Journal of clinical and diagnostic research

Coronary Intervention in Separate Origin of Left Anterior Descending and Left Circumflex Coronary Artery

Debasish Das, Debasis Acharya, Tutan Das, Subhas Pramanik

Coronary anomalies are not commonly encountered in routine clinical practice. This case report is of a 55-year-old female who presented with effort angina, Canadian Cardiovascular Society (CCS) class II, since last six months with shortness of breath. Echocardiography (ECG) revealed the presence of Non ST Elevation Myocardial Infarction (NSTEMI) and the presence of no Regional Wall Motion Abnormality (RWMA), with normal left ventricular systolic function. Right transradial coronary angiogram revealed the presence of separate origin of Left Anterior Descending (LAD) and Left Circumflex (LCX) coronary artery. Although separate origin of LAD and LCX is the most common benign coronary anomaly noted in clinical practice, interestingly both coronary arteries in this case were harboring significant atherosclerotic occlusion and were successfully revascularised with Drug Eluting Stents (DES). Coronary intervention in separate origin of LAD and LCX requires special maneuvers during guide catheter management for percutaneous intervention. Clockwise rotation of the guide catheter to selectively engage the LCX and anticlockwise rotation of the guide catheter to selectively engage the LAD is the key for procedural success during coronary intervention. This case is unique and the first to describe the separate origin of LAD and LCX presenting as NSTEMI with critically obstructive Coronary Artery Disease (CAD) in both of them and age being the only conventional cardiac risk factor behind it.

Intracranial Dermoid and Epidermoid Cysts: A Case Report

Anmol Taneja, Samarth Shukla, Sourya Acharya, Sunita Vagha

Dermoid and epidermoid cysts are ectodermally derived neuraxis cysts, both lined by keratinising squamous epithelium. Epidermoid cyst is filled by friable, often lamellated keratinous debris and is devoid of cutaneous-type adnexal structures, as found in dermoid cysts. They are usually located at the cerebellopontine angle, cerebellar vermis, fourth ventricle, parasellar region, and frontal and fronto-temporal cisternal spaces but the cerebellopontine angle being their single most common location of epidermoid cysts whereas dermoid cyst clings tightly to the midline. Hereby, the authors are presenting a case report of two cases; first case is of a one-month-old child presented with 4×4 cm sized cystic swelling over occipital region since birth with redness since 15 days with complaint of pus discharge from the swelling since one day. Cyst with contents was sent for histopathological examination and features suggestive of intracranial dermoid cyst. Second case is of 14-year-old female child who presented with the complaints of headache since six months and imbalance since two months. Magnetic Resonance Imaging (MRI) was suggestive of cerebellopontine angle tumour with hydrocephalus. Tumour was excised and sent for histopathological examination and features suggested of epidermoid cyst. These benign lesions are potentially curable. As these cases were suspected as malignant tumours but as they found out to be diagnosed as benign lesions. Although these lesions are benign but can still lead to some seroius complications. We are reporting these cases for its early diagnosis and thereby better management.

Acropigmentation of Dohi- A Rare Presentation

Samiksha Deepak Chavhan, Sugat Jawade, Bhushan Madke, Adarshlata Singh

Reticulate Acropigmentation of Dohi or Dyschromatosis symmetrica hereditaria, is an autosomal dominant genodermatosis, with very few reported autosomal recessive traits mostly seen in the Japanese population. A 27-year-old Indian male presented with light and dark coloured lesions involving bilateral arms and forearms, chest, back, and bilateral lower limbs with sparing of face, palms, and soles from 20 years. There were multiple hyperpigmented and hypopigmented macules which on detailed cutaneous examination and biopsy was diagnosed as reticulate acropigmentation of Dohi. As no definitive and effective treatment is available in this condition, the patient was treated conservatively with sun protection and sunscreen to decrease the contrast between hyperpigmented and hypopigmented lesions however the patient could not be followed-up further. Acropigmentation of Dohi being a rare entity diagnosing and differentiating it from other disorders is important.

Thyroglossal Duct Cyst with Multiple Tracts- A Case Report

S Prabakaran, T Swetha, RB Namasivaya Navin, S Rajasekaran, K Priya

A thyroglossal duct cyst is an embryological remnant which persists due to failure in the closure of thyroglossal duct. Worldwide the prevalence of thyroglossal cysts is about 7%. There is no sexual predominance seen. Normally at about 10th week of gestation the thyroglossal duct involutes, if there is any persistent duct remnant then this can lead to thyroglossal duct cyst formation. There is 1% chance of malignant transformation (papillary carcinoma). A 21-year-old female presented to the Ear, Nose and Throat Department with the complaint of swelling in front of the neck for the past one month. A 2×1.5 cm² swelling was observed in the anterior aspect of neck-infrahyoid region extending till thyroid notch. The swelling moved upwards with protrusion of the tongue and deglutition. Ultrasound neck revealed a complex cystic lesion in midline of neck of size 2×1×2.2 cm³ suggestive of thyroglossal cyst. Fine Needle Aspiration Cytology (FNAC) showed features suggestive of thyroglossal duct cyst. Patient was prepared for Sistrunk procedure. Intraoperatively multiple tracts of thyroglossal duct cyst were seen and the same were removed in toto. Patient was on regular follow-up postoperatively for a period of one year and no evidence of any recurrence was seen.

Xanthogranulomatous Pyelonephritis- A Diagnostic Dilemma

Krishnendu Maiti, Partha Pratim Sinha Roy, Dilip Kumar Pal

Xanthogranulomatous Pyelonephritis (XGPN) is a chronic inflammatory disease usually associated with renal stones, mimicking several malignant and benign pathology causing diagnostic dilemma. A rare case of XGPN of renal pelvis has been presented here. A 34-year-old female presented with left renal colicky pain, with gross haematuria without any palpable renal lump. Computed Tomography (CT) scan showed a 4.5×4.3×4.0 cm sized heterogeneous solid cystic non enhancing Space Occupying Lesion (SOL) in left renal pelvis. It was provisionally diagnosed as transitional cell carcinoma of left renal pelvis and patient underwent laparoscopic nephroureterectomy. Histopathology revealed it as XGPN. This highlights the fact that there are several overlaps of clinical and radiological findings of these entities making its diagnosis a challenging task.

Unilateral Optic Neuritis in Post COVID-19: A Case Report

Mustaq Ahmed, Siva Ranganathan Green, Lokesh Shanmugam

Optic Neuritis had been an unusual manifestation, reported in patients affected with Coronavirus disease-2019 (COVID-19). Here the authors report a case of 67-year-old male patient, who got manifested with optic neuritis as post COVID-19 sequelae. He was treated for COVID-19. Later on, after 21 days of treatment, he presented with blurring of vision and diplopia and was further evaluated and diagnosed as a case of optic neuritis with axial Time (T2) Magnetic Resonance Imaging (MRI) scan showing mild thickening and T2 hyperintensity of intracanalicular part of the optic nerve of the right eye. The patient was started on intravenous methylprednisolone followed by oral prednisolone. He had a good visual outcome. Post COVID-19, optic neuritis has become one of the possible neurological complications that may either present with unilateral or bilateral loss of vision. Hence, the clinicians should be aware of neuro-opthalmic involvement and treatment should be initiated promptly for improved outcomes.

Diplopia following Percutaneous Coronary Intervention- A Rare Case

Penta Bhavanadhar, PLVN Sairam

Acute neurologic complications are rare following cardiac catheterisation and lead to substantial morbidity and mortality. The most common abnormalities reported are seizures, visual disturbances, facial palsy, and hemiparesis, with a preponderance of anterior circulatory events among the localising deficits and intracranial bleeding. A 51-year-old male patient presented with symptom of precordial chest heaviness radiating to left upper arm associated with sweating since >24 hours. Electrocardiogram (ECG) showed QS complexes with ST-segment elevation for which the patient underwent coronary angioplasty. Later, the patient develops diplopia following successful coronary angioplasty and examination revealed isolated left partial oculomotor nerve palsy. Magnetic resonance imaging of brain showed acute infarct in the left superior pons in paramedian location and other vascular territories. The patient was managed conservatively, and symptoms improved at the time of discharge. On review of literature, there are very few case reports on the involvement of oculomotor nerve post cardiac catheterisation. Early diagnosis and management are vital for recovery.

Isolated Angiokeratoma of Oral Cavity: A Rare Case Report

Manpreet Arora, Aparna Dave, Pulin Saluja, Vijay Siwach

Angiokeratomas are rare benign mucocutaneous lesions that result from distension of subepidermal vessels, along with hyperkeratotic epidermis. Mucosal angiokeratomas are more commonly seen as a constituent of systemic variant called angiokeratoma corpus diffusum or may co-exist with similar lesion in the other sites of the body as seen in Fordyce’s or congenital forms. Solitary lesion in oral cavity is very infrequently seen and till date very few cases have been reported in literature. The biologic significance of angiokeratomas may vary greatly, which may range from lesions that have very little clinical repercussion to widespread eruptions that are a manifestation of potentially fatal, systemic, metabolic diseases therefore it is important that these lesions should be identified and evaluated to rule out underlying pathologic conditions. Hereby, authors reported a case of a 24-year-old male who presented with a unilateral swelling on dorsal tongue which gradually increased in size over 1.5 years with history of occasional bleeding and pain. It is common to see involvement of oral cavity in systemic variety but very rare in localized solitary form, therefore while considering the differential diagnosis of the swellings of tongue this entity should be taken into account.

Atypical Presentation of Gingival Cyst of Adult- A Case Report

Lesions of the gingiva are very common, and they vary in their clinical presentation and histological appearances. However, at times, the clinical features of these lesions appear to be similar and overlapping leading to a difficulty in diagnosis. Gingival Cyst of Adult (GCA) is a rare, abnormal, non inflammatory lesion in the oral cavity that arises mostly from the cell rests of the dental lamina. These lesions are usually solitary, sessile, painless, slow growing swelling usually involving the attached gingiva and interdental papilla and more frequently found in the canine and premolar region of the mandible. The GCA usually does not show any radiographic evidence of bone resorption. Histopathologic presentation significantly contributes to the diagnosis of the lesion. The present case report discusses about the GCA, involving the marginal gingiva and interdental papilla on the facial aspect of maxillary central incisors region in a 37-year-old female patient. Treatment plan included scaling, root planing, re-evaluation followed by surgical excision of the lesion. The lesion was sent for histopathological examination and a final diagnosis of GCA was made. Healing was uneventful without any complications. The patient was reviewed for nine months and no recurrence of the lesion was observed during the follow-up period.

Subgaleal Haematoma due to Vitamin K Deficiency in an Infant: A Case Report

Haemorrhagic Disease of the New Born by Vitamin K Deficiency Bleeding (VKDB), occurring shortly after birth and caused by deficiency of vitamin K dependent factors (factors II, VII, IX, and X) has been well documented. Subgaleal haemorrhage is an infrequent but fatal complication of childbirth, especially if accompanied by coagulation disorders. It can be due to many causes like traumatic birth, coagulation factors deficiency, vitamin K deficiency etc. The most common cause is traumatic birth. Authors hereby report a case of subgaleal haematoma in an eight-week-old female child secondary to vitamin K deficiency. The patient responded well following administration of parenteral vitamin K.

Gastric Perforation due to Candida Infection in Association with Prolonged Proton Pump Inhibitor Use: A Report of Two Cases

Amrita Neelakantan, Rakesh Rajiv Patkar, Shilpa Mishra

Fungus as a cause of gastric perforation is very rare. Very low pH of stomach usually does not support fungal growth. It is usually associated with immunocompromised state or is seen in debilitated patients like patients receiving steroid therapy, patients with Diabetes Mellitus (DM) and Human Immunodeficiency Virus (HIV) infection, patients undergoing transplant. Prolonged use of strong antacids can also be a predisposing factor for gastric fungal infection; although this theory is controversial, authors could find few studies which were similar to present study. Here, authors are reporting two cases of gastric perforation leading to peritonitis, in otherwise healthy individuals due to prolonged Proton Pump Inhibitors (PPIs) use, due to Candida infection, in the following case report. Both patients (48-year-old male and 65-year-old female) had history of chronic PPI use, had gastric perforation and underwent exploratory laparotomy. On histopathological examination of perforation edge biopsy yeast forms and few pseudohyphae of Candida species were identified. Postoperatively one of the patients survived with systemic antifungal, antibiotic therapy along with replacement of PPI with histamine H2 receptor blockers. The other patient could not survive and died postoperatively due to septicaemia. Fungal aetiology in gastric perforation should prompt further evaluation to look for underlying cause. This case report highlights the effects of unjust and over use of strong antacids for prolonged period.

Rheumatoid Neutrophilic Dermatitis as a Presenting Manifestation of Seronegative Rheumatoid Arthritis

Lakshman Meena, Danveer Bhadu

Rheumatoid Neutrophilic Dermatitis (RND) is rare type of skin manifestation in Rheumatoid Arthritis (RA) patients usually seen in long standing seropositive RA. It has very rarely been reported in seronegative RA patients. Here, a case of a young 24-year-old male with clinical features including skin rash over the body, non tender macular lesions on palms, forearms, legs, trunk and pain in joints has been reported. Clinical examination, skin biopsy, raised inflammatory markers and other investigations were suggestive of seronegative RA with neutrophilic dermatitis. The patient was successfully managed with steroids and conventional disease modifying drugs like hydroxychloroquine and methotrexate at three months follow-up period. Thus, RND may involve complications with progressive joint involvement in patients with seronegative RA.

Non Surgical Management of Class I Invasive Cervical Resorption and Anterior Aesthetic Rehabilitation: A Case Report with Two-Years Follow-Up

Girish Nanjannawar, Saquib Mulla, Divya Gupta, Sharad Kamat

Amongst all the types of external resorption, External Cervical Resorption (ECR) is the least understood. ECR usually encompasses the cervical region of the tooth and is located immediately below the epithelial attachment. The diagnosis and management of ECR defects is usually difficult. However, a comprehensive knowledge pertaining to the true nature and exact location of the defect helps achieve effective management and render appropriate treatment. Advancements in digital imaging like Cone Beam Computed Tomography (CBCT) have made possible, the diagnosis of pathological lesions like ECR with greater precision. Here we report a case of 21-years old male patient, treated with the successful retreatment of maxillary central incisor along with the non invasive management of ECR associated with the tooth. The patient presented with a history of spontaneous pain in respect to maxillary left central incisor and punched out radiolucent lesion was evident on the disto-cervical aspect radiographically. It also revealed an incomplete endodontic treatment. As the patient was not willing for any surgical intervention, conservative non surgical endodontic re-treatment was performed which involved long term calcium-hydroxide therapy. At two years follow-up, the patient remained asymptomatic demonstrating radiographic evidence of bone-like tissue filling the resorptive defect. The clinical implications of this paper aim at an appropriate diagnosis of the resorptive lesion using three dimensional (3D) imaging techniques and a conservative non surgical long term calcium-hydroxide therapy for the management of ECR. The endodontic treatment was further followed by aesthetic rehabilitation for the asymmetric smile correction using minimally invasive technique of EMax crowns.

Invasive Intracholecystic Papillary Neoplasm of Gall Bladder with Perforation: A Case Report

Primary Gall Bladder (GB) carcinoma ranks globally as the sixth most common malignancy of gastrointestinal cancers and most common malignancy of biliary tract. Intracystic Papillary Neoplasm of GB (ICPN) is a subtype carcinoma of Intraductal Papillary Carcinoma of Bile duct (IPCB) and grows submucosally. Here the authors report a rare case of 58-years-old male patient, who came with the complaints of acute sharp pain in right upper quadrant and intermittent bilious vomiting. On examination, patient had right upper quadrant tenderness. He was diagnosed with moderately differentiated invasive ICPN of GB presenting as acute abdomen with right hypochondrial pain mimicking acute cholecystitis. On imaging, there was presence of gallbladder wall thickening with pericholecystic fluid collection suggestive of GB perforation. The patient also had incidental finding of congenital non rotation of gut. Intraoperatively, there was polypoidal lesion in GB with perforation of GB. Histopathology was reported as invasive ICPN and to the best of our knowledge, invasive ICPN presenting as acute abdomen with GB perforation is not reported in the literature.

OEIS Complex: A Rare Case Report

Aaina Garg, Setu Rathod, Sunil Kumar Samal

The Omphalocele, Exstrophy, Imperforate anus and Spinal defects (OEIS) complex is a rare midline defect that consists of omphalocele, bladder exstrophy, imperforate anus, spinal and genital abnormalities. The presentation varies from case to case representing the most severe form of Exostrophy Epispadias Sequence (EES). Regular prenatal visits and investigations including ultrasound is needed to diagnose this anomaly, but in this case diagnosis was delayed due to irregular antenatal visits by the patient. The aetiology is thought to be multifactorial as was in the present case which was provisionally diagnosed prenatally at 19 weeks. The foetus had classic ultrasound findings of OEIS complex which were later confirmed post expulsion with gross and infantogram features. Advanced level of radiological expertise is required to prenatally diagnose a case of OEIS complex. Depending on severity, management of such cases ranges from termination of pregnancy in severe cases to survival with surgical corrections postnatally in milder forms.

Giant Splenic Artery Aneurysm as a Rare Sequelae of Chronic Pancreatitis

Nikhil Shellagi, Hirak Pahari

Splenic Artery Aneurysms (SAAs) is the third commonest intra-abdominal aneurysms, following abdominal aorta and iliac artery aneurysms. The SAAs can be either true aneuryms or pseudoaneurysms. SAA measuring >5 cm are generally described as giant. Herein, a case of giant SAA is presented. A 52-year-old male patient with history of alcohol related chronic pancreatitis for the past five years presented with abdominal pain and upper abdominal fullness. Computed Tomography (CT) abdomen was suggestive of giant splenic aneursymal mass. Surgical treatment was planned due to the large size and symptomatic nature of the aneurysm. Splenic artery aneurysmectomy with distal pancreatectomy with splenectomy was performed. The most important and critical complication of giant SAA is spontaneous rupture which has high mortality. Open abdominal surgical excision is still the gold standard for management of giant splenic artery aneuryms, despite recent advances in endovascular treatment options.

Sweet Syndrome Masquerading as Severe Infection: A Case Report

Binni Makkar, Umair Khan, Mary Torrez, Mary Seiler

Sweet Syndrome is an uncommon condition noted to occur worldwide, and it usually occurs in females aged between 30 to 50 years. Its exact prevalence is unknown. Hereby, authors report a case of 34-year-old female with a past medical history of Anti-Neutrophil Cytoplasm Antibody (ANCA) vasculitis, End Stage Renal Disease (ESRD) on haemodialysis and history of recent hospitalisation for sepsis secondary to multifocal pneumonia presented with fever and disseminated bullous rash. Patient was started on board spectrum antibiotics in view of Systemic Inflammatory Response Syndrome (SIRS) positivity. Subsequently, she underwent skin biopsy due to lack of improvement of symptoms on antibiotics. It showed dermal neutrophilic infiltrates suggestive of sweet syndrome. Patient was then started on high dose intravenous steroids with subsequent improvement of her symptoms. She was gradually transitioned to oral steroids and was discharged in a stable condition. Thus, Sweet syndrome is an uncommon condition which can easily be confused with other medical conditions like infection or vasculitis. Careful assessment and thorough work up including skin biopsy are vital in confirming the diagnosis.

Unilateral Bifid Ureter with Persistent Left Superior Vena Cava: A Cadaveric Case Report

Nidhi Lal, Samanwita Basak

This is a case report of unilateral bifid ureter with Double Superior Vena Cava (DSVC) which was observed during the routine dissection on a 60-year-old male cadaver. The finding is of interest due to the presence of urogenital and vascular anomalies. The case belonged to the category of incomplete double renal pelvis and ureter along with a Persistent Left Superior Vena Cava (PLSVC) with an enlarged coronary sinus and a normal Right Superior Vena Cava (RSVC). Incomplete double ureter with the angled point of junction of the two ureters creates a narrowing that can further obstruct normal flow, predisposing to uretero-ureteric reflux and associated complications such as hydronephrosis, as well as increases the possibility of ureteral injury during surgery. PLSVC is usually an insignificant finding, however, its presence makes it difficult for insertion of central venous catheter via left internal jugular vein and is important to surgeons and interventionalists.

Caesarean Scar Ectopic Pregnancy: A Case Successfully Managed using Systemic Methotrexate and Suction and Evacuation

Priyanka Parihar, Monika Gupta, Pallavi Kapoor, Preeti, Santosh Minhas

Caesarean Scar ectopic Pregnancy (CSP) is a rare type of ectopic pregnancy. But, its frequency has been increasing with increase in number of caesarean sections (C-section) performed worldwide. It is a form of ectopic pregnancy in which implantation occurs in the myometrium at the site of a previous caesarean scar. It can result in dreadful complications such as severe hemorrhage, uterine rupture and severe maternal morbidity. Thus, it becomes necessary to diagnose it at an early stage and also accurately to avoid complications and for preservation of future fertility. The recommendation is to therapeutically terminate the pregnancy at the time of diagnosis. Several types of conservative treatment modalities have been used: administration of methotrexate by local or systemic routes, dilatation and curettage, excising the trophoblastic tissue, ligation of hypogastric arteries bilaterally along with evacuation of trophoblastic tissue and selectively embolising the uterine artery followed by curettage with or without administration of Methotrexate (MTX). In this report, the author discusses a case of 38-year-old female patient of viable CSP which was managed successfully with combination of systemic MTX and subsequent suction and evacuation (S&E).

A Rare Presentation of Extraskeletal Osteosarcoma in the Arm

Rajeswari Thivya , Aarthi Kannan , K Priyadharshini Ganesh

Extraskeletal Osteosarcoma (ESOS) is a rare mesenchymal malignancy that commonly manifests in the fifth to seventh decade of life. It occurs frequently in the deep soft tissues of the lower extremities, in particular the thigh. These are aggressive tumours, showing local recurrence, and almost 90% show a distant metastasis in particular to the lung at the time of diagnosis, so it becomes crucial to diagnose these lesions at an early stage. Here, authors report a case of 56-year-old female, who presented with painless swelling of size 2×2 cm in the lateral aspect of the right arm. There was no history of prior trauma. On imaging studies, it was found to be a subcutaneous swelling with calcification and not attached to the nearby bone. Excision biopsy showed a malignant neoplastic lesion with osteoid surrounded by atypical cells with frequent mitosis, and with heterologous bone and cartilage formation. The diagnosis of ESOS was confirmed using special AT-rich sequence-Binding protein 2 (SAT-B2) immunohistochemistry. The case is presented here because of its rarity of occurrence in the arm, size and utilisation of SAT-B2 in confirming the diagnosis.

Anticipated Difficult Airway Management with Ambuscope in a Patient with Rhino-orbito-cerebral Mucormycosis

Michell Gulabani, Vibhor Gupta, Suman Choudhry, Ashok Kumar Saxena

Management of a difficult airway can be a nightmare for even an experienced anaesthesiologist. Video laryngoscopes have been mentioned in the difficult airway cart as a requisite equipment according to 2016 All India difficult airway guidelines. Ambuscope is a recently introduced flexible videoscope which is portable, light weight and single use device. This was a case of 25-year-old male who presented with loss of vision in both eyes and diffuse swelling of the face in the Ophthalmology Department. A diagnosis of post Coronavirus Disease-19 (COVID-19), Rhino-orbito-cerebral mucormycosis was made. Further patient was scheduled for emergency surgical debridement and bilateral orbital exentration under general anaesthesia. Airway assessment revealed mouth opening of one finger, Mallampati (MPG) score of 4, thyromental distance of 4.5 cm and a receding mandible with normal neck flexion and extension. Ambuscope™ 3 was employed for facilitating endotracheal intubation after anaesthesia induction. Ambuscope is a useful aid in confirming the position of endotracheal tubes and tracheostomy tubes in the operating room and intensive care unit. They are a disposable, convenient and practical alternative to fibreoptic bronchoscopes in patients of difficult airway. AmbuscopeTM 3 has tip movements with 150° up and 130° down. These unique features make this equipment user-friendly in anticipated and unanticipated difficult airway scenarios. Flexible endoscopes have carved a niche for themselves in the armamentarium of the anaesthesiologist airway cart to be equipped for any challenge.

Bilateral Basal Ganglia Haemorrhage in a COVID-19 Positive Patient- Rare and Unusual Imaging Findings

Lokesh Meena, Anuj Taparia, Bhavya Sharma, Rahul Dev, Swarnawa Tarafdar

Coronavirus Disease 2019 (COVID-19) is the most challenging problem for the world today. The disease is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), leading to high morbidity and mortality worldwide. Numerous pathways are involved in the neurological manifestation of the disease. The imaging findings are not limited to encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic stroke, and intracerebral haemorrhage. Bilateral basal ganglia haemorrhages as manifestations are exceedingly rare. A 42-year-old male normotensive patient with no co-morbidities presented to the hospital with left hemiparesis. Magnetic Resonance Imaging (MRI) brain revealed haemorrhagic lesions in bilateral basal ganglia. No associated abnormalities were found in vasculature of brain. Hereby, authors report this rare and unusual case of COVID-19 infected patient presenting as bilateral basal ganglia haemorrhage.

Innovative Clinical Technique of Space Maintenance using Customised Functional Space Maintainer: A Case Series

Space maintenance is of particular importance following the premature loss of deciduous molars to prevent development of malocclusion. The usage of fixed space maintainers is more common in clinical practice. Traditionally fixed unilateral space maintainers were advocated following the premature loss of primary molars but they have certain clinical disadvantages such as loss of arch length, improper eruption of permanent successors and primarily the loss of function of mastication which cannot be achieved with the available fixed unilateral space maintainers. The paper is about three cases with an interesting design of fixed functional space maintainers which might overcome the disadvantages in the existing strategies in space maintainers and space maintenance and restore the primary function of mastication. To incorporate functionality into the conventional space maintainers a stainless-steel crown or an acrylic tooth of customised adequate dimension is incorporated into the traditional design.

Post COVID-19 Mucormycosis in Immunocompromised Individuals with Uncontrolled Diabetes Mellitus: A Series of Seven Cases

An upsurge in the cases of severe opportunistic infections such as mucormycosis has been observed due to Coronavirus Disease 2019 (COVID-19), that is a viral infection caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Even though it was a rare opportunistic infection, the incidence of this disease seems to be increasing with the emergence of COVID19 infection worldwide. Individuals are vulnerable to this secondary infection due to uncontrolled diabetes, coronavirus disease infection therapy, immunosuppression, and pre-existing co-morbidities. This case series aimed to report how aggressive and fatal mucormycosis can be in diabetic and immunocompromised cases as well as the outcome of its treatment protocol. Authors hereby have reported seven individuals treated at our institute, who were affected by COVID-19 a few months back, were long-term diabetics and then, developed mucormycosis. Removal of all devitalised tissue was the treatment protocol author followed, along with antifungal therapy. All the cases were monitored using clinical evaluation and Computed Tomography (CT). Amongst the seven individuals, five survived uneventfully with no recurrence of the infection.

Soft Tissue Sarcomas with Enigmatic Clinical Presentation- Unveiled by Histomorphology and Immunohistochemical Picture

Sneha, Tushar Kanti Das, Sarbashis Hota, Sukanya Ghosh

Soft Tissue Sarcomas (STS) are aggressive neoplasms of dismal outcome, predominantly occurring in elderly age group. Synovial Sarcomas (SS) show preponderance in adolescents and poorly differentiated histological variants need exhaustive work up employing Immunohistochemistry (IHC) and molecular pathology. Pleomorphic liposarcomas have short preoperative period and hence necessitates early identification despite being rare. Rhabdomyosarcomas are often diagnostic with skeletal muscle differentiation on histology even in the absence of embryonic or alveolar pattern. However, while dealing with small blue round cell tumours of adolescents in the absence of any specific differentiation and pattern, molecular analysis including PAX-FOXO1 fusion, FUS-ETS fusion, EWSR1-non ETS fusion, CIC and BCOR fusion is of paramount importance. In this series, we have compiled a set of four cases with diversified histomorphology, presenting at extremely uncommon sites with varying clinicoradiological profiles yet biologically behaving aggressive almost to a similar extent necessitating adjuvant therapy. An intriguing case of biphasic SS in the axilla, an uncommon site was discussed where narrowing the differentials was an uphill task. Another case of monophasic SS at yet another uncommon site (inguinolabium) with overlapping histology warranted the need to rule out the other probabilities employing IHC. The next case of pleomorphic liposarcoma encountered here needs special mention owing to low incidence and labelling it with certanity required meticulous analysis including extensive sampling and IHC. Another interesting case of pleomorphic rhabdomyosarcoma with striking histology where role of IHC was only supplementary further reinforced the vital role of histopathological examination in the diagnostic work up of sarcomas.

Placenta Accreta Spectrum Disorders, a Formidable Challenge of Contemporary Obstetrics: A Case Series and Brief Review

Tajinder Kaur, Karishma Singh

The prevalence of Placenta Accretea Spectrum disorders (PAS) is rising as a result of increasing caesarean section rates. PAS is considered high risk because of severe maternal morbidity and mortality associated with it. A peripartum hysterectomy is required leading to loss of future fertility. The knowledge and awareness of clinical risk factors, associated with possibility of PAS, is essential for antenatal diagnosis and optimum planning to reduce maternal morbidity. The purpose of present case series was to evaluate the risk factors, the circumstances and modality of diagnosis, clinical course, mode of management, and clinical outcome in six cases of PAS identified at a tertiary care centre, over a period of 18 months from February 2019 to August 2020. All the patients had histological confirmation of PAS. The most common risk factors observed were previous caesarean in 5 (83.33%) cases, concomitant placenta previa in 5 (83.33%), multiparity in 5 (83.33%), and increased maternal age in 4 (66.66%) cases. Ultrasound imaging was the imaging modality of choice, but missed diagnosis in two cases. Obstetric haemorrhage was the most common complication observed in 5 (83.33%) of cases. The primary mode of management was caesarean delivery followed by hysterectomy. The initiatives such as, Trial Of Labour After Caesarean (TOLAC) and External Cephalic Version (ECV) in primi breech can help reduce caesarean rates, and thus incidence of PAS. A knowledge of high risk factors and antenatal imaging expertise can help in timely diagnosis of PAS. A good outcome is dependent on early antenatal diagnosis, preparation for delivery and postpartum care. The management should involve a multidisciplinary team.

Role of Multidetector Computed Tomography in Congenital Pulmonary Arterial Malformations: A Case Series

Congenital and developmental abnormalities of pulmonary vasculature encompass a wide-ranging spectrum of conditions, which exhibit myriad differences. Most of them present at birth; however, age of clinical presentation varies according to blood flow restriction and associated airway compromise. In this case series, we aim to describe embryological basis of development of pulmonary vasculature and normal anatomy. Authors intend to highlight case based imaging findings of pulmonary arterial congenital malformations both in isolation as well as in association with other congenital cardiac malformations referred at the rural tertiary healthcare hospital. Multidetector Computed Tomography (MDCT) scan not only proved to be an excellent non invasive modality in diagnosis of Pulmonary Artery (PA) malformations, associated cardiac and extra cardiac malformations, but is also an indispensable tool to provide adequate road map for intervention.

Employing Cribbed Wire to Increase Compliance of Face Mask Wear during COVID-19 Pandemic

Mohd Nazar Rana, Mushahid Hasan, Abhishek Singha Roy, Hiba Shahzad

To begin with, face masks were not designed to be worn round the clock, but in the aftermath of Coronavirus Disease-2019 (COVID-19) pandemic, duration of masks use has increased. However, conventional way of wearing of masks for such long period is giving rise to myriad of issues ranging from constant irritation to erythematous and painful changes at back of ear, thereby decreasing compliance and increasing risk of acquiring and spreading viruses. To enhance compliance with the Standard Operating Protocol (SOP), a simple technique of securing mask at back of the head with steel wire is being proposed to make it trouble-free, snug fit with less leakage of air. Enhanced comfort ensured by present technique discourages one from touching face, mask or ears inadvertently; thus offering better health protection.

Role of Diffusion-Weighted MRI in Imaging of Mucormycosis in Paranasal Sinuses

Rama Krishna Narra, Kaniti Sruthi

Dear Editor, Mucormycosis is a fatal angioinvasive fungal sinusitis. Predisposing factors include diabetes mellitus, immunodeficiency, corticosteroids, and immunosuppressive drugs, iron overload, haematological stem cell transplantation, and malignancies (1). It is caused by fungi of order mucorales which include mucor, rhizopus, and absidia species. A 61-year-old diabetic male patient was referred to Department of Radiodiagnosis, for a contrast-enhanced Magnetic Resonance Imaging (MRI) paranasal sinuses study. The patient had a history of Coronavirus Disease-2019 (COVID-19) 20 days back and was treated with methylprednisolone 1-2 mg/kg intravenous (i.v) in 2 divided doses and enoxaparin 0.5 mg/kg subcutaneously twice daily for 10 days. The patient presented with complaints of headache, postnasal drip, pain in the right orbit, and epistaxis with black eschar for the past one week. On diagnostic nasal endoscopy, deviated nasal septum to left with right inferior turbinate hypertrophy and black eschar was noted in the nasal cavity. MRI paranasal sinuses was performed in three orthogonal planes using T1 weighted, T2 weighted, Short Tau Inversion Recovery (STIR), Diffusion-Weighted Imaging (DWI) and postcontrast T1 fat sat sequences. Hypointense to isointense signal on T1 weighted and T2 weighted sequences, a hyperintense signal on STIR sequence noted in all paranasal sinuses. On DWI restriction (Table/Fig 1) and decreased Apparent Diffusion Coefficient (ADC) values (mean: was 0.495×10-3 mm2/s) (Table/Fig 2) were noted in bilateral sphenoid sinuses. On contrast, no enhancement was noted. Histopathological examination of transnasal sphenoid sinus biopsy showed broad, non-septate hyphae with irregular wide branching fungal elements (Table/Fig 3) and extensive inflammatory infiltrate, suggesting mucormycosis as the causating agent. Intracranial spread of mucormycosis is better depicted on contrast-enhanced T1-weighted imaging by showing meningeal enhancement, infarcts, abscesses. It is also useful for the identification of the cavernous portion of internal carotid artery invasion (2). Diffusion restriction is seen in intracranial extension and sinuses with decreased ADC values in case of sinonasal mucormycosis whereas bacterial sinusitis does not show any restriction on DWI unless associated with thick purulent secretions or complicated subperiosteal abscess. Diffusion restriction in mucormycosis cases may be due to ischemia and necrosis of tissue with debris and fungal elements itself which is resulting from the angioinvasive nature of fungal infection (3). The diagnosis of mucormycosis can be endorsed by aggressive clinical features of the immunocompromised host however it must be confirmed by histopathological examination of transnasal or cerebral biopsy (4).

Biosynthesis and Characterisation of Ellagic Acid Coupled Silver Nanoparticles- An In-vitro Study

A Shafie Ahamed, M Chittrarasu

Introduction: Nanomedicine dominated the world of therapeutics and diagnostics. Horizons are extending daily to identify a piece of the puzzle that helps us produce eco-friendly and costeffective nanoparticles. In this, authors tried to synthesise a novel Silver Nanoparticle Coated with Ellagic Acid (EA-AgNPs) obtained from pomegranate using a simple method and explore its characterisation precisely. Aim: To biosynthesise and assess the characterisation of Ellagic Acid coupled Silver Nanoparticles. Materials and Methods: The present in-vitro study assessed the portrayal of EA-AgNPs using various analytical techniques. Firstly, to analyse: the size of the EA-AgNPs using Ultraviolet (UV)- Visible Spectrometer; Secondly to determine the hydrodynamic size and its dispersity using Dynamic Light Scattering (DLS) and Zeta potential; thirdly to quantify the average size of EA-AgNPs by using Scanning Electron microscope (SEM); and lastly to identify the functional groups by using Fourier Transform Infrared Spectroscopy (FTIR) method. Descriptive statistics were used to analyse the results. Results: Brownish colour change and shift of peak wavelength from 430-423 nm using UV-Visible Spectrometer analysis confirmed the formation and stability of EA-AgNPs. The DLS analysis revealed that EA-AgNPs were in nanosize (129.7 nm) with less aggregated polydispersity index (0.483). The Zeta potential confirmed that this newly synthesised nanoparticle was negatively charged -0.268 mv. The SEM determination confirmed the formation of spherical-shaped nanoparticles with sizes ranging from 84.34- 98.80 nm. The FTIR revealed EA-AgNPs exhibited different functional groups, which help to prevent particle aggregation. Conclusion: In this work, the novel EA-AgNPs exhibited the apt characterisation needed for an effective and cost-efficient nanoparticle that could be effectively tapped in various fields of nanodentistry.

Metabolic Profile of Lean/Non Obese NAFLD (Non Alcoholic Fatty Liver Disease) Subjects

Akash Jaiswal, Kavita Jain, Nagendra Babu

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) in the absence of overweight and obesity has been defined as ‘lean NAFLD’. Metabolic syndrome associated diseases in low and middle income countries have variable phenotypes and clinical outcomes. Hypothetically, 'Lean NAFLD' can be a part of the spectrum of classical obesity related NAFLD or separate entity with different pathophysiology. Aim: 1) To characterise the NAFLD in lean/non obese subjects; 2) To explore how it differs from classical 'obese phenotype' of the NAFLD; 3) To explore how these lean/non obese subjects with NAFLD are different from healthy lean/non obese subjects in terms of metabolic profile. Materials and Methods: The present study was a crosssectional observational study conducted over a period of six months. Forty subjects were categorised into four groups (1. Lean NAFLD without Diabetes; 2. Lean NAFLD with Diabetes; 3. Obese NAFLD with Diabetes; 4. Lean healthy subjects). Clinical history, examination, anthropometry, biochemical data including insulin resistance by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were analysed. Results: Mean Body Mass Index (BMI), Fasting Blood Glucose (FBG) and HbA1c (Glycated haemoglobin) of group 2 and group 3 were significantly higher than that of group 1 and group 4 subjects (p<0.001). Mean HOMA-IR of the patients of group 2 and group 3 were significantly higher than that of group 1 and group 4 (p<0.001). No significant difference was seen in HOMAIR between patients of group 1 and group 4 (p>0.05) and also of group 2 and group 3 subjects (p>0.05). Conclusion: Lean NAFLD subjects have a different metabolic profile than overweight-obese patients with NAFLD, particularly in relation to diabetes. On the basis of all metabolic parameters and insulin resistance, authors propose a spectrum of insulin resistance 'Non obese Control - Non obese NAFLD without Diabetes Mellitus (DM) - Non obese NAFLD with DM - Obese NAFLD with DM'.

Impact of Educational Programme on Inhalational Device Usage Techniques among the Patients Suffering from Asthma

S Rajesh Kumar Jain

Introduction: Aerosol inhalation is a mode of drug administration used in the management of asthma. Improper inhaler device usage techniques can lead to suboptimal therapeautic effect. Patients are very often prescribed inhaler devices without proper instructions regarding the correct usage technique, as the provider themselves may not be aware of the same. Aim: To compare the techniques of inhalational devices usage before and after training the patients suffering from asthma. Materials and Methods: An institution-based, prospective study was conducted among asthmatics reporting to the Department of Pulmonary Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India, from March 2020 to September 2020. A total of 249 asthmatic patients who met diagnostic criteria recommended by Global Initiative for Asthma (GINA), who were on inhaler devices namely: pressurised Meter Dose Inhaler (pMDI), pMDI with spacer, Rotahaler®, and Revolizer®, and who consented to be part of the study were included in the present study. Each patient was advised to use the inhaler medication, during which the patient was observed, and the checklist was scored. Subsequently patients were educated regarding the correct, device specific usage technique with demonstration. After one month (posttraining visit), using the same checklist, each patient was reevaluated. For each correct step, the patient received a score of "one", whereas, each incorrect step, as well as "no-response" was valued as "zero". The sum of the scores for all the steps was calculated for each patient and each type of inhaler. The Microsoft Excel 2010 spreadsheet was used to enter the data. Descriptive statistics were represented using percentages, frequencies, graphs and in the form of tables. Mean difference was used to compare the scores before and after the training. A p-value<0.05 was considered statistically significant. The scores were categorised into "handling errors" and "inhalational errors", percentage of participants committing at least one error, handling and inhalational error was tabulated. Results: Prior to the training, none of the subjects using pMDI and pMDI with spacer were able to complete all the steps appropriately. Whereas 7.8% of patients (4/51) using Rotahaler®, 4.5% of patients (2/44) using Revolizer® were able to perform all the steps accurately. During post-training followup, 59.22% (61/103) and 39.22% (20/51) patients using pMDI and pMDI with spacer, respectively, were able to perform all the steps accurately. Whereas 50.98% (26/51) and 72.73% (32/44) patients using Rotahaler® and Revolizer®, respectively, were able to perform all the steps accurately. Conclusion: The majority of asthmatics erred while utilising the inhaler devices. Errors were committed both during handling and inhalational steps. When trained, the error percentage was reduced significantly

Association between Postpartum Depression and Premenstrual Dysphoric Disorder in Primigravida after Elective Caesarean Section: A Prospective Cohort Study

Introduction: The determinants of Postpartum Depression (PPD), such as Premenstrual Dysphoric Disorder (PMDD) are not properly focused specially in the developing countries like India. But, it may help in proper screening, early diagnosis and management of such cases with improved prognosis. Aim: To determine the association between PPD and PMDD in primigravida undergoing elective caesarean section. Materials and Methods: This prospective cohort study included 78 primigravida undergoing elective caesarean section conducted in a tertiary centre from February 2019 to January 2020. PPD was screened by Edinburgh Postnatal Depression Scale (EPDS) and the severity assessed by Beck's Depression Inventory (BDI) on day 7,14,42 postpartum. Primarily, the association of PPD with PMDD was assessed by Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The socio-demographic determinants of PPD were the secondary outcome measurement of this study. Unpaired Student's t-test and Chi-square test were used to determine the association. Numerical variables were analysed by Unpaired Student’s t-test and categorical variables were analysed by Chi-square test. Results: Total 78 primipara females undergoing elective caesarean section participated, out of which six females were lost to follow-up, hence 72 were the study subjects. Total 22 participants (30.55%) developed PPD. The prevalence of PMDD was n=26 (36.11%) in study population (81.81% in depression group, 16% in non depression group). So, a greater prevalence of PMDD was noted in patients with PPD (p-value <0.0001). In the present study, marital satisfaction, planned pregnancy and family without any history of psychiatric disorders were found to be associated with lower prevalence of PPD. Conclusion: This study with a small sample size gives a direction to assess the det

Prevalence of Meningitis in First Episode of Febrile Seizure in Children Aged between 6 to 18 Months: A Cross-sectional Study

Chirag Saluja, Ajay Kumar, Samannay Das

Introduction: Febrile Seizures (FS) are the most common type of childhood seizures, affecting 2-5% of children older than one month and most commonly from six months to 5-year-old. It is a major cause of paediatric admissions worldwide. In India, American Academy of Paediatrics (AAP) 2010 guidelines are followed for performing Lumbar Puncture (LP) in first episode of FS, despite the fact that epidemiological differences exist between the two countries. The present study has been done to find out whether AAP guidelines are applicable in India. Aim: To find out the prevalence and predictors of meningitis in first episode of FS in children aged 6-18 months. Materials and Methods: This was a cross-sectional study carried out in 200 children, aged between 6-18 months admitted with first episode of FS in Paediatric Ward of tertiary care hospital New Delhi, India, over a period of 18 months (May 2018 to December 2019). The LP was performed and blood, Cerebrospinal Fluid (CSF), clinical parameters were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The prevalence of meningitis in children aged 6-18 months presenting with first episode of FS was 16% (n=32). Bacterial Meningitis (BM) was seen in 3% (n=6) of cases. The independent predictors of meningitis were high Total Leucocyte Count (TLC) (>16500 cells/mm³ ) and positive C-Reactive Protein (CRP). Blood culture was positive in seven cases (three cases of Streptococcus pneumoniae, two MRSA, one each Klebsiella pneumoniae and Neisseria meningitidis). Most common type of cell seen was monocytes which was alone seen in 56.2% (n=18) of the meningitis cases. Conclusion: India should have its own guidelines for performing LP in cases of first episode of FS as the prevalence of meningitis in children with first episode of FS in India is more than in the USA, and immunisation coverage for Haemophilus and Pneumococcal Vaccine (PCV) is very less as compared to USA. Meningitis can be predicted in those with high TLC (16500 cells/ mm³ ) and CRP positive.

Restoration of Liver Function in Cases of Surgical Obstructive Jaundice after Biliary Decompression: A Longitudinal Study

Udybir Singh, Sumit Chakravarti, Atul Jain, Sarika Arora, Shyam Lal, PK Patnaik

Introduction: Surgical Obstructive Jaundice (SOJ) is caused by obstruction of bile duct with the resultant increase in serum bilirubin level with or without pruritus, biliary colic and cholangitis. Liver Function Tests (LFTs) can help the clinician in screening patients for presence of liver disease with probable cause, its severity with prognosis assessment and also monitor efficacy of therapy. Aim: To study the liver biochemical parameters with pattern and extent of restoration in cases of SOJ (benign and malignant), before and after biliary decompression, done either by definitive surgery or endoscopic procedure. Materials and Methods: This longitudinal study was carried out from October 2014 to May 2016 in 50 patients of obstructive jaundice at Employees State Insurance Post Graduate Institute of Medical Sciences and Research and Hospital, Basaidarapur, New Delhi, India. All patients with benign as well as malignant conditions leading to SOJ, who were amenable to endoscopic or surgical decompression were included and patients of medical jaundice were excluded. Clinical examination and blood investigations, {Liver Function Test (LFT)} were done preoperative, postoperative on day 3, day 7, day 14 and during follow-up at 4 week, 12 week. Collection of data was done from the patients included demographical data, presenting features, aetiology and therapeutic intervention carried out obstructive jaundice (endoscopic or surgical), the preoperative parameters and postprocedure parameters (LFT) in a sequential manner. Data analysis was carried out on Statistical Package for the Social Sciences (SPSS) version 22.0. The statistical significance of difference in values of various biochemical and clinical parameters over the study period was assessed by using one-way Analysis of Variance (ANOVA). The p-value of <0.05 was considered significant. Results: A total of 50 patients were included; of these 14 were males and 36 were females. Age of patients in the present study ranged between 25-80 years. Total 33 patients were of benign conditions (Group I) and 17 patients were of malignant conditions (Group II). Preoperative bilirubin levels were significantly higher (p-value <0.001) in each group. The mean percent fall in Aspartate Aminotransferase (AST) levels were similar in both the groups i.e., 29% vs 30% on day 3, 49% vs 45% on day 7 and 53% vs 49.5% on day 14, 70% vs 64.6% on 4th week and on 12th week 76% vs 73% in Group I and II. Conclusion: The hepatic recovery after biliary decompression either by definitive surgery or endoscopic procedure was identical for both benign and malignant causes. However, the level of preoperative levels of bilirubin determines the total time taken for recovery.

Seroprevalence of Hepatitis A among Medical Students of a Tertiary Care Centre in Kerala, Southern India

VS Sujatha, KA Jasmine, VK Sureshbaboo, PM Anitha

Introduction: Hepatitis A Virus (HAV) is a major cause of acute viral hepatitis caused by a Ribonucleic Acid (RNA) virus. The mode of transmission is fecal-oral route and the risk factors include unsafe water, poor personal hygiene and sanitation. Even though seroprevalence rate is high in low socio-economic regions, it is low in urban areas and the need of vaccination is looked for. Aim: To estimate the seroprevalence of hepatitis A in medical students of Southern India. Materials and Methods: The present study was a cross-sectional study conducted in the medical students of Government Medical College, Manjeri, Kerala, India. Blood samples of 377 students during the year 2015-2018 were taken. These students were in their 1st, 2nd, 3rd and 4th year MBBS course who admitted in the years 2018, 2017, 2016 and 2015, respectively. Commercially available Enzyme-Linked Immunoassay (ELISA) kits for anti HAV IgG antibodies were used. Chi-square test was used for statistical analysis. Results: Out of 377 participants 238 (63.2%) were females and 139 (36.8%) were males. A total of 51 (13.5%) were positive for IgG antibodies. A total of 43 were in 21-22 age group with a p-value >0.05. An association of seropositivity and seronegativity with frequency of dining out pattern was there with a p-value <0.05. Conclusion: The seroprevalence of hepatitis A was found in a declining stage hence, vaccination against hepatitis A should be included in the National Immunisation Schedule.

The Correlation between Foot Length and Birth Weight among Newborns

Natwar Lal Gaur, Prachi Saffar Aneja, Dipti Devi, Shavi Garg, Shilpi Garg

Introduction: The birth weight of a newborn is an important parameter which reflects the overall health of neonates, chances of future growth and survival. The large number of neonatal deaths, contributing to an average 64% of all neonatal deaths, mostly occurs in the starting 6-7 days of life. Most of neonatal deaths are due to Low Birth Weight (LBW). In small villages of our country the weighing facility may not be available for all home deliveries. Thus, a simple parameter like foot length may be considered in place of birth weight. Aim: To find out the correlation between foot length and birth weight so that the birth weight could be assessed by measuring foot length alone. Materials and Methods: The observational cross-sectional study was conducted in the KD Medical College Hospital and Research Centre, Mathura, Uttar Pradesh, India, between July 2018 to January 2020. Healthy 1082 full term newborns were included in the present study. All the measurements were recorded within 24 hours of birth. Sick newborns and newborns with congenital anomalies were excluded from this study. Birth weight was recorded by electronic weighing scale in fraction of kilograms (kg) and length of foot was measured in fraction of centimetre (cm). Correlation between foot lengths with birth weight were statistically analysed by Pearson’s Correlation Coefficient test and regression analysis. Results: Out of 1082 neonates, there were 558 (51.57%) males and 524 (48.43%) females. The newborn in group I (weight below 2.5 kg) had a mean foot length of 7.1357 cm. In group II (weight between 2.5-3.5 kg) the mean foot length was 7.7998 cm. In group III (weight more than 3.5 kg) the foot length was 8.2428 cm. The correlation coefficient between birth weight and foot length in group I and group II showed significant positive correlation (r=0.494, r=0.624). Conclusion: In the present study, foot length of neonates significantly correlated with their birth weight. Thus Foot Length parameter can be used in rural areas, by health care workers, for early and quick identification of LBW newborns.

Incidental Neuroradiological Findings with Magnetic Resonance Imaging of Brain and Spine: A Cross-sectional Study

Nida Heetawala, Renu Khamesra, Ravinder K Kundu

Introduction: Advanced radiological imaging technology allows detailed anatomical view for diagnosis of diseases. The prevalence of incidental Magnetic Resonance Imaging (MRI) findings is relatively higher. Aim: To identify and describe the Incidental Findings (IF) in patients undergoing MRI brain and spine at a tertiary care centre in Southern Rajasthan, India. Materials and Methods: The cross-sectional observational study was carried out for a period of 18 months on patients referred to the Department of Radiodiagnosis for MRI brain and spine at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, where report showed any incidental neuroradiological abnormality were included in the study. Patients were subjected to MRI machine (1.5 tesla SEIMENS-MAGNETOM Avanto OR 3 tesla GE SIGNA Architect) with T1-T2 weighted sequences. Incidental MRI findings with provisional diagnosis and clinical history were recorded and analysed for prevalence and proportion of IF (along with age and anatomical location specific IF). After entering data into Microsoft Excel 365, it was analysed for prevalence and proportion of IF (also categorised by age and anatomical location of IF among patients). All the data were in number or percentage. Results: Total 49 patients had IF with an overall prevalence of 0.82%. Male: female ratio was 1.04:1. Mean age of patients was 47.6±29.03 years. Majority 29 (59.18%) patients were in age group 31-60 years. Most common IF noted was meningioma 13 (26.5%) and 10 out of 13 meningioma patients belonged to 31-60 years age group. Other findings like glioma and pituitary macroadenoma were noted in 5 (10.2%) patients each. Total 22 (44.89%) patients had IF in supratentorial region of brain. Conclusion: Overall, low prevalence of IF was noted in the present study. Meningioma was one of the most common findings, especially among adults. Review of MRI scans by neuroradiologist, neurophysician and neurosurgeon for diagnosis of IF should be made mandatory

Impact of Oral Nutritional Supplement on Growth, Nutrient Intake and Frequency of Illness in Children aged 4-6 Years: A Randomised Controlled Study

Anuradha Khadilkar, Ashish Dhongade, Neha Agrawal

Introduction: Protein-Energy Malnutrition (PEM) and prevalence of under-weight children in India, is an important health concern. Aim: To evaluate the effect of Oral Nutritional Supplement (ONS) on growth, overall nutrient intake and frequency of illness in nutritionally at-risk Indian children. Materials and Methods: In this prospective, randomised, gender-stratified, controlled, parallel group, open label study, 216 children (aged 4-6 years with weight-for-age z-score between -2 and -1) were randomised (1:1) to receive either 45 g of ONS {Test product+Dietary advice (T+D)} or control group {Dietary advice only (D-only)} for three months. Primary endpoints included weight-for-age z-score and weight gain in terms of g/kg/day from baseline to three months. Secondary endpoints included change in height-for-age z-scores; frequency of illness, change in dietary nutrient intake and Protein/Energy (P/E) ratio from baseline through three months. Safety endpoint included Adverse Events (AEs). PROC MIXED was used to perform Repeated Measures Analysis Of Variance (RMANOVA) based on the changes in z-scores. The z-scores changes within the group from baseline to the end of three months End-ofStudy (EOS) were compared using paired t-test. Results: At baseline, the mean (SD) weight-for-age z-scores were similar in both the groups {1.50 (0.309) and -1.49 (0.312) in T+D and D-only groups, respectively}. At the EOS, only T+D group showed significant mean (SD) change from baseline in weight-for-age z-score compared to the D-only group {0.59 (0.296), p<0.001 vs. 0.04 (0.267), p=0.0974}. Mean rate of weight gain (g/kg/day) was significantly higher in T+D group vs. D-only group (1.12 vs. 0.26, p<0.0001). At baseline, height-for-age z-scores were similar in both the groups {-1.36 (0.668) vs -1.37 (0.638) in T+D and D-only groups, respectively}. At EOS, the mean (SD) change from baseline in height-for-age z-score was -0.02 (0.198), p=0.2389 in T+D group and -0.15 (0.171), p<0.001 in the D-only group. However, the change was not proportionate to weight-for-age z-score. Total absolute number of illness episodes was less in T+D group vs. D-only group (9 vs. 13). Improvement in dietary nutrient intake (carbohydrate, fat, protein and energy) and P/E ratio was significantly higher (p<0.001) in T+D group vs. D-only group. Overall, 8.3% children in T+D group experienced at least one treatment-emergent AE. Conclusion: The ONS helps to improve growth, nutrient intake and reduces frequency of illness in nutritionally at-risk children.

Effectiveness of Breathing Exercises as a Play-way Method after Nebulisation vs Conventional Nebulisation on Respiratory Parameters among Children with Lower Respiratory Tract Infection- A Pilot Study

Ankitha Kharvi, S Shanthi, Anju Saji

Introduction: Retained airway secretion is linked to a wide-range of respiratory illnesses. Breathing exercise plays a remarkable role in airway clearance and parenchyma expansion. Aim: To evaluate the effect of breathing exercises as a play-way method after nebulisation on respiratory parameters among Children with Lower Respiratory Tract Infection. Materials and Methods: The present study was aquasi-experimental pre-test and post test design conducted at AJ Institute of Medical Sciences, Mangaluru, Karnataka. This study selected 20 children admitted to the paediatric ward with a diagnosis of bronchitis, bronchiolitis and pneumonia from March 2020 to May 2021. The level of dyspnoea was assessed before nebulisation using a Paediatric Dyspnoea Scale (PDS). Respiratory rate per minute, oxygen saturation in percentage (%), chest expansion in centimeter (cm) and respiratory sounds were assessed after nebulisation. Interventional group was advised to blow the balloon after nebulisation for 15 minutes once a day for two days consecutively. Unpaired t-test and Analysis of Variance (ANOVA) were used to find significance in between changes of respiratory parametres in both groups and those of pre-test and post test within the group respectively. Results: In the total sample of 20 children, mean age of those in the intervention group (n=10) was 9.1±2.71 years while those in the control group (n=10) was 8.75±2.75 years. The birth order of the children was significantly dominant as second order (70%) in the control group while first order (80%) in the experimental group. Independent t-test showed that there was a statistically significant difference in the post test findings of respiratory rate (p-value=0.005), oxygen saturation (p-value=0.0004) and chest expansion (p-value=0.0006). Conclusion: The study concluded that regular practice of balloon blowing exercise improves oxygen saturation and chest expansion to a great extent in children with lower respiratory tract infection.

Effect of Maternal Anaemia on Different Macronutrients of Breast Milk in the Rural Population of India: An Observational Cross-sectional Study

Priyanka Rai, Girija Kumari, Kalpana Kumari

Introduction: Anaemia during pregnancy is a major public health problem throughout the world, particularly the developing countries. Maternal anaemia affects the major macronutrients contents of breast milk. Aim: To analyse the major nutrients and components of transitional milk in anaemic mothers and healthy non anaemic mothers. Materials and Methods: This was an observational crosssectional study conducted from January 2018 to June 2019 for a period of 18 months, included 180 lactating mothers who were divided into two groups: Anaemic {Haemoglobin (Hb) <11 gm/dL} and Non anaemic (Hb >11 gm/dL) based on their antenatal haemoglobin status. Anaemic group patients were further subdivided according to severity as recommended by the Indian Council of Medical Research. Breast milk samples (15-20 mL) were collected from postpartum patients on day 4 to 14. The sample was collected in the morning 1 hour after the previous breastfeeding and instilled into a milk analyser and compared the following major components (fat, lactose, protein) in both the groups. The data was coded in Microsoft excel sheet and was analysed by using Statistical Package for the Social Sciences (SPSS) version 24.0 software. Analysis of the component of transitional milk was done. Results: There were 90 cases in each group, with total 180 lactating mothers. The mean age of the anaemic group was 26.18±2.89 and non anaemic group was 26.03±3.43 (p-value= 0.792) were statistically similar. The mean parity of both the group (p-value=0.039) were significant. Study shows that anaemia grossly affects the protein and lactose content of the breast milk but there is no significant change in fat content. In severe anaemia, there was significant difference present in all the 3 components, fat, protein, and lactose (p-value=0.012, p-value=0.051, p-value=0.001 respectively). Conclusion: Maternal anaemia particularly of severe type adversely affects all the macronutrients of breast milk in terms of protein, fat, and lactose.

Prevalence of Extended Spectrum Beta-lactamase and Carbapenemase Producers in Gram Negative Bacteria causing Blood Stream Infection in Intensive Care Unit Patients

Introduction: Blood Stream Infections (BSI) in Intensive Care Unit (ICU) patients at initial stages are acute infections which might even become life threatening. In developing countries, increasing antimicrobial resistance and emergence of Extended Spectrum Beta-Lactamases (ESBL) and carbapenemase has also added an extra burden on physicians. Aim: To study the prevalence of emergence of ESBL and carbapenemase producing Gram Negative Bacteria (GNB) causing BSI in ICU patients. Materials and Methods: The present cross-sectional study was conducted on 1537 blood samples which were received in duration of two years from 2018 to 2020 in the Department of Microbiology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Haryana, India from various ICUs. A 5-7 mL of blood was aseptically added to BACTEC bottles and bottles after proper labeling were inserted into the machine and incubated upto five days. 0.1 mL of broth from positively flagged bottles was cultured on Blood and MacConkey Agar. These plates were incubated at 37° C for 24 hours and processed as per standard microbiological procedures. Data was entered locally and calculated on the Microsoft Excel database. Results: Among 1537 samples, 263 (17.11%) samples were flagged positive by BACTEC system. On culture out of 263 samples, 51 (19.40%) were Gram Positive Cocci (GPC), 21 (07.98%) were Candida spp. and 191 (72.62%) were GNB. Among 191 Gram negative isolates, Escherichia coli 64 (33.51%) was the predominant organism followed by Klebsiella spp. 60 (31.41%). For all gram negative isolates, meropenem was the most sensitive drug followed by imipenem. Tigecycline (81.25%) was the second most effective drug against Acinetobacter baumannii. ESBL detection was done by Combine Disc Test on 124 samples (Escherichia coli and Klebsiella spp.) which showed Klebsiella spp. 25 (20.16%) as the highest ESBL producing organism The rate of carbapenemase producer was 20 (10.45%) among all the gram negative isolates. Conclusion: For BSI in ICU patients, culture and sensitivity along with screening for prevalence of ESBL and carbapenemase producers should be done prior to starting antibiotics.

Correlation of Clinical, Endoscopic and Histopathological Activity in Ulcerative Colitis: A Cross-sectional Analysis

Reslin A Khader, Asiq N Sideeque, Janaky Ramakrishnan

Introduction: There are several scoring systems in use to determine the endoscopic, clinical and histopathological activity in Ulcerative Colitis (UC) which helps in defining the optimal management strategy. Aim: To understand the correlation between histological activity with simplified Geboes Score (GS), clinical activity with Truelove and Witts Score (TLWS) and endoscopic activity with Mayo Endoscopic Score (MES) in UC. The study also aimed at describing the common histopathological features of UC. Materials and Methods: A cross-sectional analysis was conducted at a tertiary care hospital in Southern India for 1.5 years (November 2014 to May 2016). Consecutive colonoscopy biopsies of patients who presented with lower gastrointestinal symptoms and endoscopic findings suggestive of UC were included. Baseline characteristics including age, gender, symptoms, clinical signs and extent of disease were recorded. Disease severity was graded using TLWS, MES using endoscopy and GS. Spearman’s correlations between the MES, GS and TLWS were calculated. Results: A total of 62 cases of clinically diagnosed UC patients were evaluated based on endoscopy and histopathology findings. The mean age was 44.7 years and 42 (67.74%) were males in the study. Proctosigmoiditis was the most common extent (32.25%), followed by cases of proctitis (25.80%), pancolitis (22.58%), and left sided colitis (14.51%). There was a strong correlation between MES/TLWS with a rho=0.614 (p<0.001), followed by MES/GS with rho=0.421 (p<0.001) and GS/MES with a rho=0.375 (p<0.01). Basal plasmacytosis was found in 92.86% of moderate to severe disease. Conclusion: The GS system strongly correlates with both MES and TWLS in patients with UC which could be used concurrently to determine the extent of healing and optimise treatment strategy. Findings of basal plasmacytosis, mucin depletion, dysplasia and pseudopolyps are associated with moderate to severe disease activity.

A Prospective Observational Study of Short-term Mortality Indicators in Acute Stroke Patients

Anugraha Durairaj, Hrishikesh Shivakumar, G Madhu, TN Diwakar

Introduction: Stroke is the second leading cause of death worldwide, causing 6.2 million deaths in 2011. There is a lack of uniform consensus regarding the predicting factors for mortality associated with stroke. Aim: To determine the various factors which influence the mortality in acute stroke. Materials and Methods: This was a prospective study conducted between November 2017 to February 2020 at the hospitals attached to Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. All the patients diagnosed with Cerebrovascular Accident (CVA) using neuroimaging of brain within 24 hours of a symptoms were enrolled and followed-up for 28 days. After obtaining informed consent, demographic, clinical, laboratory and radiological data was recorded. Patients were assessed using standardised data sheet containing different variables and treated appropriately for ischaemic and haemorrhagic stroke. Results: The study included 100 patients; 33 died during followup. The mean age of the patients was 55.35±15.78 years; there were 54 males and 46 females. Male gender (p-value <0.001), poor Glasgow Coma Scale (GCS) (p-value <0.001), severe neurodeficit (p-value <0.001), raised intracranial pressure (p-value <0.001) and complication like delayed recovery of GCS (p-value <0.001), aspiration pneumonia (p-value<0.001), Acute Kidney Injury (AKI) (p-value <0.001), fever (p-value <0.001), dysphagia (p-value <0.001), bedsore (p-value <0.001) and seizure (p-value <0.001) were the predictors of mortality in acute stroke. Conclusion: The factors like poor GCS, severe neurodeficit, raised intracranial pressure at the time presentation of patient and occurrence of complication like delayed recovery of GCS, aspiration pneumonia, AKI, fever, dysphagia, bedsore and seizure can be used as prognostic marker in acute stroke. Comprehensive neurological care wherever feasible involving neurologist, neurosurgeon, interventional radiologist, physiotherapist which take care of the immediate need and to prevent the long term complication would help to decrease mortality in acute stroke.

Role of Apo B and Apo A1 Levels in Relation to Conventional Lipid Profile in Patients of Ischaemic Heart Disease with or without Type II Diabetes Mellitus

Introduction: Ischaemic Heart Disease (IHD) or Coronary Artery Disease (CAD) is the most prevalent chronic disease and the main leading cause of death in the world, with more than half a million newly diagnosed IHD patients each year. Central to this are disorders of lipoprotein metabolism. Apolipoprotein B (Apo B) and Apolipoprotein A1 (Apo A1) are structural and functional components of lipoprotein particles that serve as transporters of cholesterol. Apo B and Apo A1 are among the emerging markers for Cardiovascular Diseases (CVD). Routine conventional lipid profile does not incorporate these markers. Aim: To determine the level of Apo A1 and Apo B in patients of IHD with or without Type II Diabetes Mellitus (T2DM) and analyse the significance of these parameters over the conventional lipid profile. Materials and Methods: The case-control study was conducted at Government Medical College, Bhavnagar, Gujarat, India from July 2013 to December 2013. The study consists of 100 participants including 50 having IHD only (Group I), 50 having IHD with T2DM (Group II) as study groups and 50 healthy individuals (Group III) as control. Various biochemical parameters including Apo B and Apo A1 were analysed and statistically evaluated to come to conclusion. Results: The demographic details of the participants which shows no significant different in age and gender among groups I, II and III. Apo B and A1 were elevated in group I and II and were found highly significant (p-value <0.0001) as compared to the group III. There was positive correlation of serum Apo B levels with total cholesterol (r=0.495, p-value <0.0001), Low-Density Lipoproteins (LDL-C) (r=0.526, p-value <0.0001) and Apo A1 (r=0.685, p-value <0.0001) in group I and LDL-C (r=0.468, p-value=0.001) and Apo A1 (r=0.754, p-value <0.0001) in group II. Similarly, Apo A1 levels were positively correlated with Apo B (r=0.685, p<0.0001) in group I and LDL-C (r=0.305, p-value=0.031) and Apo B (r=0.754, p-value <0.0001) in group II. Conclusion: As the Apo B and Apo A1 cover both atherogenic and antiatherogenic lipid parameters respectively, it can be used as a better predictor of development of IHD with and without T2DM in comparison to conventional parameters of lipid profile.

Melanocytic Lesions- A Hospital-based Descriptive Study from Central Kerala, India

Feby Thekkanath Francis, Mathew Chalissery Francis

Introduction: Malignant melanoma is a tumour of melanocytic origin. There is considerable geographic variation in the incidence of melanocytic lesions and are related to exposure to sunlight and susceptibility of the population. Descriptive and statistical studies of melanocytic lesions are few among Indian populations. Aim: To describe and categorise melanocytic lesions, analyse their histological features and form evidence based data applicable to Indian population. Materials and Methods: The present descriptive study was conducted in Department of Pathology in a tertiary care centre in central Kerala, India from August 2013 to July 2016. Total duration of the study was 36 months starting from 2013 August to 2016 July. Melanocytic lesions received in Pathology Department for the study period were analysed. Data including age, gender, signs and symptoms, anatomical site, clinical and gross photographs were analysed. For each case, gross and histopathological examination were done. In some cases histopathological study alone was not diagnostic, so Immunohistochemistry (IHC) including Human Melanoma Black (HBM)-45 and Melan-A were conducted to establish melanocytic differentiation. Final statistical analysis was done by frequency measurements and cross tabulation using Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: Total sample size was 57, among which 44 cases were from cutaneous sites (27 benign and 17 malignant) and 13 were from mucosal sites (2 benign and 11 malignant). Most of the cases were from above 60 years age group (35%). Anatomically, majority of cutaneous melanomas were from lower limb {15 (88.2%)} and majority of mucosal melanomas were from upper gastrointestinal tract {5 (38.4%)}. Although prominent nucleoli are said to be characteristic feature of melanomas, 8 out of the 28 total cases of melanomas had inconspicuous nucleoli (28.5%). When cell morphology of melanomas was studied, majority of cases had oval cells 10 (35.7%). It was also found that there was a significant correlation between spindle cell morphology and absence of pigment in melanomas (p-value=0.004). There was no association between mitosis in melanomas and vertical tumour diameter (p-value=0.1837). Conclusion: A female predominance was observed and the commonly effected age group was above 60 years. Intradermal nevi were the major benign melanocytic lesion, while the common site was lower limb among cutaneous melanomas and upper gastrointestinal tract among mucosal melanomas. A positive association between absence of pigment in malignant melanomas and predominance of spindle cells was found.

Outcome of COVID-19 in Patients Requiring Haemodialysis- A Retrospective Observational Study

Girish P Vakrani, Tanuja Nambakam

Introduction: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are risk factors for COVID-19 infection. Patients with kidney disease also have other co-morbidities like hypertension, diabetes mellitus, cardiovascular disease that are risk factors for poor outcome in COVID-19 infections. Severe COVID-19 has multiorgan involvement including AKI. Compared to normal population, renal failure patients with COVID-19 have extensive lung involvement, need more ventilator support, and have higher mortality. Aim: To assess outcome (mortality, recovery) and association between factors (age, gender, co-morbidities), biochemical parameters with mortality in COVID-19 patients requiring haemodialysis. Materials and Methods: It was a retrospective observational study wherein, data was collected, entered and analysed with Statistical Package for the Social Sciences (SPSS) version 19.0 using medical records of all COVID-19 patients who had renal failure (AKI or CKD) requiring haemodialysis. The study period was from June-September 2020 at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Results: Out of total 68 COVID-19 positive patients, mean age of presentation was 55.08 years and with 75% of the study population were males. Most patients presented with severe COVID-19 illness with tachypnoea and hypoxia. The AKI occurrence and mortality was noted in 44.1% and 47%, respectively. It was noted that medication usage was higher for corticosteroids, oseltamivir, vitamin C, zinc therapy. Conclusion: In the present single centre study involving COVID19 patients requiring haemodialysis, it was noticed that severe COVID-19 illness, presence of AKI, chronic respiratory illness and high inflammatory markers were associated with higher mortality.

Assessment of Incidence, Causes and Types of Removable Denture Fractures: A Cross-sectional Clinical Survey from Northern Karnataka, India

Introduction: Removable dentures are subjected to fracture due to many causes and reasons. Due to sudden fracture of denture, the individual’s social and mental well-being is affected. As Prosthodontists, we must investigate and solve the problems pertaining to removable dentures. Aim: To investigate the incidence, causes and types of removable denture fractures and to determine the association between different variables and fractured removable dentures. Materials and Methods: A cross-sectional clinical survey was carried out in Department of Prosthodontics in PMNM Dental College and Hospital, Bagalkot, North Karnataka, India. A total of 214 adult patients within the age group of 25-80 years were included in the study and assessed over a period from August 2018 to February 2020, by four clinicians with the help of questionnaire. Ten parameters namely gender, age of wearer, type of denture, Kennedy’s classification, age of denture, cause of fracture, type of fracture, number of previous fracture, retention and type of antagonist were evaluated. The participants responded to all the questions and the data obtained was organised in a tabular form and statistically analysed by Chi-square test. Results: Amongst a total of 214 adult patients (142 males and 72 females), the results showed that the incidence of removable denture fracture was seen higher in male patients (66.36%) than in female patients (33.64%). Age group greater than 60 years showed higher incidence 108 (50.47%) of denture fractures. The lower complete dentures were the most commonly fractured removable dentures 96 (44.86%). Acrylic denture base resin fracture was most frequent denture fracture type 144 (67.29%). Fractures for the first time were higher in number compared to previous 1, 2 or 3 fractures. Higher incidence of fracture was seen in poorly retained dentures 111 (51.87%) and in dentures with complete denture as antagonist 163 (76.17%). The variables like gender of wearer (p-value=0.001), age of wearer (p-value=0.014), age of denture (p-value=0.019), retention quality of denture (p-value=0.017) and type of antagonist (p-value=0.001) showed a statistically significant relation with denture fracture. Conclusion: Improvement in the processing techniques and type of resin used along with innovative methods of increasing the fracture toughness of removable dentures is of great importance to reduce the incidence of denture fracture.

Effect of Teaching Intervention on Cancer Facts to Reduce Cancer Social Stigma in Rural Adults-A Pilot Study

Rose Mary Mathew, Shambhavi, Sandra Maria Sibi

Introduction: Worldwide, cancer is the second major cause of death and is accountable for an approximately 9.6 million deaths in the year 2018. Cancer carries a stigma due to its link with death. This affects the health seeking behaviour of the cancer patients. Aim: To evaluate the effect of teaching intervention on cancer facts to reduce social stigma among rural adults. Materials and Methods: This quasi-experimental pretest posttest control group study was conducted from 5th January 2021 to 5th February 2021, in rural community at Mangalore, Karnataka, India. Hundred adults between 18-65 years of age were selected based on purposive sampling technique and randomly assigned to an experimental and control group. Data was collected using baseline proforma and self-designed cancer social stigma scale which is a 5-point rating scale, consisting of 20 statements. The total score of each participant was calculated and categorised as severe, moderate, mild and no social stigma. Individual teaching intervention was given on first day to the intervention group and post-test was conducted after seven days on both the groups. The data were analysed using the t-test and chisquare tests. Results: The total study population of 100 adults was divided into intervention group (mean age 33.34±4.46 years) and control group (mean age 36.22±4.07 years) of 50 subjects each. Before the teaching intervention, the mean and Standard Deviation (SD) of social stigma scores of intervention group and control group were 59.9±13.6 and 61.38±9.8, respectively. After the intervention, the score of the intervention group and control group were 30.62±4.5 and 61.44±10.8, respectively. Independent t-test showed that there was a significant difference in social stigma score between intervention group and control group after the intervention (p-value <0.05). Conclusion: Study findings revealed that teaching intervention on cancer fact is effective in reducing social stigma among general population. Since the prevalence of cancer is high, there is an immediate need to educate the rural population on prevention, myths and realities of cancer.

Non Invasive Methods versus Liver Biopsy for Making Therapeutic Decisions in Chronic Hepatitis B Patients with High HBV DNA Levels and Mildly Elevated Transaminases

Introduction: Staging of liver fibrosis is essential for making therapeutic decisions in patients with Chronic Hepatitis B (CHB) having raised Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) levels (>2000 IU/ml) and normal or mildly elevated Alanine Transaminase (ALT). Though the gold standard for assessment of liver fibrosis has been liver biopsy, many non invasive models have been developed to mitigate the risks associated with liver biopsy and overcome its limitations. Aim: To evaluate the non invasive models predictive of significant fibrosis in this selected subgroup of Chronic Hepatitis B patients. Materials and Methods: Fifty-six CHB patients were evaluated. This longitudinal observational study was conducted at Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University from February 2017 to July 2018 on 56 patients. Liver Stiffness Measurement (LSM), Aspartate Aminotransferase (AST)to Platelet Ratio Index (APRI), FIBROSIS-4 (FIB-4) and Gamma-Glutamyl Transpeptidase (GGT) to platelet ratio (GPR) were estimated. Liver fibrosis staging was done using Metavir score. Significant fibrosis corresponds to Metavir score F2-F4 and advanced fibrosis as more than F3.The performance of non invasive methods was assessed using Receiver Operating Characteristic (ROC) curves. Z -test was used to compare Area Under ROC Curves (AUROCs). Results: Twenty-one patients (37.5%) had significant fibrosis, out of which seven had F3-F4 fibrosis. Patients with F2-F4 fibrosis had higher age, Hepatitis B e antigen (HBeAg) positivity, HBV DNA, ALT, AST, GGT, LSM, APRI, FIB-4 and GPR values than patients with F0-F1 fibrosis. Metavir fibrosis stages positively correlated with LSM values (r=0.831, p<0.0001), APRI (r=0.338, p=0.011), FIB-4 (r=0.375, p=0.003) and GPR (r=0.36, p=0.012). To predict advanced fibrosis, the AUROC of LSM had higher AUROC than APRI (0.956 vs 0.755, p=0.01), FIB-4 (0.956vs 0.786, p=0.01) and was comparable to GPR (0.956 vs 0.895, p=0.2). Conclusion: Transient Elastography (TE) is a reliable non invasive test for the diagnosis of liver fibrosis. GPR is a new model which is comparable to APRI and FIB-4 but inferior to TE.

Towards Universal Health Coverage: Access to Maternal and Child Health Services in Hard-to-Reach Areas in a Community Development Block of a Health District, West Bengal, India

Introduction: It is well established that poor economic condition is an important contributor of barrier to accessibility. However, non financial barriers also constitute significant constraints to the equitable access of full range of health services included under national Universal Health Coverage (UHC) policies. Aim: To study the accessibility of Maternal and Child Health Services in remote and hard-to-reach areas towards UHC and also to identify and synthesise non financial access barriers to accessibility of Maternal and Child Health Services and to distinguish them from financial barriers. Materials and Methods: A retrospective, observational study was done using a mixed method approach in the Institute of Public health, Kalyani, Kolkata, West Bengal, India from December 2016 to May 2017. Quantitative analysis of Health Management Information System (HMIS) data along with qualitative study by Focused Group Discussion (FGD) and In-depth Interview (IDI) was performed. Two FGDs were conducted among antenatal mothers and Accredited Social Health Activist (ASHA) workers and IDI was conducted with female health supervisor of that block. The mothers who attended the Subcentre (SC) for checkup on a particular day were asked to participate, and 10 ASHA workers who had come to the rural hospital on that day for monthly meeting were chosen for another FGD, with the help of a structured questionnaire. Results: Quantitative analysis of HMIS reports revealed decreasing trend in utilisation of Maternal and Child Health Services. There were 3048 antenatal registrations in the year 2012-2013, whereas it was 2771 in the year 2016-2017. The number of institutional deliveries was 1166 in the year 2012-2013, whereas it was 471 in the year 2016 to 2017. The number of health service providers also decreased than that of the previous year. Number of skilled birth healthcare providers were 11 in the year 2012-2013, whereas it become reduced to zero in the year 2016-2017. The qualitative analysis showed financial and non financial barriers played role in service accessibility. Regarding the non financial barrier, poor communication due to inaccessible geography was the key player in accessibility. Conclusion: The lack of skilled human resources as well as the poor communication due to inaccessible geographical location is the most important reason behind the poor UHC in the block.

Comparison of King Vision Video Laryngoscope with Macintosh Laryngoscope in Patients Requiring Nasal Intubation for Oromaxillofacial Surgery-A Randomised Controlled Study

Ashish P Jain, Krupa P Patel, Chinar N Patel, Hetal A Parikh

Introduction: Anaesthesiologists are at constant risk of contracting Coronavirus Disease-2019 (COVID-19) disease. They are constantly conducting surgical procedures despite being surrounded by pandemic. Patients requiring Nasotracheal Intubation (NTI) for oromaxillofacial surgery expose anaesthesiologists to aerosol-risk. Video laryngoscope simplifies NTI with diminished aerosol exposure, decreased time and difficulty for intubation in patients undergoing oromaxillofacial surgery. Aim:This study was intended to compare the effectiveness of King Vision Video Laryngoscope (KVVL) and Macintosh laryngoscope in patients requiring NTI for oromaxillofacial procedures. Materials and Methods: This prospective randomised controlled study was conducted on total of 40 patients undergoing oromaxillofacial surgery under general anaesthesia with NTI in Parul Sevashram Hospital, Vadodara, India, from September 2020 to February 2021. Patients were randomly allocated into group KL and group ML of 20 patients each. Laryngoscopy in group KL was performed with KVVL (non channelled blade), while in group ML patients were intubated using Macintosh laryngoscope. Intubation time, Modified Nasointubation Difficulty Scale (MNIDS), haemodynamic parameters, and complications were noted. Student t-test and Chi-square test were used respectively for continuous and categorical variables. Results: There was no significant difference in the mean age, weight and gender between the groups KL and ML (p-value >0.05).The mean age of the group KL patients were 32.65 years and group ML was 33.95 years which was not statistically significant. Time required for passing tube from glottic opening to trachea (T3) was significantly less (13.5 seconds) in group KL than (17.4 seconds) in group ML (p-value <0.001). A total of 16 patients (80%) and 12 (60%) patients respectively, in group KL and group ML had MNIDS of 0. Increase in Heart Rate (HR) and Mean Arterial Pressure (MAP) was significantly higher in group ML than group KL. Also, a video laryngoscope increases the distance between the operator and airway and hence reduces aerosol exposure. Conclusion: Intubation time, assist manoeuvre, and change of head position were less in group KL than group ML. KVVL reduces distance between patient and anaesthesiologist. Video laryngoscopes reduce aerosol transmission better than macintosh laryngoscopes. Thus, the video laryngoscopes were found better than macintosh laryngoscopes.

Prevalence of Midline Diastema and Willingness for Treatment in Adults of Chennai: A Cross-sectional Study

J Logeswari, Shruthi Suresh, Salome Anbudaiyan, SG Rajhavee Shreeyha

Introduction: Dental midline diastema is a major aesthetic concern. The prevalence of midline diastema varies in different population groups and with age, gender and race. Aim: To determine the prevalence of midline diastema among 500 adult patients (18 to 35 years) in Chennai and their willingness to undergo treatment. Materials and Methods: A cross-sectional study was conducted from January 2018 to June 2018 at Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India. A total of 500 patients were clinically examined. Midline diastema, if present was measured intraorally using a divider and ruler by measuring the distance between the mesioincisal angles of the central incisors. The presence of potential factors leading to diastema and willingness to undergo treatment were assessed and recorded. The collected data was statistically analysed and Chi-square test was done to elucidate the association between proportionate variables. The p-value =0.001 was considered significant. Results: A total of 500 patients (339 females and 161 males) in the age group of 18-35 years (mean age 23.61±6.59 years) were included in this study. Out of 500 patients, 128 had midline diastema. Prevalence of midline diastema was higher in the maxilla (21.80%) than in mandible (9%). The most common aetiological factor was generalised spacing with deleterious habits for midline diastema in the maxilla (30.30%) and periodontitis for the mandible (44.44%). The 35 people were willing to undergo treatment (62.86% for the maxillary arch and 42.86% for the mandibular arch) of which 5 people chose cosmetic treatment over orthodontic treatment. Conclusion: The prevalence of maxillary midline diastema was high. The willingness to undergo treatment for maxillary diastema was greater due to aesthetic concern. The lack of knowledge and awareness among the patients regarding midline diastema and the availability of treatment often results in delayed diagnosis and necessary treatment.

Outcome of Oberlin II versus Intercostal Nerve to Musculocutaneous Nerve Transfer Procedure for Elbow Flexion in Adult Brachial Plexus Injury

Introduction: In the management of brachial plexus injury restoration of elbow flexion has been prioritised over shoulder abduction in pan plexus injury due to scarcity of suitable donor nerve for nerve transfer procedure. Literature has shown promising result in restoring elbow flexion both in upper type as well as pan plexus injury by early intervention. Aim: To assess the outcomes of Oberlin II and intercostal nerve to musculocutaneous nerve transfer procedures to restore elbow flexion, in upper type and pan plexus type adult brachial plexus injury respectively. Materials and Methods: A prospective cohort study was conducted from November 2015 to October 2018 at tertiary care hospital at Cuttack, Odisha, India. Oberlin II procedure in 20 cases of upper type and intercostal nerve to musculocutaneous nerve transfer procedure in 20 cases of pan plexus type adult brachial plexus injury to restore elbow flexion, were included. In both the groups elbow flexion was assessed by British Medical Research Council (MRC) motor grading scale. Statistical analysis was made using IBM Statistical Package for the Social Sciences (SPSS) version 21.0, Pearson’s Chi-square test was used for the data analysis and p-value <0.05 was considered as significant. Results: The study had a total of 40 cases with age range from 19 to 58 years with mean age of 31.78±11.07 years. Full range of elbow flexion against gravity i.e., M3 power was achieved in 17 out of 19 (89.5%) of cases in less than six months of denervation, seven out of eight (87.5%) of cases in six to nine months of denervation and five out of 13 (38.5%) of cases in more than nine to 12 months of denervation (p-value <0.006). In case of Oberlin II procedure full range of elbow flexion against gravity i.e., M3 power or more was achieved in 100% of cases, whereas in case of intercostal nerve transfer full range of elbow flexion against gravity i.e., M3 power only was achieved in 45% of cases and M0 power in 55% of cases (p-value <0.001). Conclusion: The study has concluded that in adult brachial plexus injury early intervention by Oberlin II nerve transfer procedures results in full range of elbow flexion against gravity i.e., M3 power or more was achieved in 100% of cases. In cases of pan plexus type injury full range of elbow flexion against gravity i.e., M3 power only was achieved in 45% of cases.

A Study of Diaphyseal Nutrient Artery Foramina of Dry Fibula in Human, done in a Government Medical College of Upper Assam, India

Malamoni Dutta, Mukul Sarma, Annie Doley

Introduction: The nutrient foramina is the external opening in each bone which has a particular position and number in its diaphysis. A thorough knowledge of the position, number, direction and variation of the nutrient foramina of fibula is very much important, as this is one of the most common bone used in bone grafts, vascularised bone microsurgery and mandibular reconstruction. Aim: To determine the position of nutrient artery foramina in fibula and also their size and direction. Materials and Methods: This was a descriptive cross-sectional study which was conducted in the Department of Anatomy, Assam Medical College, Dibrugarh, Assam, India, from MarchJune 2021. The study was conducted on 167 numbers of adult human cleaned and dried fibulae. The number, position, size and direction of nutrient foramina were recorded in a pretexted proforma. Foraminal Index (FI) was calculated and the range, mean and standard deviation of FI were determined. Results: In the present study, 167 bones were taken but only 159 showed nutrient foramina. Single dominant foramen was found in 92.5% (147/159) of bones. Secondary foramina were present in 7.5% (12/159) of bones. The FI was calculated. According to FI, maximum number of foramina was present on middle third of fibula (92.56%). In 7.44% of fibula the foramina were located in distal third of the bone. Conclusion: A thorough anatomical knowledge of the nutrient foramen is useful in planning the vascularised fibular graft. Hence the result of this study will provide detail data about the number, position and direction of nutrient artery foramina in fibula for successful outcome of various orthopaedic and plastic reconstructive surgeries.

Burkholderia cepacia from an Unidentified Organism to an Emerging Pathogen in a Tertiary Care Hospital- A Retrospective Study

Introduction: Burkholderia is an important opportunistic pathogen in hospitalised and immunocompromised patients. It is responsible for approximately 0.6% of all Ventilator Associated Pneumonia (VAP). Burkholderia cepacia (B. cepacia) is a resilient organism, capable of survival in environments devoid of significant nutritional resources. Authors have come across many cases of B.cepacia in hospital for the last six years. Aim: To know the prevalence and microbiological profile of Burkholderia infection in tertiary care hospital, Srinagar, India. Materials and Methods: The present retrospective study was carried out in the Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India, from January 2013 to October 2018. The records of all patients diagnosed with B.cepacia in Intensive Care Unit (ICU), wards, and Outpatient Department (OPD) were reviewed. Identification was done by Vitek 2. Descriptive analysis was done and data was presented as percentages. Results: The number of cases showed a steady rise from 2013 through 2016 and the peak number of cases occurred in the year 2016. Then, again the numbers started to decline. Surgical ICU was the most common location (n=490) where the cases were detected. Most of the isolates were sensitive to cotrimoxazole, ceftazidime, tigecycline and levofloxacin and moderately sensitive to minocycline and meropenem. Conclusion: Burkholderia is no longer restricted to patients with Cystic Fibrosis (CF) and can affect patients in ICU setting and that the mortality from the infection remains high in our part of the world. Further studies are needed to be carried out to address this issue.

Role of Apolipoprotein E Gene Variants in Cognitive Outcome of Patients after Moderate Degree Diffuse Brain Injuries

Momin Abdul Jaleel, Syeda Zubeda, Aditya Grandhi, Qurratulain Hasan

Introduction: Diffuse Brain Injury (DBI) has been shown to be the major form of the primary brain traumatic injury. Apolipoprotein E (APOE) is considered to be associated in the prognosis of DBI. Aim: To analyse change in cognitive outcome of moderate degree DBI patients and its association with APOE gene polymorphism. Materials and Methods: This prospective cohort study was conducted at the Department of Genetics and Molecular Medicine, Kamineni Hospitals, LB Nagar, Hyderabad, Telangana, India, from March 2018 to May 2019, in which 23 patients who had moderate DBI were included. Patients were genotyped for APOE polymorphism and intellectual function was assessed when the patient was being discharged using Mini Mental State Examination (MMSE) score and was repeated after three months. Wilcoxon Signed Rank Test was used to determine the change in MMSE score taken at the time of discharge and after three months in follow-up. Results: Of the total 23 patients, 19 (82.60) were males and 4 (17.40%) were females where the average age of subjects included was 41.59±17.64 years. E2/E3 APOE genotype was present in 16 (69.56%) subjects. The improvement of MMSE score at the end of three months following discharge showed that best recovery was in subjects with E2/E3, genotype with mean of 4.9±2.1, followed by E2/E2 i.e., 3.5±2.6. In order to evaluate the changes in MMSE score at the time of discharge and after three months due to the presence of APOE genotype E2/E3 a Wilcoxon Signed Rank Test was performed which revealed statistically significant positive change in MMSE score after three months, z=-3.512, p=0.00044, with a large effect size (r=0.620). Conclusion: This preliminary study indicated that APOE E2/ E3 individuals showed a better recovery after traumatic brain injuries based on MMSE scores. However, extended studies are needed to establish this which may also give more weightage for genotyping APOE as a prognostic marker.

Bupivacaine versus Ropivacaine for Postoperative Analgesia in Femorosciatic Blocks in Lower Limb Surgeries-A Randomised Clinical Trial

Introduction: Peripheral Nerve Blockade (PNB) is a wellaccepted component of comprehensive anaesthetic care. Ropivacaine is a newer local long acting anaesthetic agent. Despite the extensive use and relative safety of bupivacaine, ropivacaine has been developed as alternative agent to decrease the risk for cardiac and nervous system. Aim: To compare safety, efficacy and duration of postoperative analgesia between bupivacaine and ropivacaine in femorosciatic blocks. Materials and Methods: This randomised clinical study was conducted, from August 2017 to April 2018, at HBT Medical College and Dr R.N.Cooper, Municipal General Hospital, Mumbai, Maharashtra, India. Total of 78 patients scheduled to undergo elective knee and below knee orthopaedic surgeries under subarachnoid block were divided into two groups- group A, patients received 25 mL of 0.25% injection bupivacaine for femoral nerve block and sciatic nerve block each and in group B, patients received 25 mL of 0.25% Inj. ropivacaine for femoral nerve block and sciatic nerve block each. After giving femorosciatic block, Sub-Arachnoid Block (SAB) was given to all patients. The primary and secondary outcome variables were duration of analgesia and time of rescue analgesia, Visual Analogue Scale (VAS) score, patient satisfaction score, surgeon satisfaction score, respectively. Continuous variables were analysed by unpaired t-test. The ordinal data was analysed using Mann-Whitney U test. Categorical data was analysed using chisquare test. Results: Demographic and haemodynamic parameters were statistically not significant. Time to the first rescue analgesia in group A was 718.2 minutes and in group B time was 652.1 minutes which was statistically significant (p-value=0.001). There was no statistically significant difference in VAS score at each time interval postoperatively. Both the drugs provided effective postoperative pain relief. All surgeons and patients were in agreement with analgesia, as evidenced by good patient satisfaction score. Mean surgeon satisfaction score was 7 in each groups. Conclusion: Bupivacaine provides longer duration of postoperative analgesia than ropivacaine. Both bupivacaine and ropivacaine achieved comparable quality of analgesia. Ropivacaine being a more cardiostable drug can be effectively used as an alternative to bupivacaine for femorosciatic nerve block in several clinical situations.

Relationship between Emotional Maturity and Perceived Stress Regarding Life among Nursing Students: A Cross-sectional Study

Preeval Josna Saldanha, Patsey Sera Castelino, Mini Poulose

Introduction: Nursing students experience high levels of perceived stress as they interact with a wide variety of individuals including colleagues, clients and families in a high stress environment. The ability to cope with stress inducing stimuli and manage emotions is referred to as emotional maturity. An emotionally mature person has full control over the expression of his feelings. Data on the correlates of emotional maturity and perceived stress among nursing students remains limited hence there was the need of this study. Aim: To study the correlation between emotional maturity and perceived stress regarding life among nursing students. Materials and Methods: The present study was a crosssectional study carried out in April 2021. Data were collected from 205 first year Bachelor of Science (B.Sc) nursing students selected purposively from Athena, Yenepoya, Dr MV Shetty and Laxmi Memorial College of Nursing, Mangalore, Karnataka, India. A predesigned, semi structured proforma was used to collect demographic details from the participants. Emotional maturity scale was used to assess their emotional maturity and perceived stress scale developed by Cohen was used to assess their perceived stress. Data were analysed by Statistical Package for the Social Sciences (SPSS) version 21.0. Data was analysed using descriptive and inferential statistics. Karl Pearson correlation coefficient was used to find the correlation between the variables. Results: Majority of the students were in the age group of 17-19 years (96.1%). The ratio of males to female was 1:11.8. Majority (87.3%) of the participants had experienced moderate perceived stress. Mean scores of emotional maturity were 19.13 (±4.287) and that of perceived stress scores were 102.902 (±25.93). Emotional maturity positively correlated to perceived stress of nursing students (r=0.275, p<0.05). Significant association was found between emotional maturity and perceived stress of nursing students with their place of residence. Conclusion: Emotional maturity was found to be correlated with perceived stress of nursing students.

Clinical Evaluation of the Peak Expiratory Flow Rate in Patients with Chronic Low Back Pain: A Cross-sectional Study

Introduction: Stabilisation of the spine is done by the abdominal and extensor muscles of the back. In chronic Low Back Pain (cLBP) patients, atrophy of these muscles lead to neuromuscular weakness and this may result in instability of the spine. Spinal instability and ineffective forced expiration due to weak contraction of the muscles may reduce the pulmonary function. Aim: To find the alteration of Peak Expiratory Flow Rate (PEFR) in patients with cLBP and the factors responsible for it. Materials and Methods: The cross-sectional study done in Maharashtra Institute of Physiotherapy, Latur, Maharashtra, India, from June 2019 to January 2020. Hundred patients with cLBP were recruited. Age, gender, weight, height and duration of the symptoms were recorded for demographic values. The PEFR was measured by Mini-Wright peak flow meter. Highest value of the three repetitions was documented for analysis. Statistical Package for the Social Sciences (SPSS) version 20.0 version was used to calculate the Pearson’s correlation between the variables. Results: Mean age of the participants were 37.31 years, and there were 50 males. Correlation coefficient between the patient value and their expected value of PEFR was 0.906 (p-value <0.01). Calculated t-value of 52.0733 (p-value <0.0001) showed a statistically significant reduction of PEFR value in cLBP patients in comparison to their expected PEFR value, calculated by the machine based on the age, height and weight of the individual person. Conclusion: It was found that the reduction in PEFR among cLBP patients is due to core muscle weakness, instability of the spine, pain and kinesiophobia. Thus, clinicians should design their treatment to include the exercise to increase the PEFR in the management of cLBP.

Prevalence and Antibiotic Susceptibility Patterns of Mycoplasma hominis and Ureaplasma urealyticum in Females with Genital Infections from Central Kerala, India

Sneha Rajan, Suryakala R Nair

Introduction: Genital mycoplasmas namely Mycoplasma Hominis and Ureaplasma Urealyticum are sexually transmitted disease pathogens which are associated with genital infections, infertility, obstetric and neonatal complications. The pathogenesis, prevalence, epidemiology and antibiotic resistance of genital mycoplasmas in Indian women have been studied very minimally. Aim: To determine the prevalence and antibiotic susceptibility pattern of M.hominis and U.urealyticum among females presenting with genital tract infections Materials and Methods: The hospital-based descriptive cross-sectional study was carried out among 120 females of reproductive age group (15-49 years) attending Outpatient Department of Obstetrics and Gynaecology of a tertiary care centre in central Kerala, India, from January 2018 to December 2018. Endocervical/vaginal/urethral samples were collected depending on the clinical presentation. Detection, quantitation and antibiotic sensitivity pattern of M.hominis and U.urealyticum were performed using Mycoplasma IST 2 Kit. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 11.5 and statistical association was analysed using Chi-square test. Results: The prevalence of genital mycoplasmas was 25.83%. U.urealyticum infection was present in 20 (20.8%) and M.hominis infection was present in 12 (10%) of the patients. Age group of 26-35 years was commonly affected. All isolates showed high susceptibility rates to doxycycline, josamycin and pristinamycin. Intermediate to high resistance was noted to commonly prescribed macrolides and quinolones. Conclusion: Genital mycoplasmas are prevalent in one-fourth of the study population with U.urealyticum infections being more common than M.hominis infections. The increased resistance rates to quinolones and macrolides warrants the need for routine screening and antibiotic susceptibility testing of these pathogens.

Identification of Predominant Learning Approaches in Medical Students using ASSIST in An Indian Medical School: A Cross-sectional Survey

Anuradha S Joshi, Jaikumar B Contractor, Jaishree D Ganjiwale, Mehrie H Patel

Introduction: Approaches to study and learning may either improve or attenuate educational outcomes. Medical educators, therefore need to monitor the various approaches adopted by students in pursuit of their learning. This can be achieved using Approaches to Study and Skills Inventory for Students (ASSIST). Aim: To find predominant learning approach amongst medical students in a western Indian medical school. Materials and Methods: A cross-sectional observational study was conducted at second year MBBS students in September 2015, at the private medical college of Pramukhswami Medical College, Gujarat, India for documenting details about their understanding about learning and its concepts, different learning approaches and preferences for different types of courses and teachings adopted by students in their daily academic routine. Descriptive analysis was carried out finding frequency (n) and percentages (%) and Independent sample t-test was applied to compare the scores of quantitative data between the sub groups. Analysis was done using the software Statistics and Data Science (STATA) version 14.2. Results: Out of 100 students, 75 participated (38 females and 37 males). Results displayed the frequency scores of ASSIST and its three sections. Under first section i.e., "what is learning" and "what are concept", there was no significant difference (p-value >0.05) in mean (Standard Deviation) scores. While in second section on "Approaches of learning" maximum students used Strategic Approach (SA) (79.82±8.97), followed by Deep Approach (DA) (64.39±6.01) and then surface approach (50.10±9.87). There was a positive correlation between deep and strategic learning approach (r=+0.44) whereas deep and surface approach showed negative relation (r=-0.23). In addition, surface approach had negative relation with SA (r=-0.21). In regards to the preferences for different types of course and teaching, there was no significant difference (p>0.05). Conclusion: Knowledge of student's 'approaches to learning', 'conceptions of learning' and 'preference towards different types of teaching styles can help optimise the quality of student learning, as well can support teaching and assessment methods used by educators.

Clinical and Epidemiological Profile of Children with COVID-19 in a Tertiary Care Centre in Tamil Nadu, India

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, leading to Corona Virus Disease-2019 (COVID-19) has been a recent pandemic and has spread all over India. Many children with SARS-CoV-2 infection were referred to our tertiary care centre from April 2020 to till date. COVID-19 has been an extremely severe infectious disease. However, very few studies have focused on the epidemiological characteristics of this disease in children. Aim: To identify the clinical and epidemiological profile of children with COVID-19 in a tertiary care centre in South India. Materials and Methods: During the recent pandemic of COVID-19, in Chengalpattu district, Tamil Nadu, this crosssectional study was done in children with SARS-CoV-2 infection, from March 2020 to June 2021 at Paediatric Department, Chengalpattu Medical College Hospital, Tamil Nadu, India. A total of 191 children who were tested positive for SARS-CoV-2 were admitted to the isolation ward of our Institution, as per the Indian Council of Medical Research (ICMR) guidelines and was monitored till discharge or death. The clinical features including fever, cough, diarrhoea, respiratory distress were noted with mean duration of symptoms. Laboratory parameters like leucocytosis/leucopenia, thrombocytosis/thrombocytopenia, C-Reactive protein (CRP), D-dimer (D fragments of protein fibrin) and serum ferritin were noted. Results: Among the total study population of 191 children, 108 (56.54%) children were of age group between five years to 12 years. Majority of children, 136 (71.2%), were asymptomatic and the disease has more incidence in boys than girls {104 (54.45%) vs 87 (45.55%)}. Eight (4.19%) children had co-morbid illness. A total of 166 (86.91%) children were infected with SARS-CoV-2 during first wave and 25 (13.09%) children were infected during second wave. Among the study population of 55 (28.8%) symptomatic children, fever was the predominant symptom in 27 (14.14%) children followed by fever with cough in 10 (5.23%) children. Mean duration of symptoms were 4.5±1.3 days. The CRP was elevated in 13 (6.80%) of children. Out of 11 (5.79%) children who required oxygen and ventilator support, 6 (3.14%) required only oxygen. Three children had features suggestive of Multisystem Inflammatory Syndrome in Children (MIS-C) of which one child died. Conclusion: In the present study, most of the children were asymptomatic. The prevalence of symptomatic COVID-19 was low in children. The incidence of severe COVID-19 infection in this study was very low. The most severe form of the disease was MIS-C. Mortality is low in the present study group and it occurs in patients with underlying disease or morbid obesity.

Knowledge about Danger Signs in Neonates and Health Seeking Behaviour amongst Mothers Attending Tertiary Healthcare Centre in Punjab, India

Introduction: The early identification of neonatal illness is critical for improving infant survival rates. Neonates are less likely to exhibit overt symptoms of sickness. The only signs of illness are often listlessness or non acceptance of feeds, and the illness can progress rapidly. There is a lack of data on mothers' knowledge of Neonatal Danger Signs (NDS). Aim: To evaluate mother's awareness of NDS and health seeking behaviour. Materials and Methods: An Institution-based descriptive crosssectional study was performed in Punjab Institute of Medical Sciences, Jalandhar, Punjab, India, from 31st January 2020 to 31st March 2020. A total of 550 mothers attending the Outpatient Department (OPD) with their infants for immunisation were included in the study. Awareness of more than three NDS was considered as good knowledge, 1-2 NDS as poor knowledge and zero awareness was categorised as absent. Data was collected using a questionnaire and statistically analysed using Chi-square test. Results: A total of 550 mothers were included in the study. The mean age of study participants was 26.5 years. A 273 (49.6%) had good knowledge of NDS. A 68 (12.4%) had zero knowledge and 209 (38%) had poor knowledge. Education status of the mother (p-value <0.01), Institutional delivery (p-value=0.023) and adequate antenatal visit (p-value=0.026) were important determinants of mother's knowledge of possible danger signs in their newborn. Development of danger signs in neonates was observed to be associated with 24.3% mothers having poor knowledge as compared to 42.3% mothers with good knowledge. Conclusion: With less than 50% of mothers having a good knowledge of NDS healthcare workers have a lot of scope for educating and counselling the mothers, thereby, enabling them to recognise the early signs of illness in their newborn and ensuring timely presentation to healthcare facility and early clinical intervention.

The Rising Threat of Drug Resistant Pseudomonas aeruginosa- A Nightmare for Intensive Care Unit Patients

Shivendra Dutt Shukla, Geeta Gupta, Razia Khatoon, Ritu Jain, Ankita Gupta

Introduction: Multidrug Resistant (MDR), Extensively Drug Resistant (XDR) and Pan Drug Resistant (PDR) variants manifest a high level of intrinsic resistance to antimicrobial drugs by the help of efflux pump, biofilm formation and aminoglycoside modifying enzymes. The potentiality of Pseudomonas spp. to produce variety of drug resistance mechanism has led to evolution of drug resistant phenotypes this poses a challenge for clinicians in the treatment of severe infection among Intensive Care Unit (ICU) patients. Aim: To determine the phenotypic profiling of β-lactamases and burden of MDR, XDR and PDR Pseudomonas aeruginosa (P. aeruginosa) in ICU patients. Materials and Methods: The present cross-sectional prospective study was carried in the Department of Microbiology, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, after permission from Institutional Ethics Committee (IEC). A total of 115 isolates of P. aeruginosa were isolated from 502 human clinical samples from January 2019 to February 2021 and all the clinical samples were non duplicate. Antimicrobial Susceptibility Testing (AST) was performed for all isolates by standard KirbyBauer disc diffusion method on Mueller Hinton Agar (MHA). Phenotypic profiling of Extended Spectrum β-Lactamase (ESBL), Metallo β-Lactamase (MBL) and Ampicillinase C (AmpC) was performed by disc potentiation test; Imipenemase (IMP) - Ethylenediamine Tetraacetic Acid (EDTA) combined disc test and Cefoxitin Cloxacillin Double Disc Synergy Test (CC-DDST), respectively. The obtained results were statistically analysed in numbers and percentages using MS Excel 2013 version. Results: Out of 502 total human clinical samples, 115 isolates were P. aeruginosa giving the prevalence rate of 23%. Among 115 Pseudomonas isolates, 60 (52%) were MDR phenotypes, 8 (7%) were XDR phenotypes and there was no PDR phenotypes isolated in present study as all isolates were sensitive to Ticarcillin/Clavulanic acid, Colistin and Polymyxin B. Out of 115 isolates, 59 (51%) were ESBL producers, 26 (23%) were MBL producers, and 6 (5%) were AmpC producers. Conclusion: Strict antibiotic policies and regular surveillance programme of antimicrobial resistance must be tailored to fend off the emergence of drug resistant Pseudomonas aeruginosa.

Disease Activity in Untreated Patients of Rheumatoid Arthritis in Eastern India

Anirban Ghosh, Rimi Som Sengupta, Mriganka Baruah
Introduction: Rheumatoid Arthritis is a common chronic inflammatory disease, causing joint pain damage and disability. Assessment of disease activity is an important step in optimal management of these patients. Aim: To describe the disease activity in untreated Indian patients with rheumatoid arthritis. Materials and Methods: A cross-sectional observational study was done on 86 consecutive patients attending Medicine Outpatient Department (OPD) of a tertiary care hospital in eastern India and were with definite rheumatoid arthritis as per 2010 classification criteria who never received any Disease Modifying Anti Rheumatic Drugs (DMARDs) or steroids. Tender and swollen joint count out of 28 joints was measured along with Erythrocyte Sedimentation Rate (ESR) and patient’s assessment of his/her global health on a Visual Analogue Scale (VAS). Disease Activity Score (DAS) for 28 joints with ESR value (DAS28-ESR) was calculated for each patient by medical calculator app based on these variables and then patients were classified into having high, moderate or Low Disease Activity (LDA) based on the DAS28-ESR values. Results: The ratio of female: male patients were 3.5:1. The average age of the patients was 38.17 years. The mean DAS28-ESR value was 6.19 and majority of the patients (81%) were in the High Disease Activity (HDA) group. The patient reported global health assessment which was also very high (mean 64.12/100 mm). Conclusion: Most of the untreated rheumatoid arthritis patients in our community are in a HDA group and presents with significantly higher amount of pain and disabilities. This finding underlines the need to improve the screening of arthritis in our community to reduce the number of patients who would present to health facilities with advanced disease having irreversible deformities resulting in disabilities. This would result in early increase in the number of pain free days for the patient and also reduce the overall cost of therapy.

Comparison of Intravenous Ondansetron, Ramosetron and Palonosetron for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy: A RCT
Introduction: Postoperative Nausea and Vomiting (PONV) poses a major problem in anaesthetic practice and is associated with various untoward consequences. The 5-hydroxytryptamine Type 3 (5-HT3) receptor antagonists such as ondansetron, ramosetron have been studied and found effective in prevention of PONV. Palonosetron is a newer antiemetic extensively used in chemotherapy patients for prevention of nausea and vomiting. Aim: To compare the incidence and severity of PONV, when ondansetron, ramosetron and palonosetron were administered as prophylactic antiemetics in gynaecological surgeries. Materials and Methods: This was a randomised double blind study conducted on 90 women undergoing total abdominal hysterectomy under general anaesthesia. Patients were randomly assigned to three groups to receive intravenously, either ondansetron 8 mg (Group O) or ramosetron 0.3 mg (Group R) or palonosetron 75 µg (Group P), 30 minutes prior to extubation. Incidence and severity of PONV was measured on a Visual Analogue Scale (VAS). A one-way Analysis of Variance (ANOVA) was used to compare continuous variables between the groups. Results: Incidence of nausea was similar in all the three groups and though not statistically significant, only 2 patients (6.6%) in group P had incidence of nausea at 6 hours after surgery (T6) when compared to 8 (26.6%) in group O. The incidence of vomiting was 9 (30%) in group O compared to 3 (10%) in group P, which was statistically insignificant. Conclusion: Incidence and severity of PONV is similar in patients who received prophylactic doses of ondansetron, ramosetron and palonosetron, while undergoing abdominal hysterectomy under general anaesthesia.

A Comparative Analysis of Four Different Diagnostic Techniques for Malaria

Chaitali Sharma, Umesh, Vinita Rawat, Rajesh Kumar Singh
Introduction: Malaria is one of the major parasitic diseases and laboratory diagnosis of malaria infection requires the availability of a rapid, sensitive, and specific test that is affordable. There is the availability of several laboratory procedures for malaria diagnosis. Aim: To compare the performance of conventional microscopy using leishman staining against an immunochromatographic antigen detection test, fluorescent microscopy using Acridine Orange (AO), and molecular technique by Polymerase Chain Reaction (PCR) in the laboratory diagnosis of malaria. Materials and Methods: In the present cross-sectional study, 432 specimens were collected from patients suspected of malaria attending Dr. Susheela Tiwari Government Hospital, Haldwani, Uttarakhand, India, during the study period from January 2018 to September 2019. Microscopic examinations of Leishman stained smears, immunochromatographic Rapid Diagnostic Test (RDT), fluorescent microscopy using AO, and PCR were done using appropriate statistical analysis. Results: Out of the 432 specimens tested, a total of 208 (48.2%) were found positive for malaria using all four tests. Microscopy using leishman staining, RDT, and fluorescent microscopy were performed on all samples out of which 180 (41.6%) samples showed a positive result on Leishman staining, 186 (43%) were detected using AO fluorescent microscopy while the RDT had a yield of 208 (48.2%) positive results for malaria. While PCR was performed on 124 samples that yielded 79 (63.7%) positive results. Conclusion: Though, peripheral blood smears are still considered the gold standard for malaria diagnosis. But, in this study, it was observed that newer RDT for malaria surpassed the diagnostic efficacy of clinical microscopy and hence, has a superior role in clinical practice and diagnosis.

Intraoperative Prognostic Factors in Patients with Traumatic Acute Subdural Haematoma Undergoing Decompressive Craniectomy- A Pilot Study
Introduction: Traumatic Acute Subdural Haematoma (TASH) remains one of the most lethal of all head injuries with high mortality and morbidity. The admission Glasgow Coma Score (GCS), age, pupillary response and size, hypoxia, hyperthermia, and raised Intra Cranial Pressure (ICP) are the conventional prognostic indicator markers for TASH. However, these markers do not represent secondary brain injury. Aim: To identify the intraoperative prognostic markers and devise a scoring system based on these factors to aid in defining prognosis of patients with TASH undergoing Decompressive Craniectomy (DC). Materials and Methods:This pilot study was conducted in the Department of Neurosurgery, Government Medical College Thrissur, Kerala, India, over a period of one year from July 2018 to August 2019. Total 100 patients who presented with TASH and underwent DC were included in the present study. Intraoperative factors such as hypotension, saturation fall, brain bulge, brain pulsations, clot volume and Sub Arachnoid Haemorrhage (SAH) size were recorded. The primary outcome on the 30th day as alive or dead and functional outcome by Modified Rankin scale on 60th day was recorded. Based on these factors a scoring system was devised. Parameters were assessed using Chi-square test. Results: Among the 100 patients, 95 were males and five females with maximum cases (56) clustered between 36 to 50 years. Intraoperative fall in Blood Pressure (BP) lasting >5 minutes, fall in saturation of O2 , presence of brain bulge (moderate to severe), clot volume >30 mL, poor brain pulsation, presence of co-existant SAH and presence of brain contusion indicated unfavourable prognosis. Poor GCS score was associated with poor functional outcome of Modified Rankin Scale (MRS) 6. Based on intraoperative prognostic scoring, patients belonging to Grade A category had favourable prognosis (no death). Patents belonging to Grade C had poor prognosis (43 death). Conclusion: Intraoperative factors should serve as vital prognostic tools, hand in hand with the conventional admission GCS and Computed Tomography (CT) while managing a patient with TASH undergoing DC. Such an approach would mirror the maximum damage suffered by brain due to injury which is inclusive of primary brain injury and secondary insults as well, suffered up to and until the time of a durotomy.

Comparison of Dimensional Accuracy of Acrylic Resin Denture Base using Conventional and RS Tension Methods of Packing- An In-vitro Study
Introduction: Retention and stability are some of the important aspects of a successful denture. Laboratory procedures such as methods of packing have a great influence on the outcome of the denture. Different methods such as methods of closing, impression quality, type of acrylic resin, the processing cycle, cooling procedure, and water sorption have been suggested by the researchers to reduce the discrepancy in the dimensional accuracy of the complete removal dentures. Here, an attempt is made to compare conventional and Rafael Saide (RS) Tension techniques in the present study. Aim: The aim of present study was to evaluate and compare the dimensional accuracy of the heat cured denture base processed by the Conventional and RS (Rafael Saide) tension method of packing. Materials and Methods: The present in-vitro study was conducted at the Department of Prosthodontics, Crown and Bridge and Implantology, Modern Dental College and Research Centre, and at Shri Govindram Seksaria Institute of Technology (SGSITS) Indore Madhya Pradesh, India, from September 2014 to October 2015. A metal die with the base and counter was used to fabricate 60 specimens of heat-cured acrylic resin by conventional and RS tension method of clamping. After finishing these denture bases the samples were decoded. All the samples were assessed for the discrepancy in dimensional accuracy when compared with the metal die at five different specified locations. The student’s t-test was used to compare the measurements of the two methods. Results: The average mean marginal gap between all the points by the conventional method was 275.42 µm (minimum 264.5 μm, maximum 282.7 µm), p-value >0.001 and RS tension method was 171.8 μm (minimum 88.66 µm, maximum 248.82 µm), p-value <0.001. There was significant difference in dimensional accuracy when the mean marginal gaps of the two techniques were compared (p-value <0.001). Conclusion: The RS tension clamping method for the fabrication of dimensionally more accurate and more retentive removable complete dentures should be recommended in the laboratories.

Histopathological Changes in the Kidney of Albino Rat due to Chromium and the Ameliorative Role of α-Tocopherol

Nahid Yasmin, Md Sabir Hussain
Introduction: Potassium dichromate, a chromium {Cr(VI)} compound is the most toxic form of Cr(VI) which causes nephrotoxicity associated with oxidative stress in animals and humans. The study of toxicity and biological effects associated with chromium has generated a lot of interest due to its wider distribution in the environment and its use. Aim: To study the potassium dichromate-induced nephrotoxicity and ameliorative role of vitamin E in albino rats. Materials and Methods: The present experimental study was conducted in the Department of Anatomy, Subharti Medical College, Meerut, Uttar Pradesh, India. Study population consisted of 36 albino rats which were randomly divided into four equal groups (n=9, each). Group I served as control while groups II and III were administered Potassium dichromate (K₂ Cr₂ O₇ ) dissolved in sterile distilled water 10 mg/kg body weight single dose orally for 1, 14 and 42 days, 3 rats in each sub-groups. In addition to Cr(VI), group III also received α-tocopherol 125 mg/kg body weight daily orally. Group IV rats were maintained as α-tocopherol control and they received α-tocopherol as above daily for 42 days. At the end of 1, 14 and 42 days, all the rats were sacrificed for the estimation of the histopathological changes in kidney. The Z-proportion test was used for evaluation of data. Results: Thirt-six albino rats of both sex, age about 60 days weighing approximately 140±10 gm were studied. Prominent pathological changes like glomerular mesangial proliferation and obliteration of bowman’s space were observed in the kidney of group II rats. Co-treatment with α-tocopherol in group III significantly reversed the Cr(VI) induced changes with a p-value=0.009 and 0.007 for glomerular mesangial proliferation and obliteration of bowman’s space respectively. Conclusion: The α-tocopherol exhibited protective effect against Cr(VI) induced damage to the kidney.

Ultrastructural Morphological Evidence of Effect of Physical Barrier in Prevention of Dental Caries: An In-vitro Experimental Study

Prashanth Sadashiva Murthy, Seema Deshmukh, MD Indira, MS Girish
Introduction: Dental Caries is primarily a disease of multifactorial origin. The streptococcus mutans the causative agent adheres to the tooth surface and breaks down the sugar to produce lactic acid as the by product which brings about demineralisation of tooth structure. There is a need to identify substance which prevents adhesion of the organism to the tooth surface thereby preventing colonisation. Aim: To assess conditioning of the tooth surface with butter prior to subjecting the tooth to demineralisation. Materials and Methods: An in vitro experimental trial was conducted on 45 non carious premolars. The teeth were divided in 3 groups of 15 each. Group I received no pretreatment. The group II and III received thin and thick layer of butter coating, respectively. The teeth were then immersed in demineralising solution and the effect of the of the same was assessed using Scanning Electron Microscope (SEM). Since the data obtained was qualitative, any statistical test were not applied. The observations recorded were based on the repetition of the similar findings in more than 50% of the samples. Results: The results of the study indicated the presence of islands of protected enamel and limited destruction in the prismatic pattern on the samples with thin coating of butter. Samples with thick butter coating showed presence of intact prismatic substance in contrast to the unprotected teeth which showed loss of prismatic substance. Conclusion: Pretreatment of the tooth surface with thin coating of butter prior to exposing the tooth to cariogenic environment protects the enamel from undergoing demineralisation.

Comparison of Intermittent Bolus versus Continuous Infusion of Epidural Labour Analgesia by 0.15% Ropivacaine and Fentanyl: A Randomised Clinical Study

Rahul Chalekar, Basavaraj Patil, Nirmala Kagalkar, N Keshava Reddy
Introduction: Epidural labour analgesia is considered to be the most effective method to produce pain relief during labour. Programmed Intermittent Epidural Bolus (PIEB) has been observed to have many advantages over Continuous Epidural Infusion (CEI) like reduced incidence of breakthrough pain, local anaesthetic usage, instrumental delivery, shorter second stage of labour and more maternal satisfaction. Administration of local anaesthetic solution as PIEB at regular intervals has shown to spread more extensively in the epidural space compared to CEI, possibly enabling greater efficacy. Aim: To compare the intermittent bolus versus continuous infusion of epidural labour analgesia with the primary objective to measure the total local anaesthetic consumption of 0.15% ropivacaine and fentanyl. Materials and Methods: The randomised double blind study was carried out on parturient in Obstetrics and Gynaecology Department at Fortis Hospital, Bengaluru, Karnataka, India from June 2014 to June 2015. The present study compared 60 primiparous females (divided into two groups of 30 each). Labour analgesia was provided by bolus of 12 mL of 0.15% ropivacaine and 2 μg/mL fentanyl, after one hour of the initial bolus dose, group I parturients received 8 mL of 0.15% ropivacaine with fentanyl 2 μg/mL hourly and group C parturients received same solution as continuous infusion immediately. If patient complained of pain or Visual Analog Scale (VAS) score ≥4, additional 8 mL of the same solution was given. Total dose of 0.15% ropivacaine, number of rescue doses, pain scores, motor block and second stage of labour were compared. Results: The mean age in group I was 27.93±1.14 and in group C was 27.87±1.28 years. Total dose of ropivacaine in group I was 41.45±14.62 mg and in group C was 59.20±21.12 mg (p-value=0.0004). In group C, at 2nd hour, VAS score (3.03±1.88) was more compared to intermittent bolus group (1.40±2.02), which was statistically significant (p-value=0.002). No motor block was observed in group I, but two parturients in group C had modified Bromage score of 4. Second stage of labour was significantly reduced in group I compared to group C (p-value <0.001). Less instrumental delivery and more maternal satisfaction was observed in group I. Conclusion: Intermittent bolus group required less rescue doses hence, less total local anaesthetic dose with better analgesic efficacy

A Cross-sectional Study on the Electrophysiological Profile of Leprosy Patients in a Tertiary Care Institute in Chhattisgarh, India

Rakesh Kumar Patel, Mitesh Kumar Sinha, SA Dilip Kumar, Akhilesh Behra
Introduction: Leprosy is a bacterial infection caused by Mycobacterium leprae. It mainly infects skin, mucosa and nerves. Neural involvement is primarily due to the selective affinity of Schwann cells for lepra bacilli. Nerve involvement leads to Nerve Function Impairment (NFI) which presents as sensory and/or motor deficit, cutaneous nerve thickness or painful neuritis eventually lead to deformity and disability. NFI can be accessed by Nerve Conduction Study (NCS). Early diagnosis and treatment plays important role in the prevention of permanent nerve damage due to leprosy. Aim: To study the electrophysiological profile of Pure Neuritic Leprosy (PNL), Tuberculoid Hansen’s Disease (TTHD) and Borderline Tuberculoid Hansen’s Disease (BTHD). Materials and Methods: A cross-sectional study was conducted on 63 newly diagnosed patients in dermatology Out Patient Department (OPD) in Late Shri Lakhiram Agrawal Memorial Medical College, Raigarh, Chhattisgarh, India, from June 2020 to May 2021. The NCS was conducted after obtaining approval from the Institutional Ethical Committee. The bilateral ulnar nerve, median nerve, common peroneal nerve, posterior tibial nerve and sural nerve were assessed by NCS for each patient. Data was collected and analysed by unpaired student's t-test using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Total 378 nerves were examined for nerve thickness. Total 106 nerves were found to be thickened. The most common neuropathy found was of demyelinating sensory and sensorimotor type seen in 21 (33.33%) patients. A total of 12 (19.05%) patients had both axonal and demyelinating neuropathy (mix neuropathy). Only 5 (7.94%) patients had pure axonal neuropathy of sensorimotor or sensory nerves. Conclusion: Most common neuropathy found was demyelinating sensory and sensorimotor neuropathy. The ulnar nerve was found to be the most common nerve involved in leprosy.

Effect of Endodontic Retreatment Protocols on Bond Strength of Fiberglass Post to Root Canal Dentine: An In-vitro Study
Introduction: Fiberglass Posts (FGPs) associated with composite resin foundation materials have become the primary alternative to restoring teeth with root canal treatment presenting excessive coronal destruction. Despite technical evolution, loss of retention between FGP and root dentine continues to be reported. Aim: To examine the effect of endodontic retreatment protocols on the bond strength of FGP to radicular dentine. Materials and Methods: This in-vitro study was conducted at Evangelical University of Goiás, Brazil from August 2019 to June 2020. A total of 30 freshly extracted bovine incisors were instrumented, filled and distributed into three experimental groups with 10 incisors in each groups. Group 1 was control, group 2 had incisors with gutta-percha removed using K-type files and group 3 had incisors with gutta-percha removed using ProTaper Universal Retreatment instruments. After root canal retreatment and re-sealing, the fiber posts were cemented into prepared post spaces using a resin-based cement. Roots were transversally sectioned into six 1 mm thick specimens. The pushout test was performed, and the modes of failure were evaluated. Data were analysed with two-way Analysis of Variance (ANOVA) and Tukey’s test. Results: There was no significant difference between the mean bond strength values in group 1, 2 and 3 with p-value >0.05. The cervical third of root canal presented higher bond strength values compared with the middle and apical thirds. However, significant differences were observed only for the control group (p-value=0.005). Adhesive failure between resin cement and radicular dentine was the most prevalent type of failure. Conclusion: The endodontic retreatment protocol did not influence the bond strength of FGP to radicular dentine.

Role of MDCT in the Evaluation of Blunt Abdominal Trauma in Himalayan Region of Northern India
Introduction: Blunt abdominal trauma is a major cause of morbidity and mortality in young people. Abdominal Ultrasonography (USG) can detect organ injury and free intraabdominal fluid which provides indirect evidence of injury. Multidetector Computed Tomography (MDCT) is the modality of choice in haemodynamically stable patients as it can accurately diagnose and ascertain the severity of injuries. It can also evaluate retroperitoneum and detect arterial contrast extravasation or pseudoaneurysm which predicts the need for surgery or angioembolisation. Aim: To study the spectrum of abdomino-pelvic injuries on MDCT and to compare the MDCT findings with operative findings wherever possible. Materials and Methods: The prospective cohort study was conducted in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from the period 1st June 2019 to 31st May 2020. Patients with history of Road Traffic Accidents, fall, or assault or other causes where clinically blunt trauma of abdomen was suspected and referred for MDCT abdomen and pelvis were included. The blunt abdominal patients who were Focused Assessment with Sonography for Trauma (FAST) positive or had clinical suspicion of abdomino-pelvic injury were evaluated with MDCT. The present study was conducted on 64 slice MDCT scanner light speed Volume Computed Tomography Xte General Electrics (VCT Xte GE) medical systems. All patients underwent CECT abdomen and pelvis in arterial (30 seconds) and porto-venous phase (60 seconds). The MDCT findings were compared with operative findings and clinical follow-up was done after three months. Data were entered into Microsoft Excel sheet and Statistical Package for the Social Sciences (SPSS) software 20.0 version was used for analysing data. Results: Thirty five haemodynamically stable patients with blunt abdominal trauma were included in the study with mean age of 28.5±8.8 years with male predominance. Road traffic accident was the most common mechanism of injury. Visceral injury or free fluid was seen in all the 35 patients on MDCT of abdomen and pelvis. Twenty eight patients were managed conservatively while seven patients were operated. Solid organ injury was seen in 28 patients. Amongst solid organ injury, spleen was the most common organ injured followed by liver. On comparing MDCT and operative findings, pancreatic transection was found in three patients. Sigmoid perforation, renal injury and UB perforation were confirmed in one patient each. On comparing with surgical findings, MDCT had a sensitivity of 100%, specificity of 100% for detecting solid organ injury and the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 100% and 100%, respectively. Amongst hollow visceral injury, jejunal perforation was seen in two patients while ileal perforation and Urinary Bladder (UB) perforation was seen in one patient each. However, one case of sigmoid perforation was missed on MDCT. On comparing with surgical findings, MDCT has a sensitivity of 66.66%, specificity of 100% for detecting hollow visceral injury and the PPV and NPV were 100% and 80%, respectively. Conclusion: The MDCT is helpful in detecting solid organ injuries. The MDCT plays a major role in the management of blunt abdominal trauma and helps in making decision regarding operative and non operative treatment. Therefore, MDCT is the investigation of choice in patients with blunt abdominal trauma.

Staining Effect of Amflor, Zerosense and Ceti-F Mouthwashes on Dental Enamel: In-vitro Study

Sowmithra Devi Saravanan, Navaneethan
Introduction: Chemical methods of plaque control, especially mouthwashes, offer great help in maintaining good oral hygiene and preventing dental caries. However, these mouthwashes often result in staining of the enamel. Aim: To evaluate discolouration caused by three different fluoride mouthwashes on dental enamel. Materials and Methods: This was an in-vitro study that included 40 freshly extracted premolar teeth and was conducted at University of Saveetha in January 2021. A total of four groups were made with 10 teeth in each group. Group 1 included teeth as the control group where distilled water was used, Group 2: Amflor mouthwash group, Group 3: Ceti-F (Cetyl Pyridinium Chloride, Triclosan and Sodium Fluoride) mouthwash group and Group 4: Zerosense mouthwash group. Pretreatment colour change examination according to CIELAB {International Commission on Illumination L: value or degree of lightness, a: positions on red/green (+a=red, -a=green); b: yellow/blue (+b=yellow, -b=blue) axes} colour space system was done before immersing in the mouthwash solution (T1). Then each group of teeth were immersed in their respective mouthwash for 24 hours and postimmersion colour change was determined (T2). Analysis of Variance (ANOVA) test was done to determine intergroup comparison of all four groups in terms of differences in colour changes between T1 and T2. Intragroup comparison using paired t-test was done to find out colour differences within the study groups. Results: On observing total sample of 40 freshly extracted premolar teeth (10 teeth in each group. Group 1-control group, Group 2-Amflor mouthwash group, Group 3-Ceti-F mouthwash group and Group 4-Zerosense mouthwash group. ANOVA test revealed a statistically significant difference between T1 and T2 for the three mouth washes (p<0.05). Paired t-test for intragroup comparison revealed a statistically significant colour difference in all the three mouthwash groups except for the control group (p<0.05). The colour change (?E) value was significantly higher for the Amflor group, and least for the Zerosense group. An obvious colour change was noted for all the mouthwash under study. Conclusion: Fluoride mouthwashes produce an obvious staining effect on dental enamel. Among the three test groups included, Zerosense showed the least colour change.

Awareness of Facemask and its Usage in the Rural Community of Western Maharashtra during COVID-19 Pandemic: A Cross-sectional Survey
Introduction: The Coronavirus Disease-19 (COVID-19) pandemic caused by 2019 novel coronavirus was first reported in Wuhan, China. It is a disease of the respiratory system with clinical presentation of fever, cough, breathlessness, headache, fatigue etc. Transmission route is through person to person contact and through direct contact with respiratory droplets generated when an infected person coughs or sneezes. In such cases usage of facemasks is very crucial. At the same time awareness regarding the same in the community is very important. Hence, through this survey authors have assessed and recorded the awareness about facemasks and its usage in the community in the Indian population along with the basic hygiene precautions taken by the people. Aim: To conduct a detailed survey regarding the awareness and usage of facemask in the rural population in Maharashtra. Materials and Methods: The study was a three month crosssectional online survey conducted by Maharashtra Academy of Engineering Education and Research’s (MAEER’s) Talegaon Dabhade Physiotherapy College in the rural community of western Maharashtra, India, from October to December 2020. A self-administered online questionnaire consisting of 20 questions was prepared regarding the awareness about masks usage and proper methods to be considered with reference to the guidelines given by World Health Organisation (WHO), Indian Council of Medical Research (ICMR), Centers for Disease Control (CDC) and Prevention and literature reviews. The forms were shared on social media platforms such as WhatsApp, Facebook, and Instagram using Google forms. Statistical analysis was done by descriptive analysis using percentage. Results: Out of total 390 participants, 210 (53.84%) were males and 180 (46.15%) were females. Considering the knowledge about the types of masks available was 67.1%, self-education was 88%. A 44% of the population thinks that one can wear a facemask up to eight hours if worn properly. Similarly knowledge about disinfecting the mask before throwing was 86%. Active efforts to maintain good hygiene by washing hands was 90%. Also, 55% of the population avoids touching their mask frequently. In practice, 56.1% of the population avoids wearing a mask while walking or jogging. Varieties of masks are being used by the people depending on the cost and availability. Conclusion: The coronavirus pandemic has evoked a sense of awareness about self-care, hygienic habits and being updated about one’s health. Further work can be done on cost effectiveness and availability of the good quality masks.

A Cross-sectional Study on Prevalence of Vitamin B12 Deficiency and Peripheral Neuropathy between Metformin Users and Non Users in Participants with Type 2 Diabetes Mellitus
Introduction: Metformin is a first line drug for treatment of Type 2 Diabetes Mellitus (T2DM) which acts by decreasing insulin resistance. Metformin use can lead to vitamin B12 deficiency. Aim: To evaluate the difference in proportion of vitamin B12 deficiency and clinical neuropathy between metformin users and metformin non users in patients with T2DM. Materials and Methods: This cross-sectional study was conducted at Department of General Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, from Jul 2015 to June 2017. Hundred patients with T2DM were recruited in the study, and divided into two groups i.e., T2DM patients on metformin (n=50) and without metformin (n=50). One group were patients of diabetes who were on metformin for more than three years, and the other group were those who had not taken metformin in last three months. All participants were evaluated with serum vitamin B12. Toronto Clinical Neuropathy (TCN) score was used to diagnose peripheral neuropathy. Multivariable logistic regression was done to look for association between metformin use and vitamin B12 deficiency and peripheral neuropathy separately. Results: Between the metformin users and non metformin user group, the proportion of males (72% vs 66%, p-value=0.66) and the age (56.02±9.19 vs 56.16±8.33 years, p-value=0.93) were similar in both groups. Median duration of diabetes among metformin users was 10.18 years (IQR=6.68-16.68 year) and non metformin user group was 7.68 years (IQR=5.68-12.68 year). There was a significantly higher prevalence of vitamin B12 deficiency in metformin users (38,76%) than non metformin users (21,42%). The prevalence of vitamin B12 deficiency was highest (11,100%) in those with metformin use for more than 15 years. Association of vitamin B12 deficiency in metformin users was significant {(OR=7.17 (2.46-20.92), p-value <0.001}. Peripheral neuropathy assessed by TCN scoring was significantly more common in metformin users (37,74% vs 23,46%; p-value=0.004). Conclusion:This study reports high prevalence of vitamin B12 deficiency in T2DM patients with significantly higher prevalence among metformin users. Peripheral neuropathy was significantly more common in metformin users and was associated with vitamin B12 deficiency. Hence, metformin treated T2DM patients, especially those with peripheral neuropathy should be evaluated for vitamin B12 deficiency

Reliability and Validity of Gujarati Pittsburgh Sleep Quality Index: A Cross-sectional Study

Darshana M Nariya, Subhash Khatri
Introduction: Poor quality of sleep is a common symptom of many sleep disorders. Pittsburgh Sleep Quality Index (PSQI) is self-administered questionnaire that measures quality of sleep of an individual. It includes subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications and day time sleepiness. Aim: To translate English PSQI into Gujarati Language and to find reliability and validity of Gujarati version of PSQI. Materials and Methods: This cross-sectional study was conducted from August 2020 to February 2021. Permission was taken to translate original English PSQI to Gujarati language from the Mapi Research Trust. This study was carried out in four phases: 1) Cultural adaptation and translation of PSQI into Gujarati language; 2) Face and content validation by expert clinical review; 3) Cognitive interviews; 4) Test retest reliability. Forward-backward-forward method was used to translate PSQI. The consensus method was used to find face and content validity of Gujarati PSQI. The group of experts having mean experience of 10.5 years in different fields examined each item of Gujarati PSQI. Total 120 participants aged between 18-60 years were included in this study. To find reliability of Gujarati PSQI, internal consistency and test retest reliability was determined. Statistical Package for the Social Sciences (SPSS) vesrsion 24.0 was used to analyse the data. Test retest reliability was determined by Intraclass Correlation Coefficient (ICC) and internal consistency was calculated by chronbach’s alpha. Results: Gujarati version of PSQI showed excellent test retest reliability as evidenced by high ICC (ICC=0.87) and high internal consistency (α=0.93). Conclusion: Gujarati version of the PSQI has excellent reliability and good face and content validity. It is adequate and useful for evaluation of quality of sleep in Gujarati speaking population.

Role of Shear Wave Elastography in Assessing the Severity of Bladder Outlet Obstruction in Patients with Benign Prostatic Hyperplasia: A Cross-sectional Study
Introduction: Benign Prostatic Hyperplasia (BPH) is a disease prevalent in ageing men. The BPH causes Bladder Outlet Obstruction (BOO) which may even lead to hydronephrosis and renal insufficiency. Therefore, diagnosis of severity of BOO is necessary in the treatment of patients with BPH. Aim: To assess the accuracy of various ultrasound parameters {volume of prostate, Resistive Index (RI) of capsular arteries of prostate and stiffness of prostate} in the prediction of severity of BOO in patients with BPH. Materials and Methods: The cross-sectional study was conducted between November 2020 and January 2021 in the Department of Radiology at at Government Kilpauk Medical College, Chennai, Tamil Nadu, India. Total 55 males between 40 to 80 years of age with symptoms of lower urinary tract obstruction participated. Multi-parametric Transrectal Ultrasound (TRUS) examination of the prostate including Grey scale, Colour Doppler Sonography (CD) and Shear Wave Elastography (SWE) were performed on patients with BPH who had undergone urodynamic evaluation. Volume of the prostate gland, RI of capsular arteries and stiffness or elastic modulus of the prostate gland were measured in the TRUS examination and compared with uroflowmetry which was used as a standard. Receiver Operating Characteristic (ROC) curve was used to assess diagnostic performance of the three ultrasound parameters. The thresholds maximising the Youden index were calculated, and corresponding sensitivity, specificity, positive predictive value, negative predictive value and accuracy are reported. Results: Among the 55 males in the study the mean age of study population was 59.6 years and standard deviation of 7.9. Mean International Prostate Symptom Score among the population was 18.9±4.9. Mean volume of prostate was 33.66±7.166 cc. Mean RI was 0.75±0.11. Mean stiffness of prostate calculated was 40.9±11.3 Kpa. The stiffness or elastic modulus of the prostate was the most strongly correlated indicator with the severity of BOO (R2 =0.77, p-value <0.001), and had the largest area under the ROC curve 0.942 (95% CI was 0.844-0.987) with a significant p-value of <0.0001 while RI and volume of the prostate gland had an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.810 (95% CI was 0.64-0.87) and 0.779 (95% CI was 0.64-0.88), respectively. The diagnostic cut-off values for stiffness of prostate, RI of capsular arteries and volume of prostate were 31.6 kPa, 0.68 and 28 mL, respectively. Conclusion: The stiffness of the prostate measured on SWE is a promising indicator in the assessment of the severity of BOO.

Measurement of Perfusion Index of all the Fingers of Both the Hands in Healthcare Volunteers: A Cross-sectional Study
Introduction: Perfusion Index (PI) is an indirect, non invasive and continuous method to measure peripheral perfusion. In case of circulatory shock, the peripheral tissue bed is assumed to be sacrificed first and reperfused last in resuscitation. Aim: To measure the peripheral PI from different fingers of both hands in healthy healthcare workers of a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted in Coronavirus Disease-2019 (COVID-19) designated healthcare hospital in January 2021. In this study, healthy volunteers with the age of 18-60 years were included. All the volunteers were evaluated with a pulse oximeter in all extremities of both the hands to check their PI. For significant results of repeated measure of ANOVA, post-hoc Bonferroni test were used to evaluate all multiple comparisons. All p-values <0.05 were considered significant. Results: A total of 96 healthcare volunteers with the mean age of 35.25±11.074 years were included in the present study. Majority of the population were male (80.2%). The highest perfusion was recorded in the right hand ring finger (8.59±4.03%). The lowest reading was noted in the right hand thumb (6.27±2.89%). The PI noted in the right thumb was significantly less than all the other fingers (p-value <0.05) except left thumb and left little finger (p-value >0.05). Conclusion: From this study, authors more emphasis on the choice of the finger during the measurement of PI because both highest and lowest perfusions were reported in the dominant hand.

Clinical Spectrum and Outcome of Conduction Disturbances in Acute Myocardial Infarction in Thrombolytic Era at a Tertiary Care Centre

Ajaz Qadir, Aadil Ahmad Mir, Abid Rasool, Aiman Waseem
Introduction: Significant number of deaths in Acute Myocardial Infarction (AMI) is attributed to conduction disturbances. Aim: To determine the incidence, pattern of conduction disturbances and their clinical outcome in AMI. Materials and Methods: This was a hospital-based study conducted at Sher-E-Kashmir Institute of Medical Sciences (SKIMS) Jammu and Kashmir, India, a tertiary care hospital from August 2015 to July 2017, in which a total of 429 patients with diagnosis of AMI were included. There were 89 (20.7%) patients with conduction disturbances, and 340 (79.3%) patients without conduction disturbances. They were examined clinically and Electrocardiography (ECG) and Echocardiography (Echo) and many other relevant routine clinical investigations were done to look for development of conduction disturbances and other complications of MI. Frequency (n) and percentage (%) analysis was done on collected data and Fischer's exact test and Chi-square test was conducted for p-value calculations and checked for significance. Results: Out of 429 patients 358 (83.40%) males and 71 (16.60%) females, mean age 57.6±12.39 years), 219 (51.04%) received thrombolysis. In those subjects with conduction disturbances, Atrioventricular (AV) blocks were found in 54 (12.58%) constituting the maximum subjects, followed by intraventricular blocks in 35 (8.1%). Among AV blocks, complete AV block in 45 (10.48%) with mostly transient nature and in intraventricular blocks where Right Bundle Branch Block (RBBB) 17 (3.96%) were the most common types. Intraventricular blocks were more common in anterior infarction and AV blocks in inferior infarction (p<0.001). Age >70 years, diabetes and worse Killip class at presentation were independent predictors of conduction disturbances. Temporary pacemaker requirement was more than permanent pacemaker 24 (26.9%) vs 5 (5.6%). Right coronary artery (RCA) was dominant artery among AV blocks, which was statistically significant (p-value 0.003). Mortality was about 12.9% amongst the subjects of Atrioventricular Node block and 25.7% amongst those of Intraventricular Blocks while it was 9.41% amongst the subjects without conduction disturbances (p-value 0.013). Mean duration of stay in the hospital was 7±2 days. Conclusion: Conduction blocks were more common in age >70 years, diabetics, in worse Killip class and in inferior infarction. However, no statistically significant correlation was found between occurrence of conduction blocks and various risk factors like hypertension and smoking.

Association of Anthropometric Indices of Obesity and Body Fat Composition with Diabetes Mellitus, Hypertension, and Dyslipidemia: A Case-control Study

Raghav Gutlur, BR Vikas, Tejaswini Nagesh
Introduction: Presently, obesity has evolved as a global epidemic, impacting both developed and developing nations with same intensity. It require serious attention from both public and clinicians. Aim: To evaluate anthropometric indices as potential indicators of increased risk of Diabetes Mellitus (DM), hypertension, and dyslipidemia. Materials and Methods: This case-control study, conducted between November 2012 to April 2014 at the General Medicine Department of a tertiary care teaching hospital in Sulia, Karnataka, India. A total of 200 patients of either gender, aged 30 to 90 years with either hypertension, or type 2 DM, or dyslipidemia, or obesity or any combinations of the above were recruited and grouped as cases. Another 200 apparently healthy volunteer were considered controls. Anthropometric indices, like height, weight, Body Mass Index (BMI), Waist Circumference (WC), Waist-toHip Ratio (WHR), Hip Circumference (HC), body and visceral fat percentage, and skin fold thickness were measured. Statistical tests like Shapiro-Wilk test, Chi-square test and Mann-Whitney test were applied using software R version 3.6.0. Results: Out of total 200 patients, majority were males (52%) followed by females (48%). No significant difference was observed between study groups with respect to age (p-value=0.115). Among cases, 54 (27%) had only DM, 44 (22%) had only hypertension, whereas 102 (51%) had both DM and hypertension. Statistically, a significant difference was found between study groups with respect to distribution of BMI (p-value <0.0004), WC (p-value <0.001), WHR (p-value <0.001), body fat (p-value <0.001), visceral fat (p-value <0.0002), skin fold (p-value <0.001), glycaemic (p-value <0.001) and lipid profile (p-value <0.00001). Cases were 3.2 times more likely to have dyslipidemia than controls (OR: 3.2; CI: 2.1-4.9). With a unit increase in the body fat, visceral fat, Fasting Blood Sugar (FBS), triglycerides and BMI, odds of having hypertension or diabetes increases by a factor of 1.39, 1.16, 1.46, 1.03 and 0.67, respectively. Conclusion: There was a strong significant association of anthropometric indices of obesity and body fat percentage with hypertension, diabetes, and dyslipidemia.

Effect of Passive Ultrasonic Irrigation and Laser Disinfection in Single Visit Root Canal Therapy on Postoperative Pain
Introduction: Postoperative pain is an unwanted common sensation after endodontic treatment. Postoperative discomfort affects anywhere from 3 to 58% of patients. Complete elimination of bacteria in the form of biofilm from the canals is very difficult. But there is no one unique irrigant that can meet all the requirements of ideal irrigant. Aim: To compare and evaluate the effect of Passive Ultrasonic Irrigation (PUI) and laser disinfection for postoperative pain and discomfort after a single visit root canal therapy in non vital single rooted teeth. Materials and Methods: This randomised clinical study was conducted on 44 patients, in the Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from July 2018 to December 2018. Administration of local anaesthetic agent (1:2,00,000 lignocaine with adrenaline) followed by isolation with rubber dam and access cavity preparation was done. Cleaning and shaping of the teeth were done. The patients were randomised into two groups using a flip coin procedure. In Group A, laser disinfection was done using 810 nm diode laser, 2 W power. In Group B, ultrasonic agitation with 5.25% of sodium hypochlorite (NaOCl) was done. Final irrigation with normal saline was done followed by obturation and postendodontic restoration using composite resin. Postendodontic evaluation was done by the blinded evaluator with help of modified verbal rating scale for 6 hours, 24 hours, 48 hours and 7 days. After evaluation, the data was collected and statistically analysed using Pearson’s Chi-square test with 5% level of significance using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among 44 patients, 25 were male and 19 were female. The age of 10 patients was between 40-60 years, age of 28 patients was 30-40 years, while age of remaining 6 patients was between 18-29 years. The results showed no statistically significant difference in the postoperative pain and discomfort of PUI and laser disinfection when used for disinfection in a single visit root canal therapy (p-value= 0.086). Conclusion: Both PUI and laser disinfection are equally effective in reducing postoperative pain and discomfort after single visit root canal treatment. In the initial hours, laser disinfection has slightly higher edge over PUI.

Impact of Health Education on Knowledge, Attitude and Practices of COVID-19 among Slum Dwellers of Nashik, India

Supriya Dhakne Palwe, Maanya Sumeet Bajaj
Introduction: The spread of Coronavirus Disease 2019 (COVID19) pandemic can be effectively curtailed by COVID-19 appropriate practices. Identifying knowledge gaps and giving health education to address the weak areas will be key to breaking the chain of COVID-19. Aim: To assess the Knowledge, Attitude and Practices (KAP) of COVID-19 among slum dwellers and to assess the impact of health education on the same. Materials and Methods: The quasi-experimental was conducted among the slum dwellers from July 2021 to August 2021 at three slums (Sant Kabir Nagar, Anandwalli slum behind Wasan bungalow, Kamgar nagar) of Nashik city, Maharashtra, India. To assess KAP using a prevalidated questionnaire with 16 knowledge questions, six attitude questions and eight practice questions. A brief video was utilised for health education regarding COVID-19. Knowledge was reassessed after the intervention. A total of 164 participants from three slums completed the preintervention and postintervention questionnaire. Data was analysed using appropriate statistical tests like Chi-square test, Wilcoxon signed-rank test. Results: Satisfactory level of knowledge, attitude and practices was found in 72.56%, 82.32% and 51.83% of the study participants. Knowledge gap was found in social distancing (35.98%), possibility of re-infection (20.73%) and infection after vaccination (28.66%). Around 25.61% said that children need not follow COVID-19 appropriate practices. About 97.56% participants had taken at least 1st dose of COVID vaccine. There was high prevalence of inappropriate practices like not maintaining social distancing at workplace (21.95), using public transport (65.24%), etc. There was no association of sociodemographic characteristics and the COVID-19 KAP. There was significant increase in the knowledge level after the health education. Preintervention and postintervention knowledge scores was 10.82±2.39 and 12.91±1.79, respectively. Conclusion: In spite of satisfactory knowledge level and attitudes, around half the population was involved in incorrect practices. There was no association of socio-demographic factors on the KAP of COVID-19. Post health education, knowledge level improved significantly.

Education-based Self-management Intervention on Awareness among Patients with Systemic Lupus Erythematosus at Tertiary Care Hospital, Chennai, India

S Jesika Mary, P Geetha, K Sathiya, S Rajeswari
Introduction: Education-based self-management intervention that incorporates both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. Aim: To assess the effect of education-based self-management intervention on awareness among patients with Systemic Lupus Erythematosus (SLE) at tertiary care hospital. Materials and Methods: The quantitative experimental study one group pretest post-test design using purposive sampling technique was conducted on 55 patients, who were all diagnosed with SLE in Rheumatology Outpatient Department, Tertiary Care Hospital, Chennai, Tamil Nadu, India. The patients received the intervention “education-based self-management” which comprised of audio recorded powerpoint teaching on various aspects of SLE like definition, risk factors, signs and symptoms diagnostic investigations, treatment, complications and self-care measures. The investigator taught a group of 4-5 patients for 30-40 minutes using the presentation, followed by which they were provided a booklet on self-management guidelines. The pre and post-test self-management awareness determined through reliable and valid self-structured questionnaire (SLE awareness questionnaire) and their values were analysed through inferential and descriptive statistics. Results: The SLE was reported to be highest among the age group of 21-35 years (72.7%), with higher incidence in females 96.4% than male 3.6%. Majority (n=44) 80% of the patients were founds to have inadequate level of awareness in the pretest. During the post-test on 15th and 30th day, the awareness among the patients was found to be adequate with the score of 38.2% and 94.5%, respectively. There was a significant difference noted in level of awareness between pretest and post-test on 15th day at p-value=0.04 and between pretest and post-test on 30th day at p-value=0.01. Conclusion: The education-based self-management intervention is effective in improving the awareness levels among patients with SLE and it can also be effective for patients to manage their symptoms.

Dorsal Epidural Migration of Lumbar Disc Fragment Causing Cauda Equina Syndrome- A Case Report

Vijayanand Balasubramanian, Kevin Dhas, Rajavel Kalirajan
Several anatomic factors like midline septum, lateral peridural membrane and epidural fat prevent dorsal migration of disc fragment. Hence, dorsal epidural migration of lumbar disc has a rare occurrence. It has a propensity to present with cauda equina syndrome. Epidural disc fragments mimic benign masses and hence poses a diagnostic challenge. The prognosis is good compared to other types of disc prolapse when surgical decompression is done early. A 45-year-old male labourer presented with chronic lower back pain with recent onset of motor weakness in right lower limb and bladder disturbance. Magnetic Resonance Imaging (MRI) showed a huge sequestrated L4-L5 disc. Emergency decompression with laminectomy was done and a large fragment of sequestrated disc found in posterior epidural space was removed. Symptoms improved dramatically following surgery within 10 days. Awareness about this rare disc prolapse is important for timely diagnosis and management of it.

Quality of Antenatal Care in a Tertiary Care Hospital of Odisha: A Cross-sectional Study
Introduction: Antenatal Care (ANC) is the starting point of continuum of care in pregnancy, labour and puerperium. Increased coverage and quality ANC averts 71% of neonatal death, 33% still birth and 54% of maternal death. Aim: To assess the quality of ANC service delivery in terms of examination, screening, counselling and treatment including the adequacy in number. Materials and Methods: The cross-sectional study was conducted in an urban setting at SCB Medical College, Cuttack, Odisha, India, from January 2020 to June 2021 to assess the quality of ANC service provided to women visiting the tertiary healthcare facility. Data was collected from the sample of 200 pregnant women who were recruited in the third trimester through non probability sampling. Quantity is actually sufficiency in number. However, all the services provided during ANC to screen for high risks factors from history, examinations, routine care like investigations, nutritional supplementation, counselling and health education were assessed under quality services by a questionnaire. Data were entered in Statistical Package for the Social Sciences (SPSS) version 24.0. Continuous variables were expressed in mean and Standard Deviation (SD). Categorical variables were expressed in proportion. Results: Total 72.5% of women made four or more visits to antenatal clinics. The mean age of participants were 26.1±4.0 years. The majority of participants were primigravida (47.5%). Total of 60% of the participants were of middle socio-economic status and maximum were having education upto primary level (46.5%). Total 78.5% of the women had done their first ANC check-up within the first trimester. Haemoglobin level, blood grouping and blood sugar were estimated among 96.5%, 93.5% and 96.0% of the women, respectively. Counselling about danger signs of pregnancy was done in 15.5% cases and birth preparedness and emergency readiness was done in only 7.0% of women. Conclusion: The study revealed that the health facility is providing better coverage of ANC services by the tertiary level service providers. Most of the routine investigations, vaccinations and necessary supplementation were in accordance with World Health Organisation (WHO) focussed ANC model.

Recasting of Base Metal Alloys and its Effect on Metal Ceramic Bond Strength

Preeti Kumari, Sandeep Garg, Nidhi Mangtani Kalra
Introduction: A steep rise in the cost of noble metals leads to use of base metal alloys, due to their low cost, good mechanical properties and low density. It would be economically advisable to use fresh alloy in combination with reuse alloy, to reduce the cost of fixed partial dentures. Aim: To evaluate the effect of recasting of Nickel-Chromium (Ni-Cr) and Cobalt-Chromium (Co-Cr) base metal alloys on the metal ceramic flexural bond strength. Materials and Methods: This in-vitro study was conducted in the Department of Prosthodontics, Crown and Bridge of Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, Haryana, India in October 2020. A total of 60 specimens were fabricated using Ni-Cr and Co-Cr metal alloys (n=30). Different proportions of new and old Nickel-Chromium (Group A) and Cobalt-Chromium (Group B) base metal alloys were used to fabricate the specimens i.e., Control subgroup A0/ B0 (100% new alloy), subgroup A1/B1 (50% new alloy and 50% remnants from subgroup A0/B0), subgroup A2/B2 (50% new alloy and 50% remnants from subgroup A1/B1). Ceramic was applied in the centre of each prepared metal specimen in the dimension of 8×3×1 mm. All specimens were subjected to three point bending test in Universal Testing Machine (UTM) till failure occurred and values were recorded. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) software version 17.5. Data obtained was compiled and analysed using one-way Analysis of Variance (ANOVA), Post-hoc tukey’s and Student t-tests. The p-value <0.05 was considered as statistically significant. Results: In Group A (Nickel-Chromium) and Group B (CobaltChromium), maximum flexural bond strength was observed in subgroup A0, B0 (control subgroup) followed by subgroup A1, B1 whereas minimum was observed in subgroup A2, B2. A highly significant difference (p-value <0.001) in flexural strength was observed among all the subgroups. Metal ceramic bond strength observed in Group A (Ni-Cr) was higher than the metal ceramic bond strength observed in Group B (Co-Cr) in all the subgroups. This difference was statistically significant in subgroup 0 and subgroup 1 equal variances assumed (p-value=0.023), whereas no significant difference was observed in subgroup 2 with equal variance assumed (p-value=0.058). Conclusion:From the present study, it can be suggested that recasting of base metal alloys should be avoided, since it causes significant reduction in metal ceramic bond strength.

Primary Anastomosis vs Creation of Stoma without Anastomosis in Surgical Management of Acute Intestinal Obstruction: A Cross-sectional Study
Introduction: The surgical management of Acute Intestinal Obstruction (AIO) may require resection of non viable gut in presence of strangulated bowel. After gut resection, the surgeon has to choose between a primary anastomosis and a creation of stoma only without anastomosis, to attain an uneventful recovery. Aim: To evaluate and compare the early postoperative outcome of patients of AIO treated with either primary anastomosis or with stoma only, without anastomosis following intestinal resection and to identify the factors associated with postoperative morbidity and mortality in both groups of patients. Materials and Methods: A cross-sectional study was conducted from July 2018 to June 2019 in a teaching hospital with tertiary care facility, on first 100 adult patients of AIO treated surgically within the study period with either primary anastomosis or with stoma formation only following gut resection. Patients undergoing primary anastomosis were placed in Group A (N=48) while patients undergoing stoma formation only were placed in Group B (N=52). Preoperative and postoperative data were collected and final outcome within the first two weeks of postsurgery was noted. The primary outcome was postoperative recovery or death of the treated patients. The secondary outcome was determined using parameters like time taken to resume oral diet, time of discharge from hospital and presence of postoperative complications in both groups of patients. Chi-square test and Mann-Whitney U tests were applied using confidence interval of 95% and p-value <0.05 considered as statistically significant. Results: Mean age in Group A was 44.5 years and in Group B was 38 years. Number of deaths was more in the stoma group and it was statistically significant (p-value=0.029). Among the factors related to death in both the groups, preoperative and postoperative leucocytosis, preoperative and postoperative hypoalbuminemia, preoperative uraemia and hyperkalaemia were more severe in the stoma group and these were statistically significant. Intraoperative presence of feculent peritoneal fluid was significantly higher in the group treated with stoma formation. Diabetes mellitus as a co-morbidity was significantly higher in the stoma group (p-value <0.001). Patients with stoma tolerated oral diet earlier and were discharged home earlier which were statistically significant (p-value <0.001). Wound infection and dehiscence were comparable in both groups. None of the procedure related specific complications were statistically significant in either group. Conclusion: Both procedures have their own benefits and limitations. Irrespective of the surgical procedure, early postoperative outcome is actually governed by factors controlling perioperative sepsis and presence of medical co-morbidities like diabetes. Patients with stoma formation have a better early postoperative outcome. Therefore, stoma formation without anastomosis is comparatively superior to primary anastomosis in AIO.

Risk Factors and Outcome of Respiratory Disease in Children Aged between 2 Months to 5 Years: A Prospective Observational Study

R Swathi, SV Kishore, Madhusmita Pradhan, Jyotiranjan Champatiray
Introduction: Acute Respiratory Infection (ARI) constitutes a leading cause of morbidity and mortality in children. It is one of the major causes of under-five mortality in the world and in India. India is improving its position in ranking following the recent measures it has made toward improving access to child health interventions like Haemophilus influenzae type b (Hib) and pneumococcal vaccination, promoting exclusive breast feeding as well as strengthening critical care services to protect children from severe disease Aim: To assess the risk factors associated with respiratory disease and detect mortality and morbidity among children between the age of 2 months to 5 years. Materials and Methods: The study was conducted in the Department of Paediatrics, SCB Medical and Hospital, Cuttack, Odisha, India. A total of 306 cases of acute respiratory diseases between the age group of 2 months to 5 years admitted during the period from September 2018 to September 2019 were enrolled. After detailed history and examination, the risk factors were compiled. Morbidity was assessed in the form of need for ventilation, prolonged Paediatric Intensive Care Unit (PICU) stay and hospital stay. Chi-square test for categorical data and Kruskal-Wallis test for non parametric data was used to identify whether various risk factors for morbidity and mortality of ARI cases were statistically significant. Results: Out of 2793 children between 2 months to 5 years of age, 306 (10.95%) had ARI. Of these, 288 (94.12%) children survived and 18 (5.88%) died. Most of them were males 186 (60.78%) but mortality was more among females, 10 (8.33%) Children who were not exclusively breastfed were 173 (56.54%) and who were from low socio-economic class (24,79.41%), inadequately immunised were 191 (62.4%), or had bad child rearing practices were 175 (57.2%), had higher risk of ARI were 12 (66.67%) and mortality 18 (100%) was also higher in this group. Sepsis 18 (100%), malnutrition 14 (77.78%) and need for mechanical ventilation 18 (100%) were significant risk factors for mortality. Conclusion: Low socio-economic status, malnourishment and lack of exclusive breastfed for 1st six months of age have significant bearing on the occurrence of ARI. Children between 2-12 months are most vulnerable. Very severe pneumonia and bronchiolitis had a poor outcome.

Association of COVID-19 with MucormycosisAn Appalling and Enervating Disease in North-western India

Preeti Agrawal, Ashish Pandey, Kanishk Mehta, Megha Shukla Pandey
Introduction: The pandemic Coronavirus Disease-2019 (COVID-19) continues to be a significant problem worldwide. The disease pattern ranges from mild to life threatening pneumonia. Association of COVID-19 with mucormycosis is rare but an increase in this association has been observed recently, particularly in a background of immunocompromised state with rhino-orbital-cerebral region being the most common site of involvement. Aim: To study the site and presentation of mucormycosis in COVID-19 patients with histopathological association. Materials and Methods: A descriptive study was conducted at American International Institute of Medical Sciences, Udaipur, Rajasthan, India, in which first 20 patients of COVID-19 with mucormycosis of rhino-orbital region were included in the study. The study was conducted for a period of two months (April-May 2021). Detailed clinical history and associated co-morbidities were noted for each patient. Histopathological examination of all the specimens resected for fungal infection was done along with special stain. Statistical analysis was done using Chisquare test. Results: COVID-19 association with mucormycosis was observed in all 20 cases. Maximum number of cases (11) were present in the age group of 20-40 years. Diabetes Mellitus (DM) had a strong association with mucormycosis. Maxillary sinus was most commonly associated site. Preoperative Potassium Hydroxide (KOH) was positive in all 20 cases, detailed histopathology study along with Periodic Acid Schiff (PAS) stain was performed in all cases. Additional microscopic findings like angioinvasion (03), granuloma (01) and giant cell reaction (13) were also recorded. Conclusion:COVID-19 has emerged as a global threat to mankind. In the present scenario the entire medical fraternity should have a prompt and team approach towards the management of this pandemic, in terms of, early detection of the infection, meticulous use of corticosteroids and screening of co-morbidities to safeguard patients from such life threatening fungal infections.

Association of Oral Melanosis with Soft Tissue Pathologies: A Hospital-based Observational Study

Aarushi Garg, R Maheswari, Aadithya B Urs
Introduction: Oral pigmentation can be physiological/pathological, exogenous/endogenous. Melanin is the most important pigment responsible for normal pigmentation. Recent increasing evidence shows that melanosis occurs in many oral soft tissue pathologies. Aim: To assess the pigmentation in various oral soft tissue lesions with that of normal oral mucosa. Materials and Methods: An observational study was conducted at Maulana Azad Institute of Dental Sciences, New Delhi, India, for a period of six months. A total of 805 study participants were included in the study population. Among these, 605 study participants with soft tissue pathologies with or without tobacco habits were selected and 200 study participants without any pathology and habit comprised were taken as controls. Assessment of oral melanosis was done at various sites within the oral cavity. Prevalence of melanosis with oral lesions and habits was estimated using Statistical Package for the Social Sciences (SPSS) statistical software (version 16.0). Results: Out of 605, 280 cases (46.28%), and out of 200, 54 controls (27%) showed melanosis which was statistically significant. Melanosis was most prevalent in men, in the age group of 21-40 years predominantly involving the buccal mucosa. Maximum cases presenting melanosis were amongst smoked tobacco users and with both tobacco habits were found in leukoplakia (37.7% and 28.3%, respectively). However, 74.2% smokeless tobacco users with melanosis showed Oral Submucous Fibrosis (OSMF) which was statistically significant. Conclusion: Various forms of tobacco consumption commonly induce intra mucosal pigmentation which could be due to high chemical and mechanical irritation by tobacco. The study attempts to assess the overall prevalence of melanosis in study participants with pathologies and habits to understand the implications of melanosis in pathologies in the general population.

Performance of Chip Based Real Time RT-PCR (TrueNat) and Conventional Real Time RT-PCR for Detection of SARS-CoV-2
Introduction: Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is ravaging the globe due to its rapid spread. Since providing fast results is of critical importance in a time of shortage of medical personnel and beds in isolation wards and to ensure timely treatment for patients, developing high quality rapid Point Of Care (POC) diagnostics is essential. Aim: To compare the diagnostic performance of chip based real time Reverse Trancriptase Polymerase Chain Reaction (RT-PCR) (Truenat) which has a shorter turnaround time compared to conventional real time RT-PCR in samples of suspected COVID-19 patients. Materials and Methods: The present cross-sectional observational study was carried out in a tertiary care hospital in New Delhi, India. Five hundred randomly selected Oropharyngeal (OP) swabs samples received from May-July 2020, were included in the study to compare the diagnostic performance of chip based real time RT-PCR (Truenat) with conventional real time RT-PCR for diagnosis of SARS-CoV-2 infection. All statistical analysis was performed using STATA version 16.1 software (College station, Texas, USA). Results: The sensitivity of Truenat test was 100% while the specificity was found to be 99.12% at 95% confidence intervals. The positive predictive value was 91.84% and the negative predictive value was 100%. Conclusion: The short turnaround time, good sensitivity and specificity makes Truenat a reliable and affordable option to provide rapid results in cases requiring urgent interventions and to augment SARS-CoV-2 testing capacity at peripheral settings where sample load is less.

Urinary Kidney Injury Molecule-1 as an Early Detection Biomarker for Diagnosis of Acute Kidney Injury in Patients of Snake Bite

Manjukarthikeyani Krishnamurthy, Neethu Varghese, Sasivadhanam Natarajan
Introduction: Acute Kidney Injury (AKI) refers to a sudden impairment of kidney function that results in the retention of nitrogenous waste products. Acute tubular necrosis involves localised necrosis of epithelial lining in renal tubules. A soluble form of human Kidney Injury Molecule-1 (KIM-1) is a type 1 membrane-spanning protein which lends epithelial cells the capacity to perceive and phagocytose dead cells in post ischaemic kidney. Aim: To estimate urinary KIM-1 level in patients with snake bite as a potential biomarker for early detection for AKI. Materials and Methods: This was an analytical case-control study, which was conducted on 100 patients admitted for snake bite at Thanjavur Medical College and hospital, Thanjavur, Tamil Nadu, India, from January 2014 to August 2014. Patients without AKI were regarded as controls and those who developed AKI were considered as cases. Blood and urine samples were collected and analysed for urinary KIM-1 by Enzyme-Linked Immunosorbent Assay (ELISA), method, serum creatinine (by kinetic JAFFE’S method) and serum urea (by Urease- glutamate dehydrogenase method). Student’s t-test was used and p-value <0.05 was regarded significant. Pearson’s correlation coefficient was used to assess correlation between measured parameters. Results: Among 100 patients, 44 were diagnosed as patients having AKI and 56 of them did not develop AKI. No significant difference was found in urinary KIM-1 values between age group of <40 years and age group ≥40 years in cases (p-value=0.39) and in controls (p-value=0.65). A significant elevation of urinary KIM-1 was seen among cases of snake bite who developed AKI. Urinary KIM-1 levels were found to significantly rise within 24 hours of admission (p-value <0.001), whereas, serum creatinine and urea values were not increased until the day 3 of nephrotoxic trauma. The urine KIM-1 and serum creatinine on day 1 had negligible correlation (r-value=0.093, p-value=0.54) and urine KIM-1 and urea on day 1 had low positive correlation (r-value=0.380, p-value=0.011). With progressive damage to the kidneys, a positive correlation was found between urine KIM-1 and serum urea (r-value=0.864), creatinine (r-value=0.882) on third day. Also, levels of urinary KIM-1 significantly increased (p<0.001) with the severity of tubular injury. Conclusion: Urinary KIM-1 is a promising quick predictive marker of AKI in contrast to traditional markers, serum urea and creatinine.

Effects of Mentoring in First Year Medical Undergraduate Students using DASS-21
Introduction: Medical students often require high level of specialised institutional and personal support to facilitate success. Distress is commonly observed in medical undergraduate students which leads to poor academic performances. The stress though looks reasonable it needs to be addressed with right amount of counseling. A good mentoring session helps in reducing depression, stress and anxiety. Aim: To determine the effects of mentoring in first year medical students using Depression, Anxiety and Stress Scale - 21 Items (DASS 21). Materials and Methods: It was an interventional study conducted in Seth GSMC, Department of Physiology, Mumbai, Maharashtra, India, from July 2019 to February 2020. Total 120, first-year medical undergraduates were recruited in the study. At the beginning, an orientation session was conducted for the faculty. Mentoring sessions were conducted for students once in a week. Data was collected using DASS-21 in the beginning in July 2019 to February 2019. Statistical analysis was done using Wilcoxon sign rank test. Five-point Likert scale was used for qualitative analysis of the feedbacks received from mentors as well as mentees. The p-value <0.05 was considered as significant. Results: Out of 15 faculty members were eight were males and seven were females with mean age of 47±8 and 46±1 years, respectively. Among mentees, 64 were males and 56 were females with mean age of 17±8 and 17 ±6 years. A significant decrease was obtained in the levels of depression, anxiety and stress scores of students after mentoring. Wilcoxan sign rank sum test was used. The p-value before and after mentoring session was 0.00418 for Depression, 0.00033 for anxiety and 0.00805 for stress. Conclusion: Mentoring was found to reduce stress, anxiety and depression in first-year medical undergraduate students. The mentoring program was found to be useful to students as well as faculty. It should be extended through all the years of under graduation.

Proprioceptive Neuromuscular Facilitation Techniques versus Closed Kinematic Chain Exercises in Scapular Dyskinesia among Hospital Housekeeping Staff: An Experimental Study
Introduction: Housekeeping staff in the hospitals perform various overhead upper extremity motions. These repeatedly performed movements in turn place high physical load on the shoulder joint causing weakness of the scapulothoracic muscles which in turn may lead to scapular dyskinesia. Scapular Dyskinesia is the alteration in normal position or motions of the scapula during arm movement. Proprioceptive neuromuscular facilitation techniques apply neuro-physiological principles to the sensory and motor system to treat various neuro-musculoskeletal dysfunctions. Aim: To evaluate the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) techniques versus Closed Kinematic Chain (CKC) exercises on pain, scapula position and upper extremity work related musculoskeletal disorders in housekeeping staff with scapular dyskinesia. Materials and Methods: This single blinded experimental study, in which participants were blinded to the treatment allocated was conducted between June 2019 to January 2020, at Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Thirty housekeeping staff with scapular dyskinesia, suffering from neck or/and shoulder pain, and aged 18-40 years were randomly assigned to one of the two groups-group A (PNF) or group B (CKC). Both groups received intervention for five days per week for four weeks. Outcome measures were the Numeric Pain Rating Scale (NPRS), Lateral Scapula Slide Test (LSST), Extended Nordic Musculoskeletal Questionnaire (ENMQ) which was assessed pretreatment at 2nd and 4th week of intervention. Data was analysed in PRIMER of biostatistics version 7.0 statistical software. The Friedman Test was used for intra group comparison whereas the Mann-Whitney Rank Sum Test was utilised for intergroup comparison of the results. The statistical difference significance was set at p-value <0.05 for all the tests performed. Results: The mean age of participants in group A and group B were 35.14±4.73 and 33.08±4.51 years, respectively. All the outcome measures on intragroup analysis showed significant improvements. Intergroup comparison revealed no statistical significant difference in the scores of NPRS on rest and activity between both the groups. The LSST for right side of position 3 (p-value=0.04) and of position 1 (p-value=0.02), 3(p-value=0.002) on the left side, showed stastically significant difference between both groups. There was also greater improvement in the scores of ENMQ in the participants of group A receiving PNF compared to group B which received CKC Exercises. Conclusion: The present study proved that both PNF techniques and CKC exercises show significant improvement on pain intensity, increase in the scapular muscle strength and reduction in the upper extremity work related musculoskeletal disorders. However, when compared (LSST and ENMQ), PNF techniques showed statistically greater improvement than CKC exercises.

Does the Pattern of Endometrium Influence the Frozen Embryo Transfer Cycle Outcome?
Introduction: Implantation rates vary between 25-35% despite all advancements in Assisted Reproductive Technology (ART). Successful implantation requires embryo endometrial synchrony. Transvaginal Ultrasonography (TVS) plays an essential role in assessing endometrial receptivity. Aim: To study the influence of different echo patterns of the endometrium in predicting the outcome of Frozen Embryo Transfer (FET) cycle. Materials and Methods: A prospective observational study was performed to determine the effect of endometrial pattern on the outcomes of FET cycles. A total of 348 women who underwent endometrial preparation for FET from January 2012 to December 2017 were included. On the day of starting progesterone, the study participants were divided into three groups based on the endometrial pattern: Type A: Triple line or multilayer pattern; Type B: Isoechoic pattern; and Type C: Hyperechoic pattern. The association of endometrial pattern with the outcomes of FET cycles- pregnancy rate (primary end point), clinical pregnancy and live birth rate (secondary outcome), were determined. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 software using paired student’s t-test, Chi-square test, Fisher’s-exact test, Analysis of Variance (ANOVA) and logistic regression. A probability value of <0.05 was considered statistically significant. Results: The baseline characteristics such as Body Mass Index (BMI), duration, type and causes of infertility, were comparable between the study groups. There was no significant difference in the pregnancy, clinical pregnancy and miscarriage rates, and live birth rates between the study groups (Pregnancy rate: Type A: 55.9%; Type B: 51.2%; and Type C: 44.4%; p=0.594). Conclusion: According to the above findings, the endometrial pattern doesn’t significantly influence the outcomes of FET cycles.

Oxidant-antioxidant Status Discrepancy between Patients with ST Segment Elevation and Non ST Segment Elevation Myocardial Infarction: A Case-Control Study
Introduction: Depending on the degree of coronary artery occlusion and the damage to the myocardium, two types of myocardial infarction can be distinguished: non ST Elevation Myocardial Infarction {NSTEMI type (without ST segment elevation)} and ST Elevation Myocardial Infarction {STEMI type (with ST segment elevation)}. Consequently, this may lead to diverse levels of Reactive Oxygen Species (ROS) and dissimilar oxidative profile between the two conditions. Aim: To assess the oxidant-antioxidant status in STEMI versus NSTEMI patients and healthy controls. Materials and Methods: This case-control study was carried out from September 2018 to March 2019. A total of 67 Acute Myocardial Infarction (AMI) patients, categorized into two groups: those with STEMI (Group 1) and those with NSTEMI (Group 2), were enrolled into the study, and were compared with 75 healthy controls. Oxidant-antioxidant markers, lipid profile and uric acid were quantified for all participants. Statistical comparison between all groups was performed by one-way Analysis of Variance (ANOVA) test followed by Tukey post-hoc test. Results: The findings showed a significant increase in the level of oxidative markers as determined by serum Malondialdehyde (MDA), Carbonyl Proteins (CP), Nitric Oxide (NO•) and superoxide radicals (p-value<0.001) in AMI patients particularly in those with STEMI. Concomitantly, there was a notable decrease in the level of antioxidants such as Glutathione (GSH) and catalase (p-value<0.001). A noteworthy raise was also noticed in the serum uric acid concentration in patients with AMI as compared to healthy subjects. However, no statistically significant difference between the two cases groups was revealed. Conclusion: The magnitude of imbalance between oxidant and antioxidant markers is greater in STEMI patients, most likely because of the expanse of myocardial necrosis and superior occlusion of their coronary arteries.

Students Perception of their Educational Environment in a Medical College in India- A Survey using DREEM Questionnaire

Muralidhar Reddy Sangam, Mangala Charana Das, S Krishnan
Introduction: Educational plays an important role in the achievement of student’s academic success. Understanding the perception of students towards their educational environment helps to identify the lacunae in the curriculum and make the changes accordingly. Aim: To assess the perceptions of the students towards medical education using Dundee Ready Educational Environment Measure (DREEM) questionnaire as a tool. Materials and Methods: This was a cross-sectional study done at NRI Medical College, Guntur, Andhra Pradesh, India, from September 2020 to December 2020. A total of 414 students participated in the study. The DREEM questionnaire was used to collect the data. The questionnaire consists of five components with 50 statements assessed on five-point Likert scale (0-4). Data were expressed as mean and standard deviation, frequency, and percentages. Independent t-test and one-way Analysis of Variance (ANOVA) were used for comparing the groups. Results: Out of 600 students, 414 filled in the forms and submitted them (response rate was 69%). 266 (64.2%) were female and 148 (35.8%) were males. Age of the students ranged from 17 to 25 years with mean age 22.64±2.62 years. The mean DREEM score of study population was 130±6.7/200 which indicated a more positive than negative perception of learning. Subscale scores for student’s perception of learning, perceptions of teachers, academic self-perceptions, perceptions of atmosphere and social self-perceptions were 30.9±2.4, 28.9±1.5, 22.4±3.1, 30.8±2.3 and 16.9±1.7 respectively. Conclusion: There was a positive perception of students towards their educational environment. Strong areas were student's confidence, teacher's knowledge, and curricular relevance. Weak areas were identified as the inability to provide constructive criticism by teachers, the teachers were authoritarian and necessary steps can be taken for the improvement.

A Retrospective Study on Adverse Drug Reactions of Anticancer Drugs in a Tertiary Care Hospital in Northeast India
Introduction: Anticancer drugs account to high susceptibility towards Adverse Drug Reactions (ADRs) due to their narrow therapeutic window and increased toxicity, which makes pharmacovigilance studies essential. Aim:To determine the nature and severity of ADRs in cancer patients based on the reports received from the Department of Radiation Oncology to the Pharmacovigilance centre of a tertiary care hospital. Materials and Methods:A retrospective, descriptive study was conducted in the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India on the patients who developed ADRs due to anticancer drugs during the period from January 2018 to December 2020. These ADRs were assessed for causality using World Health Organisation- Uppsala Monitoring Centre (WHOUMC) criteria. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 and frequencies and percentages were determined for each variable. Results: A total of 913 ADRs were reported from 334 patients. Total 62.57% females developed ADRs and age group of 51-60 years (31.14%) were affected the most. Bronchogenic carcinoma (20.9%) was found to be the most common cancer and haematological system (31.11%) was mostly affected. Most common ADRs observed were alopecia (16.32%) followed by anorexia and anaemia. Carboplatin (23.21%) followed by Cisplatin, Paclitaxel, Docetaxel were the most common drugs causing different ADRs. On causality assessment, as per WHO-UMC criteria 67.25% ADRs were 'probable' and 32.75% were ‘possible’. Severity assessment using modified Hartwig and Siegel scale showed 56.41% ADRs as mild, 41.95% moderate and 1.64% severe reaction. Preventability assessment using Schumock-Thornton scale showed 44.69% ADRs were ‘not preventable’ whereas 41.62% ADRs were ‘definitely preventable’ and 13.69% were ‘probably preventable’. Conclusion: The use of anticancer drugs is associated with various adverse effects. However, early detection of the ADRs may help to modify the doses or the drug regimen to minimise the adverse effects.

Merits of Enhanced Recovery after Surgery Protocol following Whipple Pancreaticoduodenectomy: A Pilot Study
Introduction: While Enhanced Recovery After Surgery (ERAS) has been widely implemented in upper and lower gastrointestinal operations, its application after whipple pancreaticoduodenectomy remains at an experimental level and has not been accepted as a standard of care in most centers including ours. Aim: To assess the merits and safety of ERAS after Whipple pancreaticoduodenectomy. Materials and Methods: This was a pilot study (prospective cohort study design) conducted at Christian Medical College Vellore, Tamil Nadu, India. Total 30 consecutive patients who underwent whipple procedure between September 2016 and May 2017 were managed using the ERAS protocol in the postoperative period. The operations were performed by one of the three senior surgeons and a standard method of reconstruction was followed. All patients underwent a feeding jejunostomy as part of the operation. The primary end point was duration of hospital stay and secondary end points were number of days required for urinary catheter removal, ambulation, cessation of intravenous fluids, discontinuation of infusional analgesia, removal of nasogastric tube, normal oral intake and drain removal. The rates of complications including Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), intra abdominal collection, post pancreatectomy haemorrhage and death were also calculated and compared with previous year data to assess the safety of ERAS protocol. Results: Mean age of patients was 53.9 years. There were 26 males and four females in this study. Total 21 out of the 30 patients had ampullary adenocarcinoma. More than 80% of the patients achieved milestones like urinary catheter removal, ambulation, cessation of i.v. fluids and infusional analgesia. Total 14 out of 30 (46.6%) patients tolerated normal diet by day 6 and 17 patients were managed without utilising the feeding jejunostomy. Drains were removed only in seven patients as per protocol. The mean hospital stay was 20.1 in comparison to the mean stay of the previous year which was 22.8 days. However, 15 patients were fit for discharge by day 15 based on discharge criteria, but were not discharged as the patients wanted to stay longer. There was no increase in morbidity or mortality in comparison to the previous year. Conclusion: The implementation of ERAS protocol appears to have no negative impact in the postoperative recovery in the patients with a potential for shortening hospital stay without added postoperative morbidity

Effects of a Mindfulness-based Intervention on Chronic Pain Sufferers: Lessons Learned from a Replicated Single-case Design Study in an Indian Setting
Introduction: Chronic pain is an emerging healthcare problem in India. Chronic pain is not physical pain alone it has psychological, social, and economic perspectives. The treatment modalities of chronic pain in India mostly focus on physical pain. It is important to search for an optimal-cost selfhelp therapy that can help the sufferer to live a meaningful life despite the chronic pain. Mindfulness, gaining popularity in the western world maybe a viable option. Aim: To explore the preliminary effects of mindfulness on different outcome variables like pain intensity, chronic pain acceptance, anxiety and depression and World Health Organisation-Quality Of Life (WHO-QOL) in Indian chronic pain sufferers. Materials and Methods: This replicated single-case design study was conducted at Harmony Mindfulness Centre and Kalyani ESI Hospital, Kolkata, West Bengal, India from December 2020 to May 2021. The effects of a face-to-face eight-week mindfulness based intervention were studied in six chronic pain sufferers. The quantitative variables like Numerical Rating scale (NRS), Chronic Pain Acceptance Questionnaire (CPAQ), WHO-QOL, and Hospital Anxiety and Depression Score (HADS) were studied at three time points; pre-session, immediate post-session and six months after completion of the session. Reliable Change (RC) based on Reliable Change Index (RCI) was calculated and modulus RC i.e., |RC| > 1.96 was considered to be statistically significant with p-value <0.05. Qualitative data was collected post-session by getting written responses to a question “How did you experience the effects of this mindfulness based intervention?” The responses were categorised into five emergent themes to determine which aspect of the programme appealed to the participants the most. Results: The pre-session variables showed significant improvement (p-value <0.05) based on the reliability change index in post-session. The post-session improvement in the variables was maintained even at six months follow-up. Positive mental state was the most common theme marked by participant’s post-session. Conclusion: The Mindfulness-Based Intervention (MBI) has a positive impact on pain intensity, chronic pain acceptance, anxiety and depression and QOL of Indian chronic pain sufferers.

Association between Non Alcoholic Fatty Liver Disease and Severity of Coronary Artery Disease in Patients Aged 45 Years and Below with Acute Coronary Syndrome
Introduction: Coronary Artery Disease (CAD) is an important extrahepatic cardiovascular complication of Non Alcoholic Fatty Liver Disease (NAFLD). Aim: To determine the prevalence of NAFLD in young (≤45 years) Acute Coronary Syndrome (ACS) patients, and to assess the association between severity of NAFLD and severity of CAD. Materials and Methods: This cross-sectional study was conducted from May 2017-April 2018, with a total of 85 patients. CAD severity was determined by coronary angiogram while its complexity by SYNTAX score. Fatty liver was diagnosed and graded by liver ultrasound examination. Results: The prevalence of NAFLD was 100%. Thirty-three (38.9%) had ST-Elevation Myocardial Infarction (STEMI), 32 (37.6%) had Non STEMI (NSTEMI) and 20 (23.5%) had unstable angina. There was no significant correlation between NAFLD steatosis grades and ACS subtypes (p=0.721), severity of CAD (p=0.822) and SYNTAX score (p=0.982). No association between NAFLD fibrosis score and ACS subtypes (p=0.232), severity of CAD (p=0.445) or SYNTAX score (p=0.839) were observed. Conclusion: The NAFLD was extremely prevalent in young ACS patients. However, no significant association between severity of NAFLD and severity of CAD was found.

Small Bowel Obstruction in the Virgin Abdomen: A Retrospective Study for a New Management Pathway

Asma Chaabouni, Hichem Jerraya, Chadli Dziri, Ramzi Nouira
Introduction: Adhesions are the main cause of Small Bowel Obstruction (SBO) for patients with previous abdominal surgery. In this case, conservative management has traditionally been efficient. However, aetiologies and therapeutic decisions are less obvious to determine for patients without previous abdominal surgery. Aim: To identify the accuracy of the results of clinical findings, laboratory investigations and Computed Tomography (CT) scan as tools to suggest a management pathway to deal with SBO in the virgin abdomen. Materials and Methods: This retrospective study included 59 patients that had been admitted for SBO with a virgin abdomen between January 2008 and December 2016. Clinical, laboratory and radiological findings were assessed to determine the difference between the urgent surgical versus the non operative management groups. Statistical analyses were performed using SPSS version 24.0. Logistic regression was used to determine the independent predictive factor of an urgent surgery. Results: Overall, 59 patients with no prior abdominal surgery were admitted to Department. There were 37 males and 22 females. The median age was 52 years. The CT scan performed in 52 cases, revealed the cause of obstruction in 35 cases (67.30%). The most common cause of obstruction was Crohn’s disease present in 13 cases (22.03%). Twenty-nine patients (49.15%) underwent surgery. A rate of C-Reactive Protein (CRP) >135 mg/L was an independent predictor of an urgent surgery {p-value=0.010; OR=1.009 ; IC=95% (1.001-1.018)}. Conclusion: Although there was compelling evidence that the CT scan was essential in the management pathway, it was not accurate in the present study in terms of determining the causes of obstruction and predicting the need for performing urgent surgery. A rate of CRP =135 mg/L was a predictive factor of urgent surgery.

Study of Urinary Glycosaminoglycans among Essential Hypertensive Patients

IC Devaraj , Dhiraj J Trivedi , Vidya S Patil , V Indumati , NB Sanjeevini
Introduction: Essential hypertension is a systemic disease which affects endothelial basement membrane. Changes in Glycosaminoglycans (GAG) distribution pattern on glomerular basement membrane has been noted in hypertension. Hence it seems likely that an increase excretion of GAG levels may be an indicator of reduction in renal function. The qualitative or quantitative determination of urinary GAGs may be of value and could constitute a non invasive marker to assess the renal damage in essential hypertension. Aim: Differential analysis of urinary GAGs in essential hypertensive patients. Materials and Methods: This analytical case-control observational study which was conducted from November 2014 to June 2016 in Department of Biochemistry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The study group included 50 male patients with age group of 30-60 years, clinically diagnosed with essential hypertension. Control group included 50 healthy male individuals with age group of 30-60 years, blood donors visiting to hospital blood bank. Random urine sample was collected. Urine creatinine was estimated by Jaffe’s method, urine GAGs by Dimethyl methylene blue (DMMB) dye method and urine microalbumin by particle enhanced Turbidimetric inhibition immunoassay method. Correlation was tested with Spearman’s correlation coefficient. Level of significance was set for p-value <0.05 with confidence interval of 95%. Results: In present study, urinary GAGs levels in essential hypertensive study group was 14.57±10.16 mg/dL and in control group was 10.09±6.04 mg/dL. Urinary GAGs levels in essential hypertensive group was significantly high (p-value=0.890) when compared with normotensive control group. But no statistical significant correlation was found between urine GAGs and urine microalbumin in hypertensive study group. Conclusion: Estimation of urine glycosaminoglycans in essential hypertensive patients is a simple, rapid and cost effective test which asseses the glomerular function. It can be used as one of the early marker for diagnosis of nephropathy before microalbuminuria sets in.

Occlusal Contact Points, Areas and Bite Force Distribution in Angle's Class I, II and III Patients using T-scan
Introduction: Number of occlusal contacts and uniform bite force distribution during maximum intercuspation are determinants of a good functional occlusion. Distribution of posterior contacts in the three malocclusion groups along with force distribution has been a topic of research. Aim: To quantify the number of occlusal contacts and areas, bite force distribution in Angle’s Class I, II, III subjects using T-scan and to identify the center of force trajectory. Materials and Methods: This cross-sectional, observational study was conducted in the Department of Orthodontics, SRM College, Chennai, Tamilnadu, India from June 2018 to December 2018. 45 subjects in the age group of 18 to 24 years were divided into three groups of 15 subjects each based on Angle’s classification of malocclusion with teeth in normal line of occlusion. T-Scan system sensor and software were used to record and store data. The collected data were analysed with IBM Statistical Package for the Social Sciences (SPSS) software version 23.0. The descriptive statistics were performed, followed by Analysis of Variance (ANOVA). Post-hoc Tukey test was done to find the difference between the groups. Chi-square test was done for the categorical data and the Paired t-test for determining the significant difference between the bivariate samples in paired groups. Level of significance was set at p<0.05. Results: Out of three study groups mean contact points (p<0.001), contact areas (p<0.001) and bite forces (p=0.0032) were statistically highly significant in Angle’s class I group when compared to the other groups. Statistically, the right and the left side differences in force distribution of the three groups were significant with the forces predominantly being higher on the right side. Conclusion: Subjects with Angle’s Class I molar relation had greater contacts, contact area and better bite force distribution. There was preference to the right side in bite force distribution in all the three groups. Center of force trajectory was concentrated between first and second molars in all the groups.

Primary Gastrointestinal Lymphomas in Adults: An Institutional Experience of 15 Years from Northern India
Introduction: Primary Gastrointestinal Lymphomas (PGIL) are uncommon and distinct Gastrointestinal Tract (GIT) malignancies which vary in their epidemiologic and clinicopathologic features worldwide. Since gastrointestinal malignancies are commonest malignancies in Kashmir valley, we intended to study PGIL in our hospital set up. Aim: To study the clinicopathological and demographic profile of PGIL Materials and Methods: This combined retrospective (eight and a half years) and prospective (six and a half years) descriptive observational study of 15 years was performed at Sher-i-Kashmir Institute of Medical Sciences, Srinagar from April 1998 to March 2013. Total 93 cases were included as per Dawson’s criteria. All the cases were reviewed and reclassified according to the World Health Organisation (WHO)-Revised European American Classification of Lymphoid Neoplasms (REAL). Statistical analysis was done using GraphPad Prism 8. Results: Ninety-three patients (Male:Female ratio, 3:1) with a mean age of 47 years (age range=18-70 years) were studied. Patients mostly presented with non specific symptoms like abdominal pain (n=79) and anorexia (n=45); and small intestine (n=30), stomach (n=27) and large intestine (n=26) were the major sites affected. Histopathological and Immunohistochemical (IHC) studies revealed most of them to be Non Hodgkin’s Lymphoma (NHL) of B-cell type (n=89) with Diffuse Large B-Cell Lymphoma (DLBCL), the commonest subtype (n=66) followed by Mucosa Associated Lymphoid Tissue (MALT) lymphoma (n=21). Stage distribution included 64 stage IE, 27 stage IIE and two stage IIIE patients. Surgical resection was performed in 53 patients along with chemotherapy (25), chemoradiotherapy (20) and anti-Helicobacter pylori (anti-H. pylori) treatment (2). Forty patients received chemotherapy without surgery, along with anti-H.pylori treatment (14) and radiotherapy (7). Mean survival of patients was 42 months. Conclusion: Primary Gastrointestinal Lymphomas (PGIL), although uncommon GIT malignancy, can clinically mimic any GIT disease and can involve any part of GIT. A high degree of suspicion can pick up these lymphomas early and a judicial combination of surgery, chemotherapy and radiotherapy can be offered for better survival. Further, IHC studies including genetic and molecular studies along with long term follow-up studies, are required to have a better understanding of these lymphomas in our region.

Neurodevelopmental Profile of Preterm Babies in the First Year of Life: A Prospective Cohort Study

Richa, Monika Sharma, Inderpreet Sohi
Introduction: Improved survival of preterm babies has also increased the incidence of neurodevelopmental problems. The first year of life is the most sensitive period for early intervention and hence targeting early detection principles to this age will be most useful. Aim: To study the neurodevelopmental profile of preterm babies (<35 weeks), born in a tertiary care hospital, till the age of 12 months of Corrected Gestational Age (CGA). Materials and Methods: The prospective cohort study was conducted between January 2014 and August 2015 at Christian Medical College and Hospital, Ludhiana, Punjab, India. All preterm newborns (<35 weeks) born in the tertiary care hospital during the study period were included. A total of 57 babies were enrolled. Neuromotor assessment at discharge and on follow-up at six and 12 months of CGA was done using Infant Neurological International Battery (INFANIB) and Developmental Assessment Scales for Indian Infants (DASII). One-way Analysis of Variance (ANOVA), Chi-square test, Fischer 's-Exact test and inter-rater kappa agreement were used for statistical analysis. Results: A total of 78 preterm (35 weeks) were born, 21 were excluded, 57 were enrolled and 42 babies were followed-up till 12 months of CGA. The mean INFANIB score at discharge, 6 months and 12 months of CGA were 58.93±5.11, 68.74±7.71 and 82.95±5.90, respectively. At 12 months of CGA, 64% of the babies were normal, 33.33% were transient and 2.8% were abnormal as per INFANIB. The mean DASII score for Motor Development Quotient (MoDQ) at six and 12 months were 89.84 ±8.41 and 93.49±10.39, respectively, whereas Mental Development Quotient (MeDQ) at six and 12 months, were 70.39±10.54 and 65.58±13.19, respectively. The neuromotor assessment of infants with INFANIB compared well with the motor developmental score on DASII with an inter-rater kappa agreement of 1 (kappa=1). Conclusion: The preterm babies showed improvement in motor development quotient, but not in mental development quotient. Results of INFANIB and DASII matched in their motor assessment. The INFANIB is a reliable and quick tool for neuromotor assessment.

Cerebrospinal Fluid Leak in Base of Skull Fractures- Incidence and Complications
Introduction: Cerebrospinal Fluid (CSF) leak is a serious complication in base of skull fractures with high probability of complications like meningitis. Aim: To find out incidence and duration of CSF leak, occurrence of meningitis, type of organism and antibiotic sensitivity and incidence of those requiring surgery among the head injury patients with base of skull fracture. Materials and Methods: A prospective cohort study was conducted in the Neurosurgery and General Surgery Ward, Government Medical College, Kozhikode, Kerala, India. All patients with clinically evident CSF leak in base of skull fracture from 15th April 2017 to 30th November 2018 were included in the study. Incidence of CSF leak, incidence of meningitis and patients requiring surgery were noted. Results were expressed in terms of frequency and percentages. Results: A total of 167 patients were included in the study. Total 81 (48.49%) patients was between 21-40 age group (years). The most common mode of injury was road traffic accidents, accounting to 83.23%. Of the total 167 patients, 35 patients (20.95%) developed post traumatic CSF leak. Of these 30 (85.71%) had CSF rhinorrhea and 6 (17.14%) had CSF otorrhea. Duration of CSF leak was 1 day in 18 patients (51.42%), 2-10 days in 10 patients (28.57%), more than 10 days in 7 patients (20.00%). Meningitis occurred in 9 out of 35 (25.7%) patients. Most common organism was Streptococcus, found in 2 patients (22.2%), followed by resistant Klebsiella. Cultures were sterile. Two Streptococcus infected patients were found to be sensitive to penicillin. Of the total 35 only 7 patients (20%) needed surgical interventions. Conclusion: The incidence of CSF leak in patients with base of skull fractures is approximately 20%. Most of the cases resolve spontaneously. With persistent leak, there is significant morbidity and mortality in the form of meningitis and requirement of surgery for repair of defect.

Immunohistochemical Expression of Galectin-3 and Cytokeratin 19 in the Spectrum of Thyroid Neoplasms

Ankita Pranab Mandal, Rama Saha, Sudipan Mitra
Introduction: In systemic malignancies, thyroid carcinoma represents only 1%, but it is the most common endocrine malignancy with poor prognosis. Fine Needle Aspiration (FNA) is considered a requisite tool in providing a rational advent for the clinical management of these nodules. However, when solely based on cytopathological assessment, FNA leads to imprecise biopsy results in 10-20% of all cases. So, immunohistochemical markers, Galectin-3 (Gal-3) and Cytokeratin 19 (CK19) have received considerable attention as diagnostic marker for thyroid cancer. Aim: To study the expression of Gal-3 and CK19 in different thyroid neoplasms. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital from January 2019 to January 2021 on 120 cases. The thyroidectomy specimens received were fixed in 10% buffered formalin followed by gross examination. The paraffin embedded tissue blocks were subsequently stained for Haematoxylin and Eosin stain (H&E) followed by histopathological reporting. Qualitative immunohistochemical assessment of the marker Gal-3 and CK19 was performed on representative histologic sections of the thyroid neoplasms. Data were analysed using Graph Pad Instat 3. Results: The positive expression of Gal-3 was significantly more in malignant tumours (87.5%) than in benign (36.0%) (p-value <0.001). In Papillary Thyroid Carcinomas (PTC) and in Follicular Variant of Papillary Thyroid Carcinomas (FVPTC) expression of Gal-3 was notably higher than in Follicular Adenoma (FA) (p-value=0.01 and p-value=0.0001, respectively). Follicular Thyroid Carcinomas (FTC) had higher expression FA (p-value=0.003). In malignant tumours (71.8%), positive expression of CK19 was significantly more than benign tumours (24.0%) (p-value <0.001). Significant difference in expression of CK19 was seen between PTC and FTC (p-value=0.019). Between PTC and FA, differences in expression were significant (p-value <0.001). Significant difference in expression was also seen between FVPTC and FTC (p-value=0.032) as well as with FA (p-value=0.028). Conclusion: The most sensitive marker is Gal-3 for the diagnosis of thyroid malignancies. When combined with CK19, the specificity increases in identifying the thyroid cancers. More combination of markers together with Gal-3 and CK19 can be useful in the distinction between malignant and benign thyroid tumours because it is essential for further treatment and long-term management of the patient.

Correlation of BCL-2 and Ki-67 Expression with Clinicopathological Parameters in Oral Squamous Cell Carcinoma

S Ganraj Bhat, Sulata M Kamath, Vijaya V Mysorekar
Introduction: Oral Squamous Cell Carcinoma (OSCC) is the most common oral malignancy. Despite advancements in cancer therapeutics, early diagnosis, and prognosis of OSCC remains challenging. Evaluating clinicopathological characteristics, molecular biomarkers and their expression helps comprehend biological traits and tumour behaviour, which is crucial for early diagnosis and favourable prognosis. Aim: To evaluate the immunohistochemical expressions of B-cell Lymphoma 2 (BCL-2) and Ki-67 in OSCC and to correlate their molecular expressions with clinicopathological tumourigenic parameters. Materials and Methods: This cross-sectional study was conducted at Ramaiah Hospital, Bangalore, Karnataka, India, over a period of two years from June 2017 to May 2019 on 60 radical resection specimens of OSCC. After gross specimen examination, multiple representative tissue bits were obtained and subjected to Haematoxylin and Eosin (H&E) staining and staged. Immunohistochemical detection of BCL-2 and Ki-67 expression, semi-quantitative and intensity assessment of staining was performed. Data were analysed using statistical software R-version 4.0.1. The p=0.05 was considered statistically significant. Results: The mean age was 57.88±13 years, and a large proportion were females (49, 81.67%). Mean BCL-2 and Ki-67 expression (%) were 24.58±11.29 and 29.5±17.21, respectively. The correlation of BCL-2 (p<0.001) and Ki-67 (p<0.001) expression with histological grades was statistically significant. The correlation of BCL-2 and Ki-67 expression with gross/ clinicopathological features was not significant. A positive moderately strong significant correlation existed between BCL-2 and Ki-67 expression (p<0.001). Conclusion: The BCL-2 and Ki-67 expression is independent of clinicopathological features of OSCC but is directly associated with increasing tumour grades. There is a direct moderately strong correlation between BCL-2 and Ki-67, indicating adverse clinical outcome. Their early identification is critical for effective therapeutic intervention and desirable prognosis.

Access to Healthcare during Lockdown, and its Effect on Glycaemic and Blood Pressure Control in Patients with Type 2 Diabetes and Hypertension- A Cross-sectional Study

Anoop Joseph, Sowmya Mathew
Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic had an impact on the health of patients with pre-existing comorbidities due to increased risk of hospitalisation and mortality. This study looked at accessibility of healthcare and pharmacy services, preference for telemedicine and changes in the diet and lifestyle patterns of patients with type 2 diabetes and hypertension during lockdown. Aim: To assess how the lockdown impacted the accessibility to healthcare, diet and lifestyle, and its overall impact on the glycaemic and blood pressure control of this population. Materials and Methods: A descriptive, cross-sectional study was done at Father Muller Hospital, Thumbay (Dakshin Kannada district, Karnataka, India). It involved patients who had type 2 diabetes and/or hypertension and was done over a period of six months from May 31, 2020 (the day lockdown was lifted) to November 30, 2020. A questionnaire was administered. The questions related to proximity and accessibility of healthcare and pharmacy services, awareness, preference for telemedicine, availability of glucometer and blood pressure machines, and diet and lifestyle changes in lockdown were asked. The Body Mass Index(BMI), Glycated Haemoglobin (HbA1c) levels, and blood pressure measurements, before and after the lockdown were compared. Data was tabulated on an excel worksheet and analysed by calculating frequency (n), percentages (%), mean±standard deviation and paired t-test. Results: A total of 115 patients were interviewed (64 females, 51 males). A total of 74.8% of patients reported that their nearby health centres were open, but only 26.1% patients chose to visit. A 95.7% of patients had no difficulty in getting medications. Few (25.2%) were aware, and fewer (17.4%) had access to telemedicine during the lockdown. The percentage of 53% would prefer telemedicine, though how many used this facility was not assessed. Most (91.3% and 85.2%, respectively) were compliant with medication and the recommended diet. A 60.7% noted no change in levels of physical activity. Those who smoked or consumed alcohol did not report any increase in consumption. An insignificant increase was noted in the BMI, systolic blood pressure and the HbA1c levels after lockdown. Conclusion: Despite reduced access to healthcare facilities, BMI, glycaemic and blood pressure control were not significantly affected. This was probably due to the easy availability of medications, and the relatively few changes in the diet and lifestyle of most patients.

Effect of Erosive Challenges on Microhardness of Three Different Nanocomposites: An In-vitro Study
Angiokeratomas are rare benign mucocutaneous lesions that result from distension of subepidermal vessels, along with hyperkeratotic epidermis. Mucosal angiokeratomas are more commonly seen as a constituent of systemic variant called angiokeratoma corpus diffusum or may co-exist with similar lesion in the other sites of the body as seen in Fordyce’s or congenital forms. Solitary lesion in oral cavity is very infrequently seen and till date very few cases have been reported in literature. The biologic significance of angiokeratomas may vary greatly, which may range from lesions that have very little clinical repercussion to widespread eruptions that are a manifestation of potentially fatal, systemic, metabolic diseases therefore it is important that these lesions should be identified and evaluated to rule out underlying pathologic conditions. Hereby, authors reported a case of a 24-year-old male who presented with a unilateral swelling on dorsal tongue which gradually increased in size over 1.5 years with history of occasional bleeding and pain. It is common to see involvement of oral cavity in systemic variety but very rare in localised solitary form, therefore while considering the differential diagnosis of the swellings of tongue this entity should be taken into account.

Perception of Dentists towards Periodontal Diagnosis, Treatment and Referral in Belagavi District, Karnataka, India: A Cross-sectional Study

KB Menaka, Nikitha Shetty, Vilas Pattar, Vinayak Kumbhojkar, Aditi Mahajani
Introduction: Periodontitis poses a major burden to the society because of lack of awareness about periodontal health among the population. Patients diagnosed with periodontitis require special attention which usually goes unnoticed due to lack of comprehensive periodontal examination. The standard of periodontal care varies among the dentists. Aim: To assess the perception of the dentists towards periodontal diagnosis, treatment and referral. Materials and Methods: A cross-sectional web-based questionnaire survey was conducted in the Department of Periodontics, KLE Academy of Higher Education and Research (KAHER), VK Institute of Dental Sciences, Belgaum, Karnataka, India, between October 2020 to January 2021 among the dentists in Belagavi district of Karnataka. A total of 19 custom designed multiple choice, open ended and checklist questions were formulated and an online link to the questions was circulated via email and whatsApp among professional colleagues. The questions were designed to embark on periodontal diagnosis, treatment provided by the dental practitioners and their routine referral to a periodontist. The data acquired was statistically evaluated using descriptive analysis with the IBM Statistical Package for the Social Sciences (SPSS) software (Version 20.0 Chicago IL, USA) and Chi-square test with a significance level of p<0.05. Results: Of the total responses obtained (n=150), 98.6% of the dentists carried out full mouth examination. Dentists surveyed were aware of the parameters for periodontal diagnosis, 73.3% used periodontal probe and 92.7% were aware of the critical probing depth. A total of 68.6% of the dentists provided scaling followed by referral to a periodontist. Statistical significance was observed between the years of experience of a dental practitioner towards the awareness of interrelationship between periodontitis and systemic health (p=0.009). Female practitioners contributed more to education and motivation regarding periodontal health (p=0.048). Treatment outcomes and longer periodontal recall were the factors considered by 66% of the dentists that influenced a periodontal referral. Conclusion: Within the limitations of the study, it was found that the dentists were able to diagnose periodontitis, majority of them provided scaling followed by periodontal consultation. Mucogingival deformity was most often planned for a periodontal referral. Contribution towards patient education, motivation and reinforcement to have a regular periodontal maintenance therapy was positively implemented in their practice.

Decoding Blue Round Cell Tumours using Immunohistochemistry- A Prospective Cohort Study
Introduction: Small blue round cell tumours are heterogeneous group of neoplasms characterised by small, round and relatively undifferentiated cells. These tumours pose a great challenge to the histopathologist for definite diagnosis and Immunohistochemistry (IHC) plays an important role in the further evaluation of these tumours. Aim: To analyse the round cell tumours according to site, gender and age of the patient and ascertain the significance of IHC for its accurate morphological characterisation. Materials and Methods: This prospective cohort study was conducted at Department of Pathology, Guntur Medical College, Andhra Pradesh, India, which included 53 patients from August 2013 to August 2015. Immunohistochemical studies were done to categorise the tumours using the relevant panel of immunohistochemical antibodies streptavidin biotin detection method. Frequency and percentage statistics was used to present the results. Results: Out of 53 cases there were 29 cases of Non Hodgkin Lymphoma (NHL), eight cases of Ewing’s Sarcoma/PNET, four cases of Esthesioneuroblastoma, three cases of small cell carcinoma, two cases of medulloblastoma, each one case of ependymoblastoma, alveolar rhabdomyosarcoma, sinonasal Undifferentiated Carcinoma (SNUC), mesenchymal chondrosarcoma, nephroblastoma, desmoplastic small round cell tumour and small cell carcinoma ovary. Conclusion: Most common tumour was NHL with highest incidence in males and age group of more than 40 to 60 years years. Immunohistochemistry represents an adjunctive tool for accurate typing and classification of round cell tumours.

Proportion of Myocardial Bridge in a Tertiary Care Hospital of North India: A Retrospective Observational Study

Sanjeev Kumar Singla, Rakendra Singh
Introduction: Myocardial bridging, a congenital coronary anomaly, is a condition in which a segment of a major epicardial coronary artery runs intramurally through the myocardium. During systole, the coronary artery is compressed and can cause angina, arrhythmia, depressed left ventricular function, myocardial stunning and sudden death. Aim: To find the proportion of Myocardial Bridge (MB) in patients admitted for cardiac evaluation in a tertiary care hospital of north India. Materials and Methods: A retrospective, observational study was performed in the Cardiac Care Unit of the Adesh institute of Medical Sciences and Research Bathinda from January 2017 to December 2020. A total of 3800 adult patients of both sexes, who underwent diagnostic coronary angiography were evaluated for MB between January 2017 to December 2020. The data was collected from the patients and statistically analysed on 15th April 2021. Results: The proportion of MB was 208 (5.50%), in which 74.51% were males and 25.49% were females. Dominance-wise, 72.11% were right dominant, 22.60% were left dominant and 5.29% had balanced circulation. The incidence of myocardial bridging was 3.95% in right dominant, 1.24% in left dominant and 0.28% in balanced dominant patients. Total 199 (95.67%) MB were located on the Left Anterior Descending Artery (LAD) of which mid LAD were in 186 (89.42%), distal LAD in 9 (4.45%), proximal LAD in 4 (1.95%) and on diagonal (D1) it was 9 (4.45%). Double bridge was observed in 6 (2.89%) cases in proximal and distal regions of LAD. Conclusion: Clinical suspicion of a MB should be considered in young patients with typical or atypical chest pain, where the probability of atherosclerosis is low and who there are no other cardiovascular risk factors. There was higher incidence of MB in proximal distal segments of LAD and diagonal arteries

Analysis of Factors Influencing Hand Grip Strength and Acute Effect of Grip Strength Test on Blood Pressure in Young Adults

Noor Abdullatif, Aiman Rizvi, Sareesh Naduvil Narayanan
Introduction: Isometric Hand Grip (IHG) strength measurement is extensively used in many areas of medicine and sport science as a functional test of overall strength. By testing the IHG strength, maximum isometric strength of the hand and forearm muscles can be estimated. Weak hand grip strength is a key component of sarcopenia and is associated with subsequent disability and mortality. Aim: To evaluate the role of handedness, gender, ethnicity, Body Mass Index (BMI) on hand grip strength and to examine the acute effect of grip strength test on blood pressure in young adults. Materials and Methods: This cross-sectional study was done between November 2018-November 2019 on normal healthy participants (n=83; average age 20.24±0.21 years) representing various ethnicities. Participants’ demographic data was collected and their IHG strength was determined in both dominant and non dominant hand. Blood pressure was recorded before and after the IHG strength test. A correlation analysis was performed to determine the association between resting blood pressure/BMI with IHG strength. Results: A total of 83 subjects of different ethnicities and both male and female genders were included in the study. The IHG strength was not influenced by handedness in both the sexes. Amongst males, IHG strength was found to be slightly higher in the Arab population as compared to South-asian and Emirati. A lower IHG strength was observed in females compared to males in every ethnicity studied. Moderate positive correlation was found between IHG strength with BMI (dominant hand IHG strength vs BMI: r=0.34; p-value <0.001, non dominant hand IHG strength vs BMI: r=0.35; p-value <0.001) and with Systolic Blood Pressure (SBP) (r=0.55; p-value ≤0.0001) (SBP). Both the SBP and Diastolic Blood Pressures (DBP) were observed to be reduced after IHG strength test. Conclusion: Handedness did not influence IHG strength, but, ethnicity mildly and gender significantly influenced it. Blood pressure was reduced by IHG test. The IHG strength was positively correlated with BMI and SBP.

Association of Xanthine Oxidase and Neutrophil Activation Marker Elastase in Preeclampsia: A Case-control Study
Introduction: Preeclampsia is an obstetric emergency for both mother and the foetus with unknown aetiology. Delivery is the only effective way in the prompt management. Due to oxidative stress factors, there is an increased conversion of xanthine dehydrogenase to xanthine oxidase, so there is more production of hydrogen peroxide. Hydrogen peroxide affects the cell function of trophoblast. Therefore, oxidative stress is one of the causative factor for complications of preeclampsia. Aim: To determine the association between xanthine oxidase and plasma elastase (Neutrophil activation marker) in preeclampsia. Materials and Methods: The case-control study was conducted from March 2019 to December 2019 on normotensive pregnant females and preeclamptic patient categorised as group 1 (control) and group 2 (case) respectively. The level of xanthine oxidase and plasma elastase were estimated spectrophotometrically. To compare means between the two groups, Student's t-test was used and correlation between parameters were estimated through Pearson's correlation coefficient. A p-value of <0.05 was considered statistically significant. Results: A total of 60 subjects were included and analysed in two groups 1 and 2 respectively. Neutrophil activation marker (elastase) was elevated 4.5-fold in group 2 (26.81±7.9) but, it was non significant when compared to group 1 (6.02±3.4). Xanthine oxidase levels amongst group 1 was 34.01±38.26 U/L which was significantly elevated in pregnant group 2 patients as 218.78±220.42 U/L with probability p-value <0.05 and positive correlation of r=0.320. Conclusion: Elevated levels of xanthine oxidase adds to oxidative stress and may result in trophoblastic dysfunction in preeclampsia. The situation is convoyed by increased concentration of proinflammatory signaling molecules like cytokines such as Tumour Necrosis Factor-a (TNF-a), activated neutrophils and positive acute phase plasma proteins. Elastase as neutrophil activation marker showed 4.5-fold increase in preeclampsia which shows aggravated inflammatory condition.

Fetomaternal Outcomes between Instrumental Vaginal Delivery and Caesarean Section in Second Stage of Labour: A Prospective Interventional Study

Debdulal Mandal, Anindya Kumar Das, Anirban Mandal, BC Kameswari
Introduction: Rates of caesarean section deliveries are increasing worldwide including India. The reasons for this increasing trend are many. Caesarean section being a major operative procedure is associated with various complications. Instrumental vaginal delivery has the advantage of reducing these complications associated with caesarean delivery. As of today, there is no clear consensus regarding the safest and most effective mode of intervention in second stage of labour. Aim: To compare foetal and maternal outcomes between instrumental vaginal delivery and caesarean section in second stage of labour. Materials and Methods: It was a hospital-based prospective interventional study, conducted over a period of 18 months. A total of 104 mothers with live, singleton, term foetuses in vertex presentation who required intervention in second stage of labour were included in the study. The entire study population was divided into two groups depending on the type of intervention used in second stage- instrumental vaginal delivery (n=52) and caesarean section (n=52). Maternal outcomes of Postpartum Haemorrhage (PPH), perineal lacerations, febrile illness, blood transfusion and wound infection were compared using Chi-square test. Neonatal outcomes like birth weight, need for resuscitation, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, neonatal jaundice, sepsis and mortality were compared using Chi-square test and t-test. Results: Females undergoing caesarean section had more atonic PPH (5.8%), need for blood transfusion (19.2%), postpartum wound infection (17.3%) and febrile illness (26.9%, p=0.010). Third and fourth degree perineal lacerations were more common in the instrumental delivery group (19.2%, p=0.001). Mean weight of babies born by caesarean section (3127 g) was higher than those by instrumental delivery (2962 g). Composite neonatal outcome was not significantly different in both groups. Conclusion: Caesarean section in second stage of labour leads to increased maternal morbidity as compared to instrumental vaginal delivery. In skilled hands, these instruments can aid in smooth delivery of a healthy baby and can avoid the risks associated with second stage caesarean section.

Cutaneous Melanoma in African Albinos: A Systematic Review

Nnaemeka Thaddeus Onyishi, Samuel Robsam Ohayi
Introduction: Cutaneous melanoma (CM) is reported rare in African albinos inspite of their non or hypomelanised sun-sensitive skin and inhabitance of high ultravoilet index environment. The precise prevalence of CM has not been established in African albinos. Aim: To highlight the frequency of CM in all histologically confirmed skin cancer lesions in African albinos. Materials and Methods: The search was conducted on 28th May 2020 and updated on 8th September 2020 for systematic review. Five databases- African Journals On Line (AJOL), PubMed, Europe PubMed Central, Google scholar and Cochrane library were systematically searched for relevant articles. Included studies were case reports and cross-sectional studies of histologically confirmed skin cancers in which African albinos were the overall subject of the study or were identified as a sub group in mixed sample with normally pigmented Africans. Results: There were 715 skin cancer lesions presenting in 556 African albino skin cancer patients. Only six CM were identified. Over 80% (22/27) of the reviewed studies reported no case of CM. Out of the six melanomas two were acral lentiginous, two nodular, while the histologic subtype was unspecified in two cases. Conclusion: The frequency of CM amongst histologically confirmed skin cancer lesions in African albinos is extremely low. Given that only a fraction of albinos develops skin cancer, authors extrapolate that prevalence of CM in the general population of African albinos is infinitesimal. Elucidating the processes inhibiting melanomagenesis in African albino could provide targets for melanoma therapy in the wider population.

Health Surveillance in India: Current and Future Prospects

Vinoth Gnana Chellaiyan, Sasithra
Surveillance is an information for action. India has created considerable improvement in control, prevention and eradication of certain communicable diseases. Few such diseases that have been effectively controlled are polio, smallpox, vector-borne illness, nipah, Coronavirus Disease-2019 (COVID-19) and so on. These achievements are the outcome of an active surveillance system incorporated at community, facility, and health system level. Any of these progresses is impossible without a robust public health surveillance structure. Therefore, enhancing the public health surveillance system further will be helpful in managing upcoming pandemics at its earliest. Improvements in public health surveillance should be synchronised with the goals of Universal Health Coverage and its regulating standards of safe guarding universal health as a right besides privilege, ensuring equity, non-discrimination, guarding the affected individual’s rights and respect their choice and placing health in people’s hand. In alignment with the National Digital Health Mission, the new Integrated Health Information Platform (IHIP) aims to substitute traditional surveillance data-entry system with modern advances in digital health and technology. This platform also initiates various sector collaboration, including public and private healthcare organisations and civil societies. Recommendations to strengthen the surveillance system starts with enhancement of laboratory infrastructure, referral networks and health organisations at the block level with the aim of strengthening community-based surveillance and responding in a timely manner for upcoming outbreaks.

Surgical Procedures for Placement of Zygomatic Implant- A Review
Zygomatic Implants (ZIs) have become a popular choice in recent times, which anchor the dense Zygomatic Bone (ZB). Unlike maxillary bone, ZB does not resorb and acts as a ladder step that takes most of load similar to the pillars of a ladder, thereby providing an obvious advantage for implant placement. These ZIs are an alternative to conventional implants in narrow/atrophic maxillary ridges, that require grafting techniques which might be quite expensive, time-consuming. Whereas, on the other hand ZIs are relatively quick, painless, and with an immediate implant loading prosthesis protocol. The objective of this review article was to study the published literature for various surgical techniques available for the placement of ZI and the procedures through which they are done. An extensive search of electronic databases like PubMed, Google Scholar, CrossRef, Science Direct was performed. Key search terms used were dental implant, zygomatic arch, atrophy, maxillary sinus, surgical techniques, quad zygoma, defective maxillary bone. The clinician’s experience, proper clinical assessment, case selection and use of appropriate surgical procedure are imperative for the success of ZI. Among various available surgical techniques, a single technique is preferred over the other based on anatomy of the maxillary sinus, skeletal forms of zygomatic buttress-alveolar crest complex and prosthetic bailout.

Improper Disposal of Used Masks during COVID-19: A Health Hazard?

Bhuvan Adhlakha, Pihu Sethi
The Novel Coronavirus disease has taught us all to live the new normal way. As the virus transmission is mainly person-to-person through droplets, the outbreak has forced, even the general population to wear mask all the time when outdoors or meeting people. Everyone is educating the public about wearing the masks correctly by covering face and nose completely, however, correct methods of disposal of these used masks, which may be infected, is not being discussed. Proper biological waste management system is not followed while discarding the used masks and hence jeopardising the community health.

Chronic Obstructive Pulmonary Disease and COVID-19: A Double Trouble

Jyoti Bajpai, Surya Kant, Ajay Kumar Verma, Avishek Kar
Coronavirus Disease 2019 (COVID-19) is a respiratory and systemic illness that may progress to severe Acute Respiratory Distress Syndrome (ARDS). There is a pressing need to identify clinical predictors of severe COVID-19 which can help in risk stratification and prognostication. The COVID-19 pandemic tends to have more severe clinical presentation in older age group and in chronic diseases; Chronic Obstructive Pulmonary Disease (COPD) is one of them. COPD is the common cause of high mortality and morbidity worldwide. It is obvious to fear for patients with underlying COPD. Acute episode of exacerbation and COVID-19 pneumonia are the two pivotal differential diagnoses in contemporary era, in patients of COPD presenting with worsening dyspnoea. Mortality rate have been higher among COPD group of patients with the development of hypoxemia. Literature shows that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognosis. Even after recovery from the acute event, proper adherence to maintenance therapy for COPD (inhalational agents) continues to be of paramount importance and remains the standard of care. Because COPD remains a subset that is highly vulnerable for adverse outcomes with COVID-19 infection, preventive therapy should be directed towards–attenuation of contact with droplets, proper hand hygiene and maintenance of adequate nutritional status. The aim of this brief review is to know the burden and impact of COPD on COVID-19 pandemic and challenges in diagnosis and management of COPD patients.

A black intruder into the Pandemic: Rhino-Orbital Mucormycosis Complicating COVID-19
There is an increased incidence of rhino orbital mucormycosis during the Coronavirus Disease-2019 (COVID-19) pandemic attributed to diabetes mellitus, corticosteroid usage and immunocompromise caused by COVID-19. In this series, seven biopsy proven cases of mucormycosis (six male patients and one female patient) are presented from a tertiary care center in Eastern India from (May 2021 to June 2021). Empirical systemic liposomal amphotericin B, radical sinus surgery with orbital decompression and irrigation of sinus and orbit with amphotericin B was performed. The mean age of the patients were 42.71±7.34 years with a male preponderance (85.7%). Five patients had orbital involvement (71.42%), and two had cerebral involvement (28.6%). All of them had elevated blood glucose levels, though only three (42.85%) were known cases of type 2 diabetes. The most common manifestations were sinus tenderness (100%), paresthesia (100%), facial swelling (71.42%) and nasal discharge (28.57%). Follow-up at two months showed zero mortality. Timely diagnosis, appropriate management with intravenous amphotericin B and endoscopic radical sinus surgery, debridement of the necrotic tissue proved to be necessary for a good outcome in rhino-orbito-cerebral mucormycosis