Journal of clinical and diagnostic research

Isolated Intramedullary Cervical Spinal Cord Cysticercosis- A Case Report

Neurocysticercosis is the most prevalent parasitic infection in developing countries, caused by the encysted larvae of taenia solium. It predominantly affects the brain alone or both the brain and the spinal cord. In spinal cysticercosis, the thoracic cord is most commonly involved. Isolated involvement of the cervical spinal cord is very rare. Authors report the case of a 19-year-old male patient with intramedullary cysticercosis in the cervical cord. The lesion was diagnosed with magnetic resonance imaging and serology. Albendazole and steroids were used to treat the patient medically.

COVID-19 Infection Induced Mania

Ishani Roy, Debasish Sanyal

Coronavirus Disease-2019 (COVID-19) infection or Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) infection, is associated with various psychiatric consequences, which are because of various types of stressors, may be due to fear of infection or social isolation, hospitalization, death and so on. In the present case report, a 44-year-old female with a history of pentazocine addiction and no known history of previous psychiatric illness was admitted to the Emergency Department with vacant, withdrawn look, unnatural fixed posture, mutism, refusal to eat. These symptoms developed after discharge from another hospital where she was treated for COVID-19 induced severe pneumonia (resolving). The very next day, the patient demonstrated excessive talkativeness and jovial mood with echolalia. The patient was treated symptomatically and recovered without the use of any antipsychotics. This report highlights the probability of the mania like symptoms being linked to COVID-19 (SARS-CoV-2 infection) highlighting the need for assessment of various psychiatric manifestations during COVID-19 infection.

Masturbation Injury Following Intravaginal Introduction of a Candlestick: A Case Report

Masturbation, a common sexual behaviour, may result in life-threatening injuries. Here, the authors present a case of 40-year-old female patient, P2L2 who presented to the Gynaecological Emergency unit, on account of a three-hour history of bleeding per vagina following candlestick masturbation which resulted in a 4 cm right lateral vaginal fornix laceration and accompanying Hypovolaemic shock. She was separated from her husband for a period of two years. She underwent examination under anaesthesia and repair of vaginal laceration. Postoperatively, she had one unit of blood transfused and was discharged home on haematinics, broad spectrum antibiotics and analgesics. Counselling on marital stress and sexual distress was provided, while encouraging the use of adult sex toys in favour of improvised ones when necessary.

Non Infectious Descemetocele Treated with a Surgical Drape Patch: A Case Report

A corneal descemetocele is the anterior herniation of an intact Descemet membrane through an overlying stromal defect. Though, a rare complication, it is a serious one that needs to be treated at the earliest. If not treated promptly, it may result in a full-thickness corneal perforation which will hinder the ocular integrity and may end up with vision-threatening complications. Here, the authors report a case of a 58-year-old female patient who came to the Outpatient Department with complaints of redness and pain in the Right Eye (RE). The patient on examination had a descemetocele impending perforation of the right eye. On the initial visit, a Bandage Contact Lens (BCL) was placed. On follow-up, after one week, the BCL was displaced due to undue rubbing of the eye by the patient, and on readjustment, it ended up with corneal perforation. As an emergency, treatment was required and due to a shortage of donor corneal tissue in the ongoing pandemic, a tectonic patch was made by trephining non-sticky part of sterile plastic drape which was available on-site and a double drape patch technique was performed. Both the patches were then placed over the perforation, which sealed the perforation completely. On a consecutive follow-up of one week and one month, the authors found the patch to be intact and maintaining ocular integrity. A tectonic drape patch technique is a viable and easy method of closing an open wound with nontraumatic corneal perforations when other methods to immediately seal the wound are not available.

Diffuse Large B-cell Lymphoma-Treatment Failure, Recovery and COVID-19: A Case Report

Diffuse Large B-cell Lymphoma (DLBCL) is the most common form of non-hodgkin lymphoma, involving multiple organ system including lymph node, bone marrow, spleen etc. Among overall cases of DLBCL, 40% are extranodal in origin and stomach being the most common site. While most of the (60%) are not diagnosed until the disease reach stage 3 or 4. While in the present case of a 65-year-old female, patient had predominant involvement of neck lymph nodes. Following the final diagnosis, patient was given first line treatment in the form of Rituximab, Cyclophosphamide, Hydroxydaunorubicin hydrochloride (doxorubicin hydrochloride), vincristine (Oncovin) and Prednisone (R-CHOP) regimen, to which patient didn’t respond and further the patient was given Rituximab, Ifosfamide, Carboplatin, and Etoposide (R-ICE) regimen, to which patient responded quickly. With Coronavirus Disease 2019 (COVID-19) pandemic, the patient encountered infection with its associated complication. The following case report is all about the timely management of DLBCL and patient’s survival with COVID-19 and its related complication. Haematological malignancy such as lymphomas, leukaemias, myelomas cause severe myelosuppression and lymphodepletion increasing the risk for development of COVID-19. Studies have shown that patients with malignancy had an estimated two-fold increased risk of contracting Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) than the general population. The survival rates strongly depend on COVID-19 stage and other factors such as immune (neutropenia) status and systemic inflammation.

Minimally Invasive Surgical Approach for the Treatment of Miller’s Class I Recession Defects- A Report of Two Cases

Ridhima Uppal, Anurag Bhatnagar, Amit Bhardwaj, Aishaan Sharma, Madhur Goyal

Gingival recession is defined as the apical displacement of the gingival margin leading to exposure of the root surface. Occurrence of the gingival recessions in the anterior teeth is a major concern for the patients as it leads to compromised aesthetics and achieving the aesthetics and functional requirements of the patients remains a major therapeutic challenge for the treating dental surgeon. Incorporating the principles of Minimally Invasive Surgical Technique (MIST), surgical trauma is minimised, thus causing less cell damage, eventually resulting in less inflammation and less discomfort. MIST aims to achieve aesthetically superior outcomes that are made possible due to improved visual acuity. Therefore, the intent of this case report was to emphasise the impact of implementing the minimally invasive surgical procedure in the management of marginal gingival recessions using the conventional Coronally Advanced Flap (CAF) and the Tarnow’s technique, with the use of microsurgical instruments and magnifying surgical loupes.

Role of Imaging in the Diagnosis of Isolated Renal Echinococcosis: A Case Report

Kalidindi Valli Manasa, Satish D Patil, Anil G Joshi

Echinococcosis is a parasitic infection caused by Echinococcus tapeworm. The most common organs involved are liver, lungs and spleen. Primary renal echinococcosis is a very rare manifestation of hydatid disease. Clinical manifestations in primary renal echinococcosis are variable and can have varied symptomatologies which are non specific. A 62-year-old female patient presented with abdominal fullness since six months, palpable mass and left flank pain since three months. On imaging, a large multiloculated cyst and multiple peripherally situated daughter cysts involving the middle and lower pole of left kidney with gross dilatation of upper pole calyx with severe cortical thinning was noted. It usually presents as a cystic renal mass on imaging and often gets misdiagnosed and operated as a cystic renal malignancy. Hence, radiological imaging plays an important role and care should be taken when dealing with a cystic renal mass to avoid unnecessary nephrectomies.

Oral Manifestations of Bicytopenia: A Case Report

CJ Sanjay, Nagabhushana Doggalli, P Karthikeya, KR Renuka Devi, S Viveka

Cytopenia’s are frequently seen haematological disorders encountered in daily clinical practice. Bicytopenia is defined as a decrease in any of the two cell lines of the blood i.e., Red Blood Cells (RBC), White Blood Cells (WBC), or platelets. Though bleeding gums is a common complaint in dental practice, bleeding of gums as a result of systemic diseases is rare. The author presents a case of a 65-year-old male patient who reported spontaneous bleeding of the gums. The patient was diagnosed with gingival bleeding secondary to bicytopenia. Gingival bleeding was treated with local styptic agents and systemic platelet infusion as recommended by a haematologist. The patient was also prescribed antifibrinolytics and antibiotics for further dental management. This case reports highlights the concerns about the oral manifestations and the dentist’s responsibility to be familiar with the recognition and customised management of patients with Bicytopenia by analysing the clinical and haematological profiles of patients.

Recurrent Botryomycosis and Management Strategy with a Follow-up of Four Years: A Case Report

PS Gopinath Thilak, Sharanyamenon Radhakrishnan

Cervicofacial botryomycosis is a chronic, granulomatous suppurative infection with varied presentations in the head and neck region. Since the discovery of this entity, treatment has been elusive without evidence of complete resolution of the lesion with a long period of follow-up. Here the authors report a case of cervicofacial botryomycosis with oral manifestations in a 37-year-old male patient with a history of trauma, for whom the authors devised a treatment plan tailored to the patient’s microbiological profile after culture and sensitivity testing in addition to systemic and local antibiotic therapy and heat therapy which showed drastic regression of the lesion and an improved mouth opening. The patient has been under follow-up for the past four years without signs of recurrence. Botryomycosis is an aggressive lesion where a surgery-only approach is usually futile and requires further intervention due to recurrences. The present experience suggests surgical debridement along with antibiotic and local heat therapy to be effective in managing this usually recurring lesion.

Dual Innervation to the Gluteus Maximus: A Case Report with Clinical Implications

Anatomical variations of the gluteus maximus have significant clinical implications. The gluteus muscle is commonly innervated by the Inferior Gluteal Nerve (IGN). However, this innervation could be affected by its embryological development. An anomalous innervation of the gluteus maximus by the Sciatic Nerve (SN) was identified during a bilateral dissection of the gluteal region. Dissection was performed on an elderly female cadaver, preserved with 10% formalin, and performed following the guidelines given in Grant’s Dissector 16th edition. The left and right gluteus maximus were innervated by their corresponding IGN. However, both demonstrated an additional innervation by the SN. This branch by the SN was located proximal to the IGN and emerged near the inferior border of the piriformis muscle. Patients with dual gluteus maximus innervation can present with clinical signs and symptoms which might be easily misdiagnosed. Therefore, physicians need to be aware of this abnormal innervation to accurately diagnose and avoid potential iatrogenic nerve injuries during interventions.

Conservative Management for Acanthomatous Ameloblastoma of Anterior Maxilla: A Rare Case Report

Sanjeev Kumar, Jitender Kumar, Aasimah Hameed, Alok Bhatnagar, Keerat Preet Kour

First described by Broca in 1886, Ameloblastoma is one of the most frequently encountered epithelial odontogenic benign tumour. The literature reports Mandible as the utmost favourable area of this tumour with approximately 80% of the cases involving this area. Histologically, an ameloblastoma can have six variations i.e, follicular, plexiform, basal, granular, desmoplastic and/or acanthomatous form. According to the 2005 World Health Organisation (WHO) classification the incidence of acanthomatous ameloblastoma is 7.06%. The acanthomatous type of ameloblastoma is deemed to be a rare and uncommon variation that mostly involves the mandible in 81% of the cases and maxilla in only 19% of the cases. In the maxilla, it is most commonly seen in the molar area, antral area and nasal floor with reported rate of occurrence being 47%, 33% and 9% respectively. The incidence in the canine are is only 9%. On the basis of previous studies, acanthomatous ameloblastoma is usually found in the geriatric population than in younger ones and is considered as an aggressive variant of ameloblastoma. Authors hereby present a case of acanthomatous ameloblastoma occurring in the anterior maxilla in a 36-year-old male patient presenting with painless swelling involving the left side of the anterior upper jaw managed with a conservative type of treatment. This type of presentation of the already rare acanthomatous ameloblastoma is extremely sporadic. Also, the occurrence of such a tumour in maxilla can significantly affect the progression and prognosis of such tumours because of the anatomical and histopathological differences in the maxilla and mandible and their densities, thereby further influencing the management and follow-up.

Acute Confusional State in a Neuropsychiatric Systemic Lupus Erythematosus Patient: A Case Report

Sambhu Prasad, Shikha Jha

Systemic Lupus Erythematosus (SLE) affects various systems in human including central and peripheral nervous systems. The Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) is a severe complication of SLE which causes a formidable challenge in term of diagnosis and its management. Acute confusional state (delirium) is a rare entity of numerous symptoms of NPSLE which is being overlooked even though it is associated with increased mortality. The present case report describe about the presentation of SLE consisting of hyperpigmentation maculopapular rashes over face, neck regions, lower back and extremities in a 36-year-old female with abrupt onset and fluctuating course of psychotic symptoms, acute confusional state and oddities in behaviours. Treatment with low dose of antipsychotic (aripiprazole) resolve the symptom with due consideration taken to rule out steroid induced manifestation of above symptoms.

Arrhythmogenic Right Ventricular Dysplasia Diagnosed in a Patient with Long-term Undiagnosed Syncope

Avi Shah, Ramesh Patel, Sandeep Aggarwal

Arrhythmogenic Right Ventricular Dysplasia (ARVD) is an inherited cardiomyopathy which represents progressive replacement of right ventricular myocardium with fibrofatty tissue. In the present case, a 42-year-old male presented to the hospital as he fell down, due to syncope. He had a history of recurrent syncopal in past 4-5 years. His chest radiogram revealed cardiomegaly (CT ratio 0.64), repeat electrocardiogram showed symmetric T-wave inversions and epsilon waves in right precordial V1, V2 and V3 leads, and echocardiogram revealed mild left ventricular dysfunction (ejection fraction - 45%) and dilated right atrium and ventricle. Cardiac Magnetic Resonance Imaging (MRI) confirmed the diagnosis of ARVD.The patient was advised for the placement of an Automatic Implantable Cardioverter Defibrillator (AICD), but he denied for this treatment. Thus, he was managed with anti-arrhythmic drugs and was advised for regular follow-up. The patient was followed-up for six months where episodes of syncope had significantly reduced to one in six months but need of AICD implantation was still there to avoid sudden cardiac death.

Little Old Lady’s Hernia with Hiatus Hernia- A Case Report

N Nasida Fathima, Sushanto Neogi, Manu Vats, Surya Elangovan

With the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic, it is not uncommon to see patients who present with respiratory symptoms secondary to an abdominal pathology, being suspected of having COVID-19. Here, authors report a case of an 80-year-old female who presented with recent-onset dyspnoea, shortness of breath, pain abdomen and non passage of flatus and stools. Examination revealed that the patient had tachycardia, tachypnoea, and dyspnoea with an oxygen saturation (SpO₂) of 92%. Her abdomen was distended, non tender with no free fluid detected. All the hernial orifices were free. Computed Tomography (CT) scan revealed a left diaphragmatic hernia and a left-sided obturator hernia with obstructed ileal segment. However, intraoperatively a Type IV hiatus hernia was discovered, where the Gastrooesophageal (GE) junction, stomach, colon, and omentum were the contents. This case highlights an unusual clinical presentation of a rare cause of intestinal obstruction and its management during the COVID-19 pandemic. Obstructed obturator hernia is associated with high morbidity and mortality.

A Case of Bednar Tumour in the Sacral Region- A Rare Pigmented Variant of Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma Protuberans (DFSP) is a relatively rare soft tissue neoplasm of intermediate malignancy. Metastasis of this tumour seldom occurs. The DFSP is a locally aggressive tumour with a high recurrence rate. The DFSP accounts for less than 0.1% of all malignant neoplasms and approximately 1% of all soft tissue sarcomas. Bednar tumour is an uncommon variant of dermatofibrosarcoma protuberans. Also known as pigmented dermatofibrosarcoma protuberans, this tumour is a rare, aggressive, cutaneous tumour that constitutes 1-5% of all DFSPs of intermediate grade. These tumours can be easily mistaken for fibrosarcoma and melanoma. It is seen in adults with a predisposition to affect the shoulder region, and trunk. Authors hereby report a case of 50-years-old female presented with complaints of recurrent swelling in the lower back for a duration of four months. Pain aggravated on lying in the supine position, swelling was painless otherwise. Patient also had complaints of itching over the swelling with occasional blood stained discharge on self-inflicted trauma. Magnetic Resonance Imaging (MRI) scan and histopathological examination of excised tumour confirmed the diagnosis of bednar tumour. She underwent wide local excision with split skin grafting and was on follow-up for the last two years with no evidence of recurrence. Hence, adequate clearance and thorough and regular follow-up is essential to prevent recurrence.

Anomalous Right Coronary Artery Originating from Mid Left Anterior Descending Artery- An Unexpected Encounter during Primary Percutaneous Coronary Intervention

Ashwin Tumkur, Dharmendra Kumar Borad

The appearance of single coronary artery with anomalous Right Coronary Artery (RCA) originating from left coronary artery is an extremely rare encounter. Here, the authors report one such case of a 34-year-old male, who was serendipitously encountered with a single coronary artery with anomalous RCA arising from mid Left Anterior Descending (LAD) artery. He presented with anterior wall ST-elevation Myocardial Infarction (STEMI) and developed complete heart block. His mid LAD supplying anomalous RCA was totally occluded which was successfully recanalised using drug-eluting stent. The computed tomographic angiography confirmed single coronary artery with anomalous RCA arising from mid LAD across the stent.Thus, if RCA is not seen during traditional coronary angiography, the interventionalist should keep in mind that RCA can originate from LAD.

Cannibalistic Cell as a Marker for Relapse in Oral Cancer: A Case Report with Brief Review on Potential Risk Factors for Relapse

Deepa Jose, Soma Susan Varghese, Pramod P Mathews, C Joseph Sebastian

Oral Squamous Cell Carcinoma (OSCC), a grave debilitating disease besides causing structural abnormalities, it harms patient’s quality of life as well. Several pathological parameters can predict the survival and prognosis of OSCC. Cell Cannibalism (CC), a distinctive morphological feature have already been explored and proved in various malignancies. However, cannibalistic cells are often ignored during routine histopathological assessment of head and neck OSCC and have not been extensively studied. The authors present a case report of a 64-year-old, female, OSCC patient with uncontrolled diabetes, in which many cannibalistic cells was observed on slide evaluation. On further examination a Histologic Tumour Thickness (HTT) of 8 mm and a depth of invasion of 6 mm was noted, which again can foretell an adverse prognosis. Subsequently, patient was referred and managed at a cancer centre but a regular postoperative evaluation was scheduled in the institute for better patient care. Interpreting and understanding these risk factors and being more empathetic towards the patient, will not only help in postoperative evaluation but also ensure a better quality of life thereafter.

Acute Kidney Injury as an Initial Presentation in Mantle Cell Lymphoma- A Rare Case Report

Mantle Cell Lymphoma (MCL) is a rare aggressive lymphoid neoplasm accounting for 3-7% of all Non Hodgkin Lymphomas (NHL). Kidney involvement in MCL is rarely reported in biopsies from living patients, being caused by direct lymphoid infiltration. Only 19 cases have been documented of Acute Kidney Injury (AKI) with lymphomatous infiltration. This case report is of a 50-year-old male who presented with AKI and was found to have a MCL infiltrating the kidneys.

Traumatic Uterine and Bladder Rupture due to Instrumental Vaginal Delivery by Vacuum: A Case Report

Rajasri G Yaliwal, Shreedevi S Kori, Subhashchandra R Mudanur, Sindhu Manne

Uterine rupture is a very rare but critical obstetrical complication that requires prompt diagnosis and treatment. It is a major complication of instrumental delivery due to lack of skilled personnel and inadequate monitoring in the intrapartum period of delivery. Here, authors present a case report of a 30-year-old woman, who presented to the hospital with complaints of acute abdominal pain, per vaginal bleeding and leakage of urine following vacuum assisted vaginal delivery. This led to traumatic postpartum haemorrhage that required further surgical evaluation and management. Retrospective analysis of such cases give us an idea of the problems that still exist with instrumental deliveries and the importance of labour surveillance during the 2^nd stage of labour. Traumatic uterine and bladder rupture following vacuum delivery is a preventable cause of postpartum haemorrhage. Timely recognition of the condition can reduce the maternal morbidity and mortality.

Solitary Bone Cyst of Maxilla in a 12-year-old Child: A Case Report

Ghanta Venkanna Babu, Shilpy Dwivedi, Anukrati Doneria

Solitary Bone Cyst (SBC) are the bony cysts which lack epithelial lining. They are also known as simple bone cysts or pseudocyst. This fluid filled lesions, lies in an intact bony wall. These lesions are not a common clinical finding and are frequently discovered by chance in radiographs during routine examinations. The aetiopathogenesis has not been studied in depth, and the management remains controversial. When presented in oral cavity, the most common site of occurrence is body of mandible with 75% occurrence among jaw bones while prevalence in maxilla is only 1% in the jaw bone. In this case report, solitary bone cyst is presented in a 12-year-old male patient, who came with chief complaint of bony enlargement on buccal aspect of maxilla in the posterior region. The lesion presented as a painless swelling for three months gradually increasing in size. The patient was treated with surgical excision and there was no sign of regional recurrence at three months of postoperative follow-up. In this paper, the authors presented a rare case report of solitary bone cyst in maxilla in a paediatric patient.

Inexplicable Abdominal Pain in a Patient with Advanced Recurrent Osteogenic Sarcoma: A Case Report

Abdominal pain is one of the most common causes of emergency department visits. Comprehensive patient assessment is required to identify the cause of abdominal pain. The origin of abdominal pain can be intra-abdominal or extra-abdominal. The majority of the cases with abdominal pain will have typical symptoms, suggesting intra-abdominal pain. A small subset of patients has atypical symptoms suggesting an extra-abdominal cause for the pain. Reports suggest that patients who presents with pain in the abdomen have the primary aetiology from the spinal column. This case report presents a 32-year-old male patient, with abdominal pain in advanced, recurrent Osteogenic Sarcoma (OGS) with spinal metastasis as the primary aetiology. Compression of nerve roots due to spinal bony metastasis lead to abdominal pain in the present case. Even though it was of spinal origin, clinically it micmicked to be of abdominal origin, so oncologists have to be vigilant in considering the rare causes of abdominal pain. Detailed history and clinical examination of the patients is ideal approach to identify the cause.

Dilemma in Diagnosing Herpes Zoster with Prodromal Odontalgia in Immunocompetent Patient: A Case Report

Nelly Nainggolan, Tenny Setiani Dewi

Herpes Zoster (HZ) is an acute viral infection characterised by painful unilateral vesicular lesions, generally occurs in immunocompromised conditions, and progresses through three stages i.e., prodromal, active, and chronic stages. Odontalgia may occur when trigeminal nerve branches are involved during this prodromal stage. More than 53% of doctors have difficulty in diagnosing HZ on the prodromal stage before the emergence of the skin eruption. This report describes the HZ infection affecting all three branches of the trigeminal nerve which causes odontalgia on the prodromal stage. A-62-year-old male referred with the complaint of painful oral ulcers, multiple vesicles and crusts with swelling and pain on his left side of the face. Previously, it was only confined to the lips but gradually spreads to the eyes followed by odontalgia and pain on the left side of mandible. The diagnosis of HZ affecting three branches of trigeminal nerves was determined from the presence of unilateral lesions on the skin and oral cavity. The lesions healed completely after two months. Odontalgia in trigeminal HZ that occurs in the prodromal stage can pose a dilemma, be misdiagnosed, and become a diagnostic challenge for dentists. The presence of an unidentified cause of odontalgia should be an alarming sign of HZ infection, especially in the elderly.

A Rare Case Report of a 8-weeks-old Infant with Hypercalcaemia and Subcutaneous Fat Necrosis

KS Manjula, KV Shweta, AN Shruthi, E Adarsh, K Shasikala

Subcutaneous Fat Necrosis (SCFN) is an uncommon transient panniculitis more commonly seen in first week of newborn life. Hypercalcaemia is tell-tale of this disorder, resulting in consequences like metabolic derangements, polyuria, seizures, vomiting, nephrocalcinosis and cardiovascular disturbances contributing to morbidity and mortality of SCFN. This is a case report of an eight-week-old male infant who presented with hypercalcaemia and multiple nodules all over the body. Histopathology is the gold standard method which helps in diagnosis and evaluation of a patient with SCFN. In this case, histopathological report revealed focal areas of fat necrosis in the fat lobules along with lobular panniculitis with infiltration of lymphocytes, histocytes, fibroblasts and multinucleated giant cells. Its granules were suggestive of SCFN. The diagnosis of SCFN was confirmed by skin biopsy and additionally supported by hypercalcaemia. This study highlights the importance of performing detailed skin examination for the evaluation of patients until the resolution of hypercalcaemia and skin lesions. In this case, hypercalcaemia resolved by the end of 12th week of life. Though, it is a benign and self-limiting condition, educating and creating awareness among the parents is of utmost importance and to prevent renal and cardiac complications associated with hypercalcaemia. Rehydration therapy, calcium and Vitamin D restricted diet are the modes of treatment for treating this condition.

Right Paraduodenal Hernia Causing Small Bowel Obstruction in an Adult with Down Syndrome: A Rare Case Report

Shriya Himmat Thacker, Mirat Manoj Dholakia

Out of all internal hernias, Paraduodenal Hernia (PDH) is the variety but in PDH right sided one is not that common. In Down Syndrome, morgagni hernias are often seen as compared to right PDHs. A 41-year-old male patient, a known case of Down Syndrome presented with chief complaints of abdominal pain, nausea, vomiting and abdominal distension since two days. Patient was surgically managed for the right PDH and later re-explored for adhesive intestinal obstruction on postoperative day 12 and later presented with small bowel obstruction symptoms due to adhesions and hence, relaprotomy for postoperative adhesive obstruction was performed. Right PDH is a rare entity encountered in Down Syndrome which makes it even rare.

Paediatric Prosthetic Rehabilitation using Decoronated Avulsed Teeth

Traumatic Dental Injury (TDI) mostly occurs as a result of any sports injury or an accident. The prognosis of teeth following injury is determined by the kind of TDI, emergency treatment, and the amount of time between emergency treatment and definitive care. Patients with missing anterior teeth lack an impressive appearance aesthetically as well as psychologically. Speech issues and some loss of function can lead to a decline in oral health, which can affect one’s quality of life. This case addresses the patient aesthetic concern in anterior region of maxilla of 15-year-old male due to trauma which resulted in avulsion of both centrals and lateral incisor. Patient’s own completely displaced teeth placed in biological tooth functional space maintainer was planned. The use of natural tooth as functional space maintainer method is less expensive, easy to fabricate, easy to modify according to age and produces better aesthetics. It also maintains space loss in growing children.

Budd-Chiari Syndrome as an Initial Presentation of Antiphospholipid Syndrome in a Male

In Budd-Chiari Syndrome (BCS) there is narrowing and obstruction of the veins of the hepatic veins. Patients have upper quadrant abdominal pain, hepatomegaly and/or ascites. Authors hereby, discuss a case report of a 20-year-old male with history of abdominal pain, progressive distension of abdomen and mild jaundice for two months. He had hepatic vein thrombosis as well as lupus anticoagulant and was positive for anti beta 2-glycoprotein I antibody indicative of antiphospholipid syndrome. The patient was worked up for hypercoagulable states in view of unusual site of venous thrombus. Patient recovered after being treated with prolonged anticoagulation and hepatic vein stenting. The link between antiphospholipid syndrome and BCS is well documented in the literature, but occurrence of BCS due to primary antiphospholipid syndrome is rare. Early identification, treatment of underlying cause can prevent chronic BCS and liver cirrhosis.

Experiences in Reproductive Health Services in COVID-19 Era: A Nightmare

Surinder Kaur, Preet Kamal, Sangeeta Pahwa, Ripan Bala

With consistent efforts for the last four decades in the area of family planning, it had been a rare instance to receive emergencies with uterine perforation, gut injury, septicaemia, and multiorgan failure with unsafe surgical intervention. But Coronavirus Disease 2019 (COVID-19) pandemic has caused major disruption to the family planning information and services globally. These gaps have been due to breakdown in contraceptive supply chains, closure of primary healthcare and abortion clinics, diversion of staff from family planning services to COVID-19 response team and the poor response was also due to fear of infection in hospital. As a result, many unsafe abortions in the form of near-miss mortality nightmares were revisited. The present series is of five cases, done at a tertiary care teaching hospital wherein there was mismanagement of the abortion due to lack of expert services during the COVID-19 pandemic. Uterine perforation with sepsis was observed in all the patients with bowel injury in three and broad ligament haematoma in one patient. A comprehensive, women’s sexual health system response to address family planning services provision during pandemics is the need of the hour for India to avoid unwanted pregnancies and prevent additional mortality and morbidity in women.

Perforation of Jejunal Diverticula in COVID-19 Positive Patients: A Case Series

Jejunal diverticulosis is the herniation of mucosa through weakened wall of jejunum on the mesenteric border. Individuals are usually asymptomatic for most of their lives and are diagnosed incidentally by radiological investigations or during surgery. Increased number of hospital admissions and investigations done to better understand the phenomenon of Coronavirus Disease 2019 (COVID-19) had increased the rate of incidental diagnosis. Four patients admitted to the COVID-19 ward of the hospital were diagnosed with COVID-19. They were treated according to the protocol followed in the state, which included high dose of steroids. During the course of treatment, they experienced abdominal pain with distension and were diagnosed with jejunal diverticulitis with perforation. Exploratory laparotomy with jejunal resection and jejuno-jejunal anastomosis with feeding jejunostomy was performed and adequate postoperative care was provided. Two out of the four patients survived and were discharged after they achieved full recovery and became COVID-19 negative. The cause of perforation can be attributed to the high dose of steroids used during the treatment as steroids have been proved to cause spontaneous bowel perforations.

Acute Upper Airway Obstruction as Atypical Manifestation of Uncommon Aetiologies- A Case Series

Manju Mathew, Anjana Mary Reynolds, Sunil Mathew, Reena Thomas

Acute upper airway obstruction, an emergent situation, can sometimes put the clinician in a dilemma with no positive history or clinical findings to aid in the diagnosis. A myriad of conditions causes upper airway obstruction. Priority is to secure the airway and then seek out the underlying cause. Computed tomography scan is an important imaging modality for reaching a definitive diagnosis and might at times, reveal unexpected findings. In this case series, authors report three cases of acute upper airway obstruction which were atypical manifestation of diseases. Case 1 (82-year-old male) is about Lemierre’s syndrome with compromised airway in the absence of abscess formation. Case 2 (47-year-old male) depicts an atypical presentation of Boerhaave syndrome as retropharyngeal accumulation of air and pneumomediastinum. Case 3 (67-year-old male) is about retropharyngeal haematoma in a patient with anticoagulant therapy without any definite history of trauma. Treatment with reversal of anticoagulation was successful in the case 3. It is important for the clinician to be aware of the unusual reasons for airway compromise, as early suspicion can translate into better patient survival. Airway should be secured by either intubation or tracheostomy. Many a time, radiological and blood investigations help to arrive at a definite diagnosis.

Diagnostic Challenges of Uncommon Paediatric Head and Neck Masses- A Case Series

Karthik Sigamani, Preethi Srinivasan

Paediatric head and neck masses pose diagnostic challenge to the clinicians owing to the wide spectrum of lesions including congenital (developmental), inflammatory and neoplastic lesions. In the present case series, uncommon paediatric head and neck mass lesions that were diagnosed in a tertiary care hospital over a period of three years from January 2017 to December 2019, had been included, emphasising on the diagnostic challenges encountered. First case was of Cervical Chondrocutaneous Branchial Remnant (CCBR) that was misdiagnosed as branchial cyst clinically. Second case was a lymphoepithelial cyst that masqueraded as an acute suppurative lymphadenitis in Fine Needle Aspiration Cytology (FNAC) due to florid inflammation. Third case was an aggressive poorly differentiated malignant neoplasm of left nasal cavity namely Nuclear protein in Testis (NUT) carcinoma that had to be differentiated from several other small round blue cell tumours. Fourth was a case of lipoblastoma which could be mistaken for myxoid liposarcoma. The last two cases were vascular tumours, one of them was juvenile capillary hemangioma with a benign clinical course while the other was an intermediate grade tumour namely kaposiform hemangioendothelioma. A wholesome clinical, radiological and pathological evaluation will help to solve the diagnostic dilemmas in this group of lesions.

Labial Agglutination in Different Age Groups: A Case Series

Sukumar Mitra, Damayanti Banerjee, Debdatta Chakrabarty, Seema Das

Labial adhesion or agglutination is varying degree of apposition between the labia minora which may be complete or partial. Here, a case series of five patients of different age groups ranging from toddler, prepubertal, postpartum and postmenopausal age groups were included. Most often, labial adhesions are encountered in prepubertal age group due to hypoestrogenic state. Parents most often diagnose incidentally while changing diapers. Similar hypoestrogenic environment encountered in postmenopausal state where in addition to apposition, women have co-existent genitourinary symptoms for which they seek care. Old people may be delayed in seeking care due to uncertainty. Labial adhesions among reproductive age group are quite rare. Most of the cases have a past history of trauma which was not adequately managed and the agglutination developed, as a remote complication. All the five patients were managed as per the severity of adhesions. Treatment included from conservative approach of oestrogen cream application to surgical adhesiolysis.

A Quaint Collation of Childhood Renal Neoplasms- Wilms and Beyond: Perspective of a Tertiary Care Hospital of Eastern India

Meghadipa Mandal, Sanghamitra Mukherjee, Tushar Kanti Das

Paediatric renal neoplasms are rarely encountered entities. Histopathology is essential in most of the cases, where there is significant degree of clinical and radiological overlap. Present series has 32 cases which aimed to evaluate clinical and pathologic spectrum of renal tumours in children. Nephrectomy specimens of renal neoplasms of children below 12 years of age were included. Haematoxylin and Eosin (H&E) staining and Immunohistochemistry (IHC) were done. Findings were tabulated in a master sheet along with other demographic variables, clinical histories and imaging findings. Abdominal lump was the commonest presentation. Wilms tumour was the major histologic variant (66%), followed by Congenital Mesoblastic Nephroma (13%). Anaplasia and advanced Children’s Oncology Group (COG) staging were the adverse prognostic indicators. Clear Cell Sarcoma and Rhabdoid tumours were seen to have adverse outcomes, whereas Congenital Mesoblastic Nephroma, Multicystic Dysplastic Kidney and Paediatric Cystic Nephromas had overall favorable prognosis. Histopathology plays a key role for confirmatory opinion on nature of the neoplasm. Better understanding of these cases will increase the diagnostic accuracy with early implementation of definitive therapy.

Numb Chin Syndrome in Sickle Cell Disease

Nipun Bawiskar, Sourya Acharya

Hyperglycemia, Glycosuria, Ketonuria and their Association with Severity of Organophosphate Poisoning- A Cross-sectional Study

Introduction: Organophosphate Poisoning (OP) is very common in India and presents with features of cholinergic excess. Timely diagnosis and prompt treatment helps in prevention of complications like aspiration pneumonitis, respiratory failure etc. Due to non availability of Pseudo cholinesterase measuring facility at many rural areas and subcentres and as hyperglycaemia, glycosuria and ketonuria are commonly seen in OP poisoning, the study of association of these three parameters with OP poisoning is of utmost importance. Aim: To study the association of hyperglycaemia, glycosuria and ketonuria with severity of OP. Materials and Methods: This was a cross-sectional study with a sample size of 120 patients of OP poisoning, who reported to Karnataka Institute of Medical Sciences Hospital, Hubli, from December 2017 to November 2018. Adults >18 years of age with OP poisoning with no pre-existing diabetes were included. Clinical features with Peradeniya Organophosphate Score (POP Score), Complete Blood Count (CBC), Pseudo cholinesterase level, serum amylase, Gylcated Haemoglobin (HbA1c), Random Blood Sugar (RBS), urine ketones, urine glucose levels were obtained. The data was analysed using Chi-square test, Analysis of Variance (ANOVA), paired t-test, Pearson’s and Spearman’s correlation test. Results: Majority of the study population belonged to age group of 20-40 years (57.5%). Mean RBS at presentation was 200.58±110.31 mg/dL. Mortality was associated with higher RBS at presentation and RBS after 12 hours. There was significant association between RBS and outcome. Increasing RBS levels had direct correlation with mean duration of Artificial Manual Breathing Unit (AMBU) ventilation, mechanical ventilation, ICU stay duration, hospital stay duration and mortality rate. Deaths in cases with RBS <150 mg/dL was 2 and in >250 mg/dL is 22. Among the study population, eight cases had glycosuria and six had ketonuria at presentation. Mean POP score was also higher among these subjects with hyperglycaemia, glycosuria and ketonuria. Conclusion: Blood sugar levels, urine analysis for glucose and ketones are useful, simple and cheap markers for identifying the severity of OP. Their presence indicates patient was at higher risk of developing complications and patient may be planned for referral to higher centre from non equipped centres. Hyperglycaemic state is a poor prognosticating factor.

Diagnostic Accuracy of Rapid Antigen Test for COVID-19 Infection: A Retrospective Analysis

Introduction: For the diagnosis of Coronavirus Disease 2019 (COVID-19), Real-Time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) is a laboratory-based technique and is considered a gold standard test, but is time consuming. A Rapid Antigen Test (RAT) is used for screening which is an immunoassay that identifies the presence of a viral antigen causing infection at the point of care. The RAT is quick, inexpensive, easily accessible and doesn’t need lab handling or sample preprocessing. Aim: To measure the sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of RAT in comparison to RT-PCR. Materials and Methods: This retrospective study was conducted in Department of Community Medicine at Government Medical College (tertiary care centre), Surat, Gujarat, India, using secondary data from 1^st July 2020 to 5^th Dec 2020. The samples were collected from all the patients of Acute Respiratory Illness (ARI), Severe Acute Respiratory Illness (SARI), Influenza Like Illness (ILI), the suspected COVID-19 cases and all walk-in patients for testing or treatment purposes. A total of 264 participants enrolled in the study underwent both the RAT and RT-PCR tests. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated using MS Excel Statistical Package for the Social Sciences (SPSS) version 17.0. Results: Total 264 cases were analysed, amongst which 161 (60.9%) were males and 103 (39.1%) were females and the mean age of the patient was 41.6 years and 36.8 years for males and females, respectively. The overall sensitivity was 52.47%, specificity was 87.11%, PPV was 71.62% and the NPV was 74.73%. While among symptomatic patients, sensitivity was 55.55%, specificity was 88.54%, PPV was 76.97% and NPV was 74.35%. Conclusion: Because of the low sensitivity of the RAT, if used alone, a high number of false negative cases will be resulted. Hence, it is employed in community and clinical settings as sequential screening in conjunction with RT-PCR, which results in improved net gain and aids in disease transmission control.

Evaluation of Patient Satisfaction with Clinical Laboratory and Phlebotomy Services in a NABL Accredited Laboratory in a Tertiary Care Hospital, Eastern India: A Cross-sectional Study

Kavita Aggarwal, Sumit Jhajharia, Tapaswini Pradhan, Viyatprajna Acharya

Introduction: Clinical laboratories play an indispensable role in patient care. Laboratory results help in approximately 70% of medical decision making. Patients are the best source of information on quality of service provided by an Institute, as their feedback can help in future planning and taking corrective action. Aim: To evaluate patient satisfaction with clinical laboratory and phlebotomy services in a National Accreditation Board for Testing and Calibration Laboratories (NABL) accredited laboratory in a tertiary care hospital in Eastern India. Material and methods: This was a hospital-based cross-sectional study, conducted from May 2021 to June 2021, on the patients visiting the central laboratory of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha. A total of 265 participants above the age of 18 years were included in the study. They were provided with a feedback questionnaire (13 questions). A 5-point Likert scale rating of very dissatisfied, dissatisfied, neutral, satisfied and very satisfied was used. Descriptive statistics such as number and percentage were used to present the data. Results: Out of the total, 96% was the response rate, hence, the complete questionnaires analysed were of 254 participants (130 males and 124 females). Out of the total 254 participants, 155 (61%) were very satisfied, 61 (24%) were satisfied, 28 (11%) were neutral and 10 (3.93%) were dissatisfied with the overall laboratory services. Laboratory test results were reliable scored very high and was reported to be very satisfactory by 177 participants (69.68%), satisfactory by 51 participants (20.07%) and 165 participants (64.96%) were very satisfied and 58 participants (22.83%) were satisfied with staff courtesy, skill and behaviour. However, none of the participants were very dissatisfied and 10 (4%) were dissatisfied, expected the laboratory services to be little better. For explanation of test results 79 participants (31.10%) were very dissatisfied and another 114 participants (44.88%) were dissatisfied. A total of 34 participants (13.38%) were very dissatisfied and another 50 participants (19.68%) were dissatisfied with the given information about location and time of report collection. Conclusion: Patient satisfaction is an important indicator of the quality of service delivered. The overall satisfaction level with the laboratory service was 85%, showing a majority of the participants were satisfied or very satisfied with the overall services of the laboratory. There is a need to improve on cleanliness and more emphasis is to be laid, on transmission of accurate and adequate information to the patients.

Primary Extranodal Lymphomas: A Five Year Retrospective Study from a Tertiary Care Cancer Centre, Kerala, India

Introduction: Primary Extranodal Lymphomas (pENLs) are defined as lymphomas with dominant extranodal involvement with no or minor involvement of lymph nodes after routine staging procedures. The present study highlights the profile of pENLs in Kerala, South India which is not yet reported in literature. Aim: To study the frequency, distribution and histopathology profile of pENLs diagnosed in a tertiary care cancer centre. Materials and Methods: This was a retrospective cross-sectional study done in a tertiary care cancer centre in Kerala, Southern India for a period of five years. All the cases of pENLs diagnosed during this five year period which fulfilled the inclusion criteria were included in this study. These 3,357 cases were reviewed and classified according to the 2017 revised 4^th edition World Health Organisation (WHO) classification of Tumours of Haematopoietic and Lymphoid tissues. Data was summarised using descriptive statistics. The frequency, distribution and histopathology features of pENLs were studied. Results: A total number of 3,357 lymphomas were diagnosed at the centre during this period. Non Hodgkin lymphomas (NHLs) constituted of 2610 (77.7%) cases. pENLs constituted 477 cases which included two cases of classical hodgkin lymphomas. Primary extranodal NHL (n=475) constituted 18.2% of NHL. Diffuse large B-cell lymphoma (DLBCL), Not Otherwise Specified (NOS), was the most common histologic subtype (173 cases, 36.2%) followed by Mucosa Associated Lymphoid Tissue (MALT) lymphoma (77cases, 16.1%). Most common site of presentation were Gastrointestinal Tract (GIT) (117 cases, 24.5%) and Head and Neck region (HN) (117 cases, 24.5%). Conclusion: DLBCL, NOS was the most common subtype. GIT and HN region was the most common site of pENLs in present study. The frequency of pENLs in present study was comparable to few other Indian studies but was lower than Far Eastern studies. The frequency of Adult T-cell leukaemia/Lymphoma (ATLL) was high which was not mentioned in similar studies on pENLs from India.

Macular Thickness- An Early Predictor of Diabetic Macular Oedema

Chandrika Sareddy, Shubha Nagpal, Deepa Muzumdar

Introduction: Diabetic Macular Oedema (DME) accounts for visual morbidity in about three-fourth of Diabetic Retinopathy (DR) patients. Traditional examination on 90D slit lamp or stereoscopic fundus photograph may not be able to identify early maculopathy. Optical Coherence Tomography (OCT) is a sensitive, non invasive modality which may detect early retinal thickness changes in DME. Aim: To identify any increase in macular thickness in diabetic patients with early DR without any clinically detectable macular oedema. Materials and Methods: This cross-sectional analytical study was conducted from September 2018 to July 2020 in the Ophthalmology Department at Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India. A total of 277 eyes of 184 subjects were evaluated. Of these 182 eyes were of diabetic patients (124 patients) and 95 eyes belonged to controls (60 subjects). Amongst the diabetic eyes evaluated, group I consisted of 100 eyes with no evidence of DR and group II consisted of 82 eyes with mild Non Proliferative Diabetic Retinopathy (NPDR). Group III included 95 eyes of non diabetic age matched controls. Macular thickness was measured using the Topcon 3D OCT-1 Maestro System. The central 1 mm macular thickness of the three groups was analysed and compared using student’s t-test. Results: The mean Central Macular Thickness (CMT) showed no statistically significant difference (p-value <0.7) between group III (222.4±10.8) and group I (223.0±13.7 μm). However, a significant increase in CMT (p-value <0.0001 and p-value <0.0006) was noted in group II (230.7±15.6 μm) when compared with group III (222.4±10.7 μm) and group I (223.0±13.7 μm). Macular thickness amounting to Subclinical Macular Oedema (SCME) was seen in only in 6.09% of eyes in group II, five eyes of the total number of 82 eyes with mild NPDR. Conclusion: Increased CMT was detected in mild NPDR patients on Optical Coherence Topography (OCT) even without any clinical evidence of macular oedema. Since eyes with SCME, diagnosed at base line assessment, are at a higher risk of developing clinical macular oedema subsequently, it is recommend that a base line OCT be performed in all patients detected to have mild NPDR irrespective of the absence of clinical findings suggestive of DME.

Immunohistochemical Characterisation of Cell of Origin in Diffuse Large B-cell Lymphoma and its Association with the Double Expressor Phenotype: A Retrospective Study

Introduction: Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL) and is categorised into the Germinal Centre B-cell (GCB) and Activated B-cell (ABC/Non GCB) subtypes as per the Cell Of Origin (COO) model with the help of gene expression profiling/immunohistochemistry. The non GCB subtype has been found to associate with the Double Expressor (DE) phenotype (i.e., co-expression of BCL-2 and c-myc by IHC and this association was substantiated and proven to be statistically significant in the present study. Aim: To categorise all DLBCL cases into GCB and Non GCB and further into DE and Non-DE by using Hans and Choi IHC alogrithm. Materials and Methods: A retrospective study of 50 patients was carried out with the help of archival material filed in the Department of Anatomic Pathology at Dharamshila Narayana Superspeciality Hospital, New Delhi, India from 1st January 2019 to 30th June 2020. The study was approved by Instituitional Ethics Committee (IEC). The study cohort was divided into two groups- group A with nodal presentation and group B with extranodal presentation. By using the Hans and Choi IHC algorithms, the cases were categorised into the GCB and non GCB subtypes in both the groups. Chi-square test and Yates correction were used for statistical analysis. Results: The median age at presentation was 49 years (20-81 years) with a male to female ratio of 2.3:1 (35 males and 15 females). Group A with nodal disease included 28 patients and group B with extranodal disease included 22 patients. The DE phenotype was determined in each case by the co-expression of c-myc (>40%) and BCL-2 (>50%) by IHC. By using the statistical chi-square test analysis and Yates correction, the association of DE was found to be statistically significant with non GCB type lymphomas and non DE with GCB lymphomas with p-value being 0.0005 and 0.00168, respectively. Conclusion: Due to the heterogeneity inherent in DLBCL, prediction of the DE phenotype and the COO by IHC is a sensitive tool and helps in the prognostication and therapeutic triage of patients. Hence, in all the cases diagnosed as DLBCL, a detailed morphological and IHC work up is mandatory to determine prognosis and possibly tailor therapy according to COO and DE phenotype.

Influence of CRP on Antibiotics Prescription Pattern for Dental Infections: A Prospective Interventional Study

Introduction: Over the years, antibiotic prescription rates have increased dramatically for the treatment of dentoalveolar infections. A byproduct of this indiscriminate antibiotic prescription by dentists is the antibiotic resistance. Antibiotic resistant infections are a severe global health problem, putting the capacity to treat common diseases and perform complex medical procedures at risk. Aim: To compare the amount of antibiotics prescribed for dental infections with and without analysing C-reactive Protein (CRP) value. Materials and Methods: A prospective interventional study was conducted in Manipal University College Malaysia (MUCM), Melaka, Malaysia, dental clinic between October 2020 to March 2021 to record the antibiotic prescription by dentists. The study was divided into two phases where phase I had 28 subjects and phase II had 21 subjects and permission from Institutional Ethical Committee clearance was obtained for the study. The study was done to evaluate the effectiveness of C-reactive protein (CRP) to reduce antibiotic prescriptions in MUCM Dental Clinic. Data was summarised by computing frequency and percentages. The antibiotic prescription rate during phase I (n=28) (conventional method or routine pattern of prescribing antibiotics was done) and phase II (n=21) (CRP rapid test was done and the decision whether to prescribe antibiotics or not was done accordingly) was compared. The data was analysed by using Statistical Package for the Social Sciences (SPSS) software program, version 15.0 (South Asia, Bangalore) and compared applying the Chi-square test. Results: There was no significant difference in the distribution of the presence of medical condition (p=0.201) and distribution of clinical features (p=0.804) of subjects included in phase I and phase II. The antibiotics prescription rate reduced significantly from 89.3% in phase I to 52.4% in phase II (p=0.0014), indicating that CRP rapid test helps in reducing antibiotics prescription. Conclusion: The CRP rapid test aid in lowering antibiotic prescription in dental clinic settings. This may be useful to combat antibiotic resistance in general.

Mental Health Status among the Quarantined Population during COVID-19 Pandemic: A Cross-sectional Study from Western Rajasthan

Charan Singh Jilowa, Parth Singh Meena, Mahendra Jain, Prem Prakash, Pinki Tak

Introduction: Although, isolation and quarantine are important measures to curb the exponential growth of the prevailing Coronavirus Disease-2019 (COVID-19) pandemic, but at same time this can impose psychological issues among the affected population and also to their family members. Aims: To evaluate the mental health problems, their severity and associated factors in quarantined population during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted among 207 quarantined subjects at different quarantine centres of Ajmer, associated with JLN Medical College, Ajmer, India, from August to October 2020, after getting approval from Ethics Committee of the centre. All the consenting quarantined subjects who were of age 18 years and above, irrespective of their gender were enrolled in the study. For the assessment of psychiatric morbidity, participants were screened using Mini-International Neuropsychiatric Interview (MINI) 6.0.0. Finally, the relevant psychiatric assessment tools like Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Yale-Brown Obsessive Compulsive Scale were applied to assess the severity of the disorders. Pearson correlation analysis was used to evaluate the relationship among various clinical variables. The level of significance was considered at p-value <0.05. Results: Majority 85 (41.1%) subjects belonged to the age group 31-40 years of age. Around 160 (77.3%) participants were male. Around 51 (24.6%) presented moderate depression and 25 (12%) presented with severe depression. Also 182 (87.9%) presented with moderate anxiety. The study showed a statistically significant association between depression/anxiety and substance abuse, insomnia, co-morbidities, suicidal ideation/attempts. Conclusion: The findings of the present study concluded that a significant proportion of the quarantined population suffered from psychological issues. So, the psychological impact of a mandatory quarantine should be weighed more thoughtful and in an evidence based manner.

In-vitro Activity of Tigecycline versus Daptomycin against Clinical Isolates of Enterococcus Species

Reena Rajan

Introduction: Tigecycline is a potential therapeutic agent for multidrug resistant gram positive and gram negative organisms. The clinical efficacy of synergic combination of daptomycin with betalactam antibiotics have been described against various species of Enterococcus isolates. Aim: To detect the in-vitro activity of tigecycline and daptomycin against Enterococcus species and to compare their antimicrobial activity by Vitek 2 automated system. Materials and Methods: This was a cross-sectional study conducted at Department of Microbiology, Vinayaka Mission’s Kirupananda Variyar (VMKV) Medical College and Hospitals, Salem, Tamil Nadu, India. Isolates of Enterococcus obtained over a period of two years from March 2016 - March 2018 from various clinical samples were identified by standard biochemical method and their antimicrobial susceptibility pattern was determined. Minimum Inhibitory Concentration (MIC) of tigecycline and daptomycin was determined by Vitek 2 automated system. Analysis of data was done by using frequency distribution and percentage. Results: Out of 211 Enterococcus isolates studied, 23 (10.90%) isolates showed decreased susceptibility to daptomycin with MIC of ≥8 μg/mL. All isolates showed 100% susceptibility to tigecycline. Conclusion: The present study showed potent antimicrobial activity of tigecycline against various species of Enterococcus. Decreased susceptibility to daptomycin has been observed among the study isolates. Further clinical investigations are required to know the potential benefits of these agents in therapy.

Incidence of Complications of Unsafe Chronic Suppurative Otitis Media Presenting in a Tertiary Care Hospital at Assam, India- A Retrospective Study

Rupam Borgohain, Manaswi Sharma, Asha Saikia

Introduction: Chronic otitis media is inflammation of the middle ear cleft presenting with recurrent ear discharge through a tympanic membrane perforation. The disease spectrum ranges from mild to severe forms of complications. Complications of chronic otitis media can be extracranial or intracranial. Aim: To evaluate the demographic profile of patients with chronic otitis media and to estimate the incidence of complications in upper Assam province during a period of five year. Materials and Methods: This retrospective study was carried out on a total of 260 patients of chronic otitis media admitted in Ear, Nose and Throat Department, Assam Medical College and Hospital, Dibrugarh, Assam, India, during a period of five years from August 2016 to July 2021. The data collected were tabulated in Microsoft Excel Worksheet. The categorical variables were summarised as proportions and percentages. Results: From the records, majority (31.2%) of the cases were found in the age group of 11-20 years with a male to female ratio of 1.13. The disease was more common during the winter season (56.5%). A 13.5% cases showed complications of chronic otitis media. Mastoiditis was the most common extracranial complication (31.4%) , followed by periosteal abscesses (22.9%), facial nerve paralysis (11.4%) and labyrinthitis (5.7%). Conclusion: The early identification of symptoms by rural healthcare personnels and immediate management of unsafe chronic otitis media, to avoid complications.

Role of Intraoperative Frozen Section in the Diagnosis of Ovarian Neoplasms- A Retrospective Study in an Oncology Centre

Introduction: Ovarian malignancy is the sixth most common cancer in women and the seventh most common cause of cancer death. Intraoperative frozen section evaluation plays a critical role in guiding the type and extent of surgery. The overall accuracy of the intraoperative frozen section diagnosis for ovarian tumours was reported to be ranging from 85% to 95%. Aim: To determine frozen section accuracy in the diagnosis of ovarian neoplasms. Materials and Methods: The present study was a retrospective study taken up in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, from January 2011 to December 2018 during which all the ovarian masses which were sent for frozen section and later for regular Histopathological Examination (HPE) were included in the study. All the slides of these cases were reviewed by two senior pathologists in a double blind study. The frozen section and the permanent section reports of each patient were compared. The overall accuracy, sensitivity, specificity, positive and negative predictive values of the frozen section diagnoses were studied for benign, borderline and malignant cases by using 2×2 tables. The final histopathological diagnosis was considered as gold standard. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) software version 22.0 for windows. Results: The study included 289 cases and the overall accuracy of frozen section was 87.89%. Thirty five cases were incorrectly diagnosed, of which 24 cases were underdiagnosed and 11 were overdiagnosed. With respect to malignant potential, the sensitivity for malignant tumours was 81.4% with specificity of 96.8%. For benign tumours, the sensitivity and specificity were 93% and 91.4%, respectively. Borderline tumours had the lowest sensitivity of 68.7% with specificity of 91.8%. Conclusion: Gross examination is to be done carefully for tumour tissue selection for frozen section diagnosis intraoperatively. The results help to decide the type and extent of surgical management.

Comparative Analysis of Ki-67 in Different Scoring Patterns and its Association with other Prognostic Markers of Breast Carcinoma

Introduction: Immunohistochemical evaluation of Ki-67 is widely used for estimation of tumour proliferation in breast cancer. Till date, no specific method or a cut-off point for Ki-67 exists. Aim: To perform a comparative analysis between different scoring patterns and mean Ki-67 value and association of mean Ki-67 with other prognostic markers like tumour size, lymph node status, tumour stage and grade and different molecular subtypes of breast cancer. Materials and Methods: A cross-sectional study was conducted at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, between August 2019 to August 2021. Total of 50 new diagnosed cases of breast cancer were studied for the histologic type, grade and stage of the tumour. Immunohistochemistry for Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor 2 (HER2) and Ki-67 was performed. Association of Ki-67 with other prognostic markers like tumour size, lymph node status, tumour stage and grade and different molecular subtypes of breast cancer was evaluated by expressing Ki-67 as a continuous variable (mean±SD) and also by dividing Ki-67 into different scoring patterns (I: ≤14%, >14%, II: ≤15%, 16-30%, >30% and III: <20%, 20-50%, ≥50%). Statistical tests like Kruskal-Wallis test (mean Ki-67 with tumour size, tumour grade and molecular subtypes), Mann-Whitney Rank Sum test (mean Ki-67 with lymph node status) and one way Analysis of Variance (ANOVA) (mean Ki-67 with staging) respectively. Results: Out of 50 patients, 40 (80%) were older than 50-year-old. Twenty six (52%) cases affected the left breast. A total of 49 (98%) were diagnosed as Invasive Ductal Carcinoma (IDC). Among them 26 (52%) cases were of grade III and 25 (50%) cases were of Luminal A. Mean Ki-67 and molecular subtypes of breast cancer had statistically significant association (p=0.002). No association was found between mean Ki-67 and tumour size (p=0.608), lymph node status (p=0.506) stage (p=0.979) and grade (p=0.095) of the tumour. Although scoring pattern I and III had no remarkable findings. Notably, scoring pattern II showed higher tumour sizes, lymph node positivity, higher stage and grade and basal-like tumours demonstrated a higher Ki-67 index. Conclusion: Evaluation of Ki-67 as a continuous variable yielded significant association with other prognostic markers of breast cancer. There was no single “best” scoring pattern identified. A direct association of Ki-67 was found with molecular subtypes of breast cancer.

A One Man Army- TrueNat Testing for the Identification of COVID-19 in Firozabad, Uttar Pradesh, India

Lekha Tuli, Rohit Patawa

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has affected the entire world. The need of timely detection of the virus has been of prime importance and the efforts to develop sensitive, specific, rapid, portable and cost-effective diagnostic methods promoted the indigenous development of TrueNat testing for viral load in COVID-19 detection which had been previously designed for detection of tuberculosis and other infectious organisms. Aim: To see the importance of TrueNat testing among symptomatic and asymptomatic cases in different age groups and gender. Materials and Methods: This retrospective study conducted in the Department of Microbiology, Autonomous State Medical College and SNM Hospital, Firozabad, Uttar Pradesh, India, from June 2020 to May 2021, a total of 4,659 samples were collected from patients (Influenza Like Illness (ILI), Severe Acute Respiratory Illness (SARI), symptomatic, asymptomatic, those seeking hospitalisation, emergency), contacts and travellers and were subjected to testing by TrueNat (Molbio Quattro). The cases were divided into group A of patients who presented with symptoms ≤7 days; group B of patients who presented with signs and symptoms >7 days and group C comprised of asymptomatic patients. The symptoms of patients were associated with the Cycle threshold (Ct) values of the Envelope (E) gene and the RNA-dependent RNA polymerase gene (RdRp) gene. The Chi-square test was done to test the statistical significance of association of symptomatic patients with the outcome of the test. Results: The maximum number of positive cases were found in the people 20-39 years (p-value <0.05). The least positivity was found in the higher (80 years) and lower (below nine years) age groups. The positivity rates had no significant impact on the gender. The percentage positivity as detected by TrueNat testing was 3.3% and maximum positive patients were found in the group having symptoms <7 days (p<0.05). On association of the Ct values of E gene and RdRp gene with the symptoms it was found that 28.1% and 27.2% of the patients were in the high Ct value group. Conclusion: TrueNat was found to be a portable and easy to perform test which did not require special laboratory set up. The use of Viral Lysis Medium (VLM) reduced the time of RNA extraction which not only rendered it safer to perform but expedited the results.

Clinico-aetiological Analysis of Anaemia along with Haematological Parameters in Children and Adolescents: A Retrospective Study from a Tertiary Care Hospital, Chhattisgarh, India

Gyanesh Mishra, Rinu Dwivedi

Introduction: Anaemia is defined as a decreased concentration of blood haemoglobin. World Health Organisation (WHO) estimates that 42% of children less than five years of age worldwide are anaemic and prevalence of anaemia in India in children 6-59 months for year 2019 was 53.4%. Childhood anaemia not only affects physical health but cognitive and social development as well. Aim: To determine various causes of anaemia in children in age groups 1-5 years, 6-12 years and 13 to 18 years and to determine clinical features and haematological investigations in moderate to severe anaemia. Materials and Methods: This retrospective, observational study was conducted in Department of Paediatrics, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Charttisgarh, India, from September 2021 to December 2021. The data collection was done retrospectively over a period of two years, from September 2019 to September 2021 from patients case records which were available from Medical Record Department. A total of 300 patients from age one year to 18 years who were admitted in the paediatric ward with anaemia were included for study. Anaemia was defined and severity categorised based on WHO definition. The aetiology of anaemia was analysed based on Complete Blood Count (CBC) and investigations including serum ferritin, vitamin B12 level, bone marrow examination, High Performance Liquid Chromatography (HPLC) and other relevant investigations. Data was entered in a excel sheet and analysed using software Statistical Package for the Social Sciences (SPSS) version 21.0. Statistical test used was student’s t-test for paired and unpaired data for continuous variables. The p-value <0.05 was considered significant. Results: Out of total 300 patients, 148 (49.3%) were males and 152 (50.7%) were females. Most of the patients were in 1-5 years of age (45.6%), followed by 13-18 years age (29.4%) and 6-12 years (25%). Total 95 (31.6%) patients had mild, 112 (37.3%) had moderate and 93 (31%) had severe anaemia. The three most common causes of anaemia were iron deficiency in 77 patients (37.5%), haemolytic anaemia in 54 patients (26.3%) and vitamin B12 deficiency in 34 patients (16.5%). Mean Red Cell Distribution Width (RDW )(31.1±10.1%) values and mean of Mean Corpuscular Volume (MCV) (98.2±15.2 fL) were higher in vitamin B12 deficiency patients as compared to iron deficiency patients mean RDW (17.2±3.5%) and mean of MCV (58.14±7.3 fL), this difference was found to be significant with p-value <0.001. Conclusion: Most of the patients had moderate anaemia. Iron deficiency was most common cause of anaemia overall in children and especially below 13 years followed by haemolytic anaemia mainly sickle cell anaemia and Vitamin B12 deficiency anaemia. The MCV and RDW values from CBC can be used to identify two most common causes of nutritional anaemia.

Detection and Distribution of Low Level and High Level Mupirocin Resistance among Clinical Methicillin Resistant Staphylococcus aureus Isolates

P Ganesh Perumal, Subisha Kannan, B Appalaraju

Introduction: Prolonged and improper use of antibiotics increases the resistance among pathogens and leads to life-threatening implications and increases mortality. The incidence of mupirocin resistance in Methicillin Resistant Staphylococcus aureus (MRSA) clinical isolates were reportedly increasing. Aim: To determine the rate of high level and low level mupirocin resistance in clinical MRSA isolates in a tertiary care hospital. Materials and Methods: A cross-sectional study was carried out for a period of three months from December 2019 to February 2020 in Department of Microbiology, PSG Institute of Medical Sciences and Research (PSG IMSR), Coimbatore, Tamil Nadu, India. A total of 100 non duplicate Staphylococcus aureus isolates from different specimens were subjected to mupirocin susceptibility by Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) 2019 standards. The low (MuL) and high (MuH) level mupirocin resistance were detected by using 5 and 200 μg mupirocin discs (Himedia) respectively. The isolate exhibiting diameter of ≥14 mm indicates its susceptibility. The isolate exhibiting diameter ≤13 mm for both 5 and 200 μg indicates MuL and MuH strains respectively. Pearson’s Chi-square test was calculated and p-value of <0.05 was considered as statistically significant. Results: Total 51% Staphylococcus aureus isolates were found to be MRSA. In present study, 6 out of 51 (11.8%) MRSA isolates were found to exhibit MuL and 5 out of 51 (9.8%) MRSA isolates were found to be having MuH. Low level and high level mupirocin resistance were not observed in Methicillin Sensitive Staphylococcus aureus (MSSA). Conclusion: The incidence of MuH and MuL resistance among MRSA were found to be 9.8% and 11.8%, respectively. Screening for mupirocin resistant MRSA to be carried out periodically and stringent infection control practices to be in place to prevent further spread of mupirocin resistant MRSA.

Prognostic Role of CRS in High Grade Serous Ovarian Tumour Patients Receiving Neoadjuvant Chemotherapy in a Tertiary Care Hospital of Central India

Introduction: Ovarian tumours are rarely diagnosed early, patients presents only when the abdominal mass is appreciable in size. The current mode of treatment involves neoadjuvant chemotherapy with interval debulking surgery, followed by completion of the chemotherapy. The pathological examination of the interval debulking specimen allows an evaluation of the extent of the response to the chemotherapy and sensitivity of the tumour to the same. The Chemotherapy Response Score (CRS) developed by Bohm S et al., is being used to predict the prognosis of these patients. The advent of molecular genetics has allowed us to categorise tumours as per the mutations they possess, the prominent in High Grade Serous Carcinoma (HGSC) being Tumour Protein 53 (TP53), Breast Carcinoma 1/2 (BRCA1/2) and Homologous Recombination Deficiency (HRD). This knowledge is used to cater to the specific therapeutic needs of the patients. Aim: To apply the CRS to cases of high grade serous carcinomas of the ovary, presenting to the centre and association of the score with their survival. Materials and Methods: This retrospective and prospective study was conducted in a tertiary care hospital, on 30 patients of high grade serous carcinoma of ovary who received neoadjuvant chemotherapy and had interval debulking surgery were included in the study. The histopathological examination of the resected specimen was done with special emphasis on the omental deposits and the degree of necrosis, fibrosis, inflammation, macrophages and residual tumour. Chi–square test was used to analyse the histopathological parameters with CRS. The p-value <0.05 was considered as statistically significant. Results: The histological parameters of necrosis, chronic inflammation and residual tumour in the omental deposits were found to be the statistically significant in association to the CRS scores. Also, the CRS grading was associated with the survival of the patients. Conclusion: The CRS was found to associate well with the survival of the patients. This study recommends that CRS score be done in all post Neoadjuvant Chemotherapy (NACT) high grade serous ovarian tumours, which will guide further treatment.

Knowledge and Perception of Faculty towards Competency Based Medical Education: A Cross-sectional Study

Introduction: Competency-Based Medical Education (CBME) is newly transformed education system in India to enhance five major qualities in doctors like, clinician, communicator, leader, life-long learner and professional. The CBME was launched in 2019 in all Medical Institution of India to uniform one’s knowledge, skills and a new domain Affection but this newly reformed system need hike in manpower, infrastructure, budget and technology which is a dilemmatic thought. Aim: To perceive the acceptance of the faculty participants about CBME system and also to explore various domains including the efficiency of training orientation/sensitisation, sufficiency of knowledge about CBME, infrastructure, manpower and finance required and strategies or implementation. Materials and Methods: This cross-sectional study was conducted in Government Medical College, Azamgarh, Uttar Pradesh, India, from January 2020 to July 2020. Total 60 participants were included in the study. The study used a validated set of questions about CBME. The assessed domains were competency definition, difference between traditional and new curriculum, merits and demerits of CBME, stages of competence and strategies to implement. Descriptive statistics were used to describe the data using Microsoft Excel. Results: Total 60 (39 trained+21 untrained faculty) were included in the study, with maximum 28 (46.67%) were aged between 30-40 years {males were 38 (63.33%) and 22 (36.67%) were females}. Total 37 faculties knows “what is competency”, 37 participants responded for difference between CBME and traditional Medical education, 22 participants responded for stages of competency, 22 responded on steps and strategy for its implementation, 38% answered on merits and demerit of current curriculum. Conclusion: The sufficiency of knowledge of CBME can be easily judged by proportion of responses of open ended questions which was not more than 50% faculty for all questions. Closed ended questions have suggested that infrastructure, manpower and finance are not up to mark to implement CBME.

Effectiveness of Femoral Nerve Block versus Intravenous Nalbuphine in Positioning of Patients with Intertrochanteric Fractures for Spinal Anaesthesia: A Randomised Clinical Study

Amit Pradhan, Amrita Panda, Pragna Doppalapudi

Introduction: Femoral fracture is a common entity in all age groups. It is more common in elderly, and is a painful condition. Various modalities like peripheral nerve blocks, intravenous opioids can mitigate the pain associated with it, which is deterrent to ideal patient positioning for spinal anaesthesia. Aim: To compare the effectiveness of Femoral Nerve Block (FNB) versus Intravenous Nalbuphine (IVN) in positioning of patients with intertrochanteric fracture for spinal anaesthesia. Materials and Methods: A randomised clinical study was conducted in 70 patients of American Society of Anaesthesiologists (ASA) physical status I and II, with intertrochanteric fractures posted for surgery under subarachnoid block. Group IVN received intravenous Nalbuphine at dose of 0.1 mg/kg, and Group FNB received femoral nerve block with 20 mL of 0.2% ropivacaine 15 minutes, prior to positioning of patients for subarachnoid block. The ease of patient positioning was assessed by the pain relief observed during positioning for spinal anaesthesia, and by means of anaesthesiologist satisfaction score. Time taken to position the patients during spinal anaesthesia, and patient satisfaction scores were also measured. Independent ‘t’ test and Mann-Whitney U test were used for the analysis. Results: The Visual Analogue Scale (VAS) score achieved during positioning of patients for subarachnoid block was significantly better in FNB (3.87±0.99), as compared to IVN (5.09±1.23). No significant differences were observed between both the groups regarding anaesthesiologist satisfaction score, (p=0.11). Time taken for positioning of patients for spinal anaesthesia in seconds (p=0.69), and patient satisfaction score (p=0.08) were also comparable between both groups of patients. Conclusion: FNB is more effective for positioning of patients of intertrochanteric fractures for spinal anaesthesia. Although either of the techniques can be adopted for improving patient care, FNB may have an edge over IVN.

A Cross-sectional Study on Adherence to Personal Protective Equipment among Healthcare Workers during COVID-19 Pandemic in a Tertiary Care Centre, Tamil Nadu, India

Introduction: Personal Protective Equipment (PPE) provides physical barrier against hazardous injury or infectious agents. With the outbreak of COVID-19 pandemic, PPE plays a vital role with face mask and gloves are being most essential. The frontline Healthcare Workers (HCW) utilises them to minimise the risk of contaminated contact or infected droplet exposure. Aim: To evaluate the appropriate use of PPE among healthcare workers in tertiary care hospital. Materials and Methods: This cross-sectional study was conducted in SRM Medical College Hospital and Research Centre, Potheri, Chengalpet district, Chennai, Tamil Nadu, India, from February 2021 to May 2021, on utility of PPE among the healthcare workers. There were a total of 273 participants including doctors, residents (postgraduate)/interns, nurses and laboratory technicians. A predesigned questionnaire was utilised to collect information, apart from observation of their PPE practice and 360 degree observation from peers were also used to evaluate. Statistical analysis was done using Chi-square test, Fisher’s-exact test and logistic regression model. Results: Among 273 HCWs, there were 58 (21.24%) doctors, 163 (59.71%) residents and interns, 19 (6.96%) nurses and 33 (12.09%) technicians. There was no association in the frequency of mask with the type of HCW (p-value=0.217). However, the usage frequency of gloves (p-value=0.003), face shield/goggles (p-value=0.004), disposable gown (p-value=0.001) and doffing according to protocol (p-value=0.001) showed statistically significant difference between the category of HCWs. Conclusion: In this study, PPE adherence was high among HCW; however, there was a subtle difference in compliance across the varied groups of healthcare professional and type of PPE used. The PPE compliance among HCW cannot be assumed to be good blindly; frequent official training programs, availability of PPE logistics along with scrutinisation regarding its appropriate usage and discarding at regular intervals minimises the non compliance and also helps in curtaining the COVID-19 transmission.

PULP Score vs AAST EGS Grading System in Prediction of Outcome of Perforated Peptic Ulcer Disease: A Retrospective Study

B Bharath, Gade Sagar Reddy, John M Francis

Introduction: Peptic Ulcer Disease (PUD) is the most common diagnosis for upper abdomen pain, and it includes ulcerations and erosion in the stomach and duodenum. Complication such as Perforated PUD (PPUD) is only second to bleeding and remains a life-threatening emergency. Aim: To compare the American Association for the Surgery of Trauma-Emergency General Surgery (AAST EGS) scoring system with a widely accepted Peptic Ulcer Perforation (PULP) scoring system for PULP to determine the discriminative capacity and pairwise comparison of both scoring systems. Materials and Methods: This was a retrospective study conducted from September 2018 to August 2020 at Department of General Surgery, PES institute of Medical Science, Kuppam, Andhra Pradesh, India. All the adults diagnosed with perforated PUD were included. Preoperative, Intraoperative, and postoperative data were collected. The scores were generated for PULP and AAST EGS grades and analysed using Statistical Package for Social Sciences (SPSS) version 17.0. Spearman’s rho test evaluated a comparison of each variable with the AAST EGS grade. The pairwise comparison was performed for complication development, patient duration of stay, mortality and described using the Area Under the Receiver Operating Characteristic (AUROC) with 95% Confidence Intervals (CI). Results: This study included 165 patients in this 87% male with a mean age of 56.89±16.79 years. All the total patients were divided into those ≥50 years (n=56, mean age: 36.8±9.04 years) and >50 years (n=109, mean age: 67.2±8.4 years) and comparative analysis was performed accordingly. Overall, the patients were categorised into the following AAST EGS grade I (9, 5.5%), grade II (99, 60%), grade III (42, 25.45%), grade IV (15, 9%), there were no patients with grade 5 AAST EGS. The AAST EGS grade was comparatively better them PULP score for postoperative complications, but there is not much difference between the PULP score and AAST EGS score for the patient’s duration of stay. AAST EGS grade and the PULP discriminated, patient 30-day mortality similarly, but if Area Under Curve (AUC) >0.8, it is a good predictor. Conclusion: The AAST EGS scoring system and the PULP scoring system do similarly predict mortality and complication. But the presence of many variables with points and tabulation which requires laboratory investigation makes PULP scoring system inconvieninent at bedside.

Effect of Yogic Breathing Manoeuvre on Pulmonary Function and VO₂ Max in Male Football Players

Shubham Jangam, P Sathya, Jibi Paul

Introduction: Yoga has proven to improve spiritual as well as psychophysiological behaviour of a human being. This helps them to perform better in their game improving abdominal strength and gives benefits to every player’s need. It also helps improve both physical and mental health. Aim: To analyse the effects of yogic breathing manoeuvre on pulmonary functions and Maximal Aerobic Capacity (VO₂ max) in male football players. Materials and Methods: This quasi-experimental study was conducted in Department of Physiotherapy, School of Physiotherapy at D.Y. Patil University, Navi Mumbai, Maharashtra, India, from February 2019 to February 2020. The study included 60 male players within the age group from 18-25 years with at least two years of experience. They were divided into two groups- group A was experimental group and group B was control group. Group A performed pranayama along with routine football specific training and group B performed only football specific training for six weeks. Pre and post values for pulmonary functions and VO₂ max were taken by Pulmonary Function Test (PFT) and Queens College step test as outcome measures. The data was analysed using independent t-test. Results: Mean age of group A and group B was 19.7±1.69 years and 20.6±1.89 years, respectively. After doing yogic breathing maneuvers for six weeks, there was a significant (p-value <0.001) improvement in pulmonary function and VO₂ max values in male football players for experimental group as compared to control group. The mean difference for Forced Expiratory Volume in 1 second (FEV1) was 0.3% and 0.13% and for VO₂ max was 0.71 mL/kg/min and 2.71 mL/kg/min for control and experimental group, respectively. Conclusion: Implementing regular practice of yogic breathing manoeuvre along with football training improves pulmonary functions of the football players.

Magnetic Resonance Imaging findings in Primary Extracutaneous Melanoma from a Tertiary Cancer Care Centre: A Retrospective Cohort Study

Introduction: Extracutaneous melanomas are rare, aggressive type of tumour, clinically and biologically distinct from their cutaneous counterpart. The two large broad categories of the extracutaneous melanomas are ocular and mucosal subtypes. Melanomas are classically hyperintense on T1 weighted images and hypointense on T2 weighted images due to the paramagnetic effects of melanin and presence of paramagnetic elements. Aim: To describe the Magnetic Resonance Imaging (MRI) findings in primary extracutaneous melanomas at various anatomic sites. Materials and Methods: This was a retrospective cohort study in which 13 cases of primary extracutaneous melanomas were identified from Picture Archiving and Communication System (PACS) archive over a period of eight years (January 2013-December 2020). Location and morphology of the tumour, signal intensity characteristics in T1 weighted, T2 weighted (hyperintense/isointense/hypointense to adjacent muscle) and Diffusion Weighted Imaging (DWI) (presence or absence of diffusion restriction) were analysed. Results: The ocular melanomas (n=2) were seen as well-defined small intraocular mass attached to the choroid. The mucosal melanomas of the nasal cavity (n=2), rectum (n=4), vagina (n=3) and cervix (n=2) presented as large intraluminal polypoidal masses. Three categories of MRI appearances emerged in this study. Majority of the cases (n=8) showed hyperintense signals in T1-weighted images and hypointense signals in T2 weighted images (category 1). Diffusion restriction was seen in all cases (n=13) with low Apparent Diffusion Coefficient (ADC) values which ranged from 439-966 mm/sec with an average value of 755 mm/sec. Conclusion: T1 and T2 shortening are typical of melanoma, the absence of these does not exclude the diagnosis. Although diffusion restriction and low ADC values help in the diagnosis of these tumours, they do not tend to play a specific role in the diagnosis.

Approach for Safe Transfusion Practices during COVID-19 Pandemic: Observation of an Indian Rural Blood Bank

Nikhil, Subhashish Das, A Hemalatha, R Kalyani

Introduction: Focus of blood transfusion services is continuous, judicious and well-timed supply of safe blood. The Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) pandemic has caused the major disruption throughout the world and declaration of nationwide lockdown by Government of India from 25^th March 2020 to 31^st May 2020 to halt the spread of virus has afflicted the blood bank services enormously. Aim: To keep the focal point on approaches implemented for safe blood transfusion services during Coronavirus Disease-2019 (COVID-19) pandemic in rural blood bank and to observe how COVID-19 pandemic has affected blood transfusion services in year 2020 with regards to blood collection, supply and organisation of camps as compared to year 2019. Materials and Methods: A retrospective study was done in the Blood Bank in a rural tertiary care hospital in Southern India, from January 2019 to December 2020. Various measures were implemented to increase the donor safety and prevention of spread to community and to increase the number of voluntary donors. Statistical analysis performed using Statistical Package for Social Sciences (SPSS) software version 21.0. All data was entered and tabulated in excel sheet. A two sided t-test was utilised for comparing dual variables and one sided Analysis of Variance (ANOVA) for multiple variables. The p-value <0.05 was considered significant. Results: Mean number of units received during pre-COVID-19 year were significantly higher (4468±4127.2) as compared to COVID-19 year 2020 (2282±1856.4) with significant p-value <0.001. Overall utilisation of Packed Red Blood Cell (PRBC) (0.001), Human Platelets (Single Donor Platelets (SDP)/Random Donor platelets (RDP)) p-value 0.003, Fresh Frozen Plasma) FFP (p-value 0.001) was significantly higher in pre-COVID-19 year as compared to COVID-19 year 2020. Total number of camps conducted in pre-COVID-19 year was 41 as compared to 23 in COVID-19 year 2020. Patients deferred for blood donation were much higher in COVID-19 year 2020 (n=400) with maximum (32.5%) under category of self-deferral due to clinical illness as compared to year 2019 (n=200). Conclusion: As a result of our strict and effective implementation of COVID-19 safety protocols, no donor had complained of post donation COVID related symptoms and none of our blood bank staff had developed any COVID-19 related illness. Hence during the COVID-19 pandemic, our blood bank maintained 100% attendance (with staggered duty hours).

Comparison between Haemodynamic Responses of Propofol Induction between BIS Guided Dose and Sleep Dose: A Randomised Control Trial

Introduction: Propofol contributes largely in the rapid evolution of day care surgery due to its superior recovery characteristics. However, it is associated with dose-dependent systemic arterial hypotension which increases morbidity and mortality. Bispectral index (BIS) is an Electroencephalographic (EEG) derived parameter used to assess the depth of anaesthesia. Titrating drugs to a specific BIS value during general anaesthesia allows to adjust the dose of anaesthetic needed by the patient thereby, reducing the dose related side-effects. Aim: To determine whether the dose of propofol guided BIS values causes less arterial hypotension than the commonly used sleep dose method. Materials and Methods: The present study was a randomised control trial conducted on 92 patients of American Society of Anesthesiologists (ASA) I and II physical status, aged 18-60 years, of both genders, scheduled for elective surgeries under general anaesthesia and were randomly divided into group A and B (46 in each). For induction of anaesthesia, group A received propofol till the BIS values reached 50±1 for 30 seconds, while group B received sleep dose of propofol without BIS monitoring. Haemodynamic effects Heart Rate (HR), Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP) and Mean Arterial Pressure (MAP) were recorded at baseline, during induction and at 1,5, 10 and 15 minutes after intubation. Total propofol consumption and secondarily, level of sedation after extubation using Ramsay Sedation Scale were also measured in both the groups. Results: The total dose requirement of propofol was reduced significantly in group A compared to group B (p<0.005). Blood pressure decreased from the baseline in both the groups following induction with propofol but was insignificant. The HR increased by 2.2% in group A while it decreased by 8.5% in group B but was insignificant (p>0.005). On arrival to Post Anaesthesia Care Unit (PACU), group A were more co-operative, oriented patients compared to group B (67.4% vs 32.6, respectively. Conclusion: The BIS monitoring significantly reduces the consumption of propofol for induction of anaesthesia while the incidence of hypotension was similar in both the groups. Lower sedation level with comparatively better extubation score with the use of BIS helps in fast tracking.

Morphometric Study of Proximal Femur and its Applications in Prosthesis Designing: A Cross-sectional Study from Western India

Sajan Skaria, Manoj Kulkarni, Hetal Vaishnani

Introduction: The hip joint is subjected to daily stresses as it bears the weight of the upper body. Osteoarthritis of the hip may cause irreversible damage. Proximal geometry of the femur, like neck-shaft angle and torsion is important in designing prostheses for a specific population. Most of the prostheses manufacturers follow the Western parameters as there is a scarcity of data in the Indian context. Aim: To analyse the normal Neck-Shaft Angle (NSA) and torsion of the femur in the Indian population. Materials and Methods: This cross-sectional analytical study was carried out in a total of 300 dried femur (150 right and 150 left) of unknown age and gender without any defect or damage during a period of 2.6 years (June 2019 to December 2021) in Sumandeep Vidyapeeth University, Gujarat, India. The NSA and the angle of femoral torsion was measured using a Goniometer. Mean and standard deviation were calculated. Student’s t-tests was applied to ascertain the statistical difference between right and left femur. Results: The average NSA was 128.55±6.99°. The mean values were 130.70±6.03° and 126.41±7.22° on right and left sides respectively with statistically significant difference (p-value <0.0001). The average femoral torsion was found to be 16.43±2.34°. On the left side, it was 16.43±2.31° and 16.43±2.36° on the right side with No statistically significant difference was found between right and left femorae (p-value=1.00). Conclusion: The accuracy and success of the hip replacement surgery demands complete knowledge of the morphometry of the proximal femur which is highly specific among the races, region and gender. The present study provides the normal morphometry of the proximal femur of Indian population.

Association of Multisystem Inflammatory Syndrome Temporally Associated with COVID-19 (MIS-C) with Coinfections: A Retrospective Cross Sectional Analytical Study from Northern India

Afreen Khan, Aparna Chakravarty, Rizwan Naqishbandi, Rekha Harish, Faizan Kamili

Introduction: Multisystem Inflammatory Response Syndrome in Children (MIS-C) temporally associated with Coronavirus Disease 2019 (COVID-19) is characterised by fever, raised inflammatory markers, multisystem involvement with evidence of COVID-19 infection (positive RT-PCR or serology). It occurs concurrently or after 4-6 weeks of acute COVID infection. It has wide range of clinical presentation ranging from mild asymptomatic infection to severe life-threatening illness. Clinical presentation of MIS-C has considerable overlapping features with other tropical infections. During peak wave of COVID-19, when large proportion of population has been affected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), contracting other infections during and within four weeks of active COVID-19 is inevitable. Despite of this concern, only few researchers have studied co-infection and they explained a complex interaction between COVID-19 and other infections like tuberculosis and dengue. They demonstrated how one infection augments the severity of other. To the best of our knowledge no paediatric population-based study explained the interaction of acute COVID-19 and MIS-C with other infections so far. Aim: To determine the association of MIS-C with co-infections in SARS-CoV-2 positive children of one month to less than 18 years of age. Materials and Methods: A retrospective cross-sectional analysis of the medical records of paediatric patients with SARS-CoV-2 infection, treated from September 2020 to February 2021, was performed. All the patients who fulfilled World Health Organisation (WHO) criteria of MIS-C were included. Detailed demographic, clinical, laboratory parameters and associated co-infections were recorded.The severe and non severe MIS-C groups were compared. Sample ‘t’ test, Wilcoxon test and Chi-squared test were used for statistical analysis. Results: A total of 44 children fulfilled the diagnostic criteria of MIS-C and were included in the study. Out of 44, 20 children (45.4%) had severe disease and 24 had non severe disease. The mean age of children with severe MIS-C was 7.38±5.39 years, as compared to 4.37±4.61 years in the non severe group (p-value=0.044). Males were predominantly affected in both the groups (Male: Female=1.22:1 in severe MIS-C and 2.4:1 in non severe MIS-C). The gastrointestinal system was most commonly affected in both groups. Associated coinfection was noted more in severe MIS-C group (11 vs 1 patient in severe vs non severe group, p-value <0.001). Tuberculosis was found to be associated in three patients, followed by complicated enteric fever, and severe dengue in two patients each. The odds ratio for developing severe MIS-C in the presence of co-infections was 10.5 (CI=2.33-47.27) while in its absence it was 0.10 (0.02-0.43). Conclusion: The findings of this study support that concurrent infections in COVID-19 can exacerbate the severity of COVID-19 illness and may lead to severe MIS-C.

Clinical Grading of Diabetic Foot Ulcer Infection and its Predictors among Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: Globally, about 425 million people are living with diabetes mellitus. Diabetic Foot Ulcers (DFU) are one of the severe complications of poorly controlled diabetes and over the time, about 50% of DFUs become infected which may require hospitalisation. Aim: To find out the DFU infection severity pattern and its predictors among Type 2 Diabetes Mellitus (T2DM) patients. Materials and Methods: This cross-sectional study was conducted at Integrated Diabetes and Gestational Diabetes Clinic (IDGDC), IQ City Medical College and Multispeciality Hospital, Durgapur, West Bengal, India, among T2DM patients from June 2018 to November 2018. Total 1534 T2DM patients attended IDGDC during data collection period of four months and 132 of them had diabetic foot ulcer. After taking written informed consent, detailed data were collected from 132 of study participants using predesigned, semi structured and pretested schedule developed with the help of Infectious Disease Society of America (IDSA) and International Working Group on the Diabetic Foot (IWGDF/IDSA) classification system. Socio-demographic characteristic like age, sex, education, residence were recorded along with clinical data like glycated haemoglobin (HbA1c), duration of diabetes, treatment modalities. Anthropometric measurements were taken as per World Health Organisation (WHO) guidelines. T2DM was defined and classified as per American Diabetes Association (ADA) Guidelines. DFU infection severity was classified into uninfected, mild infection, moderate infection and severe infection as per IWGDF/IDSA guidelines. Chi-square test was used to show association between categorical variable. One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test was used to show association between mean HbA1c level and DFU infection severity. The p-value ≤0.5 was considered significant. Results: Proportion of DFU was found to be 8.6%. As per the IWGDF/IDSA classification of DFU infection severity was found to be moderate in 59 (44.7%) of the study participants and mild in 32 (24.2%) of the study participants. 22 (16.7%) of study subjects had severe infection and required hospitalisation for optimal care. Only 14.4% of study subjects did not have DFU infection. Increasing age (p-value=0.023), rural residence (p-value=0.015), poor education (p-value=0.001), obesity (p-value=0.001), central obesity (p-value=0.001), longer duration of diabetes (p-value=0.028), and poor glycaemic control (p-value=0.001) was found to be significant risk factors for severe infection in DFU. Conclusion: Routine clinical assessment of DFU infection may help in making clinical decision of treatment modalities and help in saving lower limb as well as life of people with T2DM.

Clinical Characteristics and Risk Factors for Mortality in COVID-19 Patients: A Retrospective Cohort Study

Introduction: Coronavirus Disease in 2019 (COVID-19) is globally a major factor in the mortality of patients. Hence, there is an immediate requirement to recognise the mortality predictors in the COVID-19 patients. Aim: To identify the clinical features and risk factors for the mortality of adult patients suffering from COVID-19 in Sirjan, Iran. Materials and Methods: In this retrospective cohort study, all demographic, clinical, laboratory data of COVID-19 patients who were admitted to hospitals of Sirjan city was collected from July to October 2020 and data was analysed in November 2020. In this period, 269 patients with COVID-19 were admitted. The findings based on the considered parameters of patients in the hospital was recorded; Univariable and multivariable logistic regression methods were applied to find the risk factors due to in hospital death. Results: Out of 269 patients, 39 patients (14.5%) died in the hospital and the rest were discharged. A total of 152 (56.5%) patients had co-morbidities. Hypertension (HTN) was the most common underlying disease 71 (26.4%), followed by Diabetes Mellitus (DM) 55 (20.4%), cardiac disease, and Chronic Obstructive Pulmonary Disorder (COPD). The most common symptom was dyspnoea 207 (77%), followed by cough, 192 (71.4%) and fever, 127 (47.2%). The most common findings in the chest Computed Tomography (CT) scan of patients was ground-glass opacity with a frequency of 150 among 188 patients (79.8%) in patients with the abnormal CT scan. Multivariable regression indicated the increased odds of in-hospital death associated with COPD (OR=3.20, 95% CI 1.02-10.04; p=0.046), arterial saturation of oxygen =93% (OR=5.70, 95% CL 2.42-13.40; p<0.001), and leukocytosis (OR=7.26, 95% CL, 3.02-17.49, p<0.001). Conclusion: Based on the results of the present study, COPD, arterial saturation of oxygen (=93%), and leukocytosis were risk factors for the hospital mortality of COVID-19. It might be proper for the initial determination of patients, who may need life saving interventions.

Clinical Profile and Treatment Response in Tuberculous Meningitis- A Comparison between HIV Positive and HIV Negative Patients

Introduction: Tuberculous Meningitis (TBM) is a common infection in patients with Human Immunodeficiency Virus (HIV) and it shows significant differences in clinical profile, treatment response, and outcome compared to patients without HIV infection. Aim: To describe the clinical presentation, laboratory parameters, and radiological findings of TBM patients with and without HIV co-infection and to observe differences between them in treatment response, complications, and mortality. Materials and Methods: This was a prospective observational study, conducted on 80 TBM patients with (n=40) and without (n=40) HIV co-infection. Demographic, clinical, laboratory data, and various imaging findings were noted at the start of the study and at three and six months follow-up, for any changes from baseline to know the treatment response. Appropriate statistical tests were applied, and p-value less than 0.05 were considered statistically significant. Results: Mean age of HIV patients was 36.75 years and that of the non HIV patients was 29.35 years (p<0.05). Altered sensorium (90% in HIV and 72.5% in non HIV), seizures (50% in HIV and 20% in non HIV) were common in HIV patients, and weight loss (95% in non HIV and 87.5% in HIV) was common in non HIV patients. Common signs noted were nuchal rigidity (90% in HIV and 87.5% in the non HIV group), focal neurological deficit (50% in HIV and 22.5% in non HIV), and cranial nerve palsy (37.5% in HIV and 12.5% in non HIV). Anaemia was seen in 56.3% (87.5% in HIV and 25% in non HIV) and raised Erythrocyte Sedimentation Rate (ESR) was seen in 56.3% (25% in HIV and 87.5% in non HIV) patients. Tuberculoma was the most common (32.5%) Magnetic Resonance Imaging (MRI) brain finding. Adverse drugs reactions due to ATT (other causes ruled out) were seen in 22.5% of HIV patients (none in non HIV), and Antiretroviral Therapy (ART)-induced Adverse Drugs Effects (ADE) was noted in 10% of patients. Patient survival was better among non HIV (65%) compared to HIV (55%) patients. Multidrug-resistant Tuberculosis (MDR-TB) was more prevalent in HIV (7.5%) than non HIV (2.5%) cases. Conclusion: TBM involves a younger population, has a worse prognosis in HIV co-infection patients with more adverse reactions to treatment.

Molecular Analysis of Oxacillinase Genes and Identification of Drug Resistance Pattern in MDR Strains of Acinetobacter baumannii Isolated from Burn Wound Samples in Kermanshah, Iran

Introduction: Carbapenem Resistant Acinetobacter Baumannii (CRAB) is a dangerous nosocomial pathogen that can cause high mortality in patients. This bacterium has a remarkable ability to acquire various resistance mechanisms due to this it is considered as one of the health priorities. Aim: To investigate the prevalence of the OXA-23, OXA-24, and OXA-58 genes in Acinetobacter baumannii isolates collected from burn wound samples in Kermanshah, Iran. Materials and Methods: A cross-sectional study was done during 11 months period from December 2018 to October 2019, 74 A. baumannii isolates were collected from those admitted to the Burns Unit of Imam Khomeini Hospital in Kermanshah, Iran. The 74 A. baumannii isolates were detected using particular bacteriological methods. Following determination of the antibiotic sensitivity of the specimens using the disk diffusion technique, polymerase chain reaction was performed to determine the frequency of the OXA-23, OXA-24, and OXA-58 genes using their specific primers. Data were analysed using Fisher’s-exact test and Chi-squared test in Statistical Package for the Social Sciences (SPSS) version 20.0. A p-value <0.05 was considered statistically significant. Results: All the 74 A. baumannii isolates were Multidrug-Resistant (MDR) (41 from males and 33 from females). The highest drug resistance was against cefotaxime (100%) and piperacillin (98.6%), while all the isolates were sensitive to polymyxin B and colistin. Oxacillinase genes with the highest and lowest frequencies were OXA-23 (64.7%) and OXA-58 (3.5%), respectively. The highest frequency of isolates with two genes were related to OXA-23 and OXA-24. A significant relationship was observed among the existence of oxacillinase genes and resistance to some antibiotics. Conclusion: The results of this study indicated the significance of OXA carbapenemase genes in burn patients. Due to the high drug resistance of A. baumannii isolates collected from wound samples, the identification of carbapenemase-producing A. baumannii isolates is paramount in developing prevention and control programs for these drug-resistant isolates.

Clinical, Laboratory and Radiological Profile of COVID-19 Patients during the Second Wave with Special Reference to Vaccination Status

Introduction: Coronavirus Disease-19 (COVID-19) has been creating havoc worldwide since the first report in December, 2019. Vaccination against the disease was thought to bring respite, reducing the severity of disease, morbidity and mortality. However, considering the fact that no vaccine is fully efficient, people may get COVID-19 even after full vaccination. Aim: To determine the clinical, laboratory, radiological features of COVID-19 including the outcome and compare these between vaccinated and unvaccinated patients. Materials and Methods: The prospective observational study was conducted in a dedicated COVID-19 hospital in Odisha, India, from May 2021 to June 2021. Detailed history including symptoms and vaccination status, laboratory parameters, and radiological investigations were collected from 200 patients. The cases were classified as mild, moderate and severe as per the Ministry of Health and Family Welfare (MoHFW) guidelines. All the patients were followed till the end of hospital stay. The results were expressed as the mean±standard deviation and percentages. Chi-square test was used to compare the categorical variables, and unpaired t-test was used to compare two discrete variables. A p-value of less than 0.05 was considered significant. Results: Majority of the patients were unvaccinated (65%) and belonged to the age group of 39-59 years (58.5%). Among the non vaccinated patients, 32.3% had moderate disease, while 35.4% had severe disease. In the vaccinated group, 51.4% had moderate disease, whereas only 28.6% patients developed severe disease. Increased Neutrophil to Lymphocyte Ratio (NLR), D-dimer levels, and radiological evidence of pneumonia in chest radiology were witnessed in both groups. Inflammatory markers between the vaccinated and unvaccinated groups did not show any statistical significance (p>0.05). A total of 12 (6%) patients died, out of which five were vaccinated (p=0.6). Conclusion: Vaccination is found to be protective in terms of disease severity and mortality. Vaccination of all individuals is recommended to curb the wrath of the virus.

Emergence of Dengue as a Febrile Illness in Rewa and Nearby Districts of Madhya Pradesh During the Year, 2021: A Cross-sectional Study

Taruna Singh, Amaresh Nigudgi, Vijay Tiwari, Pramod Kushwaha, Ashutosh Garg

Introduction: Dengue is a mosquito borne viral disease, found in tropical and subtropical countries. Dengue virus (DENV) infected mosquitoes of Aedes species are crucial for the transmission of disease. It has emerged as a threat to the public health systems. Dengue is endemic in many parts of India but still the status of dengue cases in Rewa Madhya Pradesh is not reported convincingly. Aim: To investigate the presence of dengue in Rewa district of Madhya Pradesh. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology at Shyam Shah Medical college Rewa under National Vector Borne Disease Control Programme (NVBDCP), Rewa, Madhya Pradesh, India, including 1113 Outpatient/Inpatient (OPD/IPD) Department samples received during March 2021 to October 2021. Blood samples were collected from patients having febrile illness and after serum separation, serum were subjected to NS1 Enzyme Linked Immunosorbent Assay (ELISA) test. Descriptive statistics and Chi-square tests were applied for data analysis. Results: A total of 1113 sample were received and tested for dengue NS1 out of that 108 sample were found NS1 positive by ELISA. The cases of dengue started from the month of July 2021. But in the month of October dengue positivity was highest in number. Dengue cases reported were 6.73 in the rainy season (July-August), but the dengue positivity increased 12.3 in the post rainy season (September-October). Overall prevalence of dengue was higher in the 21-30 years (34.3%) age group followed by 11-20 years (24.1%), 31-40 years (18.5%), 41-50 years (18.5%), 51-60 years (7.4%) and >60 years (3.70%) age groups with respect to total positive cases. The prevalence of dengue was higher in male (12.94%) in comparison to females (5.54%). Conclusion: This study warrants the dengue virus infection as one of the important causes of fever during rainy and post rainy season in this region. Early diagnosis and reporting of cases are important for the better management of disease.

Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study

Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poor immunological response of the vaccine in postrenal transplant patients, the emergence of newer strains, and the possibility of a third wave in India, makes it even more important to know more about the course and outcome of the disease in post renal transplant patients. Aim: To evaluate the demographics, clinical presentation, biochemical profile, course of hospitalisation in post kidney transplant patients with COVID-19. Materials and Methods: This retrospective observational study study with 18 patients was conducted in Madurai Medical College, Tamil Nadu, India for duration of four months, from May 2021 to August 2021 and data collection from May 2021 to July 2021 and data analysis in August 2021. All post kidney transplant patients having evidence of COVID-19 were included. Detailed clinical history, biochemical profile, radiological findings, treatment, and final outcomes were collected and compared. Non parametric statistical tests were used, in addition to Chi-square test and odds ratio. Kaplan-Meier plot was used for survival analysis. Results: The most common presentation was fever 15 (83.3%), followed by cough 10 (55.6%). C-reactive Protein (CRP) {65 mg/L (11.48-94.48)}, D-dimer {0.72 mcg/mL (0.59-1.1)}, serum creatinine {3.5 mg/dL (2.12-5.93)}, and platelet count {200,000 cells/cu.mm (1.75-2.22)} and showed statistically significant (p<0.05) association with the outcome. About 15 (83.3%) patients developed Acute Kidney Injury (AKI). Seven patients (38.9%) had stage three AKI necessitating haemodialysis, of which six did not survive. The median survival time was 22 days, with 95% confidence interval (19.792-24.208), with case fatality rate of 33.3% Conclusion: Postkidney transplant patients are at high risk of contracting COVID-19. CRP, D-dimer, serum creatinine, platelet counts, and arterial oxygen saturation may serve as prognostic markers. Dialysis may be required in view of high incidence of AKI and acute graft dysfunction, though the outcome seems dismal in such patients. Hence, the need for early hospitalisation and more effective treatment protocol is essential to improve outcome.

Comparing Clonidine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Ropivacaine in Elective Infraumbilical Surgeries- A Randomised Clinical Study

Lakshmi Priya, BC Vijayalakshmi, HR Divya, Arjun Swaroop

Introduction: Ropivacaine is popular as a safe intrathecal anaesthetic drug due to its higher safety profile over bupivacaine. Intrathecal additives are known to increase the quality of anaesthesia and analgesic duration. Aim: To compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric ropivacaine in elective infraumbilical surgeries. Materials and Methods: This randomised, double-blinded, clinical study was undertaken at Krishnarajendra Hospital and Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from January 2018 to June 2018. Total 60 adult patients aged between 18-60 years of age, American Society of Anaesthesiologists (ASA) I and II status, and posted for infraumbilical surgeries, were randomised to two groups of 30 patients each i.e., group C patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and clonidine 15 mcg, and group F patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and fentanyl 25 mcg. The onset, extent and duration of sensory and motor blockade, heart rate, mean arterial pressure, prolongation of analgesia in the postoperative period, and any complications were observed. Statistical analysis was done using Student’s t-test, and Chi-square test to test significance of variables. The p-value <0.05 was taken as statistically significant. Results: Demographic characteristics were comparable in both the groups. The onset of sensory blockade and the maximum height of sensory blockade attained were similar in both groups i.e., group C-2.12±0.22 min vs group F-2.24±0.66 min, group C-4.94±0.91 min vs group F-5.12±1.38 min, respectively. The duration of sensory blockade was prolonged in group C (148.5±10.84 min vs 109.37±14.5 min), resulting in delayed demand for analgesic after surgery in this group. The onset of motor block and the complete motor blockade was prolonged in group C patients (3.22±1.01 min vs 1.16±0.3 min, 6.8±1.49 min vs 3.72±1.31 min). The recovery from motor blockade was also significantly delayed in Group C (125.17±13.29 min vs 95.47±13.08 min). The incidence of hypotension was similar in both the groups. Conclusion: Clonidine, and fentanyl both provide early and adequate spinal anaesthesia, but the former (clonidine 15 mcg), prolongs the duration of spinal anaesthesia with ropivacaine 0.42% hyperbaric solution, and significantly increases the time for the demand for analgesia in the recovery period, compared to fentanyl.

A Retrospective Study on the Functional and Radiological Outcomes of Basicervical Femoral Neck Fractures Treated with Proximal Femoral Nail

Jipin Gopi, NR Fijad, PP Unais, Aarabhy Jayan

Introduction: Basicervical fractures are one of the rarest peri-trochanteric fractures. They have an inherent instability which make makes them notoriously prone for treatment failure. Because they cannot be classified as neither strictly intertrochanteric, nor intracapsular fractures, their treatment protocol is also not standardised. Newer implants are regularly tested in their management, with varying degrees of success. Aim: To assess the functional and radiological outcome of basicervical neck of femur fracture with the use of the proximal femoral nail. Materials and Methods: This retrospective study was conducted in Department of Orthopaedics at Malabar Medical College, Hospital and Research Centre, Kozhikode, Kerala, India, from September 2021 to December 2021. It was performed on 31 patients who were identified from a patient pool of 1526 individual with neck of femur fracture, as having basicervical fracture, but one patient follow-up details were not available hence, total sample size was 30. The patients were followed-up for a year and the functional outcome was assessed using modified Harris Hip Score and classified as poor, fair, good, or excellent. Radiological outcome was assessed based on reduction. Reduction was classified as anatomical (deviation <5°), acceptable (deviation 5-10°) or bad (deviation >10°) as per the classification suggested by Hardy et al. Descriptive statistical measures, namely mean, frequency and standard deviation were calculated. Results: With the Proximal Femoral Nail (PFN), anatomical reduction was attained in 22 subjects (73.3%), acceptable in 6 subjects (20%) and bad in 2 subjects (6.7%). There were no instances of deep vein thrombosis, non union or avascular necrosis head of femur. The average time to radiological union was 13.5±1.8 weeks. Using modified Harris Hip Score, functional outcome was poor in 2 patients (6.7%), good in 2 patients (6.7%) and excellent in 26 patients (86.6%). Conclusion: The PFN, even though, phased out in first world countries, is a safe and viable implant choice for the management of basicervical femoral neck fractures, with good functional and radiological outcome.

Socio-demographic and Clinical Profile of Patients with Substance Use Disorder at a Tertiary Care Centre in Vindhya Region: A Hospital-based Study

Gyanendra Raghuvanshi, Umesh Pathak, Akshat Varma, Amrendra Kumar Singh

Introduction: The rampant increase in substance use in India makes it a serious public health hazard, in consonance with the western trend. The upsurge of substance use is getting so alarming that the preventive strategies have become a matter of national priority. The youth constitute the most vulnerable section in the society. Similar to the unprecedented rise of substance use all over India, Madhya Pradesh did not remain untouched by this erosion. In the recent past, the pattern of substance use in this region has worsened leading to an increase in behavioural disturbances due to substance use, poor family dynamics, illegal issues and restrained interpersonal relationships. Aim: To study the clinical and socio-demographic profile of various substance users in the Vindhya region, Madhya Pradesh, India. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Department of Psychiatry, Shyam Shah Medical College, Vindhya, Madhya Pradesh, India, from January 2019 to May 2019. Patients of all ages, both genders (339), diagnosed under substance use disorders as per Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria were included in the study. A detailed assessment including socio-demographic and clinical history, physical examination and other relevant investigations were done. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS), version 21.0. Results: After the screening of 432 patients, 339 fulfilled the inclusion criteria. Total 92 (27.29%) patients were multiple substance users, followed by opioids 82 (24.33%), and benzodiazepines 66 (19.58%). Alcohol, tobacco, and cannabis users were 42 (12.46%), 29 (8.6%), and 28 (8.3%) respectively. Majority of the study participants 160 (47.2%) were in the younger age group (21-30 years). Most of them were males 303 (89.4%), single 230 (67.8%), from urban areas 204 (60.2%), and belonging to the lower-middle socio-economic class 108 (32%). The bulk participants were students 95 (28%), and well-educated (undergraduate and above). The chief reason for seeking the treatment was withdrawal symptoms. The majority of the subjects with substance use had onset within the age range of 10-20 years (149, 44%). Peer group influence was the most common factor responsible for the initiation of substance use overall (145, 42.7%). Strong craving (77, 22.7%) was the most important continuation/maintenance factor. Conclusion: The younger age groups with a family history were at a high risk of developing substance use disorders. Easy accessibility of substances along with peer motivation for substance-taking behaviour has made increased the number of adolescents and young substance users.

Assessment of Attitude of First Year Medical Undergraduate Students Towards Communication Skills Training: A Cross-sectional Study

Khaled M Badaam, Shazia Masroor Shaikh, Asim M Badaam

Introduction: Attitude, Ethics and Communication modules (AETCOM) for undergraduate medical students have been suggested by the Indian Medical Council (2015) in the new curriculum based on competencies. There is a need to assess the attitude of students towards communication skills training modules. Communication Skills Assessment Scale (CSAS) is an accepted tool for it. Aim: To assess the attitude of first year medical undergraduate students towards communication skills learning programme. Materials and Methods: The present cross-sectional study was conducted in Department of Physiology at Government Medical College, Aurangabad, Maharashtra, India, in the third week of November 2016. Total 60 students from first year undergraduate (MBBS) course were included in the study. The CSAS questionnaire has 26 items using five-point Likert scale with 13 positive and 13 negative statements about communication skills training labelled as Positive Assessment Scale (PAS) and Negative Assessment Scale (NAS). The scores were compared for gender groups and English medium and vernacular medium group by Independent two-tailed student’s t-test. Results: Sixty students (34 females and 26 males) were present with mean age of 18.4±0.8 years. Overall, PAS was 53.5±7.8, and NAS was 32.2±6.1. Among 26 males, PAS was 52±10.7, and among 34 females it was 54.7±4.4 (p-value=0.18). NAS in males was 34.2±6.3, whereas, in females, it was 30.7±5.6 (p-value=0.026). Conclusion: The findings indicate the acceptability of communication skills training among first year MBBS students. There is a need to utilise these positive perception among students and train them to become competent doctors with the desired communication skills.

Prognostic Role of Histological Scoring of Oral Squamous Cell Carcinoma

SVR Raja Sekhar, Priyanka Pappala, Ravi Chandra Bonu, Gouthami Balli

Introduction: Diagnosis of oral squamous cell carcinomas require assessment of parameters like histologic grade, tumour depth of invasion, lymphovascular invasion, perineural invasion, margin status, worst pattern of invasion, But for treatment purpose only Tumour, Nodes and Metastases (TNM) staging is given importance. Aim: To develop a scoring system based on different histopathological tumour characteristics and to know its prognostic role in oral squamous cell carcinomas. Materials and Methods: This retrospective study was conducted in Department of Pathology at Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India, from September 2011 to August 2016 and data was followed-up for 5 years, upto August 2021. Resection of primary oral lesions with cervical lymph nodal dissection were included in the study, while cases of non squamous cell carcinomas, variants of squamous cell carcinoma, post radiotherapy cases, defaulted cases, patients who lost for follow-up were excluded. The Histoscore (H score) was obtained by the scores of all histopathological tumour characteristics and it ranged from 2-11. This H score was divided into three groups and mean survival period of these three Histoscore Groups (HS groups) were calculated for their prognostic use (Group 1 has score 2-5, Group 2 has score 6-8, Group 3 has score 9-11). Medians and ranges were used to summarise continuous data, while frequency counts and percentages were used for categorical data. Kaplan-Meier’s analysis was used for evaluating 5 years survival. The p-value <0.05 was considered as statistically significant. Results: A total of 90 cases were studied. Mean survival period was compared to HS groups, Group 1 had 64±7.59 months, Group 2 had 40.8±11.88 months, Group 3 had 26.06±12.25 months with a p-value <0.001, indicating it as a statistically significant parameter. Based on TNM staging, majority were in T2 (N=41, 45.55%), N1(N=34, 37.77%) and Mx (N=87, 96.66%). Conclusion: Histoscore groups of the oral squamous cell carcinomas have significant differences in the mean survival period among themselves. Hence, this histoscore groups can be an additive to the TNM classification, which provide more prognostic information to the oncologists.

Comparison of Two Home-based Chemically-induced Teeth Whitening in Adults: A Randomised Clinical Trial

Introduction: Whitening strips are one of the Over The Counter (OTC) bleaching products which performed tooth whitening through an easy-to-use, low-cost product with good esthetic results. Aim: To compare the bleaching efficacy, tooth sensitivity and gingival irritation, of home-based chemically-induced teeth whitening treatment performed using either a conventional customised tray or strips as delivering systems for whitening agents. Materials and Methods: This randomised clinical trial was conducted at Federal University of Pernambuco (UFPE), Brazil, from 15^th May 2015 to 20^th January 2018. Total 21 subjects, with maxillary incisor’s shade A3 or darker were selected for this study. Patients were randomly assigned into two groups, according to the bleaching technique used i.e, G1 (n=10) was carbamide peroxide 10% (Whiteness Perfect/FGM) delivered in a customised tray, G2 (n=11) was hydrogen peroxide 10% delivered in strips (3D White Whitestrips/OralB). Colour changes were evaluated by an objective (Easyshade Spectrophotometer/VITA) method at baseline, middle of treatment period, end of treatment, 15 and 30 days after treatment end. Tooth sensitivity, gingival irritation and degree of satisfaction were also recorded. Fisher’s-exact test was used for categorical variables i.e, Kolmogorov-Smirnov Normality Test for quantitative variables and Mann-Whitney’s test for comparison between two groups. Results: No significant difference was observed in occurrence of tooth sensitivity (p-value=0.635), gingival irritation (p-value=0.090) and treatment satisfaction (p-value=0.476) between groups. Increased whitening effectiveness was observed in both groups after 30 days of clinical evaluation, however with no significant difference between groups (p-value=0.139). Conclusion: Both bleaching systems showed similar effectiveness and high degree of satisfaction. Low degree of tooth sensitivity and gingival irritation was observed with no difference between groups.

A Comparison of Dexmedetomidine and Fentanyl as Co-induction Agents to Propofol for Insertion of Proseal Laryngeal Mask Airway: A Randomised Clinical Study

Rashmi Pal, Koti Prem, KK Arora, Rashpal Singh Gill

Introduction: The Supraglottic Airway Devices (SAD) are bridges between a face mask and Endotracheal Tubes (ETT). Various induction agents like sevoflurane and propofol were used till date for smooth insertion. Propofol causes dose-dependent cardiorespiratory depression while opioids may increase the haemodynamic instability. Aim: To investigate the role of dexmedetomidine and fentanyl as co-induction agents to propofol for Proseal Laryngeal Mask Airway (PLMA) insertion conditions. Materials and Methods: The present study was a randomised clinical study in which 60 patients of American Society of Anaesthesiologists (ASA) grade I-II, 20-60 years of age were divided into two groups. Group P+D received 2.5 mg/kg propofol+1 μg/kg dexmedetomidine while Group P+F received 2.5 mg/kg propofol+1 μg/kg fentanyl. A Bispectral Index (BIS) value of 50-45 was taken as desired end point for insertion of PLMA. Induction time, insertion time, ease of insertion, number of attempts, total propofol requirement and various haemodynamic changes were taken into consideration. Results: Mean induction time with dexmedetomidine (8.28±0.81 min) was lower as compared to that with fentanyl (9.28±0.83 min) (p<0.0001). Total propofol requirement was also less with dexmedetomidine (93.66±15.64 mg) as compared to that with fentanyl (135.8±10.95 mg). Dexmedetomidine also provided better insertion score for PLMA (p=0.044) with less number of attempts (p=0.044), when compared with fentanyl. Conclusion: Dexmedetomidine, as an adjuvant to propofol can be considered as an attractive choice for insertion of PLMA.

Clinical Association of TSH Receptor Antibody and Related Autoimmune Markers with Subclinical Graves’ Disease: A Study from Eastern Indian Population

Introduction: Graves’ Disease (GD), the leading cause of hyperthyroidism is caused by interaction between various autoantibodies generated as a result of autoimmune dysregulation in genetically suspected individuals. Aim: To study the prevalence of serum levels of Thyroid Stimulating Hormone (TSH) Receptor Antibody (TRAb), Antithyroid Peroxidase Antibody (Anti TPOAb) and Antithyroglobulin Antibodies (Anti TgAb) in subclinical cases of GD. Materials and Methods: This was a hospital based cross-sectional study conducted in the Department of Biochemistry, in a tertiary care hospital, over a period of one and half years from January 2019 to June 2020. A total of 120 patients with subtle symptoms of GD of age group between 30 to 60 years and same number of age and sex matched healthy controls were enrolled for the study. Collection of data was done and serum TRAb was estimated by Enzyme Linked Immunosorbent Assay (ELISA), while AntiTPO and AntiTg antibodies were measured using Electrochemiluminescence Immunoassay (ECLIA). Results: Serum levels of all the three antibody titres were found to be significantly higher in cases compared to controls. When diagnosis and differentiation of GD was done between cases and controls based on TRAb positivity (80.0%) or negativity (20.0%), it was found to have a sensitivity of 80% and specificity 98.3%. TRAb also had positive and negative predictive values of 97.9% and 84.3%, respectively. TRAb positive cases also had higher levels of Anti TPO and Anti TgAb in comparison to TRAb intermediate or negative group. Conclusion: Prevalence of high titres of autoantibodies especially TRAb are pathognomonic of early GD. Their detection in covert stages of disease shall provide insight into predicting outcome and frame management strategies in patients with this thyroid disorder.

Comparison of Gait Pattern among Blind and Blind Folded Sighted Subjects: A Cross-sectional Study

Sweta Kumari, Naveen Bankey, Shomi Anand

Introduction: Gait is the normal way of walking pattern. The visual system of sighted subjects furnishes information concerning the environment from distant and plays important role in maintaining the stability and planning of the route during locomotion. During movement of the sighted subject, the visual perception of the surroundings enables the orientation towards the goal. Movement and position of limbs is also important in order to adjust foot clearance or foot placement to regulate the walking pace. Aim: To compare the gait pattern among blind and blind folded sighted subjects as well as among healthy and underweight blind and blind folded sighted subjects. Materials and Methods: The cross-sectional study was conducted in Department of Physiology, RKDF Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh, India, from October 2019 to April 2021. A total of 181 sighted and 150 blind subjects aged between 10-17 years were taken in the study. Foot print method was used to record spatial components. The temporal components were measured with stop watch. Rivermead Visual Gait Analysis (RVGA) was used to analyse kinematic characteristics. The estimation of healthy and underweight subjects were done by calculation of Body Mass Index (BMI). Quantitative data was expressed as mean±standard deviation. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: The mean value of gait in blind folded sighted and blind subjects was found to be 3.28±0.48 and 2.01± 0.79 km/hr respectively and was found statically significant having (p-value=0.001). The results of mean value of gait on the basis Body Mass Index (BMI), the healthy blind folded sighted and healthy blind subjects showed 3.29±0.46 and 1.99±0.75 respectively (p-value=0.001). Similarly, the gait pattern in underweight blind folded sighted and underweight bind subjects was observed to be 3.26±0.61 and 1.98±0.77 km/hr respectively (p-value=0.001). Conclusion: The gait pattern was found to be significantly better among the blind folded sighted subjects in comparison to the blind subjects.

A Study of Tuberculosis among Patients Visiting Regional Tuberculosis Centre in Central India- A Cross-sectional Study

Vikrant Singh Chauhan, Manoj Bansal, Vikash Sharma, Rajesh Gupta

Introduction: Number of Drug-Resistant Tuberculosis (DRTB) patients has increased. Determination of the causes of delay in timely diagnosis and treatment is one of the most important steps for complete cure. Delay in diagnosis and treatment of disease are important factors and these may arise from patients and by the healthcare system. Aim: To study factors related to Tuberculosis (TB) patients visiting a regional DRTB centre in central India. Materials and Methods: A cross-sectional study was conducted at DRTB centre, Lashkar, Gwalior, Madhya Pradesh, India, from January 2019 to June 2019. Purposive sampling technique was used for data collection. Patients who visited the centre were requested to fill the performa regarding their TB status. Total 371 patients, who visited and filled the form, participated in the study. Patients were divided into drug resistant and drug sensitive patients. For the significant independent variables adjusted odds ratio and p-values were calculated. The p-values <0.05 was considered to be significant. Results: Total 227 (61.2%) drug-resistant and 144 (38.8%) drug-sensitive patients were included in the study. Education played a significant role with only 5.7% and 6.9% of drug resistant and sensitive patients, respectively, developed disease. Overall, 186 (81.9%) participants took more than six months of treatment prior to final initiation of Proper Anti-Tubercular Treatment (ATT) were DRTB cases. Conclusion: Delay in proper diagnosis and multiple visits to health facility and further delay in initiation of definitive treatment poses threat for emergence of drug resistance.

Histopathological Changes in Kidneys of Developing Chick Embryo on Exposure to Artesunate

Rajesh Kumar, Lavlesh Kumar Mittal, Ghazal Mittal

Introduction: Chick embryo is one of the most commonly used animals to study the adverse effects of various drugs for research purpose. In India, Malaria imposes incredible socio-economic burden on humankind. India reports approximately two million cases of malaria yearly, with large number of deaths. Surveys have demonstrated that the rates of treatment failure are higher than 50% due to Chloroquine resistance and poor efficacy of Sulphadoxine Pyrimethamine. Artesunate is a concentrate of Artemisia plant found in China, also called as Qinghaosu. It is a subordinate of a group of drugs artemisinin that have the most rapid action of all current drugs against Chloroquine resistant Plasmodium vivax and Plasmodium falciparum malaria. Aim: To understand the adverse effects of artesunate on kidney of developing chick embryo. Materials and Methods: The present study was an experimental study which comprised of steps like selection and sampling of eggs in groups (control and experimental), selection and preparation of drug (dose titration), drug administration, incubation of eggs, manual hatching to obtain chick embryo, isolation of kidney, sectioning of kidney and staining for slide preparation, microscopical analysis of the slides. In the present study, the fertilised eggs used were of White Leghorn chicken and were procured from King and King poultry farm Hapur, Uttar Pradesh, India. Hundred fertilised chicken eggs were divided into five experimental groups denoted by A, B, C, D, and E and five control groups denoted by a, b, c, d and e, one for each experimental group respectively. Each experimental and control group had 10 eggs. Experimental groups A, B, C, D and E were exposed to artesunate with dose of 0.0004 mg, 0.0005 mg, 0.0006 mg, 0.0007 mg and 0.0008 mg respectively and control group a, b, c, d and e were treated with same concentration of normal saline as artesunate. The eggs were broken by scalpel on 18^th day of incubation and chick embryos were obtained. The kidneys were removed sectioned, stained and studied using light and compound microscope. Results: Histopathological changes like tubular degeneration, vacuolation in the cytoplasm of epithelium lining of Proximal Convoluted Tubules (PCT) and Distal Convoluted Tubules (DCT), congestion in Glomeruli, haemorrhage in urinary space and mild lymphocytic infiltration were observed. Conclusion: Exposure to artesunate increases the risk of nephrotoxicity with increase of embryonic age.

Neonatal Pulse Oxymetry Screening for Detection of Congenital Heart Disease in Asymptomatic Newborns: A Cross-sectional Study from a Tertiary Care Hospital

Introduction: Screening for Congenital Heart Diseases (CHD) depends on the antenatal ultrasonography and clinical examination of the newborn, however both these methods have low detection rates and often life-threatening congenital heart diseases are missed. Pulse Oximetry (PO) is an easy, accurate, rapid, non invasive method of detecting hypoxaemia. The purpose of using PO to identify Critical Congenital Heart Disease (CCHD) is that clinically non detectable minimal hypoxaemia can be detected by pulseoximetry. Aim: To study the accuracy of pulse oxymetry as a screening tool for early detection of critical congenital heart diseases in asymptomatic newborns. Materials and Methods: This cross-sectional study was conducted in the Department of Paediatrics and the Postnatal Ward of Obstetrics and Gynaecology at Sri Venkateswara Medical College, Tirupathi, Andhra Pradesh, India, from January 2017 to December 2020. All the term asymptomatic newborns of age more than 24 hours were screened using PO. Screening was positive if a: PO was <90% in right hand or foot at any stage of screening, b was 90% to <95% on both; there was >3% absolute difference in oxygen saturation between the right hand and foot on three consecutive measures (each separated by one hour). All the screen positive babies were subjected to 2D echocardiography. All statistical analyses were performed using OpenEpi website epicalculator, and Chi-square’s test was used to calculate the p-value. Results: The mean gestational age (weeks) was 38±4 days. Out of 14,400, PO screening was positive in 45 babies, and subsequent echocardiography detected CHD in 30 babies. The sensitivity was 66.67%, positive predictive value was 66.67%, negative predictive value was 99.90%, with a diagnostic accuracy of 99.79%. On 2D electrocardiography, 30 were true positive cases, whereas, false positives and false negatives were 15 each. Remaining 14340 newborns were true negatives. Conclusion: Pulse oximetry is a safe, accessible, feasible test that can be used for early detection of CCHD’s that are often undetected on antenatal ultrasonography.

A Novel Approach in Understanding and Retaining the Subject Concepts among Medical Undergraduates using Treasure Hunt Competition as a Tool: A Quasi-experimental Study

Introduction: There is a need to incorporate innovative teaching methods other than conventional didactic lectures to generate interest of medical undergraduates in learning Pharmacology. Game-based Learning (GBL) is a new strategy in medical education that can create a fun based atmosphere for learning. Aim: To assess the effectiveness of GBL as a tool in learning process and in memory retention of the knowledge acquired in pharmacology using treasure hunt competition. Materials and Methods: The quasi-experimental study was conducted on 4^th semester MBBS students of Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India, from February to March 2019, as a part of the Advanced Course in Medical Education (ACME) project work, Medical Council of India. Entire phase II students (N=150) were included in the study. Students were divided into the GBL group and the Facilitated Learners (FL) group. Both groups were exposed to their respective GBL and FL based learning. Before and after the respective GBL and FL sessions, a pretest and two post-test multiple choice questions based tests were conducted. The second post-test was conducted one month later as a surprise one. Thereafter, a questionnaire was given to pen down the perceptions about GBL. Pretest and post-test marks were analysed by one-way Analysis of Variance (ANOVA) followed by the Tukey-Kramer test. Perceptions about GBL were entered in percentage. Results: The mean scores of the GBL group were significantly more (p-value <0.001) as compared to the FL group in both the post-tests. In their feedback about GBL, the students appreciated the usefulness of this innovative way of learning pharmacology. Conclusion: The GBL is an effective tool to teach pharmacology to medical undergraduates.

Prognostic Effect of Hypoalbuminaemia on Severity and Outcome in COVID-19: A Retrospective Cohort Study

Manasa AS Gowda, K Smruthi, R Vedavathi

Introduction: Severe Acute Respiratory Disease-Coronavirus-2 (SARS-CoV-2) is a novel virus first detected in December 2019 causing the Coronavirus Disease-2019 (COVID-19) which has evolved into a pandemic rapidly. In patients who become symptomatic, 5% require oxygen and 15% develop severe disease ranging from respiratory failure to sepsis and septic shock. Severe COVID-19 infection is associated with high mortality. Hypoalbuminaemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. Hypoalbuminaemia is found in patients with severe COVID-19 disease. Aim: To assess the prognostic value of hypoalbuminaemia on severity and mortality of patients with COVID-19 infection. Materials and Methods: The present retrospective cohort study analysed data of 200 consecutive patients, with confirmed diagnosis of COVID-19 admitted, discharged or diseased between the period of April 2021 to June 2021. They were further classified as severe and non severe, survivors and non survivors based on Oxygen Saturation (SpO₂) levels as per World Health Organisation (WHO) criteria and based on survival status of the patients. Hypoalbuminaemia was defined as serum albumin <3.5 g/dL. Demographic characteristics, previous co-morbidities, clinical findings and laboratory findings were collected. Analytical variables were compared using the Chi-square test, level of significance was set at p-value <0.05. Results: Hypoalbuminaemia was more frequent in patients with severe disease than in patients with non severe disease (28% vs 15%, Ch-square value was 34.54, p<0.001), also hypoalbuminaemia was more frequent in non survivors than survivors (23.5% vs 19.5%. Chi-square value was 43.794, p<0.001). A binary logistic regression analysis was performed to attribute the true association between hypoalbuminaemia and severity and survival status of the patients with 95% CI for OR and it was found statistically significant (p-value <0.001). Hence, hypoalbuminaemia was found to be an independent predictor of severity and mortality in the study subjects. Conclusion: Hypoalbuminaemia may serve as an independent prognostic marker and may be used to identify patients at risk of severity and death in COVID-19 patients.

Gastrointestinal Complications and its Association with Common Risk Factors of Cerebrovascular Accident: A Retrospective Observational Study from Central India

Vijay Kumar Nandmer, Ajay Kumar Nandmer

Introduction: Patients with Cerebrovascular Accidents (CVA) may present with Gastrointestinal (GI) complications, negatively affecting the prognosis. However, the whole spectrum of GI complications in CVA patients is unknown. Aim: To assess GI complications in CVA patients and their association with risk factors of CVA. Materials and Methods: The retrospective, facility-based, observational study was conducted in Department of Medicine at Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh, India, from March 2019 to August 2021. Total 100 patients with CVA (age >13 years) were studied based on their medical records and laboratory examinations. Details on socio-demographic variables and clinical history were obtained. Detailed general and systemic examination and vitals were documented. Complete blood picture, liver function test, renal function test, lipid profile and magnetic resonance imaging scan was also performed. A Chi-square t-test was applied to assess the association of GI complications with various variables. A p-value <0.05 was considered statistically significant. Results: Most CVA patients were males (51%). Mean age of study population was 71.49±11.46 years. A history of hypertension and diabetes mellitus was observed in 60% and 54% of cases. Constipation (43%) was the most common GI complication, followed by dysphagia (25%). No significant association of GI complications with age (p-value=0.261), gender (p-value=0.217), hypertension (p-value=0.540) and diabetes mellitus (p-value=0.257) was observed in CVA patients. However, raised serum bilirubin, serum glutamic-oxaloacetic transaminase, and serum glutamic pyruvic transaminase in 47%, 23%, and 37% cases with CVA was observed. Conclusion: Gastrointestinal complications are commonly observed in stroke patients irrespective of stroke but are more common in patients with ischemic stroke. Constipation and dysphagia were the most common. Faecal incontinence, abdominal pain, hiccups, and melena may also be seen in patients with CVA.

Evaluation of Nitric Oxide, Endothelial Nitric Oxide Synthase and Lipid Profile in Breast Cancer: A Case-control Study

Introduction: Breast cancer accounts for 25% of all female cancer cases in India. Although, lipids and free radicals like Nitric Oxide (NO) have been related to breast cancer, but its pathogenesis remains controversial. Aim: To estimate NO, endothelial NO Synthase (eNOS) and lipid profile in serum of breast cancer patients and also to determine their possible role in patients of breast cancer in Indian women. Materials and Methods: This was a hospital-based case-control study conducted for a period of 24 months from July 2012 to June 2014 in Dr. V.M. Government Medical College, Solapur, with a total of 100 women (50 breast cancer cases and 50 healthy age-matched controls) of age group 35-65 years. Fasting venous blood samples were collected. Biochemical parameters analysed in the study were serum NO, serum eNOS, serum Total Cholesterol (TC), serum Triglycerides (TG), serum High Density Lipoprotein (HDL) and serum Low Density Lipoprotein (LDL). Results were expressed as mean±Standard Deviation (SD) and Student’s unpaired t-test was used to compare the pairs of means. Results: There was no significant difference in mean age between cases (49.73±8.16 years) and controls (48.23±8 years). Serum levels of NO, eNOS, TC, TG and LDL were significantly higher in cases than in controls (55.92±6.54 μmol/L vs 49.58±6.74 μmol/L for NO; 175.4±22.92 U/mL vs 148.6±9.77 U/mL for eNOS; 271±9.16 mg/dL vs 177.58±6.41 mg/dL for TC; 180.70±8.48 mg/dL vs 107.57±8.98 mg/dL for TG; 177.39±6.21 mg/dL vs 98.16±8.90 mg/dL for LDL). However, serum HDL levels did not showed significant difference in case group (57.55±6.40 mg/dL) when compared with control group (57.15±5.35 mg/dL). Conclusion: The present study demonstrated that high serum levels of NO, eNOS and lipids are associated with breast cancer and thereby, suggests that increased NO, eNOS and abnormal lipid profile may have a role in pathogenesis of breast cancer.

Prescription Pattern of Antibiotics in Admitted Patients of a Tertiary Care Government Teaching Hospital, Kerala, India

Abdul Aslam Parathoduvil, MB Sujatha, Sreelakshmi Venugopal

Introduction: Antibiotics have a remarkable role in prolonging life, especially in underdeveloped and developing countries. Insufficient knowledge among doctors, peer pressure and patient demands, diagnostic uncertainties, lack of communication between the doctor, pharmacist and patients all implicate inappropriate antibiotic prescribing practices. Irrational antibiotic prescription can lead to antibiotic resistance, marking a global crisis. Aim: To evaluate the prescription pattern of antibiotics in the admitted patients of a tertiary care teaching hospital and assess the prescriptions’ rationality. Materials and Methods: This was a retrospective record-based study done in the inpatients of Government Medical College, Manjeri, Kerala, India, for three months (1^st October 2017 to 31^stDecember 2017). Data was collected using a data collection checklist which included patient identity and demographic factors, name and route of the antibiotic prescribed, usage of multiple antibiotics, usage of prophylactic antibiotic, usage of generic names, adherence to National List of Essential Medicines (NLEM) and rational use. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 and frequencies and percentages were determined for each variable. Results: Total 1,186 medical records were analysed, and 49.7% were prescribed antibiotics; 38.2% contained more than one antibiotic, and 64.8% contained parenteral antibiotics. Cefotaxime was found to be the most commonly prescribed antibiotic. An 88.3% of prescriptions were adhering to NLEM, and 29% contained generic names of antibiotics. Overall, 69 out of 589 (11.7%) were irrational prescriptions, and the use of multiple antibiotics with the same spectrum of coverage was found to be the most common reason for irrationality. Conclusion: In this study, the most prescribed drugs were from the NLEM. Cephalosporins were the most commonly used antibiotics for the inpatients in this hospital. Prescriptions with generic names of drugs were low. Irrational prescriptions contributed a minor percentage, and reserve antibiotics were too little.

Soft Tissue Treatment Goals for Orthodontic Patients- A Photogrammetric Analysis of Facial Profile for Soft Tissue Norms and Gender Variations in Young Adults, Hyderabad, India

Srerama Janardhana Rao, Spandana Valapula

Introduction: An average face is always more aesthetic than an atypical face, so setting soft tissue treatment goals for male and female orthodontic patients required local norms, like average measurements of local aesthetically pleasing profile is more important than adopting universal norms. Aim: To obtain angular and average measurements of soft-tissue facial profiles for males and females in young adults of Hyderabad, India. Materials and Methods: The cross-sectional study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, Government Dental College and Hospital, Hyderabad, India, from the December 2007 to January 2010. The study included 104 aesthetically pleasing individuals between the age group of 16 years to 25 years (42 male and 62 female) selected by Orthodontists and laypersons, facial profile photographs were taken with standardised photographic set up with camera using 100 mm macrolens. Photographs were traced and 12 angular measurements were taken. Descriptive statistical analysis was done using software MATLAB (Matrix Laboratory) mean, maximum, minimum value, standard deviation and confidence intervals were calculated. Student’s t-test was done to determine sexual dimorphism, and p-value ≤0.05 was considered statistically significant. Results: Total of 104 subjects (42 male subjects; mean age: 21.4 years and 62 female subjects; mean age: 19.6 years) were analysed. There was a statistically (p-value <0.05) significant sexual dimorphism in seven of the angular measurements were noted. The nasofrontal (females-141°±4.8°, males-137.86°±5.2°), nasal angle (females -84.4±9°, males-80.7°±6.9°), vertical nasal (males-32.08°±3.3°, females-28.33°±3.636°), nasal dorsal angle (males-180.19°±7.112°, females-174.43°±6.648°), cervico-mental angle (females-98.41°±5.4°, males-95.7°±5.1°), angle of facial convexity (females-173.2°±4.4°, males-169.6°±54.8°), and angle of total facial convexity (females-149°±4.6°, males-144.4°±5.2°), showed sexual dimorphism. In the present study, large variability was observed with the nasolabial (p-value=0.314), and mentolabial (p-value=0.798) angles. Conclusion: Successful orthodontic treatment is mainly measured by patient appraisal only, this can be obtained by giving the locally more aesthetically pleasing facial profile to the patient, setting soft tissue facial profile treatment goals to native individuals is far more important than following universal norms in the total benefit of the patients.

Diphtheria in Children- Clinical Profile of Cases during an Outbreak in Kerala, India

Introduction: Diphtheria is an acute potentially fatal infectious disease caused by the toxigenic strains of Corynebacterium diphtheriae. Acute respiratory obstruction, toxic myocarditis and neurologic weakness are the most important complications of diphtheria. The clinical presentation and severity of diphtheria vary in immunised and non immunised children. Early diagnosis and prompt treatment including administration of diphtheria antitoxin and antibiotics minimise mortality. Aim: To observe the changing trends in the clinical presentation of diphtheria during the 2016 outbreak and its association with immunisation status and antitoxin administration. Materials and Methods: This longitudinal prospective study was conducted among children admitted to Government Medical College, Kozhikode, Kerala, a tertiary care centre with a diagnosis of diphtheria during January 2016 to December 2016. Details of socio-demographic data, clinical presentation, investigations, immunisation status, treatment and complications were collected using a semi-structured performa. These children were managed by an interim guideline provided by the state authorities. They were followed-up for 3 months i.e. till March 2017. The data was analysed using Statistical Package for Social Sciences (SPSS), version 18.0. Results: Among 76 children, 62(81.6%) were from Malappuram and Kozhikode districts, which have relatively low immunisation coverage. Most admissions were in July 2016. Majority 58 (76.3%) of children belonged to Muslim community. The mean age was 8.1 years with male to female ratio 1.53:1. Most of the children 47 (61.8%) were unimmunised or partially immunised. Cultures were positive for C. diphtheriae in 20 children. Complications were noted in 36 children, which included asymptomatic myocarditis in 31, symptomatic myocarditis in one, palatal palsy in nine, loss of accommodation in four and distal weakness in five. Only one child who received antitoxin within 72 hours of disease onset developed neurological complications. Complications were common in children who received less than minimum three doses of diphtheria vaccines compared to those who received three or more doses (54% vs. 44%). There was no mortality. Conclusion: There was an upward shift in age of affected children. Neurological complications were significantly less in those who received antitoxin within 72 hours of disease onset. Regular monitoring helped to detect asymptomatic myocarditis. The outbreak highlighted the need to improve awareness about diphtheria and better vaccination coverage, especially in older children.

A Case-control Study of Sexual Dysfunction and Serum Prolactin Levels in Patients with Psychotic Disorders

Mohd Rashid Alam, Pali Rastogi, Rahul Mathur, Vijay Niranjan

Introduction: Sexual functioning has remained widely neglected aspect of patient care for those suffering from severe mental disorders and has received little attention. Yet, it has been construed as one of the major factors contributing to non-adherence with antipsychotic medications. Aim: To study sexual dysfunction in patients with psychotic disorders and its clinical association with serum prolactin levels. Materials and Methods: This case-control study was conducted in the Department of Psychiatry at MGM Medical College and associated Mental Hospital, Indore, Madhya Pradesh, India, from 13^th February 2020 to 21^st January 2021. The study sample consisted of 200 subjects including 100 cases and 100 controls. The case group included patients with a diagnosis of psychotic disorders currently in remission for atleast one month. Remission of the patients was ensured by Brief Psychiatric Rating Scale (BPRS) with a score of <4 on all items and <28 total score. Assessment of sexual dysfunction was done using Arizona Sexual Experience Scale (ASEX). The control group included healthy subjects aged between 18-65 years, either sex having active sexual partners with a score of <3 on all the items of the General Health Questionnaire (GHQ-12). Collection of blood sample was done and serum was analysed for prolactin levels using the Chemiluminescent Microparticle Immunoassay (CMIA) method. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 28.0 for windows. Results: The mean age of the case group was 39.9±7.457 years while that of the control group was 35.60±9.37 years. The number of male patients (71% and 73%) was higher than females (29% and 27%) in the control group and case group respectively. The difference between the two were statistically significant. The total number of cases who experienced sexual dysfunction came out to be 59 out of 100. Total 55.93% of those having sexual dysfunction were suffering from difficulty in sexual arousal, followed by difficulty with penile erection/vaginal lubrication (49.15%), orgasmic dysfunction (34.48%), and reduced sexual drive (23.72%). Among the cases, the mean serum prolactin level (14.14±10.60 ng/mL) was seen to be significantly higher (p-value <0.001) than the control group (9.46±6.05 ng/mL). Maximum serum prolactin level (29.00±9.95 ng/mL) was seen to be associated with usage of a combination of both 1^st and 2^nd generation antipsychotics. Conclusion: There was a significant prevalence of sexual dysfunction in psychotic patients and is associated significantly with elevated serum prolactin levels.

Effect of Bacterial Diarrhoea on Serum Zinc Levels in Children with Special Reference to Different Bacterial Pathogens: A Cross-sectional Study

Introduction: Diarrhoea significantly leads to morbidity and mortality in under-five children, particularly in developing countries. Reduced serum zinc levels in acute non infectious diarrhoea has an impact on the frequency, severity and duration. However, evidence is still evolving on the status of zinc level in bacterial diarrhoea. Aim: To assess serum zinc level in bacterial diarrhoea and compare the serum zinc level in children with the different bacterial pathogens. Materials and Methods: This cross-sectional study was conducted in Department of Paediatrics at Federal Medical Centre, Owerri, Imo State, Nigeria, from August 2015 to February 2016, among 201 children aged 6 to 59 months with diarrhoea. Stool specimens were isolated for bacteria, using conventional culture techniques, while serum zinc levels were determined using atomic absorption spectrometry. Serum zinc level <65 μg/dL was regarded as zinc deficiency. The data collected was analysed using the Statistical Package for Social Sciences (SPSS) version 19.0. Results: Out of 201, 58 (28.9%) of the children with diarrhoea had bacteria in the stool. The most common organism isolated was Escherichia coli (33,16.4%) followed by Salmonella (13, 6.5%). All of the children with positive stool culture, irrespective of the type of microbial agent, had zinc deficiency with significant association between infective diarrhoea and zinc deficiency (χ²=15.437; p-value=0.004). Children with shigella diarrhoea had the lowest mean serum zinc level, compared to other bacterial agents (33.6±4.4 μg/dL, p-value <0.001). Conclusion: Bacterial pathogens contribute significantly to the cause of diarrhoea in under-five Nigerian children, and are significantly associated with zinc deficiency. Thus, reinforcing the need for zinc supplementation and food fortification programs within the population, and maybe for longer in children with identified bacterial diarrhoea.

Effect of Foam Rolling along with Self-stretching on Pain and Range of Motion in Plantar Fasciitis Patient- A Quasi-experimental Study

Sunny Yadav, Shikha Malik, Saru Bansal

Introduction: The most common cause of heel pain is plantar fasciitis. Previous literature suggests that stretching exercise had shown better results in the non surgical treatment options available, due to this technique muscle strength and the force production capacity is reduced. Myofascial release is an alternate technique which can improve Range Of Motion (ROM) and reduce pain without compromising the muscle performance. Aim: To evaluate the effect of foam rolling along with self-stretching on pain and ROM in plantar fasciitis patients. Materials and Methods: This quasi-experimental study was conducted between May 2020 to May 2021, at Kailash Institute of Nursing and Paramedical Sciences, Greater Noida, Uttar Pradesh, India. Thirty participants with plantar fasciitis meeting the inclusion criteria of age between 24-60 years were included and allocated into two groups by convenience sampling. Group A received self-stretching of calf and plantar fascia whereas group B received foam rolling along with self-stretching of calf and plantar fascia for three weeks. Visual Analog Scale (VAS) and Weight Bearing Lunge Test (WBLT) were recorded at baseline and by the end of 3^rd week for both the groups to measure pain and ankle ROM. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 statistical software. The independent sample t-test was used for intergroup comparison and student’s paired t-test was utilised for within group comparison. The statistical difference significance was set at p-value <0.05 for all the test performed. Results: Within group analysis has shown that there was a statistically significant difference (p<0.001) in all the outcome measures in both the groups. The between-group analysis showed no statistically significant difference in VAS (p=0.405) however significant difference were found in WBLT (p=0.003). Conclusion: The present study proved that both self-stretching and foam rolling with self-stretching showed significant improvement on pain and increasing ROM in plantar fasciitis. However, effectiveness of foam rolling with self-stretching was superior to self-stretching in terms of increasing WBLT.

Molecular Characterisation of Corynebacterium diphtheriae Isolates of Faucial Diphtheria Cases from Assam: A Cross-sectional Study

Introduction: Diphtheria caused by toxigenic Corynebacterium diphtheriae is an acute respiratory infection characterised by pseudomembrane formation in the throat. Although diphtheria is often reported sporadically across India, molecular characterisation of C.diphtheriae strains could play a crucial role in epidemiological investigations. Aim: The present study aimed at molecular characterisation of Corynebacterium diphtheriae isolates of faucial diphtheria cases from Assam, North-East India utilising Multi-Locus Sequence Typing (MLST). Materials and Methods: In this cross-sectional study, three isolates were obtained from three different cluster of cases that occurred across two districts of Assam, India for a period from November 2019 to June 2020. MLST of these three C.diphtheriae isolates were performed in Multidisciplinary Research Unit of Assam Medical College and Hospital by using the 7-gene MLST alleles of C.diphtheriae to determine the Sequence Types (ST). Results: The MLST of the three isolates of this study revealed two distinct STs, ST-588 and ST-576 with multi-clonal lineages with ST-466, reported in C.diphtheriae strains of North Kerala and ST-301 related strains of Bangladesh respectively. Conclusion: In spite of frequent reports of diphtheria cases from Assam, molecular typing of the C.diphtheriae strains found in North-Eastern region of India has not yet been performed. This is one of the initial investigations from this region of India to use MLST for typing C.diphtheriae strains. Therefore, studies related to molecular characterisation of C.diphtheriae strains found throughout India could immensely help in determining the clonality and diversity existing among these strains.

Evaluation of Antimicrobial Potency of Tinospora cordifolia on Subgingival Microbiota: An In-vitro Study

Yandapalli Roja, C Greeshma, MLV Prabhuji, K Arul Selvam, C Spandana

Introduction: Tinospora cordifolia (Tc), a well-known ayurvedic herb commonly known as giloy, has demonstrated multifaceted benefits, such as anti-inflammatory, analgesic, antibacterial and antioxidant properties, in animal, as well as, in-vitro studies. All these are properties which can be collectively applied in the management of periodontal conditions which demonstrate infective as well as inflammatory facets. But prior to its applications as such, it is necessary to definitively determine the optimal concentration and mode of application of the medication. Aim: To evaluate the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of Tc on general subgingival microbiota. Materials and Methods: The in-vitro, analytical study was conducted in Krishnadevaraya Dental College and Hospital, Bengaluru, Karnataka, India for duration of two and half months starting from November 2021 to January 2022. Ethanolic extracts of Tc were prepared in serial dilutions. Subgingival plaque samples of 12 chronic periodontitis patients were collected, cultured on Brain Heart Infusion (BHI) agar and subject to serial dilutions of Tc. In-vitro antibacterial activity of the ethanolic extracts was assessed using agar well diffusion method with Chlorhexidine (CHX) as positive control and Dimethyl sulfoxide (DMSO) as negative control, MIC and MBC were determined based on the zones of inhibition after 48 hours of anaerobic incubation. The Statistical Package for Social Sciences (SPSS) for windows version 22.0 was used to perform statistical analyses. Results: The MIC of Tc was noted to be 100 mg/mL where the maximum zone of inhibition was 11.42 mm. MBC was noted at a concentration of 25 mg/mL. The zones of inhibition at these concentrations was comparable to the CHX. The difference in the diameter of the zones produced by Tc, DMSO/Saline and CHX were statistically significant. Conclusion: Although CHX remains the gold standard, Tc extract has significant antimicrobial activities and can be considered for further clinical trials.

Correlation of Upper Limb Explosive Power with Smash Velocity and Performance in Badminton Players: A Cross-sectional Study

Nitin Kumar Indora, Pooja Anand, Sudesh Chettri, Vipin Kumar

Introduction: Badminton is a popular Olympic game played in different age groups with different levels of skills. Various techniques of strokes are used by the players. Smashing is one of the offending and powerful stroke techniques used in badminton to defeat the opponent player. Various components of fitness like speed, agility, flexibility, endurance, and power plays an important role in an athlete’s performance and upper limb explosive power is one such component that is utilized for a better stroke performance. Aim: To find the correlation of upper limb explosive power with smash velocity and performance in badminton players. Materials and Methods: This cross-sectional study including a total of 100 participants by convenient sampling was conducted in Manav Rachna International University, Faridabad, Haryana, India, from September 2017 to March 2019. Out of 100 players, only 85 participants (60 male and 25 female) completed the study. The participants were assessed for Upper Limb Explosive Power (ULEP), Smash Velocity and accuracy. Data analysis was performed using the Karl Pearson’s correlation coefficient (p-value ≤0.05). Results: Significant positive correlation was obtained for ULEP with smash velocity and of accuracy with smash velocity with a value of r-value=0.0414 and r-value=0.468, respectively. Conclusion: The smash velocity of badminton players is related to upper limb explosive power and accuracy.

Effect of Acupuncture on Waveform Characteristics and Visual Acuity in Idiopathic Infantile Nystagmus: A Prospective Interventional Study

Dhivya Ashok Kumar, Pradeep Sharma, Rohit Saxena

Introduction: Idiopathic Infantile Nystagmus or Infantile Nystagmus Syndrome (INS) is one of the known causes for congenital nystagmus. Though the exact aetiology is unknown, there have been studies related to its treatment using prisms and contact lens. However, there have been not many clinical studies using the alternative therapy like acupuncture is done to analyse the effect on nystagmus. Therefore, the rationale of the study was to know the effect of acupuncture in INS and identify the same by Videonystagmography (VNG). Aim: To evaluate the effect of acupuncture on waveform characteristics and visual acuity in INS. Materials and Methods: This prospective interventional study was performed at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, during the period of March 2004 to March 2006. Institutional Review Board/Ethical Clearance was obtained and patients with INS of more than 18 years, who were co-operative, underwent acupuncture needle stimulation of sternocleidomastoid. The needles in sternocleidomastoid were stimulated every five minutes for 15 minutes for 10 sittings (5 days). Nystagmus parameters like slow phase velocity, amplitude, frequency were recorded by VNG for 20 minutes. Changes in waveform and visual acuity (Snellen visual acuity charts) were examined on every visit on all five days and patients were followed-up for three months. Visual acuity, nystagmus intensity, amplitude, frequency and slow phase velocity were the parameters analysed. A repeated measure- Analysis of Variance (ANOVA) test and Freidman test was performed using Statistical Package for the Social Sciences (SPSS) (version 16.1) to analyse the data. A p-value <0.05 was considered significant. Results: Ten patients with INS underwent the procedure. Significant improvement in distant visual acuity was noted at three months (right eye p=0.039, left eye p=0.050). Significant decrease in frequency during treatment (p=0.046, p=0.014 at 10 minutes and 15 minutes, respectively) was noted. Dampening of nystagmus amplitude was seen during acupuncture therapy, which got enhanced by twirling of the needles. No permanent changes in waveform characteristics were seen after therapy in the follow-up for over three months. Conclusion: The afferent stimulation from neck muscles by acupuncture in infantile nystagmus does affect waveforms during therapy and visual acuity after the therapy on short-term.

Efficacy of a Commercially Available Herbal Formulation for the Disinfection of Elastomeric Heavy Body Impression Materials

Manini Nagi, Kennedy Kumar, Ram Sabarish, SK Balaji, Vamsi Lavu

Introduction: Cross infection refers to the transfer of harmful microorganisms from one person to another. Dental impressions are considered semi-critical as it directly comes in contact with patient’s saliva and oral mucosa. Improper handling of these dental impressions can potentially have the risk of transmitting infections especially to the dentist. The role of herbal preparation in disinfecting the dental impressions is sparse in the literature. Aim: To evaluate and compare the disinfection ability of a commercially available herbal formulation (HiOra^®) with chlorhexidine digluconate solution (0.2%) and 1% sodium hypochlorite on dental impressions made using condensation silicone. Materials and Methods: A cross-sectional study was conducted in Outpatient Department of Periodontology and Implantology at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, between June 2019 and November 2019. A total of 60 maxillary and mandibular dental impressions using condensation silicone material were obtained from 30 systemically healthy volunteers. The impressions were divided into three groups and were subjected to three antimicrobial agents for 10 minutes: 1% Sodium Hypochlorite (group 1); 0.2% chlorhexidine digluconate (group 2); HiOra^® (group 3), respectively. Following this, microbial culturing was performed to detect the presence of Streptococcal and Staphylococcus species in samples obtained both prior and after impression disinfection. One-way Analysis of Variance (ANOVA) was performed to assess the significance of the difference in microbial reduction between the groups. Results: Antimicrobial efficacy was similar against both Streptococcus spp., and Staphylococcus spp., for the three disinfectants tested. No statistically significant difference in the microbial colony count reduction between the three disinfectants tested was observed (Streptococcus spp, p-value=0.064, Staphylococcus spp., p-value=0.337). Conclusion: The herbal mouthwash was found to have an equivalent efficacy as chlorhexidine, sodium hypochlorite for disinfection of impressions made from condensation silicone.

Accuracy of Elastomeric Impression Made with Standard and Dual Arch Tray: An In-vitro Study

Introduction: The dual arch impression techniques utilise special stock impression trays of various designs. These trays are made of plastic or metal with fabric or mesh material placed across the occlusal surfaces of the teeth connecting their buccal and lingual flanges. These special trays register the impression of the opposing segments of the dentition. The dual arch impression technique is used in dentistry effectively since many decades but, there is very little evidence published regarding the effect of different tray design on the accuracy of impression. Aim: To evaluate the accuracy of inter-abutment distance in dies obtained from different dual arch trays and with those obtained from stock metal trays. Materials and Methods: This in-vitro study was carried out in the Department of Prosthodontics, M.M. College of Dental Sciences and Research, Mullana, Haryana, India between June 2016 to November 2017. A total of 70 elastomeric impressions using heavy and light body addition silicone impression material were made, of the prepared typodont teeth of right mandibular first premolar and first molar for three-unit fixed partial denture. impressions were grouped into four groups, based on the type of tray used i.e. Group A consisted of impressions obtained from plastic dual arch trays (n=20), Group B- plastic reinforced with metal dual arch trays (n=20), Group C- metal dual arch trays (n=20) and Group D-full stock metal trays (n=10). Group A, B and C were further divided into subgroup I (working side poured first) (n=10) and subgroup II (non working side poured first) (n=10) depending upon the sequence of pouring. The measurements were obtained using travelling microscope and statistical analysis was done using one way Analysis of Variance (ANOVA) test which was then followed by a Tukey’s Post-Hoc test. Results: The inter-abutment distance showed a decreased value in all the groups when compared to the master model (p-value >0.05). Percentage decrease in inter-abutment distance was between 0.006-0.48%. The results indicated statistical insignificant difference when full arch metal stock tray impression is compared to all dual arch trays impression. There was insignificant difference between the inter-abutment distance obtained using dual arch trays which were poured with working or non working side first. Conclusion: The impressions obtained with both dual arch trays and stock tray, produced dies with distortion in a clinically relevant range. Thus, dual arch trays can be recommended for making impressions of short span fixed partial dentures, and can be considered to be an alternative to the conventional method.

Effect of Obesity and Hypertension on Blood Loss and Blood Transfusion Requirements in Primary Elective Total Knee Arthroplasty: A Prospective Clinical Study

Vikram Indrajit Shah, Sachin Upadhyay, Kalpesh Shah

Introduction: Identifying risk factors of operative blood loss is imperative toward establishing an effective blood management implementation strategy and further minimise the requirement for perioperative blood loss and transfusion. Aim: To investigate whether the factors like obesity and hypertension affect blood loss and transfusion requirements in primary elective Total Knee Arthroplasty (TKA). Materials and Methods: A prospective clinical study was conducted at Shalby Hospitals in Ahmedabad, Gujarat, India, from November 2017 to November 2019, on 91 patients recruited for primary elective TKA. The subjects were divided into two groups, i.e, group A (normotensive and non obese; n=46) and group B (Hypertensive and obese; n=45). Charlson-Deyo co-morbidity score was given to each patient as a measure of surgical risk. Data on intraoperative and postoperative blood loss, blood parameters (drop in haemoglobin, haematocrit value), and incidence of transfusion rates were recorded and assessed. All patients had standardised protocols of anesthesia, postsurgical and rehabilitation care protocols following surgery. Fisher’s-exact test, Chi-square test, and Student’s t-test was used for statistical analysis. Pearson’s correlation was performed to identify factors associated to blood loss. The p-value <0.05 was considered significant. Statistical Package for Social Sciences (SPSS) version 22.0 was used. Results: The intraoperative, postoperative and total blood loss (drop of haemoglobin and haematocrit) were significantly greater in the hypertensive and obese patients (p-value <0.001). The immediate postoperative day 1 haemoglobin and day 1 and 2 haematocrit were significantly better in the normotensive and non obese patients (p-value <0.001). Significantly greater number of hypertensive and obese patients required blood transfusion (p-value=0.045). There was a positive correlation between intraoperative blood loss and operative time in both groups (R?SUP?A#SUP#=0.04, p-value=0.74; R?SUP?B#SUP#=0.09, p-value=0.52) although statistically insignificant. Hypertensive and obese patients required longer hospitalisation (p-value <0.001). Three patients from group B were diagnosed to develop pulmonary embolism while admitted in hospital which was managed successfully by intensivists without any fatality. Conclusion: Hypertension and obesity were associated with greater blood loss and transfusion requirement compared to non obese and normotensive patients undergoing primary elective TKA.

Utility of Urine Reagent Strips for Analysis of Cerebrospinal Fluid in Emergency Settings: A Cross-sectional Study

MR Manjunath, Rumana Tasneem, BG Malathi, HP Srujan

Introduction: Meningitis is the inflammation of the meninges which covers brain and spinal cord, which if not identified on time will result in permanent neurological deficit or death. Mainly divided into septic and aseptic meningitis, differentiating these two and timely intervention would prevent neurological damage. Cerebrospinal Fluid (CSF) analysis helps to arrive at a diagnosis of meningitis which requires relevant trained staff and adequately equipped laboratory. These are not available in most of the healthcare centers in rural settings. Aim: To evaluate the role of urinary reagent strip method in rapid analysis of CSF, to assist the clinician in the bedside diagnosis or exclusion of meningitis and to compare the values obtained by rapid method with that of results obtained by automated analyser. Materials and Methods: This cross-sectional study was done in Pathology laboratory of Mandya Institute of Medical Sciences, District Hospital, Karnataka, Mandya, India. A total of 30 samples evaluated during the period of two months in 2019 (15^th August to 15^th October). Cerebrospinal fluid analysis was tested using combur- 10 urinary reagent strip and microscopy examination as reference standards. Automated analysers were used for the analysis of protein and glucose; and Neubauer’s counting chamber was used for leucocytes count. Statistical Package for the Social Science (SPSS) version 22.0 and Microsoft Excel were used to analyse data and generate tables. Results: The sensitivity and specificity of urinary strips in the analysis of cerebrospinal fluid for glucose, protein, leucocytes was 50.00%, 41.67%, 78.57% and 92.31%, 88.89%, 68.75% respectively. Diagnostic accuracy of urinary strip tests for glucose, protein and leucocytes were 83.33% 93.34% 86.67% respectively. Conclusion: The study shows the reliable sensitivity and specificity in some parameters, hence can be used in remote settings.

Mask-wearing Behaviours among the Public in Saudi Arabia during the COVID-19 Pandemic: A Cross-sectional Study

Mysara Alfaki, Ahmed Alkarani

Introduction: Public behaviour involving the wearing of face masks are influenced by a host of interdependent demographic, economic, and educational factors, therefore, mask-wearing behaviours among the public vary not only in different countries but also from region to region within a country. Aim: To assess mask-wearing behaviours among the public in Saudi Arabia during the Coronavirus Disease 2019 (COVID-19) pandemic. Materials and Methods: This cross-sectional study was conducted among the general public of Saudi Arabia who could communicate in Arabic, from 9th August 2021 to 12^th October 2021, after approval from Taif University. To collect as many respondents as possible, convenience sampling was used and a total of 481 participants gave consent for the same. A social media platform was used for the data collection. Descriptive statistics and a logistical regression model were employed for data analysis. Results: A total of 481 participants consented to take part in the current research, with 56.8% being males and 43.2% being females. Most individuals showed poor compliance (67.6%). Female participants, participants who had graduate degree, and people who worked in a confined environment, including a hospital, restaurant or similar place, reported better compliance with the use of a face mask (χ²=13.29; p-value <0.001), (χ²=8.26; p-value=0.041), and (χ²=16.84; p-value <0.010), respectively. Regression analysis defined three characteristics linked with good compliance ie., sex, level of education and present work/living situation. Conclusion: Most people did not comply with public behaviour concerning the use of face masks. Female participants were more likely to wear a face mask.

Depression, Perceived Stress and Socio-demographic Correlates among General Population During COVID-19 Pandemic: A Cross-sectional Survey from Southern India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic and its socio-economic consequences have had a significant impact on mental health. A quantifiable data regarding increase of mental health problems as a result of the pandemic is required to take necessary steps in tackling the issue. Aim: To estimate the prevalence of depression, perceived stress and its socio-demographic correlates among general population of South India during COVID-19. Materials and Methods: This cross-sectional survey conducted from 25^th August 2021 to 25^th October 2021 among the general population of South India during COVID-19. A total of 600 subjects were enrolled into the study. Study subjects included people of either sex between 20-50 years of age who were able to read and understand English and with access to internet. Subjects responded to a questionnaire packet of Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale 10 (PSS-10) and a proforma for socio-demographic data. Data was analysed using GNU PSPP version 1. One-way Analysis of Variance (ANOVA) and independent t-test were used to assess associations. A value of p-value <0.05 was considered to be statistically significant. Pearson’s correlation coefficient was used to determine correlation. Results: Of the 600 subjects who were enrolled into the study, 26.7%, 15.7%, 9.3% and 7.2% had mild, moderate, moderately severe and severe depression, respectively. About 62.7% had moderate and 17.5% had high perceived stress. Whereas, 28.7% had death wishes or thoughts to hurt themselves. Females (PHQ-9: p-value=0.006; PSS-10: p-value <0.001), 20-29 age group (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), students (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who were unmarried (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), living with parents (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who had a loss of income (PHQ-9: p-value <0.001; PSS-10: p-value=0.018) or job (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) in the past one year, those with a history of psychiatry disorder (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) had a significantly higher score in both depression and perceived stress. Correlation analysis showed a significant correlation between depression and perceived stress scores (r=0.691). Conclusion: The present study showed a high prevalence of depression and perceived stress and shows the need for strengthening mental health services to address the challenge.

Supraclavicular versus Infraclavicular Approach to Brachial Plexus Block under Ultrasound Guidance for Elective Surgeries of the Upper Limb: A Randomised Clinical Trial

Introduction: Ultrasonography has revived the infraclavicular approach to brachial plexus block resulting in many studies available in the literature. However, very few studies have assessed the sensory block characteristics of individual nerve territories by this approach. Aim: To compare the supraclavicular with the infraclavicular approach with special emphasis on the assessment of block characteristics of each nerve domain. Materials and Methods: This randomised clinical trial was conducted on 40 patients of American Society of Anaesthesiologist (ASA) physical status I and II, aged between 20-60 years of age undergoing elective surgical procedures of the upper limb. They were randomly allocated into either group Supraclavicular (SC group) or Infraclavicular (IC group). Ultrasound-guided block was performed using 30 mL of 0.25% bupivacaine. The primary outcome measure was the efficacy of block, and the secondary outcome was the time taken for performance of block. Categorical variables were compared with the Chi-square test or Fisher’s-exact test. Continuous variables were analysed using the unpaired t-test. The p-value <0.05 was considered significant. Results: Sensory block was complete in radial, median, and musculocutaneous nerve territories in both groups. All patients in the IC group had a complete sensory block in the ulnar nerve territory, compared to 80% patients in the SC group (p=0.036). Patients in the IC group had higher motor block scores in the shoulder joint (p=0.016), elbow, and wrist joints (p=0.036) and finger joints (p=0.038). Block performance time was significantly longer in the IC group (p<0.001). Conclusion: Infraclavicular approach provides better motor block and more complete sensory block of the upper limb. However, the time taken for performing the block was longer.

Assessment of Knowledge Regarding Infection Control Protocols among Dental Health Professionals during COVID-19 Pandemic: An Observational Cross-sectional Study

Introduction: It is necessary to prioritise occupational welfare, safety of dental students and health professionals to reduce coronavirus transmission, to offer the best benefit for patients. Aim: To assess knowledge regarding standard operating procedures to be adhered in clinical setting during pandemic amongst undergraduate, postgraduate dental students and dental interns of dental colleges in northwest region, Karnataka, India. Materials and Methods: This observational cross-sectional study was undertaken in dental colleges in northwest region, Karnataka from January 2021 to February 2021. Sample size was estimated to be 360 based on a pilot study. Participants were selected by the simple random sampling technique and were interviewed using a questionnaire comprising of 20 close-ended questions. The questionnaire was evaluated for reliability with Cronbach’s α value of 0.82, face validity 0.85%, and content validity ratio 0.76. The collected data was entered in MS Excel and analysed using Statistical Package of the Social Science (IBM-SPSS) statistics-version 21.0 using descriptive analysis, Chi-square analysis, Spearman’s correlation coefficient test, and regression. Results: The mean age of the participants was 24.6±1.35 years with marked gender distribution of 261 (72.5%) females and 99 (27.5%) males. Overall knowledge score for the standard operating procedure to be adhered during the pandemic was found to be 10.92±1.96 (undergraduates), 12.68±1.80 (postgraduates) and 11.55±1.82 (interns). More than half of the respondents 57.78% displayed a moderate level of knowledge. Spearman’s correlation coefficient test revealed a high statistically significant difference between awareness about Coronavirus disease 2019 (COVID-19) among participants and recommended masks during the procedure. Conclusion: Postgraduate students had higher knowledge regarding standard operating procedures to be adhered in dental clinics compared to undergraduate students and interns. It’s necessary that dental students are aware of latest infection control guidelines and implement them into their practices right from beginning.

Comparison of Characteristics and Outcomes of Pregnant Women with COVID-19 in First and Second Wave Admitted in a COVID Hospital in Arunachal Pradesh: A Retrospective Observational Study

Goter Doke, Tamar Paley, Binita Singha, Tomar Basar

Introduction: Coronavirus Disease-2019 (COVID-19) has affected the pregnant women and newborn child across the world. Empirical data shows that the characteristic of the effect of COVID-19 virus varies between the subsequent wave. Aim: To compare the demographic characteristics, severity of illness, Intensive Care Unit (ICU) admissions, maternal and neonatal outcomes in COVID-19 positive pregnant women of first and second wave. Materials and Methods: A retrospective observational study was conducted at dedicated COVID-19 Hospital under Tomo Riba Institute of Health and Medical Sciences (TRIHMS) in Itanagar, Arunachal Pradesh, India. All COVID-19 positive pregnant women admitted between July 2020 and August 2021 were included in the study. The patients admitted during 1^st July 2020 to 31^st January 2021 were considered in 1^st wave of COVID-19 and those from 1^st February 2021 to 31^st August 2021 as 2^nd wave of COVID-19. Data of baseline characteristics, clinical presentations, severity, ICU admissions, abortion, modes of delivery, Neonatal Intensive Care Unit (NICU) admission, maternal and neonatal mortality were analysed and compared. Results: A total of 144 COVID-19 positive pregnant women admitted from July 2020 to August 2021 were included in the study. Of 144 patients, 58 were in first wave and 86 in second wave of COVID-19. Number of moderate and severe cases admitted was 23.3% and 7% during second wave compared to only 12.1% moderate case only in first wave (p-value=0.015). Three pregnant women died due to severe COVID-19 pneumonia during the second wave. NICU admissions and other neonatal outcomes were comparable in both the study groups. Conclusion: A significantly increase number of pregnant women were affected with severe COVID-19 morbidity and mortality in second wave. Neonatal outcomes were similar in both waves.

Morphometric Analysis of External Ear to Estimate the Stature and Sexual Dimorphism in North Indians: A Cross-sectional Study

Introduction: Anthropometry is an essential technique to understand the variations in the human body that is implicated during various reconstructive surgical procedures, and for the identification of individual during crime scene in forensics. Analysis of ear morphology plays a role in understanding the sexual dimorphism and stature in the human population. It has been found that the ear morphology changes from one region to another. Aim: To study the morphometric parameters of external ear for stature estimation, and to identify sexual dimorphism in north Indian population. Materials and Methods: This cross-sectional study was conducted among 200 subjects (100 males and 100 females) aged 17-25 years in the Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. The study participants were selected from the medical, dental and nursing undergraduates studying in Banaras Hindu University (BHU). The various aspects of ear morphology (ear length, ear width, lobule length, lobule width) were measured. Student’s t-test, Karl Pearson’s Coefficient of Correlation and Linear regression equation were calculated. Results: The mean age for males were 19.17 years and females were 19.52 years. Measurements for ear length, width and lobule width of both ears were higher in males than females. The mean right and left ear length in males were 60.77±3.74 and 59.99±3.83 mm, and that for females were 56.59±3.044 and 55.55±3.68 mm, respectively. The mean right and left ear width in males were 30.60±2.81 and 30.81±2.69 mm and that for females, the values of ear width for right and left ears were 28.55±3.12 and 28.81±2.80 mm, respectively. A strong correlation between right and left ear length and stature in females were observed using linear regression coefficient analysis. The correlation coefficient between stature to right and left ear length in females were 0.55 and 0.51, respectively (p-value=0.030). Conclusion: Ear length and width, and lobule width of the right and left ears were significantly higher in males. There were no significant differences observed in lobule length. There was a strong correlation between the stature and right and left ear length in females, moderate strength of association was seen in stature with ear width and lobule length in females.

Bacterial Contaminants and their Antimicrobial Profile from Hospital Surfaces and Equipments of Various Areas in a Tertiary Care Hospital of Gujarat, India

Patel Purav, Patel Komal, Raval Payal

Introduction: Nosocomial infection is an important concern for healthcare professional in tertiary care centre as they have significant negative impact on patient’s recovery as well as mortality and morbidity. These infections are mostly acquired through contaminated areas of hospitals. Aim: To access the bacteriological profile of various hospital surfaces and equipments those are exposed to patient in routine clinical care. Materials and Methods: This cross-sectional study was conducted in tertiary care centre in North Gujarat region, India over the duration of one month in October 2021. Swabs from surfaces were collected using aseptic precautions for aerobic culture. Microorganisms isolated from samples were subjected to identification and antibiotic sensitivity tests. Frequency and distribution of microorganisms were analysed according to different working areas in hospital. Results: Out of 494 samples, total 171 samples (34.61%) showed bacterial growth, of which 186 different organisms were isolated. Highest number of isolates were Bacillus spp. (28.49%), Staphylococcus aureus (12.90%), Pseudomonas aeruginosa (9.14%), Klebsiella spp. (7.53%) and Acinetobacter spp. (7.53%). Conclusion: Various surface areas in hospital always need a constant surveillance as they are found contaminated in various studies across the globe. So, intermittent microbiological surveillance is must in a tertiary care hospital in setting up infection control protocol.

SARS-CoV-2 Positivity using Closed System RT-PCR at a Tertiary Care Medical Institute in Manipur, India

Introduction: Rapid cost effective, Point-of-Care (PoC) Truenat assay for the diagnosis of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) have been developed to shorten the Turn Around Time (TAT) of reporting with a wireless data transfer system. Aim: To explore the SARS-CoV-2 positivity using closed system Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Materials and Methods: An observational cross-sectional study was carried out in Molecular Laboratory of, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India, using Truenat RT-PCR (Molbio diagnostics) and data was entered from May 2020 to April 2021. Manufacturer’s literature was followed while performing the test. Screening of sample was done with Envelope (E) gene test and confirmed with RNA-dependent RNA polymerase gene (RdRP) gene test. Statistical analysis was done using Microsoft Excel sheet by calculating the percentage, proportions. Results: A total of 1,528 individuals were tested for SARS-Cov-2 and 73 tests were reported positive. The positivity rate by age was highest among 21-30 years. The positivity rate was higher among males than females. Among 1,105 asymptomatic individual, 27 (2.4%) were positive and among 423 symptomatic, 46 (10.9%) were positive. Conclusion: Using Truenat, positivity rate among symptomatic Coronavirus Disease 2019 (COVID-19) suspected persons was about four times more than positivity rate among exposed contact persons who are asymptomatic.

Association of Maternal Nutritional Status with COVID-19 Infection and its Effects on Pregnancy Outcomes- A Retrospective Study

Rehana Najam, Yugantika Tomar

Introduction: Need is felt to perform research for assessing the impact of maternal nutrition status on severity of Coronavirus Disease 2019 (COVID-19) in pregnancy and effect of COVID-19 on maternal outcomes as it has not been established. Aim: To evaluate association of maternal nutritional status and pregnancy outcomes with COVID-19 infection in pregnancy. Materials and Methods: A retrospective study was conducted among 260 antenatal patients admitted in COVID-19 level 3 hospital (Teerthanker Mahaveer Medical College and Research Centre), Moradabad, Uttar Pradesh, India, from April 2020 to May 2021 with COVID-19 infection. Records were studied for the effect of maternal nutrition status along with COVID-19 and outcome of pregnancy in terms of anthropometric markers Body Mass Index (BMI), nutritional markers (haemoglobin, total serum proteins) and biochemical markers (oral glucose tolerance test, vitamin D). Pregnancy outcomes were assessed in terms of severity of symptoms, Intensive Care Unit (ICU) admission, labour outcome and obstetric complications. Data were tabulated and examined using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: Mean age of the patients enrolled was 21.4±5.6 years. A statistically significant association was seen with high body mass index (88.24%), hyperglycaemia (82.35%), hypoproteinaemia (6.01±0.47) and hypoalbuminaemia (0.93±0.24). Statistically significant association between adverse pregnancy outcomes in terms of bleeding per vaginum (11.76%), preterm labour (54.92%), gestational diabetes mellitus (82.35%), hypertension (29.41%), Intrauterine Device (IUD) baby (35.29%) with increasing severity of COVID-19 infections. Conclusion: COVID-19 adversely affects the maternal obstetric outcome. Maternal nutrition status factors associated with severity of COVID-19 were body mass index, deranged blood sugar levels and protein levels.

An Observational Cross-sectional Study of Factors Causing Delay in Diagnosis of Head and Neck Cancers at a Rural Tertiary Care Centre in Northern India

Neha Salaria, Uma Garg, Mitva Agarwal, Swaran Kaur

Introduction: Cancer is a complex genetic disease derived from the accumulation of a variety of genetic changes, which include activation of proto-oncogenes and inactivation of tumour suppressor genes. Head and Neck Cancers (HNC) are rapidly growing tumours with a median potential doubling time of only 6-7 days. Although these cancers are easily accessible, patients rarely present early. In India, most HNCs present in advanced stages resulting in increased morbidity and mortality. Hence, it is prudent to ascertain the factors which lead to delay in diagnosis of HNC as early diagnosis and treatment is the cornerstone in reducing consequences of HNC. Aim: To identify patient and professional factors causing delay in diagnosis of HNC and to identify association if any with stage of cancer presentation. Materials and Methods: An observational cross-sectional study was conducted in the Department of Ear Nose and Throat, at BPS Government Medical College for women, Sonepat, Haryana, India, from September 2019 to January 2021. Study included 55 newly diagnosed histopathologically confirmed head and neck cancer patients. Clinico-demographic details were inferred using elaborate clinical examination. Data were described in terms of range, mean±Standard Deviation (SD), frequency and relative frequency (percentages). Chi-square and Fisher’s-exact test was used for comparing categorical data. Delay due to patient and professional factors were calculated separately and the association of each delay with important variables were compared. Results: Total 55 newly diagnosed histopathologically proven primary HNC patients were included in the study. Most patients (43.6%) belonged to the age group of 51 to 60 years, and the mean age was 60.25±9.81 years. Majority of the patients were males (85.5%). The mean total delay from onset of symptoms to final diagnosis was 22.38±7.23 weeks. Delayed patient presentation was the main cause of total delay in diagnosis. The main factors responsible for patient delay were rural residential status, low formal education, socio-economic status and poor cancer awareness. Irrational therapies still contributed significantly for delayed patient presentation. Diagnostic delay led to upstaging of disease. Conclusion: Patient delay is the main factor responsible for delay in diagnosis of HNC. Even in this era of easy availability and accessibility of information, lack of awareness still exists at the fundamental level.

A Retrospective Study on Turnaround Time for Frozen Sections- A Tertiary Care Centre Experience from Southern India

S Rima, A Santhosh, Sanjeet Roy

Introduction: Intraoperative consultation by frozen sections is an integral and essential part of surgical pathology to provide critical real-time information and guide in further intraoperative management. Diagnostic accuracy and Turnaround Time (TAT) have been considered as essential parameters which decide its effectiveness. Although diagnostic accuracy has been studied extensively, very few studies have assessed TAT of frozen sections. Aim: To assess the TAT for frozen sections in a tertiary centre and identifying the various practical factors determining it. Materials and Methods: This retrospective study was conducted in Department of General Pathology at Christian Medical college, Vellore, Tamil Nadu, India, on 615 frozen section samples obtained during the time period of June 2020 to June 2021. The TAT was defined as the time interval between receipt of sample and the time at which report was conveyed to the surgeon. The TAT for frozen sections should not exceed 30 minutes as per the criteria proposed by National Accreditation Board for Testing and Calibration Laboratories (NABL). Further details such as number of sites per frozen, number of pathologists involved, number of tissue blocks and slides made, requirement of deeper sections and special stains were documented and the factors influencing TAT were analysed based upon their subspeciality. Results: A total of 35,175 specimens were received during the study period, of which 615 cases had frozen sections. Out of 615, 16.9% had TAT of more than 30 minutes, however when only one tissue block was submitted (n=221), 90% were within TAT. The delay in TAT was likely to occur when more than two pathologists participated in the FS diagnosis, more number of sections/tissue blocks were required, the pathologist had to retrieve and review previous case material during the FS procedure, simultaneously receiving additional specimens and requirement of special stains. Conclusion: Turnaround time for frozen sections depends on several preanalytical and analytical reasons. An overall TAT that includes these factors cannot be taken as a standalone quality indicator of the laboratory. Therefore, a checklist that includes specimen receiving time, slide receiving time and time at which the diagnosis was conveyed to the surgeon needs to be documented to help understand where the delay happens. A periodic assessment of intraoperative frozen section TAT should be an integral part of an ongoing quality assurance program.

Spectrum of Renal Histopathological Changes in Multiple Myeloma

Introduction: Renal involvement is very common in myeloma. The evaluation of renal status plays an important role in diagnosis and prognosis of patients with myeloma. The kidney biopsy will show various patterns of injury and the chronicity of the disease which help in planning the treatment options. Myeloma comprises a significant number of malignancies but no data regarding renal biopsy changes in myeloma is available from North Kerala, India. Aim: To describe the various morphological patterns of renal involvement in all myeloma patients who required a renal biopsy for evaluation of renal dysfunction. Materials and Methods: It was a retrospective, descriptive study conducted at Government Medical College, Kozhikode, India, a tertiary care centre from January 2016 to December 2019. A total of 63 patients of myeloma who underwent a renal biopsy for evaluation of renal dysfunction as the initial presentation or immediately after diagnosis were included in this study. Serum electrophoresis, skeletal survey, complete blood counts, bone marrow study and biochemical evaluation for serum creatinine, total protein, albumin globulin ratio were done in all patients. Data was analysed using standard analytical techniques with Statistical Package for the Social Sciences (SPSS) version 16.0 for windows. Results: A total of 63 patients presented with renal dysfunction as initial symptom underwent renal biopsy. Most common age group of the study population was between 50-70 years. In 47 (74.6%) patients the renal dysfunction was the initial presenting symptom of myeloma. The presenting features were acute renal failure, nephrotic syndrome and acute nephritis. The renal biopsy findings included myeloma cast nephropathy, amyloidosis, proliferative glomerulonephritis and tubulointerstitial nephritis with cast nephropathy being most common pattern. Acute renal failure was more common in cast nephropathy while amyloidosis presented with nephrotic syndrome. The serum creatinine and calcium levels, plasma cell counts and degree of anaemia had a correlation with histological pattern of injury. Conclusion: Acute kidney injury due to myeloma cast nephropathy is a medical emergency and prompt therapy with measures to reduce light chain load along with correction of dehydration can reduce renal damage and increase the patient survival. Many newly described entities like fibrillary and immunotactoid nephropathy can occur in myeloma and these can be identified only by electron microscopic evaluation of kidney tissue. They have important prognostic impact and significance when renal transplants are planned for. So, renal biopsy supported by newer methods like immunohistochemistry and electron microscopy is a must to keep pace with newer advances in myeloma treatment like autologous stem cell transplantation.

Effect of Chlorhexidine Mouthwash, Povidone-iodine Gargles and Herbal Mouth Sanitiser on Colour Stability and Surface Roughness of Conventional Nanohybrid Composite- An In-vitro Study

Introduction: Chlorhexidine is commonly used to treat dental diseases as a broad-spectrum topical antibacterial medication. Povidone-iodine is a water soluble blend of molecular iodine and the solubiliser polyvinyl pyrrolidone. Amsarveda (pharmaceutical company) developed a natural mouth sanitiser with liposomal curcumin. Aim: Comparative evaluation of the effect of chlorhexidine mouthwash, povidone-iodine gargle and herbal mouth sanitiser on colour stability and surface roughness of conventional nanohybrid composite. Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from November 2020 to June 2021. Total 60 extracted human permanent maxillary premolar teeth were selected. Class V restorations were performed on the extracted teeth with nanohybrid composite resin. The samples were divided into three groups by computer randomisation. The three test solution groups (n=20 each) ie., group A- chlorhexidine 0.2% mouthwash, group B has povidone-iodine (2%), group C- herbal mouth sanitiser. The colour change and surface roughness of all the samples were measured before and 15 days after immersion into the test solutions. The data was collected and statistically analysed using one-way Analysis of Variance (ANOVA) and Tukey’s post-hoc test. Results: The ΔE values for all three groups show a statistically significant difference (p-value <0.001). The mean baseline and after 15 days values for surface roughness in groups A and B showed a statistically significant difference (p-value <0.001). Whereas, no statistically significant difference in group C (p-value=0.654). Conclusion: Based on the results of the present study, it can be stated that the povidone-iodine gargle showed more surface roughness and colour change of conventional nanohybrid composite followed by chlorhexidine mouthwash and herbal mouth sanitiser.

Evaluation of Diameter of Main Hilar Renal Artery to Predict the Presence of Supplementary Renal Artery by Contrast-enhanced MDCT: A Retrospective Study in Northern India

Manu Gupta, Nishav Kaul, Ashish Kumar Shukla

Introduction: Accessory renal arteries are non anastomotic end arteries that correspond to a single renal artery’s segmental branch. It is the most common anatomic variation of renal artery, with an incidence ranging from 8.7-75.7%. Aim: To determine the normal reference range of diameter of the main hilar renal artery in presence or absence of supplementary renal arteries and using contrast-enhanced Multidetector Computerised Tomography (MDCT) in North Indian population. Materials and Methods: This retrospective study was conducted in the Department of Anatomy in collaboration with the Department of Radiodiagnosis at Santosh Medical College and Hospital, Ghaziabad and Dr. O.P Gupta Imaging Centre, Meerut, Uttar Pradesh, India, from April 2019 to October 2021. Data analysis was done from November 2021 to December 2021. Contrast-enhanced MDCT scan images were reviewed for measurement of the diameter of main hilar and supplementary renal artery. A total of 108 patients were recruited through consecutive sampling. The diameter of the main hilar and supplementary renal artery on each side was measured at the site of origin from the abdominal aorta with the help of an electronic calliper in axial view of MDCT images. The mean differences among the groups with and without supplementary renal artery were evaluated using the student’s t-test. Results: The mean diameter of the main hilar renal artery in the absence of the supplementary renal arteries on the right and left side were 5.99±1.13 mm and 6.07±1.25 mm, respectively. The mean diameter of the main hilar renal artery with supplementary renal arteries on the right side was 5.11±1.096 mm and on the left was 5.18±1.08. The mean diameter of the main hilar renal artery was smaller in kidneys with a supplementary renal artery than in those without a supplementary renal artery, statistically significant difference was evaluated (p-value <0.001 on the right and left side). Conclusion: The diameter of the main hilar renal artery can indicate whether supplemental renal arteries exist or not.

Ochrobactrum intermedium Bacteraemia in COVID-19 Positive Patients: Case Report of Rare Co-infection from Northern India

Tasneem Siddiqui, Rafat Shamim, Sangram Singhpatel, Chinmoy Sahu, Mitra Kar

Ochrobactrum intermedium (O. intermedium) is a novel emerging gram negative bacillus infecting immunocompromised hosts. It is known for its multidrug resistance and to distinguish it from other species of Ochrobactrum genus by conventional methods, is often difficult. Here, authors report two unusual and interesting cases of bacterial infection due to O. intermedium in a 28-year-old female and 46-year-old male having Coronavirus Disease-2019 (COVID-19) infection. Rapid identification by Matrix Assisted Laser Desorption/Ionisation-Time Of Flight (MALDI-TOF) mass spectrometry and patient’s treatment guided by antibiotic sensitivity yielded in favourable outcome. Present report describes clinical and microbiological characteristics of this rare pathogen and also highlights the need of automated methods for proper identification of such opportunistic pathogens and their unique antibiotic susceptibility profiles.

Rapid Plasma Reagin Card Test: A Screening Method for Syphilis in Antenatal Patients of Bastar, Chhattisgarh, India

Sahina Hassan, Satyaram Satapathy, Ratna Agrawal

Introduction: Sexually Transmitted Disease (STD) like syphilis is one of the important factor leading to adverse pregnancy outcomes in antenatal mothers. The infant and neonatal mortality rate itself is higher in the tribal region of Chhattisgarh like Bastar due to poor educational status and limited availability of health infrastructures. To prevent the disease related adverse pregnancy outcomes, early diagnosis and treatment of STDs is important by rapid screening method like Rapid Plasma Reagin (RPR) card test, which is comparatively cost effective tool available at clinical settings. Aim: To detect the incidence of syphilis among antenatal mothers of Bastar, Chattisgarh, India by using RPR card test. Materials and Methods: The present cross-sectional study was conducted on 150 blood samples of patients attending Obstetrics and Gynaecology out-patient and in-patient Department (OPD and IPD) from August 2021 to October 2021. The samples referred to Microbiology laboratory of Late Baliram Kashyap Memorial Government Medical College Jagdalpur, Chhattisgarh, India, were tested by RPR card test taking all aseptic precautions. The data were collected in Microsoft Excel sheet and results were presented in counts and percentages using descriptive statistics. Results: Out of 150 samples, 11 (7.33%) were tested positive by RPR card test while rest 139 (92.67%) were found negative. Out of the 11 (7.33%) samples which tested positive, 3 (27.27%) were from Anti Retroviral Therapy (ART) centre (concurrent Human Immunodeficiency Virus (HIV) and syphilis positive), 7 (63.64%) were from Obstetrics and Gynaecology OPD and 1 (9.09%) sample was from labour ward. Age of the patients attending antenatal clinic ranged between 11-50 years with maximum patients 103 (68.67%) were in 21-30 years of age group. Conclusion: RPR card test is one of the important cost effective, rapid screening tools for STDs like syphilis, especially in the resource poor areas like tribal region of Bastar, Chattisgarh, India. Comparatively higher percentage of syphilitic infection reported in the study may contribute in improving health infrastructure policies in the affected regions of Bastar, Chattisgarh, India.

Evaluation of Two Doses of Intrathecal Clonidine on Analgesia and Haemodynamic Profile in Elderly Patients Undergoing Endoscopic Bladder Surgeries- A Randomised Clinical Trial

Nandita Adlakha, Sujata Chaudhary, Megha Jain

Introduction: Endoscopic bladder surgeries like Transurethral Resection of Prostrate (TURP) and Transurethral Resection of Bladder Tumour (TURBT) are performed preferably under spinal anaesthesia, using local anaesthetic like bupivacaine along with an adjuvant. Of these adjuvants used, clonidine is gaining popularity because of its safety and various advantages associated with its use. However its effect on haemodynamics, effect on block characteristics and analgesia in elderly patients has not been studied extensively. Aim: To evaluate the analgesic efficacy and safety of clonidine 30 μg and 50 μg, in elderly patients undergoing endoscopic bladder surgeries. Materials and Methods: It was a double blinded randomised clinical study, conducted in Department of Anaesthesia, University College of Medical Sciences, Delhi, India, from September 2008 to October 2011. Total 60 American Society of Anaesthesiology (ASA) grade I and II patients, of age 50-80 years, undergoing endoscopic bladder surgeries, were randomly allocated into three groups of 20 each. Group C received 12.5 mg of 0.5% heavy bupivacaine (2.5 mL) without clonidine, while group A and group B received 30 μg and 50 μg, respectively of clonidine. Intraoperative non invasive and invasive haemodynamic monitoring was done. The duration of analgesia (the time from the intrathecal injection to Visual Analog Scale (VAS) score greater than 0 and Bromage Scale 3), quality of anaesthesia and haemodynamic were compared between the three groups. Analysis of variance (ANOVA) for repeated measures was used for analysing the collected data. Tukey’s Honest Significant Difference (HSD) test was applied as post hoc test whenever applicable. Results: The mean duration of complete analgesia was 3.32±1.80 hours in group A, 6.30±1.45 hours in group B, and 2.22±0.92 hours in group C. The duration of complete analgesia was significantly longer in group A and B, when compared to group C. The mean duration of effective analgesia was 6.05±0.88 hours in group A, 8.65±1.75 hours in group B, and 4.68±1.77 hours in group C. The duration of effective analgesia was significantly longer in group A and B, as compared to group C. Following intrathecal injection, there was no significant difference in heart rate, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), cardiac output, stroke volume, systemic vascular resistance in between groups. There were no significant side effects in any of the groups. Conclusion: Intrathecal clonidine in a dose of 30 μg and 50 μg provides faster onset, better quality and prolonged duration of block with stable haemodynamic and minimal side effects in patients undergoing endoscopic bladder surgeries.

Prevalence of Errors in Fundamentals of Patient Positioning in Digital Orthopantomogram- A Retrospective Study

P Poornachitra, TN Uma Maheswari, Jayanth Kumar Vadivel

Introduction: Digital panoramic radiograph or Orthopantom-ogram (OPG) has become an indispensable equipment in oral disease diagnosis. However, it is prone for positioning errors in digital imaging systems that affect quality of dental care. Aim: To assess the prevalence of errors in patient positioning in digital OPG. Materials and Methods: This retrospective study including 900 digital OPG’s (483 males and 417 females) which were collected from the Department or Oral Medicine and Radiology at Saveetha Dental college and hospital, Chennai, Tamil Nadu, India. Digital OPG images taken during the month of January from 1.1.2021 to 31.1.2021 were retrospectively collected and used for this study. The data was then analysed and interpreted in the consecutive months from 1.2.2021 to 31.3.2021. The images were assessed for the frequency of positioning errors by a single radiologist and its association with the patient gender. The results were statistically analysed using Statistical Analysis of the Social Sciences (SPSS) 23.0 software. Chi-square test was used for the statistical analyses to determine the association between positioning errors and gender (p-value ≤0.05). Results: Among the positioning errors, the most common error was “head too far forward”, 19.9% in males and 23.5% in females. The least common errors seen were excessive downward angulation and upward over-angulation 27 (5.6%) and 16 (3.3%) cases in males and 19 (4.6%) and 15 (3.6%) cases in females, respectively. The association between gender and positioning errors was found to be statistically significant at p-value 0.001 (p<0.05) with a Chi-square value of 22.455. Conclusion: This study highlights the importance of structured training in taking panoramic radiographs and quality support required for proper image outcome. This is necessary to reduce treatment cost, patient time expenditure, exposure to radiation and delay in treatment planning.

Rifampicin Resistance by Xpert MTB/RIF Assay in Pulmonary Tuberculosis- Is there a Need for Confirmation by Retesting?

Swapna Rajesh Kanade, Swati Vijay, Gita Nataraj

Introduction: Xpert Mycobacterium tuberculosis/ resistance to Rifampicin (MTB/RIF) assay detects MTB complex (MTBC)and rifampicin resistance simultaneously. In high prevalence countries like India, detection of rifampicin resistance in sputum specimen of a newly diagnosed case of pulmonary TB with a low pretest probability needs to be confirmed by retesting. Aim: To evaluate the results of retesting of rifampicin resistant specimens in newly diagnosed pulmonary TB cases. Materials and Methods: A retrospective analysis of the data of Xpert assay was performed on specimens received in Department of Microbiology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India. If rifampicin resistance was detected in a newly diagnosed case of Tuberculosis (TB), a second specimen was retested by Xpert assay for confirmation. Concordance of retesting was seen with results of Line Probe Assay (LPA). Results: Total 27,429 specimens were processed by Xpert assay of which 803 specimens showed rifampicin resistance, 157 sputum specimens fulfilling criteria of Programmatic Management of Drug resistant Tuberculosis (PMDT) guidelines were retested. High, medium, low and very low bacterial load was observed in 30, 51, 34 and 42 specimens’ respectively. All specimens having high or medium bacillary load showed rifampicin resistant result on retesting. On retesting 34 sputum specimens with low bacterial load, rifampicin resistance was confirmed in 30 specimens. LPA done after growing them by liquid culture confirmed rifampicin resistance in remaining four specimens. Conclusion: Xpert assay is recommended when the bacterial load identified by Xpert assay is very low and when there is discordance between Xpert results of rifampicin resistance and the reflex LPA testing.

Frictional Resistance of Non Coated and Epoxy Coated Superelastic NiTi Wires used for Aligning in Three Types of Brackets

Introduction: Coated archwires are preferred in combination with aesthetic orthodontic brackets by orthodontists over non metallic aesthetic archwires. Studies evaluating the frictional properties of epoxy coated round superelastic Nickel Titanium (NiTi) archwires are limited to stainless steel brackets. Aim: To evaluate and compare the frictional resistance of an epoxy coated 0.016*" superelastic NiTi archwire in stainless steel, composite and ceramic brackets and to compare it with the frictional resistance generated by non coated 0.016*" superelastic NiTi archwire in same brackets. Materials and Methods: An in-vitro experimental study was conducted in the Department of Orthodontics at SRM Dental College, Ramapuram Chennai, Tamil Nadu, India, from January to February 2020. Frictional resistance of 30 epoxy coated aesthetic 0.016*" upper superelastic NiTi wires (G4™ Nickel Titanium, 0.016*, Upper Trueform™ I, Tooth-Colored) and 30 conventional 0.016*" upper superelastic NiTi wires (G4™ Nickel Titanium, 0.016*, Upper Trueform™) from G&H® orthodontics while sliding across three different types of brackets were evaluated. Twenty stainless steel (Gemini® 3M unitek, Monrovia, California), 20 composite (FLI® RMO, Denver, Colo.), and 20 gemini clear ceramic (Gemini clear ® 3M unitek, Monrovia, California) 0.022×0.028" Slot Roth prescription maxillary first premolar brackets were used. The brackets and archwires were divided into six groups of different bracket and archwire combination with 10 samples in each. An Instron testing machine with a 10 N tension was used to measure the frictional resistance. The obtained values were analysed using One way ANOVA and followed by Post Hoc Tukey’s test HSD for multiple comparison. Results: Coated wires generated significantly high friction in ceramic brackets (136.90±3.79 gms) followed by composite brackets (125.66±3.44 gms) and stainless steel brackets (92.53±8.70 gms). Non coated wires generated significantly high friction with ceramic brackets (89.60±2.90 gms) whereas the friction generated in composite (70.87±5.79 gms) and stainless steel brackets (67.70±2.80 gms) was not significantly different. Conclusion: Epoxy coating increased the frictional resistance generated by the 0.016* superelastic NiTi archwires irrespective of bracket materials. The coated wires generated less friction in composite brackets compared to ceramic brackets. Further clinical trial are recommended to evaluate the aligning efficacy of these archwires in aesthetic brackets.

Yoga Intervention for Patients with Systemic Lupus Erythematosus- A Research Protocol

R Shobana, Emmanuel Bhaskar, K Maheshkumar, Santhi Silambanan

Introduction: Systemic Lupus Erythematosus (SLE) is one of the most common systemic autoimmune diseases with a wide range of clinical manifestations. SLE patients experience periods of exacerbation or flare and quiescent disease activity. An increase in the frequency of exacerbations or flares causes permanent organ damage, increased morbidity, and early mortality, which are mainly due to the increased activity of immune-mediated inflammatory reactions. Yoga interventions have an immune-modulatory potential that regulates the psycho-neuro-immune axis, moderates disease activity, and improves the Quality Of Life (QOL) for patients. Aim: To report the methodology for the six months specified yoga interventions to reduce the inflammatory markers and enhance health-related QOL among SLE patients. Materials and Methods: A randomised controlled trial will be conducted with a sample size of 128 SLE participants. Newly diagnosed and treatment-resistant SLE participants, patients more than 18 years of age, will be recruited. Participants will be divided into three groups: newly diagnosed, treatment-resistant SLE, and control; patients diagnosed with SLE within six months, unresponsive to “standard therapy” will be placed in the respective groups. Participants in the newly diagnosed and treatment-resistant groups will be given yoga sessions, and the effects will be compared with controls. Results: A baseline and postintervention (after six months) assessment will be performed for all the patients. Primary outcomes like anti-double stranded Deoxyribonucleic Acid (anti-dsDNA), complements-C3, C4, and inflammatory markers like Interleukin 6 (IL-6), 10, 17, Interferon-gamma, and plasma micro-RNA will be measured and quantified. The secondary outcome will include measurement of health-related QOL using the Lupus-QoL questionnaire. Conclusion: Yoga integration, along with conventional treatment for SLE, as adjunctive therapy might enhance physical functioning and improve psychological health.

Determinants of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis

Introduction: Coronary Artery Bypass Graft (CABG) surgery has potential benefits for patients with Coronary Artery Disease (CAD). The consensus associated with Percutaneous Coronary Intervention (PCI) and CABG was in terms of clinical outcomes, type of vessel disease, repeat revascularisation, stroke, myocardial infarction, and heart failure. Hence, a comparison of PCI versus CABG is becoming important to identify patients who would benefit from PCI and CABG. Aim: This review was conducted to identify the pathophysiological determinants of PCI and CABG. Materials and Methods: In the present systematic review, Medline (PubMed), EMBASE, ProQuest, and the Cochrane database were searched, by using the key words “PCI” OR “percutaneous coronary intervention” AND “CABG” OR “coronary artery bypass grafting”. The searches were restricted from January 2009 to June 2021, with studies published in the English language. Comparative studies of CABG versus PCI with stent placement were the inclusion criteria.For meta-analysis Mantel-Haenszel Odds Ratio (MHOR) with its 95% Confidence Interval (CI), Mean Difference (MD) with its 95% CI were computed. Results: Overall, 408 titles or abstracts were identified from the initial search, of which full manuscripts of 93 studies were retrieved, in the first phase. Later, 71 studies were not retrieved. Of the remaining 22 studies, 19 were subjected to meta-analysis. This review contributes a sample size of 17,053. Mean age of the study population of PCI group was 66.15±10.71 years and in CABG group it was 66.16±9.43 years. PCI was performed among patients with higher ejection fraction (MD=2.13; 95% CI=1.75 to 2.52) or higher Synergy between percutaneous coronary intervention with Taxus and coronary artery bypass surgery (SYNTAX) score (MD=-3.43; 95% CI=-3.98 to -2.87). CABG was considered for the patients with a higher Euro score (MD=0.28; 95% CI=0.2 to 0.35). Conclusion: The ejection fraction, SYNTAX score, euro score, type of vessel disease, chronic kidney disease, and diabetes are the determinants of PCI and CABG.

Bonding of Fractured Fragments using Various Bonding Materials as a Treatment Modality in Cases of Vertical Root Fracture- A Systematic Review

Introduction: Vertical Root Fracture (VRF) is third most common factor leading to extraction of root canal treated tooth. It has a longitudinal orientation. This occurs due to reduction in structural integrity and dehydration of dentine. Most common treatment includes extraction of the teeth. Other modality is amputation of involved root in molars. Various materials can also be used for bonding of the fragments. Aim: To compare and evaluate the effectiveness of dentine bonding systems in re-attatchment of fractured root. Materials and Methods: The present systematic review included a comprehensive search of last 10 years was performed in the systematic electronic database PubMed. In-vitro laboratory studies that evaluated the microtensile bond strength and fracture resistance of multiple dentine adhesive systems and compared them in human and/or animal teeth in which VRF had occurred were included. A total of 16 non duplicated studies were retrieved in the systematic search. Results: Out of 16 studies four studies were included in the systematic review. One study assessed the bond strength of the adhesive using table top testing machine. Two studies assessed the microtensile bond strength using stereo microscope and one study assessed recurrence of the fracture using Instron Machine. The studies demonstrated large variability among methodology used for evaluation. In one study, acid phosphate monomer showed highest microtensile bond strength (p<0.05), and in another study Refracture (RF) occurred easily in samples bonded with Glass Ionomer Cement (GIC) as compared to those bound with Perma Bond and Gluma (p<0.0003). Conclusion: From the present study’s analysis, dual cure adhesive resin cement either reinforced with polyethylene fibres or glass fibres, and glass ionomer cement may increase the fracture resistance of bonded tooth.

Virtual Events in the Post-COVID-19 Pandemic Era in Medical Profession: A Narrative Review

Amit Gupta, Jaine John Chenatt, Tanuj Singla, Deepak Rajput, Sweety Gupta

The Coronavirus Disease 2019 (COVID-19) pandemic wreaked havoc on almost all aspects of life and has undeniably altered the landscape of the world forever. In the medical profession, everything from education to scheduling operations was affected. Educational events such as conferences, Continuing Medical Education (CME) and other events had to be converted into virtual conferences and meetings. However, now that the pandemic is slowly coming to an end and countries and borders have started to reopen, the question now remains- should we go back to our old ways or has this become the new normal? This review discusses the advantages and limitations of conducting virtual events and discusses future trends of holding such events in these uncertain times.

Worrisome Implications of Accidental Injection of Colourless Corrosive Chemicals Intraorally into Perioral Tissue Spaces: A Severe Negligence

Pulkit Khandelwal, Neha Hajira

During certain treatment procedures in a dental clinic, few colourless chemicals like Local Anaesthetics (LA), sodium hypochlorite, formalin, hydrogen peroxide, xylene, chloroform etc., are often used simultaneously. Instead of LA, these chemicals may be accidentally injected in oral soft tissues due to casual handling. These accidental injections produce severe corrosive effects in and around perioral tissues and may lead to chemical necrotising cellulitis within 24 hours. Osteolytic changes of underlying bone and fatty infiltration with necrosis of the soft tissues can also occur. These events of accidental injection of such corrosive chemical solutions in patients during dental treatment may occur owing to the use of empty LA bottles for storage of these corrosive chemicals which can be easily mistaken for LA solution. Every solution has its indicated use in dentistry and treatment procedure. While performing any treatment procedure in dental clinic, utmost care and precautions must be taken to avoid any medical negligence in administering such corrosive chemicals intraorally which may make the patient’s life havoc because of hazardous complications in maxillofacial region. This paper reviews accidental intraoral injection of these colourless chemicals and also discusses the adverse effects, prevention and management of such inadvertent injections. Successful management includes cautious debridement and empirical drug therapy (antibiotics and analgesics).

Machine Learning Models in Prediabetes Screening: A Systematic Review

Introduction: The increasing prevalence of type 2 Diabetes Mellitus (DM) can be done from identifying those with prediabetes and offer early interventions by utilising prescreening diagnostic tools. Machine learning algorithms and big data mining approaches have been postulated for predictive disease modelling in hospital and clinical settings. Aim: To outline the relative performance accuracies in predicting prediabetes conditions in different machine learning algorithms. Materials and Methods: A systematic literature search was conducted at Universiti of Kebangsaan, Kuala Lumpur, Malaysia, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review protocol, and the research question was formulated based on the keywords of “Prediabetes” (Population), “Internet of Things” and “prediction model” (Intervention) and “screening” and “risk” (Outcome). International Prospective Register of Systematic Reviews (PROSPERO) registration (CRD42021264947) was done and databases were screened on 10^th-24^th June 2021 via Web of Science, Scopus, PubMed, Ovid and EBSCOhost. Inclusion criteria was English language prediction studies published between 2011-2021. Review articles, editorials, proceedings, commentary articles and articles not focusing on prediabetes were excluded. The quality of the articles was ranked via the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results: A total of five articles that were published in 2014-2021 were included. The sample sizes ranged from 570 to 24,331 participants. Three studies (South Korea, United State of America (USA), Japan) suggested the applicability of the screening score prediction models for use in clinical settings related to personalised risk assessment and targeted interventions, with the predictors used being suitable for either the clinic or hospital. The simplicity of gender, age, Body Mass Index (BMI), blood pressure and waist circumference as predictors suggested that they can be utilised by the community. Conclusion: This review highlights the fact that the heterogeneity of the population used and validation issues may affect generalisation. Future studies should address these concerns to guide advocacy among healthcare providers in clinical practice as well as in data and expertise sharing for developing and validating urgently needed prediabetic prediction models.

Value of Endoscopy in Cholesteatoma Clearance: A Systematic Review

Prakash S Handi, Harish Onkarappa Mudhbasalar

Introduction: The primary goal of cholesteatoma surgery is to eradicate it from the middle ear cleft. However, due to linear axis of illumination of the microscope, in some of the recesses or hidden areas in middle ear are not visualised. To overcome this, many studies have been done on the complimentary use of endoscopes in visualising these hidden areas. Aim: To assess the outcome of complimentary use of endoscopes in addition to microscope on improved access to hidden areas in the middle ear and resultant cholesteatoma clearance. Materials and Methods: In this systematic review, literature search was conducted using the keywords both manually and electronically in PubMed, Google scholar and Directory of Open Access Journals for articles published till December 2021 at ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India. The primary inclusion criteria used was all full text original, both prospective and retrospective, articles in which endoscopes were used as an adjunct to microscope for cholesteatoma clearance from middle ear cleft. Retrieved articles were reviewed by two independent authors for their eligibility for inclusion in the study. The selected original papers were analysed. Data was entered in Microsoft Excel 2007 and analysed for descriptive statistics like frequency and proportions. Results: A total of 48 studies were identified initially. After removing duplicates, screening was done for title, abstracts and full text retrieval to check for inclusion criteria being met. Six studies were found using complimentary endoscopes for cholesteatoma surgery and were analysed. Of these, four were prospective and two were retrospective studies. Total 604 patients underwent endoscopic examination after microscopic clearance. Residual cholesteatoma was seen in 105 patients (17%), which were cleared with endoscopic assistance. Conclusion: Complimentary endoscopy detects residual cholesteatoma in significant number of cases during primary cholesteatoma surgery. In cholesteatoma surgery, they are predominantly used as observational tools.

Analysis of Burden and Outcomes of Oral Hypoglycaemic Agent Induced Adverse Drug Effects at a Tertiary Care Centre

Kavita S Joshi, Arnav H Tongaonkar, Alhad AMulkalwar

Introduction: Recent studies, both globally as well as in India, have depicted an alarming rise in the prevalence of Diabetes Mellitus (DM). Oral Hypoglycaemic Agents (OHAs) are the most common drugs used in the treatment of type 2 diabetes mellitus. There are numerous established Adverse Drug Reactions (ADR) associated with their use, such as, hypoglycaemia, weight gain, gastrointestinal disturbance, lactic acidosis and fluid retention. Aim: To assess the incidence of ADRs, clinical profile, severity and causality among the admitted patients, taking OHAs, in a tertiary care hospital. Materials and Methods: This was a hospital-based, prospective, observational, non interventional cohort study undertaken at the General Medicine Wards of a public teaching hospital, Seth GSMC and KEMH, Mumbai, Maharashtra, India. The present study was conducted in the Department of Medicine from June 2017 to December 2018. The patient’s data was recorded using a structured ADR reporting form. The baseline parameters, medical history and underlying diseases, clinical data, characteristics of ADRs and details of medication responsible for ADRs as well as medication for treatment of ADRs were recorded. The data was analysed using descriptive statistics with the Statistical Packages for the Social Sciences (SPSS) version 26.0 software. Results: Out of 164 patients admitted due to ADRs, within the study period, 48 (29.3%) patients had developed ADRs due to OHAs (sulfonylureas). The severity of ADRs of five patients fell under the moderate category (three males in the age group of 61-80 years and two females in the age group of 21-40 years), all of whom successfully recovered. The remaining 43 (89.6%) were associated with severe ADRs. Four patients had succumbed to the ADR while one reported further sequelae, and the rest of the patients recovered (one was still recovering at the time of data analysis). Conclusion: Sulfonylurea-induced hypoglycaemia is the most common ADR seen in patients on treatment of type 2 diabetes mellitus. Presence of systemic co-morbidities and polypharmacy are significant risk factors associated with OHA-induced ADRs.

Ultrasound Guided Acupuncture: A Case Series

S Parthasarathy

Acupuncture is an ancient system of medicine which involves introduction of specific needles in described sites into prescribed depths. A few apprehensions about this technique are the close proximity of the needles with vital structures and possible injuries. In the present paper, an attempt was made to use ultrasound which is a non invasive technique of identifying vital structures in two cases and to find out its utility. First case is of a 35-year-old male, with history of alcoholism, presented with a wrist drop, was advised electroacupuncture where the needles were placed in the centre of the muscle bulk with ultrasound guidance to elicit good motor response. Another case, a 45-year-old female patient had tennis elbow where the superficial veins and nerves were avoided before pricking on selected sites. The response was as expected and normal. The first case had satisfactory motor recovery while the second one had adequate pain relief. There was neither bleeding from any site nor any other complications. A survey scan of the puncture site can be advised before inserting acupuncture needles. Ultrasound guided acupuncture is feasible without compromising the traditions. This concept becomes easier as ultrasound and acupuncture have been conveniently handled together by anaesthesiologists.