Journal of clinical and diagnostic research

Recurrent Thymoma Mimicking T-Lymphoblastic Lymphoma: An Unusual Case Presentation

Thymoma and T-Lymphoblastic Lymphomas (T-LBL) are primary mediastinal neoplasms that can have similar clinical presentations and overlapping histological features. Because of immature lymphocytes associated with thymoma, it may resemble T-LBL. In this present case report, a 20-year-old male patient with recurrent unresectable thymoma has received definitive chemoradiation therapy. Significant reduction of gross tumour volume was observed while patient underwent weekly image verification before radiotherapy at the end of fourth week, causing the suspicious about the possibility of a highly radiosensitive tumour in mediastinum like lymphoma or extragonadal germ cell tumour. External review of immumohistochemistry features were suggestive of T-LBL.

Management of Consequences of Gold Enamel Tattooing in Maxillary Central Incisors: A Case Report

Navdeep Jethi, Gaurav Pandav, Sakshi Pandav, Sharanjit Kaur

Gold enamel tattooing is a customary practice seen in various clans of Asia and the Indian subcontinent, for ages. The incidence of such cases is very low; hence they can be used as identification marks in forensic sciences and symbols of some tribes and clans. In India, these tattoos or chomps are frequently done by amateurish creatures, making gross harm to the physiology of the tooth and causing consequences like pulp involvement and periapical infection. Here, authors presents a case of 32-year-old male presented with chief complaint of dull, intermittent pain which aggravates with hot stimulus, particularly on taking hot tea and broken upper front teeth because of biting on a hard nut five days back. Patient also complaint of pus discharge over his front teeth for three days. The patient gave the history of gold inking his two maxillary central incisors, ten years back. Pulp damage and periapical lesion was noticed due to enamel inking in upper central incisors. A periapical abscess was resulted due to violation of enamel thickness of the tooth during tooth preparation. In dental clinics, traditional gold tattoos can be done with minimal invasive cavity preparation. Enamel thickness estimation in such cases plays a very important role to safeguard a healthy tooth from the consequences of structural damage.

Non Vascularised Fibula Strut Graft Augmentation for Fixation of Proximal Humerus 3-Part Fracture using PHILOS Plate and CC Screws in a Young Male

Amit Supe, Pranay Kondewar, Eknath Pawar, Rohit Topno, Lalkar Gadod

Proximal humerus fracture accounts for 4-5% of all fractures. Locking Compression Plate (LCP) Proximal Humerus Internal Locking System (PHILOS) fixation is currently the most widely used method for the management of unstable proximal humerus fractures. LCP system of the proximal humerus is better than other available implants because of better anatomic design, fixed angulated configuration of locking screws, rotational and angular stability. This case report was of a 35-year-old male who presented with pain, swelling and difficulty in movement at the right shoulder, after a road traffic accident. Plain radiograph of right shoulder (anteroposterior) view revealed displaced 3-part proximal humerus fracture (humeral head with lesser tuberosity, greater tuberosity and shaft). It was managed with philos plate, Cannulated Compression (CC) Screws and non vascularised fibular strut graft. At two years follow-up, patient showed good shoulder range of motion with no complication.

Extraosseous Aneurysmal Bone Cyst at Hypothenar Area in an Adult Male- A Case Report

Sheerin Shah, Vikram Narang, Rajinder K Mittal, Ramneesh Garg, Amandeep Kaur

Aneurysmal Bone Cyst (ABC) is a benign tumour of bone which develops most frequently in the metaphysis of long bones and the posterior elements of vertebral bodies. The ABC generally occurs during the first two decades of life and has a slight predilection for the female sex. Radiographically, ABC is usually eccentric, lytic and expansile with well defined margins. Soft tissue or extra osseous ABC is extremely rare in occurrence, with only few case reports found in literature. Extraosseous ABC is usually found in soft tissues of lower limb and arm. Its occurrence in soft tissue of hands is extremely rare. Hereby, authors reported a case of a 30-year-old male patient who had swelling of approximately 9×6 cm in hypothenar area of left hand starting proximally from the wrist crease and extending distally till distal palmar crease and from the ulnar border of the palm till the mid palmer area. Authors described this case to highlight this entity, at an uncommon location (hypothenar area of palm) and importance of excisional biopsy in such cases.

Treating Shoulder Pain with Trigger Point Dry Needling: A Case Report

Vikrant Bhardwaj, Madhvi Awasthi, Kuljeet Singh Anand

Shoulder pain is highly prevalent even in the young population and could have a multifactorial aetiology. Myofascial Trigger Points (MTrPs) could be one of the pathophysiological basis of shoulder pain. Dry needling has shown promising results in releasing MTrPs in different muscles. Hereby, authors present a case report of a 24-year-old male with a history of shoulder pain, with no history of trauma or injury, who was referred to the physiotherapist by orthopaedic surgeon with a diagnosis of shoulder strain of muscular origin. Being a flight attendant by profession, his job involved continuous picking, pushing and lifting things during his working hours in the flights. The patient presented with severe pain and with reduced Range of Motion (ROM) mainly on left side. Following thorough assessment of the patient by the physiotherapist, the trigger point dry needling was administered. The pain was reduced as measured by Numeric Pain Rating Scale (NPRS), increasing the Pain Pressure Threshold (PPT) as measured by algometer with increase in ROM of left shoulder. After the dry needling treatment session, there was an instant improvement in the restricted ROM of shoulder which may be a consequence of the decrease in pain and improvement in muscle tone and elasticity after treatment. Although there are few papers highlighting the effectiveness of dry needling but still, there is dearth of literature that highlight the quantification (PPT) in addition to reporting of pain (score based) and ROM. Thus, the results of the present case report can assist in providing insight for examining the effectiveness of dry needling, which are subdued literature but are important to frame body of knowledge.

Extracalvarial Porocarcinoma- A Rare Case Report

Eccrine Porocarcinoma (EPC) is a very infrequent malignant neoplasm of skin. It usually emerges from the ductal parts of sweat glands. It is seen mostly between the age group of 60 to 80 years with a female preponderance. Several cases of EPC have been reported in medical literature till date. Though, it rarely presents with distant metastasis, still evidences of metastasis to organs like lung, retroperitoneum, breast, urinary bladder and ovaries have been reported. Conventionally, it arises de novo, and may develop on sites of long standing eccrine poroma. Several unusual sites like trunk, head, face, eyelids, upper limbs, and scrotum have been reported; though lower extremities are the most common site of origin. Locoregional recurrence and metastasis have also been reported. Histopathological documentation of mitoses, lymphovascular invasion and measurement of tumour depth predicts adverse prognosis in EPC. Earlier, eccrine adenocarcinoma or malignant eccrine poroma terminology were used. As far as clinical presentation is concerned, the EPC is usually symptomless to begin with, which further ulcerates and may become aching and irritable. From a clinicopathological perspective the importance of the tumour lies in its early correct diagnosis, awareness of the close differentials, adequate surgery and most importantly clearance of surgical margins and adjuvant radiotherapy are mandatory decisions to prevent the high local recurrence. The basis of management involves wide local excision with clear margin. The following case, a 42-year-old male presented with an ulcerated mass on the scalp, which on further evaluation was diagnosed as an EPC of the scalp after histopathologic confirmation. The patient was treated with local wide excision with clear margin and was referred radiotherapy.

Leiomyosarcoma: A Rare Cause of Colocolic Intussusception

Prashanth Puvvada, Nain Singh, Om Prakash Pathania, Raghav Yelamanchi

Intussusception is an infrequent presentation in adult patients and accounts for less than 1% of all cases of adult bowel obstruction. Colon is most commonly involved site and in 56% cases, the underlying cause is a malignant neoplasm. Leiomyosarcoma of colon is an extremely rare tumour. A 30-year-old male patient presented to the Surgery Department with chief complaints of dull, diffuse and colicky abdominal pain associated with abdominal distension and vomiting for 15 days. On abdominal examination, abdomen was distended with generalised tenderness and rigidity. X-ray abdomen showed features suggestive of bowel obstruction. Contrast Enhanced Computed Tomography (CECT) revealed bowel within bowel appearance of a segment of descending colon suggestive of colocolic intussusception. Exploratory laparotomy revealed colocolic intussusception with a large obstructing growth in the descending colon acting as a lead point. Left hemicolectomy with colocolic anastomosis was done. Final histopathological report confirmed epithelioid leiomyosarcoma. Adjuvant chemotherapy was administered and the patient is disease free at one year of follow-up. Present case report was a rare case of colonic leiomyosarcoma presenting with intussusception. The rarity of this disease and the rare presentation makes this an interesting case. Surgical management remains the mainstay of treatment of these cases.

Mimicker of Renal Cell Carcinoma- A Case Report

Giri Pranav, Vasugi Arumugam, Susruthan Murali, Praveen Paul, K Natarajan

Oncocytoma is a rare epithelial tumour composed of oncocytes which are epithelial cells with excessive amount of mitochondria. The tumour is most often benign, and diagnosis can be made on the basis of histopathological examination. Here, the authors present a 64-year-old female patient, with complaints of abdominal discomfort and flank pain, along with history of loss of weight and appetite for one month. Radiology showed a left renal mass of measuring 9×7×4.5 cm involving the upper and middle pole suggestive of malignancy. Following which radical nephrectomy was done. Examination of gross specimen showed a fairly circumscribed brownish lesion in the upper and middle pole of left kidney measuring 8.8×7×4.5 cm with a central scar. There was no evidence of hilar and perirenal fat invasion. Histology showed sheets of large polygonal eosinophilic cells with centrally placed nucleus. The differentials were eosinophilic variant of clear cell renal cell carcinoma, chromophobe renal cell carcinoma and oncocytoma. A panel of Immunohistochemical (IHC) markers was performed for further categorisation and the lesional cells were positive for CD 117 and negative for CD 7 and CD 10. This ruled out the differentials and confirmed oncocytoma, thus ruling out the necessity for chemotherapy.

Management of Bilateral Maxillary Second Molars with Extra Palatal Root: A Case Report

A crucial understanding of teeth’ internal and external anatomy is critical for the successful outcome of endodontic therapy. The presence of two palatal roots in maxillary molars, particularly in the second molar is rare. The present case report addresses this anatomical variation in an 18-year-old female patient with a chief complaint of severe pain in the upper left back teeth region since one week. Preoperative radiographic evaluation of maxillary second molar did not reveal the aberrant anatomy due to its location and impaction of maxillary third molar onto the roots of the second molar. After access opening, inspection of the pulp chamber floor revealed a slightly deviated location of the palatal canal and a bleeding point mesial to the palatal canal. Intensive exploration for determining any additional canals was done using David Green (DG) 16 endodontic explorer under 3X magnification using dental loupes. A narrow field of view Cone Beam Computed Tomography (CBCT) was obtained to evaluate the unusual root canal morphology. Following a thorough analysis of CBCT, root canal treatment was performed employing a standard protocol. This case report highlights the successful diagnosis and management of the bilateral maxillary second molar with two separate palatal roots. With CBCT and magnification, determining the root morphology and canal configuration will be more accurate, further improving the quality of root canal treatment.

Progressive Systemic Sclerosis and its Dental Implications: A Case Report

Scleroderma is a complex autoimmune rheumatic disease characterised by the widespread fibrosis of skin and visceral organs, dysregulation of immune system and vasculopathy. The aetiology of this disease remains unknown till now. It is known to exist in two forms namely localised and generalised/progressive. It is known to affect females more commonly than males, and also shows a wide range of oral and paraoral manifestations including xerostomia, periodontal disease, restricted mouth opening, burning mouth syndrome, dysphagia, gastroesophageal reflux. Here, authors presents a case of 76-year-old female patient presented with the chief complaint of dry mouth, restricted mouth opening, burning sensation in mouth and reduced taste perception for the past seven years. On the basis of gastrointestinal disorder, Raynaud’s phenomenon, fish mouth appearance and various other extraoral and intraoral features a diagnosis of Progressive Systemic Sclerosis (PSS) was made. The present case also emphasised upon the crucial role of a general dentist in diagnosing such rare systemic diseases. This disease is known to carry a significant burden in the form of pain and disability which potentially limits the proper functioning of major internal organs and results in various life limiting complications. Thus, early diagnosis with appropriate investigations followed by specialist and multidisciplinary approach to treatment, is the key for the successful management of disease.

Recurrent Benign Phyllodes Presenting as High Grade Malignancy: A Case Report

Aditya Mehta, Roshni Manek, D Suhas

Johannes Muller initially described Phyllodes Tumours (PT) to be “cystosarcoma phyllodes” in 1838. The connotation for the term “phyllodes” is leaf like, which on pathologic examination gives appearance of typical papillary projections. The PT are fibroepithelial in nature and account for an unbefitting 1% of overall primary neoplasms of the breast. They are known for its rapid growth and seen in women of 35-55 years of age, with a mean age of presentation as 45 years. Regardless of the histology recurrence is very common, in both malignant and benign PT. The stromal pattern of expression of CD10 marker strongly correlates with the grade of PT thus helps in the differentiating between malignant and benign variants of PT. Authors hereby, discuss a case of 48-year-old female patient with recurrent PT of breast who underwent surgical excision of benign phyllodes tumour twice and presented with a briskly growing recurrent lump in the left breast for the third time, diagnosed as malignant PT. Very finite data is available on the outcome of surgical management and the advantage of adjuvant Radiation Therapy (RT) in PT. The PT carry high risk of recurrence as well as become aggressive when malignant in nature. Thus, wide local excision of the tumour with negative margins should be followed by adjuvant chemotherapy and radiotherapy to decrease the recurrence rate.

Unmasking of Obsessive Compulsive Disorder in a Vulnerable Preadolescent Girl due to COVID-19 Related Stress: A Case Report

Nidhi Chauhan, Abhinav Agrawal, Ira Domun, Ritika Goyal

Coronavirus Disease-2019 (COVID-19) pandemic has been especially hard for children and adolescent’s mental health due to their inherent vulnerabilities and added stress of lockdown, mobility restrictions, school closure, absence of peer interaction. This case report highlights the unmasking of obsessive compulsive symptoms due to the COVID-19 pandemic stress and the role of inherent vulnerabilities in a 11-year-old female. The management of the index case emphasised upon age appropriate strategies for intervention. Although, Obsessive Compulsive Disorders (OCD) is not a stress disorder per se but the index case highlights the role of stress in manifestation of mental illness in vulnerable individuals favouring the biopsychosocial model for mental illness.

Complementary Therapy of Pranic Healing in Managing Moderate Panic Disorder with Mild Agoraphobia during COVID-19 Pandemic: A Case Report

V Vinu, Srikanth N Jois

Panic disorder refers to recurrent unexpected panic attacks, including symptoms such as dizziness, chest pain or discomfort, a feeling of unreality, fear of losing control, and fear of dying which could last for few minutes. Here, authors presents a case of 71-year-old male during Coronavirus Disease-2019 (COVID-19) lockdown experienced moderately distressing panic attack symptoms and feared going out by himself, due to the worry of future attacks. These symptoms made significant interference with social activities. The subject was under homeopathic medication and later referred to take Pranic Healing as an add-on therapy. Panic disorder severity (panic disorder severity scale-self report) and severity of agoraphobia (severity measure for agoraphobia-adult) were measured at day 0, day 60 and day 240. Moderate panic disorder (raw score was 12) with mild agoraphobia (raw score was 10) was reduced after 14 pranic healing sessions given in two months duration. No symptoms of agoraphobia or panic disorder were found after six months follow-up. Pranic healing along with homeopathic treatment were found effective in reducing moderate panic disorder with mild agoraphobia. Psychological therapies, combined with medication can be used as gold standards in treating panic disorder.

Malrotation of Small Bowel with Midgut Volvulus in a COVID-19 Positive Young Male: A Rare Case Report

Ajay Kumar Pal, Amit Karnik, Agastya Maria, Awanish Kumar, Harvinder Singh Pahwa

Malrotation of small bowel with midgut volvulus has a very low incidence of 0.2% in adults. Symptomatic malrotation in neonates occur in one in 6000 live births. The normal 270 degrees counter-clockwise gut rotation around the axis of superior mesenteric artery is absent in such cases. A 20-year-old male presented with intermittent colicky abdominal pain since four to five months, post-prandial bilious vomiting since one week and obstipation since two days. He also had difficulty breathing since two days. Abdominal examination revealed vague lump in right lower abdomen with no signs of peritonitis. Radiological investigations Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) abdomen demonstrated over distended stomach with dilated D1 and D2 showing changes in relation to superior mesenteric artery and superior mesenteric vein with rotation of mesentery in whirlpool pattern. His Reverse Transcriptase-Polymerase Chain Reaction Test (RT-PCR) was positive for Coronavirus Disease-2019 (COVID-19). Conservative trial for two days was followed by surgical exploration which revealed gut malrotation with mid-gut volvulus. Ladd’s procedure was performed. Malrotation with midgut volvulus is an acute surgical emergency that demands high index of suspicion in an adult. Associated COVID-19 pneumonia can increase mortality. Patient was followed-up after three weeks with fruitful results, proving that an early diagnosis and definitive surgical correction of malrotation with midgut volvulus is essential.

Malignant Transformation of Oral Lichen Planus: A Peril of COVID-19 Pandemic

Debarati Deb, Rupam Sinha, Subhadeep Maity, Harsh Vardhan Jha, Mainak Datta

Oral Lichen Planus (OLP) is a chronic autoimmune inflammatory disease of the oral mucosa. The erosive variety of OLP is multifocal, ulcerative, and painful in nature. Patients with OLP have a higher risk of developing Oral Squamous Cell Carcinomas (OSCCs). Here, authors presents a case of 49-year-old female patient presented to the Department of Oral Medicine and Radiology with the chief complaint of burning sensation in the inner aspect of right cheek, since one year. A diffuse whitish area surrounded by erythematous area was present in the right buccal mucosa. Lesion was diagnosed primarily as erosive Lichen Planus (LP). She discontinued the medication and did not come for follow-up visits because of the Coronavirus Disease-2019 (COVID-19) pandemic. After 10 months, she came back with pain and a diffuse swelling with indurated margin in the same region involving right buccal vestibule and retromolar area. After incisional biopsy it was found that the lesion has progressed to squamous cell carcinoma, and the patient was referred to the Department of Oral Surgery where segmental mandibulectomy was done with placement of free fibula graft. The OLP is considered as a potentially malignant disorder and patient should be advised to avoid additional risk factors such as tobacco and alcohol and should be followed at minimum one year interval as prognosis and patient survival is directly related to stage and grade of cancer at its initial diagnosis.

Adult Supracristal Ventricular Septal Defect with Aortic Regurgitation: A Case Report

Debasish Das, Debasis Acharya, Jaideep Das Gupta, Subhas Pramanik

Supracristal Ventricular Septal Defect (VSD) develops Aortic Regurgitation (AR) with the passage of time due to prolapse of the right coronary cusp. It brings clinical attention in early child hood with an incidental continuous murmur, recurrent respiratory tract infection of failure to thrive. This report is about a rare case of 52-year-old female who presented with increased fatiguability since the last six months. Clinical examination revealed the presence of cardiomegaly with holosystolic-diastolic murmur in Left Upper Sternal Border (LUSB). Echocardiography revealed the presence of supracristal VSD with moderate AR without prolapsing aortic leaflet or dilatation of aortic sinus. In view of presence of moderate AR, the patient was advised to be on Angiotensin Receptor Blocker (ARB) with regular follow-up to monitor the progression of AR. Such a late index presentation of supracristal VSD with moderate AR in fifth decade of life has not been described in literature so far. To conclude, nature retards the natural history with bless in disguise.

Glandular Odontogenic Cyst- An Unusual Presentation in the Maxilla

Ishita Singhal, Aparna Dave, Manpreet Arora, Pulin Saluja

The Glandular Odontogenic Cyst (GOC) is thought to be a developmental cyst arising from the remnants of dental lamina. This cyst has an unpredictable and a potentially aggressive behaviour, with a worldwide prevalence of 0.17%. It occurs in patients aged 40- 70 years, occurring exclusively in the anterior mandibular jaw. Here, authors presents a case of 42-year-old male patient reported to the Department of Oral Medicine and Radiology with a chief complaint of pain in the upper right back tooth region since five days. Two radiolucencies were observed in the maxillary anterior and posterior regions, as an incidental finding in the radiographic examination. Cone Beam Computed Tomography (CBCT) revealed two separate unilocular homogeneously hypodense regions with radiopaque sclerotic borders in the maxillary arch, located in the anterior and posterior regions of the maxilla, crossing the midline, which is quite rare. A final diagnosis of GOC was made based on the histopathological examination of the specimen after complete enucleation. Diagnosis of this cyst is challenging clinically and radiographically, as it can be confused with other cysts or malignancies of the jaws. Hence, diagnosis of GOC can only be based on characteristic histopathological findings.

Prosthetic Management of Flabby Ridge Tissues with Different Grades of Displaceability: A Case Series

Nishanth A Sudharson, Rohit Sunny Mathew, Angleena Y Daniel, Meril Joseph

Flabby ridges/displaceable tissues are a common finding in edentulous patients. Careful management is mandatory, failing which flabby ridges adversely affect the retention, stability and support of complete dentures. This article described a series of three clinical cases, which incorporated varied impression techniques and materials for recording this condition. Window technique with light body polyvinyl siloxane impression for maxillary ridge and double spacer with additional relief holes and light body polyvinylsiloxane impression for mandibular ridge were used for the first case, window technique with impression plaster for maxillary ridge was employed in the second case, and double spacer with additional relief holes and zinc oxide eugenol impression were used in the third case. From the conventional to the latest techniques utilised, the decision to consider which material is appropriate for a particular situation still remains in question. Moreover, the advent of newer dental materials also adds to this confusion. The proper diagnosis and planning is required for selecting the material and technique according to the displaceability of the tissues.

Preorthodontic Management of Gingival Recession using Epithelial Embossed Connective Tissue Graft: A Case Report with Two years Follow-up

PG Resmi, R Ambili, M Neethu Prasad, Leander Deepu

Gingival recession is an aesthetic and functional problem requiring surgical management in most cases. Adequate gingival health is a prerequisite to maintain plaque control during orthodontic treatment. This case report described management of gingival recession before orthodontic treatment using a novel surgical method. Here, authors presented a case of 27-year-old female patient reported to the Department of Periodontics for management of gingival recession in the lower front tooth region. The patient was diagnosed with Miller’s Class II gingival recession on mandibular right central incisor. Vestibular depth and width of attached gingiva was found to be inadequate at the recession site. The case was managed with epithelial embossed connective graft. The recipient site was prepared using envelope technique and internal vestibular deepening was performed before placing the graft. Complete root coverage, adequate vestibular depth and width of attached gingiva were obtained postoperatively. Due to high aesthetic demand of the patient, orthodontic therapy was instituted six months following root coverage and patient could maintain good oral hygiene during orthodontic treatment. Results of surgical treatment were maintained till two years follow-up. Careful selection of surgical technique could enhance thickness and width of attached gingiva and retain vestibular depth at the recipient site. Successful case management enabled the patient to maintain gingival health during orthodontic treatment.

Scrub Typhus with Guillain-Barrè Syndrome: Section An Atypical Sequela due to Delayed Diagnosis

Mayank Agarwal, Aishwarya, Mukesh Bairwa, Ravikant

Scrub typhus is a zoonotic infection which is endemic to the tropical regions of South-East Asia including the sub-Himalayan belt of North India. Clinical manifestations of scrub typhus range from self-limiting acute febrile illness to sometimes fatal multi-organ involvement. However, it does not usually involve the central nervous system, if affected meningoencephalitis is the most common presentation. Hereby the authors report a 60-year-old patient of scrub encephalitis who developed acute onset ascending, symmetric flaccid quadriparesis with sensory involvement. Electrophysiological studies and demonstration of antiganglioside antibodies confirmed the diagnosis of AMSAN variant of Guillain-Barré syndrome. The patient was treated successfully with five days of intravenous immunoglobulins. She became ambulatory with complete recovery four weeks after discharge. Guillain-Barré syndrome is a treatable entity and should be evaluated in all cases of scrub typhus having a similar presentation. It can lead to a diagnostic challenge that can often be missed as it is a rare presentation of scrub infection. Therefore, prompt diagnosis and treatment is necessary for better outcomes.

Elemental Analysis of Natal Teeth in a Monoidentical Twin using Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy- A Case Report

Jayachandran Sadaksharam, Vetriselvi Vimalesan, Sophia Jeba Priya

Dental eruption is a normal physiological process that begins with eruption of primary lower central incisors when a child is sixmonth-old. Natal teeth are teeth present at birth while neonatal teeth are teeth that erupt within the first month of life. Primary teeth erupting prematurely are referred to as congenital teeth, predeciduous teeth, foetal teeth, and dentitia praecox. The exact aetiology is not known. Natal teeth are three times more common than neonatal teeth. However, natal or neonatal teeth is quite rare with incidence of 1:1000 to 1:30,000 which usually erupts during birth or within one month. This case reports a 24-day-old male neonate with two teeth in the mandibular alveolar region. Since one of the teeth were immature and hypermobile, it was planned for removal fearing aspiration. The extracted natal tooth was quantitatively and qualitatively assessed for the elements present in it by Energy Dispersive X-Ray Spectroscopy (EDX) and Scanning Electron Microscopy (SEM) at the level of middle third, both on the internal and external surfaces. Carbon and oxygen were predominantly present in natal teeth when compared to permanent teeth, which mainly composed of calcium and phosphorus. The natal tooth caused mild problem in feeding, as it was mobile. So, it was extracted to avoid aspiration. The aim of this case report is to discuss a rare case of occurrence of two natal teeth in one of the premature monoidentical twins (male babies) and also to analyse the elemental components present in the natal tooth using SEM and EDX.

Bilateral Nasopalatine Duct Cyst: A Diagnostic Quandary Solved

The Nasopalatine Duct Cyst (NPDC) also commonly referred to as the anterior midline palatine cyst is a developmental cyst derived from the proliferation of embryonic epithelial remnants of nasopalatine duct. It is unique for the reason that it develops in only one location, which is the midline of anterior maxilla in close relationship to the nasopalatine canal. Radiographically, it presents as a well-demarcated ovoid or heart shaped cystic structure which is seen in close proximity to the apex of maxillary central incisors. Due to its anatomical location, it can be sometimes misdiagnosed as central giant cell granuloma, periapical cyst or follicular cyst. Chronic, large periapical lesions following traumatic injuries are challenging to diagnose and treat. The present case report described the successful management of a rare case of bilateral NPDC in a 30-year-old male patient, who gave a presentation closely mimicking that of an infected periapical cyst. The case was treated by both conventional endodontic therapy and surgical intervention. The NPDC tends to show a predilection in giving rise to squamous cell carcinomas which commonly occur in the anterior part of the maxilla. Therefore, cystic lesions seen in the premaxillary region require a thorough analysis so as to successfully treat the lesion and to avoid further complications that may arise due to a missed diagnosis.

Intracystic Papillary Carcinoma of Breast: Report of Two Cases

Abishek H Karthik, Lisha Suraj

Malignancy of breast presenting as cystic lesion is a complex entity to the surgeon and pathologist especially when there is a large cyst at the previous mastectomy site. The incidence of papillary carcinoma is 0.5% of all the invasive carcinomas of the breast. In localised variety, it forms a mass which can be cystic or solid. It can be diffuse with terminal duct lobular units and correspond to papillary variant of Ductal Carcinoma in-situ (papillary DCIS). Here, authors reported an interesting case of a 62-year-old female who presented with large cystic lesion on left breast that after excision was reported as papillary carcinoma of breast. Another patient, 73-year-old also presented with cystic lesion on breast which was diagnosed as papillary carcinoma after excision biopsy. The main fact to be noted here is that approximately half of patients with intracystic carcinoma are associated with underlying ductal carcinoma (in-situ/invasive).

A Middle-aged Male with Erythema Nodosum and Polyarthritis: What can be the Diagnosis?

Pradipkumar Prajapati, Ripal Shah, Priyank Sen, RM Oza, Salome Shukla

Pancreatic panniculitis is a rare triad of pancreatitis, panniculitis and polyarthritis. Due to underlying pancreatic disease, there is subcutaneous fat necrosis forming erythematous nodules especially in the lower extremities. This is accompanied with history of multiple joint pain. Timely diagnosis is the key to treatment, as pancreatic disease can progress rapidly causing life threatening complications. Authors hereby presented a rare case of pancreatic panniculitis in a 48-year-old male. Patient had a recent history of acute pancreatitis (alcohol induced) with development of erythema nodosum with pain and swelling in joints. Histopathological examination of the skin nodules revealed panniculitis, associated with elevated pancreatic enzymes on laboratory investigations and patient responded to anti-inflammatory medicines, thereby confirming the diagnosis of pancreatic panniculitis. He was treated with analgesics and steroids which reduced the erythematous nodules.

Lipoedema and Overweight Leading to Generalised Oedema: A Case Report

Jose Maria Pereira De Godoy , Lívia Maria Pereira De Godoy

The aim of the case report was to discuss generalised oedema in a patient with lipoedema and obesity, describing a novel concept of a stage 0 lymphoedema that was denominated as subclinical systemic lymphoedema. A 35-year-old female patient reported to the clinic due to telangiectasia of the lower limbs and leg pain that increased in the heat and when she spend a lot of time in a standing position. The patient had a physical appearance of lipoedema involving the upper and lower limbs associated with a family history of lipoedema, Body Mass Index (BMI) of 33.9 kg/m2 . Bioelectrical impedance analysis demonstrated important changes in intracellular and extracellular water as well as in all limbs and the thorax beyond the limits of normality. The telangiectasia was treated with sclerotherapy and pateint was instructed to lose weight and perform physical activity.

Recurrent Cutaneous Adenoid Cystic Carcinoma of Forehead

Adenoid Cystic Carcinoma (ACC) is a malignant tumour more commonly seen in salivary glands and rarely arises from the skin as adnexal tumour. Cutaneous ACC is a rare malignant adnexal tumour of eccrine origin. It has an indolent course and rarely metastasizes. Hereby, authors report a case of 48-year-old male with complaints of swelling on right forehead present for the past four years. Clinical diagnosis of infected sebaceous cyst was made and excised with simple excision. The swelling reappeared within 15 days of first surgery. The cytological examination of the swelling revealed abundant cellularity with predominantly cohesive clusters of monomorphic population of cells centered around eosinophilic hyaline globules suggestive of ACC. Retrieval of previous biopsy report revealed diagnosis of ACC reaching the margins of excision, the report of which was neither collected by either operating surgeon nor by the patient. Histopathological examination revealed classical cribriform pattern of arrangement of tumour cells with perineural infiltration by tumour cells. Immunohistochemistry further confirmed the diagnosis. The present case report brings out the importance of clearance of surgical margins in malignant tumours, including skin adnexal tumours. It also highlights the importance of histopathological examination of benign looking skin adnexal tumours.

Bouveret’s Syndrome- An Uncommon Variant of Gallstone Ileus: Case Series and Review of Literature

Akash Jaiswal, Amit Singh, Kavita Jain

Bouveret’s syndrome is a rare form of gallstone ileus. It refers to gastric outlet or small bowel obstruction caused by the formation of a biliary enteric fistula with subsequent migration and impaction of a large gallstone into stomach or small intestine. Its diagnosis is often delayed or overlooked. Diagnosis is based on the clinical manifestations, presence of pneumobilia, visualisation of stone and demonstration of small bowel obstruction on imaging. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. The aim of this case series was to analyse the presentation of Bouveret’s syndrome and strategise the optimum surgical approach based on the available literature and authors experience. Authors hereby report three cases of Bouveret’s syndrome encountered within last two years with clinical presentation, surgical approaches and operative findings. Computed Tomography (CT) scan is most commonly used to diagnose this rare entity. Early detection and optimum timing of surgery plays crucial role in outcome. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality.

Hypohidrotic Ectodermal Dysplasia

Chiranjit Ghosh, Shabnam Zahir, Shyamal Bar

Differing High Resolution Computed Tomography Patterns of COVID-19 Disease

Ramakrishna Narra, Kaniti Sruthi

Authors Reply to Readers’ Questions about Ivermectin Use in COVID-19 Prophylaxis

Waheed M Shouman, Abdelmonem Awad Hegazy

To the Editor: Our clinical trial research entitled “Use of Ivermectin as a Potential Chemoprophylaxis for COVID-19 in Egypt: A Randomized Clinical Trial” was recently published in the Journal of Clinical and Diagnostic Research (1). According to readers’ questions sent to the journal, we would like to clarify their points. First point: The study reports that of severity of the disease in index cases in the two groups was 14, 135 and 54 and 20, 43 and 38 for mild, moderate and severe, respectively. The probability that this is due to chance is 0.000063. This means that the probability that the study is truly randomized is far below 0.001. Reply: We wrote the following in the article: “The protection rate was highly significant whatever the severity of index cases with p-values of 0.001, <0.001 and <0.001 for mild, moderate and severe cases, respectively.” Also, we did randomization for index cases and contacts, not for severity. It is clear in our results that the randomization was performed for the index cases as a whole; and they were not sub-grouped initially according to severity of index cases or the number of contacts of each case. Then, we randomized the index cases and their contacts not depending on numbers of contacts; just randomized on the bases of having positive swab index case, whatever the severity and at the same time having a close family contact that could be traced and can precipitate in study. The protection was highly significant whatever the severity of index cases. This was noticed only after performance of statistical analysis. Second point: The study recruits between 1 June and 28 July 2020 and is submitted on 16 September, which is given the twoweek follow-up rate very fast. Reply: We wrote the followings: “We did a follow-up on our study participants for 14 days. This is depending on documented incubation period of COVID-19 that ranges from one to 14 days, with a mean of 5-6 days (13).” Moreover, 11 chest physicians have share in the study; 4 of them have been acknowledged at the end of the text. As swab performance was low at the same time, each of the physicians had at least one swab positive case during his/her daily clinical practice. This denotes that it was so simple to execute the study in a very short time at that rate of cases, keeping in mind the two weeks follow-up. All 11 chest physicians have their private clinics and work at Zagazig University Isolation Hospitals and other Isolation Hospitals. N.B.: Our locality “Sharkia Governorate” has around 8 million people. It was not fast, but we and most previous studies noticed that the incubation is mostly less than 14 days; ranging from 1-14 days. We also wrote the following in the paper itself: “Chest physicians contributing in this work were responsible for simultaneous randomization and follow-up of participants, as they diagnosed and referred the index cases. It was carried out at the faculty of Medicine, Zagazig University, Egypt; the period from June 1 to July 28, 2020.” At the previously mentioned time, the numbers of cases were high; as Egypt was in the first wave of pandemic. Third point: As the participants were all non-hospitalized at recruitment it is remarkable that this study was executed without budget. Reply: Most of our studies registered in the university have no allotted grants. All the steps of this work have been done by the authors themselves without receiving any funding. Treatment for each contact is cheap as each 8 tablets (6 mg) of Ivermectin (generic name Iverzine) costs 15 Egyptian pounds equaling less than one USD. Fourth point: The treatment is remarkably strong, 7.4% versus 58.4%. Reply: That is why we believe in efficacy of ivermectin as prophylaxis as the results were excellent and denotes effectiveness. Yes, we wrote the followings in our paper: “The protection was noticed to be of high values in both uni- and multivariate analysis.” Furthermore, the protection offered by use of ivermectin till present still can be noticed daily in the cases from our localities. We just tried to record what we saw and conducted this trial to assist in combating the current pandemic that has swept the world. Finally, we declare that we have no conflict of interest with anyone else. At the same time, we recommend further investigation into the efficacy of ivermectin for the prevention of COVID-19, which is very easy and not time consuming and does not cause an economic or health burden. This also does not require great facilities except for volunteers to participate in the investigation.

Letter to the Editor: Presence of Supernumerary First Dorsal Interossei Muscle

Debra Kusnierek

Study of Microalbuminuria in Type 2 Diabetes Mellitus as a Predictor of Left Ventricular Dysfunction- A Cohort Study

Pranay Kumar Patro, Bijay Kumar Dash, Shaktibrata Choudhury, Rama Chandra Sethy

Introduction: Diabetes Mellitus (DM) is a global health problem and India is the capital of it. It leads to acute metabolic and long-term complications with high morbidity and mortality. Cardiovascular (CV) disease is the major cause of mortality. Microalbuminuria (MAU) has been associated with generalised vasculopathy in major organ systems. Left Ventricular (LV) dysfunction and premature onset of CV disease is predicted by MAU. Aim: To evaluate the correlation of degree of microalbuminuria in Type 2 Diabetes Mellitus (Type2DM) as a predictor of LV dysfunction. Materials and Methods: This was a cohort study conducted in the Outpatient Department (OPD) of Medicine on 251 patients clinically diagnosed with Type2DM. Subjects were selected as per American Diabetic Association (ADA) criteria and cases having hypertension Ischaemic Heart Disease (IHD), valvular heart disease, Chronic Kidney Disease (CKD), Urinary Tract Infection (UTI), Chronic Liver Disease (CLD) were excluded from the study. MAU was assessed as having persistent albuminuria in two out of three urine samples as (30-300 mg/day or 20- 200 microgram per mg or an albumin creatinine ratio of 30- 300 microgram per mg creatinine). Echocardiogram to assess LV function were done in the Department of Cardiology using dual mode real time, 213/M-Mode, colour doppler, pulsed web doppler, continuous web doppler, considering criteria of American Society of Echocardiography and Mayo Clinic criteria. Data was analysed by Unpaired t-test for normal data, Chi-square test for dichotomous data and values were correlated using Pearson’s correlation coefficient. Results: Out of 251 study subjects, 148 were males and 103 were females with male to female ratio of 1.43:1. MAU was positive in 24.7% cases out of 251 cases. Echocardiogram revealed 77.4%% of study population have LV dysfunction and 46.8% of cases having diastolic dysfunction. With increased level of MAU, the incidence of LV diastolic dysfunction and LV systolic dysfunction also increased. In LV systolic dysfunction, severity of MAU was negatively correlated with Ejection fraction (EF), Fractional Shortening (FS), Cardiac Output (CO) and positively correlated with E Point Septal Separation (EPSS). In LV diastolic dysfunction, all parameters were positively correlated with severity of MAU. Severity of MAU and LV dysfunction were correlated and was found statistically significant (p<0.05). Conclusion: Severity of MAU was found to have significant correlation with parameters of LV systolic and diastolic function with significant p-value. LV dysfunction has also a strong correlation with poor glycaemic control and duration of DM.

Immediate Effect of Valgus Knee Brace and Lateral Wedge Insole on Gait Parameters in Medial Compartment Osteoarthritis of Knee: A Cross-sectional Study

Introduction: Orthoses have been reported to improve function and symptom reduction in knee Osteoarthritis (OA) of the medial compartment. Biomechanical changes introduced instantly in the gait with the use of orthoses can be evaluated to understand their effectiveness. Aim: To determine and compare the immediate effect of valgus knee brace and Lateral Wedge Insole (LWI) on gait parameters in medial compartment OA knee patients. Materials and Methods: This was a cross-sectional study conducted in the Department of Physical Medicine and Rehabilitation at a tertiary centre from August 2018 to July 2019. A 56 patients of knee OA (Kellgren-Lawrence system grades 2 or 3) were assessed by instrumented gait analysis before and just after orthotic fitment. Gait parameters related to External Knee Adduction Moment (EKAM) (e.g., maximum Ground Reaction Force (mGRF), vertical Ground Reaction Forces (vGRF), Varus Angle (VA) were assessed via motion capture during walking, in all four conditions: barefoot (B), LWI, valgus Knee brace (KB), Combined (C) i.e., (LW+KB). Statistical analysis was done using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 24.0. To find the significant difference in given parameters, repeated measure Analysis of Variance (ANOVA) was applied taking p-value <0.05. Results: A total of 56 patients (13 men, 43 women) mean age of 58.04±5.8 years and a mean Body Mass Index (BMI) of 27.4±3.5 kg/m² were analysed. A 35 patients had OA grade 2 and 21 were classified as grade 3. No significant difference in mean vGRF and VA values was found among LW, KB and C (p=0.118) and (p=0.894) throughout the stance phase. The significant difference was in mean mGRF values during initial stance phase (0-20% of gait cycle) (p=0.036). Conclusion: The orthoses may not swiftly provide beneficial biomechanical changes in gait parameters of medial OA knee patients.

Clinical and Cardiorespiratory Polygraphy Profile in Children with Obstructive Sleep Apnoea Syndrome: A Cross-sectional Study

Jeyakumar Settu, Stalin Selvaraj, Seenivasan Venkatasamy

Introduction: Cardiorespiratory Polygraphy (CRP) is a less costly and simplified alternative to time consuming and laborious over night polysomnography for diagnosis of Obstructive Sleep Apnoea Syndrome (OSAS) in children. The Apnoea Hypopnea Index (AHI) is simple and useful index that can be estimated by using CRP. The magnitude of AHI which reflects severity of OSAS is unknown in the paediatric population. Aim: To describe the clinical characteristics and to estimate AHI in a population of children with obstructive sleep apnoea and hypopnea syndrome. Materials and Methods: This cross-sectional observational study was conducted on 1500 children, below 12 years of age, from January 2018 to November 2018. They were screened using Paediatric Sleep Questionnaire (PSQ) in the Outpatient Departments of General Paediatrics and Pulmonology respectively, at the Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India. Those children identified to have probable OSAS were made to undergo cardiorespiratory assessment. Children with craniofacial syndromes and congenital heart disease were excluded from the study. Anthropometric parameters, vital signs, and Body Mass Index (BMI) were recorded. AHI and oxyhaemoglobin desaturation index were estimated in CRP. After descriptive analysis, non parametric Mann-Whitney test was used to find out any significant difference in median values of AHI in clinical subgroups. Regression analysis was done between AHI values and BMI. Results: Total 47 children were subjected to cardiorespiratory polygraphy. There was no statistically significant difference in gender distribution and prevalence of adenoid enlargement (p-value=0.1447 and 0.7705, respectively). It was found that maximum occurrence of OSAS was at the age of 6 years (25.5%). Based on AHI score 44.7% children fell in moderate to severe OSAS category. There was a poor correlation between BMI scores and AHI, though no significant difference was observed (r=-0.266, p-value=0.07087). The difference in median AHI between males and females was not statistically significant (p-value=0.5256), while that between children with/without adenoid enlargement was statistically significant (p-value ≤0.001). Conclusion: Children with adenoid hypertrophy have higher AHI than children without adenoid hypertrophy. There is lack of evidence for male predominance in the study. Obesity poorly correlated with AHI score.

Prognostic Relevance of C-Reactive Protein in Short Term Adverse Outcome in Patients with Acute Ischaemic Stroke

Subhasish Singh, Rashmita Pradhan

Introduction: Elevated C-Reactive Protein (CRP) is a predictive marker for future cardiovascular events in ischaemic stroke patients but the timing of CRP evaluation in relation to the onset of the qualifying event has not been determined. Aim: To study the predictive accuracy of CRP in relation to adverse outcome of patients with acute ischaemic stroke. Materials and Methods: This prospective single centre, observational study was conducted on 62 cases of acute ischaemic stroke admitted to the Department of Medicine, SCB Medical College and Hospital, Cuttack, Odisha, India. CRP was determined quantitatively in all the patients of ischaemic stroke both at the time of admission and discharge. The CRP value was correlated with infarct size (Computed Tomography (CT) scan), mortality, morbidity (disability i.e., Barthel Index (BI), Canadian Neurologic Stroke Scale (CNSS) and vascular events). The end points were death or any new non fatal vascular events (recurrent stroke, unstable angina, myocardial infarction) recorded during six months of follow-up period. Results: CRP at admission correlates with the occurrence of fatal events only but CRP at discharge correlates with occurrence of both fatal and non fatal events. On follow-up occurrence of events correlates more strongly with CRP at admission. Out of total 14 non fatal events, maximum was restroke i.e., 7 (50%) which occurs in high CRP group. BI (degree of disability), both on admission and at six months strongly correlated with CRP at discharge (p-value=0.008 and 0.001 respectively). Conclusion: The severity of stroke and degree of disability was highest in high CRP group. The CRP at discharge was a better predictor of future outcome in terms of fatal and non fatal events than CRP at admission.

Layered Closure Versus Retention Closure Technique for the Abdominal Wall in Midline Laparotomy: A Longitudinal Cohort Study

Arumugam Murugan, Manoj Karthik, Ananthakrishnan Nilakantan

Introduction: Midline laparotomy wound is closed in layers co-opting the various layers separately from historical times; however various methods of closure had come into vogue in the recent years. One such is the single layer mass closure technique, in which all the layers of the abdominal wall are closed in single layer, except for the skin and subcutaneous tissue. Yet another method described is the retention closure technique incorporating all layers including skin and subcutaneous tissue are closed in a single layer. Aim: To compare the postoperative wound complications in layered closure with retention closure technique in midline laparotomy. Materials and Methods: This was a longitudinal cohort study done on 57 consecutive patients who underwent midline laparotomy on an elective or emergency basis over a 12 months period from January 2014 to January 2015 in the Department of General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India. They were divided in to two groups depending on the closure type, layered closure (Group A) and retention closure (Group B) depending on the operating surgeon: retention closure was done in a single surgical unit and layered closure was done in rest of the respective units. Patients were followed-up meticulously and immediate postoperative complications were recorded up to four weeks. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, US) software with regression modules installed. Chi-square test and t-test were used to analyse the data. Results: In Group A there was 30 patients while in Group B there were 27 patients. In layered closure technique out 30 patients 12 (40%) patients developed wound infection, 1 (3.3%) patient developed partial dehiscence, and 2 (6.6%) patients developed complete dehiscence. In retention closure technique out of 27 patients only 5 (18.5%) patients developed wound infection, 3 (11%) patients developed partial dehiscence and none of them had complete dehiscence in this group. There was significant association between wound complications and patients with uraemia and hypoalbuminemia. Out of 12 uremic patients 8 (66%) developed wound infection (p-value=0.002), 2 (16.7%) patients developed partial dehiscence and 2 (16.7%) patients developed complete dehiscence (p-value=0.06). In patients who had hypoalbuminemia, out of seven patients, 5 (71.4%) patients had wound infection and 2 (28.6%) patients did not have wound infection (p-value=0.01). Four (57.1%) patients had partial dehiscence and 2 (28.6%) had complete dehiscence only 1 (14.3%) patient did not have any dehiscence (p-value=0.001). Conclusion: Retention closure has some advantages over layered closure in preventing wound infections and burst abdomen. Various risk factors are associated with postoperative wound complications, among which hypoalbuminemia and uraemia have a strong association.

Challenges of Organisational Structure and Human Resources in Pre Hospital Emergency Medical Systems for Cardiopulmonary Resuscitation: A Qualitative Study

Introduction: Studies about Cardiopulmonary Resuscitation (CPR) in pre hospital setting in Iran is limited. Despite the importance of this issue, numerous challenges in this area are left unattended. Aim: To explore the challenges of the organisational structure and the human resources in pre hospital Emergency Medical Systems (EMSs) for CPR. Materials and Methods: This qualitative study was conducted using content analysis approach. Data was collected through semi-structured interviews in 2020, until saturation was achieved. The participants were 16 Iranian emergency medical staff who were selected through a purposive sampling method. Data were analysed based on the Graneheim UH and Lundman B approach. Results: Thirteen participants were males and the rest were females. The mean age of the participants was 33.06±7.85 years and their mean work experience was 10.62±6.63 years. By analysing the data, the information was placed in two main categories- “the challenges of human resources” which includes four sub categories (lack of experience and skills, intrapersonal challenges, non targeted performance and weakness in education as the existing challenges), and “the challenges of organisational structure” which includes three sub categories (improper structure and access, lack of organisational support and shortages of the facilities and the equipment as the existing challenges). Conclusion: Results from the present study revealed that pre hospital EMSs staff had to face various problems, challenges and limitations in CPR. Therefore, the ability of these staff to manage these challenges should be increased through the opportunity to acquire clinical knowledge and skills in order to improve patient-centered services.

Protective Effect of Yerba Mate on Rats Fed on High Cholesterol Diet- An Experimental Study

Shimaa Mohammad Hussain Aboelnaga, Fahmida khatoon Zahid Balouch

Introduction: Yerba mate tea, a concoction made from the leaf extracts of the tree Ilex paraguariensis, is a broadly consumed non alcoholic beverage in Latin America which is gaining rapid introduction into the world market. Aim: To explore the influence of Yerba Mate (Ilex paraguariensis) powder and beverage on induced hypercholesterolemic rats. Materials and Methods: The experiment was carried out for a duration of one year from February 2020 to January 2021 at University of Ha’il, Ha’il, Saudi Arabia, on 48 male Albino rats divided into six subgroups; Control (-) group: group fed a basal diet. Rats in the other five groups fed on basal diet containing 2% cholesterol+0.25% bile salts for two weeks to induce hypercholesterolemia. Then those rats were subdivided into: control (+) group: group that remained hypercholesterolemic. Yerba Mate Powdered (YMP) 15% group: fed on hypercholesterolemic diet+YMP15%; YMP 10% Group: fed on hypercholesterolemic diet+YMP10%; Yerba Mate Beverage (YMB) 15% group: fed on a hypercholesterolemic diet+YMB 15%; and YMB 10% group: fed on a hypercholesterolemic diet+YMB 10%. Results: It was found that, with increasing the amount of Yerba Mate powder or beverage, the total cholesterol, triglycerides, Low Density Lipoprotein-Cholesterol (LDL-C), Aspartate Transaminase (ALT), Alanine Transaminase (ALT), urea nitrogen and glucose levels decreased significantly (p<0.05) and the best result belonged to the group of rats that fed on Yerba Mate 15% powder. Conclusion: It can be concluded that, supplementation with high percentage of Yerba Mate powder (15%) exerts a positive impact on the lipid profile and other biochemical parameters in hypercholesterolemic rats.

Culture of Interpersonal Communication in ICU Nurses: An Ethnographic Study

Introduction: Interpersonal Nurses Communication (IPC) in Intensive Care Unit (ICU) is known to be important due to the critical situation of patients and the nurses’ experience with moral distress. Nurses interpersonal relationships and ways of resolving conflicts are influenced by the culture of this sector. Aim: To specify the culture of IPC among nurses in ICU. Materials and Methods: This was a qualitative multi-site ethnographic study conducted from May 2017 to September 2019 at Kermanshah University of Medical Sciences. Data were collected through participatory observation and formal and informal semi-structured interviews. The study environment included four ICUs in two hospitals. Data were obtained from an uninterrupted observation for five months, intermittent observation for six months, 15 formal interviews and 31 informal interviews. The process stems from the research evolutionary cycle model and Spradley’s Steps. In order to discover the meaning of the patterns from the obtained themes, the findings were interpreted after analysis. In this study, Spradley method was used to analyse the data. Results: In this study, 66.7% of the nurses were female, the mean age was 38.66±9.1 years, and mean work experience was 14.43±8.4 years. The three main themes of the high-level code consensus emerged as follows: Grouping which included the formation of groups, cooperation and competition between groups, and demarcation and characteristics of groups. The governing organisational relationships include managerial strategies and nature of the wards. And the individual characteristics that included top-down look, work discipline and experience. Conclusion: The IPC among the ICU nurses is a dynamic and inevitable process and influenced by factors such as nurses’ membership in the groups established in the ICU, nurses’ cooperation, management strategies, physical and emotional nature of critical care units, work experience and former communications, discipline, and features such as a top-down attitude.

High Concordance of HER2 Overexpression by Immunohistochemistry on Mucosal Biopsies and Resection in Gastric Adenocarcinoma

Introduction: High expression of Human Epidermal growth factor Receptor 2 (HER2) is a predictive biomarker for the treatment of gastric carcinomas with targeted agents. Targeted therapy could improve the outcome of patients with gastric carcinoma overexpressing HER2. There is limited information on mucosal biopsies to characterise the HER2 expression status of a tumour. Aim: To study HER2 expression by Immunohistochemistry (IHC) in matched mucosal biopsies and surgical specimens in patients with gastric adenocarcinoma and to discover the level of concordance. Materials and Methods: This was a prospective observational study conducted in the Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India, for one year (1st July 2016 to 30th June 2017). The IHC for HER2 was performed on matched mucosal biopsies and corresponding gastrectomy specimens of 72 patients. The HER2 overexpression (HER2+) was defined by a score 3+ on IHC. The results were analysed using Statistical Package for the Social Sciences (SPSS) software and Chi-square test was done for statistical significance. Results: The overall HER2 positivity rate was 11.11% (8/72). The HER2 positive rates (score 3+) were 9.72% on biopsy (7/72) and 8.33% on resection (6/72). Five cases showed concordance of HER2 between mucosal biopsies and resection specimens, however the other three cases showed a discordance i.e., two mucosal biopsies showed HER2 positivity and one resection showed HER2 positivity. The concordance rate in this study was 95.83% between resection and mucosal biopsies. Among the eight HER2 positive cases, five cases showed good concordance. One case showed positive shift: HER2 score was 0 on the mucosal biopsy and HER2 score was 3+ on the resection. Two cases showed a negative shift: mucosal biopsy showed HER2 score 3+ and the resection HER2 score 0. All the three discordant cases had received Neoadjuvant Chemotherapy (NACT) and showed heterogeneous staining on the resection specimen. None of the five concordant cases had received NACT and three of the five resections showed heterogeneous staining pattern. Conclusion: To the best of the authors’ knowledge, this was the first study to compare HER2 expression in gastric adenocarcinoma in matched biopsies and the corresponding resections in India. There was concordance of HER2 expression in 69 cases and discordance in three. Differences between biopsy and resection HER2 expression could be explained by intra-tumoural heterogeneity and possibly by decreased HER2 expression after NACT. The HER2 analysis by IHC on both mucosal biopsy and resections could optimise the selection of trastuzumab-eligible patients in case of gastric adenocarcinoma.

Platelet Indices in Preeclampsia and Normotensive Pregnancy in a Tertiary Care Centre: A Cross-sectional Study

Kratika Kamath, E Gomathy

Introduction: Preeclampsia is a serious pregnancy-related complication. Platelets are potentially important in the pathogenesis of preeclampsia, and platelet function analyses may prove as a sensitive preeclampsia biomarkers. It is well established that pregnancy itself induces a pro-coagulant state due to a rise in the levels of pro-coagulant proteins and a lower level of some endogenous natural anticoagulants. Additionally, it has been reported that preeclampsia is associated with an increase in platelet function. Aim: To assess the platelet indices in preeclamptic and normotensive pregnant women. Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. A total of 132 pregnant women were involved in this study. Among them 66 were preeclamptic women treated as cases (Group A) and 66 were normotensive pregnant treated as controls (Group B). The duration of the study was from October 2018 to July 2020. A detailed clinical history along with the antenatal examination was done. The Blood Pressure (BP) recording were documented and for the patient with hypertension repeat BP recording after four hours were documented. Complete blood count was done for all the patients and White Blood Cells (WBC), Platelet Count (PC), Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) were documented in all the patients. Comparison was done between the platelet indices of normotensive pregnant women and women with preeclampsia using Chi-square test. Results: In this study, majority of the subjects were in the age group of 21-30 years in group A and 18-25 years in group B. The PC was 50,000-1 lac in about 26 (39.4%) in group A. The mean PDW (fl) was 12.62±2.14 in group A and in group B it was 10.98±1.06. The mean MPV (fl) (femtoliter) was 10.27±1.11 in group A and in group B 9.81±1.01. There was a statistically significant difference in clinical parameters like PC, PDW (fl) and MPV (fl) between the study groups (p-value <0.05). In the present study, adverse foetal outcomes were more in group A than group B. In group A, 40 babies born to preeclamptic mothers showed adverse outcomes. Twelve (30%) cases suffered Intrauterine Growth Restriction (IUGR). In group A, 39 cases and in group B 26 cases showed maternal abnormalities. Placental abruption was observed in 9 (23.08%) patients of group A and 2 (7.69%) in group B and anaemia was observed in 9 (23.08%) patients in group A and 7 (26.92%) in group B. Conclusion: This study concluded that there is decrease in PC and increase in the platelet indices like MPV, PDW, in preeclampsia women as compared to normal pregnant women. Adverse neonatal outcomes like IUGR and foetal distress were also found to be more in women with preeclampsia (not statistically significant). Particularly in developing countries like India, the platelet indices can be used as effective biomarkers which are both easy and economical to obtain. Platelet indices can be used as a prognostic tool, for prediction of preeclampsia and help in improving the feto-maternal outcome.

Predisposing Factors of Pseudomonas Pneumonia: A Hospital Based Cross-sectional Study

Abdul Razak Nader , Fatima Nazish , Mohammad Shameem , Rakesh Bhargava

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is a usual causative organism of both hospital-acquired pneumonia and community-acquired pneumonia. Although, it is less commonly reported in otherwise healthy hosts, most patients have an identifiable risk factor for disease. These risk factors include those with structural lung abnormalities like bronchiectasis and those with a compromised immune system. With the emergence of multidrug resistant strains of P. aeruginosa, the severity of infection and mortality associated with pneumonia has increased drastically. The insight into the risk factors of Pseudomonas pneumomia helps to suspect and treat the condition at the earliest and thereby reduce the mortality as well as the duration of hospital stay. Aim: To determine various risk factors associated with P. aeruginosa pneumonia. Materials and Methods: An observational cross-sectional study was conducted from November 2018 to November 2020 at Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, Inida, after obtaining Institutional Ethics Committee (IEC) approval. A total of 89 patients with diagnosis of Pseudomonas pneumonia, defined as the presence of signs and symptoms of pneumonia along with sputum or tracheal culture positive for P. aeruginosa were enrolled in the study. These patients were thoroughly assessed by clinical history, physical examination and relevant investigations to detect any risk factors like age, diabetes, smoking, Chronic Obstructive Pulmonary Disease (COPD), chronic steroid use and prior hospital admission. Data analysis was done using Statistical Package for Social Sciences (SPSS version 22.0). Categorical variables were compared with the Chi-square test. Results: Out of 89 patients with Pseudomonas pneumonia, 77.5% were above 40 years of age, 37.08% were smokers, 25.84% had COPD, 22.47% had bronchiectasis, 31.46% were diabetic, 15.73% were on long term steroid use and 14.61% had history of prior hospital admission. Conclusion: Age, smoking, structural lung diseases like COPD, bronchiectasis, long term steroid use and prior hospital admission are important risk factors for Pseudomonas pneumonia.

Single Dose Preoperative Intravenous Antibiotic versus 5 Days Postoperative Per Oral Antibiotic Therapy in Third Molar Surgery- A Randomised Clinical Trial

R Sathish , Arya Anil

Introduction: Surgical extraction of third molars is carried out in dentistry worldwide and is mostly performed under local anaesthesia on an outpatient basis. In minor oral surgery, various antibiotic regimens have been used. Antibiotic medication can be given immediately after surgery and continued for several days or as single or multiple doses several days before surgery as a preventative measure. Antibiotics can also be given prior to surgery and continued after surgery. Aim: To evaluate the effectiveness of single dose preoperative injection amoxicillin 1 gm administered 1 hour before the procedure, over routine 5 days postoperative peroral antibiotic therapy in decreasing the frequency of postoperative complications after third molar surgery. Materials and Methods:This randomised clinical trial was conducted at JSS Dental College and Hospital, Mysuru, Karnataka, India, during the period of August 2020 to April 2021, among 30 patients with bilaterally impacted mandibular third molars. Each subject underwent removal of impacted tooth on one side with oral amoxicillin 500 mg thrice daily for 5 days postsurgically (Group A) and that on the other side was removed after two weeks with a single dose intravenous (i.v.) 1 gram Inj. amoxicillin 1 hour preoperatively (Group B). Postoperatively each patient was evaluated on the 3rd, 7th and 14th postoperative day for variables like surgical site infection and alveolar osteitis. Oedema, erythema and Purulent Discharge (PD) were the parameters assessed to diagnose surgical site infection. Pain greater than 36 hours, Loss of Blood Clot (LOBC) and Evidence of Exposed Bone (EEB) were the parameters to diagnose alveolar osteitis. Chi-square test was used for statistical analysis. Results: Amongst 30 patients selected for this study, 14 (46.7%) were females and 16 (53.3%) were males with a mean age of 25.17±5.74 years. In 30 subjects, oedema, erythema and pain more than 36 hours were evident by the (p-value=0.559, 0.80, 0.436 respectively on 3rd day) which resolved completely by 14th postoperative day. There was no occurrence of alveolar osteitis and surgical site infection among both groups. Conclusion: Inj. amoxicillin 1 gm administered 1 hour prior surgery was found to be equally effective as compared to capsule amoxicillin 500 mg administered per orally thrice daily for 5 days. Hence, Inj. amoxicillin 1 gm an hour prior surgery was found to be a viable option.

Determination of Sexual Dimorphism by Odontometric Study of Permanent Maxillary Incisors and Canines: A Cross-sectional Study from Population of Haryana

Anju Devi, Shruti Gupta, Mala Kamboj, Anjali Narwal, Vinay Kumar, Rahul Raman

Introduction: Sex determination is one of the prime factors employed to assist with the identification of an individual. As extensively mutilated bodies are difficult to identify, teeth can be used as they can withstand bacterial decomposition and fire. Odontometric parameters can be used for gender determination in a specific population. Variations have been documented in different regions in determining sex of an individual using tooth size and accuracy of odontometric sex prediction which prompted us to draw population specific data. Aim: To evaluate permanent maxillary incisors and canines for sexual dimorphism and to estimate the level of accuracy with which they could be used for sex determination in the age group of 18-24 years in Haryana. Materials and Methods: This cross-sectional study comprised of 300 subjects (150 males and150 females) in the age group of 18-24 years, from population of Haryana during January 2017 to May 2017. Maximum mesiodistal (MD) diameter of permanent maxillary incisors and canines were measured using digital vernier calliper. The mean, range, and standard deviation were calculated for the size of the teeth. A two-sample t-test was used to test for statistical difference between means. Results: The present study comprised of 300 individuals (150 males with mean age of 20.81 years and 150 females with mean age 20.54 years) between the age group of 18-24 years. Mean mesiodistal dimension for each tooth was found to be greater in males as compared to females with statistically significant difference for right canine (p-value=0.003), left canine (p-value=0.001) and right lateral incisor (p-value=0.019). Left maxillary canine showed highest percentage (3.164%) of sexual dimorphism. The level of accuracy of sex determination when all the teeth under study were taken into consideration was 62.7% of females and 58% of males. Conclusion: Sexual dimorphism of teeth is population specific and was well evident in population of Haryana, hence the mesiodistal dimensions in maxillary left permanent canine can aid in sex determination.

Burns Demography and Management during COVID-19 Pandemic- A Descriptive Study

Abha Rani Kujur, Nita Trina Dsouza, Rajeswari Dharmarajan

Introduction: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus has affected many people in India in 2020. This has put a huge strain on hospitals and healthcare workers. Burn patients usually require hospitalisation and surgery, which adds to the burden of care provided by healthcare workers. Modifications in management protocol during a pandemic are of utmost importance to prevent transmission of Coronavirus Disease-2019 (COVID-19) while simultaneously treating burn patients. Aim: To study burn demography and describe changes in burn management protocol during COVID-19 pandemic. Materials and Methods: This descriptive study was done from March to July 2020, during the COVID-19 pandemic’s initial stages in India, at a tertiary care hospital in Southern India. During these months, screening protocol and guidelines for admission and testing of patients for COVID-19 were followed as given by Indian Council of Medical Research (ICMR). All burn patients who visited the hospital’s Emergency Room (ER) during this period were included in the study. Those patients whose records were incomplete were excluded from the study. Detailed documentation was done of patient’s burn history, travel history and contact history by healthcare workers wearing level 1 Personal Protection Equipment (PPE). Demographic details were collected and entered into Microsoft Excel spread sheet and the percentages were calculated. Results: A total of 77 burn patients visited the ER and 44 patients required admission. A total of 22 (50%) of the admissions were children. A total of 45 patients (58.44%) had sustained scald burns, 23 patients (29.87%) sustained flame burns and nine patients (11.69%) sustained electric burns. Thirty two patients sustained burns upto 20% and 12 patients had major burns (>20%). Nine patients underwent surgery. There were two fatalities. All patients were seen by healthcare workers wearing level 1 PPE. No COVID-19 positive patient was reported during the study period. Conclusion: There was an increase in paediatric burn accidents during the COVID-19 pandemic in India due to crowded and congested homes and a lack of continuous supervision from adults otherwise occupied with work done remotely from home. It is routine practice to admit only critical burn patients or in situations where home care is not possible. Minor burns dressing must be done at home instead of; at Outpatient Department (OPD) visit. Lifesaving surgeries in children were done using live skin donor. Diagnosis, treatment, physiotherapy and follow-up of patients through teleconsultation to avoid spread of COVID-19 virus was encouraged.

Utility of Serum Transaminases in Predicting Disease Severity in Dengue Fever- A Cross-sectional Study

Introduction: Thrombocytopenia has been known to be a manifestation as well as predictor of severe dengue. However, use of additional biomarkers like Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT) alone or in conjunction with platelet count may help in early and better predictability of severe dengue cases. Aim: To determine the correlation between transaminase elevation and severity of dengue fever. Materials and Methods: This was a single centre, cross-sectional study conducted at a tertiary care centre of Western Maharashtra. Total 110 hospitalised patients with a diagnosis of suspected dengue fever, based on clinical signs and symptoms with a positive NS1 antigen test (non structural protein 1)/Immunoglobulin M (IgM) test using rapid test kits were taken as study population. The patients were clinically evaluated on daily basis for development of any warning signs and symptoms along with monitoring of haematological and biochemical parameters. For statistical analysis the technique of percentages, mean and Pearson ‘r’s were employed using IBM Statistical Package for the Social Sciences (SPSS 20.0) version for windows. The p-value of 0.05 was considered as significant value. Results: Out of 110 patients, 83 were males and 27 females. Clinical fluid accumulation was seen in 5 patients (4.5%), bleeding manifestations and fluid accumulation in 4 (3.6%) and bleeding manifestations in 17 (15.5%). Negative correlation was observed between thrombocytopenia with bleeding manifestations (r=-0.17, p=0.04), whereas positive correlation was seen in incidence of bleeding with serositis (r=0.19, p=0.04), AST with serositis (r=0.21, p=0.02) and ALT with Packed Cell Volume (PCV) (r=0.22, p=0.01). Conclusion: Additional biomarkers like AST and ALT alone or in conjunction with platelet count can also help in early prediction of severity of dengue fever.

Adoption of Safety Measures against COVID-19 by Tribal Families in Southern Rajasthan- A Cross-sectional Study

Introduction: The outbreak of COVID-19 pandemic during early 2020 forced the people to make drastic changes in their lifestyle. The people’s response to preventive measures initiated by the Government to control COVID-19 is the focus of the study. Aim: To assess the knowledge for prevention and adoption of safety measures against COVID-19 by the tribal masses. Materials and Methods: The cross-sectional study, covering 300 selected tribal families, was conducted in a tribal belt during the period September 2020 to December 2020. The questionnaire covered socio-demographic profile, knowledge aspects and adoption pattern regarding preventive measures of COVID-19. The head of the family or in his/her absence any available adult family member has been the respondent to provide the required information. Based on maximum score of 15 for correct knowledge, the families were categorised as poor (≤5), average (6-10) and good (11-15). With a maximum score of 24 for correct adoption, the categorisation was made as poor (≤8), average (9-16) and good (17-24). The association of socio-demographic factors with knowledge and practice level was tested through Chi-square test and correlation coefficient between knowledge and adoption scores. Results: Among the 300 families studied, the nuclear type tribal families dominated in the study area 204 (68%) and the average age of respondents was 61 years. The mean knowledge score was 7.6 (50.67%) and adoption score was 11.22 (46.75%). The percentage shares of respondents in poor, average and good categories were 31.33%, 35.33% and 33.33% for knowledge and 32.66%, 34.66% and 32.66%, respectively for adoption scores. The education level, income of the family and access to media sources were found to have significant association between knowledge and adoption scores. Conclusion: The highest education level of family members, family income and access to media sources were significantly associated with knowledge as well as practice. The positive correlation between knowledge and adoption scores indicated that the adoption level can be improved by enhancing knowledge to the socially backwards tribal communities. Socially visible practices like mask wearing were well adopted by tribals whereas the adoption level of invisible components like immunity building was relatively low

Prognostic Significance of Baseline Serum Calcium Levels in Patients with Acute Coronary Syndrome- An Observational Study

Rohit Raina, Puneeta Gupta

Introduction: The risk stratification is very important for the management of patients with Acute Coronary Syndrome (ACS). Extraskeletal calcium plays a critical role in a range of biological processes. There is an urgent need to accurately identify, the additional factors which are important in the clinical course and outcome of patients of ACS. Aim: To evaluate impact of baseline serum calcium levels in patients with ACS and to determine prognostic significance of baseline serum calcium levels in patients with ACS. Materials and Methods: The present observational study was conducted on 100 patients of ACS, over a period of one year from December 2018 to December 2019 at Acharya Shri Chander College of Medical Sciences, Sidhra, Jammu and Kashmir, India. They were divided into three tertile ranges as: hypocalcaemic (<8.1), normocalcaemic (8.1-10.4), hypercalcaemic (>10.4). The clinical outcome was measured in terms of Left Ventricular Ejection Fraction (LVEF) development of acute pulmonary oedema, rates of emergency revascularisation, development of arrhythmias, recurrence of chest pain, mortality within 7 days of admission, readmission rates with reinfarction or any other cardiovascular complication and finally, mortality within 90 days of follow-up. Quantitative variables were compared using ANOVA/Kruskal Wallis Test between the three groups. Results: The mean age of the study population was 73.29±8.11 years. Baseline calcium on admission was found to be <8.1 mg/dL in ACS patients and more common in males, older age group, patients with higher Body Mass Index (BMI) and was associated with worse prognosis as compared to those with normal serum calcium levels. Mortality within 90 days of follow-up occurred in 42.86%, 20% and 6.25% in unstable angina and 39.29% 11.76% and 13.33% in AMI in hypocalcaemic, normocalcaemic and hypercalcaemic groups, respectively. It is inferred that 64% of the patients in hypocalcaemia tertile (n=14) were males in unstable angina and overwhelming 78.57% in AMI. Conclusion: Hypocalcaemia (corrected calcium <8.1 mg/dL) is common in patients of ACS and a predictor of adverse outcomes.

Diagnostic Accuracy of B-scan Ultrasonography for Posterior Segment Eye Disorders- A Cross-sectional Study

Maheswar Chaudhury, Bikash Parida, Sandeep Kumar Panigrahi

Introduction: Ophthalmic Ultrasound (USG) produces real time high resolution images of the eye and orbit. It can categorise, predict location and diagnose posterior segment pathology of the eye very well and is usually used in preoperative evaluation. However, the diagnostic accuracy, in terms of predicting probability of Posterior Segment Disease (PSD) post-USG, has usually not been studied, that too in Indian set-up. Hence, this study was conducted. Aim: To find out the prevalence and pattern of PSD among patients referred to radiology department using B-scan USG, and to find out the diagnostic accuracy of B-scan USG in such cases. Materials and Methods: The study was cross-sectional in nature conducted over a period of two years (2007-09) and conducted in the Department of Radiodiagnosis and Ophthalmology of a tertiary care centre of Eastern India. Patients were referred to the Radiology department for ruling out intraocular pathology using B-scan ophthalmic USG were included in the study, irrespective of any age and gender. Data were captured on an excel sheet and analysed using Stata 12.1. Prevalence and pattern of PSDs were established from the data while diagnostic accuracy was calculated in terms of sensitivity, specificity, predictive values and log Likelihood Ratios (LR). Accuracy of B-scan USG was also estimated and adjusted for verification bias. Results: The mean age of 84 study participants was 37.4±19.5 years, with maximum in between 41-50 years. Males predominated (72.6%). A 50% presented with low vision, and most commonly associated with cataract 45 cases (54%). Prevalence of posterior segment eye disorders was 13.1%. Adjusted sensitivity, adjusted specificity and Negative Predictive Values (NPV) were 100%. Positive Predictive Value (PPV) was 45.33%. Post-test probability was 46.6%, while after adjustment it was infinite. Adjusted accuracy was 100%. Conclusion: Prevalence of posterior segment eye disorders was 13.1% for cases referred to radiology department. The most common PSD that was found was retinal mass. Using B-scan USG for preoperative assessment and confirmation of diagnosis increases the probability of detecting presence or absence of posterior segment pathology. Absence of PSD using this is also very helpful in ruling out disease entirely. It also has a very high sensitivity and hence has a scope to be used even in rural health centres.

Frequency of CYP2C19*2 Allele in Patients with Acute Coronary Syndrome: A Cross-sectional Study from Central Kerala, India

Introduction: Ischaemic Heart Diseases (IHD) are increasing at an alarming rate globally. Pharmacotherapy, the mainstay of management of IHD, has Dual Antiplatelet Therapy (DAPT) at its crux. DAPT, comprising of clopidogrel and aspirin, is used often for 12 months in medically managed Acute Coronary Syndrome (ACS). Clopidogrel being a prodrug, needs to be activated after ingestion, mainly by Cytochrome family of enzymes, for the desired pharmacological effects. Abnormal enzymes that convert clopidogrel to its active form can reduce the effectiveness of the drug. Therefore, Single Nucleotide Polymorphisms (SNPs) of the enzymes involved, would predispose the patient to therapy failure and recurrence of the illness. This study aims at identifying the presence of a genetic variant associated with clopidogrel responsiveness in patients with ACS. Aim: To estimate the frequency of CYP2C19*2 allele in patients with ACS presenting to Government Medical College, Thrissur, Kerala, India. Materials and Methods: Present study was a cross-sectional study done among 60 patients who presented to Government Medical College, Thrissur with ACS, between June 2018 to June 2019. Having obtained informed consent from the participants blood samples were collected in Ethylene diamine tetra-acetic Acid (EDTA) tubes. Samples were used to look for presence of CYP2C19*2 allele by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Results: Out of 60 patients 38 were males and 22 were females. Most common age group was 61-65 years. The frequency of CYP2C19*2 allele was 41% in the study population and the variant genotype (AA/AG) was present in 62%. Conclusion: The variant genotype was found to be present in a high frequency in the study population implying the high risk for therapy failure in the study population. This asserts the need to probe the matter further, as the gene is also implicated in the metabolism of several other drugs. The introduction of pharmacogenomic testing prior to initiation of therapy may be therefore recommended for better treatment outcome. However, to validate the same, further studies with larger sample size may be necessary

Isolation of mecC Gene carrying Methicillin Resistant Staphylococcus aureus in Clinical Samples from a Tertiary Care Institute, Northern India

Introduction: mecC Methicillin Resistant Staphylococcus aureus (MRSA) after its initial recovery in 2007 has been reported with varying frequency from different parts of the world. These isolates assume importance due to the fact that with routine testing platforms available for the detection of MRSA they can be misidentified as being methicillin sensitive which can adversely affect the treatment and outcome of infections due to MRSA harbouring the mecC gene. Aim: Evaluation of mecC gene carrying MRSA in clinical isolates. Materials and Methods: This retrospective study was conducted in the Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India for a period of three months (May-July 2020). A total of 102 laboratory confirmed isolates of MRSA (based on biochemical tests and cefoxitin disc diffusion results) were subjected to screening for the presence of mecA and mecC gene by Polymerase Chain Reaction (PCR). Deoxyribonucleic Acid (DNA) was extracted using an in house extraction method following which mecA and mecC were amplified in a total reaction volume of 25 μL using 2x PCR master mix, 5 μL of template and 1 μL (0.4 μM final concentration) each of reverse and forward primers specific for the above mentioned genes. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software v24.0. Results: All the isolates were confirmed as being methicillin resistant with 96.1% isolates carrying the mecA gene and 3.9% carrying the mecC gene. mecC MRSA were recovered from pus, swab and endotracheal tip in middle aged men. One of the patient from whose sample mecC MRSA was recovered was suffering from hypertension, diabetes and renal faliure. MRSA exhibited high resistance to all the antimicrobial agents tested however all of them were sensitive to vancomycin and linezolid. Conclusion: The presence of mecC gene in clinical isolates of MRSA is a cause of concern and calls for an extensive and continuous surveillance of such isolates as they can in future be implicated in causing severe human infections.

Immunohistochemical Expression of p63 in Benign and Malignant Breast Lesions

Introduction: Breast carcinoma demands attention as it causes high morbidity and mortality. It is important to recognise benign lesions to distinguish them from in situ and invasive breast cancer and to assess a patient’s risk of developing breast cancer, so that the most appropriate treatment modality for each case can be established. The p63 has been characterised as a reliable marker of myoepithelial cells of lactiferous duct. It is exclusively expressed in myoepithelial cells of normal breast tissue. Hence, p63 can be of great help in the differential diagnosis involving benign lesions. Also, p63 may aid in distinguishing benign from malignant lesions. Aim: To study the Immunohistochemistry (IHC) expression of p63 in benign and malignant breast lesions. Materials and Methods: The prospective study was conducted on 76 breast specimens for a period of one year, from 1st December 2018 to 30th November 2019 in the Department of Pathology, Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India. IHC assessment for p63 nuclear protein was performed. The intensity of p63 expression was evaluated as continuous positive, discontinuous positive and negative. The extent was scored on the basis of percentage of positive cells and assigned a score of negative (0%), 1 (<25%), 2 (26-90%) and 3 (91-100%). Results: Out of 76 cases, 38 cases were diagnosed as benign and 38 cases as malignant. IHC staining with p63 showed nuclear positivity in all benign lesions. Among malignant lesions, four were positive and 34 were negative. Conclusion: According to the above results, p63 is a very useful IHC marker in diagnosing difficult cases, cases of carcinoma in situ, borderline cases and cases with inconclusive histomorphological diagnosis.

Effects of Variations in Imaging Parameters on Image Quality of Non Contrast Computed Tomography Scans of Brain: A Cross-sectional Study

Introduction: The radiation dose absorbed during Computed Tomography (CT) investigation of the head, which could be reduced by altering the scan parameters, is of great concern considering the radiosensitive organs around this region. Aim: To investigate the relationship between variations in scan parameters and image quality in brain CT scanning. Materials and Methods: This was an experimental cross-sectional study conducted at a private diagnostic clinic in Enugu State, Nigeria, from September 2018 to February 2019 with a total sample size of 150. All adult patients who reported at the centre for non contrast CT of brain during the study period {but not limited to participants with Anteroposterior Circumference Diameter (APCD) 170-180 cm of brain} were selected using consecutive sampling method. The samples was divided into three groups, a control group and two experimental groups. Scan parameters such as kilovolts (kV), milliamperes (mA) and Gantry Rotation Time (GRT) varied across the three groups studied and the corresponding image parameters such as image noise, Contrast to Noise Ratio (CNR) and Signal to Noise Ratio (SNR) were obtained and statistically analysed using both descriptive and inferential statistics. Results: There were statistically significant correlations of image parameters with scan parameters Group I (control): (CNR: r=0.857, p-value <0.001; Image noise: r=0.206, p-value=0.125, and SNR: r=0.875, p-value <0.001) (CNR: r=0.857, p-value <0.001; Image noise: r=0.211, p=0.115 and Image noise: r=-0.164, p-value=0.124 and SNR: r=0.880, p-value <0.001) for mA and kV, respectively. Group II (CNR: r=0.744, p-value <0.001, Image noise: r=0.521, p-value=0.024, and SNR: r=0.765, p-value <0.001), (CNR=r=0.761, p-value <0.001, Image noise: r=0.241, p-value=0.011 and SNR: r=0.780, p-value p=0.024) for mA and GRT, respectively. Group III (CNR: r=0.684, p-value=0.032; Image noise: r=0.646, p-value=0.032 and SNR: r=0.664, p-value=0.001) for mA. There was statistically significant relationship between scan parameters and radiation does parameters across all the sub groups at p-value <0.05. Conclusion: Altering the scan parameters (mA, kV and GRT) during CT brain investigation has tremendous effects on the image quality, particularly on the image noise and also on the radiation dose received by the patients.

Grading of Liver Fibrosis using Shear Wave Elastography and Aminotransferase Platelet Ratio Index in Chronic Viral Hepatitis: A Case-control Study

Introduction: Liver fibrosis is a progressive disorder that if diagnosed early and staged precisely, allows early clinical intervention that may hinder or slow down the progression to end stage decompensated cirrhosis. Grading of hepatic fibrosis is important not only for diagnosis but also for prognostic evaluation, planning appropriate therapy, and follow-up of patients with chronic viral hepatitis. Liver biopsy has been considered the reference standard for grading liver fibrosis. As liver biopsy is invasive and associated with complications, non invasive serological and imaging techniques like Shear Wave Elastography (SWE) and Aminotransferase Platelet Ratio Index (APRI) have come to the spotlight. Aim: To evaluate SWE alone and together with APRI as a reliable alternative to liver biopsy for diagnosing and grading hepatic fibrosis in chronic viral hepatitis. Materials and Methods: This case control study was conducted over a period of 18 months from October 2017 to March 2019, at a tertiary care hospital in New Delhi, India. Total 120 subjects (60 cases of chronic viral hepatitis and 60 case matched healthy volunteers as controls) were enrolled in the study. Biopsy could not be performed in 10 cases so these cases and their matched controls were excluded from the statistical analysis. SWE was performed using a 1-5 MHz curvilinear transducer (Philips iU22x MATRIX). The APRI and the mean of six SWE measurements (in kilopascals) were calculated for all subjects. The analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Among all 50 cases of chronic hepatitis who have underwent biopsy, the mean SWE values corresponding to the histopathological grade of fibrosis i.e., F0, F1, F2, F3 and F4 was found to be 4.48±1.05 kPa, 7.16±0.75 kPa, 8.08±1.05 kPa, 8.44±0.47 kPa and 16.01±3.78 kPa, respectively. The mean APRI values of the cases in F1, F2 and F3 grades showed significant overlap (cut off value between 0.5-1.5). Also, when APRI was used along with SWE, does not have a statistically significant contribution to improve its diagnostic accuracy in liver fibrosis grading. Conclusion: Shear wave elastography has high accuracy in detecting and grading of fibrosis. APRI does not appear to have a significant role in the grading of liver fibrosis however it can be combined with SWE for post-treatment follow-up of chronic viral hepatitis patients thus avoiding the need for repeated biopsy.

Peripheral Arterial Disease as an Underdiagnosed Entity in COPD and its Impact on Functional Exercise Capacity- A Cross-sectional Study from a Tertiary Care Hospital in Eastern India

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of morbidity and mortality globally. COPD is a systemic disease, cardiovascular and Peripheral Arterial Disease (PAD) are common entities in COPD. Asymptomatic, undiagnosed PAD can lead to impaired functional exercise capacity, increased morbidity and mortality. Aim: To find out the occurrence of PAD in COPD and relative contribution of PAD, severity of COPD, and Health Related Quality of Life (HRQL) on functional exercise capacity. Materials and Methods: The present study was a prospective, cross-sectional, analytical study carried out in the Department of Respiratory Medicine of a teaching institution in eastern India over a period of six months. All COPD patients diagnosed as per Global Initiative for Obstructive Lung Diseases (GOLD) criteria were recruited for the study after obtaining written informed consent. HRQL was assessed by Clinical COPD Questionnaire (CCQ). Exercise capacity was assessed by Six Minute Walk Test (6MWT) and PAD was evaluated by Ankle Brachial Index (ABI) on Ultrasound (USG) Doppler. Data were analysed using appropriate statistical tests. Mean, Standard Deviation (SD) and percentages were calculated for descriptive frequencies, p-value was calculated using Fischer’s-exact test or Chi-square test for categorical data and independent sample t-test and Kruskal Wallis test for parametric and non parametric data, respectively. Results: Out of 75 COPD patients, PAD was present in 18 (24%) patients. Majority of COPD patients (n=35; 46.6%) were in GOLD group D. There was no statistically significant difference in age, Body Mass Index (BMI) and smoking index between COPD with and without PAD. Most PAD patients were asymptomatic. In comparison to COPD without PAD, severe PAD cases had significantly less Six Minute Walk Distance (6MWD), more episodes of leg cramps and needed to stop more frequently during 6MWT. Apart from PAD, increasing severity in COPD was associated statistically significant changes in Forced Expiratory Volume in the first second (FEV1), CCQ score, 6MWD, post 6MWT Heart Rate (HR), Respiratory Rate (RR), Borg score, fatigue, Oxygen Saturation (SpO2 ). Conclusion: The PAD is a frequent entity in COPD and can be diagnosed easily by measuring ABI. Increasing COPD severity affect HRQL and exercise capacity significantly.

Prophylactic Iron Supplementation in Pregnancy and its Implications in Development of Pre-eclampsia: A Case-control Study

Lakbir Singh, Ajit Thakur, Fayyaz Mukarab Khan, Minakshi Misra, Saurabh Singh

Introduction: Pre-eclampsia is a serious complication of pregnancy and is associated with increased maternal and perinatal morbidity and mortality. Increased iron and ferritin concentration is associated to a higher risk of pre-eclampsia and prophylactic iron supplementation can sometimes be harmful to pregnant women who are otherwise not iron deficient. Aim: To analyse serum iron, serum ferritin, serum Transferrin Receptor (sTFR) levels, Total Iron Binding Capacity (TIBC) among iron supplemented pre-eclamptic cases and normotensive pregnant controls. Materials and Methods: This prospective, observational, case-control study was conducted in Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India for a period of one year from (February 2019-January 2020). A total of 200 pregnant females, all on iron supplementation during the course of their pregnancy, 100 in pre-eclampsia group (case group); 100 in normotensive group (control group), in third trimester and between 18-45 years of age were enrolled in the study. Serum iron, serum ferritin, sTFR and TIBC were estimated using fully automated analysers. Results: Median Interquartile Range (IQR) of serum ferritin levels in cases were higher than the controls [41 (30-70) vs 24 (17-44); p<0.001]. Serum ferritin in cases were also found to correlate positively with systolic (r=0.37, p=0.001) Blood Pressure (BP) whereas TIBC correlated negatively with diastolic BP (r=-0.238, p-value=0.017). The median IQR differences of TIBC values among cases and controls were insignificant {485 (404-523) vs 493 (448-544)} and differences of median IQR of sTFR values among cases and controls were significant {8.5 (7-9) vs 8.9 (8-10)}. Subjects with serum feritin levels >40 ng/mL had three times increased risk of PE (Odds ratio=3, 95% Cl=1.571-5.157). Conclusion: Elevated serum ferritin, decreased sTFR levels and correlation of Ferritin and TIBC to BP in pre-eclampsia compels us to put cautionary remarks over testing these parameters before continuing with iron supplements. This may prevent a possible iron related added complications in pre-eclampsia and help clinicians decide about restricting/lowering iron supplement doses in case a situation of iron overload arise.

Analysis of Errors in a Clinical Laboratory of a Tertiary Care Hospital, Odisha, India

Introduction: Medical and laboratory errors can be caused due to many reasons, including communication problem, inadequate training of the staff members, improper identification. Quality indicators can help in objective measurement of errors in various crucial steps. Aim: To determine the nature and frequency of preanalytical, some of the analytical and postanalytical errors in the clinical laboratory with the help of quality indicators. Materials and Methods: This was a retrospective study and data was collected for preanalytical, some of analytical and postanalytical errors from December 2020 to May 2021, from the central laboratory and were classified under various quality indicators. MS Excel was used to analyse the data and descriptive statistics such as number and percentage were used to present the data. Results: Out of the total 677,887 samples received from both Outpatient Department (OPD) and Inpatient Department (IPD) in the central laboratory for clinical chemistry, preanalytical error was found in 482 samples (0.071%) and most common was haemolysis and billing errors. Out of total 677,887 samples received repeat testing was done in 287 samples (0.042%), Turnaround Time (TAT) exceeded in total 2,29,629 samples (33.87%) and transcription errors/amended report were seen in 41 (0.006%). Conclusion: Sample haemolysis, billing errors, insufficient sample and clotted sample are the most common preanalytical errors encountered in clinical laboratory. The TAT was exceeded in one third of the samples. These errors can be minimised by repeated training, annual competency assessment and more automation in preanalytical phase.

Pattern of Drug Utilisation in the Management of Hyperpigmentary Disorders in a Tertiary Care Hospital- An Observational Study

Vijayamathy Arunnair, Girish Kumaraswamy, M Ramesh

Introduction: Hyperpigmentary disorders, a common skin disorder affecting individuals with darker skin especially Asians, Blacks, Hispanics and American Indians, has a great impact on patient’s Quality of Life (QOL) with physical distress and psychological impact, and studies have shown that there is an improvement in QOL after treatment. The topical medications include sunscreens, demelanising agents, immunomodulators like tacrolimus, retinoids and Glucocorticoids (GCs). Systemic therapy includes GCs and antioxidants. Physical therapy includes chemical peels, microderma abrasion, Laser and light therapies and mesotherapy. Aim: To determine the pattern of drug use in hyperpigmentary disorders, to assess the tolerability of therapy and to analyse the effect of hyperpigmentary disorders of skin to the prescribed medications on the QOL before and after treatment. Materials and Methods: This was a prospective, observational study conducted on 102 newly diagnosed and untreated participants with hyperpigmentary disorders, who attended Dermatology Outpatient Department of a tertiary care hospital, Bangalore, India. The pattern of drug therapy, route of administration and Adverse Events (AEs) to the therapy was documented and analysed using descriptive statistics. The QOL using Dermatology Life Quality Index (DLQI) was assessed before and after treatment using Analysis of Variance (ANOVA). The patients were monitored every 30 days for three months to study the appropriateness, changing trends in prescription pattern, tolerability and QOL. Results: A total of 102 participants were enrolled for the study. The mean age was 33.71±10.68 years in males and 34.07±10.27 years in females. The different classes of drugs used were demelanising agents, sunscreens, antifibrinolytics, calcineurin inhibitors, keratolytics, glucocorticoids. The number ranged from 2-4 drugs per participant with a mean of 3.01±1.01. A significant improvement in the QOL was observed after treatment (p-value <0.01). Most of the AEs were self limiting except a few (acneiform eruption, rosacea) which were topical GCs induced. Conclusion: The individualised prescription pattern by treating physician was in concurrence with the standard line of therapy as they fulfilled the desired objectives. Hydroquinone (HQ), tranexamic acid and triple formula were the mainstay of treatment. The QOL improved after treatment.

Immunohistochemical Expression of Vascular Endothelial Growth Factor in Ovarian Surface Epithelial Neoplasms and its Association with Histological Type, Grade, Clinical Stage and Tumour Metastasis

Introduction: Ovarian carcinoma is one of the most common gynaecologic cancers and remains the leading cause of death as the patients are diagnosed at the advanced stage of the disease. Vascular Endothelial Growth Factor (VEGF), a promoter of angiogenesis, participates in multiple mechanisms to promote ovarian cancer cell growth, angiopoiesis and distant metastasis. So, it is a promising target for antiangiogenic therapy in management and downstaging of ovarian cancer. Aim: To evaluate the immunohistochemical expression of VEGF in different surface epithelial neoplasms of ovary and compare it with histological type, grade and stage in malignant cases. Materials and Methods: This was an observational cross-sectional study conducted from August 2018 to January 2020. Total 50 consecutive cases of surface epithelial ovarian neoplasms received in Pathology Department of Srirama Chandra Bhanja (SCB) Medical College, Cuttack were examined for expression of VEGF by Immunohistochemistry (IHC). Data was examined to find association of VEGF expression with demographic profile, grade, stage and were analysed statistically using Statistical Package for the Social Sciences (SPSS) software version 21.0. Statistical significance was tested by using Pearson's chi-square test. The p<0.05 was considered significant. Results: Total 50 cases of ovarian surface epithelial neoplasms of different types and grade were included in the study. A 42 of the 50 cases (84%) showed VEGF expression. Out of the 42 positive cases, 18 were high VEGF expressors and 24 were low VEGF expressors. The VEGF expression was significantly higher in carcinomas as compared to benign and borderline neoplasms and also in high grade malignancies in comparison to low grade (p≤0.001). Conclusion: The study shows that the differential expression of VEGF in different ovarian epithelial neoplasms which can be a diagnostic and prognostic tool and can be applied as a VEGF targeted therapy in certain group of patients.

Evaluation of Location of Femoral and Tibial Tunnels after Arthroscopic Anterior Cruciate Ligament Reconstruction: A Longitudinal Study

Madhusudan Sharma, Hemant Jain, Kishore Raichandani, Shubham Agarwal

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament when knees are injured. The position of the bone tunnels, and therefore the graft, is an important factor for successful reconstruction and clinical results. An incorrect positioning may result in impingement of neoligament at roof of intercondylar notch, or impaction against Posterior Cruciate Ligament (PCL) or may cause abnormal tension on the graft and may cause clinical problems such as loss of range of motion and recurrent instability. Aim: To evaluate the location of tunnels and its impact on functional outcome in patients who underwent arthroscopic ACL reconstruction. Materials and Methods: In this prospective longitudinal cohort study at a tertiary healthcare centre, from December 2017 to November 2019. A total of 50 patients who had isolated ACL injury and had undergone arthroscopic ACL reconstruction with minimum one year follow up were included. Their postoperative radiographs were evaluated for femoral and tibial tunnels. International Knee Documentation Committee questionnaire (IKDC), Lysholm scoring, pivot shift and Lachman test were used for evaluating the functional outcome. Findings were summarised and t-test was used for evaluation of results. Results: There were 48 male and two female patients, 64% patients involving right side. Mean position of tibial tunnel in coronal plane was 45.48±2.55 mm from medial edge. Average tibial tunnel angle in coronal plane was 69.46±7.57 degrees with only one patient having tibial tunnel >80 degrees. Position of tibial tunnel in sagittal plane was 41.35 ±7.3 mm, eight patients with >50% posterior location of tibial tunnel from anterior edge. Average Coronal angle of femoral tunnel was 42.52±6.34 degree. Position of femoral tunnel along Blumensaat’s line from posterior edge of femoral cortex was 35.19±6.09 mm. Graft impingement was not found in any of the case intraoperatively nor postoperatively, as analysed on x-rays. Conclusion: The position of femoral and tibial tunnels is a very important indicator for good functional outcome postoperatively. Thus, there needs to be further research to exactly quantify the limits for tunnel position beyond which the outcome of ACL reconstruction will be definitely poor.

Effect of Body Weight Support Treadmill Training on Gait Recovery, Lower Limb Function and Dynamic Balance in Patients with Chronic Stroke: A Randomised Controlled Trial

Introduction: Stroke is an omnipresent health problem that causes impairments in multiple domains and often leads to serious long-lasting consequences like pathological gait patterns. Gait rehabilitation is an important criterion for improvement in functionality. Body Weight Supported Treadmill Training (BWSTT) is being used as a method of gait rehabilitation, but efficiency of this method beyond traditional training is lacking evidence. Aim: To evaluate the effect of body weight supported treadmill training on gait recovery, lower limb function and dynamic balance in chronic stroke patients. Materials and Methods: A randomised controlled trial conducted in the Department of Neurorehabilitation of a specialty hospital, on 30 ambulatory chronic stroke patients having post stroke duration of six months or more. Study subjects were randomised into two groups. Group A received BWSTT with conventional rehabilitation for four weeks. Group B received only conventional rehabilitation for four weeks. Duration of conventional rehabilitation was 40 minutes in each group. Along with that group A received 20 minutes BWSTT and group B received 20 minutes of conventional gait training. Therapy was given three days a week. Assessment tools were Timed Up and Go test (TUG), Cadence, 10 metre Walk Test and Berg Balance Scale (BBS). The paired t-test was used for intragroup analysis and the unpaired t-test was used for intergroup analysis. Results: Total of 30 patients were registered in the study with mean age (years) 52.07±3.6736 and 52.40±3.906 for group A and group B, respectively. There was significant improvement in all outcome measures, e.g., BBS, TUG, 10 metre walk test and Cadence, in both the groups, pre and post intervention, but group A showed statistically significant improvement in parameters like dynamic balance, walking speed, and postural control and walking function (p<0.05). Conclusion: The BWSTT offers improvement in gait, in terms of walking speed, dynamic balance, posture control, that is significantly more than that of conventional gait training, as found in this study. The BWSTT might be included as a part of stroke rehabilitation program. Further multicentre studies with larger samples can throw more light on the intensity, dosage and methods of using BWSTT.

Correlation of RT-PCR Cycle Threshold Value and Chest Computed Tomography Scan Severity Score in Patients with COVID-19: A Cross-sectional Study

Introduction: Chest Computed Tomography (CT) scan for Coronavirus Disease-2019 pneumonia is used widely and viral load is predicted by the Cycle threshold (Ct) values of Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Studies correlating viral load in Severe Acute Respiratory SyndromeCoronavirus-2 (SARS-CoV-2) RT-PCR positive patients and severity of chest CT scan are limited. Aim: To find an association between viral load and chest CT findings. Materials and Methods: This was a cross-sectional study conducted on patients admitted to Believers Church Medical College Hospital, Thiruvalla, Kerala between September 2020 to March 2021. TrueNat RT-PCR test was performed on nasopharyngeal swabs, targeting the Orf1 gene of SARS-CoV-2 and results were quantified as Cycle threshold (Ct) values. Chest CT-Total Severity Score (TSS) ranged from 0-40 and was calculated by summing up the acute inflammatory lesions in each of the five lobes of both the lungs. Correlation was assessed using Spearman's Correlation Coefficient. Independent sample t-test and one-way Analysis of Variance (ANOVA) were used for comparison of means. Results: Of the 102 patients in the study [mean age of the patients 64.13±13.17 years and majority were males (70.6%)], 11 had lung changes unrelated to COVID-19. There was an inverse relationship between viral load Ct value of SARS-CoV-2 in nasopharyngeal specimens and TSS of chest CT scan. The mean viral load was highest in patients with mild (21.48±8.31), moderate (21.22±6.30) and severe (24.19±4.67) CT involvement. There was a significant difference between mean duration to symptom onset and chest CT scan among those with a high viral load (4.97±2.65) compared to those with a low viral load (6.81±4.5), (p-value=0.01). Among those who died due to COVID-19, (12/13) 92.3% were above 60 years of age. Presence of co-morbidities/dyspnoea/fever at presentation did not have any significant association with TSS severity. Conclusion: Viral load is not a critical factor that influences pulmonary manifestations in COVID-19, nor in-hospital mortality. CT scan may be more useful to detect lung involvement when done nearing or after the first week of symptom onset, irrespective of the viral load. Viral load can be important in predicting transmissibility and to minimise potential spread, whereas chest CT can help identify cases requiring extensive medical care

Comparative Evaluation of the Canal Shaping Ability of F6 SkyTaper, Navigator EVO and One Shape File Systems in Preparation of Curved Root Canals using Cone Beam Computed Tomography

Malvika Gupta, Sonali Taneja, Vidhi Kiran Bhalla, Akshay Rathore
Introduction: Knowledge on shaping ability of advanced Nickel Titanium (NiTi) rotary instruments holds a great significance in the field of endodontics. Root canal shaping systems should maintain the original canal anatomy and thereby, reduce the risk of iatrogenic errors. Aim: To compare and evaluate the canal transportation, centering ability and time taken for preparation of curved root canals after instrumentation with F6 SkyTaper, Navigator EVO and One Shape file systems using Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: This was an in vitro study conducted in the Department of Conservative Dentistry and Endodontics, I.T.S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India in July 2020. Thirty mesiobuccal canals of extracted mandibular molars with an angle of curvature between 20 to 40 degrees were selected and divided into three groups (n=10 into each group): F6 SkyTaper (group I), Navigator Evo (group II) and One Shape (group III). Canals were biomechanically prepared till size 30/6%; scanned using CBCT, before and after instrumentation to evaluate shaping ability at 3 mm, 5 mm, 7 mm and 9 mm from the apex. The results were subjected to statistical analysis using Analysis of variance (ANOVA) and Bonferroni post-hoc test with level of significance set at p-value <0.05. Results: Out of three file systems selected, Navigator EVO showed significantly least canal transportation (0.222) (p-value <0.05) and highest centering ability (0.535) as compared to F6 SkyTaper and One Shape. Overall, F6 SkyTaper and One Shape showed comparable results with respect to canal transportation and centering ability. The F6 Skytaper showed the fastest preparation (75.72 sec) of canals while Navigator EVO took the maximum time (307.046 sec). Conclusion: Navigator EVO showed superior shaping ability in curved canals than single file systems, although the time taken was the least with F6 SkyTaper.

Usability Evaluation of the Information System Used in Neuroscience Research Centres
Introduction: Information systems are tools for facilitating information management in research centres that improve quality by reducing errors and increasing speed and precision. Accordingly, their usability is of utmost importance. Usability problems can lead to user errors, may threaten patient safety, and negatively impact the quality of care. Aim: To evaluate the usability of the information system used in Neuroscience Research centres of hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran. Materials and Methods: This was a descriptive study conducted in July 2020 at SBUMS. Before starting the study, ethical considerations such as obtaining informed consent, anonymity, confidentiality, and the participants’ freedom to withdraw from the study were taken into account. The data collection instrument was a questionnaire adapted from the Usefulness, Satisfaction, and Ease of Use (USE) and ISO Metrics questionnaires. Samples were information system used in Neuroscience Research Centres of hospitals affiliated with SBUMS. Therefore, from the centres affiliated with SBUMS, only two hospitals met this requirement, which were Educational hospitals affiliated with SBMUS. The content validity of the questionnaire was examined, and its reliability was checked by Cronbach’s alpha. Results: The information systems of the mentioned centres had a usefulness of 5.93, learnability of 5.79, memorability of 5.22, user satisfaction of 4.89, and ease of use of 4.76, based on a 7-point Likert scale. Overall, the usability of the designed systems had an acceptable and favourable state based on all the criteria. Conclusion: Of the examined criteria, usefulness and learnability achieved a higher score, indicating the good design of the system in terms of these dimensions. However, the ease of use had the lowest score, showing the poor user design of the information system in this dimension. To achieve an excellent level of information system usability in these centres, attention should be paid to all the dimensions of information system usability.

Histopathological Spectrum of Cutaneous Basal Cell Carcinoma- An 11 Year Retrospective Study in a Tertiary Care Hospital in Southern Karnataka

Namratha Ravishankar, Vijaya Basavaraj, Reshma Raju
Introduction: Basal Cell Carcinoma (BCC) is a slow growing, locally invasive, malignant skin tumour with increasing incidence in recent decades. Various histological subtypes of BCC have been described which include nodular, superficial, adenoid, keratotic, basosquamous, and morpheiform. Aim: To analyse the clinical data of patients with BCC and the histomorphological spectrum of BCCs in a population of Southern Karnataka. Materials and Methods: This was an 11 year retrospective descriptive observational study of all histologically confirmed BCCs diagnosed in the Department of Pathology in a tertiary care centre in Southern Karnataka from January 2010 to January 2021. Detailed clinical data of 64 patients including age, gender, clinical diagnosis and anatomic location were analysed. Results: The maximum number of BCCs occurred in the sixth decade with a slight female preponderance. Head and neck lesions were the most common and uncommon sites noted included the vulva and axilla. Most cases presented as an irregular plaque followed by presentation as an ulcerative lesion. Pigmentation was noted in 18 (28%) cases clinically. Majority of patients (63/64 or 98.4%) had a single lesion. Histological types included nodular, superficial, adenoid, basosquamous and BCC with sebaceous differentiation. Nodular BCC was the most commonly encountered type in our setting, followed by superficial BCC. Only one case of basosquamous carcinoma showed evidence of metastasis to lymph nodes. Conclusion: Histological evaluation of BCC is of paramount importance not only to establish the diagnosis but also to predict behaviour and risk of recurrence. In addition to the diagnosis, pathologist should also describe subtypes of the tumour which has a prognostic implication. This study reveals the morphological spectrum of BCC in the population of southern Karnataka and reveals significant patterns in anatomical distribution of BCC. It also highlights a significant percentage of BCCs presenting as pigmented lesions in the Indian population.

Lifestyle Behaviour among Undergraduate Medical Students in Tamil Nadu: A Cross-sectional Study

R Anuradha, S Priyadharshini, Aruna Patil
Introduction: Lifestyle related behavioural risk factors such as physical inactivity and nutrition transition like increased consumption of high-fat and low-fiber diet are found to be risk factors for Non Communicable Diseases (NCD) worldwide. Medical students are susceptible to poor eating habits, physical inactivity, lack of sleep or acquisition of new habits, such as smoking and alcohol. They have been shown to exhibit early risk factors for chronic diseases. Hence, it is essential to assess the lifestyle behaviour among medical students as they are future healthcare providers. Aim: To assess the lifestyle behaviour among the undergraduate medical students and to compare lifestyle behavioural factors between gender. Materials and Methods: A cross-sectional study was conducted among 200 undergraduate medical students, selected by using random sampling method from first year to final year of a government medical college in Chennai, Tamil Nadu from June 2018 to August 2018. Self-administered questionnaire was used to collect data regarding socio-demographic profile and lifestyle behaviours such as dietary pattern, physical activity, sedentary behaviour, sleep duration, smoking and alcohol consumption. Descriptive statistics for qualitative data and Chi-square test to test the proportions were used. Results: A total of 200 undergraduate medical students participated in the study. The mean age of the study participants was 20.2 years with a standard deviation of 1.34. Out of the 200 study participants, 132 (66%) were females and 68 (34%) were males. Skipping of meals was seen in 54% students. Vegetables and fruits intake ≤3 times/week were found in 25.5% and 63% students respectively. Smoking was observed in 3% and alcohol intake in 7.5% students. Lack of exercise was noted in 46%. Television viewing/mobile usage for >4 hours per day was observed in 30.5% students. Sleep duration of <6 hours/day was noted in 11%. Frequent carbonated drinks consumption (>3 times/week) was significantly higher in males (14.7%) as compared to females (5.3%). Inadequate exercise was significantly higher in females. Conclusion: Behavioural risk factors such as unhealthy diet, irregular eating habits, and physical inactivity were prevalent among the medical undergraduate students.

Study on Microbiome of Chronic Non Healing Diabetic Ulcers with Special Reference to Biofilm and Multidrug Resistant Strains

P Ramaprabha, CP Ramani, R Kesavan
Introduction: Diabetic Foot Ulcers (DFU) represent a silent epidemic and are the leading cause of 80% of non traumatic lower-limb amputations. Anaemia in diabetes may have adverse effects on systemic diseases and predict the progression of diabetes complications. Biofilms act as a mechanical barrier to antimicrobials and immune system cells and contribute to Multidrug Resistance (MDR). Aim: To determine the bacteriome and mycobiome of diabetic ulcers and the associated biofilm formation and anti-microbial resistance profile of the pathogens. Also, to determine the molecular characterisation of biofilm-forming resistant isolates by Polymerase Chain Reaction (PCR). Materials and Methods: This cross-sectional study was done on 150 diabetic patients with non healing ulcers and was chosen and studied from January-December 2019. Pus and tissue bit samples were processed as per standard microbiological procedures. Antimicrobial susceptibility test was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Biofilm formation was detected by the tissue culture plate method. Molecular characterisation of resistant pathogens was done by PCR. Variables were expressed as proportions or percentages. Results: Out of 150 diabetic patients, 17.3% of patients underwent amputation. A 90% of patients were associated with anaemia. Most ulcers were polymicrobial in nature. Predominantly isolated pathogens were Pseudomonas aeruginosa 37 (17.1%) and Staphylococcus aureus 33 (15.2%) among aerobic bacteria, Peptostreptococcus 10 (4.6%) among the anaerobes and Candida albicans 20 (9.2%) in fungus. Gram negative bacteria showed high sensitivity to piperacillin-tazobactam, meropenem, and gram positive cocci to vancomycin and linezolid. A 82% of bacterial isolates and 50% of fungal isolates were biofilm producers. Staphylococcus aureus was a strong biofilm producer. On molecular characterisation, bla_CTX-M, bla_TEM, bla_NDM-1, bla_OXA-23, mecA genes were present in resistant biofilm-forming isolates. Conclusion(s): Polymicrobial wound infection and biofilm formation in DFU confers antibiotic resistance and contributes to Multidrug Resistant Organisms (MDRO's). However, proper antibiotic surveillance and antibiotic policy, and preventive strategies can curtail the spread of resistant strains.

Study on Association of Serum Uric Acid and Calcium with Insulin and its Resistance in Newly Diagnosed Type 2 Diabetes Mellitus Patients

Saffalya Nayak, Roma Rattan, Manmath Kumar Mandal, Debjyoti Mohapatra
Introduction: Type 2 Diabetes Mellitus (T2DM) is a multifactorial pathological condition associated with insulin resistance and insulin deficiency. Uric acid and calcium have shown inconsistent association with occurrence of diabetes. Aim: To evaluate the role of uric acid and calcium in development of T2DM. Materials and Methods: This was a case-control study conducted in Department of Biochemistry from March to November 2019 in Sriram Chandra Bhanja, Medical College and Hospital, Cuttack, Odisha, India. A 180 subjects undertaken with the objective of finding any association of serum uric acid and calcium with insulin and its resistance in newly diagnosed T2DM cases. Newly diagnosed T2DM patients were taken as cases. Age and sex matched healthy individuals were taken as controls. Fasting Plasma Glucose (FPG), serum insulin, serum uric acid and ionised calcium were measured in autoanalyser and insulin resistance was calculated using Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Other confounding risk factors for T2DM like Body Mass Index (BMI), family history was taken into account. Results: A significant positive correlation of serum uric acid with serum insulin (p=0.029) and its resistance (p=0.032) in cases. Serum calcium was negatively associated with insulin and its resistance in both cases and controls. Regression models showed serum uric acid as a strong independent risk factor for levels of insulin and its resistance. Conclusion: The findings of the study showed that regular evaluation of serum uric acid and calcium should be done in those who are at risk of developing T2DM. Larger prospective studies will be required for definite assessment.

Medial Malleolus Fracture Fixation in Weber Type B and C Ankle Injuries

Mohd Rafeeq Wani, Stanzin Sonum, Zubair Younis Ringshawl
Introduction: Medial malleolus fractures are commonly encountered by orthopaedic surgeons in their daily practice. Medial malleolus fractures are articular fractures and hence need anatomical reduction to prevent the potential complications. Many methods of fixation are in practice for fixing medial malleolus with the aim to achieve stable fixation and union of the fracture site. Aim: To evaluate the outcome of medial malleolus fracture fixation by three different methods- two partially threaded screws, one partially threaded screw and one k-wire and tension band wiring, in Weber type B and C ankle injuries. Materials and Methods: This prospective interventional study was conducted from August 2017 to September 2020 in a tertiary care orthopaedics hospital in Srinagar, Jammu and Kashmir, India. A total of 40 patients (aged 18 years or greater) of Weber B and C types medial malleolus fracture, were included in the present study. The medial malleolus was fixed with two partially threaded screws in 16 patients (Group A), one partially threaded screw and one Kirschner wire (K)-wire in 14 patients (Group B) and tension band wiring was done in 10 patients (Group C). The fixation was decided on intraoperative finding of fragment size and comminution as well as quality of bone. The parameters assessed were time of union, delayed union, non union, ankle range of motion and symptomatic hardware. One-way Analysis of Variance (ANOVA) test was used to compare parametric data of the three groups. The p-value <0.05 was considered statistically significant. Results: The mean age of the patients was 40.20 years with range 18-65 years. 22 patients were females and 18 were males and the male to female ratio was 0.81. The mean time of healing of fracture was 10.25 weeks in group A, 11.14 weeks in group B and 10.80 weeks in group C. There were two cases of delayed union, one each in group B and C. Symptomatic hardware was mostly seen in group C. There was no case of non union in the present study. Conclusion: It can be concluded that all the three fixation methods used in this study achieved the union in comparable time duration with no case of non union. A particular method of fixation should be used by taking into consideration the type of fracture, size of the fragment, comminution and quality of the bone.

Effect of 2% Sodium Hypochlorite, Denture Cleansing Tablet and Tea on the Discolouration and Surface Roughness on Two Types of Denture Acrylic Resin: An In vitro Study
Introduction: Denture cleansers affect the physical properties of denture materials, such as colour and surface roughness. Using denture cleanser with the least side effects in the best choice. There are only limited studies available evaluating the effects of denture cleaners in association with staining solutions on acrylic resins. Aim: This study aimed to investigate the effect of denture cleansers in association with staining solution (tea), on the denture colour and surface roughness. Materials and Methods: In this in vitro study conducted at Dental Faculty of Tabriz Medical University of Science, Tabriz, East Azarbaijan, Iran, from May 2018 to June 2019, 56 samples each were prepared from two types of acrylic resin (Acrosun and TDV Dental). The 2% Sodium Hypochlorite (NaOCl) solution and professional cleansing tablets were used as detergents, and tea was used as a dye. The samples were assigned to seven groups (n=8 samples in each group) for each type of acrylic used. The study groups consisted of group 1 (NaOCl solution for 10 minutes), group 2 (NaOCl solution for 8 hours), group 3 (cleansing tablet solution for 8 hours), group 4 (tea solution for 2 hours), group 5 (first tea solution and then NaOCl), group 6 (tea solution and then cleansing tablets) and group 7 (distilled water). Surface roughness was analysed with Ra and Rz indices, and colour changes were evaluated with CIELAB index before and after the experiment, and the data were recorded. Finally, data analysis was performed with Statistical Package for the Social Sciences (SPSS) version 21.0. The p-value less than 0.05 was considered as significant. Results: The results of 112 disk-shaped samples prepared showed that in all the study groups, the colour change of Acrosun acrylic resin was more severe compared to that in TDV dental acrylic resin, which was significant only in groups 1, 2, and 5 (p-value <0.05). Comparison of the mean Ra index showed that surface roughness was the maximum and minimum in groups 6 and 1, respectively, compared to other groups. A comparison of the effect of different cleaning methods on acrylic resin surface roughness showed that the surface roughness indices of Ra and Rz were not significantly different in any of the groups (p-value >0.05). Conclusion: The two types of acrylic resin did not differ significantly in surface roughness after the experiments. However, the TDV dental acrylic resin was superior in terms of colour stability

Nail Patterns in Papulosquamous Disorders- An Observational Study from Southern India

Amutha Antony, Karthika Sivaprakasam, Revathy Mathan
Introduction: Nail changes are always a cause of physical handicap and psychological stress in this era where utmost importance is given to cosmetic appearance. Other than trauma and infections, Papulosquamous disorders are major contributor to nail changes. Thorough knowledge of their patterns will aid in early detection and treatment before irreversible damage to nails occurs. Aim: To observe the clinical patterns of nail changes in various papulosquamous disorders. Materials and Methods: This observational descriptive crosssectional study was conducted in a tertiary care set up at Government Coimbatore Medical College, Coimbatore from June 2016 to June 2017. The study group comprised of 104 cases of various papulosquamous disorders. The type of papulosquamous disorder, presence of nail changes, their onset, duration, various patterns and associated co-morbidities were noted in detail. The observed data were entered in Microsoft Excel and data analysis was done in Epi Info system. Results: Out of the 104 cases taken for study 71 (68%) had nail changes. Majority of them were in 31-45 years age group (n=29; 41%). More of males (n=38, 54%) had nail changes than the females (n=33, 46%). Psoriasis (n=47; 66%) was the most common papulosquamous disorder with nail changes followed by lichen planus (n=9; 13%) and pityriasis rubrapilaris (n=7; 10%). Pitting of nails was the most common nail pattern (n=44; 62%), followed by subungual hyperkeratosis (n=24; 34%), thickened nail plate and longitudinal striations (both n=19; 27%). Finger nails were more affected than toe nails. Psoriasis and pityriasis rubrapilaris had 100% nail involvement. The patterns of nail changes were maximum in psoriasis and lichen planus. Beaus lines was observed in most of the papulosquamous disorders except Lichen nitidus and Lichen striatus. The time gap for onset of nail changes was longer for psoriasis (4.2 years) and shorter for pityriasis rosea (two months). In lichen striatus and lichen nitidus, nails were involved only in children. Minimal nail changes were observed in para psoriasis and pityriasis lichenoides. More number of co-morbidities like diabetes, hypertension, atopy and arthritis were seen in psoriasis. Conclusion: In the present study, it was observed that the nail changes were more common in psoriasis, lichen planus and pityriasis rubra pilaris among the papulosquamous disorders. The highly frequent nail patterns were pitting and subungual hyperkeratosis.

Effect of Squat Training with Whole Body Vibration on Balance and Functional Performance in Elderly- A Quasi-experimental Study
Introduction: Elderly population shows many health related disorders which disrupt their functional performance. Exercise training can alter muscle strength, balance, gait, endurance and finally physical function. Whole Body Vibration (WBV) may enhance reduced performance. Hence, the present study evaluated the effects WBV on balance and functional performance in elders. Aim: To assess and compare the effects of squat training on WBV versus plane surface on balance using Timed Get-Up and Go Test (TUG) and functional performance using Short Physical Performance Battery (SPPB). Materials and Methods: This quasi-experimental study was conducted at Dr. D.Y. Patil College of Physiotherapy, Pune, Maharashtra, India from August 2015 to March 2016, including 30 healthy elderly individuals with age between 60 to 70 years. They were divided into group A (Squat training on vibratory surface) and group-B (squat training on plane surface). Training was given for four weeks, three sessions per week. Pretest and post-test values of TUG and SPPB which included balance, gait speed and lower extremity strength was assessed. Epi Info version 7 software was used for statistical analysis. Results: Mean age in group A was 64.53±3.22 years and group B was 65±3.81 years. Group A showed significant reduction (p-value <0.001) in time taken to complete TUG from 15.27 seconds to 12.53 seconds and also group B showed improvement from 14.53 seconds to 13.93 seconds. The SPPB score showed improvement in balance (p-value <0.001), gait speed (p-value <0.001) and strength (p-value <0.001) in group A and gait speed (p-value <0.001) in group B. When compared, Group A showed significant improvement in TUG (p-value=0.01) and lower extremity performance (p-value <0.001) than group B. Conclusion: Squat training on vibratory surface significantly improves balance and functional performance in elderly. Hence, this training can be included as a routine exercise for elderly population with all precautions.

Diagnostic Utility of C-Reactive Protein and Permutation Combination of Quantitative and Qualitative Haematological Parameters in Neonatal Sepsis

Sapna Shreyas Deshpande, Mohasin Jakirhusain Halgale, Ravindra Vilas Ramteke

Introduction: Neonatal sepsis at times is subclinical and lacks specific symptoms. The C-Reactive Protein (CRP) which is an acute phase reactant protein is thought to be an alternative biomarker to blood culture. Haematological parameters of sepsis are indirect biomarkers of infection. Authors found it worthwhile to discern efficacy of haematological parameters obtained by such three part haematology analysers in diagnosis of neonatal sepsis, when used in their pure form or with peripheral blood smear or with CRP, in isolation or in their combinations. Aim: To find out the diagnostic utility of combinations of haematological parameters as obtained by three part differential automated haematology analyser and peripheral blood smear along with CRP in neonatal sepsis. Materials and Methods: This observational and analytical study of diagnostic test outcome was carried out over a period of 12 months from January - December 2016 in Rajarshi Chhatrapati Shahu Maharaj Medical College and Chhatrapati Pramilaraje Rugnalaya, Kolhapur, Maharashtra, India, with special reference to clinical profile, blood culture, qualitative and quantitative haematological parameters and CRP. The statistical analysis included calculating diagnostic utility of isolated and combination of parameters and performing Chi-square test to study difference in frequency of occurrence and significance of association. Results: There were 104 cases of neonatal sepsis out of which culture proven sepsis was seen in 73 (70.2%) cases while probable sepsis was seen in 31 (29.8%) cases. There were 32 (30.8%) fatalities. With parallel method with OR values, combination of haemoglobin, platelet parameters and White Blood Cells (WBC) parameters as obtained by analyser and peripheral blood smear exhibited sensitivity of 98.6%, specificity and Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 96.9% and Diagnostic Accuracy (DA) of 99%. This was surpassed by combination of CRP and all these parameters to attend values of 100%. Combination of all haematological parameters obtained purely by analyser showed these values to be 89%, 100%, 79.5% and 92.3%. Immature to Total WBC (I:T) ratio and platelet count influenced clinical outcome of fatality. Conclusion: The liberal use of combination of haematological parameters is rewarding in supporting diagnosis of neonatal sepsis. The same was obtained by purely using analyser which showed remarkable diagnostic utility suitable for resource poor settings.

A Cross-sectional Study on Coping Styles and Suicidal Intent among Young Adult Suicide Attempters at a Tertiary Care Centre in Kerala, India

Introduction: Suicide attempts in young adults have grown exponentially across the globe in the last three decades. Suicide is one of the most common cause of death among young adults worldwide. The studies on the coping styles influencing suicidal intent among young adult suicide attempters are few from the Indian context. Young adults are of utmost importance in any nation and interventions for suicide prevention have to be undertaken at different levels. Aim: To estimate the coping styles and suicidal intent among young adult suicide attempters and to assess the various coping styles associated with the suicidal intent. Materials and Methods: This was a descriptive cross-sectional study, which was carried out at the Suicide Prevention Clinic of the Department of Psychiatry at a Tertiary Care Centre in Kerala, India over a period of one year from October 2015 to September 2016. The consecutive 160 young adult suicide attempters were interviewed. Beck’s Suicide Intent Scale was used to assess the severity of suicide attempts. The coping styles of the participants were assessed using the Ways of Coping Questionnaire-Revised (WCQ-R) Scale. Statistical significance of socio-demographic factors, suicidal intent and coping styles were assessed by Independent Student t-test and One-way Analysis of variance (ANOVA). The correlation between the severity of suicidal intent and the coping styles were assessed using Pearson’s correlation coefficient. Results: The mean age of the participants were 21.75±2.69 years. The sample consisted of 72 (45%) males and 88 (55%) females. Out of the 160 participants, 50 (31.2%) had low suicidal intent, 71 (44.4%) had medium suicidal intent and 39 (24.4%) had high suicidal intent. The present study found that all the coping strategies except the escape avoidance and positive reappraisal are having significant association with the severity of suicidal intent with p<0.05. This study also found that seeking social support (r=-0.284, p<0.001), accepting responsibility (r=-0.344, p<0.001) and planned problem solving (r=-0.333, p<0.001) were coping styles which have a protective role in preventing suicidal behaviour by reducing the suicidal intent. Conclusion: This study had found significant correlation between the various coping styles and suicidal intent among the young adult suicide attempters in Kerala. The present study also found significant association between previous suicide attempt and co-morbid psychiatric diagnosis with the coping scores.

Effect of Ardh Matsyendrasana, OM Chanting and Proprioceptive Neuromuscular Facilitation on Cervical Range of Motion and Health Related Quality of Life in Subacute Bilateral Mechanical Neck Pain: A Randomised Controlled Trial

Aditi Singh, Jasobanta Sethi, Ishwar Basavaraddi

Introduction: Mechanical Neck pain is evoked by sustained poor neck posture, movement of neck, and on palpation. Patient experiences pain in cervical muscles with absence of any pathology. Previous studies found that Proprioceptive Neuromuscular Facilitation (PNF) as well as yoga asana is effective for treatment of mechanical neck pain. This study was designed to assess the efficacy of neck PNF, Ardh Matsyendrasana with OM chanting and its combination approach on neck Range Of Motion (ROM) and quality of life of people suffering from subacute mechanical neck pain. Aim: To assess the effectiveness of Ardh Matsyendrasana, OM chanting and PNF and its combined approach on neck ROM and quality of life of patients suffering from bilateral subacute mechanical neck pain. Materials and Methods: This randomised controlled trial was conducted in Amity Institute of Physiotherapy Out Patient Department (OPD), Amity University, Noida, Uttar Pradesh, India. The study was conducted between January 2019 to January 2021. A total of 103 subjects of bilateral mechanical neck pain were randomised into four groups (group 1-4): PNF group (n=27), yoga group performed Ardh Matsyendrasana with OM chanting (n=25), combined group performed both PNF, Ardh Matsyendrasana with OM chanting (n=26) and control group (n=25) performed bilateral active stretching of neck muscles. Interventions were given for four weeks with five sessions per week. Outcome measures were Cervical Range of Motion (CROM) assessed using digital cervical goniometer and health related quality of life assessed using SF-36v2 tool. Data were assessed at baseline and four weeks post intervention. Within group analysis was done using paired t-test with p<0.05 was considered significant. Results: Both CROM measurements as well as health related quality of life parameters showed statistically significant improvement for all four groups from baseline to four weeks postintervention (p<0.05). Improvement scores showed that the group performing Ardh Matsyendrasana with OM chanting and combined PNF neck patterns with Ardh Matsyendrasana and OM chanting showed better improvement in neck flexion, extension, right and left lateral flexion and right and left rotation ROM as well improved mental and physical component scores of quality of life parameter for bilateral subacute mechanical neck pain cases. Conclusion: In this study, neck PNF patterns, Ardh Matsyendrasana with OM chanting, combined PNF, Ardh Matsyendrasana with OM chanting and active stretching exercise of neck muscles specifically sternocleidomastoid and rhomboids, all interventions were found to be effective in improving neck ROM and quality of life in bilateral subacute mechanical neck pain post four weeks of intervention. But yoga group (Ardh Matsyendrasana with OM chanting) and combined group which performed combined PNF neck pattern with Ardh Matsyendrasana and OM chanting proved them to be an effective treatment for improving CROM and health related quality of life in bilateral subacute mechanical neck pain.

Clinicopathological Outcome of Patients Undergoing Whipple's Operation- A Retrospective Study over a Decade in a Tertiary Care Centre

Pradip Ramabhau Butale, Sagar Gawai

Introduction: The surgical procedure pancreaticoduodenectomy is popularly known as Whipple's operation. Whipple procedure is one of the major surgeries performed in tertiary care centres. Aim: The present research was undertaken to study indications of Whipple's operation and also to evaluate pathological findings of periampullary tumours with biochemical investigations. Materials and Methods: This retrospective study was conducted in total 155 patients who had undergone Whipple's operation over a period of ten years from January 2009 to December 2019 at a tertiary care hospital in a central India. The hematoxylin and Eosin (H&E) stained slides were reviewed and various parameters were studied like presence or absence of the tumour, site of origin of tumour (ampulla/ head of pancreas/distal common bile duct/duodenum), histological type (adenocarcinoma/neuroendocrine/lymphoma), differentiation (well/moderate/poor), depth of invasion, Lymphovascular Invasion (LVI), perineural infiltration, lymph node status (metastasis), resection margin status (involved/not involved) and {Tumour (T), Nodes (N), Metastasis (M)} staging. Perioperative complications and postoperative follow-up of minimum 30 days for all patients were studied. Results: The most common indication for Whipple's operation was periampullary carcinoma irrespective of its site of origin and was most commonly seen in males in age group of 51-60 years. Out of total 155 cases, four cases were excluded as no tumours were found in those cases. Tumours from ampulla were most common (101) followed by those from Common Bile Duct (CBD) (22) and pancreas (22) and duodenum (6). The median size of the tumour in Whipple's specimen was 1.44 cm2. Most frequent histological type was adenocarcinoma (145, 96.02%). Moderate differentiation was most commonly observed histological grade in periampullary carcinomas 116 (76.8%). Perineural and lymphovascular infiltration was seen more commonly in pancreatic cancers 90.9% (20/22). Lymph node metastasis was significantly high in pancreatic cancers. Perioperative complications were seen in 32 patients with common complications were biliary leak. The perioperative mortality was 7.9%. Distal cholangiocarcinoma was found to be more aggressive followed by pancreatic and ampullary cancers. Conclusion: Whipple procedure is associated with a unique set of common complications and continues to be associated with considerable morbidity. With careful patient selection, Whipple procedure can be performed safely.

Comparison of Lung Masses Perfusion Characteristics by Dynamic Contrast Enhanced CT with Histopathology: A Cross-sectional Study

Introduction: The management of lung masses depends upon the nature of the mass i.e., being benign or malignant. The use of contrast based Computed Tomography (CT) scan helps in ascertaining the malignant nature of the lesion. In previous studies, computed tomographic evaluations are done to evaluate pulmonary nodules, but only few studies characterised the lung masses into benign and malignant lesions. Aim: To evaluate the diagnostic accuracy of a non invasive modality (dynamic contrast enhanced perfusion CT), in the characterisation of lung masses by comparing with histopathology. Materials and Methods: A cross-sectional observational study was conducted at a tertiary care centre, Lucknow, Uttar Pradesh, India from January 2018 to November 2019 where 62 patients between age group 20-80 years of both sexes with lung masses and no contraindications to the administration of iodinated contrast material were enrolled in the study. Dynamic Contrast Enhanced CT (DCE-CT) perfusion was done which included parameters like Blood Flow (BF) in mL/100 g/min, Blood Volume (BV) in mL/100 g, Mean Transit Time (MTT) in seconds, and Flow Extraction Product (FEP) in mL/100 mL/min. The DCE-CT features were compared with histopathology to determine the sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Results: Among the 62 lung mass cases included in the study, 30 were histopathologically found to be benign lesions and 32 were malignant lesions. On contrast enhancement, the values of the CT perfusion parameters among the malignant masses were significantly higher as compared to benign (p<0.001). DCECT was able to correctly diagnose 31/32 cases of malignant and 26/30 cases of benign lung masses in concordance with histopathology. Thus, the overall, sensitivity, specificity, PPV, NPV, and diagnostic accuracy was 96.90%, 86.70%, 88.60%, 96.30%, and 91.90%, respectively. Conclusion: The DCE-CT has a high diagnostic value in differentiation of malignant from benign lung masses and thus can be promoted for its use as a non invasive methods for lung masses characterisation.

Glycated Haemoglobin: Is it a Better Reference Method than Oral Glucose Tolerance Test for the Diagnosis of Gestational Diabetes Mellitus?

Meenakshi Puri, Lal Chandra Upadhyay, Parijat Gogoi

Introduction: Insulin resistance during pregnancy is associated with adverse effects on foetal and maternal health, including macrosomia, congenital malformations, perinatal mortality and pre-eclampsia. A 100 g Oral Glucose Tolerance Test (OGTT) is recommended by World Health Organisation (WHO) as the diagnostic test for Gestational Diabetes Mellitus (GDM). However, the inconvenience caused to the pregnant females due to time consuming and cumbersome multi-invasive procedure for performing OGTT has prompted the exploration of an alternative method. Aim: To ascertain whether Glycated Haemoglobin (HbA1c) can be used instead of OGTT for diagnosis of GDM. Materials and Methods: It was a case-control study which was conducted for one year from June 2012 to May 2013. In this study, 200 pregnant females with gestational age from 22-40 weeks underwent Fasting Blood Sugar (FBS), Glucose Challenge Test (GCT) with 50 g glucose load, OGTT and HbA1c investigations. Results: The mean HbA1c of Group 1 with GDM was 5.29±0.68% and mean HbA1c of Group 2 without GDM was 4.83±0.46%. At the HbA1c cut-off of ≥5.85%, 18% of GDM patients were identified with specificity of 97%. A higher HbA1c cut-off of ≥5.95% showed sensitivity and specificity of 16.3% and 70%, respectively. An arbitrary cut-off of ≥5.85% would have diagnosed only 18% of patients with GDM with reasonable specificity. According to this study, 88% of GDM cases stayed undiagnosed by HbA1c at a cut-off of ≥5.85%. Hence, it can play only a supplemental role to OGTT in diagnosing GDM. Conclusion: On the basis of the present study, HbA1c can be used as a supplemental investigation in addition to OGTT for confirmation of GDM in pregnant females. Only drawback was the lack of fixed HbA1c cut-off for diagnosing GDM.

Comparison between I-gel and Classic Laryngeal Mask Airway for Airway Management of Patients with Anticipated Difficult Airway: A Randomised Clinical Trial

Rajesh Raman, Shefali Gautam, Suraj Sonka, Rati Prabha, Sharif Alam

Introduction: I-gel and classic Laryngeal Mask Airway (cLMA) are two Supraglottic Airway Devices (SAD) used for management of airway in various situations, including for management of difficult airway. Despite widespread use of these devices, there are very few trials studying I-gel and classic LMA for management of patients with difficult airway. The outcome of present study determines which SAD is better for managing difficult airway. Aim: To compare I-gel and cLMA in managing anticipated difficult airway. Materials and Methods: This randomised and single blinded clinical trial study was conducted in King George’s Medical University, Lucknow, Uttar Pradesh, India, between February 2019 to January 2020. Adult patients with Mallampati class 3 or 4, thyromental distance <6 cm, sternomental distance <12 cm, restricted neck movement, micrognathia/retrognathia or short/thick neck undergoing elective short duration surgery under general anaesthesia were included in this study. Total 50 patients divided into group C received cLMA while group I patients received I-gel for airway management. Fifty patients were recruited in each group. Nominal variables were analysed using chi-squared test. A two-sided p<0.05 were considered significant for all the tests. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 25.0 for windows. Results: Mean age in group C was 40.38±12.96 (years) and in group I was 37.94±11.77 (years) with p-value 0.327. Overall (n=44 in group C, 50 in group I, p-value=0.012) and first attempt (n=10 in group C, 40 in group I, p-value <0.001) success rate of device placement was higher for I-gel. Number of attempts, manipulations, time needed to insert and Leak Fraction was significantly lower for I-gel (p-value <0.001). Compared to cLMA, Oropharyngeal Leak Pressure (OLP) was higher with I-gel. Fibreoptic view on a four-point scale was better with I-gel. Desaturation, tachycardia, bradycardia, and postoperative sore throat was more frequent with cLMA. Conclusion: Compared to cLMA, I-gel has higher success rate of insertion in patients with difficult airway and has added advantage of more rapid insertion, higher OLP and need for fewer insertion attempts and manipulations with lower rates of complications.

Comparison of Cardiopulmonary Fitness among Obese and Non Obese School Children

Gaurav Arora, Jyoti P Khodnapur, Satish G Patil, Sumangala M Patil

Introduction: Childhood obesity is now rising as a significant health problem. In India, some studies showed a rising trend in the prevalence of overweight and obesity in children. This shocking rise in childhood obesity often accounts for increased intake of high calorie foods and decreased physical activity. In addition, non communicable diseases like diabetes mellitus, cardiovascular diseases and cancer are more common in obesity. Aim: To assess the relationship between cardiopulmonary fitness and Body Mass Index (BMI) in school going adolescents between 12 to 16 years. Materials and Methods: This study was a cross-sectional observational study conducted from March 2018 to March 2019. The study included 60 healthy students (between 12 to 16 years) full sample size divided into two groups and four subgroups. After the general physical examination and history taking, participants' selection made in line with pre-defined inclusion and exclusion criteria. Anthropometric and body composition parameters were recorded. Using the modified Harvard's Step test, cardiopulmonary fitness parameters like Physical Fitness Index (PFI) and Maximal oxygen consumption (VO2max) of each subject were calculated by applying the concerned formulae. All statistical analysis has been done by using Statistical Package for the Social Sciences (SPSS) software version 16.0. Results: Total 60 apparently healthy students included 30 males and 30 females. Mean age was 14.93±0.96 years in Group I (normal weight boys, n=15) and 14.47±1.41 years in Group II (overweight/obese boys, n=15). Also mean age was 14.93±0.59 years in Group III (normal weight girls, n=15) and 15.27±0.59 years in Group IV (overweight/obese girls, n=15). Pearson correlation showed a significant negative correlation between BMI and PFI (r=-0.504, p-value <0.001) also between BMI and VO2max (r=-0.459, p-value <0.001). Conclusion: Appropriate measures should be taken to enhance cardiopulmonary fitness among school children who are the wealth of the country at the school and community levels.

Association of Motor Function and Neuroimaging in Cerebral Palsy: A Cross-sectional Study

Introduction: Cerebral Palsy (CP) is one of the most common causes of disability in children. Neuroimaging is useful in determining structural or functional relationships in children with CP. It provides an opportunity to link various CP types to the localisation of the brain maldevelopment or lesion. Aim: To study association of motor function and brain structure on neuroimaging Magnetic Resonance Imaging (MRI) in CP children. Materials and Methods: This cross-sectional observational study was conducted in a tertiary care hospital from August 2015 to December 2016. A total of 50 diagnosed cases of CP were included after satisfying inclusion and exclusion criteria. After detailed history and clinical examination, MRI of brain was advised. All parameters were assessed in terms of Gross Motor Functional Classification System (GMFCS), Manual Ability Classification System (MACS) and MRI Grading. Categorical variables were presented as numbers and percentage and association was checked using Chi-square test or Fischer’sexact test. A p-value of <0.05 was considered statistically significant. Results:Patients with CP in the study ranged from 2-12 years with mean age of 5.43 (±2.58) years. Out of 50 cases, 30 (60%) were in the age group of 2-5 years, 17 (34%) were in the age group of 6-10 years and three (6%) were in the age group of 11-12 years. Out of 50 enrolled cases, maximum cases were having GMFCS level 3 (n=14) and MACS level 2 (n=15). There was significant positive association (p-value <0.05) between GMFCS level and grading of MRI. Similar significant association was observed for analysis of association of MACS level and MRI Grading. Conclusion: The present study highlighted that there was a significant association between extent and type of brain lesion and motor functions (GMFCS and MACS levels). Type and extent of brain lesion helps clinician to understand prognosis of functional motor outcome in CP children.

Effect of Thoracic Manipulation on Pain and Postural Sway in Chronic Mechanical Neck Pain Patients: A Quasi-experimental Study

Uma Devi, Satish Kumar Anumula, Ammar Suhail

Introduction: Mechanical Neck Pain (MNP) is a prevalent musculoskeletal problem. MNP has a high-risk of becoming chronic in nature. Recent studies demonstrate altered Postural Sway (PS) among MNP patients. There are various management strategies used for improving pain and PS among Chronic MNP (CMNP). Numerous studies have been done on the effect of thoracic thrust manipulation on pain. However, the evidence is deficient for the impact of thoracic manipulation on PS in MNP patients. Aim: To analyse the effect of Thoracic Spine Manipulation (TSM) on pain and PS in CMNP patients. Materials and Methods: The quasi-experimental study was carried out on 31 patients. All the patients received three sessions of thoracic manipulation on three consecutive days. Numeric Rating Scale (NRS) and PS were measured during three treatment sessions and at baseline. One-way repeated measure Analysis of Variance (ANOVA) was used to examine the effects of treatment on each outcome variable. Results: Thirty-one patients with a mean age of 22.23 (SD=2.667) years with 61.3% females, and 38.7% males fulfilled the prerequisite considerations to be in the study. Patients showed significant improvements in pain after TSM 1 (F=105.8, p<0.05). The PS measured as sway velocity based on the Center of Foot Pressure (COFP) showed a significant reduction in both anteroposterior direction (F=3.55, p=0.02) and mediolateral direction PSY (F=5.10, p=0.03). Conclusion: The results demonstrated that thoracic manipulation improves pain and reduces PS. The study concludes that TSM can alter PS immediately post manipulation. TSM can be an alternative to Cervical Spine Manipulation (CSM) in patients with a contraindication for CSM.

Epley’s Maneuver versus Semont’s Maneuver in the Treatment of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Cohort Study

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in otorhinolaryngological practice. Canalolithiasis and cupulolithiasis are the main theories which describe the pathophysiology of BPPV. Particle repositioning maneuvers are non invasive, simple, bedside procedure that are better tolerated by patients and give symptomatic relief. Aim: To compare the effectiveness of Epley's vs Semont's maneuver in the treatment of Posterior Semicircular Canal (PSC) BPPV. Materials and Methods: A cohort study was conducted in Otorhinolaryngology Department of Chettinad Hospital and Research Institute from October 2020-March 2021. A total of 108 patients who reported to the outpatient department and were diagnosed with PSC BPPV were included in this study. A detailed clinical history was recorded audio vestibular examination was conducted and Dix-Hallpike maneuver were performed to confirm the diagnosis. Following which, patients were subjected to treatment with either Epley's maneuver or Semont’s maneuver. A total of 54 patients were treated with Epley’s maneuver and 54 patients were treated with Semont's maneuver. Patients were followed-up one week after performing the maneuver. In case of presence of persistent symptoms, the maneuver was repeated upto a maximum of three times. Successful treatment was assessed based upon the patient’s symptomatic improvement of vertigo and a negative Dix-Hallpike test which was performed at the follow-up. Data was presented in proportion (descriptive statistics) and chi-square test was used. The p-value <0.05 was considered as statistically significant. Results: In a total of 108 cases, the most common age group affected by BPPV was that of 21-40 years. Left side BPPV was noted in 50 (46.3%) patients, right side BPPV in 48 (44.4%) patients and 10 (9.3%) patients were found to have bilateral BPPV. Fifty two patients responded well for Epley's maneuver and had complete resolution of symptoms on first follow-up and 46 patients responded to Semont's maneuver and improved symptomatically. Conclusion: Greater number of patients improved symptomatically in the first visit itself with Epley's maneuver compared to Semont's maneuver. Hence, Epley's maneuver is the preferred initial treatment and effective modality for PSC BPPV.

Restarting Elective Surgeries during COVID-19 Pandemic: Innovations and Anaesthesiologist’s Perspective

Harjot Singh, Sanjaya Kumar Gupta, Rajat Chauhan, Pratistha Lall

Introduction: Lockdown imposed due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) caused by coronavirus led to disruption of all aspects of life across the world with serious consequences in delivering of routine surgical services to the patients. Anaesthesiologists and surgeons in the study Institute devised clinical assessment based protocols for preanaesthesia assessment {not including routine preoperative Coronavirus Disease 2019 (COVID-19) Testing} to ensure timely conduct of elective surgeries as soon as patients started reporting to hospital. Aim: To evaluate the efficacy of various measures taken by anaesthesiologists and operation theatre team to impart surgical care during COVID-19 pandemic without increasing the risk of transmission of COVID-19 disease. Materials and Methods: A retrospective observational study was carried out with the idea of comparing the surgical workload of year 2020 (January to December 2020) with the previous year 2019 (January to December 2019). The study was conducted in the month of March 2021, in a 627-bedded secondary care multispeciality hospital in northern India. The data on total number of patients undergoing surgeries in year 2020 was compared with that of year 2019 on the basis of elective surgeries, emergency surgeries and different modalities of anaesthesia used to conduct all those surgeries. These variables from both the years were compared using chi-square tests and Statistical Package for Social Sciences (SPSS) trial version 23.0. Results: The total numbers of surgeries had reduced in year 2020 (3923 in 2019 vs 2500 in 2020) with highest reduction in the months of April and May 2020 (83.08 and 74.75%, respectively). However, with implementation of clinical assessment based protocols and targeted changes in anaesthesia practice, the decrease in elective surgeries came to statistically non significant levels by the month of September 2020. The difference in percentage of cases carried out under regional anaesthesia (4.23% in 2019 vs 3.24% in 2020) was statistically not significant (p-value=0.051). The emergency surgeries in 2019 were 805 vs 742 in 2020, percentage change from 2019 base data was -7.83. The incidence of COVID-19 infection during postoperative period was nil in the Institute. The incidence of COVID-19 infection among the staff was found to be similar to the patients reported to the hospital despite of handling elective surgical cases. Conclusion: Regular surgical care can be safely provided after thorough clinical assessment of the patients in this ongoing pandemic. This did not lead to increase in incidence of COVID19 infection in healthcare workers as shown in our data. Hence, preoperative COVID-19 testing should be performed only when indicated by clinical history and examination. However, more studies with multiple centres are required to validate these protocols and hence facilitate the formation of even more refined ones.

Effect of Nebulised Lignocaine on the Quality of I-gel Insertion: A Randomised Controlled Trial

Sushma K Sannaboraiah, HS Pushpavathi, KL Yashaswini

Introduction: Supraglottic Airway Devices (SAD) are integral part of airway management during General Anaesthesia (GA) and are less invasive than endotracheal intubation. I-gel is a novel and innovative SAD, with non inflating cuff and it is widely used among available devices. Various drug combinations are being studied to obtain better insertion conditions. Lignocaine nebulisation is popularly used as topical anaesthesia for the airway. Authors hypothesised that it could improve the insertion conditions of the airway in addition to induction agents. Aim:To assess the efficacy of lignocaine nebulisation for I-gel insertion conditions in terms of the frequency of optimal insertion conditions and haemodynamic changes observed during and after the insertion of I-gel. Materials and Methods: This randomised controlled trial was conducted for one year from January 2019 to January 2020 in Karnataka Institute of Medical sciences, Hubli, Karnataka, India. Ninety patients of age group 18 to 45 years, belonging to American Society of Anaesthesiologists’ (ASA) grade I and II, undergoing minor surgical procedures were included. They were randomised into two equal groups, group L received 5 mL of 4% lignocaine and group D received 5 mL of normal saline nebulisation 5 minutes before induction of GA. Optimal insertion conditions (successful insertion at the first attempt without adverse response) and haemodynamic responses were noted down as primary and secondary outcomes respectively. The data was analysed using Chi-square test and Student’s t-test according to parameters. Results: A total of 43 patients were in group lignocaine nebulisation (Group L) and 44 in the normal saline nebulisation group (Group D) and they had the mean age of 28.8±6.3 and 29.0±5.1 respectively. The optimal insertion (p-value 0.26), successful first attempt insertion (p-value 0.175) and time for insertion (p-value 0.512) were not statistically significant between the two groups. In group L at 1 and 5 minutes, fall in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was noted and compared with other group which was not statistically significant. Conclusion: Preinduction lignocaine nebulisation doesn’t improve optimal insertion conditions of I-gel statistically. Even though better haemodynamic were noted with the same, it cannot be recommended for the sole purpose by nebulisation route

Impact of Renal Stone Clearance in Patients of Chronic Kidney Disease: A Prospective Observational Study from a Tertiary Care Centre

Dhananjay Selukar, Nikhar Jain, Monika Akare, Ajit Patel

Introduction: Varying degrees of renal insufficiency is associated with renal stone disease. The incidence of Chronic Kidney Disease (CKD) in renal stone is around 0.8 to 17.5%. There is limited data on the outcomes of Percutaneous Nephrolithotomy (PCNL) in CKD patients like improvement in Glomerular Filtration Rate (GFR), Effective Renal Plasma Flow (ERPF), postoperative complications, morbidity like dialysis dependence and mortality and various other factors. Aim: To study the impact of PCNL in patients of urolithiasis with CKD. Materials and Methods: A prospective observational study was conducted on 100 patients of chronic kidney disease seeking operative treatment during June 2017 to September 2019 in the Department of Urology, Superspeciality Hospital and Government Medical College (GMC), Nagpur, Maharashtra, India. All suspected patients underwent a plain Computed Tomography (CT) scan. Patients were classified into three groups; group 1 included stage III, group 2 included stage IV and group 3 included stage V CKD patient. Patients with Acute Kidney Injury (AKI) underwent urine diversion first. Both short term impact like hospital stay, need for blood transfusion, AKI, sepsis, fever and long term impact like change in renal function, stage migration were studied. Statistical analysis was done using Kruskal Wallis Test (age distribution); Chi-squared test (gender and AKI); Fisher’s exact test (stone Composition and transfusion); Kruskal Wallis Test {Body Mass Index (BMI), hospital stay, Effective Renal Plasma Flow (ERPF) and Estimated Glomerular Filtration Rate (eGFR)}. Results: A total of 55 patients were of Grade III CKD, 31 were of Grade IV CKD and 14 patients were of stage V CKD and classified into groups 1, 2 and 3, respectively. Age and gender distribution were not significantly different among various groups. There was no significant difference in BMI (Kg/m²) or diabetes in the groups. The most common stone composition was calcium oxalate dihydrate (53%). Among 100 patients, urine culture was sterile in 77 patients. No significant difference was found in the incidence of urinary tract infection (p-value=0.629). Group 3 presented with significantly higher incidence of AKI (p-value=0.001). Stone free rate was not significantly different among groups (p-value=0.252). Blood transfusion rates was not statistically different in these groups (p-value=0.066). Mean hospital stay was significantly higher with higher stages of CKD (p-value <0.001). Change in renal function was evaluated by change ERPF and eGFR. ERPF significantly increased by 1.96±4.87 (p-value=0.001) after surgery. Similarly, there was significant increase in eGFR over time (p-value=0.037). Conclusion: PCNL in patients of chronic kidney disease has a minor but significant improvement in GFR with good clearance rates.

Bacterial Aetiology and Susceptibility of Pathogens Associated with Acne Vulgaris

M Deborah Pusushottam, Nasepogu Padmaja, A Venkateshwara Rao

Introduction: Acne vulgaris is a pilosebaceous disorder among youth during puberty and also in young adults. Hormonal imbalance, bacterial activity and inflammation can cause acne formation. Due to some anti-inflammatory effects and temporary self treatment of acne using some antibiotics, there is overuse/ improper use of antimicrobial agents which leads to resistance in bacterial strains. Aim: To provide an overview of bacteria that may cause acne and determine their susceptibility to antibiotics and reduce the overuse of antibiotics which leads to antibiotic resistance. Materials and Methods: This was a cross-sectional study done on samples from from 100 patients with chief complaints of acne, attending Dermatology Department at Konaseema Institute of Medical Sciences and Research Foundation (KIMS RF). This study was done between November 2019 to February 2021. Acne pustules were cultured on all the basic media like blood agar and Mac Conkey agar, under aerobic and anaerobic conditions. Bacterial identification was performed by gram staining and relevant biochemical tests. Antibiotic susceptibility was done based on the Clinical and Laboratory Standards Institute (CLSI) 2019. Data was calculated and analysed statistically by Statistical Package for Social Science (SPSS) version 21.0. Results: Total 100 participants were taken for the study. Females (63%) were more commonly affected as compared to males (37%) and the most commonly affected age group was teenage i.e., 10 to 20 years in both male and females. Among 100 subjects, 77 cases showed bacterial growth by aerobic and anaerobic culture and 23 cases showed negative for bacterial culture. All isolates were susceptible to rifampin (100%) (p<0.001). Propionibacterium acnes (P. acnes) was susceptible to doxycycline (88.8%) and minocycline (88.8%), while 22.3% was resistant to erythromycin, clindamycin, and tetracycline. 33.3% showed resistance to ofloxacin. Gram positive cocci like Staphylococcus epidermidis (S.epidermidis) was susceptible to the antibiotic minocycline and rifampin (100%); but resistant to quinolines like ofloxacin (52.5%) macrolides like erythromycin (62.5%), clindamycin (47.5%) and tetracycline (17.5%). The susceptibility of gram positive cocci like S. epidermidis to doxycycline was (87.5%), which was lower than that of P. acnes (88.8%). Staphylococcus aureus (S. aureus) was found to be sensitive to minocycline (90.9%), doxycycline (72.7%), clindamycin (63.6%), and tetracycline (63.6%); but it was resistant to macrolide like erythromycin (45.5%) and quinolines like ofloxacin (36.5%). Conclusion: This study suggested that bacterial culture and antibiotic sensitivity can be better suggested if the culture and sensitivity is available so that, sensitivity and resistant pattern is known. The use of clindamycin and macrolide (erythromycin) needs to be reduced as most gram positive cocci like S. epidermidis were resistant to both.

Volunteering Motivations of Medical Undergraduates for Community Service at a Tertiary Care Teaching Hospital- A Qualitative Study

UB Vijayalakshmi, V Chandrasekhar , P Srinivasa Rao

Introduction: There are very few studies from Western countries and almost none from India, that have tried to understand the factors influencing students’ motivation to volunteer for community service and much less on medical student’s motivation to volunteer for community service. Aim: To identify the factors that influence motivation of medical students to volunteer for community service. Materials and Methods: This was a descriptive study was done over a period of two weeks in November 2017. The study participants were medical students of a private medical college from Southern India. Semi-structured interviews were conducted using an interview guide based on a standardised motivation to volunteer inventory. Data was collected till data saturation was reached, which was 20 students. The interviews were conducted in privacy. Verbatim notes were taken and the interview was also recorded after taking consent from the participants. The data was transcribed and triangulation done. The data was analysed using the thematic analysis approach. Results: The main motives were enhancement and career motives. Value was not the main motive. Two other motives emerged, that were curiosity and relief from boredom. Conclusion: The study shows that the main motives behind volunteerism were enhancement and career. This was the first such study from India to the best of our knowledge which has enquired into the motives behind volunteerism in medical students.

Accidental Consumption of Distinguished Substance in Disguise- A Rare Case of Minoxidil Poisoning

Minoxidil is a powerful direct acting vasodilator that was used clinically as an oral antihypertensive drug in combination with beta blockers and diuretics in cases of hypertension refractory to other antihypertensives. A 58-year-old male presented to the Emergency Department with an alleged history of accidental consumption of around 10 mL of 5% topical minoxidil solution. He had developed tachycardia, severe hypotension, and characteristic Electrocardiogram (ECG) changes with no obvious chest pain. He was treated with continuous intravenous (i.v.) crystalloids, dual inotropes and other supportive measures. The patient also developed acute pulmonary oedema and acute kidney injury. He responded to treatment and gradually improved haemodynamically with resolution of ECG changes and acute kidney injury. He was discharged seven days after admission. The patient showed resolution of characteristic ECG changes and improvement in haemodynamic condition of patient with supportive management in hospital.

Surgical Outcome in Posterior Fossa Tumours- A Retrospective Study

Introduction: Posterior fossa tumours are the most common solid tumours in children, while 15 to 20% of adult brain tumour occurs in posterior fossa. Aim: To determine the surgical outcome of posterior fossa tumours. Materials and Methods: A retrospective study of 63 patients from all age groups who underwent surgery for posterior fossa tumours in Department of Neurosurgery at Government Medical College, Thrissur, Kerala, India, during March 2015 to February 2020 were included. Surgical outcome in terms of clinical improvement which includes Glasgow Coma Score (GCS), presence or absence of new cranial nerve involvement and radiological assessment of extent of excision was noted with Computed Tomography (CT) scan. Complications which occurred during perioperative period till discharge were noted. Data was presented in terms of frequency and percentages. Statistical software Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyse data. Results: The mean age was 41.86±21.75 years. A total of 34 (54%) were females and 29 (46%) were males. Cerebrospinal Fluid (CSF) leak and pseudomeningocele was the most common complication observed. It was noted in 16 (25.39%) patients. Excellent outcome was noted in 8 patients (12.69%), good outcome in 36 (57.14%) patients, acceptable outcome in 15 (23.80%) patients and poor outcome in 4 patients (6.35%). It was observed that 72.22% (26) extra-axial tumours had excellent to good outcome while only 66.66% (18) intra-axial tumours had excellent to good outcome. Conclusion: Surgical outcome in posterior fossa tumours was better in extra-axial tumours. Even with so many technical and surgical advances posterior fossa tumour surgery still carry morbidity.

Assessment of Consumer Satisfaction to Improve Quality of Services Provided in Tertiary Care Hospital of Uttar Pradesh- A Cross-sectional Study

Sumit Saxena, Kuldeep Srivastava, Anurag Srivastava, Anju Saxena

Introduction: Satisfaction of the patient play a very important decisive factor for pay-for-performance metrics and it also replicates the type of care being provided. One of the major parameters to establish patient satisfaction is to measure success of services provided in hospital. Aim: To assess the quality of care in terms of patient’s satisfaction in a tertiary care hospital of Uttar Pradesh. Materials and Methods: A community based cross-sectional study was carried out among patients attending the Outpatient Department (OPD) at Varunarjun Medical College and Rohilkhand Hospital, Uttar Pradesh, India. Total 88 people (patients or attendants) were interviewed by using a predesigned and pretested semi-structured proforma, in Hindi language. The questionnaire contained questions related to an individual’s experience with the staff and environment of health system at the end of their outpatient visit. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The majority 37 (42.0%) belonged to age group of 34-49 years, 58 (66%) were males, 36 (40.9%) educated upto high school and 45 (51.2%) belonged to general category. In the present study, regarding hospital informatory, 28 (31.8%) respondent found good direction indicators. Waiting period was less than half-an-hour reported by 47 (53.4%) patients. Sixty-three (71.5%) patients had opportunity to ask questions about their disease and treatment. Most of the respondent 50 (56.8%) said that hospital staff listened to their questions and problems. Statistically significant association was found inbetween patient satisfaction and socio-demographic variable like age, gender, education and socio-economic status (p-value <0.05). Around 68 (77.2%) respondent were not satisfied with behaviour of hospital staff (nurses and paramedical staff) whereas only 35 (39.8%) respondent were satisfied with the behaviour of treating doctor. Conclusion: Among the different domains of measurements of patient satisfaction, only few were satisfied with doctor’s and paramedical staff. Doctor's time, behaviour of paramedical staff and poor quality of services were the main reasons for dissatisfaction among dissatisfied patients.

Knowledge and Attitude about Stem Cells and their Potential Applications in Field of Medicine among Medical Students of Arar, Saudi Arabia

Tehreem Aftab, Ehtisham Khyzer

Introduction: The use of stem cell has opened new avenues in the management and cure of diseases in modern era. They have enabled us to achieve remissions and cure in malignancies. They have enormous ability of stimulating the repair process in diseased and damaged tissue. As the medical specialists are a reliable source of information, so their knowledge and approach are vital in counselling the patients regarding the use of stem cells as an advanced treatment option. Aim: To assess the knowledge and attitude level about stem cells and their therapeutic applications among medical undergraduates. Materials and Methods: This cross-sectional study was carried out for a period of six months from January 2021 to June 2021. It included 150 MBBS students (2nd to final year) of Northern Border University (NBU), Arar, Saudi Arabia. A well-structured questionnaire was used to collect data after obtaining informed consent. It included 15 statements to assess knowledge and 10 statements about attitude. The total knowledge and attitude scores were calculated for each student and classified as poor, moderate or high score. The knowledge and attitude scores were correlated using Pearson’s correlation. Results: Majority of the participating students were males (63.3%) with mean age of 23.62±1.5. Adequate knowledge about stem cells was observed in 65.3% of students while 10% had excellent knowledge. An overall positive attitude was reported with a mean score of 36.9±3.71. There was a low positive relationship between knowledge and attitude scores with p-value <0.001 and Pearson’s score(r) of 0.396. Conclusion: The study indicates an overall good knowledge and positive approach towards stem cell use in medicine among medical undergraduates. It is suggested to organise comprehensive training sessions and update the curriculum regarding recent developments in stem cell research to further enhance students’ awareness and attitude.

Health Related Quality of Life in Osteoarthritis Patients with Total Knee Replacement: A Longitudinal Cohort Study

Amandeep Singh Bakshi, Sanjeev Kumar, Girish Sahni, Anku Jain

Introduction: End-stage knee results in pain, loss of physical function and a decrease in Quality Of Life (QOL). Total Knee Replacement (TKR) is one of the most successful surgical interventions, providing substantial relief from pain. Because patient’s perceptions of treatment outcomes may vary from clinician’s judgment; measuring patient’s perspectives using Health Related Quality of Life (HRQOL) instruments has become an important approach for outcome evaluation. Aim: To assess the HRQOL outcome after TKR in patients with Osteoarthritis (OA) Knee. Materials and Methods: A longitudinal cohort study was conducted in Orthopaedic Department of tertiary care teaching hospital from July 2018 to June 2020. Of 63 patients eligible for the study, 56 completed the follow-up data. Knee injury and Osteoarthritis Outcome Score (KOOS) was measured preoperatively. Patients were followed-up at three months and six months, and postoperative KOOS were measured to evaluate HRQOL after TKR. Student t-test was used to analyse differences between KOOS mean aggregate and subscale scores. Results: There were 34 (60.71%) females and 22 (39.29%) males in the study. Mean age of the study population was 58.93±9.57 years. Left knee was involved in 33 (58.93%) cases and right in 23 (41.07%) cases. There was significant difference in preoperative KOOS (prKOOS) and postoperative KOOS (psKOOS) in the patients (p-value <0.001). It was observed that 29 (51.79%) patients were having excellent HRQOL outcome (psKOOS ≥90), 9 (16.07%) each good (psKOOS 80-89), 8 (14.29%) fair (psKOOS 70-79) HRQOL outcome and 10 (17.86%) poor HRQOL outcome (psKOOS <70) at six 6 months follow-up. Conclusion: At six months follow-up there was significant improvement in KOOS as well as subscales of symptom, pain, Activities of Daily Living (ADL), sport/recreation and QOL score. Thus, it can be said that TKR leads to significant improvement in HRQOL.

Alexithymia in Children with Traumatic Dental Injuries- A Cross-sectional Study

Introduction: Alexithymia is a personality trait that affects the emotional regulation. It has been found associated especially with pain disorders. It is a personality construct which is characterised by inability to experience and describe feelings, making an alexithymia patient suffer from mental clouding. Therefore, it is important to diagnose patients with alexithymia in dental clinics since it may adversely affect the doctor patient relationship and treatment outcome. Aim: To find the prevalence of alexithymia and to find any difference in alexithymia traits between children with Traumatic Dental Injury (TDI) and those without it. Materials and Methods: This cross-sectional study was conducted on 10-19 years old adolescents reporting to K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India, from February 2018 to September 2018. A total of 420 participants were enrolled with 210 in each group (with TDI and without TDI). Toronto Alexithymia Scale (TAS-20) was used to identify alexithymia. Andreasen’s classification for TDI was used to classify the TDI. Chi-square was used to compare the non parametric data between the groups. Unpaired t-test was performed for the comparison of scores between groups for total TAS-20 score and as well as for the nine dimensions. Results: The prevalence of alexithymia was found to be 86.1% in children with TDI compared to 30.9% in children without TDI. The difference in prevalence of alexithymia between children with TDI and those without was statistically significant (p-value=0.0001). Children with TDI reported with significantly higher total TAS scores. However, difference with respect to gender was not statistically significant. Conclusion: The prevalence of alexithymia was found significantly higher in children with TDI. Also, the TAS-20 score and the individual domain scores were higher in children with TDI. Hence, alexithymia may be associated with TDI.

Is Socio-economic Status Associated with Oral Healthcare Utilisation and Dental Health among Female Cancer Survivors? A Cross-sectional Study from Southern Iran

Introduction: Cancer patients are more prone to dental caries. Exposure to chemotherapy and/or radiation therapy, leads to hypofunction of salivary glands and consequently increases dental caries. A considerable number of cancer survivors are exposed to a heavy economic burden imposed by the disease. Aim: To study the effects of Socio-economic Status (SES) on oral health and the utilisation of Oral Healthcare (OHC) services among female cancer survivors in Iran. Materials and Methods: A cross-sectional study was conducted from June 2019 to October 2019 on 200 female cancer patients. Proportion of dental caries, OHC services utilisation, and SES were assessed in participants older than 18 years, who visited Shiraz cancer clinics at Shiraz, Iran. The data on OHC utilisation and SES among individuals were collected using the questionnaires by face to face interviews and oral examinations. Pearson’s Chisquared test, the independent samples t-test, and binary logistic regression were used for statistical analyses. Results: Total of 200 female cancer patients were included and the median age was 49 years. Filled Teeth (FT) and Decayed, Missing and Filled Teeth (DMFT) (Poisson Regression (PR): 1.64, p-value <0.001; and PR: 1.11, p-value 0.04 in respect) were significantly higher; while, Decayed Teeth (DT) (PR: 0.80, p-value 0.03) and Missing Teeth (MT) (PR: 0.69, p-value <0.001) were significantly lower, in higher levels of SES. Hundred and fourteen participants had at least one dental visit during the previous year. SES did not affected having a dental visit in the previous year (p-value 0.6). Conclusion: Among female cancer survivors, SES was associated with oral health and was not a determinant for the rate of utilised OHC services. Treatment in comparison with prevention/regular dental check-ups was the most prevalent reason for the last dental visit.

Demographic and Biochemical Parameters of Community Survey Participants with Metabolic Syndrome from Terai Region of Nepal

Introduction: Psychological and recreational activities have been found to be useful in the field of psychiatry. ‘Art Therapy’ uses therapeutic use of art within the professional role in the personal development of the patient by creating art and finding meaning through them. People can improve their awareness of self and cope with symptoms of stress, anxiety, and traumatic experiences. They can also improve cognitive abilities and gain pleasure in making art. Aim: To evaluate the effectiveness of art therapy on cognitive functions and psychological well-being among mentally ill patients admitted with major mental disorders. Materials and Methods: An evaluative approach with a pre-experimental, one group pre and post-test design was adopted to select 60 patients admitted with major mental disorders in a selected psychiatric unit, Udupi, Karnataka, India through purposive sampling technique. Data collection was done from 1st December 2019 to 31st January 2020. Information was collected through Montreal Cognitive Assessment (MoCA) Scale and Psychological General Wellbeing Index (PGWBI) Scale. The pretest was conducted on the first day. Art therapy sessions were conducted for four consecutive days. Post-test assessments were done on the seventh and fourteenth day. Results: The mean baseline MoCA score was 16.70±4.04 which improved to 19.10±4.07 on 7th day and 21.28±4.33 on 14th day. Similarly, baseline score of PGWBI was 35.28±13.94 which improved to 53.58±13.88 on 7th day and further increased to 81.80±17.69. Conclusion: Art therapy has a strong effect on the psychological well-being of the patients with mental illnesses and is effective in improving cognitive functions and psychological well-being

Effect of Art Therapy on Cognitive and Psychological Well-being of Patients with Major Mental Disorders- An Experimental Study

S Sharmila, Thereza Mathias, J Shivakumara, Jaison Jacob

A Cross-sectional Study on Cutaneous Sideeffects Associated with Mask Usage among Doctors during COVID-19 Pandemic

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has brought major changes in people’s lifestyle, especially in healthcare workers. Healthcare workers caring for COVID-19 patients are spending long hours wearing Personal Protective Equipment (PPE). There are reports of adverse skin reactions secondary to wearing PPE, especially face masks. However, it is essential to wear the protective equipment. Aim: To assess the proportion of doctors who report adverse skin reaction after the use of face masks and enlist the skin reactions reported. Also to study the relationship between certain suspected factors and occurrence of skin reactions. Materials and Methods: This was a cross-sectional study conducted using a questionnaire containing both open and closed ended questions which was distributed through online platform. The questionnaire contained details on the type of mask, duration of usage, frequency of change and dermatological manifestations experienced. Sample population constituted doctors who were willing to participate in the study. IBM Statistical Package for the Social Sciences (SPSS) version 17.0 was used for analysis of data. Results: The male to female ratio among the 220 doctors studied was 1:1.59. Maximum number of doctors (56.4%) wore N95 masks. Total 33.63% of them used one new mask every day and 60.90% of them used the mask for more than 6 hours continuously on a day. Acne was the most commonly reported problem accounting for 48.2%. Doctors using N95 masks reported acne more commonly. Conclusion: N95 masks were the most commonly used masks. Total 88.18% of the doctors reported cutaneous manifestations. Acne was the most common dermatological problem reported. It was associated with the use of N95 masks and longer duration of use of N95 masks.

MCM2 Expression in Different Molecular Subtypes of Epithelial Breast Cancers and its Association with Clinicopathological Parameters and Ki-67 Expression

Meghadipa Mandal, Anadi Roy Chowdhury, Susmita Mukhopadhyay

Introduction: Breast cancer is one of the most common malignancies, with few subtypes having a more aggressive outcome and resistance to conventional therapies, Triple Negative Breast Cancers (TNBCs) being one such variant. The Ki-67 lacks reproducibility and a standardised cut-off. MCM2 (Minichromosome Maintenance 2) has role in DNA repair and replication and its role as alternate marker for prognosis has been studied in this case. Aim: To study MCM2 expression with respect to histologic grade, stage, nodal status and molecular subtypes of breast carcinoma. Also, to look for any correlation between Ki-67 and MCM2 expressions. Materials and Methods: A cross-sectional, observational study conducted on a group of 20 patients who underwent mastectomy in a Tertiary Care Centre, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India, for a total duration of six months. Histologic grading, staging, nodal status was evaluated from Haematoxylin and Eosin (H&E) stained sections. Formalin-Fixed Paraffin-Embedded (FFPE) blocks suitable for Immunohistochemistry (IHC) were selected and MCM2, Estrogen Receptor (ER), Human Epidermal Growth Factor Receptor 2 (HER2), Progesterone Receptor (PR)/neu and Ki67 were performed. Scores given based on visual examination under light microscope. Analysis was done using IBM Statistical Package for the Social Sciences (SPSS) version 25.0 software. Results: Most of the subjects belonged to 41-55 years age group. Statistical significance was seen between high MCM2 and Ki67 expressions (p-value=0.0171) and high histologic grade and TNBCs (p-value=0.009). High MCM2 and Ki-67 expressions also come with increased risk for advanced disease. High Ki-67 is also a risk predictor for lymph node positive cases. Positive correlation was seen between MCM2 and (R)= 0.4318. Conclusion: The MCM2 is a predictor for adverse outcomes in breast carcinoma cases. It may serve as an alternative to Ki-67 as a proliferation marker, to guide clinicians in treatment strategies. Its role as a therapeutic target in aggressive breast carcinomas may be evaluated with larger study population in the future.

Efficacy of Different Doses of Dexamethasone as Pre-emptive Analgesia in Patients Undergoing Total Abdominal Hysterectomy under General Anaesthesia: A Prospective Non Randomised Placebo Controlled Study

Preeti Sharma, Shaista Yaqoob, Waqar-UL-Neesa

Introduction: Pre-emptive analgesia reduces postoperative analgesic requirement, avoiding side-effects that occur with parenteral narcotics. Dexamethasone, a long acting synthetic corticosteroid with predominantly glucocorticoid activity is one of the entities used for pre-emptive analgesia. The optimum dose of dexamethasone for pre-emptive analgesia is not defined. Aim: To study the efficiency of different (low, intermediate and high) doses of dexamethasone as pre-emptive analgesia in patients undergoing total abdominal hysterectomy under general anaesthesia. Materials and Methods: The prospective non randomised placebo controlled dose range study was conducted in the Department of Anaesthesiology, at a tertiary care institute at Srinagar, Jammu and Kashmir, India, over a period of two years from July 2017 to June 2019. Eighty female patients (age 40-65 years, American Society of Anaesthesiologists (ASA) I and II) scheduled for total abdominal hysterectomy were divided into four groups (Groups A, B, C and D) on the basis of dexamethasone dose. Group A with low dose (0.1 mg/kg), group B with intermediate dose (0.12-2 mg/ kg), group C with high dose (>0.2 mg/Kg) and group D with no dexamethasone. Early and late acute postoperative pain {Visual Analog Scale (VAS) score}, cumulative analgesic consumption upto 24 hours, intraoperative blood sugar levels, Postoperative Nausea and Vomiting (PONV), and adverse events were recorded. Analysis of variance (ANOVA) was used for intergroup comparison of means and Chi-square test was used for categorical variables. Results: The mean age (years) of group A was 52.3 ±8.87, group B was 48.3±5.23, group C was 49.8±6.85 and group D was 51.7±4.46. Postoperative VAS score for 0 hour, 1 hour, 2 hour, 3 hour, 4 hour was more in patients who had not received dexamethasone pre-emptively (p-value <0.05). VAS score at 6 hour, 12 hour, 24 hour was more in patients who had not received dexamethasone preemptively. There was a statistically significant difference in VAS score at 6, 12, 24 hours when low dose dexamethasone group was compared with intermediate and high dose dexamethasone groups (p-value <0.05). Rescue analgesia consumption was significantly less in patients who received intermediate to high dose dexamethasone. Blood sugar levels increased significantly in patients receiving dexamethasone, but returned to baseline after 24 hours. The incidence of nausea and vomiting and the need for rescue antiemetic was significantly less in patients receiving dexamethasone (p-value <0.05). The incidence of postoperative adverse effects was not different among these groups (p-value >0.05). Conclusion:b Intermediate and high dose dexamethasone, given preoperatively in patients undergoing abdominal hyster-ectomy produces better postoperative analgesia with added antiemetic benefit.

Queries and Satisfaction in Telemedicine Counselling for COVID-19 in West Bengal, India

Soumitra Mondal , Saikat Bhattacharya

Introduction: Telemedicine counselling service for Coronavirus Disease 2019 (COVID-19) has an immense importance in India. Hard to reach rural areas have more skewed ratio and due to mandatory quarantine during COVID-19, availing physical consultation from doctors has become more difficult. Aim: To find out the queries of the callers in COVID-19 support cell and their satisfaction of this service. Materials and Methods: This cross-sectional study was conducted at Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata in May 2021. Total 152 participants were included in the study. Data were collected by telephonic interview using a pre designed pretested interview guide. Queries of the callers to the telemedicine centre were recorded along with their demographics. Satisfaction was measured on a scale of 0-10. Results: Mean age of the patients were 44.5±17.05 years; 114 (75%) callers were male and 93 (61.2%) were from rural areas of West Bengal. There were 78 (51.3%) callers who were repeat callers. The most common query {90 (59.21%)} was “when positive patients would undertake next Rapid Antigen Test (RAT)/Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test to find out whether they were negative.” The mean satisfaction score was 6.29. Conclusion: Telemedicine services were availed by many callers from rural area. The support cell responded to queries like what drugs to be taken and home isolation duration. Majority of the callers felt satisfied after consultation, thus, indicating effective role of teleconsultation

Functional and Radiological Outcomes of Proximal Tibial Fracture with Compromised Skin Condition Treated with Ilizarov External Fixator: A Clinical Interventional Study

Introduction: In proximal tibia fractures, the main goal is to achieve accurate reduction and stability without significantly compromising the soft tissue integrity and vascularity. Ilizarov external fixation minimises iatrogenic soft tissue dissection and associated complication and permits early mobilisation and weight bearing. Aim: To describe the clinicoradiological outcome of proximal tibial fractures with compromised skin condition treated with ilizarov external fixation with or without minimal internal fixation. Materials and Methods: A prospective clinical interventional study containing 30 cases (23 closed with compromised skin condition and seven open) of proximal tibia fractures who were treated with ilizarov external fixator between June 2018 to October 2020 was conducted. After discharge patients were followed-up at an interval of two weeks after discharge, and then on monthly basis until fracture union occurred for a minimum period of 6-12 months. Results were analysed both clinically and radiologically using Johner and Wruh’s criteria. Results: In present study of 24 males and six females were included and their mean age was 39.66±11.32 years. Fracture union was achieved in all cases with a maximum period of 22 weeks and minimum being 12 weeks on fixator. Average number of days on fixator was 105. Average range of motion of knee was 115.52±13.32° with one patient having extension lag up to 15° and six patients having extension lag up to 10°. No patient complained of functional knee instability. Pin track infection occurred in six patients, three patients had joint stiffness and limb shortening occurred in two patients. Overall results according to Johner and Wruh’s criteria were excellent in 23 patients, good in five patients and fair in two patients. Conclusion: Illizarov external fixature is an excellent treatment method in proximal tibia fracture with compromised skin condition not immediately amenable to internal fixation.

A Randomised Clinical Trial on Analgesic Efficacy of Intravenous Paracetamol as an Adjunct to Patient Controlled Epidural Analgesia with Ropivacaine and Fentanyl in Labour

Preetilata Singh, Pratima Yadav, Gayatri Tanwar, Shobha Ujwal

Introduction: Intravenous (i.v.) paracetamol is considered as an effective and safe analgesic agent in labouring women, but its effect on patients already receiving epidural analgesia is not well documented. Aim: To know whether i.v. paracetamol reduces epidural local anaesthetic opioid combination consumption in labour by virtue of its analgesic effects. Materials and Methods: The present double blind, randomised clinical study was conducted on 88 singleton term pregnant women in active labour. Half of these women (n=44, Group P) received 1000 mg (100 mL) i.v. paracetamol and rest (n=44, Group C) received 100 mL normal saline as placebo (n=44). Thirty minutes later all women received 10 mL of ropivacaine 0.125% with 2 μg/mL fentanyl through epidural catheter, followed by continuous background epidural infusion of 5 mL/h with a provision of patient controlled bolus 5 mL of same drug with a lock-out interval of 15 minutes. The primary outcome was hourly mean consumption of epidural drug in mL. Results: The hourly mean drug consumption in the paracetamol group was significantly lower as compared to control group (7.75±0.93 mL/hr vs. 8.23±0.99 mL/hr; p=0.022). The mean number of boluses needed by parturient were also significantly less in the paracetamol group (0.58±0.66 vs. 1.02±0.82; p=0.005). Pain relief after epidural placement was adequate in both groups with similar Visual Analogue Scale (VAS) values without significant intergroup differences. Conclusion: It can be concluded that 1000 mg i.v. paracetamol is a safe and effective adjunct to Patient Controlled Epidural Analgesia (PCEA).

Validity of Computed Tomography in Evaluation of Acute Ischemic Stroke in Comparison to Magnetic Resonance Imaging: A Cross-sectional study

Tanmoy Dey, Prabhat Debbarma, Jaybrata Ray, Pradip Bhowmik

Introduction: Cerebrovascular disease represents a major reason for mortality and morbidity worldwide. Imaging plays a pivotal role in the management of stroke patients. Haemorrhagic stroke diagnosis is straightforward using a Computed Tomography (CT) scan whereas early ischaemic strokes are sometimes difficult to diagnose by imaging. The use of Magnetic Resonance Imaging (MRI) may diagnose ischaemic stroke more convincingly; however MRI remains less available, time consuming and complicated. Unenhanced CT can be performed quickly; can help to identify early signs of stroke. Aim: To determine the validity of CT in the evaluation of acute ischaemic stroke compared to MRI for early diagnosis. Materials and Methods: The study was a cross-sectional study conducted in the Department of Radiodiagnosis, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India. The study period was from December 2018 to December 2020 and included 70 patients. The instruments used were SIEMENS 128 slice CT-SOMATOM model definition AS and SIEMENS 3.0 Tesla MRI-SKYRA model. Statistical Package for Social Sciences (SPSS) for Windows, version 25.0 (SPSS Inc, Chicago, USA) was used for data analysis. Results: Out of all patients (n=70) 63 patients were ultimately found to have infarction. Out of these 63 cases of infarction 69.84%(n=44) were male and 30.16% (n=19) were female. Sensitivity of CT scan was 87.3%, specificity was 71.4%, positive predictive value was 96.4%, negative predictive value was 38.4% and accuracy was 85.7%. The p-value was 0.002. In all patients who presented before six hours (n=15) showed decreased creatinine value during Magnetic Resonance Spectroscopy (MRS) in the lesion area compared to the normal side of brain. None of the patients showed variation in the lactate value. Those presenting after 6 hours (n=48), creatinine was reduced in all the cases (100%), Choline was increased in 89.6%. Conclusion: Sensitivity and specificity of CT scan is lower than MRI. Diffusion-Weighted Imaging (DWI) has 100% sensitivity in diagnosing acute infarction.

Socio-demographic and Morbidity Pattern among Under-Five Children in Rural Areas of Adilabad District of Telangana, India

J Devidas, Jagatabandhu Mohapatra, Parthsarathi Dehury, Ranjit Kumar Dehury

Introduction: The health and wellbeing among children is an important parameter for the measurement of the progress of a nation, which is also most precious asset in the community for socio-economic development in long run. It is not wise to neglect the health rights of the children in the process of nation building. The under-five children are the most vulnerable group in a society in which there is lack of guarantee for adequate nutrition and social protection. The lack of essential health services ultimately leads to childhood diseases like diarrhoea, respiratory infections, and measles in various parts of India. Aim: To understand the socio-demographic and morbidity pattern among the children of under five years in a district of Telangana state, India. Materials and Methods: A cross-sectional study was undertaken by interviewing mothers with the help of a predesigned and pretested questionnaire to understand the morbidity pattern of children under five years in the rural areas of Adilabad district, Telangana, India. The study was conducted in one month, March 2015 in 30 villages. The study assessed various determinates of morbidity by applying scientific principles. The sample size was calculated as 210. The data was analysed by using MS Excel spread sheet and Statistical Package for the Social Sciences (SPSS) software to understand the morbidity pattern. Descriptive statistical tests were done to find out the results. Results: The result confirms that 154,73.33% of the children under five years have several forms of morbidities. The most common morbidity is Acute Respiratory Infection (ARI) (25.71%), which is followed by worm infestation (8.09%), and diarrhoea (20%) and fever (7.61%), scabies (7.61%), asthma (2.3%) and seizure (fits) (1.9%) in last three months from the data collection. All these diseases are prevalent in rural areas of high concern due to the impeding morbidity and mortality. Conclusion: ARI and diarrhoea were found to be the cause of concern among under-five children, which dominate the morbidity pattern. The factors responsible with such precarious situation were deeply entrenched conditions like illiteracy, poor socio-economic conditions, poor environmental sanitation, and increased birth order among the population.

Acute Effect of Resistance Exercise on Serum Cortisol and its Correlation to Blood Glucose in Healthy Non Obese Adults: A Pilot Study

Introduction: Different types and intensity of resistance training/exercises lead to variable cortisol responses, which is essential for growth and homeostasis on short term and long term basis. But the variable responses are not accurately defined to be of any help in tailoring one’s exercise program. Aim: To study the effect of resistance exercise on serum cortisol and its correlation to blood glucose in healthy non obese subjects. Materials and Methods: It was an experimental analytical pilot study extending from February 2017-July 2018 involving 48 healthy non obese subjects (24 males and 24 females) of age group 18-25 years, were enrolled in the study after the screening protocol. High volume exercise training regimen was used involving major muscle group of arms, legs and trunk. Regime involved five exercises with three sets. Between each set, subjects took 30 seconds rest and with each exercise, a rest period of one minute. Height, weight were measured to calculate Body Mass Index (BMI) and serum blood glucose was done along with serum cortisol. Results: The serum cortisol levels in males in pre-exercise group was 145.47±33.67 μg/dL while postexercise group had 116.57±34.40 μg/dL reflecting moderately significant decrease (p<0.01). The serum cortisol levels in females in pre-exercise group were 141.83±38.38 μg/dL while in postexercise group 118.46±35.53 µg/dL with a moderately significant decrease (p<0.01). The Random Blood Sugar (RBS) levels in both males and females postexercise was significantly increased (p<0.05). There was decrease in serum cortisol levels in comparison to rise in RBS in both genders, a highly significant decrease (p<0.001) in males in comparison to moderately significant decrease (p<0.05) in females. Conclusion: Resistance exercise induced decrease in cortisol hormone and its interplay with serum glucose can be better understood by multivariate/elaborate studies on a large sample size.

Effect of Nutritional Therapy on Body Mass Index of Cancer Patients- A Pilot Study

S shanthi , Shambhavi

Introduction: Nutritional issues are typically encountered throughout the treatment of cancer. Cancer cachexia is usually recognised as not only reduced bodily function and quality of life, but also poor positive outcome in patients. Naturally, Body Mass Index (BMI) is frequently used for determining nutritional status of a patient. Intervening nutritional problems of the patient leads to better prognosis. It is necessary to identify patients at-risk earlier and provide effective nutritional interventions. Aim: To determine the level of BMI and evaluate the effect of nutritional therapy on BMI and find its association with demographic characteristics. Materials and Methods: This was a quasi-experimental interventional trial conducted among 100 patients admitted in the hospital with a diagnosis of head, neck and breast cancers. Parameters assessed were baseline proforma, weight and height which were measured and BMI was calculated (BMI=kg/m2 in which kg is a individuals weight in kilograms and m2 is their height in meters squared) and classified as per World Health Organisation (WHO) guidelines. Results: Before nutritional intervention 20% and 26% of patients were underweight in the experimental and control group respectively, whereas after 21 days 18% in experimental and 32% in control were underweight. Z score for post-test level of BMI in the experimental and control group were 2.125 and 2.34, respectively is greater than the tabulated value (Z=1.96 at p-value=0.05 level of significance), hence there was a significant difference between post-test level of BMI in the experimental and control group. High protein high caloric whole food was significant. Conclusion: Investigators concluded from the present study that nutrition therapy can help to maintain or improve the nutritional status among patients on cancer treatment.

Logistical Aspects of Different Online Teachinglearning Methods among Medical Students during COVID-19 in a Tertiary Care Teaching Hospital, Thrissur, Southern India

Introduction: Due to the Coronavirus Disease-2019 (COVID-19) lockdown implemented by the government, we had to transform our classes into the online sphere. The most commonly used methods of online teaching in Government Medical College, Thrissur were, live online lectures, PowerPoint presentations with narrations, prerecorded videos and assignments. Aim: To assess the logistical aspects, merit and demerits of different online teaching-learning methods among phase-1 medical student in a tertiary care teaching hospital during COVID-19 lockdown Materials and Methods: This cross-sectional study was conducted from July 2020 to September 2020, among phase-1 MBBS students of Government Medical College, Thrissur, Kerala, India. Data was collected from 161 students through a questionnaire consisting of two parts. The first part dealt with logistical aspects, like net connectivity, gadget, expenditure, financial burden, residence and eye strain with online teaching learning methods. The second part dealt with the merits and demerits of each type of teaching learning methods, according to the students. All statistical data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 16. Qualitative data was expressed as a percentage. Results: A total of 97.5% population of students was able to frequently access the online classes. Online learning strained the eyes of 47.8% of students. Mobile phones were used by 92.5% of students for attending online classes internet connectivity was mainly through 4G (71.4%) followed by Wi-Fi (19.9%) connections. Their most preferred method of online learning was online live lectures (35.4%) followed by PowerPoint presentations with narrations (33.5%). Blended learning (online and traditional together) was best preferred method of learning (46.6%). Conclusion: Live online lectures and blended learning were preferred by the majority of students. Thus, the online classes can be continued along with the traditional teaching in future.

Experimental Evaluation of Prophylactic and Therapeutic Antioxidant Potential of Trimetazidine in Carbon Tetrachloride Induced Oxidative Stress in Rats

Introduction: Exposure to various drugs and chemicals lead to oxidative stress. Carbon Tetrachloride (CCl4 ) produces rise in oxidative stress leading to hepatic damage. The drug Trimetazidine (TMZ) shows hepatoprotective activity but its mechanism is not known. The present study would help in establishing antioxidant activity of TMZ as probable mechanism. Aim: To evaluate the antioxidant potential of TMZ in CCl4 induced oxidative stress when given prophylactically/therapeutically in rats. Materials and Methods: An experimental animal study was conducted on 80 adult Wistar rats of either sex (weight-150 to 200 gm) from March 2010 to December 2010 in Bharati Vidyapeeth Medical College, Pune, Maharashtra, India. Randomly, all animals were grouped into 10 equal groups. Group i was normal control (received only water). To induce oxidative stress CCl4 (0.5 mL/kg/d i.p.) was given to all the animals of Group ii to Group x for seven days. The TMZ was given in two doses, TMZ1 (5 mg/kg orally for Group iii and vii) and TMZ2 (10 mg/kg orally for Group iv and viii). Positive standard control (Group v and Group ix) received Liv.52 (1 mL/kg orally). Group vi and Group x received combination of TMZ1 (5 mg/kg orally)+Liv.52 (1 mL/kg orally). Drug treatment was given to animals in group iii, iv, v and vi for 1-14 days (preventive group) and in group vii, viii, ix and x from day 8 to day 14 (therapeutic group). On 15th day, rats were sacrificed and dissected for collection of liver. Part of the livers was homogenised to assess oxidative stress marker enzymes Malondialdehyde (MDA), Superoxide Dismutase (SOD) spectrophotometrically. Statistical analysis was done with one-way Analysis of Variance (ANOVA) followed by post-hoc analysis (Dunnett’s test) using GraphPad Prism 5.0 software. Results: Trimetazidine (5 mg/kg and 10 mg/kg) significantly reduced MDA levels and increased SOD levels when compared with CCl4 treated group suggested antioxidant activity. Combined administration of Liv.52 and TMZ1 also reduced oxidative stress and increased antioxidant activity. Conclusion: Results of the present study suggested that increased oxidative stress was significantly attenuated by drug TMZ in dose dependant manner when compared with the CCl4 group. The antioxidant potential of prophylactic and therapeutic administration of TMZ was comparable. The increased antioxidant effect by Liv.52+TMZ1 combination was only due to the additive antioxidant effects of Liv.52 and TMZ or any other mechanism was involved, needs to be further evaluated.

Qualitative Evaluation of Platelet Concentrates Prepared with Different Methods

Varshashree, Subhashis Das, K Prabhakar

Introduction: One of the most important responsibility of Blood Bank is to ensure uninterrupted supply of quality blood products, namely Platelet Concentrate (PC), which are in high demand particularly during pandemic. In India, PCs are of three types prepared by different methods like Platelet Rich Plasma-Platelet Concentrate (PRP-PC), Buffy Coat Platelet Concentrates (BCPC), and Single Donor Platelets (SDP) units. Hence, establishing optimum quality standards across all the three types of PC remains a challenge in order to maximum benefit to recipients. Aim: To assess and compare the quality parameters of platelet concentrate prepared by PRP-PC, BC-PC and apheresis methods (SDP). Materials and Methods: This laboratory based observational study was conducted at rural, tertiary care, postgraduate, teaching hospital located at South India from December 2018 to November 2019. A total of 156 PCs were studied with 52 units belonging to PRP method, 52 units BC-PC method and the remaining were 52 units of SDP prepared by apheresis method. Quality parameters include volume, pH, swirling, White Blood Cell (WBC) count/bag, platelet count/bag and platelet indices. Platelet indices include Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), and Platelet Large Cell Ratio (PLCR). Arterial Blood Gas (ABG) analysis was also done to assess (pH, partial pressure of Carbon Dioxide (pCO₂ ), plasma bicarbonate (pHCO₃-)). The p-value less than 0.05 were considered statistically significant. Statistical Package for the Social Sciences (SPSS) software version 23.0 used for statistical analysis. Results: All the 156 PC units were analysed as per the Director General of Health Services (DGHS) India, criteria. Among the 156 platelet concentrates scored as per DGHS criteria, a score of 5 was obtained for 34.61% [18/52], 30.76 [16/52] and 11.5% [6/52] SDP, BC-PC and PRP-PC units, respectively. All the PC units were sterile and Red Blood Cell (RBC) contamination was within acceptable limits. Conclusion: In this study, quality parameters of SDP was better than BC-PC and PRP-PC but with improvement and more standardisation of procedures and storage, BC-PC units can give a yield similar to that of SDP units.

Retrospective Analysis of Cardiotoxic Scorpion Envenomation in Konkan Region of Western India with Special Reference to Echocardiography

Suvarna Netaji Patil, Pranav Shamraj, Janhavi Deshpande

Introduction: Mortality due to scorpion sting is high in rural India as preference is given to traditional healers above hospitalisation. In rural Indian settings where there is a lack of diagnostic facilities Electrocardiogram (ECG) was supposed to be the only test to diagnose cardiotoxicity. However, we proposed to study Echocardiography (ECHO) serially in scorpion sting cases for classifying them into mild, moderate and severe envenomation. Aim: To study serial changes of cardiac dimensions on ECHO in cardiotoxic scorpion sting patients. Materials and Methods: This study was a retrospective and cross-sectional analysis of 925 patients stung by scorpion, admitted from January 2011 to December 2017 at BKL Walawalkar Hospital, Chiplun, Maharashtra, India. All patients were classified into mild, moderate and severe envenomation based on clinical findings and electrocardiography. All patients had ECHO done on admission but only 81 severely or moderately envenomed had complete records of ECHO readings. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0 (SPSS Inc., Chicago, USA). Data has been presented as mean and Standard Deviation (SD) for all the ECHO measurements. Results: In 81 patients, ECHO on admission showed severe Left Ventricular (LV) dilatation. There was significant reduction in LV size (3.69 cm to 3.025 cm for systolic and 4.19 cm to 3.82 cm for diastolic, p-value <0.001 for both) in subsequent ECHOs, showing improvement in cardiac status and LV function {Ejection Fraction (EF) 28.17% to 43.31%, p-value=0.002} with normal coronary angiography. Conclusion: Diagnosis of cardiotoxicity, following scorpion sting, is challenging on ECG. In present study, LV dimensions on serial 2D ECHO were studied. After the sting, LV dysfunction occurs initially and it is completely reversible on subsequent serial ECHO.

A Cross-sectional Study on Empathy and Factors Associated with Individual Variations in Empathy Levels among College Students in Central Kerala

Shaliet Rose Sebastian, Joyal Alias Saji, Geethu Mathew, Bichu P Babu

Introduction: Empathy is a social skill that exerts influence on the quality of social relationships. An empathetic person is able to understand the emotions of others, accurately express their feelings, comprehend other’s situations and act appropriately. Added to the volatile nature of the age, the youth face challenges from social exclusion, gender based violence and the lack of access to rights and opportunities. Aim: To measure empathy levels among college students aged 18-28 years in Kerala and to find out the factors associated with individual variations in Empathy levels among them. Materials and Methods: A cross-sectional survey was conducted among 610 college students of both gender randomly selected from Pathamthitta, Kottayam, Alappuzha, Kollam, and Trivandrum districts in South Central Kerala, India. Interpersonal Reactivity Index (IRI), short version of Malach-Pines (2005) and Burnout Measure was used for collecting information from study participants. Data was analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (Chicago, USA). Results were expressed as percentages and proportions. Results: The mean age of the study participants was 21±1.6 years. The mean empathy score and burnout score of study participants were 58±11.9 and 41.03±12.3, respectively. The empathy score among study participants was found to be significantly associated with age of study participants and burnout. Conclusion: The present study revealed a good prevalence of empathy and humanistic values among college students in Kerala. However, certain factors like burnout that can affect total individual empathy scores need to be addressed.

Morbidity Pattern among Geriatric Population in a Rural Area of West Bengal: A Cross-sectional Study

Subhasish Kumar, Sukanta Majumdar, Avijit Paul, Nabanita Bhattacharyya

Introduction: Aging is associated with gradual accumulation of a wide variety of molecular and cellular damage resulting in different types of morbidities in geriatric population especially in rural areas in India where health infrastructure is insufficient. Aim: To assess socio-demographic profile and morbidity pattern of geriatric population in Memari-I block of East Burdwan district, West Bengal. Materials and Methods: A cross-sectional observational study was conducted among 436 rural geriatric population from October to December 2020 at Memari-I block in West Bengal and multistage proportionate population sampling was done. Data was collected through house-to-house survey by pretested predesigned structured schedule and data analysed with help of International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 16.0. Results: Among the 436 study population, 263 (60.3%) were male and 272 (62.4%) were in the age group of 60-69 years. Out of total, 156 (35.7%) had pallor, 428 (98.2%) had Gastrointestinal (GI) and 403 (92.4%) had musculo-skeletal problems. Hypertension was found in 110 (41.8%) males and 124 (71.7%) females and diabetes were found in 30 (11.4%) males and 53 (30.6%) females. Diabetes and hypertension were significantly associated with age group (60-69 years), gender (female), Body Mass Index (BMI) (obese), and dependency on others. Conclusion: Geriatric population from the Memari block suffer from multiple co-morbidities, predominantly musculoskeletal disorders, GI disorder, hypertension and ophthalmic disorders. A significant number of study population were underweight and belonged to lower socio-economic group. Diabetes and hypertension showed significant association with age group (60-69 years), gender (female), BMI (obese) and dependency on others.

Role of Transtympanic Steroid in Sudden Sensorineural Hearing Loss: A Retrospective Study

Introduction: Sudden Sensorineural Hearing Loss (SNHL) is medical emergency in otology. The diagnosis and treatment of sudden SNHL remains a matter of discussion as no single treatment is gold standard. Antivirals, systemic and intratympanic steroids, vasodilators, antioxidants and hyperbaric oxygen therapy are a few treatment options for sudden SNHL. Aim: To assess role of transtympanic steroid in sudden SNHL cases in view of frequency specific gain and average hearing gain. Materials and Methods: A retrospective cross-sectional study was conducted in Otorhinolaryngology Department of a tertiary teaching hospital, in which records of total 27 patients with diagnosis of sudden SNHL from 1st January 2019 to 31st December 2020 were analysed. All enrolled patient underwent pure tone audiometry before treatment, after 3rd transtympanic injection and On 7th day follow-up. post follow-up. All patient received three transtympanic 0.5 mL methyl prednisolone injection on day 1, day 3 and day 5 of treatment. Pretreatment and post-treatment frequency specific hearing threshold and frequency specific hearing gain along with average hearing gain were assessed. Statistical analysis was done using student paired t-test independent t-test and one-way Analysis of Variance (ANOVA) test. Results: Total 35 case ears were analysed among 27 patients as 8 patients had bilateral sudden SNHL. Average gain for frequency 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz were 18 dB, 25 dB, 27 dB, 28 dB and 30 dB, respectively. There was average 42% audiometric gain in hearing after transtympanic steroid injection. Cases who received treatment within four days had average gain of 48.5% while those who came after four days had average hearing gain of 39%. Hearing gain in <40 years and >40 years was 44.3% and 41.8% respectively. Hearing gain in bilateral ear was 42.9% and in unilateral ear was 43.5%. Conclusion: Sudden SNHL has high emotional and social impact on patient and family as it has influence on life quality. Transtympanic steroid injection promises good outcome in all patients with sudden SNHL. However, early diagnosis and early management of sudden SNHL is the key in significant success.

Reduction of Tunnelled Haemodialysis Section Catheters Related Infections by Intervention and Training: A 12 and 18-month Audit

Riyaz Ahmed Asad, Shashwat Shrivastava, Shitij Shrivastava

Introduction: Catheter-Related Blood Stream Infections (CRBSI) are an important complication of both non tunnelled and tunnelled haemodialysis catheters, but are often poorly reported for tunnelled haemodialysis-catheters. Aim: To assess the rate, aetiology, and outcomes of CRBSI in patients using a tunnelled catheter at 12-month and 18-month audits at the newly-opened haemodialysis unit having care bundle as a part of routine catheter care. Materials and Methods: A retrospective cross-sectional study involving two audits of CRBSI risk (12-month and 18-month audit) was conducted by the dialysis unit doctors and nursing staff at Medanta Super-Specialty Private Hospital, Indore, Madhya Pradesh, India. Centres for Disease Control (CDC) and prevention core intervention/care bundle for Blood Stream Infections (BSI) reduction were incorporated as a part of routine catheter care. The 12-month (May 2018 to April 2019) and 18-month (May 2018 to November 2019) internal clinical audit were evaluated to assess the impact of care bundle on incidence of CRBSIs. Kidney-DiseaseOutcome Quality-Initiative (KDOQI)-2006-criteria was used to define CRBSI. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0 software (IBM Corporation, New York, United States). Descriptive and dispersion statistical analysis was done for studied variables. Results: Total patients in 12-months audit with tunnelled haemodialysis catheter were 14 (7 male and 7 female) with median age 64 years and in 18-months audit patient with tunnelled haemodialysis catheter were 18 (11 male and 7 female) with median age 67.5 years. CRBSI incidence was 2.58 per 1000 catheter days at the end of 12-month, with 132 (71.25-202.25) days of median catheter use. Over the 18-month, the incidence of CRBSI dropped to 1.99 per 1000 catheter days. Median period of catheter use increased to 149.5 (83.5-294.5) days. The primary organisms isolated were predominantly gram negative bacterias. Conclusion: Tunnelled catheters may be a reasonable alternative vascular access for haemodialysis in patients with arteriovenous fistula failure as implementation and maintenance of multidisciplinary care bundle reduces CRBSI rate in such patients.

Modified Benign Prostate Hyperplasia (BPH) Specific Quality of Life Scale and IPSS in Assessment of Quality of Life in Lower Urinary Tract Symptom Patients due to BPH

Debansu Sarkar, Ankit Sandhu, Dilip Kumar Pal

Introduction: Lower Urinary Tract Symptoms (LUTS) in association with Benign Prostatic Hyperplasia (BPH) are common in elderly males. Almost half of this age group over fifth-decade of age complain of moderate to severe degree of LUTS which impedes their Quality of Life (QoL). Aim: To assess the QoL in patients with LUTS due to BPH and compare the outcomes on modified BPH-QoL scale and International Prostate Symptom Score (IPSS) scale. Materials and Methods: An observational study was conducted from November 2019 to November 2020. A total of 400 men were selected for the study. The responses on both the scales (IPSS and BPH specific QoL scale) were noted and the total score was calculated. The BPH-specific QoL was compared with the IPSS scale by using the Pearson coefficient relation test. Results: Most men were in age group 50-60 years with median age of 58 years. The correlation of BPH-specific QoL scale questions with QoL question of IPSS was found to be statistically significant. The correlation coefficients of BPH-specific QoL questionnaire were found to be r=0.560 (p<0.0001) with the total IPSS and r=0.376 (p<0.0001) with the QoL score of IPSS. The reliability i.e., Cronbach’s alpha for BPH specific QoL was 0.879. Adverse symptoms of BPH in the form of fear of cancer and fear for surgery were noted while conducting the study. Conclusion: The correlation of BPH specific QoL scale and IPSS was found to be statistically significant. The BPH specific QoL scale is very useful and more comprehensive in addressing the QoL in patients with LUTS due to BPH than the IPSS scale. The BPH specific QoL scale was brief and easy to administer. It is the first study in India to use the BPH specific QoL scale to assess QoL and compare it with IPSS.

Impact on Quality of Life among Females with Diffuse Hair Loss at a Tertiary Care Centre: A Cross-sectional Study

Meera Lalu, Navakumar Manickam, Kannan Gopalan, Seethalakshmi Ganga Vellaisamy

Introduction: There is an important link between hair and identity, especially for women. Although, hair loss is a benign problem, experience of alopecia or hair loss is psychologically damaging, causing intense emotional suffering and personal, social and work related problems. Aim: To assess the impact of diffuse hair loss on the Quality of Life (QoL) among females with the help of Dermatology Life Quality Index (DLQI). Materials and Methods: This was a hospital based crosssectional study conducted over a period of one year from February 2019 to February 2020. All female patients more than 18 years with complaints of diffuse hair loss attending the Dermatology Outpatient Department (OPD) of Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Tamil Nadu, India, were recruited and QoL was assessed in them using the DLQI scale. For statistical analysis, Analysis of variance (ANOVA) test was used to compare quantitative variables, while Fisher's-exact test was used to analyse qualitative data. Post-hoc ANOVA was used to test the statistical significance within the groups and a p-value <0.05 was considered statistically significant. Results: The study included 100 female patients with diffuse hair loss, out of which most commonly seen was Acute Telogen Effluvium (ATE) in 52 patients followed by Female Pattern Hair Loss (FPHL) in 30 patients and Chronic Telogen Effluvium (CTE) in 18 patients. Majority of the study subjects were in the age group of 18-39 years (64%). The mean age of the study population was 35.36±10.30 years. The mean duration of hair loss was 8.14±8.639 months. Majority (92%) of females had moderate to severe effect on the QoL. The mean DLQI was significantly higher in FPHL (8.77±1.83) and ATE (8.73±1.98) as compared to CTE (p-value=0.014). The mean DLQI was highest (8.70±2.253) in the younger age range of 18-29 years (p-value=0.027) and also in those with duration of hair loss more than one year (9±1.76) (p-value=0.0381). Conclusion: Diffuse hair loss in females has a moderate to severe impact on the QoL as assessed by the DLQI. There is a strong association seen between DLQI and age, duration of disease and type of hair loss.

Effects of Intravenous Dexmedetomidine and Clonidine on Haemodynamic Response in Laparoscopic Lower Abdominal Oncosurgeries under General Anaesthesia: A Randomised Controlled Trial

Introduction: From the early 1970's, laparoscopic procedures became well established because of their advantages like excellent visualisation, improved cosmesis, reduced postoperative pain and reduced hospital stay. Despite its advantages, laparoscopic surgeries have its demerits such as pneumoperitoneum and positional changes. Alpha-2 agonists have shown promising results in attenuating the stress response in laparoscopic surgeries. Aim: To compare clonidine and dexmedetomidine in attenuating haemodynamic stress response during laparoscopic lower abdominal oncosurgeries. Materials and Methods: A randomised controlled trial was conducted at Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India, during the period of December 2018 to May 2019. Institutional Ethical Committee clearance was obtained for the trial. Total 48 patients were recruited into two groups with 24 participants in each group: A (clonidine) and B (dexmedetomidine). Both drugs were infused at a dose of 1 μg/kg for 15 minutes along with premedication before induction. Haemodynamic stress response was estimated using parameters like Heart Rate (HR), systolic and diastolic blood pressure and mean arterial pressure at induction, pneumoperitoneum and at extubation. All the data were analysed using the statistical software R (V3.6.2). Continuous data were presented in the form of Mean±Standard Deviation (SD). The difference in mean value of the various parameters between the two groups was analysed using Student’s t-test. A p-value of <0.05 was considered to be significant. Results: Patients in both the groups were comparable with regards to demographic features. The mean age was 46.76±8.17 years, 46.24±9.70 years and weight was 55.76±7.28 and 56.08±6.06 for group A and group B, respectively. There were statistically significant differences in attenuating stress response in dexmedetomidine compared to clonidine group. Statistically significant reduction in the HR was noticed in group B as compared to group A at 12 minutes of infusion (p=0.008), at the end of infusion (p=0.008), before intubation (p=0.005), 10 minutes after intubation (p=0.008) and after pneumoperitoneum (p=0.045). Group B which was given dexmedetomidine drug compared to group A with clonidine drug showed better attenuation of the systolic blood pressure during extubation (p=0.006). Conclusion:To conclude, both clonidine and dexmedetomidine effectively attenuate the haemodynamic response in patients undergoing laparoscopic lower abdominal oncosurgeries when administered as intravenous bolus dose. In addition, the dexmedetomidine attenuates haemodynamic responses better than clonidine.

Effective Dose of Streptozotocin to Induce Diabetes Mellitus and Variation of Biophysical and Biochemical Parameters in Albino Wistar Rats

Suhasini Padugupati, S Ramamoorthy, Kumar Thangavelu, DVHS Sarma, Deepak Jamadar

Introduction: There is a need to develop diabetic animal model, to have a better understanding of the complications of diabetes mellitus. The dose of Streptozotocin (STZ) to induce diabetes mellitus in animals is important as it may lead to inadequate induction of diabetes or mortality. Intravenous injection of STZ in adult Wistar rats, leads to the degeneration in Langerhans islet ß-cells and induces experimental diabetes mellitus in 3-5 days. Aim: To optimise the dose of STZ to create a diabetic animal model with sustained hyperglycaemia and to compare the changes in body weight, serum glucose and C-peptide levels between non diabetic and diabetic rats. Materials and Methods: This experimental animal study was conducted at animal house, Pal amur Bioscience Pvt., Ltd. The sample size included 30 albino Wistar rats divided into five groups T0, T1, T2, T3 and T4 with six rats in each group (three males and three females). Group T0 was the control, while STZ at different concentrations were administered intraperitoneally in group T1, T2, T3 and T4, respectively. Blood samples were drawn from retro-orbital plexus of animals and blood glucose, C-peptide levels along with the body weight was checked on 7th, 14th, 21st and 28th day. The F statistics, one-way Analysis of variance (ANOVA) was used to compare the different groups. Denny’s test was used to compare the control group versus different test groups. Results: When compared with the control group T0 on 7th, 14th, 21st and 28th day, the test group T1 had no variation in the body weight. On the other hand groups T2, T3 and T4 had variations in the body weights. Initially there was increase in the weight, later here was a gradual decrease in the body weight when compared to the control group. Hyperglycaemic profile (blood glucose level >120 mg/dL) was achieved in group T1, T2, T3 and T4 after 7 days. High mortality rate was observed in group T4 followed by group T3. Group T2 had persistent hyperglycaemia while group T1 had reversible hyperglycaemic profile. The C-peptide levels were gradually decreased in the test groups and it was statistically significant (p-value <0.0001). Conclusion: Intraperitoneal dose of STZ of 55 mg/kg created diabetic animal model with persistent hyperglycaemia. However, dose above increased the mortality rate and below failed to create diabetic animal model.

Effectiveness of Whatsapp as a Teaching Learning Tool for Problem Based Learning in Pharmacology: A Quasi-experimental Study

Parama Sengupta, Tania Sur

Introduction: Instant Messaging Applications (IMAs) like Whatsapp has changed our lives including medical education in many ways. Aim: To explore and compare the effectiveness and acceptability of Whatsapp as a Teaching Learning (TL) tool for Small Group Learning (SGL) sessions when compared with traditional classroom based learning SGL sessions, for a specific topic (pharmacokinetics) in Pharmacology in Problem Based Learning (PBL) sessions. Materials and Methods: This quasi-experimental study was conducted in a tertiary care government medical college in Eastern India on second phase Bachelors of Medicine and Bachelor of Surgery (MBBS) students in the year 2021 over a period of five weeks (from March to April 2021). After Didactic Lecture (DL) on the topic, the willing students were randomly divided into two groups, group A (n=46) and group B (n=45). Then group A and group B students attended classroom based and Whatsapp based SGL sessions, respectively, for a period of five consecutive days on "Pharmacokinetics" using PBL method. Students appeared for a Multiple Choice Question (MCQ) based examination (predecided and prevalidated) of 30 marks before and after the SGL sessions. Next, group A students attended Whatsapp based PBL session on the same topic in the same manner as group B and vice-versa. Finally the students filled in a feedback form using a 5-point Likert scale. Results: The post-test scores for both the groups were significantly better compared to the pretest scores; however, there were no significant differences in the post-test scores of both the groups. Regarding students’ feedback on the type of SGL, except for enjoyment (p-value=0.0345) and interactiveness (p-value=0.022), there were no significant differences between the two group scores. The students significantly preferred combination of both types of SGL to either of them (p-value=0.001). Conclusion: In this study, Whatsapp based SGL showed comparable effectiveness as classroom based SGL as measured in terms of MCQ based examination scores. Except for interactiveness and interest, classroom based SGL was equally acceptable to the students as Whatsapp based SGL. Interestingly, the students preferred a combination of both the type of SGL to either of them on the particular topic of Pharmacology

A Cross-sectional Comparative Study of hs-CRP Levels between Non Diabetic and Diabetic Patients of Chronic Obstructive Pulmonary Disease

Rajesh Sahu, Ratan Kumar, Jusmita Dutta, Gayatri Yadav

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterised by persistent airflow limitation and is a global health issue with high social and economic burden. Type 2 Diabetes Mellitus (T2DM) is a major global metabolic disorder affecting approximately 300 million individuals worldwide. Accordingly, chronic low grade systemic inflammation is probably one of the common denominators between COPD and T2DM. Aim: To evaluate the status of systemic inflammation in COPD patient with/without T2DM, using quantitative serum high sensitivity C-Reactive Protein (hs-CRP) and Total Leucocyte Count (TLC). Materials and Methods: This cross-sectional study was conducted for a period of one year from May 2019 to April 2020 on 100 patients of COPD patients attending outpatient department. Either known patients of COPD or patients with complains of chronic cough was evaluated with chest x-ray and pulmonary function test (spirometry) after thorough history and physical examination. Global Initiative for Chronic Obstructive Lung Disease-GOLD guidelines a grading system for COPD was used for assessing severity. For assessing diabetes, criteria adopted from American Diabetes Association (ADA) i.e., symptoms of diabetes plus random plasma glucose >200 mg/dL (11.1 mMol/L). Venous blood samples were obtained to perform quantitative hs-CRP estimation by immune turbidimetry method as a marker of systemic inflammation. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26.0 of International Business Machines (IBM) Corporation, California, United States of America (USA). Results: The T2DM was present in 40% COPD patients. The frequencies of T2DM in patients with GOLD stages I, II, III, and IV were 16%, 45%, 28%, and 11%, respectively. The mean hs-CRP levels for diabetic group was 5.45±1.07 mg/L, which was significantly higher (p<0.05) than 2.26±0.69 mg/L that of non diabetic group. Conclusion: Present study concluded that the inflammatory process is a definite pathophysiological factor that has a significant link between COPD and T2DM and can be evaluated using a marker like hs-CRP level and TLC.

Relationship between Sleep Quality and Internet Addiction among First Year Medical Students in a Government Medical College in West Bengal: A Cross-sectional Study

Debalina Sengupta, Sumana Gupta, Suranjana Sur Mukherjee, Sulagna Das

Introduction: Internet overuse has emerged progressively and the pathological use of the internet- conceptualised as ‘internet addiction’– a menace which disturbs the sleep quality in a community. There is not much evidence proving the association of internet addiction and sleep disturbances and the severity of this association remains unclear. Aim: To find the association between internet addictions and sleep quality among undergraduates in a Government Medical College in West Bengal, India. Materials and Methods: This was cross-sectional observational study conducted among 211 undergraduate medical students from January 2019-March 2019 using a predesigned pretested structured selfadministered questionnaire, which consisted of information on the sociodemographic profile and lifestyle questions, Pittsburg Quality of Sleep Index (PQSI) scale and the Internet Addiction Test (IAT) scale. The participants were divided into two groups: PSQI score ≤5 (good sleep quality) and those with PSQI score >5 (poor sleep quality) and IAT scores. Statistical analysis was done using the statistical software of Statistical Package for the Social Sciences (SPSS) version 23.0. Independent sample t-test (continuous variables) and Fisher’sexact test (categorical variables) were used to analyse the significance of difference in demographic data and IAT scores and PSQI scores between the groups. Results: Students with poor quality of sleep were having high IAT scores compared to ones with good quality of sleep and this finding was statistically significant (p-value <0.001). Among all participants 33.2% were “moderate users or possible addicts” of internet. Approximately, 49.3% of all participants had poor sleep quality and rest of them had good quality of sleep as per PSQI scale. Mean IAT score was significantly higher among participants living on campus (p=0.006) as compared to ones residing off campus. As far as sleep quality was concerned, mean PSQI scores were significantly higher among participants who were aged more than 20 years and among those who were involved in “less than three times per week physical activity” (p=0.028 and 0.004, respectively). Conclusion: Quality sleep is a key to good health and internet addiction should not hamper it. Proper counseling if needed should be done to attain it.

Antimicrobial Effect of 1,25 Dihydroxy Vitamin D on Vibrio cholerae and its Association with Serum 25-Hydroxy Vitamin D Level in Rural Elderly Women: An Experimental Study

Joyeta Ghosh, Aditi Nag Chaudhuri, Indranil Saha, Debnath Chaudhuri

Introduction: Aging is associated with a variety of functional, demographic and immunologic changes, responsible for increasing the incidence and severity of infectious diseases in the elderly. Aim: To examine the association of serum 25-hydroxy vitamin D status with antimicrobial activity of cultured macrophages isolated within an exclusively elderly population cohort and also to examine the effect of in-vitro 1,25 hydroxy vitamin D supplementation in it. Materials and Methods: This experimental study was conducted among 113 elderly women aged between 60 to 70 years of age, during the period of April 2014 to August 2018, at Amdanga block, North 24th Parganas, West Bengal, India. Their vitamin D status was assessed by the estimation of serum 25-hydroxy vitamin D and classified into three groups, sufficient group (60 subjects), insufficient group (27 subjects) and deficient group (26 subjects). Later their Peripheral Blood Mononuclear Cells (PBMC) were isolated and cultured from fresh blood of each and every study subject. Supplementation of 1,25 dihydroxy vitamin D {1,25(OH)₂ D} was given selectively at a dose of 10×10-8 M for 72 hours in the culture media and were exposed to Vibrio cholerae and inducible nitric oxide synthase (iNOS), Superoxide Dismutase (SOD) activity and Bactericidal activity were screened. Statistical Package for the Social Sciences (SPSS) software, version 20.0 was used to perform statistical analysis. Results: The sufficient group iNOS activity had significantly higher than the other two groups. Whereas in-vitro 1, 25(OH)₂ D supplementation increases iNOS activity significantly among all three groups. As per the Colony Forming Unit (CFU) reduction rate against Vibrio cholerae infection the sufficient serum 25(OH) D consisting group had significantly (p-value=0.03) high CFU reduction rate than the other two groups. Although in-vitro 1, 25(OH)₂ D supplementation had no significant impact on CFU reduction rate among all three groups. Conclusion: Bacteria killing capacity of macrophages varies significantly with serum 25-hydroxy vitamin D level of the target population. Sufficient group macrophages always had better profile than other two groups. In-vitro 1, 25(OH)₂ D supplementation increases iNOS and SOD activity significantly

Comparative Analysis of Immunohistochemistry of Hormone Receptors in Breast Cancer by Conventional and Microwave Tissue Processing Methods

Janaky Ramakrishnan, Asiq N Sideeque, Reslin A Khader

Introduction: Rapid histopathological processing of neoplastic biopsies is crucial for initiating early therapy in patients. Microwave processing shortens the time to diagnosis and is less labour intensive. Aim: To compare the quality of immunohistochemical staining of Estrogen Receptors (ER) and Progesterone Receptors (PR) on paired breast samples using microwave processing versus conventional processing. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Kerala, India, from February 2014 to September 2015. A total of 44 paired samples from breast carcinoma patients were taken. Baseline characteristics of the patients such as age and type of carcinoma were noted. Haematoxylin and Eosin (H&E) stain was used. One slide of the pair was processed conventionally and the other using a microwave. The stained slides were observed by three pathologists. The validity of ER and PR receptor status was evaluated with sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Kappa statistics and Spearman’s correlation test was used to denote the agreement between them. Results: The mean age was 51.32±11.16 years. There was agreement (Cohen k=0.902) between the microwave processed and conventionally processed paired breast samples for ER. The sensitivity and specificity of microwave processing in ER evaluation was 87.5% and 100% while that of PR evaluation was 92.9% and 100% respectively. The PPV was 100% and NPV was 93.3% for ER evaluation by microwave processing. Conclusion: Microwave aided tissue processing had significant advantages over conventional methods for providing a rapid diagnosis, being less laborious and had effective staining, which makes it a better choice.

Histomorphological Study of Urinary Bladder Biopsies- A Retrospective Study in a Tertiary Care Centre, Kerala, India

S Preethamol, PS Prasanth

Introduction: Urinary bladder diseases are quite frequent in clinical practices. Both non neoplastic and neoplastic lesions are quite common. Bladder malignancies are on an increasing incidence and are considered as an important cause of cancer related morbidity and mortality. To provide accurate diagnosis and treatment histopathology remains as the gold standard investigation. Aim: To study the histomorphology of lesions of bladder obtained through Trans Urethral Resection of Bladder Tumour (TURBT) and cystoscopic biopsies. Materials and Methods: The present study was a five years descriptive retrospective study conducted over a period of six months starting from July 2020 to December 2020 and data were collected from records for the period of January 2015 to December 2019 carried out in the Department of Pathology, Government Medical College, Trivandrum, Kerala, India. Record of all patients who visited to Urology Outpatient Department (OPD) with lower urinary tract symptoms and obstructive bladder symptoms and subjected to cystoscopy were included in study. The detailed clinico-histomorphological features of all biopsies were studied using World Health Organization (WHO)/ International Society of Urologic Pathologists (ISUP) 2016 histological grading and Tumour (T), Nodes (N), and Metastasis (M) (TNM) staging were used in classifying the bladder tumours. Results: The data for the present study was collected over a period of five years; during which a total of 742 lesions were histopathologically evaluated. A total of 688 cases (92.72%) were neoplastic, 46 cases (6.19%) were diagnosed as non neoplastic and 8 cases were (1.07%) were metastatic malignancy. A total of 646 cases (87.06%) were males. Most common affected age group was 61-80 years. Haematuria was the most common clinical presentation. A 332 cases (48.25%) were of non invasive papillary urothelial neoplasm low grade. Conclusion: Lesions of urinary bladder are heterogenous in nature. Detailed awareness regarding the various histological features of these lesions, their neoplastic potential, risk of recurrence and possible pitfalls can help pathologists for accurate diagnosis. The study also emphasised on inclusion of smooth muscle in the biopsy for accurate grading and staging in bladder tumours

Knowledge about Kangaroo Mother Care among the Mothers and Grandmothers- A Cross-sectional Study in a Neonatal Follow-up Clinic of a Tertiary Care Hospital in Tamil Nadu, India

S Ramya, KS Kumaravel, T Palanivelraja, B Tharini, V Anurekha, S Gobinathan

Introduction: Kangaroo Mother Care (KMC) is a simple method of caring Low Birth Weight (LBW) babies with a birth weight below 2500 grams. The grandmothers play a key role in child rearing in the Indian society. Aim: To estimate the level of knowledge about the KMC in the grandmothers and to compare it with that of the mothers. Materials and Methods: The cross-sectional study was conducted in the neonatal follow-up clinic of a tertiary care hospital with a convenience sampling of all the mother (Group 1) and grandmother (Group 2) dyads. The mothers and grandmothers were interviewed separately using a pre-validated questionnaire with 15 open ended questions to assess the knowledge about the KMC. Mann-Whitney U test and Fischer’s-exact test were used for statistical analysis. Results: There were 390 mother- grandmother dyads in the study group. The mean age of the mothers and grandmothers were 24.69±1.54 years and 53.89±1.80 years, respectively. For all the 15 questions the grandmothers had a significantly lower score when compared to the mothers (p<0.001). The grandmothers (mean score: 8.48±2.00) had a significantly lower overall knowledge scores than the mothers (mean score: 23.10±1.55). On comparison of the mean knowledge scores of the mothers with their age, educational status and socio-economic class, it was found to be independent of these factors (p-value=0.209, 0.691 and 0.731, respectively). Conclusion: This study had demonstrated that the grandmothers have a significantly lower knowledge about KMC. There is an urgent need to empower them with the knowledge about KMC for the successful continuation KMC in the home.

Conventional Blind Method Versus SORT Manoeuvre of Nasogastric Tube Insertion in Anaesthetised Patients: A Randomised Clinical Study

Introduction: Nasogastric Tube (NGT) placement is frequently performed in the preoperative period and critical care scenario. The SORT manoeuvre, a comparatively new method of NGT placement, is comprised of four components such as Sniffing position, Orientation of NGT, Rotation of patient’s head to the contralateral side of the nostril being used, and Twisting movements of hand. Any obstruction during introduction of NGT is managed with withdrawal of NGT a bit, and proceeding again, to find the path of least resistance, thereby reducing injury. Aim: To determine the efficacy of SORT manoeuvre in comparison with the conventional blind method of NGT insertion in anaesthetised intubated adult patients. Materials and Methods: The interventional, single-blinded, parallel group, randomised study was conducted in Nil Ratan Sircar Medical College and Hospital, a Government Medical College, Kolkata, West Bengal, India. A total of 202 adult patients, undergoing abdominal surgeries under general anaesthesia, and requiring intraoperative NGT placement were recruited for this study. The study spanned between February 2019 to April 2020. The patients were randomly allocated into two groups to receive NGT placement using either conventional blind technique (group B, n=101) or SORT manoeuvre (group S, n=101). The proportion of patients in each group with successful NGT placement in a single attempt was recorded. The procedure time, haemodynamic parameters and the incidence of adverse events were also noted. Chi-square test, Fisher’s-exact test, Mann-Whitney test, and t-test were applied as appropriate according to the nature of data. Results: Successful NGT insertion in a single attempt was possible in 95 patients (94%) using SORT maneuver in comparison with 78 patients (77.2%) using conventional blind method (p-value=0.0006). The procedure time was longer using SORT method compared with that using blind method (25 vs 22 seconds, respectively; p-value=0.024). The incidence of all types of adverse events were found to be considerably lower in patients receiving NGT placement using SORT manoeuvre. In both the groups, coiling was found to be the most common adverse event and that was also considerably low with the SORT method compared with blind method (21.8% vs 43.6%, respectively; p-value=0.001). Conclusion: The SORT manoeuvre appears to be a better alternative to conventional technique for NGT insertion in anaesthetised intubated adult patients, in terms of higher success rate and lower adverse events.

Physiotherapy Management of Musculoskeletal Disorders in Diabetes Mellitus- A Narrative Review

Neha Mukkamala, Jitendra Lakhani, Lata Parmar

Patients with diabetes are more prone to get musculoskeletal problems and show higher pain levels, poorer functional outcomes, reduced quality of life and a reduced response to treatment compared to those without diabetes. Physiotherapy is often the first line of treatment for majority of these conditions. Inspite of this, not many studies have seen the effects of physiotherapy interventions specifically in diabetes related musculoskeletal disorders. A literature search of PubMed, Google Scholar, PEDro and Cochrane library was carried out which yielded 1645 articles out of which 12 were included in the final review. Very few studies on physiotherapy management in diabetes related musculoskeletal disorders were retrieved. Good quality studies which specifically study the effects of physiotherapy interventions in diabetes related musculoskeletal disorders are needed so that early treatment can be initiated and quality of life can be improved.

Recent Advances in Diagnosis and Management of Myofascial Pain Syndrome: A Narrative Review

Shilpa Jain, Ramesh K Goyal, Puneeta Ajmera, Geeta Aggarwal, Sapna Dhiman

Myofascial Pain Syndrome (MFPS) is a disorder common among patients who experience musculoskeletal pain. The condition originates from the muscles and the fascia which surrounds it. Initially, this condition used to be prevalent among people in their 40s and 50s. But presently, even young adults are affected. In this review, several databases have been consulted in the course of reviewing MFPS related studies. Aspects reviewed include its aetiopathophysiology, diagnostic criteria and management of MFPS. It is important to note that an increasing number of people among the ageing population suffer from musculoskeletal discomfort that interferes with their everyday activities and functions. It has a huge influence on their overall well being. This is creating a growing financial burden on the healthcare system. There is a lack of consensus regarding proper diagnostic criteria or tool, and treatment of MFPS. This review aimed to summarise recent advances in the diagnosis and intervention.

Understanding Polycystic Ovary Syndrome: A Multifactorial Endocrine Disorder

Surankita Sukul, Pushkal Sinduvadi Ramesh, Narahari Agasti

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting a significant population of women of reproductive age group worldwide. Due to the complex pathophysiology and overlapping symptoms, this disorder is often difficult to diagnose. Genome-wide association studies have identified several new risk loci and candidate genes for PCOS. However, currently, there are no standard genetic markers for PCOS susceptibility testing owing to the inconsistent findings. Despite the advent of the genomic era, the challenge to identify and pinpoint the heritable genetic basis of PCOS still exists. This mini-review explores the basic definition and phenotypes of PCOS, the different criteria for the diagnosis, the incidence, gestational complications associated with it, the basis of genetic heritability, and the influence of various gene polymorphisms. Also, this review briefly summarises the reports of genome-wide association studies conducted to identify candidate genetic markers to aid in understanding the complex pathophysiology of PCOS.

Salivary Markers as Diagnostic Tool for Dental Caries, Periodontal Disease and Peri-implantitis: A Literature Review

Biomarkers are molecules that can be used in screening, diagnosing, characterising, and monitoring diseases, or as prognostic indicators. There are many salivary molecules that can be used as biomarkers of oral diseases such as enzymes, specific and non specific proteins, antibodies, and other substances. This study aimed to research the effectiveness of using salivary biomarkers as a means of diagnosis and raised the following question that are salivary biomarkers sufficient to diagnose oral diseases such as caries, periodontal and peri-implant disease, avoiding systemic diseases? Given this question, this study aimed to investigate the topic in recent scientific literature, looking for information that could clarify the issue. Therefore, a bibliographic review on the topic was carried out, and scientific articles were searched in the PubMed database. The findings showed that salivary biomarkers are sufficient to diagnose oral diseases since several biomarkers in saliva have already been identified, which allow the early diagnosis of these conditions, the monitoring of their progression and their response to treatments. This review may be the first to offer a summary classification of existing salivary biomarkers that can be collected by saliva in a simple and non invasive manner, allowing for early diagnosis. The main finding in this regard was the immune molecules β-defensin-2 and LL-37, collagen I, fibronectin, soluble Cluster of Differentiation 14 (sCD14) cells, Interleukin (IL)-4, IL-13, Interleukin-2 Receptor Alpha chain (IL-2 RA) and eotaxin/CCL11 as predictors of dental caries. For periodontal disease, the higher levels of saliva of IL-1β, IL-6, Metalloproteinase-8 (MMP-8), MMP-9, Macrophage Inflammatory Protein-1α (MIP-1α), Osteoprotegerin (OPG), Tissue Inhibitors of Metalloproteinases-1 (TIMP-1), salivary Total Antioxidant Capacity (TAOC), albumins, uric acid, Superoxide Dismutase (SOD) and peroxidase were related to the pathogenesis of the disease. For peri-implantitis, dysbiosis must be associated with the presence of IL-1β, Tumour Necrosis Factor alpha (TNF-α), TIMP-2, Vascular Endothelial Growth Factor (VEGF), OPG and procalcitonin. These findings may provide an easier view of the copresence of other components in the oral environment, such as proteins/cytokines in saliva, transient microbials, which can contribute to the pathogenesis of the disease and date the multifactorial aetiology of oral diseases. This constitutes a personalised medical approach, reinforcing the power of clinical examination and medical history assessments to form an accurate diagnostic tool.

Barefoot Running: Myths and Realities of Barefoot and Shod Mechanics towards Implicating Running Related Injuries

Zafar Azeem, Priyanshu Rathod, Tushar J Palekar

Modern footwear has changed in its role over the years from providing protection to controlling foot motion and stabilisation. However, Running Related Injuries (RRIs) continue to increase despite technological innovations in fabrication and design. As we evolve in our understanding of barefoot running, examining this pattern of running is worth giving attention to. Barefoot running changes the foot strike pattern to forefoot strike with reduction in stride length and impact loading. Also, barefoot form of running provides a greater proprioceptive challenge to plantar surface of the foot and increased energy conservation at the arches. The advent of new footwear trend in form of minimalist shoe is slowly gaining attention but it is presumptive to appreciate its benefits over barefoot running. The purpose of this review was to study the evidence regarding differences between shod and barefoot mechanics and how different footwear affords mechanical changes between them. Future directions on barefoot running mechanics and its progression are also suggested.

Maxillary Right Lateral Incisor Agenesis and Left Peg Lateral IncisorA Long Term Follow-up

Missing maxillary lateral incisor is commonly found in orthodontic daily practice. To close the space using intermaxillary elastics with sliding jig is successful alternative. This case report described a case of a young adult 18-year-old patient with missing maxillary right lateral incisor, with a permanent canine in its position and a retained deciduous canine. In addition, the patient presented with a peg shaped left lateral incisor. To solve the problem, the teeth in the maxillary right quadrant were moved medially towards the midline. A multidisciplinary approach involving periodontic-restorative procedure were proposed, but just orthodontic alignment and leveling were performed with minor canine reshaping and no reshaping in the peg-shaped left lateral incisor. At the 15.8 years follow-up consultation the right canine and left lateral incisor were reshaped, improving the outcome. In a long term perspective, radiographic images show no sign of bone loss or root resorption and the results continue to be stable, with maintenance of the clinical results achieved.

Lifestyle, Immunity and COVID-19: An Amalgamation of Modern Science and Ayurvedic Perspective

Since 2019 the entire world is facing a crisis named as Coronavirus Disease-2019 (COVID-19). Within a short amount of time this disease which started from a small place in China has transformed into a pandemic and claimed millions of lives worldwide. India has witnessed the first and second wave of this infection with numerous variants of COVID-19, and an upsurge in infectivity rates and mortality rates. COVID-19 is a pernicious infection caused by a recent variant of Coronavirus. There are several research studies that have been carried out to understand it’s aetiology, pathophysiology, prevention and treatment strategies. As per the ancient Indian wisdom- “Prevention is better than Cure.” Any kind of infection can be prevented by taking necessary precautions and preventive measures against exposure to suspected environment and pathogen. A strengthened immune system further is able to fight and curb the disease even if there is exposure to the virus or any other pathogen. Significant data is available to support the need and importance of lifestyle modifications, particularly as mentioned in _Ayurvedic and Yogic scriptures for immunity boosting in all age groups. The present review aims to provide a comprehensive, holistic and easy understanding of practical lifestyle modifications that can boost an individual’s immunity and help mitigate infectious diseases like COVID-19.

Pathophysiological Determinants of Cardiac Remodelling- A Systematic Review and Meta-analysis

AP Bhaskaran, R Jujjavarapu, P Bhaskaran

Introduction: Cardiac remodeling is a physiological and pathological condition followed by Myocardial Infarction (MI), valvular dysfunctions and cardiomyopathy. It is associated with cardiac function and structural characteristics. Hence, the remodeling is a therapeutic target following cardiac events. Aim: This review was conducted to determine the risk of morbidity, mortality and structural characteristics related cardiac remodeling. Materials and Methods: PubMed, MEDLINE, EMBASE, and ProQuest, were searched electronically, by using {("Morbidity" and "Mortality" and "LV parameters" and "Structural Characteristics") and Cardiac ("Remodeling" and "Regeneration")}. "Mantel-Haenszel Odds Ratio", "mean differences", and "95% Confidence Interval (CI)" were computed for meta-analysis. Results: Overall, 425 titles or abstracts were identified from the initial search, of which full manuscripts of 103 studies were retrieved. Out of the 103 studies, 22 were subjected to data extraction and analysis. The risk of mortality was higher among patients with myocardial fibrosis. Metoprolol treated group had a lesser incidence of Postoperative Atrial Fibrillation (PAF). Ejection fraction, end systolic and diastolic volumes were consistent between the medical treatments and Percutaneous Coronary Interventions (PCI) groups. Conclusion: The PCIs are associated with long term survival among the patients with cardiac remodeling.