Transmissible Infections (TTIs). Aim: To determine the prevalence and trend of blood borne infection namely Human Immunodeficiency Virus (HIV) among blood donors donating blood in a tertiary care hospital of Haryana, India. Materials and Methods: A retrospective study was conducted in the Department of Transfusion Medicine of Pt. B.D Sharma PGIMS, Haryana, India, from September 2012 to August 2014 to calculate the prevalence and trend of HIV positivity among blood donors over a period of five years (2008-2012). Results were expressed in terms of frequency and percentage. Results: There were a total of 1,59,077 donations, including both voluntary and replacement donors. The overall prevalence of HIV infection among blood donors was found to be 0.26% over a period of five years (2008-2012). The HIV prevalence among blood donors showed an increased trend from 2008 (0.18%) to 2011 (0.34%), and then there was a dip in the year 2012 (0.23%). Conclusion: The number of female blood donors were less in comparison to male blood donor. The maximum number of donors were voluntary males followed by replacement males.

Transurethral Holmium Laser Cystolithotripsy Under Local Anaesthesia in Adult Patients: A Prospective Observational Study at a Tertiary Care Centre in North-east India

Stephen Lalfakzuala Sailo, Laltanpuii Sailo, Cornerstone Wann

Introduction: Urinary bladder stones comprise 5% of all urinary stones. Various modalities for the treatment of symptomatic bladder stones are available. They are open cystolithotomy, extra corporeal shock wave lithotripsy, cystolitholapaxy, suprapubic or transurethral cystolithotripsy using various energy sources. Presently transurethral holmium laser cystolithotripsy is considered as the treatment of choice for symptomatic bladder stones. Aim: To report the experience of holmium laser cystolithotripsy for the treatment of symptomatic urinary bladder stones under local anaesthesia in adult patients. Materials and Methods: This prospective observational study was conducted on 86 patients at Department of Urology, North-eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India, between June 2016 and August 2019. It included consecutive adult patients with symptomatic bladder stones of size upto 4 cm who underwent transurethral holmium laser cystolithotripsy under local anaesthesia during the study period. Laser energy was delivered through a 9.5F semi rigid ureteroscope using 365 μm or 550 μm end-firing fibre. Pain during the procedure was assessed using Visual Analogue Scale (VAS). Descriptive statistics was used for analysis of the results. Results: During the study period, 86 patients (84 men, 2 women) underwent transurethral holmium laser cystolithotripsy under local anaesthesia. Complete fragmentation of the stones was achieved in all patients. The mean stone size was 15.04 mm and the mean operating time was 23.81 minutes. The procedure was well tolerated by the patients and the mean pain score was 3.26. It was associated with minor complications only. There was no major complication or mortality during the study. Conclusion: Transurethral holmium laser cystolithotripsy under local anaesthesia is a safe procedure. It is well tolerated by adult patients and it can be used for the treatment of bladder stones of size upto 4 cm.

Comparison between Direct Laryngoscopy with and without Aerosol Box for Intubation in Patients undergoing General Anaesthesia during COVID-19 Pandemic- A Randomised Controlled Study

Krupa P Patel, Ashish P Jain, Vaidehi J Mehta, Hetal A Parikh, Chinar N Patel

Introduction: The airway management of patients with COVID-19 is a high risk task for anaesthesiologists. Several innovations have been born as a result of this problem, including aerosol boxes and clear plastic sheets. Aim: To compare the timing and attempt of direct laryngoscopy with and without aerosol box for intubation in patients undergoing general anaesthesia during the COVID-19 pandemic. Materials and Methods: This was a randomised controlled study was conducted in Parul Sevashram Hospital, Parul University, Vadodara, Gujrat, India from April 2021 to September 2021. A total of 50 patients were randomly divided into two equal groups as group A was intubated with an aerosol box and a macintosh laryngoscope, while group B was intubated with a clear plastic sheet and macintosh laryngoscope. With proper airway precautions and Personal Protective Equipments (PPE) comparative assessment of patients undergoing surgery in general anaesthesia was done. Time to intubate, number of attempts, ease of Endotracheal Tube (ETT) tube insertion, quality of Laryngoscopy view and Cormack Lehane scores were assessed in both the groups. Results: The mean time for intubation was high at 29.72 seconds in group A, while it was 23.16 seconds in group B; the difference was significant. Overall, 20 out of 25 (80%) patients could be intubated in 1st attempt in group B as compared to 15 out of 25 (60%) in group A. Airway visualisation using Percentage of Glottic Opening (POGO) scoring and Cormack Lehane staging were suggestive of better visualisation in group B than group A. Difficulties encountered during intubation like laryngoscopy, glottic visualisation, arm movement restriction, ETT negotiation, and stylet removal were lesser in group A as compared to group B. The incidence of complications like sore throat and airway bleeding were lower in group B as compared to group A. Conclusion: In the COVID-19 era, aerosol box and clear plastic sheets are effective barrier measures for airway management to prevent the anaesthesiologists from the aerosol transmission. But, airway management with clear plastic sheet is technically easier than aerosol box.

Effect of Mint Flavoured Chewing Gum in Observing Changes in Cognitive Function while Assessing Test Performance- An Interventional Study

S Anu, K Jeyashree, SN Vishnuvarthini, N Prasanna Venkatesh, J Vijay Anto

Introduction: Cognition is the mental process of acquiring knowledge and understanding through aspects such as awareness, perception, reasoning, memory and judgement. Chewing movement of jaw stimulates memory parts of brain by increasing blood flow and glucose delivery. Taste and odour of mint is also known to stimulate memory areas of the brain. The synergistic effect of chewing and flavour is expected to have a greater effect on cognition than chewing alone. Aim: To assess the effect of use of mint flavoured, flavourless and absence of chewing gum on an individual’s cognitive function among the medical undergraduates. Materials and Methods: This comparative, interventional study, was conducted in the Department of Physiology at Velammal Medical College and Hospital, Madurai, Tamil Nadu, India, August 2019 to September 2019. Study involved 75 (39 females, 36 males) MBBS first year students, aged 18-20 years. Only students with cognitive score between 28-30 based on Mini-Mental State Exam (MMSE) score were included in the study and were divided into 3 groups. Group A (n=25) who were given mint flavoured chewing gum, Group B (n=25) given flavourless chewing gum and Group C (n=25) the control group, not provided with chewing gum. Baseline memory, Heart Rate (HR), Reaction Time (RT) and Stress Levels (SL) were recorded. Groups were taken into separate rooms where they were allowed to study a particular topic i.e Parkinson’s disease for 30 minutes. Then they were allowed to take tests on standard Parkinson’s questionnaire for 20 minutes and assessed based on the test performance. Group A and Group B were provided with chewing gums both during studying the topic as well as taking tests. Post intervention test performance (short term memory), HR, RT and SL were again recorded. Test performance was also assessed after one month to assess the effect of chewing gum on long term memory. One-way Analysis of Variance (ANOVA) and paired t-test were used to compare all the post test parameters between the three groups. Results: A statistically significant increase in short term memory (p-value=0.001) and HR (p-value=0.001) were observed after intervention. Similarly, short term memory level of the three groups subjects statistically differed (p-value=0.001). When considering the reaction time (p-value=0.068) and stress level (p-value=0.927), there was no significant difference among the three groups after the intervention. Assessment of the test scores alone after one month (long term memory) showed a significantly higher score (p-value <0.001) in Group A when compared with the other two groups. Conclusion: Mint flavoured chewing gum improves cognition as evidenced by improvement in test scores, alertness and attention. The performance in the flavour less chewing gum group was lesser than mint flavoured group, but significantly better than control group.

Evaluation of Knowledge, Attitudes and Practices Related to Dietary Supplements Intake among College Students: A Cross-sectional Study

Hadeel ALi Ghazzawi, Enas Salem Abu Hazem, Adam Tawfiq Amawi

Introduction: Food intake has been connected to health status for a long time. There are some products that are used to boost the nutrient density of the food intake, such as Dietary Supplements (DS). DS can defined as a concentrated source of nutrients with a nutritional or physiological effect that adds further nutritional value to the normal diet. Aim: This study investigated the intake of DS among students at the University of Jordan (JU) in Amman, as well as consumer’s Knowledge, Attitudes and Practices (KAP) regarding DS according to gender, Body Mass Index (BMI), science and humanities, and academic year streams. Materials and Methods: A descriptive cross-sectional questionnaire-based study was conducted on 381 students selected by using convenient sampling method from the University of Jordan (JU) in Amman, from different faculties including freshmen students and senior students between April and May 2018. The KAP was used to assess awareness of the study group on the topic. The questionnaire was divided into two parts, part I included questions related to participant’s socio-demographic characteristics and part II included 11 questions for assessing KAP related to DS. Face to face interview technique was used for data collection. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22.0. Pearson’s chi-square test for independence was used for the qualitative variables to detect the relationship between gender, BMI, faculty (humanities or science) and academic year and the corresponding KAP toward DS. The p-value less than 0.05 was considered as statistically significant. Results: The results showed that the overall percentage of student’s knowledge of DS is only 13.65%, which indicates lack of knowledge in regard to DS. It was found that the percentage of intake of DS at least one per week among students was approximately 42%, which is considered relatively high. Regarding the results of the present study, there were statistically significant differences in faculty (p=0.001**) and BMI subdivisions (p=0.03*) in term of previous knowledge. Science facultie’s students had more information than humanities about the risks of DS (p=0.008*). Nearly (80%) of science and humanities faculties’ students have not received any training or attended in any health campaign about DS. Most of the students trusted the information that comes from health care professionals (65%). One third of DS users consumed them for no certain purpose (34%). Pharmacies were the most common source to buy supplements (87%). Furthermore, vitamin D and iron were the most frequently reported DS type used, while herbal supplements, omega 6, omega 9, multi minerals were the least common DS among participants. Conclusion: It can be concluded from results of this study that there was a relative high prevalence of DS consumption among JU students and students in general lacked knowledge about DS.

Haemodynamics and Arterial Blood Gases in Smokers versus Non Smokers during General Anaesthesia for Abdominal Surgeries: A Prospective Observational Study

Rashmi Pal, Hemlata Patel, KK Arora, Neetu Gupta

Introduction: Tobacco smoking is a worldwide accepted health hazard and its effect on cardiopulmonary system is a well known fact. In a long run, it results in to gross derangements in haemodynamics and Arterial Blood Gases (ABG) which can lead to further complications during general anaesthesia. Aim: To evaluate the effect of smoking on cardiopulmonary system and also to compare its effects on haemodynamics and ABG during general anaesthesia for abdominal surgeries in smokers and non smokers. Materials and Methods: This prospective observational analytical study was conducted in the Department of Anaesthesiology, Mahatma Gandhi Memorial Medical Colledge, Indore, Madhya Pradesh, India, from May 2020 to April 2021. The study included 74 male patients of American Society of Anaesthesiologist (ASA) grade I and II, aged 20-70 years, undergoing elective abdominal surgeries. The patients were divided into two groups, smokers and non smokers, depending on their smoking status. Haemodynamic monitoring was done from preinduction time till 48 hours after extubation and ABG analysis was also done before induction and two hours after extubation in both the groups. T-test and Mann-whitney test were applied according to the requirement. A p-value <0.05 was taken as statistically significant. The statistical software Statistical Package for Social Sciences (SPSS) version 20.0 and Medcalc 19.5 were used for the analysis. Results: Significant increase in Heart Rate (HR) and Mean Arterial Pressure (MAP) was observed in smokers as compared to non smokers at all time intervals (p-value <0.001). End-tidal carbon dioxide concentration (EtCO₂) values were found to be significantly higher in smokers (37.77±2.63 mmHg) than non smokers (32.99±2.83 mmHg) (p-value <0.001). Regarding arterial blood gas analysis significant difference was observed in preoperative and postoperative arterial carbon dioxide concentration (PaCO₂) (p-value <0.0001) and pH levels (p-value <0.0001) in both the groups. A significant difference was also seen in preoperative and postoperative PaCO₂ levels of the smokers (p-value=0.0004) with a corresponding change in their pH levels also (p-value=0.0012). Peak Expiratory Flow Rate (PEFR) was lower in smokers in comparison to non smokers (p-value <0.0001). Conclusion: Smoking has significant effects on haemodynamic status and ABG of smokers which can be aggravated during general anaesthesia.

Study of Colonisation Pattern and Antifungal Sensitivity Profile of Candida Species in Diabetic Patients

Anurag Ambroz Singh, Rakesh Tank, Pooja Singla

Introduction: In recent times, various studies have pointed out the rise in prevalence of Candida species causing Urinary Tract Infections (UTIs). Candiduria appears to be underdiagnosed entity and thus has been the source of morbidity and mortality. Emergence of drug resistant Candida species has further complicated the patient management. Aim: To understand the colonisation pattern and antifungal sensitivity profile of Candida species in diabetic patients. Materials and Methods: This cross-sectional study was conducted for a period of six months (July 2019 to December 2019) at a tertiary care teaching centre of southern Haryana, India. A total of 360 urine samples were collected from patients admitted both out-patient and in-patient. Glycated Haemoglobin (HbA1c) ≥6.5% was taken as having diabetes. The urine samples were collected as per standard guidelines. Urine wet mount examination was performed. Confirmation of identification and antifungal susceptibility testing was done for all the Candida isolates. Data was analysed using statistical software. Results: The prevalence of candiduria was 65 (18.1%) among study subjects. Out of significant candiduria patients 19 (29.23%) were having Candida albicans, 30 (46.16%) were Candida tropicalis, 10 (15.38%) were Candida krusei, 6 (9.23%) Candida glabrata. Candida albicans was found to be sensitive to amphotericin-B in 100% of cases. Sensitivity to flucytosine, voriconazole and fluconazole was found to be 89.47%, 89.47% and 84.21% respectively in case of Candida albicans. Conclusion: The prevalence of candiduria is definitely high in this region. Non albicans Candida species are more resistant to antifungal drugs compared to Candida albicans.

Fear of COVID-19 among Staff Nurses Working in Tertiary Care Hospital, Erode, Tamil Nadu: A Cross-sectional Study

Introduction: The new Coronavirus Disease 2019 (COVID-19) has put a strain on healthcare workers, and the virus offers major personal and professional threats. Mental health has been affected by the COVID-19 epidemic, causing them to be fear of becoming sick. During the COVID-19 pandemic, healthcare professionals have been psychologically impacted including fear, anxiety, and depression. Aim: To determine the level of COVID-19 fear among hospital nurses in tertiary hospital care hospital, Erode dristrict, Tamil Nadu. Materials and Methods: This cross-sectional survey study was conducted among employees of Government Erode Medical College Hospital and nearby Hospitals in Erode district, Tamil Nadu, India, from July 2020 to August 2020, to evaluate the fear of COVID-19 using the Fear of COVID-19 Scale (FCV-19S). It used a self-administered questionnaire (online Google form survey). It consisted of two parts, first was socio-demographic details and second was fear of COVID-19 Scale (FCV-19S). The inclusion criteria of participants were all staff nurses working in COVID-19 ward, for minimum of three months in Erode district and willingness to participate. One-way Analysis of Variance (ANOVA), F-test and student Independent t-test analysis was performed to examine the relationship between demographic characteristics and fear levels. Results: The study included a total of 277 staff nurses. The participant’s mean age was 32.25±6.45 years, with females accounting for 93.5% of the total. The scale’s internal reliability was excellent, with a Cronbach’s alpha of 0.902. Overall, the mean COVID-19 fear score was (59.3%) 20.8 out of 35. The maximum fear score was for the statement “I am most afraid of Corona” (65%) and the minimum fear score was for “I cannot sleep because I am worried about getting Corona” (51.8%). Fear levels were higher in females (p-value=0.02), overweight people (p-value=0.001), those living in joint families (p-value=0.01), married individuals (p-value=0.03), participants with two children (p-value=0.001), and Primary Healthcare Centre (PHC) staff (p-value=0.001). Conclusion: The survey found a high level of fear in staff nurses who work in COVID-19 wards. Steps must be taken to preserve their health, by providing adequate resources to relieve their worries and anxiety, enabling them to carry out their frontline duties in the face of the COVID-19 epidemic.

Special Protection and Provision of Rest during Work and Occupational Health Hazards: A Survey among Steel and Power Industry Workers in Odisha, India

Parthsarathi Dehury, K Anil Kumar

Introduction: In India, there are many labour laws implemented for the legal provision of working hours, services, and employment conditions of workers. Special protection and rest provision plays a pivotal role in occupational injuries and illness. Aim: To determine the special protection and various provision of rest at the workplace. Materials and Methods: A survey was conducted among steel and power industry workers in Odisha, India. The study was conducted with 425 male respondents by adopting the population proportion sampling technique. The primary data was taken from a Steel and Power limited industry situated in Angul district of Odisha from February 2019 to October 2019. Statistical Package for Social Sciences software (SPSS version 25.0) was used in the analysis process by using the univariate and bivariate models to assess the objectives. Results: The study showed 92.5% of respondents were provided rest, and 59.1% of respondents were in the employment contract. More than 43.3% of respondents reported they received compensation during occupational injury and diseases, whereas 45.6% didn’t get any compensation in the event of occupational diseases. Out of the 393 workers got rest, a vast majority (95.4%) of respondents reported that they were allowed night rest, and 84.5% were allowed for meal breaks during work. More than 59% of respondents receive short breaks during work, and 52.9% were entitled to weekly breaks/rest. Religion, caste, education, technical education, occupation, type of work, and the number of working hours were strongly associated with the respondent's characteristics. Conclusion: Special protection provisions are critical factors for the treatment of occupational health hazards. It has been confirmed that night rest and meal break rest were provided to the workers. Except for the shift work rest and extended workload rest, the provision of rest was sufficiently provided at the workplace. Special protections are expected to strengthen the occupational health of workers and stay away from medical expenses.

Radiological Outcome of Subcentimeter Arterially Enhancing Nodules Detected during Surveillance for Hepatocellular Carcinoma- A Cohort Study

Prabhat Prakash Gupta, Nimisha Lohiya

Introduction: Hepatocellular Carcinoma (HCC) is the sixth most diagnosed cancer and the fourth leading cause of cancer-related death globally. The male:female ratio for HCC in India is 4:1 with age of presentation ranging from 40-70 years. There is limited clinical information on the course of Subcentimeter-Sized Nodules (SCSNs) detected during surveillance for HCC. Aim: To evaluate the serial outcome of subcentimeter arterially enhancing nodules evolving into HCC and henceforth, to identify specific radiological features which can prognosticate and, if possible, predict which SCSNs will turn into HCC. Materials and Methods: A prospective cohort study was conducted in a tertiary care centre in Delhi, India, in the Department of Radiodiagnosis between 1st May 2018 and 30th April 2019. Total of 72 lesions in 59 patients were evaluated during the study period of one year, which included images spanning over a mean duration of three years (range 2-6.5 years). Dynamic contrast enhanced imaging was done as per Liver Imaging Reporting and Data System version 2018 (LI-RADS version 2018) using either Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). The gold standard for HCC diagnosis was LR 5 lesion. Size cut-off, rate of growth, enhancement features were studied and calculated. Student’s t-test was used for comparison of quantitative outcome parameters. Results: A total of 59 patients were analysed with mean age 53±12 years, of which 85% were males. The cumulative HCC development rate was 47.5%. A 60.9% of the SCSNs which turned into HCCs showed an increase in size, 31.6% of the non HCC-SCSN lesions also showed an increase in size. Upon baseline comparison, the growth difference was more in the HCC group (8.2±12.24 mm) than in the non HCC group (3.37±7.39 mm). The optimal cut-off points after which the likelihood of an arterially enhancing lesion turning into HCC increased significantly was 8.5 mm on CT and 10.5 mm on MRI. Conclusion: Around 47.5% of arterially enhancing SCSN converted into HCC; this percentage is much higher than quoted literature. A six monthly follow-up may be considered as 52.2 percent of lesions turned into HCC in a span of 1 year. The optimal cut-off points after which the likelihood of an arterially enhancing lesion turning into HCC increases can be taken as 8.55 mm on CT and 10.5 mm on MRI. Among the lesions showing washout, 80.8% on CT and 91.3% nodules on MRI changed into HCC.

Hypoxia Inducible Factor 1 Alpha and Matrix Metalloproteinase-9 in Dysfunctional Uterine Bleeding

Ketki Khandhadiya, Mrinal Gupta, Shailesh Kumar

Introduction: Dysfunctional Uterine Bleeding (DUB) is prevalent in 10-15% of gynaecological patients. Matrix Metallopeptidase-9 (MMP-9) expression is stimulated by reduced oxygen levels in a highly aggressive, metastatic breast cancer cell line, although MMP-2 expression is unaffected. Under hypoxic conditions, Hypoxia Inducible Factor 1 Alpha (HIF-1α) rapidly accumulates and transactivates hundreds of genes, including angiogenic growth factors as well as receptors. Aim: To compare and estimate the serum HIF-1α, serum MMP-9 in ultrasonographically proven DUB patients and in controls with normal menstruation. Materials and Methods: This case-control study was conducted in Department of Biochemistry at Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India, from July 2020 to November 2021. A random venous blood sample (4 mL) was drawn from the DUB cases and controls into a sterile red topped vacutainer which was allowed to clot for 30 minutes. The sample was centrifuged and the serum was separated and analysed for desired parameters. Serum HIF-1α and MMP-9 was estimated by using sandwich Enzyme Linked Immunosorbent Assay (ELISA) method. Student’s t-test was used for comparison between the variables and Pearson’s correlation test was used to assess the correlation between the parameters. Results: The mean age of controls was 33.9±7.10 years (N=40) compared to cases where it was 38.8±5.32 years (N=40). Serum HIF-1α showed significantly elevated levels of median in DUB cases (1.16 ng/mL) compared to normal control group (0.28 ng/mL, p-value=0.04). Mean serum levels of MMP-9 significantly decreased in DUB cases as compared to normal control group (34,142±19,043, 61,500±16,169, respectively, p-value=0.003). Presence of hypoxia leading to HIF-1α and MMP-9 formation plays a role in endometrial thickness and angiogenesis leading to various signs and symptoms of DUB. The present study did not find any correlation between MMP-9 and endometrial thickness as well as HIF-1α and endometrial thickness in DUB cases and controls. There was significant low positive correlation between serum MMP-9 and HIF-1α in DUB cases (r-value=0.423, p-value <0.05). Conclusion: Elevated levels of HIF-1α and decreased levels of MMP-9 was observed in DUB cases. No correlation was found between MMP-9 and endometrial thickness as well as HIF-1α and endometrial thickness in DUB cases and controls. Hence, whether this can be used for diagnostic and therapeutic prospects needs to be further studied.

Patients and Clinicians Satisfaction with Clinical Laboratory Services at a Tertiary Care Hospital: A Cross-sectional Study

Bi A Khadeja, Santhosh Viswan, A Kaviyathendral, Suganya Sasikumar

Introduction: Clinical laboratories are an essential part of the healthcare system providing vital information required for patient’s care. As the importance of monitoring the satisfaction status is becoming necessary and no data regarding the same is available in this region, so present study was designed to implement it in the institution. Aim: To estimate the clinicians and patients satisfaction status with the services provided by the Central Clinical Laboratory, Karpaga Vinayaga Institute of Medical Sciences and Research Centre (CCL-KIMS and RC) in Kanchipuram District, Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted in the Central Clinical laboratory, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, a tertiary care Medical college hospital in Kanchipuram district, Tamil Nadu, India between April 2019 to December 2019 in three phases including a total of 150 clinicians and 150 patients. The patient’s satisfaction status was assessed using questionnaires by the investigator. Self-administered structured questionnaire was used for determining the clinician’s satisfaction status. Likert scale was used and the mean score of satisfaction for each, patients and clinician was calculated. Data entry and analysis was done using Statistical Package for the Social Sciences (SPSS) 25.0 V software. Chi-square test was used to find out the association between satisfaction status and the different attributes. Spearman’s correlation was performed to assess the relationship between the satisfaction status and the different phases of the study. Results: In present study, the mean age of patients was 38.0±11.6 years and clinicians 42.9±8.7 years, respectively. Majority of participants among patients were females 82 (54.7%), and clinicians were males 105 (70%). Among patients 95% were married 63.3%, 135% came from the middle category of socio-economic status (90), while 122% resided in the semi-urban area 81.3%. 101 of the clinicians (67.3) had an experience of more than three years at KIMS and RC. Overall 131 (87.3) of the patients and 106 (70.7) of the clinicians were satisfied with the services provided by the central clinical laboratory at KIMS and RC. An improvement in the satisfaction status of the patients and clinicians from phase I to III was observed. Around n=19 (12.7%) and n=44 (29.3%) of the patients and clinicians were dissatisfied with the laboratory services. Conclusion: In the present study, the overall level of patients and clinicians satisfaction status was high and satisfactory. An improvement in the observed satisfaction status from phase I to III was attributed to the trainings given to the laboratory staff on the international standards of laboratory management. Domains like the turn around time, interface of laboratory and hospital information system and waiting time for specimen collection required improvement.

Effects of Different Types of Phototherapy Units on Neonatal Jaundice: A Cross-sectional Study

Introduction: Phototherapy is the mainstay of treatment of neonates who develop significant jaundice. Light-emitting Diode (LED) and compact florescent lamp phototherapy units are the newer devices in the management of neonatal hyperbilirubinaemia. The advantage of LED phototherapy includes portability, energy efficiency, less heat production and durability. Blue and white phototherapy devices are more economical but generate more heat leading to hyperthermia and dehydration more often. Aim: To determine the efficacy and side effects of three modes of phototherapy units viz conventional blue and white light phototherapy, Compact Fluorescent Lamp (CFL) phototherapy, and LED phototherapy on neonates having jaundice. Materials and Methods: This cross-sectional study was conducted in Department of Paediatrics at SRM Medical College Hospital and Research Centre (tertiary care teaching hospital), Kattankulathur, Tamil Nadu, India, from February 2021 to January 2022. A total of 150 neonates with hyperbilirubinaemia in the phototherapy range, American Academy of Paediatrics (AAP), were included in this study. Study subjects were divided into three groups of 50 neonates each to receive phototherapy using one of the three phototherapy devices, i.e., blue and white light, CFL, LED phototherapy groups. Data of serum bilirubin levels were recorded at the beginning and end of phototherapy. The number of babies who required exchange transfusion and other clinical side effects among the study groups was recorded. Descriptive statistics were reported as Mean±SD for continuous variables, frequencies (percentage) for categorical variables. The One-way Analysis of Variance (ANOVA) test was used to determine the statistically significant differences between the means of three independent groups. Results: All the three type of phototherapy units generated statistically non significant mean flux (p-value=0.754). Mean difference (from the baseline bilirubin) at end of phototherapy for blue and white light group was 5.77±1.72 mg%, for CFL group was 5.48±1.32 mg%, and for LED group was 6.34±1.48 mg%. The difference was statistically significant in all three groups (p-value=<0.001). The reduction in serum bilirubin at the end of phototherapy was lesser in CFL group compared to blue and white light group and LED group. Conclusion: Light-emitting diode and blue and white light phototherapy units are more effective than CFL phototherapy in treating neonatal hyperbilirubinaemia.

Correlation between Perceived Stress, Physical Fitness and Health Related Quality of Life in Young Adults

Tarunjit Kaur, Shagun Agarwal

Introduction: A majority of population all around the world battles with psychological conditions such as anxiety, stress and depression. Its effects on disease and certain health conditions is almost well known but what effect does it have on an individual free from disease is yet to be found. Aim: To establish a relationship between perceived stress levels, physical fitness and health related quality of life in young adults. Materials and Methods: This cross-sectional study was conducted in Department of Physiotherapy at Institute of Applied Medicine and Research, Ghaziabad, Uttar Pradesh, India, from April 2020 to January 2021. A total of 120 subjects participated and were evaluated for perceived stress using Perceived Stress Scale (PSS), strength, endurance and flexibility were screened with help of dynamic sit up test, plank test and trunk lift test. World Health Organisation Quality of Life Instrument (WHOQOL- BREF) was used to measure the Health Related Quality Of Life (WHOQOL- BREF) domains and the statistical test used was Pearson’s correlation coefficient. Results: The mean age of subjects was 20.82 years out of which 64 were females and 42 were males. Significant negative correlation (r-value=-0.819) was observed between perceived stress and endurance, negative correlation of significant nature (r-value=-0.805) was present between perceived stress and strength, a non significant, weak positive correlation at (r-value=0.105) was seen between perceived stress and flexibility. Consistent significant negative correlation was seen (r-value=-0.386, -0.423, -0.203, -0.124) between perceived stress and HRQOL. Conclusion: High perceived stress has a negative effect on physical fitness and HRQOL in young adults.

Effect of BMI on Tightness of Iliopsoas Muscle in Students due to Prolonged Sitting for Online Classes during COVID-19 Pandemic

Neha Goyal, Vaishali Chaudhary

Introduction: Muscle tightness is produced by a reduction in a muscle’s capacity to deform. As a result of prolong sitting, pelvic position can be changed which can lead to iliopsoas tightness. During the COVID-19 pandemic, as a result of online classes, student’s hours of sitting have increased drastically. Aim: To compare iliopsoas muscle tightness in students who were engaged in prolonged sitting due to online classes with higher Body Mass Index (BMI) and students with normal BMI. Materials and Methods: This cross-sectional study was conducted in Department of Physiotherapy at Institute of Applied Medicine and Research, Ghaziabad, Uttar Pradesh, India, from April 2021 to January 2022 on 101 students (59 females and 42 males). Height and weight of the subjects were measured by the ruler and digital weighing machine respectively for the BMI calculation. Two groups were made, group with normal BMI students and group with High BMI students. Using modified Thomas test, iliopsoas muscle was measured for the flexibility. Independent sample t-test was used for statistical analysis. Results: Total 51 students were with normal BMI and 50 were with higher BMI were included in the study. The mean age of the subjects was 19.59 years including 59 females and 42 males. The significantly increased Modified Thomas Test (MTT) angle was found in students with higher BMI when compared to students with normal BMI for both right (p-value=0.003) and left side (p-value <0.001). Iliopsoas muscle tightness was present in more in higher BMI group as compared to normal BMI group. Conclusion: The study concluded that both the groups had the iliopsoas muscle tightness but the students with higher BMI had more muscle tightness.

Efficacy of Bepotastine versus Olopatadine Ophthalmic Solutions in Mild to Moderate Vernal Keratoconjunctivitis as a Sole Therapy

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic, seasonally exacerbated allergic ocular inflammation of the conjunctiva. It affects predominantly the school going male population and is not so common. There is a paucity of comparative studies on efficacies of dual-action topical agents having both antihistamine and mast cell stabilising properties. These are currently the first line drugs in the management of mild to moderate VKC. Aim: To compare the efficacy and safety of bepotastine besilate 1.5% and olopatadine Hydrochloride (HCl) 0.1%, ophthalmic solutions in mild to moderate VKC patients. Materials and Methods: This prospective, comparative study was conducted in the Ophthalmology Department at National Institute of Medical Sciences Hospital, Jaipur, Rajasthan, India, from January 2020 to January 2021. It included 76 patients having mild to moderate VKC who were randomised into two groups of 38 patients each. Each group was assigned to be treated with one of the two treatment options namely bepotastine besilate 1.5% and olopatadine HCl 0.1% ophthalmic solutions. Typical symptoms and signs of VKC like ocular itching, watering, mucoid discharge, conjunctival hyperaemia and tarsal papillary hypertrophy were recorded at baseline and at the time of follow-up on 7^th, 15^th and 30^th day using simplified scoring 4-point scales ranging from 0-3. Safety assessment was also done. Friedman’s test and Mann-Whitney’s U test were performed for intra-arm and inter-arm analysis of continuous variables respectively. Nominal categorical data between the groups were compared using the Chi-square test. The p-value <0.05 was considered as statistically significant. Results: The mean age of the participants was 10.49±2.95 years and the male to female ratio (M:F) was 1.7:1. After 30 days of drug therapy, patients in both arms showed significant improvement in the symptoms and signs scoring of VKC. There was no statistically significant difference in efficacy on inter-arm analysis at baseline and subsequent follow-ups. Almost all patients became free from their symptoms and signs at the end of the study. However, 25 of 38 (65.8%) patients in bepotastine treated group and 23 of 38 (60.5%) patients in olopatadine treated group had residual tarsal papillae. None of the patients in either group reported any significant adverse effects. Conclusion: Both bepotastine besilate 1.5% and olopatadine HCl 0.1% ophthalmic solutions are safe and equally effective in alleviating the clinical symptoms and signs of mild to moderate VKC.

Markers of Coagulation Dysfunction and Inflammation in Diabetic and Non Diabetic COVID-19 Patients- A Retrospective Study

Firdushi Begum, Malavika Barman, Elteza Tahjiba Jahir

Introduction: Since the end of 2019, a novel Coronavirus Disease 2019 (COVID-19), declared a pandemic by World Health Organisation (WHO) has ravaged the world. Diabetic patients have been reported to be more susceptible to intensive care admissions, and deaths due to COVID-19. Diabetes Mellitus (DM) and COVID-19, both associated with chronic and acute inflammation respectively can impact each other in terms of clinical progression and outcome. Given the novelty of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pathogen, there is need to update and increase the limited evidence on the probability of DM acting as a risk factor and influencing disease severity and progression. Aim: To compare the markers of inflammation and coagulation dysfunction between COVID-19 patients with and without DM as co-morbidity and thereby, to study the effect DM has on the prognosis of COVID-19. Materials and Methods: This was a retrospective, observational, single-centre study, conducted Department of Biochemistry at Gauhati Medical College and Hospital, Guwahati, Assam, India, from January 2021 to June 2021. Clinical and laboratory data of 500 laboratory confirmed COVID-19 patients were reviewed in the present study. The patients were grouped as diabetic case group and non diabetic control group. Data was presented as percentages for categorical variables and median (interquartile range) for continuous variables. Chi-square test was used to see the association of different qualitative information and Mann-Whitney U test was used to see the association of quantitative data and all p-values were given for justification. A p-value <0.05 was considered statistically significant. Results: The sample included 300 diabetic and 200 non diabetic COVID-19 patients. The mean age of non diabetic patients (47.5 years) was significantly less as compared to the diabetic group (54.5 years), p-value <0.001. The serum level of inflammatory biomarkers, C-Reactive Protein (CRP), ferritin, and markers of hypercoagulable state, D-dimer, was found to be significantly high (p-value <0.001) in diabetic patients as compared to non diabetic patients. Diabetics had a poor prognosis with 231 (77%) receiving oxygen as compared to 51 (25.5%) of non diabetic patients. Total 173 (57.7%) of diabetic COVID-19 patients had to be shifted to ICU, 201 (67%) suffered from post COVID-19 complications and the mortality rate was higher at 18% in diabetics as compared to 1.5% in non diabetic subjects. Conclusion: Diabetic patients are at higher risk of uncontrolled inflammation and hypercoagulable state which eventually leads to deterioration of COVID-19 infection status.

A Retrospective Cohort Study on the Risk of Kidney Disease in HIV Positive Individuals Receiving Tenofovir Based Regimens

Vikash Khandelia, Umashankar Nama, Ashok Mahavar, Anjali Rathore

Introduction: Exposure to tenofovir often leads to the development of some irreversible high risk for kidney disease events. In Human Immunodeficiency Virus (HIV) patients, the prolonged treatment with tenofovir use frequently causes mild-to-moderate nephrotoxicity. Hence, there is a need to further investigate the efficacy and the adverse effects associated with tenofovir use to combat the decreased morbidity and mortality associated with the declined kidney function. Aim: To investigate the risk of kidney disease associated with tenofovir use. Materials and Methods: A retrospective cohort study was conducted at the tertiary care centre in northern India, from August 2009 to January 2017 and analysed during January to May 2021. The patients with HIV infection who were administered Tenofovir, Lamivudine and Efavirenz (TLE) and Zidovudine, Lamivudine and Nevirapine (ZLN) were included. The patients were divided into two group based on the TLE and ZLN regimen they received. These patients were on a regular follow-up for six months. The data was assessed on the basis of serum creatinine and estimated Glomerular Filtration Rate (eGFR) (using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation), body weight and Cluster of Differentiation (CD4) count. Results: Out of 703 patients, 364 patients were administered with TLE, while 339 patients received ZLN. In both the groups, the number of patients were between the age 21-40 years was significantly higher, followed by patients between the age 41-60 years. The mean weight and CD4 count of the patients in both the groups significantly increased with the progression of time (p<0.001). The creatinine levels at baseline and at 24 months were comparable in both the groups, p>0.05. The mean eGFR level was significantly lowered in TLE group (112.2 mL/min/1.73 m²) compared to ZLN group (123.5 mL/min/1.73 m²) at 24-months follow-up (p<0.001). Conclusion: Overall results demonstrate that increasing exposure to tenofovir was associated with a higher incidence of CKD. The serum creatinine levels were comparable between the TLE and ZLN group.

Relationship Between Disorders of Lipid Profile and Features of Liver Cirrhosis- An Open Prospective and Comparative Analysis of Patients of Stavropol Territory in Russian Federation

Introduction: Liver plays an essential role in the metabolism, synthesis, transport and clearance of lipids and lipoproteins, therefore, changes in the lipid profile in liver pathology reflects the degree of its dysfunction. Leading role in the development of atherosclerosis belongs to lipid spectrum disorders in the form of hyperlipidaemia and dyslipidaemia, associated with an increased cardiovascular risk in liver cirrhosis. Aim: To study the relationship between violations of lipid profile of blood with the features and the clinical picture of Liver Cirrhosis (LC). Material and Methods: The study was an open prospective and comparative analysis of patients with LC, conducted at Stavropol State Medical University (Stavropol State, Russia). Research was conducted from June till August 2020. In 108 patients with LC, blood concentration of total cholesterol, triglycerides, High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL) were studied in association with manifestations of the disease. Control group constituted of 45 healthy individuals, comparable in sex, age and ethnicity. Two sample student’s t-test, Newman Keuls test, chi-square test with Yates’s correction and Pearson’s linear correlation coefficient (r) were calculated. Receiver Operating Characteristic (ROC) analysis was used, the Odds Ratio (OR) and its 95% Confidence Interval (CI), sensitivity, specificity, positive and negative predictive value and accuracy were determined. Differences were considered statistically significant at p≤0.05. Results: Regardless of gender and age of patients, decrease of serum levels of total cholesterol (p<0.05), triglycerides (p<0.05), HDL (p<0.05) and LDL (p<0.05) were marked, associated with expression of portal hypertension and severity of liver cirrhosis. Parameters of LDL more than 2.16 mmol/L {OR 6.78-95% CI (2.74-16.78)} were connected with absence of oesophageal varices. Levels of triglycerides less than 0.83 mmol/L {OR 10.85-95% CI (2.86-41.19)} were associated with presence of oesophageal varices of grade III. Generally, hyperlipidaemia was observed in 17.6% of patients, and it was associated with alcoholic aetiology of liver cirrhosis (χ²=3.7; p=0.053). Hypocholesterolaemia (81.5% of cases) or hypotriglyceridaemia (48.1% of cases) was more commonly observed in patients with ascites (χ²=8.8; p=0.003), and classes B, C according Child-Pugh score (χ²=4.0; p=0.045). Conclusion: In this study, it was found that, in liver cirrhosis, there is a decrease in the serum content of total cholesterol, triglycerides, HDL and LDL, regardless of gender and age of patients. The LDL values of more than 2.16 mmol/L are associated with an increased chance of absence of oesophageal varices in patients with liver cirrhosis.

Effect of Short-term Respiratory Proprioceptive Neuromuscular Facilitation on Peak Expiratory Flow Rate and Six-minute Walk Test in Patients with Stable Chronic Obstructive Pulmonary Disease: A Quasi-experimental Study

Parkavi Kumaresan, Umarani Ravichandran, Dhanpal Singh, Mangaleswaran Seraman

Introduction: Proprioceptive Neuromuscular Facilitation (PNF) of respiratory muscles was found to improve lung function and haemodynamic parameters in mechanically ventilated patients. It has been proven that respiratory PNF had immediate significant effects in Chronic Obstructive Pulmonary Disease (COPD) patients. As pulmonary rehabilitation for COPD patients is a long-term hospital based service, there arises a need to provide a therapy that provides optimal benefit in short term. Aim: To study the effect of short term respiratory PNF on Peak Expiratory Flow Rate (PEFR) and six-minute walk test in patients with stable COPD. Materials and Methods: This quasi-experimental study was carried out in the Department of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital at Annamalai University, Chidambaram, Tamil Nadu, India. Twelve male COPD patients attending Medicine Department outpatient service between December 2020 to January 2021 were conveniently recruited. They were assessed for their PEFR using peak flow meter and exercise tolerance by six-minute walk test. They were treated with three respiratory PNF techniques namely, intercostal stretch, vertebral pressure high and anterior stretch by lifting posterior basal area for five consecutive days. Each treatment session lasted for about 30-40 minutes. The post intervention assessment of PEFR and six-minute walk was made. The pre and post intervention data were statistically analysed using paired samples t-test. Results: In this study, the mean age of the participants was 63.0±5.80 years. The mean post intervention measurement of PEFR (226.67±51.09 L/min) and six-minute walk distance (271.92±50.55 m) was found to be significantly higher (p=0.001) than the mean pre interventional values (165.42±46.19; 219.58±43.24 respectively). Conclusion: Implementation of respiratory PNF techniques on short term basis optimally improves the functional exercise capacity and PEFR in patients with stable COPD.

Flat Foot in 14-16 Years Old Adolescents and its Association with Bmi and Sports Activity

R Jagadish Raj, Chamanahalli Appaji Ashwini, Shiv Manik Ajoy

Introduction: The main arches of foot are the medial longitudinal, the lateral longitudinal and the transverse arches. The term pes planus denotes an excessively flat foot. There is no precise degree of flatness that defines pes planus and it may be either physiological or pathological. Aim: To identify flat foot in age group of 14-16 years by clinical examination, classify them into flexible and rigid and to study the association of Body Mass Index (BMI) and sports activity with flat foot. Materials and Methods: The present cross-sectional study was conducted on 323 adolescents in the age group of 14-16 years chosen from five high schools in and around MS Ramaiah Medical College Campus, Bangalore, Karanataka, India. Both foot were clinically examined separately, with foot raised off the ground (non weight bearing) and standing on the same foot with the other foot raised (weight bearing position). Presence of arch in non weight bearing and absence in weight bearing was classified as flexible flat foot. Absence in both positions was classified rigid flat foot. The BMI was calculated and history of sports activity was recorded. Descriptive statistics were used to analyse the data. Results: Out of the total participants, 106 (32.8%) participants had flat foot. Among them, 89.62% were flexible and 10.37% rigid flat foot. Bilateral Pes Planus was common when compared to unilateral, being more prevalent among the male students. Chi-square test gave a p-value of 0.521 for flexible and 0.176 for rigid flat foot in association with BMI. Conclusion: Flat foot in the age group of 14-16 years is predominantly flexible. Higher prevalence of flexible and rigid flat foot was observed among males. No association between BMI or sports activity with Pes Planus was noted.

Anaesthetic and Haemodynamic Effects of Dexmedetomidine vs Midazolam used as Premedication in Minor Obstetrics and Gynaecological Procedures- A Prospective Interventional Study

Anita Manoj Kulkarni, Shilpayogesh Gurav, Leena Shibupaulose

Introduction: Preoperative anxiety for any surgery is a frequent condition. It may lead to high catecholamine levels which increases blood pressure, heart rate and oxygen consumption. Various agents have been used for anxiolysis and sedation as premedicants. Aim: To compare the anaesthetic and haemodynamic effects of injection Dexmedetomidine and injection Midazolam used as premedication in minor Obstetrics and Gynaecological procedures. Materials and Methods: This was a prospective interventional study conducted from July 2016 to September 2017, on total number of 60 patients of American Society of Anaesthesiologist Physical Status (ASA PS I and II) enrolled for the study. They were randomised in two groups: Group A (n=30) for Injection (Inj.) Midazolam 0.04 mg/kg and Group B (n=30) for injection Dexmedetomidine 1mcg /kg injected over a period of 10 minutes prior to General Anaesthesia. After appropriate monitoring like, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean arterial Pressure (MAP), Peripheral oxygen saturation (SpO₂), Respiratory Rate (RR) were noted during the procedure at interval of 5 minutes till 30 minutes and, Ramsay Sedation Score (RSS) and Visual Analogue Scale (VAS) in postoperative period for 1 hour at interval of 15 minutes. The significance between all variables and amongst the two groups was calculated by Chi-square test, Repeated measure Analysis of Variance (ANOVA) test and Independent sample t-test. Results: It was observed that mean HR, SBP (p<0.05), DBP (p<0.05) and MAP (p<0.05 ) decreased significantly in group B. The RR (p<0.05) was significantly decreased in group B. There was no significant difference in SpO₂ (p=0.4) value in both the groups. VAS (p<0.05) of group B patients was significantly reduced in the postoperative period but there was no significant difference in RSS score (p=0.1) at 45 and 60 minutes in both the groups. Conclusion: Dexmedetomidine is more effective as a sedative agent than injection Midazolam when used in minor gynaecological procedures. Though Dexmedetomidine caused significant reduction in SBP, DBP and HR, it maintained haemodynamic stability well without causing any adverse effects.

Assessment of Serum Ferritin, CRP and Insulin Levels in First Trimester of Pregnancy as a Predictive Biomarker of Gestational Diabetes Mellitus: A Longitudinal Study

Mayukh Chakraborty, Amit Kumar Sil, Sanghamitra Chakraborty

Introduction: Gestational Diabetes mellitus (GDM) increases the risk of foetal morbidity and mortality heralding the future risk of development of type 2 diabetes in mother. The GDM develops mainly due to insulin resistance along with interplay of risk factors like advancing maternal age, family history of diabetes, obesity, ethnicity, history of macrosomia. Aim: To detect whether estimation of serum ferritin, C-reactive protein and insulin in first trimester can predict the subsequent occurrence of GDM and whether susceptible mothers can be managed cautiously to prevent foeto-maternal complications. Materials and Methods: This hospital-based longitudinal study was done in Department of Gynaecology and obstetrics in collaboration with the Department of Biochemistry, Medical College and Hospital, Kolkata, West Bengal, India, from January 2018 to June 2019. The study included 80 antenatal mothers attending the Antenatal Outpatient Department in first trimester. The blood samples were collected from them during first trimester and serum ferritin, C-reactive Protein (CRP) and insulin were estimated using different methods as specified later. The anthropometric measurements of the mother {Body Mass Index (BMI), skin fold thickness and waist hip ratio} were measured. These enrolled study participants have undergone Oral Glucose Tolerance Test (OGTT) with 75 gm of anhydrous glucose at 24-28 weeks of gestation. The performance parameters like sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio of ferritin and CRP was calculated. Results: The mean age of participants who developed diabetes (n=12) 25.75±2.92 and who did not develop diabetes (n=68) 23.91±3.74 years. There was 15% prevelance of GDM in study population. The median concentration of serum ferritin and CRP was significantly higher in patients who developed GDM (n=12) among the study population (N=80). The sensitivity of serum ferritin {83.33% (95% confidence interval=51.59-97.91%)} was higher in comparison to CRP {31.82% (95% CI=13.86-54.87%)}. Conclusion: There was a remarkable decline of insulin sensitivity with the advancement of pregnancy. This implies that latent insulin resistance may start from first trimester and screening in high risk ethnicity group like India should be a routine protocol.

Topical use of Autologous Platelet Rich Fibrin in Tympanoplasty: A Prospective Interventional Study

Introduction: Tympanoplasty is the surgery performed in Chronic Otitis Media (COM) to improve the hearing function and prevent ear discharge. Platelet Rich Fibrin (PRF) is one of the materials that can be used to improve the graft uptake and hearing outcome. It is obtained by centrifugation of blood. The PRF contains leukocytes, cytokines, structural glycoproteins and growth factors which accelerates healing. It has been used in various surgical procedures to improve the outcome. Aim: To determine the efficacy of autologous PRF in closure of tympanic membrane perforation after tympanoplasty and to study the influence of PRF on the hearing outcome in the study population. Materials and Methods: This prospective interventional study was conducted in Department of Ear, Nose and Throat at SDM Medical College, Dharwad, Karnataka, India, from November 2018 to June 2020. The study included 60 patients with safe type of COM, who underwent tympanoplasty. Two group were made, group A consisted of 30 consecutive patients with safe type COM who underwent tympanoplasty with PRF application and group B, consisted of 30 patients who underwent tympanoplasty without PRF application. The outcome was assessed by endoscopic evaluation every month for three months to look for graft uptake. Hearing gain was evaluated by Pure Tone Audiometry (PTA) after three months of surgery. Statistical analysis was done using Chi-square test. Results: The majority of cases belonged to young adults between 21 to 30 years of age. Group A had 29 cases with complete tympanic membrane closure and only one failure. However in group B, three out of 30 cases had failure. Thus, the overall the success rate was 96.66% in group A and 90% in group B. Postoperative PTA in group A showed that 18 cases (60%) had an improvement of >15 dB whereas in group B, 12 cases (40%) had hearing improvement of >15 dB. Conclusion: Considering the higher success rate of tympanoplasty with group A compared to group B and no noticeable side effects, it is recommended that tympanoplasty with autologous PRF should be preferred.

Effect of Narration and Painting Methods on the Self-concept of Children with Thalassemia Major before and Three Months after Intervention: A Randomised Clinical Trial

Fariba Jamalpoor, Mohammad Sahebalzamani, Hojjatolah Farahani

Introduction: Children with thalassemia are at risk for mental and behavioural disorders due to their reduced quality of life. Interventions to improve their mental health have shown good outcomes. The narration and painting intervention approaches have a positive effect on self-concept. Aim: To compare the effect of two methods of narration and painting on the self-concept of children with thalassemia. Materials and Methods: This randomised clinical trial with post-test/pretest method was carried out on 35 children with thalassemia major, admitted to hospitals affiliated to Tehran University of Medical Sciences, Iran. Children who met the inclusion criteria were divided into two groups based on the intervention: narration (n=19, six sessions of 90 minutes) and painting (n=16, six sessions of 30 minutes, drawing whatever they wanted). At the end of the first session, and three months later, the Piers-Harris questionnaire was used for self-concept assessment. To analyse the data Paired t-test and Chi-squared test were used. Results: The mean age in the painting group was 12.4 years, and in the narration group was 12.6 years. Girls constituted 43.9% (n=9) in the painting group, and 31.6% (n=6) in the narration group. The mean score of self-concept in the children belonging to the narration group was 46.46±7.74 before the intervention, which increased to 48.10±9.61 after the intervention (p=0.579). In the painting group, the mean score of self-concept in the preintervention phase was 42.44±6.30, and increased to 48.87±9.41 after the intervention (p=0.033). Conclusion: The implementation of two methods of narration and painting in children with thalassemia major had a favourable effect on their self-concept. Considering that various psychotherapy methods are used to help patients to adapt to complications of their disease, narration and painting therapies as a non invasive, affordable and low-cost methods can also be used in this regard.

Determinants of Non Communicable Diseases: A Mixed-method Study on its Prevalence and Perceptions among Rural Population of Muchisa, West Bengal

Sinjita Dutta, Ankita Mishra, Mausumi Basu, Meghna Mukherjee

Introduction: Most people with Non Communicable Diseases (NCDs) are unaware of the problem because it usually does not have any signs or symptoms in the initial stages. The measures for prevention of NCDs are not well known to the rural population which results in a huge burden on the health system. Aim: To estimate the burden of NCDs, and its risk factors among the rural population residing in a village of Budge Budge II block, West Bengal. Also to explore their perceptions regarding determinants, complications and prevention of NCDs, and to look for the association of NCDs with the risk factors and socio-demographic characteristics. Materials and Methods: An observational study, with cross-sectional design using mixed-methods approach, was conducted on 160 residents of Muchisa, from December 2020 to March 2021. A predesigned, pretested and structured schedule, prepared on the basis of World Health Organisation (WHO) STEPS framework, was used to assess the presence NCD and associated risk factors in the study population. Focused group discussion guide was employed to inquire about their perceptions. The participants were selected through cluster random sampling. The data were explored using Pearson’s Chi-square test, logistic regression and thematic analysis. A p-value of <0.05 was considered significant. Results: Mean age of the participants was 45.0±16.8 years, and 69.4% participants were females. Total 75% of the participants suffered from atleast one NCD. All the participants had atleast one risk factor for NCD. Age group of 40-59 years (p-value <0.001) and 60 years or above (p-value=0.002), female gender (p-value=0.009), and preschool education or below (p-value=0.006) were associated with a higher risk of NCD. Qualitative data analysis revealed that lifestyle modification was not perceived to be effective against NCDs. Conclusion: Socio-demographic factors, like age, gender and education have a bearing on the risk of developing NCD. Lack of awareness about the prevention of NCDs is the challenge in addressing the problem.

Comparing the Effectiveness of Oral versus Intramuscular Vitamin D Supplementation in Adults with Fracture around Hip and Vitamin D Deficiency

Introduction: Cholecalciferol plays vital role in bone mineralisation. Major circulating and storage form of vitamin D is 25-hydroxycholecalciferol {25(OH)D3} which is formed in the liver after 25-hydroxylation. It is also the form of vitamin D that is measured in blood tests to detect deficiency of vitamin D. There is scarcity of literature to support the best therapy at the lowest effective dose that is practicable, cost efficient and devoid of probable side effects. Oral medication compliance is a major stumbling block to replenishing vitamin D levels in the body. Vitamin D administered intramuscularly (i.m.) may be able to overcome this limitation. Aim: To compare the effectiveness of oral versus intramuscular vitamin D in adults with fracture around hip and vitamin D deficiency. Materials and Methods: This prospective interventional study was conducted in Orthopaedics Ward in Mahatma Gandhi Institute of Medical Sciences, Jaipur, Rajasthan, India, from January 2020 to June 2021. Total 60 male and female, above 18 years, with fractures around the hip and vitamin D levels less 30 ng/mL were included in the study. In group O (n=30) patient received oral vitamin D supplementation of 60000 IU once a week for six weeks. In group I (n=30) patient received single dose of 600000 IU vitamin D injection (i.m.). Follow-up of patients was done at baseline, six weeks and 12 weeeks for serum values of vitamin D, calcium, alkaline phosphatase and parathyroid hormone levels. Bivariate analytical techniques has been used to measure the improvement of group I with group O. Results: The mean age in group I was 60.40±16.38 years and in group O was 59.47±15.17 years (p-value=0.82). There were total 31 females, 13 in group I and 18 in group O. No significant difference was observed among the groups in vitamin D level at the baseline, {group I: 13.84±3.54 ng/mL; group O: 16.45±6.3 ng/mL, p-value=0.053}. At six weeks, the mean value of the vitamin D significantly increased in both groups (p-value=0.001; group I: 40.94±4.67 ng/mL and group O: 33.64±9.89 ng/mL). At the 12^th week, the mean value of the vitamin D was significantly higher in group I (44.52±7.09 ng/mL) compared to group O (24.65±10.92 ng/mL), p-value <0.001. The vitamin D mean was significantly raised with the time in group I and group O at six weeks and still remained increased at 12 weeks in group I but not in group O. Conclusion: The present study concluded that although both administration routes are effective and appear to be safe, intramuscular application is more effective in increasing 25(OH)D levels and sustaining it for a longer period of time as compared to oral dose.

Outcome Analyses of the Admitted Patients in a Paediatric Intensive Care Unit in a Resource Poor Setting: A Prospective Observational Study

Chandra Jyoti Bora, Rashmita Bora, Suhani Borbhuyan

Introduction: Paediatric intensive care is an indispensible part in the management of critically ill children. Facilities for intensive care are sparse in low income countries requiring strict admission criteria. Adequate data generation regarding the profile of patients, outcomes and identification of the risk factor for poor prognosis can help in appropriate utilisation of this specialised care. Aim: To analyse the outcome of admissions in the Paediatric Intensive Care Unit (PICU) of a tertiary care centre in upper Assam and identification of risk factors for poor prognosis. Materials and Methods: A prospective observational study was carried out at the PICU of Assam Medical College Hospital, Dibrugarh, Assam, India, from March 2019 to April 2020. Data collected were demographic details of the admitted children, the outcome and the risk factors affecting the mortality. Statistical methods used were Odds Ratio (OR), simple proportion test, Chi-square test and Relative Risk (RR) estimation with 95% confidence intervals, backward and forward logistic regression. Results: Total 495 children were enrolled in the study. The three most common disease categories were neurological disease (33.3%), respiratory disease (31.1%), and sepsis (10.7%). The overall mortality was 17.8%. Diseases related to the nervous system were the leading cause of death (38.6%). Highest mortality (43.2%) was in the age group of one month to one year. Highest disease specific mortality was due to Acute Encephalitis Syndrome (AES) (28.4%). Presence of circulatory shock, poor Glasgow Coma Scale (GCS) (GCS <8), hypoxia, dyselectrolytaemia, malnutrition, renal failure, and requirement of ionotropic support, mechanical ventilation were significantly associated with mortality with p-value <0.05. Conclusion: Mortality rate (17.7%) was relatively high. Requirement of mechanical ventilation and Cardiopulmonary Resuscitation (CPR), use of inotropes, GCS ≤8, malnutrition, renal failure, dyselectrolytaemia, hypoxia and sepsis were associated with increased mortality. Circulatory shock, requirement of CPR and mechanical ventilation were the independent predictors of mortality.

Comparison of Intraocular Lens Power Estimation by Optical Biometry and Ultrasound Biometry in Cataract Surgery

Gayatree Mohanty, Himansu Rajguru, Khushi Agarwal

Introduction: The evolution of modern technologies for cataract surgery has made it crucial for aiming emmetropia with highly defined vision. The key factor responsible for postoperative emmetropia is an accurate biometry, along with various other factors. Ultrasonic biometry is the gold standard method of Intraocular Lens (IOL) power calculation but the corneal indentation with the probe underestimate the axial length and result in a myopic shift which is overcome by the newer optical biometry devices, including swept source optical coherence biometry which uses infrared light to measure the ocular distances. Aim: To determine the precision and accuracy of IOL power calculation by ultrasound A-scan and optical IOL master and their refractive outcomes. Materials and Methods: This prospective, and observational study was conducted between September 2019 to February 2021 in 155 patients with cataract undergoing phacoemulsification in Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. All subjects underwent comprehensive ocular examination and biometry with two formulae {Sanders-Retzlaff-Kraff (SRK) and Holladay-I}. Biometry included corneal curvature (keratometry), axial length, anterior chamber depth, IOL power calculation, predicted refractive error. There were two broad groups. One group underwent biometry by ultrasound A-scan and the other group underwent optical biometry by IOL Master 700. The IOL power was calculated with the two formulae in both the groups. Comparisons between variables measured using the IOL master and A-scan were done using paired t-test. The p-values <0.05 were considered statistically significant. Results: In a 18 month period, 155 eyes were consecutively enrolled in the study. The mean age of all enrolled patients was 62.1±8.65 years (range 34-80 years) with male:female ratio of approximately 1.25:1. The mean axial length measured by IOL master was higher (23.15 ± 0.85) than that by A-scan (22.96±0.81 diopters) with a mean difference of 0.197±0.35 mm (p-value <0.001, paired t-test). The mean predicted IOL power was 20.81±1.84 diopters by IOL master and 21.13±1.62 by A-scan by SRK-II formula (p-value <0.001). While mean predicted IOL power with Holladay-I by IOL Master 700 was 20.61±1.92 and 21.44±1.98 diopters by A-scan with a mean difference (-0.82±0.76 diopters) with a significant p-value <0.001. Bland-Altman analysis plots showed almost perfect agreement between both methods regarding predicted IOL power. Conclusion: The swept source Optical Coherence Tomography (OCT) based IOL master 700 proved to be a faster non contact device to use with a shorter learning curve, higher accuracy in average axial length eye and less refractive surprises.

Clinical Profile of Non Strabismic Binocular Vision Anomalies in MBBS and Nursing Students in a Teaching Hospital: A Cross-sectional Study

Introduction: Bachelor of Medicine and Bachelor of Surgery (MBBS) and nursing students spend a lot of time in near vision activities daily while studying. In the Coronavirus Disease-2019 (COVID-19) and post pandemic era, the emphasis on electronic teaching and studying has increased immensely. Students have started depending more on online studying, teaching and search for study material leading to more time being spent using electronic devices like mobile phones, tabs, Personal Computer (PC), etc. This can lead to lot of eye strain (digital eye strain) and this predisposes them to develop Non Strabismic Binocular Vision Anomalies (NSBVA) related to accommodation and convergence of eyes. Aim: To study prevalence of NSBVA and report associated ocular symptoms and association of electronic devices (mobile, laptop) use with prevalence NSBVA, in MBBS and nursing students of a teaching hospital in Western Maharashtra. Materials and Methods: This study was a cross-sectional observational study conducted between November 2020 to April 2021 at Rajiv Gandhi Medical College and CSM Hospital, Thane, Maharashtra, India. In this study, a total of 110 students including both MBBS and nursing students from all academic years of the hospital were examined for a comprehensive ophthalmic examination and complete binocular vision assessment. The prevalence of NSBVA, associated ocular symptoms, prevalence of refractive errors and duration of electronic device use in the students was documented. Student’s t-test was used to compare the total daily duration of electronic devices (mobile, laptop, computer tablets) use between students with and without NSBVA. Chi-square test was used to find association of variables duration of electronic device use and occurrence of NSBVA. Results: Out of 110 students examined, there were 37.27% (n=41) were males and 62.72% (n=69) females. Age range was 18-30 years with mean age 21.85±2.67 years. Overall, 47 (42.72%) students had NSBVA including 34 MBBS and 13 nursing students. 12 (11%) students had ocular symptoms with NSBVA while 35 (31.8%) students had NSBVA without any ocular symptom. Eye strain was the most common ocular symptom. Average electronic device use was 4.53 hours/day. Most used electronic device was mobile phone. There was no association between NSBVA and electronic device use. Conclusion: The NSBVA is highly prevalent among MBBS and nursing students. Ocular symptoms are absent in many students with NSBVA which may lead to delayed diagnosis and worsening of ocular symptoms due to NSBVA. Older age group of students have higher prevalence of NSBVA. Electronic device exposure is not significantly associated with NSBVA in these students. Screening of such at risk population is important for timely diagnosis and treatment of NSBVA.

Evaluation of Ultrasound-guided Pre-emptive Fascia Iliaca Compartment Block for Postoperative Analgesia in Femur and Hip Fracture Surgeries: A Randomised Controlled Trial

Introduction: Spinal anaesthesia is the preferred anaesthetic technique for fractures of the hip and femur. Ultrasound-guided Fascia Iliaca Compartment Block (FICB) provides more intense analgesia which can prolong the duration of postoperative analgesia and also mitigate the pain encountered while positioning for spinal anaesthesia. Aim: To evaluate the efficacy of ultrasound-guided pre-emptive FICB in hip and femur fracture surgeries. Materials and Methods: This randomised, double-blinded, control study was conducted between May 2019 to December 2019, at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Total 66 patients scheduled for hip and femur fracture surgeries under spinal anaesthesia were randomly divided into two groups i.e, group A received Ultrasound-Guided (UG) FICB preoperatively and group B received no block. All the patients received fentanyl 1 mcg/kg intravenous (i.v.) 15 min before spinal anaesthesia. The Anaesthesiologist performing spinal anaesthesia graded the score of positioning as 0 as not satisfactory, 1 as satisfactory, 2 as good, 3 as optimal. The time for the first request for analgesia, consumption of analgesics and Visual Analog Scale (VAS) scores for 24 hours postoperatively and any adverse effects were compared between the two groups. Student’s t-test was used to compare continuous data and unpaired t-test for categorical data. Results: The time for the first request for analgesia was 671.52±66.73 min in group A and 480.3±57.65 min in group B and was statistically significant (p-value <0.0001). In group A, the quality of positioning for spinal anaesthesia was optimal in 13 patients and good in 14 patients. In group B, it was unsatisfactory in 12 patients and just satisfactory in four patients (p-value=0.0009). Majority of the patients (24) in group A required three doses of paracetamol, while 26 patients required two doses for group B. The total number of doses for tramadol was 4 in group A, and 13 in group B. The VAS scores were reduced at the 8^th and 10^th hours following surgery in group A. No adverse effects were encountered in the study. Conclusion: The FICB prolongs the time to first request for analgesia postoperatively, improves patient positioning for spinal anaesthesia, reduces the consumption of analgesics, and improves VAS scores postoperatively without any adverse effects.

Knowledge, Attitude and Practices in Treating Children with Special Healthcare Needs among Dental Practitioners in Mumbai Metropolitan Region: A Questionnaire-based Survey

Harshali Patil, J Jasmin Winnier, Zaineb MF Haradwala

Introduction: Dentistry for children with Special Healthcare Needs (SHCN) is challenging and it is essential to understand the barriers faced by dentists in managing such patients. Aim: To assess the knowledge, attitude and practice of dental practitioners in Mumbai Metropolitan Region (MMR) in treating Children with Special Healthcare Needs (CSHCN). Materials and Methods: An observational, cross-sectional questionnaire-based study was conducted in Mumbai Metropolitan Region (MMR) from January 2021 to August 2021. A 19-item questionnaire was sent to 1624 dentists through email and/or WhatsApp. The age, gender, years of clinical practice, the type of special children encountered, the behaviour management modalities and treatment done for these children were recorded.Data collected was entered into the software International Business Management (IBM) Statistical Package for Social Sciences (SPSS) statistics version 20.0 and analysed. Microsoft word and excel (year 2019) were used to generate tables. Results: Of the 1624 surveys sent, 650 responses were received making it to 40% response rate. Majority of the respondents were between 24-35 years of age with the mean of 29.5±4.6 years. Majority of respondents 67% (n=433) were general dental practitioners and 64% (n=416) had their own private practice. Only 39% (n=251) dentists had treated CSHCN in their practice. The most commonly encountered disability was mental retardation and cerebral palsy 23% (n=151). Amongst the clinicians referring the case, most of them, 148 (59%) preferred to refer to paediatric dentists. Regarding the method of management, 78% (n=197) of respondents were confident in treating special children with non pharmacological behaviour management methods and 58% (n=146) were confident with pharmacological methods. The frequently performed treatment procedures were restorative and preventive methods. A total 61% (n=399) of respondents had not encountered CSHCN. Among them, 65% (n=261) felt they had inadequate training in their curriculum, 59% (n=157) wished to treat such patients in future and 56% (n=223) were interested in continuing dental education programmes on the same. Conclusion: Majority of the dentists had treated children with mental retardation, cerebral palsy and physical disabilities than emotional disabilities. Non pharmacological behaviour management methods were preferred, and preventive and restorative procedures were frequently preformed. Most of the dentists in the present study reported themselves to lack knowledge in treating children with SHCN.

Comparing the Effectiveness of Ambu® AuraGain™ Laryngeal Mask Airway with LMA® ProSeal™ in Patients undergoing Laparoscopic Surgeries- A Randomised Clinical Trial

MK Manisha, Archana Anilkumar Bharadwaj, Shyamsunder Kamath

Introduction: Second generation Supraglottic Airway Devices (SADs) contain a gastric drain tube which separates the respiratory and the alimentary tract. This provides a better oropharyngeal seal and reduces the risk of pulmonary aspiration of refluxed gastric contents compared to the first generation SADs. Aim: To compare Ambu® AuraGain™ (AAU) laryngeal mask airway with LMA® ProSeal™ (PLMA) in terms of Oropharyngeal Leak Pressure (OLP) in laparoscopic surgeries. Materials and Methods: This randomised clinical study was conducted from December 2017-September 2019, at Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, India in 80 patients, aged 18-65 years, of American Society of Anaesthesiologists (ASA) physical status I and II undergoing laparoscopic surgeries. Patients were randomly assigned to one of the two groups: group PLMA and group AAU. After induction of anaesthesia, SADs were inserted by an experienced anaesthesiologist. OLP, pharyngeal mucosal pressure, peak airway pressure and secondary outcome parameters (the number of attempts, time required, ease, and haemodynamic response associated with insertion of LMA) were recorded at set time points. Data was analysed using Statistical Packages for Social Sciences (SPSS) version 22. Results: All patients in both the groups were comparable in terms of demographic data and baseline vital parameters. The Oropharyngeal Leak Pressure of group AAU was comparable to group PLMA at all measured time-points. The two groups were comparable in terms of pharyngeal mucosal pressure immediately after insertion of LMA, but group AAU had lesser pharyngeal mucosal pressure compared to group PLMA immediately after pneumoperitoneum, at 30 and 60 minutes. Mean peak airway pressures were lower in group AAU than group PLMA immediately after insertion of LMA (15.53±1.50 versus 17.06±2.56 cmH₂O, p=0.004) and immediately after creation of pneumoperitoneum (23.03±2.96 versus 26.58±10.12 cmH₂O, p=0.04). Both the groups were comparable in terms of number of attempts, time taken, haemodynamic response associated with LMA insertion and with passage of gastric tube except that PLMA was easier to insert in the first attempt compared to AAU (26/40 versus 13/40, Grade 1 ease of insertion). Conclusion: Ambu® AuraGain™ could be a useful alternative to LMA® ProSeal™ in patients undergoing laparoscopic surgeries.

Association between Chest CT Severity Scores and SARS-CoV-2 Vaccination among COVID-19 Patients: A Cross-sectional Study from Pune, India

Introduction: The novel Coronavirus disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is seen to primarily affect the human respiratory system. Chest CT Severity Score (CTSS) provides a semi-quantitative assessment of pulmonary involvement in COVID-19 patients. COVID-19 pandemic mitigation measures such as SARS-CoV-2 vaccination are being deployed worldwide. However, with the emerging variants of concern of SARS-CoV-2, a high prevalence of post vaccination breakthrough infections is seen. Aim: To assess the association of CTSS with the vaccination status in a cohort of COVID-19 patients referred to a tertiary diagnostic centre and to evaluate the association of CTSS with other clinical parameters including co-morbidities in these patients. Materials and Methods: This cross-sectional observational study was conducted at a tertiary care diagnostic imaging centre in the city of Pune, Maharashtra, India. Data of 1002 symptomatic, adult patients who underwent chest CT and SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction (RT-PCR)/Rapid Antigen Test (RAT) laboratory test between March 13, 2021 and June 22, 2021, were collected. COVID-19 Reporting and Data System (CO-RADS) categories and the corresponding semi-quantitative CTSS were calculated for each patient. Based on their vaccination status, patients were categorised into three groups: unvaccinated, partially vaccinated and fully vaccinated. The association of CTSS with various categories of vaccination status, demographics, co-morbidities and stages of the disease of the patients, was evaluated. Results: Of the 1002 COVID-19 patients, 768 (76.6%) were unvaccinated, 190 (19.0%) were partially vaccinated and 44 (4.4%) were fully vaccinated. Mean CTSS in the fully vaccinated cohort was significantly lower (3.75±4.7) than that in the partially vaccinated (6.05±5.7) and unvaccinated (8.29±4.9) patients (mean 3.75 vs. 6.05 vs. 8.29, respectively; (p<0.05). Mean CTSS in patients with no co-morbidities was significantly lower than that in patients with hypertension and diabetes (7.12 vs. 8.75 vs. 10.39, respectively; (p<0.05). Conclusion: Significant association was noted between the Chest CTSS and the vaccination status, age, gender, co-morbidities and stage of disease in this large cohort of COVID-19 patients. The study reiterates that full vaccination aids in reducing the severity of lung involvement in COVID-19 infection.

Comparative Evaluation of Morphometry of Mental Foramen using Orthopantomogram and Dry Bones in North Indian Population

Ravdeep Kaur, Rajan Kumar Singla, Ravi Kant Sharma, Sanju Singla

Introduction: Mental Foramen (MF) holds strategic importance in clinical dentistry and oral surgery. Its accurate identification determines the effectiveness of nerve blocks and prevention of postoperative neurovascular complications. Aim: To compare mental foramen on dry bones with their orthopantomogram and to find out if any difference and correlation exist between both modalities. Materials and Methods: This descriptive, cross-sectional study was conducted at Anatomy Department of Government Medical College Amritsar, Punjab, India, from January 2018 to December 2021. It comprised of 200 dry human mandibles belonging to either sex, ranging from dentulous to partial dentulous. Orthopantomagram (OPG) of same mandibles were taken. Study was conducted in two phases. Phase I was dry bone phase and Phase II was radiographic phase. Distance of mental foramen from symphysis menti, posterior border of ramus, alveolar crest, lower border of body of mandible and distance between depth of the socket and mental foramen were evaluated. Student’s t-test for comparison and Pearson’s correlation coefficient were applied to find any correlation between two modalities . Results: Distance of mental foramen from symphysis menti, posterior border of ramus of mandible, alveolar crest and depth of socket showed statistically significant difference (p-value <0.001) in between dry bone and orthopantomogram on both right and left sides. Actual bone length from mental foramen to symphysis menti, to posterior border of ramus and inferior border of body of mandible was more than it appeared on OPG. Distances obtained with OPG from MF to alveolar crest (dry bone: right=13.49±3.46 mm; left=13.42±3.49 mm and on OPG: right=16±4.15 mm; left=15.42±3.84 mm) and to depth of socket (dry bone: right=2.48±1.58 mm; left=2.70±1.68 mm and on OPG: right=3.69±2.08 mm; left=4.26±1.99 mm) were magnified. Conclusion: The results of the present study depicted that structures were not equally magnified. Knowledge about magnification at particular region is important before proceeding any surgery in that region.

A Prospective Observational Study on Prescribing Pattern and Outcome of Acute Stroke from a Tertiary Care Hospital in Bengaluru, India

Gargi Dey, R Jyothi, C Pradeep, K Girish

Introduction: Stroke is the most common cerebrovascular disorder and a second leading cause for death. Early diagnosis and treatment of stroke along with controlling of risk factors, post stroke infection and rehabilitation can enhance patient outcomes. Stroke is an important economic burden for the society, requiring increasing attention for more effective healthcare planning and resources allocation. Aim: To determine the prescribing pattern, risk factors and outcome of acute stroke in a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in the Department of Medicine, at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bangalore, Karnataka, India, from January 2018-June 2019 for 18 months. After approval and clearance obtained from the Institutional Ethics Committee, 100 acute stroke subjects of either gender with or without co-morbidities were included in the study. Relevant information about the ongoing drug therapy, co-morbidities, personal and past history were obtained. The outcome of the stroke was assessed by Modified Rankin Scale (mRS). Chi-square test was used for categorical data, student t-test for continuous data and Analysis of Variance (ANOVA) test for temporal change in mean mRS. Results: The mean age of the subjects in the study was 68.41±12.98 years. Ischaemic stroke (72%) was more common than haemorrhagic stroke (28%). Hypertension and diabetes were significantly associated with stroke with p-value of 0.04 and 0.02, respectively. Association of smoking and alcohol with stroke was significant with p-value of 0.01 and 0.001, respectively. The most commonly prescribed drugs were aspirin, clopidogrel and statins. The mean mRS at admission for both ischaemic and haemorrhagic stroke came down after 28 days with treatment and rehabilitation. At the end of 28^th day Ischaemic Stroke showed better outcome than haemorrhagic stroke (p-value: 0.03). Conclusion: Early diagnosis, lifestyle changes and combination drug therapy reduce complication of stroke and improve patients’ outcome. Risk factors such as hypertension, diabetes mellitus, smoking and alcohol should be controlled. Antiplatelet agents, antihypertensive agents and statins are commonly prescribed for secondary prevention and treatment of stroke. Greater awareness is needed to reduce the burden of stroke.

Hepatitis Activity Index and its Clinical and Biochemical Parameters in Liver Diseases- A Retrospective Study

Prema Devi Elangovan, Subashree Kannan, Rajesh Haridass, D Prathiba

Introduction: Hepatitis Activity Index (HAI) is a scoring system devised by Ishak K et al., for grading and staging chronic hepatitis. The HAI provides a numerical score that is both objective and reproducible, it may be useful as either an alternative or supplement to the use of conventional pathological terminology in the study and management of chronic hepatitis patients. Aim: To assess the efficiency of HAI scoring in the non neoplastic liver diseases by relating it with the clinical and biochemical parameters. Materials and Methods: This retrospective study was conducted in the Department of Pathology at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from 2010 to 2015. A total of 57 neoplastic cases and 41 non neoplastic cases were retrieved. The data was reassessed, HAI score and grade was noted and compared with the clinical and biochemical parameters. Chronic liver disease was classified as chronic viral hepatitis {Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)} or cirrhosis. Alkaline phosphatase levels, Serum Glutamic Oxaloacetic Transaminase (SGOT) levels, Serum Glutamic Pyruvic Transaminase (SGPT) levels were analysed. Descriptive analysis was done and the data was represented as frequency and percentage in Microsoft Excel. Results: Among the non neoplastic cases, 21 (51.2%) belonged to hepatitis and cirrhosis and 20 (48.8%) belonged to others. In patients with high alkaline phosphatase levels, the predominant HAI score was 4. In cases with high SGOT levels, the predominant HAI score was 5 and 6. In cases with high SGPT levels, the HAI score was 5,6, and 7. Conclusion: The HAI is useful in assessing the extent of active inflammation. It gives an objective guideline to the treating physician. The HAI score in combination with clinical and biochemical parameters offers a better insight into disease severity.

Assessment of Alteration in Aerobic Conjunctival and Meibomian Gland Microbial Flora after Cataract Surgery and its Association with Postoperative Meibomian Gland Dysfunction

Sonia Bhargav, Surinder Kumar, Tarun Arora

Introduction: Combination of various commensal microorganism species is capable of protecting the ocular surface from colonisation by potentially pathogenic microbes. These homeostatic microorganisms can be easily altered by environmental factors like cataract surgery. These may play a role in the development of postcataract surgery Meibomian Gland Dysfunction (MGD), whose exact pathogenesis is still unknown. Aim: To assess the change in aerobic bacterial flora of meibomian glands and conjunctiva and its association with the development of MGD after cataract surgery. Materials and Methods: This prospective clinical study was conducted in Department of Ophthalmology at BPS Government Medical College for Women, Sonepat, Haryana, India, from June 2021 to February 2022. A total of 60 eyes of 60 patients who had undergone uncomplicated phacoemulsification surgery with intraocular lens implantation were selected. Conjunctival and Meibomian Gland (MG) secretions samples were collected preoperatively before starting antibiotics and at six weeks postoperatively. Aerobic bacteria isolated from the culture samples of patients before and after surgery were analysed for microbial flora change (MFC). At six weeks postoperative follow-up visit, the diagnosis of the MGD was made on slit lamp examination of lid margin and meibomian glands. Chi-square test was applied to assess the association between patients with MFC and patients with MGD. Results: There were 33 males and 27 females, with a mean age of 62.41 years. Preoperative conjunctival samples of 20 patients (33.33%) and MG samples of 27 patients (45%) were culture positive for aerobic bacteria. Most common microorganism isolated from preoperative samples was Coagulase Negative Staphylococci (CoNS). Isolation rate of Staphyloccus aureus increased postoperatively in both conjunctival and MG culture samples. Postoperative aerobic Microbial Flora Change (MFC) in culture samples of either conjunctival or MG or both was present in 30 patients (50%). Total 16 patients (26.6%) developed MGD out of which 13 patients (81.25%) had MFC. The association between MFC and MGD was statistically significant (p-value=0.004). Conclusion: There is alteration of ocular aerobic bacterial flora after cataract surgery and it has a statistically significant association with postcataract surgery MGD. Replenishment of ocular surface microflora can play a preventive and therapeutic role in the management of postcataract surgery MGD.

Effect of Oil Pulling on pH, Buffering Capacity and Total Antioxidant Capacity of Saliva in Children: A Randomised Control Study

Introduction: Saliva is emerging as a diagnostic tool in the field of dentistry. The changes in salivary composition, its physical and chemical properties determine the state of both oral and general health. Chemical plaque control measures improve oral health, by effectively controlling the microbial load in the dental plaque and these agents are thought to alter the properties of saliva. Oil pulling with edible oils has proved to be an adjunct to routine oral hygiene methods to improve oral health. Aim: To evaluate and compare the effect of oil pulling therapy with sesame oil and virgin coconut oil with Chlorhexidine (CHX) gargling and plain water gargling on pH, buffering capacity, and total antioxidant capacity of saliva. Materials and Methods: A four armed randomised controlled study was conducted in 80 female children in the age group of 12-14 years from July 2019 to December 2019 in Department of Paediatric and Preventive Dentistry, Kannur Dental College, Anjarakandy, Kannur, Kerala, India. Children with mild to moderate gingivitis were selected and assigned into four groups to use different types of mouth rinsing (Group A: chlorhexidine, Group B: sesame oil , Group C: virgin coconut oil and Group D: plain water as control) for one month. Unstimulated whole saliva, collected from these participants were evaluated for the changes in pH, buffering capacity and total antioxidant capacity, at baseline and at 30 days. The data were tabulated and statistical analysis was done using Analysis of Variance (ANOVA) (Post-hoc), followed by Dunnet’s t-test, using Statistical Package for Social Sciences (SPSS) 25.0 version. Tukey’s post-hoc test was done to identify the significant pairs. Results: The mean age of the study participants was 13.4 years. Intragroup comparisons showed there were statistically significant changes in the baseline to 30th day values of gingival index, values, antioxidant capacity and buffering capacity for all the experimental groups (p<0.05). Coconut oil pulling (p=0.0345) and sesame oil pulling (p=0.026) and CHX gargling (p=0.045) showed statistically significant changes in salivary buffering capacity when compared to the control. On intergroup comparisons of experimental groups, there was no statistical difference in antioxidant capacity, salivary buffering capacity and pH of the saliva (p>0.05). Conclusion: Oil pulling with coconut oil and sesame oil had equal effectiveness as CHX on the antioxidant capacity and buffering capacity of saliva.

Minimal Side-effects and Adequate Analgesia in Spinal Anaesthesia: A Randomised Double Blinded Study Comparing Buprenorphine and Clonidine

DM Ramya, KN Vikas, Sudhir S Rao

Introduction: Postoperative patient management includes managing the acute postoperative pain as well as the side-effects associated with the use of various medications in pain management. Opioids like buprenorphine are excellent in providing analgesia but causes nausea and vomiting among other side-effects. Clonidine is another class of drugs used as an adjuvant but the dose related sympatholytic effect is troublesome to handle. Aim: To evaluate the efficacy buprenorphine (45 μg) and clonidine (22.5 μg) when used in low doses as an adjuvant in spinal anaesthesia and to study the incidence of the most common side-effects. Materials and Methods: The double-blinded randomised clinical study was conducted in Bangalore Baptist Hospital, Hebbal, Bengaluru, karnataka, India, from January 2014 to October 2014. Hundred patients, aged between 18-55 years, American Society of Anaesthesiologists (ASA) grade I and II, scheduled for lower limb and lower abdominal surgeries were studied. They were divided randomly into two groups i.e, group X and group Y of 50 each. All patients were given 15 mg (3 mL) of 0.5% hyperbaric bupivacaine and along with that the patients in the group X (buprenorphine group) were given 45 μg (0.15 mL) of buprenorphine and the patients in group Y (clonidine group) were given 22.5 μg (0.15 mL) of clonidine. The duration of analgesia, requirement of supplemental analgesics and incidence of side-effects were noted. Results: The duration of analgesia was found to be longer in the buprenorphine group (448.47±78.08 min) as compared to the clonidine group (311.70±71.92 min). The requirement of supplemental analgesics were, 94% in buprenorphine group required 1-2 doses and 92% in the clonidine group required 3-5 doses of analgesics in the first 24 hours, postoperatively. Among the side-effects, 4% of the patients in the buprenorphine group had bradycardia and hypotension, while 6% had nausea and vomiting. In comparison, 18% of patients in the clonidine group had hypotension, nausea (14%), vomiting (12%) and bradycardia (6%). Conclusion: Both buprenorphine and clonidine, in low doses, provide effective postoperative analgesia with minimal side-effects; while in comparison, buprenorphine has been found to fair better.

Evaluation of Hardness and Fracture Toughness of Feldspathic Porcelain by Various Surface Finishing Techniques

Introduction: Dental porcelain is fired at a high temperature inside the furnace and subsequently glazed for intraoral use as a restoration. There is no clarity on the correlation between physical properties of porcelain and its surface finishing techniques. Aim: To evaluate surface hardness and fracture toughness of feldspathic porcelain with different porcelain surface finishing methods. Materials and Methods: This in-vitro descriptive study was conducted between November 2018 to August 2019 at Department of Prosthodontics, Ragas Dental College and Hospital, Tamil Nadu, India, with 40 samples of Nickel Chrome (NiCr) alloy specimens, with addition of porcelain. The sample were divided into four groups S1: Unpolished, S2: Polished, S3: Autoglazed, S4: Add-on glaze according to the finishing procedures used with each group containing 10 samples. All samples were tested for surface hardness and Fracture toughness and were subjected to One-way Analysis of Variance (ANOVA), Bonferroni posthoc tests and Statistical Package of the Social Sciences (SPSS) California, USA. Results: Mean value of fracture toughness (in MPa^1/2) for 0.2 kg load was 0.729672 for S1, 1.187567 for S2, 0.89482 for S3, 1.324399 for S4. Mean value of surface hardness (in kg/mm²) for 1 kg load was 360.048 for S1, 519.166 for S2, 508.817 for S3, 527.916 for S4. Maximum deviation of 24.752 and error of 7.8273 was found in S4, least deviation of 10.7760 and error of 3.4077 was found in S1 group. Conclusion: The glazed porcelain had the highest micro hardness and fracture toughness followed by polished porcelain and autoglazed porcelain.

Comparison of the Remineralisation Potential between Flaxseed Paste, Aloe Vera Gel and Fluoride Toothpaste on Artificially Created White Spot Lesions around Orthodontic Brackets: An In-vitro Study

Rasiga Gandhi, Dilip Srinivasan, Sangeetha Duraisamy, Ravi Kannan

Introduction: White Spot Lesion (WSL) is one of the major iatrogenic effect at the end of treatment that might reduce both patient’s and orthodontist’s satisfaction in otherwise promising treatment results. Flaxseed and Aloe Vera (AV) have been used as phytotherapeutic agents because of inherent antimicrobial, anti-inflammatory, antioxidants and healing properties. They were considered in this study for their effectiveness in remineralisation of WSL. Aim: To evaluate and compare the remineralisation potential of organic flaxseed paste, Aloe Vera gel and fluoride toothpaste on artificially created white spot lesions around orthodontic brackets using Vicker’s microhardness assessment, spectrophotometry and Scanning Electron Microscope (SEM). Materials and Methods: This experimental in-vitro study was undertaken in Department of Orthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India, in October 2020. Forty eight extracted premolar teeth were exposed to demineralising solution for 48 hours in-vitro and randomly assigned to four groups: Group 1- untreated control, group 2- treated with flaxseed paste, group 3- treated with Aloe Vera gel and group 4-treated with fluoride toothpaste. All groups except control were treated with their respective remineralising paste for 28 days. Vicker’s Microhardness Number (VHN) and spectrophotometric values (?L, ?a, ?b, ?E) were evaluated for normal enamel, WSL, remineralisation after 14 and 28 days. The surface characteristics were analysed using SEM. Statistical analysis was performed using repeated measures Analysis of Variance (ANOVA) and post hoc Bonferroni test was for pairwise comparison between groups with significance level p≤0.05. Results: Total of 48 extracted teeth were treated and analysed in their respective groups after 28 days. Aloe Vera gel showed highest surface microhardness (SMH) (144.09±6.05 VHN) and has statistically significant difference (p<0.001) compared to flaxseed paste (125.28±3.75 VHN) and then the fluoride toothpaste (121.20±5.12 VHN). There was no significant difference (p-value=0.31) between flaxseed paste and fluoride toothpaste. Significant (p-value=0.05) DE changes were observed in groups treated with flaxseed paste (16.39) and fluoride toothpaste (15.08) after 28 days. SEM verified mineral gain in all three treatment groups. Conclusion: All the three groups increased mineral gain. Aloe Vera gel showed promising results by significantly remineralising WSLs. Flaxseed paste and fluoride toothpaste had SMH recovery which was lesser than Aloe Vera gel but, these two groups significantly improved the colour of WSL.

Assessment of Ease of Insertion of Laryngeal Mask Airway Comparing different Doses of Suxamethonium with Etomidate: A Comparative Randomised Double-blind Controlled Study

Introduction: Laryngeal mask airway (LMA) is used more often in today’s anaesthesia practice. Smooth and successful insertion needs proper mouth opening and minimal or no airway reflexes such as gagging, coughing, or laryngospasm. Induction agents like propofol and etomidate are known to blunt the laryngeal reflexes but often patient movement, coughing, and gagging create an unpleasant situation. Aim: To assess the effects of suxamethonium 0.25 mg/kg, and 0.5 mg/kg, and placebo (normal saline) on the facilitation of laryngeal mask airway insertion along with etomidate as an induction agent in order to achieve haemodynamic stability and fewer complications. Materials and Methods: This was a double-blind randomised controlled study, which included, a total of 90 adult patients, American Society of Anaesthesiologists (ASA) class I-II, scheduled for minor surgery under general anaesthesia and was conducted from December 2021 to February 2022, at Malla Reddy Medical College for Woman, Hyderabad, Telangana, India. The total participants were randomly allocated into three groups (Normal Saline (NS), S1 and S2). The group NS (placebo) received normal saline, and Group S1 and S2 received injections of suxamethonium 0.25 mg/kg, or 0.5 mg/kg, respectively. Induction of anaesthesia was performed with a bolus dose of etomidate 0.3 mg/kg. Study drugs were administered when the patient had lost consciousness. Laryngeal mask airway size 3 or 4 (as appropriate) was inserted. Relaxation of the jaw, coughing, gagging, laryngospasm, and any patient movements was observed during the insertion of LMA. The overall insertion conditions were graded according to modified scheme of Lund and Stovner. The statistical analysis was carried out by using Chi-square test, Fisher’s-Exact test and Bonferroni’s t-test. Results: A total of 89 patients were analysed (group NS: n=29, group S1: n=30, group S2: n=30). Good jaw relaxation (absolutely relaxed with no muscle tone) was noted in 16 patients of group S2, 12 in group S1, and 2 in group NS (p<0.001). There was significant difference in coughing and gagging among the three groups (p=0.041). However, in the group NS, eight patients had mild movement and six had moderate movement during the insertion of LMA (p=0.002). Overall insertion conditions were better in suxamethonium groups (p=0.0001). Conclusion: Etomidate as the sole induction agent for LMA insertion is not ideal. Concurrent use of a low dose of suxamethonium (0.5 mg/kg) might significantly obtund the airway reflexes in response to LMA insertion.

Qualitative Assessment of Cerebral Perfusion in Post Stroke Seizure Patients using Arterial Spin Labeling: A Case-control Study

Anjali B Susan, Uttam B George, Jeyaraj D Pandian

Introduction: Arterial Spin Labeling-Perfusion Weighted Imaging (ASL-PWI) assesses cerebral blood flow using magnetically labeled inflowing arterial blood water protons as freely diffusible tracer without exogenous contrast agent. Seizures are one of the sequelae of stroke with its mechanism not well studied. Aim: Qualitative assessment of cerebral perfusion in post stroke seizure patients using ASL-PWI and comparison of perfusion patterns in post stroke seizure patients and stroke patients. Materials and Methods: This was a case-control study among 100 stroke patients who underwent Magnetic Resonance Imaging (MRI) of brain in Department of Radiodiagnosis, from Outpatient and Inpatient Department of Neurology, Christian Medical College, Ludhiana, Punjab, India, from 1^st January 2018 till 1^st January 2020. Total 50 post stroke seizure patients included as cases and 50 age matched post stroke patients without seizure included as controls. Perfusion pattern was compared qualitatively using ASL-PWI. Qualitative variables were associated using Chi-square test/Fisher’s-exact test. Results: The mean age of the study subjects were 56.38±16.98 years (age range from 19-87 years) and that of controls were 59.66±11.86 years (age range from 19-89 years) (p-value=0.265). Cerebral hypoperfusion was noted in 39 (78%) of total 50 post stroke seizure patients irrespective of type of stroke. Cortical and subcortical area of frontal and parietal lobes was predominantly involved in post stroke seizure patients. Out of 39, 23 (71.88%) early onset seizure and 16 (88.89%) late onset seizure patients had hypoperfusion. There was no significant association of perfusion abnormality with onset of seizure (p-value=0.241). Hypoperfusion was noted in cases and controls without any statistical difference. Conclusion: Cortical and subcortical area of involvement was noted in post stroke seizure patients. Post stroke seizure patients showed hypoperfusion irrespective of stroke type and onset of seizure. There was no difference seen in perfusion abnormality between post stroke seizure patients and stroke patients without seizure.

Focused Ultrasonography in COVID-19: A Prospective Cross-sectional Study

Manju Mathew, Antony Kalliath

Introduction: The Coronavirus disease-2019 (COVID-19) pandemic requires adaptation of the care delivery process. Since the point of care ultrasonography (USG) is an essential diagnostic tool that aids in making clinical management decisions in a short time, wider adoption of USG by general health practitioners dealing with COVID-19 patients across the country could improve the care delivery process in a pandemic scenario. A simple diagnostic algorithm of USG limited to two echo views was proposed for ease of training and broader adoption of the technique. The study analysed the efficacy of focused USG in COVID-19 using this approach for diagnosing and managing critically ill COVID-19 patients. Aim: To determine the concordance between ultrasonographic diagnosis based on a focused algorithm and clinical diagnosis in COVID-19 patients. Materials and Methods: A prospective cross-sectional study was conducted on 58 COVID-19 positive patients admitted to the COVID-19 Intensive Care Unit (ICU) of a tertiary care hospital, in Kerala, India from October 2020 to March 2021. The inclusion criteria were age 18 years or above, hypoxaemia (SpO₂<94%) and hypotension (systolic blood pressure <90 mmHg). Apical four chamber and subcostal views were captured using a phased array probe (1.7-4 Hz). The cause of hypoxaemia or hypotension was diagnosed based on an algorithm constructed with Echocardiographic (ECHO) findings in COVID-19. A clinical diagnosis was made, laboratory data, and chest radiograph. Agreement between ultrasonographic and clinical diagnosis was assessed using the Cohen’s Kappa inter-rater coefficient. Statistical Package for the Social Sciences (SPSS) version 20 was used for the statistical analysis. Results: Mean age of the population was 65.6±17.3 years, and the male to female ratio was 1.5:1. Clinical diagnoses were categorised into six groups. The agreement between the ultrasonographic and the clinical diagnoses was substantial (95.1%), with Kappa 0.905 (0.851-0.959). The median time taken for image acquisition was 30 seconds (IQR 30, 60). Additional views performed for lungs and vessels did not change the clinical diagnosis or management. Conclusion: The proposed technique is simple yet effective for clinical management decisions. It has the potential for improving patient care delivery on a larger scale, since it reduces the time lag in instituting therapy.

Efficacy of Nanocrystalline Calcium Sulphate Bone Graft (NanoGen®) and Platelet Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Split Mouth Randomised Clinical Study

Introduction: Periodontal disease leads to the loss of supporting structures of the tooth. Recent years have witnessed the evolution of many regenerating materials that have shown to be effective in regenerating the loss structures. Aim: To evaluate and compare clinically and radiographically the efficacy of Platelet Rich Fibrin (PRF) and Nanocrystalline Calcium Sulphate Bone Graft (NanoGen®) in the treatment of intrabony defects. Materials and Methods: A split mouth randomised clinical study was conducted in the Department of Periodontology, DAPM RV Dental College, Bangalore from November 2018 to May 2020. In this study, 30 surgical sites were selected from 15 chronic periodontitis patients American Academy of Periodontology (AAP, 1999) of age between 35-65 years and with interproximal probing depth ≥5 mm following phase I therapy and radiographic evidence of intrabony defects ≥3 mm deep. They were divided into two groups: Group I (n=15) received open flap debridement with nanocrystalline Calcium Sulphate (nCS) and Group II (n=15) open flap debridement with PRF. Clinical parameters assessed were Gingival Index (GI), Plaque Index (PI), Gingival Recession (GR), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Intragroup was compared using Repeated Measures of Analysis of Variance (ANOVA) followed by Bonferroni’s Post hoc test and intergroup was compared using Independent student’s t-test. Results: Total 15 patients were selected in each group of which 10 were male and 5 were female patients. Mean age of the patients was 39.3 years. There was significant reduction in GI (p-value=0.04), PPD (p-value=0.04) and gain in CAL (p-value=0.04) in group I. The mean difference in CAL at six months was also statistically significant in group II (p-value=0.01). The mean difference of PI was not statistically significant between baseline to three months and baseline to six months in both groups. GR increased from baseline to three months and remained same at six months (p-value for group I and group II=0.36) in both groups. On intergroup comparison, group I (nCS) showed better improvement in clinical parameters like PPD (p-value=0.01), CAL (p-value=0.01) and BF (p-value=0.002) at all time intervals compared to group II (PRF). Conclusion: There was improvement in all clinical parameters except GR in both groups. So both can be used as regenerative materials. But based on this study nanocrystalline calcium sulphate bone graft can be preferred over PRF as a regenerative material.

Effect of Standardised Virtual Communication on Anxiety in Relatives of Patients with COVID-19 Infection in Central Gujarat: A Prospective Interventional Study

Komal Makwana, Sangeeta Jain, Balaji Ghugare, Niraj Rathod

Introduction: There are various researches for increased anxiety in Coronavirus Disease 2019 (COVID-19) patients and their relatives due to separation, but most of them are observational. Audio-video communication can be employed for communication between patients in rigorous isolation and their relatives. There were few researches available about the effectiveness of video calling on anxiety in COVID-19 patient. Gujarat lags considerably behind, according to bibliometric analysis of the India-based COVID-19 publication. Thus, the authors sought to conduct present study to evaluate that how video conferencing between COVID-19 patients in isolation and their relatives, affects anxiety. Aim: To determine the effect of standardised virtual communication on anxiety levels in relatives of COVID-19 intubated patient’s. Materials and Methods: This prospective interventional study was conducted at a tertiary care centre, Gujarat Medical Education and Research Society Medical College and Hospital, Vadodara, Gujarat, India, from April 2021 to July 2021. Total 283 relatives of COVID-19 patient were recruited by purposive sampling. Virtual communication unit was set up, where relatives can communicate audio-visually with their patient and caregiver with help of video calling technology. Inside Intensive Care Unit (ICU), the caregivers (intern, doctors or nurses) wearing Personal Protective Equipment (PPE) kit handled the portable audio-visual screen and answered on behalf of the patient. The Hamilton anxiety scale was used to measure the anxiety of relatives before and after the communication. Paired t-test was used to statistically analyse the data. Level of significant p-value <0.05 was considered. Results: A total of 283 subjects with 178 males and 105 female relatives were enrolled in the study. As an effect of communication, the mild anxiety prevalence decreased from 69.71% to 46.27%, the moderate anxiety prevalence decreased from 4.93% to 3.81%, and 49.92% of relatives reported being anxiety-free after communication. Statistical analysis of the paired t-test of Hamilton anxiety score showed a drop in anxiety score after communication from 4.77±3.66 to 2.88±2.34 (p-value <0.001). Conclusion: Audio-visual technology is effective as a mode of communication and counselling during a pandemic to reduce anxiety in COVID-19 victim families.

Haemodynamic Effects and Quality of Intrathecal Block in Lateral Decubitus Position using 25G Whitacre versus 25G Quincke Spinal Needles- A Cohort Study

Babita Ramdev, Shivani Rathee, Kunwar Deepak Neelendra

Introduction: Various attempts have been made to manipulate the needle designs to counter the adverse effects (hypotension, postdural puncture headache) of spinal anaesthesia. This includes the modification of the tip, the location of the orifice, the length and material of the needle. Aim: To access if a whitacre needle is a better substitute than the classical commonly used, Quincke spinal needle along with intraoperative haemodynamic changes and quality of intrathecal block. Materials and Methods: The present study was a hospital-based cohort study which included 100 patients in the age group of 20-50 years, who belonged to American Society of Anaesthesiologists (ASA) grade of I and II, and were operated for lower abdominal and lower limb surgeries under spinal anaesthesia. They were assigned into two groups A and B, wherein group A, 25G Whitacre and in Group B, 25G Quincke needles were used respectively. The primary outcome measures were the differences in the incidence of hypotension, bradycardia, and quality of sensory and motor blockade in the two groups. The t-test and Chi-square test were used. Statistical calculations were done using Statistical Package for the Social Science (SPSS) 21.0 version. Results: There was a noteworthy drop in the blood pressures {Systolic blood pressure (SBP), Diastolic blood pressure (DBP), and Mean Arterial Pressure (MAP)}, but the variance between the two needle groups was statistically insignificant (p>0.05). There was no statistically significant difference between the two needles group to the quality of intrathecal block. Sensory block onset in group A (83.08±12.26 seconds), group B (81.42±17.81 seconds) with p-value 0.410. The mean Bromage score in group A (2.90±0.30), group B (2.88±0.33). Conclusion: Both the needles provided excellent sensory and motor blockade and haemodynamic steadiness.

Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Patients undergoing Open Heart Surgery: A Prospective Cross-sectional Study

PD Vivek, VS Joshi, Anil Kumar, HN Madhusudana

Introduction: Adverse neurologic outcomes following cardiac surgery can be catastrophic to the patient, next of kin, healthcare facility and community at large. Ultrasonographic measurement of Optic Nerve Sheath Diameter (ONSD) has emerged as a promising modality to reflect Intracranial Pressure (ICP) and neurological status in various neurological settings. Aim: To explore ONSD as a tool to reflect ICP changes and predict neurologic outcomes in a cardiac surgical perioperative setting during Cardiopulmonary Bypass (CPB). Materials and Methods: This was an open-label, prospective cross-sectional study conducted in Department of Anaesthesia, Command Hospital, Karnataka, India, from June 2016 to July 2018. Total 50 patients aged between 15 and 80 years who underwent open heart surgeries irrespective of gender, primary diagnosis and preoperative American society of Anaesthesiologist’s Physical Status (ASA PS) grade were enrolled in the study. Serial ultasonographic ONSD of both eyes in two planes (viz. sagittal and transverse) were acquired by a single observer at the following time intervals: baseline (prior to general anaesthesia induction, immediately postintubation, and every 15 minutes interval during CPB (until 150 minutes or end of the CPB whichever was earlier). Postoperative neurologic reassessment was done at 6 hours/postextubation (whichever earlier), at 24 hours and after 7 days, postoperatively. Continuous variables were compared using the student t-tests, while Chi-square or Fisher’s-exact test was used to compare categorical variables. To assess inter-rater reliability for categorical variables, the Cohen’s Kappa statistic was used. Results: The mean age of the study cohort was 56.30±11.42 years. A slight male preponderance (56%) was observed. With regards to mean of total CPB time, it was insignificantly higher in patients with adverse neurologic outcomes as compared to those without adverse neurological outcomes (165.83±53.61 minutes vs. 121.36±21.41 minutes; p-value=0.098). Patients with adverse neurologic outcomes had significantly higher ONSD (average of both planes) on CPB from 60 minutes through 150 minutes/end of CPB timeline for right eye (p-value <0.001), left eye (p-value <0.001), and both eyes (p-value <0.001). For patients with ONSD value (average of both eyes in both planes of each eye) ≥5.5 mm had more likelihood to develop adverse neurologic outcomes, postoperatively. With respect to maximum ONSD anytime during CPB (average of both eyes in both planes of each eye), an arbitrary cut-off of ≥5.5 mm showed a sensitivity of 100%, specificity of 95%, diagnostic accuracy of 100%, and predictive value of 100% with significant p-value of <0.001. Conclusion: Serial ultrasonographic ONSD measurement is assuredly a promising tool to monitor elevated level of ICP as well as a good predictor for the assessment of major adverse neurologic outcomes secondary to open heart cardiac surgeries.

Intravenous Dexmedetomidine versus Intravenous Esmolol in Blunting the Laryngoscopy Response in Adult Normotensives undergoing Elective Surgeries: A Randomised Clinical Trial

Introduction: A wide array of drugs are available for blunting the laryngoscopy response. Amongst them both dexmedetomidine, and esmolol belong to the non opioid group having least interference with the recovery process without causing significant respiratory depression, thus are suitable intervention for this purpose. Dexmedetomidine a sedative highly selective α2 adrenoceptor agonist and has an anaesthetic-sparing effect at induction. It suppresses the release of catecholamine in response to a noxious stimulant because of its central sympatholytic action. Esmolol with a different pharmacokinetic profile is a water soluble, cardio-selective, an ultrashort acting beta blocker has a short half-life (t1/2) thus suited for suppressing the transient pressor reflexes following acute noxious surgical or anaesthesia stimuli. Aim: To compare the degree of attenuation of the laryngoscopy response following the use of single preinduction dose (Intravenous infusion at a dose of 1 μg/kg) of dexmedetomidine with that of esmolol (intravenous bolus at a dose of 0.5 mg/kg) in adult normotensives undergoing elective intubations. Materials and Methods: The randomised clinical trial was conducted in Pondicherry Institute of Medical Sciences, Puducherry, India from September 2016 to March 2018, on 60 patients of either sex, aged between 20-60 years with American Society of Anaesthesiologist (ASA) physical status I or II requiring elective intubations for general surgical procedures. The patients were randomly divided into two groups (n=30 each). Prior to induction group A received 1 μg/kg dexmedetomidine Intravenous (i.v.) infusion over 10 minute, and group B received 100 mL IV infusion of normal saline over 10 minute. Also 2 minute before laryngoscopy group A received 10 mL of normal saline (IV) bolus, whereas, group B received esmolol 0.5 mg/kg IV diluted in 10 mL of normal saline as a bolus. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded at baseline i.e, preprocedure before the study drug infusion, preinduction, at laryngoscopy (0 min) and 1, 3, 5 minute after intubation. A rise of MAP and/or HR more than 20% from the baseline was considered as positive laryngoscopy response. Student’s unpaired t-test was used for analysis of intergroup variables. Intragroup variables were analysed using repeated measures Analysis of Variance (ANOVA). Results: Mean age of patients in group A was 38.77±13.082 years and group B was 37.20±13.069 years (p-value=0.644). Results revealed that both the groups had an increase in HR and MAP at 1 minute after laryngoscopy and intubation. Mean readings of MAP showed a maximum rise of group A (2.15%) vs group B (7.25%) from the baseline readings at 1 minute following laryngoscopy which showed no statistical significance. The maximum HR increase following laryngoscopy was at 1 minute in group A (8.28%) vs group B (13.59%), which were below the positive laryngoscopy response. The mean HR, SBP, DBP and MAP recorded at preinduction, at laryngoscopy, 1, 3 and 5 minutes following intubation showed no statistical difference (p-value >0.05) between the two groups. Conclusion: Usage of single dose preinduction dexmedetomidine iv infusion 1 μg/kg over 10 minute was found to be equally effective in blunting the pressor response to laryngoscopy and intubation when compared to bolus dose of iv esmolol 0.5 mg/kg given 2 minute prior to laryngoscopy.

Clarithromycin versus Levofloxacin Based Triple Drug Therapy as First Line Eradication for Helicobacter pylori Infection- A Randomised Clinical Study

Introduction: Helicobacter pylori (H. pylori) are microaerophilic gram negative, spiral shaped, flagellated bacterial pathogens transmissible to humans. The prevalence of infection with H. pylori infection varies worldwide. Pharmacologic therapy for eradication must be initiated in symptomatic individuals with emphasis on hygiene and sanitation. The high prevalence of H. pylori infection in the country, and the lack of adequate evidence on the efficacy of the standard triple therapy in Southern India was the drive to conduct this study. Aim: To compare and evaluate the efficacy of 14 days clarithromycin based triple drug therapy over 10 days levofloxacin based triple drug therapy in H. pylori eradication. Materials and Methods: A randomised clinical study was conducted from September 2018 to February 2019, at a tertiary care teaching hospital and research centre in suburban Chennai, Southern India. Eighty patients with dyspepsia, who were diagnosed with H. pylori infection based on both Rapid Urease Test (RUT) and histopathology of antral biopsy, were alternately assigned to treatment with either 14 days clarithromycin based triple drug regimen (PAC) or 10 days levofloxacin based triple drug regimen (PAL). Efficacy of the drugs were compared using both RUT and histopathology of endoscopic antral biopsy specimen four weeks after completion of the treatment. Chi-square test was used for data analysis. Results: Out of the 80 enrolled patients, 70 individuals completed the study, of which 41 were males and 29 were females. Baseline characteristics were similar in the both the groups-mean age 42.31±14.8 years in PAC and 42.20±12.67 years in PAL (p=0.150); 65.7% were males and 34.3% were females in PAC group, 51.4% were males and 48.6% were females in PAL group (p=0.225). Clearance of infection was seen in 23 patients (65.7%) in PAL group as compared to 32 patients (91.4%) in the PAC (p=0.01). Among patients with failure of eradication, 3 (1.05%) from PAC group and 12 (4.20%) from PAL group had persistence of dyspeptic symptoms. In addition, 7.14% (5 out of 70-two from PAC and three from PAL group) of subjects who had H. pylori eradication had persistence of same symptoms of dyspepsia on follow-up at four weeks after completion of the regimen. Conclusion: A 14 days clarithromycin based triple drug regimen is more effective than 10 days levofloxacin based triple drug regime for the eradication of H. pylori infection.

Clinicopathological Study of Primary Gastrointestinal Lymphoma from a Tertiary Care Hospital in Southern India

Kavita Gupta, Ranjini Kudva, Vidya Monappa, Pawan Nikhra

Introduction: Primary Gastrointestinal Lymphoma (PGIL) is a heterogeneous disease in terms of patient characteristics, site, histologic types and treatment modalities. Although rare disease, it is the most common site for extranodal lymphomas accounting for 10-15% of all Non-Hodgkin lymphoma and 30-40% of all extranodal lymphoma. Aim: To study the different types of PGIL and its anatomic distribution along with its association with the clinical outcomes. Materials and Methods: This was a retrospective study conducted in Department of Pathology of a tertiary care hospital, South India over a period of five years (2009 to 2013). A total of 61 cases of PGIL were identified, which included both resected surgical and endoscopic biopsy specimens. Histopathological classification of all cases was done based on morphologic and immunophenotypic criteria according to latest World Health Organisation (WHO) 2008 classification. Anatomic distribution of various types of lymphoma and associated clinical features were studied. The cases were then followed-up and survival analysis was also done. Descriptive statistical analysis methods were used to analyse the data. Overall Survival (OS) rates were calculated using Kaplan Meier method for 33 cases. Results: There was predominance of men with peak incidence in 7^th decade. Abdominal pain was the commonest presenting symptom seen in 77% of the cases. The most common site of involvement was stomach (41%) followed by large intestine (37.7%). All cases of primary GI lymphomas were of Non-Hodgkin type. B cell lymphomas (n=54; 88.5%) were more frequent than T cell lymphomas (n=7; 11.5%). Diffuse Large B Cell Lymphoma (DLBCL) was the most common subtype accounting for 67.2% of cases (n=41) followed by MALT lymphoma (n=9; 14.8%). Follow-up was possible in 33 cases out of which 20 patients (32.8%) died with a median overall survival period of 13 months (95% CI, 7.8-18.2). The five-year overall survival (OS) for 33 patients who were followed-up was 67.2%. Conclusion: Diagnosing PGILs correctly according to the recent WHO classification is important so that correct treatment protocols can be followed.

Clinical and Therapeutic Aspects of Cardiovascular Complications in COVID-19 Patients: A Cross-sectional Study

K Brinda Angel, M Kulandaiammal, K Thamayanthi, M Mohanalakshmi

Introduction: Less is known regarding the Cardiovascular (CV) manifestations in Coronavirus Disease 2019 (COVID-19) patients. Among the complications, in patients with COVID-19 with pre-existing cardiovascular disease, there seem to be worse outcomes with an increased risk of mortality despite treatment. Several therapeutics are still under investigation for COVID-19 patients with cardiovascular impairment, but none of them has shown proven clinical efficacy to date. Aim: To associate clinical and therapeutic aspects of cardiovascular complications in COVID-19 patients at a tertiary care hospital. Materials and Methods: The data used for this single-centre cross-sectional study were collected from all the case sheets of COVID-19 positive patients with cardiovascular complications from the Medical Records Department of a Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, between May 2020 and December 2020. Parameters like demographic details, co-morbid conditions, time of presentation, clinical presentation, complications, therapy and the outcome of the treatment in terms of mortality rate, Intensive Care Unit (ICU) admission and duration of stay in the hospital were obtained. Chi-square test or Odds Ratio (OR) was used to analyse the data for 97 patients. Results: The mean age of total 97 patients in the study was 58.48±13.1 years and 30.9% were female. The most common cardiovascular complications include acute coronary syndrome (46.4%), conduction abnormalities (21.6%), cardiac failure (18.6%) and accelerated hypertension (11.3%). Remdesivir use significantly reduced the duration of ICU stay in COVID-19 patients (OR: 8.18; 95% CI: 2.9-22.9). There was no effect found with remdesivir on cardiovascular complications like acute coronary syndrome, conduction abnormalities, cardiac failure and accelerated hypertension. Cardiac drug use significantly reduced the duration of ICU stay in COVID-19 patients (OR: 3.3, 95% CI: 2.4-4.48). There was a significant reduction in cardiovascular complications like thromboembolism and conduction abnormalities with the use of cardiac drugs. In contrast, the use of steroids had no impact on the duration of ICU stay and other cardiovascular complications except for conduction abnormalities (OR: 5.2; 95% CI: 1.1-24.1). Conclusion: COVID-19 patients presenting with cardiovascular complications were associated predominantly with pre-existing hypertension. The use of remdesivir and cardiac drugs significantly reduced the duration of ICU stay in COVID-19 patients. There was a significant reduction of cardiovascular complications like thromboembolism and conduction abnormalities only with the use of cardiac drugs.

Correlation of Morphometric Parameters of Spleen and Height of the Deceased: A Cross-sectional Study in North Indian Population

Introduction: Estimation of stature is a major forensic anthropological concern used in the identification of unknown and mutilated human remains. Studies considering spleen morphometric parameters to decipher the height of the deceased are very rare especially in Haryana, though, research studies involving correlation between height and other body organs have been done. Aim: To determine the correlation between the morphometric parameters of the spleen and height of the deceased. Materials and Methods: The cross-sectional study was carried out in the Department of Anatomy in collaboration with the Department of Forensic Medicine in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from September 2010 to September 2012. The spleen specimens (30 males and 30 females) obtained from deceased adults in the age group of 16-70 years (both age inclusive) belonging to north India from the Department of Forensic Medicine during autopsy. The measurement of splenic parameters (weight, length, breadth, thickness and surface area) was done using direct measurement (standard methodology) accepted by anthropologists. The data was analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0. Pearson’s correlation test was used to evaluate the association between the splenic parameters and height. Correlation formula was derived to calculate the height from the splenic measurements. Results: Correlation of height was positive with splenic measurements (weight, length, breadth, thickness and total surface area) in both males and females and was significant with splenic weight (r-value=0.54 and p-value=0.02) and splenic length (r-value=0.548; p-value=0.002) in females. It was significant for splenic thickness in males (r-value=0.042; p-value=0.018) and significant for total surface area of spleen for both males and females (r-value=0.80 and p-value <0.00001 in males and r-value=0.58 and p-value=0.000781 in females). Conclusion: Correlation of height was significant for splenic weight and length in females; significant for splenic thickness in males and significant for total surface area of spleen for males and females. This study would help anthropologists and Forensic Medicine experts to calculate the height of the deceased using various regression equations, if spleen is intact and is measured.

Clinical Profile and Cardiac Complications of Haemoglobinopathies in Children at Tertiary Care Centre in Hyderabad, India: A Cross-sectional Study

Introduction: Haemoglobinopathies include a group of inherited, chronic haemolytic anaemias which are transfusion dependent. Haemolytic Anaemia is a public health problem and has a high prevalence in Asian countries. Cardiac morbidity and mortality are burdens of these disorders as a result of chronic anaemia and iron overload despite iron chelation therapy. For this reason, it is recommended that regular cardiac evaluation should be done for all patients with haemoglobinopathies. Aim: To study the clinical and laboratory profile of haemoglobinopathies and, the cardiac complications in transfusion-dependent patients by conventional echocardiography. Materials and Methods: This hospital-based, cross-sectional observational study was conducted in Department of Paediatrics at Niloufer Hospital, Hyderabad, Telangana, India, from March 2020 to February 2022. Diagnosis was confirmed clinically or by laboratory including 2D Echocardiography (ECHO). Variable measures are demographic data of the child, clinical features, laboratory changes, and 2D ECHO changes. Continued variables (quantitative) were analysed calculating mean and standard deviation and performing T-test or Mann-Whitney’s test. Results: Total 68 patients who received blood transfusions were part of the research. The mean age of children with haemoglobinopathy was 4.8±2.86 years. Patients with serum ferritin >1000 mg/dL had more than 10 transfusions per year in 33 cases. The 2D ECHO was abnormal in 65% of patients, among these 61% of patients showed increased Left Ventricular (LV) mass/m²" in ECHO, and 39% had normal LV mass/m²" . The mean ejection fraction in the patients was 64.82%. Pulmonary hypertension was seen in 25% of patients and 42 patients had mild tricuspid regurgitation. Conclusion: There is a possibility of reducing the disease burden by health education and avoiding parental consanguinity as almost half of the patients have parental consanguinity. Serial echocardiography is recommended to screen for early discoveries of cardiac abnormalities in asymptomatic children and timely initiation of appropriate therapy

A Clinicopathological Study of Developmental and Acquired Causes of Intestinal Obstruction in Paediatric Population- A Retrospective Study

Introduction: Intestinal Obstruction (IO) in the paediatric age group can be due to a variety of developmental and acquired causes which depend on the age at presentation. Histopathological examination of the resected intestine can provide definite evidence of underlying aetiology. Aim: To analyse the spectrum of lesions causing IO and it’s relation with clinicopathological features. Materials and Methods: This was a retrospective study conducted in the Department of Pathology at Seth G.S. Medical College and Dr. R.N. Cooper Hospital, Mumbai, Maharashtra, India. Gross and microscopy of 70 surgically resected specimens of patients with IO, received over a period of five years, from January 2009 to December 2013, data was analysed between January 2021 to June 2021, studied after getting ethical clearance. Clinical details were retrieved from the records. Lesions were classified as developmental and acquired which were further categorised into infective, neoplastic and miscellaneous categories. Data was analysed using Microsoft excel 2010 and was expressed as frequency and percentage. Results: Out of the 70 cases studied there were 40 males and 30 females. There were 37 cases less than one month old, 13 cases between one month to one year age and 20 cases between 1-12 years of age. The developmental category comprised of 52/70 cases (74.29%) with 17 cases of Meckel’s diverticulum,16 cases of intestinal atresia, three cases each of mesenteric cysts and duplication cysts, five cases of duodenal webs, four cases of congenital bands, one case each of lymphangiectatic cyst, malrotation, blind ileal loop and meconium ileus. In the acquired category, there were three cases of tuberculosis and one case each of fungus and Ascaris infection. In the neoplastic category, there were five cases of polyps and one case each of cystic teratoma and Burkitt’s lymphoma. There were three cases of volvulus, two of perforation and one case of intussusception. Conclusion: The present study highlights the various causes of IO in children from neonatal period up to 12 years of age. With proper gross and microscopic examination, it was possible to give confirmed diagnosis, which is necessary for further management of the patient.

Food Faddism Complicating Jaundice in Gilbert’s Syndrome Patients- A Prospective Cohort Study

Pentakota Kiranmayi, Lohitha Polisetty, Yellapu Radha Krishna

Introduction: Food faddism is a term that refers to a particular food or food group that is overemphasised in the regular diet or omitted to cure a specific condition. It affects an individual’s health by complicating the health status of already infected individuals, which harms their nutritional status in particular, causing macro and micronutrient deficiencies. In the present study, authors have analysed the effect of food faddism in Gilbert’s syndrome patients. The state of vitamin B12 deficiency (Megaloblastic anaemia) is observed because of dietary restrictions due to food myths causing ineffective erythropoiesis prolonging hyperbilirubinemia in Gilbert’s syndrome patients. Aim: To study the effect of food faddism on haematological parameters in recently diagnosed Gilbert’s syndrome patients. Materials and Methods: A prospective cohort study was conducted in a tertiary care centre of north coastal Andhra Pradesh, India, from June 2019 to June 2021. A total of 125 consecutive patients, newly-diagnosed with Gilbert’s syndrome, were enrolled. A constant rise in the indirect bilirubin levels between 2-5 mg/dL with normal serum liver transaminases was considered for diagnosing Gilbert’s syndrome. On monthly follow-up for six months, 21 patients presented with extreme fatigue and limb paraesthesia. Every month during the follow-up, thorough history about any recent changes in food habits was noted. Blood investigations like complete blood pictures and Vitamin B12 levels were done at the time of diagnosis, after six-month follow-up, and after treatment with co-methyl (Cyanocobalamin) B12 injections. Comparison of study variables at the time of diagnosis of Gilbert’s syndrome, before and after the treatment with co-methyl (Cyanocobalamin) B12 injections was done using paired t-test based on nature of distribution, and p-value was calculated. Results: Out of 125 Gilbert’s syndrome patients with a mean age distribution of 36.15±11.82 in (109) males and 36.06±11.93 in (16) females, 21 patients presented with symptoms after six months of follow-up, a habit of practicing a fad diet was noted, along with depression of cell lines showing pancytopenia. There was a significant decrease in the mean values of Haemoglobin (Hb)% (12.68 to 7.95), Total Count (TC) (8219.05 to 3819 cells/cumm), Mean Corpuscular Haemoglobin Concentration (MCHC) (33.30 to 32.17) and Vitamin B12 (391.63 to 125.68) and increase in mean value of Mean Corpuscular Volume (MCV) (91.33 to 101.18), at the time of diagnosis and after six months of follow-up. On treatment of the patients with co-methyl (Cyanocobalamin) B12 injections a significant improvement in the mean values of Hb% (7.95 to 13.28), TC (3819 to 8652 cells/cumm), MCHC (32.17 to 33.43) and Vitamin B12 (125.68 to 311.81) along with decrease in the mean value of MCV (101.18 to 90.0) was noted. Conclusion: The most common fad diet followed by Gilbert’s syndrome patients is the restriction of high protein diet (mainly non vegetarian) and bland diet consumption leading to vitamin B12 deficiency and worsening jaundice. By taking thorough dietary history, considering cultural practices, one can tailor the therapy accordingly. A simple measure like dietary education and busting the myths can improve quality of life by accelerating recovery.

Potential Risk Factors for COVID-19 Infection among Healthcare Workers in a Tertiary Care Centre, Kerala, India

Introduction: Understanding the virus transmission patterns and routes of transmission among Healthcare Workers (HCWs) is limiting the amplification events in healthcare facilities. Aim: To estimate the secondary infection rate and to describe the clinical presentation of infection and the risk factors for infection among healthcare worker contacts of Coronavirus Disease-2019 (COVID-19) cases. Materials and Methods: A descriptive cross-sectional study was conducted from June 2020 to July 2021, at a tertiary care centre, in central Kerala, India, among all the healthcare workers with exposure to a COVID-19 confirmed cases within the institution, between 15th July 2020 to 15th August 2020. Data including demographic details, information on contact and possible exposure with the COVID-19 infected patient was obtained using a questionnaire adapted from the World Health Organisation (WHO). Data was entered into Microsoft Excel and analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 22.0. Results: A total of 433 healthcare workers (382 females and 51 males, mean age: 34.33±10.79 years) were found to be exposed to COVID-19 confirmed cases in the institution. The 21% of the healthcare worker contacts were exposed while working in non COVID Intensive Care Unit (ICU) setting. Out of the 433 HCWs who were exposed to COVID-19 patients, 9 tested positive for COVID-19 [secondary infection rate was 2.07% with a Confidence Interval (CI) of 0.7-3.4%]. All nine of the positive HCWs were females, of which 88.89% were symptomatic. Conclusion: Healthcare workers are at risk of transmission of COVID-19 while providing care, hence further explorative studies, including serologic studies are recommended to further understand the epidemiology.

Calibre of the External Urethral Meatus in Indian Population: A Cross-sectional Study

Introduction: Transurethral resection instruments are designed as per western standards and are often found to be larger for Indian patients, leading to urethral trauma during instrumentation or higher incidence of urethral strictures postoperatively. Aim: To assess and record the calibre of the External Urethral Meatus (EUM) among Indian male and female population. Materials and Methods: This cross-sectional study was done at a tertiary health care centre over a period of one and half years from July 2016 to December 2017. All male and female patients above the age of 12 years undergoing lower urinary tract instrumentation at the institute underwent assessment for EUM calibre. A total of 1,127 males and 182 females were enrolled in the study. Descriptive statistics (mean, Standard Deviation, and range) were performed for age, height and the EUM in males and females. Linear regression analysis was used to analyse the correlation between EUM calibre and age; and EUM calibre and body height. The correlation was considered statistically significant when p<0.05. Results: The mean EUM calibre of the male population was observed to be 23.23±1.60 Fr (French scale) and that of the female population was 23.58±2.00 Fr. On linear regression analysis, a significant but weak correlation was found between EUM calibre and body height in male (R² value: 0.024, p-value <0.0001). On the other hand, no correlation was observed between EUM calibre and body height in females (R² value: 0.009, p-value=0.196). Conclusion: The average calibre of the EUM in Indian males was 23.23 Fr which is about 3 Fr smaller than the standard transurethral resectoscope sheath. Thus, use of larger sized sheaths may result in urethral stricture in narrow calibre urethra.

Outcome of Conventional versus Digital Mode of Behaviour Modification With or Without Maternal Presence in Paediatric Dental Patients- A Pilot Study

Neetika Verma, Anil Gupta, Shalini Garg, Shikha Dogra, Sakshi Joshi, Parika Vaid

Introduction: In managing paediatric patients most common challenge is to encounter child’s fear and anxiety during dental procedures. In modern era smart phone dentist games can be used as a modification of Tell Show Do (TSD) technique. Aim: To evaluate the effectiveness of different behaviour modification techniques in paediatric patients at first dental visit and to compare conventional techniques: TSD, TSD + maternal presence, Mobile Dental game (MD) and MD + maternal presence as behaviour modification techniques in preschool children. Materials and Methods: The present pilot study (a randomized parallel group clinical trial) was conducted in the Department of Paediatric and Preventive Dentistry of Faculty of Dental Sciences, SGT University, Gurugram,Haryana from July 2021 to December 2021 over a period of 6 months in 80 children Between the age group of 4 to 6 years with deft (d=decayed, e=extracted due to caries, f=filled, t=teeth) <3 and caries in any primary second molar indicated for Glass Ionomer Cement (GIC) filling, visiting the dentist for the first time. Patient with Frankl behaviour rating score of 1 and 2 accompanied by their mothers with positive dental attitude were included. Patients were equally divided into four groups. Behaviour was assessed using Frankl behaviour rating scale, Raghavendra, Madhuri, Sujata Pictorial scale (RMS-PS) and Face, Leg, Activity, Cry, Consolability (FLACC) scale before and after treatment. Results: The mean age of patients in the study was 4.99±0.92 years. The difference between pre and post Frankl behaviour rating score and RMS-PS were statistically significant in all the four groups (p<0.01), whereas difference in pre and post FLACC score was significant in group 2 and 4 (p<0.01). On comparing mean RMS-PS between four groups, significant difference was observed in group 1 and 4 (p<0.01). When mean FLACC score was compared, significant difference was observed between mean scores of Group 1 compared to Group 2 and Group 4. Conclusion: In the present study all the behaviour modification techniques showed improvement in child’s behaviour but use of digital mode of behaviour management along with maternal presence in paediatric dental operatory had displayed significantly better results.

Analgesic Efficacy of Dexamethasone and Dexmedetomidine as an Adjuvant to 2% Lignocaine Adrenaline and 0.5% Bupivacaine in Transversus Abdominis Plane Block after Caesarean Delivery

Introduction: The ultrasound-guided Transversus Abdominis Plane (TAP) block is an analgesic technique which involves injection of a local anaesthetic between the internal oblique abdominal and the transversus abdominis muscle planes. It provides analgesia to the cranial branches of T10-L1 nerve roots. It has been a practice to provide analgesia in patients following various surgical procedures including the gynaecological procedures like hysterectomy and caesarean section. Aim: To assess the analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine in TAP block following caesarean delivery. Materials and Methods: This was a cross-sectional study conducted at Konaseema Institute of Medical Sciences and Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India for a period of one year from January 2021 to December 2021. One hundred patients with an American Society of Anaesthesiologists (ASA) physical scores of I-II, who underwent caesarean section under the Pfannenstiel incision method under subarachnoid anaesthesia with 0.5% heavy bupivacaine, were enrolled in the study. Group I consisted of patients that received an ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 20 mcg dexmedetomidine. Group II included patients who received ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine adrenaline, and 8 mg dexamethasone. The Electrocardiogram (ECG) recordings and blood pressure were recorded during the block in each patient. This approach enabled a more precise analgesic approach for each individual patient. The patients were assessed for pain up to 12 hours of surgery based on a Visual Analog Scale (VAS), where 0 represented no pain and 10 represented ‘the worst pain ever possible. Results: The mean age in the dexamethasone group was 26.48±3.93 and in the dexmedetomidine group was 25.92±4.13 years. The patients who received ultrasound-guided TAP block with dexmedetomidine were significantly less on-demand of tramadol (p-value=0.005). The patients who received ultrasound-guided TAP block with dexmedetomidine were had significantly lower VAS scores at 4 hours (p-value=0.002), 6 hours (p=0.001), and 12 hours (p=0.3), postoperatively. Conclusion: This study proved that dexmedetomidine was more effective when compared to dexamethasone, when added as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine. Ultrasound guided TAP block was a safe and effective postoperative analgesia in caesarean section.

Impact of Duration of Disease and Glycosylated Haemoglobin Level in Determining the Severity of Coronary Artery Disease in Patients with Type-2 Diabetes Mellitus: A Prospective, Cross-sectional, Observational Study

Krishna Chandra Narzary , Sanjib Kumar Boro , Naba Kanta Das

Introduction: Duration of Type 2 Diabetes Mellitus (T2DM) and degree of glycaemic control play a pivotal role in the development of macrovascular complications of T2DM, including Coronary Artery Disease (CAD). However, association of the duration of T2DM and Glycosylated Haemoglobin (HbA1c) level with the severity of CAD is still an ongoing matter of debate in the diabetic patient subset. Aim: To investigate the association of duration of T2DM and HbA1c level with severity of CAD in patients presenting with T2DM suspected of CAD. Materials and Methods: This prospective, cross-sectional, observational study was conducted on 500 T2DM patients at GNRC Medical, Guwahati, Assam, India from June 2017 to June 2019. The T2DM patients with suspected CAD were studied and stratified according to the duration of T2DM (<10 and >10 years) and HbA1c level (<7% or ≥7%). All patients underwent coronary angiography to assess number of diseased vessels i.e., insignificant CAD (defined as <50% diameter stenosis in left main and <70% diameter stenosis in other branches), Single Vessel Disease (SVD), Double Vessel Disease (DVD), Triple Vessel Disease (TVD), and Left Main Coronary Artery (LMCA) disease. Chi-square test was used to assess the association of the duration of T2DM and HbA1c level with angiographic severity of CAD. The data were analysed using the Statistical Package for Social Sciences (SPSS) version 16.0, (Chicago, IL, USA). Results: A total of 500 patients were studied, of which, 295 (59%) and 205 (41%) patients had <10 and ≥10 year duration of T2DM, respectively. Overall, 264 (52.8%) patients had HbA1c <7%, and 236 (47.2%) had ≥7%. Normal coronary artery (42.4% vs. 5.9%; p=0.00001), insignificant CAD (9.8% vs. 2.4%; p=0.00124), SVD (21% vs. 6.8%; p=0.00001), and LMCA disease (2.4% vs. 13.2%; p=0.00001) were significantly higher in patients with <10 year duration of T2DM than ≥10 year. On the other hand, DVD (12.9% vs. 28.8%; p=0.00001), and TVD (11.5% vs. 42.9%; p=0.00001) were significantly higher in patients with ≥10 year duration of T2DM as compared to <10 year. Normal coronary artery (34.8% vs. 19.1%; p=0.0001), and insignificant CAD (10.2% vs. 2.9%; p=0.0013) was higher in patients with HbA1c level <7% than ≥7%. The prevalence of TVD (18.6% vs. 30.9%; p=0.0013), and LMCA disease (3.8% vs. 10.2%; p=0.0047) were significantly lower in patients with HbA1c level <7 than ≥7%. Conclusion: The T2DM patients with suspected CAD, longer duration of T2DM and poor glycaemic control were associated with more severe CAD.

Social Media Use in Dental Practice by Dental Practitioners of India: A Cross-sectional Survey

Introduction: In recent years, social media use has been increased by Healthcare Professionals (HCPs) in their healthcare practice and it has emerged as a new platform for disseminationof knowledge, information exchange, and interpersonal communication. Aim: This study was conducted with an aim to assess the use of social media in dental practice among dental practitioners in India. Materials and Methods: This cross-sectional survey was conducted from October 2019 to March 2020 at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India by implementing a 15-item questionnaire to 36218 dental practitioners in India registered with Indian Dental Association (IDA) through an Electronic Survey Application. The questionnaire consisted of a section on demographic details of the participants which included their age, gender, type and number of years of practice. Second section consisted of items about the use of social media in dental practice and one open ended question on the topic. Data was analysed using descriptive statistics and comparisons were made using a Chi-square test. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. Level of significance was kept at 5%. Results: A total of 3180 dentists responded and returned the filled questionnaire. Social media was used by 1980 (62.3%) of dentists in their practice and the most commonly used platform was WhatsApp 1650 (83.3% of social media users). Most common reason for using social media in dental practice was for learning new things related to dentistry and staying updated 1470 (74.2%) followed by participation into discussion related to dentistry 1170 (59.1%). Dentists younger than 45 years (p-value=0.002), dentists with practice of less than 10 years (p-value <0.001), dentists with specialty practice (p-value <0.001) and dentists having practice website (p-value <0.001) were more likely to use social media in their dental practice. Conclusion: Dental practitioners are actively incorporating social media in their practice and non users also showed interest in incorporating social media into their practice in near future albeit some of them were lacking in the knowledge of the same.

Oxidative Stress and Biochemical Parameters among Recovered COVID-19 Patients: A Case-control Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has spread rapidly, infecting more than 194 million and killing more than 4 million people worldwide. Algeria has not escaped this scourge; according to World Health Organisation (WHO), 162,155 confirmed cases and 4,063 deaths have been recorded from 3^rd January 2020 to 26^th July 2021. Recent studies have indicated the critical role of an altered immune system, and oxidative stress in the pathological process contributing to several complications during COVID-19 disease. Aim: To determine blood markers, oxidant/antioxidant status and biochemical parameters in patients recovered from COVID-19 and compare with those who have never contracted COVID-19; considered as controls. Materials and Methods: The present case-control study was conducted in Tiaret, Algeria, between May 2021 and June 2021. Thirty healthy volunteers who had never contracted COVID-19 and 16 volunteers who recovered from COVID-19 in the last six months were included in the study. Blood samples were taken after 8 to 12 hours of fasting, the blood markers and biochemical parameters were evaluated. The participant with chronic diseases (diabetes, hypertension, cardiovascular diseases, kidney disease) was excluded. Student’s t-test was performed for statistical comparison between the two groups. Statistical analysis was performed using Excel Microsoft 2010 software. Results: The control group consisted of 46.7% males (n=14) and 53.3% females (n=16). While, the case group consisted of 62.5% males (n=10) and 37.5% females (n=6). The plasma levels of Low Density Lipoprotein-Cholesterol (LDL-C), p-value=0.004** and creatinine increased significantly in the cases compared to the controls. While, total cholesterol, p-value=0.04* and Glutamate Pyruvate Transaminase (GPT), p-value=0.03* increased significantly in the case group on comparision to the control group. On the other hand, erythrocyte Malondialdehyde (MDA) levels, p-value=0.009** increased very significantly in the case group compared to controls. The erythrocyte activity catalase decreased significantly in the case group compared to the controls. But erythrocyte Reduced glutathione (GSH) decreased very significantly in group cases compared to controls. Conclusion: The findings in the present study confirmed the persistence of metabolic alterations and oxidative stress in COVID-19 patients after recovery. Antioxidant supplementation is recommended to improve redox status and reduce oxidative stress after recovery.

Percutaneous Pulmonary Valvuloplasty by JOMIVA Balloon in Adults: Long Term Retrospective Study from a Tertiary Care Hospital of Eastern India

Chandrakanta Mishra, Archana Mishra, Satyanarayan Routray

Introduction: Isolated pulmonary valve stenosis with intact ventricular septum constitutes the third most common congenital heart disease apart from Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD). Percutaneous balloon pulmonary valvuloplasty is an effective therapeutic alternative procedure of choice in severe valvular PS. Conventionally, the Mansfield balloon is being used worldwide for pulmonary valvuloplasty. Joseph Mitral Valvuloplasty (JOMIVA) balloon offers advantages of longer size, lower cost and its familiarity to use this balloon for mitral valvuloplasty in this institution since long. Aim: To assess the immediate and long term results of Joseph Mitral Valvuloplasty (JOMIVA) balloon for Pulmonary valvuloplasty in isolated severe Pulmonary Stenosis (PS). Materials and Methods: This was a long term retrospective study conducted at the Cardiology Department of SCB Medical College and Hospital, Cuttack, Odisha, India, where pulmonary valvuloplasty was performed using single JOMIVA balloon in 21 adults and adolescent patients. Clinical and Echocardiography (Echo) Doppler evaluation for restenosis and Pulmonary Regurgitation (PR) were assessed. All the cases were followed-up serially in Outpatient Department (OPD) for 12 years in retrospect manner. Results: Data of total 21 participants (15 males and six females; mean age was 18.3±6.8 years) were analysed in the study. After pulmonary valvuloplasty, the median transvalvular gradient significantly decreased from 115 mmHg (interquartile range (IQR) 101-128 mmHg) to 46 mmHg (IQR 37-51 mmHg) (p-value <0.0001). Also, the right ventricular systolic pressure reduced significantly from 136 mmHg (IQR 122-148 mmHg) to 67 mmHg (IQR 57-71 mmHg) (p-value <0.0001). Catheterisation Laboratory (Cath Lab) complications were transient and self-limiting. Mild to moderate (PR) was noted in all cases i.e., Grade I in 12 cases (57.1%) and Grade II in 9 cases (42.8%) which showed evidence of regression on follow-up. Neither significant restenosis nor significant PR (Grade III/IV) was observed during follow-up period of 12 years. Conclusion: Percutaneous valvuloplasty using JOMIVA Balloon, in case of severe valvular PS in adults, is a cost-effective procedure. It has excellent immediate results, and long term incremental benefits was observed in the present 12-year follow-up study.

Secondary Infections among COVID-19 Hospitalised Patients and their Antimicrobial Susceptibility Pattern: A Cross-sectional Study in a Tertiary Care Hospital

Introduction: The novel coronavirus (2019-nCoV) is a contagious virus that causes respiratory infection and has shown evidence of human-to-human transmission. In this infection, the immunity of the patient is decreased; making them susceptible to various secondary infections. This leads to increased morbidity and mortality in these patients. Aim: To estimate the profile of secondary infections in hospitalised Coronavirus Disease-2019 (COVID-19) patients and analyse their antimicrobial susceptibility pattern. Materials and Methods: A cross-sectional study was conducted for a period of five months from June to October 2021, which included COVID-19 positive patients with secondary infection admitted in the dedicated COVID hospital, Maharaja Krishna Chandra Gajapati Medical College and Hospital (MKCG MCH), Berhampur, Odisha, India. Clinical samples like blood, urine, sputum, tissue biopsy and Bronchoalveolar Lavage (BAL) were collected aseptically from patients with COVID-19 and were processed in microbiology laboratory as per standard operating procedures. All the necessary information like demographic features (age, gender), associated co-morbidities and oxygen saturation levels of COVID-19 positive patients at the time of admission were collected and entered in a Microsoft Excel sheet for further analysis. Results of continuous variables were described by mean and range while categorical variables were described by frequency. All the generated data was analysed by Statistical Package for the Social Sciences (SPSS) 16.0. Results: A total of 438 patients suspected of COVID-19 were admitted during the study period, out of which 138 patients were positive for COVID-19 by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Out of 138 COVID-19 positive patients, 105 patients were willing to give samples and their samples were processed for bacterial and fungal culture and sensitivity. Total 18/105 (17.1%) samples were positive for bacterial and fungal growth. Blood Stream Infection (BSI) were seen in 14/18 (77.8%) and was predominantly associated with Staphylococcus aureus 5/14 (35.7%), followed by Enterococcus spp. 3/14 (21.4%). Out of total culture positive cases, 2/18 (11.1%) showed Urinary Tract Infection (UTI). Of the UTI cases, Escherichia coli was isolated from 1/2 (50%) of cases. Out of total culture positive cases, 2/18 (11.1%) were identified having mucormycosis. All gram positive bacteria had shown maximum resistant to ampicillin and gram negative bacteria were resistant to ampicillin-sulbactam, levofloxacin, cotrimoxazole. Conclusion: In COVID-19 positive patients with secondary infection, early diagnosis and prompt treatment will lead to improved patient care and better outcome.

Knowledge, Attitude and Practices Regarding Utility of CBNAAT in the Diagnosis of SARS-CoV-2 Disease among Medical Interns: A Cross-sectional Study

Anindita Ballav, Susmita Bhattacharya, Parthasarathi Chakrabarty, Debalina Das

Introduction: Coronavirus Disease-2019 (COVID-19) causes respiratory tract infections in human beings ranging from mild illnesses like common cold to severe disease like pneumonia. Currently, nucleic acid amplification tests Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and TrueNat) and rapid antigen detection tests are approved for diagnostic purpose by Indian Council of Medical Research (ICMR). Medical interns, the primary contact healthcare personnel, need to be sensitised regarding proper utilisation of CBNAAT, so that rapid and accurate diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can be made in comparison to the more commonly used RT-PCR technique. Aim: To evaluate the Knowledge, Attitude and Practices (KAP) of Bachelor of Medicine and a Bachelor of Surgery (MBBS) interns towards accessibility of CBNAAT in SARS-CoV-2 infection in a tertiary care hospital. Materials and Methods: A cross-sectional study was performed through questionnaire shared via online platform amongst 102 Medical interns working at College of Medicine and Sagore Dutta Hospital from 22^nd August 2021 to 21^st September 2021. Based on their response, KAP was assessed by using a three-point Likert Scale. The collected data was entered in Microsoft excel, and reported as frequencies and percentages. Results: Among 102 internees, 84 interns responded. Among 84 medical interns 31% had good, 50% had average whereas 19% had poor level of knowledge. About 58 (69%) agreed that CBNAAT can be used as a method for rapid diagnosis of SARS-CoV-2. About 75 (89.3%) answered that they are sending samples for COVID-19 testing. Only 56 (66.7%) agreed that CBNAAT should be recommended. Conclusion: The present study revealed that majority of the MBBS interns had positive attitude towards different aspects of CBNAAT utility but most of them had gaps in their KAP. This demands extra efforts to sensitise and train them adequately.

A Three-dimensional Finite Element Analysis of Effect of Abutment Materials on Stress Distribution around Peri-implant Bone in Immediate and Delayed Loading Conditions

Saumya Agarwal, Anshul Trivedi, Chandan K Kusum, Roma Goswami, Apoorva Mowar

Introduction: Osseointegration is important for successful dental implant treatments. Abutment materials affect the load transfer to the implant and surrounding bone thus determining the long term implant survival. Aim: To perform stress analysis around peri-implant hard tissue with different abutment materials and their comparative evaluation in immediate and delayed loading conditions using finite element analysis. Materials and Methods: An in-vitro experimental study was carried out at Department of Prosthodontics at Subharti Dental College Meerut, Uttar Pradesh in December 2021. on a root form titanium grade IV Implant, assembled with an abutment Ø4.0-0.5GH and this test model was three-dimensional (3D) scanned, reconstructed on computer-aided design software CREO. Six abutment groups: group 1- zirconia with Delayed Loading (DL), group 2- Polyether Ether Ketone (PEEK) with DL, group 3- Titanium grade Extra Low Interstitial (ELI) with DL, group 4- zirconia with Immediate Loading (IL), group 5- PEEK with IL, group 6- titanium grade ELI with IL, were loaded from vertical, horizontal and oblique direction. Von Mises and principal stress analysis was done on the implant and the peri-implant bone using the finite element method and the statistical analysis was done. Results: For delayed loading group, highest stresses were generated in group 1 (462.88 MPa), followed by group 3 (413.72 MPa) and least in group 2 (319.38 MPa). For immediate loading, highest to lowest stresses were in group 4 (694.32 MPa), group 6 (620.58 MPa) and group 5 (479.07 MPa). The principal stress analysis showed significant difference between all groups in cancellous bone and cortical bone except between titanium and customised zirconia abutment in cortical bone in delayed loading (p=0.0846) and in immediate loading (p=0.1125). Conclusion: Change in abutment materials significantly affects the stress generated in and around the implant thus more studies must be carried out to reach a consensus on the most optimal material encouraging least dissipation in peri-implant hard tissues.

Factors Associated with Age of Onset of Bipolar Affective Disorder from a Tertiary Care Hospital in Southern India: A Cross-sectional Study

Introduction: Bipolar Affective Disorder (BPAD), is a chronic debilitating disorder. The mean age at onset for BPAD is observed to be around 20-30 years. The Age at Onset (AO) of BPAD is affected by various factors, including gender, family history, substance use, and other environmental factors. Aim: To assess the AO of BPAD in the clinical population and the relationship of socio-demographic and clinical factors with AO. Materials and Methods: A cross-sectional study, was conducted at Department of Psychiatry, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, from January 2020 to January 2021. The socio-demographic details of total of 53 participants suffering from BPAD attending the tertiary care psychiatric setting were collected. The AO of the sample data and its correlation with gender, family history, substance use, marital status, residential background, etc. was analysed by using Statistical Package for the Social Sciences (SPSS) version 22.0. Independent t-test and one-way Analysis of Variance (ANOVA) were applied to compare AO among different variables. Pearson’s correlation coefficient and multiple linear regression were applied to assess the correlation. Results: Out of the 53 participants, 30 participants (56.6%) were males and 23 (43.4%) were females of which 31 (58.5%) of the participants had a family history of psychiatric illness. Eighteen (33.8%) had some substance use before onset. No substance use was reported by females. The mean AO of the sample was 24±7.8 years. The mean AO was significantly earlier for, males (t=-2.598; p=0.012), those with a family history of psychiatric illness (t=-2.968; p<0.01) and urban dwellers (t=-3.752; p<0.01). Multiple linear regression analysis showed only family history (B=-3.07, p=0.01) and urban background (B=3.60, p=0.01) significantly predicted earlier AO. AO also negatively correlated with number of suicides per person years of illness (r=-0.387; p<0.01), and number of episodes per person years of illness (r=-0.322, p=0.01). Conclusion: Presence of a family history of psychiatric illness and residing in urban areas showed an overall early prediction of AO rather than gender, and other environmental factors. Earlier AO was associated with worse clinical outcomes of BPAD. Knowledge about AO and its factors might help in predicting treatment outcomes, and in planning primary preventive strategies for vulnerable populations.

Assessment of Vitamin A and Vitamin E Levels in Patients with Controlled and Uncontrolled Type 2 Diabetes Mellitus: A Case-control Study

Rajan Kumar Thakur, Sudha Ambiger, Varsha M Shindhe

Introduction: The prevalence of diabetes in India according to the International Diabetes Federation (IDF), Diabetes Atlas 2015 is reported to be 8.7%. Diabetes mellitus is a metabolic disorder, which results from body’s insensitivity to insulin and affects humankind at an alarming pose. Glycated Haemoglobin (HbA1c) is an important biomarker in assessing glucose level serologically. If HbA1c level is <7% the diabetes is said to be in controlled conditions. Vitamin A and E plays pivotal role as antioxidants in order to control oxidative stress which is an important contributing factor in diabetes mellitus by neutralising free radicals generated. Aim: To assess the antioxidants vitamin A and vitamin E levels in controlled and uncontrolled Type 2 Diabetes Mellitus (T2DM) patients and also to correlate the vitamin A and E levels with HbA1c in controlled and uncontrolled T2DM patients. Materials and Methods: The present case-control study was conducted for 12 months from January 2019 to December 2019 in the Department of Biochemistry, Jawaharlal Nehru Medical College Belgaum, Karnataka, India. The blood samples were collected from KLE’S Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India. A total of 110 subjects were divided into two group’s controlled Group 1 (55) and uncontrolled Group 2 diabetes (55) on the basis of HbA1c levels. Vitamin A and E levels were assessed by Enzyme Linked Immunosorbent Assay (ELISA) method. HbA1c was estimated by using Bio-Rad D-10 HbA1c program. The data was assessed using Chi-square test, Independent t-test, and Karl-Pearson corelation test. Results: There were a total of 29 males and 26 females in controlled T2DM group and a total of 34 males and 21 females in uncontrolled T2DM group. The mean ages in controlled and uncontrolled T2DM subjects were 57.11±8.82 and 54.22±7.93 years respectively. The HbA1c (%), vitamin E and vitamin A in controlled T2DM subjects were 6.01±0.56, 1.01±0.43 mg/dL and 21.66±7.94 μg% respectively. The HbA1c (%), vitamin E and vitamin A in uncontrolled T2DM subjects were 9.31±0.25, 0.58±0.29 mg/dL and 14.66±5.36 μg% respectively. Correlation of vitamin A and E with HbA1c was found to be non significant statistically. Conclusion: Vitamin A and E levels were comparatively higher in controlled diabetes patients in comparison to uncontrolled T2DM patients.

Association between Urodynamic and Cystoscopic findings in Women with Bothersome Lower Urinary Tract Symptoms: A Prospective Observational Study

Sunirmal Choudhury, Kasim Atar, Dilip Kumar Pal

Introduction: Lower Urinary Tract Symptoms (LUTS) are responsible for negative impact on quality of life of women. Urodynamic Study (UDS) is gold standard objective investigation in evaluating bothersome LUTS. Cystoscopy is important where UDS is difficult or unavailable. Despite vital role and unique properties of UDS and cystoscopy, the role of UDS and cystoscopy in the assessment of bothersome LUTS in young females continues to be heavily debatable subject as there is limited study in this age group. Aim: To evaluate causes of LUTS in young female patients and associate them with urodynamic and cystoscopic findings. Materials and Methods: This was a prospective observational study conducted in IPGMER and SSKM Hospital, Kolkata, West Bengal, India, from July 2019 to December 2020. A total of 100 female patients from adulthood to menopause were evaluated having decreased quality of life due to LUTS called bothersome LUTS in the form of history taking, clinical examination, basic biochemical tests, ultrasonography followed by urodynamic and cystoscopic examination. Patients were classified according to their LUTS into three groups: storage dysfunction, urinary incontinence and bladder emptying dysfunction. Association of UDS parameters like Idiopathic Detrusor Overactivity (IDO), IDO with detrusor underactivity, Compensated Bladder Outlet Obstruction (CBOO) was made with cystoscopic findings like dilated veins with cystitis, lax urethra, bladder trabeculations, diverticula, urethral stricture. Results were analysed using Microsoft Excel spreadsheet and International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0. Results: In storage dysfunction group, frequency with nocturia (53.3%) and in urinary incontinence group, stress urinary incontinence (58.3%) was predominant bothersome symptom. In storage dysfunction group 73.3% patients had IDO and 26.7% patients had normal UDS findings. In these patients on cystoscopic examination, 83.3% patients had dilated veins with cystitis changes. In urinary incontinence group 70.8% patients had IDO and 29.2% patients had IDO with detrusor underactivity on UDS examination. In these patients cystoscopic examination 54.2% had lax urethra with cystitis changes. In bladder emptying dysfunction group on UDS examination, all patients had CBOO and 75% had urethral stricture on cystoscopy. Conclusion: Significant association exists between UDS and cystoscopic findings on evaluation of LUTS in young females patients. Storage dysfunction symptoms were the most common in young age group followed by urinary incontinence symptoms. Bladder emptying dysfunction symptoms were least common.

Comparison of Ultrasound-based Diaphragmatic Thickness Fraction (DTF) with Rapid Shallow Breathing Index and DTF alone for Predicting Successful Weaning from Mechanical Ventilation: A Randomised Control Trial

Introduction: The timing for weaning from mechanical ventilator support is crucial because both early discontinuation and delayed weaning may lead to increased morbidity and mortality as well as high medical cost. Diaphragmatic Thickness Fraction (DTF), among the various ultrasound-based diaphragmatic measurements, can not only assess the readiness to wean but also predict the simple weaning. The Rapid Shallow Breathing Index (RSBI) or Yang Tobin index is a tool that is used in the weaning of mechanical ventilation. RSBI is the ratio of Respiratory Rate To Tidal Volume in litre (RR/VT). Aim: To estimate success of weaning process by using the ultrasound-guided DTF alone as a weaning predictor, and compare it with the index derived from the combination of both DTF% and RSBI. Materials and Methods: This randomised control study was conducted on 100 patients admitted to Intensive Care Unit (ICU) during one year, from October 2019 to September 2020. When the patients satisfied the weaning criteria, they were given Spontaneous Breathing Trial (SBT). After SBT the ultrasound was done and RSBI were calculated. Composite Index (CI) was derived by combining DTF% and RSBI. Patients were divided in two groups. In “group C” CI was used as weaning predictor, and in “group D” DTF% alone was taken as weaning predictor. Incidence of weaning failure was noted in each group. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) Version 19.0. Chi-square test, Student’s t-test, Receiver Operating Characteristic (ROC) curve, 2×2 tables were used. Results: The mean age of the study participants was 35.27±11.88 years. The DTF% value >44.0% was found to be 95.2% sensitive, and 96.2% specific based on the ROC curve. The proportion of cases requiring reintubation was significantly higher in group D (DTF%) compared to group C (CI) (30.0% vs 12.0%). The RSBI with DTF% had a better sensitivity and specificity than DTF% alone. Conclusion: The DTF% with RSBI is a much better predictor than DTF% alone. Sonography is subjective and has a long learning curve DTF% can be combined with RSBI to improve patient outcome.

Decision-making Styles and Job Security among Nurses Working at Public Hospitals in Saudi Arabia: A Cross-sectional Multicentre Study

Ahmed Alzahrani, Ghareeb Bahari, Kholoud Alharbi, Naji Alqahtani

Introduction: Decision-making and job security have been linked to increased motivation and productivity in nursing. However, research on these variables in the Saudi context is limited. Aim: To examine the association between decision-making styles and job security among nurses working at public hospitals in Saudi Arabia. Materials and Methods: A cross-sectional, multicentre study was conducted on a convenience sample of 295 nurses working at four public hospitals in Saudi Arabia from March to June of 2021. Data were collected through an online self-administered survey. The Nurse decision-making instrument was used to measure decision-making style. Job security scale was utilised to measure job security among nurses. An independent sample t-test, Pearson’s coefficient correlation, one-way Analysis of Variance (ANOVA), and multiple linear regression analyses were conducted using Statistical Package for the Social Sciences (SPSS). Results: Nurses reported intuitive decision-making (Mean=87.85, SD=21.08) and a moderate level in job security (Mean=20.93, SD=7.48). A significant difference was found between average income level and job security (p-value<0.05). Decision-making style was also significantly and positively associated with job security (r=0.450, p<0.05). In a multivariate analysis, income level (β=0.182, p<0.05) and decision-making style (β=0.436, p<0.05) were predictors of job security. Conclusion: Decision making style was found associated with job security. Improved patient care outcomes require excellent nurse decision-making.

Emergency Peripartum Hysterectomy in a Tertiary Care Centre of North India during COVID-19 Pandemic: A Retrospective Study

Jigyasa Singh, Shikha Sachan, Deeksha Singh, Uma Pandey

Introduction: The pandemic of Coronavirus Disease 2019 (COVID-19) had a significant impact on obstetric surgeries. Obstetric surgical procedures during the COVID-19 pandemic affect individuals who are suspected or proven to be high-risk endeavors. Aim: To evaluate the demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes in the women who had an Emergency Peripartum Hysterectomy (EPH) during the first and second waves of the COVID-19 at a tertiary care centre in North India. Materials and Methods: This was a retrospective cohort study, conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in Uttar Pradesh, India, including women who underwent EPH operated from March 2020 to May 2021 in terms of demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes. Information about their self-reported health issues due to traumatic birth (when they came for a follow-up visit at five weeks) were also obtained. Simple frequency, percentage, and proportion were calculated using descriptive statistics. Results: A total number of 1827 deliveries were conducted and out them 11 cases underwent emergency peripartum hysterectomy at the institute during the time frame of the COVID-19 pandemic. All of the patients were in the age range 21-34. All of these were unplanned pregnancies and arrived at various gestational ages. Eight cases had the previous scarring on the uterus, with six women having morbidly adhered placenta. All of the women in the study cohort were unbooked, and 72.73% (8 out of 11) of them were referred to the centre because they had high-risk factors. Due to substantial blood loss, five females required Critical Care Unit (CCU) support. The study sample had a poor newborn outcome, with three early neonatal deaths out of 11 deliveries. As a part of their 5^th-week follow-up, after the women had been stabilised and discharged from the ICU, they were asked to share their major issues related to health, psychological status and social interaction. The main worries revolved around the newborn child’s and COVID-19 positive husband’s health. Pregnant women who delivered during the COVID-19 pandemic had a significant rate of postpartum depression and Post-traumatic Stress Disorder (PTSD). Conclusion: The predominant cause of EPH in the study population was a morbidly adherent placenta. It is critical to protect women’s physical and psychological health during traumatic childbirth in order to mitigate the pandemic’s already-existing harmful impacts.

Comparative Evaluation of the Effect of Clonidine and Dexmedetomidine as Adjuncts to Lignocaine in Intravenous Regional Anaesthesia in Forearm and Hand Surgeries- A Randomised Clinical Study

Introduction: Intravenous regional anaesthesia for forearm and hand surgeries, which is one of the safe, cost-effective and rapid onset anaesthesia is less popular nowadays, because of its lesser postoperative analgaesia and tourniquet pain. Aim: To compare dexmedetomidine and clonidine as an adjuvant to 0.5% lignocaine to study block characteristics, tourniquet pain and postoperative analgaesia in forearm and hand surgeries. Materials and Methods: This randomised clinical trial was conducted in Acharya Vinoba Bhave Rural Hospital (Tertiary Care Hospital), Wardha, Maharashtra, India, from September 2019 to September 2021 on 70 patients posted for forearm and hand surgeries. The patients were divided into two groups of 35 each. Group C received clonidine 1 mcg/kg with 40 mL of 0.5% lignocaine preservative free. Group D received dexmedetomidine 1 mcg/kg with 40 mL of 0.5% lignocaine preservative free. Independent samples t-test was used for evaluation of demographic data, haemodynamic data, block characteristics, duration of surgery and tourniquet, onset of tourniquet pain, duration of analgaesia and intraoperative and postoperative analgesic requirement. Results: Onset of sensory and motor block was faster with dexmedetomidine group (1.60±0.60 min and 2.77±0.81 min) when compared to clonidine group (3.57±0.74 min and 6.40±1.26 min). Duration of analgaesia was significantly longer in group D (345.23±44.52 min) compared to group C (205.14±37.76 min), sensory and motor regression was delayed with group D (7.69±0.72 min) as compared to group C (6.40±0.85 min). There was no significant adverse effect noted in both the groups. Conclusion: Dexmedetomidine is an excellent adjuvant when added to lignocaine for Intravenous Regional Anaesthesia (IVRA) in terms of block quality, postoperative analgaesia, and adverse effects.

Comparison of Residual Bioceramic and Epoxy Resin Sealers following Retreatment with Reciprocating File System in Oval Root Canals: A Micro-computed Tomography Study

Sonal Agrawal, Sheetal Mali, Ashish Jain, Rahul Rao, Amit Patil, Himmat Jaiswal

Introduction: When endodontic treatment has failed, non surgical retreatment is often the first choice. This procedure includes removal of previous obturating material followed by chemomechanical preparation, disinfection and refilling of the root canals. However, residual sealer during retreatment remains a concern when such bioceramic sealers are utilised for obturation and this can affect the prognosis. Aim: To evaluate and compare the amount of residual filling material after retreatment in straight and oval root canals filled with iRoot SP and AH Plus sealer using V-Blue file system using Micro-Computed Tomography (micro-CT). Materials and Methods: This in-vitro study was conducted at Bharati Vidyapeeth (deemed to be) Dental College and Hospital, Navi Mumbai, Maharashtra, India, between November 2020 to December 2021. Sixty freshly extracted human mandibular premolar with straight and oval canals standardised with Cone Beam Computed Tomography (CBCT) were prepared with ProTaper next files and were assigned to two groups for obturation with gutta-percha using AH Plus and iRoot SP sealer respectively. Quality of obturation was confirmed with CBCT. After one month, retreatment was carried with V-Blue files and percentage of remaining obturating material was were evaluated before and after retreatment through micro-CT imaging. Two sample means and Kolmogorov Smirnov test were used to analyse data. Results: Data of all the samples from the micro-CT evaluation indicated that the mean volume of the initial filling material did not differ significantly among AH Plus sealer and iRoot SP sealer group (p>0.05). Percentage of residual volume of AH Plus sealer (0.02%) was lower than that of iRoot SP sealer group (0.06%) and this difference was statistically significant (p<0.05). Conclusion: According to the considerable amount of iRoot SP sealer remained after retreatment using V-Blue file as compared with AH Plus sealer.

Knowledge, Attitude and Practice of Dental Practitioners towards Computer Guided Implant Surgery in Central India: A Cross-sectional Survey

Introduction: Incorporating digital technologies has been recently gaining popularity because of the known benefits like increased accuracy, predictable outcomes and reduction in treatment time. It is very important for the clinicians to analyse the necessity of incorporating these digital approaches into routine patient care. Aim: To assess the knowledge, attitude and practice of dental practitioners towards Computer Guided Implant Surgery (CGIS) in Central India. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics at the Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India, to assess the attitude towards CGIS and Non Computer Guided Implant Surgery (non CGIS) by analysing responses from a total of 100 dental practitioners. A questionnaire consisting of 30 questions was circulated through a web-based program. Analysis was done using descriptive and inferential statistics using the Kruskal Wallis test and the Mann Whitney U test. Responses were collected and analysis was performed using Statistical Analysis for the Social Sciences (SPSS) 27.0 version. Results: Around 100 participants were included in the survey. A total of 52 participants were female and the remaining 48 were male with mean age of 34±1.75 (age range 23-50 years). Among all 97 (97%) participants were interested in CGIS but only 40 (40%) participants had any previous experience with the technology. Increased accuracy (z=7.08, p=0.0001) and predictability (z=10.64, p=0.0001) were considered the significant advantages by the participants. The overall difference in attitudes of CGIS and non CGIS users towards increased accuracy of CGIS was not statistically significant (z=0.394, p=0.694). Conclusion: The advantages of CGIS over non CGIS were acknowledged by majority of the practitioners. The major advantages were related to the greater accuracy and predictability associated with CGIS whereas the limited accessibility and higher cost were the most common disadvantages. The specialisation and the clinical experience did not significantly affect the attitude of the practitioners.

Usefulness of Reticulocyte Haemoglobin Equivalent in the Evaluation of Iron Deficiency Status: A Cross-sectional Study

KS Mouleeswaran, Dinisha Einstien, A Prathiba

Introduction: Iron deficiency is the most frequent cause of nutritional anaemia. Evaluation of parameters like serum ferritin and iron is critically important for evaluation of the iron status of patients and diagnosis of Iron Deficiency Anaemia (IDA). But in inflammatory disorders, ferritin concentration may be normal or increased due to the acute phase response, resulting in inaccurate interpretation of the iron status. Similarly, the serum iron levels may be high in cases of thalassaemia with combined iron deficiency. Reticulocyte Haemoglobin equivalent (RET-He) which correlates to the iron content in reticulocytes is effective, convenient and provides useful information for the immediate diagnosis and treatment of iron deficient states. Aim: To evaluate the diagnostic performance of RET-He level by comparing it with the iron status of the patients. Materials and Methods: This cross-sectional study was done in Department of Pathology at Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, from December 2020 to November 2021. The complete blood count, RET-He, serum iron and serum ferritin levels of 406 patients with microcytic hypochromic anaemia and dimorphic anaemia were reviewed and RET-He levels were compared with the serum iron and ferritin levels. The p-value was calculated using Statistical Package for Social Sciences (SPSS) IBM software version 28.0. The sensitivity of RET-He and serum ferritin levels in evaluating iron deficiency was calculated. Results: Low RET-He was observed in 394 cases, low serum iron in 401 cases and reduced serum ferritin in 376 cases. Total 34 cases of IDA with concomitant inflammation showed low RET-He and serum iron, despite normal to high serum ferritin levels. Five cases of iron deficiency with concomitant haemoglobin defect also showed low RET-He levels and serum ferritin, whereas the serum iron was raised. Low RET-He was observed in 17 cases of dual deficiency anaemia i.e., iron deficiency along with vitamin B12/folate deficiency. Conclusion: It was concluded that measurement of the reticulocyte haemoglobin content provides useful information for the diagnosis, treatment and monitoring of iron deficient states.

Physical Activity and Pelvic Girdle Pain in Pregnancy: A Cross-sectional Study

Hemalatha, B Sathyaprabha, N Venkatesh, R Sivakumar

Introduction: Physical Activity (PA) is an important component of a healthy pregnancy, for both the mother and her child. Sedentary lifestyle during pregnancy may increase development of pregnancy related musculoskeletal discomforts. Studies show that 25% of women experience severe Pelvic Girdle Pain (PGP) during pregnancy and 8% are severely disabled due to PGP. Aim: To analyse the association between the PA and PGP during pregnancy. Materials and Methods: This cross-sectional study was conducted at antenatal outpatient department, Sri Ramachandra Hospital, Chennai, Tamil Nadu, India from November 2019 to March 2020. Total 250 mothers were screened and finally 150 participants were selected. They were asked to fill-up the Pregnancy Physical Activity Questionnaire (PPAQ), Pregnancy Musculoskeletal Dysfunction Scale (PMDS) to assess the PA level and musculoskeletal dysfunction. Mothers who complaints of PGP were clinically diagnosed and were asked to fill the Pelvic Girdle Questionnaire (PGQ). Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of 26 (17.33%) pregnant women in this study had PGP. The association between the total PA and PGP showed that the risk of PGP decreased as the PA increased which was statistically significant (p=0.03). PGP was also significantly associated with increased body weight (p=0.014). Conclusion: It was found that there was an association between total PA and PGP in pregnancy. Increased PA is associated with reduction in PGP. Hence, moderate PA is recommended during pregnancy.

Evaluation of the Effect of Titanium Dioxide and Silicon Dioxide Nanoparticles on Impact Strength of Two Commercially Available Heat Cure Acrylic Resins

Introduction: Poor mechanical properties are among the main limitations of denture base resin. There has been a continuous attempt to improve the mechanical properties of denture base resins. Nanotechnology has evolved health care industry to a large scale and its applications are a boon to modern medicine and dental science. Nanoparticles are nowadays, extensively used in prosthodontics as they are incorporated in Polymethyl Methacrylate denture bases to alter the properties such as impact strength. Aim: To evaluate and compare the effect of titanium dioxide and silicon dioxide nanoparticles on impact strength of two commercially available heat cure acrylic resins. Materials and Methods: The in-vitro study was conducted in Department of Prosthodontics and Crown and Bridge, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India between April 2019 to May 2021, that involved 120 samples. Materials compared were Dental Products of India (DPI) heat cure acrylic and Trevalon heat cure acrylic. Each group was further categorized into four groups to measure the impact strength i.e, without incorporation of nanoparticles and with incorporation of nanoparticles SiO₂ and TiO₂ and a combination of both. Samples obtained were tested for impact strength using Izod method. Statistical analysis was done using a one-way Analysis of Variance (ANOVA), Student’s t-test and Post-hoc Bonferroni test. Results: In the two types of materials studied, the mean impact strength of Trevalon was statistically significantly higher (p-value=0.045) than DPI. After the addition of nanoparticles, i.e; SiO₂ and TiO₂ the mean impact strength was higher in Trevalon (8.66 kJ/m² without the addition of nanoparticles, 5.79 kJ/m² addition of 1% TiO₂ nanoparticles, 5.77 kJ/m² addition of 1% SiO₂ nanoparticles and 5.75 kJ/m² when a 1% combination of both the above was added) than DPI (7.19 kJ/m² without the addition of nanoparticles, 5.86 kJ/m²- addition of 1% TiO₂ nanoparticles, 5.77 kJ/m² addition of 1% SiO₂ nanoparticles and 5.66 kJ/m² when a 1% combination of both the above was incorporated). Conclusion: Mean Impact strength of Trevalon was higher than mean impact strength of DPI. Incorporation of TiO₂, SiO₂ Nanoparticles or in combination decreases impact strength of both the commercially available heat cure denture base resin with statistically no significant difference.

Analysis of Olfactory Fossa Anatomy using Cone Beam Computed Tomography

Madhura Mahajan, Manjushri Waingade, Raghavendra S Medikeri, Daya K Jangam

Introduction: Olfactory fossa is an important structure in the anterior skull base. It is made of Lateral Lamella of Cribriform Plate (LLCP) and fovea ethmoidalis which are very delicate parts that can get damaged during surgical procedures causing numerous serious complications. To avoid such complications, the knowledge of anatomical variations of these parts is mandatory. As there are very few studies which have used Cone Beam Computed Tomography (CBCT) for evaluation of olfactory fossa, the authors have assessed the olfactory fossa with the help of Kero’s and Gera’s classification for lateral lamella of cribriform plate. Aim: To evaluate the anatomy of olfactory fossa using CBCT. Materials and Methods: A retrospective observational study was conducted in the Department of Oral Medicine and Radiology, from 1^st January 2019 to September 2021. The CBCT scans of 107 adults were analysed to evaluate the height of LLCP according to Kero’s classification and the angle between the LLCP and the true horizontal plane according to Gera’s classification. Comparison of height of lateral lamella (mm) and Gera angle (degree) among right and left sides were done using Student’s Independent t-test. The comparison of Gera angle with Kero’s type was analysed by one way Analysis of Variance (ANOVA) test. Chi-square test was performed to assess categorical data on the right and left sides. Results: A total of 107 CBCT scans consisting of 59 males (55.14%) and 48 females (44.86%) were included in the study. The mean age of the study population was 31.60±11.17 years. Kero’s type II (69.6%) and Gera’s class II (92.1%) LLCP were found to be most commonly seen. The Gera angle on right side (60.26±9.84) was greater than on left side (56.38±10.16) which was statistically significant (p-value=0.005). On right side, Kero’s type II was more common in males (71.2%) and on left side, Kero’s type II was more common in females (77.1%). Conclusion: Kero’s type II Olfactory fossa (OF) was found as most common type, with no significant difference between gender and /or side. Similarly, class II Gera angle was most common and the values were higher on right side.

Comparison of Lipid Profile in Prediabetic and Non Prediabetic Adult Off-springs of Type 2 Diabetics Patients: A Cross-sectional Study

Sayali Eknathrao Raut, Smita Suresh Bute, Urjita Zingade, Atish Bhaskar Pagar

Introduction: Lipid abnormality is an important modifiable risk factor associated with the type 2 diabetes mellitus and prediabetes. Dyslipidaemia occurring in diabetic patients, has important role in development of macrovascular atherosclerosis and increases the risk of cardiovascular disease. Furthermore, prediabetes has also been found to be associated with an increased risk for cardiovascular disease. Considering the prevalence and increased risk of cardiovascular disease in diabetes, it is becoming necessary to diagnose prediabetic individuals and assess their lipid profile and prevent them from developing overt diabetes and the further complications. Also, data available on lipid abnormalities in prediabetics is relatively less in the Indian population. Aim: To compare lipid profile in prediabetic and non prediabetic adult off-springs of type 2 diabetics and to evaluate the association between lipid profile and prediabetes. Materials and Methods: This cross-sectional study was conducted on 150 healthy young adult (>18 years) off-springs of type 2 diabetic patients, willing to participate in the study in Government Medical College and Hospital, Miraj from January 2019 to December 2019. All the relevant information was collected by administering a structured case record form. Fasting blood samples were collected and fasting blood glucose level, lipid profile including Total cholesterol (TC), Triglycerides (TG), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL), Very Low-Density Lipoproteins (VLDL) were estimated and compared. Data collected was entered in the Microsoft Excel (2010), expressed as frequency and mean. Chi-square test and Fisher’s-exact test was applied to observe the association between different study parameters. A p-value <0.05 was considered statistically significant. Results: Prevalence of prediabetes was 17.3% (fasting BLS 100 to 125 mg/dL) in age group of 26 to 30 years (26.67%). It was found that occurrence of prediabetes was more in male participants (25.37%) as compared to female participants (10.84%). Association between gender of the participants and occurrence of prediabetes was found to be statistically significant (p-value=0.019). The association between prediabetes and higher TC levels, lower HDL levels, higher LDL levels, higher VLDL levels was found to be statistically significant (p-value <0.05) and the association between prediabetes and higher TG levels (mean-48.65±18.45 and 28.18±9.47 mg/dL) was not significant (p-value=0.056). Conclusion: Total cholesterol, LDL, TG, VLDL were significantly raised, whereas HDL was significantly lower in prediabetic subjects as compared to non prediabetic healthy subjects. The association between prediabetes and higher TC levels, lower HDL levels, higher LDL levels, higher VLDL levels was found to be statistically significant (p-value<0.05) and the association between prediabetes and higher TG levels was not significant (p-value=0.056). So, prediabetic individuals, though asymptomatic have significant dyslipidaemia, that puts them at higher risk for developing cardiovascular disease.

Pyogenic Granuloma of the Lower Airway- A Systematic Review

Introduction: Pyogenic granulomas (PGs) are benign lesions that are very common in the upper aerodigestive tract. These lesions occur due to hormonal imbalance or due to a predisposing traumatic factor. They are relatively rare in the lower respiratory tract. There are few published papers of PG involving the lower airway in the past 30 years. Aim: A case of pyogenic granuloma of larynx mimicking malignancy has been presented along with the systematic review on methods of diagnosis, successful management, and prevention of pyogenic granuloma recurrence in the lower respiratory tract. Materials and Methods: This systematic review of literature included reports from 1981 till date, where complete details of the records were available. These reports were collected from the search engines “PubMed” and “Google Scholar” using the MeSH terms “pyogenic granuloma” OR “lobular capillary haemangioma” AND “lower respiratory tract”. The results were reviewed by three different authors independently with a main focus on methods of diagnosis and successful management and prevention of recurrence. Results: A 59-year-old male patient presented to ENT Department with hoarseness of voice for the past six months. On examination with video laryngoscope, a pale pinkish polypoidal mass originating from the anterior commissure and extending into the subglottic wedge with normal vocal cord mobility was noted. Neck examination showed splaying of thyroid cartilage with tenderness and there were no palpable lymph nodes. Computed Tomography (CT) examination suggested a neoplastic etiology of thyroid cartilage erosion. The patient was managed by microlaryngeal excision of the mass and histopathological analysis revealed pyogenic granuloma with no evidence of malignancy. From the 25 papers reviewed, a predisposing trauma like a history of intubation/lower airway procedures like bronchoscopy or laryngoscopy is not a prerequisite for the occurrence of PG of the lower airway. The lesions can be excised via microlaryngoscopy or using the bronchoscope depending on the site of lesion. The various surgical modalities used for excision are cold steel dissection, laser excision and cryotherapy. Conclusion: Meticulous dissection and removal of the lesion with postoperative measures to prevent additional trauma like antireflux measures and appropriate antibiotic therapy seems to be helpful in preventing recurrence. Role of steroids in the management of pyogenic granuloma has not been supported by adequate literature. Further studies are required to comment on the adequacy of duration of follow-up.

miRNA26 Expression in Plasma- A Potential Biomarker for the Diagnosis of Parkinson’s Disease

Usha S Adiga, Sachidananda Adiga, BS Varashri

Parkinson’s Disease (PD) is a chronic, progressive neurodegenerative disease characterised by both motor and non motor features. The diagnosis of PD is based on clinical evaluation, patient’s signs and symptoms, neurological and physical examinations. No diagnostic tests have been devised so far that can conclusively diagnose PD. So, the review aimed to assess the role of a minimally invasive biomarker for the early diagnosis of PD. Circulating microRibonucleic Acid (miRNA) could be the promising biomarker for PD. miRNA expression could be a useful marker for the diagnosis of PD. Early diagnosis may help in improving quality of life of patients with PD. Correlation of miRNA with disease severity may be useful in predicting the response to therapy as well as prognosis of the disease.

Quantification of Lumbar Lordosis by Tactile and Non Tactile Methods: A Revisit

Anushree Rai, Zubia Veqar

Lumbar lordosis alteration results in various disabilities and common problems like low back pain, among others which severely impacts the quality of life of a person. This paper focuses on postural evaluation used to identify this alteration, which till date has received little attention even though it is an important outcome measure in various experimental studies. This review focuses on both quantitative and qualitative postural evaluation methods. Conventional methods range from visual observation method to the gold standard method, namely, radiography and various other non invasive methods like photogrammetric, flexicurve, spinal mouse, and inclinometer. However, recent research suggests some 3 Dimensional (3D) analysis methods like 3D radiographs, inertial sensors and posturometer. There is a lack of consensus on the most suitable method for this evaluation, hence, the selection is difficult for clinical as well as research purposes. Although there are few reviews available, none of them have attempted to establish the pros and cons of all these methods. This review provides a comprehensive overview of different 2D, 3D, tactile and non tactile methods or tools that have been developed to measure posture or shape of lumbar spine. This review will also provide practical recommendations to researchers as well as clinicians about the tool selection for lumbar lordosis assessment.

Effect of Mindfulness-based Intervention on the Treatment of Women’s Sexual Dysfunction: A Literature Scoping Review

Introduction: The significance and role of sexual function in quality of life is an undeniable fact that should be taken into account in the care provided for individuals. The use of modern non pharmacological methods in the treatment of sexual dysfunction, especially in women, is required to be investigated. Aim: To review the effect of mindfulness-based interventions in the treatment of women’s sexual dysfunction in the previous studies. Materials and Methods: This literature scoping review was conducted on all observational and experimental studies published in Persian and English languages, from 2008 to 2021. The databases that were searched for relevant studies were Google Scholar, Web of Science, PubMed, and Scopus. The keywords used for the search included, mindfulness, mindfulness-based interventions, sexual dysfunction and women. Data related to the study year of publication, place, type of study, sample population, and the effect of mindfulness-based interventions in the treatment of women’s sexual dysfunction were recorded. Results: A total of 742 studies were found, of which 23 studies were extracted. Among the reviewed articles, 5 (21.74%) articles are published in Persian and 18 (78.26%) articles in English. In total, 22 articles confirmed positive effects and one article found no effects on mindfulness-based interventions in improving sexual function in women suffering from sexual dysfunction. Conclusion: Mindfulness-based interventions, though it is implemented based on different approaches (stress reduction, cognitive-behavioural and sex therapy), are effective in treating all types of sexual dysfunction in women.

Cerebral Venous Thrombosis Presenting as Cortical Subarachnoid Haemorrhage- A Case Report and Review

Parag Rameshrao Aradhey, Kedar Takalkar, Jiwan Kinkar, Tushar Patil

In the presence of Subarachnoid Haemorrhage (SAH), diagnosis of underlying Cerebral Venous Thrombosis (CVT) is challenging as there is no difference in clinical presentation and therapeutically it is important because CVT needs to be treated with anticoagulant, unlike SAH. This article is about a 50-year-old male presenting with headache, right hemiparesis, and recurrent seizures. Computed Tomography (CT) head was suggestive of SAH in right posterior parietal region. But Magnetic Resonance Imaging (MRI) venogram showed cerebral venous sinus thrombosis. Hence, he was treated with anticoagulants. The patient showed significant clinical improvement. SAH secondary to underlying CVT is a relatively rare entity. After reviewing medical literature of such cases, 42 case reports and case series forming 95 cases of SAH secondary to CVT were found.

Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF), causing Rupture Uterus, Haemoperitoneum and Mortality- A Case Report

Gwendolyn Fernandes, U Sujith, Asha Shenoy, Manjusha Karegar

Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF) is a very rare entity with a couple of cases in the literature. Amianthoid fibers are thick acellular mats composed of crystalline collagen fibers. This is an unusual case of a 53-year-old female with Chronic Kidney Disease (CKD), who presented with pain in the abdomen for three weeks. Computed Tomography (CT) showed a degenerated subserosal leiomyoma in the posterior wall of the uterus which had ruptured leading to haemoperitoneum. An emergency exploratory laparotomy with simple hysterectomy was done. Histopathology revealed a ruptured atypical leiomyoma with abundant amianthoid-like fibers. The patient expired seven days after surgery due to hypovolaemic shock. Rupture of the uterus in leiomyoma with amianthoid fibers has not been reported in the literature. Awareness of this entity is important in view of acute catastrophic consequences like haemoperitoneum, hypovolaemic shock, and death.

A Narrative Review of Anatomy and Clinical Biopsychosocial Assessment of Sacroiliac Joint Pain

Nidhi Suresh Sharma, Tajuddin Burhanuddin Chitapure, Anuja Atul Bhalerao

Sacroiliac Joint (SIJ) pain is a severe disorder that affects 15% to 25% of individuals having axially low back pain (LBP). The most common causes of depressive symptoms are fear of movement, pain catastrophising, stress, and nervous system sensitisation. Recent research has shown that radiological imaging, are inadequate for diagnosing SIJ pain. For immersive and patient centred experiences, a comprehensive professional Biopsychosocial (BPS) physiotherapy evaluation is suggested. A new biopsychosocial model has been proposed that acknowledges all critical health and disease factors and promotes the interaction of biological, psychological, and social influences, but moves further than a narrow perspective. Psychosocial influences on well-being have generated an interest in physician services, physiotherapy evaluation, and implementation in a more systematic approach to a patient. This method is used to determine the current pain mechanism (predominant nociceptive, neuropathic, or non neuropathic central sensitisation pain) as well as the underlying pain mechanism. Patient’s biopsychosocial variables can establish and maintain sacroiliac discomfort. For a better plan of therapy to manage SIJ dysfunction, the biopsychosocial clinical assessment takes precedence over the examination of sacroiliac joint discomfort alone.

Potential Determinants of Manual Lifting: Validation of Ergonomic Assessment by Scoping Review Applying Meta-analysis Approach

Introduction: Despite automation, manual load lifting is unavoidable in occupations like industry, healthcare, defence, etc. Ergonomics studies on manual lifting conducted across the globe explored few aspects of biomechanical and physiological responses. It was hypothesised that, ‘holistic ergonomics approach’ involving simultaneous recording of these responses under single study, would elucidate potential injury causing factors more effectively and results could be validated by applying meta-analysis technique of literature review. Aim: To identify the potential determinants of manual lifting by applying multivariate statistics to existing data and correlate the results with determinants as per literature review applying meta-analysis. Materials and Methods: Clustering and principal component analysis tools of factor analysis was applied on the data obtained under the pilot study (n=11) undertaken by same authors previously on manual lifting that assessed 26 dependent parameters simultaneously for load magnitudes (10 kg, 20 kg), lifting heights (floor-knuckle, knuckle-shoulder and floor-shoulder) and lifting frequencies (1 lift/min, 4 lift/min). Further, extensive scoping literature review on determinants of manual load lifting was done applying text mining tool of meta-analysis technique on R software platform using 921 Pubmed abstracts published between 1991 and 2018. Results: Salient findings of factor analysis corroborated with that of scoping literature review. Accordingly, dependent variable ‘Vertical Ground Reaction Force (VGRF)’ and independent variable ‘vertical height of lift’ changed most significantly during manual lifting, showing significant positive correlations. Newton’s third law of motion states that while bipedal standing/walking/running on floor, two forces (with three vector components) are acting upon a person: the force of gravity (downward force, equivalent to body weight) and the Ground Reaction Force (GRF, an equal upward force exerted by floor). However, while standing still at one place for lifting load, only the largest vector component of GRF, i.e., VGRF acts on the body (=‘body weight’+‘load magnitude’) through the vertical height of lift. Conclusion: It may be concluded that ‘vertical height of lift’ and VGRF are possible indicators of injury potential of manual lifting. However, studies on larger sample size and meta-analysis of relevant full papers instead of abstracts need to be done in future.

Shoulder Impingement and its Association with Acromial Morphology- A Review

Rashmi C Goshi, K Pushpalatha

Shoulder with its chronic disability recognised by impingement of the rotator cuff beneath the coracoacromial arch. Varying acromial morphology revealed alterations attributable to mechanical impingement. The undersurface of the anterior part of the acromion and the front lip were always implicated. Extrinsic factors caused impingement and tendonopathy, with the anterolateral acromion ‘impinging’ on the superior surface of the rotator cuff. The present review clearly describes the acromial morphology and its role as extrinsic causative factor in shoulder impingement. Treatment options for confirmed impingement range from analgesics and physiotherapy to injectable therapy and, open and arthroscopic surgery. In most studies, the results of arthroscopic subacromial decompression are positive, and data suggests that, the operation minimises the occurrence of rotator cuff injuries when compared to a control group. Complete acromionectomy and lateral acromionectomy yielded dismal results, prompting researchers to investigate the undersurface of the acromion in the development of impingement syndrome. There are, however, contradictory studies discussing the role of extrinsic and intrinsic causative factors of impingement.

Approach to Publish Medical Literature- A Guide for Students in the Field of Healthcare

Alhad Mulkalwar

Significant contributions have been made to the field of medical science by numerous students in the formative stages of their career. While medical research was earlier an exclusive domain of residents and senior doctors, we are now witnessing a positive trend of increasingly more number of undergraduate students indulging in research projects and today, research has become an integral and indispensable component of medical education. While undertaking research activities, it is imperative for young researchers to understand the importance of publishing quality data in journals of repute, without compromising on any aspect of the process.