Journal of clinical and diagnostic research

Traumatic Bull Gore Injuries to Oropharynx- A Case Report

Namasivaya Navin, S Prabakaran, S Rajasekaran, M Parijatha

Bull gore injury is not an uncommon injury comprises 2% among the traumatic injuries, especially in the rural area. The damage is predominantly caused by the animal's horn tip. The abdomen and perineum are the most commonly affected organs; additional organs include the lower limb, upper limb, chest, and others. Palatal lacerations are more common in children when they put objects in their mouth or by falling down with the object inside, but oropharyngeal injuries due to bull gore are scarce. Authors hereby reports two cases, in first case, a 3-year-old female child was brought with alleged history of injury to the soft palate by the horn of a cow. The tensor veli palatine muscle tear was repaired, submucosa and mucosal layer was sutured. In second case, a 62-year-old male came with alleged history of trauma, hit by a bull while driving two wheeler following which patient had deep laceration in the submental region, laceration in the floor of mouth and ventral surface of tongue. The mylohyoid muscle injury was identified and repaired. The wound was closed in layers from muscle to skin. Thus, bull gore injuries have a wide range of presentation from minor lacerations to life threatening injuries to oral cavity, neck, chest and abdomen. Timely admission and prompt treatment, repair of lacerations under proper sterile environment is important.

Polyglobulia Masquerading as Polycythaemia Vera Presenting as Superior Mesenteric Vein Thrombosis: A Case Report

Janhavi Nitin Mahajan, Prerna Verma, Yogesh Kakde, Sunil Kumar, Anil Wanjari

Polyglobulia is secondary polycythaemia commonly due to underlying non haematological diseases like Chronic Obstructive Pulmonary Disease (COPD), obstructive sleep apnoea and also sometimes in people living in hilly or forest areas. It can occur in any venous or atrial thrombosis of the vessels, but cardiac, cerebral, and mesenteric vessels are usually involved. One of the rare causes of abrupt severe abdominal discomfort is portal vein thrombosis, usually associated with liver cirrhosis and thrombophilia. In this case report, the authors have highlighted a case of a 36-year-old male residing in the hilly area of Maharashtra, India, who reported to hospital with severe abdominal pain due to superior mesenteric vein thrombosis. On investigation, he had increased haemoglobin with raised haematocrit diagnosed as polyglobulia and became part of polycythaemia with positive JAK2 V617F mutation.

A Rare Case Report of Neurofibromatosis Type 1 with Bladder Ganglioneuroma in a Paediatric Patient

Ankit Vyas, Mayank Agarwal, Alhad Mulkalwar, Sujata Patwardhan

Neurofibromatosis type 1 (NF1) is a rare Autosomal Dominant (AD) disease manifesting in paediatric age group with an incidence of 1/3500 births. It has a varied clinical presentation most commonly involving skin followed by the skeletal and central nervous systems. Genitourinary involvement is very rare. Peripheral neuroblastic tumours are classified into Neuroblastomas (NB), Ganglioneuroblastomas (GNB) and Ganglioneuromas (GN). They are classified according to their stage of maturation in a spectrum, which starts from NB, the most primitive form, and extends to GN, the most mature form. The authors hereby present a rare case report of a paediatric patient presenting with NF1 features and a bladder ganglioneuroma. The 11-year-old male child presented with a history of haematuria since two weeks accompanied with increased micturation frequency and nocturia. Neurocutaneous markers suggestive of a diagnosis of Neurofibromatosis type 1 were observed during clinical examination. Computed Tomography Intravenous Urogram (CT-IVU) revealed a large irregular pelvic mass involving the wall of the urinary bladder. Enlarged mesenteric lymph nodes were observed during exploratory laparotomy, frozen section bipopsy of which was reported as ganglioneuroma. Partial cystectomy was performed along with complete excision of the mass. Histopathological examination confirmed the diagnosis of bladder ganglioneuroma.

Trichoscopic Overlap of Trichotillomania Superseding Alopecia Areata: A Report of Two Cases

G Sukanya, Sivaramakrishnan Sangaiah, NR Vignesh, Ojas Dipak Kulkarni

Trichoscopy is a non invasive tool useful for diagnosis of dermatoses on hair bearing skin. Alopecia Areata (AA) is a common non scarring alopecia with varying aetiologies including autoimmune and genetic factors. Trichotillomania (TTM) is a psychocutaneous dermatosis characterised by compulsive hair plucking leading to hair loss at accessible sites. Trichoscopy can be used for diagnosing both these dermatoses at an early stage due to presence of distinct trichoscopic signs. Authors hereby intend to report two cases presenting with a trichoscopic overlap of trichotillomania superseding alopecia areata. First case was of a 27-year-old male presented with patchy hair loss for three months over scalp. On clinical examination, the case appeared to be of AA with involvement of three well-defined patches on the scalp, though trichoscopy suggested an overlap of AA with TTM. On probing patient gave a history of stressors predominantly of unemployment due to Coronavirus Disease-2019 (COVID-19) pandemic but denied the history of compulsive hair pulling, indicating that TTM must have superseded patches AA. The second case was a 20-year-old female presenting with a single patch of hair loss over mid scalp. There was atrophy in the centre and easy pluckability at borders. Trichoscopy yet again suggested an overlap of AA with TTM. The patch of AA was persistent in the patient giving rise to depression and anxiety which had probably provoked hair plucking. TTM and AA are two distinct clinical entities but can be simultaneously present in patients. Trichoscopy can be indeed helpful for diagnosis in such cases. Treatment modalities should therefore address both these conditions in such cases for better outcomes.

Combined Neurophysiotherapy and Accelerated Skill Acquisition Programme in Improving Upper Extremity Motor Function in Hemiplegia after Brain Tumour Resection

Astrocytomas are one of the most common primary tumours of central nervous system seen in paediatric population. Although it is treatable and has a good prognosis, some individuals suffer from motor dysfunction following brain tumour resection which could result in decreased mobility, difficulty with daily tasks, increased risk of immobility-related problems, falls, pain, anxiety/depression. Thus, having a negative impact on overall quality of life and functional independence. Comprehensive neurophysiotherapy in such cases play a critical role in preventing and alleviating motor dysfunction, and its effects, and improve functional independence. This is the report of a 10-year-old female with astrocytoma in the right frontoparietal lobe, which was diagnosed using magnetic resonance imaging and immunohistochemistry. She underwent craniotomy for the same. But after tumour resection, she developed left hemiplegia wherein involvement of upper limb was more as compared to lower limb. She was given neurophysiotherapy and Accelerated Skill Acquisition Programme (ASAP) which aided in improving upper extremity motor function and functional independence.

Paraparesis as a Rare Complication of Dengue Fever Causing Spontaneous Spinal Subarachnoid Haemorrhage

Pradnya Diggikar, Simran Bhullar, Farhanulla Basha, Prashant Gopal

A smaller number of confirmed dengue cases worldwide present with neurological symptoms such as headache, seizure, neck stiffness, drowsiness, altered sensorium, behavioural disorders, delirium, cranial nerves palsies, and rarely, spinal cord involvement. This report is about a 54-year-old female patient with dengue, who presented with acute spinal cord compression due to spontaneous spinal Subarachnoid Haemorrhage (SAH). She complained of sudden onset of febrile illness associated with headache, myalgia, retro-orbital pain, and low backache for three days, followed by sudden onset paraplegia three days after the onset of the illness. A haemogram was obtained, which showed a platelet count of 60,000/μL. She had antibodies against dengue NS1 and dengue Immunoglobulin M (IgM), but not against dengue IgG. A Magnetic Resonance Imaging (MRI) spine contrast imaging revealed a spinal SAH from the level of T12 to L1, as well as significant cord compression. An MRI of the brain revealed a SAH in the bilateral parieto-occipital region. She underwent an emergency laminectomy and complete haematoma evacuation. Postsurgical period was uneventful with complete recovery of sensation and weakness. In patients from endemic areas of dengue infection who present with fever and spinal cord involvement a high degree of suspicion of this disease should arise and it should always be investigated further for dengue-related neurological complications.

Polycystic Kidney with Gross and Histological Aspects: A Case Report

Renal cysts are fluid-filled cavities on the surface of kidneys which may be solitary or multiple. They may present as incidental finding during routine radiological investigations for chronic renal failure, end-stage renal disease or due to associated abdominal symptoms. During routine cadaveric dissection at the Institute, multiple cysts were observed on the surface of left kidney in a 67-year-old male cadaver. The cysts were carefully observed for gross appearance and histological examination of the cysts and biochemical analysis of cystic fluid was done. The right kidney was normal in gross appearance but was associated with double renal arteries. The left kidney, which appeared smaller, showed polycystic appearance with total 14 cysts on the surface of left kidney and distorted histology. Knowledge of renal cysts and variations in renal vascular anatomy should be kept in mind for planning effective treatment.

Delftia acidovorans: A Rare Pathogen Isolated from Pleural Fluid in an Immunocompromised Host

P Ganesh Perumal, B Appalaraju, Preethi Thiruvengadam

Delftia acidovorans is an aerobic, non fermentative gram negative rod that belongs to the Pseudomonas ribosomal Ribonucleic Acid (rRNA) homology Group III. The sources of isolation are sludge, biological waste water treatment plants. Patients in hospitals or with compromised immune systems are more likely to be affected. Delftia acidovorans can result in infectious endocarditis, ocular infections, otitis media, peritonitis, urinary tract infections, empyema, cavitary and interstitial pneumoniae, and nosocomial bacteraemia, including bacteraemia linked to central venous catheters in people with compromised immune systems. This case report is about a 57-year-old male with complaints of loss of appetite for six days and vomiting, as well as loss of weight. He was diagnosed with HIV two years ago and was on HAART (Highly Active Antiretroviral Therapy). This atypical bacterium was isolated from pleural fluid of the patient; and he was managed with albumin infusion, anticoagulants, beta blockers, fluid and salt restriction and intravenous antibiotics. It is an emerging source of Gram negative bacilli which is normally a non pathogen causing serious infections among immunocompromised patients.

Surgical Repair of Atrial Septal Defect and Lung Lobe Resection for Pulmonary Sequestration and Cystic Malformation in One Stage: A Case Report

Incidence of congenital cystic malformation of lungs ranges from 1 in 11,000 to 1 in 35,000 live birth. Concurrence of Congenital Pulmonary Airway Malformation (CPAM) with congenital heart disease is even infrequent. Even rarer, is the incidence of congenital pulmonary vascular and cystic parenchymal lesions with cardiac defects. The non functioning lung tissue is separated from bronchial tree and vascularised by aberrant artery from the systemic circulation. Simultaneous repair of cardiac and pulmonary defects, though challenging, but are preferable because of surgery being done in single stage with better cosmesis. A 10-year old female child presented to the hospital with recurrent chest infections and respiratory distress while running since five years of age. The patient underwent atrial septal defect closure and right lower lobectomy for CPAM in one stage through midline sternotomy. We conclude that such complex cases can be managed successfully with meticulous planning and multidisciplinary team approach.

Monophasic Synovial Sarcoma of Foot Masquerading Squamous Cell Carcinoma

Sakthi Kannamma, Sankappa P Sinhasan, Saravanan Pandian

Synovial sarcoma being a rare sarcoma typically arises near articular surface most commonly around knee joint. Hereby, a case report of a 38-year-old male with complaint of cauliflower-like proliferative growth on the plantar aspect of left foot. It rapidly progressed in size over a period of one month. Wedge biopsy was done and diagnosis of malignant mesenchymal tumour was suggested. Further clinical workup of the case was carried out and the surgeons proceeded with amputation of the foot. Gross examination of specimen showed a large, ulcerated, nodular, exophytic, cauliflower-like growth over the plantar aspect of left foot along with areas of haemorrhage and necrosis masquerading more common squamous cell carcinoma. Histopathology revealed characteristic hypocellular and hypercellular areas showing pleomorphic spindle cells in fascicles and whorls suggesting monophasic synovial sarcoma. Immunohistochemistry stains further confirmed the diagnosis. The current case report highlights the rare presentation of synovial sarcoma as a cauliflower type of growth at a rare location.

Closure of Oroantral Communication with Gelfoam and Collagen Membrane after Periapical Cyst Enucleation- A Case Report

A Senthil Kumar, C Prasad, Davidson Rajiah, P Kamalakannan, S Praveen Kumar

Periapical cyst is the most common inflammatory cyst that occurs in jaw bones. Epithelial cell rests of Malassez in periodontal ligaments are the main cause for the periapical cysts to be formed. Periapical cyst occurs commonly in infected and necrotic periapical area, with male sex predilection and occurs, especially in the 3^rd to 6^th decades of life. Non vital tooth left untreated for long time predisposes to periapical cyst formation. Oroantral Communication (OAC) is one of the most routinely encountered complications during surgical procedure by oral and maxillofacial surgeons when attempting to remove a cyst from maxilla. Oroantral communication is the abnormal, pathologic, unnatural open connection between the oral cavity and maxillary sinus. If such a communication remains open it can cause ingress of microorganisms from the oral cavity into the antrum resulting in maxillary sinusitis, and develops into an Oroantral Fistula (OAF). Hereby, authors presented a case report of a 32-year-old female patient with the complaint of pain and swelling in relation to the left upper back tooth region. The gelfoam and collagen membrane were used to close an oroantral communication, which was developed after periapical cyst enucleation.

Giant Pleomorphic Adenoma of Parotid Gland: A Rare Cytological Diagnosis

Satyajeet, Prerna Tewari, Ruchi Sinha, R Abhirami Ganesh

Pleomorphic adenoma is the most common salivary gland neoplasm, which affects both major and minor salivary glands. It is also the most common neoplasm arising in the parotid. In minor salivary glands, it most commonly involves the palate and rarely involves the lips, cheek and gingiva. It is also called Benign Mixed Tumour (BMT), since it is composed of a variable amount of epithelial and mesenchymal elements. Diagnostic modalities include Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). MRI provided the most precise structural information of the tumour as well as surrounding structures. A 60-year-old female presented with a massive right-sided infra-auricular swelling, since 20 years. On Contrast Enhanced Computed Tomography (CECT), a huge lobular exophytic lesion with thin enhancing septation and few calcific foci was visualised in the right parotid region. The Fine Needle Aspiration Cytology (FNAC) yielded the diagnosis of Pleomorphic Adenoma (PA). Giant PA with an indolent course is a rare entity in itself. This is a case of giant PA of the parotid gland growing insidiously over a period of 20 years.

Use of Free Gingival Graft and PRF to Increase the Width of the Attached Gingiva: A Novel Approach

Deepika Ajit Masurkar, Priyanka Jaiswal, Bhairavi Kale, Aishwarya Rathod

Inadequate width of attached gingiva can lead to difficulty in maintaining oral hygiene, can cause recession and if the patient is undergoing orthodontic treatment the bands and brackets might get engrossed in the buccal mucosa. Therefore, increasing the width of attached gingiva is necessary. Here, authors presents a case of 19-year-old female patient who was referred from the Department of Orthodontics for impinging of bands into gingiva which was identified to be because of in adequate width of attached gingiva. Horizontal incision was given at mucogingival junction from tooth 34 to 44 region. Full-thickness flap was raised till the required vestibular depth recipient site is required. Free Gingival Graft (FGG) of size 15×10 mm in size was harvested from left palatal mucosa from distal to 24 to mesial to 26 region. Harvested FGG was sutured from 32 to 42 region in the recipient site. Platelet Rich Fibrin (PRF) membrane was prepared using patients own blood and this membrane was sutured at 33 and 43 region at the recipient site. An aluminium foil was kept at the donor site and above the membrane at the recipient site on which periodontal pack was given. After 21 days of healing, the width of attached gingiva increased from 2 mm at baseline to 8 mm. According to Visual Analog Scale (VAS), mild pain was felt by the patient and no difference in the colour was seen at both recipient and donor site at 21 days after surgery. Use of FGG and PRF helps to achieve improved results for increase width of attached gingiva.

Solitary Osteochondroma of L2 Spinous Process

Osteochondroma is the most common primary benign bone tumour frequently affecting the appendicular skeleton and rarely involves the spine and even more rarely involves the lower lumbar region. The present case report was a rare case of osteochondroma arising from spinous process of L2 vertebra. A 12-year-old male visited with his parents with complaints of progressive painless swelling in the lower back for six months. After thorough evaluation, osteochondroma arising from L2 spinous process was diagnosed. The patient was operated with extraperiosteal enbloc excision of the tumour along with L2 spinous process. Enbloc excision of axial exostosis should be considered owing to the risk factor of neurological involvement and rare malignant transformation.

Affirmative Outcome after Modified Cardiopulmonary Rehabilitation in Postpump Syndrome with Reduced Ejection Fraction following Coronary Artery Bypass Graft

Moli Jai Jain, Vaishnavi Dilip Yadav, Vishnu Vardhan

In Coronary Artery Bypass Graft (CABG) patients’ Postoperative Pulmonary Complications (PPCs) like atelectasis, pleural effusion, pneumonia, pulmonary oedema, and pneumothorax are the leading cause of morbidity. Secondary prevention and Cardiac Rehabilitation (CR) are essential aspects of the post revascularisation care approach. Here, authors presents a case of 56-year-old male, diagnosed with triple vessel disease with reduced ejection fraction, underwent CABG surgery and developed Postpump Syndrome (PPS). There was pleural effusion secondary to the cardiopulmonary bypass machine. Postoperatively, the patient complained of pain at the incision site, cough, and difficulty in breathing. He underwent two weeks of a precise, planned early phase I CR protocol with regular vital monitoring. Post rehabilitation, the two-Minute Walk Test (MWT) and Borg’s scale showed improvement in the walking distance sequentially from 7th, 11th, and 14th day postoperatively. There was a decrease in the perception of difficulty in breathing. He showed a tremendous level of recovery in vitals, functional capacity, pain, and quality of life seen postrehabilitation. It can be concluded that exercise-based CR is an important adjunct therapy for secondary complications in post CABG patients.

En-masse Distalisation of Mandibular Dentition with Ramal Miniplate for Correction of Class III Malocclusion: A Case Report

Mandibular arch distalisation is a non extraction camouflage treatment modality for class III malocclusion, and the introduction of skeletal anchorage devices has enabled its use with minimal patient compliance and reciprocal side effects. The aim of the present case report was to show the efficacy of the retromolar fossa as a suitable skeletal anchorage site for mandibular dentition distalisation. Inter-radicular mini screws are the most commonly used forms of skeletal anchorage; however, they are often problematic in the mandible because of their high failure rate in the posterior region. In order to avoid these issues, some clinicians place mini screws extraradicularly in the buccal shelf area or in the retromolar area. This approach is demonstrated through a case report of an 18-years-old male patient with a chief complaint of extra teeth and spacing in the upper front teeth. The diagnosis formulated was a Class III skeletal pattern, anterior divergence, Angle’s Class III malocclusion with an edge-to-edge bite and presence of mesiodens in the premaxillary region. The treatment approach was to use skeletal anchorage to distalise the mandibular arch with ramal plates after extraction of the mandibular third molars, since the patient refused the surgical treatment. At one year follow-up appointment, there was no noticeable relapse or signs or symptoms of adverse effects like gingival recession, mobility and bone loss.

Acute Abdomen during Pregnancy with Fibroid Uterus: Red Degeneration or Torsion?

Vignesh Durai, Poojitha Kalyani Kanikaram, Chitra Thyagarajan, Papa Dasari

During pregnancy, red degeneration and torsion of subserosal fibroid may present with acute abdomen, creating a diagnostic dilemma. Red degeneration of fibroid during pregnancy responds to conservative management, whereas torsion of a subserosal fibroid requires emergency myomectomy. This case report describes a clinical scenario wherein difficulties were encountered in diagnosing the cause of acute abdomen during mid-trimester in a pregnant woman with fibroid uterus and the role of imaging to differentiate the above two clinical conditions. A 26-year-old staff nurse, a primigravida with subserous fibroid presented at 19 weeks with pain in abdomen and vomiting. She was provisionally diagnosed with red degeneration and treated conservatively for 48 hours. Her symptoms persisted, and hence torsion of the subserous fibroid was suspected. However, no pedicle was visualised on 2D Ultrasound (USG). Therefore, Magnetic Resonance Imaging (MRI) was done, which revealed the pedicle, and accordingly, the decision for emergency laparotomy was taken, and the fibroid was excised. Histopathology revealed infarction of leiomyoma. The pregnancy continued in a regular course.

Mineral Trioxide Aggregate for Management of Three Resorptive Areas in a Single Rooted Tooth

Girija S Sajjan, G Swapnika, R Kalyan Satish, K Madhu Varma, J Sai Dinesh

The maxillary anterior tooth is the key tooth for the esthetics of an individual. Unfortunate trauma to the maxillary anterior tooth results in compromised esthetics and self-esteem of a young patient. Multiple resorptive defects in a tooth may compromise its prognosis and may be indicated for extraction following replacement by the implant. However, “a naturally retained tooth is the ultimate implant”. A 25-year-old patient visited the Department of Conservative Dentistry and Endodontics with the complaint of purulent pus discharge and unacceptable colour in the front tooth region for two months. The yellowish-brown discolouration was observed in 11. Radiographic imaging revealed two internal resorption areas. Apical resorption was evident on the distal aspect of the root. The Cone-beam Computed Tomography (CBCT) imaging revealed two internal resorptive areas with external resorption. This case report describes the successful surgical therapy of communicating internal, external and apical resorption with complicated pulp space that was managed effectively with the help of CBCT, magnification and bioceramic materials. This case report highlights the importance of Mineral Trioxide Aggregate (MTA), Dental operating microscope and CBCT for the diagnosis and effective management of a structurally compromised tooth.

Medullary Solitary Plasmacytoma of Maxilla- A Rare Case Report

Jigna S Shah, Jaya Dubey

Solitary Plasmacytoma (SP) is a rare disease characterised by a localised proliferation of neoplastic monoclonal plasma cells, without evidence of systemic disease. The aetiology of SP remains unknown, but chronic stimulation, overdose irradiation, viruses, and gene interactions in the reticuloendothelial system have been suggested as the aetiologic factor. While pain is the most common symptom of osseous mandible SP, it is usually painless in the maxilla and may manifest orally with paresthesia, swelling, soft tissue masses, mobility and migration of teeth, haemorrhage, or pathologic fracture due to cortical destruction of bone. Because the amount of haemopoitic bone marrow in the maxilla is decreased, oral involvement of the maxilla is less common than that of the mandible. Here, authors reported a case of 46-year-old male patient presented with the chief complaint of mobility of his upper left back teeth and swelling over his left-side palatal area. Clinical examination was suggestive of benign odontogenic tumors and salivary gland tumors, while two-Dimensional (2D) and three-Dimensional (3D) imaging were suggestive of malignant tumors arising from either alveolar bone or maxillary sinus. The laboratory investigations and biopsy revealed solitary plasmacytoma of maxilla. There were clinical symptoms of paresthesia and mobility, but no other signs of malignancy were observed. As the case report concludes, all necessary investigations need to be conducted to exclude all other pathologies, so that treatment can begin as soon as possible.

Mandibular Reconstruction with Iliac Crest Graft Associated with L-PRF and Hyperbaric Oxygen Therapy: A Case Report

Maxillofacial reconstructions with free grafts have become a routine reality for plastic surgeons and maxillofacial surgeons in the last decade. This condition usually occurs after radical treatment of benign or malignant pathologies of the stomatognathic complex, through en bloc resections with a safety margin to reduce the chances of recurrence of the pathology. One of the great challenges faced by surgical teams is no longer just in relation to the technique used for planning, but the predictability and maintenance of the graft performed in the face of systemic changes that can compromise the success of the graft, such as diabetes mellitus. Several aspects have been explored in recent years, such as the use of ozone, synthetic membranes, formation of Leukocyte and Platelet Rich Fibrin (L-PRF) and hyperbaric therapy in the quest to maximize the chances of graft success, reducing the chances of infection and bone resorption mainly through osteoinductive and osteogenic stimuli, which are not characteristics present in a metabolic dysfunction such as diabetes. Another important data for these types of surgery is the bone quality offered by the donor bed, because in maxillofacial reconstructions, a balance in the amount of corticalized bone and medullary bone is important, which leads us to characteristics such as the best donor bed for these surgical reconstructions in the iliac crest region. Here the authors present a case of 64-year old male hypertensive patient with history of (h/o) diabetes mellitus, managed by a mandibular reconstruction surgery with iliac crest graft associated with L-PRF and hyperbaric oxygen therapy after extensive resection of a benign mandibular tumour in a patient with diabetes mellitus.

The Charisma of 3D Imaging in Managing Endodontic Mishaps in Calcified Canal: A Case Report

Ruchi Shah, Palak P Shah, Aparna Dwivedi, Nimisha C Shah, Meet Kumar Dedania

Management of calcified canals is always challenging and is much more prone to mishaps such as perforations and ledge formations. The Two-dimensional (2D) imaging has a limitation, the 2D image of a Three-dimensional (3D) structure overlaps adjacent structures even over the root canals. This can create large confusion during treatment. Here, we are reporting a case where 2D imaging misled the treatment and 3D imaging evolved as a magical tool. A 32-year-old female, presented with complaints of pain, blackish discolouration and repeated sinus tract formation after her initial sitting of previous root canal treatment with upper right front tooth #11. On the radiograph, improper obturation and periapical radiolucency were evident. Hence, re-root canal treatment was advised and initiated. Gutta-percha was removed and radiographs were taken to ensure the removal of gutta-percha followed by working length estimation, which was satisfactory. After following all irrigation protocols, calcium hydroxide was placed as intracanal medicament but the patient came after two days with a draining pus sinus. The same happened with double antibiotic paste. Hence, Cone-beam Computed Tomography (CBCT) was advised. A buccal perforation and calcified unnegotiated canal were evident in all sections of CBCT. With the consent of the patient, the canal was again negotiated and guided with multiple angled radiographs. Intraoperative CBCT was advised with a master gutta-percha cone to verify the correct position of the canal. After verification, perforation was sealed with biodentine followed by obturation with crown placement in subsequent visits. Thus, 2D imaging can be misleading and 3D imaging is a guiding tool.

Surgical-orthodontic Treatment of Skeletal Class III Malocclusion and Concomitant Open Bite: A Case Report

Surgical-orthodontic treatment for the correction of skeletal Class III malocclusion and concomitant open bite is challenging due to the probability of postsurgical relapse. The present case (19 year-old male) describes successful surgical-orthodontic treatment for the correction of Class III malocclusion with anterior and posterior open bite. Treatment consisted of the use of an Edgewise fixed appliance (0.022” × 0.028”) and bimaxillary orthognathic surgery. Treatment resulted in bilateral Class I molar and canine relationships, normal overjet and overbite, the correction of anterior and posterior open bite, alignment of the midlines, leveling of the curve of Spee, satisfactory facial harmony, and passive lip seal. The correct diagnosis as well as the proper indication and execution of orthodontic and surgical treatments enabled the achievement of satisfactory functional and facial results and smile esthetics.

Peculiar Ultrasonography Feature of a Subcutaneous Abscess on Cheek - A Rare Case Report

Venkatalakshmi Aparna Potruli, Beshia Arnold, Santana Natarajan

The skin on the face is prone to a number of ailments due to the presence of hair follicles, glands, and pores. One such infection is a bacterial infection that affects the hair follicles. Folliculitis is a hair follicle infection caused by the inflammation of hair follicles as a result of physical injury, chemical irritation, or infection. It is possible that the hair within the follicle will become contaminated if it is trapped and unable to break through the epidermis, which can lead to an abscess in the subcutaneous layer. In skin and soft tissue infections, ultrasound imaging is more reliable, which increases ability of clinicians to discern between an abscess cavity and deeper infections. It excels due to its high resolution and ability to perform dynamic testing, such as compressing structures, which allows for reliable separation of potentially perplexing physical findings. Sonography enables the discovery of clinically occult collections and provides guidance for diagnostic aspiration, which is often required to distinguish an abscess from a necrotic or cystic tumor, haematoma, or seroma. Here the authors presents a case of a 27-year-old male patient who presented with a discrete swelling on the right cheek region over a period of six months. Ultrasonography revealed a mysterious linear echogenic area surrounded by a hypoechoic area that was unusual of an abscess leading to perplexity in diagnosis. Later, the abscess was drained and the swelling had completely subsided after a week follow-up. Thus, a better understanding and knowledge of ultrasonography and its imaging features in soft tissue lesions will aid in precise diagnosis and may prevent unnecessary further imaging.

Paradigm Shift in the Management of Pseudoaneurysm Following Nephrolithotomy-A Case Series

Sunirmal Choudhury, MD Taquedis Noori, Dilip Kumar Pal

Renal artery pseudoaneurysm after nephrolithotomy or pyelolithotomy is rare, but is more often following Percutaneous Nephrolithotomy (PCNL) or renal biopsy. It is a potentially life-threatening condition, with an incidence of 0.1 to 0.3% after nephrolithotomy or pyelolithotomy. Manifestation may vary, from asymptomatic to symptoms like local bloody discharge, haematuria, pain, high blood pressure, and rupture causing a life-threatening condition. A minimally invasive technique, selective or super-selective angioembolisation is the treatment of choice. This case series reports, five cases presented with either bloody wound discharge or intermittent haematuria in the Emergency Department, post nephrolithotomy. All patients were resuscitated in the Emergency Department with intravenous fluid and packed red blood cell transfusion. After resuscitation, three patients were diagnosed with renal artery pseudoaneurysm on Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) and angiography, and two patients with digital subtraction angiography during the intervention. All were treated with super-selective renal artery angioembolisation, with endovascular coiling of different sizes. All patients made an uneventful recovery, and on followup no complication was evident. Now-a-days the popularity of angioembolisation for renal artery pseudoaneurysm has increased, which shows a paradigm shift from a traditional surgical intervention.

Urinary Bladder Calculus as a Rare Cause of Obstructed Labour: A Series of Three Rare Cases

Obstructed labour by large urinary bladder stones is one of the rare complications. Very small number of cases have been described in available literature. The diagnosis is generally based on the history of patient, their clinical evaluation and ultrasonography scans during pregnancy. Majority of antenatal cases in rural areas come first time in Primary Healthcare Centre (PHC) with labour pain and usually without any previous ultrasound scans. These cases are referred to higher centres due to prolonged obstructed labour. Although rare, but one should consider a large urinary bladder calculus as a cause of obstructed labour as early diagnosis and timely management of urinary bladder stones can prevent various complications like mechanical dystocia and Vesico-vaginal Fistula (VVF). Here, authors reported three cases of a large urinary bladder calculus causing obstructed labour. Caesarean section was done for obstructed labour and cystolithotomy was performed simultaneously in all three cases.

Role of Computed Tomography Chest and Bronchoscopy in the Diagnosis of Endobronchial Masses

Sai Durga Mydukuru, Anil Kumar Kodavala, Prasanna Purna Kuruganti

Endobronchial Masses (EBM) can present with Central Airway Obstruction (CAO). Causes of EBM can be benign or malignant in origin. Malignant endobronchial masses are more common than expected. However, they are underdiagnosed because of their non specific clinical and radiological presentations. The authors present a case series of seven cases of endobronchial growth. Three cases were of squamous cell carcinoma, one was bronchioloalveolar carcinoma, one was a typical carcinoid, and another one was Endobronchial Tuberculosis (EBTB). All were males, and five were above 50 years of age. Breathlessness, cough, wheeze, and haemoptysis were the common symptoms. In three patient diagnoses were delayed as Computed Tomography (CT) chest and bronchoscopy were not done during the initial evaluation. In one of the cases, empiric treatments for pulmonary tuberculosis delayed definite diagnoses of endobronchial growths. In another patient, empiric treatments for pleural tuberculosis delayed the diagnosis of carcinoma of the lung. In one patient empiric treatment with corticosteroids for asthma delayed the diagnosis of EBTB. However, in three patients early CT chest and bronchoscopy revealed the diagnoses of different types of carcinomas of the lung despite acute symptoms. One patient had carcinoma of the lung and EBTB. Early and optimal use of chest CT and bronchoscopy can clinch the diagnoses. Investigation should be done for both EBTB and malignancy in a case of endobronchial growth.

Bone Cement Implantation Syndrome- A Case Series

R Aishwarya, Kirti Sharma, K Gopalakrishnan, N Nagalingam

In Bone Cement Implantation Syndrome (BCIS) there occurs hypoxia, hypotension, and loss of consciousness at around the time the bone is cemented. Hip arthroplasty has become a frequent intervention with the increase in aging population. Hereby, the authors discussed five cases (three male and two female patients), all aged 58 years and above. Few patients found to have co-morbid medical conditions in the Preanaesthetic Clinic (PAC). All the patients developed adverse responses after the bone cementing procedure. One of the patients presented for PAC and was scheduled for right-sided knee arthroplasty. The generalised signs observed amongst these patients were hypoxia, hypotension, unexpected loss of consciousness, cardiovascular collapse, either intraoperatively or postoperatively, and were of varying severity. Patients were accordingly managed medically and were also given Cardiopulmonary Resuscitation (CPR), whenever required. Two patients could not be revived while three got discharged in good condition. The incidence of morbidity and mortality due to BCIS can be reduced by carefully identifying high-risk patients.

Intrathecal Morphine as an Alternative for Epidural Analgesia for Postoperative Pain in a Resource Constrained Set-up: A Case Series

Anil Kumar Narayan, Ajay S Shandilya, Harini Krishna

Management of postoperative pain is a central piece in the jigsaw of postoperative care. This article reports a series of three patients who were managed with intrathecal morphine to provide postoperative analgesia, for major abdominal surgeries. Morphine was injected intrathecally before the induction of anaesthesia. The patients were pain free postoperatively, required minimal intravenous opioids on the first postoperative day. There was no incidence of postoperative nausea or vomiting, pruritus and respiratory depression. Intrathecal morphine improves the quality of postoperative analgesia, there is a reduction in pain scores in the first 24 hours after surgery and the need for rescue analgesia with intravenous opioids is less. Intrathecal morphine can be used as an alternative to continuous epidural analgesia in early postoperative period.

Emergency Dynamic Central Venous Cannulation in Preterm Neonates- A Case Series

S Saravanakumar, S Sridharan, RJ Balamurugan

Neonatal venous cannulation is one of the challenges faced by Anaesthesiologists in routine practice. Neonatal cannulation is extremely difficult and time consuming and it has become an inevitable procedure in neonatal intensive care unit, because of the small vessel diameter and sometimes it is impossible to differentiate between artery and vein. Routinely umbilical vein, scalp vein and peripherally inserted central catheters cannulation are done during initial neonatal period. Central vein cannulation is needed in sick neonates for nutrition, antibiotics, venous sampling, and inotropic support and enables haemodynamics monitoring. Even with the point of care ultrasound, neonatal cannulation is technically challenging in well-experienced hands. Cannulation in a preterm neonate is highly demanding and nightmarish for all intensivists. The present case series aimed to show the successful placement of ultrasound guided supraclavicular subclavian cannulation in a very low birth preterm (less than 1500 gm) in three septic neonates. All three cannulations were done bedside in Neonatal Intensive Care Unit (NICU) with close monitoring of heart rate, pulse oximeter and electrocardiogram. Venipuncture was done under ultrasound guidance. After identifying the anatomic landmarks, subclavian cannulation was done using Seldinger technique. Subclavian cannulation was preferred because of easy accessibility, comfortable fixation and low infection rate.

Predictors of Duration of Hospital Stay in COVID-19 Disease: A Retrospective Study

Introduction: A cluster of pneumonia cases were recognised at the end of the year 2019, and later designated as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It was declared as pandemic in early 2020. Coronavirus Disease 2019 (COVID-19) caused considerable morbidity and mortality. Further, it was discovered that presence of co-morbidities like diabetes mellitus, ischaemic heart disease and appearance of cytokine storm caused increased mortality. Aim: To identify co-morbidities and laboratory parameters associated with prolonged hospitalisation in COVID-19 disease. Materials and Methods: This retrospective study was conducted in Department of General Medicine at SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India (tertiary care hospital). Data between 1^st July 2020 to 30^th September 2020 was collected, and analysis and interpretation was done from November 2020 to March 2021 from data obtained from medical records. Data of 402 participants was analysed for baseline characteristics like demographic distribution (age and gender), presence of comorbidities like diabetes mellitus, hypertension, ischaemic heart disease. Patients were divided as per level of oxygen requirements, duration of hospitalisation and usage of remdesivir or steroid or both. Laboratory parameters studied were complete blood count, platelet count, serum sodium, parameters of hyperinflammation like C-reactive Protein (CRP), Lactate dehydrogenase (LDH), ferritin. Markers of COVID-19 associated with high mortality like Neutrophil to Lymphocyte Ratio (NLR) and D-dimer were also taken. Mean hospital stay was associated with all the parameters. Data was analysed by one way Analysis of Variance (ANOVA) and Independent t-test. Results: Maximum patients seen were in the age group of 40-60 years (45.52%). Common co-morbidities observed were diabetes mellitus (48.26%) and hypertension (45.27%). Presence of comorbidities like diabetes mellitus (p-value=0.0171), hypertension (p-value =0.0238), ischaemic heart disease (p-value=0.0024) was associated with prolonged hospitalisation. Among laboratory markers higher level of parameters of inflammation like NLR >2 (p-value=0.0183), CRP >6 mg/L (p-value=0.004), ferritin >300 ng/mL (p-value=0.05) and indicators of hypercoagulable state {D-dimer >500 ng/mL (p-value=0.0014)} were associated with significantly prolonged stay. patient who received both remdesivir and steroids stayed longer compared to either remdesivir alone or only steroids (p-value=0.0001). Conclusion: State of hyperinflammation and presence of comorbidity especially uncontrolled diabetes mellitus and usage of steroids were associated with prolonged hospitalisation. Periodic assessment of these patients until recovery may help reducing mortality and morbidity.

Foetal Brain Biometry using Magnetic Resonance Imaging in an Indian Population- A Retrospective Cohort Study

Chandrasekhar Priyanka, Rajeswaran Rangasami, Chitra Andrew, N Paarthipan

Introduction: The utility of Magnetic Resonance Imaging (MRI) has increased significantly in the assessment of foetal brain development. Foetal biometry is a part of every imaging examination and is needed to confirm that the growth is proceeding normally. Aim: To provide normal MRI reference biometric data of the foetal brain in Indian population. Materials and Methods: This was a retrospective cohort study conducted in the Department of Radiodiagnosis at Sri Ramachandra Hospital, Chennai, Tamil Nadu, India. The data was collected from the MR imaging studies done between January 2013 to December 2020. The present study was carried out on 101 foetuses with gestational age ranging from 20 to 38 gestational weeks with normal brain appearance. Following biometric parameters had been obtained: skull occipitofrontal diameter and Biparietal Diameter (BPD), Brain-Biparietal Diameter (BPD) and fronto-occipital length, Head Circumference (HC), atrial diameter, vermian height, width and area. Descriptive statistics was used to calculate the median value with Interquartile Range (IQR). A p-value of less than 0.05 was considered as significant using Spearman’s rank correlation. Results: The skull occipitofrontal diameter (r-value=0.88, p-value <0.001), skull biparietal diameter (r-value=0.92, p-value <0.001), brain biparietal diameter (r-value=0.95, p-value <0.001), brain fronto-occipital length (r=0.94, p-value <0.001), head circumference (r-value=0.92, p-value <0.001), atrial diameter (r-value=0.86, p-value <0.001), Vermian height (r-value=0.86, p-value <0.001), Vermian width (r-value=0.84, p-value <0.001) and Vermian area (r-value=0.88, p-value <0.001) showed positive correlation with gestational age. Mean Head Circumference (HC) and BPD values were almost similar to the standard Indian reference mean values of ultrasound. All biometric parameters were compared with the European references. The values from present study were found to be in the lower range of the European biometric values. Conclusion: Normal biometric MRI data of the foetal brain in an Indian population from 20 to 38 weeks gestational age was presented. A significant correlation was found between gestational age and parameters. MRI BPD and HC values showed a positive correlation with ultrasound BPD and HC values.

Histomorphometric Analysis of Chick Embryo Kidneys on Exposure to 1800 MHz and 2100 MHz Radiofrequency Radiation Emitted from Cell Phone

Mary Hydrina Dsilva, Rijied Thompson Swer, Jayaraman Anbalagan

Introduction: With its sophisticated and multifunctional features, the cell phone has become an integral part of human life. Scientific reports are still inconclusive, regarding the possible ill effects of Radiofrequency Radiation (RFR) emitted from cell phones on biological tissues. Aim: To evaluate the possible tissue damage in developing kidneys of chick embryos, following exposure to 1800 MHz and 2100 MHz radiofrequency radiation emitted from 2G and 3G cell phones. Materials and Methods: This experimental study was conducted in Department of Anatomy at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, from August 2011 to June 2015. Fertilised chick embryos (144±20 eggs) were divided into three groups with a sample size of 48 eggs per group. Group A was exposed to 2G radiation (1800 MHz), group B was exposed to 3G radiation (2100 MHz) and group C was a sham exposed control group. The embryos were sacrificed from the 5^th-12^th day, and processed for routine histological procedures, to check structural and morphometric changes in the kidney. The standard epithelial height and nuclear diameter of both proximal convoluted tubule and distal convoluted tubule, karyorrhexis changes and diameter of urinary space were analysed using an ocular micrometer and square reticle. The results were statistically analysed using one-way Analysis of Variance (ANOVA). Results: The results showed cytoplasmic changes (vacuolations) and nuclear changes (nucleomegaly, karyorrhexis) in proximal convoluted tubule and distal convoluted tubule, vascular changes (haemorrhage and infiltrations) in the interstitium and increased urinary space in the glomerulus of chick embryo kidneys. Conclusion: Based on the study findings, it was concluded that RFR exposure from cell phones causes histopathological changes in the developing kidneys of chick embryos.

Angiographic Profile of Type 2 Diabetic Patients with ST Elevation Myocardial Infarction: A Cross-sectional Study

Anand Koppad, G Krupashree, Sushma Shetty, geeta chintamani

Introduction: Coronary atherosclerosis is common in diabetics, and it is diffuse in form, with multivessel involvement. It demonstrates the involvement of multiple vessels rather than a single vessel. Aim: To evaluate the angiographic profile of diabetic patients with ST Elevation Myocardial Infarction (STEMI). Materials and Methods: The present study was a cross-sectional study which enrolled 104 diabetic patients presenting with STEMI from December 2019 to March 2020. Seventy percent or more stenosis in any major coronary artery or its major branches (>2.5 mm) was considered as significant. Results: Mean age of the patients was 55.61±11.32 years, with 75 subjects being males and 29 subjects being females. A total of 28 (26.92%) had Anterolateral Wall Myocardial Infarction (ALWMI), 4 (3.84%) had Anteroseptal Wall Myocardial Infarction (ASWMI) 39 (37.5%) had Anterior Wall Myocardial Infarction (AWMI), 1 (0.96%) had extensive AWMI, 2 (1.9%) had Inferolateral Wall Myocardial Infarction (ILWMI), while 30 (28.84%) patients had Inferior Wall Myocardial Infarction (IWMI). Furthermore, 51 (49.0%) were thrombolysed while 53 (50.96%) patients were non thrombolysed. Thirty eight (36.53%) had single vessel disease, 40 (38.46%) had double vessel disease, while 26 (25%) had triple vessel disease. Among these patients, Left Main Coronary Artery (LMCA) was involved in 3 (2.88%) of patients. Seventy three patients had a Glycated Haemoglobin (HbA1c) of greater than 8.5 and had multivessel involvement, whereas 31 had a HbA1c of less than 8.5. Major Adverse Cardiac Events (MACE) was observed during hospital stay in the form of death, recurrent myocardial infarction and cardiovascular stroke, which occurred in 20 (19.23%) patients of the total 104 diabetic patients. Conclusion: In the present study, the severity and extent of Coronary Artery Disease (CAD) and incidence of triple/multivessel disease was significantly high in diabetics. Diabetic patients with high HbA1c had more coronary vessel involvement. In this case, Coronary Artery Bypass Graft (CABG) is the mode of treatment.

Perception, Working Experience and Psychiatric Morbidity among Information Technology Professionals during COVID-19 Lockdown: A Cross-sectional Survey

Anirban Ray, Subrata Das, Debasish Sanyal, Mainak Sankar Majumder

Introduction: In the year 2020, the functioning of the world changed in a big way. For a large part of the year, the world stayed locked indoor, due to the novel Coronavirus Disease -2019 (COVID-19). The need for Information Technology (IT) has reached a new height, and this is certain to persist. Though the IT professionals were mostly working indoors in 'work from home' mode, work pressure and boredom increased according to few studies. Work from home also has different set of employees’ expectations and organisational responsibilities. Aim: To assess the psychiatric morbidity working experience and related perspectives of the new normal, as perceived by IT professionals. Materials and Methods: This cross-sectional survey was conducted in Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India, between May 2020 and August 2020. A Google form-based survey was done which aimed to reach throughout the country. Consent was included as the first question of the form. An ethical clearance was taken from Institutional Ethical Committee of IPGME&R, Kolkata in convenience sampling of IT professionals. For the survey, a semistructured questionnaire was developed and Brief Resilience Coping Scale (BRCS), Ten Items Personality Inventory (TIPI), and K6 psychiatric morbidity screener were used to measure the psychiatric morbidity. Snow ball sampling methods was used to get the sample through free sharing of google forms over the internet. Relevant statistical tests were used to analyse the data, where p<0.05 had been considered significant. Results: Total 72 IT professionals responded to the survey but only 71 were included due lack of informed consent. About 20 (28.2%) showed a high risk of losing their job as per their perception and 35 (49.29%) were highly worried about having COVID-19, while 44 (61.9%) were highly worried about bringing the infection home. 78.9% (n=71) showed screener positive psychiatric morbidity. Psychiatric morbidity was only dependent on “emotional stability” as a personality trait and “risk of Job loss” by regression analysis. Total 67 people were working from home, 37 (55.22%) felt the family time had increased, 28 (41.79%) felt family was happier due to work from home. Conclusion: This study showed the psychiatric morbidity of IT professionals was quite high and it was not related to their resilience level and own perception of morbidity. Psychiatric morbidity was determined by emotional stability, and the threat of losing jobs. It also shed light on disease perception and state of work perception of IT professionals. Though work from home mode may compromise the work quality slightly but it was good for the families and personal stress levels of the employees.

Incidence of UTI and Stent-related Symptoms in Patients with Peri-interventional Antibiotic Prophylaxis Only vs Low-dose Continuous Antibiotic Treatment among Double J Stented Patients: A Randomised Clinical Trial

Introduction: Endourological surgeries like Percutaneous Nephrolithotripsy (PCNL) and Ureteroscopic Lithotripsy (URSL) is the standard of care for upper urinary tract urolithiasis. Placement of Double J stent (DJ stent) is a routine practice, following these surgical interventions. Though endourological surgeries are less invasive, these are not without complications. Main postoperative complications following these procedures, which hamper daily activities are Urinary Tract Infection (UTI) and Stent Related Symptoms (SRS). There is a lack of literature, about appropriate postoperative antibiotic strategy following uncomplicated endourological surgery for upper urinary tract stone disease in patients, who are on DJ stent. Aim: To evaluate the incidence of UTI and SRS in patients given, a peri-interventional antibiotic prophylaxis only versus a continuous low-dose antibiotic treatment for entire stent indwelling time. Materials and Methods: This was a randomised clinical study conducted in the Department of Urology, SDM Medical College and Hospital, Dharwad, Karnataka, India from january 2020- march 2021. A total of 70 patients following uncomplicated endourological surgery were randomised, to either receive periinterventional antibiotic prophylaxis only (group A=31) or low-dose antibiotic treatment for entire stent indwelling time (group B=39). Randomisation was done to allocate sample into two groups using computer randomisation program. All patients received cefotaxime injection 1 gm at the time of anaesthesia induction as peri intervention prophylaxis. Patients in group B, in addition received nitrofurantoine 100 mg tablet at bedtime for entire stent indwelling time. Patients were evaluated for incidence of UTI and SRSs. Statistical analysis was done using Chi-square and Yates corrected Chi-square for analysis of association between attributes. Independent t-test was used for comparison of two groups with numerical variables. Results: The incidence of UTI was not significantly different between the two groups {group A- 4 (12.9%) and group B- 6 (15.38%)}. UTI was more common following URSL compared to PCNL {group A 24 (77.42%) and group B 29 (74.36%)}, and more common in those with diabetes mellitus. Similarly the incidence and severity of SRSs was very similar in both the groups {group A 28 (90.32%) and group B 37 (94.87%)}. Conclusion: According to the present study findings, continuous low-dose antibiotic treatment during entire stent indwelling time does not reduce the incidence of UTI and has no effect on SRSs.

Morphometry of Sella Turcica, Anterior Clinoid Process and Carotico-clinoid Foramen among North Indian Population: A Cross-sectional Study

Introduction: Sella Turcica (ST), a complex bony landmark located on the body of sphenoid bone. Its lateral bony wall mainly consists of anterior and posterior clinoid processes and optic strut which bear a strong relationship with pituitary fossa. Aim: To estimate various morphometric parameters of ST, Anterior Clinoid Process (ACP) with its anatomical variations, Optic Strut (OS) and Carotico-clinoid Foramen (CCF) among North Indian population group. Materials and Methods: The present cross-sectional anatomical study was conducted on 30 adult dry fully ossified skull and 10 formalin fixed adult cadaveric cranial base present in the Department of Anatomy, SGT University Gurugram, Haryana, India, over a period of one year from January 2021 to December 2021 to evaluate various morphometric parameters such as anteroposterior, transverse diameter and depth of sellar region including ACPs with various bony distances. The range, mean and standard deviation of each parameters were measured by using Statistical Package for the Social Sciences (SPSS) latest version (version 21.0) and Student’s t-test was applied for bilateral comparison. Frequency of morphological variability of CCF was calculated in percentages. Results: Among the 40 samples (both dry skull base and cadaveric skulls) the average dimensions of ST were 10.03±2.40 mm, 13.65±2.09 mm and 5.74±1.92 mm as anteroposterior, transverse and depth, respectively. The length, width and thickness of ACP were 11.22±1.74 mm, 8.04±1.73 mm and 2.27±0.70 mm, respectively. Also the length and width of OS were 3.61±0.78 mm and 3.72±0.47 mm, respectively. Significant difference was observed for distance of ACP to OS. The frequency of CCF was 10 (25%) among the total samples both bilateral and unilateral; out of which 8 (80%) of the samples presented with incomplete foramen, 1 (10%) presented contact type of CCF, and 1 (10%) of the samples exhibited a complete variety of CCF. Conclusion: Bilateral significant difference was observed for the transverse diameter. The mean value for length of ACP was found significant. Detailed morphometry and morphological variations of structures present in sellar region is mandatory for the clinicians specially neurosurgeons and radiologist for the diagnosis and to decide the modality of treatment.

Correlation of Serum Biochemical Parameters and Oxidative Stress in Malnourished Children: A Case-control Study

Nilima Kumari, Manish Goyal, Ravi Kant Tiwari

Introduction: There are evidence regarding enhanced oxidative stress in the form of serum Malondialdehyde (MDA) and depleted activities of serum zinc and iron in malnourished children. The deficiency of trace elements predisposes the susceptibility to various infections. Changes in oxidant and antioxidant levels may be responsible for grading in Protein Energy Malnutrition (PEM). Aim: To correlate the levels of serum biochemical parameters such as proteins, zinc, iron with oxidative stress in the form of Malondialdehyde (MDA), in malnourished children of 1-5 years of age and also to compare the findings with age and gender matched well-nourished children. Materials and Methods: This case-control study was conducted in the Biochemistry Department at Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, from January to December 2014. A total of 202 children (aged 1-5 years) were included in the study. Out of these, 103 children were undernourished and 99 children were healthy control. Out of 103 undernourished children 46 were severe malnourished and 57 were moderate malnourished. Blood samples were analysed for the estimation of serum zinc, iron, MDA, albumin and total protein. T-test, one-way Analysis of Variance (ANOVA) and Pearson correlation were used for statistical analysis and p-value <0.001 was considered significant. Results: Mean weight of moderate malnourished (10.44±2 kg) and severe malnourished children (9.36±1.54 kg) were significantly low (p-value <0.001) when compared with control group (12.73±2.36 Kg). Compared to controls (0.71±0.18 nmol/mL) the serum MDA level were significantly high (p-value <0.001) in both moderate (1.84±0.38 nmol/mL) and severe (3.44±0.59 nmol/mL) malnourished children. Serum zinc and serum iron levels, serum total protein and albumin of malnourished cases were significantly low (p-value <0.001) as compared to the control subjects. Conclusion: Compared to control, the malnourished children had significant high level of serum MDA while low levels of serum zinc, iron, albumin, globulin and total proteins. Early replacement of antioxidants, nutrients, proteins, zinc and iron supplement could be useful in the therapy of this disease.

Comparison of β-Catenin Protein Expression in Calcifying Odontogenic Cyst and Dentinogenic Ghost Cell Tumour

Introduction: Calcifying Cystic Odontogenic Tumour (CCOT)/Calcifying Odontogenic Cyst (COC) display a varying tissue morphology, while exhibiting different biological progression also at the same time. Attempts at classifying COC have largely been unsuccessful due to the present lack of knowledge about the development of these tumours and their underlying molecular changes. Wingless-beta catenin (Wnt–β catenin) signalling pathway has been found to be a cornerstone in the ectodermal development and tumour initiation-progression to malignant tumours, but its specific role in the pathogenesis of odontogenic ghost cell lesions is unknown. Aim: To elucidate the participation and comparison of β-catenin protein expression in pathogenesis of benign odontogenic ghost cell lesions, CCOT and Dentinogenic Ghost Cell Tumour (DGCT). Materials and Methods: A cross-sectional Immunohistochemical (IHC) study was performed in the Department of Oral and Maxillofacial Pathology, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India, from December 2019 to June 2021. Research was conducted on tissue sections of centrally located 16 cases of CCOT categorised as group 1 and four cases of DGCT categorised as group 2 using β-catenin tumour marker. The study samples were retrieved from the archives. IHC stained slides were subjected for histopathological analysis, where labelling index of tumour cells were assessed in three high power fields. Resultant β-catenin expression was compared between Benign Odontogenic Ghost Cell Lesions (BOGCL). Results were subjected to statistical analysis, Statistical Package for Social Sciences for Windows 17.0 (SPSS, Philadelphia, IL) software to analyse the data. Results: β-catenin positivity was assessed in tumour cells of both the groups, 16 CCOT (group 1) and 4 DGCT (group 2). In each case, number of cells in three high power field i.e., under 40X magnification were evaluated. Both the groups expressed membranous, cytoplasmic and nuclear positivity in the basaloid tumour cells. Whereas, ghost cells showed no reactivity to the biomarker, β-catenin. On comparison using Mann Whitney U and Wilcoxon W test, there was no statistically significant difference in β-catenin expression between CCOT and DGCT. Conclusion: β-catenin plays an important role in the tumourigenesis of benign odontogenic ghost cell lesions. Immunohistochemically CCOT and DGCT showed no significant difference in the β-catenin expression. Hence, the results suggest that CCOT and DGCT may show variation in clinical behaviour but share similar histogenesis.

Clinical and Microbiological Evaluation of Manual Toothbrush, Electric Toothbrush and Nano-b Toothbrush on Plaque Removing Efficacy among Visually Impaired Children: A Randomised Clinical Trial

AR Jaya, Kalyani Magandas Choudhar

Introduction: Oral hygiene can be maintained by mechanical and chemical methods. Maintenance of oral hygiene is challenging in visually impaired children due to physical limitations. Aim: To compare plaque removal efficacy using different toothbrushes among visually impaired children. Materials and Methods: This randomised clinical trial conducted on 45 visually impaired children aged between 7-12 years from a blind school in Bengaluru, Karnataka, India, after obtaining informed consent. Study was conducted in the month of September 2020 and October 2020 for a period of two months. All potential participants were randomly divided into three groups depending on the type of toothbrush used. A plaque disclosing agent (Alpha Plac) was applied and Turesky Modified Quigley Hein Plaque Index (TQHPI) was recorded for all subjects on 15^th, 30^th, 45^th and 60^th day from the baseline. Plaque samples were collected from all the subjects and microbial assessment was done for detection of Colony Forming Units (CFUs), on 30th and 60th day from the baseline. Data was analysed using One-way Analysis of Variance (ANOVA) test followed by Tukey’s posthoc analysis at baseline and post interventional time periods. Friedman’s test followed by Wilcoxon’s Signed Rank post-hoc analysis was used to compare mean CFUs between different time intervals, in each study group. Results: At baseline, no statistically significant difference was noted between the three groups with respect to TQHPI and CFUs. At two months follow-up, nano-b toothbrush group showed significant decrease in mean Plaque Index (PI) score compared to electric toothbrush group (p-value=0.01) and manual toothbrush group (p-value <0.001). Similarly, at two months, mean reduction in CFUs was greater in nano-b toothbrush group followed by electric toothbrush group and manual toothbrush group which was statistically significant (p-value=0.003). Conclusion: Plaque removal efficacy in visually impaired children was superior in nano-b toothbrush group, followed by electric toothbrush group and manual toothbrush group in succession, respectively.

Relationship Between Lithium Dose, Serum Concentration and Duration of Lithium Therapy with Cutaneous Side-effects in Bipolar Affective Disorder Patients

B Suganya Priyadharshini, Syed Ummar Ibrahim, Karthikeyan, Jeevithan

Introduction: Lithium has been used in the treatment of mood disorders for more than five decades. Despite a few studies focusing on the relationship between the dose of lithium, serum lithium levels, duration of therapy, and cutaneous side-effects, results remain inconclusive. Lithium is known to cause multiple cutaneous side-effects like acneiform eruptions, psoriasiform eruption, seborrhoeic dermatitis, and follicular keratitis. Aim: To evaluate the relationship between cutaneous side-effects of lithium with the serum lithium levels, dosage and duration of lithium therapy in bipolar affective disorder patients. Materials and Methods: An ambispective observational study was conducted among 52 bipolar affective disorder patients on lithium therapy recruited by convenient sampling methods from both Inpatient and Outpatient Psychiatry Units of PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, between June 2014 to August 2014. The patients with bipolar affective disorder who were either newly started on lithium or already on lithium therapy were included in the study. They were followed-up to assess the effect of lithium dosage, duration of lithium and serum lithium level with skin lesions, once a month for six months and once in two months for one year. Kaplan-Meier survival analysis was done with varying lithium dosages and serum lithium levels. Association between the lithium dose and serum lithium levels with the cutaneous side-effects were calculated using the survival analysis, taking p<0.01 to be statistically significant. Results: Out of the total, 59.6% of the participants were in the age group less than 40 years and 34.6% were in the age group 40-60 years. There was almost equal distribution of males and females, 51.9% and 48.1%, respectively. Overall, 38.46% participants had cutaneous lesions. Various lithium dosage and serum lithium levels did not correlate statistically with skin reactions up to one year. Survival analysis at the end of 10 years revealed that participants with higher dosage and serum levels had higher prevalence of skin lesions (40% vs 4%: 47.1% vs 6.6% respectively, p<0.001). The cumulative proportion of skin lesions at the end of three, five, seven and 10 years for higher dose (>800 mg/day) was 38%, 46.9%, 52.2%, and 59% and for higher lithium levels (>0.8 mEq/L) was 41%, 58.2%, 65.2%, and 73.9%. Conclusion: The patients who were treated with lower dosage and who had lower serum lithium level had reduced risk for cutaneous lesions. Lithium continued to exert its mood stabilisation property even when the serum level was maintained less than 0.8 mEq/L. This resulted in better compliance.

Effectiveness of Prophylactic Drugs for COVID-19 among Healthcare Professionals- A Cross-sectional Observational Study

Namrata Krishna Jaiswal, Veena Rani Vemuri

Introduction: The risk of Coronavirus Disease 2019 (COVID-19) infections among healthcare workers are far greater than those in the general population. A number of prophylactic drugs were being studied during this time for use by the Healthcare Professionals (HCP) who were the first contacts of an infested patient, more so than the general population Aim: To evaluate the drugs used for pre-exposure prophylaxis for COVID-19 and their efficacy and safety among healthcare workers. Materials and Methods: A cross-sectional survey was conducted among two hundred and thirty seven healthcare professionals after taking requisite permission from the Institutional Ethics Committee (IHC). A prevalidated survey questionnaire containing 21 questions and an inbuilt consent form was prepared using the Google form. The responses were presented using descriptive statistics of frequency and percentage. Results: Out of total, 112 (47.26%) participants were on a preexposure prophylactic drug, while 125 (52.74%) had not taken any prophylaxis. A total of 19 (16.96%) had used alternative medicine (Ayurveda and Homeopathy). Participants who had taken pre-exposure prophylaxis of modern medicine (n=93), 56 (60.21%) had received Hydroxychloroquine (HCQ) alone or with another drug, and in total 27 (81.8%) had tested negative for COVID-19 infection while on HCQ. Ivermectin which seems to be the other drug which was preferred was taken by 16 participants, three were tested for COVID-19 and two were positive. Only four participants had reported experiencing an adverse drug reaction. Three of them experienced acidity, while on HCQ and one experienced headache, while on ivermectin. Conclusion: HCQ given in the dose as recommended by Indian Council of Medical Research (ICMR) had significantly reduced the number of infections among HCP.

Relation of Circulatory Levels of Endothelin-1, Antioxidants, and Inflammatory Markers with Varying Blood Pressure Levels in Preeclampsia: A Case-control Study

Introduction: Preeclampsia is a pregnancy disorder with gestational hypertension and proteinuria, it affects maternalfoetal vasculature. The risk of preeclampsia increases upon exposure to different genetic mutations, environmental changes, obesity, gestational diabetes mellitus, multifoetal gestations, and hydatidiform mole. Preeclampsia affects the mother and foetus; its pathogenesis is complex involving inflammation, stress, and molecular factors. Aim: To measure the circulatory levels of Endothelin-1 (ET-1), Glutathione (GSH), Interleukin-6 (IL-6), and Tumor Necrosis Factor-α (TNF-α) by Enzyme Linked Immunosorbent Assay (ELISA) kit (sandwich) in preeclamptic women and healthy controls. Materials and Methods: The present study was a casecontrol study carried out in the Department of Biochemistry at Government Institute of Medical Science (GIMS), Greater Noida, and Santosh Medical College, Ghaziabad, Uttar Pradesh, India, from November 2018 to November 2020. The demographic data was recorded, and blood samples were studied. Preeclamptic women (cases, n=90) were grouped as group A: with BP 140/90- 149/99 mmHg, group B: with BP 150/100-159/109 mmHg, and group C: with BP 160/110 mmHg along with controls (n=70). The normotensive pregnant women without family history of preeclampsia were included as controls. The competitive ELISA principles were used to quantify ET-1, GSH, IL-6, and TNF-α levels. One-way Analysis of Variance tests (ANOVA) and Tukey Posthoc Test was carried out to compare the clinical characteristics, ET-1, GSH, IL-6, and TNF-α between the cases and controls. Results: The demographic data of age, gestational age, and Body Mass Index (BMI) were not significantly different between cases and control. The ET-1 levels were significantly (p-value=0.042) higher in groups (A: 116±79.4, B: 99.2±72, C: 159±96) than controls (54±49). In contrast, GSH levels were low in preeclampsia. In addition, cases had elevated IL-6 and TNF-α levels (IL-6; groups A: 112.3±49.3, B: 127±17.5, C: 324±52.9, and control 40.3±13, TNF-α; groups A: 241±179, B: 200.9±196, C: 391±299 and controls: 167±104). GSH levels decreased with the rise in Blood Pressure (BP), while IL-6 increased significantly with an increase in BP. Conclusion: Every 10 mmHg increase in BP led to increasing in IL-6 levels. The ET-1 and TNF-alpha levels were increased in all three groups when compared to controls. Similarly, the GSH levels were decreased. Thus, the present study provided evidence that links oxidative stress, inflammation, and a potent vasoconstrictor ET-1 with altered antioxidants (GSH) that led to the pathophysiology of preeclampsia.

Knowledge, Attitude and Practice of Diabetes among School Teachers in Upper Siang District of Arunachal Pradesh: A Cross-sectional Study

Obang Perme, Ojing Komut, Manjit Boruah

Introduction: Diabetes is a global problem and expected to affect around 300 million adults all over the world and around 57 million in India by year 2025. Studies indicate that the awareness of diabetes among general population in Arunachal Pradesh is low. School teachers form the backbone of a society and are entrusted with the work of spreading knowledge and awareness among children and youths on many topics including health. School teachers also act as community leaders and shape the public perception. Aim: To assess the Knowledge, Attitude and Practice (KAP) of diabetes among school teachers in Upper Siang district of Arunachal Pradesh, India. Materials and Methods: The present cross-sectional study was carried out in all the five high and higher secondary schools in headquarter region of Upper Siang district of Arunachal Pradesh, India. Data was collected from February to May 2018. In each school, 22 randomly selected teachers from staff register were interviewed regarding KAP of diabetes using predesigned questionnaire. Data was descriptively analysed in form of frequencies and percentages and presented in form of tables. Results: A total of 110 school teachers were interviewed. Majority 108 (98.18%) had knowledge about condition called diabetes. About 96 (87.27%) thought more and more people are getting affected from diabetes. However, only 4 (3.63%) of the respondents had knowledge that diabetes can impact younger people also. According to the responses, renal 63 (57.27%) and ocular 46 (41.82%) involvement were the two most common organs involved in diabetes. Almost half of the respondents felt that family history of diabetes, 54 (49.09%) was the most important risk factor for development of diabetes. Almost onethird, 34 (30.91%) of the respondents did not feel eating healthy and regular blood sugar 103 (93.64%) checking is important in diabetes. About 44 (40%) responding negative to the practice of morning walk for diabetes control. Conclusion: Among school teachers in Arunachal Pradesh majority had a knowledge about diabetes as an entity but there was a significant lacuna in attitude and practices towards diabetes which needs to be inculcated as a means for better education for the teachers and transition of knowledge to students.

Analgesic Effect of Intrathecal Nalbuphine in Comparison with Fentanyl as an Adjuvant with Hyperbaric Bupivacaine (0.5%) during Spinal Anaesthesia in Lower Abdominal Surgery: A Double-blinded Randomised Clinical Study

Introduction: Local anaesthetics are sometimes added with intrathecal adjuvants. Nalbuphine is a synthetic agonistantagonist of opioid μ receptor. Fentanyl is a highly potent lipophilic synthetic opioid with rapid onset of action and it acts like morphine. It can be used during spinal anaesthesia for the purpose of decreasing the postoperative pain. Aim: To compare the safety and efficacy of preservative free intrathecal nalbuphine and fentanyl as additives to intrathecal hyperbaric bupivacaine (0.5%) for spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical study was undertaken at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India during March 2020 to August 2021 in which a total of 100 patients, belonging to American Society of Anaesthesiology (ASA) physical status I and II and undergoing elective lower abdominal surgery, were randomised into two equal group of 50 each. Group N received intrathecally 0.5 mg of nalbuphine with 3 mL (15 mg) of 0.5% hyperbaric bupivacaine, and group F received 25 μg of Fentanyl with 3 mL (15 mg) of 0.5% hyperbaric. Visual Analogue Scale (VAS) score, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR) were recorded at varied intervals during intraoperative and postoperative period. Results: Significantly lower (p-value <0.001) mean VAS scores was observed beyond six hour of postoperative period in the group F. No significant changes (p-value >0.05) in SBP, DBP, MAP and HR were there between the groups. Few adverse effects like (hypotension, nausea, vomiting) were observed more in the fentanyl group which was statistically insignificant (p-value >0.05). Conclusion: Intrathecal fentanyl as compared to nalbuphine produces a significant postoperative analgesia when administered as an adjuvant with hyperbaric bupivacaine in cases of lower abdominal surgery.

Development and Validation of Quality of Life Tool among Chemotherapy Patients: A Pilot Trial

Virendra Kumar Jain, Anil Sharma

Introduction: Quality of Life (QoL) is a main alarm of patients with life-threatening cancer. Symptoms have an effect on their QoL. There are many standardised tools which measure the QoL among cancer patients. But there is no specific questionnaire or tool available to evaluate the chemotherapy patients in Indian context. Aim: To develop and validate a QoL tool for chemotherapy patients. Materials and Methods: This mixed method pilot study with sequential exploratory design was led at Outpatient Department (OPD) and Inpatient Department (IPD) of S. N. Shah Cancer Hospital, Nadiad city, Gujarat, India, from April to May 2020. In qualitative stage, the data was gathered by involving in detail interview of 15 chemotherapy patients. Interview data were analysed by utilising conventional content analysis method and themes and subthemes were formed. Based on it, a pool of items for the questionnaire was prepared. In quantitative stage, psychometric properties of the questionnaire were assessed by using face, content and construct validity. The reliability of the tool was evaluated by internal consistency and Cronbach’s alpha. Overall 15 patients participated in qualitative and quantitative phase separately. Results: At the end of phase I, a draft of 104 questionnaires was formed. In phase 2, a specialist panel reviewed 84 items relevant with the domains and 20 items were erased on the basis of expert opinion, Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI). At this time, 84 item tool were given to 15 chemotherapy patients. In view of the patient’s opinion, researcher drew a screen plot based on eigen value of above 1. These four domains showed 53.846% of the total variance. Last 84 items were scrutinised as per specific domain. The end draft had a Cronbach’s alpha value of 0.932. Conclusion: The newly develop tool will help the chemotherapy patients and healthcare team to evaluate the QoL. This QoL tool will also impact the cancer treatment and implement strategies accordingly.

Reference Interval of Serum Cystatin C in Dravidian Population Subset of South Asian Ethnic Groups: An Observational Cross-sectional Study

Shajee Sivasankaran Nair, K Geetha Damodaran, Sestin Sebastian

Introduction: Serum Cystatin C (Cys C) facilitates to detect mild renal dysfunction and overall risk of death in older patients with chronic renal diseases. The requirement for creating a particular reference interval is mandatory for such renal diseases in South Asian population since the value of serum creatinine varies largely with age, gender and population/ethnicity and data of same is short for South Asian population. Aim: To determine the reference interval of serum Cystatin C amongst the Dravidian population subset of South Asian ethnic groups. Materials and Methods: This observational cross-sectional study was conducted in Department of Biochemistry and Transfusion Medicine at Government Medical College, Thrissur, Kerala, India, from July 2020 to January 2021 among on 235 healthy adults (20-60 years). A 4 mL of blood was drawn by aseptic precautions and serum was separated within three hours of blood collection. Serum Cys C was assayed by latex enhanced immunoturbidimetric cystatin C assay using a calibrator traceable to international standard European Specific Protein Reference Material (ERM DA-471) developed by the International Federation of Clinical Chemistry (IFCC) and Laboratory Medicine. Serum Creatinine (sCr) by Jaffe method in a fully automatic clinical chemistry analyser was assessed. Categorical variables are presented using frequency (percentage) while continuous variables are summarised with an interpercentile range. The Kolmogorov-Smirnov test was used to assess the normality of the distribution of continuous variables. Results: Total of 235 subjects (20-60 years of age with 17 males and 218 females) were included in the study. The non parametric reference intervals for Cys C were found to be from 0.39 to 0.79 mg% and that of sCr ranged from 0.79 to 1.2 mg%. The relationship between Cystatin C with age showed an increase in Cystatin C levels as age advances; Spearman’s rank correlation coefficient (rho=0.197). The weak correlation between Cystatin C and sCr was also observed (rho=0.37; p-value <0.0001). Conclusion: The level of serum cystatin C (0.39 to 0.79 mg%) can be used as a diagnostic concentration reference interval of the protein that helps to recognise, standardise and establish it as a potential biomarker to detect renal disorders in South Asian ethnic population.

Dentists’ Knowledge, Attitude and Practices Regarding Dental Care for Children with Special Healthcare Needs in Saudi Arabia

Introduction: Despite advancements in dentistry, children with special needs continue to have poor oral health, with a higher prevalence of untreated dental caries and periodontal disease. Many treating dentists and the parents of these children encounter difficulty managing these children and the quality of their oral health will be determined by this. Hence, identifying and overcoming the barriers of managing children with Special Healthcare Needs (SHCN) can be assessed as important step in addressing their treatment needs. Aim: The study investigated the perceptions of general and paediatric dentists in Saudi Arabia, regarding the treatment needs and challenges posed while providing dental care to children with special needs. Materials and Methods: A cross-sectional, questionnairebased study was conducted among 447 general dentists and 76 paediatric dentists in Saudi Arabia during five month period between 15th October 2021 to 15th March 2022. A prevalidated questionnaire consisting of 18 close-ended questions assessing the knowledge, attitude and practices of the dentists related to children with SHCN was emailed to each dentist. The data was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 22.0 (IBM, Chicago, USA). The threshold for significance was established at 5%. The significance of study variables was determined utilising Chi-square test. Results: Most paediatric dentists and general dentists were of the opinion that mental/behavioural/cognitive disability was the most difficult to manage (p<0.001). Out of the total, 66.2% of the dentists were aware of the dental home concept in managing children with SHCN. The knowledge related factors that were significantly associated, included type of impairment most difficult to manage (p<0.001) and awareness of the dental home concept (p<0.001). Regarding attitude, both general and paediatric dentists agreed that providing oral care is as important as providing medical care and that they were confident in treating these children (p<0.001). The practices related factors that were significantly associated included supporting staff's comfort in treating these children (p=0.004), accessibility of clinic (p<0.001), the availability of equipment to treat (p=0.02), and the techniques most commonly used for managing the behaviour of SHCN children (p<0.001). Conclusion: The two most significant challenges to a SHCN child receiving dental care were a lack of access to a dentist who can provide oral care and limitations in the child’s cooperation during the procedure. The unmet treatment needs of these children can be considerably reduced by improving parental awareness, facilitating approaches that enhance patient compliance and providing convenient access to dental care.

Work-related Musculoskeletal Disorders, Workability and its Predictors among Nurses Working in Delhi Hospitals: A Multicentric Survey

Falguni Sharma, Sheetal Kalra, Richa Rai, Varsha Chorsiya, Sunil Dular

Introduction: Nurses are considered to be the frontline healthcare professionals with prolonged hours of caring for ailing as well as critically ill patients. This highly demanding work pattern can lead them to experience Work-related Musculoskeletal Disorders (WRMSD) and thus makes it important to study its prevalence and its impact on workability and to develop appropriate supportive strategies to improve their health and work efficiency. Aim: To explore the prevalence of WRMSDs among hospital nurses in Delhi, including the risk factors and coping strategies adopted by them to avoid the risk of WRMSDs. Materials and Methods: This multicentric survey, cross-sectional study was conducted in different hospitals in Delhi, India, from October 2020 till March 2021 among 260 nurses. Data were collected using the Nordic Musculoskeletal Questionnaire (NMQ), Perceived Stress Scale (PSS) and Workability Index (WAI). Pearson’s product moment correlation was used to develop correlations for continuous variables and Biserial correlation test was used for dichotomous variables. The level of significance was 95% (p-value <0.05). Results: The mean age and mean work duration were 35.62±7.12 years, and 8.60 hours per day, respectively. Out of total, 230 (88.5%) were females and 30 (11.5%) were males. The prevalence of WRMSD was 80% during the last 12 months with low back pain, the most commonly reported problem. The majority of nurses communicated moderate workability (47.7%) and moderate level of stress (73.5%). The result of linear multiple regression analysis showed that the independent variables of (age, work hours, type of job, back and shoulder pain) explained 46.4% of the workability index (R²=0.444, adjusted R²=0.395), and the model significant (F-value=14.76, p-value <0.001). Conclusion: Nurses are at high-risk for WRMSD as well as observing prolonged stress and reduced workability. Special measures should be taken to ensure that they work in an ergonomically acceptable workplace and that proper body mechanics and stress management practices are adopted. Lifestyle intervention would help in preventing and reducing impact of WRMSDs.

Diagnostic Yield of Closed Pleural Biopsy Using Cope’s Needle in the Diagnosis of Exudative Pleural Effusion

Preetam Goswami, Anirban Das, Rathindra Nath Biswas, Pronoy Sen, Rana Barik

Introduction: The aetiology of pleural effusion may be difficult to diagnose based on the pleural fluid cytology, biochemical and microbiological study. Pleural biopsy using Cope’s needle may help in such cases where definitive diagnosis can not be achieved with the help of cytology. Aim: To make aetiological diagnosis of undiagnosed exudative cases using Closed Pleural Biopsy (CPB) and to determine the diagnostic yield of CPB taken by Cope’s needle in aetiologically confirmed exudative pleural effusion. Materials and Methods: This prospective observation study was conducted in Department of Pulmonary Medicine at Burdwan Medical College and Hospital, Burdwan, West Bengal, India, from April 2021 to March 2022 among 52 patients. Under local anaesthesia, diagnostic and therapeutic thoracocentesis were done. The pleural fluid was sent for complete biochemical, microbiological analysis, and cytology. Later, pleural biopsy was also done using Cope’s pleural biopsy needle. The variables studied were age, gender, pleural fluid cytology, pleural fluid for Acid Fast Bacilli (AFB), gram stain, and culture and pleural biopsy histopathology. Results: Out of 52 patients, 34 (65.4%) were males and 18 (34.6%) were females. The majority of the patients (41, 78.8%) had a right-sided pleural effusion. The mean value of lymphocytes and polymorphs count was 57.7% and 32.7%, respectively. Histopathology showed granulomatous inflammation compatible with tuberculosis in 18 (34.6%) patients, non specific inflammation in 17 patients (32.7%), and 5 (9.6%) patients as adenocarcinoma. Squamous cell carcinoma was seen in 2 (3.8%), 4 (7.7%) showed undifferentiated carcinoma, while 6 (11.5%) samples had inadequate tissue for opinion. The true positives were 18 and 11 for tuberculous and malignant pleural effusion, respectively. The diagnostic yield of pleural biopsy was found to be 75% in case of tubercular pleural effusion and 78.5% for malignant pleural effusion. Conclusion: This study suggests that tuberculosis and malignancy are the two common aetiologies for exudative pleural effusion. Pleural biopsy plays an additional role in histopathological confirmation of aetiologically diagnosed exudative pleural effusion.

Profile and Outcome of DAMA among Paediatric Patients from a Tertiary Care Centre of a Non Profit Private Teaching Institute at Gujarat, India

Introduction: The problem of Discharge Against Medical Advice (DAMA) has been reported globally, including in patients of the paediatric age group. Even the Indian subcontinent faces such problems, whether, it is the private sector or public sector. Terminal illness, low affordability, social reason are a few of the common reasons for this DAMA problem. Aim: To know the outcome and demographic profile of DAMAs among paediatric patients at a tertiary care teaching institute. Materials and Methods: This mix-method, prospective descriptive study was conducted in Department of Paediatrics, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India, from March 2020 to February 2021. Contact details of patients, whose parents took DAMA from the hospital, were retrieved from the Electronic Health Record system. Interviews were recorded and the required information was gathered. Median (interquartile range), frequency, percentage and proportion of age, sex, diagnosis, and reasons of DAMAs were derived. Results: Out of a total 1752 registered paediatric patients (1 month to 18 years), 74 patients were given DAMA, of which 42 consented to interview. The mean age of the subjects were 70.36±67.9 months and 65% were males. Amongst these 42, 31 (73.81%) were taken to home and 11 (26.19%) to another hospital; 20 (47.62%) patients died. Among the rest, 6 (14.28%) had morbidity. Total deaths were 20, out of which six died within one hour, another four died within 24 hours, two died within 7 days and rest eight died any time after 7 days till contacted. Family or social reason was the top cause of DAMA, whereas, poor prognosis with or without affordability issues was next. Among all diagnoses, nearly half of the cases were infectious/ inflammatory, 10.77% tumour/malignancy, and 6.15% trauma/ head injuries. Conclusion: DAMA rate was not high in this study. But this was not preventable in majority of the cases as poor prognosis as well as family or social reasons were the major causes of DAMA.

Efficacy and Safety of Angiotensin Receptor Neprilysin Inhibitor versus Angiotensin Converting Enzyme Inhibitor in Heart Failure with Reduced Ejection Fraction- A Prospective Observational Study from a Major Tertiary Care Hospital, Assam, India

Bornali Dutta, Waseem Farooqui, Farhin Iqbal

Introduction: Angiotensin Receptor Neprilysin Inhibitor (ARNI) has shown to reduce morbidity and mortality in comparison to Angiotensin Converting Enzyme Inhibitors (ACEI) in patients of Heart Failure with Reduced Ejection Fraction (HFrEF). However, the use of ARNI in real-world practice is limited and has not been studied in North-eastern Indian population Aim: To compare the efficacy and safety of ARNI with ACEI in the management of symptomatic chronic HFrEF in North-eastern Indian population. Materials and Methods: The prospective observational study was conducted in the Department of Cardiology at Gauhati Medical College, Guwahati, Assam, India, from April 2019 to October 2020. The study included patients with diagnosis of chronic HFrEF <40%, on ACEI therapy and who had atleast one hospitalisation for Acute Decompensated Heart Failure (ADHF) in the last six months. A total of 63 patients were included in this study. Three patients were lost on follow-up. Out of the 60 patients who were included in the final analysis, 30 patients each were included in two groups i.e, ARNI group and ACEI group. As per discretion of the treating physician, the patients were started on ARNI 50 mg twice daily which consist of Sacubitril/Valsartan (24/26 mg), along with other antiheart failure medications, and they were compared with the patients who continued on ACEI. Uptitration was considered with the aim to double the dose till the target dose was achieved at every two to four weeks at the treating physician’s discretion The endpoints included the rate of repeat Heart Failure (HF) hospitalisation, mortality, renal outcomes and quality of life. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS, IBM) software version 20.0. Results: The demographics and clinical characteristics were comparable between the groups. The dose of ARNI was uptitrated to a maximum of 100 mg twice daily in 11 patients. ARNI significantly reduced HF hospitalisation (36.7% vs. 66.7%; p-value=0.039) and mortality (10% vs. 20%, p-value=0.038) compared to patients with ACEI. There was a significant improvement in the KCCQ score in the ARNI group as compared to the ACEI group (p-value=0.001). Treatment with ARNI was also associated with a significant improvement in the New York Heart Association (NYHA) functional class, serum creatinine, and estimated Glomerular Filtration Rate (eGFR) and a significant reduction in N-Terminal pro B-type Natriuretic Peptide (NTproBNP) level. Conclusion: In patients with symptomatic HFrEF, shifting to ARNI from background therapy on ACE inhibitors in comparison with continuation of ACE inhibitors appeared to be safe and superior in reducing the risk of death and of hospitalisation, when initiated on outpatient basis. ARNI could not be uptitrated in two-third of patients, yet substantial benefits are evident even at low doses in comparison to ACE inhibitor ramipril.

A Multisite Survey of E-learning Readiness and Academic Performance among Nursing Students in Saudi Arabia

Introduction: Determining students’ readiness for e-learning is critical to implementing more effective education and performance. Nursing education in Saudi Arabia continues to struggle with a shortage of technical tools to enable teaching and acquiring critical nursing skills. Aim: To assess the level of e-learning readiness and academic performance and their association in nursing students and to determine the factors associated with e-learning readiness and academic performance. Materials and Methods: A cross-sectional, multisite study was conducted on a convenience sample of nursing students (N=139) attending nursing programs from multiple public and private universities in Saudi Arabia. A structured questionnaire was used for data collection from May 2020 to August 2020. Multivariate analyses were run using Statistical Package for Social Sciences (SPSS). Results: The mean age of the study participants was 27.3±6.34 years. The total average of e-learning readiness was 4.16 (SD=0.54). Bivariate analyses showed that age was associated with both e-learning readiness (r=0.175, p=0.03) and academic performance (r=0.341, p<0.001). Employment status, level of education, and previous experience with e-learning displayed significant association with e-learning readiness (p<0.05). In multivariate analyses, only previous experience with e-learning had positive influence on students e-learning readiness (β=0.188, p<0.05). Technology access subscale (β=0.206, p<0.05) and level of education (β=0.323, p<0.05) had both positive impacts on students’ academic performance. Conclusion: The e-learning readiness score was high among the nursing students, especially if they were employed or had previous experience with it. Access to technology improved students’ academic performance. The current e-learning mechanism may need some developments in order to meet students’ different needs.

Comparison of Kinesio Taping and Nerve Flossing Technique on Balance, Gait and Ankle Flexibility in Diabetic Neuropathy

Basudeo Rajbhor, Aarti Gupta, Saurabh Kumar

Introduction: Diabetic Neuropathy (DN) is the most frequent neuropathy in developed countries, with a wide spectrum of clinical symptoms. Kinesiology Tape (KT) is a thin, stretchy, elastic cotton strip with an acrylic adhesive almost identical to human skin in both thickness and elasticity. Nerve Flossing Technique (NFT) is an alternation of combined movements of atleast two joints. Aim: To assess and compare the effects of KT and NFT on diabetic neuropathy patients’ balance, gait and ankle flexibility. Materials and Methods: This experimental study was conducted in Outpatient Department of Physiotherapy at SGT University, Gurugram, Haryana, India, from March to May 2021. Total 20 diabetic neuropathy patients were conveniently included from the hospital environment and were divided into two treatment groups. Group A (KT) included 10 patients, kinesio taping along with conventional physiotherapy and group B (NFT) included 10 patients, nerve flossing technique along with conventional physiotherapy. In both the groups, treatment was provided for three days a week for two weeks to improve their balance, gait and ankle flexibility. Performance Oriented Mobility Assessment (POMA) scores were utilised to assess balance and gait, and a universal goniometer was used to assess ankle Range Of Motion (ROM). Data was analysed by using Independent and Paired t-test. Results: The mean age in group A was 55.3±5.056 years and in group B was 55±4.714 years and there was no significant difference (t=0.137, p-value=0.892). There was a significant difference in POMA score in both the groups (t=-5.344, p-value <0.001) after two weeks of treatment. Ankle joint ROM was improved in group B than group A. Conclusion: The study concludes that KT improves balance and gait more than NFT, whereas NFT improves ankle range of motion more than KT in diabetic neuropathic patients.

Comparison between Epidural Bupivacaine with and without Magnesium Sulphate in Patients undergoing Elective Total Abdominal Hysterectomy: A Double-blinded Randomised Clinical Trial

Aishwarya Guru, S Vijay Narayanan, B Anusha

Introduction: The effectiveness of a local anaesthetics increased by the addition of an adjuvant. Magnesium sulphate along with bupivacaine is effective in reducing the pain and extending the analgesia period. Aim: To compare the duration of analgesia among subjects receiving plain bupivacaine and bupivacaine with magnesium sulphate among patients undergoing total abdominal hysterectomy. Materials and Methods: This double-blinded randomised clinical trial was conducted in Department of Anaesthesiology at Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India, (tertiary care center) between November 2019 to October 2021. The study was done among 50 subjects undergoing elective total abdominal hysterectomy. The subjects were divided into two groups: one group received only bupivacaine while the other group received bupivacaine with 500 mg magnesium sulphate. Onset and duration of blocks were observed. Haemodynamic parameters were monitored intraoperatively and postoperatively. Data was analysed using Chi-square test and Fischer’s-exact test. Results: Demographic variables like age (p-value=0.17), height (p-value=0.62), weight (p-value=0.14) and Body Mass Index (BMI) (p-value=0.24) were comparable between the two groups. The mean duration of analgesia was significantly more among the bupivacaine with magnesium sulphate group (416.72±93.6) in comparison to the bupivacaine alone group (204.96±71.25). The bupivacaine with magnesium sulphate group required two doses of rescue analgesia in 24 hours, while the other group required four doses of analgesia. Significantly more side-effects were noted among the bupivacaine alone group (12 vs 6) (p-value=0.04). Conclusion: The study showed that bupivacaine with magnesium sulphate group showed less intraoperative side effects, reduced postoperative Visual Analogue Scale (VAS) score, increased duration of analgesia, decreased requirement of analgesia required in 24 hours and reduced postoperative side-effects.

Viral Aetiology of Severe Acute Lower Respiratory Tract Infection in Children from the Paediatric Intensive Care Unit at a Tertiary Care Hospital, Eastern India- A Retrospective Study

Neha Ahuja, Somenath Gorain, Partha Pratim Pal, Mousumi Das

Introduction: Viral infections are the common source of lower respiratory tract infection worldwide. Rapid and accurate detection of viral infections is important that can prevent antibiotic abuse. However, there are few studies determining viral aetiologies in paediatric subjects in Eastern India. Aim: To study viral aetiology in children hospitalised with severe Acute Lower Respiratory Tract Infection (ALRTI) over a period of two years and to detect the impact of co-infection on severity and duration of hospitalisation. Materials and Methods: This was a retrospective study based on electronic database in a tertiary care Paediatric Intensive Care Unit (PICU) of Bhagirathi Neotia Woman and Child Care Centre, Kolkata, West Bengal, India. Data was collected for all the patients who fulfilled the selection criteria and were admitted to PICU with ALRTI from March 2018 to March 2020. The medical records were reviewed in 51 patients with positive viral Reverse Transcription- Polymerase Chain Reaction (RT-PCR). Data was collected for the type of viruses infecting the subjects and whether there were single infection or co-infection. Co-infection is simultaneous infection with more than one virus. Statistical analysis was done using the IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 24.0 (Armonk, NY: IBM Corp). Student’s t-test and Chi-square test was used to compare single infection and coinfection. A p-value <0.05 was considered significant assuming the confidence interval of 95% as the level of significance. Results: The highest positivity rate was 66.7% (34/51) observed in children in the age group 1-12 months. The common viruses detected were adenovirus seen in 26 subjects, Respiratory Syncytial Virus (RSV) in 16 subjects and Rhino/Enterovirus in 12 subjects. Clustering of cases were observed for RSV and influenza A in the colder months of the year. Single infection was seen in 74.5% of samples and co-infection in 25.5%. Comparison between single and co-infection with two viruses in terms of complications (p-value=0.163), average duration of PICU stay (p-value=0.70), C-reactive protein (p-value=0.952), procalcitonin (p-value=0.198), white blood cell count (p-value=0.737), absolute neutrophil count (p-value=0.612) were not significant. Conclusion: This present study found that adenovirus and RSV were the leading viral pathogens for ALRTI in the PICU. Co-infection with multiple viruses compared with a single viral infection in a patient did not impact severity.

Motivational Factors and Post Vaccination Symptoms among COVID-19 Vaccinated Beneficiaries at a Tertiary Care Hospital, West Bengal, India: A Cross-sectional Study

Nabanita Chakraborty, Maumita De, Jhuma Sarkar

Introduction: Since, the emergence of Coronavirus Disease-2019 (COVID-19) pandemic, there has been an intense burden on the health system and economy worldwide with millions of people being affected leading to several deaths. In this scenario vaccination seems to be a hope to control the pandemic. However, fear of adverse events following immunisation sometimes makes people hesitant about vaccination. Aim: To assess the spectrum of post vaccination symptoms and also to identify the motivational factors along with their determinants at a tertiary care hospital, West Bengal, India. Materials and Methods: A cross-sectional study was conducted in the COVID-19 Vaccination Centre at Nil Ratan Sircar Medical College and Hospital, Kolkata West Bengal, India (tertiary care hospital), from August to November 2021. A total of 448 vaccinated beneficiaries were enrolled in the study. Data collection was done by an online questionnaire, sent to the participants in their registered mobile numbers. Descriptive statistics and Chi-square tests were used for data analysis. Results: Among 448 study participants, 262 (58.5%) were in 18-44 years of age group, 248 (55.4%) female, 384 (85.7%) Hindu, 132 (29.5%) medical or paramedical students, 290 (64.7%) passed graduation and above and 306 (68.3%) belonged to nuclear family. About 228 (50.9%) beneficiaries reported post vaccination symptoms. Most common being local pain at injection site, found among 150 (65.8%) out of them. Most common motivational factors of COVID-19 vaccination were found to be fear of COVID-19 infection, reported by 274 (61.2%) participants, which showed significant difference with various age groups (p-value=0.001), religions (p-value=0.030), occupations (p-value<0.001) and educations (p-value=0.002). Statistical significant (p<0.05) differences were also found according to age, gender, co-morbidities, interval between vaccination and past COVID-19 infection and type of COVID-19 vaccine in relation to onset of post vaccination symptoms. Conclusion: Following COVID-19 immunisation minor adverse events were reported. Monitoring of those adverse events will help in further responding and prompt action. Also, the knowledge about motivational factors is expected to reduce vaccine hesitancy among unvaccinated people.

Splenectomy in Sickle Cell Haemoglobinopathies from a Tertiary Hospital of Southern Odisha: A Retrospective Study

Introduction: Sickle Cell Disease (SCD) is a common haemoglobinopathy, where spleen is considered to be the first organ to be involved. Although it initially undergoes enlargement, but most often there occurs autosplenectomy. But in some cases, there is persistence of splenomegaly which may be associated with various complications. In these situations, splenectomy is considered as a good option to mitigate all these morbidities. Aim: To analyse the effect of splenectomy on haematological parameters and complications in patients of SCD in postoperative period. Materials and Methods: This was a retrospective study conducted at SLN Medical College and Hospital, Koraput, Odisha, India, from April 2019 to March 2021. Total 42 patients of SCD underwent splenectomy. The haematological parameters {Haemoglobin (Hb), Total Leukocyte Count (TLC) and Total Platelet Count (TPC)} and blood transfusion needs were compared in preoperative and postoperative periods and analysed statistically with Student’s t-test. Results: Primary indication of splenectomy was hypersplenism 31 (73.8%) followed by splenic sequestration crisis in 8 patients (19.05%) and splenic abscess in 3 patients (7.1%). Postsplenectomy haemoglobin improvement was around 5.17 gm% (p-value<0.001). Postoperative complication was also minimal, seen in only eight patients, it was mostly due to surgical site infection (n=6) and fever (n=8). Preoperative blood transfusion rate was 9.07±1.92. Blood transfusion requirement rates were also drastically reduced to 0.5±0.707 postsplenectomy in these patients (p-value<0.001). Conclusion: Following splenectomy, the need of blood transfusion was grossly reduced and also, the incidence of its complication was reduced.

Comparison between Dexamethasone Alone and its Combination with 5-Hydroxytryptamine Receptor Antagonist for Antiemesis during Laparoscopic Surgeries: A Double-blind Randomised Clinical Study

HG Manjunath, G Sandeep, Greeshma Murdeshwar

Introduction: Post Operative Nausea and Vomiting (PONV) are often associated with the laparoscopic surgeries under General Anaesthesia (GA). The PONV guidelines recommended the use of 5-hydroxytryptamine receptor antagonist (5-HT3RA) as the first-line prophylactic agents in patients categorised as high-risk for emesis perioperatively. There are very few studies comparing the efficacies of combinations of newer 5HT3 RA with dexamethasone. Aim: To compare the severity of emetic episodes as well as the complete response rate to antiemetics like dexamethasone or its combination with palonosetron or ramosetron during the first 48 hours after laparoscopic surgeries. Materials and Methods: This randomised clinical double-blind study was conducted in the Department of Anaesthesiology at Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from November 2014 to August 2016 among 90 patients, aged between 18 to 60 years belonging to the American Society of Anaesthesiology (ASA) grade I and II scheduled for elective laparoscopic surgery under general anaesthesia. They were randomly allocated into three equal groups. Group D received dexamethasone 8 mg, group RD received ramosetron 0.3 mg with dexamethasone 8 mg, and group PD received palonosetron 0.075 mg with dexamethasone 8 mg. Postoperative Nausea and Vomiting (PONV), retching were recorded via direct questioning or by the spontaneous complaints from the patients at 2, 6, 24, 48 hours. A scoring system was used to assess PONV. Complete response rate was also noted i.e, percentage of patients in a group with absence of nausea, retching, vomiting and no requirement of rescue antiemetic medications within postoperative 48 hours. Results: The baseline characteristics were similar in all three groups. Early and late PONV were significantly lesser with group PD compared to group D (p-value=0.01) and group RD (p-value=0.007). The complete response rate in group PD (86.6%) was significantly highest compared to group D (40%) and group RD (76%). Rescue anlgesics required was nil in group PD compared to group D (36.3%), and group RD (10%) over 48 hours. Conclusion: Combination of palonosetron with dexamethasone is a better alternative to combination of ramosetron with dexamethasone in preventing PONV.

Comparison of Optical Properties of Clear Aligners Before and After In-vivo Aging

Binu Punnoose Gold, Duraisamy Sangeetha, Ravi Kannan

Introduction: There is a rising demand for clear aligners among orthodontic patients and after the expiry of invisalign patent many indigenous aligners have been introduced in several part of the globe including India. The major advantage of the aligners is its invisibility which is attributed to its unique optical properties. The optical properties vary between different aligners and any changes in the optical properties during the clinical use is an important factor to be considered. Aim: To evaluate and compare the optical properties of three different types of indigenous clear orthodontic aligners before and after in-vivo aging. Materials and Methods: A prospective clinical study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, SRM Dental College, Chennai, Tamil Nadu, India, from August to December 2021. Total 36 volunteers participated in the study and were divided into three study groups. In group A subjects had Clearbite aligners (JJ Orthodontics Pvt. Ltd, Thrissur, Kerala), group B had Dentcare clear aligners (Dent Care Dental Lab Pvt. Ltd. Ernakulum, Kerala) and group C had Smile aligners (smile aligners Inc. Mumbai, Maharashtra). Polyvinyl siloxane impression of the maxillary arch was obtained and sent for the fabrication of two sets of clear aligners. One set of aligners were used to measure absorbance and transmittance before invivo aging and another set after an intraoral use of 14 days. The measurement of absorbance and transmittance were made at the wavelength range of 400-700 nm using a Shimadzu UV-3600i Plus UV-Vis-NIR spectrophotometer. Intergroup and intragroup comparisons were done using Independent sample t-test and One-way Analysis of Variance (ANOVA). Results: In all the three groups of aligners evaluated, an increase in the absorbance values was noted at all the wavelengths after in-vivo aging but the increase was not statistically significant (p-value >0.05). Transmittance values of group A samples reduced after in-vivo aging but not significantly, whereas group B values reduced significantly between 400-440 nm (p-value <0.05) and group C values reduced significantly between 400-460 nm and 680-700 nm (p-value <0.05). Intergroup comparison of the mean absorbance and transmittance values of the group A, B and C samples before and after in-vivo aging showed no significant difference at all wavelengths (p-value >0.05). Conclusion: The absorbance and transmittance values of all the three indigenous aligners did not change significantly after invivo aging at most of the evaluated wavelengths.

Cytogenetics in Acute Lymphoblastic Leukaemia Patients: A Retrospective Study from a Teaching Hospital in Karnataka, India

Girish Kamat, Mekhala Rao, Deepak Goni, Girish Balikai

Introduction: Cytogenetic assessment is an essential test in patients with Acute Lymphoblastic Leukaemia (ALL), as it is required for diagnosis, treatment and to know the prognosis. Although these tests are done as standard of care in most of the institutes, there are limited publications from India describing karyotypic abnormalities in ALL patients. Aim: To assess the various cytogenetic abnormalities encountered in patients suffering from ALL and to know the pattern of chromosomal abnormalities. Materials and Methods: This retrospective cross-sectional study was conducted at a tertiary care teaching hospital in Karnataka, India. Patients who were diagnosed with ALL based on flow cytometry between January 2017 to June 2021 were included in the study and total 61 patients were evaluated for the cytogenetic findings. The medical records of these 61 patients were reviewed to collect their details like age, sex, immunophenotype and cytogenetic findings. Results: During flow cytometry analysis, side scatter vs Cluster of Differentiation 45 (CD45) expression strategy was applied. Events with low side scatter and dim CD45 expression (blast gate) was gated. Leukaemias expressing precursor markers (CD34/HLA-DR) along with cytoplasmic/surface CD3 were diagnosed as T-cell Acute Lymphoblastic Leukaemia (T-ALL). Leukaemias with precursor markers along with any two out of three B-cell markers i.e CD19, CD79a or CD10 were diagnosed as B-cell Acute Lymphoblastic Leukaemia (B-ALL). In this study 13 patients out of 35 had normal karyotype and this was the most common cytogenetic finding. The most common cytogenetic abnormality in B-ALL patients was hypodiploidy, but t(9;22) (q34;q11.2) was the most common cytogenetic abnormality in adult patients with B-ALL. Among the patients with T-ALL, only 2 (15.38%) patients had chromosomal abnormalities. Conclusion: The present study highlights the role of cytogenetics in patients undergoing treatment for ALL. Chromosomal abnormalities like t(9;12) (q13;p11.2), t(X;1) (q13;p36.1) and t(9;15) (p13;q11.2) are novel chromosomal abnormalities which were found in the present study. Long-term follow-up is necessary to identify prognostic implications of such chromosomal abnormalities.

Effect of Mobile Phone Radiation on Parotid and Submandibular Salivary Glands- An Ultrasonographic Study

Introduction: In this era of digitalism, mobile phones have become a cultural accessory. Frequent smartphone usage results in possible adverse effects from low radiofrequency radiation and thermal effect emitted by these devices. One of the major concerns is salivary glands as the mobile phones are held against the side of face in close proximity to these glands. Aim: To assess the effect of cell phone radiation on the volume, systolic velocity, salivary flow rate of parotid and submandibular gland between the dominant and non dominant side of mobile phone users. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Medicine and Radiology, Government Dental College and Hospital, Kadapa, Andhra Pradesh, India, from September to November 2021. The sample size of 100 (50 males and 50 females). Inclusion criteria were based on the frequency of mobile phone usage of more than two hours per day. Mobile phone usage was determined based on patient’s answer to the questionnaire. Ultrasonography (USG) of both parotid and submandibular gland was done bilaterally to measure the volume of the glands and colour doppler of external carotid artery to measure systolic velocity. Modified Schirmer tear strips were used bilaterally to measure unstimulated salivary flow rate. The data was entered into MS excel and significance was calculated using independent sample t-test. Results: In parotid gland, mean volume, mean systolic velocity and mean salivary flow rate were of higher value in the dominant side (14.22±2.17 mL; 15.14±3.74 cm/s; 0.37±0.26 mm/5 mins) compared to the non dominant side (13.76±2.14 mL; 14.53±3.39 cm/s; 0.24±0.2 mm/5 mins). In submandibular gland, mean volume, mean systolic velocity and mean salivary flow rate were of higher value in the dominant side (9.60±1.96 mL; 15.70±6.44 cm/s; 0.30±0.22 mm/5 mins) compared to the non dominant side (8.88±2.17 mL; 13.87±4.83 cm/s; 0.26±0.21 mm/5 mins). Conclusion: The volume, systolic velocity of blood flow, the salivary flow rate, of the parotid gland and submandibular gland were significantly more on the dominant side than the non dominant side of mobile phone usage. The study emphasised that prolonged mobile phone usage causes biological changes in salivary glands and its flow rate.

Comparison of Plaque Removal Efficacy of Toothbrush with Bristle Containing Neem and Charcoal for Maintaining Oral Hygiene: A Randomised Clinical Trial

Introduction: To facilitate good oral health, plaque control by toothbrushing is of utmost importance. The poor oral hygiene leads to accumulation of plaque and calculus. It is the primary aetiological factor for gingival diseases. Aim: To compare the plaque removal efficacy of toothbrush bristles containing neem and charcoal to assess the effect on oral hygiene. Materials And Methods: This was a double-blind, randomised clinical trial conducted among 30 participants of age group between 33 to 44 years, who reported to the Outpatient Department of Sharad Pawar Dental College and Hospital, Maharashtra, India, for 21 days, in June 2021. Neem and charcoal toothbrushes were given to allotted participants and plaque index was measured at baseline, 7^th day, and 15^th day. For intergroup and intragroup comparison Independent t-test and repeated measures Analysis of Variance (ANOVA) tests were used. Results: The mean plaque index score of neem toothbrush and charcoal toothbrush at baseline was 2.13 and 2.18 and, on day 7^th was 1.79 and 1.48, respectively. No significant difference was found between the plaque scores of both the groups at baseline and seven days. However, a statistically significant difference was observed in the plaque index at 15^th day between neem (1.21) and charcoal (0.61) groups with p-value=0.004. Conclusion: It is concluded that when compared to neem toothbrushes, charcoal toothbrushes had greater plaque control efficacy for maintaining good oral hygiene.

Effect of Tinospora cordifolia on Oxidative Stress Level due to Drug Induced Nephrotoxicity: An Experimental Study

Janani Maheshwari V Vyas, Senthil Kumar Sampath Kumar, Leena Dennis Joseph

Introduction: Various herbs are known to confer nephroprotectivity against renal damage of different origins. Tinospora cordifolia (Willd.) Miers is known to treat kidney disorders. Yet, a lacuna of studying the protective effect of the herb on drug induced nephrotoxicity at different time periods exists. Aim: To determine the protective effect of T. cordifolia (Willd.) Miers on drug induced nephrotoxic biochemical changes upon post-treatment with the herb. Materials and Methods: An experimental study was carried out at the Centre for Toxicology and Developmental Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from September 2020 to October 2020. Gentamicin induced drug nephrotoxicity model was employed for the study. The ethanolic extract of T. cordifolia was prepared. Total 51 adult male Wistar rats were housed under standard animal laboratory conditions for 30 days and were assigned to four groups: Control group (Olive oil, per os), Nephrotoxicity group (Gentamicin), Toxicity cessation group (Gentamicin-Olive oil) and Post-treatment group (Gentamicin T. cordifolia ethanolic extract). To induce nephrotoxicity, gentamicin (100 mg/kg) was administered through the Intraperitoneal (IP) route for 8 days. The ethanolic extract of the stem of T. cordifolia (Willd.) Miers (400 mg/kg) was administered orally for one, two and three weeks following nephrotoxicity induction. Levels of activity of Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx), Reduced Glutathione (GSH) content and Lipid peroxidation in the kidney were measured. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) and Post-hoc tests. Results: The reduction in SOD (6.33±1.19 unit/ mg/mt), CAT (57.56±25.89 mcm/mt/mg ptn), GPx (5.79±1.87 nm/mt/mg ptn) activity, and GSH (4.98±0.31mcm/g tissue) levels and increase in the lipid peroxidation (196.28±100.05 nm/g tissue) in the kidney due to gentamicin nephrotoxicity was reversed upon post-treatment with T. cordifolia (Willd.) Miers extract for 1 week (7.06±0.25 unit/mg/mt, 119.69±22.79 mcm/mt/ mg ptn, 7.08±1.73 nm/mt/mg ptn, 6.19±0.99 mcm/g tissue and 93.10±9.11 nm/g tissue), 2 weeks (7.03±0.43 unit/ mg/ mt, 181.79±39.00 mcm/mt/mg ptn, 5.07±0.81 nm/mt/mg ptn, 7.58±0.73 mcm/g tissue and 188.31±54.89 nm/g tissue) and 3 weeks (7.81±0.47 unit/mg/mt, 165.83±37.48 mcm/mt/ mg ptn, 3.92±1.87 nm/mt/mg ptn, 7.03±1.28 mcm/g tissue, 214.40±72.93 nm/g tissue). Conclusion: Post-treatment with T. cordifolia (Willd.) Miers stem extract is protective in drug induced nephrotoxic condition, even upon 1 week of administration. Its therapeutic influence on the alterations in the oxidative stress markers and antioxidant levels produced due to gentamicin nephrotoxicity has been demonstrated.

Effect of Various Concentrations of Sodium Hypochlorite on the Microhardness of Bulkfill Restorative Composite Resin used as a Pre-endodontic Restoration

Introduction: A four-walled access cavity plays a vital role in successful endodontic treatment. The materials used for preendodontic restoration are flowable composites, restorative composite resins, packable composite resins, silver amalgam, or glass ionomer cement. Researchers have claimed that exposure of composite resins to low pH liquids and root canal irrigants can have a deleterious effect on their physical and mechanical properties. Aim: To evaluate the microhardness of a bulk-fill restorative composite resin material before and after being exposed to distilled water, 1% sodium hypochlorite, 3% sodium hypochlorite, and 5% sodium hypochlorite. Materials and Methods: This was an in-vitro experimental study that was conducted at the Department of Conservative Dentistry and Endodontics, M.G.M Dental College and Hospital, Mumbai, Maharashtra, India, over a period of eight months from January 2021 till August 2021. Total 32 disc-shaped samples were made from a bulk-fill restorative composite resin, 3M^TM Filtek Bulk fill posterior restorative composite resin (3M^TM, St. Paul, MN, USA). Each disc was prepared using polytetrafluoroethylene (Teflon) molds of 10 mm inner diameter and 4 mm depth. The bulkfill composite resin discs were randomly divided into four main groups, group 1 (distilled water), group 2 (1% NaOCl), group 3 (3% NaOCl), and group 4 (5% NaOCl), with eight samples in each group. Baseline Vickers hardness testing was performed for each group using a 100 gram load and a dwell time of 10 seconds before being immersed in the irrigation solution. Pre and post immersion microhardness measurements were done on the same surface of each sample (top surface). Data obtained were subjected to normality tests. Further statistical analysis was done using one-way Analysis of Variance (ANOVA) followed by the Games-Howell test for pair-wise comparisons. Results: Irrespective of the different concentrations of sodium hypochlorite irrigant, all samples showed a reduction in microhardness of bulk-fill composite restorative resin. The post immersion microhardness mean values were highest in group 1 (63.06) and lowest in group 4 (58.42), and the difference was statistically significant (p<0.001). No statistical difference was seen between group 3 and group 4. On intragroup comparison, all the groups show statistically highly significant difference between pre and post immersion microhardness values {Paired-t test (p<0.05)}. Conclusion: Microhardness of bulk-fill composite restorative resin was lowered by different concentrations of sodium hypochlorite irrigant.

Experience of Nursing Interns during COVID-19 in Taif University, Saudi Arabia: A Qualitative Study

Ahmed S Alkarani

Introduction: Coronavirus Disease-2019 (COVID-19) has affected nursing staff and students mentally and physically due to their role in the frontline fighting the virus. However, data on the effect of COVID-19 on nursing students are limited and there have been no studies about Saudi nursing intern experience during this crisis. Aim: To explore the impact of COVID-19 pandemic on nursing students during their interns at hospitals and how they dealt with the COVID-19 pandemic. Materials and Methods: A qualitative descriptive study was done where 12 interviews were conducted among nursing student at the Nursing Department in the College of Applied Medical Science at Taif University, Taif, Saudi Arabia. The study was conducted from 1^st January 2021 to 10^th April 2021. The descriptive method was used to collect, understand, organise and represent in depth data. All the nursing student participants were interns and started their intern programmes during the COVID-19 pandemic. All interviews were auto-recorded, transcribed and analysed using a thematic method. Results: The four themes which emerged from findings were: student plans during COVID-19; students’ perspectives of the nursing profession; intern students’ mental states; and hospital roles. Conclusion: While the virus may negatively affect the experience of nursing intern students, the support of the media and society towards nursing staff during the pandemic has encouraged them significantly. So this study recommended that nursing stakeholders collaborate with the media to create greater interaction and embrace the nursing profession for younger generations.

Role of Serum Retinol Binding Protein 4 (RBP4) Concentration in Patients with Primary Hypertension: A Case-control Study

Introduction: Serum Retinol Binding Protein 4 (RBP4), an adipokine that transports vitamin A from the liver to other tissues, is reported to be elevated in hypertensive subjects. Positive correlation between RBP4 and cardiovascular risk factors has been noted in a few studies. Aim: To evaluate serum RBP4 levels in newly diagnosed primary hypertensive cases and non hypertensive controls and to correlate serum RBP4 levels with lipid profile. Materials and Methods: This case-control study was conducted at the Department of Biochemistry in collaboration with the Department of Medicine, from August 2019 to June 2020 in MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 51 newly diagnosed primary hypertensive patients and 51 healthy age and sex-matched individuals between the ages of 18-50 years were enrolled in the study. Systolic and Diastolic Blood Pressure (SBP and DBP) were measured in both cases and controls. Serum RBP4 was measured by Enzyme-Linked Immunosorbent Assay (ELISA) and other biochemical parameters were measured by TBA120FR autoanalyser. Statistical analysis of the data was done by using Statistical Package for Social Sciences (SPSS) software, version 22.0. Results: The mean age for controls was 36.98±8.7 years and that in cases was 39.00±8.4 years. Proportion of males was higher (56.8%) than females (43.2%). The mean SBP in the case group was significantly higher as compared to the control group. The cases had a higher level of serum RBP4 (31.82 mg/L) compared to the control groups (15.5 mg/L) RBP4 (p<0.001). The cases had a higher level of mean serum triglyceride (196.20±67.81 mg/dL) and lower level of mean serum High-Density Lipoprotein cholesterol (HDLc) (37.53±11.90 mg/dL) as compared to the control groups which had a mean triglyceride of 104.25±39.89 mg/dL and HDLc of 57.18±10.73 mg/dL (p<0.001). The serum RBP4 level positively correlated with SBP (r=0.644, p<0.001), DBP (r=0.444, p<0.001), serum triglycerides (r=0.649, p<0.001), and negatively correlated with HDLc (r=-0.313, p=0.025) Conclusion: A high serum RBP4 level was found in the newly diagnosed hypertensive cases as compared to normotensive controls. A significant positive correlation was observed between RBP4 with SBP and DBP along with triglyceride levels. A significant negative correlation was observed between RBP4 with HDLc.

Correlation between Maternal Mid Upper Arm Circumference and Neonatal Birth Weight: A Case-control Study

Introduction: Birth weight is the best marker of optimal foetal growth and development. Apart from being an important determinant of newborn survival, Low Birth Weight (LBW) also indicates nutritional deprivation and poor health of the mother during and before pregnancy. On the other hand, Maternal nutrition and anthropometry also affect infant’s birth weight. Aim: To find out the correlation of maternal Mid Upper Arm Circumference (MUAC) and neonatal birth weight. Materials and Methods: This case-control study was conducted at Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre (tertiary care hospital), Nagpur, Maharashtra, India, from September 2021 to February 2022. Convenient sampling method was used to select cases and control. All the mothers who had delivered full term live singleton new born with birth weight <2.5 kg were selected as a case and mothers who had delivered singleton new born babies ≥2.5 kg were selected as a control. There was a total of 100 mother-infant dyads with 50 pairs having infant with LBW (cases) and the rest 50 with infants having normal birth weight (controls). Data was collected on the socio-demographic status of the mothers using a predesigned questionnaire along with their weight (from record), maternal MUAC measurement, and birth weight of their babies. Analysis was done using Statistical Package for Social Sciences (SPSS) version 16.0. Results: Mean age of cases was 24.48±2.757 years and that of controls was 24.52±2.255 years. Mean birth weight was 2206±200.9 gm for cases and 2934±305.79 gm for the control group. Maternal MUAC was ≤23 cm in 52% of cases and only 16% in controls (OR- 5.69, CI: 2.23-13.74, p-value=0.001). A linear correlation was found between maternal MUAC and birth weight (r-value=0.3376, p-value=0.001). Conclusion: As there was a positive correlation between maternal MUAC ≤23 cm and LBW babies, maternal MUAC can be used as a predictor of LBW, and hence, measurement of maternal MUAC should be included during antenatal check-ups.

Prevalence of Anaemia in Women with Unsupervised Medical Abortion- An Observational Study

Neelam Patel, Gurpreet Kaur, Uttara Gupta

Introduction: According to American College of Obstetricians and Gynaecologists (ACOG) and other organisations such as the Society of Family Planning (SFP) and American Society for Reproductive Medicine (ASRM), abortion services are considered as an essential component of comprehensive healthcare. Such services are considered as a time-sensitive issue, as delay in getting comprehensive abortion services may be associated with significant impact on physical health, wellbeing and mental health of the individual. Aim: To determine proportion of women presenting to Gynaecologyy Outpatient Department (OPD) with unsupervised use of abortion pills and to estimate the percentage of anaemia among these women. Materials and Methods: The present observational study was conducted on 148 women attending the Gynaecology OPD in People’s Hospital, Bhopal, Madhya Pradesh, India and seeking treatment for complications due to unsupervised use of abortion pills during the study period of 18 months. A thorough history was obtained and a thorough physical examination was conducted. Haemoglobin estimation and Ultrasonography (USG) was done to determine complications. Data was compiled using Microsoft excel and results were expressed in terms of frequency and percentages and mean±SD. Results: During the study period, a total of 360 cases with abortions were registered, of them 150 cases were unsupervised attributing to 41.7% cases. Out of 150 females with unsupervised abortions, 2 females did not give consent to participate and thus a total of 148 females were enrolled. Consumption of unsupervised abortion pills resulted in incomplete abortion in 77 (52%) cases, while complete abortion was reported in only 22 (14.9%) cases. Other complications observed in a few cases were septic shock, in 7 (4.7%) haemorrhagic shock in 4 (2.7%), secondary infertility in 3 (2%), inevitable abortion in 3 (2%), ruptured ectopic pregnancy in 3 (2%) and chronic ovarian ectopic in 1 (0.7%). Missed abortion was documented in 20 (13.5%) cases after complete examination and in 8 (5.4%) cases viable intrauterine pregnancy was diagnosed. Mild, moderate and severe anaemia was observed in 19 (12.8%), 98 (66.2%) and 12 (8.1%) females, respectively. Conclusion: The unsupervised use of abortion pills not only increases maternal morbidity but also has been associated with life threatening complications such as septic shock, haemorrhagic shock, ruptured ectopic pregnancy etc. Anaemia is one of the most common complication of unsupervised pill consumption and preventing the latter may obviate the need for blood transfusion.

Role of Transvaginal Sonographic Parameters in Predicting Outcomes of Induction of Labour: A Prospective Observational Study

Sangeeta Gupta, Neetika Pandey, Taru Gupta

Introduction: Induction of labour is an artificial method of initiating uterine contractions before the onset of spontaneous labour, which leads to progressive cervical dilatation and effacement followed by delivery. Bishop score is the most commonly used method for assessing the favourability of the cervix. However, this method is subjective and less accurate. Transvaginal ultrasonography (TVS) has been demonstrated to be more sensitive than the Modified Bishop score in predicting successful labour induction in recent years as it avoids interobserver variations. Aim: To know the role of TVS parameters in predicting the outcome of induction of labour and to compare with the predictive power of the Modified Bishop score. Materials and Methods: This was a prospective observational study conducted between October 2019 to April 2021 in the Department of Obstetrics and Gynaecology, ESIC PGIMSR, Basaidarapur, New Delhi, India. The study was conducted on 124 pregnant women. Preinduction TVS was performed using a transvaginal probe of 6 MHz and a transabdominal probe of 3.75 MHz. Ultrasound was used to determine cervical length, posterior cervical angle and foetal head position. Following the ultrasonographic examination, a digital examination of the cervix was done, and a score was assigned based on the Modified Bishop score. The induction of labour was performed as per hospital protocol. For the purpose of this study, the successful outcome was taken as a vaginal delivery within 24 hours from the start of induction. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 25.0. McNemar’s test was used to compare sensitivity and specificity. Qualitative variables were correlated by the Chi-square test/Fisher’s exact test. Results: A total of 124 patients were selected, who underwent induction of labour. Out of these 92 (74.2%) patients who delivered vaginally, 81 patients delivered within 24 hours of induction and 11 patients delivered after 24 hours of induction, rest 32 patients delivered by caesarean. So, the unsuccessful outcome was in 8.87% the of study population. Modified bishop score, TVS cervical length, posterior cervical angle and foetal head position, all were found significant in predicting the successful induction of labour. Cervical length measured by ultrasonography can be used as a significant predictor of the successful induction of labour (p<0.001) with an optimum cut-off of <3.65 with sensitivity and specificity of 99.1% and 79.5% respectively. The posterior cervical angle can also be used as a significant predictor of successful induction of labour. Modified bishop score can be used as a significant predictor of successful induction of labour (p<0.001) with an optimum cut-off of >2 with sensitivity and specificity of 98.13% and 82.35% respectively. Although, all ultrasound parameters when combined and compared with the Bishop score were found to be more significant in predicting successful induction of labour. Conclusion: TVS parameters when combined were found to be more specific and sensitive as compared to the Modified Bishop score in predicting successful labour induction.

Ultrasound Guided versus Peripheral Nerve Stimulator Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Clinical Study

Introduction: The Transversus Abdominis Plane (TAP) block is a relatively simple technique that provides analgesia that, as part of a multimodal analgesic treatment, may be useful in the prevention of postoperative pain. Ultrasound (USG) versus Peripheral Nerve Stimulator (PNS) guided TAP blocks are being frequently given postoperatively for pain these days in laparoscopic cholecystectomy. Aim: To assess the analgesic efficacy of USG guided and PNS guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The randomised clinical study was conducted in the Department of Anaesthesiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from March 2020 to June 2021. Total 90 adult patients were enrolled and randomly allocated into three groups. Group 1 (n=30) received bilateral USG guided TAP block with 20 mL of 0.375% ropivacaine along with standard postoperative analgesia regimen. Group 2 (n=30) received bilateral PNS guided TAP block with 20 mL 0.375% ropivacaine along with standard postoperative analgesia regimen. Group 3 (Control) (n=30) received standard postoperative analgesia regimen consisting of inj. paracetamol iv 1 gm (six hourly) and inj. diclofenac 75 mg i.v. (12 hourly). Each patient was assessed for VAS score, duration of analgesia, total analgesic consumption and patient satisfaction for 24 hours postoperatively. Results: The average mean VAS score in first 24 hrs was 2.04±0.80 in group 1, 2.10±0.70 in group 2 and 3.18±0.63 in group 3. The duration of analgesia was least in group 3 (5.8±2.31 hrs) followed by group 2 (9.67±2.47 hrs) and maximum in group 1 (11.87±2.97 hrs). The total tramadol requirement in first 24 hours postoperatively was 126.67±44.98 mg in group 1, 140±62.15 mg in group 2 and 226.67±63.97 mg in group 3. Conclusion: Postoperative analgesia with USG and PNS guided TAP block enables better pain control and less analgesic consumption. PNS guided TAP block is good alternative when compared with control for postoperative analgesia when USG machine is not available.

Postoperative Analgesic Efficacy of Transverse Abdominis Plane Block versus Port Site Local Infiltration in Laparoscopic Gynaecological Surgeries- A Randomised Clinical Trial

MS Anusha, K Udaya Bhaskar, Jaganath, T Dharani Priya, Mohan Koyee

Introduction: Pain relief postoperatively has advantages related to better patient satisfaction in terms of early ambulation and discharge and also better cardiovascular stability, decreased infections, neurological complications, prevention of thromboembolic phenomenon, and chronic pain syndrome. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are the most commonly used drugs in pain management. Transverse Abdominis Plane (TAP) block is a regional analgesic technique, which provides analgesia of the anterolateral abdominal wall and hence can be used to provide analgesia for caesarean section, hernia repairs, hysterectomies, cholecystectomy. Aim: To compare the effectiveness of bilateral TAP block versus port sites local anaesthetic infiltration to relieve postoperative pain in laparoscopic gynaecological surgeries. Materials and Methods: This single-blinded randomised clinical study conducted at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The clinical trial was conducted on 80 patients belonging to American Society of Anaesthesiologist (ASA) I and II posted for elective laparoscopic gynaecological surgeries. Patients were randomly allocated into two groups with 40 patients in each group. Group T (TAP block) received 0.6 mL/kg of 0.25% bupivacaine for bilateral ultrasound guided TAP block and group O (port sites local infiltration) received 0.6 mL/kg of 0.25% bupivacaine for port sites infiltration. At the end of surgery, patients received either TAP block or port site infiltration as per the group allocated and then extubated. Postoperative pain intensity using Visual Analogue Scale (VAS) score were recorded at the time of shifting as 0 hr and then every 2 hrs, 4 hrs, 6 hrs, 8 hrs, 12 hrs and 24 hrs. The mean time for first rescue analgesia and total number of rescue analgesic given in first 24 hrs were noted. Haemodynamic parameters and side-effects with study drug were noted. For inferential statistics, numerical data was analysed by Chi-square test and for categorical data student’s t-test was used. A p-value <0.05 was considered as statistically significant. Results: Demographic parameters in both groups were comparable. There was no significant difference in VAS score upto 4 hours in between two groups. But mean VAS score was significantly low in group T when compared to group O at 6 hours (2.2±0.4 vs 2.7±0.5), 8 hours (2.7±0.4 vs 3.2±0.7) and 12 hours (3.3±0.5 vs 3.6±0.5). The time to receive rescue analgesic was longer in TAP block group (13.7±1.5 vs 10.6±1.64 hrs) when compared to port sites local infiltration group. And total number of rescue analgesia received was low in TAP block group (70% recieved single dose) when compared to port sites local infiltration group (80% received two doses). Conclusion: The TAP block and port sites infiltration in patients undergoing laparoscopic gynaecological surgeries are used for effective postoperative analgesia as part of multimodal analgesia, which reduces the use of other analgesics like NSAIDS and opioids. However, TAP block provides superior and prolonged pain relief when compared to port sites local infiltration.

Light-emitting Diode Vein Finding Device in Facilitating Peripheral Intravenous Cannulation in Children: A Randomised Clinical Study

Satyaveer Verma, Nidhi Bangarwa, Geeta Ahlawat, Kirti Kamal

Introduction: Peripheral venous cannulation in the paediatric age group is always a challenging task. The transillumination technique improves the visualisation of veins. The Light Emitting Diode (LED) vein finder device is based on the side transillumination principle. Aim: To evaluate the role of transilluminating LED vein finder device (Optramed Vein-Lite), for peripheral intravenous cannulation in children with respect to ease of cannulation, time taken and number of attempts. Materials and Methods: This randomised clinical study was conducted in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2018 to January 2020. Total 130 patients, age <3 years, of either sex, and scheduled for surgery under general anaesthesia were included in the study. They were randomised into two groups. Group I (n=65), where venous cannulation was done using a transilluminating LED vein finder device, and group II (n=65) where venous cannulation was done after visualising and palpating the vein manually (conventional technique). Both the groups were compared with respect to the Difficult Intravenous Access (DIVA) score, number of attempts, ease of intravenous (i.v.) cannulation (cannulation on first or second attempt as ‘easy’, more than two attempts as ‘difficult’ cannulation) and time required for intravenous cannulation. The qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: The mean age of the population in group I was 17±13 months, and in group II was 15±23 months (p-value=0.5427). There was a significant variation with respect to the number of attempts; the first attempt success was 90.7% in group I vs. 63% in group II (p-value=0.0014). In group I, cannulation was easy in 95% of patients, while in group II, only 76.9% of patients had easy cannulation (p-value=0.0018). Time taken for intravenous cannulation in group I was 19.385±6.2015 sec and in group II was 22.886±11.6716 sec (p-value=0.0346). Conclusion: Transillumination is a useful technique to improve the success rate of peripheral venous cannulation in infants and children.

Predictability of STOP-Bang Questionnaire and Epworth Sleepiness Scale in Identifying Obstructive Sleep Apnoea against Polysomnography: A Cross-sectional Study

Introduction: Rising morbidty resulting from Obstructive Sleep Apnoea (OSA) is an emerging public health concern. The estimated prevalence of OSA in India has been investigated to be between 2.4% to 4.96% in males and 1% to 2% in females. {Snoring, Tiredness, Observed apnoea, high blood Pressure (STOP)-Body Mass Index (BMI), Age, Neck circumference, and Gender (BANG)} and Epworth Sleepiness Scale (ESS) have proven beneficial in identifying sleep breathing disorder. Validity of these questionnaire has been verified against polysomnography in many studies. Aim: To assess the predictive ability of STOP-Bang questionnaire and ESS in identifying OSA and comparing their efficacy with Polysomnography (PSG). Materials and Methods: The cross-sectional study was conducted in the Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India, from January 2020 to June 2021, among 100 patients with symptoms of OSA. Both questionnaires {STOP-Bang Questionnaires (SBQ), and ESS} were completed in consecutive order, on the same day when consent was provided. Type 2 polysomnography was done for all the patients. The normality of data was tested by Shapiro Wilk’s test. The data obtained was statistically analysed and to compare the parameters between the group one-way Analysis of Variance (ANOVA) followed by Tukey’s Honestly Significant Difference (HSD) was used and for intragroup Paired t-test was used. Results: Mean age of the study population was 49.46±6.523 years, 79 were males and 21 females. Among the 100, 65% had OSA as per polysomnography. STOP-Bang questionnaire had a higher sensitivity as compared to ESS in predicting OSA (75.38% for STOP-Bang and 72.31% for ESS). Conversely, the specificity of ESS (82.8%) was found to be greater than STOP-Bang (45.71%). Similar results were obtained for positive predictive value, in which ESS scored 88.6% while STOP-Bang scored 50%. For negative predictive values, ESS again scored higher (65%) than STOP-Bang (61.7%). Similarly, the Likelihood Ratio for a positive result (LR+) of ESS was greater than STOP-Bang (4.2 and 1.3, respectively). The STOP-Bang questionnaire, however, had higher Likelihood Ratio for a negative test (LR-) as compared to ESS (0.5 and 0.3, respectively). Conclusion: Polysomnography is the gold standard to diagnose OSA. For screening OSA, patients with symptoms of sleep disordered breathing, this study found that STOP-Bang questionnaire is better in identifying OSA as compared to ESS.

Sleep Hygiene in Adolescents and Factors Influencing Sleep Pattern: A Cross-sectional Study from Southern India

Introduction: Adolescence is an important period of growth and development. Sleep patterns undergo changes as the child transitions from adolescence to adulthood. A proper sleep hygiene for adolescents is important for their proper health, academic performance and prevention of adult-onset diseases. Aim: To assess sleep pattern and factors influencing sleep among adolescent school going children. Materials and Methods: This cross-sectional questionnairebased study was conducted at Saveetha Medical College Hospital, Chennai, Tamil Nadu, India (tertiary care centre), from June 2021 to December 2021. A total of 826 school children aged 12-19 years, studying in class 8-12 were included in the study. Adolescent Sleep Hygiene Scale (ASHS) questionnaire, was used to collect information about the sleep practices. In addition, socio-economic class, start to school time, after school activities, sharing of bed room and access to personal devices like mobile phone were also noted. Sleep was assessed with regards to different parameters like physiological factors, cognitive and emotional factor, sleep environment factor, sleep stability factor, daytime sleep factor, bedtime routine factors. In addition, disturbance of sleep based on sharing of bed with others; use of social media, school routine preventing adequate sleep and presence or absence of outdoor activities were also assessed. The primary data was tabulated using Microsoft excel sheet. Analysis of the independent variables with dependant variables was done using a three-way Analysis of Variance (ANOVA) was done using Sigma Plot 13 (Systat Software, USA). Results: A total of 826 students were enrolled in the study. Majority of the study population were females (n=500). Mean age was 15.1±1.6 years. The mean sleep score was 118.7±14.3, out of a possible 150. Sleep stability and bedtime routine factors were the areas the children had lesser scores of 12.6 and 4.2 respectively, compared to other domains. Majority of the children, 635 (76.8%) did not have a bedroom of their own and shared it with their parents, siblings or grandparents. Total 602 children did not have television inside their bedroom, likewise, access to computer was also limited, 129 (15.6%). Socio-economic status was found to be significantly impacting behavioural arousal factors (p-value=0.006), sleep environmental factors (p-value=0.009), sleep stability factors (p-value=0.001) and bedtime routine factors (p-value=0.004) as assessed using ASHS questionnaire. Conclusion: The overall sleep quality was good in the study population. In the Indian setting, the socio-economic class and the type of family play an important role in the sleep hygiene practices of an adolescent. School based and family based interventions will do a lot of good to adolescent sleep hygiene, thereby, increasing their overall health, productivity and academic performance.

Predictive Significance of High Sensitive C-reactive Protein in Subclinical Hypothyroidism: A Prospective Observational Study

HA KRISHNAMURTHY, S RAVITEJ

Introduction: Subclinical hypothyroidism (SCH) is more common than overt hypothyroidism. It is associated with increased risk of dyslipidaemia, Coronary Artery Disease (CAD), left ventricular diastolic dysfunction, peripheral vascular diseases and chronic inflammation. Chronic inflammation plays a significant role in clinical manifestations and systemic organs injury in hypothyroidism. High-sensitivity C-Reactive Protein (hs-CRP) is a pentameric protein produced by the liver, and its level increases in response to inflammation. There are not much studies to prove that chronic inflammation could be a major risk factor for conversion of subclinical hypothyroidism in to overt hypothyroidism. Aim: To study the role of chronic inflammation as a risk factor for conversion of SCH in to overt hypothyroidism with lipid abnormalities and cardiac dysfunction, by using inflammatory markers like hs-CRP. Materials and Methods: This prospective observational study was conducted at KR hospital, Mysuru, Karnataka, India, from August 2019 to September 2020 among 112 subjects of subclinical hypothyroidism attending the Outpatient Department. The data regarding detailed history and clinical examination were collected from all the patients. Investigations such as Thyroid Stimulating Hormone (TSH), Triiodothyronine (T3), Thyroxine (T4) levels hs-CRP level, lipid profile, Electrocardiogram (ECG), Random Blood Sugar (RBS), Renal Function Test (RFT), Complete Blood Count (CBC), 2D-Echocardiography were done on day one and after six months. The data analyses was done by using the Chi-square test or Fisher’s-Exact test. The factors which were significant as per the Chi-square test were selected and subjected to multivariate analysis. Results: The number of cases of subclinical hypothyroidism (hs- CRP >3 mg/L, mean TSH=9.1±2.1 microIU/mL) at first day were 23 (20.53%). At the end of six months, those converted to overt hypothyroidism (mean TSH=11.4±2.3 microIU/mL) were 14 (12.5%) patients. The patients with hs-CRP of >3 mg/L, with mean TSH of 11.4±2.3 microIU/mL at the end of six months of study, had left ventricular dysfunction in 68 (60.07%) patients. In the same group, the low-density lipoprotein cholesterol >160 mg/dL was found in 60 (53.57%) patients and serum triglycerides level >200 mg/dL was found in 51 (45.53%) patients (p-value <0.05). Conclusion: Chronic inflammation is one of the major risk factors for conversion of subclinical hypothyroidism in to overt hypothyroidism with associated cardiovascular dysfunction and dyslipidaemia.

Comparison of Offloading Dressing with Conventional Dressing in Healing of Plantar Diabetic Foot Ulcers: A Randomised Clinical Trial

Shraddha Modi, T Tirou Aroul

Introduction: The first ever description of Diabetic Foot Ulcers (DFUs), made in the literature was in the mid 19^th century. The management principles for it were laid by late 19th century and are still being followed. For a chronic DFU to heal, offloading of pressure, surgical debridement, correction of hyperglycaemia, the use of antibiotics are the corner stone of management. Offloading is an essential modality of prevention and treatment of recurrent plantar DFU. Aim: To compare offloading dressing to conventional dressing in promoting healing of diabetic plantar foot ulcers. Materials and Methods: This randomised clinical trial was conducted at Mahatma Gandhi Medical College and Research Institute, Pondicherry, India, between January 2019 to June 2020 among the patients with DFU coming to the Department of General Surgery. A total of 44 patients were included in the study, 22 of these patients underwent offloading dressing and 22 underwent conventional dressing and these patients were followed-up for a duration of 6 weeks and compared on 2^nd, 4^th and 6^th weeks. The patients were compared according to age, gender, duration of diabetes, glycaemic control, risk factors, previous surgery such as wound debridement or previous toe amputation, vascular assessment and site of ulcer, reduction in size of ulcer. The ulcers in both the groups were classified according to the Wagener’s grading of ulcer classification. All data collected was entered into Microsoft Excel 2016 and analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 (IBM SPSS, US) software. A p-value less than 0.05 was considered as statistically significant. Results: Among 44 patients, there was equal number of males and females in both the groups, with the total mean age 53.97±10.10 years. The majority of the study population belonged to the 5^th decade (51-60 years), where the youngest patient was of 29 years and oldest was of 72 years. There were 22 patients in offloading group and 24 patients in conventional dressing groupas one patient had bilateral plantar ulcers and one patient had two separate ulcers on the plantar aspect of the foot. Total of 45.45% in conventional group and 31.82% of the study population in offloading group had diabetes for 5-10 years of duration. Bad glycaemic control was seen in 40.90% of offloading group and 50% in conventional group. The size reduction percentage of ulcers on comparing both the groups was found to be significant for 2nd week review (p-value=0.03) and was nearly significant for the 6^th week review (p-value=0.05). Conclusion: Summarising the above conducted study, offloading dressing was found to be a more efficacious alternative to the conventional dressing as there was greater difference observed in the reduction of the size of ulcer and the patients in the conventional group needed more number of dressings and the duration of healing in the two groups.

Evaluation of Cardiometabolic Markers in Helicobacter pylori Infection: A Case-control Study

MR Arpitha, HN Dinesh, N Sreenivas, S Meera, MG Lokesh, Shubha Jayaram

Introduction: Helicobacter pylori (H. pylori) is a Gram negative bacterium that naturally colonises the gastric epithelium and causes chronic gastritis. H. pylori infection affects gastric physiology and alters the lipid metabolism pathways. Highsensitivity C-Reactive Protein (hs-CRP) is a useful marker for risk assessment of future cardiovascular events. Many studies have proposed a link between cardiometabolic markers like lipid profile and hs-CRP with H. pylori infection but very limited studies are available to explain the effect of H. pylori infection on these cardiometabolic markers. Aim: To analyse the cardiometabolic markers (lipid profile and hs-CRP) in H. pylori infection. Materials and Methods: This case-control study was conducted from November 2018 to June 2019 in the Department of Biochemistry in association with the Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India. Fifty cases and 50 control subjects were enrolled. Fasting Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C), Very Low Density Lipoprotein Cholesterol (VLDL-C), hs-CRP, and Atherogenic Index of Plasma (AIP) were analysed. Statistical analysis was performed using Student’s t-test. Results: The gender distribution was almost same in the two groups. The mean age in the case group was 47.34±12.08 years, while that in the control group was 46.2±14.8 years. There was an increase in TC, LDL-C, VLDL-C, and TG in cases`, but it was not statistically significant. Serum HDL-C level was 34.59±9.79 mg/ dL and 41.62±10.29 mg/dL for cases and controls respectively and it was statistically significant. hs-CRP level was significantly increased in the case group (5.51±4.59 mg/L) when compared to the control (2.63±2.0 mg/L). AIP was also significantly high in the cases (0.246±0.219) than the controls (0.106±0.22). Conclusion: Significant decrease in HDL-C and increase in hs-CRP levels in cases show evidence of dyslipidaemia and atherogenic risk. hs-CRP also showed a significant correlation with AIP. Hence, these cardiometabolic markers may have a role in identifying individuals at higher risk for cardiovascular diseases in cases.

Factors Affecting Graft Uptake of Large Wound Surface, Covered by Mesh Split Skin Grafting: A Longitudinal Study

Rajneesh Rawat, Sunil M Lanjewar, Rohit Kumar Chauhan, Jyoti Baghel

Introduction: Skin grafting is one of the most indispensable techniques in surgery these days. In low resource settings, skin grafting using mesh, still forms the important technique of wound coverage. Aim: To evaluate the factors affecting graft uptake of large wound surface covered by mesh split skin grafting on day 5, day 10 and day 21 of postoperative days. Materials and Methods: This prospective longitudinal study was conducted at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India, from June 2017 to December 2019, among patients with large wound surface. After baseline evaluation and wound preparation; patients were posted for mesh skin grafting. Postoperatively, the graft uptake percentage was assessed on the day 5, day 10 and day 21. Other parameters that were assessed were demographic details, mean stay of the patients during the preoperative and postoperative period, effect of various factors (age, gender, co-morbidities, addictions, site and aetiology of raw area, preoperative cultures) influencing graft uptake and postoperative complications. Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: A total of 117 patients were enrolled in the study, out of which, 97 (82.9%) of the patients were males. The most common raw area was seen in lower limbs and accounted for 98 patients and the most common cause of raw area was cellulitis (n=91). Out of 117 patients, 105 (89.7%) had successful graft uptake on postoperative day 5, 102 patients (87.2%) on day 10 and 100 patients (85.4%) on day 21. Whereas, 17 (14.5%) patients had failed uptake of graft on postoperative day 21. It was observed that age (p-value=0.04) and preoperative cultures (p-value=0.01) were statistically significant factors influencing graft uptake. Conclusion: The present study concluded that mesh split skin grafting is a reliable and useful technique with successful graft uptake. Hence, it can be considered for the management of large raw areas.

Evaluation of CD9 Expression of Tumour Cells and Stromal Immune Cells in Breast Carcinoma by Immunohistochemistry

RV Sowjanya Lakshmi, ML Harendra Kumar, k Mohan Kumar

Introduction: Cluster of Differentiation 9 (CD9), known as Motility Related Protein (MRP-1) regulates cell adhesion, motility, migration and proliferation. Many studies have stated conflicting results on prognostic significance of invasive breast carcinomas with CD9 expression that had performed on tumour tissues. Aim: To assess the inter-relationship of CD9 expression of tumour cells and stromal immune cells in breast carcinoma with clinicopathological parameters which include age, tumour size, grade, histological type, lymph nodes, tumour staging and molecular classification. Materials and Methods: An observational prospective (July 2020 to June 2021) and retrospective (October 2019 to June 2020) study was done in 71 cases of resected primary invasive breast carcinoma over a period of one and half year at Sri Devaraj Urs Medical College, Karnataka, India. Immunohistochemistry (IHC) staining was done using CD9 antibody. Tumour cells (T-CD9) expression was evaluated by Immunoreactivity scoring (IS= Intensity score×Extent of staining). The stromal cells (S-CD9) expression was evaluated by percentage (%) of stromal area occupied by CD9 stained immune cells. Chi-square test was used as test of significance for qualitative data. The p-value of <0.05 was considered as statistically significant. Results: Out of 71 cases, T-CD9 expression was noticed in 40 (56.34%) cases and IS <4 considered as negative was observed in 31 (43.66%) cases. However there was no association with age, tumour size, grade and molecular markers for the expression of both T-CD9 and S-CD9. Human Epidermal growth factor receptor 2 neu (HER2neu) negative was associated with T-CD9 expression (p-value=0.05). Hence, CD9 can be used as prognostic marker for Her2neu negative cases. Conclusion: The CD9 expression was not significantly associated with tumour cells (T-CD9) and stromal cells (S-CD9) in breast carcinoma cases. However, it was significantly associated with Her2neu negative tumour cells. T-CD9 showed more positivity in Luminal A followed by triple negative, whereas S-CD9 showed more positivity in Luminal B. CD9 did not show association with any parameters except Her2neu negative.

Prevalence of Dry Eye Disease in Glass Industry Workers of Firozabad, Uttar Pradesh, India: A Cross-sectional Observational Study

Shefali Mazumdar, Ravindra Kumar Singh, SK Satsangi, Renu Agarwal

Introduction: Dry eye disease is a rising occupational hazard in India. Firozabad, is known for its glass manufacturing work worldwide. As there is limited evidence available on dry eye prevalence in glass industry workers, the present study was undertaken. Aim: To find out the prevalence and severity of Dry Eye Disease (DED) in glass industry workers of Firozabad, Uttar Pradesh, India. Materials and Methods: The cross-sectional observational study was conducted in Department of Ophthalmology at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from March 2020 to September 2021 among the glass industry workers at Firozabad. It was a field survey, conducted in the factories only. Ocular Surface Disease Index (OSDI) questionnaire was presented to 500 randomly selected glass industry workers to screen for dry eye disease. Based on subject’s response to OSDI questionnaire, score was calculated and then evaluated with an OSDI chart to assess the magnitude of dry eye symptoms. The final diagnosis and grading of dry eye was done on the basis of Schirmer’s test. Chi-square test was used to detect the association between variables. Statistical Package for Social Sciences (SPSS) software (version 28.0) was used for analysis. A p-value <0.05 was regarded as significant. Results: In the present study, the overall dry eye prevalence in glass industry workers was 28%. Mild dry eye was present in 3.2% of workers, moderate dry eye in 16.8%, and severe dry eye was present in 8% of glass workers. There was significant association between dry eye and working hours (per day) in two different study groups (≤8 hrs and >8 hrs) (χ²=20.9, p-value <0.001). There was also a significant association between the prevalence of dry eye and the years of exposure (in years) in the glass industry (χ²=51.4, p-value <0.001). Conclusion: Prevalence of dry eye in glass industry workers is significantly high. Glass industry workers should undergo regular eye checkups to pick up DED as the earliest.

Evaluation of Ovarian Reserve among Newly Diagnosed Hashimoto’s Thyroiditis Related Subclinical and Overt Hypothyroid Reproductive Women: A Cross-sectional Study

Akinepalli Pullaiah, Veerendra Kumar Arumalla

Introduction: Thyroid autoimmunity is a common autoimmune disorder among reproductive women. It is proposed that, thyroid peroxidase antibodies pass through the blood follicle barrier during follicular development which damages the growing follicles and oocytes. Previous studies have demonstrated the association between thyroid autoimmunity and ovarian failure. Serum Anti-Müllerian Hormone (AMH) levels are used as a marker of ovarian reserve in clinical practice. Aim: To evaluate ovarian reserve among newly diagnosed Hashimoto’s Thyroiditis (HT) related subclinical and overt hypothyroid women. Materials and Methods: A cross-sectional study was conducted at the Department of Biochemistry, Government Medical College Nalgonda, Telangana, India, from August 2020 to July 2021. The study included 180 subjects, 60 in each Overt Hypothyroid (EU group) (OH group), Subclinical Hypothyroid (SCH group) and Euthyroid subjects. Socio-demographic details and other parameters age, Body Mass Index (BMI), AMH, Thyroid Stimulating Hormone (TSH), free T4 (fT4), Thyroid Peroxidase Antibodies (TPOAb), Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Antral Follicular Count (AFC) were evaluated and compared in all the three groups. The above data were recorded and analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and the Analysis of Variance (ANOVA) test, Chi-square test, and Spearman’s correlation test were performed for statistical analysis. Results: The median age, BMI, and total AFC were not statistically significant (p-value >0.05). Serum TPOAb levels were significantly (p-value <0.001) high in the OH group and SCH group when compared to the EU group. The AMH levels were significantly (p-value=0.015) high in the EU group compared to the OH group, but there were no statistically significant differences among other groups. The AMH values were negatively correlated with age among all the three groups. There was no significant correlation between AMH and other parameters analysed among different groups. Conclusion: The AMH levels were significantly low in the OH group when compared to the EU group. There were no statistically significant differences among other groups. Age was found to be an independent factor for low AMH levels among all the three groups.

Mycological Profile in Otomycosis Patients and their Drug Sensitivity: A Cross-sectional Study at Union Territory of Puducherry, India

Anusheela Howlader, Prithiviraj Nagarajan, Latha Ragunathan

Introduction: In clinical Otorhinolaryngology practice, otomycosis is a common problem to overcome caused by Aspergillus and Candida species. Although, we come across many difficulties to diagnose and treat otomycosis infections, many patients show drug resistance to antifungal agents with a high prevalence rate. Aim: To elucidate the pattern of mycological agents and susceptibility testing of fungal species in samples collected from patients with an ear infection at a tertiary hospital. Materials and Methods: The present hospital-based crosssectional study conducted in the Department of Microbiology and Department of Ear, Nose, and Throat (ENT) at Aarupadai Veedu Medical College and Hospital, Puducherry, India, from August 2018 to January 2020. A total of 126 samples were collected, transported and analysed for bacteriological and mycological analysis using direct inspection and culture techniques. By using the disc diffusion technique, the antifungal susceptibility testing was carried out to determine the sensitivity and resistance against ketoconazole, itraconazole, fluconazole, and amphotericin B. Data were analysed in terms of frequency using the Statistical Package for the Social Sciences (SPSS) software 25.0 version. Results: Out of 126 samples, fungal isolates were 92, out of which the most common fungal isolate was Aspergillus niger followed by A. flavus, Candida albicans (C. albicans), A. terreus, and A. fumigatus. Also, the major common bacterial isolates were Staphylococcus aureus followed by Pseudomonas, Proteus, Escherichia coli (E. coli), and Klebsiella spp. Prevalence in males (58.73%) was more as compared to the females (41.27%), and itching was the most common presenting symptom. Otomycosis in Chronic Suppurative Otitis Media (CSOM) mainly affected males (40%) and is common in middle-aged groups (20-35 years) of outdoor and indoor workers, housewives and farmers, particularly during the monsoon season. Antifungal susceptibility testing of A. flavus and A. niger isolates revealed high sensitivity to amphotericin B, itraconazole and ketoconazole drugs but low efficacy to fluconazole drugs. Conclusion: Otomycosis should be suspected clinically to prevent the unnecessary use of antibiotics. A high incidence of otomycosis has been encountered in many tropical countries. In present study, Aspergillus spp. and Candida spp. were the commonest fungal isolates in otomycosis. In our community, currently two drugs, amphotericin B and ketoconazole are the most frequently used for fungal infection. Properly identifying fungal agents and host factors involved in otomycosis can improve such patients’ outcomes.

Evaluation of Antioxidant Effects of Antiepileptic Drugs in Adult Epileptic Patients: An Open Label, Non Randomised Interventional Study

B Swathi, D Aruna

Introduction: Oxidative stress is one of the factors implicated in the pathogenesis of epilepsy. Various antiepileptic drugs can control seizures by several mechanisms that may involve reduction of oxidative stress. Only a few studies have evaluated the antioxidant effects of Antiepileptic Drugs (AEDs). Aim: To evaluate the antioxidant activity of the AEDs (Phenytoin, Levetiracetam, Oxcarbazepine) in adult epileptic patients. Materials and Methods: The present open label, non randomised interventional study was conducted at the tertiary care hospital, Hyderabad, Telangana, India, from September 2016 to November 2017. Total of 45 subjects were divided into three groups, Phenytoin group, Levetiracetam group and Oxcarbazepine group with 15 patients in each group. Blood samples were collected prior to initiation of treatment and after three months of treatment for measurement of antioxidative parameters such as Malondialdehyde (MDA), Nitric Oxide (NO) and reduced Glutathione (GSH) levels. Paired t-test was used for within group analysis. Results: Amongst the total subjects of 45,(15 in each group), 14 subjects in phenytoin group, 12 in Levetiracetam group and 13 in oxcarbazepine group were finally analysed. The mean age was 28.92±9.62 years, mean weight was 55.87±10.73 kg and mean Body Mass Index (BMI) was 21.99±3.82 kg/m2. No statistically significant difference was seen in all oxidative parameters in phenytoin treated group. In levetiracetam group, significant decrease in MDA levels (p-value- 0.0338) and increase in GSH levels (p-value <0.0001) was observed after three months of treatment. In oxcarbazepine group, statistically significant decrease was found in MDA (p-value-0.0055) and NO levels (p-value-0.016) and increase in GSH levels (p-value- 0.0004) was observed. Conclusion: It was concluded that phenytoin has no role in reducing oxidative stress in epileptic patients, whereas levetiracetam decreases lipid peroxidation and oxcarbazepine has beneficial role in reducing oxidative stress in adult epileptic patients.

Diagnostic Accuracy of FNAC and Ultrasonography in Salivary Gland Lesions in Comparison with Histopathology

Shaheen Khan, Nandakumar Gopinathan Nair

Introduction: Modern era demands for early and accurate diagnosis. Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) are two such diagnostic modalities which have gained importance in recent years due to their rapid, repeatable and precision properties. Aim: To study the accuracy of FNAC and USG in diagnosing salivary gland lesions in comparison with histopathology and to study the expression of p63 and Cytokeratin 7 (CK7) Immunohistochemical (IHC) markers in malignant salivary gland tumours. Materials and Methods: A cross-sectional study was conducted on 106 cases who presented with salivary gland lesions possessing USG reports and underwent FNAC and surgical specimens received in Cytopathology and Histopathology Department, Government Medical College, Thiruvananthapuram, Kerala, India, during one year period (February 2017 to January 2018). In each case FNAC was performed and slides were stained with papanicolaou and giemsa stain, surgical specimens were grossed, histopathological features studied under microscope and tumours classified according to World Health Organisation (WHO) classification of salivary gland tumours 2017. Diagnosis on USG and FNAC were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy, concordance and discordance was calculated by Statistical Package for the Social Sciences (SPSS) software version 24.0. p63 and CK7 IHC markers were done only in malignant salivary gland tumours. Results: In the present study majority of lesions i.e. 82 (77.4%) cases were seen predominantly in parotid gland and pleomorphic adenoma was the most commonest lesion and neoplasm overall with 50 (47.2%) cases. Most common malignant neoplasm was mucoepidermoid carcinoma 4 (3.8%) cases. USG and FNAC had high diagnostic accuracy of 89.6% and 97.2% in comparison to histopathology in diagnosing salivary gland lesions. Conclusion: High sensitivity and specificity of USG and FNAC makes them most acclaimed preoperative diagnostic modality for salivary gland lesions, but histopathology remains gold standard. Subtyping of malignant and cystic lesions were difficult in USG and cytology.

Outcome of Active versus Expectant Management in Preterm Premature Rupture of Membranes between 34 weeks to 36 weeks Six days: A Retrospective Study

Shilpaann Baby, M Anjali

Introduction: An important cause of neonatal morbidity and mortality is the prelabour Preterm Rupture of the Membranes (PPROM) which refers to, the rupture of the membranes before 37 weeks. There are two modes of managing PPROM, active management (immediate delivery) and expectant management (therapy directed toward extending the pregnancy to improve neonatal outcome). Aim: To compare neonatal outcomes following active and expectant (conservative) management in PPROM cases from 34 weeks to 36 weeks six days. Materials and Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology at Government Medical College (tertiary care teaching hospital), Thiruvananthapuram Kerala, India, from February 2021 to July 2021. The data collection period was from January 2013 to December 2014. PPROM cases between 34 weeks and 36 weeks and six days were retrospectively studied. A total of 62 patients among the Active Management (AM) group and 62 patients among the Expected Management (EM) group were selected. The neonatal outcomes (respiratory distress syndrome, hypoglycaemia, neonatal sepsis) and maternal outcomes (caesarean section, chorioamnionitis) were compared. The latency period in conservative management and in active management was also compared. The data was analysed using the Chi-square test. Results: In the AM group, 13 (21%) babies had respiratory distress syndrome, whereas, in the EM group it was 4 (6.5%) (p-value=0.019). In the AM group, 13 (21%) babies had hypoglycaemia, whereas, in the EM group, it was 5 (8.1%) (p-value=0.041). In the AM group, 3 (4.8%) women had signs and symptoms of chorioamnionitis, whereas, in the EM group, it was 7 (11.3%) (p-value=0.187). In the AM group, 16 (25.8%) of women had Caesarean section, whereas, in EM it was 9 (14.5%) (p-value=0.117). In AM group, 1 (1.6%) has neonatal sepsis and in EM it was 3 (4.8%) p-value=0.309. The latency period in conservative management was 119.5±31 hours and in active management, it was 51.5±13.2 hours. Conclusion: The present study indicated that expectant management of PROM between 34 weeks to 36 weeks and six days leads to a statistically significant reduction of neonatal respiratory distress syndrome and hypoglycaemia.

Dental Faculties and Practitioners’ Perception of Virtual Learning as Integral Apparatus in Dental Education: A Cross-sectional Survey

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic saw a global lockdown being imposed, which restricted dental faculties access to teaching institutes and dental practitioners to continuing dental education programs. However, this resulted in a surge in the usage of virtual learning platforms for imparting and gaining information. Aim: To evaluate the knowledge, awareness and perception of dental teaching faculties and practitioners about virtual learning as a complementary tool in dental education. Materials and Methods: A nationwide cross-sectional questionnaire survey was conducted on the virtual platform (SmartSurvey) among dental faculties and dental practitioners, from June 2021 to July 2021. The questionnaire comprised of different sets of closed-ended questions customised for each group. The survey was validated and dispersed through webbased links and Quick Response (QR) codes to all the dental faculties and practitioners. Descriptive statistics was used for analysing the results. Results: A total of 596 participants (220 dental faculties and 376 dental practitioners) participated in the survey. Zoom (n=157, 82.63%) was the most popular among the virtual platforms used for dental education. Affability of time (n=192, 87.27%), convenience and comfort of learning from anywhere (n=312, 82.98%) were the main advantages of virtual education. The dominant challenge faced by the participants was the internet connectivity (n=213, 96.82%). Conclusion: Majority of the faculties and practitioners prefer virtual education as an adjunct to conventional education. The widespread reach of virtual platform can be utilised to effectively deliver the educational content on a global scale. However, a streamlined framework which addresses all the shortcomings commonly faced by the faculties and practitioners is essential to provide a hassle-free virtual learning experience.

Clinical Effectiveness of Facility and Accuracy of Accommodation in Diagnosis of Non Strabismic Binocular Vision Anomalies in Young Adults: A Prospective Cross-sectional Observational Study

Mousumi Saikia, Kamal Pant, Joydeep Dutta

Introduction: Orthoptic evaluation is highly recommended in children and young adults to diagnose binocular dysfunctions. Binocular vision dysfunctions may hamper academic performance in children. Accommodative facility and accommodative accuracy are two orthoptic tests to evaluate accommodative flexibility and accommodative status of eye. Aim: To investigate the effectiveness of facility and accuracy of accommodation in diagnosis of Non Strabismic Binocular Vision Anomalies (NSBVA) in young adults. Materials and Methods: This prospective, cross-sectional observational study was conducted at Optsight Eye Care in association with Amity Medical School, Gurugram, Haryana, India, from August 2020 to August 2021. A total of 175 subjects (both symptomatic and asymptomatic) with normal anterior and posterior segment findings, and aged between 18-25 years were evaluated for accommodative facility test with the help of accommodative lens flipper ±2D and for accommodative status test with the help of monocular estimation method (dynamic retinoscopy). Both the tests were done over their best corrected visual acuity after refractive error correction and the Pearson correlation test was applied to find out the correlation. Further, complete orthoptic examination was performed for all the subjects to correlate the abnormal findings from the two tests and conventional orthoptic tests. Independent sample t-test was applied to compare the accommodative facility between refractive groups. Results: Out of 175 subjects, 84 (48%) of the subjects were found to have NSBVA which included 26 (14.86%) convergence insufficiency, 30 (17.14%) with accommodative insufficiency, 25 (14.29%) with convergence insufficiency secondary to accommodative insufficiency and 3 (1.71%) with accommodative infacility. A positive correlation between binocular accommodative facility and status of accommodation was found with a p-value <0.001 (r=0.51). Conclusion: Status of accommodation and facility test can help to differentiate the accommodative and vergence problems making examination less time consuming. Both of these procedures should be a part of general routine eye examination protocol in the young adult group, so that detection of these anomalies become less time consuming and patient gets benefitted from early intervention.

Awareness and Compliance to International Patient Safety Goals among Healthcare Personnel of a Tertiary Care Hospital in Northern India

Dinesh Chandra Joshi, Ravinder Singh Saini

Introduction: Advances and commitment to patient safety worldwide have grown since the late 1990s which have led to a remarkable transformation in the way patient safety is viewed. Having begun as a subject of minor academic interest, it is now embedded in most healthcare systems worldwide. The International Patient Safety Goals (IPSG) are important guidelines developed by Joint Commission International to promote safe and high-quality patient care. Patient safety is the responsibility of every healthcare personnel who is directly or indirectly involved in patient care. Aim: To determine the level of awareness amongst doctors, nurses and technicians and their compliance to IPSG in a tertiary care hospital. Materials and Methods: This observational cross-sectional study was conducted from March to May 2021, in a tertiary care teaching hospital of North India. Stratified sampling technique was used in determining the number of doctors, nurses and technicians required for this study. A validated questionnaire was used to assess the awareness level of healthcare personnel to IPSG. ‘1’ mark was assigned to each correct answer and ‘0’ were awarded to wrong answers. The data was collected and coded in a Microsoft excel database. Descriptive data analysis was done. Results: A total of 394 patient records/documents were audited for patient safety compliance. It was observed that 339 (86%) documents revealed compliance to all six IPSG. Out of the six goals of IPSG, the best compliance was observed for the fourth goal of IPSG (ensure safe surgery) for which the compliance was 100%. The lowest compliance was observed for 2^nd, 5^th and 6^th goal (improve effective communication, reduce the risk of healthcare associated infection and reduce the patient harm resulting from fall) which was 81%, 80% and 78%, respectively. The awareness questionnaire was given to doctors (n=60), nurses (n=86) and technicians (n=76). The findings revealed that awareness was highest in nurses (84.8%) followed by doctors (81.7%) and technicians (80.2%). Conclusion: The study has found out that the awareness level of doctors, nurses and technicians towards patient safety goals is good. Further quality improvement in this field can be achieved by conducting on the job training, workshops, lectures and seminars.

Clinical and Biochemical Profile of Children on Follow-up with Autoimmune Thyroiditis

Veena Venugopal, Deepa Anirudhan

Introduction: Hashimotos Thyroiditis (HT) is the most common autoimmune thyroid disease and the most common cause of acquired hypothyroidism in children. Understanding the clinical profile in children with Autoimmune Thyroiditis (AIT) helps in follow-up and appropriate management of the condition. Aim: To assess the clinical, biochemical profile and the course of disease in children with AIT. Materials and Methods: This was a hospital-based longitudinal study done at a Paediatric endocrinology clinic, from January 2018 to June 2019, at Southern India on all children with autoimmune thyroiditis on follow-up for atleast three years, age group between 5 to 18 years, attending the clinic. Clinical examination for thyroid swelling, anthropometry of the child, Tanner staging for pubertal status, Thyroid Stimulating Hormone (TSH), and free Thyroxine (T4) was done at enrollment and also at follow-up after one year. Results: A total of 33 children were enrolled into the study. Of this, girls constituted 85%, with a female to male ratio of 5.6:1. Mean age at diagnosis was 9.76±1.69 years; 25 (75.8%) patients were hypothyroid and 8 (24.2%) were euthyroid at presentation; 21 (63.6%) had a positive family history of thyroid illness. The most common presentation was goitre (87.8%), 32 (97%) of them had positive thyroid antibodies either Antithyroid Peroxidase (TPO) or anti thyroglobulin (Tg) antibody. Of the 32 children with positive antibodies, 26 (81.2%) had raised anti TPO and 17 (53.1%) had positive anti Tg; 12 (37.5%) were positive for both anti TPO and anti Tg; 29 patients (78.7%) required treatment with thyroxine. All were noted to be pubertal but with no significant growth impairment. On follow-up after 1 year, the percentage of hypothyroid patients increased from 87.88% to 96.97%, and 1 (3.03%) became hyperthyroid. None of them had other autoimmune disorders during follow-up. Conclusion: Children with AIT were mostly females and the majority had goitre. The prevalence of goitre was 88% and the majority were hypothyroid at presentation. A majority of children with autoimmune thyroiditis had a positive family history of thyroid disease. On follow-up after at 1 year, all the euthyroid patients had become hypothyroid. The thyroid status of children with autoimmune thyroiditis can change over time and needs regular clinical and biochemical follow-up.

Recent Onset Cardiometabolic Effects amongst Patients Started on Psychotropics: A Cohort Study

Prashant Maravi, Nimisha Mishra, Sunil K Ahuja, Daisy Rure

Introduction: Mortality rates in schizophrenia patients due to cardiovascular events are reported to be more than the general population. Dyslipidaemia, obesity, diabetes, and hypertension are some of the common illnesses these patients are vulnerable to develop. The drugs which are used to treat schizophrenia and other related disorders i.e. antipsychotics causes increase in weight, dyslipidaemia and insulin resistance in some patients. Some agents i.e., Second Generation Antipsychotics (SGA) cause more of the above mentioned symptoms than other agents i.e., First Generation Antipsychotics (FGA). The novelty of the study includes the emergence of Metabolic Syndrome (MetS) in drug naïve or drug free patients who were prescribed trifluoperazine and olanzapine and comparative study of them. Aim: To assess the emergence of MetS in drug naïve patients of schizophrenia after the administration of trifluoperazine-FGA and olanzapine-SGA. Materials and Methods: A cohort study was conducted from May 2019 to March 2021, in the Department of Psychiatry, Shyam Shah Medical College, and Rewa, Madhya Pradesh, India. The study included 41 drug naïve indoor and outdoor patients, diagnosed as schizophrenia according to International Classification of Diseases 10 Diagnostic Criteria for Research (ICD 10 DCR). The patients were divided into two groups, one group was prescribed FGA trifluoperazine and other was prescribed SGA olanzapine. Twenty patients were prescribed olanzapine and 21 patients trifluoperazine. Metabolic parameters were taken before onset of drug treatment therapy, after two and four months respectively. The patients were given medications for four months. The changes in metabolic parameters i.e., waist circumference, blood pressure, Fasting Blood Sugar (FBS), triglycerides, and Low High Density Lipoprotein (HDL) were compared using unpaired student’s t-test and repeated measure Analysis of Variance (ANOVA) with p-value <0.05 considered as significant. Results: It was found that out of total 41 patient, 4 patients (19%) and 12 patients (60%) patients prescribed trifluoperazine and olanzapine, respectively developed Mets after four months of antipsychotic medication. Also, there was a significant change in various parameters of MetS in both groups as seen in repeated measure ANOVA. Conclusion: Second Generation Antipsychotics (SGA) cause significantly more changes in the metabolic parameters as compared to the FGA, increasing the likelihood of developing MetS and associated disorders like cerebrovascular accidents and diabetes mellitus type-II.

Comparison between Standard Technique versus Reverse Manoeuvre of Airtraq Insertion for Tracheal Intubation in Lean versus Obese Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Latika Laxmichand Dharmashi, Rajendra D Patel

Introduction: Obese patients pose challenge to anaesthesiologist in terms of securing airway due to large tongue and anatomical variations, need a novel tracheal intubation technique to quickly secure airway in obese individuals. The airtraq laryngoscope with reverse technique of insertion is used to secure airway without classical sniffing position. Aim: To compare the two techniques of airtraq insertion, standard and reverse manoeuvre, in lean versus obese patients undergoing surgery under general anaesthesia. Materials and Methods: This randomised clinical study was conducted from July 2012 to January 2014 at Seth GS Medical College and KEM Hospital, Mumbai, Maharasthra, India in a total of 200 American Society of Anaesthesiologists (ASA) physical status I to III undergoing surgery under general anaesthesia. Both lean and obese patients were randomly allocated to each technique. After induction of anaesthesia intubation was performed by an expert anaesthesiologist with each technique (three attempts) were used to intubate trachea. If there was a failure, switch over technique was applied. All the groups were analysed for intubation time, number of attempts, ease of intubation assessed by Visual Analogue Scale (VAS), haemodynamics, and complications. Data entry was done on a Microsoft Excel sheet and data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 15.0. Results: Both lean and obese groups were comparable in the airway and demographic characteristics. In lean patients there was no significant difference between intubation time with both standard and reverse manoeuvre. While in obese patients reverse manoeuvre (11.84±1.99 seconds) significantly reduced exposure time by 13 seconds as compared to standard technique (24.02±6.94 seconds), thereby reducing total duration of intubation (26.08±1.16 seconds) as compared to total duration of intubation with standard technique (39.62±8.95 seconds). Lean group was comparable in number of attempts with standard technique (47 patients in 1st attempt/3 patients in 2^nd attempt) and reverse manoeuvre (49 patients in 1?supst attempt/1 patient in 2nd attempt). Obese group with reverse manoeuvre all were intubated with first attempt (50 patients) with standard technique (46 patients in 1st attempt/1 patient in 2nd attempt) and there was switch over from standard to reverse technique in three patients. Both lean and obese groups were comparable in complications with both technique. Conclusion: Reverse manoeuvre proved beneficial in obese patients as it reduced intubation time as compared to standard technique, while lean patients showed no difference.

Efficacy of Green Synthesised Iron Oxide Nanoparticles against Various Uropathogens: A Cross-sectional Study

Introduction: The shoot up of antimicrobial resistance leading to the Multidrug Resistance (MDR) phenomenon in clinical pathogens has forced us to develop novel technologies to cease this global threat immediately. Iron oxide nanoparticles can be a breakthrough solution to this dilemma due to its magnetic properties and biocompatibility. Non toxic and biocompatible applications of magnetic nanoparticles can be enriched further by special surface coating with organic or inorganic molecules. Aim: To determine the antibacterial activity of green synthesised iron oxide nanoparticles against various clinical isolates. Materials and Methods: This was a cross-sectional study conducted from June 2021 to April 2022. This study was conducted at the Department of Microbiology, SRM Medical College Hospital and Research Centre (SRMMCH&RC), Kattankulathur, Chengalpattu, Tamil Nadu, India. Nanoparticles underwent surface modifications and characterisation using X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray (EDX), Ultraviolet (UV) Visible Absorption Spectra, and Fourier-Transform Infrared Spectroscopy (FTIR) followed by charge characterisation through agarose gel electrophoresis. Kirby-Bauer Disc Diffusion method was used for screening the sensitivity and resistance pattern of 50 selected isolates and Minimum Inhibitory Concentration (MIC) was assessed using MIC Microbroth Dilution technique with the help of resazurin. Tukey post-hoc multiple comparisons test to analyse the zone of inhibition of antibacterial efficacy. Results: Out of the four different concentrations of bare and coated nanoparticles (0.0375 mg/mL, 0.07 mg/mL, 0.15 mg/mL, 0.3 mg/mL), bare nanoparticles inhibited the growth of Methicillin Resistant Staphylococcus aureus (MRSA) at 0.3 mg/mL while citrate coated nanoparticles inhibited the growth at 0.15 mg/mL, 0.018 mg/mL, 0.0375 mg/mL, 0.07 mg/mL, and 0.15 mg/mL dilutions were used in case of Carbapenem-resistant Klebsiella pneumoniae (CR K. pneumoniae) and MDR Escherichia coli, from which both organisms were inhibited at 0.15 mg/mL of bare and coated nanoparticles. Conclusion: Iron nanoparticles synthesised from the marine algae Chaetomorpha antennina could be used in the future as a drug carrier or as an antimicrobial agent.

Changing Trends of Maternal Mortality in a Rural Medical College in Eastern India: A 23-Year Retrospective Study

Debjani Deb, Anindya Kumar Das, BC Kameswari, Aditya Prasad Sarkar

Introduction: Maternal mortality in a region is a measure of reproductive health of women in that area. The direct causes of maternal deaths are largely preventable. A new era of more comprehensive, international development agenda-the Sustainable Development Goals (SDG 3.1) was launched by the United Nations General Assembly 2015, New York for ending preventable maternal deaths. Aim: To determine the causes and changing trends of maternal mortality in at a rural centre in Eastern India. Materials and Methods: A retrospective observational study was carried out in the Department of Obstetrics and Gynaecology of Bankura Sammilani Medical College in West Bengal in Eastern India. Individual hospital records of all the maternal deaths, from January 1998 to December 2020 were collected. Data regarding demographic profile and reproductive parameters like gravida, parity, antenatal care and cause of death were collected. The records were divided into two four yearly periods, to compare the changing trends (1998-2001) vs (2017-2020) and three five yearly (2002-2006), (2007-2011), (2012-2016) periods. The first term (1998-2001) was taken as the reference period. Results: Comparison between first (1998-2001) and last term (2017-2020) shows significant declining trend of Maternal Mortality Ratio (MMR) (364 vs 148)/100000 live birth (p-value <0.00001). Majority of deaths occurred in primigravida (57.5% vs 60.6%). Direct obstetric causes accounted for majority of the deaths, but with a declining trend (74.7% vs 66.9%). Eclampsia remained the leading direct cause (35.5% vs 32.2%) followed by haemorrhage (20.4% vs 18.8%) and sepsis (18.8% vs 15.7%) in the first term (1998-2001) vs last term (2017-2020). Jaundice 6.45% vs 10.3%, heart disease 2.15% vs 7.1%, embolism 4.3% vs 0.8%, anaemia 6.45% vs 1.6% and other diseases 5.91% vs 13.4% in the first vs last term were the indirect causes of maternal mortality. Conclusion: There is a declining trend of maternal mortality since 1998, which can be attributed to improvement at all levels of healthcare. Eclampsia/preeclampsia and its complications remain the leading cause of maternal mortality. Majority of these maternal deaths can be prevented by regular screening of highrisk cases, integrated antenatal and postnatal care, institutional deliveries, timely referral, and proper implementation of national health programmes.

Effect of Preoperative Continuous Femoral Nerve Block in Ease of Administration of Spinal Anaesthesia for Fracture Neck of Femur Stabilisation: A Case-control Study

Fathimath Shakira, KK Mubarak, Komu Fijul

Introduction: Subarachnoid block remains the anaesthesia modality of choice for surgical fixation of femur. Extreme fracture pain makes ideal positioning for spinal anaesthesia difficult. Preoperative continuous femoral block can provide analgesia for such patients. Aim: To evaluate the effect of continuous femoral nerve block in ease of administration of spinal anaesthesia for fracture neck of femur stabilisation. Materials and Methods: This was a prospective case-control study conducted at the Government Medical College, Kozhikode, Kerala, India, from September 2020 to September 2021. Total of 86 adult patients posted for fracture femur neck stabilisation were selected and divided into two groups- group 1 and group 2. Patients in group 1, were administered ultrasound guided continuous femoral nerve block with 0.2% ropivacaine (15 mL) followed by subarachnoid block and group 2 patients were administered subarachnoid block without prior femoral nerve block. Parameters observed included were Visual Analogue Score (VAS) score while positioning for spinal anaesthesia, ease of palpating interspinous space, time required to perform spinal anaesthesia, number of attempts required to achieve dural puncture, patient satisfaction score as well as haemodynamic and respiratory changes while positioning for subarachnoid block. Statistical analysis was done using IBM SPSS (Statistical Package for the Social Sciences) Statistics for Windows, version 20.0. Results: Group 1 patients had significantly lower VAS scores while positioning for spinal anaesthesia (4.2±1.8 in group 1 as compared to 6.3±1.2 in group 2, p-value=0.001). There was a significant difference in the number of attempts required for dural puncture (1.3±0.4 in group 1 as compared to 1.8±0.6 in group 2, p-value=0.04) and total performance time for spinal anaesthesia (2.2±0.4 min in group 1 as compared to 3.3±0.9 minutes in group 2, p-value=0.02) between two groups. Patient satisfaction scores were significantly higher in group 1 compared to group 2 (9.3±0.6 in group 1 as compared to 6.5±0.5, p-value <0.001). Both groups were comparable in terms of ease of palpating inter spinous space, haemodynamic and respiratory changes during positioning for subarachnoid block. Conclusion: Preoperative administration of continuous femoral nerve block provides better conditions for performing subarachnoid block in fracture neck of femur surgeries by reducing the pain while positioning.

Psychosocial Impact of Pandemic and State Imposed Lockdown on Caregivers of Patients Presenting with Respiratory Complaints Mimicking COVID-19: A Short-term Follow-up Study

Ravi Kumar Garg, Kranti Garg, Vishal Chopra, Nitin Gupta, Roopesh Bharti

Introduction: Pandemics and subsequent lockdowns affect mental health of different subgroups of populations. In Coronavirus Disease-2019 (COVID-19), caregivers of those patients who have respiratory complaints is one such subgroup which is more vulnerable to disturbances in mental health, because of the fear that their patient’s respiratory symptoms could be because of COVID-19. Aim: To assess the psychosocial impact of COVID-19 and subsequent state imposed lockdown on the caregivers of patients presenting with respiratory complaints and also to evaluate the effect of relaxation of lockdown after following-up them over a period of time. Materials and Methods: This prospective observational study was conducted in the Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India (tertiary care institute), from April 2020 to June 2020. Baseline assessment was done using socio-demographic proforma, lockdown related questionnaire {3 domains, summed as total score (lockdown)}, COVID-19 related questionnaire {total score (COVID-19)} and General Health Questionnaire-12-Hindi version (GHQ-12). Reassessment was done twice i.e., at 11-15 days and 41-45 days after relaxation of lockdown. Quality Of Life (QOL) at first and second follow-up versus prelockdown times (score A and C) and first follow-up versus unlockdown (score B) was also noted. Analysis was conducted using Statistical Package for Social Sciences (IBM, SPSS)version 22.0. Results: Total 65 caregivers were enrolled in the study. Mean age of the participants was 40.2±11.812 years with maximum caregivers 25 (41.7%) aged between 31-40 years. Majority (83.3%) were men. Psychological distress was experienced in 50% of caregivers at baseline and 23.7% caregivers at first follow-up (p-value=0.001). Worry for COVID-19 (p-value=0.035), Domain 1 scores (p-value <0.001), Domain 2 scores (p-value=0.003), Domain 3 scores (p-value=0.001), and Total score lockdown (p-value <0.001) decreased significantly at first follow-up. Mean C score was significantly better than mean A score (p-value <0.001). Baseline psychological distress was significantly more in those with worry for COVID-19 (p-value=0.018), poorer scores of domains 1 (p-value=0.005), domains 2 (p-value <0.001), domains 3 (p-value <0.001), total score (lockdown) (p-value <0.001) and total score (COVID-19) (p-value=0.010). Follow-up psychological distress was more in those with “worry for COVID-19” (p-value <0.001), negative thoughts (p-value=0.001), poorer follow-up scores of three domains, total score (lockdown), mean A, B and C scores (p-value <0.001). Conclusion: Caregivers experienced extreme levels of psychological distress, which decreased, but persisted even after relaxation in lockdown.

CT Perfusion in Evaluation of Cervical Lymph Node Metastasis in Head and Neck Malignancies: A Cross-sectional Study

Rekha, MK Mittal

Introduction: Though, many cross-sectional modalities are available for evaluation of cervical lymph node metastasis but their results are highly variable. There is paucity of the literature in India, regarding lymph nodal assessment using Computed Tomography (CT) perfusion in head and neck malignancies even though, there is high incidence of oral cancer in India. Aim: To assess the role of Computed Tomography Perfusion (CTP) in evaluation of cervical lymph nodes in head and neck malignancies, by using CT perfusion parameters as compared to histopathology. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis in collaboration with the Department of Surgery and Pathology at Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India, from October 2017 to April 2019. The study included 30 newly diagnosed head and neck cancer patients, with 46 nodes planned for surgical neck dissection. Computed tomography scan of neck was acquired using Siemens Somatom Definition Flash 256CT scanner. Reconstruction and post processing was performed on workstation and perfusion parameters were obtained to generate the CT perfusion maps. Differentiation between benign and malignant lymph nodes was done, on the basis of CT perfusion parameters such as Blood Flow (BF), Blood Volume (BV), Mean Transit Time (MTT) and Permeability Surface (PS), which were compared with histopathological findings of resected lymph nodes. McNemar’s test was applied for comparison and statistical analysis. Receiver Operating Characteristic (ROC) curve of quantitative parameters were obtained, for the detection of sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPP) and diagnostic accuracy. Results: Out of 46 nodes, 23 were metastatic and 23 were non metastatic. The average value of BF in metastatic nodes was 174.61±71.76 mL/100g/min, BV was 16.32±11.9 mL/100g, MTT was 4.83±2.54 seconds and PS was 49.3±28.59 mL/100g/min. The average values for non metastatic nodes were: BF 88.06±34.4 mL/100g/min, BV: 9.89±7.63 mL/100g, MTT: 13.11±18.58 seconds and PS: 37.07±29.26 mL/100g/ min. The differences between the parameters like blood flow (p-value <0.0001), blood volume (p-value=0.005) and MTT (p-value=0.002) in malignant and benign nodes were significant. In case of blood flow, sensitivity was 82.61% and diagnostic accuracy was 84.78%. In case of blood volume, sensitivity was 91.30% and diagnostic accuracy was 73.91%. In case of mean transit time, sensitivity was 56.52% and diagnostic accuracy was 73.91%. In case of permeability surface, sensitivity was 91.30% and diagnostic accuracy was 67.39%. Conclusion: Blood flow and blood volume values were significantly increased in metastatic cervical lymph nodes as compared to non metastatic nodes, whereas MTT was significantly low. Permeability surface showed equivocal results.

Prevalence of Genomic Resistance to Macrolide in Mycoplasma Isolates among Children with Community Acquired Pneumonia

Introduction: Mycoplasma pneumonia is traditionally susceptible to macrolides, tetracycline and fluroquinolones. Since, tetracycline and fluoroquinolone are used cautiously in children, macrolides remain the antibiotic of choice for treating Mycoplasma pneumonia. But, resistance to macrolides has been reported in mycoplasma since the 2000s especially from Asia. Currently, there is no evidence on macrolide resistance of Mycoplasma pneumoniae from India. Aim: To identify the prevalence of genomic resistance to macrolides in mycoplasma isolates among children hospitalised with community acquired pneumonia. Materials and Methods: This descriptive cross-sectional study was conducted in Department of Paediatrics at Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India (tertiary care centre for children in South India), from September 2019 to August 2020. Children between 2 months to 12 years of age, who were hospitalised with community acquired pneumonia were included in the study. The sampling procedure used was induced sputum or mini bronchoalveolar lavage (in intubated children). The samples were processed for culture in Pleuropneumonia Like Organisms (PPLO) agar. The culture isolates showing the typical fried egg colonies were subjected to Polymerase Chain Reaction (PCR) to detect the presence of resistance conferring mutation in the P1 adhesin gene MPN141. Chi-square test was used to test statistical significance. Results: Among the 268 children included in the study, mycoplasma pneumonia was positive in 33 (12.3%) cases. Mycoplasma pneumoniae was most common in children aged 1-5 years old (51.5%), followed by infants (36.4%) and children aged 5-12 (12.1%). There was no significant difference in distribution among males (39.4%) and females (60.6%) (p-value=0.08). None of the mycoplasma isolates in the study showed mutation for resistance conferring genes. Conclusion: Macrolide resistance conferring genes were not identified in the study population, which may indicate that the mycoplasma strains from this part of India are still susceptible to macrolides.

Changing Clinical Profile of Dengue Fever Epidemic in North Kerala- A Retrospective Study

SM Sarin, Jennet Anirudhan, B Kadeeja Beevi, VK Pramod

Introduction: Dengue fever is one of the most common vectorborne infections worldwide and is now endemic in Kerala. Knowledge about changing clinical presentation of dengue fever is important for timely diagnosis and appropriate management. Aim: To document changing trends in clinical presentation and course of illness among patients admitted with dengue fever in Kerala, India. Materials and Methods: This hospital-based, retrospective, observational study was conducted at Government Medical College and Hospital, Kannur, Kerala, India, from September 2021 to June 2022. The patients with dengue fever, presented in seasonal epidemic of the year 2019 was compared to similar patients presented during the year 2014. Data regarding clinical presentation, duration of hospital stay, complications and haematological parameters of the study population was collected using prevalidated questionnaire. Descriptive data were expressed in frequency, percentage, mean and standard deviation. Continuous and discrete variables were compared by Welch’s t-test, whereas categorical variables were compared using Pearson’s Chi-square test. Results: Out of the total 184 patients studied, 91 were from 2014 and 93 from 2019. The major presenting complaints were fever, body aches, headache, nausea and vomiting, arthralgia, and retro-orbital pain incidence of which were similar in both the study years. Patients admitted in 2019 had shorter duration of fever (5.78 vs 6.79 days), earlier onset of severe thrombocytopaenia (6.62 vs 7.27 days) and delayed onset of complications (5.56 vs 3.6 days) compared to those admitted in 2014. They also had higher incidence of thrombocytopaenia (70.97% vs 54.94%) and complications (49.46% vs 14.29%) during the course of their illness. Conclusion: The study indicates towards a significant shift in clinical presentation of dengue fever in Kerala which may influence the admission and monitoring protocol of dengue fever patients in the years to come.

Comparative Efficacy of Addition of Fentanyl and Neostigmine to Isobaric 0.75% Ropivacaine in Elderly Patients undergoing Transurethral Resection of Prostate under Spinal Anaesthesia: A Double-blinded Randomised Clinical Study

Pragya Shukla, Sandeep Loha, Ravi Kumar Verma

Introduction: Ropivacaine is a well-accepted local anaesthetic drug used in spinal and peripheral nerve blocks. It provides a better Central Nervous System (CNS) and cardiovascular stability in comparison to bupivacaine. Adjuvants are also added with these drugs as they provide haemodynamic stability, increase efficacy, and decrease the dose requirement of the local anaesthetic drugs. Aim: To determine the efficacy of isobaric 0.75% ropivacaine in combination with normal saline, fentanyl, and neostigmine in Elderly Patients Undergoing Transurethral Resection of Prostate Under Spinal Anaesthesia. Materials and Methods: This double-blinded randomised clinical study was conducted in the Department of Anaesthesiology and Critical Care, Institute of Medical Sciences- Banaras Hindu University, Varanasi, Uttar Pradesh, India, from July 2018 to June 2019. The study included 90 patients who were divided into three groups of 30 subjects each. Ropivacaine combined with normal saline in group RNS, ropivacaine combined with fentanyl in group RFE and ropivacaine combined with neostigmine in group RNE, was administered intrathecally. Heart rate, respiratory rate, blood pressure, onset and duration of sensory and motor block, along with the duration of analgesia, were recorded at different time points. The Analysis of Variance (ANOVA) was used to compare the variables among the three study groups, and Student-Newman-Keuls post hoc test was used to compare the data between the groups. Results: Patients in group RNE showed a significant fall in heart rate in comparison to groups RNS and RFE at all the time points. Respiratory rate followed a similar pattern in group RNE (p<0.001), except at 5 min and 90 min. Mean systolic blood pressure showed a significant rise in group RNE compared to the other two groups, while diastolic blood pressure followed a similar trend at 10, 20, 30, and 60 min. The SpO2 (%) was comparable among groups. The onset of sensory loss was significantly earlier in group RNE (239.6±28.8 sec) than in groups RNS (298.1±27.8 sec), and RFE (261.9±32.2 sec). The duration of the sensory block was significantly longer in group RFE (227.8±30.5 min). The mean time to the onset of motor block (480.7±30.2 sec) and analgesia (582.33±30.2 min) was longer in group RNE than in other groups. Conclusion: The addition of neostigmine to ropivacaine intrathecally is a reliable method to prolong spinal anaesthesia but close monitoring of vitals is desirable.

Assessment of Examination Related Anxiety among Students in a Medical College at Kolkata, India: A Cross-sectional Study

Sunetra Kaviraj Roy, Sukanta Majumdar, Mahul Mukherjee, Avijit Paul

Introduction: Medical education is considered to be one of the most academically and emotionally demanding training programmes out of any profession. Stress causes a negative effect on the students’ psychosocial well-being. Students having anxiety can experience intense feeling of fear or panic and also impairs concentration and working memory. Aim: To estimate the examination related anxiety levels among medical students. Also, to find out its association with different lifestyle and behavioural factors. Materials and Methods: This institution-based cross-sectional descriptive study was conducted among 365 medical students of Calcutta National Medical College, Kolkata, West Bengal, India, from February 2022 to March 2022. The study used predesigned, pretested, and semi-structured questionnaire. To assess anxiety level, the 10-item Westside Test Anxiety Scale was used. The scale consists of 10 questions which are answered based on a 5-point scale. Data was analysed in Statistical Package for Social Sciences (SPSS) version 16.0. Results: Out of 365, 108 (29.6%) students suffered from moderately-high test anxiety during exams in both first and second professional MBBS year. Only 8.2% students had comfortably-low test anxiety, whereas, 11.2% had extremely high test anxiety. Among the first year students 37.5% male and 19.5% female had moderately high to extremely high level of test anxiety. In second year students 34.6% male and 20.6% female had moderately high to extremely high level of test anxiety. Male gender, addiction to smoking, addiction to alcohol, virtual gaming habit, coming from a nuclear family, and staying at home during exams had greater odds of having high anxiety than their counterparts. Addiction to smoking had adjusted odds of 1.52 and was found to be statistically significant. Students who resided in their homes had 2.34 times more chances of having high test anxiety and this association was found to be statistically significant. The practice of yoga was found to be protective with adjusted odds of 0.31 and this was also statistically significant. Conclusion: Male gender, addiction to smoking and alcohol, virtual gaming habit, coming from a nuclear family and staying at home during examination time had greater impact on anxiety level than their counterparts. The practice of yoga was found to be protective. Involving students in different extra-curricular activities like outdoor games, yoga, playing music may be helpful in alleviating anxiety level.

Assessment of Water, Sanitation, and Hygiene in South-East Asia: A Systematic Review

Deepak Kumar Behera, Kalolinid Samant, Ranjit Kumar Dehury

Introduction: Water, Sanitation and Hygiene (WASH) can be used as an indicator for the assessment of the health of a country. Without WASH facilities, it is very difficult for the sustenance of health and well-being of the people. Aim: This systematic review tries to bring out various nuances of practices on WASH and their intervention in the South-East Asia Region (SEAR). Materials and Methods: In the present systematic review, searches were made systematically in scholarly sources like Google Scholar, PubMed and Science Direct to unearth data from January 2005 to February 2020 with a language restriction to English for all the published articles. The literature search was conducted from March to May, 2020. The full-text articles (accessible) were retrieved from each of the searches and a few of the papers which appeared to be relevant were obtained for review. Articles were included from both urban and rural set-ups. Irrelevant topics and headings were excluded. The final review included 15 articles. Results: The area of SEAR has a different level of practice and outcomes on WASH. The studies show that low-quality WASH practices in Bangladesh, India and Sri Lanka contribute to public health issues. The studies on the health impact of WASH from many countries like Indonesia, Myanmar, Sri Lanka and Timor-Leste are also found to be inadequate in the maintenance of health. The report mentioned about many diseases like gastroenteritis, stunting and helminthes infection among many people in the community. The source of drinking water and drinking water quality needs to be assessed according to the recommendation of studies across the SEAR region. Two infectious diseases recently emerged such as Soil Transmitted Helminths (STH) and Escherichia coli contamination due to inadequate WASH practices. Conclusion: The diarrhoeal diseases and sanitation related issues are numerous in the entire region. Diverse consumption of sanitary practices and drinking water is seen in India, as reported in one study; whereas open defecation has not been eliminated as reported in another study, where 32% of households are still defecating openly. Health impacts due to the lack of proper WASH practices are still a rising concern. Special attention is required for underprivileged areas like slums and rural areas. The involvement of the government in providing WASH facilities to underprivileged people is very significant.

Comparison of Dermoscopic Findings of Chronic Hand Eczema and Palmoplantar Psoriasis: A Cross-sectional Study

Introduction: Differentiation between Chronic Hand Eczema (CHE) and Palmoplantar Psoriasis (PP) is a diagnostic challenge. Dermoscopy can help to distinguish between the two conditions. Aim: To establish and compare the dermoscopic findings of the CHE and PP using Dermalite DL4 dermoscope and to confirm the accuracy of the dermoscopic findings with the histopathological findings. Materials and Methods: A cross-sectional study was conducted at Navodaya Medical College, Hospital and Research Centre, Raichur, Karnataka, India, from January 2017 to June 2018. Fifty patients each of CHE (26 male and 24 female subjects) and PP (25 male and 25 female subjects) were included in the study. A detailed clinical history, cutaneous clinical and dermoscopic findings of each case were noted. A 4 mm punch biopsy was taken from 30 patients for histopathological analysis. The data was tabulated, analysed and tested for significance using the Chi-square test. A p-value <0.05 was considered significant. Results: The mean age of the patients were 46±4 years. On dermoscopic examination, diffuse white scales in 45 (90%) patients, over a red background in 49 (98%) patients with regularly arranged dots and globules in 45 (90%) patients were seen in PP. Patchy yellow scales 46 (90%), yellow dots, globules and yellow to brown crusts against a yellow background was seen in all patients (100%) of CHE (p-value <0.001). Histopathological findings are in agreement with dermoscopic findings in 9/16 and 10/14 cases of CHE and PP respectively. Conclusion: Dermoscope is a useful non invasive clinical aid to differentiate between CHE and PP. The presence of diffuse white scales over a red background and regularly arranged vessels indicates PP, whereas the presence of patchy distribution of yellow scales, yellow dots and globules; and yellow to brown crusts against a yellow background is more suggestive of CHE.

Traditional Classroom Teaching versus Online Teaching in COVID-19 Pandemic: Perspective and Experiences of School Teachers in Northern India

Palak Sharma, Shiv Kumar Yadav, AR Piyush

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic affected everyone across the globe. The complete lockdown was imposed worldwide to cut down the chain of transmission. During lockdown, the decision was taken to shift from classroom teaching to online application (app)-based teaching. Numerous studies have documented that compared to classroom teaching, online teaching possesses various challenges both for teachers and learners. Aim: Assessment of perception of the school teachers regarding online teaching compared to traditional classroom teaching. Materials and Methods: A cross-sectional study was conducted among 100 school teachers of various government and private schools in Northern India from November 2020 to December 2020. An online questionnaire (English language) was used for assessing school teachers’ perspectives and experiences of online teaching compared to traditional classroom teaching and was designed on the basis of 5-point Likert scale. Informed consent was obtained before the data collection. Data analysis was done using Microsoft Excel 2019 software. Results: Among the 100 school teachers who participated in the study, 74% were females and the majority of study participants i.e. 69% were in the age group 31-50 years. Overall, 86% agreed that the online method is a supplement and not a replacement for traditional classroom teaching. Only nine teachers were fully satisfied with online teaching methods. The difference in school teachers’ perceptions was found to be statistically significant (Paired t-test) while comparing classroom teaching to online teaching on various variables viz-teachers satisfaction, students’ feedback, students’ punctuality, and learning experience. Conclusion: Classroom teaching provides more opportunities to monitor students’ progress, learning, assessment, feedback and discussion, and online teaching can also be used to supplement classroom teaching as and when required.

Clinical Profile of Refractive Errors Associated with Screen Time in Children Aged 5-15 Years in a Tertiary Care Hospital of Southern India during COVID Pandemic: A Prospective Study

Navneeth Servey, NVN Prasanna Bharathi, M Radhika, B Hyndavi, B Srividya

Introduction: Refractive errors cannot be prevented, but it is important to detect them early to improve the quality of life and prevention of blindness. Refractive errors screening in children during Coronavirus disease-2019 (COVID-19) pandemic was difficult task as they were high-risk group. Increased near activity due to online classes and smart devices usage may increase the uncorrected refractive errors. The study emphasises on the refractive errors screening during COVID pandemic. Aim: To study the clinical profile of refractive errors of the children aged 5-15 years in a tertiary care hospital in COVID pandemic in association with screen time, outdoor activity, type of gadget, amblyopia and educational status of mother. Materials and Methods: This was a hospital based prospective analytical study conducted in children 5-15 years attending the Ophthalmology Outpatient Department of ESIC Medical College and Hospital, Telangana, India, from May to October 2021. Children were screened for refractive errors and compared with the refractive errors data of different children of same age referred from Paediatric Outpatient Department and who attended to Ophthalmology Outpatient Department for regular eye checkup in prepandemic time. Unaided visual acuity of all children were measured with the help of Snellen’s chart. Children with refractive errors underwent cycloplegic retinoscopy followed by postmydriatic test. Screen time and outdoor activity duration were recorded. Interpretation and analysis of obtained results was carried out using Statistical Package for Social Sciences version 22.0 for descriptive statistics. Non parametric tests like Pearson Chi-square test were used to express the qualitative data. Data with p-value less than 0.05 was considered statistically significant. Results: A total of 790 children were screened out of which 358 (45.3%) presented with refractive error when compared with the prepandemic prevalence 276 (34.9%) out of 790 children screened, presented with the refractive error. A total of 118 (33%) of the children presented with increased blink rate associated with increased screen time and dry eye. Rate of progression of more than 1D was observed in 44 (12.29%) of which myopia 28 (7.8%), astigmatism 10 (2.7%) and hypermetropia 6 (1.6%) in six months. A total of 286 (79.8%) children presented with myopia and 24 (6.7%) presented with hypermetropia, 48 (13.4%) presented with astigmatism. A total of 258 (72.06%) presented with screen time for four to seven hours and 32 (8.9%) children presented with amblyopia. Conclusion: Refractive errors increased due to smart classes in schools or use of laptops, television viewing, computers or mobiles. Hence, this reinforces the need to screen all the school going children and children with the history of gadgets use.

Effect of Stress in Muscle Function between Sedentary and Physically Active Adults using Mosso’s Ergograph: A Cross-sectional Study

S Vimala Rani, R Leela Bhavani, S Sasikumar

Introduction: Skeletal muscle is essentially involved in body movement. Structured physical activity refines the physical and mental well-being and it is viewed as one of the important factor which influences the skeletal muscle activity. Stress hormones causes metabolism of muscle proteins thereby reduces the muscle strength. Aim: To demonstrate the effect of stress in muscle function between sedentary and physically active adults. Materials and Methods: This cross-sectional study was done amid of 100 (inactive) sedentary and 100 exercising (physically active) adults in Sree Balaji Medical College and Hospital, Tamil Nadu for a duration from January 2022 to April 2022. Total 200 male subjects (100 sedentary and 100 physically active adults) between age group 25-30 years were included in this study. Muscle function (work done) was studied using Mosso’s Ergograph. Perceived stress score was analysed by Cohen’s perceived stress scale questionnaire. Work done by muscle and stress score was correlated. Pearson’s and Chi-square test were used to assess the correlation between work done by muscle and stress score. Result: On analysis of 200 study subjects (100 sedentary and 100 physically active), work done by physically active adults was more. The effect of stress in reducing the muscle strength was comparatively lesser in physically active adults. There was a negative correlation found between work done by muscle and stress score among sedentary adults (r=0.011, r=-0.432, r=-0.835) and also among physically active adults (r=1.524, r=- 0.012, r=-0.035) with statistically significant (p-value <0.05). Conclusion: Amount of work done in physically active adults was more as compared to sedentary adults. Perceived stress had a negative effect on the muscle strength (work done) of the young adults. Exercise reduces the stress and improves the work done level of muscle.

Drug Storage and Self-medication Practices in Kashmir, India: A Cross-sectional Study

Rehana Tabassum, Syed Sajad Hussain, Sajad Hussain Arif

Introduction: Among the various potential health risks, selfmedication and inappropriate storage of medicines at home are found to be very important. Inappropriate storage conditions and irrational use of medication without medical consultation may result in serious health problems. Worldwide there has been an increase in the self-medication rate, which can lead to waste of resources and serious adverse reactions. Aim: To assess the practice of self-medication and household storage of medicines amongst the study population. Materials and Methods: This was a cross-sectional and questionnaire based study conducted in the southern district of Kashmir, India from 1st September 2021 to 28th February 2022. A total of 471 households were included and interviewed to determine the practice of home storage of medicines and selfmedication pattern. Quantitative data was presented as means and standard deviation (mean±SD) and qualitative data as frequency and 95% Confidence Interval (CI). Results: Almost three quarters of the households were having monthly income of less than 20,000 INR whereas 219 (46.50%) of them were illiterate. Proton pump inhibitors, minerals and vitamins, antibiotics and analgesics were the most common medicines stored at home. Drawer was the most common place used for storage of medicines whereas the refrigerator was used in less than 1% of cases for the same. Solid dosage forms were mostly used by the householders and the injectables were least used for household storage purposes. Conclusion: The study revealed that the studied householders stored large amount of medicines in homes, often under inappropriate storage conditions. There is a need for better public knowledge and information about the risks of reuse of prescribed medications.

COVID-19 Vaccination: An Observational Study on Postvaccination Infections and Side-effects

Introduction: Given the mortality and morbidity caused by the Coronavirus Disease 2019 (COVID-19) and the lack of therapeutic options, the need for vaccines has become inevitable. Knowledge about covid infection after vaccination and vaccine-related side-effects are essential to educate people and avoid myths about vaccination. Aim: To evaluate the side-effects and incidence of COVID-19 in vaccinated people, and to compare the side-effect profile and postvaccination incidence of the infection. Materials and Methods: This cross-sectional, email-based, survey was done from 1st July 2021 to 31st July 2021 at Guntur Medical College, Guntur, Andhra Pradesh, India. A total of 920 people were sent emails about the details and questionnaire of the study. All COVID-19 vaccinated and those who were more than 18 years of age were included in this study. A total of 506 subjects responded. Total 18 questions in the English language were there. The questions were about demographics, co-morbidities, the name of vaccine taken, postvaccination adverse effects, and COVID-19 positivity. Results: Of the 506 vaccinated subjects, 287 (56.71%) received Covaxin^®, 203 (40.11%) received Covishield^® and 16 (3.16%) received other vaccines (BioNTech COVID-19 Vaccine-8, Sputnik V-3, Spikevax-5). The mean age of the participants was 37 years, and 45.2% (229) were females and 54.8% (277) were males. Side-effects were reported by 73.1%, and 65.17% of individuals after the first and second doses of Covaxin^®, respectively, compared to 84.7% and 62.5% after Covishield^®. Local pain and tiredness were the most common symptoms after Covaxin^® and Covishield^®. Conclusion: Local pain and tiredness were the most common side-effects of Covaxin^® and Covishield^® vaccines. The number of participants in other vaccine groups was very minimal to study and compare their effects. Overall, the vaccines are safe and seem to show protection, although mild side-effects can be observed, which are usually non fatal. No difference in the incidence of infections was observed between vaccine groups.

Effect of Suryanamaskar on the Sleep Quality and General Well-being among Young Adults: A Quasi-experimental Study

Jasmine Kaur Chawla, Tamanna Arya, Roshani Sharma, Pragya Kumar

Introduction: Rapid decline in physical functionality has an adverse impact on both physical and psychological health. Deteriorating sleep quality during the pandemic is one such common manifestation, that further affects the general well-being. Therefore, safe non pharmacological treatments are warranted, and the practice of suryanamaskar is one such intervention. Aim: To find the effectiveness of suryanamaskar on sleep quality and general well-being among young adults. Materials and Methods: This quasi-experimental study was conducted in Physiotherapy Department at Ashirwad Bhagwat Multispecialty Clinic, Sonipat, Haryana, India, from March to July 2021. A total of 30 young adults were enrolled in the study and randomly divided into two groups of 15 participants each. The experimental group practiced eight weeks of suryanamaskar yogic exercise, also known as sun salutations, which comprises of 12 different postures performed with controlled breathing. The control group performed 20 minutes of walk. Sleep quality and General Well-being (GWB) were evaluated preintervention and postintervention using the Pittsburgh Sleep Quality Index (PSQI) and Psychological General Well-Being Index (PGWBI) respectively, along with the resting Heart Rate (HR) and Blood Pressure (BP). A higher PGWBI score denotes greater psychological well-being and a total PSQI score of 5 or more indicates poor sleep quality. The effect of the intervention on GWB, sleep quality, BP and HR were assessed using Wilcoxon signed-rank test within the group and the Mann-Whitney test was used to find a statistical difference between the two groups. Results: After eight weeks of yoga training, a significant difference was found in the overall sleep quality (9.53±1.68, p-value=0.001), GWB (78.33±14.76, p-value=0.001), HR (77.07±5.48, p-value=0.001), SBP (116.67±2.99, p-value=0.001) and BMI (23.01±3.17, p-value=0.019) in the experimental group. However, the control group revealed a significant difference only in the GWB (50.80±13.87, p-value=0.019) postintervention. Additionally, when compared to the control group, the experimental group revealed statistically significant results for sleep quality (p-value=0.001), GWB (p-value <0.001) and HR (p-value=0.007). Conclusion: The study suggests, that yoga training comprising suryanamaskar has positive effects on sleep quality and general well-being.

Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study

Matendra Singh Yadav, Vipin Kumar Singh, DK Singh

Introduction: Ventilator Associated Pneumonia (VAP) is the second most common nosocomial infection. Aspiration of bacteria from the upper digestive tract is important in the pathogenesis of this infection. Oral decontamination using antiseptic like chlorhexidine reduces the incidence of VAP but not mortality. There is conflicting results about oral decontamination with antibiotics in preventing VAP, some suggesting benefit and others showing no benefit. Aim: To use two different prophylactic oral decontaminant, gentamicin and chlorhexidine, to compare the incidence of VAP, prevalence of bacterial flora, duration of Intensive Care Unit (ICU) stay, and mortality. Materials and Methods: This double-blind, randomised, clinical study was conducted at Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from January 2017 to December 2018. Patients intubated within 24 hours of admission and who needed mechanical ventilation with an expected duration of more than 48 hours were included. All the adult patients between age group 18-50 years were studied. Patients were randomised to receive either Topical Antimicrobial Prophylaxis (TAP) with 2% gentamicin (Group G) or 2% chlorhexidine (Group C). Patients were followed until extubation or death. Sequential cultures from endotracheal tube were sent on days 3,7,14, and 21, and for oropharyngeal swab culture were sent on days 0, 3,7,14 and 21. VAP was diagnosed with the help of Clinical Pulmonary Infection Score (CPIS). Results: Out of 151 patients, 82 patients were in group G (2% gentamicin) and 69 in group C (2% chlorhexidine). On follow-up of various interval among both the groups, CPIS increased with ICU stay but incidence of VAP was comparable between the groups (50% vs 71%, p-value=0.009). Pseudomonas was found to be most prevalent bacteria among both the groups. Discharge rate from ICU was higher in group G (54.9%) than group C (52.2%) (p-value=0.744). The mortality rate was higher in the group C (43.9%) than group G (44.9%) (p-value=0.744). Conclusion: Prophylactic oral-decontamination with gentamicin or chlorhexidine does not reduce incidence of VAP and outcome among ICU patients. Gentamicin could be a better option for patients on ventilator because it may lead to less colonisation of Pseudomonas in oral cavity along with lower CPIS in the later stages of VAP.

Comparative Evaluation of Microshear Bond Strength of Adhesive Resin Incorporated with Inorganic Nanofillers Cerium Dioxide: An In-vitro Study

Introduction: Dental adhesives are used for a wide range of clinical applications in dentistry. Bonding is required in direct composite resin restorations. In clinical situation, resin to dentin bonds are less resistant than resin to enamel bonds. Because of varying structure and composition of dentin, the failure of resin-dentin bonding resulting in staining, caries recurrence microleakage. These set of circumstances can hasten the failure and degradation of resin to dentin bonding hence inorganic fillers can be added to improve the bond strength. Cerium dioxide (CeO₂) is a rare earth oxide has been increasingly used as a nanotherapeutic material and can be successfully used in adhesive resin to improve the physical properties of adhesive resin. Aim: To evaluate and compare microshear bond strength of adhesive resin after incorporation of inorganic nanofillers cerium dioxide. Materials and Methods: This in-vitro study was conducted in Department of Preventive and Paediatric Dentistry at School of Dental Sciences, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from February 2022 to April 2022. The unfilled dental adhesive was used as a control (group A) and dental adhesives formulated with nanosized Cerium dioxide (CeO₂) as the inorganic filler (group B). Total 24 samples were prepared, 12 samples in each group and adhesives were evaluated for microshear bond strength. Intragroup comparison between experimental and control group was done using Unpaired t-test. Results: The mean microshear bond strength of the adhesive system containing nanosized cerium dioxide at a concentration of 2% was 6.89±2.22 MPa (group B), which was significantly greater than that of the adhesive system without additives (group A) 4.37±1.22 MPa. Conclusion: Microshear bond strength of the dental adhesives with nanosized CeO₂ particles, was significantly higher than the unfilled adhesive.

Effect of Air versus 1% Lignocaine used for Endotracheal Tube Cuff Inflation on Laryngotracheal Morbidity after Laparoscopic Surgery- A Randomised Clinical Study

Introduction: Endotracheal intubation in general anaesthesia is associated with post intubation morbidity due to prolonged inflation of Endotracheal Tube (ETT) cuff with air. During laparoscopic surgery their incidence increases further. Lignocaine is likely to diffuse through ETT cuff when instilled into it. As a result, it decreases coughing, sore throat and hoarseness by reducing local irritation and inflammation of the airway. Aim: To compare the effect of air and 1% lignocaine used for ETT cuff inflation on postoperative sore throat, hoarseness of voice and coughing in patients undergoing laparoscopic surgeries. Materials and Methods: This double-blind randomised clinical study was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India, between September 2021 to March 2022. Total of 54 patients were randomly divided into two groups with 27 in each; group A (air) and group X (1% lignocaine= 2% lignocaine and equal volume of normal saline). Postextubation patients were assessed for Postoperative Sore Throat (POST), hoarseness and coughing at 2 hours and 18-24 hours. Fisher’s Exact test was used to find the association between categorical variables in both the groups. The p<0.05 was considered statistically significant. Results: The mean age in group A was 46.04±10.26 years, and in group X was 48.59±10.92 years. At 2 hours, in group X 11% (n=3) of patients had POST as compared to group A where nine patients (33%) reported POST (p=0.099). Group X showed a significantly reduced incidence of POST at 18-24 hours, hoarseness of voice, coughing at 2 hours and at 18-24 hours as compared to group A. Conclusion: The use of 1% lignocaine for ETT cuff inflation in laparoscopic surgeries was associated with reduced incidence of POST, hoarseness of voice and coughing as compared to air.

Assessment of Current Trends in Demographic and Clinical Characteristics of Male Patients with Rheumatoid Arthritis: A Retrospective Study

Bharat Kumar Singh, Seema Singh

Introduction: Role of gender in development of an autoimmune dysfunction in Rheumatoid Arthritis (RA) is very complex and therefore novel concept of gender medicine has come into limelight. Aim: To assess current trends in demographic and clinical characteristics of male patients with RA. Materials and Methods: This retrospective study was conducted among patients with RA attending Outpatient Department of Rheumatology at Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur and Centre for Arthritis and Autoimmune Rheumatic Disorders, Jaipur, Rajasthan, India, during April 2015 to April 2021. Men who qualified the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria for RA were included in this study. The medical records of patients were reviewed for collecting demographic and clinical characteristics, disease activity, disease duration, deformities, extra-articular manifestations, and co-morbid illness. Results: A total of 179 men were enrolled, and the mean age was 45.3±11.1 years. The majority of patients had severe disease with more than two years of disease duration. Subcutaneous nodule (27.8%) was most frequently observed extra-articular manifestations. Rheumatoid factor positivity and cyclic citrullinated peptide were prevalent in 107 and 110 patients, respectively. Osteoporosis (21.1%) and hypertension (19.2%) were the most common co-morbidities and majority of patients reported wrist deformities. Conclusion: Overall observations indicate the presence of subcutaneous nodule as the common extra-articular manifestation with more than two years of disease duration, osteoporosis and hypertension as the most common co-morbidities; and high prevalence of wrist deformities in male patients with RA.

Efficacy of a Novel Face-to-Face Lateral Position (Partha’s Technique) in Children to Aid Identification of Caudal Space during Single Dose Caudal Epidural Anaesthesia for Elective Infraumblical Surgeries- A Feasibility Study

S Parthasarathy, S Kulandayan, R Surya

Introduction: A single dose of caudal epidural block accounts for 30-40% of paediatric regional anaesthesia. For infraumblical procedures, it is administered with or without general anaesthesia. The traditional patient position for assisting caudal blocks in children is lateral, with the child's back facing the anaesthesiologist. For caudal epidural block, a novel face-toface orientation of the anaesthesiologist with respect to the child in lateral position was used. Aim: To determine whether a novel face-to-face position of the anesthesiologist and the child is feasible in identification of the caudal epidural space during administration of caudal epidural anaesthesia following general anaesthesia in paediatric patients undergoing elective infraumblical surgery. Materials and Methods: This prospective feasibility study was conducted from November 2020 to November 2021 on 15 children belonging to American Society of Anaesthesiologists (ASA) physical status I, who were scheduled for elective infraumblical procedures under general anaesthesia, with single dose caudal epidural anaesthesia. While performing caudal block, a novel face-to-face orientation of the anaesthesiologist and patient was used. The following variables were recorded: first pass success rate, number of attempts, block performance time, block failure rate, performer satisfaction score, duration of postoperative analgesia, and complications. Results: There were eight males and seven females. The mean age of the population was 6.6±2 years and the mean weight was 20.6±3.4 kilograms. The first pass success rate was 86.6% (13/15) with overall success rate of 100%. Number of attempts for successful block were 1.2±0.5. Block performance time and duration of postoperative analgesia were 31.8±12.1 seconds and 176±31.8 minutes, respectively. Performer’s satisfaction score was excellent in 86.6% (13/15) and good in 13.3% (2/15). No incidence of block failure and complications were noted. Conclusion: The novel face-to-face position in child ergonomics with respect to anaesthesiologist during caudal epidural block performance is a feasible and effective method in children undergoing elective infraumblical procedures.

Role of Intraoral Scanners in the Detection of Dental Caries: A Review

Dental caries is an irreversible, microbial disease of the tooth which is characterised by demineralisation and dissolution of the hard tissues. Conventional methods such as visual and tactile examination, radiography, laser or light induced fluorescence methods help in the diagnosis of dental caries, though they lack sensitivity. Being an irreversible process, it is important to detect the caries process in its incipient stages. Very recently, intraoral scanners have also found their way through to the detection and diagnosis of dental caries, particularly, the incipient lesions. Use of advanced technology for the detection of dental caries in its incipient stages has enabled a change in the paradigm to minimally invasive dentistry which focuses more on a preventive approach to caries management. The present review paper attempts to summarise the available literature on the role of intraoral scanners in caries diagnosis by performing a online search on PubMed, Embase, SCOPUS and MEDLINE databases. Only full text studies authored in English and published in peer reviewed journals between 2010 and 2022 were included in the research. Keywords and terms from both review articles and original research papers were taken. A total of 36 papers were reviewed including full texts and abstracts.

A Review on Obesity and its Management: Focus on Meal Replacement Therapy

Obesity is one of the major health concerns worldwide. In India, over 135 million subjects are affected by obesity. In the last two decades, the prevalence of obesity has increased rapidly. Several factors such as sedentary lifestyle, increased portion size in diet, environmental factors and genetic predisposition are responsible for the increased prevalence of obesity. Obesity also increases the risk of several disease conditions, which has a negative impact on quality of life, work productivity and healthcare costs, leading to a rise in mortality rates. Asian Indians are at a higher risk of developing obesity related co-morbidities at lower levels of Body Mass Index (BMI) and waist circumference compared with Caucasians. Weight loss is a logical step in the management of obesity. Even a modest weight loss of 5-10% of total body weight has shown to significantly improve health and well-being. A negative energy balance achieved by lesser calorie consumption than expenditure serves as the basic principle for weight loss. The role of Meal Replacement (MR) in the management of obesity is discussed in this review. Studies have shown that MR is effective for safe weight loss. MR is designed to deliver optimum nutrition with a minimum glycaemic index. Optifast by Nestle Health Sciences is one such MR product, which is effective for weight management in individuals with obesity.

Contemporary Consortium of Periodontal Diseases and Atherosclerotic Cardiovascular Diseases- A Narrative Review

Roshan R Rughwani, Priyanka K Cholan, Dhayanand John Victor

Periodontal medicine unravels the relationship between periodontal health and disease with systemic health and disease. Periodontal disease serves as a niche for abundant quantity of microorganisms and their byproducts that disseminate into the blood stream. This systemic spread of endotoxins is directly related to the amount of periodontal destruction occurring at any given point of time and is responsible for bridging the link between inflammatory periodontal disease and various other systemic diseases. It is a well-known fact that periodontal diseases have been linked to various systemic diseases including osteoporosis, kidney diseases, adverse pregnancy outcomes, diabetes and even atherosclerotic cardiovascular diseases. Both periodontal diseases and atherosclerotic cardiovascular diseases share the same risk factors. Although both the diseases are multifactorial, the complex pathogenic mechanism orchestrating periodontal and atherosclerotic cardiovascular diseases share a considerate portion of the proinflammatory trait and several biochemical mediators play a role in the pathogenesis and inflammatory response in periodontitis caused by bacterial infections, linking chronic periodontitis to atherosclerotic cardiovascular disease. This review focuses on enlightening the plausible mechanisms that link periodontal and cardiovascular diseases and highlights the various other aspects of periodontal medicine that establishes a two-way relationship between periodontal diseases and atherosclerotic cardiovascular diseases. Understanding the nature of this association would ultimately aid clinicians to carefully plan treatment for patients and emphasise the importance of maintaining optimal oral hygiene in atherosclerotic patients in a more comprehensive and acceptable manner.

A Rapid Review on Nordic Walking as a Novel Approach to Rehabilitation- Exercise or Sport?

Pallavi Rajeshwar Bhakaney, Vishnurajeshwar Vardhan

Nordic Walking (NW) is an advanced walking technique that combines walking with the use of poles, to build core as well as upper body conditioning. This review was documented to focus on the literature regarding the use of NW in rehabilitation. A thorough search of articles from databases (PubMed, Scopus, Web of Science, Pedro, Cinhal, EBSCO) was conducted to identify randomised control trials done on NW. Ten randomised control trials were found and discussed in this review. The trials discussed the efficacy of NW on functional capacity, quality of life, gait patterns, balance strength, weight, ejection fraction, psychological parameters, and blood composition in various populations such as patients with Parkinson’s disease, elderly women, post menopausal women, lung transplants. The results of the study prove that NW can be used as a safe and efficient method of rehabilitating patients.

Tamil Syllable to Record Vertical Dimension in Edentulous Patients- A Phonetic Technique

Gamal Abdul Nasser, Preetha Krishnamurthy

In edentulous patients, an accurate recording of vertical dimension is always a prime consideration for any dentist. Though there have been many advances in techniques and materials for recording vertical dimension, there is still a lack in describing an accurate method of evaluation in edentulous patients. This article describes a quick and easy phonetic technique using Tamil syllables to record the vertical dimension in edentulous patients. Vertical dimension was assessed by asking them to pronounce Tamil syllables. The phonetic method described in this article reduces the chair side time and use of other equipment, ensuring comfort for both the patient and clinician while determining vertical dimension in edentulous patients.

Disseminated Tuberculosis with Neurotuberculosis Presenting as Status Epilepticus: A Case Report

Sourya Acharya, Samarth Shukla, Aditi Goyal, VS Irshad, Charan Bagga

Disseminated Tuberculosis (TB) results when the infection spreads though lymphohaematogenous route involving multiple organ systems. Irrespective of the availability of diagnostic modalities and treatment, it is usually diagnosed late increasing the mortality. Though, it usually occurs in immunocompromised patients, yet, incidence of disseminated TB is rising in immunocompetent subjects. This case report describes a 48-year-old male who presented to the Emergency Department (ED) with status epilepticus. Investigations revealed neurotuberculosis along with generalised tubercular lymphadenopathy involving cervical, axillary, mediastinal and abdominal lymphnodes. Diagnosis was confirmed after Cerebrospinal Fluid (CSF) and lymphnode biopsy. He was started on first line antitubercular drugs and tapering dose of tab. Prednisolone over one month. He was discharged after two weeks of hospitalisation. At 15 days follow-up the patient was asymptomatic.

Role of Teleconsultation and Telerehabilitation in Cerebral Palsy Patients during COVID-19 Era in India- A Review

Minhaj Akhter, Satyasheel Singh Asthana, Rambeer, Nitesh Manohar Gonnade

Recently Coronavirus Disease-2019 (COVID-19) pandemic has caused major problems throughout the world. Apart from all morbidity and deaths due to this virus many patients with other chronic illness have also suffered due to lack of follow-up. Many general and specialised hospitals were turned into COVID centres and partial or complete lockdown was enforced by Governments. Due to this, patient with Cerebral Palsy (CP) were not able to follow their scheduled physical appointments. Many CP patients who were taking calibrated medication for different complication and following individualised rehabilitation programs were in turmoil without guidance of specialist doctors. This has led to exponential rise in use of telemedicine appointments. Telemedicine has both advantages and disadvantages which are discussed in this review. This review also focuses on rehabilitation of cerebral palsy patients using telemedicine in this dire situation where it is difficult for most patients to visit hospitals for physical appointments.

Correction: 2014 Oct:8(10): GE01-GE04

Shagufta Naaz, Erum Ozair, Dexmedetomidine in Current Anaesthesia Practice- A Review (Published in Journal of Clinical and Diagnostic Research. 2014 Oct, 8(10): GE01-GE04 ) There was a correction in the clinical applications section of the article, under premedication, the article cites that the dose for premedication is 0.33- 0.67mg/kg i.v, which should be correctly read as 0.33- 0.67mcg/kg.