Journal of clinical and diagnostic research

Autoamputation of Toes in a Renal Transplant Recipient: Warning Sign of an Impending Graft Rejection?

V Siva Kesava Reddy, Shubham Nimkar, Mansi Patel, Sourya Acharya

The peripheral arterial occlusive disease is responsible for a significant amount of morbidity and mortality in patients of end-stage renal disease. This disease might not be as common as end-stage renal disease in vascular complications arising after renal transplant. The peripheral arterial occlusive disease is responsible for lower limb amputation in chronic kidney disease. It is important to identify the peripheral arterial occlusive disease as it may lead to septicaemia which in turn can result in multiple organ failure and thus can prove to be a potentially fatal complication of renal disease. Here the authors report a case of a 42-year-old female who had undergone a renal transplant four years back. She presented with breathlessness and bilateral pedal oedema along with autoamputation of toes and ultimately had to be taken for haemodialysis. The patient was intervened for an arteriovenous fistula for haemodialysis in view of graft rejection. Through this brief case report, the authors highlight the importance of a neglected autoamputation which was a missed warning sign of impending renal graft rejection in the present case.

Synchronous Primary Carcinoma of Cervix and Ovary-A Rare Case Report

Synchronous malignancies of female genital tract account for less than 3% of all genital tract neoplasms. Amongst synchronous tumours, ovarian with endometrial carcinoma accounts for 51.7% while ovarian with cervix accounts for less than 10% of them. Unusually, they have a favourable prognosis with five years survival rate being 73.3%. Authors hereby, present a case of 51-years-old female presented with bleeding per vagina and on examination cervical mass was detected. The cervical mass biopsy confirmed cribriform adenocarcinoma of cervix. Uterus and cervix could not be removed as it was FIGO (The International Federation of Gynecology and Obstetrics) stage III B (inoperable) thus was managed on chemotherapy and radiotherapy. A month later she presented with bilateral ovarian masses for which she had undergone bilateral oophorectomy and omentectomy. Histopathology confirmed moderately differentiated mucinous cystadenocarcinoma of bilateral ovaries. Thus a case of synchronous carcinoma of cervix and ovary was concluded. She tolerated all managements successfully.

Junctional Epidermolysis Bullosa in a 30-day-old Infant: A Case Report

Pratima Bisen, Sumeet Baheti, Amol Nagre, Chitra Nayak, Poonam Wade

Epidermolysis bullosa is a group of hereditary mechanobullous disorders which are associated with appearance of bullae secondary to physical stress like heat or mechanical trauma or sometimes without any trigger. There are four major subtypes: Epidermolysis Bullosa Simplex (EBS), Junctional Epidermolysis Bullosa (JEB), Dystrophic Epidermolysis Bullosa (DEB) and Kindler syndrome. Diagnosis is by skin biopsy histopathology, immunofluorescence staining and genetic testing. The treatment is mainly supportive consisting of avoiding trauma, good skin care and careful wound management. A rare case of JEB in an infant is being presented here. A 30-day-old male infant presented with fluid filled blisters and multiple raw areas over the fingers, buttocks, legs, scalp and elbow were seen. Nail changes were also present. Crusting was present over some lesions. Skin histopathological and immunofluorescence studies were done. Final diagnosis of JEB was made and patient was managed with supportive management. Minimal handling and strict asepsis was advised to the parents. The patient was discharged and prognosis was explained to them. The child was not brought for regular follow-up and he died at four months of age.

Tuberous Sclerosis Complex Associated Renal Cell Carcinoma with Leiomyomatous Stroma

Renu Mariam Thomas, Parvathy D Ullas, VP Gangadharan

This case report is about an unusual subtype of renal cell carcinoma with distinct morphological pattern in a 24-year-old female patient with tuberous sclerosis complex. She presented with pain in the left flank and an Magnetic Resonance Imaging (MRI) upper abdomen showed a solid cystic lesion in the interpolar region of left kidney, measuring 2.8×2.8×2.8 cm. She underwent partial nephrectomy which revealed a solid cystic tumour. Microscopically, the tumour was composed of long branching tubules lined by cells with voluminous clear/vacuolated cytoplasm. A prominent fibromyomatous stroma was seen focally, separating the tumour into nodular aggregates. Tumour cells were positive for Cytokeratin 7 (CK7) on immunohistochemical study. These features were consistent with renal cell carcinoma with leiomyomatous stroma. Genetic study showed a heterozygous non sense variation in Tuberous Sclerosis 1 (TSC1), gene, diagnostic of tuberous sclerosis. This report exemplifies the pivotal role pathologists play in the initial identification of certain hereditary cancer syndrome. The distinct morphology and immunohistochemical profile of the tumour is described.

A Case Report of Perioperative Jerks in a Patient undergoing Cranioplasty under General Anaesthesia

Kumar Venkatesh, S Arunkumar, S Parthasarathy

After neurosurgical procedures, perioperative seizures are relatively common. It is extremely rare for a patient to experience intraoperative jerky movements while under General Anaesthesia (GA). The authors, hereby presented a 25-year-old male who was scheduled for cranioplasty. The routine investigations within normal limits and there were no preoperative morbidities. He was taking phenytoin. The procedure began with a routine GA with controlled ventilation using sevoflurane and vecuronium. After 45 minutes of uneventful intraoperative course, perioperatively, involuntary jerking movements of his arms and legs were observed, which resolved on their own. A muscle relaxant was given to prevent further episodes of muscle jerks, but they persisted for a few minutes. Except for a slight increase in blood pressure, all other parameters were normal. Following a smooth extubation around 90 minutes later, he was shifted to postoperative high dependency unit with stable vitals. Supplemental oxygen was administered via a simple facial mask. The patient had another episode of persistent jerky movements of his foot lasting for 30 seconds after 10 minutes with no loss of consciousness. One mg of intravenous midazolam was administered. The complete absence of a loss of consciousness goes against a seizure. The postoperative course was uneventful and a follow-up for two months was non contributory. It can be concluded that a combination of sevoflurane and phenytoin in a setting of a neurosurgical intervention could have possibly caused a jerky motion. This case is presented for its rarity.

Challenges in the Anaesthetic Management of Congenital Disorder Infantile Hypertrophic Pyloric Stenosis

Monika Sharma, Aruna Chandak, Vijay Chandak

Pyloric stenosis is characterised by a thicker, lengthened, and larger pylorus as well as hypertrophy of the circular and, to a lesser extent, the longitudinal smooth muscles.The classical presenting features are non bilious, projectile vomiting, visible peristalsis and hypochloremichypokalaemic metabolic alkalosis. Definitive treatment is often performed by a relatively quick surgical procedure shortly after diagnosis. Surgery for pyloromyotomy is usually performed when fluid, acid/base, and electrolyte imbalances have been properly and completely corrected, which inturn results in speedy recovery of patient. The complications linked to these diseases call for caution when administering anaesthesia for even ostensibly straightforward surgical procedures. The case report is about a 1-month old male neonate who presented with features of pyloric stenosis. Weighing the increase risk of complications and mortality, the neonate was managed using rapid sequence induction approach in combination with caudal block for an adequate analgesia.

Verrucous Hyperplasia Masquerading as a Verrucous Carcinoma: A Diagnostic Challenge

Vijaykumar Tharani, G Nandhini, Snehesh Dinesh, KB Vinitha

Verrucous Hyperplasia (VH) is a rare exophytic oral mucosal lesion that can progress to Verrucous Carcinoma (VC) and it has increased probability of converting into Squamous Cell Carcinoma (SCC). These lesions present diagnostic difficulties to the clinician. In diagnosing this, histopathology remains the gold standard. In VH cases, these entities can be distinguished by the lack of invasive growth; as a result, when performing a biopsy of the lesion’s epithelium, it is critical to include a margin with adequate depth. Therefore, it is pivotal that biopsies of verrucous lesions include a lesional margin with adequate depth. The present case report discusses about the VH, of a 53-year-old male patient presented with a complaint of non healing growth in the left lower back tooth region. During clinical examination, well-defined oval soft growth with cauliflower like projections on the surface was present and measured 2×1 cm with well-defined borders. Treatment plan includes surgical excision. The lesion was sent for histopathological examination and the final diagnosis was made. The patient was reviewed for three months, no recurrence of the lesion was observed during the follow-up period.

Management of Repeated Denture Fracture Through Direct Metal Laser Sintering Metal Reinforced Denture

Manu Rathee, Sandeep Singh, Maqbul Alam, Prachi Jain, S Divakar

Direct Metal Laser Sintering (DMLS) is a type of additive metal production that is simpler, more precise, and healthier than traditional manufacturing, while being highly cost-effective. In this process, the metal powder which is free of binder or fluxing agent, is completely melted by the scanning of a high-power laser beam. The resulting part has properties like the original material. In removable prosthodontics, the fracture of heat cure acrylic resin dentures is an unsolved problem. The most common issue is a midline fracture of the maxillary denture. Among midline fractures, 71% were reported in maxillary complete dentures and 29% in mandibular dentures. Patients with heavy masticatory loads and those with parafunctional habits are more likely to experience this. In such circumstances, a metal framework base improves a prosthesis’s fracture resistance, stability, and retention. A 45-year-old female patient reported with a chief complaint of repeated fracture of maxillary complete denture and gave the history of midline fracture of upper denture three times in last 2 years. Intraoral examination revealed v shaped deep hard palate and severely resorbed mandibular ridge. DMLS metal reinforced maxillary denture and metal mesh reinforced mandibular denture was planned to prevent fracture of the denture in future. Metal framework reinforcement of complete denture is a simple, quick, and cost-effective technique to decrease the chances of denture fracture in future, thus beneficial for both patient and the dentist. One year follow-up has been done and patient is comfortable with the denture.

Thyrotoxic Periodic Paralysis Precipitated by Viral Hepatitis

Ronak Patel, Sanchit Uppal, Abhinav Meelu, Mini Bhatnagar

Thyrotoxic hypokalaemic Periodic Paralysis (TPP) is a medical emergency usually seen in Grave’s disease, commonly in persons of oriental descent. The present case is a rare first time presentation of TPP in association with acute viral hepatitis A. A 46-year-old female presented with weakness, vomiting, fever, altered sensorium and yellow discolouration for 20 days. She was diagnosed to have hepatic failure due to viral hepatitis A. The patient’s serum potassium level was 1.79 mmol/L. Treatment for hepatic failure and i.v. potassium chloride replacement was started. Sensorium improved but severe hypokalaemia and flaccid paralysis persisted. Thyroid functions were assessed and thyrotoxicosis due to Grave’s disease was diagnosed. Carbimazole and systemic corticosteroids were also started and potassium infusion was continued. Serum potassium became normal only after thyroid hormones reached normal limits followed by improvement in muscle weakness. TPP can be precipitated in conditions of stress, thyroid functions should be assessed in cases of hypokalaemic periodic paralysis even in absence of overt thyroid disease.

Surgical Approach to Odontogenic Maxillary Sinusitis Caused by Tooth Root Displacement into the Maxillary Sinus: A Case Report

Paranasal sinuses affected by foreign bodies are uncommon clinical situations. Foreign body displacement into facial sinuses is a potential iatrogenic complication, that may cause an oroantral fistula, sinusitis, cellulitis, and subdural emphysema. The maxillary sinus is usually the most affected by tooth displacements, due to its proximity. A dental fragment in the maxillary sinus may cause Odontogenic Maxillary Sinusitis (OMS). The present case report presents a case from the diagnosis to treatment of OMS originated by a fragment of tooth root displacement into the sinus during a previous dental extraction. A female patient, 13-year-old, had characteristic signs of sinusitis, reporting rhinorrhoea, headache, eye pain, and pain on the left side of the face. The clinical examination showed pain on palpation in the buccal region of the upper left first molar, which was absent. The Cone Beam Computed Tomography (CBCT) showed a foreign body inside the maxillary sinus, complete opacification, and bone defect on the sinus floor. Given the final diagnosis of OMS, the treatment selected was the combination of antibiotic therapy and fragment removal from the sinus. The diagnosis, planning, and correct use of surgical techniques described in the literature are essential for preventing iatrogenesis and actively ensuring patient health. In this sense, patients need to be informed about any complication, which should be written in the medical records along with resolution measures.

Hypersensitivity Reaction of Tongue: Oral Adverse Effect of COVID-19 Vaccine: A Case Report

Coronavirus Disease-2019 (COVID-19) has introduced the new normal in this 21st century. This viral has caused a great infection storm in the recent past affecting more than half of the world population. Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) causes various symptoms from mild to severe. Mortality rate has been reported to be low, mostly associated with pre-existing medical history. Literature also states that mortality was high among those with poor immune surveillance. Based on the duration of symptoms, it has been classified into long COVID-19 and short COVID-19 and to combat the outcome of the disease, many vaccines were invented worldwide by various pharmaceutical companies and they helped a lot in controlling the severity of the disease. The vaccines effectively reduced the incidence of long COVID-19 and serious symptoms, thereby, reducing the death rate. Although the vaccines were very effective in control of serious complications of the infection, few patients had certain adverse reactions to the vaccines of both types’ whole virus and viral-vector based vaccine. In the present case report, authors would like to document the delayed hypersensitivity reaction in the tongue as a potential Adverse Drug Reaction (ADR) postvaccination for SARS-CoV-2 infection in a 48-year-old female patient without any previous history of medical illness or drug allergy. The ADR was effectively controlled with systemic steroids and the symptoms were effectively controlled within a period of few months.

Use of Cyclosporine for the Treatment of Stevens- Johnson syndrome and Toxic Epidermal Necrolysis Induced by Carbamazepine- A Case Report

Sanket G Malu, Ravindra S Beedimani, Santoshkumar R Jeevanagi

Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, potentially life threatening, severe mucocutaneous adverse reactions characterised by extensive epidermal detachment, erosion of mucosa and severe constitutional symptoms. However, the use of Carbamazapine may be associated with a plethora of adverse effects, the most serious being SJS/TEN, wherein the patient typically presents with fever, skin eruption and mucosal involvement. It occurs between 1/1,000 and 1/10,000 new exposures to the drug. Here, the authors report a case of severe life threatening SJS/TEN induced by Carbamazepine in a three-year-old boy who presented with high grade fever, skin rash and all mucosal involvement. This condition is best approached with immediate discontinuation of offending drug and prompt administration of oral cyclosporine. The case is being reported to emphasise the need for timely diagnosis and prompt treatment with cyclosporin for successful outcome as it can cause irreversible organ damage or death if untreated early.

Rheumatoid Arthritis Presenting with Raynaud’s Phenomenon in an Elderly: End of Road?

Aaditi Agarwal, Abhinav Ahuja, Neha Phate, Sunil Kumar

Rheumatoid Arthritis (RA) is an autoimmune and chronic inflammatory disorder where the immune system of the body attacks the healthy cells and causes inflammation. Raynaud’s Phenomenon (RP) is a disorder of small blood vessels supplying the distal parts of the limbs where decrease in blood supply leads to infarction of that area. It occurs secondary to other disorders as in this case with RA. The report is about an 80-year-old female patient who presented with chief complaints of bluish discolouration over distal parts of hands and feet as well as pain in joints of all limbs. She had gangrene developing over the tips of fingers and toes, ulcer over the lower end of right foot, cold extremities, swelling over elbow and knee joints, oedematous hands and feet, and loss of pin prick needle sensations. With all the clinical presentations and investigation findings, the patient was diagnosed with RA presenting with RP. The patient was first started with the treatment for RA and then was managed symptomatically for vasculitis. Due to the old age factor and the advanced stage of the disease, the patient developed septicaemia and died due to cardiac arrest.

Scarless Modified Approach to Subcondylar Fracture Bypassing the Parotid Gland- A Case Report

Stuti Shah, Ridhi Matariya, Parth Parikh, Ekta Mistry, Devanshi Vaghela

Subcondylar fractures contribute about 19-29% amongst all the mandibular fractures worldwide, yet the treatment paradigm remains slightly controversial. Subcondylar fractures are pivotal in maxillofacial surgery for diverse reasons, as they can result in number of complications, whether treated or not. Initial clinical outcomes may appear pragmatic but complications such as pain, restrictions of jaw movements, muscle spasm, mandibular deviation, malocclusion, and facial asymmetry may become apparent. Fracture of tympanic part, mandibular fossa of temporal bone, may or may not be escorted by dislocation of condylar segment into middle cranial fossa, damage to blood vessels, arteriovenous fistula are some additional complications. Choosing right surgical strategy is for minimising postoperative complications management of subcondylar fractures and it should be taken in account that, perioperative, functional, and patient-reported outcomes. The majority of studies that have been published describe the use submandibular, retromandibular, or preauricular incisions have drawbacks such as poor visibility, accessibility, and the potential to harm facial nerve and complications related to the parotid gland. Hereby, the authors present a case report of left subcondylar fracture in a 55-year-old, male patient, where a modified percutaneous approach was taken, to access the fracture, and aid in adequate reduction and proper fixation without any postoperative complications. In this approach, parotid gland is bypassed and masseter muscle fibres are excised to reach the fractured site at subcondylar region. It is small, straight forward, elementary, safe, reliable and scarless approach for the management of subcondylar fractures that ensures adequate exposure of the fractured site, osteosynthesis and minimal potential postoperative complications.

Occurrence of Extensive Scrofuloderma in an Immunocompromised Child: A Rare Case Report

Scrofuloderma also called Tuberculosis colliquativa cutis is one of the variants of cutaneous tuberculosis. It can be a skin manifestation of concealed tuberculosis infection. It is most common in developing countries like India. It is possible that the individual suffering from Scrofuloderma may not have underlying tuberculosis however, the patient may have come in contact with a tuberculosis patient in the past and due to his/her immunocompromised state the disease manifests. Here, we describe the case of a four-year-old boy presented to the Outpatient Department (OPD) with all the classical sign and symptoms of tuberculosis as low-grade fever, multiple ulcerated nodules at the site of lymph nodes over the neck, axillae, anterior chest wall and inguinal region with history of rupture and extensive crusting. On the basis of presentation and examination the differential diagnosis was made in which Scrofuloderma was first listed. To confirm the diagnosis all the relevant investigations were advised in which Mantoux test, Erthrocyte Sedimentation Rate (ESR) came positive and chest X-ray revealed old resolved tuberculosis. After correlating, clinical findings and laboratory investigations a confirmed diagnosis of scrofuloderma was made and the patient was treated with standard Antitubercular Treatment (ATT). After the completion of standard prescribed period of treatment and specific puckered healing of the ulcerated lesions again confirmed the diagnosis. The aim of reporting is presentation of lesions as superficial bacterial infection and healed old tuberculosis.

Lymphangioma Circumscripta- A Diagnostic Dilemma

Priyanka Rastogi, Sachin Kumar, Dipen Majumder, Rudra Bhardwaj, Deveshi Nigam

Lymphangiomas are developmental malformations that present as benign hamartomas of lymphatic channels. They present at birth or before two years of age, with 50-70% predilection for the head and neck region and less frequently reported in the oral cavity. However, affected sites in the oral cavity include the tongue, palate, gingiva, buccal mucosa, lips and alveolar ridge. Lymphangioma of the buccal mucosa is rare, only 27 cases of lymphangioma of buccal mucosa have been reported till date, out of which seven were in children. The prognosis is good for most patients, but recurrence has also been reported in some cases. This present case is of Lymphangioma Circumscriptum in a 13-year-old female patient involving right buccal mucosa and lip since birth. This lesion was surgically removed under general anaesthesia and there was a recurrence of the lesion after one year of follow-up. In the literature there was no reported case of Lymphangioma Circumscriptum involving the lip of a child, so this present case was the first reported case of Lymphangioma Circumscripta involving the lip in a child with recurrence.

Secondary Bloodstream Infection caused by Streptococcus pneumoniae Primary Source either from Respiratory Pneumonia or Pneumococcusuria: A Case Report

G Vaishnavadevi

Streptococcus pneumoniae (S. pneumoniae) is one of the bacterial aetiologic agent in otitis media, Community Acquired Pneumonia (CAP), meningitis and septicaemia. Bacteriuria is the isolation of the microorganisms as ≥105 Colony-Forming Unit (CFU)/mL in association with clinical signs of Urinary Tract Infections (UTIs) and urinalysis. However, the isolation of S. pneumoniae in urine specimen is a rare event as it can only survive in environment for several hours in pH between 5 to 6 has short duration between collection of the urine sample and culture, and due to immune clearance mechanism. The primary source of infection originates from distant sites such as respiratory tract. The predisposing factors include immunosuppression and asplenia leads to UTI. The literature details showing lack of information regarding S. pneumoniae as a cause of UTI. Present case report describes S. pneumoniae isolate in the blood and sputum specimen from 53-year-old male presented with fever, shortness of breath, cough with chest pain and mild clinical symptoms of UTI.

Cervical Epidural Anaesthesia in a Patient with Ebstein’s Anomaly requiring Total Thyroidectomy

Geetha Soundarya Udayakumar, Hannah Mounika Nunna

Ebstein’s anomaly is a congenital malformation of the tricuspid valve with myopathy of the right ventricle leading to dilatation and atrialisation of the right ventricle, with varying degrees of malformation along with restriction of diastolic filling of ventricles. Disease severity in Ebstein’s anomaly can range from asymptomatic patients to severe debilitating disease. These patients are at increased risk of developing ventricular and supraventricular tachycardia, congestive cardiac failure and death. This case report is about a 37-year-old female with Ebstein’s anomaly who presented with atrial fibrillation and right-sided heart failure. She successfully underwent total thyroidectomy under cervical epidural anaesthesia.

Ovarian Carcinoma Presenting as Meigs’ Syndrome- A Rare Case Report

Francis Ankita, K Sahana, Sabarinath Ravichandar, G Jishna

Presence of fluid and air within pleural space is known as hydropneumothorax. A large proportion of patients present with shortness of breath, dry cough and pricking type of pleuritic chest pain as a result of pleural involvement. However, fever and constitutional symptoms like loss of appetite and loss of weight is most likely associated with tuberculosis. Meigs’ syndrome is a triad of ascites, hydrothorax and benign ovarian tumours (ovarian fibromas and fibrothecomas). Pseudo-Meigs’ syndrome shows accumulation of ascites, pleural effusion and associated with a pelvic or abdominal tumours. Here, is a case report of a 62-year-old postmenopausal female, who presented with right pleuritic chest pain and breathlessness, since one week. Chest radiograph showed right-sided hydropneumothorax which required an intercostal drainage tube insertion. Upon further evaluation, the primary unknown cancer was found to be of ovarian origin.

Metastatic Prostate Carcinoma Masquerading as Primary Sphenoid Sinus Tumour: A Case Report

Lincy Joseph, Jassal Mathew, KP Nabeela

Metastasis from prostate adenocarcinoma to Paranasal Sinuses (PNS) is extremely rare. Usually, they metastasise to the pelvic lymph nodes and bones of the axial skeleton. Authors hereby, present a case of a 71-year-old male patient with diplopia on left lateral gaze and frontal headache since two months. On examination, he had left lateral rectus palsy. Computed Tomography (CT) Brain was normal. Computerised Tomography of Paranasal Sinuses (CT PNS) and Magnetic Resonance Imaging (MRI) brain revealed an ill-defined isodense lesion causing clival erosion and extending anteriorly to the sphenoid sinus. The patient underwent endoscopic endonasal trans-sphenoidal excision. The histopathological diagnosis was adenocarcinoma. Immunohistochemistry (IHC) was done for further evaluation which showed both CK7 and CK20 to be negative. Hence, sinonasal carcinoma was excluded and possibility of metastatic tumour was considered. Ultrasonography (USG) abdomen was normal and further IHC showed Prostate-Specific Antigen (PSA) positivity. Elevated serum PSA and Positron Emission Tomography (PET) scan confirmed primary carcinoma prostate with multiple skeletal metastases. The patient was treated with a Gonadotropin-Releasing Hormone (GnRH) antagonist and an antiandrogen which showed good response. So, the possibility of metastasis from an occult primary prostate carcinoma was considered as the differential diagnosis in an elderly patient presenting with sinonasal mass. Hence, proper screening and IHC studies are mandatory for accurate diagnosis and treatment.

Creeping Bugs and Winding Rash-Series of Cutaneous Larva Migrans Cases from Southern Suburban Chennai, Tamil Nadu, India

SR Sree Shyamini, Alexander Mannu, Sunitha Ramasamy, Jaishree Vasudevan

Cutaneous Larva Migrans (CLM) is caused by penetration of skin by the third stage larvae of hookworms, and most commonly caused by Ancylostoma braziliense (dog hookworm). Humans act as dead-end hosts for this parasite. This series reports six cases of creeping eruptions that occurred on buttocks and back in four infants and on the feet in two toddlers. All the cases clustered after the rainy seasons in the months of December and January. Diagnosis was established based on history and clinical examination. All six children were administered five days of albendazole and they recovered completely. This series is presented to make readers aware of the underestimated public health problem in infants with distinctive skin eruptions of larva migrans occurring in the tropical subcontinent of Indian coastal areas. This is clinically relevant as treatment of this condition is very simple and cost-effective.

Retrospective Analysis of Otorhinolaryngology Related Elective Surgeries Performed in a Tertiary Care Centre, North Kerala, India

E Muhammed Afsal, R Suma

Introduction: Due to a better understanding of the disease process, surgical workshops, conferences, and better patient awareness, the trend of Ear Nose Throat (ENT) related surgeries has changed significantly over the years. Aim: To analyse the profile of various ENT-related elective surgeries performed over three years in a tertiary care centre. Materials and Methods: This retrospective observational study was conducted in the Department of ENT, in a tertiary care centre, North Kerala, India. Patients of both sexes and of all age groups who underwent elective ENT surgeries in the Department from January 2017- December 2019 were included in the study. Data analysis was done from 1/12/2020 to 1/6/2021 period. Emergency surgeries were excluded from the study. Data was collected from hospital records and analysed using appropriate statistical methods. Results: A total of 2895 patients underwent various major and minor procedures in the period of January 2017 to December 2019 in the study institute. The majority of procedures were tympanomastoid surgeries (n=896, 30.94%), which were followed by sinonasal surgeries including advanced endoscopic surgeries (n=670, 23.14%), tonsilloadenoid surgeries (n=550, 18.98%) and excision of various solid and cystic lesions from head and neck region (n=310, 10.70%). The remaining number contributed by various other procedures like laryngeal surgeries (n=99, 3.4%) and other miscellaneous procedures (n=370, 12.78%) which include preauricular sinus excision, punch biopsies, tongue tie release, styloidectomy, excision of rhinosporidiosis from nose and nasopharynx, nasal bone fracture reduction and young’s operation. Conclusion: The most common elective procedures performed in the study period were tympanomastoid surgeries. In the present study, there was an increasing trend of all major and minor surgeries in the department in subsequent years.

Comparison of Resistance to Fracture of Endodontically Treated Teeth Reinforced with Various Posts: An In-vitro Study

Sajani Ramachandran, Suresh Babu, Manikandan, Ranukumari

Introduction: Endodontically treated tooth reinforced with posts should restore its lost structural integrity, as well as withstand the various masticatory forces. Choosing the appropriate post, so that a durable prosthesis can be given, is often a challenge to a restorative dentist. Aim: To compare the resistance to fracture, of endodontically treated teeth restored with the various posts when subjected to compressive loads, and analyse the different types of fractures and cracks which are visible under normal eye, microscope and radiograph. Materials and Methods: An in-vitro study was conducted in the Department of Dentistry, Pondicherry Institute of Medical Sciences, Puducherry, India, from February 2019 to March 2020. Study was done with four types of posts namely cast post, stainless steel, fibre and titanium on seventy extracted teeth, which were randomly allocated into five groups with one group as control without any post. The teeth were subjected to increasing compressive loads with universal testing machine and the loads at which fracture occurred was recorded. The data was analysed statistically with one way Analysis of Variance (ANOVA) and the groups were compared with Tukey’s Honestly Significant Difference (HSD) test. The types of fractures that occurred were also analysed. Results: The loads at which the teeth reinforced with various posts fractured, showed significant difference (p-value <0.0001). The mean load at which fracture occurred for teeth restored without any posts was 711.6086 N and teeth with stainless steel post was highest at 1605.955 N. Those with titanium posts were found to have minimum microcracks (14.2%) when seen under dissection microscope. Maximum number of teeth with titanium posts had favourable fracture and withstood the load (64.29%), with fracture occurring only at root tip and no fracture elsewhere. Tukey’s HSD test was done to compare the fracture resistance between the groups and there was no significant difference in the load at which fracture occurred between groups. Conclusion: In the present study, of all different post and core materials, stainless steel post resisted highest load and titanium posts had favourable fractures.

Role of Dermal Ridge Patterns in Prediction of Periodontal Disease- A Cross-sectional Study

Introduction: Periodontitis is a chronic inflammatory disease which affects the supporting tissues of the teeth and was initially thought to be environmental in origin. The difference in the disease prevalence among the population could not be attributed to environment alone. Limited studies have been done on diagnosing the future occurrence of periodontal diseases by recording the fingerprint patterns of the patients. Aim: To evaluate the relationship between fingerprints patterns existing among patients with plaque induced gingivitis, chronic localised and generalised periodontitis. Materials and Methods: This was a cross-sectional observational study, carried out over a period of 6 months from January 2022 to July 2022 at Rajas Dental College and Hospital, Kavalkinaru, Tamil Nadu, India. Subjects were equally divided into three groups including 100 patients under each group: Group I as plaque induced gingivitis, group II as localised chronic periodontitis and group III as generalised chronic periodontitis based on 1999 classification system. The fingerprint patterns observed were loops, whorls and arches. The fingerprint patterns were compared within the group and also between the three groups. Boneferroni test and Analysis of Variance (ANOVA) test were used for statistical analysis. Results: Total of 300 patients were included in this study, out of which 175 were males and 125 were females with the mean age 34.16±1.33 years. On comparison of the fingertip patterns within the groups, a significantly equal distribution of whorl and loop patterns with a value of 4.950±3.10 and 4.750±3.09 respectively were found among the group I subjects. A significantly increased prevalence of whorls with a value of 5.300±3.37 was found in group II subjects and significantly increased prevalence of loop pattern with a value of 5.800±2.72 was found among group III subjects. The arch pattern was more in group II and group III when compared to group I with a value of 1.450±2.21 and 1.200±1.33, respectively. Conclusion: It was concluded that a strong association between fingerprint patterns and chronic periodontitis existed. The present study proved that dermatoglyphics can be used as a powerful tool for early prediction and better prevention of periodontitis.

Serum miRNA-30a-5p in Steroid Sensitive Idiopathic Nephrotic Syndrome in Indian Children: A Case-control Study

Introduction: Childhood Nephrotic Syndrome (NS) is a podocytopathy. Micro Ribonucleic Acid (miRNA), composed of 21-25 non coding nucleotides, regulates gene expression by inhibiting protein transcription by binding to complementary messenger RNA. The microRNA-30a is expressed in the human glomerular podocytes and collecting ducts. This microRNA protects the podocytes by targeting the Calcineurin-nuclear Factor of Activated T cells (NFATc) pathways. Serum microRNA-30a-5p is a validated biomarker which is upregulated in NS. Aim: To determine the serum miRNA-30a-5p in steroid sensitive idiopathic NS in Indian children. Materials and Methods: This case-control study was conducted at the Department of Paediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India, from from January 2018 to June 2019. Thirty children with NS and age and gender matched controls were recruited. Relative expression of microRNA-30a-5p was analysed by Real-Time quantitative Polymerase Chain Reaction (RT-qPCR). Estimations were done both in cases and controls at enrollment and also at four weeks when in remission in cases. The fold change was calculated as a power of cycle threshold. Statistical tests Kolmogorov-Smirnov test was used to establish the normality using Statistical Package for Social Sciences (SPSS) version 22.0. Results: There was upregulation of microRNA-30a-5p expression among children with NS with a significant fold change (~184) at enrollment. The levels declined, but remained above baseline (~6) after four weeks of treatment when compared to controls. The mean differences in delta threshold cycle and threshold cycle between the three groups were significant (p<0.001). There was no correlation with the biochemical parameters. Conclusion: The present study concludes that serum microRNA-30a-5p expression is upregulated in children with steroid sensitive NS in Indian children.

Immunohistochemical Expression Profile of SATB2 in Colorectal Adenocarcinoma and Association with Clinicopathological Parameters

M Suvaitha, CD Anand, Jaison Jacob John

Introduction: Colorectal carcinoma is the third most common cancer worldwide. Several clinicopathological parameters act as prognostic factors in colorectal carcinoma, but only a few are helpful in predicting the treatment outcome. Therefore, there is a need for better prognostic markers which also aids in assessing treatment benefits in colorectal carcinoma patients. Special AT Rich Sequence Binding Protein 2 (SATB2) is a highly specific marker for colorectal tissue. Decreased expression of SATB2 is also associated with poor prognosis in colorectal carcinoma. Aim: To analyse the histomorphology, immunohistochemical expression profile of SATB2 and association with clinicopathological parameters in colorectal adenocarcinoma. Materials and Methods: The cross-sectional study included 84 cases of colorectal carcinoma received in the Department of Pathology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India, in the period between April 2021 to September 2022. Both biopsy and resected specimens were included in the study. Relevant clinical data was collected. Histological diagnosis, grading and staging of the tumour was done using Haematoxylin and Eosin (H&E) slides as described and tabulated. Immunohistochemistry (IHC) for SATB2 was done and expression profile compared with the clinicopathological parameters to assess prognostic significance. Data was analysed using software-Statistical Package for Social Sciences (SPSS, version 23.0). Results: Out of the 84 cases, 42 were biopsy and 42 were resected specimens. Mean age of the patients in the study was 57.9 years. Patients were predominantly males (n=51, 60.7%) with a male:female ratio of 1.54:1. Of the 84 cases, 40.5% (n=34) had tumour located in the rectum. Majority of the cases were moderately differentiated adenocarcinoma (n=48, 57.1%). Predominantly, stage III tumours (n=33, 39.3%) were noted. Out of the tumours showing decreased expression of SATB2, 55% (n=22) were left-sided tumours, metastasis was seen in 60% (n=24 cases), 37.5% of cases (n=9) showed lymphovascular invasion, and 55% (n=22) had a stage III tumour. Conclusion: The present study results indicate that a decrease in SATB2 expression is associated with presence of lymphovascular invasion, perineural invasion, regional and distant metastasis and a higher pathological stage which signifies poor prognosis in colorectal carcinoma. These aid the physician for risk stratification of patients and enable personalised treatment choices including adjuvant chemotherapy in high-risk groups.

Improvement in Visual and Auditory Reaction Time with Reduced Detraining Effects of Yogic Breathing Manoeuvers- A Non Randomised Controlled Study

Uday Sankar Ray, Gopinath Bhowmik Bhunia

Introduction: Earlier, different components of yoga i.e., asanas (static physical postures), Yoga Breathing Manoeuvers (YBM) and meditation were reported to have different magnitude of effects on reaction time. YBM showed greater magnitude of effects on Visual Reaction Time (VRT) and Auditory Reaction Time (ART), than that of asanas in different groups of subjects. So, to observe the effect of different proportions of asanas and YBM in a yoga program on reaction time, with its possible applications in training and in detraining management, the study was undertaken. Aim: To study the effects of asanas and YBM in different proportions on VRT and ART among the same subjects to explore the magnitude of its effects for applications in training and detraining management. Materials and Methods: This interventional non randomised controlled study was conducted in the Department of Sports Science and Yoga, Ramakrishna Mission Vivekananda Educational and Research Institute, Belur Math, West Bengal, India, from July to September 2019 on 32 healthy male, undergraduate student volunteers in the age group of 19-21 years. Subjects were divided into two groups i.e., Yoga Group (YG) and Control Group (CG). CG did not practice yoga. YG practiced yoga for 45 minutes daily, six days per week for 12 weeks. Total time of practicing YBM gradually increased every week. For the first two weeks, it was a session of 45 minutes and from 3rd week YBM was increased by one to two minutes every week up to 6th week. Then, at 7th week it increased by eight minutes. From 8th week to 10th week it increased by one to two minutes in every week. On 11th and 12th week it increased 10-12 minutes on average. Up to 6th week they practiced mostly all asanas. From the 7th week to 12th week mostly YBM were practiced. Thus, at the end of 6th and 12th week, effect of greater duration of mostly all asanas and YBM, respectively were available. Measurements of VRT and ART were taken by ‘Audio-visual reaction timer’, at baseline, 6th week and 12th week end of training on both groups. Study design helped to observe separately the effect of greater duration of asana and YBM practice on same group of subjects. Intragroup and intergroup comparisons were done by repeated measures of Analysis of Variance (ANOVA) and unpaired t-test, respectively. Results: Both YG and CG had similar age, body weight and body fat percentage and activity pattern. So, groups were homogeneous in nature. VRT and ART were improved significantly (p-value <0.001) by greater practice of asanas for six weeks. Similarly greater YBM practice on subsequent six weeks showed further improvement (p-value <0.001) in both parameters, which even masked the natural detraining effects of these parameters due to withdrawal of asana practice, which was reflected in the magnitude of improvement (as obtained from the percentage calculation from difference of mean values between two time points like baseline to 6th week end) at the 6th week end (VRT: 7.4%, ART: 7.8%) as compared to that of 6th to 12th week end (VRT: 10.4%, ART: 11.6% ). YG showed significantly (p-value <0.001) faster VRT and ART than those of CG at the 6th and 12th week end. Conclusion: Judicious selection of the proportion of asanas, YBM and meditation in a yoga program, optimise Central Nervous System (CNS) arousal with better VRT and ART. YBM helped to reduce detraining effects of reaction time due to the curtailment of asana practice. This might have application in any training and also to counteract detraining effects in sports and among recuperative patients.

Functional Ability and Quality of Life Status following Manual Therapy and Specific Exercise Conditioning in Subacromial Impingement Syndrome: A Randomised Controlled Study

Kanthanathan Subbiah, Srinivasan Rajappa, AS Subhashini, Sailakshmi Ganeshan

Introduction: Subacromial Impingement Syndrome (SIS) is a common shoulder problem that leads to considerable functional loss and a decline in Quality of Life (QoL). Conservative treatment is the first line of management, often multimodal where physiotherapy is commonly recommended. But limited information is available regarding the combined effect of various treatments. Aim: To evaluate the combined effect of manual therapy and specific exercise conditioning in improving function and QoL among patients with SIS and also to compare with the conventional therapy. Materials and Methods: This single-blinded randomised controlled study was conducted in the rehabilitation center, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India, from January 2017 to February 2020. A total of 126 subjects were recruited and randomly allocated into two groups: Group 1 (n=63) received manual therapy and eccentric exercise, Group 2 (n=63) received conventional exercise, spread over three weeks followed by a home program for another nine weeks. Regional and self-rated functional limitations were obtained using the Shoulder Pain and Disability Index (SPADI) and Patient Specific Functional Scale (PSFS) at baseline, after 10 sessions of treatment and follow-up at 12 weeks with other clinical outcomes. A Short Form Health Survey (SF 36) was used to obtain QoL status at baseline and follow-up at 12 weeks. Data were analysed using one-way Analysis of Variance (ANOVA) and unpaired t-test. Results: The mean age was 45.02±10.30 years and 45.12±11.42 years in groups 1 and 2, respectively. Male to female ratio was 25:21 and 30:21 in groups 1 and 2, respectively. All outcomes improved by three weeks and during follow-up at 12 weeks in both groups (p-value <0.00001 and p-value <0.0005, respectively). However, on between group analysis significant improvement was observed with pain intensity (p-value <0.0005), range (p-value <0.05), external rotator strength (p-value=0.016) and PSFS score (p-value=0.014) by three weeks. External rotator strength (p-value <0.0005), SPADI (p-value <0.0005), PSFS (p-value=0.035), physical (p-value=0.008) and mental (p-value=0.006) cumulative scores of SF 36 had significant improvement in group 1 during follow-up at 12 weeks. Conclusion: The combined effect of manual therapy and specific exercise conditioning improved regional, self-rated functional ability and QoL among individuals with SIS.

RDW as a Prognostic Marker of Sepsis and its Comparison with APACHE II Score: A Prospective Observational Cross-sectional Study

Ajeet Kumar Chaurasia, Poonam Gupta, Manoj Kumar Mathur, Vipin Pandey

Introduction: Sepsis is one of the most important and common cause for Intensive Care Unit (ICU) admission. Life-threatening organ dysfunction is caused by a dysregulated host response to infection. Clinical scoring system is cumbersome for prognosticating sepsis outcome. Red cell Distribution Width (RDW) is a part of routine investigation done in the form of Complete Blood Count (CBC), inexpensive and easily available. Aim: To evaluate RDW as a prognostic marker of sepsis and its comparison with APACHE II (Acute Physiology and Chronic Health Evaluation II) score. Materials and Methods: The present study was a prospective observational cross-sectional study was conducted at MLN Medical College and associated Swaroop Rani Nehru Hospital, Prayagraj, Uttar Pradesh, India, which included 110 patients diagnosed with sepsis. The patients were divided into survivors and non survivors group. CBC, liver function test, kidney function test, serum electrolytes, Arterial Blood Gas (ABG) analysis, blood culture, site-specific culture were done and APACHE II was calculated. Results: Out of the 110 patients enrolled in the study, 61 were males and 49 were females. Mean±SD age of the non survivors (n=42) was 57.45±22.93 years and that of survivors (n=68) was 58.59±17.18 years. APACHE II score in the non survivors was 18.50±6.80 while that among the survivors was 10.51±6.61 (p<0.001). RDW in the non survivors was 17.62±4.29 while that in the survivors was 13.99±1.66 (p<0.001). Conclusion: The RDW was found to be significantly higher in non survivor group as compared to survivor in this study. So RDW at admission can be used as simple, easy to perform prognostic marker of sepsis.

Morphological and Distribution Pattern of Calcifications on Full Field Digital Mammography versus Digital Breast Tomosynthesis and Comparison of Diagnostic Abilities of the Two Modalities: A Retrospective Study

Neha Singh, James Marak, Pranjali Joshi, Deepak Kumar Singh

Introduction: Microcalcification (MC) is an effective and sometimes the only indicator of breast cancer. Early detection and characterisation of malignant MC can facilitate early diagnosis and timely treatment of breast cancer. However, due to the small size and low contrast as compared to the background parenchyma, it is difficult and time-consuming for radiologists to accurately evaluate MC. Aim: To compare the diagnostic abilities of Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT) in the detection and characterisation of breast calcifications. Materials and Methods: This retrospective descriptive study was conducted in the year 2022 at the breast imaging unit of Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India and data of patients who had undergone FFDM and DBT between March 2019- September 2020 was collected. Mammograms of 702 women with 1217 breasts were evaluated and MC was detected in 622 breasts. Based on the morphology and distribution pattern, Breast Imaging Reporting and Data System (BI-RADS) assessment Category was assigned from 2-5. Cases with BI-RADS 2 and 3 were followed-up by repeat Mammograms at 6-month to 1-year intervals. Cases with BI-RADS 4 and 5 were biopsied under stereotactic or ultrasound guidance. Histopathology findings and the stability of the calcifications on sequential mammograms were considered the gold standard for final BI-RADS categorisation. The Chi-square test was applied for the comparison of FFDM and DBT. Results: Typically benign morphology MC was noted in 508 (81.67%) of breasts on FFDM and 505 (80.67%) on DBT. Suspicious morphology MC was noted in 114 (18.33%) of breasts on FFDM and 121 (19.33%) on DBT. Vascular calcification was the most common benign MC seen in 233 cases (37.45%) on FFDM and 244 cases (38.9%) on DBT. Similarly, fine pleomorphic was the most common suspicious morphology MC on FFDM and DBT both seen in 47 cases (7.5%) and 44 cases (7.02%), respectively. The most common distribution pattern was diffuse seen in 582 cases (93.56%) on FFDM and 583 cases (93.13%) on DBT, respectively. No significant difference was observed (p=0.283) in the rate of detection or characterisation of MC by FFDM or DBT. The sensitivity of both modalities were almost similar (97.7% and 97.9%) without any significant difference (p=0.278). Similarly, there was no difference in the specificity (94.9% and 94.4%, respectively, p=0.289). Conclusion: According to the observation of the present study the performance of FFDM and DBT for the detection and characterisation of MC was not significantly different.

Effectiveness of Fitness Testing for Assessment of Male Basketball Athletes- A Cross-sectional Study

Amita Aggarwal, Chaitanyaa Wani, Yash Jaiswal

Introduction: Basketball players should have physical characteristics which include sports-specific skills and demands. Activities including sprinting, and jumping require abilities with speed, power, strength, and agility. These have to be evaluated using fitness tests which help in having a good impact on the game. Assessment of their performance will be helpful for designing and monitoring the efficacy of basketball athletes’ training regimes. Aim: To assess the body composition and fitness tests specific to cardiorespiratory fitness, upper and lower limb strength, endurance, flexibility and agility in 20-29 years male basketball players. Materials and Methods: It was an observational cross-sectional study which was conducted on 30 male basketball players in Dr. DY Patil Medical College, Pune, Maharashtra, India from June 2017 to December 2017. Participants were assessed for specific fitness tests conducted in two days. Agility, upper extremity strength, lower extremity endurance including flexibility, was tested on the first day, followed by body composition, cardiorespiratory fitness, upper extremity endurance and lower extremity strength on another day. Results: The mean age of the male basketball players was 21.8 years. The mean Body Mass Index (BMI) was 22.53 Kg/m2. It showed a poor (35.58±4.80) cardiorespiratory fitness using the Beep Test. For the upper limb, there was poor flexibility (13.01±3.45). However, the lower limb endurance (60.33±19.80) and agility (12.08±0.66) showed excellent results. Conclusion: The study concluded that lower extremity fitness was better than upper extremity in male basketball players.

Sleep Disorders and Attention-Deficit/Hyperactivity Disorder in Children: A Hospital-based Observational Study from a Regional Early Intervention Centre in Kerala, India

Shafiq Ahamed Mohamed Ismail, Fabina Abdul Gafoor

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most extensively studied neurobehavioural disorders of childhood. The association of sleep disorders with ADHD is multidimensional, and understanding them is important in effectively managing patients with ADHD. Aim: To examine the presence of sleep disorders in children with ADHD, to correlate it with parameters of age and ADHD subtypes, and to find out the association between sleep disorders and other socio-demographic, and clinical factors. Materials and Methods: The study sample of this hospital-based observational study consisted of 70 subjects who presented to the Regional Early Intervention Centre (REIC), Thrissur, diagnosed with ADHD based on Diagnostic and Stastistical Manual of Mental Disorders (DSM)-5 criteria and belonging to the age group 5-16 years. Subjects were interviewed using a structured questionnaire to assess socio-demographic and clinical details. The ‘Sleep Disturbance Scale for Children’ (SDS-C) was used to assess sleep disorders in children. The information thus obtained was analysed using SPSS software version 23. Results: Out of the 70 subjects with ADHD, 49 (70%) had sleep disorders. The mean age of study population was 8.66±2.72 years, and the male:female ratio was 4:1. There was co-morbid behavioural disorder in 32 subjects (45.7%), and parental history of ADHD in 33 subjects (47.1%). There was a significant association between sleep disorders and behavioural disorders (p-value=0.003) and parental history of ADHD (p-value=0.042). There was a significant negative correlation between age and sleep disorder (p-value=0.033). Conclusion: The prevalence of sleep disorders in ADHD is high in the study population. The relationship between sleep disorders and the presence of co-morbid behavioural disorders in ADHD suggests that recognition and management of sleep disorders may require more attention. The association between sleep disorder and parental history of ADHD may enhance the understanding of genomic variants associated with ADHD.

Effectiveness of Minocycline in Multidrug Resistance Gram Negative Bacilli: A Cross-sectional Study

Gunasekaran Santhi, Palraj Kennedy Kumar, Kopula Satyamoorthy Sridharan

Introduction: Antibiotic resistance is a global public health threat and remains a challenge for the physicians. Due to increased incidence of resistance to the commonly prescribed antibiotics, a newer drug or a re-emerge of an older class of antibiotic will be a choice of treatment of the Multidrug Resistant (MDR) organisms. Aim: To determine the effectiveness of minocycline in MDR gram negative bacterial isolates by determining its Minimum Inhibitory Concentration (MIC) and to compare its effectiveness with imipenem and meropenem. Materials and Methods: A cross-sectional periodical study was conducted during May 2016 to May 2017 using 150 non repetitive MDR gram negative bacterial isolates recovered from various clinical specimens sent to Central Laboratory, Department of Microbiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Porur, Chennai, India. All the isolates were subjected for antibiotic susceptibility testing by disc diffusion method for the routine antibiotics and MIC determination by Epsilometry test (E-strip) for minocycline and meropenem and interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2016. Statistical analysis was calculated with Open Epi using two by two table version 3.01. Results: Out of the 150 study isolates minocycline was susceptible in 105 (70%) followed by imipenem and meropenem both susceptible for isolates 94 (62.7%). Minocycline was also susceptible among the 79 (84%) out of 94 of meropenem susceptible strains with a statistically significant p-value of <0.05. Similarly 26 (46.4%) out of 56 of meropenem resistant strains were susceptible for minocycline which was also statistically significant with a p-value <0.05. Conclusion: Considering the cost of treatment with colistin which is the choice of treatment for carbapenemase producing gram negative bacteria’s, minocycline can be considered as it is cheaper and less toxic. The possibility to switch from injectable to oral formulation is also possible with minocycline and so can also be considered as an alternative for colistin in such conditions.

Perception and Attitude towards Passive Euthanasia among Doctors in a Tertiary Care Hospital in Northeast India: A Cross-sectional Study

RS Devandiran, Akoijam Brogen Singh, Pukhrambam Romola, Chibi Rushitha

Introduction: The medical fraternity now has more control over the processes of life and death due to advances in medical technology and equipment. Euthanasia has been debated around the world for more than half a century and it continues to raise important questions in medical ethics, moral theology, civil rights and liberty. Physicians’ attitudes to life and death emerge to relate their end-of-life decision-making, although usually carried out at the request of ailing person. Physicians’ contemplation on euthanasia is a vital building block in the path towards any change, in the euthanasia situation in a country. Aim: To determine perception and attitude towards passive euthanasia among doctors and to evaluate the association between attitude and variables favourable to passive euthanasia. Materials and Methods: A cross-sectional survey in the Regional Institute of Medical Sciences (tertiary care hospital), Manipur, India, between October 2018 and September 2020, in Northeast was carried out among 673 doctors. A self-administered questionnaire was designed and approved by three specialists with expertise in palliative care and medical ethics. The questionnaire had a total of 46 questions in English language, of which 15 questions were on socio-demographic profile, 13 were attitude questions and 18 were questions on perception towards passive euthanasia. Attitude questions were scored using 5-point Likert scale from strongly disagree (-2) to strongly agree (+2). Total attitude score ranges from -26 to +26. Score above zero was considered to have positive attitude and vice-versa. There was no scoring to determine perception towards euthanasia. The questionnaires were given to the doctors and postgraduate trainees of clinical and non clinical specialities in a tertiary care hospital in North Eastern India during their work hours. Data were summarised using descriptive statistics. Chi-square test was used to assess factors favouring attitudes toward passive euthanasia. Results: Age of the respondents ranged from 24 years to 63 years, with a mean age of 37.1±10.7 years and mean duration of experience was eight years. Out of 577 respondents, 368 (63.8%) were postgraduate trainees and 209 (36.2%) were doctors. Majority 463 (80.2%) of the respondents had positive attitude, 97 (16.9%) had negative attitude and 17 (2.9%) had neutral attitude. Total 543 (94.1%) respondents agreed that declaration from patient/family members must be obtained before the act of passive euthanasia. Also, the quality of life as viewed by the patient himself (452, 78.3%) and humanitarian basis (372, 64.4%) were the important factors in influencing decision making regarding passive euthanasia on a terminally ill patient. There was no significant association between sex, age, religion, working category, specialisation, Intensive Care Unit (ICU) experience and attitude towards passive euthanasia. Conclusion: Majority of the respondents had positive attitude towards passive euthanasia in the face of intractable suffering and terminal illness. Hastened death looks easier to the patients and family because of physical suffering and financial burdens they are subjected to. The doctors got request for euthanasia by the patients and relatives which reflects the public awareness on euthanasia.

Shoulder and Upper Arm Surgery Anaesthesia with Interscalene Approach of Brachial Block and Sedation versus Same Method Adjunct with Additional Suprascapular Nerve Block: A Randomised Controlled Study

Introduction: Interscalene Brachial Plexus Block (ISBPB) provides optimal analgesia for shoulder and upper arm surgery. However, higher incidence of phrenic nerve palsy limits the application of ISBPB for patients with limited pulmonary reserve. The Supplemented Suprascapular Nerve Block (SSNB) is a landmark based technique that is believed to block the sensory fibres supplying major part of shoulder joint, as well as, supraspinatus and infraspinatus muscles. Aim: To compare the analgesic effect and duration of sensory block in interscalene versus interscalene with SSNB block for shoulder and upper arm surgery. Materials and Methods: This double-blinded randomised controlled study was conducted in a Tertiary Care Institute, from April 2021 to March 2022. Eighty patients posted for shoulder and upper arm surgery were divided into two equal groups (group A and B). In group A (n=40), 30 mL 0.5% levobupivacaine in ISBPB and in group B (n=40), 15 mL 0.5% levobupivacaine in ISBPB+15 mL 0.5% levobupivacaine in SSNB were administered. Demographic data, sensory and motor block, onset times and durations, time to administer first rescue analgesic, total analgesic requirement, indications of upper arm surgeries, surgical bleeding and surgeon’s satisfaction score, postoperative Visual Analogue Scale (VAS) score were recorded for each patient. Results: The onset and duration of sensory and motor block was significantly faster and longer in group B. Consequently, time to administer first rescue analgesic in group A vs group B (325.88±33.23 vs. 348.34±37.12, respectively) minutes were significantly delayed and lesser in amount in group B. On the other hand, suprascapular block reduced the odds of block-related respiratory (group A vs group B are 14 and 10, respectively) complications. In group B postoperative VAS score at 24 hour was significantly lower (p-value <0.05) than group A was (3.5 vs 4.5). Intraoperative haemodynamic parameters were comparable among two groups throughout the study period. Conclusion: SSNB when supplemented with Interscalene Block (ISB) could be an effective adjunct for shoulder and upper arm surgery. This combination prolongs the sensory blockade duration, reduces requirement of analgesics and side-effects in postoperative period.

Green Synthesis of Terminalia Arjuna-mediated Hydroxyapatite Nanoparticles, Its Morphological Assessment and Evaluation of Cytotoxic and Antioxidant Properties: An In-vitro Study

Seerab Husain, Shantha Sundari, Ravindra Kumar Jain, S Rajesh Kumar

Introduction: Terminalia Arjuna (TA) has been used in the field of ayurvedic and unani medicine for quite some time now. It has been shown to possess several medicinal properties. Literature has highlighted the osteoinductive properties of TA and has been extensively been used for its fracture healing and bone forming potential. This would have a positive impact in the field of periodontics and orthodontics, which require bone grafts to maintain ideal periodontal conditions. Aim: To synthesise TA-mediated Hydroxyapatite Nanoparticles (TA-HApNPs) and subject it to morphological assessment and evaluate its cytotoxic and antioxidant properties. Materials and Methods: This in-vitro study was done under a laboratory setting within the city of Chennai, Tamil Nadu, India, extending for a period of one month from April 2022 to May 2022. A 1 g of TA plant bark was mixed with 100 mL distilled water and heated to derive the plant extract. A 20 mL of distilled water was mixed with 0.502 g of Hydroxyapatite (HAp). An 80 mL of TA extract was mixed with 20 mL of HAp solution. The mixture was placed in a magnetic stirrer and was subjected to an Ultraviolet Visible (UV-Vis) double beam spectrophotometer. The solution was dried and was subjected to Transmission Electron Microscope (TEM) analysis for morphological characterisation, 2,2-Diphenylpicrylhydrazyl (DPPH) assay for the assessment of antioxidant properties and brine shrimp lethality test to evaluate its cytotoxic properties. The results were obtained electronically, tabulated in a spreadsheet and were subjected to descriptive statistics using Microsoft excel 2019 Management Services Organisation (MSO) (Version 2202; Build 16.0.14931.20118). Results: The UV-Spectroscopy revealed a sharp peak at 375 nm wavelength suggesting Nanoparticle (NPs) formation. Spherical shaped NPs with size ranging from 5-25 nm were seen under the TEM. At concentration of 48 μL also TA-HApNPs elicited good cytotoxicity as seven out of 10 brine shrimps were alive at the end of 24 hours. Good antioxidant properties at 50 μL concentration with a DPPH assay reading of 1.044 was noted. Conclusion: The TA-HApNPs can be synthesised using simple and routinely used laboratory armamentarium in the size range of 5-25 nm. TA-HApNPs have minimal cytotoxic effect and a good antioxidant activity.

Association of Adverse Events Following Immunisation with COVID-19 Vaccine and Lifestyle of Individuals: A Cross-sectional Analytical Survey

Poojita Santosh Rao, Vasavi Santosh, Deepak Langade

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, being an emerging world health issue, has led to the swift development of vaccines. Various lifestyles, health conditions, and behaviours affect the body’s reaction to immunisation. Aim: To evaluate the association of Adverse Effects Following Immunisation (AEFI) with different lifestyles and health patterns. Materials and Methods: A cross-sectional online epidemiological analytical survey in study population across India was carried out in Mumbai, India, from 1st June 2021 to 21st June 2021, using Google form survey. It included a sample of 586 responders. A questionnaire consisting of 26 questions regarding lifestyle habits and AEFIs following COVID-19 vaccine administration was distributed. Questions about lifestyle were obtained using Simple Lifestyle Indicator Questionnaire (SLIQ) which includes questions regarding diet, activity/exercise, alcohol consumption, smoking, and stress. Association between the SLIQ score, number and duration of AEFI was determined. Measurement data was presented as means with standard deviation. The SLIQ scores and age were compared between the different groups (AEFI present/absent, number of AEFI and duration of AEFI) using one-way Analysis of Variance (ANOVA). Results: The incidence of reported AEFI was 577 (76.4%). The most frequently reported AEFI was redness 328 (74.38%) followed by pain, 233 (52.83%), swelling 233 (52.83%) and fever 222 (50.34%). It was observed that those with a higher SLIQ score, had an increased number and duration of AEFI (p=0.001). With increase in age, number and duration of AEFI experienced decreased (p<0.0001). Conclusion: Balanced diet, mild to moderate exercise, abstinence from smoking and alcohol, reduced stress and younger age increase the number of AEFI, indicating a robust immune response.

Lactoferrin as a New Alternative for Prevention of Recurrent Preterm Delivery: A Case Report

Manila Reddy, Manjusha Agrawal, Deepika Dewani, Nidhi Goyal, Dhruva Halani

The upper female genital tract connects to the external world through the vaginal canal and can be a potential route of entry to pathogens into the reproductive organs. Lactobacilli exert their protective action by reducing the vaginal pH by producing lactic acid by degrading glycogen released by epithelial cells. Whenever a breach in this intricate defence mechanism or its balance is disturbed, the female genital tract becomes vulnerable to infections. A 30-year-old female reported with complaints of abdominal pain and vaginal discharge with poor obstetrical history and had three consecutive Preterm Premature Rupture of Membranes (PPROM) at the 20th, 22nd, and 25th week of gestation. All three pregnancies were natural conceptions. Three consecutive miscarriages were presumed to be due to recurrent vaginitis, cervical inflammation, and chorioamnionitis. The vaginal discharge culture examination was negative for Lactobacilli and positive for gram-positive bacteria. The patient was advised topical antibiotics, oral probiotics containing Lactobacilli species, and prebiotic Lactoferrin 100 mg. In a few weeks, Lactobacillus predominant vaginal flora was observed. During pregnancy, she used Lactoferrin and Lactobacillus combination orally until delivery. Cervical maturation was not observed before the term in this gestation. Lactobacillus had been the dominant vaginal flora during pregnancy, and the course of the pregnancy was good. She delivered vaginally at term a healthy male infant. Aetiopathogenesis of preterm delivery in humans has been hypothesised to be triggered by the inflammatory response caused by intrauterine infections. Lactoferrin inhibits the production of inflammatory cytokines and significantly prevents preterm delivery induced by infection.

Inflammatory Markers in Lung Cancer- A Comparative Cross-sectional Study

Introduction: Lung cancer is the most common cause of cancer mortality worldwide, principally because of its late diagnosis. Chronic inflammation plays a significant role in tumour growth and progression via increasing the levels of inflammatory markers in blood. Inflammatory markers are expected to be valuable prognostic biomarkers in cancer. Markers like Absolute Neutrophil Count (ANC), Absolute Lymphocyte Count (ALC), platelet count, Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) may aid in assessing prognosis of lung cancer. Aim: To study the inflammatory markers (ANC, ALC, Platelet count, NLR and PLR) in lung cancer and correlate these markers with cancer stage and histopathological type. Materials and Methods: A hospital-based comparative cross-sectional study was conducted in lung cancer patients at Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. Sixty patients with lung cancer and sixty controls were included. The clinical characteristics, ANC, ALC, platelet count, NLR and PLR of cases and controls were assessed and compared. Also, the comparison of these inflammatory markers with Tumour, Nodes and Metastases (TNM) staging and histopathological type of lung cancer were documented and results were interpreted. The data analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, (Ver.) 26. Results: Mean age (years) of the case and control groups was 60.17 and 61.03, respectively. Distribution of gender in cases and controls was comparable. The major histology of lung cancer was Non-Small Cell Lung Cancer (NSCLC, 81.66%) out of which squamous cell carcinoma constituted 55.00% and adenocarcinoma 21.67%, followed by small cell carcinoma at 18.33%. Overall, 46.67% of the patients belonged to TNM staging IVA followed by IIIB (25.00%). The levels of ANC, platelet count, NLR and PLR were significantly elevated and ALC was decreased in cases as compared to control. There was no statistically significant association between the inflammatory markers ANC, ALC, platelet counts, NLR and PLR with the histopathological type of lung cancer. Mean ANC, platelet count, NLR and PLR were found to be significantly elevated in late stages of lung cancer, whereas, ALC had no such association with the stages of lung cancer. Conclusion: Inflammatory markers (ANC, platelet count, NLR, PLR, ALC) can serve as valuable prognostic biomarkers in lung cancer and can easily be used in resource-limited areas.

Correlation of Homocysteine, Paraoxonase 1 and Malondialdehyde in Healthy Elderly Population: A Cross-sectional Study

Prachee Harishchandra Nirmale

Introduction: There is rapid increase in the life expectancy worldwide. Altered metabolism and biochemical interactions between homocysteine, Paraoxonase 1 (PON1) and Malondialdehyde (MDA) result in development and worsening of various diseases of elderly population. Aim: To correlate the levels of homocysteine, PON1 and MDA in healthy elderly population with respect to age, vitamin B12 and lipid profile. Materials and Methods: The present cross-sectional study was conducted in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra, India between July 2013 to July 2014. Study group consisted of 61 participants (30 elderly and 31 young healthy volunteers). Serum homocysteine and vitamin B12 were estimated by Chemiluminescence Microparticle Immunoassay (CMIA) while PON1 and MDA by spectrophotometry. Lipid profile was estimated by biochemistry autoanalyser. Statistical analysis was done by Pearson’s correlation coefficient. Results: Homocysteine and PON1 levels were found to be lower in elderly participants than in young participants (p-value <0.05, <0.01). The levels of vitamin B12 and MDA were higher in elderly participants than in young participants (p-value <0.01, <0.01). The levels of Total Cholesterol (TC) (p-value <0.01), High Density Lipoprotein (HDL) (p-value <0.05) and Low Density Lipoprotein (LDL) (p-value <0.05) were statistically significantly high in elderly participants as compared to young participants. Statistically significant negative correlation of homocysteine with vitamin B12 levels in both elderly participants (p-value <0.01) as well as young participants (p-value <0.01) were observed. There was no statistically significant correlation between homocysteine and PON1 well as MDA in both the groups. There was statistically significant negative correlation between the levels of homocysteine and TC (p-value <0.05), HDL (p-value <0.05) and LDL (p-value <0.01) in elderly participants. Conclusion: Elderly population is not at the risk of developing diseases whose risk factor is homocysteine. Males are at higher risk of development of diseases because of homocysteine than females of any age group. Homocysteine is not pathogenic in old age even in the presence of other risk factors such as lipid peroxidation, decreased defense mechanisms to lipid peroxidation, raised levels of atherogenic lipids and overweight. Improvement in the vitamin B12 status can decrease the homocysteine levels.

Clinical Profile and Antibiotic Sensitivity Pattern of Community Acquired Urinary Tract Infections in Children Attending a Tertiary Care Hospital in Assam, India

Dulal Kalita, Fahima Naznin Islam, Mahibur Rahman

Introduction: Urinary Tract Infection (UTI) is a common problem in children. It is a very common cause of fever in children after gastrointestinal and respiratory diseases. Uropathogens causing community acquired UTI is increasing due to changing antibiotic sensitivity pattern over time. Appropriate choice of antibiotic is crucial to prevent complications related to UTI. Aim: To study the clinical profile, risk factors, associated pathogen spectrum and their antibiotic sensitivity pattern in community acquired UTI. Materials and Methods: A cross-sectional observational study with 150 sample size was conducted in the Department of Paediatrics, Gauhati Medical College and Hospital, Guwahati, Assam, India and was carried out among children (1 month to 12 years of age) with community acquired UTI, over a period of one year in the state of Assam. Fresh urine samples were collected by clean catch mid-stream method for toilet trained children and by transurethral catheterisation for infants and young children. It was followed by routine urine examination and culture and sensitivity testing to diagnose UTI. Descriptive statistics was used to describe the results Proportion test was used for statistical evaluation. Results: Majority of UTI cases were in the age group 1-5 years (57.3%) and there was female preponderance (59.3%). Fever was the most common presentation (55.3% cases) in the present study. This was followed by poor feeding (12.6%), lower abdominal pain (10.6%), failure to gain weight (10.6%). In urinalysis, 87 cases (58%) showed pyuria, 6 cases (4%) showed significant haematuria. Most prevalent uropathogens in the present study was Escherichia coli (E.coli) (66%cases), followed by Enterococcus sp. (16.7%), Klebsiella sp. (14%). E.coli had maximum sensitivity for nitrofurantoin (90.9%). It was followed by amikacin (80%), co-trimoxazole in 64.6% and gentamycin in 62.6% cases. Conclusion: All fever cases in children should be screened to rule out UTI. All UTI cases should undergo culture and sensitivity testing to determine the sensitivity pattern.

Clinical, Radiological and Spirometric Analysis of Treated Tuberculosis Patients-A Cross-sectional Study

ChiragH Chakravarti, Kaushani H Patel, Vasavi R Cheguri, Bhavesh M Patel

Introduction: Post-Tuberculosis (TB) complications may involve the lungs, mediastinum, pleura, chest wall, or any combination of these structures. It can also affect the caliber of the airways which might lead to the increase in their resistance and decrease in the airflow, severely impairing the quality of life. Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of post-TB complications are currently available. Aim: To study the clinical symptoms, radiological involvement and the spirometry pattern of previously treated TB patients. Materials and Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Shri MP Shah Government Medical College and Guru Govind Singh Government Hospital, Jamnagar, from July 2018 to December 2019. Total 102 patients with history of TB and currently sputum negative were enrolled in the study. All patients underwent clinical examination, microbiological examination, chest radiograph, and spirometry. Data was collected from case record form and entered into MS Excel spreadsheet 2016. Data analysis was done in Statistical Package of Social Science (SPSS) software version 26.0. Results: Out of the 102 patients, there were 66 (64.71%) males and 36 (35.29%) females. Of the study population, 13 (12.74%) was asymptomatic, 7 (6.86%) had dyspnoea, 17 (16.66%) had cough and 65 (63.72%) had both cough and dyspnoea. Spirometry analysis revealed that 26 (25.49%) were normal, 6 (5.88%) had restrictive pattern, 69 (67.64%) had obstructive pattern and 1 (0.98%) had mixed pattern. Chest radiograph revealed unilateral chest involvement in 78 patients (76.47%) and 24 patients (23.52%) had bilateral chest involvement. Conclusion: There is high prevalence of post-TB pulmonary disability causing clinical symptoms, radiological involvement and spirometry changes and thus should be assessed early to prevent further complications.

Correlation of Health-related Quality of Life and Factors Affecting among Different Age Groups in Transfusion-dependent Thalassaemia Patients- A Cross-sectional Study

Hitali Ramesh Mali, Yashoda Ravindra Kattimani, Bageshree Seth, Satish D Pathak

Introduction: Health-Related Quality of Life (HRQoL) aims to measure a person’s views on the impact of their disease. Children suffering from thalassaemia require frequent blood transfusions throughout their lives because of impaired Haemoglobin (Hb). This may necessitate them to stay in the hospital for a longer transfusion day. School, physical activities, competencies, and family stability are all compromised in some way. Assessing HRQoL in individuals with thalassaemia and identifying variables that contribute to low quality of life is crucial. Aim: To correlate HRQoL and factors affecting among different age groups in transfusion-dependent thalassaemia patients. Materials and Methods: A cross-sectional study was conducted at MGM College and Hospital, Navi Mumbai, Maharashtra, India from October 2020 to August 2021, 70 thalassaemia patients aged 8-25 years registered for regular blood transfusions were included in the study and divided into three age groups: Group-I (8-12 years) n=25, II (13-17 years) n=24, and III (18-25 years) n=21. The study was approved by Institutional Ethics Committee. Paediatric Quality of Life (PedsQL™) 4.0 generic core scale questionnaire was used to assess patients’ HRQoL. This questionnaire has two parallel reports: child self-reports and parent proxy reports and assess HRQoL across four dimensions: physical, emotional, school, and social functioning. Anthropometric and demographic parameters considered are height, weight and age. Pretransfusion Hb and ferritin levels, Cardiac iron overload, age of first transfusion, frequency of transfusion, annual blood requirement were collected and correlated with HRQoL scores. One-way ANOVA, unpaired student’s t-test and Pearson’s correlation were applied for statistical analysis and p-value less than 0.05 was considered significant. Results: Comparison of total mean score of child’s self-report between three age groups showed significant difference (p=0.001). In Group-I, the lowest score was for physical functioning (41.9±18) and significantly correlated with pretransfusion Hb, annual blood requirement, and age of first transfusion. In Group-II, the lowest score was for school functioning (54±18) and significantly correlated with pretransfusion Hb, annual blood requirement, cardiac iron loading, and age of first transfusion. In Group-III, the lowest score was for school functioning (50.9±12) and significantly correlated with pretransfusion Hb, ferritin level, age of first transfusion, annual blood requirement, and frequency of transfusion. Conclusion: The HRQoL scores of thalassaemia patients was low in parent’s report as compared to children’s report in all four dimensions in all three groups. The predominant factors affecting are pretransfusion Hb level, annual blood requirement, and age of the first transfusion.

Correlation of Pupil Cycle Time and Postural Hypotension as a Marker for Diabetic Neuropathy

Vasanthi B Kotian, Puneet Hegde

Introduction: Diabetic Neuropathy (DN) can involve autonomic nervous system like cardiovascular system and pupillary reflex. Cardiovascular DN can be measured by estimating the change in Blood Pressure (BP) based on position. Ocular DN can be evaluated by using Pupil Cycle Time (PCT), which is an early diagnostic tool to estimate ocular DN. It is a simple way to measure autonomic reflex activity and is a specific test to study parasympathetic function. Aim: To assess the correlation of effects of postural hypotension and PCT on persistent diabetes. Materials and Methods: The prospective cross-sectional study was conducted in Ophthalmology Out Patient Department (OPD) at KS Hegde Medical Academy, Mangalore, Karnataka, India, from January 1st 2019 to December 31st 2019. The study included 60 male patients between the age group of 40-60 years which were divided into two groups of 30 diabetics (Random Blood Sugar (RBS) >200 mg/dL, Fasting Blood Sugar (FBS) >126 mg/dL and Glycated Haemoglobin (HbA1c) >6.5%) and 30 non diabetics. The blood pressure of all the patients were recorded using a sphygmomanometer in sitting and standing positions. PCT was measured in both eyes using Haggstreit-type of slit lamp after the subject was seated in a dimly lit room after dark adaptation for 15 minutes. Results: The mean age of patients in the diabetic group was 54±3.2 years and the non diabetic group was 52±2.7 years. The mean HbA1c of diabetics was 6.9±0.8%. The mean BP among diabetics in standing position was 133.86±29.34 mmHg systolic and 87.4±16.72 mmHg diastolic whereas in sitting position, it was 141.66±28.17 mmHg systolic and 85.26±13.39 mmHg diastolic. The mean BP among non diabetics in standing position was 129.46±24.84 mmHg systolic and 83.46±13.52 mmHg diastolic whereas in sitting position, it was 132.06±26.48 mmHg systolic and 81.26±11.45 mmHg diastolic. The mean PCT-I and PCT-II in diabetics was 1000.52±187.73 and 1006.09±199.45, respectively. The systolic and diastolic BP, both during sitting and standing postures, in diabetic patients were high. The mean PCT-I and PCT-II in non diabetics was 853.23±181.54 and 880.17±192.72, respectively. The PCT-I and PCT-II were found to be significantly high in diabetic patients as compared to controls. The PCT-I and PCT-II negatively correlated with both diastolic and systolic blood pressure in sitting and standing postures. Conclusion: Prolongation of PCT in diabetics correlates significantly with evidence of autonomic neuropathy obtained from testing of postural BP variations. Patients whose cardiovascular reflexes are very abnormal tend to have pupils which cycle slowly.

Prevalence of Insomnia and its Associated Factors among Aged Population in an Urban Locality of Bengaluru, Karnataka, India- A Cross-sectional Study

Introduction: Insomnia is a major public health concern among the aged population due to its impact on quality of life and raises an economic burden to the family and community. However, in the Indian scenario, the lack of information from community-based studies, stresses the need to assess the prevalence and factors associated with insomnia. Aim: To find out the prevalence of insomnia and its associated factors, among aged population in an urban locality of Bengaluru, Karnataka, India. Materials and Methods: This cross-sectional study was conducted in the urban field practise area of a Medical College in Bengaluru, Karnataka, India, with 880 elderly subjects, from October 2016 to March 2017. Using Probability Proportional to Size (PPS), study subjects were surveyed in eight urban localities under Urban Health Training Centre. Insomnia was assessed by using {Difficulty in Maintaining Sleep (DSM)-IV-TR} diagnostic criteria. Variables associated with insomnia such as socio-personal characteristics and financial status was also assessed. The data was analysed using Chi-square test. Results: The mean age of study subjects was 67.5±3.4 years and 455 (51.7%) were females and 425 (48.3%) were males. The prevalence of insomnia among aged population was 571 (64.9%) and prevalence of insomnia was more among females (p<0.001), Hindu by religion (p=0.001), unemployed (p<0.001), single (p<0.001), those with poor Self-Perceived Health (SPH) status (p<0.001), chronic diseases (p<0.001), history of stressful life events (p<0.001), with financial dependency (p<0.001) and social assistance (p<0.001). Conclusion: The present study revealed high prevalence of insomnia in female, Hindu religion, unemployment, single, poor SPH status, presence of chronic diseases, history of stressful life events, presence of financial dependency and social assistance found to be significantly associated with insomnia.

Radiological Assessment of Pituitary Hyperplasia in Newly Diagnosed Cases of Primary Hypothyroidism after Hormone Therapy: A Longitudinal Study

Manoj Mathur, Rajesh K Badhan, Sudesh Kumari, Amit Mehta

Introduction: With long-standing hypothyroidism, thyrotrophin hyperplasia can result in the enlargement of the pituitary gland. Regression of the hyperplasia has been shown to occur following adequate treatment of primary hypothyroidism with hormone replacement. Characteristics of pituitary gland hyperplasia on Magnetic Resonance Imaging (MRI) have been described previously in profound primary hyperthyroidism cases. But, hyperplasia and its regression have not been well-defined in newly diagnosed acute and uncomplicated cases after thyroid hormone therapy. Aim: To assess pituitary gland size on MRI in the newly diagnosed acute cases of primary hypothyroidism after eight weeks of hormone replacement therapy. Materials and Methods: This longitudinal study was carried out by enrolling 50 patients of recently diagnosed primary hypothyroidism in the Department of Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala, India from July 2018 to June 2021. In all newly diagnosed cases of primary hypothyroidism, MRI of the pituitary gland was done and the size of the gland was measured in the coronal section before the start of treatment. MRI of all the patients was also done after treatment with levothyroxine at the interval of eight weeks to assess the size of pituitary gland. Student t-test was used for pre and post-treatment measurement. Data was entered in Microsoft (MS) excel and analysed using Statistical Package for Social Sciences (SPSS) software. Results: Mean age of the patients included was 36.9±14.1 years. The mean Thyroid Stimulating Hormone (TSH), Triiodothyronine (T3), Triiodothyronine (T4) levels were 27.5±71.1 miu/L, 0.72±0.33 ng/mL, and 3.6±1.4 mcg/dL, respectively. The mean size of the pituitary gland before treatment was 6.3±1.9 mm and after eight weeks of treatment was 5.5±1.9 mm (p=0.97). Conclusion: This study does not find significant radiologically evident hyperplasia of pituitary gland in newly diagnosed cases of primary hypothyroidism, which might be because of MRI in the initial stage of the disease.

Microbiological Profile of Urinary Tract Infections in Males: A Cross-sectional Study

V Haritha, Sanjeev D Rao, Syed Shafeequr Rahman

Introduction: Urinary Tract Infections (UTIs) are uncommon among men. It is because the male urethra is longer and is away from the anal opening. Moreover, the perianal area is dry, and the prostatic secretion prevents from occurring of any infection. Hence, if men suffer from UTI, it is considered as a complicated infection. Complicated UTIs are difficult to treat and are more prone to treatment failures. Microorganisms causing these infections have a wide spectrum ranging from a variety of both Gram-negative and Gram-positive organisms. Early diagnosis and treatment of UTIs, plays a major role in preventing the spread of infection to the upper urinary tract. Aim: To determine the microbiological profile and antibiotic sensitivity pattern from urine samples of male patients. Materials and Methods: The present cross-sectional study was done for a period of two years (1/3/2019 to 31/4/2021) in the Department of Microbiology, Malla Reddy Institute of Medical Sciences and Research, Jeedimetla, Hyderabad, Telangana, India. Urine samples from male inpatients and outpatients suffering from various clinical conditions received in the microbiology laboratory were processed and analysed. These samples were cultured by conventional semiquantitative methods and the organisms were identified using standard biochemical reactions. Antibiotic sensitivity testing was done on Mueller Hinton agar by Kirby-Bauer’s disk diffusion technique. Clinical history, associated conditions and co-morbidities were noted from the case sheets of all the culture positive patients to identify the risk factors which made them prone to UTIs. The data was descriptive and percentages were calculated for all the numerical data obtained. Results: Total 304 urine samples received, 104 (34%) were found to be positive for bacterial and fungal isolates. E. coli (44%) was the predominant organism, followed by Klebsiella spp. (15%) among the Gram-negative bacteria isolated. Coagulase-negative Staphylococcus (5%) was the predominant organism among the Gram-positive bacteria followed by Staphylococcus aureus (4%) and Enterococcus spp. (4%). A 84.8% of E. coli and 68% of Klebsiella spp. were Extended-spectrum beta-Lactamase (ESBL) enzymes producing organisms. An analysis of the health conditions of the patients who were culture positive showed that 28% of patients had signs and symptoms suggestive of UTI. Diabetes (25%), hypertension (20%), and Benign Prostatic Hyperplasia (BPH) (5%) were observed commonly in patients above 60 years. Conclusion: The UTI in male patients are quite uncommon as in female patients. The microbiological profile and drug sensitivity pattern of these organisms causing the infection is similar to that in female patients suffering from UTI. But, as UTI in males is considered a complicated infection thorough investigation of these patients for various health conditions like diabetes mellitus, hypertension and BPH has to be done, particularly in elderly males. This helps in initiating prompt treatment to prevent recurrent UTIs and drug resistance.

Cytomorphological Variations in Pap Smears amongst Postmenopausal Women Reporting at a Tertiary Care Centre, Tamil Nadu, India

Introduction: In developing countries, cervical cancer is the leading cause of death amongst women. Since women spend one third of their lives in the postmenopausal period, which is most neglected phase, needs a technically simple, non invasive and, cost-effective screening tool for cervical cancer detection and the exact answer is the Pap smear screening test. This simple screening test when performed at regular intervals in post menopausal population, can detect precursor lesions there by reducing cervical cancer morbidity and mortality. Aim: This study was undertaken to evaluate the cytomorphological variations in Pap smears amongst postmenopausal women. Materials and Methods: In this prospective study, a total of 138 satisfactory smears were considered for study amongst 146 postmenopausal women from August 2020 to July 2022 at Bhaarath Medical College and Hospital and then evaluated and categorised based on Bethesda system for reporting cervical cytology 2014. Reporting elements include specimen type, specimen adequacy, general categorisation, interpretation/result includes general categories of negative for Intraepithelial Lesion or Malignancy (NILM), epithelial cell abnormalities and other malignancies. Results: Out of 138 satisfactory cases, 78.26% (108 cases) 14.5% (20 cases) and 7.24% (10 cases) were diagnosed as of inflammatory/benign conditions, epithelial abnormalities and normal cytology respectively. The mean age for inflammatory/benign lesions was 57.5 years and majority presenting with postmenopausal bleeding and white discharge. Amongst epithelial abnormalities Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesions (LSIL) were commonest. The incidence of ASCUS 7.24% (10 cases), and incidence of LSIL 2.89% (4 cases). The mean age was 57.5 years and majority of patients presented with postmenopausal bleeding and mass per vaginum. Incidence of High grade Squamous Intraepithelial Lesion (HSIL) was 2.17% (three cases), the mean age was 65.5 years and presented with white discharge and postmenopausal bleeding. Incidence of SCC was 2.17% (three cases) and the mean age was 70.5 years, presented with, postmenopausal bleeding and white discharge. Conclusion: Pap smear is a simple, cheap, safe and gold standard diagnostic tool for screening postmenopausal women for all cervical abnormalities in particular pre-invasive and invasive lesions.

Influence of Exteriorised versus Intra-abdominal Uterine Repair Caesarean Delivery under Spinal Anaesthesia on Intraoperative and Postoperative Complications

Introduction: Caesarean techniques have evolved over time to increase their safety. Intra-abdominal closure of uterine incision seems more physiological. Exteriorisation makes repair easier with a better exposure. But this causes tension to the supporting structures attached to uterus and stretching of vasculature with the risk of intraoperative haematoma or aneurysm later on. Aim: To compare the in-situ repair group and exteriorised repair group caesarean delivery under spinal anaesthesia regarding occurrence of intraoperative and postoperative complications of interest. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal, India, over a period of two years from April 2014 to March 2016. Four hundred women undergoing caesarean section who fulfilled the inclusion and exclusion criteria were recruited in the study. They were randomly allocated into two study groups as per a computer generated random allocation table. In Group A (n=200) uterine incision was closed after uterus was exteriorised and in Group B (n=200) uterine incision was closed keeping it inside the abdomen. Intraoperative and postoperative parameters of interest such as nausea-vomiting, drop in pulse rate, incision closure time, drop in haemoglobin, blood transfusion rate, return of bowel sounds, febrile morbidity, surgical site infection, hospital stay etc., were noted and compared between the two groups. Numerical variables were expressed as mean and standard deviation and analysed using independent sample t-test. For qualitative variables frequency and percentage were calculated and analysed using Chi-square. Collected data was transferred and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The p-value ≤0.05 was considered significant. Results: The demographic profiles like age, parity, gestational age etc. of both the groups were similar. There was a significant difference in uterine closure time (9±2.5 minutes in in-situ repair group vs. 10±2 minutes in exteriorisation and repair groups, respectively (p<0.001**). Mean drop in pulse rate, incidence of nausea, vomiting were similar in both the groups (p>0.05). Mean drop of haemoglobin was more in the intraabdominal closure group (1.5±1.3 gm/dL) as compared to the group of closure after exteriorisation (1.4±1.3 gm/dL) though the difference was not significant statistically (p=0.44). Postpartum blood transfusion rate was 6.5% in exteriorised repair group and 9% in in-situ repair group (p=0.35). Postoperative morbidity like fever, surgical site infection, length of hospital stay was similar in both the groups. Conclusion: Choice of uterine closure method is operator dependent and either method of uterine closure is acceptable when practiced and skill is gained. Exteriorisation is advantageous when excessive bleeding is encountered. Though time taken for closure in in-situ group is statistically more it is similar practically. Bowel sounds returned earlier postoperatively in in-situ group.

Comparing the Efficacy of Intra-articular Dexmedetomidine versus Buprenorphine for Postoperative Analgesia Following Arthroscopic Knee Surgeries: A Prospective Interventional Study

BV Rajeshwari, Basavaraj Patil, Sunil Khyadi

Introduction: Arthroscopy for knee surgery is the most often used minimally invasive orthopaedic surgical technique. Postoperative discomfort can be caused by irritation to the nerve endings in the synovial tissue, the fat pad in the front of the knee, and the joint capsule that can take place during the excision and resection. Aim: To compare the efficacy of Intra-Articular (IA) dexmedetomidine versus buprenorphine for postoperative analgesia following arthroscopic knee surgeries. Materials and Methods: A prospective interventional study was carried out for a period of one and a half years from January 2021 to June 2022 at Department of Anaesthesiology B.L.D.E. (Deemed to be University) Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India. Around 80 patients of both genders of American Society of Anaesthesiologists (ASA) grade I and II who were scheduled for arthroscopic knee surgeries were randomly divided into two equal groups of 40 each. After the operation was finished, the patients in each group received the respective medications intra-articularly through an arthroscopy port. Group D received Inj. Dexmedetomidine 100 mcg+ Inj. Bupivacaine 0.25%, 20 mL. Injections of buprenorphine 100 mcg and bupivacaine at a concentration of 0.25% , 20 mL were given to the participants in group B. Immediately following surgery, the patient’s temperature, pulse, Mean Arterial Pressure (MAP), and Visual Analogue Scale (VAS) score for pain were all monitored and recorded at the 1st, 2nd, 4th, 8th, 12th and 24th hour. Time to first rescue analgesia, the number of patients requiring rescue analgesia within the next 24 hour, the visual analog scale at rest, and on mobilisation at 1st, 2nd, 4th, 8th, 12th, and 24 hour were measured. Side-effects like sedation, pruritis, nausea, vomiting, respiratory depression, and hypotension were also monitored. Descriptive statistics were reported as mean (SD) for continuous variables, and frequencies (percentage) for categorical variables. Data were statistically evaluated with IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 26.0, IBM Corp., Chicago, IL. Results: The mean age of the study participants was 38.38±11.30 years among the buprenorphine group and 36.40±12.07 years among the dexmedetomidine group. Among the buprenorphine group 52.5% were females and 47.5% were males. There was a statistically significant difference in VAS score at rest and mobilisation between the groups. The mean time for first rescue analgesia was longer for the buprenorphine group 1016.22±137.54 minutes and for the dexmedetomidine group, it was 523.67±117.47 minutes. Rescue analgesia was given to 9 (22.5%) in the buprenorphine and 18 (45%) in the dexmedetomidine group. Conclusion: In comparison to IA dexmedetomidine, buprenorphine produces analgesia for a longer period of time and reduces the amount of postoperative rescue analgesic that is required.

Effect of Mind Sound Resonance Technique on Selected Psycho-emotional Well-being Parameters in Secondary School Students: A Randomised Controlled Trial

Anindita Saha, Satya Prakash Purohit

Introduction: Mind Sound Resonance Technique (MSRT) is a yogic relaxation technique, which creates a resonance of the “A,” “U,” “M,” “AUM,” and Mahämåtyuïjaya mantra chanting to provide a delicate massage sensation throughout the body. Adolescence is a developmental stage marked by changes in social, emotional and cognitive functioning. Studies have demonstrated the benefits of yoga, pranayama and meditation regarding health and mental issues in both adolescents and adults. Aim: To see the effect of the MSRT on selected psycho-emotional parameters in secondary school students. Materials and Methods: In this randomised controlled trial, data of total 63 adolescents, intervention group (n=32) and control group (n=31) were analysed, who were selected from two English medium schools in Udaipur, Tripura (northeast India). The intervention group was provided the MSRT for 30 minutes each day for 21 sessions, whereas the control group went through only the daily routine, in the month of April 2022. The data were collected using questionnaires, prior to and after the intervention. Independent sample test and paired sample t-test were done for ‘between groups’ and ‘within group’ comparison respectively for the variables i.e., emotion regulation, impulsivity, creative thinking, critical thinking and interpersonal relationship. Mann-whitney test and Wilcoxon-signed rank test were done for ‘between groups’ and ‘within group’ comparison, respectively for the variables i.e., aggression and mindfulness. Results: The intervention group showed significant improvement in mindfulness (p<0.001), creative thinking (p<0.001), critical thinking (p<0.001), interpersonal relationship (p<0.001), emotion regulation (p-0.005) and a significant reduction in aggression (p<0.001) and impulsivity (p-0.001) compared to control group. Conclusion: Based on the result of the present study, it is suggested that MSRT can help to improve the psycho-emotional well-being of adolescents.

Comparison of Colour Doppler Ultrasonography and Indirect Computer Tomography Venography for the Diagnosis of Deep Venous Thrombosis in Patients with Suspected Pulmonary Thromboembolism at a Tertiary Care Centre in Chennai, Tamil Nadu, India

Introduction: Pulmonary Thromboembolism (PTE) and Venous Thromboembolism (VTE) are prevalent conditions with a high mortality rate and need immediate medical attention. The initial and standard imaging techniques are Computed Tomography Pulmonary Angiography (CTPA) for the diagnosis of PTE and Colour Doppler Ultrasonography (CDUS) for Deep Vein Thrombosis (DVT). However, there can be some issues when using these two different approaches, like the requirement for a separate area and more time. With the so-called indirect Computed Tomography Venography (CTV) approach, thrombi in the deep venous system that may cause PTE can be examined right after pulmonary CT Angiography (CTA) without the need for additional contrast agent. Aim: To determine the accuracy of indirect CTV for the diagnosis of deep venous thrombosis in patients with suspected PTE. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology in Government Stanley Medical College, Chennai, Tamil Nadu, India, India from June 2021 to May 2022. A total of 50 patients with a probable diagnosis of PTE and was established with CTA were included. All 50 patients underwent indirect CTV and CDU on the same day. For indirect CTV lower extremities between the iliac crest and the popliteal region were scanned without administration of extra contrast medium. Colour Doppler Ultrasound (CDUS) was considered as Gold standard. To find the efficacy of CTV in determining DVT the Receiver Operating Characteristics curve (ROC) was used. Results: Of the total 50 patients, who were enrolled in the study, 21 (42%) patients were females and 29 (58%) patients were males. The mean age of the study subjects was 43.5±12.1 years. Among these DVT was detected in 25/50 patients (50.0%) by Doppler Sonography, Similarly DVT was detected in 23/50 patients (46%) by CTV. The sensitivity of CTV was 76% and the specificity was 84%, Positive Predictive Value (PPV) of 82.6%, Negative Predictive Values (NPV) of 77.8%. The p-value and kappa value between CTV and CDUS was calculated as 0.0005 and 0.600, respectively. Conclusion: According to the results of the present study, a combined CTA indirect CTV method can determine the DVT with a moderate level of sensitivity and specificity.

Incidence of Enteric Fever and their Resistant Pattern among School going Children in Ghaziabad, Uttar Pradesh- A Matter of Concern

Sanjay Singh Kaira, Geeta Gupta, Anuradha Makkar

Introduction: Children still experience enteric fever as a severe health problem in developing countries like India. It is an infectious disease that exclusively affects humans. In the developing world, it is one of the most prevalent bacterial causes of acute febrile sickness and is spread by the consumption of unhygienic food or water. Aim: To identify the incidence and resistance pattern of Salmonella Typhi and Salmonella Paratyphi isolated from school age children. Materials and Methods: This cross-sectional study was conducted among children with Salmonella enterica infections in the Department of Microbiology, Santosh Medical College and Hospital in Ghaziabad, Uttar Pradesh, India. During the study period, (July 2021 to June 2022) a total of 776 blood samples were obtained from school going children (03-17 years old) and immediately inoculated into Bact/Alert aerobic blood culture bottle and incubated at 37°C for upto five days. After receiving a positive result from Bact/Alert, gram staining was done. Standard microbiological procedures were followed such as different biochemical reactions, agglutination with different antisera for the identification of Salmonella serotypes. Antibiotic susceptibility testing was done using the Kirby-Bauer disk diffusion method. Data was analysed by software version 16.0 of the Statistical Package for the Social Sciences (SPSS). Results: Total 88 Salmonella isolates were found, of which 21 (23.86%) were Salmonella Paratyphi A and 67 (76.14%) were Salmonella Typhi. Infection rate was more common in summer season. S. Typhi as well as S. Paratyphi A was found to be most resistance to nalidixic acid {58 (86.6%), 19 (90.5%)} followed by ciprofloxacin {42 (62.7%), 18 (85.7%)}. Ceftriaxone and azithromycin resistance pattern among S. Typhi isolates was 07 (10.4%) and 15 (22.4%), respectively and among S. Paratyphi A it was found to be 07 (33.33%) and 06 (28.6%), respectively. Conclusion: This study found an increase in resistance to ceftriaxone and azithromycin, which are frequently thought of as the best medications for empiric therapy in children. Regular monitoring of the resistance pattern is necessary for doctors to select the appropriate empiric therapy due to the increasing resistance to the available class of antibiotics.

A Study to Assess Changes in Cortisol Level and Heart Rate Variability between Fixed Duty and Shift Duty Health Care Providers in a Tertiary Care Hospital- A Cross-sectional Study

Saptarshi Roy, Soma Gupta, Suranjana Sur Mukherjee, Maumita Das

Introduction: Increased demand of service 24 hours around the clock has divided the workers into 2 domains as “Fixed duty” and “Shift duty”. Personals associated with shift duty are increasing in numbers day by day. Shift duty or more specifically night duty is associated with increased stress which results in high morbidity and decrease in work efficiency. Cortisol hormone and Heart Rate Variability (HRV) are useful parameters to determine the effects of stress. Aim: To find any change in cortisol levels, HRV, Athens score among the fixed duty and shift duty healthcare providers. Materials and Methods: A descriptive cross-sectional comparative study was conducted in a tertiary care hospital at Kolkata between July, 15th to Sept, 15th 2021. Predesigned and pretested questionnaire was made and ethical clearance was taken from institutional IEC. Then after taking consent total 120 (60 fixed duty and 60 shift duty) healthcare providers were recruited for the study. Subjects of the study filled up a questionnaire {including Athens Insomnia Scale (AIS)}. After applying exclusion criteria (any cardiovascular, neurological, psychological, sleep disorder) 120 health individuals were taken five minutes short-term HRV (time and frequency domain) recording in supine posture and 4 PM blood sample (for cortisol) were obtained from the participants which was further analysed in Chemiluminescence Immunoassay (CLI). Data was analysed in SPSS version 20.0. Statistical tests like student t-test, Cronbach’s alpha and Chi-square tests were applied significant p<0.05 (95% CI). Results: After analysis, shift duty workers showed a significant (p<0.001, Odd’s 10.706) higher chance of having insomnia (Athens score >6) than fixed duty workers. Blood test showed that shift duty workers had significantly high evening cortisol level than fixed duty workers (p=0.036). The time domain of HRV showed that the parameters like Standard Deviation all NN interval (SDNN) (p=0.001), Mean HR (p=0.037), RMSSD (p<0.001), NN50 (p=0.006), pNN50 (p=0.002) were significantly different in the two groups. Whereas the frequency domain of HRV showed that HF power was lower and LF power (p=0.002), LF/HF ratio (p<0.001) were significantly higher in shift duty workers. Conclusion: The study showed that shift duty workers had comparatively higher stress levels resulting in significantly high sympathetic drive and increased risk of insomnia. This can be associated with morbidity and ill-health in the shifting duty workers.

Use of TWIST Score and BAL Score in Diagnosing Testicular Torsion in Children with Acute Scrotum: A Retrospective Study

Liya Joseph

Introduction: Early diagnosis and management of Torsion Testis (TT) in children is challenging. To improve the reliability of diagnosis, various clinical scoring systems have been proposed. Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score and Boettcher Alert (BAL) score have been used for the diagnosis of TT in children with acute scrotum. Aim: To find the utility of TWIST and BAL score for diagnosing testicular torsion in children with acute scrotum. Materials and Methods: This was a retrospective record-based study that included medical records of children with acute scrotum who underwent surgery between January 2019 and December 2021 in a tertiary care hospital. A total of 112 patients were included in the study. TWIST and BAL scores were calculated, retrospectively. Univariate analysis of the clinical features were done using Chi-square test. Sensitivity, specificity, Positive Predicitive Value (PPV) and Negative Predicitive Value (NPV) for scoring systems were calculated. Results: There were 73 patients in TT group and 39 in Non Torsion Testis (NTT) group. The mean age was 4.5±2.98 years in torsion group and 5.2±2.2 years in non torsion group. Among the components of TWIST and BAL score, absent cremasteric reflex, hard testicle, high riding testis, nausea/vomiting and pain duration <24 hours were found to be statistically significant. PPV and specificity of TWIST score ≥5 were 98.15% and 97.44%, respectively whereas NPV and sensitivity of BAL score ≥2 group was 100%. Conclusion: TWIST and BAL scores are reliable bedside and easy to perform clinical diagnostic tools for TT. These scores can help in early detection and plan surgical intervention to reduce ischaemia time of TT.

Comparative Study of Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery

Introduction: Various types of incisions have been adopted and applied in Manual Small Incision Cataract Surgery (MSICS) with the primary objective to attain minimum postoperative Surgically Induced Astigmatism (SIA). Aim: To evaluate and compare the postoperative visual acuity and to determine SIA in Batwing incision and Frown incision in MSICS. Materials and Methods: The present study was a prospective, cross-sectional, interventional, comparative descriptive study in which a total of 380 patients aged 40 years and above with senile, uncomplicated cataract, undergoing MSICS were included. Patients were randomly divided into: Group B (Batwing incision), and Group F (Frown incision). Patients were compared on 6th week postoperatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) and SIA (performed using SIA Calculator Version 2.1). The data was collected in terms of demographic, clinical and biochemical characteristics that were expressed as range, mean and median and subjected to statistical analysis to obtain results. Results: In group F, total 04 (2.11%) patients showed no astigmatism, 115 (60.53%) patients showed 0-0.5D of SIA, 64 (33.68%) were seen with 0.5-1D of SIA and 07 (3.68%) patients with 1-1.5 D SIA, no patient showed SIA more than 1.5 D. In Group B 01 (0.52%) patient showed no SIA, in 61 (32.11%) 0-0.5D of SIA was seen, in 79 (41.58%) patients 0.5-1D of SIA was seen and 45 (23.68%) patients had presented with 1-1.5D of SIA while 04 (2.11%) patients with more than 1.5D of SIA. In group F, average preoperative astigmatism preoperatively was 0.55±0.36D and average astigmatism at six weeks postoperatively was 0.46±0.33D. In Group B, average preoperative astigmatism was 0.49±0.39D and average astigmatism six weeks postoperatively was 0.54±0.40D. Conclusion: The present study showed the superiority of Frown incision over Batwing incision in terms of less SIA and improved postoperative unaided visual results.

Comparison of Percutaneous Cystolithotripsy and Transurethral Cystolithotripsy for Treatment of Medium Size Bladder Stone: A Retrospective Study

Introduction: Vesical calculus accounts for nearly 5% of urinary system calculi and is commonly seen in patients with Bladder Outlet Obstruction (BOO), chronic infection, and neurogenic bladder. Open cystolithotomy is an invasive surgery with a long postoperative period and with a high wound infection rate, so only best recommended for large stones. With recent advancements in endourological instruments, cystolithotripsy either by Percutaneous Cystolithotripsy (PCCL) or Transurethral Cystolithotripsy (TUCL) approach has become a safer treatment for medium size stone (2-4 cm). Aim: To compare the outcome of PCCL and TUCL for medium size bladder stones in adult patients. Materials and Methods: This retrospective study was conducted between January 2019 to December 2021 in the Department of Urology, Superspeciality Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. Group I was PCCL (n=32) and group II was TUCL (n=30). PCCL group was compared with TUCL group II for age, stone size, number of stones, operative time, mean urethral entries, postoperative hospital stays, peri and postoperative complications. Statistical analysis was performed using Chi-square and t-test. Differences were accepted to be statistically significant at p-value ≤0.05. Results: A total of 168 were treated for bladder stones in the Institute and 62 patients were included in the study. No residual stone was observed in any of the two groups. Complete stone clearance was achieved in both groups of patients. Mean operative time and the number of urethral entries were 46.75±2.45 min and 1.06±0.25 min in the PCCL group, and 59.67±3.84 min and 2.87±0.82 min in the TUCL group (p-value -<0.001). Conclusion: The PCCL appears to be a better technique and preferable over TUCL in bladder stones of size between 2-4 cm.

Correlation of Serum Zinc Level with Hyperbilirubinemia in Neonates- A Case-control Study

Deeptha, Ramlingareddy, Jayashree, K Shreedhara Avabratha, M Malathi

Introduction: Neonatal jaundice is the common cause of hospitalisation in the first month of life. Factors that affect the severity of neonatal jaundice includes maternal, pre-natal, and neonatal factors as well as environmental factors. Zinc (Zn) is one of the factors that affect the severity of neonatal jaundice as it prevents the lipid depolarization of the cell membranes. Hypozincemia may alter the erythrocyte membrane resulting in deficient synthesis of enzymes which play a key role in bilirubin metabolism. Aim: To correlate the serum Zinc level with bilirubin level in neonates with hyperbilirubinemia and also to compare with healthy controls. Materials and Methods: This case-control study was done in Clinical Biochemistry Laboratory of Father Muller Medical College and Hospital, Mangalore, Karnataka, India, from April 2018 to June 2018. Total 60 subjects were included in the study, which was divided into two groups: Neonates with clinically diagnosed hyperbilirubinemia (Group I) and normal healthy neonates as controls (Group II). Serum levels of zinc, total bilirubin, conjugated and unconjugated bilirubin were compared among groups. Correlation among the biochemical parameters was analysed by Karl Pearson’s Correlation Analysis. Results: In present study, 30 subjects were males and 30 females with mean age of 4.90±1.06 days among Group I and 2.50±1.61 days among Group II. This study observed significantly decreased mean levels of serum Zinc (171.24±19.82 μg/dL) in Group I patients when compared to mean levels of serum Zinc (189.23±17.90 μg/dL) in Group II controls. There was statistically significant positive correlation among serum levels of Zinc and total bilirubin in Group I patients (p<0.05) when compared to Group II. Conclusion: There was statistically significant positive correlation was found among serum levels of Zinc and total bilirubin in cases when compared to healthy controls. Current results showed, zinc may have a protective effect in the incidence of neonatal jaundice.

Knowledge, Attitude and Practice Regarding Medication use among Pregnant Women Attending Antenatal Clinic: A Cross-sectional Study

Rohan Sen, Ananya Mandal, Suman Chattopadhyay, Supreeti Biswas Mondal

Introduction: Medication use during pregnancy is a major concern in India and poor awareness is driven by non scientific information sources. Primary care providers play a role in providing information on risk of teratogenic and folate deficiency birth defects. Aim: To assess Knowledge, Attitude and Practice (KAP) of pregnant women attending antenatal clinic regarding medication use and self-medication during pregnancy. Materials and Methods: This cross-sectional study was conducted on 100 pregnant women attending the antenatal clinic in a tertiary care teaching hospital of Eastern India from August to October 2021. The study looked at sources of drug information, attitudes regarding medication use and practice of medication use and self-medication among pregnant mothers attending antenatal clinic of the hospital. Consenting women were enrolled in the study and the qualitative data gathered from the women were analysed using tools of descriptive statistics. Results: This study included 100 pregnant women with mean age of 22±2.0 years of which 42% were primigravida. Of the participants 80% had atleast high school education. Two third of the mothers 66% cited their family members as source of their drug information and 76% were aware of the risks of self-medication during pregnancy. Self medication practice was seen in 25% pregnant women mainly with Paracetamol use for pain or over-the-counter drugs to control acid reflux and morning sickness symptoms. All the participants (100%) took their iron and folic acid supplements as advised. Conclusion: The pregnant women attending the hospital showed adequate knowledge and satisfactory practices regarding medication use. Counselling of the mothers attending the clinic regarding drug use and possible harms to the mother and baby can help reduce long-term risks.

Prevalence of Musculoskeletal Pain among Sonographers in Makkah Province and Factors Associated with the Pain: A Cross-sectional Study

Introduction: Work-related musculoskeletal pain is a serious public health issue affecting healthcare providers, particularly, sonographers. The lack of research into this issue, together with the limited knowledge of factors associated with pain among Saudi sonographers promoted the authors to perform this study. Aim: To explore the prevalence of work-related musculoskeletal pain and potential factors related to this disorder among sonographers. Materials and Methods: This cross-sectional study targeted 102 sonographers working in the Radiology Departments of hospitals located in the Makkah province from September 2019 to February 2020. The questionnaire comprised 27 questions- 11 questions related to demographic and psychosocial, nine on work scheduling and task factors (average time per scan and amount of job tasks), one on anatomical areas affected by pain over the last six months, six questions on work-related posture factors (position of the body during scanning). Bivariate analysis was considered to investigate the relationships between work-related musculoskeletal pain and potential factors affecting the musculoskeletal system of sonographers. Results: The prevalence of work-related musculoskeletal pain among Saudi sonographers was 81 (98.78%), and the pain was located at a single or multiple body sites, with the highest being in shoulders (70, 86.4%), followed by lower back (61, 75.3%), hand and wrist (58, 71.6%). Mental stress was only associated with shoulder pain (p-value: 0.03), and demographic factors (institution type) were related to hand and wrist pain (p-value ≤0.003). Upper back pain was significantly related to work-related posture factors (p-value ≤0.008), and both work related posture factors, as well as task factors, have shown a significant relationship with lower back pain (p-value ≤0.04). Conclusion: Work-related musculoskeletal pain is highly prevalent among Saudi sonographers and the pain from different anatomical parts were found to be associated with different factors including psychological, demographic, task, and work-related posture factors.

Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Community Acquired Pneumonia in Children: A Cross-sectional Study

Elizabeth Daniel, Archana Ramachandran

Introduction: Pneumonia is one of the most common causes of childhood morbidity and mortality, which warrants a proper diagnosis and adequate treatment. Early diagnosis of Community Acquired Pneumonia (CAP) is essential to reduce the total burden of this disease. Aim: To evaluate the diagnostic accuracy of Lung Ultrasound (LUS) in CAP in children as compared to Chest Radiograph (CXR). Materials and Methods: This was a cross-sectional study involving 91 subjects with clinically suspected pneumonia, who underwent Ultrasound Examination (US) examination in the Department of Radiodiagnosis, Government Medical College, Thrissur, Kerala, India from December 2018 to December 2019. LUS was done to obtain information regarding different patterns of presentation of pneumonia. Although Computed Tomography (CT) is considered the gold standard imaging for pneumonia, it is used only for complicated pneumonia and is not routinely performed in the paediatric age group as radiation exposure will be more than that of the CXR. Hence, a CXR was taken as a reference standard in this study, and findings of LUS were compared. The data was managed using Microsoft Excel 2016 and statistical analysis was done with International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy were calculated. Results: Overall, LUS had a sensitivity of 95.83%, a specificity of 93.02%, a PPV of 93.88%, a NPV of 95.24%, and an accuracy of 94.5% (p<0.001) as compared to CXR which had a sensitivity of 93.8%, specificity of 95.23%, the PPV of 95.80%, the NPV of 93.0% and accuracy of 95%. Substantial agreement between LUS and a CXR was found, for diagnosing specific patterns of CAP with Cohen’s Kappa value of 0.74. Conclusion: LUS offers an important contribution to the diagnosis of pneumonia in children as compared with a CXR. With its high NPV, it can replace CXR in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.

Comparison of Three Different Calcium Channel Blockers on Gingival Overgrowth in Hypertensive Patients

Introduction: Calcium Channel Blockers (CCBs) like Nifedipine is the most widely used drug in many countries in the management of hypertension, with other drugs also in use like Amlodipine, and Felodipine. Gingival hyperplasia is the common adverse effect of the three classes of CCBs used commonly as dihydropyridine calcium antagonists. Aim: To compare the effect of three different CBCs on gingival overgrowth in hypertensive patients. Materials and Methods: The present cross-sectional study was carried out in the Department of Periodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. The study was conducted between September 2020 and February 2022. A total of 206 patients with hypertension taking CCBs, were enrolled and divided into three groups based on the patient’s medication as group I (nifedipine; n=83), group II (amlodipine; n=71) and group III (felodipine; n=52). Gingival Overgrowth (GOG) was graded and periodontal parameters like Plaque Index (PI), Gingival Index (GI), and Probing Pocket Depth (PPD) were recorded. One-way analysis of variance and Tukey’s post-hoc test were done to evaluate and compare between the groups. Results: Mean age of the patients in group I was 60.81±4.13 years, in group II was 62.70±4.19 years, and in group III was 59.54±3.42 years. No significant difference in PI scores and GI scores was seen between the groups. The mean score for PPD in group I was 5.91±0.14 mm, in group II score was 5.76±0.14 mm and in group III the score was 5.13±0.22 mm. A statistically significant difference (p<0.001) was observed in group I when compared with group II and group III. The mean GOG scores in group I, group II, and group III were 3.49±0.22, 2.98±0.3, and 2.74±0.16, respectively. A statistically significant (p=0.001) increase in GOG scores was observed in group I followed by group II and group III. Conclusion: Nifedipine was the most prescribed drug with high amount of gingival overgrowth in patients with hypertension, compared with amlodipine and felodipine.

Comparison of Parallelism of Different Levels of Ala-Tragus Lines to Occlusal Plane in Dentate Subjects via Cephalometric Analysis: A Cross-sectional Study

Introduction: In prosthodontics, fabrication of Complete Denture (CD) is a challenging task because numerous factors have to be taken care of while rehabilitating the patients. The establishment of Occlusal Plane (OP) should be adaptable with the functional activity of the stomatognathic system. Aim: To ascertain the parallelism of different levels of ala-tragus lines to the OP in class 1 occlusion among dentate subjects via cephalometric analysis. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, February 2020 to September 2021. A total of 100 subjects were included in the study which included 50 males and 50 females. The various cephalometric parameters traced were Sella (S), Gnathion (Gn), OP, Anterior Nasal Spine (ANS). Metallic balls were placed on the lower border of ala of nose and tragus which was divided into three parts: Superior (S), Middle (M), and Inferior (I). Lateral cephalograms were shot for all subjects. The data collected was tabulated for easy interpretation and subjected to statistical analysis using Analysis of Variance (ANOVA), post-hoc test. Results: The mean angular measurement of angle I was highest followed by angle OP, angle M and least in angle S in both males and females. The comparison of the mean angle S was found to be significant (p<0.001) when subjected to one way ANOVA test, there was non-significant difference observed between angle OP and Angle I in males (p-value 0.464), and Angle OP and Angle M in females (p-value 0.984). Conclusion: Clinically, from the present cephalometric study it can be suggested that in males, the inferior point on the tragus and in females, the middle point on the tragus can be used to mark the Camper’s plane.

Histopathological Changes of Placenta in Maternal Hypertensive Disorders and its Association with Birth Weight: A Case-control Study

Introduction: One of the most common complications during pregnancy is hypertension. It leads to pathological changes which reduce the placental blood flow. Hypertensive disorders are strongly associated with foetal growth restriction, prematurity, lower foetal birth weights and contribute largely to perinatal mortality and morbidity. Aim: To study the histomorphological changes of placenta in cases of maternal hypertensive disorders and compare it with normal controls as well as find out its association with neonatal birth weight. Materials and Methods: A case-control study was conducted at the Department of Pathology of a Tertiary Care Hospital, Faridabad, Haryana, India. Duration of the study was two months from July to August 2018. This study is a part of Indian Council of Medical Research (ICMR) Short Term Studentship (STS) scheme for MBBS students. Control group was formed by 30 placenta of full term deliveries without any complications and 30 placenta of the females presenting with hypertensive pregnancies formed the case group. Specimens of placenta were studied in detail for morphological and histological changes. Neonatal Birth weight was recorded just after delivery of all the cases and controls. Analysis of statistical difference between the means of both groups was performed using student unpaired t-test. The data obtained was entered in Microsoft excel sheet and statistically analysed using Epi Info version 7. Results: Mean maternal age for cases was 28.60 years and controls were 25.23 years. This association was found to be significant. Mean for gestational weeks at the time of delivery was 34.93 weeks in cases and 37.20 weeks in controls (p-value <0.0001). Average placental weight in cases was 410.20 grams and in controls was 480.80 grams (p-value <0.001). Histopathological changes comprised of syncytial knot formation, cytotrophoblasts proliferation, proliferation of endothelial lining of capillaries, stromal fibrosis, calcification, hyalinisation of villi and infarction were comparatively more frequent in cases (n=30). Mean neonatal birth weight was found to be 2809.67±128.32 grams in control group as compared 2427.67±152.22 grams in cases (p-value <0.001). Conclusion: During pregnancy significant histomorphological changes in placenta are caused due to hypertensive disorders which lead to harmful and severe foetal outcomes. A valuable insight into the mechanism of placental dysfunction can be achieved through a detailed examination after delivery.

Impact of Diet on Serum Lipids, Atherogenic Index of Plasma and Non HDL-c in Pre and Postmenopausal Women

Introduction: Menopause is an inevitable phase of a woman’s natural ageing process, marked by cessation of ovarian function. Hormonal changes during the phase causes derangement of lipid metabolism and thereby increasing cardiovascular risk in postmenopausal women. Diet plays a major role in influencing serum lipids. Aim: To determine and compare lipid profile, Atherogenic Index of Plasma (AIP) and non High-Density Lipoprotein-cholesterol (HDL-c) in pre and postmenopausal women based on vegetarian and non vegetarian diet. Materials and Methods: This cross-sectional study was comprised of 92 women (46 were premenopausal and 46 were postmenopausal) carried out at AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India between December 2019-May 2020. The groups were further divided into vegetarian and non vegetarians. Fasting lipid profile was determined by enzymatic methods. AIP and non HDL levels were calculated. Comparison of means between two groups was done using student t-test. Association between categorical variables was analysed using Chi-square test. Statistical significance was considered at p<0.05. Results: Serum Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein-cholesterol (LDL-c), Very Low-Density Lipoprotein-cholesterol (VLDL-c), AIP and non HDL-c levels were LDL-c and HDL-c was high (184.09±17.49, 131.96±9.49, 106.00±20.92, 26.46±1.96, 0.05±0.07, 132.45±22.39 and 51.64±5.88, respectively) in vegetarians compared to non vegetarians in premenopausal women. In postmenopausal women, similar pattern was observed with regards to serum TC, TG, LDL-c, VLDL-c, AIP, non HDL-c and HDL-c in vegetarians and non vegetarians (p<0.05). An alarming proportion of non vegetarian postmenopausal women showed “very high” TC (91.3%), “low” HDL-c (56.5%), “very high” LDL-c (69.6%) and “high-risk” AIP (91.3%). Conclusion: The findings of this study indicated that all lipid parameters, AIP and non HDL-c were higher in non vegetarians except HDL-c in pre and postmenopausal women. Relevant dietary recommendations can be given to premenopausal women to promote positive health outcomes and alleviate cardiovascular risk.

Clinical Profile of Patients on Antiepileptic Drugs Experiencing Ataxia as an Adverse Drug Reaction: A Longitudinal Observational Study

Balaji More, S Murugesan, T Arun Prakash

Introduction: Ataxia is one the common adverse drug effect caused by Antiepileptic Drugs (AEDs). It can result from either single therapeutic dose of a particular drug, prolonged use of same drug or acute poisoning. Aim: To determine the disease burden and clinical profile of patients who are on AEDs and develop ataxia. Materials and Methods: This was a longitudinal observational study, carried out at Mahatma Gandhi Medical College and Research Institute, Puducherry, from January 2016 to March 2022. The clinical characteristics of patients who presented with ataxia on AEDs and with no previous history of ataxia were documented. Based on the time of onset of ataxia patients were divided into three groups: Group A- Ataxia developed within 24 hours of onset of drug intake; Group B- Ataxia developed within 24 to 72 hours from prescription of drug; Group C- Ataxia developed after 72 hours from the time of drug administration. Patients were further classified into those having sensory ataxia and cerebellar ataxia. Based on the time of clinical resolution patients were classified into three subgroups: Group 1- Clinical resolution within 72 hours; Group 2- Clinical resolution in 72 to 144 hours; and Group 3- Clinical resolution after 144 hours. Data was collected systematically and results were statistically analysed using Microsoft Excel spreadsheet software program. Results: Out of the total number of epileptic patients (1600) on AEDs, 34 patients developed ataxia. Of these 34 patients, 15 (44.11%) were on Phenytoin, 12 (35.29%) were on Carbamazepine, 3 (8.82%) were on Gabapentin, 2 (5.88%) were on Zonisamide, and 2 (5.88%) were on Lamotrigine. Dose of these drugs were modified within one day, after one and three weeks and after one month in 9 (26.47%), 7 (20.58%), 12 (35.29%), and 4 (11.76%) patients, respectively. Two patients had presented with acute poisoning. Half, 50% (n=17) patients had symptoms of sensory ataxia and remaining half had symptoms of cerebellar ataxia. Conclusion: Ataxia secondary to AEDs is seen with both the older and newer drugs. Awareness of the possibility of AEDs induced ataxia can help in early diagnosis and its management.

Correlation of Chest CT Scan Severity Score and Disability in Post-COVID-19 Patients: A Cross-sectional Study

Introduction: After recovering from Coronavirus Disease 2019 (COVID-19) patients face various problems like cognitive difficulties, mobility, and self-care. COVID-19 affects the respiratory system at varying severity. The severity of the lung infection was assessed by Chest Computed Tomography (CT) Severity Score (CTSS)- higher the score higher the severity of the disease. Aim: To identify if the CTSS that is done during active disease has any correlation with post-COVID-19 illness disabilities and fatigue. Materials and Methods: A cross-sectional study was conducted in the post-COVID-19 rehabilitation clinic of the Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. Total of 36, post-COVID-19 patients were included from December 2020 to June 2021. Fatigueness was assessed on Fatigue Severity Score (FSS) and disability was assessed on World Health Organisation Disability Assessment Scale 2.0 (WHODAS 2.0). CTSS was recorded from the patient’s non contrast Chest CT scan report. This CT scan of chest scan was done during active COVID-19 disease. Spearman rank-order Correlation Coefficient (SCC) was used to identify correlations. Results: There was no positive correlation of CTSS (10.3±6.4) with disability (11.3±11.8, p-value- 0.424) and fatigue (3.3±1.8, p-value- 0.225). There was no correlation found between post-COVID-19 disabilities (11.3±11.8) and fatigue (3.3±1.8, p-value- 0.993). Conclusion: There was no positive correlation found between lung infection severity and disabilities, fatigue after COVID-19.

Effect of Anaemia on Sensory Nerve Conduction in Diabetic Peripheral Neuropathy: A Cross-sectional Study

Nirang Jhana, Shuba

Introduction: Diabetic Peripheral Neuropathy (DPN) occurs in more than 50% of patients with Type 2 Diabetes Mellitus (T2DM). Though multifactorial pathogenesis has been claimed for the occurrence of DPN, the exact mechanism is unclear. Recently, it was found that the prevalence of anaemia is two to three times higher in diabetic patients even with preserved renal function. Aim: To compare the sensory nerve conduction study variables such as latency (ms), amplitude (μV) and Nerve Conduction Velocity (NCV) (m/s) of the median, ulnar and sural nerves in DPN patients with anaemia to those without anaemia. Materials and Methods: This cross-sectional study was conducted in the Department of Neurology, PSG Hospital, Coimbatore, Tamil Nadu, India, December 2017 to December 2018 with 80 DPN subjects, included both males and females of age group from 35 to 70 years, grouped into those without anaemia (n=40) and those with anaemia (n=40). Subjects were considered to have anaemia based on the World Health Organisation (WHO) classification of haemoglobin. Sensory nerve conduction studies were performed on right and left median, ulnar and sural nerves. Logistic regression was performed in DPN without and with anaemia to rule out confounding variables. Independent t-test and Mann-Whitney U test were used to compare the variables between the groups with normal and skewed distribution, respectively. The p-value <0.05 was considered to be statistically significant. Results: Among 80 study participants, 38 (47.50%) were male and 42 (52.50%) were female. About 20 (50%) were male and 20 (50%) were female in group A (DPN without anaemia). Seventeen (42.50%) were male and 23 (57.50%) were female in group B (DPN with anaemia). Among DPN subjects with anaemia, 57.50% had mild anaemia and 42.50% had moderate anaemia. In the present study, normocytic normochromic anaemia was the predominant form of anaemia seen. NCV of right median nerve, right ulnar nerve, right sural nerve and left sural nerve were significantly reduced in DPN with anaemia when compared to DPN without anaemia with values <0.001, <0.001, 0.001 and <0.001, respectively. The amplitude of right sural nerve and left sural nerve were significantly reduced in DPN with anaemia, compared to DPN without anaemia with p-values <0.001 and 0.017, respectively. Conclusion: The DPN patients with anaemia had lower NCV and amplitude of sensory nerves, when compared to those without anaemia. Hence, even mild to moderate anaemia could be a possible risk factor that exacerbates the severity of DPN.

Association of Radiological Features with Histological Features in Patients with Renal Cell Carcinoma: A Cross-sectional Study

Introduction: Renal Cell Carcinoma (RCC) is a group of neoplastic lesions with unique cytogenetic characteristics and histopathological features. The majority of studies till date on RCC have been focusing on tissue histology to plan neoadjuvant treatment in clinical settings. An accurate forecast of the histopathological subtype has clinical implications in management and response to newer treatment strategies. It is pertinent to preoperatively distinguish a solid renal masses histologically but, there are currently no well-established imaging criteria to classify these tumours on the basis of radiographic evaluation. Aim: To evaluate the differences in imaging characteristics of different histological subtypes of RCC by Power Doppler Ultrasound and Multi-Detector Computed Tomography (MDCT) scan. Materials and Methods: This cross-sectional study was conducted in the Department of Urology, Gauhati Medical College and Hospital, Guwahati, Assam, India from March 2016 to December 2017. The study population consisted of 61 patients of RCC who were evaluated with MDCT and Doppler ultrasound prior to surgery and findings were correlated with histopathological forms of tumour. The Pearson Chi-square test and ANOVA test was used to statistically analyse the data. Results: Histopathology revealed clear cell Renal Cell Carcinoma (ccRCC), chromophobe Renal Cell Carcinoma (chRCC) and papillary Renal Cell Carcinoma (pRCC) in 52, 4 and 5 patients, respectively. Heterogenous enhancement was found in 51 cases and among these 90.4% were ccRCC. Absolute attenuation values in Corticomedullary Phase (CMP) and Nephrographic Phase (NP) for clear cell and chromophobe subtype were higher than papillary subtype, i.e., 88.04±30.40 Hounsfield Unit (HU) and 72.41±20.17 HU for clear cell, 60.75±22.54 HU and 88±16.06 HU for chromophobe; 22.40±12.52 HU and 58.00±4.41 HU for papillary subtype, respectively. Papillary RCC (pRCC) showed a unique enhancement pattern, with a low peak enhancement (average peak of 55.40 HU) and greatest enhancement during the NP. In this study population ccRCC, ChRCC RCC and pRCC had mean Resistive Index (RI) of 0.63±0.06, 0.58±0.0 and 0.67±0.11, respectively. Conclusion: Power doppler flow imaging is not useful in discriminating subtypes of RCC while multiphasic Computed Tomography (CT) imaging may be useful, particularly the phasic enhancement pattern to distinguish common RCC subtypes which may facilitate treatment planning and choosing appropriate tyrosine kinase inhibitors.

Comparative Evaluation of Different Retreatment Files for Gutta-percha Removal from Curved Root Canals Accessed with Novel Ultra-conservative Opening: An In-vitro Study

Introduction: In endodontic retreatment, gutta-percha removal must be done correctly in order to assure a successful outcome following failed procedures. The goal of this study was to compare the effectiveness of stainless-steel hand files with three different nickel-titanium rotary instrument systems for removing gutta-percha using ultra-conservative access opening in curved canals. Aim: To compare the efficacy of different rotary instruments for removing obturating material from root canals with Ninja access in mandibular mesiobuccal moderately curved canals measured radiographically using Cone-beam Computed Tomography (CBCT). Materials and Methods: An in-vitro study was conducted in the Conservative and Endodontics Department, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India in the time period of June 2022 to July 2022. Forty extracted human mandibular molar teeth were accessed through Ultraconservative opening (Ninja Access). After preparing the root canals, they were sealed using gutta-percha and AH Plus sealer through lateral compaction. The teeth were then stored for one week. The samples were divided into four groups according to the rotary file used: Group I- Hedstrom Files; Group II- ProTaper Universal Retreatment (PTUR) Files; Group III- Neoendo Retreatment Files; Group IV- R-Endo Retreatment. The amount of remaining filling material after the retreatment procedure was checked with CBCT. The statistical analysis was performed using R statistical analysis software version 4.1.0 for windows. Results: In sagittal section, there was significant difference of residual filling material between the four file systems in middle third only (p=0.048) while significant difference was seen only in apical third in the coronal section (p=0.011). However, the three rotary retreatment files left significantly less remnants than Hedström files during removal of the gutta-percha. The time taken for retreatment was significantly higher for Hedström files (398.90±20.717) sec followed by R-endo retreatment files (274.30±14.407). Conclusion: H file was the least effective in removing gutta-percha from the canals when compared to the other three file systems. The Neo-Endo rotary retreatment system was faster.

Pap Smear and Colposcopic Examination of the Cervix in Pelvic Inflammatory Disease and other Gynaecological Conditions: A Prospective Analytical Study

Introduction: Pap smear and colposcopy are commonly done procedures in gynaecology practice. The Pap test is a low-cost, straight forward, and widely used tool for detecting cervical cancer and preinvasive cervical abnormalities. Colposcopy is also widely used to detect Cervical Intraepithelial Neoplasia (CIN) to guide cervical biopsy sites with clinical symptoms of suspected cervical diseases. Aim: To evaluate the diagnostic implications of Pap smear and colposcopy in inflammatory cellular changes and to estimate the incidence of Cervical Intraepithelial Neoplasia (CIN)/invasive carcinoma in the study population through biopsy. Materials and Methods: This prospective analytical study was conducted at JNU Medical College, Jaipur, India, where Pelvic Inflammatory Disease (PID), and other gynaecology Out Patient Department (OPD) patients without any previous diagnosis of cervical malignancy, were included in the study. A total of 150 study patients, underwent Pap smear and colposcopic examination with biopsy as the gold standard. Descriptive analysis of data was done using means and standard deviation for continuous variables and nominal variables as frequencies. The Chi-square test was applied to categorical variables to find out the association and Receiver Operating Characteristic (ROC) analysis was done to predict the diagnostic ability of Pap smear, and colposcopy in cervical pathology. Results: The mean age of the patient population was 36±3 years. The mean age at first coitus and marriage of all the women were 18.9±2.7 years and 19.5±3.4 years, respectively. Twenty (13.3%) and 5 (3.3%) cases were reported as CIN and carcinoma, respectively after colposcopic biopsy. Pap smear results showed a sensitivity of 87.7% and a specificity of 78.2%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 72.8% and 68.7%, respectively. Sensitivity of the colposcopic report was 89.4% and the specificity was 98.8%. The PPV is 96.6% and NPV is 82.3% for colposcopic report. Conclusion: This study suggested that PID and gynaecology OPD patients can be better targeted with a good opportunity for screening the potential premalignant changes in the cervix by using Pap smear and colposcopy.

Environment to Store Alginate at its Best: An In-vitro Study

Ankita Pal, Mukesh Kumar Singhal, Divya Jha, Megha Chopra, Kunal Yadav

Introduction: Irreversible hydrocolloid alginate impressions are among the widely used impression materials in dentistry but they suffer from one major drawback, i.e., dimensional change after setting. Because of clinical limitations, impressions are poured to make cast after a time delay which is so long as compared to the recommended period. This can be reduced by storing the impression material in different storage environments. Aim: To assess the impact of the storage environment on the dimensional accuracy of alginate impression material. Materials and Methods: In this in-vitro study, 70 samples were made with chromatic alginate impression material according to the manufacturer’s guidelines and divided into seven groups (Exposed to atmosphere, Airtight container in the refrigerator, 2% NaCl (Sodium Chloride) solution, Air-tight container, Distilled water, 1% K₂SO₄ (Potassium Sulphate) solution and Mixture of 2% NaCl and 1% K₂SO₄ Solution). Samples were made with stainless steel die fabricated according to ADA specification 18 and dimensions were noted after 24 hours of storage. Distance between the cross lines was calculated using profile projector. ANOVA Test and Tukey Test were applied to compare the mean dimensional change of seven groups and to compare the difference in mean dimensional change between the groups. Results: Samples kept in a solution of 1% K₂SO₄ and 2% NaCl solution had no significant dimensional change (F-value 2026.0, p-value <0.001), whereas samples stored in open-air resulted in the greatest dimensional change (Group 7 > Group 6 > Group 3 > Group 4 > Group 2 > Group 5 > Group 1). Conclusion: The impressions which are kept in a combined solution of 1% K₂SO₄ and 2% NaCl have shown the best impact on the dimensional accuracy of alginate impression materials. However, these can also be seen in 1% K₂SO₄ or in 2% NaCl solutions, respectively.

Oral Health-Related Quality of Life Improvement in Children with Special Needs Following Comprehensive Dental Treatment under GA: A Saudi-Based Follow-up Study

Introduction: Children with Special Healthcare Needs (CSHCN) are considered difficult to maintain oral hygiene and challenging for caregivers and dentists to attain co-operation in dental treatment under general anaesthesia. Family Impact Scale (FIS) and Parental-Caregiver Perceptions Questionnaire (P-CPQ) are useful tools to assess patient’s oral health quality of life and caregivers perception. Aim: To assess the impact of dental treatment under general anaesthesia on the quality of life and oral hygiene of CSHCNs, as perceived by caregivers. Materials and Methods: This prospective follow-up survey study was carried out at Dammam Medical Complex, Saudi Arabia, from December 5th, 2019 to December 15th, 2021. The CSHCN of either gender, aged 12 years, and falling within the American Academy of Paediatric Dentistry (AAPD) definition of special-needs patients referred for invasive procedures under general anaesthesia (American Society of Anaesthesiologists {ASA}) class I or II), were included. The baseline and, after a one-year follow-up, information obtained from two surveys that were altered from Thompson’s P-CPQ and FIS were decoded into the numeric ordinal scales Never (“0”), Once or Twice (“1”), Sometime (“2”), Always (“3”), and Daily (“4”). Analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 84 participants were caregivers of CSHCN who underwent dental procedures under General Anaesthesia (GA), of whom 77 (91.7%) were mothers and 7 (8.3%) were fathers of the CSHCN. The mean age of children was 8.29±2.14 years (Range=3-12 years); 38 (45.2%) were males and 46 (54.8%) were females. The median FIS after treatment was zero, compared to the median before treatment which was 2, revealing a significant impact on being absent from work, a child requiring more care, the impact of presence, sleeping disturbances, feeling angry, feeling guilty, and a child disputing or blaming either parent (p<0.001). Following the pattern of one year post-treatment FIS, median was 0 (Never) for all items including halitosis, pain, food trapped in palate and teeth, swallow, breath, time, sleep, irritable, frustrating, nervous, shy, absent, laugh, and continue school (p<0.001). Conclusion: The modified FIS and P-CPQ evaluations before and after dental treatment under GA revealed a significant improvement in the oral health quality of life for those CSHCN, as well as the impact on their caregivers. Regular check-ups would be useful for early and non invasive intervention without GA.

Intestinal Metaplasia in Barrett’s Oesophagus: A Clinicopathological Study

Jaya Bagchi Samaddar, Dwaipayan Samaddar, Kalyan Khan

Introduction: The incidence of Oesophageal Adenocarcinoma (EAC) has increased at a faster rate than any other cancer in the developed nations. Despite advances in treatment, five year survival rate for EAC is <15%. Till date, Barrett’s Oesophagus (BE) is the only known precursor of EAC increasing its risk by greater than 30 to 60 fold. Most important risk factor for development of dysplasia and EAC is specialised Intestinal Metaplasia (IM) in BE. Aim: To find the association between clinical, endoscopic and histopathological features and presence of IM in patients with endoscopically suspected BE. Materials and Methods: This was an institution based descriptive study with a cross-sectional design conducted in the Departments of Pathology and Surgery, in a tertiary care centre of North Bengal for four years (2017-2021), among patients attending Surgery and Medicine Outpatient Department (OPDs) or Inpatient Department (IPDs), suspected on clinical basis and subsequent endoscopic detection of BE utilising Prague criteria. Periodic Acid-Schiff (PAS) and Alcian Blue (pH 2.5) stains were used to detect complete or incomplete IM and results were analysed using appropriate statistical software. Results: Among 120 cases included in the study, 72 (60%) had Short Segment Barrett’s Oesophagus (SSBE) and 48 (40%) Long Segment Barrett’s Oesophagus (LSBE). Hiatal hernia was significantly more frequent in LSBE patients (32 out of 48) compared to patients with SSBE (24 out of 72). The associations of tobacco and alcohol abuse with microscopically proven BE were statistically significant with p-values of 0.005 and 0.004, respectively. The association of IM with the increasing length of Columnar Lined Oesophagus (CLE) was statistically significant (p-value=0.004). Conclusion: Tobacco and alcohol abuse, presence of hiatal hernia (particularly in LSBE patients) were significantly associated with BE. Increasing length of CLE is more commonly associated with IM. Incomplete IM was observed more commonly in LSBE cases whereas complete IM was detected more frequently in cases diagnosed as SSBE by endoscopy.

An Auxiliary Approach to Prediction of Binary Outcome with Bayesian Network Model: Exploration with Data for Recurrence of Breast Cancer

Introduction: Logistic regression is the classical statistical model that is incorporated to predict a binary outcome variable. These models have theoretical assumptions of independence of predictor variables and linearity of association with the outcome in the logarithmic scale. Alternative models developed in the machine learning context like Naïve Bayes model with similar assumptions and Bayesian Network (BN) model can be used for binary prediction. Aim: To compare the predictive performance of logistic regression, Naïve Bayes and BN model in predicting the recurrence of Breast cancer. Materials and Methods: The dataset was procured from UCI Machine Learning repository on recurrence of breast cancer. The study was done on retrospective data from December 2021 to July 2022. The sample size was boosted with the bootstrapping with logistic regression model. The dataset was split into training (70%) and testing (30%) dataset for internal validation. The effect estimates of the potential prognostic variables were estimated using multiple logistic regression model. Naïve Bayes and BN model was also learnt from the training dataset. The indices of predictive accuracy were estimated for the models in both training and testing dataset. Results: Degree of malignancy and side of affected breast were found to be significant predictors of recurrence of breast cancer. BN model had the least misclassification rate and the best sensitivity in comparison to other models in spite of imbalance in outcome variable. Conclusion: BN model performed the best in comparison to logistic regression model when the assumptions of logistic regression model were violated and there is imbalance in proportion of outcome.

Two Dosages of Dexamethasone (2 mg and 4 mg) as Analgesic Adjuvant to Levobupivacaine in Ultrasound-guided Brachial Plexus Block in Upper Limb Surgery- A Randomised Clinical Trial

Introduction: Perineural dexamethasone gives promising results in prolonging duration of analgesia in brachial plexus block. Doses between 1 to 10 mg have been used but the optimum dose is not yet settled. Aim: To compare the analgesic efficacy of two low doses of dexamethasone in Ultrasonography (USG)-guided brachial plexus block for planned upper limb surgery. Materials and Methods: A double-blind randomised clinical trial was conducted with 126 adult patients of either sex, randomised in equal numbers to 2 mg and 4 mg dexamethasone groups, the steroid being administered in conjunction with 0.5% levobupivacaine. Time to onset of sensory and motor blocks, duration of analgesia, duration of motor block, total consumption of analgesics in the first 24 hours postoperative period, haemodynamic parameters and features of neurotoxicity were compared. Tramadol 50 mg intravenous was permitted as analgesic. Stastistical Package for Social Sciences (SPSS) Version 24.0 was used for data analysis. Results: No significant differences in onset of sensory and motor blocks were encountered. Duration of sensory block with 4 mg {median (Interquartile range); 1080 (915-1140) min} clearly exceeded that with 2 mg {840 (720-960) min} (p-value <0.001) dexamethasone. Duration of motor block was also greater with 4 mg dexamethasone {1080 (1020-1170) versus 870 (810-990) min} (p-value <0.001). Total analgesic consumption in first 24 hours was 225 (175-250) mg versus 100 (75-200) mg in 2 mg and 4 mg groups respectively (p-value <0.001). No features of neurotoxicity were encountered in either group. Conclusion: Perineural dexamethasone 4 mg gives better results as analgesic adjuvant to bupivacaine compared to 2 mg in brachial plexus block for upper limb surgery without increasing adverse effects.

Morphometric Analysis of the Body, Pedicle and Lamina of Typical Thoracic Vertebrae: An Observational Study

Introduction: Thoracic vertebrae are a part of the vertebral column. The thoracic vertebrae have a body size between the cervical and lumbar vertebrae, which increase gradually from above downward and are characterised by the presence of facet joints for articulation with the head of the ribs on the side of the vertebral bodies. Aim: To measure the various morphometric parameters of different components of dry thoracic vertebrae and compare various components on the right and left-sides. Materials and Methods: The present observational study was carried on 100 dry human thoracic vertebrae for direct measurements of the vertebral body, pedicle and lamina. Using a digital Vernier calliper, all the parameters were measured. The data was entered in Microsoft excel sheet. The mean and standard deviation (M±SD) of all parameters were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Student’s t-test was used for the comparison of morphometric dimensions of the right and left-sides. Results: In a typical thoracic vertebra, the mean Transverse Diameter (TD) was 25.58±2.34 mm, and the mean Anteroposterior Diameter (APD) of the vertebral body was 18.53±2.59 mm. The mean Anterior Height (AH) and Posterior Height (PH) of the body were 16.24±1.54 mm and 17.81±1.67 mm, respectively. The mean Pedicle Width (PW) was 3.75±0.98 mm on the right-side and 3.74±0.97 mm on the left-side. The mean Pedicle Height (PH) was 9.64±1.04 mm on the right-side and 9.68±1.14 mm on the left-side. The mean Lamina Height (LH) on the right-side was 17.07±2.15 mm and on the left-side was 17.20±1.98 mm. The right-side and left-side mean Lamina Widths (LW) were 5.26±0.94 mm and 5.13±0.85 mm, respectively. PW and PH and lamina thickness and LH measurements showed no statistically difference between right and left-sides. Conclusion: Designing implants and instruments using data from such researches can benefit the surgeon during preoperative planning.

Comparative Evaluation of Fracture Resistance of Maxillary Premolars with Class II Cavities Restored with Glass Hybrid Restorative System and Nanohybrid Composite Resin: An In-vitro Study

Introduction: Maxillary premolars are the most susceptible teeth to fracture if both marginal ridges are compromised. Composite restorations have performed remarkably in restoring the marginal ridges. However, it has certain disadvantages, thus to overcome this, modified glass ionomer based restorative materials with improved mechanical properties were introduced. Aim: To compare and evaluate the fracture resistance of maxillary premolars with class II Mesio-Occluso-Distal (MOD) cavities which received Glass hybrid restorative system and Nanohybrid Composite resin. Materials and Methods: The present study was an in-vitro study conducted at KM Shah Dental College and Hospital, Vadodara, Gujarat from December 2019 to June 2020, on 30 Extracted Maxillary premolars. Total samples were divided into group A (n=15) restored by glass hybrid restorative system and group B (n=15) restored by nanohybrid composite resin. Standardised class II MOD Cavity preparation was done in all the samples. The samples were subjected to a thermocycling procedure, and a universal testing machine measured the fracture resistance. Data obtained from all the samples was analysed by Independent sample t-test with a p-value set at less than 0.05. Results: In group A, mean fracture resistance (at mean force 947.07±236.41) was found to be greater than in Group B. However, the difference among the groups was not statistically significant with a p-value of 0.555. Conclusion: Glass Hybrid restorative system showed better fracture resistance than Nanohybrid Composite Resin in maxillary premolars with class II MOD Cavities.

Assessment of Relationship between Saphenofemoral Junction Reflux and Great Saphenous Vein Diameter using Doppler Ultrasonography in Patients with Chronic Venous Disease: A Cross-sectional Study

Introduction: Chronic venous disease is a commonly occurring disease that includes a variety of pathological conditions like varicose veins, oedema, skin abnormalities, and ulceration, among which the most prevalent are the varicose veins. Doppler imaging is presently the first investigation for evaluating chronic venous disease. Aim: To investigate the relationship between Saphenofemoral Junction (SFJ) reflux and Great Saphenous Vein (GSV) diameter in patients with chronic venous disease and to determine the best cut-off value of GSV diameter in predicting reflux. Materials and Methods: The present cross-sectional study was conducted in the Department of Radiology, SRM Medical College and Hospital, Tamil Nadu, India, from December 2019 to June 2021 on 76 patients with chronic venous disease. The study was conducted on a GE Logic P9 ultrasound machine, the diameter of GSV was measured close to the SFJ, at the Proximal Thigh (PT); 15 cm distal to the SFJ, and at the calf. The diameter of the GSV was compared with the presence of SFJ reflux. Similarly, Short Saphenous Vein (SSV) diameter was also measured posterior to the knee and was correlated with Saphenopopliteal Junction (SPJ) reflux. Chi-square and student t-tests were used for analysis with a cut-off value determined through Receiver Operating Characteristic (ROC) curve analysis. Results: The mean age of study participants was 51±15.85 years with age range of 19-78 years. Of total, 42 (55.26%) had chronic venous insufficiency on the left side and 34 (44.74%) had on the right side. The mean GSV diameter at SFJ and at PT was higher in patients with SFJ incompetence and was statistically significant with a p-value of 0.001 and 0.002, respectively by t-test. Although the mean GSV diameter at calf was higher in patients with SFJ incompetence, it was statistically insignificant. The GSV diameter at the SFJ had the best cut-off value for predicting incompetence, with a mean diameter of 5.95 mm with 76.3% sensitivity and 76.3% specificity. The cut-off of SSV at the posterior knee for predicting SPJ incompetence was 4.6 mm which had a sensitivity of 72.7% and specificity of 88.7% and diagnostic accuracy of 86.84%. Conclusion: The GSV diameter at SFJ and PT help in predicting SFJ incompetence. The SSV diameter at SPJ aids in predicting SPJ incompetence.

Evaluation of Serum Cortisol Levels in Patients with Hypothyroidism at a Tertiary Care Hospital, Telangana, India: A Case-control Study

Venkatamani Yaamarthy, C Jhansi Rani, R Hemamalini, Mohd Iqbal Ahmed

Introduction: Serum Cortisol is a glucocorticoid hormone released from the zona fasciculata layer of the adrenal cortex, which plays an important role in regulation of blood pressure and metabolism. Hypothyroidism causes elevated cortisol levels due to both decreased clearance and negative feedback of cortisol on the hypothalamic pituitary-adrenal axis. Aim: To investigate the correlation of serum cortisol and with Triiodothyronine (T3), Thyroxine (T4), Thyroid Stimulating Hormone (TSH) and serum cortisol levels in patients with hypothyroidism. Materials and Methods: Present case-control study was carried out in the Department of Biochemistry, Gandhi Medical College and Hospital, Secunderabad, Telangana, India, July 2022 to August 2022. A total of 60 patients with hypothyroidism (cases) aged between 35-60 years, and 60 controls were selected from Gandhi Medical College and Hospital. Samples were analysed in Siemens Advia centaur XPT. T3, T4, TSH and cortisol levels were estimated by “CLIA” method. Data were statistically analysed using Karl Pearson’s correlation test. Results: In present study, there were five males and 55 females in control group, 23 males and 37 females were in case group. The mean age in cases was 39.39±6.44 years and in control group was 39.38±10.97 years. The mean T4 in subjects cases was 10.74±5.34 ng/mL, as compared to 8.99±2.43 ng/mL, in controls. The mean TSH level in cases was 13.38±20.43 mIU/L, as compared to 3.47±4.20 mIU/L, in controls. The mean cortisol level in cases was 64.88.44±16.25 μg/dL, as compared to 9.55±5.59 μg/dL, in controls. There was significant positive correlation between serum cortisol level and T3 (r=0.12, p-value 0.02), T4 (r=0.12, p-value 0.02), and TSH Levels (r=0.31, p-value 0.01) in case group. Conclusion: The results of present study showed that serum levels of cortisol were significantly increased in hypothyroidism patients as compared to normal healthy controls.

Profile of Arteriovenous Fistula Surgery in Patients with Chronic Kidney Disease at a Tertiary Care Urology Hospital Karnataka, India: A Prospective Interventional Study

JB Narendra, Mayur M Narkhede, Dhruvit K Soni

Introduction: Haemodialysis (HD) is the most important treatment approach in patients with Chronic Kidney Disease (CKD), awaiting kidney transplantation, demanding the long-term need for dialysis access. Aim: To study the profile of Arteriovenous Fistula (AVF) surgery in patients undergoing haemodialysis in the Karnataka region, India. Materials and Methods: This prospective, interventional single-centre study was conducted at the Institute of Nephrology and Urology, KR Hospital Campus, Mysuru, India, from April 2018 to April 2021. All the patients undergoing haemodialysis with AVF aged between 11-90 years were included. Demographic details (age, sex, co-morbidities) and fistula-related complications associated with surgery were examined in the immediate, late, and delayed postoperative period. Categorical variables were presented as numbers and percentages whereas, continuous variables were expressed as mean {Standard Deviation (SD)}. The data was collected in excel sheet and the statistical analysis was performed using Statistical Package for Social Sciences (SPSS), version 20.0. Results: In total, 200 patients with a mean (SD) age of 48.8 (13.0) years underwent AVF formation and the majority were below <60 years of age (n=154, 77.0%). The incidence of fistula surgery and patency rates was higher in men (n=140, 70.0%). Most patients had left non dominant arm (n=187, 93.5%) and remaining right non dominant arm (n=13, 6.5%). The most common site of AVF was left brachial cephalic (n=135, 67.5%). The most common cause of CKD was diabetes mellitus (n=90, 45.0%). The most common immediately observed complications were bleeding (n=13, 6.5%), pain (n=12, 6.0%) and oedematous limb (n=5, 5.0%). Stitch abscess was the most common late complication observed in 14 patients (7%). Rupture of the aneurysm and AVF failure were delayed complications observed in eight (1.5%) and 17 (8.5%) patients, respectively. Conclusion: In this study, bleeding, stitch abscess and AVF failure were found to be the most common immediate, late, and delayed postoperative complications, respectively. However, more studies are required to understand the outcome of AVF in Chronic Renal Failure (CRF) patients from India.

Comparative Evaluation of Accuracy of Reconstructed 3D Printed Rapid Prototyping Models and Conventional Stone Models with Different Ranges of Crowding: An In-vitro Study

Introduction: The digitalisation of dental models has made significant contribution to the current success of orthodontic practices. Rapid Prototyping (RP) is an innovative method of producing physical objects based on Computer-Aided Design (CAD) Computer-Aided Manufacturing (CAM). Aim: To compare the accuracy of the Three-Dimensional (3D) printed rapid prototyped models with orthodontic stone models across different ranges of crowding. Materials and Methods: An in-vitro study carried out at the Bharati Vidyapeeth Deemed to be University, Dental College and Hospital, Sangli, Maharashtra, India during September 2019 to September 2020. A total of 36 rapid prototyped models were reconstructed from stone models using Light Emitting Diode (LED) scanner and Digital Light Processing (DLP) technology. Dental stone models and RP models were evaluated using digital caliper for different linear measurements and arch dimensions. The data was analysed using Statistical Package for Social Sciences (SPSS) version 26.0. To evaluate accuracy, t-test analyses and Bland-Altman plotting were performed. Results: T-test showed statistically non significant difference in all parameters of measurements of RP models when compared to stone models. According to Bland-Altman plotting. The mean difference between stone and RP models for the various degree of crowding was minimal and within ±0.07 mm in all planes. Conclusion: Discrepancy between dental plaster models and RP models were less than 0.5 mm which was considered clinically non significant. Suggesting that RP models can be effectively used as an alternative to stone models.

Serum Magnesium Levels in Chronic Kidney Disease with and without Diabetes Mellitus and its Correlation with Calcium and Phosphate Levels: A Case-control Study

M Deepthi, Sujatha Mahadevarao Premnath

Introduction: Nearly 10% of the world population is affected by Chronic Kidney Disease (CKD). Hypermagnesaemia is seen in late stages of CKD whereas Diabetes Mellitus (DM) is commonly associated with hypomagnesaemia. Monitoring Mg levels and early correction may prevent the future risk for cardiovascular and CKD. Aim: To compare the serum Mg levels in healthy controls, diabetic patients without CKD, late stages of CKD with and without diabetes and to evaluate its correlation with serum phosphate and calcium levels in CKD patients. Materials and Methods: A case-control study was conducted in Vydehi Institute of Health Sciences and Research Centre, Bangalore, Karnataka, India from January 2018 to December 2019. A total of 100 participants were divided into four groups of 25 each. Group I were healthy controls, Group II were DM patients without CKD, Group III CKD stage 3 and more without DM and Group IV CKD stage 3 and more with DM. Serum creatinine, urea, estimated Glomerular Filtration Rate (eGFR), calcium, phosphorous and magnesium levels were estimated in all the groups. Analysis of Variance (ANOVA) and Pearson’s correlation was used to statistically analyse the data. Results: The Group III participants who had CKD but no DM were relatively younger in age (mean age 48.5±5.5 years) compared to other groups and there was a significant difference in the age group between four groups (p-value 0.0113). Though there was a male preponderance in all the four groups, the gender difference was not significant. Significant difference in the Mg was observed between the four groups (p-value <0.001). The DM group showed low serum magnesium. CKD patients with and without DM showed high but within reference range Mg levels. Sub-group analysis revealed DM patients on haemodialysis had lower Mg level as compared to non DM. Mg levels in CKD showed significant positive correlation with phosphorous levels (r-value 0.5002, p-value 0.0002). Conclusion: High levels of Mg in late stages of CKD are expected but CKD with DM had relatively low Mg level. Low Mg level was also seen in DM patients on haemodialysis.

Effect of Hip/Shoulder Width Ratio on the Spread of Spinal Anaesthesia in Term Parturients: A Cross-sectional Study

Introduction: There is increased cephalad spread of spinal anaesthesia with similar dose of hyperbaric bupivacaine in parturients with greater hip width and shorter shoulder width. Aim: To determine the effect of Hip and Shoulder width Ratio (HSR) on the spread of spinal anaesthesia in term parturients. Materials and Methods: The present study was a prospective cross-sectional study conducted in the Department of Anaesthesiology, Regional Institute of Medical Sciences, a tertiary care centre, at Imphal, Manipur, India, from October 2019 to September 2021. A total of 92 parturients aged 18-40 years of age, American Society of Anaesthesiologists (ASA) I and II, undergoing elective caesarean section under subarachnoid block were enrolled. With the parturient in lateral position, a 25G spinal needle was inserted in the L4-L5 interspace. A 2 mL of 0.5% hyperbaric bupivacaine was injected intrathecal in 10 seconds. Age, height, weight, Body Mass Index (BMI), HSR and Vertebral Column Length (VCL) were recorded. Spinal anaesthesia spread was assessed at 0,5,10,15,20,25,30 minutes after the procedure with pin prick test starting from the anaesthetised area and continued cephalad till the sensation changed from the dullness to sharp pain in both the mid-clavicular lines. Statistical analysis of the data obtained was done using Windows based Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age, weight, height and BMI were 28.82±6.2 years, 62.36±5.8 kilograms, 158.63±4 centimetre, and 24.77±2 Kg/m2, respectively. HSR and shoulder width had a significant correlation with the cephalad spread of spinal anaesthesia with r=-0.672 and p-value <0.001 and r=0.369 and p-value <0.001, respectively. Conclusion: The HSR and shoulder width has a significant correlation with spread of spinal anaesthesia with a given dose of 0.5% hyperbaric bupivacaine in parturients. The study should expect more cephalad spread of anaesthesia in parturient population when the HSR >1.

Effect of Long-term Oxygen Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Clinical Study

PJ Sruthi Raghunath, Poriyanganattu Thankappan Anandan, N Safreena Mohamed

Introduction: Long-Term Oxygen Therapy (LTOT) has the potential to improve the mortality and morbidity in Chronic Obstructive Pulmonary Disease (COPD) patients. Aim: To assess the effect of LTOT on the Quality of Life (QoL) in stable COPD patients with severe resting hypoxemia. Materials and Methods: This was a prospective observational study conducted in a tertiary care teaching hospital in Kozhikode, Kerala, India on stable COPD patients with severe hypoxemia who were newly initiated on home LTOT for ≥15 hours per day. Health Related Quality of Life (HRQoL), modified Medical Research Council (mMRC) grade of dyspnoea, frequency of exacerbations and adherence to treatment on LTOT were studied. Total of 60 patients were followed-up for one year. Significance of mean was tested using paired t-test and association between qualitative variables was tested using Chi-square test. The p-value <0.05 was considered statistically significant. Results: Out of all, 7 patients died during the study period and 53 patients were included in the final analysis. The mean total St.George’s Respiratory Questionnaire (SGRQ) scores at 3, 6 and 12 months improved to 53.73±13.2, 53.97±13.22 and 54.63±13.16, respectively, from a baseline score of 72.51±8.88. At the end of 12 months of LTOT, 22 (41.51%) patients did not have exacerbations and 31 (58.49%) patients had exacerbations. There was no statistically significant improvement in dyspnoea after one year of LTOT. Among the 53 patients, who completed one year follow-up, 36 (67.92%) participants were adherent and remaining 17 (32.07%) participants were non adherent to LTOT. Conclusion: The LTOT improves the HRQoL in stable COPD patients with severe hypoxemia. Use of domiciliary oxygen for atleast 15 hours per day can reduce the number of COPD exacerbations.

Role of Biomarkers (Interleukins (IL)-2,5,6,16,17,1b) in Saliva and Serum for Diagnosis of Pulmonary Tuberculosis and for Monitoring Response to Intensive Phase Treatment

Megha Pradeep, Nitin Sinha, Parul Goyal, Shyam Kumar, Annie Singh, Ishaan Singh

Introduction: Majority of the currently used diagnostic tests for Pulmonary Tuberculosis (PTB) have variability in sensitivity and specificity in diagnosing PTB. Therefore, evaluating new biomarkers in easily obtainable samples like serum and saliva can contribute to the diagnosis of PTB. Aim: To evaluate the role of Interleukins(IL)- 2,5,6,16,17,1βin the diagnosis of PTB by comparing their levels in Other Respiratory Diseases (ORD) group and monitoring the response to treatment in PTB group. Materials and Methods: This prospective observational study was conducted between January 2021 to May 2022 in a tertiary care hospital in New Delhi, India. A total of 80 cases were taken of which 40 cases of PTB and 40 cases having diagnosis of ORD were studied. IL-2,5,6,16,17,1βlevels were measured in saliva and serum using Enzyme Linked Immune Sorbent Assay (ELISA) kits. These IL were also measured in diagnosed PTB patients in serum and saliva after two months of treatment. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0. Kruskal Wallis H Test, Wilcoxon signed-rank sum test, Chi-square test and Fisher’s exact test were applied at appropriate areas and a p-value <0.05 was taken as significant. Results: On comparing the levels of IL between serum and saliva in PTB group at baseline, IL-2, IL-17 levels were higher in serum while IL-5, IL-1βlevels were higher in saliva with these results being statistically significant (p-value <0.001). However, after two months of treatment, the levels of IL-2, IL-16 decreased significantly in both serum and saliva whereas IL-17 level decreased significantly only in serum after treatment. None of the IL showed significant difference in levels between serum and saliva in PTB and ORD groups. Conclusion: The diagnostic role of IL in PTB could not be established whereas IL-2, IL-16 and IL-17 can be used for monitoring response to treatment as the levels decreased significantly with treatment.

Variations in Superficial Veins of Neck among Population of Eastern India in the Light of Embryological Explanation: A Cadaveric Cross-sectional Study

Susmita Ghosh, Anup Shyamal, Mithu Paul, Oyndrila Sengupta, Sibani Mazumdar

Introduction: Development of veins of head and neck is complex. Variations in the venous architecture of head and neck includes persistence or complete obliteration of communication between Internal Jugular Vein (IJV) and External Jugular Vein (EJV) and also partial obliteration in EJV. Knowledge of variations in venous architecture is beneficial to avoid injuries to these veins during interventions like EJV cannulation for diagnostic and therapeutic purposes. Aim: To study the variations in the venous architecture of the neck in the cadavers. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India during December 2017 to December 2019. Total 26 specimens of both male and female cadavers were dissected, and variations in the venous architecture was noted, also each variation was explained in the light of embryology. Results: Retromandibular Vein (RMV) was found to be undivided in all 10 of the variations found in the eight male and two female cadavers. EJV was found to be absent in one specimen among 26 dissected. Communication between IJV and EJV was found in one specimen. In another specimen, EJV was found to be draining into IJV which can be embryologically seen as a communication between IJV and EJV while the caudal part of EJV had degenerated. Conclusion: Undivided RMV, particularly absent posterior division is not very uncommon in male and female in this ethnicity. Absence of common facial vein was more common in male as compared to female. Persistent communication between EJV and IJV were also more in male. Moreover occurrence of facial vein drainage into EJV was also remarkably high.

Clinicopathological Spectrum of Vulvar Lesions-A Retrospective Study

Sesha Deepthi Pratti, Pratti Lohi S Rajlaxmi, Yadavalli RD Rajan

Introduction: Vulvar lesions constitute a wide spectrum ranging from non neoplastic inflammatory lesions to malignancies. Some show nodular masses and others remain asymptomatic. This poses challenges to clinicians in differentiating non neoplastic inflammatory dermatoses from benign and malignant lesions. Along with the clinical history and physical examination, a biopsy of the lesion plays an important role in proper diagnosis and treatment. Aim: The aim of the present study was to identify the morphological spectrum of vulvar lesions with clinical and histological findings. Materials and Methods: This was a retrospective observational study conducted in the Konaseema region of India for two years from January 2019 to January 2021. A total of 85 female patients with vulvar lesions were included in the study. Biopsy samples were obtained from all the 85 cases and were formalin-fixed, routinely processed, and paraffin embedded. Haematoxylin and Eosin (H&E) staining was done. Special stains were done wherever necessary. The results were analysed using Microsoft excel. Results: The age of patients ranged from 18-88 years. The most common age of patients was in the 4th decade (30 cases amounting for 35.29%). The mean age of the study population was 39.5±15 years. Among the 82 cases, 40 (48.78%) were non neoplastic lesions, and 42 (51.21%) were neoplastic lesions. Among the neoplastic category, 27 (64.2%) were benign lesions and 15 (35.71%) were malignant lesions. The non neoplastic category included five infections (12.5%) and 35 non infectious inflammatory lesions (87.5%). The infections included one case of MC and 4 cases of condyloma acuminatum. The non infectious, and non neoplastic inflammatory lesions included 10 cases of Lichen Sclerosus Atrophicus (LSA), one case of Lipomatoushamartoma, four cases of Lichen planus, six cases of epidermal cysts, 10 cases of Bartholin cysts and four cases of Gartner duct cyst. The benign lesions in the neoplastic category included four cases of Hidradenomapapilliferum, four cases of Aggressive Angiomyxoma (AA), 12 cases of Fibroepithelial Stromal Polyps (FEP), and a case of Leiomyoma. The malignant lesions included 14 cases of squamous cell carcinoma and a case of extramammary Paget’s disease. Conclusion: Vulvar lesions can be due to eclectic causes and pose a diagnostic difficulty both clinically and histopathologically due to their similar presentation. Thorough clinical and pathological examination along with proper clinicopathological correlation is required for accurate diagnosis and treatment.

Clinical and Radiological Features of Seizures in Children Admitted in the PICU at a Tertiary Care Hospital in North-eastern India: A Retrospective Study

Introduction: A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behaviour, or movement, which affect persons of all ages, but are particularly common in childhood. Seizure is a serious neurological symptom in the Paediatric Intensive Care Unit (PICU), yet data on the clinical spectrum of seizures occurring in the PICU setting in India are scarce. Aim: To determine the aetiology, clinical and radiological features of seizures in critically ill children admitted to PICU at a tertiary care hospital. Materials and Methods: This retrospective study was conducted at Gauhati Medical College and Hospital, Guwahati, Assam, India, from April 2017 to September 2018. A total of 253 children aged between 29 days to 12 years, admitted to PICU with seizures were enrolled in the study. Data regarding demographics, diagnosis, clinical seizures, associated diagnosis, Electroencephalogram (EEG) features, imaging, length of stay in PICU, and in-hospital mortality were collected. Data was presented in frequencies, mean, standard deviation. Results: In present study, male to female ratio was 1.5:1 with mean age of 48.9±44.5 months. The most common causes of seizures in PICU setting were acute symptomatic in 185 (73.1%) and epileptic in 68 (26.9%) patients. Central Nervous System (CNS) infections constituted 15.8% of the PICU admissions following seizures. Most frequent co-existent diagnosis at admission was infectious diseases in 96 (38%) patients, followed by pulmonary diseases in 28 (11%) and cardiologic diseases in 14 (5.5%). Conclusion: The CNS infections are the most common cause of acute symptomatic seizure, while non infectious diseases such as metabolic disorders, epilepsy and immune disorders also contribute to seizure occurrence in PICU. Identification of common seizure aetiologies in PICU is important step for a prompt and effective treatment.

An Outcome Analysis of Asymptomatic COVID-19 Patients Presenting with Angina- A Retrospective Study

Dipankar Ghosh Dastidar, Rakhi Sanyal, Nandita Ghosh Dastidar, Tirna Halder

Introduction: Cardiovascular disorders have long been considered as one of the leading causes of mortality in India, which when presented with concurrent Coronavirus Disease (COVID-19) infection becomes even more fatal. Evidence suggests that COVID-19 affects the cardiovascular system by causing exuberant cytokinaemia, which results in endothelial inflammation and microvascular thrombosis, leading to multiorgan failure. Aim: To analyse the outcome of the asymptomatic COVID-19 patients presenting with cardiac angina during the second wave of COVID-19 in India. Materials and Methods: This is a retrospective data analysis of asymptomatic COVID-19 patients hospitalised with angina that was conducted between April 2021 to June 2021 at Bardhhaman Medical College and Hospital located at Bardhdhaman district of West Bengal, India. A total of 1235 patients underwent all regular biochemical, haematological and cardiac investigations after undergoing test for COVID-19 test. Data was retrospectively collected. The outcome of these patients was analysed. Estimation of mean, standard deviation, percentage, p-value (from Pearson’s correlation) was performed to establish the aim of the study. Results: Seventy six out of 1235 patients tested positive for asymptomatic COVID-19. The mean age of this study population was 55.075±10.95 years, of which were 55 male and 21 female. Hypertension was the most prevalent co-morbidity followed by diabetes, 73 (96%) presented with chest pain. A total of 47 (62%) of these 76 patients had ST Elevated Myocardial Infarction (STEMI). 11 (14.4%) underwent Percutaneous Coronary Intervention (PCI) whereas 36 (47.3%) underwent fibrinolytic therapy with tenecteplase, followed by secondary PCI in 27 (75%) of them. Rest 29 (38%) were medically managed for unstable angina. Mortality rate was as low as 6.5%. Age and co-morbidity were the contributing factors for STEMI among asymptomatic COVID-19 patients. Conclusion: The results indicate that age and co-morbidity are the factors, which lead to death or increases the life risk among patients with asymptomatic COVID-19. In this study, we have established that for the current patient population STEMI and age are negatively correlated. Medical management with thrombolytic agent became a lot more accepted in this scenario. PCI still remains the gold standard to treat myocardial infarction. It is recommended that there should be an ICMR guided protocol for the management of such cases with the concurrent COVID-19.

Patient’s Perspective of Preoperative Anxiety and Need for Support- An Observational Study

C Vidya Shree, Ravi Madhusudhana

Introduction: Majority of the patients undergoing elective surgery generally experience anxiety. Preoperative anxiety causes emotional distress and needs support to cope. Aim: To evaluate the prevalence of preoperative anxiety in patients undergoing elective surgery and to examine association between the intensity of anxiety and need for assistance. Materials and Methods: An observational study was conducted at Sri Devaraj Urs Medical College, Kolar, Karnataka, India on 100 participants. The inclusion criteria were- age >18 years of either sex belonging to American Society of Anaesthesiologists (ASA)- Physical Status (PS) grade I or II and undergoing elective surgery. After obtaining informed consent, a questionnaire including both Amsterdam Preoperative Anxiety Information Scale (APAIS) and Numeric Rating Scale (NRS) to measure anxiety was given to the patients in preanaesthetic evaluation clinic by anaesthesiology resident one day prior to the scheduled surgery. The questionnaire included a semi-dichotomous scale (yes/no) for anxiety assessment; to quantify the intensity of anxiety levels the questions on APAIS were given on 5-item scale (not at all/somewhat/moderate/moderately-high/extremely) and NRS on 4-item scale (no anxiety/mild/moderate/severe). Results: The prevalence of anxiety was 100%.The mean age was 43.3±11.9 years. The majority (53%) were females. According to NRS, majority of patients undergoing major surgeries had higher mean anxiety levels (6.95±1.96). APAIS anxiety about anaesthesia was 4.78±2.1 and about surgery was 5.52±1.9. A cut-off of 13 on the APAIS anxiety scale had a sensitivity of 90% and a specificity of 81.1%. A cut-off of 3.5 on the NRS scale had a sensitivity of 72.7% and a specificity of 65.2%. Conclusion: All the patients undergoing elective surgery should be subjected for preoperative anxiety assessment and those with higher anxiety levels requiring support should be addressed to have better postoperative outcomes. Grade of surgery had a significant role in causing anxiety. Hence both Anaesthesiologist and Surgeons should be involved in counselling the patient.

Tumour Budding as a Predictive Factor for Lymph Node Metastases in Preoperative Oral Cancer Biopsies: A Retrospective Study

Introduction: The enormous advancement in understanding of Oral Squamous Cell Carcinomas (OSCCs) has not been accompanied by a significant reduction in the high morbidity and mortality rates associated primarily with disease recurrence and lymph node metastases. Aim: To evaluate the tumour budding as an independent prognostic marker to predict lymph node metastasis in preoperative biopsies. Materials and Methods: The present retrospective study was conducted in the Department of Pathology, Guntur Medical College (tertiary care centre), Andhra Pradesh, India, from January 2018 to December 2021. Samples was collected from 32 patients with preoperative diagnostic oral cavity biopsies, who also underwent resection with cervical lymph node dissection. The degree of differentiation, preoperative tumour budding, postoperative tumour budding, and intratumoural budding in preoperative biopsies were all assessed histologically in each case. The results were analysed using Chi-square test, Kaplan-Meier method and log-rank test. Results: Thirty two OSCC cases were examined by Haematoxylin and Eosin (H&E) stained slides. By using univariate analysis, the histological factors like depth of invasion (p-value=0.04), pattern of invasion (p-value=0.004), presence of preoperative tumour budding (p-value=0.008), postoperative tumour budding (p-value=0.004), intratumoural tumour budding (p-value=0.019), and sex (p-value=0.03) all significantly associated with risk of lymph node metastasis. Other clinical and histological factors, including age, the largest tumour size, histological grade, Lymphovascular Invasion (LVI), Perineural Invasion (PNI), and stromal response, did not significantly associate with the probability of lymph node metastasis. Conclusion: The potential of morphological features, such as Tumour Budding (TB) evaluated in OSCC diagnostic preoperative biopsies may aid in identifying patients who may benefit from more aggressive treatments.

Clinical Presentation of COVID-19 and Correlation of Severity with Laboratory Parameters among Children Admitted with Severe Acute Respiratory Infection- An Observational Study

T Usha Rani, C Nirmala, Vinodh Kumar Mandala, Maria, Karthik, Rakesh Kotha

Introduction: On March, 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In adults it causes mild to severe infections, but in children it usually causes asymptomatic or mild illness. Being a new pandemic, it is prudent to analyse the clinical profile, laboratory parameters and severity interpreters in children to formulate optimal management protocols. Aim: To determine the clinical and laboratory profile of children hospitalised for Severe Acute Respiratory Infections (SARI) and to evaluate the correlation between clinical severity and laboratory parameters- C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) and thrombocytopenia. Materials and Methods: The present study was a prospective observational study which was undertaken for the duration of seven months from 1st April to 30th November 2020. The study included children aged 1 month to 12 years with the criteria of SARI and who were Coronavirus Disease-2019 (COVID-19) positive. Test parameters such as Complete Blood Count (CBC), CRP, serum electrolytes and kidney function tests were performed at local laboratory as per standard guidelines. The correlation of laboratory parameters (thrombocytopenia, CRP and NLR) with disease severity was done with Pearson’s Rho correlation coefficient. Chi-square test was used for statistical analysis. Results: A total of 118 (10.2%) children were tested positive for COVID-19, 71 (60.17%) were boys and 47 (39.83%) were girls. The commonest clinical symptoms were fever and tachypnea. Gastrointestinal symptoms were found in 54 (45.76%) of the cases. Myocarditis and shock were noticed in 10 (8.47%) children. In 25 (59.52%) of severe COVID-19 cases, NLR was >3.5 and 18 (42.86%) had thrombocytopenia. Seventeen children died of the disease with a mortality rate of 14.41%. Platelet count and NLR ratios were significantly correlated with disease severity (p≤0.05). Conclusion: Markers such as NLR and thrombocytopenia which can be used efficiently to assess the severity even in low resource settings, are relevant to a developing country like India. The ratio of neutrophils to lymphocytes can be used as a prognostic marker in resource-constrained settings.

COVID-19 Vaccine Acceptance and its Associated Factors among Pregnant and Lactating Women in Coastal Karnataka, India: A Cross-sectional Study

Shahul Hameed, K Chethana, Shahla Ahmed Shaffi, Thouseep, KG Kiran

Introduction: Coronavirus Disease-2019 (COVID-19) has become a global threat. Despite the hazard of the pandemic and availability of COVID-19 vaccines, a major hindrance exists related to vaccine hesitancy. The acceptance of vaccine among pregnant and lactating women widely differs in countries. Aim: To assess the COVID-19 vaccine acceptance and the factors influencing it among pregnant and lactating women. Materials and Methods: A cross-sectional study was conducted at four selected Primary Health Centres (PHCs) of Dakshina Kannada district, Karnataka, South India, from October 2021 to December 2021 among 350 pregnant and lactating women. A questionnaire was developed based on the literature review and validated by two subject experts regarding knowledge of COVID-19 vaccines, perceptions, attitude and their vaccination status and information was collected using questionnaire. Perceptions and attitude were scored based on Likert scale. Predictors of COVID-19 vaccine acceptance were identified using univariate analysis. Further, multivariate regression model was used to obtain the Adjusted Odds Ratios (AOR) and Confidence Intervals (CI) using Statistical Package for the Social Sciences (SPSS) software version 27.0. Results: Study participants included 247 (70.6%) pregnant women and 103 (29.4%) lactating women. Among them 218 (62.3%) were aware that pregnant women can take the vaccine and 184 (52.6%) were aware that lactating women can take the vaccines. Overall vaccine acceptance among the study participants was 208 (59.4%). Vaccine acceptance was significantly higher among pregnant women (AOR: 3.02; CI: 1.58-5.77), women living in nuclear families (AOR: 4.27; CI: 2.31-7.89) and those with a positive attitude (AOR: 17.48; CI: 9.52-32.09) as compared to their counterparts. Conclusion: The study highlights that vaccine acceptance was higher in pregnant women as compared to lactating mothers. Improving the awareness and acceptance of COVID-19 vaccination to overcome the fear of vaccination would help to control the disease.

Comparison of Microneedling with Platelet Rich Plasma vs Minoxidil (5%)+Finasteride (0.1%) Topical Therapy in Androgenetic Alopecia: A Randomised Clinical Study

Arphool Khan, Deepika Agarwal, Ankur Talwar

Introduction: Androgenetic Alopecia (AGA) is a progressive loss of hair in a patterned distribution for which treatment selection is limited. Long-term efficacy, safety and cost leads to low compliance rate. Among various treatment modalities (medical and surgical) available, microneedling and Platelet Rich Plasma (PRP) are emerging as a newer, useful and safe non surgical treatment regime. Aim: To evaluate the effectiveness and safety of microneedling with PRP versus minoxidil (5%) + finasteride (0.1%) topical therapy in AGA. Materials and Methods: This randomised clinical trial was done at Department of Dermatology, Venereology and Leprology (DVL), Hind Institute of Medical Sciences, Safedabad, Barabanki, Uttar Pradesh, India, from November 2021 to November 2022. Total of 60 adult males clinically diagnosed with AGA were enrolled and randomised into group 1 and group 2. Subjects in group 1 were treated with microneedling+PRP and group 2 were advised minoxidil+finasteride topical therapy. Microneedling alongwith intradermal injection of autologous PRP was done every month for four consecutive months in group 1 (n=30) while 1 mL of minoxidil (5%)+finasteride (0.1%) lotion was advised to be applied over dry scalp twice daily for four months in group 2 (n=30) patients. Both groups were followed-up for next two months. Hair density was assessed by Hamilton Norwood Scale using photographic and dermoscopic images and patients self-assessment scores. Data assessment was done by Chi-square test. Statistical Package for the Social Sciences (SPSS) version 26.0 was used to analyse data and p-value for significance was established at <0.05. Results: Patients in group 1 with mean age 27.9±4.15 years showed almost similar increase in hair density compared to group 2 with mean age 25.8±3.94 years, as assessed by patient assessment score, photography, dermoscopy, Hamilton Norwood scale at six months of study (p-value >0.05), however onset of action was quicker in group 1. Investigator assessment on improvement in hair density using Hamilton Norwood Scale at three months (p-value=0.920) and six months (p-value=0.995) showed that microneedling+PRP therapy is as effective as minoxidil+finasteride lotion since the difference between results of both groups was not statistically significant. Conclusion: Microneedling and PRP although safe, effective and promising treatment modality in AGA is comparable to minoxidil+finasteride topical therapy.

Correlation of Pain and Spasticity with the Quality of Life in Individuals with Spinal Cord Injury

Introduction: After Spinal Cord Injury (SCI), life is associated with risks of many musculoskeletal problems which affect the life of an individual. There is a need for an early assessment for neurological functions and physical activities. Aim: To assess the correlation of pain and spasticity with Quality of Life (QoL) in individuals living with SCI. Materials and Methods: This cross-sectional study was conducted at Axon Spine Hospital, Ahmedabad, Gujarat, India, from January 2022 to April 2022, which comprised of 54 participants. Demographic details, American Spinal Injury Association (ASIA) scale, pain with Numeric Rating Scale (NRS), spasticity with NRS and World Health Organisation Quality of Life Brief (WHOQoL-BREF) had four domains, 26-items questionnaire regarding different aspects of life were recorded. Categorical data has been presented as frequencies and percentages and quantitative data as means and standard deviations. Linear correlation analysis of WHOQoL-BREF with pain and spasticity respectively has been done. Level of statistical significance was 5%. Results: The mean age of participants were 30.54±7.6 years and the male to female was 39:15. Out of 54, total 39 (72.22%) had complain of pain and total 38 (70.38%) reported spasticity. Mean score of pain intensity is 4.1±3.4 and spasticity is 2.7±2.4. WHOQoL-BREF means of 4 domain score-physical health domain 54.05±18.56, psychological health domain 58.14±11.95, social relationship domain 59.14±13.59, and environmental domain 56.29±18.58. There was a negative linear correlation between pain (r-value=-0.489) and spasticity (r-value=-0.063) with WHOQoL-BREF. Conclusion: Pain is correlated with QoL, which was lower in people living with SCI along with some associated conditions like spasticity affecting physical activities.

Dose and Duration Dependent Effect of Fluoxetine on Dorsolateral Lobe of Prostate of Albino Rats-An Experimental Study

Alka Aggarwal, SL Jethani, RK Rohatgi, Juhi Kalra

Introduction: Fluoxetine is a prototype drug of the Selective Serotonin Reuptake Inhibitors (SSRIs) group of antidepressants. SSRIs help prostatic disease patients by improving quality of life in terms of decreased requirement of anti-inflammatory and antibiotic medication, decreasing the pain in the genital area, pain, and difficulty during urination, and improving urinary flow. Aim: To investigate histological changes in the prostate (dorsolateral lobe) produced by different doses (10, 20 and 40 mg/kg/day) of fluoxetine given for different duration (Phases) in adult male albino rats. Materials and Methods: An experimental study was done in the Anatomy Department, Himalayan Institute Medical Sciences (HIMS), Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India. The duration of the study was twelve months from May 2009-April 2010. Present study was done on 36 adult male albino rats divided into Control (Group 1) and Experimental (Group 2, 3 and 4). Rats received 10 mg/kg/day, 20 mg/kg/day, and 40 mg/kg/day of fluoxetine intraperitoneally (I/P) for phases of 2 weeks, 4 weeks, and 12 weeks. Prostate (dorsolateral lobe) tissue was collected, processed, and examined in a light microscope after Haematoxylin and Eosin (H&E) staining. Morphometric and statistical analysis (mean, standard deviation and student’s t-test) was done. Results: Group 2 rats received fluoxetine for 12 weeks, Group 3 rats received fluoxetine for 4 weeks and 12 weeks, and Group 4 rats received fluoxetine for 7-10 days showed histological changes in the dorsolateral lobe of the prostate gland and stroma in the form of Smooth Muscle (SM) hypertrophy, epithelial cell changes (become cuboidal to flatten), epithelial cell degeneration, decreased diameter of the prostate acinus, and decrease in epithelial infoldings. Conclusion: Fluoxetine (SSRI) alters the histology (both glandular acini as well as stroma) of the dorsolateral lobe of the prostate if used in low doses for a long duration, moderate doses for a few weeks and also for a long duration, and high dose for one week. This changed histology might be helpful in relieving the symptoms, pain, and discomfort felt by prostatic disease patients.

Knowledge, Attitude and Self-efficacy of School Teachers towards Students with Epilepsy in Haryana, India: A Cross-sectional Study

Radhamohan Rana, Sanjay Kumar, Mahesh Kumar

Introduction: Epilepsy is the commonest childhood neurological disorder mostly affecting children in the first decade of life. Globally, school teachers have many false beliefs and misinformation about epilepsy. The knowledge and attitude of teachers towards students with epilepsy have a huge impact on their future life. Aim: To evaluate the knowledge, attitude and self-efficacy of school teachers towards students with epilepsy. Materials and Methods: A cross-sectional study was conducted from 20 August 2022 to 31 October 2022 at BPS GMC for women, Khanpur Kalan, Sonepat, Haryana, India, using self-administered questionnaire including randomly selected 427 school teachers from 15 schools of Haryana (India). The questionnaire included the scale of Attitude Towards Persons with Epilepsy (ATPE), a summated rating scale for measuring knowledge and attitude. Several additional knowledge and attitude items were also evaluated. Effect of socio-demographic characteristics of participants were also evaluated as a predictor of knowledge and attitude. Data was collected and statistics were applied using Statistical Package for the Social Sciences (SPSS) software and p-value <0.05 was considered as statistically significant. Results: The mean age of teachers in the present study was 37.7±8.8 years (range=23-58 years). Among the total participants, 79.4% were female teachers. They had approximately two times higher probability of getting a good knowledge and attitude score. Age group 30-50 years had higher chances of getting a good knowledge score. Teaching experience has a positive effect on the knowledge score. Awareness about epilepsy was quite high (85%). Only 14% teachers had previous or current contact with persons with epilepsy. A total of 10.7% teachers had performed first aid management of seizures and 9% of teachers thought that epilepsy is contiguous. The median score for knowledge and attitude were 6 (range=-21 to +26) and 25 (range=-19 to +62), respectively showing overall good knowledge and attitude score. But there were deficits in individual items score and first aid management of seizures. Conclusion: The overall result of study indicated a good knowledge and attitude towards students with epilepsy, among the participant teachers. Although there were some deficient areas which need to be improved regarding knowledge and attitude and first aid management of seizure episodes. There is a pressing need for integration of educational training courses about epilepsy in the teachers training curriculum.

Efficacy of Comforting Manoeuvres in Reducing Anxiety in Patients undergoing Caesarean Section under Regional Anaesthesia- Randomised Control Trial

Introduction: Comforting manoeuvres like hand holding and calming conversation with the parturients may decrease anxiety among them by establishing a rapport and building confidence and trust to alleviate fear. Aim: Evaluation of role and effectiveness of comforting manoeuvres (hand holding and calming conversation) in relieving patient’s anxiety and subjective satisfaction undergoing caesarean section in regional anaesthesia. Materials and Methods: This was a single-blind randomised control trial conducted in the Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from February 2022 to June 2022. There were 144 parturients, in the age group 18-40 years, American Society of Anaesthesiology (ASA) II, and admitted for Caesarean section under regional anaesthesia. Patients were randomised into four groups- control group (C)- group 1, only calming conversation (CC)- group 2, only Hand Holding (HH)- group 3 and Hand Holding and Calming Conversation (CH)- group 4. Demographic details of the patient, Visual Analogue Scale (VAS) for anxiety, Blood Pressure (BP), Heart Rate (HR), Respiratory Rate (RR) and patient satisfaction score on a 1-5 Likert scale were noted preoperatively. VAS was noted preoperatively and postoperatively for all groups. Patient Satisfication Score (PSS) was noted postoperatively. The HR, Mean Arterial Pressure (MAP), and RR were noted every five minutes for 20 minutes, then every 10 minutes till the end of the surgery, and 30 minutes after surgery. Any anxiolytic medication used intraoperatively was documented for all groups. Results: Total of 144 participants were analysed with 36 patients in each of four groups. Mean age (years) for group 1 was 23.36, group 2 was 23.25, group 3 was 23.17, and group 4 was 23.22. Baseline VAS was similar in all the groups. Postoperative VAS differed significantly- group 1 was 3.33±0.926, group 2 was 1.53±0.845, group 3 was1.47±0.845 and group 4 was 1.11±0.708. PSS also differed significantly- for group 1 was 2.42±0.732, group 2 was 3.50±0.697, group 3 was 3.67±0.717 and group 4 was 3.92±0.692. Stabilisation of haemodynamics in terms of BP, HR and RR was significantly better in all three interventional groups as compared to the control group. Conclusion: All three manoeuvres (hand holding, calming conversation alone and in combination) were equally effective in reducing perioperative anxiety, stabilising the haemodynamics and improving patient satisfaction in parturients undergoing caesarean section under regional anaesthesia. Comforting manoeuvres are simple, easy to practice and without any financial implication.

Effect of Oral Drug Apremilast on Histopathological Changes in Patients of Plaque Psoriasis: A Prospective Observational Study

Yogendra Singh, Ashish Bagaria, Bhawna Bagaria, Yogesh Gupta

Introduction: Psoriasis is a chronic non infectious recurrent papulosquamous inflammatory disorder characterised by vascular alterations such as angiogenesis, dilatation, increased endothelial venule generation, epidermal keratinocyte hyperproliferation, and aberrant differentiation, and lymphocytic invasion of T-cells. The aetiopathogenesis of disease is influenced by both hereditary and environmental factors. Pathogenesis is significantly influenced by immune dysregulation, which affects both innate and acquired immunity. A relatively recent medication for the management of moderate to severe plaque psoriasis is apremilast, an oral phosphodiesterase-4 inhibitor. Compared to other immune-suppressing drugs used in psoriasis apremilast causes no reactivation of tuberculosis or opportunistic infections, does not need dose adjustment in elderly or patients with hepatic impairment, and is not contraindicated in diabetes, ischaemic heart disease, or congestive cardiac failure. Due to its advantage of the absence of the need for laboratory monitoring, the patients on long-term methotrexate can also be switched to apremilast. Aim: To evaluate the histopathological changes in the skin of all plaque psoriatic patients treated with oral drug apremilast. Materials and Methods: This hospital-based prospective study was done in the Department of Pathology at the Rajasthan University of Health Sciences (RUHS), Jaipur, India for a period of one year from February 2020 to January 2021 comparing the efficacy of Apremilast clinically by evaluating plaque psoriasis patients’ by Psoriasis Area and Severity Index (PASI) scores. Patients of all age groups with a clinical diagnosis of psoriasis were subjected to a punch biopsy from an active lesion by a dermatologist. For histopathological examination, biopsy was taken from the lesion before starting treatment with apremilast and after four weeks of apremilast therapy. The subsequent changes in the form of histopathological score and PASI score were analysed and compared with the previous score to study the effect of oral drug apremilast. Results: Total of 100 patients enrolled in the study with the mean age 39.14 years including 59% males and 41% females. Main site of lesion was back, hand and leg. The PASI score at the first visit was 11.28 and at the second visit were 7.27 with the improvement 35.54% which was statistically significant from first visit (p-value <0.001). The histopathological score at the first visit was 15.98 and at the second visit were 10.06 with the improvement 37.1%. Conclusion: Apremilast was found to be a safe and effective treatment for psoriasis patients, and this impact was unaffected by confounding variables.

Evaluation of Hard Tissue, Soft Tissue and Airway Changes Post Twin Block Therapy: An In-vitro Study

Introduction: Aesthetic improvement happens to be one of the main reasons for seeking orthodontic treatment in patients with Angle’s Class II malocclusion. Prognathic maxilla, retrognathic mandible or a combination of both are the main aetiological factors for this malocclusion. Growth modification treatment with different methods can be performed in order to correct skeletal class II malocclusion. Appliance therapy to correct similar malocclusions should immaculately be directed towards addressing the dentoskeletal discord, in order to gain a favourable facial aesthetic result. Aim: To assess the effects of twin block on mandibular length, soft tissue profile and Oropharyngeal Airway (OAW) dimensions in skeletal class II malocclusion patients. Materials and Methods: An in-vitro study was carried out in the Department of Paedodontics in collaboration with Department of Orthodontics and Dentofacial Orthopaedics at Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, from June 2018 to March 2021. Study was done on lateral cephalograms of 15 growing children with Angle’s Class II Division 1 malocclusion in the age group of 9-12 years, who had undergone functional appliance therapy with twin block appliance. Standardised lateral cephalograms were evaluated at pretreatment (0 month) and postactive phase of twin-block therapy (9-12 months). Selected hard tissue, soft tissue and airway landmarks were marked and traced to evaluate hard tissue, soft tissue and airway changes. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: There was a statistically significant increase in effective mandibular length (Condyle-Gnathion) and mandibular base length Gonion-Pogonion (Go-Pog) values (p-value <0.001). Significant decrease in the facial convexity Glabella-Soft tissue Nasion (G-Sn) Soft tissue Nasion-Soft tissue Pogonion (Sn-Pog) was observed and airway dimensions showed significant increase after twin block therapy. Conclusion: Correction of Class II malocclusion by twin block appliance resulted in significant cephalometric changes in the hard tissue profile (increase in mandibular length), together with clinically favourable soft tissue changes and OAW dimensions.

Derivation of Simplified Blood Pressure Percentile Chart for Children Aged 1-13 Years in Southern India: A Cross-sectional Study

Shiva Narain Thiagarajan, Balaji Chinnasami

Introduction: Systemic arterial hypertension is an important cause of adverse cardiovascular events with high morbidity and mortality in adults. Blood Pressure (BP) percentile chart from outside India varies significantly in comparison with Indian charts. Percentile distribution charts have already been developed for adults in various studies but its use is limited in paediatric age group. Aim: To measure blood pressure values of children aged between 1-13 years and derive percentile charts for each age group. Materials and Methods: A cross-sectional study was conducted at SRM Medical College and Research Centre in Kattankalathur, Tamil Nadu, India. Duration of the study was six months from July to December 2021. After Registration of an Institutional Review Board (IRB) approval, 1230 children were recruited and BP was measured using oscillometric method. Blood pressure values were represented as mean with standard deviations. Univariate analyses between blood pressure, age, height, and weight were done with Pearson’s correlation method, and gender differences were tested with Student’s t-test. Results: Study group included 1,230 children with a mean (SD) age of 6.1 (3.4) years. Simplified percentile charts were created using age and gender. Height and weight was not used as it was seen to explain very little variability of BP. 95th percentile values suggested levels indicating hypertension to be 110/71.5, 125/79, 131/83.5 at ages of 1,5 and 10 years, respectively for female while the same for male was 105/70, 124/79, 129/82. Conclusion: Simplified reference tables and charts, and simple convenient thresholds may be useful for rapid screening of hypertension using oscillometric method.

Predicting Difficult Laryngoscopy by Ultrasound Quantification of Anterior Neck Soft Tissue Thickness-A Prospective Observational Study

Vidur Mago, Vivek Chakole, Yatharth Bhardwaj

Introduction: Difficult airway can possess a challenge to intubation and deciding role in morbidity and mortality. Hence, at these times Ultrasonography (USG) can play a vital role in the prediction of a difficult airway. Aim: To determine if USG measurement of anterior neck soft tissue thickness at the hyoid bone, and anterior commissure levels can be used to predict difficult laryngoscopy. Materials and Methods: This prospective observational study was carried out at the Department of Anaesthesia, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences from January 2021 to January 2022. Total 50 patients, aged 20-60 years were included, and scheduled to undergo general anaesthesia. Correlation analysis between roles of screening tests like Mallampati scoring (MMP), Cormack Lehane (CL) grade Neck Circumference (NC), Thyromental Distance (TMD) and USG measurements was done for predicting difficult laryngoscopy. Portable USG machine with a linear frequency probe, measuring tape and laryngoscope blade was required. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The incidence of difficult laryngoscopy was 18% and the mean age of the study participants in the easy group was 44.26 years and in the difficult group it was 45.13 years. The USG measurements were significant (p-value=0.01) in determining difficult intubation, which shows greater validity to predict difficult laryngoscopy. USG measurement along with bedside screening test aids in better identification and assessment of difficult airway. Conclusion: Anterior neck soft tissue thickness measured by USG at the hyoid bone, and anterior commissure levels combined with the screening tests and risk factors might increase the ability to predict difficult airways.

Two-hourly Feeding versus Three-hourly Feeding for Attaining Early Enteral Feed in Low-birth-weight Preterm Babies: A Randomised Controlled Trial

B Sunil, Rahumath Nisha, Pavankumar S Kalla

Introduction: There has been no consensus on whether a two-hour or three-hour feeding interval is safe and economical for preterm neonates. The parameters like feeding tolerance, the occurrence of infection and time required to attain full enteral feed and other outcome need to be clinically proven. Aim: To investigate whether two-hourly or three-hourly feeding interval is better in preterm neonates to ensure full enteral feeding in lesser time. Materials and Methods: The present randomised controlled trial was conducted in the Department of Paediatrics, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India, from January 2021 to June 2021. Hundred preterm neonates, less than 36 weeks of gestation with birth weights between 1 kg and 1.8 kg, were included in the study. Group 1 was subjected to three-hourly feedings and group 2 were subjected to two-hourly feedings. An independent t-test or Mann-Whitney U test was used to analyse GA, birth weight and time of achievement of full feeds. In addition, Chi-square test was used to analyse categorical data. Results: Total 100 neonates were included, in which the age ranged from 5-13 days. There were 50 male and 50 female babies in the present study. Mean time of attainment of full feeds in group 2 was significantly higher (13.72±3.54 days) than group 1 (11.94±3 days). The mean time of achievement of full feeds birth weight 1-1.5 kg was 12.86 days in 3-hourly schedules, and 14.67 days in 2-hourly schedules. When the gestational age increased, the time of achievement of full feeds decreased. Conclusion: The time to achieve full feeds was better in 3-hourly feeding schedules compared to 2-hourly schedules. The feed tolerance was also better in 3-hourly feeding schedules. The incidence of complications was lesser in 3-hourly compared to 2-hourly feeding schedules.

Isolation of Methicillin-Resistant Staphylococcus aureus from Wound Samples during the COVID-19 Pandemic: A Retrospective Study

Shugufta Roohi, Tufail Ahmed, Insha Altaf, Bashir Fomda

Introduction: On March 11th, 2020, the World Health Organisation (WHO) declared the outbreak of the novel coronavirus disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) as a pandemic. This recently discovered β-coronavirus spread instantaneously across mainland China due to human-to-human transmission and crossed international borders aided by intercontinental travel. In most nations, the logarithmic growth of the cases very quickly overwhelmed the healthcare system which led to the overcrowding of the hospitals and led to a sudden surge in Hospital-Acquired Infections (HAIs). Implementation of contact precautions was implemented to control cross-infection. Aim: To determine the effect of Coronavirus Disease-2019 (COVID-19) on the prevalence of HAIs with special emphasis on Staphylococcus aureus (S. aureus). Materials and Methods: This three year retrospective study (September 2018 to August 2021) was undertaken at Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, an apex tertiary care institute in Northern India. A total of 2548 wound swabs samples were collected and processed in the laboratory for the presence of aerobic bacterial isolates. S. aureus was identified using conventional methods and antimicrobial sensitivity was performed by the Kirby-Bauer disc diffusion method. Data was entered in Microsoft excel and later analysed in International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A steady increase in the isolation of Methicillin-resistant Staphylococcus aureus (MRSA) was noted during the study period (60.5% in 2018 to 78.1% in 2021). A statistically significant increase was noted in the detection of MRSA after the onset of the COVID-19 pandemic (p=0.018) despite the reduced number of surgeries conducted in the institution and rigorous execution of contact precautions. Conclusion: There was an increase in the rate of MRSA isolation during the study period. The increase was significantly affected by the onset of COVID-19. To contain the spread of MRSA, novel methods including preoperative screening of patients undergoing elective surgeries and periodic screening of hospital staff need to be implemented along with standard infection control precautions at all times.

Comparative Evaluation of Colour Difference using Different Digital Photography Equipment to Standardise Colour Assessment in Dental Photography

Introduction: Photography has always been thought to be an important part of dentistry. Since the introduction of digital technology; imaging has become simpler and more accessible. Colour matching is critical for the success of restorative and prosthetic dental treatments, also communication with the dental laboratory is still subjective, and further research is needed on this aspect. Aim: To compare the colour difference using different digital photography equipments to standardise colour assessment in dental photography. Materials and Methods: A single blind clinical study was conducted on total 22 participants from December 2020 to June 2021. A spectrophotometer was used to determine the Colour space defined by International Commission on Illumination (CIELAB) values of the right central incisor for each participant. They were then photographed with five different photography equipment along with a grey reference card. The five different groups were: Group A: Canon 1300D Digital Single Lens Reflex (DSLR) with 100 mm lens and pop-up flash (N=22). Group B: Canon 1300D DSLR+100 mm lens+70 GSM white tissue paper (N=22). Group C: Canon 1300D DSLR+100 mm lens with ring flash (N=22). Group D: Canon 1300D DSLR+100 mm lens+ring flash+diffuser (N=22). Group E: Iphone 11 (N=22). CIELAB values were obtained for all the groups using adobe Photoshop software after white balancing. Delta E was calculated by comparing CIELAB values of each group with the spectrophotometer values. The data was tabulated and analysed with one way Analysis of Variance (ANOVA) and Posthoc test using IBM Statistical Package for the Social Science (SPSS) version 20.0 software with p-value <0.05 considered statistically significant. Results: Mean value of Delta E was least in group D (DSLR+ ring flash with diffuser) (5.033) followed by group B (DSLR+ pop up flash with white tissue paper) (6.57), group A (DSLR+pop-up flash) (10.70), group E (Iphone11) (10.74) and highest in group C (DSLR+ ring flash) (11.32). Conclusion: Group D (DSLR+ring flash with diffuser) was determined to be closest to the standard spectrophotometric values for colour assessment in dental photography.

Sonoelastographic Evaluation of Pelvic Adnexal Masses and its Association with Clinicopathological Findings at a Tertiary Care Centre in Western Uttar Pradesh, India

Mudit Jain, Deepti Arora, Ankur Malhotra, Shruti Chandak, Arpit Deriya

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India, for a period of 18 months from January 2020 to June 2021 and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The youngest patient was 16-year-old and eldest was 70 years and the mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses.

Comparative Evaluation of Efficacy of Jati Ghrita and 1% Chlorhexidine Gluconate on Aphthous Stomatitis- A Research Protocol for Randomised Control Trial

Introduction: Aphthous ulcer is seen to be one of the most commonly occurring ailments found among patients that dentists may come across on a daily basis. Taking into consideration, the agents that have been used for treatment of aphthous stomatitis safety, least toxic properties with symptomatic relief and topical application are considered. These days there are few reliable natural remedies which are emerging as a therapy for aphthae. Herbal and polyherbal medicines will alleviate pain, induce healing, prevent infection and lessen inflammation in aphthous ulcers without any adverse-effects. Aim: To evaluate and compare the efficacy of Jati Ghrita and 1% chlorhexidine gluconate on aphthous stomatitis patients. Materials and Methods: A randomised control trial will be carried out for an expected time period of 3-4 months, in the Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Dattatray Ayurvedic Rasashala, Wardha, Maharashtra, India. The study population consisting of 30 patients (age 18-65 years) with aphthous stomatitis will be divided randomly into two groups i.e., Jati Ghrita and 1% Chlorhexidine gluconate, each group consisting of 15 patients. Efficacy will be assessed by patient’s response through Visual Analogue Scale (VAS) and oral physician’s observation-5 point Investigator’s Global Assessment (IGA) scale. The intergroup comparison will be done by Independent sample t-test.

Effect of Deep Cervical Flexor versus Core Stability Exercises on Range of Motion and Function in Individuals with Forward Head Posture-A Research Protocol

Sakshi Padmawar, Deepali Patil

Introduction: The human spine forms cervical and lumbar lordosis and thoracic kyphosis when it is aligned in the sagittal plane against a vertical reference. When the head protrudes forward from the sagittal plane and appears to be in front of the body, it is called Forward Head Posture (FHP). The atlantooccipital joint and upper cervical vertebrae extend, whereas the lower cervical and upper thoracic vertebrae flex. FHP puts more strain on the neck causing problems with the musculoskeletal, neurological, and respiratory systems. The Deep Cervical Flexor (DCF) muscles have been revealed to have an important role in the cervical spine’s support and strengthening. FHP is one of the most typical incorrect postures that has increased in popularity recently. Need of the study: The present study would help to assess the effect of both the techniques, CSE and DCF on pain, range and function in individuals with FHP to help the patient and the therapist in a better approach to rehabilitation. Aim: To compare the impact of Core Stability Exercises (CSE) to DCF exercises on people who have a FHP. Materials and Methods: In this interventional comparative study, a total of 70 patients with FHP and neck pain will be included with Craniovertebral Angle (CVA) less than 50o. They will be divided into two equal groups. After a warm-up, Group A will receive DCF exercises while Group B will receive CSE for four weeks, and pain, range, and function will be assessed at the beginning, after two weeks, and after four weeks of intervention. Pain will be assessed by the Visual Analogue Scale (VAS), range will be evaluated with a goniometer, and function will be assessed by Neck Disability Index (NDI). The statistical tests used will be Chi-square test and the Student t-test.

Oral Stimulation by 3-D Printed Speech-sensory Appliance Series to Evaluate Speech and Associated Oral Sensory Difficulties in Children with Autism Spectrum Disorder: Protocol for Randomised Controlled Trial

Introduction: Oral sensory problems in Autism Spectrum Disorder (ASD) are mainly due to lack of sensory-motor synchronisation and incomplete neuromuscular development. Direct oral stimulation can play a significant role as a part of oral therapy, because the speech outcome by Speech Therapy (ST) has subjective variation and requires a long period of time. The other oral muscular therapy has lack of specificity and sensitivity. However, the direct oral stimulation in the form of appliance therapy has not yet been investigated. Aim: To explore the precise role of Speech-sensory Appliance (SSA) on speech disorder and associated oral sensory problems in ASD children. Materials and Methods: In this single-arm, randomised controlled trial, 40 ASD-diagnosed children between the age group of 4 to 11 years will be involved. The study participants will be split into two groups of 20 each at random. While the other group will be exposed to SSA+ST therapy, one of the groups will undergo SSA therapy. The speech therapist was unaware of the group of children who received both therapies (blind). Analyses of the results will be conducted utilising voice recordings and Visual Analogue Scales (VAS). Before and after therapy, the voice recording graph will be collected. Parents will be given a short questionnaire as part of the VAS to track any changes in feeding behaviour.

Association of Craniofacial Anthropometry and Personality with Impact of Metacognitive and Emotional Intervention among Medical Students: A Research Protocol

Ankit Srivastava, Vilas Chimurkar, Nisha Mani Pandey, Anand Bihari

Introduction: Physiognomic evaluation of the human face has been widely considered in computer-based visual applications to know the characteristic properties of human. This had given rationality for the present study to be planned on craniofacial anthropometry and its relationship with personality traits in medical students. Need of the study: The presence study will find out the association of craniofacial anthropometry with personality traits and also the impact of metacognitive and emotional intervention on personality types and skill of medical students. Aim: Evaluate the effectiveness of different craniofacial anthropometry; cephalic index, forehead width, forehead length, bizygomatic width, bigonial width, upper facial index and facial index with the type of personality traits and impact of metacognitive and emotional interventions on personality among medical students. Materials and Methods: A cross-sectional interventional analytical study on Bachelor of Medicine and Bachelor of Surgery (MBBS) undergraduate students with sample size of 293 will be conducted in Jawahar Lal Nehru Medical College, DMIMS, Wardha, Maharashtra, India. The age group of samples will be 18-30 years. The expected duration of study will be August 2022 to July 2025. The data collection will be carried out for a period of one and half year (January 2023 to June 2024). The tools for data collection shall be craniofacial anthropometric measurement, Big Five Personality Test (BFPT) questionnaire, metacognitive awareness inventory, Emotional Intelligence self-assessment Questionnaire (EIQ), Personal information Questionnaire (PIQ).

Efficacy of Power Breathe Device versus Threshold Inspiratory Muscle Training Device on Inspiratory Muscle Strength in Upper Abdominal Surgery Patients: A Research Protocol

Komal Agrawal, Vishnu Vardhan

Introduction: Surgery care is important in the treatment of a variety of disorders as well as the alleviation of human suffering. Surgery is essential for meeting basic healthcare needs all across the world, although to varying degrees depending on disease subtypes and epidemiological regions. Laparoscopic surgery is now widely established. Benefits of laparoscopic surgery include improved cosmetic results, reduced postoperative pain, and reduced length of hospital stay with patient satisfaction. Upper abdominal surgery initiates a series of physiological events that result in postoperative pulmonary complications such as increased morbidity, mortality, and hospitalisation. Preoperatively in abdominal surgeries, Inspiratory Muscle Training (IMT) devices have been used to reduce postoperative pulmonary complications as well as improve the quality of life of the patients. Need of the study: Surgery is a crucial part of the healthcare system, and it has a direct impact on the respiratory system. With changes in postoperative pulmonary functions, there are limitations in lung volume and capacities such as total lung capacity, vital capacity, and tidal volume. Power breathe devices have been utilised preoperatively in abdominal procedures for inspiratory muscle training and to prevent postpulmonary complications. As a result, the purpose of this study is to see how the power breath device and the threshold IMT device affect inspiratory muscle strength in upper abdominal operations. Aim: To compare the effect of a power breathe device versus a threshold inspiratory muscle training device on inspiratory muscle strength in patients who had upper abdominal surgery. Materials and Methods: The present comparative research protocol is planned to be conducted on 60 patients with upper abdominal surgery with reduced inspiratory muscle strength. The expected study duration is of one year from 2022 to 2023.Total subjects will be randomly divided into two groups, Group-A will receive power breathe plus conventional physiotherapy five days per week and Group-B will receive threshold IMT plus conventional physiotherapy five days per week for period of two weeks. Before initiating the intervention, patients will have their PImax (maximal inspiratory pressure) evaluated using hand-held pressure manometer equipment. After two weeks, patients will be reviewed again using the same outcome measures.

Comparative Evaluation of Antimicrobial Efficacy of Simvastatin Paste and Aloe Vera Paste as a Pulpotomy Medicament-An In-vitro Study

Sakshi Pravin Kabra, Nilima Thosar

Introduction: Pulpotomy is the complete removal of the coronal part of the dental pulp, followed by the application of an appropriate dressing or medicament to promote healing and maintain the viability of the teeth in the dental arch. Aloe vera has anti-inflammatory, antibacterial properties which can be used as a pulpotomy medicament. Simvastatin, a lipid-lowering medication has recently emerged as a potential medicament in regenerative dentistry. It has an anti-inflammatory and antioxidant properties. Hence, it can be used as a pulpotomy medicament. Need of the study: The present study can provide evidence regarding the use of Aloe vera and Simvastatin in pulpotomy with respect to their bactericidal activity, biocompatability and promoting root pulp healing. Aim: To evaluate and compare the antimicrobial efficacy of Aloe Vera paste and Simvastatin paste as pulpotomy medicament against Pseudomonas aeruginosa and E. faecalis Materials and Methods: An in-vitro study will be conducted in Department of Paediatric and Preventive Dentistry at Sharad Pawar Dental College, Wardha, Maharashtra, India, in which Aloe Vera paste and Simvastatin paste will be prepared in an aseptic environment. The antimicrobial activity of simvastatin paste and Aloe Vera paste against E.faecalis and pseudomonas will be assessed using the agar diffusion method. It will be cultured overnight in brain heart infusion broth. On blood agar media, pseudomonas aeruginosa will be inoculated. 4 mm wells will be punched out on plates with a puncher and will be instantly loaded with freshly customised test materials. The agar plates shall then be incubated in an incubator at 37°C for 24 hours and 72 hours before being analysed. Statistical analysis will be done using Chi-square test, ANOVA test and multiple comparision 2k test.

Assessment and Comparison of Sense of Coherence in Young Individuals Participating in the Treatment of their Cleft Lip and Palate Anomalies: A Prospective Interventional Study

Introduction: Cleft lip and/or Cleft of Palate (CL/P) is amongst the most common congenital oral and maxillofacial deformities. CL/P is not thought to be harmful to one’s health. However, even if a cleft is treated early in a child’s development, there are genuine consequences, including the possibility of long-term negative health impacts such as functional and psychological issues. Antonovsky A developed a questionnaire to measure the Sense Of Coherence (SOC). It consists of three elements: comprehensibility, manageability, and meaningfulness. In patients having any kind of deviancy, SOC provides positive experiences such as increased sense of purpose, expectations, spiritual practices, respect and understanding, self-improvement and confidence, and connections have all improved. Need of the study: Undergoing orthodontic treatment along with psychological counselling can improve the mental, emotional and social well-being of cleft lip and palate patients. Aim: To assess changes in SOC of young patients undergoing treatment for cleft lip and palate anomalies. Materials and Methods: The present prospective interventional study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India, and to be conducted on 20 patients of 14 years and below, with cleft lip and palate. Data will be gathered via questionnaires which will be distributed to patients having CL/P undergoing orthodontic treatment. The questionnaires will be collected within half an hour and will be checked, if completed. Patients will be given the same questionnaires at different points of time, i.e., at the start of the treatment, two months, six months and one year after the start of treatment. Statistical Package for the Social Sciences (SPSS) statistical software (27.0) and Graph Pad Prism will be used to analyse the data (version 7.0).

Evaluation and Correlation of Vitamin D Levels and Jaw Bone Mineral Density in Premenopausal and Postmenopausal Female Patients Undergoing Implant Therapy: Protocol for a Cross-sectional Study

Ekta Mukesh Kanojia, Anjali Rajeev Borle, Seema Sathe Kambala

Introduction: Vitamin D deficiency is one of the most common nutritional deficiencies worldwide. The amount and quality of bone at the implant installation site have an impact on the implant’s prognosis however, the effects of menopause on jaw bone remain unknown. Few studies have looked at the prevalence of vitamin D deficiency in India’s general population, but none have looked at the link between vitamin D deficiency (osteoporosis) and postmenopausal women’s jaw Bone Mineral Density (BMD). This is the first study of its sort in India to look at postmenopausal women’s vitamin D levels and jaw BMD. Need of the study: The present study would enhance the relationship between vitamin D levels and BMD in premenopausal and postmenopausal females and will help to conclude the effect of menopause on bone quality and quantity which should be considered in dental treatment. Aim: To evaluate and correlate vitamin D levels and jaw BMD in pre and postmenopausal females undergoing implant therapy. Materials and Methods: This cross-sectional study will include 50 partially or completely premenopausal (n=25) and postmenopausal females (n=25) having edentulous anterior and posterior maxillary and mandibular jaws. Females will be tested to evaluate their vitamin D levels and jaw BMD with Cone Beam Computed Tomography (CBCT) and results will be recorded in Hounsfield Units (HU) using Planmeca romexis viewer software. Chi-square test and Students t-test will be used.

Effect of Musical Therapy on Salivary Cortisol Levels and Oral Health Related Quality of Life in Patients with Fixed Prosthesis- A Research Protocol of Randomised Controlled Trial

Ankita Pathak, Mithilesh Dhamande, Seema Sathe, Anjali Borle, Surekha Godbole

Introduction: Tooth loss exerts a significant psychological impact on adult patients. Also, it affects the psychological aspect of patient’s behaviour, which can have a dynamic effect on an individual’s mind. Many patients feel anxious while facing dental clinics or while getting treated. These stressful situations can cause alterations in neuro hormonal mechanism and can induce cardiovascular events. If the patient’s mind is distracted to listen to music during treatment processes, his or her anxiety levels can be lowered, resulting in maximum compliance. Need of the study: The need of the research is to determine impact of musical therapy on salivary cortisole level. As different therapy such as musical therapy, has achieved significant among alternative therapies as it is not invasive and very helpful to decrease the unfavourable effect of strength on patients mind. Aim: To determine the effect of musical therapy on salivary cortisol levels and Oral Health Related Quality of Life (OHRQoL) in patients under prosthetic rehabilitation with fixed prosthesis. Materials and Methods: This randomised controlled trial will be conducted at Sharad Pawar Dental College and Hospital, Sawangi(M), Wardha on 30 patients undergoing fixed prosthetic rehabilitation. Salivary cortisol levels will be checked in both experimental group and control group, undergoing prosthetic rehabilitation with fixed partial denture. To analyse OHRQoL before and after treatment in both groups. Oral Health Impact Profile (OHIP) will be used, which includes a questionnaire. Following the assessment, correlation of OHRQoL of both groups and their salivary cortisol levels before and after treatment will be done.

Narrative Review on Prenatal, Intrapartum and Neonatal Risk Factors for Cerebral Palsy in Children

Pranali Saurabh Thakkar, Madhavan Govindarajan Iyengar

Cerebral Palsy (CP) is not a disease, however a syndrome advanced characterised by associate aberrant management of movement or posture, that seems early in life and ends up in long motor incapacity. The underlying causes of CP are still poorly understood. Many individual risk factors of CP are known, however less is understood concerning their interaction and the way they could relate to completely different pathophysiological pathways. The risk factors may be prenatal, intrapartum, neonatal or combined. Articles were searched to identify risk factors for CP, published from 2001 to 2021. A total of 43 relevant articles including randomised and non randomised controlled trials, systematic reviews and comparative studies were included in this review. From selected analysis reports, most of the studies enclosed within the review showed sturdy strength of association as a causative factor responsible for CP. From this review, it had been ended that multiple risk factors overcome the defence mechanisms and lead to CP. Although any one factor, if severe, may be sufficient to cause CP so preventive strategies and early intervention for high-risk infants are needed.

Applications of Dermatoglyphics in Dentistry- A Bibliographic Review

Subhashree Mohapatra, Rahul Mohandas

Introduction: Dermatoglyphics is the study of the characteristic ridged skin patterns on the fingertips, palms, toes, and soles of all primates, including humans. Due to this unique and unalterable nature, dermatoglyphics can be used as an excellent tool for population studies, personal identification, and morphological and genetic research. In recent years, dermatoglyphics has drawn a lot of attention in the field of dentistry, as a potential adjunct diagnostic tool in the identification of various orofacial and dental anomalies. Aim: To identify and analyse all the articles published on applications of dermatoglyphics in dentistry. Materials and Methods: A comprehensive search of bibliographic databases was performed by two independent reviewers, from October 2022 to December 2022, using medical sub-heading terms like “Dermatoglyphics”, “Dental”, and “Oral” in several combinations. All types of published studies were included in this bibliographic analysis. The articles were identified, tabulated and analysed to extract the various bibliometric details. Results: A total of 536 citations were achieved cumulatively by 57 publications included in this review. The article that received the maximum number of citations (citation=46) was by Reddy BRM et al., published in the Journal of Clinical and Diagnostic Research in year 2013. Maximum publications (n=46) originated from India. Most of the published articles were focused on application of dermatoglyphics for the diagnosis of dental caries (n=21) followed by malocclusion (n=14). Conclusion: The present bibliometric analysis identifies and analyses the most-cited articles on applications of dermatoglyphics in dentistry. The findings of this review not only provide insight into the scientific evolution in the field but also reveal trends in further research and clinical practice.

An Update on the Recent Diagnostic Modalities of SARS-CoV-2: A Review

Marie Victor Pravin Charles, Arunava Kali, Santhanam Vidyalakshmi

The pandemic of respiratory viral pneumonia initiated as an outbreak during December 2019, at the Hubei region, China. The demanding research work conducted by the scientific community across the globe identified the causative agent as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The Case Fatality Rate (CFR) is high for the infection. Laboratory diagnosis of infectious diseases has an integral role in case surveillance, diagnosis, treatment and prevention. SARS-CoV-2 is a positive sense single stranded Ribonucleic Acid (RNA) virus grouped under the order Nidovirales, family Coronaviridae, and subfamily Orthocoronavirinae. The structural proteins are spike protein (S), membrane protein (M), nucleocapsid protein (N), and the envelope protein (E). The common symptoms are fever, cough, dyspnoea, fatigue, headache, muscle pain, anosmia and ageusia. The less common symptoms are sore throat, congestion, nausea, vomiting and diarrhoea. Sample collection is a critical step in the laboratory diagnosis of SARS-CoV-2 infection. The molecular methods used for diagnosis of SARS-CoV-2 are Real time Reverse Transcription Polymerase Chain Reaction (r-RT-PCR), Reverse Transcription Loop Mediated Isothermal Amplification (RT-LAMP), digital PCR, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) based assay and sequencing methods. The antigen and antibody detection methods supplement the molecular tests. Although, a huge array of tests are available, the pertinent choice of diagnostic test is crucial. The molecular detection methods are highly sensitive, accurate and reliable.

Role of Animal Models in Periodontal Clinical Research and its Present-Day Status: A Narrative Review

Muskan Baheti, Khushboo Durge, Pavan Bajaj, Bhairavi Kale, Unnati Shirbhate

The use of animal models have aided in the development of new information in periodontology research. Animal models enable legal acceptance of human welfare. Dogs, rats, ferrets, hamsters, mice and on rare occasions, rabbits and sheep have been used to study human periodontal diseases. Animal models were chosen because they have similar anatomical and physiological features of the oral cavity and periodontium, as well as the presence of causative agents that contribute to the occurrence of natural periodontal disease in humans. There has been a progression toward the development of a feasible and sufficiently accurate model that accurately reflects the true pathogenic mechanisms of living person periodontal disease. Non human primates have been used extensively in periodontal investigations as well as in medical technology to understand the origin of periodontal disease. Caries and calculus study is best accomplished through hamsters and rat. Periodontal disease and calculus formation in ferrets could be potential and encouraging in the research area. Thus, the structural and pathophysiology of the animal kingdom differs from that of human beings and seems sometimes troublesome with the latest therapies. Hamster stays an intriguing model for immunological studies. New possibilities in the periodontal analysis are now accessible, enabling broader cohorts that are easier to build. The goal of this review is to give an overview of the animal models that have been employed in the periodontal investigation. The purpose of this review is to identify the best animal model for periodontal research and also for the safety precautions for human beings. The use of fact-finding models used in periodontal disease is crucial to grasp the root source in the human being. Animal models are beneficial in periodontal surveys and an unavoidable step before accessing clinical testing with the latest biomaterials and therapies.

Root Canal Morphology of Primary Mandibular First Molar: A Systematic Review

KG Malavika, Victor Samuel, Kavitha Ramar

Introduction: Pulp therapy procedures especially pulpectomy, aids in retaining the teeth in oral cavity. The complex morphology and pulp-periodontal intricacies insists the need for the understanding of internal pulp canal morphology to treat the primary teeth with dental caries and dental trauma which aids for efficient endodontic therapy. Aim: To explore the root canal morphology of primary mandibular first molar in different ethnic population based on different diagnostic aids used. Materials and Methods: Present systematic review was registered in PROSPERO database and was carried out from August 2021 till October 2021 including data from January 1970 to May 2021 by following PRISMA guidelines. Four electronic databases (Web of Science, Pub Med, Scopus, and Cochrane) were searched. In-vivo, in-vitro studies, comparative and evaluative studies have been included and studies mentioning anamolies, accessory canals and case reports all were excluded. Quality assessment was done by using Anatomical Quality Assessment tool (AQUA). Results: Out of 215 studies, nine studies were retrieved and those investigated root canal morphology of primary mandibular first molar were included. Most predominantly two rooted primary mandibular first molar (99.9%) with four canals (81.25%) of straight morphology (>90% even 100% in few studies) showing root length of 6.4 to 9.4 mm exhibiting Vertuccis type I and IV, were reported to be prevalent. Conclusion: Inspite of varying ethnicity most predominantly two rooted primary mandibular first molar with four canals of straight anatomy seems to be prevalent in all the included diagnostic techniques.

Middle Ear Function Changes due to the Combined Effect of Pressure along with Fluid in Middle Ear Pressure Regulation- A Review

Puja Dinkar Lanjekar, Sagar Gaurkar

The pressure changes in Middle Ear (ME) are due to the effect of both fluid and pressure, which can be detected by tympanometry. In this review article, the mathematical and formal model of regulation of ME pressure is discussed. The air pressure in the ME chamber and the surrounding environment are the same. The auditory tube is a common connection between the ME chamber and the nasopharynx. The main functional role of the auditory tube is the ventilation of ME. When a person breathes air through an auditory tube, it enters into the ME and ventilates it. The ossicles in the ME collect sound from the tympanic membrane and transfer it to the inner ear, which requires proper ventilation of the ME. The auditory tube maintains ME pressure, the same as the external auditory canal and outside pressure. If an auditory tube is blocked, it leads to failure to ventilate ME, leading to changes in ME pressure. Swallowing and yawning allow the passive opening of the auditory tube and thus results in air flow out of the chamber. Easy and passive air exchange is allowed from the ME to the pharynx if, the pressure in the ME is higher than in the surrounding environment. ME pressure is highly variable and can change in many conditions. ME pressures increase when the body rotates from a vertical to a horizontal position because it increases the effusion of the ME mucosa due to an increase in hydrostatic pressure, which leads to an increase in the perfusion rate. Therefore, pressure increases in the case of sleeping and drowsiness. Regulation of ME pressure is a physiological process in which pressure between ME and the surrounding environment is maintained at equilibrium. The mechanism of pressure regulation is possible because of the complex sensory neural reflex pathway. A laser doppler vibrometer measures displacement of the tympanic membrane in response to sound and ME compliance is calculated by tympanometry. The movement of the tympanic membrane reduces due to the combined effect of fluid and pressure on the ME. The ME functions are altered due to the negative pressure of the fluid rather than the positive pressure.

Monkeypox Pathogenesis, Transmission, Preventive Measures and Treatment Modalities

Vaishnavi Uttam Goradwar, Anil Agrawal

Monkeypox is a disease transmitted through animals but can also spread from human to human. The causative agent is monkeypox virus which is a ds-DNA virus. Monkeypox virus belongs to the orthopox genus of the poxviridae family. Other members of this family are the variola virus and the vaccinia virus. This virus was first discovered in 1958. In 1970, when various types of research were going on to eradicate smallpox, the first case of smallpox in humans was reported in the Democratic Republic of Congo. Both smallpox and monkeypox share the same clinical features. Other symptoms are adenopathy and papular rashes. Monkeypox can spread through various modes of transmission. The most common mode is direct contact with contagious animals or contagious humans. Disease progression can be limited by spreading awareness, among the people about the factors responsible for transmission, clinical manifestations, and preventive methodologies.

Altered Quality of Life in Patients with Temporomandibular Joint Disorders: A Review

Temporomandibular Joint Disorders (TMD’s) represents a cluster of disorders that include the Temporomandibular Joint (TMJ) and also the masticatory apparatus. Any alteration in its function will have an impact on the overall function of the masticatory apparatus and in turn the stomatognathic system. Though the aetiology, symptoms, and treatment modalities for TMD’s have been extensively studied, they remain a subject of prime concern for clinicians as it not only affects the form and function but also negatively affects the overall standard of living of the patient. Symptoms of TMD’s such as chronic pain, restriction of function, and psychological effects lead to a lower Quality of Life (QoL) for the patient, which is caused due to various factors such as chronic pain, sleep deprivation, and stress or anxiety. Additionally, personal, professional, and social problems directly or indirectly affect the lifestyle of the patient. Some extra-craniofacial symptoms such as otologic and neurologic symptoms tend to worsen the situation. Majority of patients reporting to an orthodontist present with atleast one symptom of TMD that has affected their QoL. Various questionnaires can be used to assess the patient’s QoL, and plan the treatment accordingly. Managing TMD’s at an early stage while considering these factors and a multidisciplinary approach may help in improving the QoL of the patient.

Efficacy of Carbon Dioxide Laser in Treating Oral Lichen Planus-A Scoping Review

Introduction: Oral Lichen Planus (OLP) is a chronic disorder and its aetiology is multifactorial. Factors like local and systemic inducers of cell-mediated hypersensitivity, stress, autoimmune response and viral infection play a major role. Due to the varying aetiological factors, there are varying treatment modalities. With systemic medication, remission of the lesion is the most common side-effect. Aim: To determine the efficacy of carbon dioxide laser in treating OLP. Materials and Methods: In this systematic review, the study was done between January 2022 to April 2022 at Rajas Dental College and Hospital, Tamil Nadu. Search categories were specifically followed to databases like PubMed, PubMed Central, Cochrane, Medline, Embase and in Google Scholar. MeSH terms like CO2 Laser, OLP, Carbondioxide Laser and Oral Premalignant Condition were used for searching the articles. Results: A total of 942 articles had been collected. But after analysing the articles, only 16 articles based on the preformed inclusion and exclusion criteria had been selected. Out of these three were retrospective studies, five were prospective studies, one clinical trial, one observational study and one study was a Randomised Control Trial (RCT), one was a non RCT, one was a structured abstract, one was a single arm intervention study, one was a case series, and one was a case report. Conclusion: Carbon dioxide laser was very efficient in treating larger size lesions. Recurrence rate of the lesions was very less when treated at an early stage.

An Analysis of the COVID-19 Vaccination Campaign in India

Gulshan R Bandre, Jagadish Makade, Nandkishore Bankar, Dattu V Hawale

The Coronavirus Disease-2019 (COVID-19) pandemic has been affecting people all across the world for the past two years. For the virus to be destroyed, basic personal health education is a need, and it plays a significant role in the virus’s downfall. The entire population of a country cannot be protected by coronavirus vaccines, which only offer some amount of protection. World Health Organisation (WHO) claims that affluent nations are now able to immunise the majority of their citizens, poor nations are unable to immunise even their medical staff. The present study primary goal was to examine India’s immunisation campaign. In this study paper, secondary data predominately were used.

Non-Hodgkin’s Lymphoma Presenting as a Soft Tissue Mass on Right Thigh

Sanjeevkumar Neelakantappa Bentoor, Savitri Mallikarjun Nerune, R Nikitha

Non-Hodgkin’s Lymphomas (NHL) are a heterogeneous group of lymphoproliferative malignancies with a greater preference for disseminating to extranodal locations. Prevalence of extranodal involvement in NHL has increased in the past decade, and the sites involved are the stomach, spleen, waldeyer’s ring, Central Nervous System (CNS), lungs and skin. This is a rare case of NHL in a 48-year-old female who presented with solitary exophytic mass with ulceration over the right thigh and erythematous plaque over postaxillary region and enlarged right inguinal and left axillary lymph nodes. Magnetic Resonance Imaging (MRI) of the right thigh showed lobulated mass involving skin and subcutaneous soft tissues without any intramuscular extension suggestive of neoplastic mass. Fine Needle Aspiration Cytology (FNAC) of the inguinal node and biopsy of the right thigh lesion showed features suggestive of NHL. She was treated with three cycles of Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone (CHOP) regimen, but the patient succumbed to death after six months of chemotherapy.

Anaesthetic Management of Parturient with Severe Mitral Stenosis Planned for Elective Caesarean Section for Safe Confinement

Maitri Patel, Sanjot Ninave, Amol Bele, Pallavi Deulkar, Nitin Alaspurkar

Perioperative management of pregnant women with cardiac disease is challenging. The physiological cardiac changes that occur during late pregnancy leads to haemodynamic stress to the patient with the cardiac disease during and immediately after parturition. Pregnant women with severe valvular disease do not tolerate haemodynamic changes associated with pregnancy. The choice of anaesthesia technique either general anaesthesia or regional anaesthesia is depending on the haemodynamic goals, cardiac status of the patient, and mode of delivery. A 23-year-old female patient was planned for elective caesarean section for safe confinement. She was an operated case of Balloon Mitral Valvuloplasty (BMV). General anaesthesia was preferred due to the severity of mitral stenosis. Incorporation of epidural analgesia with general anaesthesia provided intraoperatively haemodynamic stability during laryngoscopy, intubation, and extubation. Also, postoperatively analgesia could be achieved due to epidural top-ups. Ultimately, a good perioperative outcome has been achieved due to haemodynamic stability which reduces perioperative morbidity and mortality of the patient.

An Elusive Case of Pleural Effusion

The incidence of distant metastasis in head and neck Squamous Cell Carcinoma (SCC) is relatively low. The most frequently involved sites for distant metastasis are lungs, followed by bone and liver. The most important predictive factors for distant metastasis appear to be site of the primary tumour (hypopharynx), advanced T&N classification, locoregional control and histologic grade. A 61-year-old male, chronic smoker, presented with complaints of Grade 4 mMRC (Modified Medical Research Council) dyspnoea. He had left-sided buccal mucosal SCC (locally advanced) and was on palliative chemotherapy. He had undergone treatment for pulmonary tuberculosis seven years back. He was tachypneic and clinical examination revealed absent breath sounds in the left hemithorax. Chest radiograph showed a massive left pleural effusion which was found to be exudative after therapeutic thoracocentesis. Cytology tests were negative for malignant cells. Positron Emission Tomography (PET) scan showed uptake along the left pleura (SUV Max-5.06) and left buccal mucosa (SUV Max -4.1). Thoracoscopic frozen section pleural biopsy revealed metastatic squamous cell carcinomatous deposits in the pleura. On table pleurodesis was done with doxycycline. The patient was continued on palliation with no recurrent effusion. However, he succumbed to the disease after four months. This case report describes a rare case of malignant pleural effusion from a primary buccal mucosal SCC without any concurrent lung involvement.

Global Impact of COVID-19 Pandemic on Antimicrobial Resistance: An Overview

Amresh Kumar Singh, Nandini Singh, Sushil Kumar, Ankur Kumar

Antimicrobial Resistance (AMR) is a condition which occurs, when pathogens evolve and no longer respond to antibiotics, making infections more difficult to treat and leads to death. Apart from the truth that antibiotics have increased the life expectancy of human, AMR is a serious threat. AMR is a major public health threat declared by World Health Organisation (WHO) since 2014. During the different waves of the pandemic, patients with Coronavirus Disease-2019 (COVID-19) infection caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) accounted for the majority of hospital admissions, frequently necessitating an antibiotic upon admission. Among hospitalised patients with COVID-19 infection, a major cause of mortality was mainly due to secondary infections, which was due to overuse of antibiotics and poor infection control procedures which may lead to rapid emergence of Multidrug Resistance (MDR). Before COVID-19 pandemic, AMR was estimated to kill around 700,000 people yearly that are predicted to increase upto 10 million by 2050. Before COVID-19 pandemic, there was lower incidence of hospital associated infections across world. AMR was surprisingly prevalent in patients with bacterial co-infections during the first 18 months of the COVID-19 pandemic. The latest update as per WHO guidance for antibiotic stewardship, which does not recommend antibiotic therapy or prophylaxis for patients with mild/moderate COVID-19 unless signs and symptoms of a bacterial infection. Now, the researchers must consider secondary bacterial infection rate, MDR isolation rate, and high mortality among COVID-19 with secondary infection. This shows the urgent need for surveillance, reinforcement of infection control practices and strict antimicrobial stewardship to combat increasing AMR.

Cognition and Functional Recovery in Severe Mental Disorders-A Narrative Review

J Jane Rinita, Suvarna Jyothi Kantipudi

Severe Mental Illness (SMI) like schizophrenia and mood disorders has a prolonged and strenuous course which takes a major toll on the lives of the patients. In an effort to understand the consequence of these illness functional recovery has been studied in detail in the past. Cognitive impairment has been identified as an important contributor to the functional recovery. Cognitive impairment is an important component, independent of the symptoms, of SMI. Various cognitive deficits are found to occur in patients with SMI. Patients with lesser cognitive deficits were found to have better outcomes. This narrative review explains about cognitive impairment and functional outcome in people with SMI and the existing evidence for the relationship between both. Authors had performed manual search strategy of PubMed, Google Scholar engines for relevant research publications and reviewed them along with cross references from the retrieved articles. A broad review on the research shows, cognitive impairment has been recognised in both patients with schizophrenia and bipolar disorder even during periods of symptomatic remission and that people with symptomatic recovery continued to have functional deficits. This review also showed that patient with lesser cognitive deficits had better outcomes. Keeping this in mind, cognitive rehabilitation should be made a part of the management of SMI to achieve complete functional recovery.

Effectiveness of Injectable Platelet Rich Fibrin with Demineralised Freeze Dried Bone Allograft in Class II Furcation Defects: Protocol for a Randomised Clinical Trial

Unnati Ashokrao Shirbhate, Pavan Suresh Bajaj

Introduction: In cases of substantial furcation involvement, non surgical mechanical debridement results in disease progression. Surgery allows for root debridement, osseous recontouring, odontoblasts, and periodontal regeneration while maintaining periodontal attachment, to stop the disease process. The current study evaluates whether combining injectable-Platelet Rich Fibrin (i-PRF) mixed with Demineralised Freeze-Dried Bone Allograft (DFDBA) for treating class-II furcation diseases is successful. Need for the study: In comparison to ‘Open Flap Debridement’ (OFD) alone, certain studies have shown that DFDBA results in a considerable and persistent increase in periodontal regeneration. The current study evaluates whether combining i-PRF mixed with DFDBA for treating class-II-furcation diseases is successful or not. Aim: To compare evaluation of i-PRF with DFDBA compared to DFDBA alone in the treatment of the class-II furcation defects- a randomised controlled clinical trial. Materials and Methods: The current investigation will be a randomised, double-blinded clinical trial, onb total twenty-four patients of ‘Class-II furcation’ including the buccal/lingual sides of the tooth. By the completion of the first therapy and before the beginning of surgery, the chosen defects will be randomly allotted to group A and group B equally, using a computer-generated randomisation process employing a randomised table. Group A will operate with both i-PRF and DFDBA, whereas group B here will only be given DFDBA. To estimate outcomes, a re-evaluation will be done at six and nine months after starting therapy.

Introspection in Surgery

Manika Agarwal, Sharat Agarwal, Ritisha Basu

It is well known that a surgeon needs knowledge and skill to perform good surgeries. A well-executed surgery leads to high patient satisfaction and is a matter of pride for the surgeon. However, in spite of knowledge and good skill, certain practices can compromise the outcome. These practices are built gradually and subtly and sometimes are not realised. This article is written with the aim of giving insight to the surgeons to introspect, reflect on their attitudes and correct them if required.